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  • Red Drug Classification

    Prescribing responsibility should remain with the consultant or specialist clinician. Medicines with one or more of the following criteria should be categorised as RED. These are drugs that:

    1. are unlicensed medicines unsuitable for use in primary care or are being used ‘off-label’ for an indication with no established evidence base;
    2. require long-term on-going specialist monitoring of efficacy or require long-term on-going specialist monitoring of toxicity (either because of difficulty in recognising side effects or high cost/availability of investigations to identify toxicity);
    3. are specifically designated as hospital only by nature of the product;
    4. are being used as part of a hospital based clinical trial;
    5. are not listed in the current BNF or BNFc;
    6. are part of a defined commissioning arrangement

    Always check the latest Summary of Product Characteristics for the licensed indications

    DrugIndications
    3,4-diaminopyridineLambert-Eaton myasthenic syndrome (LEMS)
    5-methoxypsoralenPUVA treatment of psoriasis
    Abacavir HIV infection
    Abacavir/lamivudine HIV infection
    Abacavir/dolutegravir/lamivudineHIV infection
    Abaloparatide
    Male and juvenile osteoporosis
    Abatacept All indications
    AbirateroneTreatment of cancer
    AcetylcysteineRed for newly diagnosed patients with cystic fibrosis (CF)
    Acitretin Psoriasis
    Adalimumab All indications
    Adefovir Hepatitis B
    Afatinib
    Treatment of cancers
    Aflibercept All indications
    Agalsidase alfa
    Fabry's disease
    Agalsidase beta
    Fabry's disease
    AgomelatineAntidepressant. Red for new patients
    Albumin-bound paclitaxelTreatment of cancers
    Albutrepenonacog alfaHaemophilia B
    AlbutropinAdult onset growth hormone deficiency
    Aldesleukin
    Treatment of cancers
    Alemtuzumab All indications
    Alglucosidase alfa
    Pompe disease
    Alipogene tiparvovecLipoprotein lipase deficiency
    Alpha mannosidase recombinant human
    Alpha mannosidase deficiency
    Alpha-1 antitrypsin
    Alpha-1 antitrypsin deficiency
    Alisporivir
    Hepatitis C
    Alitretinoin Severe chronic hand eczema refractory to potent topical corticosteroids
    Alteplase Thrombolytic
    AmbrisentanPulmonary arterial hypertension
    Amifampridine
    Lambert-Eaton myasthenic syndrome (LEMS)
    Amikacin inhalation
    Cystic fibrosis (CF)
    Amikacin liposomal
    Cystic fibrosis (CF)
    Amphotericin liposomal
    Fungal infections
    Anagrelide Essential thrombocythaemia
    Anakinra Rheumatoid arthritis (RA)
    Anidulafungin IV antifungal agent
    Antihaemophilic factor/Von Willebrand factor complexAs per BCSH guidelines for specialised indications
    Antilymphocyte globulin
    Aplastic anaemia organ transplant
    Antipseudomonas aeruginosa IgY
    Cystic fibrosis (CF)
    Antithrombin III
    As per BCSH guidelines for specialised indications

    Antithymocyte immunoglobulin
    Aplastic anaemia organ transplant
    Anti-retroviralsHIV Infection
    ApixabanSee DOACs
    ApremilastAccording to NICE (TA433) for the treatment of active psoriatic arthritis & (TA419) for treating moderate to severe plaque psoriasis

    Aprepitant Nausea/vomiting with highly emetogenic chemotherapy
    Asenapine Treatment of bipolar disorders
    Asfotase alfaHypophosphatasia
    Asunaprevir with daclatasvir
    Hepatitis C
    Atacicept
    Systemic lupus erythematosus (SLE)
    Ataluren
    Duchenne muscular dystrophy
    Atazanavir HIV Infection
    Atazanavir/cobicistatHIV infection
    Atezolizumab1. For treating previously platinum-treated locally advanced/ metastatic non squamos or squamos non-small cell lung cancer
    2. For locally advanced or metastatic urothelial cancer previously treated with platinum-based chemotherapy only if the agreed criteria is met.
    AvastinFor Neovascular Glaucoma and Neovascularization of the Retina
    Avoralstat
    Hereditary angioedema
    Axitinib
    Cancer
    Azacitidine Treatment of cancers
    AzathioprineImmunosuppression in transplant patients
    Aztreonam lysine Red for newly diagnosed cystic fibrosis (CF) patients
    Baricitinib
    Paediatric indications (where adult NICE TA available)
    Basiliximab
    Renal transplant
    Becaplermin Treatment of diabetic ulcers
    Beclabuvir
    Hepatitis C
    Bedaquiline
    TB
    Begelomab
    Graft versus host disease
    Belatacept
    Renal transplant
    BelimumabSystemic lupus erythematosus (SLE)
    Bendamustine Treatment of cancer
    Benralizumab
    Asthma
    BenzbromaroneUnlicensed medicine - Gout
    Beractant
    Respiratory distress syndrome
    Betaine
    Homocystinuria
    Bevacizumab All indications
    Bexarotene Treatment of cancers
    Bimagrumab
    Inclusion body myositis
    BiopatchPrevention of catheter site infection
    Biotin Vitamin induced hair loss. Multiple sclerosis (MS)
    Bivalirudin Use in perctaneous coronary intervention procedures
    BlinatumomabRecommended as an option for treating Philadelphia-chromosome-negative relapsed or refractory precursor B-cell acute lymphoblastic leukaemia in adults.
    Blisibimod
    Systemic lupus erythematosus (SLE)
    Boceprevir Hepatitis C
    Bone morphogenic protein (dibotermin, eptotermin)Bone fractures - see bone morphogenic protein commissioning statement
    Bone morphogenic protein (dibotermin, eptotermin)Complex spinal surgery
    BortezomibAll indications
    Bosentan All indications
    Bosutinib
    Cancer
    Botulinum toxin All indications
    BrentuximabTreatment of cancers
    BrincidofovirCytomegalovirus
    Brodalumab
    Paediatric indications (where adult NICE TA available)
    Bulkamid Periurethral injection for the management of female stress incontinence
    Buserelin Gonadorelin analogue for IVF
    Busulfan Treatment of cancers
    C1 esterase inhibitorsHereditary angioedema
    CabazitaxelTreatment of cancers
    CabozantinibTreatment of cancers
    Canakinumab
    Cryopyrin associated periodic syndrome and juvenile arthritis - paediatric
    Capecitabine All indications
    Caphosol® oral rinse For the prevention and treatment of mucositis caused by high dose chemotherapy
    Capsaicin patches 8%Neuropathic pain
    Carglumic acidUrea cycle disorders
    Carnitine
    Carnitine deficiency
    CaspofunginFungal infections
    Catridecacog
    Congenital factor XIIIa-subunit deficiency
    CeralifimodMultiple sclerosis (MS)
    CeritinibAll indications
    Cerliponase alfa
    Neuronal ceroid lipofuscinosis
    Certolizumab pegol All indications
    Cetrorelix IVF
    CetuximabTreatment of cancers
    Chenodeoxycholic acid
    Cerebrotendinous xanthomatosis and primary biliary cirrhosis
    Chloral Hydrate Insomnia (Short term use)
    Chlorambucil Treatment of cancers
    ChlordiazepoxideAcute alcohol withdrawal
    Cholic acidInborn errors in primary bile acid synthesis
    Chondriotin sulphateBladder instillation for patiients with damaged or glycosaminoglycan deficient bladder epithelium
    Chorionic gonadotrophinGonadorelin analogue for IVF
    Ciclosporin eye drops 1mg/ml (Ikervis®)Red for indications other than persistent dry eye (NICE TA369)
    Cidofovir Cytomegalovirus retinitis in AIDS (acquired immune deficiency syndrome)
    CinacalcetHyperparathyrodism in dialysis patients
    Ciprofloxacin inhalation
    Cystic fibrosis (CF)
    Ciprofloxacin liposomal (inhaled)
    Cystic fibrosis (CF)
    Cladribine
    Multiple sclerosis (MS) and pulmonary Langerhans histiocytosis
    Clinical trials material All trials
    ClofarabineTreatment of cancers
    Clomifene IVF treatment
    Clozapine Atypical antipsychotic for schizophrenia
    CobicistatHIV infection
    Cobitolimod
    Paediatric indications (where adult NICE TA available)
    Co careldopa intestinal gelSevere Parkinson's disease
    Co Enzyme Q10Enzyme deficiency in children
    ColestilanRenal dialysis - adults
    Colistimethate sodium Red for newly diagnosed patients with cystic fibrosis (CF)
    Conestat alfa
    Hereditary angioedema
    Crizotinib
    Treatment of cancers
    CyclophosphamideAll indications
    CyproteroneProstate cancer -
    Red for new patients
    Amber for existing patients
    Cyproterone (off-label indications)Off-label indications
    Cytotoxic injectable drugsAll indications
    DabigatranSee DOACs
    Dabrafenib Treatment of cancer
    DaclatasvirHepatitis C
    Daclizumab
    Multiple sclerosis (MS)
    Dalteparin
    Pre-procedural bridging therapy for patients usually on warfarin (as directed by surgeon/clinical haematologist).
    Extended post-operative thromboprophylaxis.
    High risk patients with plaster cast (~6 weeks whilst immobile) – off-label indication.
    Treatment of acute VTE & maintenance during pregnancy.
    Antenatal thromboprophylaxis in women at high risk of VTE in pregnancy.
    Postpartum thromboprophylaxis in high risk women (7 days or 6 weeks)
    Daratumunab•As monotherapy for the treatment of adult patients with relapsed and refractory multiple myeloma, whose prior therapy included a proteasome inhibitor and an immunomodulatory agent and who have demonstrated disease progression on the last therapy.
    •In combination with lenalidomide and dexamethasone, or bortezomib and dexamethasone, for the treatment of adult patients with multiple myeloma who have received at least one prior therapy
    Darunavir HIV infection
    Darunavir/cobicistatHIV infection
    DarbepoetinAll indications
    Dasabuvir

