|
Tayside Area
Formulary (TAF) |
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|
Month |
TAPG
Section |
Drug(s)/Topic |
Changes |
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| Jan/Feb 2016 |
Cytokine modulators |
Infliximab (Remicade®) now non-formulary. Biosimilar infliximab (Remsima®▼) now formulary and added to Gastroenterology specialist formulary list. Addition of statement on use of biosimilars added. |
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|
Other drugs used in constipation |
Naloxegol (Moventig®▼) added to formulary and Acute Pain, Chronic Pain, Palliative Care, and Oncology & Haematology non-chemo drugs Specialist formulary lists as GPs may prescribe under specialist direction (Amber traffic light) for opioid-induced constipation in adult patients who have had an inadequate response to at least 4 days treatment with at least one class of laxative. See SMC advice on Page 5. Link to Naloxegol local new medicine treatment protocol added. |
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|
ADHD in adults |
Atomoxetine oral solution (Strattera®) added to formulary for use in patients who are unable to swallow capsules. See SMC advice on Page 3. Dexamfetamine [off-label], lisdexamfetamine, and methylphenidate [off-label] added as formulary for treatment of ADHD in adults in accordance with the local Adult ADHD Treatment Shared Care Agreement. |
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|
Levodopa |
Brand names removed from co-beneldopa, co-careldopa, and co-careldopa with entacapone drug entries as generic preparations available. Link to documents with Preparations of co-beneldopa and co-careldopa currently available and on formulary and Preparations of co-careldopa with entacapone currently available and on formulary updated. |
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|
Sodium-glucose co-transporter 2 inhibitors (SGLT2 inhibitors) |
Empagliflozin (Jardiance®▼) now first choice SGLT2 inhibitor. Empagliflozin in combination with insulin added to Endocrinology specialist formulary list (Amber traffic light) (GPs may prescribe under the direction of the Diabetes team). Empagliflozin and metformin (Synjardy®▼) now formlary. Dapagliflozin▼ now second choice SGLT2 inhibitor and canagliflozin▼ and canagliflozin and metformin (Vokanamet®▼) now non-formulary. |
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|
Emergency contraception - hormonal methods |
Link to statement from the Faculty of Sexual and Reproductive Healthcare (FSRH) on quick-starting hormonal contraception after use of ulipristal acetate (ellaOne®) added. As FSRH advice includes off-label use of ulipristal acetate, further information has been added to the ulipristal acetate formulary entry. |
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|
Cytokine modulators |
Infliximab (Remicade®) now non-formulary. Biosimilar infliximab (Remsima®▼) now formulary and added to the Rheumatology specialist formulary list. Addition of statement on use of biosimilars added. |
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|
Cytokine modulators |
Infliximab (Remicade®) now non-formulary. Biosimilar infliximab (Remsima®▼) now formulary and added to the Dermatology specialist formulary list. Addition of statement on use of biosimilars added. |
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|
Preparations for warts and calluses |
Salactol® paint replaced with Salatac® gel as it does not require a dressing/plaster. |
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| Nov/Dec 2015 |
5-fluorouracil 1% cream in ungentum M cream (unlicensed special) added to the Dermatology specialist formulary list for Hospital Only prescribing in Darier’s disease (keratosis follicularis). |
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|
Palliative Care specialist formulary list reviewed and updated. Medicines removed that are already within the Scottish Palliative Care Guidelines. Duloxetine (Cymbalta®) and lidocaine infusion added to the Palliative Care specialist formulary list in line with the Chronic Pain Specialist formulary list. See page 2 for further information. |
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|
Renal Specialist formulary list reviewed and the following changes have been undertaken this month: removal of Methoxy polyethylene glycol-epoetin beta (Micera®), calcium acetate (PhosLo®), and sevelamer hydrochloride (Renagel®). Indication amended for cyclophosphamide tablets. Indication expanded for mycophenolate mofetil, azathioprine, tacrolimus and ciclosporin. Link to guidance on medical management of adult patients with ESKD undergoing parathyroidectomy added for alfacalcidol entry. |
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|
Nicorandil |
Now restricted to symptomatic treatment of patients with stable angina who are inadequately controlled or have a contraindication or intolerance to first-line antianginal therapies (such as beta-blockers and/or calcium antagonists). This is further to the risk of ulcerations and progression to complications with nicorandil. See page 2 for further information. |
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|
Midodrine |
Licensed midodrine tablets now available. Non-formulary entry updated to include licensed preparation. See SMC advice on page 4 for further information. |
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|
Useful links |
Removal of previous Guidance on inhaler devices 12 years +, as this was out of date. Relevant information from this previous guidance has been incorporated into a new sub-section 03.01.05 - see below. |
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|
Compound bronchodilator preparations |
Spiolto Respimat® added to the formulary as Green traffic light as an option for patients with COPD at Step 3 as per Inhaled Medicine Chart for COPD. See SMC advice on page 6. |
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|
Spacer devices |
AeroChamber Plus® and Volumatic® from previous Guidance on inhaler devices for 12 years +, now formulary entries. Relevant information from previous guidance incorporated into the notes section of this new formulary sub-section. |
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|
Compound preparations - asthma |
Budesonide and formoterol dry powder for inhalation (DuoResp Spiromax®) added to formulary as Green traffic light option for combined ICS/LABA in asthma steps 3-5 as per Inhaled Medicine Chart Asthma. Symbicort Turbohaler® and Seretide Accuhaler® now non-formulary. |
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|
Compound preparations -COPD |
Budesonide and formoterol dry powder for inhalation (DuoResp Spiromax®) added to formulary as Green traffic light option for COPD as per Inhaled Medicine Chart COPD. Seretide Accuhaler® now non-formulary. Note added that the place of combined ICS/LABA in COPD is limited to those patients with more severe disease, and those having 2 or more exacerbations over a 12 month period (i.e. frequent/regular exacerbators). |
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|
Haloperidol injection |
Link to memo on haloperidol injection shortage added. |
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|
Lithium carbonate |
Information on rebranding of lithium carbonate 250mg tablets added. See page 2 for further information. |
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|
Nefopam |
Wording of formulary indication clarified as reserved for patients who have a proven contraindication, intolerance or a poor response to both opioid and NSAID analgesia or on advice of the Pain team, following nefopam supply shortage. |
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|
Morphine |
Link to Breathlessness guideline from the Scottish Palliative Care Guidelines added. |
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|
Fentanyl nasal spray (PecFent®) |
Restricted to patients unsuitable for Abstral® added to formulary entry for clarification of local formulary status. |
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|
Ketamine |
Controlled drug symbol added as now a Schedule 2 controlled drug. Link to Tayside Prescriber Issue 136 - Ketamine Rescheduling to Schedule 2 Controlled Drug added. |
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|
Some other antibacterials |
Sivextro® (tedizolid phosphate) added to formulary as Hospital-Only use: restricted to only under ID/microbiology advice (Alert Antibiotic). Only licensed for skin and soft tissue infection and for a maximum 6 days duration. See previous SMC advice on page 6. |
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|
HIV infection |
Evotaz® (atazanavir/cobistat) and Isentress® (raltegravir) added to formulary as Hospital-Only (Red Traffic light) by HIV clinic. See SMC advice on page 4 and 5. |
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|
Glucagon-like peptide-1 receptor agonists |
Insulin degludec/liraglutide 100 units/mL / 3.6mg/mL solution for injection pre-filled pen (Xultophy®) added to formulary as a note within liraglutide entry and added to the Endocrinology Specialist formulary list (Amber traffic light) (prescribing by GPs under direction of the diabetic clinic). See SMC advice on page 3. |
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|
Mirabegron |
New contra-indications added to formulary entry and a link to the MHRA Drug Safety Update - Mirabegron: risk of severe hypertension and associated cerebrovascular and cardiac events, October 2015. See page 1 for further information. |
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|
Antiproliferative immunosuppressants |
Additional indication ‘Maintenance of remission of ANCA associated systemic vasculitis and SLE nephritis following induction therapy with cyclophosphamide or rituximab ‘ added for mycophenolate mofetil and azathioprine. |
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|
Corticosteroids and other immunosuppressants |
Additional indication ‘Maintenance of remission of nephrotic syndrome’ added for tacrolimus [off-label] and ciclosporin. |
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|
Erythropoietin |
Methoxy polyethylene glycol-epoetin beta (Mircera®) now non-formulary. |
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|
Phosphate-binding agents |
Calcium acetate (PhosLo®) discontinued - now non-formulary and annotated as discontinued. Sevelamer hydrochloride (Renagel®) now non-formulary, generic sevelamer carbonate preferred. |
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|
Vitamin D |
Alfacalcidol - link added to medical management of adult patients with ESKD undergoing parathyroidectomy guidance. |
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|
Tear deficiency, ocular lubricants, and astringents |
VitA-POS® added back into formulary as not discontinued. Xailin Night® remains in formulary as an alternative to VitA-POS® if it is unavailable. Ciclosporin 1mg/mL (0.1%) eye drops emulsion (Ikervis®) added to formulary and Ophthalmology Specialist formulary list (Amber traffic light) for severe keratitis in adults with dry eye disease in addition to tear substitutes. This has replaced the previous ciclosporin 2% eye drops which were unlicensed. See SMC advice on page 3. |
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| Sep/Oct 2015 |
|
|
Links to Amiodarone tablets (Adults) Shared Care Agreement and Patient Information Leaflet added. |
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|
|
Epilepsy Specialist formulary list added. Includes medicines for epilepsy approved for prescribing by or on the recommendation of a prescribing neurology specialist. Further details of corresponding formulary changes are listed below under TAF section 04.08.01 and 04.08.02. |
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|
|
PPIs
|
Note added that PPIs are associated infrequently with cases of subacute cutaneous lupus erythematosus (SCLE), a non-scarring dermatosis that can develop in sun-exposed skin sites. Link to article from Drug Safety Update, September 2015 added for further information. |
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|
|
Prednisolone
|
Note added that 10mg and 20mg strength prednisolone tablets are non-formulary. See page 3 for further information. |
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|
|
Amiodarone
|
Links to Amiodarone tablets (Adults) Shared Care Agreement and Patient Information Leaflet added. |
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|
|
Stroke prevention in AF
|
Tayside Approach to Thromboprophylaxis for patients with non-valvular AF - interim update regarding information on drug interactions and prescribing in patients at extremes of weight. The Tayside Approach to Thromboprophylaxis for patients with non-valvular AF is expected to receive further review soon. |
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|
|
Control of epilepsy
|
Link to SIGN guideline 143 Diagnosis and management of epilepsy in adults, May 2015 added. Additional prescribing information added throughout section including advice on drug interactions with antiepileptic drugs, particularly with hormonal contraceptives. Link to Faculty of Sexual & Reproductive Healthcare guidance on interactions with hormonal contraceptives added. The following medicines have been added as Amber traffic light (GPs may prescribe under specialist direction): oxcarbazepine, eslicarbazepine, ethosuximide, lacosamide, perampanel, phenobarbital, retigabine, tiagabine, vigabatrin, zonisamide, and clobazam. The following medicines have been changed from Green to Amber traffic light: carbamazepine, lamotrigine, phenytoin, topiramate, and sodium valproate. |
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|
|
Drugs used in status epilepticus
|
Link to SIGN guideline 143 Diagnosis and management of epilepsy in adults, May 2015 added. The following medicines have been added as Red traffic light (Hospital Only): phenytoin IV, sodium valproate IV, and levetiracetam IV. Links to local protocols for management of status epilepticus in adults in General Practice (community) or hospital (inpatient) added. |
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|
|
Dopamine receptor agonists - Restless legs
|
Ropinirole, pramipexole, and rotigotine drug entries updated with restless legs as an indication/condition that GPs may initiate treatment for (Green traffic light). Link to Restless legs syndrome (RLS) / Willis-Ekbom disease (WED) treatment algorithm added to drug entries for ropinirole, pramipexole, and rotigotine. |
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|
|
Darunavir/cobicistat (Rezolsta®)
|
Added to formulary as Hospital Only (HIV Clinic) as an alternative to darunavir (Prezista®) plus ritonavir (Norvir®) where HIV protease inhibitor therapy is required (in adults). |
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|
|
Chronic hepatitis C
|
Ledipasvir/sofosbuvir (Harvoni®) indication for use in treatment of genotype 3 chronic hepatitis C (CHC) in adults added to Gastroenterology specialist formulary list (Hospital Only (Hepatitis C Clinic)). |
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|
|
Sitagliptin
|
Sitagliptin as add-on to insulin (with or without metformin) for type 2 diabetes mellitus added to Endocrinology specialist formulary list - GPs may prescribe under direction of the Diabetes team. |
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|
|
Prednisolone
|
Note added that 10mg and 20mg strength prednisolone tablets are non-formulary. See page 3 for further information. |
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|
|
Calcium Resonium®
|
Sorbisterit® (polystyrene sulphonate resins) discontinued, replaced with Calcium Resonium® (polystyrene sulphonate resins). |
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|
|
Prednisolone
|
Note added that 10mg and 20mg strength prednisolone tablets are non-formulary. See page 3 for further information. |
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|
|
Liquid paraffin eye ointment (Xailin Night®)
|
Liquid paraffin eye ointment (VitA-POS®) discontinued, replaced with Xailin Night® eye ointment (liquid paraffin, white soft paraffin). |
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|
|
Subfoveal choroidal neovascularisation
|
Aflibercept (Eylea®) - indication for treatment of visual impairment due to macular oedema secondary to branch retinal vein occlusion added to Ophthalmology specialist formulary list (Hospital Only). |
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|
|
Preparations for psoriasis
|
Sub-sections for Scalp psoriasis have been created. Addition of the following medicines: Betamethasone valerate 0.12% foam, hydrocortisone butyrate 0.1% lotion (Locoid Crelo®), Dovobet® gel, Dermovate® scalp application, Clarelux® foam, Etrivex® shampoo, Tacalcitol lotion (Curatoderm®), Emulsiderm® liquid emulsion, olive oil, coconut oil, dithranol (Dithrocream® and Micanol®). Removal of the following: Calcipotriol scalp solution (now non-formulary as significantly more expensive than other treatment options). |
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| Jul/Aug 2015 |
Cardiology |
Cardiology specialist formulary list reviewed and updated. Fluvastatin and minoxidil added for prescribing by GPs under the direction of the Cardiovascular Risk Clinic (Amber traffic light). |
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|
Vedolizumab |
Indication for adults with moderately to severely active Crohn’s disease who have had an inadequate response with, lost response to, or were intolerant to adalimumab or infliximab added to vedolizumab (Entyvio®▼) formulary entry and Gastroenterology specialist formulary list (Hospital Only). |
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|
Cardiovascular system |
Links to CCU therapeutic schedule removed throughout. Links to Tayside Cardiology protocol- Management of patients with Atrial Fibrillation (Staffnet intranet link only) updated throughout to current version in use. |
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|
Vasodilator antihypertensive drugs |
Minoxidil added to formulary and Cardiology specialist formulary list for prescribing by GPs for severe resistant hypertension in combination with a beta-blocker and adequate dose of diuretic under the direction of the Cardiovascular risk clinic (Amber traffic light). |
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|
Nitrates |
Links to GTN protocol for management of chest pain where GTN Suscard Buccal is not available removed as out of date. Addition of M/R tablets as formulation of isosorbide mononitrate. |
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|
Oral anticoagulants |
Note added that patient alert cards for apixaban are available via the SPC link. |
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|
Statins |
Fluvastatin added to formulary and Cardiology specialist formulary list for prescribing by GPs for patients who cannot tolerate atorvastatin, simvastatin, or rosuvastatin, under the direction of the Cardiovascular risk clinic (Amber traffic light). Guidance on Aggressive lipid lowering in Acute Coronary Syndrome updated to reflect atorvastatin as formulary first choice statin. Simvastatin changed from second choice to standard formulary. |
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|
Ezetimibe |
Tayside Algorithm A - Ezetimibe plus a statin and Tayside Algorithm B - Ezetimibe without a statin updated. |
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|
Respiratory system |
Link to NHS Tayside Respiratory MCN Adult Asthma Inhaled Medicine Chart updated. |
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|
Antimuscarinic bronchodilators - Asthma |
Tiotropium (Spiriva® Respimat®) solution for inhalation added to formulary and Respiratory specialist formulary list for prescribing by GPs as add-on option for adult patients with asthma who remain symptomatic at BTS step 4, under the direction of the Respiratory / Asthma clinic (Amber traffic light). |
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|
Single agent corticosteroids |
Budesonide dry powder for inhalation changed from second choice to standard formulary. Beclometasone as Qvar® and Clenil Modulite® changed from first choice inhaled single agent corticosteroids to first choice MDI at Step 2. |
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|
Compound preparations - asthma |
Fostair®, Flutiform®, and Seretide Accuhaler® now all equal formulary choices for asthma at Steps 3 or 4. Flutiform® and Seretide Accuhaler® now equal formulary choices for asthma at Step 5 as per updated NHS Tayside Respiratory MCN Adult Asthma Inhaled Medicine Chart. |
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|
Nicotine dependence |
Tayside Guidance for Smoking Cessation reviewed and updated. Guidance is linked to from formulary entries for NRT and varenicline (Champix®▼). Information on drug interactions when stopping smoking added to prescribing notes. |
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|
Cephalosporins |
Ceftobiprole concentrate for solution for infusion (Zevtera®▼) added to formulary (Hospital Only) for use only in accordance with Alert Antibiotics guidelines. |
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|
Macrolides |
Postoperative ileus indication [off-label] (Hospital Only) added to erythromycin formulary entry as per General Surgery specialist formulary list. |
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|
Sulphonamides and trimethoprim |
Co-trimoxazole for preventing biliary stent occlusion [off-label] for prescribing by GPs under the direction of a Consultant Surgeon added as per General Surgery specialist formulary list. |
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|
Triazole antifungals |
Posaconazole concentrate for solution for infusion (Noxafil®) added to formulary (Hospital Only) for use in haematology patients for prophylaxis if oral route unavailable. |
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|
Chronic hepatitis C |
Ombitasvir/paritaprevir/ritonavir (Viekirax®▼) and dasabuvir (Exviera®▼) added to formulary (Hospital Only) and Gastroenterology specialist formulary list for treatment of chronic hepatitis C in adult patients. |
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|
Denosumab |
Note added that patient reminder cards regarding osteonecrosis of the jaw for denosumab (Prolia®) for osteoporosis and denosumab (Xgeva®) (non-formulary) are now available via the SPC link. See page 2 for further information. |
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|
Breast cancer |
Fulvestrant now non-formulary. |
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|
Magnesium |
Magnesium aspartate (Magnaspartate®) added as formulary (Green traffic light) for the treatment and prevention of magnesium deficiency as diagnosed by a doctor. |
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|
Ibuprofen |
Information on new contra-indications at higher dosage added to formulary entry and link to Drug Safety Update article, June 2015 (High-dose ibuprofen (> 2400mg/day): small increase in cardiovascular risk added. |
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| Jun/Jul 2015 |
General Surgery |
General Surgery Specialist Formulary List added. Includes medicines approved for prescribing by or on the recommendation of a Consultant Surgeon (for Colorectal, Upper GI or Vascular Surgery). Further details of corresponding formulary changes are listed throughout this table under the relevant formulary section. |
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|
Substance Misuse |
Substance Misuse Specialist Formulary List added. Includes medicines approved for prescribing by or on the recommendation of a Consultant from Tayside Substance Misuse Service (TSMS). |
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|
Esomeprazole (intravenous) |
Administration as intravenous injection added to formulary (previously only intravenous infusion listed) and General Surgery Specialist Formulary List (Hospital Only) as intravenous PPI for patients Nil by Mouth. |
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|
Cytokine modulators |
Golimumab and infliximab added to formulary and Gastroenterology specialist formulary list (Hospital Only) for moderately to severe active ulcerative colitis in adults in accordance with NICE MTA 329. |
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|
|
Vedolizumab |
Vedolizumab added to formulary and Gastroenterology specialist formulary list (Hospital Only) for adults with moderately to severe active ulcerative colitis who have failed to respond or relapsed with infliximab or golimumab. See SMC advice on page 3. |
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|
Management of anal fissures |
Glyceryl trinitrate rectal ointment 0.2% (unlicensed), glyceryl trinitrate rectal ointment 0.4%, and diltiazem rectal cream 2% (unlicensed) added to formulary and General Surgery Specialist Formulary List (GPs may prescribe under the direction of a Consultant Surgeon). |
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|
Iloprost injection |
Iloprost injection for infusion (unlicensed) added to formulary and General Surgery specialist formulary list (Hospital Only). |
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|
COPD |
Chapter Links: NHS Tayside Respiratory MCN Inhaled Medicine Chart updated. |
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|
Long-acting beta2 agonists - Chronic Obstructive Pulmonary Disease |
Salmeterol now non-formulary. Olodaterol (Striverdi® Respimat®) added to formulary. All medicines within this sub-section given equal formulary status (as per updated Respiratory MCN Inhaled Medicine Chart). |
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|
Antimuscarinic bronchodilators - Chronic Obstructive Pulmonary Disease |
Tiotropium as Spiriva® HandiHaler® now non-formulary. Tiotropium as Spiriva® Respimat® added to formulary. Umeclidinium (Incruse® Ellipta®) added to formulary. All medicines within this sub-section given equal formulary status. |
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|
Compound bronchodilator preparations |
Umeclidinium and vilanterol (Anoro® Ellipta®) added to formulary. All medicines within this sub-section given equal formulary status. |
|||||||||
|
Compound preparations - Chronic Obstructive Pulmonary Disease |
All medicines within this sub-section given equal formulary status. |
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|
Domperidone and metoclopramide |
Postoperative ileus indication added [unlicensed use ‘off-label’] (Hospital only) to formulary and General Surgery specialist formulary list. |
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|
Other drugs for Ménière's disease |
Higher than licensed dosage for licensed indications (Vertigo, tinnitus and hearing loss associated with Ménière's disease) in patients not responding to standard dose treatment who do not have adverse effects at standard dosage added to formulary and ENT Specialist Formulary List (GPs may prescribe under the direction of an ENT surgeon). Link to local protocol added. |
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|
Dipeptidylpeptidase-4 inhibitors (DPP-4 inhibitors) |
Sitagliptin now first choice DPP-4 inhibitor. Alogliptin and alogliptin with metformin (Vipdomet®) added to formulary. Alogliptin now second choice DPP-4 inhibitor. Saxagliptin and saxagliptin with metformin (Komboglyze®) now non-formulary. |
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|
Glucagon-like peptide-1receptor agonists (GLP1-RA) |
Liraglutide now listed as first choice GLP1-RA and lixisenatide listed as second choice GLP1-RA. Exenatide once weekly M/R injection (Bydureon®) added to formulary in a new sub-section - Glucagon-like peptide-1 receptor agonists - once weekly. |
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|
Sodium-glucose co-transporter 2 inhibitors (SGLT2 inhibitors) |
Dapagliflozin now listed as first choice SGLT2 inhibitor and canagliflozin listed as second choice SGLT2 inhibitor. Wording in formulary notes for dapagliflozin and canagliflozin amended to be consistent with manufacturers SPCs. |
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|
Somatostatin analogues |
Management of gastrointestinal secretions [unlicensed use ‘off-label’] added to octreotide and lanreotide formulary entries and General Surgery specialist formulary list (Hospital only). |
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|
Ferric Carboxymaltose (Ferinject®) |
Further indication added to formulary and General Surgery specialist list – to increase haemoglobin reserves prior to surgery in patients at risk of low haemoglobin post-op [unlicensed use ‘off-label’]. |
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|
Selenium |
Selenium ACE® +D added to formulary (Hospital Only) as Selenium ACE® discontinued. |
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|
Magnesium Glycerophosphate |
Formulary choice of magnesium glycerophosphate tablets changed to chewable tablets (MagnaPhate®) (4mmol of magnesium per tablet). This product is classed as a food supplement, however is manufactured under GMP conditions. Magnesium glycerophosphate 1mmol/mL oral solution [unlicensed] added to formulary and General Surgery specialist formulary list (GPs may prescribe under specialist direction). |
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|
Drugs affecting the immune response |
Apremilast (Otezla®)
added to formulary and Dermatology specialist formulary list
(Hospital Only) for the
treatment of moderate to severe chronic plaque
psoriasis in adult patients who failed to respond to or who
have a contraindication to, or are intolerant to other systemic
therapy including narrowband ultraviolet B, psoralen and
ultraviolet-A (PUVA), acitretin, methotrexate and
ciclosporin.
