| Formulary Chapter 5: Infections - Full Chapter
|
| Chapter Links... |
 COVID-19 Therapeutic Alert |
| Interim Clinical Commissioning Policy: Antivirals or neutralising monoclonal antibodies in the treatment of COVID-19 in hospitalised patients (Version 5 - effective from 10th February 2022) |
| NICE NG15: Antimicrobial stewardship: systems and processes for effective antimicrobial medicine use |
| NICE NG63: Antimicrobial stewardship: changing risk-related behaviours in the general population |
| North of Tyne, Gateshead and North Cumbria - Antibiotic and Diagnostic quick reference tools |
| Primary Care Antimicrobial Guidelines |
| TEWV: Antibiotic Prescribing Procedure |
| UK Interim Clinical Commissioning Police - Therapies for patients with symptomatic hospital-onset COVID-19 |
| Details... |
| 05.03 |
Antiviral drugs |
|
|
| 05.03.01 |
HIV infection |
|
|
|
|
| 05.03.01 |
Nucleoside reverse transcriptase inhibitors |
|
|
Abacavir
|
Formulary
|
|
|
|
Didanosine
|
Formulary
|
|
|
|
Emtricitabine
|
Formulary
|
|
|
|
Lamivudine
|
Formulary
|
- 150 mg and 300 mg tablets
- 50 mg/5ml oral solution
|
|
|
Stavudine
|
Formulary
|
|
|
|
Tenofovir Disoproxil
|
Formulary
|
|
|
|
Zidovudine
|
Formulary
|
|
|
|
| 05.03.01 |
Protease inhibitors |
|
|
Saquinavir
|
Formulary
|
|
|
|
Tipranavir
|
Formulary
|
|
|
|
Atazanavir
|
Formulary
|
- For limited use as part of triple therapy where other protease inhibitors are unsuitable
|
|
|
Atazanavir sulfate and cobicistat
|
Formulary
|
To be used in accordance with NHS England Clinical Commissioning Policy (SSC1614).
|
|
|
Darunavir
|
Formulary
|
|
|
|
Darunavir and Cobicistat
|
Formulary
|
To be used in accordance with NHS England Clinical Commissioning Policy (SSC1614).
|
|
|
Fosamprenavir
|
Formulary
|
|
|
|
Indinavir
|
Formulary
|
|
|
|
Nelfinavir
|
Formulary
|
|
|
|
Ritonavir
|
Formulary
|
|
|
|
| 05.03.01 |
Non-nucleoside reverse transcriptase inhibitors |
|
|
Efavirenz (Sustiva®)
|
Formulary
|
|
|
|
Etravirine (Intelence®)
|
Formulary
|
|
|
|
Nevirapine
|
Formulary
|
|
|
|
Rilpivirine hydrochloride
|
Formulary
|
- For patients who, due to renal impairment, require reduced doses that are not able to be accommodated by the fixed combination product.
|
|
|
| 05.03.01 |
Other antiretrovirals |
|
|
Cabotegravir (Vocabria®)
|
Formulary
|
- 30mg tablet
- 600mg/3ml prolonged-release suspension for injection
- Approved in combination with rilpivirine (Rekambys) for treating HIV-1 in adults in line with NICE
|
NICE TA757: Cabotegravir with rilpivirine for treating HIV-1
|
Dolutegravir
|
Formulary
|
|
|
|
Enfuvirtide
|
Formulary
|
|
|
|
Fostemsavir (Rukobia®)
|
Formulary
|
- 600mg MR tablets
- Approved for the treatment of multi-drug resistant HIV-1 infection in adults
|
|
|
Maraviroc
|
Formulary
|
- Approved for use in the treatment of patients with HIV infections that are resistant to standard therapy in accordance with British HIV Association and EACS guidelines.
|
|
|
Raltegravir
|
Formulary
|
- Approved for use in the treatment of patients with HIV infections that are resistant to standard therapy in accordance with British HIV Association and EACS guidelines.
