RAG list
On this page you will find our RED, AMBER, GREEN and DNP/GREY lists for adults (scroll down to see the list). Please check the paediatric RAG list for those drugs/indications which are specific to use in children only.
RAG list entries may be subject to a lag period to allow for implementation by Trusts/localities. Please check with your individual Trust or locality.
If an indication is not stated then the designated status relates to licensed indications only.
Exceptions may arise and it is to be remembered that the RAG list is advisory and cannot be expected to include every possible use of every drug. Primary care prescribers and specialist teams are encouraged to discuss individual patient circumstances and consider where prescribing is best managed taking into account monitoring requirements, drug interactions, frequency of routine patient visits to the specialist and the specialist nature of the condition being treated. Clinical judgement should be used to arrive at the most reasonable outcome. However, if it is not possible to reach a consensus or a specific issue has arisen, please submit an application to the Clinical Reference Group to assess or re-assess the RAG status.
Please read the Guidelines on Defining Red, Amber, Green, DNP, and Grey Status for further detail on assigning a RAG status prior to submitting any queries or applications to GMMMG.
In line with NHS England guidance, GM do not routinely support prescribing for conditions which are self-limiting or amenable to self-care. For further details see GM commissioning statement.
Red Amber Green Classifications
| Classification | Guidance |
|---|---|
| Red | Drugs considered to be specialist medicines and prescribing responsibility for these medicines should normally remain with the consultant or specialist clinician. These drugs should not be initiated or prescribed in primary care. It is recommended that the supply of these specialist medicines should be organised via the hospital pharmacy or specialist service. This may include arranging for supply via a home care company. |
| Amber | Drugs suitable for shared care arrangements under a shared care protocol. |
| Green | Drugs that are suitable for initiation and ongoing prescribing within primary care. |
| Green (specialist initiation) | Drugs that are suitable for ongoing prescribing within primary care following initiation by a specialist service. Little or no monitoring is required. |
| Green (specialist advice) | Drugs that are suitable for initiation by primary care following written or verbal advice from a specialist service. Little or no monitoring is required. |
| DNP | Products which are not recommended for prescribing in any setting. “Do Not Prescribe” status may relate to a specific medicine, or to prescribing for a particular indication. This is in addition to all medicines with a “not NHS” or “Drugs of Low Clinical Value” classification in the BNF, and those medicines with a NICE “Do not do” recommendation. |
| Grey | Products which are not suitable for routine prescribing but suitable for exceptional use in a defined patient population. Prescribers should ensure that more suitable alternatives have been considered and ruled out as not being appropriate before recommending or prescribing a medicine with a GREY list status. In these cases a RAG of RED, AMBER or GREEN will also be assigned to clarify in which care setting prescribing responsibility lies. |
| Other |
Criteria for inclusion on DNP/grey lists:
- Criterion 1: Products of low clinical effectiveness, where there is a lack of robust evidence of clinical effectiveness or there are significant safety concerns.
- Criterion 2: Products which are clinically effective but where more cost-effective products are available, including products that have been subject to excessive price inflation.
- Criterion 3: Products which are clinically effective but, due to the nature of the product or condition being treated, are deemed a low priority for NHS funding.
| Drug (proprietary examples) | BNF chapter | Indications and rationale | Formulary drug | RAG status | Information | Responsible commissioner | Date added |
|---|---|---|---|---|---|---|---|
| Abacavir | 5 | HIV medicines. | Yes | Red | NHSE | ||
| Abatacept | 10 | Biologics/cytokine modulators | Yes | Red | NHSE-commissioned for paediatric indications where adult TA available and for juvenile arthritis. |
ICS | |
| Abiraterone | 8 | Prostate cancer | Red | NHSE | |||
| Abrocitinib | 13 | Biologics/cytokine modulators | Yes | Red | ICS | Jan 2023 | |
| Acamprosate | 4 | Alcohol Dependence | Yes | Green | in conjuction with specialist service |
Public health |
|
| Acetazolamide tablets | 11 | Glaucoma | Yes | Green (specialist initiation) | ICS | ||
| Acetazolomide | 2 | Idiopathic intracranial hypertension (off-label indication) | No | Green (specialist advice) | ICS | ||
| Acitretin | 13 | Red status predominantly due to safety concerns in pregnancy. | Yes | Red | ICS | ||
| Acne – mild (OTC/self care) | 13 | Criterion 3 For example: benzoyl peroxide creams and gels |
DNP | DNP | For further information, including details of exceptions, see Commissioning Statement |
Oct 2019 | |
| Actipatch | 4 | Criterion 1 | DNP | DNP | Jun 2019 | ||
| Adalimumab | 10 | Biologics/cytokine modulators | Yes | Red | NHSE-commissioned for paediatric indications where adult TA available and for juvenile arthritis. |
ICS | |
| Adefovir | 5 | Antivirals for treatment of Hepatitis B | Yes | Red | NHSE | ||
| Aflibercept | 11 | Ophthalmic indications | Yes | Red | ICS | ||
| Agomelatine | 4 | Major depressive disorder. Criterion 1: Only for use in patients with severe depression when other preparations recommended by NICE have been tried and have failed. Not to be prescribed in the elderly. | Grey | Green (specialist initiation) | ICS | ||
| Albendazole | 5 | For hydatid disease | Red | ICS | Mar 2020 | ||
| Alendronate (once weekly) | 6 | Osteoporosis NB: alendronate 70mg weekly is not licensed for use in men, but this is common practice |
Yes | Green | ICS | Aug 2021 | |
| Alendronate plus Vitamin D (Fosavance®) | 6 | Criterion 2 | DNP | DNP | |||
| Alfacalcidol | 9 | Patients with severe renal impairment requiring vitamin D therapy should be prescribed alfacalcidol. It is essential that plasma calcium monitoring is undertaken; frequency of monitoring should be determined by secondary care clinicians and communicated to primary care. | Yes | Green (specialist advice) | ICS | ||
| Alimemazine | 3 | Criterion 2 | DNP | DNP | ICS | ||
| Alipogene tiparvovec | 9 | Agents for the treatment of metabolic disorders | Red | NHSE | |||
| Alirocumab | 2 | Primary hypercholesterolaemia and mixed dyslipidaemia | Yes | Red | ICS | ||
| Aliskiren | 2 | Criterion 2 | DNP | DNP | See NHS England guidance on items not for routine prescribing in primary care |
Oct 2019 | |
| Alitretinoin | 13 | Chronic hand eczema. | Yes | Red | ICS | ||
| Alogliptin | 6 | Gliptins (DPP-4 Inhibitors). | Yes | Green | ICS | ||
| Alpha-1 antitrypsin | 9 | Alpha-1 anti-trypsin deficiency: Type 1 diabetes mellitus in children. | Red | NHSE | |||
| Alpha-1 antitrypsin | 9 | Alpha-1 anti-trypsin deficiency: Emphysema |
Red | ICS | Nov 2019 | ||
| Alprostadil cream | 7 | Second line treatment option for management of erectile dysfunction, as an alternative to intracavernous or intraurethral alprostadil injection. | Yes | Green | ICS | ||
| Alteplase | 2 | Fibrinolytics | Yes | Red | ICS | ||
| Alu-Cap® (aluminium hydroxide) | 9 | Phosphate binding agents | No | Green (specialist initiation) | ICS | ||
| Amantadine | 4 | Parkinson's disease, as per NICE guidance. Multiple sclerosis (unlicensed). | Green (specialist advice) | ICS | |||
| Ambrisentan | 2 | Pulmonary hypertension | Red | NHSE | |||
| Amikacin eye drops | 11 | Anti-infective eye preparations | Yes | Red | ICS | ||
| Aminophylline injection | 3 | Severe or life-threatening acute asthma | Yes | Red | ICS | ||
| Amiodarone | 2 | Yes | Amber | SCP in development |
ICS | ||
| Amiodarone injection | 2 | For serious cardiac arrhythmias | Yes | Red | ICS | ||
| Amisulpride | 4 | Antipsychotics (oral) Use in dementia patients (unlicensed). Prescribing of antipsychotics in dementia is expected to be short term. In exceptional circumstances, longer term prescribing may be required [which would be outside of the product licence for any drugs which have a marketing authorisation for such use]. In these situations, there should still be regular review with the aim of reducing or stopping, and the best methods of ensuring continuity of supply should be negotiated between all healthcare professionals involved in that patient’s care. |
Yes | Red | For new patients only. Local commissioning arrangements may vary and in some localities this remains an amber drug so please check with your locality. |
ICS | |
| Amisulpride | 4 | Atypical antipsychotics (oral) - unlicensed indications not supported by NICE guidance | Yes | Red | ICS | ||
| Amisulpride | 4 | Atypical antipsychotics (oral) - licensed Indications and unlicensed indications as recommended by NICE guidance (i.e. in psychotic depression or anxiety in bipolar patients). Red if no SCP | Yes | Amber | ICS | ||
| Anagrelide | 8 | Essential thrombocythaemia (review after 12 months). | Red | ICS | |||
| Anakinra | 10 | Biologics/cytokine modulators | Red | NHSE | |||
| Anastrozole | 8 | Hormone antagonists for treatment and chemoprevention of breast cancer | Yes | Green (specialist advice) | ICS | ||
| Andexanet alfa | 2 | Reversing anticoagulation from apixaban or rivaroxaban | Yes | Red | NICE TA697: Andexanet alfa for reversing anticoagulation from apixaban or rivaroxaban |
ICS | Oct 2021 |
| Anidulafungin | 5 | Antifungal | Red | NHSE | |||
| Anti-D immunoglobulin | 14 | Antenatal anti-D prophylaxis | Red | ICS | |||
| Anti-thymocyte immunoglobulin | 8 | Immunosuppressants | Red | NHSE | |||
| Antipsychotics | 4 | Challenging behaviours in patients with intellectual disability | Red | ICS | |||
| Apixaban | 2 | Yes | Green | ICS | |||
| Apomorphine injection | 4 | Parkinson's disease. | Yes | Amber | ICS | ||
| Apraclonidine 0.5% eye drops | 11 | Glaucoma | Yes | Green (specialist initiation) | ICS | ||
| Apraclonidine 1% eye drops | 11 | Glaucoma (unlicensed) | Yes | Red | ICS | ||
| Apraclonidine eye drops | 11 | Ocular peri-operative drugs | Yes | Red | ICS | ||
| Apremilast | 13 | Moderate to severe plaque psoriasis and active psoriatric arthritis | Yes | Red | ICS | ||
| Aripiprazole | 4 | Antipsychotics (Oral) Use in dementia patients (unlicensed). Prescribing of antipsychotics in dementia is expected to be short term. In exceptional circumstances, longer term prescribing may be required [which would be outside of the product licence for any drugs which have a marketing authorisation for such use]. In these situations, there should still be regular review with the aim of reducing or stopping, and the best methods of ensuring continuity of supply should be negotiated between all healthcare professionals involved in that patient’s care. |
Yes | Red | For new patients only. Local commissioning arrangements may vary and in some localities this remains an amber drug so please check with your locality. |
ICS | |
| Aripiprazole | 4 | Atypical antipsychotics (oral) - unlicensed indications not supported by NICE guidance | Yes | Red | ICS | ||
| Aripiprazole | 4 | Atypical antipsychotics (oral) - licensed Indications and unlicensed indications as recommended by NICE guidance (i.e. in psychotic depression or anxiety in bipolar patients).
