The South East London Red, Amber, Grey (RAG) Medicines List for Adults - Updated January 2020

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The South East London Red, Amber, Grey (RAG) medicines list for adults - updated January 2020

Definitions and notes to accompany the RAG list

NON FORMULARY Drugs are included as a separate RAG list and shaded blue to guide prescribers regarding out of area requests. Requests for GPs to prescribe non-formulary drugs should be returned to the specialist and not prescribed in primary care. Inclusion of a drug on the RAG list does not confer that a drug is commissioned for use within SEL trusts, please refer to the SEL joint formulary.

Definition of RED • A consultant or suitably trained specialist (e.g. a specialist non-medical prescribing nurse) within the secondary, tertiary, or primary care clinic should initiate, continue to prescribe and monitor red listed drugs. • RED list drugs are NOT recommended for GPs to prescribe and responsibility for prescribing, monitoring, dose adjustment and review should remain with the specialist. In very exceptional circumstances a specialist may discuss individual patient need for a RED drug to be prescribed by a GP and the GP should consider informing the Medicines Management team before a decision is made to prescribe for individual patients. • Supply of these medicines should be organised through the hospital pharmacy or where appropriate a home care company. If it is necessary to supply on a FP10HNC (previously FP10HP), liaison with a nominated community pharmacy is recommended. • Medicines for specified indications included in the red list should only be prescribed subject to inclusion in the SEL Joint Medicines Formulary and funding being arranged at the individual acute Trust. Drugs that are not on the SEL joint formulary may be included on the red list to inform GPs where a request to prescribe has originated from a provider outside of SEL.

Criteria For Inclusion on the RED List • Patient receives the majority of ongoing care, including monitoring, by the specialist. • It is in the interest of the patient’s safety to receive the drug treatment through the specialist. • The drug is only available through the hospital. • The drug is unlicensed or being used for an unlicensed indication where there is a lack evidence or widespread medical acceptance by recognised reputed body e.g. not in BNF; NICE guidance or British Association of Dermatology special product list. • The drug is newly licensed or has a new indication, requiring specialist initiation and place in therapy or risks are uncertain. • SEL APC’s view that the drug is unsuitable for general prescribing. • Hospital recommend restricting prescribing to hospital only for clinical reasons. • Designated as hospital or specialist only in its licence or by DoH/MHRA/NICE. • Drugs subject to High-tech Hospital at Home guidance, EL(95)5

Definition of AMBER • Initiated by or at the recommendation of a specialist which includes consultant, suitably trained specialist non-medical prescriber or GP with specialist interest within a secondary, tertiary, or primary care clinic. • Where a patient remains under the care of a specialist, on-going communication is imperative. • Off-label use must be noted but is not an exclusion criteria where a body of evidence supports its use e.g. NICE. • Contact for specialist support must be explicit and easily accessible. • Timely re-referral routes are essential.

Categories of AMBER AMBER 1. Recommendation by a specialist, but is considered non urgent and therefore could be started in primary care at the discretion of the GP after the GP’s consideration. AMBER 2. Initiation by a specialist, stabilisation for a specified time, then continuation in primary care under an individual management plan. AMBER 3. As above, requiring shared/transfer of care document

Criteria For Inclusion on the AMBER List (number denotes which amber category as above, which this applies to)

• requires specialist assessment to enable patient selection and initiation of treatment¹ ˒²˒³. • requires short or medium term specialist monitoring of efficacy ²˒³. • requires short or medium term specialist monitoring of toxicity (difficulty in recognising side effects or appropriateness/availability of investigations to identify toxicity) ²˒³. • are rarely used, such that individual GPs are unlikely to see sufficient patients and acquire a working knowledge of the drug² ˒³.

Definition of GREY • Medicines not normally recommended for routine prescribing. • Weak evidence of cost effectiveness, benefit and/or safety. • Drugs which the SEL APC consider do not represent good value to the NHS • Drugs where the formulary application is not presented to the NDP within the SEL APC specified timeframes.

Abbreviations SEL JF South East London Joint Formulary JFC Joint Formulary Committee SEL APC South East London Area Prescribing Committee NHSE NHS England

South East London Area Prescribing Committee. A partnership between NHS organisations in South East London: Bexley/ Bromley/ Greenwich/ Lambeth/ Lewisham & Southwark Clinical Commissioning Groups (CCGs) & GSTFT/KCH/SLAM/Oxleas NHS Foundation Trusts & Lewisham & Greenwich NHS Trust Not to be used for commercial or marketing purposes. Strictly for use within the NHS only . South East London Red, Amber, Grey (RAG) list for ADULT indications January 2020

Notes: 1. This list covers indications in ADULTS only. 2. Please see separate list for use in paediatrics. 3.See separate list at the end of this document for out of area requests (medicines that are not on the SEL joint formulary but GPs may be requested to prescribe by outer SEL Trusts) 4. See 'Definitions and notes' for further information.

Abelcet, AmBisone, Amphotericin RED All uses IV Amphocil Anagrelide Xagrid RED All uses Specialist use only Anakinra Kineret RED All uses NICE/ SEL APC Specialist use only Anastrazole Arimidex AMBER 1 All licensed indications Requires specialist initiation Anidulafungin Ecalta RED All uses IV Antibiotics (intravenous) Various RED All uses Clear patient pathway required Licensed indications for GP initiation with immediate referral if emergency. Require specialist APC SEL shared care for some Antiepileptic Drug Therapy Various AMBER 3 NICE epilepsy- adults initiation and review. AEDs. Antihemophilic Factor/von Various RED All uses Congenital Von Willebrand Disease Willebrand Factor Complex Antilymphocyte globulin RED All uses Specialist use only Prophylaxis of venous thromboembolism in surgery of patients with Antithrombin (recombinant) A Tryn RED All uses congenital antithrombin deficiency Prophylaxis of venous thromboembolism in adults after Apixaban Eliquis RED NICE Full supply by Trust total hip replacement or total knee replacement All licensed uses except VTE prevention post hip and knee Apixaban Eliquis AMBER 3 NICE, SEL APC Requires specialist initiation SEL APC transfer of care replacement where full course should be supplied by trust Apomorphine solution for APO-go; Apo-go AMBER 3 Parkinson's Disease Requires specialist initiation and review SEL APC shared care agreement injection; solution for infusion pen; Apo-go PFS Apraclonidine 0.5% eye drops Iopidine AMBER 2 Chronic glaucoma SEL APC Last option for those who refuse or are not suitable for surgery Control/prevention of Specialist use only Apraclonidine 1% eye drops Iopidine RED postoperative elevation of intra- ocular pressure Severe to moderate plaque Apremilast Otezla RED NICE SEL APC psoriasis Aprepitant Emend RED As per the SEL joint formulary JFC JFC Arachis oil GREY All uses SEL APC Not listed on BAD Specials list (2014) Licensed indications in Aripiprazole depot injection Abilify Maintena AMBER 3 accordance with SEL APC SEL APC Requires specialist initiation and review SEL APC shared care agreement shared care Licensed indications. Amended - removed reference to Aripiprazole oral Abilify AMBER 2 Management of Depression NICE TAG Requires specialist initiation and review indication in adolescents as covered (unlicensed indication) by paediatric tab Clinician to clinician discussion should occur regarding individual patients and the on-going Aripiprazole oral Abilify AMBER 2 Off-label indications Requires specialist initiation and review responsibilities of each party, including access to timely support when required. Statement from the British Thyroid Association Executive Committee (Nov 2007) Armour Thyroid GREY Hypothyroidism highlights there is no Not licensed in the UK. Insufficient evidence to support use. evidence that armour thyroid should be prescribed over thyroxine tablets. Arsenic trioxide Trisenox RED All uses Relapsed/refractory acute promyelocytic leukaemia Artesunate RED All uses Antimalarial combination, named patient only Aspirin injection RED All uses JFC JFC Off-label use in acute Aspirin tablets RED JFC Specialist use only Added pericarditis Atazanavir Reyataz RED All uses BHIVA Guidelines HIV Atezolizumab Tecentriq RED All uses NICE TA As per NICE TA for urothelial carcinoma or non-small cell lung cancer RAG status Shared care/ Transfer of care Common Brand National /Regional Changed/Added since October Drug Name (Adults unless Indication for RAG status Comments/ reason for inclusion or RAG status guidance/ additional Name(s) Guidance 2019 otherwise stated) information SEL APC shared care agreement Amended - removed reference to Atomoxetine Strattera AMBER 3 ADHD SEL APC Requires specialist initiation and review for adults and for children and indication in children as covered by adolescents paediatric tab As per SEL APC guidance on options for the pharmacological Atropine 1% eye drops Hypersalivation in adult AMBER 2 SEL APC management of hypersalivation in adult neurology patients. Specalist Added (administered sublingually) neurology patients (off-label) initiation. Auranofin Ridaura AMBER 2 All licensed indications NICE Requires specialist initiation and review Aurothiomalate sodium Myocrisin AMBER 2 All licensed indications NICE Requires specialist initiation and review Rarely prescribed. Avelumab Bavencio RED All uses NICE TA

Axicabtagene ciloleucel Yescarta RED All uses NICE TA 559 Specialist use only

NICE Axitinib Inlyta RED All uses SEL APC NHSE Azacitidine Vidaza RED All uses NICE Specialist use only Amended - indication of urticaria changed from RED to AMBER 3 in Renal transplant (new and line with updated urticaria pathway. Azathioprine Imuran RED repatriated patients). NHSE Repatriation programme of liver patients delayed. Autoimmune hepatitis removed from New liver transplant patients. RED category as now included in shared care guideline. All indications covered by the Amended - in line with the SEL APC SEL APC shared care shared care guideline for non- guideline for non-biological SEL APC shared care guideline for biological immunomodulatory drugs, immunomodulatory drugs; Off- non-biological immunomodulatory addition of urticaria use in this Azathioprine Imuran AMBER 3 SEL APC Requires specialist initiation and review. label use in urticaria as per the drugs. SEL APC urticaria treatment category in line with updated urticaria SEL APC Urticaria treatment pathway. pathway. Removal of reference to use pathway; Existing patients post in children as covered by paediatric liver transplant; tab. Clinician to clinician discussion Other licensed indications not should occur regarding individual listed as Red/Amber 3; patients and the on-going Azathioprine Imuran AMBER 2 Rare disorders such as Requires specialist initiation and review responsibilities of each party, Wilson's Disease, including access to timely support Off label use when required. Azithromycin Zithromax AMBER 2 Management of COPD SEL APC Requires specialist initiation SEL APC COPD guideline Existing patients only. Amended - reference to use in All licensed indications when SEL APC SCA for existing patients. Aztreonam Lysine Cayston AMBER 3 NICE RED for new patients paediatric patients removed as delivered via NHSE commissioned covered by paediatric tab nebulisation/inhalation Baricitinib Olumiant RED Rheumatoid arthritis NICE TAG Specialist use only Basiliximab Simulect RED All uses NICE Specialist use only

Beclometasone dipropionate Off-label use as a spray for oral As per SEL APC guide for primary care on the off-label use of medicines metered dose inhaler 50 Clenil, Qvar AMBER 2 SEL APC lesions in the Oral Medicine Clinics microgram or 100 microgram

Beclometasone dipropionate, formoterol fumarate dihydrate Trimbow AMBER 1 All licensed indications SEL APC SEL APC COPD guideline and glycopyrronium inhaler device

Beclometasone Graft vs host disease following Amended - RED indication no longer dipropionate m/r Clipper RED haematopoietic stem cell NHSE Maximum 4 weeks supply, so full course to be supplied by specialist applies to ulcerative colitis tablets transplantation (off-label)

Second-line option after prednisolone tablets for active mild or moderate Beclometasone ulcerative colitis. Maximum 4 weeks supply. If specialost requires Amended - from RED to AMBER 1 to dipropionate m/r Clipper AMBER 1 Ulcerative colitis SEL APC treatment to be started urgently then prescription should be supplied at align with SEL APC IBD pathway tablets the point of initiation for supply via the hospital outpatient pharmacy. NICE Belimumab Benlysta RED All uses NHSE Bendamustine Levact RED All uses NICE First line treatment of chronic lymphocytic leukaemia

Benralizumab Fasenra RED All formulary approved uses NICE TA 565 Specialist use only

Beractant Survanta RED All uses Specialist use only Beraprost RED All uses Unlicensed Betaine Cystadane RED All uses Specialist use only RAG status Shared care/ Transfer of care Common Brand National /Regional Changed/Added since October Drug Name (Adults unless Indication for RAG status Comments/ reason for inclusion or RAG status guidance/ additional Name(s) Guidance 2019 otherwise stated) information As per SEL APC guide for primary care on the off-label use of medicines Betamethasone 0.1% ointment Betnovate ointment AMBER 2 Off-label use for oral lesions SEL APC in the Oral Medicine Clinics Betamethasone ointment pre- Special' order As per SEL APC guide for primary care on the off-label use of medicines RED Off-label use for oral lesions SEL APC mixed in orabase product in the Oral Medicine Clinics Off-label use as a steroid As per SEL APC guide for primary care on the off-label use of medicines Betamethasone soluble tablets AMBER 2 SEL APC mouthwash for oral lesions in the Oral Medicine Clinics Bevacizumab Avastin RED All formulary approved uses NICE Specialist use only Bexarotene Targretin RED All uses Specialist use only Bicalutamide Casodex AMBER 1 Prostate cancer Initiation by consultant/ specialist only

Binimetinib Mektovi RED All formulary approved uses NICE TA 562 Specialist use only

Bisphosphonates IV RED All uses SEL APC SEL APC Bivalirudin Angiox RED All uses Anti-coagulant for patients undergoing percutaneous coronary infusion Bleomycin Bleo-Kyowa RED All uses Metastatic germ cell cancer and, non-Hodgkin’s lymphoma NICE Lymphoma (Hodgkin's, CD30-positive) Blinatumomab Blincyto RED All uses NHSE

Boceprevir Victrelis RED All uses NICE Treatment of genotype 1 chronic hepatitis C

