Aylesbury Vale and Chiltern CCGs Traffic Light list October 2014
Transcription
Aylesbury Vale and Chiltern CCGs Traffic Light list October 2014
Aylesbury Vale and Chiltern CCGs Traffic Light list October 2014 http://www.bucksformulary.nhs.uk For further information on formulary restrictions for individual drugs please refer to the Buckinghamshire Formulary at: Black (B) Not recommended or awaiting application Avanafil Red (R ) Amber Protocol (AP) Amber Initiation (AI) Amber Recommended (AR) To be initiated in secondary care, To be initiated in secondary care, To be prescribed in secondary care only for continuation by GPs in accordance with for continuation by GPs a shared care protocol Acetylcysteine tab for pulmonary fibrosis Acamprosate Principles for shared care Specialist may recommend that a GP starts this drug Alimemazine syrup Aliskiren Agomelatine Responsibilities for shared care Alglucerase Alprostadil, for distress impotence Atomoxetine Alprostadil in Erectile dysfunction SLS indications. Aripiprazole In psych. distress alprostadil=red. Apixaban for AF Betaxolol eye drops Ambrisentan Anti-retrovirals (e.g. for HIV) Azathioprine - NPT Aquadeks liquid Cabergoline Amifampridine (Firdapse) Anti-TNF Ciclosporin - NPT Atorvastatin 80mg in Acute Coronary Syndrome Duloxetine for depression & GAD Anakinra L-arginine in metabolic disorders Denosumab for osteoporosis NPT Bimatoprost 300 mcg/ml eye drops (preserved) Duloxetine 60mg only for neuropathic pain Alprostadil cream for impotence Apraclonidine eye drops Dexamfetamine Ciclesonide Etoricoxib for ankylosing spondylitis only Aquadeks capsules (liquid is AI) Apomorphine for Parkinsons Donepezil Colistimethate for non-CF bronchiectasis (redlisted for CF) Exemestane Asenapine artemeter/lumefantrine (Riamet®) for falciparum malaria on I.D. Advice Galantamine Dabigatran for AF Febuxostat Atorvastatin chewable Beclometasone m/r tabs Clipper® Benzbromarone for gout Dalteparin prophylactic doses except antenatal which is red Domperidone Letrozole Bisacodyl Supp 7.5mg (Aralax®) Brimonidine Cream (Mirvaso®) Bosentan - designated PAH centres only Gold - sodium aurothiomalate & auranofin NPT Goserelin neoadjuvant use for prostate cancer prior to radiotherapy - NPT for this indication only Leflunomide - NPT Entacapone Mesalazine give once daily (Mezavant XL®) Botulinum Toxin A for hyperhidrosis Botulinum toxin (black for hyperhidrosis) Buprenorphine patch (Butrans®) Caffeine oral and iv Liraglutide only in accordance with lical diabetic algorithm Lithium - NPT Mirabegron for over active bladder (if patients fit NICE criteria) Probenecid for gout Calcipotriol & Betamethasone Topical Calcitonin Memantine Carteolol eye drops Chlorhexidine cloths/wipes Mercaptopurine - NPT Eplerenone (post MI for 1 year only then switch to spironolactone) Erythropoetin and darbopoetin (all patients except ORH Renal Patients - red for this centre) Eye drops - combined drops containing timolol with a 2nd agent for use in glaucoma Exenatide bd & weekly Catheterisation procedure pack (i.e. any pack containing catheters with gloves, aprons). Prescribe elements separately Cinacalcet Methotrexate tabs - NPT - and SC - NPT - in adults Hydroxychloroquine Topiramate Cannabinoids/Sativex Clopidogrel 300mg tablet Methylphenidate Triptorelin in Gynaecology (see amber protocol for use in Prostate Ca) Chlorthalidone Clozapine Mycophenolate after transplants - NPT. Co-careldopa intestinal gel Cyclophosphamide in Rh A Penicillamine - NPT Ibandronic acid - in metastatic disease of breast cancer Insulin degludec in type 1 diabetes patients with problematic nocturnal hypos; 100U/ml is amber; 200 unit/ml is black Ivabradine for LVF, 2nd line to beta-blockers Co-proxamol Cystic fibrosis - nebules and inhalations (colistimethate, dornase, tobramycin, mannitol) - Hospital supply to start at next review Cytotoxics for the treatment of malignancy Rivastigmine Lacosamide for refractory epilepsy that requires multiple