Ciclosporin 25mg, 50mg, 100mg capsules Ciclosporin oral solution 100mg/ml
|
|
- Aldous Strickland
- 5 years ago
- Views:
Transcription
1 Shared Care Protocol Ciclosporin for the treatment of rheumatoid arthritis Name of drug, form and strength Background Ciclosporin 25mg, 50mg, 100mg capsules Ciclosporin oral solution 100mg/ml Ciclosporin is a cyclic polypeptide with immunosuppressive properties. Studies suggest that ciclosporin inhibits the development of cell-mediated reactions. It appears to block the resting lymphocytes in the G0 to G1 phase of the cell cycle, and also inhibits lymphokine production and release, including interleukin 2 (Tcell growth factor). The available evidence suggests that ciclosporin acts specifically and reversibly on lymphocytes. It does not depress haemopoeisis and has no effect on the function of phagocytic cells. Response to treatment may take up to 3 months. Patients should be stabilised on a particular brand of oral ciclosporin because switching between formulations without close monitoring may lead to clinically important changes in blood-ciclosporin concentration. Therapeutic indication Local enhanced services for shared care Dose Rout of administration Duration of The guidance in this document should be read in conjunction with the Summary of product characteristics (SmPC) and current British National Formulary (BNF) Treatment of severe active rheumatoid arthritis. Rheumatoid arthritis Criteria for shared care Prescribing responsibility will only be transferred when: Treatment is for a specified indication and duration Treatment has been initiated and established by the secondary care consultant. The patient s clinical condition is considered to be stable or predictable; have received at least 2 months of treatment and their blood results remain within acceptable limits. The patient s GP has not declined shared care The patient understands shared care and is in agreement that this should proceed For the first 6 weeks of treatment the recommended dose is 3 mg/kg/day orally given in 2 divided doses. If the effect is insufficient, the daily dose may then be increased gradually as tolerability permits, but should not exceed 5 mg/kg/day. To achieve full effectiveness, up to 12 weeks of Ciclosporin therapy may be required. For maintenance treatment the dose has to be titrated individually to the lowest effective level according to tolerability Oral If responding then treatment is usually long term, maybe withdrawn after a
2 treatment prolonged period of disease remission in selected cases at Consultant s discretion (typically at 5 years). Adverse effects Renal dysfunction Hypertension Blood and lymphatic system disorder Hepatobiliary disorders Cautions and contraindications Monitoring requirements Cautions Pregnancy manufacturer advises avoid unless potential benefit outweighs risk. Lactation manufacturer advises avoid present in milk. Elderly increased risk of systolic hypertension or creatinine increases (monitor renal function with particular care). Hyperuricaemia Increased risk of malignancies related to duration and degree of immunosuppression. Can increase risk of hypomagnaesmia and hyperkalaemia. Patients who have no history of exposure to varicella zoster virus (VZV) i.e. chickenpox or herpes zoster (shingles), should avoid contact with individuals with chickenpox or herpes zoster. Varicella zoster immunoglobulin (VZIG) is recommended for individuals who are at increased risk of severe varicella (including patients taking immunosuppressant medicines e.g. azathioprine, ciclosporin, methotrexate, leflunomide) and who have no antibodies to varicella zoster virus and who have significant exposure to chickenpox or herpes zoster. If the patient is infected with VZV, appropriate measures should be taken, which may include antiviral therapy and supportive care. Infections may be more severe, consider early and vigorous treatment. Avoid excessive exposure to UV light, including sunlight (BNF) Contra-indications Uncontrolled hypertension. Uncontrolled infections. Malignancy Abnormal baseline renal function Pre-treatment screening A full blood count, U&Es, creatinine, lipids and LFTs should be carried out at the start of treatment (as a baseline). Blood pressure should be within normal range on two separate occasions prior to treatment Check varicella zoster serology in patients where there is an unclear history of chicken pox or shingles. Ongoing monitoring Full blood count, U&Es, LFTs every 2 weeks for 6 weeks, then monthly for 3 months and every 3 months thereafter. Blood pressure and glucose at each monitoring visit. If subsequent dose increase required or concomitant NSAIDs introduced or increased monitor FBCs, U&Es and LFTs every 2 weeks for six weeks thereafter revert to the previous schedule.
3 Actions to take in the event of abnormal test results or symptoms Lipids every six months Abnormal Full Blood Count result Result White cell count < 3.5 x 10 9 / L Neutrophils > 1.6 but < 2.0 x 10 9 /L Action immediately. nurse specialist. Check trend. Neutrophils < 1.6 x 10 9 /L Platelets >100 but < 150 x 10 9 /L Platelets <100 x 10 9 /L MCV > 105fl Lymphocytes < 0.5 x 10 9 /L Abnormal Liver Function Test >2 fold rise in aspartate transaminase (AST), alanine transaminase (ALT) (from upper limit of reference range) > 3 fold rise in AST, ALT(from upper limit of reference range) Renal function test Creatinine >30% above baseline and/or calculated GFR <60ml/min/1.73m 2 Potassium > 5.5mmol/ L Other Significant rise in fasting lipids High blood pressure >140/90 on two consecutive readings two weeks apart immediately nurse specialist immediately Check B12, folic acid and thyroid stimulating hormone (TSH). Supplement as appropriate or discuss with hospital consultant or specialist nurse. nurse specialist nurse specialist. immediately Repeat in 1 week and if still >30% above baseline withhold and discuss with hospital Withhold ciclosporin until discussed with rheumatology team Withhold ciclosporin until discussed with rheumatology team Treat raised blood pressure before stopping ciclosporin (note interactions with several antihypertensives). If blood pressure cannot be controlled, stop ciclosporin and achieve blood pressure control before restarting ciclosporin. Discuss with rheumatology team.
