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 Formulary Chapter 5: Infections - Full Chapter
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05.01  Expand sub section  Antibacterial drugs
 note 
  • For full prescribing information, please see antimicrobial website
  • For information regarding restricted antibiotics, please see restricted antibiotics page within antibiotic guide
Nitrofurantoin
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Second Choice
Green
  • Second line choice, reserved for patients resistant to trimethoprim in uncomplicated UTI
  • Capsules are the preferred option
  • Tablets are reserved for enteral tube administration
  • Nitrofurantoin 25mg/5ml suspension significantly more expensive. Please refer to pharmacy for more information  
  •    
    Aztreonam (Cayston®)
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    Restricted Drug Restricted
    Red
    High Cost Medicine
    For nebulisation in Cystic Fibrosis.
    NHSE commissioned 
       
    Colistimethate sodium
    View adult BNF View SPC online  Track Changes
    Restricted Drug Restricted
    Amber SCA
    High Cost Medicine
    Colomycin® powder for reconstitution for nebulisation. Promixin® powder for nebuliser solution.
    Please ensure colistimethate is prescribed and dispensed by brand. Due to the devises they are used with, they may not be interchangeable.

    Used in bronchiectasis and cystic fibrosis. Latter is high cost drug excluded to tariff, NHSE commissioned.
    Specialist Respiratory prescribing
    See Antimicrobial website for further details  
       
    Colistimethate sodium  (Colobreathe®)
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    Restricted Drug Restricted
    Amber SCA
    High Cost Medicine
    Dry powder for inhalation, hard capsule
    For use in cystic fibrosis in line with NICE TA 276 only.
    High cost drug excluded to tariff, NHSE commissioned.
    Specialist Respiratory prescribing.

    Date of entry of decision to Formulary: April 2013
     
    Link  MHRA Advice: Colobreathe (colistimethate sodium dry powder for inhalation): risk of capsule breakage—new instructions for use
    Link  NICE TA 276: Colistimethate sodium and tobramycin dry powders for inhalation for treating pseudomonas lung infection in cystic fibrosis
       
    Dalbavancin
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    Restricted Drug Restricted
    Red

    Treatment of acute bacterial skin and skin structure infections in adults. Consultant only

     
       
    Rifaximin
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    Restricted Drug Restricted
    Amber Simple
    Specialist hepatologist initiation only for hepatic encephalopathy

    Date decision added to Formulary: June 15 
    Link  Leicestershire Guidance: Rifaximin
    Link  NICE TA 337: Rifaximin in hepatic encephalopathy
       
    Sodium fusidate (Fusidic acid)
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    Restricted Drug Restricted
    Red
    Oral and Intravenous
    See antimicrobial website.
    Restricted antibiotic, microbiology approval needed 
    Link  Antimicrobial website - Sodium fusidate
       
    Tobramycin  (Bramitob®)
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    Restricted Drug Restricted
    Red
    High Cost Medicine
    Nebuliser solution for inhalation in cystic fibrosis
    High cost drug excluded to tariff, NHSE commissioned.
    Specialist Respiratory prescribing
    See Antimicrobial Website for further information. 
       
    Tobramycin  (Tobi ® podhaler )
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    Restricted Drug Restricted
    Red
    High Cost Medicine
    Dry powder for inhalation
    For use in cystic fibrosis in line with NICE TA 276 only.
    High cost drug excluded to tariff, NHSE commissioned.
    Specialist Respiratory prescribing

    Date of entry of decision to Formulary: April 2013
     
    Link  NICE TA 276: Colistimethate sodium and tobramycin dry powders for inhalation for treating pseudomonas lung infection in cystic fibrosis
       
    05.02.01  Expand sub section  Triazole antifungals
     note 

    Posaconazole and Voriconazole are high cost drugs excluded to tariff, NHSE commissioned.  See Antimicrobial website for further details

    05.02.03  Expand sub section  Polyene antifungals
     note  Amphotericin liposomal formulations are high cost drugs excluded to tariff, commissioned by NHSE.  See Antimicrobial Website for further details.
    05.02.04  Expand sub section  Echinocandin antifungals
     note  Caspofungin and Micafungin are high cost drugs excluded to tariff commissioned by NHSE.  See antimicrobial website for further information
    05.03  Expand sub section  Antiviral drugs to top
    05.03.01  Expand sub section  HIV infection
    05.03.01  Expand sub section  Nucleoside reverse transcriptase inhibitors
    Abacavir
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    Restricted Drug Restricted
    Red
    High Cost Medicine
     
