Formulary Chapter 11: Eye - Full Chapter
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Notes: |
NORTH OF TYNE AND GATESHEAD GUIDELINES FOR MANAGEMENT OF COMMON OPHTHALMOLOGIAL CONDITIONS IN PRIMARY / COMMUNITY CARE
Preservative Free Eye Drops Microbial contamination of multidose bottles of eye drops can cause eye infections that may lead to damage of the eye and in extreme cases loss of sight. To minimise the risk, multidose bottles of eye drops contain an antimicrobial preservative such as benzalkonium chloride. The preservatives used in eye drops are normally well tolerated, but they are not completely harmless. They can cause irritation and damage to the corneal epithelium. This risk is understood to be greater in patients with pre-existing damage to the ocular surface and where large quantities of preservative containing eye drops are applied repeatedly over a prolonged period (e.g. if applied more than 4 to 6 times daily for several weeks/ months). To avoid these problems the use of preservative-free eye drops is recommended in: Patients who have experienced hypersensitivity reactions or irritation due to preservatives in eye drops. Patients who have received corneal grafts. Patients with conditions where there is already damage to the ocular surface as a result of disease or trauma, such as dry eye, blepharitis, ocular burns etc. Treatment with preservative-free eye drops will usually be initiated by an ophthalmologist and details on their availability and use is available from the pharmacy at Newcastle’s Royal Victoria Infirmary (and on the North of Tyne and Gateshead Area Prescribing Committee’s website). |
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Details... |
11.01 |
Administration of drugs to the eye |
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11.02 |
Control of microbial contamination |
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11.03 |
Anti-infective eye preparations |
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Chloramphenicol 0.5% eye drops & ointment
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First Choice
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- Preservative-free eye drops are also approved for use:
- 0.5% preservative-free Minims® - first choice.
- 0.5% preservative-free eye drops
unlicensed - approved only for patients who are unable to use Minims®due to dexterity problems
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Fusidic Acid (Fucithalmic®)
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Alternatives
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Gentamicin 0.3% ear/eye drops & 0.3% Minims®
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Alternatives
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- 1.5% eye drops with and with out preservative are also approved -
unlicensed and 
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Ofloxacin 0.3% Eye drops
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Alternatives
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Propamidine Isetionate
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Alternatives
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- For use in the treatment of acanthamoeba keratitis – used with PHMB.
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Benzylpenicillin 0.3% Eye drops
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Unlicensed
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Cefuroxime 5% eye drops
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Unlicensed
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Erythromycin 0.5% Eye ointment
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Unlicensed
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Polyhexamethylene biguinide (PHMB) 0.02% Eye drops
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Unlicensed
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Povidone iodine 5%
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Unlicensed
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11.03.02 |
Antifungals |
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There are currently no licensed topical antifungal agents available for the treatment of eye infections. Products such as those below can be obtained as unlicensed medicines to meet specific needs on request from an ophthalmologist or microbiologist. Contact pharmacy at the RVI (0191 2825398) for details. |
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Amphotericin B Preservative-free (eye drops)
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Unlicensed
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Econazole 1% Eye drops (In arachis oil)
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Unlicensed
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Natamycin 5% (eye drops)
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Unlicensed
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Voriconazole (eye drops)
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Unlicensed
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- 100microgram in 0.1ml (0.1%) - preservative-free eye drops.
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Aciclovir 3% eye ointment
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Formulary
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Aciclovir 800mg Tablets
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Formulary
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- For the treatment of ophthalmic zoster.
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Ganciclovir 0.15% ophthalmic gel (Virgan®)
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Formulary
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Trifluorothymidine 1% Eye drops
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Unlicensed
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11.04 |
Corticosteroids and other anti-inflammatory preparations |
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Betamethasone 0.1% eye drops & eye ointment
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First Choice
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Prednisolone 0.5% with Neomycin 0.5% (Predsol-N®)
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Formulary
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Betamethasone 0.1% with Neomycin 0.5% eye drops
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Alternatives
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Dexamethasone 0.1% eye drops (Maxidex®)
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Alternatives
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- Preservative-free eye drops are also approved.
- 0.1% Minims® - first choice.
- 0.1% preservative free eye drops
unlicensed - approved only for patients who are unable to use Minims®due to dexterity problems.
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Dexamethasone 0.1% Preservative-free
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Alternatives
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First choice
Unit dose vials (Minims®)
Alternative
Eye drops (unlicensed) - only for patients who are unable to use Minims® due to dexterity problems
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Dexamethasone with Neomycin and Polymyxin B sulphate (Maxitrol®)
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Alternatives
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- Eye drops and eye ointment
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Fluorometholone 0.1% Eye drops (FML®)
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Alternatives
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- For use in patients who experience ocular hypertension with other corticosteroids – treatment to be initiated with the advice of an ophthalmologist.
