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Recent Formulary Updates

First Line
Second Line
Specialist
Hospital Only

April 2024

Drug changes and additions
  • Epimax Oatmeal Cream has been added to the Devon Formulary as a blue (second line) option for patients who may prefer an emollient cram containing colloidal oatmeal when treating dermatological conditions. This has replaced Zeroveen Oatmeal Cream which has been removed from the Devon Formulary.
  • LimbO Waterproof Protectors (Adult Half Leg, Adult Elbow, and Adult Foot) have been added to the Devon Formulary as a green (first line) option to protect dressings on adults with long-term conditions such as leg ulcers caused by diabetes or those undergoing IV treatment through a PICC Line or Midline. Seal-Tight limb protectors have been removed from the formulary.
  • Desitrend (levetiracetam) granules: 250mg, 500mg, 1g. Levetiracetam granules are included in the Devon Formulary for use in paediatric patients who cannot take the tablets and cannot tolerate the oral solution. Prescribe by brand. Desitrend granules are licensed to be administered via a feeding tube. Generic levetiracetam granules are not licensed to be given via this route.
Revised formulary guidance
  • Guidance on the Management of insomnia in adults has been updated in line with the British Association of Psychopharmacology consensus statement (2019) and NICE CKS for insomnia (updated 2022). Updated guidance includes advice on sleep hygiene, management of short-term insomnia (<3 months) and long-term insomnia (>3 months) and incorporates the recent NICE TA for daridorexant for long-term insomnia.
  • Management of eczema guidance has been updated in line with NICE CG57: Atopic eczema in under 12s: diagnosis and management but applies to all ages unlike the NICE Clinical Guideline. Topical calcineurin inhibitors (TCIs) have been reclassified from amber (specialist input) to blue (second line) in South & West.

March 2024

Revised formulary guidance
  • Following consultation with local specialists, the section on pharmacological treatment and the treatment pathway for the management of type 2 diabetes in adults has been updated in line with NICE NG28 guidance. 
Revised sections
  • NHS England commissioning recommendations for national procurement for direct-acting oral anticoagulants (DOACs) (January 2024 update): the updated recommendations supersede the recommendations published in January 2022 and reflect the loss of exclusivity of apixaban, enabling sufficient stock of the generic product to be available to the NHS.
    • Subject to NICE TA criteria, clinicians should use the best value DOAC that is clinically appropriate for the patient.
    • The updated commissioning recommendations list generic apixaban as the best value DOAC.
    • For patients commencing treatment for atrial fibrillation: if the highest ranked best value DOAC (generic apixaban, twice a day treatment) is contraindicated or not clinically appropriate for the specific patient then, subject to the criteria specified in the relevant NICE TA guideline, clinicians should then consider edoxaban, then rivaroxaban, then dabigatran, then branded apixaban (Eliquis) until an appropriate treatment is identified.
    • Click here for updated guidance on anticoagulation for atrial fibrillation.
    • Click here for updated formulary entries for DOACs.
NICE Technology Appraisals
  • Daridorexant 25mg and 50mg tablets have been added to the Devon Formulary as a blue (second line) option for the treatment of insomnia in adults with symptoms in line with NICE TA922.
    • Revised formulary guidance on the management of insomnia will be published shortly.
    • Click here for the formulary entry.
"Shared Care" / Specialised Medicines Service (SMS) guidelines

New guidelines:

  • Guanfacine for attention deficit hyperactivity disorder (ADHD) in children and adolescents
    • This is a new Devon-wide SMS guideline; it covers the use of guanfacine for the treatment of ADHD in children and adolescents aged 6 years to 17 years where previous treatment with stimulants AND previous treatment with atomoxetine is ineffective OR not tolerated OR these treatments are not suitable (see Commissioning Policy for more details).
    • The guideline will be remunerated at tier 2.
    • The guideline can be found on the NHS Devon ICB Website, or via the individual drug entry in the Devon Formulary.

