Requests for RED or Non-Formulary products
You may occassional receive requests from Speciailst Teams to prescribe a medication which you know is a RED category drug, or you feel is not appropriate for primary care prescribing, or at least until further information is made available to you by the Specialist Team. This Non-Formulary Feedback form is intended to be used by primary care prescribing teams to easily communicate with the specialist team, and can be found here.
Please remember to never send patient identifiable information to the CCG, so alway remove any PID before sending to the Medicines Optimisation Team.
THE TRAFFIC LIGHT SYSTEM (scroll down)
NB It is not obligatory for GPs to prescribe “Amber” medications purely because we have an agreed Shared Care Guideline. Clinical responsibility is with the prescriber and therefore individual GPs need to decide on whether it is appropriate for them to accept this responsibility for a particular drug in a particular patient. If this situation occurs timely communication with the specialist is essential so that alternative arrangements can be implemented.
Shared Care Guideline template - download this template to start a new SCG.
RED - Hospital / Specialist initiation and continued prescribing only
AMBER - Hospital / Specialist recommendation OR Hospital / Specialist initiation and prescribing, with requested transfer of prescribing to GP upon agreement once patient is stabilised
GREEN - Green listed items have been removed from the Traffic Light List since they had no particular restrictions. Any associated prescribing guidance is now listed under Prescribing Guidance in the Medicines Management section on CCG LIVE.
|Drug name||Category||Condition listed / Notes||Link to Shared care Guideline|
|Acapella Choice||Amber||No SCG required. Mucous clearing device (e.g. cystic fibrosis). For specialist initiation and specialised patient training required. Prescribing in primary care if patient benefit shown.|
|Adalimumab (Humira™)||Red||Crohn's Disease|
|Alirocumab||Red||Primary hypercholesterolemia and mixed dyslipidaemia (as per NICE TA393 and TA394)|
|Alitretinion (Toctino™)||Red||Hand Eczema|
|Amiodarone||Amber||Cardiac rhythm disorders||SCG|
|Apomorphine (Apo-Go™)||Amber||Parkinson's Disease- now provided directly via Homecare||SCG (includes homecare)|
|Atomoxetine (Strattera™) Adult||Amber||Attention Deficit Hyperactivity Disorder (ADHD) in Adults||SCG|
Inflammatory Bowel Disease
Prevention of rejection transplant. Bechet’s syndrome, chronic active hepatitis, Idiopathic thrombocytopenic purpura, interstitial lung disease, myasthenia gravis, Polymyositis, Rheumatoid arthritis, sarcoidosis, scleritis and uveitis, SLE, vasculitic syndromes, eczema, pemphigoid and psoriasis.
|SCG in development|
|Azathioprine (Imuran™)||Amber||Severe Uveitis||SCG|
|Bicalutamide||Amber||Management of Prostate Cancer||SCG|
|Buprenorphine ™||Amber||Opioid withdrawal. CGL primarily prescribe medications for substance misuse. They will now routinely prescribe Espranor™, a rapidly dissolving orolyophilisate for mucosal absorption. Bioavailability differs so should not be interchanged with standard sublingual tablets.|
|Buserelin (Suprefact™, Suprecur™)||Amber||Prostate cancer|
|Cannabis Derived Medicines (including Cannabis oil)||Red||
Following the recent legislative review relating to legal prescribing of cannabis, please see the following NHS England Bulletin.
Prescribing will be limited to “specialists” in the areas associated with its potential use, and that GPs should NOT prescribe cannabis products.
When licensed products become available, which could take a while dependent on the licencing processes, this current prescribing position will be reviewed. Therefore, cannabis products are classed on the Gloucestershire traffic light system as ‘red’ drugs.
NHS England Guideline Oct 2018
NHS Choices Website- useful to print out for patients- clearly advises them of the specifics of who can prescribe, and for what conditions.
