Medicines Formulary
Please also refer to: Somerset CCG Prescribing formulary If a drug is not listed, formulary decisions from the local CCG, relevent to the patients county of residence, are effective. Somerset CCG Prescribing Traffic lights Pan Dorset Formulary
Chapter 1: Gastro-intestinal system
Therapeutic Area Formulary Choices Restrictions and/or Advice Antacids/Alginates Gaviscon Advance 1.1
Antispasmodics Mebeverine 1.2
Helicobacter Pylori Eradication See YDH Antimicrobial Guidelines. Antimicrobial Guidelines
H2 Receptor Antagonists Ranitidine
1.3 Proton Pump Inhibitors Omeprazole Avoid omeprazole and esomeprazole in patients who are taking clopidogrel.
Lansoprazole
Esomeprazole Consultant Gastroenterologist initiation only. Acute Diarrhoea Codeine
Loperamide
1.4 Specialist initiation only Eluxadoline for treating irritable bowel syndrome with Eluxadoline 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. Specialist initiation only. For maintenance of remission of Crohn’s disease Immuno- suppressants Azathioprine and ulcerative colitis (unlicensed indication).
Specialist initiation only. For severe acute ulcerative colitis refractory to Ciclosporin corticosteroid treatment (unlicensed indication).
Specialist initiation only. For maintenance of remission of severe Crohn’s Methotrexate disease (unlicensed indication). Specialist use only In accordance with NICE guidance for the treatment of Cytokine modulators Adalimumab (paediatric patients require Blueteq approval) Crohn’s disease and ulcerative colitis. www.nice.org.uk/TA187 1.5 www.nice.org.uk/TA329
Specialist use only In accordance with NICE guidance for the treatment of Infliximab (Paediatric patients require Blueteq approval) Crohn’s disease and ulcerative colitis. www.nice.org.uk/TA187 www.nice.org.uk/TA329
Specialist use only Also for use in accordance with NICE guidelines for the treatment of acute exacerbations of ulcerative colitis. www.nice.org.uk/TA163
Specialist use only In accordance with NICE for treating moderately to Golimumab (Paediatric patients require Blueteq approval) severely active ulcerative colitis after the failure of conventional therapy. www.nice.org.uk/TA329
Specialist use only For use in accordance with NICE guidelines for the Vedolizumab (Paediatric patients require Blueteq approval) treatment of moderately to severe active ulcerative colitis. www.nice.org.uk/TA342
Specialist use only Also for treating moderately to severely active Crohn's disease after prior therapy in accordance with www.nice.org.uk/TA352 1.5
Specialist use only for moderately to severely active Crohn’s disease after Ustekinumab (Paediatric patients require Blueteq approval) previous treatment in accordance with www.nice.org.uk/TA456
Specialist use only for treating moderately to severely active ulcerative colitis in accordance with www.nice.org.uk/TA633
Specialist use only for moderately to severely active ulcerative colitis in Tofacitinib (Paediatric patients require Blueteq approval) accordance with www.nice.org.uk/TA547 Bulk-forming Laxatives Ispaghula Husk
Stimulant Laxatives Senna
Glycerin suppositories Faecal Softener Arachis Oil enema
Osmotic Laxatives Lactulose
Laxido sachets GI Specialist prescribing only in accordance with NICE guidelines for 5HT4 receptor agonists Prucalopride constipation in women. www.nice.org.uk/TA211 Prucalopride is also licensed for use in men
Linaclotide GI Specialist prescribing only 1.6 GI Specialist prescribing only in accordance with NICE guideline for treating Lubiprostone chronic idiopathic constipation. www.nice.org.uk/TA318
Naloxegol In accordance with NICE guidelines for treating opioid‑induced constipation.
www.nice.org.uk/TA345
for the treatment of opioid-induced constipation (OIC) in adult patients who Naldemedine tosylate have previously been treated with a laxative. Using same criteria as per NICE TA345 for Naloxegol Bowel Cleansing Preparations Fleet Phospho-soda
Citramag
Moviprep Haemorrhoidal Preparations Soothing agent Anusol All available as ointment and suppositories.
1.7 + corticosteroid Anusol HC
Scheriproct Preparations for Anal Fissures Rectogesic® ointment 0.4%
Drugs affecting Biliary Composition Ursodeoxycholic Acid & Flow
Specialist use only in line with Nice guidance Obeticholic acid for treating Obeticholic Acid primary biliary cholangitis. www.nice.org.uk/TA443 1.9 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.
Chapter 2: Cardiovascular System
Therapeutic Area Formulary Choices Restrictions and/or Advice Cardiac Glycosides Digoxin 2.1
Thiazide & Related Diuretics Bendroflumethiazide
Indapamide
Metolazone (unlicensed) Specialist initiation only Loop Diuretics Furosemide
Bumetanide 2.2 2.2 Potassium-sparing Diuretics Amiloride
In combination with furosemide: Co-amilofruse Aldosterone Antagonists Spironolactone
For Consultant Cardiologist initiation only, in line with the NICE Clinical Eplerenone Guidance for secondary prevention for patients in primary and secondary care after an MI. www.nice.org.uk/CG172 Anti-Arrhythmic Drugs Amiodarone
Flecainide
2.3 Sotalol
For Consultant Cardiologist/Specialist initiation only, in accordance with NICE Dronedarone guidance for the treatment of non- permanent atrial fibrillation. www.nice.org.uk/TA197 Beta-Blockers Atenolol
Bisoprolol 2.4 Metoprolol
Sotalol Alpha-Adrenoceptor Blocking Drugs Doxazosin ACE Inhibitors Ramipril
Lisinopril
Perindopril (generic only) 2.5 Angiotensin-II Receptor Antagonists Candesartan
Losartan For consultant cardiologist initiation only in accordance with NICE guidance Sacubitril/Valsartan for treating symptomatic chronic heart failure with reduced ejection fraction www.nice.org.uk/TA388 Nitrates Isosorbide mononitrate (standard and MR tablets)
GTN spray Calcium Channel Blockers Amlodipine
Lercanidipine
Different versions of modified-release preparations containing more than Diltiazem 60mg diltiazem hydrochloride may not have the same clinical effect. To avoid confusion between these different formulations of diltiazem, prescribers 1st line as Zemtard XL should specify the brand to be dispensed.
