- Dumfries and Galloway Prescribing Support Team

Nostrum March 2015
Celebrating 10 years of the prescribing formulary
New Joint Formulary 2015; Main Changes at a Glance
In this edition of Nostrum:
•
New Joint Formulary
Changes 2015
•
SMC updates
•
Update on tiotropium
•
NOAC reminder
•
Mebeverine shortage
The new Joint Formulary (which is celebrating its 10th year!) is now available and copies
are being distributed throughout the region. If you do not have a copy, please contact
your Prescribing Support Pharmacist (details overleaf).
BNF Chapter
Added
Removed
Chapter 1, GI
Colofac® MR,
Chapter 2,
Cardiovascular
Bisoprolol (anxiety/palpitation)
Univer ®
Chapter 3 Resp
Fostair Nexthaler®
Duoresp Spiromax®
Mebeverine
Accrete® D3 tablets
Propranolol
(anxiety/palpitations)
Securon® SR
amiloride
Symbicort® 200/6 and 400/12
Seretide ® (excluding
Seretide ® 50 evohaler)
Avamys
Mini-Wright ® peak flow
Formulary Inhalers update
We have updated the formulary to
include Fostair® Nexthaler/MDI and
also Duoresp® Spiromax® both of
which can be used in patients 18
years of age and over.
Fostair® (Beclomethasone 100
micrograms/Formoterol 6
micrograms per puff)
MDI licensed in asthma
(and fMART) and COPD
Nexthaler (a dry powder
inhaler) is only licensed in
asthma.
Fostair® contains extra fine
particles of beclomethasone and is
not dose equivalent to other CFCfree MDI’s. Fostair ®100/6 is
equivalent to beclomethasone 250
micrograms in Clenil®, 100
microgrmas beclometasone in
QVAR® or 100 micrograms
fluticasone.
Duoresp® Spiromax®: a dry
powder inhaler, licensed in asthma
and COPD and is available in 2
strengths.
Chapter 6,
Endocrine
Episenta® MR (sodium valproate)
Migraine prophylaxis update: 1st line
atenolol
2nd line propranolol
Gluco Rx ® strips & lancets
Glucoject ® Lancet Plus (name change)
Vitrex ® lancet
GlucoRx ® fine point needles
Linagliptin
Empagliflozin
Cangliflozin
Unistix ®3 lancet
Saxagliptin
Lixisenatide
Advice on quantity of ketone strips
Propranolol (hyperthyroidism)
Femoston ® Conti (continuous combined no
hysterectomy)
Chapter 7
Obs/Gyn/
Urinary Tract
Oestrogel ® (women who have had a
hysterectomy or have a Mirena ® in situ)
Decapepyl ®SR
Ulipristal acetate 30mg
Replens ®
Hyalofemme ®
Vesomni ® (tamsulosin/solifenacin)
Trospium 60mg (Regurin ® XL)
Solifenacin
Mirabegron
Chapter 9
Demeclocycline (due to short
supply)
Ella-One ®
Darifenacin
Propiverine (Detrunorm ®)
electrolade
Nutrition & Blood
160/4.5 is equivalent to
Budesonide 200
micrograms/formoterol 6
micrograms
Chapter 10 MSK
320/9 is equivalent to
budesonide 400
micrograms/formoterol
12micrograms
Chapter 12 Ear,
This replaces Symbicort® 200/6 and
400/12 strengths in the formulary.
.
Chapter 4, CNS
Mometasone nasal spray
Medi Pack Flow Meter®
New appendix on antiepileptic drugs
Chapter 11 Eyes
Piroxicam gel
Latanoprost minims (see restrictions)
Optive fusion ®
Systane balance ®
Mometasone
Timoptol ® (LA)
Hylo-tears ®
Systane ultra ®
Avamys ®
Ultrabase ®
Zerolatum plus ®
Synalar N ®
Picato gel ®
Betnovate N ®
Dovobet ® (30g ointment)
Carbo-dome ®
Polytar liquid ®
nose and
oropharynx
Chapter 13 Skin
Latest SMC Decisions
For full advice see www.scottishmedicines.org.uk
Specific Drug Issues
Warfarin – First line oral
anticoagulant
Following on from the updated
formulary advice we would like
to remind all prescribers that the
first line anticoagulant of choice
in NHS D&G is warfarin. NOACs
can be considered second line
as per the local guideline
available at:
http://dgprescribingmatters.co.u
k/documents/NOAC_guidance.
pdf
Mebeverine
There continues to be a supply
problem with generic
mebeverine 135mg tablets with
no date as yet as to when this will
be resolved. This in turn has led
to difficulties sourcing Colofac
135mg tablets due to the higher
demands placed on the
branded product.