See SMC advice on page 2. Secukinumab (Cosentyx®) added to formulary and Dermatology specialist formulary list (Hospital Only) for the treatment of moderate to severe plaque psoriasis in adults who are candidates for systemic therapy and who have failed to respond to standard systemic therapies (including ciclosporin, methotrexate, narrowband UVB phototherapy and PUVA), or are intolerant to, or have a contraindication to these treatments. See SMC advice on page 3. |
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|
Non-BNF |
Gastrografin® gastroenteral solution added to formulary and General Surgery specialist list - Hospital Only (once-only use under the direction of a Consultant Surgeon) [unlicensed use]. |
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| May 2015 |
Oral anticoagulants |
Prescribing notes added on drug interactions including link to BNF Appendix 1 (Anticoagulants). Note added on appropriate measure of renal function for adjusting drug dosages as per BNF advice. |
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|
Hydroxyzine |
Link to MHRA advice: risk of QT interval prolongation and Torsade de Pointes, April 2015 added. |
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|
Temazepam |
Link to Tayside Prescriber No. 135: Temazepam Prescribing Change - 1 June 2015 added. |
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|
Opioid dependence |
Buprenorphine sublingual tablets, buprenorphine and naloxone (Suboxone®) sublingual tablets, lofexidine hydrochloride tablets, and naltrexone hydrochloride tablets added to formulary (Amber traffic light) in line with the NICE pathway, Drug Misuse, April 2014. Naloxone (Prenoxad®) injection added to formulary (Green traffic light). Link to NHS Tayside PGD for the supply of naloxone 2mg/2ml injection added (intranet (Staffnet) only access). |
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| April/May 2015 |
Compound bronchodilator preparations |
Aclidinium/formoterol fumarate dihydrate 340/12 micrograms inhalation powder (Duaklir Genuair®▼) added to formulary as a combined (long-acting beta2 agonist) LABA/(long-acting muscarinic antagonist) LAMA option for use in management of COPD. See SMC advice on page 1 of the Supplement. Indacaterol/glycopyrronium (Ultibro® Breezhaler▼) changed from first choice LABA/LAMA combination inhaler to standard formulary as choice of combined LABA/LAMA also depends on individual inhalers prescribed previously.
|
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|
Benzodiazepines |
Link to Tayside guidelines for management of delirium in adults and older in-patients replaced with new guideline - The Diagnosis and Management of Delirium in adults and older people, December 2014 within the oral lorazepam entry.
|
|||||||||
|
Antipsychotic Drugs |
Link to Tayside guidelines for management of delirium in adults and older in-patients replaced with new guideline - The Diagnosis and Management of Delirium in adults and older people, December 2014 within sub-section links, oral haloperidol entry and quetiapine entry.
|
|||||||||
|
Alcohol dependence |
Nalmefene 18mg film-coated tablets (Selincro®) added to formulary (Green traffic light) as per SMC advice, see page 3 of the Supplement. Links to local agencies offering psychosocial support added, see also page 3 of the Supplement. Links to the following NICE guidance added: NICE Pathways Alcohol-use disorders, June 2014; NICE CG115 Alcohol-use disorders: diagnosis, assessment and management of harmful drinking and alcohol dependence, Feb 2011; and NICE CG100 Alcohol-use disorders: diagnosis and clinical management of alcohol-related physical complications, June 2010. Naltrexone tablets added to formulary (Amber traffic light) as an intervention for moderate/severe alcohol dependence in line with the NICE pathway.
|
|||||||||
|
Antibiotics |
Fosfomycin 40mg/mL powder for solution for intravenous infusion (Fomicyt®) added to formulary as Hospital-Only (Red traffic light) and added to Alert Antibiotic List - on Infectious Diseases/Microbiology recommendation only.
|
|||||||||
|
Chronic hepatitis C |
Ledipasvir/sofosbuvir 90mg/400mg tablets (Harvoni®▼) added to formulary (Hospital-Only, Red traffic light) and Gastroenterology Specialist Formulary List for treatment of chronic hepatitis C in adult patients, restricted to genotype 1 and 4 chronic hepatitis C.
|
|||||||||
|
Intra-uterine progestogen-only contraceptives |
Levonorgestrel 13.5mg intrauterine delivery system (Jaydess®▼) added to formulary (Green traffic light) as a second choice progestogen-only intra-uterine contraceptive. See SMC advice on page 2 of the Supplement.
|
|||||||||
|
Fluids and electrolytes |
Links to the following NHS Tayside policies added for information: NHS Tayside Food, Fluid and Nutritional Care Policy: Fluid Balance Monitoring, February 2015 |
|||||||||
| Mar 15 |
|
Antisecretory drugs and mucosal protectants
|
Link to NICE CG184: Dyspepsia, GORD, or both, Sept 2014 added.
|
|||||||
|
|
VTE treatment |
Apixaban 2.5mg & 5mg, film-coated tablets (Eliquis®) added to formulary (Amber traffic light) and Cardiology specialist formulary list as second line choice for treatment of confirmed uncomplicated DVT or PE. See SMC advice on page 4 of the Supplement. |
||||||||
|
|
Statins
|
Atorvastatin now formulary first choice statin. Atorvastatin primary prevention dose (20mg daily) added as prescribing note. Simvastatin is now formulary second choice statin. Note added that simvastatin 80mg daily is non-formulary. See article on page 2 of the Supplement for further information.
|
||||||||
|
|
Compound bronchodilator preparations
|
Umeclidinium/vilanterol, 55/22 micrograms, inhalation powder (Anoro®) - changed from SMC not recommended to non-formulary. See SMC advice on page 3 of the Supplement.
|
||||||||
|
Obstetrics & Gynaecology Specialist List
|
Anterior pituitary hormones
|
Follitropin alfa 75 units, 150 units, 225 units, 300 units, 450 units pre-filled pen for subcutaneous injection (Bemfola®) added to formulary (Hospital Only) (Red traffic light) and Obstetrics & Gynaecology specialist formulary list (under specialist supervision - Assisted Conception Unit). See SMC advice on page 3 of the Supplement. |
||||||||
|
|
Mycophenolate mofetil and mycophenolate sodium
|
|
||||||||
|
|
Mycophenolate mofetil and ustekinumab
|
Links to MHRA Drug Safety Update article - mycophenolate mofetil and mycophenolic acid: risk of hypogammaglobulinaemia and risk of bronchiectasis, Jan 2015 and MHRA Drug Safety Update article - ustekinumab: risk of exfoliative dermatitis, Jan 2015 added.
|
||||||||
|
|
Topical NSAIDs
|
Ibuprofen 5% topical gel now first choice topical NSAID. Piroxicam 0.5% gel now non-formulary as no longer cost-effective in primary care.
|
||||||||
|
Drugs for oral ulceration and inflammation
|
Caphosol® oral rinse (medical device), now Amber traffic light (can be prescribed by GPs under specialist direction) and added to the Oncology & Haematology (non-chemo drugs) specialist formulary list.
|
|||||||||
|
|
Management of skin conditions
|
Links to BNF - Excipients and sensitisation and MIMS - potential skin sensitisers as ingredients of emollients added under heading– Excipients and sensitisation.
|
||||||||
|
|
Emollients
|
Prescribing advice on use of emollients updated. All emollients in the BNF should be considered suitable for prescribing as appropriate, however specific preparations have been listed in order to provide further guidance. Cost and patient acceptability should be considered when prescribing. Link to Primary Care emollient price chart (January 2015) added. Layout of formulary section split up into: Ointments; Creams/gels; Lotions; Preparations containing urea; Spray emollients; Soap Substitutes; and Emollient bath and shower preparations. Preparations changed from formulary to non-formulary: Aqueous cream; Epaderm® ointment; E45® cream; Oilatum® shower emollient; Oilatum® emollient bath additive; Balneum® Plus bath oil; Dermol® 200 shower emollient; Dermol® 600 bath emollient; and Oilatum® Plus bath additive. Preparations added to the formulary: Hydromol® ointment; QV® Intensive ointment; Diprobase® ointment; QV® lotion; Diprobase® lotion; QV® cream; Hydromol® Intensive cream; Eucerin® Intensive lotion; Emollin® spray; Dermamist® spray; QV® gentle wash; and Hydromol® Bath and shower emollient.
|
||||||||
|
|
Barrier preparations
|
Preparations changed from formulary to non-formulary: Drapolene®; Sudocrem®; and Zinc and Castor Oil Ointment. Preparations added to the formulary: Metanium® ointment and Zinc Paste Compound BP.
|
||||||||
|
|
Mycophenolate mofetil and ustekinumab
|
Links to MHRA Drug Safety Update article - mycophenolate mofetil and mycophenolic acid: risk of hypogammaglobulinaemia and risk of bronchiectasis, Jan 2015 and MHRA Drug Safety Update article - ustekinumab: risk of exfoliative dermatitis, Jan 2015 added. |
||||||||
|
|
Sunscreen preparations
|
Delph® lotion SPF 30 non-formulary as discontinued. Uvistat® cream SPF 30, Uvistat® lipscreen SPF 50 and Anthelios® XL SPF 50+ Melt-in cream added to formulary. Prescribing advice on sunscreens updated. See article on page 2 for further information.
|
||||||||
|
|
Continence products
|
Links to NHS Tayside Continence Skin Care Leaflet & Product Guidelines and NATVNS Excoriation & Moisture Related Skin Damage Tool added.
|
||||||||
| Feb 15 |
Long-acting beta2 agonists - Chronic Obstructive Pulmonary Disease |
Olodaterol 2.5 microgram solution for inhalation (Striverdi® Respimat®) - changed from SMC not recommended to non-formulary. See SMC advice on page 3 of the Supplement. |
||||||||
|
Omalizumab |
New indication added to formulary (Hospital Only) (Red traffic light) and Dermatology specialist formulary list restricted to prescribing by Consultant Dermatologists (chronic urticaria clinic) for use in adults and adolescents with chronic spontaneous urticaria, according to national treatment guidelines. See SMC advice on page 3 of the Supplement. |
|||||||||
|
Other beta-lactam antibiotics |
Aztreonam lysine, 75mg, powder and solvent for nebuliser solution (Cayston®) added to formulary (Amber traffic light) and Respiratory specialist formulary list as 3rd line treatment for chronic pulmonary infections due to Pseudomonas aeruginosa in patients with cystic fibrosis (who are intolerant to, or where condition has deteriorated with tobramycin and colistin). See SMC advice on page 2 of the Supplement. |
|||||||||
|
Polymyxins |
Link to MHRA Drug Safety Update article - Colobreathe: risk of capsule breakage - new instructions for use, November 2014, added to colistimethate sodium (Colobreathe®) entry. |
|||||||||
|
Other antidiabetic drugs |
Canagliflozin plus metformin 50mg/850mg and 50mg/1000mg immediate-release tablets (Vokanamet®) added to formulary and Endocrinology specialist formulary list (triple therapy with insulin) as per SMC advice - see page 3 of the Supplement. |
|||||||||
|
|
Preparations for Acne and Rosacea |
Brimonidine, 3.3mg/g (0.33%) gel equivalent to 5mg/g brimonidine tartrate (Mirvaso®) added to formulary (GPs under the direction of Dermatology) and Dermatology specialist formulary list. See SMC advice on page 2 of the Supplement. Links to Isotretinoin Patient Specific Direction (Staffnet intranet link only) updated to current version. |
||||||||
|
HIV infection |
Dolutegravir 50mg, abacavir 600mg plus lamivudine 300mg film-coated tablets (Triumeq®) added to formulary (Hospital Only). See page 4 of the supplement. |
|||||||||
|
Bisphosphonates and other drugs affecting bone metabolism |
Click here for updated recommendations on osteonecrosis of the jaw and hypocalcaemia, added to denosumab entry. |
|||||||||
|
Local corticosteroid injections |
Triamcinolone acetonide 10mg/mL Intra-articular/Intradermal injection (Adcortyl®) entry updated to include Hospital Only use by Dermatology (intradermal injection) for keloids and hypertrophic scars. |
|||||||||
|
Drugs used in nasal allergy |
Azelastine hydrochloride 137micrograms plus fluticasone propionate 50micrograms per actuation nasal spray (Dymista® nasal spray) added to formulary - restricted to patients where a combination of nasal corticosteroid and nasal antihistamine is appropriate e.g. where monotherapy with nasal corticosteroid is not considered sufficient and an oral non-sedating antihistamine is not preferred or not tolerated. Additional prescribing notes added to section to help clarify treatment options. |
|||||||||
|
Addition of Triamcinolone acetonide 10mg/mL Intradermal injection (Adcortyl®) (Hospital Only) for keloids and hypertrophic scars. Addition of Fluorouracil 50mg/mL (5-FU) intralesional injection [off-label] (Hospital Only) for patients who have not responded to intradermal triamcinolone acetonide injection for keloids and hypertrophic scars. |
||||||||||
|
|
Preparations for Acne and Rosacea
|
Addition of statement on combined preparations containing a topical antibiotic with topical retinoid which may be suitable where both are clinically indicated. See also SMC advice on page 3. Clindamycin 1% / tretinoin 0.025% gel (Treclin®) now formulary. |
||||||||
|
Local anaesthesia - Lidocaine
|
Tetracaine / lidocaine (Pliaglis 70 mg/g + 70 mg/g cream®) now also for restricted use (Hospital Only) by Consultants from Plastic Surgery (and Dermatology) for anaesthesia before laser treatment where alternatives are not suitable. See page 5 of the supplement. |
|||||||||
|
COPD (Chronic Obstructive Pulmonary Disease) |
COPD formulary guidelines updated. Click here for updated guidance. See page 3 of supplement for further information. |
|||||||||
|
Antipsychotic Drugs |
Links added to Tayside guidance - Antipsychotics in older people with dementia (after excluding delirium) (Staffnet intranet link). Haloperidol now listed as first choice for stress and distress (behavioural and psychological symptoms of dementia (BPSD)) in Alzheimer’s disease [off-label] (licensed for agitation and restlessness in the elderly). Risperidone listed for this indication [off-label] as an alternative to haloperidol (risperidone licensed for persistent aggression in Alzheimer’s dementia (up to 6 weeks)). See also page 1 of the supplement. |
|||||||||
|
CNS stimulants and other drugs used for attention deficit hyperactivity disorder (ADHD) |
Atomoxetine 10mg, 18mg, 25mg, 40mg, 60mg, 80mg and 100mg capsules (Strattera®) added to formulary and Mental Health Specialist formulary list for treatment of ADHD in adults (GP under the direction of Mental Health Specialist) as per SMC advice (see Updates from previous SMC advice). Link added to Adult ADHD Shared Care Agreement (Staffnet intranet link). |
|||||||||
|
Lidocaine plaster |
Link added to updated local treatment protocol from lidocaine plaster formulary entry and on Chronic Pain Specialist Formulary List. See page 1 of the supplement. |
|||||||||
|
Drugs for dementia |
Link added to Tayside guidance - Antipsychotics in older people with dementia (after excluding delirium) (Staffnet intranet link). Link to Tayside guidance - Antipsychotics in older people with dementia (after excluding delirium) (Staffnet intranet link) also added to quetiapine entry on the Dementia specialist formulary list. |
|||||||||
|
Urinary-tract infections |
Oral fosfomycin [unlicensed] now Amber traffic light (GPs may prescribe on ID or microbiology advice; or if proven sensitivities) for multi drug resistant urinary tract infections (including ESBL (extended spectrum beta lactamase) producing Enterobacteriacae such as E. coli. See page 1of supplement for further information. |
|||||||||
|
Chronic hepatitis C |
Daclatasvir 30mg and 60mg film-coated tablets (Daklinza®) added to formulary and Gastroenterology specialist formulary list as Hospital Only - Hepatitis Team. See SMC advice on page 4 of the supplement.
|
|||||||||
|
|
Mifepristone and misoprostol
|
Mifepristone 200mg tablet and misoprostol 0.2mg vaginal tablets combipack (Medabon®) added to formulary and Obstetrics & Gynaecology specialist formulary list as Hospital Only. See SMC advice on page 4 of the supplement.
