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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
08.02.02 Corticosteroids and other immunosuppressants
NICE TA85: Renal transplantation - immuno-suppressive regimens (adults) NICE TA99: Renal transplantation - immunosuppressive regimens for children and adolescents

Ciclosporin (Neoral® Deximune®)
(Oral)

Amber SPIS
Restricted Drug Restricted

Capsules and liquid available

Entry reviewed May 2025

BNF BNFc SPC

Ciclosporin 50mg/1mL (Sandimmun®)
(Injection)

RED
Formulary


 Restricted - must seek authorisation from a consultant before prescribing

BNF BNFc SPC

Prednisolone

GREEN
Formulary
1mg, 5mg &
Restricted Item 20mg tablets Restricted to chemotherapy patients or those on higher doses



BNF BNFc SPC

Sirolimus (Rapamune®)

RED
Restricted Drug Restricted

Hospital only for new transplant patients.

Prescribe same brand.

GPs may prescribe for existing transplant patients (following specialist initiation).

 

BNF BNFc SPC

Tacrolimus
(Oral - various brands)

RED
Restricted Drug Restricted

Hospital only for new transplant patients.

Prescribe same brand.

GPs may prescribe for existing transplant patients (following specialist initiation).

 

Standard strength liquid is 5mg/5ml as per RCPCH/NPPG guidance - RCPCH/NPPG Standardised strengths of unlicensed liquids

 

Red Triangle Some brands not suitable for patients with peanut allergy

BNF BNFc SPC

Voclosporin (Lupkynis®)
(7.9 mg soft capsules)

RED
Restricted Drug Restricted

RESTRICTED FOR ALL PRESCRIBING - Blueteq or High cost drug form required - see link from Formulary homepage.

For use in accordance with the following NICE TA(s) only:

BNF BNFc SPC BlueTeq
NICE TA882: Voclosporin with mycophenolate mofetil for treating lupus nephritis
Non formulary items

Prednisolone (Enteric Coated)

DNP
Non Formulary

If patient requires gastroprotection - standard prednisolone should be prescribed together with an appropriate gastro-protective agent

BNF BNFc SPC

Tacrolimus (Intravenous infusion)

 
Non Formulary
Not suitable for prescribing outside specialist hospitals. Not compatible with our IV equipment as it adsorbs onto all PVC containing equipment and we cannot monitor tacrolimus levels.
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.