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Loteprednol Eye drops
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Alternatives
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- Approved as a second line agent to conventional corticosteroid eye drops, treatment to be imitated with the advice of an ophthalmologist only.
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Prednisolone 0.5% Single Use Minims®
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Alternatives
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Prednisolone eye drops
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Alternatives
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- The following formulations are approved
- 0.5% eye drops and 1% (Pred-Forte).
- 0.1% and 0.3% eye drops - both
unlicensed.
- Approved preservative free formulations include
- 0.5% minims.
- 0.1%, 0.3%, 0.5% and 1% - all
unlicensed.
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Rimexolone
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Alternatives
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- For use where Fluorometholone (FML) drops (which are much cheaper) are likely to be insufficiently effective.
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Dexamethasone 700 microgram intravitreal implant (Ozurdex®)
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Alternatives
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- Approved for macular oedema following central retinal vein occlusion
in line with NICE.
- Approved for treating diabetic macular oedema in line with NICE.
- Approved for the treatment of non-infectious uveitis in line with NICE and NHS England Commissioning Policy
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NICE TA229 Dexamethasone intravitreal implant for the treatment of macular oedema secondary to retinal vein occlusion
NICE TA349: Diabetic Macular Oedema
NICE TA460 Adalimumab and dexamethasone for treating non-infectious uveitis
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Fluocinolone 190 microgram intravitreal implant
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Alternatives
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- Recommended as a possible treatment for people with chronic diabetic macular oedema who have an artificial lens in their eye if the implant is used in the eye with the artificial lens and their diabetic macular oedema has not got better with other treatments - in line with NICE.
- Approved for the treatment of recurrent non-infectious uveitis in line with NICE
- Approved for treating chronic diabetic macular oedema in phakic eyes after an inadequate response to previous therapy in line with NICE
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NICE TA301Fluocinolone acetonide intravitreal implant for treating chronic diabetic macular oedema after an inadequate response to prior therapy
NICE TA590: Fluocinolone acetonide intravitreal implant for treating recurrent non-infectious uveitis
NICE TA613: Fluocinolone acetonide intravitreal implant for treating chronic diabetic macular oedema in phakic eyes after an inadequate response to previous therapy
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11.04.02 |
Other anti-inflammatory preparations |
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Antazoline 0.5% with Xylometazoline 0.05% (Otrivine-Antistin®)
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Formulary
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Ciclosporin 0.1% (1mg/1ml) Eye Drops
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Formulary
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Ikervis®
- Approved as a possible treatment for people with dry eye disease that has not improved despite treatment with artificial tears NICE.

Verkazia®
- Approved for the treatment of severe vernal keratoconjunctivitis in children and adolescents.

- If treatment is longer than 12 months then 3-6 monthly reviews will be required.
- A 0.2% eye ointment is also approved as an alternative to eye drops for this indication
and unlicensed.
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TA 369 Ciclosporin for treating dry eye disease that has not improved despite treatment with artificial tears
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Olopatadine (Opatanol®)
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Formulary
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Sodium Cromoglicate 2% Eye drops
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Formulary
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- A 2% preservative free preparation is also approved
unlicensed - treatment to be imitated with the advice of an ophthalmologist only.
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Adalimumab
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Formulary
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- 40mg Injection
- Approved for the treatment of children with Severe Refractory Uveitis in line with interim NHS England Clinical Commissioning Policy.
- Approved for the treatment of adults with Severe Refractory Uveitis in line with interim NHS England Clinical Commissioning Policy.
- Approved for the treatment of non-infectious uveitis in line with NICE and NHS England Commissioning Policy (replaces interim policy for adalimumab for adults with severe refractory uveitis from 24th October 2017)
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Adalimumab for Children with Severe Refractory Uveitis
NICE TA460 Adalimumab and dexamethasone for treating non-infectious uveitis
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11.05 |
Mydriatics and cycloplegics |
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Atropine
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Formulary
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- 1% eye drop.
1% ointment. 1% preservative-free eye drops unlicensed.
