Should Not Prescribe List

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Shauna Harrington
5 years ago
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1 a Alendronate plus Vitamin D (Fosavance ) Separate components more cost effective Fosavance for 4 tablets vs Alendronate 70mg tabs 0.96 Ammonium Chloride preparations e.g. DriChlor, Anhydrol Forte, Odaban Antiperspirant preparations not suitable for prescribing as readily available over the counter. 19/09/2016 Self management of hyperhidrosis is recommended. Antifungal nail paint Systemic treatment more effective Tioconazole nail solution for 12mls Antihistamines - branded Brands are considerably more expensive. Not cost effective use of NHS resources. Generic cetrizine 10mg tablets 1.05 for 30; Loratadine 10mg tablets 1.07 for 30 Armour thyroid preparations Blephaclean, blephasol, blephagel and similar related products for blepharitis Evidence supports the use of levothyroxine alone in the treatment of hypothyroidism. There is a lack of robust trial evidence in peer-reviewed publications for products containing thyroid extract Levothyroxine more cost effective option Alternative more cost effective options are available see NHS Choices blepharitis Unlicened in UK so significant costs attached 18/04/2016 Bio Oil No evidence base. More cost effective preparations available Calcium 500mg and colecalciferol 200units (e.g. Calcichew D-3) (prescribed generically) NB: Products that contain a minimum of 400 IU vitamin D are appropriate for prescribing Prescriptions written as calcium and ergocalciferol or calcium and vitamin D without a strength will be dispensed as the generic product containing 400 units of ergocalciferol per tablet and costing for 28 tablets. 800 units of Vitamin D (20mcg cholecalciferol) is required daily to treat deficiency and those at risk of deficiency and for the prevention of osteoporosis related fractures and falls. For prevention of vitamin D deficiency in at risk patients, a dose of 400 units daily is required. For these groups of patients self-care is appropriate. Cannabis extract (Sativex ) for add on treatment for symptom improvement in moderate to severe spasticity due to MS NICE guidance does not support it due to insufficient evidence. Does not represent value for money in terms of use of NHS resources. 28/09/2017 SCCG policy can be found at: Chlorpropamide Safety concern Cilostazol (Pletal ) NICE do not recommend - TA223

2 Co-careldopa intestinal gel (Duodopa ) Co-proxamol Markedly more toxic in overdose than paracetamol.withdrawn from market in 2005 due to and marketing authorisations cancelled at end of a Limited evidence of benefit with regards long term clinical evidence Commissioned by NHSE via IFR. Cod liver oil capsules Codeine and aspirin combination product (Cocodaprin ) Limited evidence of benefit with regards long term clinical evidence Not cost effectiveness This preparation does not allow for effective dose titration and the advantages of using a compound formulation have not been substantiated. There is no instance where this product is appropriate to use from a safety or efficacy point of view, over existing treatments. The BNF considers this product less suitable for prescribing. Dental products recommended by community dentists Flouride (including toothpaste), mouthwashes, oral inflamation treatment DHEA (Dehydroepiandrosterone) Poor evidence base Not cost effective use of NHS resources. 17/10/2016 Inappropriate for dentist to ask GP to take prescribing responsibility Diuretics with Potassium There is sufficient concern over safety that it is not appropriate to be prescribed due to K+ supplements increasing levels BNF considers such products to be less suitable for prescribing Doxazosin MR Dymista (fluticasone/azelastine) for the symptomatic treatment of severe seasonal and perennial allergic rhinitis. Eflornithine 11.5% cream No good evidence of increased benefit over immediate release doxazosin. Both formulations provide effective blood pressure control and are effective at controlling the symptoms of BPH and improving maximum urinary flow rate. Half-life of immediate release doxazosin is about 22 hours, allowing once daily dosing. Not cost effective use of NHS resources. Offers very little benefit for the management of facial hirsutism in women. The treatment of hirsutism is a cosmetic procedure which is a low priority for funding by CCGs. Laser treatment for hirsutism is listed as a procedure of low clinical value and not funded. Hence other treatments for hirsutism are also viewed as low clinical value. There is limited evidence for efficacy and patient satisfaction with eflornithine. standard relesae doxasozin 4mg tablets 1.04 per 28; modified release 4mg tablets 5.00; 8mg modified release tablets /09/2016 Self-funded cosmetic treatments for reduction in hair growth or hair removal (e.g. shaving, plucking, laser treatment, electrolysis) should be the primary options for the majority of women with hirsutism.

