On this page you will find our RED, AMBER, GREEN and DNP/GREY lists for adults (scroll down to see the list). Please check the paediatric RAG list for those drugs/indications which are specific to use in children only.

RAG list entries may be subject to a lag period to allow for implementation by Trusts/localities. Please check with your individual Trust or locality.

If an indication is not stated then the designated status relates to licensed indications only.

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.  Primary care prescribers and specialist teams 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 specialist 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 Clinical Reference Group to assess or re-assess the RAG status.

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

In line with NHS England guidance, GM do not routinely support prescribing for conditions which are self-limiting or amenable to self-care. For further details see GM commissioning statement.

Red Amber Green Classifications

Classification Guidance
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 or specialist service. This may include arranging for supply via a home care company.

Amber

Drugs suitable for shared care arrangements under a shared care protocol.
Prescribing and monitoring responsibilities may be transferred from specialist teams to primary care prescribers in line with a shared care protocol. Shared care arrangements will usually be supported by a GMMMG shared care protocol (SCP). See here for a list of GMMMG approved SCPs.

Green

Drugs that are suitable for initiation and ongoing prescribing within primary care.

Green (specialist initiation)

Drugs that are suitable for ongoing prescribing within primary care following initiation by a specialist service. Little or no monitoring is required.

Green (specialist advice)

Drugs that are suitable for initiation by primary care following written or verbal advice from a specialist service. Little or no monitoring is required.

DNP

Products which are not recommended for prescribing in any setting. “Do Not Prescribe” status may relate to a specific medicine, or to prescribing for a particular indication. This is in addition to all medicines with a “not NHS” or “Drugs of Low Clinical Value” classification in the BNF, and those medicines with a NICE “Do not do” recommendation.

Grey

Products which are not suitable for routine prescribing but suitable for exceptional use in a defined patient population. Prescribers should ensure that more suitable alternatives have been considered and ruled out as not being appropriate before recommending or prescribing a medicine with a GREY list status. In these cases a RAG of RED, AMBER or GREEN will also be assigned to clarify in which care setting prescribing responsibility lies.

Other

Criteria for inclusion on DNP/grey lists:

  • Criterion 1: Products of low clinical effectiveness, where there is a lack of robust evidence of clinical effectiveness or there are significant safety concerns.
  • Criterion 2: Products which are clinically effective but where more cost-effective products are available, including products that have been subject to excessive price inflation.
  • Criterion 3: Products which are clinically effective but, due to the nature of the product or condition being treated, are deemed a low priority for NHS funding.
Drug (proprietary examples) BNF chapter Indications and rationale Formulary drug RAG status Information Responsible commissioner Date added
Abacavir 5 HIV medicines. Yes Red NHSE
Abatacept 10 Biologics/cytokine modulators Yes Red

NHSE-commissioned for paediatric indications where adult TA available and for juvenile arthritis.

ICS
Abiraterone 8 Prostate cancer Red

NICE TA259

NICE TA387

NHSE
Acamprosate 4 Alcohol Dependence Yes Green

in conjuction with specialist service

Public
health
Acetazolamide tablets 11 Glaucoma Yes Green (specialist initiation) ICS
Acetazolomide 2 Idiopathic intracranial hypertension (off-label indication) No Green (specialist advice) ICS
Acitretin 13 Red status predominantly due to safety concerns in pregnancy. Yes Red ICS
Acne – mild (OTC/self care) 13 Criterion 3
For example: benzoyl peroxide creams and gels
DNP DNP

For further information, including details of exceptions, see Commissioning Statement 

Oct 2019
Actipatch 4 Criterion 1 DNP DNP Jun 2019
Adalimumab 10 Biologics/cytokine modulators Yes Red

NHSE-commissioned for paediatric indications where adult TA available and for juvenile arthritis.

ICS
Adefovir 5 Antivirals for treatment of Hepatitis B Yes Red NHSE
Aflibercept 11 Ophthalmic indications Yes Red ICS
Agomelatine 4 Major depressive disorder. Criterion 1: Only for use in patients with severe depression when other preparations recommended by NICE have been tried and have failed. Not to be prescribed in the elderly. Grey Green (specialist initiation)

NICE CG90: depression in adults.

MHRA: risk of liver toxicity

ICS
Albendazole 5 For hydatid disease Red ICS Mar 2020
Alendronate (once weekly) 6 Osteoporosis
NB: alendronate 70mg weekly is not licensed for use in men, but this is common practice
Yes Green

NICE TA464: Bisphosphonates for treating osteoporosis

ICS Aug 2021
Alendronate plus Vitamin D (Fosavance®) 6 Criterion 2 DNP DNP

NICE – TA464

CKS – osteoporosis

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. Yes Green (specialist advice) ICS
Alimemazine 3 Criterion 2 DNP DNP

Drug Tariff (Sept 2016)

ICS
Alipogene tiparvovec 9 Agents for the treatment of metabolic disorders Red NHSE
Alirocumab 2 Primary hypercholesterolaemia and mixed dyslipidaemia Yes Red ICS
Aliskiren 2 Criterion 2 DNP DNP

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

Oct 2019
Alitretinoin 13 Chronic hand eczema. Yes Red

See MHRA Drug Safety Update for safety advice

ICS
Alogliptin 6 Gliptins (DPP-4 Inhibitors). Yes Green

As per NICE guidance.

ICS
Alpha-1 antitrypsin 9 Alpha-1 anti-trypsin deficiency: Type 1 diabetes mellitus in children. Red NHSE
Alpha-1 antitrypsin 9 Alpha-1 anti-trypsin deficiency:
Emphysema
Red ICS Nov 2019
Alprostadil cream 7 Second line treatment option for management of erectile dysfunction, as an alternative to intracavernous or intraurethral alprostadil injection. Yes Green ICS
Alteplase 2 Fibrinolytics Yes Red ICS
Alu-Cap® (aluminium hydroxide) 9 Phosphate binding agents No Green (specialist initiation) ICS
Amantadine 4 Parkinson's disease, as per NICE guidance. Multiple sclerosis (unlicensed). Green (specialist advice)

NICE NG71 – Parkinson’s disease

NICE CG186 – multiple sclerosis

ICS
Ambrisentan 2 Pulmonary hypertension Red NHSE
Amikacin eye drops 11 Anti-infective eye preparations Yes Red ICS
Aminophylline injection 3 Severe or life-threatening acute asthma Yes Red ICS
Amiodarone 2 Yes Amber

SCP in development

MHRA DSU: Amiodarone (Cordarone X): reminder of risks of treatment and need for patient monitoring and supervision

ICS
Amiodarone injection 2 For serious cardiac arrhythmias Yes Red ICS
Amisulpride 4 Antipsychotics (oral) Use in dementia patients (unlicensed).
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.
Yes Red

For new patients only.

Local commissioning arrangements may vary and in some localities this remains an amber drug so please check with your locality.

ICS
Amisulpride 4 Atypical antipsychotics (oral) - unlicensed indications not supported by NICE guidance Yes Red ICS
Amisulpride 4 Atypical antipsychotics (oral) - licensed Indications and unlicensed indications as recommended by NICE guidance (i.e. in psychotic depression or anxiety in bipolar patients). Red if no SCP Yes Amber

Oral Second Generation (Atypical) Antipsychotics for Adults – Review due 21/4/18

ICS
Anagrelide 8 Essential thrombocythaemia (review after 12 months). Red ICS
Anakinra 10 Biologics/cytokine modulators Red

NICE TA685: Anakinra for treating Still’s disease

NHSE
Anastrozole 8 Hormone antagonists for treatment and chemoprevention of breast cancer Yes Green (specialist advice) ICS
Andexanet alfa 2 Reversing anticoagulation from apixaban or rivaroxaban Yes Red

NICE TA697: Andexanet alfa for reversing anticoagulation from apixaban or rivaroxaban

ICS Oct 2021
Anidulafungin 5 Antifungal Red NHSE
Anti-D immunoglobulin 14 Antenatal anti-D prophylaxis Red ICS
Anti-thymocyte immunoglobulin 8 Immunosuppressants Red NHSE
Antipsychotics 4 Challenging behaviours in patients with intellectual disability Red ICS
Apixaban 2 Yes Green ICS
Apomorphine injection 4 Parkinson's disease. Yes Amber

Apomorphine use in Parkinson’s Disease – Review due 1/1/18

ICS
Apraclonidine 0.5% eye drops 11 Glaucoma Yes Green (specialist initiation) ICS
Apraclonidine 1% eye drops 11 Glaucoma (unlicensed) Yes Red ICS
Apraclonidine eye drops 11 Ocular peri-operative drugs Yes Red ICS
Apremilast 13 Moderate to severe plaque psoriasis and active psoriatric arthritis Yes Red

NICE TA419 – psoriasis

NICE TA433 – psoriatic arthritis

ICS
Aripiprazole 4 Antipsychotics (Oral)
Use in dementia patients (unlicensed).
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.
Yes Red

For new patients only.

Local commissioning arrangements may vary and in some localities this remains an amber drug so please check with your locality.

ICS
Aripiprazole 4 Atypical antipsychotics (oral) - unlicensed indications not supported by NICE guidance Yes Red ICS
Aripiprazole 4 Atypical antipsychotics (oral) - licensed Indications and unlicensed indications as recommended by NICE guidance (i.e. in psychotic depression or anxiety in bipolar patients).
Red if no SCP
Yes Amber

Oral Second Generation (Atypical) Antipsychotics for Adults – Review due 21/4/18

ICS
Aripiprazole 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.
Yes Amber ICS
Asenapine 4 Antipsychotic for use in acute phase only. Red ICS
Atazanavir 5 HIV medicines. Yes Red NHSE
Atidarsagene autotemcel 9 Metachromatic leukodystrophy Red

NICE HST18: Atidarsagene autotemcel for treating metachromatic leukodystrophy.

NHSE Sep 2022
Atomoxetine 4 ADHD Yes Amber

Atomoxetine, dexamfetamine, guanfacine, lisdexamfetamine and methylphenidate for ADHD In Adults

ICS
Atorvastatin 30mg and 60 mg preparations 2 Criterion 2 DNP DNP

Drug Tariff

Atosiban 7 Premature labour Red ICS
Atovaquone 5 Pneumocystis pneumonia - only to be used if other treatments e.g. co-trimoxazole have failed or are not suitable No Green (specialist advice) ICS
Atripla® (efavirenz + tenofovir + emtricitabine) 5 HIV medicines. Yes Red NHSE
Autologous chondrocyte implantation 10 Symptomatic articular cartilage defects of the knee Red NHSE
Avatrombopag 9 Thrombocytopenia Yes Red

NICE TA626: Avatrombopag for treating thrombocytopenia in people with chronic liver disease needing a planned invasive procedure

ICS Feb 2021
Azathioprine 3 Idiopathic pulmonary fibrosis Red

N.B. use not recommended by NICE

ICS
Azathioprine 8 Immunosuppressants (non-transplant indications)
Red for all indications with no SCP
Yes Amber

Shared care protocols available for:

– IBD in adults
– IBD in paediatrics
– Rheumatological conditions in adults
– Dermatology in adults
– Neurological conditions in adults
– Interstitial lung disease in adults
– Autoimmune hepatitis in adults

ICS
Azathioprine 8 Post-transplant use Amber

To remain amber until repatriation occurs

NHSE
Azelastine/fluticasone nasal spray (Dymista®) 12 Allergic rhinitis
Criterion 3
Only for use in patients for whom intranasal antihistamines and glucocorticoids are not sufficient
Grey Green ICS Jul 2019
Aztreonam lysine nebules 5 Cystic fibrosis Red

For new patients only

NHSE
Baricitinib 13 Biologics/cytokine modulators Yes Red

NICE TA466: Baricitinib for moderate to severe rheumatoid arthritis

NICE TA681: Baricitinib for treating moderate to severe atopic dermatitis

ICS
Basiliximab 8 Immunosuppressants - transplant Red NHSE
Bazedoxifene/conjugated oestrogens (Duavive®) 6 Criterion 1 DNP DNP Nov 2019
Bee & wasp allergen (Pharmalgen®) 3 Allergen immunotherapy Yes Red ICS
Belatacept 8 Immunosuppressants - transplant Red NHSE
Belimumab 10 Biologics/cytokine modulators Yes Red

NHSE-commissioned for paediatric indications where adult TA available and for juvenile arthritis.

ICS
Bempedoic acid 2 Primary hypercholesterolaemia or mixed dyslipidaemia. To be used together with ezetimibe in line with NICE TA694. Yes Green (specialist advice)

NICE TA694: Bempedoic acid with ezetimibe for treating primary hypercholesterolaemia or mixed dyslipidaemia

ICS Oct 2021
Benralizumab 3 Severe eosinophilic asthma Yes Red

NICE TA565

NHSE Jun 2019
Benzydamine oral spray and rinse 12 For use in palliative care or following radiotherapy Yes Green ICS Sep 2018
Berotralstat 3 Hereditary angioedema Red

TA738: Berotralstat for preventing recurrent attacks of hereditary angioedema

NHSE Mar 2022
Betaine 9 Homocystinuria Red

Highly specialised criteria only

NHSE
Bevacizumab 11 Ophthalmic indications (unlicensed) Red ICS
Bezlotoxumab 5 For prevention of Clostridium difficile recurrence in adults at high risk of recurrence DNP DNP

GMMMG HCD subgroup recommendation
Not recommended for routine commissioning. IFR required

Nov 2019
Bicalutamide 8 Prostate cancer Yes Green (specialist initiation)

Note: unlicensed if used in prostate cancer (metastatic) with the aim of retaining sexual function

ICS
Bimekizumab 13 Biologics/cytokine modulators Yes Red

NICE TA723: Bimekizumab for treating moderate to severe plaque psoriasis

ICS Feb 2022
Bio-oil 0 Criterion 1 DNP DNP

Cosmetic product with no robust clinical trial data for efficacy.

BioXtra® toothpaste and mouth rinse 0 Criterion 1 DNP DNP

What should be considered when choosing or prescribing saliva substitutes? (July 2019)

Bivalirudin 2 Coronary intervention / coronary intervention procedures Yes Red ICS
Bosentan 2 Digital ulcers
Pulmonary hypertension
Red NHSE
Botulinum toxin 0 For hyperhidrosis, prophylaxis of migraine, and chronic sialorrhoea Yes Red

See GMMMG botulinum toxin guidance.