       
    Abacavir and Lamivudine (Kivexa®)
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    Restricted Drug Restricted
    Red
    High Cost Medicine
    High Cost Therapy excluded to tariff 
       
    Bictegravir, Emtricitabine and Tenofovir Alafenamide (Biktarvy®)
    View adult BNF View SPC online  Track Changes
    Restricted Drug Restricted
    Red

    High cost drug excluded to tariff
    Restricted, to be used in line with NHSE policy only

     
       
    Didanosine
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    Restricted Drug Restricted
    Red
    High Cost Medicine
    High Cost Therapy excluded to tariff 
       
    Efavirenz, Emtricitabine and Tenofovir Disoproxil (Atripla®)
    View adult BNF View SPC online
    Restricted Drug Restricted
    Red
    High Cost Medicine
    High Cost Therapy excluded to tariff  
       
    Elvitegravir, Cobicistat, Emtricitabine and Tenofovir Alafenamide  (Genvoya®)
    View adult BNF View SPC online  Track Changes
    Restricted Drug Restricted
    Red
    High Cost Medicine
    High Cost Therapy excluded to tariff  
    Link  MHRA advice: Cobicistat, ritonavir and coadministration with a steroid: risk of systemic corticosteroid adverse effects
    Link  MHRA Advice: Elvitegravir boosted with cobicistat: avoid use in pregnancy due to risk of treatment failure
    Link  NHSE Policy: Tenofovir Alafenamide
       
    Elvitegravir, Cobicistat, Emtricitabine and Tenofovir Disoproxil  (Stribild®)
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    Restricted Drug Restricted
    Red
    High Cost Medicine
     
    Link  MHRA advice: Cobicistat, ritonavir and coadministration with a steroid: risk of systemic corticosteroid adverse effects
    Link  MHRA Advice: Elvitegravir boosted with cobicistat: avoid use in pregnancy due to risk of treatment failure
    Link  NHSE Policy: Stribild
       
    Emtricitabine
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    Restricted Drug Restricted
    Red
    High Cost Medicine
    High Cost Therapy excluded to tariff 
       
    Emtricitabine and Tenofovir Alafenamide (Descovy®)
    View adult BNF View SPC online  Track Changes
    Restricted Drug Restricted
    Red
    High Cost Medicine
    High cost drug excluded to tariff
    Restricted, to be used in line with NHSE policy only 
    Link  NHSE Policy: Tenofovir Alafenamide
       
    Emtricitabine, Rilpivirine and Tenofovir Alafenamide (Odefsey®)
    View adult BNF View childrens BNF  Track Changes
    Restricted Drug Restricted
    Red
    High Cost Medicine
    High cost therapy excluded to tarrif
    Restricted, to be used in line with NHSE policy only 
    Link  NHSE Policy: Tenofovir Alafenamide
       
    Emtricitabine, Rilpivirine and Tenofovir Disoproxil  (Eviplera®)
    View adult BNF View SPC online  Track Changes
    Restricted Drug Restricted
    Red
    High Cost Medicine
    High Cost Therapy excluded to tariff
    Only for those intolerant or non responsive to Atripla 
       
    Lamivudine
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    Restricted Drug Restricted
    Red
    High Cost Medicine
    High Cost Therapy excluded to tariff
    Also used in treatment of Hepatitis B, commissioned by NHSE in line with NICE CG165 only
     
    Link  NICE CG165: Hepatitis B (chronic): Diagnosis and management of chronic hepatitis B in children, young people and adults
       
    Tenofovir Disoproxil
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    Restricted Drug Restricted
    Red
    High Cost Medicine
    High Cost Therapy excluded to tariff 
       
    Tenofovir Disoproxil and Emtricitabine (Truvada®)
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    Restricted Drug Restricted
    Red
    High Cost Medicine
    High Cost Drug excluded to tariff  
       
    Zidovudine
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    Restricted Drug Restricted
    Red
    High Cost Medicine
    High Cost Therapy excluded to tariff 
       
    Zidovudine and Lamivudine
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    Restricted Drug Restricted
    Red
    High Cost Medicine
    High Cost Therapy excluded to tariff
    Generic combination has a lower cost than the individual components prescribed separately 
       
    Darunavir, Cobicistat, Emtricitabine and tenofovir alafenamide (Symtuza®)
    View adult BNF View SPC online  Track Changes
    Restricted Drug Restricted
    Red
    NHS England

    High cost drug excluded to tariff. Restricted, to be used in line with NHSE policy only

     
    Link  NHSE Commissioning Policy: Clinical Commissioning Policy: Use of cobicistat as a booster in treatment of HIV infection
       
