Recent Updates

July 2018

Escitalopram tablets 5mg, 10mg, and 20mg have been amended to include unipolar depression as a first line indication, it remains second line for generalised anxiety disorder. Please see the formulary for further information.

  • Citalopram has been amended to second line for unipolar depression.

Jobst UlcerCARE (ready to wear) and Jobst UlcerCARE (custom-fit) leg ulcer compression hosiery kits have been added into the formulary, as second line options, for patients with longer limbs and those who require a made-to-measure option. Please see formulary for further guidance.

Tadalafil 2.5mg and 5mg tablets have been removed from the formulary following national guidance from NHS England. Click here for more information.

Acute sore throat: Following publication of NICE NG84: Sore throat (acute): antimicrobial prescribing (January 2018) Formulary guidance has been revised and updated. Please see the formulary for further guidance.

Vitamin and mineral supplementation following bariatric surgery: New formulary guidance has been added to the formulary to offer support to prescribers on the nutritional supplementation for patients who have undergone bariatric surgery. The guidance can be found here.

Following public consultation; NHS England (NHSE) and NHS Clinical Commissioners (NHSCC) published guidance for CCGs on items which should not be routinely prescribed in primary care. Click here for more information. The following items have new guidance attached in the formulary:

Commissioning Policy: The routine commissioning of lurasidone is not accepted in Devon for patients with schizophrenia (see Commissioning Policy for more details)

Commissioning Policy: The routine commissioning of Relvar Ellipta is accepted in Devon for the treatment of asthma in adults and adolescents aged 12 years and older (see Commissioning Policy for more details). Relvar Ellipta has been added to the formulary as a blue (second line) option in patients with asthma aged 12 years and older. Click here for more information.

Consideration given to: Patients in the Plymouth area, with refractory cellulitis (failed on oral antibiotics), will no longer be automatically accepted by the Acute Care at Home team for IV ceftriaxone. From the 1st of August 2018 these patients can access an Acute GP service pathway at University Hospitals Plymouth NHS Trust (UHPNT) for a trial period. If patients are suitable for oral linezolid therapy, this will be prescribed by the Acute GP service. The trial of the pathway will run for 6 months during which time data will be collected for service evaluation. This pathway is for stable patients. If a patient is unwell / requires antibiotics for suspected cellulitis at a time when the Acute GP service is not available then they should be referred via the usual routes to the most suitable service (ED / AAU / MAU).

Devon Formulary and Referral User Survey 2017

We would again like to thank everyone who took part in the Devon Formulary and Referral user survey last year. The responses have been analysed and the findings published:

May 2018

AgaMatrix Ultra-Thin Lancets 0.2mm/33G have been added into the formulary here, they replace BD Microfine + Lancets 0.2mm33G, which have been removed due to discontinuation.

Management of constipation in adults: Guidance has been updated to be more clear and concise, including relevant product choices. Please see the formulary for further guidance.

Asthma – paediatric treatment: NICE NG80: Asthma: diagnosis, monitoring and chronic asthma management (November 2017), prompted a review of the current guidance, which is based on recommendations made by the British Thoracic Society (BTS) and the Scottish Intercollegiate Guidelines Network (SIGN). Formulary guidance continues to follow the recommendations made by BTS/SIGN, with minor changes to offer clarity to existing guidance. Please see the formulary for further guidance.

Rotating/ switching opioids: Guidance on rotating/ switching opioids has been reviewed and revised in the Management of Opioids guidance.

Transmucosal fentanyl: Guidance on transmucosal fentanyl preparations has been revised and incorporated in section 16.2 Treatment of pain palliative care.

March 2018

Alprostadil urethral sticks 250 microgram, 500 microgram, 1000 microgram have been added to the formulary here, as an alternative to intracavernosal injection and topical cream.

