Recommendations

The Pan Mersey Area Prescribing Committee recommends the prescribing of abatacept infusion and subcutaneous injection (Orencia ®) for rheumatoid arthritis and infusion for polyarticular juvenile idiopathic arthritis as described below.

The Pan Mersey Area Prescribing Committee recommends the prescribing of abatacept infusion and subcutaneous injection (Orencia ®) for rheumatoid arthritis and infusion for polyarticular juvenile idiopathic arthritis as described below.

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The Pan Mersey Area Prescribing Committee does not recommend the prescribing of oral acetylcysteine in idiopathic pulmonary fibrosis.

The Pan Mersey Area Prescribing Committee recommends the prescribing of adalimumab injection (Humira®) for rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, non-radiographic axial spondyloarthritis, polyarticular juvenile idiopathic arthritis and in patients fitting other criteria commissioned by Pan Mersey CCGs, as described.

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The Pan Mersey Area Prescribing Committee does not currently recommend the prescribing of AFLIBERCEPT intravitreal injection (Eylea®▼) for the treatment of Choroidal Neovascularisation.

The Pan Mersey Area Prescribing Committee recommends the prescribing of ALIROCUMAB (Praluent®▼) by specialists only, for treating primary hypercholesterolaemia and mixed dyslipidaemia in accordance with NICE TA393.

The Pan Mersey Area Prescribing Committee does not currently recommend the prescribing of ALIROCUMAB solution for injection (Praluent®▼) for reduction of cardiovascular risk in adults with established atherosclerotic cardiovascular disease.

The Pan Mersey Area Prescribing Committee does not recommend the prescribing of antioxidant supplements based on the AREDS or AREDS2 formulae for patients with age related macular degeneration.

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The Pan Mersey Area Prescribing Committee does not recommend the prescribing of ASCORBIC ACID for any indication, other than scurvy.

The Pan Mersey Area Prescribing Committee recommends the prescribing of azithromycin following specialist initiation for certain chronic airway conditions in children.

The Pan Mersey Area Prescribing Committee recommends the prescribing of azithromycin tablets in selected high risk patients, when recommended by a respiratory specialist, for the prevention of exacerbations in COPD and bronchiectasis.

The Pan Mersey Area Prescribing Committee recommends the prescribing of BARICITINIB film-coated tablets (Olumiant®▼), by specialists only, for rheumatoid arthritis in accordance with
NICE TA466.

The Pan Mersey Area Prescribing Committee recommends the prescribing of INTRAVENOUS BISPHOSPHONATES (ibandronic acid and zoledronic acid), by specialists only, for treating osteoporosis in accordance with NICE TA464.

The Pan Mersey Area Prescribing Committee recommends the prescribing of ORAL BISPHOSPHONATES (alendronic acid, ibandronic acid and risedronate sodium) for treating osteoporosis in accordance with NICE TA464.

The Pan Mersey Area Prescribing Committee recommends the prescribing of Blood Glucose Testing Strips in accordance with the supplied guidance.

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The Pan Mersey Area Prescribing Committee recommends no more than TWO TREATMENT SESSIONS per YEAR of Botulinum Toxin Type A Injection (Botox®) by specialists for the treatment of severe axillary hyperhidrosis that has not responded to treatment with topical antiperspirants or other antihidrotic treatment, as a potential alternative to surgery.

The Pan Mersey Area Prescribing Committee recommends prescribing a maximum of TWO COURSES of botulinum toxin type A injection in the treatment of chronic anal fissure which has not healed despite a minimum course of at least 8 weeks of topical management.

The Pan Mersey Area Prescribing Committee recommends the restricted prescribing of BRIMONIDINE TARTRATE gel (Mirvaso®) for use in adults with moderate to severe facial erythema associated with rosacea, following dermatology specialist initiation, and continued only if the criteria below are met.

The Pan Mersey Area Prescribing Committee recommends the prescribing of BRIVARACETAM tablets/oral solution (Briviact®▼) for adjunctive treatment of focal seizures following initiation by a consultant neurologist.

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The Pan Mersey Area Prescribing Committee does not currently recommend the prescribing of BRIVARACETAM tablets or oral solution (Briviact®▼) for the treatment of epilepsy in children and adolescents.

The Pan Mersey Area Prescribing Committee recommends the prescribing of BRODALUMAB solution for injection (Kyntheum®▼), by specialists only, for treating plaque psoriasis in accordance with NICE TA511.

