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Latest additions or changes to the Paediatric RAG list

June

New

Antipsychotics
Nutritional Supplement Drinks
Potassium Phosphate
SSRIs

Updates

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Current Paediatric Red Amber Green (RAG) List

On this page you will find our Red Amber Green list for Paediatrics (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 are grouped by class (unless indicated). If an indication is not stated then the designated status relates to licensed indications only.

The Paediatric RAG list only includes those drugs and indications specific to use in children only. Please check Adult RAG list for those drugs/indications which may be used in both children and adults including all 'off label' use of licensed medicines.

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.

Please read the supporting information contained within the RAG list opening page and the Guidelines on Defining Red, Amber Green Status prior to submitting any queries or applications to GMMMG.

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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Filter list by status 

 

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Filter list by chapter 

 

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PAEDIATRIC -  Red Amber Green (RAG) List

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Drug
(proprietary examples)

BNF
Chapter

Indications and Rationale

Status

Comments

Responsible
commissioner

 

Amiodarone 

2 

 

Red 

 

CCG 

 

Amisulpride 

4 

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

Amber 

 

CCG 

 

Amisulpride 

4 

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

Red 

 

CCG 

 

Antipsychotics 

4 

When used by the eating disorder service 

Red 

 

CCG 

 

Aripiprazole 

4 

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

Amber 

 

CCG 

 

Aripiprazole 

4 

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

Red 

 

CCG 

 

Aripiprazole 

4 

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

Red 

Red (for new patients only) 

CCG 

 

Atomoxetine 

4 

ADHD amber once patient stabilised 

Amber 

 

CCG 

 

Aztreonam Lysine Nebules 

5 

Cystic fibrosis
April 13: commissioned by NHS England 

Red 

Red (for new patients) 

CCG 

 

Betaine 

9 

Homocystinuria 

Red 

 

NHSE. Highly specialised criteria only 

 

Ciclosporin 

8 

Uncomplicated childhood nephrotic syndrome 

Amber 

 

NHSE 

 

Citalopram 

4 

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

Amber 

 

CCG 

 

Citalopram 

4 

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

Amber 

 

CCG 

 

Citalopram 

4 

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

Amber 

 

CCG 

 

Clobazam for epilepsy 

4 

Antiepileptic.
As per NICE guidance 

Green 

Green (following specialist advice) 

CCG 

 

Clonazepam for epilepsy 

4 

Antiepileptic.
As per NICE guidance 

Green 

Green (following specialist advice) 

CCG 

 

Clonidine 

4 

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

Red 

Red (for new patients only)  

CCG 

 

Clozapine 

4 

Atypical antipsychotics (Oral) use in children  

Red 

 

CCG 

 

Colistimethate - nebulised 

5 

Colomycin®, Promixin® for cystic fibrosis 

Red 

Red (for new patients) 

NHSE 

 

Dexamfetamine 

4 

ADHD amber once patient stabilised 

Amber 

 

CCG 

 

Domperidone 

1 

Gastro indications 

Amber 

 

CCG 

 

Dornase alfa (Pulmozyme®

3 

Cystic fibrosis 

Amber 

 

NHSE 

 

Ethinylestradiol 

6 

Pubertal induction 

Amber 

 

CCG 

 

Flecainide 

2 

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

Red 

Red until patient stabilised then Green 

CCG 

 

Fluoxetine 

4 

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

Amber 

 

CCG 

 

Fluoxetine 

4 

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

Amber 

 

CCG 

 

Fluoxetine 

4 

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

Amber 

 

CCG 

 

Fluvoxamine 

4 

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 

4 

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

Amber 

 

CCG 

 

Goserelin 

6 

Precocious puberty 

Red 

 

CCG 

 

Growth Hormone (Somatropin) 

6 

For children 

Amber 

 

CCG 

 

Guanfacine 

4 

ADHD 

Amber 

 

CCG 

 

Haloperidol 

4 

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

Red 

Red (for new patients only) 

CCG 

 

IV Formulations 

Misc 

unless part of an agreed local pathway 

Red 

 

CCG or NHSE depends on indication and drug 

 

Leuprorelin 

6 

Precocious puberty 

Red 

 

CCG 

 

Lisdexamfetamine 

4 

ADHD amber once patient stabilised 

Amber 

 

CCG 

 

Lithium 

4 

Paediatric use 

Red 

 

CCG 

 

Melatonin (licensed product first line) 

4 

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 

 

CCG 

 

Metformin 

6 

Type 2 diabetes 

Green 

Green (following specialist initiation) 

CCG 

 

Methylphenidate 

4 

ADHD amber once patient stabilised 

Amber 

 

CCG 

 

Midazolam (buccal) 

4 

Epilepsy 

Green 

Green (initiated by specialist) 

CCG 

 

Modafinil 

4 

Sleepiness associate with narcolepsy 

Red 

 

CCG 

 

Nadolol 

2 

Prolonged QT syndrome 

Red 

 

CCG 

 

Nutritional Supplement Drinks 

9 

When used by the eating disorder service 

Green 

 

CCG 

 

Olanzapine 

4 

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

Amber 

 

CCG 

 

Olanzapine 

4 

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

Red 

 

CCG 

 

Olanzapine 

4 

Eating disorders 

Red 

 

CCG 

 

Omalizumab 

3 

Allergic asthma prophylaxis 

Red 

 

NHSE 

 

Omalizumab 

3 

Severe chronic spontaneous urticaria 

Red 

 

CCG 

 

Omeprazole MUPS tablets 

1 

GORD 

Green 

 

CCG 

 

Paliperidone 

4 

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

Amber 

 

CCG 

 

Paliperidone 

4 

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

Red 

 

CCG 

 

Palivizumab 

5 

RSV 

Red 

 

NHSE 

 

Paraldehyde 

4 

Status epilepticus 

Red 

 

CCG 

 

Poractant alfa (Curosurf®

3 

Pulmonary surfactant 

Red 

 

NHSE 

 

Potassium Phosphate 

9 

When used by the eating disorder service 

Red 

 

CCG 

 

Quetiapine 

4 

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

Amber 

 

CCG 

 

Quetiapine 

4 

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

Red 

 

CCG 

 

Risperidone 

4 

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

Amber 

 

CCG 

 

Risperidone 

4 

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

Red 

 

CCG 

 

Risperidone 

4 

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

Red 

Red (for new patients only)  

CCG 

 

Sertraline 

4 

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

Amber 

 

CCG 

 

Sertraline 

4 

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

Amber 

 

CCG 

 

Sertraline 

4 

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

Amber 

 

CCG 

 

SSRIs 

4 

When used by the eating disorder service 

Amber 

 

CCG 

 

Stiripentol 

4 

paediatric patients 

Red 

 

CCG 

 

Sulpiride 

4 

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

Red 

Red (for new patients only) 

CCG 

 

Testosterone injection 

6 

Delayed puberty 

Green 

Green (following specialist initiation) 

CCG 

 

Tobramycin - nebulised 

5 

Tobi®, Bramitob® for cystic fibrosis 

Red 

Red (for new patients) 

NHSE 

 

Triptorelin 

6 

Precocious puberty 

Red 

 

CCG 

 

 

 

 

 

70 Records  

 

 

 

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