MEDICINES FORMULARY Medicines formulary between MCHFT and Primary Care as agreed by the Joint Medicines Management committee Introduction Welcome to the MCHFT Medicines Formulary. The formulary includes medicines that have been approved by the Joint Medicines Management Committee (JMMC) for prescribing within the trust. The purpose of the formulary is to ensure prescribing is evidence based and cost effective. All prescribing within the trust (i.e. inpatient, outpatient and FP10HNC prescribing) must comply with the formulary. This will be monitored on a regular basis. Some drugs may appear in more than one section. The formulary is arranged in sections corresponding to those in the British National Formulary (BNF) as below; GASTRO-INTESTINAL SYSTEM ................................................................................................................ 4 CARDIOVASCULAR SYSTEM .................................................................................................................... 8 RESPIRATORY SYSTEM .......................................................................................................................... 13 CENTRAL NERVOUS SYSTEM ................................................................................................................ 16 INFECTIONS ............................................................................................................................................. 22 ENDOCRINE SYSTEM .............................................................................................................................. 25 OBSTETRICS, GYNAECOLOGY AND URINARY-TRACT DISORDERS .................................................. 30 MALIGNANT DISEASE AND IMMUNOSUPPRESSION ............................................................................ 33 NUTRITION AND BLOOD ......................................................................................................................... 38 MUSCULOSKELETAL AND JOINT DISORDERS ..................................................................................... 42 EYE ............................................................................................................................................................ 44 EAR, NOSE AND OROPHARYNX ............................................................................................................. 48 SKIN ........................................................................................................................................................... 49 IMMUNOLOGICAL PRODUCTS AND VACCINES .................................................................................... 54 ANAESTHESIA .......................................................................................................................................... 55 Page 1 of 56 Operation of the Formulary Items available for general prescribing and restricted items are identified according to the following colour coding; Item Colour Code Items available for general prescribing Second line/use on specialist advice Consultant prescribing only Where a drug is the subject of a NICE Technology Appraisal (TA) the reference number of the guidance is given below the drug entry. Where a drug has been approved by the Joint Medicines Management Committee (JMMC) the month and year of the relevant meeting is also listed below the drug entry. NICE guidance can be found at; Technology Appraisals (TA) http://www.nice.org.uk/guidance/published?type=ta Clinical Guidelines (CG) http://www.nice.org.uk/guidance/published?type=cg MHRA Alerts and recalls on drugs and medical devices https://www.gov.uk/drug-device-alerts Patients taking a non-formulary drug on admission Treatment with a non-formulary drug may be continued in this instance; however it must be borne in mind that there may be a delay in obtaining a non-formulary drug. Additions to the formulary The addition of a new drug or preparation will only be made after approval by the Joint Medicines Management Committee. To request an addition to the formulary a New Product Request (NPR) form must be submitted to the JMMC. This form can be found under Frequently Used Forms- Medicines Management on the trust intranet. New non-formulary drugs required for an individual patient in exceptional circumstances Such an application for a “one-off” use may be made to the chairperson of the JMMC, if the drug is required before the next JMMC meeting. Page 2 of 56 Updates Date BNF Update Details Section February 11.8.2 Nepafanac eye drops 2015 8.1.5 Imatinib 2.8.2 Apixaban 1.6.7 Linaclotide 4.10.1 Nalmefene 8.1.1 Bendamustine/Thalidomide/Dexamethasone March 5.3.1 Dolutegravir and dolutegravir in combination with Abacavir and lamivudine. 