1. No category

Aylesbury Vale and Chiltern CCGs
Traffic Light list October 2014
http://www.bucksformulary.nhs.uk
For further information on formulary restrictions for individual drugs please refer to the Buckinghamshire Formulary at:
Black (B)
Not recommended or awaiting
application
Avanafil
Red (R )
Amber Protocol (AP)
Amber Initiation (AI)
Amber Recommended (AR)
To be initiated in secondary care,
To be initiated in secondary care,
To be prescribed in secondary care only for continuation by GPs in accordance with for continuation by GPs
a shared care protocol
Acetylcysteine tab for pulmonary fibrosis
Acamprosate
Principles for shared care
Specialist may recommend that a GP starts
this drug
Alimemazine syrup
Aliskiren
Agomelatine
Responsibilities for shared care
Alglucerase
Alprostadil, for distress impotence
Atomoxetine
Alprostadil in Erectile dysfunction SLS indications. Aripiprazole
In psych. distress alprostadil=red.
Apixaban for AF
Betaxolol eye drops
Ambrisentan
Anti-retrovirals (e.g. for HIV)
Azathioprine - NPT
Aquadeks liquid
Cabergoline
Amifampridine (Firdapse)
Anti-TNF
Ciclosporin - NPT
Atorvastatin 80mg in Acute Coronary Syndrome
Duloxetine for depression & GAD
Anakinra
L-arginine in metabolic disorders
Denosumab for osteoporosis NPT
Bimatoprost 300 mcg/ml eye drops (preserved)
Duloxetine 60mg only for neuropathic pain
Alprostadil cream for impotence
Apraclonidine eye drops
Dexamfetamine
Ciclesonide
Etoricoxib for ankylosing spondylitis only
Aquadeks capsules (liquid is AI)
Apomorphine for Parkinsons
Donepezil
Colistimethate for non-CF bronchiectasis
(redlisted for CF)
Exemestane
Asenapine
artemeter/lumefantrine (Riamet®) for
falciparum malaria on I.D. Advice
Galantamine
Dabigatran for AF
Febuxostat
Atorvastatin chewable
Beclometasone m/r tabs Clipper®
Benzbromarone for gout
Dalteparin prophylactic doses except antenatal
which is red
Domperidone
Letrozole
Bisacodyl Supp 7.5mg (Aralax®)
Brimonidine Cream (Mirvaso®)
Bosentan - designated PAH centres only
Gold - sodium aurothiomalate & auranofin NPT
Goserelin neoadjuvant use for prostate cancer
prior to radiotherapy - NPT for this indication
only
Leflunomide - NPT
Entacapone
Mesalazine give once daily (Mezavant XL®)
Botulinum Toxin A for hyperhidrosis
Botulinum toxin (black for hyperhidrosis)
Buprenorphine patch (Butrans®)
Caffeine oral and iv
Liraglutide only in accordance with lical
diabetic algorithm
Lithium - NPT
Mirabegron for over active bladder (if patients
fit NICE criteria)
Probenecid for gout
Calcipotriol & Betamethasone Topical
Calcitonin
Memantine
Carteolol eye drops
Chlorhexidine cloths/wipes
Mercaptopurine - NPT
Eplerenone (post MI for 1 year only then switch to
spironolactone)
Erythropoetin and darbopoetin (all patients
except ORH Renal Patients - red for this centre)
Eye drops - combined drops containing timolol
with a 2nd agent for use in glaucoma
Exenatide bd & weekly
Catheterisation procedure pack (i.e. any
pack containing catheters with gloves,
aprons). Prescribe elements separately
Cinacalcet
Methotrexate tabs - NPT - and SC - NPT - in
adults
Hydroxychloroquine
Topiramate
Cannabinoids/Sativex
Clopidogrel 300mg tablet
Methylphenidate
Triptorelin in Gynaecology (see amber protocol
for use in Prostate Ca)
Chlorthalidone
Clozapine
Mycophenolate after transplants - NPT.
