Download Spiriva - Harrogate and Rural District CCG

Our ref:
MMT/AdvisoryNote/Spiriva Handihaler
Date
October 2016
To:
Practice Prescribing Leads
Practice Managers
Re:
Unit 1
St James Business Park
Grimbald Crag Court
Knaresborough
HG5 8QB
Spiriva Handihaler
Dear Colleague,
For the October “Hints and Tips on Prescribing”, the Medicines Management Team would like to encourage
practices to review patients who have been prescribed a Spiriva Handihaler for the treatment of COPD.
This is because there are now alternative inhalers available which patients may find easier to use. The
Handihaler requires patients to load a capsule into the device, whereas Spiriva Respimat and the newer
options such as Incruse Ellipta and Eklira Genuair are ready to use and do not require pre-loading and
so are particularly beneficial for elderly patients and those with reduced manual dexterity.
Spiriva Handihaler contains tiotropium and the alternative devices also contain long acting muscarinic
agonists (LAMAs). In addition, the newer devices are also lower in price and by switching over to one of
these products, over £60k could be saved per annum in HaRD CCG.
Incruse Ellipta, Eklira Genuair and Spiriva Respimat are included in the new guidelines for the diagnosis
and management of COPD from HDFT and the Respiratory Team at HDFT are also encouraging the use of
these new devices.
Brand name
Spiriva Handihaler
Manufacturer
Boehringer
Ingleheim
LAMA
Tiotropium
Manufacturer’s
licensed dose
Strength
18 microgram capsule
18micrograms (one
capsule) once a day
Price
Device plus 30
caps £34.87
30 capsules only
£33.50
Spiriva Respimat
Incruse Ellipta
Eklira Genuair
Boehringer
Ingleheim
Tiotropium
GSK
Umeclidinium
bromide
Astra Zeneca
Aclidinium
bromide
2.5 microgram per dose
5 micrograms (two
puffs) once daily
60 dose inhaler
65 micrograms per
dose (equiv. to
55micrograms of
umeclidinium)
55 micrograms of
umeclidinium once
a day
30 dose dry
powder inhaler
375 micrograms per
dose (equiv. to 322
micrograms of
aclidinium)
322 micrograms of
aclidinium twice a
day
60 dose dry
powder inhaler
£23
£27.50
£28.60
Action points

Please review all patients who are currently prescribed a Spiriva Handihaler and consider changing
to Spiriva Respimat, Incruse Ellipta, Eklira Genuair.

We suggest that each practice obtains some placebo devices from the local company reps in order
to allow all staff involved in the treatment of COPD to become familiar with these new devices.
Contact details of company reps:
Spiriva Handihaler
Monthly briefing/letter – Oct 16
GSK: Maria Lancaster 07771 810661
Page 1 of 2
HaRD Medicines Management Team
Astra Zeneca: Yvonne Webster 07810 528683
Boehringer: Donna Dabell 07770 334904

Ensure that patients are shown how to use their new inhaler.

If patients are switched to Spiriva Respimat, Incruse Ellipta or Eklira Genuair, please prescribe by
the brand name.

Please be aware there have been two recent prescribing errors involving Spiriva Respimat inhaler,
which contains only tiotropium and Spiolto Respimat inhaler, which is a LAMA / LABA combination
inhaler and contains tiotropium and olodaterol.

Please share this information with all members of staff in the practice who are involved in the
treatment of patients with COPD.
Prescriptions for Spiriva Handihaler in HaRD practices - 3 months to June 2016
Prescriber Name
BEECH HOUSE SURGERY
CHURCH AVENUE MEDICAL GROUP
CHURCH LANE SURGERY
DR AKESTER & PARTNERS
DR INGRAM & PTRS
EAST PARADE SURGERY
EASTGATE MEDICAL GROUP
KINGSWOOD SURGERY
NIDDERDALE GROUP PRACTICE
NORTH HOUSE SURGERY
PARK PARADE SURGERY
RIPON SPA SURGERY
SPRINGBANK SURGERY
STOCKWELL ROAD SURGERY
THE LEEDS ROAD PRACTICE
THE MOSS PRACTICE
THE SPA SURGERY
TOTALS
Total Items (3m)
Total Costs (3m)
Est. annual savings if switch
137
£4,254.66
£2794
179
£7,640.41
£5018
348
£11,434.45
£7509
111
£3,538.36
£2324
48
£1,533.30
£1007
78
£4,325.86
£2841
262
£8,827.30
£5797
108
£3,878.87
£2547
139
£4,326.10
£2841
226
£7,095.62
£4660
65
£2,646.40
£1738
244
£7,736.41
£5081
72
£2,273.65
£1493
98
£3,888.58
£2554
226
£7,095.47
£4660
373
£13,478.72
£8852
179
£7,093.49
£4658
2,893
£101,067.65
£66374
Our Prescribing Support Team is available to help practices with this work if required. HaRD versions of
OptimiseRx and SystmOne and EMIS formularies will be amended to incorporate these recommendations.
Local community pharmacies have been e-mailed to inform them that practices will be undertaking this
switch. As the timings of the switch will vary between practices it is advisable that each practice notifies its
local pharmacies in advance of the switch to enable effective management of stock.
Yours sincerely,
The Medicines Management Team, HaRD CCG.
References
1. eBNF accessed 8.9.16
2. Guidelines for the diagnosis and management of HDFT:
http://www.harrogateformulary.nhs.uk/chaptersSubDetails.asp?FormularySectionID=3&SubSectionRef=03&SubSectionID=A100
Spiriva Handihaler
Monthly briefing/letter – Oct 16
Page 2 of 2
HaRD Medicines Management Team