• Approved for selective internal radiation therapy for the treatment of unresectable advanced hepatocellular carcinoma in line with NICE

• Abatacept 250mg injection is approved for:
  • Juvenile idiopathic arthritis in patients aged six years and above (licensed) and under six years. It should only be prescribed with informed consent.
  • People aged 6 years and older to treat polyarticular juvenile idiopathic arthritis (JIA) whose diease has responded inadequately to other DMARDs, including at least one tumour necrosis factor (TNF) inhibitor in accordance with NICE.
  • Rheumatoid arthritis after the failure of a TNF inhibitor in line with NICE.
  • Treatment in adults with severe rheumatoid arthritis not previously treated with DMARDs or after conventional DMARDs only have failed in accordance with NICE.
  • Treatment of severe treatment-resistant morphoea in line with NHS England Clinical Commissioning Policy
  • Treating modertae rheumatoid arthritis after conventional DMARDs have failed in line with NICE
  • Treating idiopathic inflammatory myopathies in adults and children aged 2 and over in line with NHS England Commissioning Policy
• Abatacept 125mg SC injection (prefilled syringe) is approved for moderate to severe rheumatoid arthritis in accordance with NICE.

• 50mg, 100mg and 150mg tablets


• Approved as an options for treating locally advanced or metastatic, hormone receptor-positive, human epidermal growth factor receptor 2 (HER2)-negative breast cancer as first endocrine-based therapy in adults in line with NICE


• Approved with fulvestrant for treating hormone receptor-positive, HER2 negative advanced breast cancer after endocrine therapy in line with NICE 

• Approved for castration-resistant metastatic prostate cancer in line with NICE.
• Approved for treating metastatic hormone-relapsed prostate cancer before chemotherapy is indicated in line with NICE and NHS England Commissioning Policy.

• COUNTY DURHAM  acamprosate, chlordioazepoxide, disulfiram & nalmefene prescribing should be retained within the commissioned service within County Durham.
  • For referral information see https://codurhamrecovery.co.uk/get-support/

• 1mg tablets

• second line carbonic anhydrase inhibitor for glaucoma

• T o be diluted to 2.5%
  - approved for the use in the detection of dysplasia/ neoplasia
  in Barrett’s oesophagus

• 600mg effervescent tablets.
•  Green for licensed indications.
•  For use on specialist advice in the treatment of idiopathic pulmonary fibrosis.
• For the prevention of x-ray contrast media induced renal damage .

• Tablets: 200mg, 400mg, 800mg
• Dispersible tablets: 200mg, 400mg, 800mg
• Oral suspension (sugar-free available): 200mg/5ml, 400mg/5ml

• 800mg Tablets
• For the treatment of ophthalmic zoster.

• Injection (for IV infusion): 250mg, 500mg

• 10mg and 25mg capsules 

• Aclidinium 340 microgram/dose & formoterol 12 microgram/dose (equivalent to aclidinium bromide 396 microgram/dose, formoterol fumarate dihydrate 11.8 microgram/dose) inhalation powder (DPI)

Conformable antimicrobial barrier dressing consisting of polyester core between low adherent silver-coated high density polyethylene mesh.

• Specialist initiation only

Knitted fabric of activated charcoal with one-way stretch, with silver residues, within spun-bound nylon sleeve

Polyurethane Foam Film Dressing without Adhesive Border

Non-woven, calcium sodium alginate dressing

Polyamide and Cellulose Contour Bandage, BP 1988

• Adalimumab is approved for:
• The treatment of adults with severe rheumatoid arthritis not previously treated with DMARDs or after conventional DMARDs only have failed in accordance with NICE 
• Rheumatoid arthritis after the failure of a TNF inhibitor in accordance with NICE.
• Treatment of severe active ankylosing spondylitis in adults whose disease has responded inadequately to, or who cannot tolerate, non-steroidal anti-inflammatory drugs in accordance with NICE.
• Psoriatic arthritis in accordance with NICE.
• As a second-line anti-TNF therapy in children with juvenile idiopathic arthritis and uveitis.
• Children and adults aged 2 years and older to treat polyarticular juvenile idiopathic arthritis (JIA) whose disease has responded inadequately to 1 or more DMARD in accordance with NICE.
• Treating moderate rheumatoid arhritis after conventional DMARDs have failed in line with NICE

• 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.

• adapalene 0.1%/benzoyl peroxide 2.5% & adapelene 0.3%/benzoyl peroxide 2.5%

• 6mg in 2ml injection
• 25mg in 5ml injection unlicensed
• 30mg in 10ml injection for infusion - NHCT only
• 130mg in 130ml IV infusion unlicensed

• 1 in 1,000 injections in 1ml syringes and 1ml & 10ml ampoules.
• 1 in 10,000 injections in 1ml & 10ml ampoules & syringes.

• with & without masks
• See RightBreathe for options

• NETAG approved for the treatment of depression only following an adequate trial of at least three alternative antidepressant drugs at maximally tolerated doses (as described by NICE and as stated in the BNF).
• Prescribing and monitoring should be initiated by specialist mental health physicians. 
  • Transfer of prescribing to primary care at around 6 months / when LFT monitoring completed following dose increase

• Alemtuzumab 30mg in 1ml concentrate for IV infusion is approved for use in, lymphocytic leukaemia & prevention of graft vs. host disease in bone marrow transplant patients, and high-risk kidney and pancreas transplantation.

• Alemtuzumab 12mg in 1.2ml concentrate for IV infusion is approved for treating adults with active relapsing– remitting multiple sclerosis in line with NICE and NHS England commissioning policy. 

• 250 nanogram & 1 microgram capsules
• 2 microgram/ml sugar-free oral drops – one drop containing approx. 100 nanograms of alfacalcidol 
• 1 microgram in 0.5ml & 2 micrograms in 1ml injections

• 500micrograms in 1ml [ST&S], 1mg in 2ml, 5mg in 10ml & 5mg in 1ml injection ampouless - approved for initiation by specialists in palliative care

• 30mg/5ml syrup.
  
