Anti-infective | |||||
---|---|---|---|---|---|
Anti-infective / Amoebic infection | |||||
mepacrine hydrochloride | Restricted | ||||
MEPACRINE HYDROCHLORIDE
This is Red in the Black Country IMOC formulary, i.e. for hospital prescribing only. |
|||||
metronidazole | Restricted | ||||
METRONIDAZOLE
Treatment of Rosacea and fungating wounds Oral use and gel are Green in the Black Country IMOC formulary and the IV form and suppositiries are Red |
|||||
Anti-infective / Bacterial infection | |||||
amikacin | Restricted | ||||
AMIKACIN
On microbiological advice for resistant infections. The IV form is Red in the Black Country IMOG formulary, i.e. for hospital prescribing only. This is commissioned by NHSE for or the treatment of Non-tuberculous mycobacterial pulmonary disease caused by Mycobacterium avium complex that is refractory to current treatment options and a Blueteq form must be completed before prescribing. Please contact the Pharmacy High-Cost Drugs team if any assistance is required. |
|||||
Solution for injection | |||||
Amikacin (Non-proprietary) | Restricted | ||||
Amikacin
On microbiological advice for resistant infections. The IV form is Red in the Black Country IMOG formulary, i.e. for hospital prescribing only. |
|||||
Nebuliser dispersion | |||||
Arikayce (Insmed Ltd) | Restricted | ||||
amoxicillin | On Formulary | ||||
Amoxicillin
The oral form is Green and the IV form is Red in the Black Country IMOG formulary, i.e. for hospital prescribing only. |
|||||
ampicillin | Off Formulary | ||||
azithromycin | Restricted | ||||
AZITHROMYCIN
|
|||||
Oral suspension | |||||
Zithromax (Pfizer Ltd) | Off Formulary | ||||
Powder for solution for infusion | |||||
Zedbac (Aspire Pharma Ltd) | Off Formulary | ||||
aztreonam | Restricted | ||||
Aztreonam
On Microbiology advice. The nebuliser solution is Red in the Black Country IMOC formulary, i.e. for hospital prescribing only. |
|||||
Powder for solution for injection | |||||
Azactam (Bristol-Myers Squibb Pharmaceuticals Ltd) | Off Formulary | ||||
Powder and solvent for nebuliser solution | |||||
Cayston (Gilead Sciences Ltd) | Off Formulary | ||||
benzathine benzylpenicillin | Restricted | ||||
Benzathine benzylpenicillin
On the advice of GUM medicine. This is Red in the Black Country IMOC formulary, i.e. for hospital prescribing only. |
|||||
benzylpenicillin sodium | On Formulary | ||||
Benzylpenicillin
The injectable form is Green for suspected meningitis in the the Black Country IMOC formulary |
|||||
cefaclor | Off Formulary | ||||
cefadroxil | Off Formulary | ||||
cefalexin | Restricted | ||||
cefazolin | Restricted | ||||
Cefazolin
This is Red in the Black Country IMOC formulary, i.e. for hospital prescribing only on Microbiology advice |
|||||
cefepime | Restricted | ||||
Cefepime
This is Red in the Black Country IMOC formulary, i.e. for hospital prescribing only on Microbiology advice |
|||||
cefiderocol | Restricted | ||||
Cefiderocol
Only in line with NICE guidance with documented Microbiology approval on Unity and where there is no other treatment available. This is Red in the Black Country IMOC formulary, i.e. for hospital prescribing only. A Blueteq application is required. This is commissioned by NHSE for treating severe drug-resistant Gram-negative bacterial infections and a Blueteq form must be completed before prescribing. Please contact the Pharmacy High-Cost Drugs team if any assistance is required. |
|||||
cefixime | Restricted | ||||
CEFIXIME
GUM – treatment of gonorrhoea according to BAASH guidelines. This is Red in the Black Country IMOC formulary, i.e. for hospital prescribing only. |
|||||
cefotaxime | Restricted | ||||
CEFOTAXIME
Pregnant women and paediatrics only, or on Microbiology advice. The injectable form is Red in the Black Country IMOC formulary, i.e. for hospital prescribing only. |
|||||
Powder for solution for injection | |||||
Cefotaxime (Non-proprietary) | Off Formulary | ||||
cefoxitin | Off Formulary | ||||
cefradine | Off Formulary | ||||
ceftaroline fosamil | Off Formulary | ||||
ceftazidime | Restricted | ||||
CEFTAZIDIME
This is Red in the Black Country IMOC formulary, i.e. for hospital prescribing only on Microbiology advice. This is Green under the OPAT scheme. |
|||||
Powder for solution for injection | |||||
Ceftazidime (Non-proprietary) | Off Formulary | ||||
Fortum (Sandoz Ltd) | Off Formulary | ||||
ceftazidime with avibactam | Restricted | ||||
Cetazidime with avobactam
Only in line with NICE guidance with documented Microbiology approval on Unity and where there is no other treatment available. This is Red in the Black Country IMOC formulary, i.e. for hospital prescribing only. This is commissioned by NHSE for for treating severe drug-resistant Gram-negative bacterial infections and a Blueteq form must be completed before prescribing. Please contact the Pharmacy High-Cost Drugs team if any assistance is required. |
|||||
ceftobiprole | Restricted | ||||
Ceftobiprole
For hospital use only with Microbiology advice documented on Unity. This is Red in the Black Country IMOC formulary, i.e. for hospital prescribing only. |
|||||
ceftolozane with tazobactam | Restricted | ||||
Ceftolazone
Only in line with NICE guidance with documented Microbiology approval on Unity and where there is no other treatment available. This is Red in the Black Country IMOC formulary, i.e. for hospital prescribing only. |
|||||
ceftriaxone | Restricted | ||||
CEFTRIAXONE
For meningitis, pelvic inflammatory disease, outpatient treatment of cellulitis, or on Microbiology advice only. In primary care this is Green in the Black Country IMOC fromulary for OPAT.