    Hepatitis C
    Dasatinib Treatment of cancers
    Daunorubicin Treatment of cancers
    DecitabineTreatment of cancers
    Deferasirox Iron chelation in thalassaemia and sickle cell
    Deferiprone
    Iron chelation in thalassaemia and sickle cell
    Defibrotide
    Hepatic veno-occlusive disease
    DegarelixProstate cancer
    DelamanidExtensively drug-resistant TB and multi drug-resistant TB
    DenosumabPrevention of skeletal events from breast cancer
    Desferrioxamine Iron chelation in thalassaemia and sickle cell
    Dexamethasone intravitreal implant Macular oedema
    Dexrazoxane

    Anthracycline extravasation and cardiotoxicity
    Dexmedetomide Maintenance of sedation during intensive care
    Dibotermin alfa Complex spinal surgery
    Dibotermin alfa Bone fractures. See bone morphogenic protein commissioning statement
    Didanosine HIV Infection
    Dihydrotestosterone(Androstanolone®)Unlicensed - recommendation from Leeds paediatric surgeons
    Dimethyl fumarateTreatment of adult patients with relapsing multiple sclerosis (MS)/
    treatment of psoriasis
    Dinoprostone vaginal delivery systemCervical ripening/induction of labour
    Disodium pamidronate (IV)Bisphosphonate all licensed indications
    DOACsRed for prevention of venous thromboembolic events (VTE) in adults who have undergone elective hip or knee replacement surgery. Acute coronary syndrome (ACS). Full courses supplied through Acute Trust. Check licensed indications and doses of individual drugs
    Docetaxel Advanced/metastatic breast cancer/prostate cancer
    DolutegravirHIV Infection
    Dornase alfa Red for newly diagnosed patients with cystic fibrosis (CF)
    Dornase alfa Primary ciliary dyskinesia
    Drisapersen

    Duchenne muscular dystrophy
    Droperidol injection Post operative nausea and vomiting
    Dupilumab

    Asthma
    Ecallantide
    Hereditary angioedema
    Eculizumab
    All indications
    EdoxabanSee DOACs
    Edratide
    Systemic lupus erythematosus (SLE)
    Efavirenz HIV Infection
    Efmoroctocog alfa Haemophilia
    Efraloctocog alfa/efmoroctocog alfa/factor VIII FC fusion protein

    Haemophilia A
    Elbasvir

    Hepatitis C
    Eliglustat

    Gaucher's disease
    Elosulfase alfaLysosomal storage disorders
    EltrombopagIdiopathic thrombocytopenic purpura
    ElvitegravirHIV infection
    Emricasan
    Non-alcoholic steatohepatitis fibrosis
    EmtricitabineHIV infection
    Emtricitabine/tenofovir alafenamide fumarate
    HIV infecion
    Emtricitabine/elvitegravir/cobicistat/tenofovir alafenamide fumarateHIV infection
    Emtricitabine/tenofovir alafenamide fumarateHIV infection
    Emtricitabine/rilpivirine/tenofovir alafenamide fumarateHIV Infection
    Enfuvirtide HIV Infection
    Entecavir Chronic hepatitis B infection
    Enzalutamide

    Treatment of cancers
    EpoetinDialysis-induced anaemia
    Epoprostenol Off-label indications
    Eprodisate
    Amyloidosis
    Epratuzumab

    Systemic lupus erythematosus (SLE)
    Eptotermin alfa
    Bone fractures - see bone morphogenic protein commissioning statement
    Eptotermin alfaComplex spinal surgery
    EribulinTreatment of cancers
    Erlotinib Treatment of cancers
    Estramustine Treatment of cancers
    Etanercept All indications
    Eteplirsen

    Duchenne muscular dystrophy
    EthambutolTreatment of TB
    Etoposide Treatment of cancers
    Etravirine HIV infection
    Etrolizumab

    Paediatric indications (where adult NICE TA available)
    Everolimus (Afinitor®)

    Treatment of cancer
    Everolimus (Certican®)
    Preventing transplant rejection
    Everolimus (Votubia®)
    Tubular sclerosis
    Evicel®Tissue adhesive - to be used in patients undergoing pelvic surgery or laparoscopic partial nephrectomies
    Evolocumab
    Homozygous familial hypercholesterolaemia
    Ex-vivo expanded autologous human corneal epithelial cells containing stem cells

    Limbal stem cell deficiency
    Factor IX

    As per BCSH guidelines for specialised indications
    Factor VIIa (Recombinant) (NovoSeven®)Bleeding episodes in surgery in specific patients
    Factor VIIa

    As per BCSH guidelines for specialised indications
    Factor VII

    As per BCSH guidelines for specialised indications
    Factor VIII

    As per BCSH guidelines for specialised indications
    Factor VIII inhibitor bypassing factor
    As per BCSH guidelines for specialised indications
    Factor XIII
    As per BCSH guidelines for specialised indications
    Fampridine
    Multiple sclerosis (MS)
    Ferric carboxymaltoseIron deficiency anaemia
    Ferric carboxymaltoseHeart failure patients with or without decreased haemoglobin levels
    Fibrinogen



    As per BCSH guidelines for specialised indications
    Fibroblast growth factor 1 gene therapy
    Somatostatin analogue
    Filgrastim Neutropenia and Barth syndrome
    FilgotinibPaediatric indications (where adult NICE TA available)
    Filibuvir

    Hepatitis C
    Fingolimod
    Management of multiple sclerosis (MS)
    FitusiranHaemophilia A and B
    FludarabineTreatment of cancers
    Fluocinolone acetonide intravitreal implant Treatment of chronic diabetic macular oedema
    Follitropin alfa/beta IVF gonadotrophin
    Fondaparinux Parenteral anticoagulant
    Forigerimod acetate

    Systemic lupus erythematosus (SLE)
    FosamprenavirHIV Infection
    Fosaprepitant injection Chemotherapy induced nausea and vomiting
    Foscarnet

    Cytomegalovirus
    Fosfomycin IV2nd line antibiotic for patients with carbapenemase resistant infections or with confirmed anaphylactoid reaction to penicillins presenting with suspected meningitis
    Fostemsavir
    HIV infection
    Fulvestrant Breast cancer
    Galsulfase

