DOCSLIB.ORG

West Sussex Health and Social Care NHS Trust

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
West Sussex Health and Social Care NHS Trust SUSSEX PARTNERSHIP NHS FOUNDATION TRUST MEDICINES FORMULARY GUIDELINE VERSION 26 RATIFYING GROUP (individual formulary Drugs and Therapeutics Group (DTG) decisions and linked guidelines) DATE PUBLISHED July 2021 NEXT REVIEW DATE July 2023 FORMULARY SPONSOR Chief Medical Officer FORMULARY EDITOR Chief Pharmacist LINKED POLICIES AND GUIDELINES Linked policies and antipsychotic Physical health linked guidelines guidelines • Antipsychotics, guidelines for cardiac • Antipsychotics, prescribing guidelines rhythm screening (ECGs) • Asenapine, prescribing guidelines • Antipsychotics, guidelines for the • Clozapine inpatient and community management of weight gain and team policies metabolic disturbances • Clozapine, protocol for the use of • Metformin, information for GPs on its intramuscular injection use with antipsychotics • Clopixol Acuphase, prescribing • Hyperprolactinaemia, prescribing guideline guidelines on the treatment of • Lurasidone, prescribing guidelines antipsychotic induced symptoms • Perinatal mental health, prescribing • Anticoagulants, prescribing guidelines guidelines • Insulin, prescribing guidelines • Rapid tranquilisation policy • Medicines code Long acting antipsychotic guidelines Anxiolytics and hypnotic guidelines • Long acting antipsychotic injections, • Alcohol and benzodiazepine guidelines for use dependence (adults), prescribing • Aripiprazole long acting injection, guidelines for inpatients • Benzodiazepine as anxiolytics (adults), prescribing guidelines prescribing guidelines • Olanzapine long-acting injection, • Benzodiazepines, calculating prescribing guidelines equivalent doses • Paliperidone monthly long acting • Hypnotics (including benzodiazepines) injection, prescribing guidelines and insomnia, prescribing guidelines • Paliperidone palmitate 3-monthly long acting Injection, prescribing guidelines Antidepressant prescribing guidelines Emotionally unstable personality disorder • Antidepressants, prescribing (EUPD), prescribing guidelines guidelines (note there are separate guidelines for adults and CAMHS) • Agomelatine, prescribing guidelines in major depressive episode Bipolar affective disorder linked Substance dependence guidelines guidelines • Alcohol and benzodiazepine • Mood stabilizers, prescribing dependence (adults), prescribing guidelines in bipolar affective disorder guidelines for inpatients • Lithium, prescribing guidelines for • Opiate dependence, prescribing guidelines for inpatients inpatients • Substances and drugs of abuse, a guide to how long they can be detected in the body after consumption • Tobacco dependence pathway Dementia and SOAMHs linked guidelines Attention Deficit Hyperactivity Disorder • Dementia, prescribing guidelines (ADHD) • Behavioural problems in older people, • ADHD Shared care guidelines prescribing guidelines (CAMHS) • Dementia, non-pharmacological • ADHD (adults), prescribing guidelines approaches to challenging behaviour • Guanfacine (CAMHS), prescribing guidelines • Melatonin Shared care guidelines (CAMHS) All prescribing guidelines and policies can be found on the Trust website from the following link: https://www.sussexpartnership.nhs.uk/medication Page 2 of 29 Index 1. Sussex Partnership NHS Foundation Trust: Formulary principles 4 2. SPFT formulary medicines for mental health diagnoses 6 2.1 Hypnotics 6 2.2 Anxiolytics 7 2.3 Antipsychotics 9 2.4 Mood stabilisers 17 2.5 Antidepressants 20 2.6 Medicines used in alcohol and substance dependence 23 2.7 Medicines used in dementia 24 2.8 Medicines used in the treatment of Attention Deficit Hyperactivity Disorder (ADHD) 26 2.9 Approved unlicensed medicines use for behaviour that challenges in Autism Spectrum Disorder (ASD) and Learning Difficulties (LD) 28 Page 3 of 29 