| Formulary Chapter 5: Infections - Full Chapter
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| Notes: |
This chapter of the formulary is under development, please use local/national antimicrobial guidelines to support prescribing choices.
Prescribers must follow the relevant local and national guidance when treating an infection. Some anti-infectives require approval from the local Trust microbiology team for use, consult local guidance for further information.
Not all anti-infectives listed in this chapter will be available in all localities; availability will be guided by local need and resistance patterns.
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| Chapter Links... |
 Blackpool Teaching Hospitals: Antimicrobial Formulary |
| Central Lancashire/LSCFT/Morecambe Bay Primary Care: NICE Summary of antimicrobial prescribing guidance - managing common infections |
| East Lancashire Primary Care: Antimicrobial guide primary care |
| East Lancashire Secondary Care: Antimicrobial guide secondary care |
| Lancashire Teaching Hospitals Secondary Care: Tap on the bugs app (App store) |
| Lancashire Teaching Hospitals Secondary Care: Tap on the bugs app (Google) |
| University Hospitals of Morecambe Bay: Antimicrobial guide secondary care |
| West Lancashire Primary Care: Pan Mersey antimicrobial guide |
| British Association for Sexual Health and HIV |
| NICE CG165: Hepatitis B (chronic): diagnosis and management |
| NICE NG120: Cough (acute): antimicrobial prescribing |
| NICE NG125: Surgical site infections: prevention and treatment |
| NICE NG19: Diabetic foot problems: prevention and management |
| NICE NG191: COVID-19 rapid guideline: managing COVID-19 |
| NICE NG240: Meningitis (bacterial) and meningococcal disease: recognition, diagnosis and management |
| WHO: AWaRe classification of antibiotics for evaluation and monitoring of use, 2023 |
| NICE NG51: Sepsis: recognition, diagnosis and early management |
| NICE NG78: Cystic fibrosis: diagnosis and management |
| Details... |
| 05.01 |
Antibacterial drugs |
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| 05.01 |
Table 1. Summary of antibacterial therapy |
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| 05.01 |
Table 2. Summary of antibacterial prophylaxis |
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| 05.01.01 |
Penicillins |
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| 05.01.01.01 |
Benzylpenicillin and phenoxymethylpenicillin |
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Benzylpenicillin
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Formulary
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Injection 600mg, 1.2g
When prescribing, dispensing, or administering, check that this is the correct preparation—benzylpenicillin sodium is a short-acting form of benzylpenicillin and is not interchangeable with benzathine benzylpenicillin.
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Phenoxymethylpenicillin
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Formulary
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Tablets 250mg
Liquid 125mg/5mL, 250mg/5mL
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| 05.01.01.02 |
Penicillinase-resistant penicillins |
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Flucloxacillin
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Formulary
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Capsules 500mg, 250mg
Liquid 125mg/5mL, 250mg/5mL
Cholestatic jaundice and hepatitis may occur very rarely, up to two months after treatment with flucloxacillin has been stopped. Administration for more than 2 weeks and increasing age are risk factors. Manufacturer advises:
- flucloxacillin should not be used in patients with a history of hepatic dysfunction associated with flucloxacillin
- flucloxacillin should be used with caution in patients with hepatic impairment
- careful enquiry should be made about hypersensitivity reactions to beta-lactam antibacterials.
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Flucloxacillin injection
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Formulary
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Injection 250mg, 500mg, 1g
Cholestatic jaundice and hepatitis may occur very rarely, up to two months after treatment with flucloxacillin has been stopped. Administration for more than 2 weeks and increasing age are risk factors. Manufacturer advises:
- flucloxacillin should not be used in patients with a history of hepatic dysfunction associated with flucloxacillin
- flucloxacillin should be used with caution in patients with hepatic impairment
- careful enquiry should be made about hypersensitivity reactions to beta-lactam antibacterials.
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Temocillin (Negaban®)
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Formulary
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Injection 1g
Microbiology request only
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| 05.01.01.03 |
Broad-spectrum penicillins |
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Amoxicillin
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Formulary
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Capsules 250mg, 500mg
Liquid 125mg/5mL, 250mg/5mL
Sachets 3g
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Amoxicillin injection
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Formulary
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Injection 500mg, 1g
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Co-amoxiclav
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Formulary
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Tablets 375mg (250/125), 625mg (500/125)
Oral suspension 125mg/31mg/5ml, 250mg/62mg/5ml, 400mg/57mg/5ml (for paediatric use)
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Co-amoxiclav injection
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Formulary
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Injection 500mg/100mg, 1000mg/200mg
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| 05.01.01.04 |
Antipseudomonal penicillins |
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Piperacillin with tazobactam
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Formulary
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Injection 2.25g, 4.5g
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| 05.01.01.05 |
Mecillinams |
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Pivmecillinam
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Formulary
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Tablets 200mg
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| 05.01.02 |
Cephalosporins, carbapenems and other beta-lactums |
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| 05.01.02 |
Cephalosporins |
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| 05.01.02 |
Other beta-lactam antibiotics |
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| 05.01.02.01 |
Cephalosporins |
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Cefalexin
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Formulary
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Capsules 250mg, 500mg
Oral suspension 125mg/5ml, 250mg/5ml
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Cefuroxime
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Formulary
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Tablets 125mg, 250mg
Suspension 125mg/5mL
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Cefaclor
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Formulary
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Modified release tablet 375mg
Capsule 500mg
Oral suspension 125mg/5mL, 250mg/5mL
**RAG under consultation and awaiting update - Please use local/national antimicrobial guidelines to support prescribing choices. **
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Cefiderocol
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Formulary
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Powder for concentrate for solution for infusion 1g
On advice of Microbiology only.
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Cefixime (Suprax®)
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Formulary
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Tablets 200mg
**RAG under consultation and awaiting update - Please use local/national antimicrobial guidelines to support prescribing choices. **
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Cefotaxime
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Formulary
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Injection 500mg, 1g, 2g
**RAG under consultation and awaiting update - Please use local/national antimicrobial guidelines to support prescribing choices. **
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Ceftaroline
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Formulary
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Intravenous infusion 600mg
On advice of Microbiology only.
