netFormulary
 Report : A-Z of formulary items 15/08/2020 03:20:59
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Section Name Details
11.03.02 Amphotericin  

  • 5 microgram in 0.1ml

  • Intravitreal monograph see link.

  • RPH - Specialist advice

  • Formulary at all other trusts

20 Budesonide Viscous slurry 

  • Second line treatment for eosinophilic esophagitis in adults and paediatric patients unable to manage administration of fluticasone.

  • A slurry can be made by mixing the contents of budesonide nebules with a sugar solution- a patient instruction leaflet exists with directions on how to do this, see below. 

03.01.04 Indacaterol & glycopyrrolate inhaler Ultibro Breezhaler®
  • See CCG COPD Pathway (link below).
  • Second line LABA/LAMA for COPD who do not tolerate Spiolto Respimat or who need step up to LABA/LAMA combination and currently on Glycopyyronium monotherapy ( Seebri Breezhaler).
  • 20 3,3’,5-triiodothyroacetic acid 350mcg oral tablets TRIAC

     




      • Unlicensed medicine, still in phase 3 trials



     




      • JDTC May 2018:- Approved for use to treat resistance to thyroid Hormone due to defective MCT8 thyroid hormone transporter (Allan Herndon Dudley Syndrome) continuation of therapy post trial, on a compassionate access basis



     

    A5.09 3M Coban® 2 Compression System 
    • For venous leg ulcer with regular limb shape - with mild to severe oedema (refer to appropriate pathway for selection within hosiery guideline).
    • Coban® 2-layer compression systems are designed to deliver comfortable, therapeutic compression for the treatment of venous leg ulcers, lymphoedema and other conditions where compression therapy is appropriate.  
    • Product Information:
      • Comfort foam layer (layer 1) 10cm, 15cm
      • Compression layer (layer 2) 10cm, 15cm
    05.03.01 Abacavir Ziagen®

    CUH additional advice:



    • For Clinic 1A: HIV patients in whom all other HIV treatment has failed or had unacceptable side effects.


     

    05.03.01 Abacavir and Lamivudine 

    CUH additional advice:



    • Restricted to ID / GU Medicine advice only clinic 1A. Generic prescribing.



    • Abacavir sulphate 600mg and lamivudine 300mg Previously Kivexa® - Now prescribe as generic.



    • Abacavir hydrochloride 600mg and lamivudine 300mg Previously Lupin – Now prescribe as generic.



    • Abacavir hydrochloride 600mg and lamivudine 300mg Previously Mylan – Now prescribe as generic.



    • Abacavir 600mg and lamivudine 300mg Previously Teva – Now prescribe as generic.


     

    05.03.01 Abacavir and Lamivudine and Zidovudine Trizivir®

    CUH additional advice:



    • Restricted to ID / GU Medicine advice only



    • Clinic 1A - AIDS/HIV patients - combination to lighten pill-burden & increase compliance.


     

    10.01.03 Abatacept Orencia®

    • By IV infusion in the treatment of rheumatoid arthritis in line with NICE TA195. and after the failure of conventional disease-modifying anti-rheumatic drugs in line with NICE TA280.



    • Can also be used via the subcutaneous route for Homecare patients



    • Approved for use as per NICE TA 373 for JIA.



    • TERMINATED APPRAISAL NICE TA568 - Abatacept for treating psoriatic arthritis after DMARDs. 


     

    02.09 Abciximab 

    • RPH: Formulary

    • CUHFT: Approved only for Dr. Higgins to treat FOUR patients annually for thrombo-embolic complications of neuro-surgery. All other uses at CUHFT non formulary.

    • NWAFT: Non Formulary

    08.01.05 Abemaciclib Verzenios®

    • Approved for use in line with

      • NICE TA563 - Abemaciclib with an aromatase inhibitor for previously untreated, hormone receptor-positive, HER2-negative, locally advanced or metastatic breast cancer. 

      • NICE TA579 - Abemaciclib with fulvestrant for treating hormone receptor-positive, HER2-negative advanced breast cancer after endocrine therapy. 



    08.03.04.02 Abiraterone Zytiga®

    • Approved in line with NICE TA259 for use by an oncologist for castration resistant metastatic prostate cancer, previously treated with docetaxel.

    • Commissioners have confirmed that abiraterone in the above indication is not routinely commissioned in England in patients who have received prior enzalutamide therapy. An exception will be where enzalutamide has had to be stopped within 3 months of its start solely as a consequence of dose-limiting toxicity and in the clear absence of disease progression.

    • Also approved in accordance with the National Cancer Drugs Fund List for first line (i.e. chemotherapy naïve) treatment of metastatic castration resistant prostate cancer. Confirm funding approved on BlueTeq for all new CDF starters.

    • Patients commenced on the drug prior to 1st May 2011 are eligible for free of charge stock via a compassionate use programme.

    04.10.01 Acamprosate 

     

    • CUHFT, CPFT and RPH: Formulary

     

    • NWAFT: Non- formulary (not to be initiated within the Trust)

     

    • Prescribing can be continued in Primary care following initiation from an appropriate specialist at CUHFT, CPFT, RPH and the drug and alcohol services. 

     

    06.01.02.03 Acarbose Glucobay®

    • Useful in the occasional overweight patient but limited by gastrointestinal intolerance.

    • NWAFT  restricted to existing patients only. No new patients.

    02.08.02 Acenocoumarol Sinthrome®

    • CUHFT: Specialist Initiation- for patients intolerant of warfarin.

    • Non formulary at all other Trusts


     

    20 Acetarsol  
  • Discontinued August 2016.
  • 04.08.01 Acetazolamide 

    See also section 11.6 for glaucoma indication

    • CUHFT: Formulary for the management of epilepsy
    • Non-formulary at all other Trusts for this indication

    June 2020 - Supply issues with acetazolamide SR 250mg capsules

    • Acetazolamide SR 250mg capsules are out of stock until the end of July 2020.
    • Advice and guidance for potential management options for the indication of epilepsy should be sought from the individual patient's specialist. 
    11.06 Acetazolamide Diamox®

    June 2020 - Supply issues acetazolamide SR 250mg capsules

    • Acetazolamide SR 250mg capsules are out of stock until the end of July 2020.
    • Acetazolamide immediate release 250mg tablets remain available.
    • For patients with insufficient supplies, clinicians should consider prescribing acetazolamide immediate release 250mg tablets.
    • See the links below for further advice about management and switching from acetazolamide modified-release capsules to immediate release formulations.
    • Where prescribing of acetazolamide is not for the indication of glaucoma, urgent advice and guidance on potential management options should be discussed with the patient’s specialist.

     

     

    11.08.02 Acetylcholine Chloride 

    • Intra-ocular irrigation 1% Miochol-E® 

    03.07 Acetylcysteine  unlicensedunlicensed
  • CUHFT only , following Respiratory advice.
  • Non formulary at other Trusts and in Primary Care.

  • 18 Acetylcysteine Parvolex Injection
  • Paracetamol overdose
  • 20 Acetylcysteine 
  • Vascular Surgeons for radio-contrast patients.
  • 20 Acetylcysteine 

    • Used in the treatment of pulmonary fibrosis at a dose of 600mg THREE times daily.

    • Off-label for meconium ileus in neonates (often these neonates go on to be diagnoses with CF) and Distal Intestinal Obstructive syndrome in CF

    20.01 Acetylcysteine 

    • Injection given orally.

    • Limited evidence.

    • Dr Fitzgerald for gastroendoscopy. The use of acetylcysteine provided better visual examination of the GI tract, stomach and oesophagus, therefore enhancing early diagnosis.

    • Off-label for meconium ileus in neonates (often these neonates go on to be diagnoses with CF) and Distal Intestinal Obstructive syndrome in CF

    11.08.01 Acetylcysteine 5% with Hypromellose 0.35% Ilube®

    • Eye drops

    05.03.02.01 Aciclovir 
    12.03.02 Aciclovir 

    • See section 5.3.2.1

    • Topical aciclovir cream (for the management of cold sores) can be purchased from a Community Pharmacist. Recommend Self-Care

    13.10.03 Aciclovir 
    11.03.03 Aciclovir eye ointment 3% 

     

    • Recommended for prescribing in Primary Care or Secondary Care but restricted to paediatric patients only (licensed indication). 
    05.03.02.01 Aciclovir IV 
    13.05.02 Acitretin Neotigason®

    (Capsules)



    • CUHFT Restricted Item Dermatology specialist only.

    • NWAFT - Formulary

    03.01.04 Aclidinium and formoterol inhaler Duaklir Genuair ®
  • See CCG COPD Pathway (link below).
  • Third line LABA/LAMA combined inhaler for COPD who do not tolerate Spiolto Respimat or Ultibro Breezhaler or who are currently receiving either aclidinium or formoterol monotherapy and need to step up to a LABA/LAMA combination.
  • 03.01.02 Aclidinium bromide Eklira Genuair®
  • Third line LAMA inhaler for COPD patients unable to use tiotropium or glycopyrronium inhalers.
  • A5.09.03 ActiGlide® L&R
    • Available to purchase over the counter from Community Pharmacies. 
    13.08.01 Actikerall® 

     

    • Cutaneous solution fluorouracil 0.5%, salicylic acid 10%
    • Recommended for prescribing in Primary and Secondary Care:
      • Topical treatment for the management of actinic (solar) keratosis.  
      •  Restricted Item to dermatology only within the trusts.  
    18 Activated charcoal 
  • Reduction of absorption of poisons in the gastro-intestinal system or for active elimination techniques
  • Actidose-Aqua® Advance - Oral suspension, activated charcoal 1.04 g/5 mL
  • Carbomix® - 50g Granules, activated charcoal
  • 01.05.03 Adalimumab Amgevita®, Humira®, Imraldi®


    • Paediatrics:

      • Adalimumab and infliximab for Crohn's and ulcerative colitis subject to prior funding being agreed wth commissioners on an individual basis.





    • Imraldi (1st line) and Amgevita (2nd line) across Cambridgeshire and Peterborough health system. 


     

    10.01.03 Adalimumab Amgevita®, Humira®, Imraldi®

    • Restricted for RA and psoriatic arthritis in line with NICE guidance - rheumatology consultants only). Paeds JIA TA 373 via homecare.



    • Imraldi (1st line) and Amgevita (2nd line) across Cambridgeshire and Peterborough health system. 


     

    11.99.99.99 Adalimumab Amgevita®, Humira®, Imraldi®

    • JDTC May 2016- pending review of evidence to adopt NHSE commissioning policy for use in severe refractory uveitis in paediatrics.



    • For use in accordance with NICE TA460 - Adalimumab (Humira) and dexamethasone for treating non-infectious uvetis. 



    • Imraldi (1st line) and Amgevita (2nd line) across Cambridgeshire and Peterborough health system. 

    13.05.03 Adalimumab Amgevita®,Humira®, Imraldi®

     

    • Formulary at all trusts.
    • Approved for use in accordance with NICE TA146 for the treatment of plaque psoriasis.
    • A GPA form needs to be completed and returned to the CCG via commissioning for every individual patient. GPA Forms
    • Approved for use in accordance with NICE TA392 - Adalimumab for treating moderate to severe hidradenitis suppurativa.
    • NHS England Approved for use in accordance with NICE TA455 - Adalimumab for treating plaque psoriasis in children and young people.
    • Imraldi (1st line) and Amgevita (2nd line) across Cambridgeshire and Peterborough health system. 



     

    13.06.01 Adapalene Differin®

    (Gel 0.1%, Cream 0.1%)



    • In Primary Care - Formulary 2nd line

    • CUHFT Restricted Item Dermatologists only.

    • NWAFT - Formulary

    • Second generation retinoid, less irritant

    02.03.02 Adenosine 
    08.02.02 AdoPORT® 

    Capsule (Prescribe by brand)
    TWICE DAILY TACROLIMUS



    • Restricted to use within new patients only in accordance with a phased implementation plan in the following patient groups: Adult renal, Paediatric renal, Ophthalmology (adults), Gastroenterology (adults) and Haematology (adults).

    • Caution, narrow therapeutic index drug, several brands and formulations available. Must be prescribed, dispensed and administered by brand, switching between brands only to be undertaken under specialist supervision with blood level monitoring.

    • RPH: Available via homecare.

    • Tacrolimus is NHS England commissioned for immunosuppression associated with transplantation.

    02.07.03 Adrenaline / Epinephrine  

    • Cardiopulmonary resuscitation

    03.04.03 Adrenaline / epinephrine Jext®, Epipen®, Emerade®,
    • Injection technique is device specific. To ensure patients receive the auto-injector device that they have been trained to use, prescribers should prescribe by brand.
    • Adrenaline auto-injectors should be issued as an acute prescription, repeated as needed and on expiry only. For further information see link below - Summary for prescribers

    July 2020 - Adrenaline Auto-injectors Supply Issues

    Shortage of Emerade 150mcg, 300mcg and 500mcg adrenaline auto-injector devices

    • Emerade (Bausch and Lomb) devices will be unavailable for the foreseeable future. 
    • Patient and/or carers should return Emerade 150, 300 and 500 microgram auto-injectors to their local pharmacy once they have obtained a prescription for, and been supplied with, an alternative brand. 
    • On the 18th May 2020 the MHRA issued a Class 2 recall to patient level for all unexpired batches of Emerade 500 microgram auto-injectors due to an error in one component of the auto-injector which is believed to cause some pens to fail to activate and deliver adrenaline. Prescribers should:
      • Identify patients who have been supplied with Emerade 500 micrograms auto-injectors and ensure they are reviewed to determine whether their adrenaline auto-injector prescription is still appropriate and in line with existing guidance. 
      • Replace each Emerade 500 microgram auto-injector with one new 300 microgram adrenaline pen in an alternative brand. Healthcare professionals should be aware that the licensed dosing recommendations for each brand of pen are not identical.
      • See link to MHRA Class 2 Medicines Recall to patient level issued 18th May 2020 for further information below. 
    • On the 7th April 2020 the MHRA issued a Class 2 recall to patient level for all unexpired batches of Emerade 300 microgram auto-injectors due to an error in one component of the auto-injector which is believed to cause some pens to fail to activate and deliver adrenaline. Prescribers should:
      • Identify patients who have been supplied with Emerade 300 micrograms auto-injectors and ensure they are reviewed to determine whether their adrenaline auto-injector prescription is still appropriate and in line with existing guidance. 
      • Replace each Emerade 300 microgram auto-injector with one new adrenaline pen in an alternative brand. Healthcare professionals should be aware that the licensed dosing recommendations for each brand of pen are not identical.
      • See link to MHRA Class 2 Medicines Recall to patient level issued 7th April 2020 for further information below. 
    • On the 4th March 2020 the MHRA issued a Class 2 recall to patient level for all unexpired batches of Emerade 150 microgram auto-injectors due to an error in one component of the auto-injector which is believed to cause some pens to fail to activate and deliver adrenaline. Prescribers should:
      • Identify patients who have been supplied with Emerade 150 micrograms auto-injectors and ensure they are reviewed to determine whether their adrenaline auto-injector prescription is still appropriate and in line with existing guidance
      • Replace each Emerade 150 microgram auto-injector with one new adrenaline pen in an alternative brand. Healthcare professionals should be aware that the licensed dosing recommendations for each brand of pen are not identical.
      • See link to MHRA Class 2 Medicines Recall to patient level issued 4th March 2020 for further information below.

    Latest Supply Status of EpiPen® 0.3mg and 0.15mg Adrenaline Auto-Injectors

    • Prescription validation has been lifted for both EpiPen Junior and EpiPen devices therefore these are available to order through the usual wholesaler routes.
    • Specific batches of EpiPen 300 micrograms have received MHRA approval for extended use by four months beyond the labelled expiry date:
      • Clinicians should check with patients requesting new EpiPen 300 micrograms to establish if they currently hold one of the batches that can be used beyond the listed expiry. If one of the listed batches is held, further supplies should be delayed until the extended expiry date, counselling the patient on the extended expiry.
    • See links below for further information.  

    Availability of Jext Auto-Injectors:

    • Jext 150mcg and 300mcg devices are currently available to order. 
    • ALK have provided a letter to healthcare professionals regarding extended use beyond labelled expiry date for selected lots of Jext® 150 mcg and 300 mcg:
      • Clinicians should check with patients requesting new Jext 150 micrograms and 300 micrograms to establish if they currently hold one of the batches that can be used beyond the listed expiry. If one of the listed batches is held, further supplies should be delayed until the extended expiry date, counselling the patient on the extended expiry.
    • See links below for further information. 

    Summary

    All healthcare professionals in primary, secondary or specialist healthcare services who prescribe, supply or administer AAIs, or who advise patients and carers should ensure that:

    • When patients next request a prescription, they are reviewed to ensure their AAI prescription is still appropriate.
    • Prescribers issue no more than TWO AAIs per patient (exceptions to this are listed in the DHSC supply disruption alert issued the 29th of November 2019 below).
    • Patients are aware to not expose any brand of AAI to temperatures above 25°C. Storage above 25°C may increase the likelihood of a fault occurring with Emerade AAIs.
    • Patients are aware that certain Jext batches can be used beyond the listed expiry. If one of the listed batches is held by the patient, further supplies should be delayed until the extended expiry date.
    • Patients use their device(s) as instructed until the expiry date/extended expiry date. N.B. a device expiring in ‘March 2020’ does not expire until 31 March 2020. 
    • Patients are aware of the signs of anaphylaxis and the actions they should immediately take.
    03.04.03 Adrenaline / epinephrine 1 in 1,000 
  • Minijet Non formulary at CUHFT
  • 03.04.03 Adrenaline / epinephrine 1 in 10,000 (dilute) Minijet®
  • IV use of 10ml in anaphylaxis is for experienced specialist only (see BNF) - IM injection of 1:1,000 is first line for anaphylaxis (see above)
  • Note: This product is also used in CPR.
  • 08.02.02 Advagraf® 

    Capsule MR (Prescribe by brand)
    ONCE DAILY TACROLIMUS

    • Nephrologists - transplantation programme.

     

    • Must be prescribed, dispensed and administered by brand, switching between brands only to be undertaken under specialist supervision with blood level monitoring.

     

    • RPH: Non-formulary

     

    • Tacrolimus is NHS England commissioned for immunosuppression associated with transplantation.

    FEBRUARY 2020 - DO NOT REPATRIATE EXISTING PATIENTS, SHARED CARE GUIDELINES ARE CURRENTLY UNDER REVIEW.

     

    08.01.05 Afatinib Giotrif®

    • Approved in accordance with NICE TA310 for NSCLC.



    • Terminated appraisal NICE TA444 - Afatinib for treating advanced squamous non-small-cell lung cancer after platinum-based chemotherapy. 

    08.01.05 Aflibercept Zaltrap®

    • Was approved accordance with the National Cancer Drugs Fund List for the second line treatment of metastatic colorectal cancer. Removed from the CDF list on 12th Match 2015. 



    • Remains on formulary for patients with funding approved prior to this date.

    11.08.02 Aflibercept Eylea®

    • Approved as per NICE TAs:

      • Aflibercept for treating Diabetic Macular Oedema (NICE TA346).

      • Aflibercept for treating visual impairment caused by macular oedema after branch retinal vein occlusion (NICE TA409). 

      • Aflibercept for treating choroidal neovascularisation (NICE TA486). 



    • A GPA must be completed see link.

    • BlueTeq required.

    20 Ajmaline 
  • For the diagnosis of Brugada Syndrome
  • 05.05.01 Albendazole 

    • CUHFT only - Non formulary at all other Trusts.

    • Micro/ID Recommendation  required only.

    • Unlicensed medicine.

    20 Albendazole 
  • Micro/ID Recommendation only.
  • 08.01.05 Alectinib Alecensa®

    • Approved for use in accordance with NICE TA536 for untreated ALK-positive advanced non-small-cell lung cancer. 

    08.02.03 Alemtuzumab Lemtrada®

    • CUHFT: Consultant Neurologists, in line with NICE TA312 for relapsing-remitting multiple sclerosis. Shared Care Guideline in place for monitoring only.

    • RPH: Restricted to use in transplant patients (not shared care)

    • Non-formulary at all other Trusts

    20.01 Alemtuzumab 
  • Oncologists for BMT and CLL patients.
  • Vasculitis.
  • Kidney and kidney/pancreas transplant.
  • Available via PAS.
  • 06.06.02 Alendronic Acid Binosto®

    • Treating postmenopausal osteoporosis.



    • Restricted to use as third line option in patients who are unable to swallow normal tablets either, daily, weekly or monthly but are able to remain upright for 30 minutes' post dosing. 


    • Patients should be prescribed EITHER an oral bisphosphonate OR an intravenous bisphosphonate. Patients should NOT be co-prescribed both.



    06.06.02 Alendronic Acid 

    • 10mg once DAILY dosing. 



    • Treating postmenopausal osteoporosis.



    • Treatment of osteoporosis in men.



    • Prevention and treatment of corticosteroid induced osteoporosis in postmenopausal women not receiving hormone replacement therapy. 



    • Approved for use in accordance with NICE TA464 - Bisphosphonates for treating osteoporosis.


    • Patients should be prescribed EITHER an oral bisphosphonate OR an intravenous bisphosphonate. Patients should NOT be co-prescribed both.



    06.06.02 Alendronic Acid 

    • 70mg once WEEKLY dosing. 



    • Treatment of post menopausal osteoporosis.



    • Approved for use in accordance with NICE TA464 - Bisphosphonates for treating osteoporosis. 


    • Patients should be prescribed EITHER an oral bisphosphonate OR an intravenous bisphosphonate. Patients should NOT be co-prescribed both.



    09.06.04 Alfacalcidol One-Alpha®
    15.01.04.03 Alfentanil 

     

    • CUHFT - Formulary Injection: 1mg/2mL, 5mg/1mL(HIGH STRENGTH)
    • NWAFT - Formulary Injection
    • RPH - Formulary Injection

    May 2020 - Medicine Supply Notification for Opioid agents (parenteral use in critical care)

    • See link below for further information. 
    07.04.01 Alfuzosin 

    • CUHFT: Restricted to when first line choices are clinically unsuitable or contraindicated

    • If M/R tablet needed use Xatral® XL

    • If needed normal release tablets can be crushed and dispersed in water.

    • Do not crush MR tablets.

    • NWAFT and RPH: Non-formulary

    03.04.01 Alimemazine 
  • Not to be prescribed in primary care.
  • 02.12 Alirocumab 

    • Approved for treating primary hypercholesterolaemia and mixed dyslipidaemia in line with NICE TA393.

    13.05.01 Alitretinoin Toctino®

    (Capsules)



    • CUHFT - Restricted Item Restricted to use under NICE TA 177

    • NWAFT - Formulary


     



    • Restricted to use in adult patients with severe chronic hand eczema unresponsive to treatment with potent topical corticosteroids in accordance with NICE TAG 177.

      • Pregnancy prevention precautions to be adhered to. For details see SPC



    10.01.04 Allopurinol 
    06.01.02.03 Alogliptin Vipidia▼®

    • For use within its licensed indication only. Not licensed as a monotherapy.

    • Dose should be reduced to 12.5mg once daily in moderate to severe renal impairment( CrCl less than 50mls/min to 30mls/min). For patients with severe renal impairment ( CrCL less than 3omls/min or end stage renal disease requiring dialysis, 6.25mg once daily is the recommended dose. See SPC for more detail.

    09.06.05 Alpha Tocopheryl Acetate 

    • Formulary at all trusts

    • 500mg (750 units) in 5ml.

    • RPH: 75unit, 200unit and 400unit capsules available for cystic fibrosis patients

    • Vitamin E formulations can be purchased from a Community Pharmacist. However, if a prescriber has particular concerns that a patient might not be able to, or is unwilling to self-care and treatment with a medication is required, then a prescription (FP10) should be considered.


     

    13.09 Alphosyl 2 in 1® 

     

    • Available to purchase over the counter for 12 years of age and over. Under 12 years of age it should be used with caution and only on the recommendation of a doctor or pharmacist.
    • Shampoo 125mL.
    • NWAFT only.

     

    07.04.05 Alprostadil Caverject®, MUSE®

     

    • CUHFT and NWAFT: Formulary.
    • Non-formulary at all other Trusts.
    • Patients will require training specific to formulation prescribed by medically trained personnel and self-administration may only be undertaken after medical supervision and proper training.

     

    02.10.02 Alteplase 

     

    • CUHFT, NWAFT and RPH: Recommended as per NICE TA264 for stroke patients presenting within 4.5 hours of the stroke and intracranial haemorrhage has been excluded by appropriate imaging techniques.
    • RPH: Also in combinations with Dornase alfa for pleurodesis. 

    June 2020 - Shortage of Urokinase

    • CUHFT -  Due to a nationwide shortage of Urokinase, we are sourcing Alteplase as a temporary replacement. Internal guidance has been circulated. For further information contact pharmacy.

     





     

     

    A5.09 Altipress® Leg Ulcer Hosiery Kit 40mmHg 
    • For venous leg ulcer with regular limb shape - no or mild oedema (refer to appropriate pathway for selection within hosiery guideline).
    • Full compression.
    • Management of venous leg ulcers.
    • Prevent recurrence of healed ulcers. 
    • Product Information:
      • 2 liners, 1 outer layer stocking.
      • 5 sizes -up to 40.5cm - 50cm calf measurement.
      • Designed to last for a minimum of 3 months.
      • Handwash at 40°C.
      • Latex free.
    • Patient should be prescribed TWO garments per leg (ONE to wash and ONE to wear). These should be replaced every 3 months. 
    A5.09 Altipress® Liner Pack 10mmHg 
    • For venous leg ulcer with regular limb shape - no or mild oedema (refer to appropriate pathway for selection within hosiery guideline).
    • Provides very mild compression for ambulatory and non-ambulatory patients and can be worn for 24 hours per day.
    • Can be applied pre-doppler - refer to pre-doppler pathway. 
    • Product Information:
      • 3 liners per pack.
      • 5 sizes - up to 40.5cm - 50cm calf measurement.
      • Designed to last for a minimum of 3 months.
      • Handwash at 40°C.
    • Patient should be prescribed TWO garments per leg (ONE to wash and ONE to wear). These should be replaced every 3 months. 
    20 ALUM Bladder Irrigation 10% 
  • For treatment of bladder haemorrhage by consultant urologists.
  • 13.12 Aluminimum Chloride Hexahydrate 20%  Driclor®
    20 Aluminium Acetate 
  • Ear drops 8% and 13%.
  • 09.05.02.02 Aluminium Hydroxide Alu-Cap®

    • Generally reserved for short term use in patients with severe and difficult to control hyperphosphataemia.

    04.09.01 Amantadine 
    02.05.01 Ambrisentan 

    • RPH: Restricted to use in pulmonary hypertension only, available via homecare

    • Non formulary at all other Trusts

    05.01.04 Amikacin 

    • NWAFT and CUHFT: Consultant Microbiologist recommendation only

    • CUHFT: <15mg/Kg ONCE daily in normal renal function (based on ideal body weight). Trough level to be taken before second dose, aim for <5mg/L, no need for post dose levels unless recommended by microbiology. Take sample and wait for level before giving second dose.

    • RPH: Not restricted for use by the Thoracic Directorate


     

    11.03.01 Amikacin 

    • Eye drops 400microgram (0.4mg) in 0.1ml.

    • Intravitreal monograph see link.

    • RPH - Specialist advice

    02.02.03 Amiloride Hydrochloride 

    March 2020 - Shortage of amiloride 5mg tablets

    • Accord are out of stock until August 2020.
    • Wockhardt stock should be available to support during this time. 
    03.01.03 Aminophylline Phyllocontin Continus®, Forte Continus®

     



     

    03.01.03 Aminophylline  
    05.01.09 Aminosalicylic acid Granupas®

    • CUHFT and NWAFT: Restricted for use in adult patients with multi-drug-resistant tuberculosis.


     

    20 Aminosalicylic acid (PASA) Para Aminosalicylic Acid
  • Multi-drug resistant TB.
  • ID consultants and respiratory consultants only.
  • 02.03.02 Amiodarone 
    • Treatment should be initiated only under hospital or specialist supervision. Clear information must be provided by the hospital specialist to the GP
    • UNDER REVIEW: In line with NHS England guidance the place in therapy of amiodarone is under review locally.
    • Guidance is currently being developed to support the place in therapy for new patients and support primary care with the review of existing patients.

     

    20 Amiodarone 
  • 250mg/5mL suspension
  • 50mg/5mL suspension
  • Paediatric cardiology patients for arrhythmias.
  • 04.02.01 Amisulpride 

    • Requires specialist initiation by mental health team

    04.03.01 Amitriptyline 
    04.07.03 Amitriptyline 

    • Tricyclic antidepressants are first-line for neuropathic pain (unlicensed).

    04.07.04.02 Amitriptyline 

    • Unlicensed indication.

    • 2nd line formulary choice in Primary Care after propranolol

    • NWAFT: Non-formulary

    02.06.02 Amlodipine 
    05.01.01.03 Amoxicillin 

    • Prophylaxis against endocarditis in dental procedures is generally not required.

    • CUHFT info: Sachets  restricted to Chest physicians only.

    • Amoxil 500mg and 250mg Capsules discontinued 31/12/2018 please prescribe generically.

    05.01.01.03 Amoxicillin IV 
    05.02 Amphotericin Fungizone®

    • NWAFT: Non formulary

    • CUHFT: For intravitreal use and for eye/ear drop preparation only. Other amphotericin preparations are used for iv administration.

    • RPH: Nebulised

      • Not restricted for use in Cystic Fibrosis or Transplant patients

      • Available via homecare for use by transplant patients







     

    05.02 Amphotericin Liposomal  AmBisome®

     




      • Restricted to use in oncology and haematology (Neutropenic sepsis).



     




      • ALL other indications require microbiology approval.



     




      • CUH additional advice: the Consultant Microbiologist authorising the prescription should contact pharmacy (ex 3502). Pharmacy should contact Microbiology to confirm that a Consultant Microbiologist has approved an unexpected prescription.



     

    08.01.05 Amsacrine Amsidine®
    12.03.01 Anaesthetic throat lozenges Tyrozets®

    • CUHFT only - Tyrozets lozenges post general anaesthesia in recovery areas only (available on stocklist only)

    • Non formulary at all other trusts

    09.01.04 Anagrelide 

    • NWAFT: Formulary

    • CUHFT: Formulary for essential thrombocythaemia 

    • Non formulary at all other trusts and in Primary Care


     

    10.01.03 Anakinra Kineret®

    • CUHFT only via Lloyds OP: NHSE Clinical Commissioning Policy - Anakinra to treat periodic fevers and autoinflammatory diseases (all ages).

    • CUHFT only via Lloyds OP: NHSE Clinical Commissioning Policy - Anakinra/tocilizumab for the treatment of Adult-Onset Still's Disease Refractory to second-line therapy (adults).

    08.03.04.01 Anastrozole 

    • No liquid version, but tablets disperse in water. Ideally do not crush first. This should be avoided by women of child bearing potential and preferably be done in a closed system.

    • Advanced breast cancer in post menopausal women who previously had a clinical response to tamoxifen.

    05.02.04 Anidulafungin 

    • CUHFT: Hospital only via inpatient pharmacy for invasive candidiasis in adult patients.

    • RPH: Restricted use.

    • Non-formulary at all other Trusts.

    11.04.02 Antazoline 0.5% with Xylometazoline 0.05% Otrivine-Antistin®

    Available OTC consider self care.

    14.05.03 Anti-D (Rh0) Immunoglobulin  CUHFT:
  • As per maternity guidelines. See link.
  • Injection (Rhophylac® and D-Gam®)

    NWAFT:
  • Non-formulary - Not obtained through pharmacy
  • 20 Anti-Thymocyte Globulin (ATG) Rabbit
  • Transplant only – treatment of steroid resistant rejection.
  • Prophylaxis in kidney/pancreas and paediatric liver transplant.
  • 08.02.02 Antithymocyte immunoglobulin (rabbit)  Thymoglobuline®

    • Transplant only – treatment of steroid resistant rejection.

    • Prophylaxis in kidney/pancreas and paediatric liver transplant. (Non-formulary at RPH for this indication)

    18 Antivenoms for non-indigenous venomous animals  Discussion with National Poisons Information Service recommended.
  • Held supra-regionally for treatment of significant envenomation
  • Held by the pharmacy, Royal Liverpool Hospital and Guy’s & St Thomas’ NHS Foundation Trust
  • See European Viper Venom antiserum entry for Viper Berus bite treatment.
  • 01.07.02 Anusol-HC 

    • Consider Self Care

    02.08.02 Apixaban Eliquis®

    • Warfarin remains a suitable first-line option for most patients.

    • Where warfarin is not clinically appropriate, edoxaban is the lowest acquisition cost DOAC in primary care for Non-Valvular Atrial Fibrillation

    • Prescribing is restricted to:

      • Apixaban for preventing stroke and systemic embolism in people with nonvalvular atrial fibrillation (TA275) (Can be initiated in Primary Care)

      • Apixaban for the treatment and secondary prevention of deep vein thrombosis and/or pulmonary embolism (TA341)

      • Apixaban for the prevention of venous thromboembolism after total hip or knee replacement in adults (TA245) (Hospital only)



    04.09.01 Apomorphine 

    • CUHFT and NWAFT: For use by Consultant Neurologists and Geriatricians ONLY in line with Shared Care Guideline

    • RPH: Non-formulary
       

    11.08.02 Apraclonidine Iopidine®

    • Eye drops 0.5%

    • Eye drops 1% (preservative free)

    • 1% solutions may be prescribed by Ophthalmic surgeons, peri-operatively.

    • 0.5% solution as per local guidelines for treatment of glaucoma see chapter link.

    10.01.03 Apremilast Otezla®

    • Restricted in line with NICE TAs

    13.05.03 Apremilast Otezla®

    • Formulary at all trusts.



    • Approved in accordance with NICE TA419 Apremilast for treating moderate to severe plaque psoriasis.



    • A GPA form needs to be completed and returned to the CCG via commissioning for every individual patient. GPA Forms


     

    04.06 Aprepitant Emend®

    • CUHFT and NWAFT: For oncology patients only.

    • RPH: 4th line choice in Cystic Fibrosis (unlicensed)

    • Non-formulary at all other Trusts and in Primary Care

    02.11 Aprotinin Trasylol®

     

      • CUHFT: Formulary - see major haemorrhage protocol

     

      • RPH: Formulary

     

      • Non-formulary at all other Trusts and in Primary Care

     

    20.01 Aprotinin 
  • Patients undergoing liver transplantation:
    1. 2nd line when not responding to tranexamic acid.
    2. With fulminant hepatic failure.
  • 13.02.01 Aquadrate® 

    • Primary Care - Not recommended

    • CUHFT and RPH - Formulary 3rd line (ONLY 1st and 2nd line have not been tolerated/effective)

    • NWAFT and CPFT - Formulary

      • 10% urea



    13.02.01 Aqueous Cream BP 
    • Formulary at all trusts.
    • Greasy level 1/4 (least greasy).
    • Suitable as soap substitute.
    • Aqueous cream may be associated with skin reactions (stinging, burning, itching and redness) when used as a 'leave-on' emollient, often within 20 minutes of application.
    • Use Emollients Safely There is a fire risk associated with all emollients whether they contain paraffin or not.

    22.02 Aqueous cream BP  Less suitable for leave-on emollient, but suitable soapsubstitute
    02.08.01 Argatroban Exembol®

    • CUHFT and RPH: Anticoagulation in adult patients with heparin-induced thrombocytopenia type II who require parenteral antithrombotic therapy, where fondparinux is not suitable.

    • NWAFT: Non formulary

    09.08.01 Arginine  

    • unlicensed - All preparations are unlicensed.



    • CUHFT:

      • Indicated for urea cycle disorders, MELAS and mitochondrial disorders (Neuro). 

      • For paediatric metabolic disorders on specialist advice only. 

      • Available as:

        • L-arginine 100mg/ml oral solution.

        • 500mg tablets.

        • 1g tablets. 



      • Restricted Item 5g in 10ml injection only - restricted to emergency treatment for hyperammonaemia.





    • NWAFT - Restricted Item 5g in 10ml injection only - restricted to treating hyperammonaemia in a patient with ornithine transcarbamylase deficiency as per protocol.



    • Non formulary at all other trusts.


     

    20 Arginine Hydrochloride (tablets, oral solution, injection) 

    Available as (all unlicensed):


    L-arginine 5g/10ml injection (emergency treatment)


    L-arginine oral solution 100mg/ml (on drug tariff specials list)


     L-arginine tablets 1g Urea cycle disorders, MELAS, Mitochondrial disorders (neuro)



    • Adult and Paediatric - Metabolic Disorders.

    • Powder is licensed for urea cycle disorders.
      For paediatric use must be specialist prescribed

    • Powder is non formulary

    04.02.01 Aripiprazole 

    • Requires specialist initiation by mental health team

    04.02.02 Aripiprazole Abilify Maintena®

    • Requires specialist initiation by mental health team

    08.01.05 Arsenic Trioxide Trisenox®

    • Haematologist/oncologists ADULTS only. 



    • Approved in accordance with the Cancer Drug Fund as a fast-tracked drug for relapsed acute promyelocytic leukaemia (PML).



    • Approved for use in line with NICE TA526 for treating acute promyelocytic leukaemia. 

    05.04.01 Artemether with lumefantrine Riamet®

    • CUHFT: Approved infectious disease for resistant-malaria.

    • NWAFT: Formulary.

    • Non-formulary at all other Trusts.

    20 Artesunate 

    • CUHFT and NWAFT: Severe malaria falciparum.

    • ID/Micro recommended only.

    15.02 Articaine Hydrochloride with Adrenaline Septanest®

    • NWAFT


     



    • CUHFT - in dental surgery. Hospital only via inpatients (stock). 


     

    09.06.03 Ascorbic Acid 

    • Can be purchased from a Community Pharmacist. However, if a prescriber has particular concerns that a patient might not be able to, or is unwilling to self-care and treatment with a medication is required, then a prescription (FP10) should be considered. 



    • CUHFT only: for palliative care in combination with zinc. 

    09.08.01 Asfotase alfa Strensiq®

    • CUHFT only via Homecare - in line with NICE HST6 for treating paediatric-onset hypophosphatasia.

    04.07.01 Aspirin 

     

    • Consider self care - where the patient is willing and able.
    • Enteric Coated tablets (EC) are non-formulary. 

     

    10.01.01 Aspirin 

    • Less suitable as an analgesic

    • CUHFT: Formulary

    • NWAFT: Suppositories and dispersible tablets only (post -stroke)

    • RPH: Non formulary

    02.09 Aspirin (antiplatelet) 

     

    • Aspirin dispersible and EC tablets (75mg) can be purchased from a Community Pharmacist. 
    • Pregnant women at an increased risk of preeclampsia at their booking appointment should be offered a prescription of 75mg - 150mg aspirin to be taken each night from 12 weeks of pregnancy until birth (off-label use):
      • Please note Community pharmacies cannot legally sell aspirin as a Pharmacy Only Medicine for prevention of pre-eclampsia in pregnancy in England.
      • Aspirin for this indication must be prescribed.
      • Please see links below for further information. 

     

    10.02 Ataluren Translarna®

    • CUHFT: Approved in accordance with NICE HST3/SSC1633 for the treatment of Duchenne muscular dystrophy resulting from a nonsense mutation in the dystrophin gene. 

    • Non-formulary at all other trusts.

    05.03.01 Atazanavir Reyataz®

    CUH additional advice:



    • Restricted to ID / GU Medicine advice only.

    • Clinic 1A only for AIDS/HIV patients.

    02.04 Atenolol 
    08.01.05 Atezolizumab Tecentriq®

    • Approved for use in line with NICE TAs:


      • Atezolizumab for untreated PD-L1-positive locally advanced or metastatic urothelial cancer when cisplatin is unsuitable (NICE TA492).




      • Atezolizumab for treating locally advanced or metastatic non-small-cell lunch cancer after chemotherapy (NICE TA520). 




      • Atezolizumab for treating locally advanced or metastatic urothelial carcinoma after platinum-containing chemotherapy (NICE TA525).



      • Atezolizumab in combination for treating metastatic non-squamous non-small-cell lung cancer (NICE TA584).



    04.04 Atomoxetine Strattera®

    • Requires specialist initiation by mental health team in line with Shared Care Guidelines


     

    02.12 Atorvastatin 

    • Primary prevention: 20mg daily.

    • Secondary prevention: 80mg daily.

    07.01.03 Atosiban 

    • NWAFT: Formulary

    • Non-formulary at all other Trusts

    05.04.08 Atovaquone Wellvone®

    • CUHFT additional advice.


    MUST have prior approval from microbiology or ID.


    Fourth line for PCP treatment and prophylaxis in immunocompromised patients only if alternatives trimethoprim/sulfamethoxazole, penthamidine and dapsone) are not appropriate.



    • NWAFT additional advice


    Restricted to 2nd line use in Pneumocystis jirovecci or following consultant microbiologist approval

    15.01.05 Atracurium Besilate 

    • CUHFT - Restricted Item Restricted

    • NWAFT - Formulary

    • RPH - Formulary

    11.05 Atropine 

     

    • Eye drops 1%

     

    • Minims 1%

     

    • RPH -  Specialist advice

     

    15.01.03 Atropine  

    • CUHFT - Formulary Injection 600micrograms/mL Injection pre-filled syringe 500micrograms/5mL(Miniject), 3mg/10mL, 1mg/5mL, 1mg/10mL (Miniject)

    • NWAFT - Formulary Injection and minijet®Atropine

    • RPH - Formulary

    18 Atropine 
  • Antidote for organophosphorus, carbamate insecticides poisoning or nerve agents. Discussion with National Poisons Information Service recommended.
  • Treatment of bradycardia
    See also section 15.1.3
  • 10.04 Autologous chondrocyte implantation (ACI) 

    • Approved for use in line with:

      • NICE TA477 - Autologous chondrocyte implantation for treating symptomatic articular cartilage defects of the knee.

      • NICE TA508 - Autologous chondrocyte implantation using chondrosphere (Spherox®) for treating symptomatic articular cartilage defects of the knee.



    08.01.05 Avelumab Bavencio®

     

    • Approved for use in accordance with NICE TA517 for treating metastatic Merkel cell carcinoma. 

     

    • CUHFT: Avelumab in combination with axitinib - Early Access to Medicines Scheme: First line treatment of adult patients with advanced renal cell carcinoma (RCC) (SSC2054. Agreed at September 2019 OSTS).
    08.01.05 Axicabtagene ciloleucel Yescarta®

    • Approved for use in accordance with NICE TA559 for treating diffuse large B-cell lymphoma and primary mediastinal large B-cell lymphoma after 2 or more systemic therapies. 

    08.01.05 Axitinib Inlyta®
    • Approved in accordance with NICE TA 333 for the treatment of advanced renal cell carcinoma after failure of a first-line kinase inhibitor or cytokine.

     

    • CUHFT: Axitinib in combination with avelumab - Early Access to Medicines Scheme: First line treatment of adult patients with advanced renal cell carcinoma (RCC) (SSC2054. Agreed at September 2019 OSTS).
    08.01.03 Azacitidine Vidaza®
  • Approved for use in line with NICE TA218.
  • 01.05.03 Azathioprine 

     

    • Maintenance of remission of acute ulcerative colitis and Crohn’s disease in adults– unlicensed but in line with national guidelines and shared care.
    • Inflammatory bowel disease in line with national guidelines and shared care.
    • Where a liquid preparation is clinically required in paediatric patients, Azathioprine 50mg/5mL is the standardised liquid strength which should be prescribed in children (unlicensed unlicensed):
      • Using standardised strengths of unlicensed liquid medicines in children, will reduce the risk of errors being made in the doses given to children and prevent hospitalisation from accidental under and overdoses.
      • See link below for further information.
    08.02.01 Azathioprine 

     

    • Cytotoxic - do not crush tablets. Liquid (unlicensed special) may be obtained specially if required.
    • For post-transplant immunosuppression, prescribing for existing patients should remain with the current prescriber until repatriation to specialist centre is agreed. (RPH: Shared Care Guideline available).
    • Where a liquid preparation is clinically required in paediatric patients, Azathioprine 50mg/5mL is the standardised liquid strength which should be prescribed in children (unlicensed unlicensed):
      • Using standardised strengths of unlicensed liquid medicines in children, will reduce the risk of errors being made in the doses given to children and prevent hospitalisation from accidental under and overdoses.
      • See link below for further information.

