Medicines Updates October 2018

The Medicines Optimisation Team at Sunderland CCG recently published the October edition of their Medicines Safety Net newsletter. Here are some of the highlights that community pharmacists need to know (and the entire newsletter can be downloaded here)

Dalteparin supply issue: there is a supply issue with dalteparin. This is currently the first choice low molecular weight heparin on the Sunderland Joint Formulary. It is expected that the 2,500unit, 5,000unit and 7,500unit presentations will be out of stock at various times during October and November. During this time, please use enoxaparin as an alternative if dalteparin is not obtainable. City Hospitals Sunderland has advised that clinicians will be switching patients to enoxaparin whilst dalteparin is unavailable.

Ulipristal acetate (Esmya): Following an EU review of the risk of serious liver injury, the MHRA have announced new restrictions to use and requirements for liver function monitoring before, during and after treatment with ulipristal acetate. Ulipristal acetate was temporarily removed from the Sunderland Joint Formulary in February 2018, pending the result of the EU review. The medication has now been reinstated onto the formulary, but as a RED drug.
Please ensure that ulipristal acetate is not prescribed in primary care; any existing patients need to be referred back to secondary care for the necessary monitoring and any future prescriptions.

Methotrexate 10mg tablets Reminder: methotrexate 10mg tablets are non-formulary and should not be prescribed. To avoid error with low-dose methotrexate, it is recommended that only the 2.5mg strength of methotrexate tablet is prescribed.

Epanutin (phenytoin) 30mg/5ml oral suspension – supply disruption: Pfizer have stated that they will be out of stock of Epanutin (phenytoin) 30mg/5ml oral suspension from w/c 29th October until early December 2018. Pfizer are the only licensed UK supplier of phenytoin 30mg/5ml oral suspension and alternative phenytoin formulations are not directly interchangeable. Switching to an alternative formulation may require specialist advice, support or referral. GPs are advised to identify all patients currently prescribed this medication, and follow the advice in the Supply Disruption Alert, which can be found here.

Pregabalin and gabapentin to be controlled as class C drugs: The government has announced that pregabalin and gabapentin are to be reclassified as Class C controlled substances from April 2019. This follows concerns over rising numbers of fatalities linked to the drugs. The change means that it will be illegal to possess pregabalin and gabapentin without a prescription and it will be illegal to supply or sell them to others.