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Ceftazidime
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Formulary
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Injection 500mg, 1g, 2g
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Ceftazidime with avibactam
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Formulary
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Infusion 2g/0.5g
On advice of Microbiology only.
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Ceftolozane with tazobactam
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Formulary
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Powder for concentrate for solution for infusion 1g/0.5g
On advice of Microbiology only.
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Ceftriaxone
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Formulary
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Injection 250mg, 1g, 2g
On advice of Microbiology only.
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 MHRA: Ceftriaxone (rocephin): incompatible with solutions containing calcium
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Cefuroxime
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Formulary
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Injection 250mg, 750mg, 1.5g
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| 05.01.02.02 |
Carbapenems |
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Ertapenem
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Formulary
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Intravenous infusion 1g
On advice of Microbiology only.
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Meropenem
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Formulary
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Injection 500mg, 1g
On advice of Microbiology only (except for neutropenic sepsis).
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Meropenem with vaborbactam
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Formulary
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Powder for concentrate for solution for infusion 1g/1g
On advice of Microbiology only.
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| 05.01.02.03 |
Other beta-lactums antibiotics |
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| 05.01.03 |
Tetracyclines |
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Doxycycline
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Formulary
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Capsules 50mg, 100mg
Dispersible tablets 100mg
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Lymecycline
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Formulary
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Capsules 408mg
**RAG under consultation and awaiting update - Please use local/national antimicrobial guidelines to support prescribing choices. **
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Oxytetracycline
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Formulary
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Tablets 250mg
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Tetracycline
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Formulary
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Tablets 250mg
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Tigecycline
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Formulary
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Intravenous infusion 50mg
On advice of Microbiology only.
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MHRA: Tigecycline (Tygacil▼): increased mortality in clinical trials
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Minocycline
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Formulary
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LSCMMG: Minocycline
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| 05.01.04 |
Aminoglycosides |
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Amikacin
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Formulary
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Injection 500mg/2mL
 For neutropenia in children undergoing chemotherapy - Manchester protocol
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MHRA: Liposomal and lipid-complex formulations: name change to reduce medication errors
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Gentamicin
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Formulary
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Injection 20mg/2mL (paediatric), 80mg/2mL
**RAG under consultation and awaiting update - Please use local/national antimicrobial guidelines to support prescribing choices. **
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Neomycin Sulphate
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Formulary
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Tablets 500mg
**RAG under consultation and awaiting update - Please use local/national antimicrobial guidelines to support prescribing choices. **
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Tobramycin
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Formulary
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Injection 80mg/2mL, 240mg/6mL
Nebuliser solution 300mg/5mL
Inhalation powder capsules with device 28mg
On advice of Microbiology only.
Nebuliser solution restricted for use in cystic fibrosis patients only.
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NICE TA276: Colistimethate sodium and tobramycin dry powders for inhalation for treating pseudomonas lung infection in cystic fibrosis
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| 05.01.05 |
Macrolides |
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Azithromycin
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Formulary
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Tablets 250mg, 500mg
Liquid 200mg/5mL
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Clarithromycin
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Formulary
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Tablets 250mg, 500mg
Liquid 125mg/5ml, 250mg/5mL
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Clarithromycin
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Formulary
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Intravenous infusion 500mg
Clarithromycin is rapidly and well absorbed orally. Intravenous clarithromycin is reserved for those who are severely ill and /or unable to tolerate oral medication
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LSCMMG: Critical Care Intravenous Drug Monographs
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Erythromycin
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Formulary
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Tablets e/c 250mg
Suspension 125mg/5mL, 250mg/5mL
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MHRA: Erythromycin: caution required due to cardiac risks (QT interval prolongation); drug interaction with rivaroxaban
MHRA: Erythromycin: update on known risk of infantile hypertrophic pyloric stenosis
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Erythromycin
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Formulary
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Intravenous infusion 1g
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LSCMMG: Critical Care Intravenous Drug Monographs
MHRA: Erythromycin: caution required due to cardiac risks (QT interval prolongation); drug interaction with rivaroxaban
MHRA: Erythromycin: update on known risk of infantile hypertrophic pyloric stenosis
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| 05.01.06 |
Clindamycin |
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Clindamycin
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Formulary
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Capsules 75mg, 150mg
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Clindamycin
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Formulary
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Injection 300mg/2mL, 600mg/4mL
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| 05.01.07 |
Some other antibacterials |
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| 05.01.07 |
Chloramphenicol |
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Chloramphenicol
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Formulary
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Capsules 250mg
Injection 1g
On advice of Microbiology only.
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| 05.01.07 |
Fosfomycin |
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Fosfomycin (Monuril®)
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Formulary
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Oral solution sachets 3g
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Fosfomycin injection
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Formulary
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On advice of Microbiology only.
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| 05.01.07 |
Fusidic acid |
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Sodium fusidate
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Formulary
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Tablets 250mg
Liquid 250mg/5mL as fusidic acid
**RAG under consultation and awaiting update - Please use local/national antimicrobial guidelines to support prescribing choices. **
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MHRA: Systemic fusidic acid and interaction with statins
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Sodium fusidate injection
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Formulary
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Infusion 500mg
On advice of Microbiology only.
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MHRA: Systemic fusidic acid and interaction with statins
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| 05.01.07 |
Glycopeptide antibacterials |
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Dalbavancin
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Formulary
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Powder for concentrate for solution for infusion 500mg
On advice of Microbiology only.
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Oritavancin
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Formulary
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Powder for concentrate for solution for infusion 400mg
On advice of Microbiology only.
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LSCMMG: Oritavancin
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Teicoplanin
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Formulary
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injection 200mg, 400mg
**RAG under consultation and awaiting update - Please use local/national antimicrobial guidelines to support prescribing choices. **
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Vancomycin
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Formulary
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Capsules 125mg (liquid 250mg/5mL on request)
**RAG under consultation and awaiting update - Please use local/national antimicrobial guidelines to support prescribing choices. **
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MHRA: Prescribing medicines in renal impairment: using the appropriate estimate of renal function to avoid the risk of adverse drug reactions
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Vancomycin
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Formulary
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Injection 500mg, 1g
On advice of Microbiology only.
