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Roflumilast NHS

NHS. Coronavirus (COVID-19) Find our resources or medicines guidance summaries. Use gov.uk for the government response, and nhs.uk for health information. Hide message Daxas · Takeda. Manufacturer. Takeda Trade Name. Daxas Formulation. Tablet f/c 500 micrograms. NICE approves COPD treatment roflumilast for routine NHS use Thousands of patients to benefit from roflumilast, also known as Daxas, to treat chronic obstructive pulmonary disease (COPD) after NICE says it should be more widely available. 22 June 201 Roflumilast is a new medicine that can be used to treat flare-ups. It is recommended for people whose symptoms have suddenly become worse at least 2 times over the past 12 months, and who are already using inhalers. Roflumilast comes as tablets and the medicine helps reduce inflammation inside the lungs and airways Daxas® 500 microgram tablets x 30 = £37.71 (Drug Tariff March 2018). Annual treatment cost: £490.23 References Daxas® 500mcg tablet summary of characteristics (accessed 29/3/2018). NICE TA 461: Roflumilast for treating chronic obstructive pulmonary diseas NHS Number GP address I confirm that this patient is eligible to receive roflumilast under the restrictions listed below DOB Signature Patient address Date Contact details . Rationale for Choice. Relevant Diagnosis: Chronic obstructive pulmonary disease (18 years and over) Agreed Indication(s) fo

Roflumilast is available for the management of COPD, where considered clinically appropriate in accordance with NICE guidance. Roflumilast should only be initiated by a consultant respiratory physician and the side effects of the medication should be considered closely for each individual patient when assessing suitability of the product Effect of Roflumilast on cognitive function in schizophrenia. Research type. Research Study. Full title. A Randomized, Double-Blind, Placebo Controlled, 3-period, Proof of Mechanism, Cross-Over Study of Roflumilast (250 or 500 µg) Administered up to Steady State to Evaluate the Effects of Add-on Roflumilast to Second Generation Antipsychotics on Cognitive Impairment as well as Brain Imaging.

Roflumilast - Medicines - SPS - Specialist Pharmacy

NICE approves COPD treatment roflumilast for routine NHS

  1. Roflumilast approved by NICE for routine NHS use HB News: 23/06/2017 - 10:41 When the treatment was first reviewed by NICE in 2012, limited data meant that it was recommended only if patients were using it as part of a clinical trial
  2. The results suggest that phosphodiesterase-4 inhibition, with roflumilast, can improve electroencephalogram cognitive markers, which are impaired in schizophrenia, and that phosphodiesterase-4 inhibition acts at an intermediate rather than early or late cognitive processing stage. This study also un
  3. following a resubmission: roflumilast (Daxas®) is not recommended for use within NHS Scotland. Indication under review: for maintenance treatment of severe chronic obstructive pulmonary disease (COPD) (forced expiratory volume in one second [FEV1]) post-bronchodilator less than 50% predicted) associated with chronic bronchitis in adult patients with a history of frequent exacerbations as add.
  4. ROFLUMILAST (Daxas® ) for COPD The Pan Mersey Area Prescribing Committee recommends the prescribing of ROFLUMILAST tablets (Daxas® ) following specialist recommendation as an add-on to bronchodilator therapy, for treating severe chronic obstructive pulmonary disease in adults with chronic bronchitis (in accordance with NICE TA461)

Chronic obstructive pulmonary disease (COPD) - Treatment - NH

  1. e PDE4 Occupancy of Roflumilast. Research type. Research Study. Full title. An Open-Label, [11C](R)-Rolipram, Positron Emission Tomography (PET) Study to Deter
  2. The first stop for professional medicines advice. 25 September 2020 · Additional information relating to breastfeeding To be used in conjunction with individual drug entries for specific information and guidance. Bronchodilators Most bronchodilators are considered t
  3. Email: slakahan.dhadli@nhs.net 6 Item Action reviewed on a 3-6 monthly basis depending on stability. The Medicines and Healthcare products Regulatory Agency (MHRA) in 2014 looked at roflumilast and the risk of suicidal behaviour. It was recommended that roflumilast is not prescribed for patients with a history of depressio
  4. NICE turnaround for AstraZeneca's COPD drug Daxas. AstraZeneca's Daxas is now likely to be routinely available on the NHS to patients with chronic obstructive pulmonary disease (COPD), after new evidence helped persuade cost regulators that the drug offers value for money in this setting. The National Institute has now issued draft guidance.
  5. Roflumilast (Daxas®) for the maintenance treatment of severe chronic obstructive pulmonary disease (COPD) (forced expiratory volume in one second [FEV1]) post-bronchodilator less than 50% predicted) associated with chronic bronchitis in adult patients with a history of frequent exacerbations as add on to bronchodilator treatment (September 2017