     

     

     

    10.01.03 Azathioprine 

     

    • For use in rheumatological Conditions as per Shared Care Protocol.
    • Cytotoxic - do not crush tablets. 
    • Where a liquid preparation is clinically required in paediatric patients, Azathioprine 50mg/5mL is the standardised liquid strength which should be prescribed in children (unlicensed unlicensed):
      • Using standardised strengths of unlicensed liquid medicines in children, will reduce the risk of errors being made in the doses given to children and prevent hospitalisation from accidental under and overdoses.
      • See link below for further information. 

     

    13.05.03 Azathioprine 

     

    • CUHFT Restricted Item Severe refractory eczema .
    • NWAFT - Dermatology use only.
    • StarCytotoxic - do not crush tablets.
    • Where a liquid preparation is clinically required in paediatric patients, Azathioprine 50mg/5mL is the standardised liquid strength which should be prescribed in children (unlicensed unlicensed):
      • Using standardised strengths of unlicensed liquid medicines in children, will reduce the risk of errors being made in the doses given to children and prevent hospitalisation from accidental under and overdoses.
      • See link below for further information.

     

    13.06.01 Azelaic Acid Finacea®
    • Gel 15%
    • Primary Care:
      • This is recommended first line for the relief of mild to moderate papular-pustular acne of the facial area.
      • This is recommended second line for the topical treatment of rosacea in adults.
    • CUHFT - Formulary. 
    • NWAFT - Non-formulary. 

    13.06.01 Azelaic Acid Skinoren®

    (Cream 20%)

    • In Primary Care this is 1st line.
    • CUHFT - Formulary.
    • NWAFT - Formulary.



     

    13.06.03 Azelaic Acid Finacea®
    • Gel 15%
    • Primary Care:
      • This is recommended first line for the relief of mild to moderate papular-pustular acne of the facial area.
      • This is recommended second line for the topical treatment of rosacea in adults.
    • CUHFT - Formulary. 
    • NWAFT - Non-formulary. 

    12.02.01 Azelastine and fluticasone Dymista

    • Status Ratified by C&P CCG JPG at the March 2019 meeting. 

    12.02.01 Azelastine Hydrochloride Rhinolast®

    • Status Ratified by C&P CCG JPG at the March 2019 meeting. 

    05.01.05 Azithromycin 

    • Primary Care: 2nd line in Otitis media if other antibiotics have failed. 1st line in Chlamydia Trachomatis.

    • CUHFT:  Restricted to use in; 1. Infectious Disease Team (clinic 1a) 2. Paediatricians for: • CF and as third line option for acute respiratory infection in children who do not have CF. • Pharyngitis/tonsillitis • Otitis media • community acquired pneumonia • Impetigo/infected eczema • Cellulitis • Periorbital cellulitis

    • NWAFT- restricted to use in paediatrics, gynaecology and respiratory patients

    • RPH: No restriction on use by Thoracic Directorate or Transplant


     

    05.01.02.03 Aztreonam Azactam®

    • CUHFT and NWAFT : Consultant Microbiologist recommendation required

    • RPH: Not restricted for use by the Thoracic Directorate.

      • Indicated for surgical prophylaxis of PTE.




     

    05.01.02.03 Aztreonam nebuliser solution Cayston®

    • RPH: Available via homecare for treatment in Cystic Fibrosis

    • Non-formulary at all other Trusts

    07.04.04 Bacillis Calmette-Guerin (BCG) 

    • CUHFT and NWAFT: Formulary

    • Non-formulary at all other Trusts and in Primary Care

    10.02.02 Baclofen 

    • Tablets and liquid are formulary choice in all Trusts and Primary Care

    • CUHFT: Intrathecal injection (Hospital only)

    • Intrathecal injection is non formulary at all other Trusts


     

    20 Bacteriostatic water   •Compassionate supplies of bacteriostatic to be supplied alongside leptin only
    •Aim is to reduce required number of vials per day
    •To be bring back to JDTC once compassionate supplies is no longer available, which is likely to be at the point of leptin being marketed in the UK.
    13.02.01 Balneum® Plus cream 

    • In Primary Care this is self-care Self-care Policy

    • CUHFT and RPH - Formulary 1st choice

    • NWAFT - Formulary 2nd choice

    • CPFT - Formulary

      • Plus Cream urea 5%, lauromacrogols 3%.

      • Cream urea 5%, ceramide 0.1% non-formulary.



    10.01.03 Baricitinib Olumiant®

    • Restricted to rheumatology in line with NICE TA466

    08.02.02 Basiliximab Simulect®

    • CUHFT:

      • For renal transplants to reduce incidence of acute rejection in line with NICE.

      • Maintenance of immunosuppression following intestinal transplant: Off-label use of basiliximab is approved for this indication in a small cohort of patients being treated by Dr Massey.

      • Otherwise not approved for other transplants or for use as maintenance therapy.



    • RPH: Formulary for use in transplant patients

    20.01 Basiliximab 
  • Maintenance of immunosuppression following intestinal transplant for small cohort of patients being treated by Dr Massey.
  • 08.02.04 BCG bladder instillation 

    • See section 07.04.04

    14.04 BCG intradermal vaccine plus diluent InterVax

    unlicensedunlicensed



    • CUHFT - Approved for use in CUH by JDTC October 2016.

    • Used globally but no UK markerting authorisation.

    • NWAFT - Formulary

    14.04 BCG vaccine diagnostic agent  unlicensedInjection - Tuberculin PPD 2 units/0.1ml - unlicensed product, SSI brand
    unlicensedInjection - Tuberculin PPD 10 units/0.1ml - unlicensed product, SSI brand

  • CUHFT - Non-formulary
  • NWAFT - Formulary
  • 14.04 BCG vaccine Intradermal  Injection
    Restricted Item See National Vaccination Schedule
  • Part of the Childhood Immunisation Schedule for selected individuals
      To be given to infants in areas of the country with TB prevalence >= 40/100,000
      To be given to infants with a parent or grandparent born in a high incidence country

  • April-August 2015. National supply problem of only brand. See guidance below
  • Prioritisation of local stocks should be undertaken as per PHE policy here

    Red Traffic Light  Not available on the NHS for travel

  • Alternative brand used in hospital - contact Pharmacy Department
  • 03.02 Beclometasone Soprobec®
    • Prescribe by BRAND.
    • Preferred brand in Primary Care is Soprobec®.
    • Soprobec is licensed for use in children and adults for asthma.
    • Soprobec is equivalent to Clenil Modulite, same active ingredient (beclometasone) and same device (MDI). 
    • Soprobec® and Qvar® are not interchangeable. Qvar has extra fine particles and is approximately twice as potent as Soprobec. 
    03.02 Beclometasone Qvar®
    • Prescribe by BRAND.
    • Preferred brand in Primary Care is Qvar®.
    • Qvar® is licensed for use in children over 12 years of age and adults for asthma. 
    • Soprobec® and Qvar® are not interchangeable. Qvar has extra fine particles and is approximately twice as potent as Soprobec. 
    • CUHFT Restricted- To be initiated by Respiratory team only.
    • RPH: Restricted use.

     

    03.02 Beclometasone / formoterol / glycopyrronium bromide pressurised metered dose inhaler  (Trimbow®)

     




      • For the treatment of COPD ( as per pathway) only where triple therapy is indicated



     

    03.02.03 Beclometasone / formoterol / glycopyrronium bromide pressurised metered dose inhaler  (Trimbow®)

     




      • For the treatment of COPD ( as per pathway) only where triple therapy is indicated



     

    03.02 Beclometasone and formoterol Fostair MDI®
  • First choice LABA/ICS combination.
  • Prescribe by brand. Fostair ® has extra fine particles and is more potent than traditional beclomethasone CFC free inhalers.
  • Licensed for adults only. 200/6 strength is licensed in Asthma only.
  • See BTS guidance.
  • Fostair NEXThaler is NOT RECOMMENDED

  • 12.02.01 Beclometasone Dipropionate 

    • Nasal spray 50micrograms per spray 

    • Suitable for self care - patients aged 18 years and over may purchase from a Community Pharmacy. 


     

    05.01.09 Bedaquiline Sirturo®

    • CUH only. Non -formulary at NWAFT.

    • Only to be used as specfied in NHS England Specialised Services : Clinical Commissioning Policy: Bedaquiline and Delamanid for defined patients with MDR-TB and XDR-TB.

    03.04.02 Bee and Wasp Allergen Extracts Pharmalgen®

    Discontinued by the company - December 2019. 

    • CUHFT Tertiary Specialist service only - (Clinic 2a).
    • Non- formulary at other Trusts and in Primary Care. 
    • For use as per NICE guidance Pharmalgen.
    • CUHFT switched to Alutard SQ due to discontinuation of Pharmalgen in December 2019. 
    03.04.02 Bee and Wasp Venom Alutard SQ®

     

    • CUHFT Tertiary Specialist service only - (Clinic 2a). 
    • Non- formulary at other Trusts and in Primary Care.
    • CUH Switched to Alutard SQ when Pharmalgen was discontinued in December 2019. 
    • For use as per NICE guidance Pharmalgen.
    08.02.02 Belatacept Nulojix® Clinically approved for organ transplant recipients who are:
    • EBV seropositive AND
    • Intolerant of first-line immunosuppressive therapy (for example thrombotic microangiopathy with tacrolimus/ciclosporin, acute tubular necrosis with tacrolimus/ciclosporin, ymphocele with sirolimus) AND
    • In whom maintenance immunosuppression with an anti-proliferative agent (mycophenolate mofetil or mycophenolate sodium) and steroids alone is insufficient.
  • NOT ROUTINELY FUNDED. NEW PATIENTS REQUIRE FUNDING APPROVAL BEFORE INITIATING.
  • 20.01 Belatacept Nulojix® Clinically approved for organ transplant recipients who are:
    • EBV seropositive AND
    • Intolerant of first-line immunosuppressive therapy (for example thrombotic microangiopathy with tacrolimus/ciclosporin, acute tubular necrosis with tacrolimus/ciclosporin, ymphocele with sirolimus) AND
    • In whom maintenance immunosuppression with an anti-proliferative agent (mycophenolate mofetil or mycophenolate sodium) and steroids alone is insufficient.
    NOT ROUTINELY FUNDED. NEW PATIENTS REQUIRE FUNDING APPROVAL BEFORE INITIATING.
    10.01 Belimumab Benlysta®

    • Approved as per NICE TA397 and as commissioned by NHSE - suitable for shared care between specialist and secondary care via network model

    08.01.01 Bendamustine 

    • Approved in accordance with NICE TA216 for the treatment of chronic lymphocytic leukaemia.



    • Approved in accordance with NICE TA472 - Obinutuzumab with bendamustine for treating follicular lymphoma refractory to rituximab.



    • Also approved in accordance with the National Cancer Drugs Fund List for the indications below where the specified criteria are met:


      • The treatment of Chronic Lymphocytic Leukaemia (2nd, 3rd or 4th line). 

      • The first line treatment of low grade lymphoma.

      • The treatment of relapsed low grade lymphoma.

      • The treatment of rituximab refractory low grade lymphoma. Was removed from the CDF list on 12th March 2015. Remains on formulary for patients with funding approved prior to this date.

      • The first line treatment of mantle cell non-Hodgkin's lymphoma.

      • The treatment of relapsed mantle cell non-Hodgkin's lymphoma.

      • The treatment of relapsed multiple myeloma.





    • If to be funded by the CDF confirm approval on BlueTeq for all new starters

      For more information see Cancer Drug Fund List

    02.02.01 Bendroflumethiazide 
    03.04.02 Benralizumab Fasenra®

     

      • CUHFT only - approved for use in line with NICE TA565 for treating severe eosinophilic asthma (in adults).

     

    20 Benzathine Benzylpencillin 
  • ID/Clinic 1a for syphilis.
  • Can be difficult to source, use procaine benzylpencillin in this circumstance.
  • 03.08 Benzoin Tincture, Compound, BP Friars' Balsam
  • Not to be prescribed on an FP10 in primary care. Consider Self care if needed.
  • 13.06.01 Benzoyl Peroxide Acnecide®

    • Benzoyl Peroxide 5% gel in an aqueous, non-alcoholic gel base (Acnecide 5% gel).



    • PanOxyl® Aquagel 10% has been discontinued.




    • CUHFT - Formulary.



    • NWAFT - Non-formulary.


     

    12.03.01 Benzydamine Hydrochloride 

    • Mouthwash

    • Oromucosal spray

    • Consider whether prescribing in Primary Care should be by a dentist. Suitable for self-care. Can be purchased from a Community Pharmacist

    13.10.04 Benzyl Benzoate Application BP 25% 

    CUHFT - Formulary



    • Less suitable for prescribing (BNF)

    • Not recommended for treatment of scabies in local guidance

    • Not recommended for children — dilution to reduce irritant effect also reduces efficacy. Some manufacturers recommend application to the body but to exclude the head and neck. However, application should be extended to the scalp, neck, face, and ears (BNF)



    • Non formulary at all other trusts

    05.01.01.01 Benzylpenicillin Crystapen®

    • CUHFT specific information:Cellulitis: The addition of benzylpenicillin to flucloxacillin is not part of the guidelines for cellulitis. Treatment of cellulitis at CUHFT is as follows:


      • Cellulitis where necrotising fasciitis is unlikely – flucloxacillin monotherapy is adequate.

      • Necrotising fasciitis where aetiology is uncertain or polymicrobial or complicated (e.g. groin involvement, injection drug users, immunocompromised) – give ceftriaxone and clindamycin

      • Necrotising fasciitis where streptococcal aetiology is confirmed – give benzylpenicillin and clindamycin.


    • NWAFT: Formulary

    • RPH: Formulary for the treatment of endocarditis

    04.06 Betahistine Dihydrochloride 

    • Menières disease, vertigo.  


    09.08.01 Betaine Cystadane®

     

      • Available as Cystadane® Powder or 500mg tablets (unlicensed - unlicensed).




      • CUHFT only - Commissioned by NHSE for highly specialised services (metabolic liposomal disorders). Powder to be considered on case-by-case basis. Contact formulary/commissioning for further info.




      • Non formulary at all other trusts.



     

    20 Betaine tablets  

    • For consideration when powder unavailable or patient intolerant to.

    • 500mg

    06.03.02 Betamethasone Betnesol®

    • Injections & tablets for Obs & Gynae only for prophylaxis in threatened abortions.

    10.01.02.02 Betamethasone Betnesol®

    • CUHFT:

      • Maternity wards for threatened preterm labour.

      • Please note supply issues - dexamethasone is a suitable alternative.



    • Non formulary at all other Trusts

    12.03.01 Betamethasone 

    • Soluble betamethasone 500 micrograms tablets (as sodium phosphate).

    13.04 Betamethasone (as Dipropionate) 0.05% with Salicylic Acid 3% Diprosalic®

    Potent



    • In Primary Care - Formulary

    • CUHFT - Dermatology only.

    • Formulary at all other trusts

    13.04 Betamethasone (as Valerate) 0.025% 

    (Cream 0.025%, ointment 0.025%) (1 in 4 dilution of Betnovate® cream)


    Moderate

    13.04 Betamethasone (as Valerate) 0.1% Betnovate®

    Use generic for cream and ointment 0.1%, Scalp application 0.1%, Lotion 0.1%


    Potent



    • Primary Care - Formulary first choice

    • NWAFT - Non formulary

    • Formulary at all other trusts

    13.04 Betamethasone (as Valerate) 0.1% with Fucidic Acid 2% Fucibet®

    (Cream, Lipid cream)


    Potent with antimicrobial



    • In Primary Care - Formulary first choice if antimicrobial is needed

    11.04.01 Betamethasone 0.1% with Neomycin 0.5% eye drops Betnesol N®

    • RPH -  Specialist advice

    13.04 Betamethasone Dipropionate 0.064% with Clotrimazole 1% Lotriderm®

    (Cream)


    Potent with antifungal



    • Primary Care - Formulary 2nd line if antimicrobial is needed

    12.01.01 Betamethasone ear drops 

    • Eye, ear or nose drops 0.1%.

    • Intermittent supply problems. 


     

    11.04.01 Betamethasone eye drops Betnesol®

     

    • Eye drops 0.1%.
    • RPH - Specialist advice.


    July 2020 - Supply difficulties Betamethasone (Vistamethasone) 0.1% eye drops

    • Martindale are out of stock until October 2020.
    • RPH Pharma have sufficient supply of Betnesol eye/ear 0.1% drops to support the market.
    11.04.01 Betamethasone eye ointment Betnesol®

    • Eye ointment 0.1%

    • RPH - Specialist advice

    12.02.01 Betamethasone Sodium Phosphate  

    • Drops (for ear, eye, or nose) 0.1%

    12.02.03 Betamethasone Sodium Phosphate 0.1% with Neomycin Sulphate 0.5% Betnesol-N®
  • Drops (for ear, eye, or nose), betamethasone sodium phosphate 0.1%, neomycin sulfate 0.5%
  • 11.06 Betaxolol Betoptic®

    • As per NICE and local guidelines for treatment of glaucoma see link.

    • Ophthalmic solution 0.5%

    • Unit dose eye drop suspension 0.25% preservative free

    • For opthalmology use ONLY in patients who do not respond to or cannot tolerate timolol or levobunolol.

    08.02.03 Bevacizumab Avastin®

    • Only approved in accordance with the National Cancer Drug Fund List for the indications below where the specified criteria are met:

    • The third line treatment of low grade gliomas of childhood.

    • The first line treatment of recurrent or metastatic cervical cancer in combination with chemotherapy.

    • The first line treatment of advanced epithelial ovarian, fallopian tube or primary peritoneal cancer.

    • The treatment of advanced breast cancer. >To be removed from the CDF list on 4th November 2015. Remains on formulary for patients with funding approved prior to this date.

    • The first line treatment of advanced colorectal cancer with combination chemotherapy. To be removed from the CDF list on the 12th March 2015. Remains on formulary for patients with funding approved prior to this date.

    • The second or third line treatment of advanced colorectal cancer. > To be removed from the CDF list on 4th November 2015. Remains on formulary for patients with funding approved prior to this date.

    • The third or fourth line treatment of metastatic colorectal cancer as a single agent. Was removed from the CDF list on 4th November 2015. Remains on formulary for patients with funding approved prior to this date.

      Off-label intravitreal use (pre-filled syringes obtainable from Moorfields) for the following indications:
      • Neovascular glaucoma
      • For non-age related wet AMD
      • Anterior progressive ROP in neonates

    • Confirm funding approved on BlueTeq for all new CDF starters. Contact High Cost Drugs or oncology pharmacist for assistance.

    • TERMINATED APPRAISAL NICE TA560 - Bevacizumab with carboplatin, gemcitabine and paclitaxel for treating the first recurrence of platinum-sensitive advanced ovarian cancer. 


      For more information see Cancer Drug Fund List

    11.08.02 Bevacizumab  Avastin®
  • Off-label intravitreal use (pre-filled syringes obtainable from Moorfields) for the following indications:
    • Neovascular glaucoma
    • For non-age related wet AMD
    • Anterior progressive ROP in neonates
  • 20.01 Bevacizumab  Avastin®
  • Off-label intravitreal use (pre-filled syringes obtainable from Moorfields) for the following indications:
    • Neovascular glaucoma
    • For non-age related wet AMD
    • Anterior progressive ROP in neonates
  • 08.01.05 Bexarotene Targretin®
  • Clinically approved by JDTC, routinely commissioned.
  • 02.12 Bezafibrate 
    08.03.04.02 Bicalutamide 

    • If needed tablets can be crushed finely and dispersed in water, but this should be avoided by women of child bearing potential. Carers should wear protective clothing to minimise contact with crushed/ dispersed tablets.

    05.03.01 Bictegravir, emtricitabine, tenofovir alafenamide  Biktarvy®
    • CUHFT: 
      • Restricted to ID / GU Medicine advice only.
      • Clinic 1A - AIDS/HIV patients.
    11.06 Bimatoprost Lumigan®

     




      • For use by consultant opthalmologists ONLY as a 2nd line agent in patients who have an inadequate response to or cannot latanoprost or Travoprost.



     




      • 0.03% and 0.01% are both on the formulary.



     




      • 0.03% drops were discontinued at the end of April 2015. The 0.01% is considered an acceptable alternative (at the same dose: 1 drop once a day)



     




      • The 0.01% formulation contains a different concentration of excipients; this leads to greater absorption of the active drug into the eye. Thus the 0.01% formulation is considered to be equivalent in IOP-lowering efficacy to the 0.03% formulation, and is a suitable alternative to the discontinued product. Due to a higher preservative load, there is a potential for preservative- related reactions. If these occur, a preservative free option may be required.



     

    11.06 Bimatoprost with Timolol Ganfort®

    • As per local guidelines for treatment of glaucoma see link.

    • Eye drops

    • Minims

    08.01.05 Binimetinib Mektovi®

    • Approved for use in accordance with NICE TA562 - Encorafenib with binimetinib for unresectable or metastatic BRAF V600 mutation-positive melanoma. 
       

    12.03.05 Biotene Oralbalance® 

     

    • Artificial Saliva Gel
    09.08.01 Biotin  

    Tablets Injection

    06.01.01.02 Biphasic Insulin Aspart NovoMix® 30
    06.01.01.02 Biphasic Insulin Lispro Humalog® Mix
  • Available as Mix25 and Mix50.
  • 01.06.02 Bisacodyl 
    20 Bisacodyl 2.74mg/ml rectal solution  

    • Unlicensed

    • Approved for use in paeds patients with chronic constipation and ACE formation

    02.04 Bisoprolol 

    • First line choice of beta blocker in hypertension.

    09.05.01.02 Bisphosphonates 

    See Section 6.6.2

    02.08.01 Bivalirudin Angiox®

    • RPH: Formulary

    • Non formulary at all other Trusts

    08.01.02 Bleomycin 
    08.02.03 Blinatumomab Blincyto®

    • Used in accordance with NICE TA450 - Blinatumomab for previously treated Philadelphia-chromosome-negative acute lymphoblastic leukaemia. 

    14.04 Boostrix-IPV 
  • Diphtheria, tetanus, pertussis (acellular, component) and poliomyelitis (inactivated) vaccine (adsorbed, reduced antigen(s) content)

  • Part of the routine vaccination schedule for pregnant women (see link)
  • 20 Boric Acid 
  • Persistent vaginal candidiasis.
  • 08.01.05 Bortezomib Velcade®

    • Approved for use in accordance with NICE:


      • TA129 for the treatment of progressive multiple myeloma in people who are at first relapse having received one prior therapy and who have undergone, or are unsuitable for, bone marrow transplantation.

      • TA228 for the first-line treatment of multiple myeloma if high-dose chemotherapy with stem cell transplantation is considered inappropriate and the person is unable to tolerate or has contraindications to thalidomide.

      • TA311 for induction therapy in multiple myeloma before high-dose chemotherapy and autologous stem cell transplantation.





    • TERMINATED APPRAISAL NICE TA453 for treating multiple myeloma after second or subsequent relapse.



    • Also approved in accordance with the National Cancer Drugs Fund List for the indication(s) below where the specified criteria are met:


      • The treatment of bortezomib naive relapsed multiple myeloma. Confirm CDF approval is in place before treatment by reference to Blueteq.





    • The following indications were removed from the CDF list on 12th March 2015. Treatment remains available for patients with funding approved prior to this date:


      • The treatment of relapsed/refractory mantle cell lymphoma.

      • The treatment of relapsed multiple myeloma that has previously responded to bortezomib.

      • The treatment of relapsed Waldenstrom's Macroglobulinaemia.

        For more information see Cancer Drug Fund List



    02.05.01 Bosentan 

    • RPH: Restricted to use in pulmonary hypertension only, available via homecare 

    • CUHFT: Restricted to the treatment of digit ulceration in systemic sclerosis. Prior approval required (NHSE)

    • Non formulary at all other Trusts and in Primary Care


     

    08.01.05 Bosutinib Bosulif®

    • Apprived in accordance with NICE TA401 for use in chronic, accelerated and blast phase Philedelphia chromosome positive chronic myeloid leukaemia in adults if they have previously had one or more tyrosine kinase inhibitors, imatinib/nilotinib/dasatinib are not appropriate and it is discounted. 



    • Formerly approved in accordance with the National Cancer Drug Fund List the indications below where the specified criteria are met:


      • The treatment of chronic phase and accelerated phase Chronic Myeloid Leukaemia where other treatments are not tolerated. To be removed from the CDF on 4th November 2015. Remains on formulary for patients with funding approved prior to this date.

      • The treatment of blast crisis Chronic Myeloid Leukaemia where other treatments are not tolerated. To be removed from the CDF list on 12th March 2015. Remains on formulary for patients with funding approved prior to this date.





    • TERMINATED APPRAISAL NICE TA576 - Bosutinib for untreated chronic myeloid leukaemia. 

    04.09.03 Botulinum neurotoxin type A Xeomin®
    • Approved for use in line with NICE TA605 - Xeomin (botulinum neurotoxin type A) for treating chronic sialorrhoea. 
    • CUHFT: Approved for focal spasticity after brain or spinal lesions or neurodegenerative conditions in adults - requires GPA. 

     

    04.09.03 Botulinum Toxin Dysport®, Botox®, Neurobloc®,

    • CUHFT and NWAFT: Consultant recommendation only in line with Commissioned Indications.

    • (Neurobloc® is non-formulary at NWAFT)

    • CUHFT only: Dysport® is the formulary choice preferred product for new patients (Botox® is normally reserved for historic patients as not supposed to switch between products).

    • For CCG commissioned treatments a GPA is required prior to treatment commencing.

    • Botulinum toxin formulations are not interchangeable

    • Non-formulary at all other Trusts



    04.09.03 Botulinum Toxin Dysport®, Botox®, Neurobloc®,

    • CUHFT and NWAFT: Consultant recommendation only in line with Commissioned Indications.

    • CUHFT only: Dysport® is the formulary choice preferred product for new patients (Botox® is normally reserved for historic patients as not supposed to switch between products).

    • (Neurobloc® is non-formulary at NWAFT)

    • For CCG commissioned treatments a GPA is required prior to treatment commencing.

    • Botulinum toxin formulations are not interchangeable

    • Non-formulary at all other Trusts



    01.07.04 Botulinum toxin type A 

    • 3rd line: botulinum toxin. Single injection only, subsequent injections will not be routinely funded.

    • Tariff excluded

    • See CPJPG website for details of prior approval, funding and supporting information

    04.07.04.02 Botulinum Toxin Type A botox®

     



    • CUHFT: Consultant recommendation only in line with NICE TA260

    • Treatment not initiated at other Trusts

    07.04.02 Botulinum toxin type A  
    • Approved for:
      • The treatment of urinary incontinence in patients (adults) where antimuscarinic and a beta-3-adrenocepter agonists are inappropriate.
      • Low compliance or low capacity bladder in paediatrics.
    • Treatment is Tariff Excluded.
    • See CPJPG website for details of prior approval, funding and supporting information.

     

    13.12 Botulinum toxin type A  

    • CUHFT - Restricted Item In accordance with relevant Local Policy (below)

    • NWAFT - Restricted Item In accordance with relevant NICE TAs (below)

    • Approved for use in accordance with CPCCG 'Management of Hyperhidrosis' Policy Clinical Policies Link

    • Funding should be applied for under this policy using a GPA form

    20.01 Botulinum Toxin Type A 
  • Consultant recommendation only
    li>Warning: Units are not equivalent to Botox units.
  • Choice of botulinum toxin A across the Trust is under review (currently Dysport).
  • Indications on Formulary for hospital use only in accordance to prior approval documents(Dysport unless otherwise indicated - under review)
    1) Severe Blepharospasm in Adults
    2) Dysphagia caused by Achalasia
    3)Focal Spasticity after Brain or Spinal Lesions or neurodegenerative Conditions
    4)Torsion dystonias and other involuntary movements
    5)Low compliance/low capacity bladders in paediatrics
    6)Hyperhidrosis (axillae only
    7)Prophylaxis of migraine as per NICE TA 260 (administered through headache clinic)
    8)Musculoskeletal spasticity in cerebral palsy
    9)Spasticity in multiple sclerosis
    10)Contracture of the joint in multiple sclerosis
    11)Detrusor Overactivity
    12)Anal outlet obstruction in patient with internal anal sphincter achalasia and Hirschsprung disease
    13)Anal fissure
    14) Open abdomen following laparotomy surgery (funded by division)
    *PLEASE SEE CPJPG DRUG CLASSIFICATION DOCUMENT FOR LINKS TO PRIOR APPROVAL DOCUMENTS AND SUPPORTING INFORMATION*
  • 18 Botulism antitoxin antidote
  • Not routinely stocked.
  • Contains specific antitoxic globulins that have the power of neutralising the toxins formed by types A,B & E of Clostridium Botulinum
  • See also section 14.4
  • For post-exposure prophylaxis of botulism and for the treatment of persons thought to be suffering from botulism
  • 01.06.05 Bowel Cleansing Solutions Citramag®

    • As part of bowel preparation regime (available as a pre-packed kit) only.

    08.01.05 Brentuximab vedotin Adcetris®

    • Only approved in accordance with the National Cancer Drugs Fund List for the indications below where the specified criteria are met:

      • The treatment of refractory systemic anaplastic lymphoma.

      • The treatment of relapsed or refractory CD30+ Hodgkin lymphoma.





    • Approved for use in line with NICE TA478 - Bretuximab vedotin for treating relapsed or refractory systemic anaplastic large cell lymphoma.



    • Approved for use in line with NICE TA524 - Bretuximab vedotin for treating CD30-postiive Hodgkin lymphoma. 



    • Approved for use in line with NICE TA577 - Brentuximab vedotin for treating CD30-positive cutaneous T-cell lymphoma. 



    • Confirm funding approved on Bluteq for all new starters.
      For more information see Cancer Drug Fund List

    08.01.05 Brigatinib Alunbrig®

    • Restricted to use in line with NICE TA571 for treating ALK-positive advanced non-small-cell lung cancer after crizotinib. 

    11.06 Brimonidine tartrate 0.2% 

    • Ophthalmologists only. Second line in the management of glaucoma when prostaglandin analogues or beta blockers not tolerated, contraindicated or not effective.

    11.06 Brimonidine Tartrate 0.2% with Timolol 0.5% Combigan®

    • Eye drops

    • Ophthalmologists only. Second line in the management of glaucoma when prostaglandin analogues or beta blockers not tolerated, contraindicated or not effective.

    20 Brincidofovir  

    CUHFT:



    • Approved clinically  for symptomatic Adenovirus infection in immunosuppressed patients including transplant recipients with specified criteria including toxicity experienced by cidofovir subject to agreed supply from manufacturer

    • Please contact ChimerixNPP@ubc.com to apply for use if patient likley to be eligible

    • 100mg oral tablets and 10mg/ml oral solution (both unlicensed) only available through expanded access/compassionate use programme.Phase III trial product in the US only

    • Hospital only via inpatient pharmacy  

    • Standard dose for >or = to 50kg is 100mg twice weekly and for < 50kg is 2mg/kg twice weekly (max. 100mg twice weekly).

    • If a patient is taking ciclosporin then dose of 1.4mg/kg (up to max. of 70mg) twice weekly is recommended for 5 weeks or until Adenovirus cleared.


     


     

    11.06 Brinzolamide Azopt®

    • Eye drops 1%

    • Brinzolamide may be useful when dorzolamide is not tolerated due to local side-effects.

    11.06 Brinzolamide 1% with Timolol 0.5%  Azarga®

     

    • Eye drops
    • May be useful when dorzolamide + timolol is not tolerated due to local side-effects.

     

     

    A5.09 British Standard Activa® British Standard Compression Stockings: CCL1 14-17mmHg, CCL2 18-24mmHg or CCL3 25-35mmHg
    • Circular knit compression garment for regular limb shapes  (refer to appropriate pathway for selection within hosiery guideline). 
    • No oedema.
    • No sharpe distortion.
    • Superficial or early varices and prevention of DVT whilst travelling (CCL 1).
    • Medium varices, treatment and prevention VLU and associated conditions (CCL 2/3).
    • Product Information:
      • Size S - XL.
      • Handwash at 40°C.
      • Colours available: Black or sand. 
      • 3 months guarantee - 100 washes.
    • Patient should be prescribed TWO garments per leg (ONE to wash and ONE to wear). These should be replaced every 3 months. 
    04.08.01 Brivaracetam Briviact®

     



    • NWAFT and CUHFT: Specialist initiation for patients who experience behaviour side effects with levetiracetam (epilepsy)

    • RPH: Non-formulary

    • The potential for clinically relevant differences to exist between different brands is considered to be extremely low - consider prescribing generically

    13.05.03 Brodalumab Kyntheum®

    • Approved for use in line with NICE TA511 - Brodalumab for treating moderate to severe plaque psoriasis.

    04.09.01 Bromocriptine 

    • CUHFT: For use by Consultant Neurologists and Geriatricians ONLY.

    • Non-formulary at all other Trusts

    • For hyperprolactinaemia see section 6.7.1

    • If needed tablets can be dispersed in water. Give immediately and flush well with water.

    06.07.01 Bromocriptine 

    • Suppression of lactation. Although bromocriptine and cabergoline are licensed to suppress lactation, they are not recommended for routine suppression (or for the relief of symptoms of postpartum pain and engorgement) that can be adequately treated with simple analgesics and breast support. If a dopamine-receptor agonist is required, cabergoline is preferred. See BNF for further information

    01.05.02 Budesonide Budenofalk ®

    • 1st line formulary choice where a rectal formulation is required

    01.05.02 Budesonide Budenofalk®, Entocort®

    • For Adult Crohn's disease patients only

    • BRAND prescribing advised to ensure correct product for correct indication and correct dosing

    • CUHFT:

      • Both Budenofalk® GR 3mg capsules and Entocort CR 3mg capsules are on the formulary for Crohns Disease/ disease affecting the right side of the colon- clinicians can® use either/or although normally Budenofalk should be considered first line. (Specialist initiation)

      • Budenofalk E/C has also been approved for use in Graft versus Host Disease, Autoimmune hepatitis, and in transplant patients with suffering with significant side-effects to prednisolone (Hospital only)



    • NWAFT: Entocort® is on formulary (Oral Budenofalk® is non-formulary)

    • Non-formulary at all other Trusts

    01.05.02 Budesonide Cortiment MMX®

     

    • CUHFT and NWAFT: Adult patients only with Ulcerative Colitis. For induction treatment only (2-3 months treatment per year).
    • Brand prescribing advised to ensure correct product for correct indication.
    • Non-formulary at all other Trusts and in Primary Care. 

     

     

    03.02 Budesonide 

    • Budesonide MDI inhalers generally available.



    • Turbohaler restricted to patients unable to use other devices.



    • Pulmicort Respules



    • CUHFT:

      • Restricted to paediatric patients only requiring nebulised steroids.

      • HOSPITAL ONLY  

        • Second line treatment for eosinophilic esophagitis in adults and paediatric patients unable to manage administration of fluticasone.

        • A slurry can be made by mixing the contents of budesonide nebules with a sugar solution- a patient instruction leaflet exists with directions on how to do this, see unlicensed chapter. 







    • NWAFT: formulary


     

    03.02 Budesonide and formoterol Symbicort®
    • Primary care initiation following specialist recommendation for paediatric patients only - 1st line choice.
      • Not to be used in adult patients- Fostair is the first line alternative.
    • Prescribe by brand.
    03.02 Budesonide and formoterol DuoResp Spiromax®
  • Second line LABA/ICS inhaler for COPD where patients do not respond to Fostair.
  • Third line LABA/ICS for asthma after Fostair and Flutiform, or for asthmatic patients requiring breath actuated device.
  • Licensed for adults only
  • Prescribe by brand.
  • 02.02.02 Bumetanide 

     

    • Injection: Hospital only.
    • NWAFT: Only tablets on formulary.




     






     

     

     

    15.02 Bupivacaine and Adrenaline 

    • CUHFT - Restricted Item  Injection anhydrous bupivacaine hydrochloride 2.5 mg/mL (0.25%), adrenaline 1 in 200 000 (5 micrograms/mL). Injection anhydrous bupivacaine hydrochloride 5 mg/mL (0.5%), adrenaline 1 in 200 000 (5 micrograms/mL).

    • NWAFT - Formulary

    15.02 Bupivacaine Hydrochloride 

     

    • CUHFT: Restricted Item Injection 0.25%, Injection 0.5%, Infusion (epidural) 0.1% and 0.125% Restricted ItemIntralipid 20% is approved for use by consultant anaesthetists ONLY for use in patients with accidental overdose of bupivicaine unresponsive to basic and advanced life support. Stock and protocol held in theatres.

     

    • NWAFT: Formulary

     

    • RPH: Formulary - bupivacaine 0.1% 250ml bag. 

     

    15.02 Bupivacaine Hydrochloride with Glucose Marcain Heavy®

    • CUHFT only - Restricted Item Injection anhydrous bupivacaine hydrochloride 5 mg/mL (0.5%), glucose 80 mg/mL

    • NWAFT: Formulary

    • Non-formulary at all other Trusts


     

    15.02 Bupivacaine with Fentanyl 

     

    • CUHFT: Infusion (epidural), bupivacaine hydrochloride 1 mg/mL (0.1%), fentanyl (as citrate) 2 micrograms/mL. Infusion (epidural), bupivacaine hydrochloride 1.25 mg/mL (0.125%), fentanyl (as citrate) 2 micrograms/mL.

     

    • NWAFT: Formulary - 0.1% bupivicaine with fentanyl 2 micrograms in 1ml 250ml infusion.

     

    • RPH: Formulary - 0.1% bupivicaine with fentanyl 5 micrograms/mL; 250ml epidural infusion bag.



     

    04.07.02 Buprenorphine BuTrans®, Reletrans®, Sevodyne®

    • Patch (Weekly patch)

    • When compared to other opiates weekly buprenorphine patches are very weak and expensive.

    • See above for place in therapy.

    • CAUTION when switching between patches as different brands are not interchangeable.

    • When prescribed in Primary Care, preferred brands are Reletrans® or Sevodyne®. Prescribe by BRAND name and not generically.

    • CUHFT and RPH: Non-formulary

    04.07.02 Buprenorphine Temgesic®

    • CUHFT: Restricted to

      • DME.

      • Palliative Care.

      • Pain team for chronic pain.



    • Non-formulary at all other Trusts and in Primary Care

    04.07.02 Buprenorphine Transtec®, Bupeaze®

     

    • Patch (96 hours (4 days) patch)
    • When compared to other opiates weekly buprenorphine patches are very weak and expensive.
    • See above for place in therapy.
    • CAUTION when switching between patches as different brands are not interchangeable.
    • When prescribed in Primary Care, preferred brands is Bupeaze®. Prescribe by BRAND name and not generically.
    • RPH: Non-formulary.

    July 2020 - Supply Issues with Bupeaze Patches (Buprenorphine 96 hour patches)

    • Dr Reddy's have confirmed that the:
      • 35mcg and 52.5mcg patches are currently unavailable, due to be replenished in August.  
      • 70mcg patches are available.
    • NAPP pharmaceuticals have confirmed that they have stock available of all strengths of their 96-hour buprenorphine patch - Transtec: 35mcg, 52.5mcg and 70mcg.
    • Where patients need to be switched onto the alternative brand, please ensure that the prescription is written by the brand name TRANSTEC. 

     

     

    04.10.03 Buprenorphine Subutex®

    • For use by psychiatrists/dependence service only

    • Trusts: For continuation of established treatment only. Not currently commissioned to provide specialist prescribing for substance misuse services

    • Treatment to be retained by the specialist dependence service and not prescribed in Primary Care


     

    04.10.02 Bupropion Hydrochloride Zyban®

     

    • Prescribable in Primary Care only in combination with intensive behavioural support
    • Non-formulary at all other Trusts

    June 2020 - Supply issues with Zyban (bupropion hydrochloride) 150mg prolonged release tablets

    • Zyban® (bupropion hydrochloride) 150mg prolonged release tablets will be out of stock from week commencing 15th June 2020 until the end of November 2020.
    • See Supply Disruption Alert link below (issued 29th May 2020) for further information on how to manage patients during this shortage. 

     



     

    04.01.02 Buspirone Hydrochloride 

    • CPFT and CUHFT: For short term management of anxiety

    • Non-formulary at all other Trusts


     

    08.01.01 Busulfan 
    03.04.03 C1 esterase inhibitor Cinryze®

     



    • CUHFT only (JDTC October 2016).


     



    • HAE prophylaxis where oral prophylaxis has failed.


     



    • Non formulary at NWAFT and RPH. At RPH use Berinert instead (contact Haematology)


     



    • Approved as per NHSE circular pending homecare approval.


     



    • Tariff Excluded. Bluteq required.


     

    03.04.03 C1 Esterase Inhibitor Berinert®

    • Tariff excluded.

    • For the acute treatment of hereditary angioedema (see guideline below)

    • CUHFT: 500 units on formulary stocked in inpatients and the ED. 1500 units restricted to consultant immunologist initiation only and only stocked in Lloyds outpatients.

    • RPH: Blood product, not available from Pharmacy

    08.01.05 Cabazitaxel Jevtana®

    • Approved for use in line with NICE TA391.



    • Confirm funding approved on Bluteq for all new starters.


    04.09.01 Cabergoline 

    • CUHFT and RPH: Consultant Neurologists and Geriatricians

    • If needed tablets can be dispersed in water. Give immediately and flush well with water.

    • NWAFT: Non-formulary

    06.07.01 Cabergoline 

    • On formulary for hyperprolactinaemia

    • Restricted for the prevention of Ovary Hyperstimulation Syndrome (OHSS) with IVF (off-label).

    • Suppression of lactation. Although bromocriptine and cabergoline are licensed to suppress lactation, they are not recommended for routine suppression (or for the relief of symptoms of postpartum pain and engorgement) that can be adequately treated with simple analgesics and breast support. If a dopamine-receptor agonist is required, cabergoline is preferred.

    20.01 Cabergoline  April 2013 JDTC:
  • Prevention of ovary hyper stimulation syndrome due to IVF complications.
  • 08.01.05 Cabozantinib Cometriq®

    • Approved in accordance with the National Cancer Drugs Fund List for the indication below where the specified criteria are met:


      • The first line treatment of medullary thyroid cancer.





    • Approved for use in line with NICE TA516 - Cabozantinib for treating medullary thyroid cancer.



    • Confirm funding approved on Bluteq for all new starters. 




    • TERMINATED APPRAISAL NICE TA582 - Cabozantinib for previously treated advanced hepatocellular carcinoma. 

    08.01.05 Cabozantinib Cabometyx®

    • Approved in accordance with the National Cancer Drugs Fund List for the indication below where the specified criteria are met.



    • Approved for use in line with NICE TAs:

      • Carbozantinib for previously treated advanced renal cell carcinoma (NICE TA463).

      • Cabozantinib for untreated advanced renal cell carcinoma (NICE TA542).



