| Formulary Chapter 5: Infections - Full Chapter
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| Chapter Links... |
 NENC ICB - Cellulitis Diagnosis and Management in Ambulatory Adults in primary care; Supporting Information |
| NICE NG15: Antimicrobial stewardship: systems and processes for effective antimicrobial medicine use |
| NICE NG63: Antimicrobial stewardship: changing risk-related behaviours in the general population |
| Primary Care Antimicrobial Guidelines |
| TEWV: Antibiotic Prescribing Procedure |
| Details... |
| 05.03.01 |
HIV infection |
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| 05.03.01 |
Nucleoside reverse transcriptase inhibitors |
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Abacavir
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Formulary
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Bictegraivr/emtricitabine/tenofovir alafenamide (Biktarvy®)
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Formulary
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- Bictegravir (as Bictegravir sodium) 30 mg, Emtricitabine 120 mg, Tenofovir alafenamide (as Tenofovir alafenamide fumarate) 15 mg &
Bictegravir (as Bictegravir sodium) 50 mg, Emtricitabine 200 mg, Tenofovir alafenamide (as Tenofovir alafenamide fumarate) 25 mg tablets
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Didanosine
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Formulary
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Emtricitabine
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Formulary
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Lamivudine
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Formulary
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- 150 mg and 300 mg tablets
- 50 mg/5ml oral solution
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Stavudine
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Formulary
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Tenofovir Disoproxil
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Formulary
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Zidovudine
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Formulary
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Protease inhibitors |
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Saquinavir
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Formulary
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Tipranavir
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Formulary
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Atazanavir
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Formulary
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- For limited use as part of triple therapy where other protease inhibitors are unsuitable
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Atazanavir sulfate and cobicistat
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Formulary
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To be used in accordance with NHS England Clinical Commissioning Policy (SSC1614).
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Darunavir
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Formulary
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Darunavir and Cobicistat
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Formulary
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To be used in accordance with NHS England Clinical Commissioning Policy (SSC1614).
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Fosamprenavir
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Formulary
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Indinavir
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Formulary
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Nelfinavir
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Formulary
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Ritonavir
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Formulary
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| 05.03.01 |
Non-nucleoside reverse transcriptase inhibitors |
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Efavirenz (Sustiva®)
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Formulary
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Etravirine (Intelence®)
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Formulary
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Nevirapine
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Formulary
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Rilpivirine hydrochloride
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Formulary
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- For patients who, due to renal impairment, require reduced doses that are not able to be accommodated by the fixed combination product.
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| 05.03.01 |
Other antiretrovirals |
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Cabotegravir
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Formulary
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- 30mg tablet
- 600mg/3ml prolonged-release suspension for injection
- Approved in line with NICE for:
- in combination with rilpivirine (Rekambys) for treating HIV-1 in adults
- preventing HIV-1 in adults and young people
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NICE TA757: Cabotegravir with rilpivirine for treating HIV-1
NICE TA1106: Cabotegravir for preventing HIV-1 in adults and young people
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Dolutegravir
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Formulary
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Enfuvirtide
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Formulary
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Fostemsavir (Rukobia®)
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Formulary
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- 600mg MR tablets
- Approved for the treatment of multi-drug resistant HIV-1 infection in adults
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Maraviroc
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Formulary
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- Approved for use in the treatment of patients with HIV infections that are resistant to standard therapy in accordance with British HIV Association and EACS guidelines.
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Raltegravir
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Formulary
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- Approved for use in the treatment of patients with HIV infections that are resistant to standard therapy in accordance with British HIV Association and EACS guidelines.
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| 05.03.01 |
Pharmacokinetic enhancers of anti-retrovirals |
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Cobicistat (Tybost®)
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Formulary
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 Clinical Commissioning Policy: Use of cobicistat as a booster in treatment of HIV infection (all ages)
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| 05.03.01 |
Combination Products |
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Abacavir & Lamivudine
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Formulary
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Abacavir & Lamivudine & Zidovudine
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Formulary
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Abacavir & Lamivudine & Dolutegravir
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Formulary
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Dolutegravir Sodium & Lamivudine (Dovato®)
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Formulary
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- Film-coated tablet containing dolutegravir sodium equivalent to 50 mg dolutegravir and 300 mg lamivudine
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Dolutegravir Sodium & Rilpivirine Hydrochloride (Juluca®)
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Formulary
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- Film-coated tablets containing dolutegravir sodium (equivalent to 50 mg dolutegravir) and rilpivirine hydrochloride (equivalent to 25 mg rilpivirine)
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Emtricitabine & Tenofovir Disoproxil
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Formulary
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- Tablets: Emtricitabine 200 mg and Tenofovir disoproxil (as fumarate) 245 mg
- Use generic preparation in preference to the branded product (Truvada®)
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Emtricitabine & Rilpivirine & Tenofovir disoproxil (Eviplera®)
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Formulary
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- Tablets: 200 mg / 25 mg / 245 mg
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Tenofovir Disproxil & Cobicistat & Elvitegravir & Emtricitabine
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Formulary
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- To be used in accordance with NHS England Clinical Commissioning Policy.
