TAM (Treatments and Medicines) NHS HighlandImportant: Therapy notes
MHRA advice: CDK4/6 inhibitors (abemaciclib, palbociclib, ribociclib): reports of interstitial lung disease and pneumonitis, including severe cases (June 2021) (www.gov.uk).
SACT (Systemic anticancer therapy) (Formulary)
What's new / Latest updates
25/04/24 - Olaparib tablets 100mg. 150mg SMC2617 indication added.
25/04/24 - Daratumumab concentrate for solution for infusion 10mg/ml - additional indication added: in place of SMC advice 2302: In combination with bortezomib, lenalidomide and dexamethasone (Dara-VRD), for the treatment of adult patients with newly diagnosed multiple myeloma who are eligible for autologous stem cell transplant.
25/04/24 - Talazoparib capsules 0.25mg, 1mg SMC2607 added.
25/04/24 - Loncastuximab powder for concentrate for solution for infusion 10mg SMC2609 added.
25/04/24 - Ivosidenib tablets 250mg SMC2615 added.
30/04/24 - Bevacizumab corrected SMC indication from 878/13 to 806/12.
Important: Therapy notes
Important: Formulation and dosage details
Formulation:
Tabets 100mg (hospital use only)
Dosage:
See SMC advice 2346, 2347 and 2348.
Notes:
Homecare is the preferred option - contact nhsh.homecare@nhs.scot
Important: Therapy notes
Important: Formulation and dosage details
Formulation:
Tablets 20mg, 30mg, 40mg, 50mg (hospital use only)
Dosage:
See SMC advice 920/13.
Important: Therapy notes
MHRA advice: Systemically administered VEGF pathway inhibitors: risk of aneurysm and artery dissection (July 2020) (www.gov.uk).
Important: Formulation and dosage details
Formulation:
Concentrate for solution for infusion 25mg/mL (hospital use only)
Dosage:
See SMC advice 878/13.
Important: Therapy notes
Important: Formulation and dosage details
Formulation:
Capsules 150mg (hospital use only)
Dosage:
See SMC advice 2012.
Important: Therapy notes
Important: Formulation and dosage details
Formulation:
Injection 50mg/mL unlicensed (hospital use only)
Important: Therapy notes
Important: Formulation and dosage details
Formulation:
Concentrate for solution for infusion 1mg/ml (hospital use only)
Dosage:
See SMC advice 2181.
Important: Therapy notes
Important: Formulation and dosage details
Formulation:
Tablets film-coated 20mg, 40mg (hospital use only)
Dosage:
See SMC advice 2482.
Important: Therapy notes
MHRA advice: Systemically administered VEGF pathway inhibitors: risk of aneurysm and artery dissection (July 2020) (www.gov.uk).
Important: Therapy notes
Important: Formulation and dosage details
Formulation:
Film-coated tablets 40mg (hospital use only)
Dosage:
See SMC advice 2587.
Important: Therapy notes
Also for selected patients with indolent (FCC, MCL, MZL, SLL, LPC) non-Hodgkin’s lymphoma.
MHRA advice: Bendamustine (Levact): increased risk of non-melanoma skin cancer and progressive multifocal encephalopathy (PML) (March 2021) (www.gov.uk).
MHRA advice: Bendamustine (Levact): increased mortality observed in recent clinical studies in off-label use; monitor for opportunistic infections, hepatitis B reactivation (July 2017) (www.gov.uk).
Important: Formulation and dosage details
Formulation:
Powder for concentrate for solution for infusion 25mg, 100mg (hospital use only)
Dosage:
See SMC advice 694/11.
Important: Therapy notes
- MHRA advice: Systemically administered VEGF pathway inhibitors: risk of aneurysm and artery dissection (July 2020) (www.gov.uk).
- MHRA advice: Bevacizumab and sunitinib: risk of osteonecrosis of the jaw (December 2014) (www.gov.uk).
- MHRA advice: Bevacizumab (Avastin): hypersensitivity and infusion reactions (December 2014) (www.gov.uk).
Important: Formulation and dosage details
Formulation:
Powder for solution for injection 15,000 units (hospital use only) unlicensed
Important: Therapy notes
Important: Formulation and dosage details
Formulation:
Tablets 100mg, 500mg (hospital use only)
Dosage:
See SMC advice 910/13.