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Atropine Sulphate Single Use Minims®
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Formulary
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Cyclopentolate Eye drops
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Formulary
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Cyclopentolate Single Use Minims®
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Formulary
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Mydricaine ® No.2
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Formulary
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- 0.3ml injection containing procaine HCl 6mg, atropine sulphate 1mg and adrenaline solution (1:1,000)
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Phenylephrine
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Formulary
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- 2.5% eye drops
unlicensed
- 2.5% single use Minims®
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Tropicamide single use Minims®
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Formulary
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Phenylephrine Hydrochloride
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Formulary
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- 2.5% eye drops
unlicensed.
- 2.5% single use Minims®.
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Mydricaine® No.2
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Formulary
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- 0.3ml injection containing procaine HCL 6mg, atropine sulphate 1mg and adrenaline solution (1 in 1,000).
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11.06 |
Treatment of glaucoma |
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Timolol
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Formulary
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- 0.25% and 0.5% eye drops.
0.25% and 0.5% unit dose eye drops.
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Timolol LA
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Formulary
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- 0.25% and 0.5% long-acting eye drops.
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11.06 |
Prostaglandin analogues |
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Latanoprost eye drops
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First Choice
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- 50 microgram/ml drops
- 50 microgram/ml preservative free SDU (Monopost)
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Bimatoprost eye drops
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Alternatives
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Bimatoprost with Timolol eye drops
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Alternatives
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- For use as a second/third-line agent in patients insufficiently responsive
to monotherapy with a prostaglandin analogue or beta blocker
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Latanoprost 0.005% with Timolol 0.5% eye drops
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Alternatives
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- For use as a second/third-line agent in patients insufficiently responsive
to monotherapy with a prostaglandin analogue or beta blocker.
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Tafluprost (Preservative Free) 15micrograms/ml unit dose eye drops
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Alternatives
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- Approved for use in children and adults. To be initiated by ophthalmologists only and is to be used third line after preservative containing latanoprost and preservative free timolol. The ophthalmologists must clearly document that signs and symptoms of preservative intolerance/ allergy have been demonstrated in their patient prior to initiation.
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Tafluprost 15microg with timolol 0.5% eye drops
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Alternatives
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Brimonidine Tartrate 0.2% eye drops
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Formulary
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11.06 |
Carbonic anhydrase inhibitors and systemic drugs |
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Brinzolamide
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First Choice
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Dorzolomide
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First Choice
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- 2% eye drops.
- 2% unit dose eye drops.
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Brinzolamide 10mg/ml & brimonidine 2mg/ml (Simbrinza®)
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Formulary
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- Approved as a third line agent as an “add-on” in patients at the very end of medical management.
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Acetazolamide
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Alternatives
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250mg tablets  500mg injection 
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Dorzolomide 2% with Timolol 0.5%
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Alternatives
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- Eye drops and unit dose eye drops
- Approved for use in patients with confirmed allergy presenting as
conjunctival changes or skin allergy. To be initiated by ophthalmologists only. The ophthalmologists must clearly document that signs and symptoms of preservative allergy have been demonstrated in their patient prior to initiation.
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Pilocarpine (eye drops)
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Third Choice
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- 0.5%, 1%, 2% and 4% eye drops.
- 1%, 2% and 4% unit dose eye drops.
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Pilocarpine 1% and 2% eye drops
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Formulary
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Lidocaine 4% with Fluorescein 0.25% Minims®
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Formulary
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Oxybuprocaine 0.4% Minims® (Benoxinate)
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Formulary
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Proxymetacaine 0.5% Minims®
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Formulary
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Tetracaine 1% Minims® (Amethocaine)
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Formulary
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11.08 |
Miscellaneous ophthalmic preparations |
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11.08.01 |
Tear deficiency, ocular lubricants, and astringents |
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Hypromellose
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First Choice
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- 0.3% eye drops
- 0.3% preservative-free eye drops:
- 1st line Tear-Lac®;
- 2nd line PF Drops®
-treatment to be initiated on the advice of ophthalmologist only
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Acetylcysteine 5% eye drops and preservative free eye drops
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Alternatives
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Acetylcysteine 5% with Hypromellose 0.35%
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Alternatives
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Balanced Salt Solution
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Alternatives
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- Sterile solution containing sodium chloride 0.64%, sodium acetate 0.39%, sodium citrate 0.17%, calcium chloride 0.048%, magnesium chloride 0.03%, potassium chloride 0.075% in 15ml bottles and 500ml bags.
- For intra-ocular or topical irrigation during surgical procedures.