Co-careldopa intestinal gel
Cyclophosphamide in Rh A
Penicillamine - NPT
Ibandronic acid - in metastatic disease of breast
cancer
Insulin degludec in type 1 diabetes patients with
problematic nocturnal hypos;
100U/ml is amber; 200 unit/ml is black
Ivabradine for LVF, 2nd line to beta-blockers
Co-proxamol
Cystic fibrosis - nebules and inhalations
(colistimethate, dornase, tobramycin,
mannitol) - Hospital supply to start at next
review
Cytotoxics for the treatment of malignancy
Rivastigmine
Lacosamide for refractory epilepsy that requires
multiple treatments
Selevamer
Lidocaine plaster in palliative care pain
(Blacklisted for all other indications)
Midazolam Buccal
Colesevelam
Colestipol
Cytotoxics, not listed elsewhere on the
traffic lights, for treatment of malignancy
Dabigatran - for thromboprophylaxis post
Somatropin in adults;
hip and knee surgery
Dalteparin all antenatal use & all treatment Sulfasalazine - NPT
doses - refer back to BHT
Dabigatran for indications other than AF
(amber) & thromboprophylaxis (red)
Dapoxetine for premature ejaculation
Dapsone for Pneumocystis carinii
prophylaxis
Denosumab monthly for cancer
Tacrolimus for transplant <NPT>. Protocol to
be provided at hospital discharge.
Triptorelin for prostate cancer - NPT
Modafinil for sleep disorders (licensed uses)
Deferasirox
Diltiazem Ointment 2%
Zonisamide - NPT
Octreotide
Doxycycline 20mg, 40mg strengths
Eltrombopag
Pramipexole for parkinson's disease
Duac -topical for acne
Erythropoetin and darbepoetin (ORH Renal
Patients only)
Filgrastrim
Prasugrel - for indications in local protocol
Pimecrolimus (topical)
Prucalopride (in patients who fit NICE criteria).
Supply for 1st 6 weeks from hospital.
Retigabine
Eflornithine
5 Fluorouracil cream for topical cancers eg
SCC
®
Fluticasone (Flixonase ) nasules usual
1
treatment course /12 then nasal spray
Fondaparinux sodium
Escitalopram
Fosfomycin
Eslicarbazepine
Fumaric acid esters (Fumaderm®) for
psoriasis
Rosuvastatin (lipid clinic only - in complex cases
who have already tried high dose atorvastatin)
Esomeprazole
Glycopyrronium orally in adults & children
Sildenafil 20mg(Revatio) for pulm. hypertension
Fampridine
Sulfinpyrazone for gout
Fesoterodine
hepatitis treatments e.g. adefovir,
telaprovir, boceprevir, entecavir, ribavirin,
Peg-interferon
2a eg TPN, CAPD
Hi
Tech Homecare
Fidaxomycin
Hospital clinical trial material
Ticagrelor - for indications in local protocol
Eculizumab
Fluoride toothpaste (e.g. Duraphat 2800) Hydroxycarbamide in haematology
Imiquimod
Fluticasone furoate / vilanterol = Relvar®
Flutter device and Acapella (for mucous Immunoglobulins
expectoration)
Flutrimazole cream
Infused medication & blood products
Glucosamine
Glycopyrronium inhaler (Seebri)
Insulin Humulin R 500 units/ml
Insulin pump therapy (devices)
Histrelin
Intravitreal medicines e.g. aflibercept,
ranibizumab, bevacizumab
Hydromorphone
Ivermectin tab
Human Papilloma Virus (HPV) Vaccine
IVF
Ibandronic acid inj (all uses) and tablets
for osteoporosis
Indacaterol
Lanreotide for carcinoid syndrome
Lenolidamide
Strontium - place in therapy now 6th line for
secondary prevention of osteoporosis
Naltrexone
Ondansetron (only licensed for 5 day course)
Dymista®
Risperidone depot injection
Minocycline in dermatology (except for acne when
it is green but 4th line)
Dermatix and similar dressings to prevent Diphencyprone for recalcitrant warts
keloid scars
Domperidone to increase milk supply
Dronedarone
Duloxetine for urinary incontinence
Levetiracetam
Rivaroxaban for AF - only to be started in the new
oral anticoagulant clinic
Rivaroxaban for PE/DVT - only for certain patient
groups see linked policy
Ropinirole XL only to be used in patients unable
to tolerate plain due to ADRs
Tacrolimus (topical)
Legend
italics Italics - Requires evaluation by Formulary
Management Group (FMG)
New position or recent review
No Written Shared Care available.
FMG Oct 2011 agreed that for new patients
consider as RED-listed until SCA available
<NPT> An amber protocol medicine which attracts a
Near Patient Testing quarterly fee
Awaiting local guidance or there is a FMG
outstanding action
► Click to read note
*
Underlined Click for link (often to local guideline)
CCG action required (usually hyperlink to be
added).
