Greater Glasgow and Clyde Medicines
Key to symbols The medicine should be initiated by, or on the advice of a specialist, but is suitable for continuation by a GP The medicine should only be used and prescribed by a specialist Indicates the preferred choice within a class or group of medicines
The medicine should be initiated by, or on the advice of a specialist, but is suitable for continuation by a GP
The medicine should only be used and prescribed by a specialist
Indicates the preferred choice within a class or group of medicines
5. Infections

5.3. Antiviral drugs

5.3.1. HIV infection

Where combination preparations include several medicines from the same class, they are included in that particular sub-section (e.g. protease inhibitors). Cross-class combinations can be found in sub-section 5.3.1.5.

5.3.1.1. Nucleoside reverse transcriptase inhibitors

Total Formulary
Specialist Only
ABACAVIR

Restrictions:

Restricted to use by HIV specialists.

BNF Link

Specialist Only
ABACAVIR, LAMIVUDINE

Restrictions:

Restricted to use by HIV specialists.

BNF Link

Specialist Only
EMTRICITABINE

Restrictions:

Restricted to use by HIV specialists.

BNF Link

Specialist Only
LAMIVUDINE

Restrictions:

Restricted to use by HIV specialists.

BNF Link

Specialist Only
TENOFOVIR DISOPROXIL

Restrictions:

Restricted to use by HIV specialists.

Prescribing Notes:

For treatment of hepatitis B see section 5.3.3.

BNF Link

Specialist Only
ZIDOVUDINE

Restrictions:

Restricted to use by HIV specialists.

BNF Link

Specialist Only
ZIDOVUDINE, LAMIVUDINE (COMBIVIR)

Restrictions:

Restricted to use by HIV specialists.

BNF Link

5.3.1.2. Protease inhibitors

Total Formulary
Specialist Only
ATAZANAVIR

Restrictions:

Restricted to use by HIV specialists. Use in naïve HIV-1 infected adults in combination with other antiretrovirals is further restricted to when other treatments are not tolerated or inappropriate.

BNF Link

Specialist Only
DARUNAVIR (tablets, oral suspension)

Restrictions:

Restricted to use by HIV specialists.

BNF Link

Specialist Only
LOPINAVIR, RITONAVIR (KALETRA)

Restrictions:

Restricted to use by HIV specialists.

BNF Link

Specialist Only
RITONAVIR

Restrictions:

Restricted to use by HIV specialists.

BNF Link

5.3.1.3. Non-nucleoside reverse transcriptase inhibitors

Total Formulary
Specialist Only
DORAVIRINE (tablet)

Restrictions:

Restricted to use by HIV specialists.

BNF Link

Specialist Only
EFAVIRENZ

Restrictions:

Restricted to use by HIV specialists.

BNF Link

Specialist Only
ETRAVIRINE

Restrictions:

Restricted to use by HIV specialists.

BNF Link

Specialist Only
NEVIRAPINE

Restrictions:

Restricted to use by HIV specialists.

Prescribing Notes:

Potentially fatal liver toxicity and skin reactions have been reported.

BNF Link

Specialist Only
RILPIVIRINE (tablets, long-acting injection)

Restrictions:

Restricted to HIV specialists use only as detailed in the prescribing notes below.

Prescribing Notes:

  • As combination treatment of HIV-1 infection in treatment naive adult patients
  • In combination with other antiretroviral medicinal products, for the treatment of HIV-1 infection in antiretroviral treatment naive patients aged 12 to 18 years of age and older with a viral load (VL) ≤ 100,000 HIV-1 RNA copies/ml

BNF Link

5.3.1.4. Other retrovirals

Total Formulary
Specialist Only
DOLUTEGRAVIR (TIVICAY)

Restrictions:

The use in combination with other antiretroviral medicinal products for the treatment of Human Immunodeficiency Virus (HIV) infected adults and adolescents above 12 years of age is restricted to use by HIV specialists.

BNF Link

Specialist Only
RALTEGRAVIR

Restrictions:

Restricted to use by HIV specialists in patients with triple-class resistant HIV-1 infection or in combination with other treatments in adult patients who are intolerant or resistant to non-nucleoside reverse transcriptase inhibitors (NNRTIs) or protease inhibitors (PIs) or when these options are compromised due to drug-drug interactions.

BNF Link

Specialist Only
CABOTEGRAVIR (VOCABRIA)

Restrictions:

Restricted to use by HIV specialists in accordance with local guidance.

BNF Link

5.3.1.5. Other HIV combination preparations

Combination preparations that consist of drugs from the different classes of HIV medicines are included in this sub-section.
Total Formulary
Specialist Only
ABACAVIR, DOLUTEGRAVIR, LAMIVUDINE (Triumeq)

Restrictions:

Restricted to use by HIV specialists.

