NHCCG Prescribing Forum
23rd July 2015
What’s New? - Product withdrawals or
shortages
Co-danthramer (dantron/poloxamer 188 25mg/200 mg) and Strong Co-danthramer
(dantron/ poloxamer 188 37.5mg/500 mg) capsules discontinued by Napp.
•
Stocks of Co-danthramer capsules are expected to last until the end of June 2015 and
•
stocks of Strong Co-danthramer capsules to last until the end of December 2015.
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Alternative suspension formulations of Co-danthramer are available.
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Review patients for a suitable alternative.
Allergan have announced that from July 1st they will cease to supply Lumigan®
(bimatoprost ophthalmic solution) 0.03% Multidose eye drop solution.
•
Reason- 0.01% (100mcg/ml) Bimatoprost has been shown to be as efficacious at lowering IOP
as the 0.03% BUT has a lower incidence of adverse effects (Am J Opthalmol 2010;149:661- 671)
•
Lumigan® 0.01% Multidose and
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Preservative Free Lumigan® 0.03% Unit dose remain available.
De- Noltab® (tripotassium dicitratobismuthate) tablets 120mg to be discontinued
Discontinued with effect from the end of Dec 2015 (the manufacturer has written to healthcare
professionals advising of this- no reason has been given for this decision in the letter).
What’s New? - Product withdrawals or
shortages contd.
Zaleplon (Sonata®) capsules have been discontinued.
•
Review patients for the continued need of a hypnotic.
•
Alternative Z- drugs (Zolpidem and Zopiclone) remain available.
•
Prescribe for short term periods only.
Tegretol® Chewtabs no longer available.
Patients currently taking Tegretol® Chewtabs should not stop taking them but be reviewed for a
•
change to a different formulation of Tegretol or to another drug by their GP or neurologist.
•
Tegretol® tablets, slow- release tablets, suppositories and liquid remain available.
•
MHRA/ CHM advice is that patients being treated for epilepsy should be maintained on a
specific manufacturer’s product (see BNF 4.8.1)- advise patients on potential side- effects and
failure of seizure- control.
Temporary Zapain Shortage.
A rep from AmCo states that the shortage of Zapain should be resolved by July 15th. The rep did say
that the company are hopeful that this won't happen again.
What’s New? - Product withdrawals or
shortages contd.
MenACWY vaccine for teenagers- shortage
(Vaccine Update Issue 230, June 2015)
•
•
•
•
•
•
Due to the speed with which the MenACWY programme is being implemented, PHE will be
holding less vaccine buffer stock than would usually be the case for a national programme.
This increases the risk that ordering restrictions may be implemented for temporary periods, or
vaccines may become temporarily unavailable for ordering, while they await further stocks to
be delivered.
For this reason, and because initial stocks may be relatively short dated, please do not stockpile
the vaccines or over-order, and please note that Menveo will be supplied in packs of five.
Details of the programme for implementation of this vaccination is set out in June’s issue of
Vaccine Update.
PHE will aim to ensure that any periods of supply disruption are minimised and will provide
regular updates through Vaccine update and the ImmForm news items.
https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/443262/PHE_
9402_VU230_June_2015_11_web.pdf
What’s New? – Savings
Medicines Optimisation Prescribing Hints
and Tips July 2015

×
Bicalutamide tablets 50mg, 150mg
Casodex® tablets 50mg, 150mg
Vitamin B Compund Strong tablets
Vitamin B Compound tablets
Biquelle® or Zaluron XL®
Quetiapine XL (if IR formulation is inappropriate)
Uniroid HC® ointment
Proctosedyl ® ointment
Sildenafil tablets 25mg, 50mg, 100mg
Viagra® tablets 25mg, 50mg, 100mg
Betnovate® valerate 0.122% cream or ointment 30g, 100g
Betamethasone valerate 0.1% cream or ointment 30g,
100g
Ferrous fumarate tablets 210mg (68mg iron)
Ferrous sulphate tablets 200mg (65mg iron)
Lucette® tablets
Yasmin® tablets (0.03 mg ethinylestradiol and 3 mg
drospirenone)
Peptac® oral liquid SF peppermint, aniseed flavours
Gaviscon Advance® oral suspension peppermint,
aniseed flavours
Paracetamol soluble tablets 500mg
Paracetamol oral solution 500mg/ 5ml
Paracetamol oral suspension 250mg/ 5ml (if oral liquid required)
Paracetamol oral solution 500mg/ 5ml
Luventa XL® capsules 8mg, 16mg, 24mg
Galantamine XL capsules 8mg, 16mg, 24mg
What’s New? - Price Concessions for
July 2015
July 2015 Concession
Drug
Generic (28)- £1.05
July Price
Difference
compared to
BNF
+ £1.60
Generic (28)- £1.44
+ £2.71
Generic (28)- £1.07
+ £3.88
Generic (28)- £1.01
+ £3.39
Mefenamic Acid
Generic (100)- £8.49
250mg capsules (100)£11.25
Mefenamic Acid
Generic (28)- £5.64
500mg tablets (28)£12.49
+ £2.76
Diclofenac Sodium
50mg gastro-resistant
tablets (28)- £2.99
Digoxin 62.5mcg
tablets (28)- £4.15
Digoxin 125mcg
tablets (28)- £4.95
Digoxin 250mcg
tablets (28)- £4.40
Drug Tariff Price
+ £6.85
Alternative Drug
Voltarol® 50mg gastroresistant
tab, 84=£4.57.
