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Do Not Prescribe and Grey Lists - May 2015

The Do Not Prescribe list contains products which have been reviewed by the GM Joint Formulary Group and have been deemed not suitable for prescribing for adults and children in primary or secondary care within Greater Manchester (in addition to all medicines with a “not NHS” or “DLCV” classification in the BNF and those agents as included within the NICE “Do not do” list). These decisions have been made on the basis of safety, efficacy and cost-effectiveness of the product using these agreed criteria

Items which are listed as Grey are deemed not suitable for routine prescribing but may be suitable for a defined patient population. Whilst prescribers should think very carefully before prescribing or recommending any of the products on the grey list, there may be exceptional instances when the use of one of these products is necessary for a particular patient. A patient may be deemed exceptional if the patient has a clinical picture that is significantly different to the general population of patients with that condition and as a result of that difference the patient is likely to derive greater benefit from the intervention than might normally be expected for patients with that condition.

This list will be reviewed by the Greater Manchester Joint Formulary Group every six months.
 

Produced by the GM FSG for use across Greater Manchester
Review date: March 2016

 

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Showing the combined Do Not Prescribe and Grey Lists 

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Medicine

BNF

Rationale

Status

Information

Alendronate plus Vitamin D (Fosavance®

6

Not a cost effective use of NHS resources. 

dnp 

NICE- TA161
CKS- osteoporosis 

Alimemazine  

3

Not a cost effective use of resources 

DNP 

Drug tariff (Sept 2016) 

All prescription only toothpastes and mouth washes e.g. Duraphat® toothpaste 

9

Safety concerns 

Grey 

Only dentists should prescribe such products due to the risk of patients developing fluorosis. 

Atorvastatin 30mg and 60 mg preparations 

2

Not a cost effective use of NHS resources 

dnp 

Drug Tariff 

Bio-oil 

Misc

Not a cost effective use of NHS resources 

DNP 

Cosmetic product with no robust clinical trial data for efficacy. 

BioXtra® toothpaste and mouth rinse 

Misc

Not a cost effective use of NHS resources 

DNP 

Saliva substitutes: choosing and prescribing the right product (UKMI; July 2015) 

Calcium 500mg and colecalciferol 200units (e.g. Calcichew D-3) 

9

Not a cost effective use of NHS resources. 

dnp 

CKS: sub-therapeutic dose for fracture prevention 

Cannabis extract (Sativex®

4

Poor evidence base. 

dnp 

NTS: Sativex® for the treatment of non-MS neuropathic pain (unlicensed indication)

(NICE Do not Do: Do not offer Sativex to treat spasticity in people with MS because it is not a cost effective treatment )  

Chlorpropamide 

6

Safety concerns. 

dnp 

CKS: Type 2 diabetes 

Cilostazol (Pletal®

2

Poor evidence base. 

dnp 

NICE: TA223 

Co-careldopa intestinal gel (Duodopa®

4

Not a cost effective use of NHS resources. 

dnp 

NHS Commissioning Board: Duodopa policy statement DC43 

Co-proxamol 

4

Safety concerns. 

dnp 

BNF: Compound Analgesic Preparations 

Cod liver oil capsules 

9

Poor evidence base. 

dnp 

NHS Choices: Supplements who needs them 

Codeine and aspirin combination product (Co-codaprin®

4

Poor evidence base. 

dnp 

BNF: aspirin with codeine phosphate 8mg 

Coenzyme Q10 (includes ubiquinone and ubidecarenone)  

9

Poor evidence base.
Should only be used for the treatment of mitochondrial disorders under the care of a specialist 

grey 

NICE CG181  

Commercial eyelid cleansing preparations 

11

Not a cost effective use of NHS resources 

DNP 

There is limited evidence to support the effectiveness of these products over traditional eyelid hygiene methods 

Cough medicines 

3

Poor evidence base 

dnp 

NICE CKS: Common Cold 

Cyanocobalamin tablets 

9

Poor evidence base.
Only for use in those patients who are truly unable to tolerate injections and who are vegan or have a proven dietary deficiency. 

grey 

BNF: drugs used in megaloblastic anaemias 

Dapoxetine (Priligy® ▼

7

Poor evidence base.
Only for use in those patients whose condition is medically related or as part of a fertility programme, however other more cost effective options should be considered first.  

