| Formulary Chapter 5: Infections - Full Chapter
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| Notes: |
Where a formulary entry does not detail a medicine’s indications for use, the medicine can be assumed to be approved for all licensed indications.
Formulary approved "off-label" use is detailed separately.
This section advises on the choice of anti-infective agents available at each Trust. Doctors should refer to local or departmental antibiotic guidelines for advice regarding specific treatments within specialised units (including prophylaxis for surgical, medical and dental procedures). Different antibiotic policies can be found in different hospitals due to local variations in resistance and antibiotic susceptibility.
M: Use of this agent only to be initiated under the advice of a microbiologist or virologist as appropriate.
S: Use of this agent only to be initiated under the advice of a relevant clinical specialist. |
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| Details... |
| 05.03.01 |
HIV infection |
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| 05.03.01 |
Nucleoside reverse transcriptase inhibitors |
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Abacavir tabs, oral solution
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Formulary
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Use generic preparations in preference
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Abacavir with lamiviudine (Kivexa®)
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Formulary
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Use generic preparation in preference
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Abacavir, lamivudine and zidovudine tabs (Trizivir®)
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Formulary
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Bictegravir, emtricitabine and tenofovir alafenamide (Biktarvy®)
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Formulary
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 NHSE Clinical Commissioning Policy 170131P: Bictegravir, emtricitabine & tenofovir alafenamide for the treatment of HIV-1 in adults
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Didanosine tabs, caps
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Formulary
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Dolutegravir & lamivudine tabs (Dovato®)
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Formulary
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 NHSE Clinical Commissioning Policy Statement 200301P: Dolutegravir/lamivudine for the treatment of Human Immunodeficiency Virus (HIV-1) infected adults and adolescents over 12 years of age
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Dolutegravir & rilpivirine tabs (Juluca®)
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Formulary
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NHSE Clinical Commissioning Policy 200210P: Dolutegravir-rilpivirine for treating HIV-1 in adults
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Dolutegravir, abacavir & lamivudine tabs (Triumeq®)
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Formulary
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MHRA Jun 18: Dolutegravir (Tivicay▼, Triumeq▼, Juluca▼): signal of increased risk of neural tube defects; do not prescribe to women seeking to become pregnant; exclude pregnancy before initiation and advise use of effective contraception
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Doravirine, lamivudine, and tenofovir disoproxil (Delstrigo® )
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Formulary
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Approved as per NHSE commissioning policy 190137P (link below)
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NHSE Clinical Commissioning Policy 190137P: Doravirine for the treatment of HIV-1 in adult
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Elvitegravir, cobicistat, emtricitabine and tenofovir alafenamide tabs (Genvoya®)
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Formulary
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MHRA Apr 2019: Elvitegravir boosted with cobicistat: avoid use in pregnancy due to risk of treatment failure and maternal-to-child transmission of HIV-1
MHRA Dec 2016: Cobicistat, ritonavir and coadministration with a steroid: risk of systemic corticosteroid adverse effects
NHSE 16043/P: Clinical Commissioning Policy: Tenofovir Alafenamide for treatment of HIV 1 in adults and adolescents
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Emtricitabine caps, oral solution
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Formulary
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Emtricitabine with rilpivirine and tenofovir alafenamide tabs (Odefsey®)
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Formulary
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NHSE 16043/P: Clinical Commissioning Policy: Tenofovir Alafenamide for treatment of HIV 1 in adults and adolescents
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Emtricitabine with tenofovir alafenamide tabs (Descovy®)
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Formulary
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NHSE 16043/P: Clinical Commissioning Policy: Tenofovir Alafenamide for treatment of HIV 1 in adults and adolescents
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Lamivudine tabs, oral solution
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Formulary
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Use generic preparations in preference
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Stavudine caps, oral solution
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Formulary
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Tenofovir disoproxil tabs (Viread®)
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Formulary
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Use generic preparations in preference
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NICE CG165: Hepatitis B (chronic) - incorporates TA173
NICE TA173: Hepatitis B (chronic) - tenofovir disoproxil
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Tenofovir disoproxil with cobicistat, elvitegravir and emtricitabine tabs (Stribild® )
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Formulary
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MHRA Apr 2019: Elvitegravir boosted with cobicistat: avoid use in pregnancy due to risk of treatment failure and maternal-to-child transmission of HIV-1
MHRA Dec 2016: Cobicistat, ritonavir and coadministration with a steroid: risk of systemic corticosteroid adverse effects
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Tenofovir disoproxil with emtricitabine and efavirenz tabs (Atripla®)
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Formulary
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Use generic preparation in preference
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Tenofovir disoproxil with emtricitabine and rilpivirine (Eviplera®)
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Formulary
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Tenofovir disoproxil with emtricitabine tabs (Pre Exposure Prophylaxis - PrEP only)
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Formulary
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Applicable to generic preparations only
NHS England will routinely reimburse the drug costs associated with Pre Exposure Prophylaxis (PrEP) for the prevention of HIV as outlined in below document (see link)
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NHSE Clinical Commissioning Policy Reimbursement for the use of generic drugs for Pre Exposure Prophylaxis (PrEP) for the prevention of HIV
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Tenofovir disoproxil with emtricitabine tabs (Truvada®)
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Formulary
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Use generic preparation in preference
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Zidovudine caps, oral solution (Retrovir®)
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Formulary
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Use generic preparations in preference
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Zidovudine with lamivudine tabs (Combivir®)
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Formulary
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Use generic preparations in preference
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| 05.03.01 |
