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Medicine Lakex

Items not to be prescribed at T&G CCG expense (DNP list) or only in limited
circumstances (Grey list)
Please note that in addition to the items listed here there should be no prescribing of any
medicine listed in Part XVIIIA (Black List) of the Drug Tariff or in the case of appliances any not
in Part IX. of the Drug Tariff.
There are a number of medications that T&G CCG believes should not be used (DNP List) or
should only be used in limited circumstances (Grey List). Grey listed items wil only be funded for
patients who meet the specified criteria. The reasons for medicines being included on the lists are
as given in the tables below and in line with the GMMMG and national guidance.
In addition there are medicines classed as Red drugs. These are medicines which should only be
prescribed in a specialist setting (usually a hospital) rather than by a GP. The lists below include
some of the more commonly requested Red drugs. It should be noted this is not the whole list of
Red drugs which can be found on the GMMMG website linked here

T&G CCG recognises that there may be exceptional patients or situations where prescribing of
DNP or Grey list items may be necessary though such situations should rare. A patient may be
deemed exceptional if the patient has a clinical picture that is significantly different to the
general population of patients with that condition and, as a result of that difference; the patient is
likely to derive greater benefit from the intervention than might normally be expected for patients
with that condition
Red drugs should only be prescribed in the specialist setting
Monitoring and control remain within secondary care As per Liraglutide Alendronate plus GMMMG Do Not Prescribe list on basis of poor cost (Fosavance®) tablets Branded preparations can be significantly more expensive than the generic. Generic prescribing is branded preparations required. Seek approval for patients who cannot tolerate e.g. Arimidex®* Product for Cosmetic Purpose. Use prior to referral for (aluminium chloride botulinum toxin therapy in line with EUR policy is hexahydrate 20%) appropriate
For use as per NICE criteria. Use outside of this requires an
approval request to be completed.
FOR use in AF a Record of initiation needs to be completed and stored on clinical system for audit purposes. Apixaban (Eliquis®)* NB For Post operative thromboprophylaxis the full course wil be provided by the hospital and it should not need to be prescribed by primary care for this indication. Please see Darbapoetin GMMMG Do Not Prescribe list on basis of significant safety concerns and poor evidence base. Cosmetic product for the treatment of minor scars, not an appropriate use of NHS resources BioXtra® toothpaste & mouth rinse (this does GMMMG DNP list – efficacy not proven not include BioXtra® oral gel) Branded preparations are significantly more expensive Branded preparations and offer no added value over the generic. Generic containing latanoprost prescribing is required. Preservative free drops should be as a single active considered before requesting approval to prescribe a Please see exenatide RATIONALE
/colecalaferol 200iu Daily dose of 800 iu Vitamin D is required for bone e.g.Calcichew D3®. protection which cannot be provided by these products Products that provide without giving a high dose of calcium. Given the 800iu daily with less possibility of this having a negative impact use of these than 2g Ca2+ are combinations is not supported appropriate Cannabis extract Added to GMMMG DNP list. Local policy already in place not to fund. Long half life and may contribute to hypoglycaemia, especial y in the elderly GMMMG assessed this as not suitable for prescribing as the patient group in trials were not representative of the groups seen in clinical practice. NICE does not endorse its use. Circadin® M/R tablets Only for use within an approved shared care protocol An infertility drug, part of on going specialist package of NHSE may commission Limited evidence of effectiveness. For OTC use patients should be advised that if not effective after a 3 month trial no benefit is likely to be gained. GMMMG GREY List only permits use in mitochondrial including ubiquinine disorders under the care of a specialist (NICE CG 181) and ubicdecarenone Compound preparations of aspirin Single dose compound preps don't support effective dose titration Prescribe drug individually Please see Linaclotide Now unlicensed due to concerns over toxicity. Banned in DNP
Co-proxamol tablets the US. Approval requires proof of exceptionality and failure to respond to all other pain kil ers to continue prescription beyond December 2010 Use tablets where a patient is unable to have B12 Injections. Hydroxycobalamin is the preferred therapy (Cytamen®) for B12 deficiency RATIONALE
