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Birmingham, Sandwell, Solihull and environs APC Formulary
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 Formulary Chapter 11: Eye - Full Chapter
Notes:

 Criteria for Preservative Free (PF) and Single Dose Unit (SDU) presentations:

These are restricted to patients with
• true preservative allergy
and/or
• evidence of epithelial toxicity from preservatives
and/or
• severe dry eyes
and/or
• require/ may require surgery in the near future
and/or
• neonates

 Details...
11.04.01  Expand sub section  Corticosteroids
Betamethasone 0.1% eye drops
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Formulary
Amber
 
   
Betamethasone 0.1% eye ointment
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Formulary
Amber
 
   
Betamethasone 0.1% with Neomycin 0.5% eye drops
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Formulary
Amber
  • Short term use only 
  •    
    Dexamethasone 0.1% eye drops (Maxidex®)
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    Formulary
    Amber
     
       
    Dexamethasone 0.1% eye drops (Single dose units)
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    Formulary
    Amber
  • for post corneal implants or OSD
  • Use the agent with the lowest acquisition cost 
  •    
    Dexamethasone with Antibacterials (Tobradex®)
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    Formulary
    Red
     
       
    Dexamethasone with Neomycin and Polymyxin B sulphate (Maxitrol®)
    (Eye Drops/Eye Ointment)
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    Formulary
    Amber
  • Specialist Ophthalmologist Recommendation. 
  •    
    Fluorometholone 0.1% (FML®)
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    Formulary
    Amber
  • Specialist Ophthalmologist Recommendation. 
  •    
    Loteprednol Etabonate 0.5% (Lotemax®)
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    Formulary
    Red
     
       
    Prednisolone 0.5% eye drops
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    Formulary
    Amber
  • Specialist Ophthalmologist Recommendation .
     
  •    
    Prednisolone 1% eye drops (Pred Forte®)
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    Formulary
    Amber
  • Specialist Ophthalmologist Recommendation.
  • For Anterior Uveitis in A&E-prednisolone acetate 1% as the drug of choice unless the patient has a preference for dexamethasone 0.1% 
  •    
    Prednisolone preservative free eye drops 0.5%
    (Minims SDU)
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    Formulary
    Amber

  • Specialist Ophthalmologist recommendation
  • Use in patients with severe Chronic Allergic Eye Disease who present to A&E with a flare up. 
  •    
    11.04.01  Expand sub section  Intravitreal corticosteroids
    Dexamethasone 700mcg intravitreal implant (Ozurdex®)
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    Restricted Drug Restricted
    Red
    High Cost Medicine
  • For macular oedema secondary to retinal vein occlusion -use in line with NICE
  • For diabetic macular oedema- use in line with NICE 
  • Link  NICE TA229: Dexamethasone intravitreal implant for the treatment of macular oedema
    Link  NICE TA349: Dexamethasone intravitreal implant for treatment of diabetic macular oedema
       
    Fluocinolone intravitreal implant (Iluvien®)
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    Formulary
    Red
     
    Link  NICE TA301: Fluocinolone acetonide intravitreal implant for treating chronic diabetic macular oedema after an inadequate response to prior therapy (rapid review of technology appraisal guidance 271)
       
     ....
     Non Formulary Items
    Dexamethasone with Antibacterials  (Sofradex®)

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    Non Formulary
     
    Hydrocortisone Acetate with Neomycin  (Neo-Cortef®)

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    Non Formulary
     
    Hydrocortisone eye ointment

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    Non Formulary
     
    Prednisolone 0.5% with Neomycin 0.5%  (Predsol-N®)

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    Non Formulary
     
    Rimexolone  (Vexol®)

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    Non Formulary
    Black
     
      
    Key
    note Notes
    Section Title Section Title (top level)
    Section Title Section Title (sub level)
    First Choice Item First Choice item
    Non Formulary Item Non Formulary section
    Restricted Drug
    Restricted Drug
    Unlicensed Drug
    Unlicensed
    Track Changes
    Display tracking information
    click to search medicines.org.uk
    Link to adult BNF
    click to search medicines.org.uk
    Link to children's BNF
    click to search medicines.org.uk
    Link to SPCs
    Cytotoxic Drug
    Cytotoxic Drug
    CD
    Controlled Drug
    High Cost Medicine
    High Cost Medicine
    Cancer Drugs Fund
    Cancer Drugs Fund
    NHSE
    NHS England
    Homecare
    Homecare
    CCG
    CCG

    Traffic Light Status Information

    Status Description

    Prescribing in children

    The APC notes that the informed use of unlicensed medicines or of licensed medicines for unlicensed applications (‘off-label’ use) is often necessary in paediatric practice.

    The APC advises GPs to consider specialist prescribing recommendations for Green and Amber medicines that are not subject to ESCAs or RICaDs in combination with the information provided in the BNFC which goes beyond that of marketing authorisations. The BNFC has been designed for rapid reference and the information presented has been carefully selected to aid decisions on prescribing.

      

    Green

    Medicines which are suitable for initiation and maintenance prescribing by primary and secondary care clinicians. These medicines should be initiated and prescribed within their licensed indications.  

    Amber

    Initiation and maintenance of prescribing by Specialists and transfer to Primary Care prescribing when appropriate, or initiation and maintenance of prescribing in Primary Care following recommendation from a Specialist.

    Some amber medicines require agreement with the local (internal) medicines committee prior to initiation; others may require a framework to support safe transfer and maintenance of care such as a RICaD or ESCA. The Formulary will be annotated to reflect these requirements.   

    Red

    Medicines for initiation and maintenance prescribing by Specialists only  

    Black

    Non-formulary medicines- medicines not recommended for routine primary care prescribing.  

    Grey

    Positive NICE TA and /or awaiting local clarification on place in therapy ; Please contact your Medicines Optimisation team for more information.  

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