JAPC Traffic Lights Prescribing Database
RED drugs are those where prescribing responsibility would normally lie with a hospital consultant or a specialist.
AMBER drugs are those that although usually initiated within a hospital setting, could appropriately become the responsibility of the GP, under a shared care agreement.
GREEN drugs are regarded as suitable for primary care prescribing.
BROWN drugs are those that JAPC does not recommend for use, except in exceptional circumstances, due to lack of data on safety, effectiveness, and/or cost-effectiveness.
BNF Drug Status Comments Date decision
made/reviewd
1 Targinact (oxycodone + naloxone) Brown
1.6 Procalopride Brown Lack of long-term data on effectiveness and safety and lack of cost effectiveness data
5) Less cost-effective than current standard therapy
2.12 Atorvastatin5,6 Brown 6) NICE guidance
1) Requiring specialist assessment to enable patient selection and initiation of treatment.
4.4 Atomoxetine1,3 Amber 3) Requiring short or medium term specialist monitoring of toxicity.
8.3 Thalidomide Red Requires specialist knowledge
11.5 Atropine sulphate eye drops 1% Green
11.5 Cyclopentolate hydrochloride eye drops 0.5%, 1% Green
11.5 Tropicamide eye drops 0.5%, 1% Green
11.6 Bimatoprost eye drops 300micrograms/ml Green
11.6 Brimonidine eye drops 0.2% Green 3rd line use
11.6 Brinzolamide eye drops 10mg/ml Green 2nd line use
11.6 Cosopt eye drops (after consultant initiation) Green
11.6 Timolol maleate eye drops 0.25% Green
11.6 Travoprost eye drops 40 microgram/ml Green
14.4 Intanza Brown Lack of data on cost effectiveness
Mecysteine Green
1.1.1 Asilone suspension Green
1.1.1 Co-magaldrox Green
1.1.2 Gaviscon Advance Suspension Green
1.1.2 Peptac suspension Green
1.2 Mebeverine 135mg tabs or 50mg/5ml liquid (1st line) Green
1.2 Peppermint oil e/c caps (Mintec) (2nd line) Green
1.3.1 Ranitidine tabs 150mg, 300mg Green
1.3.5 Esomeprazole Brown
1.3.5 Lansoprazole caps 15mg, 30mg Green
1.3.5 Omeprazole caps 10mg, 20mg Green
1.4.2 Codeine Phosphate tabs 15mg, 30mg, 60mg Green
1.4.2 Loperamide caps 2mg Green
1.5 Sulfasalazine Amber
1.5.1 Mesalazine (NB not for GP initiation) Green
1.5.1 Sulfasalazine 500mg tabs or e/c tabs 500mg (NB not for GP initiation) Green
1.5.2 Beclometasone dip MR1 Red
1.5.2 Budesonide enemas Green
1.5.2 Hydrocortisone foam Green
Prednisolone suppositories (5mg), retantion enemas (20mg), foam enemas
1.5.2 (20mg Green
1) Requiring specialist assessment to enable patient selection, initiation and ongoing treating
2) Requiring long term on-going monitoring of efficacy by a specialist
3) Requiring long term on-going monitoring of toxicity by a specialist (either because of difficulty
1.5.3 Infliximab1,2,3 Red in recognising side effects or high cost of investigations to identify toxicity)
1.6.1 Ispaghula sachet Green
1.6.2 Bisacodyl tabs 5mg, suppositories 10mg, 5mg (paed) Green
1.6.2 Co-danthramer (dantron & poloxamer '188') suspension, caps Green
1.6.2 Co-danthrusate (dantron & docusate sodium) suspension, caps Green
1.6.2 Docusate sodium caps 100mg, solution 50mg/5ml, 12.5mg/5ml (paed) Green
1.6.2 Glycerol suppositories Green
1.6.2 Manevac granules (ispaghula & senna) Green
1.6.2 Senna tablets/liquid Green
1.6.3 Arachis (peanut) oil enemas Green
1.6.4 Lactulose solution Green
1.6.4 Phosphate enemas Green
1.6.4 Sodium Citrate micro enemas (Relaxit, Micolette) Green
1) Requiring specialist assessment to enable patient selection, initiation and ongoing treating
5) That are new or a new indication for an existing drug, that needs evaluation to be undertaken to
1.6.6 Methylnaltrexone1,5 Red establish place in therapy
1.7.2 Anusol-HC ointment, suppositories Green
1.7.2 Proctosedyl ointment, suppositories Green
1.7.2 Xyloproct ointment Green
1.7.3 Glyceryl trinitrate 0.4% ointment Green
1.9.1 Ursodeoxycholic acid tabs 150mg, 300mg, capsules 250mg Green
1.9.2 Colestyramine 4g sachets Green
1.9.4 Creon Green
1.9.4 Pancrex granules Green
1.9.4 Pancrex V caps, tabs, powder Green
10.1 Hyaluronic acid injection6 Brown 6) NICE guidance
10.1.1 Celecoxib Brown
10.1.1 Dexibuprofen4 Brown 4) Lack of data on cost-effectiveness compared with standard therapy.
10.1.1 Diclofenac Green Third line NSAID, increased CV risk, use plain tablets not e/c Nov-08
10.1.1 Etoricoxib Brown
10.1.1 Ibuprofen Green first line NSAID, low CV risk if daily dose 1200mg or below
10.1.1 Indomethacin Green First line for gout otherwise fouth line Nov-08
10.1.1 Mefanamic acid Green Dysmenorrhoea and menorrhagia only Nov-08
10.1.1 Naproxen Green second line NSAID, low CV risk, use plain tablets not e/c Nov-08
10.1.2 Methylprednisolone acetate injection Green Nov-08
10.1.3 Auranofin Amber
1) Requiring specialist assessment to enable patient selection and initiation of treatment.
2) Requiring short or medium term (e.g. 3-6 months) specialist monitoring of efficacy or until the
1,2
10.1.3 DMARDS :- Amber patient is stable.
1) Requiring specialist assessment to enable patient selection and initiation of treatment.
2) Requiring short or medium term (e.g. 3-6 months) specialist monitoring of efficacy or until the
10.1.3 Hydroxychloroquine Amber patient is stable. Nov-08
10.1.3 Leflunomide Amber
10.1.3 Methotrexate (oral and injection) Amber
10.1.3 Penicillamine Amber
10.1.3 Sodium aurothiomalate Amber
10.1.3 Certolizumab Red Requires specialist knowledge
10.1.4 Allopurinol Green Nov-08
10.1.4 Colchicine Green Nov-08
10.1.5 Glucosamine sulphate (for knee OA) Green Refer to OA algorithm in the primary care formulary Nov-08
10.1.5 Glusartel Green Knee OA only
10.1.5 Dolenio Brown Lack of evidence
10.2.2 Baclofen Green follow consultant advice Nov-08
10.2.2 Diazepam Green as a skeletal muscle relaxant Nov-08
10.2.2 Ketoprofen gel Green Refer to OA algorithm in the primary care formulary Nov-08
up to 4 weeks before fully effective, stop if no improvement thereafter. Reassess every 3 months to