Verapamil Other Anti-Anginal Agents Nicorandil 2.6
For use in accordance with the NICE Clinical Guideline for the Management Ivabradine of Stable Angina. www.nice.org.uk/CG126
For Consultant Cardiologist or Specialist initiation only, Ivabradine is also recommended in accordance with NICE for the Treatment of Chronic Heart Failure. www.nice.org.uk/TA267
For use in accordance with the NICE Clinical Guideline for the Management Ranolazine of Stable Angina. www.nice.org.uk/CG126 Peripheral Vasodilators and related For use in accordance with NICE for the treatment of intermittent claudication Naftidrofuryl drugs in peripheral arterial disease. www.nice.org.uk/TA223 Parenteral Anticoagulants Low Molecular Weight Heparins Enoxaparin
Fondaparinux Fondaparinux For UA and NSTEMI Oral Anticoagulants Warfarin
most Edoxaban For use in accordance with NICE as an option for treating and preventing cost deep vein thrombosis and pulmonary embolism. effective www.nice.org.uk/TA354
Edoxaban is also recommended for preventing stroke and systemic embolism in adults with non-valvular atrial fibrillation in accordance with. www.nice.org.uk/TA355
2.8 Specialist use only in accordance with NICE guidance for the prevention of Dabigatran venous thromboembolic events in adults having elective total hip replacement surgery or elective total knee replacement surgery. www.nice.org.uk/TA157
Dabigatran is also recommended for stroke prevention in AF in accordance with. www.nice.org.uk/TA249
Dabigatran is also recommended for the treatment and secondary prevention of deep vein thrombosis and/or pulmonary embolism in accordance with. www.nice.org.uk/TA327
Idarucizumab : Reversal of the anticoagulant effect of dabigatran in accordance with. www.nice.org.uk/advice/esnm73
Specialist use only For use in accordance with NICE guidance for the Rivaroxaban prevention of venous thromboembolic events in adults having elective total hip replacement surgery or elective total knee replacement surgery. www.nice.org.uk/TA170
2.8 Rivaroxaban is also recommended for stroke prevention in AF, according to NICE guidelines. www.nice.org.uk/TA256
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. www.nice.org.uk/TA261
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. www.nice.org.uk/TA287
Specialist initiation only Rivaroxaban is also recommended for preventing adverse outcomes after acute management of acute coronary syndrome in accordance with. www.nice.org.uk/TA335
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. www.nice.org.uk/TA607
Apixaban is recommended in line with NICE recommendations for the Apixaban prevention of venous thromboembolism in adults after elective hip or knee replacement surgery in accordance with. www.nice.org.uk/TA245
Apixaban is also recommended for stroke prevention in AF, according to NICE guidelines in accordance with. www.nice.org.uk/TA275
Apixaban is also recommended as an option for treating and preventing recurrent deep vein thrombosis and pulmonary embolism in accordance with. www.nice.org.uk/TA341
Antiplatelet Drugs Aspirin
Myocardial infarction: cardiac rehabilitation and prevention of further Clopidogrel cardiovascular disease in accordance with. www.nice.org.uk/cg172
Unstable angina and NSTEMI: early management in accordance with. www.nice.org.uk/cg94
Together with clopidogrel, modified-release dipyridamole is recommended for Dipyridamole Retard preventing occlusive vascular events in adults in accordance with. www.nice.org.uk/TA210
Dipyridamole with aspirin (Molita®) 2.9 For Consultant Cardiologist initiation only, in accordance with NICE guidance Ticagrelor for the treatment of acute coronary syndromes. www.nice.org.uk/TA236
Ticagrelor is also recommended for preventing atherothrombotic events after myocardial infarction in accordance with. www.nice.org.uk/TA420
For Consultant Cardiologist initiation only, in accordance with NICE guidance Prasugrel for the treatment of acute coronary syndromes with percutaneous coronary intervention www.nice.org.uk/TA317 2.9
Tirofiban Specialist use only in line with NICE recommendations Alteplase use in Fibrinolytic Drugs Alteplase accordance with NICE for treating acute ischaemic stroke. 2.10 www.nice.org.uk/TA264
Tenecteplase Antifibrinolytic Drugs Tranexamic Acid 2.11
Statins Atorvastatin joint 1st line Rosuvastatin
Simvastatin joint 2nd line Pravastatin
For use in accordance with NICE for the treatment of adults with primary Other Lipid Regulating Drugs Ezetimibe 2.12 heterozygous-familial and non-familial hypercholesterolaemia www.nice.org.uk/TA385
Specialist use only For use in accordance with NICE for the treatment of Evolocumab adults with primary hypercholesterolaemia and mixed dyslipidaemia www.nice.org.uk/TA394
Specialist use only in line with NICE Alirocumab for treating primary Alirocumab hypercholesterolaemia and mixed dyslipidaemia www.nice.org.uk/TA393
Chapter 3: Respiratory System
Therapeutic Area Formulary Choices Restrictions and/or Advice Bronchodilators Salbutamol
Terbutaline
Formoterol
Salmeterol
Indacaterol
Olodaterol Antimuscarinic Bronchodilators Ipratropium
Tiotropium 3.1
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) Theophylline Aminophylline MR (Phyllocontin Continus®) Prescribe by brand. The rate of absorption from modified-release preparations can vary between Theophylline MR (Neulin SA®, slo-Phyllin®, Uniphyllin Continus®) brands. Prescribe beclometasone MDIs by brand name to avoid confusion over the Corticosteroids Beclometasone (Clenil®, Qvar®, Kelhale® or Soprobec® inhalers.) 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
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) 3.2 Fostair NEXThaler® (Beclomethasone/Formeterol ultrafine DPI) Fobumix Easyhaler® (Budesonide/formoterol DPI) Relvar Ellipta® (Fluticasone furoate/vilanterol DPI) Trelegy Ellipta® (Fluticasone furoate/Umeclidinium/Vilanterol DPI) Trimbow® (Beclometasone/Formoterol/glycopyrronium 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) 3.2
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) Stalpex® (Fluticasone/Salmeterol DPI) Fusacomb® Easyhaler (Fluticasone/Salmeterol DPI) Leukotriene Antagonists and Montelukast 3.3 Phosphodiesterase type-4 inhibitors
Specialist initiation only Roflumilast for treating chronic obstructive pulmonary Roflumilast disease in accordance with. www.nice.org.uk/TA461 Antihistamines Chlorphenamine