|
|||||
Powder for solution for injection | |||||
Ceftriaxone (Non-proprietary) | Off Formulary | ||||
cefuroxime | Restricted | ||||
CEFUROXIME
Injection: sub-conjunctival use only, in accordance with ophthalmology guidelines. For intra-cameral injections see Aprokam®. This is Red in the Black Country IMOC formulary, i.e. for hospital prescribing only. |
|||||
chloramphenicol | Restricted | ||||
CHLORAMPHENICOL
On microbiological advice only (injection only). The capsules are restricted to use for sepsis according to the PGD The ear drops are restricted to ENT consultants. This is Red in the Black Country IMOC formulary, i.e. for hospital prescribing only. |
|||||
Ear drops | |||||
Chloramphenicol (Non-proprietary) | Restricted | ||||
Eye drops | |||||
Chloramphenicol (Non-proprietary) | On Formulary | ||||
ciprofloxacin | Restricted | ||||
CIPROFLOXACIN
750mg tablets are not stocked. The IV form is Red in the Black Country IMOC formulary, i.e. for hospital prescribing only. |
|||||
Eye drops | |||||
Ciloxan (Novartis Pharmaceuticals UK Ltd) | Restricted | ||||
clarithromycin | On Formulary | ||||
Modified-release tablet | |||||
Xetinin XL (Morningside Healthcare Ltd) | Off Formulary | ||||
Powder for solution for infusion | |||||
Klaricid (Viatris UK Healthcare Ltd) | Off Formulary | ||||
clindamycin | On Formulary | ||||
CLINDAMYCIN
Clindamycin 300 mg capsules are expensive and non-formulary, and Black in the Black Country IMOC formulary. Please prescribe as 2 x 150 mg. |
|||||
Solution for injection | |||||
Dalacin C (Pfizer Ltd) | Off Formulary | ||||
co-amoxiclav | On Formulary | ||||
CO-AMOXICLAV
Co-amoxiclav injection is sensitive to light and temperature so it is important that the correct storage conditions are maintained. This is Red in the Black Country IMOC formulary, i.e. for hospital prescribing only. |
|||||
Oral suspension | |||||
Augmentin-Duo (GlaxoSmithKline UK Ltd) | Off Formulary | ||||
co-fluampicil | Off Formulary | ||||
co-trimoxazole | Restricted | ||||
CO-TRIMOXAZOLE
The IV form is Red in the Black Country IMOC formulary, i.e. for hospital prescribing only. |
|||||
colistimethate sodium | Restricted |
NICE TA276 |
|||
COLISTIMETHATE SODIUM
Cystic fibrosis otherwise on microbiological advice only. This is Red in the Black Country IMOC formulary, i.e. for hospital prescribing only. The IMOG will keep the status of the nebulised form under review. |
|||||
Powder for solution for injection | |||||
Colomycin (Teva UK Ltd) | Restricted | ||||
Powder for nebuliser solution | |||||
Promixin (Zambon UK Ltd) | Restricted | ||||
Colistimethate
This is commissioned by NHSE for cystic fibrosis only. This is Red in the Black Country IMOC formulary, i.e. for hospital prescribing only. |
|||||
dalbavancin | Restricted | ||||
Dalbavancin
For hospital use only with Microbiology advice documented on Unity. This is Red in the Black Country IMOC formulary, i.e. for hospital prescribing only. |
|||||
daptomycin | Restricted | ||||
DAPTOMYCIN
This is Red in the Black Country IMOC formulary, i.e. for hospital prescribing only
|
|||||
delafloxacin | Off Formulary | ||||
demeclocycline hydrochloride | Off Formulary | ||||
Demeclocycline
This is Red in the Black Country IMOC formulary, i.e. for hospital prescribing only in cases of hyponatraemia due to SIADH. It is Black for antimicrobial use. |
|||||
doxycycline | On Formulary | ||||
Dispersible tablet | |||||
Vibramycin-D (Pfizer Ltd) | Off Formulary | ||||
Modified-release capsule | |||||
Efracea (Galderma (UK) Ltd) | Off Formulary | ||||
ertapenem | Restricted | ||||
ERTAPENEM
On microbiology advice - primarily OPAT patients. It is AR for OPAT patients in the Black Country IMOG formulary, i.e. after specialist recommendation. |
|||||
erythromycin | Restricted | ||||
ERYTHROMYCIN
GP use and in cases where clarithromycin is contraindicated, e.g. pregnancy, breastfeeding |
|||||
Oral suspension | |||||
Erythromycin (Non-proprietary) | Restricted | ||||
Erythromycin Ethyl Succinate
GP use and in cases where clarithromycin is contraindicated, e.g. pregnancy, breastfeeding This is Green in the Black Country IMOG formulary. |
|||||
fidaxomicin | Restricted | ||||
Fidaxomicin
Restricted to use in line with:
|
|||||
flucloxacillin | On Formulary | ||||
Flucloxacillin
The IV form is Red in the Black Country IMOC formulary, i.e. for hospital prescribing only. |
|||||
fosfomycin | Restricted | ||||
FOSFOMYCIN
The IV form is Red in the Black Country IMOC formulary, i.e. for hospital prescribing only. |
|||||
fusidic acid | Restricted | ||||
FUSIDIC ACID
The cream and eye drops are Green in the Black Country IMOC formulary. |
|||||
FUSIDIC ACID
The IV form is Red in the Black Country IMOC formulary, i.e. for hospital prescribing only. |
|||||
gentamicin | On Formulary | ||||
GENTAMICIN
1.5% eye drops restricted for use in Corneal abscess only. The IV form is Red in the Black Country IMOC formulary, i.e. for hospital prescribing only. |
|||||
Solution for injection | |||||
Gentamicin (Non-proprietary) | On Formulary | ||||
Cidomycin (Advanz Pharma) | Off Formulary | ||||
imipenem with cilastatin | Restricted | ||||
