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BNSSG Adult Joint Formulary

9.1 Blood and blood–forming organs

Last edited: 15-04-2024

9.1.3 Anaemias, hypoplastic, haemolytic and renal

First line drugs Second line drugs Specialist drugs Secondary care drugs
Recommended in both primary and secondary care Alternatives (often in specific conditions) in both primary and secondary care Where a specialist input is needed (see introduction for definition) Prescribing principally within secondary care only

 

Continuous Erythropoietin Receptor Activators

Methoxy polyethylene glycol-epoetin beta (Mircera®) (TLS Red)

  • For use by Renal only

 

Epoetins

MHRA Public Assessment Report: Epoetins for the management of anaemia associated with cancer: risk of tumour progression and mortality (Nov 2007)

NICE guideline NG203 Chronic Kidney Disease: Managing anaemia

Darbepoetin alfa (TLS Red)

  • For use by Renal, Haematology & Oncology only
  • Oncology use see NICE TA323 Erythropoietin (alfa and beta) and darbepoetin for the treatment of cancer-treatment induced anaemia (including review of NICE TA142)

Erythropoietin (Epoetin) beta (TLS Red) 

  • For use by Renal, Haematology & Oncology only
  • Oncology use see NICE TA323 Erythropoietin (alfa and beta) and darbepoetin for the treatment of cancer-treatment induced anaemia (including review of NICE TA142)

 

Monoclonal Antibodies

Eculizumab (TLS Red)

Pegcetacoplan (TLS Red)

  • NICE TA778 Pegcetacoplan for treating paroxysmal nocturnal haemoglobinuria

Ravulizumab (TLS Red)

  • NICE TA698 Ravulizumab for treating paroxysmal nocturnal haemoglobinuria

N.B. Crizanlizumab for sickle cell disease has been withdrawn see NHSE SSC2608

 

Other

Roxadustat (TLS Red)

  • NICE TA807 Roxadustat for treating symptomatic anaemia in chronic kidney disease

 

9.1.4 Anaemias, iron-deficiency

Iron (injectable)

  • Referral guidance for IV iron available on Pathology Services Remedy page
  • Please see MHRA Drug Safety Update August 2013 regarding new strengthened recommendations to manage and minimise risk of serious hypersensitivity reactions
  • Anaphylactoid reactions can occur with parenteral administration of iron complexes. Facilities for cardio-pulmonary resuscitation must be at hand

Ferric carboxymaltose (Ferinject®) (TLS Red)

Iron dextran (CosmoFer®) (TLS Red)

Ferric derisomaltose (previously known as Monofer®) (TLS Red)

Iron sucrose (Venofer®) (TLS Red)

  • Trusts to decide which agent is most cost effective in specific clinical situations

 

Iron (oral) 

Ferrous sulphate (TLS Green)

Ferrous fumarate (TLS Green)

Alternatives: (TLS Blue)

Ferrous gluconate tablet

Sodium feredetate elixir (Sytron®)

Ferrous fumarate / Folic acid tablet (Pregaday®)

  • Ferrous gluconate or sodium feredetate may be used when patients are unable to tolerate other oral iron preparations

Ferric maltol capsules (Feraccru®

  • For treatment of iron deficiency anaemia in adults as an alternative to IV iron infusion where patients have a significant intolerance to standard oral iron preparations following appropriate interventions to minimise adverse effects as per the Treatment of Iron Deficiency Anaemia in adults pathway

 

Iron content of different iron salts
Iron salt content Amount Ferrous iron per day
Ferrous sulphate tablets 200mg three times daily 195mg
Ferrous fumarate syrup 280mg (10mLs) twice daily 180mg
Ferrous fumarate tablets 210mg three times daily 195mg
Ferrous gluconate tablets 600mg three times daily 210mg
Sodium feredetate elixir 380mg (10mLs) three times daily 165mg

 

9.1.5 Anaemias, megaloblastic

Folates

Folic acid (TLS Green)

 

Vitamin B Group

For information about prescribing for vitamin B12 deficiency, please refer to the British Society of Haematology guidelines and NICE CKS: Anaemia- B12 and folate deficiency

Hydroxocobalamin intramuscular injection (TLS Green)

Specific indication:

Cyanocobalamin (TLS Blue)

  • Vitamin-B12 deficiency of dietary origin
  • Please refer to BNF for guidance on the use of folic acid for prophylaxis in pregnancy and prevention of neural tube defects

 

9.1.6 Iron overload

Iron chelators

Deferasirox (TLS Red)

Desferrioxamine (TLS Red)

Deferiprone (TLS Red)

Combinations of Deferiprone and Desferrioxamine (TLS Red)

 

9.1.7 Neutropenia and stem cell mobilisation

Chemokine receptor antagonists

Plerixafor (TLS Red)

 

Granulocyte-colony stimulating factors

When local procurement has been finalised and as per NICE’s biosimilar position statement, if the originator biologic product is on the BNSSG joint formulary, the new biosimilar product will also be included on the formulary in accordance with its UK licence when it becomes commercially available

Lenograstim Recombinant human granulocyte-colony stimulating factor (rHuG-CSF) (TLS Red)

Pegfilgrastim (UHB only) (TLS Red)

Filgrastim (Zarzio®) (TLS Red)

  • As per agreement with NHS England

 

9.1.8 Platelet disorders, essential thrombocythaemia

Cyclic AMP Phosphodiesterase III inhibitors

Anagrelide (oral) (TLS Red)

 

9.1.9 Platelet disorders, idiopathic thrombocytopenic purpura

Thrombopoietin receptor agonists

Eltrombopag (oral) (TLS Red)

  • For treating chronic (idiopathic) thrombocytopenia purpura as per NICE TA293

Romiplostim (TLS Red)

  • NICE TA221 Romiplostim for the treatment of chronic immune (idiopathic) thrombocytopenic purpura

Lusutrombopag (TLS Red)

  • NICE TA617 for treating thrombocytopenia in people with chronic liver disease needing a planned invasive procedure

Avatrombopag (TLS Red)

  • NICE TA626 Avatrombopag for treating thrombocytopenia in people with chronic liver disease needing a planned invasive procedure
  • NICE TA853 Avatrombopag for treating primary chronic immune thrombocytopenia

 

Kinase Inhibitors

Fostamatinib (TLS Red)

  • NICE TA835 Fostamatinib for treating refractory chronic immune thrombocytopenia

 

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