    05.03.01  Expand sub section  Protease inhibitors
    Atazanavir
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    Restricted Drug Restricted
    Red
    High Cost Medicine
    High Cost Therapy excluded to tariff 
       
    Atazanavir with Cobicistat (Evotaz®)
    View adult BNF View SPC online  Track Changes
    Restricted Drug Restricted
    Red
    High Cost Medicine
    High Cost Therapy excluded to tariff 
       
    Darunavir with Cobicistat (Rezolsta® )
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    Restricted Drug Restricted
    Red
    High Cost Medicine
    High Cost Therapy excluded to tariff
     
    Link  MHRA Advice: Darunavir boosted with cobicistat: avoid use in pregnancy due to risk of treatment failure and maternal-to-child transmission of HIV-1
       
    Fosamprenavir
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    Restricted Drug Restricted
    Red
    High Cost Medicine
    High Cost Drug excluded to tariff 
       
    Lopinavir with Ritonavir
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    Restricted Drug Restricted
    Red
    High Cost Medicine

    High Cost Drug excluded to tariff

     
    Link  MHRA advice: Cobicistat, ritonavir and coadministration with a steroid: risk of systemic corticosteroid adverse effects
       
    Ritonavir
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    Restricted Drug Restricted
    Red
    High Cost Medicine
    High Cost Therapy excluded to tariff 
    Link  MHRA advice: Cobicistat, ritonavir and coadministration with a steroid: risk of systemic corticosteroid adverse effects
       
    Tipranavir
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    Restricted Drug Restricted
    Red
    High Cost Medicine
    High Cost Therapy excluded to tariff
    Third line therapy 
       
    Darunavir
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    Restricted Drug Restricted
    Red
    High Cost Medicine
    High Cost Therapy excluded to tariff
    2nd line Protease Inhibitor (PI) in patients who have failed at least one PI containing regimen. Recommended to be used in preference to tipranavir where both are an option. 
       
    05.03.01  Expand sub section  Other antiretrovirals
    Enfuvirtide
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    Restricted Drug Restricted
    Red
    High Cost Medicine
    High Cost Drug excluded to tariff 
       
    Raltegravir
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    Restricted Drug Restricted
    Red
    High Cost Medicine
    High Cost Therapy excluded to tariff 
       
    Cobicistat
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    Restricted Drug Restricted
    Red
    High Cost Medicine
    NHS England

    Pharmacoenhancer
    High Cost Therapy excluded to tariff
    For use in line with NHSE policy only

     
    Link  MHRA advice: Cobicistat, ritonavir and coadministration with a steroid: risk of systemic corticosteroid adverse effects
    Link  NHSE Commissioning Policy: Use of cobicistat as a booster in treatment of HIV positive adults and adolescents
       
    Dolutegravir
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    Restricted Drug Restricted
    Red
    High Cost Medicine

    High Cost Therapy excluded to tariff
    Supported in line with NHSE policy only. 

    MHRA Safety alert: Do not prescribe to women seeking to become pregnant; exclude pregnancy before initiation and advise use of effective contraception

     
    Link  Dolutegravir (Tivicay, Triumeq, Juluca): signal of increased risk of neural tube defects
    Link  NHSE Clinical Commissioning Policy: Dolutegravir
       
    Dolutegravir, Abacavir and Lamivudine (Triumeq®)
    View adult BNF View SPC online  Track Changes
    Restricted Drug Restricted
    Red
    High Cost Medicine

    High Cost Therapy excluded to tariff. Supported in line with NHSE policy only.

    MHRA Safety alert: Do not prescribe to women seeking to become pregnant; exclude pregnancy before initiation and advise use of effective contraception

     
    Link  Dolutegravir (Tivicay, Triumeq, Juluca): signal of increased risk of neural tube defects
    Link  NHSE Clinical Commissioning Policy
       
    Maraviroc
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    Restricted Drug Restricted
    Red
    High Cost Medicine
    High Cost Therapy excluded to tariff
    For use in treatment experienced adult patients infected with only CCR5-tropic HIV-1 virus. 
       
