Last reviewed: July Drug Monitoring required Monitoring Frequency Indication Additional Information Acenocoumarol INR 90

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1 Amber Drug Monitoring guide. Please note, if you are a SystmOne practice there is also an amber drug pilot template on s1 available for you to use. (This document has been developed from that template and using Leeds Health Pathways. ) Last reviewed: July 2017 *Monitoring guidelines may be updated - Leeds health Pathways will have the most up to date version. The S1 template will also be centrally updated* *Lifestyle information includes nutritional status, diet, level of * *Some drugs have different monitoring requirements depending on the indication. Please always check what medical condition the drug is being used for* Acenocoumarol INR 90 Adefovir Hep B viral load,fbc (inc. clotting), LFT, U&Es (inc. phosphate), Urine dipstick 6 months if stable, 3 months if high risk renal patient. Urine dipstick only 3monthly for 12 months. Chronic hepatitis B in adults Amiodarone Amisulpiride LFTs, T4,TSH BP,,Weight,BMI, Waist, Lifestyle (continue testing T4 & TSH 12 months after discontinued) Cardiac arrhythmias Apomorphine BP (Lying and standing) 30 Parkinson s disease Aripiprazole BP,,Weight,BMI, Waist, Lifestyle Aripiprazole Depot Atomoxetine Azathioprine Benperidol Carbamazepine Chlorpromazine Ciclosporin BP,,Weight,BMI, Waist, Lifestyle BP, Weight (Height and appetite also if under 18 ) ADHD in children and adults Specialist check up -children Specialist check up - adults FBC, LFTs, CRP, Amylase Children only FBC, LFTs Adults BP,,Weight,BMI, Waist, Lifestyle FBC, U&Es, LFTs, Weight In Bipolar Disorder only BP,,Weight,BMI, Waist, Lifestyle BP, lipids Adult Transplant BP, U&Es, LFTs Asthma FBC,U&Es, LFTs, Bone profile Child Rheumatology FBC,U&Es, LFTs, Lipids, BP 2 monthly Dermatology Page 1 of 7 FBC,U&Es, LFTs, Lipids, BP Adult Rheumatology As part of the annual physical health review, the following should be checked in addition to the drug monitoring detailed above. /detail.aspx?id=3635 Fasting glucose, HbA1c. Lipid profile.. Blood Pressure. Specialist will state any other monitoring required in writing, patients usually monitored in clinic

2 Calcium and phosphate 2 monthly Correction of secondary Cinacalcet PTH hyperparathyroidism in renal for first year Cyproterone acetate LFT, FBC, HbA1c, testosterone Gender dysphoria then ly FBC, LFT, U&Es, weight, consider Long Term Secondary whether still clinically appropriate Dabigatran Prevention of Venous (See appendix one on share cared Thromboembolism (VTE) guidance on lhp ) Danazol Demeclocycline Denosumab Dexamfetamine GP not responsible for tests only prescribing (Immunology dept - 6 months LFTs, annually Hep B antigen, Hep C antibody. Liver ultrasound and αfp if on this medication for over 5 years) FBC, LFT U+E Calcium, VitaminD BP, Weight Review of condition in clinic with specialist 4 monthly As per individual patient requirements - see guideline (8 prior to injection) Dronedarone LFTs,U&Es Edoxoban Entecavir Estradiol tablets Estradiol transdermal patches Flupentixol Fluphenazine Depot Haloperidol FBC, LFT, U&Es, weight, assess whether still clinically appropriate (See share cared guidance- appendix 1) Hep B viral load,fbc (inc. clotting), LFT, U&Es LFTs, Prolactin, HbA1c, Lipids (incl triglycerides),estradiol, Testosterone, FSH, LH, BP LFTs, Prolactin, HbA1c,full Lipids,Oestradiol, Testosterone, FSH, LH BP (sitting/ lying, standing),,weight,bmi, Waist, Lifestyle BP(sitting/lying, standing),,weight,bmi, Waist, Lifestyle Weight, waist, BMI, BP(sitting/lying, standing), pulse, lifestyle, HbA1c (fasting), Lipids (incl triglycerides) - at 3 months. At 12months - all the above plus LFT's, FBC's U&E's for renal function and ECG ( annually and after dose change) Hydroxycarbamide FBC, LFTs, U&Es Lamivudine Hep B viral load,fbc (inc. clotting), LFT, U&Es (inc. phosphate) for 1 year until stable, then for the first 3 years for the first year Hereditary angioedema Treatment of inappropriate anti- diuretic hormone secretion (SIADH) Treatment of Osteoporosis in; postmenopausal women and men at increased risk of fractures ADHD in adults Non-Permanent Atrial Fibrillation (to maintain sinus rhythm) Long Term Secondary Prevention of Venous Thromboembolism (VTE) Chronic hepatitis B in adults Polycythaemia, Thrombocythaemia, Chronic Myeloid Leukaemia (CML) and Psoriasis (if stable) Page 2 of 7 Chronic hepatitis B in adults Stop treatment if any of the following develop: new onset of migraine-type headache Stop treatment if any of the following develop: DVT/PE, Jaundice or liver deterioration

