netFormulary NHS
Buckinghamshire Formulary
Buckinghamshire Healthcare NHS Trust
Buckinghamshire CCG
 Search
 Formulary Chapter 8: Malignant disease and immunosuppression - Full Chapter
Notes:
1. Please refer to Appendix 11 of the BHT Medicines Policy for full details of policies and procedures for the prescribing, preparation and administration of chemotherapy (including intrathecal chemotherapy)

2. Use chemotherapy in accordance with NHSE National dose banding tables. For latest version see here.
 Details...
08.03.04.01  Expand sub section  Breast cancer
Anastrozole 1mg
(tablet)
View adult BNF View SPC online View childrens BNF  Track Changes
Restricted Drug Restricted
Amber Recommended
In secondary care restricted to prescribing by Consultants in Breast Surgery or Breast Oncology.
In primary care, may be prescribed by GPs if recommended by Consultants in Breast Surgery or Breast Oncology.  
   
Exemestane 25mg
(tablet)
View adult BNF View SPC online View childrens BNF  Track Changes
Restricted Drug Restricted
Amber Recommended
In secondary care restricted to prescribing by Consultants in Breast Surgery or Breast Oncology.
In primary care, may be prescribed by GPs if recommended by Consultants in Breast Surgery or Breast Oncology.  
   
Letrozole 2.5mg
(tablet)
View adult BNF View SPC online View childrens BNF  Track Changes
Restricted Drug Restricted
Amber Recommended
In secondary care restricted to prescribing by Consultants in Breast Surgery or Breast Oncology.
In primary care, may be prescribed by GPs if recommended by Consultants in Breast Surgery or Breast Oncology.  
   
Palbociclib 75mg, 100mg, 125mg
(capsules)
View adult BNF View SPC online View childrens BNF  Track Changes
Restricted Drug Restricted
High Cost Medicine
BlueTeq

FOR ALL PRESCRIBING - a completed and approved HIGH COST DRUG compliance form, via BLUETEQ, is required.


Prescribing by the Oncology team:


1.In combination with an aromatase inhibitor for previously untreated HER2-negative, locally advanced or metastatic breast cancer (NICE TA 495 and NHSE SSC 1810);


2. With fulvestrant for treating hormone receptor-positive, HER2-negative, advanced breast cancer (NICE TA TA 619 and NHSE SSC 2104). 


NICE TA 619: Palbociclib with fulvestrant for treating hormone receptor-positive, HER2-negative, advanced breast cancer

 
   
Ribociclib 200mg
(film-coated tablets)
View adult BNF View SPC online View childrens BNF  Track Changes
Restricted Drug Restricted
Red
Cancer Drugs Fund
NHS England
BlueTeq

FOR ALL PRESCRIBING - a completed and approved HIGH COST DRUG compliance form, via BLUETEQ, is required.

 

Restricted to prescribing by Consultant Oncologists:

 

1) In combination with an aromatase inhibitor for previously untreated, hormone receptor-positive, HER2-negative, locally advanced or metastatic breast cancer in accordance with NICE TA 496 and NHSE SSC 1810.

 

2) In combination with fulvestrant for treating hormone receptor-positive, HER2-negative, advanced breast cancer after endocrine therapy in accordance with NICE TA 687. 

 
Link  NICE TA 496: Ribociclib with an aromatase inhibitor for previously untreated, hormone receptor-positive, HER2-negative, locally advanced or metastatic breast cancer
Link  NICE TA 687: Ribociclib with fulvestrant for treating hormone receptor-positive, HER2-negative advanced breast cancer after endocrine therapy
   
Tamoxifen 10mg, 20mg
(tablet)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Green
 
   
Tamoxifen 10mg/5mL
(oral solution)
View adult BNF View SPC online View childrens BNF  Track Changes
Restricted Drug Restricted
Green
In secondary care restricted - Phone Pharmacy to Order 
   
 ....
 Non Formulary Items
Degarelix 80mg injection

View adult BNF View SPC online View childrens BNF Track Changes
Non Formulary
Black
 
Fulvestrant  (Faslodex®)

View adult BNF View SPC online View childrens BNF Track Changes
Non Formulary
Black

Non formulary when used in accordance with NICE TA 503 and NICE TA 239

Link  East Midlands Cancer Network : Hormone Algorithm - Advanced Breast Cancer
Link  NICE TA 503: Fulvestrant for untreated locally advances or metastatic oestrogen-receptor positive breast cancer
Link  NICE TA239: Fulvestrant for the treatment of locally advanced or metastatic breast cancer
 
Toremifene  (Fareston®)

View adult BNF View SPC online View childrens BNF
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

Black

Not recommended for use because of lack of evidence of clinical effectiveness, cost effectiveness or safety.
Drugs which have been evaluated and rejected by the Medicines Value Group (MVG)
Drugs defined as ‘Low Priority’ by the South Central Priorities Committee
New drugs which have not as yet been evaluated by the MVG
Any drug not listed in the Buckinghamshire Formulary  

Red

Drugs which should only be prescribed in secondary care by a specialist.
Require specialist knowledge and/or equipment for patient selection and initiation
Require long term on-going monitoring and dose adjustment to ensure efficacy and minimise toxicity by a specialist
Designated as “hospital only“ by product licence, NICE, DoH or BNF
May need further evaluation by a specialist
Are hospital initiated clinical trial materials  

Red Specialist Centre

As for ‘red’ (above) with the addition of the following:
Designated by NHS England to require initiation by or in prior agreement with a Specialist Centre. Continuation where appropriate by BHT (or other secondary care provider)
Detailed requirements for Specialist Centre initiation to be described in the wording of the formulary restriction  

Amber Protocol

Drugs which should be initiated in secondary care by the specialist with follow-on prescription and monitoring according to a drug specific Shared Care Protocol(SCP). Prescribing may be continued in primary care following the SCP
Require specialist knowledge and/or equipment for patient selection and initiation
Require short or medium term (eg. 3 to 6 months) specialist monitoring of efficacy or toxicity. The need for stabilisation will vary with different drugs and patients, but is usually a minimum of 2 months (see principles for shared care)
Require significant long term monitoring
Require ongoing communication between the GP and the specialist
Have clearly defined consultant, GP and patient responsibilities documented in a shared care protocol (see responsibilities for amber protocol drugs)  

Amber Initiation

Drugs suitable for primary care prescribing following specialist initiation
Require specialist knowledge and/or equipment for patient selection
Monitoring does not require specialist knowledge or equipment
If the drug is one with which the primary care prescriber is unfamiliar the specialist is expected to provide sufficient information on the drug indication, dose, duration , monitoring and any further necessary dose adjustments
Require the first prescription to be written by the specialist  

Amber Recommended

Drugs suitable for primary care prescribing following specialist recommendation
As for amber initiation except that:- The first prescription may be written by the GP after specialist recommendation.  

Green

Drugs for which primary care prescribers would normally take full responsibility for prescribing and monitoring
Drugs not included in the Traffic Light list but included on joint formulary.
New drugs classified as red or amber but as greater experience regarding their safety and efficacy is established may move to Green after re-consideration by the MVG and APC.  

netFormulary