    20.02 Cade oil ointment 
  • 12%:6%
  • 6%:3%
  • Only for severe scalp psoriasis.
  • 03.05.01 Caffeine Citrate 
    • NWAFT only: Non formulary at CUHFT and RPH.
    • Injection 5mg/ml BASE (10mg/ml caffeine citrate).
    • Oral Solution 5mg/ml BASE (10mg/ml caffeine citrate).
    • Prescribe as "caffeine citrate" (see MHRA warning below).

    July 2020 - Shortage of Caffeine Citrate 10mg/mL oral solution

    • Martindale, sole supplier, are out of stock of caffeine citrate 10mg/mL oral solution. Anticipated resupply date 3rd August 2020. 
    • Caffeine citrate 10mg/mL solution for injection, which is licensed for oral use, remains available and there is sufficient stock to support the market whilst the oral solution is unavailable. 
    • See Medicine Supply Notification (published 29/05/2020) for further information. 
    20 Caffeine Citrate 

    Injection 5mg/ml BASE (10mg/ml caffeine citrate)- licensed
    Oral Solution 5mg/ml BASE (10mg/ml caffeine citrate)- unlicensed for use in NICU/paeds

    13.03 Calamine 

    • In Primary Care this is self-care Self-care Policy



      • Lotion (Cutaneous suspension)

      • Oily lotion (BP 1980) - Contains arachis (peanut) oil



    09.05.01.01 CalciChew® 

    • Can be purchased from a Community Pharmacist - Consider self-care where the patient is willing and able

    13.05.02 Calcipotriol Dovonex®

    (Ointment 50micrograms/g)



    • In Primary Care - Formulary 1st choice

    • CUHFT Restricted Item Dermatologists for patients with psoriasis.

    • Formulary at all other trusts

    13.05.02 Calcipotriol 50micrograms/g with Betamethasone 0.05% Dovobet® Gel, Dovobet® Ointment, Enstilar® Foam

     

    • Dovobet Gel - available for patients with scalp psoriasis only. 
    • Dovobet Ointment and Enstilar Cutaneous Foam - licensed for the topical treatment of psoriasis vulgaris in adults.
    • In Primary Care - Formulary 2nd line choices.
    • CUHFT: Restricted Item Restricted to initiation by a Dermatologist.
    • RPH: Restricted Item Continued on the recommendation of a dermatologistformatti
    06.06.01 Calcitonin (salmon) / Salcatonin 
  • Nasal spray has been withdrawn from market due to concerns over increased risk of malignancies.
  • Name changed from salcatonin to calcitonin
  • EMA recommendation limiting long term use of calcitonin
  • Restrictions on use of calcitonin
  • 09.06.04 Calcitriol 
    13.05.02 Calcitriol 3micrograms/g Silkis®

    • CUHFT only

    • Ointment

    • For Dermatologists for flexure psoriasis.

    18 Calcium chloride  Discussion with National Poisons Information Service recommended for serious cases
  • calcium channel blocker antidote
  • 10% injection or infusion
  • 09.05.02.02 Calcium Acetate Phosex®

     




      • Generally recommended as first line phosphate binder. More effective than calcichew and less elemental calcium.



     



     

    09.06.04 Calcium and colecalciferol  Adcal D3®

    • Caplets contain 7.5mmol calcium and 200units colecalciferol

    • Chewable tablets contain 15mmol calcium and 400units 

    • Effervescent tablets are restricted only for use when chewable tablets not tolerated, contains 15mmol calcium and 400units colecalciferol per tablet 

    • Accrete D3 or Evacal D3 should be prescribed in Primary Care. Where a patient has swallowing difficulties Calfovit D3 can be considered in Primary Care.

    09.06.04 Calcium and colecalciferol  Accrete D3®, Evacal D3®,

    • First choice in primary care

    • Accrete D3: Each film-coated tablet contains 600 mg calcium (as calcium carbonate 1500 mg) and 10 micrograms of colecalciferol (equivalent to 400 IU vitamin D3). Twice daily formulation

    • Accrete D3: Each film-coated tablet contains 0.3 mg hydrogenated soya-bean oil

    • Accrete D3: Each chewable tablet contains 2,500 mg of calcium carbonate (equivalent to 1,000 mg of calcium) and 8.8 mg of colecalciferol concentrate (powder form) (equivalent to 22 micrograms of colecalciferol = 880 IU of vitamin D3). Once daily formulation.

    • Evacal D3: Each chewable tablet contains 1,500 mg of calcium carbonate (equivalent to 600 mg of calcium) and 4.0 mg of colecalciferol concentrate (powder form) (equivalent to 10 micrograms of
      colecalciferol = 400 IU of vitamin D3). Twice daily formulation.

    • Alternative brands will be prescribed in Secondary Care due to difference in contract prices

    • Can be purchased from a Community Pharmacist. However, if a prescriber has particular concerns that a patient might not be able to, or is unwilling to self-care and treatment with a medication is required, then a prescription (FP10) should be considered.

    09.06.04 Calcium and colecalciferol  Calfovit D3®

    • First choice in primary care for adult patients who are unable to take tablets or chewable tablets

    • Calfovit D3: Each sachet contains calcium phosphate 3100 mg (equivalent to 1200 mg or 30 mmol of elemental calcium per sachet) and 20 micrograms colecalciferol (equivalent to 800 IU). Once daily formulation

    • Alternative brands will be prescribed in Secondary Care due to difference in contract prices

    • Calcium and Vitamin D products can be purchased from a Community Pharmacist. However, if a prescriber has particular concerns that a patient might not be able to, or is unwilling to self-care and treatment with a medication is required, then a prescription (FP10) should be considered.

    09.06.04 Calcium and colecalciferol  Calcichew D3 Forte®, ®

    • Calcichew-D3 Forte 500 mg/400 IU chewable tablets contain calcium carbonate 1250 mg (equivalent to 500 mg of elemental calcium) and colecalciferol 400 IU (equivalent to 10 micrograms vitamin D3). Twice daily formulation.

    • Accrete D3 or Evacal D3 should be prescribed in Primary Care

    09.05.02.02 Calcium Carbonate Calcichew®

    • Calcium-based phosphate binders may be used as the initial binder therapy for patients with chronic kidney disease as they are cheap and relatively efficacious, in conjunction with dietary phosphate restriction, to control phosphorus and parathyroid levels.

    • If hypercalcaemia develops with the use of calcium carbonate, it may be necessary to convert to calcium acetate, a non calcium-containing phosphate binder, or a combination of both.

    • Link to SPC

    09.05.01.01 Calcium Chloride 14.7%

    • 10 mmol in 10ml

    • Acute treatment of hypocalcaemia.

    08.01 Calcium Folinate Folinic acid
    18 Calcium folinate  Methotrexate, methanol or formic acid overdose
  • See also section 8.1
  • Discussion with National Poisons Information Service recommended for methanol poisoning
  • Also known as folinic acid
  • 20.01 Calcium Folinate 
  • Paediatric neurologists for epilepsy in children with suspected folinic acid responsive seizures.
  • 18 Calcium gluconate   Injection
  • Discussion with National Poisons Information Service recommended for all cases of hydrofluoric acid poisoning and serious cases of calcium channel blocker poisoning
  • See also section 9.5.1.1
  • 09.05.01.01 Calcium Gluconate 10%  

    • Effervescent tablet is formulary at CUHFT. Non formulary at all other trusts

    18 Calcium gluconate gel  2.5% Gel
  • Discussion with National Poisons Information Service recommended in primary care, and for serious cases in secondary care
  • For hydrofluoric acid burns
  • 09.05.01.01 Calcium Salts Adcal®

    • CUHFT non formulary

    • Formulary at all other trusts

    • Can be purchased from a Community Pharmacist - Consider self-care where the patient is willing and able


     

    09.05.02.02 Calcium Salts with magnesium Osvaren®

    • Second line phosphate binder after Calcichew or Phosex.

    • Can be prescribed in primary care on hospital initiation.

    09.05.01.01 Calvive 1000® formerly Sandocal

     

    • RPH - Non formulary
    • Formulary at all other trusts
    • As of May 2020, GSK have discontinued Sandocal 1000 effervescent tablets and re-branded as Calvive 1000 effervescent tablets which is an equivalent product. 
    06.01.02.03 Canagliflozin Invokana▼®

     

    • In line with NICE TA315 and NICE TA390, only if triple therapy indicated
      Triple therapy in combination with metformin and either a sulfonylurea or pioglitazone  Dual therapy in combination with metformin, only if a sulfonylurea is contraindicated or not tolerated OR the patient has a significant risk of hypoglycaemia In combination with insulin (alone or with other drugs).  As monotherapy in patients who cannot tolerate metformin or where metformin, pioglitazone and sulfonylureas are inappropriate as an alternative to a dipeptidyl peptidase 4 (DPP-4) inhibitor.
    • Notes on licensing:
      • Licensed for initiation in adults aged over 18years.
      • For dose adjustment recommendations according to eGFR, please refer to the manufacturers summary of product characteristics

    • Due to its mechanism of action, patients taking canagliflozin will test positive for glucose in their urine and are at increased risk of urinary tract infection.

     

    02.05.05.02 Candesartan 
    04.08.01 Cannabidiol Epidyolex®
    • Approved for use in line with NICE TA614 - Cannabidiol with clobazam for treating seizures associated with Dravet syndrome.
    • Approved for use in line with NICE TA615 - Cannabidiol with clobazam for treating seizures associated with Lennox–Gastaut syndrome. 
    20 Cannabinoid oral solution Epidiolex®

    CUHFT only:



    • Clinically approved by CUHFT for up to seven children aged 2-8 years with at least one life threatening episodes per month (requiring urgent medical assessment or rescue therapy), with either Dravets or Lennox-Gastaut syndromes causing epilepsy, on the basis of recommendation of RCP and ABPN interim guidance (see document below).

    • Current best evidence for the use of cannabis based medicinal products suggests efficacy and short-term safety of Epidiolex® (cannabidiol) in two epileptic encephalopathies (Dravet and Lennox-Gastaut syndromes)

    • There is no licensed cannabis based medicinal product available in the UK; Epidiolex® is licensed in the US (but not in the UK or Europe) for Dravet and Lennox-Gastaut syndromes only.

    • Access to Epidiolex is limited to a compassionate use programme (max 5 patients allocated to CUHFT)

    • Epidiolex® is not currently commissioned; NICE is due to review clinical and cost effectiveness and is expected to publish guidance by the end of 2019.

    • Patients will need to be consented in line with current policies on the use of unlicensed medicines and compassionate use.

    • Epidiolex® is available in 100mg/ml. The starting dose is 2.5mg/kg twice daily, after a week this can be increased to a maintenance dose of 5mg/kg twice daily and this can be increased further to a max. of 10mg/kg twice daily as tolerated.

    13.09 Capasal® 

     



    • In Primary Care this is self-care Self-care Policy

    • CUHFT Restricted Item Dermatologists only

    • Non formulary at all other trusts

    08.01.03 Capecitabine Xeloda®

    20 Caphosol mouth rinse  

    Medical device
    Contains:-
    Dibasic Sodium Phosphate 0.052, Monobasic Sodium Phosphate 0.009, Calcium Chloride 0.052, Sodium Chloride 0.569, Purified water qs (%w/w).
    To treat and prevent oral mucositis caused by radiation or high dose chemotherapy
    Hospital only

    20 Caplacizumab Caplivi®

    • JDTC May 2019: clinically approved to trat acquired thrombotic thrombocytopenic purpura (aTTP) via compassionate access scheme only

    • Drug is licensed but not yet launched in the UK

    • Can be obtained out of hours in emergency from company (they operate 24hrs)

    • 10mg powder adn solvent for injection. Normally given as 10mg i/v given with plasma exchange followed by 10mg s/c daily for 30 days

    05.01.09 Capreomycin Capastat®

    • CUH only. Restricted for use in MDR tuberculosis.

    10.03.02 Capsaicin Axsain®



    • NWAFT and Primary Care: Capsaicin 0.075% cream for people with localised neuropathic pain (off-label) who wish to avoid, or who cannot tolerate; oral treatments.
    • CUHFT: Specialist advice via Lloyds OP.
    • Non formulary at all other Trusts.
    • Zacin® Cream 0.025% and Qutenza® cutaneous patches are not recommended for prescribing in primary or secondary care. 





     

     

    02.05.05.01 Captopril 

    • CUHFT: Accepted on Formulary for use by cardiologists for ACEI test dose; not for treatment. (Hospital only)

    • RPH: Restricted to the treatment of refractory autonomic dysreflexia

    • NWAFT: formulary

    04.02.03 Carbamazepine 

    • Requires specialist initiation by mental health team

    • For prophylaxis of bipolar disorder unresponsive to lithium. Not recommended for acute mania.

    • Consider drug interactions.

    • Modified release (MR) tablets may help reduce incidence of dose-related side-effects.


     

    04.07.03 Carbamazepine 

    • Approved for neuropathic pain.

    04.07.03 Carbamazepine 
    04.08.01 Carbamazepine Tegretol®

    • May be appropriate for specialist GP to initiate or any GP to prescribe whilst awaiting hospital referral (Specialist advice).

    • If using carbamazepine, offer controlled-release carbamazepine preparations [NICE 2012].

    • Patients should be maintained on an agreed brand.

    • Care when switching between formulations as bioavailability varies and the patient may require a change in dose.

    • In Primary Care - Tegretol® is the preferred brand.

    06.02.02 Carbimazole Neo-Mercazole®

    • Warning neutropenia and agranulocytosis - Prescribers are reminded of the importance of recognising bone marrow suppression induced by this medication and the need to stop treatment promptly.

    • If needed tablets can be crushed and dispersed in water.

    03.07 Carbocisteine 
    11.08.01 Carbomers 

     

      • Can be purchased from a Community Pharmacist. Recommend self-care where patient is willing and able

     

      • Trusts: Restricted to ophthalmologists, for dry eye syndrome (Brands may vary to those used in Primary Care due to contract prices)

     

      • 2nd line formulary choice in Primary Care. Preferred brands are:

          • Clinitas® Carbomer 0.2% eye gel (contains cetrimide). Expires 28 days after opening

          • Viscotears® 2mg/g liquid gel (contains cetrimide). Expires 28 days after opening

          • Where a preservative free formulation is required (in-line with Primary Care guidance) Viscotears® 0.6ml Unit Dose Vials. Discard each single dose vial after use




     

    08.01.05 Carboplatin 
    07.01.01 Carboprost Hemabate®

    • CUHFT: For Rosie Maternity Hospital in line with Post Partum Haemorrhage (PPH) guidelines.

    • NWAFT: Formulary

    • Non-formulary at all other Trusts

    08.01.05 Carfilzomib Kyprolis®

    • In line with NICE TA457 for previously treated multiple myeloma. 

    09.08.01 Carglumic Acid Carbaglu®

    • CUHFT only: Hyperammonaemia due to N-acetylglutamate synthase (NAGS) deficiency - Specialist use only.

    11.08.01 Carmellose 

    • Can be purchased from a Community Pharmacist. Recommend self-care where patient is willing and able

    • Trusts: Restricted to ophthalmologists, for dry eye syndrome (Brands may vary to those used in Primary Care due to contract prices)

    • 3rd line formulary choice in Primary Care. Preferred brands are:

      • Optho-Lique 0.5% eye drops® (contains oxychloro complex, preservative which dissolves upon administration)Expires 28 days from opening

      • Cellusan Light 0.5% eye drops preservative free® Expires 90 days from opening OR Cellusan 1% eye drops preservative free® Expires 90 days from opening.




     


     

    08.01.01 Carmustine Gliadel®
  • As per NICE TA121 for use by neuro-oncologists and neuro-surgeons ONLY.
  • 11.06 Carteolol Teoptic®

    • For opthalmology use ONLY in patients who do not respond to or cannot tolerate timolol or levobunolol.

    02.04 Carvedilol 

    • Management of Heart Failure

    • When initiated in secondary care- Restricted to Consultant Cardiologist only

    20.01 Carvedilol 
  • Prophylaxis of variceal bleeding.
  • 05.02.04 Caspofungin Cancidas®

    • CUHFT: Microbiology approval only when Ambisome not effective.

    • NWAFT: Recommended as per Trust guidelines or on microbiology advice

    • RPH: No restriction when used by Thoracic, Transplant or Critical Care Directorates.


     

    07.04.04 Catheter Patency Solutions 

    • CUHFT: Formulary

    • Non-formulary in all other Trusts and Primary Care

    07.04.04 Catheter Patency Solutions 

    • CUHFT: For catheter patency when syringe sod. chloride too fierce. Sodium chloride 0.9% Urotainers may be used for patients requiring catheter maintenance (except urology patients with haematuria).

    • NWAFT: 3 litre and 100ml bladder irrigation on formulary

    • Primary Care: Bard Optiflo Sodium Chloride 0.9% 50ml is formulary choice

    • Non-formulary in all other Trusts

    07.04.04 Catheter Patency Solutions 

    • NWAFT: Formulary

    • Primary Care: Urotainer Twin Suby G (3.23% citric acid) is formulary choice. (On specialist advice only)

    • Non-formulary at all other Trusts

    05.01.02.01 Cefalexin 

     

    • Primary Care: Recommended as a treatment option for the management of lower UTI in pregnancy. See Primary care Antibiotic Guideline for further information.
    • NWAFT: First line in treatment of UTI in pregnancy.
    • CUHFT: Empiric first line for pregnant UTI treatment.
    • RPH: Non-formulary.

       

     

    05.01.02.01 Cefepime Renapime®
    • NWAFT only via OPAT: Restricted to use on the recommendation of Microbiology only as a second line treatment option when first line anti-pseudomonal therapies are unsuitable due to resistance/allergies. 
    05.01.02.01 Cefixime Suprax®

    • Primary Care: Suspected Epididymo-orchitis- high risk of STI, 2nd line 400mg single dose as an alternative to ceftriaxone if not available.

      Ideally, refer for same-day or next-day assessment by a sexual health specialist (if mumps orchitis is not diagnosed).


      Only treat if urgent referral to a sexual health service is not possible:


      Obtain a MSU for dipstick, microscopy and culture. Test for STI. Treat without waiting for test results for all suspected organisms.


      In sexually active adolescents and men younger than 35 years of age, the causative organism is likely to be Chlamydia trachomatis or Neisseria gonorrhoeae


       

    • CUH info : For Clinic 1A/ID only for treatment of gonorrhoea (400mg stat).

    • NWAFT info: Non formulary

    05.01.02.01 Cefotaxime 

     




      • NWAFT info: restricted to use in neonates and children under 3 months

      • RPH: Non-formulary



     

    20 Cefotaxime Preservative Free 
  • Severe corneal infections as second line to ofloxacin.
  • Extemporaneous preparation.
  • 05.01.02.01 Ceftazidime 

     




      • CUH additional info: Injection can be used to manufacture an intravitreal injection. See appropriate monograph on Trust Intranet.

      • NWAFT info: Restricted to Pseudomonas infection in respitatory patients.

      • RPH: Use is not restricted within the Thoracic Directorate



     

    11.03.01 Ceftazidime  

    • CUHFT only

    • 2mg in 0.1ml.

    • Intravitreal monograph see link.

    • Non formulary at all other trusts

    • RPH - Specialist advice

    05.01.02.01 Ceftazidime and Avibactam Zavicefta®

    • CUHFT: (Micro Consultant Advice Only):

      • Clinically approved for the treatment of of carbapenemase-producing organisms (CPO) specifically Klebsiella pneumoniae Carbapenemase (KPC)-Producing where alternative treatments are not tolerated or where antibiotic resistance leaves no alternative efficacious regime in adults

      • 3rd or 4th line where standard antimicrobials had failed to treat the infection and probably in combination with either amikacin or colistemethate (to reduce resistance), where sensitivity tests had proven susceptibility and there was no other alternative or if a patient had experienced nephrotoxicity then it may be used as monotherapy.



    • NWAFT: Non-formulary

    • RPH: Restricted use

    05.01.02.01 Ceftolozane and Tazobactam Zerbaxa®

    • CUHFT: (Micro Consultant Advice Only):

      • Clinically approved for the treatment of multi-drug resistant Pseudomonas aeruginosa infections in adults

      • 3rd or 4th line where standard antimicrobials had failed to treat the infection and probably in combination with either amikacin or colistemethate (to reduce resistance), where sensitivity tests had proven susceptibility and there was no other alternative or if a patient had experienced nephrotoxicity then it may be used as monotherapy. Double the standard, licensed dose may be used if appropriate.



    • NWAFT: Non-formulary

    • RPH: Restricted use

    05.01.02.01 Ceftriaxone 

    • CUH info: Ceftriaxone no longer feature as first line therapy in the ADULT antibiotic guidelines and requires Microbiology or Infectious Diseases approval : EXCEPTIONS include community acquired CNS infections such as meningitis or brain abscess. Ceftriaxone is not restricted in paediatric patients.

    • NWAFT info: Restricted to treatment of meningitis, typhoid fever and  for use in paediatrics.

    05.01.02 Cefuroxime 

    • CUH Non- formulary

    10.01.01 Celecoxib Celebrex®

    Routine use of Cox II selective inhibitors is not recommended.



    • Celecoxib should be used ONLY in patients who:
      1) Have severe disease uncontrolled by simple analgesics AND
      2) Are considered to be at high risk of gastrointestinal bleeding AND
      3) at least one of the following applies:

      • Are intolerant of NSAID + PPI because of GI symptoms

      • Are intolerant of PPIs (e.g. because of headaches / GI side-effects)

      • Have asthma that is exacerbated by conventional NSAIDs. [N.B. Many, but not all, patients with asthma will also fail to tolerate Cox-2 inhibitors]

      • Are on multiple medications and have problems with concordance that are likely to be exacerbated by the addition of two drugs rather than one

      • Are judged to be at VERY high risk of gastrointestinal complications (e.g. history of previous bleeds or ulcer complications) but have symptoms that cannot be adequately controlled without the use of anti-inflammatory drugs. In these cases a COX II selective inhibitor may be combined with a PPI on the advice of a specialist (but note that a robust evidence base for this is lacking).



    08.01.05 Cemiplimab Libtayo®

    • Approved for use in line with NICE TA592 - Cemiplimab for treating metastatic or locally advanced cutaneous squamous cell carcinoma:

      • Cemiplimab is recommended for use within the Cancer Drugs Fund as an option for treating locally advanced or metastatic cutaneous squamous cell carcinoma in adults when curative surgery or curative radiotherapy is not appropriate. It is recommended only if the conditions in the managed access agreement are followed.



    20 Cemiplimab  Libtayo (proposed)

    Due to be licensed as Labtayo® in near future



    • JDTC/OSTS April 2019. Clinically approved as per compassionate access scheme for cutaneous squamous cell cancer  ie.e. free of charge scheme only

    • 350mg/7ml solution infusion

    08.01.05 Ceritinib Zykadia®

    • Approved in accordances with NICE TAs:

      • Ceritinib for previously treated anaplastic lymphoma kinase positive non-small-cell lung cancer (NICE TA395).

      • Ceritinib for untreated ALK-positive non-small-cell lung cancer (NICE TA500). 



    10.01.03 Certolizumab Pegol Cimzia®

     




      • Approved in accordance with NICE TA375, TA383, TA415, TA445 and TA574.



     

    03.04.01 Cetirizine 
    Consider Self care if clinically appropriate.

    At all hospital trusts- review indication and check whether continued use is needed during inpatient hospital stay before ordering from pharmacy.
    13.02.01 Cetraben® 

     

    • Primary Care and NWAFT only.
    • Cream.
    • Greasy level 1/4 (least greasy).
    • Use Emollients Safely There is a fire risk associated with all emollients whether they contain paraffin or not.
    08.01.05 Cetuximab Erbitux®

    Approved in accordance with NICE:



    • TA145 for the treatment of locally advanced squamous cell cancer of the head and neck where platinum-based treatment is contraindicated. 



    • TA176 for the first-line treatment of metastatic colorectal cancer where the metastatic disease is confined to the liver but is unresectable and the patient is fit enough to undergo surgery to resect the primary tumour and the liver if the metastases become resectable.



    • TA473 for treating recurrent or metastatic squamous cell cancer of the head and neck.


    Also approved in accordance with the National Cancer Drugs Fund List for the indication(s) below where the specified criteria are met:



    • The first line treatment of advanced head and neck cancer.



    • The first line treatment of metastatic colorectal cancer that does not meet the criteria of NICE TA176.



    • The second or third line treatment of metastatic colorectal cancer with combination chemotherapy. Was removed from the CDF list on 12th March 2015. Remains on formulary for patients with funding approved prior to this date.



    • The third or fourth line treatment of metastatic colorectal cancer as a single agent. 

      For more information see Cancer Drug Fund List.

    09.08.01 Chenodeoxycholic acid 
    • CUHFT:
      • Approved for treating inborn errors of bile acid synthesis (sterol 27-hydroxylase enzyme deficiency) (all ages) as per NHS England commissioning policy 170127P only. 
      • Strictly no other indications allowed.
    • DO NOT PRESCRIBE in Primary Care or other Secondary Care Trusts in C & P.
    • Formulary submission specific to indication must be submitted and approved prior to prescribing and use. 
    • Cost to Primary Care (Drug Tariff May 2020): £14,000 per 100 capsules of 250mg strength. 

     

    04.01.01 Chloral Hydrate 

     

    • CUHFT and NWAFT: Specialist initiation for paediatric use only.
    • Non-formulary at all other Trusts and in Primary Care.
    • Where a liquid preparation is clinically required for paediatric patients, Chloral Hydrate 500mg/5mL is the standardised liquid strength which should be prescribed in children (unlicensed unlicensed):
      • Using standardised strengths of unlicensed liquid medicines in children, will reduce the risk of errors being made in the doses given to children and prevent hospitalisation from accidental under and overdoses
      • See link below for further information.
    08.01.01 Chlorambucil 
    05.01.07 Chloramphenicol 

    • CUH Only : and only to be prescribed on advice by Microbiology.

    • NWAFT: non- formulary.

    11.03.01 Chloramphenicol 

    • Eye drops 0.5%, Eye ointment 1%, Minims 0.5% (preservative free)

    • Chloramphenicol preparations are the 1st line formulary choice for treatment of bacterial eye infections.

    • Consider Self Care for children and adults over 2 years with acute bacterial conjunctivitis


          Star Drops should be stored in a fridge

    05.01.07 Chloramphenicol IV 

    • Restricted to on the advice of Microbiology only.

    • NWAFT additional info: Restricted to use in the treatment of meningitis, where there is documented evidence of anaphylaxis with penicillins.

    04.01.02 Chlordiazepoxide 

    • For use in alcohol withdrawal only


     

    12.03.04 Chlorhexidine 

     

      • All Trusts: Mouthwash 0.2%
      • -CUH: Obtain from trust procurement, not pharmacy

     

      • Dental Gel is formulary at NWAFT only

     

      • Consider whether prescribing in primary care should be by a dentist

     

      • Consider self-care. Can be purchased from a Community Pharmacist

     

    20 Chlorhexidine 0.02%  
  • Management of Acanthomeba keratitis.
  • Ophthalmologists only.
  • 13.11.02 Chlorhexidine 0.05% 

    Prescribe Unisept® Sachets in primary care



    • CUHFT - Formulary

      • Product dependent on whether to obtain from pharmacy or procurement.

      • For cleansing and disinfecting wounds and burns.

      • Pink solution



    • Non formulary at all other trusts

    12.02.03 Chlorhexidine Hydrochloride 0.1%, Neomycin Suphate 0.5% Naseptin®
    05.04.01 Chloroquine 
    10.01.03 Chloroquine 

    • CUHFT: Non-formulary for discoid lupus erythematosus and for rheumatology.

    • Non formulary at all other Trusts

    02.02.01 Chlorothiazide 

    • CUHFT: Suspension 250mg/5ml for paediatric use only. Available as an unlicensed import.unlicensed unlicensed

    • Non formulary at all other Trusts and in Primary Care

    03.04.01 Chlorphenamine 
    • Consider Self care if clinically appropriate.
    • At all hospital trusts- review indication and check whether continued use is needed during inpatient hospital stay before ordering from pharmacy.
    • Chlorphenamine use in pregnancy - Where use of chlorphenamine in pregnancy is being considered, the available pregnancy safety data and its limitations should be discussed with the patient. See link below for further information. 
    04.02.01 Chlorpromazine 

     



    • Requires specialist initiation by mental health team

    • Use of intramuscular chlorpromazine is not recommended - can cause marked postural hypotension.

    • NWAFT and CUHFT: Tablets are on formulary for intractable hiccup  


     

    04.06 Chlorpromazine 

    See section 4.2.1



    • CUHFT and NWAFT only: May be used in the treatment of hiccup

    02.02.01 Chlortalidone 

    • CUHFT: Formulary (may be difficult to obtain)

    • Non-formulary at all other Trusts and in Primary Care

    14.04 Cholera vaccine Dukoral®
  • Oral suspension

    Amber Traffic Light In Primary Care - Available free of charge to some travellers (see links)

  • CUHFT - Non-Formulary
  • NWAFT - Non-Formulary
  • PAPWORTH - Non-Formulary
  • 12.03.01 Choline Salicylate Bonjela® Adult

    • NB: Bonjela Adult is suitable from 16 years only.

    • Suitable for self-care. Advise patients they can purchase from a Community Pharmacist

    06.05.01 Chorionic Gonadotrophin Gonasi®

     




      • Pregnyl (all strengths) discontinued. unlicensed  Gonasi is an unlicensed import as this is the only alternative in correct strength. Consistent practice across UK



     




      • Also known as Human Chorionic Gonadotrophin; HCG.



     


     

    20 Chorionic gonadotrophin Gonasi®

    Unlicensed medicine.
    Available as 2,000IU and 5,000IU
    Imported from Italy.
    JDTC Jan ’18:-
    o Clinically and financially approved
    o Formulary status: Hospital only via clinic
    To be used by Cambridge IVF for hypogonadoptrophanism to aid spermatogenesis and


     


    the HCG stimulation test, to determine the Leydig cell responsiveness of the testes.


     


    this replaces Pregnyl which has now been discontinued. Gonasi and Pregnyl are conisdered to be therapeutically equivalent. There is no UK licensed product available in strength required.

    03.02 Ciclesonide Alvesco®
    • Prescribable in Primary Care after Specialist Initiation.
    • Restricted - to patients where there is persistne oral thrush with standard therapy - Licensed for adolescents and adults aged 12 years and above. 
    01.05.03 Ciclosporin 

     



    • Maintenance of remission of severe ulcerative colitis or steroid refractory disease not requiring immediate surgery – unlicensed but in line with national guidelines and shared care.

    • Patients should be stabilised on a specific brand - switching is not recommended


     

    08.02.02 Ciclosporin Neoral® and Sandimmun®

     

    • Capsules25mg, 50mg, 100mg, Oral Solution(Neoral®), Injection (Sandimmun®)
    • MHRA specify that ciclosporin must be prescribed and dispensed by brand as bioavailability differences exist between brands. Neoral is the preferred brand in Cambridgeshire for transplant indications.Neoral liquid is equivalent to Neoral capsules. If changing from any other preparation contact Medicines Information for assistance.
    • RPH: Shared Care Guideline in place and also supply can be made via Homecare.

    FEBRUARY 2020 - DO NOT REPATRIATE EXISTING PATIENTS, SHARED CARE GUIDELINES ARE CURRENTLY UNDER REVIEW.

     

    10.01.03 Ciclosporin 

    See also section 8.2.2



    • MHRA specify that ciclosporin should be prescribed by brand. The formulary brand may varify across Trusts.

    • If a patient needs to change ciclosporin brand or between formulations contact Pharmacy / Medicines Information or the Medicines Optimisation Team for assistance.

    • NB. Neoral liquid is equivalent to Neoral capsules.

    11.99.99.99 Ciclosporin Ikervis®

     

        • Oily eye drops 2% formulated in arachis oil. Avoid in peanut allergy.

     

        • Preservative free.



        • Severe dry eye induced keratitis not responding to artificial tears.



        • As per NICE TA369.




        • Specialist initiation only.

     

    13.05.03 Ciclosporin 

     

    • CUHFT Restricted Item For psoriasis, consultant dermatologists only.
    • CONTINUATION IN PRIMARY CARE:  Prescribable in primary care after specialist initiation in line with the shared care guideline for inflammatory dermatoses. See link below. 
    • Non formulary at all other trusts.

     

    20 Ciclosporin  
  • 1st Line: Dr Kerr-Muir and named consultants.
  • For the management of inflammatory and immune based eye disease in adults intolerant to steriod eye drops or where steroid eye drops are ineffecitve or cause adverse effects.
  • 20 Ciclosporin 0.05% Minims 
  • 2nd line.
  • For the management of inflammatory and immune based eye disease in adults intolerant to steroid eye drops or where steroid eye drops are ineffective or cause adverse effects.
  • 20 Cidofovir  Vistide®
  • Cidofovir infusion approved clinically by JDTC July 2014 for following indications:

    • First-line treatment in haemato-oncology patients for Adenovirus viraemia(*please submit IFR for external funding)

    • Second or third line treatment in CMV viraemia (routinely commissioned by NSHE- no need for IFR)

    • Treatment of BK polyma virus viraemia and/or adenovirus viremia in immunocompromised patients (*please submit IFR for external funding)
    *Note internally funding agreed for those cases where an IFR is declined, ahead of decision i.e. treatment should not be delayed
  • 20 Cidofovir 1%  
  • Clinically approved at JDTC 2004.
  • Dermatologists for recalcitrant warts & GIN patients.
  • Cost has increased 8 fold since 2004.
  • Available via Lloyds Pharmacy.

  • 20.02 Cidofovir cream (in Unguentum M) 
  • 1%.
  • Not in BAD list.
  • 05.03.02.02 Cidofovir infusion Vistide®

    • CUHFT only


    Cidofovir infusion (no longer licensed in UK) approved clinically and financially by JDTC July 2014 for following indications: • First-line treatment in haemato-oncology patients for Adenovirus viraemia • Second or third line treatment in CMV viraemia • Treatment of BK polyoma virus viraemia and/or viruria in umminucompromised patients. However please discuss with commissioing on ext 6834 as there may be grounds to apply for external funding.


    Non  formulary at all other Trusts.

    09.05.01.02 Cinacalcet Mimpara®

     

    • CUHFT:
      • For the management of SECONDARY hyperparathyroidism (SHPT) in patients with chronic renal failure (CRF) - HOSPITAL ONLY (SCG currently being finalised).
      • For the management of PRIMARY hyperparathyroidism in patients with severe hypercalcaemia awaiting surgery or deemed unfit for surgical management - Specialist Initiation with SCG for continuation in Primary Care. 
    • NWAFT - For the management of secondary hyperparathyroidism (SHPT) in patients with chronic renal failure (CRF) - Specialist Initiation with SCG for continuation in Primary Care. 

     

     

    04.06 Cinnarizine 
  • For vestibular disorders, vertigo, motion sickness
  • If needed tablets can be dispersed in water. (They disperse within 1 minute).

  • 05.01.12 Ciprofloxacin 

    • Avoid oral AND IV ciprofloxacin because of C. diff - unless specifically mentioned in Trust antibiotic guidelines.

    • NWAFT and CUHFT: Microbiology approval is required for all other cases.

    • Liquid available (250mg in 5ml), but tablets can be crushed & dispersed in water if needed. Liquid should NOT be used for administration via enteral tubes (e.g. PEG) as this can cause blockages.

    • 500mg orally gives equivalent AUC to 400mg IV. 750mg orally gives higher AUC and same peak.

    • RPH: 2nd line for the treatment of UTI.

      • May be issued as a reserve course by Thoracic Directorate




     

    11.03.01 Ciprofloxacin 

    • Eye drops 0.3%, Eye ointment 0.3%

    • Ciprofloxacin 0.2% preservative free eye drops only when microbiology sensitivities show susceptibility to ciprofloxacin and resistance to levofloxacin.

    • RPH -  Specialist advice

    12.01.01 Ciprofloxacin Cetraxal®

     


     

    05.01.12 Ciprofloxacin IV 
    08.01.05 Cisplatin 
    04.03.03 Citalopram 

    • First line choice antidepressant

    • 8mg (4 drops) of citalopram 40mg/ml oral drops is equivalent in therapeutic effect to one 10mg citalopram tablet

    • Please note MHRA safety advice below relating to maximum doses


     

    20 Citric acid 
  • Approved for reflex testing on NCCU.
  • 08.01.03 Cladribine Mavenclad®

     

    • Approved for use in line with NICE TA616 treating relapsing–remitting multiple sclerosis. 

     

    08.01.03 Cladribine Leustat®
  • For the treatment of Hairy Cell Leukaemia.
  • Use in multiple sclerosis and pulmonary langerhans histiocytosis is not routinely commissioned - IFR approval must be sought before initiation.
  • Contact formulary pharmacist.
  • 05.01.05 Clarithromycin 

    • Usually macrolide of choice.

    05.01.05 Clarithromycin 
    05.01.06 Clindamycin 

    • Recommended second line in Primary Care for unresolving cellulitis and erysipelas: see primary care antimicrobial guidelines

    • Pseudomembranous colitis is a serious toxic effect of clindamycin

    • 90% bioavailability orally so IV not necessary unless dose needs to go over 450mg qds (secondary care only). IV relatively expensive and irritant.


     

    07.02.02 Clindamycin Dalacin®

    • Bacterial vaginosis where oral metronidazole is inappropriate.

    13.06.01 Clindamycin 1% Dalacin T®

    (Lotion, Topical Solution, Gel)



    • In Primary Care - Lotion is Formulary 2nd line (Topical Solution and Gel are Non-formulary)

    • CUHFT - Topical solution is Formulary (Lotion is non-formulary)

    • NWAFT - Formulary

    04.08.01 Clobazam 

     

    • CUHFT and NWAFT: Formulary for the management of epilepsy
    • RPH: Non-formulary
    • Base the need for continued supply of a particular brand on clinical judgement and consultation with patient and/or carer, taking into account factors such as seizure frequency and treatment history.

     

    13.04 Clobetasol propionate 0.05% Clarelux®

    • Foam

    • Very potent

    • NWAFT only - Restricted to use in dermatology

    • Non formulary at all other trusts

    13.04 Clobetasol Propionate 0.05% Dermovate®

    (Cream, Ointment, Scalp application, Shampoo (Etrivex®))


    Very Potent



    • In Primary Care - Formulary

    • CUHFT Restricted Item  Dermatology only.

    • Non formulary at all other trusts

    13.04 Clobetasone Butyrate 0.05% 

    Moderate


    NB. At CUHFT this is classified as being mildly potent, this differs from the classification in the BNF but was done so after consultation with the Dermatologists.

    13.04 Clobetasone Butyrate 0.05%, Oxytetracycline 3%, Nystatin 100 000 units/g Trimovate®

    Moderately potent with antimicrobials

    08.01.03 Clofarabine Evoltra® Approved in accordance with the National Cancer Drugs Fund List for the indication(s) below where the specified criteria are met:
  • The treatment of relapsed/refractory acute lymphoblastic leukaemia

  • The treatment of relapsed/refractory acute myeloblastic leukaemia


  • Confirm funding approved on BlueTeq for all new starters.

    For more information see Cancer Drug Fund List


  • 05.01.10 Clofazimine 

    • RPH: Use is not restricted for Cystic Fibrosis

    06.05.01 Clomifene Citrate 

     




      • Treatment of infertility is specialist advice as per CCG formulary and GPs can prescibe on recommendation from hospital. Note this is still funded. Only the IVF procedure itself is no longer funded by Cambridgeshire and Peterborough CCG

      • Clomifene is not recommended for the management of hypogonadism in males (off-label).



     

    04.03.01 Clomipramine 

     

    • Not recommended for first line use (mental health indications)

     

    • May be considered as an alternative to SSRIs in obsessive-compulsive disorder (OCD).

     

    • NWAFT: Non-formulary

     

    • CUHFT and CPFT: Formulary

     

    • RPH: Restricted to initiation by Sleep Consultants for cataplexy (Amber no SCG)

     



     

    04.08.01 Clonazepam 

    • NWAFT and CUHFT: Formulary for the management of epilepsy

    • Base the need for continued supply of a particular brand on clinical judgement and consultation with patient and/or carer, taking into account factors such as seizure frequency and treatment history

    • CUHFT: Also restricted to the following off-label uses:


      • prevent seizures in high risk neuroblastoma

      • REM Sleep Behaviour Disorder (REMSBD) in Parkinson's Disease

      • restless legs syndrome in renal patients


    • RPH: Non-formulary

    • CPFT: Also restricted to the following off-label uses:


      • behavioural control (Hospital only)

      • anxiety

      • tardive dyskinesia



     


     

    04.08.02 Clonazepam 

    • NWAFT and CUHFT: Formulary for the management of statis epilepticus 

    • (see section 04.08.01 for other indications)

    • Base the need for continued supply of a particular brand on clinical judgement and consultation with patient and/or carer, taking into account factors such as seizure frequency and treatment history.

    02.05.02 Clonidine 

    • CUHFT: Restricted for the maintenance of sedation in ICU. unlicensed unlicensed

    • NWAFT: Specialist use only

    • RPH: Restricted to

      • Hypertensive crisis.

      • Restlessness and agitation in critically ill patients. unlicensed unlicensed




    See Section 4 for prophylaxis of migraine, attention deficit-hyperactivity disorder (unlicensed unlicensed) and Tourette’s syndrome (unlicensed unlicensed).

    04.07.04.02 Clonidine 

     

    • Prescribe generically.
    • Primary care initiation following specialist advice from the neurologist for the prophylaxis of migraine.
    • Primary care initiation following specialist advice from the mental health team for attention deficit-hyperactivity disorder (unlicensed unlicensed indication) and Tourette’s syndrome (unlicensedunlicensed indication).
    • NWAFT: Non-formulary for this indication.

    July 2020 - Shortage of Clonidine 25microgram tablets

    • Accord are out of stock and unable to advise a resupply date.
    • Sandoz are out of stock but expect further supplies w/c 6th July 2020.
    • See link below for further information.
    20 Clonidine  
  • 50micrograms/5mL
  • Routinely used in paediatrics (PICU).
  • 02.09 Clopidogrel 

     

    • GI risks very similar to aspirin.
    • Prescribe generically
    • Use in the following circumstances:

      • People who have had an ischaemic stroke or who have peripheral arterial disease or multivascular disease (as per NICE TA210)

      • Following MI only if aspirin is contra-indicated or not tolerated

      • Proven gastro-intestinal haemorrhage with low dose aspirin.

      • For cardiologists to treat patients who have had an acute coronary syndrome (ACS).


    • Where a liquid preparation is clinically required in paediatric patients, Clopidogrel 25mg/5mL* is the standardised liquid strength which should be prescribed in children (unlicensed unlicensed):
      • *Clopidogrel strength is agreed, but as no monograph for this medication exists yet in the BNFC it is not yet published there. 
      • Using standardised strengths of unlicensed liquid medicines in children, will reduce the risk of errors being made in the doses given to children and prevent hospitalisation from accidental under and overdoses.
      • See link below for further information.

     

    07.02.02 Clotrimazole 

    • Consider Self Care (in line with product licensing)

    • Cream 1%

    • Cream 10% (intravaginal stat treatment)

    • Pessary 100mg (6 dose treatment), 500mg (stat treatment)

    12.01.01 Clotrimazole 

    • NWAFT: Formulary

    • Non-formulary at all other Trusts

    13.10.02 Clotrimazole 
    04.02.01 Clozapine Denzapine®, Clozaril®, Zaponex®

    • Initiation by consultant psychiatrist only.

    • Patients should receive the brand specific to the monitoring service with which they are registered.

    • CPFT brand of choice is DENZAPINE®

    • All patients must be registered with the Fulbourn Pharmacy or the Cavell Centre Pharmacy.

    • WARNING: Missed doses are particularly significant in someone taking Clozapine. Please contact your local CPFT pharmacy department (including the out of hours service if applicable) and the patient’s psychiatrist if you are aware of a patient that has missed doses of Clozapine.