1. Sussex Partnership NHS Foundation Trust: Formulary principles Only the following medicines can be prescribed to patients within Sussex Partnership NHS Foundation Trust (SPFT): • Medicines associated with their mental health need and diagnoses which are detailed in this formulary and have been approved for use by the Trust’s Drugs and Therapeutics Group (DTG). Senior medical staff in this formulary are defined as consultants, associate specialists and speciality doctors with at least 3 years’ experience. Please note that all medicines in every Trust must be approved for use by the local Area Prescribing Committee (APC) which is led by the Clinical Commissioning Group (CCG) according to each geographical location (East Sussex/ Brighton and Hove/ West Sussex). The newly formed Sussex Health and Care Partnership (SHCP) which spans across all 3 counties is working to align the separate formularies into a single SHCP formulary. Currently the links to each of these formularies can be accessed from the Trust website via this link: https://www.sussexpartnership.nhs.uk/formularies In the joint formularies, each medicine is colour coded. • Only medicines colour coded as green are permitted to be prescribed by the patient’s General Practitioner (GP). If your intention is that the patient’s GP will continue the prescription, please ensure it is coded green before initiating, • Blue coded medicines can only be transferred for GP prescribing once treatment is stabilised (usually after 3 months), • Amber coded medicines are approved for shared care with details outlined in individual shared care guidelines (SCGs), • Red medicines are specialist only medicines which can only be prescribed by a specialist. These include mental health medicines. The prescribing of red coded medicines for mental health can only be prescribed by SPFT clinicians, they cannot be transferred for GP prescribing. • Physical health medicines as approved for use according to the joint formulary by geographical location. You must only prescribe physical health medicines that are coded as green on the joint formularies. Please note that physical health medicines can only be prescribed for inpatients. Physical health medicines must not be prescribed on FP10 in community teams or clinics, except in exceptional and urgent circumstances. The responsibility for prescribing and monitoring physical medicines for patients in community teams or clinics is with the patient’s general practitioner (GP). • Over-the-counter (OTC) medicines if approved for use in the Trust formulary or in the relevant CCG’s joint formulary. • Complementary, essential oils, herbal and homeopathic medicines, if approved for use in the Trust formulary or in the relevant CCG’s joint formulary. N.B. Medicine supply for complementary, essential oils, herbal and homeopathic medicines is only permitted for those included within the formulary. However, if the patient has their own supply of a non-formulary medicine within these product groups then they may be prescribed for use only after a pharmacist has assessed their safety and clinical appropriateness (including assessment of drug interactions). Page 4 of 29 For inpatients; the pharmacist must endorse within the additional information on the front of the drug chart that they have clinically screened each item for use before administration may take place. For non-formulary items; the patient’s own supply must be used for administration. In order to request a new medicine or a new indication (diagnosis) for an existing medicine to be used within the Trust, the process within the ‘formulary, named-patient and unlicensed medicine use request protocol’ must be followed. This protocol is available through this link: https://www.sussexpartnership.nhs.uk/medication-related-guidance All associated forms to this protocol can be accessed through this link: https://www.sussexpartnership.nhs.uk/charts-and-forms • Unlicensed medicines o Wherever clinically appropriate, medicines must be prescribed within their product licence (PL) and within their marketing authorisation (MA). A medicine maybe used outside of its PL (unlicensed medicine) or MA (“off-label” medicine) where there is significant clinical evidence base to support its use and that use has been approved for use by the Drugs and Therapeutic Group (DTG). In the majority of cases, this is for an unlicensed indication but in rare situations may also include route and/ or dosage. o Every request for an unlicensed use of a medicine must be ratified by the Trust’s DTG. A prescriber is not authorised to prescribe an unlicensed medicine in this Trust, unless that use has been ratified by the DTG. A database of all unlicensed uses of medicines including named-patient forms where appropriate will be maintained by the Trust’s pharmacy team. Please ask your pharmacy team for a current copy of the approved unlicensed medicines database. Page 5 of 29 2. SPFT formulary medicines for mental health diagnoses 2.1 Hypnotics Please refer to the following SPFT clinical guidelines and NICE Technical Appraisals (where applicable) for prescribing, administration and monitoring advice: SPFT clinical guidelines NICE Technical Appraisals (found here: https://www.sussexpartnership.nhs.uk/medication- (TA) related-guidance) Hypnotics (including benzodiazepines) and insomnia, TA77: prescribing guidelines http://guidance.nice.org.uk/TA77 Z Drugs (oral) Additional notes, including where unlicensed Zolpidem TA77 First line in older people Zopiclone TA77 Benzodiazepines (oral) Loprazolam TA77 Temazepam TA77 Controlled drug – schedule 3 Oxazepam Only to be used when all other options have failed - unlicensed use (see below) Other oral hypnotics Chloral hydrate Can only be initiated by senior medical staff Clomethiazole Melatonin See unlicensed uses below
Load more

Recommended publications
  • Stable Pressurised Aerosol Solution Composition of Glycopyrronium Bromide and Formoterol Combination
    (19) TZZ¥¥_T (11) EP 3 384 898 A1 (12) EUROPEAN PATENT APPLICATION (43) Date of publication: (51) Int Cl.: 10.10.2018 Bulletin 2018/41 A61K 9/00 (2006.01) A61M 15/00 (2006.01) A61K 31/167 (2006.01) A61K 31/40 (2006.01) (2006.01) (2006.01) (21) Application number: 18171127.6 B65D 83/54 A61K 31/573 A61K 31/54 (2006.01) A61K 45/06 (2006.01) (2006.01) (2006.01) (22) Date of filing: 23.12.2014 A61K 9/12 A61K 31/58 A61M 39/22 (2006.01) (84) Designated Contracting States: • COPELLI, Diego AL AT BE BG CH CY CZ DE DK EE ES FI FR GB 43100 PARMA (IT) GR HR HU IE IS IT LI LT LU LV MC MK MT NL NO • DAGLI ALBERI, Massimiliano PL PT RO RS SE SI SK SM TR 43100 PARMA (IT) Designated Extension States: • USBERTI, Francesca BA ME 43100 PARMA (IT) • ZAMBELLI, Enrico (30) Priority: 30.12.2013 EP 13199784 43100 PARMA (IT) (62) Document number(s) of the earlier application(s) in (74) Representative: Bianchetti Bracco Minoja S.r.l. accordance with Art. 76 EPC: Via Plinio, 63 14825154.9 / 3 089 735 20129 Milano (IT) (71) Applicant: Chiesi Farmaceutici S.p.A. Remarks: 43100 Parma (IT) This application was filed on 08-05-2018 as a divisional application to the application mentioned (72) Inventors: under INID code 62. • BONELLI, Sauro 43100 PARMA (IT) (54) STABLE PRESSURISED AEROSOL SOLUTION COMPOSITION OF GLYCOPYRRONIUM BROMIDE AND FORMOTEROL COMBINATION (57) The invention concerns an aerosol solution lower than the limit of quantification, when stored in ac- composition intended for use with a pressurised metered celerated conditions at 25°C and 60% relative humidity dose inhaler, comprising glycopyrronium bromide and (RH) for 6 months in a can internally coated by a resin formoterol, or a salt thereof or a solvate of said salt, op- comprising a fluorinated ethylene propylene (FEP) poly- tionally in combination with one or more additional active mer.