10.2.2 Quinine salts Green determine further need by interupting treatment Nov-08
10.3.2 algesal Green Refer to OA algorithm in the primary care formulary Nov-08
10.3.2 Ibuprofen gel Green Refer to OA algorithm in the primary care formulary Nov-08
10.3.2 Transvasin Green Refer to OA algorithm in the primary care formulary Nov-08
11.3.1 Chloramphenicol eye drops 0.5%, eye ointment 1% Green First line drug. Do not confuse with ear drops (5% and 10%)
11.3.1 Gentamicin eye drops 0.3% Green Second line drug
11.3.1 Levofloxacin Eye Drops Red Requires specialist knowledge
11.3.2 Ganciclovir Eye Gel Red Requires specialist knowledge
11.3.3 Aciclovir eye ointment 3% Green Refer patient to hospital eye department. Do not confuse with 5% cream.
11.4.2 Olopatadine eye drops 1mg/ml Green 3rd line use
11.4.2 Otrivine-Antistin eye drops Green
11.4.2 Sodium cromoglicate aqueous eye drops 2% Green
11.6 Cosopt eye drops (after consultant initiation) Green
11.6 Duotrav eye drops (after consultant initiation) Green
11.6 Ganfort eye drops (after consultant initiation) Green
11.6 Trusopt eye drops (after consultant initiation) Green
11.8.1 Carbomer gel (GelTears, Liposic, Liquivisc, Viscotears) Green Prescribe the cheapest brand
11.8.1 Carmellose sodium (Optive) eye drops 0.5% Green
11.8.1 Celluvisc eye drops (not first line) Green
11.8.1 Hypromellose eye drops 0.3% Green
11.8.1 Liquid paraffin eye ointment (Lacri-Lube) Green
11.8.1 Polyvinyl alcohol eye drops (Sno tears) Green
1) Requiring specialist assessment to enable patient selection, initiation and ongoing treating
2) Requiring long term on-going monitoring of efficacy by a specialist
11.8.2 Apraclonidine eye drops1,2 Red
1) Requiring specialist assessment to enable patient selection, initiation and ongoing treating
2) Requiring long term on-going monitoring of efficacy by a specialist
11.8.2 Ranibizumab1,2 Red
12.1.1 Chloramphenicol 5%, 10% ear drops Green
12.1.1 Gentamicin 0.3% drops Green
12.1.1 Gentisone HC ear drops Green
12.1.1 Locorten-vioform ear drops Green
12.1.1 Otomize spray Green
12.1.1 Tri-adcortyl otic ointment Green
12.1.1. Betnesol-N drops Green
12.1.3 Olive Oil Green
12.1.3 Sodium bicarbonate 5% ear drops Green
12.2.1 Beclometasone 50microgram nasal spray Green
12.2.1 Budesonide 100microgram nasal spray Green Once daily dosing
12.2.1 Fluticasone furoate nasal spray (Avamys) Brown
13.10.1 Flamazine cream 50g, 250g, 500g Green
13.10.1 Fusidic Acid 2% (Fucidin) cream, gel, ointment, 15g, 30g Green
13.10.1 Metronidazole gel 0.75% (Acea) 40g (for rosacea) Green
13.10.1 Metronidazole gel 0.75% (Anabact) 15g, 30g (for malodorous wounds) Green
13.10.1 Polyfax ointment 20g (1st line for mild impetigo) Green
13.10.1.1 Retapamulin 1% ointment4 Brown 4) Lack of data on cost-effectiveness compared with standard therapy.
13.10.2 Clotrimazole 1% cream 20g, 50g, spray 100g, dusting powder 30g (1st line) Green
13.10.2 Terbinafine (Lamisil) 1% cream 15g, 30g (2nd line) Green
13.10.4 Dimeticone 4% lotion (Hedrin) 50ml, 150ml (1st line) Green
13.10.4 Hedrin lotion Green
13.10.4 Malathion 0.5% aqueous liquid 50ml, 200ml Green
13.10.4 Permethrin 5% dermal cream 30g Green
13.10.4 Phenothrin 0.5% aqueous liquid 200ml Green
13.10.5 Full Marks solution spray Brown
13.11 Sodium Chloride 0.9% (Normasol) solution 25ml, 100ml sachet Green
13.12 Aluminium chloride hexahydrate 20% solution Green
13.2.1 Aqueous cream 500g Green
13.2.1 Cetraben cream 50g, 125g, 500g pump dispenser Green
13.2.1 Diprobase cream 50g, 500g pump dispenser Green
13.2.1 Doublebase Gel 100g, 500g pump dispenser Green
13.2.1 E45 cream 50g, 125g, 350g, 500g pump dispenser Green
13.2.1 Epaderm ointment 125g, 500g tub Green
13.2.1 Hydromol ointment 125g, 500g tub Green
Liquid Paraffin & White Sodt Paraffin Ointment 50%LP & 50%WSP 500g
13.2.1 tub Green
13.2.1 Oilatum cream 40g, 150g, 500ml pump dispenser Green
13.2.1.1 Dermalo 500ml bath emollient (1st line) Green
13.2.1.1 Oilatum emollient 250ml, 500ml (2nd line) Green
13.2.2 Zinc & Castor oil ointment 50g, 100g Green
Betametasone (betnovate) (potent) 0.1% cream, ointment 30g, 100g, scalp
13.4 lotion 100ml Green
13.4 Clobetasol (dermovate) (very potent) 0.05% cream, ointment, 30g, 100g Green
Clobetasone (eumovate) (moderate potency)0.05% cream, ointment, 30g,
13.4 100g Green
Hydrocortisone cream, ointment (mild potency) 0.5%, 1%, 2.5%, 15g, 30g,
13.4 100g Green
13.4 Hydrocortisone/Clotrimazole (Canesten HC) (mild potency) cream 30g Green
13.5.1 Alitretinoin4 Red 4) Specifically designated as “hospital only” by product licence or by DH/NICE
13.5.2 Acitretin4 Red 4) Specifically designated as “hospital only” by product licence or by DH/NICE
13.5.2 Betamethasone/Calcipotriol (Dovobet) ointment 60g, 120g Green
13.5.2 Calcipotriol (Dovonex) cream 60g, 120g, scalp application 60ml, 120ml Green
13.5.2 Calcitriol (Silkis) ointment 100g Green
13.5.2 Dithrocream 0.1%, 0.25%, 0.5%, 1%, 2% cream 50g Green
13.5.2 Polytar liquid 250ml Green
13.5.2 Sebco scalp ointment 40g, 100g Green
13.5.2 Xamiol Scalp gel Green
1) Requiring specialist assessment to enable patient selection, initiation and ongoing treating
3) Requiring long term on-going monitoring of toxicity by a specialist (either because of difficulty
13.5.3 Ciclosporin1,3 (except as a DMARD when amber) Red in recognising side effects or high cost of investigations to identify toxicity)
1) Requiring specialist assessment to enable patient selection, initiation and ongoing treating
2) Requiring long term on-going monitoring of efficacy by a specialist
3) Requiring long term on-going monitoring of toxicity by a specialist (either because of difficulty
13.5.3 Efalizumab1,2,3 Red in recognising side effects or high cost of investigations to identify toxicity)
1) Requiring specialist assessment to enable patient selection, initiation and ongoing treating
2) Requiring long term on-going monitoring of efficacy by a specialist
3) Requiring long term on-going monitoring of toxicity by a specialist (either because of difficulty
13.5.3 Etanercept1,2,3 Red in recognising side effects or high cost of investigations to identify toxicity)
13.5.3 Pimecrolimus (topical) Red
13.5.3 Tacrolimus (topical) Red
1) Requiring specialist assessment to enable patient selection, initiation and ongoing treating
2) Requiring long term on-going monitoring of efficacy by a specialist
3) Requiring long term on-going monitoring of toxicity by a specialist (either because of difficulty
13.6 Ustekinumab1,2,3 Red in recognising side effects or high cost of investigations to identify toxicity)
13.6.1 Adapalene (Differin) cream, gel 45g Green
13.6.1 Azelaic acid (Skinoren) cream 20%, 30g Green
13.6.1 Benzoyl peroxide preps 2.5%, 5%, 10% (Panoxyl) Green
13.6.1 Clindamycin (Dalacin T) solution, lotion 1%, 30ml Green
Tretinoin (Retin A) cream 0.025% 60g, gel 0.01%, 0.025% 60g, lotion 0.025%
13.6.1 100ml Green
13.6.2 Co-Cyprindiol (Dianette) tabs Green
13.6.2 Isotretinoin tablets Red
13.8.1 Solaraze gel (Diclofenac 3%) (on consultant advice) Green
13.9 Eflornithine cream Brown
1) Requiring specialist assessment to enable patient selection, initiation and ongoing treating
2) Requiring long term on-going monitoring of efficacy by a specialist
3) Requiring long term on-going monitoring of toxicity by a specialist (either because of difficulty
15.1.1 Ketamine1,2,3 Red in recognising side effects or high cost of investigations to identify toxicity)
2.1.1 Digoxin tabs 62.5, 125, 250 micrograms Green
2.11 Tranexamic acid tabs 500mg Green
1) Lack of data on effectiveness compared with standard therapy.
