Nottinghamshire Area Prescribing Committee Formulary


	Nottinghamshire Area Prescribing Committee Joint Formulary

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Formulary Chapter 11: Eye - Full Chapter

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Calculator tables to work out how many bottles needed

Eye drop compliance aids (Moorfields)

Order to administer multiple eye drops

Details...

11.08.01

Tear deficiency, ocular lubricants, and astringents

Hypromellose

First Choice

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.
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^®)

Restricted

Eye drops. £15

Ophthalmologist recommendation only for corneal filaments
See Eye lubricant guidelines and Eye lubricants table of products.

Acetylcysteine 5% eye drops

Restricted

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

Formulary

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.
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

Restricted

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).

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)

Restricted

Eye drops (preservative free)- NUH only

Hydroxypropyl Guar (Systane Balance^®)

Restricted

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

Ophthalmologist recommendation only for meibomean gland deficiency.
Note there are other types in the 'Systane' range (Ultra, gel, hydration, HD) which are non formulary.
See Eye lubricant guidelines and Eye lubricants table of products.

Hypromellose 0.3% with Dextran 70 0.1% (Tears naturale^®)

Formulary

Eye drops- NUH only

preservative free unit dose is non-formulary

Liquid Paraffin eye ointment

Formulary

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

Xailin night^®- most cost effective brand

Polyvinyl Alcohol (Liquifilm Tears or Sno Tears^®)

Formulary

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

NUH: Liquifilm Tears
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^®)

Formulary

5g tube, 6 months expiry

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

Solutions 19mL, 500mL, 500mL (latex free)

Sodium Chloride (Minims^® Saline)

Formulary

Eye drops 0.9% (preservative free) - 0.5 mL

multidose preparation is an unlicensed special and non-formulary
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)

Formulary

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. ( Ophthalmologist recommendation only for punctuate keratitis)

Other non-formulary brands include Hylo-Fresh^® (0.03%), Hylo-Tear^® (0.1%), Lubristil^®, Thealoz Duo^®, Vismed^®, VisuXL^®.See Eye lubricant guidelines and Eye lubricants table of products.

Eye lubricants - guidance

Eye lubricants - table of preferred products

....

Non Formulary Items

Acetylcysteine 10% eye drops

Non Formulary

preserved or preservative free

Unlicensed special listed in drug tariff

for severe dry eye with mucous tear film

Carboxymethylcellulose, glycerine & castor oil eye drops (Optive Plus^®)

Non Formulary

10ml bottle (6 months expiry)

Non formulary for new patients ONLY. Switching current patients to an alternative is NOT expected
See Eye lubricant guidelines and Eye lubricants table of products.

Hydroxypropyl Guar (Systane Ultra^®)

Non Formulary

Systane Ultra^® 10ml bottle, 6 months expiry.

Non-formulary for new patients ONLY, switching patients to an alternative is NOT expected
See Eye lubricant guidelines and Eye lubricants table of products.

Liquid Paraffin and Liquid Paraffin light eye drops

Non Formulary

Unlicensed medicine

other licensed ocular lubricants available

Optive^® eye drops

Non Formulary

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^® (carboxymethylcellulose 0.5%, glycerine 1%, castor oil 0.25%) is also non-formulary - see above. The equivalent formulary product containing mineral oil is Systane Balance.

Paraffin Yellow Soft
(Simple eye ointment)

Non Formulary

Eye Ointment 4g

Current cost is £52! (Sept 2020)
Use Hylo Night^® instead.

Sodium Hyaluronate 0.1%, Co-enzyme Q10 0.1%, Vitamin E 0.5% (VisuXL®,^®)

Non Formulary

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

Link to reviews

Sodium hyaluronate 0.15% with trehalose 3% (Thealoz Duo^®)

Non Formulary

Reviewed and rejected at the APC, March 2019.

Link to reviews

Soybean oil unit dose eye drops (Emustil^®)

Non Formulary

No formal submission

Key

	Notes
	Section Title (top level)
	Section Title (sub level)
	First Choice item
	Non Formulary section
	Restricted Drug
	Unlicensed
	Display tracking information
	Link to adult BNF
	Link to children's BNF
	Link to SPCs
	Scottish Medicines Consortium

	Cytotoxic Drug
	Controlled Drug
	High Cost Medicine
	Cancer Drugs Fund
	NHS England
	Homecare
	CCG

Traffic Light Status Information

Status	Description
	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.
	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.
	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.
	*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
	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.
	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.