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5.3 Antiviral drugs


The most recent Guidelines for Primary and Secondary Care can be found below: 

Antimicrobial Guidelines in Primary Care

Antimicrobial Guidelines for Secondary Care

For further guidance refer to local Consultant Microbiologists or contact your pharmacist.

5.3.1 HIV Infection

Please refer to Lancashire Formulary for AntiRetroviral Therapy (ART) - click here
Nucleoside reverse transcriptase inhibitors
RED          Abacavir tablets 300mg                                                                                                                  (NHS England Commissioned)  
RED          Abacavir with Lamivudine tablets 300mg, 600mg ( Kivexa®)                                                          (NHS England Commissioned)
RED           Zidovudine 300mg, lamivudine 150mg (Combivir®)                                                                         (NHS England Commissioned) 
RED           Didanosine  tablets 25mg,  capsules e/c 250mg, 400mg                                                        (NHS England Commissioned)   
RED           Lamivudine tablets 100mg,150mg                                                                                              (NHS England Commissioned)  
RED           Tenofovir tablets 245mg                                                                                                               (NHS England Commissioned)   
RED           Tenovir 245mg, emtricitabine 200mg tablets (Truvada®)                                                               (NHS England Commissioned)
RED           Zidovudine  capsules 100mg, 250mg/  syrup 50mg/5mL                                                        (NHS England Commissioned)   
Protease inhibitors
RED           Atazanavir capsules 150mg, 200mg, 300mg  [Second line use only]                                       (NHS England Commissioned)
RED           Darunavir tablets 75mg, 150mg, 400mg, 600mg                                                                     (NHS England Commissioned) 
                  oral suspension 100mg/mL  [Second line use only]
RED           Fosamprenavir tablets 700mg                                                                                                     (NHS England Commissioned) 
RED           Glecaprevir with pibrentasvir   NICE TA499                                                                               (NHS England Commissioned)
RED           Indinavir capsules 200mg                                                                                                            (NHS England Commissioned) 
RED           Kaletra® tablets (lopinavir 200mg, ritonavir 50mg)                                                                 (NHS England Commissioned)   
RED           Nelfinavir tablets 250mg                                                                                                              (NHS England Commissioned)   
RED           Ritonavir capsules 100mg                                                                                                            (NHS England Commissioned)  
RED           Saquinavir capsules 200mg                                                                                                         (NHS England Commissioned)   
RED           Elbasvir-grazoprevir tablets 50mg, 100mg   NICE TA 413                                                        (NHS England Commissioned)
Non-nucleoside reverse transcriptase inhibitors
RED           Efavirenz, tablets 600mg, capsules 200mg                                                                                         (NHS England Commissioned)   
RED           Etravirine tablets 100mg, 200mg  [Third line use only]                                                            (NHS England Commissioned)   
RED           Nevirapine tablets 200mg                                                                                                           (NHS England Commissioned) 
Other antiretrovirals
RED           Raltegravir tablets 400mg                                                                                                           (NHS England Commissioned)   
RED           Maraviroc tablets 150mg, 300mg (Celsentri®)                                                                                  (NHS England Commissioned)

5.3.2 Herpesvirus infections Herpes simplex and varicella-zoster infection
GREEN      Aciclovir
                   tablets 200mg, 400mg, 800mg
                   suspension 200mg/5mL
                   injection 250mg/10mL, 500mg/20mL, 1000mg/40mL
AMBER     Famciclovir (second line use only)
                   tablets 125mg, 250mg, 750mg Cytomegalovirus infection
Valganciclovir is used in the treatment of reactivated CMV in immunosuppressed patients treated with MabCampath® as per
protocols at Manchester Royal Infirmary.
RED           Ganciclovir injection 500mg vial                                                                                                  (NHS England Commissioned)
RED           Valganciclovir tablets 450mg                                                                                                       (NHS England Commissioned) 
RED           Foscarnet Sodium (Foscavir®)   
                  (cytomegalovirus retinitis in AIDS patients)                                                                                   (NHS England Commissioned)  
RED            Cidofovir capsules 250mg (Vistide®)    
                  (cytomegalovirus retinitis in AIDS patients)                                                                                   (NHS England Commissioned) 

RED              Letermovir tablets 240mg (Prevymis ▼)
NICE TA591  recommended as an option for preventing cytomegalovirus reactivation and disease after an allogeneic 
                     haematopoietic stem cell transplant in adults who are seropositive for CMV.                NHS England Commissioned