2) Lack of data on safety compared with standard therapy.
1,2,4
2.12 Colesevalem Brown 4) Lack of data on cost-effectiveness compared with standard therapy.
2.12 Ezetimibe (as per NICE guidance) Green
2.12 Inegy Brown
2.12 Niaspan (only on consultant recommendation) Green
2.12 Omacor Brown
2.12 Pravastatin tabs 40mg Green
2.12 Rosuvastatin Brown
2.12 Rosuvastatin Green
2.2.1 Bendroflumethiazide tabs 2.5mg, 5mg Green
2.2.2 Furosemide tabs 20mg, 40mg, injection 20mg, 50mg Green
2.2.3 Amiloride tabs 5mg Green
2.2.3 Eplerenone (only if spironolactone not tolerated) Green
2.2.3 Spironolactone tabs 25mg (only indicated for heart failure) Green
2.3.2 Amiodarone tabs 100mg, 200mg Green
2.4 Atenolol tabs 25mg, 50mg, 100mg Green
Bisoprolol tabs 1.25mg, 2.5mg, 3.75mg, 5mg, 7.5mg, 10mg (Heart failure
2.4 only) Green
2.4 Carvedilol tabs 3.125mg, 6.25mg, 12.5mg, 25mg (Heart failure only) Green
2.4 Nebivolol (only on consultant recommendation) Green
1) Requiring specialist assessment to enable patient selection, initiation and ongoing treating
2) Requiring long term on-going monitoring of efficacy by a specialist
3) Requiring long term on-going monitoring of toxicity by a specialist (either because of
difficulty in recognising side effects or high cost of investigations to identify toxicity)
2.5.1 Ambrisentan1,2,3 Red
1) Requiring specialist assessment to enable patient selection, initiation and ongoing treating
2) Requiring long term on-going monitoring of efficacy by a specialist
3) Requiring long term on-going monitoring of toxicity by a specialist (either because of difficulty
2.5.1 Bosentan1,2,3 Red in recognising side effects or high cost of investigations to identify toxicity)
1) Requiring specialist assessment to enable patient selection, initiation and ongoing treating
2) Requiring long term on-going monitoring of efficacy by a specialist
3) Requiring long term on-going monitoring of toxicity by a specialist (either because of difficulty
2.5.1 Iloprost1,2,3 Red in recognising side effects or high cost of investigations to identify toxicity)
2.5.1 Sildenafil 20mg tab (Revatio) for PAH1,2 Red
Moxonidine tabs 200, 300, 400 micrograms (may be used as 4th line add
2.5.2 on therapy) Green
2.5.4 Doxazosin tabs 1mg, 2mg, 4mg (may be used as 4th line add on therapy) Green
2.5.5.1 Enalapril tabs 2.5mg, 5mg, 10mg, 20mg Green
2.5.5.1 Lisinopril tabs 2.5mg, 5mg, 10mg, 20mg Green
2.5.5.1 Ramipril caps 1.25mg, 2.5mg, 5mg, 10mg Green
2.5.5.2 Candesartan tabs 2mg, 4mg, 8mg, 16mg Green
2.5.5.2 Micardis plus Brown
1) Lack of data on effectiveness compared with standard therapy.
2) Lack of data on safety compared with standard therapy.
1,2,4
2.5.5.3 Aliskiren Brown 4) Lack of data on cost-effectiveness compared with standard therapy.
2.6.1 GTN pump spray cfc-free Green
2.6.1 GTN s/l tabs 300, 500, 600 micrograms Green
2.6.1 Isosorbide Mononitrate (ISMN) tabs 10mg, 20mg, 40mg Green
2.6.2 Amlodipine tabs 5mg, 10mg Green
Diltazem slow release (Slozem caps 120mg, 180mg, 240mg, 300mg are a
2.6.2 cost effective option) Green
2.6.2 Exforge5 Brown 5) Less cost-effective than current standard therapy
Verapamil slow release (Securon SR tabs 120mg, 240mg are a cost
2.6.2 effective option) Green
2.6.3 Ivabradine (only on consultant recommendation) Green
2.6.3 Nicorandil (3rd or 4th line) Green
2.6.3 Ranolazine Brown
1) Requiring specialist assessment to enable patient selection, initiation and ongoing treating
2) Requiring long term on-going monitoring of efficacy by a specialist
3) Requiring long term on-going monitoring of toxicity by a specialist (either because of difficulty
2.8.1 Epoprostenol1,2,3 Red in recognising side effects or high cost of investigations to identify toxicity)
2.8.1 LMWH (e.g. enoxaparin, tinzaparin)1 Amber 1) Requiring specialist assessment to enable patient selection and initiation of treatment.
2.8.2 Dabigatran4 Red 4) Specifically designated as “hospital only” by product licence or by DH/NICE
2.8.2 Rivaroxaban4 Red 4) Specifically designated as “hospital only” by product licence or by DH/NICE
Warfarin tabs (use of 1mg strength is recommended to minimise
2.8.2 confusion) Green
2.9 Asasantin Retard (aspirin 25mg & dipyridamole 200mg) Green
2.9 Aspirin 75mg dispersible tabs Green
2.9 Clopidogrel tabs 75mg Green
2.9 Dipyridamole m/r caps 200mg Green
2.9 Glycoprotein IIb/IIIa Inhibitors1 Red
2.9 Prasugrel Red One month's treatment
3.1.1 Formoterol (Atimos modulite) Green First-line LABA
3.1.1 Formoterol Easyhaler Green
3.1.1 Salbutamol inhalers & nebules Green
3.1.1 Salmeterol MDI Green Second-line LABA
3.1.2 Ipratropium inhaler & nebules Green
3.1.2 Tiotropium inhalers Green First-line long-acting bronchodilator in COPD
3.1.3 Theopylline tabs/caps Green Prescribe by brand name
3.1.4 Combivent nebuliser solution Green Only in severe COPD [FEV 1 <30%], initiated by a specialist
3.1.5 Fostair Green
3.2 Ciclesonide1,5 Brown 1) Lack of data on effectiveness compared with standard therapy. 5) Less cost-effective than current standard therapy
3.2 Clenil modulite Green Prescribe by brand name
3.2 Fostair Green Combination inhaler choice, if one is required
3.2 Qvar Green Prescribe by brand name
3.3.2 Montelukast Green Step 3 choice for children aged 2 – 5 years
3.4.1 Cetirizine Green
3.4.1 Chlorphenamine Green
3.4.1 Desloratidine5 Brown 5) Less cost-effective than current standard therapy
3.4.1 Levocetirizine5 Brown 5) Less cost-effective than current standard therapy
3.4.1 Loratadine Green
3.4.2 Grazax4 Brown 4) Lack of data on cost-effectiveness compared with standard therapy.
1) Requiring specialist assessment to enable patient selection, initiation and ongoing treating
2) Requiring long term on-going monitoring of efficacy by a specialist
3.4.2 Omalizumab1,2 Red
3.7 Carbocisteine Green
1) Requiring specialist assessment to enable patient selection, initiation and ongoing treating
2) Requiring long term on-going monitoring of efficacy by a specialist
3) Requiring long term on-going monitoring of toxicity by a specialist (either because of difficulty
3.7 Dornase alpha1,2,3 Red in recognising side effects or high cost of investigations to identify toxicity)
1) Requiring specialist assessment to enable patient selection, initiation and ongoing treating
2) Requiring long term on-going monitoring of efficacy by a specialist and not suitable for shared
care
3.7 Dornase alpha1,2,3 Red 3) Requiring long term on-going monitoring of toxicity by a specialist
1) Lack of data on effectiveness compared with standard therapy.
