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					                                                             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)
3)                                                     toxicity by a specialist
            Requiring long term on-going monitoring of efficacyby 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

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.
                                                                           JAPC Traffic Lights Prescribing Summary
Oct-08
Those in bold have been agreed by CEPPaC/JAPC/Traffic lights group

BROWN                                           RED                                          AMBER
JAPC does not recommend for use except in                                                    Usually initiated within a hospital
                                                Prescribing responsibility lies normally
exceptional circumstances. Seek advice from                                                  setting but suitable for shared care
                                                with a hospital consultant or a
your prescribing adviser and record your                                                     with GP under a shared care
                                                specialist (which could be a GPSI)
reasons for prescribing.                                                                     agreement
Aliskiren1,2,4                                           4
                                                Acitretin                                    Acamprosate1
Armour thyroid1,2,5                                               1,2,3
                                                Ambrisentan                                  Apomorphine1 (in Parkinson’s disease)
Atorvastatin5,6                                 Adefovir1,2                                  Atomoxetine1,3
Buprenorphine patches                           Anagrelide1,2                                Buprenorphine (for opiate dependance)
Celecoxib                                       Apraclonidine eye drops1,2                   Colistin (including Promixin)1,3
Ciclesonide1,5                                  Aripiprazole injection1,2                    Dexamfetamine1,3
Colesevalem1,2,4                                Azathioprine1,3 (except as a DMARD when amber) isulfiram1,2
                                                                                             D
Colief liquid                                   Basiliximab1,2,3                             DMARDS1,2:-
Co-proxamol (unlicensed)                        Bexarotene1,2,3                                     Auranofin
Desloratidine5                                  Bosentan1,2,3                                       Azathioprine
Dexibuprofen4                                                            1,3
                                                Botulinum Toxin                                     Ciclosporin
Disofrol1,2                                     Busulfan   1,2,3
                                                                                                    Hydroxychloroquine
Duodopa5                                                           1,2,3
                                                Capecitabine                                        Leflunomide
                                                                   1,2,3
Eflornithine cream                              Chlorambucil                                        Methotrexate (oral and injection)
Erdosteine1,4                                                   1,3
                                                Ciclosporin (except as a DMARD when amber)          Penicillamine
Escitalopram4,5                                               1,2
                                                Cinacalcet                                          Sodium aurothiomalate
                                                                             1,2,3
Esomeprazole                                    Clodronate sodium                                   Sulfasalazine
Etoricoxib                                      Clozapine                                    Donepezil1,3
Eucreas1,2,4 (vildagliptin + metformin)                                      1,2,3
                                                Cyclophosphamide                             Galantamine1,3
Evra patch                                      Dabigatran4                                  Growth Hormone
Exforge5                                        Daclizumab1,2,3                              Lanreotide1,5
Fesoterodine1,4                                 Darbepoetin1,2,3                             Lithium
Fosavance1,5                                    Dasatinib1,2,3                               LMWH (e.g. enoxaparin, tinzaparin)1
Grazax4                                         Deferasirox1,2                               Lofexidine
Hyaluronic acid injection6                      Deferiprone1,2,3                             Melatonin1,5
                                                                     1,2,3
Ibandronate 150mg tablet                        Dornase alpha                                Methadone
Inegy                                           Efalizumab1,2,3                              Methylphenidate1,3
Leuprorelin1,2,5                                                   1,2,3
                                                Estramustine                                 Midazolam buccal
Levocetirizine5                                 Epoprostenol1,2,3                            Modafinil1,5
Melatonin prolonged-release (Circadin) 1                  1,2,3
                                                Erlotinib                                    Naltrexone
Memantine                                       Erythropoetin (Epoetin)1,2,3                 Octreotide1,5
                                                              1,2,3
Micardis plus                                   Etanercept                                   Riluzole1,5
Minocycline                                     Etoposide1,2,3                               Rivastigmine1,3
Omacor                                          Exenatide                                    Sevelamer (with Derby hospitals)
Paliperidone5                                   Fludarabine1,2,3                             VSL#3 1,3,5 (pouchitis only)
Retapamulin 1% ointment4                                       1,2
                                                Fulvestrant
Rosuvastatin                                    Glatiramer acetate1,2,3,4
Sativex (unlicensed)                            Glycoprotein IIb/IIIa Inhibitors1
Sitagliptin1,2,4                                HIV anti-virals1,2,3
Suboxone1                                       Hydroxycarbamide1,2,3
Testosterone patch (Intrinsa)1,2,4              Idarubicin1,2,3
Valdecoxib                                      Iloprost1,2,3
Valproate semisodium (Depakote)                 Imatinib1,2,3
Vildagliptin1,2,4 (and vildagliptin+metf’min)   Infliximab1,2,3
                                                Ionsys4 (fentanyl transdermal system)
                                                Interferons1,2,3, α - and β -
                                                Isotretinoin tablets
                                                Ketamine1,2,3
                                                                1,2
                                                Lamivudine
                                                Lanthanum carbonate1,2
                                                Linezolid1,3
                                                Lomustine1,2,3
                                                Melphalan1,2,3
                                                Mercaptopurine1,2,3
                                                Methylnaltrexone1,5
                                                Mircera1
                                                Midodrine1,7
                                                Mitotane1,2,3
                                                Mycophenolate1,2,3
                                                Natalizumab1,2,5
                                                Omalizumab1,2
                                                Ondansetron etc.