4 Responsibilities of the hospital Responsibilities of the GP Request shared care with the patient s GP using the mid Essex approved template letter and shared care protocol. Agreement to shared care will be assumed unless GP advises otherwise. Inform the GP after each clinic attendance if there is any change to treatment or monitoring. Inform GP of patients who do not attend clinic appointments. To provide any advice to the patient/carer / GP when requested. Initiate treatment, prescribe and monitor until patient is stable or clinical condition is predictable. Routine clinic follow-up on a regular basis. Send a letter to the GP after each clinic attendance ensuring current dose, most recent blood results and frequency of monitoring are stated. Evaluation of any reported adverse effects by GP or patient. Advise GP on review, duration or discontinuation of treatment where necessary. Ensure that backup advice is available at all times. Agreement to shared care protocol Report any adverse events to the hospital specialist, where appropriate. Request advice from the hospital specialist when necessary. Monitor patient s overall health and well-being. Prescribe the drug treatment as described. To carry out blood test and monitor patients as detailed in the shared care protocol FBC Every 3 months LFTs ESR and CRP Every 6 months U&Es and creatinine Every 3 months Blood lipids Every 6 months Clinically important drug interactions Other information Contact information Help in monitoring the progression of disease. Prompt referral to specialist if there is any change in patient s status. NSAIDs; particular caution with concomitant NSAIDs, especially diclofenac, closely monitor renal function if NSAID is introduced or dose increased. Statins; avoid simvastatin and rosuvastatin. Adjust dose of atorvastatin to maximum dose of 10mg daily if concomitant use is unavoidable. Avoid grapefruit and grapefruit juice. Live vaccines; avoid due to increased risk of infection when given with ciclosporin Colchicine; avoid or adjust colchicine dose. Concurrent infection During a serious infection i.e. hospitalisation or requiring antibiotics, ciclosporin should be temporarily discontinued until the patient has recovered from the infection. Consider restarting ciclosporin one week after stopping antibiotic treatment. Consultant (direct line for urgent queries): (to be included on clinic letter) Secretaries: Clinical Nurse specialists:
5 Title Document reference Author Ciclosporin in Rheumatoid Arthritis Shared Care Protocol CiclosporinRheumSC PRO201810V3.0 final Stella Muorah, Senior Interface Pharmacist, MECCG Clare Drain, Medicines Information Manager, MEHT Consulted with Approved by Dr Emese Balogh, Consultant Rheumatologist, MEHT Mid Essex Area Prescribing Committee Date approved January 2019 Next review date January 2021 Previous version CiclosporinRheumatologyGUI v2.0FINAL Key changes New template. Additional information regarding adverse effect, contraindication and drug interaction added. Reference abnormal biochemistry results updated.
6
NORTH AND EAST DEVON HEALTHCARE COMMUNITY SHARED CARE PRESCRIBING GUIDELINE
NORTH AND EAST DEVON HEALTHCARE COMMUNITY SHARED CARE PRESCRIBING GUIDELINE http://www.devonpct.nhs.uk/treatments/ne_devon_shared_care_guidelines.aspx#a Azathioprine Treatment of rheumatological conditions
More informationSHARED CARE PRESCRIBING GUIDELINE LEFLUNOMIDE IN ADULT PATIENTS WITH RHEUMATOID ARTHRITIS DOCUMENT DETAILS
SHARED CARE PRESCRIBING GUIDELINE LEFLUNOMIDE IN ADULT PATIENTS WITH RHEUMATOID ARTHRITIS DOCUMENT DETAILS Document type Shared Care Prescribing Guideline Document name Shared Care Prescribing Guideline:
More informationSHARED CARE PRESCRIBING GUIDELINE AZATHIOPRINE IN ADULT PATIENTS WITH RHEUMATOID ARTHRITIS DOCUMENT DETAILS
SHARED CARE PRESCRIBING GUIDELINE AZATHIOPRINE IN ADULT PATIENTS WITH RHEUMATOID ARTHRITIS DOCUMENT DETAILS Document type Shared Care Prescribing Guideline Document name Shared Care Prescribing Guideline:
More informationAzathioprine Shared Care Guideline for GPs
Indication: Azathioprine Shared Care Guideline for GPs Active rheumatoid arthritis and other types of inflammatory arthritis, systemic lupus erythematosus, dermatomyositis and polymyositis, vasculitis
More informationORAL CICLOSPORIN RHEUMATOLOGY LOCAL SAFETY MONITORING SCHEDULE
ORAL CICLOSPORIN RHEUMATOLOGY LOCAL SAFETY MONITORING SCHEDULE This local safety-monitoring schedule supports clinicians under the Local Enhanced Service for High Risk Drug Monitoring (formerly Near Patient
More informationProducts available Methotrexate tablets 2.5mg ONLY (Methotrexate tablets 10mg are NOT recommended as per NPSA guidance 5 ).
