CCG Updates Prescribing Edition Issue 41 - October 2014

CCG Updates
Prescribing Edition
Issue 41 - October 2014
Welcome to the October issue of CCG Updates - Prescribing Edition
Patient Safety!
Alerts this month are for e-cigarettes & domperidone, We are also aware of a number of dual anti-platelet
significant events – good quality medication reviews are essential….
NICE bites is a comprehensive review of the recent CKD guidance (July 2014). This includes a table
showing the new classification including ACR measurements, and recommended frequency of monitoring.
The progression of CKD is clarified, and a reminder that NSAID use is associated with progression.
Please note that the recent Lipid Modification guidance is under review by Greater Manchester &
Stockport CCG, so do not change prescribing practice yet.
Dr Heather Procter
Domperidone
Electronic Cigarettes
The UK Commission on Human
Medicines has reviewed the safety
of this medicine for supply over the
counter in pharmacies and advised
that medical supervision is required.
Recent guidance from oxygen homecare providers state that
electronic cigarettes should not be used whilst a patient is
undergoing oxygen therapy. Additionally, batteries of electronic
cigarettes should not be charged in the vicinity of a patient
undergoing oxygen therapy or the oxygen source itself. As of 4th September 2014,
medicines containing domperidone
will only be available on prescription.
Please reiterate to patients that the dangers of using an
electronic cigarette or similar device whilst using oxygen
therapy are exactly the same as they would be with smoking
ordinary cigarettes. Electronic devices also carry a risk of
explosion or ignition and can cause a fire whilst recharging.
For more information click here.
Useful information:
• Use of e-cigarettes with homecare oxygen
• Guidance for long-stay environments
Inside this issue:
• Grey and black list changes
• Testosterone guidance
• Dual anti-platelet therapy
• Denosumab prescribing
• Nitrofurantoin
Nice Bites – Sept 2014
Chronic kidney disease in adults
in primary and secondary care.
Click here to view.
CCG Updates - Issue 41 - Prescribing edition
New Product!
Grey and Black
List changes
Molludab® Potassium hydroxide soln 5%
There is poor evidence of efficacy for the
licensed indication. Condition is self-limiting
and prescribing would not be an appropriate
use of NHS resources.
Insulin Degludec & Liraglutide (IDegLira®)
This has a negative recommendation from
GMMMG, see here.
Pollinex
Use is restricted to within the specialist allergy
service.
COPD Rescue
Prescriptions
As the winter months approach,
please could practices consider
identifying their COPD patients who
self-manage exacerbations at home
with rescue medicines i.e. steroids
and antibiotics, to check and ensure
they have an adequate supply of in
date medication.
Testosterone Guidance
The testosterone guidance has
been updated and added to
the CCG website here. This is
a good tool to help you review
your testosterone patients, who
should be small in number, but can
yield impressive savings to your
prescribing budget.
DuoResp Spiromax (Budesonide/formoterol fumarate
dihydrate) inhalation powder has been launched
for treatment of asthma or chronic obstructive
pulmonary disease in adults, where use of an inhaled
corticosteroid and a long-acting beta2 agonist is
appropriate.
The breath-actuated dry powder inhaler is available in
two strengths:
• 160/4.5 (equivalent to a metered dose of
budesonide 200 microgram/formoterol fumarate
dihydrate 6 microgram per dose)
• 320/9 (equivalent to a metered dose of budesonide
400 microgram/formoterol fumarate dihydrate 12
microgram per dose)
This dry powder device offers a cost effective
alternative for patients who may have difficulty using
Symbicort Turbohalers.
PBMC Corner
Latest black, grey, red and specials epact reports were shared,
these included the newly updated GMMMG red list drugs , some
of which remain amber in Stockport if supported by Shared Care
Protocols.
A further reminder was given that the dual antiplatelet SOP should
be run every month to support the prevention of further significant
events.
The newly published compound haemorrhoidal SOP was shared,
this supports changes from various products to either Uniroid-HC
or Scheriproct preparations. The prescribing lead in the practice
must decide which of the two products they would like to change
the patients over to. Scheriproct is slightly less expensive but
has had supply issues in the past, although they are currently
resolved. Uniroid is a bit more expensive but hasn’t historically
had any supply issues.
Ahead of the forthcoming waste campaign, PBMC’s were asked
to check prescription requests to identify potential quantity and
alignment changes to repeat medication items.
CCG Updates - Issue 41 - Prescribing edition
Dual Anti-platelet Therapy
Please ensure that patients taking dual anti-platelets
are regularly audited and have stop dates added
to their prescriptions. There have been quite a
few serious incidents recently where patients have
been continued after their stipulated stop date. Your PBMC’s should be completing a monthly audit
and presenting clinicians with a monthly sheet
comprising of new patients initiated on dual antiplatelets and also patients who are due to stop in
that month. Please look out for these sheets and
ask your PBMC or prescribing advisor if this is not
happening in your practice.
Further support for these reviews has come this
week from NICE:
‘A randomised controlled trial reported that
continuing dual antiplatelet therapy beyond a
year after stent implantation did not statistically
significantly reduce the risk of the combined
outcome of death or cardiovascular events
compared with continuing aspirin monotherapy.
However, continuing dual antiplatelet therapy was
associated with a statistically significant increase in
the combined risk of major or minor bleeding. This
is consistent with NICE guidance that recommends
dual antiplatelet therapy as a treatment option for up
to 12 months after stenting.’
Nitrofurantoin – can now be prescribed
for short courses in patients not previously
recommended.
Nitrofurantoin is now contraindicated in patients with
an estimated glomerular filtration rate (eGFR) of
less than 45 ml/min. However, a short course (3 to
7 days) may be used with caution in certain patients
with an eGFR of 30 to 44 ml/min. Only prescribe to
such patients to treat lower urinary tract infection
with suspected or proven multidrug resistant
pathogens when the benefits of nitrofurantoin are
considered to outweigh the risks of side effects.
Click here for more information.
New MHRA guidance on reporting
suspected adverse drug reactions
in children
The MHRA are publishing new guidelines for
reporting suspected adverse drug reactions
(ADRs) in children and adolescents aged under
18 years via the Yellow Card Scheme.
The advice on which suspected ADRs to report
in children is now the same as for adults (ie, they
are no longer requesting all suspected ADRs to
be reported for children).
Click here to view.
Denosumab prescribing
A MHRA Drug Safety Update (click here to view)
advises healthcare professionals of updated
recommendations to minimise the risk of
osteonecrosis of the jaw and hypocalcaemia
during treatment with denosumab.
Before starting denosumab treatment, a dental
examination and appropriate preventive dentistry
are now recommended. Patients should be
advised to maintain good oral hygiene and report
any oral symptoms.
The risk of hypocalcaemia increases with
degree of renal impairment. Calcium levels
should be monitored depending on the indication
and patients should report symptoms of
hypocalcaemia. We are currently working with
Secondary care to update the Shared Care
Protocol.