Formulary Chapter 13: Skin - Full Chapter
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Notes: |
Specials Recommended by the British Association of Dermatologists for Skin Disease
Most prescribing uses licensed medicines whose safety and efficacy are assured. For many common dermatological diseases including psoriasis and eczema, the range of licensed medicines is limited. As a result, Dermatology prescribing may rely significantly on unlicensed creams and ointments (known as ‘Specials’) containing tars, dithranol, salicylic acid, steroids and other active constituents in a range of concentrations and bases. This is of particular concern in primary care where lack of effective price controls and a mechanism to ensure independent scrutiny of product quality has increased costs and concern about standards. To address these concerns, and help optimise quality of care, adherence to the revised British Association of Dermatologists (BAD) list of preferred Specials (2018) is encouraged. |
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Details... |
13.02 |
Emollient and barrier preparations |
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13.02 |
Soap substitute |
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13.02.01 |
Emollients |
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Aqueous Cream BP
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Formulary
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- Due to the SLS content to be used as a soap substitute only.
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Aveeno® (Cream)
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Formulary
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Cetraben® (Cream and ointment)
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Formulary
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DoubleBase®gel
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Formulary
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E45®
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Formulary
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Emulsifying Ointment BP
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Formulary
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Epaderm® emollient
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Formulary
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- Hydromol® Ointment is made to the same formula and is more cost effective.
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Epimax®
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Formulary
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MHRA Drug Safety Update: Epimax Ointment and Epimax Paraffin-Free Ointment: reports of ocular surface toxicity and ocular chemical injury
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Hydromol® ointment
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Formulary
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- This product is also known locally as ‘Emulsifying Ointment RVI
Formula’. It is softer than emulsifying ointment BP. Epaderm ointment is made to the same formula, but is more expensive.
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Hydrous® ointment
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Formulary
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Oilatum® cream
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Formulary
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Oilatum® Junior cream
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Formulary
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Paraffin sterile liquid
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Formulary
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QV®
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Formulary
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- Approved for used in radiotherapy only.
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ZeroAQS®
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Formulary
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- SLS free alternative to Aqueous Cream.
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Zerobase®
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Formulary
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Zerocream®
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Formulary
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- Alternative to E45® Cream.
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Zerodouble® Gel
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Formulary
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- Alternative to Doublebase gel.
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Zeroveen® cream
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Formulary
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White Soft Paraffin BP
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Formulary
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Yellow Soft Paraffin BP
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Formulary
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AquaGel lubricating jelly (oil-free)
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Formulary
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- Approved for the relief of dryness of the nose, lips and face when a patient is using oxygen via nasal prongs, CPAP masks etc
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13.02.01 |
Emollients - preparations containing urea |
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Balneum® Plus cream (Emollient preparation containing Urea)
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Formulary
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Calmurid® emollient
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Formulary
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13.02.01 |
Emollients - with antimicrobials |
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Dermol®
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Formulary
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Dermol® 500 Lotion
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Formulary
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13.02.01.01 |
Emollient bath and shower preparations |
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Bath and shower preparations for dry and pruritic skin conditions
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Formulary
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Emollient Prescribing Guideline and Formulary North East North Cumbria
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Hydromol® bath and shower
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Formulary
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- For inpatient use only as per Trust Moisture-Associated Tissue Damage (MASD) guidelines
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13.02.02 |
Barrier preparations |
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Barrier preparation (Cavilon®Film)
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Formulary
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Dimeticone (Siopel®)
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Formulary
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Drapolene®
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Formulary
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Medi Derma-Pro Foam & Spray Skin Cleanser And Skin Protectant Ointment (Medi Derma-Pro Foam & Spray Skin Cleanser®)
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Formulary
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Medi Derma-S barrier film (Medi Derma-S ®barrier film)
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Formulary
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Sorbaderm® cream
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Formulary
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- 2g, 28g & 92g barrier cream, 28ml pump spray, sterile 1ml no
sting barrier film foam applicator, sterile 3ml no sting barrier film foam applicator
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Deegan's ointment
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Unlicensed
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Sucralfate cream
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Unlicensed
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- For limited use around gastrostomies when wound breakdown is thought to be aggravated by leakage of gastric acid.
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13.02.02 |
Community |
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13.02.02 |
Hospital |
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13.03 |
Topical local anaesthetics and antipruritics |
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Crotamiton (Eurax®)
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Formulary
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Lidocaine 5% ointment
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Formulary
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Lidocaine and prilocaine (EMLA®)
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Formulary
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Menthol and aqueous cream
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Formulary
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- available as Dermacool
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13.04 |
Topical corticosteriods. |
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13.04 |
Topical corticosteriod preparation potencies |
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13.04 |
Mild |
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Hydrocortisone 0.5%, 1% & 2.5%
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Formulary
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Hydrocortisone 1% with Clotrimazole 1% (Canesten HC®)
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Formulary
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- Cream 30g
- 15g available Over the Counter.