  • see section 03.04.01 for other formulations.

• Approved for adults with severe chronic hand eczema that have not responded to potent topical corticosteroids in line with NICE.

Polyurethane Foam Film Dressing with Adhesive Border

Silicone gel wound contact dressing, with polyurethane foam film backing

Soft silicone wound contact dressing, with central mesh screen, polyurethane foam film backing and adhesive border

• An allopurinol 100mg in 5ml suspension (unlicensed) is also approved for use. 

• 50mg, 150mg and 200mg tablets
• Approved with fulvestrant for treating hormone receptor-positive, HER2-negative, PIK3CA-mutated, locally advanced or metastatic breast cancer in adults in line with NICE

• 500mg in 5ml suspension
• 134mg (200 unit) capsules

• Vitaros® 3mg/g cream
• Muse® 500microgram, and 1mg.

Treatment with alprostadil cream (Vitaros®) is NOT approved for use in County Durham and Tees Valley

• 10mg, 20mg, and 50mg injections.
• Also approved for stoke in accordance with NICE guidance. 
• 2mg in 2ml injection - approved for unblocking intravenous lines, mainly in paediatric dialysis patients.

• Aluminium chloride hexahydrate 20% solution in an alcoholic basis

• Approved for pulmonary hypertension - in accordance with NHS England Commissioning policy. 

• 250mg/10ml injection
• COPD: intravenous aminophylline of limited benefit.
• Injection used in hospital for acute asthma not responding to steroids and continuous inhaled bronchodilators.
• Plasma levels need to be checked before administration if patient has previously taken theophylline/ aminophylline.

• Preferred calcium channel blocker for treating hypertension.
  
  • If a 10mg dose is not tolerated e.g. due to leg/ankle
    oedema, consider reducing dose before changing to an
    alternative such as lercanidipine.
  
  

• 50mg injection (Fungizone®)
• 50mg liposomal injection (Ambisome®)

• Approved for:
  • Juvenile Idiopathic Arthritis (JIA) in line with NICE and NHS England Clinical Commissioning Policy: E03/P/d
  • Periodic Fevers and Autoinflammatory conditions in line with NHS England Clinical Commissioning Policy: 170062P
  • Adult‑onset Still’s disease and systemic juvenile idiopathic arthritis in people 8 months and older in line with NICE
  • Cryopyrin Associated Periodic Syndrome in line with NHSE Service Specification. 
  • The treatment of severe gout in patients who have not responded to other treatment and for patients with pseudogout who have failed to respond to conventional treatment or unable to tolerate conventional treatment.
  • Chronic Infantile Neurocutaneous Arthritis (CINCA) and Muckle-Wells Syndrome (unlicensed indications).
  • Islet cell transplantation as part of a protocol including alemtuzumab and etanercept to improve outcomes (i.e. insulin dependance)
  • Haemophagocytic Lymphohistiocytosis (HLH) for adults and children in all ages

• 200mg powder for solution for infusion

• Approved for reversing anticoagulation from apixaban and rivaroxaban in adults with life-threatening or uncontrolled bleeding in line with NICE

• Specialist use only

• Used to relieve symptoms in patients who have had radiotherapy and may be of value in some patients with acute oesophagitis. Not for routine use as an antacid.

•  ACBS

• Approved for the prevention of RhoD sensitisation in
  women in line NICE.
• Approved for use by haematologists in appropriate patients with immune thrombo-cytopenia. The 1,500 and 5,000 unit vials (WinRho) are much more expensive than the other formulations and should only be used on advice from haematologists. It is the only formulation licensed for use in immune thrombocytopaenia.

• NETAG approved for aplastic anaemia in adults (unlicensed).

• Cream and Suppositories
•  Self Care Medicine: Advise that a prescription for treatment of haemorrhoids should not routinely be offered in primary care as the condition is self-limiting and will clear up on its own without the need for treatment.

• 60mg tablets
• Approved for treating hormone‑relapsed non‑metastatic prostate cancer that is at high risk of metastasising in adults in line with NICE
• Approved for treating hormone-sensitive metastatic prostate cancer in adults in line with NICE, only if:
  
  • docetaxel is not suitable

• 5mg/1ml (20ml) solution for infusion for infusion pumps & 10mg/1ml (3ml) solution for injection cartridges (Dacepton®) - NEW PATIENTS
• 30mg/3ml solution for injection (APO-go®) - Patients commenced on treatment prior to July 2022 can continue on APO-go® (including 50mg/10ml solution for infusion pre-filled syringes for infusion pumps)
• Apomorphine 10mg lozenges are also approved (RVI) Unlicensed

• 0.5% and 1% ophthalmic solution.

• 10mg, 20mg & 30mg tablets
• To be used in accordance with NICE guidance

• For limited use in cardiothoracic surgery.

Soft non-woven pad containing hydrocolloid-fibres with foam layer, without adhesive border

• Not to be prescribed on FP10

• Due to the SLS content to be used as a soap substitute only.

• For use on advice of haematologists in patients with heparin induced thrombocytopenia.

•  CNTW
•  TEWV
• Approved for the treatment of psychosis and schizophrenia in line with NICE guidance

• Approved for severe malaria in in line WHO guidance.

• Use cheapest
• Available products include
  • AS Saliva Orthana®
  • Biotene Oralbalance® gel
  • BioXtra® Glandosane® spray
  • Malic acid Salivix®
  • Oralieve® Moisturising Spray & Gel 
• Patients should be advised of self-care measures and signposted to purchase over the counter remedies where appropriate.

