medicines formulary

Medicines Formulary

Please also refer to: If a drug is not listed, formulary decisions from the local CCG, relevent to the patients county of residence, are effective.

Somerset CCG Prescribing formulary

Somerset CCG Prescribing Traffic lights

Pan Dorset Formulary

Formulary Choices Restrictions and/or Advice

Antacids/Alginates Gaviscon Advance

Antispasmodics Mebeverine

Helicobacter Pylori Eradication See YDH Antimicrobial Guidelines. Antimicrobial Guidelines

H2 Receptor Antagonists Ranitidine

Proton Pump Inhibitors Omeprazole Avoid omeprazole and esomeprazole in patients who are taking clopidogrel.

Lansoprazole

Esomeprazole Consultant Gastroenterologist initiation only.

Acute Diarrhoea Codeine

Loperamide

EluxadolineSpecialist initiation only Eluxadoline for treating irritable bowel syndrome with

diarrhoea in accordance with

www.nice.org.uk/TA471

Racecadotril Restricted to ward 10 inpatients

Chronic Bowel Disorders

Aminosalicylates Mesalazine

1st line as Octasa®

2nd line as Asacol® and Mesren® for patients stabilised on these preparations

Mezavant XL Consultant Gastroenterologist initiation only.

For consideration in the treatment of irritable bowel syndrome (unlicensed

indication) in accordance with

www.nice.org.uk/CG61

Corticosteroids 1st line Prednisolone Retention enema

Hydrocortisone Foam enema

Expensive Prednisolone Foam enema

Prednisolone

Budesonide

Beclometasone dipropionate (Clipper®) Consultant Gastroenterologist initiation only.

Immuno- suppressants AzathioprineSpecialist initiation only. For maintenance of remission of Crohn’s disease

and ulcerative colitis (unlicensed indication).

CiclosporinSpecialist initiation only. For severe acute ulcerative colitis refractory to

corticosteroid treatment (unlicensed indication).

MethotrexateSpecialist initiation only. For maintenance of remission of severe Crohn’s

disease (unlicensed indication).

Cytokine modulators Biosimilar Adalimumab (paediatric patients require Blueteq approval)Specialist use only In accordance with NICE guidance for the treatment of

Crohn’s disease and ulcerative colitis.



Biosimilar Infliximab (Paediatric patients require Blueteq approval)Specialist use only In accordance with NICE guidance for the treatment of

Crohn’s disease and ulcerative colitis.



Specialist use only Also for use in accordance with NICE guidelines for the

treatment of acute exacerbations of ulcerative colitis.


Golimumab (Paediatric patients require Blueteq approval)Specialist use only In accordance with NICE for treating moderately to

severely active ulcerative colitis after the failure of conventional therapy.


Vedolizumab (Paediatric patients require Blueteq approval)Specialist use only For use in accordance with NICE guidelines for the

treatment of moderately to severe active ulcerative colitis.


Specialist use only Also for treating moderately to severely active Crohn's

disease after prior therapy in accordance with


Chapter 1: Gastro-intestinal system

1.1

1.2

Therapeutic Area

1.3

1.5

1.4

http://formulary.somersetccg.nhs.uk/

https://www.somersetccg.nhs.uk/prescribing-and-medicines-management/

http://www.dorsetformulary.nhs.uk/

http://ycloud/teams/InfectionControl/SitePages/Antimicrobial Guidelines.aspx

http://www.nice.org.uk/TA471

http://www.nice.org.uk/CG61






https://www.nice.org.uk/guidance/ta329

https://www.nice.org.uk/guidance/TA342


Ustekinumab (Paediatric patients require Blueteq approval)Specialist use only for moderately to severely active Crohn’s disease after

previous treatment in accordance with


Specialist use only for treating moderately to severely active ulcerative colitis

in accordance with


Tofacitinib (Paediatric patients require Blueteq approval)Specialist use only for moderately to severely active ulcerative colitis in

accordance with


Bulk-forming Laxatives Ispaghula Husk

Stimulant Laxatives Senna

Glycerin suppositories

Faecal Softener Arachis Oil enema

Osmotic Laxatives Lactulose

Laxido sachets

5HT4 receptor agonists PrucaloprideGI Specialist prescribing only in accordance with NICE guidelines for

constipation in women.


Prucalopride is also licensed for use in men

Linaclotide GI Specialist prescribing only

LubiprostoneGI Specialist prescribing only in accordance with NICE guideline for treating

chronic idiopathic constipation.


Naloxegol In accordance with NICE guidelines for treating opioid‑induced constipation.


Naldemedine tosylateIn accordance with NICE guidelines for treating opioid-induced constipation


Bowel Cleansing Preparations Fleet Phospho-soda

Citramag

Moviprep

Haemorrhoidal Preparations

Soothing agent Anusol All available as ointment and suppositories.

+ corticosteroid Anusol HC

Scheriproct

Preparations for Anal Fissures Rectogesic® ointment 0.4%

Drugs affecting Biliary Composition

& FlowUrsodeoxycholic Acid

Obeticholic AcidSpecialist use only in line with Nice guidance Obeticholic acid for treating

primary biliary cholangitis.


Bile Acid Sequestrants 1st line Colestyramine

2nd line Colesevelam

Pancreatin Creon

Probiotic Infloran Paediatric use only

Vivomixx® sachets or capsules Specialist use only for probiotic dietary supplementation.


Cardiac Glycosides Digoxin

Thiazide & Related Diuretics Bendroflumethiazide

Indapamide

Metolazone (unlicensed) Specialist initiation only

Loop Diuretics Furosemide

Bumetanide

2.1

2.2

1.6

1.7

1.9

1.5

Chapter 2: Cardiovascular System

Therapeutic Area









Potassium-sparing Diuretics Amiloride

In combination with furosemide: Co-amilofruse

Aldosterone Antagonists Spironolactone

Eplerenone

For Consultant Cardiologist initiation only, in line with the NICE Clinical

Guidance for secondary prevention for patients in primary and secondary

care after an MI.


Anti-Arrhythmic Drugs Amiodarone

Flecainide

Sotalol

DronedaroneFor Consultant Cardiologist/Specialist initiation only, in accordance with NICE

guidance for the treatment of non- permanent atrial fibrillation.


Beta-Blockers Atenolol

Bisoprolol

Metoprolol

Sotalol

Alpha-Adrenoceptor Blocking Drugs Doxazosin

ACE Inhibitors Ramipril

Lisinopril

Perindopril (generic only)

Angiotensin-II Receptor Antagonists Candesartan

Losartan

Sacubitril/ValsartanFor consultant cardiologist initiation only in accordance with NICE guidance

for treating symptomatic chronic heart failure with reduced ejection fraction


Nitrates Isosorbide mononitrate (standard and MR tablets)

GTN spray

Calcium Channel Blockers Amlodipine

Lercanidipine

Diltiazem

1st line as Zemtard XL® or Slozem®

Verapamil

Other Anti-Anginal Agents Nicorandil

IvabradineFor use in accordance with the NICE Clinical Guideline for the Management

of Stable Angina.


For Consultant Cardiologist or Specialist initiation only, Ivabradine is also

recommended in accordance with NICE for the Treatment of Chronic Heart

Failure.


RanolazineFor use in accordance with the NICE Clinical Guideline for the Management

of Stable Angina.


Peripheral Vasodilators and related

drugsNaftidrofuryl

For use in accordance with NICE for the treatment of intermittent claudication

in peripheral arterial disease.


Parenteral Anticoagulants

Low Molecular Weight Heparins Enoxaparin

Fondaparinux Fondaparinux For UA and NSTEMI

2.5

2.2

Different versions of modified-release preparations containing more than

60mg diltiazem hydrochloride may not have the same clinical effect. To avoid

confusion between these different formulations of diltiazem, prescribers

should specify the brand to be dispensed.

2.3

2.4

2.6

2.8

https://www.nice.org.uk/guidance/cg172







Oral Anticoagulants Warfarin

most

cost

effective

EdoxabanFor use in accordance with NICE as an option for treating and preventing

deep vein thrombosis and pulmonary embolism.


