RiluzoleShared Care Guideline • October 16th, 2018
This shared care agreement outlines suggested ways in which the responsibilities for managing the prescribing of riluzole for patients with the amyotrophic lateral sclerosis form of motor neurone disease (MND) can be shared between the specialist (Consultant neurologist), the patient and you as the patient’s general practitioner (GP).
Shared Care GuidelineShared Care Guideline • April 5th, 2021
Ciclosporin for Rheumatology and Dermatology use (Adults) (Unlicensed use) Introduction This shared care agreement outlines the responsibilities between the specialist and the generalist for managing the prescribing of ciclosporin for unlicensed use in the indications listed below. Indication This is guidance for the unlicensed use of ciclosporin in the following conditions:• Rheumatic and connective tissue disease• Severe psoriasis in patients in whom conventional therapy is inappropriate or ineffective.• Other cutaneous disease Indications not covered by this shared care guideline:• Prevention of graft rejection (see separate shared care guideline from tertiary centre).• Endogenous uveitis• Nephrotic syndrome Dosage and administration For ALL indications patients should remain on the brand initiated and prescribing should be brand specific. Rheumatic and connective tissue disease Initiated at 1-2mg/kg day orally in two divided doses for six weeks (as per the Yorkshire DMARD gui
Shared Care GuidelineShared Care Guideline • April 5th, 2021
Leflunomide (Adults) Introduction This shared care agreement outlines the responsibilities between the specialist and the generalist for managing the prescribing of leflunomide for indications listed below. Indication Treatment of active rheumatoid arthritis and active psoriatic arthritis. Licensing information Treatment of active rheumatoid arthritis and active psoriatic arthritis Dosage and administration 10mg or 20mg tablets once daily. Contraindications and cautions • Severe immunodeficiency states• Patients with significantly impaired bone marrow function or significant anaemia, leucopenia, neutropenia or thrombocytopenia due to causes other than rheumatoid or psoriatic arthritis.• Patients with serious infections.• Patients with moderate to severe renal insufficiency, because insufficient clinical experience is available in this patient group.• Patients with impairment of liver function.• Patients with severe hypoproteinaemia, e.g. in nephrotic syndrome.• Pregnant women or wom
Shared Care GuidelineShared Care Guideline • April 5th, 2021
Amiodarone (adults) Introduction This shared care agreement outlines the responsibilities between the specialist and the generalist for managing the prescribing of amiodarone for indications listed below. Indication Oral amiodarone is indicated only for the treatment of severe rhythm disorders not responding to other therapies or when other treatment cannot be used. Tachyarrhythmias associated with Wolff-Parkinson-White syndrome. Atrial flutter and fibrillation when other drugs cannot be used.All types of tachyarrhythmias of paroxysmal nature including: supraventricular, nodal and ventricular tachycardias, ventricular fibrillation; when other drugs cannot be used. Dosage and administration Initially, 200mg THREE times a day for 1 week, then reduced to 200mg TWICE daily for 1 week, and then reduced to 200my daily (or the minimum dose to control the arrhythmia). Rarely, the patient may require a higher maintenance dose. The scored 100mg tablet should be used to titrate the minimum dos
Shared Care GuidelineShared Care Guideline • July 31st, 2020
Azithromycin long term use in asthma Introduction This shared care agreement outlines the responsibilities between the specialist and the generalist for managing the prescribing of azithromycin for indications listed above. Indication This is an ‘off-label’ use for azithromycin. Dosage and administration Azithromycin 500 mg three times a week. A starting dose of azithromycin 250mg three times a week can be used to minimise side effect risk with titration to clinical response. (usually Mon Wed Fri) Contraindications and cautions • LFTs > 2x upper limit of normal• Atypical mycobacterial infection (treat active infection before starting)• Allergy to azithromycin or erythromycin or any macrolide• Use with caution in patients on digoxin and avoid co prescribing with drugs known to prolong QT interval on ECG• Only to be used in pregnancy if the benefit outweighs the risk• Not to be used whilst breastfeeding• Macrolide monotherapy should be avoided if on an Non-tuberculous mycobacterial
Shared care guideline for sulfasalazine in adultsShared Care Guideline • March 31st, 2017
General Principles This agreement outlines suggested ways in which the responsibilities for managing the prescribing of the drug treatment and clinical indication listed in the table below can be shared between the Specialist and General Practitioner (GP). The Specialist(s) is responsible for initiating treatment, prescribing the drug and monitoring of therapy until such a time as when the patient is deemed to be stable. If GPs are not confident to undertake these roles, then they are under no obligation to do so. In such an event, the total clinical responsibility for the patient for the diagnosed condition remains with the Specialist.If a Specialist asks the GP to prescribe this drug, the GP should reply to this request as soon as practicable.Sharing of care assumes communication between the Specialist, the GP and the patient. The intention to undertake shared care should be explained to the patient by the doctor initiating treatment. It is important that patients are consulted about
