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 Formulary Chapter 20: Unlicensed Medicines / Significant off-label use - Full Chapter
20  Expand sub section  Unlicensed Medicines / Significant off-label use
23-valent pneumococcal polysaccharide vaccine (Previously known as Pneumovax® II)
(Diagnose or exclude antibody deficiency)
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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. 

Approved as test vaccination to diagnose or exclude antibody deficiency including CVID and SAD (JFC May 2017)

Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • Non-formulary
  • RNOH:
    • Non-formulary
  • UCLH:
    • Diagnose or exclude antibody deficiency including CVID and SAD (UMC March 2017)
  • WH:
    • Non-formulary
 
   
Acetylcysteine
(Renal protection)
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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:
    • Non-formulary
 
   
Alteplase
(Catheter Directed Thrombolysis (CDT))
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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:
    • Non-formulary
    • Any suitable patients to be referred to RFH as per guidelines
  • RFL:
    • Approved for:
      • Iliofemoral DVT with (i) May-Thurner syndrome OR extensive clots AND (ii) who have severe symptoms despite 5-7 days anticoagulation OR where a limb is threatened (JFC July 2018)
      • Paget-Schroetter Syndrome
    • Not approved for:
      • Massive or high risk PE (defined as acute PE with sustained hypotension [SBP ≤ 90 mm Hg for at least 15 min or requiring inotropic support, not due to a cause other than PE, such as arrhythmia, hypovolemia, sepsis, or LV dysfunction], pulselessness or persistent profound bradycardia [pulse < 40 bpm], with signs or symptoms of shock) (JFC July 2018)
  • RNOH:
    • Non-formulary
  • UCLH:
    • Approved for:
      • Iliofemoral DVT with (i) May-Thurner syndrome OR extensive clots AND (ii) who have severe symptoms despite 5-7 days anticoagulation OR where a limb is threatened (UMC June 2018)
      • Upper Limb Central Venous Catheter (CVC) Related Thrombosis as last-line therapy (UMC June 2018)
    • Not approved for:
      • Paget-Schroetter Syndrome- Refer patient to RFH (UMC June 2018)
      • Stent rethrombosis (UMC June 2018)
      • Massive or high risk PE (defined as acute PE with sustained hypotension [SBP ≤ 90 mm Hg for at least 15 min or requiring inotropic support, not due to a cause other than PE, such as arrhythmia, hypovolemia, sepsis, or LV dysfunction], pulselessness or persistent profound bradycardia [pulse < 40 bpm], with signs or symptoms of shock) (UMC June 2018)
  • WH:
    • Non-formulary
 
   
Aluminium acetate 8% or 13% ear drops
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Formulary

Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • No restriction stated
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Non-formulary
 
   
Anakinra
(Granulomatous Disease)
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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:
    • Non-formulary
  • RFL:
    • Approval for chronic Granulomatous Disease (January 2013)
    • Prior funding approval required
    • Restricted to use by the Amyloidosis centre only
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Non-formulary
 
   
Anakinra
(Familial Mediterranean Fever, Pericarditis and DIRA)
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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:
    • Non-formulary
  • RFL:
    • Approved for Familial Mediterranean Fever, Pericarditis and DIRA (RFL only; JFC May 2016)
    • Prior funding approval required
    • Restricted to use by the Amyloidosis centre only
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Non-formulary
 
   
Botulinum toxin Type A (Botox®, Dysport®, Xeomin®)
(Sphincter of Oddi Dysfunction, Achalasia)
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Restricted Drug Restricted

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

Approved for Sphincter of Oddi Dysfunction  (JFC January 2013). QUERY funding

Provider notes

  • NMUH:
    • Xeomin is formulary when used in the treatment of achalasia (other brands and indications are non-formulary)
  • RFL:
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Non-formulary
 
   
Budesonide nebuliser suspension
(Eosinophilic oesophagitis)
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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 as second-line choice (after fluticasone inhaler) for eosinophilic oesophagitis in both adults and children. Dose should be dispersed in viscous suspending agent (e.g. Splenda slurry). Starting dose is 1 mg twice-daily for adults and children > 10 years old, 1 mg once-daily for children < 10 years old; down titrate dose for maintenance dosing (JFC February 2018)

Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • See local policy for information on use
  • RNOH:
    • Non-formulary
  • UCLH:
    • Non-formulary
  • WH:
    • As above
 
