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 Formulary Chapter 8: Malignant disease and immunosuppression - Full Chapter
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08.01.02  Expand sub section  Anthracyclines and other cytotoxic antibiotics
Cytotoxic Drug Bleomycin
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Formulary
Red
  • Also approved for use in intralesional sclerotherapy in the treatment of low-flow vascular lesions. unlicensedunlicensed indication
 
 
Cytotoxic Drug Dactinomycin
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Formulary
Red
 
 
Cytotoxic Drug Daunorubicin
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Formulary
Red
  • The following formualtions are approved:
    • 20mg injection;
    • 10mg, 15mg, 35mg;
    • 40mg prefilled syringes.

 
 
Cytotoxic Drug Doxorubicin
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Formulary
Red
  • Doxorubicin 50mg injection - includes use with DC Beads for use in transcatheter arterial chemoembolisation (TACE) therapy in patients with hepatocellular cancer. 
  • Doxorubicin 20mg & 50mg pegylated liposomal injection - approved for second-line (or subsequent) treatment in advanced ovarian cancer in line with NICE. 
  • Approved for the treatment of recurrent ovarian cancer in line with NICE.
 
Link  NICE TA389 - Topotecan, pegylated liposomal doxorubicin hydrochloride, paclitaxel, trabectedin and gemcitabine for treating recurrent ovarian cancer
Link  MHRA Drug Safety Update (July 2020): Liposomal and lipid- complex formulations: name change to reduce medication errors
 
Cytotoxic Drug Epirubicin
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Red
  • Note: epirubicin 100mg injection is unlicensedunlicensed.
 
 
Cytotoxic Drug Idarubicin
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Formulary
Red
  • Approved formulations include:
    • 5mg and 10mg capsules;
    • 10mg injection.

 
 
Cytotoxic Drug Mitomycin
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Formulary
Red
  • Also approved for treatment in combination with 5-Fluorouracil for bladder cancer concurrent with radiotherapy.
  • Mitomycin 0.04% preservative free eye drops  are also approved for use - unlicensedunlicensed.
 
 
Cytotoxic Drug Mitoxantrone
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Formulary
Red
 
 
Cytotoxic Drug Pixantrone
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Formulary
Red
  • Approved as a possible treatment for adults with multiply relapsed or refractory aggressive non-Hodgkin's B cell lymphoma if they have previously been treated with rituximab and they are having third- or fourth-line treatment in line with NICE. 
 
Link  NICE TA306: Pixantrone monotherapy
 
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Key
note Notes
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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Link to adult BNF
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Link to children's BNF
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Link to SPCs
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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