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 Formulary Chapter 5: Infections - Full Chapter
Notes:

Intravenous antibiotics are more expensive than oral equivalents, some are very expensive. They put patients at risk of IV cannula infections. Oral antibiotics are usually fairly cheap. IM injections are rarely if ever indicated.

Course lengths:
Prescriptions for oral antibiotics for in-patients should be reviewed at or before five days. Prescriptions for intravenous antibiotics should be reviewed at or before 48 hours after which the patient should be considered for an oral antibiotic if there is an equivalent available (see IV to oral switch policy). For uncomplicated urinary tract infections three days treatment is usually sufficient in adult women. Complicated infections require longer treatment.

When initiating therapy with agents marked with Restricted, you must seek Microbiology/Infectious Diseases advice.

The restricted antimicrobials may be prescribed without discussion with microbiology if they are being used for an approved indication as specified. Use outside these indications (and any use for some antimicrobials) requires DOCUMENTED approval from one of the medical microbiologists or Infectious Diseases Physician prior to prescribing.

Chapter Links...
 Details...
05.01  Antibacterial drugs
05.01.01  Penicillins
05.01.01.01  Benzylpenicillin and phenoxymethylpenicillin
Phenoxymethylpenicillin
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Formulary
Green
  • Also known as penicillin V
  • Available as:
    • Tablet
    • Oral Solution (125mg/5ml and 250mg/5ml). 
 
Link  It it really penicillin allergy?
   
Benzylpenicillin
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Formulary
Green

Injection

  • See local guidelines. [SFH guideline][NUH guideline]
  • NUH OPAT service:Red Traffic Light  24 hour infusions via a continuous infusion pump device. Unlicensed compounded medicine - named patient use only.
 
   
Benzathine Benzylpenicillin
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Restricted Drug Restricted
Red
  • Available as injection 2.4 Mega unit
  • Long acting IM penicillin, similar to procaine benzylpenicillin
  • Preferred option (except for neuro syphillis)
  • Unlicensed medicine - named patient use only
  • For GU Med only.
 
Link  BASHH guidelines on syphillis (reference only - refer all patients to GUM)
   
Procaine benzylpenicillin
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Restricted Drug Restricted
Red
  • Also known as Procaine Penicillin G
  • Unlicensed medicine - named patient use only
  • Long acting IM penicillin, similar to benzathine benzylpenicillin
  • Preferred option for neuro syphilis
  • Available as 0.6mu vials (Usual dose 2.4mu)
  • Doses of 2.4mu are given as 4 seperate 0.6mu IM injections using a green needle (it's quite thick)
 
Link  BASHH guidelines on (neuro) syphillis (reference only - refer all patients to GUM)
   
05.01.01.02  Penicillinase-resistant penicillins
Flucloxacillin
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Formulary
Green

Capsules, injection, oral solution.

  • CSM has advised that cholestatic jaundice may occur up to several weeks after treatment with Flucloxacillin has been stopped. Administration for more than 2 weeks and increasing age are risk factors. LFT’s should be monitored where prolonged therapy is used.
  • NUH OPAT service:Red Traffic Light  24 hour infusions via a continuous infusion pump device. Unlicensed compounded medicine - named patient use only.
  • See local guidelines. [SFH guideline][NUH guideline]
 
Link  Impetigo guideline (Notts APC)
Link  UKMI Q&A: Can 2g flucloxacillin be given as a slow IV
   
Temocillin (Negaban®)
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Restricted Drug Restricted
Red

Injection / Infusion

 
   
05.01.01.03  Broad-spectrum penicillins to top
Amoxicillin
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Formulary
Green
Capsule, Oral suspension (125mg/5ml and 250mg/5ml), Injection
  • If a 3g dose of amoxicillin is required, it is recommended that 6 x 500mg capsules be supplied, to be taken with plenty of fluid over a period of about half an hour. This is considerably less expensive than the use of Amoxil 3g sachets, and less unpleasant to take.
  • Use as prophylaxis for endocarditis is classified red.
  • See local guidelines. [SFH guideline][NUH guideline
  • Link  COVID19: Management of community acquired pneumonia (Notts CCG)
    Link  COVID19: NICE (NG165) - managing suspected or confirmed pneumonia in the community
       
    Co-Amoxiclav
    View adult BNF View SPC online View childrens BNF
    Formulary
    Green

    Tablet (375mg and 625mg), Oral suspension (125/31mg or 250/62mg in 5ml), Injection.

    • CSM has advised that cholestatic jaundice may occur either during or just after treatment with co-amoxiclav. It is more common in patients above the age of 65 years and in males. The duration of treatment should be appropriate to the indication and should not usually exceed 14 days.
    • Dispersible tablets discontinued 2010. For 625mg doses give 10ml of 250/62mg liquid. No liquid equivalent to 375mg dispersible tablets. (See table of liquid medicines requiring dose adjustment) 
    • See local guidelines. [SFH guideline][NUH guideline]
     
       
    05.01.01.04  Antipseudomonal penicillins
    Piperacillin and Tazobactam
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red

    Injection

    • Previously known as Tazocin®
    • Restricted antibiotic: see local guidelines
    • NUH OPAT service:Red Traffic Light  24 hour infusions via a continuous infusion pump device. Unlicensed compounded medicine - named patient use only.
    • SFH: Memo on bolus administration
    • See local guidelines. [SFH guideline][NUH guideline]
     
       
    Ticarcillin with clavulanic acid (Timentin®)
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    Restricted Drug Restricted
    Red
    Injection
  • NUH only
  • Restricted antibiotic: see local guidelines [NUH guideline]
  • Supply problem - contact pharmacy for advice regarding current availability. 
  •    
    05.01.01.05  Mecillinams
    Pivmecillinam
    View adult BNF View SPC online View childrens BNF
    Formulary
    Amber 3

    Tablets

    • For use in line with Primary Care Antimicrobial guidelines
    • In secondary care see local guidelines. [SFH guideline][NUH guideline]
    • A penicillin antibiotic - avoid in penicillin allergy
    • Has significant activity against many Gram-negative bacteria including Escherichia coli, klebsiella, enterobacter, and salmonellae
  • Amber 2 specialist recommendation for long term recurrent UTI use 
  • Link  Link to reviews
       
    05.01.02  Cephalosporins, carbapenems and other beta-lactums
    Ceftolozane & tazobactam (Zerbaxa®)
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red
    Infusion
    NUH only:
  • Microbiology/Infectious diseases approval only
  • See local guidelines. [NUH guideline
  • Link  NICE 2016: Evidence summary of new medicines: intra-abdominal
    Link  NICE 2016: Evidence summary of new medicines: UTI
       
    05.01.02.01  Cephalosporins
    Cefalexin
    View adult BNF View SPC online View childrens BNF
    First Choice
    Green

    Capsules*, Tablets* 
    Liquid (250mg in 5ml)

     
    Cefuroxime
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    Formulary
    Red

    Injection

     
       
    Cefaclor
    View adult BNF View SPC online View childrens BNF
    Formulary
    Amber 2
    • Used in CF exacerbations at NUH as per CF guideline.
    • Used in treatment of mastoiditis in paediatrics at NUH as per Paediatric Mastioiditis Antibiotic Guideline. Treatment can be up to 4 weeks. 
    • Dose as per cBNF
     
       
    Cefazolin
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red

    Injection

    • Available at NUH: Restricted to ID/microbiology advice only
    • Link to SPCs (1g) (2g)
    • See local guidelines. [NUH guideline]
     
    Link  Summary of product characteristics: 1g vial
    Link  Summary of product characteristics: 2g vial
       
    Cefixime (Suprax®)
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red

    Tablet

    Available at NUH only:

    • Restricted antibiotic for gonorrhoea: see local guidelines [NUH guideline]
    • For the management of irinotecan induced diarrhoea in paediatric patients, not responsive to standard treatments
     
       
    Cefotaxime
    View adult BNF View SPC online View childrens BNF
    Formulary
    Amber 3

    Injection

    • See local guidelines. [SFH guideline][NUH guideline][Primary Care guidelines]
    • Supply problem: 1g injection out of stock and manufacturer cannot give a date for when it will be available again. 500mg reserved for hospital use only. Consider ceftriaxone as an alternative in primary care. See local guidance on meningitis for dosing. (last checked October 2020)
     
       
    Cefoxitin
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red

    Injection
    NUH only: For the treatment of Mycobacterium abcessus infection in paediatric patients with cystic fibrosis. See local guidelines  [NUH guideline]

     
    Link  NUH: Guideline for the management of children and young people with Cystic Fibrosis
       
    Ceftazidime
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    Restricted Drug Restricted
    Red
    Injection
  • See local guidelines. [SFH guideline][NUH guideline
  •    
    Ceftriaxone
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Amber 3

    Injection

     
       
    05.01.02.02  Carbapenems to top
    Ertapenem (Invanz®)
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red
    Infusion
  • Restricted antibiotic: see local guidelines
     
  •    
    Imipenem with Cilastatin
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red
    Infusion
    NUH only: For the treatment of Mycobacterium abcessus infection in patients with cystic fibrosis. See local guidelines 
    Link  NUH: Guideline for the management of children and young people with Cystic Fibrosis
       
    Meropenem (Meronem®)
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    Restricted Drug Restricted
    Red
    Injection
  • See local guidelines. [SFH guideline][NUH guideline
  •    
    Meropenem and Vaborbactam (Vaborem®)
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red

    Infusion

    Available at NUH only:

    • For use in adults on Microbiology/Infectious diseases approval only
    • See local guidelines. [NUH guideline]
     
       
    05.01.02.03  Other beta-lactums antibiotics
    Aztreonam (Azactam®)
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red

    Injection

     
    Link  Link to reviews
       
    Aztreonam nebuliser solution (Cayston®)
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red
    High Cost Medicine
    Homecare
    • For patients with CF only
    • Available through homecare for NUH patients. Please contact pharmacy medicines homecare team for further information
     
    Link  Link to reviews
       
    Ceftazidime/ avibactam (Zavicefta®)
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    Restricted Drug Restricted
    Red

    Infusion

    • Restricted antibiotic for adults - Microbiology/Infectious diseases approval only
    • See local guidelines. [NUH guideline]  [SFH guideline]
     
    Link  Link to reviews
       
    05.01.03  Tetracyclines
    Demeclocycline
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Amber 2
    Capsule
  • Treatment should only be initiated and reviewed by a consultant endocrinologist or oncologist.
  • For use in SIADH only. SIADH dose differs from antibiotic dose, see BNF.
  • Where specialists have requested a GP prescribe, this should only occur if there is a clearly documented plan giving information on the monitoring and follow up of treatment.
  • A dose of 300mg TDS for 28 days costs around £1000 (DT,June 17)
     
  • Link  Hyponatraemia treatment (flowchart)
    Link  Hyponatraemia treatment (full guideline)
    Link  See unexpectedly expensive medicines list
       
    Doxycycline
    View adult BNF View SPC online View childrens BNF
    Formulary
    Green
    Capsule, Dispersible Tablet.
  • Can be used if sensitivities state "tetracycline". Including MRSA.
  • See local guidelines. [SFH guideline][NUH guideline
  • Link  COVID19: Management of community acquired pneumonia (Notts CCG)
    Link  COVID19: NICE (NG165) - managing suspected or confirmed pneumonia in the community
    Link  Impetigo guideline (Notts APC)
       
    Lymecycline
    View adult BNF View SPC online View childrens BNF
    Formulary
    Green
    Capsule
     
    Link  Link to reviews
       
    Tetracycline
    View adult BNF View SPC online View childrens BNF
    Formulary
    Green

    Tablets

     
       
    05.01.03  Tigecycline
    Tigecycline (Tygacil®)
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red
    IV infusion
  • Restricted antibiotic: see local guidelines
     
  • Link  Link to reviews
       
    05.01.04  Aminoglycosides
    Amikacin
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red

    Injection

     
       
    Cerament®
    Restricted Drug Restricted
    Red

    Cerament, Cerament G and Cerament V

    • NUH only: Surgical treatment for complex trauma and orthopaedic patients.
     
