see attached

• Hyperhidrosis Aug2011.doc

First line for generalised hyperhidrosis: 15mg tds (licensed)

Third line for low score primary focal hyperhidrosis: fourth line for HDSS score 3-4 primary focal hyperhidrosis.

• Hyperhidrosis Aug2011.doc

To relax the abdominal wall in preparation of abdominal wall reconstruction. 300 units to be administered 2 to 4 weeks before the procedure (300 units reconstituted in 150ml sodium chloride 0.9%)

NICE Guidelines:Botulinum toxin type A for the prevention of headaches in adults with chronic migraine

• NICE TA 260

Overactive Bladder algorithm

• Overactive bladder -algorithm FINAL update oct 2015.doc

HOSPITAL ONLY

On Formulary - Approved for use in October 2019 at Drugs and Therapeutics Committee (DTC) - Xeomin brand ONLY

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

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

• Trust Cire Policy End of Life
• Trust Core Policy Syringe Driver
• opioid conversion table August 2017.docx
• ToptipsPalliativeCareAM28Jan14.doc
• Palliative care guidelines vs3 August 2017.doc

Breezhaler is a Dry Powder Inhaler and requires Quick and Deep Inspiratory effort.

Always prescribe by Brand and Device

These ‘specials’ are medications which are used in rare dermatological conditions and recommended by British Association of Dermatologists. Most of them are used due to no other availability of alternative products.

These products will be restricted to only be prescribed by dermatologists within hospital, and not in primary care.

The Committee have agreed to add these to the Barts Health formulary, based on BAD’s recommendations. These will be restricted for use within Dermatology only.

• BAD list table (plus pack sizes).xlsx
• BAD Specials Booklet 2018 FINAL.pdf

• Alopecia Pathway 03.pdf

Used with Co-Cyprindol (with additional cyproterone 50mg daily for the first 10 days of  each cycle of Co-Cyprindol) for treatment of hirsutism

• NICE TA 958

Dermol 600 is an alternative to first line choice Dermol 500.

Please see Microguide (App)

For how to access to Microguide app open poster below or follow link

• MicroGuide poster 2018
• link to app

Hospital only medicine

Refer to Parasitology section of MicroGuide

Update of malaria prevention guidelines for travellers from the UK

• Malaria prevention guidelines in UK travellers

Hospital only medicine

For how to access MicroGuide App follow the link

• Link to App

• British Association of Dermatology

• Pregnancy prevention programme

First line option for acne

Approved for the treatment of inflammatory acne.

Once daily at bedtime for 3-6 months

For how to access MicroGuide App follow the link

• Link to App

Following sensitivity pattern results

Unlicensed use.

On microbiology advice only.

• AK algorithm final Nov 14 SG.pdf

FOR HOSPITAL USE ONLY

Tirbanibulin 10mg/g ointment approved at NEL FPG for the treatment of non-hyperkeratotic, non-hypertrophic (Olsen grade 1) actinic keratosis of the face or scalp in adults.

Hospital Only

• Imiquimod shared care- v3.doc

• AK algorithm final Nov 14 SG.pdf

• Acitretin BAD PIL.pdf

• Pregnancy prevention programme

NB: Continuous use beyond six months is contraindicated therefore off license if used beyond this time period.
NB: Pregnancy monitoring is required for 3 years after stopping this treatment as it has a longer half life than other retinoids.

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.

• Pregnancy prevention programme

HOSPITAL ONLY

Severe Chronic Hand Eczema in patients who are unresponsive to potent topical corticosteroids.

see attached

• Nicta 419 Apremilast for treating moderate to severe plaque psoriasis

IBD Shared Care Guidelines

• IBD Shared care guidelines Final Version.docx

see attached

• Dermatology high risk drugs monitoring sheet final.xls

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

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

Approved at NEL FPG (Nov 2022)

Betesil® 2.250mg medicated plaster is the only potent corticosteroid indicated in adults for the treatment of inflammatory skin disorders.

The plaster is licensed to use for a maximum of 30 days at a time, with a maximum of 6 plasters being used at any one time. Plasters may be changed once every 24 hours.

Amber-may be prescribed by or on the advice of a specialist 

Bimekizumab for treating moderate to severe plaque psoriasis- as per NICE TA 723. October 2021 DTC.

