Tablets

• Maintenance of remission of acute ulcerative colitis and Crohn’s disease in adults.
• Amber 1: For use in adults with Inflammatory Bowel Disease as per shared care protocol- see below
• Amber 1: For use in Inflammatory Bowel disease for children >12 years old as per shared care protocol - see below
• Oral suspension (expensive) available as an unlicensed special - recommended strength is 50mg/5mL as per RCPCH guidance. At SFH send patients to SFH pharmacy for supplies

Tablets

• Amber 1: For use in adults with Auto-immune Hepatitis as per shared care protocol- see below
• Oral suspension (expensive) available as an unlicensed special - recommended strength is 50mg/5mL as per RCPCH guidance. At SFH send patients to SFH pharmacy for supplies

Injection, Capsules- Secondary Care only

• Treatment of ulcerative colitis
• MHRA specify that ciclosporin must be prescribed and dispensed by brand as bioavailability differences exist between brands.
• Capimune^® is preferred brand for new patients at SFH. For advice on switching see BNF.
• Relative prices of different brands [Hospital price][GP price]

Tablets, suspension.

• Maintenance of remission of acute ulcerative colitis and Crohn’s disease in adults – unlicensed but in line with national guidelines
• Suspension (Xaluprine®) (expensive) only for patients where tablets are not suitable (i.e. small doses in paediatrics).
• Note that mercaptopurine use in children (under 18 years) is excluded from shared care and can be considered as .
• Amber 1: For use in Inflammatory Bowel Disease as per shared care protocol

Tablets

• The day(s) of the week the patient takes their methotrexate should be highlighted on the prescription and the medication packaging see MHRA Alert
• 2.5mg tablets preferred as per NPSA alert
• Cytotoxic, do not crush and disperse in water, liquid may be available if required.
• Amber 1 for adults (>18yrs) with inflammatory bowel disease as per the shared care protocol below
• NUH: Metoject® injection available for paediatric patients - routinely supplied via homecare (prescribe by brand and generic name)
• Available through homecare for NUH patients. Please contact pharmacy medicines homecare team for further information

Concentrate for intravenous infusion
Pre-filled syringe/pre-filled pen for subcutaneous injection

• For use in line with NICE guidance in ulcerative colitis (TA342) and Crohn's disease (TA352)
• Subcutaneous injection available through homecare for SFH, NUH and Treatment Centre patients. Please contact pharmacy medicines homecare team for further information.

Injection

• Approved in accordance with NICE TA187 for the treatment of Crohn's disease.
• Approved in accordance with NICE TA329 for treating moderately to severely active ulcerative colitis after the failure of conventional therapy.
• Approved for treating lymphocytic/microscopic colitis uncontrolled by conservative treatment in adult patients. (Unlicensed indication - named patient only)
• Approved for treating pouchitis uncontrolled by conservative treatment in adult patients. (Unlicensed indication - named patient use only)
• Available through homecare for NUH patients. Please contact pharmacy medicines homecare team for further information
• Biosimilar Imraldi^® is the first line option for new patients
• Biosimilar Amgevita^® can be used second line in those who are unable to tolerate Imraldi^®

Injection

SFH: Approved for treating moderately to severely active ulcerative colitis after the failure of conventional therapy as per NICE TA329.

NUH: Approved for treating moderately to severely active ulcerative colitis after the failure of conventional therapy as per NICE TA329. Prior approval with pharmacy required pending full assessment of local implementation.

Available through homecare for NUH patients. Please contact pharmacy medicines homecare team for further information

Infusion (Infliximab biosimilar)

• SFH - Remsima^® brand biosimilar to be used for all new patients.
• Approved for treating lymphocytic/microscopic colitis uncontrolled by conservative treatment in adult patients. (Unlicensed indication - named patient only)
• Approved for treating pouchitis uncontrolled by conservative treatment in adult patients. (Unlicensed indication - named patient use only)
  Available at NUH only:
• Approved in accordance with NICE TA163 for acute exacerbations of ulcerative colitis
• Approved in accordance with NICE TA187 for the treatment of Crohn's disease.
• Approved in accordance with NICE TA329 for treating moderately to severely active ulcerative colitis after the failure of conventional therapy.
• Approved for the treatment of Crohn’s disease and ulcerative colitis in paediatric patients.
• Approved for the treatment of immunotherapy induced colitis in oncology patients who fail to respond to high dose steroids.
  
  Infliximab biosimilar

Infusion (Infliximab biosimilar)

• Available through NUH only:  Approved as per clinical commissioning policy for refractory or progressive neurosarcoidosis (adults and post-pubescent children). Unlicensed indication.