DROP Drugs

Here you'll find information on the Drugs to Review for Optimised Prescribing DROP-List.

Below is a list of the now 30 Drugs to Review for Optimised Prescribing items - along with links to where you can find the resources:

The DROP-List Bulletin v4.0 - July 2015

The 2015/16 version of the DROP list and supporting documents can be found here. A slideset is also available for use locally. This bulletin includes Drop List searches in Systmone, EMIS Web and Vision.

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DROP-List Searches

These searches incorporate all the items in the DROP list with instructions on using the searches.

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The DROP List and self care

Some of the items on the DROP List are suitable for self care. We have developed a separate self care webkit looking specifically at items suitable for self care and treating minor ailments. The self care items will eventually be removed from the DROP List.

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DROP-List visual scorecard

The DROP list scorecard has been combined with our other scorecards on visual analytics.

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Analgesia

This bulletin covers prescribing for analgesia items (excluding POM medicines), where these products are being prescribed for minor ailments such as acute mild pain, fever etc.

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Rubefacients

This bulletin reviews the place in therapy of the rubefacients which also have a nice do not do attached to them. An audit and patient letter are available as supporting tools.

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Travel vaccines

This bulletin and supporting resources will support CCGs wishing to review their prescribing policies on travel vaccines. It identifies vaccines that should not be prescribed on the NHS for travel.

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Antihistamines

Hayfever can be managed as part of self care and several antihistamines and nasal sprays are available to purchase over the counter. The self care resources on hayfever are patient information resources.

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Liothyronine

This bulletin looks at the place in therapy of liothyronine and combination products containing levothyroxine and liothyronine. In light of a limited evidence base supporting its use and the increased cost of these products, a review of therapy is recommended.

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Lidocaine plasters

This bulletin looks at lidocaine plasters and provides the rationale for not initiating lidocaine plasters in new patients, and for current patients to be considered for discontinuation of their prescription for lidocaine plasters.

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Nasal sprays OTC

Nasal sprays for the symptomatic relief of hayfever and congestion can be purchased by the as part of self care.

Doxazosin MR

This bulletin supports the review of doxazosin MR prescribing and supports a switch to the immediate release formulation in line with the NHS England "Items which should not routinely be prescribed in primary care" guidance.

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Fentanyl

Immediate release fentanyl has a NICE do not do as a first line treatment for breakthrough pain. This bulletin will focus on fentanyl immediate-release formulations.

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Male sexual dysfunction

PrescQIPP have produced two sets of resources in this area. One looking at male sexual dysfunction in general and treatment options available, and the other focusing specifically on once daily tadalafil.

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Tadalafil once daily

PrescQIPP have produced two sets of resources in this area. One looking at male sexual dysfunction in general and treatment options available, and the other focusing specifically on once daily tadalafil.

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Omega-3 fatty acids

These resources will support the review of Omega 3 fatty acid treatment in line with the NHS England guidance on items which should not routinely be prescribed in primary care.

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Haemorrhoid treatments

There are several preparations available over the counter to treat haemorrhoids. The self care resources provide patient information.

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Dental products on FP10

This bulletin has been developed to encourage dentists to prescribe and not refer to GPs for a prescription (which can take up valuable appointment time).

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Co-proxamol

This bulletin discusses the use of co-proxamol and supports reviewing and discontinuing prescribing in patients still taking this unlicensed medicine.

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Tramacet®

This bulletin focuses on Tramacet® (paracetamol 325mg/tramadol 37.5mg) and provides the rationale for new patients to be initiated on paracetamol or paracetamol with codeine.

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Oxycodone/Naloxone (Targinact ®)

This bulletin and resources provide further information on the evidence base for for using oxycodone/naloxone prolonged release tablets, the rationale to stop treatment and also suggests alternative treatment options.

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Antifungal nail pain

This bulletin focuses on topical antifungal nail treatment, i.e. amorolfine 5% nail lacquer (Loceryl®, Curanail®, Omicur®), tioconazole 28% cutaneous solution (Trosyl®) and salicylic acid, tannic acid and boric acid paint (Phytex®).

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Vitamins and minerals

This bulletin reviews the place in therapy for the multivitamin and mineral supplements and also the vitamin B complex products. They are not recommended for prescribing as general pick me ups and should be reviewed and discontinued where appropriate.

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Dosulepin

These resources review the place in therapy of dosulepin which is listed as a NICE 'do not do'. The drug has a very small margin of safety between the maximum therapeutic dose and potentially fatal doses.

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Eflornithine

This bulletin focuses on eflornithine cream which is a low priority treatment considered as a cosmetic treatment for hirsutism in women. It provides the rationale for self-funded hair removal methods as the primary treatment option for women with hirsutism.

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Perindopril arginine

This bulletin, focuses on different perindopril formulations (salts) which are not directly equivalent. It provides the rationale for new patients to be commenced on generic perindopril erbumine, also known as tert-butylamine.

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Antioxidant vitamins for AMD

The evidence to support the use of antioxidant vitamins to reduce the progression of age related macular degeneration is limited. This bulletin reviews the evidence available and supports reviewing and stopping treatment with antioxidant vitamins.

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Cough and cold remedies

Coughs and colds are self limiting illnesses that can be managed with self care. These resources provide patient information.

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Amiodarone

Review patients on amiodarone to ensure treatment is being appropriately monitored and that it is discontinued in indications where use is short-term only.

Minocycline

This bulletin focuses on minocycline for the treatment of acne vulgaris and provides the rationale for new patients to be commenced on an alternative antibiotic and for current patients to be considered for stopping therapy or a switch to an alternative antibiotic.

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Aliskiren (Rasilez®)

NICE state there is insufficient evidence of the effectiveness of aliskiren to determine its suitability for use in resistant hypertension.

Complementary therapies, herbal supplements and homeopathy

There is a limited evidence base and a lack of robust randomised controlled trials directly comparing complimentary therapies with standard treatments. Some complimentary therapies are also associated with severe adverse effects, may significantly interact with other medicines and can delay accurate diagnosis of underlying pathology.

Glucosamine

There is limited evidence to support the use of glucosamine and chondroitin products and they are listed as a NICE do not do. This bulletin reviews the use of glucosamine (with or without chondroitin) preparations.

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Infantile colic

This bulletin covers the treatment of colic and the place in therapy for lactase, simeticone and gripe water products. Supporting materials include patient information leaflet and an audit.

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Probiotics

This bulletin provides is an update on probiotics. It focuses on reviewing prescribing of probiotics (including VSL#3® and Vivomixx®) and discontinuing therapy in light of the fact probiotic products are no longer approved under the ACBS scheme. An audit and patient letter are available for organisations considering reviewing this therapy area.

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Cannabis sativa

Cost effectiveness evidence does not support use of cannabis sativa.

Sunscreens

The sunscreens resource has been added to the DROP list as an item where review of prescribing is recommended to ensure all prescribing is in line with ACBS criteria.

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