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 Formulary Chapter 8: Malignant disease and immunosuppression - Full Chapter
Notes:
Unless explicitly stated, any brand names included in brackets next to a drug's generic name are there solely to aid searching and identification, and should not be considered to limit use to that specific brand.  
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08.01.03  Expand sub section  Antimetabolites
Cytotoxic Drug Azacitidine (Vidaza®)
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Restricted Drug Restricted
Red
  • Azacitidine Injection

 Supported for use in line with NICE TA218.

 
Link  NICE TA218: Azacitidine for the treatment of myelodysplastic syndromes, chronic myelomonocytic leukaemia and acute myeloid leukaemia (March 2011)
 
Cytotoxic Drug Capecitabine
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Restricted Drug Restricted
Red
  • Capecitabine Tablets
     
 
Link  NICE TA100: Capecitabine and oxaliplatin in the adjuvant treatment of stage III (Dukes’ C) colon cancer (April 2006)
Link  NICE TA191: Capecitabine for the treatment of advanced gastric cancer (July 2010)
 
Cytotoxic Drug Cladribine
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Restricted Drug Restricted
Red
  • Cladribine Injection (LITAK® for subcutaneous injection)
     


Restricted for use within agreed protocols under the supervision of appropriate specialists

 
Link  MHRA Drug Safety Update: Cladribine (Litak, Leustat) for leukaemia: reports of progressive multifocal encephalopathy (PML); stop treatment if PML suspected (December 2017)
 
Cytotoxic Drug Cytarabine
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Red
  • Cytarabine Injection

    Restricted for use within agreed protocols under the supervision of appropriate specialists 
  •  
    Cytotoxic Drug Fludarabine Phosphate
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    Restricted Drug Restricted
    Red
    • Fludarabine Tablets
       
      Supported for use in line with NICE TA116 and TA29.
     
    Link  NICE TA119: Fludarabine monotherapy for the first-line treatment of chronic lymphocytic leukaemia (February 2007)
    Link  NICE TA29: Guidance on the use of fludarabine for B-cell chronic lymphocytic leukaemia (September 2001)
     
    Cytotoxic Drug Fluorouracil
    (Chemotherapy)
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    Restricted Drug Restricted
    Red
  • Fluorouracil Injection
  • Fluorouracil Infusion

    Restricted for use within agreed protocols under the supervision of appropriate specialists 
  •  
    Cytotoxic Drug Gemcitabine
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    Restricted Drug Restricted
    Red
    • Gemcitabine Injection
       
     
    Link  NICE TA116: Gemcitabine for the treatment of metastatic breast cancer (January 2007)
    Link  NICE TA25: Guidance on the use of gemcitabine for the treatment of pancreatic cancer (May 2001)
    Link  NICE TA476: Paclitaxel as albumin-bound nanoparticles with gemcitabine for untreated metastatic pancreatic cancer (September 2017)
     
    Cytotoxic Drug Mercaptopurine
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    Restricted Drug Restricted
    Amber SCG
  • Mercaptopurine Tablets

    Restricted for use within agreed protocols under the supervision of appropriate specialists 
  • Link  Mercaptopurine and Azathioprine Shared Care Guideline for Inflammatory Bowel Disease
     
    Cytotoxic Drug Methotrexate
    (Chemotherapy)
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    Restricted Drug Restricted
    Red
  • Methotrexate Injection

    Restricted for use within agreed protocols under the supervision of appropriate specialists 
  • Link  DSU: Methotrexate once-weekly for autoimmune diseases: new measures to reduce risk of fatal overdose due to inadvertent daily instead of weekly dosing (September 2020)
    Link  EMA: EMA reviewing risk of dosing errors with methotrexate (April 2018)
    Link  SPS Q&A: Should patients drink alcohol whilst taking long-term low-dose methotrexate? (December 2018)
     
    Cytotoxic Drug Pemetrexed
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    Restricted Drug Restricted
    Red
    BlueTeq
    • Pemetrexed Injection
       


    Blueteq® registration and approval for use is required for this product before it may be dispensed.

     
    Link  NICE TA135: Pemetrexed for the treatment of malignant pleural mesothelioma (January 2008)
    Link  NICE TA181: Pemetrexed for the first-line treatment of non-small-cell lung cancer (September 2009)
    Link  NICE TA190: Pemetrexed for the maintenance treatment of non-small-cell lung cancer (August 2017)
    Link  NICE TA402: Pemetrexed maintenance treatment for non-squamous non-small-cell lung cancer after pemetrexed and cisplatin (August 2016)
     
    Cytotoxic Drug Trifluridine-tipiricil (Lonsurf®)
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    Restricted Drug Restricted
    Red
    • Trifluridine Tipiricil Tablets (Lonsurf®) 


     
    Consultant Medical Oncologist use only.

    Blueteq® registration and approval for use is required for this product before it may be dispensed.

     
    Link  NICE TA405: Trifluridine–tipiracil for previously treated metastatic colorectal cancer (August 2016)
     
     ....
    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
    click to search medicines.org.uk
    Link to adult BNF
    click to search medicines.org.uk
    Link to children's BNF
    click to search medicines.org.uk
    Link to SPCs
    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

    Green

    Green - Drugs suitable for generalised use in accordance with position summary. Inform primary care of need to prescribe using a TTO chart if in patient or Treatment Advice Note (TAN) if Outpatient.   

    Amber

    Amber - these drugs require specialist initiation or recommendation  

    Amber SCG

    Amber Share Care - Drugs suitable for generalist use, in accordance with position summary, normally following specialist initiation and stabilisation. Ongoing division of responsibility for drug and disease monitoring between specialist and GP by a Shared Care Guideline (SCG). If no SCG in place status reverts to red.  

    Red

    Red - Drugs for specialist use only, in accordance with position summary. GP’s should not be asked to prescribe these products.  

    Red ULM

    Red ULM - Unlicensed medicines for specialist use only, in accordance with position summary. GP’s should not be asked to prescribe these products.  

    Grey

    Grey drugs - No formal commissioning position. Check appropriate CCG /NHSE commissioning list or contact CCG/NHSE Medicines Management team for advice. Fill in individual funding request for appropriate CCG/NHSE. This will need to be signed by the Chief Pharmacist and a copy of the relevant DTC submission attached.   

    Black

    Black - Drugs not routinely commissioned so should not usually be prescribed  

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