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Bedfordshire and Luton Joint Formulary
Bedfordshire Hospitals NHS Foundation Trust
Bedfordshire, Luton and Milton Keynes ICB
Formulary Chapter: 8 - Malignant disease and immunosuppression 
Notes:

Any drug not listed on the Formulary should be considered Non-Formulary - Not recommended for prescribing
08.02.01 Antiproliferative immunosuppressants
NICE TA99: Renal transplantation - immunosuppressive regimens for children and adolescents

Azathioprine
(Immunosuppression)

 
Formulary

Amber SPA 25mg & 50mg Tablets
10mg/mL Suspension. Restricted to paediatric patients or patients with swallowing difficulties.

Avoid concomitant use of azathioprine with allopurinol, unless supervised by an appropriate specialist.

NB: 75mg and 100mg tablets were rejected for use Feb 2024 due to safety concerns relating to dosing errors and disproportionate cost. Do not prescribe these strengths. 

 Amber SCG Autoimmune renal disease 

Azathioprine / Mercaptopurine for Renal Autoimmune Disease – Shared care Guideline – BLMKICB Medicines Optimisation

Entry reviewed: August 2024

BNF BNFc SPC
Drug Safety Update Thiopurines and intrahepatic cholestasis of pregnancy

Mercaptopurine
(Immunosuppression)

SCG
Formulary

 Autoimmune renal disease 

Azathioprine / Mercaptopurine for Renal Autoimmune Disease – Shared care Guideline – BLMKICB Medicines Optimisation

Entry reviewed: July 2024

BNF BNFc SPC
Drug Safety Update Thiopurines and intrahepatic cholestasis of pregnancy

Mycophenolate Mofetil (oral)
(Immunosuppression)

 
Restricted Drug Restricted

Red Hospital only for new transplant patients.

Existing transplant patients may continue to receive in Primary Care.

Amber SCG Autoimmune renal disease

Mycophenolate Mofetil / Mycophenolic acid for Renal Autoimmune Disease – Shared care guideline – BLMKICB Medicines Optimisation

Continue same brand / strength. Available as 250mg capsule, 500mg tablets various brands.

Also availabe as an oral suspension 1g in 5mL for patients with swallowing difficulties.

Entry reviewed August 2024

BNF BNFc SPC

Mycophenolic Acid (oral)
(Immunosuppression)

SCG
Restricted Drug Restricted

Autoimmune renal disease

For patients who are unable to tolerate mycophenolate mofetil due to its side effects but still have disease response.

Mycophenolic acid 720 mg is approximately equivalent to mycophenolate mofetil 1 g but avoid unnecessary switching because of pharmacokinetic differences.

Mycophenolate Mofetil / Mycophenolic acid for Renal Autoimmune Disease – Shared care guideline – BLMKICB Medicines Optimisation

Entry reviewed August 2024

BNF BNFc SPC

Mycophenolate Mofetil 500mg IV Infusion
(For transplant patients)

RED
Restricted Drug Restricted

For transplant patients who are unable to take orally.

BNF BNFc SPC
Classifications
GREEN
May be initiated in any care setting
Amber SPA
Specialist to advise therapy and provide first 28 days supply, continuation in Primary Care
Amber SPIS
Specialist to initiate and stabilise medicine prior to continuation in Primary Care
SCG
To be prescribed as per Shared Care Guidance. If no SCG in place status reverts to red.
RED
Red medicines are designated as specialist only medicines which should only be prescribed by a specialist, usually within secondary care (either due to the requirement for specialist knowledge, long-term monitoring requirements, or restrictions that mean medicine supplies are only available to hospitals).
DNP
A decision has been made either locally and/or nationally not to routinely commission this preparation. Do not prescribe.
SELF
To be purchased over the counter. May be prescribed for chronic, long term conditions or on admission to hospital if essential.