    05.03.02.02  Expand sub section  Cytomegalovirus infrection to top
     note  Cidofovir, Foscarnet, Ganciclovir and Valganciclovir are high cost drugs excluded to tariff commissioned by NHSE in line with Trust guidelines for Cytomegalovirus infection.
    05.03.03  Expand sub section  Viral hepatitis
    Daclatasvir
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    Restricted Drug Restricted
    Red
    High Cost Medicine
    NHS England
    BlueTeq

    Specialist prescribing in Hepatitis C
    Commissioned by NHSE in line with NICE TA only
    Blueteq prior approval required before initiation



    Date of entry of decision to formulary: February 2016

     
    Link  NICE TA 364: Daclatasvir for treating chronic hepatitis C
       
    Dasabuvir
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    Restricted Drug Restricted
    Red
    High Cost Medicine
    NHS England
    BlueTeq

    Specialist use in Hepatitis C
    NHSE commissioned in line with NICE TA 365
    Blueteq prior approval required before intiation
    Date of entry of decision to Formulary: March 2016

     
    Link  NICE TA 365: Ombitasvir–paritaprevir–ritonavir with or without dasabuvir for treating chronic hepatitis C
       
    Elbasvir and grazoprevir (Zepatier®)
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    Restricted Drug Restricted
    Red
    High Cost Medicine
    NHS England
    BlueTeq

    Specialist use in Hepatitis C
    NHSE commissioned in line with NICE TA 413
    Blueteq prior approval required before initiation
    Date of entry of decision to formulary: January 2017

     
    Link  NICE TA 413: Elbasvir–grazoprevir for treating chronic hepatitis C
       
    Entecavir
    View adult BNF View SPC online  Track Changes
    Restricted Drug Restricted
    Red
    High Cost Medicine
    Specialist prescribing in Hepatitis B
    Commissioned by NHSE in line with NICE TA 153 only 
    Link  NICE TA 153: Entecavir for the treatment of chronic hepatitis B
       
    Glecaprevir and pibrentasvir (Maviret®)
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    Restricted Drug Restricted
    Red
    High Cost Medicine
    BlueTeq

    Specialist prescribing for hepatitis C.
    NHSE Commissioned in line with NICE TA 499 only. 
    Blueteq prior approval required before initiation

    Date of entry of decision to Formulary: February 2018

     
    Link  NICE TA 499: Glecaprevir–pibrentasvir for treating chronic hepatitis C
       
    Ledipasvir and sofosbuvir  (Harvoni®)
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    Restricted Drug Restricted
    Red
    High Cost Medicine
    NHS England
    BlueTeq

    Specialist prescribing in Hepatitis C
    Commissioned by NHSE in line with NICE TA only
    Blueteq prior approval required before initiation

    Date of entry of decision to formulary: February 2016

     
    Link  NICE TA 363: Ledipasvir–sofosbuvir for treating chronic hepatitis C
       
    Ombitasvir, paritaprevir, and ritonavir  (Viekirax®)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Restricted Drug Restricted
    Red
    High Cost Medicine
    NHS England
    BlueTeq

    Specialist prescribing in Hepatitis C
    NHSE commissioned in line with NICE TA only with or without Dasabuvir
    Blueteq prior approval required before initiation


    Date of entry of decision to formulary: February 2016

     
    Link  NICE TA 365: Ombitasvir–paritaprevir–ritonavir with or without dasabuvir for treating chronic hepatitis C
       
    Simeprevir
    View adult BNF View SPC online  Track Changes
    Restricted Drug Restricted
    Red
    High Cost Medicine
    NHS England

    Specialist prescribing in Hepatitis C
    Commissioned by NHSE in line with NICE TA only.

    Genotype 4 patients require Blueteq prior approval before initiation

    Date decision added to Formulary: May 15

     
    Link  NICE TA 331: Simeprevir for chronic Hepatitis C
       
    Sofosbuvir
    View adult BNF View SPC online  Track Changes
    Restricted Drug Restricted
    Red
    High Cost Medicine
    NHS England
    BlueTeq

    Specialist prescribing in Hepatitis C
    NHSE commissioned in line with NICE TA only
    Blueteq prior approval required before initiation

    Date decision added to Formulary: May 15

     
    Link  NICE TA 330: Sofosbuvir for chronic Hepatitis C
       
    Sofosbuvir, velpatasvir, voxilaprevir (Vosevi®)
    View adult BNF View SPC online  Track Changes
    Restricted Drug Restricted
    Red
    High Cost Medicine
    NHS England
    BlueTeq

    Specialist prescribing in Hepatitis C

    NHSE commissioned in line with NICE TA 507 only 
    Blueteq prior approval required before initiation 

    Date of entry of decision to formulary: May 2018

     
    Link  NICE TA 507: Sofosbuvir–velpatasvir–voxilaprevir for treating chronic hepatitis C
       
    Sofosbuvir/valpatasvir (Epclusa®)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Restricted Drug Restricted
    Red
    High Cost Medicine
    NHS England
    BlueTeq

    Specialist prescribing in Hepatitis C
    NHSE commissioned in line with NICE TA only
    Blueteq prior approval required before initiation

