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

Postscript Primary Care - June 2012

Travel vaccines

Travel vaccines which may be prescribed on the NHS under the General Medical Service Contract are:
• Cholera
• Diptheria/Tetanus/Polio
• Hepatitis A
• MMR/Rubella
• Smallpox
• Typhoid 

All other travel vaccines and malaria prophylaxis should be prescribed via a private prescription. NHS travel vaccines are supplied and administered on an individual basis and therefore should be prescribed on a GP10. Stock orders should not be used in place of a GP10 to supply medication to named patients.

Travel vaccines should not be obtained by stock order. The purpose of a stock order is:
• To order drugs and appliances for the immediate treatment of patients and drugs which are to be administered by the doctor himself, eg adrenaline injection for anaphylaxis or benzylpenicillin for suspected meningitis
• For supply to a patient when their need cannot be met by giving a prescription in normal way, eg in emergencies

Unlike prescriptions, stock orders are subject to the addition of 17.5% oncost plus VAT which increases the cost of such supplies to the NHS.

For more travel vaccine details see: www.travax.scot.nhs.uk, www.fitfortravel.nhs.uk, www.dh.gov.uk 

Tacrolimus prescribing advice

Oral tacrolimus products should be prescribed and dispensed by brand name only to minimise the risk of medication errors.

This updated advice was issued by the Commission on Human Medicines to minimise the risk of switching between products which has been associated with toxicity and graft rejection.

When prescriptions have previously been written generically, the brand on which the patient has been stabilised should be established to ensure they are supplied with the same product.

If a prescriber intends to switch between brands, this should be accompanied by careful medical supervision and therapeutic monitoring. Patients should be advised to take careful note of their usual brand and check with their doctor or pharmacist if they receive a different brand or have any other questions about the prescription, eg about the dose.

Intranasal corticosteroids

Rhinocort Aqua® nasal spray (budesonide 64mcg/spray) replaced mometasone as the formulary preferred list second choice steroid nasal spray in February 2012.

The first line choice remains beclometasone nasal spray (50mcg/spray, 200 dose pack size) with budesonide as an alternative in patients in whom beclometasone is ineffective or not tolerated.

Fluticasone propionate and fluticasone furoate (Avamys®) are included in the total formulary but restricted to specialist initiation and should be reserved for patients that cannot tolerate or do not respond to the preferred list drugs.

Sunscreens and ACBS

In certain conditions, some foods and toiletry preparations have the characteristics of drugs. The Advisory Committee on Borderline Substances (ACBS) advises on the circumstances in which these products may be regarded as drugs.

Sunscreen preparations marked ‘ACBS’ are only regarded as drugs when prescribed for skin protection against ultraviolet radiation in abnormal cutaneous photosensitivity resulting from genetic disorders or photodermatoses, including vitiligo and those resulting from radiotherapy; chronic or recurrent herpes simplex labialis. Preparations with SPF less than 30 should not normally be prescribed.

NHSGGC Formulary options-
Preferred list - Sunsense® Ultra lotion SPF 50
Total formulary - Uvistat® cream SPF 30

Anapen® precautionary recall

An MHRA alert was issued in May advising people who suffer from severe allergic reactions to see their GP or clinic as soon as possible to discuss alternatives after a precautionary recall of all Anapen® injectors.

A potential problem with the speed and delivery of adrenaline by Anapen® injectors was found by the manufacturers but no problems have been reported by patients or healthcare professionals.

Patients changing device should be supplied with two new auto-injectors and provided with training on how to administer them. Using the same injection technique for a different delivery system could lead to patient harm.

People with Anapen® injectors at home are advised to continue using them until they can attend their GP or clinic.

Formulary oral contraceptives

The contraceptive section of the NHSGGC Formulary was reviewed and updated earlier this year with changes made to both preferred list and total formulary options. The updated guideline is available on StaffNet, included in the electronic formulary and synonyms, and the Sandyford service has already adopted it.

1st line combined oral contraceptive
• Rigevidon®
1st line progestogen-only contraceptive
• Micronor® or Noriday®

Where more than one brand is available containing the same hormones at the same strengths, the most cost-effective brand has been included in the formulary and savings can be made by switching patients to the preferred brands. 



Femodene® Millinette® 30/75
Femodette® Millinette® 20/75
Logynon® TriRegol®
Mercilon® Gedarel® 20/150
Microgynon 30® Rigevidon®
Ovranette® Rigevidon®










Updated Wound Dressings Formulary

The updated NHSGGC Primary Care Wound Dressing Formulary is now available here. The new dressings list will be included in the next electronic formulary and synonyms updates for GP prescribing systems.

Indwelling Pleural Catheter Drainage Systems

Indwelling Pleural Catheter Drainage Systems are now included in the Scottish Drug Tariff. A number of products from the Rocket range are available including -

  • Dressing Pack & Bottle - R54400
  • Pre-evacuated Bottle - R54410
  • Drainage Bag & Dressing Pack - R54401
  • Mini Dressing Pack & Bottle - R54400-00-PP
  • Drainage Line - R54400-00-DL
  • Valve Cap - R54410-00-CP

Products should be prescribed by description and code. Clarification may be sought from Respiratory departments if necessary for individual patients.