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Nottinghamshire Area Prescribing Committee
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 Formulary Chapter 11: Eye - Full Chapter
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11.08  Expand sub section  Miscellaneous ophthalmic preparations
Idebenone (Raxone®)
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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
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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®)
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Restricted Drug Restricted
Amber 2

Eye drops. £15

 
   
Acetylcysteine 5% eye drops
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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
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    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
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    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)
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    Restricted Drug Restricted Eye drops (preservative free)- NUH only 
       
    Hydroxypropyl Guar (Systane®)
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    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®)
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    Formulary
    Red

    Eye drops- NUH only

    • preservative free unit dose is non-formulary
     
       
    Liquid Paraffin eye ointment
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    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®)
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    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®)
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    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)
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    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®
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    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®)
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    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
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    Formulary
    Green
    Eye drops 2% (preservative free Minims®)
  • Diagnostic use only
  • Bio Glo 1mg ophthalmic strips have been discontinued

     
  •    
    Indocyanine green
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    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 to top
    Acetylcholine Chloride (Miochol-E®)
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    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®)
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    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)
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    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)
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    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
    Aflibercept (Eylea®)
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    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®)
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    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®)
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    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®)
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    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®)
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    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
       
     ....
     Non Formulary Items
    Acetylcysteine 10% eye drops

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    Non Formulary
    Grey
    preserved or preservative free
  • Unlicensed special listed in drug tariff
  • for severe dry eye with mucous tear film
  •  
    Bromfenac  (Yellox®)

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    Non Formulary
    Grey
    Link  Link to reviews
     
    Carboxymethylcellulose, glycerine & castor oil eye drops  (Optive Plus®)

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    Non Formulary
    Grey

    10ml bottle (6 months expiry)

     
    Flurbiprofen  (Ocufen®)

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    Non Formulary
    Grey
     
    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.
     
    Hydroxypropyl Guar  (Systane Ultra®)

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    Non Formulary
    Grey

    Systane Ultra®  10ml bottle, 6 months expiry.

     
    Liquid Paraffin and Liquid Paraffin light eye drops

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    Non Formulary
    Grey
    Unlicensed medicine
  • other licensed ocular lubricants available
  •  
    Nepafenac  (Nevanac®)

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    Non Formulary
    Grey

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

    Link  Link to reviews
     
    Optive® eye drops

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    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)

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    Non Formulary
    Grey

    Eye Ointment 4g

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

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    Non Formulary
    Grey
    High Cost Medicine

    Link  Link to reviews
    Link  NICE guidance on pegaptanib in AMD (August 2008)
     
    Rose Bengal  (Minims® Rose Bengal)

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    Non Formulary
    Grey
     
    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®)

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    Non Formulary
    Grey

    Reviewed and rejected at the APC, March 2019. 

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

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    Non Formulary
    Grey
  • No formal submission
  •  
      
    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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