3.7 Erdosteine1,4 Brown 4) Lack of data on cost-effectiveness compared with standard therapy.
1) Lack of data on effectiveness compared with standard therapy.
3.7 Erdosteine1,4 Brown 4) Lack of data on cost-effectiveness compared with standard therapy.
3.7 n_Acetylcysteine Amber
4.1.1 Melatonin prolonged-release (Circadin)1 Brown
4.1.1 Melatonin prolonged-release (Circadin)1 Amber
1) Requiring specialist assessment to enable patient selection and initiation of treatment.
5) Specific long term monitoring for toxicity
4.1.1 Melatonin1,5 Amber
4.1.1 Temazepam Green
4.1.1 Zaleplon, zolpidem, zopiclone (as per NICE guidance) Green
4.1.2 Chlordiazepoxide Green For Alcohol withdrawal only
4.1.2 Diazepam Green
4.10 Acamprosate1 Amber 1) Requiring specialist assessment to enable patient selection and initiation of treatment.
4.10 Buprenorphine (for opiate dependance) Amber
4.10 Buprenorphine patches Brown
1) Requiring specialist assessment to enable patient selection and initiation of treatment.
2) Requiring short or medium term (e.g. 3-6 months) specialist monitoring of efficacy or until the
4.10 Disulfiram1,2 Amber patient is stable.
1) Requiring specialist assessment to enable patient selection, initiation and ongoing treating
2) Requiring long term on-going monitoring of efficacy by a specialist
3) Requiring long term on-going monitoring of toxicity by a specialist (either because of difficulty
4.10 Lomustine1,2,3 Red in recognising side effects or high cost of investigations to identify toxicity)
4.10 Naltrexone Amber
4.10 Suboxone1 Brown 1) Lack of data on effectiveness compared with standard therapy.
4.10 Varenicline Green
1) Requiring specialist assessment to enable patient selection and initiation of treatment.
4.11 Donepezil1,3 Amber 3) Requiring short or medium term specialist monitoring of toxicity.
1) Requiring specialist assessment to enable patient selection and initiation of treatment.
4.11 Galantamine1,3 Amber 3) Requiring short or medium term specialist monitoring of toxicity.
4.11 Memantine Brown
1) Requiring specialist assessment to enable patient selection and initiation of treatment.
4.11 Rivastigmine1,3 Amber 3) Requiring short or medium term specialist monitoring of toxicity.
4.2.1 Amisulpride Green
1) Requiring specialist assessment to enable patient selection, initiation and ongoing treating
2) Requiring long term on-going monitoring of efficacy by a specialist
4.2.1 Aripiprazole injection1,2 Red
4.2.1 Aripiprazole oral Green only on consultant recommendation
4.2.1 Aripiprazole oral (only on consultant recommendation) Green
4.2.1 Clozapine Red
4.2.1 Haloperidol Green
4.2.1 Olanzapine Green on consultant recommendation only.
4.2.1 Paliperidone5 Brown 5) Less cost-effective than current standard therapy
4.2.1 Quetiapine Green only on consultant recommendation
4.2.1 Risperidone Green
4.2.1 Sulpiride Green
4.2.1 Trifluoperazine Green
4.2.1 Olanzapine LA Red Requires specialist knowledge
4.2.2 Flupentixol decanoate Green
1) Requiring specialist assessment to enable patient selection, initiation and ongoing treating
2) Requiring long term on-going monitoring of efficacy by a specialist
3) Requiring long term on-going monitoring of toxicity by a specialist (either because of difficulty
4.2.2 Risperidone depot injection1,2,3 Red in recognising side effects or high cost of investigations to identify toxicity)
1) Requiring specialist assessment to enable patient selection, initiation and ongoing treating
2) Requiring long term on-going monitoring of efficacy by a specialist
3) Requiring long term on-going monitoring of toxicity by a specialist (either because of difficulty
4.2.2 Risperidone depot injection1,2,3 Red in recognising side effects or high cost of investigations to identify toxicity)
4.2.2 Zuclopenthixol decanoate Green
4.2.2 Haloperidol decanoate Green
4.2.3 Carbamazepine Green
4.2.3 Lithium Amber
4.2.3 Lithium Carbonate Amber prescribe by brand name
4.2.3 Lithium citrate Amber Prescribe by brand name
4.2.3 Sodium Valproate Green
4.3.1 Dosulepin Green Continuation use only
4.3.1 Dosulepin (continuation use only) Green
4.3.1 Lofepramine Green
4.3.2 Moclobemide Green
4.3.3 Citalopram Green
4) Lack of data on cost-effectiveness compared with standard therapy.
4.3.3 Escitalopram4,5 Brown 5) Less cost-effective than current standard therapy
4.3.3 Fluoxetine Green
4.3.4 Agomelatine4 Brown 4) Lack of data on cost-effectiveness compared with standard therapy.
4.3.4 Duloxetine (3rd line antidepressant and 3rd line diabetic neuropathy use only) Green
4.3.4 Mirtazapine Green
1) Requiring specialist assessment to enable patient selection, initiation and ongoing treating
2) Requiring long term on-going monitoring of efficacy by a specialist
3) Requiring long term on-going monitoring of toxicity by a specialist (either because of difficulty
4.3.4 Tryptophan1,2,3 Red in recognising side effects or high cost of investigations to identify toxicity)
4.3.4 Venlafaxine Green as per depression guidelines
4.3.4 Venlafaxine (as per depression guideline) Green
1) Requiring specialist assessment to enable patient selection and initiation of treatment.
4.4 Dexamfetamine1,3 Amber 3) Requiring short or medium term specialist monitoring of toxicity.
1) Requiring specialist assessment to enable patient selection and initiation of treatment.
4.4 Methylphenidate1,3 Amber 3) Requiring short or medium term specialist monitoring of toxicity.
1) Requiring specialist assessment to enable patient selection and initiation of treatment.