Part of on going specialist care Part of on going specialist care Part of on going specialist care Pro drug of loratadine which is cheaper. Desloratadine offers no added benefit Please see gliclazide MR Most patients do not require potassium supplements and DNP
many of the preparations have low levels of potassium (Diumide-K Continus®) insufficient for those who do require supplementation. Dosulepin preparations NICE states specifical y not to use this drug. As per Liraglutide Dental preparations are best assessed and monitored by DNP
Duraphat® Toothpaste a dental practitioner. Not prescribable by General Practitioners. NTS does not recommend use. Reserved for patients in Dymista® (Fluticasone whom other medical treatments have failed before /azelastine nasal referral to secondary care ( listing under review) Eicosapentaenoic Only prescribable for hyper-triglyceridaemia on specialist GREY
acid preparations e.g. advice. Review in line with the Standard Operating Omacor®/Maxepa® See Albiglutide* Poorly absorbed with a high incidence of side effects and complex dose regimen Erythropoetin Alpha Part of ongoing specialist care and Beta Esomeprazole tablets - Branded preparations are significantly more expensive and offer no added value over the generic. Generic preparation e.g. prescribing is required. As per Liraglutide RATIONALE
As per Liraglutide Please see Deferasirox Please see piroxicam (oral preps) Please see iron –all modified release preparations Use only on advice of microbiologist Use restricted to Fidaxomicin (Dificlir®)* preserve the effectiveness of this drug against C Diff. Fluoride supplements These products should only be prescribed at CCG expense by a qualified Dental Practitioner who can assess the individuals fluoride status. Only for patients treated with this drug before 30/11/2011 GREY
Fulvestrant (Faslodex®) Negative NICE TA 239. Gabapentin topical* GMMMG DNP list – efficacy not proven GMMMG DNP list – efficacy not proven (all preparations) Similar effect to standard release formulations which are Gliclazide MR tablets much cheaper at equivalent doses. 30mg MR 80mg standard release Glucosamine any salt Poor Evidence of efficacy in osteoarthritis. Glucosamine with Poor Evidence of efficacy in osteoarthritis. Chrondroitin Grass Pollen extract NHS Stockport do not fund and NTS do not recommend. DNP
Click Here to view statement. Icaps® products See Multivitamin Preps for eye health Idoxuridine in dimethyl sulfoxide Of little value. Superseded by more effective agents. (Herpid®) Inositol Efficacy in peripheral vascular disease is not established (Hexopal®) Iron –al modified Offer little added benefit and greatly increased cost. release preparations Ketoconazole oral Lactase e.g.Colief® Lacks supporting evidence base. Can be bought OTC Lacks evidence to support use. Can be bought OTC Cosmetic use, product is licensed to thicken eye lashes. Latisse® eye drops This restriction does not apply to 0.3% drops for treatment DNP
(bimatoprost 0.03%)* of Glaucoma. Pro-drug of cetirizine which is better value for the NHS. Levocetirizine offers no added benefit RATIONALE
NTS does not recommend this product for this indication Lidocaine (Versatis®) as they felt that efficacy and cost effectiveness of the patches/plasters for product in comparison to other agents had yet to be post herpetic neuralgia proven. The group is aware that lidocaine plaster is also currently used ‘off label' for indications other than treatment of Lidocaine Patches post-herpetic neuralgia and the group do not recommend this ‘off label' use for the reasons outlined above. Al alternatives must have been dried to evidence exceptionality For use with in NICE TA Liothyronine extracts including Armour National Guidance not to prescribe in hypothyroidism thyroid preparations Only to be used for people with type 2 diabetes within the NICE guideline see sections 1.6.28 1.6.29 Please see Edoxaban As per Liraglutide Please see pregabalin Please see Circadin Less effective than benzodiazepines and greater hazard DNP
Please see Ergotamine See branded preparations containing latanoprost as a single active ingredient Branded preparations can be significantly more branded preparations* expensive and offer no added value over the generic. Generic prescribing is required. Efficacy in peripheral vascular disease is not established (Opilon®) Multivitamin & mineral preps marketed for eye health or for AMD There is no instance where these products are e.g. Icaps, Occuvite appropriate to use from a safety or efficacy point of view, over existing treatments. The list of preparations is Preservision lutein, not exhaustive due to the large number of supplements Viteyes original plus- lutein, Ocuvite lutein, Visionace, Vitalux-plus) For use within the NICE TA within the agreed local RATIONALE