Lanoxin PG 62.5mcg tablets
(500)= £8.09
Lanoxin 125mcg tablets (500)=
£8.09
Lanoxin 250mcg tablets (500)=
£8.09
Ponstan 250mg capsules 100 =
£8.17
Ponstan Forte tablets 500mg 100
= £15.72 (16p per Ponstan tablet
compared to 53p for the generic)
or double- up doses of 250mg
capsules (500mg dose = 16p
using ponstan or 26p using
generic 250mg capsules).
What’s New? –Drug Tariff Anomalies
Paracetamol oral solution SF
•
Paracetamol 500mg /5ml oral solution SF is not listed in the drug tariff and is therefore treated as a
special.
•
Paracetamol 500mg /5ml oral suspension SF (£20.00/ 150ml) is listed in NHS England Drug Tariff.
However,
•
consider other cheaper formulations e.g. 500mg soluble tablets (£7.75/ 100 soluble tabs), 250mg/5ml
oral suspension (£1.36/ 100ml) or 250mg/5ml oral suspension SF (£1.74/ 200ml).
Liraglutide is not in the drug tariff
•
•
•
•
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There is currently no generic product available and as such pharmacies can obtain supplies from any
manufacturer and charge accordingly.
Prices in excess of £200 for 2 x 3ml Liraglutide Injections 6mg/ ml are not unknown compared to
prescribing the branded product Victoza®, list price £78.48.
GPs should therefore, prescribe the brand for those patients already established on this treatment.
However, the CCG’s preferred GLP-1 is lixisenatide and should be prescribed for all new initiations of
this group of antidiabetic drugs.
Remember NICE TA 203 recommends liraglutide administered at a dose of 1.2 mg once a day as a
possible treatment for some people with type 2 diabetes mellitus. However, NICE does not
recommend liraglutide administered at a higher dose of 1.8 mg once a day.
What’s New? –Drug Tariff Anomalies
contd.
Review the prescribing of an unlicensed medicine when there is a licensed medicine
available.
Unlicensed medicines- frequent offenders:
Unlicensed
Licensed
Fluoxetine 10mg tablets
Olena® 20mg dispersible tablets
Lamotrigine liquid
Lamotrigine dispersible tablets
Melatonin capsules all strengths
Midazolam Oromucosal Solution
10mg/ml
Melatonin 2mg MR tablets
Midazolam Oromucosal Solution
10mg/ml pre-filled syringe
Nitrofurantoin 100mg/5ml oral
supension
Nitrofurantoin 25mg/5ml oral
suspension
What’s New? –Drug Tariff Anomalies
contd.
Colecalciferol 15,000units/5ml oral solution and oral suspension
(Nhsbsa Newsletter Hints & Tips July 2015 Issue 20)
•
Colecalciferol 15,000units/5ml oral solution (i.e. Colecalciferol 3,000units/ml oral solution) is
now available as a licensed medicine and is listed in Drug Tariff Part VIIIA (£119.70/ 100ml),
whereas Colecalciferol 15,000units/5ml oral suspension (i.e. Colecalciferol 3,000units/ml oral
suspension) is only available as a Special Order product.
http://www.nhsbsa.nhs.uk/Documents/PrescriptionServices/Information_Services__Issue_20_(V2)_07.2015.pdf
Prices of Valsartan
• Prescribe generic capsules and double up doses, if appropriate, where strengths are not made:
Valsartan 40mg tablets 7 £2.75
Diovan® 40mg tablets 7=£3.49
Valsartan 40mg capsules 28 £2.78
Diovan® 40mg capsules 28=£13.97
Valsartan 80mg tablets 28 £13.97
Valsartan 80mg capsules 28 £2.98
Diovan® 80mg capsules 28=£13.97
Valsartan 160mg capsules28 £3.24
Diovan® 160mg capsules 28=£18.41
Valsartan 320mg tablets 28 £14.89
What’s New? –Drug Tariff Anomalies
contd.