3 Lanreotide All monitoring is done in secondary Neuroendocrine tumours care - GP prescribes and Acromegaly Lanthanum All monitoring is done in secondary Hyperphosphataemia In care - GP prescribes Adult Renal Patients Leflunomide BP, LFTs, FBC after titrated. Adult Patients with Rheumatoid Arthritis (RA) or Psoriatic Arthritis (PsA) *if patient is taking any hepatotoxic medicines (e.g methotrexate) in combination with leflunomide monitoring needs to be monthly Leuprorelin Levomepromazine Levamisole (unlicensed medicine) Lisdexamfetamine Lithium * all monitoring to be done 12 hours post last dose *Lithium SHOULD BE PRESCRIBED LFTs, Prolactin, FSH, LH, Full Lipids 3 - during incl triglycerides, Oestradiol, hormone stabilisation Testosterone, U&E, FBC, Calcium, TFT, period then ly weight, BMI &BP, fasting glucose Weight, waist, BMI, BP(sitting/lying, standing), pulse, lifestyle, HbA1c (fasting), Lipids (incl triglycerides) - at 3 months. At 12months - all the above plus LFT's, FBC's U&E's for renal function and ECG ( annually and after dose change) All monitoring is done in secondary care - GP prescribes BP, Weight Review of condition in clinic with specialist Lithium levels U&Es (inc. egfr), TFTs, serum Calcium, BMI, Weight ADHD in adults Mania, recurrent or resistant depression, prophylaxis against bipolar affective disorders and to control Mercaptopurine FBC, LFTs Inflammatory Bowel Disease *Patient needs testing every 3 months if is a higher risk patient, clinician can confirm testing frequency Mesalazine *There is no evidence to suggest any one oral brand of mesalazine is more effective than another, however, release characteristics may differ. If it is necessary to switch brand the patient should be informed and advised to report any changes in symptoms. U&Es Inflammatory Bowel Disease FBC (only is suspicion of blood dyscrasia) Methotrexate FBC, LFTs Methylphenidate Metyrapone Modafinil Mycophenolate *Prescribers should clearly prescribe mycophenolate mofetil OR mycophenolic acid. THEY ARE NOT INTERCHANGABLE. NB: Please see separate guidelines in renal or liver transplant Non- Cancer Indications in Adults BP, Weight, (Height and appetite also if under 18 ) ADHD in children and adults Specialist check up -children Specialist check up - adults U&Es, BP, see shared care guideline for other essential clinical monitoring Cushing s Syndrome and ADRs Narcolepsy and Fatigue in Psychiactric symptoms, BP, pulse, LFTs patients with Multiple Sclerosis Prevention of Graft Rejection as agreed with specialist (see clinic in Children Post Renal letters) Transplant Primary care will only be asked in exceptional circumstances to perform monitoring (see clinic letters) Primary care will only be asked in exceptional circumstances to perform monitoring (see clinic letters) FBC, U&Es, LFTs and BP Prevention of Relapse in Frequently Relapsing Nephrotic Syndrome in Paediatrics Rheumatological Conditions in Children Adult rheumatoid conditions, idiopathic pulmonary fibrosis and autoimmune hepatitis in adults *U&Es : if moderate renal impairment, patient over 70 years, or clinican concern for renal function *Patients on steroidal contraceptives should be switched to more appropriate product. This drug requires no additional monitoring over that undertaken at LTH. N/a Prophylaxis of Adult Renal Page 3 of 7

4 Octreotide FBC, U&Es, LFTs Oestrogel Olanzapine Paliperidone injection ROUTINE MONITORING - for the first year and LFT Prolactin HbA1c Lipid profile Oestradiol (required for follow up appts) Testosterone (required for follow up appts) FSH Weight, waist, BMI, BP(sitting/lying, standing), pulse, lifestyle, HbA1c (fasting), Lipids (incl triglycerides) - at 3 months. At 12months - all the above plus LFT's, FBC's U&E's for renal function for the first year naive GP to Prophylaxis of Adult Liver *Hospital monitor in transplant follow-up clinics. If patient is stable and appts become less frequent then GP maybe asked to perform monitoring Changes in smoking habit - smoking induces the metabolism of olanzapine, changes in smoking habit can affect olanzapine effect. If the person stops smoking, monitor for adverse effects and seek advice about dose adjustment if necessary Penicillamine FBC and Urinalysis for protein, blood, white cells and platelets. Treatment of Adults and Paediatrics Pericyazine naive GP to Perphenazine naive GP to Phenindione INR Pimozide - ECG annually and at dose changes naive GP to Page 4 of 7

