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Sunderland Joint Formulary
NHS Sunderland Clinical Commissioning Group
South Tyneside and Sunderland NHS Foundation Trust
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 Formulary Chapter 8: Malignant disease and immunosuppression - Full Chapter
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08.01.03  Expand sub section  Antimetabolites
Cytotoxic Drug Azacitidine (Vidaza®)
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Formulary
Red
High Cost Medicine

Vial: 100mg

 
Link  NICE TA 218: Azacitidine for myelodysplastic syndromes
Link  NICE TA 399: Azacitidine for treating acute myeloid leukaemia with more than 30% bone marrow blasts
   
Cytotoxic Drug Capecitabine
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Formulary
Red

Tablets: 150mg & 500mg

 
Link  NICE TA 60: Colorectal cancer - capecitabine and tegafur uraci
Link  NICE TA 100: Colon cancer (adjuvant) - capecitabine and oxaliplatin
Link  NICE TA 191: Gastric cancer (advanced) - capecitabine
Link  NICE TA 212: Bevacizumab in combination with oxaliplatin and either fluorouracil plus folinic acid or capecitabine for the treatment of metastatic colorectal cancer
Link  NICE TA 263: Bevacizumab in combination with capecitabine for the first-line treatment of metastatic breast cancer
   
Cytotoxic Drug Cladribine
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Formulary
Red
High Cost Medicine

Solution for preparing infusions: 10mg in 10ml
Subcutaneous injection: 2mg in 1ml
- approved for Hairy Cell Leukemia

Tablets: 10mg

 as an option for relapsing-remitting multiple sclerosis as per NICE (see link)

 
Link  NICE TA 616: Cladribine for treating relapsing–remitting multiple sclerosis
   
Cytotoxic Drug Cytarabine
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Formulary
Red

Injections: 100mg in 5ml, 1g in 10ml
Vial: 50mg (cytarabine encapsulated in liposomes)

 
   
Cytotoxic Drug Daunorubicin/ cytarabine (Vyxeos)
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Formulary
Red
High Cost Medicine
NHS England
  • Approved for untreated acute myeloid leukaemia in line with NICE 
  • Link  NICE TA 552: Liposomal cytarabine - daunorubicin for untreated acute myeloid leukaemia
       
    Cytotoxic Drug Fludarabine
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    Formulary
    Red

    Tablets: 10mg
    Injection: 50mg

     
    Link  NICE TA 29: Leukaemia (lymphocytic) - fludarabine
    Link  NICE TA 119: Leukaemia (lymphocytic) - fludarabine
       
    Cytotoxic Drug Fluorouracil
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    Formulary
    Red

    Injections: 2.5g in 50ml & 2.5g in 100ml
    unlicensedunlicensed Subconjunctival injection: 10mg in 0.4ml
    (FOLFIRINOX is approved for the management of selected patients with inoperable pancreatic cancer in patients with performance status 0-1).

     
       
    Cytotoxic Drug Gemcitabine
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    Formulary
    Red

    Injection: 200mg, 1g, 2g

     
    Link  NICE NG 85: Pancreatic cancer - gemcitabine
    Link  NICE TA 116: Breast cancer - gemcitabine
    Link  NICE TA 389: Topotecan, pegylated liposomal doxorubicin hydrochloride, paclitaxel, trabectedin and gemcitabine for treating recurrent ovarian cancer
       
    Cytotoxic Drug Mercaptopurine
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    Formulary
    Red

    Tablets: 50mg
    unlicensedunlicensed Suspension: 20mg in 1ml


     


    Note, mercaptopurine is amber if used for inflammatory bowel disease

     
       
    Cytotoxic Drug Methotrexate
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    Formulary
    Red

    Tablets: 2.5mg
    unlicensedunlicensed Oral solution: 10mg in 5ml
    unlicensedunlicensed Injections (various strengths) – including prefilled syringes
    Intrathecal injection: 5mg in 2ml

     

    Note, methotrexate is amber if used in chronic inflammarory conditions, e.g. Crohn's disease, rheumatoid arthritis

     
       
    Cytotoxic Drug Pemetrexed
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    Formulary
    Red
    High Cost Medicine
    Cancer Drugs Fund

    Injection: 100mg & 500mg

     
    Link  NICE TA 124: Lung cancer (non-small-cell) - pemetrexed
    Link  NICE TA 135: Mesothelioma - pemetrexed disodium
    Link  NICE TA 181: Lung cancer (non-small cell, first line treatment) - pemetrexed
    Link  NICE TA 190: Lung cancer (non-small-cell) - pemetrexed (maintenance)
    Link  NICE TA 402: Pemetrexed maintenance treatment for non-squamous non-small-cell lung cancer after pemetrexed and cisplatin
       
    Cytotoxic Drug Tegafur with Uracil (Uftoral®)
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    Formulary
    Red

    Capsules:  containing tegafur 100mg & uracil 224mg

     
    Link  NICE TA 61: Capcitabine and tegafur - Colorectal cancer
       
     ....
     Non Formulary Items
    Cytotoxic Drug  Clofarabine  (Evoltra®)

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    Non Formulary
    High Cost Medicine
    Cancer Drugs Fund
     
    Cytotoxic Drug  Decitabine  (Dacogen®)

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    Non Formulary
    High Cost Medicine
    Link  NICE TA270: Leukaemia (acute myeloid ) - decitabine (terminated appraisal) (TA270)
     
    Nelarabine  (Atriance®)

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    Non Formulary
    High Cost Medicine
    Cancer Drugs Fund
     
    Cytotoxic Drug  Raltitrexed  (Tomudex®)

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    Non Formulary
     
    Cytotoxic Drug  Tioguanine  (Lanvis®)

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    Non Formulary
     
      
    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 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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