   
Carvedilol
(Portal hypertension)
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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 primary and secondary prevention of variceal bleeding for patients who do not respond to or cannot tolerate propranolol (August 2015)

Provider notes

  • NMUH:
    • See restrictions on use
  • RFL:
    • See restrictions on use
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • See restrictions on use
 
   
Celiprolol
(vascular Ehlers-Danlos syndrome)
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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 vascular Ehlers-Danlos syndrome (JFC April 2016)

Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • Non-formulary
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • No restriction stated
 
   
Clonidine
(Pain)
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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:
  • RFL:
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
 
   
Colchicine
(Oral mucosal inflammatory disease)
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Restricted Drug Restricted

Approved for oral mucosal inflammatory disease in particular ‘Recurrent apthous stomatitis (RAS)’ and ‘Oral ulceration in Behcet’s disease’ (JFC April 2018).

Additional information: Transfer of care to GPs after stabilisation in secondary care. Monitoring requirements to be communicated to the GP via letter. Monitoring requirements are FBC, U&E and LFTs at 3 months, 6 months and then annually, CK only if myalgia.

Provider notes

  • NMUH:
    • As above. Unlicensed form must be completed prior to use.
  • RFL:
    • Non-formulary
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • As above
 
   
Dapsone
(Oral mucosal inflammatory disease)
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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. 

Approved for oral mucosal inflammatory conditions: mucous membrane pemphigoid (MMP), recurrent aphthous stomatitis (RAS) and linear IgA bullous dermatosis (JFC April 2018)

Additional information: Transfer of care to GPs after stabilisation in secondary care. Monitoring requirements to be communicated to the GP via letter. Monitoring requirements are FBC and reticulocyte count weekly for four weeks, monthly for 6 months, then every 3 months thereafter. LFTs should be monitored monthly for 3 months, then every 3 months thereafter for duration of therapy.

Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • Non-formulary
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • As above
 
   
Denosumab (XGEVA®)
(Malignant hypercalcaemia)
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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. 

Approved for hypercalcaemia of malignancy who are either refractory to bisphosphonates or have creatinine clearance <30mL/min in whom bisphosphonates are contraindicated (JFC August 2018).

Only on the advice of oncology or palliative care consultants.

Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • As per above agreed indication
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • As above
 
   
Dibotermin Alfa, rhBMP-2 (Inductos®)
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Formulary

 Provider notes

  • RNOH:
    • Complex spinal funsion surgeries in line with NHSE commissioning policy
    • Restricted Item Restricted This product is currently unavailable in the UK
 
Link  NHSE 16063/P: Bone morphogenetic protein-2 in spinal fusion
Link  RNOH: Commissioning and Prescribing of Bone Morphogenic Protein
   
Dutasteride
(Frontal fibrosing alopecia)
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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. 

Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • Approved for use by Dermatology for frontal fibrosing alopecia (third line drug. Off label use)
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Non-formulary
 
   
Eculizumab
(Hyperhaemolysis)
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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 2nd line management of Delayed Haemolytic Transfusion Reactions [DHTRs] hyperhaemolysis in adult Sickle Cell and β-thalassaemia patients who have not responded to IVIG and steroids (pending internal funding approval; JFC July 2019)

Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • Non-formulary
  • RNOH:
    • Non-formulary
  • UCLH:
    • Restricted to haematology. UMC to be informed of each patient. Funding agreed for 1 patient per annum. 
  • WH:
    • Non-formulary
 
   
Ephedrine tablets
(Priaspism in sickle cell disease)
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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:
    • Approved for use for priaspism (unlicensed use).
    • See links below
  • RFL:
    • Non-formulary
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Non-formulary
 
Link  NMUH: Sickle cell guidelines for adult patients
Link  NMUH: Sickle cell guidelines for paediatric patients
   
Etanercept
(TRAPS, HIDS)
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Restricted Drug Restricted
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. 

JFC approved Benepali as the brand of choice.

Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • Restricted to National Amyloidosis Centre
  • RNOH:
    • Non-formulary
  • UCLH:
    • Non-formulary
  • WH:
 
   
Fluticasone inhaler (DPI)
(Eosinophilic oesophagitis)
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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 as first-line choice (before budesonide nasules) for eosinophilic oesophagitis in adults. Fluticasone Accuhaler (dry powder inhaler) '250' should be sucked 1-2 doses twice daily and down titrate dose for maintenance dosing (JFC February 2018)

Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • Non-formulary
  • RNOH:
    • Non-formulary
  • UCLH:
    • Non-formulary
  • WH:
    • As above
 
   
Haemophilus influenzae type B Combined Vaccine (Menitorix®)
(Diagnose or exclude antibody deficiency)
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Restricted Drug Restricted

Approved as Test vaccination to diagnose or exclude antibody deficiency including CVID and SAD (JFC May 2017)

Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • Non-formulary
  • RNOH:
    • Non-formulary
  • UCLH:
    • Test vaccination to diagnose or exclude antibody deficiency including CVID and SAD (UMC March 2017)
  • WH:
    • Non-formulary
 
   
Indometacin suppositories
(Tocolytic)
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Formulary

Approved for tocolytic therapy during pre-natal repair of myelomeningocele, a serious form of spina bifida (UCLH only; JFC February 2018)

Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • Non-formulary
  • RNOH:
    • Non-formulary
  • UCLH:
    • As tocolytic therapy during pre-natal repair of myelomeningocele (fetal spina bifida) (UMC Dec 2017)
  • WH:
    • Non-formulary
 
   
Infliximab
(Ipilimumab-induced colitis)
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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. 

Remsima is the preferred brand.

Approve for steroid-refractory ipilimumab-induced colitis (August 2016)

 
   
Letrozole
(Induction of ovulation)
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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 as a second-line option to induce ovulation in women with WHO group II infertility, following failure of treatment with clomifene citrate (JFC January 2018)

Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • Non-formulary
  • RNOH:
    • Non-formulary
  • UCLH:
    • 2nd line after the failure of clomifene citrate for ovulation induction in women with WHO Group II anovulation
  • WH:
    • As above
 
   
Lidocaine infusion
(Pain)
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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:
    • Non-formulary
  • RFL:
    • Approved for chronic pain (JFC July 2018)
    • Approved for use in neurology for the treatment of headaches - see local protocol
  • RNOH:
    • Non-formulary
  • UCLH:
    • Approved for
      • Chronic pain (RESTRICTED to Pain Management Centre at Cleveland Street for chronic pain; UMC May 2018)
      • Perioperative pain (RESTRICTED to UCH and Westmoreland Street Operating Theatres in line with guideline only; UMC July 2018)
  • WH:
    • Non-formulary
 
   
Magnesium lactate modified release (MagTab®)
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Formulary

Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • Approved for renal tubular disorders (RFL only; JFC September 2018).
    • For use in renal tubular disorders outpatients clinic only
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Non-formulary
 
   
Metformin
(Polycystic ovaries syndrome)
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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:
    • Gynaecology and Endocrinology only
  • RNOH:
    • Non-formulary
  • UCLH:
    • No restriction stated
  • WH:
    • Non-formulary
 
   
Methotrexate injection
(Ectopic pregnancy)
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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:
    • Zlatal is stocked. This is a licensed preparation, but it is not licensed for use in ectopic pregnany
  • RFL:
    • See local protocol
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • No restriction stated
 
   
Mycophenolate mofetil
(Oral mucosal inflammatory disease)
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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 immunobullous diseases including Pemphigus Vulgaris (PV), Mucous membrane pemphigoid (MMP) and Oral lichen planus (OLP) (JFC, June 2017)

Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • As above
  • RNOH:
    • Non-formulary
  • UCLH:
    • No restriction stated
  • WH:
 
   
Mycophenolate mofetil
(Dermatology)
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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:
    • Non-formulary
  • RFL:
    • For pyoderma gangrenosum, eczema and psoriasis
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • For pyoderma gangrenosum, eczema and psoriasis
 
   
Naltrexone
(Cholestatic itch)
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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. 

Approved for cholestatic itch as third-line agent, after cholestyramine and antihistamines, and before rifampicin (JFC June 2016)

Provider notes

  • NMUH:
    • To be prescribed on the recommendation of Gastroenterologists ONLY as a 3rd line option for cholestatic pruritus, after cholestyramine and antihistamines, and before rifampicin. This is an off-label use.
  • RFL:
  • RNOH:
  • UCLH:
  • WH:
    • For intractable pruritus due to cholestatic liver disease. To be used as a third-line agent, after cholestyramine and antihistamines, and before rifampicin 1st line – antihistamines; 2nd line – cholestyramine; 3rd line – Naltrexone; 4th line – Rifampicin.
 