    Mucopolysaccharidosis
    Ganetespib
    Treatment of cancer
    Ganciclovir Maintenance of cytomegalovirus (CMV) retinitis in patients with AIDS. CMV disease in immunocompromised & patients with AIDS. Use in liver transplant patients
    Gefitinib Oral treatment for cancer
    Gevokizumab
    Uveitis
    Glatiramer Multiple sclerosis (MS)
    Glecaprevir
    Hepatitis C
    Glucarpidase
    Methotrexate-induced renal dysfunction
    Glycerol phenylbutyrate
    Urea cycle disorders
    Glycopegylated factor IX
    Haemophilia A
    Glycopyrronium (topical)Hyperhidrosis
    Golimumab All indications
    Gonadorelin IVF hypothalmic hormone
    Goserelin IVF gonadorelin analogue
    Granulocyte-macrophage colony-stimulating factor
    Antibody-positive pulmonary alveolar proteinosis
    Grazax®Seasonal allergic hayfever
    Grazoprevir
    Hepatitis C
    HIV-fusion inhibitorsHIV infection
    HIV-integrase inhibitorsHIV infection
    HIV vaccine
    HIV infection prophylaxis
    Human (haem) arginate
    Hepatic porphyria
    Human heterologous liver cells
    Urea cycle disorders
    Human menopausal gonadotrophinsIVF Gonadotrophin
    Human parathyroid hormone-related protein analogue
    Male and juvenile osteoporosis hypoparathyroidism
    HydroxycarbamideTreatment of solid tumours
    Hydroxyprogesterone Caproate Prevention of recurrent miscarriages
    Ibalizumab
    HIV infection
    Ibandronic acid injectionBisphosphonate - all licensed indications
    IbrutinibTreatment of cancers
    Icatibant
    Hereditary angioedema
    Idarubicin Treatment of cancers
    Idebenone
    Duchenne muscular dystrophy
    IdelalisibTreatment of cancers
    Idursulfase

    Mucopolysaccharidosis
    Iloprost
    Pulmonary arterial hypertension
    Imatinib mesilate All indications
    Imiglucerase Enzyme replacement - Gaucher's disease
    Imiquimod Basal cell carcinoma
    Immunoglobulin Intravenous (IVIg)All indications
    Indinavir HIV Infection
    Indocyanine dye Ophthalmology
    Infliximab Crohn’s disease; rheumatoid arthritis
    Insulin Humulin R® U500500unit/mL insulin for use in severely insulin resistant patients
    Interferon alfa All licensed indications
    Interferon beta Multiple sclerosis
    Irinotecan Metastatic colorectal cancer used with 5 FU and folinic acid
    Iron Sucrose Iron deficiency anaemia requiring intravenous therapy
    Ipilimumab Treatment of cancer
    Isavuconazole
    Fungal infections (licensed indications)
    IsoniazidTreatment of TB
    Isotretinoin Oral retinoid - acne
    Ivacaftor Red for newly diagnosed cystic fibrosis (CF) patients
    IVF Treatment All drugs
    Ixazomib
    For the treatment of adult patients with multiple myeloma who have received at least one prior therapy
    Ketamine All indications
    Lamivudine HIV Infection
    Lamivudine Hepatitis B treatment
    Lamivudine/abacavir/dolutegravirHIV infection
    Lamivudine/zidovudineHIV infection
    Lamivudine/zidovudine/abacavirHIV infection
    LanreotideRed for NHS England indications
    LanthanumAdult renal dialysis patients
    Lapatinib Breast cancer
    Laquinimod
    Multiple sclerosis (MS)
    Laronidase
    Mucopolysaccharidosis
    Lebrikizumab
    Asthma
    Ledipasvir/sofosbuvir Hepatitis C
    Lenalidomide All indications
    Lenograstim Recombinant human granulocytecolony stimulating factor - neutropenia
    Letermovir
    Cytomegalovirus
    Levofloxacin (inhaled)
    Cystic fibrosis (CF)
    Linezolid Antibiotic - Microbiologist initiation only
    Lithium carbonate Motor neurone disease (MND)
    Lipegfilgrastim
    Neutropenia
    Lixivaptan
    Hyponatraemia; other endocrine uses
    Lomitapide
    Homozygous familial hypercholesterolemia
    Lomustine Treatment of cancers
    Lonafarnib
    Treatment of cancers
    Lopinavir/ritonavirHIV infection
    Loteprednol Peri-operative use
    Lumacaftor/ivacaftorCystic fibrosis
    Macimorelin
    Growth failure
    MacitentanPulmonary arterial hypertension
    Mannitol dry powder inhalerTreatment of cystic fibrosis in adults
    Maraviroc HIV infection
    Masitinib
    Pancreatic cancer.
    Gastrointestinal stromal tumour (GIST)
    MavrilimumabPaediatric indications (where adult NICE TA available)
    Mecasermin Growth failure
    Melphalan Treatment of cancers
    Mepolizumab
    Asthma
    Mercaptamine (cysteamine)Nephropathic cystinosis
    Mercaptopurine Treatment of cancers
    Mesenchymal stem cellsAll indications
    Methotrexate
    (oral, IM & SC)
    Cancer indications
    Methotrexate
    (IM and SC)
    Non-cancer indications
    Metreleptin
    Dyslipidaemia

    Metyrapone Management of patients with Cushing’s Syndrome
    *(Red for new patients - Green Specialist initiation for existing patients)
    MexiletineTreatment of life-threatening ventricular arrhythmias
    Micafungin
    Fungal infections
    Midodrine Management of hypotension (Red - will be re-classified once Shared Care Guideline is approved)
    Migalastat
    Fabry's disease
    Miglustat
    Gaucher's disease; Niemann-Pick disease
    Mitotane Treatment of cancers
    Momelotinib
    Treatment of cancers
    MycophenolateIndications not classified as amber
    Nabilone Antiemetic.
    Multiple sclerosis (MS) treatment
    Nafarelin IVF - gonadorelin analogue
    Nalmefene
    (only for patients under the care of alcohol services including shared care)
    Alcohol dependence
    Natalizumab
    Multiple sclerosis (MS)
    NelarabineTreatment of cancers
    Neomycin oral tabletSurgical prophylaxis alongside oral metronidazole, plus standard intravenous surgical prophylaxis for colorectal surgery –with mechanical bowel preparation
    Netupitant and palonosetronAnti-emetic for use with cancer chemotherapy
    Nevirapine HIV Infection
    Nilotinib Treatment of cancers
    NintedanibTreatment of cancers; idiopathic pulmonary fibrosis
    NitazoxanideCryptosporidiosis and Giardiasis
    Nitazoxanide
    Hepatitis C
    Nitisinone
    Alkaptonuria; tyrosinaemia
    Nitric oxide

    Pulmonary arterial hypertension

    NivolumabTreatment of cancers
    NOACsSee DOACs
    Nonacog alpha
    Haemophilia B
    Nonacog beta pegol
    Haemophilia B
    Non-nucleoside reverse transcriptase inhibitorsHIV infection
    Nucleoside reverse transcriptase inhibitors (nucleoside analogues)HIV infection
    Obeticholic acid
    Primary biliary cirrhosis
    Obinutuzumab Treatment of cancers
    Ocrelizumab
    Multiple sclerosis (MS)
    OcriplasminRetinal disorders
    Octocog alfa
    Haemophilia A
    Octreolin
    Acromegaly
    Octreotide Off-label indications and NHS England indications
    -
    Ofatumumab
    Cancer and pemphigus vulgaris
    Olanzapine (IM injection)Atypical antipsychotic - schizophrenia and bipolar disorders
    OlaparibTreatment of cancers
    Olesoxime
    Spinal muscular atrophy
    Omalizumab Prophylaxis of allergic asthma
    Ombitasvir/paritaprevir/ritonavir Hepatitis C
    Oraldine® gel and mouthwashOral hygeine
    Osilodrostat
    Cushing's disease
    OsimertinibTreatment of cancers
    Oxaliplatin Metastatic colorectal cancer with 5 FU and folinic acid
    Ozanimod
    Multiple sclerosis (MS)
    Pacritinib

