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Tayside Area
Formulary (TAF) - Updates:
2017 |
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DTC Supp No - Month |
TAPG
Section
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Drug(s)/Topic
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Changes
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Issue 160 - April 2017
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Specialist Formulary Lists
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Gastroenterology
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Gastroenterology Specialist Formulary
list
updated to remove telaprevir and
boceprevir and add
elbasvir and grazoprevir film-coated tablet (Zepatier®) for chronic hepatitis C.
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01.01
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Dyspepsia and gastro-oesophageal reflux disease
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Gaviscon Advance® now restricted to prescribing for symptoms of laryngopharyngeal reflux
(LPR) (Silent Reflux) and link to ENT department
Silent
Reflux PIL
added.
Note added that Mucogel® (current formulary choice of co-magaldrox) is more cost effective than
Maalox®.
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01.02
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Antispasmodics and other drugs altering gut motility
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Link to
MHRA Drug Safety Update. Hyoscine butylbromide (Buscopan) injection: risk
of serious adverse effects in patients with underlying cardiac
disease, February 2017 added.
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01.03
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Antisecretory drugs and mucosal protectants
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Link to updated guidance on
H Pylori Testing and Eradication in
Adults added. See
page 2
for further information.
Ranitidine effervescent tablets and oral solution
removed from formulary due to cost and note added to highlight
this.
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01.05
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Chronic bowel disorders
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New sub-sections (Oral, Topical,
and Parenteral) added under Corticosteroids to make this section
clearer. Prednisolone 25mg tablets, and 2.5mg E/C tablets now
non-formulary. Cost of 5mg soluble tablets highlighted.
Hydrocortisone rectal foam
(Colifoam®) now listed as first choice
topical preparation; budesonide rectal foam (Budenofalk®) now listed as second choice
topical preparation; and prednisolone rectal foam now listed as
third choice topical preparation. Note also added on significant
cost of prednisolone rectal foam.
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01.05.04
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Probiotics
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Link to
Tayside Treatment Protocol for VSL#3
Probiotic in Pouchitis
updated to latest reviewed
version (no changes to protocol content).
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01.06
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Laxatives
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Laxido® Orange now joint first choice
osmotic laxative with lactulose.
Docusate sodium solution/liquid
removed from formulary due to cost and note added to highlight
this.
Arachis oil enema note added on
significant cost of this preparation.
Klean-Prep® replaced with Moviprep® for bowel cleansing
preparations prior to procedures (Picolax® remains in formulary for some
procedures). Choice of preparation is guided by the specialist
area performing the procedure.
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02.07
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Sympathomimetics
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Midodrine (Bramox®) now formulary (Amber traffic
light) and added to the
Medicine for the Elderly Specialist
Formulary list for prescribing under
specialist direction for severe orthostatic hypotension (only
after other interventions have been tried) as per updated
guidance notes.
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02.08.02
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Stroke prevention in AF
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Apixaban and rivaroxaban now
both equal formulary choices (after Warfarin (first choice)) for
prevention of stroke and systemic embolism in adults with
non-valvular atrial fibrillation as per updated
Tayside Approach to Thromboprophylaxis
for patients with non-valvular AF.
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02.12
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Bile acid sequestrants
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Colesevelam hydrochloride added
to formulary,
Cardiology Specialist Formulary list
and
Gastroenterology Specialist Formulary
list (Amber traffic light) for use
only under specialist direction. Off-label for bile acid
malabsorption. Link added to
NICE ESUOM22 Bile acid malabsorption:
colesevelam, October 2013.
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Specialist Formulary Lists
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Respiratory
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Respiratory Specialist Formulary list
updated to remove tiotropium
(Spiriva® Respimat®) for asthma as per
BTS/SIGN guidance,
as this is now a Green traffic
light medicine within the formulary. Aminophylline (intravenous
infusion) added as a Red traffic light (Hospital Only) medicine.
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Chapter 3
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Respiratory system
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Links to
Respiratory MCN Adult Asthma Inhaled
Medicine Chart and
Respiratory MCN COPD Inhaled Medicine
Chart
are to latest updated versions.
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03.01.01.01
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Long-acting
beta2
agonists - Chronic Obstructive Pulmonary Disease (COPD)
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This section removed from the
formulary including: indacaterol (Onbrez Breezhaler®), formoterol fumarate
(Easyhaler®), and olodaterol (Striverdi
Respimat®) - all
single agent
long-acting
beta2
agonists for COPD
now non-formulary.
