Apologies for the delay in publication; this was due to the launch of the new Trust website and some teething problems it has created getting new links to put in the newsletter. The Pharmacy Team has pulled together all the electronic versions of medication related documents, excluding patient information leaflets, into one area of the Trust’s website at: www.sussexpartnership.nhs.uk/medication Patient medication information related linked websites and the Trust’s own leaflets are available at: http://www.sussexpartnership.nhs.uk/medication-information

New Trust website – IMPORTANT MESSAGE

All our current medication guidelines, policies, patient leaflets and other medication documents have been successfully transferred to the new website. However, the new website’s launch was soon followed by the closure of the old website. This has resulted in all our old links to other documents often embedded in our guidelines and policies, no longer working. We are now going to have to check every document and replace the old links with one to the new website. As this will take some time to achieve, there may be occasions where you expect an embedded document to appear at a click of a mouse and you get a ‘404 error’ message pop up, saying the link is no longer valid. If this happens I am afraid you will have to search for the document on the new website (links above). Gradually this will become less of a problem as the documents get reviewed and old links are updated.

GP communication checklistTo improve communication between primary and secondary care the checklist at the link below has been drawn up with primary care to ensure key information related to medication is put into correspondence with GPs. Failure to provide the information listed can impact negatively on the patient’s experience. GPs would normally expect secondary care to initially review patients started on medication that they do not normally initiate themselves, e.g. medication for bipolar disorder and schizophrenia.Checklist

If you require this document in an alternative format, i.e. easy read, large text, audio, Braille or a community language please contact the Pharmacy Team on

01243 623349 (Text Relay calls welcome)

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Featured in this issue:

Featured in this issue: Learning from medication incidents Lurasidone formulary update Drugs and Therapeutics Group Update Availability of translated dose directions Recent changes to the Medicines Code An important update on pregabalin Two articles on GP communication

Welcome to the April issue of

The Drugs & Therapeutics Newsletter

Issue 1

30 September 2010

Issue 34

April 2015

Report and Learn

Lesson 1Following a recent Coroner’s inquest into the death of a patient under the care of one of our CAMHS teams, one of the recommendations related to poor communication around medication. The Coroner rightly brought up her concerns that when changes in medication were made; no copy of the correspondence sent to the GP was given to the family or the patient, who was an older adolescent. As a result the family continued to order medication from their son’s GP, which had been supposedly stopped, for several months. This highlights the importance of making sure that not only GPs but also patients and if appropriate carers, are given clear written information about changes to medication. On this occasion the GP failed to stop the medication. Unless patients and carers are kept fully informed, they cannot help detect the mistakes that can sometimes occur. (See also the article on GP communication pads below).

Lesson 2We have had several recently reported incidents that have resulted in time and money being wasted, security being put at risk and medication doses being missed. The common theme in all of them has been the failure of a nurse to take the trouble to complete a task properly, possibly because of being busy, and the result has been much more work for others. In one incident a patient on a lot of physical medicines, not held by the receiving ward, was transferred with no medicines. The medicines left on the original ward were wasted, a special order had to be put in for a new supply and the result was that the patient received their morning dose of medication late. Another notable example left one nurse chasing several other nurses and pharmacy to discover why a patient had not had their buprenorphine patch replaced. The patch had been delivered, but the nurse receiving it had given the job of putting it away to another nurse who had forgotten to it. This meant the night staff could not find the patch in the Controlled Drug (CD) cupboard and therefore it wasn’t replaced. Subsequently it had been found by another nurse who wrongly stored it in the drug trolley, which was why the nurse reporting the incident was struggling to get to the bottom of what had happened. She and another nurse, aware that the patch was on the ward somewhere wasted a lot of time searching, before discovering it in the drug trolley.

It is fully appreciated that the wards are getting increasingly busy, but small amounts of time saved not doing a task properly by one member of staff, can have big time repercussions on other staff and possibly patients. Please be mindful that your omissions often create much more work for others down the line.

