| Formulary Chapter 1: Gastro-intestinal system - Full Chapter
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| 01.05.03 |
Drugs affecting the immune response |
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Azathioprine
(25mg, 50mg Tablets)
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Formulary
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Walsall
 Amber Initiation Walsall only
Wolverhampton
 Amber Shared Care Wolverhampton only
ESCA Azathioprine (Wolverhampton only)
Sandwell
Amber Shared Care Sandwell only
For use in Inflammatory Bowel Disease (IBD) as per effective shared care agreement
ESCA Azathioprine (Sandwell only)
Dudley
Amber Shared Care Dudley only
ESCA Azathioprine (Dudley only)
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Ciclosporin
(10mg, 25mg, 50mg, 100mg Capsules. 50mg/ml IV infusion)
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 Restricted
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Treatment of ulcerative colitis - for specialist use only
MHRA specify the ciclosporin must be prescribed and dispensed by brand as bioavailabilty differences exist between brands
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Mercaptopurine
(50mg Tablets)
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Formulary
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Maintenance of remission of acute ulcerative colitis and Crohn’s disease in adults – unlicensed but in line with national guidelines
For use in Inflammatory Bowel Disease (IBD)
Walsall
Amber Initiation- Walsall only
Wolverhampton
Amber Shared Care- Wolverhampton only
ESCA Mercaptopurine-Wolverhampton only
Sandwell
Amber Shared Care- Sandwell only
ESCA Mecaptopurine (Sandwell only)
Dudley
Amber Shared Care Dudley only
ESCA Mecaptopurine (Dudley only)
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Methotrexate
(Tablets, Injection)
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Formulary
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Tablets 2.5mg (2.5mg tablets preferred as per NPSA alert)
Cytotoxic - do not crush and disperse in water
For use in active Crohn's disease
For specialist initiation only
Wolverhampton
Amber Shared Care Wolverhampton only
ESCA :Methotrexate (Wolverhampton only):
Walsall
Amber Initiation Walsall only
Sandwell
Amber Shared Care Sandwell only
ESCA:Methotrexate in active Crohn's disease (Sandwell only)
Dudley
Amber Shared Care Dudley only
ESCA:Methotrexate (Dudley only)
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| 01.05.03 |
Cytokine inhibitors |
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Key |
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Restricted Drug |
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Unlicensed |
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Link to adult BNF
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Link to children's BNF
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Link to SPCs
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Cytotoxic Drug |
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Controlled Drug |
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High Cost Medicine |
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Cancer Drugs Fund |
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NHS England |
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Homecare |
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ICB |
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Low carbon footprint |
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Medium carbon footprint |
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High carbon footprint |
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| Status |
Description |
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All Settings
Suitable for initiation, ongoing prescribing, and discontinuation in both primary and secondary care settings. They are generally familiar, frequently used therapies that can be started within their licensed indications without specialist oversight. |
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Specialist only
Designated for initiation, ongoing prescribing, monitoring, exclusively by a specialists either in a hospital or as part of a specialist service (to note this could be in a non-hospital setting). Primary care should neither start nor continue these treatments except as part of a specialist service. A specialist could be either a medical or non-medical prescriber. |
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Specialist advice
Prescribers in primary care should seek advice and a recommendation from a specialists prior to initiating a medicine. Once agreed with a specialist, medicines can be initiated, prescribed and monitored in primary care without a formal shared-care agreement. |
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Specialist initiation
Medicines in this category require a specialist to start therapy, titrate dosage, and assess initial efficacy or tolerability. Once stabilised, prescribing responsibility may transfer to primary care without the need for a formal shared-care agreement. |
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Shared care agreement
Prescribing responsibility can be shared across health settings and between specialists and GPs only when formal shared care arrangement has been made. For example, there may be extensive and complex monitoring requirements or significant safety concerns (note would need a national policy on this to define the criteria for requiring a formal SCA), this will be produced once nationally. |
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Do not prescribe
Not approved for routine prescribing in primary or secondary care. For example, because they are agents classified in the BNF as “not NHS” or “Drugs of Low Clinical Value”, or they are products on NICE’s “do not do” list or NHS England’s “should not routinely prescribe” list. |
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Self Care
Not for routine prescribed in primary or secondary care unless as part of care for a long term condition. Instead, patients should be encouraged to self care with support from community pharmacy. |
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Medicines which are suitable for initiation and maintenance prescribing by primary and secondary care clinicians. These medicines should be initiated and prescribed within their licensed indications |
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Amber Specialist Initiation: Initiation and maintenance of prescribing by Specialists and transfer to Primary Care prescribing when appropriate. This may be supported by a RICaD, annotated within the formulary entry. |
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Amber Shared Care: Initiation and maintenance of prescribing by Specialists and transfer to Primary Care prescribing, in accordance with an ESCA, annotated within the formulary entry. |
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Amber Specialist Recommendation: Initiation and maintenance of prescribing in Primary Care following recommendation from a specialist. |
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Medicines for initiation and maintenance prescribing by Specialists (hospital or GPs with Special Interest) only |
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Positive NICE TA and /or awaiting local clarification on place in therapy; Please contact your Medicines Optimisation team for more information. |
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Non-formulary Medicines which APC/Trust DTC has actively reviewed and do not recommend for use. |
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