Should not routinely used for primary prevention of cardiovascular disease.

Enteric coated aspirin should not be used as it has a poor cost:benefit ratio. There is no convincing evidence that it reduces gastrointestinal bleeding (Drug Ther Bulletin, Jan 1997, p.7-8) and it has a lower bioavailability vs dispersable.

Gastroprotection with lansoprazole is advised.

Aspirin has multiple indications, follow the links below for more information

Unstable angina and NSTEMI guidelines

http://www.nice.org.uk/guidance/CG94

Stroke guidelines

http://www.nice.org.uk/Guidance/CG68

STEMI guidelines

http://www.nice.org.uk/guidance/CG167

AF guidelines

http://www.nice.org.uk/guidance/cg180

Hypertension in pregnancy guidelines

http://www.nice.org.uk/guidance/CG107

Oral diclofenac no longer recommended as per MHRA alert. 

Reserved for use as suppositories in maternities and injection for renal colic.

Topical diclofenac may still be used as indicated.

INJECTION FORMULATION IS FOR HOSPITAL USE ONLY

For Patient Controlled analgesia Trust Policy see link
For Trust Epidural Policy see link

• PCA and NCA Guidelines
• Epidural Continuous Infusion Guidelines
• opioid conversion table August 2017.docx
• Opioid side effects v2.docx
• BH treatment algorithm for pain in adults.pdf

• NSAIDs BH 2014.doc

Oral diclofenac no longer recommended as per MHRA alert. 

Reserved for use as suppositories in maternities and injection for renal colic.

Topical diclofenac may still be used as indicated.

INJECTION FORMULATION IS FOR HOSPITAL USE ONLY

Only available for use at Newham

Akis brand of Diclofenac to replace Voltarol on the formulary, Akis does not require a buffer to dilute pior to administration

For Patient Controlled analgesia Trust Policy see link
For Trust Epidural Policy see link

• opioid conversion table August 2017.docx
• BH treatment algorithm for pain in adults.pdf
• PCA Trust Policy
• Epidural Trust Policy

see attached

• NSAIDs BH 2014.doc

For patent ductus arteriosus - please refer to children's BNF

For patent ductus arteriosus - please refer to children's BNF

Only tablets and capsules on formulary

Only 250mg and 500mg of enteric coated formulation on formulary

Approved at NEL FPG in line with NICE TA 824.

Dexamethasone intravitreal implant (Ozurdex) is recommended as an option for treating visual impairment caused by diabetic macular oedema in adults only if their condition has not responded well enough to, or if they cannot have non-corticosteroid therapy.

This is an update and replacement of TA 349

• NICE TA 824

see attached

• CF Prescribing Pathway Final Version 5 Dec 2015.doc

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

FOR HOSPITAL USE ONLY

Approved at June 2021 DTC for Pericarditis (for 3 months treatment). To be initiated in hospital and continued by GP

Oral diclofenac no longer recommended as per MHRA alert. 

Reserved for use as suppositories in maternities and injection for renal colic.

Topical diclofenac may still be used as indicated.

INJECTION FORMULATION IS FOR HOSPITAL USE ONLY

For Patient Controlled analgesia Trust Policy see link
For Trust Epidural Policy see link

• PCA and NCA Guidelines
• Epidural Continuous Infusion Guidelines
• opioid conversion table August 2017.docx
• Opioid side effects v2.docx
• BH treatment algorithm for pain in adults.pdf

• NSAIDs BH 2014.doc

Oral diclofenac no longer recommended as per MHRA alert. 

Reserved for use as suppositories in maternities and injection for renal colic.

Topical diclofenac may still be used as indicated.

INJECTION FORMULATION IS FOR HOSPITAL USE ONLY

Only available for use at Newham

Akis brand of Diclofenac to replace Voltarol on the formulary, Akis does not require a buffer to dilute pior to administration

For patent ductus arteriosus - please refer to children's BNF

Only 250mg and 500mg of enteric coated formulation on formulary

Approved at DTC March 2022 for the management of refractory idiopathic myopathies (adults and chidren aged 2 and over) as per NHSE commissioning policy (Hospital Only)

FOR HOSPITAL USE ONLY

Abatacept for treatment of severe treatment-resistant morphoea (localised scleroderma) (adults and children 2 years and over) (210505P) [1921]

Approved in October 2021 DTC- as per NHSE commissioning policy statement (Hospital Only)

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.

