Area Drug & Therapeutics Committee August & September 2011 NHS Ayrshire & Arran Formulary Bulletin In this issue: Alzheimer s disease medicines Filgrastim injection (Zarzio ) Retigabine tablets (Trobalt ) Methotrexate prefilled syringes (Metoject ) Histrelin acetate implant (Vantas ) Degarelix injection (Firmagon ) Triptorelin injection (Decapeptyl SR ) Rivaroxaban tablets (Xarelto ) Bemiparin injection (Zibor ) Tapentadol prolonged-release tablets (Palexia SR) Calcium, cholecalciferol tablets (Kalcipos-D 500mg/800 IU chewable tablets ) Golimumab injection (Simponi ) SMC Not recommended for use medicines Discontinued preparations Area Drug & Therapeutic Committee updates Medicines under review by AMT Medicines under review by FMG Medicines under review by MRG Endorsement of these decisions will be obtained at the November 2011 Area Drug & Therapeutics Committee (ADTC) meeting. NICE TA217: Donepezil, galantamine, rivastigmine and memantine for the treatment of Alzheimer s disease The guidance issued by NICE in March 2011 and the SMC advice issued on galantamine, memantine and rivastigamine with regards Alzheimer s disease has therefore been superceded. These recommend: 1. The three acetylcholinesterase (AChE) inhibitors donepezil, galantamine and rivastigmine are recommended as options for managing mild to moderate Alzheimer s disease under all of the conditions specified in 3 and 4. 2. Memantine is recommended as an option for managing Alzheimer s disease for people with: moderate Alzheimer s disease who are intolerant of or have a contraindication to AChE inhibitors or severe Alzheimer s disease 3. Treatment should be under the following conditions: Only specialists in the care of patients with dementia (that is, psychiatrists including those specialising in learning disability, neurologists, and physicians specialising in the care of older people) should initiate treatment. Carers views on the patient s condition at baseline should be sought Treatment should be continued only when it is considered to be having a worthwhile effect on cognitive, global, functional or behavioural symptoms. Patients who continue on treatment should be reviewed regularly using cognitive, global, functional and behavioural assessment. Treatment should be reviewed by an appropriate specialist team, unless there are locally agreed protocols for shared care. Carers views on the patient s condition at follow-up should be sought If prescribing an AChE inhibitor (donepezil, galantamine or rivastigmine), treatment should normally be started with the drug with the lowest acquisition cost (taking into account required daily dose and the price per dose once shared care has started). However, an alternative AChE inhibitor could be prescribed if it is considered appropriate when taking into account adverse event profile, expectations about adherence, medical comorbidity, possibility of drug interactions and dosing profiles Include (restricted) ADTC Decision galantamine, memantine and rivastigmine are include in the formulary for consultant initiation, as per NICE TAG217 Implication for all A & A Prescribers - for Consultant initiation within NHS Ayrshire & Arran, as per NICE TAG217. NHS Ayrshire & Arran Formulary Bulletin, Medicines Utilisation Unit August & September 2011 Page 1 of 8
The following products have been recommended for use in NHS Scotland and included in the NHS Ayrshire & Arran formulary for specialist consultant initiation. 704/11 Filgrastim, 30 million units (300 micrograms)/0.5ml, 48 million units (480 micrograms)/0.5ml, solution for injection or infusion in pre-filled syringe (Zarzio ) Reduction in the duration of neutropenia and the incidence of febrile neutropenia in patients treated with established cytotoxic chemotherapy for malignancy (with the exception of chronic myeloid leukaemia and myelodysplastic syndromes) and reduction in the duration of neutropenia in patients undergoing myeloablative therapy followed by bone marrow transplantation considered to be at increased risk of prolonged severe neutropenia. The safety and efficacy of filgrastim are similar in adults and children receiving cytotoxic