Approved at NEL FPG October 2022 - Hospital ONLY 

Adalimumab is indicated for treatment of moderate to severe plaque psoriasis in adult patients who are candidates for systemic therapy.
In adult patients, an initial dose of 80 mg administered subcutaneously, followed by 40 mg subcutaneously given every other week starting one week after the initial dose.
The British Association of Dermatology guidance (British Association of Dermatologists guidelines for biologic therapy for psoriasis 2020: a rapid update, Smith et al 2020) recommend that patients with an inadequate response to the 40mg received every other week should receive an increase in dosage to 40mg every week. For needle phobic patients, this can be given as 80mg every other week in practice.
No additional monitoring is required for the escalated dosages.

see attached

• Faecal Calprotectin Testing guidance March 2015 - adjusted.docx

IBD Shared Care Guidelines

• IBD Shared care guidelines Final Version.docx

Metered Dose Inhaler. Requires Slow and Steady Breath. Suitable for patients with low Inspiratory effort.

All Inhalers should be prescribed by Brand and Device Names.

• adult-asthma-action-plan.pdf
• Guidelines for the Management of Asthma for Adults Final.docx

Budesonide approved at NEL FPG treating for primary IgA nephropathy (HCD) 

Formulary Status: Hospital Only

• NICE TA 937

Budesonide Nasal spray is not our 1st line intranasal corticosteroid.

Budesonide orodispersible tablet for inducing remission of eosinophilic oesophagitis as per NICE TA708

Approved as Hospital Only. September 2021 DTC.

Dry Powder Inhaler. Requires Quick and Deep Breath/ Inspiratory effort.

All Inhalers should be prescribed by Brand and Device Names.

• adult-asthma-action-plan.pdf
• Guidelines for the Management of Asthma for Adults Final.docx

Verkazia® (ciclosporin) 1 mg/mL eye drops approved at NEL FPG for  

• Severe Vernal Keratoconjunctivitis (VKC)  

Off-label indications:  

• Severe Atopic Keratoconjunctivitis (AKC),  

• Blepharo-keratoconjunctivitis (BKC) / Ocular Rosacea, 

• Thygeson’s keratitis & Chronic GvHD 

• Dry Eye Disease (DED)/ Keratoconjunctivitis Sicca (KCS) 

Formulary Status: Amber - Specialist initiated 

Etrasimod approved at NEL FPG treating for moderately to severely active ulcerative colitis in people aged 16 and over

• NICE TA 956

Approved at July 2022 DTC for moderately to severely active ulcerative colitis in line with NICE TA792

• NICE TA 792

see attached

• Faecal Calprotectin Testing guidance March 2015 - adjusted.docx

The committee Approved the anti-TNFs onto the Barts Health Formulary, in accordance with NICE TA715.

Infliximab S/C in patients with IBD approved via chairs action on January 2021.

IBD Shared Care Guidelines

• IBD Shared care guidelines Final Version.docx

 Octasa is the first line brand choice for mesalazine in the Trust:

• This only applies to patients newly prescribed mesalazine.
• Prescribing must be done by brand.
• Mesalazine only to be considered for Crohn’s disease post-surgery. 
• No current patients to be changed from their current brand of mesalazine if it differs to the above.
• Mezevant XL – high dosing only
  • More convenient for, and may improve adherence of patients needing 4.8g of mesalazine to take 4 Mezevants 1.2g  than 6 Octasa 800mg.
     

IBD Shared Care Guidelines

• IBD Shared care guidelines Final Version.docx

see attached

• Methotrexate oral: Trust Policy

• Methotrexate for Ectopic Pregnancy Proforma Nov 16 update.pdf

Mirikizumab approved at NEL FPG for treating moderately to severely active ulcerative colitis in line with NICE TA.

• NICE TA 925

Prednisolone G/R tablets are non-formulary, predisolone normal release should be used instead

Risankizumab approved at NEL FPG for treating moderately to severely active ulcerative colitis in line with NICE TA

Formulary Status: Hospital Only

• NICE TA 998

Tofacitinib approved at NEL FPG for treating active ankylosing spondylitis in line with NICE TA.

Hospital Only

• NICE TA 920

 Upadacitnib approved at NEL FPG for previously treated moderately to severely active Crohn’s disease in line with NICE TA.

• NICE TA 905

Approved at NEL under the FOC scheme for the management of Crohn’s disease. NICE is currently in the process of appraising upadacitinib for Crohn’s disease and the technology appraisal (TA) is expected in June 2023.   

Upadacitinib approved at NEL FPG (March 23) for treating moderately to severely active ulcerative colitis in line with NICE TA 856,

• NICE TA 856

Approved at NEL FPG for treating active non-radiographic axial spondyloarthritis.

• NICE TA 861

Ustekinumab approved at NEL FPG for dose escalation in psoriasis.