Shared Care GuidelineShared Care Guideline • April 5th, 2021
Oral Methotrexate (Adults) Introduction This shared care agreement outlines the responsibilities between the specialist and the generalist for managing the prescribing of methotrexate for indications listed below. Indication Methotrexate is well established, effective treatment for several different conditions including rheumatic disease (rheumatoid arthritis and psoriatic arthritis), connective tissue diseases (eg systemic lupus erythematosus (SLE), vasculitis), psoriasis, psoriatic arthritis, and several other types of skin problems (eg pemphigoid, pemphigus, sarcoidosis, scleroderma and eczema). Licensing information Varies for different manufacturers- includes severe, uncontrolled psoriasis, rheumatoid arthritis, psoriatic arthritis. Formulations Oral yellow tablets; 2.5mg and 10mg strengths. It is requested, for patient safety, that only 2.5mg tablets are prescribed. Dosage and administration For all indications doses may vary from 2.5mg to 30mg ONCE WEEKLY (same day each week a
Shared care guideline for Leflunomide for active rheumatoid arthritis and psoriatic arthritis in adultsShared Care Guideline • March 31st, 2017
General principles This agreement outlines suggested ways in which the responsibilities for managing the prescribing of the drug treatment and clinical indication listed in the table below can be shared between the Specialist and General Practitioner (GP). The Specialist(s) is responsible for initiating treatment, prescribing the drug and monitoring of therapy until such a time as when the patient is deemed to be stable. If GPs are not confident to undertake these roles, then they are under no obligation to do so. In such an event, the total clinical responsibility for the patient for the diagnosed condition remains with the Specialist.If a Specialist asks the GP to prescribe this drug, the GP should reply to this request as soon as practicable.Sharing of care assumes communication between the specialist, the GP and the patient. The intention to undertake shared care should be explained to the patient by the doctor initiating treatment. It is important that patients are consulted about
Shared Care GuidelineShared Care Guideline • April 5th, 2021
Azathioprine (Adults) Introduction This shared care agreement outlines the responsibilities between the specialist and the generalist for managing the prescribing of Azathioprine for indications listed below. Indication Disease modifying drug for rheumatoid arthritis, connective tissue disease, vasculitis, Crohn’s disease and ulcerative colitis, autoimmune conditions. Licensing information Licensed indications: Severe rheumatoid arthritis; systemic lupus erythematosus; dermatomyositis and polymyositis; autoimmune chronic active hepatitis; pemphigus vulgaris; auto-immune haemolytic anaemia; chronic refractory idiopathic thrombocytopenic purpura (ITP). Unlicensed indications: Atopic dermatitis; psoriasis; bullous pemphigoid; chronic actinic dermatitis; pyoderma gangrenosum; Granulomatous Polyangiitis (GPA); cutaneous vasculitis and vasculitides e.g. polyarteritisand giant cell arteritis; Crohn’s disease; ulcerative colitis; sarcoidosis; Diffuse Parenchymal Lung Disease (DPLD). Dosage
Shared Care GuidelineShared Care Guideline • April 5th, 2021
Mycophenolate mofetil (Adults) for the treatment of autoimmune disease Introduction This shared care agreement outlines the responsibilities between the specialist and the generalist for managing the prescribing of Mycophenolate for indications listed below. Indication This is a guideline for unlicensed use of mycopheolate mofetil in the treatment of certain autoimmune diseases: • Rheumatology (connective tissue disease and vasculitis)• Dermatology (SLE, dermatomyositisis and polymyositisis, severe psoriasis, severe atopic dermatitis, blistering conditions such as pyoderma ganrenosum and autoimmune bullour dermatoses such as pemphigus)• Gastroenterology (ulcerative colitis)• Ophthalmology services (uveitis, scleritis, ocular sarcoidosis). Licensing information Prophylaxis of acute transplant rejection in patients receiving allogeneic renal, cardiac or hepatic transplants. Note: this licensed indication is not covered by this shared care Guideline. Dosage and administration Starting
Shared Care GuidelineShared Care Guideline • February 18th, 2019
This shared care agreement outlines suggested ways in which the responsibilities for managing the prescribing of methotrexate oral and subcutaneous injection, azathioprine, sulphasalazine, leflunomide and hydroxychloroquine can be shared between East Kent Hospitals Rheumatology Consultants, Connect Health Specialist Rheumatology Nurses i.e the specialist and the general practitioner (GP).