Methotrexate Traffic light classification- Amber 1 Information sheet for Primary Care Prescribers Part of the Shared Care Protocol: Management of Rheumatological Conditions with Disease-Modifying Anti
More informationDuration of treatment All DMARDs are long term treatments. Clinical benefit may take up to 6 months. 1
Leflunomide Traffic light classification- Amber 1 Information sheet for Primary Care Prescribers Part of the Shared Care Protocol: Management of Rheumatological Conditions with Disease-Modifying Anti Rheumatic
More informationCiclosporin for Rheumatology and Dermatology use (Adults)
Shared Care Guideline Ciclosporin for Rheumatology and Dermatology use (Adults) Introduction This shared care agreement outlines the responsibilities between the specialist and the generalist for managing
More informationGreater Manchester Interface Prescribing Group Shared Care Template
Greater Manchester Interface Prescribing Group Shared Care Template Shared Care Guideline for Oral Methotrexate for Rheumatological Conditions Author(s)/Originator(s): (please state author name and department)
More informationESCA: All non-biological DMARDs (oral/subcutaneous) and agreement for transferring of DMARD Prescribing & Monitoring to GP
ESCA: All non-biological DMARDs (oral/subcutaneous) and agreement for transferring of DMARD Prescribing & Monitoring to GP Dermatology/ Haematology/ Gastroenterology/ Neurology/ Ophthalmology/ Respiratory/
More informationPrescribing Framework for Methotrexate for Immunosuppression in ADULTS
Hull & East Riding Prescribing Committee Prescribing Framework for Methotrexate for Immunosuppression in ADULTS Patient s Name:.. NHS Number: Patient s Address:... (Use addressograph sticker) GP s Name:...
More informationAzathioprine and Mercaptopurine
This guideline is currently under review. In the interim, the guideline remains valid; if GPs have any specific concerns or questions, they should seek advice from the specialist with whom they have agreed
More informationPRESCRIBING GUIDANCE TACROLIMUS for the treatment of INFLAMATORY BOWEL DISEASE (IBD)
PRESCRIBING GUIDANCE TACROLIMUS for the treatment of INFLAMATORY BOWEL DISEASE (IBD) For the latest information on interactions and adverse effects, always consult the latest version of the Summary of
More informationPrescribing Guidelines Prescribing arrangement for the management of patients transferring from Secondary Care to Primary Care
Berkshire West Integrated Care System Representing Berkshire West Clinical Commisioning Group Royal Berkshire NHS Foundation Trust Berkshire Healthcare NHS Foundation Trust Berkshire West Primary Care
More informationPrescribing Guidelines Prescribing arrangement for the management of patients transferring from Secondary Care to Primary Care
Berkshire West Integrated Care System Representing Berkshire West Clinical Commisioning Group Royal Berkshire NHS Foundation Trust Berkshire Healthcare NHS Foundation Trust Berkshire West Primary Care
More informationSHARED CARE AGREEMENT: METHOTREXATE S/C
NB: This document should be read in conjunction with the current Summary of Product Characteristics (SPC) and BSR Guideline for disease-modifying anti-rheumatic drug (DMARD) therapy (available at www.rheumatology.org.uk/resources/guidelines/bsr_guidelines.aspx
More informationShared Care Guideline Stepping Hill Hospital and North Derbyshire CCG
Shared Care Guideline Stepping Hill Hospital and North Derbyshire CCG Rheumatological Conditions in Adults Reference Number Replaces: Issue date: November 2017 Author(s)/Originator(s): (please state author
More informationPrescribing Guidelines Prescribing arrangement for the management of patients transferring from Secondary Care to Primary Care
Berkshire West Integrated Care System Representing Berkshire West Clinical Commisioning Group Royal Berkshire NHS Foundation Trust Berkshire Healthcare NHS Foundation Trust Berkshire West Primary Care
More informationShared Care Guideline Stepping Hill Hospital and North Derbyshire CCG
Shared Care Guideline Stepping Hill Hospital and North Derbyshire CCG Shared Care Guideline for Sulfasalazine in Rheumatological Conditions in Adults Reference Number Replaces: Issue date: November 2017
More informationShared Care Guideline
Shared Care Guideline Mercaptopurine inflammatory bowel disease Executive Summary Unlicensed indication, but widely established use of mercaptopurine. Dosing: 25mg daily for two weeks, then 1-1.5mg/kg
More informationTreatment monitoring protocol for Dimethyl fumarate therapy in active Relapsing Remitting Multiple Sclerosis
Treatment monitoring protocol for Dimethyl fumarate therapy in active Relapsing Remitting Multiple Sclerosis This protocol provides monitoring guidance for adult patients requiring Dimethyl fumarate therapy
More informationDMARDS MONITORING GUIDELINES SELKIRK MEDICAL PRACTICE
DMARDS MONITORING GUIDELINES SELKIRK MEDICAL PRACTICE LIST OF DRUGS INCLUDED: ACITRETIN (Neotigason) ADALIMUMAB AMIODARONE AMISULPIRIDE ARIPRAZOLE AZATHIOPRINE CICLOSPORIN CYCLOPHOSPHAMIDE CLOZAPINE DENOSUMAB
More informationPrescribing Framework for Ciclosporin Post Solid Organ Transplant
Hull & East Riding Prescribing Committee Prescribing Framework for Ciclosporin Post Solid Organ Transplant Patient s Name:.. NHS Number: Patient s Address:... (Use addressograph sticker) GP s Name:...
