netFormulary NHS
North East and North Cumbria
ICS Formulary
 Search
 Formulary Chapter 8: Malignant disease and immunosuppression - Full Chapter
Chapter Links...
 Details...
08.01.01  Expand sub section  Alkylating drugs
Cytotoxic Drug Bendamustine
View adult BNF View SPC online View childrens BNF
Formulary
Red
  • 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  MHRA Drug Safety Update (July 2017): Bendamustine (Levact): increased mortality observed in recent clinical studies in off-label use; monitor for opportunistic infections, hepatitis B reactivation
Link  MHRA Drug Safety Update (March 2021): Bendamustine (Levact): increased risk of non-melanoma skin cancer and progressive multifocal encephalopathy (PML)
Link  NICE TA216: Bendamustine for CLL
 
Cytotoxic Drug Busulfan
View adult BNF View SPC online View childrens BNF
Formulary
Red
  • Approved formulations include:
    • 2mg tablets;
    • 25mg capsules (unlicensedunlicensed);
    • 60mg in 10ml injection.

 
 
Cytotoxic Drug Carmustine
View adult BNF View SPC online View childrens BNF
Formulary
Red
  • Approved formualtions include 100mg injection and 7.7mg implants.
  • Approved for newly diagnosed glioblastoma multiforme (GBM) in line with NICE.
 
Link  NICE TA121: Glioma (newly diagnosed and high grade) - carmustine implants and temozolomide
 
Cytotoxic Drug Chlorambucil
View adult BNF View SPC online View childrens BNF
Formulary
Red
 
 
Chlormethine hydrochloride (Ledaga®)
(gel)
View adult BNF View SPC online View SMC online View childrens BNF
Formulary
Red

  • 160micrograms/g gel 

  • Approved for the treatment of mycosis fungoides-type cutaneous T-cell lymphoma in line with NICE

 
Link  NICE TA720: Chlormethine gel for treating mycosis fungoides-type cutaneous T-cell lymphoma
 
Cytotoxic Drug Cyclophosphamide
View adult BNF View SPC online View childrens BNF
Formulary
Red
 
 
Estramustine Phosphate
(UNDER REVIEW)
View adult BNF View SPC online View childrens BNF
Formulary
Red
 
 
Cytotoxic Drug Ifosfamide
View adult BNF View SPC online View childrens BNF
Formulary
Red
 
 
Cytotoxic Drug Lomustine
View adult BNF View SPC online View childrens BNF
Formulary
Red
  • Note: 10mg capsules are unlicensedunlicensed.
 
 
Cytotoxic Drug Melphalan
View adult BNF View SPC online View childrens BNF
Formulary
Red
 
Link  NICE TA822: Melphalan for haematological diseases before allogeneic haematopoietic stem cell transplant (terminated appraisal)
 
Thiotepa
View adult BNF View SPC online View childrens BNF
Formulary
Red
 
 
Treosulfan
View adult BNF View SPC online View childrens BNF
Formulary
Red

  • Approved in combination with fludarabine for malignant disease before allogeneic stem cell transplant in line with NICE and NHS England Commissioning Policy

 
Link  NICE TA640: Treosulfan with fludarabine for malignant disease before allogeneic stem cell transplant
 
 ....
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.  

netFormulary