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 Formulary Chapter 9: Nutrition and blood - Full Chapter
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09.01.03  Expand sub section  Drugs used in hypoplastic, haemolytic, and renal anaemias
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)
View adult BNF View SPC online View childrens BNF
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
 ....
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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