NHS England have recently produced a guide for prescribers
|CAPD (Continuous Ambulatory Peritoneal Dialysis fluids)||Red|
|Chorionic Gonadotrophin (Profasi™, Pregnyl™, Choragon™)||Red||Infertility. Refer to Items not Normally Funded (INNF)|
|Ciclosporin (Neoral™, Sandimmun™, SangCya™)||Amber||Rheumatoid Arthritis|
|Ciclosporin (Capimune™, Neoral™, Deximune™ )||Amber||Psoriasis. Dermatologists will prescribe by brand, using Capimune™ as the first line choice||SCG|
|Ciclosporin (Neoral™, Sandimmun™)||Amber||Renal transplant||SCG|
|Ciclosporin (Neoral™, Sandimmun™, SangCya™)||Red||Ulcerative Colitis|
|Ciclosporin (Capimune™)||Amber||Severe Uveitis||SCG|
|Ciclosporin (Ikervis™) eye drops||Red||Severe keratitis unresponsive to other agents. See Joint Formulary|
|Cinacalcet (Mimpara™)||Red||Secondary Hyperparathyroidism in patients with end-stage renal disease on maintenance therapy|
|Clozapine (Clozaril™)||Red||Atypical antipsychotic NICE June 2002.|
|Amber||Osteoporosis in women and men where biphosphonates not appropriate. Specialist initiation, then shared care. Recorded reasons for preference over alternatives be noted.||SCG|
|Denosumab (XGEVA™)||Amber||prevention of skeletal related events in adults with bone metastases from solid tumours.||SCG|
|Desferrioxamine (Desferal™)||Red||Elimination of excess iron. Specialist use only|
|Dexamfetamine||Amber||ADHD refractory to methylphenidate and/or atomoxetine, under specialist supervision (Adult)||SCG|
|Disodium Pamidronate (Aredia™)||Red||For use in management of multiple myeloma|
|Donepezil (Aricept™)||Green||G-Care holds local supporting guidance for GPs||Downgraded Sep 2018|
|Dornase Alfa (Pulmozyme™)||Red||Cystic Fibrosis. For patients currently receiving this in primary care, the GP should contact the Specialist Team and arrange a repatriation time. Until repatriated, prescribing may continue under the previous SCG, but this shoudl be temporary.||SCG only whilst repatriation is being arranged.|
|Dronederone (Multaq™)||Red||Atrial Fibrillation (AF) - see SPC for full details|
|Eltrombopag||Red||Chronic idiopathic thrombocytopenic purpura|
|Entacapone (Comtess™)||Amber||Parkinson's Disease|
|Eplerenone (Inspra™)||Green||Heart failure post MI. Classified green on 26/11/19, only where spironolctone is not appropriate.|
|Epoprostenol (Flolan™)||Red||Primary pulmonary hypertension. Hospital Trusts are responsible for making the necessary arrangements for patients to receive intravenous treatment at home|
|Erythropoiesis Stimulating Agents (darbepoietin alfa, Methoxy polyethylene glycol Epoietin beta)||Amber||Pre-dialysis, dialysis and renal transplant||SCG|
As per NICE guidelines March 02.
Recommended for rheumatoid arthritis in patients who meet certain criteria (including non response to at least 2 DMARDs to include methotrexate if not contra-indicated).
Also recommended for juvenile idiopathic arthritis where methotrexate has failed.
|Evolucumab||Red||Primary hypercholesterolemia and mixed dyslipidaemia (as per NICE TA393 and TA394)|
|Fampridine (Fampyra™)||Red||Use in multiple sclerosis - specialist use only|
|Flutamide (Drogenil™)||Amber||Management of Prostate cancer|
|Follitropin alfa and beta (Gonal F™ and Puregon™)||Red||Infertility Items Not Normally Funded (INNF)|
|Galantamine||Green||Recommended for the treatment of Alzheimer’s disease. Changed to green in January 2019|
|Gold (Auranofin™, Myocrisin™)||Amber||Rheumatoid and juvenile arthritis|
|Gonadorelins||Amber||Prostate cancer||A shared SCG|
|Gosorelin||Amber||Prostate Cancer||Part of a shared SCG|
|Growth Hormone in Adults||Amber||As per NICE guideline|
|Growth Hormone in children||Amber||As per NICE guideline. For use in short stature due to growth hormone deficiency, Turner Syndrome and chronic renal insufficiency||SCG|
|Hydroxychloroquine (Plaquenil™)||Amber||Rheumatoid Arthritis|
As per NICE guidelines April 02.
Recommended for the treatment of severe crohns disease where certain criteria are met.
As per NICE guidelines March 02.
