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Imperial College Healthcare NHS Trust Drug Formulary September 2021 DATE to end September 2021 Indication/Use Formulary PBR; status Red List. Drugs that are in the Red List are individually annotated. In PBR funding form A = addition the following drug groups are also in the Red List: required (F); approved; all IV antibacterials National Cancer BNF Drug Name Formulations R = All antiretroviral drugs for the treatment/prophylaxis of HIV infection Drug Fund requiring Chapter restricted; Oncology use of all intravenous and oral cytotoxics a notification form NA = not Biologic agents for treatment of autoimmune conditions (NCDF); approved, Biologic agents used in ophthalmology Drug on the local All injectable cytotoxic drugs Red List (RL) Oral cytotoxic drugs for non-cancer 8-methoxypsoralen tablets 10mg (unlicensed); 13.05.2 A Restricted for use by Dermatology teams only. (Methoxalen) bath lotion 1.2% solution in an aqueous base (unlicensed); gel 0.005% in aqueous gel 5-methoxypsoralen tablets 20mg (unlicensed) 13.05 R Restricted for use by Dermatology teams only. 8-methoxypsoralen tablets 10mg; 13.05 R Restricted for use by Dermatology teams only. bath lotion 1.2% solution in an aqueous base; gel 0.005% in aqueous gel (unlicensed) abacavir tablets 300mg 5.03.1 R Level 2 anti-infectives restricted to specific indications: PBR oral liquid 20mg in 1ml sugar free As per HIV guidance RL As per Paediatric HIV guidance As per Maternity & neonatal Guidelines got HIV positive mothers (QCCH & SMH) abacavir / lamivudine tablets 600mg/300mg 5.03.1 R Level 2 anti-infectives restricted to specific indications: PBR available in a range of generic products (first As per HIV guidance RL line) and Kivexa ® brand As per Paediatric HIV guidance As per Maternity & neonatal Guidelines got HIV positive mothers (QCCH & SMH) abatacept injection 250mg 10.01.3 R 1. In line with NICE TA guidance no. 375, Jan-2016 : Adalimumab, PBR pre-filled syringe 125mg/mL etanercept, infliximab, certolizumab pegol, golimumab, tocilizumab and abatacept, all in combination with methotrexate, are recommended as options for treating rheumatoid arthritis only if disease is severe, that is, a disease activity score (DAS28) greater than 5.1 and disease has not responded to intensive therapy with a combination of conventional disease-modifying antirheumatic drugs (DMARDs) and the companies provide certolizumab pegol, golimumab, abatacept and tocilizumab as agreed in their patient access schemes. ICHNT Formulary drugs September 2021 (A-Z) 1 of 210 Imperial College Healthcare NHS Trust Drug Formulary September 2021 abatacept injection 250mg 10.01.3 R 2. In line with NICE TA guidance no. 373, December 2015: Abatacept, PBR pre-filled syringe 125mg/mL adalimumab, etanercept and tocilizumab are recommended, within their marketing authorisations, as options for treating polyarticular juvenile idiopathic arthritis (JIA), including polyarticular-onset, polyarticular-course and extended oligoarticular JIA. That is for abatacept, people 6 years and older whose disease has responded inadequately to other disease- modifying anti-rheumatic drugs (DMARDs) including at least 1 tumour necrosis factor (TNF) inhibitor. abemaciclib tablets 50mg, 100mg, 150mg 8.01.5 R In line with NICE TA guidance no. 563, February 2019: Abemaciclib with PBR an aromatase inhibitor is recommended, within its marketing RL authorisation, as an option for treating locally advanced or metastatic, hormone receptor-positive, human epidermal growth factor receptor 2 (HER2)-negative breast cancer as first endocrine-based therapy in adults. Abemaciclib is recommended only if the company provides it according to the commercial arrangement. abemaciclib tablets 50mg, 100mg, 150mg 8.01.5 R In line with NICE TA guidance no. 579, May 2019: Abemaciclib with PBR fulvestrant is recommended for use within the Cancer Drugs Fund as an RL option for treating hormone receptor-positive, human epidermal growth factor receptor 2 (HER2)-negative locally advanced or metastatic breast cancer in people who have had endocrine therapy only if exemestane plus everolimus would be the most appropriate alternative and the conditions in themanaged access agreementfor abemaciclib with fulvestrant are followed. Abidec ® Drops 0.6ml contains vitamin A 4000 units, 9.06.7 A thiamine hydrochloride (vitamin B1) 1mg, riboflavin (vitamin B2) 400 micrograms, pyridoxine hydrochloride (vitamin B6) 500 micrograms, calciferol (vitamin D) 400 units, nicotinamide 5mg and ascorbic acid 50mg. Abiraterone tablets 250mg 8.03.4 R In line with NICE TA guidance no. 259, June 2012: Abiraterone (in PBR combination with prednisone or prednisolone) is recommended as an RL option for the first-line treatment of castration-resistant metastatic prostate cancer previously