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 Formulary Chapter 10: Musculoskeletal and joint diseases - Full Chapter
Notes:
Please contact EKHUFT Medicines Information ext. 7236001 or 01233 616001 with any queries.NHS
 Details...
10.01.03  Expand sub section  Drugs which suppress the rheumatic disease process
 note 

Restricted Item ALL SPECIALIST USE ONLY - RESTRICTED

10.01.03  Expand sub section  Gold
10.01.03  Expand sub section  Penicillamine
10.01.03  Expand sub section  Antimalarials
10.01.03  Expand sub section  Drugs affecting the immune response to top
 note 


All other doctors may only prescribe having competency for that cytotoxic drug and route in that indication.
For drugs exempt from tariff in this section (high cost drugs) see

Abatacept (Orencia)
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Restricted Drug Restricted
Red
High Cost Medicine
CCG
BlueTeq

NHS status 250 mg powder for concentrate for solution for infusion

  • Rheumatologist
  • PBR excluded drug via Blueteq
  • Use only according to current NICE TAs

    NHS status 125 mg solution for injection (pre-filled syringe) iv or s/c (no application received to add to formulary)

    Star  High cost drug reimbursed separately from NHS England tariff (PBR excluded).

    Critical medication: Omission of this medication in some of its indications can lead to serious patient harm of death. Please see continuity of critical medicines guidelines and procedure how to obtain medicines out of hours.
 
Link  NICE TA195: Adalimumab, etanercept, infliximab, rituximab and abatacept for the treatment of rheumatoid arthritis after the failure of a TNF inhibitor
Link  NICE TA373: Abatacept, adalimumab, etanercept and tocilizumab for treating juvenile idiopathic arthritis
Link  NICE TA375: Adalimumab, etanercept, infliximab, certolizumab pegol, golimumab, tocilizumab and abatacept for rheumatoid arthritis not previously treated with DMARDs or after conventional DMARDs only have failed
   
Adalimumab (Humira)
(Rheumatology)
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Restricted Drug Restricted
Red
High Cost Medicine

Injection: - multiple new biosimilar brands Black triangle drug - contract ones must be used on new patients and most patients will have switched to one of contract ones

NHS status NHS use and access depends upon indication:

  • Adult Rheumatoid/Psoriatic Arthritis as per relevant NICE TAs(eg TA199)

    1. Rheumatologist(Dermatologist)
    2. PBR excluded drug via Blueteq (CCG commissioned)
    3. Usually supplied via homecare, usually Healthcare at Home
  • Psoriasis (as per NICE TA 146)

    1. Dermatologist
    2. PBR excluded drug via Blueteq (CCG commissioned)
    3. Usually supplied via homecare, usually Healthcare at Home
  • Crohns Disease (as per NICE TA187)

    1. Gastroentrologist
    2. PBR excluded drug via Blueteq (CCG commissioned)
    3. Usually supplied via homecare, usually Healthcare at Home
  • Juvenile arthritis

    1. Initiation by Specialist Centre(NHS England commissioned)
    2. Suitable for shared care between specialist and secondary care via network model (ie initiating Trust would have to subcommission EKHUFT)


    UPDATE NICE TA373: Abatacept, adalimumab, etanercept and tocilizumab for treating juvenile idiopathic arthritis - EKHUFT is not commissioned by NHSE to provide this treatment

    NHS status Uveitis - paediatric

    1. Initiation and supply by Specialist Centre Only(NHS England access via IFR possible)

    NHS status TA262:Unable to recommend NHS use for Ulcerative colitis (moderate to severe, second line). TA terminated due to lack of evidence submission

    Star High cost drug reimbursed separately from NHS England tariff (PBR excluded)

    Critical medication: Omission of this medication in some of its indications can lead to serious patient harm of death. Please see continuity of critical medicines guidelines and procedure how to obtain medicines out of hours.
  • UPDATE NICE TA375: Adalimumab, etanercept, infliximab, certolizumab pegol, golimumab, tocilizumab and abatacept for rheumatoid arthritis not previously treated with DMARDs or after conventional DMARDs only have failed; These drugs are for adults with severe rheumatoid arthritis who have tried conventional DMARDs only but they have not worked

    UPDATE NICE TA383:TNF-alpha inhibitors for ankylosing spondylitis and non-radiographic axial spondyloarthritis
  • Restricted Item NHS England does not commission the Trust to deliver TA392 Adalimumab for treating moderate to severe hidradenitis suppurativa. According for this indication the drug is non formulary and patients will have to be referred to an NHS specialist dermatology service.
 
