1. NHCCG Prescribing Forum 22nd September 2016

2. What’s New? – MHRA Drug Safety Update July 2016
Warfarin: reports of calciphylaxis. Calciphylaxis is a very rare but serious condition causing vascular calcification and skin necrosis. Advice for healthcare professionals: 
calciphylaxis is a very rare but serious condition that is most commonly observed in patients with known risk factors such as end-stage renal disease
cases have been reported in patients taking warfarin, including those with normal renal function, and evidence suggests that on rare occasions warfarin use might lead to calciphylaxis
if calciphylaxis is diagnosed, appropriate treatment should be started and consideration should be given to stopping treatment with warfarin
Citalopram: suspected drug interaction with cocaine; prescribers should consider enquiring about illicit drug use.  Possible illicit drug use should be considered when prescribing medicines that have the potential to interact adversely.
MHRA have received a Coroner’s report that raised concerns about a suspected drug interaction between citalopram and cocaine after the death of a man due to subarachnoid haemorrhage.
There are plausible mechanisms for an interaction between cocaine and citalopram that could lead to subarachnoid haemorrhage, including
hypertension related to cocaine and
an additive increased bleeding risk in combination with citalopram.

3. What’s New? – MHRA Drug Safety Update July 2016 contd.
N-acetylcysteine: risk of false-low biochemistry test results due to interference with Siemens assays. N-acetylcysteine may interfere with assays from Siemens ADVIA Chemistry and Dimension/Dimension Vista instruments, leading to false-low biochemistry test results.
State if a patient is receiving N-acetylcysteine when requests for biochemistry tests (eg, cholesterol, uric acid, lactate) include any affected assays from these instruments 
Letters sent to healthcare professionals in June 2016 On 20 June 2016, a letter was sent to healthcare professionals about risks of viral reactivation and pulmonary hypertension associated with Thalidomide Celgene.

4. What’s New? – Drug Safety Update August 2016
Riociguat (Adempas): not for use in patients with pulmonary hypertension associated with idiopathic interstitial pneumonias
Patients with pulmonary hypertension associated with idiopathic interstitial pneumonias should not be treated with riociguat in light of interim results from a recently terminated study.
Riociguat treatment should be discontinued in any patient with PH-IIP. The patient’s clinical status should be carefully monitored after stopping riociguat
the benefits of riociguat in its approved indications still continue to outweigh the risks
Letters sent to healthcare professionals in July 2016 In July 2016, the following letters were sent to relevant healthcare professionals:
riociguat (Adempas): not for use in patients with pulmonary hypertension associated with idiopathic interstitial pneumonias (see also article above)
posaconazole (Noxafil): tablets and oral suspension are not interchangeable

5. What’s New? – Drug Safety Update September 2016

6. What’s New? – Vaccines (Vaccine update: Issue 248, June 2016 produced by PHE)
REMINDER – changes to the meningococcal C
(MenC) vaccination schedule from 1 July Flyer now available to order.
Due to the success of the MenC programe the infant dose of MenC that is normally given at three months of age will be removed from the childhood immunisation schedule from 1 July The infant dose of Men C that is given at 12 weeks of age should no longer be given.
All children will continue to be offered a combined Hib/MenC vaccine when they reach one year of age.
This, along with the adolescent MenACWY vaccination, will help to provide protection to infants and children.
A flyer (product code ) for parents and healthcare workers to explain these changes to the MenC programme from 1 July is now available to download or order from the DH Orderline ( and can also be downloaded from the immunisation website (
Additionally, the complete routine and routine childhood schedules have been updated to reflect this change (

7. What’s New?- Vaccines (Vaccines Update Special Edition: Issue 250, & Issue 251 August 2016 produced by PHE)
The 250th issue of vaccine update includes:
information on the shingles programme from 1 September 2016
ordering control information for the children’s part of the 2016 to 2017 national flu vaccination programme
an update on Hepatitis B vaccine ordering
MenACWY vaccine ordering restrictions & updates to MenACWY resources
Intervax BCG vaccine availability
shingles vaccine expiry
2017 National Immunisation Network meeting
The August edition of Vaccine Update features:
influenza vaccine supply for the children's part of the flu programme
guidance on ordering resources including leaflets and posters
Please follow the link below:
At the bottom of the online newsletter you will find details on how to receive regular issues of Vaccine Update, which your practice nurses responsible for vaccinations will find useful, especially when and how to place orders, stock shortages and changes to the immunisation programme.

