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Latest additions or changes to the Adult RAG list

April

New

Imiquimoid cream

Updates

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Do Not Prescribe list

Current Adult Red Amber Green (RAG) List

On this page you will find our Red Amber Green list for Adults (scroll down to see the list). The entries can be filtered by status plus BNF Chapter and we also provide a printable version of the list - click on the printer image. Documents that have been added or updated within the last three months are flagged on the left-hand-side of the list.

Please note that drugs appear individually alphabetically and are not grouped by class (unless indicated). If an indication is not stated then the designated status relates to licensed indications only.

The list provides a framework for defining where clinical and therefore prescribing responsibility should lie through categorisation of individual drugs. The criteria used for defining status is based on the specialist nature of the drug, the complexity of the assessment and monitoring arrangements required for the care of the patient, clinical responsibility and competency associated with the prescribing of a medicine and is not based on the cost of a medication.

Please check Paediatric RAG list for those drugs/indications which are used only in children.

RAG list entries with a NEW flag or UPDATED flag may be subject to a lag period to allow for commissioning approval and implementation by Trusts/CCGs. Please check with your individual Trust or CCG.

Drugs without a UK marketing authorisation [“Product licence”] are automatically classified as red unless designated otherwise on the list below. Please note that while some drugs are not listed in the BNF or the Electronic Medicines Compendium, a Summary of product Characteristics is available from the MHRA.  For off-label use of licensed medicines, the following advice is offered:

Where there is body of evidence or support from a recognised professional body such as NICE, NHS Clinical Knowledge Summaries, Scottish Medicines Consortium [SMC], Scottish Intercollegiate Guidelines Network [SIGN] or a Royal College, then the RAG status of a drug when used at licensed doses in off-licence indications should default to the same RAG status as when used within licensed indications, providing little or no extra monitoring is required and little or no increase in risk to patient safety can be identified.

Exceptions may arise and it is to be remembered that the RAG list is advisory and cannot be expected to include every possible use of every drug. GPs and Consultants are encouraged to discuss individual patient circumstances and consider where prescribing is best managed taking into account monitoring requirements, drug interactions, frequency of routine patient visits to the Consultant and the specialist nature of the condition being treated.  Clinical judgement should be used to arrive at the most reasonable outcome. However, if it is not possible to reach a consensus or a specific issue has arisen, please submit an application to the Interface Subgroup to assess or re-assess the RAG status.


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Red Amber Green Classifications

Red

Drugs designated red are considered to be specialist medicines and prescribing responsibility for these medicines should normally remain with the consultant or specialist clinician. These drugs should not be initiated or prescribed in primary care. It is recommended that the supply of these specialist medicines should be organised via the hospital pharmacy, this may include arranging for supply via a home care company.

Amber

Drugs designated amber are suitable for shared care arrangements under a shared care protocol.
Prescribing may be transferred from secondary to primary care once the patient is stabilised and agreed shared care arrangements have been established. Alternatively primary care may initiate under the supervision of secondary care if this option is given in the shared care document. It is recommended that shared care arrangements should be drawn up following local discussion and agreement by prescribing parties.

Green (specialist initiation)
specialist initiation

Drugs designated green with specialist initiation are suitable for on-going prescribing within primary care. Little or no monitoring is required. Transfer of prescribing should occur after initiation and an initial review (unless specified) in secondary care.

Green (specialist initiation)
following specialist
recommendation

For drugs that can be initiated by primary care following written or verbal advice from a specialist and can then subsequently be safely prescribed in primary care with little or no monitoring required.

Green

Drugs designated green are suitable for initiation (unless specified otherwise) and ongoing prescribing within primary care.

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ADULT -  Red Amber Green (RAG) List

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Drug
(proprietary examples)

BNF
Chapter

Indications and Rationale

Status

Comments

Responsible
commissioner

 

Abacavir 

5 

HIV medicines.  

Red 

 

NHSE 

 

Abatacept 

10 

Biologics/Cytokine modulators 

Red 

 

NHSE for paediatric indications where adult TA available and for juvenile arthritis. CCG for adults. 

 

Abiraterone  

8 

Prostate cancer (BUT not approved via cancer LDP)  

Red 

 

NHSE 

 

Acamprosate 

4 

Alcohol Dependence 

Green 

in conjuction with specialist service 

Public health 

 

Acetazolamide tablets 

11 

Glaucoma 

Green 

Green (following specialist initiation) 

CCG 

 

Acetazolomide 

2 

Idiopathic intracranial hypertension 

Green 

Green (following specialist advice) 

CCG 

 

Acitretin 

13 

Red status predominantly due to safety concerns in pregnancy. 

Red 

 

CCG 

 

Adalimumab 

10 

Biologics/Cytokine modulators 

Red 

 

NHSE for paediatric indications where adult TA available and for juvenile arthritis. CCG for adults. 

 

Adefovir 

5 

Antivirals for treatment of Hepatitis B  

Red 

 

NHSE 

 

Afatinib 

8 

Chemotherapy - see NPSA alerts 

Red 

 

NHSE 

 

Aflibercept 

8 

Chemotherapy - see NPSA alerts 

Red 

 

NHSE 

 

Aflibercept 

11 

Ophthalmic indications 

Red 

 

CCG 

 

Agomelatine 

4 

Adults with major depressive disorder 

Red 

 

CCG 

 

Aldesleukin 

8 

Chemotherapy - see NPSA alerts 

Red 

 

NHSE 

 

Alemtuzumab 

8 

Chemotherapy - see NPSA alerts  

Red 

 

NHSE = for all indications 

 

Alfacalcidol  

9 

Patients with severe renal impairment requiring vitamin D therapy should be prescribed alfacalcidol. It is essential that plasma calcium monitoring is undertaken; frequency of monitoring should be determined by secondary care clinicians and communicated to primary care. 

Green 

Green (following specialist advice)  

CCG 

 

Alirocumab 

2 

Primary hypercholesterolaemia and mixed dyslipidaemia 

Red 

 

CCG 

 

Aliskiren 

2 

 

Green 

Green (following specialist initiation) 

 

 

Alitretinoin 

13 

Chronic hand eczema 

Red 

 

CCG 

 

Alogliptin 

6 

Gliptins (DPP-4 Inhibitors)
As per NICE guidance and see new therapies recommendations  

Green 

 

 

 

Alprostadil Cream 

7 

Erectile dysfunction 

Green 

 

CCG 

 

Alteplase 

2 

Fibrinolytics 

Red 

 

CCG 

 

Alu-Cap® (Aluminium hydroxide) 

9 

Phosphate Binding Agents  

Green 

Green (following specialist initiation) 

CCG 

 

Amantadine 

4 

Antiparkinson's drugs
As per NICE guidance  

Green 

Green (following specialist advice) 

CCG 

 

Amantadine 

4 

Multiple sclerosis (unlicensed) 

Green 

Green (following specialist advice) 

CCG 

 

Ambrisentan 

2 

pulmonary hypertension  

Red 

 

NHSE 

 

Amifostine 

8 

Chemotherapy - see NPSA alerts  

Red 

 

NHSE/CDF for all chemotherapy indications 

 

Amikacin eye drops 

11 

Anti-infective eye preparations 

Red 

 

CCG 

 

Aminophylline injection 

3 

Severe or life-threatening acute asthma 

Red 

 

CCG 

 

Amiodarone 

2 

 

Green 

Green (following specialist initiation)  

CCG 

 

Amiofostine 

8 

Chemotherapy - see NPSA alerts  

Red 

 

CCG 

 

Amisulpride 

4 

Antipsychotics (Oral) Use in dementia patients (unlicensed). Local commissioning arrangements may vary and in some localities this remains an amber drug so please check with your CCG. Prescribing of antipsychotics in dementia is expected to be short term. In exceptional circumstances, longer term prescribing may be required [which would be outside of the product licence for any drugs which have a marketing authorisation for such use]. In these situations, there should still be regular review with the aim of reducing or stopping, and the best methods of ensuring continuity of supply should be negotiated between all healthcare professionals involved in that patient’s care.  

Red 

Red (for new patients only) 

CCG 

 

Amisulpride 

4 

Atypical antipsychotics (Oral) - Licensed Indications and also Unlicensed indications as recommended by NICE guidance (i.e. in psychotic depression or anxiety in bipolar patients).Red if no SCP 

Amber 

 

CCG 

 

Amisulpride 

4 

Atypical antipsychotics (Oral)
All other unlicensed indications 

Red 

Red (for new patients only) 

CCG 

 

Amprenavir 

5 

HIV medicines. 

Red 

 

NHSE 

 

Amsacrine 

8 

Chemotherapy - see NPSA alerts  

Red 

 

NHSE/CDF for all chemotherapy indications 

 

Anagrelide 

8 

Essential thrombocythaemia (review after 12 months)  

Red 

 

CCG 

 

Anakinra 

10 

Biologics/Cytokine modulators 

Red 

 

CCG 

 

Anastrozole 

8 

Hormone Antagonists for breast cancer 

Green 

Green (following specialist initiation)  

CCG 

 

Anidulafungin 

5 

Antifungal 

Red 

 

NHSE 

 

Anti-D immunoglobulin 

14 

Antenatel anti-D prophylaxis 

Red 

 

CCG 

 

Anti-thymocyte immunoglobulin 

8 

Immunosuppressants 

Red 

 

NHSE 

 

Antipsychotics 

4 

Challenging behaviours in patients with intellectual disability 

Red 

 

CCG 

 

Apixaban 

2 

 

Green 

 

CCG 

 

Apomorphine injection 

4 

Parkinson's disease. 

Amber 

 

CCG 

 

Apraclonidine 0.5% eye drops 

11 

Glaucoma (unlicensed) 

Green 

Green (following specialist initiation) 

CCG 

 

Apraclonidine 1% eye drops 

11 

Glaucoma (unlicensed) 

Red 

 

CCG 

 

Apraclonidine eye drops 

11 

Ocular peri-operative drugs 

Red 

 

CCG 

 

Apremilast 

13 

Moderate to severe plaque psoriasis and active psoriatric arthritis 

Red 

 

CCG 

 

Aprepitant 

8 

Chemotherapy - see NPSA alerts 

Red 

 

CCG 

 

Aripiprazole 

4 

Atypical antipsychotics (Oral) All other unlicensed indications  

Red 

 

CCG 

 

Aripiprazole 

4 

Atypical antipsychotics (Oral) - Licensed Indications and also Unlicensed indications as recommended by NICE guidance (i.e. in psychotic depression or anxiety in bipolar patients).Red if no SCP 

Amber 

 

CCG 

 

Aripiprazole 

4 

Antipsychotics (Oral) Use in dementia patients (unlicensed). Local commissioning arrangements may vary and in some localities this remains an amber drug so please check with your CCG. Prescribing of antipsychotics in dementia is expected to be short term. In exceptional circumstances, longer term prescribing may be required [which would be outside of the product licence for any drugs which have a marketing authorisation for such use]. In these situations, there should still be regular review with the aim of reducing or stopping, and the best methods of ensuring continuity of supply should be negotiated between all healthcare professionals involved in that patient’s care.  

Red 

Red (for new patients only) 

CCG 

 

Aripiprazole depot injection 

4 

Antipsychotic depot injection (Schizophrenia).
Only for those patients who are stable and if SCP available; or if under the care of a community psychiatric nurse. In some localities there may be commissioning arrangements in place to permit step down. 