Bimekizumab approved at NEL FPG for treating axial spondyloarthritis in line with NICE TA.

Hospital Only

• NICE TA 918

Bimekizumab approved at NEL FPG for treating active psoriatic arthritis in line with NICE TA.

Hospital Only

• NICE TA 916

(Enstilar ® ) Calcipitriol monohydrate 50micrograms/g and bethamethasone dipropionate 0.5mg/g cutaneous foam Spray

Approved for use in mild to severe psoriasis vulgaris DTC February 2017

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

see attached

• Dermatology high risk drugs monitoring sheet final.xls

see attached

• Ciclosporin - Dermatology.doc

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 

Licehn sclerosis

These ‘specials’ are medications which are used in rare dermatological conditions and recommended by British Association of Dermatologists. Most of them are used due to no other availability of alternative products.

These products will be restricted to only be prescribed by dermatologists within hospital, and not in primary care.

The Committee have agreed to add these to the Barts Health formulary, based on BAD’s recommendations. These will be restricted for use within Dermatology only.

• BAD list table (plus pack sizes).xlsx
• BAD Specials Booklet 2018 FINAL.pdf

Deucravacitinib Approved at NEL FPG for treating moderate to severe plaque psoriasis in line with NICE TA.

Hospital Only

• NICE TA 907

Approved to treat moderate to severe plaque psoriasis in line with NICE TA475.  Prior approval required via Blueteq

Appproved to treat moderate to severe atopic dermatitis in line with NICE TA554.  Prior approval required via Blueteq.

NOTE: Available as

Fluticasone PROPIONATE available as Flixonase Brand 50mcg/spray

Dose: 100mcg (2sprays) into both nostrils OD up to 100mcg (2sp) into both nostrils BD

Avamys® (Fluticasone FUROATE) 27.5mcg/ spray

Dose: 55mcg (2sprays) into both nostrils OD.

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 to treat moderate to severe plaque psoriasis in line with NICE TA521.  Prior approval required via Blueteq.

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

September 2021 DTC

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.

Lebrikizumab approved at NEL FPG for treating moderate to severe atopic dermatitis in people 12 years and over in line with NICE TA.

Formulary Status: Hospital Only

• NICE TA 986

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

see attached

• Dermatology high risk drugs monitoring sheet final.xls

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

Hospital only

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

• Dermatology high risk drugs monitoring sheet final.xls

https://www.nice.org.uk/guidance/ta575

Hospital Only FOC Scheme for severe atopic dermatitis- to be reviewed when NICE TA published.

DTC Jan 2022

 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

INJECTION IS HOSPITAL ONLY

Please see Microguide (App)

Please see attached memo

• Medicine Shortage Hydrogen Peroxide 3% and 6% solution.pdf

Please see attached memo

• Medicine Shortage Hydrogen Peroxide 3% and 6% solution.pdf

see attached

• Potassium permanganate PIL BH 2016.doc

​​Difelikefalin​ approved at NEL FPG for treating pruritus in people having haemodialysis in line with NICE TA.

Hospital Only

• NICE TA 890

Hospital only medicine

For how to access MicroGuide App follow the link

• Link to App

see attached

• Trust Policy MRSA

First line choice for dermatophytoses

Second line for treatment of vaginitis due to Candida albicans and other yeasts

Topical griseofulvin - non formulary

Is used for tinea infections caused by trichophyton spp

• Alopecia Pathway 03.pdf

Second line choice after clotrimazole (first) for dermatophytoses.

Third line choice after clotrimazole (first) then miconazole (second)

• CF DRUG DOSES changes Aug 17 NC_AL.doc

Unlicensed use.

On microbiology advice only.

Available from GSTT NHS Trust as a special order: obtain approval from dermatology pharmacist

Also known as mono benzyl ether of hydroquinone - usual base is cetomacrogol cream

Prescribed as per the agreed specials list on hospital script for the outpatient pharmacies

Pigmanorm Cream

hydroquinone 5%, tretinoin 0.1g, hydrocortisone 1g.

Differin Cream 0.1%

• Depigmentation Guidelines no 3.doc

refer to adapalene monograph for further information https://www.formularycomplete.com/view/drug/forms/9891

refer to adapalene monograph for further information https://www.formularycomplete.com/view/drug/forms/9891

• Adapalene