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Lancashire and South Cumbria Critical Care - Vancomycin Guideline
MHRA: Prescribing medicines in renal impairment: using the appropriate estimate of renal function to avoid the risk of adverse drug reactions
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| 05.01.07 |
Daptomycin |
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| 05.01.07 |
Linezolid |
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Linezolid
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Formulary
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Tablets 600mg
On advice of Microbiology only.
Severe optic neuropathy may occur rarely, particularly if linezolid is used for longer than 28 days.
Haematopoietic disorders (including thrombocytopenia, anaemia, leucopenia, and pancytopenia) have been reported in patients receiving linezolid. It is recommended that full blood counts are monitored weekly.
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LSCMMG: Linezolid
LSCMMG: Linezolid Prescriber Information Sheet
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Linezolid injection
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Formulary
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Intravenous infusion 600mg/300ml
On advice of Microbiology only.
Severe optic neuropathy may occur rarely, particularly if linezolid is used for longer than 28 days.
Haematopoietic disorders (including thrombocytopenia, anaemia, leucopenia, and pancytopenia) have been reported in patients receiving linezolid. It is recommended that full blood counts are monitored weekly.
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| 05.01.07 |
Quinupristin and dalfopristin |
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| 05.01.07 |
Polymyxins |
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Colistimethate
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Formulary
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Injection 1 million units, 2 million units
Inhalation powder capsules 1,662,500unit
On advice of Microbiology only.
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NICE TA276: Colistimethate sodium and tobramycin dry powders for inhalation for treating pseudomonas lung infection in cystic fibrosis
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Colistimethate for nebulisation (Colomycin®)
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Formulary
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Injection 1million unit (Colomycin®)
Bronchiectesis (non cystic fibrosis)
On advice of Microbiology only.
Training and education regarding use of nebuliser to be provided by specialist.
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LSCMMG: Colistimethate for nebulisation (Colomycin®) - Prescribing Information Sheet
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| 05.01.07 |
Rifaximin |
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Rifaximin
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Formulary
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Tablets 550mg tablets (Targaxan®), 200mg tablets (Xifaxanta®)
Second line antibacterial treatment for the treatment of small intestinal bacterial overgrowth.
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LSCMMG: Rifaximin
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Rifaximin (Targaxan®)
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Formulary
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Tablets 550 mg
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NICE TA337: Rifaximin for preventing episodes of overt hepatic encephalopathy
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| 05.01.07 |
Fidaxomicin |
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Fidaxomicin
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Formulary
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Tablets 200mg
On advice of Microbiology only.
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LSCMMG: Fidaxomicin
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| 05.01.08 |
Sulphonamides and trimethoprim |
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Co-trimoxazole
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Formulary
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Tablets 80mg/400mg, 160mg/800mg
Oral solution 40mg/200mg/5ml, 80mg/400mg/5ml
Low dose prophylaxis of pneumocystis jirovecii (Pneumocystis carinii) infections post-transplant.
Subacute bacterial peritonitis prophylaxis.
On advice of Microbiology only.
**RAGs under consultation and awaiting update - Please use local/national antimicrobial guidelines to support prescribing choices. **
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LSCMMG: Co-trimoxazole AMBER0
LSCMMG: Co-trimoxazole RED
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Co-trimoxazole injection
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Formulary
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Infusion 480mg/5mL
On advice of Microbiology only.
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Trimethoprim
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Formulary
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Tablets 100mg, 200mg
Liquid 50mg/5mL
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| 05.01.09 |
Antituberculosis drugs |
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Bedaquiline
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Formulary
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Tablets 100mg
On advice of Microbiology or a respiratory consultant only.
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NHSE: Clinical commissioning policy for resistant TB
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Capreomycin
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Formulary
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Injection 1g
On advice of Microbiology or a respiratory consultant only.
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Cycloserine
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Formulary
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Capsules 250mg
On advice of Microbiology or a respiratory consultant only.
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Delamanid
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Formulary
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Tablets 50mg
On advice of Microbiology or a respiratory consultant only.
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NHSE: Clinical commissioning policy statement (2317): treatment for defined patients with rifampicin resistant (RR) tuberculosis (TB), multidrug-resistant (MDR) TB, pre-extensively drug-resistant (pre-XDR) TB and extensively drug-resistant (XDR-TB) includ
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Ethambutol
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Formulary
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Tablets 100mg, 400mg
On advice of Microbiology or a respiratory consultant only.
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Isoniazid
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Formulary
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Tablets 100mg
Liquid 50mg/5mL (unlicensed)
Injection 50mg/2mL
Use Rifater® where possible.
On advice of Microbiology or a respiratory consultant only.
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Pretomanid
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Formulary
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On advice of Microbiology or a respiratory consultant only.
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NHSE: Clinical commissioning policy for resistant TB
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Pyrazinamide
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Formulary
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Tablets 500mg
Use Rifater® where possible
On advice of Microbiology or a respiratory consultant only.
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Rifampicin
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Formulary
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Intravenous infusion 600mg
On advice of Microbiology or a respiratory consultant only.
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Rifampicin
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Formulary
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Capsules 150mg, 300mg
Liquid 100mg/5mL
On advice of Microbiology or a respiratory consultant only. May be prescribed by GP upon consultant microbiologist advice.
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Rifampicin and Isoniazid
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Formulary
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Tablets rifampicin 300mg, isoniazid 150mg (Rifinah® 300)
Tablets rifampicin 150mg, isoniazid 100mg (Rifinah® 150)
On advice of Microbiology or a respiratory consultant only.
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Rifampicin and Isoniazid and Pyrazinamide (Rifater®)
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Formulary
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Tablets rifampicin 120mg, isoniazid 50mg, pyrazinamide 300mg
On advice of Microbiology or a respiratory consultant only.
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Rifampicin, isoniazid, pyrazinamide and ethambutol (Voractiv®)
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Formulary
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Tablets ethambutol hydrochloride 275mg, isoniazid 75mg, pyrazinamide 400mg, rifampicin 150mg
On advice of Microbiology or a respiratory consultant only.