Consensus statement Bosentan Tracleer RED All uses National Pulmonary Pulmonary hypertension specialist only Hypertension Centre All uses (except for untreated NICE Bosutinib Bosulif RED chronic myeloid leukaemia for SEL APC NHSE which is it Grey) Azzalure, Red for all uses. See SEL JF/ Bocouture, Botox, APC recommendations and NICE Botulinum A&B toxin RED Specialist use only, SEL APC Dysport, Xeomin, appendix 1 for commisioned SEL APC NeuroBloc, brands and indications. NICE Brentuximab Adcetris RED All uses NHSE Brigatinib Alunbrig RED All uses NICE TA 571 Brimonidine 3mg/g gel Mirvaso GREY All uses SEL APC Brinzolamide/brimonidine eye In accordance with SEL APC Simbrinza AMBER 2 SEL APC Requires specialist initiation drops guidance For epilepsy, in line with SEL Brivaracetam oral tablets and GPs may be asked to take on Briviact AMBER 2 APC focal epilepsy pathway and SEL APC Specialist (consultant neurologist) initiation and supply solution prescribing after at least 6 months. guidance. Approved as per detail in SE London APC Psoriasis Biological Drug Brodalumab Kyntheum RED All uses SEL APC, NICE TA Treatment Pathway Incorporated into SEL APC IBD pathway for mild or moderate Crohn's Budesonide CR capsule Entocort AMBER 1 Crohn's disease in adults disease upon discussion with secondary care For mild to moderate active Budesonide MR tablets Cortiment RED SEL APC See SEL APC recommendation ulcerative colitis Buprenorphine prolonged- See SEL APC formulary recommendation. Note that this release injection (weekly or Buvidal RED Opioid dependence SEL APC recommendation has a 1 year time limited approval until May 2019 monthly) following which it will be subject to a review. RED for Bexley, Bromley and other SEL CCGs where all prescribing Prescribe in accordance with local Buprenophine sub lingual Subutex AMBER 2 Opioid dependence NICE under specialist services pathways Substance misuse specialists only Buprenorphine sublingual Gabup, Natzon, Treatment of opioid RED NICE (AMBER if alternate service commissioned but still prescribed in tablets Prefibin, Subutex, dependence conjunction with misuse services) RED for Bexley, Bromley and other SEL CCGs where all prescribing Prescribe in accordance with local Buprenorphine with naloxone Suboxone AMBER 2 All licensed indications under specialist services pathways Substance misuse specialists only Buprenorphine with naloxone Treatment of opioid Suboxone RED (AMBER if alternate service commissioned but still prescribed in sublingual tablets dependence conjunction with misuse services) Buserelin Suprefact RED Infertility NICE Specialist use only, package of commissioned service Busulfan Myleran RED All uses Specialist use only C1 esterase inhibitor Berinert, Cinryze RED All uses Specialist use only NICE Cabazitaxel Jevtana RED All uses SEL APC NHSE Cabergoline Cabaser AMBER 2 Parkinson's Disease Requires specialist initiation and review Cabergoline Dostinex AMBER 2 Hyperprolactinaemia NICE Requires specialist initiation Cabometyx, NICE TA Renal cell carcinoma / medullary thyroid cancer Cabozantinib RED All uses Cometriq NHSE Cade oil 6% and salicylic acid GREY All uses SEL APC Not listed on BAD Specials list (2014) 3% in emulsifying ointment RAG status Shared care/ Transfer of care Common Brand National /Regional Changed/Added since October Drug Name (Adults unless Indication for RAG status Comments/ reason for inclusion or RAG status guidance/ additional Name(s) Guidance 2019 otherwise stated) information Cade oil in olive oil scalp lotion GREY All uses SEL APC Not listed on BAD Specials list (2014) 10% Cade oil pomade scalp cream GREY All uses SEL APC Not listed on BAD Specials list (2014) 6% Caffeine citrate Nymusa RED All uses Primary apnoea in premature newborns Calcitonin Miaclacic RED All uses Specialist use only Calcium Folinate RED All uses Specialist use only Hyperkalaemia associated with anuria, severe oliguria and in dialysis Calcium Polystyrene Sulphonate Calcium Resonium RED All uses patients Canakinumab Ilaris GREY Gout NICE TA281 NICE does not recommend canakinumab for gout Add-on treatment for patients Specialists reporting back to APC if treatment delays or prevents the Cannabidiol and delta-9- Sativex RED with MS who have moderate to SEL APC need for more invasive treatments such as intrathecal baclofen or tetrahydrocannabinol severe spasticity botulinum toxin CAPD fluids Various RED All uses Specialist use only Capecitabine Xeloda RED All uses NICE Specialist use only Capsaicin Plaster Qutenza RED All formulary approved uses JFC Peripheral neuropathic pain in non-diabetic patients Licensed indications for Carbagen GP initiation with immediate referral if emergency. Require specialist Carbamazepine AMBER 2 epilepsy- adults NICE Tegretol initiation and review. Bipolar disorder Prevention of uterine atony Carbetocin Pabal RED JFC following caesarean section Carbocisteine Mucodyne AMBER 1 All uses SEL APC Carboplatin Paraplatin RED All uses NICE Specialist use only NICE Multiple myeloma Carfilzomib Kyprolis RED All uses NHSE Cariprazine Reagila RED Schizophrenia SEL APC Specialist use only Carnitine Carnitor RED All uses Carnitine deficiency Carvedilol tablets AMBER 1 All licensed indications RESTRICTED USE Treatment of NYHA class IV heart failure Carvedilol tablets AMBER 2 Portal hypertension SEL APC 2nd line treatment option after propranolol Caspofungin Cancidas RED All uses IV Ceftazidime/Avibactam Zavicefta RED All formulary approved uses JFC JF Ceftolozane with tazobactam Zerbaxa RED All formulary approved uses JFC injection Cenegermin is not recommended, within its marketing authorisation, for Cenegermin Oxervate GREY All uses NICE TA treating moderate or severe neurotrophic keratitis in adults NICE Ceritinib Zykadia RED All uses SEL APC NHSE Certolizumab Cimzia RED All uses NICE Specialist use only Cetrorelix Cetrotide RED Infertility Specialist use only, package of commissioned service Cetuximab Erbitux RED All uses NICE Specialist use only Chlorambucil Leukeran RED All uses Specialist use only Post-procedural use in plastic Chloramphenicol eye ointment RED surgery to the face (topical JFC along suture line) All licensed indications for long term use. Note that schizo- Chlorpromazine oral Largactil AMBER 2 NICE Requires specialist initiation and review affective disorder is a sub-type of schizophrenia. Clinician to clinician discussion Off-label indications (except in should occur regarding individual migraine symptoms on patients and the on-going Chlorpromazine oral Largactil AMBER 2 Requires specialist initiation and review withdrawal regimens in responsibilities of each party, medication overuse headache) including access to timely support when required. Migraine symptoms on Chlorpromazine oral Largactil RED withdrawal regimens in medication overuse headache Chlorpromazine solution for All licensed indications Largactil RED Palliative care Extremely rarely prescribed injection for long term use Chlorpromazine solution for All licensed indications for long Largactil GREY Not recommended for use in mental health patients injection term use Choriogonadatropin α Ovitrelle RED All uses NICE Specialist use only, package of commissioned service Chorionic gonadotrophin Choragon, Pregnyl RED All uses NICE Specialist use only, package of commissioned service Ciclesonide inhaler Alvesco AMBER 2 All licensed indications SEL APC Initiation by respiratory specialist SEL APC asthma guideline Capimune, Amended - indication of urticaria Capsorin, Renal transplant (new and Ciclosporin RED NHSE Repatriation programme of liver patients delayed. changed from RED to AMBER 3 in Deximune, Neoral, repatriated patients). line with updated urticaria pathway. Sandimmun RAG status Shared care/ Transfer of care Common Brand National /Regional Changed/Added since October Drug Name (Adults unless Indication for RAG status Comments/ reason for inclusion or RAG status guidance/ additional Name(s) Guidance 2019 otherwise stated) information All indications covered by the Amended - in line with the SEL APC SEL APC shared care SEL APC shared care guideline for shared care guideline for non- guideline for non-biological Neoral, Sandimmun, non-biological immunomodulatory biological immunomodulatory drugs, Ciclosporin AMBER 3 immunomodulatory drugs; Off- Requires specialist initiation and review. Deximune drugs. SEL APC urticaria treatment addition of urticaria use in this label use in urticaria as per the pathway. category in line with updated urticaria SEL APC Urticaria treatment pathway. pathway. For treating severe keratitis in SPC notes that treatment must be initiated by adult patients with dry eye an ophthalmologist or a healthcare professional disease that has not improved qualified in ophthalmology despite treatment with tear Initiation and first prescription Ciclosporin eye drops Ikervis AMBER 2 substitutes. Off-label use in NICE supplied by the ophthalmology Vernal Keratoconjunctivitis specialist team (VKC) or Atopic ketatoconjunctivitis (AKC) in adults Cidofovir Vistide RED All uses BHIVA Guidelines HIV Treatment of intermittent NICE does not recommend this as an option in the treatment of Cilostazol Pletal GREY claudication in peripheral NICE TA223 intermittent claudication in peripheral arterial diesease arterial diesease Cinacalcet Mimpara RED Primary hyperparathyroidism SEL APC NHSe commissioned, no in date shared care agreement Secondary Hyperparathyroidism in Adult End-Stage Renal Cinacalcet Mimpara AMBER 3 SEL APC Requires specialist initiation Review due under SEL APC. Disease (ESRD) Patient Established on Dialysis Therapy Cisplatin Cisplatin RED All uses NICE Specialist use only Cladribine Mavenclad RED All formulary approved uses NICE / NHSE SEL APC Specialist use only Frisium Clobazam AMBER 2 All licensed indications Require specialist initiation and review Perizam Specially Clobetasol in propylene glycol manufactured AMBER 2 BAD First supply from specialist however can be re-started at GPs discretion. 40% cream product Clobetasol propionate 0.05% As per SEL APC guide for primary care on the off-label use of medicines Dermovate ointment AMBER 2 Off-label use for oral lesions SEL APC ointment in the Oral Medicine Clinics Clobetasol propionate ointment Special' order As per SEL APC guide for primary care on the off-label use of medicines RED Off-label use for oral lesions SEL APC pre-mixed in orabase product in the Oral Medicine Clinics Clobetasol propionate ointment GREY All uses SEL APC Not listed on BAD Specials list (2014) 0.0125% Clofazimine, clarithromycin and Anti-MAP therapy RED Crohn's disease in adults SEL APC rifabutin GPs could initiate, unlikely to be routine and only if felt within Red if part of IVF as specialists Clomifene Clomid AMBER 2 Infertility, (not part of IVF) NICE competance provide package of care. Non-REM parasomnia (off-label Third line monotherapy treatment option in non-REM parasomnia. Clomipramine AMBER 2 SEL APC SEL APC local pathway indication) Requires specialist initiation and review by specialist sleep service. Shared Care Prescribing Guideline Cataplexy associated with for the management Narcolepsy (+/- Clomipramine AMBER 3 SEL APC Initiation and minimum 3 months supply by the specialist sleep service. narcolepsy Cataplexy) and Idiopathic Hypersomnia in adults All licensed indications. Management of restless legs Requires specialist initiation and review. Usually a second line treatment Minimum 3 months supply by the Clonazepam AMBER 2 syndrome (RLS) (off-label) SEL APC option in non-REM parasomnia. specialist team Management of non-REM parasomnia (off-label) Unlicensed use for ADHD and Clonidine tablets Catapres, Dixarit AMBER 2 sleep disorders; vasomotor Requires specialist initiation symptoms in the menopause Opioid withdrawal symptoms in Clonidine tablets Catapres, Dixarit RED medication overuse headache and chronic pain (off-label) Clozapine Clozaril RED All uses NICE Specialist use only Moderate to severe psoriasis Coal tar (crude) in YSP ointment AMBER 2 when commercial tar treatments SEL APC No alternative licensed product available for indication 1%, 2%, 5%, 10%, 20%, 30% have been ineffective

Coal tar (crude) with salicylic acid 2% in emulsifying ointment GREY All uses SEL APC Not listed on BAD Specials list (2014) 1%, 2%, 5%, 10%, 20% RAG status Shared care/ Transfer of care Common Brand National /Regional Changed/Added since October Drug Name (Adults unless Indication for RAG status Comments/ reason for inclusion or RAG status guidance/ additional Name(s) Guidance 2019 otherwise stated) information Coal tar (crude) with zinc oxide 15% in soft paraffin ointment 1%, GREY All uses SEL APC Not listed on BAD Specials list (2014) 2%, 5%, 10%, 20% Moderate to severe psoriasis of the trunk and limbs when other Coal tar solution 10% in 1/4 AMBER 2 treatments such as Vitamin D SEL APC No alternative licensed product available for indication strength betnovate analogues have been ineffective Coal tar solution in YSP 2%, 6% GREY All uses SEL APC Not listed on BAD Specials list (2014) NICE Cobimetinib Cotellic RED All uses SEL APC NHSE Coconut oil compound ointment GREY All uses SEL APC Not listed on BAD Specials list (2014) 25% Minimum 3 months supply by the Management of restless legs Codeine Phosphate AMBER 2 SEL APC SEL APC neurology specialist team syndrome (RLS). (specialising in RLS) Colchicine RED Pericarditis (off-label) JFC Off-label use for urticaria as per Colchicine AMBER 2 the SEL APC Urticaria SEL APC See SEL APC Urticaria treatment pathway treatment pathway Existing patients only. Amended - reference to use in All licensed indications when SEL APC SCA for existing patients. Colistimethate (colistin) Colistin; Promixin AMBER 3 NICE RED for new patients paediatric patients removed as delivered via NHSE commissioned covered by paediatric tab nebulisation/inhalation Colistimethate (colistin) Colistin; Promixin RED All indications for new patients NICE Specialist use only Collagenase clostridium Xiapex GREY Peyronie’s disease SEL APC SEL APC Collagenase clostridium Xiapex RED Dupuytren's contracture NICE TAG Specialist use only Oestrogen deficiency symptoms SEL APC Minimum 3 month’s supply from Conjugated oestrogens and Duavive AMBER 2 in postmenopausal women with SEL APC specialist gynaecology bazedoxifene acetate a uterus team/menopause clinic. Co-proxamol GREY Unlicensed drug Has now been withdrawn from market due to safety concerns Crisantaspase Erwinase RED All uses Specialist use only NICE Crizotinib Xalkori RED All uses SEL APC NHSE Initiation on recommendation of a palliative care specialist in end of life Cyclizine injection AMBER 1 Palliative care use care patients seen in the community Cyclophosphamide Endoxana RED All uses Specialist use only Cyproterone Acetate Cyprostat, Androcur AMBER 2 Prostate cancer Initiation by consultant/ specialist only

Cytarabine and daunorubicin Untreated acute myeloid Vyxeos RED NICE TA 552 Specialist use only (liposomal) leukaemia as per NICE TA 552 Cytotoxics and cytostatic IV Various RED All uses NHSE Specialist use only Prophylaxis of venous thromboembolism in adults after Dabigatran Pradaxa RED NICE Full supply by trust total hip replacement or total knee replacement All licensed uses except VTE prevention post hip and knee Dabigatran Pradaxa AMBER 3 NICE, SEL APC Requires specialist initiation SEL APC transfer of care replacement where full course should be supplied by Trust Dabrafenib Tafinlar RED All formulary approved uses NICE SEL APC Dacarbazine RED All uses Specialist use only NICE Daclatasvir Daklinza RED All uses SEL APC NHSE Daclizumab Zenapax RED All uses NICE Specialist use only Amended - reference to paediatrics Dactinomycin Cosmegen Lyovac RED All uses removed as covered by paediatric tab Dalteparin Fragmin RED All uses Low molecular weight heparin for obstetrics only Off-label use for urticaria as per Amended - category change from Danazol Danol AMBER 3 the SEL APC Urticaria SEL APC GP information sheet replaces full shared care for this indication. RED to AMBER 3 following treatment pathway introduction of GP information sheet Dantrolene IV Dantrium RED All uses BNF warning, specialist use only Treatment of chronic, severe Dantrolene capsules Dantrium AMBER 2 spasticity of skeletal muscle in Specialist initiation and stabilisation/ review adults Dapoxetine Priligy GREY Premature ejaculation. SEL APC See SEL APC website Dapsone Dapsone RED All uses Historic JFC recommendation.Current APC agreement. RAG status Shared care/ Transfer of care Common Brand National /Regional Changed/Added since October Drug Name (Adults unless Indication for RAG status Comments/ reason for inclusion or RAG status guidance/ additional Name(s) Guidance 2019 otherwise stated) information Complicated skin and soft-tissue infections due to known or suspected Daptomycin Cubicin RED All uses methicillin-resistant Staphylococcus aureus (MRSA) infection and on the advice of local microbiologists or specialists in infectious disease Daratumumab Darzalex RED All uses NICE TA Darbepoetin Alfa Aranesp RED All uses Renal Anaemia Darunavir Prezista RED All uses BHIVA Guidelines HIV Darunavir/cobicistat/ HIV as per NHSE Policy emtricitabine/tenofovir Symtuza RED NHSE NHSE commissioned FO3/P/b alafenamide Perianal fistulas in Crohn's Darvadstrocel Alofisel GREY NICE Not recommended within its marketing authorisation by NICE TA disease NICE Dasabuvir Exviera RED All uses SEL APC NHSE Dasatinib Sprycel RED All uses Specialist use only Cerubidin, Daunorubicin RED All uses Specialist use only DaunoXome For untreated acute myeloid Decitabine Dacogen GREY NICE TA 548 NICE terminated appraisal leukaemia as per NICE TA 548 Deferasirox Exjade RED All uses Chronic iron overload Deferiprone Ferriprox RED All uses Chronic iron overload Degarelix Firmagon RED All uses susceptability to QT-interval prolongation In accordance with SEL APC Amended - reference to use in Degludec insulin Tresiba AMBER 3 transfer of care guidance for SEL APC Requires specialist initiation SEL APC children removed as covered by adults with type 1 diabetes only. paediatric tab