Link  NICE TA195: Rheumatoid arthritis -Adalimumab, etanercept, infliximab, rituximab and abatacept for the treatment of rheumatoid arthritis after the failure of a TNF inhibitor
Link  NICE TA373: Abatacept, adalimumab, etanercept and tocilizumab for treating juvenile idiopathic arthritis
Link  NICE TA375:Adalimumab, etanercept, infliximab, certolizumab pegol, golimumab, tocilizumab and abatacept for rheumatoid arthritis not previously treated with DMARDs or after conventional DMARDs only have failed
Link  NICE TA383 TNF-alpha inhibitors for ankylosing spondylitis and non-radiographic axial spondyloarthritis
   
Cytotoxic Drug Azathioprine
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Restricted Drug Restricted
Amber 1

Tablets

  • Intermittant supply problems with tablets. Rationalise doses to use available tablet strengths, or 50mg tablets can be halved (but carers should handle with care)
  • Consultant only initiation
     
 
   
Belimumab (Benlysta)
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Formulary
Red
High Cost Medicine
On formulary as per;NICE TA397 UPDATE: Belimumab for treating active autoantibody-positive systemic lupus erythematosus has now been recommended by NICE.  
Link  NICE TA397: Belimumab for treating active autoantibody-positive systemic lupus erythematosus
   
Certolizumab Pegol (Cimzia)
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Restricted Drug Restricted
Red
CCG
BlueTeq

Injection

  • Rheumatologists
  • PBR excluded drug via Blueteq
  • Usually supplied via homecare, usually Healthcare at Home
    NHS status Not routinely commissioned by NHS England in paediatric indications

    Star High cost drug reimbursed separately from NHS England tariff (PBR excluded)
  • Use according to relevant NICE TAs

    UPDATE NICE TA383:TNF-alpha inhibitors for ankylosing spondylitis and non-radiographic axial spondyloarthritis
  • DERMATOLOGY
  • TA574 (see attached) CCG commisioned requires blue-teq
 
Link  NICE TA375: Adalimumab, etanercept, infliximab, certolizumab pegol, golimumab, tocilizumab and abatacept for rheumatoid arthritis not previously treated with DMARDs or after conventional DMARDs only have failed
Link  NICE TA383 TNF-alpha inhibitors for ankylosing spondylitis and non-radiographic axial spondyloarthritis
Link  TA 574 Certolizumab pegol for treating moderate to severe plaque psoriasis
   
Ciclosporin
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Restricted Drug Restricted
Amber 2
Capsules as Neoral, IV infusion as concentrate, Oral solution as Neoral
  • Consultant only initiation
  • Patients should be stabilised on a particular brand of oral ciclosporin because switching between formulations without close monitoring may lead to clinically important changes in blood-ciclosporin concentration. Prescribing and dispensing of ciclosporin should be by brand name to avoid inadvertent switching. If it is necessary to switch a patient to a different brand of ciclosporin, the patient should be monitored closely for changes in blood-ciclosporin concentration, serum creatinine, blood pressure, and transplant function.For patient treated on FP10 we need to prescribe as brand specific and the most cost effective brand is Deximune.
    NHS continuationNHS England transplant immunosuppression only if formal repatriation agreed (contact pharmacy first)


    Critical medication: Omission of this medication in some of its indications can lead to serious patient harm of death. Please see continuity of critical medicines guidelines and procedure how to obtain medicines out of hours.

     
  •    
    Cytotoxic Drug Cyclophosphamide
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    Restricted Drug Restricted
    Red
    Injection, Tablets
  • Consultant only initiation

    Critical medication: Omission of this medication in some of its indications can lead to serious patient harm of death. Please see continuity of critical medicines guidelines and procedure how to obtain medicines out of hours.  
  •    
    Etanercept (Enbrel Benepali)
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    Restricted Drug Restricted
    Red
    High Cost Medicine

    Injection (new brands Black triangle drug and most NHS patients will be on these)

