5.6 Viral infection
| First line drugs | Second line drugs | Specialist drugs | Secondary care drugs |
Traffic light status (TLS) explained:
- Green: Routine prescribing within licensed indication
- Amber 1: specialist recommendation followed by GP initiation and continuation
- Amber 2: specialist or GP initiation in line with local guideline after 1st line failure followed by GP continuation
- Amber 3: specialist initiation and stabilisation followed by GP continuation
- Amber SCG: specialist initiation and stabilisation followed by GP continuation in line with an agreed shared care guideline
- Red: Hospital or specialist prescribing only
- Double Red: These medicines have been evaluated and rejected by MKPAG and are NOT approved for use within MK. They are not recommended for use because of lack of clinical effectiveness, cost effectiveness or safety.
5.6.1 Hepatitis
5.6.2a Hepatitis B, Chronic
Nucleoside Analogues
Entecavir
- Baraclude® Tablets 500micrograms, 1mg
- Baraclude® Oral solution 50micrograms/mL
Notes:
- Entecavir should be used second-line for chronic hepatitis B in cases of treatment failure or pre-selected resistance to tenofovir.
- Use as per: NICE TA153: Entecavir for the treatment of chronic hepatitis B (August 2008)
Nucleotide Analogues
Adefovir dipivoxil
- Hepsera® Tablets 2mg
Interferons
Peginterferon Alfa
- Pegasys® Peginterferon alfa-2a Injection,
- 135 microgram pre-filled pen/syringe,
- 180 microgram pre-filled pen/syringe
- ViraferonPeg® Peginterferon alfa-2b (rbe) Injection
- 50 microgram pre-filled pen,
- 80 microgram pre-filled pen,
- 120 microgram pre-filled pen,
- 150 microgram pre-filled pen
Notes:
- Use as per NICE TA300: Peginterferon alfa and ribavirin for treating chronic hepatitis C in children and young people (November 2013)
- Use as per NICE TA200: Peginterferon alfa and ribavirin for the treatment of chronic hepatitis C (September 2010)
- Use as per NICE TA106: Peginterferon alfa and ribavirin for the treatment of mild chronic hepatitis C (Published date: August 2006. Last updated: November 2013)
- Use as per NICE TA75: Interferon alfa (pegylated and non-pegylated) and ribavirin for the treatment of chronic hepatitis C (Published date: January 2004. Last updated: November 2013)
Hepatitis C, Chronic
HCV Inhibitors
Elbasvir/grazoprevir
- Zepatier® Tablets film-coated 50mg/100mg
Note:
- MHRA Drug Safety Update (Decenber 2018)Direct-acting antiviral interferon-free regimens to treat chronic hepatitis C: risk of hepatitis B reactivation
- Use as per NICE TA413: Elbasvir–grazoprevir for treating chronic hepatitis C (October 2016)
Nucleoside Analogues
Ribavirin
- Capsules 200mg
Notes:
- Use as per NICE TA75: Interferon alfa (pegylated and non-pegylated) and ribavirin for the treatment of chronic hepatitis C (Jan 2004)
- Use as per NICE TA106: Peginterferon alfa and ribavirin for the treatment of mild chronic hepatitis C (Aug 2006)
- Use as per NICE TA200: Peginterferon alfa and ribavirin for the treatment of chronic hepatitis C (Sept 2010)
Nucleotide Analogues
Sofosbuvir
- Sovaldi® Tablets 400mg
Notes:
- MHRA Drug Safety Update (Decenber 2018)Direct-acting antiviral interferon-free regimens to treat chronic hepatitis C: risk of hepatitis B reactivation
- Sofosbuvir tablets are not funded for routine use at Milton Keynes Hospital; it is not for initiation or routine supply for patients managed at Milton Keynes Hospital
- Use as per NICE TA330: Sofosbuvir for treating chronic hepatitis C (February 2015)
5.6.3 Herpesvirus infections
Nucleoside Analogues
Aciclovir
- Tablets, Sugar Free 200mg, 400mg, 800mg
- Oral Suspension, Sugar Free 200mg/5mL, 400mg/5mL
- Intravenous infusion 250mg, 500mg, 1g vials (Hospital only)
Notes:
- Aciclovir is first line on the basis of the evidence and cost.