Fat soluble vitamin supplement DEKAs AMBER 1 SEL APC for cystic fibrosis patients Bone metastases from solid Denosumab Xgeva RED NICE Specialist use only tumours Shared care agreements are Prevention of osteoporotic currently CCG specific, however Denosumab Prolia AMBER 3 fractures in postmenopausal NICE Requires specialist initiation the APC are progressing a SEL women joint SCA. Prevention of skeletal-related Denosumab GREY NICE NICE terminated appraisal events in multiple myeloma Dermovate in Unguememtum M GREY All uses SEL APC Not listed on BAD Specials list (2014) Cream 10% Dermovate in WSP ointment 25% GREY All uses SEL APC Not listed on BAD Specials list (2014) Desferrioxamine Desferal RED All uses Chronic iron overload SEL APC Recommendation: Low dose desmopressin oral Desmopressin low dose (25 - 50 Nocturia due to idiopathic lyophilisate (Noqdirna®) for the Noqdirna RED SEL APC micrograms) soluble tablets nocturnal polyuria symptomatic treatment of nocturia due to idiopathic nocturnal polyuria in adults Intracameral use in Endoscopic Cyclophotocoagulation (ECP) and cataract surgery where there is increased inflammation. Only the Hospira Dexamethasone injection RED Intracameral use (off-label) AMPOULE (preservative free) formulation is approved for use in this indication. Initiation on recommendation of a palliative care specialist in end of life Dexamethasone injection AMBER 1 Palliative care use care patients seen in the community Dexamethasone Intravitreal Ozurdex RED All uses NICE Treatment of macular oedema secondary to retinal vein occlusion Implant Dexamfetamine Dexedrine AMBER 2 ADHD adults NICE, SEL APC Requires specialist initiation Sleep centre initiation only Shared Care Prescribing Guideline Idiopathic hypersomnia; for the management Narcolepsy (+/- Dexamfetamine Amfexa, Dexedrine AMBER 3 SEL APC Narcolepsy GPs can be asked to continue prescribing after 6 months treatment as Cataplexy) and per SE London shared care agreement Idiopathic Hypersomnia in adults Dexmedetomidine infusion Dexdor RED All formulary approved uses JFC Specialist use only Dexrazoxane Cardioxane RED All uses Prevention of cardiotoxicity caused by doxorubicin or epirubicin All uses (except palliative care, Diamorphine injection RED see below) Initiation on recommendation of a palliative care specialist in end of life Diamorphine injection AMBER 1 Palliative care use care patients seen in the community Third line monotherapy treatment option in REM behaviour disorder and REM behaviour disorder; non- Diazepam AMBER 2 SEL APC non-REM parasomnia. Requires initiation and minimum 3 months supply SEL APC local pathway REM parasomnia (off-label) by the specialist sleep service. RAG status Shared care/ Transfer of care Common Brand National /Regional Changed/Added since October Drug Name (Adults unless Indication for RAG status Comments/ reason for inclusion or RAG status guidance/ additional Name(s) Guidance 2019 otherwise stated) information Consensus statement Diazoxide Eudemine RED All uses National Pulmonary Pulmonary hypertension specialist only Hypertension Centre For maintenance of mydriasis Diclofenac 0.1% w/v unit dose RED prior to femtosecond laser JFC JFC eye-drops assisted cataract surgery Didanosine Videx RED All uses BHIVA Guidelines/NICE HIV Ensure historic patients are reviewed as is rarely appropriate Diethylstilbestrol Diethylstilbestrol AMBER 2 All licensed indications Requires specialist initiation therapy unless patient is unhappy to receive other more effective treatments. Dihydroergotamine injection DHE45; Import RED JFC Specialist use only Anal Fissure and post operative Diltiazem cream RED SEL APC SEL APC anal spasm in high risk patients NICE Dimethyl fumarate Tecfidera RED All uses SEL APC NHSE Dinutuximab beta Qarziba RED All uses NICE TA Used for neuroblastoma Disodium Pamidronate Aredia RED All uses NICE Specialist use only Monitoring requirements, ensure primary care role understood and Disopyramide Rythmodan AMBER 2 All licensed indications appropriate reviews undertaken RED for Bexley, Bromley and other SEL CCGs where all prescribing Prescribe in accordance with local Disulfiram Antabuse AMBER 2 All licensed indications under specialist services pathways Dithranol with salicylic acid 2% in emulsifying ointment 0.1%, GREY All uses SEL APC Not listed on BAD Specials list (2014) 0.2%, 0.5%, 1%, 2%, 4%, 8%, 10%, 15%, 20% Docetaxel Taxotere RED All uses NICE Specialist use only SEL APC integrated medication Donepezil Aricept AMBER 1 All licensed indications NICE guidelines Last line treatment option where MR melatonin, clonazepam, diazepam, REM behaviour disorder (off- Donepezil Aricept AMBER 2 SEL APC zopiclone, rotigotine transdermal and pramipexole have failed or are not SEL APC local pathway label indication) tolerated. Requires specialist initiation and review. Cystic fibrosis, new patients. Off- label use in intrapleural Dornase Alfa Pulmozyme RED JFC Specialist use only fibrinolysis (together with alteplase). Existing patients only. Amended - reference to use in All licensed indications when SEL shared care SEL APC SCA for existing patients. Dornase Alfa Pulmozyme AMBER 3 RED for new patients paediatric patients removed as delivered via guidelines NHSE commissioned covered by paediatric tab nebulisation/inhalation Not recommended for prescribing in SEL. Review all patients prescribed dosulepin for suitability for switching to a safer antidepressant or suitable agent. For patients under the care of a relevant specialist, involve them Dosulepin Prothiaden GREY All uses SEL APC, NHSE in the decision. Dosulepin should not be stopped abruptly unless serious side effects have occurred. Slowly tapering the dose over three to four weeks can help prevent discontinuation symptoms. Off-label use as per the SEL Amended - category change from Doxepin AMBER 3 APC Urticaria treatment SEL APC GP information sheet replaces full shared care for this indication. RED to AMBER 3 following pathway introduction of GP information sheet Doxorubicin Caelyx, Myocet RED All uses NICE Cancer As per SEL APC oral medicine As per SEL APC guide for primary care on the off-label use of medicines Doxycycline soluble tablets Vibramycin-D AMBER 2 SEL APC guidance indications in the Oral Medicine Clinics Specialist supervision recommended in BNF. SEL cardiovascular Dronedarone Multaq AMBER 2 Cardiac arrhythmias NICE working group recommendation stands, of 6 months under specialist before transfer of care. Droperidol Xomolix RED All uses Used postoperatively SEL APC transfer of care after 3 Amended - timelines for transfer of Dulaglutide solution for injection Trulicity AMBER 3 Type 2 diabetes mellitus SEL APC, NICE CG See SEL APC recommendation months specialist prescribing as prescribing amended from 6m to 3m per GLP-1 pathway to align with GLP-1 pathway Duloxetine 20mg and 40mg Treatment of stress urinary Initiation and first month’s supply from urology/gynaecology specialist Yentreve AMBER 2 SEL APC capsules incontinence team Approved for treating moderate to severe atopic dermatitis as per NICE Dupilumab Dupixent RED All uses NICE technology appraisal guidance Durvalumab Imfinzi RED All uses NICE TA578 Dutasteride/ Tamsulosin Combodart GREY Benign prostatic hyperplasia SEL APC See SEL APC website Eculizumab Soliris RED All uses Specialist use only RAG status Shared care/ Transfer of care Common Brand National /Regional Changed/Added since October Drug Name (Adults unless Indication for RAG status Comments/ reason for inclusion or RAG status guidance/ additional Name(s) Guidance 2019 otherwise stated) information All licensed uses except VTE prevention post hip and knee Edoxaban Lixiana AMBER 3 NICE, SEL APC Requires specialist initiation SEL APC transfer of care replacement where full course should be supplied by trust Efavirenz Sustiva RED All uses BHIVA Guidelines/NICE HIV Not on JF. Facial hair removal is not NHS funded under SEL Treatment Eflornithine cream Vaniqa GREY All licensed indications Access Policy. NICE Elbasvir Zepatier RED All uses SEL APC NHSE Chronic ITP post-splenectomy (or if splenectomy contra- Eltrombopag Revolade RED All uses NICE indicated).Option when refractory or in severe disease needing frequent rescue therapy For treating severe aplastic Eltrombopag GREY anaemia refractory to NICE Terminated Appraisal immunosuppressive therapy Eluxadoline AMBER 2 Irritable bowel syndrome NICE TAG Requires specialist initiation Emtricitabine Emtriva RED All uses BHIVA Guidelines/NICE HIV Emtricitabine & Tenofovir Truvada RED All uses BHIVA Guidelines/NICE HIV Emulsifying ointment and GREY All uses SEL APC Not listed on BAD Specials list (2014) aqueous cream 50:50

Encorafenib Braftovi RED All formulary approved uses NICE TA 562 Specialist use only

Enfuvirtide Fuzeon RED All uses BHIVA Guidelines/NICE HIV All licensed indications except VTE prevention post-surgery (including caesarean) and Cardiovascular steering group Enoxaparin sodium Clexane AMBER 2 Requires specialist initiation maternity patients where full guidance being progressed. course should be supplied by the trust. Entacapone Comtess AMBER 2 Parkinson's Disease NICE Requires specialist initiation and review Entecavir Baraclude RED All uses NICE Specialist use only NICE Enzalutamide Xtandi RED All uses SEL APC NHSE Epirubicin Pharmorubicin RED All uses Specialist use only Eprex, Epoetin Alfa, Beta and Zeta NeoRecormon, RED All uses NICE Specialist use only Binocrit, Retacrit Epoprostenol Flolan RED All uses Pulmonary hypertension Glycoprotein IIb/IIIa inhibitors (GPI) : Moderate- and high-risk acute Eptifibatide Integrilin RED All uses coronary syndromes (ACS) Short-term use as an expectorant for the treatment of Erdosteine Erdotin GREY acute NICE CG 101 NICE does not recommend use of mucolytics to prevent exacerbations exacerbations of chronic bronchitis. For treating locally advanced or metastatic breast cancer after 2 NICE TA 423 Eribulin Halaven RED or more chemotherapy NHSE regimens as per NICE TA 423 For treating locally advanced or metastatic breast cancer after 1 NICE TA 515 Eribulin Halaven GREY NICE does not support use in this setting chemotherapy regimen as per NHSE NICE TA 515 Erlotinib Tarceva RED All uses NICE Specialist use only Prevention of infections post elective colorectal surgery. Diabetic foot Ertapenem Invanz RED All uses infections of the skin and soft tissue. Intra-abdominal infection Licensed indications for adults Eslicarbazepine acetate Zebinix AMBER 2 in line with SEL APC focal NICE Require specialist initiation and review epilepsy pathway Supraventricular arrhythmias, Tachycardia and hypertension in peri- operative period. Esmolol Hydrochloride Brevibloc RED All uses

Etanercept Enbrel RED All uses NICE Specialist use only NICE Etelcalcetide Parsabiv RED All uses Specialist use only NHSE Ethambutol RED All uses Treatment requires specialist knowledge and supervision Licensed indications for Ethosuxamide Emeside, Zarontin AMBER 2 NICE Require specialist initiation and review epilepsy- adults RAG status Shared care/ Transfer of care Common Brand National /Regional Changed/Added since October Drug Name (Adults unless Indication for RAG status Comments/ reason for inclusion or RAG status guidance/ additional Name(s) Guidance 2019 otherwise stated) information Amended - reference to use in Included due to reported requests for primary care to prescribe. For Etilefrine Unlicensed RED All uses SEL APC children removed as covered by specialist use only. paediatric tab Etoposide Etopophos, Vepesid RED All uses Specialist use only

Symptomatic relief of symptoms Etoricoxib Arcoxia AMBER 1 in ankylosing spondylitis and SEL APC rheumatoid arthritis Etravirine Intelence RED All uses BHIVA Guidelines/NICE HIV Afinitor, Certican, NICE Everolimus RED All uses SEL APC Votubia, Zortress NHSE Evolocumab Repatha RED All uses NICE SEL APC Exemestane Aromasin AMBER 1 All licensed indications NICE Restricted to use in patients intolerant to letrozole or anastrozole As an add on therapy to dual or triple oral regimens for type 2 No longer approved for initiation in new patients in SEL. Category is SEL APC Diabetes Group, pathway Amended - now non-formulary for Exenatide MR Bydureon GREY NICE/ SEL APC diabetes in accordance with AMBER 2 for existing patients only. and SCA TBC new patients NICE As an add on therapy to insulin Transfer to primary care after in obese patients with type 2 No longer approved for initiation in new patients in SEL. Category is Amended - now non-formulary for Exenatide TWICE DAILY Byetta GREY SEL APC minimum of 6 months under diabetes, in accordance with AMBER 3 for existing patients only. new patients specialist SEL APC shared care All uses (excluding palliative Fentanyl injection Sublimaze RED Specialist use only care)

Fentanyl immediate-release formulations (sublingual tabs, Initiation on recommendation of a palliative care specialist in end of life Various AMBER 1 Palliative care use buccal tabs, nasal spray and care patients seen in the community injection)

Fentanyl immediate-release formulations (sublingual tabs, Various GREY All uses except palliative care SEL APC buccal tabs and nasal spray) SEL pharmacological management Fentanyl patches Various AMBER 2 Adult chronic non-cancer pain SEL APC Requires specialist initiation of adult non-cancer chronic pain in primary care Iron deficiency when oral iron preparations are ineffective or cannot be Ferric carboxymaltose Ferinject RED All uses used Initiation and first prescription Iron deficiency anaemia in Ferric maltol Feraccru AMBER 2 SEL APC Requires specialist initiation supplied by the specialist adults with IBD gastroenterology team Fibrin sealants RED Specialist use only Information sheet to be discussed Fidaxomicin Dificlir AMBER 1 Treatment of C Difficile ONLY on consultant microbiologist recommendation with microbiologists Neupogen, Filgrastim Ratiograstim, Zarzio RED All uses NHSE Specialist use only (new in BNF) Fingolimod Gilenya RED All uses NICE Treatment of highly active relapsing-remittting multiple scerosis From January 2019 - ONLY recommended for prescribing in patients as listed in the SEL APC position statement. Initiation and prescribing for SEL APC Freestyle Libre Flash Flash glucose monitoring eligible patients will be the responsibility of specialist services for first 6 Freestyle Libre AMBER 3 Type 1 diabetes SEL APC Glucose Monitoring system - system months before transfer of prescribing to primary care if criteria are met. position statement Those currently funding their own Freestyle Libre may be transferred to primary care earlier than 6 months, if criteria are met. Flecanide Tambocor AMBER 2 All licensed indications Specialist supervision recommended in BNF for many indications Flucytosine Ancotil RED All uses IV Fludarabine phosphate Fludara RED All uses NICE Second line therapy for B-cell chronic lymphocytic leukaemia (CLL) Fluocinolone acetonide Iluvien RED All uses NICE Diabetic macular oedema intravitreal implant Fluorouracil (except cream) RED All uses Specialist use only Non-REM parasomnia (off-label Third line monotherapy treatment option in non-REM parasomnia. Fluoxetine Prozac AMBER 2 SEL APC SEL APC local pathway indication) Requires specialist initiation and review. Shared Care Prescribing Guideline Cataplexy associated with for the management Narcolepsy (+/- Fluoxetine Prozac AMBER 3 SEL APC Initiation and minimum 3 months supply by the specialist sleep service. narcolepsy Cataplexy) and Idiopathic Hypersomnia in adults RAG status Shared care/ Transfer of care Common Brand National /Regional Changed/Added since October Drug Name (Adults unless Indication for RAG status Comments/ reason for inclusion or RAG status guidance/ additional Name(s) Guidance 2019 otherwise stated) information Liaison required between specialist All licensed indications for long service and GP practice regarding term use. Note that schizo- Flupentixol decanoate injection Depixol AMBER 2 NICE Requires specialist initiation and review role of practice nurse and any affective disorder is a sub-type additional training or support of schizophrenia. required. All licensed indications for long term use. Note that schizo- Flupentixol oral Depixol AMBER 2 NICE Requires specialist initiation and review affective disorder is a sub-type of schizophrenia. Clinician to clinician discussion should occur regarding individual patients and the on-going Flupentixol oral and injection Depixol AMBER 2 Off-label indications Requires specialist initiation and review responsibilities of each party, including access to timely support when required. Liaison required between specialist All licensed indications for long service and GP practice regarding Fluphenazine Decanoate term use. Note that schizo- Modecate AMBER 2 NICE Requires specialist initiation and review role of practice nurse and any injection affective disorder is a sub-type additional training or support of schizophrenia. required. Flutamide Drogenil AMBER 2 Prostate cancer Initiation by consultant/ specialist only Fluticasone furoate, umeclidinium bromide and Trelegy Ellipta AMBER 1 All licensed indications SEL APC SEL APC COPD guideline vilanterol inhaler device

Fluticasone propionate metered Off-label use as a spray for oral As per SEL APC guide for primary care on the off-label use of medicines dose inhaler 50 microgram or Flixotide Evohaler AMBER 2 SEL APC lesions in the Oral Medicine Clinics 125 microgram

