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Prescription Update - May 2014 Summary

Stay informed on hot topics, new inhalers, NICE guidelines, and drug shortages in the latest prescribing update. Learn about important medication updates such as Domperidone and Strontium. Get details on new COPD and asthma inhalers and essential prescribing guidelines.

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Prescription Update - May 2014 Summary

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  1. Prescribing Update Catherine Armstrong – May 2014

  2. Summary • Hot topics • New inhalers • NICE guidelines • Drug shortages • Updated BNF distribution schedules

  3. Hot Topic: Domperidone • MHRA Alert – 25th April • Small increased risk of potentially life-threatening effects on the heart • ONLY for nausea and vomiting • MAX 7 days treatment • ADULT dose – 10mg TDS • Check for QT prolongation meds and CYP3A4 inhibitors • Review patients at next routine appointment

  4. Hot Topic: Strontium • Restricted to severe osteoporosis • …who cannot use any other treatments • Do NOT start in patients who have or had • Ischaemic heart disease • Peripheral arterial disease • Cerebrovascular disease • Uncontrolled hypertension • STOP if develop any of the above

  5. New Inhalers • COPD • Aclidinium bromide • Glycopyrronium bromide • Indacaterol + Glycopyrronium • Asthma • Fluticasone furorate + vilanterol

  6. Aclidinium bromide (EkliraGenuir®) • LAMA – 400micrograms/dose – TWICE daily for COPD • ↑ effect on lung function vs placebo • No robust evidence of benefit vs other LAMA options • Device: multi-dose dry powder inhaler • On some local formularies: • North of Tyne  • Gateshead ? • South Tyneside • Sunderland ? • Durham&Darlington

  7. Glycopyrronium bromide (SeebriBreezhaler®) • LAMA – 44micrograms/dose – ONCE daily for COPD • ↑ effect on lung function, exercise endurance & patient outcomes vs placebo • May provide more rapid bronchdilation than tiotropium • Needs long term safety data & direct comparator trials • Device = capsule based dry powder inhaler • On some local formularies: • North of Tyne  • Gateshead ? • South Tyneside • Sunderland ? • Durham&Darlington

  8. Indacaterol + Glycopyrronium (UltibroBreezhaler® • LABA+LAMA 85micrograms indacaterol + 43micrograms glycopyronnium • ONCE daily for COPD • Device = capsule based dry powder inhaler • ↑ lung function vs placebo, separates + fluticasone/salmeterol • ↓ rate of exacerbations compared to glycopyronnium alone • Not considered locally yet

  9. Fluticasone furorate + vilanterol (Relvar®) • ICS+LABA – 2 strengths 92/22 & 184/22micrograms • ONCE daily for asthma • Superior to fluticasone furoate alone • 92/22 comparable efficacy to fluticasone/salmeterol 250/50 BD • CONCERNS re product – MHRA review • Not considered locally yet

  10. NICE Guidelines • CG171: Urinary Incontinence in Women • Darifenacin, oxybutynin (IR) & tolteridone (IR) – 1st line • CG172: Myocardial Infarction – secondary prevention • Omega 3 fatty acids – DO NOT RECOMMEND for 2ndry prevention of MI • CG173: Neuropathic Pain – pharmacological management • Tramadol not for long-term neuropathic pain control • Carbamazepine ONLY for trigeminal neuralgia

  11. Drug Shortages - Valsartan • Intermittent supply problems – all strengths & forms • May last several months * Dose equivalences are approximate and individual responses may vary so BP should be monitored following the switch and dosing adjusted accordingly, if needed #Valsartan doses may be given as 2 divided doses depending on indication Taken from NHS England Memo 10/3/2014: http://www.medicinesresources.nhs.uk/en/Communities/NHS/SPS-E-and-SE-England/Medicines-Information/Discontinuation-Supply-Shortage-Memos/Shortage-of-Valsartan-/

  12. Drug shortages – Piroxicam gel • Some supplies available • NHS prices currenly based on Feldene® gel • 60g = £6.00 (was £2.71) • 112g = £9.41 (was £5.06) • Compared with • Ibuprofen 5% gel £2.11 (50g), £4.22 (100g) • Ibuprofen 10% gel £5.79 (100g)

  13. Drug shortages - various • Clomipramine • Branded product discontinued • Cross-tapering with SSRIs, venlafaxine or duloxetine – specialist use only • Example switch to imipramine: • Gradually reduce to 75mg/day, stop and start imipramine 50-100mg/day the next day • Co-amoxiclav • Can be obtained – prices higher than usual • 375mg £5.30/21 625mg £6.93/21 • Use ONLY where clinically appropriate

  14. Drug shortages – various (2) • Amiloride £19.10 per 28 • Co-amilofruse 2.5/20 £4.32 per 28 5/40 £5.29 per 28 • Co-tenidone 50/12.5 £5.18 per 28 100/25 £5.18 per 28 • Is a potassium sparing diuretic needed? • Avoid combination products where possible

  15. Drug shortages – various (3) • Mebeverine 135mg tablets £17.50 per 100 • Peppermint oil 0.2ml caps £7.04 per 84 • Propranolol • 10mg £5.30 (28) 40mg £4.10 (28) 80mg £6.44 (56) • Consider alternative beta-blocker • HF – bisoprolol, carvedilol and nebivolol = licensed options

  16. BNF Distribution • From Sept 2013 edition – annually in PRINT • Still updated every 6 months (print copy) • Online/App versions updated monthly • Register for NHS Athens account: http://www.nice.org.uk/mpc/BritishNationalFormulary.jsp • Info regarding print distribution: http://www.nice.org.uk/mpc/BritishNationalFormulary.jsp • ALL GPs should receive annual PRINT copy to place of work • Email BNF@binleys.com

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