ICS
Brimonidine gel (Mirvaso®) 13 Criterion 3
For treatment of acne rosacea erythema. Only for use in patients with severe erythema, where all other formulary options have failed, and immediately prior to referring for laser treatment.
Grey Green

NICE evidence summary: facial erythema of rosacea: brimonidine tartrate gel

ICS Nov 2019
Brivaracetam 4 Antiepileptic drugs, as per NICE guidance No Green (specialist initiation)

NICE CG137: epilepsies, diagnosis and management

ICS
Brodalumab 13 Biologics/cytokine modulators Yes Red ICS Jul 2018
Brolucizumab 11 Ophthalmic indications Yes Red

NICE TA672: Brolucizumab for treating wet age-related macular degeneration

Brolucizumab (Beovu▼): risk of intraocular inflammation and retinal vascular occlusion increased with short dosing intervals

ICS Mar 2021
Budesonide MR capsules 1 Chronic bowel disorders. 3mg modified-release capsules. Yes Green (specialist advice)

GI specialist initiation

ICS Nov 2019
Budesonide orodispersible tablets (Jorveza) 1 Only for inducing remission of eosinophilic oesophagitis in adults (treatment duration of up to 12 weeks), as per NICE TA708. Yes Green (specialist initiation)

NICE TA708: Budesonide orodispersible tablet for inducing remission of eosinophilic oesophagitis

ICS Oct 2021
Buprenorphine (sublingual tablets & oral lyophilisate) 4 Opioid dependence Prescribe by brand; due to difference in bioavailability Espranor® is not dose-equivalent with sublingual products. Patient to be maintained on their normal brand of buprenorphine if admitted as an inpatient’ Yes Other

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

ICS
Buprenorphine (sublingual) 4 Pain No Green (specialist advice)

Licensed indication(s) vary among products. See product information

ICS
Burns and scalds – mild (OTC/self care) 13 Criterion 3
For example: antiseptic creams, analgesics, dressings
DNP DNP

For further information, including details of exceptions, see Commissioning Statement 

Oct 2019
Buserelin 6 Infertility drugs Yes Red ICS
C1-esterase inhibitor 3 Angioedema Red NHSE
Cabergoline 4 Antiparkinson's drugs,
as per NICE guidance
No Green (specialist advice)

NICE NG71: Parkinson’s disease in adults

ICS
Calcichew 500mg chewable tablets 9 Phosphate binding agents Yes Green (specialist initiation) ICS
Calcium 500mg and colecalciferol 200units (e.g. Calcichew D-3) 9 Criterion 1 DNP DNP

CKS: Osteoporosis – prevention of fragility fractures

Calcium acetate/magnesium carbonate (Osvaren®) 9 Phosphate binding agents Yes Green (specialist initiation)

NHSE for adult renal dialysis only

NHSE
Calcium resonium (oral) 9 Hyperkalaemia Yes Green ICS
Canakinumab 8 Biologics/cytokine modulators; gouty arthritis. Red ICS
Canakinumab 8 Inherited autoinflammatory disorders Red NHSE
Candesartan 4 Prophylaxis of migraine (off-label indication) Yes Green ICS Jun 2022
Cannabis-derived, cannabis-based and hemp products 0 Criterion 1
Excluding nabilone, Epidyolex and Sativex, when used within their marketing authorisations.
DNP DNP

NICE NG144: Cannabis-derived medicinal products 

Mar 2019
Capsaicin patch (Qutenza®) 4 Criterion 2
Only for use in adults with post-herpetic neuralgia (PHN) who have not achieved adequate pain relief from, or who have not tolerated, conventional first and second-line treatments.
Grey Red

GM Neuropathic pain pathway

ICS
Capsaicin patch (Qutenza®) 4 All unlicensed indications
Criterion 1
DNP DNP Nov 2019
Carbamazepine 4 Antiepileptic drugs.
As per NICE guidance
Yes Green (specialist advice)

NICE CG137: epilepsies, diagnosis and management

ICS
Carbamazepine 4 Bipolar disorder Yes Green (specialist initiation) ICS
Carboprost 7 Postpartum haemorrhage Red ICS
Carglumic acid 9 Agents for the treatment of metabolic disorders Red NHSE
Cariprazine 4 Criterion 2
For treatment of schizophrenia in adults aged 18 years and older with negative symptoms, where at least 2 generic antipsychotics (such as amisulpride, olanzapine, risperidone, aripiprazole or clozapine) have been trialled and have failed.
Grey Red

Red pending SCP (in development)

Less is known regarding long term safety and adverse effects of cariprazine versus more established antipsychotics

ICS Jul 2018
Casirivimab / imdevimab (Ronapreve®) 5 COVID-19 infection Yes Red

NG191: COVID-19 rapid guideline: managing COVID-19

COVID-19 antivirals: reporting to the UK COVID-19 Antivirals Pregnancy Registry

NHSE Jan 2022
Caspofungin 5 Antifungal Yes Red NHSE
Cefuroxime eye drops 11 Ocular peri-operative drugs (unlicensed) Yes Red ICS
Cefuroxime intravitreal injection (Aprokam) 11 Prophylaxis of postoperative endophthalmitis after cataract surgery Yes Red ICS
Celecoxib (capsules) 4 Criterion 1
Only for use in palliative care for relief of cancer pain
Grey Green

GMMMG Palliative Care Pain and Symptom Control Guidelines for Adults

ICS Jan 2020
Cenegermin 11 Criterion 1 DNP DNP

NICE TA532

Nov 2018
Cenobamate 4 Focal onset seizures in epilepsy Yes Green (specialist initiation)

To be initiated by a tertiary epilepsy service.

NICE TA753: Cenobamate for treating focal onset seizures in epilepsy.

ICS May 2022
Certolizumab pegol 10 Biologics/cytokine modulators Yes Red

NHSE-commissioned for paediatric indications where adult TA available and for juvenile arthritis.

ICS
Cetrorelix 6 Infertility drugs Red ICS
Chemotherapy drugs 8 All drugs with direct anti-tumour activity, including cytotoxic agents, monoclonal antibodies, immunomodulatory agents (for example thalidomide, lenalidomide) and targeted treatments (for example imatinib, nilotinib and other tyrosine kinase inhibitors) and any other new classes of both parenteral and oral anti-cancer medicines. Red NHSE
Chenodeoxycholic acid 9 Agents for the treatment of metabolic disorders Red NHSE
Chlordiazepoxide 4 Alcohol dependence Yes Green

In conjunction with specialist service

Public
health
Jul 2022
Chlorhexidine eye drops 11 Anti-infective eye preparations Yes Red ICS
Chlorpromazine 4 For palliative care use Green ICS Jan 2019
Chlorpropamide 6 Criterion 1 DNP DNP

CKS: Type 2 diabetes

Cholic acid 9 Agents for the treatment of metabolic disorders Red NHSE
Chorionic gonadotropin 6 Infertility drugs Red ICS
Ciclosporin 8 Immunosuppressants (non-transplant indications)
Red for all indications with no SCP
Amber

Shared care protocols available for:

– Dermatology
– Rheumatological conditions

ICS
Ciclosporin 8 Post-transplant use Amber

To remain amber until repatriation occurs

NHSE
Ciclosporin eye drops 11 Keratosis due to dry eye disease Yes Green (specialist initiation)

Use licensed product only

ICS
Cidofovir 5 CMV Red NHSE
Cilostazol (Pletal®) 2 Criterion 2 DNP DNP

NICE: TA223

Cinacalcet 9 Primary hyperparathyroidism Yes Amber

Shared care protocol: Cinacalcet for primary hyperparathyroidism

ICS
Cinacalcet 9 Secondary hyperparathyroidism (patient under regular review by secondary care) Yes Red

NHSE – hyperparathyroidism – dialysis patients only

NHSE
Ciprofloxacin ear drops (Cetraxal®) 12 Criterion 3.
For treatment of otitis externa only in cases of proven Pseudomonas infection
Grey Green ICS Aug 2018
Cladribine 8 Relapsing-remitting multiple sclerosis Yes Red

NICE TA616: cladribine for relapsing-remitting multiple sclerosis

MHRA DSU: Cladribine (Mavenclad): new advice to minimise risk of serious liver injury

NHSE Jan 2020
Clindamycin 1% / tretinoin 0.025% gel (Treclin®) 13 For use in patients with moderate to severe acne for whom other combination products (topical antibacterial and benzoyl peroxide) have failed or are not tolerated, and where a topical antibacterial/retinoid combination is indicated Yes Green

GM guidelines for the management of acne in primary care

ICS Nov 2019
Clobazam 4 Antiepileptic. As per NICE guidance Yes Green (specialist advice)

NICE CG137: epilepsies, diagnosis and management

ICS
Clomifene 6 Infertility Drugs Yes Red ICS
Clonazepam 4 Antiepileptic, as per NICE guidance Yes Green (specialist advice)

NICE CG137: epilepsies, diagnosis and management

ICS
Clozapine 4 Atypical antipsychotics (oral). All unlicensed indications, except selected mental health trust programs Yes Red ICS
Co-beneldopa 4 Antiparkinson's drugs, as per NICE guidance Yes Green (specialist advice)

NICE NG71: Parkinson’s disease in adults

ICS
Co-careldopa 4 Antiparkinson's drugs, as per NICE guidance Yes Green (specialist advice)

NICE NG71: Parkinson’s disease in adults

ICS
Co-careldopa + entacapone (Stalevo®) 4 Antiparkinson's drugs, as per NICE guidance Yes Green (specialist advice)

NICE NG71: Parkinson’s disease in adults

ICS
Co-careldopa intestinal gel (Duodopa®) 4 Criterion 3 DNP DNP

NHS England: Clinical commissioning policy: Levodopa-carbidopa intestinal gel

Co-proxamol 4 Criterion 1 DNP DNP

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

Co-trimoxazole 5 No Green (specialist advice) ICS
Cod liver oil capsules 9 Criterion 3 DNP DNP
Codeine and aspirin combination product (Co-codaprin®) 4 Criterion 2 DNP DNP

BNF: aspirin with codeine phosphate 8mg

Coenzyme Q10 (includes ubiquinone and ubidecarenone) 9 Criterion 3 Grey Green (specialist initiation)

NICE CG181

ICS
Colchicine 2 Treatment of pericarditis pain, as an adjunct to standard therapy. No Green (specialist advice)

See ESC pericardial diseases guideline, 2015.

GM Information leaflet for prescribers in primary care

ICS Nov 2019
Cold sores of the lip – infrequent (OTC/self care) 5 Criterion 3
For example: aciclovir cream, Zovirax cold sore cream
DNP DNP

For further information, including details of exceptions, see Commissioning Statement 

Oct 2019
Colesevelam hydrochloride 1 Colesevelam for diarrhoea associated with bile acid malabsorption (unlicensed indication; must be used 2nd line) No Green (specialist advice) ICS
Colesevelam hydrochloride 2 Criterion 1
Licensed indications (primary hypercholesterolaemia, with or without a statin or ezetimibe).
DNP DNP Nov 2019
Colestyramine 1 Bile acid sequestrant - GI indications. Yes Green (specialist advice) ICS
Colistimethate 5 Cystic fibrosis. Inhaled or nebulised Yes Red NHSE
Colistimethate – nebulised 5 For non-cystic fibrosis patients Yes Amber

Shared care protocol: Nebulised colistimethate in adult patients with non-CF bronchiectasis or bronchial sepsis

ICS
Collagenase 10 Dupuytren's contracture Yes Red ICS
Commercial eyelid cleansing preparations 11 Criterion 1 DNP DNP

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

Conestat alfa 3 Angioedema Red NHSE
Conjunctivitis (bacterial or viral) (OTC/self care) 11 Criterion 3
E.g.: Bacterial: Chloramphenicol eye drops or ointment
Viral: hypromellose eye drops
DNP DNP

For further information, including details of exceptions, see Commissioning Statement 

Oct 2019
Constipation – infrequent, duration less than 2 weeks (OTC/self care) 1 Criterion 3
For example: senna, lactulose, macrogol sachets
DNP DNP

For further information, including details of exceptions, see Commissioning Statement 

Oct 2019
Coughs, colds and nasal congestion (OTC/self care) 0 Criterion 3
For example: simple linctus, codeine linctus, pholcodine linctus, pseudoephedrine nasal sprays and oral preparations, xylometazoline and ephedrine nasal sprays and drops
DNP DNP

For further information, including details of exceptions, see Commissioning Statement 

Oct 2019
Crizanlizumab 9 Sickle cell disease Yes Red

NICE TA743: Crizanlizumab for preventing sickle cell crises in sickle cell disease

NHSE Apr 2022
Cyanocobalamin tablets 9 Criterion 3 Only for use in those patients who are truly unable to tolerate injections and who are vegan. Grey Green

BNF: drugs used in megaloblastic anaemias

ICS
Cyclophosphamide 10 DMARD Red ICS
Cyproterone 6 Prostate cancer & male hypersexuality Yes Green (specialist advice)

Licensed indication(s) vary among products. See product information

MHRA Drug Safety Update: risk of meningioma

ICS
Cyproterone acetate 6 Transgender use of hormone therapy, as per NHSE shared care arrangements. Amber

NHSE Gender Dysphoria Clinical Programme

GMC Guidance: Trans healthcare

GMMMG supporting information for GPs

MHRA Drug Safety Update: risk of meningioma

NHSE
Cystitis – mild (2-3 days, women only) (OTC/self care) 7 Criterion 3
For example: potassium citrate mixture or sachets, cranberry products
DNP DNP

For further information, including details of exceptions, see Commissioning Statement 

Oct 2019
Dabigatran 2 Yes Green ICS
Dalteparin 2 See entries for low molecular weight heparins (dalteparin, enoxaparin, tinzaparin) Yes Other ICS
Dandruff (mild scaling of the scalp without itching) (OTC/self care) 13 Criterion 3
For example: shampoos, including antifungal, antiseptic, selenium, and cold tar
DNP DNP

For further information, including details of exceptions, see Commissioning Statement 

Oct 2019
Dapagliflozin 6 Chronic kidney disease Yes Green

NICE TA775: Dapagliflozin for treating chronic kidney disease

ICS Nov 2022
Dapagliflozin 2 Treatment of symptomatic chronic heart failure with reduced ejection fraction. Yes Green (specialist advice)

NICE TA679: Dapagliflozin for treating chronic heart failure with reduced ejection fraction

ICS Mar 2021
Dapoxetine (Priligy®▼) 7 Criterion 1 DNP DNP
Dapsone 5 Leprosy and dermatitis herpetiformis Yes Green (specialist advice) ICS
Dapsone 5 50mg & 100mg tablets
Second line option for Pneumocystis carinii pneumonia (PCP) prophylaxis, for patients who have an allergy to co-trimoxazole (trimethoprim/ sulfamethoxazole) who are transplant recipients or receiving augmented immunosuppression for autoimmune conditions.
No Green (specialist initiation) ICS Feb 2022
Daptomycin 5 Red ICS
Darunavir 5 HIV medicines. Yes Red NHSE
Darvadstrocel 1 Criterion 1
For complex perianal fistulas in Crohn's disease
DNP DNP

NICE TA556

Apr 2019
Degarelix 8 Prostate cancer Amber

Degarelix in advanced hormone dependent prostate cancer

ICS
Delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD) (Sativex®) 4 Moderate to severe spasticity in adults with multiple sclerosis Yes Red

NICE NG144: Cannabis-based medicinal products.