8. What’s New? – Safety contd.
Shingles immunisation programme for 2016
The Department of Health has written to healthcare colleagues about the shingles immunisation programme from September 2016.
From the 1st September 2016 shingles vaccine should be offered to patients aged 70 or 78 years on the 1st September 2016.
In addition, patients who have been eligible in previous years but remain unvaccinated may also be offered the vaccine. This would include anyone aged 71 to 73 or 79 on the 1st September 2016.
Anyone who reaches their 80th birthday is no longer eligible for the vaccine due to the reducing efficacy of the vaccine as age increases.
The letter also notes that by the end of March 2016 just under half of eligible 70 and 78 year olds had been vaccinated against shingles.

9. What’s New? – Safety contd.
Pertussis: guidelines for public health management –update
Important changes include:
updated epidemiology of pertussis in England since the immunisation programme for pregnant women,
pertussis vaccines for post exposure management and outbreak control and
revised definitions of the priority groups for public health action.
Medicines, excipients and dietary intolerances
(Drug and Therapeutics Bulletin)
An overview is provided of several dietary conditions/issues (coeliac disease, lactose intolerance, peanut allergy [AL], egg AL and vaccines, shellfish AL and glucosamine, E-numbers) and pharmaceutical issues that need to be considered when advising on suitability of a medicine.

10. What’s New? – Safety contd.
NYSTATIN doses for children
(BNFc Last update: 6 June 2016)
Indications and dose: Oral and perioral fungal infections,
By mouth
Neonate
units 4 times a day usually for 7 days, and continued for 48 hours after lesions have resolved.
Child 1 month–1 year
units 4 times a day usually for 7 days, and continued for 48 hours after lesions have resolved, divide administration of the dose between both sides of the mouth.
Child 2–17 years
– units 4 times a day usually for 7 days, and continued for 48 hours after lesions have resolved, divide administration of the dose between both sides of the mouth.

11. What’s New? – Safety contd.
Insulin Glargine (Abasaglar)
(Medicines Management team of Brent CCG)
Abasaglar® is a new biosimilar form of insulin glargine that has the same primary amino acid sequence as the original insulin glargine product (Lantus®).
Abasaglar® has been shown to have a comparable pharmacological and toxicological profile to Lantus®.
Although Abasaglar® is licensed for the same indication as Lantus® (treatment for adults, young people and children aged 2 years and above with diabetes mellitus), they should not be regarded as interchangeable. There is a potential for unexpected hypoglycaemia if patients are inadvertently switched between brands.
The administration devices for Lantus® and Abasaglar® are slightly different. Lantus® uses the Solostar pen, and Abasaglar® the Kwikpen device: prescribers are advised to prescribe by brand name to avoid the possibility of patients receiving a different product to that intended.
Prescriptions for insulin glargine should always specify the brand to be dispensed (this is in line with MHRA recommendations for all biosimilar products).
GP practices should confirm the brand of insulin patients are dispensed and their PMR should be updated accordingly to ensure future prescriptions reflect this.
Consider the prescribing of the cost effective biosimilar brand of Abasaglar® for new prescriptions of insulin glargine, but do not switch existing patients from their current brand.

12. What’s New? – Safety contd.
Ensuring the safe administration of insulin
(Patient Safety Wales)
This patient safety alert from Patient Safety Wales has been published to highlight that the extraction of insulin from pen devices using an insulin syringe is not permitted as this can result in the incorrect dose of insulin being administered to patients.
The alert highlights that high strength insulin preparations are now available (e.g. Toujeo (Insulin glargine) 300units/mL, Humalog (Insulin lispro) 200 units/mL, Tresiba (insulin degludec) 200 units/mL), and that these preparations are only available as prefilled pen devices.
Extraction of high strength insulin from these pen devices, using an insulin syringe, results in the incorrect dose of insulin being administered to patients, and causes patient harm.
Furthermore the extraction of standard strength insulin from pen devices using an insulin syringe and needle damages the mechanism of the pen device.
Subsequent use of the damaged pen device can result in dosing errors, and causes patient harm.