     


     


     

    13.05.02 Coal Tar and Salicylic Acid Ointment, BP 

    (Ointment coal tar 2 g, salicylic acid 2 g, emulsifying wax 11.4 g, white soft paraffin 19 g, coconut oil 54 g, polysorbate ‘80’ 4 g, liquid paraffin 7.6 g)


    Special order product



    • CUHFT Restricted Item All tars dermatology only,

    • Non formulary at all other trusts

    20.02 Coal tar in yellow soft paraffin 
  • 1%
  • 2%
  • 5%
  • 10%
  • 20%
  • May be long-term or repeated treatment.
  • 13.05.02 Coal Tar Paste, BP 

    (Paste strong coal tar solution 7.5%, in compound zinc paste)


    Special order product



    • CUHFT Restricted Item All tars Dermatologist only.

    • Non formulary at all other trusts

    13.05.02 Coal tar solution BP 

    (Solution coal tar 20%, polysorbate ‘80’ 5%, in alcohol (96%))


    Special order product



    • CUHFT Restricted Item All tars dermatology only.

    • NWAFT - Formulary

    20.02 Coal Tar solution in Betnovate 
  • 5% and 10%.
  • 02.02.04 Co-amilofruse  
    02.02.04 Co-amilozide 

    • CUHFT: formulary

    • Non formulary at all other Trusts

    05.01.01.03 Co-Amoxiclav 

    • NOTE: contains penicillin

    • CSM has advised that cholestatic jaundice may occur either during or just after treatment with co-amoxiclav. It is more common in patients above the age of 65 years and in males. The duration of treatment should be appropriate to the indication and should not usually exceed 14 days.

    • Prescribe generically in Primary Care


    • Co-amoxiclav provides anaerobic cover. Addition of metronidazole not normally required


       




     

    05.01.01.03 Co-Amoxiclav IV 

    • NOTE: contains penicillin

    • CSM has advised that cholestatic jaundice may occur either during or just after treatment with co-amoxiclav. It is more common in patients above the age of 65 years and in males. The duration of treatment should be appropriate to the indication and should not usually exceed 14 days.

    • Co-amoxiclav provides anaerobic cover. Addition of metronidazole not normally required

    • RPH info: Restricted to Consultant and Microbiologist advice only

    • CUHFT info: not to be used for discharge via OPAT. Ceftriaxone once daily is normally a suitable alternative


     

    04.09.01 Co-Beneldopa Madopar®

     

     

    04.09.01 Co-Careldopa Sinemet®

     

    • Prescribe generically.

    June 2020 - Shortage of co-careldopa 25mg/100mg tablets (Teva)

    • Teva, a generic supplier is out of stock and is currently unable to provide a resupply date.
    • MSD, the supplier of the brand Sinemet Plus can cover supply for the whole market during this time.
    04.09.01 Co-Careldopa and Entacapone Stalevo®, Stanek®, Sastravi®,

     

    • For initiation by Consultant Neurologists and Geriatricians ONLY.
    • A combination product is preferable to administering the components separately as per NICE guidance.
    • Please prescribe by brand. Brands available include Sastravi®, Stanek® and Stalevo®
    • For new patients the current preferred brand is Stanek®.
    • CUHFT only the preferred brand is Sastravi®.

    June 2020 - Supply issues with Stanek and Sastravi (levodopa/carbidopa/entacapone) tablets 

    • Teva and Accord have informed the DHSC that there are supply issues impacting on the following presentations of Stanek and Sastravi tablets.
    • Anticipated resupply dates as per table below:
    Presentations Affected Stanek Sastravi
    75mg/18.75mg/200mg tablets
    Pack size 30  Early August 2020 Available
    100mg/25mg/200mg tablets
    Pack size 100 Mid-July 2020 Late-June 2020
    Pack size 30 Mid-July 2020 Late-June 2020
    125mg/31.25mg/200mg tablets
    Pack size 30 Available Late-June 2020
    150mg/37.5mg/200mg tablets
    Pack size 100 Early August 2020 Available
    Pack size 30 Available Late-June 2020
    175mg/43.75mg/200mg tablets
    Pack size 100 Out of stock from late June until end of July 2020 Late-June 2020
    Pack size 30 End of July Late-June 2020
    200mg/50mg/200mg tablets
    Pack size 100 Early August 2020 Out of stock from late June until end of July 2020
    • All other Stanek and Sastravi presentations remain available during this time.
    • Supplies of Stalevo tablets which are considered equivalent, continue to remain available. 
    • For patients with insufficient supplies of Stanek or Sastravi until the anticipated resupply date, clinicians should consider prescribing levodopa/carbidopa/entacapone tablets generically so that pharmacies can supply an equivalent preparation of an available product.  
    • Patients who are required to change brand should be monitored for side effects/change in disease control. 
    • Patients should be counselled on any changes to avoid medication errors, especially for those patients on more than one strength of  tablets. 
    • See Medicine Supply Notification below for further information. 



    12.01 Cochlear implants for children and adults with severe to profound deafness 

    • Approved for use in line with NICE TA566 - Cochlear implants for children and adults with severe to profound deafness. 

    13.06.02 Co-Cyprindiol 2000/35
    (Cyproterone Acetate 2mg with Ethinylestradiol 35micrograms)
     

    note MHRA advice: The benefits of co-cyprindiol outweigh the risks in women of reproductive age for the treatment of:skin conditions related to androgen sensitivity (eg,severe acne withor without seborrhoea)hirsutism



    • In Primary Care - Formulary 1st line (generic only) Dianette should not be prescribed

    • CUHFT Restricted Item restricted

      • Co-cyprindiol provides effective contraception in these women. An additional hormonal contraceptive should not be used in combination with co-cyprindiol

      • The need to continue treatment should be evaluated periodically by the treating physician

      • The risk of VTE is rare but this remains an important side effect, and healthcare professionals should themselves be vigilant for signs and counsel patients to remain vigilant for signs and symptoms. note Remember that suspected adverse reactions to co-cyprindiol should be reported to us on a Yellow Card (Click Here)



    • NWAFT - Formulary

    • CSM Advice: Co-cyprindiol is licensed for use in women with severe acne which has not responded to oral antibacterials and for moderately severe hirsutism; it should not be used solely for contraception. It is contra-indicated in those with a personal or close family history of venous thromboembolism. Women with severe acne or hirsutism may have an inherently increased risk of cardiovascular disease.

    01.06.02 Co-danthramer 
  • Restricted to use in terminally ill patients only.
  • 01.06.02 Co-danthrusate 
  • Restricted to use in terminally ill patients only.
  • 01.04.02 Codeine 
    04.07.02 Codeine 

    • Low strength co-codamol products can be purchased from a Community Pharmacist for short term supply only

    • Injection is non-formulary, no advantages over morphine and is a CD.

    • Works by small amounts (~10%) being converted to morphine (some people do not convert).

    • Restrictions on use of codeine in children and breastfeeding mothers - see MHRA advice below.

    • Consider alternative analgesia in paediatrics 

    • Suppositories are non-formulary at NWAFT and in Primary Care




    03.09.01 Codeine Linctus BP 
  • Codeine linctus is the 1st line formulary choice of cough suppressant in acute Trusts and other inpatient settings.
  • Please use Pholcodine in primary care and consider self care if needed.
  • Codeine statement (paediatrics) August 2013 See link.
  • 03.09.01 Codeine Phosphate 
  • Codeine statement (paediatrics) August 2013 see link.
  • 10.01.04 Colchicine 
    09.06.04 Colecalciferol 

    RPH only - Restricted to cystic fibrosis patients 

    09.06.04 Colecalciferol  

    • CUHFT - Delristol brand. 


      • 20,000 units = 500 micrograms

      • Dekristol is contraindicated for peanut or soya allergy sufferers, as capsules contain arachis oil (peanut oil).

      • Therapeutically equivalent to ergocalciferol (ref: Martindale)



    Preferred treatment choice in primary care is currently Invita D3 range (licensed product)

    09.06.04 Colecalciferol  Invita D3®
    • Preferred brand when prescribed in Primary Care for the treatment of deficiency for adults 18 years and above:
      • Invita D3 50,000 IU soft gel capsules: ONE capsule once weekly for 6 weeks. 
      • Invita D3 50,000IU/ml oral solution: ONE ml oral solution ampoule once weekly for 6 weeks. 
      • The FULL course should be prescribed as an ACUTE prescription.  
      • Patients requiring maintenance doses of vitamin D for insufficiency should be recommended to SELF-CARE where the patient is both willing and able.
    • NWAFT, CUHFT and RPH:
      • Non formulary (alternative brands are recommended). 
      • Trust to provide full treatment course for vitamin D deficiency.



     

    09.06.04 Colecalciferol  Thorens® 10,000 units/ml oral drops
    • Preferred brand when prescribed in Primary Care for treatment of deficiency for paediatric patients 1 month of age and above - see link to guideline below for dosing details dependent upon age.
    • The FULL course should be prescribed as an ACUTE prescription.
    • Self-care for maintenance doses
      • Vitamin D supplementation for insufficiency or aligned to national prevention recommendations, parents/guardians should be requested to purchase over the counter, where the parent/guardian is willing and able.
      • Healthy Start Vitamin Drops are available for those who qualify from local distribution points. See guideline below for further details. 
    • NWAFT, CUHFT and RPH:
      • Non formulary (alternative brands are recommended). 
      • Trust to provide full treatment course for vitamin D deficiency.



     

    09.06.04 Colecalciferol  Invita D3® 25,000IU single-dose oral solution unit
    • Primary Care - Second line formulary choice for treatment of deficiency for paediatric patients 1 month of age and above who require weekly dosing due to compliance - see link to guideline below for dosing details dependent upon age.
    • The FULL course should be prescribed as an ACUTE prescription.
    • Self-care for maintenance doses
      • Vitamin D supplementation for insufficiency or aligned to national prevention recommendations, parents/guardians should be requested to purchase over the counter, where the parent/guardian is willing and able.
      • Healthy Start Vitamin Drops are available for those who qualify from local distribution points. See guideline below for further details. 
    • NWAFT, CUHFT and RPH:
      • Non formulary (alternative brands are recommended).
      • Trust to provide full treatment course for vitamin D deficiency.



     

    09.06.04 Colecalciferol 3,000 units per ml liquid 

    • NWAFT - Paediatric use only  


    1mL = 3,000 units = 75 micrograms.


    Therapeutically equivalent to ergocalciferol (ref: Martindale).


    Unlicensed formulation. Use licensed product where available.

    09.06.04 Colecalciferol 3200 unit capsules Fultium D3®
    • Primary Care - Second line formulary choice for treatment of deficiency for adults 18 years and above including pregnant or breastfeeding women:
      • Fultium-D3 3,200 IU capsules: ONE capsule daily for 12 weeks.  
      • Peanut-oil free capsules have been formulated since October 2014 but the peanut (arachis) oil version will continue to be available at wholesalers for some time, so it is recommended that the product formulation is checked before dispensing to patients with a known peanut or soya allergy. 
      • The FULL course should be prescribed as an ACUTE prescription.
      • Patients requiring maintenance doses of vitamin D for insufficiency should be recommended to SELF-CARE where the patient is both willing and able. 
    • NWAFT, CUHFT and RPH:
      • Non formulary (alternative brands are recommended). 
      • Trust to provide full treatment course for vitamin D deficiency.
    09.06.04 Colecalciferol 800 units Desunin®

    • CUHFT only

    • Non - formulary at all other trusts


     

    01.09.02 Colesevelam Cholestagel®

     

    • Recommended second line for the management of bile acid malabsorption causing diarrhoea after colestyramine and where conventional anti-diarrhoea medications have failed (unlicensedunlicensed indication).

    June 2020 - Cholestagel (colesevelam)

    • This product is currently available to order. See link below for further information. 

     

    01.09.02 Colestyramine Questran®, Questran® Light

     

    • Recommended first line for the management of bile acid malabsorption (unlicensedunlicensed indication).

    June 2020 - Supply issue with Questran Powder and Questran Light 4g sachets

    • Bristol-Myers Squibb (BMS) divested the Questran range (Questran and Questran Light) to Cheplapharm.
    • Questran Powder 4g sachets are currently out of stock until 2021. 
    • Questran Light sachets are available in limited supplies through the wholesaler Alliance Healthcare (manufacturer is delivering to wholesalers on a two weekly basis).
    • Generic colestyramine light 4g sachet (recently launched by Mylan), currently available from the wholesalers AAH, Alliance Healthcare and Phoenix.
    • For further information please see link below. 

     

    05.01.07 Colistimethate 

    • RPH: There is no restriction of the use of the injection by the Thoracic Directorate or Transplant

    05.01.07 Colistimethate Promixin®

     




      • Requires a different nebuliser to the Colomycin brand of colistin which has a shorter administration time. Approximately twice the price of Colomycin.

      • CUHFT: For non-cystic fibrosis bronchiectasis patients Colomycin® brand is preferred.

      • RPH: Available via homecare for Cystic Fibrosis patients (Hospital only).

        • Shared care available for for the treatment of Pseudomonas aeruginosa lung infections in non-cystic fibrosis bronchiectasis





     

    05.01.07 Colistimethate for nebulisation Colomycin®

    • Colomycin® brand licensed for nebulisation.

    • RPH: Available via homecare for Cystic Fibrosis patients (Hospital only).

      • Shared care available for for the treatment of Pseudomonas aeruginosa lung infections in non-cystic fibrosis bronchiectasis




     

    05.01.07 Colistimethate inhaler Colobreathe®

    • Available for use in line with NICE for: treating pseudomonas lung infection in cystic fibrosis NICE TA276 

    • For non-cystic fibrosis bronchiectasis use Colomycin® brand.

    • RPH: Available via homecare for Cystic Fibrosis patients (Hospital only).

      • Shared care available for for the treatment of Pseudomonas aeruginosa lung infections in non-cystic fibrosis bronchiectasis




     

    01.01.01 Co-Magaldrox Mucogel®

    • Suspension

    • Consider Self Care

    • 2nd Line choice - Mucogel brand only

    • Low Sodium

    06.04.01.01 Combined continuous HRT patch Evorel® Conti, Femseven Conti

     

    • Evorel® Conti patches and Femseven® Conti patches are both approved for use second line where combined tablets are not suitable.
    • Evorel® Conti - estradiol 50mcg per 24 hour, norethisterone acetate 170mcg per 24 hour.
    • Femseven® Conti - estradiol 50mcg per 24 hour levonorgestrel 7mcg per 24 hour.
    • No bleed products for women with an intact uterus.
    • Please note above the differences in progesterone between these formulations.
    • Beware there are differences in licensing of the combined continuous HRT patches.
    • Please see SPC for further information. 

    June 2020 HRT shortages:

    • Evorel® Conti patches - These are unavailable until June 2020 (date to be confirmed). 
    • Shortage of Femseven® Conti patches - Theramex the sole supplier have advised this range will be out of stock until the end of 2020.  





     

    06.04.01.01 Combined continuous HRT tablet Kliofem, Kliovance, Femoston Conti

     

    • No bleed products for women with intact uterus.
    • Tablets are the first line choice.
    • Kliovance and Kliofem are the most cost effective choices for continuous HRT products, containing estradiol and norethisterone.
    • Kliovance® is a lower strength than Kliofem®
    • Femoston®-conti tablets contains estradiol and dydrogesterone.

     

     

     

    09.02.02.01 Compound Sodium Lactate Intravenous Infusion 

    • Hartmann's Solution

    • Link to SPC. Hartmann's Solution = Sodium Chloride 0.6%, Sodium Lactate 0.25%, Potassium Chloride 0.04%, Calcium Chloride 0.027%

    03.04.03 Conestat Alfa Ruconest®

    • CUHFT only (JDTC November 2018): via Lloyds Outpatients (supply stored in ED). Agreed as per NHSE Clinical Commission Policy.



    • Used in the treatment of acute attacks of hereditary angioedema (adults).



    • Currently limited Berinert® availability so supports current supply issues - not to be used for prophylaxis.



    • Standardised dose (irrespective of weight).



    • Extract from rabbit so allergy is a possibility - patients will be carefully screened.



    • Non formulary at all other trusts.


     

    13.02.02 Conotrane® 

     

    • First choice in primary care
    • Suitable for self-care. Can be purchased from a Community Pharmacist.

    May 2020 - Discontinuation of Conotrane Cream 100g

    • Karopharma have confirmed that Conotrane cream 100g has been discontinued.
    • Conotrane cream 500g is available from Alliance Healthcare. 
    06.01.06 Continuous Glucose Monitoring (CGM) System 

    • Restricted to patients who meet the criteria within the policies below

    • To be provided by secondary care or through Community Consultant Lead Diabetes Clinics

    01.04.02 Co-Phenotrope Lomotil®

    • Co-phenotrope 2.5/0.025 (diphenoxylate hydrochloride 2.5 mg, atropine sulfate 25 micrograms.

    • NWAFT: Reserve for 3rd line use and in stoma patients (tablets)

    • Non formulary at all other Trusts

    01.01.01 Co-Simalcite Altacite plus ®

    • Suspension

    • NWAFT: Restricted to Palliative Care only

    • Non-formulary at all other Trusts

    02.02.04 Co-triamterzide 

    • CUHFT: formulary

    • Non formulary at all other Trusts


     

    05.01.08 Co-trimoxazole 

     

    • NWAFT: Restricted to use in respiratory patients, HIV patients and Haematology (HOSPITAL ONLY).
    • CUHFT: Forte tablet is non formulary IMPORTANT FOR HIGH-DOSE CO-TRIMOXAZOLE: **Please refer to Trust guidance before prescribing high dose co-trimoxazole as the doses differ from the BNF** (HOSPITAL ONLY).
      • Pre and post dose levels are required after 5 days of treatment for patients with CrCl >15ml/min and after 3 days for <15ml/min. Contact Microbiology or a pharmacist for advice.
      • For all indications not specified in the relevant Trust antibiotic guidelines, please obtain dosing advice from Microbiology or Infectious Diseases.
      • An increased incidence of PCP/PJP is being seen in renal transplant patients (June 15). Prophylaxis is advised in all renal transplant patients. First line prophylaxis is co-trimoxazole 480mg od. FBC, LFTs & U&Es are required 2 & 4 weeks after initiation then monthly.
      • IV should only be used when the oral route is not possible - See SPC. (Exception: Severe PCP treatment).
    • RPH: Use is not restricted within the Thoracic Directorate and within Transplant (HOSPITAL ONLY). 
    • CONTINUATION IN PRIMARY CARE: Prescribable in primary care after specialist initiation (no SCG) for immunocompromised adult patients post heart and / or lung transplant and prophylaxis against infective exacerbations in adult patients with CF or bronchiectasis where considered the most suitable agent.

     

     

     

    08.01.05 Crizotinib Xalkori®

    • Only approved in accordance with the National Cancer Drugs Fund List for the indications below where the specified criteria are met:


      • Approved in accordance with NICE TA406 - Crizotinib for untreated anaplastic lymphoma kinase-positive advanced non-small-cell lung cancer.

      • Approved in accordance with NICE TA529 - Crizotinib for treating ROS1-positive advanced non-small-cell lung cancer. 




    13.03 Crotamiton Eurax®
    20.02 Crude coal tar, salicylic acid 2% in emulsifying ointment 
  • 1%
  • 2%
  • 5%
  • 10%
  • 20%
  • May be long-term or repeated treatment.
  • 09.01.02 Cyanocobalamin 

     



    • Cyanocobalamin tablets can be purchased from a Community Pharmacist. Self care recommended for the prevention of deficiency.



    • For guidance on when it is appropriate to use IM hydroxocobalamin or oral cyanocobalamin (available OTC) please see the Guideline for the management of Vitamin B12 deficiency (adults) – link below.



    • NWAFT:  Restricted to treatment of, or to prevent, vitamin B12 deficiency in a patient who is a vegan or who has proven vitamin B12 deficiency of dietary origin.



    • Non - Formulary at all other trusts. 





     

    04.06 Cyclizine Valoid®
    • Primary Care:
      • Consider after 1st line choices (prochlorperazine or metoclopramide).
      • Cyclizine orally is a first line option for moderate symptoms of nausea and vomiting in pregnancy (unlicensed unlicensed). 
    • CUHFT: 2nd line formulary choice after ondansetron
    • Formulary at all other Trusts

     

    02.02.01 Cyclopenthiazide 

    • CUHFT: Restricted to Clinical pharmacologists only for exceptional circumstances. (May be difficult to obtain)

    • Non formulary at all other Trusts and in Primary Care


     

    11.05 Cyclopentolate  

     

    • Eye drops 0.5%
    • Eye drops 0.5% (preservative free) (Minims®)
    • Eye drops 1% (preservative free) (Minims®)

     

    08.01.01 Cyclophosphamide 
    10.01.03 Cyclophosphamide 

    • CUHFT:

      • Cyclophosphamide may be used at a dose of 1 to 1.5 mg/kg daily by mouth for rheumatoid arthritis with severe systemic manifestations unlicensed unlicensed ; it is toxic and regular blood counts (including platelet counts) should be carried out.

      • Cyclophosphamide can also be given intravenously in a dose of 0.5 to 1 g (with prophylactic mesna) for severe systemic rheumatoid arthritis and for other connective tissue diseases (especially with active vasculitis), repeated initially at fortnightly then at monthly intervals (according to clinical response and haematological monitoring).



    • Non formulary at all other Trusts

    05.01.09 Cycloserine 

    • CUHFT only: Restricted for use in MDR tuberculosis.

    • NWAFT : Restricted for use in respiratory patients


     

    18 Cyproheptadine Periactin® Tablets
  • Discussion with National Poisons Information Service recommended
  • For the treatment of serotonin syndrome
  • Link to SPC
  • 08.03.04.02 Cyproterone 

    • If needed tablets can be dispersed in water, but this should be done in a closed system- put the tablet in an oral syringe and suck up some water to dissolve it.

    06.04.02 Cyproterone Acetate 

    • Monitor LFTs.

    • Avoid contact with crushed or broken tablets.

    08.01.03 Cytarabine 
    14.05.02 Cytomegalovirus immunoglobulin CMVIG

    • RPH: Restricted to use in transplant patients

    • Non-formulary at all other Trusts

    02.08.02 Dabigatran Pradaxa®

    • Warfarin remains a suitable first-line option for most patients.

    • Where warfarin is not clinically appropriate, edoxaban is the lowest acquisition cost DOAC in primary care for Non-Valvular Atrial Fibrillation

    • Prescribing is restricted to:


      • Dabigatran etexilate for the prevention of stroke and systemic embolism in atrial fibrillation (TA249) (Can be initiated in Primary Care)

      • Dabigatran etexilate for the treatment and secondary prevention of deep vein thrombosis and/or pulmonary embolism (TA327) (5 days of parenteral heparin is recommended prior to switching to dabigatran for DVT and PE treatment.)

      • Dabigatran etexilate for the prevention of venous thromboembolism after hip or knee replacement surgery in adults (TA157) (Hospital only


    • Do not crush or open capsules as this increases bioavailability by 75%.

    08.01.05 Dabrafenib Tafinlar®

    • Approved in line with NICE TA321 for treating unresectable or metastatic BRAF V600 mutation‑positive melanoma.



    • Approved in line with NICE TA396 for treating unresectable or metastatic melanoma in combination with trametinib.



    • Approved in line ith NICE TA544 for adjuvant treatment of resected BRAF V600 mutation-positive melanoma with trametinib. 



    • TERMINATED APPRAISAL NICE TA564 Dabrafenib with trametinib for treating advanced metastatic BRAF V600E mutation-positive non-small-cell lung cancer.


    08.01.05 Dacarbazine 
    05.03.03.02 Daclatasvir  Daklinza®

     



    • Used in accordance with treatment options and run rates as established for the Eastern Liver Network ODN. All second and third line treatments must be discussed regionally for approval. Further information can be found at www.easternliver.net.



    • Commissioning policy NHS England B07/P/a and NICE TA 364: Commissioned for use in: • Genotype 3 with compensated cirrhosis in combination with sofosbuvir and ribavirin for 12 weeks where interferon is contraindicated (note regimen is unlicensed). • Genotype 3 with decompensated cirrhosis in combination with sofosbuvir and ribavirin for 12 weeks (note regimen is unlicensed).



    • Prior approval via Blueteq system required via Lloyds. 


     

    08.01.05 Dacomitinib  Vizimpro®
    • Approved for use in line with NICE TA595 - Dacomitinib for untreated EGFR mutation-positive non-small-cell lung cancer. 
    08.01.02 Dactinomycin Cosmegen Lyovac®
    05.01.07 Dalbavancin Xydalba®

     

    • CUHFT Only: Approved for treatment of acute skin and soft tissue infectious, particularly in IVDU patients (can have via OPAT or inpatient) or those who are not suitable for OPAT as shorter course of treatment will facilitate expedited discharge.

     

    02.08.01 Dalteparin 

     

    • Dalteparin is the LMWH of choice (excluding RPH where Tinzaparin is 1st line).
    • See Trusts guidelines for further information on dosing and duration of treatment.
    • Traffic light status for initiation and continuation of treatment is indication specific. Please see LMWH Prescribing Guideline (THIS GUIDELINE IS CURRENYLY UNDER REVIEW). 
    • For paediatric patients under the age of 16 years, both the prescribing and monitoring of dalteparin should remain - HOSPITAL ONLY. 
    • Patients, irrespective of age, requiring administration of dalteparin from vials, both the prescribing and monitoring should remain - HOSPITAL ONLY.
    • Dalteparin is indicated for VTE prophylaxis where high risk pregnancy is confirmed:
      • High risk pregnancy may be confirmed either by the hospital or within general practice.
      • Presribing and monitoring to be continued by the patient's GP. 

     

    02.08.01 Danaparoid Orgaran®

    • CUHFT: Haematologist approval required only if heparin causes thrombocytopenia.

    • NWAFT: Restricted to use in thromboembolic disease in patients with history of heparin-induced thrombocytopenia.

    • RPH: Non formulary.

    06.07.02 Danazol 

    May 2020 - Discontinuation of Danazol 100mg and 200mg capsules

    • Danazol 100mg and 200mg capsules have been discontinued in the UK and remaining supplies of both strengths are now exhausted.
    • Danazol has several licensed indications and off-label uses. The management of patients prescribed danazol for licensed indications will differ to those prescribed danazol for an off-label use.
    • Please see Supply Disruption Alert issued 29th May 2020 for further supportive information on how to manage patients prescribed danazol. 
    10.02.02 Dantrolene 

    • If needed capsules can be opened and contents dispersed in water or acidic fruit juice (eg orange).

    18 Dantrolene  See also section 15.1.8
  • Discussion with National Poisons Information Service recommended if treating drug related malignant hyperpyrexia unless due to anaesthetic
  • 15.01.08 Dantrolene Sodium Dantrium Intravenous®
    01.06.02 Dantron 

    • Restricted to use in terminally ill patients only.

    06.01.02.03 Dapagliflozin Forxiga▼®

     

    • In line with NICE TA288, NICE TA390 and NICE TA418,
      Triple therapy in combination with metformin and a sulfonylurea.  Dual therapy in combination with metformin only if glycaemic control is inadequate, and patient has a significant risk of hypoglycaemia OR if sulfonylurea contraindicated or not tolerated.  In combination with insulin (alone or with other antidiabetic drugs)  As monotherapy in patients who cannot tolerate metformin or where metformin, pioglitazone and sulfonylureas are inappropriate as an alternative to a dipeptidyl peptidase 4 (DPP-4) inhibitor.
    • Notes on licensing:
      • Licensed for initiation in adults between 18 and 75 years only.
      • Should not be initiated in patients with a glomerular filtration rate [GFR] < 60 mL/min and should be discontinued at GFR persistently below 45 mL/min.
      • Due to its mechanism of action, patients taking dapagliflozin will test positive for glucose in their urine and are at increased risk of urinary tract infection.
    • SPECIALIST INITIATION with prescribing to be continued in Primary Care in line with NICE TA597 - Dapagliflozin with insulin for treating type 1 diabetes.  Primary care may continue to supply treatment following the initiation and first months supply are provided by secondary care/consultant led diabetes clinic. Patient's to be reviewed for continued need in line with NICE TA597 at 6 months by secondary care/consultant led diabetes clinic. 
    05.01.10 Dapsone 

     

    • Prescribing to be continued in Prmary Care following Specialist Initiation in line with Shared Care Guidance for Dermatitis Herpetiformis and other Dermatoses.
    • NWAFT:
      • Restricted to Dermatology
      • 2nd line in PJP prophylaxis (HOSPITAL ONLY). 
    • CUHFT: An increased incidence of PCP/PJP is being seen in renal transplant patients (June 15). Prophylaxis is advised in all renal transplant patients (HOSPITAL ONLY).
    • If needed tablets can be crushed and dispersed in water.
    • RPH: Use is restricted (HOSPITAL ONLY). 



     

    05.01.07 Daptomycin Cubicin®

    • Regular CPK monitoring required 

    • Consultant Microbiologist approval required.

    • CUH OPAT service : • PSSU sisters will supply and administer the first dose after patients have been formally accepted onto the service. • Inpatient Pharmacy will only supply this drug on discharge if the district nurse is administering this drug, or the patient is expected to self administer. • If discharge is delayed, patients should be converted to ‘formulary’ antibiotics and switched to dapsone at the point of discharge.

    08.01.05 Daratumumab Darzalex®

    • TERMINATED APPRAISAL NICE TA454 - Daratumumab with lenalidomide and dexamethasone for treating relapsed or refractory multiple myeloma.



    • For use in line with NICE TA510 - Daratumumab with lenalidomide and dexamethasone for treating relapsed or refractory multiple myeloma. 



    • For use in line with NICE TA573 - Daratumumab with bortezomib and dexamethasone for previously treated multiple myeloma. 

    09.01.03 Darbepoetin Alfa Aranesp®

    • CUHFT:

      • Approved in line with NICE TA323 for treating anaemia in people with cancer having chemotherapy.

      • Renal team for renal patients not on haemodialysis.

      • Haematologists for multiple myeloma, to prevent or reduce blood transfusions.

      • As per Trust guideline on refusal of transfusion



    • NWAFT: Restricted to use in renal patients

    • Non-formulary at all other Trusts

    07.04.02 Darifenacin Emselex®

    • Primary Care and all other Trusts: 2nd line formulary choice Care

    • CUHFT and NWAFT: Non-formulary

    05.03.01 Darunavir Prezista®

    CUH additional advice:



    • Restricted to ID / GU Medicine advice only.

    • Clinic 1A.

    05.03.01 Darunavir & cobicistat Rezolsta®

    CUH additional advice: JDTC October 2016:



    • Clinical and funding approval granted.

    • Issues around service capacity to switch eligible patients onto more cost effective brands.

    • For now, patients can continue treatment if admitted on this but no patient's to be switched until HIV Pharmacist in post.

    05.03.03.02 Dasabuvir Exviera®

    • Used in accordance with treatment options and run rates as established for the Eastern Liver Network ODN. All second and third line treatments must be discussed regionally for approval. Further information can be found at www.easternliver.net.



    • Commissioning policy NHS England B07/P/a and NICE TA365.



    • Prior approval via Blueteq system required : suppplied via Lloyds at CUH.



    • Commissioned for use in: • Genotype 1a and 1b with compensated cirrhosis in combination with ombitasvir/paritepravir/ritonavir and ribavirin for 12 weeks.




    08.01.05 Dasatinib Sprycel®
    • Approved in accordance with the National Cancer Drugs Fund List for the indication(s) below where the specified criteria are met:
      • The treatment of Philadelphia chromosome positive (Ph+) acute lymphoblastic leukaemia.
      • The treatment of chronic phase chronic myeloid leukaemia.
      • The treatment of accelerated phase chronic myeloid leukaemia.
      • The treatment of lymphoid blast crisis chronic myeloid leukaemia. Was removed from the CDF list on 12th March 2015. Remains on formulary for patients with funding approved prior to this date.
    • Approved for use in line with NICE TA426Dasatinib, nilotinib and imatinib for untreated chronic myeloid leukaemia. 
    • Confirm funding approved on BlueTeq for all new starters.
    08.01.02 Daunorubicin 
    09.01.03 Deferasirox 

     




      • CUHFT: Commissioned by NHSE for Iron chelation in sickle cell anaemia and Iron chelation in thalassaemia. Not routinely commissioned for Iron chelation in Myelodysplastic Syndrome



     




      • NWAFT: Deferasirox is only for patients intolerant to or poorly compliant with desferrioxamine. It is NOT for patients with myelodysplastic syndromes. Funding approval is required



     




      • Tariff excluded for chronic iron overload



     




      • Non-formulary at all other Trusts



     

    20.01 Deferasirox 
  • Via homecare in up to 15 patients per year, currently funded through the Trust.
  • Not routinely commissioned by either NHSE or CCG for:
    - Iron chelation in Myelodysplastic Syndrome
    - Clinically approved at JDTC December 2016.
    - CCG reviewing January 2017.
    *Note as of June 2017, the dispersible tablets will be discontinued and a film-coated alternative will be available. The film-coated tablet is formulated in different strengths and the bioavailbility is different.case of switching from dispersible tablets to film-coated tablets, the dose of the film-coated tablets should be 30% lower than the dose of the dispersible tablets, rounded to the nearest whole tablet.Please refer to SPC for furtehr details
  • 09.01.03 Deferiprone Ferriprox®

     




      • CUHFT: Commissioned by NHSE for Iron chelation in sickle cell anaemia and Iron chelation in thalassaemia. Not routinely commissioned by either NHSE or CCG for Iron chelation in Myelodysplastic Syndrome



     




      • Non formulary at all other trusts



     

    06.03.02 Deflazacort Calcort®

    • CUHFT only

    • Non formulary at all other trusts


     

    08.03.04.02 Degarelix Firmagon®
  • Approved in accordance with NICE TA404 Degarelix for treating advanced hormone-dependent prostate cancer.
  • 05.01.03 Demeclocycline 

    • Endocrinology only for SIADH (not as antibiotic).

    06.06.02 Denosumab XGEVA®

    • Restricted for preventing skeletal related events in adults with bone metastases from breast cancer and from solid tumours other than prostate in accordance with NICE.

    • Denosumab is not recommended for preventing skeletal-related events in adults with bone metastases from prostate cancer, (this is in line with NICE).

    • Xgeva: pathway in development (not yet agreed). NICE TA 265 in place for use in bone metastases.

    • NICE TA549 TERMINATED APPRAISAL: Denosumab for preventing skeletal-related events in multiple myeloma. 

    06.06.02 Denosumab Prolia®
    • Denosumab (PROLIA® ) for the treatment of osteoporosis in postmenopausal women and in men at increased risk of fractures is available as a local enhanced service in Primary Care. See link below. 
    • Approved for use in postmenopausal women as per NICE TA204 in whom IV bisphosphonates aren't suitable. NICE TA204 - Denosumab for the prevention of osteoporotic fractures in postmenopausal women (see link below). 
    • Vitamin D and calcium level need to be sufficient prior to treatment.
    13.02.01 Dermol® 

     

    • Primary Care: Emollients with antimicrobials should only be used where infection is clinically significant in flare ups. Use should be targeted and short term. Formulary choices are restricted to Dermol 500 or Dermol Cream. See CCG Emollient Prescribing Guideline.
    • Can be purchased from a Community Pharmacist where the patient is willing and able
    • CUHFT and RPH - Restricted Item  For dermatologists only.
    • NWAFT and CPFT - Formulary
      • Dermol® Cream - Greasy level 2/4
      • Dermol® 500 Lotion - Greasy level 1/4 (least greasy)
    • Use Emollients Safely There is a fire risk associated with all emollients whether they contain paraffin or not.





     

     

    18 Desferrioxamine  Injection
  • Discussion with National Poisons Information Service recommended
  • Iron poisoning
  • Also see section 9.1.3
  • 20.01 Desferrioxamine 
  • Not routinely commissioned by either NHSE or CCG for:
    - Iron chelation in Myelodysplastic Syndrome
    - Clinically approved at JDTC December 2016.
    - CCG reviewing January 2017.
  • 09.01.03 Desferrioxamine Mesilate 

    • NWAFT and RPH: Formulary

    • Tariff Excluded for chronic iron overload

    • CUHFT: Not routinely commissioned by either NHSE or CCG for Iron chelation in Myelodysplastic Syndrome

    • Non-formulary at all other Trusts

    15.01.02 Desflurane 

    Anaesthetic



    • CUHFT Restricted Item Named consultant only.

    • NWAFT - Formulary

    • Non formulary at all other trusts

    06.05.02 Desmopressin 

    • Desmopressin acetate: Tablets and nasal spray (10micrograms/dose).

    • DDAVP®: Tablet, sublingual tablet, injection 4mcg/ml indicated for diabetes insipidus or polyuria/polydypsia. (Generic nasal spray also available).

    • DesmoMelt®: Oral Lyophilisates.

    • Specify required dose of nasal spray on the prescription to avoid errors; there is a preparation available with 10 microgram/dose and 150microgram/dose.  

    • Desmospray®

    • Desmotabs®: Indicated for primary nocturnal enuresis. Usually once daily.

    • Octim®: Injection 15mcg/ml - For bleeding episodes in responding patients with mild haemophilia A, Von Willebrands Disease and platelet function disorders. (HOSPITAL ONLY)

    07.04.02 Desmopressin 

    • See section 06.05.02

    07.03.02.01 Desogestrel 75mcg Zelleta®

     

    • Prescribe as Zelleta 75mcg tablets in Primary Care. 

     

    06.03.02 Dexamethasone 

    Also used in neurology and as an antiemetic in some trusts (off label use)

    • CUHFT - suspension and soluble tablets only.
    • Current IV formulation = 3.3mg/1mL and 6.6mg/2mL. For pragmatic purposes, 3.3mg IV is considered approximate to 4mg PO.
    • NWAFT - use soluble tablets only.

    June 2020 - Dexamethasone in the treatment of COVID-19 

    • Dexamethasone has been demonstrated to have a clear place in the management of hospitalised patients with COVID-19.
    • Out of hospital treatment is not appropriate and therefore this should not be prescribed for this indication in Primary Care.
    • Further information can be found in the CAS alert published HERE.

     

    10.01.02.02 Dexamethasone 

    • CUHFT: Injection 4mg in 1mL Injection 8mg in 2mL as an alternative to betamethasone for threatened preterm labour in case of supply problems

    • Non formulary at all other Trusts

    11.04.01 Dexamethasone eye drops Maxidex®

    • Eye drops 0.1%

    • RPH - Specialist advice

    11.04.01 Dexamethasone eye drops single use 

    • 0.1% minims

    • RPH - Specialist advice

    11.04.01 Dexamethasone intravitreal implant Ozurdex®
    • Approved for use as per NICE TAs: see links below. 
    • RPH - Specialist advice.




     

    12.01.01 Dexamethasone with Antibacterial Sofradex®

     

    • For eye or ear drops (Dexamethasone 0.05%, Framycetin Sulphate 0.5%, Gramicidin 0.005%).

    June 2020 - Shortage of Sofradex ear/eye drops

    • Sanofi are out of stock until September 2020.  

     

    11.04.01 Dexamethasone with Antibacterials Sofradex®

     

    • For ear or eye.
    • RPH - Specialist advice. 

    June 2020 - Shortage of Sofradex ear/eye drops

    • Sanofi are out of stock until the September 2020.  

     

    11.04.01 Dexamethasone with Antibacterials Tobradex®

    • NWAFT only

    • Non formulary at all other trusts

    11.04.01 Dexamethasone with Neomycin and Polymyxin B sulphate Maxitrol®

    • Eye drops, Eye ointment.

    • RPH - Specialist advice

    04.04 Dexamfetamine 

    • For management of ADHD - requires specialist initiation by mental health team in line with Shared Care Guideline.

    • RPH: Restricted to the management of excessive sleepiness associated with narcolepsy in line with the Shared Care Guideline


     

    15.01.04.04 Dexmedetomidine  
    • CUHFT:
      •  Restricted Item Clinically approved by JDTC Feb 2013 for use in a subset of patients with agitated delirium in the ITU to avoid escalation to benzodiazepines or antipsychotics when they have not responded to clonidine. 
      • July 2017 update - funding now agreed by division and extended for use in the NCCU (patients numbers low).
      • Hospital use only.
    • NWAFT - Injection.
    • RPH - Injection. 

     

    08.01 Dexrazoxane Savene®

    • Contact oncology pharmacist for latest guidance/protocol.

    • Refer to extravasation policy for use.

    • Dexrazoxane (Savene) for anthracycline extravasation is commissioned by NHSE.

    • Dexrazoxane (Cardioxane) for the prevention of cardiotoxicity due to anthracycline use is NOT commissioned and is NOT on formulary. 

    04.07.02 Diamorphine Ayendi®

    • NWAFT: Ayendi Nasal Spray (paediatrics) should only be administered by practitioners experienced in the administration of opioids and with appropriate monitoring. (Unlicensed in adults and children 16yrs and over)

    • Non-formulary at all other Trusts and in Primary Care

    04.07.02 Diamorphine 
    • In palliative care should be used 2nd line to morphine.

    June 2020 - Shortage of Diamorphine Hydrochloride powder for reconstitution and injection 5mg and 10mg ampoules: 

    • There are two suppliers of diamorphine hydrochloride 5mg and 10mg in the UK, Wockhardt and Accord.
    • Accord are out of stock of both 5mg and 10mg strengths, with a re-supply date of Summer 2020.
    • Wockhardt's 5mg and 10mg strengths are currently available with limited supplies. 
    • The indication from both suppliers of diamorphine 5mg and 10mg strengths is that the supply will remain unpredictable for the foreseeable future. 
    • Diamorphine hydrochloride 30mg ,100mg, 500mg are available but manufacturers are unable to support an increase in demand on these strengths.
    • Please note - Morphine has superseded diamorphine as the end of life choice of opioid in adults in primary and secondary care. Sufficient supplies of morphine sulfate 10mg/ml injection are available from Ethypharm and Hameln to support this supply disruption. The Hameln presentation is preservative free. Morphine and diamorphine are not equipotent, and care should be taken when switching patients or amending guidelines, see shortage memo below for further information.
    • Please refer to the Central Alerting System (CAS) alert issued 25/03/2020: https://www.cas.mhra.gov.uk/ViewandAcknowledgment/ViewAttachment.aspx?Attachment_id=103486 
    • See shortage memo below for further information also. 

     

    20.01 Diamorphine 
  • The injection may be used intranasally in children on AED only.
  • 04.01.02 Diazepam 

     

    • Diazepam injection comes in two forms - solution (IM or IV) and emulsion Diazemuls® (IV only). Emulsion is preferred for IV as it is less irritant to the vein.
    • CPFT: lorazepam IM injection is used for rapid tranquillisation, as diazepam injection (both formulations) is non-formulary.
    • Injection formulations are hospital only.

     



     

    04.08.02 Diazepam 

    • Note: Diazepam injection comes in two forms - solution (IM or IV) and emulsion

    • Diazemuls® (IV only). Emulsion is preferred for IV as it is less irritant to the vein.

    • Injectable formulations are Hospital only

    04.08.03 Diazepam 

    See section 4.8.2

    10.02.02 Diazepam 

    See also section 4.1.2

    15.01.04.01 Diazepam 

    • CUHFT - Formulary Injection 10mg/2ml, tablets, syrup. Note: Diazepam injection comes in two forms - solution (IM or IV) and emulsion Diazemuls® (IV only). Emulsion is preferred for IV as it is less irritant to the vein.

    • NWAFT - Formulary Injection, tablets

    • RPH - Formulary

    18 Diazepam  Rectal tube
    Injection
  • Convulsions or agitation related to overdose / poisoning
  • 06.01.04 Diazoxide 

    • CUHFT, RPH and NWAFT only.