Amber 

 

CCG 

 

Arsenic trioxide 

8 

Chemotherapy - see NPSA alerts 

Red 

 

NHSE 

 

Asenapine 

4 

Antipsychotic for use in acute phase only. NTS recommended in March 2012 that not for use in primary care. 

Red 

 

CCG 

 

Atazanavir 

5 

HIV medicines.  

Red 

 

NHSE 

 

Atomoxetine 

4 

ADHD 

Amber 

 

CCG 

 

Atosiban 

7 

Premature labour 

Red 

 

CCG 

 

Atovaquone 

5 

Pneumocystis pneumonia - only to be used if other treatments e.g. co-trimoxazole have failed or are not suitable. 

Green 

Green (following specialist advice) 

CCG 

 

Atripla® (Efavirenz + Tenofovir + Emtricitabine) 

5 

HIV medicines.  

Red 

 

NHSE 

 

Avanafil 

7 

Erectile dysfunction 

Green 

 

CCG 

 

Axitinib 

8 

Chemotherapy - see NPSA alerts  

Red 

 

NHSE/CDF for all chemotherapy indications 

 

Azacitidine 

8 

Chemotherapy - see NPSA alerts  

Red 

 

NHSE/CDF for all chemotherapy indications 

 

Azathioprine 

8 

autoimmune conditions, IBD (unlicensed), severe refractory eczema(unlicensed) 

Amber 

 

CCG 

 

Azathioprine 

8 

Immunosuppressants Licensed indications only. Red if no SCP  

Amber  

 

NHSE for transplant immunosuppressant only. All other indications CCG. 

 

Azathioprine 

13 

Dermatology indications 

Amber 

 

CCG 

 

Azathioprine 

10 

DMARDs Rheumatoid Arthritis. 

Amber 

 

CCG 

 

Azathioprine 

3 

Interstitial lung disease 

Amber 

 

CCG 

 

Azathioprine 

8 

Post transplant use 

Amber 

To remain amber until repatriation occurs 

NHSE 

 

Azathioprine 

3 

Idiopathic pulmonary fibrosis 

Red 

 

CCG 

 

Aztreonam Lysine Nebules 

5 

Cystic fibrosis
April 13: commissioned by NHS England  

Red 

Red (for new patients) 

NHSE 

 

Basiliximab 

8 

Immunosuppressants - transplant 

Red 

 

CCG 

 

Bee & wasp allergen (Pharmalgen®

3 

Allergen immunotherapy 

Red 

 

CCG 

 

Belatacept 

8 

Immunosuppressants - transplant 

red 

 

CCG 

 

Belimumab 

10 

Biologics/Cytokine modulators 

Red 

 

NHSE for paediatric indications where adult TA available and for juvenile arthritis. CCG for adults. 

 

Bendamustine 

8 

Chemotherapy - see NPSA alerts  

Red 

 

NHSE/CDF for all chemotherapy indications 

 

Betaine 

9 

Homocystinuria 

Red  

 

NHSE. Highly specialised criteria only. 

 

Bevacizumab 

8 

Chemotherapy - see NPSA alerts  

Red 

 

NHSE/CDF for all chemotherapy indications 

 

Bevacizumab 

11 

Ophthalmic indications 

Red 

 

CCG 

 

Bexarotene 

8 

Chemotherapy - see NPSA alerts  

Red 

 

NHSE/CDF for all chemotherapy indications 

 

Bicalutamide 

8 

For Prostate cancer 

Green 

Green (following specialist initiation) 

CCG 

 

Bivalirudin 

2 

Hirudin 

Red 

 

CCG 

 

Bleomycin 

8 

Chemotherapy - see NPSA alerts  

Red 

 

NHSE/CDF for all chemotherapy indications 

 

Boceprevir 

5 

Hepatitis C 

Red 

 

NHSE 

 

Bortezomib 

8 

Chemotherapy - see NPSA alerts  

Red 

 

NHSE/CDF for all chemotherapy indications 

 

Bosentan 

2 

pulmonary hypertension, digital ulcers 

Red 

 

NHSE 

 

Bosutinib 

8 

Chemotherapy - see NPSA alerts 

Red 

 

NHSE 

 

Botulinum Toxin 

13 

Intradermal for hyperhydrosis. 

Red. 

 

CCG 

 

Brentuximab vedotin 

8 

Chemotherapy - see NPSA alerts  

Red 

 

NHSE/CDF for all chemotherapy indications 

 

Brivaracetam 

4 

Antiepileptic Drugs. As per NICE guidance 

Green 

Green (following specialist initiation) 

CCG 

 

Buprenorphine 

4 

Opioid dependence 

Other 

Status depends on local commissioning arrangements for substance misuse or if GP with specialist interest 

CCG 

 

Buprenorphine (sublingual) 

4 

Pain 

Green 

Green (following specialist advice 

CCG 

 

Buserelin 

6 

Infertility Drugs  

Red 

 

CCG 

 

Busulfan 

8 

Chemotherapy - see NPSA alerts  

Red 

 

NHSE/CDF for all chemotherapy indications 

 

C1-esterase inhibitor 

3 

Angioedema 

Red 

 

NHSE 

 

Cabazitaxel 

8 

Chemotherapy - see NPSA alerts  

Red 

 

NHSE/CDF for all chemotherapy indications 

 

Cabergoline 

4 

Antiparkinson's drugs As per NICE guidance  

Green 

Green (following specialist advice) 

CCG 

 

Cabozantinib 

8 

Chemotherapy - see NPSA alerts 

Red 

 

NHSE 

 

Calcichew 500mg chewable tablets 

9 

Phosphate Binding Agents  

Green 

Green (following specialist initiation)  

CCG 

 

Calcium Resonium (oral) 

9 

Hyperkalaemia 

Green 

 

CCG 

 

Canakinumab 

8 

Inherited autoinflammatory disorders 

Red 

 

CCG 

 

Canakinumab 

10 

Biologics/Cytokine modulators 

Red 

 

CCG 

 

Capecitabine 

8 

Chemotherapy - see NPSA alerts  

Red 

 

NHSE/CDF for all chemotherapy indications 

 

Capsaicin patch (Qutenza®

10 

Peripheral neuropathic pain in non-diabetic adults 

Red 

 

CCG 

 

Carbamazepine 

4 

Antiepileptic Drugs As per NICE guidance  

Green 

Green (following specialist advice) 

CCG 

 

Carbamazepine 

4 

Bipolar disorder 

Green 

Green (following specialist initiation) 

CCG 

 

Carboplatin 

8 

Chemotherapy - see NPSA alerts  

Red 

 

NHSE/CDF for all chemotherapy indications 

 

Carboprost 

7 

Postpartum haemorrhage 

Red 

 

CCG 

 

Carmustine 

8 

Chemotherapy - see NPSA alerts  

Red 

 

NHSE/CDF for all chemotherapy indications 

 

Caspofungin 

5 

Antifungal 

Red 

 

NHSE 

 

Catumaxomab 

8 

Chemotherapy - see NPSA alerts  

Red 

 

NHSE/CDF for all chemotherapy indications 

 

Cefuroxime eye drops 

11 

Anti-infective eye preparations 

Red 

 

CCG 

 

Ceritinib 

8 

Chemotherapy - see NPSA alerts  

Red 

 

NHSE 

 

Certolizumab Pegol 

10 

Biologics/Cytokine modulators 

Red 

 

NHSE for paediatric indications where adult TA available and for juvenile arthritis. CCG for adults. 

 

Cetrorelix 

6 

Infertility Drugs  

Red 

 

CCG 

 

Cetuximab 

8 

Chemotherapy - see NPSA alerts  

Red 

 

NHSE/CDF for all chemotherapy indications 

 

Chemotherapy Drugs 

8 

Chemotherapy - see NPSA alerts 

Red 

 

NHSE 

 

Chlorambucil 

8 

Chemotherapy - see NPSA alerts  

Red 

 

NHSE/CDF for all chemotherapy indications 

 

Chlorhexidine eye drops 

11 

Anti-infective eye preparations 

Red 

 

CCG 

 

Chorionic Gonadotropin 

6 

Infertility Drugs  

Red 

 

CCG 

 

Ciclosporin 

13 

Dermatology indications 

Amber 

 

CCG 

 

Ciclosporin 

8 

Immunosuppressants
Licensed indications only.
Red if no SCP  

Amber  

 

CCG 

 

Ciclosporin 

10 

DMARDs Rheumatoid Arthritis. 

Amber 

 

CCG 

 

Ciclosporin 

8 

Post transplant use 

Amber 

To remain amber until repatriation occurs 

NHSE 

 

Ciclosporin eye drops 

11 

Keratosis due to dry eye disease 

Green 

Green (following specialist initiation)

Use licensed product only 

CCG 

 

Cidofovir 

5 

CMV 

Red 

 

NHSE 

 

Cinacalcet 

9 

Primary hyperparathyroidism (transfer of prescribing to primary care only under a shared care guideline)  

Amber  

 

CCG 

 

Cinacalcet 

9 

Secondary hyperparathyroidism (patient under regular review by secondary care)  

Red 

 

NHSE - hyperparathyroidism - dialysis patients only 

 

Cisplatin 

8 

Chemotherapy - see NPSA alerts  

Red 

 

NHSE/CDF for all chemotherapy indications 

 

Cladribine 

8 

Chemotherapy - see NPSA alerts  

Red 

 

NHSE/CDF for all chemotherapy indications 

 

Clobazam for epilepsy 

4 

Antiepileptic.
As per NICE guidance 

Green 

Green (following specialist advice) 

CCG 

 

Clofarabine 

8 

Chemotherapy - see NPSA alerts  

Red 

 

NHSE/CDF for all chemotherapy indications 

 

Clomifene 

6 

Infertility Drugs  

Red 

 

CCG 

 

Clonazepam for epilepsy 

4 

Antiepileptic.
As per NICE guidance 

Green 

Green (following specialist advice) 

CCG 

 

Clozapine 

4 

Atypical antipsychotics (Oral) All other unlicensed indications  

Red 

 

CCG 

 

Clozapine 

4 

Except selected approved mental health trust programs.  

Red 

 

CCG 

 

Co-beneldopa 

4 

Antiparkinson's drugs As per NICE guidance  

Green 

Green (following specialist advice) 

CCG 

 

Co-careldopa 

4 

Antiparkinson's drugs As per NICE guidance  

Green 

Green (following specialist advice) 

CCG 

 

Co-careldopa + Entacapone (Stalevo®

4 

Antiparkinson's drugs As per NICE guidance  

Green 

Green (following specialist advice) 

CCG 

 

Co-trimoxazole 

5 

 

Green 

Green (following specialist advice) 

CCG 

 

Colesevelam 

1 

Colesevelam for diarrhoea associated with bile acid malabsorption (nb unlicensed indication so must be used 2nd line)  

Green 

Green (following specialist advice)  

CCG 

 

Colestyramine 

1 

Bile acid sequestrant - GI indications. 

Green 

Green (following specialist advice) 

CCG 

 

Colistimethate - inhaled 

5 

For Cystic Fibrosis patients (Colobreathe®

Red 

 

NHSE 

 

Colistimethate - nebulised 

5 

For Cystic Fibrosis patients 

Red 

For new patients presenting to the service only 

NHSE 

 

Colistimethate - nebulised 

5 

For non-Cystic Fibrosis patients 

Amber 

 

CCG 

 

Colistimethate - nebulised 

5 

For Cystic Fibrosis patients 

Amber 

For existing patients only awaiting repatriation, including new starters on this drug 

NHSE 

 

Collagenase 

10 

Dupuytren's contracture 

Red 

 

CCG 

 

Combivir® 

5 

HIV medicines.  