Colofac MR 200mg capsules are
available at present and can be
used instead – please note that
the frequency should be TWICE
daily.
Scriptswitch has been updated
with a message to reflect this.
Accepted for Use in NHS Scotland
Umeclidinium/vilanterol (Anoro®) GSK (No.978/14). Indication under review: As a
maintenance bronchodilator treatment to relieve symptoms in adult patients with
chronic obstructive pulmonary disease. ACCEPTED. NOT added to D&G formulary
but under review pending assessment of similar LABA/LAMA combinations
Canagliflozin/metformin (Vokanamet) Janssen-Cilag Ltd (No. 1019/14). Indication
under review: in adults aged 18 years and older with type 2 diabetes mellitus as an
adjunct to diet and exercise to improve glycaemic control. ACCEPTED RESTRICTED.
NOT added to D&G formulary
Brimonidine (Mirvaso) Galderma (No.1016/14). Indication under review: the
symptomatic treatment of facial erythema of rosacea in adult patients. ACCEPTED
RESTRICTED. NOT added to D&G formulary
Olodaterol respimat soft mist inhaler (Striverdi Respimat) Boehringer-Ingelheim
(No.974/14). Indication under review: maintenance bronchodilator treatment in
patients with chronic obstructive pulmonary disease. ACCEPTED. NOT added to
D&G formulary
NOT RECOMMENDED for use in NHS Scotland
Abiraterone (Zytiga®) Janssen-Cilag (No.873/13). Indication under review: with
prednisone or prednisolone for the treatment of metastatic castration resistant
prostate cancer in adult men who are asymptomatic or mildly symptomatic after
failure of androgen deprivation therapy in whom chemotherapy is not yet
clinically indicated. NOT RECOMMENDED – NOT added to D&G formulary
Tiotropium MHRA and SPC updates
The MHRA has updated its advice and also the summary of product characteristics for
both the tiotropium Respimat and the Handihaler devices in COPD to include the
following:
•
Contact the Prescribing Support Team
Dr Paul Beardon paul.beardon@nhs.net
Nikki Cameron Nicola.cameron2@nhs.net
Dr Jennifer Dillett jennifer.dillett@nhs.net
Liane Holmes liane.holmes@nhs.net
Dr Emily Kennedy emily.kennedy@nhs.net
Dorothy Kirkpatrick dot.kirkpatrick@nhs.net
Mandy Mackintosh mandy.mackintosh@nhs.net
Gordon Loughran gordon.loughran@nhs.net
Susan Roberts susan.roberts10@nhs.net
Amy Robinson amy.robinson@nhs.net
Nostrum extra – wound
management. March 2006
take the risk of cardiovascular side effects into account for patients with
conditions that may be affected by the anticholinergic action of tiotropium,
including:
o
myocardial infarction in the last 6 months
o
unstable or life threatening cardiac arrhythmia
o
cardiac arrhythmia requiring intervention or a change in drug therapy in
the past year
o
hospitalisation for heart failure (NYHA Class III or IV) within the past year
Patients should be advised to report any worsening of cardiac symptoms after starting
tiotropium. This is because patients with these conditions were excluded from clinical trials
of tiotropium, including TIOSPIR
The treatment of all patients already taking tiotropium should be reviewed as part of the
comprehensive management plan to ensure that it remains appropriate for them.
Patients at high risk of cardiovascular events should be reviewed regularly.
Patients should also be reminded not to exceed once daily dosing.
Dumfries and Galloway NHS
10th Anniversary of the local formulary