Roflumilast - Medicines Managemen

  1. Rationale: Roflumilast is an oral, once-daily phosphodiesterase IV (PDE4) inhibitor under investigation for chronic obstructive pulmonary disease (COPD). This study investigated the cost effectiveness of roflumilast in patients with severe to very severe COPD from the perspective of the UK society and UK NHS
  2. In draft guidance, the UK National Institute for Health and Care Excellence (NICE) has recommended roflumilast (DAXAS) for routine use within the National Health Service (NHS) for the treatment of severe chronic obstructive pulmonary disease (COPD) in patients with worsening symptoms despite other treatment
  3. NHS indicative price Drug tariff Drug tariff price; Roflumilast 250 microgram; 28: tablet (POM) £35.20 Part VIIIA Category C: £35.20: Daxas 500microgram tablets (AstraZeneca UK Ltd) Active ingredients Size Unit NHS indicative price Drug tariff.
  4. NICE has approved roflumilast (Daxas) for use within NHS England in patients with severe chronic obstructive pulmonary disease (COPD) with chronic bronchitis. by Sandhiya Sodha. Roflumilast provides an alternative approach to reducing the occurrence of exacerbations in patients with severe COPD. | SCIENCE PHOTO LIBRARY
  5. The United Kingdom's National Institute for Health and Care Excellence (NICE) recently approved Daxas (roflumilast), developed by AstraZeneca, as a treatment for chronic obstructive pulmonary disease (COPD).. The new indication could potentially benefit about 122,000 adults in the U.K. who are estimated to be eligible to receive Daxas, according to NICE, which is part of the National Health.

Acute Assessment Advice and Guidance Bereavement Support COVID Oximetry @ Home Virtual Ward Death Certification and Cremation Forms Dementia referral & support during COVID-19 Domestic Abuse during COVID-19 End of life care and ReSPECT Endoscopy during COVID-19 Information for the Public LD and COVID-19 Long COVID (4-12 weeks) Long COVID (after 12 weeks) Long COVID in children Mental Health. Roflumilast (0303030B0) Part of chapter 3 Respiratory System, section 3.3 Cromoglycate, leukotriene and phosphodesterase type-4 inhib, paragraph 3.3.3 Phosphodiesterase Type-4 inhibitors High-level prescribing trends for Roflumilast (BNF code 0303030B0) across all GP practices in NHS England for the last five years Roflumilast is recommended as an add-on to bronchodilator therapy for treating severe chronic obstructive pulmonary disease in adults with chronic bronchitis providing certain criteria are met. For feedback or enquiries relating to this service please email: medicinesresources@gstt.nhs.uk. Roflumilast, as an add-on to bronchodilator therapy, is recommended as an option for treating severe chronic obstructive pulmonary disease in adults with chronic bronchitis, only if: •the disease is severe, defined as a forced expiratory volume in 1 second (FEV1) after a bronchodilator of less than 50% of predicted normal, an 2.1 Roflumilast (Daxas, Merck Sharp & Dohme) has a marketing authorisation for maintenance treatment of severe COPD (FEV1post-bronchodilator less than 50% predicted) associated with chronic bronchitis in adult patients with a history of frequent exacerbations as an add-on to bronchodilator treatment

Effect of Roflumilast on cognitive function in

NICE recommends roflumilast for people with severe COPD only if they are taking part in a research study (clinical trial) that is investigating using roflumilast at the same time as a bronchodilator. evidence about how well it works or about the best way to use it for it to be recommended for general use within the NHS Medicine Roflumilast (Daxas, Nycomed) Document status Reviewed at NHS Suffolk Drug and Therapeutics Committee meeting July 15th 2010 Date of last revision September 2010 Traffic light decision Blue - initiated in Primary Care Clinical priorities group decision Double Red- not to be prescribed in NHS Suffolk For COPD, those patients who are prescribed triple therapy inhalers and/or roflumilast; Patient has a code from Rule 3 in SNOMED_Flu_Subset_v2. AND. For Asthma, those who have been prescribed a LABA or LABA/ICS or leukotriene over the six months AND who have had four or more prescriptions for prednisolone over the six month Roflumilast and cilomilast are oral phosphodiesterase-4 (PDE₄) inhibitors proposed to reduce the airway inflammation and bronchoconstriction seen in COPD. This Cochrane Review was first published in 2011, and was updated in 2017 and 2020. Objectives: To evaluate the efficacy and safety of oral PDE₄ inhibitors for management of stable COPD