|
||||||||
|
|
Carbonic anhydrase inhibitors |
Brinzolamide 10mg/mL and brimonidine tartrate 2mg/mL eye drops, suspension (Simbrinza®) added to formulary and Ophthalmology specialist formulary list (GPs may prescribe under direction of Ophthalmology) as a second line treatment option where both brinzolamide and brimonidine are appropriate to decrease elevated intraocular pressure (IOP) in adults with open-angle glaucoma or ocular hypertension for whom monotherapy provides insufficient IOP reduction. See SMC advice on page 4 of the supplement. |
||||||||
|
Subfoveal choroidal neovascularisation
|
Aflibercept, 40mg/mL solution for injection (Eylea®) added to formulary and Ophthalmology specialist formulary list (Hospital Only) as 2nd line treatment for treatment of visual impairment due to diabetic macular oedema (DMO). See SMC advice on page 4 of the supplement. |
|||||||||
|
|
Naloxone |
Prescribing status of naloxone hydrochloride injection changed to Green traffic light for use in the community e.g. by GPs. |
||||||||
|
Section 14: Specialist dressings |
Format update and addition of Specialist dressings for Burns added. |
|||||||||
|
Chapter 20:
|
Continence products |
New Chapter added with links to Continence Product Order form and Form for the prescription of non-formulary continence products. |
||||||||
| Oct/Nov 14 |
Dyspepsia and gastro-oesophageal reflux disease |
Link to NICE CG17 - Dyspepsia updated to NICE CG184: Dyspepsia and gastro-oesophageal reflux disease: Investigation and management of dyspepsia, symptoms suggestive of gastro-oesophageal reflux disease, or both, Sept 2014. |
||||||||
|
Compound alginate preparations |
Gastrocote® tablets and sugar-free liquid removed from formulary as discontinued by manufacturer. Peptac® liquid and Gaviscon® Advance tablets or liquid remain as formulary alternatives. |
|||||||||
|
Atrial fibrillation |
Links to NICE CG36 - Atrial fibrillation updated to NICE CG180: Atrial fibrillation: the management of atrial fibrillation, June 2014. |
|||||||||
|
Second-Generation Antipsychotic Drugs
|
Lurasidone, 18.5mg, 37mg, 74mg film-coated tablets (Latuda®) added to formulary and Mental Health Specialist Formulary List for schizophrenia as Amber traffic light (GPs may prescribe under the direction of Mental Health). See SMC advice on page 4 of Supplement. Alternative to aripiprazole in patients in whom it is important to avoid weight gain and metabolic adverse effects. See formulary entry for further information including drug interactions. |
|||||||||
|
Antipsychotic depot injections |
Pipotiazine palmitate (Piportil® Depot) injection changed to non-formulary as discontinued by manufacturer. Information on discontinuation added to non-formulary entry. Removed from Mental Health Specialist Formulary List. For further information see page 2 of Supplement. |
|||||||||
|
Drugs used for mania and hypomania |
Link to NICE CG38 - Bipolar disorder updated to NICE CG185: Bipolar disorder, Sept 2014. Link also updated on Mental Health Specialist Formulary List. Chewtabs formulation of carbamazepine removed as discontinued. See page 2 of Supplement. |
|||||||||
|
Opioid analgesics - Severe pain (step 3) |
Statement added at top of formulary section to emphasise differences between modified release (MR) opioid preparations for background pain and immediate release (IR) opioid preparations for breakthrough pain. Links to NPSA guidance - Reducing Dosing Errors with Opioid Medicines, July 2008 and the NHS Tayside Safe and Secure Handling of Medicines added. Difference between MR tablets and IR capsules emphasised for oxycodone entry. Links to Oxycodone MR Stepdown advice and Local Treatment Protocol for Oxycodone MR in the Acute Pain Setting updated to most recent versions. |
|||||||||
|
Neuropathic pain |
Capsaicin, 179mg, cutaneous patch (Qutenza®) added to formulary and Chronic Pain Specialist Formulary List as Hospital Only (Red traffic light). See SMC advice on page 3 of Supplement. |
|||||||||
|
Control of epilepsy |
Chewtabs formulation of carbamazepine removed as discontinued. For further information see page 2 of Supplement. |
|||||||||
|
Triazole antifungals |
Indication for oral voriconazole in aspergillus related lung disease where itraconazole is ineffective or otherwise inappropriate added to formulary and Respiratory Specialist Formulary List* as Amber traffic light (as per Shared Care Agreement). Posaconazole 100mg gastro-resistant tablets (Noxafil®) added to formulary as Hospital OnlyHaematology. See SMC advice on page 4 and 5 of Supplement. |
|||||||||
|
Dipeptidylpeptidase-4 inhibitors |
Alogliptin 12.5mg plus metformin1000mg combination tablet (Vipdomet®) added as non-formulary. See SMC advice on page 3 of Supplement. |
|||||||||
|
Other antidiabetic drugs |
Empagliflozin 10mg and 25mg tablet (Jardiance®) added as non-formulary. See SMC advice on page 4 of Supplement. |
|||||||||
|
Hypercalcaemia and hypercalciuria |
Cinacalcet 30mg, 60mg, 90mg tablets (Mimpara®) changed to Amber prescribing status (GPs may prescribe under the direction of a Renal physician) in formulary and Renal Specialist Formulary List* as per Local Treatment Protocol. See also page 5 of Supplement - Updates from previous SMC advice. |
|||||||||
|
Section 1: Formulary dressings |
Aquacel ribbon added. |
|||||||||
|
Section 8: Burns |
Chapter review and update. |
|||||||||
| Sept/Oct 14 |
Asthma & COPD (Chronic Obstructive Pulmonary Disease)
|
Links to BTS/SIGN Asthma guidance updated to latest version - SIGN 141 British guideline on the management of asthma, October 2014. New sub-sections created for Asthma and Chronic Obstructive Pulmonary Disease within the following sections to make formulary choices clearer:i · 03.01.01.01 Long-acting beta2 agonists · 03.01.02 Antimuscarinic bronchodilators · 03.02 Corticosteroids - Compound preparations Acetylcysteine SCA (Shared Care Agreement) removed from formulary and Respiratory specialist list as out of date. Updated version awaited. Azathioprine - link to GP letter removed from formulary and Respiratory specialist list as no longer accurate. Updated version awaited. |
||||||||
|
Orlistat |
Link to Tayside Adult Weight Management Pathway added (Staffnet intranet link). |
|||||||||
|
Chronic hepatitis C |
Simeprevir 150mg hard capsules (Olysio®) added to formulary and Gastroenterology Specialist Formulary List as Hospital Only - Hepatitis Team. See SMC advice on page 3 of the supplement. |
|||||||||
|
Dipeptidylpeptidase-4 inhibitors |
Alogliptin, 25mg, 12.5mg, 6.25mg, film-coated tablets (Vipidia®) added as non-formulary. See SMC advice on page 3 of the supplement. |
|||||||||
|
Drugs for urinary frequency, enuresis, and incontinence |
Link to Wound Management Continence Product Order Form added to help users find this. |
|||||||||
|
Oral Nutrition |
Links to Abbott adult oral nutritional supplement range and Nutricia dysphagia product range updated to the latest versions. |
|||||||||
|
Drugs for the treatment of soft-tissue disorders and topical pain relief |
NHS Tayside Extravasation Policy removed as out of date. A new NOSCAN (North of Scotland Cancer Network) version is awaiting publication. |
|||||||||
|
Topical NSAIDs |
Ibuprofen 5% topical gel added to formulary as a second choice topical NSAID. Piroxicam 0.5% topical gel remains the first choice topical NSAID. |
|||||||||
|
Herpes Simplex Keratitis |
Aciclovir 3% eye ointment changed from Hospital Only (Red traffic light) to Can be prescribed by GPs under the direction of an Optometrist or Ophthalmologist (Amber traffic light) for treatment of recurrent herpes simplex keratitis in formulary and on Ophthalmology Specialist Formulary List. See article on page 1 of the supplement for further information. |
|||||||||
|
Section 1: Formulary dressings |
Updated to reflect current hospital ordering and
new SKU code column added.
Foam Adhesive Heels: Permafoam concave & Mepilex heel added. Non-adherent Dressings: Tricotex changed to NA Aquacel Ag Extra changed to Aquacel Ag+ Extra Aquacel Ag changed to Aquacel Ag+ |
|||||||||
|
Section 5: Leg Ulcers Specialist List |
Bullet point regarding a hydrofiber with polyurethane foam dressing removed from other considerations. |
|||||||||
|
Section 6: Pressure Ulcers |
Bullet point regarding a hydrofiber with polyurethane foam dressing removed from other considerations. Fibrous hydrocolloid with foam added to treatment options. |
|||||||||
|
Section 7: Diabetic Foot Ulcers |
Bullet point regarding a hydrofiber with polyurethane foam dressing removed from other considerations. Fibrous hydrocolloid with foam added to treatment options. |
|||||||||
|
Section 10: Wound Infection
|
Bullet point regarding a hydrofiber with polyurethane foam dressing removed from other considerations. Fibrous hydrocolloid with foam added to treatment options for Cavity Grade 1, 3 & 4. Section 10 split and renumbered to now reflect – Section 11: Fistulae/Sinuses/Cavities Section 12: Overgranulation Section 13: Fungating Wounds |
|||||||||
| Jul/Aug 14 |
Infliximab (IBD) |
Added to formulary and Gastroenterology specialist formulary list* as an alternative to adalimumab in patients with fistulating Crohn's disease or issues with compliance to weekly/fortnightly adalimumab therapy at home. In accordance with NICE MTA 187. See also page 5 of the supplement. |
||||||||
|
Corticosteroids |
Beclometasone/formoterol (Fostair®) added to formulary as first choice combination ICS/LABA MDI in severe COPD. See page 3 for SMC advice. Seretide 500 Accuhaler® now first choice ICS/LABA DPI in severe COPD. Relvar Ellipta® now listed as second choice ICS/LABA in severe COPD as Symbicort® no longer formulary for COPD. Existing patients on Symbicort® for COPD should continue. Budesonide Turbohaler and Fluticasone (Flixotide®) both for asthma now non-formulary. Budesonide Easyhaler® remains in formulary as second choice single agent corticosteroid. |
|||||||||
|
Orlistat |
Prescribing status changed from Green to Amber. See page 2 of the supplement for further information. |
|||||||||
|
Other antidiabetic drugs |
Dapagliflozin (Forxiga®) for triple therapy in combination with metformin and sulphonylurea, as an alternative to a dipeptidyl peptidase-4 (DPP-4) inhibitor – indication added to formulary. See SMC advice on page 3 of the supplement.. Dapagliflozin plus metformin 5mg/850mg and 5mg/1000mg film-coated tablets (Xigduo®) added to formulary and Endocrinology specialist formulary list* (triple therapy with insulin) as per SMC advice - see page 4 of the supplement. |
|||||||||
|
Urinary incontinence |
Botulinum toxin type A powder for solution for injection (BOTOX®) for overactive bladder with symptoms of urinary incontinence, urgency and frequency in patients who have failed standard oral treatments including mirabegron - indication added to formulary and Urology specialist formulary list*. See SMC advice on page 3 of the supplement. |
|||||||||
|
Cytokine modulators |
Certolizumab pegol solution for injection in pre-filled syringe (Cimzia®) now first choice for active PsA when response to at least 2 standard DMARDs (individually or in combination) has been inadequate (added to formulary and Rheumatology specialist formulary list*). See SMC advice - page 3 of the supplement. Tocilizumab solution for injection in pre-filled syringe (RoActemra®) added as a new formulation to formulary and Rheumatology specialist formulary list*. See SMC advice - page 5 of the supplement. |
|||||||||
|
Locorten-Vioform® (flumetasone with clioquinol) |
Changed to non-formulary with note added that it has been discontinued by manufacturer. (Will no longer be listed at all after 2 years or next Chapter 12 review). |
|||||||||
|
Pliaglis® (lidocaine7% and tetracaine 7%) |
Added as non-formulary. Approved for restricted use by Consultant Dermatologists for anaesthesia before laser treatment where alternatives are not suitable (added to Dermatology specialist formulary list*). |
|||||||||
| Jun/Jul 14 |
1.5 & netFormulary* |
Corticosteroids |
Mild to moderate Crohn’s disease affecting the ileum or ascending colon added as a further indication for budesonide 9mg gastro-resistant granules (Budenofalk®). See SMC advice on page 3 of the supplement.
|
|||||||
|
2.5 & netFormulary*
|
Alpha-adrenoceptor blocking drugs |
Phenoxybenzamine hydrochloride injection concentrate for intravenous infusion (Hospital-Only) now removed from formulary as not in use. |
||||||||
|
4– Central Nervous System Guidelines & netFormulary*
|
Psychiatric Guidance Notes - Using antidepressants in primary care
|
This guidance has been reviewed and updated along with the algorithm on choosing an antidepressant and the algorithm on monitoring treatment with antidepressants. |
||||||||
|
5 & netFormulary* |
Hepatitis C |
Sofosbuvir▼400mg tablet (Sovaldi®) added to formulary and Gastroenterology specialist formulary list for the treatment of chronic hepatitis C in adults (Hospital-Only - Hepatitis team). See SMC advice on page 3 of the supplement.
|
||||||||
|
6.1 & netFormulary* |
Other antidiabetic drugs |
Canagliflozin▼100mg and 300mg film-coated tablets (Invokana®) added to formulary as dual therapy with metformin or as triple therapy with metformin plus a sulphonylurea or triple therapy with metformin plus pioglitazone. Canagliflozin▼in combination with insulin added to formulary and Endocrinology specialist formulary list (GPs may prescribe under direction of the Diabetes Clinic). See SMC advice on page 3 of the supplement.
|
||||||||
|
netFormulary only* |
6.5.1– Anterior pituitary hormones |
Choriogonadotrophin alfa (HcG) injection (Ovitrelle®), follitropin alfa pre-filled pen injection (Gonal-F®), and menotrophin (human menopausal gonadotrophins) injection (Menopur®), added to formulary and Obstetrics & Gynaecology specialist formulary list as infertility treatments (Hospital-Only- under specialist supervision - Assisted Conception Unit). |
||||||||
|
6.7.2 - Drugs affecting gonadotrophins and gonadorelin analogues |
Triptorelin (Decapeptyl® SR) 3mg and 11.25mg injection added to formulary and Obstetrics & Gynaecology specialist formulary list as an alternative to goserelin for endometriosis (GPs may prescribe under specialist direction). Buserelin 150 micrograms/dose nasal spray and injection (Suprecur®), and cetrorelix (Cetrotide®) injection added to formulary and Obstetrics & Gynaecology specialist formulary list as infertility treatments (Hospital-Only - under specialist supervision - Assisted Conception Unit). |
|||||||||
|
7.1.1 - Prostaglandins and oxytocics |
Dinoprostone pessaries (Propess®) and vaginal gel (Prostin E2®), ergometrine injection, ergometrine with oxytocin (Syntometrine®) injection, oxytocin (Syntocinon®) injection, and carboprost injection added to formulary and Obstetrics & Gynaecology specialist formulary list (Hospital-Only, but may be used by community midwives). |
|||||||||
|
7.2 & netFormulary* |
Vaginal atrophy / Topical HRT |
Estriol intravaginal cream 0.1% (Ovestin®) added to formulary. |
||||||||
|
Preparations for other vaginal infections |
Clindamycin vaginal cream 2% (Dalacin®) added to formulary restricted to use in bacterial vaginosis in pregnancy as an alternative to oral metronidazole (as per local guidance). |
|||||||||
|
7.3 & netFormulary* |
Oral contraceptives / Combined hormonal contraceptives |
Microgynon 30 ED® (30mcg ethinylestradiol with levonorgestrel) added to formulary as an ’every day’ (28-day) preparation. |
||||||||
|
11.8.2 & netFormulary* |
Subfoveal Choroidal Neovascularisation |
Aflibercept▼solution for intravitreal injection 40mg/mL added to formulary and Ophthalmology specialist formulary list for treatment of neovascular (wet) age-related macular degeneration (AMD) as an alternative to ranibizumab (Hospital-Only). Aflibercept▼is also an alternative to ranibizumab for macular oedema secondary to central retinal vein occlusion (CRVO). |
||||||||
| May/Jun 14 |
3 - Respiratory guidance notes & netFormulary* |
Recommended dose and duration of oral prednisolone in COPD exacerbation updated. Dose now oral prednisolone 40mg for 5 days (30mg if <60kg / 9½ stone). See page 2 of Supplement for further information. |
||||||||
|
4.2.2 & netFormulary* |
Antipsychotic depot injections |
Aripiprazole 400mg powder and solvent for prolonged release suspension for injection (Abilify Maintena®) added to formulary (Hospital-Only) and Mental Health Specialist Formulary List for patients who have responded to oral aripiprazole and depot medication is required due to problems with compliance. See SMC advice on page 3 of Supplement. |
||||||||
|
4.6 & netFormulary* |
Drugs used in nausea and vertigo |
Domperidone - new restrictions, new contraindications, and reduced dose and duration of use updated following MHRA advice. Link to MHRA Drug Safety Update, Volume 7, Issue 10, May 2014 added. Link to UKMi Rapid Communication – Domperidone: new restrictions in use, May 2014 added. |
||||||||
|
netFormulary only* |
Tramadol |
Tramadol - note that tramadol has been re-classified as a schedule 3 Controlled Drug (exempt from safe custody requirements). Link to NHS Tayside memo added. |
||||||||
|
6.6 & netFormulary* |
Other drugs affecting bone metabolism |
Strontium ranelate removed from the formulary. The Tayside Medicine for the Elderly (MFE) Osteoporosis treatment algorithm has also been updated to remove strontium. For further information see page 2 of Supplement. |
||||||||
|
10.1.3 & netFormulary* |
Cytokine modulators |
Certolizumab pegol 200mg/mL solution for injection in pre-filled syringe (Cimzia®) added to formulary (Hospital-Only) and Rheumatology Specialist Formulary List for ankylosing spondylitis (AS) and axial spondyloarthritis without radiographic evidence of AS (nr-axSpA). See SMC advice on page 3 of Supplement for further information. |
||||||||
| Apr/May 14 |
4.7.3
& netFormulary*
|
Neuropathic pain | Duloxetine for the treatment of peripheral neuropathic pain (non-diabetic) [off-label] added to Chronic Pain specialist formulary list and formulary (GPs may prescribe under the direction of the Pain Clinic). Restricted to use in patients who are intolerant of first, second, or third-line options for the treatment of neuropathic pain or where these treatments have been ineffective. GPs may prescribe under the direction of the Pain Clinic, following initiation and 2 week review by the Pain Clinic. See local treatment protocol | |||||||
|
11.8.2 & netFormulary*
|
Subfoveal choroidal neovascularisation
|
Aflibercept (Eylea®) added to Ophthalmology specialist formulary list and formulary (Hospital-Only) as 2nd line choice for treatment of visual impairment due to macular oedema (MO) secondary to central retinal vein occlusion (CRVO) (see page 2 for SMC advice). |
||||||||
|
Tiotropium (Spiriva Respimat®) removed from Respiratory specialist formulary list. Tiotropium (Spiriva Respimat®) may be prescribed when appropriate for patients who cannot use other formulary devices. |
||||||||||
|
3.1 & netFormulary*
|
Bronchodilators - long acting beta2 agonists
|
Formoterol fumarate added back in to formulary as 3rd choice long-acting beta2 agonist in COPD.
|
||||||||
|
3.2 & netFormulary* |
Inhaled corticosteroids -compound preparation |
In last months DTC supplement 135 it stated that Seretide 100 Accuhaler® and Seretide 250 Accuhaler® were removed from the formulary. This was an error as they remain in the formulary for the treatment of asthma (only Seretide 500 Accuhaler® licensed for use in COPD). See Adult Asthma - Inhaled Medicine Chart.
