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Decisions 6th May 2025
Decisions 6th May 2025
The following decisions were made at the Joint Formulary Group (adult) meeting held on Tuesday 6th May:
New Drug Requests
Oxybutynin 2.5mg and 5mg immediate-release tablets (off-label) (TLS Amber Specialist Initiated)
- Approved for vasomotor symptoms in menopause with the criteria for use restricted to for use in women with a history of cancer for whom HRT is contraindicated or complex cases of treatment resistance that are managed by the UHBW clinic only.
Procainamide vials for intravenous infusion (unlicensed) (TLS Red)
- Approved for severe or symptomatic ventricular arrhythmia, as a third-line option for specialist use only
Sufentanil 30mcg sublingual tablets (TLS Red)
- Approved for dressing changes and incidental pain only under the advice of anaesthetist and acute pain service at NBT only.
Aztreonam with Avibactam Powder (TLS Red)
- Approved for use under the advice of a microbiologist
Aztreonam (TLS Red)
- Approved for use under the advice of a microbiologist
Other discussions/decisions
- Mycophenolate: A final decision was not reached by the group. There was a TLS status request for Mycophenolate to change the TLS from TLS Amber Three Months to TLS Amber One Month. Further discussions are needed to for information to determine the next steps.
- Efmody: There was a request for Efmody cohort to be extended. JFG agreed to group to remove the following wording off the adult formulary entry ‘Only for use in patients who were established on Efmody whilst under the care of paediatric endocrinology to support continuity of care’.
- Pabrinex: Due to recent shortages of IV Pabrinex and the planned discontinuation of IM Pabrinex, the group approved the alternative treatments to be added to the adult joint formulary: generic Vitamin B and C concentrate for intravenous infusion (TLS red) and Thiamine hydrochloride solution for injection (TLS Blue).
- Zafirlukast has been discontinued and removed from formulary.
- Drug safety update about topical steroids information has been added to both adult and paediatric chapters 13.3.
- Tirzepatide communications and FAQS have been updated and uploaded onto Remedy.
- ADHD adult SCPs: Updated as per local clinical consensus in that asking about such psychiatric adverse effects at the annual review is sufficient and patients should be counselled to proactively report any such adverse effects if they occur.
- GLP-1s: Link added to diabetes page to highlight the recent FSRH guidance in relation to GLP1-s
- Vivaire® and Bibecfo®: Added to the adult chapter 3.1 for treatment of airways disease. These are branded generic beclometasone/formoterol pressured metered dose inhalers.
- Palliative Care Formulary chapter review: The palliative care adult chapter has been reviewed incorporating feedback from specialist teams across UHBW, NBT, St Peter’s Hospice, Sirona and primary care. The majority of the changes outlined in the Chapter Review are editorial changes and are in alignment with the TLS definitions and do not require specific action. JFG approved the following recommendations:
- Oxycodone remains TLS Blue as advised by the palliative care team despite the implications of the current working that stat is Amber Specialist Recommended.
- Octreotide to be changed from TLS Blue to TLS Amber Specialist Recommended
- Co-danthramer and Co-danthrusate to be changed from TLS Blue to TLS Amber Specialist Recommended
- Methylnaltrexone to be changed from TLS Blue to TLS Amber Specialist Recommended
- Phenobarbital to be changed from TLS Blue to TLS Amber Specialist Recommended
- Domperidone suppositories removed due to lack of use and unlicensed status.
- Methadone to be removed as it is not used in current practice for cough
- Midazolam to be removed as not appropriate for general anxiety management in palliative care; use reserved for the last days of life only