Greater Manchester Medicines Management Group

Greater Manchester Clinical Standards Board

NHS

Current Paediatric Red Amber Green (RAG) List

THE PAEDIATRIC RAG LIST INCLUDES THOSE DRUGS AND INDICATIONS SPECIFIC TO USE IN CHILDREN ONLY.

For those drugs/ indications which may be used in both children and adults, check the adult RAG/DNP/grey list. This includes all 'off label' use of licensed medicines.

RAG list entries 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.

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

Some indications in paediatrics may be “off-label” use of licensed medicines. Medicines which are being used outside of product license (e.g. licensed medicine used for unlicensed indication or at an unlicensed dose) may be used if there is a recognised evidence base and/or it is standard treatment, in terms of paediatric medicines, that inclusion of guidance in the Children’s BNF provides a suitable evidence base.

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 Formulary & Managed Entry Subgroup to assess or re-assess the RAG status.

Please read the Guidelines on Defining Red, Amber, Green, DNP, Grey Status for further detail on assigning a RAG status prior to submitting any queries or applications to GMMMG.

Red Amber Green Classifications

Red

Drugs 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 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

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
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.

DNP

Products which have been reviewed by the GM Formulary & Managed Entry Subgroup 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, those agents with a NICE “Do not do” recommendation, and those agents included in the NHS England: “Items which should not routinely be prescribed in primary care” guidance).

Grey

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.

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Filter list by RAG status

 

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Filter list by BNF Chapter

 

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Filter list by Formulary drug

 

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Drug (proprietary
examples)

BNF
Chapter

Indications and
rationale

Formulary
drug

RAG
status

Information

Responsible
commissioner

Date added

Amiodarone 

 

 

Red
 

 

CCG 

 

Amisulpride 

Atypical antipsychotics (Oral) use in children. Licensed Indications & unlicensed indications supported by NICE. 

 

Amber
 

 

CCG 

 

Amisulpride 

Atypical antipsychotics (Oral). All other unlicensed indications incl short-term use. 

 

Red
 

 

CCG 

 

Antipsychotics 

When used by the eating disorder service 

 

Red
 

 

CCG 

 

Aripiprazole 

Atypical antipsychotics (Oral) use in children. Licensed Indications & unlicensed indications supported by NICE. 

 

Amber
 

Shared care protocols:
- bipolar disorder
- OCD
- Psychosis and   schizophrenia 

CCG 

 

Aripiprazole 

Atypical antipsychotics (Oral). All other unlicensed indications incl short-term use. 

 

Red
 

 

CCG 

 

Aripiprazole 

Tourette's Syndrome and other tic disorders in children and adolescents 

 

Red
(for new
patients only) 

 

CCG 

 

Atomoxetine 

ADHD amber once patient stabilised 

 

Amber
 

Atomoxetine for ADHD
in children and
adolescents
 

CCG 

 

Aztreonam Lysine Nebules 

Cystic fibrosis April 13: commissioned by NHS England  

 

Red
(for new
patients) 

 

NHSE 

 

Betaine 

Homocystinuria 

 

Red
 

 

NHSE
Highly
specialised
criteria only 

 

Ciclosporin 

Uncomplicated childhood nephrotic syndrome 

 

Amber
 

Ciclosporin for use in childhood nephrotic syndrome 

NHSE 

 

Citalopram 

Selective Serotonin Reuptake Inhibitors (SSRIs) for Obsessive Compulsive Disorder or Body Dysmorphic Disorder in children and adolescents below 18 years of age 

 

Amber
 

SSRIs for the treatment of OCD and Body Dysmorphic Disorder (BDD) in children and adolescents 

CCG 

 

Citalopram 

Selective Serotonin Reuptake Inhibitors (SSRIs) for the treatment of Anxiety in children and adolescents 

 

Amber
 

SSRIs for the treatment of Anxiety Disorders in children and adolescents 

CCG 

 

Citalopram 

Selective Serotonin Reuptake Inhibitors (SSRIs) for major depression in children and adolescents below 18 years of age 

 

Amber
 

SSRIs for the treatment of Depression in children and adolescents 

CCG 

 

Clobazam 

Antiepileptic. As per NICE guidance 

 

Green
(following
specialist
advice) 

 

CCG 

 

Clonazepam 

Antiepileptic. As per NICE guidance 

 

Green
(following
specialist
advice) 

 