The Pan Mersey Area Prescribing Committee does not currently recommend the prescribing of BUDESONIDE orodispersible tablets (Jorveza®▼) for eosinophilic oesophagitis.

NHS England specialised commissining resources: the clinical reference group responsible for allergy and immunology has published a commissioning policy that defines access to a particular service for a cohort of patients.

The Pan Mersey Area Prescribing Committee recommends the prescribing of CALCIPOTRIOL 50 micrograms and BETAMETHASONE 500 micrograms per 1 gram cutaneous foam (Enstilar®) for psoriasis vulgaris in adults.

The Pan Mersey Area Prescribing Committee recommends the prescribing of CANAGLIFLOZIN, DAPAGLIFLOZIN and EMPAGLIFLOZIN as combination therapies for the treatment of type 2 diabetes in accordance with NICE guidance.

The Pan Mersey Area Prescribing Committee recommends the prescribing of CANAGLIFLOZIN, DAPAGLIFLOZIN and EMPAGLIFLOZIN as MONOTHERAPIES as options for treating type 2 diabetes in adults in accordance with NICE TA390.

The Pan Mersey Area Prescribing Committee does not currently recommend the prescribing of CANNABIS-BASED products for medicinal use.

The Pan Mersey Area Prescribing Committee does not currently recommend the prescribing of Cariprazine capsules (Reagila®▼), for the treatment of schizophrenia in adult patients.

The Pan Mersey Area Prescribing Committee recommends the prescribing of certolizumab injection (Cimzia®) for rheumatoid arthritis, ankylosing spondylitis, non-radiographic axial spondyloarthritis and psoriatic arthritis, as well as in patients fitting other criteria commissioned by Pan Mersey CCGs, as listed below.

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The Pan Mersey Area Prescribing Committee recommends the prescribing of CERTOLIZUMAB PEGOL (Cimzia®) and SECUKINUMAB (Cosentyx®▼), by specialists only, for psoriatic arthritis in accordance with NICE TA445.

The Pan Mersey Area Prescribing Committee recommends the prescribing of CERTOLIZUMAB PEGOL solution for injection (Cimzia®▼), by specialists only, for moderate to severe plaque psoriasis in accordance with NICE TA574.

The Pan Mersey Area Prescribing Committee does not currently recommend the prescribing of CICLOSPORIN 1 mg/mL eye drops, emulsion (Verkazia®▼) for the treatment of severe vernal keratoconjunctivitis.`

The Pan Mersey Area Prescribing Committee recommends the prescribing of COLESEVELAM HYDROCHLORIDE (Cholestagel®), following specialist initiation, for adult patients with bile acid malabsorption-associated diarrhoea who do not tolerate, or fail to respond to, 1st line treatments.

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The Pan Mersey Area Prescribing Committee recommends the prescribing of COLLAGENASE CLOSTRIDIUM HISTOLYTICUM injection (Xiapex®), by hand surgeons only, for the treatment of Dupuytren’s contracture with a palpable cord in adults in accordance with NICE TA459.

The Pan Mersey Area Prescribing Committee does not recommend the prescribing of COLLAGENASE CLOSTRIDIUM HISTOLYTICUM injection (Xiapex®) for Peyronie's disease.

The Pan Mersey Area Prescribing Committee does not recommend the routine prescribing of ORAL COMBINATION PRODUCTS that are available as the separate constituents.

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NHS England specialised commissining resources: the clinical reference group responsible for allergy and immunology has published a commissioning policy that defines access to a particular service for a cohort of patients.

The Pan Mersey Area Prescribing Committee does not recommend the prescribing of CO-PROXAMOL tablets.

The Pan Mersey Area Prescribing Committee does not currently recommend the prescribing of DAPAGLIFLOZIN tablets (Forxiga®) in combination with insulin for the treatment of Type 1 Diabetes Mellitus.

The Pan Mersey Area Prescribing Committee recommends the prescribing of DAPOXETINE tablets (Priligy®) for the treatment of premature ejaculation when recommended by a psychosexual service or a specialist clinician with experience of treating psychosexual disorders. Treatment is restricted to three doses per month.

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The Pan Mersey Area Prescribing Committee recommends the prescribing of DEGARELIX SC injection (Firmagon®) following specialist initiation for treating advanced hormone-dependent prostate cancer in people with spinal metastases in accordance with NICE TA404.

