Standard Operating Procedure (SOP) for changes from: GENERIC ...

Standard Operating Procedure (SOP) for changes from:
GENERIC VENLAFAXINE MODIFIED RELEASE CAPSULES TO GENERIC
VENLAFAXINE MODIFIED RELEASE TABLETS
November 2010
Prepared by-Medicines Management Team
Dudley PCT
Background
A principle duty of the PCT Medicines Management and Practice Based Pharmacist Teams
is to recommend and facilitate changes to prescribing practice to ensure good quality, safe,
evidence-based and cost effective medicines use. This can include recommendations to a
practice that they use alternative products to those already being prescribed, necessitating a
‘planned change to patient’s medication’
Objectives
• To ensure that where appropriate patients receiving generic modified release
venlafaxine (75mg and 150mg) capsules are changed to the equivalent medication
prescribed as generic venlafaxine modified release tablets
• To make this change with as little disruption as possible for both the patient and the
practice.
To ensure that the patient, practice staff and local community pharmacists are informed of
the change.
Scope
All patients prescribed generic Venlafaxine modified release capsules
Procedure
Actions needed At Each Practice
An Action plan needs to be produced to cover risk minimisation and agree mechanism for
informing patients. Decisions could include
• Call patients in
• Telephone contact
• Patient letter, which will be printed on Practice headed paper, (Examples on page 4).
• See patients individually at routine clinic appointments
• Face to face medication review clinics with pharmacist or by other means which must
be agreed and documented
Planned changes to patient’s medication should only be made after the patient and/or carer
has been informed of the change and with the patient’s consent. If the patient is unable to
positively contribute to the review process, the involvement of an advocate may be
appropriate, following the Code of Practice for the Mental Capacity Act

Preparation and Agreement of Practice
• A GP partner to agree to planned change to patient’s medication and sign ‘Practice
Agreement’ Form. Same GP partner takes responsibility for discussing and agreeing
proposed planned change to medicines with other GPs in practice.
• Responsible pharmacist ensures all GPs in practice have been informed of proposed
planned change to patient’s medication and communicates in agreed practice
manner.
• Template letter prepared by PCT Medicines Management Team to inform patients of
the planned change to their medicines. Letter must explain reason for planned
change to medicines, detail exactly how prescription has changed, contact details in
case of query and how and when they should obtain new prescription.
• Capacity to see patients face to face in a clinic to be assessed
• GP agreeing planned change to patient’s medication to approve method of informing
patients, either at routine clinic appointments, at face to face medication review clinics
with pharmacist or by proposed patient letter, which will be printed on Practice
headed paper, or by other agreed and documented means. Lead GP should see,
approve and sign the ‘template letter’ for use in practice. Example attached on page
4.
• Any patients that practice wants excluded from the planned change to patient’s
medication should be agreed now.
• Agree a date for planned change to patient’s medication to start
• Agree who in the practice will inform patients and/or send letters.
Informing the Community Pharmacists
• Two weeks prior to the planned change to medicines commencing, the PCT
Medicines Management Team should inform local community pharmacies. Visits or
telephone contact by Practice Based Pharmacist are also recommended.
Undertaking the planned change to medicines
• Run a report from the practice computer of all patients with a current active repeat of
the drug to be changed.
• Ensure that no patient on the list has died or recently moved away. (Check with
Practice staff)
• Systematically work through the patient list. Delete any patient that doesn’t fit specific
change criteria. Agree list with GPs and decide on most appropriate method to
communicate with individual patients.
• Undertake planned change to patient’s medication of all suitable patients. Amend the
patient’s computer prescription record to the new drug and discontinue old drug,
recording reason for change. Authorise agreed number of repeats and READ code
entry in patient’s history detailing change and any monitoring requirements.
• Communicate planned change to patient’s medication to patients
• Provide list of patients changed to GPs and reception staff to help deal with any
queries.
• Refer to Repeat Dispensing Protocol for communicating changes to patients that are
part of this scheme
Monitoring
• Arrange and maintain any follow up monitoring
Confidentiality
Patient information used and seen shall be treated in the strictest confidence and not be
divulged to any third party without the express permission of the Practice.
PBPs should not take any patient identifiable data from the practice premises at any time.
Work taken outside the practice should be anonymised
Patient level data e.g. patient interventions, submitted to the PCT should also be
anonymised.
PBPs should agree a safe haven for storage of work within the practice.
The unauthorized use or disclosure of patient or other personal information is a disciplinary

matter liable to the contract being terminated forthwith.
Dudley PCT – Medicines Management Team
Practice Planned Change To Medicines Agreement Form
Practice
I agree that the planned change to medicines outlined below should go ahead according to
the PCT Standard Operating Procedure and Drug Specific Protocol. I have informed all other
GPs and relevant staff working at the practice, and have approved the proposed planned
change to medicines letter and additional methods of communication with patients.
Signed___________________________________________Date__________________
Name__________________________________________________________________
Current Product
Replacement Product
Original dose & frequency
New product dose and frequency

Appendix 1
Practice Heading
SAMPLE LETTER 1
Date
Dear
Following a review of your medication there has been a change to the formulation of
your venlafaxine. It will now be prescribed as TABLETS. There has been no change to
the overall dose you take each day.
This change is in line with local advice given to us by Walsall and Dudley Mental
Health Trust which suggests the tablet formulation should be used as the first line
treatment option if venlafaxine is required.
There has been no change to the actual medicine you receive, the only difference is
that it is a tablet rather than a capsule. So there should be no change to the benefit
you receive from your current treatment.
You will notice that the tablet is much smaller than the capsule formulation and
therefore potentially easier to swallow.
Your new prescription will read
Venlafaxine _____ XL Tablets
Take 1 daily
We hope that you are happy with this change, if you have any queries please contact
the practice.
Please finish off your old supply of medication before starting your new one.
Yours sincerely

Appendix 2
Practice Heading
SAMPLE LETTER 2
Date
Dear
Following a review of your medication there has been a change to the formulation of
your venlafaxine. It will now be prescribed as TABLETS. There has been no change to
the overall dose you take each day.
This change is in line with local advice given to us by Walsall and Dudley Mental
Health Trust which suggests the tablet formulation should be used as the first line
treatment option if venlafaxine is required.
There has been no change to the actual medicine you receive, the only difference is
that it is a tablet rather than a capsule. So there should be no change to the benefit
you receive from your current treatment.
You will notice that the tablet is much smaller than the capsule formulation and
therefore potentially easier to swallow
The advantage of using these tablets is that they are available in a higher dose tablet
which means you need to take fewer tablets each day.
You are currently taking
Venlafaxine 75mg MR Capsules
Venlafaxine 150mg MR Capsules
Take 1 daily
Take 1 daily
Your new prescription will read
Venlafaxine 225mg XL Tablets
Take 1 daily
We hope that you are happy with this change, if you have any queries please contact
the practice.
Please finish off your old supply of medication before starting your new one.
Yours sincerely

Appendix 3
Sample Prescription Note to be attached to Repeat prescriptions.
(Please note this not take into account dose changes when optimising to a higher strength of
venlafaxine tablets)
Dear Patient
CHANGE TO YOUR VENLAFAXINE
Following a review of your medication there has been a change to the formulation of
your venlafaxine. It will now be prescribed as TABLETS. There has been no change to
the overall dose you take each day.
There has been no change to the actual medicine you receive, the only difference is that
it is a tablet rather than a capsule. So there should be no change to the benefit you
receive from your current treatment.
You will notice that the tablet is much smaller than the capsule formulation and
therefore potentially easier to swallow
If you have any concerns about this change please contact the practice
Practice details
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