| Formulary Chapter 11: Eye - Full Chapter
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| Notes: |
Preservative Free Eye Drops
Microbial contamination of multidose bottles of eye drops can cause eye infections that may lead to damage of the eye and in extreme cases loss of sight. To minimise the risk, multidose bottles of eye drops contain an antimicrobial preservative such as benzalkonium chloride. The preservatives used in eye drops are normally well tolerated, but they are not completely harmless. They can cause irritation and damage to the corneal epithelium. This risk is understood to be greater in patients with pre-existing damage to the ocular surface and where large quantities of preservative containing eye drops are applied repeatedly over a prolonged period (e.g. if applied more than 4 to 6 times daily for several weeks/ months).
To avoid these problems the use of preservative-free eye drops is recommended in:
Patients who have experienced hypersensitivity reactions or irritation due to preservatives in eye drops.
Patients who have received corneal grafts.
Patients with conditions where there is already damage to the ocular surface as a result of disease or trauma, such as dry eye, blepharitis, ocular burns etc.
Treatment with preservative-free eye drops will usually be initiated by an ophthalmologist. |
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| Chapter Links... |
 North of Tyne, Gateshead and North Cumbria - Ophthalmology Referral Guidelines |
| Details... |
| 11.08 |
Miscellaneous ophthalmic preparations |
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Mercaptamine hydrocholride
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Formulary
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- Viscous eyedrops
- Approved for the treatment of corneal cystine deposits in people aged 2 years and over in line with NHS England Clinical Commissioning Policy
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Clinical Commissioning Policy Mercaptamine hydrochloride viscous eyedrops for corneal cystine deposits in people aged 2 years and over (210503P)
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| 11.08.01 |
Tear deficiency, ocular lubricants, and astringents |
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Hypromellose
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First Choice
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- 0.3% eye drops
- 0.3% preservative-free eye drops:
- 1st line Tear-Lac®;
- 2nd line PF Drops®
- treatment to be initiated on the advice of ophthalmologist only
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Artificial Tears Minims
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Formulary
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Hydroxyethylcellulose Artifical Tears Minims 4.4mg per mL Minims Eye Drops
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Xailin Night
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Formulary
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White soft paraffin and mineral oil
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Acetylcysteine 5% eye drops and preservative free eye drops
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Alternatives
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Acetylcysteine 5% with Hypromellose 0.35% (Ilube)
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Alternatives
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Eye drops: acetylcysteine 5%, hypromellose 0.35% (Ilube®)
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Balanced Salt Solution
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Alternatives
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- Sterile solution containing sodium chloride 0.64%, sodium acetate 0.39%, sodium citrate 0.17%, calcium chloride 0.048%, magnesium chloride 0.03%, potassium chloride 0.075% in 15ml bottles and 500ml bags.
- For intra-ocular or topical irrigation during surgical procedures.
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Carbomer 980 eye drops
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Alternatives
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- Viscotears® eye drops
- GelTears® single unit dose eye drops
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Carmellose sodium
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Alternatives
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Duolube® eye ointment
(Lanolin and preservative free)
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Alternatives
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UNDER REVIEW
- Please note
The brand name will soon change to Sooth Night-time and Duolube will be unable to be ordered
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Hylo Night®
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Alternatives
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- Eye ointment (containing retinol palmitate (vitamin A) 250iu/g, white soft paraffin, light liquid paraffin, liquid paraffin and wool fat)
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Sodium Chloride
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Alternatives
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- 0.9% eye drops and single dose unit eye drops.
- 5% eye drops and preservative-free eye drops.
- 5% eye ointment
 unlicensed.
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Sodium Hyaluronate
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Alternatives
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- 0.1% eye drops & preservative-free eye drops
- 0.2% eye drops & preservative-free eye drops
- 0.4% unit dose vials (Clinitas) & 0.4% preservative-free eye drops (Clinitas Multi)
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Systane®
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Alternatives
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- 10ml multidose bottles 0.8ml preservative-free vials Contains hydroxypropyl guar, polyethylene glycol 400, propylene glycol (and other ingredients).
- Long-acting ocular lubricant used for the treatment of dry eye syndrome. Liquid formulation which turns into a gel on contact with eyes providing fast and long lasting relief. The multidose bottle may be used for up to six months after opening in primary care. In contact lens wearers, Systane should be applied before inserting lenses and after removal to extend comfortable wearing times.
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| 11.08.02 |
Ocular diagnostic and peri-operative preparations and photodynamic treatment |
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| 11.08.02 |
Ocular diagnostic preparations |
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Fluorescein
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Formulary
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- 2% minims eye drops
- 1mg ophthalmic strips
- Fluorets
- 10% 5ml & 20% 5ml injections unlicensed
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Lissamine Green
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Formulary
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1.5mg ophthalmic strips
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Indocyanine green
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Unlicensed
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25mg injection.
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| 11.08.02 |
Ocular peri-operative drugs |
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Diclofenac
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Formulary
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- 0.1% eye drops and unit dose eye drops.
- For post-operative inflammation limited to patients where corticosteroids are unsuitable.
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Acetylcholine Chloride
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Formulary
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Apraclonidine
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Formulary
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- 0.5% and 1% ophthalmic solution.
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Ketorolac (Acular®)
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Formulary
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Nepafenac
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Formulary
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Povidone iodine 5% eye drops
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Formulary
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- For use in eye surgery only.
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Sodium Hyaluronate
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Formulary
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- 10mg in 1ml bag (Z-Hyalin®, formerly Ophthalin Gelbag®)
- 14mg in 1ml syringe (Healon GV®)
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Duovisc® Injection
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Unlicensed
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- Injection for use in cataract surgery containing VisCoat (1% sodium hyaluronate) and ProVisc (3% sodium hyaluronate, 4% chondroitin sulphate).
