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FROM 2010


Respiratory ract Infections - Antibiotic Prescribing; Ciclosporin: must be prescribed and dispensed by brand name; Finasteride: potential risk of male breast cancer; Can Proton Pump Inhibitors be used in pregnancy?; Pregnancy and child information.


Methylphenidate: New Patient Information; NPSA Alert - Safer Lithium Therapy; Generic Co-Beneldopa; Product Corner: Sibutramine; Medicines Q&A - What Information is Available for Drug in Diving; Legislation Allows Medicines Mixing; POM to P Reclassifications; Changes to NebuChamber Spacer Device.


Choosing medicines for patients unable to take solid oral dosage forms; acrolimus; Should patients be changed from phenytoin capsules to tablets and vice versa? (Update); What are the dosage equivalents of different benzodiazepines?


Atrial Fibrillation; Fluoxetine: possible small risk of congenital cardiac defects; Stability of generic clopidogrel tablets in monitored dosage systems.


What is the preferred triptan for the treatment of migraine in breastfeeding mothers?; Can fluconazole be used with breastfeeding?; New QoF indicators proposed; New opioid guidelines; Introduction to QIPP; Drug tariff changes; ACEI and AIIRA prescribing; Do all SSRIs interact with tamoxifen?; Prescribing of unlicensed medicines by nurse and midwife independent prescribers.


No issue.


Depression - Non-Pharmacological reatments; Quinine: not to be used routinely for nocturnal leg cramps; East Lancashire Policy/Procedure for Subcutaneous

Syringe Driver; Oral Thromboprophylaxis in

tacrolimus prescriptions; patients already on dual

antiplatelet therapy: What Book’ on the DH website.






Depression - Pharmacological reatments; AIIRAs associated with an increased risk of cancer; How should hay fever be managed in pregnancy and breastfeeding?; Patient group directions; Mixing medicines.


Brand prescribing in epilepsy; HIV drug interactions; Can the use of proton pump inhibitors increase the risk of community acquired pneumonia infection?; Rosiglitazone: current advice on cardiovascular risk. Rosiglitazone no longer recommended for use locally; Modafinil: European Medicines Agency recommends restricted use; opical ketoprofen: reminder on risk of photosensitivity reactions.


Alcohol - use disorders; Prescribing advice in response to withdrawal of Rosiglitazone; Inhaled and intranasal corticosteroids; Long-acting Beta2-agonists; Angiotensin receptor blockers warning; Updated Green Book chapter.


Hypertension in Pregnancy; Antihypertensive M e d i c a t i o n ; W i t h d r a w a l o f M i x t a r d ® 3 0 / 7 0 i n A d u l t s National electronic Library of Medicines - user guide; Implanon® contraceptive implant: changing to ;

N e x p l a n o n ® ; Y e l l o w C a r d S c h e m e Scanning for Medicines; BNF 60.




Nocturnal Enuresis; Prescribing of Metformin MR; INTERFACE Christmas Quiz

MMB Guidance

Please see the Medicines Management Board website for prescribing information on the following; www.elmmb.nhs.uk


Jext® (Adrenaline/Epinephrine) pre-loaded syringe for treatment of anaphylaxis.

Jext® is available as an alternative to the EpiPen Auto- injector® for issue to patients at risk of anaphylaxis. Jext® has a 24 month expiry, while EpiPen® only has an 18 month expiry.

Ovestin® (Estriol) – vaginal cream for topical HRT treatment.

Ovestin® has been added to the formulary to replace Premarin® (conjugated oestrogens) vaginal cream as a first line topical treatment. Topical oestrogen may be used alone in the short term in the minimum effective amount. Long term use may require oral progestogen for 10 - 14 days each month.

Algesal® (Diethylamine salicylate) cream.

Algesal® has been added to the formulary as the first line agent in topical NSAID therapy. It replaces the more expensive Movelat®. See the Topical NSAIDs article in this issue for more details.


Aliskiren (Rasilez®) – as a fifth line agent in resistant essential hypertension.

  • Aliskiren should NOT be initiated in primary care. It should only be initiated by a consultant with experience in managing resistant essential hypertension.

  • NICE recommends the use of beta-blockers, alpha blockers or additional diuretics as current fourth line treatments. Where patients are being managed in primary care, and blood pressure remains uncontrolled on adequate doses of four drugs, and expert advice has not yet been obtained, this should now be sought.