Edoxaban is also recommended for preventing stroke and systemic

embolism in adults with non-valvular atrial fibrillation in accordance with.


DabigatranSpecialist use only in accordance with NICE guidance for the prevention of

venous thromboembolic events in adults having elective total hip

replacement surgery or elective total knee replacement surgery.


Dabigatran is also recommended for stroke prevention in AF in accordance

with.


Dabigatran is also recommended for the treatment and secondary prevention

of deep vein thrombosis and/or pulmonary embolism in accordance with.


Idarucizumab : Reversal of the anticoagulant effect of dabigatran in accordance with.

www.nice.org.uk/advice/esnm73

RivaroxabanSpecialist use only For use in accordance with NICE guidance for the

prevention of venous thromboembolic events in adults having elective total

hip replacement surgery or elective total knee replacement surgery.


Rivaroxaban is also recommended for stroke prevention in AF, according to

NICE guidelines.


Rivaroxaban is also recommended for treating deep vein thrombosis and

preventing recurrent deep vein thrombosis and pulmonary embolism after a

diagnosis of acute deep vein thrombosis in adults, in accordance with NICE.


Rivaroxaban is also recommended as an option for treating pulmonary

embolism and preventing recurrent deep vein thrombosis and pulmonary

embolism in adults in accordance with.


Specialist initiation only Rivaroxaban is also recommended for preventing

adverse outcomes after acute management of acute coronary syndrome in

accordance with.


Rivaroxaban plus aspirin is recommended within its marketing authorisation,

as an option for preventing atherothrombotic events in adults with coronary

artery disease or symptomatic peripheral artery disease who are at high risk

of ischaemic events in accordance with.


Apixaban

Apixaban is recommended in line with NICE recommendations for the

prevention of venous thromboembolism in adults after elective hip or knee

replacement surgery in accordance with.


Apixaban is also recommended for stroke prevention in AF, according to

NICE guidelines in accordance with.


Apixaban is also recommended as an option for treating and preventing

recurrent deep vein thrombosis and pulmonary embolism in accordance with.


Antiplatelet Drugs Aspirin

ClopidogrelMyocardial infarction: cardiac rehabilitation and prevention of further

cardiovascular disease in accordance with.

www.nice.org.uk/cg172

Unstable angina and NSTEMI: early management in accordance with.


Dipyridamole RetardTogether with clopidogrel, modified-release dipyridamole is recommended for

preventing occlusive vascular events in adults in accordance with.


2.8

2.9






https://www.nice.org.uk/advice/esnm73/chapter/Key-points-from-the-evidence













Dipyridamole with aspirin (Molita®)

TicagrelorFor Consultant Cardiologist initiation only, in accordance with NICE guidance

for the treatment of acute coronary syndromes.


Ticagrelor is also recommended for preventing atherothrombotic events after

myocardial infarction in accordance with.


Prasugrel

For Consultant Cardiologist initiation only, in accordance with NICE guidance

for the treatment of acute coronary syndromes with percutaneous coronary

intervention


Tirofiban

Fibrinolytic Drugs AlteplaseSpecialist use only in line with NICE recommendations Alteplase use in

accordance with NICE for treating acute ischaemic stroke.


Tenecteplase

Antifibrinolytic Drugs Tranexamic Acid

Statins Atorvastatin

Rosuvastatin

Simvastatin

Pravastatin

Other Lipid Regulating Drugs EzetimibeFor use in accordance with NICE for the treatment of adults with primary

heterozygous-familial and non-familial hypercholesterolaemia


Bempedoic AcidSpecialist use only For use in accordance with NICE, with ezetimibe for

treating primary hypercholesterolaemia or mixed dyslipidaemia


EvolocumabSpecialist use only For use in accordance with NICE for the treatment of

adults with primary hypercholesterolaemia and mixed dyslipidaemia


AlirocumabSpecialist use only in line with NICE Alirocumab for treating primary

hypercholesterolaemia and mixed dyslipidaemia



Bronchodilators Salbutamol

Terbutaline

Formoterol

Salmeterol

Indacaterol

Olodaterol

Antimuscarinic Bronchodilators Ipratropium

Tiotropium

Aclidinium

Glycopyrronium

Umeclidinium

Compound preparations Anoro Ellipta® (umeclidinium/vilanterol 55/22 DPI)

Duaklir Genuair® (aclidinium/formoterol 340/122 DPI)

Ultibro Breezhaler® (glycopyrronium/indacterol 110/50 DPI)

Spiolto Respimat® (tiotropium/olodaterol 2.5/2.5 soft mist inhaler)

Bevespi Aerosphere® (glycopyrronium/formoterol 7.2/5 MDI)

Theophylline Aminophylline MR (Phyllocontin Continus®)

Theophylline MR (Neulin SA®, slo-Phyllin®, Uniphyllin Continus®)

Corticosteroids Beclometasone (Clenil®, Qvar®, Kelhale® or Soprobec® inhalers.)

Prescribe beclometasone MDIs by brand name to avoid confusion over the

product intended. Clenil Modulite®, Qvar®, Kelhale® and Soprodec® are not

equipotent

Kelhale is cost effective alternative to QVAR, and is considered equipotent.

Benefit- has a dose counter

Kelhale is licensed only for adults 18 years and above

Budesonide

2.12

2.10

3.1

2.9

2.11

3.2

joint 1st

line

joint 2nd

line

Therapeutic Area

Prescribe by brand.

The rate of absorption from modified-release preparations can vary between

brands.

Chapter 3: Respiratory System









Compound preparations AiFluSal® (Fluticasone/Salmeterol) n.b. 250/25 strength is NON-Formulary

Sereflo® (Fluticasone salmeterol) n.b. 250/25 strength is NON-Formulary

Flutiform® (Fluticasone/Formoterol CFC-free MDI) n.b. 250/10 strength is NON-Formulary

Flutiform K-haler® (Fluticasone/Formoterol CFC-free Breath Actuated

MDI)

Fostair® (Beclomethasone/Formeterol CFC-free MDI)

Fostair NEXThaler® (Beclomethasone/Formeterol ultrafine DPI)

Atectura Breezhaler® (Indacterol/mometasone DPI)

Fobumix Easyhaler® (Budesonide/formoterol DPI)

Relvar Ellipta® (Fluticasone furoate/vilanterol DPI)

Trelegy Ellipta® (Fluticasone furoate/Umeclidinium/Vilanterol DPI)

Enerzair Breezhaler® (Indacaterol/mometasone/glycopyrronium

114/136/46 DPI)

Trimbow® (Beclometasone/Formoterol/glycopyrronium MDI)

Trixeo Aerosphere® (Budesonide/Formoterol/glycopyrronium 160/5/9

MDI)

Duoresp Spiromax® (Budesonide/formoterol DPI)

Symbicort Turbohaler® (Budesonide/formoterol DPI)

Symbicort MDI® (Budesonide/formoterol MDI)

Sirdupla® (Fluticasone/Salmeterol 25mg CFC-free MDI) n.b. 250 strength is NON-Formulary

Airflusal Forspiro® (Fluticasone/Salmeterol 50mcg DPI)

Aerivio Spiromax® (Fluticasone/Salmeterol DPI)

Combisal® (Fluticasone/Salmeterol MDI) n.b. 25/250 strength is NON-Formulary

Seretide Evohaler® (Fluticasone/Salmeterol MDI) n.b. 25/250 strength is NON-Formulary

Seretide Accuhaler ® (Fluticasone/Salmeterol DPI)

Fixkoh Airmaster® (Fluticasone/Salmeterol DPI) Note: Fixkoh Airmaster 50 microgram /100 microgram strength is not

appropriate in adults and children with severe asthma.