Approved for Adult Onset Stills Disease.  Prior approval required.  Application to be submitted via Blueteq

FOR HOSPITAL USE ONLY

Approved by JPG in 2013 for patients admitted with acute gout where the use of colchicine, NSAIDs and steroids was ineffective or contra-indicated.

The decision to initiate and prescribe Anakinra must be made by a consultant rheumatologist. Patients will receive one dose of 100mg by subcutaneous injection. If the symptoms are not sufficiently reduced after 24 hours the dose maybe repeated. No more than 2 doses should be administered for an attack.

Anakinra is not licensed for the management of gout. Patients should therefore be informed of this and educated about the use of Anakinra. Informed consent from the patient must be documented in the medical record.

Approved in April 2022 DTC as per NHSE commissioning policy SSC2301.

IBD Shared Care Guidelines

• IBD Shared care guidelines Final Version.docx

Baricitinib for use in monogenic interferonopathies (adults and children 2 years and over) - NHSE commissioning circular released in sept 2021. No patients requiring treatment at present in BH. To be discussed at DTC if needed to be used for treating patients with monogenic interferonopathies in the future.

DTC Jan 2022

Approved at April 2021 DTC - Baricitinib oral tablets for atopic dermatitis

https://www.nice.org.uk/guidance/ta574

Refer to Parasitology section of MicroGuide.

Update of malaria prevention guidelines for travellers from the UK

• Malaria prevention guidelines for travellers from the UK

Prescribe ciclosporin by Brand and use generic version for all new patients.

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 

Oral diclofenac no longer recommended as per MHRA alert. 

Reserved for use as suppositories in maternities and injection for renal colic.

Topical diclofenac may still be used as indicated.

INJECTION FORMULATION IS FOR HOSPITAL USE ONLY

For Patient Controlled analgesia Trust Policy see link
For Trust Epidural Policy see link

• PCA and NCA Guidelines
• Epidural Continuous Infusion Guidelines
• opioid conversion table August 2017.docx
• Opioid side effects v2.docx
• BH treatment algorithm for pain in adults.pdf

• NSAIDs BH 2014.doc

Oral diclofenac no longer recommended as per MHRA alert. 

Reserved for use as suppositories in maternities and injection for renal colic.

Topical diclofenac may still be used as indicated.

INJECTION FORMULATION IS FOR HOSPITAL USE ONLY

Only available for use at Newham

Akis brand of Diclofenac to replace Voltarol on the formulary, Akis does not require a buffer to dilute pior to administration

FOR HOSPITAL USE ONLY

Biosimilar Benepali brand should be used used for all new patients starting treatment.

Approved at May 2021 DTC for moderate to severe rheumatoid arthritis in line with NICE TA676

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

• NICE TA 792

Guselkumab approved alone or with methotrexate, is recommended as an option for treating active psoriatic arthritis in adults whose disease has not responded well enough to disease-modifying antirheumatic drugs (DMARDs) or who cannot tolerate them. It is recommended only if they have had 2 conventional DMARDs and:
• have had at least 1 biological DMARD, or
• tumour necrosis factor (TNF)-alpha inhibitors are contraindicated but would otherwise be considered (as described in NICE's technology appraisal guidance on etanercept, infliximab and adalimumab for the treatment of psoriatic arthritis).

• NICE TA 815

Approved for the treatment of active psoriatic arthritis after inadequate response to DMARDs as per NICE TA 711

September 2021 DTC

• Alopecia Pathway 03.pdf

• Dermatology high risk drugs monitoring sheet final.xls

For Patient Controlled analgesia Trust Policy see link
For Trust Epidural Policy see link

• opioid conversion table August 2017.docx
• BH treatment algorithm for pain in adults.pdf
• PCA Trust Policy
• Epidural Trust Policy

see attached

• NSAIDs BH 2014.doc

For patent ductus arteriosus - please refer to children's BNF

For patent ductus arteriosus - please refer to children's BNF

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.

Approved for treating axial spondyloarthritis as per NICE TA 718. Hospital Only. October 2021 DTC.

