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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.

The initiation of treatment with a cytotoxic medicine must be by an experienced and specifically trained prescriber. This would normally be a Consultant but may be a non consultant specialist grade or ST doctor under supervision.

All prescribers may continue agreed treatments but they must have received generic training in the use of cytotoxics, specific training in relation to the actual medicine prescribed and be a Consultant or under the supervision of a Consultant.

FY1 and FY2 doctors are not allowed to prescribe intravenous cytotoxics but can assess patients as medically fit to receive them.

Chapter Links...
 Details...
08.01  Cytotoxic drugs
Cytotoxic Drug Azacitidine
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Red
High Cost Medicine
 
Link  treatment of myelodysplastic syndromes, chronic myelomonocytic leukaemia and acute myeloid leukaemia
   
Cytotoxic Drug Lutetium (177Lu) oxodotreotide (Lutathera®)
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Red
  • For use in line with NICE TA539 for unresectable or metastic neuroendocrine tumours
 
   
Cytotoxic Drug Radium 223 dichloride (Xofigo®)
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Red
Cancer Drugs Fund
  • in line with NICE TA412 and NHSE SSC 1699/1936
  • 1000kg/mL injection (Xofigo®)- NICE TA376/SSC1607
  • 6MBq/6mL injection
 
Link  MHRA Drug Safety Update (Sep 18): Xofigo¥ (radium-223-dichloride): new restrictions on use due to increased risk of fracture and trend for increased mortality seen in clinical trial
Link  MHRA Drug Safety Update: Radium-223-dichloride (Xofigo¥): increased risk of death and fractures in a randomised clinical trial with Xofigo used in combination with abiraterone acetate and prednisolone/prednisone (Jan 18)
Link  NICE TA412: Radium-223 dichloride for treating hormone-relapsed prostate cancer with bone metastases
   
Cytotoxic Drug Streptozocin
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Red
High Cost Medicine
 
   
08.01  Side-effects of cytotoxic drugs
08.01  Drugs for cytotoxic-induced side-effects
Calcium Folinate
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Red
High Cost Medicine
  • NHS Leeds Traffic Light List classification (link): RED - Hospital Use Only 
  •    
    Calcium Levofolinate (Isovorin®)
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    Formulary
    Red
    High Cost Medicine
  • NHS Leeds Traffic Light List classification (link): RED - Hospital Use Only 
  •    
    Mesna (Uromitxan®)
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    Red
    High Cost Medicine
  • NHS Leeds Traffic Light List classification (link): RED - Hospital Use Only 
  •    
    Palifermin (Kepivance®)
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    Formulary
    Red
    High Cost Medicine
  • NHS Leeds Traffic Light List classification (link): RED - Hospital Use Only 
  •    
    08.01.01  Alkylating drugs
    Cytotoxic Drug Bendamustine
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    Formulary
    Red
    High Cost Medicine
    Cancer Drugs Fund
    • NHSE commissioned for use with rituximab in certain lymphomas (SSC1893)
     
    Link  MHRA Drug Safety Update (July 17): increased mortality observed in recent clinical studies in off-label use; monitor for opportunistic infections, hepatitis B reactivation
    Link  NICE TA216: first-line treatment of chronic lymphocytic leukaemia
       
    Cytotoxic Drug Busulfan (Myleran®)
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    Red
    High Cost Medicine
     
       
    Cytotoxic Drug Carmustine (Gliadel®)
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    Red
    High Cost Medicine
     
    Link  NICE TA121: newly diagnosed high-grade glioma
       
    Cytotoxic Drug Chlorambucil (Leukeran®)
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    Red
    High Cost Medicine
     
    Link  LTH PIL: idiopathic membranous nephropathy (chlorambucil)
       
    Cytotoxic Drug Chlormethine (Mustine)
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    Red
    High Cost Medicine
     
       
    Cytotoxic Drug Cyclophosphamide
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    Formulary
    Amber 2
    High Cost Medicine
  • Immunosuppressant
     
  • Link  LTHT prescription chart - cyclophosphamide (neurology)
    Link  LTHT prescription chart - cyclophosphamide (renal)
       
    Cytotoxic Drug Ifosfamide (Mitoxana®)
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    Red
    High Cost Medicine
     
       
    Cytotoxic Drug Lomustine
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    Red
    High Cost Medicine
     
       
    Cytotoxic Drug Melphalan (Alkeran®)
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    Formulary
    Red
    High Cost Medicine
     
       
    Cytotoxic Drug Thiotepa
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    Red
    High Cost Medicine
     
       
    Cytotoxic Drug Treosulfan
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    Red
    High Cost Medicine
     
       
    Cytotoxic Drug Trofosfamide
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    Red
    High Cost Medicine
     
       
    08.01.02  Anthracyclines and other cytotoxic antibiotics to top
    Cytotoxic Drug Bleomycin
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    Formulary
    Red
    High Cost Medicine
  • NHS Leeds Traffic Light List classification (link): RED - Hospital Use Only 
  •    
    Cytotoxic Drug Clofarabine
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    Restricted Drug Restricted
    Red
    High Cost Medicine
    Cancer Drugs Fund
    • Not commissioned for refractory or relapsed AML (NHSE SSC1952)
     
       
    Cytotoxic Drug Dactinomycin (Cosmegen Lyovac®)
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    Red
    High Cost Medicine
  • NHS Leeds Traffic Light List classification (link): RED - Hospital Use Only 
  •    
    Cytotoxic Drug Daunorubicin
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    Red
    High Cost Medicine
  • NHS Leeds Traffic Light List classification (link): RED - Hospital Use Only 
  •    
    Cytotoxic Drug Doxorubicin (pegylated liposomal) (Caelyx®)
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    Red
    High Cost Medicine
    Cancer Drugs Fund
  • NHS Leeds Traffic Light List classification (link): RED - Hospital Use Only
  • for use in line with NICE TA389 
  • Link  NICE TA389 - recurrent ovarian cancer
       
    Cytotoxic Drug Doxorubicin Hydrochloride
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    Red
    High Cost Medicine
  • NHS Leeds Traffic Light List classification (link): RED - Hospital Use Only 
  •    
    Cytotoxic Drug Epirubicin hydrochloride
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    Red
    High Cost Medicine
  • NHS Leeds Traffic Light List classification (link): RED - Hospital Use Only 
  •    
    Cytotoxic Drug Idarubicin Hydrochloride (Zavedos®)
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    Red
    High Cost Medicine
  • NHS Leeds Traffic Light List classification (link): RED - Hospital Use Only 
  •    
    Cytotoxic Drug Liposomal Cytarabine-Daunorubicin (Vyxeos®)
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    Red
     
