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Nottinghamshire Area Prescribing Committee
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 Formulary Chapter 13: Skin - Full Chapter
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13.05.03  Expand sub section  Drugs affecting the immune response
Adalimumab
(Dermatology)
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Restricted Drug Restricted
Red
High Cost Medicine
Homecare

Injection

  • Approved in accordance with NICE TA146 for the treatment of plaque psoriasis
  • Approved in accordance with NICE TA455 for the treatment of plaque psoriasis in children and young people
  • Available through homecare for NUH patients. Please contact pharmacy medicines homecare team for further information
  • Biosimilar Imraldi® is the first line option for new patients. Biosimilar Amgevita® can be used second line in those who are unable to tolerate Imraldi®
 
Link  Link to reviews
Link  MHRA: Tuberculosis risk—screen patients before starting treatment
Link  NICE TA392: Adalimumab for treating moderate to severe hidradenitis suppurativa
Link  NICE TA455:Adalimumab, etanercept and ustekinumab for treating plaque psoriasis in children and young people
   
Apremilast (Otezla®)
(Dermatology)
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Restricted Drug Restricted
Red
High Cost Medicine
Homecare

Tablets

  • Approved in accordance with TA419 for treating moderate to severe plaque psoriasis.
  • Approved in accordance with TA433 Apremilast for treating active psoriatic arthritis.

Available through homecare for NUH patients. Please contact pharmacy medicines homecare team for further information

 
Link  MHRA Drug Safety Update (Jan 2017)
Link  NICE TA 419: Apremilast for treating moderate to severe plaque psoriasis
Link  NICE TA433: Apremilast for treating active psoriatic arthritis
   
Cytotoxic Drug Azathioprine
(Dermatology)
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Formulary
Amber 1

Tablets

 
Link  COVID19: DMARD shared care monitoring during COVID19 (Notts CCG)
Link  Notts APC Shared Care Protocol: Azathioprine for dermatology info sheet
Link  Notts APC Shared Care Protocol: Azathioprine for dermatology overarching SCP
Link  UKMI Q&A: Can mothers breastfeed while taking azathioprine?
   
Ciclosporin
(Dermatology)
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Formulary
Red

Capsules 25mg, 50mg & 100mg (Neoral® or Capimune®), Oral Solution 100mg in 1mL (Neoral®), Infusion (Sandimmun®).

  • Capimune® is preferred brand for new patients at SFH. For advice on switching see BNF
  • MHRA advise prescribe by brand
  • Neoral liquid is equivalent to Neoral capsules. If changing from any other preparation contact Medicines Information for assistance.
 
Link  NUH Lite Bite: Importance of Maintaining Brand for Certain Medicines
Link  Primary care ciclosporin cost comparison
Link  Secondary care ciclosporin cost comparison
Link  SFH Drug levels information - compilation table
Link  SFH: IV drugs which need special giving sets
   
Dupilumab (Dupixent®)
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Restricted Drug Restricted
Red
High Cost Medicine
Homecare

Injection - Pre-filled syringe

Available at Nottingham NHS Treatment Centre and SFH:

  • Approved in accordance with NICE TA534, for treating moderate to severe atopic dermatitis.

Available at NUH only:

  • Approved for adolescent patients between 12 and 18 years of age with severe atopic dermatitis for whom the available systemic therapies are not suitable in accordance with Blueteq criteria.

