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Joint Formulary
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 Formulary Chapter 1: Gastro-intestinal system - Full Chapter
01.05.03  Expand sub section  Drugs affecting the immune response
Mercaptopurine
(Gastroenterology)
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Formulary

NOTE: There is more than one monograph for this medicine, click here to search for formulary status and its use for other indications. 

Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • For patients intolerant of azathioprine
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • For patients intolerant of azathioprine (N.B. dose reduction required if switching from azathioprine)
    • FBC & LFT monitoring required
 
   
Methotrexate
(Gastroenterology)
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Formulary

NOTE: There is more than one monograph for this medicine, click here to search for formulary status and its use for other indications. 

Provider notes

  • NMUH:
    • See link below
  • RFL:
    • 2.5mg tablets must be prescribed for non-malignant indications
    • See pharmacy policy for the safe dispensing of methotrexate
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • See link below
 
Link  NCL JFC: Shared care Guideline - Prescribing and Monitoring of oral methotrexate for licensed and off-label indications
   
Azathioprine
(Gastroenterology)
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Formulary

NOTE: There is more than one monograph for this medicine, click here to search for formulary status and its use for other indications. 

Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • No restriction stated
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Azathioprine should be initiated only by the Gastroenterology team for difficult cases. FBC and LFT monitoring is required.
 
Link  NCL JFC: DMARD Quick Reference Guide for Primary Care Prescribers
   
Azathioprine
(Hepatology)
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Formulary

NOTE: There is more than one monograph for this medicine, click here to search for formulary status and its use for other indications. 

Approved for autoimmune hepatitis (JFC February 2018)

Provider notes

  • NMUH:
  • RFL:
    • See indication above
  • RNOH:
  • UCLH:
  • WH:
    • Specialist initiation, continuation in primary care
 
Link  NCL JFC: DMARD Quick Reference Guide for Primary Care Prescribers
   
Mycophenolate mofetil
(Gastroenterology)
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Formulary

NOTE: There is more than one monograph for this medicine, click here to search for formulary status and its use for other indications. 

Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • Non-formulary
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Mycophenolate is approved for treatment of inflammatory bowel disease (IBD) including ulcerative colitis (UC) and Crohn’s Disease (CD) in patients with active disease who have failed to respond to Azathioprine/ 6-Mercaptopurine, Methotrexate or biological therapy, and are not for surgery
    • Tabs 500mg
 
   
Tofacitinib tabs
(Gastroenterology)
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Restricted Drug Restricted

NOTE: There is more than one monograph for this medicine, click here to search for formulary status and its use for other indications. 

See NCL Ulcerative Colitis treatment pathway for place in therapy (JFC April 2019).

Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • Restricted to consultant gastroenterologists for NICE approved indications
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Restricted to gastroenterology consultants as per NICE TA547
 
Link  NCL JFC: Adult high-cost drug pathway for moderately to severely active ulcerative colitis
Link  NICE TA547: Tofacitinib for moderately to severely active ulcerative colitis
Link  Tofacitinib - MHRA Drug Safety Update
   
Vedolizumab
(Gastroenterology)
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Formulary
High Cost Medicine

See NCL treatment pathways for place in therapy in adults (JFC April 2019). Approved for paediatric use (JFC January 2018).

Provider notes

  • NMUH:
    • Positive NICE TA. This medicine has a positive NICE Technology Appraisal and is listed in the Trust Medicines Formulary when used  in line with NICE recommendations and/or Local Trust Guidelines.
  • RFL:
    • Restricted to consultant gastrenterologists for NICE approved indications
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • As per NICE TA342 June 2015.
 
Link  NCL JFC: Adult high-cost drug pathway for active Crohn’s disease
Link  NCL JFC: Adult high-cost drug pathway for moderately to severely active ulcerative colitis
Link  NICE TA352: Vedolizumab for treating moderately to severely active Crohn’s disease after prior therapy
Link  NICE TA342: Vedolizumab for treating moderately to severely active ulcerative colitis
   
Ciclosporin
(Gastroenterology)
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Restricted Drug Restricted

NOTE: There is more than one monograph for Ciclosporin, click here to search for formulary status and its use for other indications. 

Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • Ciclosporin is restricted to Consultant Gastroenterologists only
    • FBC, LFT & drug level monitoring required
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Ciclosporin is restricted to Consultant Gastroenterologists only
    • FBC, LFT & drug level monitoring required
 
   
01.05.03  Expand sub section  Cytokine inhibitors : Treatment of ulcerative colitis and Crohn’s disease
Adalimumab
(Gastroenterology)
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Formulary
GP - Red
High Cost Medicine

NOTE: There is more than one monograph for this medicine, click here to search for formulary status and its use for other indications. 

Provider notes

  • NMUH:
    • This medicine has a positive NICE Technology Appraisal and is listed in the Trust Medicines Formulary when used in line with NICE recommendations and/or Local Trust Guidelines
    • Red List Medicine – Hospital Only Prescribing PbR (Payment by Results) excluded drug.
    • Restricted to Consultant Gastroenterologists for NICE approved indications.
    • Check MHRA Drug Safety Update
  • RFL:
    • Restricted to Consultant Gastroenterologists for NICE approved indications.
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Restricted to consultant gastroenterologists 
    • NICE TA187 and TA329 applies
    • JFC (Oct 17): Approved for fistulising Crohn's disease in patients not able to receive infliximab.
 
Link  NCL JFC: Adult high-cost drug pathway for active Crohn’s disease
Link  NCL JFC: Adult high-cost drug pathway for moderately to severely active ulcerative colitis
Link  NICE TA187: Crohn’s disease - infliximab and adalimumab
Link  NICE TA329: Infliximab, adalimumab and golimumab for treating moderately to severely active ulcerative colitis after the failure of conventional therapy
   
Golimumab
(Gastroenterology)
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Restricted Drug Restricted
GP - Red
High Cost Medicine

See NCL treatment pathway for place in therapy (note: biosimilar adalimumab and biosimilar infliximab are preferred anti-TNFs; JFC April 2019).

Provider notes

  • NMUH:
    • This medicine has a positive NICE Technology Appraisal and is listed in the Trust Medicines Formulary when used in line with NICE recommendations and/or Local Trust Guidelines.
    • Restricted to Consultant Gastroenterologists for NICE approved indications.
    • Check MHRA Drug Safety Update.
    • See links below.
  • RFL:
    • Non-formulary
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Restricted to Consultant Gastroenterologists
    • NICE TA329 applies
 
Link  NCL JFC: Adult high-cost drug pathway for moderately to severely active ulcerative colitis
Link  NICE TA329: NICE TA329: Infliximab, adalimumab and golimumab for treating moderately to severely active ulcerative colitis after the failure of conventional therapy
   
Infliximab
(Gastroenterology)
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Restricted Drug Restricted
GP - Red
High Cost Medicine

NOTE: There is more than one monograph for this medicine, click here to search for formulary status and its use for other indications. 

Remsima is the preferred brand

 

Provider notes

  • NMUH:
    • This medicine has a positive NICE Technology Appraisal and is listed in the Trust Medicines Formulary when used in line with NICE recommendations and/or Local Trust Guidelines
    • Red List Medicine – Hospital Only Prescribing PbR (Payment by Results) excluded drug.
    • Restricted to Consultant Gastroenterologists for NICE approved indications.
    • Check MHRA Drug Safety Update
  • RFL:
    • Restricted to Consultant Gastroenterologists for NICE approved indications
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Restricted to Consultant Gastroenterologists
    • NICE TA163, TA187 and TA329 applies

 

 
Link  NCL JFC: Adult high-cost drug pathway for active Crohn’s disease
Link  NCL JFC: Adult high-cost drug pathway for moderately to severely active ulcerative colitis
Link  NICE TA163: Ulcerative colitis (acute manifestations) Infliximab
Link  NICE TA187: Crohns disease - infliximab & adalimumab
Link  NICE TA329: Infliximab, adalimumab and golimumab for treating moderately to severely active ulcerative colitis after the failure of conventional therapy
   
Ustekinumab
(Gastroenterology)
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Formulary
GP - Red
High Cost Medicine

NOTE: There is more than one monograph for this medicine, click here to search for formulary status and its use for other indications. 