Palivizumab1,2,3
Pamidronate disodium1,2,3
Pegvisomant (Somavert)1,2,3
Procarbazine1,2,3
Quinagolide1,2,3
Ranibizumab1,2
Ribavirin1,3
Risperidone depot injection1,2,3
Rituximab1,2,3
Sevelamer (with Sheffield hospitals)
Sildenafil 20mg tab (Revatio) for PAH1,2
Sirolimus1,2,3
Sorafenib1,2,3
Sunitinib1,2,3
Tacrolimus (oral)1,2,3
Tegafur/uracil1,2,3
Temozolomide1,2,3
Tenofovir1,2
Teriparatide1,2,3
Tiludronic acid1,2,3
Tioguanine1,2,3
                       1,2,3
Tobramycin nebulised
Trosulfan1,2,3
Tryptophan1,2,3
Valganciclovir1,3
Vinorelbine1,2,3
ts Prescribing Summary



                     GREEN


                     Regarded as suitable for primary care prescribing


                     Anastrozole (only on consultant recommendation)
                     Aripiprazole oral (only on consultant recommendation)
                     Cabergoline (hyperprolactinaemia only)
                     Celluvisc eye drops (not first line)
                     Cerazette
                     Depot typical antipsychotics (only on consultant recommendation)
                     Dosulepin (continuation use only)
                     Duloxetine (3rd line antidepressant and 3rd line diabetic neuropathy use only)
                     Eplerenone (only if spironolactone not tolerated)
                     Exemestane (only on consultant recommendation)
                     Ezetimibe (as per NICE guidance)
                     Fostair
                     5-FU cream (only on consultant recommendation)
                     Glitazones (as per NICE guidance)
                     Glucosamine sulphate (for knee OA)
                     Goserelin (for licensed indications)
                     Hedrin lotion
                     Ivabradine (only on consultant recommendation)
                     Letrozole (only on consultant recommendation)
                     Levetiracetam (not first line)
                     Lidocaine 5% plaster (see neuropathic pain guideline)
                     Lymecycline caps (2nd line for acne)
                     Metformin SR (2nd line use only)
                     Nebido injection (only on consultant recommendation)
                     Nebivolol (only on consultant recommendation)
                     Niaspan (only on consultant recommendation)
                     Nicorandil (3rd or 4th line)
                     Olanzapine (only on consultant recommendation)
                     Oxcarbazepine (not first line)
                     Pramipexole (only on consultant recommendation)
                     Pregabalin (see neuropathic pain guideline)
                     Quetiapine (only on consultant recommendation)
                     Rasagiline (only on consultant recommendation)
                     Rimonabant (as per NICE guidance)
                     Ropinirole (only on consultant recommendation)
                     Rotigotine (only on consultant recommendation)
                     Solaraze gel (diclofenac 3%)
                     Solifenacin (3rd line use only)
                     Stalevo
                     Strontium ranelate (2nd line use only)
                     Sustanon injection (only on consultant recommendation)
                     Testim gel (only on consultant recommendation)
                     Testogel (only on consultant recommendation)
                     Tramadol (see neuropathic pain guideline)
                     Triptorelin (for licensed indications)
                     Varenicline
                     Venlafaxine (as per depression guideline)
                     Yasmin (not first-line)
                     Zaleplon, zolpidem, zopiclone (as per NICE guidance)
                     Zonisamide (only on consultant recommendation)
                                                                 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 responsibilit y 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 safet y, effectiveness, and/or cost-effectiveness.