Red if no SCP |
Yes | Amber | ICS | ||
| Aripiprazole | 4 | Antipsychotic depot injection (Schizophrenia) Only for those patients who are stable and if SCP available; or if under the care of a community psychiatric nurse. In some localities there may be commissioning arrangements in place to permit step down. |
Yes | Amber | ICS | ||
| Asenapine | 4 | Antipsychotic for use in acute phase only. | Red | ICS | |||
| Asfotase alfa | 9 | Paediatric-onset hypophosphatasia | No | Red | NICE HST23: Asfotase alfa for treating paediatric-onset hypophosphatasia |
NHSE | Jul 2023 |
| Ataluren | 10 | Duchenne muscular dystrophy | Red | NHSE | Jun 2023 | ||
| Atazanavir | 5 | HIV medicines. | Yes | Red | NHSE | ||
| Atidarsagene autotemcel | 9 | Metachromatic leukodystrophy | Red | NICE HST18: Atidarsagene autotemcel for treating metachromatic leukodystrophy. |
NHSE | Sep 2022 | |
| Atomoxetine | 4 | ADHD | Yes | Amber | Atomoxetine, dexamfetamine, guanfacine, lisdexamfetamine and methylphenidate for ADHD In Adults |
ICS | |
| Atorvastatin 30mg and 60 mg preparations | 2 | Criterion 2 | DNP | DNP | |||
| Atosiban | 7 | Premature labour | Red | ICS | |||
| Atovaquone | 5 | Pneumocystis pneumonia - only to be used if other treatments e.g. co-trimoxazole have failed or are not suitable | No | Green (specialist advice) | ICS | ||
| Atripla® (efavirenz + tenofovir + emtricitabine) | 5 | HIV medicines. | Yes | Red | NHSE | ||
| Atropine 1% eye drops | 1 | Hypersalivation (off-label) | Yes | Green (specialist initiation) | ICS | Jan 2023 | |
| Autologous chondrocyte implantation | 10 | Symptomatic articular cartilage defects of the knee | Red | NHSE | |||
| Avacopan | 10 | No | Red | NHSE | Mar 2023 | ||
| Avatrombopag | 9 | Thrombocytopenia | Yes | Red | ICS | Feb 2021 | |
| Azathioprine | 3 | Idiopathic pulmonary fibrosis | Red | ICS | |||
| Azathioprine | 8 | Immunosuppressants (non-transplant indications) Red for all indications with no SCP |
Yes | Amber | Shared care protocols available for: – IBD in adults |
ICS | |
| Azathioprine | 8 | Post-transplant use | Amber | To remain amber until repatriation occurs |
NHSE | ||
| Azelastine/fluticasone nasal spray (Dymista®) | 12 | Allergic rhinitis Criterion 3 Only for use in patients for whom intranasal antihistamines and glucocorticoids are not sufficient |
Grey | Green | ICS | Jul 2019 | |
| Azithromycin | 5 | Long-term use for chronic respiratory diseases | Green (specialist advice) | ICS | Jul 2023 | ||
| Aztreonam lysine nebules | 5 | Cystic fibrosis | Red | For new patients only |
NHSE | ||
| Baricitinib | 13 | Biologics/cytokine modulators | Yes | Red | NICE TA466: Baricitinib for moderate to severe rheumatoid arthritis NICE TA681: Baricitinib for treating moderate to severe atopic dermatitis |
ICS | |
| Basiliximab | 8 | Immunosuppressants - transplant | Red | NHSE | |||
| Bazedoxifene/conjugated oestrogens (Duavive®) | 6 | Criterion 1 | DNP | DNP | Nov 2019 | ||
| Bee & wasp allergen (Pharmalgen®) | 3 | Allergen immunotherapy | Yes | Red | ICS | ||
| Belatacept | 8 | Immunosuppressants - transplant | Red | NHSE | |||
| Belimumab | 10 | Biologics/cytokine modulators | Yes | Red | NHSE-commissioned for paediatric indications where adult TA available and for juvenile arthritis. |
ICS | |
| Bempedoic acid | 2 | Primary hypercholesterolaemia or mixed dyslipidaemia. To be used together with ezetimibe in line with NICE TA694. | Yes | Green (specialist advice) | ICS | Oct 2021 | |
| Benralizumab | 3 | Severe eosinophilic asthma | Yes | Red | NHSE | Jun 2019 | |
| Benzydamine oral spray and rinse | 12 | For use in palliative care or following radiotherapy | Yes | Green | ICS | Sep 2018 | |
| Berotralstat | 3 | Hereditary angioedema | Red | TA738: Berotralstat for preventing recurrent attacks of hereditary angioedema |
NHSE | Mar 2022 | |
| Betaine | 9 | Homocystinuria | Red | Highly specialised criteria only |
NHSE | ||
| Bevacizumab | 11 | Ophthalmic indications (unlicensed) | Red | ICS | |||
| Bezlotoxumab | 5 | For prevention of Clostridium difficile recurrence in adults at high risk of recurrence | DNP | DNP | Nov 2019 | ||
| Bicalutamide | 8 | Prostate cancer | Yes | Green (specialist initiation) | Note: unlicensed if used in prostate cancer (metastatic) with the aim of retaining sexual function |
ICS | |
| Bimekizumab | 13 | Biologics/cytokine modulators | Yes | Red | NICE TA723: Bimekizumab for treating moderate to severe plaque psoriasis |
ICS | Feb 2022 |
| Bio-oil | 0 | Criterion 1 | DNP | DNP | Cosmetic product with no robust clinical trial data for efficacy. |
||
| BioXtra® toothpaste and mouth rinse | 0 | Criterion 1 | DNP | DNP | What should be considered when choosing or prescribing saliva substitutes? (July 2019) |
||
| Bivalirudin | 2 | Coronary intervention / coronary intervention procedures | Yes | Red | ICS | ||
| Bosentan | 2 | Digital ulcers Pulmonary hypertension |
Red | NHSE | |||
| Botulinum toxin | 0 | For hyperhidrosis, prophylaxis of migraine, and chronic sialorrhoea | Yes | Red | ICS | ||
| Brimonidine gel (Mirvaso®) | 13 | Criterion 3 For treatment of acne rosacea erythema. Only for use in patients with severe erythema, where all other formulary options have failed, and immediately prior to referring for laser treatment. |
Grey | Green | NICE evidence summary: facial erythema of rosacea: brimonidine tartrate gel |
ICS | Nov 2019 |
| Brivaracetam | 4 | Antiepileptic drugs, as per NICE guidance | No | Green (specialist initiation) | ICS | ||
| Brodalumab | 13 | Biologics/cytokine modulators | Yes | Red | ICS | Jul 2018 | |
| Brolucizumab | 11 | Ophthalmic indications | Yes | Red | NICE TA672: wet age-related macular degeneration |
ICS | Mar 2021 |
| Budesonide MR capsules | 1 | Chronic bowel disorders. 3mg modified-release capsules. | Yes | Green (specialist advice) | Counselling on the safe use of steroids should be provided by the specialist |
ICS | Nov 2019 |
| Budesonide orodispersible tablets (Jorveza) | 1 | Only for inducing remission of eosinophilic oesophagitis in adults (treatment duration of up to 12 weeks), as per NICE TA708. | Yes | Green (specialist initiation) | NICE TA708: Budesonide orodispersible tablet for inducing remission of eosinophilic oesophagitis |
ICS | Oct 2021 |
| Buprenorphine (sublingual tablets & oral lyophilisate) | 4 | Opioid dependence Prescribe by brand; due to difference in bioavailability Espranor® is not dose-equivalent with sublingual products. Patient to be maintained on their normal brand of buprenorphine if admitted as an inpatient’ | Yes | Other | Status depends on local commissioning arrangements for substance misuse or if GP with specialist interest. |
ICS | |
| Buprenorphine (sublingual) | 4 | Pain | No | Green (specialist advice) | Licensed indication(s) vary among products. See product information |
ICS | |
| Burns and scalds – mild (OTC/self care) | 13 | Criterion 3 For example: antiseptic creams, analgesics, dressings |
DNP | DNP | For further information, including details of exceptions, see Commissioning Statement |
Oct 2019 | |
| Buserelin | 6 | Infertility drugs | Yes | Red | ICS | ||
| C1-esterase inhibitor | 3 | Angioedema | Red | NHSE | |||
| Cabergoline | 4 | Antiparkinson's drugs, as per NICE guidance |
No | Green (specialist advice) | ICS | ||
| Calcichew 500mg chewable tablets | 9 | Phosphate binding agents | Yes | Green (specialist initiation) | ICS | ||
| Calcium 500mg and colecalciferol 200units (e.g. Calcichew D-3) | 9 | Criterion 1 | DNP | DNP | |||
| Calcium acetate/magnesium carbonate (Osvaren®) | 9 | Phosphate binding agents | Yes | Green (specialist initiation) | NHSE for adult renal dialysis only |
NHSE | |
| Calcium resonium (oral) | 9 | Hyperkalaemia | Yes | Green | ICS | ||
| Canakinumab | 8 | Biologics/cytokine modulators; gouty arthritis. | Red | ICS | |||
| Canakinumab | 8 | Inherited autoinflammatory disorders | Red | NHSE | |||
| Candesartan | 4 | Prophylaxis of migraine (off-label indication) | Yes | Green | ICS | Jun 2022 | |
| Cannabis-derived, cannabis-based and hemp products | 0 | Criterion 1 Excluding nabilone, Epidyolex and Sativex, when used within their marketing authorisations. |
DNP | DNP | 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 | ICS | ||
| Capsaicin patch (Qutenza®) | 4 | All unlicensed indications Criterion 1 |
DNP | DNP | Nov 2019 | ||
| Carbamazepine | 4 | Antiepileptic drugs. As per NICE guidance |
Yes | Green (specialist advice) | ICS | ||
| Carbamazepine | 4 | Bipolar disorder | Yes | Green (specialist initiation) | ICS | ||
| Carboprost | 7 | Postpartum haemorrhage | Red | ICS | |||
| Carglumic acid | 9 | Agents for the treatment of metabolic disorders | Red | NHSE | |||
| Cariprazine | 4 | Criterion 2 For treatment of schizophrenia in adults aged 18 years and older with negative symptoms, where at least 2 generic antipsychotics (such as amisulpride, olanzapine, risperidone, aripiprazole or clozapine) have been trialled and have failed. |
Grey | Red | Red pending SCP (in development) Less is known regarding long term safety and adverse effects of cariprazine versus more established antipsychotics |
ICS | Jul 2018 |
| Casirivimab / imdevimab (Ronapreve®) | 5 | COVID-19 infection | Yes | Red | NG191: COVID-19 rapid guideline: managing COVID-19 COVID-19 antivirals: reporting to the UK COVID-19 Antivirals Pregnancy Registry |
NHSE | Jan 2022 |
| Caspofungin | 5 | Antifungal | Yes | Red | NHSE | ||
| Cefuroxime eye drops | 11 | Ocular peri-operative drugs (unlicensed) | Yes | Red | ICS | ||
| Cefuroxime intravitreal injection (Aprokam) | 11 | Prophylaxis of postoperative endophthalmitis after cataract surgery | Yes | Red | ICS | ||
| Celecoxib (capsules) | 4 | Criterion 1 Only for use in palliative care for relief of cancer pain |
Grey | Green | GMMMG Palliative Care Pain and Symptom Control Guidelines for Adults |
ICS | Jan 2020 |
| Cenegermin | 11 | Criterion 1 | DNP | DNP | Nov 2018 | ||
| Cenobamate | 4 | Focal onset seizures in epilepsy | Yes | Green (specialist initiation) | To be initiated by a tertiary epilepsy service. NICE TA753: Cenobamate for treating focal onset seizures in epilepsy. |
ICS | May 2022 |
| Certolizumab pegol | 10 | Biologics/cytokine modulators | Yes | Red | NHSE-commissioned for paediatric indications where adult TA available and for juvenile arthritis. |
ICS | |
| Cetrorelix | 6 | Infertility drugs | Red | ICS | |||
| Chemotherapy drugs | 8 | All drugs with direct anti-tumour activity, including cytotoxic agents, monoclonal antibodies, immunomodulatory agents (for example thalidomide, lenalidomide) and targeted treatments (for example imatinib, nilotinib and other tyrosine kinase inhibitors) and any other new classes of both parenteral and oral anti-cancer medicines. | Red | NHSE | |||
| Chenodeoxycholic acid | 9 | Agents for the treatment of metabolic disorders | Red | NHSE | |||
| Chloral hydrate | 4 | All indications | No | Red | MHRA DSU: Chloral hydrate, cloral betaine (Welldorm): restriction of paediatric indication, Oct 2021 |
ICS | Jul 2023 |
| Chlordiazepoxide | 4 | Alcohol dependence | Yes | Green | In conjunction with specialist service |
Public health |
Jul 2022 |
| Chlorhexidine eye drops | 11 | Anti-infective eye preparations | Yes | Red | ICS | ||
| Chlorpromazine | 4 | For palliative care use | Green | ICS | Jan 2019 | ||
| Chlorpropamide | 6 | Criterion 1 | DNP | DNP | |||
| Cholic acid | 9 | Agents for the treatment of metabolic disorders | Red | NHSE | |||
| Chorionic gonadotropin | 6 | Infertility drugs | Red | ICS | |||
| Ciclosporin | 8 | Immunosuppressants (non-transplant indications) Red for all indications with no SCP |
Amber | Shared care protocols available for: – Dermatology |
ICS | ||
| Ciclosporin | 8 | Post-transplant use | Amber | To remain amber until repatriation occurs |
NHSE | ||
| Ciclosporin eye drops | 11 | Keratosis due to dry eye disease | Yes | Green (specialist initiation) | Use licensed product only |
ICS | |
| Cidofovir | 5 | CMV | Red | NHSE | |||
| Cilostazol (Pletal®) | 2 | Criterion 2 | DNP | DNP | |||
| Cinacalcet | 9 | Primary hyperparathyroidism | Yes | Amber | Shared care protocol: Cinacalcet for primary hyperparathyroidism |
ICS | |
| Cinacalcet | 9 | Secondary hyperparathyroidism (patient under regular review by secondary care) | Yes | Red | NHSE – hyperparathyroidism – dialysis patients only |
NHSE | |
| Ciprofloxacin ear drops (Cetraxal®) | 12 | Criterion 3. For treatment of otitis externa only in cases of proven Pseudomonas infection |
Grey | Green | ICS | Aug 2018 | |
| Cladribine | 8 | Relapsing-remitting multiple sclerosis | Yes | Red | NICE TA616: cladribine for relapsing-remitting multiple sclerosis MHRA DSU: Cladribine (Mavenclad): new advice to minimise risk of serious liver injury |
NHSE | Jan 2020 |
| Clindamycin 1% / tretinoin 0.025% gel (Treclin®) | 13 | For use in patients with moderate to severe acne for whom other combination products (topical antibacterial and benzoyl peroxide) have failed or are not tolerated, and where a topical antibacterial/retinoid combination is indicated | Yes | Green | ICS | Nov 2019 | |
| Clobazam | 4 | Antiepileptic. As per NICE guidance | Yes | Green (specialist advice) | ICS | ||
| Clomifene | 6 | Infertility Drugs | Yes | Red | ICS | ||
| Clonazepam | 4 | Antiepileptic, as per NICE guidance | Yes | Green (specialist advice) | ICS | ||
| Cloral betaine | 4 | All indications | No | Red | MHRA DSU: Chloral hydrate, cloral betaine (Welldorm): restriction of paediatric indication, Oct 2021 |
ICS | Jul 2023 |
| Clozapine | 4 | Atypical antipsychotics (oral). All unlicensed indications, except selected mental health trust programs | Yes | Red | ICS | ||
| Co-beneldopa | 4 | Antiparkinson's drugs, as per NICE guidance | Yes | Green (specialist advice) | ICS | ||
| Co-careldopa | 4 | Antiparkinson's drugs, as per NICE guidance | Yes | Green (specialist advice) | ICS | ||
| Co-careldopa + entacapone (Stalevo®) | 4 | Antiparkinson's drugs, as per NICE guidance | Yes | Green (specialist advice) | ICS | ||
| Co-careldopa intestinal gel (Duodopa®) | 4 | Criterion 3 | DNP | DNP | NHS England: Clinical commissioning policy: Levodopa-carbidopa intestinal gel |
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| Co-proxamol | 4 | Criterion 1 | DNP | DNP | See NHS England guidance on items not for routine prescribing in primary care |
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| Co-trimoxazole | 5 | No | Green (specialist advice) | ICS | |||
| Cod liver oil capsules | 9 | Criterion 3 | DNP | DNP | |||
| Codeine and aspirin combination product (Co-codaprin®) | 4 | Criterion 2 | DNP | DNP | |||
| Coenzyme Q10 (includes ubiquinone and ubidecarenone) | 9 | Criterion 3 | Grey | Green (specialist initiation) | ICS | ||