2015 8.1 Folfirinox regime 11.3.1 Cefuroxime Intracameral injection April 2015 2.8.2 Dabigatran 9.1.3 Eculizumab 4.8.1 Retigabine May 2015 5.3.3 Simeprevir 5.3.3 Sofosbuvir 8.1.1 Cyclophosphamide 1.5.3 Infliximab/adalimumab/golimumab June 2015 5.1.7 Rifaximin for hepatic encephalopathy 6.1.2 Empagliflozin 2.8.2 Rivaroxaban ASC with raised cardiac biomarkers July 2015 5.1.7 Rifaximin pathway approved 8.1.3 Cytarabine subcutaneous route approved August 3 APC newly approved products added 2015 13.5.3 Secukinumab 11.8.2 Aflibercept 11.4.1 Dexamethasone ocular implant 10.1.3 Etanercept and tocilizumab 2.8.2 Apixaban 1.5.3 Vedolizumab 13.5.3 Ustekinumab 5.1.7 Rifaximin September 3.4.2 Omalizumab 2015 8.2.3 Obinutuzumab 8.2.3 Ofatumumab 9.4.1 Locasol 8.1.5 Nintedanib October 1.5.3 Vedolizumab 2015 2.8.2 Edoxaban 1.6.7 Naloxagol 10.1.3 Infliximab biosimilar November 6.1.6 Freestyle Optium beta-ketone testing strip 2015 5.1.7 Fosfomycin injection 5.1.1.2 Temocillin Injection 5.2.3 Amphotericin suspension December 6.1.2 Dulaglutide 2015 2.5.5 Entresto Page 3 of 56 1 Gastro-Intestinal System 1.1 Dyspepsia and gastro-oesophogeal reflux-disease 1.1.1 Antacids and simeticone MAGNESIUM TRISILICATE MIXTURE SIMETICONE LIQUID SODIUM CITRATE ORAL SOLUTION - OXETACAINE ANTACID SUSPENSION - On Christies recommendation 1.1.2 Compound alginates and proprietary indigestion preparations GAVISCON® ADVANCE SF SUSPENSION and TABLETS GAVISCON® INFANT DUAL-SACHETS GAVISON® SF LIQUID (Aniseed) 1.2 Antispasmodics and other drugs altering gut motility Antimuscarinics DICYCLOVERINE LIQUID and TABLETS HYOSCINE BUTYLBROMIDE INJECTION and TABLETS KOLANTICON® GEL Other antispasmodics ALVERINE CITRATE CAPSULES MEBERINE 135mg TABLETS PEPPERMIINT OIL E/C CAPSULES (Mintec®) MEBEVERINE 50mg/5ml LIQUID 1.3 Antisecretory drugs and mucosal protectants 1.3.1 H2 receptor antagonists RANITIDINE INJECTION LIQUID and TABLETS RANITIDINE 150mg EFFERVESCENT TABLETS 1.3.2 Selective antimuscarinics – No products on formulary 1.3.3 Chelates and complexes – No products on formulary 1.3.4 Prostaglandin analogues MISOPROSTOL 200microgram TABLETS 1.3.5 Proton pump inhibitors LANSOPRAZOLE CAPSULES OMEPRAZOLE CAPSULES AND INJECTION PANTOPRAZOLE TABLETS ESOMEPRAZOLE CAPSULES - Restricted for use in severe GORD LANSOPRAZOLE ORODISPERSIBLE TABLETS - For use in patients with swallowing difficulties only OMEPRAZOLE DISPERSIBLE TABLETS - For use in patients with swallowing difficulties only RABEPRAZOLE TABLETS 1.4 Acute Diarrhoea 1.4.1 Adsorbents and bulk-forming drugs – No products on formulary 1.4.2 Antimotility drugs LOPERAMIDE CAPSULES and LIQUID 1.4.3 Enkephalinase inhibitors RACECADOTRIL - JMMC Approved Dec 2012 for treatment of acute diarrhoea in paediatrics 1.5 Chronic bowel disorder Page 4 of 56 1.5.1 Aminosalicylates BALSALAZIDE 750mg CAPSULES MESALAZINE 1g FOAM ENEMA ( Asacol® or Salofalk®) MESALAZINE 500mg SACHETS (Salofalk®) MESALAZINE 1g M/R SACHETS (Pentasa®) MESALAZINE SUPPOSITORIES MESALAZINE E/C; M/R TABLETS (Octasa®) MESALAZINE 500mg M/R TABLETS (Pentasa®) MESALAZINE 250mg E/C TABLETS (Salofalk®) SULFASALAZINE LIQUID, SUPPOSITORIES and TABLETS MESALAZINE 1200mg M/R TABLETS (Mezavant®) 1.5.2 Corticosteroids PREDNISOLONE 20mg FOAM AEROSOL PREDNISOLONE 20mg in 100ml ENEMA PREDNISOLONE 5mg SUPPOSITORIES BUDESONIDE 3mg E/C CAPSULES (Budenofalk®) BUDESONIDE 3mg M/R CAPSULES (Entocort®) 1.5.3 Drugs affecting the immune response AZATHIOPRINE MERCAPTOPURINE METHOTREXATE Cytokine modulators ADALIMUMAB INJECTION - NICE guidance TA187 – Crohn’s disease JMMC Approved Jun 2008 NICE guidance TA329 (includes review of TA140 and TA262) – treatment of moderate to severe ulcerative colitis after failure of conventional therapy JMMC Approved May 2015 INFLIXIMAB - NICE guidance TA163 – Ulcerative colitis (acute exacerbations) NICE guidance TA187 – Crohn’s disease NICE guidance TA329 (includes review of TA140 and TA262) – treatment of moderate to severe ulcerative colitis after failure of conventional therapy JMMC Approved May 2015 GOLIMUMAB- NICE guidance TA329 (includes review of TA140 and TA262) – treatment of moderate to severe ulcerative colitis after failure of conventional therapy JMMC Approved May 2015 VEDOLIZUMAB- NICE guidance TA342 – Moderate to severe active ulcerative colitis JMMC Approved Aug 2015 NICE guidance TA352 – Moderate to severe active Crohn’s disease after prior therapy JMMC Approved Oct 2015 1.5.4 Food allergy - No products on formulary 1.6 Laxatives 1.6.1 Bulk-forming laxatives ISPAGHULA HUSK SACHETS (Fybogel® orange) METHYLCELLULOSE 500mg TABLETS NOMACOL® PLUS SACHETS NORMACOL® SACHETS 1.6.2 Stimulant laxatives BISACODYL SUPPOSITORIES and TABLETS DOCUSATE SODIUM CAPSULES and LIQUID GLYCEROL SUPPOSITORIES SENNA LIQUID and TABLETS CO-DANTHRAMER CAPSULES and LIQUID - Only for constipation