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Hydrocortisone 1% with Miconazole Nitrate 2% (Daktacort®)
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Formulary
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- Cream 30g (15g available Over the Counter) and Ointment 30g
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MSN/2024/027: Discontinuation of Daktacort 2%/1% cream
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Hydrocortisone 1%, Oxytetracycline 3% (Terra-Cortril ®)
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Formulary
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Hydrocortisone Acetate 1% with Fusidic Acid 2% (Fucidin H®)
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Formulary
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Nystaform-HC®
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Formulary
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Timodine®
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Formulary
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13.04 |
Moderate |
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Betamethasone (as Valerate) 0.025% (Betnovate-RD®)
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Formulary
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Clobetasone Butyrate 0.05% (Eumovate®)
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Formulary
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- Cream, ointment & scalp application
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Clobetasone butyrate with nystatin and oxytetracycline (Trimovate®)
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Formulary
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- Clobetasone butyrate 500mcg/1g, nystatin 100000iu/1g, oxytetracycline (as oxytetracycline calcium) 30mg/1g
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Fludroxycortide (Haelan®) (Tape)
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Formulary
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13.04 |
Potent |
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Betamethasone (as Dipropionate) 0.05% with Salicylic Acid 3% (Diprosalic®)
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Formulary
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Betamethasone (as Valerate) 0.1%
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Formulary
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- Cream, ointment & scalp application
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Betamethasone (as Valerate) 0.1% with Clioquinol 3% (Betnovate C®)
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Formulary
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Betamethasone (as Valerate) 0.1% with Fucidic Acid 2% (Fucibet®)
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Formulary
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Betamethasone (as valerate) medicated plasters (Betesil®)
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Formulary
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- 2.25mg medicated plasters
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Flucinolone Acetonide 0.025% with Neomycin Sulphate 0.5% (Synalar N®)
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Formulary
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Fluocinolone Acetonide 0.025% (Synalar®)
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Formulary
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Fluocinolone acetonide 0.025% with clioquinol 3% (Synalar C®)
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Formulary
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Hydrocortisone Butyrate 0.1% cream (Locoid®)
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Formulary
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Mometasone Furoate 0.1% (Elocon®)
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Formulary
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13.04 |
Very Potent |
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Clobetasol Propionate 0.05% (Dermovate®)
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Formulary
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- Cream, ointment & scalp application
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Clobetasol Propionate with neomycin and nystatin (Dermovate-NN®)
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Formulary
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13.04.01 |
Topical corticosteroid scalp applications |
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Betamethasone (as Dipropionate) 0.05% with Salicylic Acid 2% (Diprosalic®)
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Formulary
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13.04.02 |
Topical corticosteroids - for use under specialist supervision only |
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13.04.03 |
Topical corticosteroids - unlicensed specials |
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13.04.04 |
Topical corticosteroids and anti-infective preparations |
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13.04.04 |
Very Potent |
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13.05 |
Preparations for eczema and psoriasis |
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13.05.01 |
Preparations for eczema |
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Alitretinoin (Toctino®)
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Formulary
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- Approved for adults with severe chronic hand eczema that have not responded to potent topical corticosteroids in line with NICE.
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MHRA Drug Safety Update (July 2021): Oral retinoid medicines (isotretinoin▼, alitretinoin▼, and acitretin▼): temporary monitoring advice during coronavirus (COVID-19) pandemic
MHRA Drug Safety Update (Jun 2019): Oral retinoid medicines▼: revised and simplified pregnancy prevention educational materials for healthcare professionals and women
NICE TA177: Alitretinoin for the treatment of severe chronic hand eczema
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Ichthammol (Zinc paste and ichthammol bandage BP 1993)
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Formulary
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Zinc oxide bandage (Viscopaste®)
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Formulary
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13.05.02 |
Preparations for psoriasis |
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5-Methoxypsoralen 20mg tablets
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Unlicensed
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8-Methoxypsoralen 10mg tablets
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Unlicensed
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Methoxypsoralen 1.2% bath additive
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Unlicensed
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13.05.02 |
Topical preparations for psoriasis |
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Calcipotriol 50mcg/g (Dovonex®)
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Formulary
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- 0.005% Cream and ointment
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Calcipotriol with Betamethasone
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Formulary
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- Calcipotriol 50mcg/1g and betamethasone (as betamethasone dipropionate) 500mcg/1g
- Gel and ointment (Dovobet®)
- approved for the treatment of scalp and mild to moderate non scalp plaque psoriasis vulgaris in adults.
- 60g cutaneous spray (Enstilar®)
- Approved for the treatment of plaque psoriasis
- Cream (Wynzora®)
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Coal tar 2% and salicylic acid 2% ointment
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Formulary
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Coal tar in emulsifying ointment solution
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Formulary
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- 1% unlicensed
- 2% unlicensed
- 5% unlicensed
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Coal tar lotion 1% (Exorex®)
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Formulary
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Cocois® (Scalp application)
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Formulary
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Diprosalic ointment
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Formulary
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Dithranol pomade
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Formulary
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- 0.2%, 0.4% & 0.6% unlicensed
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Sebco® scalp ointment
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Formulary
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Shampoos (T/Gel®)
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Formulary
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Dithranol in Full Strength Lassar's Paste BP
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Unlicensed
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- 0.1%, 0.2%, 0.4%, 0.6%, 0.8%, 1%, 2%, 4%, 6% & 8%.
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Dithranol with salycyclic acid 0.5%
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Unlicensed
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- 0.1%, 0.2%, 0.4%, 0.6%, 0.8%, 1%, 2%, 4%, 6%, 8% & 16%in emulsifying base.
