Ocular diagnostic, peri-operative and specialist-use preparations (Formulary)

TAM (Treatments and Medicines) NHS Highland
NHS Highland

Botulinum toxin type A (Drugs used in Parkinsonism and related disorders) is also used under specialist advice for blepharospasm.

ADALIMUMAB

Therapy notes

  • Amgevita® first-line
  • Humira® second-line, for specialist treatment of sight threatening, non-infectious, inflammatory eye disease off-label.
  • See NICE TA460: Adalimumab and dexamethasone for treating non-infectious uveitis.

Formulation and dosage details

Formulation:

Solution for injection, pre-filled syringe 20mg/0·4mL, 40mg/0·8mL (Amgevita®) (specialist use only) 

Dosage:

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

Formulation and dosage details

Formulation:

Solution for injection, pre-filled pen 40mg/0·8mL (Amgevita®) (specialist use only)

Dosage:

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

Formulation and dosage details

Formulation:

Solution for injection pre-filled syringe 20mg/0·4mL, 40mg/0·4mL (Humira®) (specialist use only)

Dosage:

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

Formulation and dosage details

Formulation:

Solution for injection, pre-filled pen 40mg/0·4mL (Humira®) (specialist use only)

Dosage:

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

ACETYLCHOLINE CHLORIDE

Therapy notes

Formulation and dosage details

Formulation:

Solution for intra-ocular irrigation (acetylcholine 1%, mannitol 3%) (Miochol-E®) (specialist use only)

AFLIBERCEPT

Therapy notes

MHRA alert: Systemically administered VEGF pathway inhibitors: risk of aneurysm and artery dissection (July 2020) (www.gov.uk)

Formulation and dosage details

Formulation:

Solution for intravitreal injection 40mg/ml (4mg/0·1ml) providing a 2mg dose (specialist use only)

Dosage:

See per SMC:

  • 857/13: in adults for the treatment of neovascular (wet) age-related macular degeneration. 
  • 954/14: for adults for the treatment of visual impairment due to macular oedema secondary to central retinal vein occlusion. 
  • 1003/14: for adults for the treatment of visual impairment due to diabetic macular oedema (DMO).  SMC restriction: treatment of visual impairment due to DMO in adults with best corrected visual acuity (BCVA) 75 Early Treatment Diabetic Retinopathy Study (ETDRS) letters or less at baseline.
  • 1074/15: for adults for the treatment of visual impairment due to macular oedema secondary to branch retinal vein occlusion.

Formulation and dosage details

Formulation:

Solution for intravitreal injection 114.3mg/mL (30.1mg/263microlitres) providing an 8mg dose in 70microlitres (Restricted: hospital use only)

Dosage:

As per SMC:

  • 857/13: in adults for the treatment of neovascular (wet) age-related macular degeneration. 
  • 954/14: for adults for the treatment of visual impairment due to macular oedema secondary to central retinal vein occlusion. 
  • 1003/14: for adults for the treatment of visual impairment due to diabetic macular oedema (DMO).  SMC restriction: treatment of visual impairment due to DMO in adults with best corrected visual acuity (BCVA) 75 Early Treatment Diabetic Retinopathy Study (ETDRS) letters or less at baseline. 

In NHS Highland place in therapy is:

  • Poor/short-lived response to current anti-VEGF treatment of aflibercept 2mg or other anti-VEGF within reason eg requiring injections more frequently than 8 weeks.
  • Struggling with 8 weekly injections eg due to living far away/transport issues/anxiety.

Formulation and dosage details

Formulation:

Concentrate for solution for infusion 25mg/mL (specialist use only)

Dosage:

As per SMC 878/13: in combination with irinotecan/5-fluorouracil/folinic acid (FOLFIRI) chemotherapy, aflibercept is indicated in adults with metastatic colorectal cancer (mCRC) that is resistant to or has progressed after an oxaliplatin-containing regimen.

BEVACIZUMAB

Therapy notes

MHRA alert: Systemically administered VEGF pathway inhibitors: risk of aneurysm and artery dissection (July 2020) (www.gov.uk).

Formulation and dosage details

Formulation:

Intravitreal injection, pre-filled syringe 5mg/0·2mL unlicensed (Restricted: specialist use only)

Dosage:

For neo-vascular (wet) age-related macular degeneration.

BROLUCIZUMAB

Therapy notes

MHRA advice: Brolucizumab (Beovu): risk of intraocular inflammation and retinal vascular occlusion increased with short dosing intervals (January 2022) (www.gov.uk).

Risk minimisation materials

Formulation and dosage details

Formulation:

Solution for injection 120mg/ml in pre-filled syringe (specialist use only)

Dosage:

As per SMC 2272: in adults for the treatment of neovascular (wet) age-related macular degeneration (AMD).

CEFUROXIME

Therapy notes

Formulation and dosage details

Formulation:

Powder for solution for injection 50mg (Aprokam®) (specialist use only)

CICLOSPORIN

Therapy notes

Formulation and dosage details

Formulation:

Preservative-free eye drops 0·1% (Ikervis®) (specialist use only)

Dosage:

Apply 1 drop at bedtime.

FLUORESCEIN SODIUM

Therapy notes

Formulation and dosage details

Formulation:

Preservative-free eye drops 1%, 2%

Formulation and dosage details

Formulation:

Solution for injection 10%

OCRIPLASMIN

Therapy notes

Formulation and dosage details

Formulation:

Concentrate for solution for intravitreal injection 500 micograms/0·2mL vial (specialist use only)

POVIDONE IODINE

Therapy notes

Formulation and dosage details

Formulation:

Solution for intra-ocular irrigation 5% in balanced salt solution unlicensed (specialist use only)

RANIBIZUMAB

Therapy notes


Risk minimisation materials

Formulation and dosage details

Formulation:

Solution for intravitreal injection 1·65mg/0·165mL prefilled syringe, 2·3mg/0·23mL vial (specialist use only)

SODIUM CHLORIDE

Therapy notes

  • Available for specialist use from special-order manufacturers; for information contact Medicines Information.

Formulation and dosage details

Formulation:

Preservative free eye drops 5% 10ml (specialist initiation only)

Editorial Information

Document Id: F207