NHS Greater Glasgow & Clyde Area Drug and Therapeutics Committee
Greater Glasgow and Clyde Prescribing
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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
EMTRICITABINE

Restrictions: Restricted to use by HIV specialists.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/128251.htm

LAMIVUDINE

Restrictions: Restricted to use by HIV specialists.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/57101.htm

STAVUDINE

Restrictions: Restricted to use by HIV specialists.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/57102.htm

TENOFOVIR DISOPROXIL

Restrictions: Restricted to use by HIV specialists.

Prescribing Notes:

For treatment of hepatitis B see section 5.3.3.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/106524.htm

TENOFOVIR AND EMTRICITABINE (TRUVADA)

Restrictions: Restricted to use by HIV specialists.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/129299.htm#_129299

ZIDOVUDINE

Restrictions: Restricted to use by HIV specialists.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/4002.htm

ZIDOVUDINE AND LAMIVUDINE (COMBIVIR)

Restrictions: Restricted to use by HIV specialists.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/69459.htm#_69459

ABACAVIR

Restrictions: Restricted to use by HIV specialists.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/81977.htm

ABACAVIR LAMIVUDINE ZIDOVUDINE (TRIZIVIR)

Restrictions: Restricted to use by HIV specialists.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/81977.htm

ABACAVIR LAMIVUDINE (KIVEXA)

Restrictions: Restricted to use by HIV specialists.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/129292.htm#_129292

DIDANOSINE

Restrictions: Restricted to use by HIV specialists.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/21584.htm

5.3.1.2 Protease inhibitors

Total Formulary
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: http://www.medicinescomplete.com/mc/bnf/current/128409.htm

DARUNAVIR (tablets, oral suspension)

Restrictions: Restricted to use by HIV specialists.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/130109.htm

FOSAMPRENAVIR

Restrictions: Restricted to use by HIV specialists.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/128976.htm

INDINAVIR

Restrictions: Restricted to use by HIV specialists.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/57103.htm

NELFINAVIR

Restrictions: Restricted to use by HIV specialists.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/69466.htm

RITONAVIR

Restrictions: Restricted to use by HIV specialists.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/57104.htm

LOPINAVIR AND RITONAVIR (KALETRA)

Restrictions: Restricted to use by HIV specialists.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/106116.htm

SAQUINAVIR

Restrictions: Restricted to use by HIV specialists.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/57106.htm

TIPRANAVIR

Restrictions: Restricted to use by HIV specialists.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/129518.htm

5.3.1.3 Non-nucleoside reverse transcriptase inhibitors

Total Formulary
EFAVIRENZ

Restrictions: Restricted to use by HIV specialists.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/78513.htm

ETRAVIRINE

Restrictions: Restricted to use by HIV specialists.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/201547.htm

NEVIRAPINE

Restrictions: Restricted to use by HIV specialists.

Prescribing Notes:

Potentially fatal liver toxicity and skin reactions have been reported.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/69473.htm

RILPIVIRINE (EDURANT)

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

5.3.1.4 Other retrovirals

Total Formulary
ENFUVIRTIDE

Restrictions: Restricted to use by HIV specialists.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/128190.htm

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: http://www.medicinescomplete.com/mc/bnf/current/200998.htm

DOLUTEGRAVIR (tablets)

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.

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
EFAVIRENZ, EMTRICITABINE AND TENOFOVIR (ATRIPLA)

Restrictions: Restricted to use by HIV specialists.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/200890.htm#_200890

ATAZANAVIR - COBICISTAT (EVOTAZ) (tablets)

Restrictions: Restricted to use by HIV specialists.

DARUNAVIR AND COBICISTAT (REZOLSTA) (tablets)

Restrictions: Restricted to use by HIV specialists

DOLUTEGRAVIR, ABACAVIR, LAMIVUDINE (TRIUMEQ) (tablets)

Restrictions: Restricted to use by HIV specialists.

BNF Link: https://www.medicinescomplete.com/mc/bnf/current/PHP34903-triumeq.htm?q=triumeq&t=search&ss=text&p=1#PHP34903-triumeq

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: http://www.medicinescomplete.com/mc/bnf/current/PHP33725-stribild.htm#PHP33725-stribild

ELVITEGRAVIR, COBICISTAT, EMTRICITABINE, TENOFOVIR (GENVOYA) (tablets)

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.

EMTRICITABINE AND TENOFOVIR ALAFENAMIDE (Descovy)

Restrictions: Restricted to use by HIV specialists only.

