FOI 1703 – Liquid Antidepressants
FOI Reference Number:
1703
Request
Are there any internal documents or guidelines that restrict the prescribing of liquid antidepressants?
Do you have any guidance for prescribers regarding tapering of antidepressants? If so, could you provide a copy of the relevant documents.
Do you use any prescribing decision support software, or other tools such as PMR system searches, which identify prescribing of liquid antidepressants and recommend a switch to other formulations?
Do you engage in any proactive correspondence with practices to encourage other formulations over liquid formulations?
I have also found no mention of the antidepressant Escitalopram, Paroxetine and Fluvoxamine on the formulary. Am I right to assume this will be a non-formulary item even though it is not listed on the non-formulary list?
Response
Date: 10 November 2022
FREEDOM OF INFORMATION – DECISION NOTICE
Dear Sir / Madam,
FOI Reference Number: 1703
1. Are there any internal documents or guidelines that restrict the prescribing of liquid antidepressants?
We have a specials and expensive liquid guideline which can be found on the Derbyshire Medicines Management website at the link below:
This guideline contains a list of commonly prescribed medicines and alternative methods of administration for patients with swallowing difficulties, feeding tubes or for patients prescribed unlicensed ‘specials’ medication.
In addition to specials, references to liquids are also made in other parts of the Medicines Management Website:
http://www.derbyshiremedicinesmanagement.nhs.uk/medicines-management
2. Do you have any guidance for prescribers regarding tapering of antidepressants? If so, could you provide a copy of the relevant documents.
Please see our webpage at the link below, which includes a section about stopping antidepressant medication:
https://www.derbyshiremedicinesmanagement.nhs.uk%2Fassets%2FClinical_Guidelines%2FFormulary_by_BNF_chapter_prescribing_guidelines%2FBNF_chapter_4%2FAntidepressant_choice_in_depression.pdf&data=05%7C01%7Cddicb.foi%40nhs.net%7Ccf73a50a58a34dc775d208dac31ad9ef%7C37c354b285b047f5b22207b48d774ee3%7C0%7C0%7C638036817337312649%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C3000%7C%7C%7C&sdata=MiZ0TcWR17GaJXK9zwXEhayEA6HMcUPu0xQABpyc8hA%3D&reserved=0
3. Do you use any prescribing decision support software, or other tools such as PMR system searches, which identify prescribing of liquid antidepressants and recommend a switch to other formulations?
The ICB uses OptimisRx as a point of prescribing tool to prompt appropriate prescribing.
4. Do you engage in any proactive correspondence with practices to encourage other formulations over liquid formulations?
The practice-based team will review prescribing in line with priorities and housekeeping activities, including the appropriate use of liquid medicines.
5. I have also found no mention of the antidepressant Escitalopram, Paroxetine and Fluvoxamine on the formulary. Am I right to assume this will be a non-formulary item even though it is not listed on the non-formulary list?
Please see our Medicines Management website at the location below:
http://www.derbyshiremedicinesmanagement.nhs.uk/medicines-management
Escitalopram: GREY;
1. For patients who have already been prescribed escitalopram and who are responding to the treatment.
2. For patients who have had a good response to escitalopram for a previous episode after formulary choices or now require an antidepressant, following recommendation from a tertiary centre.
Paroxetine: GREEN: Alternative options if 1st line options are not suitable for the treatment of chronic primary pain. See non-malignant chronic pain in primary care guidance.
Fluvoxamine: non-formulary item.
I hope that this answers your queries with the information we currently hold, but if I can be of any further assistance please do not hesitate to contact me.
If you are dissatisfied with the handling of your request, you have the right to ask for an internal review. Internal review requests should be submitted within two months of the date of receipt of the response to your original letter and should be addressed to:
NHS Derby and Derbyshire ICB
FOI Team
Scarsdale
Nightingale Close
Newbold
Chesterfield
S41 7PF
Or:
If you are not content with the outcome of our review, you may apply directly to the Information Commissioner for a decision. Generally, the ICO cannot make a decision unless you have exhausted the complaints procedure provided by the Derby and Derbyshire Integrated Care Board (ICB).
The Information Commissioner can be contacted at: Information Commissioners Office, Wycliffe House, Water Lane, Wilmslow, Cheshire SK9 5AF, telephone 0303 123 1113, email casework@ico.org.uk.
Yours faithfully,
Kathryn Jacklin
FOI Officer
Derby and Derbyshire ICB
All information we have provided is subject to the provisions of the Re-use of Public Sector Information Regulations 2015. Accordingly, if the information has been made available for re-use under the Open Government Licence (OGL) a request to re-use is not required, but the licence conditions must be met. You must not re-use any previously unreleased information without having the consent from the ICB. Should you wish to re-use previously unreleased information then you must make your request in writing (email will suffice) to the FOI Lead via ddicb.foi@nhs.net. All requests for re-use will be responded to within 20 working days of receipt.