IMIPENEM WITH CILASTATIN
This is Red in the Black Country IMOC formulary, i.e. for hospital prescribing only on Microbiology advice |
|||||
imipenem with cilastatin and relebactam | Restricted | ||||
Imipenem
Only in line with NICE guidance with documented Microbiology approval on Unity and where there is no other treatment available. This is Red in the Black Country IMOC formulary, i.e. for hospital prescribing only |
|||||
levofloxacin | Restricted | ||||
LEVOFLOXACIN
Escalation of antibiotic therapy for community acquired pneumonia during coronavirus pandemic; severe hospital acquired pneumonia; or as recommended by microbiology. The IV form is Red in the Black Country IMOC formulary, i.e. for hospital prescribing only. |
|||||
LEVOFLOXACIN
Consultant ophthalmologists in patients undergoing intravitreal injections who are allergic to chloramphenicol and allergic to/intolerant of preservatives
|
|||||
Eye drops | |||||
Oftaquix (Santen UK Ltd) | Restricted | ||||
linezolid | Restricted | ||||
LINEZOLID
This is Red in the Black Country IMOC formulary, i.e. for hospital prescribing only on Microbiology advice. |
|||||
lymecycline | Off Formulary | ||||
meropenem | Restricted | ||||
MEROPENEM
This is Red in the Black Country IMOC formulary, i.e. for hospital prescribing only on Microbiology advice. |
|||||
Powder for solution for injection | |||||
Meropenem (Non-proprietary) | Restricted | ||||
meropenem with vaborbactam | Restricted | ||||
Meropenem with vaborbactam
Only in line with NICE guidance with documented Microbiology approval on Unity and where there is no other treatment available. This is Red in the Black Country IMOC formulary, i.e. for hospital prescribing only. |
|||||
metronidazole | Restricted | ||||
METRONIDAZOLE
Treatment of Rosacea and fungating wounds Oral use and gel are Green in the Black Country IMOC formulary and the IV form and suppositiries are Red |
|||||
minocycline | Off Formulary | ||||
MINOCYCLINE
For pyoderma gangrenosum otherwise non-formulary. This is Black in the Black Country IMOG formulary. |
|||||
moxifloxacin | Restricted | ||||
MOXIFLOXACIN
For multi-resistant TB including patients on ITU. This is Red in the Black Country IMOC formulary, i.e. for hospital prescribing only on Microbiology advice
|
|||||
neomycin sulfate | On Formulary | ||||
NEOMYCIN SULPHATE
The oral form is Black in the Black Country IMOV formulary and the cream is Red, i.e. for hospital prescribing only on Microbiology advice |
|||||
ofloxacin | Off Formulary | ||||
OFLOXACIN
Not be used for the treatment of bacterial conjunctivitis. The oral and IV forms are Red in the Black Country IMOC formulary, i.e. for hospital prescribing only on Microbiology or GUM advice |
|||||
Eye drops | |||||
Exocin (AbbVie Ltd) | Restricted | ||||
oritavancin | Restricted | ||||
Oritavancin
Only in line with NICE guidance with documented Microbiology approval on Unity and where there is no other treatment available. This is Black in the Black Country IMOC formulary. |
|||||
oxytetracycline | On Formulary | ||||
phenoxymethylpenicillin | On Formulary | ||||
piperacillin with tazobactam | Restricted | ||||
PIPERACILLIN WITH TAZOBACTAM
The generic product will be supplied. Neutropenic sepsis, treatment of hospital-acquired pneumonia as per protocol, otherwise with microbiological advice only.
This is Red in the Black Country IMOC formulary, i.e. for hospital prescribing only.
|
|||||
pivmecillinam hydrochloride | On Formulary | ||||
rifabutin | Restricted | ||||
RIFABUTIN
Tuberculosis. The oral form is Red in the Black Country IMOC formulary, i.e. for hospital prescribing only. |
|||||
rifaximin | Restricted |
NICE TA337 |
|||
RIFAXIMIN
For patients who meet the NICE criteria Rifaximin is AI in the Black Country formulary, i.e. for prescribing in primary care following specialist initiation. Because of the cost an information sheet is being developed by the IMOG. |
|||||
streptomycin | Restricted | ||||
STREPTOMYCIN
The injectable form is Red in the Black Country IMOC formulary, i.e. for hospital prescribing only. |
|||||
sulfadiazine | Restricted | ||||
SULFADIAZINE
The oral form is Red in the Black Country IMOC formulary, i.e. for hospital prescribing only on Microbiology advice |
|||||
tedizolid | Restricted | ||||
Tedizolid
Not stocked in the Trust. This is Red in the Black Country IMOC formulary, i.e. for hospital prescribing only. |
|||||
teicoplanin | Restricted | ||||
TEICOPLANIN
This is Red in the Black Country IMOC formulary, i.e. for hospital prescribing only on Microbiology advice |
|||||
Powder and solvent for solution for injection | |||||
Targocid (Sanofi) | Off Formulary | ||||
temocillin | Restricted | ||||
Temocillin
This is Red in the Black Country IMOC formulary, i.e. for hospital prescribing only. |
|||||
tetracycline | Restricted | ||||
tigecycline | Restricted | ||||
Tigecycline
Not routinely stocked in the Trust. This is Red in the Black Country IMOC formulary, i.e. for hospital prescribing only. |
|||||
tobramycin | Restricted |
NICE TA276 |
|||
TOBRAMYCIN
Cystic fibrosis. This is Red in the Black Country IMOC formulary, i.e. for hospital prescribing only.
