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Due to unpredictability in the supply of diamorphine 5mg and 10mg injection, a national directive was issued by the DHSC and NHSE to move from diamorphine 5mg and 10mg injection to morphine sulfate injection, as the opioid of choice, where clinically appropriate. This is now to be a permanent move. The list of medicines for standard Just In Case bags for patients without COVID-19 has been updated to replace diamorphine 10mg injection for breathlessness and pain with morphine sulfate 10mg/1ml injection. If you have existing standard Just In Case bags containing diamorphine, please continue to use these. This will help to conserve stocks of morphine.
Please note an error was made in an announcement regarding Just In Case bags in the bulletin of Apr 9
th. We can confirm that there is no change to the quantities of ampoules which should be included in standard Just In Case bags - this will continue to be 3 ampoules of midazolam and 3 ampoules of an antimuscarinic for respiratory secretions in addition to the other contents which are described in detail here
Ulipristal acetate 5mg tablets have been removed from the formulary following suspension of the CCG commissioning policy pending the outcome of the new EMA Safety Review of liver injury risk.
Recommendations for ulipristal acteate for emergency contraception are not affected by the EMA Safety Review.
The way in which preferred brands are presented in the formulary has changed.
Using approved (generic) names for medicines is generally encouraged for prescribing in both primary and secondary care. There are some circumstances in which continuity of the same brand is important for clinical reasons or patient safety, and occasionally branded prescribing is more cost-effective than generic prescribing. The format of the formulary continues to define when brand prescribe is necessary for clinical or patient safety reasons. For more information and examples refer to "brand or generic prescribing" on the Formulary Information page.
Previously, where a specific brand offered a cost-efficient option to help reduce cost pressures across the NHS, these were listed in the formulary. From March 2020, a list of locally preferred brands is maintained by the NHS Devon CCG Medicines Optimisation (MO) Team and can be found on the NHS Devon CCG Website. These brands are no longer specifically referenced in the Devon Formulary; relevant formulary drug entries have been updated to list the generic name and include a hyperlink to the MO Team preferred brands page.
The routine commissioning of loteprednol is accepted in Devon for the treatment of patients with steroid responsive inflammatory eye conditions who have a known clinically significant rise in intraocular pressure with other steroid eye drops (see Commissioning Policy and formulary entry for more details)
Budesonide rectal foam has been added to the formulary as an amber (specialist) option for the management of ulcerative colitis. Click here for place in therapy for budesonide rectal foam
Thealoz Duo (sodium hyaluronate 0.15% / trehalose 3%) eye drops have been added to the formulary as an amber (specialist) option for severe dry eye. Click here for place in therapy for Thealoz Duo eye drops
Liothyronine: GPs who receive a request from a consultant to prescribe liothyronine for a patient who has not previously received liothyronine should contact the CCG Medicines Optimisation team before accepting the request. Click here
Specialised Medicines Service prescribing guidelines have been agreed for flupentixol decanoate, haloperidol decanoate, and zuclopenthixol decanoate depot injections. The guidelines only apply to patients under the care of DPT, for patients under the care of Livewell Southwest, prescribing and monitoring remains with the trust. The formulary entries have been updated with a link to the guidelines
Community-acquired pneumonia - management in the community: Following publication of NICE NG138 the formulary guidance has been updated. Click here for information
Management of hypertension in pregnancy: Following publication of NICE NG133 Hypertension in pregnancy: diagnosis and management (June 2019), formulary guidance has been reviewed and updated. Please see the formulary for further guidance.
Acute prostatitis: Following publication of NICE NG110 Prostatitis (acute): antimicrobial prescribing (October 2018). Formulary guidance has been revised and updated. Please see the formulary for further guidance.
Urinary tract infections (lower): Following publication of NICE NG109: Urinary tract infection (lower): antimicrobial prescribing (October 2018) formulary guidance has been revised and updated. Please see the formulary for further guidance.
Prescribing medicines in renal impairment: Following publication of an MHRA Safety Update on using the appropriate estimate of renal function to avoid the risk of adverse drug reactions, resource website links, useful information on when to use creatinine clearance, and a link to the calculation have been added to the formulary. Please see the formulary for further guidance.
Teratogenic potential and prescribing in pregnancy and lactation information: Following publication of an MHRA Safety Update, resource website links and useful information on effective contraception and frequency of pregnancy testing when medicines with teratogenic potential are prescribed have been added to the formulary. Please see the formulary for further guidance.
New European Medicines Agency safety alert for ingenol mebutate gel issued January 2020. Healthcare professional letter expected week beginning 27th January 2020.
DermisPlus Prevent pressure redistribution devices have been added as green (first line) options to help reduce the risk of pressure damage as part of a pressure ulcer prevention strategy. Click here for more information.
UCS Debridement single-use pre-moistened debridement cloths 20cm x 20cm have been added as green (first line) options for soft mechanical debridement of wounds. Click here for more information.
Acticoat 5cm x 5cm, 10cm x 10cm, 10cm x 20cm, 20cm x 40cm have been reclassified as amber (specialist) options for partial and full-thickness wounds with signs of local infection.
UrgoClean Ag dressings 6cm x 6cm, 10cm x 10cm, 15cm x 20cm have been added as amber (specialist) options for when infected wound sites require debridement. Click here for more information on Acticoat and UrgoClean Ag.
Fluphenazine decanoate (Modecate) injections have been removed from the formulary following product discontinuation (due to manufacturing and supply problems not any safety issues). Any remaining patients currently prescribed these products should be referred to specialist services for consideration of alternative therapy (DPT have confirmed that referral should be via the assessment teams as normal).
Acute cough guidance review: Following publication of NICE NG120 Cough (acute): antimicrobial prescribing (February 2019), formulary guidance has been revised and updated. Please see the formulary for further guidance.
Chronic Obstructive Pulmonary Disorder (COPD) guidance review: Following publication of updated guidance from both GOLD and NICE in 2019, formulary guidance on the management of COPD has been revised and updated. The review incorporates management of stable COPD and COPD exacerbations and includes new antimicrobial guidance for acute exacerbations. Please see the formulary for further guidance.
The environmental impact of inhalers: New guidance has been produced which highlights the carbon footprint of inhalers, and steps that may be taken to mitigate environmental impact in terms of inhaler device choice, waste and recycling. Please see the formulary for further guidance
Community-acquired Pneumonia (CAP) guidance review: Following publication of NICE NG138 Pneumonia (community-acquired): antimicrobial prescribing (September 2019), formulary guidance was discussed and will be updated soon, further details will be circulated at that time.
Chapter 14. Immunological products and vaccines: The chapter has undergone format changes and information has been consolidated to streamline the accessibility of clinically appropriate guidance and treatment options. Vaccination strengths, doses, and treatment regimens have been removed and replaced with a permanent link to Public Health England's 'The Green Book'. Please see the formulary for further guidance.
Chlamydia trachomatis: Following an update to the Chlamydia trachomatis guideline from the British Association for Sexual Health and HIV (BASHH), formulary guidance has been reviewed and updated. Please see the formulary for further information.
Chapter 17. Wound Management Formulary: The chapter has undergone format changes and information has been consolidated to streamline the accessibility of clinically appropriate guidance and treatment options. Please see the formulary for further guidance.Last updated: 24-04-2020