| Colchicine | 2 | Treatment of pericarditis pain, as an adjunct to standard therapy. | No | Green (specialist advice) | ICS | Nov 2019 | |
| Cold sores of the lip – infrequent (OTC/self care) | 5 | Criterion 3 For example: aciclovir cream, Zovirax cold sore cream |
DNP | DNP | For further information, including details of exceptions, see Commissioning Statement |
Oct 2019 | |
| Colesevelam | 2 | Criterion 1 CVD prevention in hyperlipidaemia Only when there is no alternative treatment option due to intolerance, or ineligibility for PCSK9i or inclisiran treatment |
Grey | Green (specialist advice) | ICS | May 2023 | |
| Colesevelam hydrochloride | 1 | Diarrhoea associated with bile acid malabsorption (unlicensed indication; must be used 2nd line) | No | Green (specialist advice) | ICS | ||
| Colestyramine | 1 | Bile acid sequestrant - GI indications. | Yes | Green (specialist advice) | ICS | ||
| Colestyramine | 2 | Criterion 1 CVD prevention in hyperlipidaemia Only when there is no alternative treatment option due to intolerance, or ineligibility for PCSK9i or inclisiran treatment |
Grey | Green (specialist advice) | ICS | May 2023 | |
| Colistimethate | 5 | Cystic fibrosis. Inhaled or nebulised | Yes | Red | NHSE | ||
| Colistimethate – nebulised | 5 | For non-cystic fibrosis patients | Yes | Amber | ICS | ||
| Collagenase | 10 | Dupuytren's contracture | Yes | Red | ICS | ||
| Commercial eyelid cleansing preparations | 11 | Criterion 1 | DNP | DNP | There is limited evidence to support the effectiveness of these products over traditional eyelid hygiene methods |
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| Conestat alfa | 3 | Angioedema | Red | NHSE | |||
| Conjunctivitis (bacterial or viral) (OTC/self care) | 11 | Criterion 3 E.g.: Bacterial: Chloramphenicol eye drops or ointment Viral: hypromellose eye drops |
DNP | DNP | For further information, including details of exceptions, see Commissioning Statement |
Oct 2019 | |
| Constipation – infrequent, duration less than 2 weeks (OTC/self care) | 1 | Criterion 3 For example: senna, lactulose, macrogol sachets |
DNP | DNP | For further information, including details of exceptions, see Commissioning Statement |
Oct 2019 | |
| Coughs, colds and nasal congestion (OTC/self care) | 0 | Criterion 3 For example: simple linctus, codeine linctus, pholcodine linctus, pseudoephedrine nasal sprays and oral preparations, xylometazoline and ephedrine nasal sprays and drops |
DNP | DNP | For further information, including details of exceptions, see Commissioning Statement |
Oct 2019 | |
| Crizanlizumab | 9 | Sickle cell disease | Yes | Red | NICE TA743: Crizanlizumab for preventing sickle cell crises in sickle cell disease |
NHSE | Apr 2022 |
| Cyanocobalamin tablets | 9 | Criterion 3 Only for use in those patients who are truly unable to tolerate injections and who are vegan. | Grey | Green | ICS | ||
| Cyclophosphamide | 10 | DMARD | Red | ICS | |||
| Cyproterone | 6 | Prostate cancer & male hypersexuality | Yes | Green (specialist advice) | Licensed indication(s) vary among products. See product information |
ICS | |
| Cyproterone acetate | 6 | Transgender use of hormone therapy, as per NHSE shared care arrangements. | Amber | NHSE Gender Dysphoria Clinical Programme GMC Guidance: Trans healthcare |
NHSE | ||
| Cystitis – mild (2-3 days, women only) (OTC/self care) | 7 | Criterion 3 For example: potassium citrate mixture or sachets, cranberry products |
DNP | DNP | For further information, including details of exceptions, see Commissioning Statement |
Oct 2019 | |
| Dabigatran | 2 | Yes | Green | ICS | |||
| Dalteparin | 2 | See entries for low molecular weight heparins (dalteparin, enoxaparin, tinzaparin) | Yes | Other | ICS | ||
| Dandruff (mild scaling of the scalp without itching) (OTC/self care) | 13 | Criterion 3 For example: shampoos, including antifungal, antiseptic, selenium, and cold tar |
DNP | DNP | For further information, including details of exceptions, see Commissioning Statement |
Oct 2019 | |
| Dapagliflozin | 6 | Chronic kidney disease | Yes | Green | NICE TA775: Dapagliflozin for treating chronic kidney disease |
ICS | Nov 2022 |
| Dapagliflozin | 2 | Treatment of symptomatic chronic heart failure with reduced ejection fraction. | Yes | Green (specialist advice) | NICE TA679: Dapagliflozin for treating chronic heart failure with reduced ejection fraction |
ICS | Mar 2021 |
| Dapoxetine (Priligy®▼) | 7 | Criterion 1 | DNP | DNP | |||
| Dapsone | 5 | Leprosy and dermatitis herpetiformis | Yes | Green (specialist advice) | ICS | ||
| Dapsone | 5 | 50mg & 100mg tablets Second line option for Pneumocystis carinii pneumonia (PCP) prophylaxis, for patients who have an allergy to co-trimoxazole (trimethoprim/ sulfamethoxazole) who are transplant recipients or receiving augmented immunosuppression for autoimmune conditions. |
No | Green (specialist initiation) | ICS | Feb 2022 | |
| Daptomycin | 5 | Red | ICS | ||||
| Darunavir | 5 | HIV medicines. | Yes | Red | NHSE | ||
| Darvadstrocel | 1 | Criterion 1 For complex perianal fistulas in Crohn's disease |
DNP | DNP | Apr 2019 | ||
| Degarelix | 8 | Prostate cancer | Amber | ICS | |||
| Delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD) (Sativex®) | 4 | Moderate to severe spasticity in adults with multiple sclerosis | Yes | Red | NHSE | Jul 2022 | |
| Demeclocycline | 6 | Hyponatraemia associated with syndrome of inappropriate antidiuretic hormone (SIADH) | Yes | Red | For new patients only |
ICS | Oct 2021 |
| Denosumab (Prolia®) | 6 | Osteoporosis in men & women | Yes | Amber | ICS | ||
| Denosumab (XGEVA®) | 6 | Oncology indication | Yes | Red | ICS | ||
| Dental caries – prevention of (OTC/self care) | 9 | Criterion 3 For example: fluoride mouthwashes, toothpastes |
DNP | DNP | For further information, including details of exceptions, see Commissioning Statement |
Oct 2019 | |
| Deoxycholic acid (Belkyra) | 0 | Moderate to severe convexity or fullness associated with submental fat (“double-chin”) in adults. Criterion 1 |
DNP | DNP | Oct 2021 | ||
| Dexamethasone eye drops | 11 | Local inflammation of eye | Yes | Red | Red pending production of a shared care protocol |
ICS | Jan 2020 |
| Dexamethasone intravitreal implant | 11 | Ophthalmic indications | Yes | Red | ICS | ||
| Dexamfetamine | 4 | ADHD | Amber | ICS | |||
| Dexamfetamine | 4 | Treatment of narcolepsy | Yes | Red | Red pending production of a shared care protocol |
ICS | Jul 2019 |
| Diarrhoea (adults) (OTC/self care) | 1 | Criterion 3 For example: loperamide, oral rehydration sachets, kaolin-containing preparations |
DNP | DNP | For further information, including details of exceptions, see Commissioning Statement |
Oct 2019 | |
| Diazoxide | 6 | Chronic hypoglycaemia | No | Green (specialist initiation) | ICS | ||
| Dibotermin alfa | 6 | Bone morphogenic protein | Red | See Commissioning statement: Dibotermin alfa (InductOs) for the treatment of non-union fracture. |
ICS | ||
| Dibrompropamidine eye ointment | 11 | For the treatment of acanthamoeba keratitis | Yes | Red | Alternative to propamidine isetionate 0.1% drops |
ICS | |
| Dicycloverine | 1 | Criterion 2 | DNP | DNP | ICS | Jul 2018 | |
| Didanosine | 5 | HIV medicines. | Yes | Red | NHSE | ||
| Diethylstilbestrol | 8 | For prostate cancer. | Yes | Green (specialist initiation) | ICS | ||
| Digoxin-specific antibody fragments | 2 | Digoxin toxicity | Red | ICS | |||
| Diltiazem ointment | 1 | Anal fissure | Yes | Green (specialist initiation) | ICS | ||
| Dimethyl fumarate | 8 | Multiple sclerosis | Red | NHSE | |||
| Dimethyl fumarate | 13 | Psoriasis | Yes | Red | ICS | ||
| Diroximel fumarate | 8 | Relapsing-remitting multiple sclerosis | Yes | Red | NICE TA794: diroximel fumarate for treating relapsing–remitting multiple sclerosis
|
NHSE | Nov 2022 |
| Disodium pamidronate | 6 | Red | ICS | ||||
| Disulfiram | 4 | Alcohol dependence Patient must be stabilised for >3 months prior to transfer of prescribing. |
Yes | Amber | Disulfiram in the treatment of alcohol dependence – Review due Feb 2018 |
Public health |
|
| Dithranol (licensed preps) | 13 | Psoriasis | Yes | Green (specialist advice) | NB: unlicensed products are RED |
ICS | |
| Diuretics with Potassium | 2 | Criterion 2 | DNP | DNP | |||
| Donepezil | 4 | Dementia - as per NICE TA 217. Local commissioning arrangements may vary and in some localities this is green on specialist advice so please check with your locality. | Yes | Green (specialist advice) | ICS | ||
| Dornase alfa (Pulmozyme®) | 3 | Cystic fibrosis | Yes | Red | NHSE | ||
| Dosulepin (licensed and unlicensed uses) | 4 | Criterion 1 | DNP | DNP | See NHS England guidance on items not for routine prescribing in primary care |
||
| 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 | ICS | Jun 2019 | |
| Dronedarone | 2 | Shared care protocol in development | Yes | Green (specialist initiation) |
Regular monitoring required, see SPC.
|
ICS | |
| Dry eyes/sore tired eyes (OTC/self care) | 11 | Criterion 3 For example: hypromellose eye drops, carbomer 980 gel, hyaluronate eye drops |
DNP | DNP | For further information, including details of exceptions, see Commissioning Statement |
Oct 2019 | |
| Dry skin – mild (OTC/self care) | 13 | Criterion 3 For example: emollient creams and lotions |
DNP | DNP | For further information, including details of exceptions, see Commissioning Statement |
Oct 2019 | |
| Dulaglutide | 6 | GLP-1 Agonists. As per NICE guidance | Yes | Green | ICS | ||
| Duloxetine | 4 | 90mg & 120mg capsules Criterion 2 Only for use where the prescriber believes that patient’s pill burden is high enough to justify the extra cost associated with the use of these formulations. |
Grey | Green | ICS | Feb 2022 | |
| Dupilumab | 3 | For chronic rhinosinusitis with nasal polyps | DNP | DNP | NICE TA648:Dupilumab for treating chronic rhinosinusitis with nasal polyps |
Jan 2021 | |
| Dupilumab | 13 | Atopic dermatitis | Yes | Red | ICS | Nov 2018 | |
| Dupilumab | 3 | Severe asthma with type 2 inflammation | Yes | Red | NICE TA751: Dupilumab for treating severe asthma with type 2 inflammation |
NHSE | May 2022 |
| Dutasteride/tamsulosin (Combodart®) | 7 | Criterion 2 | DNP | DNP | Nov 2019 | ||
| E-voke® electronic inhaler and Voke® inhaler | 4 | Criterion 1 Further data are required evaluating the use of Voke & e-Voke as a stop smoking aid, and comparing their efficacy to established smoking cessation treatments, prior to their use in the GM region. |
DNP | DNP | |||
| Earwax (OTC/self care) | 12 | Criterion 3 For example: olive oil, sodium bicarbonate ear drops |
DNP | DNP | For further information, including details of exceptions, see Commissioning Statement |
Oct 2019 | |
| Edoxaban | 2 | Yes | Green | ICS | |||
| Efavirenz | 5 | HIV medicines. | Yes | Red | NHSE | ||
| Eflornithine | 13 | For facial hirsutism Criterion 3 Only for use in patients with a confirmed diagnosis of an androgenic disease and in whom treatment with co-cyprindiol is ineffective, contraindicated, or considered inappropriate. |
Grey | Green | ICS | Nov 2019 | |
| Elosulfase alfa | 9 | Mucopolysaccharidosis type IVa | Red | NICE HST19: Elosulfase alfa for treating mucopolysaccharidosis type 4A |
NHSE | ||
| Eltrombopag | 9 | Chronic immune (idiopathic) thrombocytopenic purpura | Yes | Red | ICS | ||
| Emollient bath and shower preparations | 13 | Criterion 1 When used for the management of eczema in children or adults. This recommendation does not apply to the use of standard emollients when used in the bath as a soap substitute. |
DNP | DNP | Sep 2018 | ||
| Emollient bath and shower preparations containing antimicrobials | 13 | Criterion 1 Only for short term use in patients with infected eczema. |
Grey | Green | ICS | Sep 2018 | |
| Empagliflozin | 6 | Chronic heart failure with reduced ejection fraction | Yes | Green (specialist advice) | NICE TA773: Empagliflozin for treating chronic heart failure with reduced ejection fraction. |
ICS | Sep 2022 |
| Emtricitabine | 5 | HIV medicines. | Yes | Red | NHSE | ||
| Enfuvirtide | 5 | HIV medicines. | Yes | Red | NHSE | ||
| Enoxaparin | 2 | See entries for low molecular weight heparins (dalteparin, enoxaparin, tinzaparin) | Yes | Other | ICS | ||
| Entacapone | 4 | Antiparkinson's drugs, as per NICE guidance | Yes | Green (specialist advice) | ICS | ||
| Entecavir | 5 | Antivirals for treatment of hepatitis B | Red | NHSE | |||
| Epidyolex | 4 | Criterion 3 For children and adults with rare, severe forms of drug-resistant epilepsy. |
Grey | Red | NHSE | Mar 2019 | |
| Eplerenone | 2 | Heart failure | Green (specialist initiation) | ICS | Nov 2019 | ||
| Epoetins | 9 | Including epoetin alfa, epoetin beta, epoetin zeta, darbepoetin, methoxy polyethylene glycol-epoetin beta (Mircera) | Red | NHSE – renal dialysis only |
NHSE | ||
| Epoprostenol | 2 | Pulmonary hypertension | Red | NHSE | |||
| Epotermin alfa (Osigraft®) | 6 | Bone morphogenic protein | Red | ICS | |||
| Eptinezumab | 4 | Migraine prophylaxis | Yes | Red | ICS | Aug 2023 | |
| Erenumab | 4 | Migraine prophylaxis | Yes | Red | ICS | Aug 2021 | |
| Ergotamine containing products (Migril) | 4 | Criterion 1 | DNP | DNP | NICE “do not do”: Do not offer ergots or opioids for the acute treatment of migraine |
||
| Esketamine nasal spray | 4 | Treatment-resistant depression | DNP | DNP | Apr 2023 | ||
| Eslicarbazepine | 4 | Antiepileptic drugs, as per NICE guidance | No | Green (specialist advice) | ICS | ||
| Estradiol (oestradiol) | 6 | Transgender use of hormone therapy, as per NHSE shared care arrangements | Amber |
NHSE Gender Dysphoria Clinical Programme |
NHSE | ||
| Etanercept | 10 | Biologics/cytokine modulators | Yes | Red | NHSE-commissioned for paediatric indications where adult TA available and for juvenile arthritis. |
ICS | |
| Ethambutol | 5 | Tuberculosis, antibiotic therapy. | Yes | Green (specialist initiation) | NHSE – drug resistant TB only. Local commissioning arrangements may vary. |
NHSE | |
| Ethosuximide | 4 | Antiepileptic drugs, as per NICE guidance | No | Green (specialist advice) | ICS | ||
| Etravirine | 5 | HIV medicines. | Yes | Red | NHSE | ||
| Eviplera® (emtricitabine + rilpivirine + tenofovir) | 5 | HIV medicines. | Yes | Red | NHSE | ||
| Evolocumab | 2 | Primary hypercholesterolaemia and mixed dyslipidaemia | Yes | Red | ICS | ||
| Excessive sweating (hyperhidrosis) (OTC/self care) | 13 | For example: aluminium chloride 20% solutions (e.g. Driclor, Anhydrol Forte) |
DNP | DNP | For further information, including details of exceptions, see Commissioning Statement |
Oct 2019 | |
| Exemestane | 8 | Hormone antagonists for breast cancer | Yes | Green (specialist advice) | ICS | ||
| Exenatide (Byetta® and Bydureon®) | 6 | GLP-1 Agonists as per NICE guidance | Yes | Green | ICS | ||
