Recent Updates

March 2017

Spiriva® Handihaler® has been removed from the formulary, leaving Spiriva® Respimat® and Braltus® Zonda® as options for patients requiring tiotropium.

Naloxegol has been reclassified as amber for use in primary care following recommendation from a member of the palliative care team only. In all other indications, naloxegol should be restricted to secondary care use.

PumpCart® Novorapid insulin aspart cartridges - these cartridges are for use in insulin pumps. PumpCart® cartridges have been reclassified as amber to enable continued prescribing by primary care following specialist initiation.

January 2017

Adult tension headache guidance: This has been added into the formulary. Please refer to the formulary for this guidance.

NICE TA420 Ticagrelor for preventing atherothrombotic events after myocardial infarction was published in December. The TA recommends treatment with ticagrelor for a maximum of 3 years for patients who have had an MI and who are at high risk of a further event after the initial 12 months of ticagrelor 90mg twice daily or other ADP receptor inhibitor treatment (prasugrel or ticlopidine). The formulary advice has been amended to define those patients at high risk, please see the formulary for further information.

Asthma guidance: Both the adult and the paediatric guidance for the management of asthma have been reviewed. Please see the formulary for up to date guidance.

Management of neuropathic pain: These guidance notes have amended to highlight the advice of recording pain scores and assessing the effectiveness of the treatment, with a view of stopping treatments if they are not reducing the pain. There have been no changes in the drug choices. Please see the formulary for the up to date guidance.

Glucomen Aero® ketone test strips have been added to the formulary

Braltus® (tiotropium) inhalation powder capsules (£25.50) have been added into the formulary as a less costly alternative to Spiriva® inhalation powder capsules (£33.50). Spiriva Respimat® (£23.00) solution for inhalation is also a formulary option. Please see the formulary for further information.

Thick and Easy® Clear and Nutilis® Clear have been approved to be added to the formulary. These will be added with some guidance notes on their use, patients should remain on the products recommended and not switched between the two. Also the sachet preparations should not be prescribed as they are significantly more expensive.

September 2016

Type 2 Diabetes Guidance: The December 2015 NICE review of the type 2 diabetes mellitus guidance, has prompted a formulary review of the clinical guidance and associated products. The revised NICE guidance recommends an individualised approach to diabetes care, which is tailored to the needs and circumstances of adults with type 2 diabetes. Supporting prescribing advice has been added to the drug classes with the help of local specialists in order to assist GPs when considering the treatment options for individual patients.

The revised guidance on Type 2 Diabetes can be found here.

September 2016

Changes have been made to the licensed dose in the Summary of Product Characteristics (SPC) of Nystan®. The dose was changed from 1ml to 2ml four times a day for infants; and for over 2 years and adults to 4-6ml four times a day. There appear to be some generic preparations available whose doses have remained at 1ml four times a day, and some that have already changed. Following queries from community pharmacies, GPs and Medicines Optimisation we contacted the Microbiology departments of the four Devon acute trusts and it has been agreed to change miconazole to first-line and to change Nystan® to second-line. Full prescribing information can be found here

September 2016

Gastrointestinal guidance:

  • The Adult GORD and dyspepsia management guidance has been reviewed, in this review it was agreed to remove omeprazole MUPs and rabeprazole. The guidance can be found here
  • The guidance on Paediatric reflux management has also been reviewed, which can be found here

September 2016

  • Calcipotriol plus betamethasone foam spray (Enstilar®) has been added to the formulary. Please see here for formulary information
  • Toujeo® has been added to the formulary. This is a high strength (300 units per ml) insulin glargine licenced for the treatment of type 1 or type 2 diabetes mellitus in adults. This high-strength insulin glargine should only be used in patients with large daily insulin requirements to reduce the number or volume of injections, particularly patients with type 2 diabetes who are insulin resistant. Please see formulary entry here.
  • Levosert® has been added to the formulary. This is a levonorgestrel intrauterine system licensed for contraception and management of heavy menstrual bleeding. Levosert® is licensed for 3 years, an alternative to Mirena® which is licensed for 5 years use. Please see formulary information here and here.


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