Amlodipine 1mg/ml and 2mg/ml Oral Solution- new product
•
•
Launched for the treatment of hypertension, chronic stable angina pectoris, and vasospastic
(Prinzmetal's) angina in adults, and for treatment of hypertension in children aged 6 to 17 years
of age.
Cost for 150ml: 1mg/ml, £72.00; 2mg/ml, £110.00.
Fusidic acid 1% viscous eye drops 5g
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Significantly more expensive (£13.13/ 5g) than chloramphenicol 1% eye drops (£1.50/ 10ml)
Chloramphenicol has a broad spectrum of activity.
Reserve for 2nd- line use where fusidic acid is indicated.
PHE reminds clinicians to treat conjunctivitis if severe, as most are viral and self- limiting.
Bacterial conjunctivitis is usually unilateral and also self- limiting (65% resolving by Day 5).
What’s New? – Common queries
Mesalazine MR Prescribing
Following a review of the literature, changes have been made to the recommendations on
interchangeability of oral mesalazine preparations.
• The BNF now states that there is no evidence to show that any one oral preparation of
mesalazine is more effective than another.
• However, the delivery characteristics of oral mesalazine preparations may vary. If it is necessary
to switch a patient to a different brand of mesalazine, the patient should be advised to report
any changes in symptoms.
• PrescQIPP bulletin 79 reviews the cost of prescribing mesalazine MR generically and as the
Asacol® brand, and offers guidance and support to organisations who wish to recommend the
prescribing of branded Octasa® MR tablets.
http://www.prescqipp.info/resources/viewcategory/259-branded-mesalazine-prescribing
What’s New? – Common queries contd.
Melatonin treatment
For use in children of at least 1 year of age with neurodevelopment disability, autism, visual impairment or
neuropsychiatric disorders and chronic sleep disturbance, including chronic fatigue syndrome.
•
Licensed Circadin® tablets (melatonin 2mg MR, used off-label) should be the first line choice.
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Melatonin MR tablets 2mg (Circadin®) is the first line melatonin product as it has a UK product license (note its use in
children is off-label).
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For patients unable to swallow tablets, or requiring immediate release profile, Circadin® may be crushed or chewed.
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Off- label administration, taken from Basingstoke, Southampton & Winchester DPC Shared Care Guideline for
MELATONIN FOR SLEEP DISORDERS/DIFFICULTIES IN CHILDREN (GP Summary):
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The 2mg SR Circadin® tablet can be halved using a tablet cutter and it will retain its slow release characteristics.
•
Special order liquid medicines and capsules are unlicensed and expensive and should ONLY be used where absolutely
necessary.
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For children with difficulties swallowing, the tablet can be crushed to a fine powder and mixed with water or given
with cold soft food such as a teaspoon of yoghurt or jam. Use a small amount of food to ensure the full dose is taken.
The prescription should state that the medication is to be crushed prior to administration.
•
For administration via an enteral feeding tube, the tablet can be crushed to a fine powder and added to 15 - 30ml of
water and mixed well. This should be drawn into an oral syringe and administered taking care to rinse the
mortar/tablet crusher with water and administering the rinsings also. The feeding tube should be flushed with 30ml
water prior to and post drug administration.
•
NOTE: crushing the MR tablet will mean that it is no longer modified release.
•
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Melatonin Shared Care Guidelines approved: New shared care guidelines for the use of melatonin for sleep
disorders / difficulties in children have been developed in conjunction with local specialists. The guidelines
are available at: http://www.westhampshireccg.nhs.uk/downloads/categories/medicines/shared-careguidelines/1100-melatonin-shared-care-guidelines-gp-summary-2014-updated-may-2015/file
What’s New? – Common queries contd.
Availability of Colofac® tablets 135mg
Prescribers are being contacted by pharmacies stating that Colofac® tablets are out of
stock, and this is ultimately causing concerns regarding the CCG’s recommendation to
switch patients from generic mebeverine to the brand Colofac.®
• The manufacturer, Abbott Healthcare, at present (21.07.2015) has only limited stock
with outstanding orders to wholesalers already allocated once sufficient stock
becomes available.