    20 Diazoxide suspension 

    250mg/5ml


     For chronic hypoglycaemia


    * For use when supply issues with tablets


    Standard dose is 5mg/kg/day

    20 Dibotermin Alfa, rhBMP-2 (Bone morphogenetic protein-2 ) Inductos®

    • 4mg adnd 12mg kit for implant


    • JDTC Sept 2018: Approved as per NHSE CCP

    11.08.02 Diclofenac Voltarol® Ophtha

     




      • Eye drops 0.1% single use (preservative free)



     

    13.08.01 Diclofenac Solacutan®,Solaraze®
    • Recommended for prescribing in Primary and Secondary Care:
      • Topical treatment for the management of actinic (solar) keratosis.  
      •  Restricted Item to dermatology only within the trusts.  

     

     

    10.01.01 Diclofenac sodium 

    • Diclofenac is associated with an increased risk of thrombo-embolic events even when used short term in patients with no cardiovascular risk factors. This risk does not appear to be shared by low dose ibuprofen or naproxen.


     



    • CUHFT:



      • Diclofenac MR 100mg only tablets and 100mg suppositories to keep as a stat dose pre-med in surgery

      • Diclofenac suppositories for theatres and paediatric anaesthetist usage, head and neck oncologist usage (OP), Rosie theatres and for renal colic in EDDiclofenac, 25mg and 50mg E/C tabs, and 12.5mg, 25mg, 50mg supps, 50mg/5ml suspension (unlicensed) for paeds usage.Note suspension is not stocked and ordered on an adhoc basis only

      • Diclofenac 75mg/2ml injection for theatres, NCCU and ICU only although supply not always easy to obtain

      • All other oral prescribing is non-formulary 


    • NWAFT: Only injection and suppositories are formulary 

    • Non formulary at all other Trusts including Primary Care


     

    18 Dicobalt edetate  Injection
  • Discussion with National Poisons Information Service recommended.
  • Stock sodium nitrate 3%, sodium thiosulphate 50% and hydroxocobalamin 5g. Contact NPIS for advice if required.
  • 05.03.01 Didanosine Videx®

    CUH additional advice:



    • Powder for suspension is named patient.



    • Restricted to ID / GU Medicine advice only.



    • If needed tablets can be crushed and dispersed in water.



    • HIV patients usually in combination with Zidovudine.


     

    08.03.01 Diethylstilbestrol 
    02.01.01 Digoxin 

     




      • Injection is Hospital only. (NWAFT: unlicensed unlicensed paediatric injection)



     




      • Digoxin doses in the BNF may differ from those in product literature.



     




      • For Elixir digoxin 50 micrograms/mL: Do not dilute, measure with pipette. Special Container.



     




      • Bioavailabilites are approximately: Injection 100%, Liquid 80%, Tablets 70%.



     




      • Caution when switching between formulations as dose adjustment will be needed. Digoxin 125 micrograms tablet is approximately equivalent to 100 micrograms liquid and to 90 micrograms IV injection.






     







      • NICE Do not Do Recommendation: Routine monitoring of serum digoxin concentrations is not recommended. A digoxin concentration measured within 8–12 hours of the last dose may be useful to confirm a clinical impression of toxicity or non-adherence.



     

    02.01.01 Digoxin specific antibody fragments Digifab®

    • Very rarely needed and extremely expensive. Discuss with the National Poisons Centre (0344 892 0111) first

    18 Digoxin specific antibody fragments Digifab®
  • See section 2.1.1 for information
  • Contact pharmacy for supply.
  • 04.07.02 Dihydrocodeine 

     

    • Poor analgesic when used alone, probably similar to or theoretically slightly better than codeine, but based on minimal evidence.
    • Where combination products are prescribed (not routinely recommended) co-dydramol products must be prescribed and dispensed by strength to minimise dispensing errors and the risk of accidental opioid overdose.
    • NWAFT: Non-formulary. 

     

    05.04.02 Diloxanide 

    • For chronic amoebiasis.

    • Consultant Microbiologist approval required.

    02.06.02 Diltiazem 

     

    • Standard strength formulations (60mg) are licensed as 'generics' and there is no requirement for brand name dispensing. (In Primary Care prescribe as Tildiem 60mg MR tablets).
    • Diltiazem MR preparations above 60mg strength should be prescribed by brand name because different brands may not have the same clinical effect.
    • 60mg MR preparations have a different release profile to other modified release diltiazem products. Multiples of 60mg tablets/capsules given once or twice daily should not be used to substitute higher strength products.
    • In Primary Care: Prescribe the preferred low cost brand Zemtard XL (ONCE daily).
    • Acute Trusts:  All prescriptions for other brands will be changed to those brands kept by pharmacy, if patients own medication cannot be used on admission. Current brands:

      • Extended release (ONCE daily) - SLOZEM

      • Modified release (TWICE daily) DILZEM SR (non- formulary at NWAFT)

      • Modified release (THREE times daily) generic 60mg diltiazem.


     

    01.07.04 Diltiazem ointment 2% Anoheal

    • unlicensed unlicensed

    • 2nd line - available for patients intolerant or unresponsive of GTN ; 2nd line: (Ensure to prescribe as ointment rather than cream - ointment is more cost effective in primary care)

    • Dose 2cm twice daily. 1 tube lasts one month, store in fridge.


     

    18 Dimercaprol  Solution for injection
  • Discussion with National Poisons Information Service recommended.
  • Heavy metal poisoning
  • Held supra-regionally for treatment of heavy metal poisoning
  • 08.02.04 Dimethyl fumarate Tecfidera®

    • Approved in accordance with NICE TA320 for the treatment of adult patients with active relapsing remitting multiple sclerosis (MS).

    13.05.03 Dimethyl fumarate Skilarence®

    • Approved for use in line with NICE TA475 for treating moderate to severe plaque psoriasis. 

    13.10.04 Dimeticone Hedrin®

    • Primary Care: Live head lice can be treated by wet combing; chemical treatment is only recommended in exceptional circumstances and in these cases over the counter medicines can be purchased from a pharmacy.

    • CUHFT - Formulary. First line for Pediculosis capitis (head lice) in pregnancy (licensed) if wet combing not suitable

    • NWAFT - Formulary


     

    07.01.01 Dinoprostone Prostin E2®. Propress®.

    • CUHFT: Rosie hospital induction of labour guidelines.

    • NWAFT: Formulary

    • Non-formulary at all other Trusts


     

    08.02.03 Dinutuximab beta Qarziba®
    • For use in accordance with NICE TA538 for treating neuroblastoma. 

     

    20 Diphencyprone 
  • Consultant Dermatologists for alpecia totalis.
  • 20.02 Diphenylcyclopropanone in acetone 
  • Alopecia arreata.
  • 13.02.01 Diprobase® 
    02.09 Dipyridamole Modified Release Capsules

    • Recommended as per NICE TA210 (modified-release dipyridamole)

    • Only if alternatives are not appropriate for the individual patient.

    11.99.99.99 Disodium Edetate 0.37%  EDTA
  • Opthalmology use only.
  • Unlicensed.
  • 20 Disodium Edetate 0.37%  EDTA
  • Opthalmology use only.
  • 06.06.02 Disodium Pamidronate 
    02.03.02 Disopyramide 

     

    • NWAFT: Only capsules are on formulary 

     

    04.10.01 Disulfiram 

    • CUHFT, CPFT and RPH: Formulary

    • NWAFT: Non- formulary (not to be initiated within the Trust)

    13.05.02 Dithranol Dithrocream®

    (Cream 0.1%, Cream 0.25%, Cream 0.5%, Cream 1%, Cream 2%)



    • Primary Care - 1st line

    • CUHFT - Formulary

      • Dithranol should not be used in people with acute or pustular psoriasis or inflamed psoriasis.

      • Avoid using dithranol on the face.



    • NWAFT - Formulary

    20.02 Dithranol in Lassar’s Paste 
  • 0.1%
  • 0.25%
  • 0.5%
  • 1%
  • 2%
  • 4%
  • 8%
  • 12%
  • Occasionally longer term treatment is required.
  • 13.05.02 Dithranol Ointment BP 

    (Ointment 0.1–2%)


    Special order product


    NB. Cream can be prescribed in Primary care



    • CUHFT - Formulary

    • NWAFT - Non-formulary

    13.05.02 Dithranol Paste BP 

    (Paste 0.1–1%, Dithranol in zinc and salicylic acid (Lassar's) paste)


    Special order product 



    • CUFHT only

    • Non fomulary at all other trusts

    18 DMPS (unithiol)  Injection - unlicensed
    Hard capsules - unlicensed
  • Discussion with National Poisons Information Service recommended.
  • Held supra-regionally for treatment of heavy metal poisoning
  • 18 DMSA (succimer)  Capsules - unlicensed
  • Discussion with National Poisons Information Service recommended.
  • Held supra-regionally for treatment of heavy metal poisoning
  • 02.07.01 Dobutamine 

    • Do NOT give as a bolus.

    08.01.05 Docetaxel Taxotere®
  • As per NICE TA 101 and 109.
    1) Oncologists as approved by NICE for non small cell lung cancer.
    2) Oncologists with tratuzumab for HER2-expressing breast cancers.
    3) Oncologists for Ovarian cancer.
  • 01.06.02 Docusate Sodium 

    • Solution (Unpalatable).

    • Probably acts as a softening laxative as well as a stimulant.

    • Time to effect is approximately 24 to 48 hours.

    • RPH: Alternative to macrogols post-operatively in fluid restricted patients

    05.03.01 Dolutegravir 

    CUH additional advice:

    05.03.01 Dolutegravir, abacavir & lamivudine Triumeq®

    CUH additional advice:



    • As per NHSE specialised service circular: See guidance.

    04.06 Domperidone 

    • Primary Care: 2nd line formulary choice after prochlorperazine and metoclopramide.

    • See link below for MHRA advice about dose restrictions and contraindications

    • Non-formulary (grey) for promoting tolerance of enteral feeds in children / young people. See NICE evidence summary.

    04.11 Donepezil 

     

    • To be prescribed on the advice of a specialist experienced in the management of dementia in line with NICE TA217 and Shared Care Guideline.

     

    • Orodispersible tablets are more cost-effective than the oral solution.

     

     

    02.07.01 Dopamine 

    • Do NOT give as a bolus.

    02.07.01 Dopexamine 

    • CUHFT: Intensive care units only

    • Non formulary at all other Trusts

    03.07 Dornase Alfa Pulmozyme®

     

    • CUHFT, NWAFT and RPH: Use in cystic fibrosis patients (CUH and RPH are via homecare).
    • For CF patients supplied via homecare and any admitted hospital inpatients requiring this, should bring their own stock previously supplied to them through homecare to the hospital. *Fridge item*
    • CUHFT: Prescriptions for use of dornase in paediatric liver transplant patients should be referred to the Paediatric Pharmacist.
    • All CF patients have been repatriated back to secondary care at the request of NHS England. Shared Care no longer in operation.
    • RPH: Also available for treatment of pleurodesis

     

    20.01 Dornase/Alteplase 
  • Empyema (for patient who have not responded to intercostal drainage).
  • 11.06 Dorzolomide Trusopt®

    • Eye drops 2%

    • Eye drops 2% (preservative free)

    • Available with timolol as Cosopt®

    11.06 Dorzolomide 2% with Timolol 0.5% Cosopt®

    • Eye drops

    • Preservative free eye drops

    13.02.01 DoubleBase® 

    • In Primary Care Non-formulary. See Emollient Prescribing Guideline for formulary alternatives

    • Formulary at all other trusts


      • Greasy level 3/4

      • Please note, the Dayleve preparation is currently not on formulary.



    03.05.01 Doxapram Dopram®

     

    15.01.07 Doxapram 

    See section 3.5.1

    02.05.04 Doxazosin 

    • Immediate release only. Modified release tablets are non formulary.

    • Dose should be started low and titrated up.

    07.04.01 Doxazosin 

    • See Section 2.5.4 for use as antihypertensive

    • Prescribe as immediate release preparation.

    • Doxazosin modified release is NOT RECOMMENDED

    13.03 Doxepin Hydrochloride Xepin®

    • CUHFT: Formulary

    • Non-formulary at all other trusts and in Primary Care


     

    08.01.02 Doxorubicin Hydrochloride (Lipid formulation) Caelyx®
  • Approved in line with NICE TA389 for treating recurrent ovarian cancer.
    NB: Trabectedin in combination with pegylated liposomal doxorubicin is not recommended for treatment of the first recurrence of platinum-sensitive ovarian cancer.

  • Also approved in accordance with the National Cancer Drugs Fund List for the treatment of certain named sarcomas.

    For more information see Cancer Drug Fund List
  • 08.01.02 Doxorubicin Hydrochloride (Liposomal) Myocet ® •Overall chemo spend to be tracked against income in-year until further notice.


    05.01.03 Doxycycline 
    13.06.02 Doxycycline 

     

    • See chapter 5.1.3 for more detailed information on antibiotics.
    • Primary Care - Formulary 1st Line.




     

     

    20.01 Doxycycline 
  • Percutaneous sclerotherapy in 5-10 children per year.
  • 13.02.02 Drapolene® Cream 

    • Cream, benzalkonium chloride 0.01%, cetrimide 0.2% in a basis containing white soft paraffin, cetyl alcohol and wool fat

    • Suitable for self-care. Can be purchased from a Community Pharmacist


     

    02.03.02 Dronedarone 

     

    • Approved as per NICE TA197.
    • Prescribers in Primary Care should not initiate dronedarone for any new patient.

    • Patients currently prescribed should be reviewed by their specialist/initiating trust and dronedarone deprescribed.

    • Prescribing should only continue under exceptional circumstances after multi-disciplinary team recommendation but a shared care arrangement would be required.

       

     

    04.06 Droperidol Xomolix®

    • CUHFT only: FoR use in PONV. For IV use can be administered undiluted as a slow bolus.

    • Non-formulary at all other Trusts

    03.01.05 Drug Delivery Device AeroChamber Plus®

     

    • Recommended spacer device for QVAR®, Flutiform® and Fostair® metered dose inhalers.

     

    • Adult and children > 5 years = Blue (+/- mask).

     

    • Child 2-5 years = Yellow.

     

    • Infant (6 months - 2 years) = Orange.

     

    • CUHFT: New patients to receive AeroChamber Plus Flow-Vu Anti-Static.
    • MEDICINES OPTIMISATION (CCG) ARE CURRENTLY REVIEWING AEROCHAMBER PLUS FLOW-VU ANTI-STATIC DEVICE. PRESCRIBING CLASSIFICATION TO BE REVIEWED AT AUGUST 2020 CPJPG.

     

    03.01.05 Drug Delivery Device Haleraid®
  • Not available on FP10, patients may be advised to purchase in primary care.
  • May be supplied in secondary care to patients with dexterity problems.
  • 03.01.05 Drug Delivery Device Volumatic®
  • Recommended spacer device for Clenil Modulite®, Flixotide®, Serevent® Seretide® and Ventolin® metered dose inhalers.
  • Available as adult or paediatric spacer.
  • In adults pMDI+/- spacer is as effective as any other hand held inhaler, but patients may prefer some types of DPI [SIGN 2011].
  • 06.01.02.03 Dulaglutide Trulicity®
    • Trulicity®= once weekly formulation. 
    • Dulaglutide can be initiated in primary care in patients NOT being treated with Insulin in accordance with NICE NG28.
    • Where a GLP-1 analogue is prescribed alongside insulin, prescribing is to remain with secondary care or the community diabetes specialist until patient is stable (SPECIALIST INITIATION).
    04.03.04 Duloxetine 

    • Requires specialist initiation by mental health team when being prescribed as an antidepressant

    • Be aware of drug interactions.

    • Ensure correct strength formulation is prescribed for indication.

    • For the treatment of major depressive disorder 30mg and 60mg capsules are licensed.

    • RPH: Restricted to initiation by Sleep Consultants for cataplexy

    04.07.03 Duloxetine 

    • Recommended third line after failure of TCA and gabapentin for painful diabetic peripheral neuropathy.



    • RPH: Non-formulary.



    • NOTE: Different strengths of duloxetine have different licensed indications. 30mg and 60mg capsules are licensed for diabetic peripheral neuropathy.

    07.04.02 Duloxetine Yentreve®

    • On recommendation of Stress Incontinence Team only.

    • If needed capsules can be opened and beads mixed with water (do not crush).

    • Only 20mg and 40mg strengths licensed for this indication (women only) (Prescribe generically)

    • Non-formulary in all Provider Trusts

    20 Dulwich Mixture 
  • Phosphate Binder renal patients with hypercalcaemia.
  • Nephrologist use only.
  • 13.05.01 Dupilumab Dupixent®

     

      • Restricted to use by dermatology in line with NICE TA534

     CUH: Also available for atopic dermatitis extended to adolescents via homecare

      • CUH: Also available for severe asthma via FOC scheme via Homecare for patients as per the terms and conditions of the scheme until NICE TA publication

     

    08.02.03 Durvalumab Imfinzi®

     

      • Approved for use in accordance with NICE TA578 - Durvalumab for treating locally advanced unresectable non-small-cell lung cancer after platinum-based chemoradiation.  

     

    06.04.02 Dutasteride Avodart®

    • Non formulary at all trusts

    • Second choice in primary care

    • Use finasteride first line which is supported by the MTOPS and PCPT trials. Patients can be switched from dutasteride to finasteride in primary care if finasteride has not been tried before.


    Women of childbearing potential should avoid handling crushed or broken tablets of dutasteride.

    A5.09.03 Easy Fit Donning Aid® Juzo UK
    • Available to purchase over the counter from Community Pharmacies.
    • This cannot be prescribed on FP10.  
    A5.09.03 Easy-Slide® Credenhill
    • Available to purchase over the counter from Community Pharmacies. 
    09.01.03 Eculizumab 

    • CUHFT: Restricted to

      • Atypical Hemolytic-Uremic Syndrome (aHUS). NHS England Service Specification. Please note for this indication this should be recommended by Newcastle, procured through ourselves: proof of vaccination required for company to provide named patient supply and automatically funded for by NHSE (in addition to vaccines) but no requirement for IFR. 

      • Post-transplant refractory thrombotic microagiography (TMA):- clinically approved; funding through individual funding request (IFR).

      • Antibody-mediated transplant rejection (AMR):- only in the context of clinical trials.

      • Paroxysmal Nocturnal Haemoglobulinuria (PNH) after Leeds hospital advice, supply via Alexion pharmaceuticals: http://www.pnhleeds.co.uk/professionals/referrals/ They supply eculizumab but do not supply vaccines or prophylactic antibiotics. Vaccines are re-imbursed by NHSE for this indication. 

      • For recurrence of C3 glomerulopathy post-kidney transplant (all ages)- as per NHS England Clinical Commissioning Policy. Administered in hospital as part of admission. Manufacturer of eculizumab request proof of Meningitis B vaccination before issuing.



    • Non formulary at all other trusts

    02.08.02 Edoxaban Lixiana®

    • Warfarin remains a suitable first-line option for most patients.

    • Where warfarin is not clinically appropriate, edoxaban is the lowest acquisition cost DOAC in primary care for Non-Valvular Atrial Fibrillation

    • Prescribing is restricted to:


      • Edoxaban for preventing stroke and systemic embolism in people with non-valvular atrial fibrillation (TA355) (Can be initiated in Primary Care)

      • Edoxaban for treating and for preventing deep vein thrombosis and pulmonary embolism (TA354) (5 days of parenteral heparin is recommended before switching to Edoxaban in the treatment of DVT and PE)



     



    • CUHFT only: Cancer associated thrombosis (Specialist Initiation) unlicensed unlicensed

    05.03.01 Efavirenz Sustiva®

    CUH additional advice:



    • Restricted to ID / GU Medicine advice only. Clinic 1A only for AIDS/HIV pts (Dr. Carne and team).

    • Oral solution discontinued October 2015. Sustiva can be administered by capsule sprinkle method. Switching from oral solution to capsule sprinkle method may result in higher drug exposures; therefore patient should be monitored for toxicity during transition period.

    05.03.03.02 Elbasvir and Grazoprevir  Zepatier®

     




      • As per NICE TA413 when funding confirmed by NHSE.



     




      • BlueTeq forms required.



     

    09.08.01 Eliglustat Cerdelga®

    • CUHFT only -  in line with NICE HST5 for treating type 1 Gaucher disease. 

    09.01.04 Eltrombopag Revolade®

    • As per NICE TA293 for treating chronic immune (idiopathic) thrombocytopenic purpura

    • Group Prior Approval form for eltrombopag is available via the hyperlink and will need to be completed and submitted to the relevant CCG through the Trust commissioning team.

    01.04.02 Eluxadoline Truberzi®

     

    • For use in line with NICE TA471 for treating irritable bowel syndrome with diarrhoea. 

     

    02.11 Emicizumab Hemlibra®

     

    • CUHFT - Approved as per NHSE CCP:
      • Prophylaxis in patients with congenital haemophilia with factor VIII inhibitors (all ages).
      • Prophylaxis in severe congenital haemophilia A without factor VIII inhibitors (all ages) - dosing as per UKHCDO tables here.
    • Non-formulary at all other Trusts and in Primary Care. 

     

    06.01.02.03 Empagliflozin Jardiance▼®

    • Approved as per NICE TA336 and NICE TA390

    • Dual therapy in combination with metformin, only if: a sulfonylurea is contraindicated or not tolerated, or the person is at significant risk of hypoglycaemia or its consequences  Triple therapy regimen in combination with: metformin and a sulfonylurea or metformin and a thiazolidinedione.  In combination with insulin (alone or with other antidiabetic drugs)  As monotherapy in patients who cannot tolerate metformin or where metformin, pioglitazone and sulfonylureas are inappropriate as an alternative to a dipeptidyl peptidase 4 (DPP-4) inhibitor


    • Licensed for initiation in adults aged 18years to 85years.

    • Maximum dose is 10mg daily in patients with GFR <60ml/min and should not be used if GFR is <45ml/min.

    • Due to its mechanism of action, patients taking empagliflozin will test positive for glucose in their urine and are at increased risk of urinary tract infection.

    05.03.01 Emtricitabine Emtriva®

    CUH additional advice:



    • Restricted to ID / GU Medicine advice only.



    • Clinic 1A only for AIDS/HIV patients.


     

    05.03.01 Emtricitabine 200mg, Rilpivirine 25mg and Tenofovir 245mg Eviplera®

    CUH additional advice:



    • Restricted to ID / GU Medicine advice only.



    • Clinic 1A - AIDS/HIV patients.


     

    13.02.01 Emulsifying Ointment BP 

     

     

    • Formulary at all other trusts


      • Emulsifying wax 30%, white soft paraffin 50%, liquid paraffin 20%.

      • Greasy level 4/4 (most greasy).


    • Use Emollients Safely There is a fire risk associated with all emollients whether they contain paraffin or not.

     

    02.05.05.01 Enalapril  

     

    • NWAFT: Restricted to existing patients and paediatric use.
    • Formulary at all other Trusts where 1st line choices are unsuitable.

    July 2020 - Supply Difficulties with Enalapril 20mg tablets

    • All suppliers of enalapril 20mg tablets are out of stock until early August 2020.
    • Alternate strengths of enalapril (2.5mg, 5mg and 10mg) tablets remain available and will be able to support increased demand.
    • See Medicine Supply Notification below (issued 24/07/2020) for further actions to be taken in relation to this shortage. 

     

    08.01.05 Encorafenib Braftovi®

    • Approved for use in accordance with NICE TA562 - Encorafenib with binimetinib for unresectable or metastatic BRAF V600 mutation-positive melanoma. 
       

    05.03.01 Enfuvirtide Fuzeon®

    CUH additional advice



    • Restricted to ID / GU Medicine advice only.

    • Clinic 1A only for AIDS/HIV pts (Dr. Carne and team)- subject to funding being secured.

    02.08.01 Enoxaparin 

     

    • RPH (HOSPITAL ONLY): VTE prophylaxis in patients with renal impairment when creatinine clearance <20ml/min.
    • RPH and Primary Care Shared Care Guideline: For patients undergoing invasive procedures to establish a diagnosis of pulmonary hypertension, assess treatment response or in preparation for surgery. See link below. 
    • Non formulary at all other Trusts and in Primary Care. 
    • Biosimilars available - brand prescribing recommended. 
    • Patients, irrespective of age, requiring administration of enoxaparin from vials, both the prescribing and monitoring should remain -HOSPITAL ONLY
    • For paediatric patients under the age of 16 years, both the prescribing and monitoring of enoxaparin should remain - HOSPITAL ONLY

     

    02.01.02 Enoximone Perfan®

    • CUHFT: Restricted to intensive care units (see local IV guide with respect to administration)

    • RPH: Formulary

    • NWAFT: Non formulary


     

    04.09.01 Entacapone Comtess®
    05.03.03.01 Entecavir Baraclude®

    • Use in accordance with NICE guidance (TA153 & CG165).

    15.01.02 Entonox® 

    • CUHFT - Restricted Item For analgesia 50% nitrous oxide, 50% oxygen

    • Formulary at all other trusts

    08.03.04.02 Enzalutamide Xtandi®

    • Enzalutamide is routinely commissioned for metastatic hormone-relapsed prostate cancer previously treated with a docetaxel-containing regimen in accordance with NICE TA316.

    • Enzalutamide requires National Cancer Drugs Fund approval for the treatment of chemotherapy naïve castrate-resistant Metastatic Prostate Cancer. Confirm funding is approved on BlueTeq for all new CDF starters.

    • As per NICE TA 377.

    • Enzalutamide is NOT RECOMMENDED as per NICE TA580 for hormone-relapsed non-metastatic prostate cancer. 

    13.02.01 Epaderm® 

    • Primary Care - non-formulary. See Emollient Prescribing Guideline for formulary alternatives

    • CUHFT - Restricted - Cream: Dermatologists only. 125g pots encouraged supplied routinely. 500g need special request

    • Ointment is non-formulary and has been replaced by Hydromol ointment



    • Non-formulary at all other trusts

    02.07.02 Ephedrine 

    • CUHFT and NWAFT: Formulary

    • RPH: Non formulary

    12.02.02 Ephedrine 

    • Nasal drops 0.5% and 1%

    • Not routinely recommended for prescribing in primary care.

    13.02.01 Epimax® Original (previously Epimax) 
    • Non formulary at all trusts.




     






     

    08.01.02 Epirubicin hydrochloride 
    02.02.03 Eplerenone 

    • Second line aldosterone antagonist for controlling blood pressure when spironolactone is indicated but cannot be tolerated.

    09.01.03 Epoetin alfa Eprex®

    • NWAFT: Formulary

    • Non formulary at all other trusts

    09.01.03 Epoetin alfa Binocrit ®

    • CUHFT:


      • Approved in line with NICE TA323 for treating anaemia in people with cancer having chemotherapy.

      • Also used within haematology and renal.

      • If prescribing on the ward, confirm dialysis patients are not already receiving it from the dialysis unit.

      • Chairman's action required for Jehovah's Witnesses treatment of anaemia.


    • Non-formulary at all other Trusts

    09.01.03 Epoetin beta NeoRecormon®

    • CUHFT:

      • Approved in line with NICE TA323 for treating anaemia in people with cancer having chemotherapy.

      • Also used within haematology and renal.

      • Chairman's action required for Jehovah's Witnesses treatment of anaemia.



    • NWAFT: Formulary

    • Non formulary at all other trusts

    02.08.01 Epoprostenol Flolan®, Veletri®

    • CUHFT: Restricted to all ICUs.

    • RPH: Restricted to use in pulmonary hypertension only, available via homecare.

    • NWAFT: Non formulary

    09.06.04 Ergocalciferol 

     




      • 300,000 units in 1ml



     

    07.01.01 Ergometrine Maleate 

    • CUHFT: Restricted to

      • Management of third stage labour guidelines (ergometrine used in combination with syntocinon- Syntometrin).

      • Postpartum haemorrhage guidelines.



    • NWAFT: Formulary

    • Non-formulary at all other Trusts

    07.01.01 Ergometrine Maleate and Oxytocin Syntometrine®

    • CUHFT and NWAFT: Formulary

    • Non-formulary at all other Trusts

    08.01.05 Eribulin Halaven®

     



    • In line with NICE TA423 - Eribulin for treating locally advanced or metastatic breast cancer after 2 or more chemotherapy regimens. 



    • NOT RECOMMENDED in line with NICE TA515 - Eribulin for treating locally advanced or metastatic breast cancer agter 1 chemotherapy regimen. CUHFT Compliant. 



    • Approved in accordance with the National Cancer Drugs Fund List for the indications below where the specified criteria are met:


    08.01.05 Erlotinib Tarceva®
  • Approved in accordance with NICE TA162 and TA258.
  • Red HOSPITAL only.
  • Expected usage low.
  • 08.01.05 Erlotinib Tarceva®
  • Approved in accordance with NICE TA162 and TA258.
  • Not to be used as monotherapy.
  • 05.01.02.02 Ertapenem Invanz®

    • Penicillin ( beta lactam) type antibiotic.

    • CUH info: Restricted use for OPAT for ESBL UTI and cellulitis to facilitate discharge. Only one dose should be given in hospital. AED can use one dose overnight for those patients deemed appropriate for OPAT whilst awaiting OPAT assessment the following day.

    • NWAFT info: Consultant Microbiologist approval required.

    06.01.02.03 Ertugliflozin Steglatro®

    • Approved for use in accordance with NICE TA572 - Ertugliflozin as monotherapy or with metformin for treating type 2 diabetes. 

      • Dual therapy in combination with metformin, only if: a sulfonylurea is contraindicated or not tolerated, or the person is at significant risk of hypoglycaemia or its consequences  As monotherapy in patients who cannot tolerate metformin or in whom metformin is contraindicated, only if a dipeptidyl peptidase 4 (DPP-4) inhibitor would otherwise be prescribed and a sulfonylurea or pioglitazone is not appropriate. 



    • Approved for use in accordance with NICE TA583 - Ertugliflozin with metformin and a dipeptidyl peptidase-4 inhibitor for treating type 2 diabetes.

      • Ertugliflozin with metformin and a dipeptidyl peptidase‑4 (DPP‑4) inhibitor is recommended as an option for treating type 2 diabetes in adults when diet and exercise alone do not provide adequate glycaemic control, only if: the disease is uncontrolled with metformin and a DPP‑4 inhibitor, and a sulfonylurea or pioglitazone is not appropriate.




    Notes on licensing:


     


    • Licensed for initiation in adults aged over 18years.

    • Initiation of this medicine is not recommended in patients with eGFR <60ml/min. 

    • Due to its mechanism of action, patients taking ertugliflozin will test positive for glucose in their urine and are at increased risk of urinary tract infection.

    05.01.05 Erythromycin 

    • NWAFT- restricted to use in pregnancy and dermatology only

    05.01.05 Erythromycin 

     




      • In pregnancy when macrolide is indicated as per antibiotic guidelines.

      • NWAFT- restricted to use in pregnancy and dermatology only



     

    13.06.02 Erythromycin 

    See chapter 5.1.5 for more detailed information on macrolide antibiotics.

    • In Primary Care:
      • Formulary - 2nd line for the treatment of acne. 
      • Formulary - as an option for the treatment of moderate to severe acne rosacea in adults (off-label). 

     

    13.06.01 Erythromycin 40mg with Zinc Acetate 12mg/mL Zineryt®

    (Topical Solution (powder for reconstitution))



    • In Primary Care - Formulary 2nd line

    • CUHFT - Formulary

    • NWAFT - Non-formulary

    04.03.03 Escitalopram Cipralex®

    • Requires specialist recommendation by mental health team - second/third line ONLY

    • Please note MHRA safety advice below

    • All prescribing should be generically

    • NWAFT: Non-formulary


     

    04.08.01 Eslicarbazepine Zebinix®

    • CUHFT: Formulary for the management of epilepsy

    • Non-formulary at all other Trusts

    • Base the need for continued supply of a particular brand on clinical judgement and consultation with patient and/or carer, taking into account factors such as seizure frequency and treatment history.

    02.04 Esmolol 

    • NWAFT and RPH: Formulary

    • CUHFT: Restricted to intensive care and resuscitation areas following European Resuscitation Guidelines.

    01.03.05 Esomeprazole 

    • CUHFT only: Restricted use for Gastro specialists (severe grade III, IV oesophagitis only) when omeprazole and lansoprazole have been tried and failed.

    • CUHFT only: Approved only for an 8 week course for severe Oesophagitis ( to be supplied in full by the Hospital Trust).

    • RPH only: Restricted to Cystic Fibrosis patients where formulary PPIs have failed

    • NWAFT: Non Formulary


    Where prescribing is continued in primary care on the advice of a specialist, and formulary choices have failed, prescribe as gastro resistant tablets

    10.01.03 Etanercept Enbrel®,Benepali®

     




      • CUHFT: Etanercept biosimilar (Benepali) is currently the formulary biosimilar for adults and paediatrics.





      • Restricted for rheumatology consultants only in line with NICE guidance.



     




      • Etanercept biosimilar (Benepali) is currently the formulary biosimilar for adults. Benepali is not licensed in paediatrics.



     




      • JIA as per NICE TA 373 via homecare (must use Enbrel).



     

    13.05.03 Etanercept Enbrel®, Benepali®

    • Formulary at all trusts. 



    • CUHFT: Etanercept biosimilar (Benepali) is currently the formulary biosimilar for adults and paediatrics.



    • Approved in accordance with NICE TA103 - Etanercept and efalizumab for the treatment of adults with psoriasis.



    • NHS England Approved in accordance with NICE TA455 - Adalimumab, etanercept and ustekinumab for treating plaque psoriasis in children and young people.



    • Biosimilar should be prescribed. Enbrel is only funded via IFR route CCG IFR Form.



    • A GPA form needs to be completed and returned to the CCG via commissioning for every individual patient. GPA Forms.


     

    06.06.01 Etelcalcetide Parsabiv®

    • Approved in accordance with NICE TA448 - Etelcalcetide for treating secondary hyperparathyroidism. 

    05.01.09 Ethambutol  

     

    • If needed tablets can be crushed and dispersed in water.
    • Where a liquid preparation is clinically required in paediatric patients, Ethambutol 400mg/5mL is the standardised liquid strength which should be prescribed in children (unlicensed unlicensed):
      • Using standardised strengths of unlicensed liquid medicines in children, will reduce the risk of errors being made in the doses given to children and prevent hospitalisation from accidental under and overdoses.
      • See link below for further information.

     

    18 Ethanol (alcohol) injection  Injection (unlicensed)
  • Used in the treatment of antifreeze (ethylene glycol) or methanol poisoning
  • Discussion with National Poisons Information Service recommended.
  • Ethanol 100%
  • 06.04.01.01 Ethinylestradiol 

    June 2020 - Shortages of ethinylestradiol 10mcg and 50mcg tablets 

    • UCB, sole supplier is out of stock due to manufacturing issues and currently unable to advise a resupply date.
    07.03.01 Ethinylestradiol / Desogestrel  Bimizza®, Gedarel® 20/150
    • Monophasic low strength (21 day preparations).

    • 21 days:
      • Ethinylestradiol 20 micrograms
      • Desogestrel 150 micrograms
    • Prescribe as Bimizza® tablets OR Gedarel® 20 microgram / 150 microgram tablets in Primary Care.
    07.03.01 Ethinylestradiol / Desogestrel  Gedarel 30/150®
    • Monophasic standard strength (21 day preparation).
    • 21 days:
      • Ethinylestradiol 30 micrograms
      • Desogestrel 150 microgram
    • Prescribe as Gedarel® 30microgram / 150microgram tablets in Primary Care.



     

    07.03.01 Ethinylestradiol / Drospirenone Yacella®
    • Monophasic standard strength (21-day preparation).
    • 21 days:
      • Ethinylestradiol 30 micrograms.
      • Drospirenone 3 mg
    • Please prescribe as Yacella® tablets in Primary Care. 
    07.03.01 Ethinylestradiol / Gestodene  Millinette® 20/75
    • Monophasic low strength (21 day preparation).
    • 21 days:
      • Ethinylestradiol 20 micrograms
      • Gestodene 75 micrograms
    • Prescribe as Millinette® 20microgram / 75microgram tablets in Primary Care.




      

    07.03.01 Ethinylestradiol / Gestodene  Millinette 30/75®
    • Monophasic standard strength (21 day preparation).
    • 21 days:
      • Ethinylestradiol 30 micrograms
      • Gestodene 75 micrograms
    • Please prescribe as Millinette® 30microgram / 75microgram tablets in Primary Care.





     

    07.03.01 Ethinylestradiol / Levonorgestrel  Levest®
    • Monophasic standard strength (21-day preparations).
    • 21 days:
      • Ethinylestradiol 30 micrograms
      • Levonorgestrel 150 micrograms
    • Prescribe as Levest in Primary Care. 

     

    07.03.01 Ethinylestradiol / Noresthisterone  Brevinor®
    • Monophasic standard strength (21 day preparation).
    • 21 days:
      • Ethinylestradiol 35 micrograms
      • Norethisterone 500 micrograms
    • Prescribe as Brevinor in Primary Care.

    June 2020 - Supply issues with Brevinor

    • Pfizer the sole supplier is out of stock until Q3 2020 due to manufacturing issues.
    • UKMi, have previously advised that there are no exact equivalent preparations to available in the UK market.
    • Other ethinylestradiol and norethisterone OCP products should be available on formulary.
    • Clinicians are advised to refer to CKS guidance for advice Combined Oral Contraceptives (COCs): https://cks.nice.org.uk/contraception-combined-hormonal-methods 
    07.03.01 Ethinylestradiol / Noresthisterone  Norimin®
    • Monophasic standard strength (21 day preparation).
    • 21 days:
      • Ethinylestradiol 35 micrograms
      • Norethisterone 1 mg
    • Prescribe as Norimin in Primary Care.

    June 2020 - Shortage of Norimin tablets

    • Pfizer are out of stock until Q3 2020 due to manufacturing issues.
    • UKMi have advised that there are no exact equivalent preparations to Norimin available in the UK market.
    • Other ethinylestradiol and norethisterone OCP products should be available on formulary. 
    • Clinicians are advised to refer to CKS guidance for advice COCs:
      https://cks.nice.org.uk/contraception-combined-hormonal-methods 
    07.03.01 Ethinylestradiol / Norgestimate  Cilique®
    • Monophasic standard strength (21 day preparation).
    • 21 days:
      • Ethinylestradiol 35 micrograms
      • Norgestimate 250 micrograms
    • Prescribe as Cilique® 250microgram/35microgram tablets in Primary Care. 
    08.03.01 Ethinylestradol 

    See section 06.04.01.01 for HRT uses

    20 Ethionamide  
  • For multidrug resistant TB, prescribed by ID consultants and respiratory consultants.
  • 04.08.01 Ethosuximide 

    • CUHFT and NWAFT: Formulary for the management of epilepsy

    • RPH: Non-formulary

    • The potential for clinically relevant differences to exist between different manufacturers’ products is considered to be extremely low - consider prescribing generically
       

    15.02 Ethyl Chloride 

    • NWAFT and RPH only - Formulary

    10.01.01 Etodolac 

    • CUHFT: Restricted to rheumatology for patients intolerant of other NSAIDs.

    • Non formulary at all other Trusts

    15.01.01 Etomidate Etomidate-Lipuro®

    • CUHFT - Non-Formulary

    • Formulary at all other trusts

    15.01.01 Etomidate Hypnomidate®

    • CUHFT - Formulary

    • Non formulary at all other trusts

    07.03.02.02 Etonogestrel 68 mg implant Nexplanon ®
    08.01.04 Etoposide 
    10.01.01 Etoricoxib Arcoxia®
    • Celecoxib is the COX II selective inhibitor of choice on the formulary.
    • Etoricoxib is only suitable for prescribing in Primary Care for patients with spondylarthritis who are unable to take formulary choice non-steroidal anti-inflammatory drugs (NSAIDs).
    • NON-FORMULARY - Etoricoxib is BLACK for all other indications in Primary or Secondary Care.
    05.03.01 Etravirine Intelence®

    CUH additional advice:



    • Restricted to ID / GU Medicine advice only.

    • Clinic 1A only for AIDS/HIV pts (Dr. Carne and team)- subject to funding being secured.

    A5.09 European Standard L&R Actilymph® European Standard CCL1 18-21mmHg or CCL2 23 - 32mmHg
    • Circular knit compression garment for regular limb shapes (refer to appropriate pathway for selection within hosiery guideline). 
    • To prevent ulceration.
    • To prevent recurrence of ulceration.To manage chronic oedema in a limb that has previously been decongested.
    • Product Information:
      • 5 sizes, 2 lengths.
      • Below knee or thigh high.
      • Open or closed toe.
      • Colours available: black or sand. 
      • 3 months guarantee/100 washes. 
    • Patient should be prescribed TWO garments per limb (ONE to wash and ONE to wear). These should be replaced every 3 months. 
    A5.09 European Standard L&R Actilymph Ease® Made to Measure CCL1 18-21mmHg, CCL2 23 - 32mmHg or CCL3 34 - 46mmHg
    • Flat knit compression garment for misshapen limbs, chronic oedema and lymphoedema (refer to appropriate pathway for selection within hosiery guideline). 
    • Mild to moderate oedema.
    • Mild limb distortion.
    • Chronic oedema, lymphoedema, lipoedema, maintenance therapy. 
    • Product Information:
      • Made to measure flat knit compression garment.
      • Various styles available on prescription.
      • 3 months guarantee/100 washes. 
    • Patient should be prescribed TWO garments per leg (ONE to wash and ONE to wear). These should be replaced every 3 months. 
    18 European Viper Venom Antivenom  Vial (for intravenous infusion)
  • Vipera berus (European adder) envenomation


    The UK Department of Health now supplies (from April 2014) the viper antivenom (antiserum) product ViperaTAb® - for human use only. This product is unlicensed in the UK.
  • 08.01.05 Everolimus Votubia®
    • This is not recommended for preventing organ rejection in liver transplantation.
    • Approved for the treatment of subependymal giant cell astrocytoma (SEGA) associated with tuberous sclerosis complex in paediatrics in line with NHSE CCP 16066/P.
    • Dispensed via Outpatient Pharmacy.
    • CAUTION WITH BRAND PRESCRIBED - Afinitor® is on formulary as per restrictions. 
    • Approved for use in line with NHSE CCP B14X09 for treatment of angiomyolipomas associated with tuberous sclerosis for angiomyolipomas (AMLs) which are 30 mm or greater and which demonstrate interval growth.
    • Approved for use in line with NHSE CCP 170093P - Everolimus  for refractory focal onset seizures associated with tuberous sclerosis complex (ages 2 years and above - paediatrics only).

     

    08.01.05 Everolimus Afinitor®

    Only approved in accordance with the National Cancer Drugs Fund List for the indication(s) below where the specified criteria are met in line with NICE TAs:



    • Everolimus with exemestane for treating advanced breast cancer after endocrine therapy (NICE TA421)

    • The treatment of well differentiated pancreatic neuroendocrine carcinomas.

    • Everolimus for advanced renal cell carcinoma after previous treatment (NICE TA432)

    • Everolimus and Sunitinib for treating unresectable or metastatic neuroendocrine tumours in people with progressive disease (NICE TA449). 


    Removed from the CDF list on 12th March 2015:



    • The treatment of moderately differentiated pancreatic neuroendocrine carcinomas.


    Removed from the CDF list on 21st July 2015. Remains on the formulary for patients with funding previously.


    The treatment of metastatic renal cell carcinoma in patients treated with only one previous tyrosine kinase inhibitor and with a contraindication to 2nd line axitinib therapy or excessive toxicity with axitinib necessitating discontinuation within 3 months of starting therapy.



    • Confirm funding approved on BlueTeq for all new starters.

