netFormulary NHS
Milton Keynes Formulary
Milton Keynes University Hospital NHS Foundation Trust
Bedfordshire, Luton and Milton Keynes Clinical Commissioning Group
Milton Keynes Community Health Services
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 Formulary Chapter 1: Gastro-intestinal system - Full Chapter
01.05.03  Expand sub section  Drugs affecting the immune response
Cytotoxic Drug Azathioprine
(Gastroenterology)
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Formulary
Amber SCG
  • Tablets 25mg, 50mg
  • Tablets 10mg - available on named-patient basis only

Note:

  • Avoid concomitant use of azathioprine with allopurinol, unless supervised by an appropriate specialist.
  • See below for the Shared Care prescribing guideline for azathioprine therapy in inflammatory bowel disease (IBD).
 
Link  Shared Care Prescribing Guideline for Azathioprine and Mercaptopurine Therapy in IBD
Link  UKMI Q and A: Can mothers breast feed while taking azathioprine?
   
Ciclosporin
(Gastroenterology)
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Formulary
Amber SCG

(Amber SCG in development)

  • Capsules 10mg, 25mg, 50mg, 100mg
  • Oral solution 100mg/mL 
 
Link  Crohn’s and Colitis UK: Patient information leaflets
   
Cytotoxic Drug Mercaptopurine
(Gastroenterology)
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Formulary
Amber SCG

Tablets 50mg

See below for the Shared Care prescribing guideline for mercaptopurine therapy in inflammatory bowel disease (IBD).

 

 
Link  Shared Care Prescribing Guideline for Azathioprine and Mercaptopurine Therapy in IBD
   
Cytotoxic Drug Methotrexate
(Gastroenterology)
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Formulary
Amber SCG
Homecare

Tablets 2.5mg

Notes

Methotrexate dose is weekly.

To avoid errors it is recommended that:

  • The patient is carefully advised of the dose and frequency and the reason for taking methotrexate and any other prescribed medicine (e.g. folic acid). 
  • The prescription and the dispensing label clearly show the dose and frequency of administration.
  • The patient is warned to report immediately the onset of any feature of blood disorders (e.g. sore throat, bruising and mouth ulcers), liver toxicity (e.g. nausea, vomiting, abdominal discomfort and dark urine), and respiratory adverse effects (e.g. shortness of breath).

See below for the Shared Care prescribing guideline for methotrexate therapy in inflammatory bowel disease (IBD). 

 
Link  Shared Care Prescribing Guideline for Methotrexate Therapy in Crohn’s Disease
Link  UKMI Q&A: Interaction between methotrexate and penicillins info.
   
01.05.03  Expand sub section  Cytokine inhibitors
Adalimumab
(Gastroenterology)
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Formulary
Red
High Cost Medicine
Homecare
  • Imraldi - Injection 40mg/0.8mL prefilled pen or prefilled syringe
  • Amgevita - Injection 20mg/0.4mL, injection 40mg/0.8mL prefilled pen or prefilled syringe
  • Humira - Injection 40mg/0.4mL, injection 80mg/0.8mL prefilled pen or prefilled syringe
  • Humira - Injection 20mg/0.2mL pre-filled syringe, injection 40mg/0.8mL solution in vial for first line use in paediatrics

Notes:

  • To be prescribed by brand.
  1. First line brand in adults = Imraldi®
  2. Second line brand in adults = Amgevita®
  3. Third line brand in adults = Humira®
  • Hulio and Hyrimoz are non-formulary within Milton Keynes Healthcare.
 
Link  NICE TA187: Crohn’s disease - infliximab and adalimumab
Link  NICE TA329: Infliximab, adalimumab and golimumab for moderately to severely active ulcerative colitis
   
Golimumab (Simponi®)
(Ulcerative Colitis)
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Formulary
Red
High Cost Medicine
Homecare

Injection 50mg pre-filled pen or pre-filled syringe; 100mg pre-filled pen

 
Link  NICE TA329: Infliximab, adalimumab and golimumab for moderately to severely active ulcerative colitis
   
Infliximab (Inflectra®)
(All indications)
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Formulary
Red
High Cost Medicine

1st line Biosimilar agent

Intravenous infusion, powder for reconstitution, 100mg vial  

Specify brand when prescribing.