|
|||||
trimethoprim | On Formulary | ||||
Trimethoprim
The IV form is Red in the Black Country IMOC formulary, i.e. for hospital prescribing only. |
|||||
vancomycin | On Formulary | ||||
VANCOMYCIN
Injection only. Injection may be used orally. Thie IV form is Red in the Black Country IMOC formulary, i.e. for hospital prescribing only. The oral form is Green. |
|||||
Anti-infective / Leprosy | |||||
clofazimine | Off Formulary | ||||
CLOFAZIMINE
For tuberculosis oir after Microbiology advice this is Red in the Black Country IMOC formulary, i.e. for hospital prescribing only. |
|||||
dapsone | Restricted | ||||
DAPSONE
Skin and GUM consultants, and for second-line prophylaxis of Pneumocystis jiroveci pneumonia. This is Red in the Black Country IMOC formulary, i.e. for hospital prescribing only on Microbiology advice. |
|||||
rifampicin | On Formulary | ||||
Rifampicin
Tuberculosis. This is Red in the Black Country IMOC formulary, i.e. for hospital prescribing only. |
|||||
Anti-infective / Tuberculosis | |||||
aminosalicylic acid | Restricted | ||||
Aminosalicylic acid
For hospital use only with Microbiology advice. The IV form is Red in the Black Country IMOG formulary, i.e. for hospital prescribing only. |
|||||
bedaquiline | Restricted | ||||
Bedaquiline
This is Red in the Black Country IMOC formulary, i.e. for hospital prescribing only, with Microbiology advice. This is commissioned by NHSE for MDR-TB and XDT-TB and a Blueteq form must be completed before prescribing. Please contact the Pharmacy High-Cost Drugs team if any assistance is required. |
|||||
cycloserine | Restricted | ||||
CYCLOSERINE
For hospital use only with Microbiology advice. This is Red in the Black Country IMOC formulary, i.e. for hospital prescribing only. |
|||||
delamanid | Restricted | ||||
Delamanid
This is Red in the Black Country IMOC formulary, i.e. for hospital prescribing only on Microbiology advice. This is commssioned by NHSE for the indications below and a Blueteq form must be completed before prescribing. Please contact the Pharmacy High-Cost Drugs team if any assistance is required. Any other use is non-formulary and the non-formulary request process should be followed. MDR-TB and XDR-TB |
|||||
ethambutol hydrochloride | On Formulary | ||||
ETHAMBUTOL HYDROCHLORIDE
Ethambutol suspension restricted to consultant paediatricians for use in patients who cannot take the tablets. This is Red in the Black Country IMOC formulary, i.e. for hospital prescribing only. |
|||||
isoniazid | On Formulary | ||||
Isoniazid
This is Red in the Black Country IMOC formulary, i.e. for hospital prescribing only. |
|||||
pyrazinamide | Restricted | ||||
rifabutin | Restricted | ||||
RIFABUTIN
Tuberculosis. The oral form is Red in the Black Country IMOC formulary, i.e. for hospital prescribing only. |
|||||
rifampicin | On Formulary | ||||
Rifampicin
Tuberculosis. This is Red in the Black Country IMOC formulary, i.e. for hospital prescribing only. |
|||||
rifampicin with ethambutol, isoniazid and pyrazinamide | Restricted | ||||
Voractiv
Consultants only. This is Red in the Black Country IMOC formulary, i.e. for hospital prescribing only on Microbiology advice |
|||||
rifampicin with isoniazid | On Formulary | ||||
Rifampicin with isoniazid
This is Red in the Black Country IMOC formulary, i.e. for hospital prescribing only. |
|||||
rifampicin with isoniazid and pyrazinamide | Restricted | ||||
streptomycin | Restricted | ||||
STREPTOMYCIN
The injectable form is Red in the Black Country IMOC formulary, i.e. for hospital prescribing only. |
|||||
Anti-infective / Urinary tract infections | |||||
estradiol | On Formulary | ||||
methenamine hippurate | Restricted | ||||
Methenamine
This is Red in the Black Country IMOC formulary, i.e.for hospital prescribing only. |
|||||
nitrofurantoin | On Formulary | ||||
Anti-infective / Fungal infection | |||||
amphotericin B | Restricted | ||||
AMPHOTERICIN
Lipid formulations on microbiological advice only. Non-lipid only for Eye Theatre for intravitreal use only This is Red in the Black Country IMOC formulary, i.e. for hospital prescribing only on Microbiology advice |
|||||
anidulafungin | Restricted | ||||
ANIDULAFUNGIN
First-line. This is Red in the Black Country IMOC formulary, i.e. for hospital prescribing only on Microbiology advice |
|||||
caspofungin | Restricted | ||||
CASPOFUNGIN
Treatment of febrile neutropenia unless evidence of aspergillosis in which case use voriconazole. This is Red in the Black Country IMOC formulary, i.e. for hospital prescribing only. |
|||||
fluconazole | On Formulary | ||||
Fluconazole
The IV form is Red in the Black Country IMOC formulary, i.e. for hospital prescribing only. |
|||||
Solution for infusion | |||||
Fluconazole (Non-proprietary) | Restricted | ||||
Fluconazole
This is Red in the Black Country IMOC formulary, i.e. for hospital prescribing only. |
|||||
flucytosine | Restricted | ||||
FLUCYTOSINE
Not regularly stocked in the Trust. This is Red in the Black Country IMOC formulary, i.e. for hospital prescribing only. |
|||||
griseofulvin | Restricted | ||||
GRISEOFULVIN
Dermatological infection where topical treatment has failed. The liquid formulations are very expensive and should not be prescribed on an FP10. The cream is AI in the Black Country IMOC formulary, i.e. can be prescribed in primary care after specialist initiation. |
|||||
isavuconazole | Restricted | ||||
Isavuconazole
Not regularly stocked in the Trust. This is Red in the Black Country IMOC formulary, i.e. for hospital prescribing only. |
|||||
itraconazole | Restricted | ||||
micafungin | Restricted | ||||
MICAFUNGIN
Second-line. This is Red in the Black Country IMOC formulary, i.e. for hospital prescribing only on Microbiology advice |
|||||
nystatin | On Formulary | ||||
posaconazole | Restricted | ||||
POSACONAZOLE
Not regularly stocked in the Trust. This is Red in the Black Country IMOC formulary, i.e. for hospital prescribing only on Microbiology advice |
|||||
voriconazole | Restricted | ||||
VORICONAZOLE
This is Red in the Black Country IMOC formulary, i.e. for hospital prescribing only on Microbiology advice for resistant invasive fungal infections. |
|||||
Anti-infective / Pneumocystis pneumonia | |||||
atovaquone | Restricted | ||||
Atovaquone
Not regularly stocked in the Trust. This is Red in the Black Country IMOC formulary, i.e. for hospital prescribing only. |
|||||
Oral suspension | |||||
Wellvone (GlaxoSmithKline UK Ltd) | Off Formulary | ||||
co-trimoxazole | Restricted | ||||
CO-TRIMOXAZOLE
The IV form is Red in the Black Country IMOC formulary, i.e. for hospital prescribing only. |
|||||
dapsone | Restricted | ||||
DAPSONE
Skin and GUM consultants, and for second-line prophylaxis of Pneumocystis jiroveci pneumonia. This is Red in the Black Country IMOC formulary, i.e. for hospital prescribing only on Microbiology advice. |