NHSE Jul 2022
Demeclocycline 6 Hyponatraemia associated with syndrome of inappropriate antidiuretic hormone (SIADH) Yes Red

For new patients only

ICS Oct 2021
Denosumab (Prolia®) 6 Osteoporosis in men & women Yes Amber

Shared care protocol: Denosumab for osteoporosis

ICS
Denosumab (XGEVA®) 6 Oncology indication Yes Red ICS
Dental caries – prevention of (OTC/self care) 9 Criterion 3
For example: fluoride mouthwashes, toothpastes
DNP DNP

For further information, including details of exceptions, see Commissioning Statement 

Oct 2019
Deoxycholic acid (Belkyra) 0 Moderate to severe convexity or fullness associated with submental fat (“double-chin”) in adults.
Criterion 1
DNP DNP Oct 2021
Dexamethasone eye drops 11 Local inflammation of eye Yes Red

Red pending production of a shared care protocol

ICS Jan 2020
Dexamethasone intravitreal implant 11 Ophthalmic indications Yes Red ICS
Dexamfetamine 4 ADHD Amber

Shared care protocol: Atomoxetine, dexamfetamine, guanfacine, lisdexamfetamine and methylphenidate for ADHD In Adults

ICS
Dexamfetamine 4 Treatment of narcolepsy Yes Red

Red pending production of a shared care protocol

ICS Jul 2019
Diarrhoea (adults) (OTC/self care) 1 Criterion 3
For example: loperamide, oral rehydration sachets, kaolin-containing preparations
DNP DNP

For further information, including details of exceptions, see Commissioning Statement 

Oct 2019
Diazoxide 6 Chronic hypoglycaemia No Green (specialist initiation) ICS
Dibotermin alfa 6 Bone morphogenic protein Red

See Commissioning statement: Dibotermin alfa (InductOs) for the treatment of non-union fracture.

ICS
Dibrompropamidine eye ointment 11 For the treatment of acanthamoeba keratitis Yes Red

Alternative to propamidine isetionate 0.1% drops

ICS
Dicycloverine 1 Criterion 2 DNP DNP ICS Jul 2018
Didanosine 5 HIV medicines. Yes Red NHSE
Diethylstilbestrol 8 For prostate cancer. Yes Green (specialist initiation) ICS
Digoxin-specific antibody fragments 2 Digoxin toxicity Red ICS
Diltiazem ointment 1 Anal fissure Yes Green (specialist initiation) ICS
Dimethyl fumarate 8 Multiple sclerosis Red NHSE
Dimethyl fumarate 13 Psoriasis Yes Red ICS
Diroximel fumarate 8 Relapsing-remitting multiple sclerosis Yes Red

NICE TA794: diroximel fumarate for treating relapsing–remitting multiple sclerosis

 

NHSE Nov 2022
Disodium pamidronate 6 Red ICS
Disulfiram 4 Alcohol dependence
Patient must be stabilised for >3 months prior to transfer of prescribing.
Yes Amber

Disulfiram in the treatment of alcohol dependence – Review due Feb 2018

Public
health
Dithranol (licensed preps) 13 Psoriasis Yes Green (specialist advice)

NB: unlicensed products are RED

ICS
Diuretics with Potassium 2 Criterion 2 DNP DNP

BNF: Diuretics with potassium

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 locality. Yes Green

NICE NG97

GMMMG information for primary care prescribers

ICS
Dornase alfa (Pulmozyme®) 3 Cystic fibrosis Yes Red NHSE
Dosulepin (licensed and unlicensed uses) 4 Criterion 1 DNP DNP

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

NICE “do not do” recommendation (CG90)

Doxazosin MR 2 Criterion 2 DNP DNP

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

Doxylamine/pyridoxine (Xonvea) 4 Criterion 1
To be used only when the other preparations currently recommended by RCOG guidance have been tried and have failed.

This recommendation will be reviewed once guidance from RCOG, NICE and/or RMOC is available.
Grey Green

RCOG guidance

ICS Jun 2019
Dronedarone 2 Shared care protocol in development Yes Green (specialist initiation)

See NICE guidance

Regular monitoring required, see SPC.

 

ICS
Dry eyes/sore tired eyes (OTC/self care) 11 Criterion 3
For example: hypromellose eye drops, carbomer 980 gel, hyaluronate eye drops
DNP DNP

For further information, including details of exceptions, see Commissioning Statement 

Oct 2019
Dry skin – mild (OTC/self care) 13 Criterion 3
For example: emollient creams and lotions
DNP DNP

For further information, including details of exceptions, see Commissioning Statement 

Oct 2019
Dulaglutide 6 GLP-1 Agonists. As per NICE guidance Yes Green ICS
Duloxetine 4 90mg & 120mg capsules
Criterion 2
Only for use where the prescriber believes that patient’s pill burden is high enough to justify the extra cost associated with the use of these formulations.
Grey Green ICS Feb 2022
Dupilumab 3 For chronic rhinosinusitis with nasal polyps DNP DNP

NICE TA648:Dupilumab for treating chronic rhinosinusitis with nasal polyps

Jan 2021
Dupilumab 13 Atopic dermatitis Yes Red

NICE TA534

ICS Nov 2018
Dupilumab 3 Severe asthma with type 2 inflammation Yes Red

NICE TA751: Dupilumab for treating severe asthma with type 2 inflammation

NHSE May 2022
Dutasteride/tamsulosin (Combodart®) 7 Criterion 2 DNP DNP Nov 2019
E-voke® electronic inhaler and Voke® inhaler 4 Criterion 1
Further data are required evaluating the use of Voke & e-Voke as a stop smoking aid, and comparing their efficacy to established smoking cessation treatments, prior to their use in the GM region.
DNP DNP
Earwax (OTC/self care) 12 Criterion 3
For example: olive oil, sodium bicarbonate ear drops
DNP DNP

For further information, including details of exceptions, see Commissioning Statement 

Oct 2019
Edoxaban 2 Yes Green ICS
Efavirenz 5 HIV medicines. Yes Red NHSE
Eflornithine 13 For facial hirsutism
Criterion 3
Only for use in patients with a confirmed diagnosis of an androgenic disease and in whom treatment with co-cyprindiol is ineffective, contraindicated, or considered inappropriate.
Grey Green

See NICE CKS – hirsutism.

ICS Nov 2019
Elosulfase alfa 9 Mucopolysaccharidosis type IVa Red

NICE HST19: Elosulfase alfa for treating mucopolysaccharidosis type 4A

NHSE
Eltrombopag 9 Chronic immune (idiopathic) thrombocytopenic purpura Yes Red

NICE TA293

ICS
Emollient bath and shower preparations 13 Criterion 1
When used for the management of eczema in children or adults. This recommendation does not apply to the use of standard emollients when used in the bath as a soap substitute.
DNP DNP Sep 2018
Emollient bath and shower preparations containing antimicrobials 13 Criterion 1
Only for short term use in patients with infected eczema.
Grey Green ICS Sep 2018
Empagliflozin 6 Chronic heart failure with reduced ejection fraction Yes Green (specialist advice)

NICE TA773: Empagliflozin for treating chronic heart failure with reduced ejection fraction.

ICS Sep 2022
Emtricitabine 5 HIV medicines. Yes Red NHSE
Enfuvirtide 5 HIV medicines. Yes Red NHSE
Enoxaparin 2 See entries for low molecular weight heparins (dalteparin, enoxaparin, tinzaparin) Yes Other ICS
Entacapone 4 Antiparkinson's drugs, as per NICE guidance Yes Green (specialist advice)

NICE NG71: Parkinson’s disease in adults

ICS
Entecavir 5 Antivirals for treatment of hepatitis B Red NHSE
Epidyolex 4 Criterion 3
For children and adults with rare, severe forms of drug-resistant epilepsy.
Grey Red

NICE TA614 – Dravet syndrome

NICE TA615 – Lennox-Gastaut syndrome

NICE NG144 – cannabis-derived medicinal products

NHSE Mar 2019
Eplerenone 2 Heart failure Green (specialist initiation) ICS Nov 2019
Epoetins 9 Including epoetin alfa, epoetin beta, epoetin zeta, darbepoetin, methoxy polyethylene glycol-epoetin beta (Mircera) Red

NHSE – renal dialysis only

NHSE
Epoprostenol 2 Pulmonary hypertension Red NHSE
Epotermin alfa (Osigraft®) 6 Bone morphogenic protein Red ICS
Erenumab 4 Migraine prophylaxis Yes Red

NICE TA682: Erenumab for preventing migraine

ICS Aug 2021
Ergotamine containing products (Migril) 4 Criterion 1 DNP DNP

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

Eslicarbazepine 4 Antiepileptic drugs, as per NICE guidance No Green (specialist advice)

NICE CG137: epilepsies, diagnosis and management

ICS
Estradiol (oestradiol) 6 Transgender use of hormone therapy, as per NHSE shared care arrangements Amber

GM shared care protocol: Feminising hormones for patients aged 17 years or over under Indigo Gender Service 

NHSE Gender Dysphoria Clinical Programme

GMC Guidance: Trans healthcare

GMMMG supporting information for GPs

NHSE
Etanercept 10 Biologics/cytokine modulators Yes Red

NHSE-commissioned for paediatric indications where adult TA available and for juvenile arthritis.

ICS
Ethambutol 5 Tuberculosis, antibiotic therapy. Yes Green (specialist initiation)

NHSE – drug resistant TB only. Local commissioning arrangements may vary.

NHSE
Ethosuximide 4 Antiepileptic drugs, as per NICE guidance No Green (specialist advice)

NICE CG137: epilepsies, diagnosis and management

ICS
Etravirine 5 HIV medicines. Yes Red NHSE
Eviplera® (emtricitabine + rilpivirine + tenofovir) 5 HIV medicines. Yes Red NHSE
Evolocumab 2 Primary hypercholesterolaemia and mixed dyslipidaemia Yes Red ICS
Excessive sweating (hyperhidrosis) (OTC/self care) 13 For example:
aluminium chloride 20% solutions (e.g. Driclor, Anhydrol Forte)
DNP DNP

For further information, including details of exceptions, see Commissioning Statement 

Oct 2019
Exemestane 8 Hormone antagonists for breast cancer Yes Green (specialist advice) ICS
Exenatide (Byetta® and Bydureon®) 6 GLP-1 Agonists as per NICE guidance Yes Green ICS
Faricimab 11 Ophthalmic indiciations Yes Red

NICE TA799: diabetic macular oedema

NICE TA800: wet age-related macular oedema

ICS Nov 2022
Febuxostat 10 For treatment of gout Yes Green (specialist initiation)

NICE TA164

MHRA Drug Safety Update: hypersensitivity 

ICS
Fentanyl, immediate release 4 Criterion 2
Only to be used in patients undergoing palliative care treatment where use is in line with NICE CG140 and has been made by a multi-disciplinary team and/or other healthcare professional with a recognised specialism in palliative care.
Grey Green (specialist initiation)

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

NICE CG140

ICS
Ferric carboxymaltose (Ferinject®) 9 IV iron Yes Red ICS
Ferric derisomaltose (Monofer®) 9 IV iron Yes Red

Previously known as iron isomaltoside

ICS
Ferric maltol 9 Criterion 2
For treatment of iron deficiency anaemia in patients with intolerance to, or treatment failure with, two oral iron supplements.
Grey Green ICS
Fidaxomicin 5 Clostridium difficile - following microbiology advice No Green (specialist advice)

See commissioning statement: Fidaxomicin (Dificlir) for the treatment of Clostridium difficile infection

ICS
Filgotinib 10 Biologics/cytokine modulators Yes Red

NICE TA676: moderate to severe rheumatoid arthritis

NICE TA792: moderately to severely active ulcerative colitis

ICS Mar 2021
Filgrastim 9 GCSF for neutropenia Yes Red

Will remain subject to separate reimbursement where used for chemo indications (as per 19/20 National Tariff annex A)

ICS
Finasteride 6 Transgender use of hormone therapy, as per NHSE shared care arrangements Amber

NHSE Gender Dysphoria Clinical Programme

GMC Guidance: Trans healthcare

GMMMG supporting information for GPs

NHSE
Fingolimod 8 Multiple sclerosis Red

NICE TA254

NHSE
Flecainide 2 Yes Green (specialist initiation) ICS
Flunarizine 4 Headache
Not licensed in the UK
Yes Red ICS
Fluocinolone acetonide intravitreal implant 11 Ophthalmic indications Yes Red

NICE TA301 – diabetic macular oedema

NICE TA590 – non-infectious uveitis

ICS
Fluoride toothpaste 5,000ppm (e.g. Duraphat®) 9 Criterion 3
For patients at risk of caries secondary to treatment for head and neck cancers or reduced salivary flow rate secondary to surgery. To be continued for as long as natural teeth remain.
Grey Green (specialist advice)

The prescribing of fluoride mouthwashes and toothpastes for other indications should be by dental prescription only, and in line with GMMMG Commissioning Statement: Conditions for which over the counter items should not routinely be prescribed in primary care

ICS
Fluorometholone eye drops 11 Local inflammation of eye (short-term use) Yes Red

Red pending production of a shared care protocol

ICS
Flupentixol 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. Yes Amber

Shared care protocol: First generation (typical) antipsychotic depots in adults

ICS
Follitropin alfa 6 Infertility Drugs Red ICS
Follitropin beta 6 Infertility Drugs Red ICS
Fondaparinux 2 Thromboprophylaxis:
• Immobile patients or those deemed at high risk of DVT at home or in a care setting, and in whom treatment with warfarin or NOAC is not suitable or not tolerated.
• For travel prophylaxis in high risk patients (travelling time over 8 hrs) and only as per national recommendations. Off-label indication. See NICE CKS
Yes Green (specialist advice)

Off-label indication. Licensed if immobilised due to acute illness

ICS
Fondaparinux 2 Ongoing DVT or PE treatment*
• In patients for whom treatment with warfarin or NOAC is not suitable or not tolerated. This includes IVDUs.
• in oncology patients undergoing cancer therapy or with metastatic disease.