Notes:

  • First line brand for all licensed indications as this is the most cost-effective option.
  • If patient has a flare of the condition for which the Inflectra is being treated whilst on this medication, the patient should be switched to Remicade® and remain on this instead.
 
Link  NICE KTT15: Biosimilar medicines
Link  NICE TA163: Ulcerative colitis (acute manifestations) Infliximab
Link  NICE TA187: Crohns disease - infliximab & adalimumab
Link  NICE TA329: Infliximab, adalimumab and golimumab for moderately to severely active ulcerative colitis
   
Infliximab (Remicade®)
(Gastroenterology)
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Formulary
Red
High Cost Medicine

(Original biologic)

Intravenous infusion, powder for reconstitution, 100mg vial  

Specify brand when prescribing.

 
Link  NICE KTT15: Biosimilar medicines
Link  NICE TA163: Ulcerative colitis (acute manifestations) Infliximab
Link  NICE TA187: Crohns disease - infliximab & adalimumab
Link  NICE TA329: Infliximab, adalimumab and golimumab for moderately to severely active ulcerative colitis
   
Tofacitinib citrateBlack Triangle (Xeljanz®)
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Formulary
Red
High Cost Medicine

Tablets 5mg, 10mg

 
Link  NICE TA547: Tofacitinib for moderately to severely active ulcerative colitis
   
Ustekinumab (Stelara®)
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Formulary
Red
High Cost Medicine
BlueTeq

Solution for injection:

  • 45mg/0.5ml solution for injection pre-filled syringes
  • 45mg/0.5ml solution for injection vials
  • 90mg/1ml solution for injection pre-filled syringes

Solution for infusion:

  • 130mg/26ml concentrate for solution for infusion vials
 
Link  NICE TA456: Ustekinumab for moderately to severely active Crohn’s disease after previous treatment
Link  NICE TA633 guidance: Ustekinumab for treating moderately to severely active ulcerative colitis (published June 2020)
   
Vedolizumab (Entyvio®)
(Gastroenterology)
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Formulary
Red
High Cost Medicine

Concentrate for intravenous infusion, powder for reconstitution, 300mg vial

 
Link  NICE TA352: Vedolizumab for Crohn’s disease
Link  NICE TA342: Vedolizumab for ulcerative colitis
   
Infliximab (Remsima®)
(All indications)
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Restricted Drug Restricted
Red
High Cost Medicine

2nd line Biosimilar agent

Intravenous infusion, powder for reconstitution, 100mg vial  

Specify brand when prescribing.

Not preferred, as a more cost-effective option/brand (Inflectra®) is available.

 
Link  NICE KTT15: Biosimilar medicines
Link  NICE TA163: Ulcerative colitis (acute manifestations) Infliximab
Link  NICE TA187: Crohns disease - infliximab & adalimumab
Link  NICE TA329: Infliximab, adalimumab and golimumab for moderately to severely active ulcerative colitis
   
 ....
 Non Formulary Items
Cytotoxic Drug  Azathioprine
(Autoimmune Hepatitis)

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Non Formulary
Link  UKMI Q and A: Can mothers breast feed while taking azathioprine?
 
  
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
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Link to adult BNF
click to search medicines.org.uk
Link to children's BNF
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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

Green

Routine prescribing within licensed indication  

Amber 1

Specialist recommendation followed by GP initiation and continuation  

Amber 2

Specialist or GP initiation in line with local guideline after 1st line failure followed by GP continuation   

Amber 3

Specialist initiation and stabilisation followed by GP continuation  

Amber SCG

Specialist initiation and stabilisation followed by GP continuation in line with an agreed shared care guideline  

Red

Hospital or specialist prescribing only  

Red Red

These medicines have been evaluated and rejected by MKPAG and are NOT approved for use within MK. They are not recommended for use because of lack of clinical effectiveness, cost effectiveness or safety.  

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