BNF Link

Specialist Only
ATAZANAVIR, COBICISTAT (Evotaz)

Restrictions:

Restricted to use by HIV specialists.

BNF Link

Specialist Only
BICTEGRAVIR, EMTRICITABINE, TENOFOVIR ALAFENAMIDE (Biktarvy) (tablets)

Restrictions:

Restricted to use by HIV specialists for the treatment of adults infected with HIV-1 without present or past evidence of viral resistance to the integrase inhibitor class, emtricitabine or tenofovir.

BNF Link

Specialist Only
DARUNAVIR, COBICISTAT (Rezolsta)

Restrictions:

Restricted to use by HIV specialists

BNF Link

Specialist Only
DARUNAVIR, COBICISTAT, EMTRICITABINE, TENOFOVIR ALAFENAMIDE (Symtuza)

Restrictions:

Restricted to use by HIV specialists

BNF Link

Specialist Only
DOLUTEGRAVIR, LAMIVUDINE (Dovato)

Restrictions:

Restricted to use by HIV specialists.

BNF Link

Specialist Only
DOLUTEGRAVIR, RILPIVIRINE (Juluca) (tablets)

Restrictions:

Restricted to use by HIV specialists for treatment of adults infected with HIV-1 who are virologically-suppressed (HIV-1 RNA <50 copies/mL) on a stable antiretroviral regimen for at least 6 months with no history of virological failure and no known or suspected resistance to any non-nucleoside reverse transcriptase inhibitor (NNRTI) or integrase inhibitor.

BNF Link

Specialist Only
DORAVIRINE, LAMIVUDINE, TENOFOVIR (tablet)

Restrictions:

Restricted to use by HIV specialists.

BNF Link

Specialist Only
EFAVIRENZ, EMTRICITABINE AND TENOFOVIR (ATRIPLA)

Restrictions:

Restricted to use by HIV specialists.

BNF Link

Specialist Only
ELTEGRAVIR, COBICISTAT, EMTRICITABINE, TENOFOVIR ALAFENAMIDE (Genvoya)

Restrictions:

Restricted as outlined in the Prescribing Notes section below.

Prescribing Notes:

Treatment of adults and adolescents (aged 12 years and older with body weight at least 35kg) infected with human immunodeficiency virus-1 (HIV-1) without any known mutations associated with resistance to the integrase inhibitor class, emtricitabine or tenofovir is restricted to use by HIV specialist only.

BNF Link

Specialist Only
ELVITEGRAVIR, COBICISTAT, EMTRICITABINE, TENOFOVIR DISOPROXIL (Stribild)

Restrictions:

Restricted to use by HIV specialists.

Prescribing Notes:

Please note: Only this combination preparation containing cobicistat is included in the Formulary. Cobicistat tablets as a separate preparation (Tybost®) are not recommended for use by the Scottish Medicines Consortium and are non-Formulary.

BNF Link

Specialist Only
EMTRICITABINE, RILPIVIRINE, TENOFOVIR DISOPROXIL (Eviplera)

Restrictions:

The use for the treatment of HIV-1 infection in treatment naive adults, or treatment experienced adults without known mutations associated with resistance to the non-nucleoside reverse transcriptase inhibitor (NNRTI) class, tenofovir or emtricitabine, and with viral load ≤100,000 HIV-1 RNA copies/mL, is restricted to HIV specialists only.

BNF Link

Specialist Only
EMTRICITABINE, RILPIVIRINE, TENOFOVIR ALAFENAMIDE (Odefsey)

Restrictions:

Restricted to use by HIV specialists in line with national guidance.

BNF Link

Specialist Only
EMTRICITABINE, TENOFOVIR ALAFENAMIDE (Descovy)

Restrictions:

Use in the treatment of HIV infection is restricted to use by HIV specialists only.

Use for the pre-exposure prophylaxis (PrEP) to reduce the risk of sexually acquired HIV-1 infection in at-risk men who have sex with men, including adolescents (with body weight at least 35 kg) is restricted to specialist use for those patients who have renal or bone issues for whom other alternative PrEP options are not suitable.

Prescribing Notes:

Preferred preparation for PrEP in NHSGGC is generic Emtricitabine/tenofovir disoproxil.

BNF Link

Specialist Only
EMTRICITABINE, TENOFOVIR DISOPROXIL

Restrictions:

  • The treatment of HIV infection is restricted to use by HIV specialists.
  • Use in combination with safer sex practices for pre-exposure prophylaxis (PrEP) to reduce the risk of sexually acquired HIV-1 infection in adults at high risk is restricted to specialist use only by consultants in sexual health and infectious disease consultants.