|||||
pentamidine isetionate | Restricted | ||||
PENTAMIDINE ISETIONATE
Second line for patients with PCP after treatment with co-trimoxazole has failed. This is Red in the Black Country IMOC formulary, i.e. for hospital prescribing only. |
|||||
Powder for solution for injection | |||||
Pentacarinat (Sanofi) | Off Formulary | ||||
Anti-infective / Helminth infection | |||||
albendazole | Restricted | ||||
Albendazole
Not regularly stocked in the Trust. This is Red in the Black Country IMOC formulary, i.e. for hospital prescribing only. |
|||||
diethylcarbamazine | Restricted | ||||
Diethylcarbamazine
Not regularly stocked in the Trust. This is Red in the Black Country IMOC formulary, i.e. for hospital prescribing only. |
|||||
ivermectin | Restricted | ||||
Ivermectin
Not regularly stocked in the Trust. This is Red in the Black Country IMOC formulary, i.e. for hospital prescribing only. |
|||||
levamisole | Restricted | ||||
Levamisole
Not regularly stocked in the Trust. This is Red in the Black Country IMOC formulary, i.e. for hospital prescribing only. |
|||||
mebendazole | On Formulary | ||||
praziquantel | Restricted | ||||
Praziquantel
Not regularly stocked in the Trust. This is Red in the Black Country IMOC formulary, i.e. for hospital prescribing only. |
|||||
Anti-infective / Coronavirus | |||||
molnupiravir | Restricted | ||||
Molnupiravir
A Blueteq form should be completed before prescribing. This is Red in the Black Country IMOC formulary, i.e. for hospital prescribing only. |
|||||
nirmatrelvir with ritonavir | Restricted |
NICE TA878 |
|||
Nirmatrelvir with ritonavir
For hospital use only. This is commissioned by NHSE for Covid-19 and a Blueteq form must be completed before prescribing. Please contact the Pharmacy High-Cost Drugs team if any assistance is required. This is Red in the Black Country IMOC formulary, i.e. for hospital prescribing only. |
|||||
remdesivir | Restricted | ||||
Remdesivir
A non-formulary request should be completed as well as Blueteq before treatment starts. March 2023 - supplies of remdesivir are severely limited and the Trust may not be able to obtain any more. Draft NICE guidance on treatments for Covid has been published and is likely to be approved by the end of the month. This is Red in the Black Country IMOC formulary, i.e. for hospital prescribing only. |
|||||
sotrovimab | Restricted |
NICE TA878 |
|||
Sotrovimab
This is Red in the Black Country IMOG formulary, i.e. for hospital prescribing only. A Blueteq form should be completed before prescribing. |
|||||
tocilizumab | Restricted |
NICE TA375 NICE TA247 NICE TA518 NICE TA878 |
|||
Anti-infective / HIV infection | |||||
abacavir | Restricted | ||||
abacavir with dolutegravir and lamivudine | Off Formulary | ||||
abacavir with lamivudine | Restricted | ||||
Lamivudine combinations
This is Red in the Black Country IMOC formulary, i.e. for hospital prescribing only. |
|||||
abacavir with lamivudine and zidovudine | Off Formulary | ||||
atazanavir | Restricted | ||||
Atazanavir
This is Red in the Black Country IMOC formulary, i.e. for hospital prescribing only. |
|||||
atazanavir with cobicistat | Restricted | ||||
Evotaz
This is not routinely commissioned by NHSE. If required for a particular patient please complete the Blueteq form. This is Red in the Black Country IMOC formulary, i.e. for hospital prescribing only. |
|||||
bictegravir with emtricitabine and tenofovir alafenamide | Restricted | ||||
Bictegravir
This is Red in the Black Country IMOC formulary, i.e. for hospital prescribing only. |
|||||
cabotegravir | Restricted |
NICE TA757 |
|||
Cabotegravir
This is Red in the Black Country IMOC formulary, i.e. for hospital prescribing only. This is not routinely commissioned by NHSE and a Blueteq form must be completed before prescribing. Please contact the Pharmacy High-Cost Drugs team if any assistance is required. |
|||||
Prolonged-release suspension for injection | |||||
Vocabria (ViiV Healthcare UK Ltd) | Restricted | ||||
Vocabria
This is Red in the Black Country IMOC formulary, i.e. for hospital prescribing only. An IFR via a Blueteq form must be completed before prescribing. Please contact the Pharmacy High-Cost Drugs team if any assistance is required. |
|||||
cobicistat | Restricted | ||||
darunavir | Restricted | ||||
DARUNAVIR
This is Red in the Black Country IMOC formulary, i.e. for hospital prescribing only. |
|||||
Oral suspension | |||||
Prezista (Janssen-Cilag Ltd) | Off Formulary | ||||
darunavir with cobicistat | Restricted | ||||
Rezolsta
This is not routinely commissioned by NHSE. If required for a particular patient please complete the Blueteq form before prescribing. Please contact the Pharmacy High-Cost Drugs team if any assistance is required. This is Red in the Black Country IMOC formulary, i.e. for hospital prescribing only. |
|||||
darunavir with cobicistat, emtricitabine and tenofovir alafenamide | Restricted | ||||
Symtuza
This is not routinely commissioned by NHSE. If required for a particular patient please complete the Blueteq form. This is Red in the Black Country IMOC formulary, i.e. for hospital prescribing only. |
|||||
dolutegravir | Restricted | ||||
DOLUTEGRAVIR
This is Red in the Black Country IMOC formulary, i.e. for hospital prescribing only. |
|||||
dolutegravir with rilpivirine | Restricted | ||||
Dolutegravir with rilpivirine
This is Red in the Black Country IMOC formulary, i.e. for hospital prescribing only. |
|||||
doravirine | Restricted | ||||
efavirenz | Restricted | ||||
EFAVIRENZ
This is Red in the Black Country IMOG formulary, i.e. for hospital prescribing only. |
|||||
efavirenz with emtricitabine and tenofovir disoproxil | Restricted | ||||
Atripla
This is Red in the Black Country IMOC formulary, i.e. for hospital prescribing only. |
|||||
elvitegravir with cobicistat, emtricitabine and tenofovir alafenamide | Restricted | ||||
Tenofovir alafenamide combinations
This is Red in the Black Country IMOC formulary, i.e. for hospital prescribing only. |
|||||
elvitegravir with cobicistat, emtricitabine and tenofovir disoproxil | Restricted | ||||
Elvitegravir combinations
This is Red in the Black Country IMOC formulary, i.e. for hospital prescribing only. |
|||||
emtricitabine | Restricted | ||||
emtricitabine with rilpivirine and tenofovir alafenamide | Restricted | ||||
emtricitabine with rilpivirine and tenofovir disoproxil | Restricted | ||||
Emtricitabine combinations
This is not routinely commissioned by NHSE. If required for a particular patient please complete the Blueteq form. This is Red in the Black Country IMOC formulary, i.e. for hospital prescribing only. |
|||||
emtricitabine with tenofovir alafenamide | Restricted | ||||
Tenofovir alafenamide combinations
This is Red in the Black Country IMOC formulary, i.e. for hospital prescribing only.
