LANARKSHIRE AREA DRUG & THERAPEUTICS COMMITTEE

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LANARKSHIRE AREA DRUG & THERAPEUTICS COMMITTEE Minute of the meeting held on Wednesday 21 st September 2016 at 10am in the Board Room, Kirklands PRESENT: Dr Mehrdad Malekian [Chair] Mr George Lindsay

1 LANARKSHIRE AREA DRUG & THERAPEUTICS COMMITTEE Minute of the meeting held on Wednesday 21 st September 2016 at 10am in the Board Room, Kirklands PRESENT: Dr Mehrdad Malekian [Chair] Mr George Lindsay Mrs Christine Gilmour Dr Colin Ooi Mr Bill Angus Mrs Gail Richardson Mrs Karen Patterson Mrs Maureen Woods was also present for the first item Dr Stephanie Dundas Miss Katrina Mackie Dr Vijay Sonthalia Dr Alwaly Majumdar Ms Linda Johnstone Dr Caroline Delahunty Mrs Victoria Mackinnon (for Mrs Milne) 2016/123 Apologies Dr Harpreet Kohli, Mr John Milne, Mrs Anne Milne 2016/124 Declaration of interest Dr Malekian asked if anyone had an interest to declare for any items being discussed today. No-one indicated that they had any interests to declare. 2016/125 Take home Naloxone Mrs Woods talked through the history of the take home Naloxone programme in Lanarkshire and the changes which had ensued both via changes in legislation and changes in national recommendations. A thorough discussion ensued relating to the following points: The importance of training including the training to family and friends of potential users. The possibility of GP prescribing and the fact that ScriptSwitch messages could be used to signpost patients who could benefit from Naloxone from the GP to the Substance Misuse Service. The supply of Naloxone via acute care. The protocols which Mrs Woods spoke to were approved. 2016/126 Matters Arising not covered elsewhere on the agenda (a) Ratification of Minutes of 20 th July 2016 & 24 th August 2016 The modified minutes from 20 th July 2016 and the draft minutes of 24 th August 2016 were both approved and can now be published. AW (b) Chronic pain guidance Mrs Mackinnon indicated that the guidance on chronic and neuropathic pain had now been distributed. She also indicated that further publicity will be given to it via the prescribing notes publication and the anticipation that they 1

2 will be published on the clinical guidelines website. (c) Desmopressin update Mrs Gilmour indicated that she had written to Dr Babu Mukhopadhyay after the July meeting but has not yet received a response. Mrs Gilmour will chase this up and report at the next meeting. CG (d) Entresto update Dr Malekian indicated that the case for funding was currently under consideration. (e) Database for ADTC recommendations update Miss Mackie indicated that she had been given a contact of Suzanne Gilmour who was confident that the IT to support the database which we want to use to record the decisions of the ADTC could be prepared within NHS Lanarkshire. Miss Mackie will come back to us with updates on this in due course. (f) Insulin guidance flowchart update Mrs Richardson indicated that feedback from the Committee had been given to the MCN. The Committee agreed that we await resubmission of this flowchart from the MCN. (g) Naloxegol (Moventig) update Mrs Mackinnon indicated that the prescribing team were auditing use of this agent in order to get objective data for further reflection. (h) Guidance on the use of vitamin supplementation in alcohol abuse (update) (i) Vitamin supplementation The direction of travel was agreed. It was thought there would be added value if there was a sentence added to the document that indicated that Vitamin B (strong) had traditionally been used for this purpose but this was no longer recommended. It was also recommended that this sentence be added then correspondence with the revised draft should be had with Adam Brodie and the Mental Health Drug & Therapeutics Committee. Assuming all agree, then this update could be adopted into practice. (ii) Step down PPIs The information leaflet was discussed. It was recommended that the multidisciplinary group who put the original information sheet together should be communicated with by for confirmation from these experts that the information still remains valid. That being the case, it could be extended for a further two years. 2

3 (i) Rescue medication It was confirmed that the clinicians in the paediatric epilepsy service were in agreement with the rescue medication guidance approved at the last meeting. 2016/127 SMC NEW Submissions Confidential until 10 th October 2016 FULL SUBMISSIONS Lenvatinib (Lenvima) (No 1179/16) This was noted and feedback will come from the West of Scotland Cancer Network. Nivolumab (Opdivo) for non-squamous NSCLC (No 1180/16) This was noted and feedback will come from the West of Scotland Cancer Network. Progesterone (Lutigest) (No 1185/16) This was noted and feedback will come from specialists in Gynaecology. Aflibercept (Eylea) (No 1186/16) This was noted and feedback will come from Ophthalmology. RESUBMISSION Budesonide (Cortiment) (No 1093/15) This was noted and feedback will come from specialists in Gastroenterology. ABBREVIATED SUBMISSION Rilpivirine/emtricitabine tenofovir alafenamide (Odefsey) (No 1189/16) This was noted and feedback will come from the Blood Borne Virus Network. NON SUBMISSIONS Budesonide / formoterol (Symbicort Turbohaler) 200/6 Inhalation powder and 400/12 Inhalation powder and budesonide / formoterol (Symbicort) 200 micrograms/6 micrograms per actuation, pressurised inhalation, suspension (No. 1198/16) 3

