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Nottinghamshire Area Prescribing Committee
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 Formulary Chapter 11: Eye - Full Chapter
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11.01  Expand sub section  Administration of drugs to the eye
Tropicamide, phenylephrine hydrochloride and lidocaine hydrochloride (Mydrane®)
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Restricted Drug Restricted
Red

Injection
(One dose of 0.2 ml solution contains 0.04 mg of tropicamide, 0.62 mg of phenylephrine hydrochloride and 2 mg of lidocaine hydrochloride)

NUH Only: Approved for use in cataract surgery to obtain mydriasis and intraocular anaesthesia during the surgical procedure.

 
   
11.02  Expand sub section  Control of microbial contamination
11.03  Expand sub section  Anti-infective eye preparations
11.03.01  Expand sub section  Antibacterials
Chloramphenicol
(Ophthalmic)
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First Choice
Green

Eye drops 0.5%, Eye ointment 1%, Preservative free drops - Eykappo® 10ml bottle (~£12) or Minims (~£13 for 20) 

  • Most bacterial infections are self-limiting. Mild cases should not need
    treating. They are usually unilateral with yellow-white mucopurulent discharge.
  • See primary care antibiotic guidelines for more information
  • OTC Patients should be advised to purchase over the counter

  • May be prescribed if appropriate to in-patients; patients should be advised on discharge that further supply should be purchased
 
Fusidic Acid
(Ophthalmic)
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Second Choice
Green

Eye drops 1%

  • Alternative to chloramphenicol for empirical treatment in people who:
    - Are pregnant.
    - Have a personal or family history of blood dyscrasias, such as aplastic anaemia.
    - Are intolerant of chloramphenicol.
    - Need a twice-a-day treatment for infective conjunctivitis
    See CKS topic for more information.
  • Jan 2016: price increased from £2 a tube to £35 a tube!
 
Link  See unexpectedly expensive medicines list
   
Amikacin
(Ophthalmic)
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Restricted Drug Restricted
Red

- Eye drops 2.5% (preservative free)(Unlicensed special)
- Intravitreal injection 0.4mg in 0.1mL

  • NUH only: Intravitreal injection manufactured by Pharmacy Sterile Production Unit (Unlicensed Products).
  • For guidance on Intravitreal preparations at SFHT see link below
 
Link  SFH: Intravitreal antibiotic supply procedure
   
Azithromycin (Azyter®)
(ophthalmic)
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Restricted Drug Restricted
Red
Eye drops 1.5%
  • On recommendation from ophthalmology:
    - Ophthalmia neonatorum
    - Purulent bacterial conjunctivitis
    - Trachomatous conjunctivitis caused by Chlamydia trachomatis
     
  •    
    Benzylpenicillin
    (ophthalmic)
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    Restricted Drug Restricted
    Red

    0.3% (5,000 units/ml) PF eye drops (Unlicensed special)

     
       
    Ceftazidime
    (ophthalmic)
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    Restricted Drug Restricted
    Red
    Eye drops 5% (preservative free)-NUH only (specialist use)
  • For guidance on intravitreal anti-infections prepared at SFHT see link below
     
  • Link  SFH: Intravitreal antibiotic supply procedure
       
    Cefuroxime
    (ophthalmic)
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    Restricted Drug Restricted
    Red

    Unlicensed - Specialist use only.

    • Eye drops 5% (preservative free). Now £60 each.
    • Expiry is 14 days from defrosting when stored in a fridge unopened, or 7 days from opening when stored in the fridge (on the ward and at home).
    • Intracameral Injection 3mg in 0.3mL
     
    Link  Link to reviews
       
    Chlorhexidine
    (ophthalmic)
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    Restricted Drug Restricted
    Red

    0.02% eye drops

    • Specialist use only for Acanthamoeba keratitis.
    • Unlicensed preparation. (~£23 per 10ml bottle)
    • Usually kept as stock at NUH and SFH
     
    Link  MHRA alert: Anaphylaxis risk with chlorhexidine
       
    Ciprofloxacin
    (Ophthalmic)
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    Formulary
    Amber 2

    Eye drops 0.3% (Eye ointment 0.3% discontinued 2017)

    • SFH: Consultant request only - use ofloxacin instead if need a quinolone eyedrop.
     
       
    Erythromycin
    (ophthalmic)
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    Restricted Drug Restricted
    Red
    Eye ointment 0.5%
  • Imported (Unlicensed Product)
  • Specialist use only
  • For chlamydia, but see also azithromycin which is licensed and more easily available (or ofloxacin). 
  •    
    Gentamicin (ophthalmic)
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    Restricted Drug Restricted
    Red

    Available as:

    • Eye drops 0.3%
    • Eye drops 1.5% (forte)(preservative free - unlicensed). £10 each. Expiry once opened is 7 days when stored in the fridge (on the ward and at home).
    • At NUH amikacin 2.5% (preservative free - unlicensed) is used in place of gentamicin 1.5%.
     
       
    Levofloxacin
    (ophthalmic)
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    Restricted Drug Restricted
    Red
    Eye drops (0.5%) preservative free single use.
  • Restricted for use where preservative free 4-fluoroquinolone prep required. 
  • Link  Link to reviews
       
    Moxifloxacin eye drops (Moxivig®)
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    Restricted Drug Restricted
    Red

    Eye drops (0.5%) - self preserved 5mL bottle

    Available at NUH:

    • Restricted for use where 4-fluoroquinolone preparation without additional preservatives required.  Preferred alternative to levofloxacin PF eye drops.
    • 4 week expiry from opening
     
       
    Ofloxacin Eye drops (Exocin®)
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    Formulary
    Amber 2
    Eye drops 0.3%
  • At SFH preferred quinolone eye drop
  • At NUH restricted for Chlamydial infections if erythromycin ointment is unavailable 
  •    
    Polihexanide
    (eye drops)
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    Restricted Drug Restricted
    Red
    Eye drops 0.02% (Unlicensed Product)
  • Also known as polyhexamethylene biguanide (PHMB)
  • Expires 7 days once opened.
  • One routinely stocked at SFH.
  • Polihexanide eye drops is the usual choice for treatment of Acanthamoeba keratitis. Alternatives are propamidine (Brolene®) and chlorhexidine 0.02% eye preparations. 
  •    
    Povidone iodine 5%
    (ophthalmic)
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    Restricted Drug Restricted
    Red
    Available as 30ml bottle (NUH) or as Minims (NUH and SFH). 
       