5 Promazine - ECG annually and at dose changes naive GP to Quetiapine naive GP to Riluzole LFTs, FBC,U&Es every month for the first three months, then at 3 monthly intervals for 9 months Motor Neurone Disease for Patients with Amyotrophic Lateral Sclerosis(ALS) Risperidone naive GP to Risperidone Depot Rivaroxaban Sacubitril Valsartan Sevelamer Sirolimus Sodium aurothiomalate Sodium Valproate (see Valproate) FBC, LFT, U&Es, consider whether still clinically appropriate (See share cared guidance- appendix 1) BP, U&Es, FBC and adherence to treatment serum calcium, phosphate and ipth levels *monitored by Renal Clinic, prescribed by GP Lipids (GP) U&Es, LFTs, FBC and sirolimus trough level, BP, random blood glucose (In clinic) U&Es, LFTs, FBC and sirolimus trough level, BP, random blood glucose (In clinic) FBC and Urinalysis for protein and blood naive GP to ly or if CrCl<60ml/min 1/2 monthly At the time of each injection Long Term Secondary Prevention of Venous Thromboembolism (VTE) Symptomatic Chronic Heart Failure with Reduced Ejection Fraction Treatment Of Hyperphosphataemia In Adult Renal Patients Prophylaxis of Adult Renal Prophylaxis of Adult Liver All indications Monitored clinic prescribed by GP If patient becomes stable monitoring will be handed to the GP (letter to confirm this) Provided blood results are stable, the results of the FBC need not be available before the injection is given but must be available before the next injection i.e. it is permissible to work one FBC in arrears. Somatropin Height, weight, waist/hip ratio,bp HbA1C and random blood glucose, IGF1, TFTs, T3, Quality of life questionaire (All done by specialist) Baseline, 3,6,9,12 months and Page 5 of 7 Adults with Growth Hormone Deficiency Monitoring undertaken by specialist - GP prescribes

6 for the first year Spironalactone BP, U&Es, Testosterone Stiripentol *Prescribe by brand weight and height (refer to centile charts), FBC, LFTs Strontium U&Es, CVD risk using QRISK2 & BP Sucroferric Oxyhydroxide (Velphoro) Sulfasalazine Sulpiride Tacrolimus *Prescribe by brand only- DIFFERENT BRANDS OF TACROLIMUS ARE NOT INTERCHANGEABLE Tenofovir Testosterone Enantate Tinzaparin Trifluoperazine Valproate (Sodium Valproate/Valproic acid) *Prescribe by brand name due to differences in bioavailability Calcium and phosphate (by specialist) (i)pth levels (by specialist) FBC, LFT FBC, LFT monitoring done by secondary care unless requested monitoring done by secondary care unless requested Done in clinic - (LFTs, FBC,U&Es, tacrolimus levels ) 1-2 monthly 3-4 monthly naive GP to severe myoclonic epilepsy of *Patients need to be maintained on the same infancy (Dravet Syndrome) in preparation either capsules or powder children over 3 years. Treatment of severe osteoporosis in postmenopausal women and adult men Post paediatric renal Every 1-2 months by clinic transplant Nephrotic syndrome in At every clinic appointment children If patient is over 80 and at risk of VTE then treatment should be re-evaluated. Patient will be informed by specialist to monitor for skin rashes. Tests done in clinic Tests done in clinic every 3 months Adult renal transplant All other tests carried out in clinic LFTs, FBC,U&Es, tacrolimus levels at request of the Adult liver transplant clinic specialist Tacrolimus level, FBC, U&Es, LFTs, BP, by GP blood glucose Crohns Lipids ly by GP 6 months if stable, 3 Hep B viral load,fbc (inc. clotting), months if high risk renal LFT, U&Es (inc. phosphate), urine patient. Urine dipstick only Chronic hepatitis B in adults dipstick 3monthly for 12 months. BP, Oestrodial, Testosterone, FBC, Calcium, LFTs, Fasting lipids and triglycerides FBC, LFTs, U&Es** Weight FBC, LFTs, Weight BP,,Weight, Mental and physical health, any social needs? for the first year naive GP to 6 months after initiation hyperphosphataemia in chronic kidney disease patients on haemodialysis or Treatment of juvenile idiopathic arthritis Treatment of rheumatoid arthritis, psoriatic arthritis, connective tissue diseases and inflammatory bowel disease Treatment of venous thromboembolism (VTE) in patients with a deep vein thrombosis (DVT) or pulmonary embolism (PE) or Mood Stabilisation Venlafaxine (Doses over 300mg) BP (and after each dose change) Warfarin INR 90 Usually done by clinic Specialist will state any other monitoring required in writing, patient usually monitored in clinic Tests done in clinic see guideline to define high risk renal patient. **Patients at risk of hyperkalaemia (patients with Diabetes Mellitus, chronic renal failure, acidosis or patients taking potassium sparing drugs) should be monitored every 2-3 months. Page 6 of 7

7 Zuclopenthixol naive GP to Zuclopenthixol Depot naive GP to Page 7 of 7