CCG 

 

Clonidine 

Tourette's Syndrome and other tic disorders in children and adolescents 

 

Red
(for new
patients only) 

 

CCG 

 

Clozapine 

Atypical antipsychotics (Oral) use in children  

 

Red
 

 

CCG 

 

Colistimethate - nebulised 

Colomycin®, Promixin® for cystic fibrosis 

 

Red
(for new
patients) 

 

NHSE 

 

Dexamfetamine 

ADHD amber once patient stabilised 

 

Amber
 

Dexamfetamine for ADHD in children and adolescents 

CCG 

 

Domperidone 

Gastro indications 

 

Amber
 

Domperidone for Paediatric Gastro-oesophageal Reflux Disease (GORD) 

CCG 

 

Dornase alfa (Pulmozyme®) 

Cystic fibrosis  

 

Amber
 

 

NHSE 

 

Emollient bath additives 

13 

Criterion 1
When used for the management of eczema in children. This recommendation does not apply to the use of standard emollients when used in the bath as a soap substitute  

DNP  

DNP
 

 

 

27 09 2018 

Emollient bath additives containing antimicrobials 

13 

Criterion 1
Only for short term use in patients with infected eczema  

Grey  

Green
 

 

CCG 

27 09 2018 

Ethinylestradiol 

Pubertal induction 

 

Amber
 

Ethinylestradiol for the induction of delayed puberty 

CCG 

 

Flecainide 

For use in paediatric patients, although unlicensed in children - well established therapy and in the children's BNF.  

 

Red
until patient
stabilised
then Green.  

 

CCG 

 

Fluoxetine 

Selective Serotonin Reuptake Inhibitors (SSRIs) for Obsessive Compulsive Disorder or Body Dysmorphic Disorder in children and adolescents below 18 years of age 

 

Amber
 

SSRIs for the treatment of OCD and Body Dysmorphic Disorder (BDD) in children and adolescents  

CCG 

 

Fluoxetine 

Selective Serotonin Reuptake Inhibitors (SSRIs) for the treatment of Anxiety in children and adolescents 

 

Amber
 

SSRIs for the treatment of Anxiety Disorders in children and adolescents 

CCG 

 

Fluoxetine 

Selective Serotonin Reuptake Inhibitors (SSRIs) for major depression in children and adolescents below 18 years of age 

 

Amber
 

SSRIs for the treatment of Depression in children and adolescents 

CCG 

 

Fluvoxamine 

Selective Serotonin Reuptake Inhibitors (SSRIs) for Obsessive Compulsive Disorder or Body Dysmorphic Disorder in children and adolescents below 18 years of age 

 

Amber
 

 

CCG 

 

Fluvoxamine 

Selective Serotonin Reuptake Inhibitors (SSRIs) for the treatment of Anxiety in children and adolescents 

 

Amber
 

 

CCG 

 

Goserelin 

Precocious puberty  

 

Red
 

 

CCG 

 

Growth Hormone (Somatropin) 

For children. 

 

Amber
 

Growth hormone in paediatrics 

CCG 

 

Guanfacine 

ADHD 

 

Amber
 

Guanfacine for childhood and adolescent ADHD 

CCG 

 

Haloperidol 

Tourette's Syndrome and other tic disorders in children and adolescents 

 

Red
(for new
patients only) 

 

CCG 

 

IV Formulations 

 

unless part of an agreed local pathway  

 

Red
 

 

CCG or
NHSE
depends
on indication
and drug 

 

Leuprorelin 

Precocious puberty  

 

Red
 

 

CCG 

 

Lisdexamfetamine 

ADHD amber once patient stabilised (> 3 months)  

 

Amber
 

Lisdexamfetamine for ADHD in children and adolescents 

CCG 

 

Lithium 

Paediatric use 

 

Red
 

 

CCG 

 

Melatonin (licensed product first line)  

Paediatric patients, e.g. sleep disorders, ADHD. Unlicensed specials only to be used in exceptional circumstances e.g. disabled or autistic children. Doses greater than 6mg are RED 

 

Amber
 

Melatonin for children and adolescents 

CCG 

 

Metformin 

Type 2 diabetes 

 

Green
(following
specialist
initiation) 

 

CCG 

 

Methylphenidate 

ADHD amber once patient stabilised 

 

Amber
 

Methylphenidate for ADHD in children and adolescents  

CCG 

 

Midazolam (buccal) 

Epilepsy 

 

Green
(initiated by
specialist)  

 

CCG 

 

Modafinil 

Sleepiness associate with narcolepsy 

 

Red
 

 

CCG 

 

Nadolol 

Prolonged QT syndrome 

 

Red
 

 

CCG 

 

Nutritional Supplement Drinks 

When used by the eating disorder service 

 

Green
 

 

CCG 

 

Olanzapine 

Atypical antipsychotics (Oral) use in children. Licensed Indications & unlicensed indications supported by NICE. 