    Propamidine Isetionate (Brolene® eye drops)
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    Formulary
    Red
    Eye drops 0.1%
    Eye ointment (dibrompropamidine isetionate 0.15%) 5g
  • Red - if used for Acanthamoeba keratitis (specialist only) 
  •    
    Vancomycin
    (ophthalmic)
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    Restricted Drug Restricted
    Red
    Specialist only
  • Eye drops 5% (preservative free) - Special order, takes a few days to arrive at SFH.
  • Intravitreal injection:
    - NUH: 3mg in 0.3ml and 2mg in 0.2mL
    manufactured by Pharmacy Sterile Production Unit (Unlicensed Products - extra volume counts for dead space in the needle).
    - SFH: For guidance on Intravitreal preparations at SFHT see link below. 
  • Link  SFH: Intravitreal antibiotic supply procedure
       
    11.03.02  Expand sub section  Antifungals to top
    Amphotericin (eyedrops)
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    Restricted Drug Restricted
    Red
    Eye drops 0.15% (preservative free)- Unlicensed.
  • Ophthalmologist recommendation only.
  • Store in the fridge and have a 7 day expiry.
  • SFH: Need to be ordered in especially. Pharmacy stores keep kits which can be made up on ward if necessary until stock comes in (24-48 hours). 
  •    
    Amphotericin (intravitreal)
    Restricted Drug Restricted
    Red
    Intravitreal injection 5 microgram in 0.1mL - Unlicensed
  • NUH: Manufactured by Pharmacy Sterile Production Unit.
  • For guidance on intravitreal preparations at SFHT see link below 
  • Link  SFH: Intravitreal antibiotic supply procedure
       
    11.03.03  Expand sub section  Antivirals
    Foscarnet intravitreal injection
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    Restricted Drug Restricted
    Red

    2.4mg in 0.1mL (NUH only)

    • Opthalmology use only
    • Manufactured by Pharmacy Sterile Production Unit (Unlicensed Product)
    • Likely indications: acute retinal necrosis or cytomegalovirus retinitis
     
       
    Ganciclovir eye gel (Virgan®)
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    Restricted Drug Restricted
    Amber 2
    • Ophthalmology recommendation only
    • Amber 2 - specialist initiation.
    • Courses longer than 21 days or for prophylaxis rather than treatment are off-label use.
    • Ganciclovir eye gel may be an appropriate alternative to now discontinued aciclovir eye ointment - liaise with ophthalmology.
     
    Link  UKMI Memo on alternatives to discontinued aciclovir eye ointment
       
    Ganciclovir intravitreal injection
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    Restricted Drug Restricted
    Red

    Intravitreal injection

    • Opthalmology use only
    • Manufactured by Pharmacy Sterile Production Unit (Unlicensed Product)
    • Likely indications: acute retinal necrosis or cytomegalovirus retinitis
    • At SFH available as 6mg in 0.3ml (for 2mg doses) and 12mg in 0.3ml (for 4mg doses)(as 0.2ml extra volume counts for the dead space in the needle)
    • At NUH 2mg in 0.1mL available
     
       
    Trifluorothymidine eye drops
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    Restricted Drug Restricted
    Red

    Eye drops 1% (Unlicensed Product)

    • Also known as trifluridine.
    • Specialist use only.
    • 2nd line after aciclovir and ganciclovir.
     
       
    11.04  Expand sub section  Corticosteroids and other anti-inflammatory preparations
    11.04.01  Expand sub section  Corticosteroids
    Betamethasone
    (eye preparations)
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    Formulary
    Amber 2

    - Eye drops 0.1%
    - Eye ointment 0.1%

     
       
    Betamethasone 0.1% with Neomycin 0.5% eye drops (Betnesol N®)
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    Restricted Drug Restricted
    Red
    Eye drops
  • Specialist only - less suitable for prescribing (BNF) unless post surgery
     
  •    
    Dexamethasone
    (eye preparations)
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    Formulary
    Amber 2

    - Eye drops 0.1% (~£2)
    - Eye drops preservative free (Eythalm® 6ml bottle ~120 drops, 28 day expiry, ~£10)
    - 0.1% w/v single use eye drops unit dose (Dexafree®, ~£10 for 30 doses)

     
    Link  NUH: Dropodex to Dexafree Brand Memo May 2016
       
    Dexamethasone intravitreal implant (Ozurdex®)
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    Restricted Drug Restricted
    Red
    High Cost Medicine
    Implant 700micrograms
  • Approved for use at NUH and SFH for retinal vein occlusion (RVO) in line with NICE TA229.
  • Approved for use at NUH and SFH for diabetic macular oedema (DMO) in line with NICE TA349.
  • Order form for doctor to acquire from SFH Pharmacy
  • NUH Approved in accordance with NICE TA460 for treating non-infectious uveitis 
  • Link  Link to reviews
    Link  NICE TA349: Diabetic Macular Oedema
    Link  NICE TA460: Adalimumab and dexamethasone for treating non-infectious uveitis
       
    Dexamethasone with Neomycin and Polymyxin B sulphate (Maxitrol®)
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    Restricted Drug Restricted
    Amber 2
    Eye drops & Eye ointment
  • Opthalmology recommendation only
  • Less suitable for prescribing unless post surgery 
  •    
    Fluocinolone intravitreal implant (Iluvien®)
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    Restricted Drug Restricted
    Red
    High Cost Medicine

    Intravitreal Implant 190 micrograms

    • Available for use in line with NICE for Chronic diabetic macular oedema (DMO) NICE TA301
    • NUH prescribing will be undertaken within the ophthalmology department and will be a two consultant decision.
    • SFH prescribing will be at the discretion of the ophthalmology consultant.

    Available at NUH only:

    • In accordance with NICE TA590 for treating re-current non-infectious uveitis.
     
    Link  Link to reviews
    Link  NICE TA301: Fluocinolone acetonide intravitreal implant for treating chronic diabetic macular oedema after an inadequate response to prior therapy
    Link  NICE TA590: Fluocinolone acetonide intravitreal implant for treating recurrent non-infectious uveitis
       
    Fluorometholone (FML®)
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    Formulary
    Amber 2
    Eye drops 
       
    Hydrocortisone sodium phosphate eye drops (Softacort®)
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    Formulary
    Amber 2

    3.35 mg/ml (0.335%)

     
       
    Loteprednol (Lotemax®)
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    Restricted Drug Restricted
    Red
    Eye drops 0.5%
  • Post-operative inflammation following occular surgery in patients with glaucoma or known steroid responder 
  • Link  Link to reviews
       
    Prednisolone
    (eye preparations)
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    Formulary
    Amber 2

    - Eye drops 0.5% (Prescribe generically)
    - Eye drops 1% (Pred Forte®)
    - UDVs 0.5% (Minims ~£12 for 20) (contain less preservatives than drops but not entirely preservative free)

    • Lower strength preservative free products available on request (0.01%, 0.03%, 0.1%) - Unlicensed. Manufactured by NUH Pharmacy Sterile Production Unit. Other strengths (e.g. 0.003%, 0.005%) unlikely to be of benefit.
     
