Lancashire and South Cumbria Formulary


	Lancashire and South Cumbria Formulary

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Formulary Chapter 11: Eye - Full Chapter

Notes:

This chapter of the formulary is under continual development, please let the team know if you have any comments about the contents: mlcsu.lscformulary@nhs.net.

For more information about the formulary development process, please see: https://www.lancsmmg.nhs.uk/lancashire-and-south-cumbria-icb-formulary-development/

Details...

11.08

Miscellaneous ophthalmic preparations

Potassium ascorbate

Unlicensed

Eye drops 10%

*under review*
Not on East Lancashire formulary

11.08.01

Tear deficiency, ocular lubricants, and astringents

Acetylcysteine 5% with Hypromellose 0.35% (Ilube^®)

Formulary

Eye drops

For treatment of filamentary keratitis only

Carbomer 980 eye drops
(polyacrylic acid)

Formulary

Liquid gel eye drops 0.2%
Liquid gel unit dose eye drops 0.2%

Carmellose

Formulary

Preservative free eye drops 0.5%, 1%

Hydramed Night^®

Formulary

Lubricating eye ointment 5g

Hylo-night ^®
(formerly known as VitA-Pos^®)

Formulary

Eye ointment preservative free

2nd line to Hydramed Night

Hypromellose

Formulary

Eye drops 0.3%

Preservative free eye drops 0.3%

Polyvinyl Alcohol (Liquifilm Tears^®)

Formulary

Eye drops 1.4%
Unit dose eye drops 1.4%

LSCMMG: Over the Counter Items that Should not be Routinely Prescribed in Primary Care Policy

Sodium Chloride (Minims^® Saline)

Formulary

0.9% Minims^®

Sodium Hyaluronate

Formulary

Eye drops 0.2%

Eye drops - preservative free 0.1% & 0.2%

Sodium Chloride

Unlicensed

Preservative free eye drops 5% (unlicensed)

*under review*

in East Lancashire

LSCMMG: Over the Counter Items that Should not be Routinely Prescribed in Primary Care Policy

11.08.02

Ocular diagnostic and peri-operative preparations and photodynamic treatment

11.08.02

Ocular diagnostic preparations

Fluorescein Sodium

Formulary

Minims^® 1%, 2%

Injection 10% for WAMD clinic use only

Injection 20%

Indocyanine green

Formulary

Injection 25mg (unlicensed)

Trypan Blue (Vision Blue^®)

Formulary

Injection

For use in cataract surgery

Corneal superficial injury (CKS)

11.08.02

Ocular peri-operative drugs

Acetylcholine Chloride (Miochol-E^®)

Formulary

Intra-occular irrigation 1%

Apraclonidine (Iopidine^®)

Formulary

Unit dose eye drops 1% - perioperative use only

*under review*

Balanced Salt Solution

Formulary

Sterile irrigation solution 15mL, 500mL

Bromfenac (Yellox^®)

Formulary

Eye drops 0.09%

Diclofenac (Voltarol^® Ophtha)

Formulary

Eye drops 0.1%
Unit dose eye drops 0.1%

*under review*

in East Lancashire

Ketorolac

Formulary

Eye drops 0.5%

*under review*

in East Lancashire

Povidone iodine

Formulary

Unit dose eye drops 5%

Sodium hyaluronate
(Obtained from central stores)

Formulary

Injection 1%
Injection prefilled syringe 15mg in 1mL
Injection prefilled syringe 14mg in 1mL (Haelonid GV^®)
Irrigation 40mg/50mL

Disodium edetate
(EDTA)

Unlicensed

Preservative free solution 0.37%

11.08.02

Subfoveal choroidal neovascularisation

Aflibercept (Eylea^®)

Formulary

Solution for intravitreal injection pre-filled syringe 40mg/mL

MHRA: Aflibercept (Zaltrap▼): minimising the risk of osteonecrosis of the jaw

NICE TA: Aflibercept for treating diabetic macular oedema

NICE TA409: Aflibercept for treating visual impairment caused by macular oedema after branch retinal vein occlusion

NICE TA486: Aflibercept for treating choroidal neovascularisation

Brolucizumab

(Beovu^®

Formulary

19.8mg/0.165ml solution for injection pre-filled syringes

MHRA: Brolucizumab (Beovu▼): risk of intraocular inflammation and retinal vascular occlusion increased with short dosing intervals

NICE TA672: Brolucizumab for treating wet age-related macular degeneration

NICE TA820: Brolucizumab for treating diabetic macular oedema

Faricimab

(Vabysmo ^®)

Formulary

Solution for injection 120 mg/mL

NICE TA1004: Faricimab for treating visual impairment caused by macular oedema after retinal vein occlusion

NICE TA799: Faricimab for treating diabetic macular oedema

NICE TA800: Faricimab for treating wet age-related macular degeneration

Ranibizumab

Formulary

Solution for intravitreal injection 10mg/mL

For NICE TA637: Ranibizumab for treating diabetic retinopathy (terminated appraisal)

NICE TA274: Ranibizumab for treating diabetic macular oedema

NICE TA637: Ranibizumab for treating diabetic retinopathy (terminated appraisal)

Verteporfin injection

Formulary

15mg vial

11.08.02

Vitreomacular traction

11.08.03

Reduction of elevated intra-ocular pressure

....