Lesson 3One incident has been reported of a CD being administered two months after it went out of date. Another incident has been reported were a non-CD was administered for two weeks while out of date with no one noticing. Where pharmacy staff are responsible for ordering stock medicines, they are responsible for checking expiry dates. CD stocks are ordered and checked on a weekly basis by nurses and expiry dates should be included in this check. Although having expired stock on the ward is an uncommon occurrence, nurses must still check expiry dates before administering medicines to patients as no system is fool proof.

Lesson 4A complex incident was reported that included a report that olanzapine IM injection was administered ten minutes after a lorazepam injection in a rapid tranquilization situation. Staff are reminded that there needs to be at least an hour between the administration of lorazepam and olanzapine injections.

GP communication pads

Many of our community teams struggle to get their clinic letters typed up and sent to GPs and patients promptly. To ensure there is prompt communication with both the GP and the patient, pads of GP communication forms are available that can be hand-written at the end of any consultation and a copy handed to the patient or carer with another copy posted to the GP. One plea, please make sure that the handwriting can be read by both the GP and the patient. A copy of the form is embedded below. The triplicate forms come in pads of 50 and can be ordered from christine.vincent@sussexpartnership.nhs.uk .

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Ward medication security checks

Ward managers are reminded that they should complete a weekly security check using the checklist at the first link below. This responsibility can be delegated to a nurse with a special responsibility for medicines, but the Ward Manager retains overall responsibility for medicines security. There is also a second checklist to be done quarterly by either the unit’s matron, if the weekly checks are done by the ward manager or the ward manager if they have delegated responsibility for the weekly checks. Ward managers are responsible for the safe and secure handling of medicines on their ward and this helps give assurance that things are in line with the procedures laid down in the Trust’s Medicines Code. Weekly security checklist link and Quarterly security checklist link.

Availability of bilingual translation of simple medication directions

Translation of Medicines Directions (TransMedD©) is an easy-to-use written communication form available in a number of foreign languages to help non-English speaking patients understand how to use their medicines. It is not specific to any particular medicine, but allows anyone counselling a non-English reading patient to have a list of translated directions for each medicine they are taking, including covering additional instructions like ‘after food’ and ‘may cause drowsiness’.

TransMedD© has been developed by NHS Grampian in Scotland and they hold the copyright. However they are happy for anyone to print the forms off their website, though they would like users to register with them, so they can monitor where they are being used and ask for feedback. The current languages covered are Polish, Lithuanian, Latvian, Russian, Portuguese, Hungarian, Urdu, Romanian, Cantonese, Mandarin, Nepali and Arabic. We know a Bulgarian translation is expected soon, because Nana Tomova, one of our pharmacists, is Bulgarian and she has assisted NHS Grampian with the work.

The website can be accessed by clicking on www.nhsghpcat.org and going to the ‘Search catalogue’ boxes near the top of the home page. One search box is entitled ‘Subject’ and there is dropdown box beside it. Click on this and a long list of subjects is displayed. Scroll down to find ‘TransMedD’ and click on it. ‘TransMedD’ will appear in the ‘Subject’ box. Now click the ‘Go’ box in the bottom right-hand corner of the ‘Search Catalogue’ area. This will open a new page, which has the first page of links to the translated directions and also feedback forms for people using the translation sheets, should they wish to comment on them. To the right of the title there is a box called ‘Item option’. Click on the pdf file link in the appropriate box to see the form (or if selected, the feedback form).

More information is available by clicking on the two embedded documents.

Methotrexate – a high risk area of prescribing and administration

An inpatient incident occurred recently when two doses of this potentially toxic drug were administered just two days apart, rather than once weekly. The prescription chart had been rewritten for methotrexate 20mg “once weekly” but the prescriber omitted to state the specific day of the week intended and also failed to block out the six non-administration days each week on the administration side of the chart. The nurse(s) involved subsequently misread the chart and administered two doses of methotrexate separated by just one day. Thankfully the error was picked up by the visiting pharmacy technician before further doses were given. This incident highlights a high risk area of prescribing / administration and one which applies not just to methotrexate, but to any drug intended for use on a less than daily basis. To reduce risk:

Prescribers should not only state the frequency of administration (if not daily), but also state the day(s) administration is intended in the ‘Additional information’ box.