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03.01.02
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Antimuscarinic bronchodilators - Asthma
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Tiotropium (Spiriva® Respimat®) now listed as first choice
(antimuscarinic bronchodilator) for additional add-on therapy for
adult asthma as per
BTS/SIGN guidance.
This has also been changed from Amber to
Green traffic light.
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03.01.02
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Antimuscarinic bronchodilators - Chronic Obstructive Pulmonary Disease
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Glycopyrronium inhaler (Seebri Breezhaler®▼), umeclidinium (Incruse Ellipta®▼), and tiotropium (Spiriva®
Respimat®), now first choice antimuscarinic bronchodilators for COPD (step 2)
as per updated
Respiratory MCN COPD Inhaled Medicine
Chart.
Aclidinium (Eklira Genuair®▼) now a second choice antimuscarinic bronchodilator for COPD (step 2).
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03.01.03
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Theophylline
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Link to the
Protocol for Intravenous (IV) aminophylline and Oral (PO) theophylline
added. See
page 2
for further information.
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03.01.04
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Compound bronchodilator preparations (inhaled)
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Indacaterol and glycopyrronium (Ultibro® Breezhaler®▼),
umeclidinium and vilanterol (Anoro® Ellipta®▼),
and tiotropium and olodaterol (Spiolto Respimat®▼), now
first choice compound bronchodilator preparations for COPD (step
3) as per updated
Respiratory MCN COPD Inhaled Medicine
Chart.
Aclidinium and formoterol fumarate
(Duaklir Genuair®▼)
now a
second choice compound
bronchodilator for COPD (step 3).
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03.01.05
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Peak flow meters, inhaler devices and nebulisers
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Volumatic® spacer device removed from
formulary as AeroChamber Plus® is for use with all pressurised
metered-dose inhalers (MDIs). Text on use of spacer devices now in
line with BNF information.
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03.02
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Corticosteroids (inhaled) – single agent
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Beclometasone (Qvar®) now first choice MDI option of single agent
inhaled corticosteroid for adults with asthma as per BTS/SIGN
guidance. Beclometasone dry powder (most cost-effective device is
Easyhaler®) now first choice dry powder inhaler (DPI)
option of single agent inhaled corticosteroid for adults with
asthma as per BTS/SIGN guidance. Beclometasone (Clenil Modulite®) and budesonide dry powder inhaler now
non-formulary.
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03.02
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Compound preparations - Asthma
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Beclometasone and formoterol (Fostair®)
now first choice MDI option of compound (ICS/LABA) preparation for
adult asthma as per BTS/SIGN guidance, and
fluticasone propionate and formoterol (Flutiform®) second choice. Beclometasone and
formoterol (Fostair NEXThaler®)
now first choice DPI option of compound preparation for adult
asthma as per BTS/SIGN guidance, and
fluticasone furoate and vilanterol (Relvar
Ellipta®▼)
second choice. Budesonide and formoterol (DuoResp Spiromax®) now non-formulary.
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03.02
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Compound preparations - Chronic Obstructive Pulmonary Disease
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Beclometasone and formoterol (Fostair®) and (Fostair NEXThaler®), and fluticasone furoate and vilanterol (Relvar
Ellipta®▼)
now first choice option of compound
bronchodilator (ICS/LABA) for COPD (step 4) as per updated
Respiratory MCN COPD Inhaled Medicine Chart.
Budesonide and formoterol (Symbicort®) now second choice option of compound
preparation (aerosol inhalation) for COPD (step 4).
Budesonide and formoterol (DuoResp Spiromax®) now non-formulary.
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03.04.03
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Anaphylaxis
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Emerade®
(adrenaline (as tartrate)) solution for injection in pre-filled
pen added to formulary for self-administration of intramuscular
adrenaline for anaphylaxis in
new patients
prescribed adrenaline auto-injector.
Training of patients is required for those new to
self-administered adrenaline and for any patients who are to be
switched between different brands of devices.
See
Tayside Prescriber
No. 146
for
further information.
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03.07
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Mucolytics
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Carbocisteine now listed as restricted, see
page 3
for further
information.
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05.03.03.02
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Chronic hepatitis C
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Elbasvir/grazoprevir (Zepatier®▼) tablets added to formulary and
Gastroenterology Specialist Formulary
list(Hospital Only) as per SMC advice. See SMC advice on
page 4.
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06.01.06
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Oral glucose tolerance test
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Glucose (Rapilose® OGTT) oral solution added for oral glucose tolerance
tests (preferred agent in primary care).