Fluticasone furoate/vilanterol (Relvar Ellipta®▼92/22micrograms) added to formulary as 3rd choice ICS/LABA for COPD.
|
||||||||
|
6.1 & netFormulary*
|
Other antidiabetic drugs |
Dapagliflozin▼indication in combination with insulin, when insulin with diet and exercise, does not provide adequate glycaemic control added to formulary and Endocrinology specialist formulary list (GPs may prescribe under direction of the Diabetes Clinic).
|
||||||||
|
|
Oral nutrition
|
Ensure® Plus Commence removed from Abbott adult nutritional supplement range included within the formulary. Link added to updated Abbott adult nutritional supplement range. On initial prescription of ONS, prescribe one of the recommended standard 1.5kcal/mL products as ’mixed flavours’ on the prescription. |
||||||||
|
Cytokine modulators
|
Ustekinumab indication for active psoriatic arthritis alone or in combination with methotrexate in patients who have responded inadequately to, or are unsuitable for, treatment with an anti-TNF added to formulary and Rheumatology specialist formulary list (Hospital-Only). |
|||||||||
|
Section 6 - Pressure Ulcers and Section 10 - Wound complications: Fungating wounds have been updated. |
||||||||||
|
|
Colistimethate sodium dry powder for Inhalation (hard capsules) (Colobreathe®) added to Respiratory specialist list (GPs may prescribe under specialist direction). Shared Care Agreement updated (nebulised and inhaled). Link to pirfenidone local treatment protocol and GP letter added to Respiratory specialist list. |
|||||||||
|
3.1 & netFormulary* |
Long-acting antimuscarinic bronchodilators / COPD |
Formulary 1st choice antimuscarinic bronchodilator now glycopyrronium (Seebri Breezhaler®), 2nd choice now aclidinium (Eklira Genuair®), 3rd choice now tiotropium (Spiriva HandiHaler®). |
||||||||
|
3.2 & netFormulary* |
Inhaled corticosteroids- compound preparation |
Seretide Evohaler® removed from formulary. Seretide 500 Accuhaler® remains as first choice in COPD where combined inhaled steroid and long-acting bronchodilator indicated. Seretide 100 Accuhaler® and Seretide 250 Accuhaler® removed from formulary. |
||||||||
|
3.11 & netFormulary* |
Pirfenidone |
Link to pifenidone local treatment protocol and GP letter added. |
||||||||
|
Emergency hormonal contraception |
Levonorgestrel 1500microgram tablet (Upostelle®) added to formulary as 1st choice for emergency hormonal contraception. See SMC advice on page 3. Upostelle® brand replaces Levonelle®. |
|||||||||
| Jan/Feb 14 |
Specialist formulary lists and formulary
|
Formulations of medicines in list added for clarification. Esmolol, labetalol and metoprolol injections added to specialist list and formulary section 2.4 as Hospital Only. Hydralazine tablets, methyldopa tablets, moxonidine tablets, and valsartan capsules or tablets added to specialist list and formulary section 2.5 (GPs may prescribe under specialist direction). Several protocol links updated. |
||||||||
| Renal |
Tinzaparin added to specialist formulary list and formulary section 2.8 as Hospital Only for anticoagulation during haemodialysis.
|
|||||||||
|
Abatacept protocol and links to Shared Care Agreement – Biologic Therapies for Rheumatic Disease added to specialist formulary list (NHS Tayside Staffnet intranet links only). |
||||||||||
|
Gliptins (Dipeptidylpeptidase-4 inhibitors) |
Saxagliptin plus metformin, 2.5mg / 850mg and 2.5mg / 1000mg film-coated tablets (Komboglyze®) - updated indication as per SMC advice (page 3 of this bulletin) (triple combination therapy with a sulphonylurea).
|
|||||||||
|
|
|
Eltrombopag (Revolade®) added to Gastroenterology specialist list. |
||||||||
|
2.5 & netFormulary * |
Centrally acting antihypertensive drugs |
Methyldopa added to formulary and Obstetrics & Gynaecology specialist formulary list as Hospital Only for pregnancy induced hypertension (3rd line), restricted to the Cardiovascular Risk and Obstetrics clinics. Moxonidine added to formulary as Hospital Only for severe resistant hypertension restricted to the Cardiovascular Risk clinic.
|
||||||||
|
2.6 & netFormulary * |
Dihydropyridine calcium-channel blockers |
Lercanidipine hydrochloride added to formulary for hypertension in patients intolerant of amlodipine. |
||||||||
|
Antipsychotic drugs |
Link to NHS Tayside Guidelines for Management of High Dose Antipsychotic Therapy added to formulary and Mental Health specialist formulary list. |
|||||||||
|
4.6 & netFormulary * |
Metoclopramide |
Updated advice on restricted dose and duration of use for metoclopramide (maximum dose in 24 hours: 30mg or 0.5mg/kg and short-term use (up to 5 days)) added. Link to MHRA Drug Safety Update, August 2013 with advice following European review confirming risk of neurological adverse effects. |
||||||||
|
6.1 & netFormulary * |
Gliptins (DPP-4 inhibitors) |
Saxagliptin now first choice gliptin. Triple oral therapy indication added as per SMC advice (see page 2 of this supplement). Sitagliptin may still be preferred in some patients - see formulary for further information on indications. |
||||||||
|
Drugs affecting bone metabolism |
Link to the Tayside MFE Osteoporosis Treatment Algorithm, September 2013 added outlining treatment options for osteoporosis and their place in therapy. |
|||||||||
| Nov/Dec 2013 |
Parkinson’s disease |
Parkinson’s disease specialist formulary list added. |
||||||||
|
4.6 (netFormulary only)* |
Drugs used in nausea and vertigo |
Ondansetron orodispersible films (Setofilm®) added to formulary for haematology or oncology patients who cannot take any other oral forms of ondansetron due to enhanced risk of aspiration or swallowing difficulties.
|
||||||||
|
4.6 (netFormulary only)*
|
Domperidone |
Indication for postural hypotension associated with dopamine agonists (particularly apomorphine) [off-label] added to Medicines for the Elderly (MFE) and Parkinson’s disease specialist list (under specialist direction). |
||||||||
|
4.9.1 (net Formulary only)*
|
Dopaminergic drugs used in Parkinson’s disease |
Apomorphine and amantadine added to formulary (under specialist direction) and Parkinson’s disease specialist list. All dopaminergic drugs used in Parkinson’s disease classified as ‘Amber’ (GPs may prescribe under specialist direction).
|
||||||||
|
4.9.2 (netFormulary only)*
|
Antimuscarinic drugs used in parkinsonism
|
Trihexyphenidyl hydrochloride (benzhexol) added to formulary (under specialist direction) and Parkinson’s disease specialist list. |
||||||||
|
Prostaglandin analogues |
Bimatoprost with timolol single-dose eye drops added to formulary (under specialist direction) and Ophthalmology specialist list, restricted to patients who require both components and who cannot tolerate preservative. Bimatoprost with timolol standard eye drops are non-formulary.
|
|||||||||
|
Ocular diagnostic, peri-operative preparations and photodynamic treatment |
Ranibizumab, 10mg/mL, solution for injection (Lucentis®) added to formulary (Hospital Only) and Ophthalmology specialist list. |
|||||||||
| Specialist formulary lists and formulary development |
Obstetrics & Gynaecology specialist formulary list added. |
|||||||||
|
4 - Central Nervous System Guidelines
|
Links to the following guidelines added to this section (already included in section 4.7): Guideline on the use of Strong Opioids for Chronic Non-malignant Pain, NHS Tayside Pain Management Guidelines Book, NHS Tayside Acute Pain Service Guidance for management of anticipated complex pain. |
|||||||||
|
4.6 |
Nausea and vomiting induced by chemotherapy |
Granisetron 3.1mg / 24 hours transdermal patch (Sancuso®) added to formulary and Oncology & Haematology specialist formulary list – non-chemotherapy drug (hospital only). See SMC advice (page 3) for further information. |
||||||||
|
Drugs for urinary frequency (in the absence of outflow obstruction), urgency and incontinence |
Botulinum toxin type A (Botox®) added to formulary and Urology specialist formulary list (hospital only). See SMC advice (page 3) for further information. |
|||||||||
|
Potassium citrate
|
Potassium citrate mixture BP (approx. 1mmol/mL of citrate) (for prescribing under the direction of a Renal specialist) and potassium citrate 1080mg tablets (10mmol of citrate) (unlicensed) (hospital only) added to formulary and Renal specialist formulary list for reduction of renal stone formation including patients with hypocitraturia and renal tubular acidosis. Potassium citrate tablets restricted to patients who do not tolerate potassium citrate mixture. |
|||||||||
|
Rituximab |
Rituximab 100mg, 500mg solution for infusion (MabThera®) added to formulary, Rheumatology specialist formulary list, and Renal specialist formulary list (hospital only). See SMC advice (page 4) for further information. |
|||||||||
|
Emergency Treatment of Poisoning |
New section added. Note added: In the event of poisoning the National Poisons Information Service should be contacted. Link to TOXBASE (password protected) and information on the Rarely Used Urgent Medicines (RUUM) List added. |
|||||||||
|
Guidelines for the Perioperative Management of Patients with Diabetes |
Information in section replaced with link to current guidance: Peri-operative Diabetes Management Guideline and Intravenous Insulin Management Guideline |
|||||||||
|
Sept/Oct 2013
|
Specialist formulary lists and formulary development
|
Oncology & Haematology - non-chemotherapy drugs |
Oncology & Haematology specialist formulary list (non-chemotherapy drugs) added. |
|||||||
|
1.6 Gastroenterology specialist list |
Laxatives |
Rifaximin (Targaxan®)
added to the formulary (for prescribing under the direction of
Gastroenterology) and added to the Gastroenterology specialist
formulary list. See SMC advice (page 4) for indication. |
||||||||
|
Antifibrinolytic drugs and haemostatics
|
New section - addition of tranexamic tablets to formulary, and tranexamic acid oral solution (used as a mouthwash) (for prescribing under the direction of an oncology or haematology specialist) to the formulary and Oncology & Haematology specialist formulary list. |
|||||||||
|
Mucolytics |
Idiopathic pulmonary fibrosis (IPF) indication removed for azathioprine in combination with N-acetylcysteine (unlicensed) and prednisolone, indication for other types of alveolitis added. N-acetylcysteine as monotherapy listed for IPF. |
|||||||||
| Antifibrotics |
New section - addition of pirfenidone▼(Esbriet®) to formulary and Respiratory specialist formulary list (hospital only). See above for SMC advice. |
|||||||||
|
|
Management of nausea and vomiting induced by chemotherapy |
Antiemetics used in the management of nausea and vomiting induced by chemotherapy included in formulary: cyclizine, domperidone, metoclopramide, ondansetron and dexamethasone. Levomepromazine, granisetron and lorazepam added to formulary and Oncology & Haematology specialist formulary list (for prescribing under the direction of an oncology or haematology specialist) for chemotherapy-induced nausea and vomiting (levomepromazine and granisetron), and anticipatory nausea and vomiting (lorazepam). Aprepitant and palonosetron also added to formulary and Oncology & Haematology specialist list (hospital only). |
||||||||
|
4.7
|
Fentanyl immediate release (IR) |
Links to guidance on Abstral® and PecFent® from national Palliative care guidelines replace links to Tayside Prescriber Issue 120 - January 2011 (Fentanyl preparations for breakthrough cancer pain). |
||||||||
|
6.1
|
Other antidiabetic drugs |
Lixisenatide▼ (Lyxumia®) replaces exenatide in formulary and Endocrinology specialist formulary list. See SMC advice (page 3) for further information. |
||||||||
|
|
Bisphosphonates |
Sodium clodronate 400mg capsules and ibandronic acid 50mg tablets added to formulary and Oncology & Haematology specialist list (for prescribing under the direction of an oncology or haematology specialist). Additional indications for disodium pamidronate (hospital only) included. Zoledronic acid intravenous infusion (Zometa®) added to formulary and Oncology & Haematology specialist list (hospital only). |
||||||||
|
Parenteral contraceptives |
Medroxyprogesterone acetate subcutaneous depot injection (Sayana® Press) added to formulary. See SMC advice (page 3) for further information. |
|||||||||
|
|
Progestogens |
New section - addition of megestrol acetate and medroxyprogesterone acetate tablets to formulary and Oncology & Haematology specialist list (for prescribing under the direction of an oncology or haematology specialist). |
||||||||
|
Breast cancer |
Addition of letrozole, exemestane and fulvestrant to formulary and Oncology & Haematology specialist list (tamoxifen and anastrazole added to specialist list) (for prescribing under the direction of an oncology or haematology specialist). |
|||||||||
|
Gonadorelin analogues |
Addition of goserelin 3.6mg implant (Zoladex®) for breast cancer indication to formulary and Oncology & Haematology specialist list. |
|||||||||
|
Calcium supplements |
Addition of information on possible interaction of calcium supplements with some foods. See page 2 of supplement, Accrete D3 administration for further information. |
|||||||||
|
Vitamin D |
Addition of information on administration of vitamin D and calcium preparations and on possible interaction of calcium supplements with some foods. See page 2, Accrete D3 administration for further information. |
|||||||||
|
Oral ulceration and inflammation. |
Caphosol® oral rinse (medical device) and Gelclair® sachets (medical device) added to formulary and Oncology & Haematology specialist list (hospital only) for the relief of mucositis and ulceration in cancer patients. |
|||||||||
|
Treatment of dry mouth |
Normasol® sachets, Biotene Oralbalance® gel and Glandosane® spray added to formulary. |
|||||||||
|
Oropharyngeal fungal infections |
Fluconazole added as second line treatment for mucosal candidiasis and oral suspension first line in patients with head and neck cancers receiving chemotherapy and radiotherapy. |
|||||||||
|
|
Laxatives |
Linaclotide▼added to the formulary – see SMC advice for indication. Link to local protocol added. | ||||||||
|
Drugs affecting biliary composition and flow |
Ursodeoxycholic acid 500mg film-coated tablets added to the formulary. See page. 4 for indication. Dissolution of gallstones indication removed from formulary for ursodeoxycholic acid as non-drug techniques preferred. |
|||||||||
|
|
Heparinoids
|
Danaparoid (first line) and argatroban (second line) added to formulary and Renal specialist formulary list (hospital only). |
||||||||
| Allergic emergencies |
EpiPen® now formulary first choice adrenaline auto-injector. |
|||||||||
|
Contraceptives |
Etonogestrel/ethinylestradiol vaginal ring (NuvaRing®▼) added to formulary as an alternative route for combined hormonal contraception when non oral route preferred. |
|||||||||
|
|
Renal colic
|
Note added: Diclofenac intramuscular injection or suppositories should not be given for more than 2 days. Links to Drug Safety Update Volume 6, Issue 11, June 2013 and CKS topic – NSAIDs – Prescribing issues added. |
||||||||
|
|
Potassium removal
|
Calcium Resonium® removed from formulary and Renal specialist list. Sorbisterit® now preferred alternative preparation of calcium polystyrene sulphonate. Sorbisterit® added to core formulary. |
||||||||
|
|
Non-steroidal anti-inflammatory drugs (NSAIDs)
|
Removal of diclofenac, naproxen now also first choice. Link to Drug Safety Update Volume 6, Issue 11, June 2013 and CKS topic – NSAIDs – Prescribing issues added. Additional information simplified. |
||||||||
|
Cytokine modulators |
Abatacept (Orencia®▼) 125mg/mL solution for subcutaneous injection (pre-filled syringe) added to formulary and Rheumatology specialist list (hospital only). |
|||||||||
|
|
Prostaglandin analogues |
Latanoprost 50microgram/mL preservative-free
single-dose eye-drops added to formulary (for prescribing under
the direction of ophthalmology) and added to the Ophthalmology
specialist formulary list. |
||||||||
|
Co-cyprindiol (Dianette®) tablets |
Link added to Drug Safety Update Volume 6, Issue 11, June 2013. |
|||||||||
|
|
1.5 | Treatment of inflammatory bowel disease | Sulfasalazine moved from core formulary to GPs under direction of GI. | |||||||
| 6.1 | Drugs used in diabetes | Saxagliptin and metformin combination tablets added to the formulary. | ||||||||
| 6.6 | Drugs affecting bone metabolism | Stronium ranelate added to the Medicines for the Elderly and Endocrine specialist lists (removed from core formulary). | ||||||||
| 9.2 | Fluids and electrolytes | Dioralyte® sachets used at double the normal concentration (10 sachets in 1L of water) have been added to formulary and gastrointestinal specialist list for use in those with intestinal failure and high output stomas (unlicensed 'off-label' use). | ||||||||
| 9.6 | Vitamins |
Valupak Multivitamin and Mineral
tablets added to formulary. Forceval® capsules removed from formulary. Calceos® and Adcal D3® removed from formulary. Accrete D3® added to the formulary. |
||||||||
| 11.3 | Anti-infective preparations | Propamidine isethanoate 0.1%, chlorhexidine digluconate 0.02% (unlicensed), hexamidine 0.1% (unlicensed), polihexanide 0.02% (unlicensed), amphotericin 0.15% (unlicensed, miconazole 1% (unlicensed) eye drops all added to the formulary and ophthalmology specialist list. Ganciclovir 0.15% eye gel added to the formulary and ophthalmology specialist list. Aciclovir 3% eye ointment moved to the ophthalmology specialist list from the core formulary. | ||||||||
| Tear substitutes | Hypromellose eye drops and liquid paraffin (Lacrilube®) eye ointment removed from formulary. Carbomer eye drops now 1st choice. Carmellose sodium (Optive® and Optive Plus®). Liquid paraffin (VitA-POS®), Sodium hyaluronate (Hylo-Tear®, Hylo-Forte® and Clinitas® UDV) added to the formulary, Acetylcysteine/hypromellose (Ilube®), ciclosporin (unlicensed) and sodium chloride (unlicensed) eye drops added to the ophthalmology specialist list and formulary. | |||||||||
| Wound Management Formulary | Formulary dressings |
Mepilex 5x5cm added. Biatin adhesive, 7.5cm x 7.5cm and 15cm x 156cm added. |
||||||||
| May 2013 |
1.5
|
Treatment of inflammatory bowel disease |
Modified release mesalazine (Mesren®) has been re-branded as Octasa®. This brand name should now be used for any prescriptions for patients previously on Mesren®. |
|||||||
|
3.2
|
Inhaled corticosteroids |
Fostair MART®
(Maintenance And Reliever Therapy) regimen added to the formulary. |
||||||||
|
7.2
|
Treatment of vaginal and vulval disorders |
Vagifem®
25microgram vaginal tablets have been discontinued. They have been
removed from the formulary. |
||||||||
| Contraceptives |
Femulen®
has been discontinued. It has been removed from the formulary. |
|||||||||
|
Drugs for urinary frequency (in the absence of outflow obstruction), urgency and incontinence |
Mirabegron▼added to the formulary. |
|||||||||
|
Drugs which suppress the rheumatic disease process |
Abatacept▼added to the formulary and rheumatology
specialist list. |
|||||||||
|
Several additions have been made to the ophthalmology section of the formulary, and the ophthalmology specialist list has been published. |
Please see section 11 and the ophthalmology specialist list. |
|||||||||
|
Ocular diagnostic and peri-operative preparations and photodynamic treatment |
Ranibizumab▼has been added to the formulary and ophthalmology specialist list. |
|||||||||
| 13.4 | Topical corticosteroids |
Betnovate-C (betamethasone 0.1% and clioquinol
3%)has been discontinued. It has been removed from the formulary. Synalar-C (fluocinolone 0.025% and clioquinol 3%) has been added to the formulary. |
||||||||
|
Drugs affecting the immune response |
Methotrexate 50mg/mL (Metoject®) pre-filled syringes - GPs can now prescribe under the direction of a specialist for the treatment of severe psoriasis and severe psoriatic arthritis. |
|||||||||
|
|
Anticoagulants |
New indications for rivaroxaban▼ added to the formulary. |
||||||||
|
Female sex hormones and their modulators |
Ulipristal acetate▼5mg tablets added to formulary and endocrinology specialist list. |
|||||||||
|
Preparations for warts |
Salactol paint® replaces Salatac® gel as first line preparation on the formulary for the treatment of warts corns and calluses. Salatac® gel has been removed from the formulary. |
|||||||||
|
Sunscreens and photodamage |
Ingenol mebutate▼150micrograms/g & 500 micrograms/g gels have been added to the formulary. |
|||||||||
|
Information on the processes of the Wound Management Formulary Group added. |
||||||||||
|
List of formulary dressings updated. |
||||||||||
|
List of specialist dressings updated. |
||||||||||
|
Wound product evaluation form added. |
||||||||||
|
|
Anticoagulants |
Apixaban added to the formulary. |
||||||||
|
Drugs used in diabetes |
First line testing strips for Type 1 and 2 diabetes are now TRUEresult® for use with TRUEresult® or TRUEresult® twist meters. For those with dexterity problems the first line testing strips are One Touch Ultra® for use with the One Touch Ultra 2® meter. Please note meters are not prescribable on NHS prescription. |
|||||||||
|
Contraceptives |
Desogestrel should be prescribed generically – brand name ‘Cerazette®‘ removed from the formulary. |
|||||||||
|
Preparations for acne and rosacea |
Tretinoin gel 0.01% and 0.025% (Retin-A® gel) have been discontinued. They have been removed from the formulary. Suitable formulary alternatives include isotretinoin gel and adapalene cream or gel. |
|||||||||
|
Non-steroidal anti-inflammatory drugs |
Mefenamic acid added to the formulary for use in menorrhagia. |
|||||||||
|
Pain control in wound management |
Section 2 updated. |
|||||||||
|
Pressure ulcers dressing selection |
Section 6 updated. |
|||||||||
|
Treatment of inflammatory bowel disease |
Budesonide 3mg gastro-resistant modified release capsules (Entocort®) replaced by budesonide 3mg gastro-resistant capsules (Budenofalk®) for the treatment of mild to moderate crohn’s disease. |
|||||||||
|
|
Treatment of inflammatory bowel disease |
Budesonide 3mg gastro-resistant capsules and 9mg gastro-resistant granules (Budenofalk®) added to the formulary and gastrointestinal specialist list. |
||||||||
|
|
Antiplatelet drugs
|
Ticagrelor▼* added to formulary and cardiology specialist list. |
||||||||
|
|
Drugs used in diabetes
|
Dapagliflozin▼* 5mg and 10mg tablets added to the formulary. |
||||||||
|
|
Minerals |
Lanthanum carbonate 750mg and 1000mg oral powder added to the formulary and renal specialist list. GPs may prescribe under the direction of the renal clinic or dialysis unit.