    [Show full text]
  • Hypersalivation in Children and Adults
    Pharmacological Management of Hypersalivation in Children and Adults Scope: Adult patients with Parkinson’s disease, children with neurodisability, cerebral palsy, long-term ventilation with drooling, and drug-induced hypersalivation. ASSESSMENT OF SEVERITY/RESPONSE TO TREATMENT: Severity of drooling can be assessed subjectively via discussion with patients and their carers/parents and by observation. Amount of drooling can be quantified by measuring the number of bibs required per day and this can also be graded using the Thomas-Stonell and Greenberg scale: • 1 = Dry (no drooling) • 2 = Mild (moist lips) • 3 = Moderate (wet lips and chin) • 4 = Severe (damp clothing) CONSIDERATIONS FOR PRESCRIBING/TITRATION No evidence to support the use of one particular treatment over another. Drug choice is to be determined by individual patient factors. When prescribing/titrating antimuscarinic drugs to treat hypersalivation always take account of: • Coexisting conditions (for example, history of urinary retention, constipation, glaucoma, dental issues, reflux etc.) • Use of other existing medication affecting the total antimuscarinic burden • Risk of adverse effects Titrate dose upward until the desired level of dryness, side effects or maximum dose reached. Take into account the preferences of the patients and their carers/ parents, and the age range and indication covered by the marketing authorisations (see individual summaries of product characteristics, BNF or BNFc for full prescribing information). FIRST LINE DRUG TREATMENT OPTIONS FOR ADULTS
    [Show full text]
  • COPD Agents Review – October 2020 Page 2 | Proprietary Information
    COPD Agents Therapeutic Class Review (TCR) October 1, 2020 No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, digital scanning, or via any information storage or retrieval system without the express written consent of Magellan Rx Management. All requests for permission should be mailed to: Magellan Rx Management Attention: Legal Department 6950 Columbia Gateway Drive Columbia, Maryland 21046 The materials contained herein represent the opinions of the collective authors and editors and should not be construed to be the official representation of any professional organization or group, any state Pharmacy and Therapeutics committee, any state Medicaid Agency, or any other clinical committee. This material is not intended to be relied upon as medical advice for specific medical cases and nothing contained herein should be relied upon by any patient, medical professional or layperson seeking information about a specific course of treatment for a specific medical condition. All readers of this material are responsible for independently obtaining medical advice and guidance from their own physician and/or other medical professional in regard to the best course of treatment for their specific medical condition. This publication, inclusive of all forms contained herein, is intended to be educational in nature and is intended to be used for informational purposes only. Send comments and suggestions to [email protected]. October 2020
    [Show full text]
  • 1: Gastro-Intestinal System
    1 1: GASTRO-INTESTINAL SYSTEM Antacids .......................................................... 1 Stimulant laxatives ...................................46 Compound alginate products .................. 3 Docuate sodium .......................................49 Simeticone ................................................... 4 Lactulose ....................................................50 Antimuscarinics .......................................... 5 Macrogols (polyethylene glycols) ..........51 Glycopyrronium .......................................13 Magnesium salts ........................................53 Hyoscine butylbromide ...........................16 Rectal products for constipation ..........55 Hyoscine hydrobromide .........................19 Products for haemorrhoids .................56 Propantheline ............................................21 Pancreatin ...................................................58 Orphenadrine ...........................................23 Prokinetics ..................................................24 Quick Clinical Guides: H2-receptor antagonists .......................27 Death rattle (noisy rattling breathing) 12 Proton pump inhibitors ........................30 Opioid-induced constipation .................42 Loperamide ................................................35 Bowel management in paraplegia Laxatives ......................................................38 and tetraplegia .....................................44 Ispaghula (Psyllium husk) ........................45 ANTACIDS Indications:
    [Show full text]
  • The Use of Oral Glycopyrronium in Palliative Care
    Page 1 of 4 The use of oral glycopyrronium in palliative care April 2019 Summary There is limited information on the use of oral glycopyrronium in palliative care. It has, however, been proposed for use in the management of drooling and paraneoplastic sweating in patients with palliative care needs1. Of note, information available to support the use of oral glycopyrronium to treat excessive respiratory secretions at the end of life is not available – the literature only refers to its use when administered subcutaneously. Glycopyrronium bromide is poorly absorbed from the gastrointestinal tract following oral use which has implications for its dosing. If glycopyrronium is to be used orally the lowest effective dose should be initiated and titrated according to response. The patient should also be monitored for any adverse effects. Mechanism of action Glycopyrronium is an anticholinergic agent which inhibits the acetylcholine activity on smooth muscles and structures innervated by parasympathetic nerves.2,3 Salivation is primarily mediated by parasympathetic innervation of the salivary glands and glycopyrronium competitively inhibits cholinergic receptors in salivary glands and other peripheral tissues, thus indirectly reducing the rate of salivation3. Other effects of glycopyrronium include bronchodilation, decreased volume and acidity of gastric secretions, as well as control of excessive pharyngeal, tracheal and bronchial 2 secretions. Palliative Meds Info: Terms and Conditions The information outlined above is intended for healthcare professionals only. The information outlined above is believed to accurately reflect the medical literature at the time of writing. Healthcare professionals must use their own judgment to determine the accuracy and relevance of the information. See www.olh.ie for full terms and conditions.