Prescribers should block out with an ‘X’ the non-administration days on the administration chart.

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Nurses should double-check these unusual non-daily prescriptions and ensure that they are absolutely clear on exactly what administration pattern is being prescribed.

Nurses should consult with the prescriber or with a member of the pharmacy team if they are in any doubt regarding the prescription.

Where possible, the administering nurse should check with the patient before every administration to see if the dose is expected.

The safe administration of insulin

The Trust has recently experienced a significant inpatient incident involving the maladministration of insulin, where due to use of a general syringe marked in ‘mls’ rather than a specific insulin syringe marked in ‘units’; a 10-fold overdose occurred. Thankfully the error was spotted quickly and remedial measures undertaken so that the patient did not come to severe harm. However, the magnitude of the overdose meant that the outcome could have been much worse, particularly if the error had not been identified as soon as it was.

With regard to the use of insulin it is worth revisiting and remembering some key practice points:

When prescribing insulin the word “units” used for dosage must never be abbreviated.

Insulin must only be administered via a specific insulin administration device, e.g. an insulin syringe (marked in units) or an insulin pen. A general syringe must never be used.

Wherever possible, the administering nurse should check the insulin dose with one of the following; the patient (if appropriate), a second registered nurse, a member of the pharmacy team or a doctor, immediately prior to every administration. In the event of any concerns the prescriber or duty doctor should be contacted immediately.

The nurse administering or supervising insulin administration must be fully satisfied that the type and dose of insulin prescribed is correct and also that the volume to be administered is correct.

All clinicians should be aware that many insulin-dependent patients will have an ‘Insulin Passport’ intended to provide information about their current insulin prescription(s). If available, this should always be checked before prescribing or administering insulin.

Aripiprazole long-acting injection – a two-part plea to community prescribers

Please ensure that the Trust’s patient notification form is completed and submitted for all patients initiated in the community and sent to Jed Hewitt. This will allow the Trusts to evaluate the benefits of using this injection in due course.

Please ensure that when prescribing aripiprazole long-acting injection on an FP10 the PIMs/eCPA number is clearly included with the patient details. Cross referencing the Trust database with the community pharmacy database is significantly compromised if this information is not included.

Drug driving legislation

Just a reminder that the Drug Driving Legislation changed from the 3rd March. It may be prudent to write in the notes and in any correspondence with the GP when any discussion with the patient has taken place on this matter. Here is a link to Government information for patients, if you need a reminder: https://www.gov.uk/government/news/drug-drive-legislation-am-i-fit-to-drive

Memantine solution - risks of prescribing

Memantine solution is supplied as a 10mg per ml solution. The normal dose range is 5mg to 20mg. There are national reports that it has accidently been prescribed in doses of 5ml to 20ml (i.e. 50mg to 200mg), a ten-fold increase on the intended dose. Always state the dose to be taken in milligrams.

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Anticoagulant medicationPrior to its move into NICE, the National Patient Safety Agency (NPSA) highlighted the risks associated with prescribing both oral anticoagulants and low molecular weight heparins (LMWHs). The Trust has a special pink chart for prescribing oral anticoagulants and has guidelines for their safe use. Ward managers are reminded that if a patient is admitted or is initiated on oral anticoagulants, e.g. warfarin or LMWHs, all staff prescribing or administering the anticoagulant should be asked to read the guidelines. These guidelines are available in the ward pharmacy folder and on the Trust website. This can be accessed by clicking on: the guidelines

Disposing of controlled drugs (CDs)

