NHS Greater Glasgow & Clyde Area Drug and Therapeutics Committee
Greater Glasgow and Clyde Medicines
Medicines Update Primary Care

Medicines Update Primary Care August 2015

Lumigan® Eye Drops

Lumigan® 0.3mg/ml (bimatoprost 0.03%) eye drops for the treatment of glaucoma have been discontinued in the UK, but the lower strength preparation containing Bimatoprost 0.1mg/ml (0.01%) remains available.

Both strengths have similar efficacy in lowering intraocular pressure, with the lower strength also having a better tolerability profile.

Patients can be switched from Lumigan® 0.3mg/ml (bimatoprost 0.03%) eye drops to the 0.1mg/ml (0.01%) eye drops at the same dosing frequency without the need to be seen at ophthalmology clinic.

ScriptSwitch has been updated with this information.

Please note that this advice does not apply to patients receiving Bimatoprost 0.03% unit dose eye drops (preservative free), as this formulation has not being discontinued and so no changes are required for these patients. These should only be used for those patients who have a proven sensitivity to the preservative benzalkonium chloride.

E- Formulary Update

There have been a number of changes to quantity and dosage information in the latest EMIS e-formulary – details available here . The main changes prescribers should note are:

  • Directions for use have now been added to some antibiotics where the directions field previously had “(GP INFO - SEE ANTIBIOTIC GUIDELINES OR SYNONYMS FOR APPROPRIATE DOSE AND QUANTITY)”. Directions and quantities are based on most commonly prescribed courses and prescribers should use clinical judgement on the appropriateness of these directions for individual patients.
  • Quantity of analgesics have been amended to reflect commonly prescribed quantities for acute conditions.

Importing the latest e-formulary is a requirement for practices signed up for the Medicines Management LES.

 

The latest version of the Vision e-formulary can be imported from here

The latest version of the EMIS e-formulary can be imported from here

EMIS practices please note that after importing the new e-formulary, each user needs to be assigned to the latest version in order to use the new version.

If you have any comments regarding the e-formulary then please email Prescribing@ggc.scot.nhs.uk 

 

High Cost/ Expensive Medicines

In October 2010 a process for dealing with expensive medicines within NHS Greater Glasgow and Clyde was agreed by the Primary Care Prescribing Management Group. It directly addressed the budgetary impact of exceptionally expensive drugs and protects a practice if they were to take on the prescribing of high cost medicines.

It is not an approval process for the prescribing of high cost medicines.

The drugs automatically accounted for are those in List 1.  They are medicines that are inherently expensive and have an average cost per dispensing of >£500 and are either listed in the NHS GGC Formulary or are specialist dietary supplements for rare metabolic disorders.  The Formulary list of expensive drugs that are automatically accounted for include those medicines that should be initiated by, or on the advice of, a specialist but may be continued by a GP (light blue S)

Inclusion criteria

  • Approved list (List1)
  • Shared Care Protocol medicines which meet the High Cost/ Expensive Medicines criteria

Exclusion criteria 

  • medicines that have an average cost per dispensing of less than £500
  • inherently expensive medicines which should have been prescribed by a specialist (dark blue S ) (List2)
  • inherently expensive medicines not approved for use by SMC (e.g. Duodopa®)
  • inherently expensive unlicensed medicines

List. Inherently expensive medicines whose costs are accounted for when budget-setting  

Based on analysis of prescriptions in NHS GGC that cost >£500 per dispensing for the period January 2015 to March 2015. Prescription data will be reanalysed at the end of the financial year and the list updated.

ADEFOVIR DIPIVOXIL (HEPATITIS B TREATMENT) 
LANREOTIDE (SOMATULINE®)
APOMORPH SOLUTION FOR INFUSION (APO-GO®)
METYRAPONE
ATOVAQUONE
MERCAPTAMINE BITATRATE
BETAINE ANHYDROUS
NABILONE
CEFTAZIDIME
NORMAL IMMUNOGLOBULIN-GAMMA GLOBULIN (SUBCUVIA®)
CHLORAMPHENICOL CAPSULES 250MG
OCTREOTIDE ACETATE (SANDOSTATIN®)
CINACALCET TABLETS 90MG
PRAMIPEXOLE TABLETS 3.15MG & 2.62MG MR (MIRAPEXIN®)
COLISTIMETHATE SODIUM (COLOBREATHE®)
RISPERIDONE INJ 50MG
DARPOETIN ALFA PREFILLED PENS 500MCG/ML (ARANESP® 300MCG/0.6ML)
SODIUM PHENYLBUTYRATE (AMMONAPS®)
DORNASE ALFA NEBULISER SOLUTION (PULMOZYME®)
SOMATROPIN (GENOTROPIN®, HUMATROPE®, OMNITROPE®, ZOMACTON®, SAIZEN®, NORDITROPIN®, NUTROPINAQ®)
ENTECAVIR
TACROLIMUS
EPOETIN ALFA INJECTION 40,000U (EPREX®)
TENOFOVIR DISOPROXIL (HEPATITIS B TREATMENT)
EPOETIN BETA INJECTION 20,000U & 30,000U (NEORECORMON®)
TOBRAMYCIN DRY POWDER FOR INHALATION (TOBI POD®)
FAMCICLOVIR TABS 500 MG (FAMVIR®)
TOBRAMYCIN NEBULISER SOLN (incl BRAMITOB®, TOBI NEB®)
GALANTAMINE S/F SOLN 20MG/5ML
VALGANCICLOVIR (CMV PROPHYLAXIS)
HYDROMORPHONE HCL CAPSULES 24MG M/R (PALLADONE SR®)
VORICONAZOLE

Foods for Special Diets
ADD INS® (ORAL SACHETS) (for phenylketonuria)
XP MAXAMUM PDR (for phenylketonuria)
EASIPHEN
MODULEN
GA GEL
MSUD PRODUCTS (for Maple Syrup Urine Disease)
HCU PRODUCTS (for homocystinuria)
PHLEXY-10 (for phenylketonuria)
LOPHLEX (for phenylketonuria)
PKU PRODUCTS (for phenylketonuria)
XP MAXAMAID XP PDR (for phenylketonuria)
TYR PRODUCTS (for tyrosinaemia)

 

Where specific formulations are not listed all formulations of the medicine will be accounted for

 

List2 Inherently expensive medicines not automatically accounted for that should be prescribed by a specialist

ABACAVIR AND LAMIVUDINE
LINEZOLID
ALITRETINOIN
POSACONAZOLE
AMIFAMPRIDINE
RALTEGRAVIR
CO-CARELDOPA INTESTINAL GEL (Duodopa®)
SODIUM OXYBATE
DARUNAVIR
STIRIPENTOL
EFAVIRENZ, EMTRICITABINE AND TENOFOVIR DISPROXIL
TEMOZOLOMIDE
FILGRASTIM
TERIPARATIDE
IMATINIB
INTERFERON BETA