    Date decision added to Formulary: March 17

     
    Link  NICE TA 430: Sofosbuvir–velpatasvir for treating chronic hepatitis C
       
    Boceprevir
    View adult BNF View SPC online  Track Changes
    Restricted Drug Restricted
    Red
    High Cost Medicine
    BlueTeq

    Specialist prescribing in Hepatitis C
    Commissioned by NHSE in line with NICE TA 253 only

    Date of entry of decision to Formulary: May 2012

    Use superceded by newer drugs for Hepatitis C

    Blueteq prior approval required before initiation

     
    Link  NICE TA 253: Boceprevir for the treatment of genotype 1 chronic hepatitis C
       
    Telaprevir
    View adult BNF View SPC online  Track Changes
    Restricted Drug Restricted
    Red
    NHS England
    BlueTeq

    Specialist prescribing in Hepatitis C
    High cost drug excluded to tariff. Commissioned by NHSE in line with NICE TA 252 only

    Date of entry of decision to Formulary: May 2012

    Use superceded by newer drugs for Hepatitis C

     
    Link  NICE TA 252:Telaprevir for the treatment of genotype 1 chronic hepatitis C
       
    05.03.05  Expand sub section  Respiratory syncytial virus
    Palivizumab (Synagis®)
    View adult BNF View SPC online  Track Changes
    Restricted Drug Restricted
    Red
    NHS England
    BlueTeq

    Respiratory syncytial virus (RSV) prophylaxis
    High cost drug excluded to tariff commissioned by NHSE
    Supported in line with JVCI guidance

    From 16/17 season Blueteq prior approval required before initiation

     
       
    Ribavirin
    View adult BNF View SPC online
    Restricted Drug Restricted
    Red
    High cost drug excluded to tariff commissioned by NHSE
    Supported in line with NICE TA 75, 106, 200 
    Link  NICE TA 106: Peginterferon alfa and ribavirin for the treatment of mild chronic hepatitis C
    Link  NICE TA 75: Interferon alfa (pegylated and non-pegylated) and ribavirin for the treatment of chronic hepatitis C
    Link  TA 200: Peginterferon alfa and ribavirin for the treatment of chronic hepatitis C
       
    05.05  Expand sub section  Anthelmintics
    Mebendazole
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    Formulary
    Green
     
       
    Triclabendazole
    View adult BNF View SPC online  Track Changes
    Restricted Drug Restricted
    Red

    For use by infectious diseases consultants only for treatment of hepatic fascioliasis.

     
       
     ....
     Non Formulary Items
    Ceftobiprole  (Zevtera®)

    View adult BNF View SPC online Track Changes
    Non Formulary
    Black

    Hospital and community-acquired pneumonia in adults.

     
    Dolutegravir, Rilpivirine  (Juluca®)

    View adult BNF View SPC online Track Changes
    Non Formulary
    Black

    Not yet reviewed

     
    Doxycycline 40mg M/R  (Efracea®)

    View adult BNF View SPC online Track Changes
    Non Formulary
    Black
    Link  Leicestershire Evaluation: Efracea in Rosacea
     
    Indinavir

    View adult BNF View SPC online
    Non Formulary
    Black
     
    Nelfinavir

    View adult BNF View SPC online
    Non Formulary
    Black
     
    Saquinavir

    View adult BNF View SPC online
    Non Formulary
    Black
     
    Stavudine

    View adult BNF View SPC online
    Non Formulary
    Black
     
      
    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
    SMC
    Scottish Medicines Consortium
    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

    Black

    Drugs not recommended for use in the Leicestershire Health Community because of lack of evidence of clinical effectiveness, cost prioritization or concerns over safety. All new drugs will be black until they have been through the appropriate approval process - then they will appear as a specific entry   

    Red

    Drugs which should be prescribed only by hospital specialists (clinical review by specialist as appropriate and annually as a minimum).  

    Amber SCA

    Drugs which would initially be prescribed by a hospital specialist and then by a GP where full agreement to share the care of each specific patient has been reached under a LMSG Shared Care Agreement (SCA). Specific patient monitoring or intervention required.   

    Amber Simple

    Drugs suitable to be initiated and prescribed in primary care only after specialist assessment and recommendation. A shared care agreement is not required.  

    Green Conditional

    Drugs for which GPs are able to take full responsibility for prescribing and monitoring subject to specified conditions e.g. prescribing in line with agreed LMSG guidance or able to demonstrate suitable competence see comments under individual entries.   

    Green

    Drugs for which GPs would normally take full responsibility for prescribing and monitoring. Drugs included in this list have been specifically considered by LMSG.   

    netFormulary