    Link  NICE TA552: Liposomal cytarabine–daunorubicin for untreated acute myeloid leukaemia
       
    Cytotoxic Drug Mitomycin (Mitomycin C Kyowa®)
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    Red
    High Cost Medicine
  • NHS Leeds Traffic Light List classification (link): RED - Hospital Use Only 
  •    
    Cytotoxic Drug Mitoxantrone (Mitozantrone)
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    Red
    High Cost Medicine
  • NHS Leeds Traffic Light List classification (link): RED - Hospital Use Only 
  • Link  LTHT chart - mitoxantrone
       
    Cytotoxic Drug Pixantrone
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    Restricted Drug Restricted
    High Cost Medicine
  • For use in line with NICE guidance 
  • Link  NICE TA306: non-Hodgkin’s B-cell lymphoma
       
    08.01.03  Antimetabolites
    Cytotoxic Drug Capecitabine (Xeloda®)
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    Red
     
    Link  LTHT Patient Info Leaflet: Capecitabine treatment diary
    Link  MHRA Drug Safety Update: very rare risk of severe skin reactions - discontinue treatment (Jan 2014)
    Link  NICE TA100: stage III (Dukes’ C) colon cancer
    Link  NICE TA191: advanced gastric cancer
    Link  NICE TA61: metastatic colorectal cancer
    Link  NHSE: Gemcitabine and capecitabine following surgery for pancreatic cancer (all ages)
       
    Cytotoxic Drug Cladribine
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    Red
    High Cost Medicine
  • for use in line with NICE TA493 (SSC1806) 
  • Link  Drug Safety Update: reports of progressive multifocal encephalopathy (PML) - cease therapy (Dec 17)
    Link  NICE TA493: Cladribine tablets for treating relapsing–remitting multiple sclerosis
       
    Cytotoxic Drug Cytarabine
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    Red
     
       
    Cytotoxic Drug Fludarabine Phosphate (Fludara®)
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    Red
  • NICE does not recommend as monotherapy for first line treatment of CLL (TA119) 
  • Link  NICE TA29: B-cell chronic lymphocytic leukaemia (CLL)
       
    Cytotoxic Drug Fluorouracil
    (injection)
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    Red
     
       
    Cytotoxic Drug Gemcitabine (Gemzar®)
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    Red
     
    Link  NICE TA116: metastatic breast cancer
    Link  NICE TA25: pancreatic cancer
    Link  NHSE: Gemcitabine and capecitabine following surgery for pancreatic cancer (all ages)
       
    Cytotoxic Drug Mercaptopurine (Puri-Nethol®)
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    Red
  • Mercaptopurine 10mg tablets and capsules are unlicensed
    Red - cancer (see separate entry for IBD) 
  •    
    Cytotoxic Drug Methotrexate
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    Amber 3
    Amber3 - oral
    Red - injection
     
    Link  LHP guideline - management of ectopic pregnancy
    Link  Shared Care Guidelines (NHS access only)
       
    Cytotoxic Drug Nelarabine
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    Formulary
    Red
    Cancer Drugs Fund
     
       
    Cytotoxic Drug Pemetrexed (Alimta®)
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    Red
    Cancer Drugs Fund
    For use in line with:
  • NICE TA135 for the treatment of malignant pleural mesothelioma
  • NICE TA181 for the first-line treatment of non-small-cell lung cancer
  • NICE TA402 and NHSE SSC1647 for the maintenance treatment for non-squamous non-small-cell lung cancer after pemetrexed and cisplatin

    NICE does not recommend:
  • as maintenance therapy for people who have received pemetrexed in combination with cisplatin as first-line chemotherapy (TA190)  
  • Link  NICE TA135: treatment of malignant pleural mesothelioma
    Link  NICE TA181: first-line treatment of non-small-cell lung cancer
    Link  NICE TA190: maintenance treatment of non-small-cell lung cancer
    Link  NICE TA402: maintenance treatment for non-squamous non-small-cell lung cancer after pemetrexed and cisplatin
       
    Cytotoxic Drug Raltitrexed (Tomudex®)
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    Red
     
       
    Cytotoxic Drug Tegafur (Uftoral® / Teysuno®)
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    Red
  • July 2013: Uftoral® product unavailable. Teysuno® available as an alternative. Follow guidance in the relevant product literature 
  • Link  NICE TA61: metastatic colorectal cancer
       
    Cytotoxic Drug Tioguanine (Lanvis®)
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    Red
     
       
    Trifluridine-tipiracil (Lonsurf®)
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    Formulary
    Red
  • for use in line with NICE TA405 and NHSE SSC1662 
  • Link  NICE TA405: for previously treated metastatic colorectal cancer
       
    08.01.04  Vinca alkaloids and etoposide
    Cytotoxic Drug Etoposide
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    Red
  • NHS Leeds Traffic Light List classification (link): RED - Hospital Use Only 
  •    
    Cytotoxic Drug Etoposide (Vepesid®)
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    Formulary
    Red
  • NHS Leeds Traffic Light List classification (link): RED - Hospital Use Only 
  •    
    Cytotoxic Drug Vinblastine Sulphate
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    Formulary
    Red
  • NHS Leeds Traffic Light List classification (link): RED - Hospital Use Only 
  •    
    Cytotoxic Drug Vincristine Sulphate
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    Formulary
    Red
  • NHS Leeds Traffic Light List classification (link): RED - Hospital Use Only 
  •    
    Cytotoxic Drug Vinorelbine
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    Red
  • NHS Leeds Traffic Light List classification (link): RED - Hospital Use Only 
  •    
    08.01.05  Other antineoplastic drugs
    5-aminolevulinic acid (5-ALA) (Gliolan®)
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    Restricted Drug Restricted
    Red
  • for use during surgery for glioblastoma by named consultants only: Mr Robert Corns, Mr Simon Thomson, Mr John Goodden 
  • Link  LTHT access only: DTG summary
       
    Cytotoxic Drug Abiraterone Acetate
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    Formulary
    Red
    High Cost Medicine
    Cancer Drugs Fund
     
    Link  NICE TA259: castration-resistant metastatic prostate cancer previously treated with a docetaxel-containing regimen
    Link  NICE TA310: Afatinib for treating epidermal growth factor receptor mutation-positive locally advanced or metastatic non-small-cell lung cancer
       