13. What’s New? – Safety contd.
Diabetes in children and young people [QS125]
(Medicines Management team of Brent CCG)
This quality standard covers the diagnosis and management of type 1 and type 2 diabetes in children and young people aged under 18. This quality standard will not cover care for children and young people with other forms of diabetes mellitus (such as monogenic diabetes or cystic fibrosis-related diabetes).
1.Children and young people presenting in primary care with suspected diabetes are referred to and seen by a multidisciplinary paediatric diabetes team on the same day.
2.Children and young people with type 1 or type 2 diabetes are offered a programme of diabetes education from diagnosis that is updated at least annually.
3.Children and young people with type 1 diabetes are offered intensive insulin therapy and level 3 carbohydrate counting education at diagnosis.
4.Children and young people with type 1 diabetes who have frequent severe hypoglycaemia are offered ongoing real time continuous glucose monitoring with alarms.
5.Children and young people with type 1 diabetes are offered blood ketone testing strips and a blood ketone meter.
6.Children and young people with type 1 or type 2 diabetes are offered access to mental health professionals with an understanding of diabetes.

14. What’s New? – Safety contd.
Dosulepin
(Medicines Optimisation news headlines July 2016 West Hampshire CCG)
Dosulepin is only licensed for the treatment of depressive illness in adults.
Although it has been shown to be better tolerated than some alternative antidepressants, this is outweighed by the increased cardiac risk and toxicity in overdose. NICE CG 90 says that patients should not be initiated on it, or switched to it from other antidepressants.
There is still a significant amount of use across all practices in North Hampshire and prescribers are urged to review any patients who are taking this agent with the aim of gradually stopping treatment or switching to an alternative antidepressant.
Any patients at risk of suicide should be assessed urgently.
Dosulepin is contraindicated in patients who have had a recent myocardial infarction and in patients with heart block of any degree or other cardiac arrhythmias. It is also contra-indicated in mania and in severe liver disease.
Treatment should not be stopped suddenly unless serious side effects have occurred as patients may experience unpleasant discontinuation symptoms. Slowly tapering the dose by weekly reductions of 25-50mg can help prevent this.
Where an SSRI is indicated, it is suggested that the dose of dosulepin should gradually be reduced to 25-50mg/day and then the SSRI added at the usual starting dose. The remaining dosulepin should then be slowly withdrawn over 5-7 days.
Further information can be obtained from the Medicines Management Team.

15. What’s New? – Safety contd.
Loperamide warning
The US FDA has issued a 'Drug Safety Communication' about the risk of serious heart problems with high doses of loperamide. The warning follows 48 reports to the FDA (the US equivalent of the UK's Yellow Card scheme) over the last 39 years; over half the reports were received since 2010.
They mostly involve very high doses ranging from mg daily in patients abusing loperamide to self-treat opioid withdrawal or to achieve a feeling of euphoria. The full document can be accessed
A UKMi Medicines Q&A provides information on the use of high-dose loperamide for reducing stoma output:
Some patients with a stoma resulting from an ileostomy, jejunostomy or a colostomy, can experience high-volume liquid stoma output.  This Medicines Q&A evaluates the limited information available on the use of high dose loperamide to reduce stoma output.

16. What’s New? – Safety contd.
Adherence to pregnancy prevention measures during isotretinoin treatment
(Derbyshire Medicines Management Newsletter Volume 6 Issue 5 August 2016)
A Canadian retrospective cohort study has found adherence to pregnancy prevention measures in female users of isotretinoin to be poor.
Oral retinoids (e.g. isotretinoin) locally classified as RED are contraindicated in women of childbearing potential unless the conditions of the Pregnancy Prevention Programme are met.
Female patients must be provided with comprehensive information on pregnancy prevention before treatment is initiated.
During medication reviews where prescribing is known to primary care, clinicians should prompt a reminder to patients noting that the SPCs will detail the relevant Pregnancy Prevention Programme.