Important: Therapy notes
Important: Therapy notes
Important: Formulation and dosage details
Formulation:
Tablets 2mg (hospital use only)
Important: Therapy notes
MHRA advice: Cabazitaxel (Jevetana): risk of medication error resulting in overdose (December 2014) (www.gov.uk).
Important: Formulation and dosage details
Formulation:
Concentrate for solution for infusion 40mg/mL (hospital use only)
Dosage:
See SMC advice 735/11.
Important: Therapy notes
MHRA advice: Systemically administered VEGF pathway inhibitors: risk of aneurysm and artery dissection (July 2020) (www.gov.uk).
Important: Formulation and dosage details
Formulation:
Tablets 15mg (hospital use only)
Important: Therapy notes
MHRA advice: 5-fluorouracil (intravenous), capecitabine, tegafur: DPD testing recommended before initiation to identify patients at increased risk of severe and fatal toxicity (October 2020) (www.gov.uk).
Important: Therapy notes
Important: Formulation and dosage details
Formulation:
Powder and solvent for solution for injection 10mg (hospital use only)
Dosage:
See SMC advice 2266.
Important: Therapy notes
Important: Formulation and dosage details
Formulation:
Concentrate for solution for infusion 10mg/mL (hospital use only)
Dosage:
See NICE guidance CG121.
Important: Therapy notes
MHRA advice: Carfilzomib (Kyprolis): risk of reactivation of hepatitis B virus (November 2019) (www.gov.uk).
MHRA advice: Carfilzomib (Kyprolis): reminder of risk of potentially fatal cardiac events (August 2019) (www.gov.uk).
Important: Therapy notes
Important: Formulation and dosage details
Formulation:
Capsules 150mg (hospital use only)
Dosage:
See SMC advice 1097/15.
Important: Therapy notes
Important: Formulation and dosage details
Formulation:
Tablets 2mg (hospital use only)
Important: Therapy notes
Important: Formulation and dosage details
Formulation:
Concentrate for solution for infusion 1mg/mL (hospital use only)
Dosage:
See NICE guidance NG122.
Important: Therapy notes
MHRA advice: Cladribine (Mavenclad): new advice to minimise risk of serious liver injury (March 2022) (www.gov.uk).
Risk minimisation materials
Important: Formulation and dosage details
Formulation:
Solution for subcutaneous injection 2mg/mL (hospital use only)
Dosage:
See SMC advice 537/09.
Important: Therapy notes
Crisantaspase is the enzyme asparaginase produced by Erwinia chrysanthemi.
Important: Formulation and dosage details
Formulation:
Powder for solution for injection 10,000 units (hospital use only)
Important: Therapy notes
MHRA advice: Cirzotinib (Xalkori): risk of cardiac failure (November 2015) (www.gov.uk).
Risk minimisation materials
Important: Therapy notes
Important: Formulation and dosage details
Formulation:
Tablets 50mg (hospital use only)
Important: Formulation and dosage details
Formulation:
Powder for solution for injection 1 gram (hospital use only)
Important: Therapy notes
MHRA advice: Liposomal and lipid-complex formulations: name change to reduce medication errors (July 2020) (www.gov.uk).
Important: Formulation and dosage details
Formulation:
Intrathecal injection 20mg/mL (hospital use only)
Important: Formulation and dosage details
Formulation:
Injection 100mg/mL (hospital use only)
Important: Therapy notes
Important: Formulation and dosage details
Formulation:
Injection 200mg, 500mg (hospital use only)
Important: Therapy notes
Important: Formulation and dosage details
Formulation:
Tablets 15mg, 30mg and 45mg (hospital use only)
Dosage:
45mg once daily until disease progression or toxicity.
See SMC advice 2184.
Important: Formulation and dosage details
Formulation:
Powder for solution for injection 500 micrograms (hospital use only)
Important: Therapy notes
MHRA advice: Daratumumab (Darzalex): risk of reactivation of hepatitis B virus (August 2019) (www.gov.uk).
Risk minimisation materials
Important: Formulation and dosage details
Formulation:
Concentrate for solution for infusion 20mg/mL (hospital use only)
Dosage:
See SMC advice 1205/17 and 2302.
