Recent Updates

COVID-19 updates

For the latest updates and advice on coronavirus (COVID-19), please visit the NHS website.

For a summary of Formulary updates specific to the COVID-19 pandemic, please click here.

For Clinical Referral Guideline (CRG) updates specific to the COVID-19 pandemic, please click here. The NHS Devon Medicines Optimisation Team have produced a COVID-19 Information and Guidance page, which features a frequently asked questions section, please click here.

November 2022

Drug changes and additions
  • Morphine sulfate orodispersible tablets (Actimorph) 1mg, 2.5mg, 5mg, 10mg, 20mg, and 30mg have been added to the formulary as a green (first line) option for acute and chronic pain and palliative care.
  • Disopyramide 150mg capsules (Viatris UK Healthcare Ltd) have been discontinued and removed from the formulary.
    • Disopyramide 100mg capsules and 250mg modified-release tablets (Neon Healthcare) remain available and can support an increase in demand.
    • Prescribers should convert patients to the closest equivalent dose using the 100mg immediate-release capsules, administered every 6 to 8 hours (individual doses may differ during the day depending on how total daily dose is to be distributed) OR using the modified-release tablets, administered twice daily.
    • Click here for the formulary entry
NICE Technology Appraisals
  • Icosapent ethyl has been added to the formulary as an amber (specialist input) option in combination with statin therapy for reducing the risk of cardiovascular events in adults with raised fasting triglyceride and established cardiovascular disease in line with NICE TA805. Click here for the formulary entry.
Revised formulary guidance
  • Iron deficiency anaemia (IDA): Following consultation with local gastrointestinal specialists, formulary guidance for treatment and prophylaxis of IDA with an oral iron preparation has been updated. Recommendations are based on the BNF, NICE CKS: Anaemia - iron deficiency (November 2021) and the British Society of Gastroenterology guidelines for the management of iron deficiency anaemia in adults (September 2021).
    • Prescribe all people with iron deficiency anaemia one tablet once daily of oral ferrous sulphate or ferrous fumerate, or two tablets once daily of ferrous gluconate
    • Ferrous gluconate 300mg tablets have been reclassified from blue (second line) to green (first line) in South & West. It remains green (first line) in North & East.
    • Sodium feredetate 190mg/5ml elixir has been reclassified from green (first line) to blue (second line) in North & East. It remains blue (second line) in South & West.
    • Niferex elixir has been removed from South & West.
    • Click here for the formulary guidance.
  • Actinic keratosis: Following the recent publication of a clinical commissioning policy for tirbanibulin, formulary guidance and treatment preparations for actinic keratosis have been reviewed and updated to harmonise North & East Devon and South & West Devon. Treatment preparations now include additional information on maximum area of use, duration, and assessment of response.
    • Actikerall (fluorouracil 5mg/g (0.5%) with salicylic acid 100mg/g (10%) cutaneous solution has been reclassified from amber (specialist input) to blue (second line) in South & West. It remains blue (second line) in North & East.
    • Imiquimod 5% cream has been added as a blue (second line) option in North & East. It has been reclassified from green (first line) to blue (second line) in South & West.
    • Click here for the formulary guidance.
Formulary Interface Group (FIG) Governance
  • The Devon Formulary Interface Group (FIG) Terms of Reference (October 2022) have been updated, for more details on the functions, purpose of the group, and membership, please click here.

