Traffic Lights RED Specialist prescribing only eczema by mikeholy

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									                                            Mid-Essex Area ‘Traffic Lights’
        Red =Specialist prescribing only for the condition stated-usually secondary care but could be
        accredited GPwSI when working within an accredited specialist service.
        Amber =Prescribed under shared-care protocol (Local Enhanced Service) for the condition stated-drug
        requiring additional biochemical monitoring on a level 1, 2 or 3 basis as per Local Enhanced Service.
        Yellow = Medicines to be initiated by an accredited specialist prescriber and recommended to GP for
        continued prescribing after a defined period of time n, where n= minimum number of months for
        specialist prescribing. No additional blood monitoring is required but in some cases other assessment
        will be necessary as set out in defined guidance.
        Purple = Drugs not recommended for prescribing within Mid-Essex
        All other Formulary drugs not appearing on this list are considered to be ‘Green’ and suitable for
        prescribing in primary care. GPs and specialists should consult their Pharmacist prescribing advisor
        before prescribing any non-formulary drug for the first time. This list will be revised on a regular
        basis. Drugs may change category over time and all prescribers will be notified of any changes.
RED                            Specialist prescribing only
                                Usually secondary/tertiary care but could be accredited GPwSI

Acitretin                        Psoriasis
Adalimumab                       Rheumatoid Arthritis
Alitretinoin                     Severe chronic hand eczema
Anagrelide                       Reduction of elevated platelet counts
Apriclonidine eye drops          Intra ocular pressure
Becaplermin Gel                  Adjunct treatment of full-thickness, neuropathic, diabetic
                                 ulcers
Benperidol                       Antipsychotic – sexual disinhibition.

Beta interferon 1-a              Relapsing Remitting MS
(Avonex, Rebif)
Beta interferon 1b               Relapsing Remitting MS
(Betaferon)                      Secondary Progressive MS
Botulinum toxin                  All indications
(Botox, Dysport)
Calcium resonium                 Hyperkalaemia
Cilostazol                       Intermittent claudication
Cinacalcet                       Secondary hyperparathyroidism in end-stage renal
                                 disease on dialysis
Darbepoetin                      Anaemia associated with chronic renal failure and non-
                                 myeloid malignancies
Deferasirox                      Iron overload
Deferiprone                      Iron overload
Desferrioxamine                  Iron overload
Disodium edetate eye             Chelating agent
drops
Entecavir                        Chronic Hepatits B infection
Erythropoietin                   Anaemia associated with erythropoietin deficiency in renal
                                 failure
Etanercept                       Rheumatoid arthritis, psoriatic arthritis, psoriasis
Ganciclovir                      Life and sight threatening cytomegalovirus infections
(Cymevene)
Glycopyrrolate                   Hyperhidrosis                                                                  LINK
Grazax                           Seasonal allergic hay fever due to grass pollen in adults
                                 with a positive skin prick test or IgE test who have failed to
                                 respond to anti-allergy drugs
Hyaluronic acid &                Osteoarthritis of the knee
derivatives
        Approved by Mid Essex Area Prescribing Committee                            Updated: December 2010
        Chairman: Dr Alan Jackson
                                            Mid-Essex Area ‘Traffic Lights’
        Red =Specialist prescribing only for the condition stated-usually secondary care but could be
        accredited GPwSI when working within an accredited specialist service.
        Amber =Prescribed under shared-care protocol (Local Enhanced Service) for the condition stated-drug
        requiring additional biochemical monitoring on a level 1, 2 or 3 basis as per Local Enhanced Service.
        Yellow = Medicines to be initiated by an accredited specialist prescriber and recommended to GP for
        continued prescribing after a defined period of time n, where n= minimum number of months for
        specialist prescribing. No additional blood monitoring is required but in some cases other assessment
        will be necessary as set out in defined guidance.
        Purple = Drugs not recommended for prescribing within Mid-Essex
        All other Formulary drugs not appearing on this list are considered to be ‘Green’ and suitable for
        prescribing in primary care. GPs and specialists should consult their Pharmacist prescribing advisor
        before prescribing any non-formulary drug for the first time. This list will be revised on a regular
        basis. Drugs may change category over time and all prescribers will be notified of any changes.
(e.g.Durolane)
Imiquimod                        External genital and perianal warts
Infliximab                       Crohn’s disease, rheumatology
Interferon Alfa                  Hepatitis C
(Intron A, Viraferon,
Viraferon Peg PegIntron,
Roferon A)
Interferon Alfa-2b               Multiple myeloma/Renal Cancer; Hepatitis C
(Intron A)
Iodine (aqueous oral             Thyrotoxicosis
solution)
(Lugol’s Iodine)
Isotretinoin                     Acne
Lamivudine                       Hep B infection
Lenalidomide                     Multiple myeloma
Methoxypsoralen                  PUVA
Nimodipine                       Subarachnoid haemorrhage
Olanzapine injection             Psychiatric use only. Control of agitation and disturbed
                                 behaviour
Omalizumab                       Severe persistent allergic asthma
Ondansetron                      Nausea and Vomiting – chemotherapy/radiotherapy
                                                          induced
                                                          post-operative
Palivizumab                      Prevention of serious lower respiratory infection caused by
                                 RSV
Paricalcitol                     Secondary hyperparathyroidism                                                  LINK
Phenoxybenzamine                 Phaeochromocytoma
Pilocarpine tablets              Xerostomia
Quinagolide                      Hyperprolactinaemia
Ribavirin                        Severe respiratory sybcytial virus bronchiolitis; Hepatitis C
Rituximab                        Chronic lymphocytic leukaemia
Rivaroxaban                      Prevention of venous thromboembolism after total hip or
                                 knee replacement in adults
Sertindole                       Schizophrenia
Sodium Picosulphate              Bowel cleansing