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Salicylic Acid in emulsifying ointment
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Unlicensed
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Tar Pomade (6% coal tar solution & 2% salycylic acid in emulsifying ointment)
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Unlicensed
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Zinc and Coal Tar Paste (White's Tar Paste)
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Unlicensed
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Zinc and Salicylic Acid Compound Paste (Half Strength Lassar's Paste)
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Unlicensed
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13.05.02 |
Oral retinoids for psoriasis |
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Acitretin (Neotigason®)
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Unlicensed
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MHRA Drug Safety Update (July 2021): Oral retinoid medicines (isotretinoin▼, alitretinoin▼, and acitretin▼): temporary monitoring advice during coronavirus (COVID-19) pandemic
MHRA Drug Safety Update (Jun 2019): Oral retinoid medicines▼: revised and simplified pregnancy prevention educational materials for healthcare professionals and women
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Fumaric acid esters
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Unlicensed
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13.05.02.01 |
Topical preparations for the scalp |
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13.05.03 |
Drugs affecting the immune response |
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Abrocitinib (Cibinqo®)
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Formulary
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- Approved for the treatment of moderate to severe atopic dermatitis in line with NICE
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MHRA Drug Safety Update (April 2023): Janus kinase (JAK) inhibitors: new measures to reduce risks of major cardiovascular events, malignancy, venous thromboembolism, serious infections and increased mortality
NICE TA814: Abrocitinib, tralokinumab or upadacitinib for treating moderate to severe atopic dermatitis
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Adalimumab
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Formulary
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- Approved for psoriasis in line with NICE.
- Approved for the treatment of moderate to severe hidradenitis suppurativa in line with NICE and NHS England Commissioning Policy
- Approved for the treatment of plaque psoriasis in children and young people in line with NICE
Biosimilars are available – note that indications can differ between different products – prescribe by brand. Consult with individual trust pharmacy department for details of preferred biosimilar brand.
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NICE TA146 Adalimumab for the treatment of adults with psoriasis
NICE TA392: Adalimumab for treating moderate to severe hidradenitis suppurativa
NICE TA455 Adalimumab, etanercept and ustekinumab for treating plaque psoriasis in children and young people
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Apremilast (Otezla®)
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Formulary
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- 10mg, 20mg & 30mg tablets
- To be used in accordance with NICE guidance
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MHRA Drug Safety Update (Jan 2017): Apremilast (Otezla ): risk of suicidal thoughts and behaviour
NICE TA419: Apremilast for treating moderate to severe plaque psoriasis
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Baricitinib (Olumiant®)
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Formulary
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- Approved for treating moderate to severe atopic dermatitis in adults in line with NICE.
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NICE TA681: Baricitinib for treating moderate to severe atopic dermatitis
MHRA Drug Safety Update (April 2023): Janus kinase (JAK) inhibitors: new measures to reduce risks of major cardiovascular events, malignancy, venous thromboembolism, serious infections and increased mortality
MHRA Drug Safety Update (Aug 2020): Baricitinib (Olumiant▼): increased risk of diverticulitis, particularly in patients with risk factors
MHRA Drug Safety Update (Mar 2020): Baricitinib (Olumiant▼): risk of venous thromboembolism
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Bimekizumab (Bimzelx®)
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Formulary
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- 160mg/ml solution pre-filled pen/syringe
- Approved for the treatment of moderate to severe plaque psoriasis in line with NICE
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NICE TA723: Bimekizumab for treating moderate to severe plaque psoriasis
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Brodalumab (Kyntheum® )
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Formulary
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- 210mg/1.5ml solution for injection in pre-filled syringes.
- Approved for the treatment of moderate to severe plaque psoriasis in line with NICE
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NICE TA511: Brodalumab for treating moderate to severe plaque psoriasis
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Certolizumab pegol
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Formulary
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NICE TA574: Certolizumab pegol for treating moderate to severe plaque psoriasis
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Ciclosporin
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Formulary
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- Capsules & SF Solution
See section 8.2.2
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County Durham and Darlington Shared Care Guideline: Ciclosporin
Tees Valley Shared Care Guideline: Ciclosporin
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Deucravacitinib (Sotyktu)
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Formulary
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- 6mg tablets
- Approved for the treatment of moderate to severe plaque psoriasis in line with NICE
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NICE TA907: Deucravacitinib for treating moderate to severe plaque psoriasis
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Dimethyl fumarate (Skilarence®)
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Formulary
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- 120mg tablets
- Approved for the treatment of moderate to severe plaque psoriasis in line with NICE
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NICE TA475 Dimethyl fumarate for treating moderate to severe plaque psoriasis
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Dupilumab (Dupixent®)
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Formulary
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- 200mg/1.14ml & 300mg/2ml solution for injection
- Approved for treating moderate to severe atopic dermatitis in adults in line with NICE
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MHRA Drug Safety Upate (Nov 2022): Dupilumab (Dupixent▼): risk of ocular adverse reactions and need for prompt management
NICE TA534: Dupilumab for treating moderate to severe atopic dermatitis
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Etanercept (Enbrel®, Benapali® & Erelzi®)
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Formulary
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- Approved for psoriasis in line with NICE
- Approved for the treatment of plaque psoriasis in children and young people in line with NICE
Biosimilars are available – note that indications can differ between different products – prescribe by brand. Consult with individual trust pharmacy department for details of preferred biosimilar brand.
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NICE TA103: Psoriasis - efalizumab and etanercept
NICE TA455 Adalimumab, etanercept and ustekinumab for treating plaque psoriasis in children and young people
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Guselkumab (Tremfya®)
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Formulary
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- 100mg/1mL solution for injection
- Approved for the treatment of moderate to severe plaque psoriasis in line with NICE
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NICE TA521: Guselkumab for treating moderate to severe plaque psoriasis
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Hydroxychloroquine (Dermatology)
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Formulary
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MHRA Drug Safety Update (Feb 2022): Hydroxychloroquine, chloroquine: increased risk of cardiovascular events when used with macrolide antibiotics; reminder of psychiatric reactions
North East and North Cumbria Shared Care Protocol: Hydroxychloroquine for patients within adult services
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Infliximab (Remsima®, Inflectra®, Remicade®)
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Formulary
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- Approved for psoriasis in line with NICE.
