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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
for Rosacea use Acea gel 0.75% 40g

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

  • GUM Green in the Black Country IMOC formulary
  • Consultant paediatricians in children with chronic respiratory problems,in line with Trust antimicrobial policy for children AR in the Black Country IMOC formulary
  • Chlamydial conjunctivitis Green in the Black Country IMOC formulary
  • Respiratory consultants for the prophylaxis of exacerbations of bronchiectasis in patients who are logged at treatment start and assessed by Microbiology at the end of 6 months treatment AR in the Black Country IMOC formulary

  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.

Clindamycin suspension 75mg/5ml for children with penicillin allergy

  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.
 
The vials must be protected from light - they should be kept in the outer carton in order to protect from light.
The vials must not be stored above 25°C .
Reconstituted solution should be used immediately & any unused solution discarded.

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
Motility agent

  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:

  • Trust “Clostridioides difficile care and management” Policy
  • Microbiologist advice where it is AR  in the Black Country IMOG formulary. i.e. prescribable in primary care after specialist recommendation

  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
for Rosacea use Acea gel 0.75% 40g

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

Dear Healthcare profession letter sent by the manufacturers in October 2009 regarding severe hypersensitivity reactions

 

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

At other times only after Microbiology advice

  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).

This is Green in the Black Country IMOC formulary only during Flu season and on authorisation by NHS England/Department of Health & Social Care or via commissioned service for out of season supply

At other times only​ after Microbiology advice

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.