- In shingles, especially where there is ocular or sacral involvement, benefit is greatest in patients over 50. Treatment is only effective if started within 48 hours of rash developing.
- Primary care Health Care Professionals should refer all cases of opthalmic shingles to emergency care.
Famciclovir (Amber 2)
- Tablets 125mg, 250mg, 500mg
Valaciclovir (Amber 3)
- Tablets 500mg
Notes:
- The 250mg Tablets (Double Red) must not be prescribed by anyone as it is not cost-effective.
5.6.3 a Cytomegalovirus
Nucleoside analogues
Ganciclovir
- Injection, 500mg vial
Valganciclovir
- Tablets 450mg
- Oral solution 50mg/mL
5.6.4 HIV infection
Useful resources:
1. Antiretroviral Drug Chart (April 2018)
HIV-Fusion inhibitors
Enfuvirtide
- Injection 108mg
Note:
- 90 mg/ml powder and solvent for solution for injection
- Each vial contains 108 mg enfuvirtide.
- Each ml of reconstituted solution contains 90 mg enfuvirtide.
HIV-Integrase inhibitors (HIV-INI)
Dolutegravir
- Tivicay® Tablets 50mg
Raltegravir
- Isentress® Tablets 400mg
Non-Nucleoside Reverse Transciptase Inhibitors (NNRTI)
Efavirenz
- Tablets film-coated 600mg
- Sustiva® Capsules 50mg, 100mg, 200mg
Etravirine
- Intelence® Tablets 25mg, 100mg, 200mg
Nevirapine
- Tablets 200mg
- Viramune® Oral suspension 50mg/5mL
Rilpivirine
- Tablets 25mg
Nucleoside Reverse Transcriptase Inhibitors (NRTI)
Abacavir
- Ziagen® Tablets film-coated 300mg
- Ziagen® Oral solution sugar free, 20mg/mL
Abacavir 600mg / dolutegravir 50mg / lamivudine 300mg
- Triumeq® Tablet film-coated
Abacavir 600mg / lamivudine 300mg
- Kivexa® Tablet film-coated
Didanosine
- Videx® Tablets chewable/dispersible, 25mg
- Videx® Capsules gastroresistant, 125mg, 200mg, 250mg, 400mg
- Oral solution 10mg/mL U (Unlicensed)
Emtricitabine
- Emtriva® Capsules 200mg
- Emtriva® Oral solution sugar free, 10mg/mL
Lamivudine
- Zeffix® Tablets film-coated, 100mg
- Epivir® Tablets film-coated, 150mg, 300mg
- Epivir® Oral Solution 10mg/mL (240mL with oral syringe)
Stavudine
- Zerit® Capsules 20mg, 30mg, 40mg
- Zerit® Powder for oral solution, 1mg/mL (200mL)
Tenofovir disoproxil
- Viread® Tablets film-coated, 204mg, 245mg
- Viread® Granules 33mg/1g
Zidovudine
- Capsules 100mg, 250mg
- Retrovir® Injection, IV Concentrate for Solution for Infusion vials, 200mg/20mL
- Retrovir® Oral solution sugar free, 50mg/5mL (200mL)
Protease Inhibitors (PI)
Atazanavir
- Reyataz® Capsules 150mg, 200mg, 300mg
Atazanavir with Cobicistat
- Evotaz® Tablets, 300mg/150mg
Darunavir
- Prezista® Tablets, 400mg, 600mg, 800mg
Darunavir with Cobicistat
- Rezolsta® Tablets film-coated, 800mg/150mg
Notes:
- Drug Safety Update. Darunavir boosted with cobicistat: avoid use in pregnancy due to risk of treatment failure and maternal-to-child transmission of HIV-1 (July 2018)
Indinavir
- Crixivan® Capsules 200mg, 400mg
Lopinavir with ritonavir
- Kaletra® Tablets film-coated, 100mg/25mg, 200mg/50mg
- Kaletra® Oral solution, (80mg + 20mg) per 1mL
- Epivir® Oral Solution 10mg/mL (240mL with oral syringe)
Ritonavir
- Norvir® Tablets film-coated, 100mg