17. What’s New? – Safety contd.
EMA reviews the risk of pneumonia with inhaled corticosteroids for COPD
DTB May 2016 Volume 54 Issue 6
EMA has completed a review of the known risk of pneumonia in patients who take inhaled corticosteroid (ICS) medicines to treat chronic obstructive pulmonary disease (COPD).
The review confirmed the risk of pneumonia with ICS products, which has been known for many years, and that it is common (can affect between 1 and 10 COPD patients in 100 using these medicines).
The review did not find any conclusive evidence of differences in this risk for different products.
Overall the benefits of inhaled corticosteroid medicines in treating COPD continue to outweigh their risks and they should be prescribed in line with local guidelines.
Patients need to alert their doctors if they start to get symptoms that suggest they are developing pneumonia, so that it can be identified and treated early.
Healthcare professionals should remain vigilant for the possible development of pneumonia in patients with COPD as the clinical features of such infections overlap with the symptoms of COPD exacerbations.

18. What’s New? – Safety contd.
Morphine MR error
There is a potential for error involving the changing from morphine modified release 12-hourly capsules (e.g. Zomorph®) to MXL® capsules, a 24-hourly preparation (not to be prescribed twice daily).
ACTION: Please ensure when prescribing or switching MR morphine capsules that you choose the correct formulation for the dosing schedule required. Brand prescribing is recommended, to help avoid any prescribing and/or dispensing errors.
General advice for any patient starting a Novel Oral Anticoagulant (NOAC)
Patients should have baseline blood tests including; full blood count (FBC), renal function, liver function tests (LFTs) and a clotting screen before initiation.
Renal function should be calculated using Cockroft Gault equation and dose adjusted if necessary according to their creatinine clearance (CrCl).
Compliance, adverse effects and symptoms related to thromboembolic events should be checked every three months and renal function and LFTs should be repeated at least annually and more frequently if the patient has reduced CrCl.
Rivaroxaban should always be taken with food as absorption is significantly reduced
if taken on an empty stomach.

19. What’s New? – Safety contd.
What are the risks of using antidepressants together with novel oral anticoagulants (NOACs) and how should these risks be managed?
(Specialist Pharmacy Service)
NOACs appear to have fewer clinically significant drug interactions than warfarin but concomitant use with strong/moderate inhibitors/inducers of CYP3A4 or P-glycoprotein (e.g. amiodarone and verapamil) can result in clinically significant interactions.
Lack of familiarity with these agents may result in potential drug interactions being overlooked which can lead to patient harm because patients are not routinely monitored for changes in anticoagulation.
This review highlights potential drug interactions between the NOACs and antidepressant agents that are known inhibitors/inducers of CYP3A4 or P-glycoprotein and also those that affect haemostasis.
The review focuses on these agents since no interactions were found with other categories of antidepressants.

20. What’s New? – Safety: revised SPCs.
Revised SPC: Kaletra (lopinavir/ritonavir) products
(electronic Medicines Compendium)
SPC has been updated to contraindicate concomitant use of colchicine or dronedarone due to risk of increased plasma concentrations of these agents and serious adverse effects, which could be life-threatening in patients with renal and/or hepatic impairment on colchicine.
Check that patients are not taking medications that are restricted to hospital- only prescribing.
Revised SPC: Diprosone (betamethasone dipropionate) preparations (lotion, ointment and cream)
Information has been added to state that any of the side effects that are reported following systemic use of corticosteroids, including adrenal suppression, may also occur with topical corticosteroids, especially in infants and children.

21. What’s New? – Safety: revised SPCs contd.
Revised SPC: Aprovel (irbesartan) film-coated tablets
(electronic Medicines Compendium)
Thrombocytopenia (frequency unknown) has been added to SPC as an adverse effect.
Revised SPC: Calcichew (calcium carbonate) 500mg Chewable Tablets
SPC now states that in patients with severe renal failure (creatinine clearance <30 ml/minute), dose adjustments may be necessary dependent on serum calcium levels.
It also warns that calcium salts may decrease absorption of iron, zinc and strontium ranelate.

22. What’s New? – Safety: revised SPCs contd.
Revised SPCs: Tildiem (diltiazem) –all products
(electronic Medicines Compendium)
Sinus arrest and cardiac arrest (asystole) have been added as adverse effects of unknown frequency to SPCs.
Increase of plasma concentrations of diltiazem may be observed in the elderly and patients with renal or hepatic insufficiency.
The contraindications and precautions should be carefully observed and close monitoring, particularly of heart rate, should be carried out at the beginning of treatment.
Prescribers are therefore, reminded that elderly and patients with impaired hepatic or renal function the recommended starting dose is one tablet (60mg) twice daily.
The heart rate should be measured regularly in these groups of patients and the dose should not be increased if the heart rate falls below 50 beats per minute.

