| Formulary Chapter 14: Immunological products and vaccines - Full Chapter
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| Chapter Links... |
 HPA: Vaccine incident guidance (actions to take in response to vaccine errors) |
| MHRA: Live attenuated vaccines - Avoid use in those who are clinically immunosuppressed |
| Public Health England: Splenectomy, leaflet for patients |
| Public Health England: Splenectomy, patient alert card |
 Routine immunisation schedule from summer 2016 |
| The DoH Green book on Immunisation against infectious disease |
| Details... |
| 14.01 |
Active immunity |
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| 14.01 |
Immunisation schedule |
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| 14.02 |
Passive immunity |
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| 14.03 |
Storage and use |
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| 14.04 |
Vaccines and antisera |
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| 14.04 |
Anthrax vaccine |
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| 14.04 |
BCG vaccines |
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BCG vaccine diagnostic agent
(Tuberculline purified protein derivative (PPD))
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Formulary
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PHE: Advice on administering 2 live vaccines at the same time
Tuberculosis: The green book, chapter 32
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BCG vaccine Intradermal
(Bacillus calmette-guerin vaccine)
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Formulary
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PHE: Advice on administering 2 live vaccines at the same time
Tuberculosis: The green book, chapter 32
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| 14.04 |
Botulism antitoxin |
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Botulism antitoxin
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Formulary
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Secondary care use only: - Contains specific antitoxic globulins that have the power of neutralising the toxins formed by types A,B & E of Clostridium Botulinum.
- For post-exposure prophylaxis of botulism and for the treatment of persons thought to be suffering from botulism.
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| 14.04 |
Cholera vaccine |
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Cholera vaccine (Dukoral®)
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Formulary
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Cholera: the green book, chapter 14
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| 14.04 |
Diphtheria vaccines |
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Boostrix-IPV
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Formulary
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Contains: Diphtheria, tetanus, pertussis (acellular, component) and poliomyelitis (inactivated) vaccine (adsorbed, reduced antigen(s) content)
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Diphtheria: the green book, chapter 15
Pertussis: the green book, chapter 24
Polio: the green book, chapter 26
Tetanus: the green book, chapter 30
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Infanrix IPV®
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Formulary
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Contains: Diphtheria, tetanus, pertussis (acellular, component) and poliomyelitis (inactivated) vaccine (adsorbed).
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Diphtheria: the green book, chapter 15
Pertussis: the green book, chapter 24
Polio: the green book, chapter 26
Tetanus: the green book, chapter 30
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Infanrix-IPV+Hib®
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Formulary
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Contains: Diphtheria, tetanus, pertussis (acellular component), poliomyelitis (inactivated), and Haemophilus influenzae type b conjugate vaccine (adsorbed).
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Diphtheria: the green book, chapter 15
Haemophilus influenzae type b (Hib): the green book, chapter 16
Pertussis: the green book, chapter 24
Polio: the green book, chapter 26
Tetanus: the green book, chapter 30
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Pediacel®
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Formulary
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Contains: Diphtheria, Tetanus, Pertussis (Acellular, Component), Poliomyelitis (Inactivated) and Haemophilus Type b Conjugate Vaccine (Adsorbed)(DTaP/IPV/Hib).
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Diphtheria: the green book, chapter 15
Pertussis: the green book, chapter 24
Polio: the green book, chapter 26
Tetanus: the green book, chapter 30
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Repevax®
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Formulary
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Contains: Adsorbed Diphtheria [low dose], Tetanus, Pertussis (Acellular, Component) and Inactivated Poliomyelitis Vaccine (dTaP/IPV).
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Diphtheria: the green book, chapter 15
Pertussis: the green book, chapter 24
Polio: the green book, chapter 26
Tetanus: the green book, chapter 30
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Revaxis®
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Formulary
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Contains: Adsorbed Diphtheria [low dose], Tetanus and Inactivated Poliomyelitis (Td/IPV) vaccine
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Diphtheria: the green book, chapter 15
Pertussis: the green book, chapter 24
Polio: the green book, chapter 26
Tetanus: the green book, chapter 30
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| 14.04 |
Haemophilus influenzae type B vaccine |
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Haemophilus influenzae type B (Menitorix®)
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Formulary
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Haemophilus influenzae type b (Hib): the green book, chapter 16
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| 14.04 |
Hepatitis A vaccine |
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Hepatitis A vaccine Single Component (Avaxim®)
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Formulary
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Hepatitis A: the green book, chapter 17
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Hepatitis A vaccine Single Component (Epaxal®)
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Formulary
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Hepatitis A: the green book, chapter 17
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Hepatitis A vaccine Single Component (Havrix Monodose®)
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Formulary
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Hepatitis A: the green book, chapter 17
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Hepatitis A vaccine Single Component (Vaqta® Paediatric)
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Formulary
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Hepatitis A: the green book, chapter 17
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| 14.04 |
Hepatitis B vaccine |
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Hepatitis B vaccine Single Component (Fendrix®)
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Formulary
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Secondary care use only.
