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/CCGs. Please check with your individual Trust or CCG.

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.

CCG
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) CCG
Acetazolomide 2 Idiopathic intracranial hypertension (off-label indication) No Green (specialist advice) CCG
Acitretin 13 Red status predominantly due to safety concerns in pregnancy. Yes Red CCG
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.

CCG
Adefovir 5 Antivirals for treatment of Hepatitis B Yes Red NHSE
Aflibercept 11 Ophthalmic indications Yes Red CCG
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

CCG
Albendazole 5 For hydatid disease Red CCG 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

CCG 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) CCG
Alimemazine 3 Criterion 2 DNP DNP

Drug Tariff (Sept 2016)

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

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

As per NICE guidance.

CCG
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 CCG 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 CCG
Alteplase 2 Fibrinolytics Yes Red CCG
Alu-Cap® (aluminium hydroxide) 9 Phosphate binding agents No Green (specialist initiation) CCG
Amantadine 4 Parkinson's disease, as per NICE guidance. Multiple sclerosis (unlicensed). Green (specialist advice)

NICE NG71 – Parkinson’s disease

NICE CG186 – multiple sclerosis

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

SCP in development

CCG
Amiodarone injection 2 For serious cardiac arrhythmias Yes Red CCG
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 CCG.

CCG
Amisulpride 4 Atypical antipsychotics (oral) - unlicensed indications not supported by NICE guidance Yes Red CCG
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

CCG
Anagrelide 8 Essential thrombocythaemia (review after 12 months). Red CCG
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) CCG
Andexanet alfa 2 Reversing anticoagulation from apixaban or rivaroxaban Yes Red

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

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

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

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

NICE TA419 – psoriasis

NICE TA433 – psoriatic arthritis

CCG
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 CCG.

CCG
Aripiprazole 4 Atypical antipsychotics (oral) - unlicensed indications not supported by NICE guidance Yes Red CCG
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

CCG
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 CCG
Asenapine 4 Antipsychotic for use in acute phase only. Red CCG
Atazanavir 5 HIV medicines. Yes Red NHSE
Atomoxetine 4 ADHD Yes Amber

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

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

Drug Tariff

Atosiban 7 Premature labour Red CCG
Atovaquone 5 Pneumocystis pneumonia - only to be used if other treatments e.g. co-trimoxazole have failed or are not suitable No Green (specialist advice) CCG
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

CCG Feb 2021
Azathioprine 3 Idiopathic pulmonary fibrosis Red

N.B. use not recommended by NICE

CCG
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

CCG
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 CCG 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

CCG
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 CCG
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.

CCG
Bempedoic acid 2 Primary hypercholesterolaemia or mixed dyslipidaemia Yes Green (specialist initiation)

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

CCG 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 CCG Sep 2018
Betaine 9 Homocystinuria Red

Highly specialised criteria only

NHSE
Bevacizumab 11 Ophthalmic indications (unlicensed) Red CCG
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

CCG
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 CCG
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.

CCG
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

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

NICE CG137: epilepsies, diagnosis and management

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

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

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

GI specialist initiation

CCG 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

CCG 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.

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

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

CCG
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 CCG
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

CCG
Calcichew 500mg chewable tablets 9 Phosphate binding agents Yes Green (specialist initiation) CCG
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 CCG
Canakinumab 8 Biologics/cytokine modulators; gouty arthritis. Red CCG
Canakinumab 8 Inherited autoinflammatory disorders Red NHSE
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

CCG
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

CCG
Carbamazepine 4 Bipolar disorder Yes Green (specialist initiation) CCG
Carboprost 7 Postpartum haemorrhage Red CCG
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

CCG Jul 2018
Caspofungin 5 Antifungal Yes Red NHSE
Cefuroxime eye drops 11 Ocular peri-operative drugs (unlicensed) Yes Red CCG
Cefuroxime intravitreal injection (Aprokam) 11 Prophylaxis of postoperative endophthalmitis after cataract surgery Yes Red CCG
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

