Developed by Ipswich Hospital NHS Trust and Ipswich and East Suffolk Clinical Commissioning Group. Joint formulary - Ophthalmology

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1 Developed by Ipswich Hospital NHS Trust and Ipswich and East Suffolk Clinical Commissioning Group. Document type and title: Joint formulary - Ophthalmology Authorised document folder: New or replacing and existing document: Version number: 3.0 S:\Ipswich&East Suffolk CCG\Medicines Management\QIPP workstreams\joint formulary Replacing existing document Approving body: IESCCG Prescribing Workstream Ipswich Hospital Medicines Management Committee (IHT MMC) Date approved: IESCCG Prescribing Workstream: 05/05/15 IHT MMC: 08/05/15 Implementation date: 11/05/15 Author(s): Committee/ group/ individual responsible for updating this document Review date: July 2016 Medicines management pharmacist IESCCG and formulary pharmacist Ipswich Hospital Authors Revision History Version Date Initials Changes marked /2014 CB/RD N/A /2015 CB N/A /2015 CB Yes /2015 CB No Linked Documentation Document title Document file path Primary care formulary S:\Ipswich&East Suffolk CCG\Medicines Management\QIPP workstreams\primary care formulary work Ipswich Hospital Medicines Formulary Distribution Who to Via Date Version GP prescribing leads Workshare 01/ IHT MMC Meeting 01/ IHT formulary pharmacist 04/15 2.1

2 Joint formulary Prescriptions should be written generically unless a specific brand is recommended in the formulary below (will be shown in italics). Excipient intolerances should be included on the prescription If a preservative free eye preparation is required, please specify the rationale in the clinic letter/patient notes. Requests for preservative free products may be questioned if no rationale is provided. NB. The Ipswich Hospital pharmacy will substitute branded prescriptions for generic medication where it is available and more cost effective. Key Italics Most cost effective brand. (OTC) Item available to purchase over the counter from pharmacies and/or supermarkets Bold First choice based on available evidence and cost effectiveness Version: 3.0 Last updated: May 2015 Next review: July 2016 (or sooner if necessary) BNF section Drugs group Formulary Choices Notes 11 Eye Number of per bottle: Bottle size 2.5ml 5ml 10ml Approximate number of contained If patient has difficulty administering eye, consider co-prescribing an Opticare eye drop dispenser Unlicensed food supplements such as I-Caps etc. for age related macular degeneration should not be prescribed on the NHS Anti-infective eye preparations Antibacterials Chloramphenicol 0.5% eye (OTC) Chloramphenicol 1% eye ointment (OTC) Fucidic acid 1% gel Ciprofloxacin 0.3% eye Levofloxacin 0.5% eye Available OTC for patients over 2 years old Available OTC for patients over 2 years old Levofloxacin 0.5% preservative. free eye Antivirals Aciclovir 3% eye ointment 11.4 Corticosteroids and other anti-inflammatory preparations Corticosteroids Prednisolone 0.5% eye Betamethasone 0.1% eye/ear/nose (Vistamethasone ) Betamethasone 0.1% eye ointment Dexamethasone 0.1% eye (preservative free)

3 Other antiinflammatory preparations Fluorometholone eye (FML) Dexamethasone 0.1% single use eye (Dropodex ) Maxitrol eye Maxitrol eye ointment Rimexolone 1% eye Loteprenol eye Dexamethasone intravitreal Implant Fluocinolone acetonide intravitreal implant Sodium cromoglicate 2% eye (OTC) Nedocromil 2% eye Olopatadine 1mg/ml eye As per NICE TA229. As per NICE TA Mydriatics and cycloplegics Antimuscarinics Cyclopentolate 0.5% eye Cyclopentolate 1% eye Cyclopentolate 1% single use Tropicamide 1% single use Tropicamide 0.5% single use Atropine 1% eye Sympathomimetics Phenylephrine 2.5% single use 11.6 Treatment of glaucoma Phenylephrine 10% single use Beta-blockers Timolol 0.25% eye Prostaglandin analogues and prostamides Betaxolol 0.5% eye Timolol 0.1% unit dose eye (Tiopex ) Latanoprost 50mcg/ml eye Latanoprost preservative free eye (Monoprost ) Travoprost 40mcg/ml eye Bimatoprost 100mcg/ml. Reserved for or with poor compliance.. Reserved for.. Bimatoprost 300mcg/ml single. Reserved for use eye. Sympathomimetics Brimonidine 0.2% eye Carbonic anhydrase inhibitors and systemic drugs Dorzolamide 2% eye Brinzolamide 10mg/ml eye Acetazolamide tablets Acetazolamide injection. Reserved for patients intolerant of dorzolamide Hospital only Dorzolamide 2% unit dose eye. Reserved for Miotics Pilocarpine 1% eye Combination preparations Pilocarpine 2% eye Pilocarpine 2% single use Dorzolamide /timolol 2%/0.5% eye Latanoprost /timolol 50mcg/ml/0.5% eye

4 Brimonidine / Timolol 0.2%/0.5% eye Brinzolamide / timolol 10mg/ml/0.5% eye Bimatoprost / timolol 300mcg/ml/0.5% eye Travoprost /timolol 40mcg/ml/0.5% eye Dorzolamide /timolol 2%/0.5% single use eye 11.7 Local anaesthetics Oxybuprocaine 0.4% single use eye Proxymetacaine 0.5% single use eye Tetracaine 1% single use eye Lidocaine and fluorescein single use eye 11.8 Miscellaneous ophthalmic preparations Hypromellose 0.3% eye (OTC) Polyvinyl alcohol 1.4% eye (OTC) (Snotears ) Tear deficiency, ocular lubricants, and astringents Ocular diagnostic and peri-operative preparations and photodynamic treatment Carbomer % (OTC) Liquid paraffin eye ointment (OTC) Carmellose 1% single use eye (OTC) Carmellose 0.5% single use eye (OTC) Sodium chloride 5% preservative free eye / eye ointment [unlicensed special] Acetylcholine intra-ocular irrigation Aflibercept intravitreal injection Apraclonidine 0.5% eye Apraclonidine 1% single use eye Arceole Bevacizumab Injection Brilliant Peel Densiron 68 heavier-than-water endotamponade EasyGas C 2 F 6 pre-mixed syringes EasyGas C 3 F 8 pre-mixed syringes EasyGas SF6 pre-mixed syringes Fluorescein 1% singe use eye. Reserved for Clinitas Carbomer Gel eye is a cost effective brand Xailin Night is a cost effective brand. For night time use. Preservative free Melophthal is a cost effective brand. Each unit of Melophthal is re-sealable and may be used for up to 12 hours. Usual supply one box per month. Preservative free. Xailin Fresh 0.5% is a cost effective brand. Preservative free. As per NICE TA 294, TA305. Hospital use only. Various strengths. Only to be used when other agents not appropriate Off label special available from Moorfields.

5 Fluorescein 2% single use eye Flurbiprofen 0.03% eye Ketorolac 0.5% eye Ocriplasmin intrvitreal injection Ranibizumab intravitreal injection Vioron* As per NICE TA 297. Hospital only use As per NICE TA155, TA298, TA274, TA283. Joint formulary new drug requests Requests for new drugs from Ipswich Hospital (consultants only) please complete the Ipswich Hospital new drug submission form (available on hospital intranet) Requests for new drugs from primary care please complete the IESCCG new medication request form (available on the IESCCG website) Feedback Please send any feedback or comments to: Ipswich Hospital: Primary care: