Committee Decisions

It is recommended that slow-release and longer-acting nifedipine products are prescribed by brand.

The preferred brands for use in primary care have been updated following the discontinuation of Adipine MR in August 2024. 

The recommendations are now:

TWICE DAILY

• Coracten SR capsules OR
• Tensipine MR for patients preferring a tablet

ONCE DAILY

• Coracten XL capsules OR
• Adipine XL for patients preferring a tablet

It is recommended that slow-release and longer-acting nifedipine products are prescribed by brand.

The preferred brands for use in primary care have been updated following the discontinuation of Adipine MR in August 2024. 

The recommendations are now:

TWICE DAILY

• Coracten SR capsules OR
• Tensipine MR for patients preferring a tablet

ONCE DAILY

• Coracten XL capsules OR
• Adipine XL for patients preferring a tablet

Infliximab is agreed to be used in Crohn's Disease and Ulcerative Colitis as per the current treatment pathway.

Infliximab is agreed to be used in Crohn's Disease and Ulcerative Colitis as per the current treatment pathway.

The Surrey Heartlands integrated care system Area Prescribing Committee (APC) approves the use of capsaicin patches for the treatment of neuropathic pain when prescribed by specialist pain teams within a secondary care setting only.

The APC recommend a RED traffic light status for the use of capsaicin patches for this indication only.

Primary care prescribers should be aware that their patient is receiving this medicine and ensure that this is recorded on the patient’s medication screen as a hospital-only drug in line with guidance on the PAD. This will also alert the prescriber to potential side effects and interactions with other medicines prescribed in primary care. It will also ensure that GP records, which are accessed by other healthcare providers, are a true and accurate reflection of the patient’s medication.”

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) approves the updated ITP pathway.

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) approves the updated ITP pathway.

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) approves the updated ITP pathway.

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) approves the updated ITP pathway.

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) approves the updated ITP pathway.

The Surrey Heartlands Integrated Care System Area Prescribing Committee have agreed a GREEN traffic light status for cytisine to be used in patients who are undertaking smoking cessation therapy and are being supported by One You Surrey.

A communication form should be received from One You Surrey and reviewed before any prescribing in primary care.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

Enalapril is the preferred ACE inhibitor during breastfeeding (where an ACE inhibitor is appropriate).

Use an ARB where possible. If an ACEi is required (patient with heart failure or post MI), ramipril is the preferred option.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

Captopril should not be used as a 1st line treatment.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

Step 4 of the hypertension pathway. Adjunct in resistant hypertension.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

Step 4 of the hypertension pathway. Bisoprolol/atenolol are the preferred cardio-selective beta blockers for hypertension.

The Surrey Heartlands Integrated Care System Area Prescribing Committee have agreed a BLUE (on recommendation) traffic light status for a trial (starter pack) and then ongoing prescribing if needed, of an intravaginal device for women with stress urinary incontinence, only if other non-surgical options have been unsuccessful.

Formulary choices were agreed as:

Efemia - 1st line choice for daily or intermittent use and 1st line choice of reusable product

Contiform - 2nd line choice for daily or intermittent use.

Diveen - 3rd line choice if other devices not able to be used i.e. due to insertion / comfort etc.

Contrelle Activgard - 

This is the only single-use product currently available.  This is the most expensive reusable product for daily and intermittent use.  Please reserve for those who specifically require this product.

The Surrey Heartlands Area Prescribing Committee approved the Stoma Accessory Formulary noting that:

• cost effective choices should be used first-line
• approved formulary products should be initiated by the specialist Stoma Teams

1st line = STOCARE REMOVE ADHESIVE REMOVER / LIFT PLUS 360 CITRUS ADHESIVE REMOVER

2nd line = Adapt No-Sting, Easisipray, Remove Apple / Blackberry / Mint, Salts adhesive remover, Brava adhesive remover XL

Paeds only = APPEEL ADVANCE NO STING 

Refer to the formulary document for:

• a full list of agreed products
• recommended prescribing quantities
• contact details for local stoma care teams

The Surrey Heartlands Area Prescribing Committee approved the Stoma Accessory Formulary noting that:

• cost effective choices should be used first-line
• approved formulary products should be initiated by the specialist Stoma Teams

Wipes should be seserved for travel or adhesive build-up. Consider a spray.

1st line = STOCARE REMOVE ADHESIVE REMOVER wipes / LIFTEEZ NON-STING adhesive remover wipes

2nd line = Universal removal wipes, Salts adhesive remover wipes

Refer to the formulary document for:

• a full list of agreed products
• recommended prescribing quantities
• contact details for local stoma care teams

The Surrey Heartlands Area Prescribing Committee approved the Stoma Accessory Formulary noting that:

• cost effective choices should be used first-line
• approved formulary products should be initiated by the specialist Stoma Teams

1st line = STOCARE PROTECT SKIN BARRIER SPRAY / SKIN SAFE PROTECTIVE SPRAY

2nd line = Sorbaderm no sting barrier film spray, Cavilon no sting barrier film pump spray

Refer to the formulary document for:

• a full list of agreed products
• recommended prescribing quantities
• contact details for local stoma care teams

The Surrey Heartlands Area Prescribing Committee approved the Stoma Accessory Formulary noting that:

• cost effective choices should be used first-line
• approved formulary products should be initiated by the specialist Stoma Teams

Wipes are less cost-effective. Consider a spray film. NOT for repeat prescribing

1st line = SKIN GEL PROTECTIVE DRESSING WIPES / DERMA-GARD SKIN WIPES / STOCARE PROTECT BARRIER WIPES

2nd line = Salts Barrier film wipes, Medi Derma-S non-sting medical barrier film wipes, Cavilon no sting barrier film stoma wipes

Refer to the formulary document for:

• a full list of agreed products
• recommended prescribing quantities
• contact details for local stoma care teams

The Surrey Heartlands Area Prescribing Committee approved the Stoma Accessory Formulary noting that:

• cost effective choices should be used first-line
• approved formulary products should be initiated by the specialist Stoma Teams

Foams are least cost-effective. Consider a spray. NOT for repeat prescribing.

1st line = MEDI DERMA-S STERILE NON STING MEDICAL BARRIER FILM APPLICATORS / CAVILON FOAM APPLICATORS

2nd line = Independence Fusion Applicators

Refer to the formulary document for:

• a full list of agreed products
• recommended prescribing quantities
• contact details for local stoma care teams

The Surrey Heartlands Area Prescribing Committee approved the Stoma Accessory Formulary noting that:

• cost effective choices should be used first-line
• approved formulary products should be initiated by the specialist Stoma Teams

1st line = DANSAC SOFT PASTE / ADAPT PASTE / SALTS STOMA PASTE

2nd line = Brava paste, Stomahesive paste

Refer to the formulary document for:

• a full list of agreed products
• recommended prescribing quantities
• contact details for local stoma care teams

The Surrey Heartlands Area Prescribing Committee approved the Stoma Accessory Formulary noting that:

• cost effective choices should be used first-line
• approved formulary products should be initiated by the specialist Stoma Teams

Agreed products are: COMFORT FLANGE EXTENDERS (small, large, wide) / SALTS FLANGE EXTENDERS / 

DANSAC X-TRA STRIPS BARRIER EXTENDER / BRAVA ELASTIC TAPE and BRAVA ELASTIC TAPE X-LARGE / CERAPLUS BARRIER EXTENDER

Refer to the formulary document for:

• a full list of agreed products
• recommended prescribing quantities
• contact details for local stoma care teams

On advice of stoma nurse only. Up to two boxes per month only.

The Surrey Heartlands Area Prescribing Committee approved the Stoma Accessory Formulary noting that:

• cost effective choices should be used first-line
• approved formulary products should be initiated by the specialist Stoma Teams

Agreed products are: ABSORB ODOUR NEUTRALISING ABSORBENT GEL / TRIO PEARL SACHETS / CONVATEC DIAMOND SACHETS

Refer to the formulary document for:

• a full list of agreed products
• recommended prescribing quantities
• contact details for local stoma care teams

Stoma powders are not for primary care prescribing.

The Surrey Heartlands Area Prescribing Committee approved the Stoma Accessory Formulary noting that:

• cost effective choices should be used first-line
• approved formulary products should be initiated by the specialist Stoma Teams

Refer to the formulary document for:

• a full list of agreed products
• recommended prescribing quantities
• contact details for local stoma care teams

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

Not a preferred beta-blocker for hypertension. The cardio-selective betablockers bisoprolol or atenolol are the preferred options.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

Preferred option in pregnancy

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

On specialist recommendation.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

On specialist recommendation

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

Only in combination with an alpha-blocker. Initiation and stabilisation by specialist.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

Initiation and stabilisation by specialist

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

Do NOT prescribe as perindopril arginine.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

On specialist recommendation.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

Initiation and stabilisation by specialist

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

On specialist recommendation.

Please note; the licensed (Xaqua) and unlicensed (Zaroxolyn) tablets have different bioavailabilities. These products are NOT interchangeable = Prescribe By Brand.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

Specialist initiation and supply for at least 1 month

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

Specialist initiation and supply for at least 1 month.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Area Prescribing Committee have approved a Blood Glucose Testing Strip / Meter Fomulary for Surrey Heartlands.

