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 Formulary Chapter 8: Malignant disease and immunosuppression - Full Chapter
08.02.02  Expand sub section  Corticosteroids and other immunosuppressants
Antithymocyte immunoglobulin - rabbit (Thymoglobuline)
(Transplant)
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Restricted Drug Restricted
High Cost Medicine
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Provider notes

  • RFL:
    • Resricted to renal team for the treatment of transplant rejection
 
Link  NICE TA481 (not recommended as initial treatment): Immunosuppressive therapy for kidney transplant in adults
Link  NICE TA482 (not recommended as initial treatment): Immunosuppressive therapy for kidney transplant in children and young people
   
Basiliximab
(Transplant)
View adult BNF View SPC online View childrens BNF
Restricted Drug Restricted
GP - Red
High Cost Medicine
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See NICE TA for eligibility criteria

Provider notes

  • NMUH:
    • This medicine has a positive NICE Technology Appraisal but service is not offered at NMUH.
    • Check MHRA Drug Safety Alerts
  • RFL:
    • Prior funding required for treatment of lymphoma with radiolabelled basiliximab Approved for Renal transplant patients.
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Non-formulary
 
Link  NICE TA481: Immunosuppressive therapy for kidney transplant in adults
Link  NICE TA482: Immunosuppressive therapy for kidney transplant in children and young people
   
Ciclosporin (Capimune)
(Transplant)
View adult BNF View SPC online View childrens BNF
Formulary
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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:
    • No restriction stated
  • RFL:
    • Non-formulary
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Non-formulary
 
   
Ciclosporin (Capsorin)
(Transplant)
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Formulary
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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:
    • No restriction stated
  • RFL:
    • Non-formulary
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Non-formulary
 
   
Ciclosporin (Deximune)
(Transplant)
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Formulary
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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:
    • No restriction stated
  • RFL:
    • Deximune is the first-line choice for all new liver transplant patients. 
    • Previous liver tranplant patients must be maintained on the same brand (usually Neoral).  Brand are not interchangeable.
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Non-formulary
 
   
Ciclosporin (Neoral)
(Transplant)
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Formulary
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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:
    • Restricted to Consultant use only.
  • RFL:
    • Patients must be maintained on the same brand
    • 1st choice for renal transplant
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Non-formulary
 
   
Ciclosporin (Sandimmun)
(Transplant)
View adult BNF View SPC online View childrens BNF
Formulary
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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:
    • No restriction stated
  • RFL:
    • No restriction stated
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Non-formulary
 
   
Sirolimus
(Transplant)
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Formulary
High Cost Medicine
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GP-Red Red For all new transplants, except liver

GP-Grey Red Existing transplants and liver transplants

See NICE TA for eligibility criteria

Provider notes

  • NMUH:
    • See links below
    • Not to be intiated at NMUH. For continuation of immunosuppressant therapy
  • RFL:
    • No restriction stated
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Non-formulary
 
Link  NICE TA481 (not recommended as initial treatment): Immunosuppressive therapy for kidney transplant in adults
Link  NICE TA482 (not recommended as initial treatment): Immunosuppressive therapy for kidney transplant in children and young people
   
Tacrolimus (Adoport )
(Transplant)
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Formulary
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GP-Red Red For all new transplants, except liver

GP-Grey Red Existing transplants and liver transplants

Provider notes

  • NMUH:
    • Not to be intiated at NMUH. For continuation of immunosuppressant therapy
  • RFL:
    • Preferred brand of tacrolimus for all new liver transplant patients
    • Preferred brand of tacrolimus for all new kidney transplant patients
    • Brands are not interchangeable, patients must be maintained on the same brand
    • See individual transplant policies for dosing information
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Non-formulary
 
Link  NICE TA481: Immunosuppressive therapy for kidney transplant in adults
Link  NICE TA482: Immunosuppressive therapy for kidney transplant in children and young people
   
Tacrolimus (Modigraf )
(Transplant)
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Formulary
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GP-Red Red For all new transplants, except liver