• 20mg and 40mg tablets
• Approved as an option for treating chronic-phase Philadelphia chromosome-positive chronic myeloid leukaemia without a T315I mutation after 2 or more tyrosine kinase inhibitors in adults, in line with NICE

• Specialist use only

• Dispersible tablets: 75mg

• Approved as an option for treating Duchenne muscular dystrophy resulting from a nonsense mutation in the dystrophin gene in people 2 years and over who can walk - in line with NICE HST22.

To be used in accordance with NHS England Clinical Commissioning Policy (SSC1614).

• 840mg/14ml & 1200mg/20m concentrate for solution for infusion (IV)
• 1875mg/15ml solution for injection (S/C)
• Approved for treating locally advanced or metastatic non-small-cell lung cancer (NSCLC) in adults who have had chemotherapy (and targeted treatment if they have an EGFR- or ALK‑positive tumour).  
• Approved in combination with bevacizumab for treating advanced or unresectable hepatocellular carcinoma (HCC) in adults who have not had previous systemic treatment in line with NICE
• Approved for the treatment of advanced non-small-cell lung cancer in line with NICE
• Approved for untreated PD-L1-positive locally advanced or metastatic urothelial cancer in adults when cisplatin-containing chemotherapy is unsuitable in line with NICE
• Approved for for adjuvant treatment of resected non-small-cell lung cancer in adults in line with NICE
• Approved with carboplatin and etoposide is recommended as an option for untreated extensive-stage small-cell lung cancer in adults in line with NICE
• Approved with nab‑paclitaxel for triple-negative, unresectable, PD‑L1‑positive, locally advanced or metastatic breast cancer in adults who have not had chemotherapy for metastatic disease in line with NICE
• Approved for untreated PD-L1-positive locally advanced or metastatic urothelial cancer in adults when cisplatin-containing chemotherapy is unsuitable in line with NICE

• 10mg and 60mg tablets
  • Approved for preventing migraine in line with NICE:
    • they have 4 or more migraine days a month
    • at least 3 preventative drug treatments have failed
    • First 3 months supply from secondary care with a review at 3 months. If effective, transfer to primary care with a further 1 month supply from secondary care to allow for handover.

• 10mg, 20mg, 40mg & 80mg tablets

• Approved formulations include:
  
  • 6.75mg in 0.9ml injection
  • 37.5mg in 5ml (7.5mg/ml) concentrate for IV infusion.
  
  

• 25mg in 2.5ml
• 50mg in 5ml  
• 250mg in 25ml injection

Commissioning: NHS England 

Overview | Autologous chondrocyte implantation using chondrosphere for treating symptomatic articular cartilage defects of the knee | Guidance | NICE

• 100mg powder for concentrate for solution for infusion
• Approved for treating Pompe disease in line with NICE

• 25microgram/phentolamine 2mg solution for injection. 
• Approved as first choice intracavernosal injection option.
  • Approved for the treatment of erectile dysfunction (in accordance with SLS criteria)

• Approved as treatment for adults with advanced renal cell carcinoma when tyrosine kinase inhibitors or cytokines have not worked in line with NICE.

• See section 8.2.1

• Tablets: 250mg, 500mg
• Capsules: 250mg
• Oral suspension: 200mg/5ml

• To be used in accordance with NHS England Commissioning Policy   

• Approved for the treatment of moderate to severe rheumatoid arthritis in adults in line with NICE.
• Approved for use in monogenic interferonopathis in adults and children 2 years and over in line with NHS England Clinical Commissioning Policy.

(BCG Vaccine, Dried/Tub/BCG) 1ml multidose vials containing freeze dried powder for preparing intradermal injections

• Beclomethasone dipropionate 100 microgram/dose & formoterol 6 microgram/dose pressurised metered dose inhaler (pMDI)
• Beclomethasone dipropionate 200 microgram/dose & formoterol 6 microgram/dose pressurised metered dose inhaler (pMDI)

• Beclomethasone dipropionate 100 microgram/dose & formoterol 6 microgram/dose pressurised metered dose inhaler (pMDI)
  
  • Additional treatment option
  
  
  

• Beclomethasone 88 microgram/dose, formoterol 5 microgram/dose & glycopyrronium 9 microgram/dose dry powder inhaler (DPI)

• For use in adults and children by adult and paediatric immunologists only. Only approved for use in accordance with NICE guidance. 

• Approved for treating active autoantibody-positive systemic lupus erythematosus in line with NICE

• 180mg tablets
• Approved for the treatment of primary hypercholesterolaemia (heterozygous familial and non-familial) or mixed dyslipidaemia in adults in line with NICE and following the statin intensification pathway outlined in NEELI

• Approved for the first line treatment of CLL (Binet stage B or C) in, patients for whom fludarabine combination chemotherapy is not appropriate in line with NICE. 
• NECDAG approved for use in combination with rituximab for patients with CLL not fit for FCR chemotherapy and not fit for alemtuzumab. 
• Approved for Low Grade Non-Hodgkins Lymphoma in line with NICE - not recommended for (low grade) non-Hodgkin's lymphoma that is refractory to rituximab or a rituximab-containing regimen NICE.

• Approved for the control of deviant antisocial sexual behaviour

Tablets: 100mg

Special order product

• Approved for reversing the effects of oral anticoagulants in patients with life or limb threatening bleeding in accordance with a regional protocol.

• Injection: 4mg/ml

• Scalp application

• Cream and ointment

• Cream and ointment

• 2.25mg medicated plasters

•  unlicensed

• First choice corticosteroid ear drops.

• NETAG approved for use in the management of macular oedema
  secondary to retinal vein occlusion. This is considered a more cost
  effective treatment option in RVO compared with ranibizumab.

• NTAG approved for age related macular degeneration.