       
    Collatamp EG Sponge
    View adult BNF View SPC online View childrens BNF
    Formulary
    Red
    • NUH only: Gentamicin impregnated collagen implant - 10cm x 10cm, 5cm x 20cm
    • SFH: Obtained from Theatres Resources (not Pharmacy).
     
    Link  Link to reviews
       
    Gentamicin
    (injection)
    View adult BNF View SPC online View childrens BNF
    Formulary

    Injection
    Intrathecal Injection (preservative free)
    for MRSA bacteraemia prophylaxis at catheter change in high risk patients only. IM admin on microbiology advice. (APC Sept 14)
    for all other indications

    • NUH use includes off label use with heparin for line locks; for prevention of catheter related bacteraemia in tunneled venous catheters for haemodialysis
    • If using the once daily regimen, doses should be diluted in 100ml of n/saline and given over 1 hr. For conventional (multiple daily) dosing regimens, doses of upto 160mg can be given by bolus injection over 3-5 mins.
    • See local guidelines. [SFH guideline][NUH guideline]
     
    Link  MHRA Drug Safety Update (November 2017)
    Link  NUH Memo: Caution – Requirement for additional monitoring when administering gentamicin injectable products
       
    Gentamicin
    (Nebulised)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Red

    Use injection 80mg/2ml

    • SFH: All patients on nebulised antibiotics must be referred to a respiratory specialist nurse.
    • SFH: For nebulisation, preservative free is preferred and dispense stoppered vials rather than ampoules where possible
     
    Link  SFH: Nebulised antibiotics guideline
       
    Neomycin
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red

    Tablet

    • Available at NUH for prophylaxis the day before elective colorectal surgery according to colorectal surgical prophylaxis guideline
    • At SFH: May be used as part of colorectal surgery prophylaxis regime. Contact Medicines Information (3163) if necessary
    • See local guidelines. [SFH guideline][NUH guideline]
     
       
    Tobramycin
    (injection)
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red

    Injection

    • Restricted antibiotic
    • NUH only: We are currently unable to process tobramycin levels in house within pathology at NUH due to a problem with the assay kit. Therefore samples are being sent to Derby for tobramycin levels. Samples are being sent on a van run in the mornings Monday-Friday and Derby aim to have a result ready by 4pm on the day of receipt. The Derby system is not linked to the NUH system and therefore the pathology lab cannot put the result on to NOTIS until they receive the paper report from Derby which can take a week. Therefore, if clinical teams need the result back more urgently, which we would need as waiting a week is too long then the clinical team need to contact the enquiries line number at Derby on 01332 789400. Any queries please feel free to contact Tim Hills (780-6631) or Annette Clarkson (780-7589).
    • See local guidelines. [SFH guideline][NUH guideline]
     
       
    Tobramycin inhaler (TOBI Podhaler®)
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red
    High Cost Medicine
    Homecare

    Dry powder for inhalation

    • For patients with CF only
    • NUH: To be prescribed from the hospital only (not GPs) - in line with commissioning policy and NICE
    • Available through homecare for NUH patients. Please contact pharmacy medicines homecare team for further information
     
    Link  Link to reviews
    Link  NICE: Cystic fibrosis (pseudomonas lung infection) - colistimethate sodium and tobramycin (TA276)
       
    Tobramycin
    (Nebulised)
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red
    High Cost Medicine
    Homecare

    Nebuliser solution

    • For respiratory consultant initiation only.
    • Available through homecare for NUH patients. Please contact pharmacy medicines homecare team for further information
    • Vantobra brand non-formulary (no formal submission APC May 2015)
    • SFH notes: 
      • Use phenol-free injection solution (Teva, Hospira (Pfizer) or Actavis brand).
      • All patients on nebulised antibiotics must be referred to a respiratory specialist nurse.
      • CF patients to use product licensed for CF.
     
    Link  Link to reviews
    Link  SFH: Policy for the prescription, administering and monitoring of nebulised antibiotics in adults
       
    05.01.05  Macrolides to top
    Azithromycin
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Amber 2

    Tablet*, Injection, Oral suspension (200mg/5ml)

    • Restricted antibiotic: see local guidelines [SFH guideline][NUH guideline]
    • Amber 2 for Cystic Fibrosis and Chronic Chest Infections in children (long term use)
    • Amber 2 for non-CF bronchiectasis (long term use)
    • Amber 2 for patients with recurrent or chronic chest infections/recurrent purulent sputum as a 1-3 month initial trial (advised by a respiratory physician)
    • *Tablets are significantly cheaper than capsules in primary care (see Preferred Prescribing List). It is acceptable to swap between tablets and capsules. Tablets don't have the requirement to take on an empty stomach.
    • GPs may initiate in line with Nottinghamshire Primary Care antimicrobial guidelines.
     
    Link  Link to reviews
    Link  NICE evidence summary: Long-term azithromycin for CF
    Link  NICE evidence summary: Long-term azithromycin for non-CF bronchiectasis
       
    Clarithromycin
    View adult BNF View SPC online View childrens BNF
    Formulary
    Green
  • Usually macrolide of choice
  • Tablet, suspension (125mg in 5ml)
  • Injection - Restricted antibiotic: see local guidelines [SFH guideline][NUH guideline]
  • Use of rifampicin and clarithromycin for hirdradenitis suppurativa should only be initiated by a dermatology specialist 
  • Link  Impetigo guideline (Notts APC)
    Link  Link to reviews
       
    Erythromycin
    View adult BNF View SPC online View childrens BNF
    Formulary
    Green
    Tablet, Oral suspension (125mg or 250mg in 5ml), Injection Restricted
  • Clarithromycin preferred for most patients
  • Injection is a restricted antibiotic: see local guidelines [SFH guideline][NUH guideline]
  • Prokinetic erythromycin should only be used in critically ill patients when other treatments have failed due to risk of resistance - UKMI Q&A dose advice 
  • Link  Impetigo guideline (Notts APC)
    Link  Link to reviews
    Link  MHRA: Erythromycin- caution required due to cardiac risks (QT prolongation)
    Link  NICE Evidence summary: Erythromycin for gastroparesis in adults
    Link  UKMI Q &A: Erythromycin and Statin Interaction
       
    05.01.06  Clindamycin
    Clindamycin
    View adult BNF View SPC online View childrens BNF
    Formulary
    Amber 3

    Capsule, liquid 75mg/5ml (unlicensed- Named patient use),
     Injection

    • AMBER 3 for use in line with APC antimicrobial guidelines
    • Pseudomembranous colitis is a serious toxic effect of clindamycin
    • 90% bioavailability orally so IV often unnecessary. IV relatively expensive and irritant 
    • If needed capsules can be opened and the contents mixed with water, but the contents may smell and taste offensive so mix with orange juice or maple syrup for patients with swallowing difficulties. More Info
    • Traffic Light classification of red when used as prophylaxis for endocarditis
    • See local guidelines. [SFH guideline][NUH guideline]
     
       
    05.01.07  Some other antibacterials
    Dalbavancin
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red

    Infusion

    • NUH OPAT service only: Restricted antibiotic: see local guidelines [NUH guideline]
     
       
    Pristinamycin
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red

    Tablets (unlicensed)

    NUH only.  Approved for:

    • Treatment of bone and joint infections as well as deep soft tissue infections within the OPAT specialty only on microbiology recommendation only.
    • Treatment of M. genitalium infection on GU Medicine specialist advice only (consultant/SAS)

    - Restricted antimicrobial: see NUH restricted antimicrobials list [NUH guideline]

     
       
    Rifaximin (Xifaxanta®)
    (C.Diff and SIBO)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Red
    Tablets (200mg)
  • NUH only: management of recurrent C.Difficile as per local policy
  • NUH only: Small Intestinal Bacterial Overgrowth
    (unlicensed indications)
    Non-formulary, Awaiting submission for Traveller's diarrhoea and Pouchitis 
  • Link  Link to reviews
    Link  NICE evidence summary: Rifaximin for pouchitis
       
    05.01.07  Chloramphenicol
    Chloramphenicol
    (Systemic)
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red
    Capsule, injection
  • Restricted antibiotic: see local guidelines
  • See local guidelines. [SFH guideline][NUH guideline
  •    
    05.01.07  Fosfomycin
    Fosfomycin
    View adult BNF View SPC online View childrens BNF
    Formulary

    Sachets

    Amber Traffic Light  Amber 3 (initiate as per APC guideline) for UTIs according to guidelines. See primary care or local guidelines [SFH guidelines][NUH guideline]

    Intravenous infusion (Fomicyt®)

    Red Traffic Light NUH only Restricted antibiotic: see local guidelines. [NUH guideline]

     
    Link  Link to reviews
    Link  NICE Evidence summary: Fosfomycin for resistant urinary tract infections
    Link  NUH Memo: Adult dosing, preparation and administration of Fomicyt® brand
       