Temozolomide                     Glioma – 2nd line
Tenofovir                        Hep B infection
Teriparatide                     Osteoporosis                                                                   LINK
Tryptophan                       Antidepressant. Named patient prescribing only


        Approved by Mid Essex Area Prescribing Committee                            Updated: December 2010
        Chairman: Dr Alan Jackson
                                             Mid-Essex Area ‘Traffic Lights’
         Red =Specialist prescribing only for the condition stated-usually secondary care but could be
         accredited GPwSI when working within an accredited specialist service.
         Amber =Prescribed under shared-care protocol (Local Enhanced Service) for the condition stated-drug
         requiring additional biochemical monitoring on a level 1, 2 or 3 basis as per Local Enhanced Service.
         Yellow = Medicines to be initiated by an accredited specialist prescriber and recommended to GP for
         continued prescribing after a defined period of time n, where n= minimum number of months for
         specialist prescribing. No additional blood monitoring is required but in some cases other assessment
         will be necessary as set out in defined guidance.
         Purple = Drugs not recommended for prescribing within Mid-Essex
         All other Formulary drugs not appearing on this list are considered to be ‘Green’ and suitable for
         prescribing in primary care. GPs and specialists should consult their Pharmacist prescribing advisor
         before prescribing any non-formulary drug for the first time. This list will be revised on a regular
         basis. Drugs may change category over time and all prescribers will be notified of any changes.
Zolendronic acid                  Pagets disease                                                                 LINK
(Aclasta)                         Treatment of postmenopausal osteoporosis
All Cytotoxic drugs               All formulary approved drugs within section 8.1 of the BNF
                                  except those for which a shared care protocol is
                                  established (Amber drugs)
All drugs for HIV                 HIV infection

All drugs for pulmonary           Tertiary Care and specialized packages
hypertension
Enzyme replacement                Tertiary Care and specialized packages
therapy
Total Parenteral                  Tertiary and specialized packages. Agreed packages of
Nutrition                         home care
(TPN)
Immunoglobulins                   Primary Immunodeficiency