| Famotidine | 1 | H2 receptor antagonist | Yes | Green | ICS | Dec 2022 | |
| Faricimab | 11 | Ophthalmic indiciations | Yes | Red | ICS | Nov 2022 | |
| Febuxostat | 10 | For treatment of gout | Yes | Green (specialist initiation) | ICS | ||
| Fenfluramine | 4 | Seizures associated with Dravet syndrome | Yes | Red | NICE TA808: Fenfluramine for treating seizures associated with Dravet syndrome |
NHSE | Dec 2022 |
| 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 |
ICS | |
| Ferric carboxymaltose (Ferinject®) | 9 | IV iron | Yes | Red | ICS | ||
| Ferric derisomaltose (Monofer®) | 9 | IV iron | Yes | Red | Previously known as iron isomaltoside |
ICS | |
| Ferric maltol | 9 | Criterion 2 For treatment of iron deficiency anaemia in patients with intolerance to, or treatment failure with, two oral iron supplements. |
Grey | Green | ICS | ||
| Fidaxomicin | 5 | Clostridium difficile - following microbiology advice | No | Green (specialist advice) | ICS | ||
| Filgotinib | 10 | Biologics/cytokine modulators | Yes | Red | NICE TA676: moderate to severe rheumatoid arthritis NICE TA792: moderately to severely active ulcerative colitis |
ICS | Mar 2021 |
| Filgrastim | 9 | GCSF for neutropenia | Yes | Red | Will remain subject to separate reimbursement where used for chemo indications (as per 19/20 National Tariff annex A) |
ICS | |
| Finasteride | 6 | Transgender use of hormone therapy, as per NHSE shared care arrangements | Amber | NHSE Gender Dysphoria Clinical Programme |
NHSE | ||
| Finerenone | 2 | CKD in type 2 diabetes | Yes | Green (specialist advice) | ICS | Aug 2023 | |
| Fingolimod | 8 | Multiple sclerosis | Red | NHSE | |||
| Flecainide | 2 | Yes | Green (specialist initiation) | ICS | |||
| Flunarizine | 4 | Headache Not licensed in the UK |
Yes | Red | ICS | ||
| Fluocinolone acetonide intravitreal implant | 11 | Ophthalmic indications | Yes | Red | NICE TA301 – diabetic macular oedema NICE TA590 – non-infectious uveitis |
ICS | |
| Fluoride toothpaste 5,000ppm (e.g. Duraphat®) | 9 | Criterion 3 For patients at risk of caries secondary to treatment for head and neck cancers or reduced salivary flow rate secondary to surgery. To be continued for as long as natural teeth remain. |
Grey | Green (specialist advice) | The prescribing of fluoride mouthwashes and toothpastes for other indications should be by dental prescription only, and in line with GMMMG Commissioning Statement: Conditions for which over the counter items should not routinely be prescribed in primary care |
ICS | |
| Fluorometholone eye drops | 11 | Local inflammation of eye (short-term use) | Yes | Red | Red pending production of a shared care protocol |
ICS | |
| Flupentixol decanoate | 4 | Antipsychotic depot injection (Schizophrenia) Only for those patients who are stable and if SCP available; or if under the care of a community psychiatric nurse. In some localities there may be commissioning arrangements in place to permit step down. | Yes | Amber | Shared care protocol: First generation (typical) antipsychotic depots in adults |
ICS | |
| Follitropin alfa | 6 | Infertility Drugs | Red | ICS | |||
| Follitropin beta | 6 | Infertility Drugs | Red | ICS | |||
| Fondaparinux | 2 | Thromboprophylaxis: • Immobile patients or those deemed at high risk of DVT at home or in a care setting, and in whom treatment with warfarin or NOAC is not suitable or not tolerated. • For travel prophylaxis in high risk patients (travelling time over 8 hrs) and only as per national recommendations. Off-label indication. See NICE CKS |
Yes | Green (specialist advice) | Off-label indication. Licensed if immobilised due to acute illness |
ICS | |
| Fondaparinux | 2 | Ongoing DVT or PE treatment* • In patients for whom treatment with warfarin or NOAC is not suitable or not tolerated. This includes IVDUs. • in oncology patients undergoing cancer therapy or with metastatic disease. *initial 2 weeks of treatment is RED |
Yes | Green (specialist initiation) | Use in patients unable to stabilise on warfarin or NOACs may be off-license, depending on duration of treatment. See product information. |
ICS | |
| Fondaparinux | 2 | Initial DVT and PE treatment - initial 2 weeks or as per locally agreed pathways Thromboprophylaxis: • in oncology patients on VTE-inducing therapy • in post-surgical patients, where indicated As bridging anticoagulant therapy in surgical patients who normally receive warfarin. For people with unstable angina or NSTEMI who do not have a high bleeding risk, unless they are undergoing immediate coronary angiography. See NICE NG185: Acute coronary syndromes |
Yes | Red | ICS | ||
| Fondaparinux | 2 | Treatment and prophylaxis of DVT/PE in pregnancy Includes use by fertility clinics. Patients with mechanical heart valves or on long term warfarin should be discussed with consultant cardiologists/ haematologists before pregnancy. |
Yes | Red | Local commissioning arrangements may vary and may be amber if local agreement in some localities. |
ICS | |
| Fosamprenavir | 5 | HIV medicines. | Yes | Red | NHSE | ||
| Fosfomycin (oral) | 5 | Uncomplicated UTI caused by multiple antibacterial organisms on advice of microbiologist | No | Green | ICS | ||
| Fostamatinib | 9 | Refractory chronic immune thrombocytopenia | Yes | Red | NICE TA835: Fostamatinib for treating refractory chronic immune thrombocytopenia |
ICS | Feb 2023 |
| Fremanezumab | 4 | Migraine prophylaxis | Yes | Red | ICS | Jan 2021 | |
| Fumarate esters (Fumaderm®) | 13 | Psoriasis | Red | ICS | |||
| Fungal nail infections (OTC/self care) | 5 | Criterion 3 For example: nail lacquers, paints, and softening products |
DNP | DNP | For further information, including details of exceptions, see Commissioning Statement |
Oct 2019 | |
| Gabapentin | 4 | Antiepileptic drugs, as per NICE guidance | Yes | Green (specialist advice) | ICS | ||
| Gabapentin | 4 | Gabapentinoids for management of chronic cough (unlicensed) Criterion 1 Only for use in patients for whom low dose morphine is unsuitable. |
Grey | Green (specialist advice) | ICS | Nov 2019 | |
| Galantamine | 4 | Dementia - as per NICE TA 217. Local commissioning arrangements may vary and in some localities this is green on specialist advice so please check with your locality | Yes | Green (specialist advice) | ICS | ||
| Galcanezumab | 4 | Migraine prophylaxis | Yes | Red | ICS | Jan 2021 | |
| Ganciclovir | 5 | CMV | Red | NHSE | |||
| Ganciclovir eye gel | 11 | Herpes simplex infection | Yes | Green (specialist initiation) | ICS | ||
| Gemeprost | 7 | Licensed indications | Red | ICS | |||
| Gentamicin eye drops | 11 | Anti-infective eye preparations | Yes | Red | ICS | ||
| Givosiran | 9 | Acute hepatic porphyria | Red | NHSE | |||
| Glatiramer acetate | 8 | Multiple sclerosis | Red | NHSE | |||
| Glecaprevir-pibrentasvir | 5 | Hepatitis C | Yes | Red | NHSE | ||
| Gliclazide MR (Diamicron MR®) | 6 | Criterion 2 | DNP | DNP | BNF note: equivalent therapeutic effect to standard prep |
||
| Glucosamine (+/- chondroiton) | 10 | Criterion 1 | DNP | DNP | See NHS England guidance on items not for routine prescribing in primary care |
||
| Glycerol phenylbutyrate | 9 | Agents for the treatment of metabolic disorders | Red | NHSE | |||
| Glycopyrronium oral solution | 1 | For treatment of severe sialorrhoea. Prescribers should choose the product with the lowest acquisition cost and taking into account shelf-life of the product where appropriate. |
No | Green (specialist initiation) | Prescribers should maintain patients on the same product due to differences in bioavailability between products and the potential for error. Care should be taken if switching between oral solutions and dosing adjusted accordingly. |
ICS | Sep 2019 |
| Golimumab | 10 | Biologics/cytokine modulators | Yes | Red | NHSE-commissioned for paediatric indications where adult TA available and for juvenile arthritis. |
ICS | |
| Goserelin | 6 | For all other unlicensed indications (including testosterone castration in sex offenders) and licensed indications without a shared care protocol | Yes | Red | ICS | ||
| Goserelin | 6 | Licensed indications with a shared care protocol | Yes | Amber | Shared care protocols available for: – Goserelin for breast cancer in adults |
ICS | |
| Goserelin | 6 | Transgender use of hormone therapy, as per NHSE shared care arrangements | Amber | GnRH analogues for patients aged 17 years or over under Indigo Gender Service NHSE Gender Dysphoria Clinical Programme |
NHSE | ||
| Granisetron (5-HT3 antagonist anti-emetics) | 4 | Post op and following chemotherapy. | Yes | Red | ICS | ||
| Grass Pollen Extract (Grazax®) | 3 | Criterion 2 | DNP | DNP | |||
| Growth hormone (somatropin) | 6 | Except in proven primary and secondary hypopituitarism | Yes | Red | NHSE | ||
| Growth hormone (somatropin) | 6 | For primary and secondary hypopituitarism | Yes | Green (specialist initiation) | ICS | ||
| Guanfacine | 4 | ADHD | Amber | ICS | Jan 2020 | ||
| Guselkumab | 13 | Biologics/cytokine modulators | Yes | Red | ICS | Jul 2018 | |
| Haem arginate (human hemin) |
9 | Agents for the treatment of metabolic disorders | Red | NHSE | |||
| Haemorrhoids – minor (OTC/self care) | 1 | Criterion 3 For example: Anusol or Anusol HC cream, ointment or suppositories |
DNP | DNP | For further information, including details of exceptions, see Commissioning Statement |
Oct 2019 | |
| Haloperidol | 4 | For palliative care use See separate entry for 500 microgram tablets | Yes | Green | ICS | Jan 2019 | |
| Haloperidol 500 microgram tablets | 4 | Criterion 2 | DNP | DNP | Mar 2022 | ||
| Haloperidol decanoate | 4 | Antipsychotic depot injection (schizophrenia). Only for those patients who are stable and if SCP available; or if under the care of a community psychiatric nurse. In some localities there may be commissioning arrangements in place to permit step down. |
Yes | Amber | Shared care protocol: First generation (typical) antipsychotic depots in adults |
ICS | |
| Hay fever/seasonal rhinitis – mild to moderate (OTC/self care) | 3 | Criterion 3 For example: antihistamines, nasal sprays, eye drops |
DNP | DNP | For further information, including details of exceptions, see Commissioning Statement |
Oct 2019 | |
| Head lice (OTC/self care) | 13 | Criterion 3 For example: dimeticone, malathion, cyclomethicone, permethrin shampoos and liquids, “Bug buster” kits, nit combs |
DNP | DNP | For further information, including details of exceptions, see Commissioning Statement |
Oct 2019 | |
| Herbal medicines | 0 | Criterion 1 | DNP | DNP | |||
| Homeopathic medicines | 0 | Criterion 1 | DNP | DNP | |||
| Hydrocortisone modified-release capsules (Efmody) | 6 | For use only for patients who are not well controlled on standard release hydrocortisone when there is:
|
Yes | Green (specialist initiation) | ICS | Aug 2023 | |
| 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:
|
ICS | ||
| Hydroxychloroquine | 10 | All indications with a shared care protocol | Yes | Amber | Shared care protocols available for
|
ICS | |
| Hyoscine | 1 | Hypersalivation | Yes | Green (specialist initiation) | ICS | Jan 2023 | |
| Ibandronic acid | 6 | Breast cancer. | Amber | ICS | |||
| Ibandronic acid solution for injection | 6 | Osteoporosis | Yes | Red | ICS | Aug 2021 | |
| Ibandronic acid tablets | 6 | Osteoporosis | Yes | Green | ICS | Aug 2021 | |
| Icatibant | 3 | Angioedema | Red | NHSE | |||
| Icosapent ethyl | 2 | Cardiovascular disease (secondary prevention) | Yes | Green (specialist advice) | ICS | Dec 2022 | |
| Idarucizumab | 2 | Dabigatran reversal agent | Yes | Red | ICS | ||
| Idoxuridine in dimethyl sulfoxide (Herpid®) | 13 | Criterion 1 | DNP | DNP | No evidence to support use |
||
| Iloprost | 2 | pulmonary hypertension | Red | NHSE | |||
| Imiquimod 5% cream (Aldara®) | 8 | For superficial basal cell carcinoma | Yes | Green (specialist advice) | NHSE | Mar 2019 | |
| Imiquimoid cream | 13 | Genital warts | Yes | Green (specialist initiation) | Local commissioning arrangements may vary. |
ICS | |
| Imlifidase | 8 | Desensitisation prior to kidney transplant | Yes | Red | NHSE | Dec 2022 | |
| Immunoglobulin (normal) | 14 | Red | NHSE | ||||
| Immunoglobulin varicella-zoster (VZIG) | 14 | Normally available through local trust virology departments. | No | Green | If patient fulfils the Public Health England criteria |
Public health |
|
| Inclisiran | 2 | Primary hypercholesterolaemia or mixed dyslipidaemia | Yes | Green | NICE TA733: Inclisiran for treating primary hypercholesterolaemia or mixed dyslipidaemia An NHSE/NHS Digital tool to aid identification of eligible patients is available for some primary care clinical systems (EMIS / SystmOne). A GM Case Record finding tool will be available from Health Innovation Manchester shortly. |
ICS | Nov 2021 |
| Indigestion and heartburn – mild (OTC/self care) | 1 | Criterion 3 For example: Peptac, Gaviscon |
DNP | DNP | For further information, including details of exceptions, see Commissioning Statement |
Oct 2019 | |
| Infant colic (OTC/self care) | 1 | Criterion 3 For example: simeticone or dimeticone liquid, lactase drops (e.g. Colief®) |
DNP | DNP | For further information, including details of exceptions, see Commissioning Statement |
Oct 2019 | |
| Infliximab | 10 | Biologics/cytokine modulators | Yes | Red | NHSE-commissioned for paediatric indications where adult TA available and for juvenile arthritis. |
ICS | |
| Inositol nicotinate (Hexopal®) | 2 | Criterion 1 | DNP | DNP | |||
| Insect bites and stings (OTC/self care) | 13 | Criterion 3 For example: antihistamines (oral and topical), calamine lotion, topical corticosteroids |
DNP | DNP | For further information, including details of exceptions, see Commissioning Statement |
Oct 2019 | |
| Insulin and GLP-1 agonist combination | 6 | Not to be initiated in primary care | No | Green (specialist initiation) | ICS | ||
| Insulin aspart biosimilar (Trurapi®) | 6 | Diabetes mellitus | Yes | Green | ICS | Mar 2022 | |
| Insulin aspart, fast-acting (Fiasp®) | 6 | Criterion 3 Only for use in patients with T1DM who are planning a pregnancy or are actively pregnant, and in those who have post-prandial glucose readings >10 mmol at 2 hours. |
Grey | Green (specialist advice) | ICS | Nov 2019 | |
| Insulin degludec (Tresiba®) | 6 | Criterion 3 For treatment of type 1 or type 2 diabetes, only for use: i) If there is particular concern about nocturnal hypoglycaemia despite optimisation of medication regimen ii) For patients with an unpredictable lifestyle (e.g. shift workers) iii) For patients who need help from a carer or healthcare professional to administer injections |
Grey | Green (specialist initiation) | Available in strengths of 100 units/mL and 200 units/mL. Care should be taken to ensure the correct dose is selected for prescribing, dispensing and administration. NICE NG17: Type 1 diabetes in adults: diagnosis and management |