    05.01.07  Fusidic acid to top
    Sodium fusidate
    Formulary
    Amber 2

    Tablet, suspension

    • For use in Staphylococcus aureus infections, in combination with other agents
    • The syrup form is fusidic acid, the tablet form is sodium fusidate. Remember dose conversion when switching between tablets and syrup (500mg sodium fusidate tablets= 750mg fusidic acid syrup). See table of liquid medicines requiring dose adjustment
    • Fusidic acid 250mg/5ml syrup is expensive. See unexpectedly expensive medicines list 
    • Injection discontinued 2013
    • See local guidelines. [SFH guideline][NUH guideline]
     
    Link  MHRA safety update on interaction with statins, Sept 11
       
    05.01.07  Vancomycin and teicoplanin
    Teicoplanin (Targocid®)
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red
    Injection
  • See local guidelines. [SFH guideline][NUH guideline]
  • When used in line with the Community IV antibiotic pathway (APC Jan 15) 
  •    
    Vancomycin
    (IV)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Red
    Injection
  • See local guidelines. [SFH guideline][NUH guideline]
  • NUH only Vancomycin Prefilled Syringe (125mg in 30mL) approved for continuous infusion within the Neonatal Units as per guideline. Unlicensed medicine - named patient use only. 
  •    
    Vancomycin
    (Oral)
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Amber 3

    Capsule, injection used orally (certain brands licensed), oral solution (unlicensed)

     
       
    05.01.07  Daptomycin
    Daptomycin (Cubicin®)
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red
    Infusion
  • Regular CPK monitoring required
  • See local guidelines. [SFH guideline][NUH guideline
  • Link  Link to reviews
       
    05.01.07  Linezolid
    Linezolid
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Amber 2

    Tablet, Infusion

    • Restricted antibiotic - microbiologist recommendation only
    • Oral bioavailability ~100%. SFH - Use IV only where strictly necessary
    • SFH - Current supply problems with IV (March 2021) - If needed tablets can be crushed and dispersed in water. Zyvox brand disperses well (unlicensed) More Info
    • CHM advice: Full blood counts to be monitored weekly (see SPC for details - click yellow link below the drug name)
    • CHM advice: Severe optic neuropathy may occur rarely, particularly if linezolid is used for longer than 28 days. Advise patients to report any visual symptoms immediately. Patients who require >28 days therapy should have regular formal visual assessments
    • See local guidelines. [SFH guideline][NUH guideline]
     
    Link  Linezolid and SSRIs FAQ
    Link  Link to reviews
       
    05.01.07  Polymyxins
    Colistimethate
    View adult BNF View SPC online View childrens BNF
    Formulary
    Red
    Tablet, Syrup, Injection
  • Restricted antibiotic: see local guidelines 
  • Link  Link to reviews
    Link  UKMI: Safety Assessment for Different Formulations
       
    Colistimethate for nebulisation (Colomycin®)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Amber 2
    High Cost Medicine

    Injection (Colomycin® brand licensed for nebulisation)

    • Approved for CF and non-CF bronchiectasis on specialist initiation.
    • High cost medicine when used in cystic fibrosis only.
    • SFH: All patients on nebulised antibiotics must be referred to a respiratory specialist nurse.
    • SFH Patient Information Leaflet found here
     
    Link  Link to reviews
    Link  NICE ESUOM25: Non-cystic fibrosis bronchiectasis: colistimethate sodium
    Link  Notts APC guideline for non-CF bronchiectasis
    Link  SFH: Policy for the prescription, administering and monitoring of nebulised antibiotics in adults
       
    Colistimethate inhaler (Colobreathe®)
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red
    High Cost Medicine
    Homecare

    Inhalation powder, hard capsule with inhaler

    • Available for use in line with NICE for:
      - NUH:treating pseudomonas lung infection in cystic fibrosis NICE TA276
    • For non-cystic fibrosis bronchiectasis use Colomycin® brand.
    • Available through homecare for NUH patients. Please contact pharmacy medicines homecare team for further information
     
    Link  MHRA: Colobreathe: risk of capsule breakage—new instructions for use
    Link  NICE: Cystic fibrosis (pseudomonas lung infection) - colistimethate sodium and tobramycin (TA276)
       
    Colistimethate (Promixin®)
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    High Cost Medicine
    Homecare

    Nebule


    Red Traffic Light  For new patients. Not routinely commissioned for indications other than cystic fibrosis - contact pharmacy (at SFH 3163) for more information.
    Amber Traffic Light  For existing patients already receiving supplies from primary care. Repatriation of these patients is not expected.

    • Requires a different nebuliser to the Colomycin brand of colistin which has a shorter administration time. Approximately twice the price of Colomycin.
    • For non-cystic fibrosis bronchiectasis use Colomycin® brand.
    • Available through homecare for NUH patients. Please contact pharmacy medicines homecare team for further information
     
       
    05.01.07  Rifaximin to top
    Rifaximin (Targaxan®)
    (Encephalopathy)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Amber 2
    Tablets (550mg).
  • For use in recurrent hepatic encephalopathy. Option as per NICE TA337
  • See Xifaxanta® entry for management of recurrent C.Difficile, Small Intestinal Bacterial Overgrowth, pouchitis (unlicensed indications) and travellers diarrhoea.
  • Tablets disperse in water if needed. They do not dissolve well, so make sure all of the drug is recovered (it also tastes very bitter). See here for general advice on dispersing tablets. 
  • Link  Link to reviews
    Link  NUH: Guideline for the management of Clostridium difficile infection and antibiotic-associated diarrhoea in adults
       
    05.01.07  Fidaxomicin
    Fidaxomicin (Dificlir®)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Amber 2
    High Cost Medicine

    Tablets

    • Microbiologist recommendation only for the treatment of recurrent clostridium difficile as per antimicrobial guidelines.
    • Low anticipated numbers per year in primary care (<5)
    • Very expensive (10 day course approx £1350)
    • Fidaxomicin is licensed in UK and available via standard wholesalers, but is unlikely to be stocked in community pharmacies. Supplies may be obtained from hospital pharmacy departments if undue delay in initiation is anticipated
     
    Link  Link to reviews
    Link  PHE: management and treatment of Clostridium difficile infection May 2013
    Link  Primary care antimicrobial guidelines
       
    05.01.08  Sulphonamides and trimethoprim
    Trimethoprim
    View adult BNF View SPC online View childrens BNF
    Formulary
    Green

    Tablet & supension

    • Second line for Lower UTI and Upper UTI in primary care as per Antimicrobial Guidelines
    • See local guidelines for place in therapy in Secondary Care. [SFH guideline][NUH guideline]
    • SFH: Testing shows tablets disperse well in the barrel of an oral syringe or pot of water and may be administered by NG tube. Avoid crushing due to theoretical risk of contact sensitisation to powder.  See here for general advice on dispersing tablets.
     
       
    Co-trimoxazole
    View adult BNF View SPC online View childrens BNF
    Formulary
    Amber 3

    Tablet 480mg (Forte tablet is non formulary), Suspension, Injection

    • Amber 3 in line with APC antimicrobial guidelines
    • NUH: Restrictions in use to preserve remaining stocks see memo
    • SFH: Good oral bioavailabilty. Oral acceptable in most cases. >48 hours IV treatment should be discussed with microbiology.
    • Restricted antibiotic - See local guidelines. [SFH guideline][NUH guideline]
    • Liquid available, but if needed tablets disperse in water to make a fine suspension [picture]. Make sure the tube is flushed well afterwards.
     
       
    Sulfadiazine
    View adult BNF View SPC online View childrens BNF
    Formulary
    Red

    Tablet

    • On microbiology advice only
     
       
    05.01.09  Antituberculosis drugs
    Aminosalicylic acid (Granupas®)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Red
    Granules, e/c
    NUH:
  • Restricted to respiratory/ID consultant recommendation only, post MDT decision
  • Restricted for use in adult patients with multi-drug-resistant tuberculosis 
  •    
    Bedaquiline (Sirturo® )
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red
    High Cost Medicine

    Tablet

    NUH: Approved in accordance with NHS England commissioning policy for multi drug resistant tuberculosis (MDR-TB) and extensively drug resistant tuberculosis (XDR-TB).

     
    Link  Link to reviews
    Link  NHS England Reference: 201203P: MDR-TB and XDR-TB bedaquiline and delamanid
       
    Capreomycin (Capastat®)
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red
    Injection
    Restricted for use in resistant tuberculosis
     
       
    Cycloserine
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red

    Capsule
    Restricted for use in resistant tuberculosis
    May 2020 - long term supply problems. Unlicensed imports may be required.

     

     
       
    Ethambutol
    View adult BNF View SPC online View childrens BNF
    Formulary
    Red

    Tablet

    • Tablets disperse in water if needed. See here for general advice on dispersing tablets.
    • If liquid is needed for paediatric use, local recommended strength is 400mg/5mL as per RCPCH guidance.
    • See local guidelines. [SFH guideline][NUH guideline]
     
       
    Isoniazid
    View adult BNF View SPC online View childrens BNF
    Formulary
    Red
    Tablet
    Elixir 50mg/5ml (unlicensed)
    Injection
  • See local guidelines. [SFH guideline][NUH guideline
  •    
    Prothionamide
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red
    Capsule (Unlicensed- Named patient use)
    Restricted for use in resistant tuberculosis 
       
    Pyrazinamide
    View adult BNF View SPC online View childrens BNF
    Formulary
    Red

    Tablet, liquid (unlicenced - recommended strength is 500mg/5mL as per RCPCH guidance)

    • Tablets disperse in water (within 1-5 minutes) if needed. See here for general advice on dispersing tablets.
    • Unlicenced liquid for paediatric patients only where tablets are unsuitable.
    • See local guidelines. [SFH guideline][NUH guideline]
     
       
    Rifabutin (Mycobutin®)
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red
    Capsule
    Restricted for use in mycobacterial disease 
       
    Rifampicin and Isoniazid (Rifinah® 300)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Red
    Tablet 
       
    Rifampicin and Isoniazid (Rifinah® 150)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Red
    Tablet 
       
    Rifampicin and Isoniazid (Rimactazid® 300)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Red
    Tablet 
       
    Rifampicin and Isoniazid and Pyrazinamide (Rifater®)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Red
    Tablet
  • Tablets disperse in water if needed but use seperate components where possible. See here for general advice on dispersing tablets. 
  •    
    Rifampicin, isoniazid, pyrazinamide and ethambutol (Voractiv®)
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red
    Tablet
    NUH only:
  • Selective patients to aid compliance  
  • Link  Link to reviews
       
    Streptomycin Sulphate
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red
    Injection (unlicensed)
    Restricted for use in resistant tuberculosis
    Recipharm preparation is out of stock from Nov 12 until mid 2013. Unlicensed product is available from importers if required. 
       