Stalpex® (Fluticasone/Salmeterol DPI)

Fusacomb® Easyhaler (Fluticasone/Salmeterol DPI)

Leukotriene Antagonists and

Phosphodiesterase type-4 inhibitorsMontelukast

RoflumilastSpecialist initiation only Roflumilast for treating chronic obstructive pulmonary

disease in accordance with.


Antihistamines Chlorphenamine

Loratadine

Cetirizine

Allergen Immunotherapy Omalizumab (requires Blueteq approval)Specialist initiation only in accordance with NICE guidance for the treatment

of severe persistent allergic asthma OR chronic spontaneous urticaria



Mepolizumab (requires Blueteq approval)

Specialist use only following Specialist initiation at Specialist treatment centre

as part of Hub and Spoke arrangement. For treating severe refractory

eosinophilic asthma in accordance with.



as part of Hub and Spoke arrangement. For treating severe eosinophilic

asthma in accordance with.


Reslizumab (requires Blueteq approval)





Benralizumab (requires Blueteq approval)




www.nice.org.uk/TA565Benralizumab is not recommended if neither mepolizumab nor reslizumab

are recommended (see NICE's technology appraisal guidance 431 and

technology appraisal guidance 479).

3.4

3.2

3.3








Angioedema

For Treatment of acute episodes of hereditary angioedema in the

emergency care setting NHS England advises: utilise the non-plasma

derived products conestat alfa (Ruconest®) and icatibant acetate

(Firazyr®) in line with their licensed indications as first line agents of

choice.

NHS England Policy: Treatment of Acute Attacks in Hereditary Angiodema

(Adult)

info from Specialised Commissioning Circular 2122

Conestat alfa (Ruconest®)Specialist use only for Acute Treatment or Short-term prophylaxis prior to

planned procedures for Hereditary Angioedema and Acquired Angioedema

IcatibantSpecialist use only for Acute Treatment or Short-term prophylaxis prior to


C1 Esterase inhibitor (Berinert®)Specialist use only for Acute Treatment or Short-term prophylaxis prior to


NHS England Policy: C1-esterase inhibitor for prophylactic treatment of

hereditary angioedema (HAE) types I and II

LanadelumabSpecialist use only for preventing recurrent attacks of hereditary angioedema

in accordance with.


Mucolytics Carbocisteine

Acetylcysteine effervescent tablets

Antifibrotics PirfenidoneRespiratory Consultants Initiation only in accordance with NICE guidance for

the treatment of idiopathic pulmonary fibrosis (IPF).



Hypnotics Zolpidem

Zopiclone

2nd line Melatonin prolonged release (Circadin®)

Circadin® is indicated as monotherapy for the short-term treatment (up to 13

weeks) of primary insomnia characterised by poor quality of sleep in patients

who are aged 55 or over.

Circadin may be of benefit to elderly patients at risk of falling, or to patients

who drive and are susceptible to next-day drowsiness of z-drugs and

benzodiazepines.

It is also approved for use off label in patients with Parkinson's disease

related insomnia and for hemicrania continua where the specialist has

stabilised the patient on an effective and tolerated dose.

3rd line Temazepam

Anxiolytics Diazepam

Lorazepam

Antipsychotics Seek Specialist advice.

Antidepressants Citalopram

Fluoxetine

Sertraline

Drugs used for ADHDAttention deficit hyperactivity disorder: diagnosis and management NICE

guideline

https://www.nice.org.uk/guidance/NG87

Methylphenidate (Medikinet®, Equasym® and Xaggatin®, Matoride®,

Delmosart®, Concerta®)Paediatric specialist initiation only,

Atomoxetine Paediatric specialist initiation only,

Dexamfetamine Paediatric specialist initiation only,

Lisdexamfetamine Paediatric specialist initiation only,

Hypnotics should only be prescribed regularly (and added to a TTO) for

patients who take them regularly at home.

4.4

4.1

3.4

3.7

3.11

Therapeutic Area

4.3

1st line

Chapter 4: Central Nervous System

4.2

Product

(Brand name)

First line for acute

treatment for new

patients/attacks

First line for

prophylaxis for

new patients

C1-esterase inhibitor

(Berinert®)× ×

Icatibant

(Firazyr®)P ×

Conestat alfa

(Ruconest®)P P

1

Lanadelumab

(Takhzyro®)× P

1 Off label indication

https://www.england.nhs.uk/commissioning/wp-content/uploads/sites/12/2013/09/b09-p-b.pdf?UNLID=2326881722020124103834

https://www.england.nhs.uk/commissioning/wp-content/uploads/sites/12/2013/09/b09-p-b.pdf?UNLID=2326881722020124103834

https://www.england.nhs.uk/commissioning/wp-content/uploads/sites/12/2013/05/16045_FINAL.pdf?UNLID=2326881722020124103834

https://www.england.nhs.uk/commissioning/wp-content/uploads/sites/12/2013/05/16045_FINAL.pdf?UNLID=2326881722020124103834



https://www.nice.org.uk/guidance/NG87

Guanfacine Paediatric specialist consultant only,

Antiemetic Drugs Cyclizine n.b. IV restricted use due to cost.

Metoclopramide

Domperidone

Ondansetron

4mg and 8mg tablets only as second line treatment of N&V in pregnancy or

other non-chemo related N&V unresponsive to other antiemetics.

Aprepitant Specialist use only

Droperidol inj Restricted to theatres/recovery only

Analgesics

Non-opioid Paracetamol

Opioid Codeine n.b. co-dydramol and co-codamol 8/500 are NON-formulary

Morphine Zomorph® for 12 hourly oral use, and Oramorph® for breakthrough pain

Fentanyl

Buprenorphine

Tramadol

Diamorphine Ayendi Nasal Spray for paediatric inpatients only

Oxycodone Restricted to second line use if morphine is ineffective/not tolerated.

Targinact® Restricted to initiation by gastroenterology consultant /pain control team.

TapentadolRestricted for use within the hip and knee replacement surgery pathway OR

on recommendation of the pain control team

Neuropathic Pain AmitriptylineNeuropathic pain in adults: pharmacological management in accordance

with.


Gabapentin

Pregabalin prescribe as generic

Duloxetine

Prophylaxis of migraine Botulinum toxin type A (Botox®)Specialist use only for the prevention of headaches in adults with chronic

migraine in accordance with.


FremanezumabSpecialist use only for preventing migraine in adults in accordance with


Galcanezumab Specialist use only for preventing migraine in adults in accordance with


Erenumab Specialist use only for preventing migraine in accordance with


Antiepileptic Drugs Carbamazepine Epilepsies: diagnosis and management in accordance with.


Phenytoin

Sodium valproate MEASURES TO AVOID VALPROATE EXPOSURE IN PREGNANCY

Midazolam buccal solution

(Buccolam® or Epistatus® prefilled syringes)

Stiripentol Specialist initiation only

Lamotrigine Seek Specialist advice.

Lacosamide Seek Specialist advice.

Levetiracetam Seek Specialist advice.

Eslicarbazepine Seek Specialist advice.

Perampanel Seek Specialist advice.

Retigabine

Seek Specialist advice. Retigabine is recommended as adjunctive treatment

for partial onset seizures with or without secondary generalisation in some

people with epilepsy, in accordance with NICE.


4.4

4.6

To provide flexible dosing and to improve patient safety, do not prescribe as

the fixed combination co-codamol 30/500.

4.8

4.7






https://www.nice.org.uk/guidance/CG137

http://www.ema.europa.eu/docs/en_GB/document_library/Press_release/2018/03/WC500246391.pdf


Zonisamide Seek Specialist advice.

last line Brivaracetam Specialist initiation only

Parkinsons Drugs Co-Beneldopa

Co-Careldopa

Pramipexole Seek Specialist advice.

Ropinirole Seek Specialist advice.

Entacapone/levodopa/carbidopa (Sastravi®) Seek Specialist advice.

2nd line Opicapone Seek Specialist advice.

RiluzoleSeek Specialist advice. For use in accordance with NICE for the treatment of

the ALS form of Motor Neurone Disease.