   
Nitazoxanide
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Formulary
High Cost Medicine

Nitazoxanide for chronic resistant norovirus infection in PID patients – Approved for prescribing by Immunology only (August 2013)

 
   
Octenisan®
(Wash)
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Formulary

Approved for MRSA suppression for patients with hypersensitivity to chlorhexidine (Hibiscrub) (March 2015)

 
   
Olanzapine
(Nausea and vomiting)
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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. 

Approved for chemotherapy induced nausea and vomiting (breakthrough treamtent). Restricted to when prochlorperazine, levomepromazine and cyclizine are unavailable (March 2016)

Provider notes

  • NMUH:
    • As per indication above
  • RFL:
  • RNOH:
    • Non-formulary
  • UCLH:
    • See indication above
  • WH:
    • Non-formulary
 
   
Oxybutynin immediate release
(Hyperhydrosis)
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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. 

Approved for hyperhidrosis (JFC November 2018). Notes: Starting dose of 2.5mg titrated up to 5mg twice daily according to response.

Provider notes

  • NMUH:
    • Dermatology clinic only
  • RFL:
    • Dermatology and Vascular clinic only
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Non-formulary
 
   
Povidone-Iodine 5% eye drops
(Ophthalmic)
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Restricted Drug Restricted

Provider notes

  • NMUH:
    • For sterilisation of the eye and occular area in preparation for surgery. Povidone-Iodine 5% Eye Drops, available from ‘special-order’ manufacturers or specialist importing companies
  • RFL:
    • Non-formulary
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Non-formulary
 
   
Probiotic (VSL#3®)
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Formulary

Approved for pouchitis (to be endorsed ACBS in the community [JFC, March 2013])

Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • Non-formulary
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Consultant-only for pouchitis. Note that this was not approved for UC which was also included in the application. Please ensure that it is supplied only against the approved indication.
 
   
Propranolol
(Portal hypertension)
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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. 

Primary and secondary prevention of variceal bleeding (August 2015)

Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • Non-formulary 
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • No restriction stated
 
   
Quinidine
(Brugada Syndrome)
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Restricted Drug Restricted

Approved for Brugada Syndrome (RFL only; JFC February 2018).

Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • See above
  • RNOH:
    • Non-formulary
  • UCLH:
    • Non-formulary
  • WH:
    • Non-formulary
 
   
Rifampicin
(Cholestatic itch)
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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. 

Approved for cholestatic itch as fouth-line agent, after cholestyramine, antihistamines and naltrexone (June 2016)

 
   
Rituximab
(Other indications)
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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. 

Truxima brand is first choice (JFC March 2017).

Approved for:

  • Granulomatous–lymphocytic interstitial lung disease (GLILD); RFL ONLY (September 2016)
  • Ocular mucous membrane pemphigoid; approved for use in patients refractory to standard treatment; MEH ONLY (January 2015)
  • Neuromyelitisoptica (NMO); pending satisfactory clarification of funding/ shared care pathyway (October 2013)
  • Myasthenia Gravis; pending approval of treatment protocol and funding pathway; UCLH ONLY (October 2014)
  • Stiff person syndrome; pending approval of treatment protocol and funding pathway; UCLH ONLY (October 2014)
  • Interstitial lung disease; for 2 patient ONLY pending funding; RFH ONLY (April 2015)
  • Orbital inflammatory disease; RFH ONLY (January 2015)
  • IgG4-related disease; in line with NHS England Commissioning Policy; for RFL ONLY (March 2017)
  • Second line treatment for anti-NMDAR autoimmune encephalitis (all ages) in line with NHSE Commissioning Policy (JFC May 2018)
  • Pemphigus in line with NHSE commissioning policy (RFL only)
  • Refractory MADSAM neuropathy (RFL - Prof Ginsbery only)
  • Refractory Vasculitic neuropathy (RFL - Dr Kidd only)
  • Neurosarcoid (RFL - Dr Kidd only)

 

Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • See above
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Non-formulary
 
Link  NHSE 16057/P: Rituximab for immunoglobulin G4- related disease (IgG4-RD)
Link  NHSE 170039P: Rituximab for second line treatment for anti-NMDAR autoimmune encephalitis (all ages)
   
Ruxolitinib
(Graft versus host disease)
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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. 

Provider notes

  • UCLH approvals:
    • Approved for steroid refractory acute graft versus host disease (GVHD) subjec to IFR or compassionate access scheme (March 2017). UCLH only.
 
