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 Formulary Chapter 9: Nutrition and blood - Full Chapter
09.01  Expand sub section  Anaemias and some other blood disorders
09.01.01  Expand sub section  Iron-deficiency anaemias
09.01.01.01  Expand sub section  Oral iron
Ferrous Fumarate
(210mg tablets)
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First Choice 68mg iron per tablet 
Ferrous Fumarate
(322mg tablets)
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Formulary 100mg iron per tablet 
   
Ferrous Sulphate
(200mg tablets)
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Formulary 65mg iron per tablet 
   
Ferric Maltol (Feraccru®)
(30mg hard capsules)
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Restricted Drug Restricted
Green 2
30mg iron per capsule

Restricted Item Consultant gastroenterologist only

Alternative to IV iron in IBD patients intolerant to existing oral iron products, as per GMMMMG recommendations  
Link  GMMMG recommendation: Ferric maltol for iron deficiency anaemia in IBD patients
   
Ferrous Fumarate
(140mg/5ml sugar-free syrup)
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Formulary 45mg iron per 5ml 
   
Sodium Feredetate (Sytron®)
(190mg/5ml sugar-free elixir)
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Formulary 27.5mg iron per 5ml 
   
09.01.01.01  Expand sub section  Iron and folic acid
09.01.01.01  Expand sub section  Compound iron preparations to top
09.01.01.02  Expand sub section  Parenteral iron
 note 

IV iron dose should be calculated according to body weight and iron deficit and administered in strict accordance with the posology and method of administration described in the product information for each individual product (note that advice varies between products) Caution is needed with every dose of intravenous iron that is given, even if previous administrations have been well tolerated

IV iron products should only be administered when staff trained to evaluate and manage anaphylactic or anaphylactoid reactions—as well as resuscitation facilities—are immediately available

Patients should be closely monitored for signs of hypersensitivity during and for at least 30 minutes after every administration of an IV iron product. In the event of a hypersensitivity reaction, treatment should be stopped immediately and appropriate management initiated. Report any adverse effects via the Yellow Card Scheme (www.mhra.gov.uk/yellowcard)

Iron Isomaltoside (Monofer®)
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First Choice
Red
Injection

  
Ferric Carboxymaltose (Ferinject®)
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Second Choice
Red
Injection 
   
Iron Dextran (CosmoFer®)
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Formulary
Red
Injection

 
   
Iron Sucrose (Venofer®)
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Formulary
Red
Injection 
   
09.01.02  Expand sub section  Drugs used in megaloblastic anaemias
Hydroxocobalamin
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First Choice Injection 
Folic Acid
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First Choice Tablets
Oral syrup
Injection unlicensed(unlicensed) 
Cyanocobalamin
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Formulary
Grey
Tablets

Only for use in those patients who are truly unable to tolerate injections and who are vegan or have a proven dietary deficiency.  
   
09.01.03  Expand sub section  Drugs used in hypoplastic, haemolytic, and renal anaemias
Anti-human thymocyte immunoglobulin (rabbit)  (Thymoglobuline®)
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Formulary
Red
 
   
09.01.03  Expand sub section  Erythropoietin
 note 

MHRA Drug Safety Update 2007

Overcorrection of haemoglobin concentration in patients with chronic kidney disease may increase the risk of death and serious cardiovascular events. In patients with cancer, clinical trial data show an unexplained excess mortality and increased risk of tumour progression with erythropoietin treatment, and overcorrection of haemoglobin concentration may increase the risk of thrombosis and related complications.

• Patients should only be treated when symptoms of anaemia are present

• The haemoglobin concentration should be maintained within the range 10-12g/100ml (avoid concentrations higher than 12g/100ml). The haemaglobin concentration should not be increased beyond that which provides adequate control of symptoms of anaemia.

• Treatment of symptomatic anaemia with erythropoeitins in patients with cancer is only licensed for patients receiving chemotherapy.

• The decision to use erythropoietin should be based on an assessment of the benefits and risks for individual patients; blood transfusion may be the preferred treatment for anaemia associated with cancer chemotherapy.

 

There have been very rare reports of pure red cell aplasia in patients treated with epoetin alfa. These patients should not be switched to another form of erythropoietin.