AMBER                           Prescribe under shared-care protocol
                                 Additional biochemical monitoring required on a Level 1,2 or 3
                                 basis as per local enhanced service
http://www.midessex.nhs.uk/key_documents/Medicines-Management/Shared-Care-Guidelines/
Azathioprine                      Rheumatology                                                                   LINK
                                  Inflammatory bowel disease                                                     LINK
                                  Dermatology
Ciclosporin                       Transplantation                                                                LINK
(to be prescribed by              Dermatology                                                                    LINK
brand)
Clozapine                         Schizophrenia                                                                  LINK
(Clozaril)
Fulvestrant                       Advanced breast cancer in postmenopausal women                                 LINK
Gold injection (sodium            Rheumatology                                                                   LINK
aurothiomalate)
Leflunomide                       Rheumatology                                                                   LINK
Methotrexate Oral                 Rheumatology, Dermatology, Gastroenterology                                    LINK
Methotrexate injection            Rheumatology                                                                   LINK
Mycophenolate Mofetil             Immunosuppressants                                                             LINK
Penicillamine                     Rheumatology                                                                   LINK
Sirolimus                         Transplantation                                                                LINK
Sulfasalazine                     Rheumatology                                                                   LINK

Tacrolimus                        Transplantation                                                                LINK
(to be prescribed by
brand)
         Approved by Mid Essex Area Prescribing Committee                            Updated: December 2010
         Chairman: Dr Alan Jackson
                                            Mid-Essex Area ‘Traffic Lights’
        Red =Specialist prescribing only for the condition stated-usually secondary care but could be
        accredited GPwSI when working within an accredited specialist service.
        Amber =Prescribed under shared-care protocol (Local Enhanced Service) for the condition stated-drug
        requiring additional biochemical monitoring on a level 1, 2 or 3 basis as per Local Enhanced Service.
        Yellow = Medicines to be initiated by an accredited specialist prescriber and recommended to GP for
        continued prescribing after a defined period of time n, where n= minimum number of months for
        specialist prescribing. No additional blood monitoring is required but in some cases other assessment
        will be necessary as set out in defined guidance.
        Purple = Drugs not recommended for prescribing within Mid-Essex
        All other Formulary drugs not appearing on this list are considered to be ‘Green’ and suitable for
        prescribing in primary care. GPs and specialists should consult their Pharmacist prescribing advisor
        before prescribing any non-formulary drug for the first time. This list will be revised on a regular
        basis. Drugs may change category over time and all prescribers will be notified of any changes.
YELLOW                          Initiated by accredited specialist prescribers
                                 then recommended in writing to GP.
                                To be prescribed by specialist for a defined period of time before
                                GP is asked to prescribe. Additional biochemical monitoring not
                                required however other assessment may be necessary. Many of
                                these patients will receive continuing support from specialist.
                                GP care is within the GMS contract.