grey 

NTS: dapoxetine (Priligy®▼) for the on-demand treatment of Premature Ejaculation (PE) 

Diuretics with Potassium 

2

Safety concerns. 

dnp 

BNF: Diuretics with potassium 

Dosulepin
(licensed and unlicensed uses)  

4

Safety concerns due to risk of toxicity in overdose 

DNP 

SPC: Section 4.4: Toxicity in overdose
NICE “do not do” recommendations (Dosulepin)
 

 new  
19 Mar 18 

Doxazosin MR 

2

Not a cost effective use of NHS resources 

dnp 

See NHS England guidance on items not for routine prescribing in primary care 

E-voke® electronic inhaler 

Misc

Poor evidence base 

dnp 

NTS: E-Voke® (nicotine) electronic inhaler device 

Ergotamine containing products (Migril) 

4

Safety concerns. 

dnp 

NICE “do not do”: Do not offer ergots or opioids for the acute treatment of migraine 

Fulvestrant 

8

Poor evidence base.
Not a cost effective use of NHS resources. 

dnp 

NICE TA239 

Gamolenic Acid/ Starflower oil (Epogam®) and Efamast®

9

Poor evidence base. 

dnp 

No evidence to support use 

Gliclazide MR (Diamicron MR®

6

Not a cost effective use of NHS resources. 

dnp 

BNF note: equivalent therapeutic effect to standard prep 

Glucosamine (+/- chondroiton) 

10

Poor evidence base. 

dnp 

NTS: Glucosamine sulfate (Glusartel®) for the treatment of osteoarthritis of the knee

NICE: Do not Do 

Grass Pollen Extract (Grazax®

3

Poor evidence base. 

dnp 

NTS: Grazax for grass pollen induced hayfever in adults 

Herbal medicines 

Misc

Poor evidence base 

DNP 

GM EUR Complementary and Alternative Therapies policy 

Homeopathic medicines 

Misc

Poor evidence base. 

DNP 

GM EUR Complementary and Alternative Therapies policy 

Idoxuridine in dimethyl sulfoxide (Herpid®

13

Poor evidence base. 

dnp 

No evidence to support use 

 new  
19 Mar 18 

Immediate-release fentanyl 

4

Only to be used in patients undergoing palliative care treatment where the recommendation to use immediate release fentanyl is in line with NICE CG140 and has been made by a multi-disciplinary team and/or other healthcare professional, with a recognised specialism in palliative care. 

grey 

See NHS England guidance on items not for routine prescribing in primary care 

Inositol Nicotinate (Hexopal®

2

Poor evidence base. 

dnp 

NICE: TA223 

Iron - all modified release iron preparations 

9

Poor evidence base. 

dnp 

BNF: No therapeutic advantage and should not be used 

Ketoconazole (for oral administration) 

5

Safety concerns. 

dnp 

MHRA: Drug Safety Update 

Lactase drops e.g. Colief® 

Misc

Poor evidence base 

DNP 

BNF Appendix 2.5
NICE CKS – Colic – infantile (Nov 2014): Lactase drops 

Lanolin cream (Lansinoh HPA®

13

Not a cost effective use of NHS resources. 

dnp 

Cochrane Review 2014: Interventions for treating painful nipples among breastfeeding women 

Levocetirizine (Xyzal®

3

Not a cost effective use of NHS resources. 

dnp 

CKS: Allergic Rhinitis 

 new  
19 Mar 18 

Lidocaine plasters 

4

Only to be used in patients who have been treated in line with NICE CG173 (Neuropathic pain in adults: pharmacological management in non-specialist settings) but are still experiencing neuropathic pain associated with previous herpes zoster infection (post-herpetic neuralgia). 

grey 

See NHS England guidance on items not for routine prescribing in primary care 

 new  
19 Mar 18 

Liothyronine (T3)  

6

Only for individuals who, in exceptional circumstances, have an on-going need for liothyronine as confirmed by a consultant NHS endocrinologist. 

grey 

See NHS England guidance on items not for routine prescribing in primary care 

 new  
19 Mar 18 

Liothyronine combination products (including Armour Thyroid) 

6

Not a cost effective use of NHS resources 

dnp 

See NHS England guidance on items not for routine prescribing in primary care 

Liraglutide for obesity (Saxenda®

4

Not a cost effective use of NHS resources. 