   
Sipuleucel- T
View adult BNF View SPC online View childrens BNF
Formulary
High Cost Medicine
 
Link  NICE TA322: Sipuleucel-T for prostate cancer
   
Taurolodine and Citrate 4% (TauroLock®)
View childrens BNF
Restricted Drug Restricted

Approved for recurrent catheter-releated bloodstream infections. Restricted to patients who have had ≥ 2 CRBI in 6 months or ≥ 3 CRBI in 12 months  (August 2015)

 
   
Thalidomide
(Arteriovenous malformations)
View childrens BNF
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. 

Provider notes

  • RFL:
    • Approved for Arteriovenous malformations. For RFL only (approved by DTC in August-15)
 
   
Thalidomide
(Dermatology)
View adult BNF View SPC online View childrens BNF
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. 

  • RFH approvals
    • Approved for use in pyoderma gangrenosum (dermatology) - consultant initiation only
    • Approved for use in Behcets (rheumatology) - consultant initiation only
 
   
Thalidomide
(Gastroenterology)
View adult BNF View SPC online View childrens BNF
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. 

Provider notes

  • NMUH:
  • RFL:
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Thalidomide is available for prescribing on a named-patient basis as per protocol for refractory Crohn’s Disease by registered Consultant Gastroenterologists only.
 
   
Tocilizumab
(Amyloidosis)
View adult BNF View SPC online View childrens BNF
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. 

Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • AA amyloidosis and/ or recurrent fever syndrome in patients whose inflammatory activity has not responded to other agents. Subject to individual funding approval by NHS England.
    • Approved for Castleman's disease 
    • Restricted to National Amyloidosis Clinic (July 2015)
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Non-formulary
 
   
Ajmaline
(Brugada syndrome)
View childrens BNF
Unlicensed Drug Unlicensed

Provider notes

  • NMUH:
    • Restricted to Consultant Cardiologists ONLY.
    • Ajmaline 50mg in 10mL injection - available from 'special-order' manufacturers or specialist importing companies.
    • See link below
  • RFL:
    • Approve for diagnosis of Brugada syndrome (August 2016)
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Non-formulary
 
Link  NMUH: Guideline on Ajmaline for Provocation Testing
   
Artesunate
(Antimalarial)
View adult BNF View SPC online View childrens BNF
Unlicensed Drug Unlicensed

Approved for severe falciparum malaria (November 2015) 

Provider notes

  • NMUH:
    • To be used on the recommendation of the Infectious Diseases Team or Microbiology according to the NMUHT malaria guidelines.
    • See link below
    • Available from ‘special-order’ manufacturers or specialist importing companies
  • RFL:
    • Non-formulary
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • No restriction stated
 
Link  NMUH: Guidelines for Treatment of Malaria in Adult Patients
Link  NMUH: Guidelines for Treatment of Malaria in Paediatric Patients
Link  WH: Malaria Investigation and Treatment Guideline for Adults
   
Benzathine benzylpenicillin
View adult BNF View SPC online View childrens BNF
Unlicensed Drug Unlicensed

Provider notes

  • NMUH:
    • Used in the treatment of early syphilis and late latent syphilis
    • Benzathine Benzylpenicillin 2.4 mega unit injection, available from ‘special-order’ manufacturers or specialist importing companies
  • RFL:
    • Used in the treatment of early syphilis and late latent syphilis
    • Benzathine Benzylpenicillin 2.4 mega unit injection, available from ‘special-order’ manufacturers or specialist importing companies
      RNOH approvals
    • Non-formulary
  • UCLH:
  • WH:
    • Non-formulary
 
   
Chlorothiazide
View adult BNF View SPC online View childrens BNF
Unlicensed Drug Unlicensed

Provider notes

  • NMUH:
    • For the treatment of chronic hypoglycaemia, heart failure, hypertension and ascites, in children.
    • See the BNF for children for further prescribing information.
    • Chlorothiazide suspension 250mg/5ml, available from ‘special-order’ manufacturers or specialist importing companies
  • RFL:
    • Non-formulary
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Chlorothiazide Suspension 250 mg/5 ml (unlicensed product)
 
   
Clobetasol propionate 1 in 4 in White Soft Paraffin
(Dermatology)
View adult BNF View SPC online View childrens BNF
Restricted Drug Restricted

Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • Non-formulary
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Clobetasol propionate 1 in 4 in White Soft Paraffin 100 g (unlicensed product)
 
   
Coal tar in Betamethasone ointment
View adult BNF View SPC online View childrens BNF
Restricted Drug Restricted

Provider notes

  • NMUH:
    • To be prescribed by Consultant Dermatologists for the treatment of Psoriasis.
    • Coal Tar 10% in Betamethasone 0.025% Ointment Coal Tar 5% in Betamethasone 0.025% Ointment
    • The above preparations are available from ‘special-order’ manufacturers or specialist importing companies
  • RFL:
    • Non-formulary
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Non-formulary
 
   
Etilefrine
View adult BNF View SPC online View childrens BNF
Unlicensed Drug Unlicensed

Provider notes

  • NMUH:
    • For treatment of priapism in patients with sickle cell disease
    • Etilefrine 25mg Tablets, available from ‘special-order’ manufacturers or specialist importing companies
  • RFL:
    • Non-formulary
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Non-formulary
 
   
Flucytosine tablets
View adult BNF View SPC online View childrens BNF
Unlicensed Drug Unlicensed

Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • Non-formulary
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • 500mg tablets
 
   
Fluticasone propionate nasules / nasal spray
(Oral lichen planus)
View adult BNF View SPC online View childrens BNF
Restricted Drug Restricted

Approved for Oral lichen planus after failure of betamethasone (JFC June 2017)

Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • Non-formulary
  • RNOH:
    • Non-formulary
  • UCLH:
    • Non-formulary
  • WH:
    • Indicated for oral linchen planus (OLP) only
 
   
Foscarnet sodium 2% cream
View adult BNF View SPC online View childrens BNF
Restricted Drug Restricted

Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
  • RNOH:
  • UCLH:
  • WH:
 
   
Glycopyrronium tablets
(Excessive drooling)
View adult BNF View SPC online View childrens BNF
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. 

Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • Unlicensed - 1mg and 2mg tablets available
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • No restriction stated
 
   
LAT gel (Lidocaine 4% + Adrenaline 0.1% + Tetracaine 0.5%)
View childrens BNF
Unlicensed Drug Unlicensed

Approved for second-line management of pain in children requiring sutures/debridement (JFC February 2018)

Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • Non-formulary
  • RNOH:
    • Non-formulary
  • UCLH:
    • No restriction stated
  • WH:
    • Non-formulary
 
   
Levosimendan
View adult BNF View SPC online View childrens BNF
Restricted Drug Restricted

Approved for acutely decompensated severe chronic heart failure who have failed to respond to conventional therapy and failed to respond to or did not tolerate inotropic agents (dobutamine or enoximone) (JFC July 2017)

Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • Non-formulary
  • RNOH:
    • Non-formulary
  • UCLH:
    • Non-formulary
  • WH:
    • As above
 
   
Metronidazole ointment 10%
View adult BNF View SPC online View childrens BNF
Unlicensed Drug Unlicensed

Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • Non-formulary
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Non-formulary
 
   
Mydricaine
(Ophthalmic)
View childrens BNF
Restricted Drug Restricted

Provider notes

  • NMUH:
    • For rapid mydriasis and prevention of synechiae in uveitis.
    • Mydricaine No.1 and No.2 Injection, available from ‘special-order’ manufacturers or specialist importing companies
  • RFL:
    • Non-formulary
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • MYDRICAINE NO. 2 This is an unlicensed special and restricted to Ophthalmology.
    • MYDRICAINE NO.1 This is an unlicensed special and restricted to Ophthalmology.
 
   
Natamcyin (Natacyn®)
(Fungal keratitis )
View adult BNF View SPC online View childrens BNF
Unlicensed Drug Unlicensed

Approved for fungal keratitis (May 2013)

 
   
Phenylephrine 30% gel
View adult BNF View SPC online View childrens BNF
Unlicensed Drug Unlicensed

Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • Available as a named doctor/patient drug
  • RNOH:
    • Non-formulary
  • UCLH:
    • Non-formulary
  • WH:
    • Non-formulary
 
   
Pristinamycin tablets
View adult BNF View SPC online View childrens BNF
Unlicensed Drug Unlicensed

Provider notes

  • RNOH:
    • Restricted Item Microbiologist approval only for treatment of joint infection
    • This medicine is not licensed in the UK
    • 500mg tablets
  • RFL:
    • Microbiology approval required
 
