MHRA/CHM advice: Multiple sclerosis therapies: signal of rebound effect after stopping or switching therapy (April 2017)
MHRA/CHM advice: Fingolimod—not recommended for patients at known risk of cardiovascular events. Advice for extended monitoring for those with significant bradycardia or heart block after the first dose and following treatment interruption (January 2013)
MHRA/CHM advice: Fingolimod: new contra-indications in relation to cardiac risk (December 2017)
MHRA/CHM advice: Fingolimod: updated advice about risk of cancers and serious infections (December 2017)
Medicines that can only be prescribed within Secondary Care.
Examples of medicines which fall into this category are:
Certain new medicines and new indications for older medicines where there is at present
no experience of use in Primary Care.
Medicines or dressings not available or prescribable in Primary Care.
Where a medicine has been classified as Amber E, but an approved shared-care guideline is not yet available
Medicines which can be prescribed within Secondary Care, but are only suitable for prescribing in Primary Care after specialist referral. There is no need for approved shared care guidelines for medicines in this category. This replaces Amber 2 on the North Staffs Formulary.
Medicines which can be prescribed within Secondary Care, but are only considered suitable for prescribing in Primary Care under an approved shared-care agreement (ESCA) or Rationale for Initiation, Continuation and Discontinuation (RICaD). This replaces Amber 1 on the North Staffs Formulary
Medicines which can be prescribed in either Primary or Secondary Care.
These medicines have been reviewed by the New Medicines Committee and the Area Prescribing Committee and found not to be suitable for inclusion in the Joint Formulary.
Inadequate or weak evidence for efficacy
No clearly defined local need
Lack of long term safety data
No perceived benefit over established formulary alternatives
Prescribers can consider these medicines where formulary alternatives are unsuitable, ineffective or