| Formulary Chapter 13: Skin - Full Chapter
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| 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.
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| Details... |
| 13.05 |
Preparations for eczema and psoriasis |
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| 13.05.01 |
Preparations for eczema |
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Ichthammol with Zinc oxide ( Ichthopaste bandage®)
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Formulary
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7.5cm x 6m
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Alitretinoin (Toctino®)
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Formulary
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Capsules 10mg, 30mg
Consultant dermatologist or specialist only
Pregnancy must be excluded before initiation and before each repeat prescription.
prescriptions for women are limited to 28 days treatment
REQUIRES BLUETEQ APPROVAL
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 MHRA: Oral retinoid medicines▼: revised and simplified pregnancy prevention educational materials for healthcare professionals and women
NICE TA177: Alitretinoin for the treatment of severe chronic hand eczema
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Zinc oxide 15% and Ichthammol 1% in yellow soft paraffin (Special ointment No1)
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Formulary
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Ointment
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| 13.05.01 |
Topical preparations for eczema |
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Viscopaste® bandages
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Formulary
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Bandage 7.5cm x 6m
For community use only
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| 13.05.02 |
Preparations for psoriasis |
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Dimethyl Fumarate (Skilarence®)
(moderate/severe plaque psoriasis)
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Formulary
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Tablets 30mg, 120mg
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NICE TA475: Dimethyl fumarate for treating moderate to severe plaque psoriasis
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Ixekizumab (Taltz®)
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Formulary
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80mg/1mL pre-filled pen
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NICE TA442: Ixekizumab for treating moderate to severe plaque psoriasis
NICE TA537: Ixekizumab for treating active psoriatic arthritis after inadequate response to DMARDs
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Methoxypsoralen
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 Unlicensed
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Bath lotion 1.2%
Gel 0.005%
Tablets 10mg
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| 13.05.02 |
Topical preparations for psoriasis |
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Calcipotriol
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Formulary
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Ointment 120g
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Calcipotriol 50micrograms/g with Betamethasone 0.05% (Dovobet®)
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Formulary
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Gel 60g
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Calcipotriol 50micrograms/g with Betamethasone 0.5mg/g (Enstilar®)
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Formulary
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Cutaneous foam
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Coal tar 1% with salicylic acid 2% and precipitated sulfur 4% (Sebco®)
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Formulary
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Scalp ointment 40g
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Coal tar lotion 5% (Exorex®)
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Formulary
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Lotion 100mL
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salicylic acid in emulsifying ointment 2%, 5%, 10%
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Formulary
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Ointment 2%, 5%, 10%
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Tacalcitol 4micrograms/g (Curatoderm®)
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Formulary
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Ointment 100g
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Zinc and Salicylic Acid Paste BP
(Lassars Paste)
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Formulary
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Zinc oxide 24% / salicylic acid 2% / starch 24% / white soft paraffin 50%
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Coal Tar 2% and Salicylic Acid Ointment 2% BP (Sloppy Tar)
(For scalp use only)
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Unlicensed
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Not all coal tar products are routinely stocked by the pharmacy departments. If the product has to be obtained from a specials manufacturing unit there may be a delay of up to 4 weeks
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Coal tar in emulsifying ointment
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Unlicensed
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1%, 2%, 5%, 10%, 15%, 20%, 25%, 30% 100g
Not all coal tar products are routinely stocked by the pharmacy departments. If the product has to be obtained from a specials manufacturing unit there may be a delay of up to 4 weeks.
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Dithranol in Lassar’s Paste
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Unlicensed
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10%
(0.1%, 0.25%, 0.5%, 1%, 2%, 4%, 6%, 8% dilutions available from pharmacy)
Not all dithranol products are routinely stocked by the pharmacy departments. If the product has to be obtained from a specials manufacturing unit there may be a delay for up to 4 weeks.
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| 13.05.02 |
Oral retinoids for psoriasis |
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Acitretin (Neotigason®)
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Formulary
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Capsules 10mg, 25mg
Consultant dermatologist or specialist initiation only
Pregnancy must be excluded before initiation and before each repeat prescription.