    Terizidone
    Restricted Drug Restricted
    Red

    Capsule. Unlicensed medicine - named patient use only

    • Restricted for use in resistant tuberculosis in adults when cycloserine is not available. (May 2020 - long term supply problems with cycloserine .)
     
       
    Rifampicin
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Amber 2

    Capsule, Syrup, Infusion

    • on secondary care advice or
    • GP initiation in line with primary care antimicrobial guidelines
    • when used for TB.
    • Should not be used as a single agent (except in meningitis post-exposure prophylaxis)
    • See local guidelines. [SFH guideline][NUH guideline]
    • Use of rifampicin and clarithromycin for hirdradenitis suppurativa should only be initiated on recommendation of a dermatology specialist
     
       
    05.01.10  Antileprotic drugs
    Dapsone
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Amber 2

    Tablet

    • Amber 2 in primary care for Dermatitis herpetiformis
    • FBC, LFTs & U&Es are required 2 & 4 weeks after initiation then monthly.
    • Restricted in secondary care for use on dermatology recommendation, microbiology approval or GU/ID use as 2nd line agent for Pneumocystis carnii pneumonia prophylaxis
    • Tablets disperse in water if needed. See here for general advice on dispersing tablets.
     
       
    Thalidomide
    (Dermatology)
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red
    Capsule- Unlicensed- named patient use only
  • Dermatology consultant request only 
  • Link  SFH: Thalidomide supply procedure
       
    Clofazimine
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red
    Capsule
  • Specialist use 
  •    
    05.01.11  Metronidazole and tinidazole to top
    Metronidazole
    View adult BNF View SPC online View childrens BNF
    Formulary
    Green
    Tablet, Suspension, Infusion, Suppository
  • Liquid not suitable for any enteral tubes that do not end in the stomach (NJ/PEJ/PEGJ) or for patients with diarrhoea
  • Metronidazole 200mg/5ml liquid is expensive. See unexpectedly expensive medicines list.
  • A 2g stat dose should be prescribed as 5x400mg tablets
  • Tablets disperse in water if needed (but tastes terrible). See here for general advice on dispersing tablets.
  • See local guidelines. [SFH guideline][NUH guideline]
     
  • Link  Metronidazole and alcohol advice
    Link  UKMI Q&A: Which medicines require extra care when switching between liquid and tablet/capsule formulations?
       
    05.01.12  Quinolones
     note  CSM Warning – quinolones may induce convulsions in patients with or without a history of convulsions; taking NSAID’s at the same time may also induce them. 4-quinolones may also induce tendon damage. (At the first sign of pain or inflammation treatment should be discontinued).
    Ciprofloxacin
    View adult BNF View SPC online View childrens BNF
    Formulary
    Amber 3

    Tablet, Suspension, Infusion

    • Third line for Upper UTI in Primary Care as per Antimicrobial Guidelines.
    • Liquid available (250mg in 5ml), but tablets disperse in water if needed. See here for general advice on dispersing tablets.
    • For putting down tubes: Liquid should NOT be used for administration via enteral tubes as the beads can cause blockages. Instead use dispersed tablets. Also stop the feed for at least one hour before and after otherwise ciprofloxacin absorption is markedly reduced.
    • 500mg orally gives equivalent AUC to 400mg IV. 750mg orally gives higher AUC and same peak.
    • See local guidelines. [SFH guideline][NUH guideline][Primary Care guidelines]
     
       
    Levofloxacin
    View adult BNF View SPC online View childrens BNF
    Formulary
    Amber 3

    Tablet, Infusion
    Oral Solution (NUH Only) - Unlicensed medicine - named patient use only

    • May be prescribed in primary care following reported sensitivities
    • Tablets disperse in water if needed but some brands have a flaky coating which makes this difficult and it takes a few minutes for the coating to dissolve when mixed with water. See here for general advice on dispersing tablets.
    • Oral bioavailability is 99%. Always use oral when route available.
    • See local guidelines. [SFH guideline][NUH guideline][Primary Care guidelines]
    • May not be used for inhalation in Cystic Fibrosis without an individual funding request being approved.
    •   NUH Only oral solution for acute mastoiditis in paediatric patients who have a severe penicillin allergy
     
    Link  Link to reviews
       
    Levofloxacin (Quinsair®)
    (Inhaled)
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red
    High Cost Medicine

    Nebules

    NUH: Approved in accordance with the NHS England commissoning policy (NHS England Reference: 170078P) for chronic Pseudomonas lung infection in cystic fibrosis (adults).

     
    Link  Clinical Commissioning Policy: Levofloxacin nebuliser solution for chronic Pseudomonas lung infection in cystic fibrosis (adults)
       
    Ofloxacin
    View adult BNF View SPC online View childrens BNF
    Formulary
    Amber 3

    Tablet

     
       
    Moxifloxacin
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red
    Tablet, Injection
  • Restricted antibiotic: See local guidelines. [SFH guideline][NUH guideline
  • Link  Link to reviews
       
    05.01.13  Urinary-tract infections
    Nitrofurantoin
    View adult BNF View SPC online View childrens BNF
    Formulary
    Green

    MR capsules, capsules, tablets

    • In primary care (and at SFH), MR capsules recommended in antimicrobial guidelines. If immediate release are to be used, prescribe tablets in primary care, and capsules in secondary care (different pricing).
    • Oral suspension is £525 a bottle! For people that need suspension consider alternative options (see links below). Also see unexpectedly expensive medicines list.
    • First line for Lower UTI, UTI in pregnancy. See Primary Care Antimicrobial Guidelines
    • Contraindicated in most patients with an eGFR<45ml/min, but see MHRA (link below) and local guidance for exceptions. [SFH advice][NUH advice]
    • If used long term for prophylaxis monitor full blood count, renal function and liver function tests every 3-6 months
    • Advise the patient on the risk of pulmonary and hepatic fibrosis, peripheral and optic neuropathy and the symptoms to report if they develop during treatment
    • See local guidelines. [SFH guideline][NUH guideline]
     
    Link  MHRA: Nitrofurantoin contraindicated in most patients with an eGFR < 45 ml/min (Sept 14)
    Link  NUH: Guidance on nitrofurantoin for patients with enteral tubes and swallowing difficulties
    Link  SFH: Nitrofurantion liquid / crushing tablets information
       
    Trimethoprim
    View adult BNF View SPC online View childrens BNF
    Formulary
    Green
    See section 5.1.8 
       
    Methenamine Hippurate (Hiprex®)
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Amber 2
    Methenamine may be advised by:
  • Urologists or Infectious Diseases physicians (Amber 2 classification),
    if there are no suitable alternative therapies, due to:
  • Multi-resistant organisms,
  • Allergies, contraindications, or side-effects with prophylactic antibiotics,
  • High-risk patients for whom prophylactic antibiotics are not appropriate e.g. C.difficile carriage.
    Treatment should stop after 6 months and patient should be referred back to the advising Specialist if relapses or side-effects occur. Please refer to BNF for dosing advice. 
  • Link  Relative cost of treatments for recurrent UTI
       
    05.02  Antifungal drugs
    Lipid-complex amphotericin (Abelcet®)
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red
    High Cost Medicine

    Infusion

    • Available at NUH only - see restricted antimicrobials list
     
    Link  NUH haematology guidelines
    Link  NUH microbiology guidelines
       
    Liposomal amphotericin (AmBisome®)
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red
    High Cost Medicine

    Infusion

    Available at NUH only:

    • Approved for use, via the nebulised route, as prophylaxis against COVID-19 associated pulmonary aspergillosis (CAPA) in mechanically-ventilated ITU patients with COVID-19 infection. Unlicensed indication - named patient use only.
     
    Link  NUH guidelines - see restricted antimicrobials list
    Link  NUH haematology guidelines
    Link  SFH: Information about IV filters
       
    Amphotericin (Fungizone®)
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red

    Approved Clinical Indications:

    • For intravitreal use and for eye/ear drop preparation only
    • Use via intrathecal route on the advice of consultant microbiologist only (NUH only).
    • NB: other amphotericin preparations are used for iv administration
     
    Link  MHRA: potentially fatal adverse reaction if amphotericin products confused
    Link  NPSA alert on injectable amphotericin
       
    Fluconazole
    View adult BNF View SPC online View childrens BNF
    Formulary
    Green
    Capsule (50mg, 150mg, 200mg), Oral suspension (expensive), Infusion.
  • NUH: infusion restricted - see trust guidelines
  • See link for interactions of fluconazole. 
  • Link  Mouthcare products available for adults at SFH
    Link  NUH guidelines
    Link  UKMI Q&A: Can oral fluconazole be used with breastfeeding?
       
    Flucytosine (Ancotil®)
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red

    Tablets 500mg (Unlicensed medicine - named patient use only)

    Available at NUH only:

    • Restricted for proven systemic yeast infections. Discuss with microbiologist - Serum assays required to minimise toxicity.
     
    Link  NUH guidelines
    Link  NUH restricted antimicrobials list
       
    Griseofulvin
    View adult BNF View SPC online View childrens BNF
    Formulary
    Green
    Tablet
  • For scalp and dermatophyle infections in children 
  •    
    Isavuconazole (Cresemba®)
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red
    Capsules, Powder for Infusion
  • Available at NUH only - see restricted antimicrobials list
    IV isavuconazole must be administered using a giving set with an in-line filter – See NUH antimicrobial website for further information.
     
  •    
    Itraconazole
    View adult BNF View SPC online View childrens BNF
    Formulary
    Green
    Capsule, Liquid 
    Link  NUH guidelines
    Link  UKMI Q&A: Which medicines require extra care when switching between liquid and tablet/capsule formulations?
       
    Posaconazole (IV) (Noxafil®)
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red
    High Cost Medicine
    NUH only
    Infusion
  • Restricted for use in adult patients on recommendation of microbiology or in line with haematology guidelines
    See Microbiology guidelines - restricted agent or Haematology guidelines
     
  • Link  Posaconazole tablet and oral suspension not interchangeable - HCP letter
       
    Posaconazole (oral) (Noxafil®)
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red
    High Cost Medicine

    Suspension 200mg in 5mL

     
    Link  Link to reviews
    Link  NUH monitoring information
    Link  NUH restricted antimicrobials list
    Link  Posaconazole tablet and oral suspension not interchangeable - HCP letter
    Link  UKMI Q&A: Which medicines require extra care when switching between liquid and tablet/capsule formulations?
       