Prescribing Notes:

Preferred preparation for PrEP in NHSGGC.

 

Non-Formulary indications:

  • Treatment of HIV-1 infected adolescents aged 12 to <18 years with nucleoside reverse transcriptase inhibitor resistance or toxicities precluding the use of first-line agents

BNF Link

5.3.2. Herpesvirus infections

5.3.2.1. Herpes simplex and varicella–zoster infection

Preferred List
ACICLOVIR

Prescribing Notes:

Aciclovir and other antiviral agents are only useful in varicella and herpes zoster if started within 48 hours of the appearance of rash, with the exception of ophthalmic shingles where the use may be justified up to 7 days after the development of rash.

BNF Link

Total Formulary
FAMCICLOVIR

Prescribing Notes:

Not approved for genital herpes.

BNF Link

VALACICLOVIR

5.3.2.2. Cytomegalovirus infection

Total Formulary
Specialist Only
CIDOFOVIR

Restrictions:

Restricted to use by HIV specialists.

BNF Link

Specialist Only
FOSCARNET

Restrictions:

Restricted to use by HIV specialists.

BNF Link

Specialist Only
GANCICLOVIR

Restrictions:

Restricted to use by HIV specialists.

BNF Link

Specialist Only
LETERMOVIR (tablets)

Restrictions:

Use for the prophylaxis of cytomegalovirus (CMV) reactivation and disease in adult CMV-seropositive recipients [R+] of an allogeneic haematopoietic stem cell transplant (HSCT) is restricted to specialist use only in accordance with national protocols.

BNF Link

Specialist Only
MARIBAVIR (LIVTENCITY) (Tablet)

Restrictions:

Restricted to specialist use for the treatment of cytomegalovirus (CMV) infection and/or disease that are refractory (with or without resistance) to one or more prior therapies, including ganciclovir, valganciclovir, cidofovir or foscarnet in adult patients who have undergone a haematopoietic stem cell transplant (HSCT) or solid organ transplant (SOT).

BNF Link

Specialist Only
VALGANCICLOVIR

Restrictions:

Use in HIV and Ophthalmology is restricted to specialist use by HIV specialists and ophthalmologists specialising in ocular issues associated with HIV infection respectively. The use of valganciclovir for the prevention of cytomegalovirus (CMV) disease for patients who have received a solid organ transplantation from a CMV postive donor is restricted to initiation by physicians experienced in the care of post-transplant patients. However, GPs are able to prescribe on the advice of a specialist for this indication in order to complete the course duration (which may vary between 100-200 days dependent on type of organ transplanted).

BNF Link

5.3.3. Viral hepatitis

Total Formulary
Specialist Only
BULEVIRTIDE (Hepcludex) (injection)

Restrictions:

Restricted to specialist use for the treatment of chronic hepatitis delta virus (HDV) infection in plasma (or serum) HDV-RNA positive patients with compensated liver disease with evidence of significant fibrosis (METAVIR stage ≧ F2) whose disease has responded inadequately to interferon-based therapy or who are ineligible to receive interferon-based therapy due to intolerance or contraindications.

BNF Link

Specialist and GP
ENTECAVIR

Restrictions:

Restricted to initiation by, or on the advice of, a specialist treating hepatitis B in accordance with local protocol. Use for the treatment of chronic hepatitis B infection in adults with decompensated liver disease is not recommended by SMC and is non-Formulary.

Prescribing Notes:

Entecavir for the treatment of hepatitis B is subject to an agreed Shared Care Protocol whcih allows the ongoing prescribing to be carried out by the patient's GP under guidance and review by the acute specialist.

To access this Shared Care Agreement, and others, click here

BNF Link

Specialist Only
GLECAPREVIR, PIBRENTASVIR

Restrictions:

The treatment of chronic hepatitis C virus (HCV) infection in adults is restricted to specialist use only in accordance with local protocol. This is a pangenotype treatment option.

BNF Link

Specialist and GP
LAMIVUDINE

Restrictions:

Restricted to initiation by, or on the advice of, a specialist treating hepatitis B in accordance with local protocol.

Prescribing Notes:

Lamivudine for the treatment of hepatitis B is subject to an agreed Shared Care Protocol whcih allows the ongoing prescribing to be carried out by the patient's GP under guidance and review by the acute specialist.

To access this Shared Care Agreement, and others, click here

BNF Link

Specialist Only
LEDIPASVIR, SOFOSBUVIR (HARVONI) (tablets)

Restrictions:

Use in the treatment of chronic hepatitis C (CHC) in adult patients is restricted to specialist use in patients with genotype 1, 3 and 4 chronic hepatitis C in accordance with local protocol and implementation plan.