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NICE TA134: Infliximab for psoriasis
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Ixekizumab (Taltz®)
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Formulary
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- Approved for the treatment of moderate to severe plaque psoriasis in adults in line with NICE
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NICE TA442 Ixekizumab for treating moderate to severe plaque psoriasis
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Lebrikizumab (Ebglyss®)
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Formulary
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- Approved for treating moderate to severe atopic dermatitis in people 12 years and over in line with NICE
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NICE TA986: Lebrikizumab for treating moderate to severe atopic dermatitis in people 12 years and over
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Methotrexate
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Formulary
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County Durham and Darlington Shared Care Guideline: Methotrexate
MHRA Drug Safety Update (August 2023): Methotrexate: advise patients to take precautions in the sun to avoid photosensitivity reactions
MHRA Drug Safety Update (Sept 2020): Methotrexate once-weekly for autoimmune diseases: new measures to reduce risk of fatal overdose due to inadvertent daily instead of weekly dosing
Tees Valley Shared Care Guideline: Methotrexate
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Pimecrolimus cream (Elidel®)
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Formulary
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- 1% cream
- Approved of moderate atopic eczema on the face and neck in children between 2 and 16 years in line NICE.
- Can be initiated by prescribers (including general practitioners) with a special interest and experience in dermatology and only after careful discussion with the patient about the potential risks and benefits of all appropriate second-line treatment options.
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NICE TA82: Pimecrolimus and tacrolimus for atopic dermatitis (eczema)
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Risankizumab (Skyrizi®)
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Formulary
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- Approved for the treatment of moderate to severe plaque psoriasis in line with NICE
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NICE TA596: Risankizumab for treating moderate to severe plaque psoriasis
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Ritlecitinib (Litfulo®)
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Formulary
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- 50mg hard capsules
- Currently awaiting assessment against NENC ICB ethical framework in December 2024
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NICE TA958: Ritlecitinib for treating severe alopecia areata in people 12 years and over
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Secukinumab (Cosentyx®)
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Formulary
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- Approved for the treatment of plaque psoriasis in line with NICE.
- Approved for the treatment of moderate to severe plaque psoriasis in children and young people in line with NICE
- Approved for treating moderate to severe hidradenitis suppurativa in line with NICE
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NICE TA350: Secukinumab for treating moderate to severe plaque psoriasis
NICE TA734: Secukinumab for treating moderate to severe plaque psoriasis in children and young people
NICE TA935: Secukinumab for treating moderate to severe hidradenitis suppurativa
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Tacrolimus ointment (Protopic® )
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Formulary
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- 0.03% & 0.1% ointment
- Approved for moderate to severe atopic eczema in patients over 2 years in line with NICE.
- Can be initiated by prescribers (including general practitioners) with a special interest and experience in dermatology and only after careful discussion with the patient about the potential risks and benefits of all appropriate second-line treatment options
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NICE TA82: Pimecrolimus and tacrolimus for atopic dermatitis (eczema)
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Tildrakizumab (Ilumetri®)
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Formulary
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- 100 mg solution for injection in pre-filled syringe
- Approved for the treatment of moderate to severe plaque psoriasis in line with NICE
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NICE TA575: Tildrakizumab for treating moderate to severe plaque psoriasis
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Tralokinumab (Adtralza®)
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Formulary
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- Approved for the treatment of moderate to severe atopic dermatitis in line with NICE
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MHRA Drug Safety Update (April 2023): Janus kinase (JAK) inhibitors: new measures to reduce risks of major cardiovascular events, malignancy, venous thromboembolism, serious infections and increased mortality
NICE TA814: Abrocitinib, tralokinumab or upadacitinib for treating moderate to severe atopic dermatitis
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Upadacitinib (Rinvoq®)
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Formulary
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- Approved for the treatment of moderate to severe atopic dermatitis in line with NICE
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MHRA: Janus kinase (JAK) inhibitors: new measures to reduce risks of major cardiovascular events, malignancy, venous thromboembolism, serious infections and increased mortality
NICE TA814: Abrocitinib, tralokinumab or upadacitinib for treating moderate to severe atopic dermatitis
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Ustekinumab (Stelara®)
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Formulary
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- 45mg & 90mg SC injections approved for psoriasis in line with NICE.
- Approved for the treatment of plaque psoriasis in children and young people in line with NICE
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MHRA Drug Safety Update (Jan 2015): Ustekinumab (Stelara): risk of exfoliative dermatitis
NICE TA180: Psoriasis - ustekinumab (Updated March 2017)
NICE TA455 Adalimumab, etanercept and ustekinumab for treating plaque psoriasis in children and young people
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13.05.03.01 |
Cytokine modulators (biologic therapies) - eczema |
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13.05.03.02 |
Cytokine modulators (biologic therapies) - psoriasis |
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13.06 |
Acne and rosacea |
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13.06.01 |
Topical preparations for acne |
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13.06.01 |
Benzoyl peroxide and azelaic acid |
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Adapalene and benzoyl peroxide (Epiduo® Gel)
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Formulary
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- adapalene 0.1%/benzoyl peroxide 2.5% & adapelene 0.3%/benzoyl peroxide 2.5%
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Azelaic Acid
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Formulary
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- 15% (Finacea®) and 20% (Skinoren®) gel
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Benzoyl Peroxide 5% Gel (Acnecide®)
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Formulary
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Benzoyl Peroxide 5% with Clindamycin 1% (Duac® )
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Formulary
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13.06.01 |
Topical antibacterials for acne |
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Clindamycin (Dalacin T®)
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Formulary
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- 1% topical solution (alcohol – water basis)
- 1% lotion (aqueous)
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Erythromycin 40mg with Zinc Acetate 1.2% topical solution (Zineryt®)
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Formulary
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13.06.01 |
Topical retinoids and related preparations for acne |
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Adapalene 0.1% gel and cream (Differin®)
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Formulary
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Tretinoin 0.025% with Clindamycin 1% gel (Treclin® )
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Formulary
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Tretinoin with antibacterial Aknemycin® Plus
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Formulary
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13.06.01 |
Other topical preparations for rosacea |
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Brimonidine Tartate 0.33% gel (Mirvaso®)
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Formulary
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- For specialist initiation for the treatment of severe rosacea. Following specialist review of effectiveness, primary care can continue supply.