Red 

 

NHSE 

 

Conestat alfa 

3 

Angioedema 

Red 

 

NHSE 

 

Crisantaspase 

8 

Chemotherapy - see NPSA alerts  

Red 

 

NHSE/CDF for all chemotherapy indications 

 

Crizotinib 

8 

Chemotherapy - see NPSA alerts  

Red 

 

NHSE/CDF for all chemotherapy indications 

 

Cyclophosphamide 

8 

Chemotherapy - see NPSA alerts  

Red 

 

NHSE/CDF for all chemotherapy indications 

 

Cylophosphamide 

10 

DMARD 

Red 

 

CCG 

 

Cyproterone 

6 

Prostate cancer and male hypersexuality 

Green 

Green (following specialist advice) 

CCG 

 

Cystistat® bladder instillations (medical device) 

7 

 

Red 

 

CCG 

 

Cytarabine 

8 

Chemotherapy - see NPSA alerts  

Red 

 

NHSE/CDF for all chemotherapy indications 

 

Dabigatran 

2 

 

Green  

 

CCG 

 

Dabrafenib 

8 

Chemotherapy - see NPSA alerts 

Red 

 

NHSE 

 

Dacarbazine 

8 

Chemotherapy - see NPSA alerts  

Red 

 

NHSE/CDF for all chemotherapy indications 

 

Daclatasvir 

5 

Hepatitis C 

Red 

 

CCG 

 

Dactinomycin 

8 

Chemotherapy - see NPSA alerts  

Red 

 

NHSE/CDF for all chemotherapy indications 

 

Dapsone 

13 

Leprosy and dermatitis herpetiformis 

Green 

Green (following specialist advice) 

CCG 

 

Daptomycin 

5 

 

Red 

 

CCG 

 

Darbepoetin 

9 

6 (*except where no virement programs exist). 

Red 

 

NHSE - Renal Dialysis only. Product with lowest procurement cost to be used (NICE CG114) 

 

Darunavir 

5 

HIV medicines.  

Red 

 

NHSE 

 

Dasatinib 

8 

Chemotherapy - see NPSA alerts  

Red 

 

NHSE/CDF for all chemotherapy indications 

 

Daunorubicin 

8 

Chemotherapy - see NPSA alerts  

Red 

 

NHSE/CDF for all chemotherapy indications 

 

Decitabine 

8 

Chemotherapy - see NPSA alerts  

Red 

 

NHSE/CDF for all chemotherapy indications 

 

Deferasirox 

9 

 

Red 

 

NHSE 

 

Deferiprone 

9 

Alpha Thalassemia 

Red 

 

NHSE 

 

Degarelix 

8 

Prostate cancer 

Amber 

 

CCG 

 

Denosumab (Prolia®

6 

Osteoporosis in men & women 

Amber 

 

CCG 

 

Denosumab (XGEVA®

6 

Oncology indication 

Red 

 

CCG 

 

Desferrioxamine 

9 

see note 6 

Red 

 

NHSE 

 

Dexamethasone intraviteral implant 

11 

Ophthalmic indications 

Red 

 

CCG 

 

Dexamfetamine 

4 

ADHD  

Amber 

 

CCG 

 

Dexrazoxane 

8 

Chemotherapy - see NPSA alerts  

Red 

 

NHSE/CDF for all chemotherapy indications 

 

Diazoxide 

6 

Chronic hypoglycaemia 

Green 

Green (following specialist initiation) 

CCG 

 

Dibotermin 

6 

Bone morphogenic protein 

Red 

 

CCG 

 

Dibromopropamidine eye ointment 

11 

Anti-infective eye preparations 

Red 

 

CCG 

 

Didanosine 

5 

HIV medicines.  

Red 

 

NHSE 

 

Diesthylstilbestrol 

8 

For Prostate cancer. 

Green 

Green (following specialist initiation) 

CCG 

 

Digoxin-specific antibody fragments 

2 

Digoxin toxicity 

Red 

 

CCG 

 

Diltiazem ointment 

1 

Anal fissure 

Green 

Green (following specialist advice) 

CCG 

 

Dimethyl fumarate 

8 

Multiple sclerosis 

Red 

 

NHSE 

 

Disodium pamidronate 

6 

IV Bisphosphonate 

Red 

 

CCG 

 

Disulfiram  

4 

Alcohol dependence
Patient must be stabilised prior to transfer of prescribing. (> 3 months)  

Amber  

 

Public health 

 

Dithranol (licensed preps) 

13 

Psoriasis 

Green 

Green (following specialist advice) 

CCG 

 

Dithranol (unlicensed preps) 

13 

Psoriasis 

Red 

 

CCG 

 

Docetaxel 

8 

Chemotherapy - see NPSA alerts  

Red 

 

NHSE/CDF for all chemotherapy indications 

 

Domperidone 

4 

For inadequate lactation on recommendation by secondary care (unlicensed). 

Green 

 

CCG 

 

Donepezil 

4 

Dementia - as per NICE TA 217. Local commissioning arrangements may vary and in some localities this is green on specialist advice so please check with your CCG 

Green 

Green (following specialist initiation) 

CCG 

 

Dornase alfa 

3 

Cystic fibrosis  

Amber 

 

NHSE 

 

Doxorubicin 

8 

Chemotherapy - see NPSA alerts  

Red 

 

NHSE/CDF for all chemotherapy indications 

 

Doxorubicin Liposomal (Myocet®, Caelyx®

8 

Chemotherapy - see NPSA alerts  

Red 

 

NHSE/CDF for all chemotherapy indications 

 

Dronedarone 

2 

 

Green 

Green (initiated by specialist & regular monitoring required see SPC )  

CCG 

 

Dulaglutide 

6 

GLP-1 Agonists. As per NICE guidance and see new therapies recommendations 

Green 

 

CCG 

 

Dymista® 

3 

 

Green 

 

CCG 

 

Edoxaban 

2 

 

Green 

 

CCG 

 

Efavirenz 

5 

HIV medicines.  

Red 

 

NHSE 

 

Elosulfase alfa 

9 

Mucopolysaccharidosis type IVa 

Red 

 

CCG 

 

Eltrombopag 

9 

See NICE Guidance 

Red 

 

CCG 

 

Emtricitabine 

5 

HIV medicines.  

Red 

 

NHSE 

 

Enfuvirtide 

5 

HIV medicines.  

Red 

 

NHSE 

 

Entacapone 

4 

Antiparkinson's drugs
As per NICE guidance 

Green 

Green (following specialist advice) 

CCG 

 

Entecavir 

5 

Antivirals for treatment of Hepatitis B  

Red 

 

NHSE 

 

Enzalutamide 

8 

Chemotherapy - see NPSA alerts  

Red 

 

NHSE 

 

Epirubicin 

8 

Chemotherapy - see NPSA alerts 

Red 

 

NHSE 

 

Epoetin alfa 

9 

6 (*except where no virement programs exist). 

Red 

 

NHSE - Renal Dialysis only. Product with lowest procurement cost to be used (NICE CG114) 

 

Epoetin beta 

9 

6 (*except where no virement programs exist). 

Red 

 

NHSE - Renal Dialysis only. Product with lowest procurement cost to be used (NICE CG114) 

 

Epoprostenol 

2 

pulmonary hypertension 

Red 

 

NHSE 

 

Epotermin alfa (Osigraft®

6 

Bone morphogenic protein 

Red 

 

CCG 

 

Eribulin 

8 

Chemotherapy - see NPSA alerts  

Red 

 

NHSE/CDF for all chemotherapy indications 

 

Erlotinib 

8 

Chemotherapy - see NPSA alerts  

Red 

 

NHSE/CDF for all chemotherapy indications 

 

Eslicarbazepine 

4 

Antiepileptic Drugs
As per NICE guidance 

Green 

Green (following specialist advice) 

CCG 

 

Estramustine 

8 

Chemotherapy - see NPSA alerts  

Red 

 

NHSE/CDF for all chemotherapy indications 

 

Etanercept 

10 

Biologics/Cytokine modulators 

Red 

 

NHSE for paediatric indications where adult TA available and for juvenile arthritis. CCG for adults. 

 

Ethambutol 

5 

Tuberculosis, antibiotic therapy. Local commissioning arrangements may vary. 

Green 

Green (following specialist initiation) 

NHSE = drug resistant TB only 

 

Ethosuximide 

4 

Antiepileptic Drugs
As per NICE guidance 

Green 

Green (following specialist advice) 

CCG 

 

Etoposide 

8 

Chemotherapy - see NPSA alerts  

Red 

 

NHSE/CDF for all chemotherapy indications 

 

Etravirine 

5 

HIV medicines.  

Red 

 

NHSE 

 

Everolimus 

8 

Chemotherapy - see NPSA alerts  

Red 

 

NHSE/CDF for all chemotherapy indications 

 

Eviplera® (Emtricitabine + Rilpivirine + Tenofovir) 

5 

HIV medicines.  

Red 

 

NHSE 

 

Evolocumab 

2 

Primary hypercholesterolaemia and mixed dyslipidaemia 

Red 

 

CCG 

 

Exemestane 

8 

Hormone Antagonists for breast cancer 

Green 

Green (following specialist initiation)  

CCG 

 

Exenatide (Byetta® and Bydureon®

6 

GLP-1 Agonists
As per NICE guidance and see new therapies recommendations  

Green  

Green  

CCG 

 

Febuxostat 

10 

See NICE guidance. 

Green 

Green (following specialist initiation) 

CCG 

 

Ferric Carboxymaltose (Ferinject®

9 

IV iron 

Red 

 

CCG 

 

Ferumoxytol (Rienso®

9 

IV iron 

Red 

 

CCG 

 

Fidaxomicin 

5 

Clostridium difficile  

Green 

Green (following specialist advice) 

CCG 

 

Filgrastim 

9 

GCSF for neutropenia 

Red  

 

NHSE 

 

Fingolimod 

8 

Multiple sclerosis – as per NICE TA  

Red  

 

NHSE 

 

Flecainide 

2 

 

Green 

Green (following specialist initiation)  

CCG 

 

Fludarabine 

8 

Chemotherapy - see NPSA alerts  

Red 

 

NHSE/CDF for all chemotherapy indications 

 

Flunarizine 

4 

Headache 

Red 

 

CCG 

 

Fluocinolone acetonide intraviteral implant 

11 

Ophthalmic indications 

Red 

 

CCG 

 

Fluorometholone eye drops 

11 

Local inflammation of eye (short-term use) 

Red 

 

CCG 

 

Fluorouracil 

8 

Chemotherapy - see NPSA alerts  

Red 

 

NHSE/CDF for all chemotherapy indications 

 

Flupentixol Deconate 

4 

Antipsychotic depot injection (Schizophrenia)
Only for those patients who are stable and if SCP available; or if under the care of a community psychiatric nurse. In some localities there may be commissioning arrangements in place to permit step down. 

Amber 

 

CCG 

 

Fluphenazine Deconate 

4 

Antipsychotic depot injection (Schizophrenia)
Only for those patients who are stable and if SCP available; or if under the care of a community psychiatric nurse. In some localities there may be commissioning arrangements in place to permit step down. 

