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Oncology & Haematology Oncology & Haematology Specialist Formulary List – NON-CHEMOTHERAPY DRUGS **Other indications for particular drugs may be included on completion of further specialist lists** For information on use of unlicensed medicines or medicines used 'off-label' - click here The following medicines are approved for prescribing by or on the recommendation of a prescribing oncology or haematology specialist (including non-medical prescribers where appropriate): In the event of a broken link please forward details to [email protected] Please include the location and full title of the link MEDICINE SUMMARY OF RESTRICTED INDICATION CATEGORY PROTOCOL Aprepitant capsules Adjunct to dexamethasone and a 5HT3-receptor antagonist NOSCAN (North of Scotland Cancer in preventing nausea and vomiting associated with cisplatin Network) Antiemetic Protocol pending. containing chemotherapy regimes. Granisetron tablets, injection Chemotherapy-induced nausea and vomiting (2nd line). Prophylaxis of Chemotherapy Induced Usually given pre-chemotherapy. Nausea and Vomiting follow MASCC guidelines Levomepromazine tablets, injection Chemotherapy-induced nausea and vomiting (3rd line). www.mascc.org 6mg tablets available. Tablets may be halved. Usual dose 3mg or 6mg twice daily. Lorazepam tablets, injection Anticipatory nausea and vomiting. 0.5mg to 1mg the night before and morning of chemotherapy. Palonosetron Injection Chemotherapy-induced nausea and vomiting. Given as a single dose IV pre-chemotherapy Granisetron transdermal patch Prevention of nausea and vomiting associated with moderately or highly emetogenic chemotherapy (in adults), for a planned duration of 3 to 5 consecutive days, where oral anti-emetic administration is complicated by factors making swallowing difficult. Disodium pamidronate (concentrate for Hypercalaemia of malignancy. intravenous infusion) Osteolytic lesions and bone pain associated with bone metastases in patients with breast cancer or multiple myeloma (with calcium and vitamin D supplementation) Ibandronic acid 50mg tablets Reduction of bone damage in bone metastases in breast cancer. 2nd line in breast cancer patients requiring adjuvant bisphosphonate therapy (PREDICT score of 2 and above) at a dose of 50mg daily for 3 years (off label) in patients with poor iv access or patient choice. Sodium clodronate 400mg capsules Osteolytic lesions, hypercalcaemia and bone pain associated with bone metastases in patients with breast cancer or multiple myeloma. Maintenance of acceptable serum calcium levels in hypercalcaemia of malignancy initially treated with intravenous bisphosphonate. Zoledronic acid intravenous infusion Hypercalcaemia of malignancy. 4mg/100mL Reduction of bone damage in advanced malignancies involving bone (with calcium and vitamin D supplementation). 1st line in breast cancer patients requiring adjuvant bisphosphonate therapy (PREDICT score of 2 and above) at a dose of 4mg every 6 months for 3 years (off label). Oral ibandronate 50mg daily for 3 years (off label) is an alternative in the short term. Hydroxycarbamide capsules Myeloproliferative disorders under the direction of Haematology Denosumab (Xgeva®▼) injection Prevention of skeletal related events in adults with bone metastases from solid tumours when zoledronic acid is contraindicated. Medroxyprogesterone acetate tablets Endometrial cancer. Breast cancer. Renal cell cancer. Megestrol acetate tablets Breast cancer. Anastrazole tablets Oestrogen-receptor-positive breast cancer in postmenopausal women Exemestane tablets Oestrogen-receptor-positive breast cancer in postmenopausal women (following 2-3 years of initial adjuvant tamoxifen therapy). Letrozole tablets Oestrogen-receptor-positive breast cancer in postmenopausal women. Ovarian or primary peritoneal cancer (unlicensed: off-label use) after tamoxifen therapy no longer effective. Tamoxifen tablets Breast cancer. Ovarian or primary peritoneal cancer (unlicensed: off-label use) Bicalutamide tablets Prostate cancer Cyproterone acetate tablets Prostate cancer Goserelin 3.6mg implant (Zoladex®) Breast cancer (only Zoladex® licensed in this indication) Leuprorelin acetate (Prostap® 3 DCS) Prostate cancer prolonged-release injection Degarelix (Firmagon®▼) Hormone naïve metastatic prostate cancer patients with Note that short-term treatment with PSA>50 who have severe bone pain, spinal cord anti-androgen is not required. compression, or other serious complications of metastatic disease and who need rapid reduction of testosterone levels. Lanreotide injection (Somatuline Autogel Symptoms associated with functional gastroenteropancreatic ®, Somatuline® LA) endocrine tumours or neuroendocrine tumours Octreotide injection, depot injection Treatment of advanced neuroendocrine tumours of the Local Treatment Protocol (Sandostatin LAR®) midgut or of unknown primary origin where non-midgut sites of origin have been excluded. Symptoms associated with functional gastroenteropancreatic endocrine tumours or neuroendocrine tumours. Magnesium Glycerophosphate (4mmol) Hypomagnesemia associated with Platinum chemotherapy. Usual dose 1g twice daily or 1g three Chewable tablets (Neomag®) times daily. Caphosol® oral rinse (medical device) Prevent and treat oral mucositis. ® Gelclair sachets (medical device) Protect oral mucosa. NOSCAN Guidance for Prevention & Tranexamic Acid 500mg/5mL oral Treatment of localised oral bleeding (may be used as a Treatment of Oral Mucositis solution (unlicensed) (made by St Mary’s mouthwash). Pharmaceutical Unit, NHS Wales, ordered from Oxford Pharmacy Store). ® Naloxegol tablets (Moventig ▼) Treatment of opioid-induced constipation in adult patients Link to Local New Medicine Treatment who have had an inadequate response to at least four days Protocol for naloxegol of treatment with at least one class of laxative. Antacid with oxetacaine suspension Radiotherapy induced oesophagitis – in patients with painful Usual dose 10-15mL, swallowed (unlicensed) (manufactured by swallowing, during and following radiotherapy to the head, undiluted 15-30 minutes before meals Rosemont Pharmaceuticals Ltd., neck, or chest areas and who have not responded to simple and at bedtime, continued until available from special order antacid and analgesia. symptoms resolve (may be 2-3 weeks manufacturers) after radiotherapy treatment completed) Sodium fluoride 1.1% (5000ppm) Under the direction of a Dentist/Dental hospital/ENT/Oral RD-UK Predicting and Managing Oral toothpaste Maxillo Facial Surgery/Oncology/Radiotherapy specialists to and Dental Complications of Surgical prevent dental caries and reduce the risk of and Non-Surgical Treatment for Head and Neck Cancer: A Clinical Guideline, osteoradionecrosis in patients with head and neck cancer/oral cancer/undergoing head and neck radiotherapy. Nov 2016 Traffic light status information To be prescribed by Hospital Specialists Only. Can be prescribed in General Practice under the direction of a Specialist. Updated: 27 May 2019 .
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