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Terizidone
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Formulary
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Capsules 250mg
On advice of Microbiology or a respiratory consultant only.
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| 05.01.10 |
Antileprotic drugs |
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Dapsone
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Formulary
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Tablets 50mg, 100mg
On advice of Microbiology only.
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| 05.01.11 |
Metronidazole and tinidazole |
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Metronidazole
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Formulary
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Tablets 200mg, 400mg
Liquid 200mg/5mL
Suppositories 500mg,1g
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Metronidazole
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Formulary
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Intravenous infusion 500mg/100mL
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| 05.01.12 |
Quinolones |
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Quinolones may induce convulsions in patients with or without a history of convulsions; taking NSAIDs at the same time may also induce them.
Tendon damage (including rupture) has been reported rarely in patients receiving quinolones. |
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Ciprofloxacin
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Formulary
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Tablets 100mg, 250mg, 500mg
Liquid 250mg/5mL
On advice of Microbiology only.
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Ciprofloxacin
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Formulary
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Intravenous infusion 200mg/100mL, 400mg/200mL
Ciprofloxacin is well absorbed orally; use the intravenous infusion only when the oral route is unavailable.
On advice of Microbiology only.
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Levofloxacin
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Formulary
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Intravenous infusion 500mg/100mL
If use is not in line with local antimicrobial guidance, then please contact microbiology for advice.
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Levofloxacin
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Formulary
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Tablets 250mg, 500mg
If use is not in line with local antimicrobial guidance, then please contact microbiology for advice.
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Ofloxacin
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Formulary
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Tablets 200mg, 400mg
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| 05.01.13 |
Urinary-tract infections |
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Methenamine Hippurate
(hexamine hippurate)
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Formulary
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Tablets 1g
Considered less suitable for prescribing.
**RAG under consultation and awaiting update - Please use local/national antimicrobial guidelines to support prescribing choices. **
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Nitrofurantoin
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Formulary
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Modified release capsules 100mg
Capsules 50mg (restricted use to those unable to take gelatin capsules)
Liquid 25mg/5ml (paediatric use only, on approval by consultant microbiologist)
For patients with NG tubes or swallowing difficulties, please seek pharmacy advice.
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MHRA: Nitrofurantoin now contraindicated in most patients with an estimated glomerular filtration rate (eGFR) of less than 45 ml/min/1.73m2
MHRA: Nitrofurantoin: reminder of the risks of pulmonary and hepatic adverse drug reactions
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| 05.02 |
Antifungal drugs |
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Amphotericin B (liposomal) (AmBisome Liposomal®)
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Formulary
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Intravenous infusion 50mg
On advice of Microbiology only.
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MHRA: Liposomal and lipid-complex formulations: name change to reduce medication errors
MHRA: Parenteral amphotericin B: reminder of risk of potentially fatal adverse reaction if formulations confused
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Fluconazole
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Formulary
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Capsules 50mg, 200mg, 150mg single-dose pack
Liquid 50mg/5mL, 200mg/5mL
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Fluconazole
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Formulary
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Intravenous infusion 50mg/25mL, 200mg/100mL
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Flucytosine (Ancotil®)
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Formulary
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Intravenous infusion 2.5g/250mL
On advice of Microbiology only.
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MHRA: Flucytosine (Ancotil): new contraindication in patients with DPD deficiency
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Itraconazole
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Formulary
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Capsules 100mg
Liquid 10mg/mL
On advice of Microbiology only.
There have been reports of heart failure associated with itraconazole.
**RAG under consultation and awaiting update - Please use local/national antimicrobial guidelines to support prescribing choices. **
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Miconazole (Daktarin®)
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Formulary
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Oral gel 20mg/g
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MHRA: Miconazole (Daktarin): over-the-counter oral gel contraindicated in patients taking warfarin
MHRA: Topical miconazole, including oral gel: reminder of potential for serious interactions with warfarin
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Nystatin
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Formulary
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Liquid 100,000units/mL 30mL
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Posaconazole
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Formulary
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Tablets 100mg
Oral suspension 40mg/mL
On advice of Microbiology only.
Posaconazole tablets and oral suspension are not bioequivalent and should not be used interchangeably, due to differences in dosing frequency, administration with regards to food, and the plasma-drug concentration achieved.
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MHRA: Posaconazole (Noxafil): tablets and oral suspension are not directly interchangeable
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Rezafungin (Rezzayo®)
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Formulary
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Powder for concentrate for solution for infusion 200mg
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Terbinafine
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Formulary
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Tablets 250mg
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Voriconazole
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Formulary
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Tablets 50mg, 200mg
Liquid 200mg/5mL
Intravenous infusion 200mg
On advice of Microbiology only.
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MHRA: Voriconazole: reminder of risk of liver toxicity, phototoxicity, and squamous cell carcinoma
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| 05.02 |
Treatment of fungal infections |
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| 05.02.01 |
Triazole antifungals |
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| 05.02.02 |
Imidazole antifungals |
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| 05.02.03 |
Polyene antifungals |
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| 05.02.04 |
Echinocandin antifungals |
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Anidulafungin
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Formulary
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Powder for concentrate for solution for infusion 100mg
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|
|
Caspofungin
|
Formulary
|
Infusion 50mg, 70mg
|
|
|
| 05.02.05 |
Other antifungals |
|
|
| 05.03 |
Antiviral drugs |
|
|
Baricitinib
|
Formulary
|
Use in line with NG191.
|
NICE NG191: COVID-19 rapid guideline: managing COVID-19
|
Molnupiravir
|
Formulary
|
Use in line with NG191.
|
NICE NG191: COVID-19 rapid guideline: managing COVID-19
|
Nirmatrelvir with Ritonavir (Paxlovid®)
|
Formulary
|
Tablets 150mg/100mg
|
LSCMMG: Nirmatrelvir plus ritonavir, sotrovimab and tocilizumab
MHRA: COVID-19 antivirals: reporting to the UK COVID-19 Antivirals Pregnancy Registry
MHRA: Nirmatrelvir, ritonavir (Paxlovid▼): be alert to the risk of drug interactions with ritonavir
NICE TA878: Nirmatrelvir plus ritonavir, sotrovimab and tocilizumab for treating COVID-19
|
Remdesivir (Veklury®)
|
Formulary
|
Concentrate for solution for infusion 100mg
Agreed as a pass through cost to the ICB.
