Renal

Renal Specialist formulary list

**Other indications for particular drugs may be included on completion of further specialist lists**

For information on use of unlicensed medicines or medicines used 'off-label' - click here

The following medicines are approved for prescribing by or on the recommendation of a prescribing renal specialist:

MEDICINE	SUMMARY OF RESTRICTED INDICATION	CATEGORY	PROTOCOL
Tinzaparin	Anticoagulation during haemodialysis.
Danaparoid	Anticoagulation during haemodialysis in patients who develop heparin-induced thrombocytopenia (HIT).
Argatroban	Anticoagulation during haemodialysis in adult patients with heparin-induced thrombocytopenia (HIT) type II who require parenteral antithrombotic therapy. For use in renal failure only. Second line after danaparoid (persistent HIT or adverse reaction with danaparoid).
Cyclophosphamide injection	Rapidly progressive glomerulonephritis (RPGN), severe systemic vasculitis, (including ANCA associated vasculitis (active granulomatosis with polyangiitis (Wegener’s) (GPA) and microscopic polyangiitis (MPA)), management of nephrotic syndrome.		Cyclophosphamide protocol (NHS Tayside Staffnet intranet link only)
Cyclophosphamide tablets	Rapidly progressive glomerulonephritis (RPGN), severe systemic vasculitis, (including ANCA associated vasculitis (active granulomatosis with polyangiitis (Wegener’s) (GPA) and microscopic polyangiitis (MPA)), management of nephrotic syndrome.		Cyclophosphamide protocol (NHS Tayside Staffnet intranet link only)
Mycophenolate mofetil	Immunosuppression in kidney transplant*		See EdRen renal transplant handbook (Edinburgh Royal Infirmary Renal Unit) See Tayside Prescriber DTC Supplement No 115 – Mycophenolate Mofetil generic switch See Tayside Prescriber No 117 - Tacrolimus and Ciclosporin
Tacrolimus (Prograf^®/ Advagraf^®)	Immunosuppression in kidney transplant*
Azathioprine	Immunosuppression in kidney transplant*
Ciclosporin (Neoral^®/ Sandimmun^®)	Immunosuppression in kidney transplant*
Sirolimus	Immunosuppression in kidney transplant*
Rituximab (MabThera^®) concentrate for intravenous infusion	In combination with glucocorticoids for induction of remission in severe, active granulomatosis with polyangiitis (Wegener’s) (GPA) and microscopic polyangiitis (MPA) in patients who have relapsed following cyclophosphamide or who are intolerant to or unable to receive cyclophosphamide.
Iron sucrose (Venofer^®)	Renal anaemia. First choice parenteral iron preparation.		Anaemia guidelines in Chronic Kidney Disease under review
Ferric carboxymaltose (Ferinject^®)	Renal anaemia. Restricted to pre-dialysis patients.
Darbepoetin alfa (Aranesp^®)	Renal anaemia. First choice erythropoiesis stimulating agent.
Epoetin beta (NeoRecormon^®)	Renal anaemia
Methoxy polyethylene glycol-epoetin beta (Micera^®)	Renal anaemia
Sodium bicarbonate 500mg capsules	Chronic acidotic states		Electrolyte replacement guidelines (NHS Tayside Staffnet intranet link only)
Potassium citrate mixture BP (approx. 1mmol/mL of citrate)	Reduction of renal stone formation including patients with hypocitraturia and renal tubular acidosis (unlicensed use ‘off-label’)
Potassium citrate 1080mg tablets (10mmol of citrate) (unlicensed) (imported via Mawdsleys or IDIS)	Reduction of renal stone formation including patients with hypocitraturia and renal tubular acidosis if potassium citrate mixture not tolerated.
Calcium acetate (Phosex^®)	Hyperphosphataemia. First choice phosphate-binding agent		Guidelines for the Management of Bone Metabolism and Disease in Chronic Kidney Disease (NHS Tayside Staffnet intranet link only) Renal bone disease guidance due for review
Calcium acetate (PhosLo^®)	Hyperphosphataemia
Calcium carbonate (Calcichew^®)	Hyperphosphataemia
Sevelamer carbonate (Renvela^®)	First-choice non-calcium based phosphate-binding agent for hyperphosphataemia in patients on haemodialysis or peritoneal dialysis and patients with CKD not on dialysis with serum phosphate concentration of 1.78mmol/L or more.
Sevelamer hydrochloride (Renagel^®)	Hyperphosphataemia in patients on haemodialysis or peritoneal dialysis.
Lanthanum (Fosrenol^®)	Hyperphosphataemia in CKD (dependant upon serum calcium and PTH levels). Used in patients intolerant to sevelamer.
Cinacalcet	Severe refractory secondary hyperparathyroidism in patients with ESRD in whom parathyroidectomy is contraindicated		Guidelines for the Management of Bone Metabolism and Disease in Chronic Kidney Disease (NHS Tayside Staffnet intranet link only) Renal bone disease guidance due for review Cinacalcet request form (NHS Tayside Staffnet intranet link only)
Magnesium glycerophosphate 1g tablets (unlicensed) (made by UCLH, ordered from IDIS)	Hypomagnesaemia		Electrolyte replacement guidelines (NHS Tayside Staffnet intranet link only)
Alfacalcidol	Vitamin D deficiency and/or secondary hyperparathyroidism		Guidelines for the Management of Bone Metabolism and Disease in Chronic Kidney Disease (NHS Tayside Staffnet intranet link only) Renal bone disease guidance due for review
Valganciclovir (Valcyte^®)	Given for 200 days post-transplant for prevention of CMV disease in all transplant recipients except CMV-negative recipients of CMV-negative donors*		See EdRen renal transplant handbook (Edinburgh Royal Infirmary Renal Unit)
Hepatitis B vaccine ((HBvaxPRO^®)	Immunisation against hepatitis B infection in patients with CKD including those on haemodialysis		Immunisation against infectious disease – ‘The Green Book’ Renal Hepatitis B vaccination guidance under development

*= initiated by a tertiary transplant centre

Refer to the NHS Tayside Liverpool Care Pathway (LCP) for the Dying Patient for information on care of patients in the last hours or days of life (NHS Tayside Staffnet intranet link only). See appendix in this document for medication guidance for patients with an eGFR <30mL/min.

Traffic light status information
	To be prescribed by Hospital Specialists Only.
	Can be prescribed in General Practice under the direction of a Specialist.

Click here for a link to the NHS Tayside Adult Empirical Treatment of Infection Guidelines for Renal Patients (NHS Tayside Staffnet intranet link only).