Silicone gel wound contact dressing, with polyurethane foam film backing

• Bictegravir (as Bictegravir sodium) 30 mg, Emtricitabine 120 mg, Tenofovir alafenamide (as Tenofovir alafenamide fumarate) 15 mg  &
  Bictegravir (as Bictegravir sodium) 50 mg, Emtricitabine 200 mg, Tenofovir alafenamide (as Tenofovir alafenamide fumarate) 25 mg tablets

• For use as a second/third-line agent in patients insufficiently responsive
  to monotherapy with a prostaglandin analogue or beta blocker

• 160mg/ml solution pre-filled pen/syringe
• Approved for the treatment of moderate to severe plaque psoriasis in line with NICE

• Approved formulations of Humalog® Mix 25 and Mix 50 include:
  • 5x3ml cartridges
  • 5x3ml Kwikpen®

• 5mg & 10mg tablets.
• 1.25mg, 2.5mg, 3.75mg & 7.5mg tablets - for use in the treatment of heart failure only. The 5mg and 10mg tablets should be used where possible - cheaper than other strengths.

• Also approved for use in intralesional sclerotherapy in the treatment of low-flow vascular lesions. unlicensed indication

• For limited use in some operating theatres only.

• Approved for pulmonary hypertension - in accordance with NHS England Commissioning policy.
• Approved for systemic sclerosis with ongoing digital ulcer disease (to reduce number of new digital ulcers) - in accordance with NHS England Commissioning policy.

• Approved for use in the repair of complex hernia

• Only approved for use in accordance with NICE guidance. 

• Restricted to use in private patients receiving aesthetic treatment.
• Prescribe by brand name.

• 100 unit vials for injection (Botox) – see section 4.9.3

• Prescribe by brand name

• 50mg powder for concentrate for solution for infusion
• Approved for the treatment of relapsed or refractory systemic anaplastic large cell lymphoma in line with NICE and NHS England Commissioning Policy.
• Approved for the treatment of CD30-positive Hodgkin lymphoma in patients:
  • if they have already had autologous stem cell transplant
  • if they have already had at least 2 previous therapies when autologous stem cell transplant or multi-agent chemotherapy are not suitable. 
• Approved for the treatment of CD30-positive cutaneous T-cell lymphoma in line with NICE
• Approved in combination with cyclophosphamide, doxorubicin and prednisone for untreated systmic anaplastic large cell lymphoma in adults in line with NICE

• Approved for treating anaplastic lymphoma kinase (ALK)-positive advanced non-small-cell lung cancer (NSCLC) in adults who have already had crizotinib in line with NICE.
• Approved for treating ALK-positive advanced non-small-cell lung cancer that has not been previously treated with an ALK inhibitor in line with NICE

• Approved for use as adjunctive therapy in patients with severe/intractable partial onset seizures e.g. a sezuire frequency of 1 per week following failure of first-line adjunctive therapy. Response must be assessed within 3-6 months before transferring prescribing to primary or stopping treatment, as appropriate.

• 19.8mg/0.165mL solution for injection (pre-filled syringes)
  • Approved for treating wet age-related macular degeneration in adults in line with NICE

• 2mg foam enema


• Equal first choice with hydrocortisone foam enema  

• Budesonide 160 microgram/dose & formoterol 4.5 microgram/dose (equivalent to budesonide 200 microgram/dose & formoterol fumarate dihydrate 6 microgram/dose) dry powder inhaler (DPI)
• Budesonide 320 microgram/dose & formoterol 9 microgram/dose (equivalent to budesonide 400 microgram/dose & formoterol fumarate dihydrate 12 microgram/dose) dry powder inhaler (DPI)

• Budesonide 80 microgram/dose & formoterol 4.5 microgram/dose (equivalent to budesonide 100 microgram/dose & formoterol fumarate dihydrate 6 microgram/dose) dry powder inhaler - Easyhaler (DPI)
• Budesonide 160 microgram/dose & formoterol 4.5 microgram/dose (equivalent to budesonide 200 microgram/dose & formoterol fumarate dihydrate 6 microgram/dose) dry powder inhaler - Easyhaler (DPI) 
• Budesonide 320 microgram/dose & formoterol 9 microgram/dose (equivalent to budesonide 400 microgram/dose & formoterol fumarate dihydrate 12 microgram/dose) dry powder inhaler - Easyhaler (DPI)

• 2mg powder for solution for injection
• Approved as an option for treating chronic hepatitis D in adults with compensated liver disease in line with NICE and NHSE Specialised Commissioning Policy only if:
  • there is evidence of significant fibrosis (METAVIR stage F2 or above or Ishak stage 3 or above) and
  • their hepatitis has not responded to peginterferon alfa‑2a (PEG‑IFN) or they cannot have interferon-based therapy
• Only available from:
  • The Newcastle Upon Tyne Hospitals NHS Foundation trust

• 0.25% & 0.5% injection 10ml
• 0.25% & 0.5% + adrenaline 1 in 200,000 inj. 10ml
• 0.5% in glucose 8% injection (Marcain Heavy)
• 0.1% & 0.125% unlicensed in sodium chloride 0.9% infusions

• 8mg/0.16ml 16mg/0.32ml, 24mg/0.48ml, 32mg/0.64ml, 64mg/0.18ml, 96mg/0.27ml, 128mg/0.36ml 160mg/0.45ml prolonged-release solution for injection (pre-filled syringes).
  
  • Approved for the treatment of opioid dependance  in adults and adolescents aged 16 years and over, by substance misuse service providers, in line with NTAG and RMOC guidance.
  
  
  

• 10mg, 20mg & 30mg solution for injection
• Approved for treating X-linked hypophosphataemia in children and young people in accordance with NICE
• Approved for treating X‑linked hypophosphataemia (XLH) in adults

• 150 micrograms per spray; 268 dose spray

• Approvded for the treatment and pre-procedure prevention of angioedema attacks in patients with hereditary angioedema (HAE).


• Approvded for the routine prevention of angioedema attacks in adults and adolescents years old with severe and recurrent attacks of HAE.