|
||||||||
|
Vitamins |
Colecalciferol (Desunin®) 800international units (20micrograms) added to the formulary
|
|||||||||
|
Psoriasis |
Alphosyl HC® cream (coal tar 5% / hydrocortisone 0.5%) has been discontinued. If a topical steroid is required to be used in conjunction with the coal tar preparations, they should be used in an alternating regime. |
|||||||||
|
Preparations for Acne and Rosacea |
All strengths of Panoxyl Aquagel® (benzoyl peroxide)have been discontinued. Alternative preparations are available in the formulary (4%, 5% and 10%). Oxy On The Spot® (2.5% ) is available to buy over the counter. |
|||||||||
| Jan 2013 |
Treatment of inflammatory bowel disease |
Adalimumab▼*
added to the formulary and gastrointestinal
|
||||||||
|
|
Other antianginal drugs |
Ivabradine▼* - addition to approved use for NYHA class II to IV
heart failure. |
||||||||
|
Bronchodilators
|
Indacaterol▼*
inhalation powder added to formulary. |
|||||||||
|
|
Inhaled corticosteroids
|
Fostair®
metered dose inhaler now first line combination LABA/ICS for
asthma. |
||||||||
|
Photodynamic therapy |
5-aminolevulinic acid 7.8% gel (Ameluz®) added to formulary and specialist list. |
|||||||||
Specialist formulary lists and formulary development
|
Dermatology |
Dermatology specialist formulary list added.
|
||||||||
|
H2 receptor antagonists - Ranitidine |
Ranitidine added to dermatology specialist list for the treatment of chronic urticaria [unlicensed use “off-label”]. It may be prescribed in general practice under the direction of a specialist. |
|||||||||
|
|
Leukotriene related antagonists - Montelukast |
Montelukast added to dermatology specialist list for the treatment of chronic urticaria [unlicensed use “off-label”]. It may be prescribed in general practice under the direction of a specialist. |
||||||||
|
Sedating antihistamines - Hydroxyzine |
Hydroxyzine added to core formulary for pruritus. |
|||||||||
|
Nefopam |
Nefopam added to formulary for restricted use in patients unable to take opiates or NSAIDs or in addition to weak opioids in specific patient groups. |
|||||||||
|
Topical local anaesthetics |
Hospital only medicines added : |
|||||||||
|
Topical Corticosteroids with other agents |
Hospital only medicines added : |
|||||||||
|
Eczema |
New section. |
|||||||||
|
Psoriasis-Phototherapy |
Phototherapy section expanded. |
|||||||||
|
Drugs affecting the immune response |
New section. |
|||||||||
|
Acne |
Hospital only medicines added : isotretinoin**. |
|||||||||
|
Warts |
New links added: NHS Scotland Dermatology Referral and Management Pathway. |
|||||||||
|
Sunscreens and photodamage -Photodynamic therapy |
Photodynamic therapy section expanded. |
|||||||||
|
Skin Cleansers, antiseptics and desloughing agents |
New section. |
|||||||||
|
Hyperhidrosis– topical and systemic therapy |
New section. |
|||||||||
|
Circulatory preparations -Pentoxifylline |
New section. |
|||||||||
|
|
|
Proton Pump Inhibitors
|
Information added regarding risk of fractures & hypomagnesaemia with PPIs and link to Drug Safety Update Volume 5, Issue 9 , April 2012 and BNF section 1.3.5 Proton Pump Inhibitors added. |
|||||||
|
|
Antidepressant combination advice - |
Paragraph added regarding review of currently prescribed
antidepressants before initiating any other antidepressant for
depression or neuropathic pain. |
||||||||
|
Using Antidepressants in Primary Care |
Sentence added regarding review of currently prescribed
antidepressants before initiating any other antidepressant for
depression. |
|||||||||
|
Drugs affecting bone metabolism - Denosumab |
The denosumab protocol has been updated - DEXA scan may be performed at base-line and between 48 and 60 months (previously at 24 and 36 months). Link updated in TAF and Medicines for the Elderly and Endocrine specialist lists. |
|||||||||
|
|
Vitamin B Group
|
Dose of Pabrinex® I/V High Potency Injection for treatment of Wernicke’s encephalopathy changed to 2 to 3 pairs of ampoules three times a day for 2days then as before. Dose for prophylaxis is one pair of ampoules three times a day for 2 days then as before. |
||||||||
| Oct 2012 |
Link to online palliative care formulary removed (no longer free access) for hydromorphone (unlicensed), ketorolac (off-label), methadone and methylnaltrexone▼* injections. Contact local palliative care services for further advice added for these 4 medicines including specific contact details for each locality. |
|||||||||
|
Calcitonin nasal spray (Miacalcic®) removed from Endocrinology and Medicine for the Elderly specialist lists and 6.6 Drugs affecting bone metabolism section of the formulary. |
||||||||||
|
Use of tocilizumab as monotherapy added to rheumatology specialist list and section 10.1 Drugs used in rheumatic diseases and gout. |
||||||||||
Guidance on the responsibilities of unlicensed & off-label medicines added into section on ‘Using the Tayside Area Formulary’ and each Specialist formulary list. |
||||||||||
|
|
Prednisolone rectal foam |
Predfoam® discontinued. Brand name removed. Prescribe generically. |
||||||||
|
Lipid regulating drugs |
Advice regarding updated statin interactions added including specific advice for simvastatin and use with amlodipine, diltiazem, amiodarone or verapamil. |
|||||||||
|
Antimigraine drugs |
Section updated. Additional information on prophylaxis of migraine added. 1st choice for migraine prophylaxis now includes propranol or amitriptyline. Alternative beta blockers to propranolol added. Dose information expanded for propranolol and venlafaxine. Additional cautions / contraindications added to table for prophylactic therapies. Link to patient information leaflets for migraine on staffnet added. |
|||||||||
|
Anti-epileptic drugs |
Epanutin® capsules brand no longer available. Name has been changed to phenytoin sodium Flynn hard capsules. Epanutin® brand name removed from formulary. |
|||||||||
| Aug/Sept 2012 |
Metolazone 2.5mg tablets [unlicensed - named patient] added and further indication for eplerenone▼* added (see also page 3 of this supplement) to Cardiology specialist formulary list. |
|||||||||
|
|
Links to Guideline on the use of Strong Opioids for Chronic Non-malignant Pain inserted. |
|||||||||
|
|
Clomethiazole edislate syrup [unlicensed] added to Dementia specialist formulary list. |
|||||||||
|
SMC accepted indication for twice daily exenatide▼* added to Endocrinology specialist formulary list. See also page 4 of this supplement ‘Updates from previous SMC advice’. |
||||||||||
|
Tobramycin 28mg inhalation powder, hard capsules (TOBI Podhaler®)* added to Respiratory specialist formulary list and link to updated Shared Care Agreement added. |
||||||||||
|
Further indication for golimumab▼* added (see also page 4 of this supplement) to Rheumatology specialist formulary list. |
||||||||||
|
Note that due to supply problems alternatives (possibly unlicensed preparations) may require to be used for BCG (bacillus calmette-guérin) bladder instillation (ImmuCyst®). |
||||||||||
|
|
Metolazone
|
Metolazone [unlicensed] (2.5mg tablets- named
patient) added to formulary and Cardiology specialist formulary
list for add on therapy to a loop diuretic in heart failure
patients suffering from dyspnoea and/or oedema where there has
been an inadequate response to bendroflumethiazide
or where bendroflumethiazide has not been tolerated. |
||||||||
|
Oral anticoagulants |
Links to local guidance on the treatment of deep vein thrombosis (DVT): Ninewells Acute Medicine Unit (AMU) Management of suspected DVT and Perth Royal Infirmary (PRI) DVT Treatment Guideline inserted.Note that dronedarone* is contraindicated with dabigatran* inserted. |
|||||||||
|
Eplerenone▼* added to therapeutic notes - can be considered in addition to standard optimal therapy in NYHA class II (chronic) heart failure and left ventricular systolic dysfunction (LVEF < 30%) in patients with a recent (within 6 months) hospitalisation for a cardiovascular reason. (Careful monitoring of blood chemistry is mandatory). |
||||||||||
|
Hypnotics and anxiolytics |
Clomethiazole edislate syrup [unlicensed] added to formulary and dementia specialist formulary list for severe insomnia in the elderly (short-term use). |
|||||||||
|
Analgesics |
Link to Guideline on the use of Strong Opioids for Chronic Non-malignant Pain inserted. |
|||||||||
|
Neuropathic Pain |
A link to Guideline on the use of Strong Opioids for Chronic Non-malignant Pain inserted. |
|||||||||
|
A link to Guideline on the use of Strong Opioids for Chronic Non-malignant Pain inserted. |
||||||||||
|
Other antidiabetic drugs |
SMC accepted indication for twice daily exenatide▼* added to formulary and Endocrinology specialist formulary list. See also page 4 of this supplement ‘Updates from previous SMC advice’. |
|||||||||
|
Golimumab |
Further indication for golimumab▼* added to formulary and Rheumatology specialist formulary list. See also page 4 of this supplement ‘SMC advice issued in July and August 2012’. |
|||||||||
| July 2012 |
Making a formulary application, formulary process and new medicines |
Formulary application form |
The formulary application form has been updated. The text in this section has also been updated to include specialist formulary lists. |
|||||||
|
Gastroenterology specialist formulary list added. |
||||||||||
|
Baclofen, tizanidine [unlicensed use] and botulinum toxin type A (Botox®)* added. |
||||||||||
|
Ulcer healing drugs |
Prescribing note on sucralfate liquid added for the
prevention of re-bleeding following
oesophageal/gastric variceal banding [unlicensed indication].
Sucralfate liquid added to the gastroenterology specialist
formulary list. |
|||||||||
|
Treatment of inflammatory bowel disease |
Methylprednisolone (as sodium succinate) (Solu-Medrone®)
injection added to formulary as first choice parenteral
corticosteroid (hospital-only) and added to gastroenterology
specialist formulary list. |
|||||||||
|
Laxatives |
Phosphate enema (Fleet® Ready-to-use Enema, with standard tube), (Phosphate Enema BP Formula B, with standard tube or long rectal tube) added to formulary. |
|||||||||
|
Beta-blockers |
Propranolol for the prophylaxis of upper gastro-intestinal bleeding in patients with portal hypertension and oesophageal varices added to formulary and gastroenterology specialist formulary list. Carvedilol added to formulary and gastroenterology specialist formulary list as an alternative to propranolol (if not tolerated) [unlicensed indication]. |
|||||||||
|
Statins |
Link to guideline on aggressive lipid lowering in patients with Acute Coronary Syndromes (ACS) inserted. |
|||||||||
|
Domperidone |
Addition of safety information and link to Drug Safety Update, Volume 5, Issue 10, May 2012. |
|||||||||
|
Post-operative nausea and vomiting |
Link to current NHS Tayside guideline on prophylaxis and treatment of post-operative nausea and vomiting updated. |
|||||||||
|
Morphine |
Morphine preparations listed more clearly. Addition of link to the Pain Management in Palliative Care Guideline (from the NHS Scotland Palliative Care Guidelines) and addition of statement that dosage requirements should be reviewed for modified-release preparations of morphine if the brand is altered. |
|||||||||
|
5 - NHS Tayside Guide to Antibiotic Use
|
GI Infections |
Oral co-trimoxazole (hospital-only) added to
gastroenterology specialist formulary list for
treatment and prophylaxis of Spontaneous Bacterial Peritonitis (SBP)
and antibiotic
prophylaxis for variceal bleeding in patients with liver cirrhosis
[unlicensed indication]. |
||||||||
|
Blood Borne Viruses (BBV) |
The following hospital-only medicines (prescribed
by hospital specialists only however may be supplied from either
hospital or community pharmacies) have been added to the
gastroenterology specialist formulary list: |
|||||||||
|
Glipizide |
Removal of 2.5mg strength tablets as discontinued. |
|||||||||
|
Pituitary hormones |
Terlipressin acetate injection 1mg (Variquel®) added to formulary and gastroenterology specialist formulary list as a hospital-only medicine. |
|||||||||
|
Anaemias and other blood disorders |
Prescribing note for Ferric carboxymaltose (Ferinject®▼)* as first choice parenteral iron preparation amended to include patients with inflammatory bowel disease. |
|||||||||
|
Minerals |
Indications for oral magnesium glycerophosphate
expanded to include hypomagnesaemia
due to Crohn’s disease, bowel resection or intestinal failure.
Oral magnesium glycerophosphate added to gastroenterology
specialist formulary list. |
|||||||||
|
Vitamins |
Parenteral vitamins B and C (Pabrinex®
I/V High Potency injection) added to formulary and
gastroenterology specialist formulary list as a hospital-only
medicine. |
|||||||||
|
Oral ulceration and inflammation |
Removal of Adcortyl in Orabase as discontinued. Addition of chlorhexidine dental gel. |
|||||||||
|
Topical retinoids |
Removal of tretinoin cream as discontinued, gel still available. |
|||||||||
| May/June 2012 | Specialist formulary lists and formulary development | Mental Health | ||||||||
| Urology | ||||||||||
| Renal |
Preparation of magnesium glycerophosphate changed to 1g (4mmol) tablets made by UCLH (available from IDIS). |
|||||||||
|
Aminosalicylates (‘5 – ASA’ preparations) |
Monitoring advice for aminosalicylates updated. |
|||||||||
|
Hypnotics and anxiolytics |
Prescribing note on lorazepam for pharmacological management of acute behavioural disturbance added and link to section 4.2.1 added. |
|||||||||
|
Antipsychotic drugs |
Layout of section
updated. Additional prescribing information and advice added. Risperidone
now formulary first choice atypical antipsychotic. Lorazepam +/-
haloperidol listed as first choice for Control of agitation and
disturbed behaviours after appropriate psychological and
environmental management has failed (Pharmacological management of
acute behavioural disturbance). |
|||||||||
|
Antipsychotic depot injections |
New section. Typical antipsychotic depot drugs - Flupentixol decanoate, Fluphenazine decanoate, Haloperidol (as decanoate), Pipotiazine palmitate, Zuclopenthixol decanoate added to formulary and Mental Health specialist list. Atypical antipsychotic depot drugs - Risperidone prolonged-release injection ▼* and Paliperidone (as palmitate) prolonged-release suspension for injection ▼* added to formulary and Mental Health specialist list as Hospital-only. |
|||||||||
|
Mood stabilisers (antimanic drugs) |
Lithium carbonate tablets (Priadel®), lithium carbonate tablets (Camcolit®), lithium citrate liquid (Priadel®), semi-sodium valproate (Depakote®), and oral sodium valproate [unlicensed use] added to formulary as full entry and added to Mental Health specialist list. Olanzapine tablets, oral carbamazepine and lamotrigine tablets and dispersible tablets ▼added to formulary and Mental Health specialist list for maintenance treatment of bipolar disorder. |
|||||||||
|
Antidepressant drugs |
Additional prescribing advice added along with links to relevant
NICE guidelines. |
|||||||||
|
Drugs used in bladder outflow obstruction and benign prostatic enlargement |
Tamsulosin m/r capsules added to formulary and Urology specialist list to enhance expulsion of ureteral stones [unlicensed use]. |
|||||||||
|
Drugs for urinary frequency, urgency, and incontinence |
Oxybutynin transdermal patch (Kentera®)* added to formulary |
|||||||||
|
Drugs used for renal colic |
Diclofenac 100mg suppositories added for pain relief in renal colic. Prescribing note on tamsulosin m/r capsules to enhance expulsion of ureteral stones added as in section 7.4.1. |
|||||||||
|
Bladder instillations and interstitial cystitis |
Hospital-only bladder instillations: Mitomycin bladder
instillation (Mitomycin C Kyowa®
40mg vial and Mito-In®
device), BCG (bacillus calmette-guérin) bladder instillation (ImmuCyst®),
Sodium chondroitin sulfate 2% bladder instillation (Uracyst®)
(medical device), Sodium hyaluronate 40mg/50mL bladder
instillation (Cystistat®)
(medical device), and Sodium hyaluronate 800mg/50mL & Sodium
chondroitin sulphate 1g/50mL (2%) bladder instillation (iAluRil®)
(medical device) added to formulary and Urology specialist list. |
|||||||||
|
Drugs for erectile dysfunction
|
Tadalafil 2.5mg and 5mg tablets* added to
formulary. Sildenafil and tadalafil added to Urology specialist
list for severe distress as a result of erectile dysfunction.
Alprostadil added to formulary and Urology specialist list.
Terbutaline 5mg tablets added to formulary and Urology specialist
list as Hospital-only for priapism during dosage titration with
alprostadil [unlicensed use]. |
|||||||||
| May/June 2012 |
Gonadorelin analogues and gonadotrophin-releasing hormone antagonists |
Degarelix injection (Firmagon®▼)*
added to formulary and Urology specialist list. |
||||||||
|
Hypomagnesaemia |
Magnesium glycerophosphate in formulary now Magnesium glycerophophate 1g tablets (made by UCLH, available from IDIS) [unlicensed]. |
|||||||||
|
Urinary Tract Infections & Department of Urology
|
Intravenous (IV) Temocillin (for urinary tract infections (UTIs) caused by extended spectrum beta-lactamase (ESBL) producing organisms or 2nd line in complicated UTI) , oral fosfomycin [unlicensed] (for UTIs caused by ESBL producing organisms presenting in the community), and oral ciprofloxacin [unlicensed use] prior to needle biopsy of the prostate added to Urology specialist list as Hospital-only. |
|||||||||
| Apr 2012 | ||||||||||
|
|
Alpha-adrenoceptor blocking drugs |
Phenoxybenzamine hydrochloride capsules and injection (hospital-only) added to formulary and Endocrinology specialist formulary list. |
||||||||
|
Drugs used in diabetes |
Link to formulary
section 4.7.3 for information on diabetic peripheral
neuropathic pain inserted.