Overview Roflumilast for treating chronic obstructive

3.3.3 Phosphodiesterase type-4 inhibitors Roflumilast 3.4.2 Allergen immunotherapy Grass Pollen Extract (Grazax®) for new patients, omalizumab, Mepolizumab 3.4.3 Allergic emergencies C1-esterase inhibitor (Ruconest and Cinryze), Danazol and Oxandrolone (for hereditary angioedema), conestat alfa, icatibant, Lanadeluma The PCN recommends roflumilast as a treatment option for COPD in line with NICE TA461 Roflumilast will be considered BLUE on the traffic light system with initiation by respiratory consultants. There should be a minimum of 3 months prescribing in secondary care prior to transfer of care to primary care prescribers. Key Considerations roflumilast, whereas during solution search 100µg roflumilast reduced activity in the left orbitofrontal cortex, right DLPFC and bilateral PPC, which Mental Health NHS Trust, London, UK *These authors contributed equally to this work. Corresponding author Roflumilast This is an option to add onto triple therapy as per the criteria stated in NICE TA 461 and should only be started by a specialist in respiratory medicine Consideration of Roflumilast / Azithromycin Acute Respiratory Assessment Service (ARAS) Telephone 0191 404 1062 Fax: 0191 202 2166 If 2+ exacerbations/yr despite treatment refer to ARAS Refer to ARAS if considering nebulised bronchodilators (should not be started in community

Roflumilast: Formulary: Treatment of severe COPD. Specialist to complete Drug Checklist (SIDC) on initiation before GP can continue prescribing APC DPS008: Roflumilast - drug positioning statement APC SIDC13: Roflumilast drug checklist NICE TA461: Roflumilast for treating chronic obstructive pulmonary diseas Solent NHS Trust Medicines Management Committee meeting in September. 4.17.4 Formulary Management - applications for approval 4.17.4.1 NICE TA 461 Roflumilast for treating chronic obstructive pulmonary disease: Roflumilast is an orally administered long-acting selective phosphodiesterase-4 enzyme inhibitor licensed for maintenance treatment o

Roflumilast is recommended by the Global Initiative for Chronic Obstructive Lung Disease as add-on treatment to triple inhaled therapy for these patients. (ICS/LABA + LAMA), or triple inhaled therapy alone. The analysis was conducted from a UK National Health Service (NHS) and Personal Social Services perspective Roflumilast (Daxas ®) Designated by NHS England to require initiation by or in prior agreement with a Specialist Centre. Continuation where appropriate by BHT (or other secondary care provider) Detailed requirements for Specialist Centre initiation to be described in the wording of the formulary restriction medicines supplied over the counter. Patient NHS numbers cannot be captured from every prescription and in general are available for around 96% of prescription forms (as of December 2019). However, this proportion can differ for individual drugs and prescribing organisations. The data set provided all record level data below the British. A Tablet will disperse in 1-2 minutes. B Tablet will disperse in greater than 2 minutes. C Liquid preparation available. D Dilute reconstituted injection with 30-60ml of water before administering Roflumilast. Tablets 250 micrograms, 500 micrograms; Notes. NICE TA461: Roflumilast (Daxas), as an add-on to bronchodilator therapy, is recommended as an option for treating severe chronic obstructive pulmonary disease in adults with chronic bronchitis, only if the criteria specified in the NICE TA are met (July 2017).; Home > Formulary > Chapters > 3