CCG Jan 2020
Cenegermin 11 Criterion 1 DNP DNP

NICE TA532

Nov 2018
Certolizumab pegol 10 Biologics/cytokine modulators Yes Red

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

CCG
Cetrorelix 6 Infertility drugs Red CCG
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
Chlorhexidine eye drops 11 Anti-infective eye preparations Yes Red CCG
Chlorpromazine 4 For palliative care use Green CCG 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 CCG
Ciclosporin 8 Immunosuppressants (non-transplant indications)
Red for all indications with no SCP
Amber

Shared care protocols available for:

– Dermatology
– Rheumatological conditions

CCG
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

CCG
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

CCG
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 CCG Aug 2018
Cladribine 8 Relapsing-remitting multiple sclerosis Yes Red

NICE TA616: cladribine for relapsing-remitting multiple sclerosis

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

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

NICE CG137: epilepsies, diagnosis and management

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

NICE CG137: epilepsies, diagnosis and management

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

NICE NG71: Parkinson’s disease in adults

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

NICE NG71: Parkinson’s disease in adults

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

NICE NG71: Parkinson’s disease in adults

CCG
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) CCG
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

CCG
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

CCG 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) CCG
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) CCG
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

CCG
Collagenase 10 Dupuytren's contracture Yes Red CCG
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
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

CCG
Cyclophosphamide 10 DMARD Red CCG
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

CCG
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 CCG
Dalteparin 2 See entries for low molecular weight heparins (dalteparin, enoxaparin, tinzaparin) Yes Other CCG
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 In type 1 diabetes, as an adjunct to insulin. Does not apply to other indications, including type 2 diabetes. Yes Red

NICE TA597: Dapagliflozin with insulin for T1DM

CCG Jan 2020
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

CCG Mar 2021
Dapoxetine (Priligy®▼) 7 Criterion 1 DNP DNP
Dapsone 5 Leprosy and dermatitis herpetiformis Yes Green (specialist advice) CCG
Daptomycin 5 Red CCG
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

CCG
Demeclocycline 6 Hyponatraemia associated with syndrome of inappropriate antidiuretic hormone (SIADH) Yes Red

For new patients only

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

Shared care protocol: Denosumab for osteoporosis

CCG
Denosumab (XGEVA®) 6 Oncology indication Yes Red CCG
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

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

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

CCG
Dexamfetamine 4 Treatment of narcolepsy Yes Red

Red pending production of a shared care protocol

CCG 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) CCG
Dibotermin alfa 6 Bone morphogenic protein Red

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

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

Alternative to propamidine isetionate 0.1% drops

CCG
Dicycloverine 1 Criterion 2 DNP DNP CCG Jul 2018
Didanosine 5 HIV medicines. Yes Red NHSE
Diethylstilbestrol 8 For prostate cancer. Yes Green (specialist initiation) CCG
Digoxin-specific antibody fragments 2 Digoxin toxicity Red CCG
Diltiazem ointment 1 Anal fissure Yes Green (specialist initiation) CCG
Dimethyl fumarate 8 Multiple sclerosis Red NHSE
Dimethyl fumarate 13 Psoriasis Yes Red CCG
Disodium pamidronate 6 Red CCG
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

CCG
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 CCG Yes Green

NICE NG97

GMMMG information for primary care prescribers

CCG
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

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

See NICE guidance

Regular monitoring required, see SPC.

 

CCG
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 CCG
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

CCG Nov 2018
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 CCG
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.

CCG Nov 2019
Elosulfase alfa 9 Mucopolysaccharidosis type IVa Red NHSE
Eltrombopag 9 Chronic immune (idiopathic) thrombocytopenic purpura Yes Red

NICE TA293

CCG
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 CCG Sep 2018
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 CCG
Entacapone 4 Antiparkinson's drugs, as per NICE guidance Yes Green (specialist advice)

NICE NG71: Parkinson’s disease in adults

CCG
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) CCG 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 CCG
Erenumab 4 Migraine prophylaxis Yes Red

NICE TA682: Erenumab for preventing migraine

CCG 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

CCG
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.