Aylesbury Vale and Chiltern CCGs
Traffic Light list October 2014
http://www.bucksformulary.nhs.uk
For further information on formulary restrictions for individual drugs please refer to the Buckinghamshire Formulary at:
Black (B)
Not recommended or awaiting
application
Ingenol gel
Red (R )
Amber Protocol (AP)
Amber Initiation (AI)
Amber Recommended (AR)
To be initiated in secondary care,
To be initiated in secondary care,
To be prescribed in secondary care only for continuation by GPs in accordance with for continuation by GPs
a shared care protocol
lisdexamphetamine
Specialist may recommend that a GP starts
this drug
Ivabradine for angina
Melatonin pre EEG (short course treatment)
& in adult LDs (usual course 3/52)
Lenogastrim
Metformin to reduce weight gain (paeds)
Lid Care Wipes
Methotrexate in children
Lidocaine 5% plaster Versatis® when
used
for neuropathic pain
Linaclotide
Methysergide
Linagliptin
Methylnaltrexone inj (FNH only)
Lomitapide
Lubriprostone
Multiple sclerosis - high tech drugs e.g.
alemtuzumab, betainterferon, dimethyl
fumarate, glatiramer, fingolimod,
natalizumab, teriflunamide
Mycophenolate for Rheumatoid & Derm.
Loxapine
Maraviroc tab
Nalmefene
Omalizumab
Melatonin to aid sleep - long term use
Trial data is all short term
Miconazole tablets
Oxycodone as part of enhanced recovery
(only patients taking oxycodone before
admission to be discharged on it)
Paliperidone
Nabilone for MS
Pirfenidone
Naltrexone low dose (up to 5mg)
Pivemecillinam
Nuvaring(R)
Quetiapine in generalised anxiety disorder
Omega 3 fatty acids
Ranolazine
Oxycodone/naloxone combination
Pelvic trainer and toning devices
Retinoids orally - isotretinoin, acitretin,
alitretinoin
Riluzole
Pegfilgrastim
Sodium benzoate in metabolic disorders
Pergolide
Sodium phenylbutyrate in metabolic
disorders
Phentolamine + Papaverine
Somatropin in children.
Pigmanorm
Sucrose 24% in neonates and small
children
Piracetam
Temocillin
Pramipexole XL
Pramipexole for restless legs syndrome
Tenofovir
Thalidomide
Indapamide 2.5 mg plain tablets (m/r remain
not recommended)
Insulin Detemir - Levemir*
Isotretinoin Topical
Pregabalin
Tigecycline inj
latanoprost (generic) eye drops (preserved)
Probiotics
Trastuzumab
Propiverine
Valganciclovir
latanoprost eye drops p/f, bimatoprost eye
drops p/f and Travoprost eye drops where
allergic to benzalkonium preservative
Levonorgestrol IUD (Jaydess)
Quetiapine XL
Quinagolide
Ranolazine
Voriconazole oral and IV
Zoledronic acid inj (Aclasta®)
Methotrexate for paediatric uses
Green (G)
Medicines with a recently changed status for full green list see formulary
Aclidinium inhaled in COPD
Almotriptan - 2nd line triptan in patients with no
response to sumatriptan for 3 migraines
Aymes Shake - 1st line sip feed (where food
first advice is inadequate)
Beclometasone/Formoterol (Fostair®) in COPD
Cholecalciferol 20,000 units bd short term (see
link) 2ary care to give 1st supply when patient
Complan shake -2nd line sip feed (where food
1st is inadequate)
Dapagliflozin only to be prescribed in
accordance with the local diabetic algorithm
Dithranol (excluding specials which remain redlisted)
Diclofenac 3% Gel (Solaraze) for Actinic
keratosis
Eplerenone in male LVF patients with
gynaecomastia caused by spironolactone
Fluorouracil cream for Actinic Keratosis - GPs
can initiate in practice. If hospital outpatient
1st supply from hospital
Fluorouracil/salicylic acid (Actikerall) for Actinic
Keratosis - GPs can initiate in practice. If
hospital outpatient 1st supply from hospital.
