Memos and Alerts

How to minimise the risks of medication errors with rivastigmine patches

This Q&A aims to raise awareness on the types of medication errors reported with rivastigmine patches, as well as highlighting strategies to improve medication safety on the prescribing and administration of these patches.

Q&A Metronidazole – is it safe to use with breastfeeding?

The balance of current evidence and clinical experience, and the consensus of specialist opinion, is that there is no established mutagenic or carcinogenic risk to infants breastfeeding from mothers receiving routine short-course treatment with metronidazole by any route.

Low-dose oral metronidazole, 200-400 mg three times daily, produces milk levels only slightly lower than corresponding levels in maternal plasma (76 to 99%). Doses up to 500 mg three times daily for a 7 to 10 day course are considered to be compatible with breastfeeding.

Q&A Can oral fluconazole be used with breastfeeding?

Fluconazole is often used to treat lactation-associated candidal infections, and has been used to treat serious candidal infections in preterm and full term neonates. There is therefore clinical experience in the exposure of fluconazole to neonates and infants

The combination of these factors, and the common use of fluconazole without reported adverse effects in breastfed infants, suggests that oral fluconazole is safe in mothers breastfeeding full term infants, and no interruption of breastfeeding is necessary, regardless of which dosing regime is used.

Oral fluconazole use in mothers breastfeeding preterm infants should be approached with caution due to no direct evidence of safety and limited clinical experience.

Updated Patient Group Directions

The following Patient Group Directions for hepatitis A, hepatitis B, combined hepatitis A + B, typhoid and combined hepatitis A + typhoid have been updated.

These PGDs has been jointly developed and authorised by North of England Commissioning Support Unit (NECSU) and Cumbria & North East (NHS England), for use by practices and services within the Durham, Darlington, Tees, Cumbria, Northumberland and Tyne & Wear areas.

Disulfiram 200mg Shortage

We have received notification of a shortage affecting disulfiram 200mg tablets. The product has recently divested from Actavis to TEVA , who are now advising that supplies are unavailable until April 2017.

Ultibro® Supply Issues [Feb 2017]

We understand that some pharmacies may be experiencing supply issues with Ultibro® Inhaler at present. If your pharmacy tells you they are having difficulty getting through their normal supply routes please advise them of the following:

Alliance healthcare are currently distributing Ultibro inhaler on behalf of Novartis
If a pharmacy has difficulty obtaining supplies through their normal wholesale route they can obtain next day delivery for patients by faxing a copy of the prescription to 02030448996.
Patient details should be blacked out and replaced with the pharmacy alliance healthcare account number.GP name, date and prescription number need to be visible.
Delivery will be direct to the pharmacy on the next working day.

Controlled Drugs: Learning from Incidents February 2017

Issue 6 of controlled Drugs: Learning from Incidents, produced by NECS on behalf of NHS England covers:

Destruction of Controlled Drugs
Examples of suppliers of CD denaturing kits
CD balance checks during external stocktaking
Licensed equivalents for special order CDs

Antimicrobial stewardship: changing risk-related behaviours in the general population (Joint NICE and Public Health England guideline)

This new guideline aims to make people aware of how to correctly use antimicrobial medicines and the dangers associated with their overuse and misuse in order to reduce antimicrobial resistance. It also includes measures to prevent and control infection.

Recommendations made by NG63 cover the following areas:

overarching principles
local system-wide approaches to reducing inappropriate antimicrobial demand and use
local system-wide approaches to preventing and limiting the spread of infection
childcare and education providers
prescribers, primary care, and community pharmacy teams.

Low back pain and sciatica in over 16’s – NICE guideline [NG15]

This NICE guideline covers assessing and managing low back pain and sciatica in people aged 16 and over. It outlines physical, psychological, pharmacological and surgical treatments to help people manage their low back pain and sciatica in their daily life. The guideline aims to improve people’s quality of life by promoting the most effective forms of care for low back pain and sciatica.