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MHRA Drug Safety Update (June 2017): Brimonidine gel (Mirvaso): risk of systemic cardiovascular effects; not to be applied to damaged skin
MHRA Drug Safety Update (Nov 2016): Brimonidine gel (Mirvaso): risk of exacerbation of rosacea
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Ivermectin 1% cream (Soolantra®)
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Formulary
|
- For the treatment of papulopustular rosacea in patients as second line treatment in patient who have failed topical metronidazole.
|
|
13.06.02 |
Oral preparations for acne |
|
|
Spironolactone
|
Formulary
|
|
|
|
13.06.02 |
Oral antibiotics for acne |
|
|
Lymecycline
|
Formulary
|
|
|
Doxycycline (Capsules)
|
Formulary
|
|
|
13.06.02 |
Hormone treatment for acne |
|
|
Co-Cyprindiol 2000/35 (Cyproterone Acetate 2mg with Ethinylestradiol 35micrograms)
|
Formulary
|
- Tablets containing cyproterone acetate 2mg & ethinylestradiol 35 micrograms.
- Note: generic co-cyprindiol is much cheaper than Dianette®
|
|
Co-Cyprindiol 2000/35 (Cyproterone Acetate 2mg with Ethinylestradiol 35micrograms)
|
Formulary
|
- Tablets containing cyproterone acetate 2mg & ethinylestradiol 35 micrograms
– generic co-cyprindiol is much cheaper than Dianette®
|
|
13.06.02 |
Oral retinoid for acne |
|
|
Isotretinoin capsules
|
Formulary
|
- 5mg, 10mg, 20mg & 40mg capsules
- Isotretinoin is a toxic drug only to be prescribed by or under the supervision of a consultant dermatologist – see BNF and product literature.
- Drug Safety Updates can be found via the following link:
|
|
13.06.03 |
Rosacea |
|
|
13.06.03 |
Rosacea with symptoms of flushing, erythema (without inflammation), telangiectasia, and rhinophyma |
|
|
13.06.03 |
Papulopustular rosacea |
|
|
13.06.03 |
Ocular rosacea |
|
|
13.07 |
Preparations for warts and calluses |
|
|
Formaldehyde
|
Formulary
|
|
|
Glutaraldehyde 10% paint (Glutarol®)
|
Formulary
|
|
|
Imiquimod
|
Formulary
|
|
|
Salicylic Acid (in emulsifying ointment)
|
Formulary
|
See section 13.5.2
|
|
Salicylic Acid 16.7% with Lactic Acid 16.7% Paint (Salactol®)
|
Formulary
|
In flexible collodion
|
|
Silver Nitrate 75% & 95% applicators
|
Formulary
|
- 6 inch applicator
- 95% pencils
- 0.5% solution
|
|
Trichloroacetic Acid
|
Unlicensed
|
|
|
13.07 |
Anogenital warts |
|
|
Podophyllotoxin 0.15% cream (Warticon®)
|
Formulary
|
|
|
Imiquimod 5% cream (Aldara®)
|
Formulary
|
- Second line specialist use for treatment of ano-genital warts (mainly in genitourinary medicine [GUM] clinics).
- For the management of actinic keratosis.
|
|
13.08 |
Sunscreens and camouflagers |
|
|
13.08.01 |
Sunscreen preparations |
|
|
|
Note: Only to be prescribed as per ACBS criteria:
- When prescribed for skin protection against ultraviolet radiation and/or visible light in abnormal cutaneous photosensitivity causing severe cutaneous reactions in genetic disorders (including xeroderma pigmentosum and porphyrias), severe photodermatoses (both idiopathic and acquired) and in those with increased risk of ultraviolet radiation causing severe adverse effects due to chronic disease (such as haematological malignancies), medical therapies and/or procedures.
- Conditions for which over the counter items should not routinely be prescribed in primary care: Guidance for CCGs
|
|
Anthelios Sunscreen Lotion (SPF 50+)
|
Formulary
|
|
|
Uvistat Sun Cream® (SPF 30)
|
Formulary
|
|
|
13.08.01 |
Photodamage |
|
|
Actikerall® (Fluorouracil/ salicylic acid)
|
Formulary
|
|
|
Diclofenac 3% in sodium hyaluronate (Solaraze)
|
Formulary
|
|
|
Fluorouracil (Efudix®) (5% cream)
|
Formulary
|
- For the treatment of superficial malignant and premalignant skin lesions.
