Community Pharmacy Bulletin - england.nhs.uk€¦ · NHS England & Improvement – South West...

1 Back to the top

Community Pharmacy Bulletin

7 August 2020

NHS England and NHS Improvement – South West

In this week’s Issue:

Coming Up ........................................................................................................................................ 1

Headlines from the Week .................................................................................................................. 2

PPE Orders for Community Pharmacies ........................................................................................... 2

Second Annual Flu Letter .................................................................................................................. 3

Initial Information on the Part 2 PQS for 2020-21 .............................................................................. 3

Home Delivery of Medicines and Appliances for Patients in Local Outbreak Areas ........................... 4

Looking After You Too - Coaching Support for Primary Care Staff .................................................... 4

Medicine Supply Notification – Pethidine 50mg tablets ..................................................................... 4

Useful Information ............................................................................................................................. 5

Coming Up

August September October

Week 1

Declaration of emergency requiring the flexible provision

of Pharmaceutical services ceases 1 September 2020

Applications to amend Supplementary Hours for

Thursday 31 December 2020 must be submitted by

2 October 2020

Week 2

Week 3

Digital Primary Care Online Presence – Accessibility

Compliance Webinar (19 August 2020, 5 - 6pm)

Complete Voluntary Opening Hours form for Christmas and New Year Bank Holidays by

18 September 2020

https://forms.office.com/Pages/ResponsePage.aspx?id=kp4VA8ZyI0umSq9Q55Ctv9t-uNrsFw1FtXAtvHdXR69UQUU2SVVLTlFBWjFLOTFCNEFLMVI2MlNLQi4uhttps://www.events.england.nhs.uk/events/digital-primary-care-online-presence-accessibility-compliance-98506https://www.events.england.nhs.uk/events/digital-primary-care-online-presence-accessibility-compliance-98506https://www.events.england.nhs.uk/events/digital-primary-care-online-presence-accessibility-compliance-98506https://forms.office.com/Pages/ResponsePage.aspx?id=kp4VA8ZyI0umSq9Q55Ctvzya7Un5vTdNinv2EXGprV9UNFRHRjc4OVpHUzdWNVc2NkRDT1YxUlY0Ti4uhttps://forms.office.com/Pages/ResponsePage.aspx?id=kp4VA8ZyI0umSq9Q55Ctvzya7Un5vTdNinv2EXGprV9UNFRHRjc4OVpHUzdWNVc2NkRDT1YxUlY0Ti4u

2 Back to the top

August September October

Week 4

Applications to amend Supplementary Hours for

Thursday 24 December 2020 must be submitted by 25 September 2020

------------------------------- Applications to amend Core

and Supplementary Hours for Saturday 26 December 2020

must be submitted by 27 September 2020

Week 5 August Bank Holiday

Headlines from the Week NHS England

• We are the NHS: People Plan for 2020/2021 – action for us all

• Self-isolation of health and care workers from high risk countries

• GPhC guidance on COVID-19 rapid antibody tests

• Interim Foundation Pharmacist Programme

• Roll out of Electronic Prescription Service (EPS) Phase 4 NHS England South West Regional Team

• Urgent action - Supply issues with nabumetone tablets and Manevac granules (attached) PSNC Bulletin

• ACTNow to look after your own wellbeing

• July 2020 Price Concessions – Final Update

• Pharmacy Representation Review next steps webinar

• Self-isolation period extended to 10 days

• Brexit: DHSC plans for end of Transition Period

• RPS Inclusion and Diversity Group

• Reported drug quota issues - update

PPE Orders for Community Pharmacies (taken from the National COVID-19 Primary Care Bulletin, 6 August 2020, Issue 61) From Wednesday 5 August 2020, the Department of Health and Social Care (DHSC) started emailing community pharmacies, inviting them to register with the PPE portal. The portal has been developed by DHSC in partnership with eBay UK, NHS Supply Chain, the Army, Clipper and Royal Mail. Emails will come from PPE Dedicated Supply Channel (please note this email address does not accept incoming emails): [email protected]. Please ensure that you are regularly checking your NHS email accounts in order to ensure that the invitation is received and actioned. Pharmacies are encouraged to register promptly, to ensure they can order emergency personal protective equipment (PPE) from a central inventory. This is to supplement (not replace) the wholesale supply route that already operates. New users will initially have small order limits, but these are under review.