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The Pan Mersey Area Prescribing Committee does not currently recommend the prescribing of DENOSUMAB solution for injection (Prolia®) for the treatment of bone loss associated with long-term systemic glucocorticoid therapy.

The Pan Mersey Area Prescribing Committee does not currently recommend the prescribing of DEOXYCHOLIC ACID injection (Belkyra®▼) for submental (under chin) fat.

The Pan Mersey Area Prescribing Committee recommends the prescribing of DEXAMETHASONE intravitreal implant (Ozurdex®), by ophthalmologists only, for treating non-infectious uveitis in accordance with NICE TA460.

The Pan Mersey Area Prescribing Committee recommends the prescribing of DIMETHYL FUMARATE Tablets (Skilarence ®▼), by specialists only, for severe plaque psoriasis in accordance with NICE TA475.

DOACs are recommended as an option for treating and/or preventing recurrent DVT and/or PE where an oral anticoagulant is indicated following specialist initiation.

GREEN for NHS Wirral CCG

DOACs are recommended as treatment options for the prevention of stroke and systemic emboli in non-valvular atrial fibrillation where an oral anticoagulant is indicated.

The Pan Mersey Area Prescribing Committee does not recommend the prescribing of DOSULEPIN capsules and tablets.

The Pan Mersey Area Prescribing Committee does not recommend the prescribing of DOXAZOSIN modified release (M/R) tablets (All Brands).

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The Pan Mersey Area Prescribing Committee does not currently recommend the prescribing of DOXYLAMINE/PYRIDOXINE tablets (Xonvea®▼) for the treatment of nausea and vomiting in pregnancy.

The Pan Mersey Area Prescribing Committee recommends the prescribing of Dupilumab solution for injection (Dupixent®▼), by specialists only, for the treatment of moderate to severe atopic dermatitis in adults in accordance with NICE TA534.

The Pan Mersey Area Prescribing Committee does not recommend the prescribing of E - Cigarettes, except as part of Local Authority commissioned Stop Smoking Service arrangements.

The Pan Mersey Area Prescribing Committee does not recommend the prescribing of EFLORNITHINE 11.5% cream for facial hirsutism.

The Pan Mersey Area Prescribing Committee recommends the prescribing of Elasticated Viscose Stockinette (‘Viscose’) Garments following specialist recommendation for skin conditions.

The Pan Mersey Area Prescribing Committee does not currently recommend the prescribing of electromagnetic pulse therapy (Actipatch®) for pain relief.

The Pan Mersey Area Prescribing Committee does not recommend the prescribing of ELTROMBOPAG tablets (Revolade®) for Acquired Severe Aplastic Anaemia (SAA).

The Pan Mersey Area Prescribing Committee recommends the prescribing of ELTROMBOPAG OLAMINE tablets (Revolade®) by Haematologists only, for chronic ITP in accordance with NICE TA293.

The Pan Mersey Area Prescribing Committee recommends the prescribing of ELUXADOLINE Tablets (Truberzi®▼) following specialist initiation for irritable bowel syndrome with diarrhoea in adults in accordance with NICE TA471.

Red NHS West Lancashire CCG

The Pan Mersey Area Prescribing Committee does not currently recommend the prescribing of ERENUMAB pre-filled syringes (Aimovig®▼) for prophylaxis of migraine.

The Pan Mersey Area Prescribing Committee recommends the prescribing of ERTUGLIFLOZIN film-coated tablets (Steglatro®▼) as monotherapy or with metformin for treating type 2 diabetes in accordance with NICE TA572.

The Pan Mersey Area Prescribing Committee recommends the prescribing of ERTUGLIFLOZIN film-coated tablets (Steglatro®▼) in a triple therapy regimen for treating type 2 diabetes in accordance with NICE TA583.

The Pan Mersey Area Prescribing Committee recommends the prescribing of etanercept injection for rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, non-radiographic axial spondyloarthritis, polyarticular juvenile idiopathic arthritis and adult-onset Still’s disease, as well as in patients fitting other criteria commissioned by Pan Mersey CCGs, as listed.

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The Pan Mersey Area Prescribing Committee does not recommend the prescribing of EVOLOCUMAB injection (Repatha SureClick®▼) for reduction of cardiovascular risk in adults with established atherosclerotic cardiovascular disease.

