MEDICINES FORMULARY Medicines formulary between MCHFT and Primary Care as agreed by the Joint Medicines Management Group Introduction Welcome to the MCHFT Medicines Formulary. The formulary includes medicines that have been approved by the Joint Medicines Management Group (JMMG) for prescribing within the trust. The purpose of the formulary is to ensure prescribing is evidence based and cost effective. All prescribing within the trust (i.e. inpatient, outpatient and FP10HNC prescribing) must comply with the formulary. This will be monitored on a regular basis. Some drugs may appear in more than one section. The formulary is arranged in sections corresponding to those in the British National Formulary (BNF) as below; INTRODUCTION .......................................................................................................................................... 2 UPDATES TO THE FORMULARY (LAST UPDATED MAY 2018)............................................................... 4 1. GASTRO-INTESTINAL SYSTEM ............................................................................................................. 6 2. CARDIOVASCULAR SYSTEM .............................................................................................................. 10 3. RESPIRATORY SYSTEM ...................................................................................................................... 16 4. CENTRAL NERVOUS SYSTEM ............................................................................................................ 20 5. INFECTIONS ......................................................................................................................................... 27 6. ENDOCRINE SYSTEM .......................................................................................................................... 30 7. OBSTETRICS, GYNAECOLOGY AND URINARY-TRACT DISORDERS .............................................. 36 8. MALIGNANT DISEASE AND IMMUNOSUPPRESSION ........................................................................ 39 9. NUTRITION AND BLOOD...................................................................................................................... 47 10. MUSCULOSKELETAL AND JOINT DISORDERS ............................................................................... 52 11. EYE ...................................................................................................................................................... 55 12. EAR, NOSE AND OROPHARYNX ....................................................................................................... 59 13. SKIN ..................................................................................................................................................... 61 14. IMMUNOLOGICAL PRODUCTS AND VACCINES .............................................................................. 67 15. ANAESTHESIA .................................................................................................................................... 68 (Last updated May 2018) Page 1 of 69 i Introduction Operation of the Formulary Items available for general prescribing and restricted items are identified according to the following colour coding; Item Colour Code Items available for general prescribing Second line/use on specialist advice Consultant prescribing only Removed from the Formulary/Do not prescribe Where a drug is the subject of a NICE Technology Appraisal (TA) the reference number of the guidance is given below the drug entry. Where a drug has been approved by the Joint Medicines Management Group (JMMG, formerly a committee named JMMC) the month and year of the relevant meeting is also listed below the drug entry. NICE guidance can be found at; Technology Appraisals (TA) http://www.nice.org.uk/guidance/published?type=ta Clinical Guidelines (CG) http://www.nice.org.uk/guidance/published?type=cg MHRA Alerts and recalls on drugs and medical devices https://www.gov.uk/drug-device-alerts Patients taking a non-formulary drug on admission Treatment with a non-formulary drug may be continued in this instance; however it must be borne in mind that there may be a delay in obtaining a non-formulary drug. Additions to the formulary The addition of a new drug or preparation will only be made after approval by the Joint Medicines Management Group. To request an addition to the formulary a New Product Request (NPR) form must be submitted to the JMMG. This form can be found under Frequently Used Forms- Medicines Management on the trust intranet. New non-formulary drugs required for an individual patient in exceptional circumstances Such an application for a “one-off” use may be made to the chairperson of the JMMG, if the drug is required before