Prescribing Newsletter February 2015

Prescribing Newsletter February 2015
This email has been sent to all Vale of York GPs, Practice Managers,
Practice Nurses, Local Pharmaceutical Committee, and copied to
clinicians at York Hospitals Foundation Trust
I am pleased to enclose the latest Vale of York CCG Newsletter edited
again by our guest editor Panacea, the god of universal remedy.
Panacea’s last publication was in April 2014 and she apologises for her
absence since then, blaming it on an unregulated concoction she was
given shortly afterwards. She is optimistic in 2015 she can be more
supportive and welcomes feedback from readers.
Kind regards,
Dr Shaun O’Connell
Prescribing Lead
Please share this email with any GP locums who work for you. If they
email their contact details to Maisie Pearson we will add them to our
database and include them in all future mailings.
Key contacts:
Commissioning queries: [email protected]
Medicines information queries:
[email protected]
Laura Angus – Lead Pharmacist, Vale of York
[email protected]
Tel: 01904 555190
Alex Molyneux – Senior Pharmacist, NYCS MMT
[email protected]
Mob: 07837 873949
1. MHRA Updates: valproate; nitrofurantoin; diclofenac
2. Quick fix cost saving changes – Movicol and Durogesic
3. All Trials Campaign
4. CD Governance Newsletter - signposting
5. NICE Bites- Pneumonia
6. Practice Communication Archive – signposting
1. MHRA Updates: Valproate
Medicines related to valproate: risk of abnormal pregnancy
outcomes (Sent January 2015)
This is to inform you of important new information and strengthened
warnings related to safety of medicines related to valproate (sodium
valproate, valproic acid [brand leader: Epilim] and valproate semisodium
[brand leader: Depakote]), following completion of a Europe-wide review.
For full information:
• Children exposed in utero to valproate are at a high risk of serious
developmental disorders (in up to 30-40% of cases) and/or congenital
malformations (in approximately 10% of cases)
• Valproate should not be prescribed to female children, female
adolescents, women of childbearing potential or pregnant women unless
other treatments are ineffective or not tolerated.
• Valproate treatment must be started and supervised by a doctor
experienced in managing epilepsy or bipolar disorder.
• Carefully balance the benefits of valproate treatment against the
risks when prescribing valproate for the first time, at routine
treatment reviews, when a female child reaches puberty and
when a woman plans a pregnancy or becomes pregnant.
• You must ensure that all female patients are informed of and
- risks associated with valproate during pregnancy;
- need to use effective contraception;
- need for regular review of treatment;
- the need to rapidly consult if she is planning a pregnancy or becomes
So what?
Panacea advises practice prescribing leads: Consider searching patients
of reproductive age on valproate who may need to be informed of this
advice. The MHRA have produced information booklets and educational
materials for healthcare professionals and patients in order to inform
about the risks associated with valproate in female children, female
adolescents, women of childbearing potential and pregnant women.
Back to Contents
MHRA Updates: Nitrofurantoin in Renal Impairment
The MHRA released a Drug Safety Update (Sept 2014) on the
prescribing of nitrofurantoin in renal impairment. MHRA guidance states
that nitrofurantoin is considered safe to be prescribed in patients with an
eGFR > 45mls/min. A short course (3- 7days) may be used with caution
in certain patients with an eGFR of 30 to 44mls/min to treat a lower
Urinary Tract Infection (UTI) with suspected or proven multidrug resistant
This is likely to have a big impact on prescribing for the treatment of
lower UTIs in both primary and secondary care. Nitrofurantoin was
previously contraindicated in patients with a creatinine clearance < 60
The MHRA state that they have reviewed the evidence for this
contraindication in the context of increasing antibiotic resistance of lower
urinary tract pathogens to standard therapy (trimethoprim and
amoxicillin). They also considered the risk of Clostridium difficile colitis
associated with the widespread use of alternative broad-spectrum
antibiotics (cephalosporins and flouroquinolones). They concluded that
the existing contraindication is no longer supported and that the
available evidence justified a revised contraindication against use in
patients with an eGFR of less than 45 ml/min.