*initial 2 weeks of treatment is RED
Yes Green (specialist initiation)

Use in patients unable to stabilise on warfarin or NOACs may be off-license, depending on duration of treatment. See product information.

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

Thromboprophylaxis:
• in oncology patients on VTE-inducing therapy
• in post-surgical patients, where indicated

As bridging anticoagulant therapy in surgical patients who normally receive warfarin.

For people with unstable angina or NSTEMI who do not have a high bleeding risk, unless they are undergoing immediate coronary angiography. See NICE NG185: Acute coronary syndromes
Yes Red ICS
Fondaparinux 2 Treatment and prophylaxis of DVT/PE in pregnancy

Includes use by fertility clinics. Patients with mechanical heart valves or on long term warfarin should be discussed with consultant cardiologists/ haematologists before pregnancy.
Yes Red

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

ICS
Fosamprenavir 5 HIV medicines. Yes Red NHSE
Fosfomycin (oral) 5 Uncomplicated UTI caused by multiple antibacterial organisms on advice of microbiologist No Green (specialist advice) ICS
Fostamatinib 9 Criterion 2 Refractory chronic immune thrombocytopenia DNP DNP

NICE TA759: Fostamatinib for treating refractory chronic immune thrombocytopenia

May 2022
Fremanezumab 4 Migraine prophylaxis Yes Red

NICE TA764: Fremanezumab for preventing migraine

ICS Jan 2021
Fumarate esters (Fumaderm®) 13 Psoriasis Red ICS
Fungal nail infections (OTC/self care) 5 Criterion 3
For example: nail lacquers, paints, and softening products
DNP DNP

For further information, including details of exceptions, see Commissioning Statement 

Oct 2019
Gabapentin 4 Antiepileptic drugs, as per NICE guidance Yes Green (specialist advice)

NICE CG137: epilepsies, diagnosis and management

ICS
Gabapentin 4 Gabapentinoids for management of chronic cough (unlicensed)
Criterion 1
Only for use in patients for whom low dose morphine is unsuitable.
Grey Green (specialist advice) ICS Nov 2019
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 locality Yes Green

NICE NG97

GMMMG information for primary care prescribers

ICS
Galcanezumab 4 Migraine prophylaxis Yes Red

NICE TA659: Galcanezumab for preventing migraine

ICS Jan 2021
Ganciclovir 5 CMV Red NHSE
Ganciclovir eye gel 11 Herpes simplex infection Yes Green (specialist initiation) ICS
Gemeprost 7 Licensed indications Red ICS
Gentamicin eye drops 11 Anti-infective eye preparations Yes Red ICS
Givosiran 9 Acute hepatic porphyria Red

NICE HST16: Givosiran for treating acute hepatic porphyria

NHSE
Glatiramer acetate 8 Multiple sclerosis Red NHSE
Glecaprevir-pibrentasvir 5 Hepatitis C Yes Red NHSE
Gliclazide MR (Diamicron MR®) 6 Criterion 2 DNP DNP

BNF note: equivalent therapeutic effect to standard prep

Glucosamine (+/- chondroiton) 10 Criterion 1 DNP DNP

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

NICE: “do not do” recommendation, CG177

Glycerol phenylbutyrate 9 Agents for the treatment of metabolic disorders Red NHSE
Glycopyrronium oral solution 1 For treatment of severe sialorrhoea.
Prescribers should choose the product with the lowest acquisition cost and taking into account shelf-life of the product where appropriate.
No Green (specialist initiation)

Prescribers should maintain patients on the same product due to differences in bioavailability between products and the potential for error. Care should be taken if switching between oral solutions and dosing adjusted accordingly.

ICS Sep 2019
Golimumab 10 Biologics/cytokine modulators Yes Red

NHSE-commissioned for paediatric indications where adult TA available and for juvenile arthritis.

ICS
Goserelin 6 For all other unlicensed indications (including testosterone castration in sex offenders) and licensed indications without a shared care protocol Yes Red ICS
Goserelin 6 Licensed indications with a shared care protocol Yes Amber

Shared care protocols available for:

– Goserelin for breast cancer in adults
– LHRH analogues for treatment of prostate cancer in adults

ICS
Goserelin 6 Transgender use of hormone therapy, as per NHSE shared care arrangements Amber

GnRH analogues for patients aged 17 years or over under Indigo Gender Service

NHSE Gender Dysphoria Clinical Programme

GMC Guidance: Trans healthcare

GMMMG supporting information for GPs

NHSE
Granisetron (5-HT3 antagonist anti-emetics) 4 Post op and following chemotherapy. Yes Red ICS
Grass Pollen Extract (Grazax®) 3 Criterion 2 DNP DNP
Growth hormone (somatropin) 6 Except in proven primary and secondary hypopituitarism Yes Red NHSE
Growth hormone (somatropin) 6 For primary and secondary hypopituitarism Yes Green (specialist initiation) ICS
Guanfacine 4 ADHD Amber

Shared care protocol: Atomoxetine, dexamfetamine, guanfacine, lisdexamfetamine and methylphenidate for ADHD In Adults

ICS Jan 2020
Guselkumab 13 Biologics/cytokine modulators Yes Red ICS Jul 2018
Haem arginate
(human hemin)
9 Agents for the treatment of metabolic disorders Red NHSE
Haemorrhoids – minor (OTC/self care) 1 Criterion 3
For example: Anusol or Anusol HC cream, ointment or suppositories
DNP DNP

For further information, including details of exceptions, see Commissioning Statement 

Oct 2019
Haloperidol 4 For palliative care use See separate entry for 500 microgram tablets Yes Green ICS Jan 2019
Haloperidol 500 microgram tablets 4 Criterion 2 DNP DNP Mar 2022
Haloperidol 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.
Yes Amber

Shared care protocol: First generation (typical) antipsychotic depots in adults

ICS
Hay fever/seasonal rhinitis – mild to moderate (OTC/self care) 3 Criterion 3
For example: antihistamines, nasal sprays, eye drops
DNP DNP

For further information, including details of exceptions, see Commissioning Statement 

Oct 2019
Head lice (OTC/self care) 13 Criterion 3
For example: dimeticone, malathion, cyclomethicone, permethrin shampoos and liquids, “Bug buster” kits, nit combs
DNP DNP

For further information, including details of exceptions, see Commissioning Statement 

Oct 2019
Herbal medicines 0 Criterion 1 DNP DNP

GM EUR Complementary and Alternative Therapies policy

Homeopathic medicines 0 Criterion 1 DNP DNP

GM EUR Complementary and Alternative Therapies policy

Hydrocortisone modified-release tablets (Plenadren®) 6 Criterion 2 DNP DNP Nov 2019
Hydroxycarbamide 9 Essential thrombocythaemia, myelofibrosis or polycythaemia with high risk of complications;
Sickle cell disease
Amber

Shared care protocols available for:

  • Hydroxycarbamide for sickle cell disease in adults
  • Hydroxycarbamide for myeloproliferative disorders in adults
ICS
Hydroxychloroquine 10 All indications with a shared care protocol Yes Amber

Shared care protocols available for

  • Hydroxychloroquine for rheumatological conditions
  • Hydroxychloroquine in dermatology

 

MHRA DSU: Hydroxychloroquine, chloroquine: increased risk of cardiovascular events when used with macrolide antibiotics; reminder of psychiatric reactions

ICS
Ibandronic acid 6 Breast cancer. Amber

Shared care protocol: Ibandronate for breast cancer

ICS
Ibandronic acid solution for injection 6 Osteoporosis Yes Red

NICE TA464: Bisphosphonates for treating osteoporosis

ICS Aug 2021
Ibandronic acid tablets 6 Osteoporosis Yes Green

NICE TA464: Bisphosphonates for treating osteoporosis

ICS Aug 2021
Icatibant 3 Angioedema Red NHSE
Idarucizumab 2 Dabigatran reversal agent Yes Red ICS
Idoxuridine in dimethyl sulfoxide (Herpid®) 13 Criterion 1 DNP DNP

No evidence to support use

Iloprost 2 pulmonary hypertension Red NHSE
Imiquimod 5% cream (Aldara®) 8 For superficial basal cell carcinoma Yes Green (specialist advice) NHSE Mar 2019
Imiquimoid cream 13 Genital warts Yes Green (specialist initiation)

Local commissioning arrangements may vary.

ICS
Immunoglobulin (normal) 14 Red NHSE
Immunoglobulin varicella-zoster (VZIG) 14 Normally available through local trust virology departments. No Green

If patient fulfils the Public Health England criteria

Public
health
Inclisiran 2 Primary hypercholesterolaemia or mixed dyslipidaemia Yes Green

NICE TA733: Inclisiran for treating primary hypercholesterolaemia or mixed dyslipidaemia

An NHSE/NHS Digital tool to aid identification of eligible patients is available for some primary care clinical systems (EMIS / SystmOne). A GM Case Record finding tool will be available from Health Innovation Manchester shortly.

ICS Nov 2021
Indigestion and heartburn – mild (OTC/self care) 1 Criterion 3
For example: Peptac, Gaviscon
DNP DNP

For further information, including details of exceptions, see Commissioning Statement 

Oct 2019
Infant colic (OTC/self care) 1 Criterion 3
For example: simeticone or dimeticone liquid, lactase drops (e.g. Colief®)
DNP DNP

For further information, including details of exceptions, see Commissioning Statement 

Oct 2019
Infliximab 10 Biologics/cytokine modulators Yes Red

NHSE-commissioned for paediatric indications where adult TA available and for juvenile arthritis.

ICS
Inositol nicotinate (Hexopal®) 2 Criterion 1 DNP DNP

NICE: TA223

Insect bites and stings (OTC/self care) 13 Criterion 3
For example: antihistamines (oral and topical), calamine lotion, topical corticosteroids
DNP DNP

For further information, including details of exceptions, see Commissioning Statement 

Oct 2019
Insulin and GLP-1 agonist combination 6 Not to be initiated in primary care No Green (specialist initiation) ICS
Insulin aspart biosimilar (Trurapi®) 6 Diabetes mellitus Yes Green ICS Mar 2022
Insulin aspart, fast-acting (Fiasp®) 6 Criterion 3
Only for use in patients with T1DM who are planning a pregnancy or are actively pregnant, and in those who have post-prandial glucose readings >10 mmol at 2 hours.
Grey Green (specialist advice) ICS Nov 2019
Insulin degludec (Tresiba®) 6 Criterion 3
For treatment of type 1 or type 2 diabetes, only for use:
i) If there is particular concern about nocturnal hypoglycaemia despite optimisation of medication regimen
ii) For patients with an unpredictable lifestyle (e.g. shift workers)
iii) For patients who need help from a carer or healthcare professional to administer injections
Grey Green (specialist initiation)

Available in strengths of 100 units/mL and 200 units/mL. Care should be taken to ensure the correct dose is selected for prescribing, dispensing and administration.

NICE NG17: Type 1 diabetes in adults: diagnosis and management

NICE NG28: Type 2 diabetes in adults: management

ICS Feb 2022
Insulin glargine – high strength (Toujeo SoloStar and Toujeo DoubleStar) 6 Criterion 2
May be considered as an option in people with Type 1 or Type 2 diabetes when one or more criteria are met;
i) There is a requirement for flexible timing of injection (+/-3 hours) due to reliance on 3rd party assistance to administer insulin
ii) There is pain as a consequence of high injection volumes of standard-strength insulin (high insulin dose alone is not a reason to switch)
iii) There are unacceptable nocturnal hypoglycaemic episodes despite intensive management on other basal analogues. This must be supported by appropriately recorded data (e.g. glucose monitoring device/blood glucose diaries)
Grey Green (specialist advice)

Toujeo preparations must always be prescribed by brand and device. Toujeo DoubleStar administers two units of insulin per click: there is a risk patients could receive double the dose of insulin if the wrong Toujeo product is dispensed or the Toujeo DoubleStar is used incorrectly by assuming one click is equivalent to one unit of insulin.

FMESG recommendation: Insulin Glargine (Toujeo®) 300 units per ml for type 1 or type 2 diabetes mellitus

ICS Aug 2019
Insulin lispro (Lyumjev) 6 Criterion 2
Only for use in patients with type 1 and type 2 diabetes, including patients using insulin pumps, who have significant post-prandial hyperglycaemia (>10 mmol/L at 2 hours) despite optimised use of conventional rapid acting insulin analogues (Humalog®, Novorapid® or Apridra®).
Grey Green (specialist advice)

Available in strengths of 100 units/mL and 200 units/mL. Care should be taken to ensure the correct dose is selected for prescribing, dispensing and administration.

ICS Aug 2021
Interferon alfa 8 Including interferon alfa-2a and 2b Red NHSE
Interferon beta 8 Multiple Sclerosis Red NHSE
Interferon gamma-1b 8 Red ICS
Iron – all modified release iron preparations 9 Criterion 1 DNP DNP

BNF: No therapeutic advantage and should not be used

Iron chelators (deferasirox, deriprone, desferioxamine) 9 For licensed indications Yes Red NHSE
Iron dextran (Cosmofer®) 9 IV iron Yes Red ICS
Iron sucrose (Venofer®) 9 IV iron Yes Red ICS
Irritant dermatitis – mild (OTC/self care) 13 Criterion 3
For example: emollient creams and lotions, mild corticosteroid creams (e.g. hydrocortisone)
DNP DNP

For further information, including details of exceptions, see Commissioning Statement 

Oct 2019
Isocarboxazid 4 Non-reversible MAOI Red

For new patients only

ICS
Isoniazid 5 Tuberculosis prophylaxis in renal patients considered to be at high risk of developing tuberculosis No Green (specialist initiation)

British Thoracic Society Guidelines

ICS or
NHSE
Feb 2022
Isoniazid 5 Tuberculosis, antibiotic therapy. Yes Green (specialist initiation)

NHSE – drug resistant TB only. Local commissioning arrangements may vary.