- Norvir® Oral solution sugar free, 80mg/mL
Notes:
- Drug Safety Update. Ritonavir-containing products: reports of interaction with levothyroxine leading to reduced thyroxine levels (Oct 2018)
Other anti-retrovirals
CCR5 Inhibitos
Maraviroc
- Tablets 150mg, 300mg
Single-tablet regimens
(in alphabetical order of brand name)
Tenofovir disoproxil 245mg (as fumarate) / efavirenz 600mg/emtricitabine 200mg
- Atripla® Tablet film-coated
Zidovudine 300mg / lamivudine 150mg
- Combivir® Tablet film-coated
Tenofovir alafenamide (as fumarate) /emtricitabine
- Descovy® Tablet film-coated, 10mg / 200mg
- Descovy® Tablet film-coated, 25mg / 200mg
Notes:
- To be used in line with https://www.england.nhs.uk/commissioning/wp-content/uploads/sites/12/2013/05/16043_FINAL.pdf
Tenofovir disoproxil 245mg (as fumarate) / rilpivirine 25mg / emtricitabine 200mg
- Eviplera® Tablet film-coated
Tenofovir alafenamide 10mg (as fumarate) /elvitegravir 150mg, emtricitabine 200mg / cobicistat 150mg
- Genvoya® Tablet film-coated
Abacavir 600mg / lamivudine 300mg
- Kivexa® Tablet film-coated
Tenofovir alafenamide 25mg (as fumarate) / rilpivirine 25mg/emtricitabine 200mg
- Odefsey® Tablet film-coated
Tenofovir disoproxil (as fumarate) 245mg/ elvitegravir 150mg / emtricitabine 200mg/ cobicistat 150mg
- Stribild® Tablet film-coated, 150mg/150mg/200mg/245mg
Tenofovir alafenamide 10mg (as fumarate) /emtricitabine 200mg / cobicistat 150mg / Darunavir (as ethanolate) 800mg
- Symtuza® Tablet film-coated
Abacavir 600mg / dolutegravir 50mg / lamivudine 300mg
- Triumeq® Tablet film-coated
Tenofovir disoproxil 245mg (as fumarate) /emtricitabine 200mg
- Truvada® Tablet film-coated
5.6.5 Influenza
Useful source of information
PHE guidance on use of antiviral agents for the treatment and prophylaxis of seasonal influenza (January 2019)
Neurominidase inhibitors
Oseltamivir
- Capsules 30mg, 45mg, 75mg
- Oral Suspension Sugar Free 30mg/5mL
Zanamivir
- Dry powder for inhalation 5mg/blister
Traffic light status (TLS) explained:
- Green: Routine prescribing within licensed indication
- Amber 1: specialist recommendation followed by GP initiation and continuation
- Amber 2: specialist or GP initiation in line with local guideline after 1st line failure followed by GP continuation
- Amber 3: specialist initiation and stabilisation followed by GP continuation
- Amber SCG: specialist initiation and stabilisation followed by GP continuation in line with an agreed shared care guideline
- Red: Hospital or specialist prescribing only
- Double Red: These medicines have been evaluated and rejected by MKPAG and are NOT approved for use within MK. They are not recommended for use because of lack of clinical effectiveness, cost effectiveness or safety.
Return to Chapter: 5. Infections
Last updated by: Dupe Fagbenro on 12-03-2019 16:36
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BNF
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NICE
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Summary of product characteristics