ContractShared Care Guideline • October 18th, 2020
Methotrexate for Rheumatoid Arthritis, Psoriasis, Psoriatic Arthritis and Crohn’s Disease Shared Care Guideline: Prescribing Agreement
Shared Care GuidelineShared Care Guideline • July 31st, 2020
Azithromycin long term use in chronic obstructivepulmonary disease (COPD) Introduction This shared care agreement outlines the responsibilities between the specialist and the generalist for managing the prescribing of azithromycin for indications listed above. Indication This is an ‘off-label’ use for azithromycin. Dosage and administration Azithromycin 500 mg three times a week. A starting dose of azithromycin 250mg three times a week can be used to minimise side effect risk with titration to clinical response. (usually Mon, Wed, Fri) Contraindications and cautions • LFTs > 2x upper limit of normal• Atypical mycobacterial infection (treat active infection before starting)• Allergy to azithromycin or erythromycin or any macrolide• Use with caution in patients on digoxin and avoid co prescribing with drugs known to prolong QT interval on ECG• Only to be used in pregnancy if the benefit outweighs the risk• Not to be used whilst breastfeeding• Macrolide monotherapy should be avoided
Shared Care GuidelineShared Care Guideline • April 5th, 2021
Sulfasalazine (Adults) Introduction This shared care agreement outlines the responsibilities between the specialist and the generalist for managing the prescribing of sulfasalazine for indications listed below. Indication Rheumatoid arthritis, Crohn’s disease and ulcerative colitis. Unlicensed indications: Psoriatic arthritis, undifferentiated arthritis, spondyloarthropathies. Dosage and administration Rheumatoid arthritis:500mg daily for 1 week then 500mg twice daily for 1 week then 1g am, 500mg pm for 1 week then 1g twice daily (if gastric intolerance consider 500mg four times a day). If indicated the dose may be increased to 1.5g twice a day (max 40mg/kg/day). Gastroenterology indications: 1g-2g four times a day until remission occurs reducing to a maintenance dose of 500mg four times a day. Contraindications and cautions • Contra-indicated in hypersensitivity to sulfasalazine, its excipients, sulphonamides or salicylates (slow acetylator status).• Contra-indicated in patients
Shared Care Guideline Version 1Shared Care Guideline • June 20th, 2021
Metyrapone Medical Management of Cushing’s Disease (CD) Introduction This shared care agreement outlines the responsibilities between the specialist and the generalist for managing the prescribing of Metyrapone for indications listed below. Indication Endocrine Society guidance recommends Metyrapone as the first line treatment option for the medical management of Cushing’s Syndrome and usual practice is to stabilize patients on this steroidogenesis inhibitor pre-operatively. It is recommended also as second-line treatment after Trans- Sphenoidal Surgery in patients with CD, either with or without Radiotherapy/radiosurgery; as primary treatment of Ectopic ACTH Secretion (EAS) in patients with occult or metastatic EAS; and as adjunctive treatment to reduce cortisol levels in adrenocortical carcinoma (ACC). It is also recommended as the de facto glucocorticoid antagonist of choice in patients who are not surgical candidates (eg TSS or Bilateral Adrenalectomy) or who have persistent dise
Shared Care GuidelineShared Care Guideline • June 6th, 2021
Hydroxychloroquine (Adults) Introduction This shared care agreement outlines the responsibilities between the specialist and the generalist for managing the prescribing of hydroxychloroquine for indications listed below. Indication Rheumatoid arthritis and inflammatory osteoarthritis, discoid and systemic lupus erythematosus, and dermatological conditions caused or aggravated by sunlight. Licensing information Treatment of rheumatoid arthritis, discoid and systemic lupus erythematosus, and dermatological conditions caused or aggravated by sunlight. Dosage and administration Usually started at a dose of 200mg twice daily for the first three months and then reduced to 200mg daily as a maintenance dose if effective (aim for 3- 5mg/kg/day using ideal bodyweight ideally not exceeding 6.5mg/kg). Contraindications and cautions Contraindications• Known hypersensitivity to 4-aminoquinoline compounds e.g. chloroquine.• Pre-existing maculopathy of the eye.• Patients with rare hereditary problem
Shared Care GuidelineShared Care Guideline • May 28th, 2013