Recommended in combination with methotrexate for rheumatoid arthritis in patients who meet certain criteria (including non response to at least 2 DMARDs).
|Interferon alfa (Intron A™, Roferon A™, Viraferon™, Wellferon™)||Red||
As per NICE guidelines Oct 00.
For use in combination with ribavirin in the management of moderate to severe hepatitis C.
For chronic myeloid leukaemia.
|Intravenous / nebulised antibiotics||Amber||Cystic Fibrosis|
|Intravenous Cancer Drugs||Red||Hospital Trusts are responsible for making the necessary arrangements for patients to receive intravenous treatment at home|
|Intravenous immunoglobulins (Alphaglobin, Octagam, Sandoglobulin, Vigam)||Red||Hospital Trusts are responsible for making the necessary arrangements for patients to receive intravenous treatment at home|
|Isotretinoin (Roaccutane™)||Red||Acne, side-effects require specialist supervision|
|Lanreotide (Somatuline™)||Amber||Third-line treatment for acromegaly (second line if patient is unfit for surgery)||Now found within the SCG with Octreotide|
|Leflunomide (Arava™)||Amber||For third-line use in patients with active rheumatoid arthritis when treatment with sulphasalazine and methotrexate is contra-indicated or has been found to be ineffective or not tolerated|
|Leuprorelin||Amber||Prostate Cancer||Part of a shared SCG|
|Liraglutide||Red||Anti-diabetic agent (at 1.8mg dose). Also no longer joint formulary choice- see joint formulary here|
|Lisdexamfetamine (Elvanse™) Child||Amber||ADHD refractory to methylphenidate and/or atomoxetine, under specialist supervision (Child)||SCG|
|Lisdexamfetamine (Elvanse™) Adult||Amber||ADHD refractory to methylphenidate and/or atomoxetine, under specialist supervision (Adult)||SCG|
|Lurasidone||Amber||Schizophrenia, commenced by secondary care after alternative anti-psychotics have been tried and found unsuitable.||SCG|
|Melatonin||Amber||Sleep disturbances in neurological or behavioural problems. Circadin is preferred, and can be crushed to provide an immediate release characteristic (unlicensed). Patient leaflet||SCG expired- under review|
|Melatonin||Amber||Sleep disorders in people with learning disabilities. Circadin is preferred, and can be crushed to provide an immediate release characteristic (unlicensed). Patient leaflet||SCG expired- under review|
|Melatonin||Red||Sleep reversal associated with dementia (hospital only)|
|Memantine||Green||Alzheimer’s Disease (now also includes the treating agitation in dementia pathway)||
Downgraded Sep 2018
SCG (maybe useful for agitation advice)
|Mercaptopurine||Amber||Treatment of Inflammatory Bowel Disease||SCG|
Covers use when providing tablets or injections for Juvenile Idiopathic Arthritis, Rheumatological conditions and Uveitis
(Reflects dosing orally or by subcutaneous injection).
NB since publication, the availability of sharps bins in different sizes has improved, and larger bins are now available on FP10 prescription. See p3 of our newsletter for further information.
|Methylphenidate||Amber||As per NICE guidelines Oct 00 it is recommended for use as part of a comprehensive treatment programme for children with ADHD|
|Methylphenidate (Adult)||Amber||ADHD (Adult) under specialist supervision||SCG|
Severe heart failure and diuretic resistance – it is significantly more potent than bendroflumethiazide and will cause profound diuresis in combination with loop diuretics. Careful monitoring is required to avoid electrolyte disturbance and dehydration. Sometimes prescribed as a twice or three times weekly dose.