CCG
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

CCG
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 CCG
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) CCG
Exenatide (Byetta® and Bydureon®) 6 GLP-1 Agonists as per NICE guidance Yes Green CCG
Febuxostat 10 For treatment of gout Yes Green (specialist initiation)

NICE TA164

MHRA Drug Safety Update: hypersensitivity 

CCG
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

CCG
Ferric carboxymaltose (Ferinject®) 9 IV iron Yes Red CCG
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 CCG
Fidaxomicin 5 Clostridium difficile - following microbiology advice No Green (specialist advice)

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

CCG
Filgotinib 10 Biologics/cytokine modulators Yes Red

NICE TA676: Filgotinib for treating moderate to severe rheumatoid arthritis

CCG 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)

CCG
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) CCG
Flunarizine 4 Headache Red CCG
Fluocinolone acetonide intravitreal implant 11 Ophthalmic indications Yes Red

NICE TA301 – diabetic macular oedema

NICE TA590 – non-infectious uveitis

CCG
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

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

Red pending production of a shared care protocol

CCG
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

CCG
Follitropin alfa 6 Infertility Drugs Red CCG
Follitropin beta 6 Infertility Drugs Red CCG
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

CCG
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.

CCG
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 CCG
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 CCGs.

CCG
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) CCG
Fremanezumab 4 Migraine prophylaxis Yes Red

NICE TA631: Fremanezumab for preventing migraine

CCG Jan 2021
Fulvestrant 8 Criterion 2 DNP DNP

NICE TA239, TA503

Fumarate esters (Fumaderm®) 13 Psoriasis Red CCG
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

CCG
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) CCG 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 CCG Yes Green

NICE NG97

GMMMG information for primary care prescribers

CCG
Galcanezumab 4 Migraine prophylaxis Yes Red

NICE TA659: Galcanezumab for preventing migraine

CCG Jan 2021
Ganciclovir 5 CMV Red NHSE
Ganciclovir eye gel 11 Herpes simplex infection Yes Green (specialist initiation) CCG
Gemeprost 7 Licensed indications Red CCG
Gentamicin eye drops 11 Anti-infective eye preparations Yes Red CCG
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.

CCG Sep 2019
Golimumab 10 Biologics/cytokine modulators Yes Red

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

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

CCG
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 CCG
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) CCG
Guanfacine 4 ADHD Amber

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

CCG Jan 2020
Guselkumab 13 Biologics/cytokine modulators Yes Red CCG 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 Yes Green CCG Jan 2019
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

CCG
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
CCG
Hydroxychloroquine 10 All indications with a shared care protocol Yes Amber

Shared care protocols available for

  • Hydroxychloroquine for rheumatological conditions
  • Hydroxychloroquine in dermatology
CCG
Ibandronic acid 6 Breast cancer. Amber

Shared care protocol: Ibandronate for breast cancer

CCG
Ibandronic acid solution for injection 6 Osteoporosis Yes Red

NICE TA464: Bisphosphonates for treating osteoporosis

CCG Aug 2021
Ibandronic acid tablets 6 Osteoporosis Yes Green

NICE TA464: Bisphosphonates for treating osteoporosis

CCG Aug 2021
Icatibant 3 Angioedema Red NHSE
Idarucizumab 2 Dabigatran reversal agent Yes Red CCG
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.

CCG
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

Prescribing and implementation tools are in development by Health Innovation Manchester.

The pricing structure agreed by NHSE/I means the NICE approved cost can only be accessed in primary care.

CCG 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.

CCG
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) CCG
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) CCG Nov 2019
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

CCG 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.

CCG 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 CCG
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 CCG
Iron isomaltoside 1000 (Monofer®) 9 IV iron Yes Red CCG
Iron sucrose (Venofer®) 9 IV iron Yes Red CCG
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

CCG
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

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

Commissioner depends on drug and indication

CCG or
NHSE
Ivabradine 2 Heart failure Yes Green (specialist initiation) CCG
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 CCG
Ixekizumab 10 Biologics/cytokine modulators Yes Red

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

CCG Nov 2018
Kaletra® (lopinavir + ritonavir) 5 HIV medicines. Yes Red NHSE
Ketamine 4 For chronic pain management Red CCG
Ketamine oral solution 4 Specialist use only, for short-term use as an opiate-sparing agent Yes Red CCG 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 CCG
Ketorolac eye drops 11 Ocular peri-operative drugs Yes Red CCG
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