      For more information see Cancer Drug Fund List

    02.12 Evolocumab 

    • Approved for treating primary hypercholesterolaemia and mixed dyslipidaemia in line with NICE TA394.

    08.03.04.01 Exemestane 

     

    • No liquid version, but tablets dissolve in about 30minutes. Ideally do not crush first. This should be avoided by women of child bearing potential and preferably be done in a closed system.
    • Advanced breast cancer in post menopausal women who previously had a clinical response to tamoxifen, and can't tolerate anastrazole.

    June 2020 - Availability of exemestane 25mg tablets

    • Accord have limited supplies available. 
    • Mylan have stock available via AAH.
    • Pfizer have also confirmed availability.
    • Zentiva - this is out of stock and no date for resupply confirmed yet. 
    02.12 Ezetimibe 

    • Recommended for treating primary heterozygous-familial and non-familial hypercholesterolaemia in line with NICE TA385

    A5.09.03 Ezy-AS® Moore UK Ltd
    • Available to purchase over the counter from Community Pharmacies. 
    05.03.02.01 Famciclovir Famvir®

    • Second line oral treatment for Herpes Zoster, in patients who cannot tolerate aciclovir or comply with five times daily regimen. Not licensed for use in children or immuno suppressed patients.

    • Genital H. Simplex (primary and recurrent)

    • NWAFT: Non-formulary


     

    10.01.04 Febuxostat Adenuric®

    • For use only in line with NICE guidance for patients intolerant of allopurinol (due to adverse effects sufficient to warrant discontinuation, or to prevent full dose escalation for optimal effectiveness) or for whom allopurinol is contraindicated.

    04.08.01 Felbamate 

    • CUHFT: Formulary for the management of epilepsy

    • Non-formulary at all other Trusts and in Primary Care

    02.06.02 Felodipine 

    • RPH and CUHFT: non formulary

    • Formulary at all other Trusts and in Primary Care

    02.12 Fenofibrate 
    04.07.02 Fentanyl Durogesic®, Fencino®, Mezolar Matrix®

    • Restricted for use in cancer pain or palliative care only in line with place in therapy (as above)

    • Reservoir patches are not recommended.

    • When prescribed in Primary Care preferred brands are

      • Fencino® or Mezolar Matrix®

      • prescribe by BRAND name



    04.07.02 Fentanyl 

    • CUHFT only: Restricted to intranasal administration within the emergency department. (Hospital only) - unlicensed use

    • Non-formulary at all other Trusts and in Primary Care

    •  


     

    04.07.02 Fentanyl Abstral®
    • Very expensive (~£3-6 per dose)
    • To be prescribed only on the advice of a palliative care specialist
    • Not recommended for any other indication
    • When recommended by a Palliative care Specialist ABSTRAL sublingual tablets are formulary choice. 
    • All other formulations including EFFENTORA buccal tablet, RECIVIT sublingual tablet, BREAKYL buccal film, PECFENT and INSTANYL nasal sprays are NOT recommended for prescribing. 
    • ACTIQ lozenges are HOSPITAL only - see separate monograph.

     

    04.07.02 Fentanyl  Actiq®
    • CUH: as per transmucosal fentanyl policy - where there is severe uncontrolled pain in a paediatric patient with profound and intractable compliance issues or unsafe swallow, the specialist Paediatric Pain Service may authorise the use of fentanyl lozenges as a means of achieving immediate pain relief where other measures cannot be implemented.
      • Treatment must be authorised by the Paediatric Pain Service consultant.
      • Treatment is for inpatients only. 
    15.01.04.03 Fentanyl 

     

    • CUHFT - Formulary Injection: 100micrograms/2mL, 500micrograms/10mL
    • NWAFT - Formulary Injection
    • RPH - Formulary Injection

    May 2020 - Medicine Supply Notification for Opioid agents (parenteral use in critical care)

    • See link below for further information. 
    09.01.01.02 Ferric Carboxymaltose Ferinject®

     



    • NWAFT: Restricted to where a faster infusion is required

    • RPH: Formulary

    • Non-formulary at all other Trusts

    20 Ferric Chloride 
  • Chiropodist only.
  • 09.01.01.01 Ferric Maltol Feraccru®

     




      • CUHFT: Third-line recommendation to GP oral iron product in mild/moderate IBD ( Ulcerative colitis or Crohn's Disease) where tolerance issues/failure to at least 2 standard oral iron preparations. NOT APPROVED FOR ANY OTHER PATIENT GROUPS



     




      • Non-formulary at all other Trusts



     

    20 Ferric Subsulfate 
  • Clinic 1A.
  • Rosie Outpatients.
  • 09.01.01.01 Ferrous Fumarate 

     

    • Suitable for self-care
    • Contains 68mg iron per 210mg tablet
    • Syrup 140mg/5ml contains 45mg iron in 5ml
    • CUHFT: Non Formulary
    • Iron deficiency anaemia in pregnancy:
      • Once a woman becomes iron deficient in pregnancy, it is impossible to ensure repletion through diet alone; oral supplementation is needed. 
      • Iron requirements increase during pregnancy and the use of iron supplements is common, particularly in the second and third trimesters.
      • Suitable for self-care. 

     

    09.01.01.01 Ferrous Gluconate 

    • Suitable for self-care

    • Contains 35mg of iron per 300mg tablet. Only use if intolerent of other iron salts (but often no better).

    • NWAFT: Non Forumlary

    09.01.01.01 Ferrous Sulphate 

     

    • Suitable for self-care
    • First Choice for CUHFT and NWAFT
    • Formulary at all other trusts
    • Contains 65mg iron per 200mg tablet.
    • Iron deficiency anaemia in pregnancy:
      • Once a woman becomes iron deficient in pregnancy, it is impossible to ensure repletion through diet alone; oral supplementation is needed. 
      • Iron requirements increase during pregnancy and the use of iron supplements is common, particularly in the second and third trimesters.
      • Suitable for self-care. 

     

    03.04.01 Fexofenadine 

    • CUHFT: Approved for the management of urticaria only

    • RPH: 2nd line formulary choice

    • Non formulary at all other Trusts and in Primary Care (only to be continued in Primary Care where formulary choices have failed and the patient is unable to self-care with OTC antihistamines)


     

    13.10.05 Fibrin sealant Tisseel®

    • CUHFT: Hospital only via inpatient pharmacy. 

    05.01.07 Fidaxomicin Dificlir®

     

    • Microbiology or infectious diseases recommendation only for the treatment of second relapses of clostridium dificile as per antimicrobial guidelines.
    • Low anticipated numbers per year in primary care (<5).
    • Very expensive (10 day course approx £1350).
    • Fidaxomicin is licensed in UK and available via standard wholesalers, but is unlikely to be stocked in community pharmacies. Supplies may be obtained from hospital pharmacy departments if undue delay in initiation is anticipated.
    • RPH: Second line agent for treatment of confirmed cases of c.difficile infection. In accordance with the product licence and on microbiologists advice only. Agreement with commissioner to be confirmed. 
    • NWAFT: Non-formulary. 



     

    09.01.06 Filgrastim 

    • CUHFT: Oncologists - for neutropenic patients. Zarzio brand used

    • NWAFT: Nivestim brand used

    • RPH: Transplant and Cystic Fibrosis on the advice of haematology. Neupogen brand used

    • CPFT: Non formulary

    06.04.02 Finasteride 

     



    • First choice in primary care


     



    • CUHFT - Restricted to urologists for patients with benign prostate hypertrophy. 





    Women of childbearing potential should avoid handling crushed or broken tablets of finasteride.

    08.02.04 Fingolimod 

    • Approved for use in line with NICE TA254

    • There is currently no NHSE commissioning policy for use outside NICE; in individual funding request (IFR) should therefore be made for each individual patient.

    06.01.06 Flash Glucose Scanning (FGS) System Freestyle Libre®
    • To be initiated through Secondary Care or a Community Consultant Lead Diabetes Clinic. Secondary Care/Community Diabetes Clinic are responsible for:
      • Completing and submitting a Group Prior Approval Form to the CCG.
      • Providing the patient with the Freestyle Libre Starter Kit which includes the scanner and ONE initial sensor (14 days’ supply).
      • Training patient appropriately on the device.
      • The agreement and signing of the patient contract (stored in the patient’s hospital / community record).
      • Reviewing the patient at 6 months and then at least annually.
    • Continuation in prescribing in Primary Care is supported once a patient initiation letter has been received from Secondary Care or a Community Diabetes Clinic.
    02.03.02 Flecainide 
    13.04 Flucinolone Acetonide 0.0025% Synalar 1 in 10 Dilution®

    Mild



    • Primary Care Specialist Advice Only

    • CUHFT and RPH - Formulary

    • Non formulary at all other trusts

    13.04 Flucinolone Acetonide 0.00625% Synalar 1 in 4 Dilution®

    Moderate

    • In Primary Care Specialist Advice only
    • CUHFT, NWAFT and RPH - Formulary
    • CPFT - Non-formulary




     

    13.04 Flucinolone Acetonide 0.025% Synalar®

    (Cream, Ointment, Gel)


    Potent



    • In Primary Care - Formulary 2nd line

    • Formulary at all trusts

    13.04 Flucinolone Acetonide 0.025% with Neomycin Sulphate 0.5% Synalar N®

    (Cream, Ointment)



    • Potent

    • Primary Care Specialist Advice CUHFT Only

    • CUHFT and RPH - Formulary

    • NWAFT and CPFT - Non-formulary

    05.01.01.02 Flucloxacillin 

     




      • CSM has advised that cholestatic jaundice may occur up to several weeks after treatment with Flucloxacillin has been stopped. Administration for more than 2 weeks and increasing age are risk factors. LFTs should be monitored where prolonged therapy is used.



     

    05.01.01.02 Flucloxacillin injection

     




      • CSM has advised that cholestatic jaundice may occur up to several weeks after treatment with Flucloxacillin has been stopped. Administration for more than 2 weeks and increasing age are risk factors. LFTs should be monitored where prolonged therapy is used.



     

    05.02 Fluconazole 

    • Consider self-care: Capsule (150mg) can be purchased from a Community Pharmacist for treatment of uncomplicated candidal vaginitis. (restrictions on sale may apply based on age and frequency of use)

    07.02.02 Fluconazole 

    • Consider Self Care (within product licence)

    • See section 5.2

    • 150mg stat dose orally

    05.02 Fluconazole IV 

    • NWAFT: restricted to use in haematology and oncology patients.

    05.02 Flucytosine Ancotil®

    • Consultant Microbiologist approval required.

    08.01.03 Fludarabine Phosphate Fludara®
  • IV for ALL in adults and paediatrics.
  • PO for CLL in combination with IV rituximab and PO cyclophosphamide.
  • Not used as monotherapy for CLL.

  • 06.03.01 Fludrocortisone 

     




      • If needed tablets can be dispersed in water. Flush well if giving via enteral tube.



     




      • May also be used off label for postural hypotension



     

    13.04 Fludroxycortide 0.0125% Haelan®
    • Tape - for chronic localised recalcitrant dermatoses (but not acute or weeping) Moderate.
    • Primary Care Specialst Advice only.

    June 2020 - Shortage of fludroxycortide 0.0125% cream and ointment

    • Typharm Limited cannot release further stock of fludroxycortide cream and ointment due to updates to their licences and changes to regulatory standards.
    • There is no confirmed resupply date.
    • Fludroxycortide 4micrograms/cm2 tape remains available.

     

    15.01.07 Flumazenil 

    • In Primary Care Restricted Item Out of Hours GP Service stock this

    • CUHFT - Injection 100micrograms/mL To antagonise benzodiazepines, in A&E, Day Surg., Theatres & ICU.

    18 Flumazenil  Injection
  • Reversal of benzodiazepine effects
  • Discussion with National Poisons Information Service recommended if using for poisoned patient or in cases of severe persistent hypotension
  • Rarely required in benzodiazepine overdose
  • Not to be used in mixed overdose or as a diagnostic test (see toxbase advice)
  • Also see section 15.1.7
  • 12.01.01 Flumetasone 0.02% with Clioquinol 1% Locorten-Vioform®
    20 Flunarizine 

    JDTC July 2014: Agreed for migraine prophylaxis (incl. in paeds population)


    To be  prescribed as a 3rd or 4th line for patients with difficult to manage migraine, where other conventional agents and botulinum toxin have not been. Flunarizine is  an earlier option for patients with prominent aura or hemiplegic migraine.

    11.04.01 Fluocinolone intravitreal implant Iluvien®
    • Approved for use as per NICE TA 301 -  Fluocinolone acetonide intravitreal implant for treating chronic diabetic macular oedema after an inadequate response to prior therapy.
      • Used in an eye with intraocular (pseudophakic) lens
    • Approved for use as per NICE TA 590 - Fluocinolone acetonide intravitreal implant for treating recurrent non-infectious uveitis. 

    • BLACK: NOT recommended as per NICE TA 613 - Fluocinolone acetonide intravitreal implant for treating chronic diabetic macular oedema in eyes with natural lenses (phakic) after an inadequate response to previous therapy
    11.08.02 Fluorescein 

    CUHFT: Diagnostic test, restricted to ophthalmology for retinal angiography. IV preparation may be given IV or orally as per protocol

    11.08.02 Fluorescein 
  • Minims® Fluorescein Sodium 1% or 2%.
  • 09.05.03 Fluoride Duraphat®

     

    • CUHFT only - Duraphat toothpaste is the only fluoride preparation on Formulary (post radiotherapy)i.e. for use in patients undergoing (or who have undergone) head and neck radiotherapy to prevent or manage dental caries. See Department of Health guidance below for national recommendations.
    • Non - formulary at all other trusts.
    • Prescribing in Primary Care should be via a Dentist and not GP. Prescribing and monitoring of fluoride containing formulations should be monitored by a dentist who is experienced in the management of dental/oral health, or the patient should self-care where fluoride containing formulations are available to purchase. 

     

    11.04.01 Fluorometholone FML®

    • Specialist initiation for prescribing to be continued in primary care -  patient to remain under ophthalmology review.



    • NWAFT and CUHFT: Formulary.



    • RPH: Non-formulary.


     

    08.01.03 Fluorouracil 

    13.08.01 Fluorouracil Efudix®

     

    • Recommended for prescribing in Primary and Secondary Care:
      • Topical treatment for the management of actinic (solar) keratosis.  
      •  Restricted Item to dermatology only within the trusts.  

     

    04.03.03 Fluoxetine 

     

    • Long half-life- caution when making dose adjustments and switching to other antidepressants.
    • Specialist initiation for children and adolescents aged 8 years and above (Amber no SCG).
    • 10mg oral formulations (tablets / capsules) are expensive. Consider prescribing 20mg dispersible tablets (e.g. Olena brand) which can be halved if required or 20mg/5ml oral solution (not sugar free version as more expensive).

    June 2020 - Serious shortage protocol (SSP) in place for Fluoxetine 40mg capsules

    • Advanz, sole supplier of fluoxetine 40mg capsules are out of stock with resupply date to be confirmed.
    • Fluoxetine 20mg capsules remain available.
    • For further information see Medicine Supply Notification and SSP link below. 

    June 2020 - Serious shortage protocol (SSP) in place for Fluoxetine 10mg tablets

    • Endo Ventures are out of stock of fluoxetine 10mg tablets until March 2021.
    • Fluoxetine 10mg capsules and fluoxetine 20mg/5ml oral solution remain available.
    • For further information see Medicine Supply Notification and SSP link below. 

     

     

     

    04.02.01 Flupentixol Depixol®

    • Requires specialist initiation by mental health team

    04.02.02 Flupentixol Decanoate 

    • Requires specialist initiation by mental health team


     

    04.02.02 Flupentixol Decanoate 

    • Requires specialist initiation by mental health team

    • 200mg/ml low volume injection is more expensive so reserve for higher dose prescriptions (>250mg).

    04.02.02 Fluphenazine Decanoate Modecate®

    Discontinuation of Fluphenazine decanoate (Modecate) injection (Sanofi)

    • Being discontinued by the end of 2018, therefore, not for initiation.
    • Prescribers should complete arrangements to transfer patients on Modecate to therapeutic alternatives under medical supervision. 



     

    08.03.04.02 Flutamide 
    03.02 Fluticasone furoate & vilanterol Relvar Ellipta®
    • Prescribable in Primary Care after specialist initiation for patients (paediatrics and adults within medication license) who have poorly controlled asthma, deemed poorly compliant/concordant to their current regimen.
    • Licensed for adults and adolescents aged 12 years and over.
    03.02 Fluticasone propionate Flixotide®
  • 3rd line in Paediatric patients only .
  • 12.02.01 Fluticasone Propionate 

    • Suitable for self care - patients aged 18 years and over may purchase from a Community Pharmacy. 



    • NWAFT: Formulary.



    • Non-formulary at all other Trusts and in Primary Care

    12.02.01 Fluticasone Propionate Flixonase Nasule®

     

    • Recommended second line after mometasone nasal spray for the management of nasal polyps in chronic rhinosinusitis. Flixonase (fluticasone proprionate) nasules should be prescribed for a 6-week course and if treatment successful patient can then be switched back to a nasal steroid spray. 
    • For the treatment of oral lichen planus see link below.
    • Not recommended for any other indication.
    12.03.01 Fluticasone Propionate Flixonase®

     

    • Second line to betamethasone soluble for the management of oral lichen planus in adults and children 16 years and over (off-label indication).
    • Use first line only where betamethasone soluble (licensed treatment) is unavailable or contraindicated.
    • For the management of nasal polyps in chronic rhinosinusitis see link below. 

     

    03.02 Fluticasone propionate and formoterol Flutiform®
  • Prescribe by Brand.
  • Second line after Fostair® in Asthma patients only.
  • As per stage 3 of BTS guidelines for Asthma.
  • Low and Medium doses licensed for adults and children 12 years.
  • High doses licensed in adults > 18 years.
  • 03.02 Fluticasone propionate and salmeterol 

     

    • Prescribe by BRAND.
    • Preferred brands in Primary Care are:
      • Combisal MDI for paediatric patients (asthma). 
      • Sereflo MDI for adult patients (asthma).
    • Seretide MDI and alternative brands of fluticasone/salmeterol combination MDIs are non-formulary. 
    04.03.03 Fluvoxamine Maleate Fluvoxamine®

    • CPFT: Not recommended for first line use.

    • Non-formulary at all other Trusts

    • Where Primary Care is requested to prescribe, it should be clear why formulary choices are unsuitable 


     


     

    09.01.02 Folic Acid 

     

    • 400microgram strength can be purchased from a Community Pharmacist - Recommend Self-Care.
    • Pregnant women with diabetes, epilepsy or a raised body mass index (BMI) will need a prescription for a higher dose of folic acid, 5mg per day.
      • The 5mg strengths of folic acid must be prescribed.
      • Please see links below for further information. 



     

    06.05.01 Follitropin Alfa Ovaleap®, Bemfola®

     

      • CUHFT: Hospital only via Outpatient pharmacy- for use by specialist endocrinologists as an appropriate switch from follitropin beta which is discontinued. Confirmed NHS still commissionned to treat male infertility with certain criteria. 
      • Ovaleap: preferred biosimilar for private IVF patients at Kefford house (JDTC Feb 2020)

     

    18 Fomepizole  Injection (unlicensed in UK)
  • See Toxbase and discuss with National Poisons Information Service to ensure appropriate use.
  • Costs around £5,000 per treatment course.
  • 02.08.01 Fondaparinux  Arixtra®

    • CUHFT, NWAFT and RPH: Formulary for ACS as per NICE guidelines on unstable angina and NSTEMI. (NWAFT: Where eGFR is less than 30ml/min use dalteparin)

    • CUHFT: Also accepted for use in line with Trust guideline for HIT.

    20.02 Formaldehyde Formalin

    • 40% diluted to 4% soak.

    • For soaking warts.

    03.01.01.01 Formoterol Fumarate 

    • Long Acting - 1st choice in Primary Care.

    • 1st choice Easyhaler®

    • 2nd choice Turbohaler (Oxis ®).Restricted to those patients already on turbohalers (budesonide and terbutaline) who now require a long acting beta stimulant.

    05.03.01 Fosamprenavir Telzir®

    CUH additional advice:



    • Restricted to ID / GU Medicine advice only.

    • Restricted to Clinic 1A consultants only - funding not agreed.

    20.01 Foscarnet 

    • CUHFT: Approved for use as a stat dose (rarely repeated once) for severe cases of acute retinal necrosis. Hospital only via inpatient pharmacy.

    05.03.02.02 Foscarnet Sodium Foscavir®

    • CUHFT only

    • Dr. Lever or named colleague or Consultant Microbiologist for CMV or severe (life threatening) disseminated Herpes Simplex infection in the immuno-compromised unresponsive to aciclovir.

    • Non formulary at all other trusts.

    05.01.07 Fosfomycin Fomicyt®

     

    • High cost drug (not PbR excluded).
    • Indicated for multidrug resistant urinary tract infections.
    • CUHFT an NWAFT: Consultant Microbiologist approval required.
    • Oral sachets also available as per antimicrobial guidelines.
    • CUH additional advice : Clinically approved by JDTC for mutli-drug resistant organisms: carbapenemase-producing Enterobacteriaceae (CPE. Microbiology input needed). Funding approved by investment review board subject to usage reports being maintained and provided to JDTC at 6 months and then 9 months to ensure usage remains within scope.
    • RPH: Not restricted for use by the Thoracic Directorate.



     

    20.01 Fosfomycin 
  • Clinically approved by JDTC for mutli-drug resistant organisms: carbapenemase-producing Enterobacteriaceae (CPE. Microbiology input needed)
  • High cost drug.
  • Funding approved by investment review board subject to usage reports being maintained and provided to JDTC at 6 months and then 9 months to ensure usage remains within scope.
  • 02.02.02 Furosemide 

    • Licensed liquids may contain alcohol. For further advice contact Pharmacy, Medicines Information or Medicines Optimisation Team

    • Injection: Hospital only

    11.03.01 Fusidic Acid 
    13.10.01.02 Fusidic Acid 2% Fucidin®
    04.07.03 Gabapentin 

    • Recommended 2nd line after amitriptyline (Formulary at all Trusts).



    • CUHFT: Also on formulary for the management of facial pain (patients under the care of Mr Adlam).

    04.08.01 Gabapentin 

    • Formulary for the management of epilepsy.



    • Tablet  is much more expensive than capsules and is non-formulary.



    • The potential for clinically relevant differences to exist between different manufacturers’ products is considered to be extremely low - consider prescribing generically.


    04.11 Galantamine 

     

      • To be prescribed on the advice of a specialist experienced in the management of dementia in line with NICE TA217 and Shared Care Guideline.
      • When the modified release formulation is prescribed in Primary Care the preferred brand is Gatalin® XL Capsules

    June 2020 - Galantamine 8mg/12mg tablets

    • Teva will be out of stock of their immediate release galantamine preparations (8mg and 12mg) until July 2020.
    • We have been advised that galantamine modified release preparations are readily available (8mg, 16mg, 24mg). The preferred brand in Primary Care is Gatalin® XL Capsules
    • As per UKMi guidance for switching preparations are as follows:
      • It is recommended that the same total daily dose of galantamine is administered to patients. Patients switching to the once-daily regimen should take their last dose of galantamine tablets or oral solution in the evening and start prolonged- release capsules once daily the following morning.
    • In addition, galantamine oral solution 4mg/ml is also readily available. This option is significantly more expensive than modified release capsules and should be reserved for patients who cannot have the modified release formulation.
    05.03.02.02 Ganciclovir Cymevene®

    • NWAFT: Restricted to use in in patients with HIV infection or in haematology/oncology patients 

    11.03.03 Ganciclovir 0.15% ophthalmic gel Virgan®

     

    • This is licensed for the treatment of acute herpetic keratitis (dendritic and geographic ulcers) in adults and suitable for prescribing in Primary Care or Secondary Care.

     

     

    01.06.07 Gastrografin 

    • RPH: Restricted for use in cystic fibrosis where other treatments for distal intestinal obstruction syndrome (DIOS) have failed. 

    • Non-formulary at all other Trusts

    01.01.02 Gaviscon Infant ® 

     

    • Oral powder (sachets)
    • Restricted to Paediatric use only.
    • Not to be used in premature infants or infants under one year except under medical supervision. Premature infants or infants under one year will need to be medically assessed before parents/carers are advised to purchase this product OTC. 




     

    08.01.05 Gefitinib Iressa®
  • Approved in accordance with NICE TA192 for NSCLC
  • 09.02.02.02 Gelatin Gelofusine®

    • CUHFT - 500ml and 1 litre bags available

    • RPH - 4% infusion 500mL, 1 Litre

    • Non - formulary at all other trusts

    09.02.02.02 Gelatin Volplex®

    • NWAFT - Restricted to critical care only

    • Non - formulary at all other trusts

    09.02.02.02 Gelatin Isoplex®

    • NWAFT only - 1st choice

    08.01.03 Gemcitabine Gemzar® •Approved for use in line with NICE TA116 and TA25.
    •Overall chemo spend to be tracked against income in-year until further notice.
    07.01.01 Gemeprost 

    • CUHFT: Stored in freezer. Should be allowed to warm up to room temperature for 30 mins before use.

    • Non-formulary at all other Trusts

    08.01.05 Gemtuzumab ozogamicini Mylotarg®

    • Approved for use in accordance with NICE TA545 for untreated acute myeloid leukaemia. 

    05.01.04 Gentamicin 

    • CUHFT and RPH: Shared care for the long term prophylaxis of chronic lung infections in non-CF bronchiectasis

    • NWAFT: Non-formulary

    05.01.04 Gentamicin 

    • RPH: Intracthecal injection is non-formulary

    11.03.01 Gentamicin ophthalmic

    • Eye drops 0.3% (for ear or eye).

    • RPH - Specialist advice

    12.01.01 Gentamicin  Genticin®

    • For eye or ear drops 0.3%.

    20 Gentamicin 0.1% 
  • For use by nephrology consultants in patients undergoing peritoneal dialysis who develop exit site infections resistant to mupirocin.
  • 12.03.05 Glandosane® 

    • CUHFT - Only ACBS approved for dry mouth associated with radiotherapy or sicca syndrome.

    • NWAFT: Non-formulary


     

    08.02.04 Glatiramer Acetate Copaxone®

    • NHSE commissiosing policy implementaion plan in place:Disease Modifying therapies for Multiple Sclerosis, May 2014, Reference: NHS ENGLAND/ D04/P/b.



    • Via Lloyds homecare.

    • Available as 20mg/ml syringes for once daily dosing and as 40mg/ml syringes for three times weekly dosing. Both regimens are cost equivalent and are commissioned. New patietns should start on 40mg/ml syringes to aid compliance.



    • Approved for use in accordance with NICE TA527 - Beta interferons and glatiramer acetate for treating multiple sclerosis.

    05.03.03.02 Glecaprevir and Pibrentasvir Maviret®

    • Approved for use in line with NICE TA499 - Glecaprevir and Pibrentasvir for treating chronic hepatitis C. 

    06.01.02.01 Gliclazide 

    • First Choice in Primary Care, NWAFT, RPH and CPFT

    • CUHFT Restricted to: patients with renal impairment who are unable to tolerate glipizide. patients already established on gliclazide. If needed tablets can be crushed and dispersed in water. 


     

    06.01.02.01 Glimepiride 

    • 2nd choice in Primary Care.

    • Formulary at NWAFT 

    • Non formulary at all other trusts

    06.01.02.01 Glipizide 
    06.01.04 Glucagon GlucaGen® HypoKit
  • Used in the treatment of hypogylcaemia.
  • Also used for the treatment of drug induced severe hypotension, heart failure or cardiogenic shock.
  • 18 Glucagon GlucaGen® Hypokit Injection
  • Discussion with National Poisons Information Service recommended when used as a treatment of poisoning (e.g. beta-blocker poisoning)
    See also section 6.1.4
  • 06.01.04 Glucose 

    • Dextrose (glucose) gel is first choice in primary care.

    • CUHFT - prescribe Rapilose


     

    09.02.02.01 Glucose Intravenous 

    Available in multiple strengths


    Glucose 5% infusion 100mL, 250mL, 500mL


    Glucose 20% infusion 500mL


    Glucose 50% infusion 500mL

    13.07 Glutaraldehyde Glutarol®
    01.06.02 Glycerol (Glycerin) 

    • RPH Second line post-operatively (Senna is first line formulary choice post-operatively)

    09.08.01 Glycerol Phenylbutyrate Ravicti®

    • CUHFT only - for urea cycle disorders. 

    02.06.01 Glyceryl Trinitrate Nitrocine®

     




      • Injection: Glass or polyethylene apparatus is preferable; loss of potency will occur if PVC is used.



     


     

    02.06.01 Glyceryl Trinitrate 

    • Sublingual tablets: Discard tablets 8 weeks after opening bottle

    • Primary Care:


      • Prescribe spray as Glyceryl trinitrate 400micrograms/ dose pump sublingual spray

      • Prescribing of patches in Primary Care should be on the advice of a specialist


    18 Glyceryl Trinitrate  Injection
    Treatment of hypertension associated with poisoning or overdoses
  • Injection (secondary care only)- Use Polyethylene (PE), giving set for infusion (NOT PVC!).
  • Also see section 2.6.1
  • 01.07.04 Glyceryl Trinitrate 0.4% Rectogesic®


    07.04.04 Glycine 

    • CUHFT and NWAFT: Formulary

    • Non-formulary at all other Trusts

    20.02 Glycopyrrolate in cetimacrogol cream 
  • 0.5% and 1%.
  • 03.01.02 Glycopyrronium Seebri breezhaler®
  • LAMA, in line with NICE guidance for COPD.
  • 2nd line long acting muscarinic antagonist, if tiotropium contraindicated or not tolerated.
  • 15.01.03 Glycopyrronium 

    • In Primary Care Restricted Item for palliative care use (See CPFT Anticipatory Prescribing for patients with a Terminal Illness)

    • CUHFT - Formulary Injection 200micrograms/mL For the treatment of respiratory tract secretions for dying patients (see Liverpool Care of the dying Pathway).

    • NWAFT - Formulary

    • RPH - Formulary

    01.02 Glycopyrronium bromide  Colonis

     

    • Approved for symptomatic treatment of severe sialorrhoea (chronic pathological drooling) in children and adolescents aged 3 years and older (licensed) and adults (off-label) with chronic neurological disorders.

     

    • Existing patients currently prescribed Glycopyrronium bromide tablets formulations should be switched to the formulary formulation of Glycopyrronium bromide 1mg/5ml Oral Solution (Colonis).

     

    13.12 Glycopyrronium Bromide 0.05%  Iontophoresis

    • CUHFT - Restricted Item 0.05% solution only for patients with excessive sweating.

    • NWAFT - Restricted Item 0.005% solution and 1% cream only

    20.01 Glycopyrronium Bromide 0.05%  
  • For patients with excessive sweating.
  • Endocrinologists and dermatologists.
  • 01.05.03 Golimumab Simponi®

    • For ulcerative colitis as per NICE TA 329 after the failure of conventional therapy.

    10.01.03 Golimumab Simponi®

    • Approved for Ankylosing Spondylitis, Psoriatic Arthritis and Rheumatoid Arthritis as per NICE TAs, see links below. 


     

    06.05.01 Gonadorelin 
    06.07.02 Goserelin 
  • Local Enhanced Service (LES) available in primary care for administration.
  • 1st line GnRH in primary care for endometriosis, endometrial thinning, uterine fibroids only.
  • For malignant disease indications see section 8.3.4.2
  • 08.03.04.01 Goserelin Zoladex®

    • See section 08.03.04.02 for prostate cancer and 6.7.2 for gynae and gender dysphoria.

    • The Trust only stocks 1-monthly preparations for inpatients who are due the next dose but cannot bring in their own supply.

    • Secondary care clinics to recommend (not supply) gonadorelin analogues in line with local Formulary choices (see C&PJPG Formulary).

    • Goserelin is a first line option gonadorelin analogue for breast cancer, assisted reproduction, endometriosis, endometrial thinning and uterine fibroids; triptorelin is first line choice for prostate cancer.

    08.03.04.02 Goserelin Zoladex®

    • The Trust only stocks 1-monthly preparations for inpatients who are due the next dose but cannot bring in their own supply.

    • Goserelin is a first line option gonadorelin analogue for breast cancer, assisted reproduction, endometriosis, endometrial thinning and uterine fibroids; triptorelin is first line choice for prostate cancer.

    04.06 Granisetron 

    • CUHFT only:

      • Oncology department following anti-emetic protocol.

      • Anaesthetists for PONV (as prophylaxis).



    • Non-formulary at all other Trusts

    04.06 Granisetron transdermal patch Sancuso®
    • CUHFT only: As per anti-emetic protocol. Patients who are having 3-5 day MEC or HEC regimens AND who cannot swallow may be prescribed a granisetron transdermal patch (Sancuso) to be applied 24 hours before start of chemotherapy and left in place until at least 24 hours after chemotherapy is finished.

     

    • Non-formulary at all other Trusts
    03.04.02 Grass pollen extract Grazax®

    • CUHFT- Specialised service use and initiation only.

    • NWA - Paediatric immunologist use only.

    • GP is able to prescribe after initiation in hospital. Hospital to prescribe first months treatment.

    05.02 Griseofulvin 

    • CUHFT: On recommendation from dermatology only.

    • Non-formulary at all other Trusts


     

    04.04 Guanfacine Intuniv®

    • CPFT: Approved for the treatment of attention deficit hyperactivity disorder (ADHD) in children and adolescents 6-17 years old for whom stimulants are not suitable, not tolerated or have been shown to be ineffective.



    • Specialist initiation (1 month) with shared care for prescribing to be continued in primary care.



    • Use in adults is outside of the product license and is NOT RECOMMENDED. 



    • Non-formulary at all other Trusts unless patient is admitted on treatment

    13.05.03 Guselkumab Tremfya®

    • Approved for use in accordance with NICE TA521 for treating moderate to severe plaque psoriasis. 

    A5.09.02 Haddenham® Pertex RAL Standard CCL1 18 - 21mmHg, CCL2 23 - 32mmHg or CCL3 34-46mmHg 
    • Lymphoedema specialist garments - Specialist Advice from the Lymphoedema Service for prescribing in Primary Care. 
    • Flat knit garments for irregular limb shape. 
    • Moderate ymphoedema. 
    • Chrolnic oedema.
    • Chronic venous insufficiency.
    • Product information:
      • Made to measure flat knit compression garment.
      • Various style available on prescription.
      • Guaranteed for 6 months.  
    • Patient should be prescribed TWO garments per limb (ONE to wash and ONE to wear). These should be replaced every 6 months. 
    A5.09.02 Haddenham® Star Cotton RAL Standard CCL1 18 - 21mmHg or CCL2 23 - 32mmHg 
    • Lymphoedema specialist garments - Specialist Advice from the Lymphoedema Service for prescribing in Primary Care. 
    • Circular knit garments for regular limb shape. 
    • Mild to moderate lymphoedema.
    • Chronic oedema.
    • Chronic venous insufficiency.
    • Palliative care. (CCL1).
    • Patients with sensitive skin. 
    • Product information:
      • Below knee, thigh high, tights.
      • 8 sizes, 3 lengths.
      • Standard or extra wide width.
      • 2 colours. 
      • Guaranteed for 6 months.  
    • Patient should be prescribed TWO garments per limb (ONE to wash and ONE to wear). These should be replaced every 6 months. 
    A5.09.02 Haddenham® Veni RAL Standard CCL1 18 - 21mmHg, CCL2 23 - 32mmHg or CCL3 34 - 46mmHg 
    • Lymphoedema specialist garments - Specialist Advice from the Lymphoedema Service for prescribing in Primary Care. 
    • Circular knit garments for regular limb shape. 
    • Lymphoedema.
    • Mild oedema CCL1.
    • Mild/moderate oedema CCL2.
    • Chronic venous disease
    • Product information:
      • Below knee, thigh high, tights.
      • 8 sizes, 3 lengths.
      • Standard or extra wide width.
      • 9 colours. 
      • Guaranteed for 6 months.  
    • Patient should be prescribed TWO garments per limb (ONE to wash and ONE to wear). These should be replaced every 6 months. 
    09.08.02 Haem Arginate Normosang®

    • CUHFT - Restricted use

    • NWAFT - Clinician must contact National Acute Porphyria Service for approval before haemarginate may be supplied.

    14.04 Haemophilus influenzae type B Combined Vaccine Menitorix® Injection

    Haemophilus influenza type b (Hib) and Meningococcal group C (MenC)

  • In Primary Care - Part of the Routine Childhood Immunisation schedule (see link)

  • Vaccination for individuals with the following underlying conditions (see link):
    • Asplenia or splenic dysfunction
    • Complement disorders
  • 01.07.01 Haemorrhoid relief Anusol®

     

    • Consider self care - other brands are also available.
    • CUHFT: Available to inpatients. Non-formulary to outpatients. Encourage self-care and obtaining OTC.

     

     

     

    04.02.01 Haloperidol 

     

    • For mental health conditions - requires specialist initiation by mental health team
    • CPFT:

      • Baseline ECG is recommended prior to treatment with haloperidol (oral or IM) in all patients, especially the elderly and patients with a positive personal or family history of cardiac disease or abnormal findings on cardiac clinical examination.
      • Haloperidol may still be administered in an emergency situation, without a baseline ECG, if a member of medical staff decides that the benefit of administering the medicine outweighs the cardiac risk in an individual patient.
      • The need for further ECGs during treatment should be assessed on an individual basis
    • Injection : Now only licensed for IM administration. IV administration is unlicensed.
    • All Trusts and Primary Care: Can be used in palliative care (can be initiated in primary care)
    • RPH: 1st line treatment for delirium (Hospital only)

    March 2020 - Discontinuation of Haloperidol (Serenace) 500 microgram capsules 

     

    04.02.02 Haloperidol Haldol Decanoate®

    • Requires specialist initiation by mental health team


     

    04.09.03 Haloperidol 

    • CUHFT: Unlicensed indication.unlicensed unlicensed See section 4.2.1

    • Non-formulary at all other Trusts and in Primary Care for this indication

    20 Halothane 
  • Anaesthetists.
  • 02.08.01 Heparin 

     

      • CUHFT and NWAFT: For further advice on formulations please contact your Ward or Lead Pharmacist

     

      • RPH only:

     



    Heparinised saline flush



    10 units/mL



    5mL amp



    Heparin flush for maintaining patency of ports



    100 units/mL



    2mL amp



    Heparin preservative-free for theatres only



    1,000 units/mL



    5mL amp



    Heparin for clinical perfusionists only



    1,000 units/mL



    20mL amp



    Heparin:




    Prophylaxis and treatment of deep vein thrombosis and pulmonary embolism.




    Treatment of unstable angina pectoris and prophylaxis of mural thrombosis following myocardial infarction.




    In haemofiltration and extracorporeal circulation (bypass and ecmo).



    5,000 units/mL



    5mL amp



    Heparin for cath labs only



    1,000 units in NaCl 0.9%



    500mL bag

     

     

     

     

    02.08.01 Heparin 

    • RPH and NWAFT: Formulary

    • CUHFT: Restricted to heamatologist recommendation only for Heparin induced thrombocytopenia and thrombosis (HIT). 

    20 Heparin sulphate/Lidocaine and sodium bicarbonate 
  • To treat patients with interstitial cystitis and bladder pain.
  • 13.13 Heparinoid 0.3% Hirudoid®

    (Cream 0.3%, Gel 0.3%)



    • In Primary Care - Non-formulary but can be self-care Self-care Policy

    • CUHFT - Formulary

    • Non-formulary at all other trusts

    14.04 Hepatitis A vaccine Havrix Monodose®
  • In Primary Care - Available free of charge for travel to certain areas (see link)

  • CUHFT Restricted Item Haematologists & other prescribers treating heamophiliacs.

  • NWAFT - Formulary
  • 14.04 Hepatitis A vaccine Single Component Avaxim®
  • In Primary Care - Available free of charge for travel to certain areas (see links)
  • 14.04 Hepatitis A vaccine Single Component Vaqta® Paediatric
  • In Primary Care - Available free of charge for travel to certain areas (see links)
  • 14.04 Hepatitis A vaccine with Hepatitis B vaccine  Twinrix® and Ambirix® Injection
  • Vaccination for individuals with the following underlying conditions (see link):
    • Chronic liver conditions
    • Haemophilia

    Amber Traffic Light  Available free of charge to certain travellers (see link)
  • 14.04 Hepatitis A vaccine with typhoid vaccine Hepatyrix®
  • In Primary Care - Available free of charge for travel to certain areas (see link)
  • 14.04 Hepatitis A vaccine with typhoid vaccine VIATIM®
  • In Primary Care - Available free of charge for travel to certain area (see link)
  • 14.05.02 Hepatitis B immunoglobulin  CUHFT:
  • For Pharmacy staff: There are Pharmacy dispensing protocols for issues of Immunoglobulins and rabies vaccine on the advice of Virology. These are located in the Pharmacy Virology file and on Pharmacy Sharepoint. Please ensure all relevant information is recorded in the Virology Pharmacy file at the time of dispensing.
  • Transplant: 1st dose IV Hepatect®CP and 2nd dose SC Zutectra® approved.
  • 14.04 Hepatitis B vaccine 
  • Engerix B®- 20micrograms in 1mL Injection- 0.5mL (Paediatric) and 1mL available
  • Fendrix®- 40micrograms in 1mL Injection- 0.5mL Prefilled Syringe
  • HBvaxPRO®- Injection 10micrograms in 1mL - 0.5mL (Paediatric) and 1mL available 40micrograms in 1mL Vial

  • Part of the Childhood Immunisation Schedule for babies born to hepatitis B infected mothers (Engerix B/HBvaxPRO)
  • Vaccination for individuals with some underlying medical conditions (see link)

    Red Traffic Light  Not available on the NHS for travel
  • 20 Hexamide Disethionate 0.1% 
  • Management of acanthomeba keratitis.
  • Ophthalmologists only.
  • 12.03.04 Hexetidine 0.1%  Oraldene®

    • Consider whether prescribing in primary care should be by a dentist

    • Consider self-care. Can be purchased from a Community Pharmacist

    11.08 Holoclar® 

    • Ex vivo expanded autologous human corneal epithelial cells containing stem cells.



    • In line with NICE TA467 for treating limbal stem cell deficiency after eye burns. 

    09.02.02.02 Human Albumin Solution 

    • Managed by blood services

    14.04 Human papilloma virus vaccine Gardasil®

    • In Primary Care: Part of the Routine Childhood Immunisation Schedule for girls aged 12 to 13 years

    • CUHFT: Hospital only via outpatients/clinic stock for the Public Health England MSM vaccination programme. See link below.

    10.03.01 Hyaluronidase Hyalase®

    • Classified red for the enhancement of permeation of subcutaneous or intramuscular injections, local anaesthetics and subcutaneous infusions; promotes resorption of excess fluids and blood.

    02.05.01 Hydralazine 

    • Injection: Hospital only

    06.03.01 Hydrocortisone 
    • Hydventia is the preferred brand of hydrocortisone 10mg and 20mg tablets in Primary Care.
    • For paediatric doses which are > 2.5mg or a multiple of 2.5mg, Hydventia 10mg tablets is the preferred brand in Primary Care and this formulation is licensed to be divided into equal halves or quarters to allow for 2.5mg and 5mg dosing. The patient's community pharmacist can support in halving or quartering these tablets as appropriate.
    • Alkindi, hydrocortisone granules in capsules for opening (LINK) should only be prescribed where the patient's dose is < 2.5mg or is NOT a multiple of 2.5mg. 
    • Where other formulations of hydrocortisone are unsuitable for children (as above) Hydrocortisone 5mg/5mL is the standardised liquid strength which should be prescribed in children (unlicensed unlicensed):
      • Using standardised strengths of unlicensed liquid medicines in children, will reduce the risk of errors being made in the doses given to children and prevent hospitalisation from accidental under and overdoses.
      • See link below for further information.
       
