- For secondary prevention of stroke and TIA in cases of clopidogrel resistance, or in patients with non-cardioembolic ischaemic stroke (NIHSS ≤ 5) or high-risk TIA.

- The BNSSG Guidelines for the Prescribing of Antiplatelets are currently being updated.

Vedolizumab (TLS Red)

- For off-label use for the treatment of Grade 3-4 immune checkpoint inhibitor related colitis where symptoms have not responded to first line treatment with immunosuppression, including where treatment with corticosteroids and infliximab have failed.

Duloxetine (TLS Blue)

- Second-line treatment for major depressive disorder (MDD) and generalised anxiety disorder (GAD)

- The BNSSG Guideline for the Management of Depression Adults is currently being updated

Flupentixol dihydrochloride (oral) (Depixol®) (TLS Amber Specialist Initiated)

- For schizophrenia and other psychoses

Flupentixol dihydrochloride (oral) (Fluanxol®) (TLS Amber Specialist Initiated)

- For treatment-resistant depression

- The BNSSG Guideline for the Management of Depression Adults is currently being updated

Botulinum Toxin A (TLS Red)

- For use as a scalene block in neurogenic thoracic outlet syndrome (TOS) in cases where surgery is not an option or needs to be deferred.

Cabergoline (TLS Amber Specialist Initiated)

- To inhibit or suppress lactation following miscarriage or termination

Betamethasone (as valerate) 0.1% w/w scalp application (Betacap) (TLS Green)

Capasal Therapeutic Shampoo (TLS Green)

Shared Care Protocols

The following shared care protocols have been updated:

Lithium
Depot antipsychotics. Fluphenazine removed from the formulary and from the depot antipsychotic SCP.
Guanfacine
Sodium Valproate

Traffic Light Status Changes

Sativex TLS changed from Red to Amber Specialist Initiated
Mycophenolate changed from amber 3 months to amber 1 month pending an updated shared care protocol

NICE Technology Appraisals traffic light status discussions:

Acarizax for treating allergic rhinitis and allergic asthma caused by house dust mites in line with NICE TA1045. Potential change to existing traffic light status still to be determined. This will be discussed at the meeting in September 2025.
Relugolix–estradiol–norethisterone for treating symptoms of endometriosis as per NICE TA1057 will be added to the formulary as Amber Specialist Initiated within the NICE implementation period.
Linzagolix for treating symptoms of endometriosis as per NICE TA1067 will be added to the formulary as Amber Specialist Initiated within the NICE implementation period.

Other discussions/decisions

- Ergocalciferol formulary listing updated

- Melatonin Shared Care Protocol needs to be reviewed to reflect updated product costs

- The new drug request application template form has been updated - see paperwork

Chapter Review

The nutrition chapter (9.5.5) was reviewed and the following changes were agreed:

In section 9.5.2, oral nutritional supplements (ONS):

Linking to the Sirona diabetes and nutrition services page and adding contact information, rewording/addition of sentences to improve clarity/add information, reformatting or changing order of the page for readability, updating flavour availability and current free form and nutritional content statuses.
Previously called Aymes^® Complete which was TLS blue, changed to Actagain 1.5 Complete with TLS green status
Fortisip^®removed as an option for a ready to drink milkshake-style supplement
Aymes ActaGain® 600 and Altraplen^® Compact Daily changed from TLS blue to TLS green
Ensure^® Compact removed as an option as a low volume milkshake-style drink.
Aymes ®ActaGain Juce changed from TLS blue to TLS green
Altrajuce® (ready to drink) removed as an option as a juice-style supplement
Fortijuice added as TLS green
Plant-based section added; Aymes Actasolve Smoothie kept as TLS green and moved to this section, Foodlink Smoothie added as TLS green, Fortisip Plant Based 1.5kcal added as TLS blue, Aymes Actagain 1.5 plant Powered added as TLS blue
Altraplen^® Protein removed as an option for additional protein milkshake-style supplement
Fresubin Pro compact added as an option for additional protein milkshake-style supplement as TLS green

In other sections of chapter 9.5:

Removing outdated links in section 9.5.5 in relation to phenylketonuria (PKU) and adding further information to support prescribing
In section 9.4.6; rewording of information relating to Coeliac disease management to ensure clarity, linking the page with the Coeliac disease remedy page, addition of information regarding calcium supplementation.