Denosumab Treatment of osteoporosis in post menopausal women Introduction This shared care agreement outlines the responsibilities between the specialist and the generalist for managing the prescribing of denosumab for indications listed below. Indication NICE guidance recommends denosumab as a treatment option for the primary prevention of osteoporotic fragility fractures only in postmenopausal women at increased risk of fractures:• who are unable to comply with the special instructions for administering alendronate and either risedronate or etidronate, or have an intolerance of, or a contraindication to, those treatments and• who have a combination of T-score, age and number of independent clinical risk factors for fracture as indicated in the following table. Denosumab is recommended as a treatment option for the secondary prevention of osteoporotic fragility fractures only in postmenopausal women at increased risk of fractures who are unable to comply with the special instruction
ContractShared Care Guideline • October 4th, 2016
Shared Care Guideline: Prescribing Agreement Methylphenidate, Lisdexamfetamine▼, Dexamfetamine and Atomoxetine for
Shared Care GuidelineShared Care Guideline • March 28th, 2021
Patiromer use in Adults Introduction This shared care agreement outlines the responsibilities between the specialist and the generalist for managing the prescribing of patiromer. Indication Hyperkalaemia in patients with heart failure or stage 3b to 5 chronic renal failure if they have1. Patients with persistent hyperkalaemia with a confirmed serum potassium level of at least 6.0 mmol/L, and2. Are not taking, or are taking a reduced dosage of, a renin- angiotensin-aldosterone system (RAAS) inhibitor because of hyperkalaemia, and3. Are not on dialysis Use in line with NICE TA623 – patiromer for treating hyperkalaemia (February 202) https://www.nice.org.uk/guidance/ta623 Dosage and administration Initially 8.4g OD; adjusted in steps of 8.4g as required, dose adjustments should be made at intervals of at least one week; maximum 25.2g per day. Formulations: 8.4g and 16.8g sachets Contraindications and cautions Contra-indications: Hypersensitivity to the active substance or to any excip
ContractShared Care Guideline • October 16th, 2020
Shared Care Guideline: Prescribing Agreement Melatonin (Circadin®) for persistent sleep disorders in school age children with neurodevelopmental disabilities
Shared Care GuidelineShared Care Guideline • January 17th, 2022
Mycophenolate mofetil (Adults) for the treatment of autoimmune disease Introduction This shared care agreement outlines the responsibilities between the specialist and the generalist for managing the prescribing of Mycophenolate for indications listed below. Indication This is a guideline for unlicensed use of mycopheolate mofetil in the treatment of certain autoimmune diseases: • Rheumatology (connective tissue disease and vasculitis)• Dermatology (SLE, dermatomyositisis and polymyositisis, severe psoriasis, severe atopic dermatitis, blistering conditions such as pyoderma ganrenosum and autoimmune bullour dermatoses such as pemphigus)• Gastroenterology (ulcerative colitis)• Ophthalmology services (uveitis, scleritis, ocular sarcoidosis).• Hepatology (autoimmune hepatitis) Licensing information Prophylaxis of acute transplant rejection in patients receiving allogeneic renal, cardiac or hepatic transplants. Note: this licensed indication is not covered by this shared care Guideline.
Shared care guideline for methotrexate in rheumatoid arthritis and severe psoriasis in adultsShared Care Guideline • January 30th, 2017
General Principles This agreement outlines suggested ways in which the responsibilities for managing the prescribing of the drug treatment and clinical indication listed in the table below can be shared between the Specialist and General Practitioner (GP). The Specialist(s) is responsible for initiating treatment, prescribing the drug and monitoring of therapy until such a time as when the patient is deemed to be stable. If GPs are not confident to undertake these roles, then they are under no obligation to do so. In such an event, the total clinical responsibility for the patient for the diagnosed condition remains with the Specialist.If a Specialist asks the GP to prescribe this drug, the GP should reply to this request as soon as practicable.Sharing of care assumes communication between the Specialist, the GP and the patient. The intention to undertake shared care should be explained to the patient by the doctor initiating treatment. It is important that patients are consulted about
SHARED CARE GUIDELINEShared Care Guideline • November 18th, 2020
For the treatment of insufficiently controlled type 1 diabetes mellitus as an adjunct to insulin in adults with BMI ≥ 27 kg/m2, when insulin alone does not
