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 Formulary Chapter 9: Nutrition and blood - Full Chapter
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09.01  Expand sub section  Anaemias and some other blood disorders
Oral Rehydration Salts (Dioralyte®)
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Formulary
Green
 
 
09.01.01  Expand sub section  Iron-deficiency anaemias
09.01.01.01  Expand sub section  Oral iron
Ferrous Sulphate
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First Choice
Green
  • 200mg tablets (65mg iron).
 
Ferric maltol 30mg hard capsules (Ferracru®)
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Alternatives
Green plus

  • For the treatment of iron deficiency anemia in patients with or without inflammatory bowel disease.

  • To be initiated by specialist in inflammatory bowel disease or iron deficiency anaemia 

 
Link  Ferric Maltol for the treatment of iron-deficiency anaemia in Inflammatory Bowel Disease only
Link  Ferric Maltol for the treatment of iron-deficiency anaemia in patients without Inflammatory Bowel Disease
 
Ferrous Fumarate
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Alternatives
Green
  • First Choice oral liquid iron preparation140mg in 5ml syrup (45mg iron/5ml).
  • 210mg tablets (68mg iron/tablet).
 
 
Ferrous Gluconate
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Alternatives
Green

300mg tablets (35mg iron)

 
 
Sodium Feredetate (Sodium ironedetate, Sytron®)
Alternatives
Green
  • 190mg in 5ml sugar-free elixir (27.5mg iron/5ml).
 
 
09.01.01.01  Expand sub section  Iron and folic acid
09.01.01.01  Expand sub section  Compound iron preparations to top
09.01.01.02  Expand sub section  Parenteral iron
Ferric Carboxymaltose 100ml in 2ml & 500mg in 10ml injections (Ferinject®)
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Formulary
Red
  • For use as an alternative to iron dextran or iron sucrose. Approved for
    use by renal physicians, gastroenterologists and haematologists.
  • Unlicensed for use in children under 14 years of age. If used in this age-group, use should only be on the advice of a consultant with the informed consent of the patient and/or his/her parents/carers.
 
Link  MHRA Drug Safety Update (Nov 2020): Ferric carboxymaltose (Ferinject▼): risk of symptomatic hypophosphataemia leading to osteomalacia and fractures
 
Iron Dextran 100ml in 2ml and 500mg in 10ml injections
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Formulary
Red
 
 
Iron Isomaltoside 1000mg in 10ml injection (Monofer®)
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Formulary
Red
 
 
Iron Sucrose 100mg in 5ml injection (Venofer®)
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Formulary
Red
 
 
09.01.02  Expand sub section  Drugs used in megaloblastic anaemias
Folic Acid
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Formulary
Green
  • 400 microgram and 5mg tablets
  • 2.5mg in 5ml sugar-free syrup
  • 15mg in 1ml injection unlicensedunlicensed
  • 30mg in 2ml injection
 
 
Hydroxocobalamin 1mg in 1ml injection
(Vitamin B12)
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Formulary
Green
 
Link  NICE NG239: Vitamin B12 deficiency in over 16s: diagnosis and management
 
09.01.03  Expand sub section  Drugs used in hypoplastic, haemolytic, and renal anaemias
Eculizumab
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Formulary
Red
High Cost Medicine
  • 300mg/30ml solution for infusion
  • Approved treating atypical haemolytic uraemic syndrome in adults and children in line with NICE

Paroxysmal nocturnal haemoglobinuria treatment is only commissioned from:

  • King’s College Hospital NHS Foundation Trust, London - London and South East
  • Leeds Teaching Hospitals NHS Trust - Rest of United Kingdom
 
Link   NICE TA647: Eculizumab for treating relapsing neuromyelitis optica (terminated appraisal)
Link  Clinical Commissioning Policy: Eculizumab in the treatment of recurrence of C3 glomerulopathy postkidney transplant (all ages) Reference: NHS England: 16054/P
Link  NICE HST 1 - Eculizumab for treating atypical haemolytic uraemic syndrome
Link  NICE TA636: Eculizumab for treating refractory myasthenia gravis (terminated appraisal)
 
Pegcetacoplan (Aspaveli®)
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Formulary
Red
  • 1080mg/20 solution for infusion
  • Approved for the treatment paroxysmal nocturnal haemoglobinuria in adults who have anaemia after at least 3 months of treatment with a C5 inhibitor in line with NICE and NHSE Commissioning Policy.
  • Paroxysmal nocturnal haemoglobinuria treatment is only commissioned from:
    • King’s College Hospital NHS Foundation Trust, London - London and South East
    • Leeds Teaching Hospitals NHS Trust - Rest of United Kingdom

 

 
Link  NICE TA778: Pegcetacoplan for treating paroxysmal nocturnal haemoglobinuria
 
Ravulizumab (Ultomiris®)
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Formulary
Red
  • 300mg/30ml & 1,100mg/11ml concentrate for solution for infusion
  • Approved for the treatment of paroxysmal nocturnal haemoglobinuria in adults in line with NICE
  • Approved for the treatment of atypical haemolytic uraemic syndrome in line with NICE
  • Paroxysmal nocturnal haemoglobinuria treatment is only commissioned from 
    • King’s College Hospital NHS Foundation Trust, London - London and South East
    • Leeds Teaching Hospitals NHS Trust - Rest of United Kingdom
 