Naltrexone / Bupropion DNP
IPNTS deemed inappropriate. Agents may be prescribed (Vimovo®) Neoclarityn® Please see Desloratadine Omega 3 preparations See Eicosapentanoic acid Omeprazole- as a Branded preparations are significantly more expensive branded preparation and offer no added value over the generic. Generic prescribing is required by policy. Part of limited secondary care package of care Palexia® and Palexia® Please see tapentadol Single dose compound preps do not allow for effective dose titration and the advantages of using a compound tramadol tablets formulation have not been substantiated. This is a fixed dose combination is particularly poor value to the NHS Prescribe drug individually Pentoxifyl ine (Trental®) Efficacy in peripheral vascular disease is not established DNP
Use on Specialist recommendation only due to safety Piroxicam ( oral preps) concerns Please see cilostazol Pollinese Quatro GMMMG DNP list – efficacy not proven Now on the GMMMG do not prescribe list tablets Prednisolone MR tablets (Lodotra®) For neuropathic pain only after the maximum dose of amitriptyline (or alternatives) is unsuccessful and Gabapentin tried and is effective but not tolerated due Please see Dapoxetine Please see Dosulepin RATIONALE
GMMMG EUR group supported NICE recommendation not to routinely provide relaxation treatments Please see pregabalin Negative NICE TA. Patients prescribed the drug before Roflumilast (Daxas®) 31/12/11 can continue provided they are getting Please see nalmefene Sildenafil as a branded Branded preparations are significantly more expensive preparation e.g. and offer no added value over the generic. Generic prescribing is required but only within CCG policy Silk Garments e.g. NTS determined as not appropriate to prescribe due to a Dermasilk® , Skinnies® poor evidence of clinical benefit and Dreamskin® Simvastatin with Not cost effective. Ingredients can be prescribed ezetimibe (Inegy®) separately and dose titrated. Spatone® 100% natural The supplement contains a limited amount of iron (5mg) iron supplement. that could easily be got from other food sources or by Spatone® liquid iron using a smal dose of a licensed iron 5mg ferrous iron= 10 DNP
drops Nifrex® or1 ml Sytron® or supplement. 0.5ml of Fersamal® or Galfer® syrup Sunscreens listed under ACBS rules* LA Roche-Posay Anthelios XL SPF 50+ Nationally these are only permitted for protection from Sunsense Ultra (Ego) UV radiation in abnormal cutaneous photosensitivity resulting from genetic disorders or photodermatoses, Uvistat Lipscreen SPF 50 including those resulting from radiotherapy and chronic Uvistat Suncream SPF or recurrent herpes simplex labialis. 30 Uvistat Suncream SPF 50 Sunscreens not listed Not permitted under ACBS rules above* Synovial fluid injections including Hyaluronan There is limited evidence of effectiveness and NICE CG59 Osteoarthritis R32 recommendation states "Intra- articular hyaluronan injections are not recommended for osteoarthritis of the the treatment of osteoarthritis. RATIONALE
Tameside & Glossop CCG policy does not support the Tadalafil 2.5mg and use of daily treatment for ED and there is an NTS statement which does not recommend this product for the 2nd licensed indication of benign prostatic hyperplasia Tadalafil 10mg and Use is only permitted to a maximum of 4 treatments per month in line with NHS Tameside and Glossop CCG policy on the treatment of erectile dysfunction Restricted to those requiring treatment of severe chronic GREY
pain which can be adequately managed only with opioid therapies. Other alternatives should be tried first Testosterone Patches Marketing licence in the UK was withdrawn. Listed to for hypoactive sexual prevent supply of imported products desire (Intrinsa®)* Tobramycin – inhaled Primary care can't monitor therapy sufficiently to oversee treatment or adjust the dose where necessary to RED
Capsules are not good value for the NHS please use Topiramate capsules tablets instead for new patients and change existing prescriptions to tablets where clinically appropriate initiations
No flexibility for dose titration. Use separate agents as not DNP
Verapamil (Tarka®) Please see Dulaglutide Ulipristal acetate 5mg (Esmya®) * (Please note 30mg tablets for emergency hormonal contraception are not affected.) Unlicensed vitamins supplements for any Vitamin B Compound & Vitamin B Should only be used on the advice of a dietician or in secondary care to prevent "re-feeding syndrome Tablets Valdoxan® See Aglomelatine See branded preparations containing latanoprost as a single active ingredient Please see levocetirazine NTS deemed inappropriate due to lack of robust evidence of efficacy/safety. Please see ondansetron


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