5) Specific long term monitoring for toxicity
4.4 Modafinil1,5 Amber
4.6 Ondansetron etc. Brown
4.6 Sativex (unlicensed) Brown Not commissioned
4.7.1 Co-codamol 8/500 Green
4.7.1 Co-dydramol 10/500 Green
4.7.1 Co-proxamol (unlicensed) Brown
4.7.1 Paracetamol Green
4.7.2 Codeine Phosphate Green
4.7.2 Diamorphine Green
4.7.2 Dihydrocodeine Green
4.7.2 Fentanyl patch/tablet/lozenge Brown Lack of data on cost-effectiveness compared with standard therapy
4.7.2 Fentanyl patch/tablet/lozenge (third-line use only) Green
4.7.2 Methadone Amber
4.7.2 Morphine Green prescribe m/r preparations by brand ( Zomorph most cost effective)
4.7.2 Tramadol (see neuropathic pain guideline) Green For neuropathic pain only
4.7.3 Lidocaine 5% plaster Green For neuropathic pain only
4.7.3 Lidocaine 5% plaster (see neuropathic pain guideline) Green
4.7.4 Frovatriptan (3rd line use only) Green
4.7.4.1 Almotriptan Green
4.7.4.1 Sumatriptan Green
4.7.4.2 Amitriptyline Green
4.7.4.2 Pizotifen Green
4.7.4.2 Propranolol Green
1) Requiring specialist assessment to enable patient selection and initiation of treatment.
4.8.1 Lacosamide1,5 Red 5) Specific long term monitoring for toxicity
4.8.1 Lacosamide1,5 Amber
4.8.1 Levetiracetam (not first line) Green
4.8.1 Oxcarbazepine (not first line) Green
4.8.1 Pregabalin (see neuropathic pain guideline) Green
4.8.1 Valproate semisodium (Depakote) Brown
4.8.1 Zonisamide (only on consultant recommendation) Green Only on consultant recommendation
4.8.2 Diazepam Green
4.8.2 Midazolam buccal Amber
4.9.1 Amantadine6 Brown 6) NICE guidance
4.9.1 Apomorphine1 (in Parkinson’s disease) Amber 1) Requiring specialist assessment to enable patient selection and initiation of treatment.
4.9.1 Pramipexole (only on consultant recommendation) Green only on consultant recommendation
4.9.1 Rasagiline (only on consultant recommendation) Green only on consultant recommendation
4.9.1 Ropinirole [including XL] (only on consultant recommendation) Green only on consultant recommendation
4.9.1 Rotigotine (only on consultant recommendation) Green only on consultant recommendation
4.9.1 Stalevo Green only on consultant recommendation
1) Requiring specialist assessment to enable patient selection, initiation and ongoing treating
3) Requiring long term on-going monitoring of toxicity by a specialist (either because of
1,3
4.9.3 Botulinum Toxin Red difficulty in recognising side effects or high cost of investigations to identify toxicity)
1) Requiring specialist assessment to enable patient selection and initiation of treatment.
5) Specific long term monitoring for toxicity
4.9.3 Riluzole1,5 Amber
4.9.7 Duodopa5 Brown 5) Less cost-effective than current standard therapy
5.1.2 Ertapenem Red Requires specialist knowledge
5.1.3 Lymecycline caps (2nd line for acne) Green
5.1.3 Minocycline Brown
1) Requiring specialist assessment to enable patient selection, initiation and ongoing treating
2) Requiring long term on-going monitoring of efficacy by a specialist
3) Requiring long term on-going monitoring of toxicity by a specialist (either because of difficulty
5.1.4 Tobramycin nebulised1,2,3 Red in recognising side effects or high cost of investigations to identify toxicity)
1) Requiring specialist assessment to enable patient selection and initiation of treatment.
1,3
5.1.7 Colistin Red 3) Requiring short or medium term specialist monitoring of toxicity.
1) Requiring specialist assessment to enable patient selection, initiation and ongoing treating
3) Requiring long term on-going monitoring of toxicity by a specialist (either because of
5.1.7 Linezolid1,3 Red difficulty in recognising side effects or high cost of investigations to identify toxicity)
5) Less cost-effective than current standard therapy
7) Not accepted as cost effective compared to other service development opportunities within the
5.1.7 Prasugrel5,7 Brown PCT's Local Operational Plan
5.1.7 Promixin5 Brown 5) Less cost-effective than current standard therapy
5.1.8 Colomycin for cystic fibrosis Red Requires specialist knowledge
5.2 Voriconazole Red
1) Requiring specialist assessment to enable patient selection, initiation and ongoing treating
2) Requiring long term on-going monitoring of efficacy by a specialist
3) Requiring long term on-going monitoring of toxicity by a specialist (either because of difficulty
5.3.1 HIV anti-virals1,2,3 Red in recognising side effects or high cost of investigations to identify toxicity)
5.3.1 Lamivudine1,2 Red
1) Requiring specialist assessment to enable patient selection, initiation and ongoing treating
2) Requiring long term on-going monitoring of efficacy by a specialist
5.3.1 Tenofovir1,2 Red
1) Requiring specialist assessment to enable patient selection, initiation and ongoing treating
5) That are new or a new indication for an existing drug, that needs evaluation to be undertaken to
1,3
5.3.2 Valganciclovir Red establish place in therapy
1) Requiring specialist assessment to enable patient selection, initiation and ongoing treating
2) Requiring long term on-going monitoring of efficacy by a specialist
5.3.3 Adefovir1,2 Red
1) Requiring specialist assessment to enable patient selection, initiation and ongoing treating
2) Requiring long term on-going monitoring of efficacy by a specialist
3) Requiring long term on-going monitoring of toxicity by a specialist (either because of difficulty
5.3.5 Palivizumab1,2,3 Red in recognising side effects or high cost of investigations to identify toxicity)
5.3.5 Ribavirin1,3 Red
1) Requiring specialist assessment to enable patient selection, initiation and ongoing treating
4) Specifically designated as “hospital only” by product licence or by DH/NICE
5.5.2 Levamisole1,4 Red
6.1.1.2 Humulin R U500 Insulin Brown
6.1.2 Saxagliptin Brown
6.1.2 Janumet Brown Sitagliptin not approved
6.1.2.2 Metformin SR (2nd line use only) Green
1) Lack of data on effectiveness compared with standard therapy.
2) Lack of data on safety compared with standard therapy.
6.1.2.3 Eucreas1,2,4 (vildagliptin + metformin) Brown 4) Lack of data on cost-effectiveness compared with standard therapy.
1) Requiring specialist assessment to enable patient selection and initiation of treatment.
2) Requiring short or medium term (e.g. 3-6 months) specialist monitoring of efficacy or until the
patient is stable.
6.1.2.3 Exenatide1,2,3 Amber 3) Requiring short or medium term specialist monitoring of toxicity.
6.1.2.3 Rosiglitazone3 Brown 3) Known increase in risk of adverse events compared with standard therapy.
1) Lack of data on effectiveness compared with standard therapy.
2) Lack of data on safety compared with standard therapy.
6.1.2.3 Sitagliptin1,2,4 Brown 4) Lack of data on cost-effectiveness compared with standard therapy.
1) Lack of data on effectiveness compared with standard therapy.
2) Lack of data on safety compared with standard therapy.
6.1.2.3 Vildagliptin1,2,4 (and vildagliptin+metf’min) Brown 4) Lack of data on cost-effectiveness compared with standard therapy.
1) Requiring specialist assessment to enable patient selection and initiation of treatment.
2) Requiring short or medium term (e.g. 3-6 months) specialist monitoring of efficacy or until the
6.2.1 Liothyronine1,2 (for depression) Amber patient is stable.
6.4.2 Nebido injection (only on consultant recommendation) Green
6.4.2 Sustanon injection (only on consultant recommendation) Green
6.4.2 Testim gel (only on consultant recommendation) Green
6.4.2 Testogel (only on consultant recommendation) Green
1) Lack of data on effectiveness compared with standard therapy.
2) Lack of data on safety compared with standard therapy.