Loratadine
Cetirizine
Specialist initiation only in accordance with NICE guidance for the treatment Allergen Immunotherapy Omalizumab (requires Blueteq approval) of severe persistent allergic asthma OR chronic spontaneous urticaria www.nice.org.uk/TA278 www.nice.org.uk/TA339
Specialist use only following Specialist initiation at Specialist treatment centre Mepolizumab (requires Blueteq approval) as part of Hub and Spoke arrangement. For treating severe refractory eosinophilic asthma in accordance with. www.nice.org.uk/TA431
Specialist use only following Specialist initiation at Specialist treatment centre Reslizumab (requires Blueteq approval) as part of Hub and Spoke arrangement. For treating severe eosinophilic asthma in accordance with. www.nice.org.uk/TA479
Specialist use only following Specialist initiation at Specialist treatment centre Benralizumab (requires Blueteq approval) as part of Hub and Spoke arrangement. For treating severe eosinophilic asthma in accordance with. www.nice.org.uk/TA565 Benralizumab is not recommended if neither mepolizumab nor reslizumab are recommended (see NICE's technology appraisal guidance 431 and technology appraisal guidance 479). For Treatment of acute episodes of hereditary angioedema in the emergency care setting NHS England advises: utilise the non-plasma NHS England Policy: Treatment of Acute Attacks in Hereditary Angiodema Angioedema derived products conestat alfa (Ruconest®) and icatibant acetate 3.4 (Firazyr®) in line with their licensed indications as first line agents of (Adult) choice. info from Specialised Commissioning Circular 2122
First line for acute First line for Product treatment for new prophylaxis for (Brand name) patients/attacks new patients C1-esterase inhibitor × × (Berinert®) Icatibant P × (Firazyr®) Conestat alfa P P1 (Ruconest®) Lanadelumab × P (Takhzyro®) 1 Off label indication Specialist use only for Acute Treatment or Short-term prophylaxis prior to Conestat alfa (Ruconest®) planned procedures for Hereditary Angioedema and Acquired Angioedema
Specialist use only for Acute Treatment or Short-term prophylaxis prior to Icatibant planned procedures for Hereditary Angioedema and Acquired Angioedema
Specialist use only for Acute Treatment or Short-term prophylaxis prior to C1 Esterase inhibitor (Berinert®) planned procedures for Hereditary Angioedema and Acquired Angioedema NHS England Policy: C1-esterase inhibitor for prophylactic treatment of hereditary angioedema (HAE) types I and II
Specialist use only for preventing recurrent attacks of hereditary angioedema Lanadelumab in accordance with. www.nice.org.uk/TA606 Mucolytics Carbocisteine 3.7 Acetylcysteine effervescent tablets Respiratory Consultants Initiation only in accordance with NICE guidance for Antifibrotics Pirfenidone 3.11 the treatment of idiopathic pulmonary fibrosis (IPF). www.nice.org.uk/TA504 Chapter 4: Central Nervous System
Therapeutic Area Formulary Choices Restrictions and/or Advice Hypnotics Zolpidem Hypnotics should only be prescribed regularly (and added to a TTO) for 1st line patients who take them regularly at home. Zopiclone
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 2nd line Melatonin prolonged release (Circadin®) who drive and are susceptible to next-day drowsiness of z-drugs and 4.1 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. 4.2
Antidepressants Citalopram
4.3 Fluoxetine
Sertraline Methylphenidate, atomoxetine and dexamfetamine for the treatment of Drugs used for ADHD children and adolescents with ADHD in accordance with. www.nice.org.uk/TA98
Methylphenidate (Medikinet®, Equasym® and Xaggatin®, Matoride®, Paediatric specialist initiation only, Delmosart®, Concerta®) 4.4 Atomoxetine Paediatric specialist initiation only,
Lisdexamfetamine Paediatric specialist initiation only,
Guanfacine Paediatric specialist consultant only, Antiemetic Drugs Cyclizine n.b. IV restricted use due to cost.
Metoclopramide
Domperidone 4.6 4mg and 8mg tablets only as second line treatment of N&V in pregnancy or Ondansetron 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 To provide flexible dosing and to improve patient safety, do not prescribe as the fixed combination co-codamol 30/500.
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 4.7 Oxycodone Restricted to second line use if morphine is ineffective/not tolerated.
Targinact® Restricted to initiation by gastroenterology consultant /pain control team.
Restricted for use within the hip and knee replacement surgery pathway OR Tapentadol on recommendation of the pain control team
Neuropathic pain in adults: pharmacological management in accordance Neuropathic Pain Amitriptyline with. www.nice.org.uk/cg173 Gabapentin
Pregabalin prescribe as generic
Duloxetine Specialist use only for the prevention of headaches in adults with chronic Prophylaxis of migraine Botulinum toxin type A (Botox®) migraine in accordance with. www.nice.org.uk/TA260
Fremanezumab Specialist use only for preventing migraine in adults in accordance with www.nice.org.uk/TA631 Antiepileptic Drugs Carbamazepine Epilepsies: diagnosis and management in accordance with. www.nice.org.uk/CG137 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.
4.8 Levetiracetam Seek Specialist advice.
Eslicarbazepine Seek Specialist advice.
Perampanel Seek Specialist advice.
Seek Specialist advice. Retigabine is recommended as adjunctive treatment Retigabine for partial onset seizures with or without secondary generalisation in some people with epilepsy, in accordance with NICE. www.nice.org.uk/TA232
Zonisamide Seek Specialist advice.
last line Brivaracetam Specialist initiation only
Parkinsons Drugs Co-Beneldopa
Co-Careldopa
Pramipexole Seek Specialist advice.
Ropinirole Seek Specialist advice. 4.9 Entacapone/levodopa/carbidopa (Sastravi®) Seek Specialist advice.
2nd line Opicapone Seek Specialist advice. Seek Specialist advice. For use in accordance with NICE for the treatment of Drugs used in Essential Tremor, Riluzole the ALS form of Motor Neurone Disease. Chorea, Tics and Related Disorders www.nice.org.uk/TA20
Drugs for Dementia Donepezil Seek Specialist advice. Donepezil, galantamine, rivastigmine and memantine for the treatment of Alzheimer's disease in accordance with.