    Terbinafine
    View adult BNF View SPC online View childrens BNF
    Formulary
    Green

    Tablet

    • For use in severe tinea infections where oral therapy is appropriate as per APC antimicrobial guidance.
    • Tablets disperse in water if needed. See here for general advice on dispersing tablets.
     
       
    Voriconazole (Vfend®)
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red
    High Cost Medicine

    Tablet, Suspension, Infusion

     
    Link  MHRA: reminder of risk of liver toxicity, phototoxicity, and squamous cell carcinoma
    Link  NUH monitoring information
    Link  NUH restricted antimicrobials list
       
    05.02  Drugs used in fungal infections
    05.02.01  Triazole antifungals to top
    05.02.02  Imidazole antifungals
    05.02.03  Polyene antifungals
    05.02.04  Echinocandin antifungals
    Caspofungin
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red
    High Cost Medicine

    Infusion

    • At NUH: First line echinocandin. Approved for use in paediatric patients and adult haematology See Haematology guidelines or Microbiology guidelines
    • At SFH: Approved to be used for neutropenic patients with approval of consultant haematologist and microbiologist. Contact High Cost Drugs Team ext 4567 for more information. See local guideline below.
    • See local guidelines. [SFH guideline][NUH guideline]
     
    Anidulafungin (Ecalta®)
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red
    High Cost Medicine

    Infusion

    • Approved for use in adults. Not licensed in under 18s.
    • Second line  echinodandin where caspofungin is deemed inappropriate e.g moderate to severe liver impairment (Child Pugh score >7) . First line use in haematology remains caspofungin [NUH guideline] [SFH guideline]
     
    Link  Link to reviews
       
    Micafungin (Mycamine®)
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red
    High Cost Medicine

    Infusion

    • At NUH: removed from formulary as of 6th June 2016.
    • At SFH: not routinely stocked. Available on Microbiologist request only.
    • See local guidelines. [SFH guideline][NUH guideline]
    • Prescriber checklist available via the SPC - see risk materials tab at the top of the SPC.
     
    Link  Link to reviews
       
    05.02.05  Other antifungals
    05.03  Antiviral drugs to top
    Remdesivir (Veklury®)
    View adult BNF View SPC online
    Restricted Drug Restricted
    Red

    Infusion

    Available at SFH:

    • Approved in accordance with the interim clinical commissioning policy for the treatment of COVID-19
    • See flowchart for requesting Remdesivir
    • See antimicrobial website for further details on prescribing and supplying Remdesivir

    Available at NUH:

    • Approved for the treatment of children with coronavirus disease 2019 (COVID-19) who require invasive mechanical ventilation who meet the criteria of the compassionate access scheme.
    • Approved in accordance with the NHS England interim clinical commission policy for the treatment of patients hospitalised with coronavirus disease 2019 (COVID-19) (adults and children 12 years and older) of who meet the clinical criteria. (see NUH guideline)
     
    Link  Interim Clinical Commissioning Policy: Remdesivir for patients hospitalised with COVID-19
    Link  NICE Evidence Summary 27: remdesivir for Covid-19
    Link  NUH guideline: IV Remdesivir
       
    05.03.01  HIV infection
     note 

    At SFH: PEP packs are available from GU Medicine, A&E (KMH) and Newark emergency cupboard. These packs should be used at all times of the day (not just out of hours) and a request for a replacement pack sent to pharmacy. The current regime is one Truvada  tablet (245mg tenofovir + 200mg emtricitabine) o.d. plus raltegravir 400mg b.d.

    Atazanavir sulfate and cobicistat (Evotaz®)
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red
    High Cost Medicine
    Homecare

    Tablet

    • NUH: Restricted to ID / GU Medicine advice only, in accordance with commissioning approval.
    • Available through homecare for NUH patients. Please contact pharmacy medicines homecare team for further information

     

    • SFH:  Available at SFH for patients under the care of GU medicine in accordance to commissioning guidelines
     
       
    Bictegravir, emtricitabine and tenofovir alafenamide (Biktarvy®)
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red
    High Cost Medicine
    NHS England
    Homecare

    Tablet

    Available at NUH only:

     

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

     

    SFH:  Available at SFH for patients under the care of GU medicine in accordance to commissioning guidelines

     
       
    Cobicistat (Tybost®)
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red
    High Cost Medicine
    Homecare

    Tablet

    • NUH Only Restricted to ID / GU Medicine advice only, in accordance with commissioning approval.
      Pharmacoenhancing agent - increases systemic levels of co-administered agents that are metabolised by CYP3A.
    • Available through homecare for NUH patients. Please contact pharmacy medicines homecare team for further information
     
    Link  Link to reviews
    Link  MHRA Drug Safety Update (Dec 2016)
       
    Emtricitabine + rilpivirine + tenofovir alafenamide (Odefsey®)
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red
    High Cost Medicine
    Homecare

    Tablet

    • Restricted to ID / GU Medicine advice only
    • Approved in accordance with commissioning guidance (policy NHS England 16043/P and subsequent Specialised Services Circular 1672)
    • Available through homecare for NUH patients. Please contact pharmacy medicines homecare team for further information

    SFH:  Available at SFH for patients under the care of GU medicine in accordance to commissioning guidelines

     
       
    Tenofovir alafenamide, elvitegravir, cobicistat & emtricitabine (Genvoya®)
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red
    High Cost Medicine
    Homecare

    Tablets
    NUH Only: Restricted to ID / GU Medicine advice only, in accordance with commissioning guidance.

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

     

    SFH:  Available at SFH for patients under the care of GU medicine in accordance to commissioning guidelines

     
       
    05.03.01  Nucleoside reverse transcriptase inhibitors
    Abacavir (Ziagen®)
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red
    High Cost Medicine
    Homecare

    Tablet, Oral Solution

    • Restricted to ID / GU Medicine advice only
    • Available through homecare for NUH patients. Please contact pharmacy medicines homecare team for further information
     
       
    Abacavir and Lamivudine
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red
    High Cost Medicine
    Homecare

    Tablet

    • Restricted to ID / GU Medicine advice only
    • Prescriptions must state whether Kivexa® brand or the generic preparation should be supplied.
    • Generic should be used unless reason specified by Consultant for using Kivexa
    • Available through homecare for NUH patients. Please contact pharmacy medicines homecare team for further information
     
       
    Abacavir and Lamivudine and Zidovudine (Trizivir®)
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red
    High Cost Medicine
    Homecare

    Tablet

    • Restricted to ID / GU Medicine advice only
    • Available through homecare for NUH patients. Please contact pharmacy medicines homecare team for further information
     
       
    Didanosine (Videx®)
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red
    High Cost Medicine

    Tablet,Capsule EC, Powder for suspension (named patient)

    • Restricted to ID / GU Medicine advice only
    • Tablets disperse in water if needed. See here for general advice on dispersing tablets.
    • Dispersible tablets discontinued September 2017, capsules expected to be discontinued Q1 2020
     
       
    Emtricitabine (Emtriva®)
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red
    High Cost Medicine
    Homecare

    Capsule, Oral Solution

    • Restricted to ID / GU Medicine advice only
    • Available through homecare for NUH patients. Please contact pharmacy medicines homecare team for further information
    • Emtriva 200mg hard capsule is approximately equivalent to 24mL(240mg) Emtriva 10mg/mL oral solution. (See table of liquid medicines requiring dose adjustment)
     
       
    Emtricitabine + tenofovir alafenamide (Descovy®)
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red
    High Cost Medicine
    Homecare

    Tablet

    • Restricted to ID / GU Medicine advice only
    • Approved in accordance with commissioning guidance (policy NHS England 16043/P and subsequent Specialised Services Circular 1672)
    • Available through homecare for NUH patients. Please contact pharmacy medicines homecare team for further information
     
       
    Emtricitabine 200mg, Rilpivirine 25mg and Tenofovir 245mg (Eviplera®)
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red
    High Cost Medicine
    Homecare
    • Restricted to ID / GU Medicine advice only
    • Available through homecare for NUH patients. Please contact pharmacy medicines homecare team for further information
     
    Link  Link to reviews
       
    Lamivudine (Epivir®)
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red
    High Cost Medicine
    Homecare

    Tablet, Oral Solution

    • For HIV infection in combination with other antiretroviral drugs
    • Restricted to ID / GU Medicine advice only
    • Available through homecare for NUH patients. Please contact pharmacy medicines homecare team for further information
     
       
    Lamivudine (Zeffix®)
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red
    High Cost Medicine
    Homecare

    Tablet, Oral Solution- NUH only

    • For chronic hepatitis B infection
    • Restricted to ID / GU Medicine advice only
    • Available through homecare for NUH patients. Please contact pharmacy medicines homecare team for further information
     
    Link  CG165: Chronic Hepatitis B
       
    Rilpivirine hydrochloride (Edurant®)
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red
    High Cost Medicine
    Homecare
    • For HIV infection in combination with other antiretroviral drugs
    • Restricted to ID / GU Medicine advice only
    • Available through homecare for NUH patients. Please contact pharmacy medicines homecare team for further information
     
    Link  Link to reviews
       
    Tenofovir 245mg, Efavirenz 600mg and Emtricitabine 200mg
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red
    High Cost Medicine
    Homecare

    Tablet

    • Restricted to ID / GU Medicine advice only
    • Available through homecare for NUH patients. Please contact pharmacy medicines homecare team for further information
     
    Link  Link to reviews
       
    Tenofovir and Emtricitabine
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red
    High Cost Medicine
    Homecare

    Tablet

    • Restricted to ID / GU Medicine advice only
    • If needed, tablets can be dispersed in 100ml of water, grape or orange juice for patients with swallowing difficulties. See here for general advice on dispersing tablets.
    • Prescriptions must state whether Truvada® brand or the generic preparation should be supplied.
    • SFH: Supply generic unless legitimate need for Truvada® confirmed with prescriber
    • Available through homecare for NUH patients. Please contact pharmacy medicines homecare team for further information
     
       
    Tenofovir Disproxil
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red
    High Cost Medicine
    Homecare

    Tablet, Granules

    • Restricted to ID / GU Medicine advice only
    • NUH: Prescriptions must state whether Viread® brand or the generic preparation should be supplied
    • 7.5 scoops of Viread granules contain approximately 245mg tenofovir disoproxil as fumarate. (See table of liquid medicines requiring dose adjustment)
    • Tablets disperse in half a glass of water or orange juice if needed. See here for general advice on dispersing tablets
    • Available through homecare for NUH patients. Please contact pharmacy medicines homecare team for further information.
     