Fluticasone propionate nasal Flixonase nasules AMBER 1 Nasal polyps SEL APC drops Fluticasone propionate nasal Off-label use as a steroid As per SEL APC guide for primary care on the off-label use of medicines Flixonase nasules AMBER 2 SEL APC drops mouthwash for oral lesions in the Oral Medicine Clinics Follitropin Alfa & Beta Gonal-F, Puregon RED All uses NICE Specialist use only, package of commissioned service Acute DVT and PE, and prevention of VTE in high-risk Fondaparinux Arixtra RED patients, Treatment of acute Specialist use only coronary syndromes, Treatment of unstable angina or nstemi Fosamprenavir Telzir RED All uses BHIVA Guidelines/NICE HIV Foscarnet Foscavir RED All uses BHIVA Guidelines HIV Treatment of resistant urinary ONLY on consultant microbiologist recommendation (in line with the SEL Fosfomycin Monuril AMBER 1 tract infection joint formulary) Subcutaneous infusion for Furosemide injection AMBER 1 patients with advanced heart SEL APC Palliative care or heart failure team recommendation only Added failure at end of life (off-label) Post-operative short, defined Gabapentin Neurontin RED JFC JFC courses All licensed indications. Restless Legs Syndrome For epilepsy, in line with SEL APC (RLS). focal epilepsy pathway. For RLS Gabapentin Neurontin AMBER 2 Off-label use as per the SEL NICE; SEL APC Require specialist initiation and review minimum 3 months supply by the APC Urticaria treatment neurology specialist team pathway (specialising in RLS). [Green for neuropathic pain] SEL APC integrated medication Galantamine Reminyl AMBER 1 All licensed indications NICE guidelines Ganciclovir Cymevene, Virgan RED All uses BHIVA Guidelines HIV Ocular herpes simplex Ganciclovir 0.15% eye gel AMBER 2 SEL APC infections Gefitinib Iressa RED All uses NICE Locally advanced or metastatic lung cancer Gemcitabine Gemzar RED All uses NICE Advanced bladder cancer, pancreatic cancer & metastatic breast cancer Gemtuzumab ozogamicin Mylotarg RED All uses NICE TA 545 Specialist use only Gentamicin in aqueous cream GREY All uses SEL APC Not listed on BAD Specials list (2014) 0.3% Gentamicin injection/ infusion Cidomycin, Genticin RED All uses Specialist use only Type 2 diabetes mellitus, see Glargine insulin 300units/ml Toujeo AMBER 2 SEL APC Requires specialist initiation and review. Prescribe by brand SEL APC recommendation Glatiramer Acetate Copaxone RED All uses NICE NICE declined but NHS risk sharing scheme Glecaprevir & pibrentasvir Maviret RED All formulary approved uses NICE / NHSE Specialist use only RAG status Shared care/ Transfer of care Common Brand National /Regional Changed/Added since October Drug Name (Adults unless Indication for RAG status Comments/ reason for inclusion or RAG status guidance/ additional Name(s) Guidance 2019 otherwise stated) information Glucosamine GREY All uses NICE CG177 Poor evidence of efficacy Glycerol phenylbutyrate Ravicti RED All uses NHSE Specialist use only Added Diagnosis of cluster headache Glyceryl trinitrate spray Various RED Within the headache clinic setting ONLY (off-label) Glycoprotein IIb/IIa inhibitors Various RED All uses NICE Specialist use only All uses (excluding palliative Glycopyrronium injection RED Specialist use only care) Initiation on recommendation of a palliative care specialist in end of life Glycopyrronium injection AMBER 1 Palliative care use care patients seen in the community As per SEL APC guidance on options for the pharmacological Glycopyrronium oral solution Sialanar, generic Hypersalivation in adult SEL APC formulary AMBER 2 SEL APC management of hypersalivation in adult neurology patients. Specalist Added (licensed preparations) (Colonis) neurology patients (off-label) recommendation 110 initiation. Glycopyrronium topical solution Palmer/planter hyperhidrosis. RED SEL APC Specialist use only 0.1% Used in Iontophoresis clinic Golimumab Simponi RED All uses NICE Specialist use only Gonadorelin HRF RED All uses NICE Infertility Note: Established arrangements in place in some boroughs should not change for example the specialist service may provide the first injection Novgos,Zoladex, All licensed indications (see Goserelin AMBER 1 or provide the whole course for pre-operative patients. Practices are Zoladex LA comments box) encouraged to confirm with their CCG Medicines Optimisation Team if unsure about local arrangements. Granisetron patch Sancuso RED All uses JFC JFC Nausea and vomiting induced by cytotoxic chemotherapy or Nausea associated with chemo/ Granisetron tablets and injection Kytril AMBER 2 radiotherapy. Consider if should be prescribed as package with other radiotherapy cancer drugs for individual patients Limited clinical evidence to support use however holistic review of allergy Historic shared care agreement, Grass pollen allergen Grazax RED All uses treatments including drug therapies required to re-asses RAGG status. however none currently active. NICE Grazoprevir Zepatier RED All uses SEL APC NHSE Approved as per detail in SE London APC Psoriasis Biological Drug Guselkumab injection Tremfya RED All uses SEL APC, NICE TA Treatment Pathway Liaison required between specialist All licensed indications for long service and GP practice regarding Haloperidol decanoate solution term use. Note that schizo- Haldol deconate AMBER 2 NICE Requires specialist initiation and review role of practice nurse and any for injection affective disorder is a sub-type additional training or support of schizophrenia. required. All licensed indications for long Serenace term use. Note that schizo- Haloperidol oral AMBER 2 NICE Requires specialist initiation and review Haldol affective disorder is a sub-type of schizophrenia. Clinician to clinician discussion Off-label indications (excluding should occur regarding individual Haloperidol oral and solution for Serenace use for nausea and vomiting in patients and the on-going AMBER 2 Requires specialist initiation and review injection Haldol sickle cell crisis and use of responsibilities of each party, injection in palliative care) including access to timely support when required. Haloperidol oral and solution for Serenace Off-label use for nausea and RED JFC injection Haldol vomiting in sickle cell crisis Haloperidol solution for Serenace Initiation on recommendation of a palliative care specialist in end of life AMBER 1 Palliative care use injection Haldol care patients seen in the community Off-label use to prevent radial Heparin injection RED artery spasm in radial access JFC Added procedures All patients except where SEE INDIVIDUAL Hackett report recommendation. EXISTING patients require review, refer Home care delivered medicines RED commissioning arrangements DRUG ENTRIES to medciines management teams agreed e.g. certain dressings Human menopausal Merional, Menopur, RED All uses NICE Infertility gonadotrophin Fostimon NICE CG did not recommend use, so exceptional use should remain Hyaluronic acid Durolene RED All uses NICE under specialist Intravesical therapy for bladder Hyaluronic acid 1.6% and pain/interstitial cystitis, recurrent iAuluRil RED JFC chondroitin sulphate 2% bacterial cystitis and radiation/BCG cystitis Hydrocortisone 1%, sulphur 1%, salicylic acid 1% in GREY All uses SEL APC Not listed on BAD Specials list (2014) Unguementum M cream For Primary adrenal Hydrocortisone MR Plenadren RED SEL APC SEL APC insufficiency in adults Hydrocortisone with Terra-Cortril RED Cosmetic surgery JFC JFC oxytetracycline ointment ointment RAG status Shared care/ Transfer of care Common Brand National /Regional Changed/Added since October Drug Name (Adults unless Indication for RAG status Comments/ reason for inclusion or RAG status guidance/ additional Name(s) Guidance 2019 otherwise stated) information Hydroquinone 4% in aqueous RED Depigmentation of skin in vitiligo SEL APC Specialist use only cream Hydroquinone 5% with RED Depigmentation of skin in vitiligo SEL APC Specialist use only hydrocortisone 1% cream Hydroxycarbamide Blood monitoring requirements in addition to monitoring for secondary Hydrea RED Cancer (Hydroxyurea) malignancies in long term cancer patients Siklos, Hydroxycarbamide All licensed indications Blood monitoring requirements. Additional monitoring for secondary hydroxycarbamide AMBER 2 (Hydroxyurea) (excluding cancer) malignancies in long term cancer patients. medac Amended - in line with the SEL APC shared care guideline for non- All indications covered by the biological immunomodulatory drugs, SEL APC shared care SEL APC shared care guideline for addition of urticaria use in this guideline for non-biological non-biological immunomodulatory category in line with updated urticaria Hydroxychloroquine Plaquenil AMBER 3 immunomodulatory drugs; Off- NICE, SEL APC Requires specialist initiation and review. drugs. SEL APC urticaria treatment pathway. Deletion of RED and label use in urticaria as per the pathway AMBER 2 categories as no longer SEL APC Urticaria treatment applies in line with JMF. Removal of pathway. reference to use in children as covered by the paediatric tab. Initiation on recommendation of a palliative care specialist in end of life Hyoscine butylbromide injection Buscopan AMBER 1 Palliative care use care patients seen in the community Off-label use for urticaria as per Hyoscine butylbromide Buscopan AMBER 2 the SEL APC Urticaria SEL APC See SEL APC Urticaria treatment pathway treatment pathway Hyoscine hydrobromide All uses (excluding palliative RED Specialist use only injection care) Hyoscine hydrobromide Initiation on recommendation of a palliative care specialist in end of life AMBER 1 Palliative care use injection care patients seen in the community As per SEL APC guidance on options for the pharmacological Hyoscine hydrobromide patches Scopoderm, Kwells, Hypersalivation in adult AMBER 2 SEL APC management of hypersalivation in adult neurology patients. Specalist Added and tablets Joy-rides neurology patients (off-label) initiation. Ibandronic Acid IV Bonviva, Bondronat RED All uses NICE Specialist use only Treatment of osteoporosis in postmenopausal women at Ibandronic Acid IV Bondronat RED increased risk of fracture, who JF do not tolerate oral bisphosphonates Ibandronic Acid Oral Bonviva, Bondronat GREY All uses Not on SEL Joint Formulary. Ibrutinib Imbruvica RED All formulary approved uses NICE / NHSE Specialist use only Icatibant Firazyr RED All uses Hereditary angioedema Ichthammol 10% in Glycerol of GREY All uses SEL APC Not listed on BAD Specials list (2014) Starch BP Ichthammol 2%, 5% and 10% and GREY All uses SEL APC Not listed on BAD Specials list (2014) zinc oxide 15% in YSP ointment Idarubicin Zavedos RED All uses Specialist use only NICE Idelalisib Zydelig RED All uses SEL APC NHSE Consensus statement Iloprost Ventavis RED All uses National Pulmonary Specialist use only Hypertension Centre Imatinib Glivec RED All uses NICE Specialist use only Non-REM parasomnia (off-label Third line monotherapy treatment option in non-REM parasomnia. Imipramine AMBER 2 SEL APC SEL APC local pathway indication) Requires specialist initiation and review. Not recommended for prescribing in SEL. Robust comparative head to Imiquimod 3.75% cream Zyclara GREY All uses SEL APC head data are lacking and comparative data supporting long term safety are lacking. Imiquimod 5% cream Aldara RED Superficial basal cell carcinoma SEL APC For prescribing and supply by skin cancer specialists Flebogammadif, Immunoglobulins IV S/C Gammaplex, RED All uses Specialist use only Intratect, Kiovig Immunotherapy, sublingual Oralvac RED All indications JFC JFC Indocyanine green RED All uses JFC JFC Indometacin injection RED All uses JFC JFC Infliximab Remicade RED All uses NICE Specialist use only Treatment of intermittent NICE does not recommend this as an option in the treatment of Inositol nicotinate Hexopal GREY claudication in peripheral NICE TA223 intermittent claudication in peripheral arterial diesease arterial diesease Insulin pumps RED All uses Specialist use only, not on FP10 RAG status Shared care/ Transfer of care Common Brand National /Regional Changed/Added since October Drug Name (Adults unless Indication for RAG status Comments/ reason for inclusion or RAG status guidance/ additional Name(s) Guidance 2019 otherwise stated) information Intron A, Roferon-A, Interferon Alfa RED All uses except haem disorders Specialist use only Viraferon Avonex, Rebif, Interferon Beta RED All uses NICE NICE declined but NHS risk sharing scheme Betaferon, Extavia Interferon Gamma-1b Immukin RED All uses DoH Specialist use only Ipilimumab Yervoy RED All uses NICE Specialist use only Ipratropium nebules (nebulised Atrovent UDV AMBER 2 COPD SEL APC Requires specialist initiation. SEL APC COPD guideline bronchodilator) Ipratropium with salbutamol Combivent, Ipramol, nebules (nebulised AMBER 2 COPD SEL APC Requires specialist initiation. SEL APC COPD guideline Salipraneb bronchodilator) Irinotecan Campto RED All uses NICE Specialist use only Isocarboxazid Isocarboxazid AMBER 2 Depressive illness Specialist initiation and stabilisation/ review Isoniazid RED All uses Treatment requires specialist knowledge and supervision Off label use to prevent radial Isosorbide dinitrate injection RED artery spasm in radial access JFC Specialist use only Added procedures MHRA recommend specialist only. Off label dermatology indications include hidradenitis suppurativa - prior to biologic treatment and folliculitis All uses, including dermatology decalvans - after failure of other conventional treatment e.g topical Isotretinoin oral Roaccutane RED off-label indications antibiotics, systemic antibiotics (clindamycin and rifampicin again) and other systemic therapy, such as oral dapsone

Second line treatment option for invasive aspergillosis; first line Isuvaconazole RED JF JF treatment option for mucromycetes. Postural Orthostatic Tachycardia Syndrome (POTS) SEL APC guidance, notification of and Inappropriate Sinus Ivabradine Procoralan AMBER 3 SEL APC SEL APC initiation form and transfer of Tachycardia (IST) where a beta- prescribing form blocker has failed or is inappropriate. Chronic stable angina, chronic Ivabradine Procorlan AMBER 2 NICE, SEL APC Initiation by consultant cardiologist only heart failure For management of sinus tachycardia in patients undergoing extracorporeal Ivabradine Procorlan RED JFC JF membrane oxygenation (ECMO) and where a beta- blocker is not appropriate. NICE Should only be prescribed by physicians with experience in the treatment Ivacaftor Kalydeco, Orkambi RED All uses NHSE of CF IVF drugs Various RED For the purpose of IVF Specialist use only, package of commissioned service Ixazomib Ninlaro RED All formulary approved uses NHSE Specialist use only Ixekizumab Taltz RED All uses NICE SEL APC Facial peel used in dermatology Jessners solution RED SEL APC Specialist use only theatres SEL APC, complex pain All uses, including all formulary- Ketamine Ketalar RED in patients under the SEL APC approved off-label uses palliative care team. Licensed indications for Drug does not require complex monitoring, but ECG required. Refer to Lacosamide Vimpat AMBER 2 NICE SEL APC GP information sheet epilepsy- adults SEL APC website fordetails on GP information sheet. Lactic acid 15% with propylene GREY All uses SEL APC Not listed on BAD Specials list (2014) glycol 10% in WSP Lactic acid in diprobase cream Hyperkeratotic disorders AMBER 2 SEL APC No alternative licensed product available for indication 10% (congenital ichthyosis) Lamivudine Epivir RED All uses BHIVA Guidelines/NICE HIV Lamivudine Zeffix RED All uses NHSE Hepatitis B Lamotrigine Lamictal RED Neuropathic pain SEL APC Pain specialist prescribing only All NICE recommended Lamotrigine Lamictal AMBER 2 NICE GP initiation with immediate referral if appropriate licensed indications Lanadelumab Takhzyro RED All uses NICE NICE TA606 Added Cancer, CONGENITAL HYPERINSULINISM, carcinoid Lanreotide Somatuline RED NHSE Specialist use only syndrome and NEW patients with acromegaly Existing patients managed in Specialist initiation only. New patients are delivered through homecare RAGG status currently under AMBER 2 Lanreotide Somatuline primary care for acromegaly NHSE which is RED. review NHS, Lanthanum Fosrenol RED All uses No exisiting shared care, NHSe commissioned Trust guidelines RAG status Shared care/ Transfer of care Common Brand National /Regional Changed/Added since October Drug Name (Adults unless Indication for RAG status Comments/ reason for inclusion or RAG status guidance/ additional Name(s) Guidance 2019 otherwise stated) information Latanoprost with timolol Open angle glaucoma and preservative-free unit dose eye Fixapost AMBER 2 SEL APC ocular hypertension drops NICE Ledipasvir Harvoni RED All uses SEL APC NHSE Amended - in line with the SEL APC All indications covered by the SEL APC shared care guideline for shared care guideline for non- SEL APC shared care Leflunomide Arava AMBER 3 Requires specialist initiation and review non-biological immunomodulatory biological immunomodulatory drugs. guideline for non-biological drugs. Removed reference to use in children immunomodulatory drugs as covered by paediatric tab. All licensed indications except rheumatological conditions Leflunomide Arava AMBER 2 Requires specialist initiation and review (which are amber 3 shared care) Lenalidomide Revlimid RED All uses NICE Specialist use only Lenograstim Granocyte RED All uses Specialist use only Lenvatinib Kisplyx RED All formulary approved uses NHSE Specialist use only Lesinurad is not recommended within its marketing authorisation. Not on Lesinurad Zurampic GREY All uses NICE SEL Joint Formulary. Letrozole Femara AMBER 1 All licensed indications NICE Requires specialist initiation Note: Established arrangements in place in some boroughs should not change for example the specialist service may provide the first injection Prostap SR, Prostap All licensed indications (see Leuprorelin Acetate AMBER 1 or provide the whole course for pre-operative patients. Practices are 3 comments box) encouraged to confirm with their CCG Medicines Optimisation Team if unsure about local arrangements. Initiation on recommendation of a palliative care specialist in end of life Levetiracetam injection Keppra AMBER 1 Palliative care use care patients seen in the community

Levetiracetam GP initiation with immediate referral if emergency. Requires specialist In line with SEL APC focal epilepsy Keppra AMBER 2 All licensed indications NICE tablets/suspension /injection initiation and review pathway

Levodopa/carbidopa/entacapone Stalevo AMBER 1 All licensed indications Levodopa-Carbidopa intestinal NICE Duodopa RED All uses SEL APC gel NHSE Levofolinic acid AMBER 1 Folates Requires specialist initiation All licensed indications for long term use. Note that schizo- Requires specialist initiation and review. Includes prescribing for Levomepromazine oral Nozinan AMBER 2 affective disorder is a sub-type palliative care. of schizophrenia. Levomepromazine solution for All licensed indications for long Nozinan AMBER 2 Requires specialist initiation and review. injection term use except palliative care Levomepromazine solution for Initiation on recommendation of a palliative care specialist in end of life Nozinan AMBER 1 Palliative care use injection care patients seen in the community Lidocaine, IV and nebulised RED All uses JFC JFC solution Note only licensed in post-herpetic neuralgia. Off-label use in focal Lidocaine plasters Ralvo, Versatis AMBER 2 All uses NHSE, SEL APC neuropathic pain with allodynia only. Initiation and stabilisation by specialist (pain services or specialist palliative care services only). Restricted to use in painful excoriating wounds where more Lidocaine 2% in lutrol 24% gel RED routine methods of managing Is an unlicensed special. For palliative care recommendation only . (unlicensed) the pain have been unsuccessful In accordance with SEL APC Linaclotide Constella AMBER 1 guidance, Irritable bowel SEL APC Green where diagnosis of IBS-C confirmed by specialist syndrome with constipation Restricted use and monitoring Linezolid Zyvox AMBER 1 Licensed indications On the recommendation of microbiologist and specialist requirements For defined course after thyroidectomy and prior to Place of Liothyronine radioiodine therapy; therapy is currently being Liothyronine (oral) RED Treatment of resistant progressed under SEL depression (as monotherapy or APC combination therapy) RAG status Shared care/ Transfer of care Common Brand National /Regional Changed/Added since October Drug Name (Adults unless Indication for RAG status Comments/ reason for inclusion or RAG status guidance/ additional Name(s) Guidance 2019 otherwise stated) information

Combination of liothyronine / Not recommended for levothyroxine therapy has limited hypothyroidism from the evidence to support use, and is Monotherapy in hypothyroidisim Royal College of No robust evidence of liothyronine use, particularly monotherapy. Not considered an experimental Liothyronine (oral) GREY untill SEL APC work is Physicians, as well as the licensed for long term use. approach by the European Thyroid undertaken. British, European and Association. It recommends that American Hypothyroidism this should only be carried out societies . under the supervision of an accredited endocrinologist. SEL APC Diabetes Group, pathway Liraglutide (Victoza brand) Victoza AMBER 3 All licensed indications NICE Requires specialist initiation and ToC document Requires specialist initiation (Does not apply in Lambeth CCG which Amended - removed reference to use Lisdexamfetamine Elvanse AMBER 3 ADHD NICE, SEL APC supports initiation of lisdexamfetamine by GPs on the advice of a SEL APC shared care for adults in children as covered by the specialist.) paediatric tab Priadel; Camcolit All licensed uses, management Lithium Liskonum AMBER 2 NICE Requires specialist initiation and review of depression Li-Liquid As an add on therapy to insulin in obese patients with type 2 No longer approved for initiation in new patients in SEL. Category is SEL APC Diabetes Group, pathway Amended - now non-formulary for Lixisenatide Lyxumia GREY SEL APC diabetes, in accordance with AMBER 2 for existing patients only. and SCA TBC new patients SEL APC shared care. Lofexidine BritLofex RED All uses To be prescribed as part of specialist service Lomustine Lomustine RED All uses Specialist use only Lopinavir & Ritonavir Kaletra RED All uses BHIVA Guidelines/NICE HIV Loxapine Adasuve RED All formulary approved uses JFC, NICE JF NICE Should only be prescribed by physicians with experience in the treatment Lumacaftor Orkambi RED All uses NHSE of CF Lurasidone Latuda RED All uses SEL APC SEL APC e.g. Icaps, Viteyes Original, Occuvite Age related macular Not recommended for prescribing in SEL. Food supplements, not Lutein and antioxidants GREY NHSE, SEL APC Complete, degeneration licensed medicines. Can be purchased OTC. Preservision Lutetium (177Lu) oxodotreotide Lutathera RED All uses NICE TA injection Maraviroc Celsentri RED All uses BHIVA Guidelines/NICE HIV Medroxyprogesterone Acetate Farlutal, Provera AMBER 2 Cancer Requires specialist initiation and review (High dose) Megestrol Acetate Megace AMBER 2 Cancer Requires specialist initiation and review Management of adhesive small Meglumine amidotrizoate with Gastrografin RED bowel obstruction (off-label JFC sodium amidotrizoate indication) Melatonin (Biomelatonin) Biomelatonin RED Sleep Centre Use only SEL APC SEL APC Management of specific headache disorders as outlined Restricted as a last line option after all other treatments have been Melatonin 2mg MR tablet Circadin RED in SEL APC formulary SEL APC trialled or considered but are not effective, not tolerated or recommendation 106 (off-label contrainidicated. use) Licensed indications; The liquid should only be used for specific patients e.g. those with Melatonin 2mg MR TABLET, Circadin, (special AMBER 2 off-label use in sleep disorders SEL APC swallowing difficulties or PEG tubes. First line treatment option in non- 5mg/5ml Liquid manufactured liquid) (including in adults with ADHD) REM parasomnia. Melphalan Alkeran RED All uses Specialist use only SEL APC integrated medication Memantine Ebixa AMBER 1 All licensed indications NICE guidelines Mepacrine RED All uses Giardiasis and discoid lupus erythematosus