    Cytotoxic Drug Afatinib
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    Formulary
    Red
     
       
    Aflibercept (Zaltrap ®)
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    Formulary
    Red
    High Cost Medicine
     
    Link  MHRA Drug Safety Update (Apr 16): Aflibercept (Zaltrap): minimising the risk of osteonecrosis of the jaw
    Link  NICE TA307: Aflibercept in combination with irinotecan and fluorouracil-based therapy for treating metastatic colorectal cancer that has progressed following prior oxaliplatin-based chemotherapy
       
    Cytotoxic Drug Asparaginase
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    Red
     
       
    Atezolizumab  (Tecentriq®)
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    Formulary
    Red
    • For use in line with NICE and NHSE as below
     
    Link  EAMS: Atezolizumab in the first line treatment of adult patients with extensive-stage small cell lung cancer, in combination with carboplatin and etoposide (NHSE SSC2029)
    Link  NICE TA492: Atezolizumab for untreated locally advanced or metastatic urothelial cancer when cisplatin is unsuitable
    Link  NICE TA520: Atezolizumab for treating locally advanced or metastatic non-small-cell lung cancer after chemotherapy
    Link  NICE TA584: Atezolizumab in combination for treating metastatic non-squamous non-small-cell lung cancer
       
    Avelumab (Bavencio®)
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    Formulary
    Red
    • For use in line with NICE TA517 (NHSE SSC1899)
     
    Link  NICE TA517: Avelumab for treating metastatic Merkel cell carcinoma
       
    Cytotoxic Drug Binimetinib (Mektovi®)
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    Formulary
    Red
    • supported for use in line with NICE TA562
     
    Link  NICE TA 562: Encorafenib with binimetinib for unresectable or metastatic BRAF V600 mutation-positive melanoma
       
    Cytotoxic Drug Cabazitaxel
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    Red
    Cancer Drugs Fund
  • commissioned for use in line with NICE TA391 and NHSE SSC 1627 
  • Link  NICE TA391: hormone-relapsed metastatic prostate cancer treated with docetaxel
       
    Ceritinib (Zykadia®)
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    Formulary
    Red
    • for use in line with NICE TA395 and NHSE commissioning position SSC 1638
    • for use in line with NICE TA500 and NHSE commissioning position SSC 1853
     
    Link  NICE TA395: previously treated anaplastic lymphoma kinase positive non-small-cell lung cancer
    Link  NICE TA500: Ceritinib for untreated ALK-positive non-small-cell lung cancer
       
    Daratumumab (Darzalex®)
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    Formulary
    Red
    • For use in line with NICE guidance
     
    Link  MHRA: Drug Safety Update (Aug 2018) Daratumumab (Darzalex¥): risk of reactivation of hepatitis B virus
    Link  NICE TA510: Daratumumab monotherapy for treating relapsed and refractory multiple myeloma
    Link  NICE TA573: Daratumumab with bortezomib and dexamethasone for previously treated multiple myeloma
       
    Cytotoxic Drug Encorafenib (Braftovi®)
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    Formulary
    Red
    • supported for use in line with NICE TA562
     
    Link  NICE TA562: Encorafenib with binimetinib for unresectable or metastatic BRAF V600 mutation-positive melanoma
       
    Cytotoxic Drug Eribulin
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    Red
  • supported for use in line with NICE TA423 and SSC1701 
  • Link  NICE TA423: Treating locally advanced or metastatic breast cancer after 2 or more chemotherapy regimens
    Link  NICE TA515: NOT recommended for treating locally advanced or metastatic breast cancer after 1 chemotherapy regimen
       
    Gemtuzumab ozogamicin (Mylotarg®)
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    Red
    • For use in line with NICE TA545 - untreated acute myeloid leukaemia
     
       
    Ipilimumab
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    Red
  • for metastatic melanoma after failure of first line chemotherapy for adult patients (Unlicensed).
     
  • Link  MHRA: Drug safety Update (Jan 2019) Ipilimumab (Yervoy): reports of cytomegalovirus (CMV) gastrointestinal infection or reactivation
    Link  NICE TA268: Ipilimumab for previously treated advanced (unresectable or metastatic) melanoma
    Link  NICE TA319: Ipilimumab for previously untreated advanced (unresectable or metastatic) melanoma
    Link  NICE TA400: Nivolumab in combination with ipilimumab for treating advanced melanoma
    Link  NICE TA581: Nivolumab with ipilimumab for untreated advanced renal cell carcinoma
       
    Ixazomib (Ninlaro®)
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    Formulary
    Red
    • For use in line with NICE guidance and NHSE commissioning positions
     
    Link  NICE TA505: Ixazomib with lenalidomide and dexamethasone for treating relapsed or refractory multiple myeloma
       
    Midostaurin (Rydapt®)
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    Formulary
    Red
    • For use in line with NICE guidance as below
     
    Link  NICE TA523 (SSC1921): Midostaurin for untreated acute myeloid leukaemia
       
    Cytotoxic Drug Mitotane
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    Formulary
    Red
     
       
    Nintedanib (Vargatef®)
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    Red
  • For use in line with NICE TA 347 and NHSE SSC 1537 
  • Link  NICE TA 347: nintedanib for previously treated locally advanced metastatic or locally recurrent non-small-cell lung cancer
       
    Niraparib (Zejula®)
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    Formulary
    Red
    • For use in line with NICE guidance listed below
     
    Link  NICE TA528: Niraparib for maintenance treatment of relapsed, platinum-sensitive ovarian, fallopian tube and peritoneal cancer
       
    Obinutuzumab (Gazyvaro®)
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    Formulary
    Red
    High Cost Medicine
    • in line with NICE guidance as below
     
    Link  NICE TA343: Obinutuzumab in combination with chlorambucil for untreated chronic lymphocytic leukaemia
    Link  NICE TA472: Obinutuzumab with bendamustine for treating follicular lymphoma refractory to rituximab
    Link  NICE TA513: Obinutuzumab for untreated advanced follicular lymphoma
       
    Olaparib (Lynparza®)
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    Formulary
    Red
    High Cost Medicine
    • CAUTION: capsules and tablets are not interchangeable (see below)
    • in line with NICE TA381 and NHSE SSC 1608
     
    Link  CAUTION: olaparib tablets and capsules are not interchangeable (June 18)
    Link  NICE TA 381
       
    Pazopanib
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    Red
    High Cost Medicine
     
