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
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

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

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: The combination treatment of HIV-1 infection in treatment naive adults is restricted to HIV specialists.

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

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

EMTRICITABINE/TENOFOVIR/RILPIVIRINE (EVIPLERA)

Restrictions: The use for the treatment of HIV-1 infection in treatment naive adults is restricted to HIV specialists only

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
ADEFOVIR DIPIVOXIL

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

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

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.

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.

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

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

TENOFOVIR DISOPROXIL

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

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

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