A Compendium of Product information & Indicative manufacturer s prices

Transcription

1 A Compendium of Product information & Indicative manufacturer s prices (March 2012) for 28-days treatment with commonly used -free eye drops & ointments This information has been produced for prescribing advisers at the request of Heads of Medicines Management in NHS London. Product-specific information and costs for unlicensed medicines refer to products made by Moorfields Pharmaceuticals. Similar products may also be available from other manufacturers and there is no intention to recommend a particular manufacturer s unlicensed product. The high cost of unlicensed eye drops is a cause of concern. Indications for prescription of unpreserved eye drops October 2012 Preservative-free (PF) eye drops may be indicated when sensitivity is suspected. NB that diagnosis and the decision to prescribe PF eye drops are based on clinical opinion alone during or immediately after invasive surgery (because this may allow fluid to penetrate into the anterior chamber) Following surgery in which the corneal integrity is breached e.g. refractive surgery, corneal transplant surgery if frequency of eye drop use raises concern about cumulative exposure to s in ocular surface disease Unit dose eye drops may also be indicated when the product is only commercially available in a -free formulation when the treatment is for a very limited period only e.g. atropine for refraction on safety grounds in the case of toxic medication e.g. atropine Page 1 of 20

2 In-use shelf-life of -free eye drops: the clinical dilemma 1. The BP recommends that -free eye drops should be used immediately after, within one clinical session, and that any remaining solution should be discarded. Current (2001) RPS Guidance for Extemporaneously prepared, -free eyedrops states It is recognised that these preparations are widely used in hospital practice and that although they should be discarded immediately after single use, in practice they are given an in-use life of one to seven days. This is an issue which requires urgent investigation. The BNF also offers general guidance. 2. Ideally, PF eye drops should be supplied as single dose units, but the range of products is limited and patients with manual dexterity problems may find them difficult to use. Pharmacists should try to address this issue by recommending a suitable compliance aid designed for use with licensed eye drops in single dose units e.g. UD Eyot ( before considering unlicensed alternatives. 3. In the absence of a manufacturer s validated, product-specific recommendation, the decision about in-use shelf-life of PF eye drops rests with the prescriber and dispensing pharmacist, and should reflect consideration of all the above. The decision may vary from case to case depending upon the patient s individual condition and circumstances.. Page 2 of 20

3 This information has been produced at the request of Heads of Medicines Management in NHS London. Product-specific information and costs for unlicensed medicines refer to products made by Moorfields Pharmaceuticals. Similar products may also be available from other manufacturers and there is no intention to recommend a particular manufacturer s unlicensed product. Choice of PF product (see product-specific factsheets for further details) The choice lies between a licensed medicine, with or without an appropriate CE-marked device to aid administration, an eye drop marketed as a medical device and an unlicensed medicine. Choice should be informed by an assessment of regulatory status, product characteristics, relative risks, benefits and costs Yes Is an appropriate licensed PF medicine available? No Prescribe licensed product Prescribe unlicensed eye drops, with or without appropriate administration aid Prescribe eye drops registered as a medical device, with or without appropriate administration aid Ask initiating Consultant to continue prescribing & supply from hospital Page 3 of 20

4 This information has been produced at the request of Heads of Medicines Management in NHS London. Product-specific information and costs for unlicensed medicines refer to products made by Moorfields Pharmaceuticals. Similar products may also be available from other manufacturers and there is no intention to recommend a particular manufacturer s unlicensed product. Side effects: As listed in BNF Atropine 1% eyedrops ( free) To induce mydriasis and cycloplegia. It also acts on the blood vessels of the iris and ciliary body to restore natural permeability. Conditions which cause inflammation of the anterior segment e.g. iridocyclitis and anterior uveitis. Refraction in children. Occlusion (suppression amblyopia). Thrombotic glaucoma Usually 1 drop once, twice or three times a day. Refraction: 1 drop twice a day for 1-3 days prior to refraction depending on local practice. Occlusion: 1 drop once a day, for a limited period only GPs are strongly encouraged to seek advice from the initiating Consultant about duration & particularly the need for continued use of -free drops. Cautions: As listed in BNF. 10ml of atropine Patient monitoring: As for licensed products 1% contains 100mg of atropine sulphate. The fatal dose in children may be as low as 10 mg (1ml). The use of single dose units containing 0.5ml is strongly advised on safety grounds. Atropine is very potent, with effects that can last for up to two weeks Products Name Presentation (Indicative cost) Licensed PF Atropine 1% 0.5ml single dose Minims minims Unlicensed PF Atropine 1% eyedrops Atropine 1% (1x20x0.5ml= (4x10ml= ) (1x10ml 9.50) Storage before Room temperature Single use only Suitable for most patients with significant sensitivity or allergy to s. Minims formulation contains hydrochloric acid for PH adjustment Room temperature See introduction Suitable for patients whose manual dexterity prohibits use of Minims The Moorfields Pharmaceuticals unlicensed formulation contains boric to which patients may very rarely develop sensitivity Room Temperature 28-days at home Page 4 of 20