https://forms.office.com/Pages/ResponsePage.aspx?id=kp4VA8ZyI0umSq9Q55Ctv9t-uNrsFw1FtXAtvHdXR69UQUU2SVVLTlFBWjFLOTFCNEFLMVI2MlNLQi4uhttps://forms.office.com/Pages/ResponsePage.aspx?id=kp4VA8ZyI0umSq9Q55Ctv9t-uNrsFw1FtXAtvHdXR69UMThRNkU0SFRCWTJOQjIzSVFMRVo4NTBaMC4uhttps://forms.office.com/Pages/ResponsePage.aspx?id=kp4VA8ZyI0umSq9Q55Ctv9t-uNrsFw1FtXAtvHdXR69UQUU2SVVLTlFBWjFLOTFCNEFLMVI2MlNLQi4uhttps://www.england.nhs.uk/ournhspeople/https://www.gov.uk/government/news/health-and-care-workers-to-self-isolate-on-return-to-england-from-high-risk-countrieshttps://www.pharmacyregulation.org/news/gphc-position-covid-19-rapid-antibody-testshttps://www.hee.nhs.uk/coronavirus-covid-19/coronavirus-covid-19-information-pharmacists-pharmacy-technicianshttps://digital.nhs.uk/services/electronic-prescription-service/phase-4https://pharmacistsupport.org/charity-launches-new-wellbeing-campaign/https://psnc.org.uk/our-news/july-2020-price-concessions-final-update/https://psnc.org.uk/our-news/psnc-to-hold-pharmacy-representation-review-next-steps-webinar-for-contractors/https://www.gov.uk/government/news/statement-from-the-uk-chief-medical-officers-on-extension-of-self-isolation-period-30-july-2020https://psnc.org.uk/our-news/brexit-dhsc-plans-for-end-of-transition-period/https://www.rpharms.com/recognition/inclusion-and-diversity/abcdhttps://psnc.org.uk/our-news/reported-drug-quota-issues-update/mailto:[email protected]

3 Back to the top

Orders through the portal should arrive within 48 hours if placed before 1pm. Orders placed after 1pm will be subject to an additional 24-hours. Information on what items are available for your sector and size will be made available from Monday 3 August on the DHSC Guidance webpage. If providers have any queries or have not received an email invite by close of play Monday 10 August, please contact the PPE portal customer services at: 0800 876 6802. Further detailed information is also available on the NHS Business Services Authority website.

Second Annual Flu Letter (taken from the National COVID-19 Primary Care Bulletin, 6 August 2020, Issue 61) The second annual flu letter was published on 5 August 2020 giving more details about this year’s expanded Flu Programme. This year, as part of our wider planning for winter, we intend to vaccinate more people than ever before in the existing eligible cohorts, and we are also offering the vaccine to:

• household contacts of those on the NHS Shielded Patient List. (Specifically, individuals who expect to share living accommodation with a shielded person on most days over the winter and therefore for whom continuing close contact is unavoidable)

• children of school Year 7 age in secondary schools (those aged 11 on 31 August 2020)

• health and social care workers employed through Direct Payment (personal budgets) and/or Personal Health Budgets, such as Personal Assistants, to deliver domiciliary care to patients and service users

We aim to further extend the vaccine programme in November and December to include the 50-64 year old age group subject to vaccine supply. This extension is being phased to allow you to prioritise those in at risk groups first. In light of the risk of flu and COVID-19 co-circulating this winter, the Flu Programme will be absolutely essential to protecting vulnerable people and supporting the resilience of the NHS. We thank you for your support in delivering it. The service specification for 2020-21 has not yet been published, we will notify you as soon as that becomes available.