   
Prophyene glycol 40% in Clobetasol propionate 0.05% - Topical
(Dermatology)
View adult BNF View SPC online View childrens BNF
Restricted Drug Restricted

Provider notes

  • NMUH:
    • To be prescribed by Consultant Dermatologists ONLY for the treatment of inflammatory skin conditions such as eczema and psoriasis.
    • Propylene Glycol 40% in Dermovate Cream, available from ‘special-order’ manufacturers or specialist importing companies
  • RFL:
    • Non-formulary
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Non-formulary
 
   
Sodium dihydrogen phosphate oral solution
View adult BNF View SPC online View childrens BNF
Unlicensed Drug Unlicensed

Provider notes

  • NMUH:
    • For the treatment of hypophosphataemia or premature bone disease in paediatric patients. For further prescribing information, refer to the BNF for Children. 
  • RFL:
    • Non-formulary
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Non-formulary
 
   
Spectinomycin injection
View childrens BNF
Unlicensed Drug Unlicensed

Provider notes

  • NMUH:
    • Restricted to Consultants in GU Medicine only
    • Should only be used in penicillin-allergic patients
    • Available from ‘special-order’ manufacturers or specialist importing companies
  • RFL:
    • Non-formulary  
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Microbiology approval required
 
   
Spiramycin
(Toxoplasmosis)
View adult BNF View SPC online View childrens BNF
Unlicensed Drug Unlicensed

Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • Restricted to ID/Microbiology only
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Advice of Microbiology only
 
   
Streptomycin sulphate
View adult BNF View SPC online View childrens BNF
Restricted Drug Restricted

Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • Restricted to TB
    • All other indications require microbiology/ID approval
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Streptomycin injection available after microbiology approval
 
   
Thiamine Injection 100 mg in 1mL
View childrens BNF
Unlicensed Drug Unlicensed

Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • Non-formulary
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • No restriction stated
 
   
Triamcinolone Acetonide (Kenalog®)
(Diabetic Macular Oedema)
View adult BNF View SPC online View childrens BNF
Unlicensed Drug Unlicensed

Provider notes

  • NMUH:
    • Use of Triamcinolone (Kenalog®) injection intravitreally is unlicensed
    • See link below
  • RFL:
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
 
Link  NCL JFC: Diabetic Macular Oedema (DMO)
   
Trichloroacetic acid 50% topical solution
(Melasma, sun damage)
View adult BNF View SPC online View childrens BNF
Restricted Drug Restricted

Provider notes

  • NMUH:
    • To be prescribed by Consultant Dermatologists ONLY
    • For chemical peeling to treat sun damage
  • RFL:
    • Non-formulary
  • RNOH:
    • Non-formulary
  • UCLH:
    • Non-formulary
  • WH:
    • Non-formulary
 
   
TROMETAMOL (THAM) Injection
View childrens BNF
Unlicensed Drug Unlicensed

Provider notes

  • NMUH:
    • TROMETAMOL (Tris (hydroxymethyl) aminomethane, THAM) For treatment of severe metabolic acidosis in paediatric patients. See the BNF for Children for further information. Trometamol 7.2% Injection, available from ‘special-order’ manufacturers or specialist importing companies
  • RFL:
    • Non-formulary
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Non-formulary
 
   
 ....
 Non Formulary Items
Azithromycin tabs/caps
(Orofacial granulomatosis)

View adult BNF View SPC online View childrens BNF
Non Formulary

Not approved for orofacial manifestations of orofacial granulomatosis which are resistant to topical immunomodulatory medications, intralesional corticosteroids, and dietary modification (JFC June 2018)

 
Bezafibrate
(Primary Biliary Cholangitis)

View adult BNF View SPC online View childrens BNF
Non 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 Primary Biliary Cholangitis as second-line therapy after ursodeoxycholic acid if intolerant to obeticholic acid. Notes: daily dose of 400 mg modified-release once-daily (JFC January 2019)

 
Bleomycin
(Vascular Malformations)

View adult BNF View SPC online View childrens BNF
Non 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 sclerotherapy for low Flow Vascular Malformations of the Head and Neck (JFC March 2018)

Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • Non-formulary
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Non-formulary
 
Candesartan
(Migraine prophylaxis)

View adult BNF View SPC online View childrens BNF
Non 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 prophylaxis of chronic and episodic migraine (JFC April 2019)

Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • Non-formulary
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Non-formulary
 
Ciclosporin
(Hyperhaemolysis)

View adult BNF View SPC online View childrens BNF
Non Formulary
Black

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

Not approved for treatment and prophylaxis of hyperhaemolysis (JFC July 2019).