5 This information has been produced at the request of Heads of Medicines Management in NHS London. Product-specific information and costs for unlicensed medicines refer to products made by Moorfields Pharmaceuticals. Similar products may also be available from other manufacturers and there is no intention to recommend a particular manufacturer s unlicensed product. Chloramphenicol 0.5% eyedrops ( free) Broad spectrum antibiotic for bacterial eye infections Depends on severity of condition. Severe infections: 1 drop 0.5 to 2 hourly Pre and post-operatively: 1 drop 4 times a day Minor infections: 1 drop 4 times a day Usually 1 to 2 weeks Side effects: As listed in BNF Cautions: As listed in BNF Patient monitoring: As for licensed products A -free eye ointment is also available but some formulations contain lanolin Alternative licensed -free eye drops for treatment of bacterial conjunctivitis are azithromycin 1.5% (Azyter ), levofloxacin 0.5% (Oftaquix PF) Products Name Presentation (indicative cost) Licensed PF Chloramphenicol 0.5ml single dose 0.5% Minims Minims (1x20x 0.5mL= 9.17) Storage before Storage & shelf-life after Refrigerator Single use only Suitable for most patients with significant sensitivity or allergy to s. Minims formulation contains borax and boric acid to which patients may very rarely develop sensitivity. In these cases other formulations may offer an option. Unlicensed PF Chloramphenicol 0.5% eyedrops Refrigerator See introduction Suitable for patients whose manual dexterity prohibits use of Minims (2 x 10mL = 33.56) Chloramphenicol 0.5% (2 x 5ml = 3.30) Refrigerator 28 days at home Contain phenylmercuric acetate/nitrate or chlorhexidine as & may be acceptable in patients sensitised to benzalkonium chloride Page 5 of 20

6 This information has been produced at the request of Heads of Medicines Management in NHS London. Product-specific information and costs for unlicensed medicines refer to products made by Moorfields Pharmaceuticals. Similar products may also be available from other manufacturers and there is no intention to recommend a particular manufacturer s unlicensed product. Ciclosporin A 0.06% eye-drops ( free) Management of severe dry eye syndromes, severe allergic eye diseases. Prevention of corneal graft rejection. Autoimmune keratoconjunctivitis e.g. vernal, atopic, staphylococcal hypersensitivity. Thygeson s keratitis Ligneous conjunctivitis Non-healing corneal erosions Depends on severity of condition. Usually 1 drop 4 times a day but can be used more frequently if needed Various, depends on individual patient diagnosis. Side effects: May cause severe stinging on instillation. This may limit the dose tolerated. Cautions: Wash hands after use. Do not use in pregnancy. Do not use when there is fungal disease of the eye. Patient monitoring: No special monitoring required, systemic absorption is minimal. Products Name Presentation (Indicative cost) Storage before Licensed PF Unlicensed PF None Ciclosporin A 0.06% eye drops 0.05% cyclosporin A (Restasis ) available as imported product None 10mL multidose bottle (1 x 10ml= 88.42) Room temperature (not to be refrigerated: ciclosporin precipitates out of solution at low temperature). See introduction Used when other drugs have proved unsuccessful. Page 6 of 20