       
    11.04.02  Expand sub section  Other anti-inflammatory preparations
    Azelastine (Optilast®)
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    Formulary
    Green

    Eye drops 0.05%

    • OTC Patients should be advised to purchase a suitable product over the counter first line for allergy symptoms
     
       
    Lodoxamide (Alomide®)
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    Formulary
    Green

    Eye drops 0.1%

    • OTC Patients should be advised to purchase a suitable product over the counter first line for allergy symptoms
     
       
    Olopatadine (Opatanol®)
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    Formulary
    Green

    Eye drops 0.1%

    • OTC Patients should be advised to purchase a suitable product over the counter first line for allergy symptoms
     
       
    Ketotifen (Ketofall®)
    (Preservative free eye drops)
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    Formulary
    Green
    Ketofall® preservative free UDVs  
       
    Adalimumab
    (Ophthalmology)
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    Restricted Drug Restricted
    Red
    High Cost Medicine
    Homecare

    Injection

    Approved at NUH

    • in accordance with NICE TA460 for treating non-infectious uveitis
    • 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®
     
    Link  NICE TA460: Adalimumab and dexamethasone for treating non-infectious uveitis
       
    11.05  Expand sub section  Mydriatics and cycloplegics to top
    11.05  Expand sub section  Antimuscarinics
    Atropine
    (eye)
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    Formulary
    Amber 2
    • 1% available as Minims® (£15 per 20 Minims). See unexpectedly expensive medicines.
    • 10 ml bottle classified non-formulary GREY (now £130!). Patients unable to use minims should be prescribed cyclopentolate 1% as an alternative.
    • Preservative free multidose preparation is an unlicensed special and classified non-formulary GREY
    • 0.5% drops no longer available.
     
    Link  Cost comparison of treatments for hypersalivation
    Link  Treatment options for hypersalivation (UKMI Q and A’s)
       
    Cyclopentolate
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    Formulary
    Amber 2

    Eye drops 1% and 0.5%
    Eye drops 1% and 0.5% (preservative free) (Minims®)

     
       
    Homatropine
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    Formulary
    Red
    Eye drops 1%
    Eye drops 2%
  • rarely used at NUH
  • preservative free multidose is a unlicensed special and classfied non-formulary GREY 
  •    
    Tropicamide
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    Formulary
    Green

    Eye drops 0.5% (preservative free) (Minims®)
    Eye drops 1% (preservative free) (Minims®)

     
       
    11.05  Expand sub section  Sympathomimetics
    Phenylephrine Hydrochloride
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    Formulary
    Red

    Eye drops 10%

     

     
       
    Phenylephrine Hydrochloride (Minims® Phenylephrine Hydrochloride )
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    Formulary
    Red

    Eye drops 2.5%
    Eye drops 10%

    • Phenylephrine Minims® contain less preservative but not preservative-free
    • Supply problems into early 2020
    • RCOphth clinical guidance and shortage info here
     
       
    Phenylephrine Hydrochloride and Tropicamide (Mydriasert®)
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    Restricted Drug Restricted
    Red

    Ophthalmic insert
    (Tropicamide 0.28mg and Phenylephrine 5.4mg)

    Available at NUH and Nottingham NHS Treatment Centre:  For pre-operative use only

     
    Link  Link to reviews
       
    11.06  Expand sub section  Treatment of glaucoma
    11.06  Expand sub section  Beta-blockers
    Timolol
    (eye drops)
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    First Choice
    Amber 2

    - Eye drops 0.25%
    - Preservative free Eye drops 0.25% & 0.5% (Eysano® brand multidose bottle)
    - See below for once daily options.

    • Eye drops 0.5% (preserved) removed from formulary as minimal difference in efficacy from 0.25%
     
    Betaxolol (Betoptic®)
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    Second Choice
    Amber 2
    Beta-blocker
  • 0.5% Eye drops
  • 0.25% preservative free available (but not stocked at SFH) 
  •    
    Timolol Once-daily
    (eye drops)
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    Formulary
    Amber 2
    • Eye drops 0.25% (Timoptol®-LA)
    • Unit dose eye gel 0.1% preservative-free (Tiopex®). Tiopex eye gel is used once daily and is more cost-effective than Betaxolol preservative-free.
    • Eye drops 0.5% non formulary as minimal difference in efficacy.
     
    Link  Link to reviews
       
    11.06  Expand sub section  Prostaglandin analogues to top
    Latanoprost
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    First Choice
    Amber 2

    Eye drops 0.005%

    • Preserved latanoprost is generic and now first choice.
    • Preservative free (Monopost®) available for patients who require a preservative free prostaglandin (in unequivocal preservative toxicity / allergy cases).
     
    Travoprost (Travatan®)
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    Formulary
    Amber 2

    Eye drops 0.004%

    • Amber 2 - specialist recommendation for the treatment of glaucoma
     
    Link  Price comparison graph - all glaucoma treatments
    Link  UKMI Q&A: Switching between travoprost and generic latanoprost eye drops
       
    Bimatoprost
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    Formulary
    Amber 2

    Eye drops 0.01%, 0.03%.

    • Amber 2 - specialist recommendation for the treatment of glaucoma
    • The 0.01% formulation contains a different concentration of excipients to the 0.03% resulting in greater absorption of the active drug into the eye. Thus the 0.01% formulation is considered to be comparable in IOP-lowering efficacy to the 0.03% formulation. The 0.01% may be associated with a higher risk of preservative- related reactions due to a higher preservative load.
    • Latanoprost preferred
    • Preservative free 0.3% (Lumigan® UDVs or Eyreida® bottles) are Grey Traffic Light (no formal assessment). Use latanoprost PF UDVs instead.
     
    Link  Link to reviews
    Link  Price comparison graph - all glaucoma treatments
       
    Latanoprost with Timolol
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    Formulary
    Amber 2
    • Prescribe generically (£5.50pm).
    • Xalacom® brand is Non-formulary (£14pm)
    • For preservative free use Fixapost ® UDVs (£13.50)
     
    Link  Price comparison graph - all glaucoma treatments
       
    Bimatoprost with Timolol (Ganfort®)
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    Formulary
    Amber 2

    Eye Drops (£14pm), Preservative free UDVs (£18pm)

    • Amber 2 - specialist recommendation for the treatment of glaucoma.
     