Acamprosate                      Alcohol dependence (1 year course). Stop if patient starts
                                 drinking again
Anastrozole                      Breast Cancer
Antipsychotics (depot)           Schizophrenia & psychosis
Apomorphine                      Parkinson’s disease
Aripiprazole                     Schizophrenia
(Abilify)
Atomoxetine3                     Treatment of ADHD                                                              LINK
(Strattera)
Bicalutamide                     Advanced prostate cancer
Bimatoprost                      Intraocular pressure
Brinzolamine with                Open-angle glaucoma
timolol (Azarga)
Bromocriptine                    Advanced Parkinson’s disease/Hyperprolactinaemia
Brompheniramine                  Chronic intractable cough                                                      LINK
                                  (unlicensed – prescribe as per pathway)
Cabergoline (Cabaser)            Advanced Parkinson’s disease
Cabergoline (Dostinex)           Hyperprolactinaemia
Carbocisteine                    Reduction of sputum viscosity                                                  LINK
Carmellose sodium                Dry Eye Conditions                                                             LINK
(Optive, Celluvisc 0.5%)
Chloroquine sulphate             Rheumatology
Chloroquine phosphate            Rheumatology
Clobazam                         Epilepsy
Colestyramine                    All indications
Cyproterone acetate              Prostate cancer
Dermovate 1:5 & 1:10             Eczema/psoriasis
Dexamphetamine 5mg3              Narcolepsy. ADHD with continuing care guidance.                                LINK
Diltiazem (2% cream)             Anal fissure                                                                   LINK
                                 (unlicensed – prescribe as per pathway)
Donepezil3                       Alzheimer’s disease with continuing care guidance                              LINK
Dornase Alfa                     Cystic fibrosis
Doxepin                          All indications
        Approved by Mid Essex Area Prescribing Committee                            Updated: December 2010
        Chairman: Dr Alan Jackson
                                             Mid-Essex Area ‘Traffic Lights’
         Red =Specialist prescribing only for the condition stated-usually secondary care but could be
         accredited GPwSI when working within an accredited specialist service.
         Amber =Prescribed under shared-care protocol (Local Enhanced Service) for the condition stated-drug
         requiring additional biochemical monitoring on a level 1, 2 or 3 basis as per Local Enhanced Service.
         Yellow = Medicines to be initiated by an accredited specialist prescriber and recommended to GP for
         continued prescribing after a defined period of time n, where n= minimum number of months for
         specialist prescribing. No additional blood monitoring is required but in some cases other assessment
         will be necessary as set out in defined guidance.
         Purple = Drugs not recommended for prescribing within Mid-Essex
         All other Formulary drugs not appearing on this list are considered to be ‘Green’ and suitable for
         prescribing in primary care. GPs and specialists should consult their Pharmacist prescribing advisor
         before prescribing any non-formulary drug for the first time. This list will be revised on a regular
         basis. Drugs may change category over time and all prescribers will be notified of any changes.
Dronedarone                       Consultant cardiologist initiation only in patients with
                                  Paroxysmal Atrial Fibrillation who have a normal heart
                                  structure and one other cardiac risk factor. 3rd line
Duloxetine (Cymbalta)             3rd line alternative for depression
Entacapone                        Parkinson’s disease
Eplerenone                        Adjunct in stable patients with LVD with heart failure,
                                  following MI
Erdosteine                        Acute exacerbations of chronic bronchitis                                      LINK
Exemestane                        Advanced breast cancer
Exenatide                         Type 2 Diabetes                                                                LINK
Fentanyl nasal spray              For palliative consultant initiation only where the oral route
(Instanyl)                        is not available
Finasteride                       Benign prostatic hyperplasia
Fludrocortisone                   Mineralocorticoid replacement
Flutamide                         Advanced prostate cancer
Fluvoxamine                       Depression
Gabapentin                        Neuropathic pain, epilepsy                                                     LINK
(prescribe as capsules)
Galantamine3                      Alzheimer’s disease with continuing care guidance.                             LINK
Goserelin                         Prostate cancer
Hydroxycarbamide                  Chronic myeloid leukaemia
Hydroxychloroquine                Rheumatology
Hypromellose                      Eye lubrication
preservative free eye
drops
Ibandronic acid                   Reduction of bone damage in bone metastases in breast
(Bondronat)                       cancer
Ivabradine                        Stable angina pectoris when beta blockers contra-                              LINK
                                  indicated as per local guideline
Lacosamide                        Epilepsy
Lamotrigine                       Epilepsy
Lanreotide LA                     Symptoms associated with carcinoid tumours
(Somatuline LA and
Autogel)
Lanthanum                         Hyperphosphataemia in patients on haemodialysis or
                                  CAPD
Letrozole                         Advanced breast cancer
Leuprorelin                       Advanced prostate cancer
Levetiracetam                     Adjunctive treatment of partial seizures
Levobunolol                       Intraocular pressure
Lidocaine plasters                Post herpetic neuralgia                                                        LINK
Liraglutide                       Diabetes
         Approved by Mid Essex Area Prescribing Committee                            Updated: December 2010
         Chairman: Dr Alan Jackson
                                             Mid-Essex Area ‘Traffic Lights’
         Red =Specialist prescribing only for the condition stated-usually secondary care but could be
         accredited GPwSI when working within an accredited specialist service.
