Updated lipid pathway

The lipid management pathway for secondary prevention of cardiovascular disease has been updated. Changes include:

  • A statement has been added to ensure statin intolerance pathway has a clear emphasis
  • Further highlighting of the position of icosapent ethyl (Vaskepa®)
  • Inclisiran option for prescribing has been made clearer

The updated pathway is available on the clinical guidance and pathways page, along with links to other lipid management resources.


New guidelines and Terms of Reference

Following approval by CRG, GMMMG, and the Greater Manchester ICS Clinical Effectiveness and Governance Committee, two new GMMMG guidelines have been published;

  • HRT Guidance for Menopause Management
  • Hypersalivation and Sialorrhoea in Adult Patients

Both guidelines are available on the clinical guidance and pathways page.

The formulary and RAG list have been updated to reflect the recommendations in these guidelines. For details of the updates, see the GM formulary change log, available on the formulary page.

The Terms of Reference for GMMMG and its subgroups have also been approved, and are available here. These include:

  • Clinical reference group
  • Medicines safety group
  • Population health management and health inequalities group
  • Digital group

Formulary and subgroup decision updates

Following approval by CRG, GMMMG, and the Greater Manchester ICS Clinical Effectiveness and Governance Committee, the following decisions have been approved and published:

  • Insuman Comb 50 removed from formulary – product discontinued
  • Abrocitinib, tralokinumab & upadacitinib added for formulary as RED drugs in chapter 13

The formulary has also been updated to reflect relevant NICE guidelines and safety alerts. For full details please see the formulary change log, which is available on the formulary page.

For more information on these and other decisions, please see GMMMG decision summaries.


Consultation: actions from January 2023 meeting of CRG

On behalf of the GMMMG Clinical Reference Group, we now seek comments on the actions proposed at the January 2023 CRG meeting.

Actions in this consultation include:

  • Avatrombopag added to formulary as a RED drug for primary chronic immune thrombocytopenia.
  • Esketamine nasal spray for treatment-resistant depression added to the DNP list.

All links to MHRA drug safety updates will be added to formulary as appropriate.

To take part in this consultation, visit the consultations page. The consultation period is open until 5pm on Monday 6th March 2023.


Formulary and subgroup decision updates

Following approval by CRG, GMMMG, and the Greater Manchester ICS Clinical Effectiveness and Governance Committee, the following decisions have been approved and published:

  • The RAG status for modafinil for excessive sleepiness in narcolepsy or Parkinson’s disease has been updated to GREEN (following specialist initiation), and an information leaflet for primary care prescribers has been published.
  • Famotidine added to formulary as GREEN, in place of ranitidine
  • Metolazone – recommendation added to prescribe by brand
  • Icosapent ethyl – GREEN (specialist advice)
  • Fenfluramine – RED for Dravet syndrome
  • Imlifidase – RED
  • Roxadustat – RED
  • Setmelanotide – RED

The formulary has also been updated to reflect relevant NICE guidelines and safety alerts.

For more information on these and other decisions, please see GMMMG decision summaries.


Updated shared care protocols: potassium binders and atypical antipsychotics

Following approval by CRG and GMMMG, and by the Greater Manchester ICS Clinical Effectiveness and Governance Committee, the following revised GMMMG shared care protocols for adult patients are now available:

  • Sodium zirconium cyclosilicate for hyperkalaemia
  • Patiromer sodium for hyperkalaemia
  • Oral atypical antipsychotics

The formulary has been updated to assign an AMBER status sodium zirconium cyclosilicate, patiromer sodium, lurasidone, and paliperidone.

The updated documents can be found on the shared care page, along with all other currently active SCPs.


Consultation: actions from December meeting of CRG

On behalf of the GMMMG Clinical Reference Group, we now seek comments on the actions proposed at the December 2022 CRG meeting.

Actions in this consultation include:

  • Donepezil, galantamine and rivastigmine for mild to moderate Alzheimer’s disease, Lewy body dementia, and Parkinson’s disease: Green (specialist advice)
  • Cyclogest added to formulary as an option for vaginal micronised progesterone for prevention of miscarriage

All links to MHRA drug safety updates will be added to formulary as appropriate.

To take part in this consultation, visit the consultations page. The consultation period is open until 5pm on Thursday 26th January 2023.


Updated shared care protocol: melatonin for children and adolescents

Following approval by CRG and GMMMG, and the first meeting of the Greater Manchester ICS Clinical Effectiveness and Governance Committee on Thursday 22nd September, a shared care protocol for melatonin in children adolescents has been updated.

All of the currently active shared care protocols in Greater Manchester are available on the shared care page.


Formulary and subgroup decision updates

Following approval by CRG, GMMMG, and the Greater Manchester ICS Clinical Effectiveness and Governance Committee, the following decisions have been approved and published:

  • Ranibizumab biosimilar added to formulary as RED and made first choice anti-VEGF-A treatment for NICE-approved indications. An updated GM macular pathway is also expected.
  • Faricimab added to formulary as RED for diabetic macular oedema and wet age-related macular degeneration.
  • Adaflex tablets added to formulary as first choice option for melatonin.
  • Mexiletine capsules added to formulary as RED for life-threatening ventricular arrhythmias.
  • Filgotinib added to formulary as RED for moderately to severely active ulcerative colitis.
  • Diroximel fumarate added to formulary as RED for relapsing-remitting multiple sclerosis.
  • Teduglutide added to formulary as RED for short bowel syndrome.

The formulary has also been updated to reflect relevant NICE guidelines and safety alerts. For full details please see the formulary change log, which is available on the formulary page.

For more information on these and other decisions, please see GMMMG decision summaries.


Updated shared care protocol: apomorphine for adult patients

Following approval by CRG and GMMMG, and by the Greater Manchester ICS Clinical Effectiveness and Governance Committee, the revised GMMMG shared care protocol for apomorphine for adult patients is now available.

The updated document can be found on the shared care page, along with all other currently active SCPs.