ICS | Feb 2022 |
| Insulin glargine – high strength (Toujeo SoloStar and Toujeo DoubleStar) | 6 | 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. | Yes | Green | Formulary & RAG status have been temporarily amended to support management of patients impacted by the GLP-1 shortages. |
ICS | Aug 2019 |
| Insulin lispro (Lyumjev) | 6 | Criterion 2 Only for use in patients with type 1 and type 2 diabetes, including patients using insulin pumps, who have significant post-prandial hyperglycaemia (>10 mmol/L at 2 hours) despite optimised use of conventional rapid acting insulin analogues (Humalog®, Novorapid® or Apridra®). |
Grey | Green (specialist advice) | Available in strengths of 100 units/mL and 200 units/mL. Care should be taken to ensure the correct dose is selected for prescribing, dispensing and administration. |
ICS | Aug 2021 |
| Interferon alfa | 8 | Including interferon alfa-2a and 2b | Red | NHSE | |||
| Interferon beta | 8 | Multiple Sclerosis | Red | NHSE | |||
| Interferon gamma-1b | 8 | Red | ICS | ||||
| IQoro | 1 | Criterion 1 Neromuscular training device for stroke related dysphagia, hiatus hernia and other indications |
DNP | DNP | May 2023 | ||
| Iron – all modified release iron preparations | 9 | Criterion 1 | DNP | DNP | BNF: No therapeutic advantage and should not be used |
||
| Iron chelators (deferasirox, deriprone, desferioxamine) | 9 | For licensed indications | Yes | Red | NHSE | ||
| Iron dextran (Cosmofer®) | 9 | IV iron | Yes | Red | ICS | ||
| Iron sucrose (Venofer®) | 9 | IV iron | Yes | Red | ICS | ||
| Irritant dermatitis – mild (OTC/self care) | 13 | Criterion 3 For example: emollient creams and lotions, mild corticosteroid creams (e.g. hydrocortisone) |
DNP | DNP | For further information, including details of exceptions, see Commissioning Statement |
Oct 2019 | |
| Isocarboxazid | 4 | Non-reversible MAOI | Red | For new patients only |
ICS | ||
| Isoniazid | 5 | Tuberculosis prophylaxis in renal patients considered to be at high risk of developing tuberculosis | No | Green (specialist initiation) | ICS or NHSE |
Feb 2022 | |
| Isoniazid | 5 | Tuberculosis, antibiotic therapy. | Yes | Green (specialist initiation) | NHSE – drug resistant TB only. Local commissioning arrangements may vary. |
NHSE | |
| Isotretinoin (oral) | 13 | Red status predominantly due to safety concerns in pregnancy. | Yes | Red | ICS | ||
| IV Formulations | 0 | Unless part of an agreed local pathway. | Red | Commissioner depends on drug and indication |
ICS or NHSE |
||
| Ivabradine | 2 | Heart failure | Yes | Green (specialist initiation) | ICS | ||
| Ivacaftor | 3 | Cystic fibrosis | Red | NHSE | |||
| Ivermectin cream | 13 | Acne rosacea Criterion 3 Only for use after more established therapies such as metronidazole gel and azelaic acid have failed. |
Grey | Green | ICS | ||
| Ixekizumab | 10 | Biologics/cytokine modulators | Yes | Red | NICE TA442 (plaque psoriasis) and NICE TA537 (psoriatic arthritis) |
ICS | Nov 2018 |
| Kaletra® (lopinavir + ritonavir) | 5 | HIV medicines. | Yes | Red | NHSE | ||
| Ketamine | 4 | For chronic pain management | Red | ICS | |||
| Ketamine oral solution | 4 | Specialist use only, for short-term use as an opiate-sparing agent | Yes | Red | ICS | Nov 2018 | |
| Ketoconazole (for oral administration) | 5 | Criterion 1 | DNP | DNP | See MHRA Drug Safety Update for information on safety concerns |
||
| Ketoconazole (oral) | 6 | Cushing's disease | Red | ICS | |||
| Ketorolac eye drops | 11 | Ocular peri-operative drugs | Yes | Red | ICS | ||
| Kivexa® (abacavir + lamivudine) | 5 | HIV medicines. | Yes | Red | NHSE | ||
| Lacosamide | 4 | Antiepileptic Drugs, as per NICE guidance Criterion 2 Only for use as an option for third or fourth line use after more established therapies have failed. |
Grey | Green (specialist advice) | ICS | ||
| Lamivudine | 5 | Antivirals for treatment of hepatitis B | Red | NHSE | |||
| Lamivudine | 5 | HIV medicines. | Yes | Red | NHSE | ||
| Lamivudine/zidovudine (Combivir®) | 5 | HIV medicines. | Red | NHSE | |||
| Lamotrigine | 4 | Antiepileptic drugs, as per NICE guidance | Yes | Green (specialist advice) | ICS | ||
| Lanadelumab | 3 | For prevention of recurrent attacks of hereditary angioedema | Red | NHSE | Mar 2020 | ||
| Lanolin cream (Lansinoh HPA®) | 13 | Criterion 1 | DNP | DNP | Cochrane Review 2014: Interventions for treating painful nipples among breastfeeding women |
||
| Lanreotide | 8 | All licensed and unlicensed indications, including acromegaly | Red | NHSE | |||
| Lanthanum | 9 | Phosphate binding agent in non-dialysis patients | Yes | Green (specialist advice) | ICS | ||
| Lanthanum | 9 | Phosphate binding agent in dialysis patients | Yes | Green (specialist advice) | NHSE | Nov 2019 | |
| Ledipasvir | 5 | Hepatitis C | Red | ICS | |||
| Leflunomide | 10 | DMARDs for rheumatoid arthritis. | Yes | Amber | Shared care protocol: Leflunomide for rheumatological conditions |
ICS | |
| Lenograstim | 9 | GCSF for neutropenia | Yes | Red | Will remain subject to separate reimbursement where used for chemo indications (as per 19/20 National Tariff annex A) |
ICS | |
| Lesinurad | 10 | Criterion 2 | DNP | DNP | |||
| Letermovir | 5 | Cytomegalovirus disease prevention after a stem cell transplant | Yes | Red | NHSE | Jan 2020 | |
| Letrozole | 8 | Hormone antagonists for breast cancer | Yes | Green (specialist advice) | ICS | ||
| Leuprorelin | 6 | For all other unlicensed indications (including testosterone castration in sex offenders) and licensed indications without a shared care protocol | Yes | Red | ICS | ||
| Leuprorelin | 6 | Licensed indications with a shared care protocol | Yes | Amber | Shared care protocol : LHRH analogues for treatment of prostate cancer in adults |
ICS | |
| Leuprorelin | 6 | Transgender use of hormone therapy, as per NHSE shared care arrangements | Amber | GnRH analogues for patients aged 17 years or over under Indigo Gender Service NHSE Gender Dysphoria Clinical Programme |
NHSE | ||
| Levetiracetam (tablets and oral solution) | 4 | Antiepileptic drugs, as per NICE guidance | Yes | Green (specialist advice) | ICS | ||
| Levocarnitine | 9 | Agents for the treatment of metabolic disorders | Red | NHSE | |||
| Levocetirizine (Xyzal®) | 3 | Criterion 2 | DNP | DNP | |||
| Levofloxacin eye drops | 11 | Anti-infective eye preparations | Yes | Red | ICS | ||
| Levomepromazine | 4 | Palliative Care | Yes | Green | ICS | ||
| Lidocaine plasters | 4 | For all off-label indications Criterion 1 |
DNP | DNP | See NHS England guidance on items not for routine prescribing in primary care |
Mar 2020 | |
| Lidocaine plasters | 4 | Criterion 1 Only to be used in patients who have been treated in line with NICE CG173 but are still experiencing neuropathic pain associated with previous herpes zoster infection (post-herpetic neuralgia). |
Grey | Green | See NHS England guidance on items not for routine prescribing in primary care NICE CG173 (Neuropathic pain in adults: pharmacological management in non-specialist settings) |
ICS | |
| Linaclotide | 1 | IBS-C Criterion 1 Only for use where optimal or maximum tolerated doses of previous laxatives from different classes have not helped, and constipation has been present for at least 12 months. |
Grey | Green (specialist initiation) | ICS | ||
| Linagliptin | 6 | Gliptins (DPP-4 Inhibitors) As per NICE guidance. |
Yes | Green | ICS | ||
| Linezolid | 5 | Yes | Red | ICS | |||
| Liothyronine | 6 | For resistant depression. There is very limited evidence for thyroid hormones in depression. Where thyroid hormones are necessary due to hypothyroidism, treatment should be initiated with standard levothyroxine. All psychiatric patients currently receiving liothyronine should be reviewed by a consultant NHS psychiatrist. |
DNP | DNP | NHSE guidance on items not for routine prescribing in primary care |
Mar 2020 | |
| Liothyronine (T3) | 6 | Criterion 2 Hypothyroid crisis and short-term use post-thyroid surgery only |
Grey | Red | For new patients only |
ICS | |
| Liothyronine (T3) | 6 | Criterion 2 Where levothyroxine has failed, endocrinologists treating patients under the NHS may recommend liothyronine in exceptional circumstances for individual patients after a carefully audited trial of at least 3 months duration, in line with BTA guidance Such patients should be reviewed at least annually by their NHS Endocrinologist. |
Grey | Green (specialist initiation) | See NHS England guidance on items not for routine prescribing in primary care |
ICS | |
| Liothyronine combination products and unlicensed thyroid extract products (including Armour Thyroid and ERFA Thyroid) | 6 | Criterion 2 | DNP | DNP | See NHS England guidance on items not for routine prescribing in primary care |
||
| Liraglutide | 6 | GLP-1 Agonists As per NICE guidance |
Yes | Green | ICS | ||
| Liraglutide (Saxenda®) | 4 | For management of overweight and obesity. Must be prescribed by a specialist multidisciplinary tier 3 weight management service. | Yes | Red | ICS | Jan 2021 | |
| Lisdexamfetamine | 4 | ADHD | Yes | Amber | ICS | ||
| Lithium | 4 | Prophylaxis of cluster headache | Yes | Amber | ICS | ||
| Lithium | 4 | Yes | Amber | Shared care protocol: Lithium for patients over 18 years old including those aged 65 years and older |
ICS | ||
| Low molecular weight heparins (dalteparin, enoxaparin, tinzaparin) | 2 | Thromboprophylaxis: • Immobile patients or those deemed at high risk of DVT at home or in a care setting, and in whom treatment with warfarin or NOAC is not suitable or not tolerated. • For travel prophylaxis in high risk patients (travelling time over 8 hrs) and only as per national recommendations. Off-label indication. See NICE CKS |
Yes | Green (specialist advice) | Licensed indication(s) vary among products. See product information. |
ICS | |
| Low molecular weight heparins (dalteparin, enoxaparin, tinzaparin) | 2 | Ongoing DVT or PE treatment* • In patients for whom treatment with warfarin or NOAC is not suitable or not tolerated. This includes IVDUs. • in oncology patients undergoing cancer therapy or with metastatic disease. *initial 2 weeks of treatment is RED |
Yes | Green (specialist initiation) | Licensed indication(s) vary among products. Use in patients unable to stabilise on warfarin or NOACs may be off-license, depending on duration of treatment. See product information. |
ICS | |
| Low molecular weight heparins (dalteparin, enoxaparin, tinzaparin) | 2 | Initial DVT and PE treatment - initial 2 weeks or as per locally agreed pathways Thromboprophylaxis: • in oncology patients on VTE-inducing therapy • in pre- and post-surgical patients, where indicated • in post-natal women • for high risk patients who have suffered a fracture and are in plaster As bridging anticoagulant therapy in surgical patients who normally receive warfarin. |
Yes | Red | ICS | ||
| Low molecular weight heparins (dalteparin, enoxaparin, tinzaparin) | 2 | Treatment and prophylaxis of DVT/PE in pregnancy Includes use by fertility clinics. Patients with mechanical heart valves or on long term warfarin should be discussed with consultant cardiologists/ haematologists before pregnancy. |
Yes | Red | Local commissioning arrangements may vary and may be amber if local agreement in some localities. |
ICS | |
| Loxapine (inhaled) | 4 | Criterion 1 Agitation associated with schizophrenia and bipolar disorder. |
DNP | DNP | |||
| Lurasidone | 4 | For the treatment of schizophrenia in adults aged 18 years and older who require antipsychotic treatment, who have previously had a trial of but not responded to aripiprazole, and who fulfil one of the following criteria: - Patient gained weight on other antipsychotics and there is a need for the BMI to move towards the normal range - Patients for whom there is a need to avoid weight gain and metabolic adverse effects, e.g. patients with diabetes, cardiovascular disease - Patients with a prolonged QTc interval |
Grey | Amber | ICS | Jul 2018 | |
| Lusutrombopag | 9 | For treatment of thrombocytopenia in people with chronic liver disease needing a planned invasive procedure | Yes | Red | ICS | Jul 2020 | |
| Macitentan | 2 | Pulmonary arterial hypertension | Red | NHSE | |||
| Mannitol inhaler | 3 | Cystic fibrosis | Yes | Red | NHSE | ||
| Maraviroc | 5 | HIV medicines. | Yes | Red | NHSE | ||
| Maribavir | 5 | Refractory cytomegalovirus post-transplant | Yes | Red | NHSE | May 2023 | |
| Megestrol | 8 | Treatment of breast cancer | Yes | Green (specialist initiation) | NHSE | Nov 2018 | |
| Melatonin | 4 | For REM sleep behaviour disorder in Parkinson’s disease. Licensing varies, please check product SPCs. |
Yes | Green (specialist advice) | ICS | Oct 2021 | |
| Melatonin | 4 | Management of jet lag | DNP | DNP | NHSE | Jan 2020 | |
| Memantine | 4 | Dementia - as per NICE TA 217. Local commissioning arrangements may vary and in some localities this is green on specialist advice so please check with your locality. | Yes | Green (specialist advice) | ICS | ||
| Menotrophin | 6 | Infertility drugs | Red | ICS | |||
| Mepacrine | 5 | No | Red | ICS | Jul 2019 | ||
| Mepolizumab | 3 | Severe eosinophilic asthma | Yes | Red | NHSE | Jun 2019 | |
| Meprobamate | 4 | Criterion 1 | DNP | DNP | |||
| Mercaptamine (cysteamine) | 9 | Agents for the treatment of metabolic disorders | Red | NHSE | |||
| Mercaptopurine | 1 | Inflammatory bowel diseases (unlicensed) | Yes | Amber | Shared care protocol: Azathioprine and 6-mercaptopurine for the treatment of IBD |
ICS | |
| Mesalazine | 1 | Licensed GI Indications | Yes | Green (specialist advice) | ICS | ||
| Metformin | 6 | Unlicensed indications: - PCOS - use in pregnancy |
Yes | Green (specialist initiation) | ICS | ||
| Metformin | 6 | Diabetes prevention Reduction in risk or delay of onset of T2DM in adult, overweight patients with impaired glucose tolerance and/or increased HbA1c who are: - at high risk of developing overt T2DM and - still progressing towards T2DM despite implementation of intensive lifestyle change for 3-6 months |
Yes | Green | Second-line treatment to intensive lifestyle intervention. |
ICS | |
| Metformin 1g immediate-release tablets | 6 | Criterion 2 | DNP | DNP | Jun 2023 | ||
| Methadone | 4 | Opioid dependence | Yes | Other | Status depends on local commissioning arrangements for substance misuse or if GP with specialist interest |
ICS | |
| Methotrexate (oral) | 10 | All indications with a shared care protocol | Yes | Amber | Shared care protocols available for
|
ICS | |
| Methotrexate (parenteral) | 8 | Parenteral Formulations. This includes subcutaneous injection (Metoject®) for: Crohn’s disease, rheumatoid arthritis, psoriasis and psoriatic arthritis; pending homecare arrangements. |