Drugs for Dementia Donepezil

Galantamine www.nice.org.uk/TA217

Rivastigmine

Memantine


Antibacterial Drugs See YDH Antimicrobial Guidelines. Antimicrobial Guidelines

Fosfomycin 1st line for UTI

Temocillin Microbiology recommendation only

Tigecycline Microbiology recommendation only

Timentin Microbiology recommendation only

FidaxomicinMicrobiology recommendation only. For the treatment of Clostridium difficile

infection in line with Public Health England Guidance May 2013.

PHE 2013 Clostridium difficile management and treatment.pdf

Rifaximin (Targaxan®)Restricted to Gastroentrology team use only in accordance with NICE

guidance for preventing episodes of overt hepatic encephalopathy.


Antifungal Drugs

Oral candidiasis 1st line Nystatin mouthwash

2nd line Fluconazole

Vaginal candidiasis 1st line Clotrimazole pessary

2nd line Fluconazole

Systemic infections Fluconazole

Amphotericin (AmBisome®)

Anidulafungin

Micafungin

Voriconazole

Antiviral Drugs Aciclovir

Viral Hepatitis Adefovir

Restricted to Specialist use only (Dr Gotto & Dawn Wintle), in accordance

with NICE guidelines Adefovir dipivoxil and peginterferon alfa-2a for the

treatment of chronic hepatitis B


EntecavirRestricted to Specialist use only (Dr Gotto & Dawn Wintle), in accordance

with NICE guidelines Entecavir for the treatment of chronic hepatitis B


Lamivudine Restricted to Specialist use only (Dr Gotto & Dawn Wintle)

Tenofovir


with NICE guidelines Tenofovir disoproxil for the treatment of chronic hepatitis

B


Seek Specialist advice. Donepezil, galantamine, rivastigmine and

memantine for the treatment of Alzheimer's disease in accordance with.

4.9

5.2

5.3

4.11

Chapter 5: Infections

5.1

4.8

Therapeutic Area

Microbiology recommendation only.

Drugs used in Essential Tremor,

Chorea, Tics and Related Disorders



http://ycloud/teams/InfectionControl/SitePages/Antimicrobial Guidelines.aspx

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/321891/Clostridium_difficile_management_and_treatment.pdf





Boceprevir (requires Blueteq approval)Restricted to Specialist use only (Dr Gotto & Dawn Wintle), in accordance

with NICE guidelines Boceprevir for the treatment of chronic hepatitis C.


Telaprevir (requires Blueteq approval)


with NICE guidelines Telaprevir for the treatment of genotype 1 chronic

hepatitis C


Simeprevir (requires Blueteq approval)


with NICE guidelines Simeprevir in combination with peginterferon alfa and

ribavirin for treating genotypes 1 and 4 chronic hepatitis C


Sofosbuvir (requires Blueteq approval)Restricted to Specialist use only (Dr Gotto & Dawn Wintle), in accordance

with NICE guidelines Sofosbuvir for treating chronic hepatitis C


Elbasvir/Grazoprevir (Zepatier®) (requires Blueteq approval)Restricted to Specialist use only (Dr Gotto & Dawn Wintle) in accordance with

NICE guidelines Elbasvir–grazoprevir for treating chronic hepatitis C


Sofosbuvir/Velpatasvir (Epclusa®) (requires blueteq approval)Restricted to Specialist use only (Dr Gotto & Dawn Wintle) in accordance with

NICE guidelines Sofosbuvir–velpatasvir for treating chronic hepatitis C


Glecaprevir/Pibrentasvir (Mavriet®) (requires blueteq approval)Restricted to Specialist use only (Dr Gotto & Dawn Wintle) in accordance with

NICE guidelines Glecaprevir–pibrentasvir for treating chronic hepatitis C


Sofosbuvir/Velpatasvir/Voxilaprevir (Vosevi®) (requires blueteq

approval)

Restricted to Specialist use only (Dr Gotto & Dawn Wintle) in accordance with

NICE guidelines Sofosbuvir–velpatasvir–voxilaprevir for treating chronic

hepatitis C


Respiratory Syncytial Virus Palivizumab (requires Blueteq approval) Restricted to consultant paediatricians.


6 Insulins Type 1 diabetes in adults: diagnosis and management in accordance with.

Short-acting soluble insulin www.nice.org.uk/NG17

Actrapid®

Type 2 diabetes in adults: management in accordance with

Insuman Rapid® www.nice.org.uk/guidance/ng28

Humulin S®

insulin aspart

NovoRapid®

insulin lispro

Humalog®

Insulin Lispro Sanofi® - biosimilar to Humalog

fast acting insulin aspart

FiASP®

rapid acting

Humulin R U-500 High strength unlicensed insulin: Restricted to diabetes specialists.

insulin glulisine

Apidra®

Intermediate acting isophane insulin

Insulatard®

Insuman Basal®

Humulin I®

biphasic isophane insulin

Humulin M3®

Insuman Comb®

5.3

Therapeutic Area

Chapter 6: Endocrine System









http://www.nice.org.uk/NG17

http://www.nice.org.uk/guidance/ng28

biphasic insulin aspart

NovoMix 30®

biphasic insulin lispro

Humalog Mix25®

• Long-acting insulin detemir

Levemir®

insulin glargine

Lantus® Specialist initiation only

Abasaglar® biosimilar insulin glargine Specialist initiation only

Semglee® biosimilar insulin glargine Specialist initiation only

Toujeo® high dose 300units/ml, Specialist initiation only

Glargine in combination with Lixisenatide

Suliqua Specialist initiation only

insulin degludec

Tresiba® Specialist initiation only

Degludec in combination with Liraglutide

Xultophy® Specialist initiation only

Antidiabetic Drugs

Sulphonylureas Gliclazide

Biguanides Metformin

Other Antidiabetic DrugsConsider recommending SGLT-2 inhibitors over DPP-4 inhibitors, as better

outcome data re cardiovascular outcomes and hba1c lowering.

· DPP-4 inhibitors 1st line Alogliptin

2nd line Sitagliptin

Saxagliptin

Linagliptin

Vildagliptin

· GLP-1 agonists 1st line Lixisenatide Restricted to diabetes specialists in accordance with

Type 2 diabetes in adults: management

2nd line Exenatide (Byetta or Bydureon) www.nice.org.uk/guidance/ng28

or Liraglutide (Victoza)

or Dulaglutide

Semaglutide

Liraglutide (Saxenda) specialist use only under weight management (tier 3) service for the

management of obesity and non-diabetic hyperglycaemia (pre-diabetes) in

accordance with NICE guidelines.


· SGLT-2 inhibitors ErtugliflozinRestricted to diabetes specialists Ertugliflozin as monotherapy or with

metformin for treating type 2 diabetes in accordance with.


Restricted to diabetes specialists Ertugliflozin with metformin and a dipeptidyl

peptidase-4 inhibitor for treating type 2 diabetes in accordance with.


Restricted to diabetes specialists Canagliflozin, dapagliflozin and

empagliflozin as monotherapies for treating type 2 diabetes in accordance

with.


Dapagliflozin Restricted to diabetes specialists Dapagliflozin in combination therapy for

treating type 2 diabetes in accordance with.


Restricted to diabetes specialists Dapagliflozin in triple therapy for treating

type 2 diabetes in accordance with.


Restricted to diabetes specialists Dapagliflozin with insulin for treating type 1

diabetes in accordance with.


http://www.nice.org.uk/guidance/ng28








Restricted to Cardiology Specialists Dapagliflozin for treating chronic heart

failure with reduced ejection fraction in accordance with NICE guidance


CanagliflozinRestricted to diabetes specialists Canagliflozin in combination therapy for



EmpagliflozinRestricted to diabetes specialists Empagliflozin in combination therapy for



Thyroid Hormones Levothyroxine

Antithyroid Drugs Carbimazole

Propylthiouracil

Corticosteroids Dexamethasone

Fludrocortisone

Hydrocortisone

Methylprednisolone

Prednisolone

Triamcinolone

Testosterone and Esters Sustanon 250®

Nebido®

Testogel®

Testim®

Tostran®

Testavan®

Anti-Androgens Finasteride

Hypothalamic and Pituitary

Hormones and Anti-OestrogensClomifene

Tetracosactide (Synacthen®)

Pregnyl®

Gonal-F®

Puregon®

Somatropin Specialist use only, for the treatment of children and adults with growth

failure, according to NICE guidance.