NHSE
Isotretinoin (oral) 13 Red status predominantly due to safety concerns in pregnancy. Yes Red

See MHRA Drug Safety Update for safety advice

ICS
IV Formulations 0 Unless part of an agreed local pathway. Red

Commissioner depends on drug and indication

ICS or
NHSE
Ivabradine 2 Heart failure Yes Green (specialist initiation) ICS
Ivacaftor 3 Cystic fibrosis Red NHSE
Ivermectin cream 13 Acne rosacea
Criterion 3
Only for use after more established therapies such as metronidazole gel and azelaic acid have failed.
Grey Green ICS
Ixekizumab 10 Biologics/cytokine modulators Yes Red

NICE TA442 (plaque psoriasis) and NICE TA537 (psoriatic arthritis)

ICS Nov 2018
Kaletra® (lopinavir + ritonavir) 5 HIV medicines. Yes Red NHSE
Ketamine 4 For chronic pain management Red ICS
Ketamine oral solution 4 Specialist use only, for short-term use as an opiate-sparing agent Yes Red ICS Nov 2018
Ketoconazole (for oral administration) 5 Criterion 1 DNP DNP

See MHRA Drug Safety Update for information on safety concerns

Ketoconazole (oral) 6 Cushing's disease Red ICS
Ketorolac eye drops 11 Ocular peri-operative drugs Yes Red ICS
Kivexa® (abacavir + lamivudine) 5 HIV medicines. Yes Red NHSE
Lacosamide 4 Antiepileptic Drugs, as per NICE guidance
Criterion 2
Only for use as an option for third or fourth line use after more established therapies have failed.
Grey Green (specialist advice)

NICE CG137: epilepsies, diagnosis and management

ICS
Lamivudine 5 Antivirals for treatment of hepatitis B Red NHSE
Lamivudine 5 HIV medicines. Yes Red NHSE
Lamivudine/zidovudine (Combivir®) 5 HIV medicines. Red NHSE
Lamotrigine 4 Antiepileptic drugs, as per NICE guidance Yes Green (specialist advice)

NICE CG137: epilepsies, diagnosis and management

ICS
Lanadelumab 3 For prevention of recurrent attacks of hereditary angioedema Red

NICE TA606

NHSE Mar 2020
Lanolin cream (Lansinoh HPA®) 13 Criterion 1 DNP DNP

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

Lanreotide 8 All licensed and unlicensed indications, including acromegaly Red NHSE
Lanthanum 9 Phosphate binding agent in non-dialysis patients Yes Green (specialist advice) ICS
Lanthanum 9 Phosphate binding agent in dialysis patients Yes Green (specialist advice) NHSE Nov 2019
Ledipasvir 5 Hepatitis C Red ICS
Leflunomide 10 DMARDs for rheumatoid arthritis. Yes Amber

Shared care protocol: Leflunomide for rheumatological conditions

ICS
Lenograstim 9 GCSF for neutropenia Yes Red

Will remain subject to separate reimbursement where used for chemo indications (as per 19/20 National Tariff annex A)

ICS
Lesinurad 10 Criterion 2 DNP DNP

NICE TA506

Letermovir 5 Cytomegalovirus disease prevention after a stem cell transplant Yes Red

NICE TA591

NHSE Jan 2020
Letrozole 8 Hormone antagonists for breast cancer Yes Green (specialist advice) ICS
Leuprorelin 6 For all other unlicensed indications (including testosterone castration in sex offenders) and licensed indications without a shared care protocol Yes Red ICS
Leuprorelin 6 Licensed indications with a shared care protocol Yes Amber

Shared care protocol : LHRH analogues for treatment of prostate cancer in adults

ICS
Leuprorelin 6 Transgender use of hormone therapy, as per NHSE shared care arrangements Amber

GnRH analogues for patients aged 17 years or over under Indigo Gender Service

NHSE Gender Dysphoria Clinical Programme

GMC Guidance: Trans healthcare

GMMMG supporting information for GPs

NHSE
Levetiracetam (tablets and oral solution) 4 Antiepileptic drugs, as per NICE guidance Yes Green (specialist advice)

NICE CG137: epilepsies, diagnosis and management

ICS
Levocarnitine 9 Agents for the treatment of metabolic disorders Red NHSE
Levocetirizine (Xyzal®) 3 Criterion 2 DNP DNP

CKS: Allergic Rhinitis

Levofloxacin eye drops 11 Anti-infective eye preparations Yes Red ICS
Levomepromazine 4 Palliative Care Yes Green ICS
Lidocaine plasters 4 For all off-label indications
Criterion 1
DNP DNP

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

Mar 2020
Lidocaine plasters 4 Criterion 1
Only to be used in patients who have been treated in line with NICE CG173 but are still experiencing neuropathic pain associated with previous herpes zoster infection (post-herpetic neuralgia).
Grey Green

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

NICE CG173 (Neuropathic pain in adults: pharmacological management in non-specialist settings)

GMMMG Neuropathic Pain guideline

ICS
Linaclotide 1 IBS-C
Criterion 1
Only for use where optimal or maximum tolerated doses of previous laxatives from different classes have not helped, and constipation has been present for at least 12 months.
Grey Green (specialist initiation) ICS
Linagliptin 6 Gliptins (DPP-4 Inhibitors)
As per NICE guidance.
Yes Green ICS
Linezolid 5 Yes Red ICS
Liothyronine 6 For resistant depression.
There is very limited evidence for thyroid hormones in depression. Where thyroid hormones are necessary due to hypothyroidism, treatment should be initiated with standard levothyroxine. All psychiatric patients currently receiving liothyronine should be reviewed by a consultant NHS psychiatrist.
DNP DNP

NHSE guidance on items not for routine prescribing in primary care

Mar 2020
Liothyronine (T3) 6 Criterion 2
Hypothyroid crisis and short-term use post-thyroid surgery only
Grey Red

For new patients only

ICS
Liothyronine (T3) 6 Criterion 2
Where levothyroxine has failed, endocrinologists treating patients under the NHS may recommend liothyronine in exceptional circumstances for individual patients after a carefully audited trial of at least 3 months duration, in line with BTA guidance Such patients should be reviewed at least annually by their NHS Endocrinologist.
Grey Green (specialist initiation)

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

NICE NG145: Thyroid disease

ICS
Liothyronine combination products and unlicensed thyroid extract products (including Armour Thyroid and ERFA Thyroid) 6 Criterion 2 DNP DNP

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

Liraglutide 6 GLP-1 Agonists
As per NICE guidance
Yes Green ICS
Liraglutide (Saxenda®) 4 For management of overweight and obesity. Must be prescribed by a specialist multidisciplinary tier 3 weight management service. Yes Red

NICE TA664: Liraglutide for managing overweight and obesity

ICS Jan 2021
Lisdexamfetamine 4 ADHD Yes Amber

Shared care protocol: Atomoxetine, dexamfetamine, guanfacine, lisdexamfetamine and methylphenidate for ADHD In Adults

ICS
Lithium 4 Prophylaxis of cluster headache Yes Amber ICS
Lithium 4 Yes Amber

Shared care protocol: Lithium for patients over 18 years old including those aged 65 years and older

ICS
Low molecular weight heparins (dalteparin, enoxaparin, tinzaparin) 2 Thromboprophylaxis:
• Immobile patients or those deemed at high risk of DVT at home or in a care setting, and in whom treatment with warfarin or NOAC is not suitable or not tolerated.
• For travel prophylaxis in high risk patients (travelling time over 8 hrs) and only as per national recommendations. Off-label indication. See NICE CKS
Yes Green (specialist advice)

Licensed indication(s) vary among products. See product information.

ICS
Low molecular weight heparins (dalteparin, enoxaparin, tinzaparin) 2 Ongoing DVT or PE treatment*
• In patients for whom treatment with warfarin or NOAC is not suitable or not tolerated. This includes IVDUs.
• in oncology patients undergoing cancer therapy or with metastatic disease.

*initial 2 weeks of treatment is RED
Yes Green (specialist initiation)

Licensed indication(s) vary among products. Use in patients unable to stabilise on warfarin or NOACs may be off-license, depending on duration of treatment. See product information.

ICS
Low molecular weight heparins (dalteparin, enoxaparin, tinzaparin) 2 Initial DVT and PE treatment - initial 2 weeks or as per locally agreed pathways

Thromboprophylaxis:
• in oncology patients on VTE-inducing therapy
• in pre- and post-surgical patients, where indicated
• in post-natal women
• for high risk patients who have suffered a fracture and are in plaster

As bridging anticoagulant therapy in surgical patients who normally receive warfarin.
Yes Red ICS
Low molecular weight heparins (dalteparin, enoxaparin, tinzaparin) 2 Treatment and prophylaxis of DVT/PE in pregnancy

Includes use by fertility clinics. Patients with mechanical heart valves or on long term warfarin should be discussed with consultant cardiologists/ haematologists before pregnancy.
Yes Red

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

ICS
Loxapine (inhaled) 4 Criterion 1
Agitation associated with schizophrenia and bipolar disorder.
DNP DNP
Lurasidone 4 For the treatment of schizophrenia in adults aged 18 years and older who require antipsychotic treatment, who have previously had a trial of but not responded to aripiprazole, and who fulfil one of the following criteria:
- Patient gained weight on other antipsychotics and there is a need for the BMI to move towards the normal range
- Patients for whom there is a need to avoid weight gain and metabolic adverse effects, e.g. patients with diabetes, cardiovascular disease
- Patients with a prolonged QTc interval
Grey Red

Red pending SCP (in development)

ICS Jul 2018
Lusutrombopag 9 For treatment of thrombocytopenia in people with chronic liver disease needing a planned invasive procedure Yes Red

NICE TA617: Lusutrombopag for treating thrombocytopenia in people with chronic liver disease needing a planned invasive procedure

ICS Jul 2020
Macitentan 2 Pulmonary arterial hypertension Red NHSE
Mannitol inhaler 3 Cystic fibrosis Yes Red NHSE
Maraviroc 5 HIV medicines. Yes Red NHSE
Megestrol 8 Treatment of breast cancer Yes Green (specialist initiation) NHSE Nov 2018
Melatonin 4 For REM sleep behaviour disorder in Parkinson’s disease.
Licensing varies, please check product SPCs.
Yes Green (specialist advice)

NICE NG71: Parkinson’s disease in adults

ICS Oct 2021
Melatonin 4 Management of jet lag DNP DNP

GMMMG Travel Abroad policy

NHSE Jan 2020
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 locality. Yes Green

NICE NG97

GMMMG information for primary care prescribers

ICS
Menotrophin 6 Infertility drugs Red ICS
Mepacrine 5 No Red ICS Jul 2019
Mepolizumab 3 Severe eosinophilic asthma Yes Red

NICE TA471

NHSE Jun 2019
Meprobamate 4 Criterion 1 DNP DNP

BNF: Hypnotics and anxiolytics.

Mercaptamine (cysteamine) 9 Agents for the treatment of metabolic disorders Red NHSE
Mercaptopurine 1 Inflammatory bowel diseases (unlicensed) Yes Amber

Shared care protocol: Azathioprine and 6-mercaptopurine for the treatment of IBD

ICS
Mesalazine 1 Licensed GI Indications Yes Green (specialist advice) ICS
Metformin 6 Unlicensed indications:
- PCOS
- use in pregnancy
Yes Green (specialist initiation) ICS
Metformin 6 Diabetes prevention
Reduction in risk or delay of onset of T2DM in adult, overweight patients with impaired glucose tolerance and/or increased HbA1c who are:
- at high risk of developing overt T2DM and
- still progressing towards T2DM despite implementation of intensive lifestyle change for 3-6 months
Yes Green

Second-line treatment to intensive lifestyle intervention.

NICE public health guidance, PH38

ICS
Methadone 4 Opioid dependence Yes Other

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

ICS
Methotrexate (oral) 10 All indications with a shared care protocol Yes Amber

Shared care protocols available for

  • Oral methotrexate for rheumatological conditions
  • Oral methotrexate for sarcoid in adults
  • Oral methotrexate for IBD in adults
  • Oral methotrexate in dermatology in adults
ICS
Methotrexate (parenteral) 8 Parenteral Formulations.
This includes subcutaneous injection (Metoject®) for: Crohn’s disease, rheumatoid arthritis, psoriasis and psoriatic arthritis; pending homecare arrangements.
Red

Commissioner depends on indication

ICS or
NHSE
Methylphenidate 4 ADHD Yes Amber

Shared care protocol: Atomoxetine, dexamfetamine, guanfacine, lisdexamfetamine and methylphenidate for ADHD In Adults

ICS
Metolazone 2 Heart failure No Green (specialist initiation)

Unlicensed product

ICS
Metyrapone 6 Cushings syndrome Yes Red ICS
Mexiletine 10 Myotonia Yes Red

NICE TA748: Mexiletine for treating the symptoms of myotonia in non-dystrophic myotonic disorders

NHSE Jul 2022
Mexiletine 2 Life-threatening ventricular arrhythmias Yes Red ICS Nov 2022
Micafungin 5 Antifungal Yes Red NHSE
Micronised progesterone (Utrogestan) 6 Prevention of miscarriage Yes Green (specialist initiation)

NICE NG126: Ectopic pregnancy and miscarriage: diagnosis and initial management.

ICS Sep 2022
Midazolam (buccal) 4 Epilepsy Green (specialist initiation) ICS
Midazolam injection 4 Yes Green

GMMMG Palliative Care Pain and Symptom Control Guidelines for Adults

ICS Jan 2020
Midodrine 2 For hypotensive states No Green (specialist initiation) ICS
Mifamurtide 8 Osteosarcoma Red NHSE
Mifepristone 7 Licensed indications Red ICS
Migraine – infrequent (OTC/self care) 4 Criterion 3
For example: analgesics, Migraleve
DNP DNP

For further information, including details of exceptions, see Commissioning Statement 

Oct 2019
Minocycline 13 Criterion 1
For treatment of acne
DNP DNP

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

Oct 2019
Minoxidil foam 10 Criterion 3 DNP DNP

NB: other minoxidil preparations are listed in the Drug Tariff part XVIIIA.