    Link  Link to reviews
    Link  Price comparison graph - all glaucoma treatments
       
    Travoprost with Timolol (DuoTrav®)
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    Formulary
    Amber 2

    Travoprost with Timolol Eye Drops (£14pm)

    • Amber 2 - specialist recommendation
    • Latanoprost and timolol preferred (£5.50)
     
    Link  Price comparison graph - all glaucoma treatments
       
    11.06  Expand sub section  Sympathomimetics
     note 

    Apraclonidine see section 11.8.02

    Brimonidine Tartrate (Alphagan®)
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    Formulary
    Amber 2
    Eye drops 0.2% 
    Link  Link to reviews
       
    Brimonidine Tartrate 0.2% with Timolol 0.5% (Combigan®)
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    Formulary
    Amber 2
    Eye drops
  • Amber 2 - specialist recommendation for glaucoma  
  • Link  Link to reviews
       
    11.06  Expand sub section  Carbonic anhydrase inhibitors and systemic drugs
    Acetazolamide (Diamox®)
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    Formulary
    Amber 2
    Tablet 250mg, Capsule MR 250mg, Injection 500mg
  • oral treatments Amber 2 - specialist recommendation for glaucoma. Injection = RED
     
  • Link  SFH: Acetazolamide contraindications and precautions
       
    Brinzolamide
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    Formulary
    Amber 2
  • Eye drops 1%
  • Generic available 
  •    
    Brinzolamide 1% with Timolol 0.5%  (Azarga®)
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    Formulary
    Amber 2
    Eye drops  
    Link  Link to reviews
       
    Brinzolamide 10mg/ml & brimonidine 2mg/ml (Simbrinza®)
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    Formulary
    Amber 2
    Eye drops
  • For patients requiring brinzolamide and brimonidine as separate eye drops  
  • Link  Link to reviews
       
    Dorzolomide
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    Formulary
    Amber 2
    • Eye drops 2% (~£2)
    • Preservative free eye drops 2%. SFH stock Eydelto® multidose bottle (~£12). Trusopt® brand minims (~£24)(Contact Medicines Management team for most cost-effective brand)
     
       
    Dorzolomide 2% with Timolol 0.5%
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    Formulary
    Amber 2
    • Eye drops (~£2)
    • Preservative free eye drops. SFH stock Eylamdo® multidose bottle (~£15). Cosopt® brand (~£29)(Contact Medicines Management team for most cost-effective brand)
     
       
    11.06  Expand sub section  Miotics
    Pilocarpine
    (eye drops)
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    Formulary
    Amber 2
    preserved eye drops 1%, 2%, 4%
  • strengths other than those listed above are non-formulary  
  •    
    Pilocarpine preservative free
    (eye drops)
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    Formulary Eye drops 0.1% (preservative free) (Unlicensed Product)- NUH only
    Eye drops 2% (preservative free) unit dose Minims® 
       
    11.07  Expand sub section  Local anaesthetics
    Controlled Drug Cocaine
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    Restricted Drug Restricted
    Red
    Eye drops 4% (preservative free)
  • Restricted: specialist use only
  • Unlicensed medicine - named patient use only
  • Used in diagnosis of Horner’s syndrome 
  •    
    Oxybuprocaine (Minims® )
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    Restricted Drug Restricted
    Red
    Eye drops 0.4% (preservative free)- SFH only
  • Non-formulary at NUH: As per head of service advice to remove April 2011 
  •    
    Proxymetacaine (Minims®)
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    Formulary
    Red
    Eye drops 0.5% (preservative free)
     
       
    Tetracaine (Minims® Amethocaine)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Red
    Eye drops (preservative free)
     
       
    11.08  Expand sub section  Miscellaneous ophthalmic preparations to top
    Idebenone (Raxone®)
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red

    Tablet

    Available at NUH only: Approved in accordance with MHRA Early Access to Medicines Scheme to treat the decline of respiratory function in patients with Duchenne Muscular Dystrophy (DMD) from the age of 10 years who are currently not taking glucocorticoids. EAMS number 46555/0001.

     
       
    11.08.01  Expand sub section  Tear deficiency, ocular lubricants, and astringents
    Hypromellose
    View adult BNF View SPC online View childrens BNF
    First Choice
    Green
    • First line ocular lubricants (with preservative):
      • 0.3% (generic £1)
      • 0.5% (Isopto Plain® £1)  
    • Also preservative free available:
      • 0.3% (multi dose bottle - Evolve® Hypromellose - £2, 3 month expiry)
      • 0.3% (preservative free) (unit dose vials, Hydromoor® at NUH)
    • Other brands = non-formulary eg: Artelac®, Lumecare®
    • See Eye lubricant guidelines and Eye lubricants table of products.
    • OTC Patients should be advised to purchase over the counter

    • May be prescribed if appropriate to in-patients; patients should be advised on discharge that further supply should be purchased
     
    Acetylcysteine 5% (Ilube®)
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Amber 2

    Eye drops. £15

     
       
    Acetylcysteine 5% eye drops
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red
    Unlicensed medicine - named patient use only
  • Preservative free multidose
  • Listed in Drug Tariff specials list
  • confirm preservative free required before prescribing. Ilube available if preserved is acceptable 
  •    
    Carbomer eye drops
    View adult BNF View SPC online View childrens BNF
    Formulary
    Green

    Eye drops 0.2%

    • Clinitas® Carbomer is the current recommended brand for prescribing in primary care. See Preferred Prescribing List.
    • Other non-formulary brands include GelTears®, Viscotears®, Xailin®, Liquivisc®. See Eye lubricant guidelines and Eye lubricants table of products.
    • At NUH & SFH generic carbomer 0.2% eye gel is available.
    • OTC Patients should be advised to purchase a suitable product over the counter.

    • May be prescribed if appropriate to in-patients; patients should be advised on discharge that further supply should be purchased.
     
       
    Carmellose
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Green

    Available as:
    - Preservative free 10ml bottle (Evolve® carmellose 0.5%, 3 months expiry once opened, £5)
    - Preservative free UDVs (Celluvisc®) 0.5% (£6 per 30) and more viscous 1% (£3 per 30).

    • OTC Patients should be advised to purchase a suitable product over the counter

      • May be prescribed if appropriate to in-patients; patients should be advised on discharge that further supply should be purchased
      • Non formulary brands include Carmize® - See Eye lubricant guidelines and Eye lubricants table of products.
      • SFH advice only: Each dose unit contains 8 drops and can be re-capped and used within 24 hours of opening.
     
