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 Formulary Chapter 13: Skin - Full Chapter
13.05.03  Expand sub section  Drugs affecting the immune response
Adalimumab (Humira®)
(Dermatology)
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Red
High Cost Medicine
BlueTeq

For the treatment of:

    • Psoriasis as per NICE TA146 (APCO July 2008). For sequential use please refer to Clinical Commissioning Policy 266D (psoriasis) and Clinical Commissioning Policy 268A (psoriatic arthritis). 
    • Hidradenitis suppurativa as per NICE TA392 (APCO July 2016).
    • Plaque psoriasis in children and young people as per NICE TA455. Funded by specialised commissioning. (APCO September 2017).
 
Link  NICE TA146: Adalimumab for the treatment of adults with psoriasis
Link  NICE TA392: Adalimumab for treating moderate to severe hidradenitis suppurativa
Link  NICE TA455: Adalimumab, etanercept and ustekinumab for treating plaque psoriasis in children and young people
Link  MHRA: Tuberculosis risk—screen patients before starting treatment
   
Apremilast (Otezla®)
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Red
High Cost Medicine
BlueTeq

For the treatment of:

    • Moderate to severe plaque psoriasis as per NICE TA419 (APCO January 2017).
    • Active psoriatic arthritis as per NICE TA433 (APCO March 2017).

 

 
Link  NICE TA419: Apremilast for treating moderate to severe plaque psoriasis
Link  NICE TA433: Apremilast for psoriatic arthritis
Link  MHRA: Risk of suicidal thoughts and behaviour with apremilast
   
Cytotoxic Drug Azathioprine
(Dermatology)
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Amber Shared Care Protocol

In line with Shared Care Protocol.

APCO November 2011.

 
Link  UKMI Q&A: Can mothers breastfeed while taking azathioprine?
   
Brodalumab (Kyntheum®)
(Dermatology)
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Red
High Cost Medicine
BlueTeq

For treating moderate to severe plaque psoriasis, as per NICE TA511. 

 APCO May 2018. 

 
Link  NICE TA511: Brodalumab for treating moderate to severe plaque psoriasis
   
Ciclosporin
(Dermatology)
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Amber Shared Care Protocol

*Ciclosporin must be prescribed by BRAND NAME.*

In line with Shared Care Protocol for the treatment of:

    • Psoriasis plus other severe inflammatory skin disease
    • Atopic dermatitis

APCO May 2015.

 
Link  UKMI Q&A: Brand name prescribing in primary care
   
Dimethyl fumarate (Skilarence®)
(Psoriasis)
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Red
High Cost Medicine

For treating moderate to severe plaque psoriasis, as per NICE TA475

APCO November 2017. 

 
   
Dupilumab (Dupixent®)
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Red
High Cost Medicine
BlueTeq
  • For Eosinophilic asthma - FOC medicine following trial use in small group of patients (APCO September 2018).
  • For treating moderate to severe atopic dermatitis as per NICE TA534 (APCO May 2019).

 

 
Link  NICE TA534: Dupilumab for treating moderate to severe atopic dermatitis
   
Etanercept
(Dermatology)
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Red
High Cost Medicine
BlueTeq

For the treatment of:

    • Psoriasis as per NICE TA103.
    • Plaque psoriasis in children and young people as per NICE TA455. Funded by specialised commissioning. (APCO September 2017).

 

 
Link  NICE TA455: Adalimumab, etanercept and ustekinumab for treating plaque psoriasis in children and young people
   
Guselkumab (Tremfya®)
(Dermatology)
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Red
High Cost Medicine
BlueTeq

For treating moderate to severe plaque psoriasis as per NICE TA521.

APCO July 2018.

 
Link  NICE TA521: Guselkumab for treating moderate to severe plaque psoriasis
   
Hydroxychloroquine
(Dermatology)
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Amber Shared Care Protocol

For use in adult and paediatric dermatology in line with Shared Care Protocol.

Please see local position statement on Hydroxychloroquine and Retinopathy Screening.

APCO September 2019.

 
   
Infliximab (Remicade®)
(Dermatology)
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Red
High Cost Medicine
BlueTeq

For the treatment of adults with psoriasis as per NICE TA134. Also see Clinical Commissioning Policy 266D.

APCO March 2008.

 
Link  NICE TA134: Infliximab for psoriasis
Link  MHRA: Tuberculosis risk—screen patients before starting treatment
   
Cytotoxic Drug Methotrexate 2.5mg tablets
(Dermatology)
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Amber Shared Care Protocol

Only 2.5mg tablets should be prescribed and dispensed to avoid potentially fatal errors.

For use in adults and paediatrics line with Shared Care Protocol for:

  • Dermatology
  • Neurology
  • Gastroenterology
  • Respiratory

Rheumatology

For rheumatology please prescribe in line with Shared Care Protocol here. 

APCO September 2019

Opthalmology

For opthalmology (ocular inflammation) please prescribe in line with Shared Care Protocol here. 

APCO May 2019.

 
Link  UKMI Q&A: Methotrexate and alcohol guidance
Link  UKMI Q&A: What is the clinical significance of the interaction between methotrexate and penicillins?
   