CCG
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

CCG
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) CCG
Lanthanum 9 Phosphate binding agent in dialysis patients Yes Green (specialist advice) NHSE Nov 2019
Ledipasvir 5 Hepatitis C Red CCG
Leflunomide 10 DMARDs for rheumatoid arthritis. Yes Amber

Shared care protocol: Leflunomide for rheumatological conditions

CCG
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)

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

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

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

NICE CG137: epilepsies, diagnosis and management

CCG
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 CCG
Levomepromazine 4 Palliative Care Yes Green CCG
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

CCG
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) CCG
Linagliptin 6 Gliptins (DPP-4 Inhibitors)
As per NICE guidance.
Yes Green CCG
Linezolid 5 Yes Red CCG
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

CCG
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

CCG
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 CCG
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

CCG Jan 2021
Lisdexamfetamine 4 ADHD Yes Amber

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

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

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

CCG
Lixisenatide 6 GLP-1 Agonists
As per NICE guidance
Yes Green CCG
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.

CCG
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.

CCG
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 CCG
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 CCGs.

CCG
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)

CCG 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

CCG 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 Management of jet lag DNP DNP

GMMMG Travel Abroad policy

NHSE Jan 2020
Melatonin (Circadin) 4 For REM sleep behaviour disorder in Parkinson’s disease Yes Green (specialist advice)

NICE NG71: Parkinson’s disease in adults

CCG Oct 2021
Memantine 4 Dementia - as per NICE TA 217. Local commissioning arrangements may vary and in some localities this is green on specialist advice so please check with your CCG Yes Green

NICE NG97

GMMMG information for primary care prescribers

CCG
Menotrophin 6 Infertility drugs Red CCG
Mepacrine 5 No Red CCG 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

CCG
Mesalazine 1 Licensed GI Indications Yes Green (specialist advice) CCG
Metformin 6 Unlicensed indications:
- PCOS
- use in pregnancy
Yes Green (specialist initiation) CCG
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

CCG
Methadone 4 Opioid dependence Yes Other

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

CCG
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
CCG
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

CCG or
NHSE
Methylphenidate 4 ADHD Yes Amber

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

CCG
Metolazone 2 Heart failure No Green (specialist initiation)

Unlicensed product

CCG
Metyrapone 6 Cushings syndrome Yes Red CCG
Micafungin 5 Antifungal Yes Red NHSE
Midazolam (buccal) 4 Epilepsy Green (specialist initiation) CCG
Midazolam injection 4 Yes Green

GMMMG Palliative Care Pain and Symptom Control Guidelines for Adults

CCG Jan 2020
Midodrine 2 For hypotensive states No Green (specialist initiation) CCG
Mifamurtide 8 Osteosarcoma Red NHSE
Mifepristone 7 Licensed indications Red CCG
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
Moclobemide 4 Reversible MAOI Yes Green (specialist initiation) CCG
Modafinil 4 Parkinson''s disease or sleepiness associated with narcolepsy. Yes Amber

To remain RED until shared care protocols approved

CCG
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

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

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
CCG
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

CCG 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) CCG
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.

CCG
Nevirapine 5 HIV medicines. Yes Red NHSE
Nintedanib 3 Idiopathic pulmonary fibrosis Red NHSE
Nitisinone 9 Agents for the treatment of metabolic disorders Red NHSE
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 CCG
Octreotide 8 Acromegaly Red NHSE
Octreotide 8 Vomiting in palliative care, enterocutaneous fistula, high output stoma, refractory diarrhoea. Red

See GMMMG commissioning statement

CCG Jan 2019
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 CCG
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 CCG.

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

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

CCG
Olanzapine pamoate 4 Antipsychotic depot injection (Schizophrenia) Red CCG
Omalizumab 3 Allergic asthma prophylaxis. Yes Red NHSE
Omalizumab 3 Severe chronic spontaneous urticaria Yes Red CCG
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

CCG
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) CCG
Ondansetron (5-HT3 antagonist anti-emetics) 4 Post op and following chemotherapy. Yes Red CCG
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) CCG
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

CCG
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

CCG 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 CCG.

