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

Medicines Update Primary Care July 2017

High Cost Drugs in Cystic Fibrosis

The West of Scotland Adult Cystic Fibrosis Unit is based in the Queen Elizabeth University Hospital and currently has 265 patients.

Patients are reviewed approximately every 3 months at an out-patient clinic at the hospital.  This is a multi-disciplinary clinic where the patient is reviewed by all members of the cystic fibrosis (CF) team.

Drug treatment of CF is aimed at maintaining lung function and preventing infection.  A variety of high cost drugs can be used in the treatment of CF.  These drugs have approval to be initiated by the CF consultant in hospital and then continued in Primary Care.

The drugs in the attached file are used in the routine care of patients with CF and can be prescribed by a GP following initiation by a CF consultant.  These drugs are recognised in the High Cost Contingency arrangements which mean that additional budget will automatically be allocated. Please click here.

Contact details for the Cystic Fibrosis Pharmacists at QEUH:

 Iona Paterson:

Tel 0141 201 1100, page 15340 email iona.paterson@ggc.scot.nhs.uk

Ruth Waters:

Tel 0141 451 5717 email ruth.waters@ggc.scot.nhs.uk


Ensure Shake®  (57g sachet)

Ensure Shake® is GGC’s formulary preferred list first line product. It is a powdered supplement and is not the same as the non-formulary powdered supplement ENSHAKE® (96.5g sachet).  They are not interchangeable and care needs to be taken to check the correct product is being prescribed and dispensed as there is a significant nutritional and price difference between the two products.


Advantages of Olive Oil Ear Drops

The Practice Development Nurses in NE Glasgow HSCP evaluated the benefits of using olive oil ear drops for a prolonged period of oiling (2 weeks as opposed to 3 days with Cerumol®) to soften ear wax and reduce the need for irrigation of the ear to remove wax.  The advantages of olive oil over proprietary branded products include -

  • Olive oil does not contain excipients which can irritate the ear canal and is not nut based.
  • Olive oil has a lower acquisition cost than alternative proprietary products.

Proprietary branded products such as Cerumol® are not suitable for prolonged use i.e. 2 weeks and can lead to ear irritation which can make irrigation less comfortable. The pilot demonstrated that appropriate use of olive oil ear drops for two weeks reduced the requirement for ear irrigation improving patient safety, reducing risks and costs.  The projected annual savings were £45,000 per annum for NE Glasgow.  Savings were generated from – reduced nursing time, GP time and equipment costs from carrying out less ear irrigations, and reduced drug costs.

 The following Scriptswitch® message has been added to prescribing systems to promote active switching from all other ear irrigation products to olive oil ear drops in preference.

The use of olive oil twice daily for two weeks is recommended in NHSGGC Clinical Guideline and is proven to reduce impacted wax in a significant proportion of patients thereby avoiding irrigation.

Also, olive oil ear drops are now included first line in the Community Pharmacy Minor Ailments Scheme formulary.

Launch of Ralvo® 700mg (5%w/w) Medicated Plaster

Ralvo® medicated plasters are a newly licensed lidocaine plaster. Ralvo® medicated plasters are 15% lower cost than Versatis® but are bioequivalent and have the same licensed indications. 
Lidocaine medicated plasters are included in the NHSGGC total formulary for restricted use. For formulary advice please click here
Following consultation with specialists in pain management, it has been agreed that there is no barrier to switching patients from Versatis® medicated plasters to Ralvo® medicated plasters at the next prescription.
Community Pharmacists are being made aware of a likely reduction in prescribing of Versatis® medicated plasters and advised to monitor demand and adjust stock levels of products accordingly this month.  A ScriptSwitch message prompting prescribing of Ralvo® medicated plasters will be deployed on GP clinical systems in the middle of July 2017 to allow sufficient time for Community Pharmacists to adjust stock levels.
In addition, prescribing support staff will be encouraged to support active switching to this product in GP practices.
Treatment benefit with lidocaine patches should be reassessed at regular intervals to decide whether the number of plasters needed to cover the painful area can be reduced:  if the plaster-free period can be extended; or if treatment can be discontinued For further information on reviewing patients prescribed lidocaine 5% plasters please click here.

Drug Shortages

A Medicines Update Primary Care Supplement outlining information on known drug shortages is available please click here.

ScriptSwitch Update: ScriptSwitch Feedback Function

One of the newer features of ScriptSwitch is a feedback button on the "pop-up" which allows the prescriber to send feedback directly to the NHSGGC Central Prescribing Team.

Use of the feedback function is optional. Prescribers can provide feedback regarding what they find useful and not so useful about switches and recommendations that are viewed. All feedback is reviewed and a response is issued through local prescribing leads. Some practices already use this function to provide comments, in particular highlighting any local drug supply shortages which the team then review.

To access the feedback window click on the speech bubble icon in the bottom left hand corner of the switch or message window.

ScriptSwitch new direct equivalents
GP practices are encouraged to review the following switches, and change to the new branded products which are direct equivalents to the recognised original brand, and are significantly more cost effective:

Requip® XL (and generic ropinirole XL) prolonged release tablets →Ipinnia XL® prolonged release tablets
Stalevo® film-coated tablets → Stanek ® film-coated tablets
Mirapexin® prolonged-release tablets→ Pipexus®  prolonged-release tablets
Butrans ® (and generic buprenorphine) 7 day patches → Butec ®7 day patches 
Spiriva ® 18 microgram, inhalation powder  → Braltus® 10 microgram per delivered dose inhalation powder
Fultium D3® (and generic colecalciferol) 800 IU Capsules → Invita D3® 800 IU Capsules