treatments Selevamer Lidocaine plaster in palliative care pain (Blacklisted for all other indications) Midazolam Buccal Colesevelam Colestipol Cytotoxics, not listed elsewhere on the traffic lights, for treatment of malignancy Dabigatran - for thromboprophylaxis post Somatropin in adults; hip and knee surgery Dalteparin all antenatal use & all treatment Sulfasalazine - NPT doses - refer back to BHT Dabigatran for indications other than AF (amber) & thromboprophylaxis (red) Dapoxetine for premature ejaculation Dapsone for Pneumocystis carinii prophylaxis Denosumab monthly for cancer Tacrolimus for transplant <NPT>. Protocol to be provided at hospital discharge. Triptorelin for prostate cancer - NPT Modafinil for sleep disorders (licensed uses) Deferasirox Diltiazem Ointment 2% Zonisamide - NPT Octreotide Doxycycline 20mg, 40mg strengths Eltrombopag Pramipexole for parkinson's disease Duac -topical for acne Erythropoetin and darbepoetin (ORH Renal Patients only) Filgrastrim Prasugrel - for indications in local protocol Pimecrolimus (topical) Prucalopride (in patients who fit NICE criteria). Supply for 1st 6 weeks from hospital. Retigabine Eflornithine 5 Fluorouracil cream for topical cancers eg SCC ® Fluticasone (Flixonase ) nasules usual 1 treatment course /12 then nasal spray Fondaparinux sodium Escitalopram Fosfomycin Eslicarbazepine Fumaric acid esters (Fumaderm®) for psoriasis Rosuvastatin (lipid clinic only - in complex cases who have already tried high dose atorvastatin) Esomeprazole Glycopyrronium orally in adults & children Sildenafil 20mg(Revatio) for pulm. hypertension Fampridine Sulfinpyrazone for gout Fesoterodine hepatitis treatments e.g. adefovir, telaprovir, boceprevir, entecavir, ribavirin, Peg-interferon 2a eg TPN, CAPD Hi Tech Homecare Fidaxomycin Hospital clinical trial material Ticagrelor - for indications in local protocol Eculizumab Fluoride toothpaste (e.g. Duraphat 2800) Hydroxycarbamide in haematology Imiquimod Fluticasone furoate / vilanterol = Relvar® Flutter device and Acapella (for mucous Immunoglobulins expectoration) Flutrimazole cream Infused medication & blood products Glucosamine Glycopyrronium inhaler (Seebri) Insulin Humulin R 500 units/ml Insulin pump therapy (devices) Histrelin Intravitreal medicines e.g. aflibercept, ranibizumab, bevacizumab Hydromorphone Ivermectin tab Human Papilloma Virus (HPV) Vaccine IVF Ibandronic acid inj (all uses) and tablets for osteoporosis Indacaterol Lanreotide for carcinoid syndrome Lenolidamide Strontium - place in therapy now 6th line for secondary prevention of osteoporosis Naltrexone Ondansetron (only licensed for 5 day course) Dymista® Risperidone depot injection Minocycline in dermatology (except for acne when it is green but 4th line) Dermatix and similar dressings to prevent Diphencyprone for recalcitrant warts keloid scars Domperidone to increase milk supply Dronedarone Duloxetine for urinary incontinence Levetiracetam Rivaroxaban for AF - only to be started in the new oral anticoagulant clinic Rivaroxaban for PE/DVT - only for certain patient groups see linked policy Ropinirole XL only to be used in patients unable to tolerate plain due to ADRs Tacrolimus (topical) Legend italics Italics - Requires evaluation by Formulary Management Group (FMG) New position or recent review No Written Shared Care available. FMG Oct 2011 agreed that for new patients consider as RED-listed until SCA available <NPT> An amber protocol medicine which attracts a Near Patient Testing quarterly fee Awaiting local guidance or there is a FMG outstanding action ► Click to read note * Underlined Click for link (often to local guideline) CCG action required (usually hyperlink to be added). Aylesbury Vale and Chiltern CCGs Traffic Light list October 2014 http://www.bucksformulary.nhs.uk For further information on formulary restrictions for individual drugs please refer to the Buckinghamshire Formulary at: Black (B) Not recommended or awaiting application Ingenol gel Red (R ) Amber Protocol (AP) Amber Initiation (AI) Amber Recommended (AR) To be initiated in secondary care, To be initiated in secondary care, To be prescribed in secondary care only for continuation by GPs in accordance with for continuation by GPs a shared care protocol lisdexamphetamine Specialist may recommend that a GP starts this drug Ivabradine for angina Melatonin pre EEG (short course treatment) & in adult LDs (usual course 3/52) Lenogastrim Metformin to reduce weight gain (paeds) Lid Care Wipes Methotrexate in children Lidocaine 5% plaster Versatis® when used for neuropathic pain Linaclotide Methysergide Linagliptin Methylnaltrexone inj (FNH only) Lomitapide Lubriprostone Multiple sclerosis - high tech drugs e.g. alemtuzumab, betainterferon, dimethyl fumarate, glatiramer, fingolimod, natalizumab, teriflunamide Mycophenolate for Rheumatoid & Derm. Loxapine Maraviroc tab Nalmefene Omalizumab Melatonin to aid sleep - long term use Trial data is all short term Miconazole tablets Oxycodone as part of enhanced recovery (only patients taking oxycodone before admission to be discharged on it) Paliperidone Nabilone for MS Pirfenidone Naltrexone low dose (up to 5mg) Pivemecillinam Nuvaring(R) Quetiapine in generalised anxiety disorder Omega 3 fatty acids Ranolazine Oxycodone/naloxone combination Pelvic trainer and toning devices Retinoids orally - isotretinoin, acitretin, alitretinoin Riluzole Pegfilgrastim Sodium benzoate in metabolic disorders Pergolide Sodium phenylbutyrate in metabolic disorders Phentolamine + Papaverine Somatropin in children. Pigmanorm Sucrose 24% in neonates and small children Piracetam Temocillin Pramipexole XL Pramipexole for restless legs syndrome Tenofovir Thalidomide Indapamide 2.5 mg plain tablets (m/r remain not recommended) Insulin Detemir - Levemir* Isotretinoin Topical Pregabalin Tigecycline inj latanoprost (generic) eye drops (preserved) Probiotics Trastuzumab Propiverine Valganciclovir latanoprost eye drops p/f, bimatoprost eye drops p/f and Travoprost eye drops where allergic to benzalkonium preservative Levonorgestrol IUD (Jaydess) Quetiapine XL Quinagolide Ranolazine Voriconazole oral and IV Zoledronic acid inj (Aclasta®) Methotrexate for paediatric uses Green (G) Medicines with a recently changed status for full green list see formulary Aclidinium inhaled in COPD Almotriptan - 2nd line triptan in patients with no response to sumatriptan for 3 migraines Aymes Shake - 1st line sip feed (where food first advice is inadequate) Beclometasone/Formoterol (Fostair®) in COPD Cholecalciferol 20,000 units bd short term (see link) 2ary care to give 1st supply when patient Complan shake -2nd line sip feed (where food 1st is inadequate) Dapagliflozin only to be prescribed in accordance with the local diabetic algorithm Dithranol (excluding specials which remain redlisted) Diclofenac 3% Gel (Solaraze) for Actinic keratosis Eplerenone in male LVF patients with gynaecomastia caused by spironolactone Fluorouracil cream for Actinic Keratosis - GPs can initiate in practice. If hospital outpatient 1st supply from hospital Fluorouracil/salicylic acid (Actikerall) for Actinic Keratosis - GPs can initiate in practice. If hospital outpatient 1st supply from hospital. Fluticasone furoate nasal spray (Avamys®), 3rd line choice Fluticasone/formoterol inhaled (Flutiform®) Minocycline - 4th line antibiotic for acne Oseltamivir Sildenafil for erectile dysfunction if fits SLS criteria Sitagliptin only to be prescribed in accordance with local diabetic algorithm Rasagiline RESPeRATE Solifenacin in overactive bladder Rifaximin Ropinorole for restless legs Rosuvastatin blacklisted unless started by lipidologist (see AI list) Rotigotine patch Tadalafil 3rd line in erectile dysfunction if fits SLS criteria; daily dosing is blacklisted Timolol p/f 0.1% and 0.25% where there is established allergy to benzalkonium chloride. Review 0.5% to 0.25%. Tiotropium Respimat if unable to use Handihaler (see COPD guideline) Ulipristal