  • Aliskiren should only be used as a fifth line treatment, where NICE recommended fourth line treatments are ineffective, inappropriate or not tolerated. Use should be restricted to resistant hypertension or for patients with nephrotic syndrome who can’t tolerate an ACE or ARB. Following initiation or recommendation by the specialist, prescribing may be transferred to the primary care prescriber. It should not be used in women of child bearing potential.

  • Aliskiren can be used in combination with other anti- hypertensives. Routine monitoring of electrolytes and renal function is indicated when used with an ACE inhibitor or angiotensin receptor blocker (ARB), or when used in kidney dysfunction, diabetes mellitus or heart failure.

  • Aliskiren should not be used for the acute management of severe or malignant hypertension as effects on blood pressure are only attained after 1-2 weeks of treatment.

Denosumab (Prolia®) – in Prevention of osteoporotic fragility fractures in postmenopausal women.

  • 1.

    Denosumab is recommended as a treatment option for the primary prevention of osteoporotic fragility fractures only in postmenopausal women at increased risk of fractures:

    • who are unable to comply with the special instructions for administering alendronate and either risedronate or etidronate, or have an intolerance of, or contraindication to, those treatments and

    • who have a combination T-score1, age and number of independent clinical risk factors for fracture (see section 3).

  • 2.

    Denosumab is recommended as a treatment option for the secondary prevention of osteoporotic fragility fractures only in postmenopausal women at increased risk of fractures who are unable to comply with the special instructions for administering alendronate and either risedronate or etidronate, or have an intolerance of, or a contraindication to, those treatments.

Denosumab (Prolia®) continued.

  • 3.

    For the purposes of this guidance, independent clinical risk factors for fracture are parental history of hip fracture, alcohol intake of more than 4 or more units per day, and rheumatoid arthritis.

  • 4.

    People currently receiving denosumab for the primary or secondary prevention of osteoporotic fragility fractures who do not meet the criteria specified above should have the option to continue treatment until they and their clinician consider it appropriate to stop.


Tobramycin (Bramitob®) – nebuliser solution for cystic fibrosis in children.

Bramitob® nebuliser solution replaces the tobramycin injection on the joint formulary for the treatment of cystic fibrosis in children. Shared care guidelines can be found online at www.elmmb.nhs. uk/shared-care/.


Mycophenolate Mofetil (CellCept®) for unlicensed indications.

  • Mycophenolate mofetil for all unlicensed indications including interstitial lung disease has been given a RED traffic light status and should only be prescribed under the full supervision of the consultant.

  • Mycophenolate mofetil retains its AMBER traffic light status for all licensed indications.

  • Please see the Mycophenolate – Generic vs. Brand Prescribing article in this issue for more details on prescribing requirements.


Omalizumab (Xolair®) – for specialist treatment of asthma in children under 12.

Omalizumab has been given a BLACK traffic light status in the treatment of children under 12 years. It retains its RED traffic light status in adults and adolescents over 12.

TRAFFIC LIGHT DEFINITIONS See website for more information on these recommendations.

GREEN – Primary or Secondary care (+/- recommendations)

AMBER– Secondary care initiates/recommends, then passes to primary care (+/- recommendations)


  • Secondary care only (+/- recommendations)

BLACK – Non-Formulary. Not recommended for prescribing in primary or secondary care

INTERFACE Christmas Quiz!

Thank you to all who entered the quiz, the cake was won by Anna Atkinson, Community Pharmacy Facilitator for NHS Blackburn with Darwen.

The answers are as follows:

1. What is the second line calcium channel blocker approved by the MMB for use when Amlodipine is not tolerated?


2. Immediate prescribing strategy is appropriate for children with what, who have acute otitis media?


3. What stimulant treatment is used for children aged 6 or older?


4. Which medicines agency recently advised against the use of Rosiglitazone and Modafinil?


5. What is the rare but potentially life threatening adverse reaction associated with Quinine?


6. Which drug for depression was black listed in May’s issue of INTERFACE?


7. In March’s issue of INTERFACE which new oral liquid formulation is NOT interchangeable without careful therapeutic monitoring?


8. What should no longer be prescribed after study data showed an increased incidence of non-fatal cardiovascular events, including heart attacks and stroke?


9. Which contraceptive implant was replaced by Nexplanon® in October 2010?


10. Take the first letter of each answer 1-9 and solve the anagram



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