chemotherapy. Mobilisation of peripheral blood progenitor cells (PBPC). In children and adults with severe congenital, cyclic, or idiopathic neutropenia with an absolute neutrophil count (ANC) of 0.5 x 109/l, and a history of severe or recurrent infections, long term administration of filgrastim is indicated to increase neutrophil counts and to reduce the incidence and duration of infection-related events. Treatment of persistent neutropenia (ANC 1.0 x 109/l) in patients with advanced HIV infection, in order to reduce the risk of bacterial infections when other therapeutic options are inappropriate. Filgrastim (Zarzio ) is a biosimilar product to a reference granulocyte colony stimulating factor, filgrastim (Neupogen ). The British National Formulary advises that it is good practice to prescribe biological medicinal products by brand name. Other granulocyte colony stimulating factor products are available at lower cost. 712/11 Retigabine, 50mg, 100mg, 200mg, 300mg and 400mg film-coated tablets (Trobalt ) Indication under review: Adjunctive treatment of partial onset seizures with or without secondary generalisation in adults aged 18 years and above with epilepsy. SMC restriction: patients with refractory epilepsy. Treatment should be initiated only by physicians who have appropriate experience in the treatment of epilepsy. In two placebo-controlled studies in patients with refractory epilepsy retigabine was superior to placebo in terms of the proportion of patients experiencing 50% reduction in partial seizure frequency per 28 days. An indirect comparison indicates that retigabine has similar efficacy to two other antiepileptic drugs used as adjunctive therapy. 724/11 Methotrexate 50mg/mL solution for injection (Metoject ) prefilled syringes 12.5mg, 17.5mg, 22.5mg, 27.5mg and 30mg Indication under review: polyarthritic forms of severe active juvenile idiopathic arthritis, when the response to non-steroidal anti-inflammatory drugs has been inadequate. For patients in whom treatment with disease modifying drugs is indicated and parenteral administration of methotrexate is appropriate, this adds to the range of pre filled syringes available. The Scottish Medicines Consortium has previously accepted methotrexate for the treatment of severe active rheumatoid arthritis in adult patients where treatment with disease modifying drugs is indicated. Methotrexate injection is listed in the British National Formulary for Children 2010-11 for the treatment of juvenile idiopathic arthritis. Include (restricted) ADTC Decision include in the formulary for specialist consultant initiation, as per any SMC restrictions Implication for all A & A Prescribers - for prescribing within NHS Ayrshire & Arran, on the recommendations of a consultant NHS Ayrshire & Arran Formulary Bulletin, Medicines Utilisation Unit August & September 2011 Page 2 of 8
The following products have been recommended for use in NHS Scotland and included in the NHS Ayrshire & Arran formulary for consultant initiation, as per the West of Scotland Cancer Network (WoSCAN) Prostate Cancer Guidelines. 557/09 Histrelin acetate, 50mg subcutaneous implant (Vantas ) For palliative treatment of advanced prostate cancer. Histrelin is restricted to use in patients with an anticipated life expectancy of at least one year in whom annual administration will offer advantages. In a single-arm study, histrelin provided effective suppression of testosterone levels in patients with advanced prostate cancer. It requires less frequent administration than other leutenising hormone releasing hormone (LHRH) agonists. Other LHRH agonists are available at a lower acquisition cost. 560/09 Resubmission Degarelix 120mg and 80mg powder and solvent for solution for injection (Firmagon ) Indication under review: degarelix is a gonadotropin-releasing hormone (GnRH) antagonist indicated for the treatment of adult male patients with advanced hormone-dependent prostate cancer. In one study that included patients with all stages of prostate cancer, degarelix was shown to be non-inferior to a luteinising hormone releasing hormone (LHRH) agonist in suppressing testosterone levels over a one year treatment period without an initial testosterone flare. This SMC advice takes account of the benefits of a patient access scheme (PAS) that improves the cost-effectiveness of degarelix. This SMC advice is contingent upon the continuing availability of the patient access scheme in NHS Scotland. 