DNP 

NTS Liraglutide for obesity 

Meprobamate 

4

Safety concerns. 

dnp 

BNF: meprobamate 

Molludab (potassium hydroxide 5%) topical solution for the treatment of molluscum contagiosum 

13

Poor evidence base. 

dnp 

CKS: Molluscum contagiosum 

Moxisylyte (Opilon®

2

Poor evidence base. 

dnp 

CKS: Raynaud's Phenomenon 

Multivitamin and mineral preparations for the management of age-related macular degeneration (ARMD) e.g. Icaps, Occuvite preservision, Preservision lutein, Viteyes original plus-lutein, Ocuvite lutein, Visionace, Vitalux-plus) 

9

Safety concerns.
Poor evidence base. 

dnp 

NTS: Vitamin and mineral supplements for AMD 

 new  
13 Apr 18 

Naltrexone-bupropion (Mysimba ® ▼

4

Not a cost effective use of NHS resources 

dnp 

NICE TA494 

Naproxen & esomeprazole combination product (Vimovo®

10

Not a cost effective use of NHS resources. 

dnp 

CKS: Proven GORD 

Nefopam 

4

Only to be used in those patients with moderate to severe chronic liver disease who require analgesia stronger than paracetamol in whom NSAIDS and moderate strength opiates are contraindicated 

grey 

Due to the high cost of nefopam, a lack of evidence of superior efficacy over other analgesics, and it’s side effect profile, there is no rationale for the routine use of nefopam. 

Omega-3-acid ethyl ester (Omacor®

2

Poor evidence base
Omega-3-fatty acids (e.g. Omacor) should only be used for the treatment of hypertriglyceridaemia under the care of a lipid management specialist, all patients receiving this medication, other than for hypertriglyceridaemia under a lipid management specialist, should have the medication discontinued 

Grey 

NICE: KTT4 

updated 
20 Mar 18 

Oxycodone/naloxone MR tablets (Targinact®

4

Poor evidence base.
Not a cost effective use of NHS resources. 

dnp 

See NHS England guidance on items not for routine prescribing in primary care 

Paracetamol and tramadol combination product (Tramacet®

4

Not a cost effective use of NHS resources. 

dnp 

This combined preparation has both drugs at lower than suggested dosages and is also more expensive than the separate components. 

Pen needles costing in excess of £6 per 100 

6

Not a cost effective use of NHS resources. 

DNP 

See cost comparison chart in formulary chapter 6.1.1.3 

Pentoxifylline (Trental®

2

Poor evidence base. 

dnp 

NICE: TA223 

 new  
19 Mar 18 

Perindopril Arginine 

2

Not a cost effective use of NHS resources 

dnp 

See NHS England guidance on items not for routine prescribing in primary care 

Piroxicam oral therapies 

10

Safety concerns.
Systemic piroxicam should be initiated only by specialists as a second-line treatment for arthritis. Patients who currently take piroxicam should be reassessed at a routine appointment. 

grey 

MHRA: Drug Safety Update 

Pollinex® (all forms) 

3

Safety concerns.
Poor evidence base.
Pollinex should only be prescribed in accordance with local commissioning arrangements.  

grey 

North West Allergy and Clinical Immunology Network on the NW England use of Pollinex products for pollen allergen immunotherapy - April 2014

NHS England Prescribed Specialist Services manual 

Prazosin 

2

Only to be used for licensed indications, and not for unlicensed indications such as PTSD.  

grey 

US VA/DoD: Clinical Practice Guideline for the Management of Posttraumatic Stress Disorder and Acute Stress Disorder  

Prednisolone EC tablets 

6

Poor evidence base. 

dnp 

UKMI Q&A: Is there any evidence to support the use of enteric coated (EC) over uncoated prednisolone tablets? 