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

Red if no SCP

CCG
Paliperidone palmitate 4 Antipsychotic depot injection (schizophrenia)
Only for those patients who are stable and if SCP available; or if under the care of a community psychiatric nurse. In some localities there may be commissioning arrangements in place to permit step down.
Yes Amber

Shared care protocol: Paliperidone long-acting antipsychotic injection

CCG
Palonosetron (5-HT3 antagonists anti-emetics) 4 Post op and following chemotherapy. Red CCG
Pancreatin (Creon®) 1 Yes Green (specialist initiation) CCG
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
Parathyroid hormone 6 Osteoporosis Yes Red CCG
Paravit-CF® 9 Criterion 3
Only for use in patients with cystic fibrosis
Grey Green CCG Sep 2018
Pasireotide 8 Cushing's disease Red NHSE
Patiromer 9 Hyperkalaemia Yes Red

NICE TA623: Patiromer for treating hyperkalaemia

CCG Jan 2021
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)

CCG
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

CCG
Penicillin eye drops 11 Anti-infective eye preparations. Unlicensed. Yes Red CCG
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

CCG 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) CCG
Pergolide 4 Antiparkinson's drugs, as per NICE guidance No Green (specialist advice)

NICE NG71: Parkinson’s disease in adults

CCG
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

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

NICE CG137: epilepsies, diagnosis and management

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

NICE CG137: epilepsies, diagnosis and management

CCG
PHMB eye drops (polyhexamethylene biguanide) 11 Anti-infective eye preparations. Unlicensed. Yes Red CCG
Phosex® (calcium acetate) 9 Phosphate binding agents Yes Green (specialist initiation) CCG
Phosphate infusion 9 Yes Red CCG
Pimecrolimus 13 Eczema and psoriasis Yes Green (specialist advice) CCG
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

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

NHS England Prescribed Specialist Services manual

CCG
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

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

CCG
Pregabalin 4 Neuropathic pain Yes Green CCG
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) CCG Nov 2019
Primidone 4 Antiepileptic drugs, as per NICE guidance Yes Green (specialist advice)

NICE CG137: epilepsies, diagnosis and management

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

RED if for treatment of acanthamoeba keratitis

CCG
Propylthiouracil 6 Hyperthyroidism. Prescribing to remain within specialist care until patient stable Yes Green (specialist initiation) CCG
Prucalopride 1 Chronic constipation, when other laxatives fail to provide an adequate response Yes Green (specialist initiation) CCG
Pyrazinamide 5 Tuberculosis, antibiotic therapy. Local commissioning arrangements may vary. Yes Green (specialist initiation) CCG
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

CCG 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 CCG.

CCG
Quetiapine 4 Atypical antipsychotics (Oral) All other unlicensed indications Yes Red CCG
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

CCG
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

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

NICE NG71: Parkinson’s disease in adults

CCG
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

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) CCG
Rifaximin 1 Traveller's diarrhoea
Criterion 3
DNP DNP

GM Travel abroad policy

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

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

CCG
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 CCG Sep 2019
Risedronate (once weekly) 6 Osteoporosis Yes Green

NICE TA464: Bisphosphonates for treating osteoporosis

CCG 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 CCG.

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

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

CCG
Risperidone (Risperdal Consta®) 4 Antipsychotic depot injection (schizophrenia)
Only for those patients who are stable and if SCP available; or if under the care of a community psychiatric nurse. In some localities there may be commissioning arrangements in place to permit step down.
Yes Amber

Shared care protocol: risperidone Long-acting antipsychotic injection

CCG
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.
CCG
Rivaroxaban 2 Coronary artery disease & symptomatic peripheral artery disease (CAD/PAD) Yes Green (specialist advice)

See NICE TA607

CCG Mar 2020
Rivaroxaban 2 All licensed indications except CAD/PAD. As per NICE guidance Yes Green CCG
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 CCG.

