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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.

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05.03.01  Expand sub section  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 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
 
   
Bictegravir, emtricitabine and tenofovir alafenamide (Biktarvy®)
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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.

 
   
Cobicistat (Tybost®)
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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®)
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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
 
   
Tenofovir alafenamide, elvitegravir, cobicistat & emtricitabine (Genvoya®)
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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

 
   
05.03.01  Expand sub section  Nucleoside reverse transcriptase inhibitors
Abacavir (Ziagen®)
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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
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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®)
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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®)
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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®)
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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®)
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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®)
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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®)
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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®)
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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®)
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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
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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
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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
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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®)
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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®)
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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
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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  Expand sub section  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
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    Restricted Drug Restricted
    Red
    High Cost Medicine
    Homecare

    Tablets, Powder for oral suspension sachets

    • 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  Expand sub section  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  Expand sub section  Other antiretrovirals to top
    Dolutegravir
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    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?
       
     ....
     Non Formulary Items
    Dolutegravir, lamivudine & tenofovir  (Acriptega®)

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

    No formal assessment

     
    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
  •  
    Lamivudine & raltegravir  (Dutrebis®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
    High Cost Medicine
  • No formal submission (APC May 15)
  •  
    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
     
    Rilpiverine, emtrictabine and tenofovir alafenamide

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
    Not formally assessed (APC Nov 2015)
     
    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
  •  
      
    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