Metformin powder for oral solution (Glucophage®)*
added to formulary restricted to patients unable to swallow the
solid dosage form. Acarbose added to formulary and Endocrinology
specialist formulary list. Pioglitazone in combination with
insulin*, liraglutide injection▼* and exenatide injection▼* now on
Endocrinology specialist list (already included within formulary). |
|||||||||
|
Thyroid and antithyroid drugs |
Liothyronine sodium (L-Tri-iodothyronine sodium) tablets and injection (hospital-only) added to formulary and Endocrinology specialist formulary list. Aqueous Iodine Oral Solution (hospital-only) added to formulary and Endocrinology specialist formulary list. |
|||||||||
|
Corticosteroids |
Fludrocortisone acetate tablets for the treatment of orthostatic (postural) hypotension [unlicensed indication] added to formulary, Endocrinology and Medicine for the Elderly specialist formulary lists. Link to local Orthostatic Hypotension Guidance Notes and SIGN 113 (Parkinson’s disease) for further information on treatments for orthostatic hypotension inserted. |
|||||||||
|
Sex hormones |
New section 6.4.2 - Male sex hormones added. Testosterone enantate injection, Testosterone undecanoate injection (Nebido®▼*), Sustanon 250® injection, Testosterone undecanoate capsules (Restandol® Testocaps), Testosterone gel (Testogel®*, Tostran®*) added to formulary and Endocrinology specialist formulary list. Cyproterone acetate for male hypersexuality added to formulary. |
|||||||||
|
Pituitary hormones |
Tetracosactide injection (Synacthen®), Somatropin* (Omnitrope®, Saizen®, Norditropin®, Genotropin®), and Desmopressin acetate (nasal spray, tablets, DDAVP® Melt▼*) added to formulary and Endocrinology specialist formulary list. Thyrotropin alfa (rhTSH) (Thyrogen®), Gonadorelin (Gonadotrophin-releasing hormone; GnRH;LH-RH) injection (HRF®), and Desmopressin acetate 4micrograms/mL injection (DDAVP®) (all hospital-only) added to formulary and Endocrinology specialist formulary list. |
|||||||||
|
Drugs affecting bone metabolism |
Disodium pamidronate concentrate for intravenous infusion (hospital-only) added to formulary and Endocrinology specialist list. Calcitonin injection (hospital-only) and calcitonin nasal spray [unlicensed indication] added to formulary, Endocrinology and Medicine for the Elderly specialist formulary lists. Denosumab subcutaneous injection (Prolia®▼)* now added to Endocrinology and Medicine for the Elderly specialist formulary lists. Zoledronic acid annual intravenous infusion (Aclasta®), teriparatide (Forsteo®), recombinant human parathyroid hormone (Preotact®) (all hospital-only) now on Endocrinology and Medicine for the Elderly specialist formulary lists. |
|||||||||
|
Other endocrine drugs |
Metyrapone and goserelin (Zoladex 3.6mg implant) added to formulary and Endocrinology specialist formulary list. |
|||||||||
| 8.3.4.3 | Somatostatin analogues | Octreotide and lanreotide added to formulary and Endocrinology specialist formulary list. | ||||||||
|
Folic acid supplementation |
Advice on folic acid supplementation for before and during pregnancy has been updated - see page 2 of this bulletin for further details. |
|||||||||
|
Parenteral iron |
Information on use of ferric carboxymaltose injection (Ferinject®▼)* updated - see page 3 of this bulletin for further details. Iron sucrose injection (Venofer®) (first choice) and ferric carboxymaltose injection (Ferinject®▼)* (restricted to administration by intravenous infusion) (both hospital-only) added to the Medicine for the Elderly specialist formulary list. |
|||||||||
|
Skeletal muscle relaxants |
Baclofen [licensed] and tizanidine [unlicensed use ‘off-label’] added to formulary and Medicine for the Elderly specialist formulary list for spasticity associated with stroke. Botulinum toxin type A (Botox®) (hospital-only) added to formulary and Medicine for the Elderly specialist list (only prescribed and administered by the consultant from CBIR for this indication). |
|||||||||
| Mar/Apr 2012 |
Specialist formulary lists and formulary development |
|||||||||
|
|
||||||||||
|
Oral anticoagulants |
Rivaroxaban▼* added to formulary as first-line new oral anticoagulant for both SMC recently approved indications ( see page 2 and 4 of this supplement ). Rivaroxaban▼* also added to formulary as first-line choice for prophylaxis of venous thromboembolism (VTE) in adults undergoing elective hip or knee replacement surgery. Link inserted to local guidelines for management of patients on rivaroxaban. |
|||||||||
|
Bronchodilators |
Removal of black triangles for salmeterol aerosol inhalation, formoterol aerosol inhalation (Atimos Modulite®)*, Fostair® (beclometasone / formoterol)* aerosol inhalation. Budesonide aerosol inhalation removed as discontinued (budesonide as Easyhaler® * and Turbohaler® remain). |
|||||||||
|
Inhaled corticosteroids |
||||||||||
|
Guidance on inhaler devices 12 years+ |
Reference to NebuChamber® removed as discontinued. |
|||||||||
|
Chronic Obstructive Pulmonary Disease (COPD) guidelines
|
Further detail on oral steroid and antibiotics for treatment of exacerbation in the community added. Advice on advance supply of oral steroids/antibiotics for COPD exacerbation added. |
|||||||||
|
Hypnotics and anxiolytics |
Advice on avoiding use of hypnotics or anxiolytics in elderly patients added. Links to PRODIGY (formerly CKS) guidance updated. Addition of clomethiazole capsules to formulary and Dementia specialist formulary list. Further detail on lorazepam doses and link to guideline The Management of Delirium in Adult and Older In-Patients inserted. |
|||||||||
|
Antipsychotics in older patients |
Further advice on antipsychotics in elderly patients added. New sub-section added ‘Antipsychotics in older people with dementia’. New indications added within this section for risperidone▼and haloperidol. New indication for quetiapine added within this section and quetiapine added to Dementia specialist formulary list. Links to advice on rationalisation of antipsychotics in people with dementia added - Good Practice Guide for initiation of treatment and Good Practice Guide for reduction and cessation of treatment. |
|||||||||
|
Antidepressant drugs |
Fluoxetine now first choice SSRI due to recent safety advice on citalopram (and escitalopram non-formulary). Trazodone added to formulary and Dementia specialist formulary list. Dose information for venlafaxine added. |
|||||||||
|
Drugs for Dementia |
Link inserted to Donepezil, galantamine, rivastigmine and memantine for the treatment of Alzheimer’s Disease - Shared Care Agreement (Angus & Dundee). Cholinesterase inhibitors - donepezil, galantamine, and rivastigmine, and memantine added to formulary and Dementia specialist formulary list. Links to advice on rationalisation of anti- psychotics in people with dementia also added in section 4.2. |
|||||||||
|
Vitamin D |
Adcal-D3 caplets have replaced Adcal-D3 chewable tablets. |
|||||||||
| Feb 2012 |
|
Sevelamer carbonate (Renvela®)* now first-choice non-calcium based phosphate-binding agent for hyperphosphataemia in new patients on haemodialysis or peritoneal dialysis and patients with CKD not on dialysis with serum phosphate concentration of 1.78mmol/L or more. Sevelamer hydrochloride (Renagel®) remains on specialist list for existing patients on haemodialysis or peritoneal dialysis. Links to the Renal Department Electrolyte replacement guidelines , updated Guidelines for the Management of Bone Metabolism and Disease in Chronic Kidney Disease and the NHS Tayside Adult Empirical Treatment of Infection Guidelines for Renal Patients added. |
||||||||
|
Fluids and electrolytes |
Links added to the Renal Department Electrolyte replacement guidelines inserted. |
|||||||||
|
Phosphate-binding agents |
Updated advice on sevelamer carbonate (Renvela®)* and sevelamer hydrochloride (Renagel®) added as above. Link to the updated Guidelines for the Management of Bone Metabolism and Disease in Chronic Kidney Disease inserted. |
|||||||||
|
Vitamin D |
Link to the updated Guidelines for the Management of Bone Metabolism and Disease in Chronic Kidney Disease inserted. |
|||||||||
| Jan 2012 | Cardiology | Dronedarone▼restricted indication updated to reflect SPC changes. | ||||||||
| 2.3 | Dronedarone▼ |
Dronedarone▼entry changed to reflect SPC changes and recent MHRA advice. |
||||||||
| Dec 2011 |
E.N.T. |
E.N.T. specialist list added |
||||||||
| Rheumatology |
Golimumab▼* added to specialist list as ‘Hospital Only’ and to formulary section 10.1. |
|||||||||
| Palliative Care |
Local category ‘S’ removed for hyoscine butylbromide by subcutaneous (SC) injection or continuous subcutaneous infusion (CSCI), levomepromazine 6mg tablets, levomepromazine by SC injection or CSCI, sublingual lorazepan, buccal midazolam, morphine oral and by SC injection or CSCI for breathlessness as these may be initiated and prescribed in General Practice. |
|||||||||
|
|
Alginates |
Link to formulary section 12.4 for treatment of laryngopharyngeal reflux (LPR) added. Indication of LPR added for Gaviscon® Advance suspension. |
||||||||
|
PPIs |
Link to section 12.4 for LPR added. Restricted indication for esomeprazole 40mg daily amended. LPR indication removed as this is covered in section 12.4. Indications for long-term esomeprazole widened to include Barrett’s oesophagus or intestinal failure (unlicensed use ‘off-label’) as well as Zollinger-Ellison Syndrome*. |
|||||||||
|
Dabigatran▼* |
Dabigatran▼* added to formulary. See also page 2 of Supplement No 112 |
|||||||||
|
Contraceptives |
Updated information on drug interactions, use of long-acting reversible contraceptive (LARC) methods (hormone releasing intra-uterine system (IUS), intra-uterine devices (IUDs), or implant (Nexplanon®▼*)). Cilest® and Loestrin 20® removed, Gedarel® 20/150* added. IUDs T-Safe® 380A and Nova-T® 380 added to formulary. |
|||||||||
|
Golimumab▼* |
Added to formulary as ‘Hospital Only’ for rheumatoid arthritis (in combination with methotrexate) and ankylosing spondylitis. See also pages 3 & 4 of Supplement No 112 |
|||||||||
|
|
Drugs acting on the ear
|
Removal of Betnesol drops. Addition of Otomize Ear Spray. Addition of Ciprofloxacin eye drops for use in the ear (unlicensed use) to formulary and E.N.T. specialist list |
||||||||
|
Drugs acting on the nose |
Addition of azelastine nasal spray, certirizine, loratadine, mometasone furoate nasal spray and sodium cromoglycate nasal spray. Addition of ipratropium bromide nasal spray, and montekukast tablets* to formulary and E.N.T. specialist list. Removal of xylometazoline nasal drops. Indication for Naseptin cream added for use post-epistaxis (unlicensed use). |
|||||||||
|
Drugs acting on the oropharynx |
Link to anti-infective sections 14 & 16 of formulary for Ear, Nose & Throat infections added. |
|||||||||
|
Laryngeal Disorders |
New section added on treatment of laryngopharyngeal reflux (LPR). |
|||||||||
| Nov 2011 | Renal |
Brand of Hepatitis B vaccine changed from Fendrix® to HBvaxPRO®. |
||||||||
|
Stroke |
Addition of reference to PRI Stroke Thrombolysis Protocol. |
|||||||||
| Alteplase |
Addition of reference to PRI Stroke Thrombolysis Protocol. |
|||||||||
| Adrenaline |
Jext®* (adrenaline as tartrate) added to formulary as the preferred choice of intramuscular adrenaline injection for self-administration for new patients being prescribed adrenaline. See page 2 of this supplement for further details. |
|||||||||
| Citalopram |
Maximum dose reduced from 60mg to 40mg; in elderly and hepatic impairment dose reduced from 40mg to 20mg. |
|||||||||
| Photodamage |
Addition of treatments for actinic keratoses to formulary: Diclofenac 3% gel (Solaraze®); fluorouracil 5% cream (Efudix®); imiquimod 5% cream (Aldara®)* (restricted use). Link to local protocol for imiquimod 5% cream for actinic keratoses added. Addition of Fluorouracil 0.5% / salicylic acid 10% Cutaneous Solution (Actikerall®)* to formulary as a spot treatment for mild to moderate actinic keratoses in immunocompetent adults if cryotherapy is not available. |
|||||||||
| Oct 2011 |
Chronic Pain |
|||||||||
|
Palliative Care |
Addition of links to Tayside Palliative Care Community Pharmacy Network information from the Palliative Care specialist formulary list. |
|||||||||
|
Analgesics |
Tramadol m/r capsules added for restricted use under step 2.
Paracetamol intravenous infusion (Perfalgan®▼)*
added to formulary (hospital only) under step 3. Fentanyl
patches* and oxycodone capsules, m/r tablets* and oral solution
added under step 3. Links to the
’Approximate Equivalent Opioid Doses’
table inserted. |
|||||||||
|
Neuropathic Pain |
New section. Lidocaine
5%
medicated plasters (Versatis®)*
for post-herpetic neuralgia (PHN) and restricted use in localised
neuropathic pain (unlicensed use ‘off-label’) added to formulary
and Chronic Pain specialist list. Link to lidocaine plaster
Local treatment protocol inserted. |
|||||||||
|
4 - Central Nervous system Guidelines - Pain guidance notes
|
Management of Neuropathic Pain |
Link to new algorithm for PHN inserted. Guidance notes on duloxetine, lidocaine plasters, capsaicin cream, opioid analgesics, ketamine oral solution, ketamine infusion and lidocaine infusion added. |
||||||||
|
Approximate Equivalent Opioid Doses |
New strengths of oxycodone m/r tablets added. |
|||||||||
|
Tapentadol DoseConversion Chart |
New chart developed for tapentadol with approximate dose conversions to morphine and oxycodone. |
|||||||||
|
13.5 and Dermatology Guidance Notes - Management of Psoriasis |
Calcipotriol |
Calcipotriol cream removed as discontinued. |
||||||||
|
Reference to calcipotriol cream removed as discontinued. |
||||||||||
| Sept 2011 | Specialist formulary lists and formulary development | Stroke |
Stroke specialist formulary list added - Click here |
|||||||
| 2.2 | Indapamide |
Indapamide 2.5mg once daily added to formulary for use with perindopril erbumine (if blood pressure target not achieved with perindopril erbumine alone) in patients with a previous stroke or TIA. Link to NHS Tayside Treatment protocol for stroke patients inserted. |
||||||||
| 2.5 | ACE inhibitors |
Perindopril erbumine added to formulary as first choice for secondary prevention post-TIA or ischaemic stroke. Link to NHS Tayside Treatment protocol for stroke patients inserted. |
||||||||
| 2.8 | Oral anticoagulants |
Link to the NHS Tayside Treatment protocol for stroke patients inserted. |
||||||||
|
2.9
|
Oral antiplatelet drugs |
Clopidogrel now first choice for secondary prevention in confirmed non-cardioembolic ischaemic stroke/TIA. Aspirin is only indicated in these patients with clopidogrel allergy or intolerance. Aspirin 75mg combined with clopidogrel 75mg for at least one month has been added to the formulary and Stroke specialist formulary list (HOSPITAL ONLY) for those with clinically significant carotid disease post ischaemic stroke or TIA. |
||||||||
| 2.10 | Fibrinolytic drugs |
Alteplase added to formulary and Stroke specialist formulary list (hospital only) as first choice for thombolysis in acute stroke. Link to protocol Management of Acute Stroke Presenting within 41/2 Hours of Onset of Symptoms inserted. |
||||||||
| 2.12 | Statins |
Link to NHS Tayside Treatment protocol for Stroke patients added for use of atorvastatin 80mg. Atorvastatin 80mg daily has been added to the Stroke specialist formulary list for ischaemic stroke or TIA directly attributable to significant carotid artery disease or other known significant macrovascular disease. Additional advice on interactions with statins and medicines for HIV added. |
||||||||
| Ezetimibe |
Algorithms on Ezetimibe prescribing have been developed and a link to these added to the formulary (algorithms are for the review of Ezetimibe prescribing for the GMS QOF Meds 6 & 10 indicators 2011/12). |
|||||||||
|
9.1
|
Parenteral iron |
Ferric carboxymaltose injection (Ferinject®▼)* (hospital only) is now included in the formulary for use in areas in addition to Renal, such as Haematology & General Medicine. |
||||||||
| July 2011 | Specialist formulary lists and formulary development | Palliative Care |
Palliative Care specialist formulary list added.
|
|||||||
| Rheumatology | ||||||||||
| 2.12 | Statins |
5mg strength of rosuvastatin added to formulary.
|
||||||||
|
Ezetimibe
|
Information on restricted use of ezetimibe (in combination with a statin for patients who have failed to reach target cholesterol levels with optimised doses of statin alone) clarified further - patients should have tried both a lipophilic (simvastatin/ atorvastatin) and a hydrophilic (rosuvastatin) statin and concordance with treatment should be considered. |
|||||||||
|
3
|
Respiratory system guidelines |
Addition of a new section on long-term macrolide antibiotics to guidance notes. Information on long-term macrolides added to COPD guidelines. Links to patient information leaflets (PILs) for inhaler devices and spacer devices added to inhaler device guidance. |
||||||||
| 3.2 |
Inhaled corticosteroids
|
Addition of a note on stepping down inhaled corticosteroids in controlled asthma at start of section. Link to inhaler device guidance added. |
||||||||
|
3.4
|
Omalizumab* |
Formulary updated to include new formulation as prefilled syringe and new 75mg strength (prefilled syringes replace previous formulation of powder for reconstitution with solvent). |
||||||||
| 6.6 | Bisphosphonates |
Information on atypical stress fractures updated. Recommendation on bisphosphonate holidays added and link to local guidance (NHS Tayside Staffnet intranet link only) inserted. |
||||||||
|
8.3.4.2
|
Triptorelin* |
Formulary updated to include new 22.5mg 6-monthly injection, for use after treatment has been initiated with the 11.25mg 3-monthly injection. |
||||||||
| Parenteral iron | Addition of ferric carboxymaltose injection (Ferinject®▼)* to formulary and Renal specialist formulary list for intravenous infusion in pre-dialysis Chronic Kidney Disease (CKD) patients. | |||||||||
|
Drugs used in rheumatic diseases and gout |
Link to NHS Tayside Rheumatology Services website (NHS Tayside Staffnet intranet link only)and SIGN guideline no. 123 Management of early rheumatoid arthritis added. |
|||||||||
|
NSAIDs |
Naproxen now first choice NSAID in rheumatological disease. Additional safety information on use of NSAIDs in elderly and renal impairment, and concurrent use of NSAIDs with ACE inhibitors or Angiotensin-II receptor antagonists and diuretics added. Information on NSAIDs and association with an increased risk of thrombotic events added. |
|||||||||
|
Corticosteroids |
Information on use of corticosteroids in rheumatic disease added including links to local recommendations for diagnosis and management of polymyalgia rheumatica and giant call arteritis (NHS Tayside Staffnet intranet links only). Link to RCP guidelines for Glucocorticoid-induced osteoporosis inserted. Link to local guidance for Management of Flare of Rheumatoid Arthritis (NHS Tayside Staffnet intranet link only). Methylprednisolone acetate (Depo-Medrone®) now first choice systemic corticosteroid injection. |
|||||||||
|
DMARDs |
Methotrexate and/or Sulfasalazine now first choice DMARDs for rheumatoid arthritis (RA). Oral methotrexate 2.5mg tablets and sulfasalazine e/c tablets added to formulary and Rheumatology specialist list. Methotrexate injection (Metoject®)* (hospital only– note: may be administered in primary care) added to formulary and Rheumatology specialist list. Other DMARDs added to formulary and Rheumatology specialist list: azathioprine, ciclosporin, cyclophosphamide, hydroxychloroquine sulphate, leflunomide, minocycline, mycophenolate mofetil, penicillamine, and sodium aurothiomalate. |
|||||||||
|
Cytokine modulators |
Section on cytokine modulators (TNF-alpha inhibitors (antagonists)) added. Certolizumab pegol (Cimzia®▼)* (hospital-only) now first choice TNF-alpha antagonist for RA when response to DMARDs including methotrexate is inadequate. Adalimumab (Humira®▼)*, etanercept (Enbrel®▼)*, infliximab (Remicade®), rituximab (MabThera®)* and tocilizumab (RoActemra®▼)* (all hospital-only) added to formulary and Rheumatology specialist list. |
|||||||||
|
Drugs used for the treatment of gout |
Febuxostat (Adenuric®▼)* added to Rheumatology specialist list for management of chronic hyperuricaemia in gout where allopurinol is inadequate, not tolerated or contraindicated. |
|||||||||
| May/Jun 2011 |
Link to Renal specialist list added. CLICK HERE |
|||||||||
| Renal |
Renal specialist list added. |
|||||||||
|
Cyclophosphamide |
New section 8.1 created with cyclophosphamide (hospital only) added to formulary and Renal specialist list for use in accordance with cyclophosphamide protocol
|
|||||||||
|
|
Drugs affecting the immune response
|
New section 8.2 created with mycophenolate mofetil,
tacrolimus (Prograf®/Advagraf®*),
azathioprine, ciclosporin (Neoral®/ |
||||||||
|
Parenteral iron |
Iron sucrose (Venofer®) (hospital only) added to formulary and Renal specialist list. |
|||||||||
|
Drugs used in renal anaemia |
Darbepoetin alfa (Aranesp®) (first choice erythropoiesis stimulating agent), epoetin beta (NeoRecormon®), and methoxy polyethylene glycol-epoetin beta (Micera®*) (all hospital only) added to formulary and Renal specialist list for renal anaemia. |
|||||||||
|
|
Potassium removal |
Calcium polystyrene sulphonate (Calcium Resonium®) added to formulary and Renal specialist list for use in accordance with Management of Hyperkalaemia in Dialysis Patients on the Acute Medical Unit (AMU) guidance (NHS Tayside Staffnet intranet link only) or Management of Acute Hyperkalaemia on AMU in patients NOT Receiving Regular Dialysis (NHS Tayside Staffnet intranet link only). |
||||||||
|
Oral bicarbonate |
Sodium bicarbonate 500mg capsules added to formulary and Renal specialist list. |
|||||||||
|
|
Phosphate-binding agents |
Calcium acetate (Phosex®)
(first choice phosphate - binding agent), calcium acetate (PhosLo®*),
and calcium carbonate (Calcichew®)
added to formulary and Renal specialist list. |
||||||||
|
Secondary hyperparathyroidism |
Cinacalcet (Mimpara®*) (hospital only) added to formulary and Renal specialist list for severe refractory secondary hyperparathyroidism in patients with ESRD in whom parathyroidectomy is contraindicated. |
|||||||||
|
Hypomagnesaemia |
Magnesium glycerophosphate (unlicensed) 500mg capsules, from Martindale (containing approximately 2 mmol of magnesium per capsule) added to formulary and Renal specialist list. |
|||||||||
|
Vitamin D |
Alfacalcidol added to formulary and Renal specialist list for vitamin D deficiency and/or secondary hyperparathyroidism. |
|||||||||
|
Valganciclovir * |
Addition of information on extended duration of prophylaxis of cytomegalovirus (CMV) in kidney transplant patients to 200 days post-transplantation. |
|||||||||
|
|
Immunisations |
Hepatitis B vaccine (Fendrix®) added to Renal specialist list for immunisation against hepatitis B infection in patients with CKD including those on haemodialysis. Addition of link to NHS Tayside Immunisation policy (NHS Tayside Staffnet intranet link only) for guidance on administration of immunisations/ vaccinations to Immunisations sub-section within section 16. |
||||||||
| Mar/Apr 2011 | Pioglitazone |
Information added on risk of heart failure when pioglitazone is combined with insulin. Link to Drug Safety Update, Volume 4, Issue 6, January 2011 inserted. |
||||||||
|
Liraglutide and exenatide
|
Note added that if eGFR>60mL/min liraglutide is preferred over exenatide and exenatide is for use in patients with eGFR 30-60mL/min. Minor change to wording to incorporate SMC advice on exenatide that it may be used in combination with metformin and a thiazolidinedione as a third-line pre-insulin treatment option for patients with eGFR 30-60mL/min. |
|||||||||
|
Drugs affecting bone metabolism
|
Links to
National Osteoporosis Guideline Group (NOGG) Pocket
Guide for Healthcare Professionals
and
NICE TA161 inserted. Removal of notes on use of alendronate
and risedronate in patients with pre-existing upper GI problems
and glucocorticoid induced osteoporosis. Addition of information
on use of bisphosphonates in renal impairment. Addition of
information on increased risk of atypical fractures with
bisphosphonates and link to
Drug Safety Update Volume 2 Issue 8, March 2009 inserted.