There has been a change in the procedures for the disposal of CDs on the ward. From 1st April any CD requiring destruction will need to be disposed of in a DOOP kit, a specially designed container that CDs are put into to make them irretrievable. These 250ml DOOP kits will then be put into a new standard waste medicine bin before the lid is put on and filled with other waste medicines. The actually destruction will continue to be done by a pharmacist authorized to do so, witnessed by a nurse on the ward and the disposal recorded in the CD register. DOOP kits are available on Oracle (code KYA003 in the supply chain catalogue) and at least one should be ordered by the ward so that when CDs need to be destroyed one is available to enable the pharmacist to carry out the destruction. The legislation has also changed, so that CDs in schedule 4 part 1 (e.g. lorazepam, clonazepam) now need to be destroyed by a pharmacist using DOOP kits. From a ward’s perspective these benzodiazepines have never needed special handling, unlike temazepam and midazolam. In all other respects, other than their destruction, this hasn’t changed.

Medicines Code changesThe Trust’s Medicines Code was recently updated and below is a summary of the changes made from the previous version. A full copy is available on the website at the link below:

‘Medicines code’

Section Summary of the change13.5.8 An additional entry to make when a small stock adjustment is made to the CD

register due to a small overage when a bottle of CD medication is supposedly empty.

18.2 Advice on disposing of waste medicines, other than Controlled Drugs, has been completely updated due to the introduction of medication waste bins to all wards and departments.

19.8 Clarification on who should use the patient own medicines checklist (appendix 13)

19.10.1 & 19.11.15

Advice on the disposal of unwanted ‘patients own medication’ has been updated to reflect the introduction of medication waste bins.

38.2.2 A statement has been added that recognizes the difficulty nurses sometimes have administering medicines covertly.

38.2.3 Amended to acknowledge that on occasions staff will need to apply for a deprivation of liberty safeguard (DOLS) if covertly administering medicines.

38.4.2 The timing and level of reviews done following an initial decision to administer medicines covertly have been changed. Mini reviews are to be done more frequently, but full reviews, involving relatives/carers to be done less frequently. New statement added recognizing that an application to authorize a DOLS may need to be sought.

Appendix 6 A checklist to assist the appointed practitioner in charge assess the competency of a care assistant to become an authorized employee and undertake the role of the witness when a second qualified nurse is unavailable to witness the administration of a controlled drug.

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Drugs and Therapeutics Group Update

1. The antipsychotic lurasidone has now been approved for use across Sussex with the exception of North West Sussex, the area covering the Horsham & Mid Sussex CCG and the Crawley CCG. Unlike other CCGs they were unwilling to allow GPs to prescribe it after initiation by a specialist.

In other areas of Sussex, lurasidone is now approved for use for its one licensed indication, namely schizophrenia for the over 18s and with the following proviso’s:

Lurasidone is approved for third-line use after two previous antipsychotics have been tried, one of which must be aripiprazole, and at least one was effective but not tolerated.  Lurasidone must not be used in place of clozapine third-line if two previous antipsychotics have been tolerated and are both ineffective as this is indicative of treatment resistance.

Alternatively, lurasidone is approved for second-line use in patients identified as having significant metabolic risk factors, e.g. diabetes, obesity. In such circumstances aripiprazole must have been tried before lurasidone.

Lurasidone is not indicated for treatment-resistant schizophrenia, or for bipolar disorder.  It must not be used for unlicensed indications.

Lurasidone may only be newly prescribed by doctors of specialist staff grade or above. Other grades must not initiate therapy or adjust dose without direct instruction from their consultant.

Lurasidone is intended for once-daily administration, at the same time each day, with a meal. (Note that if taken without food the plasma levels achieved per dose will be significantly lower than intended and this may precipitate reduced efficacy and possibly treatment failure).

The usual recommended starting dose of lurasidone is 37mg once daily with a meal. Any dose increases should be in 37mg increments (if tolerated) and based on clinical judgement, observed clinical response and tolerability. (Note: increments of 18.5mg are possible, but greatly increase cost).

The usual recommended maintenance dose range of lurasidone is 37mg to 74mg once daily with a meal. Note that many lurasidone side effects are dose dependent and more likely at higher doses.