Galantamine www.nice.org.uk/TA217 4.11 Rivastigmine
Memantine
Chapter 5: Infections
Therapeutic Area Formulary Choices Restrictions and/or Advice Antibacterial Drugs See YDH Antimicrobial Guidelines. Antimicrobial Guidelines
Fosfomycin 1st line for UTI
Temocillin Microbiology recommendation only
Tigecycline Microbiology recommendation only 5.1 Timentin Microbiology recommendation only
Microbiology recommendation only. For the treatment of Clostridium difficile Fidaxomicin infection in line with Public Health England Guidance May 2013. PHE 2013 Clostridium difficile management and treatment.pdf
Restricted to Gastroentrology team use only in accordance with NICE Rifaximin (Targaxan®) guidance for preventing episodes of overt hepatic encephalopathy. www.nice.org.uk/TA337 Antifungal Drugs Oral candidiasis 1st line Nystatin mouthwash
2nd line Fluconazole
5.2 Vaginal candidiasis 1st line Clotrimazole pessary
2nd line Fluconazole 5.2 Systemic infections Fluconazole
Amphotericin (AmBisome®)
Anidulafungin Microbiology recommendation only.
Micafungin
Voriconazole Antiviral Drugs Aciclovir
Restricted to Specialist use only (Dr Gotto & Dawn Wintle), in accordance Viral Hepatitis Adefovir with NICE guidelines Adefovir dipivoxil and peginterferon alfa-2a for the treatment of chronic hepatitis B www.nice.org.uk/TA96
Restricted to Specialist use only (Dr Gotto & Dawn Wintle), in accordance Entecavir with NICE guidelines Entecavir for the treatment of chronic hepatitis B www.nice.org.uk/TA153
Lamivudine Restricted to Specialist use only (Dr Gotto & Dawn Wintle)
Restricted to Specialist use only (Dr Gotto & Dawn Wintle), in accordance Tenofovir with NICE guidelines Tenofovir disoproxil for the treatment of chronic hepatitis B www.nice.org.uk/TA173
Restricted to Specialist use only (Dr Gotto & Dawn Wintle), in accordance Boceprevir (requires Blueteq approval) with NICE guidelines Boceprevir for the treatment of chronic hepatitis C. www.nice.org.uk/TA253
Restricted to Specialist use only (Dr Gotto & Dawn Wintle), in accordance Telaprevir (requires Blueteq approval) with NICE guidelines Telaprevir for the treatment of genotype 1 chronic hepatitis C www.nice.org.uk/TA252
5.3 Restricted to Specialist use only (Dr Gotto & Dawn Wintle), in accordance Simeprevir (requires Blueteq approval) with NICE guidelines Simeprevir in combination with peginterferon alfa and ribavirin for treating genotypes 1 and 4 chronic hepatitis C www.nice.org.uk/TA331
Restricted to Specialist use only (Dr Gotto & Dawn Wintle), in accordance Sofosbuvir (requires Blueteq approval) with NICE guidelines Sofosbuvir for treating chronic hepatitis C www.nice.org.uk/TA330
Restricted to Specialist use only (Dr Gotto & Dawn Wintle) in accordance with Elbasvir/Grazoprevir (Zepatier®) (requires Blueteq approval) NICE guidelines Elbasvir–grazoprevir for treating chronic hepatitis C www.nice.org.uk/TA413
Restricted to Specialist use only (Dr Gotto & Dawn Wintle) in accordance with Sofosbuvir/Velpatasvir (Epclusa®) (requires blueteq approval) NICE guidelines Sofosbuvir–velpatasvir for treating chronic hepatitis C www.nice.org.uk/TA430
Restricted to Specialist use only (Dr Gotto & Dawn Wintle) in accordance with Glecaprevir/Pibrentasvir (Mavriet®) (requires blueteq approval) NICE guidelines Glecaprevir–pibrentasvir for treating chronic hepatitis C www.nice.org.uk/TA499
Restricted to Specialist use only (Dr Gotto & Dawn Wintle) in accordance with Sofosbuvir/Velpatasvir/Voxilaprevir (Vosevi®) (requires blueteq NICE guidelines Sofosbuvir–velpatasvir–voxilaprevir for treating chronic approval) hepatitis C www.nice.org.uk/TA507
Respiratory Syncytial Virus Palivizumab (requires Blueteq approval) Restricted to consultant paediatricians.
Chapter 6: Endocrine System
Therapeutic Area Formulary Choices Restrictions and/or Advice 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®
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 Consider recommending SGLT-2 inhibitors over DPP-4 inhibitors, as better Other Antidiabetic Drugs 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 for Type 2 diabetes in adults: management in accordance with 2nd line Exenatide (Byetta or Bydureon) www.nice.org.uk/guidance/ng28
or Liraglutide
or Dulaglutide
Semaglutide Restricted to diabetes specialists Ertugliflozin as monotherapy or with · SGLT-2 inhibitors Ertugliflozin metformin for treating type 2 diabetes in accordance with. www.nice.org.uk/TA572
Restricted to diabetes specialists Ertugliflozin with metformin and a dipeptidyl peptidase-4 inhibitor for treating type 2 diabetes in accordance with. www.nice.org.uk/TA583
Restricted to diabetes specialists Canagliflozin, dapagliflozin and empagliflozin as monotherapies for treating type 2 diabetes in accordance with. www.nice.org.uk/TA390
Restricted to diabetes specialists Dapagliflozin in combination therapy for Dapagliflozin treating type 2 diabetes in accordance with. www.nice.org.uk/TA288
Restricted to diabetes specialists Dapagliflozin in triple therapy for treating type 2 diabetes in accordance with. www.nice.org.uk/TA418
Restricted to diabetes specialists Dapagliflozin with insulin for treating type 1 diabetes in accordance with. www.nice.org.uk/TA597
Restricted to diabetes specialists Canagliflozin in combination therapy for Canagliflozin treating type 2 diabetes in accordance with. www.nice.org.uk/TA315
Restricted to diabetes specialists Empagliflozin in combination therapy for Empagliflozin treating type 2 diabetes in accordance with. www.nice.org.uk/TA336
Thyroid Hormones Levothyroxine
6.2 Antithyroid Drugs Carbimazole
Propylthiouracil Corticosteroids Dexamethasone
Fludrocortisone
Hydrocortisone 6.3 Methylprednisolone
Prednisolone
Triamcinolone Testosterone and Esters Sustanon 250®
Nebido®
Testogel®
6.4 Testim®
Tostran®
Testavan® Anti-Androgens Finasteride Hypothalamic and Pituitary Clomifene Hormones and Anti-Oestrogens
Tetracosactide (Synacthen®)
Pregnyl®
Gonal-F®
Puregon®
6.5 Somatropin Specialist use only, for the treatment of children and adults with growth failure, according to NICE guidance. www.nice.org.uk/TA188 www.nice.org.uk/TA64 Posterior Pituitary Hormones and Desmotabs® Antagonists DesmoMelts®
Desmospray®
DDAVP® 6.5
Terlipressin Drugs Affecting Bone Metabolism Preotact® Specialist use only. Calcitonin and Parathyroid Hormone
Teriparatide (Forsteo®) Specialist use only.