FreeStyle Libre interstitial glucose monitor has been added into the formulary for patients with type 1 diabetes mellitus who meet specific initiation and continuation criteria, following a commissioning decision from the Clinical Policy Committee. This device should be initiated by specialist endocrinologists only. Please see the formulary for further information.

Ondansetron tablets and oral solution have been reclassified to blue (second line); the formulary entry can be found here.

Rifaximin tablets 550mg, for the treatment of hepatic encephalopathy has changed from a red hospital only treatment to amber, specialist use. Further guidance on the use of this treatment can be found here.

Shortec has been accepted as the preferred brand for oxycodone oral solution, both 5mg/5ml and 10mg/1ml. The formulary entry for oxycodone can be found here.

Trimbow metered dose inhaler (MDI), combination of beclometasone dipropionate 87 micrograms, formoterol fumarate dihydrate 5 micrograms, and glycopyrronium bromide 9 micrograms / delivered dose, has been added to the formulary here, for use in moderate to severe COPD in patients who are not adequately treated by a combination of inhaled corticosteroid / long-acting beta2-agonist.

Zeroveen Cream has been added to the formulary here. It is an emollient 2-in-1 moisturising cream and wash containing natural oatmeal, similar in formulation to Aveeno® cream but available at a lower acquisition cost.

Following public consultation; NHS England (NHSE) and NHS Clinical Commissioners (NHSCC) published guidance for CCGs on items which should not be routinely prescribed in primary care. Click here for more information. The following items have new guidance attached in the formulary:

Vacuum devices for the management of erectile dysfunction: new guidance has been added to the formulary (here) to support GPs when asked to continue prescribing. Vacuum devices should be initiated by specialists. Once found to be an acceptable option to the patient, the device may then be continued in primary care.

Nausea and vomiting in pregnancy and hyperemesis gravidarum: new guidance has been added to the formulary to support primary care clinicians, and complement the referral guidance. The guidance can be found here.

Management of acute pain, chronic non-malignant pain, management of opioids, management of pain in substance misuse disorders: the aforementioned formulary treatment guidance and associated drug monographs have been updated with support from local specialists and consideration given to the "Opioids Aware" resource hosted by the Faculty of Pain Medicine. The guidance and associated drug monographs can be accessed in Chapter 4. Central Nervous System.

January 2018

AirFluSal metered dose inhalers (MDI) (combination of fluticasone propionate and salmeterol) 125 micrograms/ 25 micrograms, and 250 micrograms/ 25 micrograms have been added into the formulary, for use in patients aged 18 years and older with asthma. Please see the formulary for further information.

  • Seretide Evohalers 125 microgram/ 25 microgram, and 250 microgram/ 25 microgram have been removed from the formulary.

Ciprofloxacin eye drops 0.3% has been reclassified as blue second line treatment in cases of acute otitis externa and acute otitis media. It is also a suitable preparation in tympanic membrane perforation. These are unlicensed indications. Please see the formulary for further information.

Modafinil has recently had a prescribing guideline agreed between specialist services, NEW Devon CCG, and the Local Medical Committee (LMC) to support the safe prescribing and monitoring in primary care, when the GP is confident to undertake specified roles. This has been added as a note to the drug monograph. Please see the formulary for further information.

Neomag 4mmol chewable tablet has been added into the formulary as a licensed preparation of magnesium glycerophosphate, for patients who cannot tolerate high sugar content in other formulary magnesium preparations. Please see the formulary for further information.

Sodium oxybate oral solution 500mg in 1ml has been reclassified as an amber specialist input preferred treatment for the management of narcolepsy with cataplexy in adults aged 19 years and older, in Western locality only.Please see the formulary for further information.

Management of Hypertension: guidance has been reviewed in line with NICE CG127 and following consultation with specialists; no major updates were required. Please see the formulary for further information.

Following public consultation, NHS England (NHSE) and NHS Clinical Commissioners (NHSCC) published guidance for CCGs on items which should not be routinely prescribed in primary care. Click here for more information. The following items have new guidance ttached in the formulary:

 

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