Removal of link to Drug Safety Update, July 2008 on association
with AF and bisphosphonates. |
|||||||||
|
Oral nutrition
|
Removal of Enmix Plus Commence as a starter pack option as discontinued. Ensure Plus Commence remains as the recommended starter pack. Change to layout of section with supplement drinks now listed in a table format. |
|||||||||
| Feb/Mar 2011 | Specialist formulary lists and formulary development | Respiratory | Link to Respiratory specialist list added. | |||||||
| Respiratory | Respiratory specialist list added. | |||||||||
| Respiratory system Guidelines | New sections added on Adult Cystic Fibrosis and Idiopathic Pulmonary Fibrosis with links to relevant formulary sections. Link to BTS Interstitial Lung Disease Guideline within the Idiopathic Pulmonary Fibrosis section and link to information leaflet on intravenous antibiotic therapy within the Adult Cystic Fibrosis section. | |||||||||
|
Link to NHS Tayside Respiratory MCN Adult Asthma Pathway (NHS Tayside Staffnet intranet link only) added to the following sections: Notes on Managing Chronic Asthma, Emergency Management of Acute Asthma in Adults & Children over 12 years and Managing Chronic Asthma in Adults and Children over 12 years. |
||||||||||
| Introduction |
Link to NHS Tayside Respiratory MCN Adult Asthma Pathway (NHS TaysideStaffnet intranet link only) inserted. |
|||||||||
|
|
Antihistamines and allergic emergencies |
Omalizumab▼* (hospital only) added to formulary and Respiratory specialist formulary list for use in accordance with the omalizumab▼ local treatment protocol. |
||||||||
| Mucolytics |
Dornase alfa nebuliser solution added to formulary and Respiratory specialist list for use in adult cystic fibrosis in accordance with shared care agreement. N-acetylcysteine (unlicensed - in accordance with shared care agreement) and azathioprine added to formulary and Respiratory specialist list both for use in combination with prednisolone for idiopathic pulmonary fibrosis. |
|||||||||
| Primary Care Anti-infective Advisory Notes | New section on Adult Cystic Fibrosis Nebulised antibiotics featuring link to shared care agreement for nebulised tobramycin. Shared care agreement for nebulised colistin (colistimethate sodium) is under development and will be linked to once available. | |||||||||
| Jan/Feb 2011 |
Using the Tayside Area Formulary
|
Addition of
information on symbols relating to medicines within the formulary
that are included on a specialist list: |
||||||||
|
New section with links to the cardiology specialist formulary list and links to documents on formulary development. |
||||||||||
| Cardiology |
New section containing the Cardiology specialist formulary list. |
|||||||||
| Diuretics |
Eplerenone▼* added to Cardiology specialist formulary list. |
|||||||||
|
2.3
|
Anti-arrhythmics |
Flecainide, propafenone, amiodarone, disopyramide and sotalol added to Cardiology specialist formulary list. Dronedarone* added to formulary (restricted use) and Cardiology specialist formulary list to prevent recurrence of AF or lower ventricular rate in clinically stable patients with history of, or current non-permanent AF in whom beta-blockers, class 1c drugs or amiodarone are ineffective, contra-indicated or not tolerated. |
||||||||
|
Beta-blockers |
Carvedilol added to Cardiology specialist formulary list. |
|||||||||
| 2.6 |
Nitrates, calcium-channel blockers and potassium-channel activators |
Glyceryl trinitrate injection / infusion added to formulary (hospital only) and Cardiology specialist formulary list. |
||||||||
|
2.7
|
Sympathomimetics |
New section. Dobutamine, dopamine and isoprenaline (unlicensed) added to formulary (hospital only) and Cardiology specialist formulary list. |
||||||||
| 2.8 |
Anticoagulants |
Dalteparin highlighted as first choice for prophylaxis of DVT and treatment of DVT and PE. Unfractionated heparin added to Cardiology specialist formulary list. Fondaparinux* added to formulary (hospital only) and Cardiology specialist formulary list as first choice for acute coronary syndrome. |
||||||||
| 2.9 |
Antiplatelet drugs |
Prasugrel▼* added to Cardiology specialist formulary list. Tirofiban (first choice) and abciximab added to formulary (hospital only) and Cardiology specialist list for use in accordance with cardiac catheterisation laboratory protocol. |
||||||||
|
2.10
|
Stable angina, acute coronary syndromes, and fibrinolysis |
New section. Tenecteplase added to formulary and Cardiology specialist list as first choice for pre-hospital or in-hospital thrombolysis in STEMI. |
||||||||
| 7.4 |
Drugs for genito-urinary disorders |
Removal of dutasteride* due to cost. Finasteride remains first choice for benign prostatic enlargement. |
||||||||
| Dec 10/Jan11 | 1.1 |
|
Dyspepsia and GORD |
Addition of Gastrocote® preparations and expansion of prescribing advice throughout. |
||||||
|
1.2
|
Antispasmodics and other drugs altering gut motility |
Addition of hyoscine butylbromide tablets for restricted use. Expansion of prescribing advice on metoclopramide and domperidone. Links to CKS Topic on Irritable bowel syndrome and Palliative care guidelines for symptom control - nausea and vomiting inserted. |
||||||||
|
1.3
|
Ulcer healing drugs |
Addition of a quadruple therapy regimen for H.pylori eradication failure including addition of tripotassium dicitratobismuthate (De-Noltab®). Lansoprazole oro-dispersible tablets (Zoton® FasTab®)* have been added for restricted use in patients with swallowing difficulties or who require a PPI via NG or PEG tube (unlicensed use). Advice on interactions between PPIs and clopidogrel inserted. Link to Medicine for the Elderly guidance on reducing inappropriate PPI use in older people inserted. Minor amendments to prescribing advice. |
||||||||
| 1.4 |
Antidiarrhoeal drugs |
Further prescribing advice added. |
||||||||
| 1.5 |
Treatment of inflammatory bowel disease
|
Further prescribing advice added. Mesalazine now highlighted as 1st choice topical aminosalicylate treatment and mesalazine foam enema (Asacol®) added. Prednisolone now highlighted as 1st choice topical steroid treatment and prednisolone foam (Predfoam®) added. Link to azathioprine / mercaptopurine shared care agreement inserted. |
||||||||
| 1.6 | Laxatives |
Further prescribing advice added. Co-danthramer has been added - restricted to use in terminally ill patients. Link to treating constipation in palliative care guidelines added. Bisacodyl suppositories added. Ispaghula husk now 1st choice bulk-forming laxative. Magnesium hydroxide removed and lactulose now 1st choice osmotic laxative. Glycerol suppositories now 1st choice locally administered laxative. Section on bowel cleansing preparations added with additions of Sodium picosulphate (Picolax®) and Klean-Prep®. |
||||||||
| 1.7 |
Preparations for haemorrhoids |
Anusol® and Anusol-HC® highlighted as 1st line choices. Further prescribing advice added. |
||||||||
|
1.9
|
Drugs affecting intestinal secretions |
New section added. Ursodeoxycholic acid, colestyramine and pancreatin (Creon®) now in formulary. Link to NHS Tayside Patient Information Leaflet on using Pancreatic Enzyme Replacement Therapy inserted. Click here. |
||||||||
|
|
Section 1 Upper GI Guidelines |
Helicobacter pylori Eradication Therapy |
Removal of omeprazole 40mg once daily as an alternative to omeprazole 20mg twice daily in H.pylori eradication therapy. |
|||||||
| 7.3 |
Contraceptives |
Nexplanon®* has replaced Implanon® for long-acting reversible contraception.
|
||||||||
| 10.1 |
Drugs used in rheumatic diseases and gout |
Addition of febuxostat▼* restricted to use either in patients who had an inadequate response to allopurinol (at maximum tolerated dosage), or in whom allopurinol is contraindicated or not tolerated, under the direction of a rheumatologist. Further prescribing advice added. Link to local protocol on Management of Gout inserted.
|
||||||||
|
|
Treatment of glaucoma |
Addition of brinzolamide eye drops (Azopt®)* and brinzolamide with timolol (as maleate) eye drops (Azarga®▼)* as 2nd choice carbonic anhydrase inhibitors. Changes to layout of section and further prescribing advice added throughout. |
||||||||
| Oct/Nov | 2.5 |
Angiotensin –II receptor antagonists |
Losartan replaces candesartan as 1st choice angiotensin-II receptor antagonist for hypertension (in ACE-inhibitor intolerant patients). Candesartan remains 1st choice angiotensin-II receptor antagonist for heart failure (in ACE-inhibitor intolerant patients). |
|||||||
| 2.6 |
Other antianginal drugs |
Addition of ivabradine to formulary (restricted use). Indication remains as before however previous local recommendation non-formulary. |
||||||||
| 3 |
Respiratory System and Guidelines |
See Tayside Prescriber Issue 119 - Respiratory MCN Formulary Update for a summary of the changes. |
||||||||
| 4.7 |
Drugs for neuropathic pain |
Minor change to wording on pregabalin to ensure consistency with Management of Neuropathic Pain guidance. |
||||||||
| 4 |
CNS Guidelines - Pain Guidance Notes |
Management of Neuropathic Pain |
Duration of treatment with gabapentin after which alternative treatment should be considered if no improvement changed from 6 weeks to 8 weeks. Minor changes to wording throughout to improve clarity. |
|||||||
| 7.3 |
Combined oral contraceptives |
Rigevidon®
now
Formulary - 1st line choice (replaces Microgynon 30®
/ Ovranette®). |
||||||||
| 9.4 |
Oral nutrition |
Link to the NHS Tayside Nutrition Standards website inserted. |
||||||||
|
10.3
|
Drugs used for the relief of soft tissue inflammation |
Statement on use of topical NSAIDs updated to reflect advice within Clinical Knowledge Summary-osteoarthritis and NICE Clinical Guideline on Osteoarthritis. Piroxicam 0.5% gel highlighted as current product with lowest acquisition cost. |
||||||||
| Aug/Sept | 4.10 |
Drugs used in the management of substance dependence |
Management of substance misusers while in hospital |
Link to ‘Management of Patients With Substance Misuse and NOT on Methadone’ inserted. |
||||||
|
Adverse drug reaction reporting |
New section added summarising reporting of adverse drug reactions (ADRs) with a link to the on-line Yellow Card Reporting Scheme. |
|||||||||
| Aug/Sept | 6.1 | Drugs used in Diabetes | Sulphonylureas |
Addition
of a link to: Addition of glibenclamide to formulary - restricted to use in women with gestational diabetes. Information on use of metformin or glibenclamide in gestational diabetes has also been added in line with recommendations from SIGN No 116. |
||||||
| Biguanides |
Addition of
metformin hydrochloride prolonged |
|||||||||
| Thiazolidinediones |
Thiazolidinediones are 2nd
or 3rd
line treatment options in type 2 diabetes. They may be added to
metformin and
|
|||||||||
| DPP-4 inhitibors (or gliptins) |
DPP-4 inhibitors
(or
gliptins)
are 2nd
or 3rd
line treatment options in type 2 diabetes.