Bisphosphonates Bisphosphonates for treating osteoporosis in accordance with. www.nice.org.uk/TA464
Alendronate, etidronate, risedronate, raloxifene and strontium ranelate Alendronic Acid for the primary and secondary prevention of osteoporosis in accordance with. 1st line as 70mg once weekly www.nice.org.uk/TA160
Alendronate, etidronate, risedronate, raloxifene, strontium ranelate and Risedronate teriparatide for the secondary prevention of osteoporotic fragility fractures in postmenopausal women in accordance with. 6.6 www.nice.org.uk/TA161 Ibandronic Acid
Zoledronic Acid Specialist use only preferable to Ibandronic Acid IV
Strontium Ranelate
Denosumab is recommended in accordance with NICE guidance as a Denosumab possible treatment for preventing bone fractures in some postmenopausal women with osteoporosis. www.nice.org.uk/TA204
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 www.nice.org.uk/TA265
Drugs Affecting Gonadotrophins Danazol
Buserelin (Suprecur®) 6.7 Goserelin Specialist use only
Triptorelin Specialist initiation only
Chapter 7: Obstetrics, gynaecology, and urinary tract disorders
Therapeutic Area Formulary Choices Restrictions and/or Advice Drugs used in Obstetrics Carboprost
Dinoprostone (Prostin E2®)
Ergometrine
Syntometrine®
Gemeprost 7.1 Oxytocin
Mifepristone
Nifedipine
Atosiban
Ritodrine Treatment of Vaginal and Vulval Conditions Topical oestrogens Ortho-Gynest® pessaries
Ovestin® cream
Premarin® cream 7.2 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 Ulipristal Specialist initiation only Fibroids Drugs for Genito-Urinary Disorders For urinary retention Doxazosin
Tamsulosin
7.4 For urinary frequency Oxybutynin oxybutynin liquid is expensive - use patches or solifenacin oral solution
Tolterodine
Darifenacin
Trospium
Propiverine
Solifenacin
Duloxetine
Fesoterodine
7.4 In accordance with NICE guidance for treating symptoms of overactive Mirabegron bladder. www.nice.org.uk/TA290
Bladder instillations 1st line Cystistat®
Gepan Instill®
Specialist use only For patients with “radiation cystitis” when treatment with iAluril® Cystistat has failed.
Other preparations for urinary Pentosan polysulfate sodium Specialist use only for treating bladder pain syndrome in accordance with disorders www.nice.org.uk/TA610
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
Chapter 8: Malignant Disease and Immunosuppression
Therapeutic Area Formulary Choices Restrictions and/or Advice To be prescribed by Consultant Oncologists, Haematologists, Paediatric All NICE approved technologies are noted at Medicines Committee and Oncologists and Associate Specialists in oncology only, according to 8.1 Cytotoxic Drugs automatically added to formulary approved protocols available on the MOSIAQ e-prescribing system and following general guidance in the YDH Cytotoxic policy Specialist use only within NICE guidance for the treatment of multiple Immunomodulating Drugs Natalizumab (requires Blueteq approval) sclerosis. www.nice.org.uk/TA127
Specialist use only in accordance with NICE guidance for the treatment of Teriflunomide (requires Blueteq approval) multiple sclerosis (relapsing). www.nice.org.uk/TA303
Specialist use only in accordance with NICE guidance for the treatment of Alemtuzumab (requires Blueteq Approval) multiple sclerosis (relapsing-remitting). www.nice.org.uk/TA312
Specialist use only in accordance with NICE guidance for the treatment of Dimethyl Fumarate (Tecfidera®) (requires Blueteq approval) 8.2 multiple sclerosis (relapsing-remitting). www.nice.org.uk/TA320
Specialist use only in accordance with NICE guidance Cladribine tablets for Cladribine treating relapsing–remitting multiple sclerosis in accordance with www.nice.org.uk/TA616
Interferon beta -1a (requires Blueteq Approval) Specialist use only in accordance with NICE guidance Beta interferons and Interferon beta -1b (requires Blueteq Approval) glatiramer acetate for treating multiple sclerosis Glatiramer acetate (requires Blueteq Approval) www.nice.org.uk/TA527
Specialist us only in accordance with NICE guidance Ocrelizumab for treating Ocrelizumab (requires Blueteq Approval) relapsing–remitting multiple sclerosis www.nice.org.uk/TA533 Specialist us only in accordance with NICE guidance Ocrelizumab for treating primary progressive multiple sclerosis www.nice.org.uk/TA585 Sex hormones and hormone Medroxyprogesterone antagonists in malignant disease Megestrol
8.3 Tamoxifen
Anastrozole
8.3 Triptorelin injection
Goserelin implant
Bicalutamide Specialist initiation only
Cyproterone
Specialist use only Third-line treatment for acromegaly (second-line if patient Octreotide inj is unfit for surgery).