Amber 

 

CCG 

 

Follitropin alfa 

6 

Infertility Drugs  

Red 

 

CCG 

 

Follitropin beta 

6 

Infertility Drugs  

Red 

 

CCG 

 

Fondaparinux 

2 

Prophylaxis of VTE in oncology patients on VTE inducing therapy 

Red 

 

CCG 

 

Fondaparinux 

2 

Prophylaxis Post-operative use [e.g. hips, knees, general surgical] 

Red 

 

CCG 

 

Fondaparinux 

2 

Immobile patients or those deemed to be at particularly high risk of DVT at home or in care situation in patients unable to tolerate/tale warfarin or NOACs 

Green 

Green (following specialist advice) 

CCG 

 

Fondaparinux 

2 

For travel prophylaxis in high risk patients (travelling time over 8 hrs) and only as per national recommendations. http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2141.2010.08408.x/full 

Green 

Green (following specialist advice) 

CCG 

 

Fondaparinux 

2 

Use by fertility clinics, and also to prevent miscarriage 

Red 

 

CCG 

 

Fondaparinux 

2 

Prophylaxis of VTE during pregnancy. 

Red 

Local commissioning arrangements may vary and may be amber if local agreement in some CCGs. 

CCG 

 

Fondaparinux 

2 

DVT and PE treatment - initial 2 weeks or as per locally agreed pathways 

Red 

 

CCG 

 

Fondaparinux 

2 

All Surgical Specialities: Warfarin replacement. Given pre-operatively for up to 5 days up until the day of surgery instead of taking warfarin. Allows INR to fall before operation. 

Red 

 

CCG 

 

Fondaparinux 

2 

All Surgical Specialities: Given post-operatively in conjunction with warfarin whilst waiting for the INR to come into range. 

Red 

 

CCG 

 

Fondaparinux 

2 

Treatment of DVT/PE in pregnancy. First line treatment of choice. 

Red 

Local commissioning arrangements may vary and may be amber if local agreement in some CCGs. 

CCG 

 

Fondaparinux 

2 

Obstetric Use: Patients with mechanical heart valves or those on long term warfarin prior to pregnancy should be discussed with consultant cardiologists/haematologists, ideally before pregnancy. 

Red 

 

CCG 

 

Fondaparinux 

2 

DVT or PE in oncology patients undergoing cancer therapy or with metastatic disease. 

Green 

Green (following specialist initiation) 

CCG 

 

Fondaparinux 

2 

DVT or PE in patient unable to stabilise on warfarin or NOACs, with an allergy or with contra-indication to warfarin and/or NOACs. This includes IVDU patients. 

Green 

Green (following specialist initiation) 

CCG 

 

Fosamprenavir 

5 

HIV medicines.  

Red 

 

NHSE 

 

Fosfomycin (oral) 

5 

Uncomplicated UTI caused by multiple antibacterial organisms on advice of microbiologist 

Green 

Green (following specialist advice) 

CCG 

 

Fulvestrant 

8 

Not recommended by NICE 

Red 

Red for new patients (post december 2011)  

CCG 

 

Fumarate esters (Fumaderm®

13 

Psoriasis  

Red 

 

CCG 

 

Gabapentin 

4 

Antiepileptic Drugs
As per NICE guidance 

Green 

Green (following specialist advice)  

CCG 

 

Galantamine 

4 

Dementia - as per NICE TA 217. Local commissioning arrangements may vary and in some localities this is green on specialist advice so please check with your CCG 

Green 

Green (following specialist initiation) 

CCG 

 

Ganciclovir 

5 

CMV 

Red 

 

NHSE 

 

Ganciclovir eye drops 

11 

Herpes simplex infection 

red 

 

CCG 

 

Gefitinib 

8 

Chemotherapy - see NPSA alerts  

Red 

 

NHSE/CDF for all chemotherapy indications 

 

Gemcitabine 

8 

Chemotherapy - see NPSA alerts  

Red 

 

NHSE/CDF for all chemotherapy indications 

 

Gemeprost 

7 

Induction of abortion 

red 

 

CCG 

 

Gentamicin 1.5% eye drops 

11 

1.5% drops are an unlicensed special. See formulary for further information  

Red 

 

CCG 

 

Glatiramer acetate 

8 

Multiple Sclerosis 

Red 

 

NHSE 

 

Gold injection 

10 

DMARDs
Rheumatoid Arthritis. 

Amber 

 

CCG 

 

Golimumab 

10 

Biologics/Cytokine modulators 

Red 

 

NHSE for paediatric indications where adult TA available and for juvenile arthritis. CCG for adults. 

 

Goserelin 

6 

For all other unlicensed indications (including long term use > 6 months)  

Red 

 

CCG 

 

Goserelin 

6 

Licensed Indications (Pre-op management prior to endometrial ablation/ fibroid surgery). 

Amber 

 

CCG 

 

Goserelin 

6 

Licensed Indications (Prostate cancer for all and breast cancer for Goserelin). 

Amber 

 

CCG 

 

Goserelin 

6 

Precocious puberty and for testosterone castration in sex offenders (unlicensed) 

Red 

 

CCG 

 

Granisetron (5-HT3 antagonist anti-emetics) 

4 

Post op and following chemotherapy.  

Red 

 

CCG 

 

Growth Hormone (Somatropin) 

6 

For primary and secondary hypo- pituitarism. 

Amber 

 

CCG 

 

Growth Hormone - adults 

6 

Except in proven primary and secondary hypopituitarism.  

Red 

 

NHSE 

 

Haloperidol Deconate 

4 

Antipsychotic depot injection (Schizophrenia)
Only for those patients who are stable and if SCP available; or if under the care of a community psychiatric nurse. In some localities there may be commissioning arrangements in place to permit step down. 

Amber 

 

CCG 

 

Hydoxychloroquine 

13 

Dermatology 

Amber 

 

CCG 

 

Hydroxycarbamide 

8 

Chemotherapy - see NPSA alerts 

Red 

 

NHSE/CDF for all chemotherapy indications 

 

Hydroxycarbamide 

8 

Essential thrombocythaemia, myelofibrosis or polycythaemia with high risk of complications.  

Amber 

 

NHSE 

 

Hydroxycarbamide 

9 

Sickle Cell Disease 

Amber  

 

CCG 

 

Hydroxychloroquine 

10 

DMARDs Rheumatoid Arthritis. 

Amber 

 

CCG 

 

Ibandronic Acid 

6 

Breast cancer. 

Amber 

 

CCG 

 

Icatibant 

3 

Angioedema 

Red 

 

NHSE 

 

Idarubicin 

8 

Chemotherapy - see NPSA alerts 

Red 

 

NHSE 

 

Idarucizumab 

2 

Dabigatran reversal agent 

Red 

 

CCG 

 

Idealisib 

8 

Chemotherapy - see NPSA alerts 

Red 

 

NHSE 

 

Idelalisib 

8 

Chemotherapy - see NPSA alerts 

Red 

 

NHSE/CDF for all chemotherapy indications 

 

Ifosfamide 

8 

Chemotherapy - see NPSA alerts  

Red 

 

NHSE/CDF for all chemotherapy indications 

 

Iloprost 

2 

pulmonary hypertension  

Red 

 

NHSE 

 

Imatinib 

8 

Chemotherapy - see NPSA alerts  

Red 

 

NHSE/CDF for all chemotherapy indications 

 new  
21 Apr 17
 

Imiquimoid cream 

13 

Actinic keratosis 

Green 

 

CCG 

 new  
21 Apr 17
 

Imiquimoid cream 

13 

Genital warts 

Green 

Green (following specialist initiation) 

CCG 

 

ImmuCyst® 

8 

Chemotherapy - see NPSA alerts  

Red 

 

NHSE/CDF for all chemotherapy indications 

 

Immunoglobulin (Normal) 

14 

 

Red 

 

NHSE 

 

Immunoglobulin Varicella-Zoster (VIG)  

14 

Normally available through local Trust Virology departments.  

Green 

Green (if patient fulfils the DH criteria) 

Public health 

 

Indinavir 

5 

HIV medicines.  

Red 

 

NHSE 

 

Infliximab 

10 

Biologics/Cytokine modulators 

Red 

 

NHSE for paediatric indications where adult TA available and for juvenile arthritis. CCG for adults. 

 

Insulin and GLP-1 Agonist combination  

6 

Not to be initiated in primary care 

Green 

Green (following specialist initiation) 

CCG 

 

Interferon alfa 2a 

8 

 

Red 

 

NHSE 

 

Interferon alfa 2b 

8 

 

Red 

 

NHSE 

 

Interferon beta 

8 

Multiple Sclerosis 

Red 

 

CCG 

 

Interferon gamma 1b 

8 

 

Red 

 

CCG 

 

Ipilimumab 

8 

Chemotherapy - see NPSA alerts  

Red 

 

NHSE/CDF for all chemotherapy indications 

 

Irbrutinib 

8 

Chemotherapy - see NPSA alerts 

Red 

 

NHSE 

 

Irinotecan 

8 

Chemotherapy - see NPSA alerts  

Red 

 

NHSE/CDF for all chemotherapy indications 

 

Iron Dextran (Cosmofer®

9 

IV iron 

Red 

 

CCG 

 

Iron Isomaltoside 1000 (Monofer®

9 

IV iron 

Red 

 

CCG 

 

Iron Sucrose (Venofer®

9 

IV iron 

Red 

 

CCG 

 

Isocarboxazid 

4 

Non-reversible MAOI 

Red 

Red (for new patients only) 

CCG 

 

Isoniazid 

5 

Tuberculosis, antibiotic therapy. Local commissioning arrangements may vary. 

Green 

Green (following specialist initiation) 

NHSE = drug resistant TB only 

 

Isotretinoin (oral) 

13 

Red status predominantly due to safety concerns in pregnancy. 

Red 

 

CCG 

 

IV Formulations 

Misc 

unless part of an agreed local pathway.  

Red 

 

CCG or NHSE depends on indication and drug 

 

Ivabradine  

2 

Heart Failure. See IPNTS recommendation. Not to be initiated in primary care.  

Green 

Green (following specialist initiation) 

CCG 

 

Ivacaftor 

3 

Cystic fibrosis  

Red 

 

NHSE 

 

Ivermectin Cream 

13 

Acne rosacea 

Green 

 

CCG 

 

Kaletra® (Lopinavir + Ritonavir) 

5 

HIV medicines.  

Red 

 

NHSE 

 

Ketamine 

4 

For Chronic Pain management  

Red 

 

CCG 

 

Ketamine 

4 

For short term use at end of life subject to local arrangements. Please note: unlicensed indication. 

Amber 

Amber (under direction and advice of palliative care team)

Local commissioning arrangements may vary 

CCG 

 

Ketoconazole (oral) 

6 

Cushing's disease 

Red 

 

CCG 

 

Ketorolac 

11 

Ocular peri-operative drugs 

Red 

 

CCG 

 

Kivexa® (Abacavir + Lamivudine) 

5 

HIV medicines.  

Red 

 

NHSE 

 

Lacosamide 

4 

Antiepileptic Drugs
As per NICE guidance  

Green  

Green (following specialist advice) 

CCG 

 

Lamivudine 

5 

Antivirals for treatment of Hepatitis B  

Red 

 

NHSE 

 

Lamivudine 

5 

HIV medicines.  