    • Consultant only initiation
    • PBR excluded drug via Blueteq for current NICE TA approved indications
    • Usually supplied via homecare, usually Healthcare at Home
    • In paediatric indications funded by NHS England as per current NICE TAs but may need network agreement for local delivery - contact pharmacy.
    • From the 1st September 2019 to reflect cost savings and effectiveness of the Etanercept Biosimilars, the support of all clinicians is required to push all NEW patients to Benepali. Commissioners are as keen as always  for patients to access the most cost effective medication which after careful review Benepali has been moved to 1st line as an etanercept bio similar. This change going forward does not affect existing patients already stabilised on Enrelzi (no requirements to switch)

      Star High cost drug reimbursed separately from NHS England tariff (PBR excluded)

      Critical medication: Omission of this medication in some of its indications can lead to serious patient harm of death. Please see continuity of critical medicines guidelines and procedure how to obtain medicines out of hours.

      Warning WARNING - There have been rare reports (<0.1%) of new onset heart failure, including in patients less than 50 years of age without pre-existing heart disease.

      UPDATE NICE TA383:TNF-alpha inhibitors for ankylosing spondylitis and non-radiographic axial spondyloarthritis
     
    Link  NICE TA195: Rheumatoid arthritis -Adalimumab, etanercept, infliximab, rituximab and abatacept for the treatment of rheumatoid arthritis after the failure of a TNF inhibitor
    Link  NICE TA199: Psoriatic arthritis -Etanercept, infliximab and adalimumab for the treatment of psoriatic arthritis
    Link  NICE TA373: Abatacept, adalimumab, etanercept and tocilizumab for treating juvenile idiopathic arthritis
    Link  NICE TA375: Adalimumab, etanercept, infliximab, certolizumab pegol, golimumab, tocilizumab and abatacept for rheumatoid arthritis not previously treated with DMARDs or after conventional DMARDs only have failed
    Link  NICE TA383 TNF-alpha inhibitors for ankylosing spondylitis and non-radiographic axial spondyloarthritis
    Link  TA103 Etanercept and efalizumab for the treatment of adults with psoriasis
    Link  TA130 Adalimumab, etanercept and infliximab for the treatment of rheumatoid arthritis
       
    Golimumab (Simponi)
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    Restricted Drug Restricted
    Red
    High Cost Medicine
    CCG
    BlueTeq

    Injection
    NHS continuation

    • For NHS England commissioned paediatric services use according to NICE TA220
    • Rheumatologists use only according to current NICE TAs
    • PBR excluded drug via Blueteq
    • Usually supplied via homecare, usually Medco
    • NICE TA224 - Terminated appraisal

      Star High cost drug reimbursed separately from NHS England tariff (PBR excluded)

      Critical medication: Omission of this medication in some of its indications can lead to serious patient harm of death. Please see continuity of critical medicines guidelines and procedure how to obtain medicines out of hours.

      UPDATE NICE TA383:TNF-alpha inhibitors for ankylosing spondylitis and non-radiographic axial spondyloarthritis
     
    Link  NICE TA220: Psoriatic arthritis - golimumab
    Link  NICE TA225:Golimumab for the treatment of rheumatoid arthritis after the failure of previous disease-modifying anti-rheumatic drugs
    Link  NICE TA375: Adalimumab, etanercept, infliximab, certolizumab pegol, golimumab, tocilizumab and abatacept for rheumatoid arthritis not previously treated with DMARDs or after conventional DMARDs only have failed
    Link  NICE TA383:TNF-alpha inhibitors for ankylosing spondylitis and non-radiographic axial spondyloarthritis
       
    Infliximab (Remicade, Inflectra)
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    Restricted Drug Restricted
    Red
    High Cost Medicine

    Injection (many of new biosimilars used in NHS patients will be Black triangle drug)
    note Once patient started on one brand they should continue with same brand. From June 2015 patients in the Trust will start on Inflectra®.


    NHS continuation

    • CCG commissioned for NICE Adult TA's

      • Rheumatologists only use as per current NICE TAs
      • Gastroenterologists only use as per current NICE TAs
      • Dermatologists, only use as per current NICE TAs
        , HCD locally funded via MM1 for hydradenitis supprativa
      • PBR excluded drug via Blueteq
    • NHS England commissioned services (paediatrics) for current NICE TA's if sub-commissioned (always contact pharmacy)

      NHS statusNot routinely commissioned for:
    • Connective tissue disease - interstitial lung disease
    • Renal autoimmune indications
    • Sarcoidosis
    • Uveitis - paediatric
    • Other dermatological conditions including pyoderma gangrenosum as of April 2013 in Kent and Medway. Business case for use in pyoderma gangrenosum if submited will be considered in next prioritisation round. Likely now to be NHS England tertiary centre only via network agreements - contact pharmacy

      Star High cost drug reimbursed separately from NHS England tariff (PBR excluded)

      Critical medication: Omission of this medication in some of its indications can lead to serious patient harm of death. Please see continuity of critical medicines guidelines and procedure how to obtain medicines out of hours.

      UPDATE NICE TA383: TNF-alpha inhibitors for ankylosing spondylitis and non-radiographic axial spondyloarthritis
     
    Link  Clinical Commissioning Policy: Infliximab for Progressive Pulmonary Sarcoidosis in adults
    Link  NICE TA195: Adalimumab, etanercept, infliximab, rituximab and abatacept for the treatment of rheumatoid arthritis after the failure of a TNF inhibitor
    Link  NICE TA199: Etanercept, infliximab and adalimumab for the treatment of psoriatic arthritis
    Link  NICE TA375: Adalimumab, etanercept, infliximab, certolizumab pegol, golimumab, tocilizumab and abatacept for rheumatoid arthritis not previously treated with DMARDs or after conventional DMARDs only have failed
    Link  NICE TA383 TNF-alpha inhibitors for ankylosing spondylitis and non-radiographic axial spondyloarthritis
    Link  Not Routinely Commissioned Clinical Commissioning Policy 1673 for Infliximab for Progressive Pulmonary Sarcoidosis in Adults
       
    Leflunomide
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    Restricted Drug Restricted
    Amber 2
    Tablets
  • Rheumatologists

    Critical medication: Omission of this medication in some of its indications can lead to serious patient harm of death. Please see continuity of critical medicines guidelines and procedure how to obtain medicines out of hours.  
  • Link  MHRA advice regarding risk of hepatotoxicity, haemotoxicity, infections, and birth defects
       
    Cytotoxic Drug Methotrexate
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    Restricted Drug Restricted
    Green

    Warning The drug is only given weekly in its immunosuppressive indications. Internal drug charts must be scored out on the days it is not to be administered. Those administering the drug on an internal script must first check that the script has been endorsed as safe by a pharmacist. Exceptionally out of hours administration is possible on scripts endorsed by a ST3 level or above trainee in GIM or specialist physician. Note that inappropriate administration of daily oral methotrexate (even without harm) using an electronic prescribing/administration system is regarded as an NHS Never Event.
    Warning Withhold during antibiotic courses and in acute kidney injury.

    • Consultant initiation only
    • Patients should have a methotrexate diary
    • Methotrexate is available as 2.5mg and 10mg tablets. This is a potential cause of confusion and has led to patients taking accidental overdoses. To avoid this only 2.5mg tablets should be prescribed and specified on the prescription.
        F2 doctors can only prescribe or transcribe for immunosuppression if competency formally established and signed off. All other doctors may only prescribe having competency for drug and route in that indication.
       
     
    Link  Methotrexate Prescribing Safety Checklist
    Link  NHS Safety: Towards the safer use of oral methotrexate
    Link  UKMI Q&A: Is methotrexate therapy associated with an increased risk of leukaemia?
    Link  UKMI Q&A: What is the clinical significance of the interaction between methotrexate and penicillins?
    Link  UKMI QA: Methotrexate and alcohol guidance
       
    Rituximab (immunosuppressant) (MabThera)
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    Restricted Drug Restricted
    Red
    High Cost Medicine
    CCG

    Infusion (most NHS patients will be on new biosimilar brands Black triangle drug)

    See link to use in oncology indications

    • Consultant only initiation
      NHS status
      1. PBR excluded drug via Blueteq for arthritis according to locality commissioning policy, but not SLE
      2. ITP according to locality commissioning policy (pathway developed by St. George’s Hospital and subject to audit reporting in 2017)
      3. ANCA vasculitis according to NHS England commissioning policy
      4. SLE as commissioned by NHS England.
      5. Neuromyelitis optica according to NHS England commissioning policy
      6. Commissioned by NHS England for the treatment of Transplant rejection in Renal patients. Prior to initiating an MM1 form needs to be completed for the patient.
      7. Immunoglobulin G4 – related disease (IgG4 – RD) according to NHS England commissioning policy