Addition of sitagliptin 50mg / metformin 1000mg (Janumet®▼) to formulary - restricted to use in patients for whom this combination is an appropriate choice of therapy either when the addition of sulphonylureas to metformin monotherapy is not appropriate or in combination with a sulphonylurea (triple combination therapy) in patients inadequately controlled on their maximal tolerated dose of metformin and sulphonylurea. Removal of vildagliptin ▼ and vildagliptin / metformin (Eucreas®▼) from formulary. Addition of saxagliptin ▼ to formulary - restricted to use as add-on combination therapy with metformin when metformin alone does not provide adequate glycaemic control and where the addition of a sulphonylurea is not appropriate. |
|||||||||
| Incretin mimetics |
Addition of liraglutide ▼ to formulary and change of local recommendation for exenatide ▼. Both are now formulary entries - restricted to initiation by secondary care as a third line antidiabetic agent. (GPs may prescribe under the direction of the diabetic clinic). |
|||||||||
| June/July 10 |
Laxatives |
Macrogols (Movicol® switch to Laxido® Orange) |
Laxido® Orange powder for oral solution has replaced Movicol® powder for oral solution (active ingredient in both macrogol ‘3350’). Laxido® Orange should be reserved for the treatment of patients with severe constipation unresponsive to first-line laxatives. Please note: Laxido® Orange has been reformulated – it is now Sugar-free and does not contain glucose or sulphur dioxide. (However existing stock of the original formulation may still be in the supply chain). |
|||||||
| 3.2 | Inhaled corticosteroids |
Fostair®▼* (beclometasone/formoterol)
|
Fostair®▼*(beclometasone/formoterol) aerosol inhalation added to compound preparations.Note: The 100mcg dose of beclometasone in Fostair®▼is not bioequivalent to a 100mcg dose of beclometasone in several other inhaler formulations. Fostair®▼has an extra-fine particle size distribution resulting in a more potent effect than formulations of beclometasone with a non extra-fine particle distribution i.e. 100microgram beclometasone in Fostair®▼is equivalent to 250microgram beclometasone in Clenil Modulite®. Fostair®▼is restricted to use in patients aged 18 years or older on step 3 or above of the BTS/SIGN asthma guidelines. Further minor amendments to dose information for medicines throughout section 3.2 made in line with BNF. |
|||||||
| 10.1 | Drugs used in rheumatic disease and gout | Drugs which suppress the rheumatic disease process | Link to the Tayside Rheumatology website removed as not available while under development. | |||||||
| 12.2 | Drugs acting on the nose |
Fluticasone furoate (Avamys®▼)* (Nasal allergy)
|
Fluticasone furoate nasal spray (Avamys®▼)* has replaced Fluticasone propionate aqueous nasal spray. Fluticasone furoate is the second line choice of nasal corticosteroid within the TAPG. Beclometasone remains the first choice nasal corticosteroid for nasal allergy. | |||||||
| Making a formulary application, formulary process and new medicines |
|
New section outlining how to make a formulary application, formulary review process and process for local introduction of new medicines. Includes links to relevant documents. | ||||||||
| Prescribing of medicines for exceptional use – form and policy | New section providing links to the Policy on the Prescribing of Medicines for exceptional use and the form ‘Request to prescribe a medicine for exceptional use’. | |||||||||
| Apr/May 10 |
Antidepressant drugs |
SSRIs | Citalopram now first choice SSRI. Fluoxetine remains on the formulary as a second line choice. Link to SIGN guideline 114, Non-pharmaceutical management of depression in adults, January 2010 added. | |||||||
| 4.9 | Drugs used in Parkinsonism | Introduction | Following a section review, general advice on drug therapy added with a link to SIGN guideline 113, Diagnosis and pharmacological management of Parkinson’s disease, January 2010. | |||||||
| Levodopa | Additional prescribing advice added. Table of preparations available and their drug components inserted. | |||||||||
| Dopamine receptor agonists | New drug class added to formulary. Ropinirole tablets and pramipexole tablets both added as first choice dopamine agonists. Prolonged release ropinirole tablets (Requip® XL▼)*, prolonged release pramipexole tablets (Mirapexin® Prolonged Release)* and rotigotine transdermal patch (Neupro® ▼)* are included as minor entries. | |||||||||
| Monoamine-oxidase-B-inhibitors | Change in wording to information on selegiline in line with SIGN guideline 113. | |||||||||
| Catechol-O-methyltransferase inhibitors | New drug class added to formulary. Entacapone tablets and Stalevo® tablets* added to formulary. Table of preparations available and their drug components inserted for Stalevo® tablets*. | |||||||||
| Antimuscarinic drugs used for extra-pyramidal side effects | Procyclidine and orphenadrine demoted to minor entries. Prescribing advice on antimuscarinic drugs in Parkinson’s disease added. | |||||||||
| 7.3 | Contraceptives | Emergency contraception | Ulipristal acetate (EllaOne®) ▼ 30mg tablets* added to formulary. It is restricted to use between 72 hours (3 days) and 120 hours (5 days) after unprotected sexual intercourse where insertion of an IUD is not appropriate or acceptable. Levonelle® (levonorgestrel 1500microgram tablets) remains the first choice of hormonal emergency contraception up to 72 hours (3 days) after unprotected sexual intercourse. | |||||||
| 7.4 | Drugs for genito-urinary disorders | Antimuscarinic drugs | Oxybutynin standard release preparations added. | |||||||
| 13.8 | Sunscreens | E45 Sun Block lotion SPF 30+ | This has been discontinued. Delph® lotion SPF 30 now added. | |||||||
| Feb/Mar 10 |
2.9
|
Antiplatelet |
Aspirin and clopidogrel
Prasugrel |
Minor changes to wording. Added to formulary as a prescribing note. See Angioplasty antiplatelet algorithm (click here) outlining specialist treatment pathway for further information. |
||||||
| 3.6 | Oxygen | General considerations | Note on use of oxygen alert cards in acute COPD and other conditions vulnerable to hypercapnic respiratory failure inserted. | |||||||
| 9.1 | Anaemias and other blood disorders | Oral iron | First choice now ferrous fumarate. Ferrous sulphate now second line choice. Ferrous gluconate removed. Prescribing information on treatment with oral iron added. | |||||||
| Dec 09/Jan 10 | 2 | Cardiovascular system Guidelines | Management of Hypertension | Aspirin information removed and replaced with link to Tayside Prescriber Issue No 110 – Aspirin and primary prevention | ||||||
| Prevention of Cardiovascular Disease | Link to Tayside Prescriber Issue No 110 inserted. Minor amendments to cardiovascular risk table. Note on aspirin and diabetes mellitus added. | |||||||||
| 2.9 | Antiplatelet drugs | Aspirin | Link to Tayside Prescriber Issue No 110 inserted. Dose information updated. | |||||||
| Clopidogrel | Dose information minor amendment. Further information added to clarify indications, doses and durations of therapy. | |||||||||
| 6.4 | Sex hormones | HRT |
Link to Tayside Menopause Guidelines inserted. Removal of FemTab Sequi® tablets as discontinued. |
|||||||
| 6.6 | Drugs affecting bone metabolism | Bisphosphonates | Update to prescribing advice for alendronate and risedronate. | |||||||
| 7.2 | Treatment of vaginal and vulval disorders and Contraceptives | Vaginal atrophy | Dose information for estradiol vaginal tablets 25micrograms (Vagifem®) updated. Minor changes to prescribing notes on topical estrogens. | |||||||
| 7.3 | Combined hormonal contraceptives | Layout of section updated. Addition of combined oral contraceptive (COC) Femodene®. Addition of combined contraceptive patch Evra® * for women who are at substantial risk of poor compliance with COCs. | ||||||||
| Progestogen-only contraceptives |
Information on desogestrel 75micrograms tablets (Cerazette® *) expanded with recommendation as first choice progestogen-only oral preparation (POP) for less compliant women and in those with a history of ectopic pregnancy who take a POP. Norethisterone (Noriday®/Micronor®) or etynodiol (Femulen®) remain the first choice POP for the majority of patients. Etonogestrel implant (Implanon®) (long-acting reversible contraception) added as full entry. |
|||||||||
| 7.4 | Drugs for genito-urinary disorders | Alpha-blockers | Tamsulosin m/r capsules* now first choice alpha-blocker instead of doxazosin. Full entry for dutasteride* made. Link to MHRA Drug safety Update December 2009 for finasteride added due to reports of male breast cancer. Link to Tayside Urology Guidance - Lower Urinary Tract Symptoms added. | |||||||
| Drugs for urinary frequency (in the absence of outflow obstruction) |
Link to Tayside Urology Guidance - Urinary Incontinence added. Note added that higher unlicensed doses of oxybutynin - up to 30mg daily may be prescribed or recommended by specialists. Full entries added for solifenacin tablets* and tolterodine m/r capsules. Prescribing notes on antimuscarinic drugs amended. |
|||||||||
| Drugs for erectile dysfunction | Link to Tayside Urology Guidance - Erectile Dysfunction added. | |||||||||
| 8 | Malignant disease and Immunosuppression | Prostate cancer | Layout of section updated. Prescribing notes on hormone therapy added. Bicalutamide added as first choice for single agent therapy. Cyproterone acetate to remain a first choice medicine but category now first choice to prevent tumour flare with gonadorelin therapy. Prescribing notes on cyproterone acetate added. Link to BNF inserted for further information on licensed indications of gonadorelin analogues. | |||||||
| Oct/Nov 2009 | 13.2 | Emollients and barrier preparations | Barrier preparations | Link to Skin Care Guidelines for the management of urinary and faecal incontinence inserted. | ||||||
| Aug/Sept 2009 | 3.1 |
Respiratory System |
Bronchodilators |
Prescribing note inserted on drugs to be used with caution/avoid in patients with respiratory disease. | ||||||
| 3.2 |
Respiratory System |
Inhaled steroids |
Table inserted on equivalent doses of inhaled steroids. | |||||||
| 3 |
Respiratory Guidelines |
Emergency Management of Acute Asthma for under 12 years |
Links updated as per SIGN 101 - British Guidelines on the Management of Asthma (Revised June 2009) | |||||||
|
Emergency Management of Acute Asthma in Adults and Children over 12 years |
||||||||||
|
Notes of Managing Chronic Asthma |
||||||||||
| 4.7.4 |
Antimigraine Drugs |
Acute treatment/mild to moderate migraine |
Headache guidelines now incorporated
into section 4.7.4. Sample weekly headache diary inserted. Paramax (paracetamol/metoclopramide combination) removed. Aspirin, ibuprofen or paracetamol at full dose (900mg aspirin, 400mg ibuprofen or 1g paracetamol) are recommended for acute treatment. Sentence on 'Use aspirin & NSAIDs with caution in asthma and avoid in peptic ulceration' added. Table on the main efficacy and tolerability measures for the oral triptans versus sumatriptan 100mg (taken from SIGN 107) inserted. |
|||||||
|
Prophylaxis |
Pizotifen removed. Venlafaxine added as alternative to tricyclic antidepressants (taken from SIGN 107). Sodium valproate dose range increased as per SIGN 107 (new range: 400mg-1,500mg daily). Gabapentin added as per SIGN 107. Table on prophylactic therapies for patients with migraine added as per SIGN 107. |
|||||||||
| 13 | Dermatology Guidance Notes |
Management of Psoriasis - Scalp |
Sentence added on Xamiol (calcipotriol/ betamethasone dipropionate scalp gel), a newer combination preparation, which may for some people be more effective than monotherapy. | |||||||
|
|
Oxygen Therapy in Acute Management |
Oxygen |
This section has been reviewed. Covers critically unwell patients, other hypoxic patients, oxygen prescription, monitoring, postoperative patients and summary. | |||||||
| July 2009 |
Treatment of inflammatory bowel disease |
Aminosalicylates oral preparations | Pentasa Sachets® have been added. The granules should be considered first line, for maintenance, in patients with compliance problems. | |||||||
| May 2009 | ||||||||||
| Lipid regulating drugs | Statins |
80mg
dose of simvastatin removed. |
||||||||
| Ezetimibe | Note on risk of myopathy with ezetimibe alone or in combination with a statin added. | |||||||||
| 3.7 | Mucolytics | Carbocisteine | Initial duration changed to 1 month. Only continue with maintenance dose if improvement of symptoms. Mucolytics should be used with caution in those with a history of peptic ulceration and are contra-indicated in patients with active peptic ulceration. | |||||||
| 13.10 | Anti-infective skin preparations | Treatment of lice and scabies | Alcoholic malathion 0.5% deleted from TAPG and Minor Ailment Scheme (MAS) formulary. | |||||||
| April 2009 | 4.7 | Analgesics | Soluble analgesics | Paracetamol 500mg soluble tablets and co-codamol 30/500 effervescent tablets removed from the formulary. Prescribing note added on sodium content of these preparations. Maximum dose of 8 tablets a day may exceed the maximum recommended daily amount (approximately 100 mmol of sodium). | ||||||
| Mar 2009 | 1.5 | Treatment of Inflammatory bowel disease | Mesalazine | Mesren® MR – alternative to Asacol® added. Mezavant® XL* added – restricted to patients with compliance problems. Note inserted regarding monitoring of renal function with aminosalicylates. | ||||||
| 2.2 | Diuretics | Thiazide diuretics | Sentence added – on use of thiazide and ACE inhibitor post stroke or TIA - with link to SIGN Guideline 108 – Management of patients with stroke or TIA. | |||||||
| 2.5 | Drugs affecting the renin-angiotensin system | ACE inhibitors | ||||||||
| 2.9 | Antiplatelet drugs | Dipyridamole m/r |
Link inserted at beginning of section to SIGN Guideline
108. Information about when to start combination antiplatelet therapy with aspirin (75mg daily) and dipyridamole m/r (200mg twice daily) added – i.e. should be initiated when the patient is discharged or at 14 days post stroke or TIA. Monotherapy is appropriate if the patient cannot tolerate either aspirin or dipyridamole. Aspirin & clopidogrel combination is not recommended for long -term secondary prevention of ischaemic stroke. |
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| 4.7 | Analgesics | Dihydrocodeine tablets | Dihydrocodeine tablets removed from this section. | |||||||
| 6.4 | Sex hormones | Tibolone | Link inserted to MHRA – increased risk of breast cancer recurrence with tibolone. | |||||||
| 10.1 | Drugs used in rheumatic diseases and gout | Non-steroidal anti-inflammatory drugs (NSAIDs) | Reminder added – Patients should use the lowest effective dose of any NSAID for the shortest duration necessary to control symptoms. | |||||||
| Jan/Feb 2009 | 6.6 | Drugs affecting bone metabolism | Bisphosphonates | Statement added at end of section about the relative risk of atrial fibrillation with some bisphosphonates. | ||||||
| 6.7 | Other Endocrine Drugs | Dopamine-receptor agonists |
New section added. Cabergoline, bromocriptine and quinagolide listed as
main entries in section 6.7.1. |
|||||||
| Dec 2008 | 4.6 | Drugs used in nausea and vertigo | Anti-emetics | Prochlorperazine IM injection dose information added. Link to NHS Tayside guideline on prophylaxis and treatment of post-operative nausea and vomiting inserted. Link to Tayside palliative care guidelines inserted for management of nausea and vomiting in palliative care. | ||||||
| Prescribing note on betahistine added and link to CKS Clinical topic on Ménière’s Disease. | ||||||||||
| 4.7 | Analgesics | Mild to moderate pain (step 2) | Tramadol hydrochloride capsules added as alternative to paracetamol and codeine in line with NHS Tayside (Acute) Pain Management Guidelines. Link to guidelines inserted click here. | |||||||
| Moderate to severe pain (step 3) | Morphine Unit Dose Vials removed as discontinued, replaced with oral solution 10mg/5ml and 100mg/5ml. Removal of information on diamorphine shortage as resolved. | |||||||||
| Drugs for migraine | Minor changes to dose information and wording in line with BNF. | |||||||||
| 4.10 | Drugs used in the management of substance dependence | Management of acute pain in substance misusers | Link to NHS Tayside pain management guidelines book inserted. Section 5 contains advice on management of acute pain in substance misusers in secondary care. | |||||||
| 4 | Pain guidance notes | Analgesic prescribing guidelines for the management of cancer pain |
Link to SIGN
guideline No.106 Control of pain in adults with cancer, November
2008 inserted. |
|||||||
| Approximate equivalent opioid doses | Added as a new section. Includes tables with approximate equivalent doses, formulations and strengths available for commonly prescribed opioids. | |||||||||
| Management of Acute Low Back Pain | Information on diagnostic triage added. | |||||||||
| 6.1 | Drugs used in diabetes | Blood glucose meter testing strips | Link to Self Monitoring of blood glucose guidelines within Tayside Diabetes MCN handbook inserted. | |||||||
| Oral antidiabetic drugs | Sitagliptin* and vildagliptin* added to formulary. Link to Tayside guidance on treatment with oral hypoglycaemic agents inserted. | |||||||||
| Other antidiabetic drugs | Prescribing note on exenatide* added with link to protocol. | |||||||||
| 6.2 | Thyroid and antithyroid drugs | Hypothyroidism | Dose information for levothyroxine amended in line with BNF. | |||||||
| Relief of thyrotoxic symptoms | Propranolol standard tablets removed and replaced with propranolol m/r capsules as better for patient compliance. | |||||||||
| 6.3 | Corticosteroids | Dexamethasone |
Oral solution and injection 4mg/ml added. |
|||||||
| Hydrocortisone | Note inserted regarding paraesthesia & pain after IV injection of the phosphate salt. | |||||||||
| 6.4 | Sex hormones | HRT | Minor changes to wording on treatment risks. Removal of mention of Tayside Menopause guidelines as currently under review. Change to advice on maximum duration of cyclical HRT. | |||||||
| 6.5 | Pituitary hormones | Desmopressin | Addition of note regarding removal of primary nocturnal enuresis indication for desmopressin nasal spray. | |||||||
| 6.6 | Drugs affecting bone metabolism | Bisphosphonates | Prescribing note for zoledronic acid* added. | |||||||
| Other drugs affecting bone metabolism | Prescribing notes for strontium ranelate*, raloxifene, teriparatide* and recombinant parathyroid hormone* added. | |||||||||
| Nov 2008 | 4.2 | Central Nervous System | Quetiapine prolonged-release | Added for treatment of schizophrenia under the direction of a psychiatrist | ||||||
| 4.9 | Central Nervous System | Procyclidine and orphenadrine | Now listed in Section 4.9. | |||||||
| Oct 2008 | Respiratory System | Bronchodilators |
Link to BTS/SIGN
guideline updated. Dose information for each preparation
updated to clarify whether used in asthma or COPD, or both. Link
to MHRA
Drug Safety Update (Oct 2008) on theophylline containing
medicines available OTC inserted. |
|||||||
| Respiratory System | Inhaled corticosteroids |
Note added on inhaled steroids in COPD. Clenil Modulite®▼
dose information expanded to include use of Volumatic® spacer
at required doses/ages. |
||||||||
| Respiratory System | Cromoglycate related therapy and leukotriene receptor antagonists |
Dose information for montelukast amended to be in line with manufacturers product licence. Guidance on prescribing of montelukast chewable tablets and granules added as per SMC advice. |
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| 3.4 | Respiratory System | Antihistamines and allergic emergencies |
Minor changes to dose information for loratadine and alimemazine. |
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| 3.6 | Respiratory System | Oxygen |
Additions to information on patients with type 1 respiratory failure and changes to wording throughout. |
|||||||
| 3 | Respiratory System Guidelines | Guidance on Inhaler Devices 12 years+ |
Volumatic® removed from spacer device
compatibility table for Atrovent® as not compatible.
Inspiratory flow rates listed for use of Turbohaler® removed
and replaced with a general statement on dry powder
inhalers. |
|||||||
| Emergency Management of Acute Asthma for under 12 years | Replaced with a link to Management of acute asthma in children aged over 2 years and Management of acute asthma in children under 2 years from BTS/SIGN No.101 quick reference guide (pages 15 & 16), and link to Management of acute asthma in children in general practice from BTS/SIGN No.101 full guideline (Annex 5, page 99). | |||||||||
| Emergency Management of Acute Asthma in Adults and Children over 12 years | Replaced with a link to the BTS/SIGN No.101 quick reference guide which includes chart on Management of Acute Asthma in adults (pages 13 & 14), and link to the BTS/SIGN No.101 full guideline (Annex 2, page 96) which includes chart on Management of acute severe asthma in adults in general practice. | |||||||||
| Notes on Managing Chronic Asthma | Note on higher doses of inhaled steroids possibly required in smokers/ex-smokers. Link to BTS/SIGN guideline updated. | |||||||||
| Managing Chronic Asthma in Children under 12 years | Replaced with link to Summary of stepwise management in children aged 5-12 years and in children less than 5 years from BTS/SIGN No.101 quick reference guide (pages 10 & 11). | |||||||||
| Managing Chronic Asthma in Children over 12 years | Replaced with link to Summary of stepwise management in adults from BTS/SIGN No.101 quick reference guide (page 9). | |||||||||
| Chronic Obstructive Pulmonary Disease (COPD) Guidelines |
Link to Guidance
on Smoking Cessation in Tayside inserted. Further
information on use of inhaled steroids in COPD added in
combination with a long-acting bronchodilator. |
|||||||||
| Anaphylaxis Guidelines | Replaced with Resuscitation Council (UK) Anaphylaxis guidelines and Anaphylaxis algorithm | |||||||||
|
Aug/Sept |
Anticoagulants | Parenteral anticoagulants |
Link to NHS
Tayside In-Patient Anticoagulant Prescription Sheet
inserted providing further information on discharge of patients. |
|||||||
| Oral anticoagulants | Warfarin dose information amended to match NHS Tayside In-Patient Anticoagulant Prescription Sheet and link to this inserted. Information on warfarin dosing in patients with increased sensitivity added. | |||||||||
| Anticoagulant advisory notes | Anticoagulant advisory notes | Removed as superseded by information from NHS Tayside In-Patient Anticoagulant Prescription Sheet linked to from section 2.8. | ||||||||
| Slow initiation of warfarin in the elderly | Unchanged but removed as superseded by information from NHS Tayside In-Patient Anticoagulant Prescription Sheet linked to from section 2.8. | |||||||||
| Cardiopulmonary resuscitation | Emergency Drug Kits | List of contents of Emergency Drug Kits updated. | ||||||||
| Algorithms | Links to life support algorithms updated according to the Resuscitation Council (UK). Documents can be accessed via the Resuscitation intranet homepage. | |||||||||
| 4 | Central Nervous System | Hypnotics and anxiolytics | Additional information on non-drug therapies added. Treatments for anxiety separated into acute and chronic anxiety. Links to NICE guidelines on Anxiety and Obsessive-compulsive disorder added. | |||||||
| Drugs used in psychoses and related disorders |
Link to NHS
Tayside policy for the management of delirium in adult and older
in-patients inserted. Antipsychotics added –
Amisulpiride, Olanzapine, and Quetiapine. Procyclidine and
orphenadrine removed – to be placed in section 4.9 when
reviewed. |
|||||||||
| Antidepressant drugs |
Recommendation added on non-drug interventions for mild depression. Dosage information for other indications of SSRIs expanded. Sertraline added. Advice on SSRIs and risk of GI bleeding added. Information on dosulepin measures to reduce risk of fatal overdose added; see MHRA Drug Safety Update (Dec 2007). Mirtazapine orodispersible tablets removed |
|||||||||
| Drugs for dementia | Link to SIGN guideline No.86 added. | |||||||||
| 4 | Central Nervous System Guidelines – Psychiatric guidance notes | Rapid tranquillisation in the Management of acutely disturbed patients | Removed from Prescribing Guide. Review of policy and its remit awaited. | |||||||
| Using Antidepressants in Primary Care Algorithm | Amendments to reflect use of generic SSRIs first line where drug therapy indicated. Minor amendments to advice in pregnancy and breastfeeding. | |||||||||
| Monitoring treatment with Antidepressants Algorithm | Minor amendments to flowchart to provide further clarity. Notes added on use of rating scales, screening tools and national targets. Further advice on switching antidepressants. Table of recognised minimum effective doses of antidepressants added. | |||||||||
| July 2008 |
Nitrates, calcium-channel blockers and potassium-channel
activators |
Nicorandil |
Information on risk of GI ulceration added and link to MHRA
June 2008 Drug Safety Update. |
|||||||
|
Bronchodilators |
Combivent® inhaler |
Combivent®
inhaler removed from section as discontinued. Note: Combivent® UDVs®, for use
in nebulisers, will continue to be available. |
||||||||
|
Respiratory
System Guidelines |
Guidance on Inhaler Devices |
Combivent® inhaler removed from spacer device
table. |
||||||||
|
|
Anti-obesity drugs |
Orlistat and Sibutramine |
Link to Tayside
Prescriber Issue 98, July 2008, which supersedes Tayside
Prescriber Issue 90, Jan 2006 added.
Link to SMC advice on Rimonabant (Acomplia®▼)
added – not recommended by SMC. Adverse effects and
monitoring information updated. Drug interactions updated. Minor
changes to wording throughout. |
|||||||
| Sunscreens |
RoC Total Sunblock® cream SPF 25 and Vichy®
sunblock cream SPF 60 |
RoC Total Sunblock® cream SPF 25 removed as
discontinued. Uvistat® sun cream SPF 50 added.
Fragrance-free annotated for E45 Sun Block® lotion SPF
30+ and Uvistat® sun cream SPF 50. Vichy® sunblock
cream SPF 60 removed as Uvistat® added. |
||||||||
- Hospital Only
- May be prescribed in General Practice under the direction of a
Specialist