The Pan Mersey Area Prescribing Committee does not currently recommend the prescribing of EZETIMIBE (Ezetrol®) for the prevention of cardiovascular events in patients with cholesterol levels within target range.

The Pan Mersey Area Prescribing Committee recommends the prescribing of FERRIC MALTOL (Feraccru^®) following specialist initiation for the treatment of iron deficiency anaemia in adult patients with inflammatory bowel disease.

The Pan Mersey Area Prescribing Committee does not currently recommend the prescribing of FERRIC MALTOL hard capsules (Feraccru®) for the treatment of iron deficiency in adults.

The Pan Mersey Area Prescribing Committee recommends
FINASTERIDE 5mg tablets as the 5-alpha reductase inhibitor of choice for men with lower urinary tract symptoms (LUTS) as detailed.

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The Pan Mersey Area Prescribing Committee recommends the prescribing on the NHS of flash glucose monitor sensors (FreeStyle Libre®) only within the criteria outlined.

These templates should be used by Pan Mersey organisations for incorporation into their specialist diabetes service clinic documentation that informs primary care prescriber that Freestyle Libre prescribing has been initiated in an individual patient according to the agreed criteria in the Pan Mersey statement, when confirming to primary care prescriber whether the patient has met continuation criteria after review, and into patient information/ contract documentation given to each patient on commencement of prescribing.

 Initiation Criteria

 Continuation Criteria

 Primary Care Information

 Patient Contract

The Pan Mersey Area Prescribing Committee recommends the use of FLUENZ®▼ nasal spray in accordance with the Annual flu programme from Public Health England.

The Pan Mersey Area Prescribing Committee does not currently recommend the prescribing of FLUOCINOLONE intravitreal implant (Iluvien®)
for non-infectious uveitis.

The Pan Mersey Area Prescribing Committee does not currently recommend the prescribing of FREMANEZUMAB pre-filled syringe for injection (Ajovy®▼) for prophylaxis of migraine.

The Pan Mersey Area Prescribing Committee does not recommend the prescribing of FULVESTRANT solution for injection (Faslodex^®) for untreated locally advanced or metastatic oestrogen-receptor positive breast cancer, in accordance with NICE TA503.

The Pan Mersey Area Prescribing Committee does not currently recommend the prescribing of GALCANEZUMAB solution for injection (Emgality®▼) for prophylaxis of migraine.

The Pan Mersey Area Prescribing Committee does not currently recommend the prescribing of INSULIN GLARGINE + LIXISENATIDE solution for injection (Suliqua®▼) for the treatment of type 2 diabetes mellitus.

The Pan Mersey Area Prescribing Committee recommends the prescribing of DPP-4 inhibitors in accordance with NG28-Type 2 diabetes in adults: management.

The Pan Mersey Area Prescribing Committee recommends the prescribing of GLP-1 mimetics in combination with insulin for type 2 diabetes, only with specialist care advice and ongoing support from a consultant-led MDT.

The Pan Mersey Area Prescribing Committee does not recommend the prescribing of GLUCOSAMINE products with or without CHONDROITIN.

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The Pan Mersey Area Prescribing Committee recommends the prescribing of golimumab injection (Simponi®), by specialists only, for non-radiographic axial spondyloarthritis in accordance with NICE TA497.

The Pan Mersey Area Prescribing Committee recommends the prescribing of golimumab injection (Simponi®) for rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, non-radiographic axial spondyloarthritis, and in patients fitting other criteria commissioned by Pan Mersey CCGs, as listed.

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The Pan Mersey Area Prescribing Committee recommends the prescribing of GUSELKUMAB solution for injection (Tremfya®▼) in specialist settings only, for treating plaque psoriasis in accordance with NICE TA521.

The Pan Mersey Area Prescribing Committee does not recommend the routine use of HYALURONAN intra-articular injections in the treatment of osteoarthritis.

The Pan Mersey Area Prescribing Committee recommends the prescribing of IBUPROFEN (low dose) and NAPROXEN (low dose) as the non-steroidal anti-inflammatory drugs (NSAIDs) of choice, if an NSAID is appropriate.

NHS England specialised commissining resources: the clinical reference group responsible for allergy and immunology has published a commissioning policy that defines access to a particular service for a cohort of patients.

The Pan Mersey Area Prescribing Committee recommends the prescribing of infliximab infusion for rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, non-radiographic axial spondyloarthritis and adult-onset Still’s disease, as well as in patients fitting other criteria commissioned by Pan Mersey CCGs, as listed.