6.4.2 Testosterone patch (Intrinsa)1,2,4 Brown 4) Lack of data on cost-effectiveness compared with standard therapy.
6.4.2 Tostran Gel Green Specialist Initiation
6.5.1 Growth Hormone Amber
1) Requiring specialist assessment to enable patient selection, initiation and ongoing treating
2) Requiring long term on-going monitoring of efficacy by a specialist
3) Requiring long term on-going monitoring of toxicity by a specialist (either because of difficulty
6.5.1 Pegvisomant (Somavert)1,2,3 Red in recognising side effects or high cost of investigations to identify toxicity)
6.6 Denosumab Red Limited outcome data
1) Requiring specialist assessment to enable patient selection, initiation and ongoing treating
2) Requiring long term on-going monitoring of efficacy by a specialist
3) Requiring long term on-going monitoring of toxicity by a specialist (either because of difficulty
6.6.1 Teriparatide1,2,3 Red in recognising side effects or high cost of investigations to identify toxicity)
6.6.2 Clodronate sodium Oral1,2,3 Green
1) Lack of data on effectiveness compared with standard therapy
6.6.2 Fosavance1,5 Brown 5) Less cost-effective than current standard therapy.
1) Requiring specialist assessment to enable patient selection, initiation and ongoing treating
2) Requiring long term on-going monitoring of efficacy by a specialist
3) Requiring long term on-going monitoring of toxicity by a specialist (either because of difficulty
6.6.2 Pamidronate disodium1,2,3 Red in recognising side effects or high cost of investigations to identify toxicity)
6.6.2 Strontium ranelate (2nd line use only) Green
1) Requiring specialist assessment to enable patient selection, initiation and ongoing treating
2) Requiring long term on-going monitoring of efficacy by a specialist
3) Requiring long term on-going monitoring of toxicity by a specialist (either because of difficulty
6.6.2 Tiludronic acid1,2,3 Red in recognising side effects or high cost of investigations to identify toxicity)
6.7.1 Cabergoline (hyperprolactinaemia only) Green For this indication only (not acromegaly)
6.7.1 Quinagolide1,2,3 Amber For this indication only (not acromegaly)
7.3.1 Evra patch Brown
7.3.1 NuvaRing5 Red 5) Less cost-effective than current standard therapy
7.3.1 Qlaira5 (estradiol + dienogest) Brown 5) Less cost-effective than current standard therapy
7.3.1 Yasmin (not first-line) Green
7.3.1 Levest Green
7.3.2.1 Cerazette Green
7.3.5 Ulipristal Acetate (EllaOne) Green
7.4.2 Oxybutynin Green standard release prep is first line choice for urinary incontinence Mar-10
7.4.2 Duloxetine Green second line choice should be based on cost as all options are equally effective Mar-10
7.4.2 Tolterodine Green second line choice should be based on cost as all options are equally effective Mar-10
7.4.2 Trospium Green second line choice should be based on cost as all options are equally effective Mar-10
7.4.2 Fesoterodine Green second line choice should be based on cost as all options are equally effective Mar-10
7.4.2 Solifenacin Green second line choice should be based on cost as all options are equally effective Mar-10
7.4.2 Darifenacin Green second line choice should be based on cost as all options are equally effective Mar-10
7.4.5 Tadalafil 2.5mg and 5mg tablets (cialis once-a-day) Brown
1) Requiring specialist assessment to enable patient selection, initiation and ongoing treating
2) Requiring long term on-going monitoring of efficacy by a specialist
3) Requiring long term on-going monitoring of toxicity by a specialist (either because of difficulty
8.1.1 Busulfan1,2,3 Red in recognising side effects or high cost of investigations to identify toxicity)
1) Requiring specialist assessment to enable patient selection, initiation and ongoing treating
2) Requiring long term on-going monitoring of efficacy by a specialist
3) Requiring long term on-going monitoring of toxicity by a specialist (either because of difficulty
8.1.1 Chlorambucil1,2,3 Red in recognising side effects or high cost of investigations to identify toxicity)
1) Requiring specialist assessment to enable patient selection, initiation and ongoing treating
2) Requiring long term on-going monitoring of efficacy by a specialist
3) Requiring long term on-going monitoring of toxicity by a specialist (either because of difficulty
8.1.1 Cyclophosphamide1,2,3 Red in recognising side effects or high cost of investigations to identify toxicity)
1) Requiring specialist assessment to enable patient selection, initiation and ongoing treating
2) Requiring long term on-going monitoring of efficacy by a specialist
3) Requiring long term on-going monitoring of toxicity by a specialist (either because of difficulty
8.1.1 Estramustine1,2,3 Red in recognising side effects or high cost of investigations to identify toxicity)
8.1.1 Lofexidine Amber
1) Requiring specialist assessment to enable patient selection, initiation and ongoing treating
2) Requiring long term on-going monitoring of efficacy by a specialist
3) Requiring long term on-going monitoring of toxicity by a specialist (either because of difficulty
8.1.1 Melphalan1,2,3 Red in recognising side effects or high cost of investigations to identify toxicity)
1) Requiring specialist assessment to enable patient selection, initiation and ongoing treating
2) Requiring long term on-going monitoring of efficacy by a specialist
3) Requiring long term on-going monitoring of toxicity by a specialist (either because of difficulty
8.1.2 Idarubicin1,2,3 Red in recognising side effects or high cost of investigations to identify toxicity)
1) Requiring specialist assessment to enable patient selection, initiation and ongoing treating
2) Requiring long term on-going monitoring of efficacy by a specialist
3) Requiring long term on-going monitoring of toxicity by a specialist (either because of difficulty
8.1.3 Capecitabine1,2,3 Red in recognising side effects or high cost of investigations to identify toxicity)
1) Requiring specialist assessment to enable patient selection, initiation and ongoing treating
2) Requiring long term on-going monitoring of efficacy by a specialist
3) Requiring long term on-going monitoring of toxicity by a specialist (either because of difficulty
8.1.3 Fludarabine1,2,3 Red in recognising side effects or high cost of investigations to identify toxicity)
2nd line where azathioprine CI or not tolerated and where indicated as per SC. If indicated for cancer
this drug is RED 1) Requires
specialist assessment (for instance to enable patient selection and initiation of treatment).
