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BNSSG Adult Joint Formulary
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Decisions 13th December 2022

At the meeting on 13th December, the following decisions were agreed

New Drug Requests


 Tenecteplase (TLS Red)

  • For thrombolysis of acute ischaemic stroke prior to thrombectomy on advice of stroke specialist. For patients who are eligible for thrombolysis and thrombectomy treatment only. For use at NBT only.

 Insulin eye drops (TLS Red)

  • For short term use for patients with corneal persistent epithelial defects that are refractory to usual treatment in clinical practice to promote epithelisation, under the advice of a corneal specialist at Bristol Eye Hospital.

Budesonide MMX (Cortiment®) prolonged release tablets (TLS Amber no SCP)

  • for induction of remission in patients with mild to moderate active ulcerative colitis where 5-ASA treatment is not sufficient or not tolerated, as an alternative to other topical/oral corticosteroids if these are unsuitable.

Lercanidipine (TLS Blue)

  • for treatment of hypertension as a second line calcium channel blocker option when amlodipine is not tolerated or suitable

Fluocinolone 0.00625% (Synalar® 1 in 4) ointment and cream (TLS Blue)

  • as per licensed indications

Other Formulary Decisions

  • Beclometasone (Clipper®) tablets are currently TLS Green, however as this is an alternative to prednisolone, this should be reflected as TLS Blue and has therefore been updated on the formulary.
  • Oral budesonide (Budenofalk®) is currently TLS Blue, however, this would also be initiated on the recommendation of the specialist, therefore an amber no SCP TLS should be applied. This will also align with the amber no SCP status of budesonide use in ulcerative colitis.
  • Listings of oral budesonide should recommend being prescribed by brand as Cortiment® and Budenofalk® as they should not be used interchangeably due to mode of action and licensing in IBD.
  • Glycopyrronium for Parkinson's Disease patients with siallorrhea Update- further work needed before formulary position changes
    It was agreed to approve use of glycopyrronium for Parkinson's Disease patients with sialorrhoea as TLS Amber 3 months SCP, once the existing SCP for use for Motor Neurone Disease patients was updated to incorporate this indication, and the most cost effective formulation included. The formulary will be updated once the updated SCP has been approved at JFG. The current 'non formulary' position remains in place until this happens.
  • Melatonin Update- further work needed 
    The new drug request application for melatonin for off-label use for sleep disorder in adult and paediatric patients with any of: ADHD, ASD or LD was re-discussed by the Joint Formulary Group. A final decision has not been made and further work is needed before any changes may be made to the current formulary position, including financial considerations and development of appropriate shared care arrangements. There is no definitive timeline for these changes and the current formulary position remains in place at this time. 
  • Omeprazole oral suspension is non-formulary for adults in BNSSG. Please refer to the Paediatric Formulary for further information on managing paediatric patients. 
  • Insulin biosimilars on the formulary- removal of 'new patients only'
  • Emollient Brand Updates
    Aproderm emollient cream replaces Cetraben cream, Aproderm gel replaces Myribase gel, Epimax ointment replaces Zeroderm ointment