8.2.2. Corticosteroids and other immunosuppressants
Restrictions:
Restricted to specialist use only. Restricted to specialist use in selected patients who are at high risk of renal transplant rejection or for kidneys expected to have significant ischaemic damage.
Restrictions:
Restricted to specialist use in the treatment of patients aged 12 years and older with chronic graft-versus-host disease (chronic GvHD) who have received at least two prior lines of systemic therapy. It is available via the ultra-orphan pathway with reassessment by SMC following 3 years of data collection. Appropriate paperwork needs completing before prescribing to ensure registration on the national risk sharing scheme.
Prescribing Notes:
Formulations should not be substituted in individual patients due to varying bioavailability. Prescribe by brand name.
Restrictions:
Excludes 25mg tablets
Prescribing Notes:
Please note that dispersible prednisolone tablets are significantly more expensive than standard oral tablets or the oral solution [December 2024]
Restrictions:
Restricted to specialist initiation for the treatment of facial angiofibroma associated with tuberous sclerosis complex in adults and paediatric patients aged 6 years and older.
Prescribing Notes:
Licensed treatment for this condition. Apply a stop-and-start rule: discontinue sirolimus gel after 12 weeks if no effect is observed.
Restrictions:
Restricted to specialist use in renal transplant for patients with intolerance to calcineurin inhibitors.
Prescribing Notes:
Non-formulary indication:
Treatment of sporadic lymphangioleiomyomatosis with moderate lung disease or declining lung function is not recommended by SMC and remains non-formulary.
Restrictions:
Restricted to specialist initiation. Restricted to patients who are unable to swallow capsules or small changes in dosing increments.
Prescribing Notes:
Tacrolimus preparations should be prescribed and dispensed by brand name to minimise the risk of inadvertent switching between products, which has been associated with previous reports of toxicity and graft rejection.
Restrictions:
Restricted to specialist initiation.
Prescribing Notes:
Please prescribe the preferred brand used in the relevant specialist service. The preferred brand for use in patients who have undergone a liver or renal transplant is current Adoport.
Tacrolimus preparations should be prescribed and dispensed by brand name to minimise the risk of inadvertent switching between products, which has been associated with previous reports of toxicity and graft rejection.
Restrictions:
Restricted to specialist use in combination with mycophenolate mofetil for the treatment of adult patients with active class III, IV or V (including mixed class III/V and IV/V) lupus nephritis.