|
|
Tirbanibulin ▼
|
Formulary
|
|
|
Imiquimod (Zyclara®) (Actinic Keratosis)
|
Formulary
|
|
|
13.08.02 |
Camouflagers |
|
|
|
Products from the Dermacolor® Camouflage Crème and Veil cover cream ranges are included in this Formulary. They are classified as borderline substances and can be prescribed on FP10 prescription forms (marked ACBS) for postoperative scars and other deformities and as an adjunctive therapy in the relief of emotional disturbances due to disfiguring skin disease, such as vitiligo. |
|
13.09 |
Shampoos and other preparations for scalp and hair conditions |
|
|
Betamethasone 0.05%, salicylic acid 2% (Diprosalic ® ) (Scalp application)
|
Formulary
|
|
|
Betamethasone 0.1% (Scalp application)
|
Formulary
|
|
|
Capasal®
|
Formulary
|
|
|
Clobetasol 0.05% (Scalp application)
|
Formulary
|
|
|
Coal Tar Extract 5% shampoo (Alphosyl 2 in 1®) (Alcoholic)
|
Formulary
|
|
|
Eucerin 5% Dry Scalp Shampoo
|
Formulary
|
|
|
Ketoconazole 2% shampoo (Nizoral®)
|
Formulary
|
|
|
Oilatum shampoo
|
Formulary
|
|
|
Selenium Sulphide 2.5% shampoo (Selsun®)
|
Formulary
|
|
|
Shampoo Cetrimide with undecanoic acid Ceanel Concentrate®
|
Formulary
|
|
|
Shampoos (Dermax®)
|
Formulary
|
|
|
Simple shampoo (Gentle/frequent)
|
Formulary
|
|
|
13.09 |
Hirsutism |
|
|
Co-Cyprindiol 2000/35 (Cyproterone Acetate 2mg with Ethinylestradiol 35micrograms)
|
Formulary
|
- Tablets containing cyproterone acetate 2mg & ethinylestradiol 35 micrograms.
- Note: generic co-cyprindiol is much cheaper than Dianette®
|
|
Eflornithine 11.5% cream (Vaniqa®)
|
Formulary
|
- **UNDER REVIEW**
- Approved for use as a second-line treatment of facial hirsutism in patients where co-cyprindiol is ineffective, contra-indicated or considered inappropriate. Treatment should be initiated by or on the specific advice of an appropriate specialist - endocrinologist (or gynaecologist).
|
|
13.09 |
Androgenetic alopecia |
|
|
13.09 |
Dandruff, psoriasis, seborrhoeic dermatitis of the scalp |
|
|
13.09 |
Hirsutism-Postmenstrual women |
|
|
13.10 |
Anti-infective skin preparations |
|
|
13.10.01 |
Antibacterial preparations |
|
|
13.10.01.01 |
Antibacterial preparations only used topically |
|
|
Mupirocin 2% Ointment (Bactroban®)
|
Formulary
|
|
|
Silver Sulfadiazine 1% cream (Flamazine®)
|
Formulary
|
|
|
Potassium Iodide capsules
|
Restricted
|
- Unlicensed
- Potassium Iodide 60mg and 300mg capsules
- Approved for neutrophilic dermatoses (Sweet syndrome and pyoderma gangrenosum) and panniculitis (including erythema nodosum and nodular vasculitis)
- Dermatology only
|
|
Nitrofurazone 0.2% Ointment
|
Unlicensed
|
- For limited use in burns/plastic surgery patients only.
|
|
13.10.01.02 |
Antibacterial preparations also used systemically |
|
|
Fusidic Acid 2%
|
Formulary
|
|
|
Metronidazole 0.75%
|
Formulary
|
Cream & gel
|
|
13.10.02 |
Antifungal preparations |
|
|
Clotrimazole 1% cream
|
Alternatives
|
|
|
Ketoconazole
|
Alternatives
|
|
|
Miconazole 2% cream
|
Alternatives
|
|
MHRA Drug Safety Update (June 2016): Topical miconazole, including oral gel: reminder of potential for serious interactions with warfarin
|
Terbinafine 1% cream
|
Alternatives
|
|
|
13.10.03 |
Antiviral preparations |
|
|
Aciclovir 5% cream
|
Formulary
|
|
|
13.10.04 |
Parasiticidal preparations |
|
|
13.10.04 |
Scabies |
|
|
Ivermectin
|
Formulary
|
- 3mg tablets
- Approved for the treatment of scabies in accordance with DHSC Medicine Supply Notification
- Note: The licensed preparation is currenly only avialable from Alliance.
|
DHSC Medicine Supply Notification - Permethrin 5% w/w cream
|
Permethrin 5% (Lyclear® Dermal Cream)
|
Formulary
|
|
|
13.10.04 |
Head lice |
|
|
Dimeticone 4% lotion (Hedrin®)
|
First Choice
|
|
|
Malathion 0.5% solution (aqueous)
|
Second Choice
|
|
|
Permethrin 1% (Lyclear® Creme Rinse)
|
Formulary
|
|
|
|
13.10.04 |
Crab lice |
|
|
Permethrin 5% (Lyclear® Dermal Cream)
|
Formulary
|
|
|
13.10.04 |
Benzyl benzonate |
|
|
13.10.04 |
Carbaryl |
|
|
13.10.04 |
Dimeticone |
|
|
13.10.04 |
Malathion |
|
|
13.10.04 |
Permethrin |
|
|
13.10.04 |
Phenothrin |
|
|
13.10.05 |
Preparations for minor cuts and abrasions |
|
|
Bismuth Subnitrate and Iodoform (B.I.P.P.) Paste
|
Formulary
|
- For use in ENT surgery & epistaxis
1.25cm x 100cm & 2.5cm x 100cm impregnated gauze
|
|
Drapolene® cream
|
Formulary
|
|
|
Enbucrilate
|
Formulary
|
- See 13.10.05 skin tissue adhesives (Liquiband®, Liquiband Optima®, IndermilX-Fine, Histoacryl Blue®)
|
|
Lanolin Cream
|
Formulary
|
|
|
Magnesium Sulphate Paste BP
|
Formulary
|
|
|
13.10.05 |
Collodion |
|
|
Collodion Flexible BP
|
Formulary
|
- 2.5% castor oil & colophony 2.5% in a collodion base.
|
|
13.10.05 |
Skin tissue adhesive |
|
|
Fibrin sealant (Artiss®)
|
Formulary
|
- 2ml, 4ml & 10ml prefilled syringe.