|
|
|
| 05.03.01 |
Pharmacokinetic enhancers of anti-retrovirals |
|
|
Cobicistat (Tybost®)
|
Formulary
|
|
 Clinical Commissioning Policy: Use of cobicistat as a booster in treatment of HIV infection (all ages)
|
| 05.03.01 |
Combination Products |
|
|
Abacavir & Lamivudine
|
Formulary
|
|
|
|
Abacavir & Lamivudine & Zidovudine
|
Formulary
|
|
|
|
Abacavir & Lamivudine & Dolutegravir
|
Formulary
|
|
|
|
Dolutegravir Sodium & Lamivudine (Dovato®)
|
Formulary
|
- Film-coated tablet containing dolutegravir sodium equivalent to 50 mg dolutegravir and 300 mg lamivudine
|
|
|
Dolutegravir Sodium & Rilpivirine Hydrochloride (Juluca®)
|
Formulary
|
- Film-coated tablets containing dolutegravir sodium (equivalent to 50 mg dolutegravir) and rilpivirine hydrochloride (equivalent to 25 mg rilpivirine)
|
|
|
Emtricitabine & Tenofovir Disoproxil
|
Formulary
|
- Tablets: Emtricitabine 200 mg and Tenofovir disoproxil (as fumarate) 245 mg
- Use generic preparation in preference to the branded product (Truvada®)
|
|
|
Emtricitabine & Rilpivirine & Tenofovir disoproxil (Eviplera®)
|
Formulary
|
- Tablets: 200 mg / 25 mg / 245 mg
|
|
|
Lopinavir and Ritonavir (Kaletra®)
|
Formulary
|
|
|
|
Tenofovir Disproxil & Cobicistat & Elvitegravir & Emtricitabine
|
Formulary
|
- To be used in accordance with NHS England Clinical Commissioning Policy.
|
|
|
Tenofovir Disproxil & Efavirenz & Emtricitabine
|
Formulary
|
|
|
|
Emtricitabine & Elvitegravir & Cobicistat & Tenofovir alafenamide (Genvoya®)
|
Formulary
|
- Tablet: 200mg / 150 mg / 150 mg / 10 mg
- To be used in accordance with NHS England Clinical Commissioning Policy.
|
|
|
Emtricitabine & Rilpivirine & Tenofovir alafenamide (Odefsey®)
|
Formulary
|
- Film coated tablets containing rilpivirine 25mg, emtricitabine 200mg & tenofovir alafenamide (as fumarate) 25mg
- To be used in accordance with NHS England Clinical Commissioning Policy.
|
|
|
Emtricitabine & Tenofovir alafenamide (Descovy®)
|
Formulary
|
- Film coated tablets containing:
- emtricitabine 200mg & tenofovir alafenamide (as fumarate) 10mg
- emtricitabine 200mg & tenofovir alafenamide (as fumarate) 25mg
- To be used in accordance with NHS England Clinical Commissioning Policy.
|
|
|
Zidovudine & Lamivudine
|
Formulary
|
|
|
|
| 05.03.02 |
Herpesvirus infections |
|
|
| 05.03.02.01 |
Herpes simplex and varicella-zoster infection |
|
|
Aciclovir
|
First Choice
|
- Tablets: 200mg, 400mg, 800mg
- Dispersible tablets: 200mg, 400mg, 800mg
- Oral suspension (sugar-free available): 200mg/5ml, 400mg/5ml
|
|
|
Aciclovir Injection
|
Formulary
|
- Injection (for IV infusion): 250mg, 500mg
|
|
|
Valaciclovir
|
Alternatives
|
|
|
|
| 05.03.02.02 |
Cytomegalovirus infection |
|
|
Foscarnet Sodium
|
Formulary
|
|
|
|
Ganciclovir
|
Formulary
|
|
|
|
Letermovir (Prevymis®)
|
Formulary
|
- Approved for the prevention of cytomegalovirus disease after a stem cell transplant in line with NICE
|
NICE TA591: Letermovir for preventing cytomegalovirus disease after a stem cell transplant
|
Maribavir (Livtencity®)
|
Formulary
|
- 200mg film coated tablets
|
NICE TA860: Maribavir for treating refractory cytomegalovirus infection after transplant
|
Valganciclovir
|
Formulary
|
|
|
|
Cidofovir infusion
|
 Restricted
|
- For use in the prevention and treatment of cytomegalovirus infection.
