COVID-19

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/

RCGP's COVID-19 e-learning resource hub​

SPS COVID-19 resources here. They have produced a general principles document around blood monitoring and a number of individuals ones for high risk medicines.

Community pharmacy

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

eRD

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)

Palliative Care

See link for End of Life Care resources to support practices

General principles:

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:

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. 

If your local pharmacy does not have EOL medicines in stock the following pharmacies have been commissioned to keep the following medicines in stock.

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

 

Gastrointestinal System

  • Sheffield Gastroenterology COVID-19 – Information for Primary Care here

Cardiovascular System

  • ACEi / ARBs – Position statements have been released from the European Society of CardiologyBritish Cardiovascular SocietyBritish 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.

Respiratory

  • *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

Infections

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.

 Endocrine

  • 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.

  • 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 injectionguidance 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 interaction​s.

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)

 Dermatology

  • 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

 Nutrition

  • 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.

 

Stock Shortages

Specialist Pharmacy Service list of stock shortages available here

 

COVID Medicines Optimisation Bulletins

MOT COVID Bulletin is a brief summary of prescribing advice and guidelines which are related to COVID 19.

 

 

 

Last updated on 03/08/2020 by KerryWade