Drug                                                                    Status   BNF      Comments

5-FU cream (only on consultant recommendation)                          Green
Acamprosate1                                                            Amber 4.10    1)        Requiring specialist assessment to enable patient selection and initiation of treatment.
Acitretin4                                                              Red   13.5.2 4)         Specifically designated as “hospital only” by product licence or by DH/NICE
                                                                                      1)        Requiring specialist assessment to enable patient selection, initiation and ongoing treating
                                                                                      2)        Requiring long term on-going monitoring of efficacy by a specialist
Adefovir1,2                                                             Red   5.3.3
                                                                                      1)        Lack of data on effectiveness compared with standard therapy.
                                                                                      2)        Lack of data on safety compared with standard therapy.
Aliskiren1,2,4                                                          Brown 2.5.5.3 4)        Lack of data on cost-effectiveness compared with standard therapy.
Alitretinoin4                                                           Red               4)      Specifically designated as “hospital only” by product licence or by DH/NICE
Amantadine6                                                             Brown 4.9.1       6)      NICE guidance
                                                                                          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)
Ambrisentan1,2,3                                                        Red
                                                                                          1)    Requiring specialist assessment to enable patient selection, initiation and ongoing treating
Anagrelide    1,2
                                                                        Red   9.1.4       2)    Requiring long term on-going monitoring of efficacy by a specialist
Anastrozole (only on consultant recommendation)                         Green 8.3.4
Apomorphine1 (in Parkinson’s disease)                                   Amber 4.9.1       1)    Requiring specialist assessment to enable patient selection and initiation of treatment.
                                                                                          1)    Requiring specialist assessment to enable patient selection, initiation and ongoing treating
                                    1,2                                                   2)    Requiring long term on-going monitoring of efficacy by a specialist
Apraclonidine eye drops                                                 Red      11.8.2
                                                                                          1)    Requiring specialist assessment to enable patient selection, initiation and ongoing treating
Aripiprazole injection        1,2
                                                                        Red   4.2.1       2)    Requiring long term on-going monitoring of efficacy by a specialist
Aripiprazole oral (only on consultant recommendation)                   Green 4.2.1
                                                                                          1)    Lack of data on effectiveness compared with standard therapy.
                                                                                          2)    Lack of data on safety compared with standard therapy.
                      1,2,5                                                               5)    Less cost-effective than current standard therapy
Armour thyroid                                                          Brown
                                                                                          1)     Requiring specialist assessment to enable patient selection and initiation of treatment.
Atomoxetine     1,3
                                                                        Amber 4.4         3)    Requiring short or medium term specialist monitoring of toxicity.
                                                                                          5)    Less cost-effective than current standard therapy
Atorvastatin5,6                                                         Brown 2.12        6)    NICE guidance
      Auranofin                                                         Amber 10.1.3
      Azathioprine                                                      Amber 8.2.1
                                                                                          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
Azathioprine          (except as a DMARD when amber)                    Red      8.2.1    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 in
Basiliximab1,2,3                                Red     8.2.2     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 in
Bexarotene1,2,3                                 Red     8.1.5     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 in
Bosentan1,2,3                                   Red     2.5.1     recognising side effects or high cost of investigations to identify 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
Botulinum Toxin1,3                              Red   4.9.3       difficulty in recognising side effects or high cost of investigations to identify toxicity)
Buprenorphine (for opiate dependance)           Amber 4.10
Buprenorphine patches                           Brown 4.10
                                                                  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
Busulfan1,2,3                                   Red   8.1.1       recognising side effects or high cost of investigations to identify toxicity)
Cabergoline (hyperprolactinaemia only)          Green 6.7.1
                                                                  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
Capecitabine1,2,3                               Red     8.1.3     recognising side effects or high cost of investigations to identify toxicity)
Celecoxib                                       Brown   10.1.1
Celluvisc eye drops (not first line)            Green   11.8.1
Cerazette                                       Green   7.3.2.1
                                                                  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