• Abbott’s Medicines Information are unsure why stocks are so low and when the
problem will resolve.
What’s New? –Drug Safety Updates
https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/438800/Drug_Safety
_Update_-_June_2015_pdf.pdf
SGLT2 inhibitors (canagliflozin, dapagliflozin, empagliflozin) risk of diabetic ketoacidosis
(DKA)
(Drug Safety Update June 2015, Article 1).
• Test for raised ketones in patients with acidosis symptoms, even if plasma glucose levels are near
normal:
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Breathing difficulty, n & v, abdo pain, confusion and unusual fatigue or sleepiness.
Ensure patients are aware of the symptoms and to get immediate attention.
If you suspect DKA, STOP SGLT2 inhibitor treatment.
If DKA confirmed, correct it and monitor glucose levels.
High- dose ibuprofen (≥ 2400mg/day): small increase in Cardiovascular risk
(Drug Safety Update June 2015, Article 2).
• The MHRA and other EU medicines regulators have reviewed the safety of high-dose ibuprofen.
• This meta-analysis showed that people taking ≥2400 mg of ibuprofen per day are at a higher risk
of arterial thrombotic events (heart attack, stroke) than people taking placebo.
• The review confirmed that this higher risk is similar to that seen with COX-2 inhibitors and
diclofenac.
• No increase in cardiovascular risk is seen with ibuprofen doses of up to 1,200mg per day.
What’s New? –Drug Safety Updates contd.
https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/447037/Drug_Safety
_Update_-_July_2015_pdf.pdf
Denosumab (Xgeva▼, Prolia); intravenous bisphosphonates: osteonecrosis of the
jaw—further measures to minimise risk
(Drug Safety Update July 2015, Article 1).
Patient reminder cards about the risk of osteonecrosis of the jaw are being introduced;
denosumab 120 mg is now contraindicated in patients with unhealed lesions from dental or
oral surgery.
• Before prescribing denosumab or intravenous bisphosphonates:
 give patients the patient reminder card for their medicine
•
Explain the risk of osteonecrosis of the jaw and advise patients on precautions to take—
advise patients to:
 tell their doctor if they have any problems with their mouth or teeth before starting treatment; if
they wear dentures they should make sure their dentures fit properly before starting treatment
 maintain good oral hygiene and get routine dental check-ups during treatment
 tell their doctor and dentist that they are receiving denosumab or an intravenous bisphosphonate
if they need dental treatment or dental surgery
•
Do not prescribe denosumab 120 mg (cancer indication) to patients with unhealed lesions
from dental or oral surgery.
What’s New? –Drug Safety Updates contd.
https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/447037/Drug_Safety
_Update_-_July_2015_pdf.pdf
Latanoprost (Xalatan): increased reporting of eye irritation since reformulation
(Drug Safety Update July 2015, Article 2).
In 2013 the Xalatan® pH was reduced from 6.7 to 6.0 to allow for long-term storage at room
temperature. Following this reformulation there has been an increase in the number of reports of eye
irritation from across the EU.
• It is important that patients continue their treatment.
• When prescribing or dispensing the Xalatan® brand of latanoprost:
 Advise patients to tell their health professional promptly (within a week) if they experience severe eye
irritation (e.g. excessive watering) severe enough to to make them consider stopping treatment.
 review treatment if patients mention severe eye irritation.
New Yellow Card app for reporting suspected side effects
(Drug Safety Update July 2015, Article 3).
• This newly launched, free smartphone app enables healthcare professionals, patients, or carers
to report any suspected side effects to the Yellow Card Scheme—a convenient and secure
alternative to using paper Yellow Card forms or the Yellow Card website.
• On reporting, you will receive an immediate response to show that your Yellow Card report has
been accepted, and it is simple to view information for any Yellow Cards already submitted (even
if you don’t have a side effect to report at the time).
• Download the app via iTunes Yellow Card for iOS devices or via PlayStore Yellow Card for Android
devices.
What’s New? – Seasonal issues
Hayfever treatments- choosing between options.
There is no good evidence that any medicine within any of the classes used for treatment of hay fever
offers superior efficacy or safety. However, different classes of medication may be more effective
against specific symptoms in comparison to another (see table 1 on next slide).
• In most cases choice will be guided by patient preference, tolerability and cost.
• Low-cost generic products are available in almost all treatment classes.