3 a Epogam and efamast Unlicensed 'lifestyle drug' no information on long term safety withdrawal of marketing authorisation due to the data not supporting the current standard of efficacy required for authorisation of these products as medicines for the treatment of eczema and mastalgia (breast pain). 17/10/2016 Ergotamine containing products (Migril) Deemed less suitable for prescribing in BNF. More cost effective safer preparations available Freederm products More cost effective acne treatment available 17/10/2016 Gamolenic Acid/ Starflower oil (Epogam and Efamast ) Poor evidence base Glucosamine Poor evidence base Grass Pollen Extract (Grazax ) Poor evidence base Idoxuridine in dimethyl sulfoxide (Herpid ) Poor evidence base Iron all modified release iron preparations BNF - No therapeutic advantage - should not be used Inositol Nicotinate (Hexopal ) Ketoconazole (for oral administration) Safety concerns Poor evidence base not recommended by NICE Lansinoh HPA lanolin cream Poor use of NHS resources. Other products availabls Litozin (Rosehip) Poor use of NHS resources compared with conventional NSAID treatment

4 a Maculeh Light Poor evidence base 18/07/2016 Magnesiocard Meprobamate Safety concerns. European marketing authorisation suspended. Dietary supplement. Not licensed in UK. Other more cost effective magnesium supplements available for deficiency. 17/10/2016 Methcarbamol 750mg tablets Molludab (potassium hydroxide 5%) topical solution for the treatment of molluscum contagiosum Minocycline for acne Safety concerns ktt11/resources/minocycline Not cost effective use of NHS resources, deemed less suitable for prescribing in BNF. Poor evidence base Minoxidil ointment, cream, lotion and foam (Regaine for Men Extra Strength 5% scalp foam, Regaine for Men Extra Strength 5% solution, Regaine for Women Regular Strength 2% solution) These are cosmetic products and not a cost effective use of NHS resources. 20/11/2017 Moxisylyte (Opilon ) Poor evidence Multivitamin and mineral preparations for the management of age-related macular degeneration (ARMD) e.g. Icaps, Occuvite preservision, Preservision lutein, Viteyes original plus-lutein,macushield Ocuvite lutein, Visionace, Vitalux-plus) Poor evidence Naproxen & esomeprazole combination product (Vimovo ) Not cost use of NHS resources. Considerably more expensive than both drugs prescribed separately. Natural' progesterone creams (Serenity) Omega-3-acid ethyl ester (Omacor ) - for unlicensed indications such as Heart Failure Poor evidence base Poor evidence base Paracetamol and tramadol combination product (Tramacet ) Not a cost effective use of NHS resources. This combined preparation has both drugs at lower than suggested dosages and is also more expensive than the separate components.

5 Permaton (green lipped mussel extract gel) a There is no evidence of efficacy for this product 18/04/2016 Pennsaid (Diclofenac topical 1.5% solution) Not a cost effective use of resources. No benefit over diclofenac gel 1.16% and considerably more expensive 17/10/2016 Pentoxifylline (Trental ) Prednisolone EC tablets Poor evidence base not recommended by NICE e/ta223/chapter/1-guidance Poor evidence base. No benefit over plain. Prednisone MR tabs (Lodotra ) Poor evidence base. Probiotics Limited clinical efficacy 05/01/2019 VSL#3: product is no longer on the Drug tariff and off the emis system The ACBS delisting both the VSL#3 and Vivomixx Rubefacients (exluding topical NSAIDs and capsaicin cream) Poor evidence Silk garments (Dermasilk ), Dreamskin ) for use in eczema and psoriasis Poor evidence Simvastatin/ ezetimibe combination product Not cost effective use of NHS resources (Inegy ) Spatone - iron-rich spa water from the mountains of Snowdonia Poor evidence

