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 Formulary Chapter 5: Infections - Full Chapter
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05.02.01  Expand sub section  Triazole antifungals
Fluconazole Oral Preparations
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Formulary
Green
  • Capsules: 50mg, 150mg, 200mg
  • Oral solution: 50mg/5ml, 200mg/5ml 
 
 
Itraconazole Oral Preparations
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Formulary
Green plus
  • 100mg capsules 
  • 50mg in 5ml oral solution 
 
 
Fluconazole Infusion
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Formulary
Red
  • IV infusion: 50mg/25ml, 200mg/100ml
 
 
Isavuconazole (Cresemba®)
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Formulary
Red
High Cost Medicine
  • Approved for use in line with licensed indications and specifically in solid organ transplant and bone marrow transplant recipients.
 
 
Itraconazole Infusion
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Formulary
Red
  • 250mg in 25ml injection for IV infusion 
 
 
Posaconazole  (Noxafil®)
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Formulary
Red
High Cost Medicine
  • Approved for the prevention of invasive fungal infection in immunocompromised patients in whom there is a specific risk of aspergillus infection or where fluconazole and itraconazole are not tolerated or are unlikely to be sufficiently effective (largely for secondary prevention).
  • Approved for patients with invasive fungal infections that are not responding to other treatments or where they are not tolerated (largely in place of liposomal amphotericin/ voriconazole).
 
 
Voriconazole
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Formulary
Red
  • Green plus for the treatment of non-invasive fungal infections (Off-label indication) using the 100mg tablets ONLY. Can be initiated in primary care on the basis of C&S results / microbiology advice in patients who are not under secondary care.
 
Link  MHRA Safety Alert (May 2014): Voriconazole: reminder of liver toxicity, phototoxicity and squamous cell carcinoma
 
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Section Title Section Title (top level)
Section Title Section Title (sub level)
First Choice Item First Choice item
Non Formulary Item Non Formulary section
Restricted Drug
Restricted Drug
Unlicensed Drug
Unlicensed
Track Changes
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Cytotoxic Drug
Cytotoxic Drug
CD
Controlled Drug
High Cost Medicine
High Cost Medicine
NHSE
NHS England
Homecare
Homecare
CCG
CCG

Traffic Light Status Information

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. 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.  

Green plus

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.  

Green

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.  

Black

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.   

Brown

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

Not Recomended

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.  

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