| Formulary Chapter 9: Nutrition and blood - Full Chapter
|
| Chapter Links... |
 County Durham and Tees Valley Guidelines for recognition and management of non- IgE cow’s milk allergy in children |
| Guidance for the Prescribing of Vitamins and Minerals in Primary Care in County Durham and Tees Valley |
 North of Tyne, Gateshead and North Cumbria - Recommendations for symptom management in renal patients (including symptom management at the end of life) |
| South Tees Pathway for the Management of Undernutrition (ADULTS) |
| South Tees Pathway for the Management of Undernutrition (Nursing/Care Homes) |
| Details... |
| 09.01.03 |
Drugs used in hypoplastic, haemolytic, and renal anaemias |
|
|
Eculizumab
|
Formulary
|
- 300mg/30ml solution for infusion
- Approved treating atypical haemolytic uraemic syndrome in adults and children in line with NICE
Paroxysmal nocturnal haemoglobinuria treatment is only commissioned from:
- King’s College Hospital NHS Foundation Trust, London - London and South East
- Leeds Teaching Hospitals NHS Trust - Rest of United Kingdom
|
NICE TA647: Eculizumab for treating relapsing neuromyelitis optica (terminated appraisal)
Clinical Commissioning Policy: Eculizumab in the treatment of recurrence of C3 glomerulopathy postkidney transplant (all ages) Reference: NHS England: 16054/P
NICE HST 1 - Eculizumab for treating atypical haemolytic uraemic syndrome
NICE TA636: Eculizumab for treating refractory myasthenia gravis (terminated appraisal)
|
Pegcetacoplan (Aspaveli®)
|
Formulary
|
- 1080mg/20 solution for infusion
- Approved for the treatment paroxysmal nocturnal haemoglobinuria in adults who have anaemia after at least 3 months of treatment with a C5 inhibitor in line with NICE and NHSE Commissioning Policy.
- Paroxysmal nocturnal haemoglobinuria treatment is only commissioned from:
- King’s College Hospital NHS Foundation Trust, London - London and South East
- Leeds Teaching Hospitals NHS Trust - Rest of United Kingdom
|
NICE TA778: Pegcetacoplan for treating paroxysmal nocturnal haemoglobinuria
|
Ravulizumab (Ultomiris®)
|
Formulary
|
- 300mg/30ml & 1,100mg/11ml concentrate for solution for infusion
- Approved for the treatment of paroxysmal nocturnal haemoglobinuria in adults in line with NICE
- Approved for the treatment of atypical haemolytic uraemic syndrome in line with NICE
- Paroxysmal nocturnal haemoglobinuria treatment is only commissioned from
- King’s College Hospital NHS Foundation Trust, London - London and South East
- Leeds Teaching Hospitals NHS Trust - Rest of United Kingdom
|
NICE TA698: Ravulizumab for treating paroxysmal nocturnal haemoglobinuria
NICE TA710: Ravulizumab for treating atypical haemolytic uraemic syndrome
|
Roxadustat (Evrenzo® )
|
Formulary
|
- 20mg, 50mg, 70mg, 100mg and 150mg tablets
- Approved for treating symptomatic anaemia associated with chronic kidney disease in adults in line with NICE
|
NICE TA807: Roxadustat for treating symptomatic anaemia in chronic kidney disease
|
|
|
|
|
| 09.01.03 |
Erythropoietin |
|
|
Darbepoetin Alfa (Aranesp®)
|
First Choice
|
- 10, 15, 20, 30, 40, 50, 60, 80, 100, 150 & 300 microgram injections in prefilled syringes
- 20, 40, 60, 80, 100 & 300 microgram Sureclick® pens - approved for management of cancer treatment-induced anaemia in women receiving platinum-based chemotherapy for ovarian cancer
- Monitoring: monitoring of erythropeoetin (darbepoetin) in adult patients can be undertaken by GPs under a shared care arrangement
|
MHRA Drug Safety Update (Jan 2018): Recombinant human erythropoietins: very rare risk of severe cutaneous adverse reactions (SCARs)
NICE CG114: Anaemia in chronic kidney disease
NICE TA323: Erythropoiesis‑stimulating agents during chemotherapy
North of Tyne, Gateshead and North Cumbria - Shared Care Guidelines for the Monitoring of Erythropoietins in the Treatment of Patients with Chronic Kidney Disease (CKD)
|
Epoetin delta
|
Formulary
|
|
|
|
Epoetin theta
|
Formulary
|
|
|
|
Epoetin zeta
|
Formulary
|
|
MHRA Drug Safety Update (Jan 2018): Recombinant human erythropoietins: very rare risk of severe cutaneous adverse reactions (SCARs)
|
Epoetin alfa (Eprex®)
|
Alternatives
|
- Prefilled syringes (various strengths)
- Approved for management of cancer treatment-induced anaemia in
women receiving platinum-based chemotherapy for ovarian cancer
- No longer regularly used in NUTH
|
MHRA Drug Safety Update (Jan 2018): Recombinant human erythropoietins: very rare risk of severe cutaneous adverse reactions (SCARs)
NICE NG203: Chronic kidney disease: assessment and management
NICE TA323: Erythropoiesis‑stimulating agents during chemotherapy
Shared Care Guidelines for the Monitoring of Erythropoietins in the Treatment of Patients with Chronic Kidney Disease (CKD)
|
Epoetin beta (NeoRecormon®)
|
Alternatives
|
- Cartridges for use in RecopensPrefilled syringes
- Approved for management of cancer treatment-induced anaemia
in women receiving platinum-based chemotherapy for ovarian cancer.
- No longer regularly used in NUTH.
- Monitoring: monitoring of erythropeoetin (epoetin beta) in adult patients can be undertaken by GPs under a shared care arrangement
|
MHRA Drug Safety Update (Jan 2018): Recombinant human erythropoietins: very rare risk of severe cutaneous adverse reactions (SCARs)
NICE NG203: Chronic kidney disease: assessment and management
NICE TA323: Erythropoiesis‑stimulating agents during chemotherapy
Shared Care Guidelines for the Monitoring of Erythropoietins in the Treatment of Patients with Chronic Kidney Disease (CKD)
|
Methoxy Polyethylene Glycol-Epoetin Beta (Mircera®, Pegzerepoetin® alfa)
|
Alternatives
|
- 30, 50, 100, 120, 150, 200 & 250 microgram in 0.3ml and 360 microgram in 0.6ml injections in prefilled syringes.
- Approved for use as a longer-acting alternative to darbepoetin in a
small number of patients receiving peritoneal dialysis.
|
MHRA Drug Safety Update (Jan 2018): Recombinant human erythropoietins: very rare risk of severe cutaneous adverse reactions (SCARs)
|
|
|
| 09.01.03 |
Iron overload |
|
|
Deferasirox
|
Formulary
|
- Approved for iron chelation in patients with myelodysplastic syndromes (MDS) - (as per NECN Haematology Group Guidelines) and recommended for use in patients when treatment with desferrioxamine is no longer considered to be appropriate due to progressive iron overload despite maximally tolerated doses of desferrioxamine.
- Approved for the treatment of iron overload for trasnfused and non-tranfused patients with chronic inherited anaemias (all ages) in line with NHSE Specialised Commissioning Policy
|
|
|
Deferiprone (Ferriprox®)
|
Formulary
|
|
|
|
Desferrioxamine Mesilate
|
Formulary
|
- Approved for the treatment of iron overload for trasnfused and non-tranfused patients with chronic inherited anaemias (all ages) in line with NHSE Specialised Commissioning Policy
|
|
|
| .... |
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. |
|
|
|
