second line diagnostic bronchial provocation test, following either a negative mannitol test with a clinical suspicion of asthma or intolerance to mannitol.

Uromune sublingual spray vaccine (TLS Red)

for prevention of recurrent UTIs, on advice of the recurrent UTI MDT

Rituximab (TLS Red)

for treatment of moderate RA in patients for whom TNS inhibitor and JAK inhibitor are clinically contraindicated or not tolerated

Certolizumab (TLS Red)

for treatment of moderate RA as first line for patients who are actively planning to conceive or pregnant and are due to escalate to bDMARD therapy

Estradot^®patch (TLS Blue)

(Estradiol 25, 37.5, 50, 75 & 100mcg/24 hrs) -second line brand option for patients where Evorel patch reported to lack adhesion, be poorly absorbed or where localised reactions to the glue are reported.

Other additions

Dapagliflozin (TLS Amber Specialist Recommended)

In line with NICE TA902 Dapagliflozin for treating chronic heart failure with preserved or mildly reduced ejection fraction

Traffic light status changes

Sucroferric oxyhydroxide from TLS Red to TLS Amber Specialist recommended
Lanthanum from TLS Amber 1 month SCP to TLS Amber Specialist recommended
Sevalemer carbonate from TLS Amber 1 month SCP to TLS Amber specialist recommended
Sitagliptin from TLS Blue to TLS Green
Alogliptin from TLS Green to TLS Blue

Hyperlipidaemia chapter review changes

To remove Colestipol as this is now discontinued and no stock is available.
Bile acid sequestrants is not routinely used in hyperlipidaemia. It was agreed to include a message and to move to 1.7 Gastro page in agreement with Gastro team. The following statement to be included under 2.6 Hyperlipidaemia ‘bile acid sequestrants are not routinely used for hyperlipidaemia, except in the context of bile acid malabsorption. Please see NHS Accelerated Access Collaborative » Statin intolerance pathway (england.nhs.uk) for management of patients with statin intolerance. Please see 1.7 Liver disorders and related conditions (Remedy BNSSG ICB) for further information on bile acid sequestrants.'
The stock issue with Colestyramine is now resolved. It was agreed to remove the Colestyramine stock issue message.
Bezafibrate is no longer recommended as part of local guidance for cardiovascular disease prevention. It was agreed to include the following message under Bezafibrate ‘no longer recommended for routine use for cardiovascular disease prevention. For existing patients only. May be used for management of severe Hypertriglyceridaemia by lipid clinic for patients intolerant to fenofibrate'
Pravastatin and Simvastatin low intensity statins are no longer recommended for cardiovascular disease prevention. It was agreed to add restriction to both statins to advise these are now low intensity statins and to not recommend for routine use.

Other changes

SCP Review Work:

Haloperidol injection (non-depot) for mental health indications from TLS Amber 1 month to TLS Red
Rifaximin (oral) for treatment and prophylaxis of hepatic encephalopathy from TLS Amber 3 months to TLS Amber specialist initiated
Buserelin nasal spray for endometriosis from TLS Amber not specified to TLS Amber specialist recommended
Triptorelin for endometriosis from TLS Amber not specified to TLS Amber specialist recommended
Sodium valproate TLS was discussed, with an ambition to work towards TLS Amber 3 months for all indications- formulary update will take place once work completed.

Decisions 29th August 2023

New Drug Requests

Tadalafil 5mg tablets (once daily) (TLS Amber Specialist Initiated)

Methacholine (Provocholine) powder for nebuliser solution (TLS Red)