Chlorambucil1,2,3                               Red     8.1.1     recognising side effects or high cost of investigations to identify toxicity)
Ciclesonide1,5                                  Brown   3.2
      Ciclosporin                               Amber   13.5.3
Ciclosporin1,3 (except as a DMARD when amber)   Red     13.5.3
Cinacalcet1,2                                   Red     9.4.1
                                                                  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
Clodronate sodium1,2,3                          Red     6.6.2     recognising side effects or high cost of investigations to identify toxicity)
Clozapine                                       Red     4.2.1
Colesevalem1,2,4                                Brown   2.12
Colief liquid                                   Brown
Colistin1,3                                     Amber   5.1.7
Co-proxamol (unlicensed)                        Brown   4.7.1
                                                                  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
Cyclophosphamide1,2,3                           Red     8.1.1     recognising side effects or high cost of investigations to identify toxicity)
Dabigatran4                                     Red     2.8.2
                                                                  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
Daclizumab1,2,3                                 Red     8.2.2     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 in
Darbepoetin1,2,3                                                                 Red     9.1.3    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 in
Dasatinib1,2,3                                                                   Red     8.1.5    recognising side effects or high cost of investigations to identify toxicity)
Deferasirox1,2                                                                   Red     9.1.3
                                                                                                  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
Deferiprone1,2,3                                                                 Red     9.1.3    recognising side effects or high cost of investigations to identify toxicity)
Depot typical antipsychotics (only on consultant recommendation)                 Green
Desloratidine5                                                                   Brown   3.4.1
Dexamfetamine1,3                                                                 Amber   4.4
Dexibuprofen4                                                                    Brown   10.1.1
Disofrol1,2                                                                      Brown
Disulfiram1,2                                                                    Amber   4.10
DMARDS1,2:-                                                                      Amber   10.1.3
Donepezil1,3                                                                     Amber   4.11
                                                                                                  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
Dornase alpha1,2,3                                                               Red     3.7      recognising side effects or high cost of investigations to identify toxicity)
Dosulepin (continuation use only)                                                Green   4.3.1
Duloxetine (3rd line antidepressant and 3rd line diabetic neuropathy use only)   Green   4.3.4
Duodopa5                                                                         Brown   4.9.7
                                                                                                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
Efalizumab1,2,3                                                                  Red     13.5.3 recognising side effects or high cost of investigations to identify toxicity)
Eflornithine cream                                                               Brown   13.9
Eplerenone (only if spironolactone not tolerated)                                Green   2.2.3
                                                                                                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
Epoprostenol1,2,3                                                                Red     2.8.1 recognising side effects or high cost of investigations to identify toxicity)
Erdosteine1,4                                                                    Brown   3.7
                                                                                                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
Erlotinib1,2,3                                                                   Red     8.1.5 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 in
Erythropoetin (Epoetin)1,2,3                                                     Red     9.1.3 recognising side effects or high cost of investigations to identify toxicity)
Escitalopram4,5                                                                  Brown   4.3.3
Esomeprazole                                                                     Brown   1.3.5
                                                                                                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
Estramustine1,2,3                                                                Red     8.1.1 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 in
Etanercept1,2,3                                                                  Red     13.5.3 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 in
Etoposide1,2,3                                   Red     8.1.4     recognising side effects or high cost of investigations to identify toxicity)
Etoricoxib                                       Brown   10.1.1
Eucreas1,2,4 (vildagliptin + metformin)          Brown   6.1.2.3
Evra patch                                       Brown   7.3.1
Exemestane (only on consultant recommendation)   Green   8.3.4.1
Exenatide                                        Red     6.1.2.3
Exforge5                                         Brown   2.6.2
Ezetimibe (as per NICE guidance)                 Green   2.12
Fesoterodine1,4                                  Brown   7.4.2
                                                                   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
Fludarabine1,2,3                                 Red     8.1.3     recognising side effects or high cost of investigations to identify toxicity)
Fosavance1,5                                     Brown   6.6.2
Fostair                                          Green   3.1.5
Fulvestrant1,2                                   Red     8.3.4.1
