Area Prescribing Group Update January 2015 - First Edition
Here is a brief summary of prescribing advice following the November 2014 & January 2015 meetings of the Area
Prescribing Group. Click on the hyperlinks to open individual documents on the intranet.
Traffic Light Drug List Updates
The latest Traffic Light Drug List is available on the intranet under Medicines and Prescribing.
The following amendments to the Traffic Light Classification have been made:
Renavit®, for the dietary management of water soluble vitamin deficiency in renal patients was classified as
AMBER. This is the vitamin of choice, which replaces Ketovite®.
Topical alprostadil (Vitaros®) for erectile dysfunction (ED) was classified as AMBER. This adds to the list of
treatment options for ED in patients who cannot have or have failed to achieve satisfactory results with oral PDE5
inhibitors.
InsuJet and Injex, needle free devices for delivering insulin, were classified as RED
Dimethyl fumarate (Tecfidera®), for multiple sclerosis was classified as RED
Shared Care Protocols
Principles of Shared Care Protocols was approved. This is a document which sets out the standards that
should be observed when any Shared Care Protocol is revised or developed.
Guidelines
Sheffield Primary Care Guidelines for Stroke and Transient Ischaemic attack(TIA) has been
reviewed; the main change in medication for secondary prevention is long term clopidogrel 75mg daily is now first line
antiplatelet therapy for patients with TIA as well as ischaemic stroke. NICE has recently issued revised guidance on
lipid modification and prevention of stroke in AF and these sections will be further updated following publication of
local guidelines.
NICE Guidance
NICE Bites October 2014 discusses the management of dyspepsia and GORD in adults (>18 years). It also
covers endoscopic surveillance for adults with a diagnosis of Barrett's oesophagus, but does not include details on
management of Barrett's oesophagus.
NICE Bites November/ December 2014 covers the recognition, assessment and management of bipolar
disorder in children, young people and adults. It applies to people with bipolar I, bipolar II, mixed affective and rapid
cycling disorders.
Drug Safety
NHS/PSA/W/2014/016 Naloxone and long term opioid users (stage 1 warning): This alert highlights
the BNF recommendation that doses used in acute opioid/opiate overdose may not be appropriate for the
management of opioid induced respiratory depression and sedation in those receiving palliative care and in chronic
opioid use.
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Drug Safety Updates
October 2014 - Interferon beta-1a and interferon beta-1b are immunomodulatory drugs indicated for the treatment
of remitting relapsing multiple sclerosis. A European review has suggested that there may be an association between
interferon beta treatment and thrombotic microangiopathy and between interferon beta treatment and nephrotic
syndrome.
Although interferon-beta is red on the Sheffield TLD, primary care clinicians will need to be vigilant for signs and
symptoms of thrombotic microangiopathy and nephrotic syndrome in patients prescribed these products (e.g Rebif®,
Betaferon®).
December 2014 - Ivabradine in treatment of chronic angina: advises on actions to minimise the risks
of cardiac side-effects. Ivabradine is amber in the traffic light drug list for both angina and heart failure indications.
Patients should be monitored for bradycardia and atrial fibrillation and ivabradine should not be prescribed with other
medicines that cause bradycardia.
Isotretinoin: reminder of possible risks of psychiatric disorders. No new data but a reminder to monitor patients
receiving isotretinoin for signs of depression, anxiety and suicidal ideation. This is a red traffic light drug but GPs need
to be aware of risk of psychiatric disorders. GP practices are reminded to add isotretinoin as a HOD so that drug
interactions and potential side effects can be picked up.
Update information on non-vitamin K oral anticoagulants (NOACs)
Recent incidents have highlighted safety issues with prescribing NOACs and so the above advice may be useful.
Safer Prescribing of oral Amiodarone advises of actions to be taken in primary and secondary care to
ensure the safer prescribing of amiodarone. Furthermore the attached medicines management team member will be
auditing compliance with the amiodarone shared care protocol and ensuring that the transfer of care (TOC) forms are
being used, over the coming months.
Other
Fosfomycin and Pivmecillinam
The existing primary care guideline on the use of fosfomycin for the treatment of multiple resistant UTIs has been
updated and can be found here. Please note that the current fosfomycin sachet presentation supplied in Sheffield
remains an unlicensed product and should only be prescribed following advice from the STH microbiology
department. As part of the commissioned extended hours pharmacy service, Wicker Pharmacy stocks fosfomycin so
that there is on-demand availability in the event of urgent clinical need. All pharmacies are able to procure this
product so patients may be signposted to the pharmacy of their choice.
In addition, the STH microbiology department will now be recommending the use of the mecillinam antibiotic
pivmecillinam as an option for the treatment of resistant UTIs on selected sensitivity reports. Pivmecillinam is an oral
antibiotic licensed for acute uncomplicated cystitis as a three day course. For more prescribing details, see the
Summary of Product Characteristics sheet here.
Abbreviated Antibiotic Guideline
Offers a summary of the full guideline and highlights the recommended treatment for the most common infections
seen in primary care i.e. respiratory, skin and urinary tract infections.
Medical Information queries, for assistance see this guidance.
Palliative Care: Guidance for Medicines Management of Community Patients in Last Days
of Life has been revised and key changes are as follows:
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The Palliative algorithms for pre-emptive prescribing for pain, respiratory tract secretions, breathlessness,
agitation and nausea/vomiting have been updated and the doses reviewed
There are new algorithms for prescribing in patients with a creatinine clearance < 30ml/min
The document is intended to be printed in booklet format
For further information on the above, or if you have issues that may need to be addressed by the APG, please contact Sharron Kebell or Gary
Barnfield on 0114 3051331. Visit the APG section on the intranet for full details of our prescribing advice and guidelines.
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