Mercaptamine Cystagon RED All uses Nephropathic cystinosis

Off-label use for tretament of Mercaptamine 0.55% Unlicensed RED ocular manifestations of JFC preservative free eye drops cystinosis Mercaptopurine Puri-nethol RED Oncology indications SEL APC Added All indications covered by the SEL APC shared care SEL APC shared care guideline for Amended - in line with the SEL APC Mercaptopurine Puri-nethol AMBER 3 guideline for non-biological SEL APC Requires specialist initiation and review. non-biological immunomodulatory shared care guideline for non- immunomodulatory drugs drugs.. biological immunomodulatory drugs. (gastroenterology) Mesna Uromitexan RED All uses Specialist use only Androgen deficiency, male Mesterolone Pro-viron AMBER 2 Requires specialist initiation and review infertility-hypogonadism RAG status Shared care/ Transfer of care Common Brand National /Regional Changed/Added since October Drug Name (Adults unless Indication for RAG status Comments/ reason for inclusion or RAG status guidance/ additional Name(s) Guidance 2019 otherwise stated) information Substance misuse specialists only Treatment of opioid Methadone Methadose RED (AMBER if alternate service commissioned but still prescribed in dependence conjunction with misuse services) Maxtrex and Added (urticaria indication changed Methotrexate oral and injection RED Oncology indications SEL APC Metoject from RED to AMBER 3) Amended - in line with the SEL APC shared care guideline for non- All indications covered by the biological immunomodulatory drugs, SEL APC shared care SEL APC shared care guideline for addition of urticaria use in this guideline for non-biological Maxtrex and non-biological immunomodulatory category in line with updated urticaria Methotrexate oral and injection AMBER 3 immunomodulatory drugs; Off- NICE, SEL APC Requires specialist initiation and review. Metoject drugs. SEL APC urticaria treatment pathway. Deletion of AMBER 2 label use in urticaria as per the pathway. category as no longer applies in line SEL APC Urticaria treatment with JMF. Removed reference to use pathway ; in children as covered by the paediatric tab. Methoxy polethylene glycol Mircera RED All uses Renal anaemia epoetin beta Opioid-induced constipation in Methylnaltrexone Relistor RED terminally ill patients Concerta XL, Sleep centre initiation only Xenidate XL, Shared Care Prescribing Guideline Matoride XL, Idiopathic hypersomnia in for the management Narcolepsy (+/- Methylphenidate oral AMBER 3 SEL APC GPs can be asked to continue prescribing after 6 months treatment as Delmosart, Xaggitin adults, narcolepsy Cataplexy) and per SE London shared care agreement XL, Equasym XL, Idiopathic Hypersomnia in adults Medikinet XL Concerta XL, Xenidate XL, Matoride XL, Removed reference to use in children Methylphenidate AMBER 3 ADHD in adults (off-label) NICE, SEL APC Requires specialist initiation. Prescribe by brand. SEL APC shared care for adults Delmosart, Xaggitin as covered by the paediatric tab XL, Equasym XL, Medikinet XL Methylthioninium Chloride Proveblue RED All uses JFC JFC (Methylene blue) Initiation on recommendation of a palliative care specialist in end of life Metoclopramide injection Maxolon AMBER 1 Palliative care use care patients seen in the community Heart failure in patients with severe fluid overload non- Metolazone Unlicensed RED SEL APC Specialist use only Added responsive to loop diuretics (stat dose) Resistant oedema in renal Metolazone Unlicensed AMBER 2 SEL APC For specialist initiation impairment Perianal Crohn’s disease complicated by multiple fissures and/or ulcers; Metronidazole 10% ointment Chronic non-healing pilonidal RED (unlicensed) sinus disease wounds; where initial surgery has been unsuccessful.

Trichomonas vaginalis (off-label Metronidazole (oral) RED JFC Licensed indication, but high doses off-label high dose course) Cushing's syndrome. Resistant oedema due to increased aldosterone Metyrapone Metopirone RED All uses secretion in cirrhosis, nephrotic syndrome, and congestive heart failure Mexiletine USE UNDER SPECIALIST hydrochloride injection and RED All uses JFC SUPERVISION ONLY capsules Midazolam buccal liquid Buccolam AMBER 2 Epilepsy Requires specialist initiation and review 10mg/2ml All uses (excluding palliative Midazolam injection Hypnovel RED care) including as an IM Specialist use only. injection for status epilepticus Initiation on recommendation of a palliative care specialist in end of life Midazolam injection Hypnovel AMBER 1 Palliative care use care patients seen in the community Severe orthostatic hypotension due to Autonomic Dysfunction, SEL APC guidance, notification of Postural Orthostatic Midodrine Bramox AMBER 3 SEL APC SEL APC initiation form and transfer of Tachycardia Syndrome (POTS)/ prescribing form. Inappropriate Sinus Tachycardia (IST) Untreated acute myeloid Midostaurin Rydapt RED NICE TA As per NICE TA for untreated acute myeloid leukaemia leukaemia RAG status Shared care/ Transfer of care Common Brand National /Regional Changed/Added since October Drug Name (Adults unless Indication for RAG status Comments/ reason for inclusion or RAG status guidance/ additional Name(s) Guidance 2019 otherwise stated) information Mifamurtide Mepact RED All uses Osteosarcoma Associated with a greater risk of lupus-erythematosus-like syndrome; it sometimes causes irreversible pigmentation. NICE CG do not Minocycline RED All licensed indications recommend use. Clear rationale for use over other treatment options would be required if GP was to prescribe. Minoxidil in cetamacrogol cream GREY All uses SEL APC Not listed on BAD Specials list (2014) 5% Minoxidil tablets Loniten AMBER 2 All licensed indications JF USE ON SPECIALIST ADVICE Misoprostol 200mcg vaginal Mysodelle RED All uses JFC JFC delivery system Mitomycin Mitomycin C Kyowa RED All uses Upper gastro-intestinal, breast cancers and superficial bladder tumours Mitotane Luysodren RED All uses Specialist use only Metastatic breast cancer, non-Hodgkin's lymphoma and adult non- Mitoxantrone Onkotrone RED All uses lymphocytic leukaemia Moclobemide Manerix AMBER 2 Depressive illness Requires specialist initiation and review Shared Care Prescribing Guideline for the management Narcolepsy (+/- Modafinil Provigil AMBER 3 Narcolepsy NICE, SEL APC Requires specialist initiation and review Cataplexy) and Idiopathic Hypersomnia in adults Off-label use as a spray for oral As per SEL APC guide for primary care on the off-label use of medicines Mometasone nasal spray Nasonex AMBER 2 SEL APC lesions in the Oral Medicine Clinics SEL APC guidance for management of allergic rhinitis recommends as Montelukast Singulair AMBER 2 Allergic rhinitis SEL APC Step 5 for specialist initiation only in specialist allergy clinic. Monobenzylether of hydroquinone (Momobenzone) AMBER 2 Depigmentation of skin in vitiligo SEL APC in cetomacrogol cream A 10%, 20%, 30%, 40%, 50% Initiation on recommendation of a palliative care specialist in end of life Morphine injection AMBER 1 Palliative care use care patients seen in the community MHRA advice, evidence of an increased risk of life-threatening liver Moxifloxacin Avelox RED All licensed indications reactions and other serious risks (such as QT interval prolongation) Moxifloxacin 0.5% eye drops Moxivig RED Bacterial keratitis SEL APC Amended - indication of urticaria changed from RED to AMBER 3 in Renal transplant (new and Generics Cellcept, line with updated urticaria pathway. Mycophenolate mofetil RED repatriated patients). NHSE Repatriation programme of liver patients delayed. Myfenax Autoimmune hepatitis removed from New liver transplant patients. RED category as now included in shared care guideline. All indications covered by the SEL APC shared care SEL APC shared care guideline for Amended - in line with the SEL APC guideline for non-biological non-biological immunomodulatory shared care guideline for non- immunomodulatory drugs; drugs. SEL APC Shared care biological immunomodulatory drugs, Adult Liver Transplant Requires specialist initiation and review. For unlicensed indication use, guideline for the prevention of Generics, Cellcept, addition of urticaria use in this Mycophenolate mofetil AMBER 3 Recipients in existing patients NICE, SEL APC reasons for prescribing should be clearly communicated to the patient’s Organ Rejection in Adult Liver Myfenax category in line with updated urticaria only (i.e. those already being GP Transplant Recipients in existing pathway. Removed reference to use prescribed mycophenolate in patients only (i.e. those already in children as covered by the primary care); Off-label use in being prescribed mycophenolate in paediatric tab. urticaria as per the SEL APC primary care). Urticaria treatment pathway. Mycophenolic acid Renal transplant (new and Myfortic RED NHSE Repatriation programme of liver patients delayed (mycophenolate sodium) repatriated patients) SEL APC formulary Mycophenolic acid Autoimmune rheumatic and recommendation 103. SEL APC Myfortic, Ceptava AMBER 3 SEL APC In patients unable to tolerate mycophenolate mofetil Added (mycophenolate sodium) dermatological conditions non-biological immunomodulator medicines shared care guidance. Nabilone RED All uses Specialist use only N-acetylcysteine tabs unlicensed AMBER 2 Pulmonary fibrosis Limited evidence, review on case by case basis Nafarelin Synarel RED Infertility NICE Specialist use only, package of commissioned service In accordance with local commissioning pathways. Must be used in Nalmefene Selincro RED All uses NICE/ SEL APC conjunction with continuous psychosocial support Naloxone Injection Prenoxad RED Off-label use JFC JFC Immediate emergency See SEL APC formulary recommendation. Note that this Naloxone nasal spray Nyxoid RED treatment of known or SEL APC recommendation has a 1 year time limited approval until May 2019 suspected opioid overdose following which it will be subject to a review. Prescribe in accordance with local RED for Bexley, Bromley and other SEL CCGs where all prescribing is pathways. Must be used in Naltrexone Nalorex, Opizone AMBER 2 Adjunct to detox NICE, SEL APC under specialist services. conjunction with continuous psychosocial support RAG status Shared care/ Transfer of care Common Brand National /Regional Changed/Added since October Drug Name (Adults unless Indication for RAG status Comments/ reason for inclusion or RAG status guidance/ additional Name(s) Guidance 2019 otherwise stated) information Off-label use for urticaria as per Amended - category change from Naltrexone Nalorex, Opizone AMBER 3 the SEL APC Urticaria SEL APC GP information sheet replaces full shared care for this indication. RED to AMBER 3 following treatment pathway introduction of GP information sheet Naltrexone–bupropion is not recommended within its marketing Naltrexone & bupropion Mysimba GREY Managing overweight or obesity NICE authorisation. Not on SEL Joint Formulary. Natalizumab Tysabrl RED All uses NICE Specialist use only NICE Necitumumab Portrazza RED All uses SEL APC NHSE Nepafenac Nevanac RED All uses JFC JFC Netupitant with palonosetron Akynzeo RED All uses JFC Specialist use only Added Nevirapine Viramune RED All uses BHIVA Guidelines/NICE HIV A second line option to labetalol Nicardipine Injection RED JFC injection Lipid disorders with an ability to no UK licensed Nicotinic acid (m/r) AMBER 2 significantly raise HDL Initiation by consultant/ specialist only product cholesterol Nilotinib Tasigna RED All uses NICE Specialist use only NICE Nintedanib Ofev, Vargatef RED All uses SEL APC NHSE Niraparib Zejula RED All uses NICE TA Specialist use only NICE Nivolumab Opdivo RED All uses SEL APC NHSE Obeticholic acid Ocaliva RED All uses NHSE SEL APC NICE Obinutuzumab Gazyvaro RED All uses SEL APC NHSE Ocrelizumab Ocrevus RED All uses NICE TA Recommended option if an epiretinal membrane is not present and Ocriplasmin Jatrea RED All uses NICE macular hole is of specified size and type, and/or symptoms are severe Cancer, CONGENITAL HYPERINSULINISM, carcinoid Octreotide Sandostatin RED NHSE Specialist use only syndrome and NEW patients with acromegaly Management of chylothorax in adults, Variceal haemorrhage, High output ileostomy, palliative Octreotide Sandostatin RED SEL APC SEL APC Off-label use management of intestinal obstruction, diarrhoea associated with malignancy Existing patients managed in Specialist initiation only. New patients are delivered through homecare AMBER 2 Octreotide Sandostatin primary care for acromegaly NHSE which is RED. Initiation on recommendation of a palliative care specialist in end of life AMBER 1 Palliative care use care patients seen in the community. CCG commissioned for this Octreotide Sandostatin indication. NICE Ofatumumab Arzerra RED All uses SEL APC NHSE Olanzapine embonate injection Zypadhera RED All uses NICE All licensed indications for long term use. Note that schizo- affective disorder is a sub-type Olanzapine oral Zyprexa AMBER 2 NICE Requires specialist initiation and review of schizophrenia. Management of Depression (unlicensed indication) Clinician to clinician discussion should occur regarding individual patients and the on-going Olanzapine oral Zyprexa AMBER 2 Off-label indications Requires specialist initiation and review responsibilities of each party, including access to timely support when required. Olaparib RED All uses Ovarian cancer NICE Olaratumab Lartruvo RED All uses Use in combination with doxorubicin NHSE Omalizumab Xolair RED All uses NICE NHS England commissioned NICE Ombitasvir Viekirax RED All uses SEL APC NHSE cardiovascular group working on Omega 3 AMBER 1 For hypertriglyceridaemia NICE Requires specialist initiation pathway currently RAG status Shared care/ Transfer of care Common Brand National /Regional Changed/Added since October Drug Name (Adults unless Indication for RAG status Comments/ reason for inclusion or RAG status guidance/ additional Name(s) Guidance 2019 otherwise stated) information All uses with the exception of: NICE no longer endorses this as part of lipid guidance, it states : "Do not Advise people to eat a 1. Recommended on specialist offer or advise people use omega - 3 fatty acid capsules or omega-3 acid Mediterranean-style diet (more fruit, advice in refractory NICE CG172, CG170, supplemented foods to prevent another MI or for familial vegetables, pulses and fish: less Omega 3 supplements GREY hypertriglyceridaemia if fibrates CG87) hypercholesterolaemia (NICE CG172) , to manage sleep problems in meat: and replace butter and not tolerated children and young people with autism (NICE CG170)" or for primary cheese with products based on 2. Review in association with prevention of CVD in patients with Type 2 diabetes (NICE CG87). plant oils psychiatrist for schizophrenia Intractable nausea and Ondansetron injection, vominting. Note that RAG Formulations restricted to use in patients who cannot swallow or in Amended - RED category does not orodispersible tablets/ Zofran RED category does not apply to the JFC whom vomiting precludes oral administration and IV use is not possible apply in palliative care setting film/lyophilisate, suppositories injection when used in palliative or appropriate care. Nausea associated with chemo/ Ondansetron tablets Zofran AMBER 2 Nausea and vomiting induced by cytotoxic chemotherapy or radiotherapy radiotherapy Adjunctive therapy for management of end-of-dose Opicapone Ongentys AMBER 2 SEL APC motor fluctuations in Parkinson's disease Oral bowel evacuation Diafalk RED All uses Specialist use only NICE Osimertinib Tagrisso RED All uses SEL APC NHSE Oxaliplatin Eloxatin RED All uses NICE Metastatic colorectal and colon cancer Oxcarbazepine Trileptal RED Neuropathic pain SEL APC Pain specialist prescribing only Licensed indications for Require specialist initiation and review. Pain specialist initiation only for In line with SEL APC focal epilepsy Oxcarbazepine Trileptal AMBER 2 epilepsy- adults; trigeminal NICE trigeminal neuralgia). pathway neuralgia Off-label use for urticaria as per Oxybutynin AMBER 2 the SEL APC Urticaria SEL APC See SEL APC Urticaria treatment pathway treatment pathway Initiation on recommendation of a palliative care specialist in end of life Oxycodone injection OxyNorm, Shortec AMBER 1 Palliative care use care patients seen in the community SEL pharmacological management Oxycodone (all formulations) Various AMBER 1 All uses SEL APC Requires specialist initiation of adult non-cancer chronic pain in primary care Insufficient evidence available to prove that naloxone reduces the need for laxatives in the long term, as highlighted in Drugs and Therapeutics Can prescribe oxycodone Bulletin(2010)Furthermore, NICE Clinical Knowledge Summaries for pain Oxycodone/Naloxone Targinact GREY All uses monotherapy with separate laxative recommends a stimulant laxative alongside a softening laxative should (if required). be prescribed. No evidence to prove naloxone reduce incidence of constipation. Minimum 3 months supply by the Management of restless legs Oxycodone/naloxone SR tabs Targinact AMBER 2 SEL APC SEL APC neurology specialist team syndrome (RLS). (specialising in RLS) Paclitaxel Taxol RED All uses NICE Ovarian Ca, NSCLC Untreated localised prostate Padeliporfin Tookad GREY NICE TA 546 Not recommended within its marketing authorisation by NICE TA cancer Licensed indications in Paliperidone depot injection Xeplion AMBER 3 accordance with SEL APC SEL APC Requires specialist initiation and review SEL APC shared care Palivizumab Synagis RED All uses Specialist use only Pamidronate IV Aredia RED All uses Specialist use only Creon, Nutrizym, Pancreatin AMBER 2 All licensed indications Requires specialist initiation and review Pancrease, Pancrex