23. What’s New? – Safety guidelines
Prophylaxis against infective endocarditis: antimicrobial prophylaxis against infective endocarditis in adults and children undergoing interventional procedures [CG64]
(Medicines Management team of Brent CCG)
This guideline has been updated to make the wording of two of the recommendations relating to antibiotic prophylaxis more consistent.
The recommendations state that
•Antibiotic prophylaxis against infective endocarditis is not recommended routinely:
for people undergoing dental procedures
for people undergoing non-dental procedures at the following sites:
upper and lower gastrointestinal tract
genitourinary tract; this includes urological, gynaecological and obstetric procedures, and childbirth
upper and lower respiratory tract; this includes ear, nose and throat procedures and bronchoscopy

24. What’s New? – Safety guidelines contd.
Bronchiolitis in children [QS122]
(Medicines Management team of Brent CCG)
This quality standard covers the assessment, diagnosis and management of bronchiolitis in children.
1. Children with bronchiolitis are not prescribed antibiotics to treat the infection:
Bronchiolitis is caused by a viral infection so antibiotics should not be used as treatment.
The number of children who have bronchiolitis and who then develop a bacterial infection is extremely low.
Reducing unnecessary antibiotics will help prevent the development of bacterial resistance and will also reduce costs.
2. Parents and carers of children with bronchiolitis are informed that medication is not being used because the condition is usually self-limiting.
3. Parents and carers of children with bronchiolitis are given key safety information about what to expect and when to be concerned if caring for the child at home.

25. What’s New? – Savings
Medicines Optimisation Prescribing Hints and Tips  ×
Cetirizine tablets
Cetirizine capsules
Betnovate RD® cream & ointment, 100g
Bethamethasone valerate 0.025% cream & ointment
Monuril® sachets 3g
Fosfomycin sachets 3g
Laxido® paed sachets
Movicol®paed sachets
Matoride® XL tabs 18mg, 36mg, 54mg
Concerta® XL tabs 18mg, 36mg, 54mg
Olanzapine orodispersible tabs 5mg, 10mg, 15mg, & 20mg
Olanzapine oral lyophillisates and Zyprexa® Velotabs 5mg, 10mg, 15mg, & 20mg
Rizatriptan odispersible tabs 10mg
Rizatriptan oral lyophillisates 10mg and Maxalt® Melt 10mg
Prednisolone 5mg + 10mg + 20mg (multiples = £10.50)
Prednisolone tablets 25mg (£75 for 56)
Ispaghula husk 3.5g effervescent granules sachets GF SF
Ispaghula husk 3.5g sachet
Venlafaxine modified- release tablets 75mg, 150mg
Venlafaxine modified- release capsules 75mg, 150mg

26. What’s New? – savings contd.
What role for capsaicin in diabetic peripheral neuropathy?
(Drug and Therapeutics Bulletin)
Peripheral neuropathy is a common long-term complication of diabetes mellitus. In many patients, neuropathy is accompanied by pain, which is often difficult to manage effectively.
Drug treatment options include certain antidepressants and antiepileptic drugs.
Another option is the use of topical capsaicin. In this article, the evidence for capsaicin in the management of diabetic peripheral neuropathy and how it fits with current management strategies, is considered.
Review concludes that there is a very limited role for topical capsaicin in the management of painful diabetic neuropathy, and recommends that it should be considered for use only under specialist care in people with severe pain when standard treatments are ineffective/not tolerated.

27. What’s New? – savings contd.
DO NOT PRESCRIBE MEDICINES FOR DENTAL CONDITIONS ON FP10
(Medicines Management News Issue 28, July 2016 Midlands & Lancashire CSU)
National BMA and GDC guidance recommend that prescribing of dental products should be via a dentist. There may be occasions whereby a patient requires dental products to be prescribed by a GP, as part of an agreed care plan (e.g. mouth and neck cancer patients).
The key points are below:
In support of national recommendations for the treatment of dental pain and infections. It is recommended that:
•GPs should not accept requests from dentists to prescribe medicines that the dentist could prescribe.
•GPs should not accept requests from patients to issue FP10 prescriptions for items prescribed on a private prescription by their dentist during dental treatment as a private patient.
•GPs are advised that dental abscesses must be treated by dentists and that antibiotic prescribing is not routinely recommended (it is not recommended that GPs prescribe antibiotics while patients await definitive treatment).

