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 Formulary Chapter 8: Malignant disease and immunosuppression - Full Chapter
Notes:
Further information on specific drugs available locally and the pathways used is available from the East Midlands Cancer Network.  This includes drugs reviewed as part of NICE technology appraisals


The East Midlands has adopted the Palliative Adult Network Guidelines(PANG) as the single guideline across the region to conform with the requirement for a single guideline within a cancer network.  These are freely available to healthcare professionals.
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08.02.02  Expand sub section  Corticosteroids and other immunosuppressants
 note  Section in development
Currently includes high cost drugs excluded to tariff only plus drugs considered by TAS since 2000
Basiliximab
View adult BNF View SPC online  Track Changes
Restricted Drug Restricted
Red
High Cost Medicine
Specialist prescribing only in Renal Transplant in line with NICE TA 481 and TA 482
High cost drug excluded to tariff, NHSE commissioned  
Link  NICE TA 481: Immunosuppressive therapy for kidney transplant in adults
Link  NICE TA 482: Immunosuppressive therapy for kidney transplantation in children and young people
   
Everolimus
View adult BNF View SPC online View childrens BNF  Track Changes
Restricted Drug Restricted
Red
Immunosupression for the prevention of organ rejection after kidney transplant. In line with NICE TA 481 and 482 
   
Mycophenolic acid (Myfortic®)
View adult BNF View SPC online  Track Changes
Restricted Drug Restricted Specialist renal use in renal transplant only  
Link  MHRA Advice: Mycophenolate mofetil, mycophenolic acid: new pregnancy-prevention advice for women and men
   
Tacrolimus (Adoport®, Prograf® or Modigraf®)
View adult BNF View SPC online  Track Changes
Restricted Drug Restricted
Amber SCA
High Cost Medicine
Immunosuppression post renal transplant - prescribe by brand name only as different brands are not interchangeable. Specialist renal initiation only
Shared care request is mandatory 
Link  SCA: Tacrolimus, maintenance of immunosuppression following Renal transplantation
   
Tacrolimus SR (Envarsus®)
View adult BNF View SPC online  Track Changes
Restricted Drug Restricted
Red
High Cost Medicine
Once daily preparation. Prophylaxis of transplant rejection in adult kidney transplants. Must be prescribed by brand and not interchangeable with other brands. Total required daily dose is different to other brands of tacrolimus so must not be substituted with other brands 
   
Antithymocyte immunoglobulin (rabbit)
View adult BNF View SPC online
Restricted Drug Restricted
Red
High Cost Medicine
Specialist use only
High cost drug excluded to tariff, commissioned by NHSE in line with BCSH Guidelines only 
Link  BCSH Guidelines
   
 ....
 Non Formulary Items
Tacrolimus SR  (Advagraf®)

View adult BNF View SPC online
Non Formulary
Black
Oral tacrolimus products should be prescribed and dispensed by brand name only
Link  Leicestershire Evaluation: Advagraf® in Rejection
 
  
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.   

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