6 Tadalafil 'once daily' Cialis lower dose taken once a day (tadalafil 2.5mg and 5mg and cialis 2.5mg and 5mg) a NHS England Benign Prostatic Hyperplasia: NICE terminated published a their technology appraisal (TA273) due to document in Feb' receiving no evidence from the manufacturer. In 2017 (Items which NICE CG97: Lower Urinary Tract Symptoms in should not routinely Men NICE state that there is not enough evidence be prescibed in to recommend phosphodiesterase inhibitors in primary care) routine clinical practice. Targinact (oxycodone/naloxone) Insufficient evidence clinical of cost effectiveness.not supported by local pain consultant. Testosterone patches (Intrinsa ) for hypoactive sexual desire disorder (HSDD). Lack of evidence of efficacy and safety wnload/ ea2925be6aa1e c9/ Testosterone-Patch-Verdict-Oct-07.pdf Trandolapril/ verapamil combination product (Tarka ) Not a cost effective use of NHS resources This combined preparation and is more expensive than the separate components. Ubiquinone (Co-enzyme Q10) Poor evidence base Yohimbine for the treatment of erectile dysfunction Safety concerns

7 Grey List a Cyanocobalamin tablets Limited evidence of benefit For use only in patients who cannot tolerate injections Dapoxetine for the on-demand treatment of premature ejaculation Unknown long-term safety outcomes (> 24 weeks) Limited evidence of efficacy compared to other SSRIs No data on cost effectiveness Via IFR Fentanyl Immediate release Potential of products providing high dose potent opioid, and complicated tritration and maintenance instructions Limited evidence compared to immediate release morphine Significantly more expensive than other options Break through pain in cancer Flexitol Cream For diabetic patients only and issued in appropriate quantities Fluoride toothpaste and rinses Chemotherapy and post radiotherapy patients under recommendation of secondary care. Gliclazide MR More costly than immediate release preparation which can also be taken a single dose at breakfast

8 Grey List Lidocaine plasters (Versatis) a Not recommened by NICE (CG 173) due to limited clinical evidence supporting its use for neuropathic pain Expensive per box of 30 plasters Post-herpatic neuralgia intolerant of first-line therapies or where they have been ineffective Omega-3-acid ethyl ester (Omacor ) Not recommended for secondary prevention of myocardial infarction NICE CG 172 states: Do not offer or advise people use omega 3 fatty acid capsules or omega 3 fatty acid supplemented foods to prevent another MI. Advise people to eat a Mediterranean-style diet (more bread, fruit, vegetables and fish; less meat; and replace butter and cheese with products based on plant oils). NICE CG 170 states: Do not use omega-3 fatty acids to manage sleep problems in children and young people with autism per 28 capsules Consultant intiation ONLY for hypertriglyceridemia Review in association with psychiatrist for schizophrenia indication Piroxicam oral therapies MHRA Drug Safety Update 2007 stated: Systemic piroxicam should be initiated only by specialists as a second-line treatment for arthritis. Patients who currently take piroxicam should be reassessed at a routine appointment

9 Grey List a Tapentadol modified release tablets patients requiring treatment of severe chronic pain which CANNNOT be managed with more established opioid therapies. On recommendation of pain consultant only. Vitamin B tablets, Compound and Vitamin B tablets, Compound, Strong Should only be used on the advice of a dietician or in secondary care to prevent re-feeding syndrome Vitamin D suppliments 17/10/2016 Only for use with confirmed diagnosis of vitamin D deficiency

Items which should not routinely be prescribed in primary care: Summary of PCN statements PCN to PCN

Items which should not routinely be prescribed in primary care: Summary of PCN statements PCN 302-2018 to PCN 318-2018 In November 2017, NHS England issued final guidance in relation to items which should