    [Show full text]
  • NVA237 / Glycopyrronium Bromide Multinational, Multi-Database Drug
    Quantitative Safety & Epidemiology NVA237 / Glycopyrronium bromide Non-interventional Final Study Report NVA237A2401T Multinational, multi-database drug utilization study of inhaled NVA237 in Europe Author Document Status Final Date of final version 28 April 2016 of the study report EU PAS register ENCEPP/SDPP/4845 number Property of Novartis Confidential May not be used, divulged, published or otherwise disclosed without the consent of Novartis NIS Report Template Version 2.0 August-13-2014 Novartis Confidential Page 2 Non-interventional study report NVA237A/Seebri® Breezhaler®/CNVA237A2401T PASS information Title Multinational, multi-database drug utilization study of inhaled NVA237 in Europe –Final Study Report Version identifier of the Version 1.0 final study report Date of last version of 28 April 2016 the final study report EU PAS register number ENCEPP/SDPP/4845 Active substance Glycopyrronium bromide (R03BB06) Medicinal product Seebri®Breezhaler® / Tovanor®Breezhaler® / Enurev®Breezhaler® Product reference NVA237 Procedure number SeebriBreezhaler: EMEA/H/C/0002430 TovanorBreezhaler: EMEA/H/C/0002690 EnurevBreezhaler: EMEA/H/C0002691 Marketing authorization Novartis Europharm Ltd holder Frimley Business Park Camberley GU16 7SR United Kingdom Joint PASS No Research question and In the context of the NVA237 marketing authorization objectives application, the Committee for Medicinal Products for Human Use (CHMP) recommended conditions for marketing authorization and product information and suggested to conduct a post-authorization
    [Show full text]
  • Specials and Expensive Liquids Guideline
    Specials and expensive liquids guideline Click on the sub headings below for: A-Z for specials and expensive liquids A-Z eye preparations A-Z skin preparations This guideline contains a list of commonly prescribed medicines and alternative methods of administration for patients with swallowing difficulties, feeding tubes or for patients prescribed unlicensed ‘specials’ medication. Each entry takes into account alternative medicines, formulations, cost and licensing. This list is not exhaustive and will be reviewed and updated accordingly. Equality Statement Derby and Derbyshire Clinical Commissioning Group’s aim is to design and implement guidelines and policies that meet the diverse needs of the populations to be served and the NHS workforce has a duty to have regard to the need to reduce health inequalities in access to health services and health outcomes achieved as enshrined in the Health and Social Care Act 2012. Derby and Derbyshire CCG is committed to ensuring equality of access and non-discrimination, irrespective of age, gender, disability (including learning disability), gender reassignment, marriage and civil partnership, pregnancy and maternity, race, religion or belief, sex (gender) or sexual orientation. It takes into account current UK legislative requirements, including the Equality Act 2010 and the Human Rights Act 1998, and promotes equality of opportunity for all. This document has been designed to ensure that no-one receives less favourable treatment owing to their personal circumstances. Due Regard In carrying out its functions, the Derbyshire Joint Area Prescribing Committee on behalf of Derby and Derbyshire CCG is committed to having due regard to the Public Sector Equality Duty.