Initial Information on the Part 2 PQS for 2020-21 (taken from the PSNC Daily Update: 6 August 2020) An initial outline of requirements for Part 2 of the 2020-21 Pharmacy Quality Scheme (PQS) has been released. While PSNC continue to work with the Department of Health and Social Care (DHSC) and NHS England and NHS Improvement to finalise the arrangements for the Part 2 Scheme, an early view of the domains and criteria that will need to be fulfilled to make a declaration in February 2021 is available on the PSNC website. The scheme will formally commence in October 2020 and full details should be included in the September 2020 Drug Tariff. There will be five domains each with its own component criteria to achieve. All criteria in a domain must be completed to be able to claim a payment for that domain.

https://generalpracticebulletin.cmail19.com/t/d-l-cluhkc-jujhvujtt-yk/https://generalpracticebulletin.cmail19.com/t/d-l-cluhkc-jujhvujtt-yu/https://generalpracticebulletin.cmail19.com/t/d-l-cluhkc-jujhvujtt-y/https://psnc.org.uk/our-news/initial-information-on-the-part-2-pqs-for-2020-21/https://psnc.org.uk/our-news/initial-information-on-the-part-2-pqs-for-2020-21/

4 Back to the top

Home Delivery of Medicines and Appliances for Patients in Local Outbreak Areas On 22 June 2020, the Government published plans for a phased easing of the shielding advice to people who are clinically extremely vulnerable from 6 July 2020. In specific local outbreak areas, some patients have been advised to continue to follow previous shielding advice after 1 August 2020 (or advised to return to shielding if the pause has previously gone ahead in the area where they live). The NHS will continue to maintain the shielded patient list. Due to the development of local outbreaks in areas of England, the Community Pharmacy Home Delivery Service and the Dispensing Doctor Home Delivery Service will be commissioned from 1 August to 31 August 2020 for shielded patients who live in the outbreak areas in Leicester, Blackburn with Darwen and Luton only. It remains the case that where possible a friend, relative, carer or volunteer should be asked to collect medicines. The NHS Volunteer Responders Programme will remain active until at least the end of 2020 and all previously shielded and/or otherwise vulnerable patients can access this support by calling 0808 196 3646. Please pass this number on to your patients who could benefit from this support. Further details on the NHS Volunteer Responder Programme can be found here.

Looking After You Too - Coaching Support for Primary Care Staff We recognise that our frontline primary care colleagues are facing unprecedented challenges looking after others, which is why we want to look after you too. #LookingAfterYouToo is free coaching support available to all primary care staff, both in clinical and non-clinical roles, available 7 days a week, 7:15am – 10pm by phone or video. We’d like to promote this fantastic offer and reach as many people as possible. You can help us by downloading this poster to send round to colleagues, or to print out and display in your workplace.

Medicine Supply Notification – Pethidine 50mg tablets The table below provides a summary of the attached MSN:

Medicine Out of stock until Alternatives (NB FP10 prescriptions must indicate that a special is required/prescribed by the GP if relevant)

MSN/2020/048 Pethidine 50mg tablets

TBC Unlicensed imports of pethidine tablets have been sourced

There have also been changes to the resupply dates of the medicines listed below.

Original MSN reference

Date of original

MSN/SDA Supply issue

Resupply date originally

communicated

Updated resupply date as of

w/c 3rd August 2020

MSN/2020/022 28-Apr-2020 Sulfasalazine 250mg/5ml

oral suspension August 2020 End Sept 2020

https://www.england.nhs.uk/coronavirus/wp-content/uploads/sites/52/2020/03/C0112-NHS-Volunteer-Responders-Information-for-Primary-Care-Professionals_31-March-2020.pdfhttps://people.nhs.uk/lookingafteryoutoo/https://people.nhs.uk/download/2949/

5 Back to the top

Please note that supply issues that have been categorised as tier 1 or 2, DHSC and the MSRG have requested that we use our commissioning routes to distribute to community pharmacy. More serious supply issues are communicated via the Central Alerting System for action.