4 Golimumab (Simponi) 50mg solution for injection (No.1199/16) Perampanel (Fycompa) 2mg, 4mg, 6mg, 8mg, 10mg, and 12mg filmcoated tablets (No. 1200/16) Tocilizumab (RoActemra) 162 mg solution for injection in pre-filled syringe (No. 1202/16) AMENDED ADVICE Trametinib 0.5mg and 2mg film-coated tablets (Mekinist ) (No 1161/16) Dasatinib 20mg, 50mg, 80mg, 100mg and 140mg film-coated tablets (Sprycel ) (No 371/07) Carfilzomib 60mg powder for solution for infusion (Kyprolis) (No 1171/16) 2016/128 SMC follow-up Miss Mackie talked the committee through the SMC follow-up which had been previously circulated. Further advice from Dermatology specialists has been requested, before a decision on the formulary status of calcipotriol and betamethasone cutaneous foam (Enstilar ) can be made. 2016/129 Lanarkshire formulary a. Dermatology formulary chapter part 2 Following a discussion on the submitted review the ADTC requested further input from Dermatology specialists before the review could be ratified by the committee. Miss Mackie will facilitate this request. b. Eye formulary chapter review Miss Mackie requested that the Eye formulary review be discussed at the next meeting. The committee were happy to accomodate this request. 4

5 2016/130 Clinical protocols a. Surgical prophylaxis (GI surgery) antibiotic policy This was approved subject to a point of detail with regard to peg tube insertion and Dr Dundas will confirm whether or not this needs to be carried out only for high risk patients. If that is the case, then the phrase not routine will be added to the relevant sections of the grid to make it consistent with the rest of the protocol. If this is the only change required, then Dr Dundas will proceed to make that change and distribute the protocol. SD b. Paediatric acute empirical antibiotic policy This was agreed subject to typographical corrections over the spelling of pyelonephritis. SD 2016/131 ADTC Bulletin The ADTC Bulletin (No. 107) for August 2016 was noted. 2016/132 Unlicensed Medicines a. BCG The Committee agreed with the need to use the imported BCG vaccine. 2016/133 NICE/HIS Guidance Nil to note. 2016/134 Medication and clinical risk in NHS Lanarkshire The updated information about interactions between Levonorgestrel and enzyme inducing medicines was noted. This may have significant implications for the pathways which such patients should follow for emergency contraception. Mr Lindsay is meeting the sexual health leads on 22 nd September 2016 and will discuss the implications of this change in advice with them and feedback to the Committee at the October meeting. GL 2016/135 a. Regional Cancer Advisory Network RCAG Prescribing Advisory Subgroup - August 2016 advice This item was deferred until the October 2016 meeting. 2016/136 Patient Safety Alerts Nil to note 2016/137 Lay member related items 5

6 a. Mr Angus discussed the concept of social prescribing and a number of members of the Committee provided their views on the practicality of this. 2016/138 Correspondence a. ADTC Collaborative i. Scottish Formulary Pharmacist Network ii. SPSP Medicines Webex Series Reducing harm across transitions: online survey iii. National ADTC chairs' and professional secretaries' WebEx iv. Hospital Electronic Prescribing and Administration This was noted v. Venetoclax EAMS for CLL - Operational Arrangements for Scotland This was noted vi. Will my medicine make me better conference This was noted b. Approval process for Clinical Guidelines Dr Malekian introduced this paper. It was agreed that this is a step forward within NHS Lanarkshire and although it is likely that there is still a lot of learning to be had, we look forward to working/adopting the principles involved in this draft document. c. LHRH Agonist Gonadorelin Analogues (ADTC Collaborative recommended) The ADTC were happy to endorse the recommendation from the national group. We understand that this will be adopted with quick effect for patients being commenced on these medicines for the first time. Some further detail has to be worked out with regard to how it will be implemented for patients who are already established on another agent. d. Palliative care prescribing Ms Johnstone talked through the purpose of amalgamating all the prescribing and recording of administration documents together into one document. The 6

7 Committee agreed that this was a sensible way forward. e. Ostenil plus pathway There was discussion about the Ostenil plus algorithm and documents which had been circulated with the agenda. The Committee were of the view that these were not complete and persuasive about the place of Ostenil in the treatment of osteoarthritis. A number of questions were raised and Dr Malekian is going to go back to the authors to ask them to consider a more comprehensive document and the possibility of coming to the Committee meeting to discuss the issues. MM 2016/139 Any Other Business a. Open Systems Mrs Gilmour discussed how she had received an NPSA document about open systems from the Directors of Pharmacy. The Committee agreed that it would be reasonable for Mrs Gilmour to distribute this to Dr Iain Wallace and Mrs Irene Barkby for dissemination throughout the medical and nursing staff. In addition, Mrs Gilmour will discuss internally and with the Directors of Pharmacy the distribution route of this NPSA notice. CG CG b. Dr Colin Ooi Dr Malekian thanked Dr Ooi for his service to the Committee which he had provided for the past five or six years. In particular he commented upon the practicality and views which he brought to the Committee as a practising GP and how we had all benefited from his insight and opinions. He wished Dr Ooi well in his retirement. In return, Dr Ooi thanked the Committee for their support and friendship and wished them well in the future. 2016/140 Date of Next Meeting The next scheduled meeting is on Wednesday 26 th October 2016 at 10am in the Conference Room, Kirklands. 7

LANARKSHIRE AREA DRUG & THERAPEUTICS COMMITTEE. 2014/116 Apologies Mr John Milne, Mrs Victoria Mackinnon, Mr Smith Mr George Lindsay

LANARKSHIRE AREA DRUG & THERAPEUTICS COMMITTEE Minute of the meeting held on Wednesday 17 th September 2014 at 10am in the Boardroom, NHS Lanarkshire HQ, Kirklands, Bothwell PRESENT: Dr Mehrdad Malekian