Red | Commissioner depends on indication |
ICS or NHSE |
||
| Methylphenidate | 4 | ADHD | Yes | Amber | ICS | ||
| Metolazone | 2 | Heart failure | No | Green (specialist initiation) | Prescribe by brand name; products are not interchangeable. See also MHRA advice. |
ICS | Dec 2022 |
| Metyrapone | 6 | Cushings syndrome | Yes | Red | ICS | ||
| Mexiletine | 10 | Myotonia | Yes | Red | NICE TA748: Mexiletine for treating the symptoms of myotonia in non-dystrophic myotonic disorders |
NHSE | Jul 2022 |
| Mexiletine | 2 | Life-threatening ventricular arrhythmias | Yes | Red | ICS | Nov 2022 | |
| Micafungin | 5 | Antifungal | Yes | Red | NHSE | ||
| Micronised progesterone (Cyclogest, Utrogestan) | 6 | Prevention of miscarriage | Yes | Green (specialist initiation) | NICE NG126: Ectopic pregnancy and miscarriage: diagnosis and initial management. |
ICS | Sep 2022 |
| Midazolam (buccal) | 4 | Epilepsy | Green (specialist initiation) | ICS | |||
| Midazolam injection | 4 | Yes | Green | GMMMG Palliative Care Pain and Symptom Control Guidelines for Adults |
ICS | Jan 2020 | |
| Midodrine | 2 | For hypotensive states | No | Green (specialist initiation) | ICS | ||
| Mifamurtide | 8 | Osteosarcoma | Red | NHSE | |||
| Mifepristone | 7 | Licensed indications | Red | ICS | |||
| Migraine – infrequent (OTC/self care) | 4 | Criterion 3 For example: analgesics, Migraleve |
DNP | DNP | For further information, including details of exceptions, see Commissioning Statement |
Oct 2019 | |
| Minocycline | 13 | Criterion 1 For treatment of acne |
DNP | DNP | See NHS England guidance on items not for routine prescribing in primary care |
Oct 2019 | |
| Minoxidil foam | 10 | Criterion 3 | DNP | DNP | NB: other minoxidil preparations are listed in the Drug Tariff part XVIIIA. |
Sep 2022 | |
| Moclobemide | 4 | Reversible MAOI | Yes | Green (specialist initiation) | ICS | ||
| Modafinil | 4 | Excessive sleepiness associated with narcolepsy. Excessive daytime sleepiness in people with Parkinson's disease. |
Yes | Green (specialist initiation) | Supporting information for primary care prescribers available here. |
ICS | Dec 2022 |
| 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 | |||
| Molnupiravir | 5 | COVID-19 infection | Yes | Red | NG191: COVID-19 rapid guideline: managing COVID-19 COVID-19 antivirals: reporting to the UK COVID-19 Antivirals Pregnancy Registry |
NHSE | Mar 2022 |
| Morphine sulfate orodispersible tablets (Actimorph) | 4 | Criterion 3 For use as an alternative to morphine sulfate tablets or 10mg/5mL oral solution, where these would be inappropriate due to:
|
Grey | Green | ICS | Aug 2023 | |
| 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 | |||
| Moxonidine | 2 | Yes | Green (specialist initiation) | ICS | Jun 2022 | ||
| Multivitamin and mineral preparations for the management of age-related macular degeneration (ARMD) | 9 | Criterion 1 e.g. Icaps, Occuvite preservision, Preservision lutein, Viteyes original plus-lutein, Ocuvite lutein, Visionace, Vitalux-plus | DNP | DNP | See NHS England guidance on items not for routine prescribing in primary care |
||
| Mycophenolate | 3 | Immunosuppressants (non-transplant indications) Red for all indications with no SCP |
Yes | Amber | Shared care protocols available for:
|
ICS | |
| Mycophenolate | 8 | Post transplant use | Amber | To remain amber until repatriation occurs |
NHSE | ||
| Nabilone | 4 | Criterion 3. When used within marketing authorisation, i.e. for control of nausea and vomiting caused by chemotherapeutic agents used in the treatment of cancer, in patients who have failed to respond adequately to conventional antiemetic treatments. |
Grey | Red | NHSE | Nov 2019 | |
| Nabilone | 4 | Unlicensed indications Criterion 1 |
DNP | DNP | Nov 2019 | ||
| Naldemidine | 1 | Only as an option for treating opioid induced constipation in adults whose constipation has not adequately responded to laxatives alone. Patients with opioid induced constipation should have their analgesia reviewed prior to initiating naldemedine | Yes | Green (specialist initiation) | NICE TA651: Naldemedine for treating opioid-induced constipation |
ICS | Jan 2021 |
| Nalmefene | 4 | Alcohol Dependence As per NICE guidance. Nalmefene should only be prescribed in conjunction with continuous psychosocial support focused on treatment adherence and reducing alcohol consumption provided by a specialist alcohol service. |
Yes | Green | In conjunction with specialist service |
Public health |
|
| Naloxegol for opioid induced constipation | 1 | Opioid induced constipation | Yes | Green (specialist advice) | ICS | ||
| Naltrexone | 4 | Opioid dependence | Yes | Amber | Status depends on local commissioning arrangements for substance misuse |
Public health |
|
| Naltrexone | 4 | Alcohol use disorders Unlicensed use. Recommended in NICE guidance for max 6 months duration. To remain under specialist community alcohol teams. |
Yes | Red | Public health |
||
| Naltrexone-bupropion (Mysimba®▼) | 4 | Criterion 2 | DNP | DNP | |||
| 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 | |||
| Natalizumab | 8 | Multiple sclerosis | Red | NHSE | |||
| Nefopam | 4 | Criterion 3 Only to be used in patients with moderate to severe chronic liver disease who require analgesia stronger than paracetamol and in whom NSAIDS and moderate strength opiates are contraindicated |
Grey | Green | Due to the high cost of nefopam, a lack of evidence of superior efficacy over other analgesics, and its side effect profile, there is no rationale for routine use. |
ICS | |
| Nevirapine | 5 | HIV medicines. | Yes | Red | NHSE | ||
| Nintedanib | 3 | Idiopathic pulmonary fibrosis | Red | NHSE | |||
| Nirmatrelvir / ritonavir (Paxlovid®) | 5 | COVID-19 infection | Yes | Red | NG191: COVID-19 rapid guideline: managing COVID-19 COVID-19 antivirals: reporting to the UK COVID-19 Antivirals Pregnancy Registry |
NHSE | Sep 2022 |
| Nitisinone | 9 | Agents for the treatment of metabolic disorders | Red | NHSE | |||
| Nortriptyline | 4 | Prophylaxis of migraine (off-label indication) | Yes | Green | If intolerant of amitriptyline |
ICS | Jun 2022 |
| Nusinersen | 10 | Spinal muscular atrophy | Red | NHSE | Jan 2020 | ||
| Obeticholic acid (Ocaliva) | 9 | Agents for the treatment of metabolic disorders | Red | NHSE | |||
| Ocrelizumab | 8 | Relapsing–remitting multiple sclerosis | Yes | Red | NICE TA533: Ocrelizumab for treating relapsing–remitting multiple sclerosis |
NHSE | Nov 2018 |
| Ocriplasmin intravitreal injection | 11 | Ophthalmic indications | Yes | Red | ICS | ||
| Octreotide | 8 | Acromegaly | Red | NHSE | |||
| Octreotide | 8 | Vomiting in palliative care, enterocutaneous fistula, high output stoma, refractory diarrhoea. | Red | ICS | Jan 2019 | ||
| Odevixibat | 1 | Progressive familial intrahepatic cholestasis | Red | NICE HST17: Odevixibat for treating progressive familial intrahepatic cholestasis |
NHSE | Jun 2022 | |
| Ofatumumab | 8 | Multiple sclerosis | Yes | Red | NICE TA699: Ofatumumab for treating relapsing multiple sclerosis |
NHSE | Oct 2021 |
| Ofloxacin eye drops | 11 | Anti-infective eye preparations | Yes | Red | ICS | ||
| Olanzapine | 4 | Antipsychotics (oral) Use in dementia patients (unlicensed). Prescribing of antipsychotics in dementia is expected to be short term. In exceptional circumstances, longer term prescribing may be required [which would be outside of the product licence for any drugs which have a marketing authorisation for such use]. In these situations, there should still be regular review with the aim of reducing or stopping, and the best methods of ensuring continuity of supply should be negotiated between all healthcare professionals involved in that patient’s care. |
Yes | Red | For new patients only. Local commissioning arrangements may vary and in some localities this remains an amber drug so please check with your locality. |
ICS | |
| Olanzapine | 4 | Atypical antipsychotics (oral) All other unlicensed indications |
Yes | Red | ICS | ||
| Olanzapine | 4 | Atypical antipsychotics (oral) - Licensed Indications and also Unlicensed indications as recommended by NICE guidance (i.e. in psychotic depression or anxiety in bipolar patients). Red if no SCP | Yes | Amber | ICS | ||
| Olanzapine pamoate | 4 | Antipsychotic depot injection (schizophrenia) | Red | ICS | |||
| Omalizumab | 3 | Allergic asthma prophylaxis. | Yes | Red | NHSE | ||
| Omalizumab | 3 | Severe chronic spontaneous urticaria | Yes | Red | ICS | ||
| Omalizumab | 3 | Chronic rhinosinusitis with nasal polyps | DNP | DNP | NICE TA678: Omalizumab for treating chronic rhinosinusitis with nasal polyps |
Aug 2021 | |
| Ombitasvir- paritaprevir -ritonavir (Viekirax) |
5 | Hepatitis C | Red | NHSE | |||
| Omega-3-acid ethyl ester (Omacor®) | 2 | Criterion 1 Omega-3-fatty acids (e.g. Omacor) should only be used for the treatment of hypertriglyceridaemia under the care of a lipid management specialist, all patients receiving this medication, other than for hypertriglyceridaemia under a lipid management specialist, should have the medication discontinued |
Grey | Green (specialist initiation) | See NHS England guidance on items not for routine prescribing in primary care |
ICS | |
| Ondansetron (5-HT3 antagonist anti-emetics) | 4 | For exceptional use in non oncology patients with chronic emesis following consultant recommendation and where all other options have failed. | Yes | Green (specialist initiation) | ICS | ||
| Ondansetron (5-HT3 antagonist anti-emetics) | 4 | Post op and following chemotherapy. | Yes | Red | ICS | ||
| Opicapone | 4 | Parkinson's disease Criterion 2 For use only where entacapone (either alone or in combination) is considered not suitable. |
Grey | Green (specialist initiation) | ICS | ||
| Oral thrush (OTC/self care) | 12 | Criterion 3 For example: miconazole oral gel 15g |
DNP | DNP | For further information, including details of exceptions, see Commissioning Statement |
Oct 2019 | |
| Oxcarbazepine | 4 | Antiepileptic drugs, as per NICE guidance | Yes | Green (specialist advice) | ICS | ||
| Oxycodone 10mg/mL concentrated oral solution | 4 | For use in palliative care. Prescribe by brand name. There are significant risks of overdose if a concentrated product is used in error for a normal strength product. See MHRA Patient Safety Alert error report. |
No | Green (specialist advice) | GMMMG Palliative Care Pain and Symptom Control Guidelines for Adults |
ICS | Jan 2020 |
| Oxycodone/naloxone MR tablets (Targinact®) | 4 | Criterion 2 | DNP | DNP | See NHS England guidance on items not for routine prescribing in primary care |
||
| Ozanimod | 1 | Cytokine modulators | Yes | Red | ICS | Mar 2023 | |
| Pain, discomfort and/or fever associated with minor conditions (e.g. aches and sprains, headache, period pain, back pain) (OTC/self care) | 4 | Criterion 3 For example: analgesics, NSAIDS, topical anti-inflammatory preparations, heat rubs (rubefacients) and cooling products |
DNP | DNP | For further information, including details of exceptions, see Commissioning Statement |
Oct 2019 | |
| Paliperidone | 4 | Antipsychotics (oral) Use in dementia patients (unlicensed). Prescribing of antipsychotics in dementia is expected to be short term. In exceptional circumstances, longer term prescribing may be required [which would be outside of the product licence for any drugs which have a marketing authorisation for such use]. In these situations, there should still be regular review with the aim of reducing or stopping, and the best methods of ensuring continuity of supply should be negotiated between all healthcare professionals involved in that patient’s care. |
Red | For new patients only. Local commissioning arrangements may vary and in some localities this remains an amber drug so please check with your locality. |
ICS | ||
| Paliperidone | 4 | Atypical antipsychotics (oral) - Licensed Indications and also unlicensed indications as recommended by NICE guidance (i.e. in psychotic depression or anxiety in patients with bipolar disorder). | Amber | ICS | |||
| Paliperidone palmitate | 4 | Antipsychotic depot injection (schizophrenia) Only for those patients who are stable and if SCP available; or if under the care of a community psychiatric nurse. In some localities there may be commissioning arrangements in place to permit step down. |
Yes | Amber | Shared care protocol: Paliperidone long-acting antipsychotic injection |
ICS | |
| Palonosetron (5-HT3 antagonists anti-emetics) | 4 | Post op and following chemotherapy. | Red | ICS | |||
| Pancreatin (Creon®) | 1 | Yes | Green (specialist initiation) | ICS | |||
| Paracetamol and tramadol combination product (Tramacet®) | 4 | Criterion 2 | DNP | DNP | See NHS England guidance on items not for routine prescribing in primary care |
||
| Paracetamol mixture / mucilage | 4 | Criterion 1 Topical use in patients with sore mouth or throat resulting from cancer treatment |
DNP | DNP | Jul 2020 | ||
| Paracetamol with buclizine and codeine | 4 | Criterion 1 | DNP | DNP | Jun 2022 | ||
| Paracetamol with isoetheptene | 4 | Criterion 1 | DNP | DNP | Jun 2022 | ||
| Parathyroid hormone | 6 | Osteoporosis | Yes | Red | ICS | ||
| Paravit-CF® | 9 | Criterion 3 Only for use in patients with cystic fibrosis |
Grey | Green | ICS | Sep 2018 | |
| Pasireotide | 8 | Cushing's disease | Red | NHSE | |||
| Patiromer | 9 | Hyperkalaemia | Yes | Amber | GMMMG shared care protocol: patiromer for adult patients within renal and cardiology. |
ICS | Jan 2021 |
| Peanut protein powder (Palforzia) | 3 | Criterion 1 Peanut allergy Only for use in people aged 18 and over if treatment started between the ages of 4 to 17, as per NICE guidance. |
Grey | Red | NICE TA769: Palforzia for treating peanut allergy in children and young people |
ICS | Jun 2022 |
| Pegcetacoplan | 9 | Paroxysmal nocturnal haemoglobinuria | Red | NICE TA778: Pegcetacoplan for treating paroxysmal nocturnal haemoglobinuria. |
NHSE | Sep 2022 | |
| Pegfilgrastim | 9 | GCSF for neutropenia | Yes | Red | Will remain subject to separate reimbursement where used for chemo indications (as per 19/20 National Tariff annex A) |
ICS | |
| Peginterferon alfa | 9 | Including peginterferon alfa-2a and 2b | Red | NHSE | |||
| Peginterferon beta | 9 | Including peginterferon beta 1a | Red | 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 | |||
| Pen needles costing in excess of £5 per 100 | 6 | Criterion 2 This recommendation does not apply to safety needles |
DNP | DNP | |||
| Penicillamine | 10 | DMARDs | Amber | ICS | |||
| Penicillin eye drops | 11 | Anti-infective eye preparations. Unlicensed. | Yes | Red | ICS | ||
| Pentosan | 7 | Bladder pain syndrome | Yes | Red | ICS | Jun 2019 | |