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Carbomer 980 eye drops
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Alternatives
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- Viscotears® eye drops
- GelTears® single unit dose eye drops
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Carmellose sodium
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Alternatives
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Duolube® eye ointment (Lanolin and preservative free)
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Alternatives
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- Please note
The brand name will soon change to Sooth Night-time and Duolube will be unable to be ordered
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Liquid Paraffin eye ointment
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Alternatives
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Retinol palmitate 250iu/g, liquid paraffin, white soft paraffin, wool fat
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Alternatives
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Sodium Chloride
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Alternatives
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- 0.9% eye drops and single dose unit eye drops.
- 5% eye drops and preservative-free eye drops.
- 5% eye ointment
unlicensed.
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Sodium Hyaluronate
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Alternatives
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- 0.1% eye drops & preservative-free eye drops
- 0.2% eye drops & preservative-free eye drops
- 0.4% unit dose vials (Clinitas) & 0.4% preservative-free eye drops (Clinitas Multi)
- specialist recommendation for the treatment of Keraconjunctiva sicca, post refractive surgery and Corneal healing disorders.
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Systane®
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Alternatives
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- 10ml multidose bottles 0.8ml preservative-0free vials Contains hydroxypropyl guar, polyethylene glycol 400, propylene glycol (and other ingredients).
- Long-acting ocular lubricant used for the treatment of dry eye syndrome. Liquid formulation which turns into a gel on contact with eyes providing fast and long lasting relief. The multidose bottle may be used for up to six months after opening in primary care. In contact lens wearers, Systane should be applied before inserting lenses and after removal to extend comfortable wearing times.
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11.08.02 |
Ocular diagnostic and peri-operative preparations and photodynamic treatment |
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11.08.02 |
Ocular diagnostic preparations |
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Fluorescein
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Formulary
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- 2% minims eye drops
- 1mg ophthalmic strips
- Fluorets
- 10% 5ml & 20% 5ml injections
unlicensed
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Lissamine Green
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Formulary
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1.5mg ophthalmic strips
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Indocyanine green
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Unlicensed
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25mg injection.
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11.08.02 |
Ocular peri-operative drugs |
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Diclofenac
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Formulary
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- 0.1% eye drops and unit dose eye drops.
- For post-operative inflammation limited to patients where corticosteroids are unsuitable.
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Acetylcholine Chloride
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Formulary
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Apraclonidine
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Formulary
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- 0.5% and 1% ophthalmic solution.
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Hydroxypropylmethylcellulose HV (Oasis®)
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Formulary
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- 2% 2.3ml intraocular injection.
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Ketorolac (Acular®)
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Formulary
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Povidone iodine 5% eye drops
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Formulary
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- For use in eye surgery only.
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Sodium Hyaluronate
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Formulary
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- 10mg in 1ml bag (Z-Hyalin®, formerly Ophthalin Gelbag®)
- 14mg in 1ml syringe (Healon GV®)
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Duovisc® Injection
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Unlicensed
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- Injection for use in cataract surgery containing VisCoat (1% sodium hyaluronate) and ProVisc (3% sodium hyaluronate, 4% chondroitin sulphate).
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Ethanol 20% eye drops.
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Unlicensed
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- For use in the debridement of the corneal epithelium in patients with
recurrent corneal erosion syndrome.
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11.08.02 |
Subfoveal choroidal neovascularisation |
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Aflibercept 4mg/0.1ml injection (Eylea®)
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Formulary
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- Approved for wet age related macular degeneration in line with NICE.
- Approved for macular oedema – central retinal vein occlusion in line with NICE.
- Approved for diabetic macular oedema in line with NICE.
- Approved for treating visual impairment caused by macular oedema after branch retinal vein occlusion in line with NICE.
- Approved as an option for treating visual impairment because of myopic choroidal neovascularisation in adults in line with NICE
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NICE TA 294 Aflibercept solution for injection for treating wet age‑related macular degeneration
NICE TA 305 Aflibercept for treating visual impairment caused by macular oedema secondary to central retinal vein occlusion
NICE TA 346 Aflibercept for treating diabetic macular oedema
NICE TA 409: Aflibercept for treating visual impairment caused by macular oedema after branch retinal vein occlusion
NICE TA 486: Aflibercept for treating choroidal neovascularisation
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Ranibizumab 10mg/1ml injection (Lucentis®)
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Formulary
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- Approved for wet age related macular degeneration in line with NICE/.
- Approved for diabetic macular oedema in line with NICE.
- Approved for visual impairment caused by macular oedema secondary
to retinal vein occlusion in line with NICE.
- Approved as a possible treatment for sight problems caused by choroidal neovascularisation in people who also have pathological myopia in line with NICE.