|
MHRA: COVID-19 antivirals: reporting to the UK COVID-19 Antivirals Pregnancy Registry
NICE TA971: Remdesivir and tixagevimab plus cilgavimab for treating COVID-19
|
Sotrovimab (Xevudy®)
|
Formulary
|
Concentrate for solution for infusion
500mg
|
LSCMMG: Nirmatrelvir plus ritonavir, sotrovimab and tocilizumab
NICE TA878: Nirmatrelvir plus ritonavir, sotrovimab and tocilizumab for treating COVID-19
|
Tocilizumab
|
Formulary
|
Infusion
|
LSCMMG: Nirmatrelvir plus ritonavir, sotrovimab and tocilizumab
MHRA: Tocilizumab (RoActemra): rare risk of serious liver injury including cases requiring transplantation
NICE TA878: Nirmatrelvir plus ritonavir, sotrovimab and tocilizumab for treating COVID-19
|
| 05.03.01 |
HIV infection |
|
|
| |
All drugs in this section are classed as RED - Primary care prescribers must not be asked to prescribe. Treatment of HIV infection should be undertaken by specialists only. Occupational Health and A&E doctors and Consultant Microbiologists may recommend the use of antiretrovirals for post exposure prophylaxis. |
|
Atazanavir sulfate and cobicistat (Evotaz®)
|
Formulary
|
Tablets atazanavir 300 mg, cobicistat 150 mg
Specialist prescribing only
|
MHRA: Cobicistat, ritonavir and coadministration with a steroid: risk of systemic corticosteroid adverse effects
|
Cobicistat
|
Formulary
|
Tablets 150mg
 Specialist prescribing only
|
MHRA: Cobicistat, ritonavir and coadministration with a steroid: risk of systemic corticosteroid adverse effects
MHRA: Elvitegravir boosted with cobicistat: avoid use in pregnancy due to risk of treatment failure and maternal-to-child transmission of HIV-1
|
Fostemsavir (Rukobia®)
|
Formulary
|
Prolonged release tablets 600mg
Specialist prescribing only
|
|
|
Tenofovir alafenamide, elvitegravir, cobicistat & emtricitabine (Genvoya®)
|
Formulary
|
Tablets Cobicistat 150mg, Elvitegravir 150mg, Emtricitabine 200mg, Tenofovir alafenamide 10mg
Specialist prescribing only
|
MHRA: Cobicistat, ritonavir and coadministration with a steroid: risk of systemic corticosteroid adverse effects
MHRA: Elvitegravir boosted with cobicistat: avoid use in pregnancy due to risk of treatment failure and maternal-to-child transmission of HIV-1
|
|
|
|
|
| 05.03.01 |
HIV-integrase inhibitors |
|
|
Cabotegravir (Vocabria®)
|
Formulary
|
Tablets 30mg
Prolonged-release injection 600mg/3ml
Specialist prescribing only
|
NICE TA757: Cabotegravir with rilpivirine for treating HIV-1
|
Dolutegravir (Tivicay®)
|
Formulary
|
Tablets 50mg
Specialist prescribing only
|
MHRA: Dolutegravir (Tivicay▼, Triumeq▼, Juluca▼): updated advice on increased risk of neural tube defects
|
Emtricitabine with Tenofovir alafenamide (Descovy®)
|
Formulary
|
Tablets 200mg emtricitabine and tenofovir alafenamide fumarate equivalent to 10 mg of tenofovir alafenamide,
200 mg of emtricitabine and tenofovir alafenamide fumarate equivalent to 25 mg of tenofovir alafenamide
Specialist prescribing only
|
|
|
Raltegravir (Isentress ®)
|
Formulary
|
Tablets 400mg, 600mg
Specialist prescribing only
|
|
|
| 05.03.01 |
Nucleoside reverse transcriptase inhibitors |
|
|
Abacavir
|
Formulary
|
Tablets 300mg
Liquid 20mg/mL (only available when tablets are unsuitable)
Specialist prescribing only
|
MHRA: Abacavir: risk of myocardial infarction—update from epidemiological studies
|
Abacavir and Lamivudine
|
Formulary
|
Tablets abacavir 600mg with lamivudine 300mg
Specialist prescribing only
|
MHRA: Abacavir: risk of myocardial infarction—update from epidemiological studies
|
Elvitegravir with cobicistat, emtricitabine and tenofovir disoproxil (Stribild®)
|
Formulary
|
Tablets Cobicistat 150 mg, Elvitegravir 150 mg, Emtricitabine 200 mg, Tenofovir disoproxil (as Tenofovir disoproxil fumarate) 245 mg
Specialist prescribing only
|
MHRA: Cobicistat, ritonavir and coadministration with a steroid: risk of systemic corticosteroid adverse effects
MHRA: Elvitegravir boosted with cobicistat: avoid use in pregnancy due to risk of treatment failure and maternal-to-child transmission of HIV-1
|
Emtricitabine (Emtriva®)
|
Formulary
|
Capsules 200mg
Bluteq required if prescribing for pre-exposure prophylaxis (PrEP).