Desmotabs®

DesmoMelts®

Desmospray®

DDAVP®

Terlipressin

Drugs Affecting Bone Metabolism

Preotact® Specialist use only.

Teriparatide (Forsteo®) Specialist use only.

Bisphosphonates Bisphosphonates for treating osteoporosis in accordance with.


Alendronic AcidAlendronate, etidronate, risedronate, raloxifene and strontium ranelate

for the primary and secondary prevention of osteoporosis in accordance with.

1st line as 70mg once weekly www.nice.org.uk/TA160

Risedronate

Alendronate, etidronate, risedronate, raloxifene, strontium ranelate and

teriparatide for the secondary prevention of osteoporotic fragility fractures in

postmenopausal women in accordance with.


Ibandronic Acid

6.6

6.5

6.2

6.3

Posterior Pituitary Hormones and

Antagonists

Calcitonin and Parathyroid Hormone

6.4









Zoledronic Acid Specialist use only preferable to Ibandronic Acid IV

Strontium Ranelate

Denosumab

Denosumab is recommended in accordance with NICE guidance as a

possible treatment for preventing bone fractures in some postmenopausal

women with osteoporosis.


Specialist use only in line with NICE recommendations Denosumab is also

recommended for the prevention of skeletal-related events in adults with

bone metastases from solid tumours


Drugs Affecting Gonadotrophins Danazol

Buserelin (Suprecur®)

Goserelin Specialist use only

Triptorelin Specialist initiation only


Drugs used in Obstetrics Carboprost

Dinoprostone (Prostin E2®)

Ergometrine

Syntometrine®

Gemeprost

Oxytocin

Mifepristone

Nifedipine

Atosiban

Ritodrine

Treatment of Vaginal and Vulval

Conditions

Topical oestrogens Ortho-Gynest® pessaries

Ovestin® cream

Premarin® cream

Vagifem® vaginal tablets

Anti-fungal Clotrimazole 1% cream

Anti-infective Clindamycin 2% cream

Metronidazole 0.75% vaginal gel

7.3 Pre-operative Treatment of Uterine

FibroidsUlipristal Specialist initiation only

Drugs for Genito-Urinary Disorders

For urinary retention Doxazosin

Tamsulosin

For urinary frequency Oxybutynin oxybutynin liquid is expensive - use patches or solifenacin oral solution

Tolterodine

Darifenacin

Trospium

Propiverine

Solifenacin

Duloxetine

Fesoterodine

6.7

6.6

Therapeutic Area

7.4

7.2

7.1

Chapter 7: Obstetrics, gynaecology, and urinary tract disorders



MirabegronIn accordance with NICE guidance for treating symptoms of overactive

bladder.


Bladder instillations 1st line Cystistat®

Gepan Instill®

iAluril®Specialist use only For patients with “radiation cystitis” when treatment with

Cystistat has failed.

Pentosan polysulfate sodium Specialist use only for treating bladder pain syndrome in accordance with


For erectile dysfunction Alprostadil injection Specialist use only

Sildenafil Specialist use only

Tadalafil Specialist use only

Vardenafil Specialist use only

For premature ejaculation Dapoxetine Specialist use only


8.1 Cytotoxic Drugs

To be prescribed by Consultant Oncologists, Haematologists, Paediatric

Oncologists and Associate Specialists in oncology only, according to

approved protocols available on the MOSIAQ e-prescribing system and

following general guidance in the YDH Cytotoxic policy

Immunomodulating Drugs Natalizumab (requires Blueteq approval)Specialist use only within NICE guidance for the treatment of multiple

sclerosis.


Teriflunomide (requires Blueteq approval)Specialist use only in accordance with NICE guidance for the treatment of

multiple sclerosis (relapsing).


Alemtuzumab (requires Blueteq Approval)Specialist use only in accordance with NICE guidance for the treatment of

multiple sclerosis (relapsing-remitting).


Dimethyl Fumarate (Tecfidera®) (requires Blueteq approval)Specialist use only in accordance with NICE guidance for the treatment of

multiple sclerosis (relapsing-remitting).


CladribineSpecialist use only in accordance with NICE guidance Cladribine tablets for

treating relapsing–remitting multiple sclerosis in accordance with


Interferon beta -1a (requires Blueteq Approval)

Interferon beta -1b (requires Blueteq Approval)

Glatiramer acetate (requires Blueteq Approval) www.nice.org.uk/TA527

Siponimod (requires Blueteq Approval)Specialist use only for treating secondary progressive multiple sclerosis in

accordance with


Ocrelizumab (requires Blueteq Approval)Specialist us only in accordance with NICE guidance Ocrelizumab for treating

relapsing–remitting multiple sclerosis

www.nice.org.uk/TA533Specialist us only in accordance with NICE guidance Ocrelizumab for treating

primary progressive multiple sclerosis


Medroxyprogesterone

Megestrol

Tamoxifen

Anastrozole

Triptorelin injection

Goserelin implant

Bicalutamide Specialist initiation only

Cyproterone

Other preparations for urinary

disorders

All NICE approved technologies are noted at Medicines Committee and

automatically added to formulary

Sex hormones and hormone

antagonists in malignant disease

8.3

Chapter 8: Malignant Disease and Immunosuppression

8.2

Specialist use only in accordance with NICE guidance Beta interferons and

glatiramer acetate for treating multiple sclerosis in accordance with

Therapeutic Area

7.4












Octreotide injSpecialist use only Third-line treatment for acromegaly (second-line if patient

is unfit for surgery).


Anaemias and other blood disorders

Iron deficiency anaemias Ferrous sulphate 200mg tabs

Ferrous fumarate 210mg tabs

Fersamel® syrup

Sytron® syrup

Parenteral iron 1st line Cosmofer® inj

Monofer® inj

Ferinject® inj non-formulary for In-patients. Unless patient discharge same day or other IV

products contraindicated, by Consultant request only.

Megaloblastic anaemias Hydroxocobalamin inj

Folic acid 5mg, tabs and liquid

Erythropoietin

Specialist use only in line with NICE guidance Erythropoiesis‑stimulating

agents (epoetin and darbepoetin) for treating anaemia in people with cancer

having chemotherapy.


Darbepoetin Specialist use only

For iron overload Deferiprone Specialist use only

Desferrioxamine inj Specialist use only

For neutropenia Lenograstim specialist use only

Filgrastim specialist use only

Pegfilgrastim specialist use only

Drugs used in Platelet Disorders RomiplostimHaematologists only in accordance with NICE guidance for chronic immune

(idiopathic) thrombocytopenia purpura.


Eltrombopag Haematologists only in accordance with NICE guidance Eltrombopag for

treating chronic immune (idiopathic) thrombocytopenic purpura


Lusutrombopag Haematologists only in accordance with NICE guidance Lusutrombopag for

treating thrombocytopenia in people with chronic liver disease needing a

planned invasive procedure


Avatrombopag Haematologists only in accordance with NICE guidance Avatrombopag for

treating thrombocytopenia in people with chronic liver disease needing a

planned invasive procedure


Fluids and Electrolytes

Oral potassium Sando-K®

Kay-Cee-L syrup

Management of hyperkalaemia Calcium Resonium

Patiromer Sorbitex Calcium In accordance with NICE guidance for the treatment of hyperkalaemia


Sodium zirconium cyclosilicate In accordance with NICE guidance for the treatment of hyperkalaemia


Oral sodium Slow Sodium®

Calcium & Magnesium

Oral calcium Calcium gluconate

Oral magnesium Magnaspartate® 10mmol per sachet

CinacalcetSpecialist use only in accordance with NICE guidance for the treatment of

refractory secondary hyperparathyroidism.