EMTRICITABINE, TENOFOVIR, RILPIVIRINE (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.

RILPIVIRINE, EMTRICITABINE, TENOFOVIR ALAFE (ODEFSEY) (tablets)

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

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: http://www.medicinescomplete.com/mc/bnf/current/3994.htm

Total Formulary
FAMCICLOVIR

Prescribing Notes:

Not approved for genital herpes.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/14826.htm

VALACICLOVIR

Restrictions: Not approved for prevention of recurrent herpes.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/33566.htm

5.3.2.2 Cytomegalovirus infection

Total Formulary
CIDOFOVIR

Restrictions: Restricted to use by HIV specialists.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/64326.htm

FOSCARNET

Restrictions: Restricted to use by HIV specialists.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/4007.htm

GANCICLOVIR

Restrictions: Restricted to use by HIV specialists.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/4005.htm

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: http://www.medicinescomplete.com/mc/bnf/current/106526.htm

5.3.3 Viral hepatitis

Total Formulary
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 Protocol, and others, click here

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/106524.htm

SIMEPREVIR

Restrictions: Restricted to specialist use in accordance with local protocols.

BNF Link: https://www.medicinescomplete.com/mc/bnf/current/PHP34762-simeprevir.htm?q=simeprevir&t=search&ss=text&p=1#_hit

ADEFOVIR DIPIVOXIL

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

Prescribing Notes:

Adefovir 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: http://www.medicinescomplete.com/mc/bnf/current/127968.htm

BOCEPREVIR (VICTRELIS)

Restrictions: Restricted to use by consultants for the treatment of chronic hepatitis C (HCV) genotype 1 infection in combination with peginterferon alfa and ribavirin in adult patients (both treatment naive and treatment experienced) in accordance with local protocol

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/217023.htm

DACLATASVIR (DAKLINZA) (tablets)

Restrictions: restricted to specialist use in accordance with local guidelines, in patients with significant fibrosis (Metavir scores F3-F4) or compensated cirrhosis.

BNF Link: https://www.medicinescomplete.com/mc/bnf/current/PHP34951-daclatasvir.htm?q=DACLatasvir&t=search&ss=text&p=1#_hit

DASABUVIR (EXVIERA)

Restrictions: In combination with Viekirax® (ombitasvir/paritaprevir/ritonavir), with or without ribavarin, for the treatment of genotype 1 chronic hepatitis C (CHC) in adults.

ELBASIVIR AND GRAZOPREVIR (ZEPATIER) (tablets)

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

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 Protocol, and others, click here

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/129890.htm

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 Protocol, and others, click here

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/57101.htm

LEDIPASVIR AND 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.

OMBITASVIR/ PARITAPREVIR/ RITONAVIR (VIEKIRAX)

Restrictions: For formulary indications and restrictions please see below.

Prescribing Notes:

  • For the treatment of adults with genotype 1 chronic hepatitis C (CHC) in combination with dasabuvir (Exviera®), with or without ribabvirin, is restricted to specialist use in accordance with local protocol.
  • For use in combination with ribavarin for the treatment of genotype 4 CHC in adults.

RIBAVARIN

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

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/4010.htm

SOFOSBUVIR (tablets)

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: http://www.medicinescomplete.com/mc/bnf/current/PHP34491-sofosbuvir.htm

SOFOSBUVIR AND VELPATASVIR (Epclusa) (tablets)

Restrictions: Restricted to specialist use in patients with genotype 3 chronic HCV infection.

TELAPREVIR (INCIVO)

Restrictions: The treatment of genotype 1 chronic hepatitis C in combination with peginterferon alfa and ribavirin in adult patients (both treatment naive and treatment experienced) is restricted to consultant use only in accordance with local protocol.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/217728.htm

5.3.4 Influenza

Total Formulary
OSELTAMIVIR

Restrictions: Oseltamivir use in the prophylaxis of influenza is subject to NICE TA158 and the treatment of influenza is subject to NICE TA168.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/119743.htm

ZANAMIVIR

Restrictions: Zanamivir use in the prophylaxis of influenza is subject to NICE TA158 and the treatment of influenza is subject to NICE TA168.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/82108.htm

5.3.5 Respiratory syncytial virus

Total Formulary
PALIVIZUMAB

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

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/82140.htm

RIBAVIRIN

Restrictions: Restricted to specialist initiation.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/4010.htm