• 30mg tablet


• 600mg/3ml prolonged-release suspension for injection


• Approved in combination with rilpivirine (Rekambys) for treating HIV-1 in adults in line with NICE

• 50mg in 5ml injection (equivalent to 25mg caffeine base in 5ml).
• 50mg in 5ml oral solution.

• 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®)

• Calcium lactate 300mg, calcium phosphate 150mg (Ca 97mg, 2.4 mmol) & ergocalciferol 10 micrograms (400 units).

• 1.25g & 2.5g chewable tablets (Calcichew)
  (Other formulations e.g. Remegel, Rennies, Rennie Soft gel and Settler’s.
  Tums are also stocked at the RVI for use in paediatric renal patients)

• Injection:10% equivalent to calcium 6.8 mmol/10 mL

• Calvive 1000 tablets [2263 mg of calcium lactate gluconate and 1750 mg of calcium carbonate (equivalent to 1000 mg or 25 mmol of calcium)]

• 100mg/1mL oral solution
  
  
  
  • Approved for use in combination with clobazam for treating seizuires associated with Dravet syndrome in people aged 2 years and older
  
  
  • Approved for use in combination with clobazam for treating seizures associated with Lennox-Gastaut syndrome
  
  
  
  

• cannabidiol 2.5mg/dronabinol 2.7mg per dose oromucosal spray
• approved to treat moderate to severe spasticity in adults with multiple sclerosis in line with NICE 

• 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

• 10mg solution for injection
  
  
  
  • Approved with plasma exchange and immunosuppression for treating acute acquired thrombotic thrombocytopenic purpura in adults, and in young people aged 12 years and over who weigh at least 40 kg in line with NICE
  
  
  
  

• Qutenza® cutaneous patch approved for the treatment of neuropathic pain as fourth line agent for neuropathic pain and in line with the attached regionally agreed pathway. 


• 0.075% cream (Axsain®) approved for post hepatic neuralgia and peripheral diabetic neuropathy 

• Treatment should only be on the advice of a hospital paediatrician.
• 5mg in 5ml suspension are also approved for use.
• 2mg capsules are also approved for use unlicensed.

• Restricted use in treatment of trigeminal neuralgia only.

• Viscotears® eye drops
• GelTears® single unit dose eye drops

• Approved formualtions include 100mg injection and 7.7mg implants.
• Approved for newly diagnosed glioblastoma multiforme (GBM) in line with NICE.

•  Unlicensed
• 10ml bottle

• For use in the treatment of heart failure only.

• Sodium chloride 0.9% solution in 100ml sachets.

• Solution R 2 x 30ml sachets (citric acid 6%, gluconolactone 0.6%, magnesium carbonate 2.8%, disodium edetate 0.01%)

• 1g and 2g vials
• Approved as an alternative to flucloxacillin in patients with non-immediate penicillin allergy or in those who cannot tolerate flucloxacillin or alternatives
• To be used on the advice of microbiology and ID physicians only.

• Restricted for use on microbiology/infectious diseases advice, or as agreed in Trust Guidelines.
• 200mg tablets
• 100mg in 5ml paediatric suspension: also approved for the prevention of irinotecan induced diarrhoea, specialist use only .

• Restricted for use on microbiology/infectious diseases advice, or as agreed in Trust Guidelines.

• Approved for use in multiple antibiotic resistant strains of enterobacteriaceae, pseudomonas and acinetobacters on the advice of microbiology/infectious disease physicians.

• Capsules: 100mg, 200mg

• Approved for treating metastatic or locally advanced cutaneous squamous cell carcinoma in adults in line with NICE

• Approved for use in previously treated anaplastic lymphoma kinase positive non-small-cell-lung cancer in line with NICE and NHS England Commissioning Policy.
• Approved for untreated ALK-positive non-small-cell lung cancer in line with NICE and NHS England Commissioning Policy

• Approved for the first-line treatment of metastatic colorectal cancer in combination with FOLFOX in line with NICE (monotherapy or combination chemotherapy is not recommended for the treatment of people with metastatic colorectal cancer that has progressed after first-line chemotherapy -  as per NICE). 
• NECDAG approved for K-RAS wild type metastatic colorectal cancer; second line use in combination with chemotherapy in patients that have progressed on previous chemotherapy; third line use as a single agent in patients who have failed oxaliplatin- and irinotecan based therapy and who are intolerant to irinotecan. 
• Approved for locally advanced squamous cell carcinoma of the head and neck in line with NICE. 
• Approved for previously untreated metastatic colorectal cancer in line with NICE.
• Approved for the treatment of metastatic and/or recurrent squamous cell carcinoma of the head and neck (oral cavity only) in line with NICE and NHS England Commissioning Policy
• Note: cetuximab is not approved in combination with platinum-based chemotherapy for recurrent and/or metastatic squamous cell cancer of the head and neck as per NICE.

• COUNTY DURHAM  acamprosate, chlordioazepoxide, disulfiram & nalmefene prescribing should be retained within the commissioned service within County Durham.
  • For referral information see https://codurhamrecovery.co.uk/get-support/

• 0.2% mouthwash.
• 0.2% mint flavoured spray.
• 1% dental gel.
• Dental products should only be prescribed by dentists and GPs should not accept requests to prescribe medicines that the dentist could reasonably prescribe themselves, nor accept requests from patients to issue FP10 prescriptions for items prescribed on a private prescription by their dentist.
• 2% oral gel unlicensed 
  
  • For hospital use in the prevention of ventilator-associated pneumonia in adult patients who are ventilated (for >48 hours).

• 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

• 160micrograms/g gel 
• Approved for the treatment of mycosis fungoides-type cutaneous T-cell lymphoma in line with NICE

• 200mg tablets (=150mg chloroquine base)   Not NHS. 
• 68mg in 5ml syrup (=50mg in 5ml chloroquine)   Not NHS
  272.5mg in 5ml injection (=200mg in 5ml chloroquine) unlicensed .