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The Pan Mersey Area Prescribing Committee recommends the prescribing of insulin degludec 100units/mL and 200units/mL solution for injection (Tresiba^®▼) following specialist initiation for type 1 diabetes and type 2 diabetes for specific patient groups taking into account NICE guidance and key safety implications.

The Pan Mersey Area Prescribing Committee recommends the prescribing of ITRACONAZOLE, for allergic bronchopulmonary aspergillosis.

Ivabradine has been approved by NICE (TA 267)1 as an option for treating chronic heart failure following specialist initiation in patients with chronic, stable heart failure (NYHA class II-IV), left ventricular systolic dysfunction (LVEF 35% or less) and who are in sinus rhythm with a heart rate of 75 beats per minute or more.

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NHS England specialised commissining resources: the clinical reference group responsible for cystic fibrosis has published a commissioning policy that defines access to a particular service for a cohort of patients.

The Pan Mersey Area Prescribing Committee recommends the prescribing of IVERMECTIN 10mg/g cream (Soolantra®) for second line topical treatment of moderate to severe papulopustular rosacea in adult patients.

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The Pan Mersey Area Prescribing Committee recommends the prescribing of IXEKIZUMAB solution for injection (Taltz®▼) in specialist settings only, for treating plaque psoriasis in accordance with NICE TA442.

The Pan Mersey Area Prescribing Committee recommends the prescribing of IXEKIZUMAB subcutaneous injection (Taltz®▼), by specialists only, for active psoriatic arthritis in adults after inadequate response to DMARDs in accordance with NICE TA537.

The Pan-Mersey Area Prescribing Committee recommends that Lactase Enzyme Drops 50,000 units/g (Colief®) are not prescribed on the NHS. Patients are advised to purchase Colief® if they wish.

The Pan Mersey Area Prescribing Committee does not recommend the prescribing of LESINURAD 200mg TABLETS (Zurampic^®▼) for treating chronic hyperuricaemia in people with gout in accordance with NICE TA506 [7^th February 2018]

The Pan Mersey Area Prescribing Committee does not recommend the prescribing of lidocaine plaster 5% (Ralvo®, Versatis®), except in limited circumstances outlined.

The Pan Mersey Area Prescribing Committee does not recommend the prescribing of LIRAGLUTIDE (Saxenda®▼) 6mg/ml solution for subcutaneous injection for weight management.

The Pan Mersey Area Prescribing Committee does not currently recommend the prescribing of LOXAPINE inhalation powder (Adasuve®▼) for mild-to-moderate agitation in adult patients with schizophrenia or bipolar disorder.

The Pan Mersey Area Prescribing Committee recommends the prescribing of MELATONIN 2mg modified release tablets (Circadin®) 'off-label' for adults aged 18 years and over with a learning disability OR who have been transferred from paediatric services, following specialist initiation in childhood for the treatment of persistent chronic sleep disorders.

AMBER INITIATED in NHS Halton CCG

The Pan Mersey Area Prescribing Committee does not currently recommend the prescribing of MELATONIN prolonged-release tablets (Slenyto®) for the treatment of insomnia in children with neurodevelopmental conditions.

The Pan Mersey Area Prescribing Committee does not currently recommend the prescribing of MELATONIN tablets 3 mg and oral solution 1 mg/ml for jet-lag.

The Pan Mersey Area Prescribing Committee recommends the use of meningococcal group B vaccine (Bexsero)®▼ in accordance with the meningococcal B (MenB) vaccination programme from Public Health England.

The Pan Mersey Area Prescribing Committee recommends the prescribing of Mesalazine oral formulations by brand name following specialist initiation for inflammatory bowel disease. Octasa^® brand is considered to be equivalent to Asacol^® brand and currently represents a more cost effective choice.

The Pan Mersey Area Prescribing Committee recommends the prescribing of methadone tablets (Physeptone®) in adults following initiation by a consultant in pain medicine in a tertiary centre.

 Red  NHS Halton CCG

 Prescribing support information

 GP letter

The Pan Mersey Area Prescribing Committee recommends the prescribing of MIRABEGRON prolonged-release tablets (Betmiga®▼) for overactive bladder syndrome (OAB) in accordance with NICE TA290.