       
    Hydroxyethylcellulose (Minims® Artificial Tears)
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted Eye drops (preservative free)- NUH only 
       
    Hydroxypropyl Guar (Systane®)
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Amber 2

    Systane Balance® (with mineral oil). 10ml bottle, 6 months expiry.

     
       
    Hypromellose 0.3% with Dextran 70 0.1% (Tears naturale®)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Red

    Eye drops- NUH only

    • preservative free unit dose is non-formulary
     
       
    Liquid Paraffin eye ointment
    View adult BNF View SPC online View childrens BNF
    Formulary
    Green

    Liquid paraffin, white soft paraffin and wool alcohols lubricating eye ointment

    • Xailin night®- most cost effective brand

     

     
       
    Polyvinyl Alcohol (Liquifilm Tears or Sno Tears®)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Green

    Eye drops 1.4%
    Eye drops with Povidone 0.6% (preservative free)

    • NUH: Liquifilm Tears
    • OTC Patients should be advised to purchase a suitable product over the counter

    • May be prescribed if appropriate to in-patients; patients should be advised on discharge that further supply should be purchased
     
       
    Retinol palmitate with soft paraffins (HYLO Night®)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Green

    5g tube, 6 months expiry

    • OTC Patients should be advised to purchase a suitable product over the counter

    • See Eye lubricant guidelines and Eye lubricants table of products.
    • May be prescribed if appropriate to in-patients; patients should be advised on discharge that further supply should be purchased
    •  Brand name changed from VitA-POS to HYLO Night, April 20 
     
       
    Sodium Chloride
    (Balanced salt solution)
    Formulary
    Red
    Solutions 19mL, 500mL, 500mL (latex free) 
       
    Sodium Chloride (Minims® Saline)
    Formulary
    Green

    Eye drops 0.9% (preservative free) - 0.5 mL

    • multidose preparation is an unlicensed special and non-formulary
    • OTC Patients should be advised to purchase over the counter

    • May be prescribed if appropriate to in-patients; patients should be advised on discharge that further supply should be purchased
     
       
    Sodium Hyaluronate
    (eye drops)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Green

    Available as:


    - Evolve HA® 10ml bottle 0.2% preservative free - £6, 3 month shelf life once opened.
    - Hylo-forte® 10ml bottle 0.2% preservative free - £10, 6 months shelf life once opened.
    - Clinitas® UDVs (or Multi bottle) 0.4% preservative free (Amber2 Traffic Light Ophthalmologist recommendation only for very severe dry eyes), recappable, and 12 hour expiry once opened.
    - Oxyal® 0.15% 10ml bottle, 2 months expiry. (Amber2 Traffic Light Ophthalmologist recommendation only for punctuate keratitis)

     
       
    11.08.02  Expand sub section  Ocular diagnostic and peri-operative preparations and photodynamic treatment
    11.08.02  Expand sub section  Ocular diagnostic preparations
    Brilliant Peel®
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red
    Dye (Unlicensed product)- NUH only
    For use as a dye in the intraoperative staining of internal membrane during macular hole surgey 
       
    Fluorescein (Anatera®)
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red
    Specialist use only
    Injection 10%:
    - for fluorescein angiography of the ocular fundus
    - for use as a contrast media for confocal laser endomicroscopy (CLE)(Unlicensed indication)
    Injection 20% (Unlicensed Product)
     
       
    Fluorescein Sodium
    View adult BNF View SPC online View childrens BNF
    Formulary
    Green
    Eye drops 2% (preservative free Minims®)
  • Diagnostic use only
  • Bio Glo 1mg ophthalmic strips have been discontinued

     
  •    
    Indocyanine green
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red

    Injection 25mg

    Available at NUH:

    • Ophthalmology use for angiography.
    • Neurosurgery use for angiography.
    • Gynaecological surgery by intracervical injection for detection of sentinel lymph nodes.


    N.B. AKORN brand injection no longer used at NUH for intravitreal use

     
    Link  Verdye SPC
       
    11.08.02  Expand sub section  Ocular peri-operative drugs
    Acetylcholine Chloride (Miochol-E®)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Red

    Intra-ocular irrigation 1%

    • 2019: Supply problem with Miochol-E® - See memo
    • At SFH: Miphtel® available until the Miochol becomes available again.
     
       
    Apraclonidine (Iopidine®)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Amber 2
    Eye drops 0.5%
    Eye drops 1% (preservative free)
  • Specialist recommendation only for treatment of chronic glaucoma.
  • The 1% preservative free version is very expensive (£6.50 per 'single use' bottle.) Only for patients with a known preservative allergy, known ocular surface disease or those with raised intraocular pressure despite treatment with 0.5% drops.
    Short term post operative use is classified RED. 
  •    
    Ketorolac (Acular®)
    (Eye)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Amber 2

    Eye drops 0.5% 5ml. Preserved. (~£3)

    • Amber 2 specialist initiation - adult ocular surgery patients post-operatively
     
    Link  Cost comparison graph: Ocular analgesics
       
    Diclofenac (Voltarol® Ophtha)
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Amber 2

    - Eye drops 0.1% single use (preservative free) only (~£30 for 40)
    - Eye drops 0.1% multidose (~£7)(preserved) replaced by ketorolac (~£3) eye drops March 2013. Dec 18: Formulary again while ketorolac unavailable (until March 2019).

    • Amber 2 - Specialist initiation
     
    Link  Cost comparison graph: Ocular analgesics
       
    11.08.02  Expand sub section  Subfoveal choroidal neovascularisation to top
    Aflibercept (Eylea®)
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red
    High Cost Medicine

    Pre-filled syringe 3.6mg in 0.09mL
    (Each pre-filled syringe contains 3.6mg in 0.09mL solution - this contains a usable amount to deliver a dose of 2mg in 0.05ml i.e. treatment for 1 eye. If the patient is having 2 eyes treated, 2 syringes must be used)
    Intravitreal injection 40mg in 1mL - Discontinued 2020
    (Each vial contains 4mg in 0.1ml solution- this contains a usable amount to deliver a dose of 2mg in 0.05ml i.e. treatment for 1 eye. If the patient is having 2 eyes treated, 2 vials must be used)

    Available for use at NUH and SFH in line with NICE for:
    - Age-related Macular Degeneration (AMD) NICE TA294
    - Visual impairment due to macular oedema secondary to central retinal vein occlusion (CRVO) NICE TA305
    - Diabetic Macular Oedema NICE TA346
    - NUH only - Visual impairment in adults caused by macular oedema after branch retinal vein occlusion (BRVO) NICE TA409
    - NUH only - Treating choroidal neovascularization NICE TA486