Red 

 

NHSE 

 

Lamotrigine 

4 

Antiepileptic Drugs
As per NICE guidance  

Green 

Green (following specialist advice) 

CCG 

 

Lanreotide 

8 

Acromegaly 

Amber 

 

NHSE = acromegaly if prescribed by a specialist centre 

 

Lanreotide 

8 

All other licensed and unlicensed indications 

Red 

 

NHSE 

 

Lanthanum 

9 

Phosphate Binding agent in both dialysis and non-dialysis patients 

Green 

Green (following specialist initiation)  

NHSE 

 

Lapatinib 

8 

Chemotherapy - see NPSA alerts  

Red 

 

NHSE/CDF for all chemotherapy indications 

 

Ledipasvir 

5 

Hepatitis C 

Red 

 

CCG 

 

Leflunomide 

10 

DMARDs Rheumatoid Arthritis. 

Amber 

 

CCG 

 

Lenalidomide 

8 

Chemotherapy - see NPSA alerts  

Red 

 

NHSE/CDF for all chemotherapy indications 

 

Lenograstim 

9 

GCSF for neutropenia 

Red  

 

NHSE 

 

Letrozole 

8 

Hormone Antagonists for breast cancer 

Green 

Green (following specialist initation) 

CCG 

 

Leuprorelin 

6 

For all other unlicensed indications (including long term use > 6 months)  

Red 

 

CCG 

 

Leuprorelin 

6 

Licensed Indications (Pre-op management prior to endometrial ablation/ fibroid surgery). 

Amber 

 

CCG 

 

Leuprorelin 

6 

Licensed Indications (Prostate cancer for all and breast cancer for Goserelin). 

Amber 

 

CCG 

 

Leuprorelin 

6 

Precocious puberty and for testosterone castration in sex offenders (unlicensed) 

Red 

 

CCG 

 

Levetiracetam 

4 

Antiepileptic Drugs
As per NICE guidance  

Green 

Green (following specialist advice) 

CCG 

 

Levofloxacin eye drops 

11 

Anti-infective eye preparations 

Red 

 

CCG 

 

Levomepromazine 

4 

Palliative Care 

Green 

 

CCG 

 

Linaclotide 

1 

IBS-C - as per NTS recommendation only 

Green 

 

CCG 

 

Linagliptin 

6 

Gliptins (DPP-4 Inhibitors) As per NICE guidance and see new therapies recommendations  

Green  

 

CCG 

 

Linezolid 

5 

 

Red 

 

CCG 

 

Liraglutide 

6 

GLP-1 Agonists As per NICE guidance and see new therapies recommendations  

Green  

 

CCG 

 

Lisdexamfetamine 

4 

ADHD 

Amber  

 

CCG 

 

Lithium 

4 

Prophylaxis of Cluster Headache 

Amber 

 

CCG 

 

Lithium 

4 

 

Amber 

 

CCG 

 

Lixisenatide 

6 

GLP-1 Agonists As per NICE guidance and see new therapies recommendations  

Green  

 

CCG 

 

Lomustine 

8 

Chemotherapy - see NPSA alerts  

Red 

 

NHSE/CDF for all chemotherapy indications 

 

Low Molecular Weight Heparins (Dalteparin, Enoxaparin, Tinzaparin) 

2 

Prophylaxis of VTE in oncology patients on VTE inducing therapy 

Red 

Commissioning of this service will commence from the 1st April 2015 

CCG 

 

Low Molecular Weight Heparins (Dalteparin, Enoxaparin, Tinzaparin) 

2 

Prophylaxis Post-operative use [e.g. hips, knees, general surgical] 

Red 

 

CCG 

 

Low Molecular Weight Heparins (Dalteparin, Enoxaparin, Tinzaparin) 

2 

Immobile patients or those deemed to be at particularly high risk of DVT at home or in care situation in patients unable to tolerate/tale warfarin or NOACs 

Green 

Green (following specialist advice) 

CCG 

 

Low Molecular Weight Heparins (Dalteparin, Enoxaparin, Tinzaparin) 

2 

For travel prophylaxis in high risk patients (travelling time over 8 hrs) and only as per national recommendations. http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2141.2010.08408.x/full 

Green 

Green (following specialist advice) 

CCG 

 

Low Molecular Weight Heparins (Dalteparin, Enoxaparin, Tinzaparin) 

2 

Use by fertility clinics, and also to prevent miscarriage 

Red 

 

CCG 

 

Low Molecular Weight Heparins (Dalteparin, Enoxaparin, Tinzaparin) 

2 

Prophylaxis of VTE during pregnancy. 

Red 

Local commissioning arrangements may vary and may be amber if local agreement in some CCGs. 

CCG 

 

Low Molecular Weight Heparins (Dalteparin, Enoxaparin, Tinzaparin) 

2 

DVT and PE treatment - initial 2 weeks or as per locally agreed pathways 

Red 

 

CCG 

 

Low Molecular Weight Heparins (Dalteparin, Enoxaparin, Tinzaparin) 

2 

All Surgical Specialities: Warfarin replacement. Given pre-operatively for up to 5 days up until the day of surgery instead of taking warfarin. Allows INR to fall before operation. 

Red 

 

CCG 

 

Low Molecular Weight Heparins (Dalteparin, Enoxaparin, Tinzaparin) 

2 

All Surgical Specialities: Given post-operatively in conjunction with warfarin whilst waiting for the INR to come into range. 

Red 

 

CCG 

 

Low Molecular Weight Heparins (Dalteparin, Enoxaparin, Tinzaparin) 

2 

Treatment of DVT/PE in pregnancy. First line treatment of choice. 

Red 

Local commissioning arrangements may vary and may be amber if local agreement in some CCGs. 

CCG 

 

Low Molecular Weight Heparins (Dalteparin, Enoxaparin, Tinzaparin) 

2 

Obstetric Use: Patients with mechanical heart valves or those on long term warfarin prior to pregnancy should be discussed with consultant cardiologists/haematologists, ideally before pregnancy. 

Red 

 

CCG 

 

Low Molecular Weight Heparins (Dalteparin, Enoxaparin, Tinzaparin) 

2 

DVT or PE in oncology patients undergoing cancer therapy or with metastatic disease. 

Green 

Green (following specialist initiation) 

CCG 

 

Low Molecular Weight Heparins (Dalteparin, Enoxaparin, Tinzaparin) 

2 

DVT or PE in patient unable to stabilise on warfarin or NOACs, with an allergy or with contra-indication to warfarin and/or NOACs. This includes IVDU patients. 

Green 

Green (following specialist initiation) 

CCG 

 

Low Molecular Weight Heparins (Dalteparin, Enoxaparin, Tinzaparin) 

2 

Thromboprophylaxis after delivery 

Red 

 

CCG 

 

Low Molecular Weight Heparins (Dalteparin, Enoxaparin, Tinzaparin) 

2 

Thromboprophylaxis for high risk patients who have suffered a fracture and are in plaster 

Red 

 

CCG 

 

Lubiprostone 

1 

Constipation - as per NICE guidance 

Green 

Green (following specialist initiation) 

CCG 

 

Macitentan 

2 

Pulmonary arterial hypertension 

Red 

 

NHSE 

 

Mannitol inhaler 

3 

Cystic fibrosis  

Red 

 

NHSE 

 

Maraviroc 

5 

HIV medicines.  

Red 

 

NHSE 

 

Melatonin (Circadin®

4 

Circadian rhythm disorders /insomnia in service users with LD aged 18-55 where behavioural interventions have failed and ongoing treatment in CAMHS graduates where clinically indicated 

Amber 

 

CCG 

 

Melatonin (licensed product first line)  

4 

Paediatric patients, e.g. sleep disorders, ADHD. 

Amber  

 

CCG 

 

Melatonin (licensed product only)  

4 

Adult patients over 55. See New Therapies recommendation.  

Green 

Green (but not recommended for use) 

CCG 

 

Melphalan 

8 

Chemotherapy - see NPSA alerts  

Red 

 

NHSE/CDF for all chemotherapy indications 

 

Memantine 

4 

Dementia - as per NICE TA 217. Local commissioning arrangements may vary and in some localities this is green on specialist advice so please check with your CCG 

Green 

Green (following specialist initiation) 

CCG 

 

Menotropin 

6 

Infertility Drugs 

Red 

 

CCG 

 

Mepacrine 

13 

 

Red 

 

CCG 

 

Mercaptopurine 

1 

Inflammatory bowel diseases. Unlicensed but in BNF.  

Amber 

 

CCG 

 

Mercaptopurine 

8 

Chemotherapy - see NPSA alerts  

Red 

 

NHSE/CDF for all chemotherapy indications 

 

Mesalazine 

1 

GI Indications 

Green 

Green (following specialist initiation) 

CCG 

 

Metformin 

6 

Use in pregnancy (N.B. Unlicensed indication) 

Green 

Green (following specialist initiation) 

 

 

Metformin 

6 

For PCOS 

Green 

Green (following specialist initiation) 

CCG 

 

Methadone 

4 

Opioid dependence 

Other 

Status depends on local commissioning arrangements for substance misuse or if GP with specialist interest 

CCG 

 

Methotrexate 

8 

Chemotherapy - see NPSA alerts  

Red 

 

NHSE/CDF for all chemotherapy indications 

 

Methotrexate 

10 

DMARDs Rheumatoid Arthritis. 

Amber 

 

CCG 

 

Methotrexate 

10 

Parenteral Formulations.  

Red 

 

CCG / NHSE depending on indication 

 

Methotrexate (Metoject®) Subcutaneous injection 

13 

Psoriais and Psoriatic Arthritis 

Amber 

 

CCG 

 

Methotrexate (Metoject® brand only) Subcutaneous injection  

1 

Crohn's disease 

Amber 

 

CCG 

 

Methotrexate (Metoject® brand only) Subcutaneous injection 

10 

DMARDs
Rheumatoid Arthritis. 

Amber 

 

CCG 

 

Methotrexate (oral) 

13 

Dermatology indications 

Amber 

 

CCG 

 

Methotrexate (oral) 

1 

Oral. Inflammatory bowel disease (unlicensed indication but in BNF) 

Amber 

 

CCG 

 

Methoxy polyethylene glycol-epoetin beta 

9 

6 (*except where no virement programs exist). 

Red 

 

NHSE - Renal Dialysis only. Product with lowest procurement cost to be used (NICE CG114) 

 

Methylphenidate 

4 

ADHD 

Amber 

 

CCG 

 

Methysergide 

4 

Unlicensed  

Red 

 

CCG 

 

Metolazone 

2 

Heart failure 

Green 

Green (following specialist initiation) 

CCG 

 

Metyrapone 

6 

Cushings syndrome 

Red 

For new patients only 

CCG 

 

Micafungin 

5 

Antifungal 

Red 

 

NHSE 

 

Midazolam (buccal) 

4 

Epilepsy 

Green 

Green (initiated by specialist)  

CCG 

 

Midodrine 

2 

For hypotensive states  

Green 

Green (following specialist initiation) 

CCG 

 

Mifamurtide 

8 

Osteosarcoma 

Red 

 

NHSE 

 

Mifepristone 

7 

Induction of abortion 

Red 

 

CCG 

 

Mitotane 

8 

Chemotherapy - see NPSA alerts  

Red 

 

NHSE/CDF for all chemotherapy indications 

 

Mitoxantrone 

8 

Chemotherapy - see NPSA alerts  

Red 

 

NHSE 

 

Moclobemide 

4 

Reversible MAOI 

Green 

Green (following specialist initiation) 

CCG 

 

Modafinil 

4 

Sleepiness associate with narcolepsy. 

