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Nottinghamshire Area Prescribing Committee
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 Formulary Chapter 11: Eye - Full Chapter
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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.
     
       
     ....
     Non Formulary Items
    Bethamethasone with Neomycin  (Vista-Methasone-N®)

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    Non Formulary
    Grey
     
    Dexamethasone with Antibacterials  (Tobradex®)

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    Non Formulary
    Grey
     
    Dexamethasone with Antibacterials (eye)  (Sofradex®)

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    Non Formulary
    Grey
    Non Formulary for use in the eye. Available for use in the ear (see chapter 12)
     
    Hydrocortisone Acetate with Neomycin  (Neo-Cortef®)

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    Non Formulary
    Grey
     
    Hydrocortisone eye ointment

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    Non Formulary
    Grey
    Eye ointment 0.5% no longer available
     
    Prednisolone 0.5% with Neomycin 0.5%  (Predsol-N®)

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    Non Formulary
    Grey
    Eye drops
  • Specialist only - less suitable for prescribing (BNF) unless post surgery
    Discontinued Oct 2011
  •  
    Rimexolone  (Vexol®)

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    Non Formulary
    Amber 2
    Discontinued in June 2016.
     
      
    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

      

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