Cytotoxic Drug Methotrexate injection (Metoject®)
(Dermatology)
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Amber Shared Care Protocol

*Metoject® injection is the first choice brand of injection which should be used in Oxfordshire*

For use in adults and paediatrics line with Shared Care Protocol for:

  • Dermatology
  • Neurology
  • Gastroenterology
  • Respiratory

Rheumatology

For rheumatology please prescribe in line with Shared Care Protocol here. 

APCO September 2019

Opthalmology

For opthalmology (ocular inflammation) please prescribe in line with Shared Care Protocol here. 

APCO May 2019.

 
   
Pimecrolimus 1% cream (Elidel®)
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Amber Continuation

For moderate atopic eczema on the face and neck of children aged 2-16 yrs in line with NICE TA82 in the following situations:

    • When children require long term or frequent use of mild topical steroids
    • For atopic eczema that has not been controlled by topical corticosteroids
    • If there is a risk of important adverse effects from topical corticosteroids.



Usually short term treatment, stop if no response after 6 weeks.

See Guidelines for the use of Corticosteroids in Atopic Eczema.

APCO July 2011. 

 
Link  NICE TA82: Pimecrolimus and tacrolimus for atopic dermatitis (eczema)
   
Risankizumab (Skyrizi®)
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Red

For treating moderate to severe plaque psoriasis as per NICE TA596. 

APCO September 2019.

 
Link  NICE TA596: Risankizumab for treating moderate to severe plaque psoriasis
   
Secukinumab (Cosentyx®)
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Red
High Cost Medicine
BlueTeq

For the treatment of:

    • Active ankylosing spondylitis as per NICE TA407 (APCO September 2015).
    • Moderate to severe plaque psoriasis as per NICE TA350 (APCO November 2016).
    • With Certolizumab pegol for treating active psoriatic arthritis after inadequate response to DMARDs as per NICE TA445 (APCO July 2017). Funded by specialised commissioning. 

 

 
Link  NICE TA350: Plaque Psoriasis
Link  NICE TA407: Secukinumab for active ankylosing spondylitis after treatment with non-steroidal anti-inflammatory drugs or TNF-alpha inhibitors
Link  NICE TA445: Certolizumab pegol and secukinumab for treating active psoriatic arthritis after inadequate response to DMARDs
   
Tacrolimus Ointment (Protopic®)
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Amber Continuation

Suitable for continuation in primary care following specialist initiation by a dermatologist for treating moderate to severe atopic dermatitis. 

Suitable for continuation in primary care following specialist initiation by a dermatologist for psoriasis of flexures/gentials in line with Psoriasis Treatment Pathway and NICE CG153.

APCO March 2018.

 
Link  NICE TA82: Pimecrolimus and tacrolimus for atopic dermatitis (eczema)
   
Tildrakizumab (Ilumetri®)
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Red
High Cost Medicine

For treating moderate to severe plaque psoriasis as per NICE TA575.

APCO May 2019.

 
Link  NICE TA575: Tildrakizumab for treating moderate to severe plaque psoriasis
   
Ustekinumab (Stelara®)
(Dermatology)
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Red
High Cost Medicine
BlueTeq

For the treatment of:

    • Moderate to severe psoriasis as per NICE TA180 (APCO May 2017). Also see Clinical Commissioning Policy 266D.
    • Plaque psoriasis in children and young people as per NICE TA455. Funded by specialised commissioning (APCO September 2017).

 

 
Link  MHRA: Risk of exfoliative dermatitis with ustekinumab
Link  NICE TA180: Psoriasis - ustekinumab
Link  NICE TA455: Adalimumab, etanercept and ustekinumab for treating plaque psoriasis in children and young people
   
 ....
 Non Formulary Items
Efalizumab  (Raptiva®)

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Non Formulary
Black

NICE has withdrawn its guidance on the use of efalizumab for the treatment of adults with psoriasis.

APCO March 2009.

 
  
Key
note Notes
Section Title Section Title (top level)
Section Title Section Title (sub level)
First Choice Item First Choice item
Non Formulary Item Non Formulary section
Restricted Drug
Restricted Drug
Unlicensed Drug
Unlicensed
Track Changes
Display tracking information
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Link to adult BNF
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Link to children's BNF
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Link to SPCs
SMC
Scottish Medicines Consortium
Cytotoxic Drug
Cytotoxic Drug
CD
Controlled Drug
High Cost Medicine
High Cost Medicine
Cancer Drugs Fund
Cancer Drugs Fund
NHSE
NHS England
Homecare
Homecare
CCG
CCG

Traffic Light Status Information

Status Description

Red

Red: Medicines which should only be prescribed in secondary care by a specialist.  

Amber Continuation

Amber Continuation: Medicines which should be initiated or recommended by a specialist for continuation in primary care. The specialist must notify the GP that the prescribing responsibility has been transferred.   

Amber Shared Care Protocol

Amber Shared Care Protocol: Medicines which are appropriate to be initiated and stabilised by a specialist, once stabilised the medicine may be appropriate for responsibility to be transferred from secondary to primary care with the agreement of a GP and a formal ‘shared care’ agreement. The shared care protocol must be approved by the Area Prescribing Committee Oxfordshire (APCO).   

Green

Green: Medicines which are suitable for initiation and ongoing prescribing within primary care.   

Brown

Brown: Medicines which should only be prescribed in restricted circumstances.  

Black

Black: Medicines which are not recommended for use because of lack of evidence of clinical effectiveness, cost effectiveness or safety.  

OCCG Green

not used  

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