The licensed maximum dose of lurasidone is 148mg once daily with a meal. However, there is limited evidence to support the use of higher doses in the licensed range.

An information leaflet on lurasidone must be sent to the GP when first prescribing the lurasidone to update them on this relatively new antipsychotic.  A copy is available at the link:‘GP lurasidone information sheet’

A Lurasidone Patient Notification Form must be completed so an evaluation can be undertaken in due course.  This is not an approval process, just a registration process.  A copy is available at the link:’ Lurasidone patient notification form’.

The full prescribing guidelines have additional useful information on issues like switching and how to prescribe in renal impairment. Please note, using some doses doubles the cost due to the manufacturer’s pricing structure. This is also highlighted in the prescribing guidelines available at the link: ‘Lurasidone Prescribing Guidelines’.

When writing to the GP to ask them to take over prescribing after initiation, the information at the link below must be sent with the letter. This is to give them an overview of a medicine that will be completely new to them. This is available at the link: ‘GP lurasidone information sheet’.

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2. A new version of the Community Long Acting Antipsychotic Injection Prescription has been developed. It has the advantage that on the reverse of the repeat prescription there is now space to prescribe single initiation doses of the newer atypical antipsychotic long-acting injections and test doses of the older typical antipsychotic long-acting injections. A new box has been added to the top left-hand corner on the front page to remind staff to send a copy of the prescription in to the hospital when patients are admitted and if the patient is transferred between teams. It is recommended the prescriptions are photocopied onto white card. The new version is available at the link: ‘Community long acting antipsychotic injection prescription’.

3. Following on from the publication in May 2014 of prescribing guidelines for borderline personality disorder, additional supporting guidance has been published. A Prescribing Care and Communication Plan for Patients with Borderline Personality Disorder (BPD) has been approved. It was produced because GPs were becoming increasingly concerned about prescribing for BPD.

Though the long-term prescribing of psychotropic medicines solely for BPD is not usually recommended, there may be occasions when patients are benefitting. This guidance, shared with a number of clinical commissioning groups for comment, provides a framework that many GPs should be willing to prescribe under. No medicine is licensed for the treatment of BPD so unless used for a licensed co-morbidity, some GPs may feel they cannot take clinical responsibility for prescribing. It is hoped that if our prescribers follow this guidance, more GPs will feel comfortable taking over prescribing. It is recommended a copy of this is sent to GPs when requesting that they take over prescribing, explaining that you will be following the guidance. The new guidance is available at the link: ‘BPD prescribing care and communication plan’.

4. The Glasgow Antipsychotic Side-Effect Scale (GASS) has been modified and a new version validated specifically for use in patients on clozapine. The GASS – clozapine scale is freely available for use. It is recommended it is completed by patients at least every six months. Copies are available at the link: ‘GASS-clozapine’.

5. The two zolpidem patient group directions (PGDs) (community and inpatient) have been replaced by two zopiclone PGDs. This was done following a change in the licence of zolpidem, making zopiclone more appropriate for use on a PGD. Once the original copies have been signed off by the appropriate professional leads, they will be distributed to those signed off to use them in April.

COSHH Data Sheets

Under the Control of Substances Hazardous to Health (COSHH) legislation, suppliers of materials that are hazardous to handle are obliged to provide COSHH data sheets on their safe handling. Most medicines do not pose a significant hazard if handled properly. However certain groups of medicines and related products, e.g. disinfectants, supplied by pharmacy can constitute a greater hazard if handled improperly or spilled.

To make access to COSHH data sheets for these groups easier pharmacy has produced a limited range of generic COSHH data sheets to cover these products. The full range covered is:

Acetone Antibiotics e.g. amoxicillin Chlorine releasing disinfectants Cytotoxic drugs e.g. methotrexate Phenol liquids Phenothiazine antipsychotics e.g. chlorpromazine Steroid preparations e.g. Betnovate® cream, prednisolone tablets Vaccines

These data sheets should be referred to by anyone using these products for the first time or when unsure of the risks, and particularly if a spillage or contamination of the environment occurs. These data sheets can be accessed by clicking on:www.sussexpartnership.nhs.uk/coshh-control-substances-hazardous-health-data-sheets

Advice for prescribers on the risk of the misuse of pregabalin and gabapentin

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Public Health England and NHS England have jointly published advice on the risks of the misuse of pregabalin and gabapentin and the key messages below are taken from it. The full advice is embedded below.