October 2022

Drug changes and additions
  • The Devon Formulary section on oral anticoagulants and the formulary guidance for the management of atrial fibrillation have been updated with reference to the use of edoxaban in patients with creatinine clearance greater than 80mL/min:
    • For patients commencing treatment for non-valvular atrial fibrillation, in line with the NHS England Commissioning recommendations for national procurement for DOACs, please consider edoxaban first where this is clinically appropriate.
    • In patients with creatinine clearance greater than 80mL/min, edoxaban should only be considered for atrial fibrillation after a careful evaluation of the thromboembolic and bleeding risk (MHRA). A trend towards decreasing efficacy with increasing creatinine clearance was observed for edoxaban compared to well-managed warfarin in a trial for atrial fibrillation (SmPC). Consider whether an alternative DOAC may be more appropriate; rivaroxaban and apixaban are less dependent on renal excretion than edoxaban.
    • Please see section 2.8.2 Oral anticoagulants and Management of Atrial Fibrillation.
  • Sevodyne (buprenorphine) 5 micrograms, 10 micrograms, 15 micrograms, and 20 micrograms 7-day transdermal patches have been added to the Devon Formulary as a blue (second line) option for use in adults for non-malignant pain of moderate intensity when an opioid is required to provide adequate analgesia. Sevodyne patches are cost saving compared with Butec patches.
    • Butec (buprenorphine) 5 micrograms, 10 micrograms, 15 micrograms, and 20 micrograms 7-day transdermal patches will no longer be formally recommended in the Devon Formulary. An interim statement has been included to support prescribing for existing patients only until the next review, when the patient should be switched to Sevodyne transdermal patches if continuation of treatment is required.
    • Click here for the formulary entry.
  • Following the National Patient Safety Alert (NPSA) on the inadvertent oral administration of potassium permanganate and the British Association of Dermatology (BAD) guidance for minimising the risk of harm from potassium permanganate concentrate soaks in April 2022, Potassium permanganate tablets for cutaneous solution have been reclassified as amber (specialist input).
    • Potassium permanganate should only be prescribed by, or on the recommendation of, a specialist secondary care / community service team member with experience in its use.
    • The Devon Formulary Interface Group agreed that where the specialist is making a recommendation for the prescribing of potassium permanganate for use in the patient’s home, the specialist should also recommend an alternative treatment option to enable the prescriber to select the most appropriate treatment for the individual patient’s circumstances.
      • This is considered to be a pragmatic approach which would give GPs an alternative option if they were uncomfortable with prescribing potassium permanganate or a risk assessment indicated that potassium permanganate should not be prescribed. Providing an alternative option with the initial recommendation means the GP would not have to contact the specialist again for advice regarding alternatives. This would save time on the part of the GP and the specialist and would prevent delays in treatment.
    • A risk assessment MUST be undertaken for patients who will be using potassium permanganate in their home to ensure the patient can store and use potassium permanganate safely. This should be conducted at the time of each prescription in the community setting and documented in the patient’s clinical record. The points to be covered by the risk assessment are outlined in the formulary entry. More information can be found in the guidance from the British Association of Dermatology.
    • Repeat prescribing is not permitted.
    • Potassium permanganate has been removed from the formulary guidance for infected eczema.
    • Click here for the formulary entry.

September 2022

Commissioning Policies
  • The routine commissioning of tirbanibulin is accepted in Devon for the field treatment of mild to moderate (non-hyperkeratotic, non-hypertrophic) actinic keratosis of the face or scalp in adults (see Commissioning Policy for more details). Click here for the formulary entry.
Drug changes and additions
  • The following intermittent catheters have been added to the formulary (see revised formulary guidance for formulary links):
    • Actreen Glys Set, HydroSil GO, Infyna Chic, Infyna Plus, SpeediCath Flex Pocket, VaPro Pocket Hydrophilic, VaPro Plus Pocket
    • The following intermittent catheters have been removed from the formulary: HydroSil Silicone, HydroSil Gripper, HydroSil Rose, LoFric Origo Tiemann, VaPro Hydrophilic.
  • Solifenacin oral suspensionSF 1mg in 1ml has been added to the formulary as a blue (second line) option for adults with swallowing difficulties who require an antimuscarinic for urinary incontinence, frequency, and urgency. It has also been added for the treatment of neurogenic detrusor overactivity in paediatric patients aged 2 to 17 years as an amber (specialist input) indication.
  • Hydrocortisone sodium phosphate preservative-free eye drops 3.35mg in 1ml in single dose containers have been added to the formulary as an amber (specialist input) option for short-term local treatment of mild non-infectious allergic or inflammatory conjunctival diseases.
  • Shortec (oxycodone) oral solution 1mg in 1ml will be discontinued by the manufacturer on 12th September. Shortec oral solution has been removed from the formulary and replaced with oxycodone oral solutionSF 5mg in 5ml.
Revised formulary guidance
  • Intermittent catheters: following a comprehensive review involving bladder & bowel care and specialist continence teams this section has been updated with regards to recommendations on intermittent catheters.
Last updated: 11-10-2022

 

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