• Approved for the treatment of inborn errors of bile acid synthesis (all ages) in line with NHS England Commissioning Policy

• Approved the treatment of:
  
  
  
  • Interstitial cystitis/painful bladder syndrome
  
  
  • Radiation cystitis
  
  
  • Recurring bacterial cystitis
  
  
  • Overactive bladder
  
  
  
  

• Capsules: 10mg, 25mg, 50mg, 100mg
• Oral solution: 100mg/ml
  • Must be prescribed by brand name
  • Brands include Capimune, Capsorin, Deximune, Neoral, Sandimmun, Vanquoral 
• 50mg/1ml continuous infusion 

• Approved formulations include:
  • 10mg, 25mg, 50mg, and 100mg capsules;
  • 100mg in 1ml sugar free oral solution (oily).
  • Should be prescribed by brand for transplant indications   
• For Transplant indications  unless from a Trust/speciality that hasn't formally repatriated its patients or for patients who require weekly scripts for MDS boxes . 

• Capsules & SF Solution 
  See section 8.2.2

• For use in the prevention and treatment of cytomegalovirus infection. 
• For limited use by ENT Surgeons in the treatment of selected
  patients with respiratory papillomatosis (unlicensed)

• Approved for the treatment of secondary hyperparathyroidism in patients with end stage renal disease on maintenance haemodialysis where parathyroid gland surgery has failed or is inappropriate. 


• Also for short term use to control symptoms prior to a second attempt at more definitive surgery. 


• Approved for patients with primary hyperparathyroidism for whom parathyroidectomy would be indicated based on serum calcium levels, symptoms and end organ damage, but in whom parathyroidectomy is either not clinically appropriate or is contraindicated. It is not normally commissioned if serum calcium concentration is <2.85mmol/L 

• 105mg powder for concentrate for solution for infusion vials
• Approved with with miglustat (Opfolda) for treating late-onset Pompe disease in adults in line with NICE and NHSE Specialised Commissioning guidance

For information only - as there are no providers within the North East & Cumbria area that are commissioned to provide this service

•  Ciprofloxacin 0.3% and dexamethasone 0.1% ear drops

• 100mg & 200mg, 400mg intravenous infusions 

• 20mg in 10ml (2mg/ml) injection
• 150mg in 30ml (5mg/ml) injection

• Please note maximum doses
  
  • Adults = 40mg
  • Elderly = 20mg

• 0.6mmol/L solution
  
  
  
  • Approved for use to assist in the identification of silent aspiration in stroke patients.
  
  
  • Temporary approval subject to evaluation being carried out after 6 months 
    
    
  
  
  
  

• Injection (for IV infusion): 500mg

• 150mg capsules.
• 75mg in 5ml suspension unlicensed

• Ointment

• Clobetasone butyrate 500mcg/1g, nystatin 100000iu/1g, oxytetracycline (as oxytetracycline calcium) 30mg/1g

• 50mg and 100mg capsules
  
  • Approved for the treatment of non-tuberculous mycobacterial (NTM) infections, on the advice of microbiology and Infectious Diseases (ID) physicians

• For initiation by neurologists only.

• Treatment should be on the advice of a cardiologist/nephrologist.

• Approved for use in paediatric patients with Berlin Heart devices.

• First choice in patients with treatment-resistant schizophrenia. 

• Contact CNTW Pharmacy for continued supply on admission and discharge
• TEWV Clozapine Information & Guidance

• Tablets: 250/125, 500/125
• Oral suspension (sugar-free available): 125/31, 250/62, 400/57

• Used in lymphoedema
• Specialist use 

• Specialist use only

• 4% nasal solution (drops) unlicensed
  25% paste (1g syringe pack) unlicensed

• 4% solution with adrenaline unlicensed

• Tablets containing cyproterone acetate 2mg & ethinylestradiol 35 micrograms
  – generic co-cyprindiol is much cheaper than Dianette®

• Tablets containing cyproterone acetate 2mg & ethinylestradiol 35 micrograms.
• Note: generic co-cyprindiol is much cheaper than Dianette®

• Note: Co-danthramer and Co-danthrusate are generally restricted to use in the treatment of constipation in terminally ill patients. A combination of Senna and Docusate is normally preferred.

• Codeine linctus 15mg/5ml
• Approved for cough suppression in palliative care patients unable to take tablets

• 20 microgram (800 units) capsules or tablets
  
  • For first line use in the long term maintenance treatment of patients with documented vitamin D deficiency following high strength therapy and also for use in patients with symptoms and insufficient levels. 
• 80 microgram (3,200 units) capsules
  
  • For use in patients with malabsorption such as patients who have had bariatric surgery and require higher maintenance doses 
• 500 microgram (20,000 units) capsules.
  • For use in patients requiring high strength therapy for vitamin D deficiency. 
• 2740iu/ml oral solution (Fultium®-D3 Drops) 
• 1000iu and 3000iu buccal spray (DLux®) unlicensed 
  
  • Approved for use in paediatric parenteral nutrition patients with short bowel syndrome and adults with metabolic bone disease who have vitamin D deficiency despite previous treatment.

• Approved for second line use (after Colestyramine) for the treatment of bile malabsorption that results in diarrhoea.

• Also approved for the treatment for leflunomide toxicity 

• 1 million-unit & 2 million-unit vial for nebulisation/intravenous injection
  
  • Nebulised therapy for bronchiectasis 
  • Nebulised therapy for patients on assisted ventilation, patients with tracheostomies and those with persistant bacterial bronchitis 
  • To be used for treatment of Cystic Fibrosis in accordance with NHS England Commissioning Policy/NICE Guidance.
  • Nebulised therapy for CF .
  • Intravenous therapy .
  • Dry powder for inhalation (Colobreath®) .
    
    

• Mucogel is first choice in the community due to cost.   

• Pack of 16 x 1mg estradiol tablets + 12 x 1mg estradiol and 1mg norethisterone tablets

• Evra® are self-adhesive patches releasing approximately 20 micrograms ethinylestradiol and 150 micrograms norelgestromin/24 hours.
  
