Drugs affecting the immune response (Formulary)

Advise patients prescribed drugs in this section to avoid excessive exposure to UV light.

AZATHIOPRINE

Important: Therapy notes

Important: Formulation and dosage details

Formulation:

Tablets 50mg (specialist use only)

Dosage:

For initiation by hospital specialist only.

For advice on monitoring azathioprine refer to DMARD monitoring guidance. 

CICLOSPORIN

Important: Therapy notes

Important: Formulation and dosage details

Formulation:

Capsules (Neoral®) 10mg, 25mg, 50mg, 100mg (specialist use only)

Dosage:

For initiation by hospital specialist only.

For advice on monitoring ciclosporin refer to DMARD monitoring guidance. 

Important: Formulation and dosage details

Formulation:

Oral solution 500mg/5mL (specialist use only)

Dosage:

For initiation by hospital specialist only.

For advice on monitoring ciclosporin refer to DMARD monitoring guidance. 

GUSELKUMAB

Important: Therapy notes

Important: Formulation and dosage details

Formulation:

Solution for injection in pre-filled pen 100mg/mL (hospital use only)

Dosage:

As per SMC 1340/18: Treatment of moderate to severe plaque psoriasis in adults who are candidates for systemic therapy.
SMC restriction: for patients who have failed to respond to conventional systemic therapies (including ciclosporin, methotrexate and phototherapy), are intolerant to, or have a contraindication to these treatments.

METHOTREXATE

Important: Therapy notes

MHRA advice: Methotrexate: advise patients to take precautions in the sun to avoid photosensitivity reactions (August 2023) (www.gov.uk).  

Pay attention to the frequency of dosing for safety:

  • methotrexate is always given onceweekly
  • prescribing and dispensing errors have caused fatalities  
  • the 2·5mg tablet only is recommended for safety.

When methotrexate is prescribed for dermatological conditions it is usually used in conjunction with folic acid 5mg daily except on the day when methotrexate is taken.

Important: Formulation and dosage details

Formulation:

Tablets 2·5mg (specialist use only)

Dosage:

For initiation by hospital specialist only.

For advice on monitoring methotrexate refer to DMARD monitoring guidance. 

RISANKIZUMAB

Important: Therapy notes

Important: Formulation and dosage details

Formulation:

Solution for injection pre-filled pen and pre-filled syringe (Skyrizi®) 150mg/mL

Dosage:

As per SMC 2196: for the treatment of moderate to severe plaque psoriasis in adults who are candidates for systemic therapy.
SMC restriction: for patients who have failed to respond to conventional systemic therapies (including ciclosporin, methotrexate and phototherapy), are intolerant to, or have a contraindication to these treatments.

TACROLIMUS

Important: Therapy notes

MHRA advice: Oral tacrolimus products: reminder to prescribe and dispense by brand name only (November 2017) (www.gov.uk).

  • Advise patients not to apply other topical preparations within 2 hours of application.

Important: Formulation and dosage details

Formulation:

Ointment (Protopic®) 0·03%, 0·1%

BIMEKIZUMAB

Important: Therapy notes

Important: Formulation and dosage details

Formulation:

Solution for injection in pre-filled syringe 160mg (Restricted: Hospital use only)

Dosage:

As per SMC2410: For the treatment of moderate to severe plaque psoriasis in adults who are candidates for systemic therapy and who have failed to respond to standard systemic therapies (including ciclosporin, methotrexate and phototherapy), are intolerant to, or have a contraindication to these treatments.

This includes patients with:

  • moderate to severe plaque psoriasis
  • psoriatic arthritis with concomitant moderate to severe plaque psoriasis.

Homecare is the preferred option - contact nhsh.homecare@nhs.scot

Important: Formulation and dosage details

Formulation:

Solution for injection in pre-filled pen 160mg (Restricted: Hospital use only) 

Dosage:

As per SMC2410: For the treatment of moderate to severe plaque psoriasis in adults who are candidates for systemic therapy and who have failed to respond to standard systemic therapies (including ciclosporin, methotrexate and phototherapy), are intolerant to, or have a contraindication to these treatments.

This includes patients with:

  • moderate to severe plaque psoriasis
  • psoriatic arthritis with concomitant moderate to severe plaque psoriasis.

Homecare is the preferred option - contact nhsh.homecare@nhs.scot

Editorial Information

Last reviewed: 23/04/2020

Approved By: TAM Subgroup

Document Id: F134