• At recommended doses intra- nasal corticosteroids (INCS) are not generally associated with
clinically significant systemic side-effects. Reported differences in systemic bioavailability between
INCS are unlikely to be clinically relevant.
• It may nonetheless be prudent to use INCS with lower bioavailability when the potential for
systemic side-effects may be of greater concern. Correct use may minimise local adverse effects.
•
INCS begin to take effect after 7-8 hours and as-required use may have similar efficacy to oral
antihistamines for nasal symptoms.
• However, maximum efficacy may require up to two weeks use.
• Short-term use of intranasal or oral decongestants may be useful in reducing severe nasal blockage
when starting administration of other medication.
• Oral agents may be less suitable for some patients (e.g. hypertensive).
• To read the full article follow the link:
http://rdtc.nhs.uk/sites/default/files/publications/du_69_hay_fever_treatment.pdf
What’s New? – Seasonal issues contd.
Hayfever treatments- choosing between options, contd.
Table 1:
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•
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
INCs
H1-antihistamines
Oral
Intranasal
Eye drops
Chromones
Intranasal
Eye drops
Decongestants
Intranasal
Oral
Key – least effect
Sneezing Runny nose Congestion
+++
+++
+++
Itching Eye symptoms
++
++
++
++
-
++
++
-
+
+
-
+++
++
-
++
+++
+
-
+
-
+
-
+
-
++
-
-
++++
+
-
-
++++ greatest effect
What’s New? – Seasonal issues contd.
Topical Ketoprofen (brands Oruvail®, Powergel®, Tiloket®)
Photosensitivity reactions, including phototoxicity & photoallergic reactions are important and
potentially serious side- effects.
• Minimise the risk when prescribing any brand of ketoprofen 2.5% gel by:
 Checking that the patient doesn’t have any phototoxicity- or photoallergic- related C/Is.
 Check that the patient understands the risk of photosensitivity and
 Explain to the patient the steps that they need to take to minimise the risk .
Casodex® (bicalutamide)
The SPC has been updated to include photosensitivity as a rare side- effect. Patients taking
Casodex® should avoid:
• Direct exposure to excessive sunlight, or
• UV light, and
• consider using sunscreen.
What’s New? – Safety
Caution when administering Zoladex LA® (goserelin)
(PJ Vol295 No 7871 18.07.2015)
The SPC now advises extra caution when administering the drug to patients with
• a low body mass index or
• those receiving anticoagulation medicine.
Severe Mental Illness: prescribing and monitoring antipsychotics’ tool
(PJ Vol295 No 7871 18.07.2015)
Developed by CPPE this is a free online learning tool for HCPs involved in the care of children, young
people and adults with psychosis, schizophrenia or bipolar disorder.
Available from the NICE website:
http://elearning.nice.org.uk/course/info.php?id=11
Parenteral naloxone can be supplied for use in saving life in emergencies.
(RPS Support Alert 20.07.2015)
• From 1st October 2015, parenteral naloxone can be supplied for use in saving life in emergencies by
individuals employed or engaged in the provision of lawful drug treatment services, that are either
provided by or on behalf of or under the arrangements made by a relevant body (see item 4a in Part
2(a) of Schedule 17 of the Human Medicines Regulations 2012 for a list of relevant bodies).
The parenteral medication that can be supplied should only contain naloxone hydrochloride and no
other products that are prescription only substances.
What’s New? – Safety contd.
Aqueous cream: may cause skin irritation
Reminder of MHRA Alert March 2013
Although aqueous cream is useful as a leave-on emollient in a substantial proportion of patients
with eczema, it is known that in some patients, especially in children, it can cause skin reactions,
such as stinging, burning, itching and redness, but not when used as a wash product.
• The difference in the irritation potential in some patients may be related to the contact time
with the skin, as soap substitutes are largely removed in the washing process.
• Medicines Management advise avoiding its use entirely to minimise the risk to this product.
• There are several cost- effective leave- on emollients and soap substitutes that can be chosen
instead.
• The following are on the CCG’s “Preferred list”: Zerobase® cream, Aquamax© cream,
ZeroAQS® cream (the latter two can be used as a leave- on emollient and as a soap substitute).
https://www.prescqipp.info/newsfeed/bulletin-76-launched-cost-effective-and-appropriateprescribing-of-emollients
The CCGs emollient spend for the period Dec 2014- May 2015 (ePACT) was
£179,960.73 = 30439 items of this the prescribing of Aqueous cream accounted for
£6,698.79 (3.7% of cost)= 1352 items (4% of items)
What’s New? – Safety contd.