So what?
Panacea advises all prescribers: Consider using nitrofurantoin in
patients for whom it was previously not recommended. Nitrofurantoin is
a second line choice (after trimethoprim) for UTIs in the local
antimicrobial guidance.
Back to Contents
MHRA Update: Diclofenac
Jan 2015 - Diclofenac tablets now only available as a prescription
People will no longer be able to purchase diclofenac tablets, used to
treat pain and inflammation, from pharmacies without a prescription from
their doctor due to the small risk of heart problems. Topical products
such as gels will remain available for purchase from pharmacies.
Oral diclofenac will now only be available as a POM with effect
from 15th January 2015.
So what?
Panacea advises practice prescribing leads: Prescribers may see an
increase in requests for diclofenac for patients that have previously been
buying it over the counter. Prescribers are reminded that diclofenac is
not recommended for prescribing. Vale of York CCG GPs are still
prescribing significant amounts of diclofenac. Please review all current
diclofenac prescribing in line with the MHRA guidance.
First line choice NSAIDs are ibuprofen and naproxen.
Back to Contents
2. Quick Fix Cost Saving Change
 Prescribers are reminded to prescribe Matrifen® or Fencino®
patches when a fentanyl patch is required. Please do not prescribe
Durogesic® brand.
If all Durogesic prescribing was switched to Matrifen/Fencino the costsavings for Vale of York CCG would be £57,000*. There are known
problems with Matrifen not sticking so well to some patients so prescribe
small quantities first or prescribe Fencino but only if patients are not
allergic to peanuts.
 Prescribers are reminded to prescribe generic Macrogol or
Laxido® when a macrogol is required (standard strengths). Please
do not prescribe Movicol® brand.
If all Movicol (standard strength) prescribing was switched to generic
macrogol or Laxido the cost savings for Vale of York CCG, based on Q2
data would be a massive £132,000. Many practices have undertaken
this change.
So what?
Panacea advises practice prescribing leads: Please monitor for
inadvertent new repeat prescribing and any prescribers who are not
aware of this price differences .Please review prescribing and ensure
CCG preferred choices are communicated to all relevant prescribers;
change current patients to preferred choices where appropriate to do so.
Back to Contents
3. Support the All Trials Campaign
It’s time all clinical trial results are reported. Patients, researchers,
pharmacists, doctors and regulators everywhere will benefit from
publication of clinical trial results. If you’d like to see a video regarding
the All Trials Campaign:
So what?
Panacea advises: Sign the petition at If patients ask
you whether they should take part in drug trials you could ask them
whether the researchers have signed up to All Trials and committed to
making the results freely available or not. If not, is their altruism being
exploited by the drug companies?
Back to Contents
4. Controlled Drugs and Governance Update –
January 2015
It contains key information and contacts:
CD Governance
Newsletter NYH AT Jan 2015 v1 00.pdf
So what?
Panacea advises all prescribers: A quick scan of it will help
ensure you are up to date with all the relevant information
Back to Contents
5. Nice Bites – January 2015 - Pneumonia NICE
NICE Bites – a monthly bulletin for healthcare professionals involved in
The aim of this publication is to provide healthcare professionals with a
clear and succinct summary of key prescribing points taken from NICE
guidance. It has emerged from collaboration with colleagues in primary
care in response to a need for easily accessible information.
This guideline covers the diagnosis and management of
community- and hospital-acquired pneumonia in adults.
So what?
Panacea advises all prescribers: This useful, mere 2-page guidance that
helps with the implementation of NICE recommendations and also filling
your CPD log for annual appraisal!
Back to Contents
6. Practice Communications Archive
If you need to remind yourself of what has been sent out in the past our
newsletters are now all available from the Prescribing pages of the
Referral Support Site. They’re at the bottom of the QIPP page
So what?
Panacea advises all readers: Just for information/reference
Back to Contents