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 Formulary Chapter 14: Immunological products and vaccines - Full Chapter
Notes:

Please refer to the Public Health England Green Book on vaccines for the most up to date information on the recommended preparations and use.

The following vaccinations should not be prescribed on the NHS exclusively for the purposes of travel:

• hepatitis B

• Japanese encephalitis

• meningitis ACWY

• yellow fever

• tick-borne encephalitis

• rabies

• BCG.
 Details...
14.04  Expand sub section  Vaccines and antisera
 link Link    MHRA Drug Safety Updates: COVID-19 Vaccines
14.04  Expand sub section  Anthrax vaccine
14.04  Expand sub section  BCG vaccines
14.04  Expand sub section  Botulism antitoxin
14.04  Expand sub section  Cholera vaccine to top
14.04  Expand sub section  COVID-19 vaccine
14.04  Expand sub section  Diphtheria vaccines
14.04  Expand sub section  Haemophilus influenzae type B vaccine
14.04  Expand sub section  Hepatitis A vaccine
14.04  Expand sub section  Hepatitis B vaccine to top
14.04  Expand sub section  Human papilloma virus vaccine
14.04  Expand sub section  Influenza vaccine
14.04  Expand sub section  Measles vaccine
14.04  Expand sub section  Measles, Mumps and Rubella (MMR) vaccine
14.04  Expand sub section  Meningococcal vaccines to top
14.04  Expand sub section  Mumps vaccine
14.04  Expand sub section  Pertussis vaccine
14.04  Expand sub section  Pneumococcal vaccines
14.04  Expand sub section  Poliomyelitis vaccines
14.04  Expand sub section  Rabies vaccine to top
14.04  Expand sub section  Rotavirus vaccine
14.04  Expand sub section  Rubella vaccine
14.04  Expand sub section  Smallpox vaccine
14.04  Expand sub section  Tetanus vaccines
14.04  Expand sub section  Tick-borne encephalitis vaccine to top
14.04  Expand sub section  Typhoid vaccines
14.04  Expand sub section  Varicella-zoster vaccine
14.04  Expand sub section  Yellow fever vaccine
Yellow fever vaccine (Live)
View adult BNF View SPC online View childrens BNF 		Formulary
Green

Only available from designated Yellow Fever Vaccination Centres.

 
Link  MHRA Drug Safety Update (April 2019): Yellow fever vaccine (Stamaril) and fatal adverse reactions: extreme caution needed in people who may be immunosuppressed and those 60 years and older
Link  MHRA Drug Safety Update (Nov 2019): Yellow fever vaccine: stronger precautions in people with weakened immunity and in those aged 60 years or older
Link  MHRA Drug Safety Update (Nov 2021): Yellow fever vaccine (Stamaril): new pre-vaccination checklist
 
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Key
Restricted Drug Restricted Drug
Unlicensed Drug Unlicensed
click to search medicines.org.uk
 Link to adult BNF
click to search medicines.org.uk
 Link to children's BNF
click to search medicines.org.uk
 Link to SPCs
Cytotoxic Drug
 Cytotoxic Drug
CD
 Controlled Drug
High Cost Medicine
 High Cost Medicine
NHSE
 NHS England
Homecare
 Homecare
CCG
 ICB
Green Low Carbon

Low carbon footprint
Amber Medium Carbon

Medium carbon footprint
Red High carbon footprint

High carbon footprint
Status Description

Red

 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.   

Amber

 Drugs initiated by hospital specialist, but where continuing treatment by GPs may be appropriate under a shared care arrangement. These medicines are considered suitable for primary care prescribing following specialist initiation of therapy and stabilisation, with ongoing communication between the primary care prescriber and specialist as set out in the associated shared care guideline (SCG). Shared care should be initiated by the specialist, which includes consultant, suitably trained specialist non-medical prescriber or GPwER within a secondary, tertiary, or primary care clinic. The specialist should send the primary care prescriber a copy of the NENC Clinical Effectiveness and Governance (CEG) Subcommittee approved SCG to sign. The primary care prescriber should sign the SCG or indicate reasons why they are unable to accept the agreement and return a copy back to the specialist, as soon as possible. SCGs are available or are being developed for most of the drugs listed as AMBER.   

Green plus

 Drugs normally recommended or initiated by a hospital specialist who is a prescriber, a GP with an extended role [GPwER], or a specialist within primary care which can be safely maintained in primary care and monitored in primary care. In some cases, a further restriction for use may be defined. The primary care prescriber must be familiar with the drug to take on prescribing responsibility or must obtain the required information from the specialist. Therefore, provision of additional information, or an information leaflet, may be appropriate in some cases to facilitate continuing treatment by primary care prescriber or provide information re stopping criteria. These are considered suitable for primary care prescribing following specialist assessment and recommendation of therapy, with ongoing communication between the primary care prescriber and specialist, if necessary. In some case these drugs require specialist initiation and short to medium term monitoring of efficacy or toxicity until the patient’s dose is stable. Following specialist review the patient may be transferred to primary care for ongoing prescribing. Ongoing prescribing by primary care can include, if required, additional dose titrations and assessment of efficacy, with ongoing communication between the primary care prescriber and specialist, if necessary. If the drug requires urgent initiation, it is expected that the specialist undertakes the initial prescribing responsibility for an appropriate period of time, usually a minimum of 28 days. A GREEN+ drug can only be recommended to primary care for initiation if does not need to be initiated within 28 days.  

Green

 Medicines suitable for initiation, ongoing prescribing and discontinuation in all care settings, subject to appropriate communication between those responsible.  

Brown

 UNDER REVIEW: drugs whose current formulary status or RAG status is currently under review.  

Not Recomended

 Drugs that have been considered by the NENC Clinical Effectiveness and Governance (CEG) Subcommittee (or other approved body) and are not approved for prescribing within the North East and North Cumbria ICS. These may also include all medicines with a “not NHS” or “DLCV” classification in the BNF, those agents as included within the NICE “Do not do” list, and those agents included with the NHS England: Items which should not routinely be prescribed in primary care.  

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