Tamsulosin: a medicine used to treat men with - NH

  1. From the NHS perspective, the costs were EUR 1,418 for roflumilast and EUR 1,242 for placebo. These cost differences were not statistically significant. The mean number of moderate or severe exacerbations per patient was 0.96 for roflumilast and 1.06 for placebo. This difference was not statistically significant
  2. Roflumilast (Daxas®) is a first-in-class, oral phosphodiesterase type-4 inhibitor, which is licensed in a number of European countries as an add-on therapy for patients with severe COPD associated with chronic bronchitis Email: Toby.Capstick@leedsth.nhs.uk. Chronic obstructive pulmonary disease (COPD) is characterised by progressive non.
  3. roflumilast, 500 microgram, film-coated tablet (Daxas®) SMC No 635/10 AstraZeneca UK Ltd 4 August 2017 The Scottish Medicines Consortium (SMC) has completed its assessment of the above product and advises NHS Boards and Area Drug and Therapeutic Committees (ADTCs) on its use in NHS Scotland. The advice is summarised as follows
  4. Roflumilast Daxas ® Formulary: For treatment of severe COPD with chronic bronchitis in accordance with NICE TA 461 and BHT COPD guideline (BHTCG 220FM) - update in progress. To be initiated on the recommendation of a consultant Chest physician to the GP
  5. istered long-acting selective phosphodiesterase-4 enzyme inhibitor
  6. AstraZeneca's chronic obstructive pulmonary disease (COPD) drug Daxas has been turned down by the National Institute for Health and Care Excellence (NICE) for use on the NHS. PharmaTimes reports that Daxas, the branded name for roflumilast, has not been recommended for use to treat the condition in draft guidance published by the healthcare body
Phosphodiesterase-4 (PDE4) inhibitors CHF-6001 and

COPD treatment roflumilast approved for routine NHS use

  1. istered, selective phosphodiesterase 4 inhibitor that is a novel treatment for patients with severe chronic obstructive pulmonary disease (COPD).Across four randomized, double-blind, multinational trials in patients with moderate to severe or severe COPD, roflumilast 500 μg/day produced significantly greater improvements from baseline than placebo in pre- and.
  2. Comments. GREY after Respiratory Consultant/Specialist initiation: NICE TA461: (replaces TA244 - negative appraisal) Roflumilast for treating chronic obstructive pulmonary disease.. Patients care to be transferred to primary care after 3 months roflumilast treatment under the Respiratory Consultant/Specialist
  3. NHS Sheffield CCG Clinical Commissioning Group Homepage. Welcome to NHS Sheffield CCG
  4. ed the cost-effectiveness of roflumilast with tiotropium versus tiotropium alone for the management of patients with severe-to-very severe chronic obstructive pulmonary disease (COPD), from the perspective of the US payer. The authors concluded that the addition of roflumilast to tiotropium was cost-effective for these patients
  5. NICE looks at how well treatments work, and also at how well they work in relation to how much they cost the NHS. NICE recommended that roflumilast should be used only as part of a research study because at the moment there is not enough evidence about how well it works or about the best way to use it to recommend it for use in the NHS

This page contains FAQ about Covid-19, from a sarcoidosis patient perspective. The information is updated regularly when new guidance is published by the NHS, Public Health England and the UK Government. If you think there is a question missing, please fill in the form at the bottom of the page Cost-effectiveness of roflumilast as an add-on to triple inhaled therapy versus triple inhaled therapy in patients with severe and very severe COPD associated with chronic bronchitis in the UK Chris Kiff,1 Sandrine Ruiz,2 Nebibe Varol,3 Danny Gibson,4 Andrew Davies,1 Debasree Purkayastha5 1ICON plc, Abingdon, UK; 2AstraZeneca, Barcelona, Spain; 3AstraZeneca, Cambridge, UK; 4AstraZeneca, Luton. Formular

NICE rejects AstraZeneca's Daxas as NHS treatment for certain patients with COPD The acquisition includes the roflumilast franchise (Daliresp in the United States and the Daxas trade name in Europe), a first-in-class treatment for chronic obstructive pulmonary disease that is expected to be a major source of revenue growth for Takeda MSD's Daxas (roflumilast) should not be used in the UK's NHS according to final draft guidance from the National Institute for Health and Clinical Excellence (NICE). NICE said it was not possible to know whether the drug was a cost-effective use of NHS resources without direct clinical trial evidence on its use as an addition to triple therapy A new risk assessment tool has been applied across NHS records for people living in England. It aims to find people who have multiple risk factors that, when put together, make them more vulnerable to COVID-19. People who've had a prescription for Roflumilast most recently in November 2019 or December 2019 Posaconazole (SCH 56592) Cyclosporin A (Cyclosporine A) Q-VD-OPh. Birinapant (TL32711) ISRIB (trans-isomer) Itacitinib (INCB-039110) Ruxolitinib Phosphate (INC-424, INCB-18424, INCB-018424, Jakafi and Jakavi) Apremilast (CC10004