Panitumumab Vectibix RED All uses Metastatic colon cancer

NICE Panobinostat Farydak RED All uses SEL APC NHSE Papaverine injection RED All uses JFC JFC Paracetamol/tramadol Tramacet GREY All uses Subtherapeutic doses of tramadol and paracetamol

Paricalcitol Zemplar RED All uses Specialist use only

NICE Paritaprevir Viekirax RED All uses SEL APC NHSE Paromomycin Unlicensed RED Protozoal infection JFC Pazopanib Votrient RED All uses NICE First line treatment of advanced renal cell carcinoma Wet age related macular Pegaptanib Macugen GREY NICE TA155 degeneration NICE Pegaspargase Oncaspar RED All uses SEL APC NHSE RAG status Shared care/ Transfer of care Common Brand National /Regional Changed/Added since October Drug Name (Adults unless Indication for RAG status Comments/ reason for inclusion or RAG status guidance/ additional Name(s) Guidance 2019 otherwise stated) information Pegfilgastrim Neulasta RED All uses Specialist use only Pegasys, Pegintron, Peginterferon alfa RED All uses NICE Specialist use only ViraferonPeg Amended - removed reference to use Peginterferon alfa in RED All uses NICE in children as covered by paediatric combination with ribavirin tab for people who respond Pegloticase GREY inadequately to oral drugs or for NICE TA 291 whom they are contra-indicated Not routinely Pegvisomant Somavert RED All uses Acromegaly commissioned, IFR NICE Pembrolizumab Keytruda RED All formulary-approved uses SEL APC NHSE Pemetrexed Alimta RED All uses NICE Specialist use only Uses except rheumatoid Considered on an individual basis with regard to monitoring of patients Penicillamine Distamine RED NICE arthritis and cystinuria other specialist drugs prescribed Other indications are red listed and should be considered on an Penicillamine Distamine AMBER 2 Rheumatoid arthritis; cystinuria NICE individual basis Pentosan polyslfate sodium Elmiron RED All uses NICE NICE TA610 Added caps Pentostatin Nipent RED All uses Hairy cell leukaemia Prevention of osteonecrosis of Trental, unlicensed the Pentoxifylline RED JFC product jaw. Used in combination with vitamin E capsules Treatment of intermittent NICE does not recommend this as an option in the treatment of Pentoxifylline Trental GREY claudication in peripheral NICE TA223 intermittent claudication in peripheral arterial diesease arterial diesease For epilepsy, us in line with SEL Adjunct to treatment of focal NICE evidence review available - ESNM7. Psychiatric Side effects and Perampanel Fycompa AMBER 3 NICE APC focal epilepsy pathway and seizures in epilepsy weight require monitoring. Used in teritary practice. SCA Parkinson's Disease, NEW Pergolide Celance RED patients, exisitng patients, No longer routinely recommended amber Parkinson's Disease, existing Pergolide Celance AMBER 2 No longer routinely recommended. RED for new patients. patients only NICE Pertuzumab Perjeta RED All uses SEL APC NHSE Phenelzine Nardil AMBER 2 Depressive illness Requires specialist initiation and review Phenindione AMBER 2 Initiated and stabilsied by a prescriber specialising in anticoagulation Initiation on recommendation of a palliative care specialist in end of life Phenobarbital injection AMBER 1 Palliative care use care patients seen in the community NEW PATIENTS with Phenylbutazone RED BNF = Specialist only Specialist use only Ankylosing spondylitis Phenylephrine / tropicamide eye For mydriasis prior to Mydriasert RED JFC JFC drops ophthalmic surgery Licensed indications for Phenytoin Epanutin AMBER 2 NICE Require specialist initiation and review epilepsy- adults Pimecrolimus cream Elidel AMBER 2 All licensed indications BNF warning, specialist initiation for specified indications Pimozide Orap RED All uses Specialist use only Pirfenidone Esbriet RED Idiopathic pulmonary fibrosis NICE NHS England commissioned Treatment of narcolepsy with or Specialist Sleep Centre at Guy’s and St. Thomas’ NHS Foundation Pitolisant hydrochloride Wakix RED SEL APC without cataplexy in adults Trust (GSTfT) only Pixantrone Pixuvri RED All uses NICE Lymphoma (non Hodgkin's relapsed refractory) Plerixafor Mozobil RED All uses Specialist use only Polyethylene glycols (Plenvu Plenvu RED All uses JFC brand) NICE Pomalidomide Imnovid RED All uses SEL APC NHSE NICE Ponatinib Iclusig RED All uses Leukaemia NHSE Poractant Alfa Curosurf RED All uses Specialist use only Posaconazole Noxafil RED All uses Specialist use only Urine alkalinisation in cystinuria Potassium citrate effervescent in patients who cannot tolerate Effercitrate AMBER 2 tablets regular potassium citrate liquid (off-label) Potassium Citrate Mixture BP Urine alkalinisation in cystinuria Cystinuria AMBER 2 oral solution (off-label indication) RAG status Shared care/ Transfer of care Common Brand National /Regional Changed/Added since October Drug Name (Adults unless Indication for RAG status Comments/ reason for inclusion or RAG status guidance/ additional Name(s) Guidance 2019 otherwise stated) information Potassium citrate 1080mg MR Urocit K RED For cystinuria clinic use only tabs (unlicensed) Licensed indications of Pramipexole Mirapexin AMBER 1 Parkinson's Disease Restless legs syndrome; REM Requires specialist initiation and review. Third line monotherapy Pramipexole Mirapexin AMBER 2 behaviour disorder (off-label SEL APC SEL APC local pathway treatment option in REM behaviour disorder. indication) SEL APC formulary Prasterone pessaries Intrarosa AMBER 2 All licensed indicatiions SEL PAC Added recommendation 112 Off-label use as a steroid As per SEL APC guide for primary care on the off-label use of medicines Prednisolone AMBER 2 SEL APC mouthwash for oral lesions in the Oral Medicine Clinics. All licensed indications. Restless Legs Syndrome For epliepsy, use in line with SEL (RLS). APC focal epilepsy pathway. Pregabalin Lyrica AMBER 2 Off-label use as per the SEL NICE, SEL APC Require specialist initiation and review For RLS, minimum 3 months APC Urticaria treatment supply by the neurology specialist pathway team (specialising in RLS). [Green for neuropathic pain] Pristinamycin Unlicensed RED All formulary approved uses JFC Procarbazine Procarbazine RED All uses Specialist use only Propafenone Arythmol AMBER 2 All licensed indications Specialist supervision recommended in BNF for many indications hydrochloride tablets Off-label use for urticaria as per Propantheline Pro-Banthine AMBER 2 the SEL APC Urticaria SEL APC See SEL APC Urticaria treatment pathway treatment pathway Propylene glycol in water 50% GREY All uses SEL APC Not in BAD Specials list (2014) Protein C Concentrate Ceprotin RED All uses Congenital protein C deficiency Prucalopride Resolor AMBER 2 All licensed indications As per SEL APC chronic constipation pathway All licensed indications for long term use. Note that schizo- affective disorder is a sub-type Quetiapine oral Seroquel AMBER 2 NICE Requires specialist initiation and review of schizophrenia. Management of Depression, licensed as adjunct for major depression. Clinician to clinician discussion should occur regarding individual patients and the on-going Quetiapine oral Seroquel AMBER 2 Off-label indications Requires specialist initiation and review responsibilities of each party, including access to timely support when required. NICE Radium-223 dichloride Xofigo RED All uses SEL APC NHSE Raltegravir Isentress RED All uses BHIVA Guidelines/NICE HIV NICE Ramucirumab Cyramza RED All uses SEL APC NHSE Ranibizumab Lucentis RED All uses NICE Specialist use only Ranolazine Ranexa AMBER 2 Stable angina pectoris SEL APC Initiation by consultant cardiologist only Rasagaline Azilect AMBER 2 Parkinson's disease Requires specialist initiation and review Rasburicase Fasturtec RED All uses Specialist use only Acute attacks of hereditary Recombinant C1 esterase Ruconest, Conestat RED angioedema, as per NHSE NHSE inhibitor injection Alpha Policy B09/P/b NICE / NHSE Regorafenib Stivarga RED All formulary approved uses Specialist use only SEL APC Not widely prescribed in primary care, not listed in NICE guideline but Adjunct to treatment of partial In line with SEL APC focal epilepsy Retigabine Trobolt AMBER 3 NICE separately TAG approved, normally prescribed by tertiaty centres. onset seizures in epilepsy pathway Involves some complex monitoring. Newer agent All uses, including treatment of chronic hepatitis E virus Ribavirin Rebetol RED NICE Specialist use only infection in transplant recipients patients (off-label indication) Rifabutin Mycobutin RED All uses Treatment requires specialist knowledge and supervision Rifampicin Rifadin, Rimactane, RED Tuberculosis Treatment requires specialist knowledge and supervision Hidradenitis suppurativa / Ensure roles regarding monitoring AMBER 2 Rifampicin Rifadin, Rimactane, orthopaedic infection Treatment requires specialist knowledge and supervision and review are explicit Reduction in recurrence of Rifaximin Targaxan AMBER 3 NICE, SEL APC Requires specialist initiation and review SEL APC, Transfer after 6 months hepatic encephalopathy. Riluzole Rilutek AMBER 2 All licensed indications SEL APC SCA expired, felt no longer required Risankizumab Skyrizi RED All uses NICE NICE TA596 Added RAG status Shared care/ Transfer of care Common Brand National /Regional Changed/Added since October Drug Name (Adults unless Indication for RAG status Comments/ reason for inclusion or RAG status guidance/ additional Name(s) Guidance 2019 otherwise stated) information Liaison required between specialist All licensed indications for long service and GP practice regarding term use. Note that schizo- Risperidone injection Risperdal Consta AMBER 2 NICE Requires specialist initiation and review role of practice nurse and any affective disorder is a sub-type additional training or support of schizophrenia. required. All licensed indications for long term use. Note that schizo- affective disorder is a sub-type Risperidone oral Risperdal AMBER 2 NICE Requires specialist initiation and review of schizophrenia. Management of Depression (unlicensed indication) Clinician to clinician discussion should occur regarding individual patients and the on-going Risperidone oral and injection Risperdal AMBER 2 Off-label indications Requires specialist initiation and review responsibilities of each party, including access to timely support when required. BHIVA Guidelines/NICE Ritonavir Novir RED All uses SEL APC NHSE Rituximab Mab Thera RED All uses NICE Specialist use only Prophylaxis of venous thromboembolism in adults after total hip replacement; total knee replacement; post pelvic Amended - addition of indication for Rivaroxaban Xarelto RED ring/acetabular fracture. NICE, SEL APC Full supply by Trust heparin-induced thrombocytopenia Treatment of SVT (off-label use, 10mg strength); treatment of heparin-induced thrombocytopenia (off-label) All licensed uses except VTE prevention post hip and knee Rivaroxaban Xarelto AMBER 3 NICE, SEL APC Requires specialist initiation SEL APC transfer of care replacement where full course should be supplied by trust SEL APC integrated medication Rivastigmine Exelon AMBER 1 All licensed indications NICE guidelines First 3 months supply to be given Roflumilast Daxas AMBER 2 Severe COPD NICE TAG Requires specialist initiation by specialist before transfer to GP Romiplostim Nplate RED All uses Chronic immune thrombocytopenic purpura Licensed indications of Ropinirole Requip AMBER 1 SEL APC Requires specialist initiation and review Parkinson's Disease Ropinirole Requip AMBER 2 Restless legs syndrome Use immediate-release tablets only Licensed indications of Rotigotine transdermal Neupro AMBER 1 Requires specialist initiation and review Parkinson's Disease Restless legs syndrome; REM Requires specialist initiation and review. Third line monotherapy Rotigotine transdermal Neupro AMBER 2 behaviour disorder (off-label SEL APC SEL APC local pathway treatment option in REM behaviour disorder. indication) e.g Algesal cream, Balmosa cream, Deep Freeze cold Rubefacients (exclusing topical gel, Movelat GREY All uses NHSE, SEL APC Not recommended for prescribing in SEL. Can be purchased OTC. NSAIDs) cream/gel, Ralgex Heat spray, Transvasin Heat Rub Rucaparib Rubraca RED All uses NICE NICE TA611. Specialist use only. Added Not on SEL JF formulary. On the recommendation of tertiary centres Adjunct treatment of seizures in Rufinamide Inovelon AMBER 2 NICE Require specialist initiation and review only, with clarity regarding on going Lennox-Gastaut syndrome roles of both primary care and specialist NICE Ruxolitinib Jakavi RED All uses SEL APC NHSE In accordance with SEL APC Sacubitril Valsartan Entresto AMBER 3 SEL APC SEL APC transfer of care guidance Salicylic acid 0.5% and sulphur GREY All uses SEL APC Not in BAD Specials list (2014) 0.5% in aqueous cream Salicylic acid in aqueous cream 1%, 2%, 3%, 5%, 10%, 30%, 50%, GREY All uses SEL APC Not in BAD Specials list (2014) 70% RAG status Shared care/ Transfer of care Common Brand National /Regional Changed/Added since October Drug Name (Adults unless Indication for RAG status Comments/ reason for inclusion or RAG status guidance/ additional Name(s) Guidance 2019 otherwise stated) information Hyperkeratotic psoriasis, hyperkeratotic eczema, viral warts, lichen simplex, ichthyosis Salicylic acid in WSP ointment keratodermas, callus, keratotis 1%, 2%, 3%, 5%, 10%, 20%, 30%, AMBER 2 SEL APC No alternative licensed product available for indication pilaris and other hyperkeratotic 50%, 70% conditions where emollients and commercial preparations are ineffective Sapropterin Kuvan RED All uses NHSe Hyperphenylalaninemia Saquinavir Invirase RED All uses BHIVA Guidelines/NICE HIV Sarilumab Kevzara RED All formulary approved uses NICE SEL PAC Specialist use only Secukinumab Cosentyx RED All uses NICE SEL APC Selegiline Eldepryl, Zelpar AMBER 2 All licensed indications Requires specialist initiation and review SEL APC GLP-1 transfer of care Semaglutide Ozempic AMBER 3 All licensed indications SEL APC Initiation and supply by specialist diabetes teams. document. SEL APC formulary Added recommendation 111. Non-REM parasomnia (off-label Third line monotherapy treatment option in non-REM parasomnia. Sertraline Lustral AMBER 2 SEL APC SEL APC local pathway indication) Requires specialist initiation and review. NHS, Sevelamer Renagel RED All uses No exisiting shared care, NHSe commissioned Trust guidelines Consensus statement Sildenafil 20mg Revatio RED All uses National Pulmonary Pulmonary Hypertension Hypertension Centre Sildenafil tablets RED Oesophageal spasm JFC Specialist prescribing only Patients with a failing Fontan circulation; Initiation of treatment in pulmonary Local specialist centre is Royal Free Hospital. Only generic tablets Sildenafil tablets - generic RED JFC hypertension following should be supplied for these indications. discussion with local specialist centre Silver nitrate solution 0.25%, GREY All uses SEL APC Not in BAD Specials list (2014) 0.5% NICE Simeprevir Olysio RED All uses SEL APC NHSE Renal transplant (new and NHSE Sirolimus (Rapamycin) Rapamune RED Specialist use only repatriated patients) Trust guidelines Lymphangioleiomyomatosis Sirolimus (Rapamycin) Rapamune RED NHSE IFR Specialist use only (LAM) Prophylaxis of kidney rejection in patients historically managed Sirolimus (Rapamycin) Rapamune AMBER 3 under shared care. All new Requires specialist initiation and review patients should be managed by the acute trust. Sodium Benzoate Solution RED All uses NHSE Used for urea cycle disorders Sodium Chloride nebuliser As a mucolytic as per the SEL solution 3% and 7% (nebulised AMBER 2 SEL APC SEL APC COPD guideline APC COPD guideline mucolytic) Bonefos, Clasteon, Sodium Clodronate RED All uses Should be included in management of skeletal metastases by specialist Loron Gastrointestinal symptoms due Use in accordance with SEL APC Sodium Cromoglicate capsules Nalcrom AMBER 2 to food allergy in adults and in SEL APC Requires specialist initiation and review guidance children aged 2 years and over Treatment and prevention of Sodium fluoride toothpaste Duraphat RED SEL APC For prescribing by oral medicine or dentists only (not for GP prescribing) dental caries Consensus statement Sodium nitroprusside Unlicensed RED All uses National Pulmonary Pulmonary hypertension specialist only Hypertension Centre Sodium Oxybate Xyrem RED REM behaviour disorder SEL APC Unlicensed use. Sleep centre prescribing use only. SEL APC local pathway Shared Care Prescribing Guideline Treatment of cataplexy in adult for the management Narcolepsy (+/- Sodium Oxybate Xyrem AMBER 3 Requires specialist initiation and review patients with narcolepsy Cataplexy) and Idiopathic Hypersomnia in adults