In place of SMC advice 2302: In combination with bortezomib, lenalidomide and dexamethasone (Dara-VRD), for the treatment of adult patients with newly diagnosed multiple myeloma who are eligible for autologous stem cell transplant.
Important: Formulation and dosage details
Formulation:
Solution for injection 120mg/mL (15mL) (hospital use only)
Dosage:
See SMC advice 2447.
Important: Formulation and dosage details
Formulation:
Solution for injection 1800mg/15ml (hospital use only)
Dosage:
See SMC advice 2536.
Important: Formulation and dosage details
Formulation:
Concentrate for solution for infusion 100mg/5ml and 400mg/20ml (hospital use only)
Dosage:
See SMC advice 2536.
Important: Therapy notes
Important: Formulation and dosage details
Formulation:
Tablets 20mg, 50mg, 80mg, 100mg, 140mg (hospital use only)
Dosage:
See SMC advice 370/07.
Important: Therapy notes
MHRA advice: Liposomal and lipid-complex formulations: name change to reduce medication errors (July 2020) (www.gov.uk).
Important: Formulation and dosage details
Formulation:
Powder for solution for infusion 20mg (hospital use only)
Important: Formulation and dosage details
Formulation:
Injection 50mg/mL (hospital use only)
Important: Therapy notes
MHRA advice: Liposomal and lipid-complex formulations: name change to reduce medication errors. (July 2020) (www.gov.uk).
Important: Formulation and dosage details
Formulation:
Solution for injection 2mg/mL (hospital use only)
Important: Therapy notes
Important: Formulation and dosage details
Formulation:
Solution for infusion 2mg/mL (hospital use only)
Important: Therapy notes
Important: Formulation and dosage details
Formulation:
Solution for injection 0·44mg/mL (hospital use only)
Dosage:
See SMC advice 1065/15.
Important: Therapy notes
Important: Formulation and dosage details
Formulation:
Tablets 100mg, 150mg (hospital use only)
Dosage:
See SMC advice 220/05.
Important: Therapy notes
Important: Formulation and dosage details
Formulation:
Capsules 100mg (hospital use only)
Dosage:
See SMC advice 2462.
Important: Therapy notes
Important: Formulation and dosage details
Formulation:
Tablets 10mg (hospital use only)
Dosage:
Important: Therapy notes
MHRA advice: 5-fluorouracil (intravenous), capecitabine, tegafur: DPD testing recommended before initiation to identify patients at increased risk of severe and fatal toxicity (October 2020) (www.gov.uk).
Important: Formulation and dosage details
Formulation:
Solution for infusion 25mg/mL, 50mg/mL (hospital use only)
Important: Formulation and dosage details
Formulation:
Cream 5% (Efudix)
Important: Therapy notes
Important: Formulation and dosage details
Formulation:
Tablets, film coated 100mg, 150mg (hospital use only)
Dosage:
As per SMC advice 2300.
Important: Therapy notes
Important: Formulation and dosage details
Formulation:
Solution for injection 250mg (specialist recommendation or initiation only)
Dosage:
For use as monotherapy see SMC advice 114/04.
For use with palbociclib (SMC advice 2149) see fulvestrant shared care protocol.
Important: Formulation and dosage details
Formulation:
Powder for concentrate for solution for infusion 5mg (hospital use only)
Dosage:
See SMC advice 2089.
Important: Therapy notes
Important: Formulation and dosage details
Formulation:
Tablets film-coated 40mg (hospital use only)
Dosage:
See SMC advice 2252.
Important: Therapy notes
Important: Formulation and dosage details
Formulation:
Capsules 500mg (hospital use only)
Important: Formulation and dosage details
Formulation:
Oral solution 100mg/mL (hospital use only)
Dosage:
See SMC advice 2271.
Important: Therapy notes
MHRA advice: Ibrutinib (Imbruvica) reports of ventricular tachyarrhythmia; risk of hepatitis B reactivation and or opportunistic infections (August 2017) (www.gov.uk).
Important: Formulation and dosage details
Formulation:
Capsules 140mg (hospital use only)
Dosage:
See SMC advice 1150/16, 1151/16.
