netFormulary

Azacitidine

Formulary

Approved for myelodysplastic syndromes, CLL and AML - in line with NICE guidance.

NICE TA218: Azacitidine for myelodysplastic syndromes

NICE TA399: Azacitidine for treating acute myeloid leukaemia with more than 30% bone marrow blasts

NICE TA827: Oral azacitidine for maintenance treatment of acute myeloid leukaemia after induction therapy

Capecitabine

Formulary

Only approved for use in accordance with NICE guidance.

Approved in combination with gemcitabine following surgery for pancreatic cancer in line with NHS England Clinical Commissioning Policy

NICE TA100: Colon cancer (adjuvant) - capecitabine and oxaliplatin

NICE TA191: Gastric cancer (advanced) - capecitabine

NICE TA61: Colorectal cancer - capecitabine and tegafur uracil

NHS England SSC1959 - Clinical Commissioning Policy: Gemcitabine and capecitabine following surgery for pancreatic cancer (all ages)

MHRA Drug Safety Update (Jan 2014): Capecitabine:�risk�of severe�skin�reactions�-�discontinue�treatment

MHRA Drug Safety Update (Oct 2020): 5-fluorouracil (intravenous),�capecitabine,�tegafur:�DPD�testing recommended�before�initiation�to�identify�patients�at increased risk of severe and fatal toxicity

Cladribine

Formulary

10mg in 10ml solution for preparing infusions; 2mg in 1ml subcutaneous injection
Approved for Hairy cell leukaemia only.

10mg tablets
Approved for treating highly active multiple sclerosis in adults in line with NICE

MHRA Drug Safety Update (Dec 2017): Cladribine (Litak, Leustat) for leukaemia: reports of progressive multifocal encephalopathy (PML); stop treatment if PML suspected

MHRA Drug Safety Update (Mar 2022): Cladribine (Mavenclad): new advice to minimise risk of serious liver injury

NICE TA616: Cladribine for treating relapsing�remitting multiple sclerosis

Clofarabine Evoltra^®

Formulary

Cytarabine

Formulary

A cytarabine 50mg vial - intrathecal injection (cytarabine encapsulated in liposomes) is also approved for use.

Daunorubicin/cytarabine Vyxeos^®

Formulary

Daunorubicin 44mg/cytarabine 100mg powder for solution for infusion

Approved for untreated acute myeloid leukaemia in line with NICE

NICE TA 552: Liposomal cytarabine�daunorubicin for untreated acute myeloid leukaemia

MHRA Drug Safety Update (July 2020): Liposomal and lipid- complex formulations: name change to reduce medication errors

Fludarabine Phosphate

Formulary

Approved for the second line therapy of B-cell CLL in line with NICE.
Note: fludarabine is not approved for monotherapy in the first line treatment of CLL - this is in line with NICE.

NICE TA119: Fludarabine monotherapy for the first-line treatment of chronic lymphocytic leukaemia

NICE TA29: Guidance on the use of fludarabine for B-cell chronic lymphocytic leukaemia

Fluorouracil

Formulary

A fluorouracil 10mg in 0.4ml subconjunctival injection (unlicensed) is also approved for use.
FOLFIRINOX is approved for the management of selected patients with inoperable pancreatic cancer in patients with performance status 0-1.

MHRA Drug Safety Update (Oct 2020): 5-fluorouracil (intravenous),�capecitabine,�tegafur:�DPD�testing recommended�before�initiation�to�identify�patients�at increased risk of severe and fatal toxicity

Gemcitabine

Formulary

Approved in combination with paclitaxel for metastatic breast cancer in line with NICE.

NECDAG approved for the second line treatment of women with partially platinum – sensitive, platinum resistant or platinum refractory advanced ovarian cancer (To be used when liposomal doxorubicin [Caelyx] is unavailable).

Approved for pancreatic cancer in line with NICE.

Approved for the treatment of recurrent ovarian cancer in line with NICE.

Approved in combination with capecitabine following surgery for pancreatic cancer in line with NHS England Clinical Commissioning Policy

NICE NG85: Pancreatic cancer in adults: diagnosis and management

NICE TA116: Gemcitabine for the treatment of metastatic breast cancer

NICE TA389: Topotecan, pegylated liposomal doxorubicin hydrochloride, paclitaxel, trabectedin and gemcitabine for treating recurrent ovarian cancer

NHS England SSC1959 - Clinical Commissioning Policy: Gemcitabine and capecitabine following surgery for pancreatic cancer (all ages)

Mercaptopurine

Formulary

A mercaptopurine 20mg in 1ml suspension (unlicensed) is also approved for use.
Note: when prescribed for inflammatory bowel disease.

Methotrexate

Formulary

Approved formulations:
- Methotrexate 2.5mg tablets
- Methotrexate 10mg in 5ml oral solution. unlicensed
- Methotrexate injections (various strengths) – including prefilled syringes.
- Methotrexate 5mg in 2ml intrathecal injection.

NOTE: when used in chronic inflammatory conditions, e.g. Crohn’s disease, rheumatoid arthritis.
NOTE: Subcutaneous injection for chronic inflammatory conditions in Tees SICBL

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

South Tyneside & Sunderland APC Shared Care Guideline - Methotrexate in Neurology

Nelarabine Atriance^®

Formulary

Pemetrexed

Formulary

Approved for:
- Mesothelioma in line with NICE (funding has to be agreed on an individual patient basis if treatment is not in line with NICE).
- Combination with cisplatin for the first line treatment of locally advanced or metastatic NSCLC (non-squamous cell histology) in line with NICE.
- Maintenance treatment of locally advanced or metastatic NSCLC (non-squamous cell histology) in line with NICE.
- Maintenance treatment of non-squamous non-small lung cancer after pemetrexed and cisplatin in line with NICE and NHS England Commissioning Policy.
Note: pemetrexed is not approved for locally advanced or metastatic NSCLC as per NICE.