Chapter 9: Nutrition and Blood
Therapeutic Area Formulary Choices Restrictions and/or Advice 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
Specialist use only in line with NICE guidance Erythropoiesis‑stimulating Hypoplastic, Haemolytic and Renal Erythropoietin agents (epoetin and darbepoetin) for treating anaemia in people with cancer anaemias having chemotherapy. www.nice.org.uk/TA323 9.1 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 Haematologists only in accordance with NICE guidance for chronic immune Drugs used in Platelet Disorders Romiplostim (idiopathic) thrombocytopenia purpura. www.nice.org.uk/TA221
Eltrombopag Haematologists only in accordance with NICE guidance Eltrombopag for treating chronic immune (idiopathic) thrombocytopenic purpura www.nice.org.uk/TA293
Lusutrombopag Haematologists only in accordance with NICE guidance Lusutrombopag for treating thrombocytopenia in people with chronic liver disease needing a planned invasive procedure www.nice.org.uk/TA617
Fluids and Electrolytes Oral potassium Sando-K®
Kay-Cee-L syrup
Management of hyperkalaemia Calcium Resonium 9.2 Patiromer Sorbitex Calcium In accordance with NICE guidance for the treatment of hyperkalaemia www.nice.org.uk/TA623
Sodium zirconium cyclosilicate In accordance with NICE guidance for the treatment of hyperkalaemia www.nice.org.uk/TA599
Oral sodium Slow Sodium® Calcium & Magnesium Oral calcium Calcium gluconate
9.5 Oral magnesium Magnaspartate® 10mmol per sachet
Specialist use only in accordance with NICE guidance for the treatment of Cinacalcet refractory secondary hyperparathyroidism. 9.5 www.nice.org.uk/TA117
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 9.6
Colecalciferol tablets or capsules
Vitamin K Menadiol tabs
Konakion® MM inj
Multivitamins Multivitamins
Multivitamins & minerals Forceval caps
Forceval soluble tablets
Chapter 10: Musculoskeletal and Joint Diseases
Therapeutic Area Formulary Choices Restrictions and/or Advice Non-steroidal anti- inflammatory Ibuprofen tabs and 5% gel drugs
Naproxen
Diclofenac
Meloxicam Drugs that Suppress the Rheumatic Hydroxychloroquine Specialist initiation only Disease Process
Leflunamide Specialist initiation only
Specialist initiation only. Oral doses should be prescribed using 2.5mg tablets Methotrexate only.
Sulfasalazine Specialist initiation only for rheumatoid arthritis
Cytokine modulators Rheumatoid Arthritis Specialist Use only Adalimumab, etanercept, infliximab, certolizumab pegol, golimumab, tocilizumab and abatacept for rheumatoid arthritis not 1st line Biosimilar Etanercept (Paediatric patients require Blueteq approval) previously treated with DMARDs or after conventional DMARDs only have failed in accordance with NICE guidance. www.nice.org.uk/TA375 1st line Biosimilar Infliximab (Paediatric patients require Blueteq approval) 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. www.nice.org.uk/TA195
Specialist use only Baricitinib for moderate to severe rheumatoid arthritis in 1st line Baricitinib (Paediatric patients require blueteq approval) accordance with NICE guidance. www.nice.org.uk/TA466
Biosimilar Rituximab (Paediatric patients require Blueteq approval) Specialist use only
Specialist Use only Certolizumab pegol for treating rheumatoid arthritis after 4th line Certolizumab (Paediatric patients require blueteq approval) inadequate response to a TNF-alpha inhibitor in accordance with NICE guidance. www.nice.org.uk/TA415
10.1 Specialist use only Golimumab for the treatment of rheumatoid arthritis after 4th line Golimumab (Paediatric patients require blueteq approval) the failure of previous disease-modifying anti-rheumatic drugs in accordance with NICE guidance. www.nice.org.uk/TA225
Specialist use only Tofacitinib for moderate to severe rheumatoid arthritis in 4th line Tofacitinib (Paediatric patients require blueteq approval) accordance with NICE guidance. www.nice.org.uk/TA480
Specialist use only Sarilumab for moderate to severe rheumatoid arthritis in 4th line Sarilumab (Paediatric patients require blueteq approval) accordance with NICE guidance. www.nice.org.uk/TA485
5th line Adalimumab (Paediatric patients require blueteq approval) Specialist use only
Specialist Use only Tocilizumab for the treatment of rheumatoid arthritis in 6th line Tocilizumab (Paediatric patients require Blueteq approval) accordance with NICE guidance. www.nice.org.uk/TA247
7th line Abatacept (Paediatric patients require Blueteq approval) Specialist use only
Ankylosing Spondylitis
Specialist use only TNF-alpha inhibitors for ankylosing spondylitis and non- Etanercept (Paediatric patients require Blueteq approval) radiographic axial spondyloarthritis: adalimumab, certolizumab pegol, etanercept, golimumab and infliximab in accordance with NICE guidance. www.nice.org.uk/ta383
Adalimumab (Paediatric patients require Blueteq approval) Specialist use only
Specialist use only Golimumab for treating non-radiographic axial 10.1 Golimumab (Paediatric patients require Blueteq approval) spondyloarthritis in accordance with NICE guidance. www.nice.org.uk/TA497
Certolizumab (Paediatric patients require Blueteq approval) Specialist use only
Infliximab (Paediatric patients require Blueteq approval) Specialist use only
Specialist use only Secukinumab is recommended as an option for treating active ankylosing spondylitis in adults whose disease has responded Sekukinumab (Paediatric patients require Blueteq approval) inadequately to conventional therapy (non-steroidal anti-inflammatory drugs or TNF‑alpha inhibitors) in accordance with NICE guidance. www.nice.org.uk/TA407
Psoriatic Arthritis Specialist use only Etanercept, infliximab and adalimumab for the Etanercept (Paediatric patients require Blueteq approval) treatment of psoriatic arthritis in accordance with NICE guidance. www.nice.org.uk/TA199
Adalimumab (Paediatric patients require Blueteq approval) Specialist use only
Infliximab (Paediatric patients require Blueteq approval) Specialist use only
Specialist use only Golimumab for the treatment of psoriatic arthritis in Golimumab (Paediatric patients require Blueteq approval) accordance with NICE guidance. www.nice.org.uk/TA220
Certolizumab (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. Secukinumab (Paediatric patients require Blueteq approval) www.nice.org.uk/TA445
Specialist use only Ustekinumab for treating active psoriatic arthritis in Ustekinumab (Paediatric patients require Blueteq approval) accordance with NICE guidance. www.nice.org.uk/TA340