    Link  NHSE do not commission pazopanib for malignant granular cell tumours
    Link  NICE TA215: advanced renal cell carcinoma
       
    Cytotoxic Drug Pegaspargase
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    Formulary
    Red
     
       
    Cytotoxic Drug Pertuzumab
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    Red
    Cancer Drugs Fund
    • for use in line with NICE TA424 (SSC 1730) and NICE TA509
     
    Link  NICE TA424: neoadjuvant treatment of HER2-positive breast cancer
       
    Talimogene laherparepvec (Imlygic®)
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    Formulary
    Red
  • for use in line with NICE TA410 and NHSE SSC 1679 
  • Link  NICE TA410: unresectable metastatic melanoma
       
    Temozolomide
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    Restricted Drug Restricted
    Red
  • in line with NICE TA23 and TA121  
  • Link  LTHT Patient Info Leaflet: Temozolamide with radiotherapy for brain tumours
    Link  NICE TA121:Carmustine implants and temozolomide for the treatment of newly diagnosed high-grade glioma
    Link  NICE TA23: Treatment of recurrent malignant glioma (brain cancer)
       
    Tivozanib (Fotivda®)
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    Formulary
    Red
    • For use in line with NICE TA512
     
    Link  NICE TA512: Tivozanib for treating advanced renal cell carcinoma
       
    Tofacitinib (Xeljanz®)
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    Restricted Drug Restricted
    Red
     
    Link  Drug Safety Update (May 19) Tofacitinib (Xeljanz¥): restriction of 10 mg twice-daily dose in patients at high risk of pulmonary embolism while safety review is ongoing
       
    Cytotoxic Drug Vemurafenib
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    Red
    High Cost Medicine
     
    Link  NICE TA269: locally advanced or metastatic BRAF V600 mutation‑positive malignant melanoma
       
    Venetoclax
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    Formulary
    Red
    • available for the treatment of chronic lymphocytic leukaemia (CLL) in line with NICE TA487 and NHSE Commissioning Position
    • MHRA Early Access to Medicines Scheme now closed - patient access scheme post-trial available
     
    Link  NICE TA487: Venetoclax for treating chronic lymphocytic leukaemia
    Link  NICE TA561: Venetoclax with rituximab for previously treated chronic lymphocytic leukaemia
       
    08.01.05  Amsacrine
    Cytotoxic Drug Amsacrine (Amsidine®)
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    Formulary
    Red
     
       
    08.01.05  Arsenic trioxide to top
    Cytotoxic Drug Arsenic Trioxide (Trisenox®)
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    Formulary
    Red

    For use in line with NICE guidance as below

     
    Link  NICE TA526: Arsenic trioxide for treating acute promyelocytic leukaemia (NHSE SSC1925)
       
    08.01.05  Bevacizumab
    Bevacizumab (Avastin®)
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    Red
    High Cost Medicine
    Cancer Drugs Fund
    • NICE does not recommend bevacizumab for: metastatic breast cancer, ovarian cancer, metastatic colorectal cancer (NICE TAs 212/214/263/284/285/560)
     
    Link  NICE TA178: renal cell carcinoma (existing patients only)
       
    08.01.05  Bexarotene
    Bexarotene (Targretin®)
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    Red
  • Treatment of skin manifestations of T-cell lymphoma
     
  •    
    08.01.05  Bortezomib
    Cytotoxic Drug Bortezomib (Velcade®)
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    Formulary
    Red
    High Cost Medicine
    Cancer Drugs Fund
     
    Link  NICE TA129: relapsed multiple myeloma
    Link  NICE TA228: multiple myeloma
    Link  NICE TA311: induction therapy in multiple myeloma before high dose chemotherapy and autologous stem cell transplantation
    Link  NICE TA370: mantle cell lymphoma
       
    Cytotoxic Drug Carfilzomib (Kyprolis®)
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    Formulary
    Red
  • in line with NICE TA457 (SSC1801) 
  • Link  MHRA: Drug Safety Update (Aug 2018) Carfilzomib (Kyprolis¥): reminder of risk of potentially fatal cardiac events
    Link  NICE TA457: carfilzomib for previously treated multiple myelome
       
    08.01.05  Brentuximab vedotin
    Cytotoxic Drug Brentuximab vedotin (Adcetris®)
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    Formulary
    Red
  • for use in line with NICE guidance (as below) and NHSE commissioning positions 
  • Link  NICE TA478: Brentuximab vedotin for treating relapsed or refractory systemic anaplastic large cell lymphoma
    Link  NICE TA524: Brentuximab vedotin for treating CD30-positive Hodgkin lymphoma
       
    08.01.05  Cetuximab to top
    Cetuximab (Erbitux®)
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine
    Cancer Drugs Fund
  • Multiple indications in line with NICE guidance (below)

  • NB: NICE do not recommend for treatment of recurrent and/or metastatic squamous cell cancer of head and neck (TA172) 
  • Link  MHRA Drug Safety Update: importance of establishing wild type RAS (KRAS and NRAS) status before treatment of metastatic colorectal cancer (Feb 2014)
    Link  NICE TA145: locally advanced squamous cell cancer of head and neck
    Link  NICE TA242: after first line treatment for metastatic colorectal cancer
    Link  NICE TA439: for previously untreated metastatic colorectal cancer
    Link  NICE TA473: Cetuximab for treating recurrent or metastatic squamous cell cancer of the head and neck
       
    08.01.05  Crisantaspase
    08.01.05  Dacarbazine and Temozolomide
    Cytotoxic Drug Dacarbazine
    View adult BNF View SPC online
    Formulary
    Red
  • NHS Leeds Traffic Light List classification (link): RED - Hospital Use Only 
  •    
    08.01.05  Erlotinib
    Cytotoxic Drug Erlotinib (Tarceva® )
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine
  • NHS Leeds Traffic Light List classification (link): RED - Hospital Use Only 
  • Link  NICE TA258: first-line treatment of locally advanced or metastatic EGFR-TK mutation-positive non-small-cell lung cancer
    Link  NICE TA374: non-small-cell lung cancer that has progressed after prior chemotherapy
       
    08.01.05  Hydroxycarbamide
    Cytotoxic Drug Hydroxycarbamide
    View adult BNF View SPC online
    Formulary
    Amber 3
  • Myeloproliferative diseases - Polycythaemia, Thrombocythaemia, Chronic Myeloid Leukaemia (CML) and Psoriasis
  • NHS Leeds Traffic Light List classification (link): AMBER 3  
  • Link  Amber Drug Guidance - hydroxycarbamide
       