Useful Information

NHS England & Improvement – South West Region Community Pharmacy Contract Management Team contact information

Team Member Telephone Address

Jenny Collins 07979 308749 For Devon, Cornwall, Isles of Scilly, Somerset and Dorset:

NHS England and Improvement – South West Peninsula House Kingsmill Road Tamar View Industrial Estate Saltash, PL12 6LE

Please note all our offices are currently closed, please do not send post and use email wherever possible

Email: [email protected]

Michele Toy 07568 431890

Les Riggs 07730 371074

Sarah Lillington 07920 834445

Kath Hughes 07730 374739

Stacey Burch 07730 391418

Sharon Greaves 07900 715295 For Bristol, North Somerset, South Glos, Bath & North East Somerset, Gloucestershire, Swindon & Wiltshire

NHS England and Improvement – South West Sanger House, 5220 Valiant Court Gloucester Business Park, Brockworth Gloucester, GL3 4FE

Or

NHS England and Improvement – South West Jenner House, Avon Way Langley Park Chippenham, SN15 1GG

Please note all our offices are currently closed, please do not send post and use email wherever possible

Email: [email protected]

Melissa Kendall-Milnes 07730 381340

Sharon Hodges 07702 411295

Tracey Howes 07730 380479

Joy Weeks 07702 407459

Chris Yengel 07769 963478

Websites

Please see our websites for more information and any blank templates, forms and documents:

Cornwall & Isles of Scilly, Devon, Bristol, Dorset, North Somerset, Somerset and South Gloucestershire

BaNES, Gloucestershire, Swindon or Wiltshire

mailto:[email protected]:[email protected]://www.england.nhs.uk/south/info-professional/pharm-info/sw-pharm/https://www.england.nhs.uk/south/info-professional/pharm-info/south-west-north-community-pharmacy-information/

*Classification of Tiers can be found at the following link: https://www.england.nhs.uk/publication/a-guide-to-managing-medicines-supply-and-shortages/

Medicine Supply Notification MSN/2020/048

Pethidine 50mg tablets

Tier 2 – medium impact*

Date of issue: 07/08/2020

Summary

• Martindale are out of stock of pethidine 50mg tablets.

• Supplies are currently available from Teva although they will be out of stock by the end of August. There are no alternative suppliers.

• Neither company are currently able to advise a resupply date as the issue is due to a problem at the active pharmaceutical ingredient manufacturing site.

• Unlicensed supplies of pethidine 50mg tablets have been sourced.

Actions Required

Supporting Information • The following specialist importer companies have sourced unlicensed pethidine 50mg tablets

from abroad (please note there may be other companies that can also source supplies): o Alium Medical o Mawdsleys Unlicensed

• Any decision to prescribe an unlicensed medicine must consider the relevant guidance and NHS Trust or local governance procedures. Please see the links below for further information.

o Prescribing unlicensed medicines, General Medical Council (GMC), o The supply of unlicensed medicinal products, Medicines and Healthcare products Regulatory

Agency (MHRA) o Professional Guidance for the Procurement and Supply of Specials, Royal Pharmaceutical

Society (RPS)

• When prescribing a product that is not licensed in the UK due to a supply issue with the licensed alternative prescribers must indicate on the FP10 prescription that an unlicensed product is required. This can be done by annotating the prescription with the following wording: “special order”.