7 This information has been produced at the request of Heads of Medicines Management in NHS London. Product-specific information and costs for unlicensed medicines refer to products made by Moorfields Pharmaceuticals. Similar products may also be available from other manufacturers and there is no intention to recommend a particular manufacturer s unlicensed product. Ciclosporin A 2% eye-drops ( free) Management of severe dry eye syndromes, severe allergic eye diseases. Prevention of corneal graft rejection. Autoimmune keratoconjunctivitis e.g. vernal, atopic, staphylococcal hypersensitivity. Thygeson s keratitis Ligneous conjunctivitis Non-healing corneal erosions Depends on severity of condition. Usually 1 drop 4 times a day but can be used more frequently if needed Various, depends on individual patient diagnosis. Side effects: May cause severe stinging on instillation. This may limit the dose tolerated. Cautions: Wash hands after use. Do not use in pregnancy. Do not use when there is fungal disease of the eye. Patient monitoring: No special monitoring required, systemic absorption is minimal. Products Name Presentation (Indicative cost) Storage before Licensed PF Unlicensed PF None Ciclosporin A 2% eye drops 0.05% cyclosporine(restasis ) available as imported product None 10mL multidose bottle (1 x 10ml= 88.42) Room temperature. (not to be refrigerated: ciclosporin precipitates from solution at low temperature). 28 days at Room Temperature (maize oilbased formulation; Used when other drugs have proved unsuccessful. Page 7 of 20

8 This information has been produced at the request of Heads of Medicines Management in NHS London. Product-specific information and costs for unlicensed medicines refer to products made by Moorfields Pharmaceuticals. Similar products may also be available from other manufacturers and there is no intention to recommend a particular manufacturer s unlicensed product. Ciclosporin A 0.2% eye ointment ( free) Management of severe dry eye syndromes, severe allergic eye diseases. Prevention of corneal graft rejection. Autoimmune keratoconjunctivitis e.g. vernal, atopic, staphylococcal hypersensitivity. Thygeson s keratitis Ligneous conjunctivitis. Non healing corneal erosions Apply 2 to 4 times a day. Various, depends on individual patient diagnosis, is often used long term. Side effects: Mild irritation in the first few days of therapy may occur. Cautions: Wash hands after use. Do not use in pregnancy. Do not use when there is fungal disease of the eye. Patient monitoring: No special monitoring required, systemic absorption is minimal. Products Name Presentation (Indicative cost) Storage before Licensed PF Unlicensed PF None Ciclosporin A 0.2% free eye ointment. None 3.5g tube (Optimmune ) (2x3.5g = ) Below 25C. Below 25C, discard one month after first. Usually used when patients are unable to tolerate the eye drops. NB Optimmune contains Lanolin to which some patients may be sensitive. Although unlicensed for human use, Optimmune is licensed as a veterinary medicine and may be obtained from appropriate wholesalers Page 8 of 20

9 This information has been produced at the request of Heads of Medicines Management in NHS London. Product-specific information and costs for unlicensed medicines refer to products made by Moorfields Pharmaceuticals. Similar products may also be available from other manufacturers and there is no intention to recommend a particular manufacturer s unlicensed product. Cyclopentolate 1% eyedrops ( free) To induce mydriasis and cycloplegia. Conditions which cause inflammation of the anterior segment e.g. iridocyclitis and anterior uveitis 1 drop 1 to 4 times a day Various, depending on the diagnosis Side effects: As listed in BNF Cautions: As listed in BNF Patient monitoring: As for licensed products Synthetically derived and structurally dissimilar to atropine, and may be used for patients allergic to atropine. The most cost effective option will depend on the frequency of dosing for dosing up to four times per day, Minims are the most cost effective if appropriate for the patient. Products Name Presentation (Indicative cost) Storage before Storage & shelflife after Licensed PF Unlicensed PF Cyclopentolate 0.5ml single dose 1% Minims minims Cyclopentolate 1% eyedrops (6x20x0.5mL= 57.84) 10ml multidose bottle Room temperature Single use only Suitable for most patients with significant sensitivity or allergy to s. Minims contain hydrochloric acid for ph adjustment. Room temperature See introduction Suitable for patients whose manual dexterity prohibits use of Minims (4x10mL= 78.40) Some products contain boric acid and potassium chloride as a buffer. Very rarely patients may develop sensitivity to boric acid. Cyclopentolate 1% eyedrops (Mydrilate ) 5ml multidose bottle (2 x 5ml = 13.46) Refrigerated at 2-8 o C 28 days at home Page 9 of 20