Commissioned by the ICB under High Cost Drugs Pathway for Psoriasis 

• Patients ≤ 100 kg - Ustekinumab 45 mg SC every 12 weeks (licensed dose) may be increased to a maximum of 90 mg every 8 weeks

• Patients >100kg - Ustekinumab 90 mg every 12 weeks (licensed dose) may be increased to a maximum of 90 mg every 8 weeks

Teduglutide is recommended, within its marketing authorisation, as an option for treating short bowel syndrome (SBS) in people 1 year and above. People's condition should be stable following a period of intestinal adaptation after surgery before having teduglutide. 

• NICE TA804

More commonly used in prolapse

See attached

• Gastrografin EMC link
• Gastrografin - (eMC) - print friendly.mht

Enema and liquid BP available.

NB: this is peanut oil

Restricted to use in hepatic encephalopathy.

Not recommended for use in constipation at Barts Health due to cramps, flatulence and sugar content.

Palliative care only: IPNTS recommendation

Please note that this medicine is HOSPITAL ONLY.

Barts Health has agreed use in men and women but as lubiprostone has a licence in men it is anticipated prucalopride will be a  second line choice in men.

Should be considered for chronic constipation in those who have tried two previous laxatives at highest doses from different classes.
If no treatment benefit after four weeks reconsider continuation.
Patients should meet NICE criteria 1-3

Approved at DTC July 2022 for bowel cleansing for colon capsule procedure

Restricted to use in hepatic encephalopathy.

Not recommended for use in constipation at Barts Health due to cramps, flatulence and sugar content.

FOR HOSPITAL USE ONLY

FOR HOSPITAL USE ONLY

This brand should only be prescribed under specialist supervision for patients under the care of tier 3 obesity services

The therapeutic indication is as an anti-tussive in a non-productive cough.

Higher doses (e.g. 32mg per day) are used in patients with stomas or fistulas: this is UNLICENSED usage

Hospital-Only Drug

http://www.pallcare.info/ - seek advice from Macmillan Team or Palliative Care teams before using information from this website:

http://bartshealthintranet/About-Us/CAGs/Cancer/Palliative-care/Index.aspx
Palliative Care Team Contacts:

St Bartholomew's, Royal London, Mile End and London Chest
Phone: 020 3465 5600 (internal: 55600)Fax: 020 3465 5389 (internal: 55389)

Newham Phone: 020 7363 8105 Fax: 020 7363 9432

Whipps Cross – Margaret Centre Phone: 020 8535 6604 Fax: 020 8535 6952

• Opioid side effects.docx
• opioid conversion table August 2017.docx
• ToptipsPalliativeCareAM28Jan14.doc
• Palliative care guidelines vs3 August 2017.doc
• End of Life TRust Policy
• Syringe Driver Trust Policy

Famotidine may be used as an alternative during the Ranitidine supply shortage, but only for those patients where a PPI is not suitable, or where Cimetidine is not suitable due to interactions etc.

See also Ranitidine page for Ranitidine shortage information in general.

Agreed with DTC chair Jan 2020.

First-line oral PPI of choice at Barts Health

Misoprostol 25micrograms oral tablets approved at NEL FPG for induction of labour.

• NG207 – Inducing labour

Also used in third line for postpartum haemorrhage

On Formulary during Ranitidine Shortage

Nizatidine may be used as an alternative during the Ranitidine supply shortage, but only for those patients where a PPI is not suitable, or where Cimetidine is not suitable due to interactions etc.

See also Ranitidine page for Ranitidine shortage information in general.

Agreed with DTC chair February 2020.

First-line intravenous PPI of choice at Barts Health

Injection is HOSPITAL ONLY

We are currently experiencing national supply issues of all H2-antagonists. All oral and IV formulations of ranitidine are out of stock, with no date for resupply until further notice. There is currently variable supplies of other H2-antagonist preparations (Cimetidine, Famotidine and Nizatidine).

• Medicine Supply Notification All H2-antagonists Dec 2020.pdf

Please see memo for management during shortage at Barts Health

• Ranitidine Shortage Memo 28.11.19.docx

Famotidine may be used as an alternative during the Ranitidine supply shortage, but only for those patients where a PPI is not suitable, or where Cimetidine is not suitable due to interactions etc.

See also Ranitidine page for Ranitidine shortage information in general.

Agreed with DTC chair Jan 2020.

First-line oral PPI of choice at Barts Health

On Formulary during Ranitidine Shortage

Nizatidine may be used as an alternative during the Ranitidine supply shortage, but only for those patients where a PPI is not suitable, or where Cimetidine is not suitable due to interactions etc.

See also Ranitidine page for Ranitidine shortage information in general.

Agreed with DTC chair February 2020.

First-line intravenous PPI of choice at Barts Health

Injection is HOSPITAL ONLY