    Myelofibrosis
    Paliperidone Antipsychotic
    Palivizumab Prophylaxis of respiratory syncytial virus (RSV) for children
    PanitumumabTreatment of cancers
    PanobinostatTreatment of cancers
    Para-aminosalicylic acid
    TB
    Parathyroid hormone
    Specialist endocrinology conditions
    Paritaprevir
    Hepatitis C
    Paromomycin Treatment of cryptosporidium in immunocompromised patients
    Pasireotide
    Acromegaly; Cushing's disease
    Pazopanib
    Treatment of cancers
    PegaspargaseTreatment of cancers
    Pegylated liposomal doxorubicinTreatment of cancers
    Peg-filgrastim Reduction in neutropenia with cytotoxic chemotherapy
    Peg-interferon alfaTreatment of hepatitis B and C, patients not tolerating conventional interferons
    Peg-interferon beta-1aMultiple sclerosis (MS)
    Peginterferon lambda-1A
    Hepatitis C
    Pegvisomant
    Acromegaly
    PembrolizumabFor locally advanced or metastatic urothelial cancer previously treated with platinum-based chemotherapy only if the agreed criteria is met
    PembrolizumabMelanoma
    Pemetrexed Treatment of cancer
    Pentosan polysulphate Interstitial Cystitis (Unlicensed)
    Peptide receptor radionucelotide therapyTreatment of cancers
    PertuzumabTreatment of cancers
    Phenol 2% in Zinc paste Intractable pruritus ani
    Phenylbutazone NSAID - ankylosing spondylitis
    Phenylephrine/tropicamide ophthalmic insert (Mydriasert®)Surgical mydriasis
    Pirfenidone Antifibrotic for idiopathic pulmonary fibrosis
    PixantroneTreatment of cancers
    Plerixafor Stem cell mobilisation
    Pomalidomide
    Treatment of cancers
    Ponesimod
    Multiple sclerosis (MS)
    PonatinibTreatment of cancers
    Poractant alfa
    Respiratory distress syndrome
    Posaconazole All indications
    Potassium iodide For treatment of erythema nodosum
    Pretomanid
    Multi-drug resistant TB
    Procarbazine Treatment of cancers
    Protease inhibitorsHIV infection
    Protein C
    As per BCSH guidelines for specialised indications
    Prothrombin complexAs per BCSH guidelines for specialised indications
    Protein kinase inhibitorsEndocrinology; non-malignant conditions
    PyrazinamideTreatment of TB
    QuinidineShort QT syndrome, Brugada syndrome, and idiopathic ventricular fibrillation (VF)
    Radium-223 dichlorideTreatment of cancers
    Raltegravir HIV infection
    Raltitrexed Advanced colorectal cancer
    RamucirumabTreatment of cancers
    Ranibizumab All indications
    Rasburicase
    Hyperuricaemia
    Regorafenib
    Treatment of cancers
    Reslizumab
    As an add-on therapy, is recommended as an option for the treatment of severe eosinophilic asthma that is inadequately controlled in adults despite maintenance therapy with high-dose inhaled corticosteroids plus another drug, only if the agreed criteria is met.
    Reveglucosidase alfa
    Pompe disease
    Ribavirin Chronic hepatitis C treatment
    RifampicinTreatment of TB
    Rifater® (rifampicin/isoniazid/pyrazinamide)Treatment of TB
    Rifaximin Treatment of small intestinal bacterial overgrowth and for the treatment of chronic refractory pouchitis
    Rifinah® (rifampicin/isoniazid)Treatment of TB
    Rigosertib
    Myelodysplastic syndromes (MDS); pancreatic cancer
    Rilonacept
    Cryopyrin-associated periodic syndromes
    Rilpivirine HIV infection
    Riociguat
    Pulmonary arterial hypertension
    Risperidone inj Schizophrenia and other psychoses in patients tolerant to risperidone by mouth
    Ritonavir HIV Infection
    Ritonavir/lopinavirHIV infection
    Rituximab All uses
    RivaroxabanSee DOACs
    Romiplostim Thrombocyclopenic purpura
    Ropeginterferon alfa-2bHepatitis C
    RoxadustatDialysis-induced anaemia
    RuxolitinibTreatment of cancers
    Sapropterin Management of patients with phenylketonuria and tetrahydrobiopterin deficiency
    Saquinavir HIV Infection
    SarilumabPaediatric indications (where adult NICE TAs are available)
    Sebelipase alfaLysosomal acid lipase deficiency
    Secukinumab All indications
    SelexipagPulmonary arterial hypertension
    SetrobuvirHepatitis C
    SevelamerAdult renal dialysis
    Sialic acidMyopathy
    Sildenafil Off-label use for Raynaud's Disease.
    Pulmonary hypertension
    SimeprevirHepatitis C
    SirukumabPaediatric indications (where adult NICE TAs are available)
    Sodium benzoateUrea cycle disorders
    Sodium chloride 5% nebuliser solutionUnlicensed
    Sodium clodronate (IV) Bisphosphonate – osteolytic lesions, hypercalcaemia and bone pain associated with skeletal masses in breast cancer or multiple myeloma
    Sodium hyaluronate (Cystistat®)Interstitial cystitis
    Sodium oxybate Narcolepsy with cataplexy
    Sodium phenylbutyrateUrea cycle disorders
    SofosbuvirHepatitis C
    Sofosbuvir/ledipasvir Hepatitis C
    Sofosbuvir/velpatasvir Hepatitis C
    Sorafenib Treatment of cancers
    Stavudine HIV Infection
    StiripentolRare forms of epilepsy
    StreptomycinTreatment of TB
    Sucraid®Treatment of sucrase-isomaltase deficiency
    SucralfateAll indications
    Sucroferric oxyhydroxideControl of serum phosphorus levels in dialysis patients
    Sugammadex Reversal of neuromuscular blockade induced by rocuronium or vecuronium
    Sunitinib Treatment of cancers
    Susoctocog alfaHaemophilia A
    TabalumabSystemic lupus erythromatosus (SLE)
    TadalafilPulmonary arterial hypertension
    Taliglucerase alfa
    Gaucher's disease
    Talimogene laherparepvec
    Treatment of cancers
    TaribavirinHepatitis C
    TB drugsTreatment of TB
    TeduglutideShort bowel syndrome
    Tegafur with uracil Treatment of cancers
    Telaprevir Hepatitis C
    TelbivudineHepatitis B
    Temozolomide Treatment of cancers; endocrinology; non-malignant conditions
    TemsirolimusTreatment of cancers
    Tenofovir alafenamide fumarate Hepatitis B
    Tenofovir disoproxil fumarateHIV infection
    Tenofovir/cobicistat/elvitegravir/emtricitabineHIV infection
    Tenofovir/efavirenz/emtricitabineHIV infection
    Tenofovir/emtricitabineHIV infection
    Tenofovir/emtricitabine/elvitegravir/cobicistatHIV infection
    Tenofovor/emtricitabine/rilpiverineHIV infection
    TeriflunomideMultiple sclerosis (MS)
    Teriparatide All indications
    TetrahydobiopterinPhenylkenuria
    Thalidomide All indications
    ThrombinPseudoaneurysm
    Tioguanine Treatment of cancers
    Tipranavir HIV Infection
    TobramycinRed for newly diagnosed patients with cystic fibrosis (CF)
    Tobramycin dry powder InhalerSuppression of chronic pulmonary infections in cystic fibrosis (CF)
    Tocilizumab All indications
    TofacitinibXELJANZ® in combination with methotrexate (MTX) is indicated for the treatment of moderate to severe active rheumatoid arthritis (RA) in adult patients who have inadequately responded to, or who are intolerant to, one or more disease-modifying antirheumatic drugs (DMARDs). XELJANZ® can be given as monotherapy in case of intolerance to MTX or when treatment with MTX is inappropriate.
    TofacitinibPaediatric indications (where adult NICE TA available)
    Tolvaptan Hyponatraemia secondary to syndrome of inappropriate antidiuretic hormone secretion (SIADH) or cancer
    TopotecanCancer chemotherapy
    Total parenteral nutrition (TPN)Intravenous nutrition - various indications
    Trabectedin
    Treatment of cancers
    TraLife® oral spray Oral hygiene
    TralokinumabAsthma
    TrametinibTreatment of cancers
    Trastuzumab Treatment of cancers
    Trastuzumab emtansineTreatment of cancers
    Trenonacog alphaHaemophilia B
    Treosulfan Treatment of cancers
    TreprostinilPulmonary arterial hypertension
    Tretinoin (oral) Antineoplastic; induction of remission in acute promyelocytic leukaemia
    Triamcinolone hexacetonide (Lederspan®)Unlicensed - depot steroid injection for use in children
    Trientine Wilson's disease
    Trifluridine/tipiracilTreatment of cancers
    Triptorelin IVF treatment.
    Male hypersexuality
    Tryptophan Severe disabling depression. Unlicensed product - named patient use only
    Turoctocog alfaAs per BCSH guidelines for specialised indications
    Ulipristal 5mg1. Pre-operative management of uterine fibroids. Alternative treatment to hysterectomy, myomectomy, uterine embolization or GnRH agonists in perimenopausal patients with moderate to severe symptoms caused by fibroids. Also considered in younger patients with high surgical/anaesthetic risks.
    2. Intermittent treatment of moderate to severe symptoms of uterine fibroids
    Urofollitrophin IVF treatment
    Ustekinumab All indications
    VadadustatDialysis-induced anaemia
    Valganciclovir All indications
    VandetanibThyroid cancer
    VedolizumabAll indications
    Velaglucerase alfaGaucher's disease
    VelcalcetideHyperparathyrodism
    VemurafenibMelanoma
    Verteporfin Age related macular degeneration (AMD)
    Viekirax®Hepatitis C
    Vinblastine Treatment of cancers
    Vincristine Treatment of cancers
    Vindesine Treatment of cancers
    Vinorelbine Treatment of cancers
    VismodegibTreatment of cancers
    Vitamin A Retinosa pigmentosa
    Voluvyte® Injection Plasma expander
    Von Willebrand factor, recombinantVon Willebrand deficiency
    Voriconazole Fungal infections
    Ziconotide Non-opioid analgesic administered by intrathecal infusion
    Zidovudine HIV Infection
    Zoledronic acidPrevention of skeletal related events (pathological fractures, spinal compression, radiation/surgery to bone, or tumour-induced hypercalcaemia) in patientts with advanced malignancies involving bone; Treatment of tumour-induced hypercalcaemia