Prednisone MR tabs (Lodotra®

6

Poor evidence base. 

dnp 

NTS: Prednisone Modified Release Tablet (Lodotra▼®) for the treatment of moderate to severe, active rheumatoid arthritis 

RESPeRATE® 

2

Not a cost effective use of NHS resources. 

dnp 

EUR group 

Rubefacients

(Topical rubefacient products may contain nicotinate and salicylate compounds, essential oils, capsicum, and camphor. However, topical NSAID preps or Capsaicin preps are not rubefacients) 

10

Poor evidence base 

dnp 

NICE do not do: Do not offer rubefacients for treating osteoarthritis

BNF (2016): The evidence available does not support the use of topical rubefacients in acute or chronic musculoskeletal pain 

Silk garments (Dermasilk®, Dreamskin®, Skinnies Silk®)  

13

Poor evidence base. 

dnp 

UKMI 2014: Silk garments for eczema/atopic dermatitis 

Simvastatin/ ezetimibe combination product (Inegy®

2

Not a cost effective use of NHS resources. 

dnp 

NICE: TA132 

Sodium Oxybate in the management of narcolepsy with cataplexy in adult patients 

4

Limited evidence of cost effectiveness 

grey 

Only to be prescribed as recommended by GMMMG 

Spatone - iron-rich spa water from the mountains of Snowdonia 

9

Poor evidence base. 

dnp 

No evidence to support use 

Sufentanil sublingual tablet system (Zalviso® ▼

4

Not a cost effective use of resources  

DNP 

NTS not recommended

Synovial fluid injections including Hyaluronan and sodium hyaluronate injection (SportVis®

10

Poor evidence base. 

dnp 

NICE Do not Do recommendation: Do not offer intra-articular hyaluronan injections for the management of osteoarthritis.  

 new  
19 Mar 18 

Tadalafil - Once Daily  

7

Not a cost effective use of NHS resources 

dnp 

See NHS England guidance on items not for routine prescribing in primary care 

Tapentadol modified release tablets (Palexia®

4

Not a cost effective use of NHS resources.
Use of this agent should be restricted to those patients requiring treatment of severe chronic pain which CANNNOT be managed with more established opioid therapies. Prescribers are reminded that NTS does not recommend the use of tapentadol over more established opioid therapies 

grey 

NTS: Tapentadol (Palexia®) immediate and prolonged release for the treatment of acute and chronic severe pain 

Testosterone patches (Intrinsa®

6

Poor evidence base. 

dnp 

EMA Public Statement: Intrinsa (testosterone): Withdrawal of the marketing authorisation in the European Union 

Topical gabapentin (unlicensed) 

4

Poor evidence base 

DNP 

NTS: Topical gabapentin (unlicensed) for the treatment of neuropathic pain) 

Topiramate capsules 

4

Not a cost effective use of NHS resources

Topiramate tablets are on formulary and should be used where possible. Topiramate hard capsules are expensive and should not be prescribed. For those patients unable to swallow topiramate tablets “sprinkle capsules” may be considered  

grey 

Drug Tariff 

Trandolapril/ verapamil combination product (Tarka®

2

Not a cost effective use of NHS resources. 

dnp 

eMIMS: deleted products 2014 

 new  
19 Mar 18 

Travel Vaccines (vaccines administered exclusively for the purposes of travel) 

14

Hepatitis B,
Japanese Encephalitis,
Meningitis ACWY,
Yellow Fever,
Tick-borne encephalitis,
Rabies,
BCG

Not to be prescribed on the NHS solely for the purposes of travel; Only to be prescribed for other indications, as outlined in Immunisation Against Infectious Disease – the Green Book

grey 

See NHS England guidance on items not for routine prescribing in primary care  

 new  
19 Mar 18 

Trimipramine 

4

Not a cost effective use of NHS resources 

dnp 

See NHS England guidance on items not for routine prescribing in primary care 

Vitamin B tablets, Compound and Vitamin B tablets, Compound, Strong 

9

Poor evidence base
Should only be used on the advice of a dietician or in secondary care to prevent "re-feeding syndrome". 

grey 

NICE CG100 

Vitamins, minerals and antioxidants  

9

Poor evidence base. 

dnp 

NHS Choices: Supplements who needs them 

Yohimbine  

6

Safety concerns.
Poor evidence base. 

dnp 

NTS Yohimbine tablets 

 

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