    [Show full text]
  • (Lamas) a New Frontier for COPD and Asthma Treatment
    White Paper Long-Acting Muscarinic Agents (LAMAs) A New Frontier for COPD and Asthma Treatment LAMAs in Asthma and COPD Table of Contents 1. Introduction ............................................................................................. 3 2. Tiotropium Bromide ................................................................................. 4 3. Tiotropium + Olodaterol .......................................................................... 7 4. Aclidinium Bromide ................................................................................. 8 5. Aclidinium + Formoterol (ACLIFORM) ....................................................... 9 6. Glycopyrronium Bromide ....................................................................... 10 © 7. Glycopyrronium Bromide + Indacaterol (ULTIBRO )............................... 11 8. Glycopyrronium Bromide + Formoterol .................................................. 13 9. Umeclidinium ........................................................................................ 13 10. Umeclidinium + Vilanterol ..................................................................... 14 11. Triple Therapy ........................................................................................ 16 12. Conclusions ............................................................................................ 16 13. About the Author ................................................................................... 17 14. About CROMSOURCE ............................................................................
    [Show full text]
  • 208437Orig1s000
    CENTER FOR DRUG EVALUATION AND RESEARCH APPLICATION NUMBER: 208437Orig1s000 CLINICAL PHARMACOLOGY AND BIOPHARMACEUTICS REVIEW(S) CLINICAL PHARMACOLOGY REVIEW NDA 208437 Submission Date 07/29/2016 Submission Type 505(b)(2) Generic Name Glycopyrrolate Inhalation Solution Clinical Pharmacology Reviewers - Bhawana Saluja, Ph.D., Anshu Marathe Ph.D. (Team Leader) OCP Review Team Pharmacometric Reviewers - Chao Liu, Ph.D., Jingyu Yu, Ph.D. (Team Leader) OCP Division Clinical Pharmacology 2 Division of Pulmonary, Allergy, and Rheumatology OND Division Products Applicant Sunovion Respiratory Development Inc. Solution for oral inhalation, each 1 mL unit-dose single- Dosage Form and Strength use vial contains 25 mcg of glycopyrrolate (25 mcg/mL) Inhalation of the contents of one vial (25 mcg/mL strength) Proposed Dosing Regimen twice-daily via a portable nebulizer closed-system (CS) eFlow® nebulizer Relevant IND/NDA IND 110663 Maintenance treatment of airflow obstruction in patients Proposed Indication with chronic obstructive pulmonary disease (COPD) including emphysema and/or chronic bronchitis Table of Contents 1. Executive Summary .............................................................................................................................. 5 1.1. Recommendations ..................................................................................................................................... 5 1.2. Post Marketing Requirement ..................................................................................................................
    [Show full text]
  • Inhaled Bronchodilator – Muscarinic Antagonist Medication
    Inhaled Bronchodilator – Muscarinic Antagonist Medication Inhaled Bronchodilator ~ Muscarinic Antagonist Medication ~ Other names for this medication: Short-Acting: Atrovent – ipratropium bromide Long-Acting: Incruse – umeclidinium Incruse – umeclidinium bromide Seebri – glycopyrronium bromide Spiriva – tiotropium bromide Tudorza – aclidinium bromide How does this medication work? This medication helps the muscles around the bronchial tubes in the lungs to relax. This widens or bronchodilates the tubes and improves breathing. This medication also makes the muscle less likely to contract and narrow the tubes in response to exercise, cold air and irritants such as dust and cigarette smoke. How fast and long does this medication work? Atrovent: This depends on how you are advised to use it. It takes about 5 to 15 minutes to begin working. The effects can last for 4 to 6 hours. Incruse: Begins to work within 30 to 60 minutes. Seebri: Begins to work within 5 to 15 minutes. Spiriva: Begins to work within 30 to 60 minutes. Tudorza: Begins to work within 30 to 60 minutes. Please turn over 1 Inhaled Bronchodilator – Muscarinic Antagonist Medication How much medication do I take and how often? Take this medication on a regular basis as directed by your doctor. While taking this medication you may notice: headache dry mouth bad taste in mouth constipation Dry mouth often goes away. If not, talk to your health care provider about what you can do to help. Consult your doctor if: this medication is less effective than usual you have trouble passing urine If any of these occur, you may need other treatment. PD 6229 (Rev 03-2016) 2 .