Link  NICE TA698: Ravulizumab for treating paroxysmal nocturnal haemoglobinuria
Link  NICE TA710: Ravulizumab for treating atypical haemolytic uraemic syndrome
 
Roxadustat (Evrenzo® )
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Formulary
Red
  • 20mg, 50mg, 70mg, 100mg and 150mg tablets
  • Approved for treating symptomatic anaemia associated with chronic kidney disease in adults in line with NICE
 
Link  NICE TA807: Roxadustat for treating symptomatic anaemia in chronic kidney disease
 
09.01.03  Expand sub section  Erythropoietin
Darbepoetin Alfa (Aranesp®)
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First Choice
Red
High Cost Medicine

  • 10, 15, 20, 30, 40, 50, 60, 80, 100, 150 & 300 microgram injections in prefilled syringes 

  • 20, 40, 60, 80, 100 & 300 microgram Sureclick® pens - approved for management of cancer treatment-induced anaemia in women receiving platinum-based chemotherapy for ovarian cancer 



  • Monitoring: monitoring of erythropeoetin (darbepoetin) in adult patients can be undertaken by GPs under a shared care arrangement Amber

 
Epoetin delta
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Formulary
Red
 
 
Epoetin theta
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Formulary
Red
 
 
Epoetin zeta
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Formulary
Red
 
Link  MHRA Drug Safety Update (Jan 2018): Recombinant human erythropoietins: very rare risk of severe cutaneous adverse reactions (SCARs)
 
Epoetin alfa (Eprex®)
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Alternatives
Red
High Cost Medicine
  • Prefilled syringes (various strengths)
    • Approved for management of cancer treatment-induced anaemia in
      women receiving platinum-based chemotherapy for ovarian cancer
    • No longer regularly used in NUTH
 
Link  MHRA Drug Safety Update (Jan 2018): Recombinant human erythropoietins: very rare risk of severe cutaneous adverse reactions (SCARs)
Link  NICE NG203: Chronic kidney disease: assessment and management
Link  NICE TA323: Erythropoiesis‑stimulating agents during chemotherapy
Link  Shared Care Guidelines for the Monitoring of Erythropoietins in the Treatment of Patients with Chronic Kidney Disease (CKD)
 
Epoetin beta (NeoRecormon®)
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Alternatives
Red
High Cost Medicine

  • Cartridges for use in RecopensPrefilled syringes


    • Approved for management of cancer treatment-induced anaemia
      in women receiving platinum-based chemotherapy for ovarian cancer.

    • No longer regularly used in NUTH.



  • Monitoring: monitoring of erythropeoetin (epoetin beta) in adult patients can be undertaken by GPs under a shared care arrangement Amber

 
Link  MHRA Drug Safety Update (Jan 2018): Recombinant human erythropoietins: very rare risk of severe cutaneous adverse reactions (SCARs)
Link  NICE NG203: Chronic kidney disease: assessment and management
Link  NICE TA323: Erythropoiesis‑stimulating agents during chemotherapy
Link  Shared Care Guidelines for the Monitoring of Erythropoietins in the Treatment of Patients with Chronic Kidney Disease (CKD)
 
Methoxy Polyethylene Glycol-Epoetin Beta (Mircera®, Pegzerepoetin® alfa)
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Alternatives
Red
High Cost Medicine
  • 30, 50, 100, 120, 150, 200 & 250 microgram in 0.3ml and 360 microgram in 0.6ml injections in prefilled syringes.
  • Approved for use as a longer-acting alternative to darbepoetin in a
    small number of patients receiving peritoneal dialysis.
 
Link  MHRA Drug Safety Update (Jan 2018): Recombinant human erythropoietins: very rare risk of severe cutaneous adverse reactions (SCARs)
 
09.01.03  Expand sub section  Iron overload to top
Deferasirox
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Formulary
Red
High Cost Medicine
  • Approved for iron chelation in patients with myelodysplastic syndromes (MDS) - (as per NECN Haematology Group Guidelines) and recommended for use in patients when treatment with desferrioxamine is no longer considered to be appropriate due to progressive iron overload despite maximally tolerated doses of desferrioxamine. 
  • Approved for the treatment of iron overload for trasnfused and non-tranfused patients with chronic inherited anaemias (all ages) in line with NHSE Specialised Commissioning Policy
 
 
Deferiprone (Ferriprox®)
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Formulary
Red
High Cost Medicine
 
 
Desferrioxamine Mesilate
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Formulary
Red
High Cost Medicine
  • Approved for the treatment of iron overload for trasnfused and non-tranfused patients with chronic inherited anaemias (all ages) in line with NHSE Specialised Commissioning Policy
 
 
09.01.04  Expand sub section  Drugs used in autoimmune thrombocytopenic purpura
Anagrelide
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Formulary
Red
  • For the treatment of thrombocythemiaas a 2nd line agent in patients poorly/non-responsive tohydroxycarbamide therapy.
 