Funded by specialised commissioning.
APCO January 2021.
May not be available on the NHS if being given for travel.
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| 14.04 |
Human papilloma virus vaccine |
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Human papilloma virus vaccine (Gardasil®)
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Formulary
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Vaccine of choice for the national immunisation program as per Green Book.
For men who have sex with men (MSM). Prescribed by Specialist Sexual Health Services and HIV clinics. NHS E/PHE funded.
APCO September 2018.
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DoH: HPV vaccination and cervical cancer: addressing the myths
Human papillomavirus (HPV): the green book, chapter 18a
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Human papilloma virus vaccine (Cervarix®)
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Formulary
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DoH: HPV vaccination and cervical cancer: addressing the myths
Human papillomavirus (HPV): the green book, chapter 18a
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| 14.04 |
Influenza vaccine |
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Influenza vaccine
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Formulary
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Cost-effective brands include: - Enzira®: 2017 NHS price - £5.25.
- Influvac®: 2017 NHS Price - £5.22.
NB. Intanza® is black listed, see below for more details.
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Influenza: the green book, chapter 19
Public Health England: The national flu immunisation programme
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Live attenuated Influenza vaccine (Fluenz Tetra®)
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Formulary
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Part of national vaccination programme. Intranasal vaccine (Fluenz tetra®) is a live vaccine licensed for children aged 2-18ys and has different contraindications and precautions to vaccines given by injection, see SPC for more details. APCO September 2013.
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Public Health England: The national flu immunisation programme
Public Health England: Childhood flu programme: information for healthcare practitioners
PHE: Advice on administering 2 live vaccines at the same time
Influenza: the green book, chapter 19
Which flu vaccine should children have?
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| 14.04 |
Measles vaccine |
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| 14.04 |
Measles, Mumps and Rubella (MMR) vaccine |
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Measles, Mumps and Rubella Vaccine, Live (MMR)
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Formulary
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Measles: the green book, chapter 21
Mumps: the green book, chapter 23
Rubella: the green book, chapter 28
PHE: Advice on administering 2 live vaccines at the same time
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| 14.04 |
Meningococcal vaccines |
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Meningococcal A, C, W135, and Y conjugate vaccine (Menveo®)
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Formulary
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May not be available on the NHS if being given for travel.
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Meningococcal: the green book, chapter 22
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Meningococcal group B Vaccine (Bexsero®)
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Formulary
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For primary immunisation schedule and asplenia/hyposplenia schedules as per Green Book. For patients receiving eculizumab for atypical Haemolytic Uraemic Syndrome (aHUS).
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Meningococcal: the green book, chapter 22
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Meningococcal group C conjugate vaccine
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Formulary
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Brands include: Meningitec®, Menjugate Kit®, NeisVac-C®
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Meningococcal: the green book, chapter 22
Public Health England: Changes to the meningococcal C conjugate (MenC) vaccine schedule 2013 to 2015: advice for healthcare professionals
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Meningococcal polysaccharide A, C, W135 and Y vaccine (ACWY Vax®)
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Formulary
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May not be available on the NHS if being given for travel.
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Meningococcal: the green book, chapter 22
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| 14.04 |
Mumps vaccine |
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| 14.04 |
Pertussis vaccine |
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| 14.04 |
Pneumococcal vaccines |
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23-valent pneumococcal polysaccharide vaccine (Previously known as Pneumovax® II)
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Formulary
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Pneumococcal: the green book, chapter 25
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Pneumococcal polysaccharide conjugate vaccine (adsorbed) (Prevenar 13®)
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Formulary
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Pneumococcal: the green book, chapter 25
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| 14.04 |
Poliomyelitis vaccines |
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| 14.04 |
Rabies vaccine |
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Rabies vaccine
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Formulary
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May not be available on the NHS if being given for travel.