    Link  Link to reviews
    Link  NICE TA173: Hepatitis B (chronic) - tenofovir disoproxil
       
    Tenofovir, cobicistat, elvitegravir & emtricitabine (Stribild®)
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red
    High Cost Medicine
    Homecare

    Film-coated tablet

    • Restricted to use in accordance with the NHS England commissioning statement
    • Available through homecare for NUH patients. Please contact pharmacy medicines homecare team for further information
     
    Link  Clinical Commissioning Policy: Elvitegravir/cobicistat/emtricitabine/tenofovir for the treatment of HIV in adults
    Link  Link to reviews
       
    Zidovudine (Retrovir®)
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red
    High Cost Medicine
    Homecare

    Capsule, Oral solution, Injection

    • Restricted to ID / GU Medicine and Microbiology advice only
    • Available through homecare for NUH patients. Please contact pharmacy medicines homecare team for further information
     
       
    Zidovudine and lamivudine
    View adult BNF View SPC online View childrens BNF
    Formulary
    Red
    High Cost Medicine
    Homecare
    • The generic combination product of zidovudine 300mg/lamivudine 150mg is now cheaper than the separate ingredients so should be used in preference. This replaces branded Combivir® which formerly was not funded by NHSE on cost grounds.
    • Available through homecare for NUH patients. Please contact pharmacy medicines homecare team for further information
     
       
    05.03.01  Protease inhibitors
    Amprenavir (Agenerase®)
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red
    Capsule, Oral Solution
  • Restricted to ID / GU Medicine advice only
     
  •    
    Atazanavir
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red
    High Cost Medicine
    Homecare

    Capsule

    • Restricted to ID / GU Medicine advice only
    • Available through homecare for NUH patients. Please contact pharmacy medicines homecare team for further information
     
       
    Darunavir
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red
    High Cost Medicine
    Homecare

    Tablets, Oral suspension

    • Restricted to ID / GU Medicine advice only
    • Available through homecare for NUH patients. Please contact pharmacy medicines homecare team for further information
     
    Link  Link to reviews
       
    Darunavir and Cobicistat (Rezolsta®)
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red
    High Cost Medicine
    Homecare

    Tablet

    • NUH Only Restricted to ID / GU Medicine advice only, in accordance with commissioning approval.
    • Available through homecare for NUH patients. Please contact pharmacy medicines homecare team for further information
     
    Link  MHRA: Avoid darunavir with cobicistat in pregnancy
       
    Fosamprenavir (Telzir®)
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red
    High Cost Medicine
    Tablet, Oral Suspension
  • Restricted to ID / GU Medicine advice only
     
  • Link  Link to reviews
       
    Lopinavir and Ritonavir (Kaletra®)
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red
    High Cost Medicine
    Homecare

    Tablet, Liquid 

    • Available through homecare. Please contact pharmacy medicines homecare team for further information.
     
       
    Ritonavir
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red
    High Cost Medicine
    Homecare

    Tablets, Powder for oral suspension sachets

    • 100mg Capsules - supply problem until end 2021. Strictly limited to 2 months supply at once.
    • Restricted to ID / GU Medicine advice only
    • Oral solution (90ml bottles) discontinued Sept 2016
    • Available through homecare for NUH patients. Please contact pharmacy medicines homecare team for further information
     
    Link  MHRA Drug Safety Update
       
    Saquinavir (Invirase®)
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red
    High Cost Medicine
    Capsule, Tablet
  • Restricted to ID / GU Medicine advice only
     
  • Link  MHRA safety advice: update on risk of arrhythmias - reduced dose for initial treatment
       
    Tipranavir (Aptivus®)
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red
    High Cost Medicine
    Capsule
  • Restricted to ID / GU Medicine advice only
     
  • Link  Link to reviews
    Link  UKMI Q&A: Which medicines require extra care when switching between liquid and tablet/capsule formulations?
       
    05.03.01  Non-nucleoside reverse transcriptase inhibitors
    Doravirine (Pifeltro®)
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red
    High Cost Medicine
    Homecare

    Tablet

    • Available through NUH only: Restricted to ID / GU Medicine advice only
    • Approved in accordance with NHS England's Clinical Commissioning Policy: Doravirine for the treatment of HIV-1 in adults
    • Available through homecare for NUH patients. Please contact pharmacy medicines homecare team for further information.

     

     
       
    Doravirine and Lamivudine and Tenofovir disoproxil (Delstrigo®)
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red
    High Cost Medicine
    Homecare

    Tablet

    •Available through NUH only: Restricted to ID / GU Medicine advice only
    •Approved in accordance with NHS England's Clinical Commissioning Policy: Doravirine for the treatment of HIV-1 in adults (190137P)
    •Available through homecare for NUH patients. Please contact pharmacy medicines homecare team for further information

     
       
    Efavirenz (Sustiva®)
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red
    High Cost Medicine
    Homecare

    Capsule, Tablet, Oral Solution

    • Restricted to ID / GU Medicine advice only
    • Oral solution to be discontinued by the end of October 2015. Sustiva can be administered by capsule sprinkle method. Switching from oral solution to capsule sprinkle method may result in higher drug exposures; therefore patient should be monitored for toxicity during transition period
    • Available through homecare for NUH patients. Please contact pharmacy medicines homecare team for further information
     
       
    Etravirine (Intelence®)
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red
    High Cost Medicine
    Homecare

    Tablet

    • Restricted to ID / GU Medicine advice only
    • Available through homecare for NUH patients. Please contact pharmacy medicines homecare team for further information
     
    Link  Link to reviews
       
    Nevirapine
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red
    High Cost Medicine
    Homecare

    Tablet, Suspension, MR Tablet

    • Prescriptions must state whether Viramune® brand or the generic preparation should be supplied.
    • Available through homecare for NUH patients. Please contact pharmacy medicines homecare team for further information
     
       
    05.03.01  Other antiretrovirals to top
    Dolutegravir
    View adult BNF View SPC online View childrens BNF
    Formulary
    Red
    High Cost Medicine
    Homecare

    Tablet

    • NUH and SFH for use in line with NHS England Commissioning statement
    • Available through homecare for NUH patients. Please contact pharmacy medicines homecare team for further information
     
    Link  MHRA: Avoid dolutegravir in women attempting to conceive
       
    Dolutegravir and lamivudine (Dovato®)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Red
    High Cost Medicine
    Homecare

    Tablet

    • Available at NUH Only: Restricted to ID / GU Medicine advice only, for treating HIV-1 infected adults in accordance with the NHS England Clinical Commissioning Policy statement.
    • Available through homecare for NUH patients. Please contact pharmacy medicines homecare team for further information
     
    Link  Clinical Commissioning Policy Statement: Dolutegravir/lamivudine for the treatment of Human Immunodeficiency Virus (HIV-1) infected adults and adolescents over 12 years of age
       
    Dolutegravir and rilpivirine (Juluca®)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Red
    High Cost Medicine
    Homecare

    Tablet

    • Available at NUH Only: Restricted to ID / GU Medicine advice only, for treating HIV-1 in adults in accordance with the NHS England Clinical Commissioning Policy.
    • Available through homecare for NUH patients. Please contact pharmacy medicines homecare team for further information
     
    Link  Clinical Commissioning Policy: Dolutegravir-rilpivirine for treating HIV-1 in adults
       
    Dolutegravir, abacavir & lamivudine (Triumeq®)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Red
    High Cost Medicine
    Homecare

    Tablet

    • NUH and SFH for use in line with NHS England Commissioning statement
    • Available through homecare for NUH patients. Please contact pharmacy medicines homecare team for further information
     
    Link  MHRA: Avoid dolutegravir in women attempting to conceive
       
    Enfuvirtide (Fuzeon®)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Red
    High Cost Medicine

    Injection

    • Restricted to ID / GU Medicine advice only
     
    Link  Link to reviews
       
    Maraviroc (Celsentri®)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Red
    High Cost Medicine
    Homecare

    Tablet

    • Restricted to GU med only
    • NUH approved for adults
    • Available through homecare for NUH patients. Please contact pharmacy medicines homecare team for further information
     
    Link  Link to reviews
       
    Raltegravir (Isentress ®)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Red
    High Cost Medicine
    Homecare

    Film Coated Tablet, Chewable tablet (NUH only),Sachets for oral suspension (NUH only)

    • Restricted to ID / GU Medicine advice only
    • Available through homecare for NUH patients. Please contact pharmacy medicines homecare team for further information
      Note: Doses differ according to formulation used and thus tablets and chewable tablets are not equivalent. When prescribing, the formulation must be specified.
     
    Link  Link to reviews
    Link  NUH Poster: Caution raltegravir doses differ according to formulation
    Link  UKMI Q&A: Which medicines require extra care when switching between liquid and tablet/capsule formulations?
       
    05.03.02  Herpesvirus infections
    05.03.02.01  Herpes simplex and varicella-zoster infection
     note  In immunocompromised patient for treatment or prophylaxis – please refer to specialist protocol or seek expert advice. In pregnancy please seek specialist advice.
    Aciclovir
    View adult BNF View SPC online View childrens BNF
    Formulary
    Green

    Tablet, Suspension, Injection

     
       
    Famciclovir
    View adult BNF View SPC online View childrens BNF
    Formulary
    Amber 2
    Tablets
  • On GUM advice as a 2nd line agent to aciclovir in aciclovir resistant cases of genital herpes. 
  • Link  BASHH Guideline on Genital Herpes
    Link  Famciclovir is relatively expensive- see price graph
       
    Valaciclovir
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Amber 2
    Tablet
  • Restricted for use where compliance with aciclovir is a problem as more expensive than aciclovir.
  • 250mg tablets are significantly more expensive than 500mg.
     
  •    
    05.03.02.02  Cytomegalovirus infection
    Cidofovir infusion
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red
    High Cost Medicine
    Infusion- NUH only
     
       
    Foscarnet Sodium (Foscavir®)
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red
    High Cost Medicine
    Infusion- NUH only
  • Restricted use- see local guidelines
     
  •    
    Ganciclovir
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red
    High Cost Medicine

    Infusion

    • Restricted use- see local guidelines
     
    Link  SFH: Ganciclovir information
       
    Letermovir (Prevymis®)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Red
    High Cost Medicine

    Film-Coated Tablets and Intravenous Infusion

    Available at NUH only:

    • Approved in accordance with NICE TA591 for preventing cytomegalovirus disease after a stem cell transplant in adults
     
       
    Valganciclovir
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red
    High Cost Medicine
    Tablet, Liquid
  • Restricted use-see local guidelines 
  • Link  Link to reviews
       
    05.03.03  Viral hepatitis
    05.03.03.01  Chronic hepatitis B to top
    Adefovir Dipivoxil (Hepsera®)
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red
    High Cost Medicine
    Tablet- NUH only
  • Also used for Lamivudine resistant hepatitis B
  • Not routinely commissioned, hence an Individual Funding Request is required before commencing treatment. Contact the HCD team for further details.
     
