▶Nordimet(Nordic Pharma Ltd)
Methotrexate 25 mg per 1 mlNordimet 15 mg/ 0. 6 ml solution for
injection pre-filled pens| 1 pre-filled disposable injectionP
£ 14. 92 DT = £ 14. 92
Nordimet 20 mg/ 0. 8 ml solution for injection pre-filled pens| 1 pre-
filled disposable injectionP£ 16. 06 DT = £ 16. 06
Nordimet 22. 5 mg/ 0. 9 ml solution for injection pre-filled pens| 1 pre-
filled disposable injectionP£ 16. 61 DT = £ 16. 61
Nordimet 12. 5 mg/ 0. 5 ml solution for injection pre-filled pens| 1 pre-
filled disposable injectionP£ 14. 85 DT = £ 14. 85
Nordimet 10 mg/ 0. 4 ml solution for injection pre-filled pens| 1 pre-
filled disposable injectionP£ 13. 77 DT = £ 13. 77
Nordimet 17. 5 mg/ 0. 7 ml solution for injection pre-filled pens| 1 pre-
filled disposable injectionP£ 15. 75 DT = £ 15. 75
Nordimet 25 mg/ 1 ml solution for injection pre-filled pens| 1 pre-filled
disposable injectionP£ 16. 64 DT = £ 16. 64
Nordimet 7. 5 mg/ 0. 3 ml solution for injection pre-filled pens| 1 pre-
filled disposable injectionP£ 13. 37 DT = £ 13. 37
▶Zlatal(Nordic Pharma Ltd)
Methotrexate (as Methotrexate sodium) 25 mg per 1 mlZlatal
17. 5 mg/ 0. 7 ml solution for injection pre-filled syringes| 1 pre-filled
disposable injectionP£ 15. 75 DT = £ 15. 75
Zlatal 10 mg/ 0. 4 ml solution for injection pre-filled syringes| 1 pre-
filled disposable injectionP£ 13. 77 DT = £ 13. 77
Zlatal 25 mg/ 1 ml solution for injection pre-filled syringes| 1 pre-filled
disposable injectionP£ 16. 64 DT = £ 16. 64
Zlatal 20 mg/ 0. 8 ml solution for injection pre-filled syringes| 1 pre-
filled disposable injectionP£ 16. 06 DT = £ 16. 06
Zlatal 12. 5 mg/ 0. 5 ml solution for injection pre-filled syringes| 1 pre-
filled disposable injectionP£ 14. 85 DT = £ 14. 85
Zlatal 7. 5 mg/ 0. 3 ml solution for injection pre-filled syringes| 1 pre-
filled disposable injectionP£ 13. 37 DT = £ 13. 37
Zlatal 22. 5 mg/ 0. 9 ml solution for injection pre-filled syringes| 1 pre-
filled disposable injectionP£ 16. 61 DT = £ 16. 61
Zlatal 15 mg/ 0. 6 ml solution for injection pre-filled syringes| 1 pre-
filled disposable injectionP£ 14. 92 DT = £ 14. 92
Solution for infusion
▶Methotrexate (Non-proprietary)
Methotrexate (as Methotrexate sodium) 25 mg per
1mlMethotrexate 5 g/ 200 ml solution for infusion vials| 1 vialP
£ 200. 57
Methotrexate (as Methotrexate sodium) 100 mg per
1mlMethotrexate 5 g/ 50 ml solution for infusion vials| 1 vialP
£ 400. 00 (Hospital only)
Oral solution
▶Methotrexate (Non-proprietary)
Methotrexate (as Methotrexate sodium) 2 mg per
1mlMethotrexate 2 mg/ml oral solution sugar free sugar-free|
35 mlP£ 95. 00 DT = £ 95. 00 sugar-free| 65 mlP£ 125. 00 DT
=£ 125. 00
▶Jylamvo(Intrapharm Laboratories Ltd)
Methotrexate (as Methotrexate sodium) 2 mg per 1 mlJylamvo
2 mg/ml oral solution sugar-free| 60 mlP£ 112. 50Nelarabine
lINDICATIONS AND DOSE
T-cell acute lymphoblastic leukaemia and T-cell
lymphoblastic lymphoma in children who have relapsed
or who are refractory after receiving at least two
previous regimens
▶BY INTRAVENOUS INFUSION
▶Child:(consult local protocol)lCAUTIONSPrevious or concurrent craniospinal irradiation
(increased risk of neurotoxicity).previous or concurrent
intrathecal chemotherapy (increased risk of neurotoxicity)
lINTERACTIONS→Appendix 1 : nelarabine
lSIDE-EFFECTS
▶Common or very commonAnaemia.arthralgia.asthenia.