         Amber =Prescribed under shared-care protocol (Local Enhanced Service) for the condition stated-drug
         requiring additional biochemical monitoring on a level 1, 2 or 3 basis as per Local Enhanced Service.
         Yellow = Medicines to be initiated by an accredited specialist prescriber and recommended to GP for
         continued prescribing after a defined period of time n, where n= minimum number of months for
         specialist prescribing. No additional blood monitoring is required but in some cases other assessment
         will be necessary as set out in defined guidance.
         Purple = Drugs not recommended for prescribing within Mid-Essex
         All other Formulary drugs not appearing on this list are considered to be ‘Green’ and suitable for
         prescribing in primary care. GPs and specialists should consult their Pharmacist prescribing advisor
         before prescribing any non-formulary drug for the first time. This list will be revised on a regular
         basis. Drugs may change category over time and all prescribers will be notified of any changes.
Lithium                           Mania. Adjunct in depression. Priadel is brand of choice.
(Specify brand)
Low molecular weight              DVT
heparin (Clexane)
Megesterol Acetate                Endometrial cancer
Melatonin                         Sleep disorders in children strictly as per continuing care                    LINK
(Circadin)                        guidance
Methylphenidate3                  ADHD with continuing care guidance                                             LINK
(Specify brand)
Minims eye drops                  Allergy to preservatives in eye drops
Preservative free
Moclobemide                       Depressive illness (Beta MAOI)
Modafinil                         Narcolepsy
                                  (NOT to be prescribed for other indications)
Nandrolone                        Anabolic steroid
Nicorandil                        Angina                                                                         LINK
Octreotide                        Symptoms associated with carcinoid tumours
Omacor                            Hypertriglyceridaemia (3rd line)
(Omega-3-acid ethyl esters)       TG > 10
Pancreatin                        Intestinal secretions
(Creon, Pancrex,
Pancrex V)
Paroxetine                        Depression
Pergolide                         Parkinson’s Disease
Pericyazine                       Schizophrenia
Phenelzine                        Depressive illness (MAOI)
Phenobarbital                     Epilepsy
Phenytoin                         Epilepsy
(Epanutin CAPSULES)
Pilocarpine eye drops             Miotic
Pimecrolimus cream                Acute treatment of mild to moderate atopic eczema
Piracetam                         Epilepsy
Pramipexole                       Parkinson’s disease
Prasugrel                         Stent thrombosis in patients already receiving clopidogrel
(consultant cardiologist
initiation only)
Pregabalin                        Neuropathic pain                                                               LINK
Pyridostigmine                    Myasthenia gravis
Riluzole                          To extend life or the time to mechanical ventilation in
                                  amyotrophic lateral sclerosis
Rivastigmine3                     Alzheimer’s disease with continuing care guidance                              LINK
Risperidone long acting           Schizophrenia with continuing care guidance                                    LINK
         Approved by Mid Essex Area Prescribing Committee                            Updated: December 2010
         Chairman: Dr Alan Jackson
                                            Mid-Essex Area ‘Traffic Lights’
        Red =Specialist prescribing only for the condition stated-usually secondary care but could be
        accredited GPwSI when working within an accredited specialist service.
        Amber =Prescribed under shared-care protocol (Local Enhanced Service) for the condition stated-drug
        requiring additional biochemical monitoring on a level 1, 2 or 3 basis as per Local Enhanced Service.
        Yellow = Medicines to be initiated by an accredited specialist prescriber and recommended to GP for
        continued prescribing after a defined period of time n, where n= minimum number of months for
        specialist prescribing. No additional blood monitoring is required but in some cases other assessment
        will be necessary as set out in defined guidance.
        Purple = Drugs not recommended for prescribing within Mid-Essex
        All other Formulary drugs not appearing on this list are considered to be ‘Green’ and suitable for
        prescribing in primary care. GPs and specialists should consult their Pharmacist prescribing advisor
        before prescribing any non-formulary drug for the first time. This list will be revised on a regular
        basis. Drugs may change category over time and all prescribers will be notified of any changes.
IM injection
Ropinirole                       Parkinson’s disease
Rotigotine                       Parkinson’s disease
Selegiline                       Central nervous system
Sevelamer                        Hyperphosphataemia in patients on haemodialysis
Sodium Clodronate                Osteolytic lesions, hypercalcaemia and bone pain
(Bonefos)                        associated with skeletal metastases in patients with breast
                                 cancer and multiple myeloma
Somatropin (children)            In line with NICE guidance
Somatropin (adults)              In line with NICE guidance
Stalevo                          Parkinson’s disease
(Levodopa, carbidopa,
entacapone)
Tacrolimus ointment              Moderate to severe eczema unresponsive to conventional
                                 therapy
Tiagabine                        Adjunctive treatment for partial seizures with or without
                                 secondary generalisation
Timolol eye drops                Intraocular pressure
Tizanidine                       Spasticity associated with MS or spinal cord injury
Tobramcyin (TOBI)                Cystic fibrosis
Topiramate                       Migraine, epilepsy
Travoprost                       Intra ocular pressure
Tretinoin                        Acne, hyperpigmentation
Travoprost                       Glaucoma
Ursodeoxycholic Acid             Primary biliary cirrhosis
(Ursofalk)
Valproate semisodium             Bipolar disorder
(Depakote)
Valproate & salts                Epilepsy
(Epilim, Epilim Chrono,          (GP may initiate at point of referral)
Epicenta and others)
Venlafaxine3 in doses of         Depression with continuing care guidance                                       LINK
300mg and above