Specialist use only Apremilast for the treatment of active Psoriatic Arthritis in Apremilast (Paediatric patients require Blueteq approval) accordance with NICE guidance. www.nice.org.uk/TA433
Ixekizumab (Paediatric patients require Blueteq approval) Specialist use only in accordance with NICE guidance Ixekizumab for treating active psoriatic arthritis after inadequate response to DMARDs in accordance with NICE guidance. www.nice.org.uk/TA537
Tofacitinib (Paediatric patients require Blueteq approval) Specialist use only in accordance with NICE guidance Tofacitinib for treating active psoriatic arthritis after inadequate response to DMARDs in accordance with NICE guidance. www.nice.org.uk/TA543 Specialist use only in accordance with NICE guidelines for the treatment Rituximab (Paediatric patients require Blueteq approval) of Vasculitis in accordance with NICE guidance. www.nice.org.uk/TA308
Specialist Use only Tocilizumab for the treatment of giant cell arteritis in Tocilizumab (Paediatric patients require Blueteq approval) accordance with NICE guidance. www.nice.org.uk/TA518 10.1
Osteo Arthritis and other Hyaluronic Acid Specialist use only inflammatory disorders
Acute Attacks of Gout Naproxen
Indomethacin
Diclofenac
Colchicine Long-Term Control of Gout Allopurinol
Febuxostat is recommended as an option for the management of chronic Febuxostat hyperuricaemia in gout in accordance with NICE guidelines. www.nice.org.uk/TA164 Skeletal Muscle Relaxants Baclofen 10.2 Diazepam
Chapter 11: Eye
Therapeutic Area Formulary Choices Restrictions and/or Advice Antibacterials Chloramphenicol eyedrops, ointment & minims
Fusidic Acid eyedrops (Fucithalmic®)
11.3 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®)
Specialist use only in accordance with NICE guideline as a possible treatment intravitreal preparation Dexamethasone implant (Ozurdex®) for some people with macular oedema due to retinal vein occlusion in accordance with NICE guidance. www.nice.org.uk/TA229
Specialist use only Dexamethasone is also recommended by NICE for treating diabetic macular oedema in accordance with NICE guidance. www.nice.org.uk/TA349 11.4 Specialist use only in accordance with NICE guideline as a possible treatment Fluocinolone implant (Iluvien®) for people with chronic diabetic macular oedema who have an artificial lens in their eye in accordance with NICE guidance. www.nice.org.uk/TA301
Specialist use only in accordance with NICE guideline in conjunction with Adalimumab (All patients require Blueteq approval) dexamethasone for treating non-infectious uveitis in accordance with NICE guidance. www.nice.org.uk/TA460
Otrivine-Antistin® eyedrops Other anti-inflammatory preparations
Olopatadine eyedrops
Ciclosporin for treating dry eye disease that has not improved despite Ciclosporin eyedrops treatment with artificial tears in accordance with NICE guidance. www.nice.org.uk/TA369 Mydriatics and Cycloplegics Cyclopentolate eyedrops & minims
Mydrane®
11.5 Tropicamide minims
Phenylephrine minims
Mydriasert® Treatment of Glaucoma beta-blockers Timolol eyedrops for preservative free please use Eysano®
Betaxolol eyedrops
Carteolol eyedrops
Levobunolol eyedrops
11.6 prostaglandin analogues 1st line Latanoprost eyedrops
Travoprost eyedrops 11.6
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 11.7 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 Fluorescein 1% minims Peri- operative drugs
Fluorets 1mg strips
Apraclonidine 1% eyedrops
Diclofenac 0.1% minims
Fluorescein injection
Specialist use only in accordance with NICE guideline as a possible treatment Ocriplasmin for adults with an eye condition called vitreomacular traction. www.nice.org.uk/TA297
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] www.nice.org.uk/CG85
Fluorouracil subconjunctival (unlicensed) Specialist use only
11.8 Treatment of Wet Age- related Specialist use only as an option for the treatment of wet age-related macular Ranibizumab Macular Degeneration degeneration as recommended by NICE. www.nice.org.uk/TA155
Specialist use only Ranibizumab is also recommended as an option for treating visual impairment due to diabetic macular oedema, in accordance with NICE guidelines www.nice.org.uk/TA274
Specialist use only Ranibizumab is also recommended as an option for treating visual impairment caused by macular oedema in accordance with NICE guidelines. www.nice.org.uk/TA283
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. www.nice.org.uk/TA298 11.8
Specialist use only as an option for some people with wet age-related Aflibercept macular degeneration as recommended by NICE. www.nice.org.uk/TA294
Specialist use only Aflibercept is also recommended for treating choroidal neovascularisation in accordance with NICE guidance. www.nice.org.uk/TA486
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. www.nice.org.uk/TA305
Specialist use only Aflibercept is also recommended as an option for treating diabetic macular oedema in accordance with NICE guidelines www.nice.org.uk/TA346
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. www.nice.org.uk/TA409
Chapter 12: Ear, Nose and Oropharynx
Therapeutic Area Formulary Choices Restrictions and/or Advice Otitis Externa Locorten-Vioform®
Gentisone HC®
12.1 Otomize® Removal of Ear Wax Olive oil
Waxsol® Nasal Allergy 1st line Beclometasone (Beconase®)
Fluticasone furoate (Avamys®) 12.2 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 12.3 Mouthwashes Chlorhexidine gluconate 0.2%
Dry Mouth BioXtra® gel spray & moisturising gel
BNF Chapter 13: Skin
Therapeutic Area Formulary Choices Restrictions and/or Advice
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
The BAD (British Association of dermatologists) Specials recommendations have been approved for use on formulary. for more information follow link: http://www.bad.org.uk/shared/get-file.ashx?itemtype=document&id=1848 Emollients Epimax®
Aquamax®
1st line Exocream®
ZeroAQS®
Oilatum®
Zerobase®
2nd line Zerocream®
Ultrabase®
• oatmeal cream Epimax Oatmeal Cream® cost effective alternative to Aveeno
containing urea 1st line imuDERM emollient®
ClearZal® Hard Skin Remover
2nd line Dermatonics® Once Heel Balm
Flexitol® 10% Urea Cream
13.2 gels 1st line Isomol Gel®
2nd line Myribase Gel®
lotions 1st line E45® Lotion
2nd line QV® skin lotion
ointments Emulsifying ointment 13.2 1st line White Soft Paraffin BP
Fifty:50®
2nd line Pure Health® Liquid Paraffin 50% in White Soft Paraffin ointment