5.3.3    Viral Hepatitis

As per NICE guidance – see BNF.
RED         Adefovir dipivoxil tablets 10mg (Herpsera®)          (NHS England Commissioned)   
Entecavir - within its marketing authorisation, is recommended as an option for the treatment of people with chronic HBeAg-
positive or HBeAg-negative hepatitis B in whom antiviral treatment is indicated. This guidance does not apply to people with 
chronic hepatitis B who also have hepatitis C, hepatitis D or HIV. 
RED          Entecavir tablets 500microgram, 1mg /  oral solution 50microgram/ml                               (NHS England Commissioned) 
RED          Tenofovir tablets 245mg 
NICE TAG252 and NICE TAG253 approve the use of Telaprevir and Boceprevir for the treatment of Hepatitis C,  genotype 1 
RED         Telaprevir (Invico®) tablets                                                                                                            (NHS England Commissioned)   
RED         Boceprevir (Victrelis®) tablets                                                                                                       (NHS England Commissioned)      
NICE TAG300 recommends the use of Peginterferon alfa in combination with ribavirin as an option to treat chronic hepatitis C in 
children and young people.
RED          Peginterferon alfa and ribavirin in combination                                                                       (NHS England Commissioned)  Chronic Hepatitis C       

NHS England have issued a policy statement for treatment of chronic Hepatitis C in patients with cirrhosis which sets out
treatments that will be routinely commissioned.  The statement is available here.
The statement supports the use of Viekirax and Exviera and this is acknowledged.
Sofosbuvir -is recommended as an option for treating chronic hepatitis C in adults, as specified in  NICE TA330 
RED          Sofosbuvir (Sovaldi®) tablets                                                                                                        (NHS England Commissioned) 
Sofosbuvir-velpatasvir - is recommended as an option for treating chronic hepatitis C in adults, as specified in attached table, only 
if the company provides the drug with the discount agreed in the simple discount agreement. NICE TA430 
RED          Sofosbuvir-velpatasvir (Epclusa)                                                                                                   (NHS England Commissioned)  
RED          Sofosbuvir-velpatasvir-voxilaprevir is recommended as an option for treating chronic hepatitis C in adults, only if it is 
                 used as specified in the attached table, and the company provides the drug at the same price or lower than that agreed  
                 with the Commercial Medicines Unit as per NICE TA507                                                           (NHS England Commissioned)  
Simeprevir - in combination with peginterferon alfa nd ribavirin is recommended as a possible treatment for adults with genotype
1 or 4 chronic hepatitis C - NICE TA331 
RED          Simeprevir (Olysio®) capsules                                                                                                        (NHS England Commissioned)    
RED          Ledispar-sofosbuvir (Harvoni®)   tablets 90mg, 400mg                                                             (NHS England Commissioned)   
Daclatasvir - is recommended as a possible treatment for adults with some types (called genotypes) of chronic hepatitis C , 
depending on their level of fibrosis. NICE TA364 
RED        Daclatasvir (Daklinza®tablets 30mg, 60mg                                                                                (NHS England Commissioned)
Ombitasvir- paritaprevir-ritonavir with or without dasabuvir is recommended, within its marketing authorisation, as an option for
treating genotype 1 or 4 chronic hepatitis in adults - NICE TA365 
RED          Ombitasvir–paritaprevir–ritonavir (Viekirax®) tablets 12.5mg, 75mg, 50mg                        (NHS England Commissioned)  

RED          Ribavirin tablets 200mg                                                                                                                (NHS England Commissioned)   

5.3.4     Influenza

Oseltamavir and zanamivir are to be used in line with NICE guidance and local emergency planning agreements.  
Endorse prescription SLS.
GREEN     Oseltamivir, capsules 75mg, suspension 60mg/5mL
GREEN     Zanamivir inhaler 5mg blisters x 4

5.3.5     Respiratory syncytial virus

Palivizumab is to be used in line with National Joint Committee of Vaccination and Immunisation guidance in the following
1. Children under the age of 2 years with chronic lung disease who
           >     have recieved oxygen for >28 days after birth;
           >     are receiving home oxygen therapy
2. Infants less than 6 months of age who have left to right shunt haemodynamically significant congenital heart disease and /or
    pulmonary hypertension.  
Supply of palivizumab should always be from pharmacy to individual patients; it should never be issued as stock.  This allows
recharging of the costs of palivizumab to the CCGs under ‘payment by results’ by allowing the tracing of all supplies.
RED          Palivizumab injection 50mg, 100mg                                                                                                    (NHS England Commissioned)  


All material in this section is aimed at health care professionals, but is information currently held in the public domain, members of the
 public seeking advice on medicine-related matters are advised to speak with their GP, pharmacist, nurse or contact NHS111 Service
  Email: info.elmmb@nhs.net
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