Amber 

 

CCG 

 

Modafinil 

4 

All unlicensed indications e.g. postural hypotension, excessive idiopathic sleepiness or shift work disorder.  

Red 

 

CCG 

 

Mycophenolate 

8 

Immunosuppressants
Licensed indications only. Red if no SCP  

Amber  

 

CCG 

 

Mycophenolate 

10 

DMARDs Rheumatoid Arthritis. 

Amber 

 

CCG 

 

Mycophenolate 

13 

Dermatology indications 

Amber 

 

CCG 

 

Mycophenolate 

8 

Post transplant use 

Amber 

To remain amber until repatriation occurs 

NHSE 

 

Mycophenolate 

3 

Interstitial Lung Disease 

Amber 

 

CCG 

 

Nalmefene 

4 

Alcohol Dependence
As per NICE guidance and see new therapies recommendations. Nalmefene should only be prescribe in conjunction with continuous psychosocial support focused on treatment adherence and reducing alcohol consumption provided by a specialist alcohol service. 

Green 

in conjunction with specialist service 

Public health 

 

Naloxegol for opioid induced constipation 

1 

Opioid induced constipation 

Green 

Green (following specialist advice) 

CCG 

 

Naltrexone 

4 

Opioid dependence 

Other 

Status depends on local commissioning arrangements for substance misuse  

CCG 

 

Naltrexone for alcohol disorders  

4 

Recommended in NICE guidance for max 6 months duration. To remain under specialist community alcohol teams. 

Red 

 

Public health 

 

Natalizumab 

8 

Multiple Sclerosis 

Red 

 

NHSE 

 

Nelarabine 

8 

Chemotherapy - see NPSA alerts  

Red 

 

NHSE/CDF for all chemotherapy indications 

 

Nevirapine 

5 

HIV medicines.  

Red 

 

NHSE 

 

Nilotinib 

8 

Chemotherapy - see NPSA alerts  

Red 

 

NHSE/CDF for all chemotherapy indications 

 

Nintedanib 

3 

Idiopathic pulmonary fibrosis 

Red 

 

NHSE 

 

Nivolumab 

8 

Chemotherapy - see NPSA alerts 

Red 

 

NHSE 

 

Obinutuzmab 

8 

Chemotherapy -
see NPSA alerts 

Red 

 

NHSE 

 

Ocriplasmin intraviteral injection 

11 

Ophthalmic indications 

Red 

 

CCG 

 

Octreotide 

8 

Acromegaly 

Red 

 

NHSE 

 

Octreotide 

8 

All other licensed and unlicensed indications 

Red 

 

NHSE 

 

Ofatumumab 

8 

Chemotherapy - see NPSA alerts  

Red 

 

CCG 

 

Ofloxacin eye drops 

11 

Anti-infective eye preparations 

Red 

 

CCG 

 

Olanzapine 

4 

Antipsychotics (Oral) Use in dementia patients (unlicensed). Local commissioning arrangements may vary and in some localities this remains an amber drug so please check with your CCG. Prescribing of antipsychotics in dementia is expected to be short term. In exceptional circumstances, longer term prescribing may be required [which would be outside of the product licence for any drugs which have a marketing authorisation for such use]. In these situations, there should still be regular review with the aim of reducing or stopping, and the best methods of ensuring continuity of supply should be negotiated between all healthcare professionals involved in that patient’s care.  

Red 

Red (for new patients only) 

CCG 

 

Olanzapine 

4 

Atypical antipsychotics (Oral) - Licensed Indications and also Unlicensed indications as recommended by NICE guidance (i.e. in psychotic depression or anxiety in bipolar patients).Red if no SCP 

Amber 

 

CCG 

 

Olanzapine 

4 

Atypical antipsychotics (Oral)
All other unlicensed indications 

Red 

Red (for new patients only) 

CCG 

 

Olanzapine pamoate 

4 

Antipsychotic depot injection (Schizophrenia) 

Red 

 

CCG 

 

Olaparib 

8 

Chemotherapy - see NPSA alerts 

Red 

 

NHSE/CDF for all chemotherapy indications 

 

Omalizumab 

3 

Allergic asthma prophylaxis 

Red 

 

NHSE 

 

Omalizumab 

3 

Severe chronic spontaneous urticaria 

Red 

 

CCG 

 

Ombitasvir-paritaprevir-ritonavir 

5 

Hepatitis C 

Red 

 

CCG 

 

Omega-3-acid ethyl ester 

2 

Triglyceridaemia 

Green 

Green (following specialist initiation)

On grey list 

CCG 

 

OncoTICE® 

8 

Chemotherapy - see NPSA alerts  

Red 

 

NHSE/CDF for all chemotherapy indications 

 

Ondansetron (5-HT3 antagonist anti-emetics) 

4 

For exceptional use in non oncology patients with chronic emeis following consultant recommendation and where all other options have failed.  

Green 

Green (following specialist initiation)  

CCG 

 

Ondansetron (5-HT3 antagonist anti-emetics) 

4 

Post op and following chemotherapy.  

Red 

 

CCG 

 

Osvaren® 

9 

Phosphate Binding Agents  

Green 

Green (following specialist initiation)  

CCG 

 

Oxaliplatin 

8 

Chemotherapy - see NPSA alerts  

Red 

 

NHSE/CDF for all chemotherapy indications 

 

Oxcarbazepine 

4 

Antiepileptic Drugs
As per NICE guidance 

Green 

Green (following specialist advice) 

CCG 

 

Paclitaxel 

8 

Chemotherapy - see NPSA alerts  

Red 

 

NHSE/CDF for all chemotherapy indications 

 

Paclitaxel albumin (Abraxane®

8 

Chemotherapy - see NPSA alerts  

Red 

 

NHSE/CDF for all chemotherapy indications 

 

Palifermin 

8 

Chemotherapy - see NPSA alerts  

Red 

 

NHSE/CDF for all chemotherapy indications 

 

Paliperidone 

4 

Atypical antipsychotics (Oral)
All other unlicensed indications  

Red 

Red (for new patients only)  

CCG 

 

Paliperidone 

4 

Atypical antipsychotics (Oral) - Licensed Indications and also Unlicensed indications as recommended by NICE guidance (i.e. in psychotic depression or anxiety in bipolar patients).Red if no SCP 

Amber 

 

CCG 

 

Paliperidone 

4 

Antipsychotics (Oral) Use in dementia patients (unlicensed). Local commissioning arrangements may vary and in some localities this remains an amber drug so please check with your CCG. Prescribing of antipsychotics in dementia is expected to be short term. In exceptional circumstances, longer term prescribing may be required [which would be outside of the product licence for any drugs which have a marketing authorisation for such use]. In these situations, there should still be regular review with the aim of reducing or stopping, and the best methods of ensuring continuity of supply should be negotiated between all healthcare professionals involved in that patient’s care.  

Red 

Red (for new patients only) 

CCG 

 

Paliperidone palmitate 

4 

Antipsychotic depot injection (Schizophrenia)
Only for those patients who are stable and if SCP available; or if under the care of a community psychiatric nurse. In some localities there may be commissioning arrangements in place to permit step down. 

Amber 

 

CCG 

 

Palonosetron (5-HT3 antagonists anti-emetics) 

4 

Post op and following chemotherapy.  

Red 

 

CCG 

 

Pancreatin (Creon®

1 

 

Green 

Green (following specialist initiation) 

CCG 

 

Panitumumab 

8 

Chemotherapy - see NPSA alerts  

Red 

 

NHSE/CDF for all chemotherapy indications 

 

Panobinostat 

8 

Chemotherapy - see NPSA alerts 

Red 

 

NHSE/CDF for all chemotherapy indications 

 

Parathyroid hormone 

6 

Osteoporosis 

Red 

 

CCG 

 

Pazopanib 

8 

Chemotherapy - see NPSA alerts  

Red 

 

NHSE/CDF for all chemotherapy indications 

 

Pegaptanib sodium 

11 

Ophthalmic indications 

Red 

 

CCG 

 

Pegfilgrastim 

9 

GCSF for neutropenia 

Red  

 

NHSE 

 

Peginterferon alfa-2a 

8 

 

Red 

 

NHSE 

 

Peginterferon alfa-2b 

8 

 

Red 

 

NHSE 

 

Pegvisomant 

6 

Acromegaly 

Red 

 

NHSE 

 

Pembrolizumab 

8 

Chemotherapy - see NPSA alerts 

Red 

 

NHSE/CDF for all chemotherapy indications  

 

Pemetrexed 

8 

Chemotherapy - see NPSA alerts  

Red 

 

NHSE/CDF for all chemotherapy indications 

 

Penicillamine 

10 

DMARDs Rheumatoid Arthritis. 

Amber 

 

CCG 

 

Penicillin eye drops 

11 

Anti-infective eye preparations 

Red 

 

CCG 

 

Pentostatin 

8 

Chemotherapy - see NPSA alerts  

Red 

 

NHSE/CDF for all chemotherapy indications 

 

Perampanel 

4 

Antiepileptic Drugs
As per NICE guidance 

Green 

Green (following specialist advice) 

CCG 

 

Pergolide 

4 

Antiparkinson's drugs
As per NICE guidance 

Green  

Green (following specialist advice) 

CCG 

 

Pertuzumab 

8 

Chemotherapy - see NPSA alerts  

Red 

 

NHSE/CDF for all chemotherapy indications 

 

Phenelzine 

4 

Non-reversible MAOI 

Red 

Red (for new patients only) 

CCG 

 

Phenobarbital 

4 

Antiepileptic Drugs
As per NICE guidance 

Green 

Green (following specialist advice) 

CCG 

 

Phenytoin 

4 

Antiepileptic Drugs
As per NICE guidance  

Green 

Green (following specialist advice) 

CCG 

 

PHMB eye drops 

11 

Anti-infective eye preparations 

Red 

 

CCG 

 

Phosex® (Calcium acetate) 

9 

Phosphate Binding Agents  

Green 

Green (following specialist initiation)  

CCG 

 

PhosLo® (Calcium acetate) 

9 

Phosphate Binding Agents  

Green 

Green (following specialist initiation)  

CCG 

 

Phosphate infusion 

9 

 

Red 

 

CCG 

 

Pimecrolimus 

13 

Eczema and Psoriasis 

Green 

Green (following specialist advice) 

CCG 

 

Pipotiazine Palmitate 

4 

Antipsychotic depot injection (Schizophrenia) Only for those patients who are stable and if SCP available; or if under the care of a community psychiatric nurse 

Amber 

 

CCG 

 

Pirfenidone 

3 

Idiopathic pulmonary fibrosis 

Red 

 

HSE 

 

Pixantrone 

8 

Chemotherapy - see NPSA alerts 

Red 

 

NHSE 

 

Ponatininb 

8 

Chemotherapy - see NPSA alerts 

Red 

 

NHSE 

 

Porfimer sodium 

8 

Chemotherapy - see NPSA alerts  

Red 

 

NHSE/CDF for all chemotherapy indications 

 

Posaconazole  

5 

 

Red  

 

NHSE 

 

Pramipexole 

4 

Antiparkinson's drugs
As per NICE guidance 

Green 

Green (following specialist advice) 

CCG 

 

Prasugrel 

2 

Percuataneous coronary intervention 

Green 

Green (following specialist initiation) 

CCG 

 

Prednisolone enema 

1 

GI Indications 

Green 

Green (following specialist advice) 

CCG 

 

Prednisolone foam 

1 

GI Indications 

Green 

Green (following specialist advice) 

CCG 

 

Prednisolone suppositories 

1 

GI Indications 

Green 

 

CCG 

 

Pregabalin 

4 

Antiepileptic Drugs
As per NICE guidance  

Green 

Green (following specialist advice) 

CCG 

 

Pregabalin 

4 

Neuropathic pain 

Green 

CCG 

 

 

Primidone 

4 

Antiepileptic Drugs
As per NICE guidance  

Green 

Green (following specialist advice) 

CCG 

 

Procarbazine 

8 

Chemotherapy - see NPSA alerts  

Red 

 

NHSE/CDF for all chemotherapy indications 

 

Progesterone pessaries 

6 

When used in treatment of Infertility  

Red 

 

CCG 

 

Propamidine eye drops 

11 

Anti-infective eye preparations 

Green 

 

CCG 

 

Propylthiouracil 

6 

Hyperthyroidism. See FDA warning re extra monitoring required. Prescribing to remain within specialist care until patient stable 

 Green 

Green (following specialist initiation)  

CCG 

 

Prucalopride 

1 

Chronic constipation in women when other laxatives fail to provide an adequate response 

Green 

Green (following specialist initiation) 

CCG 

 

Pyrazinamide 

5 

Tuberculosis, antibiotic therapy. Local commissioning arrangements may vary. 