Enquiries If you have any queries, please contact: [email protected]

Patients with insufficient supplies of pethidine 50mg tablets should be:

• reviewed by a clinician to assess ongoing need and advice obtained from their local pain team and/or substance misuse team on choice of alternative agent or advice on weaning;

• prescribed unlicensed pethidine 50mg tablets if ongoing treatment is required. Prescribers should work with local pharmacy teams to ensure orders for unlicensed product are placed within appropriate time frames as lead times may vary (see supporting information below).

https://www.england.nhs.uk/publication/a-guide-to-managing-medicines-supply-and-shortages/https://www.england.nhs.uk/publication/a-guide-to-managing-medicines-supply-and-shortages/https://www.gmc-uk.org/ethical-guidance/ethical-guidance-for-doctors/prescribing-and-managing-medicines-and-devices/prescribing-unlicensed-medicineshttps://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/373505/The_supply_of_unlicensed_medicinal_products__specials_.pdfhttps://www.rpharms.com/Portals/0/RPS%20document%20library/Open%20access/Support/toolkit/specials-professional-guidance.pdfmailto:[email protected]

From: PHARMACYSOUTHWEST, England (NHS ENGLAND & NHS IMPROVEMENT - X24)Subject: Urgent action - Supply issues with nabumetone tablets and Manevac granulesDate: 03 August 2020 12:11:57Attachments: MSN2020_047 Senna with ispaghula husk (Manevac) granules_.pdf

MSN2020_046 Nabumetone 500mg tablets_.pdfImportance: High

Dear Pharmacy Contract Managers and teams, CDAOs, LPN chairs regional pharmacists and colleagues, On behalf of DHSC please cascade the information contained in the attached Medicine Supply Notifications for nabumetone tablets and Manevac granules,using your standard commissioning communications pathway to ALL Community Pharmacies in England.

Medicine Out of stock until Alternatives(NB FP10 prescriptions must indicate that a special is required/prescribedby the GP if relevant)

MSN/2020/046Nabumetone 500mg tablets

1 September 2020 Alternative NSAIDs/analgesics remain availableUnlicensed imports of nabumetone tablets have been sourced

MSN/2020/047Manevac granules

30 September 2020 Individual components of Manevac remain available

There have also been changes to the resupply dates of the medicines listed below. These communications were previously circulated via the NHSE&Icommissioning routes.

Original MSNreference

Date oforiginal

MSN/SDASupply issue Resupply date originally communicated

Updated resupplydate as of

w/c 3rd August2020

MSN/2019/020MSN/2019/020 -U

20-Dec-1917-Jul-20

H2-antagonists (cimetidine, famotidine andnizatidine)

Famotidine 20mg tablets: out of stock until theend of December 2019

Tillomed: Out ofstock. Resupply

mid-August 2020.Teva: Out of stock.

Resupply end-August 2020.

Famotidine 40mg tablets: out of stock until theend of December 2019

Tillomed Out ofstock. Resupply

end-August 2020.

Teva: In stock

Cimetidine 200mg tablets: out of stock until theend of January 2020

Ennogen: Out ofstock. Resupply

June 2021.Medreich: Out ofstock. Resupply to

be confirmed.




be confirmed.




be confirmed.

Nizatidine 150mg tablets: out of stock untilFebruary 2020

Mylan: Out of stock.Resupply mid-August 2020.

Medreich: Out ofstock. Resupply to

be confirmed.Relonchem: Out of

stock. Resupplyend-August 2020.

Nizatidine 300mg tablets: out of stock untilFebruary 2020

Mylan: In stock

Medreich: Out ofstock. Resupply to

be confirmed.
mailto:[email protected]

*Classification of Tiers can be found at the following link: https://www.england.nhs.uk/publication/a-guide-to-managing-medicines-supply-and-shortages/ Page 1 of 2


Senna with ispaghula husk (Manevac®) granules (Mylan)


Date of issue:03/08/2020

Summary

• Manevac® granules 250g and 400g pack sizes are out of stock until 30 September 2020 and February 2021 respectively.

• Individual components of Manevac® are available (ispaghula husk 3.5-gram sachets and senna tablets 7.5mg).