Prescribing Notes:

Treatment choice will continue to be directed by national guidance.

BNF Link

Specialist Only
ELBASIVIR, GRAZOPREVIR (ZEPATIER) (tablets)

Restrictions:

Restricted to specialist use only in accordance to national guidelines for the treatment of chronic hepatitis C (CHC).

BNF Link

Specialist Only
PEGINTERFERON ALFA 2A

Restrictions:

Restricted to specialist use only. Restricted to use in adults for the treatment of hepatitis C in combination with ribavirin in accordance with Hepatits MCN protocol.

BNF Link

Specialist and GP
RIBAVARIN

Restrictions:

Restricted to specialist use only. Use subject to Hepatitis MCN protocol with pegylated interferon alfa in hepatitis C.

BNF Link

Specialist Only
SOFOSBUVIR (Sovaldi)

Restrictions:

The use in combination with other medicinal products for the treatment of chronic hepatitis C (CHC) in adults is restricted to specialist use in accordance with local protocol (under development).

Prescribing Notes:

The SMC restriction on use is as follows:

Sofosbuvir is accepted for use in patients with genotypes 1 to 6.  Use in treatment-naive patients with genotype 2 is restricted to those who are ineligible for, or are unable to tolerate, peginterferon alfa.  Use of the 24-week interferon-free regimen of sofosbuvir in combination with ribavirin in patients with genotype 3 is restricted to those who are ineligible for, or are unable to tolerate, peginterferon alfa.

BNF Link

Specialist Only
SOFOSBUVIR, VELPATASVIR (Epclusa) (tablets)

Restrictions:

Use in the treatment of chronic hepatitis C virus (HCV) infection is restricted to specialist use in accordance with local protoclol for the following patient groups:

  • Genotype 1 chronic HCV infection
  • Genotype 2 chronic HCV infection
  • Genotype 3 chronic HCV infection
  • Genotype 4 chronic HCV infection
  • Genotype 5 chronic HCV infection
  • Genotype 6 chronic HCV infection
  • Patient with decompensated cirrhosis, irrespective of genotype

BNF Link

Specialist and GP
TENOFOVIR DISOPROXIL

Restrictions:

Restricted to initiation by, or on the advice of, a specialist treating hepatitis B in accordance with local protocol.

Prescribing Notes:

Tenofovir for the treatment of hepatitis B is subject to an agreed Shared Care Protocol whcih allows the ongoing prescribing to be carried out by the patient's GP under guidance and review by the acute specialist.

To access this Shared Care Agreement, and others, click here

BNF Link

Specialist Only
SOFOSBUVIR, VELPATASVIR, VOXILAPREVIR (VOSEVI)

Restrictions:

Use in the treatment of chronic hepatitis C virus (HCV) infection is restricted to use in accordance with local protocol in patients who have failed to acheive a sustained virologic response (SVR) with a direct-acting anti-viral (DAA) or who are DAA-naive, have genotype 3 (GT3) HCV infection, with or without cirrhosis, and are suitable for treatment with an eight-week course.

BNF Link

5.3.4. Influenza

Total Formulary
OSELTAMIVIR

Restrictions:

Please refer to the UK Health and Security guideline for the treatment and prophylaxis of influenza (2021) for oseltamivir use.  

Prescribing Notes:

Please refer to the NHSGGC guideline for use in patients with renal impairment (2023) here.

BNF Link

ZANAMIVIR

Restrictions:

  • Please refer to the UK Health and Security guideline for the treatment and prophylaxis of influenza (2021) for zanamivir use.  
  • Zanamivir IV Infusion is restricted to specialist use for the treatment of complicated and potentially life-threatening influenza A or B virus infection in adult and paediatric patients (aged ≥6 months) when:
    • The patient's influenza virus is known or suspected to be resistant to anti-influenza medicinal products other than zanamivir and/or
    • other anti-viral medicinal products for treatment of influenza, including inhaled zanamivir, are not suitable for the individual patient.

Prescribing Notes:

Please refer to the NHSGGC guideline for use in patients with renal impairment (2023) here.

Please note: this is a PROTECTED ANTIVIRAL (see policy here) and relevant paperwork should be completed.

BNF Link

5.3.5. Respiratory syncytial virus

Total Formulary
Specialist and GP
PALIVIZUMAB (SYNAGIS)

Restrictions:

Restricted to specialist initiation. Restricted to use as indicated in West of Scotland protocol.

BNF Link

Specialist and GP
RIBAVIRIN

Restrictions:

Restricted to specialist initiation.

BNF Link