Pan Mersey
Area Prescribing Committee
 
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8 Malignant disease and immunosuppression

Coronavirus guidance

Guidance to support primary care prescribers and pharmacists is available from the MLCSU Coronavirus guidance resource page. Links are provided to national resources and regional documents produced by MLCSU, RDTC, and SPS for use by Pan Mersey APC, LSCMMG, and GMMMG.

The list of resources will be updated as new material becomes available so please check back regularly for updates.

The Pan Mersey APC supports the use of COVID-specific guidance issued by NICE, and NHS England and NHS Improvement. During the COVID pandemic this will supersede any APC advice.

Malignant disease and immunosuppression

Review date: January 2022

Non-formulary drugs: Any drug or formulation not listed in the formulary is deemed to be non-formulary.

Off-label use: Drugs are included in the formulary for their licensed indications – where inclusion of off-label use is considered to be included in the formulary this is specifically stated in the formulary entry for the drug N.B. also see Paediatrics note below.

Paediatrics: Drugs are included in the formulary for paediatric use for their BNF for Children recommended indications (indicated by symbol View childrens BNF) which may be off-label, unless otherwise stated. All drugs are deemed to have the same RAG status as they have for adults unless stated otherwise.

NHS England Specialised Commissioning
Drugs carrying the NHS England logo are commissioned by them. Links to key documents, national programmes of care, and clinical reference groups are found below.

NHSE NHS England Specialised Commissioning: Key documents

NHSE NHS England Specialised Commissioning: National programmes of care and clinical reference groups

Medications which are indicated for medically assisted reproduction, including ovulation induction (e.g. clomifene, letrozole and tamoxifen) and assisted reproduction, such as In Vitro Fertilisation or Ex Vitro Fertilisation (e.g. gonadotrophins) are restricted to use by specialist secondary care physicians, and are categorised as RED drugs for these purposes.

08-02-02 Corticosteroids and other immunosuppressants

Ciclosporin

Patients should be stabilised on a particular brand of oral ciclosporin. Prescribing and dispensing of ciclosporin should be by brand name.

Switching between formulations without close monitoring may lead to clinically important changes in blood-ciclosporin concentration. If it is necessary to switch to a different brand the patient should be monitored closely for changes in blood-ciclosporin concentration, serum creatinine, blood pressure and transplant function.

Ciclosporin is RED for transplant rejection.

Please note that this RAG rating refers to use in transplant rejection. Please see other relevant chapters of this formulary for use in other indications.

Oral tacrolimus products

Prescribe and dispense by brand name only, to minimise the risk of inadvertent switching between products, which has been associated with reports of toxicity and graft rejection.

Inadvertent switching between oral tacrolimus products has been associated with reports of toxicity and graft rejection. To ensure maintenance of therapeutic response when a patient is stabilised on a particular brand, oral tacrolimus products should be prescribed and dispensed by brand name only. There are 3 different oral formulations of tacrolimus:

Switching between different oral formulations of tacrolimus requires careful supervision and therapeutic monitoring by an appropriate specialist

Tacrolimus is RED for transplant rejection.

Please note that this RAG rating refers to use in transplant rejection. Please see other relevant chapters of this formulary for use in other indications


Antithymocyte immunoglobulin (rabbit)
Formulary

Intravenous infusion 25mg

 NHS NHSE commissioned drug - see Specialised Commissioning: Key documents


Red View adult BNF  View childrens BNF
Basiliximab
Formulary

Injection 10mg, 20mg

NHS NHSE commissioned drug - see Specialised Commissioning: Key documents


Red View adult BNF  View SPC online  View childrens BNF
Belatacept
Formulary

Intravenous infusion 250mg

NHS NHSE commissioned drug - see Specialised Commissioning: Key documents


Red View adult BNF  View SPC online
Ciclosporin
Formulary

Capsules 25mg, 50mg, 100mg 
Capsules 10mg  
Oral solution 100mg/mL  
Intravenous infusion 50mg/mL

Prescribe by brand name

NHS NHSE commissioned drug - see Specialised Commissioning: Key documents

Ciclosporin is RED for transplant rejection


Red View adult BNF  View SPC online  View childrens BNF
Sirolimus
Formulary

Tablets 500 microgram, 1mg, 2mg
Oral solution 1mg/mL

NHS NHSE commissioned drug - see Specialised Commissioning: Key documents

Sirolimus is RED for transplant rejection


Red View adult BNF  View SPC online  View childrens BNF
Tacrolimus
Formulary

 

Capsules 500 micrograms, 1mg, 5mg
MR capsules 500 micrograms, 1mg, 3mg, 5mg
Granules 200 micrograms, 1mg
Oral suspension 2.5mg in 5mL (Special)
Concentrate for intravenous infusion 5mg/mL

Prescribe by brand name

NHS NHSE commissioned drug - see Specialised Commissioning: Key documents

Tacrolimus is RED for transplant rejection


Red View adult BNF  View SPC online  View childrens BNF