Red Amber Green Classifications

Classification Guidance
Red

Drugs considered to be specialist medicines and prescribing responsibility for these medicines should normally remain with the consultant or specialist clinician. These drugs should not be initiated or prescribed in primary care. It is recommended that the supply of these specialist medicines should be organised via the hospital pharmacy or specialist service. This may include arranging for supply via a home care company.

Amber

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

Green

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

Green (specialist initiation)

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

Green (specialist advice)

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

DNP

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

Grey

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

Other

Criteria for inclusion on DNP/grey lists:

  • Criterion 1: Products of low clinical effectiveness, where there is a lack of robust evidence of clinical effectiveness or there are significant safety concerns.
  • Criterion 2: Products which are clinically effective but where more cost-effective products are available, including products that have been subject to excessive price inflation.
  • Criterion 3: Products which are clinically effective but, due to the nature of the product or condition being treated, are deemed a low priority for NHS funding.
Drug (proprietary examples) BNF chapter Indications and rationale Formulary drug RAG status Information Responsible commissioner Date added
Alpha-1 antitrypsin 9 Alpha-1 anti-trypsin deficiency: Type 1 diabetes mellitus in children. Red NHSE
Amiodarone 2 Blank Red CCG
Amisulpride 4 Atypical antipsychotics (Oral) use in children. Licensed Indications & unlicensed indications supported by NICE. Blank Amber CCG
Amisulpride 4 Atypical antipsychotics (Oral). All other unlicensed indications incl short-term use. Blank Red CCG
Antipsychotics 4 When used by the eating disorder service Blank Red CCG
Aripiprazole 4 Atypical antipsychotics (Oral) use in children. Licensed Indications & unlicensed indications supported by NICE. Blank Amber

Shared care protocols available for:
– bipolar disorder
– OCD
– Psychosis and schizophrenia

CCG
Aripiprazole 4 Atypical antipsychotics (Oral). All other unlicensed indications incl short-term use. Blank Red CCG
Aripiprazole 4 Tourette's Syndrome and other tic disorders in children and adolescents Blank Red

For new patients only

CCG
Atomoxetine 4 ADHD amber once patient stabilised Blank Amber

Shared care protocol: Atomoxetine for ADHD in children and adolescents

CCG
Azathioprine 1 Inflammatory bowel disease Blank Amber

Shared care protocol: Azathioprine for IBD in paediatrics

CCG
Aztreonam lysine nebules 5 Cystic fibrosis April 13: commissioned by NHS England Blank Red NHSE
Betaine 9 Homocystinuria Blank Red NHSE
Highly
specialised
criteria only
Ciclosporin 8 Childhood nephrotic syndrome Red NHSE
Ciclosporin 0.1% eye drops (Verkazia®) 11 For treatment of vernal keratoconjunctivitis in patients aged 4 to 18 years old and who are subject to active follow-up (e.g. reviewed every 6 months) Blank Green (specialist initiation) CCG
Citalopram 4 For use in paediatric indications where a shared care protocol is available. Blank Amber

Shared care protocols available for:

  • OCD and body dysmorphic disorder
  • anxiety disorders
  • depression
CCG
Clobazam 4 Antiepileptic. As per NICE guidance Blank Green (specialist advice) CCG
Clonazepam 4 Antiepileptic. As per NICE guidance Blank Green (specialist advice) CCG
Clonidine 4 Tourette's Syndrome and other tic disorders in children and adolescents Blank Red

For new patients only

CCG
Clozapine 4 Atypical antipsychotics (Oral) use in children Blank Red CCG
Colistimethate – nebulised 5 Colomycin®, Promixin® for cystic fibrosis Blank Red

For new patients

NHSE
Dexamfetamine 4 ADHD amber once patient stabilised Blank Amber

Shared care protocol: Dexamfetamine for ADHD in children and adolescents

CCG
Domperidone 1 Gastro indications Blank Amber

Shared care protocol: Domperidone for Paediatric Gastro-oesophageal Reflux Disease (GORD)

CCG
Dornase alfa (Pulmozyme®) 3 Cystic fibrosis Blank Amber NHSE
Emollient bath additives 13 Criterion 1
When used for the management of eczema in children. This recommendation does not apply to the use of standard emollients when used in the bath as a soap substitute
DNP DNP
Emollient bath additives containing antimicrobials 13 Criterion 1
Only for short term use in patients with infected eczema
Grey Green CCG
Ethinylestradiol (tablets) 6 Pubertal induction for use only when estradiol matrix patches are unsuitable or not tolerated Grey Amber

Shared care protocol: Ethinylestradiol for the induction of delayed puberty

CCG
Flecainide 2 For use in paediatric patients, although unlicensed in children - well established therapy and in the children's BNF. Blank Red

RED until patient stabilised, then GREEN

CCG
Fluoxetine 4 For use in paediatric indications where a shared care protocol is available. Blank Amber

Shared care protocols available for:

  • SSRIS for the treatment of OCD and body dysmorphic disorder in children and adults
  • SSRIs for the treatment of anxiety disorders in children and adolescents
  • SSRIs for the treatment of depression in children and adolescents
CCG
Fluvoxamine 4 For use in paediatric indications where a shared care protocol is available. Blank Amber

Shared care protocols available for:

  • SSRIS for the treatment of OCD and body dysmorphic disorder in children and adults
  • SSRIs for the treatment of anxiety disorders in children and adolescents
CCG
Goserelin 6 Precocious puberty Blank Red CCG
Growth Hormone (Somatropin) 6 For children. Blank Amber

Shared care protocol: Growth hormone in paediatrics

CCG
Guanfacine 4 ADHD Blank Amber

Shared care protocol: Guanfacine for childhood and adolescent ADHD

CCG
Haloperidol 4 Tourette's Syndrome and other tic disorders in children and adolescents Blank Red

For new patients only

CCG
Hydrocortisone granules (Alkindi) 6 For management of adrenal insufficiency, only in patients requiring doses <5mg. Alkindi should not be used in combination with hydrocortisone tablets to make up dose increments ≥5mg. Grey Green (specialist initiation)

MHRA advice: risk of acute adrenal insufficiency in children when switching from hydrocortisone tablet formulations to granules

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

Commissioner depends on drug and indication

CCG or
NHSE
Leuprorelin 6 Precocious puberty Blank Red CCG
Lisdexamfetamine 4 ADHD amber once patient stabilised (> 3 months) Blank Amber

Shared care protocol: Lisdexamfetamine for ADHD in children and adolescents

CCG
Lithium 4 Paediatric use Blank Red CCG
Melatonin 4 Sleep disorders, ADHD. Unlicensed specials only to be used in exceptional circumstances. Doses greater than 6mg are RED Blank Amber

Shared care protocol: Melatonin for children and adolescents

CCG
Melatonin 1 mg/mL oral solution (Colonis brand licensed product) 4 Not suitable for use in children and adolescents aged 0-18 due to safety & efficacy concerns. DNP DNP

See summary of product characteristics

Metformin 6 Type 2 diabetes Blank Green (specialist initiation) CCG
Methylphenidate 4 ADHD amber once patient stabilised Blank Amber

Shared care protocol: Methylphenidate for ADHD in children and adolescents

CCG
Midazolam (buccal) 4 Epilepsy Green (specialist initiation) CCG
Modafinil 4 Sleepiness associate with narcolepsy Blank Red CCG
Nadolol 2 Prolonged QT syndrome Blank Red CCG
Nutritional Supplement Drinks 9 When used by the eating disorder service Blank Green CCG
Olanzapine 4 Atypical antipsychotics (Oral). Licensed Indications & unlicensed indications supported by NICE. Blank Amber

Shared care protocols available for:

  • bipolar disorder
  • OCD
  • Psychosis and schizophrenia
CCG
Olanzapine 4 Atypical antipsychotics (Oral). All unlicensed indications not supported by NICE, including eating disorders. Blank Red CCG
Omalizumab 3 Severe chronic spontaneous urticaria Blank Red CCG
Omalizumab 3 Allergic asthma prophylaxis. Blank Red NHSE
Omeprazole MUPS tablets 1 GORD Blank Green

Medicines for children: omeprazole for GORD

nhs.uk: how to help a choking child

CCG
Paliperidone 4 Atypical antipsychotics (Oral) use in children. Licensed Indications & unlicensed indications supported by NICE. Blank Red

Pending production of a shared care protocol

CCG
Paliperidone 4 Atypical antipsychotics (Oral). Unlicensed indications not supported by NICE Blank Red CCG
Palivizumab 5 RSV Blank Red NHSE
Paraldehyde 4 Status epilepticus Blank Red CCG
Poractant alfa (Curosurf®) 3 Pulmonary surfactant Blank Red NHSE
Potassium Phosphate 9 When used by the eating disorder service Blank Red CCG
Quetiapine 4 Atypical antipsychotics (Oral) use in children. Licensed Indications & unlicensed indications supported by NICE. Blank Amber

Shared care protocols available for:

  • Bipolar disorder
  • OCD
  • Psychosis and   schizophrenia
CCG
Quetiapine 4 Atypical antipsychotics (Oral). All other unlicensed indications incl short-term use. Blank Red CCG
Risperidone 4 Atypical antipsychotics (Oral) use in children. Licensed Indications & unlicensed indications supported by NICE. Blank Amber

Shared care protocols available for:

  • Bipolar disorder
  • OCD
  • Psychosis and   schizophrenia
CCG
Risperidone 4 Atypical antipsychotics (Oral). All other unlicensed indications incl short-term use. Blank Red CCG
Risperidone 4 Tourette's Syndrome and other tic disorders in children and adolescents Blank Red

For new patients only

CCG
Sertraline 4 For use in paediatric indications where a shared care protocol is available. Blank Amber

Shared care protocols available for:

  • depression
  • anxiety disorders
  • OCD & body dysmorphic disorder
CCG
SSRIs 4 When used by the eating disorder service Blank Amber CCG
Stiripentol 4 Paediatric patients Blank Red CCG
Sulpiride 4 Tourette's Syndrome and other tic disorders in children and adolescents Blank Red

For new patients only

CCG
Testosterone injection 6 Delayed puberty Blank Green (specialist initiation) CCG
Tobramycin – nebulised 5 Tobi®, Bramitob® for cystic fibrosis Red

For new patients

NHSE
Triptorelin 6 Precocious puberty Red CCG