Please refer to the formulary document for further information on the test strips and meters that have been agreed for:

• general use in adults (GlucoRx Q and FineTest Lite)
• paediatric use (Instant, 4SURE)
• gestational diabetes (WaveSense JAZZ, Contour Plus)
• carbohydrate counting (4SURE, CareSens Pro)
• ketone testing (GlucoRx HCT Glucose, GlucoRx HCT Ketone, KetoSens, 4SURE beta-ketone)
• visually impaired (GlucoRx Nexus)
• manual dexterity issues (Instant)

Patients with flash glucose monitoring systems should be supplied with the strips recommended for general use in adults (GlucoRx Q or FineTest Lite)

NOTE - the formulary does NOT include recommendations for insulin pumps or CGM devices - ensure that compatible strips are prescribed. If there are no specific strip requirements, please prescribe strips recommended for general adult use (GlucoRx Q or FineTest Lite).

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

Transfer of prescribing to primary care only after specialist team initiation and supply of at least the first month of treatment.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Integrated Care System Area Prescribing Committee have agreed the following place in therapy for cabergoline and bromocriptine:

For the treatment of hyperprolactinaemic disorders

• BLUE traffic light classification for initiation by specialists for 1 month before transfer of prescribing responsibilities to primary care
• Cabergoline 1st line & Bromocriptine 2nd line

Note - Monitoring remains the responsibility of secondary care in line with position statement of the British Society of Echocardiography, the British Heart Valve Society and the Society for Endocrinology. https://pubmed.ncbi.nlm.nih.gov/30818417/

For the treatment of drug induced hyperprolactinaemia

• 1st line - select alternative medicine (to remove cause of drug-induced effect)
• Non-Formulary for cabergoline and bromocriptine

Suppression of lactation

• RED traffic light classification for cabergoline - as treatment should be part of obstetric care where necessary
• Non-Formulary for bromocriptine

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Integrated Care System Area Prescribing Committee have agreed the following place in therapy for cabergoline and bromocriptine:

For the treatment of hyperprolactinaemic disorders

• BLUE traffic light classification for initiation by specialists for 1 month before transfer of prescribing responsibilities to primary care
• Cabergoline 1st line & Bromocriptine 2nd line

Note - Monitoring remains the responsibility of secondary care in line with position statement of the British Society of Echocardiography, the British Heart Valve Society and the Society for Endocrinology. https://pubmed.ncbi.nlm.nih.gov/30818417/

For the treatment of drug induced hyperprolactinaemia

• 1st line - select alternative medicine (to remove cause of drug-induced effect)
• Non-Formulary for cabergoline and bromocriptine

Suppression of lactation

• RED traffic light classification for cabergoline - as treatment should be part of obstetric care where necessary
• Non-Formulary for bromocriptine

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Integrated Care System Area Prescribing Committee have agreed the following place in therapy for cabergoline and bromocriptine:

For the treatment of hyperprolactinaemic disorders

• BLUE traffic light classification for initiation by specialists for 1 month before transfer of prescribing responsibilities to primary care
• Cabergoline 1st line & Bromocriptine 2nd line

For the treatment of drug induced hyperprolactinaemia

• 1st line - select alternative medicine (to remove cause of drug-induced effect)
• Non-Formulary for cabergoline and bromocriptine

Suppression of lactation

• RED traffic light classification for cabergoline - as treatment should be part of obstetric care where necessary
• Non-Formulary for bromocriptine

The Surrey Heartlands Integrated Care System Area Prescribing Committee have agreed the following place in therapy for cabergoline and bromocriptine:

For the treatment of hyperprolactinaemic disorders

• BLUE traffic light classification for initiation by specialists for 1 month before transfer of prescribing responsibilities to primary care
• Cabergoline 1st line & Bromocriptine 2nd line

For the treatment of drug induced hyperprolactinaemia

• 1st line - select alternative medicine (to remove cause of drug-induced effect)
• Non-Formulary for cabergoline and bromocriptine

Suppression of lactation

• RED traffic light classification for cabergoline - as treatment should be part of obstetric care where necessary
• Non-Formulary for bromocriptine

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Integrated Care System Area Prescribing Committee have agreed the following place in therapy for cabergoline and bromocriptine:

For the treatment of hyperprolactinaemic disorders

• BLUE traffic light classification for initiation by specialists for 1 month before transfer of prescribing responsibilities to primary care
• Cabergoline 1st line & Bromocriptine 2nd line

For the treatment of drug induced hyperprolactinaemia

• 1st line - select alternative medicine (to remove cause of drug-induced effect)
• Non-Formulary for cabergoline and bromocriptine

Suppression of lactation

• RED traffic light classification for cabergoline - as treatment should be part of obstetric care where necessary
• Non-Formulary for bromocriptine

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Integrated Care System Area Prescribing Committee have agreed the following place in therapy for cabergoline and bromocriptine:

For the treatment of hyperprolactinaemic disorders

• BLUE traffic light classification for initiation by specialists for 1 month before transfer of prescribing responsibilities to primary care
• Cabergoline 1st line & Bromocriptine 2nd line

For the treatment of drug induced hyperprolactinaemia

• 1st line - select alternative medicine (to remove cause of drug-induced effect)
• Non-Formulary for cabergoline and bromocriptine

Suppression of lactation

• RED traffic light classification for cabergoline - as treatment should be part of obstetric care where necessary
• Non-Formulary for bromocriptine

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

Specialist initiation and at least one month supply before transfer to primary care.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

Not 1st line. Alternative to clopidogrel and aspirin.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee recommends the use of tenecteplase for the treatment of acute ischaemic stroke in line with NICE TA990.

Tenecteplase will be considered as RED on the traffic light system.

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) approves atogepant for preventing migraine in line with recommendations made in NICE TA973.

Atogepant for this indication will be considered as RED on the traffic light system (treatment should be initiated and continued by specialist clinicians).

Primary care prescribers should ensure that patient medication records include any medicine for which prescribing remains the responsibility of secondary or tertiary care. This will ensure that GP records, which are accessed by other healthcare providers, are a true and accurate reflection of the patient's medication.

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) has agreed the reviewed AMBER shared care document for Recombinant human growth hormone for children and young people.

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) has agreed the reviewed AMBER shared care document for Recombinant human growth hormone for children and young people.

The Surrey Heartlands Integrated Care System Area Prescribing Committee have agreed a formulary status for tamoxifen, anastrozole and raloxifene for chemoprevention in women at moderate or high risk of developing breast cancer for a duration of 5 years.

A BLUE (with specialist initiation) with 1 month prescribing by the specialist team following discussions with the patient about the risks and benefits of treatment.

Tamoxifen can be used:

• Premenopausal except in those with past history or may be at increased risk of thromboembolic disease or endometrial cancer
• Postmenopausal who have severe osteoporosis or do not wish to take anastrozole if no past history or increased risk of thromboembolic disease or endometrial cancer

On occasion a patient may need time to consider treatment and may in those circumstances request that their GP prescribe. The GP will then need to consider if they have all the information from the specialist team in order to accept full clinical responsibility for prescribing for that patient.

The Surrey Heartlands Integrated Care System Area Prescribing Committee have agreed a formulary status for tamoxifen, anastrozole and raloxifene for chemoprevention in women at moderate or high risk of developing breast cancer for a duration of 5 years.

A BLUE (with specialist initiation) with 1 month prescribing by the specialist team following discussions with the patient about the risks and benefits of treatment.

Anastrozole can be used:

• Postmenopausal  WITHOUT severe osteoporosis

On occasion a patient may need time to consider treatment and may in those circumstances request that their GP prescribe. The GP will then need to consider if they have all the information from the specialist team in order to accept full clinical responsibility for prescribing for that patient.

The Surrey Heartlands Integrated Care System Area Prescribing Committee have agreed a formulary status for tamoxifen, anastrozole and raloxifene for chemoprevention in women at moderate or high risk of developing breast cancer for a duration of 5 years.

A BLUE (with specialist initiation) with 1 month prescribing by the specialist team following discussions with the patient about the risks and benefits of treatment.

Raloxifene (off-label for this indication) can be used:
- Postmenopausal in those with a uterus and have severe osteoporosis or do not wish to take anastrozole or tamoxifen if no past history or increased risk of thromboembolic disease

On occasion a patient may need time to consider treatment and may in those circumstances request that their GP prescribe. The GP will then need to consider if they have all the information from the specialist team in order to accept full clinical responsibility for prescribing for that patient.