     
    Link  Link to reviews
    Link  NICE TA409:Aflibercept for treating visual impairment caused by macular oedema after branch retinal vein occlusion
    Link  NICE TA486:Aflibercept for treating choroidal neovascularisation
       
    Bevacizumab intravitreal injection (Avastin®)
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red
    NUH only
    Intravitreal injection (Unlicensed Product)
    1.25mg in 0.05mL or 625micrograms in 0.025mL
    Restricted for;
    1. age related macular degeneration
    2. Diabetic maculopathy and/or proliferative diabetic retinopathy, unresponsive to conventional treatments such as laser, vitrectomy or intravitreal Triamcinolone
    3. Retinal vein occlusions
    4. Retinopathy of prematurity only where treatment is required and laser is not a suitable option 
       
    Ranibizumab (Lucentis®)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Red
    High Cost Medicine

    Intravitreal injection 10mg in 1mL
    (Each vial contains 2.3 mg of ranibizumab in 0.23 ml solution)
    (NUH:Each pre-filled syringe contains 1.65 mg of ranibizumab in 0.165 ml solution)

    • Available for use at NUH and SFH in line with NICE for:
      - Age-related Macular Degeneration (AMD) NICE TA155
      - Diabetic Macular Oedema (DMO) NICE TA274
      - Macular Oedema secondary to Retinal Vein Occlusion (RVO) NICE TA283
      - Choroidal neovascularisation associated with pathological myopia NICE TA298
     
    Link  Link to reviews
       
    Verteporfin (Visudyne®)
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red
    High Cost Medicine
    Injection 15mg
  • Specialist only at NUH 
  • Link  NICE Guidance 82: Age-related macular degeneration
       
    11.08.02  Expand sub section  Vitreomacular traction
    Ocriplasmin (Jetrea®)
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red
    High Cost Medicine

    Intravitreal injection - now supplied as a 'ready-diluted' formulation
    (Each vial contains 0.375 mg of ocriplasmin in 0.3 mL solution (1.25 mg/mL). This provides a usable amount to deliver a single dose of 0.1 mL containing 0.125 mg ocriplasmin.)
    NUH approved in accordance with NICE TA297 for use by ophthalmology for treating vitreomacular traction in adults. Not to be used at SFH (patients would be referred to a speciallist centre).
    NUH prescribing will be undertaken within the ophthalmology department and will be a two consultant decision.

     
    Link  Link to reviews
       
    11.09  Expand sub section  Contact lenses
     note 
    • NUH local agreement to allow dispensing of contact lens aftercare products against an order from the Optometrist with prescription charging rules applying
    • Individual patients of hospital eye departments are eligible to be supplied with contact lenses, under the NHS, where there is a clinical necessity. Aftercare products are an integral part of the treatment and should be made available to those patients whom clinically necessary contact lenses have been prescribed
    Amo Complete
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted 120mL (for rigid gas permeable or soft lenses)
  • NUH only as per local agreement 
  •    
    Boston Advance Cleaner
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted 30mL (for rigid gas permeable lenses)
  • NUH only as per local agreement 
  •    
    Boston Advance Conditioning Solution
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted 120mL (for rigid gas permeable lenses)
  • NUH only as per local agreement 
  •    
    Oxysept 1 Step
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted 30 day pack (for soft lenses)
  • NUH only as per local agreement 
  •    
    Saline Solution
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted 360mL (for all lenses)
  • NUH only as per local agreement 
  •    
    Total Care Daily Cleaner
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted 30mL (for rigid gas permeable lenses)
  • NUH only as per local agreement 
  •    
    Total Care Disinfecting and Wetting Solution
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted 120mL (for rigid gas permeable lenses)
  • NUH only as per local agreement 
  •    
    11.99.99.99  Expand sub section  Miscellaneous
    11.99.99.99  Expand sub section  Cytotoxics / wound healing modulators
    Cytotoxic Drug Fluorouracil
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red
    At NUH: Subconjunctival injection 7.5mg in 0.3mL
  • Specialist use only
  • Manufactured by Pharmacy Sterile Production Unit (Unlicensed Product)
    At SFH: Subconjunctival injection 7.5mg in 0.3mL (Prescribed when 5mg/ 0.2ml is required) or 50mg/1ml prepared by Aseptic dispensing unit (x3169) 
  •    
    Cytotoxic Drug Mitomycin
    (eyes)
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red
    Available as:
    - Eye drops 0.04%(preservative free) (Multi dose bottles)- NUH only
    - Solution for sub-conjunctival use 0.2mg in 1mL
    - Solution for sub-conjunctival use 0.4mg in 1mL (and several other concentrations at KMH aseptic unit)
  • Sub-conjunctival injection manufactured by Pharmacy Sterile Production Unit (Unlicensed Products) 
  • Link  Link to reviews
       
    11.99.99.99  Expand sub section  Fibrinolytic drugs to top
    Alteplase intravitreal injection
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red
    Intravitreal injection 25microgram in 0.1mL
  • Opthalmology specialist at NUH use only
  • Manufactured by Pharmacy Sterile Production Unit (Unlicensed Product) Lower strengths available upon request 
  •    
    11.99.99.99  Expand sub section  Glues - ocular
    11.99.99.99  Expand sub section  Immunosuppressants
    Ciclosporin
    (Eye)
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red

    Oily eye drops 2% (Unlicensed Product), formulated in arachis oil. Avoid in peanut allergy
    Eye ointment 0.2% (Unlicensed Vetinary Product, Optimmune®)used only as alternative when 2% drops unavailable. Preservative free but contains lanolin

    • both specialist use at NUH only
    • 2% eye ointment = non-formulary
    • 0.05% preservative free = non-formulary
    • 0.06% preservative free multidose = non-formulary
    • Neoral® for Uveitis Red Traffic Light
    • Ikervis® 0.1% eye drops single use- Subject of NICE TA369 - see link below for information sheet
    • Verkazia® 0.1% eye drops for vernal keratoconjuntivitis licensed for children (over 4years old) and adolecents (not adults)  = - see link below for information sheet
     
    Link  Ciclosporin eye drops information sheet - Ikarvis
    Link  Ciclosporin eye drops information sheet - Verkazia
    Link  NICE TA369 - Ciclosporin for treating eye disease that has not improved despite treatment with artificial tears
       
    Cytotoxic Drug Methotrexate
    (Eye)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Red
    Homecare
    • For use in Uveitis
    • Available through homecare for NUH patients. Please contact pharmacy medicines homecare team for further information
     
       
    11.99.99.99  Expand sub section  Treatment of burns
    Potassium Ascorbate (Ascorbic acid)
    (eye drops)
    Formulary
    Red
    Eye drops 10% (Unlicensed Product)
  • Available from NUH and SFH Pharmacy.
     