Homecare is the preferred option - contact nhsh.homecare@nhs.scot
Important: Therapy notes
Important: Formulation and dosage details
Formulation:
Capsules 5mg, 10mg (hospital use only)
Important: Formulation and dosage details
Formulation:
Powder for solution for injection 10mg (hospital use only)
Important: Therapy notes
MHRA advice: Idelalisib (Zydelig): updated indications and advice on minimising the risk of infection (September 2016) (www.gov.uk).
Important: Therapy notes
Important: Formulation and dosage details
Formulation:
Powder for concentrate for solution for injection 1 gram, 2 grams (hospital use only)
Important: Therapy notes
For use in adult patients with Philadelphia chromosome-positive acute lymphoblastic leukaemia (Ph+ALL).
Important: Therapy notes
MHRA advice: Liposomal and lipid-complex formulations: name change to reduce medication errors (July 2020) (www.gov.uk).
Important: Formulation and dosage details
Formulation:
Concentrate for solution for infusion 20mg/mL (hospital use only)
Dosage:
See NICE guidance CG131.
Important: Therapy notes
Important: Formulation and dosage details
Formulation:
Concentrate for solution for infusion 20mg/ml (hospital use only)
Dosage:
See SMC advice 2303.
Important: Therapy notes
Important: Formulation and dosage details
Formulation:
Tablets 250mg (Restricted: Hospital use only)
Dosage:
See SMC advice 2615.
Important: Therapy notes
MHRA advice: Systemically administered VEGF pathway inhibitors: risk of aneurysm and artery dissection (July 2020) (www.gov.uk).
Important: Therapy notes
Important: Formulation and dosage details
Formulation:
Powder for concentrate for solution for infusion 44mg/100mg (hospital use only)
Dosage:
See SMC advice 2130.
Important: Therapy notes
Important: Formulation and dosage details
Formulation:
Capsules 40mg (hospital use only)
Important: Therapy notes
Important: Formulation and dosage details
Formulation:
Powder for concentrate for solution for infusion 10mg (Restricted: hospital use only)
Dosage:
See SMC advice 2609.
Important: Therapy notes
Important: Formulation and dosage details
Formulation:
Tablets 2mg (hospital use only)
Important: Therapy notes
Important: Formulation and dosage details
Formulation:
Tablets 50mg (hospital use only)
Important: Formulation and dosage details
Formulation:
Oral suspension 100mg/mL (hospital use only)
Dosage:
See SMC advice 798/12.
Important: Therapy notes
Important: Formulation and dosage details
Formulation:
Tablets 400mg (hospital use only)
Important: Formulation and dosage details
Formulation:
Solution for injection 100mg/mL (hospital use only)
Important: Therapy notes
MHRA advice: Methotrexate: advise patients to take precautions in the sun to avoid photosensitivity reactions (August 2023) (www.gov.uk).
MHRA advice: Methotrexate once-weekly for autoimmune diseases: new measures to reduce risk of fatal overdose due to inadvertent daily instead of weekly dosing (September 2020) (www.gov.uk).
Risk minimisation materials
Important: Formulation and dosage details
Formulation:
Oral solution 10mg/5mL (hospital use only)
Important: Formulation and dosage details
Formulation:
Solution for injection 25mg/mL, 100mg/mL (hospital use only)
Important: Formulation and dosage details
Formulation:
Intrathecal injection 50mg/2mL (hospital use only)
Important: Therapy notes
Important: Formulation and dosage details
Formulation:
Tablets 50mg (hospital use only)
Dosage:
See SMC advice 1330/18.
Important: Therapy notes
Mitomycin 40mg is given as a bladder instillation.
Important: Formulation and dosage details
Formulation:
Powder for solution for injection 10mg, 20mg, 40mg (hospital use only)
Important: Therapy notes
Important: Formulation and dosage details
Formulation:
Concentrate for solution for infusion 2mg/mL (hospital use only)
Important: Therapy notes
Important: Formulation and dosage details
Formulation:
Film-coated tablets 40mg (hospital use only)
Dosage:
See SMC advice 2251.
Important: Therapy notes
MHRA advice: Systemically administered VEGF pathway inhibitors: risk of aneurysm and artery dissection (July 2020) (www.gov.uk).