Specialist prescribing only
|
|
|
Lamivudine
|
Formulary
|
Tablets 100mg, 150mg
Liquid 50mg/5ml (only available when tablets are unsuitable)
Specialist prescribing only
|
|
|
Lamivudine with tenofovir disoproxil and doravirine (Delstrigo®)
|
Formulary
|
Tablets Doravirine 100 mg, Lamivudine 300 mg, Tenofovir disoproxil (as Tenofovir disoproxil fumarate) 245 mg
Specialist prescribing only
|
|
|
Rilpivirine hydrochloride
|
Formulary
|
Tablets 25mg (Edurant)
Prolonged-release injection 900mg/3ml (Rekambys)
Specialist prescribing only
|
NICE TA757: Cabotegravir with rilpivirine for treating HIV-1
|
Tenofovir 245mg, Efavirenz 600mg and Emtricitabine 200mg
|
Formulary
|
Tablets efavirenz 600mg with emtricitabine 200mg and tenofavir 245mg
Specialist prescribing only
|
|
|
Tenofovir and Emtricitabine
|
Formulary
|
Tablets tenofovir 245mg with emtricitabine 200mg
Specialist prescribing only
|
|
|
Tenofovir Disproxil
|
Formulary
|
Tablets 245mg
Specialist prescribing only
|
NICE CG165: Hepatitis B (chronic): diagnosis and management
NICE TA173: Tenofovir disoproxil for the treatment of chronic hepatitis B
|
Zidovudine
|
Formulary
|
Capsules 100mg, 250mg
Oral solution 100mg/10ml
Infusion 200mg/20ml
Specialist prescribing only
|
|
|
| 05.03.01 |
Protease inhibitors |
|
|
Atazanavir
|
Formulary
|
Capsules 150mg, 200mg, 300mg
Specialist prescribing only
|
|
|
Darunavir
|
Formulary
|
Tablets 400mg, 600mg, 800mg
Oral suspension 100mg/mL (only available when tablets are unsuitable)
Specialist prescribing only
|
MHRA: Darunavir boosted with cobicistat: avoid use in pregnancy due to risk of treatment failure and maternal-to-child transmission of HIV-1
|
Lopinavir and Ritonavir
|
Formulary
|
Tablets lopinavir 200mg with ritonavir 50mg
Liquid available on request.
Specialist prescribing only
|
MHRA: Cobicistat, ritonavir and coadministration with a steroid: risk of systemic corticosteroid adverse effects
MHRA: Ritonavir-containing products: reports of interaction with levothyroxine leading to reduced thyroxine levels
|
Ritonavir
|
Formulary
|
Tablets 100mg
Specialist prescribing only
|
MHRA: Cobicistat, ritonavir and coadministration with a steroid: risk of systemic corticosteroid adverse effects
MHRA: Ritonavir-containing products: reports of interaction with levothyroxine leading to reduced thyroxine levels
|
| 05.03.01 |
Non-nucleoside reverse transcriptase inhibitors |
|
|
Doravirine (Pifeltro®)
|
Formulary
|
Tablets 100mg
Specialist prescribing only
|
|
|
Efavirenz
|
Formulary
|
Tablets 600mg
Specialist prescribing only
|
|
|
Etravirine (Intelence®)
|
Formulary
|
Tablets 100mg, 200mg
Specialist prescribing only
|
MHRA: Etravirine: reports of severe hypersensitivity reactions
|
Nevirapine
|
Formulary
|
Tablets 200mg
Specialist prescribing only
|
|
|
| 05.03.01 |
Other antiretrovirals |
|
|
| |
Other drugs for the treatment of HIV infection are available on request. Contact pharmacy for advice. |
|
Abacavir with Dolutegravir and Lamivudine (Triumeq®)
|
Formulary
|
Tablets abacavir (as abacavir sulfate) 600 mg, dolutegravir (as dolutegravir sodium) 50 mg, lamivudine 300 mg
Specialist prescribing only
|
MHRA: Abacavir: risk of myocardial infarction—update from epidemiological studies
|
Darunavir with Cobicistat (Rezolsta®)
|
Formulary
|
Tablets cobicistat 150mg, darunavir (as darunavir ethanolate) 800mg
Specialist prescribing only
|
MHRA: Cobicistat, ritonavir and coadministration with a steroid: risk of systemic corticosteroid adverse effects
MHRA: Darunavir boosted with cobicistat: avoid use in pregnancy due to risk of treatment failure and maternal-to-child transmission of HIV-1
|
Darunavir with Cobicistat, Emtricitabine and Tenofovir alafenamide (Symtuza®)
|
Formulary
|
Tablets cobicistat 150 mg, darunavir (as darunavir ethanolate) 800 mg, emtricitabine 200 mg, tenofovir alafenamide (as tenofovir alafenamide fumarate) 10 mg
Specialist prescribing only
|
MHRA: Cobicistat, ritonavir and coadministration with a steroid: risk of systemic corticosteroid adverse effects
MHRA: Darunavir boosted with cobicistat: avoid use in pregnancy due to risk of treatment failure and maternal-to-child transmission of HIV-1
|
Dolutegravir and Lamivudine (Dovato®)
|
Formulary
|
Tablets dolutegravir (as dolutegravir sodium) 50mg, Lamivudine 300mg
Specialist prescribing only
|
MHRA: Dolutegravir (Tivicay▼, Triumeq▼, Juluca▼): updated advice on increased risk of neural tube defects
|
Dolutegravir and Rilpivirine (Juluca®)
|
Formulary
|
Tablets 50mg/25mg
Specialist prescribing only
|
MHRA: Dolutegravir (Tivicay▼, Triumeq▼, Juluca▼): updated advice on increased risk of neural tube defects
|
Emrticitabine with Rilpivirine and Tenofovir disoproxil (Eviplera®)
|
Formulary
|
Tablets Emtricitabine 200mg, Rilpivirine (as Rilpivirine hydrochloride) 25mg, Tenofovir disoproxil 245mg
Specialist prescribing only
|
|
|
Emtricitabine with Rilpivirine and Tenofovir alafenamide (Odefsey®)
|
Formulary
|
Tablets emtricitabine 200mg, rilpivirine (as rilpivirine hydrochloride) 25mg, tenofovir alafenamide (as tenofovir alafenamide fumarate) 25mg