Galantamine1,3                                   Amber   4.11
Glatiramer acetate1,2,3,4                        Red     8.2.4
Glitazones (as per NICE guidance)                Green
Glucosamine sulphate (for knee OA)               Green   10.1.5
Glycoprotein IIb/IIIa Inhibitors1                Red     2.9
Goserelin (for licensed indications)             Green   8.3.4.2
Grazax4                                          Brown   3.4.2
Growth Hormone                                   Amber   6.5.1
Hedrin lotion                                    Green   13.10.4
                                                                   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
HIV anti-virals1,2,3                             Red   5.3.1       recognising side effects or high cost of investigations to identify toxicity)
Hyaluronic acid injection6                       Brown 10.1
                                                                   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
Hydroxycarbamide1,2,3                            Red   8.1.5       recognising side effects or high cost of investigations to identify toxicity)
      Hydroxychloroquine                         Amber 10.1.3
Ibandronate 150mg tablet                         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 in
Idarubicin1,2,3                                  Red     8.1.2     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 in
Iloprost1,2,3                                    Red     2.5.1     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 in
Imatinib1,2,3                                    Red   8.1.5       recognising side effects or high cost of investigations to identify toxicity)
Inegy                                            Brown 2.12
                                                                   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
Infliximab1,2,3                                  Red     1.5.3     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 in
Interferons1,2,3, α - and β -                           Red   8.2.4       recognising side effects or high cost of investigations to identify toxicity)
Isotretinoin tablets                                    Red   13.6.2
Ivabradine (only on consultant recommendation)          Green 2.6.3
                                                                        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
Ketamine1,2,3                                           Red     15.1.1 recognising side effects or high cost of investigations to identify toxicity)
Lacosamide1,5                                           Red     4.8.1
Lamivudine1,2                                           Red     5.3.1
Lanreotide1,5                                           Amber   8.3.4.3
Lanthanum carbonate (with Derby hospitals)              Amber   9.5.2.2
Lanthanum carbonate1,2 (with Sheffield hospitals)       Red     9.5.2.2
Leflunomide                                             Amber   10.1.3
Letrozole (only on consultant recommendation)           Green   8.3.4.1
Leuprorelin1,2,5                                        Brown
Levetiracetam (not first line)                          Green   4.8.1
Levocetirizine5                                         Brown   3.4.1
Lidocaine 5% plaster (see neuropathic pain guideline)   Green
Linezolid1,3                                            Red     5.1.7
Liothyronine1,2 (for depression)                        Amber
Lithium                                                 Amber   4.2.3
LMWH (e.g. enoxaparin, tinzaparin)1                     Amber   2.8.1
Lofexidine                                              Amber   8.1.1
                                                                          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
Lomustine1,2,3                                          Red     4.10      recognising side effects or high cost of investigations to identify toxicity)
Lymecycline caps (2nd line for acne)                    Green   5.1.3
Melatonin prolonged-release (Circadin)1                 Brown   4.1.1
Melatonin1,5                                            Amber   4.1.1
                                                                          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
Melphalan1,2,3                                          Red   8.1.1       recognising side effects or high cost of investigations to identify toxicity)
Memantine                                               Brown 4.11
                                                                          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
Mercaptopurine1,2,3                                     Red     8.1.3     recognising side effects or high cost of investigations to identify toxicity)
Metformin SR (2nd line use only)                        Green   6.1.2.2
Methadone                                               Amber   4.7.2
Methotrexate (oral and injection)                       Amber   10.1.3
Methylnaltrexone1,5                                     Red     1.6.6
Methylphenidate1,3                                      Amber   4.4
Micardis plus                                           Brown   2.5.5.2
Midazolam buccal                                        Amber   4.8.2
Midodrine1,7                                            Red
Minocycline                                             Brown   5.1.3
Mircera1                                                Red     9.1.3
                                                                          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
Mitotane1,2,3                                           Red   8.1.5       recognising side effects or high cost of investigations to identify toxicity)
Modafinil1,5                                            Amber 4.4
                                                                                  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
Mycophenolate1,2,3                                              Red     8.2.1     recognising side effects or high cost of investigations to identify toxicity)
Naltrexone                                                      Amber   4.10
Natalizumab1,2,5                                                Red     8.2.4
Nebido injection (only on consultant recommendation)            Green   6.4.2
Nebivolol (only on consultant recommendation)                   Green   2.4
Niaspan (only on consultant recommendation)                     Green   2.12
Nicorandil (3rd or 4th line)                                    Green   2.6.3
NuvaRing5                                                       Brown
Octreotide1,5                                                   Amber   8.3.4.3