Prescriptions for women are limited to 28 days treatment
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MHRA: Oral retinoid medicines▼: revised and simplified pregnancy prevention educational materials for healthcare professionals and women
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| 13.05.03 |
Drugs affecting the immune response |
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Abrocitinib (Cibinqo ®)
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Formulary
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Tablets 50mg - for treating moderate to severe atopic dermatitis
Tablets 100mg - for treating moderate to severe atopic dermatitis
Tablets 200mg - for treating moderate to severe atopic dermatitis
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NICE TA814: Abrocitinib, tralokinumab or upadacitinib for treating moderate to severe atopic dermatitis
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Adalimumab (Biosimilars avaliable)
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Formulary
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S/C injection 40mg pre-filled syringe, pre-filled pen
Consultant dermatologist or specilaist initiation only
Tertiary centre only for hidradenitis suppurativa
Usually supplied to patients by a home delivery company
REQUIRES BLUETEQ APPROVAL
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MHRA: Tumour necrosis factor alpha inhibitors
NICE TA392: Adalimumab for treating moderate to severe hidradenitis suppurativa
NICE TA455: Adalimumab, etanercept and ustekinumab for treating plaque psoriasis in children and young people
NIE TA146: Adalimumab for the treatment of adults with psoriasis
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Apremilast (Otezla®)
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Formulary
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Tablets 10mg, 20mg, 30mg
Usually supplied to patients by a home delivery company
REQUIRES BLUETEQ APPROVAL
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MHRA: Apremilast (Otezla ▼): risk of suicidal thoughts and behaviour
NICE TA419: Apremilast for treating moderate to severe plaque psoriasis
NICE TA433: Apremilast for treating active psoriatic arthritis
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Azathioprine
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Formulary
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Tablets 25mg, 50mg
Unlicensed indication
Consultant dermatologist or specilaist initiation only
See section 10.1.3
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 LSCMMG: Shared care guideline - Azathioprine
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Baricitinib
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Formulary
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Film-coated tablets 2mg, 4mg
Treatment of atopic dermatitis
 Treatment of alopecia areata
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NICE TA681: Baricitinib for treating moderate to severe atopic dermatitis
NICE TA926: Baricitinib for treating severe alopecia areata
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Bimekizumab (Bimzelx ®)
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Formulary
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Pre-filled pen/syringe 160mg
Usually supplied to patients via a homecare delivery company
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NICE TA723: Bimekizumab for treating moderate to severe plaque psoriasis
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Brodalumab (Kyntheum®)
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Formulary
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Solution for injection pre-filled syringes 210mg/1.5ml
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NICE TA511: Brodalumab for treating moderate to severe plaque psoriasis
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Ciclosporin
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Formulary
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Consultant dermatologist or specilaist initiation only
To be prescribed generically for dermatology patients
See section 10.1.3
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LSCMMG: Shared care guideline - Ciclosporin
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Deucravacitinib (SOTYKTU )
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Formulary
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Film coated tablets 6mg
NICE TA907: Deucravacitinib for treating moderate to severe plaque psoriasis
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NICE TA907: Deucravacitinib for treating moderate to severe plaque psoriasis
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Dupilumab (Dupixent®)
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Formulary
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Pre-filled syringe 300mg/2ml solution for injection
NICE TA648: Dupilumab for treating chronic rhinosinusitis with nasal polyps (terminated appraisal)
NICE TA955: Dupilumab for treating moderate to severe prurigo nodularis
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MHRA: Dupilumab (Dupixent▼): risk of ocular adverse reactions and need for prompt management
NICE TA534: Dupilumab for treating moderate to severe atopic dermatitis
NICE TA955: Dupilumab for treating moderate to severe prurigo nodularis
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Etanercept (Biosimilars avaliable)
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Formulary
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S/C injection 50mg pre-filled syringe, pre-filled pen
Consultant dermatologist or specilaist initiation only
Usually supplied to patients by a home delivery company
REQUIRES BLUETEQ APPROVAL
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MHRA: Tumour necrosis factor alpha inhibitors
NICE TA103: Etanercept and efalizumab for the treatment of adults with psoriasis
NICE TA455: Adalimumab, etanercept and ustekinumab for treating plaque psoriasis in children and young people
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Guselkumab (Tremfya®)
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Formulary
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Solution for injection in pre-filled pen 100mg/1ml
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NICE TA521: Guselkumab for treating moderate to severe plaque psoriasis
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Infliximab (Biosimilars avaliable)
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Formulary
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Intravenous infusion 100mg
Consultant dermatologist or specilaist initiation only
REQUIRES BLUETEQ APPROVAL
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MHRA: Tumour necrosis factor alpha inhibitors
NICE TA134: Infliximab for the treatment of adults with psoriasis
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Lebrikizumab
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Formulary
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NHSE commissioned for children / young adults aged 12-18 years
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NICE TA986: Lebrikizumab for treating moderate to severe atopic dermatitis in people 12 years and over