Zeroderm®
aerosols Dermamist®
with Anti-microbials Dermol® 500 lotion & cream
LPL 63.4® Emollient Bath/Shower Preparations Emollient Bath products NON-FORMULARY for paediatric atopic dermatitis Dermalo® patients and standard management of childhood eczema
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 13.3
Topical Corticosteroids Mildly potent 1st line Hydrocortisone 1%
2nd line Hydrocortisone 0.5%
Mildly potent with Anti-microbials Canesten HC® (hydrocortisone 1% + clotrimazole 1%) 1st Line 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%
2nd line Modrasone® (Alclometasone dipropionate 0.05%)
Haelan® (Fludroxycortide 0.0125%)
Moderately potent with Trimovate® (clobetasone butyrate 0.05%, oxytetracycline 3%, nystatin Anti-microbials 100 000 units/g) 13.4 Moderately potent 1st line Alphaderm® (Hydrocortisone 1% & Urea 10%) compound preparations 2nd line Calmurid HC® (Hydrocortisone 1%, Urea 10% & Lactic Acid 5%)
Potent 1st line Betamethasone valerate 0.1%
Locoid® (Hydrocortisone butyrate 0.1%) 2nd line Diprosone® (Betamethasone Dipropionate 0.05%)
Potent with Anti-microbials Synalar C® (Clioquinol 3% / Fluocinolone acetonide 0.025%) 1st line Synalar N® (Neomycin sulfate 0.5% / Fluocinolone acetonide 0.025%) 13.4
Lotriderm® (Betamethasone Dipropionate 0.064%/ Clotrimazole 1.0%) 2nd line 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®) 1st line 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 2nd line 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) 2nd line 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; 1st line 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) 2nd line 13.5 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
Specialist use only as a treatment option for adults with severe chronic hand Oral Preparations for Eczema Alitretinoin eczema, in accordance with NICE guidance. www.nice.org.uk/TA177
Drugs Affecting the Immune Methotrexate Response Ciclosporin Specialist Use only
Specialist initiation only Tacrolimus and pimecrolimus as an option for the Pimecrolimus second-line treatment of moderate to severe atopic eczema in accordance with NICE guidance. www.nice.org.uk/TA82
Tacrolimus Specialist initation only
Specialist Use only Dimethyl fumarate for treating moderate to severe plaque Dimethyl Fumarate (Skilarence®) psoriasis in accordance with NICE guidance. www.nice.org.uk/TA475 13.5
Adalimumab, etanercept and ustekinumab for treating plaque psoriasis in children and young people in accordance with NICE guidance. www.nice.org.uk/TA455
Specialist use only Etanercept for the treatment of adults with plaque cytokine modulators Etanercept (Paediatric patients require Blueteq approval) psoriasis, in accordance with NICE guidance. www.nice.org.uk/TA103
Specialist use only Adalimumab for the treatment of adults with psoriasis in Adalimumab (Paediatric patients require Blueteq approval) accordance with NICE guidance. www.nice.org.uk/TA146
Specialist use only Adalimumab is also recommended in adults for treating moderate to severe hidradenitis suppurativa in accordance with NICE guidance. www.nice.org.uk/TA392
Specialist use only Secukinumab for treating moderate to severe plaque Secukinumab psoriasis in accordance with NICE guidance. www.nice.org.uk/TA350
Specialist use only Ustekinumab for the treatment of adults with moderate to Ustekinumab (Paediatric patients require Blueteq approval) severe psoriasis in accordance with NICE guidance. www.nice.org.uk/TA180
Specialist use only Apremilast is recommended as an option for treating Apremilast chronic plaque psoriasis in adults whose disease has not responded to other systemic therapies in accordance with NICE guidance. www.nice.org.uk/TA419
Specialist use only Ixekizumab is recommended as an option for treating Ixekizumab (Paediatric patients require Blueteq approval) plaque psoriasis in adults in accordance with NICE guidance. www.nice.org.uk/TA442
Specialist use only Brodalumab is recommended as an option for treating Brodalumab (Paediatric patients require Blueteq approval) plaque psoriasis in adults in accordance with NICE guidance. www.nice.org.uk/TA511
Specialist use only in line with NICE guidance Guselkumab for treating Guselkumab (Paediatric patients require Blueteq approval) moderate to severe plaque psoriasis www.nice.org.uk/TA521
Specialist use only in accordance with NICE guidance Dupilumab for treating Dupilumab (Paediatric patients require Blueteq approval) moderate to severe atopic dermatitis www.nice.org.uk/TA534
Specialist use only in accordance with NICE guidance Tildrakizumab for Tildrakizumab (Paediatric patients require Blueteq approval) treating moderate to severe plaque psoriasis www.nice.org.uk/TA575
Specialist use only in accordance with NICE guidance Tildrakizumab for Certolizumab treating moderate to severe plaque psoriasis www.nice.org.uk/TA534
Specialist use only in accordance with NICE guidance Risankizumab for Risankizumab treating moderate to severe plaque psoriasis www.nice.org.uk/TA596
Acne Topical Retinoids Adapalene 0.1% (Differin®) cream or gel
Isotretinoin 0.05% (Isotrex®) gel
Topical Retinoids with benzoyl Adapalene 0.1%, Benzoyl peroxide 2.5% (Epiduo®) gel peroxide
Topical Retinoids with Tretinoin 0.025%, Clindamycin 1% (Treclin®) gel Clindamycin
Benzoyl peroxide 3% or 5%, Clindamycin 1% (Duac® Once daily) gel
Topical Retinoids with Isotretinoin 0.05%, Erythromycin 2% (Isotrexin®) gel Erythromycin Tretinoin 0.025%, Erythromycin 4% (Aknemycin Plus®) solution
Azelaic acid Azelaic acid 20% (Skinoren®) cream
Azelaic acid 15% (Finacea®) gel
Benzoyl Peroxide Panoxyl® Quinoderm® available in various strengths 13.6 Brevoxyl® Acnecide®
Topical Erythromycin Erythromycin 40mg/ml / Zinc acetate 12mg/ml (Zineryt®) lotion 13.6
oral antibacterials Doxycycline
Lymecycline oral hormones Co-Cyprindiol
oral retinoids Isotretinoin Specialist use only
Acitretin Specialist use only
Rosacea Metronidazole 0.75% w/w (Rozex® cream or gel) (Acea® gel) Topical Metronidazole (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®) 13.8
Antibacterial Preparations Retapamulin 1% ointment
Mupirocin 2% ointment/cream
Terra-cortril ointment
Antifungal Preparations Clotrimazole 1% cream
Miconazole 2% cream
Terbinafine 1% cream 13.10
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 15.1 www.nice.org.uk/TA605 Topical Local Anaesthetics 1st line Ametop
2nd line Lidocaine 5% ointment 15.2 Lidocaine 5% medicated plasters
3rd line Emla