Olanzapine (only on consultant recommendation)                  Green   4.2.1
Omacor                                                          Brown   2.12
Omalizumab1,2                                                   Red     3.4.2
Ondansetron etc.                                                Red     4.6
Oxcarbazepine (not first line)                                  Green   4.8.1
Paliperidone5                                                   Brown   4.2.1
                                                                                  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
Palivizumab1,2,3                                                Red     5.3.5     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 in
Pamidronate disodium1,2,3                                       Red     6.6.2     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 in
Pegvisomant (Somavert)1,2,3                                     Red   6.5.1       recognising side effects or high cost of investigations to identify toxicity)
Penicillamine                                                   Amber 10.1.3
Pramipexole (only on consultant recommendation)                 Green 4.9.1
Pregabalin (see neuropathic pain guideline)                     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
Procarbazine1,2,3                                               Red               recognising side effects or high cost of investigations to identify toxicity)
Promixin5                                                       Brown
Quetiapine [including MR] (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
Quinagolide1,2,3                                                Red               recognising side effects or high cost of investigations to identify toxicity)
Ranibizumab1,2                                                  Red
Rasagiline (only on consultant recommendation)                  Green
Retapamulin 1% ointment4                                        Brown
Ribavirin1,3                                                    Red
Riluzole1,5                                                     Amber
Risperidone depot injection1,2,3                                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 in
Rituximab1,2,3                                                  Red               recognising side effects or high cost of investigations to identify toxicity)
Rivaroxaban4                                                    Red
Rivastigmine1,3                                                 Amber
Ropinirole [including XL] (only on consultant recommendation)   Green
Rosiglitazone3                                                  Brown
Rosuvastatin                                                    Brown
Rotigotine (only on consultant recommendation)           Green
Sativex (unlicensed)                                     Brown
Sevelamer (with Derby hospitals)                         Amber
Sevelamer (with Sheffield hospitals)                     Red
Sildenafil 20mg tab (Revatio) for PAH1,2                 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 in
Sirolimus1,2,3                                           Red     recognising side effects or high cost of investigations to identify toxicity)
Sitagliptin1,2,4                                         Brown
       Sodium aurothiomalate                             Amber
Solaraze gel (diclofenac 3%)                             Green
Solifenacin (3rd 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 in
Sorafenib1,2,3                                           Red     recognising side effects or high cost of investigations to identify toxicity)
Stalevo                                                  Green
Strontium ranelate (2nd line use only)                   Green
Suboxone1                                                Brown
      Sulfasalazine                                      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 in
Sunitinib1,2,3                                           Red     recognising side effects or high cost of investigations to identify toxicity)
Sustanon injection (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
Tacrolimus (oral)1,2,3                                   Red     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 in
Tegafur/uracil1,2,3                                      Red     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 in
Temozolomide1,2,3                                        Red     recognising side effects or high cost of investigations to identify toxicity)
Tenofovir1,2                                             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 in
Teriparatide1,2,3                                        Red     recognising side effects or high cost of investigations to identify toxicity)
Testim gel (only on consultant recommendation)           Green
Testogel (only on consultant recommendation)             Green
Testosterone patch (Intrinsa)1,2,4                       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 in
Tiludronic acid1,2,3                                     Red     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 in
Tioguanine1,2,3                                          Red     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 in
Tobramycin nebulised1,2,3                                Red     recognising side effects or high cost of investigations to identify toxicity)
Tramadol (see neuropathic pain guideline)              Green
Triptorelin (for licensed indications)                 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
Trosulfan1,2,3                                         Red     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 in
Tryptophan1,2,3                                        Red     recognising side effects or high cost of investigations to identify toxicity)
Valdecoxib                                             Brown
Valganciclovir1,3                                      Red
Valproate semisodium (Depakote)                        Brown
Varenicline                                            Green
Venlafaxine (as per depression guideline)              Green
Vildagliptin1,2,4 (and vildagliptin+metf’min)          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 in
Vinorelbine1,2,3                                       Red     recognising side effects or high cost of investigations to identify toxicity)
VSL#3 1,3,5 (pouchitis only)                           Amber
Yasmin (not first-line)                                Green
Zaleplon, zolpidem, zopiclone (as per NICE guidance)   Green
Zonisamide (only on consultant recommendation)         Green

				
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