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06.03.01
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Replacement therapy
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Link to updated
guidance notes on
orthostatic hypotension amended.
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07.04.02
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Urinary incontinence
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Links to
NICE CG171 Urinary incontinence in women: management,
last updated Nov 2015
and
NICE CG97 Lower urinary tract symptoms in men: management, last updated
June 2015 added as previous
SIGN guideline withdrawn.
Links to
NHS Tayside Clinical Knowledge Pathway -
Physiotherapy / CATS management of urinary incontinence in women
and
Scottish Polypharmacy Guidance, March 2015 added.
Tolterodine
tartrate standard (immediate-release) tablets now first choice
antimuscarinic for urinary incontinence. Oxybutynin standard
(immediate-release) tablets now second choice antimuscarinic for
urinary incontinence. Oxybutynin patches are restricted to use in
patients who cannot take oral antimuscarinics. Note added to avoid
oxybutynin (immediate-release) tablets in
elderly, frail or those with cognitive
impairment.
Solifenacin now an Amber traffic light
(only for prescribing by GPs on the advice of
Urology/Uro-gynaecology) and added to the
Urology Specialist list
and
Obstetrics & Gynaecology Specialist list.
See
page 3
for further information.
New sub-sections added:
Beta3-adrenoceptor agonists for mirabegron, and Botulinum toxin
(urinary incontinence) for
botulinum
toxin type A (Botox®).
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13.02.02
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Barrier preparations
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Recommended barrier products used in the
management of incontinence updated: ‘Sorbaderm cream’ and
‘Sureprep no-sting film spray’ now recommended.
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13.05.02
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Other Systemic therapy for psoriasis
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Apremilast treatment protocol updated
further to
MHRA Drug Safety Update. Apremilast: risk of suicidal thoughts and
behaviour, January 2017.
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Issue 159 - February 2017 |
01.05.03
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Drugs affecting the immune response
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Methotrexate subcutaneous injection – now Amber
traffic light in formulary and
Gastroenterology specialist formulary list as per updated
Shared Care Agreement. For further information see
Tayside ADTC Supplement No 158 - December 2016.
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Chapter 2
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Cardiovascular system
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Links to
SIGN 148 Acute coronary syndrome, April 2016 updated throughout Chapter 2.
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02.09
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Antiplatelet drugs
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Ticagrelor now listed as a second choice antiplatelet
in formulary and
Cardiology specialist formulary list (Amber traffic light – GPs may prescribe under
direction of Cardiology). Ticagrelor is indicated in combination
with aspirin only on the recommendation of Cardiology for
confirmed acute coronary syndrome in accordance with
SIGN 148
Acute coronary syndrome, April 2016. Clopidogrel is first choice in combination with
aspirin for acute coronary syndrome now clarified as first choice
for
suspected acute coronary syndrome in combination with aspirin. Prasugrel is now
non-formulary. Angioplasty antiplatelet algorithm removed from
formulary as superseded by SIGN 148.
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02.12
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Other lipid modifying agents
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Alirocumab subcutaneous
injection - link added to
Alirocumab
(PCSK9)
- Consultant Only (CV risk clinic) Prescribing flow chart.
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Chapter 3
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Respiratory System
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Links throughout chapter to
BTS/SIGN guideline on the management of asthma updated to latest version
(September 2016).
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04.02
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Drugs used in psychoses and related disorders
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Formulary and
Mental Health specialist formulary list antipsychotics reviewed and
rationalised. Levomepromazine (for use in schizophrenia),
sulpiride and lurasidone now non-formulary. Antipsychotics used
only by specialist Mental Health services removed from main
formulary and listed only on
Mental Health specialist formulary list: zuclopenthixol acetate
injection (Clopixol Acuphase®), and aripiprazole injection
(Abilify®). Olanzapine and quetiapine now
listed as first choice atypical (second-generation) antipsychotics
in addition to risperidone.
Fluphenazine decanoate depot
injection now non-formulary.
Several
oral solution/liquid or oro-dispersible tablet
formulations removed from formulary due to cost and notes added to
highlight these.
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04.03
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Antidepressant drugs
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Tayside guidance for using antidepressants in primary
care updated.
Formulary and
Mental Health specialist formulary list antidepressants reviewed and
rationalised. Amitriptyline (for use as an antidepressant) and
nortriptyline now non-formulary.
Isocarboxazid and
tranylcypromine now non-formulary.