| Pentoxifylline (Trental®) | 2 | Criterion 1 | DNP | DNP | |||
| Perampanel | 4 | Antiepileptic drugs, as per NICE guidance Criterion 2 Only for use as an option for patients with highly refractory epilepsy who are unable to tolerate at least two other more established adjunctive therapies. |
Grey | Green (specialist advice) | ICS | ||
| Pergolide | 4 | Antiparkinson's drugs, as per NICE guidance | No | Green (specialist advice) | ICS | ||
| Perindopril arginine | 2 | Criterion 2 | DNP | DNP | See NHS England guidance on items not for routine prescribing in primary care |
||
| Phenelzine | 4 | Non-reversible MAOI | Yes | Red | For new patients only |
ICS | |
| Phenobarbital | 4 | Antiepileptic drugs, as per NICE guidance | Yes | Green (specialist advice) | ICS | ||
| Phenytoin | 4 | Antiepileptic drugs, as per NICE guidance | Yes | Green (specialist advice) | ICS | ||
| PHMB eye drops (polyhexamethylene biguanide) | 11 | Anti-infective eye preparations. Unlicensed. | Yes | Red | ICS | ||
| Phosex® (calcium acetate) | 9 | Phosphate binding agents | Yes | Green (specialist initiation) | ICS | ||
| Phosphate infusion | 9 | Yes | Red | ICS | |||
| Pimecrolimus | 13 | Eczema and psoriasis | Yes | Green (specialist advice) | ICS | ||
| Pirfenidone | 3 | Idiopathic pulmonary fibrosis | Yes | Red | NHSE | ||
| Piroxicam oral therapies | 10 | Criterion 1 Systemic piroxicam should be initiated only by specialists as a second-line treatment for arthritis. Patients who currently take piroxicam should be reassessed at a routine appointment. |
Grey | Green (specialist initiation) | MHRA Drug Safety Update: Piroxicam: new restrictions, including specialist initiation |
ICS | |
| Pitolisant | 4 | Obstructive sleep apnoea | DNP | DNP | Sep 2022 | ||
| Pitolisant | 4 | Narcolepsy | Red | ICS | |||
| Pollinex® (all forms) | 3 | Criterion 1. Only to be prescribed in accordance with local commissioning arrangements. |
Grey | Red | ICS | ||
| Ponesimod | 8 | Multiple sclerosis | Yes | Red | NICE TA767: Ponesimod for treating relapsing–remitting multiple sclerosis |
NHSE | Jun 2022 |
| Posaconazole | 5 | Yes | Red | NHSE | |||
| Potassium permanganate tablets for solution | 13 | Dermatology | Yes | Red | ICS | May 2023 | |
| Pramipexole | 4 | Antiparkinson's drugs, as per NICE guidance | Yes | Green (specialist advice) | ICS | ||
| Prasugrel | 2 | Percuataneous coronary intervention | Yes | Green (specialist initiation) | ICS | ||
| Praziquantel | 5 | For hydatid disease | Red | ICS | Mar 2020 | ||
| Prazosin | 4 | Criterion 1 Only to be used for licensed indications and not for PTSD |
Grey | Green (specialist initiation) | ICS | ||
| Prednisolone EC tablets | 6 | Criterion 2 | DNP | DNP | |||
| Prednisolone for rectal administration | 1 | Including enemas, foam & suppositories. GI Indications | Yes | Green (specialist advice) | ICS | ||
| Prednisone MR tablets (Lodotra®) | 6 | Criterion 2 | DNP | DNP | |||
| Pregabalin | 4 | Antiepileptic drugs, as per NICE guidance | Yes | Green (specialist advice) | ICS | ||
| Pregabalin | 4 | Neuropathic pain | Yes | Green | ICS | ||
| Pregabalin | 4 | Gabapentinoids for management of chronic cough (unlicensed) Criterion 1 Only for use in patients for whom low dose morphine is unsuitable. |
Grey | Green (specialist advice) | ICS | Nov 2019 | |
| Primidone | 4 | Antiepileptic drugs, as per NICE guidance | Yes | Green (specialist advice) | ICS | ||
| Progesterone pessaries | 6 | When used in treatment of infertility | Red | ICS | |||
| Propamidine isetionate eye drops | 11 | Minor eye infections (e.g. conjunctivitis and blepharitis) | Yes | Green | RED if for treatment of acanthamoeba keratitis |
ICS | |
| Propylthiouracil | 6 | Hyperthyroidism. Prescribing to remain within specialist care until patient stable | Yes | Green (specialist initiation) | ICS | ||
| Prucalopride | 1 | Chronic constipation, when other laxatives fail to provide an adequate response | Yes | Green (specialist initiation) | ICS | ||
| Pyrazinamide | 5 | Tuberculosis, antibiotic therapy. Local commissioning arrangements may vary. | Yes | Green (specialist initiation) | ICS | ||
| Pyridoxine | 9 | Oral pyridoxine for prophylaxis and treatment of pyridoxine deficiency secondary to isoniazid or penicillamine therapy | Yes | Green (specialist advice) | See BNF for recommended doses; discontinue when isoniazid / penicillamine therapy is stopped |
ICS | Jul 2020 |
| Quetiapine | 4 | Antipsychotics (Oral) Use in dementia patients (unlicensed). Prescribing of antipsychotics in dementia is expected to be short term. In exceptional circumstances, longer term prescribing may be required [which would be outside of the product licence for any drugs which have a marketing authorisation for such use]. In these situations, there should still be regular review with the aim of reducing or stopping, and the best methods of ensuring continuity of supply should be negotiated between all healthcare professionals involved in that patient’s care. |
Yes | Red | For new patients only. Local commissioning arrangements may vary and in some localities this remains an amber drug so please check with your locality. |
ICS | |
| Quetiapine | 4 | Atypical antipsychotics (oral)
All other unlicensed indications |
Yes | Red | ICS | ||
| Quetiapine | 4 | Atypical antipsychotics (oral) - Licensed Indications and unlicensed indications as recommended by NICE guidance (i.e. in psychotic depression or anxiety in bipolar patients). Red if no SCP |
Yes | Amber | ICS | ||
| Racecadotril | 1 | Criterion 1 | DNP | DNP | Nov 2019 | ||
| Raloxifene | 8 | Chemoprevention in women at moderate and high risk of breast cancer | No | Green (specialist initiation) | Off-label indication |
ICS | |
| Raltegravir | 5 | HIV medicines. | Yes | Red | NHSE | ||
| Ranibizumab intravitreal injection | 11 | Ophthalmic indications | Yes | Red | ICS | ||
| Ranolazine | 2 | Stable angina | Yes | Green (specialist advice) | ICS | ||
| Rasagiline | 4 | Antiparkinson's drugs, as per NICE guidance | Yes | Green (specialist advice) | ICS | ||
| Rasburicase | 10 | Hyperuricaemia associated with cytotoxic drugs | Red | NHSE | |||
| Ravulizumab | 9 | Paroxysmal nocturnal haemoglobinuria Atypical haemulytic uraemic syndrome |
No | Red | NICE TA698: Ravulizumab for treating paroxysmal nocturnal haemoglobinuria NICE TA710: Ravulizumab for treating atypical haemolytic uraemic syndrome |
NHSE | Oct 2021 |
| Relugolix / estradiol / norethisterone | 6 | Uterine fibroids | Yes | Green (specialist advice) | ICS | Mar 2023 | |
| Remdesivir | 5 | COVID-19 | Yes | Red | NG191: COVID-19 rapid guideline: managing COVID-19 COVID-19 antivirals: reporting to the UK COVID-19 Antivirals Pregnancy Registry |
NHSE | Oct 2021 |
| Reslizumab | 3 | Severe eosinophilic asthma | Yes | Red | NHSE | ||
| RESPeRATE® | 2 | Criterion 1 | DNP | DNP | |||
| Ribavirin | 5 | Hepatitis C and RSV (unlicensed) | Yes | Red | NHSE | ||
| Rifabutin | 5 | Tuberculosis, antibiotic therapy. | Yes | Green (specialist initiation) | NHSE – drug resistant TB only. Local commissioning arrangements may vary. |
NHSE | |
| Rifampicin | 5 | Tuberculosis, antibiotic therapy. | Yes | Green (specialist initiation) | NHSE – drug resistant TB only. Local commissioning arrangements may vary. |
NHSE | |
| Rifampicin + isoniazid (Rifinah®) | 5 | Tuberculosis, antibiotic therapy. | Yes | Green (specialist initiation) | NHSE – drug resistant TB only. Local commissioning arrangements may vary. |
NHSE | |
| Rifampicin + isoniazid + pyrazinamide (Rifater®) | 5 | Tuberculosis, antibiotic therapy. | Yes | Green (specialist initiation) | NHSE – drug resistant TB only. Local commissioning arrangements may vary. |
NHSE | |
| Rifaximin | 5 | Hepatic encephalopathy | Yes | Green (specialist initiation) | ICS | ||
| Rifaximin | 1 | Traveller's diarrhoea Criterion 3 |
DNP | DNP | Nov 2019 | ||
| Rilpivirine | 5 | HIV medicines. | Yes | Red | ICS | ||
| Riluzole | 4 | Motor Neurone Disease | Yes | Amber | Shared care protocol: Riluzole for Amyotrophic Lateral Sclerosis (a form of Motor Neurone Disease) |
ICS | |
| Ringworm/athlete’s foot (OTC/self care) | 13 | Criterion 3 For example: topical preparations containing miconazole, clotrimazole |
DNP | DNP | For further information, including details of exceptions, see Commissioning Statement |
Oct 2019 | |
| Risankizumab | 13 | Biologics/cytokine modulators | Yes | Red | ICS | Sep 2019 | |
| Risdiplam | 10 | Spinal muscular atrophy | Yes | Red | NHSE | May 2022 | |
| Risedronate (once weekly) | 6 | Osteoporosis | Yes | Green | ICS | Aug 2021 | |
| Risperidone | 4 | Antipsychotics (oral) Use in dementia patients (licensed only for short-term treatment, up to 6 weeks). Prescribing of antipsychotics in dementia is expected to be short term. In exceptional circumstances, longer term prescribing may be required, which would be outside of the product licence. In these situations, there should still be regular review with the aim of reducing or stopping, and the best methods of ensuring continuity of supply should be negotiated between all healthcare professionals involved in that patient’s care. |
Yes | Red | For new patients only. Local commissioning arrangements may vary and in some localities this remains an amber drug so please check with your locality. |
ICS | |
| Risperidone | 4 | Atypical antipsychotics (oral)
All other unlicensed indications |
Yes | Red | ICS | ||
| Risperidone | 4 | Atypical antipsychotics (oral) - Licensed Indications and also Unlicensed indications as recommended by NICE guidance (i.e. in psychotic depression or anxiety in bipolar patients).Red if no SCP | Yes | Amber | ICS | ||
| Risperidone (Risperdal Consta®) | 4 | Antipsychotic depot injection (schizophrenia) Only for those patients who are stable and if SCP available; or if under the care of a community psychiatric nurse. In some localities there may be commissioning arrangements in place to permit step down. |
Yes | Amber | Shared care protocol: risperidone long-acting antipsychotic injection |
ICS | |
| Ritonavir | 5 | HIV medicines. | Yes | Red | NHSE | ||
| Rituximab | 10 | Biologics/cytokine modulators | Yes | Red | NHSE-commissioned for:
|
ICS | |
| Rivaroxaban | 2 | Coronary artery disease & symptomatic peripheral artery disease (CAD/PAD) | Yes | Green (specialist advice) | ICS | Mar 2020 | |
| Rivaroxaban | 2 | All licensed indications except CAD/PAD. As per NICE guidance | Yes | Green | ICS | ||
| Rivastigmine | 4 | Dementia, including Alzheimer's disease and dementia with Lewy bodies. See NICE NG97 | Yes | Green (specialist advice) | Local commissioning arrangements may vary and in some localities this is green on specialist advice so please check with your locality. |
ICS | |
| Roflumilast (Daxas) | 3 | COPD | Yes | Green (specialist initiation) | ICS | Mar 2020 | |
| Romosozumab | 6 | Severe osteoporosis | Yes | Red | ICS | Nov 2022 | |
| Ropinirole | 4 | Antiparkinson's drugs, as per NICE guidance | Yes | Green (specialist advice) | ICS | ||
| Rotigotine | 4 | Antiparkinson's drugs, as per NICE guidance For use when more established oral dopamine agonists are ineffective or swallowing problems are present. |
Yes | Green (specialist advice) | ICS | ||
| Roxadustat | 9 | Symptomatic anaemia in CKD | Yes | Red | NICE TA807: Roxadustat for treating symptomatic anaemia in chronic kidney disease |
ICS | Dec 2022 |
| Rubefacients | 10 | Criterion 1 Topical rubefacient products may contain nicotinate and salicylate compounds, essential oils, capsicum, and camphor. Topical NSAID preps or capsaicin preps are not rubefacients. |
DNP | DNP | NICE do not do: Do not offer rubefacients for treating osteoarthritis. Rubefacients are not recommended for the treatment of osteoarthritis. |
||
| Rufinamide | 4 | Lennox Gastaut Criterion 2 Only for use as an adjunct in patients who have failed treatment with, or are intolerant of, alternative traditional antiepileptic drugs. |
Grey | Green (specialist initiation) | ICS | ||
| Sacubitril/valsartan (Entresto) | 2 | Heart failure | Yes | Green (specialist initiation) | ICS | ||
| Safinamide | 4 | Parkinson's disease | Yes | Green (specialist advice) | ICS | ||
| Salbutamol injection | 3 | Severe or life-threatening acute asthma | Red | ICS | |||
| Sapropterin | 9 | Agents for the treatment of metabolic disorders | Red | NICE TA729: Sapropterin for treating hyperphenylalaninaemia in phenylketonuria |
NHSE | ||
| Saquinavir | 5 | HIV medicines. | Yes | Red | NHSE | ||
| Sarilumab | 10 | Biologics/cytokine modulators | Yes | Red | ICS | ||
| Saxagliptin | 6 | Gliptins (DPP-4 Inhibitors). As per NICE guidance. |
Yes | Green | ICS | ||
| Secukinumab | 13 | Moderate to severe plaque psoriasis | Yes | Red | ICS | ||
| Selegiline | 4 | Antiparkinson's drugs, as per NICE guidance | Yes | Green (specialist advice) | ICS | ||
| Selumetinib | 8 | Plexiform neurofibromas associated with type 1 neurofibromatosis | Red | NHSE | Sep 2022 | ||
| Semaglutide | 6 | GLP-1 agonists
As per NICE guidance |
Yes | Green | ICS | Feb 2019 | |
| Semaglutide (oral, Rybelsus®) | 6 | For patients requiring a GLP1RA, as per NICE NG28, when an oral option is required. Where a patient expresses a preference for the oral option, prescribers should discuss that there are injectable options in the same class with proven cardiovascular benefit. | Yes | Green | An agent with proven cardiovascular benefit would be preferable to oral semaglutide in patients with established cardiovascular disease or high cardiovascular risk. This includes all patients with diabetes of 10 years duration plus one other risk factor (e.g. age over 50, hypertension, dyslipidaemia, smoking, or obesity). |
ICS | Jan 2021 |
| Semaglutide (Wegovy) | 4 | For management of overweight and obesity. For prescribing by specialist weight management services only. |
Yes | Red | ICS | Aug 2023 | |
| Setmelanotide | 1 | Obesity caused by LEPR or POMC deficiency | Red | HST21: Setmelanotide for treating obesity caused by LEPR or POMC deficiency |
NHSE | Dec 2022 | |
| Sevelamer | 9 | Phosphate binding agent in both dialysis and non-dialysis patients | Yes | Green (specialist initiation) | NHSE | ||
| Sildenafil | 2 | Pulmonary hypertension. | Red | NHSE | |||
| Sildenafil | 10 | Digital ulcers | No | Green (specialist initiation) | Off-label indication |
ICS | |
| Sildenafil | 7 | Erectile dysfunction | Yes | Green | ICS | ||
| Silk garments (Dermasilk®, Dreamskin®, Skinnies Silk®) | 13 | Criterion 1 | DNP | DNP | |||
| Simple eye ointment | 11 | Criterion 3 | DNP | DNP | Nov 2022 | ||
| Simvastatin/ ezetimibe combination product (Inegy®) | 2 | Criterion 2 | DNP | DNP | |||
| Sirolimus | 8 | Post transplant use | Amber | To remain amber until repatriation occurs |
ICS | ||
| Sitagliptin | 6 | Gliptins (DPP-4 Inhibitors).