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Tenofovir Disproxil & Efavirenz & Emtricitabine
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Formulary
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Emtricitabine & Elvitegravir & Cobicistat & Tenofovir alafenamide (Genvoya®)
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Formulary
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- Tablet: 200mg / 150 mg / 150 mg / 10 mg
- To be used in accordance with NHS England Clinical Commissioning Policy.
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Emtricitabine & Rilpivirine & Tenofovir alafenamide (Odefsey®)
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Formulary
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- Film coated tablets containing rilpivirine 25mg, emtricitabine 200mg & tenofovir alafenamide (as fumarate) 25mg
- To be used in accordance with NHS England Clinical Commissioning Policy.
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Emtricitabine & Tenofovir alafenamide (Descovy®)
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Formulary
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- Film coated tablets containing:
- emtricitabine 200mg & tenofovir alafenamide (as fumarate) 10mg
- emtricitabine 200mg & tenofovir alafenamide (as fumarate) 25mg
- To be used in accordance with NHS England Clinical Commissioning Policy.
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Zidovudine & Lamivudine
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Formulary
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Key |
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Restricted Drug |
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Unlicensed |
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Link to adult BNF
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Link to children's BNF
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Link to SPCs
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Cytotoxic Drug |
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Controlled Drug |
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High Cost Medicine |
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NHS England |
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Homecare |
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ICB |
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Low carbon footprint |
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Medium carbon footprint |
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High carbon footprint |
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| Status |
Description |
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Drugs for hospital use only. The responsibility for initiation and monitoring treatment should rest with an appropriate hospital clinician and the drug should be supplied through the hospital throughout the duration of treatment. In some very exceptional circumstances (e.g. due to distance from the hospital, storage, supply or mobility/transport problems) it may be appropriate for the GP to be asked to prescribe a Red drug. This should be negotiated on an individual patient basis and should only be done with the GP’s prior informed agreement where the roles of the GP and hospital services are clearly defined and agreed. The GP should not feel under pressure to prescribe in these circumstances. For all RED drugs automatically added to the formulary in response to a positive NICE TA: Prescribers need to ensure that local Trust new drug governance procedures and pharmacy processes are followed before any prescribing. |
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Drugs initiated by hospital specialist, but where continuing treatment by GPs may be appropriate under a shared care arrangement. These medicines are considered suitable for primary care prescribing following specialist initiation of therapy and stabilisation, with ongoing communication between the primary care prescriber and specialist as set out in the associated shared care guideline (SCG). Shared care should be initiated by the specialist, which includes consultant, suitably trained specialist non-medical prescriber or GPwER within a secondary, tertiary, or primary care clinic.
The specialist should send the primary care prescriber a copy of the NENC Clinical Effectiveness and Governance (CEG) Subcommittee approved SCG to sign. The primary care prescriber should sign the SCG or indicate reasons why they are unable to accept the agreement and return a copy back to the specialist, as soon as possible.
SCGs are available or are being developed for most of the drugs listed as AMBER. |
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Drugs normally recommended or initiated by a hospital specialist who is a prescriber, a GP with an extended role [GPwER], or a specialist within primary care which can be safely maintained in primary care and monitored in primary care. In some cases, a further restriction for use may be defined. The primary care prescriber must be familiar with the drug to take on prescribing responsibility or must obtain the required information from the specialist. Therefore, provision of additional information, or an information leaflet, may be appropriate in some cases to facilitate continuing treatment by primary care prescriber or provide information re stopping criteria.
These are considered suitable for primary care prescribing following specialist assessment and recommendation of therapy, with ongoing communication between the primary care prescriber and specialist, if necessary.
In some case these drugs require specialist initiation and short to medium term monitoring of efficacy or toxicity until the patient’s dose is stable. Following specialist review the patient may be transferred to primary care for ongoing prescribing. Ongoing prescribing by primary care can include, if required, additional dose titrations and assessment of efficacy, with ongoing communication between the primary care prescriber and specialist, if necessary.
If the drug requires urgent initiation, it is expected that the specialist provides the first prescription from the inpatient/outpatient setting, of sufficient supply for a patient’s immediate needs. The quantity provided should cover at least up to the point where the discharge/clinic letter has reached the GP, plus reasonable time for the practice to manage the document and issue further supplies. A GREEN+ drug can only be recommended to primary care for initiation if it does not need to be initiated urgently, taking into account clinical need. |
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Medicines suitable for initiation, ongoing prescribing and discontinuation in all care settings, subject to appropriate communication between those responsible. |
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Self-care – available OTC, can be purchased as part of self-care for self-limiting conditions as per NHSE policy guidance |
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UNDER REVIEW: drugs whose current formulary status or RAG status is currently under review. |
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Drugs that have been considered by the NENC Clinical Effectiveness and Governance (CEG) Subcommittee (or other approved body) and are not approved for prescribing within the North East and North Cumbria ICS. These may also include all medicines with a “not NHS” or “DLCV” classification in the BNF, those agents as included within the NICE “Do not do” list, and those agents included with the NHS England: Items which should not routinely be prescribed in primary care. |
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