- For use in plastic surgery to close dead spaces, adhere skin graft, close simple wounds and stabilise bone grafts.
|
|
Fibrin sealant (Bioglue®)
|
Formulary
|
- For use in neurosurgery and vascular surgery.
|
|
Fibrin sealant (Evicel® Human Fibrin Glue)
|
Formulary
|
2ml and 5ml kit
|
|
Fibrin sealant (Floseal® Matrix sealant)
|
Formulary
|
|
|
Fibrin sealant (Tisseel Lyo® Fibrin Glue)
|
Formulary
|
- 2ml, 4ml & 10ml kit
- Also approved for use in the treatment of mesh fixation in hernia repair.
|
|
Histoacryl Blue®
|
Formulary
|
|
|
Indermil X-Fine®
|
Formulary
|
|
|
LiquiBand Optima®
|
Formulary
|
|
|
LiquiBand®
|
Formulary
|
|
|
TachoSil®
|
Formulary
|
- 4.8 & 9.5 cm 2 Haemostatic (collagen sponge coated with fibrinogen and thrombin) - for use in liver and renal surgery.
|
|
13.11 |
Skin cleansers, antiseptics, and desloughing agents |
|
|
Gigasept PA (Solution)
|
Formulary
|
|
|
Lubricating jelly
|
Formulary
|
|
|
Plaster remover
|
Formulary
|
|
|
13.11.01 |
Alcohols and saline |
|
|
Alcohol hand rub gel
|
Formulary
|
|
|
Alcohol impregnated wipes
|
Formulary
|
Containing 70% isopropyl alcohol or methylated spirit (e.g. Clini-wipes®, Alcowipes®)
|
|
Industrial Methylated Spirit BP (Solution & spray)
|
Formulary
|
70% liquid & 70% spray
|
|
Isopropyl alcohol 70% Skin Preparation Swabs (Sterets®)
|
Formulary
|
|
|
Sodium Chloride 0.9%
|
Formulary
|
- Sterile solution – bottles
- 25ml & 100ml sachets(Normasol®)
|
|
Water for Irrigation (Sterile)
|
Formulary
|
|
|
13.11.02 |
Chlorhexidine salts |
|
|
|
In June 2014 information was published highlighting the risk of severe chemical injuries associated with the use of both alcohol-based and water-based chlorhexidine solutions for skin disinfection in premature infants. This was based on Yellow Card reports and reports identified in the literature. A European review has since considered the MHRA evidence together with additional information from spontaneous reporting and published literature The risk appears to be higher in infants born before 32 weeks of gestation than in full term infants and in the first 2 weeks of life than in later life.
Advice for healthcare professionals:
When using alcohol-based or water-based chlorhexidine solutions on premature infants, bear in mind the risk of severe chemical injuries. Use the minimum amount of chlorhexidine solution required and do not allow the solution to pool. Remove any excess solution and any soaked materials, drapes, or gowns from the skin. Use single-use containers where possible. There is a danger of accidentally using too much solution from a multiple-use container. Monitor patients frequently to detect and manage cutaneous side effects at an early stage. Please report any adverse events through the Yellow Card Scheme:www.mhra.gov.uk/yellowcard |
|
Chlorhexidine 0.015% with Cetrimide 0.15% (Solution)
|
Formulary
|
|
|
Chlorhexidine Gluconate
|
Formulary
|
- 0.05% solutions, 25ml & 100ml sachets
- 0.5% solution in 70% methylated spirit (pink, colourless & red staining)
- 2.5% in 70% methylated spirit wipes
- 0.5% hand rub (contains 70% isopropyl alcohol + emollients)
- 4% surgical scrub
- 2% in 70% isopropyl alcohol wipes (Clinell®)
- Skin swabs & skin cleanser
- 3ml & 10.5ml applicators (Chloraprep®)
- 1% Obstetric cream
|
MHRA Drug Safety Update (November 2012): Chlorhexidine: reminder of potential for hypersensitivity
|
Prontosan
|
Formulary
|
- Solution containing Betaine 0.1% (surfactant) and Polyhexanide 0.1% (a chlorhexidine polymer). Mainly for use from 40ml plastic ampoules.
Also available as a gel.
- To be prescribed/used only on the advice of tissue viability specialists.
|
|
|
13.11.03 |
Cationic surfactants and soaps |
|
|
Infacare Baby Bath Additive
|
Formulary
|
|
|
Mediscrub®
|
Formulary
|
|
|
Octenisan® wash
|
Formulary
|
- Used in some trusts as an alternative to chlorhexidine scrub and Triclosan skin cleanser in MRSA prophylaxis/eradication on secondary care advice.
|
|
13.11.04 |
Iodine and Chlorine |
|
|
Povidone-Iodine
|
Formulary
|
- 2.5% dry powder spray
- 10% alcoholic solution
- 7.5% surgical scrub
- 10% antiseptic solution (aqueous)
- 0.35% sterile aqueous solution
- approved for use in the prevention of surgical site infection in arthroplasty.