As per NICE guidance. |
Yes | Green | ICS | ||
| Sodium benzoate | 9 | Agents for the treatment of metabolic disorders | Red | NHSE | |||
| Sodium chloride 5% eye drops | 11 | Corneal odema (short-term use) | Yes | Red | ICS | ||
| Sodium fusidate (oral formulations) | 5 | No | Green (specialist advice) | Green following microbiologist advice. |
ICS | Jul 2019 | |
| Sodium hyaluronate bladder instillations (Cystistat®, medical device) | 7 | Research context only | Red | ICS | |||
| Sodium oxybate (Xyrem®) | 4 | Narcolepsy with cataplexy in adult patients. Criterion 2 Only for use in adult patients who have received and benefited from treatment with sodium oxybate as commissioned by NHS England, i.e. continuing treatment in those >19 years old. |
Grey | Red | ICS | ||
| Sodium phenylbutyrate | 9 | Agents for the treatment of metabolic disorders | Red | NHSE | |||
| Sodium valproate | 4 | Antiepileptic drugs, as per NICE guidance | Yes | Green (specialist advice) | NICE CG137: epilepsies, diagnosis and management |
ICS | |
| Sodium valproate | 4 | Treatment of manic episodes associated with bipolar disorder | Yes | Green (specialist initiation) | ICS | ||
| Sodium zirconium cyclosilicate | 9 | Hyperkalaemia | Yes | Amber | ICS | Jul 2020 | |
| Solriamfetol | 4 | Obstructive sleep apnoea | DNP | DNP | Sep 2022 | ||
| Solriamfetol | 4 | Excessive daytime sleepiness caused by narcolepsy | Yes | Red | NICE TA758: Solriamfetol for treating excessive daytime sleepiness caused by narcolepsy |
ICS | May 2022 |
| Sore throat – acute (OTC/self care) | 12 | Criterion 3 For example: sore throat lozenges and sprays, analgesics |
DNP | DNP | For further information, including details of exceptions, see Commissioning Statement |
Oct 2019 | |
| Sotrovimab | 5 | COVID-19 | Yes | Red | NG191: COVID-19 rapid guideline: managing COVID-19 COVID-19 antivirals: reporting to the UK COVID-19 Antivirals Pregnancy Registry |
ICS | May 2022 |
| 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 |
NHSE | ||
| Stanozolol | 6 | Prophylaxis of hereditary angioedema | Red | ICS | |||
| Stavudine | 5 | HIV medicines. | Yes | Red | NHSE | ||
| Steroid preservative-free eye drops | 11 | Local inflammation of eye (short-term use) | Yes | Green (specialist initiation) | ICS | ||
| Stiripentol | 4 | Criterion 3 To be used only for the treatment of Dravet Syndrome and SCN1A variant epilepsy. |
Grey | Red | ICS | Sep 2019 | |
| Stoma appliances deodorants | 1 | Criterion 3 | DNP | DNP | Should not be required if pouch is correctly fitted. No odour should be apparent except when bag is emptied or changed. |
||
| Streptokinase | 2 | Fibrinolytics | Red | ICS | |||
| Streptomycin | 5 | Tuberculosis, antibiotic therapy. | Yes | Red | NHSE – drug resistant TB only. Local commissioning arrangements may vary. |
NHSE | |
| Strontium | 6 | Osteoporosis | Yes | Red | For new patients only |
ICS | |
| Sucralfate oral suspension | 1 | For prophylaxis and treatment of gastrointestinal disorders | Yes | Green (specialist initiation) | ICS | Dec 2020 | |
| Sucroferric oxyhydroxide | 9 | Phosphate binding agent in both dialysis patients | Red | NHSE | |||
| Sufentanil sublingual tablet system (Zalviso®▼) | 4 | Criterion 2 | DNP | DNP | |||
| Sulfasalazine | 10 | DMARDs | Yes | Amber | Shared care protocols available for:
|
ICS | |
| Sun protection (except when prescribed within ACBS criteria) (OTC/self care) | 13 | Criterion 3 For example: sun creams such as Uvistat, Sunsense, etc. |
DNP | DNP | For further information, including details of exceptions, see Commissioning Statement |
Oct 2019 | |
| Sunburn due to excessive sun exposure (OTC/self care) | 13 | Criterion 3 For example: emollients, oral and topical antihistamines, analgesics |
DNP | DNP | For further information, including details of exceptions, see Commissioning Statement |
Oct 2019 | |
| Sweating – excessive (hyperhidrosis) (OTC/self care) | 13 | Criterion 3 For example: aluminium chloride 20% solutions (e.g. Driclor, Anhydrol Forte) |
DNP | DNP | For further information, including details of exceptions, see Commissioning Statement |
Oct 2019 | |
| Synovial fluid injections including hyaluronan and sodium hyaluronate injection | 10 | Criterion 1 | DNP | DNP |
GM EUR policy: Hyaluronic Acid Injections for Osteoarthritis |
||
| Tacrolimus | 8 | Post transplant use | Amber | To remain amber until repatriation occurs |
NHSE | ||
| Tacrolimus ointment | 13 | Eczema and psoriasis | Yes | Green (specialist advice) | ICS | ||
| Tadalafil | 7 | Treatment of erectile dysfunction | Yes | Green | ICS | Sep 2018 | |
| Tadalafil | 2 | Pulmonary hypertension. | Red | NHSE | |||
| Tadalafil – Once Daily | 7 | Criterion 2 | DNP | DNP | See NHS England guidance on items not for routine prescribing in primary care |
||
| Tamoxifen | 8 | Hormone antagonists for treatment of breast cancer, and chemoprevention in women at moderate or high risk. | Yes | Green (specialist advice) | ICS | ||
| Tapentadol (Palexia®) | 4 | Criterion 2 Use of this agent should be restricted to those patients requiring treatment of severe chronic pain which cannot be managed with more established opioid therapies. Prescribers are reminded that GMMMG does not recommend the use of tapentadol over more established opioid therapies |
Grey | Green (specialist advice) | ICS | ||
| Teduglutide | 1 | Short bowel syndrome | Yes | Red | NHSE | Nov 2022 | |
| Teething/mild toothache (OTC/self care) | 4 | Criterion 3 For example: teething gels, paracetamol, ibuprofen |
DNP | DNP | For further information, including details of exceptions, see Commissioning Statement |
Oct 2019 | |
| Telaprevir | 5 | Hepatitis C | Yes | Red | NHSE | ||
| Telbivudine | 5 | Antivirals for treatment of Hepatitis B | Red | NHSE | |||
| Tenecteplase | 2 | Fibrinolytics | Red | ICS | |||
| Tenofovir | 5 | Antivirals for treatment of Hepatitis B | Red | NHSE | |||
| Tenofovir | 5 | HIV medicines. | Red | NHSE | |||
| Terbutaline injection | 3 | Yes | Red | ICS | Mar 2019 | ||
| Teriflunomide | 8 | Multiple sclerosis | Red | NHSE | |||
| Teriparatide | 6 | Osteoporosis | Yes | Red | ICS | ||
| Testosterone | 6 | Criterion 3. Tostran, Testogel, Testim 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 advice) | Tostran comes in a multi-dose canister providing measured doses, thus may more easily allow administration of lower doses. MHRA advice: Topical testosterone (Testogel): risk of harm to children following accidental exposure. |
ICS | Jul 2020 |
| Testosterone patches (Intrinsa®) | 6 | Criterion 1 | DNP | DNP | |||
| Testosterone products | 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 advice: Topical testosterone (Testogel): risk of harm to children following accidental exposure. |
NHSE | ||
| Testosterone products | 6 | Licensed indications in men | Yes | Green (specialist advice) | MHRA advice: Topical testosterone (Testogel): risk of harm to children following accidental exposure. |
ICS | |
| Tetrahydrobiopterin | 9 | Agents for the treatment of metabolic disorders | Red | NHSE | |||
| Tezepelumab | 3 | Severe asthma | Yes | Red | NHSE | Sep 2023 | |
| 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) | ICS | ||
| Ticagrelor | 2 | Acute coronary syndromes | Yes | Green (specialist initiation) | ICS | ||
| Tildrakizumab | 13 | Biologics/cytokine modulators | Yes | Red | ICS | Jul 2019 | |
| Tinzaparin | 2 | See entries for Low Molecular Weight Heparins (dalteparin, enoxaparin, tinzaparin) | Yes | Other | ICS | ||
| Tipranavir | 5 | HIV medicines. | Yes | Red | ICS | ||
| Tirzepatide | 6 | Type 2 diabetes mellitus Tirzepatide (Mounjaro®) is not approved by GMMMG. NICE guidance is expected in August 2023. Tirzepatide should be considered non-formulary/ not approved until guidance is available. |
No | Other | Dec 2022 | ||
| Tizanidine | 10 | Treatment of spasticity. | Yes | Green (specialist initiation) | ICS | ||
| Tobramycin | 5 | Inhaled or nebulised for cystic fibrosis patients | Yes | Red | NHSE | ||
| Tocilizumab | 10 | Biologics/cytokine modulators | Yes | Red | ICS | ||
| Tofacitinib | 10 | Biologics/cytokine modulators | Yes | Red | ICS | ||
| Tolcapone | 4 | Antiparkinson's drugs, as per NICE guidance | Red | ICS | |||
| Tolvaptan | 6 | Autosomal dominiant polycystic kidney disease | Yes | Red | Not routinely commissioned. |
NHSE | |
| Tolvaptan | 6 | SIADH in patients requiring chemotherapy | Yes | Red | NHSE | ||
| Tolvaptan | 6 | SIADH in patients NOT requiring chemotherapy | Yes | Red | ICS | ||
| Topical anaesthetics for premature ejaculation | 7 | Criterion 1 Licensed and off-label preparations |
DNP | DNP | Jun 2019 | ||
| Topical gabapentin (unlicensed) | 4 | Criterion 1 | DNP | DNP | |||
| Topiramate | 4 | Antiepileptic drugs, as per NICE guidance | Yes | Green (specialist advice) | ICS | ||
| Topiramate | 4 | Prophylaxis of migraine | Yes | Green | ICS | Jun 2022 | |
| Topiramate sprinkle capsules | 4 | Criterion 2 Topiramate tablets are formulary choice and should be used where possible. For those patients unable to swallow tablets 'sprinkle capsules' may be considered. Do not prescribe 'hard capsules' due to high cost. |
Grey | Other | RAG status depends on indication: see other RAG list entries |
ICS | |
| Tralokinumab | 13 | Biologics/cytokine modulators | Yes | Red | ICS | Jan 2023 | |
| 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 |
NHSE | ||
| Tranylcypromine | 4 | Non-reversible MAOI | Red | For new patients only |
ICS | ||
| Travel sickness (OTC/self care) | 4 | Criterion 3 For example: cinnarizine, hyoscine, promethazine |
DNP | DNP | For further information, including details of exceptions, see Commissioning Statement |
Oct 2019 | |
| Travel Vaccines (vaccines administered exclusively for the purposes of travel) | 14 | Criterion 3 Hepatitis B, Japanese Encephalitis, Meningitis ACWY, Yellow Fever, Tick-borne encephalitis, Rabies, BCG Not to be prescribed on the NHS solely for the purposes of travel; only to be prescribed for other indications, as outlined in Immunisation Against Infectious Disease – the Green Book |
Grey | Green | See NHS England guidance on items not for routine prescribing in primary care |
ICS | |
| Triamcinolone intramuscular injection (Kenalog) | 3 | For treatment of allergic rhinitis | Yes | Red | ICS | Sep 2019 | |
| Trientine | 9 | Agents for the treatment of metabolic disorders (Wilson's disease) | Red | Dihydrochloride or tetrahydrochloride (Cuprion®) |
NHSE | ||
| Trifarotene | 13 | Acne | Yes | Green | ICS | May 2023 | |
| Trifluorothymidine eye drops | 11 | Anti-infective eye preparations | Yes | Red | ICS | ||
| Trimipramine | 4 | Criterion 2 | DNP | DNP | See NHS England guidance on items not for routine prescribing in primary care |
||
| Triptorelin | 6 | For all other unlicensed indications (including testosterone castration in sex offenders) and licensed indications without a shared care protocol | Red | ICS | |||
| Triptorelin | 6 | Licensed Indications. | Amber | Shared care protocol available for LHRH analogues for treatment of prostate cancer in adults |
ICS | ||
| Triptorelin | 6 | Transgender use of hormone therapy, as per NHSE shared care arrangements | Amber | GnRH analogues for patients aged 17 years or over under Indigo Gender Service NHSE Gender Dysphoria Clinical Programme |
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 |
NICE NG88: Heavy menstrual bleeding: assessment and management |
ICS | Oct 2021 |
| Upadacitinib | 10 | Biologics/cytokine modulators | Yes | Red | TA665: severe rheumatoid arthritis TA744: moderate rheumatoid arthritis TA814: moderate to severe atopic dermatitis TA856: moderately to severely active ulcerative colitis TA829: active ankylosing spondylitis TA861: active non-radiographic axial spondyloarthritis
|
ICS | Jan 2021 |
| Urokinase | 2 | Fibrinolytics | Red | ICS | |||
| Ustekinumab | 13 | Psoriasis | Yes | Red | ICS | ||
| Valganciclovir | 5 | Cytomegalovirus | Red | NHSE | |||
| Valproic acid | 4 | Treatment of manic episodes associated with bipolar disorder | No | Green (specialist initiation) | ICS | ||
| Vancomycin (oral) | 5 | First line for severe or recurrent C. diff only. To be used on advice of microbiology for other indications. | Yes | Green | ICS | ||
| Varicella zoster vaccine (Zostavax) | 14 | When used outside the national vaccination programme. In patients who are eligible to receive vaccination outside of the national vaccination programme (e.g. due to receiving chemotherapy or immunosuppressant therapy) it is the responsibility of the specialist service to administer vaccination; there is no route of reimbursement if administered in primary care |
Red | Commissioner depends on indication |
ICS or NHSE |
Mar 2020 | |
| Vedolizumab | 1 | Ulcerative colitis and Crohn's disease | Yes | Red | ICS | ||
| Venlafaxine (doses ≥300mg only) | 4 | Major depressive episodes. Daily doses ≥300mg to be initiated by a specialist; lower doses suitable for primary care initiation. Regular BP monitoring required - see SPC. | Yes | Green (specialist initiation) | ICS | ||
| Verapamil | 4 | Cluster headache - prophylaxis | Yes | Green (specialist advice) | Off-label indication |
ICS | |
| Verteporfin | 11 | Ophthalmic indications | Red | ICS | |||
| Vigabatrin | 4 | Antiepileptic drugs, as per NICE guidance | No | Red | ICS | ||
| Vitamin B compound strong | 9 | Criterion 1 Should only be used on the advice of a dietician for medically diagnosed deficiency, or in secondary care to prevent "re-feeding syndrome" Where a vitamin B compound is indicated, only vitamin B compound strong should be prescribed. |
Grey | Green (specialist initiation) | ICS | ||
| Vitamins, minerals and antioxidants | 9 | Criterion 3. When used for supplementation in people who have no clinical indication for use |
DNP | DNP | |||
| 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 | NHSE | Mar 2020 | ||
| Voriconazole | 5 | Antifungal | Yes | Red | For chronic pulmonary aspergillosis (CPA) as per highly specialised criteria only. |
NHSE | |
| Vortioxetine | 4 | Depression Criterion 1 Only for treatment of major depressive episode in adults whose condition has responded inadequately to 2 antidepressants within the current episode |
Grey | Green (specialist advice) | ICS | ||
| VSL#3® and Vivomixx® | 1 | Criterion 1 | DNP | DNP | Jun 2019 | ||
| Vutisiran | 9 | Hereditary transthyretin-related amyloidosis | Red | NICE TA868: Vutrisiran for treating hereditary transthyretin-related amyloidosis |
NHSE | Jun 2023 | |
| Warts and verrucae (OTC/self care) | 13 | Criterion 3 For example: salicylic acid-containing products, glutaraldehyde |
DNP | DNP | For further information, including details of exceptions, see Commissioning Statement |
Oct 2019 | |
| Yohimbine | 6 | Criterion 1 | DNP | DNP | |||
| Zanamivir solution for infusion | 5 | Red | Mar 2020 | ||||
| Zidovudine | 5 | HIV medicines. | Yes | Red | NHSE | ||
| Zidovudine with lamivudine | 5 | HIV medicines. | Yes | Red | NHSE | ||
| Zoledronic acid | 6 | IV Bisphosphonate | Yes | Red | ICS | ||
| Zonisamide | 4 | Prophylaxis of migraine (off-label indication) | Yes | Green (specialist advice) | If intolerant of topiramate |
ICS | Jun 2022 |
| Zonisamide | 4 | Antiepileptic drugs, as per NICE guidance | Yes | Green (specialist advice) | ICS | ||
| Zuclopenthixol acetate (Clopixol accuphase) | 4 | Antipsychotic injection | Red | ||||
| Zuclopenthixol decanoate | 4 | Antipsychotic depot injection (schizophrenia)
Only for those patients who are stable and if SCP available, or if under the care of a community psychiatric nurse. In some localities there may be commissioning arrangements in place to permit step down. |
Yes | Amber | Shared care protocol: First generation (typical) antipsychotic depots in adults |
ICS |