Professionals prescribing pregabalin and gabapentin should be aware not only of the potential benefits of these drugs to patients, but also that the drugs can lead to dependence and may be misused or diverted. Pregabalin and gabapentin have a well-defined role in the management of a number of disabling long-term conditions, including epilepsy and neuropathic pain; and, for pregabalin, generalised anxiety disorder.

Practitioners should prescribe pregabalin and gabapentin appropriately to minimise the risks of misuse and dependence, and should be able to identify and manage problems of misuse if they arise. Most patients who are given these drugs will use their medicines appropriately without misuse.

Prescribing for patients with a known or suspected propensity to misuse, divert or become dependent on these drugs may place these people at greater risks from their use. Prescribers must make a careful assessment to balance the potential benefits against the risks. However, it should be noted that such patients may also have a higher prevalence of the indicated conditions for these drugs and some may benefit from their use. Patients who are offered these drugs need to have sufficient information to consent to the treatment plan. Patients should be aware of the likely efficacy of the drugs for management of their symptoms and also about the risk of harms, including dependence. Less harmful, alternative drugs can often be first-line treatments for the indicated conditions for which pregabalin and gabapentin are now used, and may be tried preferentially in higher risk settings or in patients who may be more likely to be harmed by the drugs.

Buprenorphine and fentanyl patches

The Care Quality Commission has published guidance on the safe use of buprenorphine and fentanyl patches, used for pain relief. These may occasionally be initiated by Trust prescribers on inpatient units and the following advice is therefore relevant:

Ensure only those CD transdermal patches intended for current use are applied.

Ensure these patches are prescribed appropriately and the wording, e.g. 'Replace every ** hours (* days)' is clearly written in the additional information box. (Timings between patch switching vary between products so double check). In addition, prescribed omissions (X) should be recorded in the appropriate administration boxes at the time of prescribing to ensure a new one is only applied on the scheduled day.

Formally record the anatomical position of currently applied patches so that this information is readily available to inform future decisions and actions. Prescribe by brand and ensure patients using CD transdermal patches have adequate prescriptions and supplies to minimize interruption and omission of therapy.

The patch should be applied to non-irritated, non-irradiated and non-hairy skin on the torso or upper arm. The replacement patch should be sited on a different area (avoid using the same area for at least 7 days) to minimize any irritation. The removed patch should be disposed of by folding the patch over so the sticky sides are stuck together and then placing the folded patch into a sharps bin.

Transdermal CD patches must be removed and replaced every 72 hours (3 days) to 7 days, depending on the brand; see the manufacturer’s guidance (SPC). If the patches are left on for greater than the recommended timescale, patients can get breakthrough pain, but if replaced early, resources are being wasted.

Consider that patients may exhibit symptoms of opioid withdrawal when a CD transdermal patch has been omitted. The cause of these symptoms may not be recognized and patients may be treated with benzodiazepines for these symptoms, rather than have opioid therapy for their analgesia re-instated, if necessary at a reduced dose.

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Cost effective use of Venlafaxine – switching from XL to IR

The Drugs & Therapeutics Group agreed to support an initiative proposed by two of the East Sussex CCGs to improve the cost-effectiveness of venlafaxine by directing their GPs to switch suitable patients from once-daily XL formulations to twice-daily immediate-release venlafaxine. Even if just 50% of community patients in Eastbourne, Hailsham & Seaford and Hastings & Rother CCGs are switched, this will generate savings of up to £200k per year across the two localities. The plan is to switch suitable patients who are currently on daily doses of up to 225mg, but not those on greater than 225mg, as they are usually still under the direct care of our services. Similarly, where there are known compliance problems or known previous unacceptable side-effects with immediate-release venlafaxine, those patients won’t be switched. The same principles apply to the initiation of new patients on venlafaxine.

