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Products Miscellany and Supply Problems August 2016 Products Product Information Supply Now Available Sacubitril Sacubitril valsartan (Entresto®) is an valsartan angiotensin receptor neprilysin inhibitor and (Entresto®) is recommended as a treatment option for patients with symptomatic heart failure in line with NICE TA388. Treatment should only be started by a heart failure specialist with access to a multidisciplinary heart failure team. However it has been classed locally as an amber drug and prescribing may be transferred to primary care once titration to a stable maintenance dose has been achieved. New Product: Fosfomycin 3g sachets are licensed for the Monuril treatment of acute lower uncomplicated (fosfomycin) 3g urinary tract infections, caused by sensitive granules for oral pathogens in adult and adolescent females. solution It is also licensed for prophylaxis in diagnostic and surgical transurethral procedures. Ergocalciferol This new product is licensed for the 50 000 IU treatment of vitamin D deficiency and the Capsules maintenance of vitamin D levels in adults and the elderly. General Information How to get HSCIC is the national provider of Electronic information, data and IT systems for health Prescription and social care. Service (EPS) Recently there has been a problem over a service alerts few days whereby the EPS system had from the Health “gone down” and GP practices were unable and Social Care to send their electronic prescriptions to Information community pharmacies and the pharmacies Centre (HSCIC) were unable to download the electronic prescriptions for their patients. For future reference, the following information may be helpful for GP practices and community pharmacies: On the HSCIC site there is a link to the Service Status page at http://nww.hscic.gov.uk/servicemanagement/ status/, which clarifies any ongoing problems with EPS in England. RPS launches ultimate guide for pharmacists working in care homes Public Health England has issued new advice on vitamin D If you wish to receive High Severity Service Incident (HSSI) communications via email or SMS this can be done by completing the form found at the following link http://nww.hscic.gov.uk/servicemanagement/ status/subscribe/ The Royal Pharmaceutical Society (RPS) has added to its ultimate guide series with a new guide for pharmacists working in care homes or for those who are interested in starting in the role. Public Health England has issued new advice on vitamin D based on the recommendations of the Scientific Advisory Committee on Nutrition. Vitamin D and Health report published on 21 July 2016 The advice notes that vitamin D is made in the skin on exposure to UVB in sunlight but since this is difficult to quantify a daily dietary intake of 10 micrograms is being recommended. It is noted that in spring and summer the Tin Orchel Medicines Management Team Southampton City CCG Comments For more information see statement from DPC: Sacubitril_valsartan_ DPC_statement_May_2016.docx Locally, fosfomycin is an AMBER drug in our Joint Formulary. Recommendations are also made for children under 5. Children from birth to 1 year old who are breast feed should be given a daily supplement containing 8.5 to 10 micrograms of vitamin D. Formula fed children of this age consuming 500ml or more each day do not require a daily supplement because infant formula is fortified with vitamin D. Children aged 1 to 4 years should be given a daily supplement containing 10 micrograms of vitamin D. It is noted that low-income families E-mail [email protected] Products Miscellany and Supply Problems August 2016 majority of the population get enough vitamin D through sunlight on the skin and a healthy, balanced diet. In autumn and winter months it is difficult for people to meet the 10 microgram recommendation from consuming foods naturally containing or fortified with vitamin D so people should consider taking a daily supplement containing 10 micrograms of vitamin D. The advice also considers people whose skin has little or no exposure to the sun, like those in institutions such as care homes, or who always cover their skin when outside and recommends that they need to take a supplement throughout the year. Ethnic minority groups with dark skin, from African, Afro-Caribbean and South Asian backgrounds, may not get enough vitamin D from sunlight in the summer and therefore should consider taking a supplement all year round. Revised SPC: Section 4.2 now advises that the tablets Klaricid XL should not be chewed or crushed. (clarithromycin) Additionally, specific advice on dosing in 500mg tablets renal impairment has been added. Revised SPC: Section 4.4 has been updated to advise that Dolmatil sulpiride may increase prolactin levels. (sulpiride) Therefore, caution should be exercised and tablets – all patients with a history or a family history of strengths breast cancer should be closely monitored during sulpiride therapy. Specials information can access vitamin D free of charge via Healthy Start schemes. Oral Magnesium supplementation -an update and reminder It is recommended that a diagnosis and correction of the primary cause of hypomagnesaemia is identified as oral magnesium (Mg) salts are not well absorbed by the gastrointestinal system and can cause diarrhoea. Possible causes include: Drugs proton pump inhibitors , diuretics, especially loop and thiazide diuretics , ciclosporin , abusive use of laxatives , cancer chemotherapy in particular cisplatin Osmotic diuresis (diabetes) Inherited Disorders Lactation Reduced absorption (Coeliac Disease, chronic diarrhoea, short bowel syndrome, malnutrition) The reference magnesium range is 0.7 – 1.0 mmol/L. For mild hypomagnesaemia Mg =0.5mmol/L or moderate hypomagnesium and asymptomatic Mg< 0.5mmol/L consider 1st line :Magnesium aspartate dehydrateMagnasparte® 1-2 sachets daily=10-20mmol Mg 2nd line; Magnesium glycerophosphateYourMag® or Magnaphate® 2x4mmol tablet three times a day=24mmol Mg Please note that YourMag® and Magnaphate® are unlicensed products and should only be used for patients that cannot use the sachets. Tin Orchel Medicines Management Team Southampton City CCG Clinicians should be aware of this new advice. The advice consistently refers to "dietary sources" of vitamin D including foods naturally containing or fortified with vitamin D and supplements. As such prescribing of vitamin D purely for supplementation following this advice should be resisted. Patients should be encouraged to buy vitamin D in these low supplementation doses at reasonable costs. For more information visit: www.medicines.org.uk For more information visit: www.medicines.org.uk . E-mail [email protected]