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Nottinghamshire Area Prescribing Committee
Joint Formulary
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 Formulary Chapter 11: Eye - Full Chapter
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11.08.02  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
    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 to top
    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
    Bromfenac  (Yellox®)

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    Non Formulary
    Grey
    Link  Link to reviews
     
    Flurbiprofen  (Ocufen®)

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

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    Non Formulary
    Grey

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

    Link  Link to reviews
     
    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
     
      
    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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