Chapter 9: Nutrition and Blood

8.3

9.1

Hypoplastic, Haemolytic and Renal

anaemias

9.2

9.5

Therapeutic Area









Calcium & Vitamin D Adcal D3® preparations

TheiCal-D3

Phosphorus

Oral phosphate Phosphate-Sandoz®

Vitamins

Vitamin B group Thiamine 100mg

Pyridoxine 50mg

Vitamin B Co Strong

Pabrinex Inj

Vitamin C Ascorbic acid 50mg

Vitamin D Calcitriol capsules

Alfacalcidol capsules

Colecalciferol tablets or capsules

Vitamin K Menadiol tabs

Konakion® MM inj

Multivitamins Multivitamins

Multivitamins & minerals Forceval caps

Forceval soluble tablets


Non-steroidal anti- inflammatory

drugsIbuprofen tabs and 5% gel

Naproxen

Diclofenac

Meloxicam

Drugs that Suppress the Rheumatic

Disease ProcessHydroxychloroquine Specialist initiation only

Leflunamide Specialist initiation only

MethotrexateSpecialist initiation only. Oral doses should be prescribed using 2.5mg tablets

only.

Sulfasalazine Specialist initiation only for rheumatoid arthritis

Cytokine modulators

Biosimilar Adalimumab (Paediatric patients require blueteq approval)

Specialist Use only Adalimumab, etanercept, infliximab, certolizumab

pegol, golimumab, tocilizumab and abatacept for rheumatoid arthritis not

previously treated with DMARDs or after conventional DMARDs only have

failed in accordance with NICE guidance.


Specialist Use only Adalimumab, etanercept, infliximab, rituximab and

abatacept for the treatment of rheumatoid arthritis after the failure of a TNF

inhibitor in accordance with NICE guidance.


Biosimilar Rituximab (Paediatric patients require Blueteq approval) Specialist use only

Filgotinib (Paediatric patients require Blueteq approval)Specialist use only for treating moderate to severe rheumatoid arthritis in

accordance with NICE guidance.


Biosimilar Etanercept (Paediatric patients require Blueteq approval)

Upadacitinib (Paediatric patients require Blueteq)Specialist use only Upadacitinib for treating severe rheumatoid arthritis in

accordance with NICE guidelance.


Biosimilar Infliximab (Paediatric patients require Blueteq approval)

Tofacitinib (Paediatric patients require blueteq approval)Specialist use only Tofacitinib for moderate to severe rheumatoid arthritis in



10.1

Chapter 10: Musculoskeletal and Joint Diseases

9.5

Therapeutic Area

Rheumatoid Arthritis

9.6






Baricitinib (Paediatric patients require blueteq approval)Specialist use only Baricitinib for moderate to severe rheumatoid arthritis in



Sarilumab (Paediatric patients require blueteq approval)Specialist use only Sarilumab for moderate to severe rheumatoid arthritis in



Certolizumab (Paediatric patients require blueteq approval)

Specialist Use only Certolizumab pegol for treating rheumatoid arthritis after

inadequate response to a TNF-alpha inhibitor in accordance with NICE

guidance.


Abatacept (Paediatric patients require Blueteq approval) Specialist use only

Tocilizumab (Paediatric patients require Blueteq approval)Specialist Use only Tocilizumab for the treatment of rheumatoid arthritis in



Golimumab (Paediatric patients require blueteq approval)

Specialist use only Golimumab for the treatment of rheumatoid arthritis after

the failure of previous disease-modifying anti-rheumatic drugs in accordance

with NICE guidance.


Biosimilar Adalimumab (Paediatric patients require Blueteq approval) Specialist use only

Biosimilar Etanercept (Paediatric patients require Blueteq approval)

Specialist use only TNF-alpha inhibitors for ankylosing spondylitis and non-

radiographic axial spondyloarthritis: adalimumab, certolizumab pegol,

etanercept, golimumab and infliximab in accordance with NICE guidance.

www.nice.org.uk/ta383

Sekukinumab (Paediatric patients require Blueteq approval)

Specialist use only Secukinumab is recommended as an option for treating

active ankylosing spondylitis in adults whose disease has responded

inadequately to conventional therapy (non-steroidal anti-inflammatory drugs

or TNF‑alpha inhibitors) in accordance with NICE guidance.


Biosimilar Infliximab (Paediatric patients require Blueteq approval) Specialist use only

Certolizumab (Paediatric patients require Blueteq approval) Specialist use only

Golimumab (Paediatric patients require Blueteq approval)Specialist use only Golimumab for treating non-radiographic axial

spondyloarthritis in accordance with NICE guidance.


Biosimilar Adalimumab (Paediatric patients require Blueteq approval)Specialist use only

Biosimilar Etanercept (Paediatric patients require Blueteq approval)Specialist use only Etanercept, infliximab and adalimumab for the

treatment of psoriatic arthritis in accordance with NICE guidance.


Secukinumab (Paediatric patients require Blueteq approval)

Specialist use only Certolizumab pegol and secukinumab for treating active

psoriatic arthritis after inadequate response to DMARDs in accordance with

NICE guidance.


Tofacitinib (Paediatric patients require Blueteq approval)


Apremilast (Paediatric patients require Blueteq approval)Specialist use only Apremilast for the treatment of active Psoriatic Arthritis in



Biosimilar Infliximab (Paediatric patients require Blueteq approval) Specialist use only

Ixekizumab (Paediatric patients require Blueteq approval)


Certolizumab (Paediatric patients require Blueteq approval) Specialist use only

Golimumab (Paediatric patients require Blueteq approval)Specialist use only Golimumab for the treatment of psoriatic arthritis in



Ustekinumab (Paediatric patients require Blueteq approval)Specialist use only Ustekinumab for treating active psoriatic arthritis in



Biosimilar Rituximab (Paediatric patients require Blueteq approval)Specialist use only in accordance with NICE guidelines for the treatment

of Vasculitis in accordance with NICE guidance.


10.1

Specialist use only in accordance with NICE guidance Ixekizumab for treating

active psoriatic arthritis after inadequate response to DMARDs in accordance

with NICE guidance.

Ankylosing Spondylitis

Psoriatic Arthritis

Specialist use only in accordance with NICE guidance Tofacitinib for treating

active psoriatic arthritis after inadequate response to DMARDs in accordance

with NICE guidance.






https://www.nice.org.uk/guidance/ta383











Tocilizumab (Paediatric patients require Blueteq approval)Specialist Use only Tocilizumab for the treatment of giant cell arteritis in



Osteo Arthritis and other

inflammatory disordersHyaluronic Acid Specialist use only

Acute Attacks of Gout Naproxen

Indomethacin

Diclofenac

Colchicine

Long-Term Control of Gout Allopurinol

FebuxostatFebuxostat is recommended as an option for the management of chronic

hyperuricaemia in gout in accordance with NICE guidelines.


Skeletal Muscle Relaxants Baclofen

Diazepam


Antibacterials Chloramphenicol eyedrops, ointment & minims

Fusidic Acid eyedrops (Fucithalmic®)

Gentamicin 0.3% eyedrops

Azithromycin (eye drops)

Antivirals Aciclovir 3% eye ointment

Corticosteroids Dexamethasone & hypromellose (Maxidex®)

Dexamethasone minims

Fluorometholone eyedrops (FML®)

Prednisolone eyedrops

with antibacterials Dexamethasone, neomycin & polymyxin (Maxitrol®)

intravitreal preparation Dexamethasone implant (Ozurdex®)

Specialist use only in accordance with NICE guideline as a possible treatment

for some people with macular oedema due to retinal vein occlusion in



Specialist use only Dexamethasone is also recommended by NICE for

treating diabetic macular oedema in accordance with NICE guidance.


Fluocinolone implant (Iluvien®)

Specialist use only in accordance with NICE guideline as a possible treatment

for people with chronic diabetic macular oedema who have an artificial lens in

their eye in accordance with NICE guidance.