 
Avatrombopag (Doptelet®)
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Formulary
Red
High Cost Medicine
  • Approved for the treatment of severe thrombocytopenia in people with chronic liver disease needing a planned invasive procedure in line with NICE
  • Approved for treating primary chronic immune thrombocytopenia in adults in line with NICE

 

 
Link  NICE TA626: Avatrombopag for treating thrombocytopenia in people with chronic liver disease needing a planned invasive procedure
Link  NICE TA853: Avatrombopag for treating primary chronic immune thrombocytopenia
 
Caplacizumab (Cablivi ®)
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Formulary
Red
High Cost Medicine

  • 10mg solution for injection

    • Approved with plasma exchange and immunosuppression for treating acute acquired thrombotic thrombocytopenic purpura in adults, and in young people aged 12 years and over who weigh at least 40 kg in line with NICE



 
Link  NICE TA667: Caplacizumab with plasma exchange and immunosuppression for treating acute acquired thrombotic thrombocytopenic purpura
 
Eltrombopag
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Formulary
Red
High Cost Medicine
  • For the treatment of adults with chronic immune (idiopathic) thrombocytopenia purpura in line with NICE.
 
Link  NICE TA293: Eltrombopag for treating chronic ITP
 
Lusutrombopag
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Formulary
Red

  • 3mg film-coated tablets

  • Approved as an option for treating severe thrombocytopenia in adults with chronic liver disease having planned invasive procedures in line with NICE

 
Link  NICE TA617: Lusutrombopag for treating thrombocytopenia in people with chronic liver disease needing a planned invasive procedure
 
Romiplostim
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Formulary
Red
High Cost Medicine
  • For the treatment of adults with chronic immune (idiopathic) thrombocytopenia purpura in line with NICE.
 
Link  NICE TA221: Thrombocytopenic purpura - romiplostim
 
09.01.05  Expand sub section  G6PD deficiency
09.01.06  Expand sub section  Drugs used in neutropenia
Filgrastim (G-CSF) (Neupogen®, Ratiograstim®)
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Formulary
Red
High Cost Medicine
  • Available as Neupogen (original brand) and Ratiograstim – a
    biosimilar product.
 
 
Lenograstim (rHuG-CSF) (Granocyte®)
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Formulary
Red
High Cost Medicine
  • 263 microgram (33.6 million units) injection vials
 
 
Lipegfilgrastim (G-CSF)
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Formulary
Red
 
 
Pegfilgrastim (G-CSF)
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Formulary
Red
High Cost Medicine
 
 
09.01.07  Expand sub section  Drugs used to mobilise stem cells
Plerixafor (Mozobil®)
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Formulary
Red
High Cost Medicine
  • Approved by NHS England Specialist Services for stem cell mobilisation for patients with Hodgkin’s disease, Non-Hodgkins lymphoma or multiple myeloma and meet the policy for Haematopoietic Stem Cell Transplantation.
 
 
 ....
 Non Formulary Items
Ferric derisomaltose  (Diafer)

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Non Formulary
Red

Solution for injection: 100 mg/2 mL

  
Key
note Notes
Section Title Section Title (top level)
Section Title Section Title (sub level)
First Choice Item First Choice item
Non Formulary Item Non Formulary section
Restricted Drug
Restricted Drug
Unlicensed Drug
Unlicensed
Track Changes
Display tracking information
click to search medicines.org.uk
Link to adult BNF
click to search medicines.org.uk
Link to children's BNF
click to search medicines.org.uk
Link to SPCs
Cytotoxic Drug
Cytotoxic Drug
CD
Controlled Drug
High Cost Medicine
High Cost Medicine
NHSE
NHS England
Homecare
Homecare
CCG
CCG

Traffic Light Status Information

Status Description

Red

Drugs for hospital use only. The responsibility for initiation and monitoring treatment should rest with an appropriate hospital clinician and the drug should be supplied through the hospital throughout the duration of treatment. In some very exceptional circumstances (e.g. due to distance from the hospital, storage, supply or mobility/transport problems) it may be appropriate for the GP to be asked to prescribe a Red drug. This should be negotiated on an individual patient basis and should only be done with the GP’s prior informed agreement where the roles of the GP and hospital services are clearly defined and agreed. The GP should not feel under pressure to prescribe in these circumstances. 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.  

Amber

Drugs initiated by hospital specialist, but where continuing treatment by GPs may be appropriate under a shared care arrangement. The specialist should send the GP a copy of the shared care agreement to sign. The GP should sign the shared care agreement, or indicate they do not want to be part of such an agreement, and return a copy back to the specialist. Shared care guidelines are available or are being developed for most of the drugs listed as Amber. If no shared care guideline is available, the hospital specialist should provide the patient’s GP with sufficient information and support to allow treatment to be continued and managed safely in primary care.  

Green plus

Drugs normally recommended or initiated by 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.  

Green

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.  

Black

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.   

Brown

UNDER REVIEW: drugs whose current formulary status or RAG status is currently under review.  

Not Recomended

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.  

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