The Surrey Heartlands Integrated Care System Area Prescribing Committee have agreed an updated AMBER shared care document for valproate for people of childbearing potential aged under 55 with:

Licensed uses:

• Epilepsy
• Treatment of mania in bipolar disorder
• Continuation of treatment after a manic episode

Off label uses (refer to primary care responsibilities in shared care document for advice)

• Mood stabiliser in mood disorders and primary psychotic disorders, under the direction of a consultant psychiatrist
• Prevention of atypical antipsychotic-induced seizures
• Management of compulsive and aggressive behaviour

The Surrey Heartlands Integrated Care System Area Prescribing Committee have agreed an updated AMBER shared care document for valproate for people of childbearing potential aged under 55 with:

Licensed uses:

• Epilepsy
• Treatment of mania in bipolar disorder
• Continuation of treatment after a manic episode

Off label uses (refer to primary care responsibilities in shared care document for advice)

• Mood stabiliser in mood disorders and primary psychotic disorders, under the direction of a consultant psychiatrist
• Prevention of atypical antipsychotic-induced seizures
• Management of compulsive and aggressive behaviour

The Surrey Heartlands APC reviewed the Blue traffic light status for patients with epilepsy and WITHOUT child-bearing potential.

The Blue status remains with the expectation that treatment will be initiated and stabilised by a specialist and patients will receive a minimum of 1 month supply from the specialist before transfer of care.

No supplementary information sheet is required

The Surrey Heartlands APC reviewed the Blue traffic light status for sodium valproate when used in patients with mental health disorders (mania, bipolar disorder, psychotics disorders, compulsive and agressive behaviours) and WITHOUT child-bearing potential.

The Blue status remains with the expectation that treatment will be initiated and stabilised by a specialist and patients will receive a minimum of 1 month supply from the specialist before transfer of care.

No supplementary information sheet is required

The Surrey Heartlands Integrated Care System Area Prescribing Committee has agreed a BLUE (with an information sheet) traffic light status for FreeStyle Libre 2 plus and Dexcom One Plus for children and young people with Type II Diabetes.

This is in addition to FreeStyle Libre 2 and Dexcom One which were previously given a BLUE traffic light status in September 2023

The Surrey Heartlands Integrated Care System Area Prescribing Committee has agreed a BLUE (with an information sheet) traffic light status for FreeStyle Libre 2 plus and Dexcom One Plus for children and young people with Type II Diabetes.

This is in addition to FreeStyle Libre 2 and Dexcom One which were previously given a BLUE traffic light status in September 2023

The Surrey Heartlands Integrated Care System Area Prescribing Committee have agreed Nutriprem Breast Milk Fortifier for pre-term & low birthweight infants.

A BLUE (on specialist recommendation) Traffic Light Status was agreed

The Surrey Heartlands Integrated Care System Area Prescribing Committee have agreed SMA Gold Prem 2 Liquid. Ready to drink (200ml) presentation should not be prescribed in primary care unless a specific clinical need is identified and a community prescription is requested from a secondary care specialists under their ongoing care.

A RED Traffic Light Status was agreed

The Surrey Heartlands Integrated Care System Area Prescribing Committee have agreed Nutriprem 2 Liquid. Ready to drink (200ml) presentation should not be prescribed in primary care unless a specific clinical need is identified and a community prescription is requested from a secondary care specialists under their ongoing care.

A RED Traffic Light Status was agreed

The Surrey Heartlands Integrated Care System Area Prescribing Committee have agreed Nutriprem 2 powdered preterm formula as an option for pre-term infants.

A BLUE (on specialist recommendation) Traffic light status was agreed.

The Surrey Heartlands Integrated Care System Area Prescribing Committee have agreed SMA Gold Prem 2 powdered preterm formula as an option for pre-term infants.

A BLUE (on specialist recommendation) Traffic Light Status was agreed

The Surrey Heartlands Integrated Care System Area Prescribing Committee have agreed SMA High Energy as the preferred high energy formula for infants with faltering growth.

Prescribe as 200ml

A BLUE (on specialist recommendation) Traffic Light Status was agreed.

The Surrey Heartlands Integrated Care System Area Prescribing Committee have agreed Similac High Energy as a 2nd high energy formula option for infants with faltering growth.

Prescribe as 200ml

A BLUE (on specialist recommendation) Traffic Light Status was agreed

The Surrey Heartlands Integrated Care System Area Prescribing Committee have agreed Infatrini as a 2nd high energy formula option for infants with faltering growth.

Prescribe 125ml or 200ml. Care should be taken to ensure correct presentation is prescribed – avoid 500ml presentations

A BLUE (on specialist recommendation) Traffic Light Status was agreed

The Surrey Heartlands Integrated Care System Area Prescribing Committee have agreed SMA Anti-Reflux should not be prescribed for infants with Gastro-Oesphageal Reflux Disease (GORD). Pre-thickened formula can be purchased from supermarkets, pharmacies and on-line at a similar price to standard formula.  

A NON-FORMULARY Traffic Light Status was agreed

The Surrey Heartlands Integrated Care System Area Prescribing Committee have agreed SMA LF should not be prescribed when a lactose free formula is indicated. Lactose free formulas are available from pharmacies at a similar price to standard formula.

A NON-FORMULARY Traffic Light Status was agreed

The Surrey Heartland Integrated Care System Area Prescribing Committee have agreed the Surrey Heartlands guidelines for the management of vitamin B12 deficiency.

The Surrey Heartland Integrated Care System Area Prescribing Committee have agreed a BLUE (with information sheet) traffic light status for:

·         Phenelzine

·         Isocarboxacid

·         Moclobemide

·         Tranylcypromine

Specialists will initiate and prescribe a minimum of 6 months or until the patient is stable, whichever is longer, prior to transfer of care

The Surrey Heartland Integrated Care System Area Prescribing Committee have agreed a BLUE (with information sheet) traffic light status for:

·         Phenelzine

·         Isocarboxacid

·         Moclobemide

·         Tranylcypromine

Specialists will initiate and prescribe a minimum of 6 months or until the patient is stable, whichever is longer, prior to transfer of care

The Surrey Heartland Integrated Care System Area Prescribing Committee have agreed a BLUE (with information sheet) traffic light status for:

·         Phenelzine

·         Isocarboxacid

·         Moclobemide

·         Tranylcypromine

Specialists will initiate and prescribe a minimum of 6 months or until the patient is stable, whichever is longer, prior to transfer of care

The Surrey Heartland Integrated Care System Area Prescribing Committee have agreed a BLUE (with information sheet) traffic light status for:

·         Phenelzine

·         Isocarboxacid

·         Moclobemide

·         Tranylcypromine

Specialists will initiate and prescribe a minimum of 6 months or until the patient is stable, whichever is longer, prior to transfer of care

MODIFIED RELEASE TABLETS (18, 27, 36 and 54mg):

The Surrey Heartlands Integrated Care System Area Prescribing Committee have agreed the recommendation to prescribe the branded generic Methylphenidate modified release preparations (18, 27, 36 and 54mg) with the lowest acquisition cost.
Such products have an AMBER traffic light status and are the preferred alternatives to Concerta®.  
- See the "Branded generic methylphenidate letters" for information for patients and clinicians
N.B. This guidance does not apply to other strengths of modified release methylphenidate as these have different release characteristics

MODIFIED RELEASE TABLETS (18, 27, 36 and 54mg):

The Surrey Heartlands Integrated Care System Area Prescribing Committee have agreed the recommendation to prescribe the branded generic Methylphenidate modified release preparations (18, 27, 36 and 54mg) with the lowest acquisition cost.
Such products have an AMBER traffic light status and are the preferred alternatives to Concerta®.  
- See the "Branded generic methylphenidate letters" for information for patients and clinicians
N.B. This guidance does not apply to other strengths of modified release methylphenidate as these have different release characteristics

Tirzepatide should not be prescribed for the treatment of obesity until it has been approved for this indication at the Area Prescribing Committee

Shared Care arrangements for children and adolescents with ADHD are in place with Surrey and Borders Partnership NHS Foundation Trust.

Guildford & Waverley, North West Surrey and Surrey Downs have agreed a Locally Commissioned Service (LCS) for practices entering into the shared care agreement with Surrey & Borders Partnership. The LCS supports the provision of an annual physical medication review by the GP (with an annual review by the specialist so that the patient continues to receive a 6-monthly review in accordance with the product license)
See below for a copy of the Shared care with LCS agreement

There is also a non-LCS shared care agreement for all non-LCS participating practices (see shared care agreement below)

Shared Care arrangements for children and adolescents with ADHD are in place with Surrey and Borders Partnership NHS Foundation Trust.

Guildford & Waverley, North West Surrey and Surrey Downs have agreed a Locally Commissioned Service (LCS) for practices entering into the shared care agreement with Surrey & Borders Partnership. The LCS supports the provision of an annual physical medication review by the GP (with an annual review by the specialist so that the patient continues to receive a 6-monthly review in accordance with the product license)
See below for a copy of the Shared care with LCS agreement

There is also a non-LCS shared care agreement that is available for all non-LCS participating practices (see shared care agreement below)

Shared Care arrangements for children and adolescents with ADHD are in place with Surrey and Borders Partnership NHS Foundation Trust.

Guildford & Waverley, North West Surrey and Surrey Downs have agreed a Locally Commissioned Service (LCS) for practices entering into the shared care agreement with Surrey & Borders Partnership. The LCS supports the provision of an annual physical medication review by the GP (with an annual review by the specialist so that the patient continues to receive a 6-monthly review in accordance with the product license)
See below for a copy of the Shared care with LCS agreement

There is also a non-LCS shared care agreement that is available for all non-LCS participating practices (see shared care agreement below)

Shared Care arrangements for children and adolescents with ADHD are in place with Surrey and Borders Partnership NHS Foundation Trust.