More informationCardiff & Vale (C&V) UHB Corporate Medicines Management Group (c MMG) SHARED CARE. Drug: TACROLIMUS Protocol number: CV 43
Cardiff & Vale (C&V) UHB Corporate Medicines Management Group (c MMG) SHARED CARE Drug: TACROLIMUS Protocol number: CV 43 Indications: RENAL, PANCREAS OR COMBINED RENAL PANCREAS TRANSPLANTATION IN ADULTS.
More informationSHARED CARE PRESCRIBING GUIDELINE
WORKING IN PARTNERSHIP East Surrey CCG, Guildford & Waverley CCG, North West Surrey CCG, Surrey Downs CCG, Surrey Heath CCG, North East Hampshire & Farnham CCG, Crawley CCG, Horsham & Mid-Sussex CCG SHARED
More informationSHARED CARE GUIDELINE
SHARED CARE GUIDELINE Drug: Methotrexate Introduction Indication: Licensed: Rheumatoid arthritis, severe psoriasis, severe active juvenile idiopathic arthritis, severe psoriatic arthritis, mild to moderate
More informationV4.1 Amendment to hydroxychloroquine ophthalmology monitoring made. Agreed by Camden Medicines Management Committee: October 2017 August 2017
North Central London Joint Formulary Committee Quick Reference Guide for Primary Care Prescribers Monitoring Disease Modifying Anti-Rheumatic Drugs (DMARDs) Azathioprine, Mercaptopurine, Sulfasalazine,
More informationEffective Shared Care Agreement (ESCA)
Effective Shared Care Agreement (ESCA) Azathioprine (either alone or more usually in combination with corticosteroids and/or other drugs and procedures) ESCA: For the treatment of systemic lupus erythematosus
More informationShared Care Guideline Stepping Hill Hospital and North Derbyshire CCG
Shared Care Guideline Stepping Hill Hospital and North Derbyshire CCG Rheumatological Conditions in Adults Reference Number Replaces: Issue date: November 2017 Author(s)/Originator(s): (please state author
More informationShared Care Guideline
Shared Care Guideline Thiopurine treatment for paediatric gastroenterology and hepatology patients 1. Scope Prescribing and monitoring of thiopurine treatment of Paediatric gastroenterology and hepatology
More informationPrescribing Framework for Mycophenolate Mofetil for Immunosuppression in ADULTs
Hull & East Riding Prescribing Committee Prescribing Framework for Mycophenolate Mofetil for Immunosuppression in ADULTs Patient s Name:.. NHS Number: Patient s Address:... (Use addressograph sticker)
More informationLEFLUNOMIDE FOR USE IN RHEUMATOLOGY & PAEDIATRIC RHEUMATOLOGY Shared Care Protocol
Oxfordshire Clinical Commissioning Group LEFLUNOMIDE FOR USE IN RHEUMATOLOGY & PAEDIATRIC RHEUMATOLOGY Shared Care Protocol This protocol provides prescribing and monitoring guidance for leflunomide therapy.