Non Formulary Items

Key

	Notes
	Section Title (top level)
	Section Title (sub level)
	First Choice item
	Non Formulary section
	Restricted Drug
	Unlicensed
	Display tracking information
	Link to adult BNF
	Link to children's BNF
	Link to SPCs
	Scottish Medicines Consortium

	Cytotoxic Drug
	Controlled Drug
	High Cost Medicine
	Cancer Drugs Fund
	NHS England
	Homecare
	CCG
	Low carbon footprint
	Medium carbon footprint
	High carbon footprint

Traffic Light Status Information

Status	Description
	Green: Appropriate for initiation and ongoing prescribing in both primary and secondary care. Generally, little or no routine drug monitoring is required.
	Green (Restricted): Appropriate for initiation and ongoing prescribing in both primary and secondary care provided: Additional criteria specific to the medicine or device are met, or The medicine or device is used following the failure of other therapies as defined by the relevant LSCMMG pathway. Generally, little or no routine drug monitoring is required.
	Red medicines: Medicine is supplied by the hospital for the duration of the treatment course. Primary care initiation or continuation of treatment is not recommended unless exceptional circumstances such as specialist GP. Red medicines are those where primary care prescribing is not recommended. These treatments should be initiated by specialists only and prescribing retained within secondary care. They require specialist knowledge, intensive monitoring, specific dose adjustments or further evaluation in use. If however, a primary care prescriber has particular specialist knowledge or experience of prescribing a particular drug for a particular patient it would not always be appropriate for them to expect to transfer that prescribing responsibility back to secondary care. There should be a specific reason and a specific risk agreement, protocol and service set up to support this. Primary care prescribers may prescribe RED medicines in exceptional circumstances to patients to ensure continuity of supply while arrangements are made to obtain ongoing supplies from secondary care.
	Amber level 0: Suitable for prescribing in primary care following recommendation or initiation by a specialist. Little or no specific monitoring required. Patient may need a regular review, but this would not exceed that required for other medicines routinely prescribed in primary care. Brief prescribing document or information sheet may be required. Primary care prescribers must be familiar with the drug to take on prescribing responsibility or must get the required information. When recommending or handing over care, specialists should ask primary care prescribers to take over prescribing responsibility, and should give enough information about the indication, dose, monitoring requirements, use outside product licence and any necessary dose adjustments to allow them to confidently prescribe.
	Amber level 1 (with shared care): Suitable for prescribing in primary care following recommendation or initiation by a specialist. Minimal monitoring required. Patient may need a regular review, but this would not exceed that required for other medicines routinely prescribed in primary care. Full prior agreement about patient’s on-going care must be reached under the shared care agreement. Primary care prescribers are advised not to take on prescribing of these medicines unless they have been adequately informed by letter of their responsibilities with regards monitoring, side effects and interactions and are happy to take on the prescribing responsibility. A copy of locally approved shared care guidelines should accompany this letter which outlines these responsibilities. Primary care prescribers should then tell secondary care of their intentions as soon as possible by letter so that arrangements can be made for the transfer of care.
	Amber level 2 (with shared care and enhanced service): Initiated by specialist and transferred to primary care following a successful initiation period. Significant monitoring required on an on-going basis. Full prior agreement about patient’s on-going care must be reached under the shared care agreement. Suitable for enhanced service. These medicines are considered suitable for GP prescribing following specialist initiation of therapy, as per shared care document which will be sent out with the request to prescribe, with on-going communication between the primary care prescriber and specialist. Amber Level 2 medicines require significant monitoring for which an enhanced service may be suitable. (Subject to local commissioning agreements).
	Do not prescribe: NOT recommended for use by the NHS in Lancashire and South Cumbria. Includes medicines that NICE has not recommended for use and terminated technology appraisals, unless there is a local need.
	Grey medicines: Medicines which have not yet been reviewed or are under the review process. GPs and specialists are recommended not to prescribe these drugs. This category includes drugs where funding has not yet been agreed.
	Refer to local guidance.