Specialist prescribing only
|
|
|
Maraviroc (Celsentri®)
|
Formulary
|
Tablets 150mg, 300mg
Specialist prescribing only
|
|
|
| 05.03.02 |
Herpesvirus infections |
|
|
| 05.03.02.01 |
Herpes simplex and varicella-zoster infection |
|
|
Aciclovir injection
|
Formulary
|
Intravenous infusion 250mg, 500mg
|
|
|
Aciclovir oral
|
Formulary
|
Tablets 200mg, 400mg, 800mg
Dispersible tablets 200mg, 400mg, 800mg
Oral suspension 200mg/5ml
|
|
|
| 05.03.02.02 |
Cytomegalovirus infection |
|
|
Ganciclovir
|
Formulary
|
Intravenous infusion 500mg
Specialist prescribing only
|
|
|
Letermovir (Prevymis® )
|
Formulary
|
Tablets 240mg
Specialist prescribing only
|
NICE TA591: Letermovir for preventing cytomegalovirus disease after a stem cell transplant
|
Maribavir (Livtencity® )
|
Formulary
|
Tablets 200mg
Specialist prescribing only
|
NICE TA860: Maribavir for treating refractory cytomegalovirus infection after transplant
|
Valganciclovir
|
Formulary
|
Tablets 450mg
Suspension 250mg/5mL
Specialist prescribing only
|
|
|
| 05.03.03 |
Viral hepatitis |
|
|
Adefovir Dipivoxil (Hepsera®)
|
Formulary
|
Tablets 10mg
Specialist prescribing only
|
NICE TA96: Adefovir dipivoxil and peginterferon alfa-2a for the treatment of chronic hepatitis B
|
Bulevirtide (HEPCLUDEX®)
|
Formulary
|
Powder for solution for injection 2mg
Specialist prescribing only
|
NICE TA896: Bulevirtide for treating chronic hepatitis D
|
Entecavir
|
Formulary
|
Tablets 500micrograms, 1mg
Specialist prescribing only
|
NICE TA153: Entecavir for the treatment of chronic hepatitis B
|
Ribavirin
|
Formulary
|
Capsules 200mg
Specialist prescribing only
|
NICE TA106: Peginterferon alfa and ribavirin for the treatment of mild chronic hepatitis C
NICE TA200: Peginterferon alfa and ribavirin for the treatment of chronic hepatitis C
NICE TA300: Peginterferon alfa and ribavirin for treating chronic hepatitis C in children and young people
NICE TA75: Interferon alfa (pegylated and non-pegylated) and ribavirin for the treatment of chronic hepatitis C
|
Sofosbuvir
|
Formulary
|
Tablets 200mg, 400mg
Specialist prescribing only
|
MHRA: Direct-acting antiviral interferon-free regimens to treat chronic hepatitis C: risk of hepatitis B reactivation
MHRA: Direct-acting antivirals for chronic hepatitis C: risk of hypoglycaemia in patients with diabetes
MHRA: Direct-acting antivirals to treat chronic hepatitis C: risk of interaction with vitamin K antagonists and changes in INR
MHRA: Simeprevir with sofosbuvir: risk of severe bradycardia and heart block when taken with amiodarone
MHRA: Sofosbuvir with daclatasvir; sofosbuvir and ledipasvir: risks of severe bradycardia and heart block when taken with amiodarone
NICE TA330: Sofosbuvir for treating chronic hepatitis C
|
| 05.03.03.01 |
Chronic hepatitis B |
|
|
| 05.03.03.02 |
Chronic hepatitis C |
|
|
| |
Hepatitis C therapy is based on genotype and cirrhosis status. Treatment options are dictated by the 'rate card' which is published by NHSE.
All cases in this region are discussed at the hepatitis C MDT for all local Trusts. |
|
Elbasvir with grazoprevir (Zepatier®)
|
Formulary
|
Tablets elbasvir 50mg, grazoprevir 100mg
|
NICE TA413: Elbasvir–grazoprevir for treating chronic hepatitis C
|
Glencaprevir with pibrentasvir
|
Formulary
|
Tablets glecaprevir 100mg, pibrentasvir 40mg
|
NICE TA499: Glecaprevir–pibrentasvir for treating chronic hepatitis C
|
Ledipasvir and Sofosbuvir (Harvoni®)
|
Formulary
|
Tablets 45mg/200mg, 90mg/400mg
|
MHRA: Sofosbuvir with daclatasvir; sofosbuvir and ledipasvir: risks of severe bradycardia and heart block when taken with amiodarone
NICE TA363: Ledipasvir–sofosbuvir for treating chronic hepatitis C
|
Ribavirin
|
Formulary
|
Capsules 200mg
|
NICE TA106: Peginterferon alfa and ribavirin for the treatment of mild chronic hepatitis C
NICE TA200:Peginterferon alfa and ribavirin for the treatment of chronic hepatitis C
NICE TA300: Peginterferon alfa and ribavirin for treating chronic hepatitis C in children and young people
NICE TA75: Interferon alfa (pegylated and non-pegylated) and ribavirin for the treatment of chronic hepatitis C
|
Sofosbuvir (Sovaldi® )
|
Formulary
|
Tablets 200mg, 400mg
|
NICE TA330: Sofosbuvir for treating chronic hepatitis C
|
|
Sofosbuvir and Velpatasvir (Epclusa®
|
Formulary
|
Tablets 200mg/50mg, 400mg/100mg
|
NICE TA430: Sofosbuvir–velpatasvir for treating chronic hepatitis C
|
Sofosbuvir with Velpatasvir and Voxilaprevir (Vosevi®)
|
Formulary
|
Tablets Sofosbuvir 400 mg, Velpatasvir 100mg, Voxilaprevir 100mg
|
NICE TA507: Sofosbuvir–velpatasvir–voxilaprevir for treating chronic hepatitis C
|
|
|
|
|
|
|
|
|
|
|
| 05.03.04 |
Influenza |
|
|
Oseltamivir
|
Formulary
|
Capsules 30mg, 45mg, 75mg
Oral suspension 30mg/5mL
Public Health England advises that oseltamivir oral suspension should be reserved for children under the age of 1 year. Children over 1 year of age, adults with swallowing difficulties, and those receiving nasogastric oseltamivir, should use capsules which can be opened and mixed into an appropriate sugary liquid.