  • Link  NICE CG165: Hepatitis B (chronic) - incorporates TA96
    Link  NICE TA96: Hep B - adefovir dipivoxil and pegylated interferon alpha-2a
       
    Entecavir
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red
    High Cost Medicine

    Tablet

    • Use in accordance with NICE guidance (TA153 & CG165)
     
    Link  NICE CG165: Hepatitis B (incorporates TA153)
    Link  NICE TA153: Hepatitis B (chronic) - entecavir
       
    05.03.03.02  Chronic hepatitis C
    Dasabuvir (Exviera®)
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red
    High Cost Medicine

    Tablet
    Only commissioned through specialist centre. Must be prescribed and dispensed at NUH.
    Prior approval via Blueteq system required
    Approved in combination with ombitasvir/paritepravir/ritonavir in accordance with:

    • NICE TA365 for the treatment of chronic hepatitis C
    • commissioning policy (NHS England B07/P/a)
    • NHS England Commissioning Policy Statement (Ref: 170135P) for adults with recent onset (acute) hepatitis. Unlicensed Indication.
     
    Link  NICE TAG365: Ombitasvir–paritaprevir–ritonavir with or without dasabuvir for treating chronic hepatitis C
    Link  Clinical Commissioning Policy Statement: Treatment of chronic Hepatitis C in patients with cirrhosis (NHS England B07/P/a)
       
    Elbasvir/Grazoprevir (Zepatier®)
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red
    High Cost Medicine

    Tablet
    Only commissioned through specialist centre. Must be prescribed and dispensed at NUH.
    Prior approval via Blueteq system required

    Approved in accordance with

    • NICE TA413 for the treatment of chronic hepatitis C and the supporting NHS England commissioning policy.
    • NHS England Commissioning Policy Statement (Ref: 170135P) for adults with recent onset (acute) hepatitis. Unlicensed Indication.
     
       
    Glecaprevir/Pibrentasvir (Maviret®)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Red
    High Cost Medicine

    Film-coated tablets.
    Only commissioned through specialist centre. Must be prescribed and dispensed at NUH.
    Prior approval via Blueteq system required

    Approved in accordance with:

    • NICE TA499 for treating chronic hepatitis C in adults
    • NHS England Commissioning Policy Statement (Ref: 170135P) for adults with recent onset (acute) hepatitis. Unlicensed Indication.
     
    Link  NICE TA499: Glecaprevir–pibrentasvir for treating chronic hepatitis C
       
    Ledipasvir and Sofosbuvir (Harvoni®)
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red
    High Cost Medicine

    Tablet
    Only commissioned through specialist centre. Must be prescribed and dispensed at NUH.
    Prior approval via Blueteq system required
    Approved in accordance with:

    • NICE TA363 for the treatment of chronic hepatitis C
    • commissioning policy (NHS England B07/P/a)
    • NHS England Commissioning Policy Statement (Ref: 170135P) for adults with recent onset (acute) hepatitis. Unlicensed Indication.
     
    Link  NICE TAG363: Ledipasvir–sofosbuvir for treating chronic hepatitis C
    Link  Clinical Commissioning Policy Statement: Treatment of chronic Hepatitis C in patients with cirrhosis (NHS England B07/P/a)
    Link  MHRA: Avoid use of amiodarone with sofosbuvir
       
    Ombitasvir/ paritaprevir/ ritonavir (Viekirax®)
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red
    High Cost Medicine

    Tablet
    Only commissioned through specialist centre. Must be prescribed and dispensed at NUH.
    Prior approval via Blueteq system required
    Approved in combination with or without dasabuvir in accordance with:

    • NICE TA365 for the treatment of chronic hepatitis C
    • commissioning policy (NHS England B07/P/a)
    • NHS England Commissioning Policy Statement (Ref: 170135P) for adults with recent onset (acute) hepatitis. Unlicensed Indication.
     
    Link  NICE TAG365: Ombitasvir–paritaprevir–ritonavir with or without dasabuvir for treating chronic hepatitis C
    Link  Clinical Commissioning Policy Statement: Treatment of chronic Hepatitis C in patients with cirrhosis (NHS England B07/P/a)
       
    Sofosbuvir (Sovaldi®)
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red
    High Cost Medicine

    Tablet
    Only commissioned through specialist centre. Must be prescribed and dispensed at NUH.
    Prior approval via Blueteq system required
    Approved in combination with or without daclatasvir in accordance with:

    • NICE TA330 for the treatment of chronic hepatitis C
    • commissioning policy (NHS England B07/P/a)
    • NHS England Commissioning Policy Statement (Ref: 170135P) for adults with recent onset (acute) hepatitis. Unlicensed Indication.
     
    Link  NICE TA330: Sofosbuvir for treating chronic hepatitis C
    Link  Clinical Commissioning Policy Statement: Treatment of chronic Hepatitis C in patients with cirrhosis (NHS England B07/P/a)
    Link  MHRA: Avoid use of amiodarone with sofosbuvir
       
    Sofosbuvir and Velpatasvir (Epclusa®)
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red
    High Cost Medicine

    Tablet
    Only commissioned through specialist centre. Must be prescribed and dispensed at NUH.
    Prior approval via Blueteq system required
    Approved in accordance with:

    • NICE TA430 for the treatment of chronic hepatitis C
    • NHS England commissioning policy
    • NHS England Commissioning Policy Statement (Ref: 170135P) for adults with recent onset (acute) hepatitis. Unlicensed Indication.
     
    Link  NICE TA430: Sofosbuvir–velpatasvir for treating chronic hepatitis C
       
    Sofosbuvir, Velpatasvir and Voxilaprevir  (Vosevi® )
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red
    High Cost Medicine

    Tablet
    Only commissioned through specialist centre. Must be prescribed and dispensed at NUH.
    Prior approval via Blueteq system required

    Approved in accordance with:

    • NICE TA507 for treating chronic hepatitis C in adults.
    • NHS England Commissioning Policy Statement (Ref: 170135P) for adults with recent onset (acute) hepatitis. Unlicensed Indication
     
    Link  NICE TA507: Sofosbuvir–velpatasvir–voxilaprevir for treating chronic hepatitis C
       
    05.03.04  Influenza
    Oseltamivir (Tamiflu®)
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Green

    Capsule, Suspension

    • For children or in swallowing difficulties the capsule(s) should be opened and added to water or a suitable sugary diluent.
     
    Link  PHE Guidance - Treatment and prophylaxis of seasonal influenza
       
    Zanamivir inhalation (Relenza®)
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Green
    Powder for inhalation 
    Link  Link PHE Guidance - Treatment and prophylaxis of seasonal influenza
       
    Zanamivir Injection
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red

    Injection

    • Restricted for use in the management of H1N1 virus for critically ill patients who; have an Oseltamivir resistant virus, have failed to clear an Oseltamivir sensitive virus despite adequate treatment as evidenced by PCR analysis. See PHE guidance section 1.2 (linked below)
    • On recommendation of critical care consultant and microbiology/ID.
    • IV zanamivir has received UK marketing authorisation and from Dec 2019 is available to order from pharmacy. Stock needs to be ordered on an individual patient basis, and a copy of the prescription (with patient details removed) will need to be sent to Alliance Healthcare.  Please contact Pharmacy if stock is required for your patient.
     
    Link  PHE guidance on use of antivirals (includes ordering information for IV zanamivir)
       
    05.03.05  Respiratory syncytial virus
    Palivizumab (Synagis®)
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red
    High Cost Medicine

    Injection
    Restricted for respiratory syncytial virus (RSV) in paediatrics and in accordance with the Joint Committee on Vaccination and Immunisation.

    • From the winter season 15 16 all use requires prior approval registration via Blueteq. Screening pharmacist to confirm authorisation is in place before treatment is given. At SFH See "Passwords for MI" for access details. Contact High Cost Drugs Pharmacist if problems with blueteq approval.
    • Contact the pharmacy High Cost Drugs teams for further information and setting up access to Blueteq (NUH ext 55992, SFH ext 4660).

    - Approved in accordance with NHS Englands COVID-19 Rapid Policy Statement for RSV in at-risk pre-term infants where specified criteria are met

     
    Link  Blueteq prior approval registration
    Link  Blueteq procedure- approval for palivizumab use
    Link  COVID-19 Rapid Policy Statement: Palivizumab passive immunisation against respiratory syncytial virus (RSV) in at-risk pre-term infants
    Link  Link to reviews
       
    Ribavirin
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red
    High Cost Medicine

    Capsule (Rebetol®), Tablet (Copegus®), Inhalation (unlicensed, named patient, Virazole®), Injection (unlicensed, named patient - NB injection currently unavailable Dec19)

    • Restricted use at NUH only - Approval by microbiology / ID required.
    • This drug is reserved for use in severe respiratory syncytial virus (RSV) bronchiolitis in infants, children and immunocompromised patients. For hepatitis C infection
     
    Link  Link to reviews
    Link  NICE TA106: Hepatitis C - peginterferon alfa and ribavirin
    Link  NICE TA200: Hepatitis C - peginterferon alfa and ribavirin
    Link  NICE TA75: Hepatitis C - pegylated interferons, ribavirin and alfa interferon
       
    05.04  Antiprotozoal drugs
    05.04.01  Antimalarials to top
    Artemether/Lumefantrine (Riamet®)
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red

    20mg/120mg tablets

    • Treatment of acute uncomplicated P falciparum malaria. See NUH guideline for the management of malaria.
    • See local guidelines. [SFH guideline]

     

     
       
    05.04.01  Chloroquine
    Chloroquine
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red

    Tablet,Syrup. (Injection is non formulary)

    • For the treatment of malaria
    • Grey for use as malaria prophylaxis during overseas travel is On the Nottinghamshire list of Medicines & Appliances of Limited Clinical Value that should never be prescribed. Patients should be advised to purchase OTC.
     
    Link  COVID19: Can hydroxychloroquine be used to treat COVID19? (Notts CCG)
       
    05.04.01  Mefloquine
    Mefloquine (Lariam®)
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red

    Tablet

    • For the treatment of malaria only.
    • Grey for use as malaria prophylaxis during overseas travel is On the Nottinghamshire list of Medicines & Appliances of Limited Clinical Value that should never be prescribed. Supply is only available through private prescription.
    • May induce potentially serious neuropsychiatric disorders.
     