  • Amber Drug Classification

    Responsibility for prescribing may be transferred from secondary care/specialist services to primary care with agreement of an individual primary care prescriber and when locally approved and agreed shared care arrangements have been established (e.g. approved shared care guidelines are available)

    Drugs that do not have written shared care guidelines may be prescribed in primary care at the primary care prescriber’s discretion. The primary care prescriber should be satisfied that he/she has all the information and support needed to prescribe and monitor the patient.

    Medicines with the following criteria should be classified as AMBER:

    require specialist/consultant assessment to enable patient selection and initiation of treatment, plus one or more of the following;

    1. require short or medium term specialist monitoring of efficacy;
    2. require short or medium term specialist monitoring of toxicity;
    3. are very rarely used, such that individual primary care prescribers are unlikely to see sufficient patients and acquire a working knowledge of the drug.
    *The Area Prescribing Committee may accept shared care guidelines that have been produced by other organisations.
    Always check the latest Summary of Product Characteristics for the licensed indications
    DrugIndicationsShared care guideline
    AcamprosateMaintenance of abstinence in alcohol-dependent patientsAmber pending further work and shared care guideline
    Agomelatine Antidepressant (amber for existing patients)Agomelatine SCG SWYAPC
    Apomorphine Parkinson's diseaseApomorphine SCG SWYAPC
    Atomoxetine For attention deficit hyperactivity disorder (ADHD) in school-age children, adolescents and adultsAtomoxetine SCG SWYAPC
    Azathioprine Licensed indications - rheumatoid arthritis, systemic lupus erythematosus, dermatomyositis and polymyositis, auto-immune hepatitis
    Off-label indications - systemic vasculitis, inflammatory bowel diseases (Crohn’s disease, ulcerative colitis, microscopic colitis)
    Azathioprine SCG SWYAPC
    Azathioprine Dermatological conditions. Off-label indications: bullous pemphigoid, eczema, vasculitis & Behcet's syndromeAzathioprine SCG LTHT*
    Azathioprine Paediatric Inflammatory Bowel Disease (IBD) / Rheumatology LTHT*
    Bicalutamide Locally advanced prostate cancer at high risk of disease progression.
    Locally advanced non-metastatic prostate cancer when surgical castration or other medical intervention inappropriate.
    Ongoing monotherapy for prostate cancer in patients wishing to preserve sexual function.
    Maximum androgen blockade – use continuously in conjunction with LHRH analogue for three months
    Bicalutamide SCG SWYAPC
    Ciclosporin Licensed indications: rheumatoid arthritis, psoriasis.
    Off-label indication: psoriatic arthritis
    Ciclosporin
    SCG SWYAPC
    Ciclosporin Dermatological conditions. Licensed: atopic dermatitis. Off-label: bullous pemphigoid, pyoderma gangrenosum, hidradenitis suppurativa, pemphigus & lupusCiclosporin SCG LTHT*
    Ciclosporin Inflammatory bowel diseaseSCG not available for this indication - Please see Amber classification definition for further information and seek advice from requesting consultant for monitoring requirements.
    Ciclosporin Bone marrow transplantSCG not available for this indication - Please see Amber classification definition for further information and seek advice from requesting consultant for monitoring requirements.
    Ciclosporin Paediatric RheumatologyLTHT*
    Ciclosporin Post-transplantCiclosporin (post renal transplant), SCG LTHT*
    CinacalcetHypercalcaemia of primary hyperparathyroidism or parathyroid carcinoma Cinacalcet
    SCG SWYAPC
    Cinacalcet Secondary hyper-parathyroidism in patients with end-stage renal disease on maintenance dialysis therapy.Cinacalcet SCG LTHT*
    Colistimethate sodium - Colomycin®Cystic fibrosis managementSCG not available for this indication - Please see Amber classification definition for further information and seek advice from requesting consultant for monitoring requirements.
    Colistimethate sodium - Promixin®Cystic fibrosis managementSCG LTHT
    Colistimethate sodium - Colomycin®Pseudomonas infection in the lungs SCG LTHT
    Cyproterone Prostate cancerRed for new patients
    Amber for existing patients only
    CyproteroneSCG SWYAPC
    Dalteparin Treatment of acute VTE in: patients unable to take warfarin and in whom a DOAC is not appropriate/CI or patients in whom it has not been possible to stabilise on oral anticoagulant therapy and in whom a DOAC is not appropriate/CI or
    IV drug users (where warfarin is generally considered inappropriate) and in whom a NOAC is not appropriate/CI.
    Extended treatment of VTE in patients with solid tumours.
    Prevention of VTE
    in patients with solid tumours
    *please note a shared care guideline for all LMWHs is in development - therefore the review date for this shared care guideline has been extended until 16.05.2018* Dalteparin SCG SWYAPC
    DapsoneLicensed indication- dermatitis herpetiformis, and off-label indications - dermatoses (leucocytoclastic vasculitis, Sweet's syndrome, pyoderma gangrenosum)Dapsone
    SCG SWYAPC
    Darbepoetin alfa Dialysis-induced anaemia - red. All other indications - amberSCG not currently available - SCG not available for this indication. Please see Amber classification definition for further information and seek advice from requesting consultant for monitoring requirements.
    Denosumab Prevention of osteoporosisSWYAPC (please note that this shared care guideline has not been adopted by Bradford CCGs)
    Dexamfetamine For attention-deficit hyperactivity disorder (ADHD) in school-age children, adolescents and adultsDexamfetamine Lisdexamfetamine SCG SWYAPC
    DilsulfiramManagement of patients with drinking problemsAmber pending further work and shared care guideline
    Dornase alfaCystic fibrosis (CF) managementDornase alpha SCG LTHT*
    Epoetin Dialysis-induced anaemia - red.
    All other indications- amber
    SCG not available - Please see Amber classification definition for further information and seek advice from requesting consultant for monitoring requirements.
    Flutamide Advanced prostate cancer patients for:
    Long term palliative therapy when LHRH analogues or orchidectomy is contraindicated, not tolerated or oral therapy preferred.
    Hot flushes with LHRH analogue therapy or after orchidectomy
    Flutamide SCG SWYAPC
    Gender dysphoria or reassignment drugsGuidance available from Leeds Health Pathways (search 'gender')See information from Leeds
    Glycopyrronium (oral)HypersalivationGlycopyrronium SCG LTHT*
    GnRH analogues (Leuprorelin or Triptorelin) Endometriosis or uterine fibroidsGnRH analogues (Leuprorelin or Triptorelin) SCG SWYAPC
    GnRH analogues (Goserelin, Leuproelin, Triptorelin) Management of prostate cancer SWYAPC
    Goserelin EndometriosisSCG not available for this indication. Please see Amber classification definition for further information and seek advice from requesting consultant for monitoring requirements.
