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 not routinely be prescribed in primary care. This guidance was considered by the PCN in January 2018 and policy statements developed. Group 1 Prescribers in primary care should not initiate for any new patient CCGS should support prescribers in deprescribing in all patients and, where appropriate, ensure the availability of relevant services to facilitate this change No routine exceptions have been identified Advice on switching given where appropriate PCN 302-2018 Herbal Treatments The Prescribing Clinical Network does not recommend the use of herbal treatments. Herbal treatments will be considered BLACK on the traffic light system and prescribers should NOT initiate herbal treatments in any new patients De-prescribe these treatments in all current patients, in line with NHS England guidance. PCN 303-2018 Homeopathy The Prescribing Clinical Network does not recommend the use of homeopathic items. Homeopathic items will be considered BLACK on the traffic light system and prescribers should NOT initiate homeopathic medications in any new patient De-prescribe homeopathic treatments in all current patients, in line with NHS England guidance. PCN 304-2018 Perindopril Arginine The Prescribing Clinical Network does not recommend the use of perindopril arginine. Perindopril arginine will be considered BLACK on the traffic light system and prescribers should: NOT initiate perindopril arginine in any new patients Switch any patients taking perindopril arginine to perindopril erbumine in line with NHS England guidance. 1
PCN 305-2018 Trimipramine The Prescribing Clinical Network does not recommend the use of trimipramine. Trimipramine will be considered BLACK on the traffic light system and prescribers should: NOT initiate trimipramine in any new patient Switch patients taking trimipramine to an alternative, more cost effective option, in line with NHS England guidance. PCN 306-2018 Co-Proxamol The Prescribing Clinical Network does not recommend the use of co-proxamol. Co-proxamol will be considered BLACK on the traffic light system. Prescribers should: NOT initiate co-proxamol for any new patient Switch patients taking co-proxamol to an alternative pain medication in line with NHS England guidance. PCN 307-2018 Prolonged-release The Prescribing Clinical Network does not recommend the use of prolonged-release doxazosin. Prolonged-release doxazosin will be considered BLACK on the traffic light system and prescribers Doxazosin (also should: known as Doxazosin NOT initiate prolonged release doxazosin for any new patient. Modified Release) For current patients - In reviewing prescribing of this drug, consider if doxazosin remains the best option for the therapeutic indication. If still indicated switch patients taking prolonged released doxazosin to immediate release doxazosin, in line with NHS England guidance. The Prescribing Clinical Network does not recommend the use of glucosamine and chondroitin. Glucosamine and chondroitin will be considered BLACK on the traffic light system and prescribers PCN 308-2018 PCN309-2018 Glucosamine and chondroitin Lutein and antioxidants for the prevention of age related macular degeneration (AMD) should: NOT initiate glucosamine and chondroitin in any new patients De-prescribe glucosamine and chondroitin in all patients, in line with NHS England guidance. The Prescribing Clinical Network does not recommend the prescribing of lutein and antioxidants for the prevention of age related macular degeneration and they will be given a BLACK status on the traffic light system for this indication. Patients who are recommended to take these supplements can purchase these products over the counter from pharmacies. Prescribers should: NOT initiate lutein and antioxidants in any new patient De-prescribe lutein and antioxidants in current patients, in line with NHS England. 2
PCN 310-2018 PCN 311-2018 PCN 312-2018 Omega-3 Fatty Acid Compounds Paracetamol and Tramadol Combination Product Rubefacients (excluding topical NSAIDs) The Prescribing Clinical Network does not recommend the use of omega-3 fatty acid compounds for any indication other than for patients with raised triglycerides (on advice of a lipidologist). Omega-3 Fatty Acid Compounds will be considered BLACK on the traffic light system for all indications (except patients with raised triglycerides). Prescribers should: NOT initiate Omega 3 fatty acids compounds in any new patients; De-prescribe this treatment in all patients (other than patients with raised triglycerides), in line with NHS England guidance. The Prescribing Clinical Network does not recommend the use of paracetamol and tramadol combination product. Paracetamol and tramadol combination product will be considered BLACK on the traffic light system and prescribers should NOT initiate paracetamol and tramadol combination product for any new patient De-prescribe paracetamol and tramadol combination product with specialist support if appropriate, in all patients. The Prescribing Clinical Network does not recommend the use of rubefacients. Rubefacients will be considered BLACK on the traffic light system and prescribers should NOT initiate rubefacients for any new patient De-prescribe rubefacients in all patients in line with NHS England guidance. PCN 313-2018 Once Daily Tadalafil The Prescribing Clinical Network does not recommend the use of once daily tadalafil. Once daily tadalafil will be considered BLACK on the traffic light system and prescribers should NOT initiate once daily tadalafil in any new patient De-prescribe once-daily tadalafil in all patients in line with NHS England guidance. 3