705/11 Triptorelin (Decapeptyl SR ) 22.5mg powder and solvent for suspension for injection Indication under review: Treatment of patients with locally advanced, non-metastatic prostate cancer, as an alternative to surgical castration. Treatment of metastatic prostate cancer. Include (restricted) This new preparation of triptorelin allows 6-monthly administration (as triptorelin pamoate in a 22.5mg dose). Triptorelin 11.25mg (as acetate) is administered every 3 months and has previously been accepted by SMC. Bioequivalence of the pamoate and acetate salts has been demonstrated and the new preparation is cost neutral. Note: The indication for triptorelin 11.25mg formulation was reworded in 2007 to achieve consistency Europe-wide and now reads as per the indication for triptorelin 22.5mg ADTC Decision include in the formulary for consultant initiation, as per WoSCAN Prostate Cancer Guidelines Implication for all A & A Prescribers - for prescribing within NHS Ayrshire & Arran, on the recommendations of a consultant Rivaroxaban 10mg film-coated tablets (Xarelto ) Indication Prevention of venous thromboembolism (VTE) in adult patients undergoing elective hip or knee replacement surgery. Comment Scottish Medicines Consortium No 519/08: accepted for use within NHS Scotland In three large phase III studies in patients undergoing either total knee or total hip replacement surgery, rivaroxaban was superior to low molecular weight heparin in reducing the incidence of VTE and all cause mortality with patients while having a similar incidence of major bleeding events. restricted ADTC Decision include in formulary for initiation as per NHS Ayrshire & Arran orthopaedic thromboprophylaxis guidelines Implication for all NHS A & A Prescribers for prescribing within NHS Ayrshire & Arran as per orthopaedic thromboprophylaxis guidelines NHS Ayrshire & Arran Formulary Bulletin, Medicines Utilisation Unit August & September 2011 Page 3 of 8
The following products have been recommended for use in NHS Scotland and excluded from the NHS Ayrshire & Arran formulary. Scottish Medicines Consortium advice: recommended for use within NHS Scotland Bemiparin 3,500 IU in 0.2ml solution for injection in prefilled syringes (Zibor ) 204/05 Resubmission 654/10 Resubmission For the prevention of thromboembolic disease in patients undergoing orthopaedic surgery. Bemiparin was associated with a lower incidence of thromboembolic complications than unfractionated heparin and was non-inferior to another low molecular weight heparin. Tapentadol, 50, 100, 150, 200 and 250mg prolonged-release tablets (Palexia SR) Indication under review: the management of severe chronic pain in adults, which can be adequately managed only with opioid analgesics. SMC restriction: patients in whom morphine sulphate modified release has failed to provide adequate pain control or is not tolerated. Results of a meta-analysis of three, 12-week studies suggest that tapentadol prolonged release has improved gastrointestinal tolerability and similar efficacy compared to another long-acting opioid included as an active control. The manufacturer s submission related only to the use of tapentadol prolonged release in severe chronic pain. SMC has not yet received a submission for tapentadol immediate release tablets for the relief of moderate to severe acute pain in adults, which can be adequately managed only with opioid analgesics. Tapentadol immediate release tablets are not recommended for use in NHS Scotland. 