More informationCardiff & Vale (C&V) UHB Corporate Medicines Management Group (c MMG) SHARED CARE. Drug: CICLOSPORIN Protocol number: CV 06
Cardiff & Vale (C&V) UHB Corporate Medicines Management Group (c MMG) SHARED CARE Drug: CICLOSPORIN Protocol number: CV 06 Indication: RENAL, PANCREAS OR COMBINED RENAL PANCREAS TRANSPLANTATION IN ADULTS
More informationShared Care Guideline
Shared Care Guideline Ciclosporin (Neoral ) in inflammatory bowel disease Executive Summary Unlicensed indication, but widely established use of ciclosporin. Starting dose of 5-8mg/kg (in twice daily divided
More informationLeflunomide (Arava )
This guideline is currently under review. In the interim, the guideline remains valid; if GPs have any specific concerns or questions, they should seek advice from the specialist with whom they have agreed
More informationWestern Locality Shared care Information ~ Penicillamine, Rheumatology April 2013
Western Locality Shared care Information ~ Penicillamine, Rheumatology April 2013 Penicillamine Treatment of: Rheumatoid arthritis Specialist: Please complete the Shared Care letter sending a request to
More informationShared Care Protocol Responsibilities
Oxfordshire Clinical Commissioning Group CICLOSPORIN FOR USE IN DERMATOLOGY, RHEUMATOLOGY, NEUROLOGY and GASTROENTEROLOGY Shared Care Protocol This protocol provides prescribing and monitoring guidance
More informationCardiff & Vale (C&V) UHB Corporate Medicines Management Group (c MMG) SHARED CARE. Drug: AZATHIOPRINE Protocol number: CV 04
Cardiff & Vale (C&V) UHB Corporate Medicines Management Group (c MMG) SHARED CARE Drug: AZATHIOPRINE Protocol number: CV 04 Indication: RENAL, PANCREAS OR COMBINED RENAL PANCREAS TRANSPLANTATION LIVER
More informationTrust-wide Guideline
Trust-wide Guideline For Shared Care Guidelines for the Use of Leflunomide (Arava ) A guideline recommended for use In: East and North Herts NHS Trust (ENHT) East and North Herts PCT/ENHCCG By: Consultants
More informationPlease complete all sections 1. Name of Drug, Brand Name, Form and Strength
GMMMG Interface Prescribing Subgroup Shared Care Template Shared Care Guideline Ciclosporin for use in childhood nephrotic syndrome Reference Number Replaces: n/a Issue date: 15/10/2015 Author(s)/Originator(s):
More informationWest Suffolk Clinical Commissioning Group (WSCCG) Safety audit for methotrexate prescribing for patients in primary care
West Suffolk Clinical Commissioning Group (WSCCG) Safety audit for methotrexate prescribing for patients in primary care Year 2013-2014 Safety 100% of patients prescribed oral methotrexate should have
More informationShared Care Agreement Methotrexate Oral and Subcutaneous For the use in gastroenterology, dermatology and rheumatology
Shared Care Agreement Methotrexate Oral and Subcutaneous For the use in gastroenterology, dermatology and rheumatology Principles of Shared Care Shared care is the mechanism of sharing patient care between
More informationWeekly oral and subcutaneous methotrexate
This guideline is currently under review. In the interim, the guideline remains valid; if GPs have any specific concerns or questions, they should seek advice from the specialist with whom they have agreed
More informationWestern Locality Shared care information ~ Azathioprine and Mercaptopurine
The following guidelines are currently under review. In the interim, the guidelines remain valid; if GPs have any specific concerns or questions, they should seek advice from the specialist with whom they
More informationName of Shared Care Agreement: AZATHIOPRINE/6-MERCAPTOPURINE: Oral immunomodulating drugs for inflammatory bowel disease. Reference number: 01/2008
Name of Shared Care Agreement: AZATHIOPRINE/6-MERCAPTOPURINE: Oral immunomodulating drugs for inflammatory bowel disease. Reference number: 01/2008 Shared care agreement has been developed appropriately
More informationTacrolimus (Adoport, Prograf, Modigraf or Advagraf )
Shared Care Guideline DRUG: Tacrolimus (Adoport, Prograf, Modigraf or Advagraf ) for Renal Transplant (Adults) Introduction: Indication: Prophylaxis of transplant rejection in kidney recipients Tacrolimus
More informationSHARED CARE GUIDELINE FOR CICLOSPORIN IN DERMATOLOGY. 1. Aim/Purpose of this Guideline. 2. The Guidance
SHARED CARE GUIDELINE FOR CICLOSPORIN IN DERMATOLOGY 1. Aim/Purpose of this Guideline 1.1. This guideline applies to medical, nursing and pharmacy staff in the safe and appropriate prescription and administration
More informationSULFASALAZINE (Adults)
Shared Care Guideline DRUG: Introduction: SULFASALAZINE (Adults) Indication: Disease modifying drug for rheumatoid arthritis, psoriatic arthritis, undifferentiated arthritis, spondyloarthropathies, Crohn
More informationSUMMARY OF SHARED CARE PROTOCOL FOR MYCOPHENOLATE MOFETIL (MMF)
SUMMARY OF SHARED CARE PROTOCOL FOR MYCOPHENOLATE MOFETIL (MMF) Please refer to Chester Rheumatology shared care protocol for MMF and separate responsibilities document for full details. Responsibilities
More informationWORKING IN PARTNERSHIP WITH
WORKING IN PARTNERSHIP WITH Brighton and Hove Clinical Commissioning Group Crawley Clinical Commissioning Group Horsham and Mid Sussex Clinical Commissioning Group High Weald Lewes Havens Clinical Commissioning
More informationPRESCRIBING GUIDANCE METHOTREXATE for the treatment of vasculitis
PRESCRIBING GUIDANCE METHOTREXATE for the treatment of vasculitis For the latest information on interactions and adverse effects, always consult the latest version of the Summary of Product Characteristics