 
Danazol
(Angioedema)

View adult BNF View SPC online View childrens BNF
Non 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 prophylaxis of C1 esterase inhibitor deficiency and other bradykinin-mediated angioedema (JFC October 2018).

Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • Non-formulary
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Non-formulary
 
Domperidone
(Lactation stimulation)

View childrens BNF
Non Formulary

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

 
Eptotermin Alfa  (Osigraft®)

View adult BNF View SPC online View childrens BNF
Non Formulary
High Cost Medicine

PRODUCT DISCONTINUED

Approved for non-union of any long-bone (tibial, fibial, ulnar, radial, humoral, femoral and clavicular) of at least 9 months duration (April 2013).

 
Guanethidine monosulfate
(Pain)

View adult BNF View SPC online View childrens BNF
Non Formulary
Black

Not approved for complex regional pain syndrome (May 2014)

 
Imatinib tabs
(PVNS, D-TGCT)

View adult BNF View SPC online View childrens BNF
Non Formulary
Black

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

Not approved for unresectable, locally advanced or metastatic pigmented villonodular synovitis (PVNS) or diffuse tenosynovial giant cell tumour (D-TGCT) (JFC September 2018).

 
Imatinib tabs
(Chordoma)

View adult BNF View SPC online View childrens BNF
Non Formulary
Black

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

Not approved for locally advanced and metastatic chordoma (JFC June 2018)

 
Methacholine chloride
(Bronchial challenge testing)

View adult BNF View SPC online View childrens BNF
Non Formulary
Black

Not approved for bronchial challenge testing (JFC September 2013)

 

 
Montelukast
(Urticaria)

View adult BNF View SPC online View childrens BNF
Non Formulary
Black

Not approved for chronic idiopathic urticaria (JFC January 2015)

 
Nabilone
(Tourette's syndrome)

View adult BNF View SPC online View childrens BNF
Non Formulary

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

Not approved for Tourette's syndrome (JFC April 2017)

 
Oxandrolone
(Angioedema)

View adult BNF View SPC online View childrens BNF
Non Formulary

Approved for prophylaxis of C1 esterase inhibitor deficiency and other bradykinin-mediated angioedema (JFC October 2018).

Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • Non-formulary
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Non-formulary
 
Papaverine
(Intraoperative vasospasm)

View adult BNF View SPC online View childrens BNF
Non 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 as topical application intraoperatively for vasospasm during microvascular anastomosis in patients who may be undergoing free flap surgery including mandibulectomy, major glossectomy or laryngectomy (JFC March 2018)

Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • Non-formulary
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Non-formulary
 
Pegloticase  (Krystexxa)

View adult BNF View SPC online View childrens BNF
Non Formulary
Link  NICE TA291: Pegloticase not recommended for severe chronic gout
 
Pentoxifylline
(Oral mucosal inflammatory disease)

View adult BNF View SPC online View childrens BNF
Non Formulary

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

Not recommended for recurrent aphthous stomatitis (RAS) after failure of colchicine and dapsone (JFC August 2018).

 
Propranolol
(Angiosarcoma, Haemangioendothelioma)

View adult BNF View SPC online View childrens BNF
Non 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 adjunct or alternative for the third and subsequent line of treatment of angiosarcoma and haemangioendothelioma either in combination with chemotherapy or as a single agent as maintenance treatment (JFC March 2018)

Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • Non-formulary
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Non-formulary
 
Rituximab
(Hyperhaemolysis)

View adult BNF View SPC online View childrens BNF
Non Formulary
Black

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

Not approved for treatment and prophylaxis of hyperhaemolysis (JFC July 2019).

 
Tacrolimus caps
(Chronic Histiocytic Intervillosities)

View adult BNF View SPC online View childrens BNF
Non Formulary
Black

Not approved for Chronic Histiocytic Intervillosities (JFC March 2019)

 
Triclabendazole
(Human Fascioliasis)

View adult BNF View SPC online View childrens BNF
Non Formulary

Approved for Human Fascioliasis Infection (JFC April 2019)

Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • Non-formulary
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Non-formulary
 
  
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.

  

netFormulary