 

Available through homecare for NUH patients. Please contact pharmacy medicines homecare team for further information

 
Link  Link to reviews
Link  NICE TA534: Dupilumab for treating moderate to severe atopic dermatitis
   
Etanercept (Enbrel®)
(Dermatology)
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Formulary
Red
High Cost Medicine
Injection
NUH:
  • Approved in line with NICE TA103 for the treatment of adults with psoriasis
  • Approved in line with NICE TA455 for treating plaque psoriasis in children and young people
    SFH: Restricted for dermatology in line with NICE guidance. For patients not covered by NICE guidance, approval must be sought from the budget holder before initiation. 
  • Link  Independent reviews
    Link  MHRA Drug Safety Update (Dec 2014)
    Link  NICE TA103: Psoriasis - efalizumab and etanercept
    Link  NICE TA455:Adalimumab, etanercept and ustekinumab for treating plaque psoriasis in children and young people
       
    Guselkumab (Tremfya®)
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    Restricted Drug Restricted
    Red
    High Cost Medicine
    Homecare

    Injection

    Approved in accordance with NICE TA521 for treating moderate to severe plaque psoriasis

     
    Link  NICE TA521: Treatment in moderate to severe plaque psoriasis
       
    Hydroxychloroquine
    (Dermatology)
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    Formulary
    Amber 1

    Tablets

    For use in line with SCP below:

     
    Link  Notts APC: Dermatology Overarching Shared Care Protocol
    Link  Notts APC: Hydroxychloroquine Shared Care Protocol - Prescribing information sheet
       
    Infliximab (Remicade®)
    (Dermatology)
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    Formulary
    Red
    High Cost Medicine
    Infusion
  • NICE TA134
    Infliximab is recommended as a possible treatment for adults with plaque psoriasis only if:
  • their condition is very severe and
  • their condition has not improved with other treatments such as ciclosporin, methotrexate or PUVA (psoralen and long-wave ultraviolet radiation), or they have had side effects with these inthe past or there is a medical reason why they should not be given these treatments.
    Infliximab treatment should be continued beyond 10 weeks only if the psoriasis has clearly improved within this time. 
  • Link  Link to reviews
    Link  MHRA Drug Safety Update (Dec 2014)
    Link  NICE TA134: Infliximab for psoriasis
    Link  SFH: Information about IV filters
    Link  UKMI: Biosimilars - New Developments
       
    Cytotoxic Drug Methotrexate
    (Dermatology)
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    Formulary
    Amber 1
    Homecare

    Tablets (2.5mg only)

    • Methotrexate is available as 2.5mg and 10mg tablets. This is a potential cause of confusion and has led to patients taking accidental overdoses.
      To avoid this only 2.5mg tablets should be prescribed and specified on the prescription
    • Amber 1 (shared care) - Patients with severe psoriasis or eczema unresponsive to conventional therapy, when used ONCE weekly in line with Shared Care Protocol (see below). Twice weekly dosing (for any indication) is classified red.
    • NUH: Metoject® injection available for paediatric patients - routinely supplied via homecare (prescribe by brand and generic name)
     
    Link  COVID19: DMARD shared care monitoring during COVID19 (Notts CCG)
    Link  Dermatology - Methotrexate (Overarching SCP)
    Link  Dermatology - Methotrexate (shared care protocol information sheet)
    Link  Methotrexate and alcohol guidance- UKMI Q& A
    Link  NUH Lite Bite: Methotrexate for non-cancer use
    Link  NUH Lite Bite: Safer use of weekly oral methotrexate
    Link  NUH: Medicines Matters Bulletin: Safer Use of Weekly oral Methotrexate
    Link  UKMI Q&A: What is the clinical significance of the interaction between methotrexate and penicillins? (Oct13)
       
    Pimecrolimus (Elidel®)
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    Formulary
    Amber 2
    Cream 1%
  • Amber 2: Mild to moderate ecezma. Specialist initiation only
  • Usually short term treatment, stop if no response after 6 weeks 
  • Link  NICE TA82: Pimecrolimus and tacrolimus for atopic dermatitis (eczema)
       
    Secukinumab (Cosentyx®)
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    Restricted Drug Restricted
    Red
    High Cost Medicine
    Homecare