More informationHYDROXYCARBAMIDE for Haematological conditions (Adults)
Shared Care Guideline DRUG: Introduction: Contraindications & Warnings: HYDROXYCARBAMIDE for Haematological conditions (Adults) Indication: Hydroxycarbamide is an established treatment in haematological
More informationWestern Locality Shared care Information ~ Methotrexate, Rheumatology April 2013
This guideline is currently under review. In the interim, the guideline remains valid; if GPs have any specific concerns or questions, they should seek advice from the specialist with whom they have agreed
More informationGreater Manchester Interface Prescribing Group Shared Care Template
Greater Manchester Interface Prescribing Group Shared Care Template Shared Care Guideline for Azathioprine and 6-Mercaptopurine for Chronic Inflammatory Bowel Disease Author(s)/Originator(s): (please state
More informationEast Lancashire Medicines Management Board Shared Care agreement for weekly Methotrexate therapy in long term conditions
East Lancashire Medicines Management Board Shared Care agreement for weekly Methotrexate therapy in long term conditions This shared care agreement outlines the responsibilities for managing the prescribing
More informationWeekly oral and subcutaneous methotrexate
This guideline is currently under review. In the interim, the guideline remains valid; if GPs have any specific concerns or questions, they should seek advice from the specialist with whom they have agreed
More information. AREAS OF RESPONSIBILITY FOR SHARED CARE
SHARED CARE GUIDELINE FOR RILUZOLE IN THE MANAGEMENT OF MOTOR NEURONE DISEASE (MND) SPECIFICALLY AMYOTROPHIC LATERAL SCLEROSIS (ALS) INDICATION This shared care guideline has been prepared to support the
More informationMETHOTREXATE (Adults)
Shared Care Guideline Methotrexate (Adults) Contents Introduction:... 1 Contraindications & Warnings:... 2 Interactions:... 3 Adverse Effects:... 3 Responsibilities of the specialist initiating treatment:...
More informationShared care guidelines for azathioprine in adults. General principles. Presentation/Dose/Administration Oral: 25mg and 50mg tablets
Shared care guidelines for azathioprine in adults General principles This agreement outlines suggested ways in which the responsibilities for managing the prescribing of the drug treatment and clinical
More informationSHARED CARE ARRANGEMENT for DMARDs
SHARED CARE ARRANGEMENT for DMARDs Azathioprine, Ciclosporin, Leflunomide, Mercaptopurine, Methotrexate, Mycophenolate Mofetil, Penicillamine and Sulfasalazine Version: Date: Author: Status: Comment: 1.2
More informationIf your IBD has not been well controlled, or is flaring up quite often, tacrolimus may be added to your treatment.
If your IBD has not been well controlled, or is flaring up quite often, tacrolimus may be added to your treatment. What is tacrolimus? Patient Information Drugs for Inflammatory Bowel Disease Tacrolimus
More informationCardiff & Vale (C&V) UHB Corporate Medicines Management Group (c MMG) SHARED CARE. Drug: MYCOPHENOLATE MOFETIL/SODIUM Protocol number: CV 15
Cardiff & Vale (C&V) UHB Corporate Medicines Management Group (c MMG) SHARED CARE Drug: MYCOPHENOLATE MOFETIL/SODIUM Protocol number: CV 15 Indication: RENAL, PANCREAS OR COMBINED RENAL PANCREAS TRANSPLANTATION
More informationTrust Guideline. for Ciclosporin Treatment & Monitoring for Adult* Patients with Acute, Severe Ulcerative Colitis. (*ie aged 16 years and over)
Trust Guideline for Ciclosporin Treatment & Monitoring for Adult* Patients with Acute, Severe Ulcerative Colitis (*ie aged 16 years and over) abc A guideline recommended for use In: Gastroenterology/Medical
More informationIBRUTINIB (IMBRUVICA ) for Chronic Lymphocytic Leukaemia. and Mantel Cell Lymphoma
DRUG ADMINISTRATION SCHEDULE Indication Cycle Length Drug Daily Dose Route Schedule Chronic Lymphocytic Leukaemia Continuous Ibrutinib 420mg (three capsules) Oral ONCE daily Mantel Cell Lymphoma Continuous
More informationVaccination against shingles for adults aged 70 and 79 years of age Q&A s for healthcare professionals
Vaccination against shingles for adults aged 70 and 79 years of age Q&A s for healthcare professionals Background In 2010, the Joint Committee on Vaccination and Immunisation (JCVI) 1 were asked by the
More informationDegarelix Subcutaneous Injection (Firmagon ) Treatment Guideline
Mid Essex Locality Degarelix Subcutaneous Injection (Firmagon ) Treatment Guideline Contents FlowChart 2 Summary... 3 Key points... 3 Introduction... 3 Pharmacology... 3 Product information... 4 Place
More informationPazopanib (Continuous vs Drug-free Interval Strategy) STAR Trial
Pazopanib (Continuous vs Drug-free Interval Strategy) STAR Trial A Randomised Multi-Stage Phase II/III Trial of Standard first-line therapy (sunitinib or pazopanib) Comparing Temporary Cessation with Allowing
More informationRheumatology Shared Care Guidelines
Rheumatology Shared Care Guidelines 1. Introduction Rheumatoid Arthritis (RA) is a chronic, progressive inflammatory disease of the synovial lining of peripheral joints. The goals of management of RA are
More informationShared Care Guideline. Prescribing and Monitoring of oral METHOTREXATE in adults Licensed and off-label indications
North Central London Joint Formulary Committee Shared Care Guideline Prescribing and Monitoring of oral METHOTREXATE in adults Licensed and off-label indications Dear GP, Progressing to a stable, optimal
More informationShared care guidelines for hydroxychloroquine for rheumatoid arthritis and other rheumatological conditions in adults.