February 2024

National Patient Safety Alerts
  • National Patient Safety Alert (8th December 2023): Potential for inappropriate dosing of insulin when switching insulin degludec (Tresiba) products has been added to the Tresiba drug entry.
Drug changes and additions
  • Frovatriptan 2.5mg tablets have been reclassified to a blue (second line) option in South & West Devon for the treatment of acute migraine to align with North & East Devon.
  • APO-go POD 100mg/20ml solution for infusion cartridges have been added to North & East Devon as an amber (specialist input) option and to South & West Devon as a red (hospital only) option. APO-go PFS 50mg/10ml solution for infusion pre-filled syringes have been added to North & East Devon as an amber (specialist input) option, they remain a red (hospital only) option in South & West Devon. Both are indicated for refractory motor fluctuations in Parkinson's disease inadequately controlled by other anti-Parkinson's medications.
  • Akynzeo (palonosetron and netupitant) 300mg/0.5mg capsules have been added to South & West as a red (hospital only) option for the prevention of acute and delayed nausea and vomiting associated with moderately emetogenic cancer chemotherapy after aprepitant has failed in Torbay and South Devon NHS Foundation Trust as per their trust protocol
  • GelX oral spray has been added to South & West as a red (hospital only) option for the prevention and treatment of mucositis in patients receiving head and neck radiotherapy +/- chemotherapy in Torbay and South Devon NHS Foundation Trust as per their trust protocol.
Revised formulary guidance
  • Asymptomatic bacteriuria (ASB) guidance has been updated to include information on screening pregnant women.
Revised sections
  • The Nicotine dependence page has been revised and updated. All people who want to stop smoking should be referred to a smoking cessation service for behavioural support and pharmacotherapy. Additional guidance notes have been included alongside recommended NRT and oral therapies.
NICE Technology Appraisals
  • Rimegepant 75mg oral lyophilisates  have been added to the Devon formulary as a blue (second line) option for the acute treatment of migraine when the conditions of NICE TA919 are met. Rimegepant remains an amber (specialist input) option for prophylaxis of episodic migraines in line with NICE TA906.
  • Tirzepatide is recommended for management of type 2 diabetes in the same place in therapy as GLP-1 receptor agonists, in line with NICE TA924 criteria. Tirzepatide KwikPen is only available in two of the six licensed doses. The starting dose (2.5mg once weekly) and the lowest maintenance dose (5mg once weekly) are available. Up-titration to higher doses is not possible. At the time of writing, the company had not provided a timeline for making all licensed doses of tirzepatide KwikPen available to prescribe in the UK. The formulary entry for tirzepatide will be updated in due course.
    • For information on the initiation of new patients on GLP-1 receptor agonists and supply for existing patients, click here for the formulary entry.
Specialised Medicines Service (SMS) prescribing guidelines

Updated guidelines:

  • Attention deficit hyperactivity disorder (ADHD) 
    • Eight SMS guidelines (for atomoxetine, lisdexamfetamine, methylphenidate and dexamfetamine in children & young people, and in adults) have been updated to include contact details for additional ADHD service providers with an NHS Devon ICB Contract.
    • There is no change to the SMS tier for remuneration for these guidelines.
    • The SMS guidelines can be found here.
    • Further providers are planned to come online in due course; their contact details will be added to the SMS guidelines at that time.
    • Further details regarding referral to these contracted services can be found on the Devon Referrals website.
  • Priadel (lithium) for patients in adult services (click here for guideline)
    • This guideline has been updated to reflect NICE guideline NG222, specifically the recommendation for at least 6 monthly calcium monitoring (or more often if there is evidence of significant renal impairment), for people taking lithium.
    • Frequency of ECG monitoring has been amended to recognise that monitoring less frequently than annually may be appropriate when determined by the GP on an individual patient basis.
    • Additional minor updates and amendments have been made to provide greater clarity following consideration of the NHS England shared care protocol.
    • Local mental health specialists and the Devon LMC were consulted on the proposed changes prior to review and agreement by the FIG.
    • This guideline will continue to be remunerated at Tier 1.
    • Click here for the formulary entry.
  • Azathioprine for the treatment of autoimmune chronic active hepatitis (AIH) in adults) (click here for the guideline)
    • The existing West Devon SMS guideline for azathioprine for the treatment of AIH in adults has been extended to cover South Devon.
    • Since this is an extension of an existing guideline to an additional area without significant changes to individual responsibilities, funding will continue at the existing level (Tier 2).
    • Click here for the formulary entry.
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