The Pan Mersey Area Prescribing Committee recommends the prescribing of NALMEFENE (Selincro®▼) within its marketing authorisation, as an option for reducing alcohol consumption in adults with alcohol dependence, in line with NICE TA325.

Refer to Pan Mersey formulary for RAG status for each individual CCG.

The Pan Mersey Area Prescribing Committee recommends the prescribing of NALOXEGOL Tablets (Moventig®▼) as an option for treating opioid induced constipation in adults in accordance with NICE TA345 (22nd July 2015).

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The Pan Mersey Area Prescribing Committee does not recommend the prescribing of NALTREXONE-BUPROPION 8 mg/90 mg prolonged-release tablets (Mysimba®▼) for managing overweight and obesity in accordance with NICE TA494.

The Pan Mersey Area Prescribing Committee does not recommend the prescribing of CONJUGATED OESTROGENS and BAZEDOXIFENE 0.45mg/20mg modified release tablets (Duavive®) for the treatment of oestrogen deficiency in postmenopausal women with a uterus.

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The Pan Mersey Area Prescribing Committee recommends the prescribing of OPICAPONE (Ongentys®▼) following specialist recommendation as add-on therapy in adult patients with Parkinson’s disease.

BLACK NHS West Lancashire CCG

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The Pan Mersey Area Prescribing Committee does not currently recommend the prescribing of OSPEMIFENE film-coated tablets (Senshio®▼) for the treatment of vulvar and vaginal atrophy in post-menopausal women.

The Pan Mersey Area Prescribing Committee does not recommend the prescribing of OXYCODONE with NALOXONE modified release tablets (Targinact®) for adults with chronic pain

The Pan Mersey Area Prescribing Committee does not currently recommend the prescribing of OXYCODONE with NALOXONE modified release tablets (Targinact®) for restless legs syndrome.

The Pan Mersey Area Prescribing Committee does not currently recommend the prescribing of PATIROMER powder for oral suspension (Veltassa®▼) for the treatment of hyperkalaemia in adults.

The Pan Mersey Area Prescribing Committee recommends generic sildenafil as the first choice phosphodiesterase type-5 inhibitor for the treatment of erectile dysfunction.

The Pan Mersey Area Prescribing Committee recommends the prescribing of PITOLISANT tablets (Wakix®▼), by specialists working in a regional and national tertiary commissioned sleep service only, for the treatment of Narcolepsy with or without cataplexy in those who are contraindicated or have not tolerated other standard treatments.

The Pan Mersey Area Prescribing Committee does not recommend the prescribing of voriconazole or posaconazole, by GPs or specialists, for Allergic Bronchopulmonary Aspergillosis.

The Pan-Mersey Area Prescribing Committee does not recommend the prescribing of Potassium Hydroxide 5% (MolluDab® or Molutrex®) on the NHS. Patients are advised to purchase MolluDab® or Molutrex® if they wish.

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The Pan Mersey Area Prescribing Committee does not currently recommend the prescribing of PRASTERONE pessaries (Intrarosa®▼) for the treatment of vulvar and vaginal atrophy in postmenopausal women having moderate to severe symptoms.

The Pan Mersey Area Prescribing Committee does not recommend the prescribing of PREDNISOLONE ENTERIC COATED 2.5 mg and 5 mg tablets.

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The Pan Mersey Area Prescribing Committee recommends that IMMEDIATE RELEASE QUETIAPINE is the preferred formulation of quetiapine for prescribing across the Pan Mersey Area.

AMBER RETAINED NHS Southport and Formby, NHS South Sefton CCG

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The Pan Mersey Area Prescribing Committee recommends the prescribing of RANIBIZUMAB intravitreal injection (Lucentis®), by ophthalmologists only, for the treatment of visual impairment secondary to choroidal neovascularisation (CNV) in conditions not covered by NICE technology appraisals.

The Pan Mersey Area Prescribing Committee does not recommend the prescribing of Rasburicase powder and solvent for concentrate for solution for infusion (Fasturtec®▼) for the “off label” treatment of severe, refractory, tophaceous gout resistant to xanthine oxidase inhibitors (allopurinol & febuxostat) and uricosuric agents (benzbromarone) or for whom these drugs are contraindicated.

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The Pan Mersey Area Prescribing Committee recommends RIFAXIMIN 550mg tablets (Targaxan®), following specialist initiation, as an option for reducing the recurrence of overt hepatic encephalopathy in people aged 18 years or older in accordance with NICE TA 337.