10 This information has been produced at the request of Heads of Medicines Management in NHS London. Product-specific information and costs for unlicensed medicines refer to products made by Moorfields Pharmaceuticals. Similar products may also be available from other manufacturers and there is no intention to recommend a particular manufacturer s unlicensed product. Dexamethasone 0.1% eyedrops ( free) Corticosteroids have many uses and numerous adverse effects. The anti-inflammatory glucocorticoid action determines their usefulness as ocular drugs. Depends on the patient diagnosis, from 1 drop every half an hour to 1 drop on alternate days. Usually dose is reduced by tapering over a period of time Various, it depends on the patient diagnosis Side effects: As listed in BNF Cautions: As listed in BNF Patient monitoring: The drug does not require any special monitoring apart from standard ocular steroid monitoring i.e. intraocular pressure, cataract formation, delayed healing rate and corneal ulceration Products Name Presentation Storage before Licensed PF Dexamethasone phosphate 0.1% Minims 0.5ml single dose minims (6x20 x 0.5mL= 56.28). Room temperature Single use only Suitable for most patients with significant sensitivity or allergy to s. Minims contain di edetate to which Unlicensed PF Dexamethasone metasulfobenzoate 0.1% eyedrops patients may very rarely develop sensitivity. Room temperature See introduction Suitable for patients whose manual dexterity prohibits use of Minims. Dexamethasone 0.1% (Maxidex ) ( (4 x 10mL) (1x10ml= 2.80) Room temperature 28 days at home NB that clinical efficacy varies between dexamethasone salts Page 10 of 20

11 This information has been produced at the request of Heads of Medicines Management in NHS London. Product-specific information and costs for unlicensed medicines refer to products made by Moorfields Pharmaceuticals. Similar products may also be available from other manufacturers and there is no intention to recommend a particular manufacturer s unlicensed product. Pilocarpine 1%, 2%, 3%, 4%, 6% eye drops ( free) Hypromellose 0.3% eyedrops ( free)*** To reduce intraocular pressure in open angle glaucoma and other forms of chronic glaucoma constricts the pupil after cataract surgery, as a miotic and in the emergency treatment of glaucoma. Ocular lubrication for the relief of mild to moderate dry eye syndromes associates with deficient tear secretion or lubrication with hard or gas permeable contact lenses 1 drop as required Various, it depends on the patient diagnosis/response Side effects: As listed in BNF Cautions: As listed in BNF Patient monitoring: As for licensed products The most cost effective option will depend on the frequency of use, so each prescription should be individually assessed. There are licensed, generic -containing products, licensed -containing products in other strengths and other lubricants available as licensed medicines and medical devices. Products Name Presentation Storage before Licensed PF None: see p 21 Unlicensed PF Hypromellose 8ml multidose bottle 0.3% eye drops (4x10mL= 52.16) Room temperature See introduction Suitable for patients whose manual dexterity prohibits use of Minims Hypromellose 0.32% eyedrops (Artelac PF ) Hypromellose 0.3% eye drops (4 x3 x 0.5ml SDU= 67.80) (1x10ml= 1.61) 28 days at home The Moorfields Pharmaceuticals unlicensed formulation contains di edetate to which patients may very rarely develop sensitivity. Page 11 of 20

12 This information has been produced at the request of Heads of Medicines Management in NHS London. Product-specific information and costs for unlicensed medicines refer to products made by Moorfields Pharmaceuticals. Similar products may also be available from other manufacturers and there is no intention to recommend a particular manufacturer s unlicensed product. Usually 1 drop 4 times a day, but dose ranges from once a day in some patients with ocular hypertension to 4 times a day, when the intraocular pressure cannot be controlled with lower doses. To induce miosis, one or two drops should be used. In cases of emergency treatment of acute narrow-angle glaucoma, one drop should be used every five minutes until miosis is achieved. Various, depending on diagnosis Side effects: As listed in BNF Cautions: As listed in BNF Patient monitoring: Systemic side effects to be monitored Minims contain nitrate salt whilst Moorfields Pharmaceuticals preparation contains hydrochloride salt. Products Name Presentation Storage before Licensed PF Pilocarpine 0.5ml single dose Room temperature nitrate 2% minims free eye drops (Minims ) (6x20x0.5ml= 63.24) Unlicensed PF Pilocarpine 2% free eye drops Pilocarpine 1% Pilocarpine 2% Pilocarpine 4% eye drops (4 x 10mL= ) (1x10ml= 2.68) (1x10ml= 2.62) (1x10ml= 3.43) Single use only Room temperature See introduction Suitable for patients whose manual dexterity prohibits use of minims Room temperature 28 days at home Polihexanide 0.02% and 0.06% (PHMB) eye-drops ( free) and from Lucy Titcomb, Lead Ophthalmic Pharmacist, Birmingham & Midlands Eye Centre is gratefully acknowledged. Page 12 of 20

