Medicine Directory The purpose of the Trust Medicine Directory is to assist clinicians with evidence based, clinical and cost effective advice and information when prescribing medication for the management of mental health and behavioural conditions and medication associated side effects. For medication prescribed for the management of physical health conditions refer to local joint formulary recommendations (this also applies to medication included in this list when prescribed for physical health condition, e.g. prochlorperazine for nausea and vomiting or valproate for epilepsy). The aims of the Trust Medicine Directory are to: Promote adherence to existing prescribing guidance and advice (national and local) Raise awareness of and signpost clinicians to relevant prescribing guidelines, protocols and safety alerts to enable the safe and effective use of medicines. Ensure clinicians are aware of current information and advice in order to maximise the potential for individuals, teams and services to achieve Trust agreed cost improvement plans for prescribing. Raise awareness to specific resources and tools available to healthcare professionals which can be used to help support optimal prescribing and treatment with medication through shared decision making. The Medicine Directory is not intended to replace prescribing information contained in the BNF and / or Summary of Product Characteristics for specific medications, nor is it intended to replace advice included in locally developed joint formularies (which are inclusive of all conditions and not just mental health) The Medicine Directory is arranged in alphabetical order of medication with a list of conditions for which the medication may be prescribed. The following key is used to indicate the current status for each medication which is condition specific (i.e. evidence may support use for the management of depression but not anxiety). No approval required. Prescribe in accordance with Trust recommendations NON-APPROVED MEDICATION Approval is required by your Clinical Director or Associate Clinical Director prior to prescribing in order to agree that the medication is clinically appropriate, and to accept the impact on the prescribing budget. These medicines may be: Medicines that are not commissioned by the CCG Medicines that are commissioned but with conditional measures based on adherence to locally agreed procedures Please refer to Standard Operating Procedure MM26 and complete a Non-Approved Medication form (click here to access the SOP and form) These medicines are not recommended due to: Concerns over safety or effectiveness Insufficient evidence Cost effectiveness (more expensive compared to equivalent treatment options) Record the clinical rationale for treatment in the electronic patient record and discuss the treatment with your local pharmacist and/or peers. If prescribing is to continue, please refer to Standard Operating Procedure MM26 and complete a Non-Approved Medication form (click here to access the SOP and form) Refer to local joint formulary Medicine Directory Devon Partnership Trust - Drugs and Therapeutics Committee Version 18.0 – Feb 19 Page 1 of 22 Prescribing Off-Licence and Unlicensed Medicines Clinicians should always prescribe licensed medicines for licensed indications in preference to the ‘off-licence’ use of medicines (which includes indication, dose and method of administration) or unlicensed medicines. However, the Trust recognizes that prescribing of ‘off-licence’ (‘off-label’) or unlicensed medication, is occasionally necessary in order to offer and provide the optimum treatment for an individual, and in these circumstances Trust Standard Operating Procedure MM06 ‘Prescribing Unlicensed and Off- Label Medication’ must be adhered to. Trust categorisation of ‘off-label’ and ‘unlicensed prescribing’ is summarised below; Level 1 'Off-label' prescribing of a licensed drug where use is recognised in prescribing guidelines (L1) issued by The National Institute for Health and Care Excellence (NICE) and / or robust evidence of efficacy is available and reflected in the Trust Medicine Directory Level 2 'Off-label' prescribing of a licensed drug where supporting evidence is weak. (L2) Off-label indication for medication not included in Trust Medicine Directory (unless highlighting that prescribing is not recommended due to lack of evidence to support efficacy and / or safety profile) As of December 2017 it is recommended that clinicians seek a second opinion using the non-approved medicines process when prescribing level 2 off label items Level 3 Prescribing of an Unlicensed drug (Medication without UK Marketing authorisation or (L3) Central European Licence) As of December 2017 it is recommended that clinicians seek a second opinion using the non-approved medicines process when prescribing level 3 unlicensed medicines Keeping the Medicine Directory Up To Date The Medication Directory will be reviewed and updated by the Trust Drugs and Therapeutics Committee (DTC) on a monthly basis. This will be completed in collaboration with Medicine Optimisation Teams and Formulary Interface Groups (FIGs) within the local Clinical Commissioning Groups (CCGs). Please contact the Medicines Optimisation Team if you would like further information about this process. New Medications The definition of a ‘new drug’ is a newly launched treatment or a ‘new indication and / or formulation’ of an existing treatment. At the time of launch, new medicines will be included in the Medicine Directory as ‘Non-approved drugs’ and the stage of evaluation stated (i.e. “Awaiting commissioning decision from CCG Clinical Policy Committee”). Following a commissioning decision the non-approved status will be updated to reflect this. Generic and Brand Prescribing Prescribing medicines generically rather than by brand name can improve cost-effectiveness and is encouraged. However, there are some circumstances in which brand-name prescribing is preferred in order to support the safe and clinically effective delivery of treatment with medication. These include: Where there is a difference in bioavailability between brands of the same medicine, particularly if the medicine has a narrow therapeutic index Where modified release preparations are not interchangeable Where there are important differences in formulation between brands of the same medicine Where products contain multiple ingredients and brand name prescribing aids identification Where administration devices (e.g. inhaler or self-injection) have different instructions for use and patient familiarity with the same product is important Where different preparations of the same medicine have different licensed indications Medicine Directory Devon Partnership Trust - Drugs and Therapeutics Committee Version 18.0 – Feb 19 Page 2 of 22 Even where there is only one brand available, products should still be prescribed generically unless one of the reasons listed above applies. The reason for this is so that if / when a generic version becomes available, prescribing practice will not have to change and financial savings from generic prescribing will be maximised. Occasionally there will be a requirement to prescribe a branded generic version of a medicine to realise financial savings. The following symbol in the Medicine Directory indicates that medication should be prescribed by brand in order to support treatment efficacy and / or patient safety. Research and Development The Trust’s overarching research and development aims are to maximise the participation of people using its services in clinical research, innovation and improvement projects by increasing the Trust’s participation in the National Institute for Health Research portfolio studies which are open to recruitment, other high quality research and clinical trials. In order to raise awareness, where the organisation is actively involved in a research project that involves prescribing medication, information will be included in the Directory. Clinicians should contact the Research and Development Department or the Primary Investigator for more information. Cost Improvement Plans The Medicines Optimisation Team proactively works with prescribers and teams to minimize the routine costs associated with prescribing on a daily basis without compromising the safety and efficacy of treatment. Advice on optimising prescribed medication and minimising associated costs is included in the Directory under individual drugs where applicable. Cost Comparison Charts for the most commonly used medications are available here Further information and advice about safe and effective prescribing can be obtained by: Visiting the Trust Medicines Optimisation Team’s intranet site: http://daisy.exe.nhs.uk/quality-safety/medicines-optimisation.aspx Visiting the Devon Partnership Trust’s internet site for prescribers and professionals: http://www.devonpartnership.nhs.uk/For-prescribers-and-professionals.513.0.html Telephoning or emailing the Trust Medicines Optimisation Team: – Direct Dial 01392 675674 – Email address [email protected] Calling the Trust Medicines Helpline (for staff and people who use our services) Visiting the Choice and Medication Website (For staff and people who use our services) If any supporting document links do not work, please inform the Medicines Optimisation Team: [email protected] Medicine Directory Devon Partnership Trust - Drugs and Therapeutics Committee Version 18.0 – Feb 19 Page 3 of 22 Prescribing Support Documents MEDICATION Indication