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Royal United Hospitals Bath NHS Foundation Trust
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 Formulary Chapter 11: Eye - Full Chapter
Notes:

Ophthalmology-related Prescribing Guidance

Please see our Prescribing Guidelines page for all prescribing guidance relating to this chapter.

Ophthalmology-related Shared Care Agreements

There are no shared care agreements (SCAs) relating to this chapter.

 

Self-care

Many of the products in this chapter are available for purchase over-the-counter, and patients are encouraged to self-care, with the support of their community pharmacist, in the first instance.

For further information on self-care & the NHS, please refer to https://www.england.nhs.uk/medicines/conditions-for-which-over-the-counter-items-should-not-routinely-be-prescribed/

 Details...
11.04  Expand sub section  Corticosteroids and other anti-inflammatory preparations
 note 

See MHRA Drug Safety Update: rare risk of central serous chorioretinopathy with local and systemic administration of corticosteriods August 2017

For information regarding 'specials' please see Royal College of Opthalmologists Special Products August 2016

11.04.01  Expand sub section  Corticosteroids
Betamethasone 
(Drops)
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Formulary
Green
  • 0.1% eye drops

 

 
   
Betamethasone with Neomycin

(Drops)
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Formulary
Amber
  • Betamethasone sodium phosphate 0.1% with Neomycin sulfate 0.5% eye drops 

 

 
   
Dexamethasone 
(Drops)
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Formulary
Amber
  • 0.1% eye drops

 

 
   
Dexamethasone (Minims®)
(Drops)
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Formulary
    • Amber - Bath & Swindon
    • Non formulary - Salisbury
    • 0.1% preservative free eye drops in 0.5ml unit doses

 

 
   
Dexamethasone  (Ozurdex®)
(Intravitreal implant)
View adult BNF View SPC online
Formulary
Red
High Cost Medicine
CCG
BlueTeq
  • 700 micrograms intravitreal implant in applicator
  • For the treatment of adults with macular oedema following either branch retinal vein occlusion or central retinal vein occlusion ONLY in line with local commissioning criteria and NICE TA229.
  • For the treatment of patients with sight problems caused  diabetic macular oedema, in line with NICE TA349.
  • For the treatment of patients with non-infectious uveitis, in line with NICE TA460Only available in specialist centres (not RUH or SFT).

 

 
Link  NICE TA229: Macular oedema secondary to retinal vein occlusion
Link  NICE TA349: Diabetic Macular Oedema
Link  NICE TA460: Non-infectious uveitis
   
Dexamethasone with Neomycin and Polymyxin B sulphate

(Drops and ointment)
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Formulary
Amber
  • Dexamethasone 1 mg/gram with neomycin 3500 units/gram and polymyxin B sulfate 6000 unit per 1 gram in 3.5g eye ointment
  • Dexamethasone 1 mg/ml with hypromellose 5 mg/ml with neomycin (as neomycin sulfate) 3500 units/ml with polymyxin B sulfate 6000 units/ml in 5ml eye drops
 
   
Dexamethasone with Tobramycin

(Drops)
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Formulary
Green
  • Dexamethasone 1 mg/ml with tobramycin 3 mg/ml eye drops.
  • Salisbury only
  • Non formulary in BaNES and Swindon
 
   
Fluocinolone (Iluvien®)
(Intravitreal implant)
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Formulary
Red
High Cost Medicine
CCG
BlueTeq
  • For the treatment of chronic diabetic macular oedema after an inadequate response to prior therapy. In line with NICE TA301 Nov 2013.  Patients need to have gained 10 or more ETDRS letters of visual acuity between baseline and month 36 to receive a further implant at month 36 according to NICE TA301.
  • Note: concurrent treatment to both eyes not recommended (SPC).
  • A single implant releases fluocinolone for up to 36 months.
  • Implantation may not be repeated more frequently than every 36 months due to lack of evidence base of benefit.
 
Link  Iluvien Educational Risk Minimisation Materials
Link  NICE TA301: Fluocinolone acetonide intravitreal implant for treating chronic diabetic macular oedema after an inadequate response to prior therapy
Link  NICE TA590: Fluocinolone acetonide intravitreal implant for treating recurrent non-infectious uveitis
   
Fluorometholone 
(Solution)
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Formulary
Amber
  • 0.1% ophthalmic solution
 
   
Hydrocortisone sodium phosphate.