13 This information has been produced at the request of Heads of Medicines Management in NHS London. Product-specific information and costs for unlicensed medicines refer to products made by Moorfields Pharmaceuticals. Similar products may also be available from other manufacturers and there is no intention to recommend a particular manufacturer s unlicensed product. Acanthamoeba keratitis infections, usually in contact lenses users. Depends on severity of condition. 1 drop every hour day and night for 2 days, then every hour day only for 3 days. Intensive treatment is used at an early stage, while organisms are susceptible and before cysts have fully matured. Reduce to 3 hourly, then tailor thereafter according to course of disease. Treatment must be prolonged in order to eradicate cysts. Two weeks may be required before a response is seen; total duration of therapy is a minimum 3-4 weeks, with some requiring treatment for 3-4 months or longer. Side effects: Toxicity from PHMB is rare. Cautions: None listed. Patient monitoring: No special monitoring required. Products Name Presentation Storage before Licensed PF None Unlicensed PF Polihexanide 0.02% 10mL multidose bottle Room temperature 28 days (4x10ml= ) Unlicensed PF Polihexanide 0.06% 10mL multidose bottle Refrigerated 2-8C As manufacturer s labelled expiry date. (4x10ml= ) None Polyvinyl Alcohol 1.4% eye drops ( free) and from Lucy Titcomb, Lead Ophthalmic Pharmacist, Birmingham & Midlands Eye Centre is gratefully acknowledged. Page 13 of 20

14 This information has been produced at the request of Heads of Medicines Management in NHS London. Product-specific information and costs for unlicensed medicines refer to products made by Moorfields Pharmaceuticals. Similar products may also be available from other manufacturers and there is no intention to recommend a particular manufacturer s unlicensed product. Ocular lubrication for the relief of dry eye syndromes associated with deficient tear secretion or when wearing hard or gas permeable contact lenses 1-2 drops as required Various, depending on diagnosis/response Side effects: As listed in BNF Cautions: As listed in BNF Patient monitoring: As for licensed products Products Name Presentation Storage before Licensed PF Polyvinyl alcohol single dose Room temperature 1.4% eye drops containers (Refresh) (4 x30 0.4ml= 10.00) Ophthalmic eye single dose drops) containers (Liquifilm Tears (4x30x0.4ml= 21.20) Preservative Free) Unlicensed PF Polyvinyl Alcohol Room temperature 1.4% eye drops ( free) (4x10ml= 17.77) Polyvinyl Alcohol 1.4% eye drops SnoTears ) (1x15ml= 1.93) Room temperature Once opened keep refrigerated and discard after one week 28 days at home Suitable for patients whose manual dexterity prohibits use of single dose devices The CE-marked range of Refresh products contains carboxymethylcellulose as the active ingredient Prednisolone 0.3% and 0.5% eyedrops ( free) and from Lucy Titcomb, Lead Ophthalmic Pharmacist, Birmingham & Midlands Eye Centre is gratefully acknowledged. Page 14 of 20

15 This information has been produced at the request of Heads of Medicines Management in NHS London. Product-specific information and costs for unlicensed medicines refer to products made by Moorfields Pharmaceuticals. Similar products may also be available from other manufacturers and there is no intention to recommend a particular manufacturer s unlicensed product. Non-infected inflammatory conditions of the eye [licensed] Reducing host response [unlicensed] Tapering tfrom doses of higher strength preparations [unlicensed] Inflammatory keratitis due to Herpes Zoster and Herpes Simplex virus [unlicensed] Dependent on indication and severity. Note, however, that there is no evidence of a difference in clinical effectiveness between 0.3% and 0.5% preparations; consider using the licensed Minims 0.5% preparation less frequently than the 0.3% preparation for the majority of patients. Usually short term dependent on patient s condition and response. Side effects: As listed in BNF Cautions: As listed in BNF Patient monitoring: As for licensed products Products Name Presentation Storage before Licensed Minims Sterile single-use eye Prednisolone drops phosphate 0.5% w/v (4x20 0.5mL= 41.64) Unlicensed Prednisolone phosphate 0.3% w/v Prednisolone phosphate 0.5% (Predsol ) (when available) Prednisolone acetate 1% (Predforte ) 10mL multidose bottle (4 10 ml= 89.68) (1x10ml= 2.00) (1x10ml= 3.05) Store below 25 C Single use only Use in most circumstances when appropriate for the indications noted above. Store below 25 C See introduction Use when a lower strength preparation is required. Other options include alternate day use of betamethasone phosphate 0.1% eye ointment or NSAID eyedrops (PF) Store below 25 C Store below 25 C 28 days at home 28 days at home Sodium chloride 0.9% eye drops ( free)*** For moistening of contact lenses, to facilitate lens removal and first-aid removal of harmful substances. and from Lucy Titcomb, Lead Ophthalmic Pharmacist, Birmingham & Midlands Eye Centre is gratefully acknowledged. Page 15 of 20

