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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 8: Malignant disease and immunosuppression - Full Chapter
Notes:

 

NHS Clinical Commissioning Policy: Haematopoietic Stem Cell Transplantation B04/P/a

Contacting Milton Keynes Hospital

      
For Haematology and Oncology:

  • During hours: Macmillan Unit on 01908 243671; Internal Ext 5111 or 5112
  • Out of hours: Advanced Nurse Practitioner on bleep 1090    

Paediatric patients:

  • During hours: Paediatric Day Community Unit on 01908 242703; Internal Ext 2703      

Pharmacy:

  • Cancer and Aseptic Services Manager on bleep 1721
  • Aseptic Unit 01908 243952
  • On-call pharmacist via switchboard 01908 660033
Chapter Links...
 Details...
08.01.03  Expand sub section  Antimetabolites
Cytotoxic Drug Azacitidine (Vidaza®)
View adult BNF View SPC online View childrens BNF
Formulary
Red
High Cost Medicine

Injection, powder for reconstitution 100mg vial

 

 
Link  NICE TA218: azacitidine for myelodysplastic syndromes
Link  NICE TA399: Azacitidine for treating acute myeloid leukaemia with more than 30% bone marrow blasts
   
Cytotoxic Drug Capecitabine (Xeloda®)
View adult BNF View SPC online View childrens BNF
Formulary
Red

Tablets 150mg, 500mg

 

 
Link  MHRA: risk of severe skin reactions—discontinue treatment
Link  NICE TA100: Colon cancer (adjuvant) - capecitabine and oxaliplatin
Link  NICE TA191: Gastric cancer (advanced) - capecitabine
Link  NICE TA61: Guidance on the use of capecitabine and tegafur with uracil for metastatic colorectal cancer
   
Cytotoxic Drug Cladribine (Mavenclad®)
View adult BNF View SPC online View childrens BNF
Formulary
Red
High Cost Medicine
Homecare

Tablet 10mg

 
Link  MHRA Drug Safety Update (December 2017): Cladribine and PML
Link  NICE TA493: Cladribine tablets for treating relapsing–remitting multiple sclerosis
Link  NICE TA616: Cladribine for treating relapsing–remitting multiple sclerosis
   
Cytotoxic Drug Cytarabine
View adult BNF View SPC online View childrens BNF
Formulary
Red

Injection 100mg in 5mL, 500mg in 5mL, 500mg in 25mL, 1g in 10mL, 2g in
20mL

DepoCyte® lipid formulation intrathecal injection 50mg vial

 
   
Cytotoxic Drug Fludarabine Phosphate (Fludara®)
View adult BNF View SPC online View childrens BNF
Formulary
Red

Tablets 10mg
Injection, powder for reconstitution 50mg vial

 

 
Link  NICE TA119: Leukaemia (lymphocytic) - first-line treatment of chronic lymphocytic leukaemia (Feb 2007)
Link  NICE TA29: Leukaemia (lymphocytic) - fludarabine for the treatment of B-cell chronic lymphocytic leukaemia (Sep 2001)
   
Cytotoxic Drug Fluorouracil
(Chemotherapy)
View adult BNF View SPC online View childrens BNF
Formulary
Red

Capsules 250mg (named patient only) U

Injection 250mg/10ml vial

 
   
Cytotoxic Drug Gemcitabine (Gemzar®)
View adult BNF View SPC online View childrens BNF
Formulary
Red

Injection, powder for reconstitution 200mg vial, 1g vial

 
Link  NICE TA116: Breast cancer - gemcitabine
Link  NICE TA25: Pancreatic cancer - gemcitabine
Link  NICE TA389 - Topotecan, pegylated liposomal doxorubicin hydrochloride, paclitaxel, trabectedin and gemcitabine for treating recurrent ovarian cancer
   
Cytotoxic Drug Mercaptopurine
(chemotherapy)
View adult BNF View SPC online View childrens BNF
Formulary
Amber 3

Tablets 50mg
Tablets 10mg U
Suspension 100mg in 5mL

Note:
Avoid concomitant use of mercaptopurine with allopurinol, unless supervised by
an appropriate specialist.

 
   
Cytotoxic Drug Methotrexate
View adult BNF View SPC online View childrens BNF
Formulary
Amber SCG

Amber SCG for non-malignant conditions

Tablets 2.5mg, 10mg

Injection 50mg in 2mL
Metoject® PEN solution for injection in pre-filled pen (all strengths)

Notes:
Guideline for oral methotrexate.