Total Aq_Crm Prescribing Cost Dec 2014- May 2015
£1,400.00
£1,200.00
£1,000.00
£800.00
£600.00
£400.00
£200.00
£0.00
Total Aq_Crm Prescribing Cost
What’s New? – Safety contd.
Emollients containing antimicrobials
The BNF recommends when to use emollients containing an antibacterial and as such,
preparations e.g. Dermol & Eczmol, containing an antibacterial should be avoided unless infection
is present or is a frequent complication.
• Children with atopic eczema are known to carry a higher staph. colony so the use of these
products can be useful, but should be used for short periods of time.
• In all situations the use of antimicrobial- containing emollients should be reviewed regularly.
• Prescribe these medications where clinically appropriate to avoid sensitization and the
development of microbial resistance, and
• at the same time make substantial cost- savings (all of these products are more expensive
than antimicrobial- free emollients of similar lipid content.
The CCGs emollient spend for the period Dec 2014- May 2015 (ePACT) was
£179,960.73 = 30439 items of this the prescribing of antimirobial- containing emollients
accounted for £50,909.86 ( 28.3% of cost)= 8180 items (26.9% of items)
If we could switch 60% of these preparations to another emollient of a similar lipid content
the CCG could potentially save £53,594.51 per annum (based on average cost per item).
What’s New? – Safety contd.
£35,000.00
Cost of antimicrobial- containing emollients compared to total emollient spend Dec
2014- May 2015
£30,000.00
£25,000.00
£20,000.00
Total Emollient Prescribing Cost
£15,000.00
Cost of Antimicrobial- containing emollients
£10,000.00
£5,000.00
£0.00
What’s New? – Changes to CD regulations
Prescription requirement changes for Temazepam
As of 1st June 2015, prescriptions for Temazepam must fully comply with the prescription writing
requirements for Schedule 3 Controlled Drugs. Prescriptions for Temazepam must now contain the
following information:
• dose
• form
• strength (where appropriate)
• total quantity of the preparation in both words and figures
Electronic prescribing of Schedule 2 and 3 controlled drugs will be permitted where the Electronic
Prescribing System (EPS) is used. This is extended to private prescriptions, but only when private
prescribing takes place within an NHS consultation (for items not allowed at the NHS’s expense).
• Further information can be found on the PSNC website:
• PSNC CD Prescription Forms & Validity:
• http://psnc.org.uk/dispensing-supply/dispensing-controlled-drugs/controlled-drug-prescriptionforms-validity/ or
•
http://systems.hscic.gov.uk/eps/news
What’s New? – IT
EPS prescription tracker
The online EPS prescription tracker allows GP practices and pharmacies to check the status of the
prescription. This is particularly useful if you have a query about a missing electronic prescription or
wish to cancel a prescription but you need to check where in the process it is at.
• The user enters a prescription ID to find out where a prescription is in the process.
•
It is also possible to search by NHS number and date range.
• The tracker will confirm if the prescription has left the prescribing site, if it has reached the Spine
or if it has been delivered to a dispensing site.
• Shows the nominated dispenser.
• The tracker and a user guide can be found here:
http://systems.hscic.gov.uk/eps/library/rxtracker
For other information NHS England have published guidance on Electronic Repeat Dispensing and you
can find this at http://www.england.nhs.uk/ourwork/tsd/sst/erd-guidance/.
What’s New? – New NICE guidelines
NICE CG97 Lower urinary tract symptoms in men- drug treatment recommendations remain the same
as in the 2010 guidance, except “Do not offer PD5i solely for the purpose of treating LUTS in men,
except as part of a randomised controlled trial.” NICE CG97: LUTS in men: assessment and
management
NG8 Anaemia management in people with CKD- guidance
NG9 Bronchiolitis in Children- the guidelines include when to refer children to secondary care and
also advises on what treatments should NOT be used.
NG10 Violence & aggression: short- term management in mental health, health & community
settings.
NG11 Challenging behaviour & learning disbilities: prevention & interventions for people with
learning disabilities whose behaviour challenges- It recommends considering antipsychotic
medication only when:
• psychological or other interventions alone do not produce change within an agreed time
• treatment for any coexisting mental or physical health problem has not led to a reduction in the
behaviour or
• the risk to the person or others is very severe for example, because of aggression or self-injury.
• In addition, antipsychotic medication should only be offered in combination with psychological
interventions.