    Goserelin Management of prostate cancer See GnRH analogues
    GuanfacineAttention-deficit hyperactivity disorder (ADHD) in school age children, adolescents and adultsSCG SWYAPC
    Hydroxycarbamide Haematological conditionsHydroxycarbamide SCG SWYAPC
    Hydroxycarbamide Psoriasis (off-label)Hydroxycarbamide SCG LTHT*
    Hydroxychloroquine Rheumatoid arthritis, systemic and discoid lupus erythematosus (and related connective tissue diseases – off-label)Hydroxychloroquine SCG SWYAPC
    Lanreotide Neuroendocrine tumours, acromegalySCG not available for this indication. Please see Amber classification definition for further information and seek advice from requesting consultant for monitoring requirements.
    Lanthanum Control of hyperphosphataemia in patients with chronic renal failureLanthanum SCG LTHT*
    Leflunomide Rheumatoid arthritis (RA).
    Psoriatic arthritis
    *Please note: awaiting regional update of guidelines* Leflunomide SCG SWYAPC
    LeuprorelinEndometriosis or uterine fibroidsSee GnRH analogues
    Leuprorelin Management of prostate cancer See GnRH analogues
    Lisdexamfetamine For attention-deficit hyperactivity disorder (ADHD) in school-age children, adolescents and adultsDexamfetamine Lisdexamfetamine SCG SWYAPC
    Lithium Treatment and prophylaxis of mania, bipolar disorder and recurrent depressionSWYAPC
    To refer patients back into the service who have been discharged - please see the link to the SWYPFT Service directory
    Melatonin MR Treatment of sleep disorders in children and young people under 18 yearsCircadin SCG SWYAPC. Leaflet for patients Crushing Circadin tablets leaflet
    Mercaptopurine Inflammatory bowel disease: unresponsive and frequently relapsing cases of Crohn’s disease and ulcerative colitis. Auto-immune hepatitisSWYAPC
    Mercaptopurine For the treatment of Inflammatory Bowel Disease in ChildrenLTHT*
    Methotrexate (oral) Licensed indications – rheumatoid arthritis, psoriatic arthritis
    Off-label indications - other inflammatory arthritides, connective tissue disease
    (not for cancer or dermatological conditions)
    Methotrexate (Oral) SCG CHFT
    Methotrexate (oral) Licensed indication: severe uncontrolled psoriasis.
    Off-label conditions: e.g pemphigoid, pemphigus, sarcoidosis, scleroderma, dermatomyositis, eczema. See shared care guideline for further indications
    Methotrexate SCG LTHT*
    Methotrexate (oral) Non cancer indications in paediatrics LTHT*
    Methylphenidate For attention deficit hyperactivity disorder (ADHD) in school-age children, adolescents and adultsMethylphenidate SCG SWYAPC
    Modafinil Treatment of adults with excessive sleepiness associated with chronic pathological conditions, including narcolepsy. Multiple sclerosis (MS) and Parkinson’s Disease are to be included as they are chronic pathological conditions.SWYAPC
    MycophenolateOff-label indications –systemic lupus erythematosus (SLE), particularly lupus nephritis, other connective tissue diseases and systemic vasculitis. Treatment of myasthenia gravis in patients intolerant or non-responding to azathioprine*Please note: awaiting regional update of guidelines* Mycophenolate SCG SWYAPC
    Mycophenolate Suppression of rejection post transplant Mycophenolate SCG LTHT*
    Mycophenolate Paediatric rheumatologyLTHT*
    Mycophenolate For the prevention of relapse in frequently relapsing nephrotic syndrome in paediatricsLTHT*
    NaltrexoneMaintain abstinence in alcohol-dependent patientsAmber pending further work and shared care guideline
    Octreotide Amber for licensed CCG funded indications (symptoms associated with carcinoid tumours with features of carcinoid syndrome, VIPomas, glucagonomas, acromegaly, prevention of complications after pancreatic surgery). Red for NHS England indicationsAmber - SCG not available. Please see Amber classification definition for further information and seek advice from requesting consultant for monitoring requirements.
    Red for NHS England indications
    Penicillamine Rheumatoid arthritis (RA)Penicillamine SCG SWYAPC
    Phenelzine Treatment resistant depressionPhenelzine SCG SWYAPC
    Riluzole To extend life or time to mechanical ventilation for patients with amyotrophic lateral sclerosisRiluzole SCG SWYAPC
    Sevelamer Hyperphosphataemia in dialysis patientsSevelamer SCG LTHT*
    Sirolimus Prophylaxis of organ rejection in transplant patientsSirolimus SCG LTHT*
    Sodium aurothiomalate (IM gold) Rheumatoid arthritis (RA)Sodium Aurothiomalate SCG SWYAPC
    Somatropin for adults Acquired adult-onset, post-surgery growth hormone deficiency
    *Please note that Omnitrope® is what we commission in adults as growth hormone product of choice*
    Somatropin Adults SCG SWYAPC
    Sulfasalazine Licensed indication - rheumatoid arthritis (RA).
    Off-label - other inflammatory arthritides
    Sulfasalazine SCG SWYAPC
    SulfasalazinePaediatric rheumatologyLTHT*
    Tacrolimus (oral) Immunosuppressant for transplant patientsTacrolimus SCG LTHT*
    Tacrolimus Post paediatric renal transplant Tacrolimus SCG LTHT
    Tacrolimus (Adaport®)Treatment of Crohns Disease unresponsive to other immunosuppressants (off-label use) Tacrolimus SCG LTHT
    Tacrolimus Nephrotic Syndrome in children Tacrolimus SCG LTHT
    Taurine Cystic fibrosis (CF) managementSCG not available. Please see Amber classification definition for further information and seek advice from requesting consultant for monitoring requirements.
    Tobramycin (Tobi®) nebuliser solution Cystic fibrosis (CF) managementTobramycin SCG LTHT*
    Triptorelin Endometriosis or uterine fibroidsSee GnRH analogues
    Triptorelin Precocious pubertyAmber - SCG not available. Please see Amber classification definition for further information and seek advice from requesting consultant for monitoring requirements.
    Triptorelin Management of prostate cancerSee GnRH analogues

  • Green with Specialist Initiation Drug Classification

    A medicine only to be initiated by the clinicians specified below, but where there is no requirement for additional monitoring for toxicity over and above the general requirements for all medicines i.e. monitoring of efficacy, annual review etc. The primary care prescriber should be satisfied that he/she has all the information and support needed to continue to prescribe for the patient.

    Health care professionals who can initiate GSI medicines are prescribers:

    •Specialist working in a provider service

    •GPwSI

    •Independent prescribers who undertake further training to demonstrate competence in an area of healthcare.

    Primary care specialists work in a commissioned service.

    Specialists are accountable, expert healthcare professionals who can be consulted because of their in-depth knowledge and skills in a particular specialist field. Their practice is underpinned by approved governance structures and regular demonstration of competency. They must take personal responsibility for their actions and omissions and fully recognise their personal accountability.

    The person initiating prescribing should undertake any necessary pre-prescribing tests (bloods/ECGs/Xray etc) and initial monitoring.