NICE turns down AZ' Daxas for COPD. 10th February 2017. by. Selina McKee. The National Institute for Health and Care Excellence has rejected AstraZeneca's Daxas for use by the NHS to treat certain patients with chronic obstructive pulmonary disease (COPD). Draft guidelines do not recommend the drug as an add-on to bronchodilator treatment for. Please note that there is a separate traffic light entry for oral Fosfomycin. UTI in line with Primary care Multi-resistant Lower UTI Guidance. Diabetes glucose monitoring inline with NHSE criteria. As per LMSG freestyle libre documents An initiation letter is required for an initial six month trial The results for the use of roflumilast in COPD are encouraging, but there are unanswered questions regarding its efficacy and the incidence of side effects. It is possible that the future development of additional inhaled PDE-4 inhibitors may help these drugs find their place in the market

Video: roflumilast Search results page 1 Evidence search NIC

Sulfasalazine is a type of drug known as a disease-modifying anti-rheumatic drug (DMARD).It may be used on its own or with other drugs. Sulfasalazine changes the way your condition affects you, and reduces inflammation, pain and swelling in your joints The Virtual Health Library is a collection of scientific and technical information sources in health organized, and stored in electronic format in the countries of the Region of Latin America and the Caribbean, universally accessible on the Internet and compatible with international databases Roflumilast. Roflumilast is a new medicine that can be used to treat flare-ups. It is recommended for people whose symptoms have suddenly become worse at least 2 times over the past 12 months, and who are already using inhalers. Roflumilast comes as tablets and the medicine helps reduce inflammation inside the lungs and airways Roflumilast (If FEV1 <50% and chronic bronchitis phenotype) Referral for Lung Volume Reduction (valves or surgery) or Transplantation reathless only Authors: Prof Stephen ourke,1,2 Nick Lane,1,2 Helen Grover1 and arlos Echevarria.2 1 Northumbria Healthcare NHS Foundation Trust, 2 Newcastle University. Version 1. Date: 07/10/2019

NICE update on rofumilast (Daxas) — NHS Network

Roflumilast 500mcg OD PROS CONS Spiolto Respimat (olodaterol + tiotropium) 2 puffs once daily Activation of inhaler Ultibro Breezehaler (indacaterol + glycopyrronium) 1 puff once daily Best evidence base Device requires loading vilanterol + umeclidinium) 1 puff once daily Device ? effect on dyspnoea Duaklir 340/12 Genuai Refer to respiratory consultant for consideration of roflumilast (hospital only) in line with NICE TA461. Advice on how to obtain placebo inhalers can be obtained from the NHS Devon CCG Medicines Optimisation Team, please contact: d-ccg.medicinesoptimisation@nhs.net

Roflumilast approved by NICE for routine NHS use Health

28th June 2017 - The United Kingdom's National Institute for Health and Care Excellence (NICE) recently approved Daxas (roflumilast), developed by AstraZeneca, as a treatment for chronic ob GMMMG Management of overactive bladder in adults, June 2019, v3.0 Page 5 4 Initiation of 2nd line treatment (pharmacological therapy) for OAB 4.1 Introduction of pharmacological treatment If symptoms of OAB do not improve after a trial of conservative management, pharmacologica Management of COPD Smoking Cessation • Encourage and support patients to stop smoking at every opportunity. This is the only intervention that slows disease progression1. • Tailor the choice of therapy to patients' preference NHS — Chronic obstructive pulmonary disease (COPD). At every opportunity, offer treatment and support to stop smoking (where applicable). recommends that roflumilast (as an add-on to bronchodilator therapy) is an option for treating severe COPD only if: Disease is severe (forced expiratory volume in 1 second [FEV1] after a bronchodilator.