the next JMMG meeting. Local Health Economy (LHE) Formulary Policy (Vale Royal, South Cheshire and Eastern Cheshire areas). The LHE Formulary is intended to cover prescriptions written in primary care or recommendations by hospital doctors in respect of outpatients or patients leaving hospital after an admission. This is a good point of reference to confirm the continuation of medicines in Primary Care after initiation at MCHFT. The Area Prescribing Group (APG) agrees on a formulary status of medicines. These are designated by the following colours: • Green = Recommended • Green/Yellow = On formulary • Yellow = A second or third line option within a drug group (Last updated May 2018) Page 2 of 69 • Pink (Specialist Recommendation) = Medicines that can safely be initiated in primary care on the recommendation of a specialist • Pink (Specialist Initiation) = Medicines that require specialist initiation and/or stabilisation before prescribing is transferred to primary care • Pink (Shared Care) = Medicines that require a more formal shared-care approach including regular secondary care review and monitoring • Purple = Consultant/ Specialist only prescribing • Red = Discouraged • Grey = Discouraged; not considered suitable for prescribing • Blue = No formulary decision made / formulary position not yet considered (not to be prescribed until a formulary status has been agreed) The Formulary is available on the Medicines Management Team website: http://www.centralandeasterncheshiremmt.nhs.uk BACK TO TOP (Last updated May 2018) Page 3 of 69 ii Updates to the formulary UPDATES TO THE FORMULARY 2018 Date BNF Update Details Section See formulary entry for full details May 8.1.5 Avelumab 2018 Obinutuzumab Pembrolizumab 9.6.7 Paravit CF capsules & liquid 13.5.3 Brodalumab April 3.2 Fluticasone furoate/ vilanterol/ umeclidinium inhaler (Trelegy®) 2018 4.7 Methoxyflurane (Penthrox®) 6.1.2.3 Alogliptin 6.4.1.1 Raloxifene(update) Teriparatide (update) 8.1 Tivozanib 8.1.5 Cabozantinib Daratumumab Eribulin Pertuzumab Regorafenib 10.4 Autologous chondrocyte implantation using chondrosphere March 1.2 Eluxadoline to be used as for treating adults with irritable bowel syndrome with 2018 diarrhoea. Treatment pathway link added, as agreed at APG March 2018. 6.2.1 Thyroid (update to formulary status) 6.4.1.2 Medicines Safety Alert: ulipristal acetate (Esmya®). Reclassification of formulary status as GREY (Removed from the Formulary/Do not prescribe) 5.3.3.2 Sofosbuvir–velpatasvir–voxilaprevir 8.1.5 Ibrutinib Ixazomib Pembrolizumab Trastuzumab 11.4.1 Dexamethasone Intravitreal Implant 11.4.2 Adalimumab February 5.1.2.3 Ceftazidime/Avibactam 2018 8.1.5 Ceritinib 5.1.7 Dalbavanacin 8.3.4.1 Fulvestrant 5.3.3.2 Glecaprevir–pibrentasvir 10.1.3 Golimumab 8.1.5 Lenvatinib 3.11 Pirfenidone 8.1.5 Ribociclib ‘Items which should not be routinely prescribed in primary care: Guidance for CCGs’ NHS England 30/11/17. Formulary has been updated with the key recommendations: 2.5.4 Doxazosin MR tablets 2.12 Omega-3-acid ethyl esters 4.3.1 Dosulepin capsules and tablets 15.2 Lidocaine plasters 5% January 4.5.2 Naltrexone–bupropion 2018 8.1.3 Cladribine 8.1.5 Atezolizumab Ibrutinib Palbociclib (Last updated May 2018) Page 4 of 69 Regorafenib Venetoclax 8.2.3 Vismodegib 11.8.2 Nivolumab Aflibercept (Eylea®) December 4.4 Methylphenidate (Xaggitin XL® & Delmosart XL® brands) 2017 8.1.5 Brentuximab vedotin 8.2.3 Nivolumab 10.1.3 Sarilumab BACK TO TOP (Last updated May 2018) Page 5 of 69 1 Gastro-Intestinal System 1.1 Dyspepsia and gastro-oesophogeal reflux-disease 1.1.1 Antacids and simeticone MAGNESIUM TRISILICATE MIXTURE SIMETICONE LIQUID SODIUM CITRATE ORAL SOLUTION - OXETACAINE ANTACID SUSPENSION - On Christies recommendation 1.1.2 Compound alginates and proprietary indigestion preparations GAVISCON® ADVANCE SF SUSPENSION and TABLETS GAVISCON® INFANT DUAL-SACHETS GAVISON® SF LIQUID (Aniseed) 1.2 Antispasmodics and other drugs altering gut motility Antimuscarinics DICYCLOVERINE LIQUID and TABLETS HYOSCINE BUTYLBROMIDE INJECTION and TABLETS HYOSCINE HYDROBROMIDE TRANSDERMAL PATCH 1.5MG JMMG Approved Nov 2017 – off-label for symptomatic treatment of severe sialorrhoea in children and adolescents aged 3 years and older with chronic neurological disorders PRIMARY CARE: Pink (Specialist Recommendation) – Agreed at APG Jan 2018 GLYCOPYRRONIUM ORAL LIQUID (320 MICROGRAMS / ML) (SIALANAR®) JMMG Approved Nov 2017 – for symptomatic treatment of severe sialorrhoea in children and adolescents aged 3 years and older with chronic neurological disorders PRIMARY CARE: Pink (Specialist Recommendation) – Agreed at APG Jan 2018 ® KOLANTICON GEL Other antispasmodics ALVERINE CITRATE CAPSULES MEBERINE 135mg TABLETS ® PEPPERMIINT OIL E/C CAPSULES (Mintec ) MEBEVERINE 50mg/5ml LIQUID