  
  
  • Approved for use by a small number of women with gastrointestinal absorption problems or with compliance issues.
  
  
  
  

First Choice

• Rigevidon® (ethinylestradiol 30 microgram/levonorgestrel 150microgram)

Alternatives

• Cilique® (ethinylestradiol 35 microgram/norgestimate 250microgram)
• Femodene® (ethinylestradiol 30 microgram/gestodene 75 microgram)
• Femodene® ED (ethinylestradiol 30 microgram/gestodene 75 microgram)
• Gedarel 30/150® (ethinylestradiol 30 microgram/desogestrel 150 microgram)
• Levest® (ethinylestradiol 35 microgram/norgestimate 250microgram)
• Lizinna® (ethinylestradiol 35 microgram/norgestimate 250 microgram)
• Loestrin 30® (ethinylestradiol 30 microgram/ norethisterone 1.5mg)
• Lucette® (ethinylestradiol 30 microgram/drospirenone 3mg)
• Marvelon® (ethinylestradiol 30 microgram/desogestrel 150 microgram)
• Microgynon® 30 (ethinylestradiol 30 microgram/levonorgestrel 150 microgram)
• Microgynon® ED (ethinylestradiol 30 microgram/levonorgestrel 150 microgram)
• Millinette 30/75® (ethinylestradiol 30 microgram/ gestodene 75 microgram)
• Ovranette® (ethinylestradiol 30 microgram/levonorgestrel 150microgram)
• Ovysmen® (ethinylestradiol 35 microgram/norethisterone 500 microgram

• See section 05.01.08

• 480mg/5ml injection

• 0.5% and 1%.

• Tablets: 50mg & 100mg

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

• Approved for the treatment of unresectable or metastatic BRAF V600 mutation-positive melanoma in line with NICE 
• Approved for the treatment of BRAF-mutated anaplastic thyroid cancer (ATC) in line with NHSE Specialised Commissioning Policy
• Approved with trametinib for treating BRAF V600 mutation-positive advanced non-small-cell lung cancer in adults in line with NICE
• Approved with trametinib (Spexotras) for treating BRAF V600E mutation-positive glioma in children and young people aged 1 year and over in line with NICE

• Approved for the treatment of chronic hepatitis C in line with NICE and NHS England Commissioning Policy.  

• Approved as an option for untreated locally advanced or metastatic epidermal growth factor receptor (EGFR) mutation-positive non-small-cell lung cancer in adults in line with NICE

• 500mg injection
• approved for the treatment of significant deep soft tissue infections such as joint, discitis and spinal infection, on the advice of infectious disease physicians or microbiology.

• For use on advice from haematologists in patients who develop thrombocytopenia with heparins - cross reactivity with heparin antibodies is thiought to be <10%. 

• 20mg injection

• 5mg and 10mg tablets
• Approved for treating chronic heart failure with reduced ejection fraction in line with NICE
• Approved for treating chronic heart failure with preserved or mildly reduced ejection fraction in adults in line with NICE

• Used in the treatment of leprosy and some skin conditions (e.g. dermatitis herpetiformis, pemphigoid on the advice of dermatologists).

• Approved in combination with bortezomib, thalidomide and dexamethasone for untreated multiple myeloma when a stem cell transplant is suitable in line with NICE
• Approved as an option for treating relapsed and refractory multiple myeloma in adults who have had a proteasome inhibitor and an immunomodulator, and whose disease progressed on the last treatment in line with NICE
• Approved with lenalidomide and dexamethasone for untreated multiple myeloma when a stem cell transplant is unsuitable in line with NICE and NHSE Specialised Commissioning guidance
• Approved in combination for treating newly diagnosed systemic amyloid light-chain amyloidosis in line with NICE and NHSE Specialised Commissioning Guidance

• 25mg and 50mg tablets
• Approved for the treatment of long-term insomnia in line with NICE via NHS Sleep Clinics at
  • Northumbria Healthcare NHS Foundation Trust;
  • South Tees Hosptials NHS Foundation Trust; and 
  • The Newcastle upon Tyne Hospitals NHS Foundation Trust
  • First 3 months supply from secondary care with a review at 3 months. If effective, transfer to primary care with a further 1 month supply from secondary care to allow for handover

• 300mg tablets
• Approved for treating hormone-relapsed prostate cancer in adults at high risk of developing metastatic disease in line with NICE
• Approved with andorgen deprivation therapy and docetaxel for treating hormone-sensitive metastatic prostate cancer in line with NICE and NHSE Specialised Commissioning guidance

To be used in accordance with NHS England Clinical Commissioning Policy (SSC1614).

• The following formualtions are approved:
  
  • 20mg injection;
  • 10mg, 15mg, 35mg;
  • 40mg prefilled syringes.
  
  

• 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

• Approved for use in severe veno-occlusive disease following stem cell transplant - in accordance with NHS England commissioning policy. 

• Approved for intrathecal neurolysis treatment of intractable pain due to cancer in terminally ill patients

• Approved for adult patients requiring multivitamin and mineral supplementation with Cystic Fibrosis

• 450mg tablets

• 300mg powder for concentrate for solution for infusion
  
  
• approved for the treatment of acute bacterial skin and skin structure infections where other antibiotics are inappropriate either due to resistant organisms or intolerance/allergy

• 150mg capsules
  • Syndrome of inappropriate antidiuretic hormone secretion (SIADH)
    Treatment to be intitated by specialist.

• Denosumab 60mg in 1ml solution in prefilled syringe is approved for use in the treatment of postmenopausal osteoporosis in line with NICE. Also approved for male patients who dont tolerate bisphosphonates or strontium ranelate. 
• NOTE: Denosumab will remain as  in most localities until a shared care guideline has been produced. 