Paroxetine now non-formulary.
Sertraline listed as second
choice SSRI, fluoxetine remains the first choice SSRI.
Tryptophan (unlicensed) now
non-formulary.
Several oral solution/liquid formulations removed from formulary due to
cost and notes added to highlight these.
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04.06
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Other drugs for Ménière's disease
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Green traffic light removed for
betahistine (changed to Amber traffic light) - may be prescribed
by GPs under specialist direction as it is only indicated for the
prevention of episodes of Ménière's disease.
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04.07.03
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Neuropathic pain
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New sub-section added on topical
treatments for neuropathic pain. This is following a review of the
management of neuropathic pain. Menthol 1% in aqueous cream
has been added to the formulary as a first choice option for
symptomatic relief of post-herpetic neuralgia or neuropathic pain
in patients for whom a topical treatment is preferred (off-label).
Capsaicin cream 0.025% and 0.075% has also been listed as a first
choice option for the same indication (also off-label). Axsain® 0.075% cream is licensed for post-herpetic neuralgia.
Lidocaine 5% medicated plasters
are now restricted to use for patients who don’t respond to or are
intolerant of first and second line systemic therapies or first
choice topical treatments (i.e. menthol 1% in aqueous cream or
capsaicin cream). It is now recommended that lidocaine plasters
are reviewed at 2 weeks after initiation and 6 monthly thereafter.
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04.08.01
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Retigabine
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Changed to non-formulary as
manufacturer is discontinuing this.
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05.03.03.02
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Chronic hepatitis C
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Link to National Clinical Guideline on treatment of HCV in
adults updated to latest
version (January 2017).
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06.04.01.02
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Progestogens and progesterone receptor modulators
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Additional indication added to
formulary and
Obstetrics & Gynaecology specialist formulary list for ulipristal acetate (Esmya®) – for the intermittent treatment of moderate or
severe symptoms of uterine fibroids in adult women of reproductive
age.
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10.01.03
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Drugs
affecting the immune response
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Methotrexate subcutaneous injection – now Amber
traffic light in formulary and
Rheumatology specialist formulary list as per updated
Shared Care Agreement. For further information see
Tayside ADTC Supplement No 158 - December 2016.
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10.02.02
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Skeletal muscle relaxants
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Baclofen now green traffic light (non-specialist initiation) for relief
of spasticity of voluntary muscle associated with neurological
damage including stroke. Tizanidine remains as Amber traffic light
(GPs can prescribe under specialist direction).
Note added to baclofen and
tizanidine entries to remind prescribers there are numerous drug
interactions possible with baclofen or tizanidine.
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12.01
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Drugs acting on the ear
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Acetic acid 2% (Earcalm®) added to formulary for mild otitis externa as per
ENT Infection
Management Guidance.
Note on when to use ear drops or ear spray added to anti-inflammatory
preparations for otitis externa.
Ciprofloxacin 0.3% (Ciloxan®
ophthalmic solution) off-label use for otitis externa replaced by
licensed ciprofloxacin 0.3% / dexamethasone 0.1% ear drops
(Cilodex®)
(Green traffic light) as per
ENT Infection
Management Guidance.
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12.02
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Drugs acting on the nose
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Xylometazoline hydrochloride 0.1% nasal spray/drops (Otrivine Adult®)
added to formulary as a topical nasal decongestant (maximum
duration of treatment 7 days).
Chlorhexidine dihydrochloride and neomycin sulfate nasal cream (Naseptin®)
note added that this contains arachis oil and is not suitable for
those with allergies to peanuts or soya.
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12.03
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Drugs acting on the oropharynx
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Links to
NHS Tayside Oral
Thrush Guidance updated to new version (December 2016). Fluconazole and miconazole now
first choice treatments for oral candidiasis, nystatin oral
suspension listed as second choice. Note on updated dose added to
Nystatin entry. See page 1 for further information.
Tranexamic acid oral solution (unlicensed) for use as mouthwash no longer
listed in this section – information moved to section 02.11.
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13.02.01
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Emollients
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Link to cost chart for emollients updated for February 2017.
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13.05.03
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Systemic treatments
|
Methotrexate subcutaneous injection – now Amber
traffic light in formulary and
Dermatology specialist formulary list as per updated
Shared Care Agreement. For further information see
Tayside ADTC Supplement No 158 - December 2016.
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13.07
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Imiquimod
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Local protocol for the use of imiquimod 5% cream in actinic keratoses
removed as no longer required.
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