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NHS North of England Commissioning Support (NECS) prescribing newsletter - March 2014
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Darlington, DDES and North Durham CCGs

Blood glucose testing meters and strips

The APC have  recommend that the following meters and strips are considered by the APC for inclusion in the formulary:

  • GlucoRx Nexus range: Nexus, mini and voice meters (3 meters, one strip costing £9.95)
  • Mylife Pura (£9.50)
  • Supercheck 2 (£8.49)
  • B Braun Omnitest 3 (9.89)

The group also recommended that the  GlucoRx fine point needles and BBraun Omnican fine needles, both costing £5.95 for 100 should be the needles of choice in County Durham and Darlington

NECS will be sending a memo and information pack to all practices to provide  details of the products and how best to implement the change

Changes  to County Durham and Darlington formulary

Apixaban added as a green drug; link to NICE added

Lisdexamfetamine added as a red drug with restrictions noted

Pirfenidone added as tertiary drug with NICE link

Palperidone listed as rejected drug

NSAID Formulary review

As part of the Formulary Review Process the APC has recently approved a revision of the NSAID chapter, taking into account the safety warnings that have been issued relating to this class of drugs.

In this review the formulary was reduced from eleven NSAIDS to just six – a number which the APC felt was sufficient to cover the majority of cases where these drugs are indicated.

The review removed the recommendation of Diclofenac as the only recommended 4th line option , and also removed from the formulary Piroxicam, nabumetone, mefamanic acid, etodolac and etoricoxib. Safety was one of the big drivers behind the review as significant MHRA restrictions apply to piroxicam , and etoricoxib is associated with similar thrombotic event risks as diclofenac . Mefenamic acid is also extremely toxic in overdose.

Current usage data and cost was considered and some of those drugs recommended for removal are used less often than the other products and do not have a compelling reason to remain on the formulary.  An example of this would be  Etodolac and nabumetone , which have similar efficacy to naproxen but have higher acquisition costs. 

Revised NSAID Formulary Summary:

Long Term use:    Ibuprofen low dose – First line treatment

                               Naproxen low dose – Second line treatment

                               Naproxen high dose – Third line treatment

•             Alternatives or fourth line: Diclofenac, celecoxib, meloxicam, indometacin.*

•             Remove from formulary: piroxicam, nabumetone, mefenamic acid, etodolac and etoricoxib

The lowest effective dose of NSAID should be prescribed for the shortest period of time to control symptoms and the need for long-term treatment should be reviewed periodically

*The formulary already included links to MHRA guidance, however BNF warnings are now included and say:

NSAIDs and cardiovascular events

All NSAID use (including cyclo-oxygenase-2 selective inhibitors) can, to varying degrees, be associated with a small increased risk of thrombotic events (e.g. myocardial infarction and stroke) independent of baseline cardiovascular risk factors or duration of NSAID use; however, the greatest risk may be in those receiving high doses long term.

Cyclo-oxygenase-2 selective inhibitors , diclofenac (150 mg daily) and ibuprofen (2.4 g daily) are associated with an increased risk of thrombotic events. The increased risk for diclofenac is similar to that of licensed doses of etoricoxib . Naproxen (1 g daily) is associated with a lower thrombotic risk, and low doses of ibuprofen (1.2 g daily or less) have not been associated with an increased risk of myocardial infarction”.

The formulary is available at http://formulary.cdd.nhs.uk/

Methotrexate tablets

Please remember that for safety reasons, methotrexate tablets should be prescribed  and dispensed in multiples of 2.5mg i.e. 4x 2.5mg tablets for each 10mg required.

NHS North of England Commissioning Support (NECS)
Tel: 0191 374 4121
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