An IFR via a Blueteq form for use in pre-exposure prophylaxis (PrEP) must be completed before prescribing. Please contact the Pharmacy High-Cost Drugs team if any assistance is required. |
|||||
emtricitabine with tenofovir disoproxil | Restricted | ||||
Emtricitabine combinations
This is Red in the Black Country IMOC formulary, i.e. for hospital prescribing only. |
|||||
enfuvirtide | Restricted | ||||
Enfuvirtide
This is commissioned by NHSE and is Red in the Black Country IMOC formulary, i.e. for hospital prescribing only. |
|||||
etravirine | Restricted | ||||
ETRAVIRINE
This is Red in the Black Country IMOC formulary, i.e. for hospital prescribing only. |
|||||
fosamprenavir | Restricted | ||||
Fosamprenavir
This is Red in the Black Country IMOC formulary, i.e. for hospital prescribing only. An IFR via a Blueteq form must be completed before prescribing for MDR HIV1 infection. Please contact the Pharmacy High-Cost Drugs team if any assistance is required. |
|||||
fostemsavir | Off Formulary | ||||
Fostemsavir
This is not routinely commissioned by NHSE. If required for a particular patient please complete the Blueteq form before prescribing. Please contact the Pharmacy High-Cost Drugs team if any assistance is required. |
|||||
lamivudine | Restricted | ||||
LAMIVUDINE
This is Red in the Black Country IMOC formulary, i.e. for hospital prescribing only. |
|||||
lamivudine with dolutegravir | Restricted | ||||
Lamivudine combinations
This is Red in the Black Country IMOC formulary, i.e. for hospital prescribing only. |
|||||
lamivudine with tenofovir disoproxil and doravirine | Restricted | ||||
Lamivudine combinations
This is Red in the Black Country IMOC formulary, i.e. for hospital prescribing only. |
|||||
lopinavir with ritonavir | Restricted | ||||
maraviroc | Restricted | ||||
MARAVIROC
This is Red in the Black Country IMOC formulary, i.e. for hospital prescribing only. |
|||||
nevirapine | Restricted | ||||
NEVIRAPINE
This is Red in the Black Country IMOC formulary, i.e. for hospital prescribing only. |
|||||
raltegravir | Restricted | ||||
RALTEGRAVIR
This is Red in the Black Country IMOC formulary, i.e. for hospital prescribing only. |
|||||
rilpivirine | Restricted |
NICE TA757 |
|||
Rilpivirine
This is Red in the Black Country IMOC formulary, i.e. for hospital prescribing only. |
|||||
Prolonged-release suspension for injection | |||||
Rekambys (ViiV Healthcare UK Ltd) | Restricted | ||||
Rekambys
This is Red in the Black Country IMOC formulary, i.e. for hospital prescribing only. An IFR via a Blueteq form must be completed before prescribing. Please contact the Pharmacy High-Cost Drugs team if any assistance is required. |
|||||
ritonavir | Restricted | ||||
Ritonavir
This is Red in the Black Country IMOC formulary, i.e. for hospital prescribing only. |
|||||
tenofovir disoproxil | Restricted |
NICE TA173 |
|||
zidovudine | Restricted | ||||
ZIDOVUDINE
This is Red in the Black Country IMOC formulary, i.e. for hospital prescribing only. |
|||||
Oral solution | |||||
Retrovir (ViiV Healthcare UK Ltd) | Off Formulary | ||||
Retrovir
This is Red in the Black Country IMOC formulary, i.e. for hospital prescribing only. |
|||||
Solution for infusion | |||||
Retrovir (ViiV Healthcare UK Ltd) | Restricted | ||||
Retrovir
This is Red in the Black Country IMOC formulary, i.e. for hospital prescribing only. |
|||||
zidovudine with lamivudine | Restricted | ||||
Zidovudine with lamivudine
This is Red in the Black Country IMOC formulary, i.e. for hospital prescribing only. |
|||||
Anti-infective / Respiratory syncytial virus | |||||
palivizumab | Restricted | ||||
Palivizumab
This is Red in the Black Country IMOC formulary, i.e. for hospital prescribing only. This is commissioned by NHSE to reduce the risk of respiratory syncytial virus (RSV) in infantsand a Blueteq form must be completed before prescribing. Please contact the Pharmacy High-Cost Drugs team if any assistance is required. |
|||||
ribavirin | Restricted |
NICE TA200 NICE TA300 |
|||
RIBAVIRIN
Paediatrics and treatment in accordance with NICE guidelines and criteria. This is Red in the Black Country IMOC formulary, i.e. for hospital prescribing only. |
|||||
Anti-infective / Influenza | |||||
amantadine hydrochloride | Restricted |
NICE TA158 NICE TA168 |
|||
Amantadine
Not regularly stocked in the Trust. This is Red in the Black Country IMOC formulary, i.e. for hospital prescribing only. |
|||||
baloxavir marboxil | Restricted | ||||
Baloxavir marboxil
Not regularly stocked in the Trust. This is Red in the Black Country IMOC formulary, i.e. for hospital prescribing only. |
|||||
oseltamivir | Restricted |
NICE TA158 NICE TA168 |
|||
OSELTAMIVIR
This is Green in the Black Country IMOC fomulary only during Flu season and on authorisation by NHS England/Department of Health & Social Care or via commissioned service for out of season supply |
|||||
zanamivir | Restricted |
NICE TA158 NICE TA168 |
|||
ZANAMIVIR
Oseltamivir is the preferred treatment in accordance with the NICE guidelines and criteria, except for pregnant women suspected of having influenza A H1N1 (swine flu). |
|||||
Anti-infective / Herpesvirus infections | |||||
aciclovir | On Formulary | ||||
Aciclovir
Thie IV form is Red in the Black Country IMOC formulary, i.e. for hospital prescribing only. |
|||||
famciclovir | Restricted | ||||
FAMCICLOVIR
Second line for shingles |
|||||
inosine pranobex | Restricted | ||||
Inosine pranobex
Not regulary stocked in the Trust. This is Red in the Black Country IMOC formulary, i.e. for hospital prescribing only. |
|||||
valaciclovir | Restricted | ||||
VALACICLOVIR
GUM, treatment of acute retinal necrosis by Uveitis Consultants only. This is Green in the Black Country IMOC formulary for the second-line treatment of shingles. |
|||||
Anti-infective / Cytomegalovirus infections | |||||
