| Formulary Chapter 11: Eye - 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... |
| 11.08 |
Miscellaneous ophthalmic preparations |
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Potassium ascorbate
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 Unlicensed
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Eye drops 10%
*under review*
Not on East Lancashire formulary
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| 11.08.01 |
Tear deficiency, ocular lubricants, and astringents |
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Acetylcysteine 5% with Hypromellose 0.35% (Ilube®)
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Formulary
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Eye drops
 For treatment of filamentary keratitis only
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Carbomer 980 eye drops
(polyacrylic acid)
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Formulary
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Liquid gel eye drops 0.2%
Liquid gel unit dose eye drops 0.2%
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Carmellose
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Formulary
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Preservative free eye drops 0.5%, 1%
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Hydramed Night®
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Formulary
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Lubricating eye ointment 5g
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Hylo-night ®
(formerly known as VitA-Pos®)
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Formulary
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Eye ointment preservative free
2nd line to Hydramed Night
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Hypromellose
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Formulary
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Eye drops 0.3%
Preservative free eye drops 0.3%
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Polyvinyl Alcohol (Liquifilm Tears®)
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Formulary
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Eye drops 1.4%
Unit dose eye drops 1.4%
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 LSCMMG: Over the Counter Items that Should not be Routinely Prescribed in Primary Care Policy
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Sodium Chloride (Minims® Saline)
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Formulary
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0.9% Minims®
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Sodium Hyaluronate
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Formulary
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Eye drops 0.2%
Eye drops - preservative free 0.1% & 0.2%
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Sodium Chloride
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Unlicensed
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Preservative free eye drops 5% (unlicensed)
*under review*
in East Lancashire
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| 11.08.02 |
Ocular diagnostic and peri-operative preparations and photodynamic treatment |
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| 11.08.02 |
Ocular diagnostic preparations |
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Fluorescein Sodium
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Formulary
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Minims® 1%, 2%
Injection 10% for WAMD clinic use only
Injection 20%
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Indocyanine green
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Formulary
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Injection 25mg (unlicensed)
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Trypan Blue (Vision Blue®)
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Formulary
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Injection
For use in cataract surgery
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| 11.08.02 |
Ocular peri-operative drugs |
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Acetylcholine Chloride (Miochol-E®)
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Formulary
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Intra-occular irrigation 1%
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Apraclonidine (Iopidine®)
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Formulary
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Unit dose eye drops 1% - perioperative use only
*under review*
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Balanced Salt Solution
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Formulary
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Sterile irrigation solution 15mL, 500mL
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Bromfenac (Yellox®)
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Formulary
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Eye drops 0.09%
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Diclofenac (Voltarol® Ophtha)
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Formulary
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Eye drops 0.1%
Unit dose eye drops 0.1%
*under review*
 in East Lancashire
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Ketorolac
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Formulary
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Eye drops 0.5%
*under review*
in East Lancashire
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Povidone iodine
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Formulary
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Unit dose eye drops 5%
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Sodium hyaluronate
(Obtained from central stores)
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Formulary
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Injection 1%
Injection prefilled syringe 15mg in 1mL
Injection prefilled syringe 14mg in 1mL (Haelonid GV®)
Irrigation 40mg/50mL
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Disodium edetate
(EDTA)
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Unlicensed
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Preservative free solution 0.37%
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| 11.08.02 |
Subfoveal choroidal neovascularisation |
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Aflibercept (Eylea®)
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Formulary
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Solution for intravitreal injection pre-filled syringe 40mg/mL
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 MHRA: Aflibercept (Zaltrap▼): minimising the risk of osteonecrosis of the jaw
NICE TA: Aflibercept for treating diabetic macular oedema
NICE TA409: Aflibercept for treating visual impairment caused by macular oedema after branch retinal vein occlusion
NICE TA486: Aflibercept for treating choroidal neovascularisation
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Brolucizumab  (Beovu®
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Formulary
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19.8mg/0.165ml solution for injection pre-filled syringes
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MHRA: Brolucizumab (Beovu▼): risk of intraocular inflammation and retinal vascular occlusion increased with short dosing intervals
NICE TA672: Brolucizumab for treating wet age-related macular degeneration
NICE TA820: Brolucizumab for treating diabetic macular oedema
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Faricimab (Vabysmo ®)
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Formulary
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Solution for injection 120 mg/mL
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NICE TA799: Faricimab for treating diabetic macular oedema
NICE TA800: Faricimab for treating wet age-related macular degeneration
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Ranibizumab
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Formulary
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Solution for intravitreal injection 10mg/mL
 For NICE TA637: Ranibizumab for treating diabetic retinopathy (terminated appraisal)
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NICE TA274: Ranibizumab for treating diabetic macular oedema
NICE TA637: Ranibizumab for treating diabetic retinopathy (terminated appraisal)
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Verteporfin injection
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Formulary
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15mg vial
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| 11.08.02 |
Vitreomacular traction |
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| 11.08.03 |
Reduction of elevated intra-ocular pressure |
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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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