Biosimilar Adalimumab (All patients require Blueteq approval)

Specialist use only in accordance with NICE guideline in conjunction with

dexamethasone for treating non-infectious uveitis in accordance with NICE

guidance.


Other anti-inflammatory preparations Otrivine-Antistin® eyedrops

Olopatadine eyedrops

Ciclosporin eyedropsCiclosporin for treating dry eye disease that has not improved despite

treatment with artificial tears in accordance with NICE guidance.


Mydriatics and Cycloplegics Cyclopentolate eyedrops & minims

Mydrane®

Tropicamide minims

Phenylephrine minims

Mydriasert®

10.1

11.5

11.3

11.4

10.2

Chapter 11: Eye

Therapeutic Area








Treatment of Glaucoma

beta-blockers Timolol eyedrops for preservative free please use Eysano®

Betaxolol eyedrops

Carteolol eyedrops

Levobunolol eyedrops

prostaglandin analogues 1st line Latanoprost eyedrops

Travoprost eyedrops

Latanoprost & timolol eyedrops

sympathomimetics Brimonidine eyedrops

carbonic anhydrase inhibitors Dorzolamide 2% eyedrops for preservative free please use Eyedelto®

Dorzolamide with Timolol eyedrops for preservative free please use Eylamdo®

Acetazolamide tabs, MR caps & inj.

miotics Pilocarpine eyedrops & minims

Local Anaesthetics Oxybuprocaine (benoxinate) minims

Proxymetacaine minims

Proxymetacaine & fluorescein minims

Tetracaine minims

Ocular Lubricants Hypromellose 0.3% eyedrops

Carbomer 980 eyedrops (Viscotears®)

Liquid paraffin eye oint (Lacri-Lube®)

Polyvinyl alcohol 1.4% eyedrops (Sno Tears®)

Carmellose minims (Celluvisc®)

Ocular Diagnostic Preparations and

Peri- operative drugsFluorescein 1% minims

Fluorets 1mg strips

Apraclonidine 1% eyedrops

Diclofenac 0.1% minims

Fluorescein injection

OcriplasminSpecialist use only in accordance with NICE guideline as a possible treatment

for adults with an eye condition called vitreomacular traction.


Bromfenac Specialist use only for post-operative cystoid macular oedema

Mitomycin subconjunctival (unlicensed) Specialist use only in accordance with NICE guidelines Glaucoma: diagnosis

and management [Mitomycin and Fluorouracil]


Fluorouracil subconjunctival (unlicensed) Specialist use only

Treatment of Wet Age- related

Macular DegenerationRanibizumab

Specialist use only as an option for the treatment of wet age-related macular

degeneration as recommended by NICE.


Specialist use only Ranibizumab is also recommended as an option for

treating visual impairment due to diabetic macular oedema, in accordance

with NICE guidelines


Specialist use only Ranibizumab is also recommended as an option for

treating visual impairment caused by macular oedema in accordance with

NICE guidelines.


Specialist use only Ranibizumab is also recommended as a possible

treatment for sight problems caused by choroidal neovascularisation in

people who also have pathological myopia in accordance with NICE

guidelines.


11.8

11.6

11.7







AfliberceptSpecialist use only as an option for some people with wet age-related

macular degeneration as recommended by NICE.


Specialist use only Aflibercept is also recommended for treating choroidal

neovascularisation in accordance with NICE guidance.


Specialist use only Aflibercept is also recommended as an option for the

treatment of macular oedema (central retinal vein occlusion) in accordance

with NICE guidance.


Specialist use only Aflibercept is also recommended as an option for treating

diabetic macular oedema in accordance with NICE guidelines


Specialist use only Aflibercept is also recommended as an option for treating

visual impairment caused by macular oedema after branch retinal vein

occlusion in accordance with NICE guidance.


BrolucizumabSpecialist use only Brolucizumab for treating wet age-related macular

degeneration in accordance with NICE guidance.



Otitis Externa Locorten-Vioform®

Gentisone HC®

Otomize®

Removal of Ear Wax Olive oil

Waxsol®

Nasal Allergy 1st line Beclometasone (Beconase®)

Fluticasone furoate (Avamys®)

Nasal Staphylococci infection Naseptin® cream

Bactroban Nasal® ointment

Oral Ulceration and Inflammation Benzydamine oral rinse

Choline salicylate (Bonjela®)

Oropharyngeal Anti- infective Agents Nystatin oral suspension

Mouthwashes Chlorhexidine gluconate 0.2%

Dry Mouth BioXtra® gel spray & moisturising gel


for more information follow link:

Emollients Epimax®

Aquamax®

Exocream®

ZeroAQS®

Oilatum®

Zerobase®

Zerocream®

Ultrabase®

• oatmeal cream Epimax Oatmeal Cream® cost effective alternative to Aveeno

containing urea 1st line imuDERM emollient®

12.1

12.2

Therapeutic Area

11.8

The BAD (British Association of dermatologists) Specials recommendations have been approved for use on formulary.

https://www.bad.org.uk/shared/get-file.ashx?itemtype=document&id=6248

Therapeutic Area

2nd line

1st line

If the most cost effective choice emollients are not satisfactory for a patient, after a trial, then all other emollients remain on formulary as patient choice is an important factor in the management of

eczema and other skin conditions

13.2

Chapter 12: Ear, Nose and Oropharynx

12.3

BNF Chapter 13: Skin







https://www.bad.org.uk/shared/get-file.ashx?itemtype=document&id=6248

ClearZal® Hard Skin Remover

Dermatonics® Once Heel Balm

Flexitol® 10% Urea Cream

gels 1st line Isomol Gel®

2nd line Myribase Gel®

lotions 1st line E45® Lotion

2nd line QV® skin lotion

ointments Emulsifying ointment

White Soft Paraffin BP

Fifty:50®

Pure Health® Liquid Paraffin 50% in White Soft Paraffin ointment

Zeroderm®

aerosols Dermamist®

with Anti-microbials Dermol® 500 lotion & cream

LPL 63.4®

Dermalo®

Aquamax® Wash

Hydromol®

QV® bath oil

Zeroneum® bath oil

with Anti-microbials Dermol® 200 (shower emollient)

Dermol® 600 (bath emollient)

Dermol® wash emulsion

Emulsiderm® liquid emulsion

Oilatum Plus® bath additive

Zerolatum® Plus bath additive

Preparations containing menthol Menthol in Aqueous Cream (Arjun®) contains Aqueous cream

Topical Corticosteroids

Mildly potent 1st line Hydrocortisone 1%

2nd line Hydrocortisone 0.5%

Mildly potent with Anti-microbials Canesten HC® (hydrocortisone 1% + clotrimazole 1%)

Daktacort® (Hydrocortisone 1% + Miconazole 2%)

2nd line Terra-Cortril® (Hydrocortisone 1% + Oxytetracycline hydrochloride 3%)

Moderately potent 1st line Betamethasone valerate 0.025%

Clobetasone butyrate 0.05%

Modrasone® (Alclometasone dipropionate 0.05%)

Haelan® (Fludroxycortide 0.0125%)

Moderately potent with

Anti-microbials

Trimovate® (clobetasone butyrate 0.05%, oxytetracycline 3%, nystatin

100 000 units/g)

1st line Alphaderm® (Hydrocortisone 1% & Urea 10%)

2nd line Calmurid HC® (Hydrocortisone 1%, Urea 10% & Lactic Acid 5%)

Potent 1st line Betamethasone valerate 0.1%

Emollient Bath products NON-FORMULARY for paediatric atopic dermatitis

patients and standard management of childhood eczema

2nd line

1st line

2nd line

13.2

Emollient Bath/Shower Preparations

13.3

1st Line

Moderately potent

compound preparations

2nd line

13.4

Locoid® (Hydrocortisone butyrate 0.1%)

Diprosone® (Betamethasone Dipropionate 0.05%)

