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Nottinghamshire Area Prescribing Committee
Joint Formulary
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 Formulary Chapter 11: Eye - Full Chapter
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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
    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
    View adult BNF View SPC online View childrens BNF
    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 to top
    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)
    View adult BNF View SPC online View childrens BNF
    Formulary Eye drops 0.1% (preservative free) (Unlicensed Product)- NUH only
    Eye drops 2% (preservative free) unit dose Minims® 
       
     ....
     Non Formulary Items
    Acetazolamide oral liquid

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
    Unlicensed special
     
    Carteolol  (Teoptic®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
     
    Dipivefrine Hydrochloride  (Propine®)

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    Non Formulary
    Grey
    Eye drops 0.1%
  • Discontinued
  • Non-Formulary as of Oct APC 2011
  •  
    Levobunolol

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    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
     
    Metipranolol  (Minims® Metipranolol)

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    Non Formulary
    Grey
    Eye drops 0.3% (preservative free)
  • Discontinued
  •  
    Pilocaprine long acting  (Pilogel®)

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    Non Formulary
    Grey
    Discontinued by Alcon
     
    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®)

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    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
  •  
      
    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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