    Link  MHRA: Mefloquine may induce serious neuropsychiatric disorders (Oct 13)
    Link  Risk minimisation materials for Lariam (mefloquine) tablets
       
    05.04.01  Primaquine
    Primaquine
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red
    Tablet - unlicensed
  • Tablets disperse in water if needed. See here for general advice on dispersing tablets. 
  •    
    05.04.01  Proguanil
    Proguanil Hydrochloride (Paludrine®)
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red

    Tablet

    • For the treatment of malaria only.
    • Grey for use as malaria prophylaxis during overseas travel is On the Nottinghamshire list of Medicines & Appliances of Limited Clinical Value that should never be prescribed. Patients should be advised to purchase OTC.
     
       
    Proguanil Hydrochloride with Atovaquone
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red

    Tablet

    • For the treatment of malaria only.
    • Grey for use as malaria prophylaxis during overseas travel is on the Nottinghamshire list of Medicines & Appliances of Limited Clinical Value that should never be prescribed. Supply is only available through private prescription.
     
       
    05.04.01  Pyrimethamine to top
    Pyrimethamine and Dapsone
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red
    Tablets (given as individual components)
    Restricted for ID or haematology use 
       
    Pyrimethamine with Sulfadoxine (Fansidar®)
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red
    Tablet 
       
    05.04.01  Quinine
    Quinine
    (malaria)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Red
    Tablets: Quinine sulphate 200mg (quinine bisulphate not stocked)
    Injection: Quinine dihydrochloride 300mg/ml (Unlicensed)
  • Tablets disperse in water if needed. See here for general advice on dispersing tablets. 
  •    
    05.04.02  Amoebicides
    Metronidazole
    (amoebic dysentry)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Green
    See section 5.1.11 
       
    05.04.03  Trichomonacides
    Metronidazole
    (Trichomonacides)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Green
    See Section 5.1.11 
       
    05.04.04  Antigiardial drugs
    Mepacrine
    View adult BNF View SPC online View childrens BNF
    Formulary
    Red

    Tablet (unlicensed)

     
       
    Metronidazole
    (giardia)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Green
    See Section 5.1.11 
       
    05.04.05  Leishmaniacides to top
    05.04.06  Trypanocides
    05.04.07  Drugs for toxoplasmosis
    05.04.08  Drugs for pneumocystis pneumonia
    Atovaquone
    View adult BNF View SPC online View childrens BNF
    Formulary
    Red

    Suspension

     
       
    Co-trimoxazole
    View adult BNF View SPC online View childrens BNF
    Formulary
    Amber 2
    See section 5.1.8 
       
    Pentamidine Isetionate (Pantacarinat®)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Red
    Injection
    Nebules
     
       
    05.05  Anthelmintics
    05.05.01  Drugs for threadworms to top
    Albendazole
    View adult BNF View SPC online View childrens BNF
    Formulary
    Amber 2
    Tablet 400mg (unlicensed import, some products are chewable)
  • Specialist recommendation (discuss specific
    therapies and investigations with a Microbiologist or an Infectious Disease specialist)
  • Available on a named patient basis for certain worm infestations 
  •    
    Mebendazole
    View adult BNF View SPC online View childrens BNF
    Formulary
    Green

    Tablet
    Suspension

    • OTC Patients should be advised to purchase over the counter for adults and children over 2 years

     
       
    05.05.02  Ascaricides
    05.05.03  Drugs for tapeworm infections
    05.05.04  Drugs for hookworms
    05.05.05  Schistosomicides
    PRAZIQUANTEL Tablets 500 mg
    View adult BNF View SPC online View childrens BNF
    Formulary
    Red
    Unlicensed medicine - named patient use only 
       
    05.05.06  Filaricides to top
    05.05.07  Drugs for cutaneous larva migrans
    TIABENDAZOLE 500mg tabs
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red
    Unlicensed medicine - named patient use only 
       
    05.05.08  Drugs for strongyloidiasis
     ....
     Non Formulary Items
    Aciclovir lauriad  (Sitavig)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
    Mucoadhesive buccal tablet
  • No formal submission - treatment of recurrent labial herpes in immunocompetent pts presenting with more than four episodes a year
  •  
    Amoxicillin 1G dispersible tablet

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey

    large scored tablet

    •  Not cost effective against suspension
     
    Ampicillin

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
     
    Atovaquone
    (With proguanil hydrochloride)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
     
    Bezlotuxumab  (Zinplava®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
    No formal assessment
    Link  Link to reviews
     
    Boceprevir  (Victrelis®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
    High Cost Medicine

      Discontinued in the UK.

    Capsule

    • NUH: Alternative protease inhibitor for the treatment of Hepatitis C where the clinician feels there are advantages in the individual case over telaprevir / simeprevir.
    Link  Link to reviews
    Link  MHRA: predicting sepsis, worsening liver function & mortality with boceprevir & telaprevir
    Link  NICE TA253: hepatitis
     
    Cefadroxil

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
     
    Cefpodoxime

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
     
    Cefradine

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
     
    Ceftaroline  (Zinforo®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
    Link  Link to reviews
     
    Ceftobiprole  (Zevtera®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
  • no formal assessment APC May 2015
  •  
    Co-Fluampicil

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
     
    Daclatasvir  (Daklinza®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
    High Cost Medicine

      Discontinued in the UK.

    Tablet
    Only commissioned through specialist centre. Must be prescribed and dispensed at NUH.
    Prior approval via Blueteq system required
    Approved in combination with sofosbuvir in accordance with:

    • NICE TA364 for the treatment of chronic hepatitis C
    • commissioning policy (NHS England B07/P/a)
    Link  NICE TA364: Daclatasvir for treating chronic hepatitis C
    Link  Clinical Commissioning Policy Statement: Treatment of chronic Hepatitis C in patients with cirrhosis (NHS England B07/P/a)
     
    Delamanid  (Deltyba®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
    High Cost Medicine
    Tablets
  • Grey (No formal assessment)
  • Link  Link to reviews
     
    Diloxanide

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey

    Tablet

    • Discontinued
    • For chronic amoebiasis
     
    Dolutegravir, lamivudine & tenofovir  (Acriptega®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
    High Cost Medicine
    Homecare

    No formal assessment

     
    Doxycycline  (Efracea® MR)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
     
    Herafill® beads G

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey

    Discontinued January 2021

     
    Indinavir  (Crixivan®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
    High Cost Medicine
    Capsule
  • Restricted to ID / GU Medicine advice only
  • Feb 2017 - Discontinued
  •  
    Inosine Pranobex  (Imunovir®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
     
    Ketoconazole  (Nizoral®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
    Discontinued due to hepatotoxicity concerns (November 2013).
    Link  Discontinuation notification
     
    Lamivudine & raltegravir  (Dutrebis®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
    High Cost Medicine
  • No formal submission (APC May 15)
  •  
    Lefamulin  (Xenleta®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey

    Oral/IV

    Grey no formal assessment

    •  A novel pleuromutilin antibiotic, a spectrum of activity that is targeted to bacteria that cause CABP

     

    Link  Link to reviews
    Link  NICE evidence summary: Rifaximin for pouchitis
     
    Minocycline

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
    DTB review: Time to say goodbye to minocycline? (password required). Text available from SFH Medicines Information Centre.
    Link  Link to reviews
    Link  NICE therapeutic topic: Minocycline
    Link  UKMI suggested drug monitoring schedule
     
    Nalidixic Acid  (Uriben®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
     
    Nelfinavir  (Viracept®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
    High Cost Medicine
    Due to be discontinued on 23rd Jan 2013
     
    Netilmicin  (Netillin®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
     
    Niclosamide

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Red
    Unlicensed
     
    Norfloxacin

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
     
    Oritavancin  (Orbactiv®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
  • No formal submission
  •  
    Oxytetracycline

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
    Not recommended outside of acne treatment (Dec 16)
     
    Piperazine

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
    Discontinued in UK, 2013 (Pripsen® sachets)
     
    Proguanil Hydrochloride
    (With chloroquine)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey

    Use as malaria prophylaxis during overseas travel is on the Nottinghamshire list of Medicines & Appliances of Limited Clinical Value that should never be prescribed.. Patients should be advised to purchase OTC (classified as grey for this indication).

     
    Pyrimethamine  (Daraprim®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
  • Should not be used as a single agent
  •  
    Rilpivirine, emtrictabine and tenofovir alafenamide

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey

    Not formally assessed (APC Nov 2015)

     
    Simeprevir  (Olysio®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
    High Cost Medicine

      Discontinued in the UK.

    Capsule
    Only commissioned through specialist centre. Must be prescribed and dispensed at NUH.
    Prior approval via Blueteq system required
    Approved in accordance with:

    • NICE TA331 for the treatment of chronic hepatitis C
    • commissioning policy (NHS England B07/P/a)
    Link  NICE TA331: Simeprevir with peginterferon alfa & ribavirin for hepatitis C
    Link  Clinical Commissioning Policy Statement: Treatment of chronic Hepatitis C in patients with cirrhosis (NHS England B07/P/a)
    Link  MHRA: Avoid use of amiodarone with simeprevir
     
    Sinecatechins  (Veregen)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
  • no formal submission APC May 2015
    for external genital and perianal warts
  •  
    Sodium Stibogluconate  (Pentostam®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
     
    SPL7013  (VivaGel®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
    No formal assessement (APC Jan 2016)
     
    Stavudine  (Zerit®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Red
    High Cost Medicine
    Capsule, Oral Solution
  • Restricted to ID / GU Medicine advice only
    To be discontinued from Q1 2020
  •  
    Tedizolid  (Sivextro®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
  • No formal submission
  •  
    Telaprevir  (Incivo®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
    High Cost Medicine

      Discontinued in the UK.

    Tablet

    • NUH: Alternative protease inhibitor for the treatment of Hepatitis C where the clinician feels there are advantages in the individual case over boceprevir / simeprevir.
    Link  Link to reviews
    Link  MHRA: Sepsis, worsening liver function & mortality with boceprevir & telaprevir
    Link  NICE TA252: Telaprevir in hepatitis C
     
    Telavancin

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
    No formal assessment (APC Sept 14)
    Link  Link to reviews
     
    Telithromycin  (Ketek®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
     
    Tenofovir alafenamide fumarate  (Vemlidy®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
  • No formal submission (NUH DTC April 2017)
  •  
    Tinidazole  (Fasigyn®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey

    Discontinued January 2021

     
      
    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

      

    netFormulary