GP-Grey Red Existing transplants and liver transplants

Provider notes

  • NMUH:
    • Not to be intiated at NMUH. For continuation of immunosuppressant therapy
  • RFL:
    • Non-formulary
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Non-formulary
 
Link  NICE TA481: Immunosuppressive therapy for kidney transplant in adults
Link  NICE TA482: Immunosuppressive therapy for kidney transplant in children and young people
   
Tacrolimus (Prograf )
(Transplant)
View adult BNF View SPC online View childrens BNF
Restricted Drug Restricted
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GP-Red Red For all new transplants, except liver

GP-Grey Red Existing transplants and liver transplants

Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • Historic transplant patients
    • Transplant patients must be maintained on the same brand
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Non-formulary
 
Link  NICE TA481: Immunosuppressive therapy for kidney transplant in adults
Link  NICE TA482: Immunosuppressive therapy for kidney transplant in children and young people
Link  NMUH: Trust Therapeutic Drug Monitoring Guidelines
   
Tacrolimus (Vivadex )
(Transplant)
View adult BNF View SPC online View childrens BNF
Formulary
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GP-Red Red For all new transplants, except liver

GP-Grey Red Existing transplants and liver transplants

Provider notes

  • NMUH:
    • Not to be intiated at NMUH. For continuation of immunosuppressant therapy
  • RFL:
    • Non-formulary
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Non-formulary
 
Link  NICE TA481: Immunosuppressive therapy for kidney transplant in adults
Link  NICE TA482: Immunosuppressive therapy for kidney transplant in children and young people
   
Tacrolimus modified release (Advagraf )
(Transplant)
View adult BNF View SPC online View childrens BNF
Formulary
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GP-Red Red For all new transplants, except liver

GP-Grey Red Existing transplants and liver transplants

Provider notes

  • NMUH:
    • Not to be intiated at NMUH. For continuation of immunosuppressant therapy
  • RFL:
    • Envarsus is now the preferred modified release preparation
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Non-formulary
 
Link  NICE TA481 (not recommended as initial treatment): Immunosuppressive therapy for kidney transplant in adults
Link  NICE TA482 (not recommended as initial treatment): Immunosuppressive therapy for kidney transplant in children and young people
   
Tacrolimus modified release (Envarsus)
(Transplant)
View adult BNF View SPC online View childrens BNF
Formulary
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GP-Red Red For all new transplants, except liver

GP-Grey Red Existing transplants and liver transplants

Provider notes

  • NMUH:
    • Not to be intiated at NMUH. For continuation of immunosuppressant therapy
  • RFL:
    • Approved for immunosuppression in liver and renal transplants for patient in whom Advagraf would otherwise be indicated. For RFL only (approved by DTC in May-16, ratified by JFC in June-16)
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Non-formulary
 
Link  NICE TA481 (not recommended as initial treatment): Immunosuppressive therapy for kidney transplant in adults
Link  NICE TA482 (not recommended as initial treatment): Immunosuppressive therapy for kidney transplant in children and young people
   
 ....
 Non Formulary Items
Belatacept
(Transplant)

View adult BNF View SPC online View childrens BNF
Non Formulary
High Cost Medicine
Link  NICE TA481 (not recommended as initial treatment): Immunosuppressive therapy for kidney transplant in adults
Link  NICE TA482 (not recommended as initial treatment): Immunosuppressive therapy for kidney transplant in children and young people
 
Everolimus  (Certican)
(Transplant)

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

DO NOT CONFUSE Afinitor®, Votubia AND Certican AS THEY ARE LICENSED FOR DIFFERENT INDICATIONS

Link  NICE TA348 (not recommended): Everolimus for preventing organ rejection in liver transplantation
Link  NICE TA481 (not recommended as initial treatment): Immunosuppressive therapy for kidney transplant in adults
Link  NICE TA482 (not recommended as initial treatment): Immunosuppressive therapy for kidney transplant in children and young people
 
  
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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