COVID-19 virus and medicines
We have had a large number of queries about Covid-19 and medicines use. There are also a large number of resources published nationally to support and advise on issues around prescribing. This page aims to bring all these resources together. Where available we will link to national guidance and websites so that it reflects the most up to date information, if and when things change.
Practices are reminded to follow guidance which has been sent out regarding issue of prescription quantity and duration. Stockpiling will exacerbate pressures on prescribed medicine stocks and may create shortages. The current advice is for patients to continue ordering prescriptions as usual (via phone or on-line), maintaining current prescription length.
NHS England coronavirus advice page is available here
- NHSE are hosting speciality guides - available here
NICE rapid guidelines and evidence reviews are hosted here
PressPortal - See Covid-19 information on the PressPortal here
RCGP Guidance on workload prioritisation during COVID-19 can be found here (For further information on the warfarin to DOACs switch see under 'Cardiovascular System' also see ‘Nutrition & Blood ‘section for advice on Vitamin B12 below)
Some general evidence reviews available here, these are not national recommendations but may help in the management of individual patients https://www.cebm.net/oxford-covid-19/
If needed, the following pharmacies have been commissioned to hold stocks of palliative care medicines - Palliative Care Pharmacies
Delivery of medicines to shielded and vulnerable patients - options explained in this flowchart
Please see link for some hints and tips on EPS & RD produced by Sheffield CCG. This provides some suggestions on patients who may be suitable for RD.
How to guides;
Drug/condition specific national/local advice;
*Due to the speed of trying to get advice to local clinicians, these documents have not been through APG, but all are based on local expertise / national advice.
Those annotated with ** have been approved during the COVID-19 pandemic under delegated authority and when the pandemic is over they will be reviewed and potentially stood down.
Acute Kidney Injury (AKI)
- Primary care resources on AKI are on the ‘Think Kidneys’ website. Links to key documents regarding medications:
- Sick day guidance: position statement (Jan 2020)
- Quick guide to problematic drugs and actions to take (Note also see below for sick day rules around diabetes)
- ACEI/ARB use and COVID-19 (includes algorithm of suggested management of patients)
See link for End of Life Care resources to support practices
For all patients who are dying in the community;
- Continue with usual palliative care practice including advanced care planning
- Use the Sheffield palliative care formulary. Due to diamorphine shortage, use morphine following the algorithms on P77-83
- Complete the pink card as usual. Community nurses can now take verbal instructions to amend (SOP in place)
- Saf-T-Intima Lines can now be used for PRN sub cut meds
For those at end of life with COVID-19 (suspected or confirmed)
For symptoms caused by COVID or suspected COVID, national guidance is available here:
- Community Palliative, End of Life and Bereavement Care in the COVID-19 pandemic (RCGP) includes symptom management flow charts for the relief of common symptoms that may arise because of an infection with COVID-19, including how they should be managed if the patient is dying. The RCGP guidance is a live document and will be updated with relevant information on the RCGP COVID resource hub.
**COVID-19 management for end of life symptoms in the community setting - This table summarises local recommendations on treatment options in patients at EoL. For more details, refer to full guidance (SPCF, RCGP and local Palliative and End of Life Care Prescribing: Extraordinary guidance during COVID-19)
For extraordinary situations
**Local guidance has been developed for symptom control (specifically advice for symptoms related to COVID-19), for situations where there may be a shortage of either: end of life medicines or equipment/staff to administer: Palliative and End of Life Care Prescribing: Extraordinary guidance during COVID-19. In these situations, GPs and other prescribers can access specialist palliative care advice 24/7, the details are within the guideline.
Prescribing smaller quantities of anticipatory medicines
When prescribing anticipatory medicines at the end of life, take into account any medicines shortages or lack of administration equipment/staffing, prescribing of smaller quantities may be appropriate.
See link for information on suggested flow of how to access end of life medicines in the community.
NHSE/NHSI/DHSC - Coronavirus (COVID-19) - Re-use of medicines in a care home or hospice
- Sheffield Gastroenterology COVID-19 – Information for Primary Care here
- ACEi / ARBs – Position statements have been released from the European Society of Cardiology, British Cardiovascular Society, British Society for Heart Failure and the Renal Association highlighting that there is no evidence to support an increased risk to patients taking ACEi or ARB. It is strongly recommended that all patients on these medications for systemic hypertension, heart failure, post-myocardial infarction or for those with diabetes and diabetic nephropathy should continue on their therapy.