Actions Required

Supporting Information

• UKMi have advised the following:

o Manevac® licensed dose in adults and children (aged 12 years and over) is 5g or 10g of granules at night, usually up to two to three times a week. The granules are placed dry on the tongue and, without chewing or crushing, swallowed with a glass of water.

o There is no combination product containing the same constituents as Manevac® therefore clinicians are advised to use individual components, however due to its aspartame content, ispaghula husk products should not be given to patients with phenylketonuria, and senna syrup should not be given to patients with rare hereditary problems of fructose intolerance as it contains maltitol liquid.

o Ispaghula husk is licensed to be given as one 3.5g sachet morning and evening o The usual dose of senna is 7.5mg to 15mg once a day (maximum 30mg daily) o A 5g dose of Manevac® could be replaced with one sachet of ispaghula husk 3.5g and two

7.5mg senna tablets (OR 10ml senna syrup if patients are unable to swallow tablets). o As it is unclear if the above mentioned dose of ispaghula and senna would really need to be

doubled for patients on 10g dose of Manevac® at night, it would be prudent to start on lower dose and monitor response. If a higher dose is deemed necessary, ispaghula and senna would usually be prescribed as a twice daily dose.

o For patients who are used to taking Manevac® granules, clinicians will need to counsel patients appropriately to ensure they are aware ispaghula sachets must be made up in a glass of water.

o Refer to BNF for alternative products if patients are not suitable for or unable to tolerate the individual components.

For patients with insufficient supplies of Manevac® granules, clinicians should:

• review if treatment is still required;

• consider switching to individual components providing there are no issues with excipients of these products; and;

• counsel patients on the different products and dosing regimen prescribed. (See supporting information)

https://www.england.nhs.uk/publication/a-guide-to-managing-medicines-supply-and-shortages/


https://bnf.nice.org.uk/treatment-summary/constipation.html

of 2

• See SPCs below for further information:

o Manevac® granules o Senna products o Senokot® products o Ispaghula husk products

Enquiries If you have any queries, please contact [email protected]

https://www.medicines.org.uk/emc/product/4410

https://www.medicines.org.uk/emc/search?q=%22Senna%22

https://www.medicines.org.uk/emc/search?q=senokot

https://www.medicines.org.uk/emc/search?q=%22ispaghula+husk%22




Nabumetone 500mg Tablets Tier 2 – medium impact* Date of issue: 03/08/2020

Summary

• Tillomed Laboratories Ltd., sole suppliers of nabumetone 500mg tablets, are out of stock until 1st September 2020

• Unlicensed supplies of nabumetone 500mg tablets can be sourced, lead times vary

• UKMi have provided clinical advice on prescribing in the absence of nabumetone

Actions Required

Supporting information

Clinical Information

• If an NSAID is considered necessary, switch to a non-selective or COX-2 selective NSAID, with/without gastroprotection, depending on individual risk of gastrointestinal adverse events.

• Refer to NICE Clinical Knowledge Summary guidance for advice on prescribing NSAIDs

• Refer to NICE Clinical Knowledge Summary guidance for advice on analgesia for mild-to-moderate pain.

Where patients have insufficient supplies of nabumetone tablets to last until the re-supply date, clinicians/prescribers should:

• review patients to determine if continued analgesia is still required and if so, whether treatment with a non-steroidal anti-inflammatory drug (NSAID) remains appropriate.

o If NSAID treatment is considered appropriate, either; ▪ consider prescribing unlicensed imports if nabumetone is indicated.