Green 

Green (following specialist initiation) 

NHSE = drug resistant TB only 

 

Quetiapine 

4 

Atypical antipsychotics (Oral)
All other unlicensed indications  

Red 

Red (for new patients only) 

CCG 

 

Quetiapine 

4 

Atypical antipsychotics (Oral) - Licensed Indications and also Unlicensed indications as recommended by NICE guidance (i.e. in psychotic depression or anxiety in bipolar patients).Red if no SCP  

Amber 

 

CCG 

 

Quetiapine 

4 

Antipsychotics (Oral) Use in dementia patients. Local commissioning arrangements may vary and in some localities this remains an amber drug so please check with your CCG. Prescribing of antipsychotics in dementia is expected to be short term. In exceptional circumstances, longer term prescribing may be required [which would be outside of the product licence for any drugs which have a marketing authorisation for such use]. In these situations, there should still be regular review with the aim of reducing or stopping, and the best methods of ensuring continuity of supply should be negotiated between all healthcare professionals involved in that patient’s care.  

Red 

Red (for new patients only) 

CCG 

 

Raloxifene 

8 

Chemoprevention in women at moderate and high risk of breast cancer 

Green 

Green (following specialist initiation) 

CCG 

 

Raltegravir 

5 

HIV medicines.  

Red 

 

NHSE 

 

Raltitrexed 

8 

Chemotherapy - see NPSA alerts  

Red 

 

NHSE/CDF for all chemotherapy indications 

 

Ramucirumab 

8 

Chemotherapy - see NPSA alerts 

Red 

 

NHSE/CDF for all chemotherapy indications 

 

Ranibizumab intraviterial injection 

11 

Ophthalmic indications 

Red 

 

CCG 

 

Ranolazine 

2 

Stable angina 

Green 

Green (following specialist advice)  

CCG 

 

Rasagiline 

4 

Antiparkinson's drugs
As per NICE guidance  

Green 

Green (following specialist advice)  

CCG 

 

Rasburicase 

10 

Hyperuricaemia associated with cytotoxic drugs 

Red 

 

NHSE 

 

Regorfenib 

8 

Chemotherapy - see NPSA alerts 

Red 

 

NHSE 

 

Reteplase 

2 

Fibrinolytics 

Red 

 

CCG 

 

Retigabine 

4 

Antiepileptic Drugs
As per NICE guidance  

Red 

 

CCG 

 

Ribavirin 

5 

Hepatitis C and RSV  

Red 

 

NHSE 

 

Rifabutin 

5 

Tuberculosis, antibiotic therapy. Local commissioning arrangements may vary. 

Green 

Green (following specialist initiation) 

NHSE = drug resistant TB only 

 

Rifampicin 

5 

Tuberculosis, antibiotic therapy. Local commissioning arrangements may vary. 

Green 

Green (following specialist initiation) 

NHSE = drug resistant TB only 

 

Rifater® (Rifampicin + isoniazid + pyrazinamide) 

5 

Tuberculosis, antibiotic therapy. Local commissioning arrangements may vary. 

Green 

Green (following specialist initiation) 

NHSE = drug resistant TB only 

 

Rifaximin  

5 

hepatic encephalopathy  

Green 

Green (following specialist initiation) 

CCG 

 

Rifinah® (Rifampicin + isoniazid) 

5 

Tuberculosis, antibiotic therapy. Local commissioning arrangements may vary. 

Green 

Green (following specialist initiation) 

NHSE = drug resistant TB only 

 

Rilpivirine 

5 

HIV medicines.  

Red 

 

NHSE 

 

Riluzole 

4 

Motor Neurone Disease 

Amber 

 

CCG 

 

Risperidone 

4 

Antipsychotics (Oral) Use in dementia patients (licensed only for short-term treatment, up to 6 weeks). Local commissioning arrangements may vary and in some localities this remains an amber drug so please check with your CCG. Prescribing of antipsychotics in dementia is expected to be short term. In exceptional circumstances, longer term prescribing may be required [which would be outside of the product licence for any drugs which have a marketing authorisation for such use]. In these situations, there should still be regular review with the aim of reducing or stopping, and the best methods of ensuring continuity of supply should be negotiated between all healthcare professionals involved in that patient’s care.  

Red 

Red (for new patients only) 

CCG 

 

Risperidone 

4 

Atypical antipsychotics (Oral) - Licensed Indications and also Unlicensed indications as recommended by NICE guidance (i.e. in psychotic depression or anxiety in bipolar patients).Red if no SCP 

Amber 

 

CCG 

 

Risperidone 

4 

Atypical antipsychotics (Oral)
All other unlicensed indications 

Red 

Red (for new patients only) 

CCG 

 

Risperidone (Risperdal Consta®

4 

Antipsychotic depot injection (Schizophrenia)
Only for those patients who are stable and if SCP available; or if under the care of a community psychiatric nurse. In some localities there may be commissioning arrangements in place to permit step down. 

Amber 

 

CCG 

 

Ritonavir 

5 

HIV medicines. 

Red 

 

NHSE 

 

Rituximab 

10 

Biologics/Cytokine modulators 

Red 

 

NHSE for paediatric indications where adult TA available and for juvenile arthritis. CCG for adults. NHSE = ANCA-positive vasculitis, Cancer & SLE.  

 

Rivaroxaban 

2 

As per NICE guidance 

Green  

 

CCG 

 

Rivastigmine 

4 

Dementia - as per NICE TA 217. Local commissioning arrangements may vary and in some localities this is green on specialist advice so please check with your CCG 

Green 

Green (following specialist initiation) 

CCG 

 

Rivastigmine 

4 

Lewy Body Disease, as per NTS recommendation/NICE Guideline 42. Dementia (see above)  

Green 

Green (following specialist initiation  

CCG 

 

Ropinirole 

4 

Antiparkinson's drugs
As per NICE guidance  

Green 

Green (following specialist advice) 

CCG 

 

Ropinirole 

5 

Restless legs 

Green 

Green 

CCG 

 

Rotigotine 

4 

Antiparkinson's drugs As per NICE guidance  

Green 

Green (following specialist advice) 

CCG 

 

Rufinamide  

4 

Lennox Gastaut. See NTS recommendation. Not to be initiated in primary care. 

Green 

Green (following specialist initiation) 

CCG 

 

Ruxolitinib 

8 

Chemotherapy - see NPSA alerts  

Red 

 

NHSE/CDF for all chemotherapy indications 

 

Sacubitril/Valsartan 

2 

Heart failure 

Green 

Green (following specialist initiation)  

CCG 

 

Salbutamol injection 

3 

Severe or life-threatening acute asthma 

Red 

 

CCG 

 

Sapropterin (Kuvan®

9 

Hyperphenylalaninaeia and phenylkotonuria. 

Red 

 

NHSE - policy available 

 

Saquinavir 

5 

HIV medicines.  

Red 

 

NHSE 

 

Sativex® 

4 

Multiple Sclerosis. Not recommended for use - see NTS recommendation 

Red 

 

CCG 

 

Saxagliptin 

6 

Gliptins (DPP-4 Inhibitors)
As per NICE guidance and see new therapies recommendations  

Green  

 

CCG 

 

Secukinumab 

13 

Moderate to severe plaque psoriasis 

Red 

 

CCG 

 

Selegiline 

4 

Antiparkinson's drugs
As per NICE guidance  

Green 

Green (following specialist advice)  

CCG 

 

Sevelamer 

9 

Phosphate Binding agent in both dialysis and non-dialysis patients 

Green  

Green (following specialist initiation)  

NHSE 

 

Sildenafil 

2 

Erectile dysfunction 

Green 

 

 

 

Sildenafil 

2 

Pulmonary Hypertension 

Red 

 

NHSE 

 

Sirolimus 

8 

Post transplant use 

Amber  

To remain amber until repatriation occurs 

NHSE 

 

Sitagliptin 

6 

Gliptins (DPP-4 Inhibitors)
As per NICE guidance and see new therapies recommendations  

Green  

 

CCG 

 

Sodium aurothiomalate (Gold) injection 

10 

DMARDs
Rheumatoid Arthritis. 

Amber 

 

CCG 

 

Sodium chloride 5% eye drops 

11 

Corneal odema (short-term use) 

Red 

 

CCG 

 

Sodium fusidate 

5 

 

Green 

 

CCG 

 

Sodium Oxybate, (Xyrem®

4 

 

Red 

 

NHSE = paeds, CGG = adults 

 

Sodium valproate 

4 

Antiepileptic Drugs
As per NICE guidance  

Green 

Green (following specialist advice) 

CCG 

 

Sodium Valproate 

4 

Mania (BNF 4.8.1) 

Green 

Green (following specialist initiation) 

CCG 

 

Sorafenib 

8 

Chemotherapy - see NPSA alerts  

Red 

 

NHSE/CDF for all chemotherapy indications 

 

Stanozolol 

6 

 

Red 

 

CCG 

 

Stavudine 

5 

HIV medicines.  

Red 

 

NHSE 

 

Steroid Preservative Free Eye drops 

11 

Local inflammation of eye (short-term use) 

Green 

Green (following specialist initiation) 

CCG 

 

Stiripentol  

4 

paediatric patients 

Red  

 

CCG 

 

Streptokinase 

2 

Fibrinolytics 

Red 

 

CCG 

 

Streptomycin 

5 

Tuberculosis, antibiotic therapy. Local commissioning arrangements may vary 

Red 

 

NHSE = drug resistant TB only 

 

Strontium 

6 

Osteoporosis 

Red 

Red for new patients only 

CCG 

 

Sucoferric Oxyhydroxide 

9 

Phosphate Binding agent in both dialysis patients 

Red 

 

NHSE 

 

Sufentanil sublingual (Zalviso®

4 

Acute moderate to severe post-operative pain relief 

Red 

 

CCG 

 

Sulfasalazine 

10 

DMARDs
Rheumatoid Arthritis. 