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Ethanol 20% eye drops.
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Unlicensed
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- For use in the debridement of the corneal epithelium in patients with
recurrent corneal erosion syndrome.
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| 11.08.02 |
Subfoveal choroidal neovascularisation |
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Aflibercept (Eylea®)
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Formulary
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- 40mg/1ml & 114.3mg/1ml solution for injection
- Approved for wet age related macular degeneration in line with NICE.
- Approved for macular oedema – central retinal vein occlusion in line with NICE.
- Approved for diabetic macular oedema in line with NICE.
- Approved for treating visual impairment caused by macular oedema after branch retinal vein occlusion in line with NICE.
- Approved as an option for treating visual impairment because of myopic choroidal neovascularisation in adults in line with NICE
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 NICE TA 294 Aflibercept solution for injection for treating wet age‑related macular degeneration
NICE TA 305 Aflibercept for treating visual impairment caused by macular oedema secondary to central retinal vein occlusion
NICE TA 346 Aflibercept for treating diabetic macular oedema
NICE TA 409: Aflibercept for treating visual impairment caused by macular oedema after branch retinal vein occlusion
NICE TA 486: Aflibercept for treating choroidal neovascularisation
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Brolucizumab (Beovu®)
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Formulary
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- 19.8mg/0.165mL solution for injection (pre-filled syringes)
- Approved for treating wet age-related macular degeneration in adults in line with NICE
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MHRA Drug Safety Update (Jan 2022): Brolucizumab (Beovu▼): risk of intraocular inflammation and retinal vascular occlusion increased with short dosing intervals
NICE TA672: Brolucizumab for treating wet age-related macular degeneration
NICE TA820: Brolucizumab for treating diabetic macular oedema
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Faricimab (Vabysmo® )
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Formulary
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- 120mg/1ml solution for injection
- Approved for the treatment of diabetic macular oedema in adults in line with NICE
- Approved for the treatment of wet age-related macular degeneration in line with NICE
- Approved for the treatment of visual impairment caused by macular oedema after retinal vein occlusion in line with NICE
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NICE TA799: Faricimab for treating diabetic macular oedema
NICE TA800: Faricimab for treating wet age-related macular degeneration
TA1004: Faricimab for treating visual impairment caused by macular oedema after retinal vein occlusion
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Ranibizumab 10mg/1ml injection (Lucentis®)
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Formulary
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- Approved for wet age related macular degeneration in line with NICE.
- Approved for diabetic macular oedema in line with NICE.
- Approved for visual impairment caused by macular oedema secondary
to retinal vein occlusion in line with NICE.
- Approved as a possible treatment for sight problems caused by choroidal neovascularisation in people who also have pathological myopia in line with NICE.
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NICE TA 274 Ranibizumab for treating diabetic macular oedema
NICE TA 155 Ranibizumab and pegaptanib for the treatment of age-related macular degeneration
NICE TA 283 Ranibizumab for treating visual impairment caused by macular oedema secondary to retinal vein occlusion
NICE TA 298 Ranibizumab for treating choroidal neovascularisation associated with pathological myopia
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Verteporfin 15mg Injection (Visudyne®)
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Formulary
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Approved for photodynamic therapy in wet age-related macular degeneration in line NICE.
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NICE NG82: Age-related macular degeneration
NTAG Decision Summary June 2020: Verteporfin
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Bevacizumab 1.25mg/0.5ml intravitreal injection
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Unlicensed
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- 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.
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| 11.08.02 |
Vitreomacular traction |
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Ocriplasmin (Jetrea®)
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Formulary
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- Approved for use in patients with vitreomacular traction who also have no epiretinal membrane and a hole (up to 400 micrometres) in the centre of their retina or severe sight problems in line with NICE.
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NICE TA 297 Ocriplasmin for treating vitreomacular traction
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| 11.08.02.04 |
Other products - Mainly for treating ocular injuries |
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| 11.08.02.04 |
Antifungals |
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| 11.08.02.04 |
Cytotoxics / wound healing modulators |
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| 11.08.02.04 |
Fibrinolytic drugs |
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| 11.08.02.04 |
Glues - ocular |
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| 11.08.02.04 |
Immunosuppressants |
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| 11.08.02.04 |
Treatment of burns |
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Holoclar®
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Formulary
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- Approved for treating limbal stem cell deficiency after eye burns in line with NICE and NHS England Commissioning Policy as of 14 November 2017
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| 11.08.02.04 |
Visco-elastics |
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| 11.08.02.04 |
Other |
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Alteplase intravitreal injection
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Formulary
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Mydrane
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Formulary
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Intracameral injection: tropicamide 0.2 mg/mL, phenylephrine 3.1 mg/mL, lidocaine 10 mg/mL; 0.6 mL ampoules
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Ascorbic acid 10% Preservative-free eye drops
(Potassium ascorbate)
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Unlicensed
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Disodium edetate 0.37% solution
(20ml)
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Unlicensed
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Sodium Citrate 10.11% eye drops
(equivalent to citrate 6.5%)
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Unlicensed
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Tretinoin 0.05% eye drops
(Retinoic acid)
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Unlicensed
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| 11.08.03 |
Reduction of elevated intra-ocular pressure |
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| .... |
Key |
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Cytotoxic Drug
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Controlled Drug
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High Cost Medicine
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NHS England |
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Homecare |
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CCG |
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Traffic Light Status Information
| Status |
Description |
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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. |
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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. |
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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. |
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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. |
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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. |
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UNDER REVIEW: drugs whose current formulary status or RAG status is currently under review. |
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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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