Protease inhibitors |
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Atazanavir caps (Reyataz®)
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Formulary
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Use generic preparations in preference
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Atazanavir with cobicistat tabs (Evotaz tablets®)
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Formulary
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MHRA Dec 2016: Cobicistat, ritonavir and coadministration with a steroid: risk of systemic corticosteroid adverse effects
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Darunavir tabs (Prezista®)
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Formulary
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Use generic preparations in preference
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Darunavir with cobicistat tabs (Rezolsta®)
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Formulary
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MHRA Dec 2016: Cobicistat, ritonavir and coadministration with a steroid: risk of systemic corticosteroid adverse effects
MHRA Jul 2018: Darunavir boosted with cobicistat: avoid use in pregnancy due to risk of treatment failure and maternal-to-child transmission of HIV-1
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Fosamprenavir tabs, oral suspension (Telzir®)
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Formulary
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Lopinavir and ritonavir tabs, oral solution (Kaletra®)
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Formulary
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Use generic preparations in preference
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MHRA Dec 2016: Cobicistat, ritonavir and coadministration with a steroid: risk of systemic corticosteroid adverse effects
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Saquinavir caps, tabs (Invirase®)
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Formulary
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| 05.03.01 |
Non-nucleoside reverse transcriptase inhibitors |
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Doravirine tabs (Pifeltro®)
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Formulary
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Approved as per NHSE commissioning policy 190137P (link below)
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NHSE Clinical Commissioning Policy 190137P: Doravirine for the treatment of HIV-1 in adults
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Efavirenz caps, tabs, oral soultion (Sustiva®)
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Formulary
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Use generic preparations in preference
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Etravirine tabs (Intelence®)
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Formulary
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Nevirapine tabs, m/r tabs, oral suspension (Viramune®)
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Formulary
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Confirm correct tablet formulation (i.e. MR or immediate release)
Use generic preparation in preference
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Rilpivirine tabs (Edurant®)
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Formulary
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| 05.03.01 |
Other antiretrovirals |
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Dolutegravir tabs
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Formulary
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MHRA Oct 20: Dolutegravir (Tivicay▼, Triumeq▼, Juluca▼): updated advice on increased risk of neural tube defects
MHRA Jun 18: Dolutegravir (Tivicay▼, Triumeq▼, Juluca▼) - signal of increased risk of neural tube defects, do not prescribe to women seeking to become pregnant
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Enfuvirtide injection
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Formulary
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Maraviroc tabs
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Formulary
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Raltegravir tabs
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Formulary
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Both once daily (1200 mg daily) and twice daily (400 mg twice daily) regimens are approved
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Delavirdine tabs
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 Unlicensed
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  Antiretroviral: 400 mg three times a day. Alternatively 600 mg twice daily
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Didanosine powder
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Unlicensed
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 Antiretroviral
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Mylanta extra strength liquid cherry flavour
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Unlicensed
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 Antacid, used as a constituent of didanosine solution
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| 05.03.01 |
Pharmacokinetic enhancers of antiretrovirals |
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Cobicistat tabs
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Formulary
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MHRA Dec 2016: Cobicistat, ritonavir and coadministration with a steroid: risk of systemic corticosteroid adverse effects
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Ritonavir caps, oral solution (Norvir®)
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Formulary
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Use generic preparations in preference
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MHRA Dec 2016: Cobicistat, ritonavir and coadministration with a steroid: risk of systemic corticosteroid adverse effects
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| 05.03.01 |
Combination Products |
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Symtuza (Darunavir/cobicistat/emtricitabine/tenofovir alafenamide)
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Formulary
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Approved for use as per NHSE Policy FO3/P/b
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MHRA Jul 2018: Darunavir boosted with cobicistat: avoid use in pregnancy due to risk of treatment failure and maternal-to-child transmission of HIV-1
NHSE F03/P/b: Use of cobicistat as a booster in treatment of HIV infection (all ages)
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| .... |
Key |
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Cytotoxic Drug
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Controlled Drug
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High Cost Medicine
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Cancer Drugs Fund
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NHS England |
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Homecare |
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CCG |
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Traffic Light Status Information
| Status |
Description |
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Specialist or hospital prescribing only.
The responsibility for prescribing, monitoring, dose adjustment and review should remain with the specialist or hospital.
In very exceptional circumstances a specialist may discuss individual patient need for a RED drug to be prescribed by a GP and the GP should consider informing the Medicines Management team before a decision is made to prescribe for individual patients.
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Treatment can be initiated in primary care after a recommendation from an appropriate specialist |
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Specialist initiation followed by maintenance prescribing in primary care |
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Specialist initiation with ongoing monitoring required. After dose stabilisation GPs can be requested to take over prescribing responsibilities using the approved APC shared care documentation |
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Specialist and non-specialist initiation |
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Not recommended for prescribing |
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