The 10mg tablets are reserved for Haematology and Oncology use only

In the treatment of non-cancer conditions (eg. rheumatology and
dermatology), methotrexate must be given once a week or once a month.

Staff that encounter methotrexate prescriptions must ensure the correct dosing
interval is given.

In Patients who experience mucosal or gastro-intestinal side effects with
methotrexate, folic acid 5mg each week may help reduce the frequency of such
side effects.

Methotrexate-induced mucositis or myelosuppression. Folinic acid (given as
calcium folinate) is used to counteract the folate-antagonist action of
methotrexate and so facilitate recovery from methotrexate-induced mucositis or
myelosuppression.

 
Link  UKMI Q&A: alcohol and methotrexate guidance
Link  UKMI Q&A: What is the clinical significance of the interaction between methotrexate and penicillins? (Oct13)
   
Cytotoxic Drug Methotrexate
View adult BNF View SPC online View childrens BNF
Formulary
Red

Red for malignant conditions

Tablets 2.5mg, 10mg

Injection 50mg in 2mL
Metoject® PEN solution for injection in pre-filled pen (all strengths)

Notes:
Guideline for oral methotrexate.

The 10mg tablets are reserved for Haematology and Oncology use only

In the treatment of non-cancer conditions (eg. rheumatology and
dermatology), methotrexate must be given once a week or once a month.

Staff that encounter methotrexate prescriptions must ensure the correct dosing
interval is given.

In Patients who experience mucosal or gastro-intestinal side effects with
methotrexate, folic acid 5mg each week may help reduce the frequency of such
side effects.

Methotrexate-induced mucositis or myelosuppression. Folinic acid (given as
calcium folinate) is used to counteract the folate-antagonist action of
methotrexate and so facilitate recovery from methotrexate-induced mucositis or
myelosuppression.

 
Link  UKMI Q&A: alcohol and methotrexate guidance
Link  UKMI Q&A: What is the clinical significance of the interaction between methotrexate and penicillins? (Oct13)
   
Cytotoxic Drug Pemetrexed (Alimta®)
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Formulary
Red
High Cost Medicine

Alimta® Injection, powder for solution for infusion 100mg, 500mg vials

 

 

 
Link  NICE TA402:Pemetrexed maintenance treatment for non-squamous non-small-cell lung cancer after pemetrexed and cisplatin
Link  NICE TA124: Pemetrexed for the treatment of non-small-cell lung cancer
Link  NICE TA135: Mesothelioma - pemetrexed disodium
Link  NICE TA181: Lung cancer (non-small cell, first line treatment) - pemetrexed
Link  NICE TA190: Lung cancer (non-small-cell) - pemetrexed (maintenance)
   
Cytotoxic Drug Raltitrexed (Tomudex®)
View adult BNF View SPC online View childrens BNF
Formulary
Red

Tomudex® Injection, 2mg Powder for solution for infusion in vial

 

 
Link  NICE CG151: Colorectal cancer
   
Tegafur/gimeracil/oteracil (Teysuno)
View adult BNF View SPC online View childrens BNF
Formulary
Red

Teysuno Capsules 15mg/4.35mg/11.8mg, 20mg/5.8mg/15.8mg

 

 
Link  NICE TA61: Guidance on the use of capecitabine and tegafur with uracil for metastatic colorectal cancer
   
Cytotoxic Drug Tioguanine (Lanvis®)
View adult BNF View SPC online View childrens BNF
Formulary
Red

Tablets 40mg
Capsules 10mg U
Suspension 10mg in 1mL U

 
   
 ....
 Non Formulary Items
Cytotoxic Drug  Clofarabine  (Evoltra®)

View adult BNF View SPC online View childrens BNF
Non Formulary
High Cost Medicine
Cancer Drugs Fund
 
Cytotoxic Drug  Decitabine  (Dacogen®)

View adult BNF View SPC online View childrens BNF
Non Formulary
High Cost Medicine
Link  NICE: Leukaemia (acute myeloid ) - decitabine (terminated appraisal) (TA270)
 
Nelarabine  (Atriance®)

View adult BNF View SPC online View childrens BNF
Non Formulary
High Cost Medicine
Cancer Drugs Fund
 
Cytotoxic Drug  Tegafur with Uracil  (Uftoral®)

View adult BNF View SPC online View childrens BNF
Non Formulary
Link  NICE TA61: Capcitabine and tegafur - Colorectal cancer
 
  
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

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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