To assist with the switches, patient information and patient letters have been produced. Trust prescribers can also assist with this initiative by ensuring that they use the immediate release, twice daily venlafaxine whenever possible when initiating treatment and if XL tablets are essential the reason why is clearly communicated to the GP. XL capsules should never be prescribed as these are approximately twice the price of XL tablets. There is also a 225mg XL tablet, but not a 225mg XL capsule. If using a 225mg dose, please ensure you prescribe it as 225mg XL tablet, rather than 150mg XL plus 75mg XL, which used to have to happen with the capsules, as the 225mg XL tablets is much cheaper than the split dose.

It is anticipated that the same cost-effectiveness initiative will also be followed by our other CCGs in due course.

Generic pregabalin – important legal information

There has been much confusion about the prescribing of generic pregabalin lately because of the patent situation. Pfizer, the manufacturers of Lyrica®, the original brand of pregabalin, have two patents for the drug. The licence for epilepsy and general anxiety disorder (GAD) has now expired and generic pregabalin is available. However, the patent for its use for neuropathic pain is still in place. Pfizer are robustly defending this patent and are threatening to sue anyone prescribing and dispensing anything other than the Lyrica® brand for neuropathic pain. This is having a big impact on generic manufacturers, GPs and community pharmacists in particular, who are concerned about any legal challenge.

For our wards, the WSHT pharmacies we use will be legally obliged to supply the Lyrica® brand of pregabalin should someone be admitted on it for neuropathic pain. The pharmacy team will be checking the indication for any pregabalin prescribed and if for neuropathic pain they will endorse the drug chart with the word ‘Lyrica’ next to ‘pregabalin’ when it is prescribed and put in the ‘Additional instructions’ box the words ‘For neuropathic pain’ to ensure the Lyrica® brand is supplied for that named patient. For other indications, including generalised anxiety disorder, the cheaper generic pregabalin will be supplied.

Our community teams should only be prescribing it on FP10s for GAD, so continuing to prescribe it generically is not an issue and should continue. Community pharmacists are being asked to get clarity of the indication before dispensing. A letter is being distributed to all community pharmacists in Sussex explaining that no Sussex Partnership prescriber will be prescribing pregabalin for neuropathic pain. This should minimize the number of phone calls coming to prescribers checking whether the patient needs to be prescribed Lyrica®. However, please be patient with them if this happens as community pharmacists are finding themselves in a difficult and unique position.

Amisulpride change to the summary of product characteristics (SPC)

The SPC has been updated to advise that as amisulpride may increase the prolactin levels, caution should be exercised and patients with a family history of breast cancer should be closely monitored during treatment.

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Something fishy about sodium valproate tablets

There has been a Class 4 drug alert issued for various batches of the following Sodium Valproate products:

Sanofi -  Epilim 200mg and 500mg Gastro-resistant tablets. Aventis- Zentiva  Sodium Valproate 200mg and 500mg Gastro-resistant tablets

The alert reports an unusual odour associated with specific batches.  The odour has been described as “fishy”, “sweaty armpits”, “cannabis” and Sanofi has identified the root cause as being the type of aluminium foil used in the packaging and has confirmed that no impact on the quality or efficacy of the tablets has been detected.

Sanofi has since switched the foil supplier and in order to prevent a stock shortage we need (if asked) to reassure ward staff and patients that the tablet efficacy is unaffected by the unusual smell.

Please do not hesitate to contact either Ray Lyon or Jed Hewitt if you require further information on any of the topics covered in this newsletter or you have any suggestions to improve it.

Ray Lyon, Chief Pharmacist - Strategy Jed Hewitt, Chief Pharmacist – Governance and Professional Practice

ray.lyon@sussexpartnership.nhs.uk jed.hewitt@sussexpartnership.nhs.uk

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