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 Formulary Chapter 13: Skin - Full Chapter
Notes:

Dermatology services are provided by visiting consultants from Salford Royal Foundation Trust, and choice of therapy is therefore guided by SRFT's formulary. To confirm the formulary status of a product, please see http://www.srft.nhs.uk/for-professionals/formulary/
 Details...
13.05.03  Expand sub section  Drugs affecting the immune response
Adalimumab (Humira®)
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Formulary
Red
High Cost Medicine
 
Link  NICE (2008) Adalimumab for the treatment of adults with psoriasis. (TA146).
   
Cytotoxic Drug Azathioprine
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Formulary
Amber
Tablets

unlicensedunlicensed indication (severe refractory eczema) 
Link  UKMI Q&A: Can mothers breastfeed while taking azathioprine?
   
Ciclosporin
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Formulary
Amber
Capsules
Oral Solution

Must be prescribed by BRAND. (See Section 8.2.2.)
 
   
Etanercept (Enbrel®)
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Formulary
Red
High Cost Medicine
 
Link  NICE TA103: Psoriasis - efalizumab and etanercept
   
Infliximab (Remicade®)
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Formulary
Red
High Cost Medicine
 
Link  NICE TA134: Infliximab for psoriasis
   
Cytotoxic Drug Methotrexate
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Formulary
Amber
Tablets
Injection 
Link  NPSA Alert (2006): Improving compliance with oral methotrexate
   
Mycophenolate mofetil
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Formulary
Amber
Tablets
Capsules
Oral suspension

unlicensedunlicensed indication (severe refractory eczema) 
Link  MHRA (2015): Mycophenolate mofetil: risk of hypogammaglobulinaemia and risk of bronchiectasis
Link  MHRA Safety Alert: Contraception advice for male patients
Link  MHRA Safety Alert: Pregnancy prevention advice
   
Pimecrolimus 1% Cream (Elidel®)
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Formulary
Green 2
Cream

Restricted Item Consultant Dermatologist only, in line with NICE Guidance



 

Link  NICE TA82: Pimecrolimus and tacrolimus for atopic dermatitis (eczema)
   
Secukinumab (Cosentyx®)
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Formulary
Red
High Cost Medicine
 
Link  GMMMG Harmonised Biologics Pathway for Ankylosing Spondylitis
Link  NICE TA407: Secukinumab for active ankylosing spondylitis
   
Tacrolimus (Protopic®)
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Formulary
Green 2
0.03% Ointment
0.1% Ointment

Restricted Item Consultant Dermatologist only

 
Link  MHRA (2012): Tacrolimus ointment: possible risk of malignancies
Link  NICE TA82: Pimecrolimus and tacrolimus for atopic dermatitis (eczema)
   
Ustekinumab
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Formulary
Red
High Cost Medicine
NICE and GMMMG recommend ustekinumab as an option, alone or in combination with methotrexate, for treating active psoriatic arthritis in adults only when:
• treatment with TNF alpha inhibitors is contraindicated but would otherwise be considered
• or the person has had treatment with 1 or more TNF–alpha inhibitors.

Consideration should be given to discontinuing treatment in patients who have shown no response up to 28 weeks of treatment.

Available via Patient Access Scheme: please contact pharmacy for details
 
Link  MHRA 2015: Ustekinumab: risk of exfoliative dermatitis
Link  NICE (2015) Ustekinumab for treating active psoriatic arthritis (TA340)
Link  NICE TA180: Psoriasis - ustekinumab
   
 ....
 Non Formulary Items
Efalizumab  (Raptiva®)

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Non Formulary
 
  
Key
note Notes
Section Title Section Title (top level)
Section Title Section Title (sub level)
First Choice Item First Choice item
Non Formulary Item Non Formulary section
Restricted Drug
Restricted Drug
Unlicensed Drug
Unlicensed
Track Changes
Display tracking information
click to search medicines.org.uk
Link to adult BNF
click to search medicines.org.uk
Link to children's BNF
click to search medicines.org.uk
Link to SPCs
SMC
Scottish Medicines Consortium
Cytotoxic Drug
Cytotoxic Drug
CD
Controlled Drug
High Cost Medicine
High Cost Medicine
Cancer Drugs Fund
Cancer Drugs Fund
NHSE
NHS England
Homecare
Homecare
CCG
CCG

Traffic Light Status Information

Status Description

Amber

Drugs designated amber are suitable for shared care arrangements under a shared care protocol. Prescribing may be transferred from secondary to primary care once the patient is stabilised and agreed shared care arrangements have been established. Alternatively primary care may initiate under the supervision of secondary care if this option is given in the shared care document. It is recommended that shared care arrangements should be drawn up following local discussion and agreement by prescribing parties.   

Black

These products have been reviewed by the GM Joint Formulary Group and have been deemed not suitable for prescribing for adults in primary or secondary care within Greater Manchester. These decisions have been made on the basis of safety, efficacy and cost-effectiveness of the products.  

Green

Not used   

Green 1

Drugs designated green1 are suitable for initiation and ongoing prescribing within primary care.   

Green 2

Drugs designated green2 can be initiated by primary care following written or verbal advice from a specialist and then be subsequently safely prescribed in primary care with little or no monitoring required.  

Green 3

Drugs designated green3 are suitable for on-going prescribing within primary care after specialist initiation and an initial review (unless specified) in secondary care. Little or no monitoring is required.  

Grey

Not suitable for routine prescribing but may be suitable for a defined patient population. Whilst prescribers should think very carefully before prescribing or recommending any of the products on the grey list, there may be exceptional instances when the use of one of these products is necessary for a particular patient.   

Red

Drugs designated red are considered to be specialist medicines and prescribing responsibility for these medicines should normally remain with the consultant or specialist clinician. These drugs should not be initiated or prescribed in primary care. It is recommended that the supply of these specialist medicines should be organised via the hospital pharmacy, this may include arranging for supply via a home care company.   

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