morning after pill for late presenters at 3-5 days. Vardenafil 2nd line after sildenafil in erectile dysfunction if fits SLS criteria Vitamin D 800 units (see protocol) Sildenafil chewable (Nipatra) Zanamivir Rivaroxaban for prevention of venous thromoembolism around surgery Roflumilast Suvenaid Tacrolimus (oral) for dermatology Tadalafil for benign Prostatic Hypertrophy Tafloprost eye drops Tapentadol Testosterone Patch <intrinsa> Therabite Timolol 0.5% eye drops Toremifene Tramacet Tri-luma cream Vacuum Pumps for Erectile dysfunction Vitamins High Dose for Eyes Zostavax if outside national vaccination campaign Legend italics Italics - Requires evaluation by Formulary Management Group (FMG) New position or recent review No Written Shared Care available. FMG Oct 2011 agreed that for new patients <NPT> An amber protocol medicine which attracts a Near Patient Testing quarterly fee Awaiting local guidance or there is a FMG outstanding action ► Click to read note * Underlined Click for link (often to local guideline) CCG action required (usually hyperlink to be added) - will not be shaded on circulated TLL Buckinghamshire Traffic Light System Definitions Black Red Amber Protocol Not recommended for use because of lack of evidence of clinical effectiveness, cost effectiveness or safety. Drugs which have been evaluated and rejected by the Formulary Management Group (FMG) Drugs defined as ‘Low Priority’ by the South Central Priorities Committee New drugs which have not as yet been evaluated by the FMG Any drug not listed in the Bucks Joint Formulary at http://www.nelm.nhs.uk/en/Formularies/Trusts/Buckinghamshire-Formulary/ Drugs which should only be prescribed in secondary care by a specialist. Require specialist knowledge and/or equipment for patient selection and initiation, Require long term on-going monitoring and dose adjustment to ensure efficacy and minimise toxicity by a specialist Designated as “hospital only“ by product licence, NICE, DoH or BNF May need further evaluation by a specialist Are hospital initiated clinical trial materials Drugs which should be initiated in secondary care by the specialist with follow-on prescription and monitoring according to a drug specific Shared Care Protocol (SCP). Prescribing may be continued in primary care following the SCP Require specialist knowledge and/or equipment for patient selection and initiation Require short or medium term (eg. 3 to 6 months) specialist monitoring of efficacy or toxicity. The need for stabilisation will vary with different drugs and patients, but is usually a minimum of 2 months (see principles for shared care) Require significant long term monitoring Require ongoing communication between the GP and the specialist Have clearly defined consultant, GP and patient responsibilities documented in a shared care protocol (see responsibilities for amber protocol drugs) Amber initiation Amber recommendation Green Drugs suitable for primary care prescribing following specialist initiation Require specialist knowledge and/or equipment for patient selection Monitoring does not require specialist knowledge or equipment If the drug is one with which the primary care prescriber is unfamiliar the specialist is expected to provide sufficient information on the drug indication, dose, duration , monitoring and any further necessary dose adjustments Require the first prescription to be written by the specialist Drugs suitable for primary care prescribing following specialist recommendation As for amber initiation except that:The first prescription may be written by the GP after specialist recommendation. Drugs for which primary care prescribers would normally take full responsibility for prescribing and monitoring Drugs not included in the Traffic Light list but included on joint formulary. New drugs classified as red or amber but as greater experience regarding their safety and efficacy is established may move to Green after re-consideration by the FMG and APC.