Please note that the information in this newsletter is correct at the time of publication. Clinicians should always refer to the
most up to date information.
Prescribing Tip Extra – Issue 1 September 2015
Welcome to the first edition of Prescribing Tip Extra – a new regular monthly newsletter produced by your
Medicines Optimisation Team. This newsletter will be circulated in addition to the regular weekly
Prescribing Tip and will provide a useful monthly round up of prescribing information, MHRA guidance,
product updates and availability and up to date information on products where there has been significant
increases in prescribing cost.
In this ISSUE:



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Prescribing information
MHRA guidance – Drug Safety Updates
Products in short supply and product discontinuations
Products with significant cost changes
PRESCRIBING INFORMATION

New Yellow Card app for reporting
suspected side effects
A Yellow Card smart phone app was launched
on the 14th July 2015, for people to report
problems with medicines. The free mobile
app is available for all healthcare
professionals and patients to access. You can
download the app from the iTunes App Store
and/or Google Play for your IOS or Android
device.

Cardiovascular warning for high-dose
ibuprofen
The MHRA and other EU medicines regulators
have reviewed the safety of high-dose
ibuprofen. This is following the publication of
a meta-analysis of clinical trial data. This
meta-analysis showed that people taking
≥2400 mg of ibuprofen per day were at a
higher risk of arterial thrombotic events
(heart attack, stroke) than people taking
placebo. The review confirmed that this
higher risk is similar to that seen with COX-2
inhibitors
and
diclofenac.
https://www.gov.uk/drug-safety-update/high-doseibuprofen-2400mg-day-small-increase-incardiovascular-risk

Patient safety failures in asthma
care: the scale of unsafe prescribing
in the UK
A report from Asthma UK, published one year
on from the National Review of Asthma
Deaths, found that around 127,617 people
with asthma in the UK may have been put at
risk of a potentially life-threatening asthma
attack due to unsafe prescribing. For further
details the report can be downloaded here
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To contact the Medicines Optimisation Team please phone 01772 214302
Please note that the information in this newsletter is correct at the time of publication. Clinicians should always refer to the
most up to date information.

Edoxaban drug safety letter
Daiichi Sankyo UK Ltd has recently sent out a
letter to healthcare professionals informing
them of their new NOAC product Edoxaban,
MHRA
2015
GUIDANCE
– DRUG SAFETY UPDATES SEPTEMBER
https://www.gov.uk/drug-safety-update
Proton pump inhibitors (PPIs) are associated
with very infrequent cases of subacute
cutaneous lupus erythematosus (SCLE), a nonscarring dermatosis that can develop in sunexposed areas. If a patient treated with a
proton pump inhibitor (PPI) develops
lesions—especially in sun-exposed areas
of the skin—and it is accompanied by
arthralgia:




an oral anticoagulant which acts by direct
selective inhibition of factor Xa. Please click
here for a copy of the full letter.
advise them to avoid exposing the
skin to sunlight
consider subacute cutaneous lupus
erythematosus (SCLE) as a possible
diagnosis
consider stopping use of the PPI
unless it is imperative for a serious
acid-related condition; a patient
who develops SCLE with a
particular PPI may be at risk of the
same reaction with another
in most cases, symptoms resolve
on PPI withdrawal; topical or
systemic steroids might be
necessary for treatment of SCLE
only if there are no signs of
remission after a few weeks or
months

report any suspected side effect
with PPIs, or to any medicine, on a
Yellow Card
Patient reminder cards about the risk of
osteonecrosis of the jaw are being introduced
for Denosumab (Prolia®, Xgeva®) and
intravenous bisphosphonates. Additionally,
Denosumab 120mg (Xgeva®) is now
contraindicated in patients with unhealed
lesions from dental or oral surgery.
The Xalatan formulation of latanoprost has
recently been changed such that the pH is
now 6.0 compared to 6.7 previously. This
change allows for longer term storage at room
temperature; however it has also been
associated with an increase in reporting of eye
irritation. Patients as advised to tell their
health professional promptly (within a week)
if they have eye irritation (e.g. excessive
watering) severe enough to make them
consider stopping treatment.
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To contact the Medicines Optimisation Team please phone 01772 214302
Please note that the information in this newsletter is correct at the time of publication. Clinicians should always refer to the
most up to date information.
PRODUCTS IN SHORT SUPPLY AND DISCONTINUATIONS
The following links provide prescribers with up to date information on commonly prescribed
products which are currently in short supply from the manufacturers
 http://hcp.gsk.co.uk/supply.html
 http://hcp.gsk.co.uk/content/dam/Health/en_GB/DAM%20Content/Documents/Supply/der
matology.pdf
 http://psnc.org.uk/dispensing-supply/supply-chain/branded-shortages/branded-shortageslist/supply-difficulties-novartis/
Please note there are continued stock availability issues for the following items:


Fenbid Forte®
 Zantac®
 Vensir®
 Scheriproct® ointment
Ferrous fumarate 210mg tablets
Discontinued products

The manufacturer of NovoPen® 4 has
written to healthcare professionals
advising that this device is being
phased out and replaced by NovoPen®
5. It is expected that supplies of the
NovoPen® 4 will run out in September
2015. The new device will be available
in the same colours (blue and silver)
and has a memory function which
displays the number of units last
injected and gives an indication of the
amount of time that has passed since
the last injection.

The manufacturer of tripotassium
dicitratobismuthate (De-noltab®) has
written to healthcare professionals
advising that the product will be
discontinued with effect from the end
of December 2015. No reason for the
decision to discontinue this product is
provided in the letter. It is
recommended
that
appropriate
alternatives are discussed with any
patient who is currently taking this
medication as a long term treatment.
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To contact the Medicines Optimisation Team please phone 01772 214302
Please note that the information in this newsletter is correct at the time of publication. Clinicians should always refer to the
most up to date information.
SIGNIFICANT COST CHANGES


A licensed version of Midodrine is
now available. Bramox (midodrine)
tablets have been launched for
treatment of severe orthostatic
hypotension due to autonomic
dysfunction in adults when corrective
factors have been ruled out and other
forms of treatment are inadequate.
Bramox is the first licensed midodrine
preparation in the UK – previously
midodrine was available as an
unlicensed imported costly special.
Cost for 100 Bramox tablets: 2.5mg,
£55.05; 5mg, £75.05.
The current drug tariff price for Coamoxiclav 250mg/62mg/5 ml oral
suspension sugar free x 100 ml is
£1.89. Prescribers are alerted to the
use of non-sugar free version of the
suspension which has recently been
dispensed at the cost of £76 x 100 ml.

The current drug tariff price for
generic
isosorbide
mononitrate
tablets 60mg is £10.50 for 28 tablets.
Practices may wish to consider
switching to an alternative cost
effective branded preparation such as
Monomil (£3.49 for 28 tablets) or
Chemydur (£3.49 for 28 tablets).

The current drug tariff price for
salbutamol 2mg and 4mg tablets are
£104.95 and £107.43 for 28 tablets
respectively. Significant cost savings
for practices could be realised by
reviewing the ongoing need for the
medication and where appropriate
consider switching to salbutamol
2mg/5ml oral solution (sugar free)
which currently costs 72p for 150ml.

Abbott nutrition have announced that
from the 1st September 2015 there
will be a number of price changes
affecting their range of enteral feeds.
In particular there has been a
significant reduction in the costs of
their range of oral nutritional
supplements (Ensure compact and
Ensure plus) which should realise cost
savings across both CCG’s. A full list of
the product price changes can be
found here. (left click once on the PDF
icon then double click on one of the
pointers)

Dicycloverine tablets and liquid have
been subject to a huge increase in
cost over the past 6 months. Current
costs are :
 Dicycloverine tablets 10mg - £146.61
for 100 tabs
 Dicycloverine tablets 20mg - £155.09
for 84 tabs
 Dicycloverine liquid 10mg/5ml £143.84 for 120ml
Prescribers are advised to consider a possible
switch to hyoscine butylbromide or
mebeverine.
ons.pdf
TOP 10 MONTHLY PRICE REDUCTIONS AND INCREASES AS OF AUGUST 2015
Top 10 monthly price
reductions and increases.pdf
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To contact the Medicines Optimisation Team please phone 01772 214302