Guildford & Waverley, North West Surrey and Surrey Downs have agreed a Locally Commissioned Service (LCS) for practices entering into the shared care agreement with Surrey & Borders Partnership. The LCS supports the provision of an annual physical medication review by the GP (with an annual review by the specialist so that the patient continues to receive a 6-monthly review in accordance with the product license)
See below for a copy of the Shared care with LCS agreement

There is also a non-LCS shared care agreement that is available for all non-LCS participating practices (see shared care agreement below)

Shared Care arrangements for children and adolescents with ADHD are in place with Surrey and Borders Partnership NHS Foundation Trust.

Guildford & Waverley, North West Surrey and Surrey Downs have agreed a Locally Commissioned Service (LCS) for practices entering into the shared care agreement with Surrey & Borders Partnership. The LCS supports the provision of an annual physical medication review by the GP (with an annual review by the specialist so that the patient continues to receive a 6-monthly review in accordance with the product license)
See below for a copy of the Shared care with LCS agreement

There is also a non-LCS shared care agreement that is available for all non-LCS participating practices (see shared care agreement below)

Shared Care arrangements for children and adolescents with ADHD are in place with Surrey and Borders Partnership NHS Foundation Trust.

Guildford & Waverley, North West Surrey and Surrey Downs have agreed a Locally Commissioned Service (LCS) for practices entering into the shared care agreement with Surrey & Borders Partnership. The LCS supports the provision of an annual physical medication review by the GP (with an annual review by the specialist so that the patient continues to receive a 6-monthly review in accordance with the product license)
See below for a copy of the Shared care with LCS agreement

There is also a non-LCS shared care agreement that is available for all non-LCS participating practices (see shared care agreement below)

Femoston tablets - 1st line for women requiring sequential combined therapy.

Femoston Conti - 1st line for women requiring continuous combined therapy.

The Surrey Heartlands APC has agreed a traffic light status and place in therapy for the treatments of menopausal disorders in line with the CKS recommenations:

Menopause | Health topics A to Z | CKS | NICE

Elleste Duet tablets 2nd line. For women requiring sequential combined therapy but with poor cycle control on Femoston (1st-line).

Evorel Sequi patches 2nd-line. Preferred option in women with risk factors for VTE or migraine.

Elleste Duet Conti - 2nd line for women requiring continuous combined therapy but with poor cycle control on Femoston Conti (1st-line).

Evorel Conti patches - preferred in women with risk factors for VTE or migraine. Otherwise use a 1st-line oral option.

Kliofem tablets - 2nd line in women requiring continuous combined therapy but with poor cycle control on Femoston Conti (1st-line)

Kliovance tablets - 2nd line in women requiring continuous combined therapy but with poor cycle control on Femoston Conti (1st-line)

Novofem tablets - Only use if there are product shortages with Elleste Duet

Trisequens tablets - non-formulary. Consider changing to newer, 1st or 2nd line options.

The Surrey Heartlands APC has agreed a traffic light status and place in therapy for the treatments of menopausal disorders in line with the CKS recommenations:

Menopause | Health topics A to Z | CKS | NICE

Tridestra tablets - consider changing to a newer, 1st or 2nd line option.

Indivina tablets - consider changing to a newer, 1st or 2nd line option.

The Surrey Heartlands APC has agreed a traffic light status and place in therapy for the treatments of menopausal disorders in line with the CKS recommenations:

Menopause | Health topics A to Z | CKS | NICE

Bijuve capsules - 1st line for women requiring continuous combined therapy.

The Surrey Heartlands APC has agreed a traffic light status and place in therapy for the treatments of menopausal disorders in line with the CKS recommenations:

Menopause | Health topics A to Z | CKS | NICE

Femseven Conti patches - less preferred. Only use in the event of product shortages.

The Surrey Heartlands APC has agreed a traffic light status and place in therapy for the treatments of menopausal disorders in line with the CKS recommenations:

Menopause | Health topics A to Z | CKS | NICE

Elleste Solo tablets - 1st line

Estradiol patches 2nd line to tablets. No preferred patch recommendation has been made due to current stock shortages (Estraderm, Estradot, Evorel, FemSeven, Progynova TS are all treatment options)

Lenzetto spray. Caution with higher than licensed doses.

Oestrogel is the preferred gel option. Sandrena is an alternative option.

Progynova and Zumenon tablets NOT 1st line. Only prescribe where Elleste Solo tablets are unavailable.

The Surrey Heartlands APC has agreed a traffic light status and place in therapy for the treatments of menopausal disorders in line with the CKS recommenations:

Menopause | Health topics A to Z | CKS | NICE

Prescribe generically. Micronised progesterone oral capsules.

The Surrey Heartlands APC has agreed a traffic light status and place in therapy for the treatments of menopausal disorders in line with the CKS recommenations:

Menopause | Health topics A to Z | CKS | NICE

Premique Low Dose - no longer recommended. Switch to a newer, lower risk formulation.

The Surrey Heartlands APC has agreed a traffic light status and place in therapy for the treatments of menopausal disorders in line with the CKS recommenations:

Menopause | Health topics A to Z | CKS | NICE

Recommend switching to a newer, lower risk formulation.

The Surrey Heartlands APC has agreed a traffic light status and place in therapy for the treatments of menopausal disorders in line with the CKS recommenations:

Menopause | Health topics A to Z | CKS | NICE

2nd line for endometrial protection in women who have abnormal bleeding on other HRT.

10mg tablets for adjunctive progestogen therapy

The Surrey Heartlands APC has agreed a traffic light status and place in therapy for the treatments of menopausal disorders in line with the CKS recommenations:

Menopause | Health topics A to Z | CKS | NICE

Estriol vaginal cream 0.1% - Green. Prescribe generically.

Estriol vaginal cream 0.01% is non-formulary

Blissel vaginal gel is non-formulary

Estriol 500mcg vaginal tablets are non-formulary.

Estriol pessaries (Imvaggis) are non-formulary.

The Surrey Heartlands APC has agreed a traffic light status and place in therapy for the treatments of menopausal disorders in line with the CKS recommenations:

Menopause | Health topics A to Z | CKS | NICE

Initiation in primary care following specialist recommendation. Reserve for severe dryness or when other treatments are ineffective / contraindicated.

The Surrey Heartlands APC has agreed a traffic light status and place in therapy for the treatments of menopausal disorders in line with the CKS recommenations:

Menopause | Health topics A to Z | CKS | NICE

Vaginal tablets (10mcg) Prescribe generically - Green status

APC August 2023 agreed to the generic prescribing of estradiol 10mcg vaginal tablets.

Patients receiving the brands (Vagirux, Vagifem, Gina) can be switched to a generic prescription.

Vaginal ring - Green status

The Surrey Heartlands APC has agreed a traffic light status and place in therapy for the treatments of menopausal disorders in line with the CKS recommenations:

Menopause | Health topics A to Z | CKS | NICE

Initiation on specialist recommendation only. For severe dryness where other treatments are ineffective / contraindicated.

The Surrey Heartlands APC has agreed a traffic light status and place in therapy for the treatments of menopausal disorders in line with the CKS recommenations:

Menopause | Health topics A to Z | CKS | NICE

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review. 

Primary care to prescribe upon request.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and idication as part of the Joint Formulary review.

Composition and further info: https://www.sps.nhs.uk/articles/what-is-st-markos-electrolyte-mix-solution/ Patients are able to make their own rehydration solution in primary care. GPs do not prescribe.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agree the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status for this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light staus of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

PRESCRIBE BY BRAND (PRODUCT WITH MULTIPLE INGREDIENTS)

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

Insulin Pump warranties

The Surrey Heartlands Integrated Care System Area Prescribing Committee have re-affirmed the position on insulin pump warranties.

The 'tethered' (with tubing) insulin pumps have a 4 year warranty. A patient can be switched 'in warranty', to another insulin pump where:

• The Diabetes specialist team consider that the use if the current tethered insulin pump poses a safety concerns OR
• The Diabetes specialist team consider that the patient is unable to maintain expected blood sugar levels with their current 'tethered' insulin pump.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Integrated Care System Area Prescribing Committee agreed the addition of FreeStyle Libre 2 PLUS Continuous Glucose Monitoring to the currently available CGMs used for people living with Type I diabetes.

A BLUE traffic light status with an information sheet) was agreed. Initiation will be by the diabetes specialist service, who will provide the first 28 days of treatment (and capillary test strips if required), prior to transfer of care to primary care.

The Surrey Heartlands Integrated Care System Area Prescribing Committee agreed the addition of Dexcom ONE PLUS Continuous Glucose Monitoring to the currently available CGMs used for people living with Type I diabetes.

A BLUE traffic light status with an information sheet) was agreed. Initiation will be by the diabetes specialist service, who will provide the first 28 days of treatment (and capillary test strips if required), prior to transfer of care to primary care

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) agreed the removal of a dedicated information sheet for this treatment as all pertinant prescribing and monitoring information is contained within the Summary of Product Characteristics.

