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BNSSG Adult Joint Formulary
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Decisions 12th December 2023

New Drug Requests: 

Approved

Capsaicin (Qutenza®) patch (TLS Red)

  • for pain relief in diabetic neuropathy for use in pain clinic only
  • note, this patch is already on the formulary for non-diabetic peripheral neuropathy

Formoterol, budesonide, glycopyrronium (Trixeo®) pressurised inhaler (TLS Green)

  • as an option for moderate to severe COPD 

Traffic light status changes:

  • Ketorolac injection- to change to TLS Red on 10.4, 15.1 to be used in hospital setting only and to change to TLS Amber specialist recommended for palliative care (for rare cases).
  • Bupivacaine formulations to change to TLS Red for local anaesthesia:
    Bupivacaine 0.25% & 0.5% injection, Bupivacaine 5mg / Glucose 80mg/mL injection, Bupivacaine 0.25% / Adrenaline 1 in 200,000 injection,, Bupivacaine 0.5% / Adrenaline 1 in 200,000 injection, Bupivacaine 0.1% for epidural infusion, Bupivacaine 0.1% / Fentanyl 2micrograms/mL, Bupivacaine 0.1%/fentanyl 5 micrograms/ml infusion 

Other decisions and discussions:

  • Spacer devices for inhalers- it was agreed to update this section and refer to the devices generically. Clinicians are encouraged to prescribe the most appropriate and cost-effective spacer for the patient. 
  • Gepretix brand of micronised progesterone capsules added to BNSSG adult formulary as preferred brand.
  • Rimegepant for treating migraine as per NICE TA919 to be added as TLS Blue in line with implementation period (18th January 2024)
  • Daridorexant for treating long-term insomnia as per NICE TA922 to be added as TLS Blue in line with implementation period (18th January 2024)
  • iron isomaltoside 1000 changed to ferric derisomaltose due to name change
  • cilest brand removed from formulary (discontinued)
  • SCP template for mental health drugs discussed- consideration of use of NHS England template when possible and the combined BNSSG/BSW template to facilitate continued collaboration with BSW. The group agreed to use the combined template for the ADHD stimulany/ atomoxetine SCP. The group agreed to use the national NHSE (RMOC) SCP template for lithium. 

Decisions from December JFG meeting which are awaiting further work before can be actionned:

New Drug Request applications:

  • Doxylamine succinate/ pyridoxine hydrochloride (Xonvea) for treatment of nausea and vomiting in pregnant women aged 18 years and over who do not respond to conservative management as a third line option onto the BNSSG adult formulary as TLS Amber specialist initiated, pending agreement with specialist team of clear criteria. 
  • N-acetylcisteine (NAC) mixed with simeticone to improve mucosal visibility during upper GI endoscopy onto the BNSSG Adult formulary as TLS Red, pending development of a protocol to support use and ensure preparation is consistent and safe.

Traffic Light Status requests: 

  • Potassium binders (sodium zirconium and patiromer) for patients on a stable dose of potassium binder and RAASI drug. The group were supportive with the proposal of change to TLS Amber specialist initiated, pending development and approval of guideline