  •    
    Sodium Citrate
    (eye drops)
    Formulary
    Red
    Eye drops 10.11% (preservative free) (Unlicensed Product)
  • Used for acid and alkali burns to the cornea
  • Available from NUH and SFH Pharmacy. 
  •    
    11.99.99.99  Expand sub section  Visco-elastics
    Sodium Hyaluronate
    Formulary
    Red
    NUH use
  • Injection 8.5mg in 0.85mL (Haelonid)
  • Injection 7.7mg in 0.55mL (Healon G.V.)
  • Injection 1.2% - 0.8mL syringe (Amvisc)
    SFH use
  • Biolon
  • Haelon 5 
  •    
    Sodium Hyaluronate with Lidocaine
    Formulary
    Red
    Intracameral injection (Visthesia®)
    Intracameral injection (Visthesia Light®)
  • NUH only 
  • Link  Link to reviews
       
    Viscoat Viscoelastic
    View adult BNF View SPC online View childrens BNF
    Formulary
    Red
    0.5mL
     
    Link  Link to reviews
       
    11.99.99.99  Expand sub section  Other to top
    Disodium Edetate 0.37%
    View adult BNF View SPC online View childrens BNF
    Formulary
    Red
    Solution 20mL (preservative free) (Unlicensed Product)
  • Specialist use only
  • At SFH, used by ophthalmology in Daycase. Not routinely stocked, but may be ordered in if needed 
  •    
    Sodium Chloride 5% eye products
    Formulary
    Amber 2
    • For the treatment of corneal oedema or recurrent corneal erosion syndrome.
    • Eye drops 5% (Benzalkonium and thiomersol preservatives free). [picture]. 3 month expiry. Licensed as a medical device rather than a medicinal product.
    • Eye ointment 5% (Unlicensed Product). Alissa is the most cost effective PF to prescribe in primary care. Prescribe as 5g containers as product expires 4 weeks from opening.
    • At SFH, send patients to SFH Pharmacy for supplies of unlicensed medicines
     
       
     ....
     Non Formulary Items
    Acetazolamide oral liquid

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
    Unlicensed special
     
    Acetylcysteine 10% eye drops

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
    preserved or preservative free
  • Unlicensed special listed in drug tariff
  • for severe dry eye with mucous tear film
  •  
    Aciclovir eye ointment 3%  (Zovirax®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    • Discontinuation due June 2019, but exisiting supplies already exhausted.
    • Ganciclovir eye gel may be an appropriate alternative - liaise with ophthalmology.
    • Patients with suspected dendritic herpetic ulcers should receive ophthalmology assessment.
    Link  UKMI Memo and advice on alternatives
     
    Antazoline 0.5% with Xylometazoline 0.05%  (Otrivine-Antistin®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
    • Other anti-allergy eye drops preferred due to potential for rebound redness.
     
    Bethamethasone with Neomycin  (Vista-Methasone-N®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
     
    Bromfenac  (Yellox®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
    Link  Link to reviews
     
    Carboxymethylcellulose, glycerine & castor oil eye drops  (Optive Plus®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey

    10ml bottle (6 months expiry)

     
    Carteolol  (Teoptic®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
     
    Chlortetracycline
    (ophthalmic)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Red
    Eye ointment
  • SFH specialist only
  • Discontinued in the UK 2004, but may be available as an import.
  • Azithromycin now available for chlamydia
  •  
    Dexamethasone with Antibacterials  (Tobradex®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
     
    Dexamethasone with Antibacterials (eye)  (Sofradex®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
    Non Formulary for use in the eye. Available for use in the ear (see chapter 12)
     
    Dipivefrine Hydrochloride  (Propine®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
    Eye drops 0.1%
  • Discontinued
  • Non-Formulary as of Oct APC 2011
  •  
    Econazole 1% eye drops

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
    No longer available, August 2012
  • Unlicensed Product
  • NB Contains Arachis oil
  • Previously used as an alternative to amphotericin if anti-fungal eye drop needed "out of hours" and at weekends
  •  
    Emedastine  (Emadine®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
     
    Epinastine  (Relestat®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
     
    Flurbiprofen  (Ocufen®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
     
    Gentamicin single use  (Minims® Gentamicin Sulphate)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
    • Discontinued
     
    Hot eye compress

    Non Formulary
    • Including brands such as Clinitas Hot Eye Compress, Meibopatch, MGDRx EyeBag, Optase Moist Heat Mask.
    • No evidence of additional benefit compared to using a clean flannel and warm water as an eye compress.
    • A warm compress can be applied using a flannel soaked in warm water. The flannel requires resoaking in warm water periodically to prevent it from becoming cold.
    • Commerically available eye compresses can be purchased from a pharmacy or on-line for those who find these more convenient to use.
    • Information regarding use of warm eye compresses is available here.
     
    Hydrocortisone Acetate with Neomycin  (Neo-Cortef®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
     
    Hydrocortisone eye ointment

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
    Eye ointment 0.5% no longer available
     
    Hydroxypropyl Guar  (Systane Ultra®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey

    Systane Ultra®  10ml bottle, 6 months expiry.

     
    Levobunolol

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
    Eye drops 0.5%
    Removed from formulary Oct APC 2011. Other beta-blockers available. Existing stable patients do not need ot be switched
     
    Lidocaine 4% with Fluorescein 0.25%  (Minims®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
  • Non-formulary : As per head of service at NUH advice to remove April 2011.
  • Used at SFH since fluorescein and proxymetacaine minims discontinued. See memo below.
  •  
    Liquid Paraffin and Liquid Paraffin light eye drops

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
    Unlicensed medicine
  • other licensed ocular lubricants available
  •  
    Metipranolol  (Minims® Metipranolol)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
    Eye drops 0.3% (preservative free)
  • Discontinued
  •  
    Miconazole 1% eye drops

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Red
    No longer available, May 2015
    Eye Drops
  • Unlicensed Moorfields Product
  • Ophthalmologist recommendation only
  • NB Contains Arachis (Peanut) oil
  • Alternative to amphotericin if anti-fungal eye drop needed "out of hours" and at weekends.
  •  
    Nedocromil

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey

    Discontinued. Eye drops 2%

     
    Neomycin Eye drops

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
    Discontinued
     
    Nepafenac  (Nevanac®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey

    Not recommended for use by APC (July 2016). (~£16)

    Link  Link to reviews
     
    Optive® eye drops

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey

    Eye drops - all non-formulary GREY, no formal assessment. See Eye lubricant guidelines and Eye lubricants table of products for alternatives.