 

Amber
 

Shared care protocols:
- bipolar disorder
- OCD
- Psychosis and   schizophrenia  

CCG 

 

Olanzapine 

Atypical antipsychotics (Oral). All other unlicensed indications incl short-term use. 

 

Red
 

 

CCG 

 

Olanzapine 

Eating disorders 

 

Red
 

 

CCG 

 

Omalizumab 

Severe chronic spontaneous urticaria 

 

Red
 

 

CCG 

 

Omalizumab 

Allergic asthma prophylaxis.  

 

Red
 

 

NHSE 

 

Omeprazole MUPS tablets 

GORD 

 

Green
 

 

CCG 

 

Paliperidone 

Atypical antipsychotics (Oral) use in children. Licensed Indications & unlicensed indications supported by NICE. 

 

Amber
 

 

CCG 

 

Paliperidone 

Atypical antipsychotics (Oral). All other unlicensed indications incl short-term use. 

 

Red
 

 

CCG 

 

Palivizumab 

RSV 

 

Red
 

 

NHSE 

 

Paraldehyde 

Status epilepticus 

 

Red
 

 

CCG 

 

Poractant alfa (Curosurf®) 

Pulmonary surfactant 

 

Red
 

 

NHSE 

 

Potassium Phosphate 

When used by the eating disorder service 

 

Red
 

 

CCG 

 

Quetiapine 

Atypical antipsychotics (Oral) use in children. Licensed Indications & unlicensed indications supported by NICE. 

 

Amber
 

Shared care protocols:
- bipolar disorder
- OCD
- Psychosis and   schizophrenia  

CCG 

 

Quetiapine 

Atypical antipsychotics (Oral). All other unlicensed indications incl short-term use. 

 

Red
 

 

CCG 

 

Risperidone 

Atypical antipsychotics (Oral) use in children. Licensed Indications & unlicensed indications supported by NICE. 

 

Amber
 

Shared care protocols:
- bipolar disorder
- OCD
- Psychosis and   schizophrenia 

CCG 

 

Risperidone 

Atypical antipsychotics (Oral). All other unlicensed indications incl short-term use. 

 

Red
 

 

CCG 

 

Risperidone 

Tourette's Syndrome and other tic disorders in children and adolescents 

 

Red
(for new
patients
only) 

 

CCG 

 

Sertraline 

Selective Serotonin Reuptake Inhibitors (SSRIs) for Obsessive Compulsive Disorder or Body Dysmorphic Disorder in children and adolescents below 18 years of age 

 

Amber
 

SSRIs for the treatment of OCD and Body Dysmorphic Disorder (BDD) in children and adolescents 

CCG 

 

Sertraline 

Selective Serotonin Reuptake Inhibitors (SSRIs) for the treatment of Anxiety in children and adolescents 

 

Amber
 

SSRIs for the treatment of Anxiety Disorders in children and adolescents 

CCG 

 

Sertraline 

Selective Serotonin Reuptake Inhibitors (SSRIs) for major depression in children and adolescents below 18 years of age 

 

Amber
 

SSRIs for the treatment of Depression in children and adolescents 

CCG 

 

SSRIs 

When used by the eating disorder service 

 

Amber
 

 

CCG 

 

Stiripentol  

paediatric patients 

 

Red
 

 

CCG 

 

Sulpiride 

Tourette's Syndrome and other tic disorders in children and adolescents 

 

Red
(for new
patients
only) 

 

CCG 

 

Testosterone injection 

Delayed puberty 

 

Green
(following
specialist
initiation) 

 

CCG 

 

Tobramycin - nebulised 

Tobi®, Bramitob® for cystic fibrosis 

 

Red
(for new
patients) 

 

NHSE 

 

Triptorelin 

Precocious puberty  

 

Red
 

Methylphenidate for ADHD in children and adolescents  

CCG 

 


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