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.

COVID-19 Treatments
RED Paxlovid COVID-19 in patients who do not require oxygen supplementation and are at an increased risk of severe COVID-
19 infection
RED Molnupiravir mild to moderate Covid-19 [with at least one risk factor of developing severe illness]
RED Remdesivir 100mg vial: for patients hospitalised due to Covid-19 (adults and adolescents 12 years and older)
RED Baricitinib: a treatment option for adults and children aged over 2 years hospitalised with Covid-19

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

Integrase Strand Transfer Inhibitors (INSTI)

RED Cabotegravir with rilpivirine (Vocabria® with Rekambys®) NHS England Commissioned)

NICE TA757 Cabotegravir with rilpivirine is recommended, within its marketing authorisation, as an option for treating HIV‑1

infection in adults:

> with virological suppression (HIV-1 RNA fewer than 50copies/ml) on a stable antiretroviral regimen and

> without any evidence of viral resistance to, and no previous virological failure with, any non-nucleoside reverse

transcriptase inhibitors or integrase inhibitors.

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

5.3.2.1 Herpes simplex and varicella-zoster infection

GREEN Aciclovir

tablets 200mg, 400mg, 800mg

suspension 200mg/5mL

injection 250mg/10mL, 500mg/20mL, 1000mg/40mL

GREEN Valaciclovir tablets 500mg - 2nd line option, on advice of microbiology, when aciclovir is not tolerated or ineffective.

AMBER Famciclovir (second line use only)

tablets 125mg, 250mg, 750mg

5.3.2.2 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

RED Maribavir (Livtencity)

NICE TA860 Recommended, within its marketing authorisation, as an option for treating cytomegalovirus infection that is refractory to treatment including

cidofovir, foscarnet, ganciclovir or valganciclovir in adults who have had a haematopoietic stem cell transplant or solid organ transplant. It is recommended only

if the company provides it according to the commercial arrangement. NHS England Commissioned

Remdesivir for patients hospitalised due to Covid-19 (adults and adolescents 12 years and older)

RED Remdesivir 100mg powder for concentration for solution for infusion [Veklury]

Paxlovid for patients who do not require oxygen supplementation and are at an increased risk of severe COVID-19 infection

RED Paxlovid 150mg, 300mg tablets

Molnupiravir mild to moderate Covid-19 [with at least one risk factor of developing severe illness]

RED Molnupiravir 200mg capsules [Lagevrio}

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)

5.3.3.2 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

circumstances:

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