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The Pan Mersey Area Prescribing Committee does not currently recommend the prescribing of RISANKIZUMAB solution for injection (Skyrizi®▼) for moderate to severe plaque psoriasis.

NHS England specialised commissining resources: the clinical reference group responsible for specialised rheumatology has published a commissioning policy that defines access to a particular service for a cohort of patients.

NHS England specialised commissining resources: the clinical reference group responsible for specialised rheumatology has published a commissioning policy that defines access to a particular service for a cohort of patients.

RITUXIMAB (Truxima®▼, Rixathon®▼)The Pan Mersey Area Prescribing Committee recommends the prescribing of rituximab by specialists only, for immune (idiopathic) thrombocytopenic purpura before romiplostin and eltrombopag.

The Pan Mersey Area Prescribing Committee recommends the prescribing of rituximab infusion for rheumatoid arthritis in accordance with NICE TA195 and in accordance with the Mersey Rheumatoid Arthritis Biologics Pathway.  Treatment should be initiated and supervised by a rheumatologist.

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The Pan Mersey Area Prescribing Committee recommends the prescribing of Rivaroxaban 2.5mg tablets (Xarelto®▼) following specialist initiation for preventing adverse outcomes after acute management of acute coronary syndrome in accordance with NICE TA335.

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The Pan Mersey Area Prescribing Committee does not recommend the prescribing of RIVAROXABAN 2.5mg tablets (Xarelto®▼) for the prevention of atherothrombotic events in adult patients with coronary artery disease (CAD) or symptomatic peripheral artery disease (PAD) at high risk of ischaemic events – in combination with aspirin.

The Pan Mersey Area Prescribing Committee recommends the prescribing of ROFLUMILAST tablets (Daxas®▼) following specialist recommendation as an add-on to bronchodilator therapy, for treating severe chronic obstructive pulmonary disease in adults with chronic bronchitis (in accordance with NICE TA461).

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The Pan Mersey Area Prescribing Committee recommends the prescribing of ROMIPLOSTIM SC injection (Nplate®), by Haematologists only, for chronic immune (idiopathic) thrombocytopenic purpura (ITP) in accordance with NICE TA221.

The Pan Mersey Area Prescribing Committee recommends the prescribing of ROSUVASTATIN TABLETS tablets ONLY where no other statin is suitable.

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The Pan Mersey Area Prescribing Committee does not recommend the prescribing of RUBEFACIENTS (excluding topical NSAIDS and capsaicin).

The Pan Mersey Area Prescribing Committee recommends the prescribing of SACUBITRIL/VALSARTAN film-coated tablets (Entresto®▼) for treating symptomatic chronic heart failure following specialist initiation and in accordance with NICE TA388.

North West Strategic Clinical Network and Senate

 Position statement

 Treatment algorithm

 Patient information leaflet

 GP communication letter

The Pan Mersey Area Prescribing Committee recommends the prescribing of SAFINAMIDE (Xadago®▼) following specialist recommendation in the management of mid to late stage Parkinson’s disease.

BLACK NHS West Lancashire CCG

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The Pan Mersey Area Prescribing Committee does not currently recommend the prescribing of SARILUMAB solution for injection (Kevzara®▼) for the treatment of Rheumatoid Arthritis.

The Pan Mersey Area Prescribing Committee recommends the prescribing of SECUKINUMAB injection (Cosentyx®▼) for ankylosing spondylitis in accordance with NICE TA407.

The Pan Mersey Area Prescribing Committee recommends SECUKINUMAB solution for subcutaneous injection (Cosentyx®▼) for adults with plaque psoriasis only in accordance with NICE TA350.

The Pan Mersey Area Prescribing Committee does not recommend the prescribing of SILK garments (Dermasilk®, Dreamskin®, Skinnies Silk®) for eczema or atopic dermatitis.

The Pan Mersey Area Prescribing Committee recommends SODIUM OXYBATE oral solution (Xyrem®) as a treatment option for Narcolepsy with cataplexy in adult patients only when recommended by a consultant in a specialist commissioned sleep service.

The Pan Mersey Area Prescribing Committee does not currently recommend the prescribing of SODIUM ZIRCONIUM CYCLOSILICATE powder for oral suspension (Lokelma®▼) for treating hyperkalaemia.