    Medicines with the following criteria should be classified as GREEN SPECIALIST INITIATION:

    1. requires a primary or secondary care clinician with specialist knowledge to enable patient selection;
    2. requires short or medium term specialist monitoring of efficacy;
    3. requires the dose to be titrated by the specialist service;
    4. is initiated following discussion with a specialist.
    Always check the latest summary of product characteristics for the licenced indications.
    DrugIndications
    AcetylcysteineInterstitial lung disease
    Acetylcysteine sachetsIntestinal obstruction
    Aliskiren Stage 4 hypertension
    Amiodarone Arrhythmias
    Amisulpride Atypical antipsychotic – schizophrenia
    Anti-Epileptic Drugs (AED) in ChildrenSee LTHT guidance for information
    Anastrozole Breast cancer - long term therapy
    Antox® Anti-oxidant therapy for pancreatitis
    ApixabanSee DOACs
    Aripiprazole Schizophrenia
    Azithromycin Long term treatment bronchiectasis & COPD
    Bimatoprost/timolol eye drops Glaucoma
    BrivaracetamAs an adjunctive third line treatment option for the management of partial-onset seizures with or without secondary generalisation in adults. Brivaracetam may be considered if there is:
    • failure of one or more first line drugs (carbamazepine, lamotrigine or levetiracetam) AND
    • failure of one or more 2nd line drugs (topiramate, pregabalin, lacosamide, zonisamide or perampanel)
    Cabergoline Parkinson's disease
    Ciclosporin eye drops 1mg/ml (Ikervis®)For persistent dry eye (NICE TA369). All other indications are Red
    Dalteparin Urgent bridging of patients on warfarin (for VTE or heart valve), with significant subtherapeutic INR, in accordance with Trust dosing guidance (taking account of patient weight and renal function)
    DabigatranSee DOACs
    Dental Products on FP10GSI - ONLY for patients on specialist advice following treatment for head and neck cancers
    DOACsGSI for treatment of deep vein thrombosis (DVT) and pulmonary embolism (PE), and prevention of recurrent DVT and PE in adults, subject to local policy. Check licensed indications and doses of individual drugs
    Donepezil Mild to moderate dementia in Alzheimer's disease
    Dronedarone Cardiac arrhythmia
    EdoxabanSee DOACs
    Exemestane Breast cancer
    Fentanyl nasal spray Pain relief - use should be restricted to Palliative Care Consultants
    Fiasp® (insulin aspart)Treatment of diabetes in adult patients with Type 1 diabetes who are likely to benefit directly from a more rapid onset of action, including:
    1. Pregnancy
    2. Use of insulin pump
    3. Young adults unable to manage with Novorapid because of poor post-prandial glucose control, despite adequate therapeutic trial
    FidaxomicinTreatment of Clostridium difficile infection only when it prevents admission to hospital or severe illness
    Flecainide
    Flupentixol depot injection Depot antipsychotic for schizophrenia
    Fluphenazine depot injection Depot antipsychotic for schizophrenia (to be discontinued at the end of 2018 - no new patients should be started on this if treatment is expected to continue beyond the end of 2018)
    Fosfomycin Urinary tract infection (sensitivities reported by Microbiology)
    Galantamine Mild to moderate dementia in Alzheimer's disease
    Haloperidol depot injection Depot antipsychotic for schizophrenia
    Hydroxychloroquine Interstitial Pneumonitis in Children
    See LTHT guidance for information
    HydroxychloroquinePaediatric Rheumatology
    See LTHT guidance for information
    Ibandronic acid tablets 50mgPending Green Specialist Initiation for post-menopausal women with breast cancer
    Imiquimod Anogenital warts
    Insulin DegludecDiabetes mellitus (DM)
    Ivabradine Angina in sinus rhythm
    Ketogenic Dietary ProductsFor paediatric patients with epilepsy on a ketogenic diet and under the care of the regional service.
    See link to LTHT for additional information on ketogenic prescribable products
    Lacosamide Resistant partial seizures
    Letrozole Advanced breast cancer - long-term therapy
    Lidocaine patches Post-herpetic neuralgia (all off-label uses are RED)
    Loteprednol Glaucoma
    LubiprostoneTreatment of chronic idiopathic constipation
    LurasidoneSchizophenia (adults)
    Melatonin MR Cerebral palsy - these patients will require longer term treatment – there are no drug monitoring/blood monitoring requirements
    Memantine Moderately severe to severe Alzheimer's disease.
    Metyrapone Management of patients with Cushing’s Syndrome
    *(Red for new patients - Green Specialist Initiation for existing patients)
    Miconazole buccal Oropharyngeal candidiasis
    Midazolam oromucosal solution Convulsive seizures
    MidodrineIn adults for the treatment of severe orthostatic hypotension due to autonomic dysfunction when corrective factors have been ruled out and other forms of treatment are inadequate
    NaloxegolFor opioid-induced constipation according to NICE TA345
    Nephro-vite® Vitamin supplementation in renal impairment
    NOACsSee DOACs
    OctreotideFor palliative care indications
    Olanzapine (oral) Atypical antipsychotic schizophrenia and bipolar disorders
    Pancreatin preparations Pancreatic insufficiency
    Pergolide Parkinson's disease
    Phytomenadione capsulesNot licensed in UK
    Pipotiazine depot injection Depot antipsychotic for schizophrenia
    Pramipexole Parkinson's disease
    Pramipexole MR Parkinsons disease
    Propranolol Paediatric migraine
    See LTHT guidelines for more information
    Prasugrel Combination with aspirin for the prevention of atherothrombotic events in patients with acute coronary syndrome undergoing percutaneous coronary intervention
    Prucalopride Chronic constipation in women when other laxatives fail to provide an adequate response - NICE TA211
    Quetiapine Atypical antipsychotic schizophrenia
    Ranolazine Only in accordance with NICE CG126
    Rasagiline Parkinson's disease
    Renavit®Vitamin supplementation in renal impairment
    RifaximinPrevention of hepatic encephalopathy in adult patients
    Rimexolone ophthalmic suspension Local ocular steroid anti-inflammatory
    Risperidone oral Atypical antipsychotic schizophrenia
    RivaroxabanSee DOACs
    Rivastigmine Mild to moderate dementia in Alzheimer's disease
    Rivastigmine patches Mild to moderate dementia in patients with swallowing difficulties
    RoflumilastAs per TA461: Roflumilast, as an add-on to bronchodilator therapy, is recommended as an option for treating severe chronic obstructive pulmonary disease in adults with chronic bronchitis, only if:
    •the disease is severe, defined as a forced expiratory volume in 1 second (FEV1) after a bronchodilator of less than 50% of predicted normal, and
    •the person has had 2 or more exacerbations in the previous 12 months despite triple inhaled therapy with a long-acting muscarinic antagonist, a long-acting beta-2 agonist and an inhaled corticosteroid
    Ropinirole &
    ropinorole MR
    Parkinson's disease
    Rotigotine transdermal patches Parkinson’s disease, either used alone or as an adjunct to levodopa with dopa-decarboxylase inhibitor
    Sacubitril valsartan According to NICE TA388 for treating symptomatic chronic heart failure with reduced ejection fraction
    SafinamideParkinson's disease, as an adjunct to levodopa alone or in combination with other antiparkinsonian drugs, for mid- to late-stage fluctuations
    SildenafilPost prostatectomy or radiotherapy
    Silicone scar gels and sheetsWhen the specialist service recommending the treatment is funded by the NHS and has provided NHS funded care for that patient AND • The treatment is for hypertrophic or keloid scars that result from burns, trauma, keloid formation, or surgery and only when one or more of the following clinical criteria are met: a). Scar is functionally disabling b). Scar results in facial disfigurement
    Silk garmentsSevere eczema and allergic skin conditions
    Sodium chloride 7% nebuliser solution (Nebusal®)For patients with retained bronchopulmonary secretions and where usual treatment is not sufficiently effective
    Somatropin For the treatment of growth hormone insufficiency in paediatrics (see LTHT guidance)
    Tafluprost Glaucoma
    Tapentadol modified-release tabletsChronic non-malignant pain
    Testosterone gel Hypogonadism due to testosterone deficiency in men
    Testosterone injections (all brands) Use in line with licensed indications
    Ticagrelor Antiplatelet drug - use in line with NICE TA236 and TA420
    Timolol and brinzolamide Glaucoma
    Tizanidine Spasticity
    TizanidineCerebral Palsy Spasticity in Children
    See LTHT guidance for information
    TopiramatePaediatric Migraine
    See LTHT guidance for information
    Toremifine Metastatic breast cancer
    Travoprost/timolol (Duotrav®)
    Raised intraocular pressure
    ValaciclovirFor the treatment of Herpes Simplex Virus (HSV) Encephalitis in Paediatrics
    See LTHT guidance for information
    Valproate All indications
    Viteyes 2®Advanced age-related macular degeneration (AMD) in patients with category 4 disease. See commissioning statement
    VortioxetineFor treating major depressive episodes
    VSL#3® in paediatricsFor Pouchitis, Hirschsprungs disease or Ulcerative Colitis (UC) post Ileal Pouch Anal Anastomosis
    See LTHT guidance for information
    VSL#3® Management of gastro-intestinal symptoms
    Zuclopenthixol depot injection Depot antipsychotic for schizophrenia