The APC also agreed that transfer of prescribing this treatment into primary care could now occur at 4 weeks post initiation if appropriately described in communication between secondary and primary care clinicians.

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) agreed the removal of a dedicated information sheet for this treatment as all pertinant prescribing and monitoring information is contained within the Summary of Product Characteristics.

The APC also agreed that transfer of prescribing this treatment into primary care could now occur at 4 weeks post initiation if appropriately described in communication between secondary and primary care clinicians.

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) agreed the removal of a dedicated information sheet for this treatment as all pertinent prescribing and monitoring information is contained within the Summary of Product Characteristics.

The APC also noted transfer of prescribing responsibility into primary care can take place at 4 weeks post initiation if suitable (tolerability and efficacy, noting that patient fragility may mean disease may never stabilise).

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) agreed the removal of a dedicated information sheet for this treatment as all pertinent prescribing and monitoring information is contained within the Summary of Product Characteristics.

Primary care prescribers can start this treatment on advice from a specialist.

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) agreed the removal of a dedicated information sheet for this treatment as all pertinent prescribing and monitoring information is contained within the Summary of Product Characteristics.

The APC also agreed that transfer of prescribing this treatment into primary care could now occur at 4 weeks post initiation if appropriately described in communication between secondary and primary care clinicians.

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) agreed the removal of a dedicated information sheet for this treatment as all pertinent prescribing and monitoring information is contained within the Summary of Product Characteristics.

The APC also agreed that transfer of prescribing this treatment into primary care could now occur at 4 weeks post initiation if appropriately described in communication between secondary and primary care clinicians.

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) agreed the removal of a dedicated information sheet for this treatment as all pertinent prescribing and monitoring information is contained within the Summary of Product Characteristics.

The APC also agreed that transfer of prescribing this treatment into primary care could now occur at 4 weeks post initiation if appropriately described in communication between secondary and primary care clinicians.

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) agreed the removal of a dedicated information sheet for this treatment as all pertinent prescribing and monitoring information is contained within the Summary of Product Characteristics.

The APC also agreed that transfer of prescribing this treatment into primary care could now occur at 12 weeks post initiation if appropriately described in communication between secondary and primary care clinicians.

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) agreed the removal of a dedicated information sheet for this treatment as all pertinent prescribing and monitoring information is contained within the Summary of Product Characteristics.

The APC also agreed that transfer of prescribing this treatment into primary care could now occur at 4 weeks post initiation if appropriately described in communication between secondary and primary care clinicians.

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) agreed the removal of a dedicated information sheet for this treatment as all pertinent prescribing and monitoring information is contained within the Summary of Product Characteristics.

The APC also agreed that transfer of prescribing this treatment into primary care could now occur at 12 weeks post initiation if appropriately described in communication between secondary and primary care clinicians.

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) agreed the removal of a dedicated information sheet for this treatment as all pertinent prescribing and monitoring information is contained within the Summary of Product Characteristics.

The APC also agreed that transfer of prescribing this treatment into primary care could now occur at 4 weeks post initiation if appropriately described in communication between secondary and primary care clinicians.

The Surrey Heartlands Integrated Care System agreed a RED traffic light status for Remdesevir in line with NICE TA971

The Surrey Heartlands Integrated Care System Area Prescribing Committed agreed a NON-FORMULARY traffic light status for Tixagevimab plus cilgavimab in line with NICE971 & NICE TA900

Famotidine can be prescribed, for use only in situations where:

• PPIs are not suitable AND
• H2As are indicated and necessary. 

Nizatidine can be prescribed, for use only in situations where:

• PPIs are not suitable AND
• H2As are indicated and necessary. 

if Nizatidine 300mg is required prescribe as multiples of Nizatidine 150mg capsules as significantly more cost effective 

Cimetidine can be prescribed, for use only in situations where:

• PPIs are not suitable AND
• H2As are indicated and necessary OR
• Liquid preparation required AND
• no drug interactions

All preparations of ranitidine (tablets, effervescent tablets, oral solution, and injection) are out of stock until further notice. Following advice from the EMA, the MHRA have suspended all licenses for ranitidine products.

The Surrey Heartlands APC have approved the use of 

Aviptadil 25microgram/ Phentolamine 2mg (Invicorp®) solution for injection, for the symptomatic treatment of erectile dysfunction in adult males due to neurogenic, vasculogenic, psychogenic, or mixed aetiology, or use in those who have failed on oral therapies (oral phosphodiesterase type-5 inhibitors) and other non-injectable formulations of erectile dysfunction medications

It has been assigned a BLUE (on initiation by a specialist) traffic light classification. Primary care would be asked to prescribe after the patient has been shown how to use it and is able to tolerate treatment.

Alprostadil intra-urethral applications may be initiated in primary care following specialist recommendation.

The patient must have been provided with, or directed to, training materials to support self-administration before prescribing is requested from the GP.

Alprostadil intracavernosal injections should be initiated in secondary care, patients trained to self-administer and treatment shown to be effective before discharge for GPs to prescribe.

Alprostadil cream (Vitaros) is restricted by SLS criteria as identified in the Health Service Circular (HSC) 1999/148 at a maximum frequency of dosing of four times per month.

Alprostadil cream (Vitaros®) is a treatment option in primary care for patients who do not respond to PDE-5 inhibitors. This can be initiated in primary care and is considered GREEN on the traffic light system

Combination treatments (oral & non oral)
These treatments should not be used in combination with other treatments for erectile dysfunction due to the limited evidence available to support their use. 

The Surrey Heartlands APC have agreed the following update for tadalafil for erectile dysfunction:

Tadalafil "as required" dosing (10mg and 20mg) has a Green traffic light status. Tadalafil and sildenafil "as required" dosing are equally preferred treatment options.

ONCE DAILY:

Tadalafil once daily (5mg) has a Green traffic light status. If daily dosing is not tolerated, use "as required" dosing.

Tadalafil once daily (2.5mg) is NON-FORMULARY (very costly).

NOTE: SLS endorsement is still required for tadalafil prescribing on the NHS. Patients who do not meet the SLS criteria may purchase an over-the-counter product. 

Use in combination with any other oral / non-oral treatments for erectile dysfunction is not supported

The Surrey Heartlands APC has updated the recommendation for the use of tadalafil for penile rehabilitation as follows:

Tadalafil "as required" (10mg and 20mg) has a Blue traffic light status and may be prescribed in primary care on recommendation from a specialist.

ONCE DAILY:

Tadalafil daily dosing (5mg) has a Blue traffic light status and may be prescribed in primary care on recommendation from a specialist.

Tadalafil 2.5mg daily is NON-FORMULARY (very costly).

Use in combination with any other oral / non-oral treatments for erectile dysfunction is not supported

The Surrey Heartlands APC supports the use of sildenafil for penil rehabilitation.

It has been assigned a Blue traffic light status and can be prescribed in primary care following recommendation from a specialist.

Combination treatments (oral & non oral). These treatments should not be used in combination with other treatments for erectile dysfunction due to the limited evidence available to support their use

The Surrey Heartlands APC have updated the recommended treatment options for erectile dysfunction.

Sildenafil remains a preferred treatment option.

Combination treatments (oral & non oral)
These treatments should not be used in combination with other treatments for erectile dysfunction due to the limited evidence available to support their use.

The Surrey Heartlands APC have reviewed the treatments for erectile dysfunction.

Avanafil remains non-formulary.

Sildenafil or tadalafil are the preferred treatment options.

Combination treatments (oral & non oral)
These treatments should not be used in combination with other treatments for erectile dysfunction due to the limited evidence available to support their use.

The Surrey Heartlands APC have reviewed the treatments for erectile dysfunction.

Vardenafil remains non-formulary.

Sildenafil or tadalafil are the preferred treatment options.

Combination treatments (oral & non oral)
These treatments should not be used in combination with other treatments for erectile dysfunction due to the limited evidence available to support their use.

The Surrey Heartlands APC do not recommend vadenafil or avanafil for penile rehabilitation.

Sildenafil or tadalafil are the preferred options.

Please note; alfentanil injection for palliative care use will be available through the community pharmacy palliative care drug access scheme.

The Surrey Heartlands Integrated Care System Area Prescribing Committee noted the ongoing shortages of pancreatic enzyme replacement therapies.

Local guidance (below) has been produced to summarise current issues and information and actions for prescribers, community pharmacies and patients.

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) approves ritlecitinib as a treatment option in line with the recommendations made in NICE TA958, for treating severe alopecia areata in patients 12 years and over.

Ritlecitinib for this indication will be considered as RED on the traffic light system (treatment should be initiated and continued by specialist clinicians).

Primary care prescribers should ensure that patient medication records include any medicine for which prescribing remains the responsibility of secondary or tertiary care. This will ensure that GP records, which are accessed by other healthcare providers, are a true and accurate reflection of the patient's medication.

With the publication of the final Cass Report and new NHSE commissioning policies, the APC has agreed an AMBER status for gender affirming hormones in children and young people.  This applies to recommendations from both NHS and private providers subject to appropriate shared care protocols being in place.