2) Consideration of the drug is indicative of significant progression and a need for specialist input (usually
as specified in a clinical guideline)
8.1.3 Mercaptopurine1,2 Amber
1) Requiring specialist assessment to enable patient selection, initiation and ongoing treating
2) Requiring long term on-going monitoring of efficacy by a specialist
3) Requiring long term on-going monitoring of toxicity by a specialist (either because of difficulty
8.1.3 Tegafur/uracil1,2,3 Red in recognising side effects or high cost of investigations to identify toxicity)
1) Requiring specialist assessment to enable patient selection, initiation and ongoing treating
2) Requiring long term on-going monitoring of efficacy by a specialist
3) Requiring long term on-going monitoring of toxicity by a specialist (either because of difficulty
8.1.3 Tioguanine1,2,3 Red in recognising side effects or high cost of investigations to identify toxicity)
1) Requiring specialist assessment to enable patient selection, initiation and ongoing treating
2) Requiring long term on-going monitoring of efficacy by a specialist
3) Requiring long term on-going monitoring of toxicity by a specialist (either because of difficulty
8.1.4 Etoposide1,2,3 Red in recognising side effects or high cost of investigations to identify toxicity)
1) Requiring specialist assessment to enable patient selection, initiation and ongoing treating
2) Requiring long term on-going monitoring of efficacy by a specialist
3) Requiring long term on-going monitoring of toxicity by a specialist (either because of difficulty
8.1.4 Vinorelbine1,2,3 Red in recognising side effects or high cost of investigations to identify toxicity)
1) Requiring specialist assessment to enable patient selection, initiation and ongoing treating
2) Requiring long term on-going monitoring of efficacy by a specialist
3) Requiring long term on-going monitoring of toxicity by a specialist (either because of difficulty
8.1.5 Bexarotene1,2,3 Red in recognising side effects or high cost of investigations to identify toxicity)
1) Requiring specialist assessment to enable patient selection, initiation and ongoing treating
2) Requiring long term on-going monitoring of efficacy by a specialist
3) Requiring long term on-going monitoring of toxicity by a specialist (either because of difficulty
8.1.5 Dasatinib1,2,3 Red in recognising side effects or high cost of investigations to identify toxicity)
1) Requiring specialist assessment to enable patient selection, initiation and ongoing treating
2) Requiring long term on-going monitoring of efficacy by a specialist
3) Requiring long term on-going monitoring of toxicity by a specialist (either because of difficulty
8.1.5 Erlotinib1,2,3 Red in recognising side effects or high cost of investigations to identify toxicity)
1) Requiring specialist assessment to enable patient selection, initiation and ongoing treating
2) Requiring long term on-going monitoring of efficacy by a specialist
3) Requiring long term on-going monitoring of toxicity by a specialist (either because of difficulty
8.1.5 Hydroxycarbamide1,2,3 Red in recognising side effects or high cost of investigations to identify toxicity)
1) Requiring specialist assessment to enable patient selection, initiation and ongoing treating
2) Requiring long term on-going monitoring of efficacy by a specialist
3) Requiring long term on-going monitoring of toxicity by a specialist (either because of difficulty
8.1.5 Imatinib1,2,3 Red in recognising side effects or high cost of investigations to identify toxicity)
1) Requiring specialist assessment to enable patient selection, initiation and ongoing treating
2) Requiring long term on-going monitoring of efficacy by a specialist
3) Requiring long term on-going monitoring of toxicity by a specialist (either because of difficulty
8.1.5 Mitotane1,2,3 Red in recognising side effects or high cost of investigations to identify toxicity)
1) Requiring specialist assessment to enable patient selection, initiation and ongoing treating
2) Requiring long term on-going monitoring of efficacy by a specialist
3) Requiring long term on-going monitoring of toxicity by a specialist (either because of difficulty
8.1.5 Procarbazine1,2,3 Red in recognising side effects or high cost of investigations to identify toxicity)
1) Requiring specialist assessment to enable patient selection, initiation and ongoing treating
2) Requiring long term on-going monitoring of efficacy by a specialist
3) Requiring long term on-going monitoring of toxicity by a specialist (either because of difficulty
8.1.5 Sorafenib1,2,3 Red in recognising side effects or high cost of investigations to identify toxicity)
1) Requiring specialist assessment to enable patient selection, initiation and ongoing treating
2) Requiring long term on-going monitoring of efficacy by a specialist
3) Requiring long term on-going monitoring of toxicity by a specialist (either because of difficulty
8.1.5 Sunitinib1,2,3 Red in recognising side effects or high cost of investigations to identify toxicity)
1) Requiring specialist assessment to enable patient selection, initiation and ongoing treating
2) Requiring long term on-going monitoring of efficacy by a specialist
3) Requiring long term on-going monitoring of toxicity by a specialist (either because of difficulty
8.1.5 Temozolomide1,2,3 Red in recognising side effects or high cost of investigations to identify toxicity)
8.2.1 Azathioprine Amber
1) Requiring specialist assessment to enable patient selection, initiation and ongoing treating
3) Requiring long term on-going monitoring of toxicity by a specialist (either because of
1,3
8.2.1 Azathioprine (except as a DMARD when amber) Red difficulty in recognising side effects or high cost of investigations to identify toxicity)
1) Requiring specialist assessment to enable patient selection, initiation and ongoing treating
2) Requiring long term on-going monitoring of efficacy by a specialist
3) Requiring long term on-going monitoring of toxicity by a specialist (either because of difficulty
8.2.1 Mycophenolate1,2,3 Red in recognising side effects or high cost of investigations to identify toxicity)
1) Requiring specialist assessment to enable patient selection, initiation and ongoing treating
2) Requiring long term on-going monitoring of efficacy by a specialist
3) Requiring long term on-going monitoring of toxicity by a specialist (either because of difficulty
8.2.2 Basiliximab1,2,3 Red in recognising side effects or high cost of investigations to identify toxicity)
1) Requiring specialist assessment to enable patient selection, initiation and ongoing treating
2) Requiring long term on-going monitoring of efficacy by a specialist
3) Requiring long term on-going monitoring of toxicity by a specialist (either because of difficulty
8.2.2 Daclizumab1,2,3 Red in recognising side effects or high cost of investigations to identify toxicity)
1) Requiring specialist assessment to enable patient selection, initiation and ongoing treating
2) Requiring long term on-going monitoring of efficacy by a specialist
3) Requiring long term on-going monitoring of toxicity by a specialist (either because of difficulty
8.2.2 Sirolimus1,2,3 Red in recognising side effects or high cost of investigations to identify toxicity)
1) Requiring specialist assessment to enable patient selection, initiation and ongoing treating
2) Requiring long term on-going monitoring of efficacy by a specialist
3) Requiring long term on-going monitoring of toxicity by a specialist (either because of difficulty
8.2.2 Tacrolimus (oral)1,2,3 Red in recognising side effects or high cost of investigations to identify toxicity)
1) Requiring specialist assessment to enable patient selection, initiation and ongoing treating
2) Requiring long term on-going monitoring of efficacy by a specialist
3) Requiring long term on-going monitoring of toxicity by a specialist (either because of difficulty
8.2.3 Rituximab1,2,3 Red in recognising side effects or high cost of investigations to identify toxicity)
8.2.4 Glatiramer acetate1,2,3,4 Red
1) Requiring specialist assessment to enable patient selection, initiation and ongoing treating
2) Requiring long term on-going monitoring of efficacy by a specialist
3) Requiring long term on-going monitoring of toxicity by a specialist (either because of difficulty
8.2.4 Interferons1,2,3, α - and β - Red in recognising side effects or high cost of investigations to identify toxicity)
1) Requiring specialist assessment to enable patient selection, initiation and ongoing treating
2) Requiring long term on-going monitoring of efficacy by a specialist
5) That are new or a new indication for an existing drug, that needs evaluation to be undertaken
to establish place in therapy
8.2.4 Natalizumab1,2,5 Red
8.3.4 Anastrozole (only on consultant recommendation) Green
8.3.4 Leuprorelin1,2,5 Brown
8.3.4 Triptorelin (for licensed indications) Green
8.3.4.1 Exemestane (only on consultant recommendation) Green
8.3.4.1 Fulvestrant1,2 Red
8.3.4.1 Letrozole (only on consultant recommendation) Green
8.3.4.2 Bicalutamide 50mg/150mg tabs (with Derby Hospitals) Amber
8.3.4.2 Goserelin (for licensed indications) Green
1) Requiring specialist assessment to enable patient selection and initiation of treatment.
5) Specific long term monitoring for toxicity
1,5
8.3.4.3 Lanreotide Amber
1) Requiring specialist assessment to enable patient selection and initiation of treatment.