    [Show full text]
  • Drug Tariff Price Changes
    Drug tariff February 2017 Top 10 price reductions since January 2017 Medicine Pack size Basic price January 2017 Difference Chloral hydrate 143.3mg/5ml oral solution BP 150 ml £244.25 £274.90 -£30.65 Linezolid 600mg tablets 10 tablet £333.82 £360.06 -£26.24 Doxepin 50mg capsules 28 capsule £154.00 £175.18 -£21.18 Cloral betaine 707mg tablets 30 tablet £138.59 £155.98 -£17.39 Olsalazine 500mg tablets 60 tablet £161.00 £177.10 -£16.10 Budesonide 3mg gastro-resistant modified-release capsules 100 capsule £84.15 £99.00 -£14.85 Olsalazine 250mg capsules 112 capsule £144.00 £158.40 -£14.40 Mesalazine 800mg gastro-resistant tablets 180 tablet £80.75 £95.00 -£14.25 Doxepin 25mg capsules 28 capsule £97.00 £110.34 -£13.34 Methocarbamol 750mg tablets 100 tablet £45.02 £55.80 -£10.78 Top 10 price increases since January 2017 Medicine Pack size Basic price January 2017 Difference Quinagolide 75microgram tablets 30 tablet £55.00 £27.00 £28.00 Ampicillin 500mg capsules 28 capsule £40.30 £20.50 £19.80 Ampicillin 250mg capsules 28 capsule £20.50 £4.52 £15.98 Sulfadiazine 500mg tablets 56 tablet £109.37 £99.57 £9.80 Isocarboxazid 10mg tablets 56 tablet £197.95 £188.95 £9.00 Menadiol 10mg tablets 100 tablet £185.90 £177.45 £8.45 Atropine 1% eye drops 10 ml £80.34 £73.52 £6.82 Tamoxifen 40mg tablets 30 tablet £38.09 £33.50 £4.59 Ephedrine hydrochloride 30mg tablets 28 tablet £44.46 £40.25 £4.21 Testosterone enantate 250mg/1ml solution for injection ampoules 3 ampoule £79.75 £76.13 £3.62 Page 1 of 6 Top 25 price reductions since November 2016 Medicine Pack
    [Show full text]
  • Umeclidinium/Vilanterol Combination Inhaler (Anoro Ellipta)
    pat hways Chronic obstructive pulmonary disease: umeclidinium/vilanterol combination inhaler (Anoro Ellipta) Evidence summary Published: 6 November 2014 nice.org.uk/guidance/esnm49 Key points from the evidence The content of this evidence summary was up-to-date in November 2014. See summaries of product characteristics (SPCs), British national formulary (BNF) or the MHRA or NICE websites for up-to-date information. Summary Anoro Ellipta is a combination inhaler containing umeclidinium bromide (a long-acting muscarinic antagonist [LAMA]) and vilanterol (a long-acting beta2 agonist [LABA]). Umeclidinium/vilanterol is the first LAMA/LABA combination inhaler vailablea in the UK for the treatment of COPD. It is licensed as a maintenance bronchodilator treatment to relieve symptoms in adult patients with COPD. The combination inhaler has been compared in randomised controlled trials (RCTs) with its individual components, tiotropium monotherapy and placebo. Studies suggest that there are benefits for forced xpirede volume in 1 second (FEV1) with the umeclidinium/vilanterol combination inhaler. However, the clinical relevance of these benefits is unclear. There is limited evidence on patient-orientated outcomes such as shortness of breath, quality of life outcomes or exacerbation rates. © NICE 2018. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and- Page 1 of conditions#notice-of-rights). 28 Chronic obstructive pulmonary disease: umeclidinium/vilanterol combination inhaler (Anoro Ellipta) (ESNM49) Effectiveness Safety Statistically significant improvement The summary of product characteristics from baseline in trough FEV1 of (SPC) states that cardiovascular effects, such 0.090 litres with umeclidinium/vilanterol as cardiac arrhythmias, atrial fibrillation and 62.5/25 micrograms compared with both tachycardia, may be seen after the vilanterol alone and tiotropium administration of muscarinic receptor 18 micrograms (1 RCT; n=846; antagonists and sympathomimetics, including 24 weeks).
    [Show full text]