The following guidance has also been updated:

• Primary care prescribing guidance, for people who access Gender Identity Services.
• NHSE guidance on prescribing and dispensing restrictions for puberty blockers and gender affirming hormones

With the publication of the final Cass Report and new NHSE commissioning policies, the APC has agreed an AMBER status for gender affirming hormones in children and young people.  This applies to recommendations from both NHS and private providers subject to appropriate shared care protocols being in place.

The following guidance has also been updated:

• Primary care prescribing guidance, for people who access Gender Identity Services.
• NHSE guidance on prescribing and dispensing restrictions for puberty blockers and gender affirming hormones

With the publication of the final Cass Report and new NHSE commissioning policies, the APC has agreed an AMBER status for gender affirming hormones in children and young people.  This applies to recommendations from both NHS and private providers subject to appropriate shared care protocols being in place.

The following guidance has also been updated:

• Primary care prescribing guidance, for people who access Gender Identity Services.
• NHSE guidance on prescribing and dispensing restrictions for puberty blockers and gender affirming hormones

With the publication of the final Cass Report and new NHSE commissioning policies, the APC has agreed an AMBER status for gender affirming hormones in children and young people.  This applies to recommendations from both NHS and private providers subject to appropriate shared care protocols being in place.

The following guidance has also been updated:

• Primary care prescribing guidance, for people who access Gender Identity Services.
• NHSE guidance on prescribing and dispensing restrictions for puberty blockers and gender affirming hormones

With the publication of the final Cass Report and new NHSE commissioning policies, the APC has agreed an AMBER status for puberty supressing hormones in children and young people under the following circumstances:
i.    ONLY for current NHS and private patients at least until next reviewed by the service lead clinician.  Always ensure that appropriate shared care protocols are in place before continuing prescribing.  Private patients should be advised of the new NHS policy and recommendation made to return to the private provider for consideration of stopping.
ii.    DO NOT initiate in any new patients

With the publication of the final Cass Report and new NHSE commissioning policies, the APC has agreed an AMBER status for puberty supressing hormones in children and young people under the following circumstances:
i.    ONLY for current NHS and private patients at least until next reviewed by the service lead clinician.  Always ensure that appropriate shared care protocols are in place before continuing prescribing.  Private patients should be advised of the new NHS policy and recommendation made to return to the private provider for consideration of stopping.
ii.    DO NOT initiate in any new patients

With the publication of the final Cass Report and new NHSE commissioning policies, the APC has agreed an AMBER status for puberty supressing hormones in children and young people under the following circumstances:
i.    ONLY for current NHS and private patients at least until next reviewed by the service lead clinician.  Always ensure that appropriate shared care protocols are in place before continuing prescribing.  Private patients should be advised of the new NHS policy and recommendation made to return to the private provider for consideration of stopping.
ii.    DO NOT initiate in any new patients

With the publication of the final Cass Report and new NHSE commissioning policies, the APC has agreed an AMBER status for puberty supressing hormones in children and young people under the following circumstances:
i.    ONLY for current NHS and private patients at least until next reviewed by the service lead clinician.  Always ensure that appropriate shared care protocols are in place before continuing prescribing.  Private patients should be advised of the new NHS policy and recommendation made to return to the private provider for consideration of stopping.
ii.    DO NOT initiate in any new patients

The Surrey Heartlands Integrated Care System Area Prescribing Committee approves the prescribing of mexiletine for the management of drug resistant ventricular arrhythmia when initiated and continued by a specialist.

The APC recommend a RED traffic light status for the use of mexiletine for this indication.

All patients currently being prescribed mexiletine in primary care should be referred into a cardiologist for specialist review. Responsibility for prescribing must remain with the specialist.

Patients currently prescribed Namuscla® for the management of drug resistant arrhythmias should be reviewed by specialists to consider switching to the products licensed for ventricular arrhythmias noting that there isn’t an exact equivalent dose. 

The Surrey Heartlands Integrated Care System Area Prescribing Committee has agreed a change in traffic light status for Perampanel.

Perampanel for treatment in all licensed indications will be given a BLUE (on specialist initiation) traffic light status.

Neurology specialist teams will be required to prescribe 12 weeks treatment prior to a transfer of care to primary care prescribers

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) approves the updated spondyloarthritis treatment pathway.

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) approves etrasimod as a treatment option in line with the recommendations made in NICE TA956, for treating moderately to severely active ulcerative colitis in people aged 16 years and over.

Etrasimod for this indication will be considered as RED on the traffic light system (treatment should be initiated and continued by specialist clinicians).

Primary care prescribers should ensure that patient medication records include any medicine for which prescribing remains the responsibility of secondary or tertiary care. This will ensure that GP records, which are accessed by other healthcare providers, are a true and accurate reflection of the patient's medication.

Restricted Use - for use when indicated by local trust antimicrobial guidelines or specialist microbiology recommendation. Colistimethate sodium 1million unit powder for solution for injection, infusion, inhalation vials is the most cost effective option for inhalation use by nebulisation.

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) approves the following in relation to prescribing of Omega 3 for raised triglycerides in primary care in line with NHSE guidance:

Omega 3 will be given a RED traffic light status.

Patients prescribed Omega 3 in primary care will be reviewed as follows:

• Do not initiate omega-3 fatty acid ethyl esters for any new patient in primary care (with the exception of icosapent ethyl prescribed in line with NICE TA805).
• Patients for whom omega-3 fatty acid ethyl esters are prescribed for specialist indications, e.g. schizophrenia (unlicensed), or where they have been recommended by a specialist lipid clinic e.g. patient with elevated triglycerides at risk of pancreatitis, should be referred back to the specialist for review. If there is any ongoing prescribing for specialist indications, this should take place in secondary care. GPs may continue to prescribe in the meantime for these patients whilst waiting to be seen by the specialist service.
• Patients with a high risk of cardiovascular events, prescribed omega-3 fatty acid ethyl esters with statin therapy for reducing the risk of cardiovascular events with raised triglycerides should be switched to icosapent ethyl, if appropriate and in line with NICE TA805.
• In all other patients deprescribe omega-3 fatty acid ethyl esters compounds (with the exception of icosapent ethyl prescribed in line with NICE TA805). Advise patients that they may purchase them over the counter if they still wish to take them after understanding that there is a lack of consistent evidence to support their use and a risk of atrial fibrillation. See MHRA drug safety update for more information.

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) has agreed the Patient Information Leaflet (PIL) to support patients taking off label continuous progesterone as part of continuous combined HRT

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) approves fluocinolone acetonide intravitreal implant as a treatment option in line with the recommendations made in NICE TA953, for treating diabetic macular oedema.

Fluocinolone acetonide for this indication will be considered as RED on the traffic light system (treatment should be initiated and continued by specialist clinicians).

Primary care prescribers should ensure that patient medication records include any medicine for which prescribing remains the responsibility of secondary or tertiary care. This will ensure that GP records, which are accessed by other healthcare providers, are a true and accurate reflection of the patient's medication.

The Surrey Heartlands APC agreed a traffic light status and place in therapy for drugs used to treat nausea and vomiting in pregnancy.

Oral solution (sugar free) is an option for patients with swallowing difficulties.

Visit  the Guideline Profile page for a full list of these drugs and to access the CKS guidelines for nasea & vomiting and pregnancy and the BUMPS website (Best Use of Medicines in Pregnancy).

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) agreed a change in fidaxomicin traffic light status from Blue to GREEN.

This is to facilitate the prescribing of fidaxomicin following the recurrence of C diff infection within 12 weeks of a previous infection (as per NICE NG199).

For any patient requiring a liquid preparation, fidaxomicin granules should be prescribed.  The APC notes that although current NICE guidelines recommend vancomycin first line, it is recognised that this was based on cost and in exceptional cases when a liquid is required, fidaxomicin granules are appropriate to prescribe as a licensed preparation that supports timely treatment.

SUPPLY:

Vancomycin and fidaxomicin are not routinely stocked in community pharmacies but are usually obtainable on next-day delivery. However, at weekends and bank holidays, a local arrangement has been put in place whereby a small number of pharmacies will hold supplies. Please refer to the document below called "Supply of oral vancomycin and fidaxomicin for treating Clostridioides difficile in Primary Care - Mar 23"

The Surrey Heartlands APC approved doxylamine with pyridoxine for use in nausea and vomiting in pregnancy, acknowledging that the drug is licensed for this indication.

However, it was agreed that it should only be considered after a trial of a more established drug (off-label cyclizine, promethazine, prochlorperazine or chlorpromazine).

The Surrey Heartlands APC agreed a traffic light status and place in therapy for drugs used to treat nausea and vomiting in pregnancy.

Visit  the Guideline Profile page for a full list of these drugs and to access the CKS guidelines for nasea & vomiting and pregnancy and the BUMPS website (Best Use of Medicines in Pregnancy).

The Surrey Heartlands APC agreed a traffic light status and place in therapy for drugs used to treat nausea and vomiting in pregnancy.

Visit  the Guideline Profile page for a full list of these drugs and to access the CKS guidelines for nasea & vomiting and pregnancy and the BUMPS website (Best Use of Medicines in Pregnancy).

The Surrey Heartlands APC agreed a traffic light status and place in therapy for drugs used to treat nausea and vomiting in pregnancy.