- NHS England/Improvement Clinical guide for the management of anticoagulant services during the coronavirus pandemic 31 March 2020 Version 1
- **Warfarin to DOACs switch - see local guidance here (updated 2 June 2020)
- **Self-testing of INR during COVID-19 Pandemic 2020
**Hypertension: local guidance to support ongoing review and management of hypertension during COVID-19.
- *COVID-19 and respiratory illness (asthma and COPD) - current knowledge and advice as at 7 May 2020 here
- *Advice on shielding for respiratory Patients during COVID-19 outbreak - advice as at 23 April 2020 here
Central Nervous System
- Substance Misuse - SHSC have just agreed the Interim guidelines for managing continuity of care for patients in Sheffield Treatment & Recovery Team (START) & Community Pharmacists. This includes details of managing patients who are self-isolating.
- Mental Health - monitoring lithium during the COVID-19 pandemic
- NICE COVID - 19 rapid guideline: managing suspected or confirmed pneumonia in adults in the community -see here (updated 28 April 2020) for local summary of key points around prescribing.
Due to doxycycline being the first line treatment in COVID-19 bacterial pneumonia there is a need to conserve supplies of doxycycline in the community, therefore **see here, for advice on Systemic Antibiotic Treatment for Acne Vulgaris.
- Community sexual & reproductive health services - Sexual Health Sheffield are scaling back the community sexual & reproductive health services they provide in order to protect those aspects of the service considered critical, such as emergency contraception. Please see their webpage for up-to-date details.
- Sexual health bulletin: COVID edition: PCS has compiled a newsletter of resources to support clinicians managing sexual and reproductive health during COVID-19. The current edition (07/05/20) is here. These resources have not been through the APG approval process and where treatments are recommended, prescribers are requested to prescribe in line with Sheffield Formulary, wherever possible.
Corticosteroids, replacement therapy The Society for Endocrinology have developed a template letter for patients who are on long term steroids and includes advice about steroid management during a coronavirus infection.
See: Pituitary and Adrenal Insufficiency/ Letter Template updated advice for AI patients.
Denosumab - The Royal Osteoporosis Society have developed practical advice around administration and monitoring of denosumab.
- Diabetes - The Primary Care Diabetes Society have published an at-a-glance fact sheet for primary care with some important and useful information for primary care HCPs – including information around prescribing. Please balance the recommendation that people have adequate supplies of medication with the risk of putting pressure on supply chains.
The London Clinical Networks have produced crib sheets around sick days rules, see links;
Primary Care Diabetes Society (PCDS) Quick Guide: Undertaking a remote diabetes review. This quick reference guide provides the essential information and resources on conducting a safe and effective remote diabetes review; helping healthcare professionals to continue provide high quality care during coronovirus restrictions.
- LARCs - The Faculty of Sexual and Reproductive Healthcare (FSRH) have developed a webpage where they aim to share the most up to date information to help with questions about SRH delivery during the Covid-19 outbreak.
- National Diabetes Prevention Programme – Covid-19 Update here
- Testosterone injection - guidance for the administration and monitoring of testosterone injections during COVID-19 for androgen deficiency in adults
Malignant disease and immunosuppression
- Hydroxycarbamide – see here for updated advice. Note - if prescribing is being directed back to secondary care, please retain hydroxycarbamide as a specialist issued drug within the patients records so you are alerted to drug/disease interactions.
Musculoskeletal & Joint Diseases
- *Sheffield Rheumatology COVID-19 – Information for Primary Care here
- Sheffield Rheumatology COVID-19 – Information for Patients here
- SPS provides a useful resource to aid assessment if considering a delay in blood monitoring of DMARDS in stable patients– see link
- NSAIDS - see link to CAS alert here - (advice around the use of NSAIDs updated 15.04.20)
- Denosumab - The Royal Osteoporosis Society have developed practical advice around administration and monitoring of denosumab.
- The British Society for Rheumatology and other partners have published Management of patients with musculoskeletal and rheumatic conditions who are on corticosteroids, require initiation of oral/IV corticosteroids or a corticosteroid injection
- SPS provides a useful resource to aid assessment if considering a delay in blood monitoring of DMARDs in stable patients– see link
- To determine the level of risk to dermatology patients of COVID-19 and advice on what precautions to take - see link
- See the British Dietetic Association's advice re: COVID-19 and diet here
Vitamin B12: The British Society of Haematology have produced advice around vitamin B12 supplements during the COVID pandemic here (updated 06.05.20)
Vitamin D: review and guidance on supplementation here (01.07.20)
Emerging medicines for use in the treatment or prevention of COVID-19
Please note the key message - GPs and NMPs are advised not to prescribe these drugs for their patients on an FP10 or Privately.
Specialist Pharmacy Service list of stock shortages available here
- Azathioprine - updated 24 April 2020
- Inhaler supply briefing 11 May 2020
- Propantheline bromide 28 April 2020
- Ranitidine 06 May 2020
- Sulfasalazine 250mg/5ml oral suspension 28 April 2020
- Valproate semisodium (Depakote®) 250mg and 500mg tablets 12 May 2020
COVID Medicines Optimisation Bulletins
MOT COVID Bulletin is a brief summary of prescribing advice and guidelines which are related to COVID 19.