Only tablets and capsules on formulary

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

Only 250mg and 500mg of enteric coated formulation on formulary

FOR HOSPITAL USE ONLY

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

Approved via Chair's action 16th August 2022 for treating actice psoriatic arthritis in line with NICE TA803

Hospital Only

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

• NICE TA 888

NEL FPG Approved for use in Connective Tissue Disease- Interstitial Lung Disease (CTD-ILD) and Hypersensitivity Pneumonitis- Interstitial Lung Disease (HP-ILD)

Treatment of Interstitial Lung Disease (ILD) in patients with severe active disease that has failed to respond to, or patient is intolerant to at least 2 immunosuppressants (tacrolimus, methotrexate, mycophenolate or cyclophosphamide), each having been taken for at least 3 months.

Rituximab IV 1g on day 1 and day 15, then repeated 6 monthly if the patient responds.

Hospital Only

First line biologic in rheumatology patients that are not suitable for anti-TNF therapy

On Formulary for Idiopathic Membraneous Glomerulonephritis,

biopsy-proven, steroid-sensitive minimal change nephropathy or primary focal segmental glomerulosclerosis (non-commissioned).

Renal Transplant Patients

For vasculitis in renal transplant 
As immunuppression for ABO incompatible transplants

see attached

• SLE
• Rituximab protocol in the treatment of rheumatic diseases in adults version 1.0 May 2014.docx

Truxima brand is used in clinical haematology indications. 

Rituximab for the treatment of IgM paraproteinaemic demyelinating peripheral neuropathy in adults approved for use in May 2022 DTC as per Clinical Commissioning policy SSC2319

Secukinumab approved at NEL FPG for treating moderate to severe hidradenitis suppurativa in line with NICE TA

Hospital Only

• NICE TA 935

Approved at NEL-FPG in April 2023. Discount scheme applies until 2025. Commisioned by the ICB after this point as per the NEL High Cost Drug Pathway for Psoriasis 

Dose increased from 300mg once a month to 300mg fortnightly with a body weight of 90kg or higher. Patients who have an inadequate response after 3 months of dose escalation should be offered alternative treatment as per the NEL Psoriasis Pathway

HOSPITAL ONLY - NHSE commissioned for use in COVID-19 (Blueteq form required).

Also available as a subcutaneous preparation

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

Upadacitinib approved as an option for treating active ankylosing spondylitis that is not controlled well enough with conventional therapy in adults, only if tumour necrosis factor (TNF)-alpha inhibitors are not suitable or do not control the condition well enough.

• NICE TA 829

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

• NICE TA 861

Approved at July 2022 DTC for treating active psoriatic arthritis after inadequate response to DMARDs (NICE TA 768)

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

Shared Care Guidelines for Riluzole in motor neurone disease March 2020

• Riluzole in Motor Neurone Disease SCG.pdf

• NICE TA20

TEGLUTIK (riluzole) 5 mg/ml oral suspension

Amyotrophic Lateral Sclerosis (a form of motorneurone disease)

Please use 3,4 Diaminopyridine for Lambert Eaton Myasthenic Syndrome (LEMS). This is the base form of amifampridine. As this is unlicensed it is subject to unlicensed medicine policy.  We use the unlicensed form instead of licensed in this case as the trials were carried out on the base form and it is more cost effective.  The unlicensed form has been manufactured in the UK and used in the NHS for twenty years and there are no issues with safety and quality.

Starting doses are usually 10mg once daily, increasing to 10mg twice daily, then 20mg twice daily at five day intervals. Doses can be increased to maximum of 100mg per day day, although in practice the usual maximum is 60mg per day as higher doses have rarely been associated with seizures.

HOSPITAL ONLY

INJECTION IS FOR HOSPITAL USE ONLY

Hospital-Only Drug

Refer to Parasitology section  of MicroGuide

For relief of nocturnal leg cramps associated with renal replacement therapies

Hospital only medicine

 Chronic severe spasticity resulting from Multiple Sclerosis or traumatic partial section of spinal cord

FOR HOSPITAL USE ONLY

As a skeletal muscle relaxant in conditions such as Multiple Sclerosis and for control of seizures.