Sep 2022
Moclobemide 4 Reversible MAOI Yes Green (specialist initiation) ICS
Modafinil 4 Parkinson's disease or sleepiness associated with narcolepsy. Yes

To remain RED until supporting information for primary care prescribers approved

ICS
Modafinil 4 Chronic shift work sleep disorder
Criterion 1
DNP DNP Nov 2019
Molludab (potassium hydroxide 5%) topical solution for the treatment of molluscum contagiosum 13 Criterion 1 DNP DNP

CKS: Molluscum contagiosum

Molnupiravir 5 COVID-19 infection Yes Red

NG191: COVID-19 rapid guideline: managing COVID-19

COVID-19 antivirals: reporting to the UK COVID-19 Antivirals Pregnancy Registry

NHSE Mar 2022
Mouth ulcers (OTC/self care) 12 Criterion 3
For example: local anaesthetics gels, hydrocortisone buccal tablets
DNP DNP

For further information, including details of exceptions, see Commissioning Statement 

Oct 2019
Moxisylyte (Opilon®) 2 Criterion 1 DNP DNP

CKS: Raynaud’s Phenomenon

Moxonidine 2 Yes Green (specialist initiation) ICS Jun 2022
Mycophenolate 3 Immunosuppressants (non-transplant indications)

Red for all indications with no SCP
Yes Amber

Shared care protocols available for:

  • Rheumatological conditions in adults
  • Dermatology in adults
ICS
Mycophenolate 8 Post transplant use Amber

To remain amber until repatriation occurs

NHSE
Nabilone 4 Criterion 3.
When used within marketing authorisation, i.e. for control of nausea and vomiting caused by chemotherapeutic agents used in the treatment of cancer, in patients who have failed to respond adequately to conventional antiemetic treatments.
Grey Red

NICE NG144: Cannabis-derived medicinal products 

NHSE Nov 2019
Nabilone 4 Unlicensed indications
Criterion 1
DNP DNP Nov 2019
Naldemidine 1 Only as an option for treating opioid induced constipation in adults whose constipation has not adequately responded to laxatives alone. Patients with opioid induced constipation should have their analgesia reviewed prior to initiating naldemedine Yes Green (specialist initiation)

NICE TA651: Naldemedine for treating opioid-induced constipation

ICS Jan 2021
Nalmefene 4 Alcohol Dependence
As per NICE guidance. Nalmefene should only be prescribed in conjunction with continuous psychosocial support focused on treatment adherence and reducing alcohol consumption provided by a specialist alcohol service.
Yes Green

In conjunction with specialist service

Public
health
Naloxegol for opioid induced constipation 1 Opioid induced constipation Yes Green (specialist advice) ICS
Naltrexone 4 Opioid dependence Yes Amber

Status depends on local commissioning arrangements for substance misuse

Public
health
Naltrexone 4 Alcohol use disorders
Unlicensed use. Recommended in NICE guidance for max 6 months duration. To remain under specialist community alcohol teams.
Yes Red

NICE CG115: Alcohol use disorders

Public
health
Naltrexone-bupropion (Mysimba®▼) 4 Criterion 2 DNP DNP

NICE TA494

Nappy rash (OTC/self care) 13 Criterion 3
For example: barrier preparations (e.g. Sudocrem, Metanium)
DNP DNP

For further information, including details of exceptions, see Commissioning Statement 

Oct 2019
Naproxen & esomeprazole combination product (Vimovo®) 10 Criterion 2 DNP DNP

CKS: Proven GORD

Natalizumab 8 Multiple sclerosis Red NHSE
Nefopam 4 Criterion 3
Only to be used in patients with moderate to severe chronic liver disease who require analgesia stronger than paracetamol and in whom NSAIDS and moderate strength opiates are contraindicated
Grey Green

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

ICS
Nevirapine 5 HIV medicines. Yes Red NHSE
Nintedanib 3 Idiopathic pulmonary fibrosis Red NHSE
Nirmatrelvir / ritonavir (Paxlovid®) 5 COVID-19 infection Yes Red

NG191: COVID-19 rapid guideline: managing COVID-19

COVID-19 antivirals: reporting to the UK COVID-19 Antivirals Pregnancy Registry

NHSE Sep 2022
Nitisinone 9 Agents for the treatment of metabolic disorders Red NHSE
Nortriptyline 4 Prophylaxis of migraine (off-label indication) Yes Green

If intolerant of amitriptyline

ICS Jun 2022
Nusinersen 10 Spinal muscular atrophy Red

NICE TA588

NHSE Jan 2020
Obeticholic acid (Ocaliva) 9 Agents for the treatment of metabolic disorders Red NHSE
Ocrelizumab 8 Relapsing–remitting multiple sclerosis Yes Red

NICE TA533: Ocrelizumab for treating relapsing–remitting multiple sclerosis

NHSE Nov 2018
Ocriplasmin intravitreal injection 11 Ophthalmic indications Yes Red ICS
Octreotide 8 Acromegaly Red NHSE
Octreotide 8 Vomiting in palliative care, enterocutaneous fistula, high output stoma, refractory diarrhoea. Red

See GMMMG commissioning statement

ICS Jan 2019
Odevixibat 1 Progressive familial intrahepatic cholestasis Red

NICE HST17: Odevixibat for treating progressive familial intrahepatic cholestasis

NHSE Jun 2022
Ofatumumab 8 Multiple sclerosis Yes Red

NICE TA699: Ofatumumab for treating relapsing multiple sclerosis

NHSE Oct 2021
Ofloxacin eye drops 11 Anti-infective eye preparations Yes Red ICS
Olanzapine 4 Antipsychotics (oral) Use in dementia patients (unlicensed).
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.
Yes Red

For new patients only.

Local commissioning arrangements may vary and in some localities this remains an amber drug so please check with your locality.

ICS
Olanzapine 4 Atypical antipsychotics (oral)
All other unlicensed indications
Yes Red ICS
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 Yes Amber

Shared care protocol: Oral second generation (atypical) antipsychotics for adults – review due 21/4/18

ICS
Olanzapine pamoate 4 Antipsychotic depot injection (schizophrenia) Red ICS
Omalizumab 3 Allergic asthma prophylaxis. Yes Red NHSE
Omalizumab 3 Severe chronic spontaneous urticaria Yes Red ICS
Omalizumab 3 Chronic rhinosinusitis with nasal polyps DNP DNP

NICE TA678: Omalizumab for treating chronic rhinosinusitis with nasal polyps

Aug 2021
Ombitasvir-
paritaprevir
-ritonavir (Viekirax)
5 Hepatitis C Red NHSE
Omega-3-acid ethyl ester (Omacor®) 2 Criterion 1
Omega-3-fatty acids (e.g. Omacor) should only be used for the treatment of hypertriglyceridaemia under the care of a lipid management specialist, all patients receiving this medication, other than for hypertriglyceridaemia under a lipid management specialist, should have the medication discontinued
Grey Green (specialist initiation)

See NHS England guidance on items not for routine prescribing in primary care
NICE: CG181

ICS
Ondansetron (5-HT3 antagonist anti-emetics) 4 For exceptional use in non oncology patients with chronic emesis following consultant recommendation and where all other options have failed. Yes Green (specialist initiation) ICS
Ondansetron (5-HT3 antagonist anti-emetics) 4 Post op and following chemotherapy. Yes Red ICS
Opicapone 4 Parkinson's disease
Criterion 2
For use only where entacapone (either alone or in combination) is considered not suitable.
Grey Green (specialist initiation) ICS
Oral thrush (OTC/self care) 12 Criterion 3
For example: miconazole oral gel 15g
DNP DNP

For further information, including details of exceptions, see Commissioning Statement 

Oct 2019
Oxcarbazepine 4 Antiepileptic drugs, as per NICE guidance Yes Green (specialist advice)

NICE CG137: epilepsies, diagnosis and management

ICS
Oxycodone 10mg/mL concentrated oral solution 4 For use in palliative care.
Prescribe by brand name. There are significant risks of overdose if a concentrated product is used in error for a normal strength product. See MHRA Patient Safety Alert error report.
No Green (specialist advice)

GMMMG Palliative Care Pain and Symptom Control Guidelines for Adults

ICS Jan 2020
Oxycodone/naloxone MR tablets (Targinact®) 4 Criterion 2 DNP DNP

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

Pain, discomfort and/or fever associated with minor conditions (e.g. aches and sprains, headache, period pain, back pain) (OTC/self care) 4 Criterion 3
For example: analgesics, NSAIDS, topical anti-inflammatory preparations, heat rubs (rubefacients) and cooling products
DNP DNP

For further information, including details of exceptions, see Commissioning Statement 

Oct 2019
Paliperidone 4 Antipsychotics (oral) Use in dementia patients (unlicensed).
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

For new patients only.

Local commissioning arrangements may vary and in some localities this remains an amber drug so please check with your locality.

ICS
Paliperidone 4 Atypical antipsychotics (oral) - Licensed Indications and also unlicensed indications as recommended by NICE guidance (i.e. in psychotic depression or anxiety in patients with bipolar disorder). Amber

Red if no SCP

ICS
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.
Yes Amber

Shared care protocol: Paliperidone long-acting antipsychotic injection

ICS
Palonosetron (5-HT3 antagonists anti-emetics) 4 Post op and following chemotherapy. Red ICS
Pancreatin (Creon®) 1 Yes Green (specialist initiation) ICS
Paracetamol and tramadol combination product (Tramacet®) 4 Criterion 2 DNP DNP

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

Paracetamol mixture / mucilage 4 Criterion 1
Topical use in patients with sore mouth or throat resulting from cancer treatment
DNP DNP Jul 2020
Paracetamol with buclizine and codeine 4 Criterion 1 DNP DNP Jun 2022
Paracetamol with isoetheptene 4 Criterion 1 DNP DNP Jun 2022
Parathyroid hormone 6 Osteoporosis Yes Red ICS
Paravit-CF® 9 Criterion 3
Only for use in patients with cystic fibrosis
Grey Green ICS Sep 2018
Pasireotide 8 Cushing's disease Red NHSE
Patiromer 9 Hyperkalaemia Yes Red

NICE TA623: Patiromer for treating hyperkalaemia

ICS Jan 2021
Peanut protein powder (Palforzia) 3 Criterion 1
Peanut allergy
Only for use in people aged 18 and over if treatment started between the ages of 4 to 17, as per NICE guidance.
Grey Red

NICE TA769: Palforzia for treating peanut allergy in children and young people

ICS Jun 2022
Pegcetacoplan 9 Paroxysmal nocturnal haemoglobinuria Red

NICE TA778: Pegcetacoplan for treating paroxysmal nocturnal haemoglobinuria.

NHSE Sep 2022
Pegfilgrastim 9 GCSF for neutropenia Yes Red

Will remain subject to separate reimbursement where used for chemo indications (as per 19/20 National Tariff annex A)

ICS
Peginterferon alfa 9 Including peginterferon alfa-2a and 2b Red NHSE
Peginterferon beta 9 Including peginterferon beta 1a Red

NICE TA624

NHSE Sep 2020
Pegvisomant 6 Acromegaly Yes Red NHSE
Pen needles 8 mm, 10 mm or 12 mm in length 6 Criterion 1 DNP DNP

Forum for Injection Technique (FIT) guidance

Pen needles costing in excess of £5 per 100 6 Criterion 2
This recommendation does not apply to safety needles
DNP DNP

See cost comparison chart in formulary chapter 6.1.1.3 

Penicillamine 10 DMARDs Amber

Shared care protocol: Penicillamine for the treatment of rheumatoid arthritis or Wilson’s disease in adults

ICS
Penicillin eye drops 11 Anti-infective eye preparations. Unlicensed. Yes Red ICS
Pentosan 7 Criterion 3
For use as a second-line treatment for bladder pain syndrome, where conservative measures have failed.
Grey Green (specialist initiation)

NICE TA610

ICS Jun 2019
Pentoxifylline (Trental®) 2 Criterion 1 DNP DNP

NICE: TA223

Perampanel 4 Antiepileptic drugs, as per NICE guidance
Criterion 2
Only for use as an option for patients with highly refractory epilepsy who are unable to tolerate at least two other more established adjunctive therapies.
Grey Green (specialist advice) ICS
Pergolide 4 Antiparkinson's drugs, as per NICE guidance No Green (specialist advice)

NICE NG71: Parkinson’s disease in adults

ICS
Perindopril arginine 2 Criterion 2 DNP DNP

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

Phenelzine 4 Non-reversible MAOI Yes Red

For new patients only

ICS
Phenobarbital 4 Antiepileptic drugs, as per NICE guidance Yes Green (specialist advice)

NICE CG137: epilepsies, diagnosis and management

ICS
Phenytoin 4 Antiepileptic drugs, as per NICE guidance Yes Green (specialist advice)

NICE CG137: epilepsies, diagnosis and management

ICS
PHMB eye drops (polyhexamethylene biguanide) 11 Anti-infective eye preparations. Unlicensed. Yes Red ICS
Phosex® (calcium acetate) 9 Phosphate binding agents Yes Green (specialist initiation) ICS
Phosphate infusion 9 Yes Red ICS
Pimecrolimus 13 Eczema and psoriasis Yes Green (specialist advice) ICS
Pirfenidone 3 Idiopathic pulmonary fibrosis Yes Red NHSE
Piroxicam oral therapies 10 Criterion 1
Systemic piroxicam should be initiated only by specialists as a second-line treatment for arthritis. Patients who currently take piroxicam should be reassessed at a routine appointment.
Grey Green (specialist initiation)

MHRA Drug Safety Update: Piroxicam: new restrictions, including specialist initiation

ICS
Pitolisant 4 Obstructive sleep apnoea DNP DNP

NICE TA776: Pitolisant hydrochloride for treating excessive daytime sleepiness caused by obstructive sleep apnoea

Sep 2022
Pitolisant 4 Narcolepsy Red ICS
Pollinex® (all forms) 3 Criterion 1.
Only to be prescribed in accordance with local commissioning arrangements.
Grey Red

NHS England Prescribed Specialist Services manual

ICS
Ponesimod 8 Multiple sclerosis Yes Red

NICE TA767: Ponesimod for treating relapsing–remitting multiple sclerosis

NHSE Jun 2022
Posaconazole 5 Yes Red NHSE
Pramipexole 4 Antiparkinson's drugs, as per NICE guidance Yes Green (specialist advice)