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HPA: Guidelines on managing rabies post-exposure prophylaxis
Rabies: the green book, chapter 27
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| 14.04 |
Rotavirus vaccine |
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Rotavirus vaccine (Rotarix®)
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Formulary
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Oral suspension.
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PHE: Advice on administering 2 live vaccines at the same time
Rotavirus: the green book, chapter 27b
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| 14.04 |
Rubella vaccine |
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| 14.04 |
Smallpox vaccine |
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| 14.04 |
Tetanus vaccines |
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| 14.04 |
Tick-borne encephalitis vaccine |
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| 14.04 |
Typhoid vaccines |
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Polysaccharide Typhoid Vaccine (Typherix®)
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Formulary
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Polysaccharide vaccine for injection (Typhim Vi®)
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Formulary
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Typhoid Live Oral vaccine (Vivotif®)
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Formulary
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| 14.04 |
Varicella-zoster vaccine |
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Varicella Zoster vaccine (Zostavax®)
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Formulary
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In the latest JCVI guidance and as part of national vaccination programme. APCO September 2013.
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Public Health England Q&A for healthcare professionals: Vaccination against shingles for adults aged 70 and 79
PHE: Advice on administering 2 live vaccines at the same time
Shingles: the green book chapter 28a
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Varicella-zoster vaccine (Varilrix®)
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Formulary
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PHE: Advice on administering 2 live vaccines at the same time
Varicella: the green book, chapter 34
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| 14.04 |
Yellow fever vaccine |
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| 14.05 |
Immunoglobulins |
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Rabies immunoglobulin
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Formulary
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For use following recommendation by a Microbiologist (Registrar or Consultant)
The requestor must use the PHE “Request form for Rabies Post Exposure Treatment”.
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HPA: Guidelines on managing rabies post-exposure prophylaxis
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| 14.05 |
Specific immunoglobulins |
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| 14.05 |
Interferons |
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INTERFERON GAMMA-1b (Immukin®)
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Formulary
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Prescribe by brand. Secondary care use only.
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| 14.05.01 |
Normal immunoglobulin |
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Normal immunoglobulin (Privigen®)
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First Choice
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Do not substitute brands in established patients, but use Privigen for newly initiated patients. Secondary care use only.
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Normal Immunoglobulin (Cuvitru®)
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Formulary
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Prescribe by brand.
Secondary care use only. NB. Replaces Subcuvia®.
APCO January 2018.
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Normal Immunoglobulin (Flebogamma® DIF)
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Formulary
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Prescribe by brand. Secondary care use only.
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Normal immunoglobulin (Gammanorm®)
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Formulary
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Prescribe by brand. Secondary care use only.
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Normal Immunoglobulin (Gammaplex®)
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Formulary
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Prescribe by brand. Secondary care use only.
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Normal Immunoglobulin (Gamunex®)
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Formulary
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Prescribe by brand.
Secondary care use only. Funded by specialised commissioning.
APCO November 2017.
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Normal Immunoglobulin (Hizentra®)
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Formulary
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Prescribe by brand. Secondary care use only.
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Normal Immunoglobulin (Intratect®)
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Formulary
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Prescribe by brand. Secondary care use only.
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Normal immunoglobulin (Iqymune®)
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Formulary
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Prescribe by brand.
Secondary care use only. Funded by specialised commissioning.
APCO November 2017.
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Normal Immunoglobulin (Kiovig®)
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Formulary
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Prescribe by brand. Secondary care use only.
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Normal Immunoglobulin (Octagam®)
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Formulary
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Prescribe by brand. Secondary care use only.
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Normal Immunoglobulin (Subgam®)
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Formulary
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Prescribe by brand. Secondary care use only.
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| 14.05.02 |
Disease-specific immunoglobulins |
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Hepatitis B immunoglobulin (HBIG)
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Formulary
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Secondary care use only.
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Immunoglobulin: when to use
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Tetanus immunoglobulin
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Formulary
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Secondary care use only.
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Immunoglobulin: when to use
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Varicella-Zoster immunoglobulin (VZIG)
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Formulary
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Varicella-zoster immunoglobulin (VZIG) prophylaxis is recommended for individuals who fulfil all of the following three criteria: - Significant exposure to chickenpox (varicella) or shingles (zoster) during the infectious period,
- At increased risk of severe chickenpox i.e. immunosuppressed individuals, neonates and pregnant women,
- No antibodies to varicella-zoster virus (VZV). Urgent VZV antibody testing can be performed within 24 hours.