  • Black Drug Classification

    Drugs that have been classified as “black” are those drugs that commissioning organisations across the SWY APC boundaries have agreed with local trusts and clinicians that they will not commission locally. Medicines with the following criteria should be classified as BLACK:

    1. there is a clear NHSE specialised commissioning group decision to not routinely fund usage of the drug.
    2. There is a CCG local decision not to routinely fund.
    3. There is a NICE recommendation that the drug should not be prescribed on the NHS for the condition specified
    4. A medicine for which the APC considers there is a poor evidence base or lack of cost effectiveness compared to alternative commissioned treatments
    DrugIndications
    AvanafilPenile rehabilitation post-radical prostatectomy or radiotherapy
    BCG vaccine Black for travel use
    NHSE items that should not be routinely prescribed in Primary Care
    Brimonidine gelTreatment of facial erythema of rosacea in adults patients
    ChondroitinBlack - for all indications
    NHSE items that should not be routinely prescribed in Primary Care
    Co-proxamolBlack for all indications NHSE items that should not be routinely prescribed in Primary Care
    DapoxetinePremature ejaculation
    Dental Products on FP10Black with the exception of those patients on specialist advice following treatment for head and neck cancers (GSI)
    See NHSE Guidance on the conditions for which over the counter items should not routinely be prescribed in primary care.
    DosulepinBlack for new patients for all indications - NHSE items that should not be routinely prescribed in Primary Care
    Doxazosin MR Black for all indications - NHSE items that should not be routinely prescribed in Primary Care
    Fentanyl IR Black for non palliative care use - NHSE items that should not be routinely prescribed in Primary Care
    Glucosamine Black for all indications - NHSE items that should not be routinely prescribed in Primary Care
    Hepatitis B (single agent vaccine) Black for travel use
    NHSE items that should not be routinely prescribed in Primary Care
    Herbal Black - for all indications
    NHSE items that should not be routinely prescribed in Primary Care
    Homeopathic medicinesBlack - for all indications
    NHSE items that should not be routinely prescribed in Primary Care
    Hyaluronic acid (injectables)Osteoarthritis and other joint conditions
    Hydrocortisone MRReplacement in adrenocortical insufficiency
    Japanese Encephalitis vaccine Black for travel use
    NHSE items that should not be routinely prescribed in Primary Care
    Lidocaine plasters Black - for unlicensed indications
    NHSE items that should not be routinely prescribed in Primary Care
    Liothyronine and
    liothyronine with levothyroxine
    Black - not to be initiated in Primary Care for new patients
    NHSE items that should not be routinely prescribed in Primary Care
    LiraglutideManagement of obesity
    Lutein and antioxidants Black - for all indications
    NHSE items that should not be routinely prescribed in Primary Care
    Meningitis ACWY vaccine Black for travel use
    NHSE items that should not be routinely prescribed in Primary Care NHSE items that should not be routinely prescribed in Primary Care
    Methylnaltrexone subcutaneous injectionSevere opioid induced constipation
    Mysimba® (naltrexone/bupropion) For managing overweight and obesity
    Omega 3 and other fish oils Black for all indications
    NHSE items that should not be routinely prescribed in Primary Care
    Oxycodone and naloxone MR Black for all indications
    NHSE items that should not be routinely prescribed in Primary Care
    Paracetamol and tramadol Black for all indications
    NHSE items that should not be routinely prescribed in Primary Care
    Perindopril arginine Black for all indications
    NHSE items that should not be routinely prescribed in Primary Care
    Pre-exposure prophylaxis (PrEP)For prevention of HIV in adults. Only as part of a clinical trial. Further details from NHS England
    Probiotics Management of gastro-intestinal symptoms.
    Except VSL#3® which is 'green with specialist initiation' for ACBS criteria i.e. for the maintenance of remission of ileo-anal pouchitis).

    See NHSE Guidance on the conditions for which over the counter items should not routinely be prescribed in primary care.
    Prednisone MRRheumatoid arthritis (RA)
    Rabies vaccine Black for travel use
    NHSE items that should not be routinely prescribed in Primary Care
    RoflumilastClassification pending formal guidance from NICE and Commissioning
    Rubefacients Black for all indications
    NHSE items that should not be routinely prescribed in Primary Care
    Sativex® Oromucosal Spray (cannabis-based product. Delta-9-tetrahydrocannabinol/
    cannabidiol )
    Spasticity and neuropathic pain in multiple sclerosis (MS). Also see information on the DROP-List
    Tadalafil once daily Black for erectile dysfunction
    NHSE items that should not be routinely prescribed in Primary Care
    TadalafilPenile rehabilitation post-radical prostatectomy or radiotherapy
    Tick-borne encephalitis vaccine Black for travel use
    NHSE items that should not be routinely prescribed in Primary Care
    Travel vaccinesBlack
    NHSE items that should not be routinely prescribed in Primary Care
    TrimipramineBlack for new patients for all indications
    NHSE items that should not be routinely prescribed in Primary Care
    VardenafilPenile rehabilitation post-radical prostatectomy or radiotherapy
    Yellow fever vaccine Black for travel use
    NHSE items that should not be routinely prescribed in Primary Care

  • Green Drug Classification

    The drugs in this category have been reviewed and classified as GREEN by the NHS locally as being suitable for initiation, stabilisation and maintenance in a primary, secondary or tertiary care setting.
    This list is not exhaustive. Please contact your medicines management team if you are unsure if you can prescribe a particular drug.

     

    Drug Indication
    Aclidinium bromide powder inhaler Chronic obstructive pulmonary disease (COPD)
    Alogliptin Type 2 diabetes (T2DM)
    Anoro Ellipta 55/22®Chronic obstructive pulmonary disease (COPD)
    Apixaban see DOACs
    Avanafil Erectile Dysfunction in adult males
    Calcipotriol/betamethasone scalp gel Psoriasis
    Canagliflozin Type 2 diabetes (T2DM)
    Clopidogrel
    Colesevelam Hyperlipidaemia
    Dabigatransee DOACs
    Dapagliflozin Type 2 diabetes (T2DM)
    DOACsGreen for prevention of stroke and systemic embolism in adults with non-valvular atrial fibrillation, with one or more risk factors, subject to local policy. Check licensed indications and doses of individual drugs
    Duloxetine
    Edoxabansee DOACs
    Enstilar® (calcipotriol/betamethasone)
    Exenatide Type 2 diabetes (T2DM)
    Exenatide weekly Type 2 diabetes (T2DM)
    Febuxostat In line with NICE patients intolerant of allorpurinol
    Fesoterodine Overactive bladder syndrome
    Fluorouracil/salicylic acid (Actikerall®) Management of actinic keratosis
    Fluticasone furoate nasal spray
    Influenza intra-nasal vaccine
    Ingenol mebotate Management of actinic keratosis
    Insulin glargine (Abasaglar®)Diabetes mellitus (DM)
    Insulin glargine (Toujeo®)Diabetes mellitus (DM)
    Ivermectin cream Rosacea
    LiraglutideType 2 diabetes (T2DM)
    Lixisenatide Type 2 diabetes (T2DM)
    Mesalazine MR (Mezavant®)For the induction of clinical and endoscopic remission in patients with mild to moderate, active ulcerative colitis. For maintenance of remission
    Mirabegron Overactive bladder syndrome
    NOACsSee DOACs
    Pivmecillinam
    PramipexoleRestless legs syndrome
    Rivaroxabansee DOACs
    Saxagliptin Type 2 diabetes (T2DM)
    Sitagliptin Type 2 diabetes (T2DM)
    Tacrolimus (topical) Treatment of moderate to severe atopic dermatitis in adults who are not adequately responsive to or are intolerant of conventional therapies such as topical corticosteroids
    Trospium MR Urinary incontinence
    Trospium XL Urinary incontinence
    Ultibro Breezhaler®Chronic obstructive pulmonary disease (COPD)
    Venlafaxine (at doses over 300mg daily)Treatment of major depressive episodes.
    For prevention of recurrence of major depressive episodes.
    Treatment of generalised anxiety disorder.
    Treatment of social anxiety disorder.
    Treatment of panic disorder, with or without agoraphobia
    Vildagliptin Type 2 diabetes (T2DM)
    Vildagliptin with metformin Type 2 diabetes (T2DM)