- For limited use by ENT Surgeons in the treatment of selected
patients with respiratory papillomatosis ( unlicensed)
|
|
|
| 05.03.03 |
Viral hepatitis |
|
|
| 05.03.03.01 |
Chronic hepatitis B |
|
|
Adefovir Dipivoxil (Hepsera®)
|
Formulary
|
|
NICE CG165: Hepatitis B (chronic) - incorporates TA96
NICE TA96: Hep B - adefovir dipivoxil and pegylated interferon alpha-2a
|
Entecavir
|
Formulary
|
|
NICE CG165: Hepatitis B (incorporates TA153)
NICE TA153: Hepatitis B (chronic) - etecavir
|
Lamivudine
|
Formulary
|
|
NICE CG165: Chronic Hepatitis B
|
Tenofovir Disproxil (Viread®)
|
Formulary
|
|
NICE CG165: Hepatitis B (incorporates TA153)
NICE TA173: Hepatitis B (chronic) - tenofovir disoproxil
|
| 05.03.03.02 |
Chronic hepatitis C & hepatitis D |
|
|
Daclatasvir
|
Formulary
|
- Approved for the treatment of chronic hepatitis C in line with NICE and NHS England Commissioning Policy.
|
|
|
Elbasvir & grazoprevir (Zepatier®)
|
Formulary
|
- Approved for the treatment of chronic hepatitis C in line with NICE and NHS England Commissioning Policy.
|
NICE TA413: Elbasvir–grazoprevir for treating chronic hepatitis C
|
Glecaprevir & Pibrentasvir (Maviret®)
|
Formulary
|
- Approved for the treatment of chronic hepatitis C in line with NICE and NHS England Commissioning Policy.
|
NICE TA499: Glecaprevir–pibrentasvir for treating chronic hepatitis C
|
Peginterferon Alfa (Pegasys®, ViraferonPeg®)
|
Formulary
|
- Approved for hepatitis B and C in accordance with NICE guidelines and NHS England Commissioning Policies.
|
|
|
Ribavirin
|
Formulary
|
|
NICE TA106: Hepatitis C - peginterferon alfa and ribavirin
NICE TA200: Hepatitis C - peginterferon alfa and ribavirin
NICE TA75: Hepatitis C - pegylated interferons, ribavirin and alfa interferon
|
Sofosbuvir (Sovaldi®)
|
Formulary
|
- Approved for the treatment of chronic hepatitis C in line with NICE and NHS England Commissioning Policy.
|
NICE TA330: Sofosbuvir for treating chronic hepatitis C
|
Sofosbuvir & Ledipasvir (Harvoni®)
|
Formulary
|
- To be used in accordance with NHS England Commissiong Policy
|
NICE TAG63: Ledipasvir–sofosbuvir for treating chronic hepatitis C
|
Sofosbuvir & velpatasvir ( Epclusa®)
|
Formulary
|
- Approved for the treatment of chronic hepatitis C in line with NICE and NHS England Commissioning Policy.
|
NICE TA430: Sofosbuvir–velpatasvir for treating chronic hepatitis C
|
Sofosbuvir, Velpatasvir & Voxilaprevir (Vosevi®)
|
Formulary
|
- Approved for the treatment of chronic hepatitis C in line with NICE and NHS England Commissioning Policy.
|
NICE TA507: Sofosbuvir–velpatasvir–voxilaprevir for treating chronic hepatitis C
|
Bulevirtide (Hepcludex®)
|
Formulary
|
- 2mg powder for solution for injection
- Approved as an option for treating chronic hepatitis D in adults with compensated liver disease in line with NICE and NHSE Specialised Commissioning Policy only if:
- there is evidence of significant fibrosis (METAVIR stage F2 or above or Ishak stage 3 or above) and
- their hepatitis has not responded to peginterferon alfa‑2a (PEG‑IFN) or they cannot have interferon-based therapy
- Only available from:
- The Newcastle Upon Tyne Hospitals NHS Foundation trust
|
NICE TA896: Bulevirtide for treating chronic hepatitis D
|
|
|
|
|
|
|
|
|
| 05.03.04 |
Influenza |
|
|
Oseltamivir (Tamiflu®)
|
Formulary
|
- 30mg, 45mg and 75mg capsules
- 6mg/mL oral suspension
- Only approved for use in accordance with NICE guidance.
|
NICE TA158: Oseltamivir, amantadine (review) and zanamivir for the prophylaxis of influenza
NICE TA168: Amantadine, oseltamivir and zanamivir for the treatment of influenza
|
Zanamivir (Relenza®)
|
Formulary
|
- 5mg inhalation powder blisters with Diskhaler
- Only approved for use in accordance with NICE guidance.