Provider notes

  • NMUH:
    • Positive NICE TA. This medicine has a positive NICE Technology Appraisal and is listed in the Trust Medicines Formulary when used  in line with NICE recommendations and/or Local Trust Guidelines.
    • See links below
    • Check MHRA Drug Safety Updates
  • RFL:
    • Resticted to consultant gastroenterologists for NICE approved indications
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • JFC approved for fistulising Crohn's disease where anti-TNFs are contra-indicated or have previously failed (October 2017).
    • See links below.
 
Link  NCL JFC: Adult high-cost drug pathway for active Crohn’s disease
Link  NICE TA456: Ustekinumab for moderately to severely active Crohn’s disease after previous treatment
   
 ....
 Non Formulary Items
Alicaforsen

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Non Formulary
Black

Not approved for pouchitis (January 2014)

Provider notes

  • UCLH:
    • Antibiotic-refractory inflammatory bowel disease (April 2014)
 
Cobitolimod  (Kappaproct®)

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Non Formulary
Black

Not approved for steroid refractory ulcerative colitis (November 2013)

 
PegInterferon Alfa
(Chronic enteropathy)

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Non Formulary
Black

NOTE: There is more than one monograph for PegInterferon Alfa, click here to search for formulary status and its use for other indications. 

Not approved for chronic enteropathy (May 2016)

 
  
Key
note Notes
Section Title Section Title (top level)
Section Title Section Title (sub level)
First Choice Item First Choice item
Non Formulary Item Non Formulary section
Restricted Drug
Restricted Drug
Unlicensed Drug
Unlicensed
Track Changes
Display tracking information
click to search medicines.org.uk
Link to adult BNF
click to search medicines.org.uk
Link to children's BNF
click to search medicines.org.uk
Link to SPCs
High Cost Medicine
High Cost Medicine
Cancer Drugs Fund
Cancer Drugs Fund
NHSE
NHS England
Homecare
Homecare
CCG
CCG

Traffic Light Status Information

Status Description

GP - 1st

Medicines suitable for first-line use within primary care.

Can be initiated within primary care within their licensed indication, in accordance with nationally recognised formularies, for example the BNF, BNF for Children, Medicines for Children or Palliative Care Formulary. Primary care prescribers take full responsibility for prescribing. 

  

GP - 2nd

Medicines suitable for second-line use within primary care.

Can be initiated within primary care within their licensed indication, in accordance with nationally recognised formularies, for example the BNF, BNF for Children, Medicines for Children or Palliative Care Formulary. Primary care prescribers take full responsibility for prescribing. 

  

GP - Amber

Medicines that should be initiated by a specialist. Prescribing can be transferred to primary care once the patient has been stabilised.  

Shared care: For drugs with regular, ongoing need for monitoring and/or assessment of efficacy or toxicity. Prior agreement must be obtained by the specialist from the primary care provider before prescribing responsibility is transferred. The shared care protocol must have been agreed by the relevant secondary care trust Drugs and Therapeutics Committee(s) (DTC) and approved by the North Central London JFC.

Fact sheet: For drugs with some concerns surrounding safety or efficacy but do not require regular monitoring and/or monitoring of effectiveness/toxicity.

  

GP - Red

Medicines which should normally be prescribed by specialists only (hospital only).

For patients already receiving prescriptions in primary care - continue. No new patients to receive prescriptions in primary care.

  

GP - Grey

Medicines on hospital formularies which have not been reviewed for suitability in primary care.  

Black

Medicines not recommended for routine use in primary or secondary care.

Medicines, which the North Central London JFC has actively reviewed and does not recommend for use at present due to limited clinical and/or cost effective data.

  

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