    08.01.05  Imatinab to top
    08.01.05  Mitotane
    08.01.05  Panitumumab
    Cytotoxic Drug Panitumumab (Vectibix®)
    View adult BNF View SPC online
    Formulary
    Red
    Cancer Drugs Fund
  • for use in line with NICE TA439 (SSC1759) 
  • Link  NICE TA439: previously untreated metastatic colorectal cancer
       
    08.01.05  Pentostatin
    Cytotoxic Drug Pentostatin (Nipent®)
    View adult BNF View SPC online
    Formulary
    Red
  • NHS Leeds Traffic Light List classification (link): RED - Hospital Use Only 
  •    
    08.01.05  Platinum compounds
    Cytotoxic Drug Carboplatin
    View adult BNF View SPC online
    Formulary
    Red
     
       
    Cytotoxic Drug Cisplatin
    View adult BNF View SPC online
    Formulary
    Red
     
       
    Cytotoxic Drug Oxaliplatin
    View adult BNF View SPC online
    Formulary
    Red
     
    Link  NICE TA100: stage III (Dukes’ C) colon cancer
       
    08.01.05  Porfimer sodium and temoporfin to top
    Cytotoxic Drug Porfimer Sodium
    View adult BNF View SPC online
    Formulary
    Red
  • NHS Leeds Traffic Light List classification (link): RED - Hospital Use Only

     
  •    
    08.01.05  Procarbazine
    Cytotoxic Drug Procarbazine
    View adult BNF View SPC online
    Formulary
    Red
  • NHS Leeds Traffic Light List classification (link): RED - Hospital Use Only 
  •    
    08.01.05  Protein kinase inhibitors
    Cytotoxic Drug Abemaciclib (Verzenios®)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Red
    • For use in line with NICE TA563 
    Link  NICE TA563: Abemaciclib with an aromatase inhibitor for previously untreated, hormone receptor-positive, HER2-negative, locally advanced or metastatic breast cancer
       
    Cytotoxic Drug Alectinib (Unlicensed Medicine)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Red
    • for the first-line treatment of adult patients with anaplastic lymphoma kinase (ALK)-positive advanced non-small cell lung cancer (NHSE SSC1782)/patient access scheme
    • for use in line with NICE guidance as listed below
     
    Link  NICE TA536 (NHSE SSC1917): Alectinib for untreated ALK-positive advanced non-small-cell lung cancer
       
    Cytotoxic Drug Axitinib
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine
     
    Link  NICE TA333: advanced renal cell carcinoma after failure of prior systemic treatment
       
    Cytotoxic Drug Bosutinib
    View adult BNF View SPC online View childrens BNF
    Formulary
    Red
  • for use in line with NICE TA401/NHSE SSC1661 - previously treated chronic myeloid leukaemia 
  • Link  Drug Safety Update (May 16): test for hep-B virus before starting treatment
    Link  NICE TA401: previously treated chronic myeloid leukaemia
       
    Cytotoxic Drug Brigatinib
    View adult BNF View SPC online View childrens BNF
    Formulary
    Red
     
       
    Cytotoxic Drug Cabozantinib (Cabometyx®, Cometriq®)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Red
    • BRANDS are NOT interchangeable - different licenses
    • for renal cell carcinoma in line with NICE TA463 and NICE TA542 - CABOMETYX® brand tablets
    • for medullary thyroid cancer in line with NICE TA516 (SSC1884) - COMETRIQ® brand capsules
     
       
    Cytotoxic Drug Crizotinib
    View adult BNF View SPC online
    Formulary
    Red
    • For use in line with NICE guidance as below
       
     
    Link  NICE TA406: untreated anaplastic lymphoma kinase-positive advanced non-small-cell lung cancer
    Link  NICE TA422: previously treated anaplastic lymphoma kinase-positive advanced non-small-cell lung cancer
    Link  NICE TA529: ROS1-positive advanced non-small-cell lung cancer
       
    Cytotoxic Drug Dabrafenib (Tafinlar®)
    View adult BNF View SPC online
    Formulary
    Red
    • For use in line with NICE guidance as listed below
     
    Link  NICE TA321: unreselectable or metastatic BRAF V600 mutation-postive melanoma
    Link  NICE TA396 (SSC1639): Trametinib in combination with dabrafenib for treating unresectable or metastatic melanoma
    Link  NICE TA544 (SSC1971): Dabrafenib with trametinib for adjuvant treatment of resected BRAF V600 mutation-positive melanoma
       
    Cytotoxic Drug Dasatinib (Sprycel®)
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine
  • Chronic Myeloid Leukaemia in line with NICE TA425 (SSC1733) and TA426 (SSC1732) 
  • Link  Drug Safety Update (May 16): test for hep B virus before starting treatment
    Link  NICE TA425: treating imatinib-resistant or intolerant chronic myeloid leukaemia
    Link  NICE TA426: treating chronic myeloid leukaemia
       
    Cytotoxic Drug Everolimus (Afinitor®, Votubia®)
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine
    Cancer Drugs Fund
    • for use in line with NHSE B14X09 - treatment of angiomyolipomas associated with tuberous sclerosis in adults and children
    • for treating advance breast cancer after endocrine therapy in line with NICE TA421
    • for neuroendocrine tumours in line with NICE TA449 (SSC1791)
    • in line with NHSE commissioning positions
    • NICE does not recommend for use in liver transplantation (TA348)
    • NHSE does not commission for refractory focal onset seizures associated with tuberous sclerosis complex
     
    Link  NICE TA421: everolimus with exemestane for advanced breast cancer after endocrine therapy
    Link  NICE TA449: neuroendocrine tumours
       
    Cytotoxic Drug Gefitinib (Iressa®)
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine
  • NICE does not recommend gefitinib for treating non‑small‑cell lung cancer that has progressed after chemotherapy (TA374) 
  • Link  NICE TA192: first-line treatment of locally advanced or metastatic non-small-cell lung cancer
       
    Ibrutinib (Imbruvica®)
    View adult BNF View SPC online
    Formulary
    Red
    Cancer Drugs Fund
    • for use in line with NICE guidance and NHSE commissioning positions
     
    Link  NICE TA429: previously treated CLL/untreated CLL with certain mutations
    Link  NICE TA491: Waldenstrom’s macroglobulinaemia
    Link  NICE TA502: relapsed or refractory mantel cell lymphoma
       