Group 2 Prescribers in primary care should not initiate for any new patient CCGs should support prescribers in deprescribing in all patients and, where appropriate, ensure the availability of relevant services to facilitate this change In exceptional circumstances there may be a clinical need for the drug to be prescribed then this should be undertaken in a cooperation arrangement with a multi-disciplinary team and/or other healthcare professional No routine exceptions have been identified PCN 314-2018 Dosulepin The Prescribing Clinical Network does not recommend the use of dosulepin. Dosulepin will be considered BLACK on the traffic light system, prescribers should: NOT initiate dosulepin for any new patient Switch patients taking dosulepin to an alternative antidepressant In exceptional circumstances where there is a clinical need for dosulepin to be prescribed in primary care this should be undertaken in a cooperation arrangement with a multidisciplinary team and / or other healthcare professional. PCN 315-2018 Oxycodone and Naloxone Combination Product (Targinact) The Prescribing Clinical Network does not recommend the use of oxycodone and naloxone combination product. Oxycodone and Naloxone Combination Product will be considered BLACK on the traffic light system, prescribers should: NOT initiate oxycodone and naloxone combination product for any new patient De-prescribe oxycodone and naloxone combination product, with specialist support if appropriate, in all patients. In exceptional circumstances where there is a clinical need for oxycodone and naloxone combination product to be prescribed in primary care this should be undertaken in a cooperation arrangement with a multidisciplinary team and / or other healthcare professional. 4
Group 3 Prescribers in primary care should not initiate for any new patient CCGs should support prescribers in deprescribing in all patients and, where appropriate, ensure the availability of relevant services to facilitate this change In exceptional circumstances there may be a clinical need for the drug to be prescribed then this should be undertaken in a cooperation arrangement with a multi-disciplinary team and/or other healthcare professional Exceptions and further recommendations are included PCN 316-2018 Immediate Release Fentanyl for all indications other than palliative care treatment in line with NICE CG140 Immediate Release Fentanyl will be considered BLACK on the traffic light system for all indications other than palliative care treatment in line with NICE CG140. The PCN does not recommend the use of Immediate Release Fentanyl other than for patients undergoing palliative care treatment and where the recommendation to use immediate release fentanyl in line with NICE CG140 (opioids in palliative care) has been made by a multi-disciplinary team and / or other healthcare professional with a recognised specialism in palliative care. Prescribers should: NOT initiate immediate release fentanyl for any new patient Switch patients taking immediate release fentanyl to an alternative, with specialist support, in line with NHS England guidance (excluding palliative care in line with NICE CG140. In exceptional circumstances, if there is a clinical need for immediate release fentanyl to be prescribed in primary care this should be undertaken in a cooperation arrangement with a multidisciplinary team and / or other healthcare professional. 5
PCN 317-2018 Lidocaine Plasters for all indications other than use for the licensed indication (symptomatic relief of neuropathic pain associated with previous herpes zoster infection) in line with NICE CG173 The Prescribing Clinical Network does not recommend the unlicensed use of lidocaine plasters. Lidocaine plasters will be considered BLACK on the traffic light system for all unlicensed uses, primary care prescribers should NOT initiate lidocaine plasters for any new patient De-prescribe lidocaine plasters in all patients with specialist support if appropriate, in line with NHS England guidance In exceptional circumstances there may be a clinical need for lidocaine plasters to be prescribed in primary care. The specialists and the prescriber will need to have informed discussions about prescribing these medicines for individual patients. PCN 318-2018 Travel vaccines (Hepatitis B, Japanese Encephalitis, Meningitis ACWY, Yellow Fever, Tickborne encephalitis, rabies & BCG) exclusively for the purposes of travel Liothyronine (Armour Thyroid and liothyronine combination products) The Prescribing Clinical Network considers that Hepatitis B, Japanese Encephalitis, Meningitis ACWY, Yellow Fever, Tick-borne encephalitis, rabies & BCG vaccines should not be given on the NHS exclusively for the purpose of travel for any new patient. The vaccines may continue to be administered for purposes other than travel, if clinically appropriate. Hepatitis B, Japanese Encephalitis, Meningitis ACWY, Yellow Fever, Tick-borne encephalitis, rabies & BCG vaccines will be considered BLACK on the traffic light system exclusively for the purpose of travel for any new patient. New Policy statement is not required as individual indications for liothryonine already have policy statements on the PAD. Note that there is a requirement for patients currently taking liothyronine to be reviewed by specialists. 6