NICE NG71: Parkinson’s disease in adults

ICS
Prasugrel 2 Percuataneous coronary intervention Yes Green (specialist initiation) ICS
Praziquantel 5 For hydatid disease Red ICS Mar 2020
Prazosin 4 Criterion 1
Only to be used for licensed indications and not for PTSD
Grey Green (specialist initiation) ICS
Prednisolone EC tablets 6 Criterion 2 DNP DNP

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

Prednisolone for rectal administration 1 Including enemas, foam & suppositories. GI Indications Yes Green (specialist advice) ICS
Prednisone MR tablets (Lodotra®) 6 Criterion 2 DNP DNP
Pregabalin 4 Antiepileptic drugs, as per NICE guidance Yes Green (specialist advice)

NICE CG137: epilepsies, diagnosis and management

ICS
Pregabalin 4 Neuropathic pain Yes Green ICS
Pregabalin 4 Gabapentinoids for management of chronic cough (unlicensed)
Criterion 1
Only for use in patients for whom low dose morphine is unsuitable.
Grey Green (specialist advice) ICS Nov 2019
Primidone 4 Antiepileptic drugs, as per NICE guidance Yes Green (specialist advice)

NICE CG137: epilepsies, diagnosis and management

ICS
Progesterone pessaries 6 When used in treatment of infertility Red ICS
Propamidine isetionate eye drops 11 Minor eye infections (e.g. conjunctivitis and blepharitis) Yes Green

RED if for treatment of acanthamoeba keratitis

ICS
Propylthiouracil 6 Hyperthyroidism. Prescribing to remain within specialist care until patient stable Yes Green (specialist initiation) ICS
Prucalopride 1 Chronic constipation, when other laxatives fail to provide an adequate response Yes Green (specialist initiation) ICS
Pyrazinamide 5 Tuberculosis, antibiotic therapy. Local commissioning arrangements may vary. Yes Green (specialist initiation) ICS
Pyridoxine 9 Oral pyridoxine for prophylaxis and treatment of pyridoxine deficiency secondary to isoniazid or penicillamine therapy Yes Green (specialist advice)

See BNF for recommended doses; discontinue when isoniazid / penicillamine therapy is stopped

ICS Jul 2020
Quetiapine 4 Antipsychotics (Oral) Use in dementia patients (unlicensed).
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.
Yes Red

For new patients only.

Local commissioning arrangements may vary and in some localities this remains an amber drug so please check with your locality.

ICS
Quetiapine 4 Atypical antipsychotics (oral)
All other unlicensed indications
Yes Red ICS
Quetiapine 4 Atypical antipsychotics (oral) - Licensed Indications and unlicensed indications as recommended by NICE guidance (i.e. in psychotic depression or anxiety in bipolar patients).
Red if no SCP
Yes Amber

Shared care protocol: Oral second generation (atypical) antipsychotics for adults – Review due 21/4/18

ICS
Racecadotril 1 Criterion 1 DNP DNP Nov 2019
Raloxifene 8 Chemoprevention in women at moderate and high risk of breast cancer No Green (specialist initiation)

Off-label indication

ICS
Raltegravir 5 HIV medicines. Yes Red NHSE
Ranibizumab intravitreal injection 11 Ophthalmic indications Yes Red ICS
Ranolazine 2 Stable angina Yes Green (specialist advice) ICS
Rasagiline 4 Antiparkinson's drugs, as per NICE guidance Yes Green (specialist advice)

NICE NG71: Parkinson’s disease in adults

ICS
Rasburicase 10 Hyperuricaemia associated with cytotoxic drugs Red NHSE
Ravulizumab 9 Paroxysmal nocturnal haemoglobinuria
Atypical haemulytic uraemic syndrome
No Red

NICE TA698: Ravulizumab for treating paroxysmal nocturnal haemoglobinuria

NICE TA710: Ravulizumab for treating atypical haemolytic uraemic syndrome

NHSE Oct 2021
Remdesivir 5 COVID-19 Yes Red

NG191: COVID-19 rapid guideline: managing COVID-19

COVID-19 antivirals: reporting to the UK COVID-19 Antivirals Pregnancy Registry

NHSE Oct 2021
Reslizumab 3 Severe eosinophilic asthma Yes Red NHSE
RESPeRATE® 2 Criterion 1 DNP DNP

NICE CG127

Ribavirin 5 Hepatitis C and RSV (unlicensed) Yes Red NHSE
Rifabutin 5 Tuberculosis, antibiotic therapy. Yes Green (specialist initiation)

NHSE – drug resistant TB only. Local commissioning arrangements may vary.

NHSE
Rifampicin 5 Tuberculosis, antibiotic therapy. Yes Green (specialist initiation)

NHSE – drug resistant TB only. Local commissioning arrangements may vary.

NHSE
Rifampicin + isoniazid (Rifinah®) 5 Tuberculosis, antibiotic therapy. Yes Green (specialist initiation)

NHSE – drug resistant TB only. Local commissioning arrangements may vary.

NHSE
Rifampicin + isoniazid + pyrazinamide (Rifater®) 5 Tuberculosis, antibiotic therapy. Yes Green (specialist initiation)

NHSE – drug resistant TB only. Local commissioning arrangements may vary.

NHSE
Rifaximin 5 Hepatic encephalopathy Yes Green (specialist initiation) ICS
Rifaximin 1 Traveller's diarrhoea
Criterion 3
DNP DNP

GM Travel abroad policy

Nov 2019
Rilpivirine 5 HIV medicines. Yes Red ICS
Riluzole 4 Motor Neurone Disease Yes Amber

Shared care protocol: Riluzole for Amyotrophic Lateral Sclerosis (a form of Motor Neurone Disease)

ICS
Ringworm/athlete’s foot (OTC/self care) 13 Criterion 3
For example: topical preparations containing miconazole, clotrimazole
DNP DNP

For further information, including details of exceptions, see Commissioning Statement 

Oct 2019
Risankizumab 13 Biologics/cytokine modulators Yes Red ICS Sep 2019
Risdiplam 10 Spinal muscular atrophy Yes Red

NICE TA755: Risdiplam for treating spinal muscular atrophy

NHSE May 2022
Risedronate (once weekly) 6 Osteoporosis Yes Green

NICE TA464: Bisphosphonates for treating osteoporosis

ICS Aug 2021
Risperidone 4 Antipsychotics (oral) Use in dementia patients (licensed only for short-term treatment, up to 6 weeks).
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. 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.
Yes Red

For new patients only.

Local commissioning arrangements may vary and in some localities this remains an amber drug so please check with your locality.

ICS
Risperidone 4 Atypical antipsychotics (oral)
All other unlicensed indications
Yes Red ICS
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 Yes Amber

Shared care protocol: Oral second generation (atypical) antipsychotics for adults – review due 21/4/18

ICS
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.
Yes Amber

Shared care protocol: risperidone long-acting antipsychotic injection

ICS
Ritonavir 5 HIV medicines. Yes Red NHSE
Rituximab 10 Biologics/cytokine modulators Yes Red

NHSE-commissioned for:

  • ANCA-positive vasculitis, cancer & SLE
  • paediatric indications where adult TA available and for juvenile arthritis.
ICS
Rivaroxaban 2 Coronary artery disease & symptomatic peripheral artery disease (CAD/PAD) Yes Green (specialist advice)

See NICE TA607

ICS Mar 2020
Rivaroxaban 2 All licensed indications except CAD/PAD. As per NICE guidance Yes Green ICS
Rivastigmine 4 Dementia, including Alzheimer's disease and dementia with Lewy bodies. See NICE NG97 Yes Green

Local commissioning arrangements may vary and in some localities this is green on specialist advice so please check with your locality.

See information leaflet for prescribers

ICS
Roflumilast (Daxas) 3 COPD Yes Green (specialist initiation)

NICE TA461

ICS Mar 2020
Romosozumab 6 Severe osteoporosis Yes Red

NICE TA791: Romosozumab for treating severe osteoporosis

ICS Nov 2022
Ropinirole 4 Antiparkinson's drugs, as per NICE guidance Yes Green (specialist advice)

NICE NG71: Parkinson’s disease in adults

ICS
Rotigotine 4 Antiparkinson's drugs, as per NICE guidance
For use when more established oral dopamine agonists are ineffective or swallowing problems are present.
Yes Green (specialist advice)

NICE NG71: Parkinson’s disease in adults

ICS
Rubefacients 10 Criterion 1
Topical rubefacient products may contain nicotinate and salicylate compounds, essential oils, capsicum, and camphor. Topical NSAID preps or capsaicin preps are not rubefacients.
DNP DNP

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

Rubefacients are not recommended for the treatment of osteoarthritis.

Rufinamide   4 Lennox Gastaut
Criterion 2
Only for use as an adjunct in patients who have failed treatment with, or are intolerant of, alternative traditional antiepileptic drugs.
Grey Green (specialist initiation) ICS
Sacubitril/valsartan (Entresto) 2 Heart failure Yes Green (specialist initiation) ICS
Safinamide 4 Parkinson's disease Yes Green (specialist advice) ICS
Salbutamol injection 3 Severe or life-threatening acute asthma Red ICS
Sapropterin 9 Agents for the treatment of metabolic disorders Red

NICE TA729: Sapropterin for treating hyperphenylalaninaemia in phenylketonuria

NHSE commissioning policy.

NHSE
Saquinavir 5 HIV medicines. Yes Red NHSE
Sarilumab 10 Biologics/cytokine modulators Yes Red ICS
Saxagliptin 6 Gliptins (DPP-4 Inhibitors).
As per NICE guidance.
Yes Green ICS
Secukinumab 13 Moderate to severe plaque psoriasis Yes Red

See GMMMG High Cost Drugs policies

ICS
Selegiline 4 Antiparkinson's drugs, as per NICE guidance Yes Green (specialist advice)

NICE NG71: Parkinson’s disease in adults

ICS
Selumetinib 8 Plexiform neurofibromas associated with type 1 neurofibromatosis Red

NICE HST20: Selumetinib for treating symptomatic and inoperable plexiform neurofibromas associated with type 1 neurofibromatosis in children aged 3 and over.

NHSE Sep 2022
Semaglutide 6 GLP-1 agonists
As per NICE guidance
Yes Green ICS Feb 2019
Semaglutide (oral, Rybelsus®) 6 For patients requiring a GLP1RA, as per NICE NG28, when an oral option is required. Where a patient expresses a preference for the oral option, prescribers should discuss that there are injectable options in the same class with proven cardiovascular benefit. Yes Green

An agent with proven cardiovascular benefit would be preferable to oral semaglutide in patients with established cardiovascular disease or high cardiovascular risk. This includes all patients with diabetes of 10 years duration plus one other risk factor (e.g. age over 50, hypertension, dyslipidaemia, smoking, or obesity).

ICS Jan 2021
Sevelamer 9 Phosphate binding agent in both dialysis and non-dialysis patients Yes Green (specialist initiation) NHSE
Sildenafil 2 Pulmonary hypertension. Red NHSE
Sildenafil 10 Digital ulcers No Green (specialist initiation)

Off-label indication

ICS
Sildenafil 7 Erectile dysfunction Yes Green ICS
Silk garments (Dermasilk®, Dreamskin®, Skinnies Silk®) 13 Criterion 1 DNP DNP
Simple eye ointment 11 Criterion 3 DNP DNP Nov 2022
Simvastatin/ ezetimibe combination product (Inegy®) 2 Criterion 2 DNP DNP

NICE: TA132

Sirolimus 8 Post transplant use Amber

To remain amber until repatriation occurs

ICS
Sitagliptin 6 Gliptins (DPP-4 Inhibitors).
As per NICE guidance.
Yes Green ICS
Sodium benzoate 9 Agents for the treatment of metabolic disorders Red NHSE
Sodium chloride 5% eye drops 11 Corneal odema (short-term use) Yes Red ICS
Sodium fusidate (oral formulations) 5 No Green (specialist advice)

Green following microbiologist advice.

ICS Jul 2019
Sodium hyaluronate bladder instillations (Cystistat®, medical device) 7 Research context only Red ICS
Sodium oxybate (Xyrem®) 4 Narcolepsy with cataplexy in adult patients.
Criterion 2
Only for use in adult patients who have received and benefited from treatment with sodium oxybate as commissioned by NHS England, i.e. continuing treatment in those >19 years old.
Grey Red ICS
Sodium phenylbutyrate 9 Agents for the treatment of metabolic disorders Red NHSE
Sodium valproate 4 Antiepileptic drugs, as per NICE guidance Yes Green (specialist advice)

NICE CG137: epilepsies, diagnosis and management
Pregnancy Prevention Programme in effect

ICS
Sodium valproate 4 Treatment of manic episodes associated with bipolar disorder Yes Green (specialist initiation)

Pregnancy Prevention Programme in effect

ICS
Sodium zirconium cyclosilicate 9 Hyperkalaemia
NB: RAG status under review
Yes Red

NICE TA599: sodium zirconium cyclosilicate for treating hyperkalaemia

ICS Jul 2020
Solriamfetol 4 Obstructive sleep apnoea DNP DNP

NICE TA777: Solriamfetol for treating excessive daytime sleepiness caused by obstructive sleep apnoea.

Sep 2022
Solriamfetol 4 Excessive daytime sleepiness caused by narcolepsy Yes Red

NICE TA758: Solriamfetol for treating excessive daytime sleepiness caused by narcolepsy

ICS May 2022
Sore throat – acute (OTC/self care) 12 Criterion 3
For example: sore throat lozenges and sprays, analgesics
DNP DNP

For further information, including details of exceptions, see Commissioning Statement 

Oct 2019
Spatone – iron-rich spa water from the mountains of Snowdonia 9 Criterion 1 DNP DNP

No evidence to support use

Spironolactone 6 Transgender use of hormone therapy, as per NHSE shared care arrangements Amber

NHSE Gender Dysphoria Clinical Programme

GMC Guidance: Trans healthcare

GMMMG supporting information for GPs

NHSE
Stanozolol 6 Prophylaxis of hereditary angioedema Red ICS
Stavudine 5 HIV medicines. Yes Red NHSE
Steroid preservative-free eye drops 11 Local inflammation of eye (short-term use) Yes Green (specialist initiation) ICS
Stiripentol 4 Criterion 3
To be used only for the treatment of Dravet Syndrome and SCN1A variant epilepsy.
Grey Red ICS Sep 2019
Stoma appliances deodorants 1 Criterion 3 DNP DNP

Should not be required if pouch is correctly fitted. No odour should be apparent except when bag is emptied or changed.