      NHS statusFrom June 2017 NHS England does not routinely commission in the indication connective tissue disease associated interstitial lung disease
      NHS statusFrom December 2017 NHS England will not routinely commission in the following indications:
    • Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP)
    • Multifocal motor neuropathy
    • Vasculitis of the peripheral nervous system
    • IgM paraprotein-associated demyelinating neuropathy
      NHS status Assume not routinely commissioned by NHS England as interim policies appear to exist for:
    • Haemophilia
    • Connective tissue disease - interstital lung disease in adults
    • Nephritis
    • Primary Sjogren’s Syndrome (PSS) in adults

      Always check at Final NHS England clinical service policies if in doubt as many interim policies or policies for consultation are expected to be finalised in May 2016

      Star High cost drug reimbursed separately from NHS England tariff (PBR excluded)

      Critical medication: Omission of this medication in some of its indications can lead to serious patient harm of death. Please see continuity of critical medicines guidelines and procedure how to obtain medicines out of hours.
     
    Link  Lenalidomide with rituximab for previously treated follicular lymphoma
    Link  NHS England Clinical Commissioning Policy: Rituximab for Anti-Neutrophil Cytoplasmic Antibody- Associated Vasculitis April 2013 Reference:NHSCB/ A13/P/a
    Link  NHS England Clinical Commissioning Policy: Rituximab for the treatment of Systemic Lupus Erythematosus in adults September 2013
    Link  NICE TA195: Rheumatoid arthritis - drugs for treatment after failure of a TNF inhibitor
       
    Secukinumab
    (human IgG1k anti-IL17A antibody, AIN 457, AIN457)
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    Restricted Drug Restricted
    Red
    High Cost Medicine
    CCG
    BlueTeq

    Approved for use in line with NICE TA350: Secukinumab for treating moderate to severe plaque psoriasis
    Consultant use only


    Use consistent with Secukinumab for active ankylosing spondylitis after treatment with non-steroidal anti-inflammatory drugs or TNF-alpha inhibitors is expected to be commissioned from Dec 2016

    Critical medication: Omission of this medication in some of its indications can lead to serious patient harm of death. Please see continuity of critical medicines guidelines and procedure how to obtain medicines out of hours.

     
    Link  NICE TA350: Secukinumab for treating moderate to severe plaque psoriasis
       
    Tocilizumab (RoActemra)
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    Restricted Drug Restricted
    Red
    High Cost Medicine
    CCG
    BlueTeq

    Infusion - Not approved for use as specific COVID-19 treatment - see FAQs on Prescribing.
    NHS continuation

    • Rheumatologists consistent with current NICE TAs
    • PBR excluded drug via Blueteq
    • NHS England will fund specialist centre initiation in paediatric cases satisfying NICE TA247 and TA238 and deem it suitable for network care (subcontracting- contact pharmacy)
      UPDATE: NICE TA373: Abatacept, adalimumab, etanercept and tocilizumab for treating juvenile idiopathic arthritis - EKHUFT is not commissioned by NHSE to provide this treatment


      Star High cost drug reimbursed separately from NHS England tariff (PBR excluded)

      Critical medication: Omission of this medication in some of its indications can lead to serious patient harm of death. Please see continuity of critical medicines guidelines and procedure how to obtain medicines out of hours.
     
    Link  NICE TA238: Arthritis (juvenile idiopathic, systemic)
    Link  NICE TA247: Rheumatoid arthritis - update to TA198
    Link  NICE TA373: Abatacept, adalimumab, etanercept and tocilizumab for treating juvenile idiopathic arthritis
    Link  NICE TA375: Adalimumab, etanercept, infliximab, certolizumab pegol, golimumab, tocilizumab and abatacept for rheumatoid arthritis not previously treated with DMARDs or after conventional DMARDs only have failed
       
    10.01.03  Expand sub section  Cytokine modulators
    10.01.03  Expand sub section  Sulfasalazine
     ....
     Non Formulary Items
    Anakinra  (Kineret)

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    Non Formulary
    RedRed
    High Cost Medicine

    NHS status commissioned by NHS England via Cryopyrin Associated Periodic Syndrome service

    - Not approved for use as specific COVID-19 treatment - see FAQs on Prescribing.