Darbepoetin Alfa (Aranesp®)
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First Choice
Red
Injection  
Epoetin alfa (Eprex®)
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First Choice
Red
Injection 
Epoetin beta (NeoRecormon®)
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Formulary
Red
Injection 
   
09.01.03  Expand sub section  Iron overload to top
Deferasirox (Exjade®)
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Formulary
Amber
High Cost Medicine
Dispersible tablets

PbR Excluded - commissioned by NHS England 
   
Desferrioxamine Mesilate
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Formulary
Red
High Cost Medicine
Injection

PbR Excluded- commissioned by NHS England 
   
Deferiprone (Ferriprox®)
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Formulary
Red
High Cost Medicine
Tablets

PbR Excluded - commissioned by NHS England 
   
09.01.04  Expand sub section  Drugs used in platelet disorders
Anagrelide (Xagrid®)
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Formulary
Red
Capsules 
   
Eltrombopag (Revolade®)
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Formulary
Red
High Cost Medicine
Tablets

PbR Excluded - commissioned by CCG 
Link  NICE TA293: Eltrombopag for treating chronic immune (idiopathic) thrombocytopenic purpura (review of technology appraisal 205)
   
Romiplostim (Nplate®)
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Formulary
High Cost Medicine
Injection

PbR excluded - commissioned by CCG
Prescribers need to ensure manufacturer makes romiplostim available with the discount agreed as part of the patient access scheme.  
Link  NICE TA221: Thrombocytopenic purpura - romiplostim
   
09.01.05  Expand sub section  G6PD deficiency
09.01.06  Expand sub section  Drugs used in neutropenia
Filgrastim (Zarzio®)
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First Choice
Red
Injection 
Pegfilgrastim (Neulasta®)
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Formulary
Red
Injection 
Link  MHRA Drug Safety Update: Filgrastim and pegfilgrastim: risk of potentially life-threatening capillary leak syndrome
   
Lenograstim (Granocyte®)
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Formulary
Red
Injection 
   
09.01.07  Expand sub section  Drugs used to mobilise stem cells
 ....
 Non Formulary Items
Compound iron preparations  (Ferrograd C®)

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Non Formulary
 
Compound iron preparations  (Givitol®)

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Non Formulary
 
Cyanocobalamin

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Non Formulary Injection
 
Epoetin Theta  (Eporatio®)

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Non Formulary
 
Ferrous Fumarate  (Galfer®)
(305mg capsules)

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Non Formulary
 
Ferrous Gluconate

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Non Formulary
 
Ferrous Sulphate  (Ferrograd®)

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Non Formulary
 
Ferrous Sulphate  (Ironorm® drops)

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Non Formulary
 
Filgrastim  (Neupogen®)

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Non Formulary
 
Filgrastim  (Nivestim®)

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Non Formulary
 
Filgrastim  (Ratiograstim®)

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Non Formulary
 
Iron and Folic Acid  (Ferrograd Folic®)

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Non Formulary
 
Iron and Folic Acid  (Pregaday®)

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Non Formulary
 
Iron and Folic Acide  (Fefol®)

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Non Formulary
 
Iron and Folic Acide  (Galfer FA®)

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Non Formulary
 
Methoxy Polyethylene Glycol-Epoetin Beta  (Mircera®)

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Non Formulary
 
Oxymetholone

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Non Formulary
 
Plerixafor  (Mozobil®)

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Non Formulary
 
  
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

Amber

Drugs designated amber are suitable for shared care arrangements under a shared care protocol. Prescribing may be transferred from secondary to primary care once the patient is stabilised and agreed shared care arrangements have been established. Alternatively primary care may initiate under the supervision of secondary care if this option is given in the shared care document. It is recommended that shared care arrangements should be drawn up following local discussion and agreement by prescribing parties.   

Black

These products have been reviewed by the GM Joint Formulary Group and have been deemed not suitable for prescribing for adults in primary or secondary care within Greater Manchester. These decisions have been made on the basis of safety, efficacy and cost-effectiveness of the products.  

Green

Not used   

Green 1

Drugs designated green1 are suitable for initiation and ongoing prescribing within primary care.   

Green 2

Drugs designated green2 can be initiated by primary care following written or verbal advice from a specialist and then be subsequently safely prescribed in primary care with little or no monitoring required.  

Green 3

Drugs designated green3 are suitable for on-going prescribing within primary care after specialist initiation and an initial review (unless specified) in secondary care. Little or no monitoring is required.  

Grey

Not suitable for routine prescribing but may be suitable for a defined patient population. Whilst prescribers should think very carefully before prescribing or recommending any of the products on the grey list, there may be exceptional instances when the use of one of these products is necessary for a particular patient.   

Red

Drugs designated red are considered to be specialist medicines and prescribing responsibility for these medicines should normally remain with the consultant or specialist clinician. These drugs should not be initiated or prescribed in primary care. It is recommended that the supply of these specialist medicines should be organised via the hospital pharmacy, this may include arranging for supply via a home care company.   

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