16 This information has been produced at the request of Heads of Medicines Management in NHS London. Product-specific information and costs for unlicensed medicines refer to products made by Moorfields Pharmaceuticals. Similar products may also be available from other manufacturers and there is no intention to recommend a particular manufacturer s unlicensed product. Special presentations of chloride 0.9% and other irrigation solutions are used routinely for intra-ocular surgery. 1 drop as required Various, it depends on the patient diagnosis/response Side effects: None known Cautions: None known Patient monitoring: As for licensed products not normally necessary Products Name Presentation Storage before Licensed PF Minims Saline 0.5ml Single dose Room temperature units Single use only Unlicensed PF Sodium chloride 0.9% Preservative Free eye drops None: see p19 (6x20x0.5ml= 39.54) (4x10ml= 84.00) Room temperature See introduction Suitable for patients whose manual dexterity prohibits use of minims *** in addition to products available as licensed medicines, an extensive range of ocular Sodium lubricants chloride is available 5% eye as drops CE-marked ( medical devices. free)*** Details are listed on p. 20. Also see the current Drug and from Lucy Titcomb, Lead Ophthalmic Pharmacist, Birmingham & Midlands Eye Centre is gratefully acknowledged. Page 16 of 20

17 This information has been produced at the request of Heads of Medicines Management in NHS London. Product-specific information and costs for unlicensed medicines refer to products made by Moorfields Pharmaceuticals. Similar products may also be available from other manufacturers and there is no intention to recommend a particular manufacturer s unlicensed product. Used to reduce corneal oedema by drawing out water from the corneal epithelium and stroma in conditions such as bullous keratopathy. 1 drops, three times daily Often required long-term for epithelium and stroma. Side effects: Stinging sensation on Cautions: Patient monitoring: instillation There is no licensed product of chloride 5% eye drops available, either containing or -free. Products Name Presentation Storage before Licensed PF None None Unlicensed PF Sodium chloride 10mL multidose bottle Store below 25 C 5% free eye drops (4x10ml= 84.00) Licensed or CEmarked, None but see with page 19 & below See introduction Used for recurrent corneal erosions. Sodium chloride 5% eye ointment ( free)*** and from Lucy Titcomb, Lead Ophthalmic Pharmacist, Birmingham & Midlands Eye Centre is gratefully acknowledged. Page 17 of 20

18 This information has been produced at the request of Heads of Medicines Management in NHS London. Product-specific information and costs for unlicensed medicines refer to products made by Moorfields Pharmaceuticals. Similar products may also be available from other manufacturers and there is no intention to recommend a particular manufacturer s unlicensed product. Used to reduce corneal oedema due to a variety of underlying causes. Usually applied once at night; occasionally applied twice daily according to physician s criterion. Side effects: Stinging sensation on Cautions: Patient monitoring: instillation; slight transitory itching also possible Products Name Presentation Storage before Licensed PF None None None None Unlicensed PF Sodium chloride 5g tube Store below 25 C 28 days at home 5% eye ointment free (1x5g= 21.97) Muro 128 5% eye ointment (imported) None and from Lucy Titcomb, Lead Ophthalmic Pharmacist, Birmingham & Midlands Eye Centre is gratefully acknowledged. Page 18 of 20