treated with a docetaxel-containing regimen. ICHNT Formulary drugs September 2021 (A-Z) 2 of 210 Imperial College Healthcare NHS Trust Drug Formulary September 2021 Abiraterone tablets 250mg 8.03.4 R In line with NICE TA guidance no. 387, April 2016: Abiraterone in PBR combination with prednisone or prednisolone is recommended, within its RL marketing authorisation, as an option for treating metastatic hormone- relapsed prostate cancer in people who have no or mild symptoms after androgen deprivation therapy has failed, and before chemotherapy is indicated only when the company rebates the drug cost of abiraterone from the 11th month until the end of treatment for people who remain on treatment for more than 10 months. Acarbose tablets 50mg, 100mg 6.01.2 R Non-insulin dependent diabetics on maximum doses of sulphonylureas in whom metformin is either ineffective or contraindicated and who are known to be compliant with diet and other treatments. Restricted for use by Endocrinology teams. Acenocoumarol tablets 1mg 2.08.2 R For patients intolerant to warfarin (NDP September 2011) Acetazolamide tablets 250mg; MR capsules 250mg; injection 11.06 A 500mg Acetic acid solution 5% (unlicensed); solution 3% 21 A (unlicensed) Acetone 13.05 A acetylcholine chloride Solution for intra-ocular irrigation, 1% with 11.08.2 A mannitol 3%, when reconstituted (Miochol ®). acetylcysteine Eye drops, 5% with hypromellose 0.35% (Ilube 11.08.1 R Unlicensed preparations can be obtained from Moorfields Hospital. ®). Although normally held in stock they may not always be immediately Eye drops, 5%, 10%, preservative free available. (unlicensed product) Eye drops, 10% (unlicensed product) aciclovir cream 5% 13.10.3 A aciclovir (acyclovir) dispersible tablets 200mg, 400mg, 800mg; 5.03.2 A Level 1 non-reserved anti-infective suspension 200mg in 5ml, 400mg in 5ml; intravenous infusion 250mg, 500mg Acid citrate dextrose solution Formula A 500ml 2.08.1 A Acitretin capsules 10mg, 25mg (hospital or specified 13.05.2 R Dermatologists only to prescribe. RL retail pharmacy only). aclidinium/formaterol Dry powder for inhalation 340mcg/12mcg per 3.02 A For use in COPD as per the relevant national guidelines. (NDP November (Duaklir® Genuair®) dose 2015) Actichlor tablets 500mg; granules 16 A no longer pharmacy; ordered from supplies Activated charcoal oral powder 50g; 17 A oral suspension; tablets ICHNT Formulary drugs September 2021 (A-Z) 3 of 210 Imperial College Healthcare NHS Trust Drug Formulary September 2021 Adalimumab injection 40mg pre-filled pen or pre-filled 10.01.3 R 1. In line with NICE TA guidance no. 375, Jan-2016 : PBR syringe Adalimumab, etanercept, infliximab, certolizumab pegol, golimumab, tocilizumab and abatacept, all in combination with methotrexate, are recommended as options for treating rheumatoid arthritis only if disease is severe, that is, a disease activity score (DAS28) greater than 5.1 and disease has not responded to intensive therapy with a combination of conventional disease-modifying antirheumatic drugs (DMARDs) and the companies provide certolizumab pegol, golimumab, abatacept and tocilizumab as agreed in their patient access schemes. Adalimumab, etanercept, certolizumab pegol or tocilizumab can be used as monotherapy for people who cannot take methotrexate because it is contraindicated or because of intolerance, when the aforementioned criteria are met. Adalimumab injection 40mg pre-filled pen or pre-filled 1.05.3 R 2. In line with NICE TA guidance no. 187, May-10: Infliximab and PBR syringe adalimumab, within their licensed indications, are recommended as treatment options for adults with severe active Crohn’s disease whose disease has not responded to conventional therapy (including immunosuppressive and/or corticosteroid treatments), or who are intolerant of or have contraindications to conventional therapy. Infliximab or adalimumab should be given as a planned course of treatment until treatment failure (including the need for surgery), or until 12 months after the start of treatment, whichever is shorter. People should then have their disease reassessed to determine whether ongoing treatment is still clinically appropriate. Treatment should normally be started with the less expensive drug (taking into account drug administration costs, required dose and product price per dose). This may need to be varied for individual patients because of differences in the method of administration and treatment schedules. Adalimumab injection 40mg pre-filled pen or pre-filled 10.01.3 R 3. In line with NICE TA guidance no 329, Feb-2015: Infliximab, PBR syringe adalimumab and golimumab are recommended, within their marketing authorisations, as options for treating moderately to severely active ulcerative colitis in adults whose
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