718/11 Calcium carbonate equivalent to 500mg calcium, cholecalciferol (vitamin D3) 800 IU (20 microgram) tablets (Kalcipos-D 500mg/800 IU chewable tablets ) Indications under review: Prevention and treatment of calcium and vitamin D deficiency in the elderly Vitamin D and calcium supplement in addition to specific osteoporosis treatment of patients who are at risk of vitamin D and calcium deficiency. This is a new combination product with a different ratio of calcium to cholecalciferol than alternative combination preparations. It is a similar price to an alternative product containing 800IU of cholecalciferol per tablet but is more expensive than some other calcium and cholecalciferol combinations. Any overall budget impact is likely to be small 721/11 Golimumab 50mg solution for injections prefilled pen (auto-injector) or pre-filled syringe (Simponi ) Indication under review: Treatment of severe, active ankylosing spondylitis in adult patients who have responded inadequately to conventional therapy. SMC restriction: golimumab is restricted to use in accordance with the British Society for Rheumatology (BSR) guidelines for anti-tnf_ agents in adults with ankylosing spondylitis. Golimumab is restricted to use at a dose of 50mg only. In a placebo controlled study golimumab 50mg and 100mg were superior to placebo given every four weeks in terms of the proportion of patients who achieved at least 20% improvement in the Assessment in AS International Working group Criteria at week 14. An indirect comparison indicates that golimumab has similar efficacy to two other anti-tnf-α agents used in the treatment of ankylosing spondylitis. The economic case was demonstrated for golimumab when used at a dose of 50mg. The economic case was not demonstrated for the 100mg dose of golimumab. Exclude ADTC Decision exclude from the formulary Implication for all A & A Prescribers - not for prescribing within NHS Ayrshire & Arran NHS Ayrshire & Arran Formulary Bulletin, Medicines Utilisation Unit August & September 2011 Page 4 of 8
The following products have not been recommended for use in NHS Scotland and are therefore excluded from the NHS Ayrshire & Arran formulary. Scottish Medicines Consortium advice: not recommended for use within NHS Scotland 647/10 resubmission Glucosamine sulphate 1,500mg powder for oral solution (Glusartel ) Relief of symptoms in mild to moderate osteoarthritis of the knee. In a placebo- and active-comparator study, glucosamine sulphate 1,500mg once daily was significantly better than placebo in the treatment of symptoms associated with osteoarthritis of the knee. Overall the submitting company did not present a sufficiently robust clinical and economic analysis to gain acceptance by SMC 715/11 Collagenase clostridium histolyticum 0.9mg powder and solvent for solution for injection (Xiapex ) Treatment of Dupuytren s contracture in adult patients with a palpable cord. Collagenase clostridium histolyticum compared to placebo significantly reduces primary joint contracture in adults with Dupuytren s contracture and a palpable cord. The submitting company did not present a sufficiently robust economic analysis to gain acceptance by SMC. 729/11 Glucosamine sulphate (Dolenio ) Symptomatic treatment of mild to moderate osteoarthritis (OA) of the knee. The holder of the marketing authorisation has not made a submission to SMC regarding this product in this indication. As a result we cannot recommend its use within NHSScotland. 730/11 Bilastine (Ilaxten ) Symptomatic treatment of allergic rhino-conjunctivitis (seasonal and perennial) and urticaria. The holder of the marketing authorisation has not made a submission to SMC regarding this product in this indication. As a result we cannot recommend its use within NHSScotland.. 719/11 Abatacept 250mg powder for concentrate for solution for infusion (Orencia ) In combination with methotrexate, for the treatment of moderate to severe active rheumatoid arthritis in adult patients who responded inadequately to previous therapy with one or more disease-modifying anti-rheumatic drugs including methotrexate or a tumour necrosis factor (TNF)-alpha inhibitor. There is no head to head study comparing abatacept with other biologic or conventional disease-modifying anti-rheumatic drugs. In combination with methotrexate, abatacept reduced the progression of joint damage and improved physical function more than placebo in patients with moderate to severe rheumatoid arthritis who responded inadequately