    Injection

    • Approved in line with NICE TA350 for moderate to severe plaque psoriasis.
    • Approved in line with NICE TA407 for active ankylosing spondylitis after treatment with non-steroidal anti-inflammatory drugs or TNF-alpha inhibitors.
    • Nottingham NHS Treatment Centre: Approved in accordance with NICE TA445 for treating active psoriatic arthritis after inadequate response to DMARDs

    Available through homecare for NUH patients. Please contact pharmacy medicines homecare team for further information

     
    Link  NICE TA350: Plaque Psoriasis
    Link  NICE TA407: Secukinumab for active ankylosing spondylitis after treatment with non-steroidal anti-inflammatory drugs or TNF-alpha inhibitors
    Link  NICE TA445: Certolizumab pegol and secukinumab for treating active psoriatic arthritis after inadequate response to DMARDs
       
    Tacrolimus (Protopic®)
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    Formulary
    Amber 2

    Ointment 0.03%
    Ointment 0.1%

    • Moderate to severe eczema. Specialist initiation only. Follow NICE guidance.
    • Facial psoriasis - specialist recommendation after initial treatment in primary care as per the APC Psoriasis guideline.
     
    Link  Link to reviews
    Link  NICE TA82: Pimecrolimus and tacrolimus for atopic dermatitis (eczema)
       
    Tildrakizumab (Ilumetri®)
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    Restricted Drug Restricted
    Red
    High Cost Medicine

    Injection

    Approved at Nottingham NHS Treatment Centre and SFH:

    • in accordance with NICE TA575 for treating moderate to severe plaque psoriasis.
     
    Link  NICE TA575: Tildrakizumab for treating moderate to severe plaque psoriasis
       
    Ustekinumab
    (Stelara)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Red
    High Cost Medicine
    Homecare

    Injection

    • SFH: IV infusions for Crohn's patients are prepared in Aseptic Dispensing Unit. Refer to SPC for pharmacist clinical check.(ONLY first dose IV infusion, remainder: SC syringes organised via Healthcare at Home.)
    • Specialist use only for the treatment of adults with moderate to severe psoriasis, in accordance with TA180. Patients who have a sub therapeutic response to ustekinumab at a 45mg dosing and who are over 90kg may be dose escalated to a 90mg dose (nb: an unlicensed dose) as per consultant decision and BAD guidance.
    • Specialist use only for the treatment of children over 12 years old with moderate to severe psoriasis (as per licence and commissioning approval), in accordance with TA180.
    • Specialist use only, alone or with methotrexate, for the treatment of adults with active psoriatic arthritis when treatment with a TNF alpha inhibitor is contra-indicated but would otherwise be used or one or more TNF inhibitor has been used, in accordance with TA340.
    • NUH approved for treating plaque psoriasis in children and young people, in accordance with TA455.
    • NUH and Nottinghamshire Treatment Centre approved for treating adults with moderately to severely active Crohn’s disease after previous treatment, in accordance with TA456. Also approved at NUH for paediatric patients >12 years of age when in line with NHS England/Blueteq criteria.
    • NUH and Nottingham NHS Treatment centre approved for treating adults with moderately to severely active ulcerative colitis, in accordance with TA633.
    • Available through homecare for NUH patients. Please contact pharmacy medicines homecare team for further information.
     
    Link  Link to reviews
    Link  MHRA Drug Safety Update (Jan 2015)
    Link  NICE TA180: Psoriasis - ustekinumab
    Link  NICE TA340: Ustekinumab for treating active psoriatic arthritis
    Link  NICE TA455:Adalimumab, etanercept and ustekinumab for treating plaque psoriasis in children and young people
    Link  NICE TA456:Ustekinumab for moderately to severely active Crohn’s disease after previous treatment
    Link  NICE TA633: Ustekinumab for treating moderately to severely active ulcerative colitis
       
     ....
     Non Formulary Items
    Efalizumab  (Raptiva®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
    Injection sc
  • Marketing authorisation suspended Feb 2009
  • Link  Link to reviews
     
      
    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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