netFormulary North of Tyne, Gateshead and North Cumbria NHS
Area Prescribing Committee Formulary  
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 Formulary Chapter 8: Malignant disease and immunosuppression - Full Chapter
08.02.02  Expand sub section  Corticosteroids and other immunosuppressants
Ciclosporin (Neoral®)
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Formulary
Amber
  • Neoral® is the preferred product for most indications.
  • Approved formulations include:
    • 10mg, 25mg, 50mg, and 100mg capsules;
    • 100mg in 1ml sugar free oral solution (oily).

 
   
Cytotoxic Drug Sirolimus
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Formulary
Amber
  • Approved for renal transplantation in children and adolescents in line with NICE.
 
   
Cytotoxic Drug Tacrolimus
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Formulary
Amber

Approved tacrolimus formulations include:

  • 500 microgram, 1mg & 5mg capsules (Prograf® & Adoport®).
  • 1mg in 1ml oral suspension (unlicensedunlicensed) - this replaces 0.5mg/ml oral
    suspension. 
  • 5mg in 1 ml concentrate for preparing IV infusion - approved for renal transplantation in children and adolescents in line with NICE.
  • 500microgram, 1mg, 3mg & 5mg MR capsules (Advagraf®) approved for use for prophylaxis of organ rejection in kidney and liver transplantation. Advagraf® is also approved for use in patients who are currently prescribed Prograf®, and de novo patients should be prescribed Adoport®.
  • 750microgram, 1 mg and 4 mg m/r tablets (Envarsus®)
    • approved for the treatment of renal and liver transplant patients who are suffering from neurotoxicity with other formulations or for patients requiring large doses of tacrolimus. 

 
   
Antithymocyte immunoglobulin (horse)  (Thymoglobuline®)
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Alternatives
Red
  • NETAG approved for aplastic anaemia in adults (unlicensedunlicensed).
 
   
Antithymocyte immunoglobulin (rabbit)  (Thymoglobuline®)
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Alternatives
Red
High Cost Medicine
  • Used in the management of transplant rejection.
 
   
Basiliximab
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Alternatives
Red
  • Approved for limited use in adult renal transplant patients with high risk of acute organ rejection.
  • Approved for severe graft versus host disease post haematopoietic stem cell transplantation.
  • Approved for induction therapy in renal transplantation in children and adolescents in with combinations that include ciclosporin in line with NICE.
 
Link  NICE TA85: Immunosuppressives in renal transplant (Adults)
Link  NICE TA99: Immunosuppressives in renal transplant (Children)
   
Cytotoxic Drug Ciclosporin (Sandimmun®)
(Capsules & SF Solution)
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Alternatives
Amber
  • Approved Sandimmun® formulations include:
    • 50mg in 1ml & 250mg in 5ml concentrate (oily) for IV infusion. Red Traffic Light
    • 25mg & 100mg capsules (unlicensedunlicensed). Amber Traffic Light
    • 100mg in 1ml sugar-free oral solution (oily). Amber Traffic Light

  • Note: original oral formulations Sandimmun® supplied on request for patients who cannot take Neoral®.
 
   
 ....
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
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Link to adult BNF
click to search medicines.org.uk
Link to children's BNF
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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
CCG
CCG

Traffic Light Status Information

Status Description

Red

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.   

Amber

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.  

Green plus

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.  

Green

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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