to previous therapy with methotrexate alone. The submitting company s justification of the treatment s cost in relation to its health benefits was not sufficient and in addition, the company did not present a sufficiently robust economic analysis to gain acceptance by SMC. Exclude ADTC Decision exclude from the formulary Implication for all A & A Prescribers - not for prescribing within NHS Ayrshire & Arran Discontinued Preparations Non-formulary items Cortisone acetate 25mg tablets Digibind injection Predsol-N eye drops and ear drops Area Drug & Therapeutics Committee (ADTC) issues The following guidelines have been approved by the ADTC and are available on the ADTC intranet section within AthenA (accessed via AthenA home page Policies and patient information tab Drug & Therapeutic clinical guidelines, or electronically below) ADTC 130: Guidelines for the management of constipation (adults) (new guideline)) Formulary updates Movicol oral powder has been replaced with Laxido Orange oral powder as the brand of choice on the NHS Ayrshire & Arran formulary. Formulary position of Movicol Half and Movicol Paediatric Plain oral powders remain unaffected. NHS Ayrshire & Arran Formulary Bulletin, Medicines Utilisation Unit August & September 2011 Page 5 of 8
Medicines under review by Area Drug & Therapeutics Committee (ADTC) NHS Ayrshire and Arran Area Drug and Therapeutics Committee The medicines listed below are still being considered by the ADTC. A final decision will be communicated in the near future but in the meantime they are excluded from the NHS Ayrshire & Arran formulary Dalteparin sodium injection (Fragmin ) extended treatment of symptomatic venous thromboembolism and prevention of its recurrence in patients with solid tumour (SMC 683/11) Urokinase (Syner-KINASE ) lysis of blood clots Antimicrobial Management Team NHS Ayrshire and Arran Antimicrobial Management Team (AMT) The medicines listed below are still being considered by the AMT. A final decision will be communicated in the near future but in the meantime they are excluded from the NHS Ayrshire & Arran formulary Moxifloxacin injection (Avelox ) community acquired pneumonia (SMC 650/10) Temocillin (Negaban ) inj. treatment of septicaemia, urinary tract and lower respiratory tract infections Medicines under review by the Formulary Management Group NHS Ayrshire and Arran Formulary Management Group (FMG) The medicines listed below have been considered by the ADTC and their formulary status is currently being reviewed by the FMG. A final decision will be communicated in the near future but in the meantime they are excluded from the NHS Ayrshire & Arran formulary. Alteplase (Actilyse Cathflo ) injection thrombolytic treatment of occluded central venous access devices (SMC 717/11) Atazanavir (Reyataz ) capsules - HIV adults (SMC 520/08), children (SMC 656/10) Atomoxetine (Strattera ) capsules ADHD (children 6 years & adolescents (SMC 153/05) Botulinum toxin type A injection (Botox ) focal spasticity associated with stroke (SMC 80/03) Brinzolamide/timolol (Azarga ) eye drop- open-angle glaucoma or ocular hypertension (SMC 568/09) Capecitabine (Xeloda ) tablets - adjuvant treatment of stage III (Dukes stage C) colon cancer in combination with oxaliplatin (SMC 716/11) Darunavir (Prezista ) tablets HIV infection in antiretroviral naïve adults.(smc 566/09), highly pretreated children and adolescents (SMC 604/10), HIV in antiretroviral therapy experienced adults (SMC 707/11) Denosumab injection (Prolia ) osteoporosis in postmenopausal women (SMC 651/10) Enoxaparin (Clexane ) syringes/ multidose vials treatment of STEMI (SMC 380/07) Etravirine (Intelence ) tablets HIV (SMC 530/09) Fentanyl (Instanyl ) nasal spray breakthrough pain in adults on maintenance opioid therapy for chronic cancer pain. (SMC 579/09) Fentanyl (PecFent ) nasal spray breakthrough pain in adults on maintenance opioid therapy for chronic cancer pain. (SMC 663/10) Ferric carboxymaltose (Ferinject ) - iron deficiency anaemia (haemodialysis pts excluded) (SMC 463/08) Fosamprenavir (Telzir ) suspension and tablets (SMC 431/07) Fosaprepitant dimeglumine infusion (IVEmend ) - prevention of acute and delayed nausea and vomiting associated with cisplatin-based chemotherapy (SMC 678/11) Iron isomaltoside 1000 (Monofer ) iron deficiency anaemia (haemodialysis pts excluded) (SMC 697/11) Lamivudine/zidovudine (Combivir ) HIV-1 in paediatric patients (SMC 569/09) Methylphenidate (Equasym XL & Medikinet XL brands) ADHD (SMC 99/04 and 388/07) Prasugrel (Efient ) tablets prevention of atherothrombotic events in patients with ACS or STEMI undergoing or delayed PCI (SMC 562/09) Prilocaine hydrochloride (Priloketal ) hyperbaric solution spinal anaesthesia (SMC 665/10) Raltegravir tablets (Isentress ) HIV in adults (SMC 613/10) Sildenafil citrate injection (Revatio ) pulmonary arterial hypertension (SMC 688/11) Tacrolimus ointment maintenance in atopic eczema in children (SMC 608/10) and adults (SMC 609/10) Tenofovir disoproxil tablet (Viread ) chronic hepatitis B (SMC 720/10) Tipranavir (Aptivus ) -HIV-1 infection oral solution (SMC 602/10), soft capsules (SMC 616/10) NHS Ayrshire & Arran Formulary Bulletin, Medicines Utilisation Unit August & September 2011 Page 6 of 8
Medicines under review by the Medicines Resource Group NHS Ayrshire & Arran: Medicines Resource Group (MRG) The medicines listed below have been considered by the ADTC and are currently being considered by the MRG. Recurring funding has not yet been identified for the medicine and a final decision on their formulary status has not been made by the MRG. However the medicines listed below may be requested on a case by case basis, according to SMC access criteria. Requests should be sent to the Director of Pharmacy for consideration. Where it is intended to use the medicines out with SMC access criteria an exceptional case application must be completed and sent to the Medical Director for consideration. Most relevant to Primary Care: None Most relevant to Secondary Care: Azacitidine injection (Vidaza ) - treatment of adult patients who are not eligible for haematopoietic stem cell transplantation with; intermediate-2 and high-risk myelodysplastic syndrome, chronic myelomonocytic leukaemia or acute myeloid leukaemia (SMC 589/09) Bendamustine hydrochloride infusion (Levact ) first-line treatment of chronic lymphocytic leukaemia (Binet stage B or C) in patients fludarabine combination chemotherapy is not appropriate (SMC 694/11) Betaine anhydrous oral powder (Cystadane ) - adjunctive treatment of homocystinuria involving deficiencies or defects in cystathionine beta-synthase, 5,10-methylene-tetrahydrofolate reductase or cobalamin cofactor metabolism (SMC 407/07) Dabigatran etexilate capsules (Pradaxa ) - prevention of stroke and systemic embolism in patients with non-valvular atrial fibrillation (SMC 672/11) Etanercept (Enbrel ) chronic severe plaque psoriasis in children and adolescents (SMC 570/09) Febuxostat tablets (Adenuric ) chronic hyperuricaemia (SMC 637/10) Mifamurtide infusion (Mepact ) - in combination with post-operative multi-agent chemotherapy for the treatment of high-grade resectable non-metastatic osteosarcoma (SMC 621/10) Nilotinib capsules (Tasigna ) treatment of adults with newly diagnosed Philadelphia chromosome positive chronic myelogenous leukaemia in the chronic phase (SMC 709/11) Pazopanib tablets (Votrient ) first line treatment of advanced renal cell carcinoma (SMC 676/11) Rituximab infusion (MabThera ) maintenance therapy in patients with follicular lymphoma responding to induction therapy (SMC 675/11) Sunitinib capsules (Sutent ) unresectable or metastatic, well-differentiated pancreatic neuroendocrine tumours with disease progression (SMC 698/11) Ticagrelor tablets (Brilique ) - prevention of atherothrombotic events in adults with acute coronary syndromes (unstable angina, non ST elevation myocardial infarction or ST elevation myocardial infarction) (SMC 699/11) SMC approved medicines available on a Case by case or Exceptional case basis in NHS Ayrshire & Arran Full updated lists of all the medicines which are available within NHS Ayrshire & Arran on a case by case basis according to SMC criteria or on an exceptional case basis can be located on the Joint Formulary website, located