Sodium phenylbutyrate Ammonaps RED All uses NHSE Specialist use only Added

Sodium Valproate Epilim AMBER 2 All licensed indications Require specialist initiation and review Sodium zirconium cyclosilicate Lokelma RED All uses NICE Specialist use only. NICE TA599. Added Epclusa, Harvoni, NICE Sofosbuvir RED All uses SEL APC Sovaldi NHSE RAG status Shared care/ Transfer of care Common Brand National /Regional Changed/Added since October Drug Name (Adults unless Indication for RAG status Comments/ reason for inclusion or RAG status guidance/ additional Name(s) Guidance 2019 otherwise stated) information Solifenacin/tamsulosin M/R Grey listed until a finalised pathway is received from local clinicians in Vesomni GREY All uses SEL APC combination tablet SEL. Somatropin (adults) Various AMBER 3 Growth hormone deficiency NICE RED if delivered through home care company

Sorafenib Nexavar RED All uses NICE Specialist use only

Sotolol hydrochloride tablets Beta-cardone AMBER 1 All licensed indications Specialist supervision recommended in BNF for many indications Stavudine Zerit RED All uses BHIVA Guidelines/NICE HIV Stoma products (deodorants, lubricating products, skin cleansers, underwear, filters, GREY Stoma care SEL APC See SEL APC Position Statement PS-020 bag covers, bridges and bag closures) for any patient with a newly formed stoma Streptokinase Streptase RED All uses JFC JFC All uses, existing patients initiated in secondary care Strontium Ranelate Protelos RED NICE Patient selection and 6-12 monthly monitoring where alternate treatment not suitable. Sucralfate in Cavilon cream 4% GREY SEL APC Not in BAD Specials list (2014) Recommendation subject to review Hyperphosphatemia in adult once SEL hyperphosphatemia Sucroferric oxyhydroxide Velphoro RED chronic kidney disease (CKD) SEL APC Specialist use only treatment pathway has been patients on renal dialysis developed with supporting shared care Sugammadex Bridion RED All uses Specialist use only Sulfacetamide in IMS lotion 15% RED Severe fungail nail disease SEL APC Specialist use only

Amended - in line with the SEL APC shared care guideline for non- All indications covered by the biological immunomodulatory drugs, SEL APC shared care SEL APC shared care guideline for addition of urticaria use in this guideline for non-biological non-biological immunomodulatory category in line with updated urticaria Sulfasalazine Salazopyrin AMBER 3 immunomodulatory drugs; Off- NICE, SEL APC Requires specialist initiation and review. drugs. SEL APC urticaria treatment pathway. Deletion of RED and label use in urticaria as per the pathway. AMBER 2 categories as no longer SEL APC Urticaria treatment applies in line with JMF. Removed pathway. reference to use in children as covered by paediatric tab. Sulphur Hexachloride RED All uses JFC JFC microbubbles All licensed indications for long term use. Note that schizo- Sulpiride oral Dolmatil AMBER 2 Requires specialist initiation and review affective disorder is a sub-type of schizophrenia. Clinician to clinician discussion should occur regarding individual patients and the on-going Sulpiride oral Dolmatil AMBER 2 Off-label indications Requires specialist initiation and review responsibilities of each party, including access to timely support when required. NICE Sunitinib Sutent RED All uses Neuroendocrine tumours NHSE Generics, Adoport, Advagraf, Capexion, Renal transplant (new and Tacrolimus (oral) Envarsus, Modigraf, RED repatriated patients). NHSE Repatriation programme of liver patients delayed Prograf, Tacni, New liver transplant patients. Vivadex Adoport, Advagraf, All licensed indications except Capexion, RED for kidney transplant Tacrolimus (oral) Envarsus, Modigraf, AMBER 3 NICE RED for use in kidney translant patients Review under SEL APC. patients and new liver Prograf, Tacni, transplant patients. Vivadex Atopic eczema ; psoriasis of the Tacrolimus 0.03% or 0.1% face, flextures and genitals; off- As per SEL APC guide for primary care on the off-label use of medicines Protopic AMBER 2 SEL APC, NICE ointment label use in oral inflammatory in the Oral Medicine Clinics. conditions RAG status Shared care/ Transfer of care Common Brand National /Regional Changed/Added since October Drug Name (Adults unless Indication for RAG status Comments/ reason for inclusion or RAG status guidance/ additional Name(s) Guidance 2019 otherwise stated) information Vernal keratoconjunctivitis (VKC), Atopic keratoconjunctivitis (AKC); Restricted to use in where where ciclosporin eye drops are ineffective or Tacrolimus 0.1% ointment Protopic RED Ocular graft-versus-host JFC inappropriate disease (GVHD) (off-label topical ocular administration)

Tadalafil for the treatment of erectile dysfunction post prostatectomy has been Tadalafil (daily dosing) Cialis GREY SEL APC See SEL APC website. Not on SEL Joint Formulary. withdrawn. Use of tadalafil tablets as daily dosing is GREY. Tafluprost preservative-free eye Open angle glaucoma and Saflutan AMBER 2 SEL APC drops ocular hypertension

Tafluprost + Timolol Open angle glaucoma and Taptiqom AMBER 2 SEL APC preservative-free eye drops ocular hypertension

NICE Talimogene Imlygic RED All uses SEL APC NHSE Tamoxifen Soltamox AMBER 1 All licensed indications Requires specialist initiation Third-line treatment for the management of severe chronic pain

When successfully treated patients Tapentadol Palexia AMBER 2 Severe chronic pain SEL APC Requires specialist initiation are on a stable dose, care can be transferred to the patient’s GP with an accompanying letter explaining the change in chronic pain management. Taurolock RED All uses JFC JFC Telbivudine Sebivo GREY Chronic Hepatitis B NICE TA154 Temocillin Negaban RED All uses JFC JFC Temozolamide Temodal RED All uses NICE As per NICE Viread, Truvada, Tenofovir RED All uses BHIVA Guidelines/NICE Specialist use only Atripla Teriflunomide Aubagio RED All uses NICE Multiple sclerosis (relapsing) Teriparatide Forsteo RED All uses NICE Specialist use only Testosterone implant or patch Unlicensed RED Unlicensed Off-label use in women with Initiation and first prescription supplied by the gynaecology team. Note Testosterone gel Tostran, Testogel AMBER 2 decreased libido in the SEL APC supporting patient information leaflet available which should be provided. menopause Sustanon, Nebido, Testosterone oral, injection and Testim, Testogel, Licensed indications and gender Shared care agreements should be AMBER 1 gel Tostran, Restandol, dysphoria followed for gender dysphoria Testocaps Movement disorder in Tetrabenazine Xenazine RED Huntington's chorea and related Develop shared care, with subsequent move to amber disorders Tetracosactide (Tetracosactrin) Synacthen RED All uses Diagnostic test for the investigation of adrenocortical insufficiency Thalidomide Unlicensed RED All uses Specialist use only Thymol lotion 2% GREY All uses SEL APC Not in BAD Specials list (2014)

Thyroid extracts (unlicensed), e.g. Armour thyroid, compounded thyroid hormones, Not recommended for prescribing by the RMOC guidance - prescribing ERFA Thyroid, GREY All uses SEL APC; RMOC iodine containing preparations, of liothyronine Nature Throid dietary supplementation

Licensed indications for SEL APC GP information sheet to Tiagabine Gabitril AMBER 3 NICE Drug requires regular monitoring. epilepsy- adults follow With aspirin in adults with ACS (STEMI intended to be treated with PCI, or with NSTEMI or SEL APC summary of antiplatelet Ticagrelor Brilique AMBER 1 NICE, SEL APC GP initiation with immediate referral? where admitted into hospital options in CV disease with unstable angina and have one defined characteristic) Tildrakizumab Ilumetri RED All uses NICE TA575 RAG status Shared care/ Transfer of care Common Brand National /Regional Changed/Added since October Drug Name (Adults unless Indication for RAG status Comments/ reason for inclusion or RAG status guidance/ additional Name(s) Guidance 2019 otherwise stated) information Timolol maleate preservative In accordance with SEL APC Tiopex AMBER 2 SEL APC Requires specialist initiation free UDVs guidance Trichomonas vaginalis (off-label Tinidazole Fasigyn RED JFC Licensed indication, but high doses off-label high dose course) Tioguanine Lanvis RED All uses Specialist use only Tiotropium Respimat 2.5 Spiriva Respimat AMBER 2 Asthma in adults SEL APC Initiation by respiratory specialist SEL APC asthma guideline micrograms inhalation solution NICE Tipiracil Lonsurf RED All uses SEL APC NHSE Tirofiban Aggrastat RED All uses Moderate- and high-risk acute coronary syndromes (ACS) Tisagenlecleucel cells Kymriah RED All formulary-approved uses NICE TA 554 Specialist use only dispersion for infusion For the management of corneal Tissue adhesive Histoacryl RED JFC JFC perforations (off-label) Tivozanib Fotivda RED All uses NICE TA Tizanidine Zanaflex AMBER 2 Muscle spasticity Requires specialist initiation and review Tobramycin Tobi, Bramitob RED Cystic fibrosis, new patients NICE Removed nebs formulation so includes all forms for new CF patients Treatment of superficial Tobramycin 0.3% eye drops Tobravisc RED JFC bacterial infections of the eye Existing patients only. Amended - removed reference to use All licensed indications when SEL APC SCA for existing patients. Tobramycin nebuliser solution Tobi, Bramitob AMBER 3 NICE RED for new patients in children as covered by paediatric delivered via NHSE commissioned tab. nebulisation/inhalation. Tocilizumab Roactemra RED All uses Specialist use only Tofacitinib Xeljanz RED All uses NICE TAG Specialist use only Tolvaptan Samsca, Jinarc RED All uses Euvolaemic or hypervolaemic patients with hyponatraemia Topiramate Topamax RED Neuropathic pain SEL APC Pain specialist prescribing only Topiramate Topamax AMBER 2 All licensed indications NICE Require specialist initiation and review Ovarian cancer, monotherapy for adult patients with relapsed small cell Topotecan Hycamtin RED All uses NICE lung cancer (SCLC) for whom retreatment with the first-line regimen is not appropriate Total Parenteral Nutrition Various RED All uses Trust Guidelines Specialist use only Trabectedin Yondelis RED All uses NICE Soft tissue sarcoma, Relapsed ovarian cancer Minimum 3 months supply by the Management of restless legs Tramadol Capsules Zamadol, Zydol AMBER 2 SEL APC SEL APC neurology specialist team syndrome (RLS). (specialising in RLS) NICE Trametinib Mekinist RED All uses SEL APC NHSE Off-label use for urticaria as per Tranexamic acid Cyklokapron AMBER 2 the SEL APC Urticaria SEL APC See SEL APC Urticaria treatment pathway treatment pathway Off-label use in accordance with Tranexamic acid injection Cyklokapron RED the ECMO guideline for adults Specialist use only Added in critical care Tranexamic acid injection Off label use in non-massive Cyklokapron RED JFC Specialist use only Added (nebulised) haemoptysis Tranylcypromine AMBER 2 Depressive illness Requires specialist initiation and review Trastuzumab Herceptin RED All uses NICE Specialist use only Tretinoin Vesanoid RED All uses Specialist use only Tretinoin 0.1% in aqueous cream GREY All uses SEL APC Not in BAD Specials list (2014) Triamcinolone acetonide For maintenance Kenalog RED JFC JFC intramuscular injection treatment of severe asthma Management of refractory Triamcinolone acetonide oesophageal stricture Kenalog RED Consultant gastroenterologist use only injection (intralesional endoscopic injection) - off label indication Trichloroacetic acid solution Facial peel used in dermatology RED SEL APC Specialist use only 25%, 50%, 90%, 100% theatres Tricitrates Solution RED All uses NHSE Used for urea cycle disorders Trientine RED All uses Wilson's disease in pts intolerant to penicillamine All licensed indications for long term use. Note that schizo- Trifluoperazine oral AMBER 2 Requires specialist initiation and review affective disorder is a sub-type of schizophrenia. Clinician to clinician discussion should occur regarding individual patients and the on-going Trifluoperazine oral AMBER 2 Off-label indications Requires specialist initiation and review responsibilities of each party, including access to timely support when required. RAG status Shared care/ Transfer of care Common Brand National /Regional Changed/Added since October Drug Name (Adults unless Indication for RAG status Comments/ reason for inclusion or RAG status guidance/ additional Name(s) Guidance 2019 otherwise stated) information NICE Trifluridine Lonsurf RED All uses SEL APC NHSE Trimipramine GREY All uses NHSE, SEL APC Not recommended for prescribing in SEL Note: Established arrangements in place in some boroughs should not change for example the specialist service may provide the first injection Decapeptyl SR All licensed indications (see Triptorelin AMBER 1 or provide the whole course for pre-operative patients. Practices are Gonapeptyl Depot comments box) encouraged to confirm with their CCG Medicines Optimisation Team if unsure about local arrangements. Tuberculosis treatments various RED All uses Specialist use only Pre-op uterine fibroids (in accordance with SEL APC Amended - the intermittent treatment Approved for ONE treatment course of pre-operative treatment of guidance); Intermittent of uterine fibroids indication has moderate to severe symptoms of uterine fibroids. A maximum of 4 Ulipristal acetate 5mg tablets Esmya RED treatment of moderate to severe SEL APC changed from AMBER 2 to RED (see intermittent treatment courses are supported. Liver function monitoring is uterine fibroids in women of SEL APC formulary recommendation to be carried out in all women treated with ulipristal. reproductive age - who are not 056) eligible for surgery Urea in half strength lassars GREY All uses SEL APC Not in BAD Specials list (2014) past ointment 20%, 40% Urea in Unguentum M cream GREY All uses SEL APC Not in BAD Specials list (2014) 10% Severe nail disease in psoriasis Urea in WSP ointment 40% RED SEL APC Specialist use only (hyperkeratosis) Urokinase Syner-KYNASE RED All uses JFC JFC Ustekinumab Stelara RED All uses NICE Specialist use only Valganciclovir Valcyte RED All uses Specialist use only Vancomycin 5% preservative- Off label use in bacterial RED JFC Specialist use only Added free eye drops keratitis (2nd line) Medullary thyroid cancer as per Vandetanib Caprelsa GREY NICE TA 550 Not recommended within its marketing authorisation by NICE TA NICE TA 550 Vedolizumab Entyvio RED All uses NICE Specialist use only Vemurafenib Zelboraf RED All uses NICE Melanoma (BRAF V600 mutation positive, unresectable or metastatic) Shared Care Prescribing Guideline for the management Narcolepsy (+/- Venlafaxine M/R Various AMBER 3 Cataplexy (off-label indication) SEL APC Sleep centre initiation only Cataplexy) and Idiopathic Hypersomnia in adults NICE / NHSE Venetoclax Venclyxto RED All formulary approved uses Specialist use only SEL APC Off-label use to prevent radial Verapamil injection Securon RED artery spasm in radial access JFC Specialist use only Added procedures Verteporfin Visudyne RED All uses NICE Age-related macular degeneration Individualised management plan to Licensed indications for Vigabatrin Sabril AMBER 2 NICE Rarely used due to issues with visual field defects. be agreed with GP on a case by epilepsy- adults case basis. Vinblastine Velbe RED All uses Leukaemias, lymphomas, and some solid tumours. Vincristine Oncovin RED All uses Leukaemias, lymphomas, and some solid tumours. Vindesine Eldisine RED All uses Leukaemias, lymphomas, and some solid tumours. Vinorelbine Navelbine RED All uses NICE Specialist use only Symptomatic metastatic basal cell carcinoma, or locally Vismodegib is not recommended within its marketing authorisation. Not Vismodegib Erivedge GREY advanced basal cell carcinoma NICE on SEL Joint Formulary. that is inappropriate for surgery or radiotherapy, in adults. Voriconazole Vfend RED All uses Specialist use only Warfarin AMBER 2 Licensed indications Initiated and stabilsied by a prescriber specialising in anticoagulation Zidovudine Retrovir, Combivir RED All uses BHIVA Guidelines/NICE HIV Clinician to clinician discussion should occur if primary care are to Zinc acetate dihydrate Wilzin RED Wilson's Disease consider prescribing packages of drugs for rare conditions. Hypercalcaemia of malignancy, Zolendronic acid Aclasta, Zometa RED Specialist use only Paget’s disease Minimum 3 months supply by the Zolpidem Stilnoct AMBER 2 Restless Legs Syndrome (RLS) SEL APC SEL APC neurology specialist team (specialising in RLS) In line with SEL APC focal epilepsy Zonisamide Zonegran AMBER 3 Epilepsy- adults NICE Drug requires some complex monitoring pathway RLS: Minimum 3 months supply by Restless Legs Syndrome the neurology specialist team SEL APC. Third line monotherapy treatment option in REM behaviour Zopiclone Zimovane AMBER 2 (RLS); REM behaviour disorder; SEL APC (specialising in RLS) disorder and non-REM parasomnia. non-REM parasomnia REM behaviour disorder: see local pathway RAG status Shared care/ Transfer of care Common Brand National /Regional Changed/Added since October Drug Name (Adults unless Indication for RAG status Comments/ reason for inclusion or RAG status guidance/ additional Name(s) Guidance 2019 otherwise stated) information Zuclopenthixol All licensed indications for long Clopixol Acuphase RED Specialist use only acetate injection term use All licensed indications. Note Zuclopenthixol dihydrochloride Clopixol AMBER 2 that schizo-affective disorder is Requires specialist initiation and review oral a sub-type of schizophrenia. Clinician to clinician discussion should occur regarding individual Zuclopenthixol dihydrochloride patients and the on-going Clopixol AMBER 2 Off-label indications Requires specialist initiation and review oral and injection responsibilities of each party, including access to timely support when required. Liaison required between specialist All licensed indications. Note service and GP practice regarding Zuclopenthixol Clopixol AMBER 2 that schizo-affective disorder is Requires specialist initiation and review role of practice nurse and any decanoate injection a sub-type of schizophrenia. additional training or support required. South East London Red, Amber, Grey (RAG) list for PAEDIATRIC indications January 2020

Notes: 1. This list covers indications in PAEDIATRICS only. 2. Please see separate list for use in adults. 3.See separate list at the end of this document for out of area requests (medicines that are not on the SEL joint formulary but GPs may be requested to prescribe by outer SEL Trusts) 4. See 'Definitions and notes' for further information.

