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NHS Sunderland Clinical Commissioning Group
City Hospitals Sunderland NHS Foundation Trust
 
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 Formulary Chapter 8: Malignant disease and immunosuppression - Full Chapter
08.01.01  Expand sub section  Alkylating drugs
Cytotoxic Drug Bendamustine
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Formulary
Red
Cancer Drugs Fund

Injections: 25mg & 100mg


-approved for the first line treatment of CLL (Binet stage B or C) in patients for whom fludarabine combination chemotherapy is not appropriate in line with NICE


-NECDAG approved for use in combination with rituximab for patients with CLL not fit for FCR chemotherapy and not fit for alemtuzumab.


-approved for Low Grade Non-Hodgkins Lymphoma in line with NICE -not recommended for (low grade) non-Hodgkin's lymphoma that is refractory to rituximab or a rituximab-containing regimen NICE

 
Link  NICE TA 206 Bendamustine for the treatment of indolent (low grade) non-Hodgkin’s lymphoma that is refractory to rituximab
Link  NICE TA216: Bendamustine for CLL
   
Cytotoxic Drug Busulfan
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Formulary
Red

Tablets: 2mg
Injection: 60mg in 10ml
unlicensedunlicensed Capsules: 25mg

 
   
Cytotoxic Drug Carmustine (BiCNU)
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Formulary
Red

Implants: 7.7mg

 
Link  NICE TA121: Glioma (newly diagnosed and high grade) - carmustine implants and temozolomide
   
Cytotoxic Drug Chlorambucil
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Formulary
Red

Tablets: 2mg

 
   
Cytotoxic Drug Cyclophosphamide
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Formulary
Red

Tablets: 50mg 
Injection: 1g

 
   
Cytotoxic Drug Estramustine
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Formulary
Red

Capsules: 140mg

 
   
Cytotoxic Drug Ifosfamide
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Formulary
Red

Injection: 2g

 
   
Cytotoxic Drug Lomustine
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Formulary
Red

Capsules: 40mg
unlicensedunlicensed capsules: 10mg

 
   
Cytotoxic Drug Melphalan
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Formulary
Red

Tablets: 2mg
Injection: 50mg

 
   
Cytotoxic Drug Thiotepa
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Formulary
Red

Injection: 15mg

 
   
Cytotoxic Drug Treosulfan
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Formulary
Red

Infusion: 5g

 
   
 ....
Key
note Notes
Section Title Section Title (top level)
Section Title Section Title (sub level)
First Choice Item First Choice item
Non Formulary Item Non Formulary section
Restricted Drug
Restricted Drug
Unlicensed Drug
Unlicensed
Track Changes
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Link to adult BNF
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Link to SPCs
Cytotoxic Drug
Cytotoxic Drug
CD
Controlled Drug
High Cost Medicine
High Cost Medicine
Cancer Drugs Fund
Cancer Drugs Fund
NHSE
NHS England
Homecare
Homecare
CCG
CCG

Traffic Light Status Information

Status Description

Red

Drugs for hospital use or use by a specialist within specialist centre only. Initiation and monitoring of treatment should remain under the total responsibility of the appropriate hospital clinician or specialist. These drugs should only be prescribed under the direct supervision of that clinician or specialist and are not suitable for shared care arrangements. The drug should be supplied via the hospital or specialist centre for the duration of treatment.   

Amber

These are specialist drugs which must be initiated by secondary care specialist prescribers, but with the potential to transfer prescribing to primary care within written and agreed shared care protocols and according to the agreed process for transfer of care. For these drugs, in order to ensure patient safety, some aspects of care must remain with the specialist due to their complexity e.g. monitoring of disease or drug response. Other more routine aspects can be transferred to the GP e.g. monitoring of adverse effects and supply of the medicine. The specific responsibilities of the specialist and GP are defined in the shared care agreement for each drug. Shared care agreements are still under development for some amber drugs. Until these are available, it would be expected that any shared care request from secondary care to a GP would be accompanied by written information which defines prescribing and monitoring responsibilities. The hospital specialist should also provide the GP with enough information and support to allow the safe transfer and ongoing management of prescribing into primary care.   

Green +

Drugs which should usually be initiated in secondary care, or by a specialist clinician, 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.  

Green

These are defined as new and established drugs, which may be prescribed, initiated, changed or maintained on FP10 by the GP and, if appropriate, discontinued without recourse to secondary care. N.B. DRUGS NOT IDENTIFIED IN THE FORMULARY BY A RED, AMBER OR GREEN+ SYMBOL ARE CLASSIFIED AS GREEN.   

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