    NHS status Not routinely commissioned by NHS England in:

     
    Methotrexate  (Ebetrex)

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    Non Formulary

    Warning The drug is only given weekly in its immunosuppressive indications. Internal drug charts must be scored out on the days it is not to be administered. Those administering the drug on an internal script must first check that the script has been endorsed as safe by a pharmacist. Exceptionally out of hours administration is possible on scripts endorsed by a ST3 level or above trainee in GIM or specialist physician. Note that inappropriate administration of daily oral methotrexate (even without harm) using an electronic prescribing/administration system is regarded as an NHS Never Event.
    Warning Withhold during antibiotic courses and in acute kidney injury.

    • Consultant initiation only
    • Patients should have a methotrexate diary
    • Methotrexate is usually given at a dose of less than 25mg weekly for its non-oncological indications.

      Warning  No F1 (First year foundation programme) doctor may prescribe this drug in the Trust. See Advice on Foundation Year 1 (FY1) Prescribing F2 doctors can only prescribe or transcribe for immunosuppression if competency formally established and signed off. All other doctors may only prescribe having competency for drug and route in that indication.

      Critical medication: Omission of this medication in some of its indications can lead to serious patient harm of death. Please see continuity of critical medicines guidelines and procedure how to obtain medicines out of hours.

     

     
    Methotrexate  (Metoject)

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    Non Formulary

    Warning The drug is only given weekly in its immunosuppressive indications. Internal drug charts must be scored out on the days it is not to be administered. Those administering the drug on an internal script must first check that the script has been endorsed as safe by a pharmacist. Exceptionally out of hours administration is possible on scripts endorsed by a ST3 level or above trainee in GIM or specialist physician. Note that inappropriate administration of daily oral methotrexate (even without harm) using an electronic prescribing/administration system is regarded as an NHS Never Event.
    Warning Withhold during antibiotic courses and in acute kidney injury.

    • Consultant initiation only
    • Patients should have a methotrexate diary
    • Methotrexate is usually given at a dose of less than 25mg weekly for its non-oncological indications.

      Warning  No F1 (First year foundation programme) doctor may prescribe this drug in the Trust. See Advice on Foundation Year 1 (FY1) Prescribing F2 doctors can only prescribe or transcribe for immunosuppression if competency formally established and signed off. All other doctors may only prescribe having competency for drug and route in that indication.

      Critical medication: Omission of this medication in some of its indications can lead to serious patient harm of death. Please see continuity of critical medicines guidelines and procedure how to obtain medicines out of hours.
     
      
    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
    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

    Amber

    Requires to be initiated by specialist for repeat GP Prescribing (Purple as per Eclipse East Kent Primary Care Formulary, may be top sliced) If a downloadable EKPG Prescribing Information Sheet exists in the formulary entry for the drug, it, or an URL (shortcut to webpage/document) should be sent to the GP. See also "Hints in how to incorporate documents for medicines information into clinical communications to GPs".  

    Amber 1

    Shared Care (Orange as per Eclipse East Kent Primary Care Formulary). See the Principles of Shared Care Agreements and Shared Care Agreements: Assessment against agreed Principles of Shared Care documents. If a downloadable template document exists in the formulary entry for this drug, it should be sent to the GP (and patient) once patient specific details are incorporated. See "Hints in how to incorporate shared care documents for medicines into clinical communications to GPs".  

    Amber 2

    Shared Care and topsliced (Orange as per Eclipse East Kent Primary Care Formulary) See the Principles of Shared Care Agreements and Shared Care Agreements: Assessment against agreed Principles of Shared Care documents. If a downloadable template document exists in the formulary entry for this drug, it should be sent to the GP (and patient) once patient specific details are incorporated. See "Hints in how to incorporate shared care documents for medicines into clinical communications to GPs".  

    Black

    A decision has been made by either or both the local or national NHS not to routinely commission this preparation for its licensed indications  

    Blue

    No comment on drug in East Kent Primary Care Formulary (Blue as per Eclipse East Kent Primary Care Formulary)  

    Brown

    Exceptional Use Only (Brown as per Eclipse East Kent Primary Care Formulary)   

    Green

    On East Kent Primary Care Formulary (Pink or Green as per Eclipse East Kent Primary Care Formulary)  

    Grey

    Not assessed/Not recommended (As per Eclipse East Kent Primary Care Formulary)  

    Red

    Hospital Only (As per Eclipse East Kent Primary Care Formulary)  

    RedRed

    Known to be commissioned for local NHS patients but only available to them from another provider than EKHUFT  

    netFormulary