Tamiflu® is not prescribable in NHS primary care except for the treatment and prophylaxis of influenza as indicated in the NICE guidance; endorse prescription ‘SLS’.
|
LSCMMG: Oseltamivir
NICE TA158: Oseltamivir, amantadine (review) and zanamivir for the prophylaxis of influenza
NICE TA168: Amantadine, oseltamivir and zanamivir for the treatment of influenza
|
Zanamivir (Relenza®)
|
Formulary
|
Dry powder for inhalation 5mg/blister
Relenza® is not prescribable in NHS primary care except for the treatment and prophylaxis of influenza as indicated in the NICE guidance; endorse prescription ‘SLS’.
|
LSCMMG: Zanamivir
NICE TA158: Oseltamivir, amantadine (review) and zanamivir for the prophylaxis of influenza
NICE TA168: Amantadine, oseltamivir and zanamivir for the treatment of influenza
|
Amantadine
|
Formulary
|
|
LSCMMG: Amantadine
|
| 05.03.05 |
Respiratory syncytial virus |
|
|
Palivizumab (Synagis®)
|
Formulary
|
Injection 50mg, 100mg
|
MHRA: Respiratory syncytial virus: the green book, chapter 27a
|
| 05.04 |
Antiprotozoal drugs |
|
|
| 05.04.01 |
Antimalarials |
|
|
| |
Drugs for malaria prophylaxis are not prescribable in NHS primary care.
Tablets can be sold to the public provided it is licensed and labelled for the prophylaxis of malaria.
Expert advice must be sought in all patients suspected to have malaria. |
|
Artemether with lumefantrine (Riamet®)
|
Formulary
|
Tablets Artemether 20mg with lumefantrine 120mg
|
|
|
Artesunate
|
Formulary
|
Injection 60mg
Consultant Microbiologist request only
Available for ‘named-patient’ use from infectious disease units or specialist tropical disease centres.
|
|
|
Chloroquine
|
Formulary
|
Tablets 250mg (equivalent to chloroquine base 155mg)
Specialist prescribing only
|
MHRA: Hydroxychloroquine, chloroquine: increased risk of cardiovascular events when used with macrolide antibiotics; reminder of psychiatric reactions
|
Doxycycline
|
Formulary
|
Capsules 50mg, 100mg
Dispersible tablets 100mg
Specialist prescribing only when used for treatment of malaria
|
|
|
Primaquine
|
Formulary
|
Tablets 7.5mg, 15mg
Specialist prescribing only
|
|
|
Proguanil Hydrochloride with Atovaquone
|
Formulary
|
Tablets proguanil hydrochloride 100mg with atovaquone 250mg
Specialist prescribing only
|
|
|
Quinine sulphate
|
Formulary
|
Tablets 200mg
Specialist prescribing only when used for treatment of malaria
|
MHRA: Quinine: not to be used routinely for nocturnal leg cramps
MHRA: Quinine: reminder of dose-dependent QT-prolonging effects; updated medicine interactions
|
|
|
|
|
|
|
|
|
|
|
| 05.04.01 |
Treatment of malaria |
|
|
| 05.04.01 |
Falciparum malaria (treatment) |
|
|
| 05.04.01 |
Benign malarias (treatment) |
|
|
| 05.04.01 |
Prophylaxis against malaria |
|
|
| 05.04.01 |
Specific recommendations |
|
|
| 05.04.01 |
Artemether with lumefabtrine |
|
|
| 05.04.01 |
Chloroquine |
|
|
| 05.04.01 |
Mefloquine |
|
|
| 05.04.01 |
Primaquine |
|
|
| 05.04.01 |
Proguanil |
|
|
| 05.04.01 |
Pyrimethamine |
|
|
| 05.04.01 |
Quinine |
|
|
| 05.04.01 |
Tetracyclines |
|
|
| 05.04.02 |
Amoebicides |
|
|
Metronidazole
|
Formulary
|
Tablets 200mg, 400mg
Liquid 200mg/5mL
Suppositories 500mg,1g
|
|
|
Metronidazole
|
Formulary
|
Intravenous infusion 500mg/100mL
|
|
|
| 05.04.03 |
Trichomonacides |
|
|
Metronidazole
|
Formulary
|
Intravenous Infusion 500mg/100mL
|
|
|
Metronidazole
|
Formulary
|
Tablets 200mg, 400mg
Liquid 200mg/5mL
Suppositories 500mg,1g
|
|
|
| 05.04.04 |
Antigiardial drugs |
|
|
Metronidazole
|
Formulary
|
Intravenous infusion 500mg/100mL
|
|
|
Metronidazole
|
Formulary
|
Tablets 200mg, 400mg
Liquid 200mg/5mL
Suppositories 500mg,1g
|
|
|
| 05.04.05 |
Leishmaniacides |
|
|
| 05.04.06 |
Trypanocides |
|
|
| 05.04.07 |
Drugs for toxoplasmosis |
|
|
| 05.04.08 |
Drugs for pneumocystis pneumonia |
|
|
| |
Contact microbiology for advice. |
|
Co-trimoxazole
|
Formulary
|
See section 05.01.08
|
|
|
| 05.04.08 |
Treatment |
|
|
| 05.04.08 |
Prophylaxis |
|
|
| 05.05 |
Anthelmintics |
|
|
| |
Contact microbiology for advice. |
|
Ivermectin
|
Formulary
|
Tablets 3mg
|
LSCMMG NHS: Scabies Operational Clinical Pathway
|
Levamisole
|
Formulary
|
Tablets 50mg
named patient only
To be used on consultant microbiologist or specialist advice only
|
LSCMMG: Levamisole
|
| 05.05.01 |
Drugs for threadworms |
|
|
Mebendazole
|
Formulary
|
Tablets 100mg
|
|
|
| 05.05.02 |
Ascaricides |
|
|
| 05.05.03 |
Drugs for tapeworm infections |
|
|
| 05.05.03 |
Taenicides |
|
|
| 05.05.03 |
Hydatid disease |
|
|
| 05.05.04 |
Drugs for hookworms |
|
|
| 05.05.05 |
Schistosomicides |
|
|
| 05.05.06 |
Filaricides |
|
|
| 05.05.07 |
Drugs for cutaneous larva migrans |
|
|
| 05.05.08 |
Drugs for strongyloidiasis |
|
|
| .... |
Key |
|
|
|
|
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. |
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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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