19 This information has been produced at the request of Heads of Medicines Management in NHS London. Product-specific information and costs for unlicensed medicines refer to products made by Moorfields Pharmaceuticals. Similar products may also be available from other manufacturers and there is no intention to recommend a particular manufacturer s unlicensed product. Appendix A: Prescribable ocular lubricants available as Pharmacy Medicines PF Single Dose Units PRODUCT Active Ingredient Strength Manufacturer Dose Pack NHS Price 30 day cost* Phosphate free carbomer Viscotears PF carbomer % Alcon One drop 3-4 times daily 30 x 0.6ml Yes hydroxyethylcellulose (HEC) Minims Artificial Tear HEC/NaCl 0.44% Chauvin As required 20 x 0.5ml Yes hypromellose/hpmc Artelac SDU hypromellose 0.32% Pharma Global 1 drop, 3-5 times daily 30 x 0.5ml No Hydromoor hypromellose 0.3% Moorfields Pharmaceuticals 30 x 0.4ml Yes Lumecare Hypromellose hypromellose 0.3% Medicom Healthcare 30 x 0.5ml povidone Oculotect povidone 5% Novartis 1 drop 4 times daily 20 x 0.4ml Yes Appendix B: Prescribable ocular lubricants available as CE-marked medical devices (Drug part IXA, appliances) PF Single Dose Units PRODUCT Active Ingredient Strength Manufacturer Dose Pack NHS Price carmellose Carmeleaze 0.5% carmellose 0.5% Blumont Pharma 30 day cost* Phosphate free and from Lucy Titcomb, Lead Ophthalmic Pharmacist, Birmingham & Midlands Eye Centre is gratefully acknowledged. Page 19 of 20

20 This information has been produced at the request of Heads of Medicines Management in NHS London. Product-specific information and costs for unlicensed medicines refer to products made by Moorfields Pharmaceuticals. Similar products may also be available from other manufacturers and there is no intention to recommend a particular manufacturer s unlicensed product. Carmeleaze 1% carmellose 1% Blumont Pharma CelluVisc carmellose 0.5% Allergan 1-2 drops as required 30 x 0.4ml Yes CelluVisc carmellose 1.0% Allergan 1-2 drops as required 30 x 0.4ml Yes Carmize carmellose 0.5% Aspire Pharma 30 x 0.4ml Carmize carmellose 0.5% Aspire Pharma 90 x 0.4ml Carmize carmellose 1.0% Aspire Pharma 30 x 0.4ml Carmize carmellose 1.0% Aspire Pharma 60 x 0.4ml Hydromoor hypromellose 0.3% Moorfields Pharmaceuticals 30 x 0.4ml Yes Lumecare Hypromellose hypromellose 0.3% Medicom Healthcare 30 x 0.5ml hyaluronate Vismed hyaluronate 0.18% TRB Chemedica 1-2 drops as required 20 x 0.3ml No 20 x Vismed Gel hyaluronate 0.3% TRB Chemedica 0.45ml No Ocusan hyaluronate 0.2% Agepha 1-2 drops as required 20 x 0.5ml No Clinitas hyaluronate 0.4% Altacor 1 drop, 2-4 times daily 30 x 0.5ml No Artelac Splash hyaluronate 0.2% Bausch & Lomb 30 x 0.5ml No Artelac Splash hyaluronate 0.2% Bausch & Lomb 60 x 0.5ml No Blink Intensive Tears hyaluronate 0.2% AMO 20 x 0.4ml Yes Lubristil hyaluronate 0.15% Moorfields Pharmaceuticals 1-2 drops 4 times daily 20 x 0.3ml No hydroxypropyl guar Systane hydroxypropyl guar Alcon As required 28 x 0.8ml Yes Systane Ultra hydroxypropyl guar Alcon As required 30 x 0.7ml PF Multidose hyaluronate HyloTears hyaluronate 0.1% Scope Ophthalmics As required 10ml Yes HyloForte hyaluronate 0.2% Scope Ophthalmics As required 10ml Yes hyaluronate 0.1% hyaluronate Hylo-Care dexpanthenol 0.2% Scope Ophthalmics As required 10ml hypromellose/hpmc TearLac hypromellose 0.3% Scope Ophthalmics 10ml * one unit dose container is used to treat both eyes, four vials used daily. and from Lucy Titcomb, Lead Ophthalmic Pharmacist, Birmingham & Midlands Eye Centre is gratefully acknowledged. Page 20 of 20