See information leaflet for prescribers

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

NICE TA461

CCG Mar 2020
Ropinirole 4 Antiparkinson's drugs, as per NICE guidance Yes Green (specialist advice)

NICE NG71: Parkinson’s disease in adults

CCG
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

CCG
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) CCG
Sacubitril/valsartan (Entresto) 2 Heart failure Yes Green (specialist initiation) CCG
Safinamide 4 Parkinson's disease Yes Green (specialist advice) CCG
Salbutamol injection 3 Severe or life-threatening acute asthma Red CCG
Sapropterin 9 Agents for the treatment of metabolic disorders Red

NHSE commissioning policy.

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

See GMMMG High Cost Drugs policies

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

NICE NG71: Parkinson’s disease in adults

CCG
Semaglutide 6 GLP-1 Agonists As per NICE guidance Yes Green CCG 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).

CCG 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

CCG
Sildenafil 7 Erectile dysfunction Yes Green CCG
Silk garments (Dermasilk®, Dreamskin®, Skinnies Silk®) 13 Criterion 1 DNP DNP
Simvastatin/ ezetimibe combination product (Inegy®) 2 Criterion 2 DNP DNP

NICE: TA132

Sirolimus 8 Post transplant use Amber

To remain amber until repatriation occurs

CCG
Sitagliptin 6 Gliptins (DPP-4 Inhibitors). As per NICE guidance. Yes Green CCG
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 CCG
Sodium fusidate (oral formulations) 5 No Green (specialist advice)

Green following microbiologist advice.

CCG Jul 2019
Sodium hyaluronate bladder instillations (Cystistat®, medical device) 7 Research context only Red CCG
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 CCG
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

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

Pregnancy Prevention Programme in effect

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

NICE TA599: sodium zirconium cyclosilicate for treating hyperkalaemia

CCG Jul 2020
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 CCG
Stavudine 5 HIV medicines. Yes Red NHSE
Steroid preservative-free eye drops 11 Local inflammation of eye (short-term use) Yes Green (specialist initiation) CCG
Stiripentol 4 Criterion 3
To be used only for the treatment of Dravet Syndrome and SCN1A variant epilepsy.
Grey Red CCG 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 CCG
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

CCG
Sucralfate oral suspension 1 For prophylaxis and treatment of gastrointestinal disorders Yes Green (specialist initiation) CCG 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
CCG
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)

Tacrolimus 8 Post transplant use Amber

To remain amber until repatriation occurs

NHSE
Tacrolimus ointment 13 Eczema and psoriasis Yes Green (specialist advice) CCG
Tadalafil 7 Treatment of erectile dysfunction Yes Green CCG 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) CCG
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) CCG
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 CCG
Tenofovir 5 Antivirals for treatment of Hepatitis B Red NHSE
Tenofovir 5 HIV medicines. Red NHSE
Terbutaline injection 3 Yes Red CCG Mar 2019
Teriflunomide 8 Multiple sclerosis Red NHSE
Teriparatide 6 Osteoporosis Yes Red CCG
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.

CCG 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) CCG
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

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

NICE NG71: Parkinson’s disease in adults

CCG
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 CCG
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

CCG
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 Green (specialist advice)

Drug Tariff 

CCG
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

CCG
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

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

Limited place in therapy. See SPS evidence review.

CCG 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 CCG
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 CCG
Triptorelin 6 Licensed Indications. Amber

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

CCG
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

CCG Oct 2021
Upadacitinib 10 Biologics/cytokine modulators Yes Red

NICE TA665: upadacitinib for treating severe rheumatoid arthritis

CCG Jan 2021
Urokinase 2 Fibrinolytics Red CCG
Ustekinumab 13 Psoriasis Yes Red CCG
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

CCG
Vancomycin (oral) 5 1st line for severe or recurrent C.diff only. To be used on advice of microbiology for other indications. Yes Green CCG
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

CCG or
NHSE
Mar 2020
Vedolizumab 1 Ulcerative colitis and Crohn's disease Yes Red CCG
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

CCG
Verapamil 4 Cluster headache - prophylaxis No Green (specialist advice)

Off-label indication

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

NICE CG137: epilepsies, diagnosis and management

CCG
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

CCG
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) CCG
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 CCG
Zonisamide 4 Antiepileptic drugs, as per NICE guidance Yes Green (specialist advice)

NICE CG137: epilepsies, diagnosis and management

CCG
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

CCG