    Cytotoxic Drug Imatinib (Glivec®)
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine
    Cancer Drugs Fund
  • Unresectable or metastatic GIST
  • Chronic Myeloid Leukaemia (CML) in line with NICE TA425 (SSC1733) and TA426(SSC1732)
     
  • Link  MHRA Drug Safety Update (Aug 17): reports of ventricular tachyarrhythmia; risk of hepatitis B reactivation and of opportunistic infections
    Link  MHRA Drug Safety Update (May 16): test for hep B virus before starting treatment
    Link  NICE TA86: unresectable and/or metastatic gastro-intestinal stromal tumours
    Link  NICE TA209 (linked to TA86): unresectable and/or metastatic gastrointestinal stromal tumours
    Link  NICE TA326: adjuvant treatment of gastrointestinal stromal tumours
    Link  NICE TA425: high dose for treating imatinib-resistant chronic myeloid leukaemia
    Link  NICE TA426: treating chronic myeloid leukaemia
       
    Cytotoxic Drug Lapatinib (Tyverb®)
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine
  • NICE does not recommend lapatinib or trastuzumab in combination with an aromatase inhibitor for women who have been through the menopause and who have metastatic breast cancer that is hormone receptor and HER2 positive (TA257)

     
  • Link  NICE TA257: not recommended
       
    Cytotoxic Drug Lenvatinib (Lenvima®)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Red
    • for use in line with SSC1713 for locally advanced, unresectable/metastatic differentiated thyroid cancer after radioactive iodine
    • Multiple other indications: for use in line with NICE as below
     
    Link  NICE TA498: Lenvatinib with everolimus for previously treated advanced renal cell carcinoma
    Link  NICE TA535 (SSC1945): Lenvatinib and sorafenib for treating differentiated thyroid cancer after radioactive iodine
    Link  NICE TA551: untreated advanced hepatocellular carcinoma
       
    Cytotoxic Drug Nilotinib (Tasigna®)
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine
  • Chronic myeloid leukaemia in line with NICE TA425 (SSC1733) and TA426 (SSC1732)
     
  • Link  Drug Safety Update (May 16): test for hep B virus before starting treatment
    Link  NICE TA425: chronic myeloid leukaemia (CML)
    Link  NICE TA426: treating imatinib-resistant or intolerant chronic myeloid leukaemia
       
    Cytotoxic Drug Palbociclib (Ibrance®)
    View adult BNF View SPC online
    Formulary
    Red
    • For use in line with NICE TA495 and NHSE SSC1852
     
    Link  NICE TA495: Palbociclib with an aromatase inhibitor for previously untreated, hormone receptor-positive, HER2-negative, locally advanced or metastatic breast cancer
       
    Cytotoxic Drug Ponatinib (Iclusig®)
    View adult BNF View SPC online
    Formulary
    Red
    Cancer Drugs Fund
  • For use in line with NICE TA451 and SSC 1790 
  • Link  Drug Safety Update (Oct 18): reports of posterior reversible encephalopathy syndrome
    Link  MHRA Drug Safety Update (Apr 17): risk of vascular occlusive events—updated advice on possible dose reduction
    Link  Drug Safety Update (May 16): check for hep B virus before starting treatment
    Link  MHRA Drug Safety Update (Nov 2014): risk of vascular occlusive events
    Link  NICE TA451: Ponatinib for treating chronic myeloid leukaemia and acute lymphoblastic leukaemia
       
    Cytotoxic Drug Regorafenib
    View adult BNF View SPC online
    Formulary
    Red
    • For use in line with NICE guidance as listed below
    • Not recommended for previously treated advanced hepatocellular cancer (NICE TA514)
    • LTHT DTG have supported for a patient cohort through FOC scheme following treatment with sorafenib and where the patient is ineligible for clinical trials (Sept 18)
     
    Link  NICE TA488: previously treated unresectable or metastatic gastrointestinal stromal tumours
    Link  NICE TA514: NOT RECOMMENDED for previously treated advanced hepatocellular carcinoma
    Link  NICE TA555: Regorafenib for previously treated advanced hepatocellular carcinoma
       
    Cytotoxic Drug Ribociclib (Kisqali®)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Red
    • For use in line with NICE TA496 and NHSE SSC 1851
     
    Link  NICE TA496: Ribociclib with an aromatase inhibitor for previously untreated, hormone receptor-positive, HER2-negative, locally advanced or metastatic breast cancer
       
    Cytotoxic Drug Ruxolitinib
    View adult BNF View SPC online View childrens BNF
    Formulary
    Red
    High Cost Medicine
  • for use in line with NICE TA386 -treating disease-related splenomegaly or symptoms in adults with myelofibrosis
  • compliant with NHSE SSC 1624 
  • Link  NICE TA386 - Ruxolitinib for treating disease-related splenomegaly or symptoms in adults with myelofibrosis
       
    Cytotoxic Drug Sorafenib (Nexavar®)
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine
    Cancer Drugs Fund
  • multiple indications - see NICE guidance (below)


     
  • Link  NICE TA178: renal cell carcinoma
    Link  NICE TA474: Sorafenib for treating advanced hepatocellular carcinoma
    Link  NICE TA535 (SSC1945): Lenvatinib and sorafenib for treating differentiated thyroid cancer after radioactive iodine
       
    Cytotoxic Drug Sunitinib (Sutent®)
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine
    Cancer Drugs Fund
  • Treatment of unresectable and/or metastatic malignant gastrointestinal stromal tumour (GIST) after failure of imatinib due to resistance or intolerance
  • Treatment of neuroendocrine tumours in line with NICE TA449
     
  • Link  NICE TA169: advanced and/or metastatic renal cell carcinoma
    Link  NICE TA178: renal cell carcinoma
    Link  NICE TA179: gastrointestinal stromal tumours
    Link  NICE TA449: neuroendocrine tumours
       
    Trametinib (Mekinist®)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Red
    • for use in line with NICE guidance as listed below
     
    Link  NICE TA396 (SSC1639): in combination with dabrafenib for treating unresectable or metastatic melanoma
    Link  NICE TA544: in combination with dabrafenib for adjuvant treatment of resected BRAF V600 mutation-positive melanoma
       