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Immunoglobulin: when to use
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| 14.05.03 |
Anti-D (Rho) immunoglobulin |
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Anti-D (Rh0) Immunoglobulin
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Formulary
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For routine antenatal anti-D prophylaxis for RhD-negative women as per NICE TA156.
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NICE TA156: Anti-D in pregnant women
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| 14.06 |
International travel |
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| .... |
| Non Formulary Items |
Anthrax vaccine
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Non Formulary
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Diphtheria antitoxin
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Non Formulary
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Available from Centre for Infections (Tel (020) 8200 6868) or in Northern Ireland from Public Health Laboratory, Belfast City Hospital (Tel (028) 9032 9241). |
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Hepatitis A vaccine with Hepatitis B vaccine (Twinrix®, Ambirix®)
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Non Formulary
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 Hepatitis B vaccine is not funded by NHS for travel purposes.
APCO May 2017. |
Hepatitis A: the green book, chapter 17
Hepatitis B: the green book, chapter 18
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Hepatitis A vaccine with typhoid vaccine (Hepatyrix®)
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Non Formulary
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Prescribing Hep A and typhoid separately is more cost-effective. APCO May 2017. |
Hepatitis A: the green book, chapter 17
Typhoid: the green book, chapter 33
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Hepatitis A vaccine with typhoid vaccine (ViATIM®)
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Non Formulary
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Prescribing Hep A and typhoid separately is more cost-effective. APCO May 2017. |
Hepatitis A: the green book, chapter 17
Typhoid: the green book, chapter 33
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Hepatitis B vaccine Single Component (Engerix B®)
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Non Formulary
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May not be available on the NHS if being given for travel. |
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Hepatitis B vaccine Single Component (HBvaxPRO®)
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Non Formulary
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May not be available on the NHS if being given for travel. |
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Influenza Vaccine (Intanza®)
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Non Formulary
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Not recommended due lack of evidence of improved efficacy compared to standard therapy. APCO July 2011. |
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Japanese Encephalitis Vaccine (Ixiaro®)
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Non Formulary
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May not be available on the NHS if being given for travel. |
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Malaria vaccine (Mosquirix®)
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Non Formulary
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Normal Immunoglobulin (Aragam®)
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Non Formulary
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Normal immunoglobulin (Gammagard S/D®)
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Non Formulary
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Normal immunoglobulin (Subcuvia®)
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Non Formulary
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Being discontinued. |
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Normal immunoglobulin (Vigam®)
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Non Formulary
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Poliomyelitis Vaccine Inactivated (Salk)
(Inactivated poliomyelitis vaccine (IPV))
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Non Formulary
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Poliomyelitis Vaccine Live (oral)
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Non Formulary
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Polysaccharide vaccine with hepatitis A vaccine
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Non Formulary
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Prescribing Hep A and typhoid separately is more cost-effective. |
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Tick-borne encephalitis vaccine
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Non Formulary
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May not be available on the NHS if being given for travel. |
Tick-borne encephalitis: the green book, chapter 31
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Travel vaccines
(Vaccines administered exclusively for the purposes of travel)
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Non Formulary
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BCG requires the ‘should not be prescribed on the NHS exclusively for the purposes of travel’ caveat.
APCO September 2019. |
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Varicella-zoster vaccine (Varivax®)
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Non Formulary
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Varicella: the green book, chapter 34
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Yellow fever vaccine (Live)
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Non Formulary
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May not be available on the NHS if being given for travel. Available at designated Yellow Fever Centres only. |
PHE: Advice on administering 2 live vaccines at the same time
UKMI Q&A: Is Yellow Fever vaccine safe whilst breastfeeding
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Key |
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Cytotoxic Drug
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Controlled Drug
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High Cost Medicine
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Cancer Drugs Fund
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NHS England |
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Homecare |
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CCG |
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Traffic Light Status Information
| Status |
Description |
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Red: Medicines which should only be prescribed in secondary care by a specialist. |
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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. |
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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). |
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Green: Medicines which are suitable for initiation and ongoing prescribing within primary care. |
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Brown: Medicines which should only be prescribed in restricted circumstances. |
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Black: Medicines which are not recommended for use because of lack of evidence of clinical effectiveness, cost effectiveness or safety. |
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not used |
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