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NICE TA 155 Ranibizumab and pegaptanib for the treatment of age-related macular degeneration
NICE TA 274 Ranibizumab for treating diabetic macular oedema
NICE TA 283 Ranibizumab for treating visual impairment caused by macular oedema secondary to retinal vein occlusion
NICE TA 298 Ranibizumab for treating choroidal neovascularisation associated with pathological myopia
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Verteporfin 15mg Injection (Visudyne®)
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Formulary
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Approved for photodynamic therapy in wet age-related macular degeneration in line NICE.
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NICE TA68: Photodynamic therapy for age related macular degeneration
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Bevacizumab 1.25mg/0.5ml intravitreal injection
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Unlicensed
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- NETAG approved for use in the management of macular oedema
secondary to retinal vein occlusion. This is considered a more cost effective treatment option in RVO compared with ranibizumab.
- NTAG approved for age related macular degeneration.
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11.08.02 |
Vitreomacular traction |
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Ocriplasmin (Jetrea®)
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Formulary
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- Approved for use in patients with vitreomacular traction who also have no epiretinal membrane and a hole (up to 400 micrometres) in the centre of their retina or severe sight problems in line with NICE.
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NICE TA 297 Ocriplasmin for treating vitreomacular traction
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11.08.02.04 |
Other products - Mainly for treating ocular injuries |
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11.08.02.04 |
Cytotoxics / wound healing modulators |
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11.08.02.04 |
Fibrinolytic drugs |
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11.08.02.04 |
Glues - ocular |
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11.08.02.04 |
Immunosuppressants |
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11.08.02.04 |
Treatment of burns |
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Holoclar®
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Formulary
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- Approved for treating limbal stem cell deficiency after eye burns in line with NICE and NHS England Commissioning Policy as of 14 November 2017
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11.08.02.04 |
Visco-elastics |
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11.08.02.04 |
Other |
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Ascorbic acid 10% Preservative-free eye drops (Potassium ascorbate)
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Unlicensed
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Disodium edetate 0.37% solution (20ml)
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Unlicensed
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Sodium Citrate 10.11% eye drops (equivalent to citrate 6.5%)
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Unlicensed
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Tretinoin 0.05% eye drops (Retinoic acid)
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Unlicensed
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Contact lenses are only provided on the NHS when there is a medical need. Usually this is when vision cannot be improved with spectacles, but can be improved with contact lenses. The contact lens clinical staff at the RVI will assess eligibility. Examples of eligibility include some disorders of the cornea, very high prescriptions and 'bandage' lenses.
The following contact lens care products stocked for the care of contact lenses for patients attending the ophthalmology department at the RVI. GPs are not allowed to prescribe contact lens solutions on the NHS. |
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Alcon Optifree® Express System
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Formulary
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Bausch & Lomb contact lens solution (Boston®)
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Formulary
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Bausch & Lomb saline (Salette®)
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Formulary
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Clens 100®
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Formulary
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Miraflow® daily cleaner
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Formulary
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Oxysept® 1 Step
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Formulary
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Systane®
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Formulary
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.... |
Key |
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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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CCG |
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Traffic Light Status Information
Status |
Description |

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Drugs for hospital use only. The responsibility for initiation and monitoring treatment should rest with an appropriate hospital clinician and the drug should be supplied through the hospital throughout the duration of treatment.
In some very exceptional circumstances (e.g. due to distance from the hospital, storage, supply or mobility/transport problems) it may be appropriate for the GP to be asked to prescribe a Red drug. This should be negotiated on an individual patient basis and should only be done with the GP’s prior informed agreement where the roles of the GP and hospital services are clearly defined and agreed. The GP should not feel under pressure to prescribe in these circumstances.
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Drugs initiated by hospital specialist, but where continuing treatment by GPs may be appropriate under a shared care arrangement.
The specialist should send the GP a copy of the shared care agreement to sign. The GP should sign the shared care agreement, or indicate they do not want to be part of such an agreement, and return a copy back to the specialist. Shared care guidelines are available or are being developed for most of the drugs listed as Amber.
If no shared care guideline is available, the hospital specialist should provide the patient’s GP with sufficient information and support to allow treatment to be continued and managed safely in primary care. |

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Drugs normally recommended or initiated by hospital specialist, but where the provision of an information leaflet may be appropriate to facilitate continuing treatment by GPs. Many of these information sheets are in the process of development. |

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Drugs where prescribing by GPs is appropriate. Drugs not classified as Red, Amber or Green Plus (formerly blue in North of Tyne) are generally classified as ‘Green’ by default. The Green drugs listed here include those products normally initiated by hospital specialists where there was a need for discussion and debate as to the category in which they should be placed. |
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