28. What’s New? – savings contd.
DO NOT PRESCRIBE MEDICINES FOR DENTAL CONDITIONS ON FP10 contd.
Patients can purchase painkillers, such as paracetamol and ibuprofen, from community pharmacies while awaiting dental treatment.
Patients should be advised of self-care measures and signposted to purchase over the counter remedies for dental conditions where appropriate.
This does not affect a GPs ability to prescribe dental products where they are deemed to be an appropriate part of the care that the GP is providing for a patient, and where the GP is happy to take responsibility for that prescribing decision.
The Dental Formulary can be found in the BNF and The Drug Tariff; both are available on-line and in paper versions.

29. What’s New? – savings contd.
Co-codamol caps 30/500 prescribed generically are cheaper than Zapain caps 30/500.
The Zapain Tablets 30/500 still remain the most cost-effective.
Co-codamol 30mg/500mg capsules 100 £3.50 vs Zapain 30/500 capsules 100 £3.85
Co-codamol 30mg/500mg effervescent tablets 32 £2.50 and 100 £7.81
Co-codamol 30mg/500mg tablets 30 £1.20 (£4.00 / 100) vs Zapain 30/500 tablets 100 £3.03
We don’t advocate that we switch anyone back to save 35p on 100, but we don’t actively support use of the capsules.

30. What’s New? – new products
Fosfomycin 3g granules for oral solution are now a licensed product
Launched for the treatment of acute uncomplicated lower urinary tract infections in adults and for periprocedural prophylaxis in transurethral procedures.
It is classed as an amber drug, specialist recommendation only.
A single 3g dose is to be taken on an empty stomach.
Please ensure that it is prescribed as the brand Monuril®, and not as Fosfomycin 3G Sachets. This is because the price varies between companies that produce it and could be anything between £4.86 for Monuril® and £75.45 for the Amco product.
Feraccru (ferric maltol) 30mg capsules
Launched for the treatment of iron deficiency anaemia in patients with inflammatory bowel disease. The dose is one capsule twice daily on an empty stomach.
For specialist use only and should be classed as a RED drug.
Cost for 56 capsules: £47.60
Fleet Ready-to-Use Enema name has changed to Cleen Ready-to-Use Enema.
Subsequently, the SPC have been updated to reflect this.

31. What’s New? – new products contd.
Naproxen 250mg effervescent tablets (Stirlescent® by Stirling Anglian Pharmaceuticals) have recently been launched
There is a professional requirement that where a product is ordered on a prescription, a pharmacist must supply a product with a marketing authorization, where such a product exists and is available, in preference to an unlicensed medicine. These are restricted to use in patients unable to swallow naproxen tablets.
Cost: £7.90 for 20 tablets (equivalent to £23.70 for 30 days treatment 250mg twice daily). Compared to the current cost of unlicensed “special” naproxen liquid 250mg/5ml or 500mg/5ml cost >£100 for 100ml.
Naproxen 125mg/5ml oral suspension sugar free
This is a licensed alternative to Naproxen 125mg/5ml oral suspension

32. What’s New? – Withdrawals
Hydroxyzine dihydrochloride discontinued Hydroxyzine dihydrochloride (Ucerax®) tablets and liquid has been discontinued.
Prescribers are encouraged to actively review patients prescribed hydroxyzine dihydrochloride to consider if a replacement therapy is required.  
Discontinuation of Asasantin Retard (aspirin 25mg/dipyridamole 200mg) capsules and Persantin ampoules (10mg/2ml) in UK
These products will be discontinued at the end of December 2016 for commercial reasons. The company anticipates that stock will be available to last until that date, and residual stock may still be available for a short time after then.
Eclipse search has revealed 1 patient- practice 5210.
Humira 0.8ml preparations are being discontinued
Humira is being replaced with a new formulation that contains the same active ingredient (40mg adalimumab) in half the volume (0.4ml instead of 0.8ml).
Patients must therefore use half the volume to receive the same dose.
Patients supplied by homecare companies will automatically be switched.
Cost for 2 x vials, pre-filled syringes or pre-filled pens: £