cidofovir | Restricted | ||||
Cidofovir
Not regularly stocked in the Trust. This is Red in the Black Country IMOC formulary, i.e. for hospital prescribing only. |
|||||
foscarnet sodium | Restricted | ||||
FOSCARNET SODIUM
Treatment of CMV and acute retinal necrosis of viral aetiology by Consultant Ophthalmologits. This is Red in the Black Country IMOC formulary, i.e. for hospital prescribing only. |
|||||
Solution for infusion | |||||
Foscavir (Clinigen Healthcare Ltd) | Off Formulary | ||||
ganciclovir | Restricted | ||||
GANCICLOVIR
Ophthalmology - Second line agent for patients non-responsive to or intolerant of aciclovir Or on Microbiology advice only. This is Red in the Black Country IMOC formulary, i.e. for hospital prescribing only. |
|||||
Eye gel | |||||
Virgan (Thea Pharmaceuticals Ltd) | Restricted | ||||
letermovir | Restricted |
NICE TA591 |
|||
Letermovir
Not regularly stocked in the Trust. This is Red in the Black Country IMOC formulary, i.e. for hospital prescribing only. This is commssioned by NHSE for the indications below and a Blueteq form must be completed before prescribing. Please contact the Pharmacy High-Cost Drugs team if any assistance is required. Preventing cytomegalovirus disease after a stem cell transplant in children |
|||||
valganciclovir | Restricted | ||||
VALGANCICLOVIR
GUM consultants, otherwise named patient. This is Red in the Black Country IMOC formulary, i.e. for hospital prescribing only. |
|||||
Anti-infective / Chronic hepatitis B | |||||
adefovir dipivoxil | Restricted | ||||
ADEFOVIR DIPIVOXIL
Treatment in accordance with NICE guidelines and criteria. This is Red in the Black Country IMOC formulary, i.e. for hospital prescribing only. |
|||||
entecavir | Restricted |
NICE TA153 |
|||
ENTECAVIR
Treatment as advised by Consultant Gastroenterologists in accordance with NICE guidelines and criteria. This is Red in the Black Country IMOC formulary, i.e. for hospital prescribing only. |
|||||
lamivudine | Restricted | ||||
LAMIVUDINE
This is Red in the Black Country IMOC formulary, i.e. for hospital prescribing only. |
|||||
peginterferon alfa | Restricted |
NICE TA200 |
|||
PEGINTERFERON ALFA
Treatment in accordance with NICE guidelines and criteria. This is Red in the Black Country IMOC formulary, i.e. for hospital prescribing only. |
|||||
tenofovir alafenamide | Restricted | ||||
Tenofovir alafenamide
This is Red in the Black Country IMOC formulary, i.e. for hospital prescribing only. This is indicated for hepatitis B only. This is commissioned by NHSE for HIV and a Blueteq form must be completed before prescribing. |
|||||
tenofovir disoproxil | Restricted |
NICE TA173 |
|||
Anti-infective / Chronic hepatitis C | |||||
elbasvir with grazoprevir | Restricted |
NICE TA413 |
|||
Elbasvir with grazoprevir
This is commissioned by NHSE 1. plus or minus ribavirin for the treatment of genotype 1a /1b and 4 hepatitis C virus (HCV), or 2. (12 weeks) for the treatment of genotype 1b acute / chronic hepatitis C, or 3. for the treatment of genotype 1 and 4 acute / chronic hepatitis C, or 4. for the treatment of genotype 1(not 1b) and 4 chronic hepatitis C in children, or 5. (12 weeks) for the treatment of genotype 1b chronic hepatitis C in children and a Blueteq form must be completed before prescribing. Please contact the Pharmacy High-Cost Drugs team if any assistance is required. This is Red in the Black Country IMOG formulary, i.e. for hospital prescribing only. |
|||||
glecaprevir with pibrentasvir | Restricted |
NICE TA499 |
|||
Glecaprevir with pibrentasvir
This is commissioned by NHSE 1. (8 weeks) for the treatment of genotypes 2,5 and 6 acute / chronic hepatitis C without cirrhosis, or 2. (16 weeks) for the treatment of genotype 3 acute / chronic hepatitis C with compensated cirrhosis, or 3. (8 weeks) for the treatment of genotype 3 acute / chronic hepatitis C without cirrhosis, or 4. (16 weeks) for the treatment of genotype 3 acute / chronic hepatitis C without cirrhosis, or 5. (8 weeks) for the treatment of genotype 1 and 4 acute / chronic hepatitis C without cirrhosis, or 6. (8 weeks) for the treatment of acute / chronic hepatitis C in adults with an unknown genotype without cirrhosis, or 7. for the treatment of genotypes 1, 2, 3, 4, 5 and 6 acute / chronic hepatitis C with compensated cirrhosis. or 8. (8 weeks) for the treatment of chronic hepatitis C in adults with an unknown genotype with compensated cirrhosis, or 9. (8 weeks) for the treatment of genotype 3 chronic hepatitis C without cirrhosis in children. or 10. (16 weeks) for the treatment of genotype 3 chronic hepatitis C with compensated cirrhosis in children, or 11. (16 weeks) for the treatment of genotype 3 chronic hepatitis C without cirrhosis in children, or 12. (8 weeks) for the treatment of genotypes 2, 5 and 6 chronic hepatitis C without cirrhosis in children, or 13. (8 weeks) for the treatment of genotype 1 and 4 chronic hepatitis C without cirrhosis in children, or 14. for the treatment of genotypes 1, 2, 4, 5 and 6 chronic hepatitis C with compensated cirrhosis in children and a Blueteq form must be completed before prescribing. Please contact the Pharmacy High-Cost Drugs team if any assistance is required. This is Red in the Black Country IMOC formulary, i.e. for hospital prescribing only. |
|||||
ledipasvir with sofosbuvir | Nice-approved drug |
NICE TA363 |
|||
SOFOSBUVIR WITH LEDIPASVIR