Amber 

 

CCG 

 

Sulfasalazine 

1 

GI Indications + Rheumatology 

Amber  

 

CCG 

 

Sunitinib 

8 

Chemotherapy - see NPSA alerts  

Red 

 

NHSE/CDF for all chemotherapy indications 

 

Tacrolimus 

8 

Post transplant use 

Amber 

To remain amber until repatriation occurs 

NHSE 

 

Tacrolimus 

8 

Immunosuppressants
Licensed indications only. Red if no SCP  

Amber  

 

NHSE for transplant immunosuppressant only. All other indications CCG. 

 

Tacrolimus ointment 

13 

 

Green 

Green (following specialist advice) 

CCG 

 

Tadalafil 

2 

Severe distress caused by impotence Pulmonary Hypertension. 

Red 

 

NHSE = pulmonary hypertension 

 

Tamoxifen 

8 

Hormone Antagonists for breast cancer 

Green 

Green (following specialist initiation)  

CCG 

 

Tamoxifen 

8 

Chemoprevention in women at moderate and high risk of breast cancer 

Green 

Green (following specialist initiation) 

CCG 

 

Tapentadol 

4 

Severe chronic pain (N.B. On Grey List) 

Green 

Green (following specialist initiation)

On Grey List 

CCG 

 

Tegafur with Gimercail with Oteracil 

8 

Chemotherapy - see NPSA alerts  

Red 

 

NHSE/CDF for all chemotherapy indications 

 

Telaprevir 

5 

Hepatitis C 

Red 

 

NHSE 

 

Telbivudine 

5 

Antivirals for treatment of Hepatitis B  

Red 

 

NHSE 

 

Temoporfin 

8 

Chemotherapy - see NPSA alerts  

Red 

 

NHSE/CDF for all chemotherapy indications 

 

Temozolomide 

8 

Chemotherapy - see NPSA alerts  

Red 

 

NHSE/CDF for all chemotherapy indications 

 

Temsirolimus 

8 

Chemotherapy - see NPSA alerts  

Red 

 

NHSE/CDF for all chemotherapy indications 

 

Tenecteplase 

2 

Fibrinolytics 

Red 

 

CCG 

 

Tenofovir 

5 

Antivirals for treatment of Hepatitis B  

Red 

 

NHSE 

 

Tenofovir 

5 

HIV medicines.  

Red 

 

NHSE 

 

Teriflunomide 

8 

Multiple Sclerosis 

Red 

 

NHSE 

 

Teriparatide 

6 

Osteoporosis 

Red 

 

CCG = female osteoporosis
NHSE = male osteoporosis
 

 

Testosterone products 

6 

within licensed indications in Men 

Green  

Green (following specialist advice) 

CCG 

 

Thalidomide 

8 

Chemotherapy - see NPSA alerts All other indications  

Red 

 

NHSE/CDF for all chemotherapy indications 

 

Thiotepa 

8 

Chemotherapy - see NPSA alerts  

Red 

 

NHSE/CDF for all chemotherapy indications 

 

Tiagabine 

4 

Antiepileptic Drugs
As per NICE guidance  

Green 

Green (following specialist advice) 

CCG 

 

Ticagrelor 

2 

Acute coronary syndromes 

Green 

Green (following specialist initiation) 

CCG 

 

Tioguanine 

8 

Chemotherapy - see NPSA alerts  

Red 

 

NHSE/CDF for all chemotherapy indications 

 

Tipranavir 

5 

HIV medicines. 

Red 

 

NHSE 

 

Tizanidine 

10 

Treatment of spasticity. 

Green 

Green (following specialist initiation) 

CCG 

 

Tobramycin - inhaled 

5 

For Cystic Fibrosis patients (Tobi Podhaler®

Red 

 

NHSE 

 

Tobramycin - nebulised 

5 

For Cystic Fibrosis patients (Tobi®, Bramitob®

Red 

For new patients presenting to the service only 

NHSE 

 

Tobramycin - nebulised 

5 

For Cystic Fibrosis patients (Tobi®, Bramitob®

Amber 

For existing patients only awaiting repatriation, including new starters on this drug 

NHSE 

 

Tocilizumab 

10 

Biologics/Cytokine modulators 

Red 

 

NHSE for paediatric indications where adult TA available and for juvenile arthritis. CCG for adults. 

 

Tolcapone 

4 

Antiparkinson's drugs As per NICE guidance  

Red 

 

CCG 

 

Tolvaptan  

6 

SIADH see IPNTS recommendation  

Red  

 

NHSE = not routinely comissioned 

 

Tolvaptan 

6 

Autosomal dominiant polycystic kidney disease 

Red 

 

CCG 

 

Topiramate 

4 

Antiepileptic Drugs
As per NICE guidance  

Green 

Green (following specialist advice) 

CCG 

 

Topotecan 

8 

Chemotherapy - see NPSA alerts  

Red 

 

NHSE/CDF for all chemotherapy indications 

 

Trabectedin 

8 

Chemotherapy - see NPSA alerts  

Red 

 

NHSE/CDF for all chemotherapy indications 

 

Trametinib 

8 

Chemotherapy - see NPSA alerts  

Red 

 

NHSE 

 

Transgender use of hormone therapy 

6 

As per NHSE Primary Care Responsibilities in Prescribing and Monitoring Hormone Therapy for Transgender and Non-Binary Adults http://shsc.nhs.uk/wp-content/uploads/2016/04/SSC1620_GD-Prescribing.pdf 

Amber 

 

NHSE
(as per NHSE Shared care arrangements)
 

 

Tranylcypromine 

4 

Non-reversible MAOI 

Red 

Red (for new patients only) 

CCG 

 

Trastuzumab 

8 

Chemotherapy - see NPSA alerts  

Red 

 

NHSE/CDF for all chemotherapy indications 

 

Trastuzumab emtansine 

8 

Chemotherapy - see NPSA alerts  

Red 

 

NHSE 

 

Treosulfan 

8 

Chemotherapy - see NPSA alerts  

Red 

 

NHSE/CDF for all chemotherapy indications 

 

Tretinoin 

8 

Chemotherapy - see NPSA alerts  

Red 

 

NHSE/CDF for all chemotherapy indications 

 

Trientine Dihydrochloride  

9 

Wilsons disease 

Red 

 

NHSE  

 

Trifluorothymidine eye drops 

11 

Anti-infective eye preparations 

Red 

 

CCG 

 

Trihexyphenidyl  

4 

Drug induced parkinsonism 

Green 

 

CCG 

 

Triptorelin 

6 

Licensed Indications (Pre-op management prior to endometrial ablation/ fibroid surgery). 

Amber 

 

CCG 

 

Triptorelin 

6 

For all other unlicensed indications (including long term use > 6 months)  

Red 

 

CCG 

 

Triptorelin 

6 

Licensed Indications (Prostate cancer for all and breast cancer for Goserelin). 

Amber 

 

CCG 

 

Triptorelin 

6 

Precocious puberty and for testosterone castration in sex offenders (unlicensed) 

Red 

 

CCG 

 

Trizivir® (Abacavir + Lamivudine + Zidovudine) 

5 

HIV medicines.  

Red 

 

NHSE 

 

Truvada® (Tenofovir + Emtricitabine) 

5 

HIV medicines. 

Red 

 

NHSE 

 

Ulipristal acetate 

6 

Intermittent treatment of moderate to severe uterine fibroids
see NTS recommendation 

Green 

Green (following specialist initiation) 

CCG 

 

Ulipristal acetate 

6 

Treatment of moderate to severe symptoms of uterine fibroids prior to surgery. 

Red 

 

CCG 

 

Urokinase 

2 

Fibrinolytics 

Red 

 

CCG 

 

Ustekinumab 

13 

Psoriasis 

red 

 

CCG 

 

Valganciclovir 

5 

 

Red 

 

NHSE (CMV) 

 

Valproic acid 

4 

Treatment of manic episodes associated with bipolar disorder (BNF 4.2.3) 

Green 

Green (following specialist initiation) 

CCG 

 

Vancomycin (oral) 

5 

1st line for severe or recurrent C.diff only. To be used on advice of microbiology for other indications. 

Green 

 

CCG 

 

Vandetanib 

8 

Chemotherapy - see NPSA alerts  

Red 

 

NHSE/CDF for all chemotherapy indications 

 

Vardenafil 

7 

Severe distress caused by impotence 

Red 

 

CCG 

 

Vedolizumab 

1 

Ulcerative colitis and Crohn's disease 

Red 

 

CCG 

 

Vemurafenib 

8 

Chemotherapy - see NPSA alerts  

Red 

 

NHSE/CDF for all chemotherapy indications 

 

Venlafaxine 

4 

Depression (total daily dose ≥ 300mg only). NB see SPC BP needs regular monitoring  

Green  

Green (specialist initiation)  

CCG 

 

Verapamil 

4 

Cluster Headache - prophylaxis 

Green 

Green (following specialist advice) 

CCG 

 

Verteporfin 

11 

Ophthalmic indications 

Red 

 

CCG 

 

Vigabatrin  

4 

 

Red 

 

CCG 

 

Vinblastine 

8 

Chemotherapy - see NPSA alerts  

Red 

 

NHSE/CDF for all chemotherapy indications 

 

Vincristine 

8 

Chemotherapy - see NPSA alerts  

Red 

 

NHSE/CDF for all chemotherapy indications 

 

Vindesine 

8 

Chemotherapy - see NPSA alerts  

Red 

 

NHSE/CDF for all chemotherapy indications 

 

Vinflunine 

8 

Chemotherapy - see NPSA alerts  

Red 

 

NHSE/CDF for all chemotherapy indications 

 

Vinorelbine 

8 

Chemotherapy - see NPSA alerts  

Red 

 

NHSE/CDF for all chemotherapy indications 

 

Vismodegib 

8 

Chemotherapy - see NPSA alerts 

Red 

 

NHSE 

 

Voractiv® (Rifampicin + isoniazid + pyrazinamide + ethambutol)] 

5 

Tuberculosis, antibiotic therapy. Local commissioning arrangements may vary. 

Green 

Green (following specialist initiation) 

NHSE = drug resistant TB only 

 

Voriconazole 

5 

Antifungal 

Red 

 

NHSE fungal infection; for CPA as per highly specialised criteria only. 

 

Vortioxetine 

4 

Depression 

Green 

Green (following specialist initiation) 

CCG 

 

Zidovudine 

5 

HIV medicines. 

Red 

 

NHSE 

 

Zidovudine with Lamivudine 

5 

HIV medicines.  

Red 

 

NHSE 

 

Zoledronic acid 

6 

IV Bisphosphonate 

Red 

 

CCG 

 

Zonisamide 

4 

Antiepileptic Drugs
As per NICE guidance  

Green 

Green (following specialist advice) 

CCG 

 

Zuclopenthixol acetate (Clopixol accuphase) 

4 

Antipsychotic injection 

Red 

 

CCG 

 

Zuclopenthixol decanoate 

4 

Antipsychotic depot injection (Schizophrenia)
Only for those patients who are stable and if SCP available; or if under the care of a community psychiatric nurse. In some localities there may be commissioning arrangements in place to permit step down. 

Amber 

 

CCG 

 

 

 

 

 

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