    06.03.02 Hydrocortisone 
    • Hydventia is the preferred brand of hydrocortisone 10mg and 20mg tablets in Primary Care. 
    • For paediatric doses which are > 2.5mg or a multiple of 2.5mg, Hydventia 10mg tablets is the preferred brand in Primary Care and this formulation is licensed to be divided into equal halves or quarters to allow for 2.5mg and 5mg dosing. The patient's community pharmacist can support in halving or quartering these tablets as appropriate.
    • Alkindi, hydrocortisone granules in capsules for opening (LINK) should only be prescribed where the patient's dose is < 2.5mg or is NOT a multiple of 2.5mg. 
    • Where other formulations of hydrocortisone are unsuitable for children (as above) Hydrocortisone 5mg/5mL is the standardised liquid strength which should be prescribed in children (unlicensed unlicensed):
      • Using standardised strengths of unlicensed liquid medicines in children, will reduce the risk of errors being made in the doses given to children and prevent hospitalisation from accidental under and overdoses.
      • See link below for further information.
    06.03.02 Hydrocortisone Alkindi®
    • Prescribable in Primary Care following Specialist Advice:
      • Licensed for replacement therapy of adrenal insufficiency in infants, children and adolescents (from birth to < 18 years old).
      • These should only be prescribed where the paediatric patient's dose is < 2.5mg or is NOT a multiple of 2.5mg. 
      • For doses which are > 2.5mg or a multiple of 2.5mg, Hydventia 10mg tablets is the preferred brand in Primary Care and this formulation is licensed to be divided into equal halves or quarters to allow for 2.5mg and 5mg dosing. The patient's community pharmacist can support in halving or quartering these tablets as appropriate. 

     

    12.03.01 Hydrocortisone 
  • Mucoadhesive buccal tablets (= oromucosal tablets), hydrocortisone 2.5 mg (as sodium succinate).
  • 13.04 Hydrocortisone 

    (Cream 0.5% and 1%, Ointment 0.5% and 1%)


    Mild



    • In Primary Care this is self care for short courses Self-care Policy 

    • CUHFT - Formulary

      • When hydrocortisone cream or ointment is prescribed and no strength is stated, the 1% strength should be supplied.



    • NWAFT - Formulary

    • RPH - Formulary (1% only)

    13.04 Hydrocortisone 

    (Cream 2.5%, Ointment 2.5%)


    Mild



    • In Primary Care - Specialist Advice Only

    • CUHFT - Formulary

      • When hydrocortisone cream or ointment is prescribed and no strength is stated, the 1% strength will be supplied.



    • NWAFT - Formulary

    • Non formualry at all other trusts

    06.03.02 Hydrocortisone sodium phosphate Efcortesol®

    • CUHFT and RPH only: Usually use sodium succinate salt (Solu-Cortef), but sodium phosphate salt available for outpatients who may need to self administer (e.g. Addisonian/Adrenal crisis). It is already in solution and doesn't require reconstitution (sodium succinate salt requires reconstitution).

    • Non formulary at all other trusts


    Requires reconstitution 


     

    06.03.02 Hydrocortisone sodium succinate Solu-Cortef®

    • Injection salt usually used.

    • CPFT: Non-formulary

    13.04 Hydrocortisone 1% with Clotrimazole 1% Canesten HC®

    Mild with antifungal



    • In Primary Care this is self care Self-care Policy for patients 10 years or older for inflammed fungal sweat rash and atheletes foot

    • Formulary at all other trusts

    13.04 Hydrocortisone 1% with Miconazole Nitrate 2% Daktacort®

    Mild with antifungal



    • In Primary Care this is self-care Self-care Policy for patients 10 years or over for inflammed fungal sweat rash and atheletes foot

    • Formulary at all other trusts

    10.01.02.02 Hydrocortisone acetate 
    13.04 Hydrocortisone Acetate 1% with Fusidic Acid 2% Fucidin H®

    Mild with antimicrobial

    12.01.01 Hydrocortisone Acetate 1% with Gentamicin 0.3% Gentisone® HC

    • Ear drops.

    13.04 Hydrocortisone Butyrate Locoid®

    Potent

    12.03.04 Hydrogen Peroxide 

    • Mouthwash 6% (20 volumes) BP.

    • Usually use chlorhexidine instead.

    • NWAFT: Non-formulary

    13.11.06 Hydrogen Peroxide Solution BP 

    • CUHFT only

    22.02 Hydromol fragrance free ® bath additive  500mL Bottle
    (SS)
    13.02.01 Hydromol® 
    04.07.02 Hydromorphone Palladone®

     

    • CUHFT: Prescribable by or on the advice of Dr. Sarah Booth only. To be used as an alternative to oral morphine for palliative care patients when side effects to morphine become intolerable.

     

    • Non-formulary at all other Trusts and in Primary Care.

     

    20.02 Hydroquinone 5%, hydrocortisone 1% and Retin A cream Pigmanorm
    20.02 Hydroquinone in aqueous cream 
  • 4%
  • 13.02.01 Hydrous Ointment, BP 

     

     

    • Formulary at all other trusts

     

    • NWAFT - Non-formulary 

      • NOTE: contains lanolin.


    • Use Emollients Safely There is a fire risk associated with all emollients whether they contain paraffin or not.

     

    09.01.02 Hydroxocobalamin 

     



    • For guidance on when to use IM hydroxocobalamin or oral cyanocobalamin (available OTC) please see the Guideline for the management of Vitamin B12 deficiency (adults) - link below. 


     

    18 Hydroxocobalamin Cyanokit® Injection (for infusion)
  • Used for the treatment of cyanide poisoning
  • Discussion with National Poisons Information Service recommended.

  • 08.01.05 Hydroxycarbamide 

    • CUHFTonly: Shared Care Agreement for the for the treatment of myeloproliferative neoplasms (polycythaemia vera, essential thrombocythaemia and primary myelofibrosis) (Adults)

    • All other indications are Hospital Only

    • Unlicensed suspension is available for paediatrics not able to swallow tablets/capsules.

    09.01.03 Hydroxycarbamide Siklos®

    • RPH: Licensed for the prevention of recurrent painful vaso-occlusive crises including acute chest syndrome in patients suffering from symptomatic Sickle Cell Syndrome

    • Non-formulary at all other Trusts and in Primary Care

    10.01.03 Hydroxychloroquine 

     

    • Tablets may be crushed and dispersed in water (unlicensed unlicensed).

     

    11.08.01 Hydroxyethylcellulose Minims® Artificial Tears

    • Preservative free eye drops

    03.04.01 Hydroxyzine 

    • CUHFT: Approved for urticaria only.

    • NWAFT: Restricted to use in dermatology

    • All other trusts and Primary Care: non-formulary

    01.02 Hyoscine Butylbromide Buscopan®

    • Mebeverine is the 1st line choice oral anti-spasmodic.

    • Oral hyoscine butylbromide is poorly absorbed.

    • For Hospital Trusts the injection is the preferred formulation, where faster onset of action is required in acute clinical situations.

    04.06 Hyoscine Hydrobromide 

    • Palliative Care.

    • Paediatric Oncologistists

    • Rehab for hypersecretions.

    • For management of clozapine-induced hypersalivation (off-label) - on the advice of a specialist in mental health

    • Patches are 1.5mg total dose, but only release 1mg over 72 hours.

    • If needed tablets can be crushed and dispersed in water.

    15.01.03 Hyoscine Hydrobromide 

    • In Primary Care Restricted Item for palliative care use (See CPFT Anticipatory Prescribing for patients with a Terminal Illness)

    • Formulary at all trusts

    11.08.01 Hypromellose 

    • Can be purchased from a Community Pharmacist. Recommend self-care where patient is willing and able

    • Trusts: Restricted to ophthalmologists, for dry eye syndrome (Brands may vary to those used in Primary Care due to contract prices)

    • 1st line formulary choice in Primary Care. Preferred brands are:


      • Hypromellose 0.5% [Prescribe generically] (excipients depend on manufacturer, check with pharmacist) Expires 28 days after opening.



      • Where a preservative free formulation is required (in-line with Primary Care guidance) Evolve® Hypromellose [Hypromellose 0.3%] Expires 90 days after opening.



    06.06.02 Ibandronic Acid 

    • Metabolic bone unit in line with Trust guidelines for osteoporosis ONLY if iv bisphosphonates are required and zolendronic acid is considered inappropriate. 



    • Zoledronic acid (5mg) has replaced ibandronic acid (Bonviva) as 1st choice iv medication for patients fulfilling criteria for iv bisphosphonates as per Trust guidelines (for use by Metabolic Bone Unit consultants only).



    • NOTE difference in strength for use in cancer and for osteoporosis.



    • For oncology see chapter 8.



    • Approved for use in accordance with NICE TA464 - Bisphosphonates for treating osteoporosis. 



    • Patients should be prescribed EITHER an oral bisphosphonate OR an intravenous bisphosphonate. Patients should NOT be co-prescribed both.

    06.06.02 Ibandronic acid  Bondronat®

    • Reduction of bone damage in bone metastases in breast cancer.



    • For use by oncologists in patients with breast cancer.

    06.06.02 Ibandronic Acid 

    • 150mg once MONTHLY dosing.



    • Treating postmenopausal osteoporosis.



    • Restricted to use as second line option for patients unable to swallow normal tablets for osteoporosis on daily or weekly basis but can manage to swallow a once monthly tablet and are able to remain upright for 1 hour post dosing.



    • Approved for use in accordance with NICE TA464 - Bisphosphonates for treating osteoporosis. 


    • Patients should be prescribed EITHER an oral bisphosphonate OR an intravenous bisphosphonate. Patients should NOT be co-prescribed both.




     

    08.01.05 Ibrutinib Imbruvica®

     

    • TERMINATED APPRAISAL NICE TA452 for untreated chronic lymphocytic leukaemia without a 17p deletion or TP53 mutation. 
    • In line with NICE TA491 for treating Waldenstrom’s macroglobulinaemia.
    • In line with NICE TA502 for treating relapsed or refractory mantle cell lymphoma. 

     

    07.01.01.01 Ibuprofen Pedea® injection

    • CUHFT and NWAFT: For use in neonates for the treatment of PDAs only

    • See cBNF

    • Non-formulary at all other Trusts

    10.01.01 Ibuprofen 

    • Consider Self Care

    • First choice NSAID at doses up to 1200mg. If bigger doses are needed consider naproxen.

    • Usual dose 200-400mg prn up to 1200mg per day. 400mg qds acceptable in the short term. 2400mg per day is associated with CV risks similar to COX2s and diclofenac so try naproxen instead.

    10.03.02 Ibuprofen 5 % gel 

    • Consider Self Care

    03.04.03 Icatibant Firazyr®

     

    • CUHFT: In line with NHSE commissioning policy for hereditary angioedema: See link below.
    • CUHFT: NOT RECOMMENDED for ACE-induced angioedema (and other drug-induced angioedema). Reviewed at JDTC October 2019.
    • NWAFT and RPH: Non-formulary. At RPH (contact Haematology).




     

    13.05.01 Ichthammol 

    Bandage



    • CUHFT - Formulary

      • Ichthopaste®

      • Cotton fabric, plain weave, impregnated with suitable paste containing zinc oxide and ichthammol; requires additional bandaging, 6 m × 7.5 cm = £3.47 S&N Hlth.—Ichthopaste® (6/2%), excipients: include cetostearyl alcohol.



    • NWAFT - Non-formulary

    08.01.02 Idarubicin Hydrochloride Zavedos®
    02.08 Idarucizumab  Praxbind ®

    • CUHFT: Highly Restricted- on Haematologist advice only. Two compassionate use doses (5g) are currently held in each ED department.

    • RPH and NWAFT: Restricted use. Contact Pharmacy for advice


    20 Idebenone  (Raxone®) *Early Access to Medicines Scheme for Duchenne Muscular Dystrophy
    o Approved for use in line with EAMS scheme for patients >10 years of age with Duchenne’s muscular dystrophy who are not on corticosteroids
    o BlueTeq application is required
    o License expected Q3 at which point the EAMS scheme will cease to be operational and no new patients should be started
    o Supply route is clinical trials pharmacy)
    08.01.05 Idelalisib Zydelig®

     

    • As per NICE TA359.
    • Approved at OSTS June 2016, funding not in place.
    • Commissioning approval for activity needs completion.
    • TERMINATED APPRAISAL NICE TA469 - Idelalisib with ofatumumab for treating chronic lymphocytic leukaemia. 
    • NOT RECOMMENDED NICE TA604 - Idelalisib for treating refractory follicular lymphoma. 

     

    08.01.01 Ifosfamide Mitoxana®
    02.05.01 Iloprost  

    unlicensedunlicensed - Supplied on a named patient basis only



    • RPH: Restricted to Critical Care

    • NWAFT: Formulary.

    • CUHFT: Restricted to:

      • Vasculitis (limb ischaemia)

      • Rheumatology (peripheral vascular disease)



    20.01 Iloprost  Iv ( unlicensed product)
  • Vasculitis - for limb ischaemia.
  • Rheumatologists - for peripheral vascular disease.
  • 02.05.01 Iloprost nebules Vantavis®

    • RPH: Restricted to use in pulmonary hypertension only, available via homecare 

    • Non Formulary at all other Trusts


     

    08.01.05 Imatinib Generic Generic imatinib (Wockhardt formulation) is not licensed for gastrointestinal stromal tumours (GIST).

    Approved in accordance with NICE:
  • NICE TA70 For chronic myeloid leukaemia.
  • NICE TA326 Imatinib for the adjuvant treatment of gastro0intestinal stromal tumours.
  • NICE TA86 Imatinib for the treatment of unresectable and/or metastatic gastro-intestinal stromal tumours.
  • NICE TA251 Dasatinib, nilotinib and stardard-dose imatinib for the first-line treatment of chronic myeloid leukaemia.
  • 08.01.05 Imatinib Gilvec® Approved in accordance with NICE:
  • NICE TA70 For chronic myeloid leukaemia.
  • NICE TA326 Imatinib for the adjuvant treatment of gastro0intestinal stromal tumours.
  • NICE TA86 Imatinib for the treatment of unresectable and/or metastatic gastro-intestinal stromal tumours.
  • NICE TA251 Dasatinib, nilotinib and stardard-dose imatinib for the first-line treatment of chronic myeloid leukaemia.

    Also approved in accordance with the National Cancer Drugs Fund List for the indication(s) below where the specified criteria are met:
  • The adjuvant treatment of gastrointestinal stromal tumour patients with exon 11 mutation

  • 09.08.01 Imiglucerase Cerezyme®

    • CUHFT only

    • Non formulary at all other trusts

    04.03.01 Imipramine 

     

    • Use as an antidepressant - not recommended for first line use
    • NWAFT and RPH: Non-formulary.

    July 2020 - Shortage of Imipramine 25mg tablets

    • Imipramine 25mg tablets are out of stock until early August.
    • Imipramine 10mg tablets remain available.
    • For further information, see Medicine Supply Notification issued 25/06/2020. 



     

    07.04.02 Imipramine 

     

    • CUHFT: Use in children who have not responded to all other treatments and have undergone specialist assessment.
    • NWAFT: Formulary.

    July 2020 - Shortage of Imipramine 25mg tablets

    • Imipramine 25mg tablets are out of stock until early August.
    • Imipramine 10mg tablets remain available.
    • For further information, see Medicine Supply Notification issued 25/06/2020. 

     

    13.07 Imiquimod Aldara®

     

    • Cream 5%
    • CUHFT/NWAFT Restricted Item Restricted to the following:

      • For anogenital warts, refer to GU Medicine for advice

      • For superficial basal cell carcinoma, only if prescribed by Dermatologist

      • Clinic 1A for anal warts when podophyllotoxin cream is not acceptable. 

      • Clinically typical, nonhyperkeratotic, nonhypertrophic actinic keratoses (AKs) on the face or scalp in immunocompetent adult patients when size or number of lesions limit the efficacy and/or acceptability of cryotherapy and other topical treatment options are contraindicated or less appropriate.

     

    13.07 Imiquimod  Zyclara®
    • Cream 3.75%
    • CUHFT/NWAFT only - Restiricted to dermatology.
    • Zyclara is indicated for the topical treatment of clinically typical, nonhyperkeratotic, nonhypertrophic, visible or palpable actinic keratosis (AK) of the full face or balding scalp in immunocompetent adults when other topical treatment options are contraindicated or less appropriate.

     

     

    02.02.01 Indapamide 

    • 2.5 mg tablets only. MR prep is non formulary.

    • For use in patients with renal failure or those who are intolerant of bendroflumethiazide or co-amilozide.

    20 Indigo carmine  
  • Pancolonic dye spray and endoscopic mucosal resection of colonic adenomas.
  • 05.03.01 Indinavir Crixivan®

    CUH additional advice:



    • Restricted to ID / GU Medicine advice only.

    • Clinic 1A - Treatment of HIV patients in combinaton with nucleoside analogues.

    20.01 Indocyanine Green 
  • Used for staging in breast cancer.
  • 07.01.01.01 Indometacin Indocid PDA®

    • CUHFT: Restricted to treatment of PDA (Ibuprofen is first line). Injection unlicensed unlicensed

    • Non-formulary at all other Trusts


     



    • Ibuprofen is first line for PDA treatment.

    10.01.01 Indometacin 

    • Oral treatments: restricted to rheumatology and neurology.


     



    • CUFHT only: To prevent heterotopic ossification three times a day for six weeks (Orthopaedic surgeons only) – HOSPITAL ONLY.


     



    • Injection: CUHFT only (Hospital only) unlicensed unlicensed. All other trusts non-formulary.


     



    • For use in neonatology and obstetrics see section 07.01.01.01.


     

    20 Indometacin 100mg/4ml intramuscular injection Indotest®

    JDTC Dec 2017:
    Stat dose of 100mg as challenge (indotest) for responsive headaches; hemichrania continua and paroxysmal hemichrania to be given on R3 day unit
    If test positive then treatment with po thereafter should continue (unless contra-indicated) as specialist advice except in circumstances where above licensed dose is recommended and GPs may be unhappy to prescribe in which case hospital should conitnue

    13.11.01 Industrial Methylated Spirit BP 

    • CUHFT only

    • Product dependant on whether to obtain via procurement or pharmacy.

    • Non formulary at all other trusts

    14.04 Infanrix hexa® 
  • Diptheria, tetanus, pertussis (whooping cough), polio, Haemophilus influenza type b (Hib) and hepatitis B

  • In Primary Care - Part of the Routine Childhood Immunisation Schedule (see link)

  • 14.04 Infanrix IPV® 
  • Adsorbed Diphtheria, Tetanus, Pertussis (Acellular, Component) and Inactivated Poliomyelitis Vaccine (DTaP/IPV)
  • Diphtheria containing vaccine for children under 10 years

  • In Primary Care - Part of the Routine Childhood Immunisation Schedule (see link)
  • 01.05.03 Infliximab Flixabi®, Inflectra®

     



      • NWAFT: Flixabi is the preferred infliximab biosimilar.




      • CUHFT: Inflectra is the preferred infliximab biosimilar.




      • As per NICE TAGs. 1. Plaque psoriasis (TA134), 2. Ulcerative colitis (TA329) A Group Prior Approval via CPJPG for approved NICE indications needs completing by clinician. 3. Paediatric Crohn's and ulcerative colitis. 4. Infliximab has also been approved and commissioned for vasculitis (refractory patients). 5. Infliximab approved by OSTS for life-threatening immune-related diarrhoea (specialist initiation only). Off-Label.




      • Authorised clinicians can switch patients on Remicade, Remsima to Flixabi (NWAFT) or Inflectra (CUHFT).




      • For CCG commissioned indications patients should receive Flixabi (NWAFT) or Inflectra (CUH). Use of any other infliximab brand should be with prior agreement from the commissioner.




      • Intensified infliximab for patients with acute severe colitis (rescue therapy) using the current agreed biosimilar agreed by C&P JPG May 2019. (one or two additional doses of 5mg/kg or a single dose of  10mg/kg infliximab in patients with acute-onset UC who have a partial response to infliximab therapy by 48 hours)

         



     

    10.01.03 Infliximab Remsima®, Inflectra®, Remicade®, Flixabi®

    • CUHFT: Inflectra® is the preferred infliximab biosimilar.



    • As per NICE TAGs. 1. Plaque psoriasis (TA134), 2. Ulcerative colitis (TA329) A Group Prior Approval via CPJPG for approved NICE indications needs completing by clinician. 3. Paediatric Crohn's and ulcerative colitis. 4. Infliximab has also been approved and commissioned for vasculitis (refractory patients). 5. Infliximab approved by OSTS for life-threatening immune-related diarrhoea (specialist initiation only). Off-Label.



    • All adults and paediatric patients within gastroenterology, rheumatology, dermatology, vasculitis: Inflectra is now the preferred form of Infliximab. All new infliximab patients to be prescribed Inflectra.



    • Authorised clinicians can switch patients on Remicade, Remsima and Flixabi over to Inflectra.



    • For CCG commissioned indications patients should receive Flixabi (NWAFT) or Inflectra (CUH). Use of any other infliximab brand should be with prior agreement from the commissioner.

    13.05.03 Infliximab Remsima®, Inflectra®,Remicade® Flixabi®

     



    • CUHFT:

      • Restricted Item All infliximab prescriptions to be prescribed using a therapy plan in EPIC.

      • Inflectra is preferred brand. Authorised clinicians can switch patients on Remicade, Remsima and Flixabi to Inflectra. 





    • Approved in accordance with NICE TA134 Infliximab for the treatment of adults with psoriasis.



    • Biosimilar should be presribed. Remicade is only funded via IFR route IFR Form.



    • A GPA form needs to be completed and returned to the CCG via commissioning for every individual patient. GPA Forms.



    • For CCG commissioned indications patients should receive Flixabi (NWAFT) or Inflectra (CUH). Use of any other infliximab brand should be with prior agreement from the commissioner.

    20.01 Infliximab 


    • *Inflectra® as brand of choice.  If you require any support with prescribing please contact biologics pharmacy team  on distribution list ‘pharmacy biologics’.*


      1.All new Infliximab patients to be prescribed Inflectra.

      2.All infliximab prescriptions to be prescribed using a therapy plan in EPIC. 



    • Ipilimumab associated Immune-related diarrhoea.

    14.04 Influenza vaccine  

    • Please see NHSE link below regarding vaccines for 2019/2020 seasonal flu vaccination programme.

    08.01.05 Inotuzumab ozogamicin Besponsa®

    • Approved for use in accordance with NICE TA541 for treating relapsed or refractory B-cell acute lymphoblastic leukaemia. 

    06.01.01.01 Insulin Actrapid®
    Also for use in following situations at Acute Trusts
    For use in Variable Rate Intravenous Insulin Infusion
    For use in the management of Hyperkalaemia
    06.01.01.01 Insulin 500 units in 1mL Humulin R®

     




      • unlicensed CUHFT only for patients requiring high doses due to Insulin resistance. Prescribe by brand.



     




      • 20 ml vial (High Strength)- See MHRA advice regarding High Strength Insulins (link below). Prescribe by brand.



     




      • Non formulary at other Trusts.



     

    06.01.01.01 Insulin aspart Fiasp® S

    -Faster Acting Insulin ASPart is faster acting than Novorapid®


    -Agreed as specialist initiation for :-


    Type 1 Diabetes mellitus patients (including pregnant patients), using either basal bolus therapy (long-acting insulin with current fast acting analogues) or continuous subcutaneous insulin infusion (CSII) (current fast acting analogues) where there is a * *clinical suspicion that post meal hyperglycaemia is contributing to sub-optimal control of blood glucose


     *1) regular post-prandial glucose “spikes” 1 to 3 hours after eating of 8>mmol/mol


    2) spikes are occurring despite optimisation of all other factors such as correct background insulin delivery (whether background insulin injections or basal infusion rates in insulin pumps), correct timing of bolus injections, optimised carbohydrate counting, injection technique/ site


    3) the spikes are a problem- either because people feel unwell and/or because their HbA1c is sub-optimal. There are no other insulin regimens that could be trialled or this indication.

    06.01.01.01 Insulin Aspart  NovoRapid®

    • CUHFT - Restricted to diabetologists.

    • Formulary at all other trusts

    06.01.01.02 Insulin degludec Tresiba®

    Long acting insulin There are two strengths of insulin degludec, the standard 100units/ml strength should be routinely used. Please double check the strength to be used, before prescribing.



    • Type 1 patients with significant nocturnal hypoglycaemia despite using an optimised regimen of analogue basal insulin. 

    • “Chaotic patient” and who may be at significant risk of diabetic ketoacidosis (DKA) or hyperosmolar hyperglycaemic state (HHS) (previously known as (Hyperosmolar non –ketotic diabetic state or hyper HONK), if daily basal insulin is missed. 

    • Patients with psychological problems (e.g. eating disorders or patients with intermittent compliance issues with insulin injections, who are not supervised by a daily carer and do not qualify to receive district nurse injections of daily Glargine, and who may be at significant risk of DKA or HHS if daily basal insulin is missed. 

    • Patients who require analogue basal insulin but have established allergic reactions to levemir or glargine.

    06.01.01.02 Insulin degludec Tresiba®

    200 units/ml - not to be use routinely - reserved for patients who meet the local criteria for degludec but who are also on very high insulin doses



    • There are two strengths of insulin degludec, the standard 100units/ml strength should be routinely used where possible. Please double check the strength to be used before prescribing and also see MHRA advice regarding High strength insulins.

    06.01.01.02 Insulin degludec and liraglutide Xultophy®

    Approved for use in adult type 2 diabetes patients who are uncontrolled on basal insulin is currently using 8.5% (69mmol/mol) and BMI >30kg/m2. Review after 6 months and stop treatment if the patient meets any of the following criteria:



    • Uncontrolled diabetes with HbA1c reduction of less than 1% from baseline.

    • Increased hypoglycaemia episodes.

    • Significant weight gain from baseline > 2Kg 

    06.01.01.02 Insulin Detemir Levemir®

    • Restricted for patients as per NICE guidance following initiation by Specialist Diabetes clinics only.

    06.01.01.02 Insulin Glargine Lantus®

    100 units/ml 3mL cartridge - ClikSTAR® 3mL disposable prefilled pen - Solostar®



    • Restricted for use by diabetologists for patients as per NICE guidance

    06.01.01.02 Insulin Glargine Toujeo Solostar®
    • CUHFT, NWAFT and RPH only - for the treatment of complicated: 
      • Type 2 diabetes in adults requiring basal insulin ≥42 units/day with or without additional oral hypoglycaemics or meal-time insulin OR 
      • Type 1 or Type 2 who have recurrent problematic severe hypoglycaemia. 
    • Non- formulary at CPFT.
    • Glargine (Toujeo®)300 units/ml (high strength) 1.5ml prefilled Solostar pen. Toujeo is not interchangeable with standard strength insulin glargine (100units/ml) or other insulins.

    CAUTION PRODUCT SELECTION:

    • Toujeo® SoloStar 300units/ml. Each pen contains 450units/1.5ml. This device uses a 1-unit dosage step increments.  
    • Toujeo® DoubleStar Strength 300units/ml. Each pen contains 900units/3ml. This device uses 2-unit dosage step increments. 

     

    06.01.01.02 Insulin Glargine Toujeo DoubleStar®

     

    • Toujeo® Doublestar is recommended for patients requiring a daily dose of > 20 units of Toujeo® SoloStar. Prescribable in Primary Care after specialist initiation. 

    CAUTION PRODUCT SELECTION:

    • Toujeo® DoubleStar Strength 300units/ml. Each pen contains 900units/3ml. This device uses 2-unit dosage step increments. 
    • Toujeo® SoloStar 300units/ml. Each pen contains 450units/1.5ml. This device uses a 1-unit dosage step increments.  

     

     

    06.01.01.02 Insulin Glargine biosimilar Abasaglar®

     



    • Can be considered for new patients only requiring insulin glargine.

    • This is a biosimilar - ALWAYS prescribe by BRAND


     

    06.01.01.01 Insulin Glulisine Apidra®

    •  NWAFT only.

    • Non formulary at all other trusts


    Not to be used routinely in place of other insulins. Specialist Initiation for type 2 diabetes and type 1 diabetes.

    06.01.01.01 Insulin Lispro 100 units/ml Humalog®

    • Prescribe by brand.

    06.01.01.01 Insulin Lispro 200 units/ml Humalog®

    • CUHFT:To be considered for patients who require more than 40 units of Humalog per dose.

    • NWAFT: Non formulary.

    • Please note other Humalog formulations available.

    • Ensure patient receives correct strength of product when prescribing and dispensing.

    • Prescribe by brand.

    08.02.04 Interferon Alfa 

     

    • NB. different brands have different licensed indications
    • Screening information: Pre-filled syringes contain either 18, 30 or 60 MegaUnits
    • 18MU pen delivers contents in doses ranging from 1.5-6 MegaUnits (in 1.5 MegaUnit increments)
    • 30MU pen delivers contents in doses ranging from 2.5-10 MegaUnits (in 2.5 MegaUnit increments)
    • 60MU pen delivers contents in doses ranging from 5-20 MegaUnits (in 5 MegaUnit increments)

     

    08.02.04 Interferon Beta-1a Avonex®

    • For Neurologists for Multiple Sclerosis patients only. 



    • Approved for use in accordance with NICE TA527 - Beta interferons and glatiramer acetate for treating multiple sclerosis.

    08.02.04 Interferon Beta-1a Rebif®

    • Injection:6 mega units in 0.5mL Prefilled syringe.



    • For the Neurologists for Multiple Sclerosis patients only.



    • Approved for use in accordance with NICE TA527 - Beta interferons and glatiramer acetate for treating multiple sclerosis. 

    08.02.04 Interferon Beta-1b Extavia®

    • Approved for use in accordance with NICE TA527 - Beta interferons and glatiramer acetate for treating multiple sclerosis. 

    08.02.04 Interferon Gamma 

    • RPH: Restricted to use in Cystic Fibrosis patients

    • Non-formulary at all other Trusts

    14.05 INTERFERON GAMMA-1b Immukin® CUHFT:
    Clinically approved by JDTC for *patients with Mendelian Susceptibility to Mycobacterial infection caused by an immune mutation/partial deficiency in interferon gamma who have acquired a non-tuberculous mycobacterial infection (NTM) which is refractory to antimicrobial therapy alone.
    Specialist immunologist use only
    Funding under review with division and investment board- contact pharmacy and commissioning in interim
    Off-label use
    Drug due to be dispensed through OP in hospital and administered at home
    * Initial business application was for adults, extended to paeds use too - we are a national centre but overall patient no.'s are low.

    08.03.04.01 Intrabeam radiotherapy system Carl Zeiss UK

    • For use in accordance with NICE TA501 for adjuvant treatment of early breast cancer. 

    09.03 Intralipid 20% 

    • CUHFT via TPN service. For emergency management following inadvertent intravenous administration of local anaesthetic (bupivicaine overdose) - Off-Label use.

    • NWAFT - Formulary

    • All Trusts excluding CPFT:  Available for emergency management following inadvertent intravenous administration of local anaesthetic (bupivicaine overdose)

    07.03.04 Intra-uterine Contraceptive Device T-Safe® CU 380 A
    06.02.02 Iodine and Iodide 
  • Unlicensed, Secondary Care only.
  • Also known as Lugol's iodine.
  • 20 Iodoform/bismuth 10% w/w in paraffin base 

    • CUHFT: Restricted to use in Pre-operative patch testing and ENT

    • NWAFT: Restricted to use in ENT

    • Non-formulary at all other Trusts and in Primary Care

    20 Iohexol Omnipaque®
  • Contrast media.
  • 08.01.05 Ipilimumab Yervoy®
    • Approved in accordance with NICE TA268 - for previously treated advanced (unresectable or metastatic) melanoma
    • Approved in accordance with NICE TA319 - for previously untreated advanced (unresectable or metastatic) melanoma (NHS England has confirmed that funding will be in place from 21st October 2014)
    • Approved in line with NICE TA400 for treating advanced (unresectable or metastatic) melanoma in adults in combination with nivolumab.
      For more information see Cancer Drug Fund List
    • CUH: interim approval of limited FOC scheme Nivolumab and Ipilumab combination for MMR colorectal cancer - JDTC Nov 2019
    03.01.02 Ipratropium 
  • Standard MDI
  • 1st line choice inhaled anti-muscarinic for Asthma.
  • 12.02.02 Ipratropium Bromide Rinatec®
  • Nasal spray 0.03%, ipratropium bromide 21 micrograms/metered spray.
  • 03.01.04 Ipratropium bromide with salbutamol 

    NWAFT only Non- Formulary at other Trusts.

    02.05.05.02 Irbesartan 

    • CUHFT: Formulary

    • Non formulary at all other Trusts

    08.01.05 Irinotecan Hydrochloride 
  • Oncologists - Relapsed Metastatic Colorectal Cancer after 5-Fluorouracil in patients of good performance status (0-1).
  • Maximum 10 patients a year.
  • 09.01.01.02 Iron Dextran CosmoFer®

    • NWAFT: Formulary

    • Non-formulary at all other Trusts

    09.01.01.02 Iron Isomaltoside Monofer®, Diafer ®

    • CUHFT: First line treatment:  


      • Diafer® 5% or 50mg/ml. Approved and in use in dialysis and haemodialysis patients who administer at home.

      • Monofer®: 10% or 100ml/ml. All specialities. If patient experiences a true allergy conifrmed by mast cell triptase repsonse - then Venofer® will be recommend. There may be a small cohort of patients  who experiences severe side effects to Monofer but are not allergic to it and Ferinject may be appropriate.


    • RPH: Monofer®: For use by Thoracic Directorate and Cardiac Anaemia Clinic. (1st line parenteral iron formulation at RPH

    • Non formulary at all other Trusts


     

    09.01.01.02 Iron Sucrose Venofer®

    • CUHFT: Restricted to patient with a historically allergy to Cosmofer or Monofer

    • NWAFT: Restricted to use by renal team only

    • RPH: For use by RSSC in Restless Leg Syndrome

    05.02 Isavuconazole Cresemba

    • CUHFT: JDTC has approved the use of isavuconazole for treatment of invasive aspergillosis and mucormucosis under the following conditions:
      - microbiology recommendation only
      - GPs should not be asked to prescribe (HOSPITAL ONLY)
      - voriconazole to be used first line for invasive aspergillosis; isavuconazole to be reserved as a secondline treatment option only if voriconazole can not be used; isavuconazole is licensed for the treatment of mucormycosis in patient for whom amphotericin is inappropriate.
      - If IV is indicated, Ambisome may be more cost-effective if fewer than 5 vials are required to deliver the daily dose.

    • Non-formulary at all other Trusts


     

    15.01.02 Isoflurane 

    • Formulary at all trusts

    05.01.09 Isoniazid 

     

    • For respiratory medicine and HIV patients only.
    • Where a liquid preparation is clinically required in paediatric patients, Isoniazid 50mg/5mL is the standardised liquid strength which should be prescribed in children (unlicensed unlicensed):
      • Using standardised strengths of unlicensed liquid medicines in children, will reduce the risk of errors being made in the doses given to children and prevent hospitalisation from accidental under and overdoses.
      • See link below for further information.

    July 2020 - Shortage of Isoniazid 50mg tablets

    • There is a shortage of isoniazid 50mg tablets until late july 2020.
    • Morningside and RPH Pharmaceuticals have enough stock of 100mg isoniazid tablets to bridge the gap.
    • The tablets are not scored, but they are uncoated.
    • Halving them to provide a 50mg dose would be unlicensed and is a potential option in the interim. 
    • Patients will need to be provided with a tablet cutter and shown how to use it to ensure tablet is halved evenly. They should be advised not to split the entire supply of tablets at one time to be stored for later use, but to make sure that both halves are taken before splitting the next tablet.
    • The split tablet preparation should be taken as soon as possible to reduce the likelihood of degradation and minimise any risks.
    • The remaining half tablet should be stored in a dry, moisture free environment, not above 25°C.
    • If a patient or carer is unable to halve the tablet or an accurate half tablet cannot be achieved, or halving is not considered appropriate, unlicensed liquid presentation is available from specials manufacturers.
    06.01.01.02 Isophane Insulin Insulatard®
    06.01.01.02 Isophane Insulin Humulin® I

    • RPH - For use in steroid induced diabeted only

    • Non - formulary at all other trusts

    02.07.01 Isoprenaline 

    • RPH and NWAFT: unlicensedunlicensed - named patient use

    • CUHFT: Non Formulary


    Isoprenaline hydrochloride 1mg is equivalent to isoprenaline sulphate 1.125mg (from UCL guide).


     

    02.06.01 Isosorbide Dinitrate 

    • Injection: Hospital only (Glass or polyethylene infusion apparatus is preferable; loss of potency if PVC used)

      • RPH: 0.05% Solution for infusion and 0.1% Concentrate for dilution (For administration by IV infusion only except when administered by an intra-coronary injection during percutaneous coronary intervention) 

      • NWAFT: 0.05% Solution for infusion

      • CUHFT: 0.05% Solution for infusion



    • Oral formulations: Formulary (Specialist advice)


    Isosorbide mononitrate is preferred over isosorbide dinitrate as mononitrate preparations are more widely available and isosorbide dinitrate requires more frequent dosing. 

    02.06.01 Isosorbide Mononitrate 

    • Short acting preparations should be administered twice a day with the last dose of the day in the early afternoon (asymmetric dosing) to allow an adequate nitrate-free period and prevent development of tolerance.

    • Prescribe generically

    02.06.01 Isosorbide Mononitrate MR 

    • Long acting once daily tablet or capsule

    • Acute Trusts: MR tablets are preferred. 60mg MR tablets are scored for easy administration of 30mg dose if needed.

    • Primary Care: prescribers are asked to prescribe ISMN MR as one of the preferred low cost brands detailed below:


      • 25mg and 50mg MR formulations - Elantan LA25 or LA50 modified-release capsules

      • 40mg MR formulation - Nyzamac SR 40mg modified-release capsules 

      • 60mg MR formulation - Chemydur XL or Monomil XL 60mg modified-release tablets Do not crush MR formulations.


    • Do not crush MR formulations

    13.06.02 Isotretinoin Roaccutane®

     



    • CUHFT and NWAFT Restricted Item Dermatology specialist only.

    • Prescriptions for females of childbearing potential are only valid for 1 week and the maximum supply can only be 1 month. (Prescribers to indicate women are not of childbearing potential by endorsing prescription "not on PPP" and therefore can recieve more than 1 months supply.) See SPC section 4.4 for more details, or MEP section 3.3.11

    01.06.01 Ispaghula Husk  Product choice guided by contract prices. Pharmacists will substitute for most cost-effective option.
  • Adequate fluid intake is important to prevent obstruction (6 – 8 cups per day) and not to be taken immediately before bed.
  • Not suitable for frail patients who are unlikely to be able to drink the required volume of fluid.
  • Note: The fluid is quite thick and should be taken as soon as possible as it gets thicker on standing.
  • Time to effect is approximately 48 – 72 hours.

  • 05.02 Itraconazole 

    • CUHFT- IV on micro approval only.  Oral formulations are Formulary.

      • Oral treatment : use suspension as the bioavailability of capsules is poor. A trough level after 7-14 days of therapy should be taken.



    • NWAFT: Restricted to Hameatology and Oncology patients

    • RPH: No restricted when used by Thoracic Directorate or in transplant. Capsules are used in preferance to the suspension.

    • Intavenous administration is hospital only


     


     

    02.06.03 Ivabradine 

    • Ivabradine should be initiated by a heart failure specialist with access to a multidisciplinary heart failure team as per NICE TA267

    • Ivabradine is also recommended for stable angina as per NICE CG126

    • A prescribing support document is available.

    03.07 Ivacaftor 

     

    • CUHFT and RPH: May only be prescribed, in line with the market authorisation, by physicians with experience i nthe treatment of CF working within NHS England commissioned CF services. If the patient's genotype is unknown, an accurate and validated genotyping method should be performed before starting treatment to confirm the presence of an indicated mutation in the CFTR gene.
    • All CFTR modulator drugs are supplied via homecare and any admitted hospital inpatients requiring this should bring their own stock previously supplied to them through homecare to the hospital.
    • Non-Formulary at all other Trusts and Primary Care. 
    05.05 Ivermectin 

     




      • unlicensed unlicensed - named patient only.



     




      • Dermatology specialist use only

      • For Norwegian scabies. Patients should continue to receive the normal topical treatment in addition to Ivermectin.



     

    13.10.04 Ivermectin 

    unlicensed 



    • CUFHT Restricted Dermatology specialist only.

      • Ivermectin is restricted for Norwegian scabies. Patients should continue to receive the normal topical treatment in addition to Ivermectin.

      • dose of 200 micrograms/kg daily for 2 days.



    • Restricted to use for rosacea

    13.06.03 Ivermectin cream Soolantra®

     

    • Primary Care: This is recommended as second line for the treatment of rosacea in adults. 
    • NWAFT: formulary.
    • Non-formulary: At other trusts in Cambridgeshire and Peterborough. 

     

    08.01.05 Ixazomib Ninlaro®

    • Approved for use in accordance with NICE TA505 - Ixazomib with lenalidomide and dexamethasone for treating relapsed or refractory multiple myeloma. 

    10.01.03 Ixekizumab Taltz®

     




      • Restricted to use in line with NICE TAs



     

    13.05.03 Ixekizumab Taltz®

    •  Restricted to use in line with NICE TAs:

      • NICE TA 442 - Ixekizumab for treating moderate to severe plaque psoriasis.

      • NICE TA 537 - Ixekizumab for treating active psoriatic arthritis after inadequate response to DMARDs. 