    Osimertinib (AZD9291)
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red
  • for the treatment of patients with locally advanced or metastatic EGFR T790M mutation-positive non-small cell lung cancer (NSCLC) within a compassionate use scheme 
  •    
    08.01.05  Tezanes
    Cytotoxic Drug Docetaxel (Taxotere®)
    View adult BNF View SPC online
    Formulary
    Red
  • NHS Leeds Traffic Light List classification (link): RED - Hospital Use Only 
  • Link  NICE TA101: hormone-refractory metastatic prostate cancer
    Link  NICE TA109: adjuvant treatment of early node-positive breast cancer
    Link  NHSE commissioning position B15/PS/a: prostate cancer
       
    Cytotoxic Drug Paclitaxel
    View adult BNF View SPC online
    Formulary
    Red
  • NHS Leeds Traffic Light List classification (link): RED - Hospital Use Only
  • in line with NICE TA389 - recurrent ovarian cancer
  • NICE does not recommend for the adjuvant treatment of early node-positive breast cancer (TA108)

     
  • Link  NICE TA389 - recurrent ovarian cancer
    Link  NICE TA55: ovarian cancer
       
    Cytotoxic Drug Paclitaxel albumin (Abraxane®)
    ('nab-paclitaxel')
    View adult BNF View SPC online
    Formulary
    Red
  • in line with NICE guidance (below) and NHSE commissioning positions

     
  • Link  Feb 2014 MHRA alert (Paclitaxel albumin) - strands in product
    Link  NICE TA476: Paclitaxel as albumin-bound nanoparticles with gemcitabine for untreated metastatic pancreatic cancer
       
    08.01.05  Topoisimerase I inhibitors
    Cytotoxic Drug Irinotecan Hydrochloride (Campto®)
    View adult BNF View SPC online
    Formulary
    Red
     
       
    Cytotoxic Drug Topotecan (Hycamtin®)
    View adult BNF View SPC online
    Formulary
    Red
  • Indicated for small cell lung cancer

  • NICE does not recommend for recurrent ovarian cancer (TA389) 
  • Link  NICE TA183: recurrent and stage IVB cervical cancer
    Link  NICE TA184: relapsed small-cell lung cancer
       
    08.01.05  Trabectedin to top
    Cytotoxic Drug Trabectedin (Yondelis®)
    View adult BNF View SPC online
    Formulary
    Red
  • NHS Leeds Traffic Light List classification (link): RED - Hospital Use Only
  • NICE does not recommend for relapsed platinum-sensitive ovarian cancer (TA389) 
  • Link  NICE TA185: advanced soft tissue sarcoma
       
    08.01.05  Trastuzumab
    Cytotoxic Drug Inotuzumab ozogamicin (Besponsa®)
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red
  • For use in line with NICE guidance
     
  • Link  NICE TA541: Inotuzumab ozogamicin for treating relapsed or refractory B-cell acute lymphoblastic leukaemia
       
    Cytotoxic Drug Trastuzumab (Herceptin®, Ontruzant®)
    View adult BNF View SPC online
    Formulary
    Red
    • For use in line with NICE guidance and NHSE commissioning statements
    • NICE does not recommend lapatinib or trastuzumab in combination with an aromatase inhibitor for women who have been through the menopause and who have metastatic breast cancer that is hormone receptor and HER2 positive (TA257)
     
    Link  NICE TA208: metastatic gastric cancer
    Link  NICE TA34: advanced breast cancer
    Link  NICE TA257 - not recommended
       
    Cytotoxic Drug Trastuzumab emtansine (Kadcyla®)
    View adult BNF View SPC online
    Restricted Drug Restricted
    Red
    Cancer Drugs Fund
  • For use in line with NICE guidance
     
  • Link  NICE TA458: Trastuzumab emtansine for treating HER2-positive advanced breast cancer after trastuzumab and a taxane
       
    08.01.05  Tretinoin
    Cytotoxic Drug Tretinoin (Vesanoid®)
    View adult BNF View SPC online
    Formulary
    Red
  • Antineoplastic drug - induction of remission in acute promyelocytic leukemia

  • NHS Leeds Traffic Light List classification (link): RED - Hospital Use Only 
  •    
    08.01.05  Vismodegib
    Cytotoxic Drug Vismodegib
    View adult BNF View SPC online
    Restricted Drug Restricted
    Red
    Cancer Drugs Fund
  • available to new patients on Cancer Drug Fund only until 22 Jan 2018
  • NOT recommended by NICE for treating basal cell carcinoma 
  • Link  NICE TA489: vismodegib not recommended for treating basal cell carcinoma
       
    08.02  Drugs affecting the immune response
    08.02  Immunosuppressant therapy to top
    08.02.01  Antiproliferative immunosuppressants
    Azathioprine
    (transplant medicine and other indications)
    View adult BNF View SPC online
    Formulary
    Amber 3
    • There are a number of different indications for azathioprine. Please see here for other indications.
     
    Link  Azathioprine Amber Drug Guidance - adult renal and liver transplant
    Link  Azathioprine Amber Drug Guidance - adult Rheumatology, Gastroenterology, Respiratory, Dermatology and Neurology
    Link  Interstitital Lung Disease - Patient Information Leaflet (LTHT access only)
       
    Mycophenolate Mofetil
    View adult BNF View SPC online
    Formulary
    Amber 3

    Amber3 - Where shared care guidelines are available

    Red - Where shared care guidelines are not available

    • There are a number of different indications for mycophenolate in ADULTS - select the correct Amber Drug Guidance below
     
    Link  MHRA Drug Safety Update (Feb 18): updated contraception advice for male patients
    Link  MHRA Drug Safety Update (Dec 15) : new pregnancy-prevention advice for women and men
    Link  MHRA Drug Safety Update (Jan 15): risk of hypogammaglobulinaemia and risk of bronchiectasis
    Link  Amber Drug Guidance - mycophenolate mofetil (renal/liver transplant)
    Link  Amber Drug Guidance - mycophenolate mofetil for adult non-transplant patients: rheumatology, dermatology, respiratory, ophthalmology, neurology, hepatology, oral medicine)
    Link  Renal Association: advice for men taking mycophenolate (potential fatherhood)
       
    08.02.02  Corticosteroids and other immunosuppressants
    08.02.03  Anti-lymphocyte monoclonal antibodies
    08.02.04  Other immunomodulating drugs
    08.02.04  Interferon Alfa to top
    08.02.04  Interferon beta
    08.02.04  Interferon gamma
    08.02.04  Aldesleukin
    08.02.04  BCG bladder instillation
    08.02.04  Dimethyl fumarate to top
    08.02.04  Fingolimod
    08.02.04  Glatiramer acetate
    08.02.04  Histamine
    08.02.04  Lenalidomide, pomalidomide, and thalidomide
    08.02.04  Mifamurtide to top
    08.02.04  Teriflunomide
    08.03  Sex hormones and hormone antagonists in malignant disease
    08.03.01  Oestrogens
    Diethylstilbestrol
    View adult BNF View SPC online
    Formulary  
       