|
NICE TA158: Oseltamivir, amantadine (review) and zanamivir for the prophylaxis of influenza
NICE TA168: Amantadine, oseltamivir and zanamivir for the treatment of influenza
|
Zanamivir Injection (Dectova®)
|
Formulary
|
- 200mg/20mL solution for infusion
- Approved on the advice of virology/microbiology/ID physician only
|
NICE TA158: Oseltamivir, amantadine (review) and zanamivir for the prophylaxis of influenza
NICE TA168: Amantadine, oseltamivir and zanamivir for the treatment of influenza
|
|
|
| 05.03.05 |
Respiratory syncytial virus |
|
|
Palivizumab
|
Formulary
|
- To be used in accordance with NHS England Commissioning Policy.
|
|
|
Ribavirin (Virazole®)
|
Formulary
|
|
|
|
| 05.03.06 |
COVID-19 therapeutics |
|
|
Nirmatrelvir and Ritonavir (Paxlovid®)
|
Formulary
|
- Nirmatrelvir 150mg tablets and Ritonavir 100mg tablets (Paxlovid®)
- As per NICE TA 878
|
NICE TA878: Casirivimab plus imdevimab, nirmatrelvir plus ritonavir, sotrovimab and tocilizumab for treating COVID-19
|
Sotrovimab (Xevudy®)
|
Formulary
|
- 500mg concentrate for solution for infusion
|
NICE TA878: Casirivimab plus imdevimab, nirmatrelvir plus ritonavir, sotrovimab and tocilizumab for treating COVID-19
|
Molnupiravir (Lagevrio®)
(For use in CMDU only)
|
Restricted
|
|
|
|
|
|
|
|
| .... |
| Non Formulary Items |
Casirivimab with Imdevimab (Ronapreve®)
|
Non Formulary
|
- Not approved for treating COVID-19 as per NICE TA878
|
|
|
| |
Key |
|
|
|
|
Cytotoxic Drug
|
|
|
Controlled Drug
|
|
High Cost Medicine
|
|
NHS England |
|
Homecare |
|
CCG |
|
Traffic Light Status Information
| Status |
Description |
|
Drugs for hospital use only. The responsibility for initiation and monitoring treatment should rest with an appropriate hospital clinician and the drug should be supplied through the hospital throughout the duration of treatment.
In some very exceptional circumstances (e.g. due to distance from the hospital, storage, supply or mobility/transport problems) it may be appropriate for the GP to be asked to prescribe a Red drug. This should be negotiated on an individual patient basis and should only be done with the GP’s prior informed agreement where the roles of the GP and hospital services are clearly defined and agreed. The GP should not feel under pressure to prescribe in these circumstances.
For all RED drugs automatically added to the formulary in response to a positive NICE TA: Prescribers need to ensure that local Trust new drug governance procedures and pharmacy processes are followed before any prescribing. |
|
Drugs initiated by hospital specialist, but where continuing treatment by GPs may be appropriate under a shared care arrangement.
The specialist should send the GP a copy of the shared care agreement to sign. The GP should sign the shared care agreement, or indicate they do not want to be part of such an agreement, and return a copy back to the specialist. Shared care guidelines are available or are being developed for most of the drugs listed as Amber.
If no shared care guideline is available, the hospital specialist should provide the patient’s GP with sufficient information and support to allow treatment to be continued and managed safely in primary care. |
|
Drugs normally recommended or initiated by a specialist (hospital or GP with an extended role https://www.rcgp.org.uk/gpwer), but can be safely maintained in primary care with very little or no monitoring required. In some cases there may be a further restriction for use outlined - these will be defined in each case. Provision of additional information, or an information leaflet, may be appropriate in some cases to facilitate continuing treatment by GPs. |
|
Drugs where prescribing by GPs is appropriate. Can be initiated and prescribed in all care settings, and if appropriate, discontinued without recourse to secondary care. |
|
NOT APPROVED: Drugs that have been considered by NTAG or the NENC ICB Medicines Subcommittee (or other approved body) and are not approved for prescribing within the North East and North Cumbria. |
|
UNDER REVIEW: drugs whose current formulary status or RAG status is currently under review. |
|
NOT REVIEWED: Drugs that haven not been reviewed yet. This usually means that an application is in progress. These drugs are not normally considered appropriate for prescribing in the North East and North Cumbria until such time that a decision is taken on their formulary status. |
|
|
|
