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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...
09.08.01  Expand sub section  Drugs used in metabolic disorders
Asfotase alfaBlack Triangle (Strensiq® )
View adult BNF View SPC online View childrens BNF
Formulary
Red
NHS England

Tertiary Centre

Solution for injection

100mg/ml, 40mg/ml

 
Link  NICE: Asfotase alfa for treating paediatric-onset hypophosphatasia
 
Avalglucosidase alfa (Nexviadyme ®)
View adult BNF View SPC online View childrens BNF
Formulary
Red
NHS England

Powder for concentrate for solution for infusion 100mg - for treating Pompe disease - see link below

 
Link  NICE TA821: Avalglucosidase alfa for treating Pompe disease
 
Pegunigalsidase alfaBlack Triangle (Elafbrio®)
(2 mg/mL concentrate for solution for infusion)
View adult BNF View SPC online View childrens BNF
Formulary
Red

For treating Fabry disease

 
Link  NICE TA915: Pegunigalsidase alfa for treating Fabry disease
 
VutrisiranBlack Triangle (Amvuttra ®)
View adult BNF View SPC online View childrens BNF
Formulary
Red
NHS England

25mg solution for injection in pre-filled syringe

Red for NICE TA868 Vutrisiran for treating hereditary transthyretin-related amyloidosis

 
Link  NICE TA868: Vutrisiran for treating hereditary transthyretin-related amyloidosis
 
09.08.01  Expand sub section  Wilsons disease
Penicillamine
View adult BNF View SPC online View childrens BNF
Formulary
Amber 2

Tablets 125mg

 
Link  LSCMMG: Shared care guideline - Penicillamine
 
09.08.01  Expand sub section  Carnitine deficiency
L-Carnitine (Carnitor®)
(Levocarnitine)
View adult BNF View SPC online View childrens BNF
Formulary
Red

Injection 1g in 5mL

Restricted Item Paediatric use only

 
 
09.08.01  Expand sub section  Fabry's disease
09.08.01  Expand sub section  Gaucher's disease to top
09.08.01  Expand sub section  Mucopolysaccharidosis I
09.08.01  Expand sub section  Pompe disease
09.08.01  Expand sub section  Nephropathic cystinosis
09.08.01  Expand sub section  Urea cycle disorders
 ....
 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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