Shared Care: Listed Alphabetically

Statement for Requests for Shared Care Agreements for Historic Patients

User guides for responding to Shared care Agreements for LPT Only :

Emis Webb 

Systm One

SCA’s are currently listed alphabetically by drug name (or disease). Where a drug doesn’t have it’s own specific request form please use this one Shared Care Request Form.

A programme of review of these shared care agreement documents is currently being undertaken. These are the current shared care agreements. If there are any concerns please contact Please do not send patient identifiable information as email may be unsecure.

There has been a delay in the antipyschotic shared care agreement changes noted below. Changes in shared care agreements once the delay is rectified will be communicated by the ICB Medicines Optimisation Team.

ADHD (adults)   Request form 

ADHD (paediatric)   Request form



Amiloride (paediatric cardiology)

Atomoxetine (adults)     Request form

Atomoxetine (paediatric)     Request form

Azathioprine (dermatology)   Request form

Azathioprine (adult gastroenterology)    Request form

Azathioprine (paediatric gastroenterology)

Azathioprine neurology  Request form

Azathioprine (rheumatology)     Request form

Captopril (paediatric cardiology)

Ciclosporin (dermatology) Request form


Colistin (Historical Cystic Fibrosis Patients Only)


Denosumab (Prolia) for osteoporosis Request form

Denosumab (Xgeva)  for prevention of skeletal events with bone metastases

Dexamfetamine (adults)     Request form

Dexamfetamine (paediatric)     Request form

Enalapril (paediatric cardiology)

Furosemide (paediatric cardiology)


Guanfacine (adult)         Request form

Guanfacine (paediatric)    Request form


Leflunomide     Request form

Lisdexamfetamine (adults)     Request form

Lisdexamfetamine (paediatric)     Request form

Lisinopril (paediatric cardiology)

Lithium     Request form

Losartan (paediatric cardiology)

Mercaptopurine (paediatric gastroenterology)

Mercaptopurine (adult gastroenterology)   Request form

Methotrexate oral (rheumatology)     Request form

Methotrexate oral (dermatology) Request form

Methotrexate oral (Adult Gastroenterology)      Request form

Methylphenidate (adults)     Request form

Methylphenidate (paediatric)     Request form


Mycophenolate Mofetil Autoimmune conditions  

Mycophenolate Mofetil Request form Dermatology

Mycophenolate Mofetil Request form Neurology

Mycophenolate Mofetil Request form Respiratory

Mycophenolate (renal transplant)

Penicillamine (rheumatology)     Request form




Spironolactone (paediatric cardiology)

Sulfasalazine oral (rheumatology)     Request form

Sulfasalazine oral and rectal (gastroenterology)

Tacrolimus for Historic Renal Transplant Patients

Testosterone (adults)

Testosterone (paediatric) Request form

Venlafaxine (high dose)     Request form