| 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... |
| 13.06 |
Acne and rosacea |
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Brimonidine Gel (Mirvaso® )
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 Restricted
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3mg/g gel brimonidine tartrate
(Only for use in patients with moderate to severe, persistent facial erythema of rosacea)
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Ivermectin cream 1% (Soolantra®)
(Rosacea)
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Formulary
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Cream
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 NICE: Inflammatory lesions of papulopustular rosacea: ivermectin 10 mg/g cream
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Trifarotene 0.05% Cream (Aklief®)
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Formulary
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For acne
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| 13.06.01 |
Topical preparations for acne |
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Patients should be referred to their community pharmacist or GP for advice/prescription of topical preparations for acne. |
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| 13.06.01 |
Benzoyl peroxide and azelaic acid |
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Azelaic Acid 15% (Finacae®)
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Formulary
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Gel 30g
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Azelaic Acid 20% (Skinoren®)
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Formulary
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Cream
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Benzoyl Peroxide 5% (Acnecide®)
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Formulary
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Gel
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Benzoyl Peroxide 5% with Clindamycin 1% (Duac® Once Daily)
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Formulary
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Gel 30g, 60g
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| 13.06.01 |
Topical antibacterials for acne |
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Erythromycin 40mg with Zinc Acetate 12mg/mL (Zineryt®)
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Formulary
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Lotion 30mL, 90mL
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Clindamycin 1% (Dalacin T®)
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Formulary
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Lotion 30mL, 60mL
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Clindamycin 1% gel
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Formulary
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Gel 1%
For oncology patients only
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| 13.06.01 |
Topical retinoids and related preparations for acne |
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Adapalene 0.1% (Differin®)
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Formulary
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Cream 45g
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Adapalene 0.1% / Benzoyl Peroxide 2.5% (Epiduo®)
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Formulary
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Gel 45g
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Clindamycin 1%/ tretinoin 0.025% (Treclin®)
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Formulary
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Gel
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| 13.06.01 |
Other topical preparations for acne |
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| 13.06.02 |
Oral preparations for acne |
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| 13.06.02 |
Oral antibiotics for acne |
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Doxycycline
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Formulary
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Capsules 100mg
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Erythromycin
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Formulary
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Tablets 250mg
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Lymecycline
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Formulary
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Capsules 408mg
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Oxytetracycline
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Formulary
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Tablets 250mg
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| 13.06.02 |
Hormone treatment for acne |
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Co-Cyprindiol
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Formulary
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Tablets cyproterone 2mg / ethinylestradiol 35 micrograms
CSM advice: VTE risk - see BNF
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MHRA: Cyproterone acetate with ethinylestradiol (co-cyprindiol): balance of benefits and risks remains positive
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| 13.06.02 |
Oral retinoid for acne |
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Isotretinoin
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Formulary
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Capsules 5mg, 20mg
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.
As a RED drug, isotretinoin should be supplied by secondary care. Local exceptions to this are for patients under the care of the consultant-led integrated community dermatology service, OMNES.
Community pharmacies can dispense FP10s for isotretinoin from OMNES where it is clear that the prescription has been issued within the context of a Pregnancy Prevention Programme. Do not dispense 7 days beyond issue date of FP10. Please refer the pharmacy checklist and Isotretinoin (Roaccutane▼): introduction of new safety measures, including additional oversight of the initiation of treatment for patients under 18 years of age
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MHRA: Isotretinoin (Roaccutane▼): introduction of new safety measures, including additional oversight of the initiation of treatment for patients under 18 years of age
MHRA: Isotretinoin: risk of serious skin reactions
MHRA: Oral retinoid medicines▼: revised and simplified pregnancy prevention educational materials for healthcare professionals and women
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| 13.06.03 |
Topical preparations for rosacea |
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| .... |
| Non Formulary Items |
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Key |
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Restricted Drug |
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Unlicensed |
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Link to adult BNF
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Link to children's BNF
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Link to SPCs
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Scottish Medicines Consortium |
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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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ICB |
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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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| 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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