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 Formulary Chapter 5: Infections - Full Chapter
Notes:
The development of this chapter for the George Eliot Formulary is in progress
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05.03.01  Expand sub section  HIV infection
 note 

Treatment aims to prevent the mortality and morbidity associated with chronic HIV infection whilst minimising drug toxicity. Although it should be started before the immune system is irreversibly damaged, the need for early drug treatment should be balanced against the risk of toxicity. Commitment to treatment and strict adherence over many years are required; the regimen chosen should take into account convenience and patient tolerance. Treatment also reduces the risk of HIV transmission to sexual partners, but the risk is not eliminated completely.

The optimum time for initiating antiretroviral treatment depends primarily on the CD4 cell count. The timing and choice of treatment should also take account of clinical symptoms, comorbidities and the possible effect of antiretroviral drugs on factors such as the risk of CV events. Treatment includes a combination of drugs known at 'highly active antretroviral therapy'.

05.03.01  Expand sub section  Nucleoside reverse transcriptase inhibitors
05.03.01  Expand sub section  Protease inhibitors
05.03.01  Expand sub section  Non-nucleoside reverse transcriptase inhibitors
05.03.01  Expand sub section  Other antiretrovirals to top
DolutegravirBlack Triangle (Tivicay®)
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Formulary

Dolutegravir is a HIV-integrase inhibitor

  • Available as tablets
  • Hypersensitivity reactions (including severe rash, or rash accompanied by fever, malaise, arthralgia, myalgia, blistering, oral lesions, conjunctivitis, angiodema, eosinophilia or raised LFTs) reported uncommonly. Discontinue immediately if any sign or symptoms of hypersensitivity reactions develop.
  • If a dose is more than 20 hours late on the once daily regimen or more than 8 hours late on the twice daily regimen, the missed dose should not be taken and the next dose should be taken at the normal time.
 
Link  MHRA/CHM advice: Dolutegravir (Tivicay, Triumeq, Juluca): signal of increased risk of neural tube defects; do not prescribe to women seeking to become pregnant; exclude pregnancy before initiation and advise use of effective contraception
   
Maraviroc
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Formulary

Maraviroc is an antagonist of the CCR5 chemokine receptor.

  • Available as tablets
 
   
Raltegravir (Isentress ®)
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Formulary

Raltegravir is a HIV-integrase inhibitor

  • Available as tablets
  • Rash occurs commonly, discontinue if severe rash accompanied by fever, malaise, arthralgia, myalgia, blistering, mouth ulceration, conjunctivitis, angiodema, hepatitis or eosinophilia.
 
   
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Key
note Notes
Section Title Section Title (top level)
Section Title Section Title (sub level)
First Choice Item First Choice item
Non Formulary Item Non Formulary section
Restricted Drug
Restricted Drug
Unlicensed Drug
Unlicensed
Track Changes
Display tracking information
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Link to adult BNF
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Link to children's BNF
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Link to SPCs
SMC
Scottish Medicines Consortium
Cytotoxic Drug
Cytotoxic Drug
CD
Controlled Drug
High Cost Medicine
High Cost Medicine
Cancer Drugs Fund
Cancer Drugs Fund
NHSE
NHS England
Homecare
Homecare
CCG
CCG

Traffic Light Status Information

Status Description

Red SO

SPECIALIST ONLY - These drugs are deemed to be not appropriate for prescribing by GPs. Specialists should not ask GPs to prescribe these drugs.   

Green SI

SPECIALIST INITIATED - These drugs must be initiated, i.e. the first dose prescribed, by the specialist and then may be continued when appropriate by the patients GP following communication from the specialist.   

Green SA

SPECIALIST ADVISED – Specialists may simply advise a patients GP to initiate these drugs themselves after they have made an initial assessment.   

Amber SC

SHARED CARE - Responsibility for prescribing may be transferred from secondary to primary care with the agreement of an individual GP and when agreed shared care arrangements have been established. The specialist MUST stabilize the patient before asking for care to be transferred. Only specialists should initiate these drugs. Prescribing should be transferred to GPs according to an Shared Care Agreement [SCA]   

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