Prescribing Hints & Tips
Number 38 Page 1 September April 2016 2016
Welcome to Prescribing Hints & Tips. This newsletter has been stream lined to include a brief summary This newsletter is written by of the articles only. For further information please follow the links provided the Shared Medicines Management team. We aim to highlight news and issues Ciclosporin incident. The root cause analysis of a local incident in from both public and professional media that may which a patient died concluded that it was likely that the patient affect your prescribing. involved had been taking an excessive dose of their ciclosporin.
We have provided a This caused an over-suppression of their immune system ,which summary of each article and may have resulted in a pre-disposition to more aggressive and described action that you may want to take. For unusual infections. Prescribers should therefore be alert to patients further information please follow the links provided. requesting additional supplies of medication usually prescribed in secondary care and explore if they have been taking their Prescribing Hints & Tips will be published every 3 medication correctly. months.
Medicines and the risk of falls. Many drugs are implicated in increasing the risk of falls, and this risk is greater if these types of drug are used concomitantly. Older patients are particularly at risk of the additive effects as they tend to be prescribed more medication. This chart displays the common medication that are implicated in falls and the mechanism of this adverse effect. This may be of use when conducting medication reviews.
Otitis Externa ear drops; current availability and price comparison
Ear drop Price for 1 bottle (Aug16 drug tariff)
Hydrocortisone Acetate 1% with Gentamicin 0.3% £23.92/10ml (Generic)
Gentisone HC® DISCONTINUED Acetic Acid 2% (Earcalm ®) Can be purchased OTC £4.10 /5ml Dexamethasone with Antibacterial (Sofradex®) £7.50 /10ml Dexamethasone with antibacterial (Otomize®) £3.27 /5ml
Flumetasone 0.02% with Clioquinol 1% (Generic) £13.82 /10ml Locorten-Vioform® DISCONTINUED
See the Nottinghamshire Antimicrobial Guidelines for further information
We would value your views on this newsletter. Please send all comments to: [email protected] Page 2 September 2016
Topical Hydrocortisone price comparison. There continues to be some quite significant price differences between different formulations and strengths of topical hydrocortisone. Formulation Cost per 15g tube (Aug 16 Drug Tariff)
Hydrocortisone 1% cream £0.91 Hydrocortisone 1% ointment £1.06 Hydrocortisone 0.5% cream £1.14 Hydrocortisone 2.5% cream £5.23 Hydrocortisone 0.5% ointment £5.55 Hydrocortisone 2.5% ointment £24.43
Nottinghamshire Appliance Management Service (NAMS). As you may be aware we have been working over the past 12 months to implement a County wide stoma prescription service that will move the prescribing responsibility away from general practice. Patients have begun to be transferred to this service on a practice by practice basis. The Service user handbook gives more information.
Fosfomycin for multiresistant UTI (on microbiology advice). Is available via importing companies (e.g Mawdsleys 0161 7423482, open 8.30 – 17.30 Mon – Fri) and is stocked at QMC and King’s Mill Hospital pharmacies. If local community pharmacies are unable to obtain a supply within 24 hours, prescriptions should be presented at a hospital pharmacy or a supply obtained from either of the hospital pharmacies. See the Nottinghamshire Antimicrobial Guidelines for further information.
Antimicrobial guideline update. Following a recent C. difficile death in a patient with difficult recurrent severe disease, the wording on the antimicrobial guidelines has been updated. This update does not change any of the recommended prescribing. For further information see the C. difficile section of the Nottinghamshire Antimicrobial Guidelines
Ready to feed Nutriprem 2. This will only be recommended very occasionally at the request of the neonatal dietitian or consultant neonatologist. In this situation, the discharge letter should ask for approximately 120x200ml bottles per 28 days. The reason for requiring ready-to-feed formula rather than powder should be detailed in the letter from secondary care, along with review criteria for this decision. See the updated infant feeding guidelines for more information
A recent NHS England circular stated that primary care needs to actively undertake prescribing of hormone therapy in transgender and non-binary adults who request treatment. The APC have summarised this information and developed a position statement with a view to supporting Nottinghamshire general practitioners. Watch out for the position statement being circulated soon.