• 500mg vials (for preparing injection & oral solution)

• The following formulations are approved:
  
  • 100microgram and  200 microgram tablets;
  • 120 microgram sublingual tablets. 
  
  
• Note: nasal formulations no longer licensed for treating nocturnal
  enuresis (see section 6.5.2 for other formulations).

• 6mg tablets
• Approved for the treatment of moderate to severe plaque psoriasis in line with NICE

• Alternative choice compound antibacterial/corticosteroid ear drop.

• Preservative-free eye drops are also approved.
  
  • 0.1% Minims® - first choice.
  • 0.1% preservative free eye drops unlicensed - approved only for patients who are unable to use Minims®due to dexterity problems.
  
  

• Alternative choice compound antibacterial/corticosteroid ear drop.

• Approved for macular oedema following central retinal vein occlusion
  in line with NICE.
• Approved for treating diabetic macular oedema in line with NICE.
• Approved for the treatment of non-infectious uveitis in line with NICE and NHS England Commissioning Policy

Note: The Northern (NHS) Treatment Advisory Group recommends the sequential pharmacological management of MO secondary to RVO as per the North East Retina Group (NERG) RVO treatment pathway.

• Eye drops and eye ointment

• Recommended for use only as per NTAG advice and NHS England Guidance.

• 100 micrograms in 1ml injection approved for use in patients:
  
  
  
  
  • with traumatic brain injury, have no respiratory problems but require prolonged ventilatory support due to severe agitation, confusion and requirement for propofol/midazolam; and
  
  
  • who are difficult to sedate e.g. with overdose of MDMA/PMA/”legal highs” or who have pre-existing drug or alcohol dependence or who have failed conventional methods of treatment.
  
  
  • Paediatric patients undergoing cardiac surgery with a high risk of post-operative Junctional Ectopic Tachyarrhythmia (JET) or those suitable for fast-track surgery.
  
  
  
  


• 100 micgrograms in 1ml injection (intranasal) unlicensed route
  
  
  
  
  • approved for pre-operative sedation in anxious children at risk of respiratory depression in whom midazolam is contraindicated or those who have failed pre-operative sedation with other agents.
  
  
  
  

• 10%/0.9% 

• Diazepam 2mg tablets: are the preferred strength in primary care. 
• Diazepam 10mg tablets: should no longer be used. 
• Diazepam 10mg in 2ml injection: only approved for use in epilepsy (see section 4.8.2).
• Diazepam 2 mg/5ml oral solution: swallowing difficulties

• Note: diazepam 10mg tablets are no longer on the formulary. 

• Diazoxide suspensions can be obtained/prepared if needed. unlicensed

• Oral diclofenac is restricted to short-term use for post operative pain.
• If long-term use is required diclofenac is only approved for 4th line treatment (see below):
  
  • Ibuprofen low dose – first line treatment.
  • Naproxen low dose – second line treatment.
  • Naproxen high dose – third line treatment.
  • Diclofenac – fourth line treatment.

Tablets: 25mg, 50mg

The use of oral diclofenac is restricted. It can be used short-term for post operative pain, or as a fourth line choice for long-term use.

• Topical formulations are NOT on the formulary

Injection: 75 mg/3 ml

• 300mg in 20ml injection

• 50mcg/1ml solution for injection
• Approved for pruritus in adults with chronic kidney disease having haemodialysis in line with NICE

For the treatment of life threatening digoxin toxicity only, requests must be cleared by an appropriate clinician.

• Note: the use of dihydrocodeine 30mg tablets & 10mg in 5ml oral solution is no longer recommended for regular use. Codeine is the preferred weak opioid analgesic.
• Dihydrocodeine is only approved for use in breast feeding mothers immediately postdelivery/ c-section where adequate pain relief has not been achieved using paracetamol and NSAIDs. Patients requiring continuation of dihydrocodeine following discharge (post delivery/c-section) can have dihydrocodeine prescribed in primary care (for short-term use only).

• Preferred calcium channel blocker for angina.
• Zemtard® is the formulary brand of choice for starting new patients on long acting diltiazem.

• 100mg in 2ml injection

• 120mg tablets
• Approved for the treatment of moderate to severe plaque psoriasis in line with NICE

• 20mg/4.5mL concentrate for solution for infusion 
• Approved for the treatment of high-risk neuroblastoma in people aged 12 months and over in line with NICE

• Only approved for use in accordance with NICE guidance.
• 50mg in 5ml sugar free suspension alos avialable unlicensed.

• COUNTY DURHAM  acamprosate, chlordioazepoxide, disulfiram & nalmefene prescribing should be retained within the commissioned service within County Durham.
  • For referral information see https://codurhamrecovery.co.uk/get-support/

• 0.2%, 0.4% & 0.6% unlicensed

• Film-coated tablet containing dolutegravir sodium equivalent to 50 mg dolutegravir and 300 mg lamivudine

Tablets - 10mg Suspension - 5mg/5ml

MHRA Drug Safety Alert (May 2014): Domperidone: risk of cardiac side effects
MHRA Drug Safety Update (Dec 2019): Domperidone for nausea and vomiting: lack of efficacy in children; reminder of contraindications in adults and adolescents

• Only approved for use in accordance with NICE guidance. 

• Eye drops and unit dose eye drops
• Approved for use in patients with confirmed allergy presenting as
  conjunctival changes or skin allergy. To be initiated by ophthalmologists
  only. The ophthalmologists must clearly document that signs and
  symptoms of preservative allergy have been demonstrated in their
  patient prior to initiation.

• 100mg in 5ml injection
• 2mg/ml 500ml intravenous infusion in glucose 5%
  see section 03.05.01

• 1mg, 2mg and 4mg tablets

• Doxazosin MR preparations are classified as BLACK - not approved

• 50mg and 100mg capsules 


• 100mg/5ml injection   unlicensed
  
  
  
  • approved as sclerosing agent for lymphatic malformations in children