5) Specific long term monitoring for toxicity
8.3.4.3 Octreotide1,5 Amber
1) Requiring specialist assessment to enable patient selection, initiation and ongoing treating
2) Requiring long term on-going monitoring of efficacy by a specialist
3) Requiring long term on-going monitoring of toxicity by a specialist (either because of difficulty
9.1.3 Darbepoetin1,2,3 Red in recognising side effects or high cost of investigations to identify toxicity)
1) Requiring specialist assessment to enable patient selection, initiation and ongoing treating
9.1.3 Deferasirox1,2 Red 2) Requiring long term on-going monitoring of efficacy by a specialist
1) Requiring specialist assessment to enable patient selection, initiation and ongoing treating
2) Requiring long term on-going monitoring of efficacy by a specialist
3) Requiring long term on-going monitoring of toxicity by a specialist (either because of difficulty
9.1.3 Deferiprone1,2,3 Red in recognising side effects or high cost of investigations to identify toxicity)
1) Requiring specialist assessment to enable patient selection, initiation and ongoing treating
2) Requiring long term on-going monitoring of efficacy by a specialist
3) Requiring long term on-going monitoring of toxicity by a specialist (either because of difficulty
9.1.3 Erythropoetin (Epoetin)1,2,3 Red in recognising side effects or high cost of investigations to identify toxicity)
9.1.3 Mircera1 Red
1) Requiring specialist assessment to enable patient selection, initiation and ongoing treating
2) Requiring long term on-going monitoring of efficacy by a specialist
9.1.4 Anagrelide1,2 Red
9.4.1 Cinacalcet1,2 Red
9.5.2 Sevelamer (with Derby hospitals) Amber
9.5.2 Sevelamer (with Sheffield hospitals) Red
9.5.2.2 Lanthanum carbonate (with Derby hospitals) Amber
1) Requiring specialist assessment to enable patient selection, initiation and ongoing treating
9.5.2.2 Lanthanum carbonate1,2 (with Sheffield hospitals) Red 2) Requiring long term on-going monitoring of efficacy by a specialist
9.8.1 Mercaptamine Red
9.8.1 Trientine Red
A7.5.1 Colief liquid Brown
1) Requiring specialist assessment to enable patient selection and initiation of treatment.
3) Requiring short or medium term specialist monitoring of toxicity.
A7.5.1 VSL#3 1,3,5 (pouchitis only) Amber 5) Specific long term monitoring for toxicity
Erfa
Not licensed Thyroid Brown Lack of data on safety and effectiveness
Degarelix injection
Not yet listed Brown
5
Not yet listed
Fluticasone furoate nasal spray (Avamys) Green After consultant initiation
histrelin implant
Not yet listed Red
Liraglutide injection
Not yet listed Red
Tredaptive
Not yet listed Brown
Axorid MR Capsule (ketoprofen + omeprazole)
Not yet listed Brown Lack of data on cost effectiveness compared with standard therapy.
2.3.2 Dronedarone Green Specialist initiation. Criteria as per NICE TAG 197
Azarga eye drops (brinzolamide + timolol)
Not yet listed Green After consultant initiation)
Febuxostat
Not yet listed Green 2nd line use only
Epiduo topical Gel
Not yet listed Brown Lack of data on cost effectiveness compared with standard therapy.
Eslicarbazepine
Not yet listed Brown Lack of data on cost effectiveness compared with standard therapy.
Indacaterol (Onbrez Breezhaler)
Not yet listed Brown Lack of long-term data
Capsaicin patch (Qutenza)
Not yet listed Red Requires specialist assessment
5-FU cream (only on consultant recommendation) Green
1) Lack of data on effectiveness compared with standard therapy.
2) Lack of data on safety compared with standard therapy.
5) Less cost-effective than current standard therapy
Armour thyroid1,2,5 Brown
Colief liquid Brown Borderline substance
Depot typical antipsychotics (only on consultant recommendation) Green
1) Lack of data on effectiveness compared with standard therapy.
Disofrol1,2 Brown 2) Lack of data on safety compared with standard therapy.
Glitazones (as per NICE guidance) Green
Ibandronate 150mg tablet Brown
Midodrine1,7 Red
n-Acetylcysteine tabs (with Derby hospitals) Amber
Sekivar4 (olmesartan + amlodipine) Brown 4) Lack of data on cost-effectiveness compared with standard therapy.
1) Requiring specialist assessment to enable patient selection, initiation and ongoing treating
2) Requiring long term on-going monitoring of efficacy by a specialist
3) Requiring long term on-going monitoring of toxicity by a specialist (either because of difficulty
Trosulfan1,2,3 Red in recognising side effects or high cost of investigations to identify toxicity)
Valdecoxib Brown
Prucalopride Brown Lack of long-term data on effectiveness and safety and lack of cost-effectiveness data
4.7.2 Oxycodone Brown Exeptional use in opioid patients unable to tolerate morphine
Roflumilast tablets
Not yet classified Red
7.3.1 Gedarel Tablets 30/150 Green
7.3.1 Gedarel Tablets 20/150 Green
7.3.1 Millinette tablets 30/75 Green
7.3.1 Millinette tablets 20/75 Green
7.3.1 Rigevidon tablets Green
7.3.1 TriRegol tablets Green
Simvastatin Suspension Brown
Betesil plaster Red
Topical tacrolimus Green
VSL#3 Green
Sativex Black
Grazax Black
Promixin Black
Intanza Black
Duodopa Black
Rosuvastatin Black
Targinact (oxycodone + naloxone) Black
Escitalopram Black
Esomeprazole Black
Levocetirizine Black
Desloratadine Black
Viteyes Black
ICaps Black
Preservision Black
JOINT AREA PRESCRIBING COMMITTEE (JAPC)
Traffic light classification for prescribing
Criteria for classification
RED Drugs
A consultant or specialist, usually within a secondary or tertiary care services (in some circumstances could be a GPSI), should undertake initiation and ongoing prescribing.
Criteria for Classification
1) Requiring specialist assessment to enable patient selection, initiation and ongoing treating
2) Requiring long term on-going monitoring of efficacy by a specialist
3) Requiring long term on-going monitoring of toxicity by a specialist (either because of difficulty in recognising side effects or high cost of investigations to identify toxicity)
4) Specifically designated as “hospital only” by product licence or by DH/NICE
5) That are new or a new indication for an existing drug, that needs evaluation to be undertaken to establish place in therapy
6) That are hospital initiated clinical trial material
7) Unlicensed drugs (or not categorised in a BNF) or drugs unfamiliar to primary care prescribed “off-label”
AMBER Drugs
Drugs that are initiated in secondary care or other specialist setting but are suitable for GPs to continue ongoing prescribing. To be agreed between primary/secondary care clinicians
involved. The specialist to provide the GP with necessary information and support in order for treatment to be managed safely in primary care. Shared care guidelines will be available.
Criteria for Classification
1) Requiring specialist assessment to enable patient selection and initiation of treatment.
2) Requiring short or medium term (e.g. 3-6 months) specialist monitoring of efficacy or until the patient is stable.
3) Requiring short or medium term specialist monitoring of toxicity.
4) That are very rarely used such that GPs are unlikely to see sufficient patients and acquire a working knowledge of the drug.
5) Specific long term monitoring for toxicity
6) NICE Guidance
BROWN Drugs
JAPC does not recommend for use except in exceptional circumstances. Seek advice from your prescribing adviser and record your reasons for prescribing.
Criteria for classification
1) Lack of data on effectiveness compared with standard therapy.
2) Lack of data on safety compared with standard therapy.
3) Known increase in risk of adverse events compared with standard therapy.
4) Lack of data on cost-effectiveness compared with standard therapy.
5) Less cost-effective than current standard therapy
6) NICE guidance
7) Not accepted as cost effective compared to other service development opportunities within the PCT's Local Operational Plan
GREEN Drugs
Regarded as suitable for primary care prescribing. Drugs for which GPs (or non-medical prescribers in primary care) should take full responsibility for initiating and ongoing prescribing.
Local prescribing guidelines or NICE guidance may apply.