|
|
Sodium Hypochlorite Solution 1%
|
Unlicensed
|
|
|
13.11.05 |
Phenolics |
|
|
13.11.06 |
Oxidisers, and dyes |
|
|
Hydrogen Peroxide Solution BP
|
Formulary
|
- 10 volume (3%) & 20 volume (6%) solutions.
|
|
Potassium Permanganate
|
Formulary
|
- 5% solution unlicensed
- 400mg tablets
- Potassium permanganate not to be issued on repeat prescription
|
Inadvertent oral administration of potassium permanganate
|
Silver nitrate 0.5% Solution (UNDER REVIEW)
|
Formulary
|
|
|
Bonney's Blue Paint (Brilliant green & crystal violet)
|
Unlicensed
|
- For limited use in some operating theatres only.
|
|
Crystal Violet 0.5% Paint
|
Unlicensed
|
- For limited use in some operating theatres/critical care areas only.
|
|
Magenta Paint BPC (Castellani's paint) (UNDER REVIEW)
|
Unlicensed
|
Paint containing magenta 0.4%, boric acid 0.8%, phenol 0.004%, resorcinol 8%, acetone and alcohol (or industrial methylated spirit).
|
|
13.11.07 |
Desloughing agents |
|
|
13.11.07 |
Growth factor |
|
|
13.12 |
Antiperspirants |
|
|
Aluminimum Chloride (Driclor®, Anhydrol Forte®)
|
Formulary
|
- Aluminium chloride hexahydrate 20% solution in an alcoholic basis
|
|
Botulinum toxin type A
|
Formulary
|
|
|
Haem-agglutinin complex
|
Formulary
|
- For limited use as an alternative to surgery in some patients.
|
|
Glycopyrrolate 1% cream
|
Unlicensed
|
- To be initiated by specialist.
|
|
13.13 |
Topical circulatory preparations |
|
|
13.14.01 |
Emollients and barriers |
|
|
13.14.02 |
Steroid combinations |
|
|
13.14.03 |
Tars |
|
|
13.14.04 |
Ichthammol |
|
|
13.14.05 |
Dithranol preparations |
|
|
13.14.06 |
Keratolytics |
|
|
13.14.07 |
Miscellaneous |
|
|
Difelikefalin (Kapruvia®)
|
Formulary
|
- 50mcg/1ml solution for injection
- Approved for pruritus in adults with chronic kidney disease having haemodialysis in line with NICE
|
|
.... |
Non Formulary Items |
Amorolfine 5% nail lacquer cream (Loceryl®)
|
Non Formulary
|
|
|
Baricitinib (Olumiant®)
|
Non Formulary
|
- Not approved for the treatment of severe alopecia areata
|
NICE TA926: Baricitinib for treating severe alopecia areata
|
Dupilumab (Dupixent®)
|
Non Formulary
|
- Not approved for treating moderate to severe prurigo nodularis in adults when systemic treatment is suitable
|
MHRA Drug Safety Upate (Nov 2022): Dupilumab (Dupixent▼): risk of ocular adverse reactions and need for prompt management
NICE TA955: Dupilumab for treating moderate to severe prurigo nodularis
|
Minoxidil
|
Non Formulary
|
|
|
|
Key |
|
|
Cytotoxic Drug
|
|
Controlled Drug
|
|
High Cost Medicine
|
|
NHS England |
|
Homecare |
|
CCG |
|
Traffic Light Status Information
Status |
Description |
|
Drugs for hospital use only. The responsibility for initiation and monitoring treatment should rest with an appropriate hospital clinician and the drug should be supplied through the hospital throughout the duration of treatment.
In some very exceptional circumstances (e.g. due to distance from the hospital, storage, supply or mobility/transport problems) it may be appropriate for the GP to be asked to prescribe a Red drug. This should be negotiated on an individual patient basis and should only be done with the GP’s prior informed agreement where the roles of the GP and hospital services are clearly defined and agreed. The GP should not feel under pressure to prescribe in these circumstances.
For all RED drugs automatically added to the formulary in response to a positive NICE TA: Prescribers need to ensure that local Trust new drug governance procedures and pharmacy processes are followed before any prescribing. |
|
Drugs initiated by hospital specialist, but where continuing treatment by GPs may be appropriate under a shared care arrangement.
The specialist should send the GP a copy of the shared care agreement to sign. The GP should sign the shared care agreement, or indicate they do not want to be part of such an agreement, and return a copy back to the specialist. Shared care guidelines are available or are being developed for most of the drugs listed as Amber.
If no shared care guideline is available, the hospital specialist should provide the patient’s GP with sufficient information and support to allow treatment to be continued and managed safely in primary care. |
|
Drugs normally recommended or initiated by a specialist (hospital or GP with an extended role https://www.rcgp.org.uk/gpwer), but can be safely maintained in primary care with very little or no monitoring required. In some cases there may be a further restriction for use outlined - these will be defined in each case. Provision of additional information, or an information leaflet, may be appropriate in some cases to facilitate continuing treatment by GPs. |
|
Drugs where prescribing by GPs is appropriate. Can be initiated and prescribed in all care settings, and if appropriate, discontinued without recourse to secondary care. |
|
NOT APPROVED: Drugs that have been considered by NTAG or the NENC ICB Medicines Subcommittee (or other approved body) and are not approved for prescribing within the North East and North Cumbria. |
|
UNDER REVIEW: drugs whose current formulary status or RAG status is currently under review. |
|
NOT REVIEWED: Drugs that haven not been reviewed yet. This usually means that an application is in progress. These drugs are not normally considered appropriate for prescribing in the North East and North Cumbria until such time that a decision is taken on their formulary status. |
|
|
|