Prescribing

There is contamination of some supplies of Ranitidine and the Swiss and German regulatory authorities have started an investigation.

NDMA is the contaminant.

GP’s will review if you need to take the medication and if gastric treatment is needed will switch you to omeprazole.

From 1st April 2019, Tower Hamlets is making changes to the prescribing of medicines that can be bought over the counter for 35 minor, short-term health conditions in line with guidelines published by NHS England. These changes will benefit patients by freeing up valuable GP time and promoting self-care through community pharmacy. NHS England (NHSE) published prescribing guidance (29 March 2018) which covers 35 minor, short-term health conditions, which are either ‘self-limiting’ or suitable for ‘self-care’.

The new guidance recommends that:

• Medicines which are available over the counter should no longer routinely prescribed for 35 minor, short-term conditions.
• Vitamins, minerals and probiotics are also included in the restrictions as items of limited clinical effectiveness.

Please click here for Tower Hamlets CCG policy on this and who it applies to.

Self-limiting illnesses:
Acute Sore Throat
Infrequent Cold Sores of the lip
Conjunctivitis
Coughs and colds and nasal congestion
Cradle Cap (Seborrhoeic dermatitis – infants)
Haemorrhoids
Infant Colic
Mild Cystitis

Minor illnesses suitable for self-care:
Mild Irritant Dermatitis
Dandruff
Diarrhoea (Adults)
Dry Eyes/Sore (tired) Eyes
Earwax
Excessive sweating (Hyperhidrosis)
Head lice
Indigestion and Heartburn
Infrequent constipation
Infrequent Migraine
Insect bites and stings
Mild Acne
Mild Dry Skin
Sunburn
Sunburn Protection
Mild to Moderate Hay fever/Seasonal Rhinitis
Minor burns and scalds
Minor conditions associated with pain, discomfort and/fever. (e.g. aches and sprains, headache, period pain, back pain)
Mouth ulcers
Nappy Rash
Oral Thrush
Prevention of tooth decay or cavities
Ringworm/Athletes foot
Teething/Mild toothache
Threadworms
Travel Sickness
Warts and Verrucae
Items of limited clinical effectiveness:
Probiotics
Vitamins and minerals

From 1 April 2019, gabapentin and pregabalin will be reclassified as class C controlled drugs. Increased restrictions are intended to improve safety. These medicines are used to treat nerve pain and sometimes epilepsy or anxiety.

What patients need to know:

We will no longer be able to issue electronic prescriptions for gabapentin or pregabalin. Pharmacies will only be able to accept hand-signed paper prescriptions. This may mean you need to make alternative arrangements for collecting your prescriptions.
Repeat dispensing prescriptions will no longer be allowed (also known as ‘batch prescriptions’). This means patients will need to order their medications through reception, online or with their pharmacy each time they need a new supply.
We will only be able to issue prescriptions for a maximum of 30 days’ supply.

Patients who receive these medications in a blister pack (dosette box) do not need to do anything, the practice will make the necessary arrangements with our local pharmacies.

Proton Pump Inhibitors (or PPIs) are a group of medicines used to reduce stomach acid and include omeprazole, lansoprazole, esomeprazole and pantoprazole. These medicines are very commonly prescribed but many patients continue taking them for longer than they may need. Usually a course of two to three months is sufficient to help heartburn or indigestion to settle.

As with any prescription medication, PPIs can cause side effects which are more likely if you take a high dose or use them for a long period of time. More and more evidence is coming out that suggests this group of medications may be linked to more problems than we knew about previously. We are therefore re-assessing which of our patients these medicines remain the best choice for.

What are the possible risks from long-term use of a PPI?

Increased risk of serious stomach infections including Clostridium difficile

Increased risk of bone fractures

Decreased absorption of nutrients including magnesium, calcium, and vitamins

Reduce the effectiveness of other medicines you may take including medicines used to prevent heart attack and stroke

May increase risk of kidney disease, pneumonia, dementia and certain cancers – more research is being done on all these possible links.Always speak to your GP or pharmacist before stopping prescribed medicines. PPIs should be reduced slowly to minimise rebound symptoms. If you have a history of stomach ulcers or bleeding, or have severe symptoms it is likely that continuing your PPI is the best option – your GP can help you to make this decision.

Emollients are products like diprobase, doublebase, epaderm and E45. These are moisturisers that are used for many chronic skin conditions. They are very important for conditions like eczema and psoriasis, and we want to make sure patients with these conditions are given enough to be able to use them frequently. However they are very costly for the NHS, and so we are being asked to prescribe the lower cost options first, and only to change to higher cost options if necessary. You may start to see different versions of your emollient being prescribed, with a message about this. Please be reassured that although the name and packaging may be different, the ingredients are in most cases identical, if not very similar. We are also being asked not to prescribe emollients at all for people who don’t suffer with chronic skin conditions like eczema, but who just have dry skin.

There are emollients being prescribed such as Zerobase equivalent to Diprobase, or Zeroqas equivalent to Aqueous cream. This is part of the cost effective prescribing in the NHS.

Why has my medication been changed?

Some time ago the agency responsible for safe prescribing advised doctors that it was safer for patients to take pain relieving medications such as paracetamol and codeine separately rather than as one tablet. This reduced the chance of overdose and adverse events with combination medicines such as co-codamol. This is now considered standard ‘best practice’ in the prescribing of codeine and paracetamol and indeed any other pain relieving medications.

How do I know I will get the same pain relieving effects?

The dose is calculated by your doctor to give the equivalent dose of codeine and paracetamol to that which you are currently taking. For example; Co-codamol 30/500 is equivalent to 30mg of codeine and 500mg of paracetamol.

How do I adjust the dose with the separate tablets?

The separate tablets allow you to have much more flexibility from day to day as to the amount of pain killer tablets you take. For example they allow you to take a maximum dose of paracetamol whilst taking less codeine if you need to. When the tablets are combined you are forced to take an equal amount of both tablets.

What if I don’t like the switch after I have tried it?

If you have reasons for not liking the switch you can discuss this with your doctor or pharmacist but try it first!