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 Formulary Chapter 5: Infections - Full Chapter
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05.03.01  Expand sub section  HIV infection
 note 
Note all drugs listed in this section are to be prescribed by the HIV and Specialist Sexual Health teams in accordance with BHIVA and NHS England guidelines, unless specified otherwise. For
Treatment as Prevention (TasP) in HIV-infected adults in accordance to NHSE Clinical Commisioning Policy F03/P/c
05.03.01  Expand sub section  Nucleoside reverse transcriptase inhibitors
Abacavir 300mg
(tablet)
View adult BNF View SPC online View childrens BNF  Track Changes
Restricted Drug Restricted
Red
 
   
Abacavir 100mg/5mL
(oral solution, sugar-free)
View adult BNF View SPC online View childrens BNF  Track Changes
Restricted Drug Restricted
Red
 
   
Abacavir / Dolutegravir / Lamivudine 600mg/50mg/300mg (Triumeq®)
(tablet)
View adult BNF View SPC online View childrens BNF  Track Changes
Restricted Drug Restricted
Red
Preferred fixed dose combination
Where possible, consider switch to generic Kivexa and dolutegravir - March 2017 
   
Abacavir / Lamivudine 600mg/300mg (Kivexa®)
(tablet)
View adult BNF View SPC online View childrens BNF  Track Changes
Restricted Drug Restricted
Red
Preferred first line NRTI backbone. Generic preferred March 2017 
   
Elvitegravir/ cobicistat/ emtricitabine/ tenofovir 150mg/150mg/200mg/10mg (Genvoya®)
(tablet)
View adult BNF View SPC online View childrens BNF  Track Changes
Restricted Drug Restricted
Red
Preferred fixed dose combination 
   
Emtricitabine 200mg (Emtriva®)
(capsule)
View adult BNF View SPC online View childrens BNF  Track Changes
Restricted Drug Restricted
Red
Restricted for BHT HIV MDT 
   
Emtricitabine/ Rilpivirine/ Tenofovir 200 mg/25 mg/25 mg (Odefsey®)
(tablet)
View adult BNF View SPC online View childrens BNF  Track Changes
Restricted Drug Restricted
Red
Preferred fixed dose combination 
   
Emtricitabine/Rilpivirine/Tenofovir Disoproxil 200mg/25mg/245mg (Eviplera®)
(tablet)
View adult BNF View SPC online View childrens BNF  Track Changes
Restricted Drug Restricted
Red
Preferred fixed dose combination 
   
Lamivudine 100mg (Zeffix®)
(tablet)
View adult BNF View SPC online View childrens BNF  Track Changes
Restricted Drug Restricted
Red
Restricted - prescribing by Gastroenterologists, HIV and Specialist Sexual Health teams only in accordance with NICE TA 96 
Link  NICE TA 96: Adefovir dipivoxil and peginterferon alfa-2a for the treatment of chronic hepatitis B
   
Lamivudine 150mg, 300mg
(tablet)
View adult BNF View SPC online View childrens BNF  Track Changes
Restricted Drug Restricted
Red
 
   
Lamivudine 25mg/5mL, 50mg/5mL
(oral solution)
View adult BNF View SPC online View childrens BNF  Track Changes
Restricted Drug Restricted
Red
Restricted to the prevention of maternal to foetal HIV transmission. See protocol by Obs & Paed Depts 
   
Stavudine 30mg, 40mg
(capsule)
View adult BNF View SPC online View childrens BNF  Track Changes
Restricted Drug Restricted
Red
 
   
Stribild®
(tablet)
View adult BNF View SPC online View childrens BNF  Track Changes
Restricted Drug Restricted
Red
Contains: cobicistat 150mg/elvitegravir 150mg/emtricitabine 200mg/tenofovir disoproxil 245mg

Preferred fixed dose combination
Prescribing in accordance with NHSE Clinical Commissioning Policy F03/P/a 
Link  NHSE Clinical Commissioning Policy F03/P/a
   
Tenofovir Disoproxil / Efavirenz / Emtricitabine 245mg/600mg/200mg (Atripla®)
(tablet)
View adult BNF View SPC online View childrens BNF  Track Changes
Restricted Drug Restricted
Red
Preferred fixed dose combination. Where possible, consider switching to Truvada and generic efavirenz- March 2017 
   
Tenofovir Disoproxil /Emtricitabine 245mg/200mg (Truvada®)
(tablet)
View adult BNF View SPC online View childrens BNF  Track Changes
Restricted Drug Restricted
Red
Restricted-
1. For post-exposure prophylaxis (PEP) in accordance to BASHH guidance for PEP. MAXIMUM FIVE days supply if not prescribed by HIV and Specialist Sexual Health teams, as per local PEP secondary care guideline (BHTCG 349).
PEP 5-day starter packs are available in A&E in Stoke Mandeville and Minor Injuries Unit (MIIU) in Wycombe Hospital

