netFormulary South East London Joint Medicines Formulary NHS
Guy's and St Thomas' NHS Foundation Trust
Kings College Hospital NHS Foundation Trust
Lewisham and Greenwich NHS Trust
 
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 Formulary Chapter 8: Malignant disease and immunosuppression - Full Chapter
Notes:
Please also refer to the Cancer Drugs Fund list
 Details...
08.02.01  Expand sub section  Antiproliferative immunosuppressants
Cytotoxic Drug  Azathioprine tabs, injection (renal transplant)

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Formulary
Red
Immunosuppression in renal transplant

10mg capsules are also available for patients who require smaller doses (unlicensed product).
   
Cytotoxic Drug  Azathioprine tabs (liver transplant)

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Formulary Immunosuppression in liver transplant

Red Traffic Light for new patients

Amber Traffic Light for patients currently receiving prescriptions in primary care (see shared care link below)

Link  SE London APC Shared Care Guideline: Azathioprine in adult liver transplant patients    
Cytotoxic Drug  Azathioprine tabs (neurological conditions)

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Formulary
Amber 2
Approved off-label indication:
Disease modifying and steroid sparing treatment for neurological conditions
   
Mycophenolate Mofetil tabs, caps, suspension, injection (liver transplant)

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Formulary Imunnosupressant in liver transplant patients

Red Traffic Light for new patients

Amber Traffic Light for patients currently receiving prescriptions in primary care (see shared care link below)

Link  SE London APC Shared Care Guidance: Mycophenolate mofetil in liver transplant patients    
Mycophenolate Mofetil tabs, caps, suspension, injection (renal transplant)

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Formulary
Red
Imunnosupressant in renal transplant patients

Link  NICE TA85: Immunosuppressive therapy for renal transplantation in adults
Link  NICE TA99: Immunosuppressive therapy for renal transplantation in children and adolescents    
Mycophenolate Mofetil tabs, caps, suspension (dermatology indications - off-label)

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Restricted Drug Restricted
Amber 3
Approved off-label indications (dermatology use only):
For patients unresponsive or intolerant of standard therapies for:
  • Severe immunobullous disease
  • Atopic dermatitis or psoriasis
  •    
    Mycophenolate Mofetil tabs, caps, suspension (lupus - off-label)

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    Restricted Drug Restricted
    Amber 3
    Approved off-label indication (lupus consultants only):
    Systemic lupus erythematosus and vasculitis (SLE)
    Dose: 1-2 g daily (up to a maximum of 3 g daily)
       
    Mycophenolate Mofetil tabs, caps, suspension (neurological conditions - off-label)

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    Formulary
    Amber 3
    Approved off-label indication:
    Disease modifying and steroid-sparing treatment for neurological conditions
       
    Mycophenolate Sodium tablets (renal transplant)

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    Restricted Drug Restricted
    High Cost Medicine
    Red
    Only approved for continuing treatment of renal transplant patients

    Prescribers who want to initiate mycophenolic acid for other indications must first discuss with, and get agreement from, the patientís GP about arrangements for ongoing prescribing
       
    Mepacrine tabs (discoid lupus)

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    Restricted Drug Unlicensed
    Red
    Discoid lupus erythematosus (lupus consultants only)

    Dose: from 50 mg three times a week to a maximum dose of 100 mg three times a day (PIL available on GTi at GSTFT)
       
     ....
    Key
    note Notes First Choice Item First Choice item
    Section Title Section Title (top level) Non Formulary Item Non Formulary section
    Section Title Section Title (sub level)
    Cytotoxic Drug
    Cytotoxic Drug
    Restricted Drug
    Restricted Drug
    CD
    Controlled Drug
    Unlicensed Drug
    Unlicensed
    High Cost Medicine
    High Cost Medicine
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    Link to SPCs
    click to search medicines.org.uk
    Link to adult BNF
    Track Changes
    Display tracking information
    click to search medicines.org.uk
    Cancer Drugs Fund
    Cancer Drugs Fund
       

     

    Traffic Light Status Information

    Status Description
      Red   Specialist Prescribing only. The responsibility for prescribing, monitoring, dose adjustment and review should remain with the specialist. 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.   
      Amber 1   Treatment can be initiated in primary care after a recommendation from an appropriate specialist  
      Amber 2   Specialist initiation followed by maintenance prescribing in primary care  
      Amber 3   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  
      Green   Specialist and non-specialist initiation  
      Grey   Not recommended for prescribing  

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