    • Optive® - Carmellose 0.5% & glycerin 0.9% (preserved)
    • Optive Fusion® - Hyaluronate 0.1%, carmellose 0.5%, glycerol 0.9% (preserved and preservative free)
    • (Optive Plus® are formulary for ophthalmologist recommendation only - see above).
     
    Paraffin Yellow Soft
    (Simple eye ointment)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey

    Eye Ointment 4g

    • Current cost is £52! (Sept 2020)
    • Use Hylo Night® instead.
     
    Pegaptanib Sodium  (Macugen®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
    High Cost Medicine

    Link  Link to reviews
    Link  NICE guidance on pegaptanib in AMD (August 2008)
     
    Phenylephrine & ketorolac  (Omidria®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
    No formal assessment (Nov 2015 APC)
     
    Pilocaprine long acting  (Pilogel®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
    Discontinued by Alcon
     
    Polymyxin B Sulphate eye ointment  (Polyfax®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
    Discontinued March 2012
  • Alternative for Acanthamoeba keratitis is dibrompropamidine eye ointment (in conjunction with polihexanide 0.02% eye drops, propamidine isetionate 0.1%(Brolene) eye drops during the day and chlorhexidine 0.02% eye drops if not responding)
  •  
    Prednisolone 0.5% with Neomycin 0.5%  (Predsol-N®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
    Eye drops
  • Specialist only - less suitable for prescribing (BNF) unless post surgery
    Discontinued Oct 2011
  •  
    Proxymetacaine 0.5% with Fluorescein Sodium 0.25%  (Minims®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
    Discontinued November 2013
    Link  SFH Memo regarding alternatives
     
    Rimexolone  (Vexol®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Amber 2
    Discontinued in June 2016.
     
    Rose Bengal  (Minims® Rose Bengal)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
     
    Sodium Cromoglicate

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
    • Price has increased significantly. Alternative more cost-effective anti-allergy eye drops preferred- see price graph.
    • OTC Patients should be advised to purchase a suitable product over the counter first line for allergy symptoms

     
    Sodium Cromoglicate  (Opticrom®)
    (Preservative Free )

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
    If preservative free preparation is required consider ketotifen UDVs (Ketofall®)
     
    Sodium Hyaluronate 0.1%, Co-enzyme Q10 0.1%, Vitamin E 0.5%  (VisuXL®,®)

    View adult BNF View childrens BNF
    Non Formulary
    Grey

    Reviewed and rejected at the APC, September 2019. See Eye lubricant guidelines and Eye lubricants table of products for alternatives.

    Link  Link to reviews
     
    Sodium hyaluronate 0.15% with trehalose 3%  (Thealoz Duo®)

    View adult BNF View childrens BNF
    Non Formulary
    Grey

    Reviewed and rejected at the APC, March 2019. 

    Link  Link to reviews
     
    Soybean oil unit dose eye drops  (Emustil®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
  • No formal submission
  •  
    Tafluprost (Preservative Free) 15micrograms/ml  (Saflutan®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
    Eye drops (single dose container)
  • Latanoprost preservative free (Monopost®) is now the preservative free prostaglandin analogue of choice as it is more cost effective.
  • Link  Price comparison graph - all glaucoma treatments
     
    Tafluprost and Timolol  (Taptiqom®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
  • Fixapost (latanoprost with timolol) is preferred preservative free option. (APC Mar19)
  • Link  Price comparison graph - all glaucoma treatments
     
    Timolol Once-daily  (Nyogel®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
    Eye drops 0.1%
  • Removed from formulary Oct APC 2011
  • Minimal prescribing in Nottinghamshire. Existing stable patients do not need to be switched
  •  
    Tropicamide  (Mydriacyl®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
     
      
    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
    Display tracking information
    click to search medicines.org.uk
    Link to adult BNF
    click to search medicines.org.uk
    Link to children's BNF
    click to search medicines.org.uk
    Link to SPCs
    SMC
    Scottish Medicines Consortium
    Cytotoxic Drug
    Cytotoxic Drug
    CD
    Controlled Drug
    High Cost Medicine
    High Cost Medicine
    Cancer Drugs Fund
    Cancer Drugs Fund
    NHSE
    NHS England
    Homecare
    Homecare
    CCG
    CCG

    Traffic Light Status Information

    Status Description

    Grey

    Grey / Non-Formulary: Medicines, which the Nottinghamshire APC has actively reviewed and does not recommend for use at present due to limited clinical and/or cost effective data.
    Grey / Non-Formulary (undergoing assessment): Work is ongoing and will be reviewed at a future APC meeting.
    Grey / Non-Formulary (no formal assessment): APC has not formally reviewed this medicine or indication because it had never been requested for formulary inclusion. Often used for drugs new to market.
      

    Red

    Medicines which should normally be prescribed by specialists only. eg hospital only.
    For patients already receiving prescriptions in primary care - continue. No new patients to receive prescriptions in primary care.
      

    Amber 1

    Medicines that should be initiated by a specialist and prescribed by primary care prescribers only under a shared care protocol, once the patient has been stabilised.
    Prior agreement must be obtained by the specialist from the primary care provider before prescribing responsibility is transferred. The shared care protocol must have been agreed by the relevant secondary care trust Drugs and Therapeutics Committee(s) (DTC) and approved by the Nottinghamshire APC.
      

    Amber 2

    Medicines suitable to be prescribed in primary care / general practice after specialist* recommendation or initiation.
    A supporting prescribing guideline may be requested which must have been agreed by the relevant secondary care trust DTCs and approved by the Nottinghamshire APC.
    *Specialist is defined by the APC as a clinician who has undertaken an appropriate formal qualification or recognised training programme within the described area of practice
      

    Amber 3

    Primary care/ non specialist may initiate as per APC guideline.
    The supporting prescribing guideline must have been agreed by the relevant secondary care trust D&TC(s) and approved by the Nottinghamshire APC.
      

    Green

    Medicines suitable for routine use within primary care.
    Can be initiated within primary care within their licensed indication, in accordance with nationally recognised formularies, for example the BNF, BNF for Children, Medicines for Children or Palliative Care Formulary. Primary care prescribers take full responsibility for prescribing.   

    OTC

      

    netFormulary