View adult BNF View SPC online
Formulary
Red
  • 3.35mg/ml eye drops 0.4ml unit dose
 
   
Loteprednol 
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Formulary
Red
  • Salisbury only
  • Non formulary at RUH and GWH
 
   
Prednisolone 
(Drops)
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Formulary
Green
  • 0.5% ophthalmic drops, 1% ophthalmic drops
  • Preservative free available if indicated

 

 
   
Prednisolone 
(Drops)
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Unlicensed Drug Unlicensed
Red
  • 0.1% and 0.3% ophthalmic drops  NOTE STRENGTHS
  • GWH only - For use in herpes simplex keratitis only
  • These strengths are non formulary at RUH and Salisbury
 
   
11.04.02  Expand sub section  Other anti-inflammatory preparations
Antazoline 0.5% with Xylometazoline 0.05%

(Drops)
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Formulary
Self
  • BaNES only
  • Non formulary in Swindon and Salisbury
  • Xylometazoline hydrochloride 500 microgram, antazoline sulfate 5mg per 1ml
 
   
Olopatadine 
(Drops)
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Formulary
  • Green - Salisbury & Swindon - First-line antihistamine.
  • Non formulary - Bath.
  • 1mg/1ml ophthalmic drops.
 
   
Ketotifen (Ketofall®)
(Drops)
View adult BNF
Formulary
  • Amber - Salisbury & Swindon - 2nd-line after Olopatidine.
  • Non formulary - Bath.
  • 0.25mg/ml single dose unit drops SPC here.
 
   
Neodocromil 
(Drops)
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Formulary
Green
  • Salisbury only
  • Non formulary in Bath and Swindon
  • 2% eye drops
 
   
Sodium Cromoglicate

(Drops)
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Formulary
Self
  • 2% ophthalmic drops
  • If issuing FP10, ensure that prescriptions are written for 13.5ml, not 10ml or ‘1op’ as these preparations are ‘over-the-counter’ products and are more expensive.
 
   
 ....
 Non Formulary Items
Adalimumab     (Imraldi®Amgevita® Humira®)Black Triangle
(Ophthalmology)

View adult BNF View SPC online
Restricted Drug Restricted
High Cost Medicine
NHS England
  • Non-Formulary EXCEPT when used for Uveitis in accordance with NICE TA 460 from Specialist Centres 
  • Check Trust contracting arrangements.
 
Azelastine (Optilast®)

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Non Formulary
 
Cenegermin 

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Non Formulary
Link  NICE TA532: Cenegermin for treating neurotrophic keratitis
 
Emedastine (Emadine®)

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Non Formulary
 
Epinastine (Relestat®)

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Non Formulary
 
Lodoxamide (Alomide®)

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

View adult BNF View SPC online
Non Formulary

Discontinued

 
Sodium cromoglicate preservative free


View adult BNF View SPC online
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 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
Blueteq
High Cost Drug Approval System

Traffic Light Status Information

Status Description

Red

RED - Hospital only – to be prescribed by a specialist and supplied from secondary care ONLY throughout treatment.  

Amber

Amber medicines are considered suitable for GP prescribing following specialist initiation or recommendation.  

Amber with Shared Care

Shared Care - these medicines require specialist initiation and stabilisation. Ongoing division of responsibility for drug and disease monitoring between specialist and GP by a Shared Care Guideline (SCG). If no SCG in place status reverts to red.  

Green

These medicines are appropriate for initiation in both primary and secondary care. Prescribing is appropriate within licensed or local recommendations.  

Self

Suitable for patient to be directed to buy themselves  

Grey

Not currently used. We intend to include this TLS in future to highlight where a decision to use this medicine is under review.   

Black

Not currently used. We intend to include this TLS in future to highlight where a decision has been made by either or both the local or national NHS not to routinely commission this preparation for its licensed indications. Do not prescribe.  

Red Specialist Centre

Not currently used. We intend to include this TLS in future to highlight where this medicine and indication is ONLY available through a Specialist Centre according to a NICE Highly Specialised Technology or NHSE Specialised Commission Circular / Policy.  

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