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 Formulary Chapter 9: Nutrition and blood - Full Chapter
Notes:

This chapter of the formulary is under continual development, please let the team know if you have any comments about the contents: mlcsu.lscformulary@nhs.net

For more information about the formulary development process, please see: https://www.lancsmmg.nhs.uk/lancashire-and-south-cumbria-icb-formulary-development/

 Details...
09.01.03  Expand sub section  Drugs used in hypoplastic, haemolytic, and renal anaemias
Iptacopan
View adult BNF View SPC online View childrens BNF
Formulary
Red
NHS England
BlueTeq
Iptacopan is recommended, within its anticipated marketing authorisation, as an option for treating paroxysmal nocturnal haemoglobinuria (PNH) in adults with haemolytic anaemia.
Iptacopan will be available via the Innovative Medicines Fund (IMF) according to a set of treatment criteria which translates the NICE recommendation into a clinical guide as to use in practice. These treatment criteria can be found on the application form(s) on the Blueteq site.
NHS England will then routinely commission iptacopan in patients with PNH via commissioned centres.
 
Link  NICE TA1000: Iptacopan for treating paroxysmal nocturnal haemoglobinuria
 
Ravulizumab (Ultomiris®)
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Formulary
Red
NHS England

Concentrate for solution for infusion 300mg/3mL, 1,100mg/11mL, 300mg/30mL

Tertiary centres only

 
Link  NICE TA698: Ravulizumab for treating paroxysmal nocturnal haemoglobinuria
Link  NICE TA710: Ravulizumab for treating atypical haemolytic uraemic syndrome
 
Voxelotor
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Formulary
Red
NHS England
BlueTeq
 
Link  NICE TA981: Voxelotor for treating haemolytic anaemia caused by sickle cell disease
 
Rituximab
(For haemolytic anaemia in adults)
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Unlicensed Drug Unlicensed
Red
High Cost Medicine
BlueTeq

Off-label use for the treatment of autoimmune haemolytic anaemia in adults (AIHA)

Rituximab is recommended as an alternative treatment for adults with AIHA where patients are contraindicated to or fail to respond to standard active treatments (e.g corticosteroids).

Treatment requires initiation and continuation by specilist haematology services.

 

 

 
 
09.01.03  Expand sub section  Erythropoietin
Darbepoetin Alfa (Aranesp®)
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Formulary
Red
Injection prefilled syringe 10micrograms, 30micrograms, 50micrograms
Injection prefilled syringe and SureClick 20micrograms, 40micrograms, 60micrograms, 80micrograms, 100micrograms.

Consultant initiation only 
 
Epoetin alfa (Eprex®)
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Formulary
Red
Injection prefilled syringe 10,000units, 40,000units

Consultant initiation only 
 
09.01.03  Expand sub section  Iron overload
Desferrioxamine Mesilate (Desferal®)
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First Choice
Red
Injection 500mg, 2g vials 
Deferiprone (Ferriprox®)
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Second Choice
Red
High Cost Medicine
Tablets 500mg

Consultant haematologist only 
 
DeferasiroxBlack Triangle (Exjade®)
View adult BNF View SPC online View childrens BNF
Formulary
Red
High Cost Medicine

Tablets 90mg, 180mg, 360mg

 

For specialist prescribing by haematologists

 
 
 ....
 Non Formulary Items
  
Key
Restricted Drug Restricted Drug
Unlicensed Drug Unlicensed
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
Cytotoxic Drug
Cytotoxic Drug
CD
Controlled Drug
High Cost Medicine
High Cost Medicine
Cancer Drugs Fund
Cancer Drugs Fund
NHSE
NHS England
Homecare
Homecare
ICB
ICB
Green Low Carbon

Low carbon footprint

Amber Medium Carbon

Medium carbon footprint

Red High carbon footprint

High carbon footprint

Status Description

Green

Green: Appropriate for initiation and ongoing prescribing in both primary and secondary care. Generally, little or no routine drug monitoring is required.  

Green Restricted

Green (Restricted): Appropriate for initiation and ongoing prescribing in both primary and secondary care provided: Additional criteria specific to the medicine or device are met, or The medicine or device is used following the failure of other therapies as defined by the relevant LSCMMG pathway. Generally, little or no routine drug monitoring is required.   

Red

Red medicines: Medicine is supplied by the hospital for the duration of the treatment course. Primary care initiation or continuation of treatment is not recommended unless exceptional circumstances such as specialist GP. Red medicines are those where primary care prescribing is not recommended. These treatments should be initiated by specialists only and prescribing retained within secondary care. They require specialist knowledge, intensive monitoring, specific dose adjustments or further evaluation in use. If however, a primary care prescriber has particular specialist knowledge or experience of prescribing a particular drug for a particular patient it would not always be appropriate for them to expect to transfer that prescribing responsibility back to secondary care. There should be a specific reason and a specific risk agreement, protocol and service set up to support this. Primary care prescribers may prescribe RED medicines in exceptional circumstances to patients to ensure continuity of supply while arrangements are made to obtain ongoing supplies from secondary care.  

Amber 0

Amber level 0: Suitable for prescribing in primary care following recommendation or initiation by a specialist. Little or no specific monitoring required. Patient may need a regular review, but this would not exceed that required for other medicines routinely prescribed in primary care. Brief prescribing document or information sheet may be required. Primary care prescribers must be familiar with the drug to take on prescribing responsibility or must get the required information. When recommending or handing over care, specialists should ask primary care prescribers to take over prescribing responsibility, and should give enough information about the indication, dose, monitoring requirements, use outside product licence and any necessary dose adjustments to allow them to confidently prescribe.  

Amber 1

Amber level 1 (with shared care): Suitable for prescribing in primary care following recommendation or initiation by a specialist. Minimal monitoring required. Patient may need a regular review, but this would not exceed that required for other medicines routinely prescribed in primary care. Full prior agreement about patient’s on-going care must be reached under the shared care agreement. Primary care prescribers are advised not to take on prescribing of these medicines unless they have been adequately informed by letter of their responsibilities with regards monitoring, side effects and interactions and are happy to take on the prescribing responsibility. A copy of locally approved shared care guidelines should accompany this letter which outlines these responsibilities. Primary care prescribers should then tell secondary care of their intentions as soon as possible by letter so that arrangements can be made for the transfer of care.  

Amber 2

Amber level 2 (with shared care and enhanced service): Initiated by specialist and transferred to primary care following a successful initiation period. Significant monitoring required on an on-going basis. Full prior agreement about patient’s on-going care must be reached under the shared care agreement. Suitable for enhanced service. These medicines are considered suitable for GP prescribing following specialist initiation of therapy, as per shared care document which will be sent out with the request to prescribe, with on-going communication between the primary care prescriber and specialist. Amber Level 2 medicines require significant monitoring for which an enhanced service may be suitable. (Subject to local commissioning agreements).  

Do Not Prescribe

Do not prescribe: NOT recommended for use by the NHS in Lancashire and South Cumbria. Includes medicines that NICE has not recommended for use and terminated technology appraisals, unless there is a local need.  

Grey

Grey medicines: Medicines which have not yet been reviewed or are under the review process. GPs and specialists are recommended not to prescribe these drugs. This category includes drugs where funding has not yet been agreed.   

Multiple

Refer to local guidance and local commissioning arrangements  

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