Streptokinase 2 Fibrinolytics Red ICS
Streptomycin 5 Tuberculosis, antibiotic therapy. Yes Red

NHSE – drug resistant TB only. Local commissioning arrangements may vary.

NHSE
Strontium 6 Osteoporosis Yes Red

For new patients only

ICS
Sucralfate oral suspension 1 For prophylaxis and treatment of gastrointestinal disorders Yes Green (specialist initiation) ICS Dec 2020
Sucroferric oxyhydroxide 9 Phosphate binding agent in both dialysis patients Red NHSE
Sufentanil sublingual tablet system (Zalviso®▼) 4 Criterion 2 DNP DNP
Sulfasalazine 10 DMARDs Yes Amber

Shared care protocols available for:

  • rheumatological conditions in adults
  • inflammatory bowel disease in adults
ICS
Sun protection (except when prescribed within ACBS criteria) (OTC/self care) 13 Criterion 3
For example: sun creams such as Uvistat, Sunsense, etc.
DNP DNP

For further information, including details of exceptions, see Commissioning Statement 

Oct 2019
Sunburn due to excessive sun exposure (OTC/self care) 13 Criterion 3
For example: emollients, oral and topical antihistamines, analgesics
DNP DNP

For further information, including details of exceptions, see Commissioning Statement 

Oct 2019
Sweating – excessive (hyperhidrosis) (OTC/self care) 13 Criterion 3
For example: aluminium chloride 20% solutions (e.g. Driclor, Anhydrol Forte)
DNP DNP

For further information, including details of exceptions, see Commissioning Statement 

Oct 2019
Synovial fluid injections including hyaluronan and sodium hyaluronate injection 10 Criterion 1 DNP DNP

NICE Do not Do recommendation: Do not offer intra-articular hyaluronan injections for the management of osteoarthritis. (CG177)

GM EUR policy: Hyaluronic Acid Injections for Osteoarthritis

Tacrolimus 8 Post transplant use Amber

To remain amber until repatriation occurs

NHSE
Tacrolimus ointment 13 Eczema and psoriasis Yes Green (specialist advice) ICS
Tadalafil 7 Treatment of erectile dysfunction Yes Green ICS Sep 2018
Tadalafil 2 Pulmonary hypertension. Red NHSE
Tadalafil – Once Daily 7 Criterion 2 DNP DNP

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

Tamoxifen 8 Hormone antagonists for treatment of breast cancer, and chemoprevention in women at moderate or high risk. Yes Green (specialist advice) ICS
Tapentadol (Palexia®) 4 Criterion 2
Use of this agent should be restricted to those patients requiring treatment of severe chronic pain which cannot be managed with more established opioid therapies. Prescribers are reminded that GMMMG does not recommend the use of tapentadol over more established opioid therapies 
Grey Green (specialist advice) ICS
Teduglutide 1 Short bowel syndrome Yes Red

NICE TA804: Teduglutide for treating short bowel syndrome

NHSE Nov 2022
Teething/mild toothache (OTC/self care) 4 Criterion 3
For example: teething gels, paracetamol, ibuprofen
DNP DNP

For further information, including details of exceptions, see Commissioning Statement 

Oct 2019
Telaprevir 5 Hepatitis C Yes Red NHSE
Telbivudine 5 Antivirals for treatment of Hepatitis B Red NHSE
Tenecteplase 2 Fibrinolytics Red ICS
Tenofovir 5 Antivirals for treatment of Hepatitis B Red NHSE
Tenofovir 5 HIV medicines. Red NHSE
Terbutaline injection 3 Yes Red ICS Mar 2019
Teriflunomide 8 Multiple sclerosis Red NHSE
Teriparatide 6 Osteoporosis Yes Red ICS
Testosterone (Testogel or Tostran) 6 Criterion 3.
Off-label. For menopausal women with low sexual desire, only when HRT alone is not effective.
Not for use in non-menopausal women.
Grey Green (specialist initiation)

Tostran comes in a multi-dose canister providing measured doses, thus may more easily allow administration of lower doses.

ICS Jul 2020
Testosterone patches (Intrinsa®) 6 Criterion 1 DNP DNP

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

Testosterone products 6 Transgender use of hormone therapy, as per NHSE shared care arrangements Amber

GM shared care protocol: Masculinising hormones for patients aged 17 years or over under Indigo Gender Service

NHSE Gender Dysphoria Clinical Programme

GMC Guidance: Trans healthcare

GMMMG supporting information for GPs

NHSE
Testosterone products 6 Licensed indications in men Yes Green (specialist advice) ICS
Tetrahydrobiopterin 9 Agents for the treatment of metabolic disorders Red NHSE
Therabite 10 Criterion 1 DNP DNP Sep 2018
Threadworms (OTC/self care) 5 Criterion 3
For example: mebendazole
DNP DNP

For further information, including details of exceptions, see Commissioning Statement 

Oct 2019
Tiagabine 4 Antiepileptic drugs, as per NICE guidance No Green (specialist advice)

NICE CG137: epilepsies, diagnosis and management

ICS
Ticagrelor 2 Acute coronary syndromes Yes Green (specialist initiation) ICS
Tildrakizumab 13 Biologics/cytokine modulators Yes Red ICS Jul 2019
Tinzaparin 2 See entries for Low Molecular Weight Heparins (dalteparin, enoxaparin, tinzaparin) Yes Other ICS
Tipranavir 5 HIV medicines. Yes Red ICS
Tizanidine 10 Treatment of spasticity. Yes Green (specialist initiation) ICS
Tobramycin 5 Inhaled or nebulised for cystic fibrosis patients Yes Red NHSE
Tocilizumab 10 Biologics/cytokine modulators Yes Red ICS
Tofacitinib 10 Biologics/cytokine modulators Yes Red ICS
Tolcapone 4 Antiparkinson's drugs, as per NICE guidance Red

NICE NG71: Parkinson’s disease in adults

ICS
Tolvaptan 6 Autosomal dominiant polycystic kidney disease Yes Red

Not routinely commissioned.

NHSE
Tolvaptan 6 SIADH in patients requiring chemotherapy Yes Red

NHSE Clinical commissioning policy

NHSE
Tolvaptan 6 SIADH in patients NOT requiring chemotherapy Yes Red ICS
Topical anaesthetics for premature ejaculation 7 Criterion 1
Licensed and off-label preparations
DNP DNP Jun 2019
Topical gabapentin (unlicensed) 4 Criterion 1 DNP DNP
Topiramate 4 Antiepileptic drugs, as per NICE guidance Yes Green (specialist advice)

NICE CG137: epilepsies, diagnosis and management

ICS
Topiramate 4 Prophylaxis of migraine Yes Green ICS Jun 2022
Topiramate sprinkle capsules 4 Criterion 2
Topiramate tablets are formulary choice and should be used where possible. For those patients unable to swallow tablets 'sprinkle capsules' may be considered. Do not prescribe 'hard capsules' due to high cost.
Grey Other

RAG status depends on indication: see other RAG list entries

Drug Tariff 

ICS
Trandolapril/ verapamil combination product (Tarka®) 2 Criterion 2 DNP DNP

eMIMS: deleted products 2014

Transgender use of hormone therapy 6 Transgender use of hormone therapy, as per NHSE shared care arrangements Amber

NHSE Gender Dysphoria Clinical Programme

GMC Guidance: Trans healthcare

GMMMG supporting information for GPs

NHSE
Tranylcypromine 4 Non-reversible MAOI Red

For new patients only

ICS
Travel sickness (OTC/self care) 4 Criterion 3
For example: cinnarizine, hyoscine, promethazine
DNP DNP

For further information, including details of exceptions, see Commissioning Statement 

Oct 2019
Travel Vaccines (vaccines administered exclusively for the purposes of travel) 14 Criterion 3
Hepatitis B, Japanese Encephalitis, Meningitis ACWY, Yellow Fever, Tick-borne encephalitis, Rabies, BCG Not to be prescribed on the NHS solely for the purposes of travel; only to be prescribed for other indications, as outlined in Immunisation Against Infectious Disease – the Green Book
Grey Green

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

ICS
Triamcinolone intramuscular injection (Kenalog) 3 For treatment of allergic rhinitis Yes Red

Limited place in therapy. See SPS evidence review.

ICS Sep 2019
Trientine 9 Agents for the treatment of metabolic disorders (Wilson's disease) Red

Dihydrochloride or tetrahydrochloride (Cuprion®)

NHSE
Trifluorothymidine eye drops 11 Anti-infective eye preparations Yes Red ICS
Trimipramine 4 Criterion 2 DNP DNP

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

Triptorelin 6 For all other unlicensed indications (including testosterone castration in sex offenders) and licensed indications without a shared care protocol Red ICS
Triptorelin 6 Licensed Indications. Amber

Shared care protocol available for LHRH analogues for treatment of prostate cancer in adults  

ICS
Triptorelin 6 Transgender use of hormone therapy, as per NHSE shared care arrangements Amber

GnRH analogues for patients aged 17 years or over under Indigo Gender Service

NHSE Gender Dysphoria Clinical Programme

GMC Guidance: Trans healthcare

GMMMG supporting information for GPs

NHSE
Trizivir® (abacavir + lamivudine + zidovudine) 5 HIV medicines. Yes Red NHSE
Truvada® (tenofovir + emtricitabine) 5 HIV medicines. Yes Red NHSE
Ulipristal acetate 6 Intermittent treatment of moderate to severe symptoms of uterine fibroids in adult women who have not reached menopause when uterine fibroid embolisation and/or surgical treatment options are not suitable or have failed. Yes Red

MHRA DSU, Ulipristal acetate 5mg (Esmya): further restrictions due to risk of serious liver injury, Feb 2021

NICE NG88: Heavy menstrual bleeding: assessment and management

ICS Oct 2021
Upadacitinib 10 Biologics/cytokine modulators Yes Red

NICE TA665: upadacitinib for treating severe rheumatoid arthritis

NICE TA744: upadacitinib for treating moderate rheumatoid arthritis

ICS Jan 2021
Urokinase 2 Fibrinolytics Red ICS
Ustekinumab 13 Psoriasis Yes Red ICS
Valganciclovir 5 Cytomegalovirus Red NHSE
Valproic acid 4 Treatment of manic episodes associated with bipolar disorder No Green (specialist initiation)

Pregnancy Prevention Programme in effect

ICS
Vancomycin (oral) 5 First line for severe or recurrent C. diff only. To be used on advice of microbiology for other indications. Yes Green ICS
Varicella zoster vaccine (Zostavax) 14 When used outside the national vaccination programme.
In patients who are eligible to receive vaccination outside of the national vaccination programme (e.g. due to receiving chemotherapy or immunosuppressant therapy) it is the responsibility of the specialist service to administer vaccination; there is no route of reimbursement if administered in primary care
Red

Commissioner depends on indication

ICS or
NHSE
Mar 2020
Vedolizumab 1 Ulcerative colitis and Crohn's disease Yes Red ICS
Venlafaxine (doses ≥300mg only) 4 Major depressive episodes. Daily doses ≥300mg to be initiated by a specialist; lower doses suitable for primary care initiation. Regular BP monitoring required - see SPC. Yes Green (specialist initiation)

MHRA Safety Information: SSRIs and SNRIs

ICS
Verapamil 4 Cluster headache - prophylaxis Yes Green (specialist advice)

Off-label indication

ICS
Verteporfin 11 Ophthalmic indications Red ICS
Vigabatrin 4 Antiepileptic drugs, as per NICE guidance No Red

NICE CG137: epilepsies, diagnosis and management

ICS
Vitamin B compound strong 9 Criterion 1
Should only be used on the advice of a dietician for medically diagnosed deficiency, or in secondary care to prevent "re-feeding syndrome" Where a vitamin B compound is indicated, only vitamin B compound strong should be prescribed.
Grey Green (specialist initiation)

NICE CG100

RMOC position statement: oral vitamin B supplementation

ICS
Vitamins, minerals and antioxidants 9 Criterion 3.
When used for supplementation in people who have no clinical indication for use
DNP DNP

NHS Choices: Supplements who needs them

See Commissioning Statement: Conditions for which over the counter items should not be routinely prescribed in primary care

Voractiv® (rifampicin + isoniazid + pyrazinamide + ethambutol) 5 Tuberculosis, antibiotic therapy. Yes Green (specialist initiation)

NHSE – drug resistant TB only. Local commissioning arrangements may vary.

NHSE
Voretigene neparvovec 11 For treating inherited retinal dystrophies caused by RPE65 gene mutations Red

NICE HST11

NHSE Mar 2020
Voriconazole 5 Antifungal Yes Red

For chronic pulmonary aspergillosis (CPA) as per highly specialised criteria only.

NHSE
Vortioxetine 4 Depression
Criterion 1
Only for treatment of major depressive episode in adults whose condition has responded inadequately to 2 antidepressants within the current episode
Grey Green (specialist advice) ICS
VSL#3® and Vivomixx® 1 Criterion 1 DNP DNP

See Commissioning Statement: Conditions for which over the counter items should not be routinely prescribed in primary care

Jun 2019
Warts and verrucae (OTC/self care) 13 Criterion 3
For example: salicylic acid-containing products, glutaraldehyde
DNP DNP

For further information, including details of exceptions, see Commissioning Statement 

Oct 2019
Yohimbine 6 Criterion 1 DNP DNP
Zanamivir solution for infusion 5 Red Mar 2020
Zidovudine 5 HIV medicines. Yes Red NHSE
Zidovudine with lamivudine 5 HIV medicines. Yes Red NHSE
Zoledronic acid 6 IV Bisphosphonate Yes Red ICS
Zonisamide 4 Prophylaxis of migraine (off-label indication) Yes Green (specialist advice)

If intolerant of topiramate

ICS Jun 2022
Zonisamide 4 Antiepileptic drugs, as per NICE guidance Yes Green (specialist advice)

NICE CG137: epilepsies, diagnosis and management

ICS
Zuclopenthixol acetate (Clopixol accuphase) 4 Antipsychotic injection Red
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.
Yes Amber

Shared care protocol: First generation (typical) antipsychotic depots in adults

ICS