ataxia.confusion.constipation.diarrhoea.drowsiness.
electrolyte imbalance.fever.headache.
hyperbilirubinaemia.hypoglycaemia.increased risk of
infection.leucopenia.nausea.neutropenia.pain in
extremity.peripheral neuropathy.seizures.sensation
abnormal.stomatitis.thrombocytopenia.tremor.
vomitingSIDE-EFFECTS, FURTHER INFORMATIONIf neurotoxicity
occurs, treatment should be discontinued.
lCONCEPTION AND CONTRACEPTIONManufacturer advises
effective contraception during and for at least 3 months
after treatment in men and women.
lPREGNANCYAvoid (toxicity inanimalstudies). See also
Pregnancy and reproductive functionin Cytotoxic drugs
p. 531.
lBREAST FEEDINGDiscontinue breast-feeding.
lMONITORING REQUIREMENTS
▶NeurotoxicityClose monitoring for neurological events is
strongly recommended—discontinue if neurotoxicty
occurs.
lPATIENT AND CARER ADVICE
Driving and skilled tasksDrowsiness may affect
performance of skilled tasks (e.g. cycling or driving).lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Solution for infusion
ELECTROLYTES:May contain Sodium
▶Atriance(Novartis Pharmaceuticals UK Ltd)A
Nelarabine 5 mg per 1 mlAtriance 250 mg/ 50 ml solution for infusion
vials| 6 vialP£ 1 , 332. 00Tioguanine
(Thioguanine)
lINDICATIONS AND DOSE
Infant acute lymphoblastic leukaemia
▶BY MOUTH
▶Child:Can be given at various stages of treatment in
short-term cycles (consult local protocol)IMPORTANT SAFETY INFORMATION
RISKS OF INCORRECT DOSING OF ORAL ANTI-CANCER MEDICINES
See Cytotoxic drugs p. 531.lCONTRA-INDICATIONSAbsent thiopurine
methyltransferase activity
lCAUTIONSThiopurine methyltransferase status
CAUTIONS, FURTHER INFORMATION
▶Thiopurine methyltransferaseThe enzyme thiopurine
methyltransferase (TPMT) metabolises thiopurine drugs
(azathioprine, mercaptopurine, tioguanine); the risk of
myelosuppression is increased in patients with reduced
activity of the enzyme, particularly for the few individuals
in whom TPMT activity is undetectable. Patients with
absent TPMT activity should not receive thiopurine drugs;
those with reduced TPMT activity may be treated under
specialist supervision.
▶Long-term therapyLong-term therapy is no longer
recommended because of the high risk of liver toxicity.
lINTERACTIONS→Appendix 1 : tioguanine
lSIDE-EFFECTS
▶Common or very commonBone marrow failure.
gastrointestinal disorders.hepatic disorders.
hyperbilirubinaemia.hyperuricaemia.hyperuricosuria.
nodular regenerative hyperplasia.oral disorders.
sinusoidal obstruction syndrome.splenomegaly.
thrombocytopenia.uric acid nephropathy.weight
increased
▶Frequency not knownPhotosensitivity reaction
lCONCEPTION AND CONTRACEPTIONEnsure effective
contraception during treatment in men or women.
lPREGNANCYAvoid (teratogenicity reported when men
receiving tioguanine have fathered children). See also546 Cytotoxic responsive malignancy BNFC 2018 – 2019
Immune system and malignant disease8