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BNSSG Adult Joint Formulary
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Decisions 1st November 2022

Decisions 1st November 2022

At the meeting on the 1st November, the following decisions were agreed


New Drug Requests


5-aminolaevulinic acid (Ameluz) gel (TLS Red)

  • Photosensitiser in photodynamic therapy for treatment of Basal Cell Carcinoma and complex patients already under the secondary care dermatology team with recurrent malignant skin disease where actinic keratosis is a significant part of the disease presentation.

Oritavancin (Tenkasi) (TLS Red)

  • Restricted to use on advice of a Consultant Microbiologist only – see local guidelines.

Dermatonics Dry Skin Balm (10% urea) (TLS Blue)

  • For use within the diabetic foot emollient pathway.

 Testosterone (Testim) gel (TLS Amber 3 months)

  • Restricted to use for treatment of low libido causing distress in women with optimised HRT and with either early menopause (age 45 and under) or surgical menopause only. Use of testosterone gel for women outside of this indication / cohort is non-formulary. 


Shared Care Protocols


  • New - Guanfacine Shared Care Protocol for treatment of ADHD in adults where stimulants are not suitable, not tolerated or ineffective as a 4th line option after atomoxetine.  


Other Formulary Decisions

  • Icosapent ethyl with statin therapy for reducing the risk of cardiovascular events in people with raised triglycerides added to the formulary as TLS Blue in line with NICE TA805.

  • Actimorph orodispersible tablets – further work regarding implementation and pathway is required before further discussion at Joint Formulary Group.

  • Cyclogest pessaries - the Joint Formulary Group approved the use of Cyclogest pessaries as an alternative option to Utrogestan vaginal capsules for the treatment of women with a history of at least one previous miscarriage, with an intrauterine pregnancy confirmed by ultrasound scan with symptoms of vaginal bleeding in line with NICE NG 126 as TLS Red once internal Trust financial approval has been given. Micronised progesterone (Cyclogest) for this indication remains non-formulary until Trust financial approval has been agreed.

  • Insulin chapter layout – changes to layout approved. Table to remain but additional text will be removed.

  • Tinzaparin – it was agreed to remove reference to UHBW (Weston) under the entries for tinzaparin for VTE prophylaxis and treatment as tinzaparin is no longer used.

  • Apixaban and rivaroxaban - it was agreed to remove reference to specific acute trusts under the TLS Red indication of post-op VTE prophylaxis following elective hip and knee replacement for both drugs.

  • Complete multivitamin with minerals and trace elements – it was agreed to include bariatric surgery as an indication for prescribing a complete multivitamin with minerals and trace elements onto the adult Joint Formulary.