Study Data Shows NASH Drug Targets Steatosis, Inflammation

The effects of roflumilast, a phosphodiesterase type-4

03.03.03. Phosphodiesterase type-4 inhibitors. Roflumilast (Daxas ® ) Formulary. ONLY for initiation by a Respiratory specialist, for the treatment of COPD in adults, in line with NICE TA 461. Tablet 250mcg (for intiation only) 500microgram (maintenance) Patients should be referred only if: i) the disease is severe, defined as a forced. Roflumilast Daxas ® Tablets 500 Pirfenidone Capsules 267 mg Commissioned by NHS England NICE TA 504 . Available to buy Over The Counter. See policy statement for more info. Non. A partnership between NHS organisations in South East London: South East London Clinical Commissioning Group (covering the - Roflumilast . DPI EKLIRA Genuair. one puff BD (aclidinium 322mcg) SEEBRI Breezhaler. one puff OD (glycopyrronium 44mcg) one puff OD (umeclidinium 55mcg) SOFT MIST IN

roflumilast (Daxas) - Scottish Medicines Consortiu

NICE guidance is designed and developed for the NHS in England and is therefore not automatically applicable to Northern Ireland. On 1 July 2006 the Equality and Human Rights Consultation - NICE TA - Roflumilast for Treating Chronic Obstructive Pulmonary Disease | Department of Healt One such project is being undertaken by an NHS health innovation and excellence cluster, which is carrying out a pilot across north-east London, north central London and Essex to assess the impact of these interventions on hospital admissions due to COPD exacerbations. New treatments Roflumilast. Roflumilast is an oral. RATIONALE: Roflumilast is an oral, once-daily phosphodiesterase IV (PDE4) inhibitor under investigation for chronic obstructive pulmonary disease (COPD). This study investigated the cost effectiveness of roflumilast in patients with severe to very severe COPD from the perspective of the UK society and UK NHS The effects of roflumilast and CHF6001 on LPS induced CCL2 and CCL4 in alveolar macrophages. Alveolar macrophages from 10 COPD patients were treated with roflumilast (0.000001-10 µM), CHF6001 (0.000001-0.1 µM), or vehicle control (DMSO) for 1 h prior to stimulation with LPS (1 µg/ml) for 24 h

ROFLUMILAST (Daxas® ) for COPD - Pan Mersey AP

Roflumilast is a new anti-inflammatory drug for the treatment of COPD. Studies have reported modest, but significant increase of FEV1 with roflumilast, as well as decreased rate of exacerbations Introduction: Roflumilast is the only phosphodiesterase 4 inhibitor approved for the treatment of COPD patients with chronic cough and sputum, and a history of exacerbations, but the compliance to.

Pathway COPD

A PET Study to Determine PDE4 Occupancy of Roflumilast

Roflumilast Side Effects. Medically reviewed by Drugs.com. Last updated on Nov 15, 2020. Consumer; Professional; In Summary. More frequently reported side effects include: diarrhea, headache, nausea, weight loss, and psychiatric signs and symptoms. See below for a comprehensive list of adverse effects Part of chapter 3 Respiratory System, section 3.3 Cromoglycate, leukotriene and phosphodesterase type-4 inhib. High-level prescribing trends for Phosphodiesterase Type-4 inhibitors (BNF section 3.3.3) across all GP practices in NHS England for the last five years. You can explore prescribing trends for this section by CCG, or learn more about. Roflumilast Daxas ® Formulary: 500microgram film-coated tablets; Approved for the treatment of chronic obstructive pulmonary disease in line with NICE NICE TA461: Roflumilast for treating chronic obstructive pulmonary diseas

Chronic obstructive pulmonary disease - The Full WikiRespiratory news8 Ways to Manage Life With COPD - COPD News Today

Bambuterol Hydrochloride BeclometDiprop/Formoterol/Glycopyrronium Ephedrine Hydrochloride Formoterol Fumarate Indacaterol Maleate Olodaterol Salbutamo Chronic use of any other medication for treatment of lung disease like xanthines, antileukotrienes, systemic and inhaled corticosteroids, long acting beta2- agonists, roflumilast (other than the study drug) and cromoglycates; Long term (at least 12 hours daily) use of oxygen therapy for chronic hypoxemia Roflumilast (Daxas®) AMBER 2 COPD In line with NICE TA 461 September 2017 APC Decisions News from the APC MACCG.NottsAPC@nhs.net if you would like to make a submission or have any queries. Laura Catt, Prescribing Interface Advisor, NHS Mansfield and Ashfield CC