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8. used in the treatment of Malignant Disease & for Immunosuppression

Please note: this section does not include a full list of cytotoxics used within the Trust. Please refer to departmental protocols

8.1 Cytotoxic drugs; drugs for cytotoxic Dexrazoxane (Savene®) (for anthracycline extravasation) induced side-effects

8.1.1 Alkylating drugs Carmustine (Gliadel®)

8.1.2 Cytotoxic antibiotics mitozantrone ( in accordance with Trust MS Guidelines )

8.1.3 Antimetabolites Depocyte® (liposomal cytarabine) (Consultant haematologist only)

8.1.5 Other antineoplastic drugs imatinib ( in accordance with NICE guidance) -

8.2 Drugs affecting the immune response

8.2.1 Antiproliferative immunosuppressants azathioprine mycophenolate (Cellcept®) (Consultant only) Follow restricted high cost procedure before prescribing mycophenolate Dermatological conditions - to be prescribed by consultant dermatologists only - For use in resistant immunobullous disorders, systemic lupus erythematosus, pyoderma gangrenosum, systemic sclerosis, dermatomyositis, chronic actinic dermatitis, sub-erythrodermic and erythrodermic eczema resistant to all other therapies, hypertrophic and bullous lichen planus

Neurology conditions - to be prescribed by consultant neurologists only - For the treatment of myasthenia gravis

Rheumatology conditions - t o be prescribed by consultant rheumatologists only - For use in inflammatory rheumatological conditions that have failed to respond to other immunosuppressants - For the treatment of systemic sclerosis (Dr Ariane Herrick only)

Renal conditions - to be prescribed by renal consultants only - For prophylaxis of acute renal transplant rejection - For second line use in ANCA positive vasculitis (including Wegener's granuolamatosis) - For the treatment of lupus nephritis - For the treatment of nephrotic syndrome refractory to alternative therapy

mycophenolic acid (Myfortic®) (Renal Consultants only)

8.2.2 Corticosteroids and other ciclosporin immunosuppressants sirolimus (Renal Directorate only )) tacrolimus thalidomide (consultant haematologists only ) see also chapter 6 for corticosteroids

8.2.3 Rituximab and alemtuzumab rituximab (in accordance with NICE guidance) Also for ITP (Consultant haematologist only) 8.2.4 Other immunomodulating drug Interferon alfa glatiramer (in accordance with NICE Guidance and Trust MS guidelines ) interferon alpha-2b (Intron A® ) ( consultant only ) Interferon beta interferon alpha-2a (Roferon-A® ) ( consultant only ) interferon beta (Betaferon® first line) ( in accordance with NICE guidance and Trust MS guidelines )

bacillus calemtte-guerin (BCG) bladder instillation (Urology only ) BCG bladder instillation

8.3 Sex hormones and hormone antagonists in malignant disease

8.3.1 Oestrogens fosfestrol tetrasodium

8.3.2 medroxyprogesterone

8.3.3 see chapter 6

8.3.4 Hormone antagonists

8.3.4.1 Breast aminoglutethimide (Breast surgeons only ) letrozole (Breast surgeons only ) fulvestrant (restricted to patients who are intolerant to other therapies) 8.3.4.2 and analogues (Urology only ) (consultant only ) (Prostap® SR) (Obstetric and Gynaecology directorate only - a shared care protocol is required if care is to be continued in primary care ) 8.3.4.3 Somatostatin analogues octreotide (Gastroenterology and Endocrinology only ) - Follow restricted high cost drug procedure before prescribing octreotide

lanreotide ( Endocrinology only ) - Follow restricted high cost drug procedure before prescribing lanreotide