NHS Ayrshire & Arran Formulary Bulletin - NHS Ayrshire and Arran.

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rivastigamine with regards Alzheimer’s disease has therefore been superceded.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