Shared care guidelines for hydroxychloroquine for rheumatoid arthritis and other rheumatological conditions in adults. General Principles This agreement outlines suggested ways in which the responsibilities
More informationShared Care Guideline: Leflunomide
Basingstoke, Winchester & Southampton District Prescribing Committee Shared Care Guideline: Leflunomide Name of patient treated under this guideline: This shared care guideline has been produced to support
More informationPrimary Care Prescriber Information EDOXABAN (LIXIANA ) Treatment of acute venous thromboembolism and prevention of recurrent venous thromboembolism
Primary Care Prescriber Information EDOXABAN (LIXIANA ) Treatment of acute venous thromboembolism and prevention of recurrent venous thromboembolism INDICATION Edoxaban is a non-vitamin K antagonist oral
More informationINTRODUCTION Indication and Licensing
City and Hackney Clinical Commissioning Group Homerton University Hospital Foundation Trust DRUG NAME: Apixaban (Eliquis ) Transfer of Care document Indication: Treatment of acute venous thromboembolism
More informationYounger adults with a family history of premature artherosclerotic disease should have their cardiovascular risk factors measured.
Appendix 2A - Guidance on Management of Hypertension Measurement of blood pressure All adults from 40 years should have blood pressure measured as part of opportunistic cardiovascular risk assessment.
More informationEFFECTIVE SHARED CARE AGREEMENT (ESCA)
EFFECTIVE SHARED CARE AGREEMENT (ESCA) DRUG NAME: CICLOSPORIN INDICATION/S COVERED: FOR RHEUMATOLOGY AND DERMATOLOGY Coastal West Sussex Traffic Light system classification: Amber N.B. The eligibility
More informationPrimary Prevention Patients aged 85yrs and over
Rotherham Guideline for the management of Non-Familial Hypercholesterolaemia Type 1 Diabetes Offer lifestyle advice Over 40yrs of age? Diabetic for more than 10 years? Established nephropathy? Other CVD
More informationMYCOPHENOLATE MOFETIL In Renal Transplantation (prior to August 2004) and lupus nephritis/vasculitis
Patient name Date of Birth DOCUMENT TO BE FILED IN NOTES AND SCANNED INTO ELECTRONIC RECORDS INTRODUCTION Mycophenolate Mofetil (Cellcept ) * is currently used first line as part of the triple immunosuppressant
More informationRivaroxaban film coated tablets are available in 2 strengths for this indication: 15mg and 20mg.
Primary Care Prescriber Information RIVAROXABAN (XARELTO ) Treatment of acute venous thromboembolism and prevention of recurrent venous thromboembolism INDICATION Rivaroxaban is a non-vitamin K antagonist
More informationDRUG NAME: EDOXABAN (LIXIANA ) Transfer of Care document Treatment of acute venous thromboembolism and prevention of recurrent venous thromboembolism
City and Hackney Clinical Commissioning Group Homerton University Hospital Foundation Trust DRUG NAME: EDOXABAN (LIXIANA ) Treatment of acute venous thromboembolism and prevention of recurrent venous thromboembolism
More informationDOSING AND ADMINISTRATION GUIDE
DOSING AND ADMINISTRATION GUIDE Indication TAVALISSE is a kinase inhibitor indicated for the treatment of thrombocytopenia in adult patients with chronic immune thrombocytopenia (ITP) who have had an insufficient
More informationHydroxychloroquine (Adults)
Shared Care Guideline DRUG: Introduction: Contraindications & Warnings: Hydroxychloroquine (Adults) Indication: Rheumatoid arthritis and inflammatory osteoarthritis, discoid and systemic lupus erythematosus,
More informationTESTS: Baseline tests: - FBC, U&Es, LFTs, creatinine. - Physical exam including splenic measurement by palpation - Weight - ECG, blood pressure.