Prescribers should work with local pharmacy teams to ensure orders are placed within appropriate time frames as lead times may vary (see supporting information below); or

▪ consider an alternative NSAID treatment option (see supporting information below)

• if the above options are not considered appropriate, refer to BNF for consideration of other analgesics.


https://cks.nice.org.uk/nsaids-prescribing-issues#!scenario

https://cks.nice.org.uk/analgesia-mild-to-moderate-pain#!topicSummary

of 2

Guidance on ordering and prescribing unlicensed imports

• The following specialist importers have confirmed they can source unlicensed nabumetone 500mg tablets (please note there may be other companies that can also source supplies):

o Alium Medical o Mawdsleys Unlicensed o Target Healthcare

• Any decision to prescribe an unlicensed medicine must consider the relevant guidance and NHS Trust or local governance procedures. Please see the links below for further information:



Society


Enquiries If you have any queries, please contact [email protected].

https://www.gmc-uk.org/ethical-guidance/ethical-guidance-for-doctors/prescribing-and-managing-medicines-and-devices/prescribing-unlicensed-medicines

https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/373505/The_supply_of_unlicensed_medicinal_products__specials_.pdf

https://www.rpharms.com/Portals/0/RPS%20document%20library/Open%20access/Support/toolkit/specials-professional-guidance.pdf


Relonchem: Out ofstock. Resupply

end-August 2020.

Please be aware this communication is also being circulated separately to all GP Practices in England. Please note that supply issues that have been categorised as tier 1 or 2, DHSC and the MSRG have requested that the NHSE&I commissioning routes are usedto reach community pharmacy and GP practices. More serious supply issues are communicated via the Central Alerting System for action. If you have any queries please contact: [email protected] Please note, if the enquiry relates to any changes (additions or removals) to the mailing list, please contact the Pharmacy Contract Manager at the NHSE&Iregional team. Many thanks for your assistance with this important issue. Kind regards, Community Pharmacy TeamPrimary Care Strategy and NHS Contracts*Address: 2D | 80 London Road | London | SE1 6LH8 Email [email protected] : url: www.england.nhs.uk/primary-care/pharmacy/

mailto:[email protected]:[email protected]://www.england.nhs.uk/



Nabumetone 500mg Tablets Tier 2 – medium impact* Date of issue: 03/08/2020

Summary

• Tillomed Laboratories Ltd., sole suppliers of nabumetone 500mg tablets, are out of stock until 1st September 2020

• Unlicensed supplies of nabumetone 500mg tablets can be sourced, lead times vary

• UKMi have provided clinical advice on prescribing in the absence of nabumetone

Actions Required

Supporting information

Clinical Information

• If an NSAID is considered necessary, switch to a non-selective or COX-2 selective NSAID, with/without gastroprotection, depending on individual risk of gastrointestinal adverse events.

• Refer to NICE Clinical Knowledge Summary guidance for advice on prescribing NSAIDs

• Refer to NICE Clinical Knowledge Summary guidance for advice on analgesia for mild-to-moderate pain.

Where patients have insufficient supplies of nabumetone tablets to last until the re-supply date, clinicians/prescribers should:

• review patients to determine if continued analgesia is still required and if so, whether treatment with a non-steroidal anti-inflammatory drug (NSAID) remains appropriate.

o If NSAID treatment is considered appropriate, either; ▪ consider prescribing unlicensed imports if nabumetone is indicated.

Prescribers should work with local pharmacy teams to ensure orders are placed within appropriate time frames as lead times may vary (see supporting information below); or

▪ consider an alternative NSAID treatment option (see supporting information below)

• if the above options are not considered appropriate, refer to BNF for consideration of other analgesics.

https://www.england.nhs.uk/publication/a-guide-to-managing-medicines-supply-and-shortages/https://cks.nice.org.uk/nsaids-prescribing-issues#!scenariohttps://cks.nice.org.uk/analgesia-mild-to-moderate-pain#!topicSummary

of 2

Guidance on ordering and prescribing unlicensed imports

• The following specialist importers have confirmed they can source unlicensed nabumetone 500mg tablets (please note there may be other companies that can also source supplies):

o Alium Medical o Mawdsleys Unlicensed o Target Healthcare

• Any decision to prescribe an unlicensed medicine must consider the relevant guidance and NHS Trust or local governance procedures. Please see the links below for further information:



Society


Enquiries If you have any queries, please contact [email protected].

https://www.gmc-uk.org/ethical-guidance/ethical-guidance-for-doctors/prescribing-and-managing-medicines-and-devices/prescribing-unlicensed-medicineshttps://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/373505/The_supply_of_unlicensed_medicinal_products__specials_.pdfhttps://www.rpharms.com/Portals/0/RPS%20document%20library/Open%20access/Support/toolkit/specials-professional-guidance.pdfmailto:[email protected]



Senna with ispaghula husk (Manevac®) granules (Mylan)


Date of issue:03/08/2020

Summary

• Manevac® granules 250g and 400g pack sizes are out of stock until 30 September 2020 and February 2021 respectively.

• Individual components of Manevac® are available (ispaghula husk 3.5-gram sachets and senna tablets 7.5mg).

Actions Required

Supporting Information

• UKMi have advised the following:

o Manevac® licensed dose in adults and children (aged 12 years and over) is 5g or 10g of granules at night, usually up to two to three times a week. The granules are placed dry on the tongue and, without chewing or crushing, swallowed with a glass of water.

o There is no combination product containing the same constituents as Manevac® therefore clinicians are advised to use individual components, however due to its aspartame content, ispaghula husk products should not be given to patients with phenylketonuria, and senna syrup should not be given to patients with rare hereditary problems of fructose intolerance as it contains maltitol liquid.

o Ispaghula husk is licensed to be given as one 3.5g sachet morning and evening o The usual dose of senna is 7.5mg to 15mg once a day (maximum 30mg daily) o A 5g dose of Manevac® could be replaced with one sachet of ispaghula husk 3.5g and two

7.5mg senna tablets (OR 10ml senna syrup if patients are unable to swallow tablets). o As it is unclear if the above mentioned dose of ispaghula and senna would really need to be

doubled for patients on 10g dose of Manevac® at night, it would be prudent to start on lower dose and monitor response. If a higher dose is deemed necessary, ispaghula and senna would usually be prescribed as a twice daily dose.

o For patients who are used to taking Manevac® granules, clinicians will need to counsel patients appropriately to ensure they are aware ispaghula sachets must be made up in a glass of water.

o Refer to BNF for alternative products if patients are not suitable for or unable to tolerate the individual components.

For patients with insufficient supplies of Manevac® granules, clinicians should:

• review if treatment is still required;

• consider switching to individual components providing there are no issues with excipients of these products; and;

• counsel patients on the different products and dosing regimen prescribed. (See supporting information)

https://www.england.nhs.uk/publication/a-guide-to-managing-medicines-supply-and-shortages/https://www.england.nhs.uk/publication/a-guide-to-managing-medicines-supply-and-shortages/https://bnf.nice.org.uk/treatment-summary/constipation.html

of 2

• See SPCs below for further information:

o Manevac® granules o Senna products o Senokot® products o Ispaghula husk products

Enquiries If you have any queries, please contact [email protected]

https://www.medicines.org.uk/emc/product/4410https://www.medicines.org.uk/emc/search?q=%22Senna%22https://www.medicines.org.uk/emc/search?q=senokothttps://www.medicines.org.uk/emc/search?q=%22ispaghula+husk%22mailto:[email protected]

20200807 NHS England Weekly Pharmacy Bulletin (Final)MSN2020_048 Pethidine 50mg tabletsUrgent action - Supply issues with nabumetone tablets and Manevac granulesMSN2020_046 Nabumetone 500mg tablets_MSN2020_047 Senna with ispaghula husk (Manevac) granules_

Community Pharmacy Bulletin - england.nhs.uk€¦ · NHS England & Improvement – South West...

Documents

Transcript of Community Pharmacy Bulletin - england.nhs.uk€¦ · NHS England & Improvement – South West...