Visit  the Guideline Profile page for a full list of these drugs and to access the CKS guidelines for nasea & vomiting and pregnancy and the BUMPS website (Best Use of Medicines in Pregnancy).

Off-label use.

Promethazine Teoclate is a lower cost option for primary care - note different dosing (refer to CKS Nausea/vomiting in pregnancy | Health topics A to Z | CKS | NICE)

Promethazine oral solution is an option for patients with swallowing difficulties.

The Surrey Heartlands APC agreed a traffic light status and place in therapy for drugs used to treat nausea and vomiting in pregnancy.

Visit  the Guideline Profile page for a full list of these drugs and to access the CKS guidelines for nasea & vomiting and pregnancy and the BUMPS website (Best Use of Medicines in Pregnancy).

Off-label use

Prochlorperazine buccal tablets are an option in patients with swallowing difficulties.

2nd line treatment option. Should not be prescribed for longer than 5 days.

Oral solution is a treatment option in patients with swallowing difficulties.

Off-label use.

The Surrey Heartlands APC agreed a traffic light status and place in therapy for drugs used to treat nausea and vomiting in pregnancy.

Visit  the Guideline Profile page for a full list of these drugs and to access the CKS guidelines for nasea & vomiting and pregnancy and the BUMPS website (Best Use of Medicines in Pregnancy).

Ondansetron tablets - 2nd line treatment option. Should not be prescribed for longer than 5 days and not recommended in the first trimester.

Off-label use.

Ondanstron orodispersible films are an option in patients with swallowing difficulties.

Note - oral solution and orodispersible tablets are Non-Formulary. The orodispersible films are a more cost effective option.

The Surrey Heartlands APC agreed a traffic light status and place in therapy for drugs used to treat nausea and vomiting in pregnancy.

Visit  the Guideline Profile page for a full list of these drugs and to access the CKS guidelines for nasea & vomiting and pregnancy and the BUMPS website (Best Use of Medicines in Pregnancy).

A 2nd line treatment option but should not be prescribed for longer than 7 days.

Off-label use.

Domepridone oral suspension is an option in patients with swallowing difficulties.

MHRA drug safety update (December 2019- Domperidone for nausea and vomiting: lack of efficacy in children; reminder of contraindications in adults and adolescents : https://www.gov.uk/drug-safety-update/domperidone-for-nausea-and-vomiting-lack-of-efficacy-in-children-reminder-of-contraindications-in-adults-and-adolescents

The Surrey Heartlands APC agreed a traffic light status and place in therapy for drugs used to treat nausea and vomiting in pregnancy.

Visit  the Guideline Profile page for a full list of these drugs and to access the CKS guidelines for nasea & vomiting and pregnancy and the BUMPS website (Best Use of Medicines in Pregnancy).

This drug has been discontinued and no longer has a UK marketing license.

The Surrey Heartlands Integrated Care System Area Prescribing Committee agreed the following traffic light statuses and place in therapy for treatments used in post cholecystectomy patients with undiagnosed diarrhoea.

 GREEN traffic light status – For patients after cholecystectomy (with undiagnosed diarrhoea) waiting for an appointment with the Gastroenterologist.

·         1st line colestyramine (with sugar)

·         2nd line colesevelam

·         3rd colestyramine (sugar free) – for diabetic patients who request a sugar free formulation. Most costly preparation

The Surrey Heartlands Integrated Care System Area Prescribing Committee agreed the following traffic light statuses and place in therapy for treatments used in post cholecystectomy patients with undiagnosed diarrhoea.

 GREEN traffic light status – For patients after cholecystectomy (with undiagnosed diarrhoea) waiting for an appointment with the Gastroenterologist.

·         1st line colestyramine (with sugar)

·         2nd line colesevelam

·         3rd colestyramine (sugar free) – for diabetic patients who request a sugar free formulation. Most costly preparation

Change to traffic light status:

Esomeprazole capsules are now considered Green (3rd line).

The decision of September 2022 has been superceded BUT lansoprazole capsules remain the preferred PPI in patients with and without swallowing difficulties and in patients with an enteral feeding tube.

Note - 40mg esomeprazole capsules are restricted for short-term use prior to step down OR Zollinger-Ellison syndrome

The Surrey Heartlands Integrated Care System Area Prescribing Committee agreed the following traffic light statuses and place in therapy for treatments used in Bile Acid Malabsorption (BAM)

 BLUE traffic light status (on recommendation by a specialist)

·         1st line colestyramine (with sugar)

·         2nd line colesevelam

·         3rd colestyramine (sugar free) – for diabetic patients who request a sugar free formulation. Most costly preparation

The Surrey Heartlands Integrated Care System Area Prescribing Committee agreed the following traffic light statuses and place in therapy for treatments used in Bile Acid Malabsorption (BAM)

 BLUE traffic light status (on recommendation by a specialist)

·         1st line colestyramine (with sugar)

·         2nd line colesevelam

·         3rd colestyramine (sugar free) – for diabetic patients who request a sugar free formulation. Most costly preparation

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Integrated Care System Area Prescribing Committee have agreed that dupilumab for Prurigo Nodularis will be given a NON-FORMULARY traffic light status following publication of NICE TA955

Dupilumab is not recommended, by NICE, within its marketing authorisation, for treating this indication

Not for use after gastric band surgery.

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) has approved Guidelines for Micronutrient monitoring and supplementation post bariatric surgery.

This includes primary care monitoring and prescribing advice. Refer to guideline profiles for details.

ONLY after single anastomosis duodenal illeal bypass with sleeve (SADI-S) or duodenal switch surgery.

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) has approved Guidelines for Micronutrient monitoring and supplementation post bariatric surgery.

This includes primary care monitoring and prescribing advice. Refer to guideline profiles for details.

For supplementation in cases of concern regarding deficiency post-surgery or for prevention of Wernicke’s encephalopathy.

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) has approved Guidelines for Micronutrient monitoring and supplementation post bariatric surgery.

This includes primary care monitoring and prescribing advice. Refer to guideline profiles for details.

ONLY after post single anastomosis duodenal illeal bypass with sleeve (SADI-S) or duodenal switch surgery.

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) has approved Guidelines for Micronutrient monitoring and supplementation post bariatric surgery.

This includes primary care monitoring and prescribing advice. Refer to guideline profile for details.

DEKAs Plus Softgel capsules have been agreed as BLUE (on recommendation from a Specialist healthcare professionl).

Status Epilepticus in all age groups (over 3 months of age)

The Surrey Heartlands Area Prescribing Committee agreed that:

• Buccolam (midazolam hydrochloride) and Epistatus (midazolam maleate) will be assigned a Blue traffic light status (no information sheet required) for all ages over 3 months of age when used for Status Epilepticus.
• Buccolam and Epistatus should be prescribed by brand (in line with MHRA & NICE guidance) https://surreyccg.res-systems.net/PAD/Guidelines/Detail/5045
• The least costly preparation should be used at the point of initiation (currently Buccolam - April 2024)

NOTE: the use of Buccolam and Epistatus in patients aged 18 years and over is off-label.

Unlicensed specials will be assigned a RED traffic light status.

Patients using unlicensed preparations should be reviewed for a potential switch to the licensed product following liaison with their specialist.

Status Epilepticus in all age groups (over 3 months of age)

The Surrey Heartlands Area Prescribing Committee agreed that:

• Buccolam (midazolam hydrochloride) and Epistatus (midazolam maleate) will be assigned a Blue traffic light status (no information sheet required) for all ages over 3 months of age when used for Status Epilepticus.
• Buccolam and Epistatus should be prescribed by brand (in line with MHRA & NICE guidance) https://surreyccg.res-systems.net/PAD/Guidelines/Detail/5045
• The least costly preparation should be used at the point of initiation (currently Buccolam - April 2024)

NOTE: the use of Buccolam and Epistatus in patients aged 18 years and over is off-label.

Unlicensed specials will be assigned a RED traffic light status.

Patients using unlicensed preparations should be reviewed for a potential switch to the licensed product following liaison with their specialist.

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) agreed that special-order Midazolam Oral Solution should be given the following traffic light status:

 Sedation and anxiolysis prior to diagnostic, surgical, therapeutic, or endoscopic procedures

o   RED traffic light status

Pre-medication before induction of general anaesthesia

o   RED traffic light status

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) agreed that special-order Midazolam Oral Solution should be given the following traffic light status:

 Sedation and anxiolysis prior to diagnostic, surgical, therapeutic, or endoscopic procedures

o   RED traffic light status

Pre-medication before induction of general anaesthesia

o   RED traffic light status

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) agreed that special-order Midazolam Oral Solution should be given the following traffic light status:

 Sedation and anxiolysis prior to diagnostic, surgical, therapeutic, or endoscopic procedures

o   RED traffic light status

Pre-medication before induction of general anaesthesia

o   RED traffic light status

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) agreed that special-order Midazolam Oral Solution should be given the following traffic light status:

 Sedation and anxiolysis prior to diagnostic, surgical, therapeutic, or endoscopic procedures

o   RED traffic light status

Pre-medication before induction of general anaesthesia

o   RED traffic light status

The Surrey Heartlands Integrated Care System Area Prescribing Committee agreed the reviewed and updated  Psoriatic arthritis high cost immunomodulator treatment pathway.