33. What’s New? – Websites and webpages
UKMi is Specialist Pharmacy Service (and has a new website)
The NHS Specialist Pharmacy Service (SPS, in England only) incorporates Medicines Information (UKMi), quality assurance, medicines procurement and medicines use and safety services.
A new website brings together SPS resources (see Web Footer, overleaf). The clinical content of the UKMi website (including data from the fridge, patents, compliance aid stability and New Drugs Online databases) has been transferred to the new site as have UKMi Medicines Q&As, NICE Bites and other documents.
To find information on a specific drug:
1) Type the drug name in the search box and then
2) Click on the blue drug name at the top.
This will bring up a list of results, grouped in sections (all sections may not be visible, depending on the drug):
Articles: These can be various types of information including UKMi Medicines Q&As, NICE Bites, Shortages and discontinuations
Medicine Compliance Aid Stability: Information formerly in the UKMi MCA Stability database
Lactation Safety Information: Information formerly in the UKMi Drugs in Lactation database
Refrigerated storage : Information formerly in the UKMi Fridge database
New medicines: Information formerly in the UKMi New Drugs Online database
There is brief information about SPS in the section ‘About SPS’

34. What’s New? – Websites and webpages contd.
Hyperemesis gravidarum guidance
The Royal College of Obstetricians and Gynaecologists (RCOG) has published guidance on the management of nausea and vomiting in pregnancy in both community and hospital settings.
Epilepsy in pregnancy
A BMJ clinical update article ( covers various aspects of the management of epilepsy in pregnancy. It includes advice on preconception counselling and on the use of medicines.
Recent RCOG guidance covers the management of epilepsy in women before, during and after pregnancy, including during labour.
STOMPwLD
NHS England has published guidance on stopping over-medication in patients with learning disabilities (STOMPwLD). It includes an algorithm for reviewing, reducing or stopping psychotropic drugs, and examples of good practice.

35. What’s New? – Websites and webpages contd.
Royal College of General Practitioners (RCGP) launches new sepsis toolkit designed to support GPs with sepsis identification and treatment
(Royal College of General Practitioners)
The toolkit has been designed to help GPs and other healthcare professionals in primary care tackle the diagnosis and management of sepsis, with a series of educational materials, up-to-date guidance and training resources.

36. What’s New? – NICE
Oral health for adults in care homes - guidance (NG48)
This NICE guideline covers oral health, including dental health and daily mouth care, for adults in care homes. The aim is to maintain and improve their oral health and ensure timely access to dental treatment.
This guideline includes recommendations on:
•care home policies on oral health and providing residents with support to access dental services
•oral health assessment and mouth care plans
•daily mouth care
•care staff knowledge and skills
•availability of local oral health services
•oral health promotion services
•general dental practices and community dental services

37. What’s New? – NICE contd.
Non-alcoholic fatty liver disease (NAFLD): assessment and management – guidance (NG49)
This guideline covers how to identify the adults, young people and children with non-alcoholic fatty liver disease (NAFLD) who have advanced liver fibrosis and are most at risk of further complications.
It outlines the lifestyle changes and pharmacological treatments that can manage NAFLD and advanced liver fibrosis.
Cirrhosis in over 16s: assessment and management– guidance (NG50)
This guideline aims to improve how cirrhosis is identified and diagnosed.
It recommends tools to assess the severity of cirrhosis and gives advice on monitoring people with cirrhosis to detect and manage complications early, and referral criteria for tertiary care.

38. What’s New? – NICE contd.
Non-Hodgkin’s lymphoma: diagnosis and management – guidance (NG52)
This guideline aims to improve care of non-Hodgkin's lymphoma by promoting best tests for diagnosis and staging and most effective treatments for 6 of the subtypes.
Tests/treatments covered include excision biopsy/ radiotherapy/ immunochemotherapy/ stem cell transplantation.
NICE Guidance NG53 Transition between inpatient mental health settings and community or care home settings
This guideline aims to help people who use mental health services, and their families and carers, to have a better experience of transition by improving the way it’s planned and carried out.
This guideline includes recommendations on:
• overarching principles for good transition
• planning for admission and discharge
• out-of-area admissions
• support for families and carers

39. What’s New? – NICE contd.
Mental health problems in people with learning disabilities: prevention, assessment and management – guidance (NG54)
This NICE guideline covers preventing, assessing and managing mental health problems in people with learning disabilities. It aims to improve assessment and support, and help people with learning disabilities and their carers to be involved in their care.
This guideline includes recommendations on:
organising and delivering care
involving people in their care
prevention, including social, physical environment and occupational interventions
annual GP health checks
assessment
psychological interventions, and how to adapt these for people with learning disabilities
prescribing, monitoring and reviewing pharmacological interventions.