|Midodrine||Amber||Hypotension. Secondary care initiated.||SCG|
|Mucositis Oral Gels||Amber||Should only be used on NHS under recommendation of a specialist. Used to treat the discomfort of oral mucositis during or following radiotherapy or chemotherapy for the oral cavity. Two products available, either Gelclair oral gel (TM) or Episil oral spray (TM)|
|Mycophenolate Mofetil (CellCept™)||Amber||Prophylaxis of rejection in transplant|
|Mycophenolate Mofetil (generic)||Amber||Severe Uveitis||SCG|
|N-Acetylcysteine||Red||For prescribing by Respiratory specialists only|
|Naloxegol||Green||Resistant Constipation when use strictly under the G-Care Pathway||G-Care Link|
|Naltrexone (Nalorex™)||Amber||Prevention of relapse in detoxified opium dependency, and also Alcohol Dependence||SCG|
|Octreotide (Sandostatin LAR™)||Amber||Acromegaly and the relief of symptoms associated with neuroendocrine (particularly carcinoid) tumours. Second line treatment for patients intolerant of lanreotide (Somatuline Autogel)||Now found within the SCG with Lanreotide|
|Penicillamine (Distamine™)||Amber||Second-line choice in rheumatoid arthritis.|
|Perampanel (Fycompa™)||Amber||Seizure treatment. Specialist use.||SCG|
|Pergolide (Celance™)||Amber||Parkinson’s Disease|
|Pirfenidone||Red||Idiopathic pulmonary fibrosis|
|Pramipexole (Mirapexin™)||Amber||Parkinson’s Disease|
|Prucalopride||Green||Constipation in line with the G-Care pathway||G-Care link|
|Ranolazine (Ranexa™)||Amber||Anti-Anginal drug- specialist initiation only||SCG|
As per NICE guidelines Oct 00.For use in combination with interferon alfa in the management of moderate to severe hepatitis C.
Gastroenterology / Hepatology Consultant initiation. Hepatic encephalopathy (not associated with gastrointestinal bleeding, medication, or neurological injury) that has not responded to optimal lactulose therapy. If shows continued benefit after 6 months of consultant prescribing, can be considered for shared care.
|Riluzole(Rilutek™)||Amber||As per NICE guidelines Jan 01.Recommended for use in the amyotrophic lateral sclerosis form of Motor Neurone Disease|
|Rivastigmine Patches (PS prescribe as Alzest where possible)||Amber||
Mild to Moderately Severe Alzheimers dementia for NEW patients only, in line with NICE TAG.
|Rivastigmine Capsules||Green||Changed to green January 2019|
|Roflumilast (Daxas™)||Amber||COPD patients with chronic bronchitis||SCG being develoepd|
|Ropinirole||Amber||Parkinson’s Disease.||no SCG currently. Formulary product choice for MR is Ipinnia™|
|Sacubitril / Valsartan (Entresto™)||Amber||Symptomatic chronic heart failure with reduced ejection fraction||SCG|
|Sativex™ (Cannabinoids)||Red||Multiple Sclerosis- Specialist use only|
|Sevelamer (Renagel™)||Amber||For hyperphosphataemia in haemodialysis patients|
|Sodium Clodronate (Bonefos™, Loron™)||Amber||Osteolytic lesions, hypercalcaemia and bone pain with bone metastases with breast cancer or myeloma.|
|Somatropin||Amber||See Growth Hormone|
|Strontium Ranelate||Amber||Treatment of severe Osteoporosis, if all other treatments are not suitable||SCG|
|Sulfasalazine||Amber||Rheumatoid Arthritis (and other inflammatory arthritis)||SCG|
|Tacrolimus (Adoport™ and Prograf™)||Amber||Prevention of rejection in liver and kidney transplant.||SCG|
|Tacrolimus (Adoport™)||Amber||Severe Uveitis||SCG|
|Tapentadol||Red||Use within Pain clinic only||Link to Criteria Based Access Policy which can also be found within the Joint Formulary|
|Teriparatide (Forsteo™)||Red||Osteoporosis. Now supplied via GHT Homecare route.|
|Tizanidine (Zanaflex™)||Amber||Spasticity with Multiple Sclerosis or spinal cord injury or disease.|
|Tolvaptan||Red||Posterior Pituitary hormone|
|Totalparenteral nutrition (TPN)||Red||Hospital Trusts are responsible for making the necessary arrangements for TPN.|
|Tretinoin Cream (Pigmanorm cream (a special order))||Red||See joint formulary skin chapter|
Triptorelin (De-capeptyl SR™)
|Amber||Endometriosis.||No, as not anticipated to be used|
Triptorelin (De-capeptyl SR™)
|Amber||Prostate cancer.||Part of a shared SCG|
|Vortioxetine||Amber||Third-line as an option for treating major depressive episodes in adults whose condition has responded inadequately to 2 antidepressants within the current episode, as per NICE TA367||Specialist Initiated|