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Methotrexate
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Formulary
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Consultant dermatologist or specialist initiation only
Methotrexate should be prescribed once weekly as a single dose on the same day each week. If oral methotrexate is prescribed only use the 2.5 mg strength
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LSCMMG: Shared care guideline - Methotrexate
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Pimecrolimus 1% (Elidel®)
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Formulary
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Cream 30g, 60g, 100g
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NICE TA82: Tacrolimus and pimecrolimus for atopic eczema
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Risankizumab (Skyrizi®)
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Formulary
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solution for injection pre-filled syringes, solution for injection pre-filled pen 150mg/mL
NICE TA888 Risankizumab for previously treated moderately to severely active Crohn's disease - see link below
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NICE TA596: Risankizumab for treating moderate to severe plaque psoriasis
NICE TA803: Risankizumab for treating active psoriatic arthritis after inadequate response to DMARDs
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Ritlecitinib
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Formulary
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Severe alopecia areata
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BAD: Professional guidance supplementary to NICE TA958
NICE TA958: Ritlecitinib for treating severe alopecia areata in people 12 years and over
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Secukinumab (Cosentyx®)
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Formulary
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150mg pre-filled syringe
Usually supplied to patients by a home delivery company
REQUIRES BLUETEQ APPROVAL
Approved as  for palmoplantar psoriasis - off-label use
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NICE TA350: Secukinumab for treating moderate to severe plaque psoriasis
NICE TA445: Certolizumab pegol and secukinumab for treating active psoriatic arthritis after inadequate response to DMARDs
NICE TA734: Secukinumab for treating moderate to severe plaque psoriasis in children and young people
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Tacrolimus (Protopic®)
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Formulary
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Ointment 0.03%, 0.1% 30g, 60g
Consultant dermatologist or specilaist initiation only
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LSCMMG: Position Statement Prescribing of Oral Tacrolimus
MHRA: Tacrolimus ointment (Protopic): possible risk of malignancies including lymphomas and skin cancers
NICE TA82: Tacrolimus and pimecrolimus for atopic eczema
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Tildrakizumab (Ilumetri®)
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Formulary
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Solution for injection pre-filled syringes 100mg/1ml
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NICE TA575: Tildrakizumab for treating moderate to severe plaque psoriasis
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Tralokinumab (Adtralza ®)
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Formulary
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Pre-filled syringe 150 mg solution for injection - for treating moderate to severe atopic dermatitis - see link below
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NICE TA814: Abrocitinib, tralokinumab or upadacitinib for treating moderate to severe atopic dermatitis
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Upadacitinib (Rinvoq ®)
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Formulary
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Prolonged release tablets 15mg
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MHRA: Janus kinase (JAK) inhibitors: new measures to reduce risks of major cardiovascular events, malignancy, venous thromboembolism, serious infections and increased mortality
NICE TA814: Abrocitinib, tralokinumab or upadacitinib for treating moderate to severe atopic dermatitis
NICE768: Upadacitinib for treating active psoriatic arthritis after inadequate response to DMARDs
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Ustekinumab (Stelara®)
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Formulary
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Injection 45mg, 90mg pre-filled syringe
Consultant dermatologist or specilaist initiation only
Usually supplied to patients by a home delivery company
REQUIRES BLUETEQ APPROVAL
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NICE TA180: Ustekinumab for the treatment of adults with moderate to severe psoriasis
NICE TA455: Adalimumab, etanercept and ustekinumab for treating plaque psoriasis in children and young people
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| Non Formulary Items |
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Key |
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Cytotoxic Drug
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Controlled Drug
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High Cost Medicine
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Cancer Drugs Fund
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NHS England |
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Homecare |
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CCG |
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Low carbon footprint |
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Medium carbon footprint |
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High carbon footprint |
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Traffic Light Status Information
| Status |
Description |
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Green:
Appropriate for initiation and ongoing prescribing in both primary and secondary care.
Generally, little or no routine drug monitoring is required. |
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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.
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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. |
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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. |
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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. |
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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). |
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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. |
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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.
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Refer to local guidance. |
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