Important: Formulation and dosage details
Formulation:
Capsules (Vargetef®) 100mg, 150mg (hospital use only)
Dosage:
See SMC advice 1027/15.
Important: Therapy notes
MHRA advice: Niraparib (Zejula): reports of severe hypertension and posterior reversible encephalopathy syndrome (PRES), particularly in early treatment (October 2020) (www.gov.uk).
Important: Therapy notes
Important: Formulation and dosage details
Formulation:
Concentrate for solution for infusion 25mg/mL (hospital use only)
Dosage:
See SMC advice 1008/14.
Important: Therapy notes
Important: Formulation and dosage details
Formulation:
Capsules 50mg (hospital use only)
Dosage:
See SMC advice 1047/15.
Important: Therapy notes
MHRA advice: Paclitaxel formulations (conventional and nab-paclitaxel): caution required due to potential for medication error (January 2022) (www.gov.uk).
Important: Therapy notes
MHRA advice: CDK4/6 inhibitors (abemaciclib, palbociclib, ribociclib): reports of interstitial lung disease and pneumonitis, including severe cases (June 2021) (www.gov.uk).
Important: Therapy notes
Important: Formulation and dosage details
Formulation:
Concentrate for intravenous infusion 20mg/mL (hospital use only)
Dosage:
See NICE MTA 439.
Important: Therapy notes
Important: Formulation and dosage details
Formulation:
Capsules 10mg, 15mg, 20mg (hospital use only)
Dosage:
See SMC advice 1122/16.
Important: Therapy notes
MHRA advice: Systemically administered VEGF pathway inhibitors: risk of aneurysm and artery dissection (July 2020) (www.gov.uk).
Important: Formulation and dosage details
Formulation:
Tablets 200mg, 400mg (hospital use only)
Dosage:
See SMC advice 676/11.
Important: Therapy notes
Important: Formulation and dosage details
Formulation:
Tablets 4·5mg, 9mg, and 13·5mg (hospital use only)
Dosage:
See SMC advice 2399.
Important: Therapy notes
Important: Formulation and dosage details
Formulation:
Powder for solution for injection 10mg (hospital use only)
Important: Therapy notes
Important: Formulation and dosage details
Formulation:
Solution for injection (Phesgo) 600mg/600mg, 1200mg/600mg (hospital use only)
Dosage:
See SMC advice 2364.
Important: Therapy notes
MHRA advice: Systemically administered VEGF pathway inhibitors: risk of aneurysm and artery dissection (July 2020) (www.gov.uk).
MHRA advice: Ponatinib (Iclusig): reports of posterior reversible encephalopathy syndrome (October 2018) (www.gov.uk).
MHRA advice: Ponatinib (Iclusig): risk of vascular occlusive events - updated advice on possible dose reduction (April 2017) (www.gov.uk).
Important: Formulation and dosage details
Formulation:
Tablets 15mg, 45mg (hospital use only)
Dosage:
See SMC advice 1032/15.
Important: Therapy notes
Important: Formulation and dosage details
Formulation:
Hard capsules 100mg (hospital use only)
Dosage:
See SMC advice 2496.
Important: Therapy notes
Important: Formulation and dosage details
Formulation:
Capsules 50mg (hospital use only)
Important: Therapy notes
MHRA advice: Radium-223 dichloride (Xofigo): new restrictions on use due to increased risk of fracture and trend for increased mortality seen in clinical trial (September 2018) (www.gov.uk).
Important: Formulation and dosage details
Formulation:
Solution for injection 1,000kBq/mL (hospital use only)
Dosage:
See SMC advice 1077/15.
Important: Therapy notes
Important: Formulation and dosage details
Formulation:
Powder for solution for infusion 2mg (hospital use only)
Dosage:
See NICE guidance CG131.
Important: Therapy notes
MHRA advice: Systemically administered VEGF pathway inhibitors: risk of aneurysm and artery dissection (July 2020) (www.gov.uk).
Important: Therapy notes
MHRA advice: CDK4/6 inhibitors (abemaciclib, palbociclib, ribociclib): reports of interstitial lung disease and pneumonitis, including severe cases (June 2021) (www.gov.uk).