RAG status Shared care/ Transfer of care Common Brand National /Regional Changed/Added since October Drug Name (Adults unless Indication for RAG status Comments/ reason for inclusion or RAG status guidance/ additional Name(s) Guidance 2019 otherwise stated) information Moderate to severe manic episodes in young people aged Aripiprazole Abilify RED NICE Specialist use only 13 and over with bipolar disorder (upto 12 weeks) Schizophrenia in people aged 15-17; licensed indications in Aripiprazole oral Abilify AMBER 2 adults. Management of NICE TAG Requires specialist initiation and review Depression (unlicensed indication) SEL APC shared care agreement Atomoxetine Strattera AMBER 3 ADHD in children and adults SEL APC Requires specialist initiation and review for adults and for children and adolescents Autoimmune rheumatic diseases (adults and children) Inflammatory Bowel Disease Azathioprine Imuran AMBER 3 NICE, SEL APC Requires specialist initiation and review. SEL APC shared care agreement (adults and children), Existing patients post liver transplant; Existing patients only. All licensed indications when delivered via SEL APC SCA for existing patients. Aztreonam Lysine Cayston AMBER 3 NICE RED for new patients nebulisation/inhalation NHSE commissioned (including in cystic fibrosis in existing paediatric patients). Beclomethasone diproprionate Eczema wet wraps in AMBER 2 SEL APC No alternative licensed product available for indication in WSP ointment 0.0025% paediatrics Off-label use for atopic SPC notes that treatment must be initiated by keratoconjunctivitis (AKC) and an ophthalmologist or a healthcare professional Initiation and first prescription Ciclosporin eye drops Verkazia AMBER 2 vernal keratoconjunctivitis SEL APC qualified in ophthalmology supplied by the ophthalmology (VKC) in children aged over 4 specialist team years Dystonia/dyskinesia in Clonidine patches RED SEL APC paediatrics Existing patients only. All licensed indications when delivered via SEL APC SCA for existing patients. Colistimethate (colistin) Colistin; Promixin AMBER 3 NICE RED for new patients nebulisation/inhalation NHSE commissioned (including in cystic fibrosis in existing paediatric patients). Dactinomycin Cosmegen Lyovac RED All uses Paediatric cancers SEL APC Patients under 18 with type 2 Degludec insulin Tresiba RED SEL APC Note: Degludec is not on the formulary in SEL for use in adult patients diabetes with type 2 diabetes In accordance with SEL APC transfer of care guidance for Degludec insulin Tresiba AMBER 3 children over 1 year and SEL APC Requires specialist initiation SEL APC ADULTS with type 1 diabetes only. SEL APC shared care agreement Dexamfetamine Dexedrine AMBER 3 ADHD children NICE, SEL APC Requires specialist initiation for paediatrics Existing patients only. All licensed indications when delivered via SEL shared care SEL APC SCA for existing patients. Dornase Alfa Pulmozyme AMBER 3 RED for new patients nebulisation/inhalation guidelines NHSE commissioned (including in cystic fibrosis in existing paediatric patients). Included due to reported requests for primary care to prescribe. For Etilefrine Unlicensed RED All uses (adults and children) SEL APC specialist use only. RAG status Shared care/ Transfer of care Common Brand National /Regional Changed/Added since October Drug Name (Adults unless Indication for RAG status Comments/ reason for inclusion or RAG status guidance/ additional Name(s) Guidance 2019 otherwise stated) information South East London shared care prescribing guideline: Treatment of attention deficit Methylphenidate, atomoxetine, hyperactivity disorder (ADHD) in lisdexamfetamine, dexamfetamine Guanfacine Intuniv AMBER 3 children and adolescents aged SEL APC, NICE Initiation and minimum 3 months supply by the specialist service. and 6-17 years old guanfacine for the treatment of ADHD in Children and Adolescents aged 6-18 years SEL APC SCA for use of Autoimmune rheumatic immunomodulatory drugs in Hydroxychloroquine Plaquenil AMBER 3 SEL APC diseases in children treatment of autoimmune rheumatic diseases in children Symptomatic relief of food A clinic letter should be provided to protein induced gastrointestinal the patient’s GP detailing the Ketotifen tablets (1mg) and Zaditen AMBER 2 allergies that has not responded SEL APC Initiation and first month’s supply from specialist paediatric allergy clinic. individual management plan if liquid (1mg in 5ml) to dietary manipulation alone in requesting the GP to continue the children aged 3 years and over prescribing. Lacosamide Vimpat RED Epilepsy- paediatrics Specialist use only SEL APC SCA immunomodulatory Autoimmune rheumatic disease drugs for the treatment of Leflunomide Arava AMBER 3 SEL APC in children autoimmune rheumatic diseases in children PAEDIATRICS ONLY: Licensed indications - ONLY for Levetiracetam sachets Desitrend AMBER 1 tube-fed paediatric patients and SEL APC paediatric patients on ketogenic diets Requires specialist initiation (Does not apply in Lambeth CCG which SEL APC shared care for children, Lisdexamfetamine Elvanse AMBER 3 ADHD in adults and children NICE, SEL APC supports initiation of lisdexamfetamine by GPs on the advice of a adult in progress specialist.) Treatment of sleep disorders in SEL APC SCA for the treatment of Melatonin 2mg MR TABLET, Circadin, (special The liquid should only be used for specific patients e.g. those with AMBER 3 children and adolescents (off- sleep disorders in children and 5mg/5ml Liquid manufactured liquid) swallowing difficulties or PEG tubes. label) adolescents (off-label) Autoimmune rheumatic SEL APC SCA for treatment of Maxtrex and diseases in children and autoimmune rheumatic diseases Methotrexate oral and injection AMBER 3 SEL APC Metoject inflammatory bowel disease in and inflammatory bowel disease in children children Concerta XL, Xenidate XL, Matoride XL, ADHD in children; SEL APC shared care for children, Methylphenidate AMBER 3 NICE, SEL APC Requires specialist initiation. Prescribe by brand. Delmosart, Xaggitin ADHD in adults (off-label) SEL APC shared care for adults XL, Equasym XL, Medikinet XL SEL APC SCA for the prevention of Organ Rejection in Adult Liver Autoimmune rheumatic disease Transplant Recipients in existing in accordance with SCA (adults patients only (i.e. those already and children). For the being prescribed mycophenolate in prevention of Organ Rejection Generics, Cellcept, primary care). SEL APC SCA Mycophenolate mofetil AMBER 3 in Adult Liver Transplant NICE, SEL APC Requires specialist initiation and review. Myfenax, Myfortic, Autoimmune rheumatic disease in Recipients in existing patients adults and in children. only (i.e. those already being For unlicensed indication use, prescribed mycophenolate in reasons for prescribing should be primary care); clearly communicated to the patient’sGP Peginterferon alfa in RED All uses NICE Hepatitis C (children and young people) combination with ribavirin Sodium cromoglycate 4% Altoderm GREY Mastocytosis in children SEL APC See SEL APC website cutaneous emulsion Gastrointestinal symptoms due Use in accordance with SEL APC Sodium Cromoglycate capsules Nalcrom AMBER 2 to food allergy in adults and in SEL APC Requires specialist initiation and review guidance children aged 2 years and over Somatropin (Paeds) Various AMBER 3 Growth hormone deficiency NICE RED if delivered through home care company SEL APC SCA Autoimmune rheumatic SEL APC SCA for treatment of diseases in children and autoimmune rheumatic diseases Sulfasalazine Salazopyrin AMBER 3 SEL APC inflammatory bowel disease in and inflammatory bowel disease in children children RAG status Shared care/ Transfer of care Common Brand National /Regional Changed/Added since October Drug Name (Adults unless Indication for RAG status Comments/ reason for inclusion or RAG status guidance/ additional Name(s) Guidance 2019 otherwise stated) information Existing patients only. All licensed indications when Amended - addition of paediatric delivered via SEL APC SCA for existing patients. Tobramycin nebuliser solution Tobi, Bramitob AMBER 3 NICE RED for new patients indication. Highlighted blue as nebulisation/inhalation NHSE commissioned includes paediatric indication. (including in cystic fibrosis in existing paediatric patients). South East London Red, Amber, Grey (RAG) list for drugs not on SEL Joint formulary. The aim of this list is to advise prescribers on out of area prescribing requests for medicines that are not included in the local SEL formulary. January 2020

Notes: 1. Unless otherwise stated, this list covers adults only 2. See Definitions and notes for further information

RAG status Shared care/ Transfer of Common Brand National /Regional Comments/ reason for inclusion or RAG Changed/Added Drug Name (Adults unless Indication for RAG status care guidance/ additonal Name(s) Guidance status since January 2018 otherwise stated) information

Consensus Ambrisentan statement National Volibris RED All uses Pulmonary hypertension specialist only (not on SEL Joint Formulary) Pulmonary Hypertension Centre Amifampridine phosphate Firdapse RED All uses NHS England Policy Lambert-Eaton myasthenic syndrome (not on SEL Joint Formulary)

Amprenavir Agenerase RED All uses BHIVA Guidelines HIV (not on SEL Joint Formulary)

Becaplermin Regranex RED All uses Specialist use only (not on SEL Joint Formulary)

Carglumic Acid Carbaglu RED All uses Hyperammonaemia (not on SEL Joint Formulary)

Clofarabine Evoltra RED All uses Acute lymphoblastic leukaemia (not on SEL Joint Formulary)

Colestilan NHSE, Bindren RED All uses No exisiting shared care, NHSe commissioned (not on SEL Joint Formulary) Trust guidelines

Doripenem Hospital acquired pneumonia, complicated intra- Doribax RED All uses (not on SEL Joint Formulary) abdominal infections, complicated UTIs

Estramustine phosphate Estracyt RED All uses Specialist use only (not on SEL Joint Formulary) Fampridine Fampyra RED All uses NHS England Policy Multiple sclerosis (not on SEL Joint Formulary) Fosaprepitant Ivemend RED All uses Chemotherapy-associated nausea and vomiting (not on SEL Joint Formulary) Fulvestrant Faslodex RED All uses Specialist use only (not on SEL Joint Formulary) Galsulfase Naglazyme RED All uses mucopolysaccharidosis VI (not on SEL Joint Formulary) Ganirelix Specialist use only, package of commissioned Orgalutran RED All uses (not on SEL Joint Formulary) service Reduction of bone damage Ibandronic Acid Bondronat, Iasibon RED in bone metastases in Part of specialist package of care (not on SEL Joint Formulary) breast cancer

Ibritumomab Rituximab relapsed or refractory CD20 + Zevalin RED All uses (not on SEL Joint Formulary) follicular βcell non Hodgkin's lymphoma Idursulfase Elaprase RED All uses Mucopolysaccharidosis II (not on SEL Joint Formulary) Imiglucerase Cerezyme RED All uses Gaucher's diseas (not on SEL Joint Formulary) Indinavir BHIVA Crixivan RED All uses HIV (not on SEL Joint Formulary) Guidelines/NICE

Lapatinib Tyverb RED All uses Specialist use only (not on SEL Joint Formulary)

Laronidase Aldurazyme RED All uses Mucopolysaccharidosis (not on SEL Joint Formulary)

Lutropin α Specialist use only, package of commissioned Luveris RED All uses NICE (not on SEL Joint Formulary) service

Maribavir Camvia RED All uses Prevention of Cytomegalovirus CMV (not on SEL Joint Formulary)

Mecasermin Increlex RED All uses NHS England Policy Specialist use only (not on SEL Joint Formulary)

Micafungin Sodium Mycamine RED All uses Invasive candidiasis (not on SEL Joint Formulary)

Miglustat Zavesca RED All uses Gaucher's diseas (not on SEL Joint Formulary)

Miltefosine RED All uses Acanthamoeba keratitis. (not on SEL Joint Formulary)

Motavizumab RED All uses Specialist use only (not on SEL Joint Formulary)

Naptumomab estafenatox RED All uses Renal cell carcinoma (not on SEL Joint Formulary)

Nelarabine (not Acute lymphoblastic leukaemia T-ALL & T-LBL Atriance RED All uses on SEL Joint Formulary) cell Nelfinavir BHIVA Viracept RED All uses HIV (not on SEL Joint Formulary) Guidelines/NICE

Neuradiab RED All uses Treatment of glioblastoma multiforme (not on SEL Joint Formulary) Nimotuzumab RED All uses Pancreatic cancer (not on SEL Joint Formulary) Palifermin Kepivance RED All uses Oral Mucositis due to myeloablation (not on SEL Joint Formulary)

Paliperidone oral Not on SEL JF formulary, however may be Invega RED All uses NICE (not on SEL Joint Formulary) indicated for specific patients e.g. HIV

Pericyazine oral Not on SEL JF formulary and rarely prescribed Neulactil RED All uses (not on SEL Joint Formulary) so primary care unfamiliar

Perphenazine oral Not on SEL JF formulary and rarely prescribed Fentazin RED All uses (not on SEL Joint Formulary) so primary care unfamiliar

Piracetam Nootropil RED All uses Adjunctive treatment of cortical myoclonus (not on SEL Joint Formulary)

Porfimer sodium Photofrin RED All uses NICE NSCLC, oesophageal Ca (not on SEL Joint Formulary)

Ranpirnase Onconase RED All uses Malignant mesothelioma (not on SEL Joint Formulary) Not on SEL JF. The 550mg formulation of Rifaximin Xifaxanta (200mg All uses including travellers rifaximin (Targaxan) is on the SEL formulary for RED (not on SEL Joint Formulary) tablets) diarrhoea use in hepatic encephalopathy in line with NICE (see AMBER list). Consensus Sitaxentan statement National Thelin RED All uses Pulmonary hypertension specialist only (not on SEL Joint Formulary) Pulmonary Hypertension Centre Sodium Clodronate IV Bonefos RED All uses Specialist use only (not on SEL Joint Formulary) Sodium Phenylbutyrate Ammonaps RED All uses Urea cycle disorders (not on SEL Joint Formulary)

Sodium Polystyrene Sulphonate Hyperkalaemia associated with anuria or Resonium A RED All uses (not on SEL Joint Formulary) severe oliguria and in dialysis patients

Spheramine RED All uses Implant for Parkinson's disease (not on SEL Joint Formulary) Consensus Tadalafil statement National Cialis RED Pulmonary Hypertension Specialist use only (not on SEL Joint Formulary) Pulmonary Hypertension Centre Talactoferrinum alpha RED All uses Renal cell carcinoma (not on SEL Joint Formulary)

Tarenflurbil Flurizan RED All uses Alzheimer’s disease (not on SEL Joint Formulary)

Tegafur with Uracil Uftoral RED All uses NICE Specialist use only (not on SEL Joint Formulary)

Tetrahydrobiopterin RED All uses Phenylketonuria (not on SEL Joint Formulary)

Tetrathiomolybdate RED All uses Idiopathic Pulmonary Fibrosis (not on SEL Joint Formulary)

Tiludronic acid Skelid RED All uses Pagets disease of bone (not on SEL Joint Formulary)

Tinzaparin sodium Not on SEL JF. GPs not famililiar with Innohep RED All uses (not on SEL Joint Formulary) prescribing.

Tipranavir BHIVA Aptivus RED All uses HIV (not on SEL Joint Formulary) Guidelines/NICE

Tolcapone Tasmar RED All uses Parkinson's Disease (not on SEL Joint Formulary)

Treosulfan Treosulfan RED All uses Specialist use only (not on SEL Joint Formulary)

Treprostinil Remodulin RED All uses Specialist use only (not on SEL Joint Formulary)

Urofollitropin Specialist use only, package of commissioned Metrodin High purity RED All uses NICE (not on SEL Joint Formulary) service

Vandetanib Metastatic non-small cell lung cancer.Metastatic Zactima RED All uses (not on SEL Joint Formulary) medullary thyroid cancer

Zalcitabine BHIVA Hivid RED All uses HIV (not on SEL Joint Formulary) Guidelines/NICE

Ziconotide Prialt RED All uses Specialist use only (not on SEL Joint Formulary) Trust / CCG contact details for prescribing queries

Please remove all patient identifiable data (e.g. name, address, DOB, NHS number) from communication. If these details are required, the recipient will contact you.

Acute Trusts Guy's and St Thomas' NHS Foundation Trust [email protected] King's College Hospital NHS Foundation Trust [email protected] Lewisham and Greenwich NHS Trust [email protected] Mental Health Trusts Oxleas NHS Foundation Trust [email protected] South London and Maudsley NHS Foundation Trust [email protected] CCGs Bexley Clinical Commissioning Group [email protected] Bromley Clinical Commissioning Group [email protected] Greenwich Clinical Commissioning Group [email protected] Lambeth Clinical Commissioning Group [email protected] Lewisham Clinical Commissioning Group [email protected] Southwark Clinical Commissioning Group [email protected]

Please see individual Shared Care Guidelines for specific directorate contact details