This is Red in the Black Country IMOC formulary, i.e. for hospital prescribing only. This is commissioned by NHSE 1. for the treatment of chronic hepatitis C in patients with decompensated cirrhosis, or 2. (8 weeks) for previously IFN untreated genotype 1 acute / chronic hepatitis C without cirrhosis, or 3. (12 weeks) for previously IFN treated genotype 1 and 4 acute / chronic hepatitis C without cirrhosis, or 4. (12 weeks) for the treatment of genotype 1 and 4 acute / chronic hepatitis C with compensated cirrhosis, or 5. (12 weeks) for previously IFN untreated genotype 4 acute / chronic hepatitis C without cirrhosis, or 6. for the treatment of acute / chronic hepatitis C in patients with decompensated cirrhosis, or 7. (8 weeks) for previously untreated chronic hepatitis C without cirrhosis in children, or 8. (12 weeks) for previously untreated genotype 4 chronic hepatitis C without cirrhosis in children, or 9. (12 weeks) for previously treated genotype 1 and 4 chronic hepatitis C without cirrhosis in children, or 10. (12 weeks) for the treatment of genotype 1 and 4 chronic hepatitis C with compensated cirrhosis in children and a Blueteq form must be completed before prescribing. Please contact the Pharmacy High-Cost Drugs team if any assistance is required |
|||||
peginterferon alfa | Restricted |
NICE TA200 |
|||
PEGINTERFERON ALFA
Treatment in accordance with NICE guidelines and criteria. This is Red in the Black Country IMOC formulary, i.e. for hospital prescribing only. |
|||||
ribavirin | Restricted |
NICE TA200 NICE TA300 |
|||
RIBAVIRIN
Paediatrics and treatment in accordance with NICE guidelines and criteria. This is Red in the Black Country IMOC formulary, i.e. for hospital prescribing only. |
|||||
sofosbuvir | Nice-approved drug |
NICE TA330 NICE TA330 |
|||
SOFOSBUVIR
Please gain Blueteq approval prior to prescribing |
|||||
sofosbuvir with velpatasvir | Restricted |
NICE TA430 |
|||
Sofosbuvir with velpatasvir
This is Red in the Black Country IMOG formulary, i.e. for hospital prescribing only. This is commissioned by NHSE 1. for the treatment of genotype 3 hepatitis C virus (HCV), or 2. (12 weeks) for the retreatment of genotype 1, 2, 3, 4, 5 and 6 chronic hepatitis C, or 3. (12 weeks) for the treatment of genotype 1, 2, 3, 4, 5 and 6 acute / chronic hepatitis C in adults, or 4. (12 weeks) for the treatment of chronic hepatitis C in adults with an unknown genotype, or 5. (24 weeks) for the retreatment of chronic hepatitis C in adults with advanced or decompensated cirrhosis, or 6. (12 weeks) for the treatment of genotype 1, 2, 3, 4, 5 and 6 chronic hepatitis C in children and a Blueteq form must be completed before prescribing. Please contact the Pharmacy High-Cost Drugs team if any assistance is required.
|
|||||
sofosbuvir with velpatasvir and voxilaprevir | Restricted |
NICE TA507 |
|||
Sofosbuvir with velpatasvir and voxilaprevir
This is Red in the Black Country IMOG formulary, i.e. for hospital prescribing only. This is commissioned by NHSE 1. for the treatment of genotype 3 hepatitis C virus, or 2. (12 weeks) for the retreatment of genotype 1, 2, 3, 4, 5 and 6 chronic hepatitis C, or 3. (12 weeks) for the treatment of genotype 1, 2, 3, 4, 5 and 6 acute / chronic hepatitis C in adults, or 4. (12 weeks) for the treatment of chronic hepatitis C in adults with an unknown genotype, or 5. (24 weeks) for the retreatment of chronic hepatitis C in adults with advanced or decompensated cirrhosis, or 6. (12 weeks) for the treatment of genotype 1, 2, 3, 4, 5 and 6 chronic hepatitis C in children and a Blueteq form must be completed before prescribing. Please contact the Pharmacy High-Cost Drugs team if any assistance is required |
|||||
Anti-infective / Leishmaniasis | |||||
amphotericin B | Restricted | ||||
AMPHOTERICIN
Lipid formulations on microbiological advice only. Non-lipid only for Eye Theatre for intravitreal use only This is Red in the Black Country IMOC formulary, i.e. for hospital prescribing only on Microbiology advice |
|||||
pentamidine isetionate | Restricted | ||||
PENTAMIDINE ISETIONATE
Second line for patients with PCP after treatment with co-trimoxazole has failed. This is Red in the Black Country IMOC formulary, i.e. for hospital prescribing only. |
|||||
Powder for solution for injection | |||||
Pentacarinat (Sanofi) | Off Formulary | ||||
Anti-infective / Malaria | |||||
artemether with lumefantrine | Restricted | ||||
ARTEMETHER WITH LUMEFANTRINE
In accordance with malaria policy. This is Red in the Black Country IMOC formulary, i.e. for hospital prescribing only. |
|||||
artenimol with piperaquine phosphate | Off Formulary | ||||
atovaquone with proguanil hydrochloride | Restricted | ||||
PROGUANIL HYDROCHLORIDE WITH ATOVAQUONE
On microbiological advice only. This is Black in the Black Country IMOC formulary for prophylaxis, but can be supplied on a private prescription. |
|||||
chloroquine | On Formulary | ||||
Chloroquine
For malaria this is Black in the Black Country IMOC formulary for prophylaxis, but can be supplied on a private prescription. For all other uses it is Green. |
|||||
chloroquine with proguanil | Restricted | ||||
Chloroquine
This is Black in the Black Country IMOC formulary for prophylaxis, but can be supplied on a private prescription. |
|||||
doxycycline | On Formulary | ||||
Dispersible tablet | |||||
Vibramycin-D (Pfizer Ltd) | Off Formulary | ||||
Modified-release capsule | |||||
Efracea (Galderma (UK) Ltd) | Off Formulary | ||||
mefloquine | Restricted | ||||
MEFLOQUINE
On microbiological advice only |
|||||
primaquine | Restricted | ||||
PRIMAQUINE
Malaria and GUM consultants. This is Red in the Black Country IMOC formulary, i.e. for hospital prescribing only. |
|||||
proguanil hydrochloride | Restricted | ||||
PROGUANIL HYDROCHLORIDE
This is Red in the Black Country IMOC formulary, i.e. for hospital prescribing only. |
|||||
quinine | On Formulary | ||||
Quinine
This is Red for malaria only in the Black Country IMOC formulary, i.e. for hospital prescribing only. |
|||||
Anti-infective / Toxoplasmosis | |||||
pyrimethamine | Restricted | ||||
PYRIMETHAMINE
Not regularly stocked in the Trust. This is Red in the Black Country IMOC formulary, i.e. for hospital prescribing only. |