The Surrey Heartlands Integrated Care System Area Prescribing Committee agreed the reviewed and updated  Psoriatic arthritis high cost immunomodulator treatment pathway.

The Surrey Heartlands Integrated Care System Area Prescribing Committee agreed the reviewed and updated  Psoriatic arthritis high cost immunomodulator treatment pathway.

The Surrey Heartlands Integrated Care System Area Prescribing Committee agreed the reviewed and updated  Psoriatic arthritis high cost immunomodulator treatment pathway.

The Surrey Heartlands Integrated Care System Area Prescribing Committee agreed the reviewed and updated  Psoriatic arthritis high cost immunomodulator treatment pathway.

The Surrey Heartlands Integrated Care System Area Prescribing Committee agreed the reviewed and updated  Psoriatic arthritis high cost immunomodulator treatment pathway.

The Surrey Heartlands Integrated Care System Area Prescribing Committee agreed the reviewed and updated  Psoriatic arthritis high cost immunomodulator treatment pathway.

The Surrey Heartlands Integrated Care System Area Prescribing Committee agreed the reviewed and updated  Psoriatic arthritis high cost immunomodulator treatment pathway.

The Surrey Heartlands Integrated Care System Area Prescribing Committee agreed the reviewed and updated  Psoriatic arthritis high cost immunomodulator treatment pathway.

The Surrey Heartlands Integrated Care System Area Prescribing Committee agreed the reviewed and updated  Psoriatic arthritis high cost immunomodulator treatment pathway.

The Surrey Heartlands Integrated Care System Area Prescribing Committee agreed the reviewed and updated  Psoriatic arthritis high cost immunomodulator treatment pathway.

The Surrey Heartlands Integrated Care System Area Prescribing Committee agreed the reviewed and updated  Psoriatic arthritis high cost immunomodulator treatment pathway.

The Surrey Heartlands Area Prescribing Committee approved the Primary Care guidance for prescribing oral mucolytics to reduce sputum viscosity.

Carbocisteine should be prescribed generically.

Refer to the guidance for full details of product choice in adults, children and patients with swallowing difficulties.

The Surrey Heartlands Area Prescribing Committee approved the Primary Care guidance for prescribing oral mucolytics.

Acetylcysteine should be prescribed generically as 600mg effervescent tablets sugar free.

NOTE - all other formulations are considered non-formulary including tablets, powder, capsules, oral solution and granules.

Refer to the guidance for full details.

The Surrey Heartlands Area Prescribing Committee have approved Primary Care guidance for prescribing oral mucolytics.

Erdosteine is non-formulary.

Refer to the guidance for alternatives and recommendations.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

This decision does not relate to the use of alfentanyl in Palliative Care.

The prescribing of medicines for pain in palliative care is yet to be addressed.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

Paracetamol solid dose is considered the preferred option.

Effervescent or soluble formulations, oral suspensions (120mg/5ml & 250mg/5ml) and suppositories: 

• Reserve for patients who cannot swallow solid dose forms
• Soluble/effervescent preparations have a high sodium content and are more expensive than ordinary tablets.

Not recommended for use in any healthcare setting across Surrey Heartlands

• Paracetamol oral suspension 500mg in 5ml

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) approve the updated Interface Prescribing Policy 2024/2025 for inclusion in the acute provider contracts for the next financial year.

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) approves tirzepatide, a long-acting dual glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) receptor agonist, for treating type 2 diabetes in line with the recommendations made in NICE TA924.

Tirzepatide will be given a GREEN traffic light status for this indication.

Dulaglutide remains the preferred choice among GLP-1 options for weekly injections and semaglutide stands as an alternative to dulaglutide for weekly injections.

Please consider tirzepatide as a third line option to dulaglutide and semaglutide weekly injection, only if:

• dulaglutide and semaglutide are unsuitable.

or

• the supply of dulaglutide and semaglutide weekly injections is unavailable.

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) approves targeted-release budesonide (Kinpeygo®) for treating primary IgA nephropathy in line with the recommendations made in NICE TA937.

Targeted-release budesonide (Kinpeygo®) for this indication will be considered as RED on the traffic light system (treatment should be initiated and continued by specialist clinicians). Primary care prescribers should ensure that patient medication records include any medicine for which prescribing remains the responsibility of secondary or tertiary care. This will ensure that GP records, which are accessed by other healthcare providers, are a true and accurate reflection of the patient's medication.

The APC supports patients in trialling a treatment break of their overactive bladder medicines.

A "Leaflet for trial of stopping anticholinergics" can be found in the documents section.

The APC supports patients in trialling a treatment break of their overactive bladder medicines.

A "Leaflet for trial of stopping anticholinergics" can be found in the documents section.

The APC supports patients in trialling a treatment break of their overactive bladder medicines.

A "Leaflet for trial of stopping anticholinergics" can be found in the documents section.

The APC supports patients in trialling a treatment break of their overactive bladder medicines.

A "Leaflet for trial of stopping anticholinergics" can be found in the documents section.

The APC supports patients in trialling a treatment break of their overactive bladder medicines.

A "Leaflet for trial of stopping anticholinergics" can be found in the documents section.

The APC supports patients in trialling a treatment break of their overactive bladder medicines.

A "Leaflet for trial of stopping anticholinergics" can be found in the documents section.

The APC supports patients in trialling a treatment break of their overactive bladder medicines.

A "Leaflet for trial of stopping anticholinergics" can be found in the documents section.

The APC supports patients in trialling a treatment break of their overactive bladder medicines.

A "Leaflet for trial of stopping anticholinergics" can be found in the documents section.

The APC supports patients in trialling a treatment break of their overactive bladder medicines.

A "Leaflet for trial of stopping anticholinergics" can be found in the documents section.

The APC supports patients in trialling a treatment break of their overactive bladder medicines.

A "Leaflet for trial of stopping mirabegron" can be found in the documents section.

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) approves empagliflozin as a treatment option for treating chronic kidney disease in line with NICE TA942.

 NB: Check NICE guidance for recommended patient cohorts regarding eGFR.

Empagliflozin will be considered GREEN on the traffic light system.

Key considerations:

• If a patient with diabetes were on insulin and on multiple other treatments, a discussion with the specialist diabetes team may be prudent prior to empagliflozin initiation.

TABLETS:

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Integrated Care System Area Prescribing Committee  recommends biosimilar insulin as a treatment option for patients with diabetes mellitus where it is indicated, in line with NICE NG17, NG28 & NG18

Biosimilar insulin will be considered for use for the same APC agreed indications and traffic light status as its reference product (RP).

The Medicines Healthcare Products Regulatory Agency (MHRA) states that biosimilar medicines are interchangeable with the original biological product and with other biosimilars when approved, which is reflected in government guidance on the licensing of biosimilar products and supported by the joint EMA-HMA statement on interchangeability. Once authorised, a biosimilar product is considered to be interchangeable with their RP, which means a prescriber can choose the biosimilar medicine over the RP (or vice versa) and expect to achieve the same therapeutic effect. Likewise, a biosimilar product is considered to be interchangeable with another biosimilar to the same RP. The MHRA recommends prescribing biosimilar insulins by brand name and that the device is specified. This information should be included in patient documentation (eg, insulin safety card/patient insulin passport) to ensure that substitution of a biosimilar product does not occur when the medicine is prescribed or dispensed.

NHS England recommend that where a biosimilar is available, prescribers and patients are encouraged to have a shared decision-making conversation as part of their medicines review to consider using the biosimilar. This applies to both new patients and those who are already receiving the reference product.

The insulin pen delivery device may be unique to the brand,  patients will need to be instructed on the correct use of the device

The Surrey Heartlands Integrated Care System Area Prescribing Committee  recommends biosimilar insulin as a treatment option for patients with diabetes mellitus where it is indicated, in line with NICE  NG17, NG28 & NG18

Biosimilar insulin will be considered for use for the same APC agreed indications and traffic light status as its reference product (RP).

The Medicines Healthcare Products Regulatory Agency (MHRA) states that biosimilar medicines are interchangeable with the original biological product and with other biosimilars when approved, which is reflected in government guidance on the licensing of biosimilar products and supported by the joint EMA-HMA statement on interchangeability. Once authorised, a biosimilar product is considered to be interchangeable with their RP, which means a prescriber can choose the biosimilar medicine over the RP (or vice versa) and expect to achieve the same therapeutic effect. Likewise, a biosimilar product is considered to be interchangeable with another biosimilar to the same RP. The MHRA recommends prescribing biosimilar insulins by brand name and that the device is specified. This information should be included in patient documentation (eg, insulin safety card/patient insulin passport) to ensure that substitution of a biosimilar product does not occur when the medicine is prescribed or dispensed.

NHS England recommend that where a biosimilar is available, prescribers and patients are encouraged to have a shared decision-making conversation as part of their medicines review to consider using the biosimilar. This applies to both new patients and those who are already receiving the reference product.

The insulin pen delivery device may be unique to the brand,  patients will need to be instructed on the correct use of the device