        Approved by Mid Essex Area Prescribing Committee                            Updated: December 2010
        Chairman: Dr Alan Jackson
                                            Mid-Essex Area ‘Traffic Lights’
        Red =Specialist prescribing only for the condition stated-usually secondary care but could be
        accredited GPwSI when working within an accredited specialist service.
        Amber =Prescribed under shared-care protocol (Local Enhanced Service) for the condition stated-drug
        requiring additional biochemical monitoring on a level 1, 2 or 3 basis as per Local Enhanced Service.
        Yellow = Medicines to be initiated by an accredited specialist prescriber and recommended to GP for
        continued prescribing after a defined period of time n, where n= minimum number of months for
        specialist prescribing. No additional blood monitoring is required but in some cases other assessment
        will be necessary as set out in defined guidance.
        Purple = Drugs not recommended for prescribing within Mid-Essex
        All other Formulary drugs not appearing on this list are considered to be ‘Green’ and suitable for
        prescribing in primary care. GPs and specialists should consult their Pharmacist prescribing advisor
        before prescribing any non-formulary drug for the first time. This list will be revised on a regular
        basis. Drugs may change category over time and all prescribers will be notified of any changes.




GREEN                        All other FORMULARY drugs are freely available
                             to be prescribed.
                            (Please consult with prescribing advisor before prescribing a
                             non-formulary drug.)


Substance Misuse – prescribe under shared care protocol

Buprenorphine                  Opioid dependence
Chlordiazepoxide               Alcohol withdrawal
Disulfiram                     Alcohol withdrawal usually up to a year
Lofexidine                     Management of symptoms of opioid withdrawal
Methadone oral                 Opioid dependence
solution
1mg/1ml
Naltrexone                     Adjunct to prevent relapse in previous opioid-dependent patients




               Medicines not recommended for prescribing within Mid Essex
                                 (Refer also to the grey list)

Zotepine                       Schizophrenia
Memantine                      Alzheimer’s disease
Omega-3 acid ethyl             Secondary prevention of MI
esters
Glucosamine                    Osteoarthritis




        Approved by Mid Essex Area Prescribing Committee                            Updated: December 2010
        Chairman: Dr Alan Jackson
                                    Mid-Essex Area ‘Traffic Lights’
Red =Specialist prescribing only for the condition stated-usually secondary care but could be
accredited GPwSI when working within an accredited specialist service.
Amber =Prescribed under shared-care protocol (Local Enhanced Service) for the condition stated-drug
requiring additional biochemical monitoring on a level 1, 2 or 3 basis as per Local Enhanced Service.
Yellow = Medicines to be initiated by an accredited specialist prescriber and recommended to GP for
continued prescribing after a defined period of time n, where n= minimum number of months for
specialist prescribing. No additional blood monitoring is required but in some cases other assessment
will be necessary as set out in defined guidance.
Purple = Drugs not recommended for prescribing within Mid-Essex
All other Formulary drugs not appearing on this list are considered to be ‘Green’ and suitable for
prescribing in primary care. GPs and specialists should consult their Pharmacist prescribing advisor
before prescribing any non-formulary drug for the first time. This list will be revised on a regular
basis. Drugs may change category over time and all prescribers will be notified of any changes.




Approved by Mid Essex Area Prescribing Committee                            Updated: December 2010
Chairman: Dr Alan Jackson

								
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