Doncaster & Bassetlaw Area Prescribing Committee
(APC) Update December 2014
Welcome to the December feedback from the Area Prescribing Committee
This bulletin aims to keep you informed of items discussed at the APC as well as
updates and reviews of the Traffic Light System (TLS)
Glucosamine & Chondroitin formulations
The prescribing of Glucosamine & Chondroitin either as separate drugs or in combination are categorised
as Grey (insufficient evidence available to support use in therapy) on the Traffic Light System. Prescribing
data shows that there is still a considerable amount of prescribing across Doncaster.
Patients can be advised that both items are available to buy over the counter at many retail outlets.
Shared Care
Protocol for the Management of Children with Growth Hormone Disorders
The SCP has been reviewed and updated. The new version will be available on the Medicines
Management Website.
Abilify (brand) v aripiprazole (generic)
A generic form of aripiprazole is now available; however the generic preparation does not have a licence
for treating bipolar disorder. This is not a new situation and previous instances of this include: Bisoprolol,
Pioglitazone and Clopidogrel. Previous instances have been managed without a routine switch to brand
prescribing. The Area Prescribing Committee has discussed this issue and reached the following
recommendation:
The APC encourages the continued prescribing of generic aripiprazole for all indications. It is important
that patients are adequately counselled by the Clinician and the Pharmacist and that the off-label status is
recognised by all.
As with all prescribing decisions Clinicians must use their personal judgement to determine which
preparation is most suitable for an individual patient.
The introduction of generic alternatives will continue to occur and the APC will continue to revisit this
issue on a case by case basis to ensure the most appropriate recommendations are available for patients
and the health community.
Amiodarone prescribing (Amber- G
The guidance to support the prescribing of Amiodarone has been reviewed and updated; this
document will be uploaded on to the Medicines Management Website under Guidelines - local
http://medicinesmanagement.doncasterpct.nhs.uk/
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Amber with guidance (Amber- G Drugs)
The Definition of this category is:
Drug must be initiated and where relevant titrated to stable dosage by the specialist before GPs take over
prescribing responsibility. There may be a requirement for monitoring to be undertaken by the GP as
defined in relevant Amber G Guidance. The guidance is explained on the traffic light system under the
individual drug name.
A recent instance whereby a GP has declined to take over the prescribing of Balsalazide (Amber-G) has
prompted this reminder to be shared.
Traffic Light Status Reviews & New Entries
Drugs for Review
Alogliptin (Vipidia) for type 2 diabetes has been categorised as Green-G, Non-Formulary item
Alogliptin/Metformin (Vipdomet, Incresync) for type 2 diabetes has been categorised as GreenG, Non-Formulary item
Brinzolamide and brimonidine tartrate (Simbrinza) for open-angle glaucoma or ocular
hypertension has been categorised as Green-G
Tegafur/Uracil (Uftoral) for metastatic colorectal cancer has now been discontinued and has
been categorised as Grey-3
Lubiprostone (Amitiza) for Chronic idiopathic constipation has been categorised as Amber-G
New Drugs
Canagliflozin and Metformin Hydrochloride for type 2 diabetes mellitus has been categorised as
Green-G
Rivaroxaban (Xarelto) - Prevention of atherothrombotic events in adult patients after an acute
coronary syndrome (ACS) with elevated cardiac biomarkers is a new indication and has been
categorised as Red 1,2 (this is a new indication)
Ibrutinib (Imbruvica) for relapsed or refractory mantle cell lymphoma (MCL) and Chronic
lymphocytic leukaemia (CLL) has been categorised as Red 1, 2
Beclometasone dipropionate / formoterol fumarate dehydrate (Fostair NEXThaler (DPI) for
asthma where use of a combination product is appropriate has been categorised as Grey-4
pending discussion at the FLG.
Budesonide / formoterol fumarate dehydrate (DuoResp Spiromax) for asthma, where use of a
combination is appropriate and severe COPD has been categorised as Grey-4 pending
discussion at the FLG.
Umeclidinium (Incruse) – COPD has been categorised as Grey-4 pending discussion at the FLG.
Demeclocycline (Ledermycin) for infections caused by tetracycline-sensitive organisms/SIADH)
secondary to malignant disease has been categorised as Amber-G.
The approved minutes of the Doncaster & Bassetlaw Area Prescribing Committee meeting are now
available on the NHS Doncaster Medicines Management Website. To view these and the updated TLS use
the below link
http://medicinesmanagement.doncasterpct.nhs.uk
An up to date TLS should always available on the Medicines Management Website. If you have any
difficulties in accessing the TLS or if your version is not up to date please contact a member of the
Medicines Management Team on the address below.
If you have any comments, questions or have identified any discrepancies, omissions or additions required to the
current TLS please contact a member of the Medicines Management Team below
MedicinesManagementAdmin@doncasterccg.nhs.uk
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