on the NHS Ayrshire & Arran intranet. These can be accessed via Bulletin downloads and Area Drug & Therapeutics Committee minutes, then click on managed entry of new drugs. For further information please refer to the SMC website www.scottishmedicines.org Scottish Medicines Consortium Medicines Not Recommended for Use A full updated list of medicines which are not recommended for use within NHS Scotland for specific indications can be located on the Joint Formulary website, located on the NHS Ayrshire & Arran intranet. These can be accessed via Bulletin downloads and Area Drug & Therapeutics Committee minutes, then click on managed entry of new drugs. For access to these medicines an exceptional case application must be completed and sent to the Medical Director for consideration. For further information please refer to the SMC website www.scottishmedicines.org NHS Ayrshire & Arran Formulary Bulletin, Medicines Utilisation Unit August & September 2011 Page 7 of 8
Medicines launched, not yet reviewed and not for prescribing The following are medicines that have been launched or have had an extension to their licensed indications but have not as yet been considered by the ADTC. Since they have yet to be considered by the SMC, they are therefore NOT recommended for prescribing within NHS Ayrshire & Arran until a decision is communicated from the ADTC. They are however available on an exceptional case application basis. Requests should be sent to the Medical Director for consideration. Adalimumab (Humira ) - polyarticular juvenile Grass Pollen Extract (Grazax ) tabs children idiopathic arthritis in children from 4 years-old Alemtuzumab (MabCampath ) inf first line CLL Glatiramer (Copaxone ) injection treatment first episode and those at high risk of developing MS Azithromycin (Azyter ) eyedrops conjunctivitis Ipilimumab (Yervoy ) injection advanced melanoma Aztreonam (Cayston ) nebs cystic fibrosis L-carnitine (Carnitor ) tablets carnitine deficiency Boceprevir capsules (Victrelis ) hepatitis C Midazolam (buccal) status epilepticus Bortezomib (Velcade ) untreated multiple Moxifloxacin (Avelox ) complicated skin infections myeloma with melphalan & prednisolone Botulinum toxin type A (Xeomin ) post stroke Olmesartan/ amlodipine and hydrochlorothiazide spasticity of the upper limb. (SEVIKAR HCT ) - hypertension Bromfenac (Yellox ) eye drops cataract surgery Phenylephrine + tropicamide (Mydriasert ) Opthalmic insert diagnostic eye surgery C1-Esterase inhibitor (Berinert ) Hereditary Prednisone (Lodotra ) m/r tablets moderate to severe angioedema type I and II (acute episode) active rheumatoid arthritis Cabazitaxel (Jevtana ) prostate cancer Ramipril (Tritace ) treatment of incipient glomerular diabetic neuropathy Carmellose/ Glycerine (Optive ) eyedrops dry Ranibizumab (Lucentis ) intravitreal injection retinal vein eyes occlusion Catumaxomab (Removab ) injection - malignant Recombinant Antithrombin (Atryn ) prophylaxis of ascites Dasatinib (Sprycel ) - newly diagnosed Philadelphia chromosome positive chronic myelogenous leukaemia in the chronic phase Doripenem (Doribax) inj complicated UTIs Doxycycline (Efracea ) capsules treatment of rosacea Eribulin (Halaven ) injection metastatic breast cancer Ertapenem (Invanz ) inj community acquired pneumonia & acute gynaecological infections Exenatide once weekly injection (Bydureon ) type 2 diabetes mellitus Fingolimod (Gilenya ) capsules multiple sclerosis venous thromboembolism Salicylic acid and fluorouracil (Actikerall ) topical solution actinic keratosis Saxagliptin (Onglyza ) tabs type 2 diabetes in combination with sulphonylureas or thiazolidinedione Sitagliptin (Januvia ) tabs type 2 diabetes mellitus in combination with thiazolidinediones Somatropin (Humatrope ) inj growth disturbance in short children. Growth failure associated with SHOX deficiency Temsirolimus (Torisel ) infusion advanced renal cell cancer Travoprost (Travatan ) eye drops - benzalkonium chloride free multidose formulation Urofollitropin (Fostimon ) injection infertility NHS Ayrshire & Arran Formulary Bulletin, Medicines Utilisation Unit August & September 2011 Page 8 of 8