2. First line NRTI backbone as alternative in accordance with BHIVA guidance. 
Link  BASHH guidelines for PEP
Link  BHIVA pregnancy guidance
   
Tenofovir Disoproxil 245mg
(tablet)
View adult BNF View SPC online View childrens BNF  Track Changes
Restricted Drug Restricted
Red
1. Restricted - prescribing by HIV and Specialist Sexual Health teams only for adults with HIV
2. Restricted - to prescribing by Consultant Gastroenterologists or Associate Specialists of Gastroenterology in conjunction with Hepatitis B Clinic and in accordance with BHT Clinical Guideline on Hepatitis B and NICE TA 173. NICE compliance form required - see link on Formulary homepage.
 
Link  NICE CG165: Hepatitis B (chronic): diagnosis and management
Link  NICE TA173: Tenofovir disoproxil for the treatment of chronic hepatitis B
   
Tenofovir/Emtricitabine 200mg/25mg, 200mg/10mg (Descovy®)
(tablet)
View adult BNF View SPC online View childrens BNF  Track Changes
Restricted Drug Restricted
Red
First line NRTI backbone (alternative) 
   
Zidovudine 200mg/20mL
(injection)
View adult BNF View SPC online View childrens BNF  Track Changes
Restricted Drug Restricted
Red
For dilution and use as an intravenous infusion. Restricted to:
- use in ITU
- the prevention of maternal to foetal HIV transmission. See link below for Obs & Paeds protocol (BHT users only) 
Link  Antenatal and Newborn Screening (BHTCG 418)
   
Zidovudine / Lamivudine 300mg/150mg (Combivir®)
(tablet)
View adult BNF View SPC online View childrens BNF  Track Changes
Restricted Drug Restricted
Red
Restricted for BHT HIV MDT
 
   
Zidovudine 100mg, 250mg
(capsule)
View adult BNF View SPC online View childrens BNF  Track Changes
Restricted Drug Restricted
Red
Restricted for BHT HIV MDT 
   
Zidovudine 50mg/5mL
(oral solution)
View adult BNF View SPC online View childrens BNF  Track Changes
Restricted Drug Restricted
Red
Restricted to:
- use in ITU
- prevention of maternal to foetal HIV transmission. See link below for Obs & Paeds protocol (BHT users only)  
Link  Antenatal and Newborn Screening (BHTCG 418)
   
05.03.01  Expand sub section  Protease inhibitors
05.03.01  Expand sub section  Non-nucleoside reverse transcriptase inhibitors
05.03.01  Expand sub section  Other antiretrovirals to top
 ....
 Non Formulary Items
Abacavir / Lamivudine / Zidovudine 300mg/150mg/300mg  (Trizivir®)
(tablet)

View adult BNF View SPC online View childrens BNF Track Changes
Non Formulary
Black
 
Didanosine 250mg, 400mg  (Videx® EC)
(capsule enclosing EC granules )

View adult BNF View SPC online View childrens BNF Track Changes
Non Formulary
Black
 
  
Key
note Notes
Section Title Section Title (top level)
Section Title Section Title (sub level)
First Choice Item First Choice item
Non Formulary Item Non Formulary section
Restricted Drug
Restricted Drug
Unlicensed Drug
Unlicensed
Track Changes
Display tracking information
click to search medicines.org.uk
Link to adult BNF
click to search medicines.org.uk
Link to children's BNF
click to search medicines.org.uk
Link to SPCs
SMC
Scottish Medicines Consortium
Cytotoxic Drug
Cytotoxic Drug
CD
Controlled Drug
High Cost Medicine
High Cost Medicine
Cancer Drugs Fund
Cancer Drugs Fund
NHSE
NHS England
Homecare
Homecare
CCG
CCG

Traffic Light Status Information

Status Description

Black

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 Medicines Value Group (MVG)
Drugs defined as ‘Low Priority’ by the South Central Priorities Committee
New drugs which have not as yet been evaluated by the MVG
Any drug not listed in the Buckinghamshire Formulary  

Red

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  

Red Specialist Centre

As for ‘red’ (above) with the addition of the following:
Designated by NHS England to require initiation by or in prior agreement with a Specialist Centre. Continuation where appropriate by BHT (or other secondary care provider)
Detailed requirements for Specialist Centre initiation to be described in the wording of the formulary restriction  

Amber Protocol

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

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  

Amber Recommended

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.  

Green

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 MVG and APC.  

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