Important: Therapy notes
MHRA advice: Rucaparib (Rubraca): withdrawal of third-line treatment indication (September 2022) (www.gov.uk).
Important: Formulation and dosage details
Formulation:
Tablets 200mg, 250mg, 300mg (hospital use only)
Dosage:
See SMC advice 2224.
Important: Therapy notes
Important: Formulation and dosage details
Formulation:
Powder for concentrate for solution for infusion 180mg (hospital use only)
Dosage:
See SMC advice 2446.
Important: Therapy notes
MHRA advice: Systemically administered VEGF pathway inhibitors: risk of aneurysm and artery dissection (July 2020) (www.gov.uk).
Important: Therapy notes
Important: Formulation and dosage details
Formulation:
Film-coated tablets 120mg (hospital use only)
Dosage:
See SMC advice 2443.
Important: Therapy notes
MHRA advice: Systemically administered VEGF pathway inhibitors: risk of aneurysm and artery dissection (July 2020) (www.gov.uk).
Important: Therapy notes
Important: Formulation and dosage details
Formulation:
Capsules 0.25mg, 1mg (Restricted: hospital use only)
Dosage:
See SMC advice 2607.
Important: Therapy notes
MHRA advice: 5-fluorouracil (intravenous), capecitabine, tegafur: DPD testing recommended before initiation to identify patients at increased risk of severe and fatal toxicity (October 2020) (www.gov.uk).
Important: Formulation and dosage details
Formulation:
Capsules (Teysuno®) 15mg/4·35mg/11·8mg, 20mg/5·8mg/15·8mg (hospital use only)
Dosage:
See SMC advice 802/12.
Important: Therapy notes
MHRA advice: Temozolomide: risk of hepatic injury, including fatal hepatic failure - updated warnings and monitoring guidance (December 2014) (www.gov.uk).
Important: Therapy notes
Important: Formulation and dosage details
Formulation:
Film-coated tablets 225mg (hospital use only)
Dosage:
See SMC advice 2535.
Important: Therapy notes
MHRA advice: Systemically administered VEGF pathway inhibitors: risk of aneurysm and artery dissection (July 2020) (www.gov.uk).
Important: Formulation and dosage details
Formulation:
Hard capsules 890 micrograms and 1,340 micrograms (hospital use only)
Dosage:
See SMC advice 1335/18.
Important: Therapy notes
Important: Formulation and dosage details
Formulation:
Powder for concentrate for solution for infusion 1mg (hospital use only)
Dosage:
See NICE guidance TA389.
Important: Therapy notes
Important: Formulation and dosage details
Formulation:
Powder for concentrate for solution for infusion 0·25mg, 1mg (hospital use only)
Dosage:
See SMC advice 2283.
Important: Therapy notes
MHRA advice: Trametinib (Mekinist): risk of gastrointestinal perforation and colitis (March 2016) (www.gov.uk).
Important: Therapy notes
Important: Therapy notes
Important: Formulation and dosage details
Formulation:
Capsules 10mg (hospital use only)
Important: Therapy notes
Important: Formulation and dosage details
Formulation:
Tablets 50mg, 150mg (hospital use only)
Dosage:
See SMC advice 2398.
Important: Therapy notes
MHRA advice: Vemurafenib (Zelboraf): risk of potentiation of radiation toxicity (November 2015) (www.gov.uk).
Important: Formulation and dosage details
Formulation:
Tablets 240mg (hospital use only)
Dosage:
See SMC advice 792/12.
Important: Therapy notes
Important: Formulation and dosage details
Formulation:
Solution for injection 10mg (hospital use only)
Important: Therapy notes
Important: Formulation and dosage details
Formulation:
Solution for injection 1mg/ml (hospital use only)
Important: Therapy notes
Important: Formulation and dosage details
Formulation:
Powder for solution for injection 5mg (hospital use only)
Important: Therapy notes
Important: Formulation and dosage details
Formulation:
Capsules 20mg, 30mg (hospital use only)
Dosage:
Important: Formulation and dosage details
Formulation:
Concentrate for solution for infusion 10mg/mL (hospital use only)
Dosage:
See NICE guidance CG81.