40. What’s New? – NICE contd.
Motor neurone disease – quality standard (QS126)
This quality standard is expected to contribute to improvements in quality of life, functional ability, patient-reported outcome: symptoms, patient and carer-reported outcome: satisfaction with care and support provided, and survival from onset of symptoms.
There is a list of 5 quality statements:
Statement 1. Adults diagnosed with motor neurone disease (MND) are given information about the diagnosis, prognosis and management of MND by a consultant neurologist with expertise in treating people with MND.
Statement 2. Adults with MND who have respiratory impairment are offered non invasive ventilation (NIV) based on regular assessments of respiratory function and symptoms.
Statement 3. Adults with MND receive tailored equipment and adaptions without delay, based on regular multidisciplinary team assessments.
Statement 4. Adults with MND receive personal care and support from a consistent team of workers who are familiar with their needs.
Statement 5. Adults with MND are given opportunities to discuss their preferences and concerns about end of life care at diagnosis and key stages of disease progression.

41. What’s New? – NICE guidelines contd.
Obesity: clinical assessment and management- quality standard (QS127)
The quality standard is expected to contribute to improvements in: change in weight, BMI and waist circumference, functional status, long-term mortality, maintenance of weight loss, obesity-related comorbidities, quality of life, and remission in people with type 2 diabetes.
There are 7 quality statements:
Statement 1. People are informed of their BMI when it is calculated and advised about any associated health risks.
Statement 2. Adults with a BMI of 30 or more for whom tier 2 interventions have been unsuccessful have a discussion about the choice of alternative interventions for weight management, including tier 3 services.
Statement 3. Children and young people who are overweight or obese and have significant comorbidities or complex needs are referred to a paediatrician with a special interest in obesity.
Statement 4. Adults with a BMI of 35 or more who have been diagnosed with type 2 diabetes within the past 10 years are offered an expedited referral for bariatric surgery assessment.
Statement 5. Adults with a BMI above 50 are offered a referral for bariatric surgery assessment.
Statement 6. People who have had bariatric surgery have a postoperative follow-up care package within the bariatric surgery service for a minimum of 2 years.
Statement 7. People discharged from bariatric surgery service follow-up are offered monitoring of nutritional status at least once a year as part of a shared-care model of management.

42. What’s New? – NICE guidelines contd.
Reference Title Published Last updated
number
CG42 Dementia: supporting people with dementia and
their carers in health and social care November May 2016
CG98 Jaundice in newborn babies under 28 days May May 2016
TA217 Donepezil, galantamine, rivastigmine and
memantine for the treatment of Alzheimer's disease March May 2016
CG152 Crohn's disease: management October May 2016
CG155 Psychosis and schizophrenia in children and young
people: recognition and management January May 2016
NG47 Haematological cancers: improving outcomes May May 2016
TA390 Canagliflozin, dapagliflozin and empagliflozin as
monotherapies for treating type 2 diabetes May May 2016
NG33 Tuberculosis January May 2016
QS12 Breast cancer September 2011 June 2016
QS122 Bronchiolitis in children June June 2016
QS123 Home care for older people June June 2016 T

43. What’s New? – NICE guidelines contd.
Reference Title Published Last updated
number
TA392 Adalimumab for treating moderate to severe
hidradenitis suppurativa June June 2016
TA393 Alirocumab for treating primary
hypercholesterolaemia and mixed dyslipidaemia June June 2016
TA394 Evolocumab for treating primary
hypercholesterolaemia and mixed dyslipidaemia June June 2016
TA395 Ceritinib for previously treated anaplastic lymphoma
kinase positive non-small-cell lung cancer June June 2016
TA396 Trametinib in combination with dabrafenib for
treating unresectable or metastatic melanoma June June 2016
TA397 Belimumab for treating active autoantibody-positive
systemic lupus erythematosus June June 2016
QS124 Suspected cancer June June 2016