INDICATIONS FOR USE: Ruxolitinib Monotherapy INDICATION ICD10 Protocol Code Treatment of disease-related splenomegaly or symptoms in adult patients with: Primary myelofibrosis (chronic idiopathic myelofibrosis)
More informationMycophenolate Mofetil (MMF)
SCG: For Transplant patients The following guidelines are designed to provide information relating to mycophenolate mofetil and to outline the responsibilities of the primary and secondary care teams in
More informationShared Care Protocol Oral methotrexate 2.5mg tablets in dermatology/gastroenterology/rheumatology patients
Shared Care Protocol Oral methotrexate 2.5mg tablets in dermatology/gastroenterology/rheumatology patients Specialist Details Name: Patient Identifier (please include NHS number as minimum) Location: Telephone
More informationCoronary Heart Disease and Stroke, Primary and Secondary Prevention Guidelines (Cholesterol)
CLINICAL GUIDELINE Coronary Heart Disease and Stroke, Primary and Secondary Prevention Guidelines (Cholesterol) A guideline is intended to assist healthcare professionals in the choice of disease-specific
More informationCardiff & Vale (C&V) UHB Corporate Medicines Management Group (c MMG) SHARED CARE DRUG: LISDEXAMFETAMINE PROTOCOL NUMBER: CV 57
Cardiff & Vale (C&V) UHB Corporate Medicines Management Group (c MMG) SHARED CARE DRUG: LISDEXAMFETAMINE PROTOCOL NUMBER: CV 57 INDICATION: Attention deficit hyperactivity disorder (ADHD) as part of a
More informationShared Care Guidelines. In partnership with Acute Trust & PCTs. SIROLIMUS In renal transplant. August 2016
Shared Care Guidelines In partnership with Acute Trust & PCTs SIROLIMUS In renal transplant August 2016 Page 0 of 12 Table of Contents Introduction 2 Licensing 2 Referral 2 Initiation and maintenance of
More informationTHE CLATTERBRIDGE CANCER CENTRE NHS FOUNDATION TRUST. Systemic Anti-Cancer Treatment Protocol. Abiraterone. PROCTOCOL REF: MPHAABIRA (Version No: 1.
Systemic Anti-Cancer Treatment Protocol Abiraterone PROCTOCOL REF: MPHAABIRA (Version No: 1.0) Approved for use in: The treatment of metastatic castration resistant prostate cancer in adult men who are
More informationMycophenolate mofetil (MMF) Guidelines for its use in multisystem autoimmune diseases
Shared care guideline Mycophenolate mofetil (MMF) Guidelines for its use in multisystem autoimmune diseases Executive summary This shared care guideline outlines the responsibility of primary and secondary
More informationRoyal Wolverhampton Hospital Adult Lipid Lowering Therapy Guidelines Lipid Lowering Therapy for the Prevention of Cardiovascular Disease
Royal Wolverhampton Hospital Adult Lipid Lowering Therapy Guidelines 1 This guideline is intended to assist rational and cost-effective prescribing of lipid regulating medications across both primary and
More informationPrescribing Framework for Mycophenolate Mofetil or Mycophenolic Acid (Myfortic ) Post Solid Organ Transplant
Hull & East Riding Prescribing Committee Prescribing Framework for Mycophenolate Mofetil or Mycophenolic Acid (Myfortic ) Post Solid Organ Transplant Patient s Name:.. NHS Number: Patient s Address:...
More informationDimethyl Fumarate (Tecfidera) pathway for Walton Centre MS patients
Dimethyl Fumarate (Tecfidera) pathway for Walton Centre MS patients Author and Contact details: Responsible Director: Ian Pomeroy Service lead for MS. Tel: (0151) 529 5715 Email: ian.pomeroy@thewaltoncentre.nhs.uk
More informationPrimary Care Prescriber Information EDOXABAN (LIXIANA ) Prevention of stroke and embolism for nonvalvular atrial fibrillation
Primary Care Prescriber Information EDOXABAN (LIXIANA ) Prevention of stroke and embolism for nonvalvular atrial fibrillation INDICATION Edoxaban is a non-vitamin K antagonist oral anticoagulant (NOAC)
More informationDenosumab (Prolia 60 mg) Effective Shared Care Agreement For the treatment of Osteoporosis. Date: Date:
Denosumab (Prolia 60 mg) Effective Shared Care Agreement For the treatment of Osteoporosis Section 1: Shared care arrangements and responsibilities Section 1.1 Agreement for transfer of prescribing to
More informationBNSSG Shared Care Guidance Please complete all sections
NHS Bristol CCG NHS North Somerset CCG NHS South Gloucestershire CCG North Bristol NHS Trust University Hospitals Bristol NHS Foundation Trust Weston Area Health NHS Trust BNSSG Shared Care Guidance Please
More informationVaccination to protect against shingles
Vaccination to protect against shingles - An update for registered healthcare practitioners The programme from September 2018 and contraindications and precautions Revised July 2018 NES and HPS accept
More informationEFFECTIVE SHARED CARE AGREEMENT (ESCA) DRUG NAME: AZATHIOPRINE INDICATION/S COVERED: FOR RHEUMATOLOGY AND DERMATOLOGY
WORKING IN PARTNERSHIP WITH Coastal West Sussex Traffic Light system classification: Amber N.B. The eligibility criteria included here apply to new patients commencing treatment under this agreement &
More informationAxitinib (renal) Note: in some patients it may be appropriate to increase the dose to 6mg BD before increasing to 7mg BD.
Axitinib (renal) Indication Treatment of advanced renal cell carcinoma after failure of treatment with a first-line tyrosine kinase inhibitor (UK licensed indication states sunitinib) or a cytokine. (NICE
More information