    08.03.02  Progestogens
    08.03.03  Androgens to top
    08.03.04  Hormone antagonists
    08.03.04.01  Breast cancer
    Anastrozole (Arimidex®)
    View adult BNF View SPC online
    Restricted Drug Restricted
    Amber 2
    • Treatment of breast cancer
    • Prevention of familial breast cancer
     
    Link  Patient Decision Aid: Reducing chance of breast cancer - postmenopausal women at high risk (NICE)
    Link  Patient Decision Aid: Reducing chance of breast cancer - postmenopausal women at moderate risk (NICE)
       
    Exemestane (Aromasin®)
    View adult BNF View SPC online
    Restricted Drug Restricted
    Amber 2
    Amber1 - early breast cancer

    Amber2 - advanced breast cancer
     
    Link  NICE TA421: Everolimus with exemestane for advanced breast cancer
       
    Goserelin (Zoladex®)
    View adult BNF View SPC online
    Restricted Drug Restricted
    Amber 2
     
       
    Letrozole (Femara®)
    View adult BNF View SPC online
    Restricted Drug Restricted
    Multiple

     NHS Leeds Traffic Light List classification dependent on indication:

    Amber2 - Advanced breast cancer
    Red - Ovulation induction

     
       
    Tamoxifen
    View adult BNF View SPC online
    Formulary
    Amber 2
  • Hormone antagonist for use in breast cancer

    NHS Leeds Traffic Light List classification dependent on indication:

    Amber1 - early breast cancer
    Amber1 - prevention of familial breast cancer
    Amber2 - advanced breast cancer

     
  • Link  Amber Drug Guidance - tamoxifen for the prevention of familial breast cancer
    Link  Patient Decision Aid: Tamoxifen to reduce chance of breast cancer - premenopausal women at high risk (NICE)
    Link  Patient Decision Aid: Tamoxifen to reduce chance of breast cancer - postmenopausal women at moderate risk (NICE)
    Link  Patient Decision Aid: Reducing chance of breast cancer - postmenopausal women at high risk (NICE)
    Link  Patient Decision Aid: Reducing chance of breast cancer - postmenopausal women at moderate risk (NICE)
       
    Toremifene (Fareston®)
    View adult BNF View SPC online
    Formulary  
       
    08.03.04.02  Prostate cancer and gonadorelin analogues
    08.03.04.02  Gonadorelin analogues
    08.03.04.02  Anti-androgens to top
    08.03.04.02  Gonadotrophin-releasing hormone antagonists
    08.03.04.03  Somatostatin analogues
    08.04  Chimeric Antigen Receptor T-Cell (CAR-T) therapy
     ....
     Non Formulary Items
    Dexrazoxane  (Savene®)

    View adult BNF View SPC online
    Non Formulary
    Black
    High Cost Medicine
  • Non-formulary within LTHT. Any requests for use should be progressed via the single patient request 'Chairman's Action' process
  •  
    Fulvestrant  (Faslodex®)

    View adult BNF View SPC online
    Non Formulary
    Black

    Black - NICE does not recommend for treatment of locally advanced or metastatic breast cancer (TA239/503)
    Grey - Patients started before NICE publication may continue until they and their NHS clinician consider it appropriate to stop

    Link  NICE TA239: Fulvestrant for the treatment of locally advanced or metastatic breast cancer (NOT recommended)
    Link  NICE TA503: Fulvestrant for untreated locally advanced or metastatic oestrogen-receptor positive breast cancer (NOT recommended)
     
    Cytotoxic Drug  Padeliporfin  (Tookad®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Black
    Link  NICE TA546: Padeliporfin for untreated localised prostate cancer (NOT recommended)
     
    Cytotoxic Drug  Pegylated lipsomal Irinotecan  (Onivyde®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Black
    • NICE does not recommend for pancreatic cancer (TA440)
    Link  MHRA: Drug Safety Update (Mar 2019) Onivyde (irinotecan, liposomal formulations): reports of serious and fatal thromboembolic events
     
    Cytotoxic Drug  Vandetanib  (Caprelsa®)

    View adult BNF View SPC online
    Non Formulary
    Red
    High Cost Medicine
    • NICE TA550: NOT recommended for treating medullary thyroid cancer
     
      
    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
    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

    Green

    Medicines which are appropriate for initiation and ongoing prescribing in both primary and secondary care.  

    Amber 1

    Amber Level 1- Specialist Recommendation
    These medicines are considered suitable for GP prescribing following specialist recommendation.
     
    There is no requirement for full Amber Drug Guidance. Generic Amber Level 1 Drug Guidance detailing responsibilities and information sources is available here
      

    Amber 2

    Amber Level 2- Specialist Initiation but no monitoring requirements
    These medicines are considered suitable for GP prescribing following specialist initiation, including titration of dose and assessment of efficacy.
    Some Amber Level 2 products will have an associated Amber Level 2 Drug Guidance document, available by clicking on the traffic light symbol to the right of the drug name. If this is not available, generic Amber Level 2 Drug Guidance is available here  

    Amber 3

    Amber Level 3- Specialist Initiation with ongoing monitoring requirements (Full Amber Drug Guidance required)
    Medicines that should be initiated by a specialist, and which require significant monitoring on an ongoing basis. Full agreement to share the care of each specific patient must be reached under the amber drug agreement, and Amber Drug Guidance must be provided to the GP (available by clicking on the traffic light symbol to the right of the drug name).   

    Red

    Guidance on the responsibilities for Red Drugs can be found here. Red Drugs would usually by prescribed by the hospital for the duration of the course. Primary care prescriber initiation or continuation of treatment not recommended except by Specialist GP and community paediatric prescribing.   

    Grey

    Grey Drugs are locally-agreed medicines which are only recommended for restricted use within the Leeds Health Economy.   

    Black

    These drugs are not recommended for use within the Leeds Health Economy  

    Multiple

    Products shown as blue have different Traffic Light List classifications dependent on indication. See the accompanying text next to the product for further information the indications for which it has a Traffic Light List classification.  

    netFormulary