Fluticasone furoate nasal spray (Avamys®),
3rd line choice
Fluticasone/formoterol inhaled (Flutiform®)
Minocycline - 4th line antibiotic for acne
Oseltamivir
Sildenafil for erectile dysfunction if fits SLS
criteria
Sitagliptin only to be prescribed in accordance
with local diabetic algorithm
Rasagiline
RESPeRATE
Solifenacin in overactive bladder
Rifaximin
Ropinorole for restless legs
Rosuvastatin blacklisted unless started by
lipidologist (see AI list)
Rotigotine patch
Tadalafil 3rd line in erectile dysfunction if fits
SLS criteria; daily dosing is blacklisted
Timolol p/f 0.1% and 0.25% where there is
established allergy to benzalkonium chloride.
Review 0.5%
to 0.25%.
Tiotropium
Respimat
if unable to use
Handihaler (see COPD guideline)
Ulipristal morning after pill for late presenters at
3-5 days.
Vardenafil 2nd line after sildenafil in erectile
dysfunction if fits SLS criteria
Vitamin D 800 units (see protocol)
Sildenafil chewable (Nipatra)
Zanamivir
Rivaroxaban for prevention of venous
thromoembolism around surgery
Roflumilast
Suvenaid
Tacrolimus (oral) for dermatology
Tadalafil for benign Prostatic Hypertrophy
Tafloprost eye drops
Tapentadol
Testosterone Patch <intrinsa>
Therabite
Timolol 0.5% eye drops
Toremifene
Tramacet
Tri-luma cream
Vacuum Pumps for Erectile dysfunction
Vitamins High Dose for Eyes
Zostavax if outside national vaccination
campaign
Legend
italics Italics - Requires evaluation by Formulary
Management Group (FMG)
New position or recent review
No Written Shared Care available.
FMG Oct 2011 agreed that for new patients
<NPT> An amber protocol medicine which attracts a
Near Patient Testing quarterly fee
Awaiting local guidance or there is a FMG
outstanding action
► Click to read note
*
Underlined Click for link (often to local guideline)
CCG action required (usually hyperlink to be
added) - will not be shaded on circulated TLL
Buckinghamshire Traffic Light System Definitions
Black
Red
Amber Protocol
Not recommended for use because of lack of evidence of clinical effectiveness, cost
effectiveness or safety.
Drugs which have been evaluated and rejected by the Formulary Management Group (FMG)
Drugs defined as ‘Low Priority’ by the South Central Priorities Committee
New drugs which have not as yet been evaluated by the FMG
Any drug not listed in the Bucks Joint Formulary at
http://www.nelm.nhs.uk/en/Formularies/Trusts/Buckinghamshire-Formulary/
Drugs which should only be prescribed in secondary care by a specialist.
Require specialist knowledge and/or equipment for patient selection and initiation,
Require long term on-going monitoring and dose adjustment to ensure efficacy and minimise
toxicity by a specialist
Designated as “hospital only“ by product licence, NICE, DoH or BNF
May need further evaluation by a specialist
Are hospital initiated clinical trial materials
Drugs which should be initiated in secondary care by the specialist with follow-on
prescription and monitoring according to a drug specific Shared Care Protocol (SCP).
Prescribing may be continued in primary care following the SCP
Require specialist knowledge and/or equipment for patient selection and initiation
Require short or medium term (eg. 3 to 6 months) specialist monitoring of efficacy or toxicity. The
need for stabilisation will vary with different drugs and patients, but is usually a minimum of 2
months (see principles for shared care)
Require significant long term monitoring
Require ongoing communication between the GP and the specialist
Have clearly defined consultant, GP and patient responsibilities documented in a shared care
protocol (see responsibilities for amber protocol drugs)
Amber initiation
Amber
recommendation
Green
Drugs suitable for primary care prescribing following specialist initiation
Require specialist knowledge and/or equipment for patient selection
Monitoring does not require specialist knowledge or equipment
If the drug is one with which the primary care prescriber is unfamiliar the specialist is expected to
provide sufficient information on the drug indication, dose, duration , monitoring and any further
necessary dose adjustments
Require the first prescription to be written by the specialist
Drugs suitable for primary care prescribing following specialist recommendation
As for amber initiation except that:The first prescription may be written by the GP after specialist recommendation.
Drugs for which primary care prescribers would normally take full responsibility for
prescribing and monitoring
Drugs not included in the Traffic Light list but included on joint formulary.
New drugs classified as red or amber but as greater experience regarding their safety and efficacy is
established may move to Green after re-consideration by the FMG and APC.