NHS Greater Glasgow & Clyde Area Drug and Therapeutics Committee
Greater Glasgow and Clyde Prescribing
  • Key to symbols

9 Nutrition and blood

9.1 Anaemias and some other blood disorders

9.1.1 Iron-deficiency anaemias

9.1.1.1 Oral iron

Preferred list
SODIUM FEREDETATE (LIQUID)

Prescribing Notes:

Liquid preparation previously known as sodium ironedetate.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/4871.htm

Total Formulary

9.1.1.2 Parenteral iron

Total Formulary
FERRIC CARBOXYMALTOSE (FERINJECT) (INJECTION)

Restrictions: The treatment of iron deficiency anaemia (diagnosis based on laboratory tests) when oral iron preparations are ineffective or cannot be used is restricted to specialist use when standard IV iron is inappropriate due to its administration schedule.

Prescribing Notes:

These preparations are considerably more expensive than many other IV iron preparations. Use in patients on haemodialysis or use as a bolus injection was not recommended by SMC and remains non-Formulary.

For the relevant SMC advice click here

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/PHP5859-ferinject.htm?q=ferinject&t=search&ss=text&p=1#PHP5859-ferinject

IRON DEXTRAN

Restrictions: Restricted to specialist initiation.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/75058.htm

IRON III HYDROXIDE SUCROSE COMPLEX

Restrictions: Restricted to specialist initiation.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/129557.htm

IRON III ISOMALTOSIDE 1000 (MONOFER) (INJECTION)

Restrictions: The treatment of iron deficiency anaemia (diagnosis based on laboratory tests) when oral iron preparations are ineffective or cannot be used is restricted to specialist use when standard IV iron is inappropriate due to its administration schedule.

Prescribing Notes:

These preparations are considerably more expensive than many other IV iron preparations. Use in patients on haemodialysis or use as a bolus injection was not recommended by SMC and remains non-Formulary.

For the relevant SMC advice click here

IRON III ISOMALTOSIDE 1000 (DIAFER) (injection)

Restrictions: Treatment of iron deficiency in adults with chronic kidney disease (CKD) on dialysis, when oral iron preparations are ineffective or cannot be used is restricted to specialist use only in adults with chronic kidney disease on dialysis.

9.1.2 Drugs used in megaloblastic anaemias

Preferred list
FOLIC ACID

Prescribing Notes:

Used for folate deficiency and prophylaxis for the prevention of neural tube defects in pregnancy. To prevent first occurrence of neural tube defects, women planning a pregnancy should take folic acid 400 micrograms daily before conception and during the first 12 weeks of pregnancy. Women, who suspect they are pregnant but have not been taking folic acid, should start at once and continue until the 12th week of pregnancy. Women with a previous pregnancy affected by a neural tube defect should take folic acid 5mg daily. Women taking antiepileptic drugs may also be advised to take higher doses of folic acid.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/4906.htm

HYDROXOCOBALAMIN (INTRAMUSCULAR INJECTION)

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/4902.htm

Total Formulary
CYANOCOBALAMIN (tablets)

Restrictions:

Prescribing is restricted to a 4 week trial to establish the underlying cause of deficiency.

Prescribing Notes:

The Guideline for Treatment of Vitamin B12 Deficiency can be found here.

Cyanocobalamin tablets should not be continued long-term for vitamin B12 replacement.

9.1.3 Drugs used in hypoplastic, haemolytic, and renal anaemias

Total Formulary
METHOXY POLYETHYLENE GLYCOLEPOETIN BETA

Restrictions: Restricted to specialist initiation. Approved in NHSGGC only for anaemia associated with renal failure.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/200087.htm

DESFERRIOXAMINE

Restrictions: Restricted to specialist use only.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/4922.htm

DARBEPOETIN ALFA

Restrictions: Restricted to specialist initiation. Approved in NHSGGC only for anaemia associated with renal failure. This is the preferred Formulary agent for this indication.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/106107.htm

DEFERASIROX (tablets)

Restrictions:

Restricted to specialist use only in accordance with the Prescribing Notes below.

Prescribing Notes:

Formulary indications:

  • Treatment of chronic iron overload associated with the treatment of rare acquired or inherited anaemias requiring recurrent blood transfusions when deferoxamine therapy is contraindicated or inadequate
  • Treatment of myeloplastic syndrome (MDS) in patients with an International Prognostic Scoring System (IPSS) score of low or intermediate -1 risk when deferoxamine therapy is contraindicated or inadequate in accordance with regional protocol (in development)

It is not recommended by SMC for:

  • Treatment of patients with chronic iron overload requiring chelation therapy when deferoxamine therapy is contraindicated or inadequate in patients with non-transfusion-dependent thalassaemia syndromes and is non-Formulary for these indications.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/129928.htm

EPOETIN ALFA

Restrictions: Restricted to specialist initiation. Approved in NHSGGC only for anaemia associated with renal failure.

Prescribing Notes:

Prescribe by brand name.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/4917.htm

EPOETIN BETA

Restrictions: Restricted to specialist initiation. Approved in NHSGGC only for anaemia associated with renal failure.

Prescribing Notes:

Prescribe by brand name.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/4919.htm

9.1.4 Drugs used in platelet disorders

Total Formulary
ANAGRELIDE

Restrictions: Restricted to specialist use only for the reduction of elevated platelet counts in at-risk patients with essential thrombocythaemia who are intolerant of their current therapy or whose elevated platelet counts are not reduced to an acceptable level by their current therapy.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/129351.htm

ELTROMBOPAG (Revolade) (tablets)

Restrictions: Restricted to use as detailed in Prescribing Notes section below.

Prescribing Notes:

Formulary indications:

  • Adult chronic immune (idiopathic) thrombocytopenic purpura (ITP) is restricted to specialist use in accordance with local protocol. 
  • Treatment of thrombocytopenia in adults with chronic hepatitis C is restricted to specialist use.

Non-formulary indications:

  • Treatment in adult patients with acquired severe aplastic anaemia (SAA) who were either refractory to prior immunosuppressive therapy or heavily pretreated and are unsuitable for haematopoietic stem cell transplantation.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/206563.htm

ROMIPLOSTIM

Restrictions: Restricted to specialist use only. Restricted to use in patients with severe symptomatic immune (idiopathic) thrombocytopenia purpura (ITP) or patients with a high risk of bleeding.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/204141.htm

9.1.5 G6PD deficiency

9.1.6 Drugs used in neutropenia

Total Formulary
FILGRASTIM

Restrictions: Restricted to specialist use only. Restricted to prescribing in accordance with local protocol.

Prescribing Notes:

The BNF recommends that it is good practice to prescribe biosimilar preparations by brand name.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/4927.htm

LENOGRASTIM

Restrictions: Restricted to specialist use only. Restricted to prescribing in accordance with local protocol.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/23073.htm

LIPEGFILGRASTIM (Lonquex) (injection)

Restrictions: Restricted to specialist use in accordance with regional protocol

PEGFILGRASTIM

Restrictions: Restricted to specialist use only. Restricted to specialist use in accor-dance with local protocol in patients who would otherwise receive 5 days or more filgrastim or lenograstim.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/127939.htm

9.1.7 Drugs used to mobilise stem cells

Total Formulary
PLERIXAFOR (INJECTION)

Restrictions: Restricted to specialist use only and in accordance to regional protocol.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/203910.htm