Potent with Anti-microbials Synalar C® (Clioquinol 3% / Fluocinolone acetonide 0.025%)

Synalar N® (Neomycin sulfate 0.5% / Fluocinolone acetonide 0.025%)

Lotriderm® (Betamethasone Dipropionate 0.064%/ Clotrimazole 1.0%)

Aureocort® (Chlortetracycline hydrochloride 3.09%/ triamcinolone

acetonide 0.1%)

Very Potent Clobetasol propionate 0.05%

Antipruritics 1st line Calamine

2nd line Care ViraSoothe gel

Preparations for Psoriasis

Vitamin D Analogues Calcitriol 0.0003% (Silkis®)

Calcipotriol 50mcg/g (Dovonex®)

ointments

2nd line Tacalcitol 0.0004% (Curatoderm®)

3rd line Calcipotriol 50mcg/g, betamethasone 0.5mg/g (Dovobet®)

1st line Tacalcitol 0.0004% lotion (Curatoderm®)

Calcipotriol 50mcg/g, betamethasone 0.5mg/g gel (Dovobet®) gels/lotions/solutions

Calcipotriol 50mcg/g, betamethasone 0.5mg/g cutaneous foam

(Enstilar®)

Tazarotene Tazarotene (Zorac®)

Coal Tar Preparations 1st line Psoriderm® Emulsion 40% Bath Additive

Coal tar extract 5% shampoo (Alphosyl® 2 in 1)

Coal tar extract 2% shampoo (Neutrogena T-Gel®)

Salicylic Acid Preparations Salicylic Acid BP 2% ointment

Dithranol Dithrocream®

Combined preparations Capasal® shampoo (Coal tar 1%, coconut oil 1%, salicylic acid 1%)

Psoriderm® Scalp Lotion Shampoo (Distilled Coal Tar 2.5% w/v; Lecithin

0.3% w/v)

Psoriderm® Cream (Distilled Coal Tar 6.0% w/w; Lecithin 0.4% w/w)

Meted® shampoo (Salicylic acid 3%, sulphur 5%)

Sebco® ointment (Coal tar 12%, sulfur 4%, salicylic acid 2% in coconut

oil)

Cocois® ointment (Coal tar 12%, sulfur 4%, salicylic acid 2% in coconut

oil)

Diprosalic® (Betamethasone Dipropionate 0.05% + Salicylic Acid 3%)

ointment or scalp application

Oral Preparations for Eczema AlitretinoinSpecialist use only as a treatment option for adults with severe chronic hand

eczema, in accordance with NICE guidance.


Methotrexate

Ciclosporin Specialist Use only

Pimecrolimus

Specialist initiation only Tacrolimus and pimecrolimus as an option for the

second-line treatment of moderate to severe atopic eczema in accordance

with NICE guidance.


Tacrolimus Specialist initation only

13.5

2nd line

1st line

2nd line

1st line

2nd line

2nd line

1st line

2nd line

13.4

Drugs Affecting the Immune

Response



Dimethyl Fumarate (Skilarence®)Specialist Use only Dimethyl fumarate for treating moderate to severe plaque

psoriasis in accordance with NICE guidance.


Adalimumab, etanercept and ustekinumab for treating plaque psoriasis in

children and young people in accordance with NICE guidance.


cytokine modulators Biosimilar Etanercept (Paediatric patients require Blueteq approval)Specialist use only Etanercept for the treatment of adults with plaque

psoriasis, in accordance with NICE guidance.


Biosimilar Adalimumab (Paediatric patients require Blueteq approval)Specialist use only Adalimumab for the treatment of adults with psoriasis in



Specialist use only Adalimumab is also recommended in adults for treating

moderate to severe hidradenitis suppurativa in accordance with NICE

guidance.


SecukinumabSpecialist use only Secukinumab for treating moderate to severe plaque

psoriasis in accordance with NICE guidance.


Ustekinumab (Paediatric patients require Blueteq approval)Specialist use only Ustekinumab for the treatment of adults with moderate to

severe psoriasis in accordance with NICE guidance.


Apremilast

Specialist use only Apremilast is recommended as an option for treating

chronic plaque psoriasis in adults whose disease has not responded to other

systemic therapies in accordance with NICE guidance.


Ixekizumab (Paediatric patients require Blueteq approval)Specialist use only Ixekizumab is recommended as an option for treating

plaque psoriasis in adults in accordance with NICE guidance.


Brodalumab (Paediatric patients require Blueteq approval)Specialist use only Brodalumab is recommended as an option for treating

plaque psoriasis in adults in accordance with NICE guidance.


Guselkumab (Paediatric patients require Blueteq approval)Specialist use only in line with NICE guidance Guselkumab for treating

moderate to severe plaque psoriasis


Dupilumab (Paediatric patients require Blueteq approval)Specialist use only in accordance with NICE guidance Dupilumab for treating

moderate to severe atopic dermatitis


Tildrakizumab (Paediatric patients require Blueteq approval)Specialist use only in accordance with NICE guidance Tildrakizumab for

treating moderate to severe plaque psoriasis


CertolizumabSpecialist use only in accordance with NICE guidance Tildrakizumab for



RisankizumabSpecialist use only in accordance with NICE guidance Risankizumab for



BaricitinibSpecialist use only in accordance with NICE guidance Baricitinib for treating

moderate to severe atopic dermatitis


Acne

Topical Retinoids Adapalene 0.1% (Differin®) cream or gel

Isotretinoin 0.05% (Isotrex®) gel

Topical Retinoids with benzoyl

peroxideAdapalene 0.1%, Benzoyl peroxide 2.5% (Epiduo®) gel

Tretinoin 0.025%, Clindamycin 1% (Treclin®) gel

Benzoyl peroxide 3% or 5%, Clindamycin 1% (Duac® Once daily) gel

Isotretinoin 0.05%, Erythromycin 2% (Isotrexin®) gel

Tretinoin 0.025%, Erythromycin 4% (Aknemycin Plus®) solution

Azelaic acid Azelaic acid 20% (Skinoren®) cream

Azelaic acid 15% (Finacea®) gel

13.6

13.5

Topical Retinoids with

Clindamycin

Topical Retinoids with

Erythromycin

















Benzoyl Peroxide Panoxyl®

Quinoderm® available in various strengths

Brevoxyl®

Acnecide®

Topical Erythromycin Erythromycin 40mg/ml / Zinc acetate 12mg/ml (Zineryt®) lotion

oral antibacterials Doxycycline

Lymecycline

oral hormones Co-Cyprindiol

oral retinoids Isotretinoin Specialist use only

Acitretin Specialist use only

Rosacea

Topical Metronidazole Metronidazole 0.75% w/w (Rozex® cream or gel) (Acea® gel) (Rosiced®

cream)

Topical Azelaic acid Azelaic acid 15% (Finacea®) gel

Topical Ivermectin Ivermectin 1% (Soolantra®) cream

Topical Brimonidine Brimonidine 0.33% (Mirvaso®) gel

13.7 Preparations for Warts and Calluses Salactol®

Photodamage Ingenol mebutate (Picato®)

Antibacterial Preparations Retapamulin 1% ointment

Mupirocin 2% ointment/cream

Terra-cortril ointment

Antifungal Preparations Clotrimazole 1% cream

Miconazole 2% cream

Terbinafine 1% cream

Nail Paint Amorolfine 5%

Antiviral Preparations Aciclovir 5% cream

Head Lice Treatment Permethrin 1% cream rinse

2nd line Malathion 0.5% aqueous liquid

Scabies Treatment Permethrin 5% dermal cream

2nd line Malathion 0.5% aqueous liquid

Antimuscarinic drugs Botulinum neurotoxin type A (Xeomin®) Specialist use only for treating chronic sialorrhoea in accordance with


Topical Local Anaesthetics 1st line Ametop

2nd line Lidocaine 5% ointment

Lidocaine 5% medicated plasters

3rd line Emla

13.6

15.2

13.8

13.10

15.1


medicines formulary

Documents