NHS England specialised commissining resources: the clinical reference group responsible for infectious disease has published a commissioning policy that defines access to a particular service for a cohort of patients.

The Pan Mersey Area Prescribing Committee does not recommend the routine prescribing of ORAL COMBINATION PRODUCTS that are available as the separate constituents.

NHS England specialised commissining resources: the clinical reference group responsible for HIV has published a commissioning policy that defines access to a particular service for a cohort of patients.

The Pan Mersey Area Prescribing Committee does not recommend the prescribing of TAPENTADOL immediate release preparations (Palexia®) for pain relief.

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The Pan Mersey Area Prescribing Committee recommends TAPENTADOL prolonged release tablets (Palexia® SR) for severe chronic pain in adults only when initiated by chronic pain specialists or palliative care specialists.

The Pan Mersey Area Prescribing Committee does not currently recommend the prescribing of TELOTRISTAT film-coated tablets (Xermelo®▼) for the treatment of carcinoid syndrome diarrhoea.

The Pan Mersey Area Prescribing Committee does not recommend the prescribing of DESICCATED THYROID EXTRACTS, e.g. Armour Thyroid, in the management of hypothyroidism.

The Pan Mersey Area Prescribing Committee recommends the prescribing of TICAGRELOR tablets (Brilique®), following specialist initiation, for the management of acute coronary syndromes in adults in accordance with NICE TA236 and for preventing atherothrombotic events after myocardial infarction in accordance with NICE TA420.

 GP support resource

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The Pan Mersey Area Prescribing Committee recommends the prescribing of TILDRAKIZUMAB solution for injection (Ilumetri®▼), by specialists only, for moderate to severe plaque psoriasis in accordance with NICE TA575.

The Pan Mersey Area Prescribing Committee does not currently recommend the prescribing of TIOTROPIUM inhalation (Spiriva Respimat®▼) for asthma in children and young people < 18 years of age.

The Pan Mersey Area Prescribing Committee recommends the prescribing of TIOTROPIUM inhaler (Spiriva® Respimat®) as an option for patients with poorly controlled asthma who are already on a maintenance dose of inhaled corticosteroid plus a long-acting beta2 agonist inhaler.

The Pan Mersey Area Prescribing Committee recommends the prescribing of tocilizumab infusion and subcutaneous injection  (RoActemra®) for the treatment of rheumatoid arthritis and adult-onset Still’s disease, and the infusion for juvenile idiopathic arthritis, as described.

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The Pan Mersey Area Prescribing Committee recommends the prescribing of TOFACITINIB film-coated tablets (Xeljanz®▼), by specialists only, for moderately to severely active Ulcerative Colitis in accordance with NICE TA547.

The Pan Mersey Area Prescribing Committee recommends the prescribing of TOFACITINIB tablets (Xeljanz®▼), by specialists only, for treating psoriatic arthritis after inadequate response to DMARDs in accordance with NICE TA543.

The Pan Mersey Area Prescribing Committee recommends the prescribing of TOFACITINIB film-coated tablets (Xeljanz®▼), by specialists only, for the treatment of moderate to severe Rheumatoid Arthritis in accordance with NICE TA480.

The Pan Mersey Area Prescribing Committee recommends the prescribing of TOLVAPTAN tablets (Samsca®), by specialists only, for the treatment of hyponatraemia secondary to SIADH due to any cause.

The Pan Mersey Area Prescribing Committee does not recommend the routine prescribing of ORAL COMBINATION PRODUCTS that are available as the separate constituents.

The Pan Mersey Area Prescribing Committee does not recommend the prescribing of TRIMIPRAMINE capsules and tablets.

The Pan Mersey Area Prescribing Committee recommends that TRIPTORELIN (Decapeptyl® SR 3mg, 11.25mg and 22.5mg) INTRAMUSCULAR INJECTION is first choice gonadorelin analogue for prostate cancer following specialist urologist / oncologist initiation under applicable local arrangement.

The Pan Mersey Area Prescribing Committee recommends the prescribing of ULIPRISTAL ACETATE tablets (Esmya®), by physicians experienced in the diagnosis and treatment of uterine fibroids, in line with the prescribing criteria defined.

The Pan Mersey Area Prescribing Committee recommends the prescribing of USTEKINUMAB injection (Stelara®), by gastroenterologists only, for moderately to severely active Crohn’s disease after previous treatment and in accordance with TA456.