     

    A5.09 Jobst Ulcercare® Kit 40mmHg 
    • For venous leg ulcer with regular limb shape - no or mild oedema (refer to appropriate pathway for selection within hosiery guideline).
    • Circular knit.
    • Full compression.
    • Management of venous leg ulcers.
    • Prevent recurrence of healed ulcers. 
    • Product Information:
      • 2 liners, 1 outer layer stocking.
      • 7 sizes -up to 60cm calf measurement.
      • Guaranteed for 6 months.
      • Machine washable.
      • Latex free.
    • Patient should be prescribed TWO garments per leg (ONE to wash and ONE to wear). These should be replaced every 6 months. 
    A5.09 Jobst Ulcercare® Liner Pack 15-20mmHg 
    • For venous leg ulcer with regular limb shape - no or mild oedema (refer to appropriate pathway for selection within hosiery guideline). 
    • Provides mild compression for ambulatory and non-ambulatory patients and can be worn for 24 hours per day.
    • Can be applied pre-doppler - refer to pre-doppler pathway. 
    • Product Information:
      • 3 liners per pack.
      • 7 sizes - up to 60cm calf measurement.
      • Guaranteed for 6 months.
      • Machine washable at 60°C.
    • Patient should be prescribed TWO garments per leg (ONE to wash and ONE to wear). These should be replaced every 6 months. 
    A5.09 Jobst® Farrow Toe Caps 
    • Toe caps for oedema and lymphoedema management (refer to appropriate pathway for selection within hosiery guideline). 
    • The toe cap provides a gentle compression for patients with mild to moderate oedema.
    • Product information:
      • Offered in a range of sizes.
      • A new ready-to-wear range.
      • Fine seams with ultra-thin and smooth compression fabric.
      • Trimmable.
      • Machine washable.
      • Guaranteed for 6 months. 
    A5.09 Jobst® Farrowwrap 4000 Compression Wrap System 30 - 40mmHg 
    • For venous leg ulcer with regular limb shape - with mild to severe oedema (refer to appropriate pathway for selection within hosiery guideline).
    • Short stretch compression wrap system with adjustable bands.
    • Hybrid liner with compression in the foot.
    • For the treatment/maintenance of venous leg ulceration, chronic oedema and other lymphatic conditions of the lower limb.
    • Product Information:
      • 1 pack contains: 1 x leg piece and 1 x Farrow Hybrid liner.
      • 4 sizes, 2 lengths.
      • 2 colours - black or tan.
      • Machine washable.
      • Guaranteed for 6 months. 
    • Patient should be prescribed TWO garments per leg (ONE to wash and ONE to wear). These should be replaced every 6 months. 
    A5.09 Jobst® Farrowwrap Lite 20-30mmHg 
    • Compression wrap system for oedema and lymphoedema management (refer to appropriate pathway for selection within hosiery guideline). 
    • Mild to moderate lymphoedema, chronic oedema, chronic venous insufficiency. 
    • Short stretch technology - delivers low resting pressue and high working pressure. 
    • Product Information:
      • 5 sizes, 2 lengths.
      • Footpiece, leg piece, thigh piece (with knee piece).
      • Machine washable.
      • Guaranteed for 6 months. 
    • Patient should be prescribed TWO garments per limb (ONE to wash and ONE to wear). These should be replaced every 6 months. 
    A5.09 Jobst® Farrowwrap Strong/Classic 30-40mmHg 
    • Compression wrap system for oedema and lymphoedema management (refer to appropriate pathway for selection within hosiery guideline). 
    • Moderate to severe lymphoedema, some limb distortion, chronic oedema, chronic venous insufficiency and leg ulcer management. 
    • Short stretch technology - delivers low resting pressue and high working pressure. 
    • Product Information:
      • 5 sizes, 2 lengths.
      • Footpiece, leg piece, thigh piece (with knee piece).
      • Machine washable.
      • Guaranteed for 6 months. 
    • Patient should be prescribed TWO garments per limb (ONE to wash and ONE to wear). These should be replaced every 6 months. 
    A5.09 Juxtalite® Lower Leg Compression Wrap 20-50mmHg 
    • Compression wrap system for oedema and lymphoedema management (refer to appropriate pathway for selection within hosiery guideline). 
    • Instantly adjustable inelastic compression device for venous disease in patients who cannot tolerate or apply compression garments. 
    • Build in pressure system (BPS) to set and control correct pressure. 
    • Product Information:
      • 8 sizes, 2 lengths.
      • Guaranteed for 6 months. 
      • Comes with an undersleeve and two compression anklets. 
    • Patient should be prescribed TWO garments per limb (ONE to wash and ONE to wear). These should be replaced every 6 months. 
    A5.09.02 Juzo® Dynamic Cotton RAL Standard CCL1 18 - 21mmHg, CCL2 23 - 32mmHg or CCL3 34 - 46mmHg 
    • Lymphoedema specialist garments - Specialist Advice from the Lymphoedema Service for prescribing in Primary Care. 
    • Circular knit garments for regular limb shape. 
    • Lymphatic oedema: varicosity, ulceration. 
    • Varicose veins.
    • Varicose veins during pregnancy.
    • After vein surgery.
    • Thromboembolisms.
    • Thrombosis prophylaxis for mobile patients.
    • Chronic venous insufficiency (CVI) stage 1-3.
    • Atrophie blanche
    • Product information:
      • Below knee, thigh high, tights.
      • 6 sizes, 3 lengths.
      • 2 colours - almond and pepper.
      • Guaranteed for 6 months.  
    • Patient should be prescribed TWO garments per limb (ONE to wash and ONE to wear). These should be replaced every 6 months. 
    A5.09.02 Juzo® Expert RAL Standard CCL1 18 - 21mmHg, CCL2 23 - 32mmHg or CCL3 34-46mmHg 
    • Lymphoedema specialist garments - Specialist Advice from the Lymphoedema Service for prescribing in Primary Care. 
    • Flat knit garments for irregular limb shape. 
    • Lymphoedema. 
    • Chronic oedema.
    • Chronic venous insufficiency.
    • Product information:
      • Made to measure flat knit compression garment.
      • Various style available on prescription.
      • Guaranteed for 6 months.  
    • Patient should be prescribed TWO garments per limb (ONE to wash and ONE to wear). These should be replaced every 6 months. 
    A5.09.02 Juzo® Soft RAL Standard CCL1 18 - 21mmHg or CCL2 23 - 32mmHg 
    • Lymphoedema specialist garments - Specialist Advice from the Lymphoedema Service for prescribing in Primary Care. 
    • Circular knit garments for regular limb shape. 
    • Varicose veins.
    • Varicose veins during pregnancy.
    • After vein surgery.
    • Thromboembolisms.
    • Thrombosis prophylaxis for mobile patients.
    • Chronic venous insufficiency (CVI) stage 1-3. 
    • Product information:
      • Below knee, thigh high, tights
      • 6 sizes, 3 lengths
      • 9 colours
      • Guaranteed for 6 months.  
    • Patient should be prescribed TWO garments per limb (ONE to wash and ONE to wear). These should be replaced every 6 months. 
    04.07.03 Ketamine 

    • Oral Solution 50mg/5ml- named patient use (unlicensed).



    • CUHFT: Restricted to use in palliative care for the management of neuropathic pain.



    • Non-formulary at all other Trusts and in Primary Care.

    20.01 Ketamine 
  • Palliative Care - ketamine oral solution for neuropathic pain.
  • Local pain pathway in place (primary care)- secondary care in development.
  • 20.01 Ketamine 
  • Paediatric anaesthesia.
  • 15.01.01 Ketamine injection Ketalar®

    • CUHFTRestricted Item Oral ketamine may only be prescribed by the palliative care team as an analgesic in those patients for whom other analgesics have failed.

    • Formulary at all other trusts

    06.07 Ketoconazole Ketoconazole HRA

    • CUHFT only via Lloyds: This is an alternative agent to metyrapone which is in significant short supply for Cushing's disease. Ketoconazole therefore to be  used when metyrapone is unavailable. 

    13.09 Ketoconazole 

     


    10.01.01 Ketoprofen 

    • CUHFT: A&E injection approved only.

    • Non formulary at all other Trusts

    10.03.02 Ketoprofen 2.5% 

    • Should usually only be used short-term.

    • NWAFT: non formulary

    11.08.02 Ketorolac Acular®

    • Eye drops 0.5%

    • Restricted to opthalmologists for post-operative cataract patients with or at risk of developing CME and for ocular inflammatory conditions in patients with previous steroid induced ocular hypertension.

    15.01.04.02 Ketorolac Toradol®

    • CUHFT - Formulary Injection Restricted Item Main choices of non-opioid analgesics in the Trust are diclofenac and precoxib.

    • RPH - Formulary

    • NWAFT - Non formulary


     

    11.04.02 Ketotifen Ketofall®
    • To be used in allergic conjunctivitis where over the counter medication is ineffective or contraindicated.
    • Restricted to patients who clinically require a preservative free formulation. 
    A5.09 L&R Actico Bandages Short Stretch Compression Bandages 2Layer 
    • For venous leg ulcer with regular limb shape - with mild to severe oedema (refer to appropriate pathway for selection within hosiery guideline).
    • Inelastic cohesive compression bandages for the treatment and management of venous leg ulcers, lymphoedema and chronic oedema. 
    • Therapeutic working and tolerable resting pressure provide effective ulcer healing and oedema control.
    • Application technique will affect the level of compression applied to the limb - it will need a higher pressure than elastic bandages.  
    • Product Information:
      • Wool layer - no compression.
      • Inelastic bandage.
      • Cohesive quality of bandage allows for extended wear time, withour slippage.
      • Can be effective with ankle passive movements. 
    02.04 Labetalol 
    •  RPH: Restricted to use in Donor Care.
    • Formulary at all other Trusts and in Primary Care when 1st line formulary choices are unsuitable.
    • Labetalol tablets are licensed for use in pregnancy for the treatment of hypertension. Please see link below for further information. 

     

    04.08.01 Lacosamide  Vimpat ®

    • CUHFT and NWAFT: Formulary

    • RPH: Non-formulary

    • The potential for clinically relevant differences to exist between different manufacturers’ products is considered to be extremely low - consider prescribing generically

       

    01.06.04 Lactulose 

     

    • Lactulose is the secondline choice laxative in pregnancy (Ispaghula husk is firstline choice).
    • Useful in hepatic encephalopathy.
    • Lactulose is commonly underdosed. See BNF for correct dose (may take up to 48 hours to act).
    • Consider Self Care.
    • Lactulose is commonly used during pregnancy and the BNF states that it is not known to be harmful in pregnancy. However, pregnant women should be encouraged to eat a diet high in fibre and to drink plenty of liquid from early pregnancy onwards. Please see link below for further information. 

     

    05.03.01 Lamivudine Epivir®

    CUH additional advice:



    • For HIV infection in combination with other antiretroviral drugs.



    • Restricted to ID / GU Medicine advice only.



    • Tablets only. Treatment of patients with HIV/AIDS. Must be used as combination therapy in line with an agreed protocol.


     

    05.03.01 Lamivudine Zeffix®

    CUH additional advice:



    • For chronic hepatitis B infection.



    • Restricted to ID / GU Medicine advice only.



    • Tablets only. For Dr. G. Alexander's Hepatitis B patients. Funding allowed for 10 patients annually.


     

    04.02.03 Lamotrigine 

    • Requires specialist initiation by mental health team.

    • Licensed for the prevention of depressive episodes associated with bipolar disorder


     

    04.08.01 Lamotrigine 

    • Formulary for the management of epilepsy

    • Can be initiated in Primary Care on the advice of a specialist

    • Base the need for continued supply of a particular brand on clinical judgement and consultation with patient and/or carer, taking into account factors such as seizure frequency and treatment history.

    03.04.03 Lanadelumab Takhzyro®
    • Approved for use in line with NICE TA606 for preventing recurrent attacks of hereditary angioedema in people aged 12 years and over, only if:
      • they are eligible for preventive C1-esterase inhibitor (C1-INH) treatment in line with NHS England's commissioning policy, that is, they are having 2 or more clinically significant attacks (as defined in the policy) per week over 8 weeks despite oral preventive therapy, or oral therapy is contraindicated or not tolerated
      • the lowest dosing frequency of lanadelumab is used in line with the summary of product characteristics, that is, when the condition is in a stable, attack-free phase 
         
    08.03.04.03 Lanreotide Somatuline® LA

    • Acromegaly and palliative care (specialist initiation)

    • Oncology (neuroendocrine tumours): hospital prescribing only.

    08.03.04.03 Lanreotide Somatuline Autogel®

    • Acromegaly and palliative care (specialist initiation)

    • Oncology (neuroendocrine tumours): hospital prescribing only.


    01.03.05 Lansoprazole 

    • LANSOPRAZOLE orodispersible tablet is the orodispersible PPI first line choice.

    • Lansoprazole capsules are prescribable in primary care


    Orodispersible tablet first choice for adults with swallowing difficulties. Can be dispersed in a small amount of water and administered via a naso-gastric tube.

    09.05.02.02 Lanthanum Fosrenol ®

    • Initiation and monitoring by consultant nephrologists in patients with ESRF as an alternative agent to sevelamer.

    08.01.05 Lapatinib Tyverb®
  • Approved in accordance with the National Cancer Drugs Fund List for the indication(s) below where the specified criteria are met:
  • The treatment of advanced breast cancer. To be removed from the CDF list on 12th March 2015. Remains on formulary for patients with funding approved prior to this date.

  • Confirm funding approved on BlueTeq for all new starters.
  • 20 LAT  (Lidocaine 4%, adrenaline 0.1% and tetracaine 0.5)
  • Paediatric A&E only.
  • For use when cleaning/ suturing wounds.
  • 11.06 Latanoprost 

     

    • Eye drops 0.005%
    • Preservative free (Monopost) available.

     

    11.06 Latanoprost 0.005% with Timolol 0.5% Xalacom®

    • As per local guidelines for treatment of glaucoma see link.

    05.03.03.02 Ledipasvir and Sofosbuvir Harvoni®

    • Used in accordance with treatment options and run rates as established for the Eastern Liver Network ODN. All second and third line treatments must be discussed regionally for approval. Further information can be found at www.easternliver.net.



    • Commissioning policy NHS England B07/P/a and NICE TA 363: Commissioned for use in: • Genotype 1a and 1b with compensated or decompensated cirrhosis in combination with ribavirin for 12 weeks (note regimen is unlicensed for some cohorts). • Genotype 3 with compensated or decompensated cirrhosis in combination with ribavirin for 12 weeks (note regimen is unlicensed). • Genotype 4 with compensated cirrhosis for 12 weeks (note regimen is unlicensed). • Genotype 4 with decompensated cirrhosis in combination with ribavirin for 12 weeks (note regimen is unlicensed).



    • Prior approval via Blueteq system required. Supplied via Lloyds at CUH.


     

    10.01.03 Leflunomide 

    • Restricted to rheumatology

    08.02.04 Lenalidomide Revlimid®

     

    • Also approved in accordance with the National Cancer Drugs Fund List for second line treatment of multiple myeloma where the specified criteria are met
    • Confirm funding approved on BlueTeq for all new CDF starters.
    • TERMINATED APPRAISAL NICE TA454 - Daratumumab with lenalidomide and dexamethasone for treating relapsed or refractory multiple myeloma.  

      For more information see Cancer Drug Fund List

     

    09.01.06 Lenograstim Granocyte®

    • CUHFT and NWAFT: Restricted to mobilisation of peripheral blood progenitor cells from healthy donors only.

    • Non formulary at all other trusts

    08.01.05 Lenvatinib Lenvima®

    • Approved for use in accordance with NICE TAs: 

      • Lenvatinib and sorafenib for treating differentiated thyroid cancer after radioactive iodine (NICE TA535).

      • Lenvatinib for untreated advanced hepatocellular carcinoma (NICE TA551).





    • CUHFT: Hospital only via Lloyds OP.

    08.01.05 Lenvatinib Kisplyx®

    • Approved for use in accordance with NICE TA498 - Lenvatinib with everolimus for previously treated advanced renal cell carcinoma. 

    02.06.02 Lercanidipine 

    • RPH: Non formulary

    • CUHFT: May be prescribed by Clinical Pharmacologists for patients who suffer from ankle oedema with other calcium channel blockers.

    • Formulary at all other Trusts and in Primary Care

    05.03.02.02 Letermovir Prevymis®
    • Approved for use in accordance with NICE TA591 - Letermovir for preventing cytomegalovirus disease after a stem cell transplant. 
    08.03.04.01 Letrozole 
    06.07.02 Leuprorelin 
  • Local Enhanced Service (LES) available in primary care for administration.
  • 2nd line GnRH in primary care for endometriosis, endometrial thinning, uterine fibroids only.

  • For malignant disease indications see section 8.3.4.2
  • 08.03.04.02 Leuprorelin Acetate Prostap® 3

    • Injection 11.25mg- 3 monthly

    • Leuprorelin is a secondline option should first line options not be clinically suitable to meet the patients needs.

    05.05 Levamisole Tablets 50 mg 

     



    •   unlicensed unlicensed - named patient use only

    • Restricted to use in paediatrics for nephrotic syndrome.

    • CUHFT: Non-formulary


     

    20 Levamisole Tablets 50 mg 
  • Occassional paediatric use.
  • 04.08.01 Levetiracetam 

    • CUHFT and NWAFT: Formulary for the management of epilepsy

    • When given IV, required dose of concentrate for infusion should be diluted in 100ml of sodium chloride 0.9%. and given over 15 minutes.

    • Levels not usually needed.

    • RPH: Non-formulary

    • Can be initiated in Primary Care on the advice of a specialist

    • The potential for clinically relevant differences to exist between different manufacturers’ products is considered to be extremely low - consider prescribing generically


     



    • Desitrend® brand is restricted to patients:

      • On a ketogenic diet

      • Who are enterally tube fed



    11.06 Levobunolol 

    • As per NICE and local guidelines for treatment of glaucoma. See link.

    • Eye drops 0.5%

    15.02 Levobupivacaine Chirocaine®

    • CUHFT - Formulary Epidural infusion 0.125% (100mL and 200mL) Injection 0.25% Injection 0.5% Injection 0.75%

    • NWAFT - Injection only

    • RPH - Infusion only


     

    09.08.01 Levocarnitine Carnitor®

    Formerly known as carnitine

    • CUHFT only:
      • For carnitine deficiency.
      • For paediatric metabolic disorders on specialist advice only.
      • Available as:
        • Injection 1g/5ml
        • Paediatric solution 1.5g/5ml (30%)
        • Tablets 500mg 
    • RPH - Non formulary.

     

    05.01.12 Levofloxacin 

     

    • NWAFT: On formulary as per trust antibiotic microsite (microguide link). 

     

    • Non-formulary at all other Trusts.

     

    11.03.01 Levofloxacin 

    • Preservative free eye, single use units only.

    • Consultant opthalmologist initiation for patients requiring intensive  treatment of severe keratitis ( i.e. > 6 x daily use) only,  to limit the risk of preservative toxicity. It may be initiated in inpatient or outpatient setting for this indication.

    • Ofloxacin is formulary choice for quinolone with preservative.

    • RPH -  Specialist advice

    13.03 Levomenthol 0.5% 

     

    • CUHFT – 0.5 % cream is formulary.
    • NWAFT - 1% cream is formulary.
    • Non formulary at all other trusts.
    • Menthol in aqueous cream use in pregnancy:
      • Topical emollients are safe in pregnancy and clinical experience suggests that for some women they may provide slight temporary relief of pruritus.
      • See link below for further information.
      • Suitable for self-care. 
    04.02.01 Levomepromazine Nozinan®

     

    • For mental health conditions - requires specialist initiation by mental health team.
    • All Trusts and Primary Care: Can be used in palliative care (can be initiated in primary care).






     

    04.06 Levomepromazine 

     

    • For use in palliative care.
    • RPH: for persistent nausea in those taking highly emetogenic antibiotics (hospital only). 



     

    07.03.05 Levonorgestrel 1500 micrograms Levonelle®

    • Consider Self Care

    • If prescribed in Primary Care, prescribe generically

    07.03.02.03 Levonorgestrel 20 micrograms / 24 hours Mirena®

    • The levonorgestrel-releasing system should only be fitted by a suitably qualified practitioner after a full history and physical examination has been undertaken

    • Prescribe by BRAND NAME. Mirena® is the formulary choice in Primary Care

    07.03.02.01 Levonorgestrel 30mcg Norgeston®

    Tablet

    06.02.01 Levothyroxine 

    • If needed tablets can be crushed and dispersed in water.

    • Liquid is restricted to paediatric patients.

    02.03.02 Lidocaine 

    • ECG monitoring required

    15.02 Lidocaine  

    • CUHFT - Restricted Item Medicated plasters Update June 2016: Clinical approval from JDTC for short term management of musculoskeletal pain following trauma to prevent deconditioning whilst in hospital. Consultant or specialist initiation for inpatient use only. Only 10 days treatment allowed followed by withdrawal and further review. One additional 10 day block of treatment may be prescribed if indicated. Not to be initiated for patients who will require long term treatment (including neuropathic pain). No outpatient prescribing.

    • Only licensed  for the symptomatic relief of neuropathic pain associated with previous herpes zoster infection (post-herpetic neuralgia, PHN) in adults

    • NWAFT - Restricted Item Initiation by Pain Clinic consultant for postherpetic neuralgia. Patients must be reviewed in 2-4 weeks.

    • RPH: Non-formulary


    Prescribing in Primary Care is not recommended in line with NHS England guidance


     

    15.02 Lidocaine 
    15.02 Lidocaine 

    • unlicensedNWAFT only

    • Non-formulary at all other Trusts


     

    15.02 Lidocaine  

     

    • In Primary Care use 5% gel (as lower acquisition cost). 
    • CUHFT - Formulary 15g tube For external use on nipples, genitals, gums etc. For intact skin use EMLA® or Ametop® instead. Weaker versions which may be more appropriate for mouth ulcers are dentinox teething gel (0.33% lidocaine) or Instillagel (2% lidocaine, tastes foul). 
    • NWAFT - Formulary. 

     

    15.02 Lidocaine Xylocaine®
    15.02 Lidocaine LMX4

    • CUHFT: Topical anaesthesia venous cannulation or venepuncture (compassionate use only) to enable comparison with existing products available. 

    15.02 Lidocaine 2.5% with Prilocaine 2.5% EMLA®

    • In Primary Care - Formulary

    • CUHFT - Formulary EMLA will be replaced by Denela as soon as stocks are exhausted. Cream EMLA licensed for all ages except pre-term neonates - see SPC for dosing advice, Ametop licensed for >1 month old. EMLA apply for 1 - 5hr, then remove before use. Ametop apply for 30 - 45min, then remove. Anaesthesia remains for 4-6hrs.

    • NWAFT - Formulary

    • RPH - Formulary

    20 Lidocaine 4% colouless topical solution 

    For paediatric ENT and anaethestitst use only for topicalisation of the airway

    20.01 Lidocaine 5%  Versatis®

    See section 15.02

    15.02 Lidocaine 5% and Phenylephrine 0.5% 

    • CUHFT - Formulary Topical solution (with nasal applicator)

    • NWAFT - Formulary

    20 Lidocaine and hydrocortisone mouthwash 

    CUHFT only

    12.03.01 Lidocaine hydrochloride / Cetylpyridinium chloride Bonjela® Junior Gel

    • Suitable for self-care. Advise patients they can purchase from a Community Pharmacist

    • CUHFT and NWAFT: Formulary

    11.07 Lidocaine Hydrochloride 4% with Fluorescein 0.25% Minims®
    15.02 Lidocaine with Adrenaline Lignospan® Special

    • NWAFT only - Formulary Injection Cartridge

    • Non-formulary at all other Trusts


     

    15.02 Lidocaine with Adrenaline Xylocaine®

    Injection - Lidocaine 1% with Adrenaline 1 in 200,000 Injection - Lidocaine 2% with Adrenaline 1 in 200,000

    15.02 Lidocaine, adrenaline and tetracaine (LAT)

    • unlicensedNWAFT only - Restricted Item Restricted to use in paediatric patients and adults with needle phobia in ED

    • Non-formulary at all other Trusts


     

    15.02 Lidocaine2% with Chlorhexidine 0.25% Optilube®

    • In Primary Care - Formulary 6ml syringe for catheter insertion

    • Non Formulary at all other trusts

    15.02 Lidocaine2% with Chlorhexidine 0.25% Instillagel®

    • In Primary Care use Optilube

    01.06.07 Linaclotide Constella▼®

    • CUHFT: Indicated for patients with moderate to severe IBS-C which has not responded adequately to or can not tolerate all other suitable treatment options as per algorithm. Initiated and prescribed by consultant gastroenterologist for the first 8 weeks of treatment. Consultant gastroenterologist to review at 8 weeks to assess efficacy and tolerability.

    • GP to be requested to prescribe ongoing treatment after 8 weeks if patient gaining significant benefit. GP to review patient every 3 months and stop linaclotide if patient no longer benefiting from treatment.

    • Other Trusts: Non-formulary

    06.01.02.03 Linagliptin Trajenta▼®

    • For use in accordance with licensed indications and according to NICE guidance for Gliptins.

    • Linagliptin is not predominately excreted via kidneys. as other DPP4 inhibitors require dose adjustment in renal impairment, linagliptin may be a more appropriate choice in patients with moderate to severe renal impairment.

    05.01.07 Linezolid 

    • NWAFT and CUHFT: On microbiology or infectious diseases advice only

    • RPH: Use is not restricted within the Thoracic Directorate

    • Full blood counts to be monitored.

    • CHM advice: Severe optic neuropathy may occur rarely, particularly if linezolid is used for longer than 28 days. Advise patients to report any visual symptoms immediately. Patients who require >28 days therapy should have regular formal visual assessments.


     


     


     

    06.02.01 Liothyronine 

    • No longer routinely recommended for long term management of hypothyroidism.

    • RPH: used in donor care


    Liothyronine is no longer recommended routinely for the long-term management of hypothyroidism (no new patients to be initiated unless agreed through the Exceptional Cases panel and current patients are being reviewed)


    In line with NHS England guidance, Liothyronine is used for patients with thyroid cancer, in preparation for radioiodine ablation, iodine scanning, or stimulated thyroglobulin test. In these situations it is appropriate for patients to obtain their prescriptions from the centre undertaking the treatment and not be routinely obtained from primary care prescribers.

    08.01.05 Liposomal Cytarabine–Daunorubicin  Vyxeos®

    • Approved for use in accordance with NICE TA552 - Liposomal cytarabine–daunorubicin for untreated acute myeloid leukaemia. 



    • CUHFT: Hospital only via Cytos pharmacy.

    13.02.01 Liquid and White Soft Paraffin Ointment (50:50) 

     

     

    • Formulary at all other trusts


      • Greasy level 4/4 (most greasy)


    • Use Emollients Safely There is a fire risk associated with all emollients whether they contain paraffin or not.

     

    11.08.01 Liquid Paraffin eye ointment 

     

    • Can be purchased from a Community Pharmacist. Recommend self-care where patient is willing and able.
    • For use at night in addition to day time treatment.
    • Preferred brands in Primary Care are:
      • Xailin Night® preservative free ointment [Carbomer 0.2%] (Contains perborate which dissolves upon administration) Expires 28 days from opening.
      • Hylo Night preservative free ointment formerly Vita-POS® preservative free ointment (retinol palmitate 250 units/g, white soft paraffin, light liquid paraffin, liquid paraffin, wool fat) Expires 6 months from opening.

    • Trusts: Restricted to ophthalmologists, for dry eye syndrome (Brands may vary to those used in Primary Care due to contract prices).
    06.01.02.03 Liraglutide Victoza®

     

    • Liraglutide (1.2mg dose only) can be initiated in primary care in patients NOT being treated with Insulin in accordance with NICE NG28.
    • Where a GLP-1 analogue is prescribed alongside insulin, prescribing is to remain with secondary care or the community diabetes specialist until patient is stable (SPECIALIST INITIATION).
    • Liraglutide 1.8mg dose is to be used in exceptional cases and will be initiated by secondary care or community diabetes specialist. 

     

    04.04 Lisdexamfetamine Elvanse®

    • Requires specialist initiation by mental health team in line with Shared Care Guidelines


     

    02.05.05.01 Lisinopril 
    20 Lissamine Green 
  • Ophthalmology only.
  • 04.02.03 Lithium Carbonate Priadel®

    • Requires specialist initiation by mental health team

    • Preferred brand for new patients

    • A purple NPSA Lithium Therapy Information Pack should be given to patients on initiation of lithium treatment.

    • 200mg MR tablet (5.4mmol Li+) + 400mg MR tablet (10.8mmol Li+)


     

    04.02.03 Lithium Citrate Li-Liquid®

    • Requires specialist initiation by mental health team

    • A purple NPSA Lithium Therapy Information Pack should be given to patients on initiation of lithium treatment.

    • Oral solution 509mg (5.4mmol Li+) in 5ml and 1018mg (10.8mmol Li+) in 5ml.

    • Prescribe the liquid formulation as a twice daily dose to minimise peak plasma levels.

    • N.B. Li-Liquid 509mg/5ml = Priadel Liquid 520mg/5ml = Priadel 200mg tablet.


     

    04.02.03 Lithium Citrate Priadel®

    • Requires specialist initiation by mental health team

    • A purple NPSA Lithium Therapy Information Pack should be given to patients on initiation of lithium treatment.

    • Liquid 520mg (approx 5.4mmol Li+) in 5ml.

    • Prescribe the  liquid formulation as a twice daily dose to minimise peak plasma levels.

    • N.B. Li-Liquid 509mg/5ml = Priadel Liquid 520mg/5ml = Priadel 200mg tablet.

    04.03.01 Lofepramine 

    • Not recommended first-line for depression (use SSRI instead)

    • Lofepramine is less dangerous in overdose and less cardiotoxic than the older tricyclic antidepressants


     

    04.10.03 Lofexidine BritLofex®

    • CPFT: Used as an adjunct to opiate detoxification according to the detox regime.



    • Non-formulary at all other Trusts.


     

    08.01.01 Lomustine 
  • Unlicensed.
  • 01.04.02 Loperamide 

    • Liquid 1mg/5mL and capsules only

    • Consider Self Care. Available OTC

    05.03.01 Lopinavir and Ritonavir Kaletra®

    CUH additional advice:



    • Clinic 1A - for AIDS/HIV patients only (the combination helps with compliance).

    03.04.01 Loratadine  Consider Self care if clinically appropriate.

    At all hospital trusts- review indication and check whether continued use is needed during inpatient hospital stay before ordering from pharmacy.
    04.01.02 Lorazepam 

     

    • Tablets disperse in water if needed
    • Several brands of lorazepam tablets can be administered sublingually (unlicensed) - check with pharmacy for further information.
    • Store injection in fridge.
    • Dilute Ativan® UK brand with an equal volume of WFI or 0.9% NaCl before IM injection. Hospira and Baxter brands (unlicensed imports from US) should NOT be diluted before IM administration - see individual box leaflets.
    • NWAFT: Tablets are restricted to use in Palliative Care only.
    • RPH: 2nd line formulary option for the management of delerium (haloperidol is 1st line formulary choice)
    • CPFT: When used for rapid tranquillisation, lorazepam IM injection must not be given within 1 hour of unlicensed olanzapine IM injection

    June 2020 - Supply disruption of Lorazepam (Ativan®) 4mg/ml Solution for injection

    • Ativan® (lorazepam) 4mg/ml solution for injection will be out of stock from w/c 27th April until w/c 15th June 2020.
    • The US product, lorazepam injection 2mg/ml, supplied in Carpuject™ single dose cartridges will be available to Trusts from early May 2020 on an ‘unlicensed’ basis.
    • CarpujectTM single dose cartridges can be considered bioequivalent to the UK brand Ativan® (lorazepam) 4mg/ml solution for injection and no dosing adjustments should be required.
    • Carpuject™ cartridges must be used in combination with the Carpuject™ holder provided. Injection in cartridge is diluted with an equal volume of compatible solution for IV administration (IM injection is administered undiluted).
    • Ativan® (lorazepam) 4mg/ml solution for injection supplies will remain available for primary care customers throughout this period. 
    • See Supply Disruption Alert below for further information. 

     

    04.08.02 Lorazepam Epilepsy

    June 2020 - Supply disruption of Lorazepam (Ativan®) 4mg/ml Solution for injection

    • Ativan® (lorazepam) 4mg/ml solution for injection will be out of stock from w/c 27th April until w/c 15th June 2020.
    • The US product, lorazepam injection 2mg/ml, supplied in Carpuject™ single dose cartridges will be available to Trusts from early May 2020 on an ‘unlicensed’ basis.
    • CarpujectTM single dose cartridges can be considered bioequivalent to the UK brand Ativan® (lorazepam) 4mg/ml solution for injection and no dosing adjustments should be required.
    • Carpuject™ cartridges must be used in combination with the Carpuject™ holder provided. Injection in cartridge is diluted with an equal volume of compatible solution for IV administration (IM injection is administered undiluted).
    • See Supply Disruption Alert below for further information. 
    15.01.04.01 Lorazepam 

     

    • CUHFT - Formulary Injection 4mg/ml, Tablets
    • NWAFT - used as premedication
    • RPH - formulary

    June 2020 - Supply disruption of Lorazepam (Ativan®) 4mg/ml Solution for injection

    • Ativan® (lorazepam) 4mg/ml solution for injection will be out of stock from w/c 27th April until w/c 15th June 2020.
    • The US product, lorazepam injection 2mg/ml, supplied in Carpuject™ single dose cartridges will be available to Trusts from early May 2020 on an ‘unlicensed’ basis.
    • CarpujectTM single dose cartridges can be considered bioequivalent to the UK brand Ativan® (lorazepam) 4mg/ml solution for injection and no dosing adjustments should be required.
    • Carpuject™ cartridges must be used in combination with the Carpuject™ holder provided. Injection in cartridge is diluted with an equal volume of compatible solution for IV administration (IM injection is administered undiluted). 
    • See Supply Disruption Alert below for further information. 
    18 Lorazepam  Injection
  • Convulsions or agitation related to overdose / poisoning.
  • 02.05.05.02 Losartan 
    11.04.01 Loteprednol Lotemax®

     

    • Eye drops 0.5%.
    • NWAFT only.
    • Non formulary at all other trusts. 

     

    13.10.05 Low thrombin fibrin sealant Artiss®

    • CUHFT: Hospital only via inpatients - for use in styloid and C1 vertebral surgery by ENT. 

    01.06.07 Lubiprostone Amitiza®

    • For gastroenterology consultant initiation only in line with NICE TA318, for chronic idiopathic constipation.

    • Consultant review after 2 weeks for first course (telephone consultation is acceptable). If effective, GPs may prescribe further courses.

    • Treatment courses are limited to 2 weeks as per the licence.

    • Non-formulary for IBD.



    The manufacturers of lubiprostone have advised that healthcare professionals will no longer be able to order/obtain a supply of lubiprostone from the 14th December, 2018.

    03.07 Lumacaftor/ivacaftor Orkambi®
    • CUHFT and RPH: May only be prescribed, in line with the market authorisation, by physicians with experience i nthe treatment of CF working within NHS England commissioned CF services. If the patient's genotype is unknown, an accurate and validated genotyping method should be performed before starting treatment to confirm the presence of an indicated mutation in the CFTR gene. 
    • All CFTR modulator drugs are supplied via homecare and any admitted hospital inpatients requiring this should bring their own stock previously supplied to them through homecare to the hospital.
    • Non-Formulary at all other Trusts and Primary Care. 
    04.02.01 Lurasidone Latuda®

    • CPFT: Formulary

    • Non-formulary at all other Trusts and in Primary Care


     

    02.11 Lusutrombopag Mulpleo®
    • Approved for use in accordance with NICE TA617 - Lusutrombopag for treating thrombocytopenia in people with chronic liver disease needing a planned invasive procedure. 
    08.01 Lutetium (177Lu) oxodotreotide Lutathera

    • Approved for use in acccordance with NICE TA539 for treating unresectable or metastatic neuroendocrine tumours.

    05.01.03 Lymecycline Tetralysal® 300

    • Dermatologists only

    13.06.02 Lymecycline 

    See chapter 5.1.3 for more detailed information on antibiotics.

    • In Primary Care:
      • Formulary - 2nd line for the treatment of acne.
      • Formulary - as an option for the treatment of moderate to severe acne rosacea in adults (off-label). 
    • CUHFT: Restricted Item Dermatologists only to replace minocycline for acne.

     

    02.05.01 Macitentan Opsumit®

    • RPH: Restricted to use in pulmonary hypertension only, available via homecare 

    • Non formulary at all other Trusts

    18 Macrogol '3350' Klean-Prep® Oral powder (polyethylene glycol)
  • Discussion with National Poisons Information Service recommended
  • Used for whole bowel irrigation for agents not bound by activated charcoal e.g. iron, lithium
  • Also used for whole bowel irrigation for bodypackers and for slow release medicines
  • for standard uses see section 1.6.5
  • 01.06.04 Macrogol oral powder 

    • For intractable constipation and faecal impaction with hard stools for three days or until bowels have open. Other laxatives should also be given at the same time to ensure they continue to act once bowels have opened. Review is indicated once faecal impaction has cleared.

    • May also be used to treat chronic constipation in children with cystic fibrosis.

    • RPH only: 1st line choice for post-operative bowel care


    Hospital: Choice of brand will be reviewed based on contract arrangements.



    • Adult brands available include Laxido®, Movicol®.

    • Paediatric brands include Movicol® Paediatric Plain and Laxido® Paediatric Plain


    Primary Care: Prescribe as Cosmocol® or Cosmocol Paediatric®

    01.06.05 Macrogols Klean-Prep®

    • For use before colonic surgery, coloscopy or radiological examination ONLY to ensure the bowel is emptied of solid contents. NOT TO BE PRESCRIBED FOR CONSTIPATION.

    01.06.05 Macrogols Moviprep® and Plenvu®

    • Bowel evacuation before colonoscopy and similar procedures.

    • CUHFT: Plenvu® is a new preparation made by same manufacturer as Moviprep®. Approved for bowel cleansing in adults patients having colonoscopy or flexible sigmoidoscopy

    09.05.01.03 Magnesium Aspartate Magnaspartate®

     

    • Primary care: First line formulary choice.
    • Contain 10mmol magnesium per sachet.
    • NWAFT: Formulary.
    • CUHFT: Not recommended for use in paediatrics as too large a vol. for dissolution– this is consistent  with other Children's hospitals practice. See magnesium glycerosphosphate tablets.



     

    09.05.01.03 Magnesium Glycerophosphate 

     



    • CUHFT: Magnesium glycerophosphate chewable tablets (licensed) are first-line oral magnesium replacement in paeds and liquid (unlicensed) reserved for paeds who cannot chew

    • Contains 4mmol magnesium per tablet.


     

    20 Magnesium Glycerophosphate  JDTC Dec 2017 Magnesium glycerophosphate chewable tablets (licensed) are first-line oral magnesium replacement in paeds and liquid (unlicensed) reserved for paeds who cannot chew- [no change to current practice].
    Note only for use in secondary care i.e. Formulary status: Hospital
    Suspension 1mmol/ml.
    09.05.01.03 Magnesium Lactate  Mag-Tab SR

    • CUHFT only - Chronic muscle wasting.

    • Non formulary at all other trusts

    20 Magnesium Lactate  Mag-Tab SR
  • Chronic hypomagnasaemia in Gitelman's syndrome
    Unlicensed preparation

    Hospital clinician should liaise with GP's out of Cambridgeshire CCG to check if they are happy to continue prescription (high-cost), alternatively other arrangemetns may need to be made
    Within Cambs prescription should continue from hospital where posible, due to lower acquistion cost
  • 09.05.01.03 Magnesium oxide 

    • CUHFT only


      • Hypomagnesia

      • 500mg = 21 mmol/mg per tablet. (unlicensed special)


    • Non formulary at all other trusts


     

    20 Magnesium Oxide 
  • Hypomagnesia
  • 500mg = 21 mmol/mg per tablet.
  • 09.05.01.03 Magnesium Sulphate 

    Injection 20% (1mL = approx 0.8mmol Mg) Injection 50% (1mL = approx 2mmol Mg)







      • See local hypomagnesaemia guidance below



     

    13.10.05 Magnesium Sulphate Paste BP 

    (Paste dried magnesium sulfate 45 g, glycerol 55 g, phenol 500 mg)


    Special order product

    01.01.01 Magnesium Trisilicate  

    • Suspension only.

    • Consider Self Care.

    13.10.04 Malathion 0.5% Derbac-M®

    (Aqueous solution 50mL)



    • Primary Care: Live head lice can be treated by wet combing; chemical treatment is only recommended in exceptional circumstances and in these cases over the counter medicines can be purchased from a pharmacy.

    • CUHFT - Formulary. For crab lice, head lice, and scabies. Traditional insecticide

    • NWAFT - Non-formulary


     

    02.02.05 Mannitol 

    • IV Infusion- due to the risk of crystallization use an administration set with an in- line filter

    • 10% infusion 500ml

    • 20% infusion 500ml

    03.07 Mannitol inhalation Bronchitol ®

    • NWAFT only Dry powder for inhalation Use as recommended in NICE TA. Tariff excluded

    • RPH: Available via Home care for Cystic Fibrosis patients

    • CUHFT: Non-formulary

    05.03.01 Maraviroc 

    CUH additional advice:



    • Restricted to GU med only.

    • Clinic 1a/ ID for HIV, when used in line with BHIVA guidelines and only after genotyping - providing funding has been secured.

    14.04 Measles, Mumps and Rubella Vaccine, Live (MMR)  Injection
  • Brands include Priorix and MMRVaxPro2.
  • The vaccines are interchangable in the schedule.

  • In Primary Care - Part of the Routine Childhood Immunisation Schedule
  • 05.05.01 Mebendazole 

    • Consider self care

    01.02 Mebeverine Hydrochloride 

    • Modified release capsules are non formulary in provider trusts.


     

    20.01 Mecasermin 
  • Severe insulin resistance national service.
  • Not agreed and commisisoned for growth failure in Addenbrookes.
  • A5.09.03 Medi Butler Leg® Medi UK
    • Available to purchase over the counter from Community Pharmacies.
    • This cannot be prescribed on FP10.  
    06.04.01.02 Medroxyprogesterone Acetate Provera®

    June 2020 - Shortage of medroxyprogesterone (Provera) 400mg tablets

    • This is out of stock until mid-June 2020.
    • All other strengths are currently available. 
    07.03.02.02 Medroxyprogesterone Acetate Depo-Provera®
    07.03.02.02 Medroxyprogesterone acetate Sayana Press®

     

    • NWAFT and Primary Care: Restricted to women who find Depo-Provera unacceptable or where contra-indicated due to increased risk of bleeding and hematoma, i.e. bleeding disorders, anticoagulation.
    • Subcutaneous injection.
    • Non-formulary at all other Trusts.

     

    08.03.02 Medroxyprogesterone Acetate Provera®

    If needed tablets can be crushed (preferably in water to reduce dust production) and dispersed in water.

    June 2020 - Shortage of medroxyprogesterone (Provera) 400mg tablets

    • This is out of stock until mid-June 2020.
    • All other strengths are currently available. 
    10.01.01 Mefenamic Acid 

    • Restricted to use in gynaecology only

    • Licensed for menorrhagia, but naproxen (and maybe ibuprofen) are equally effective. See CKS review of evidence.

    • Not a first choice analgesic for any indication, and not good in overdose - See review

    05.04.01 Mefloquine Lariam®

    • For malaria prophylaxis.

    • May induce potentially serious neuropsychiatric disorders.

    20 Megestrol 40mg tablets 

    • Unlicensed import

    • Approved for hot flushes caused by hormonal treatment of breast cancer

    • Dose is 20mg once or twice daily for a maximum of 6 months

    • Full course dispensed in one episode from Lloyds OP


     


     

    08.03.02 Megestrol Acetate Megace®

    • Prescribing of 40mg tablets (unlicensed) in primary care has not been supported by CPJPG (Hospital only)

    04.01.01 Melatonin  Circadin®
    • CPFT / CCS / Primary Care: Restricted to initiation by Childrens Services only for continuation in Primary Care in line with the Shared Care Guideline. 
      • 'Off label' use of a licensed medicine. 
      • For patients who require an immediate release formulation Circadin 2mg MR tablets may be crushed and dispersed in water or milk or added to soft food like yoghurt (off-label). 
      • All other formulations are not routinely recommended. However, if a liquid preparation is required, and crushed Circadin 2mg MR tablets are not clinically acceptable, please see the LINK or contact the Medicines Optimisation Team for further support.
    • Prescribing for adult patients for any indication is not currently recommended in Primary Care. 
    • CUHFT: Restricted to short-term treatment of primary insomnia in paediatrics (HOSPITAL ONLY). 
    • NWAFT: Restricted to use in Medicine for Older People whilst in hospital or on TTO prescription (HOSPITAL ONLY). 
    • RPH: Restricted to Sleep Consultants for the management of Circadian Rhythm Insomnia (HOSPITAL ONLY). 

     

    04.01.01 Melatonin Slenyto®

     

    • Slenyto® is licensed only for children with the specific indication of Autism Spectrum Disorder or Smith-Magenis syndrome and this is the only cohort of patients that Slenyto® should be prescribed for. 
    • Prescribing for adult patients for any indication is not currently recommended in Primary Care. 
    04.07.04.03 Melatonin 

    • RPH: Formulary

    • Non-formulary at all other Trusts and in Primary Care

    20 Melatonin 
  • Unlicensed immediate-release preparation clinically and financially approved for use in children within CUH but not in primary care.i.e. Hospital only

  • Unlicensed immediate release capsules are preferred and if needed these can be opened and the contents dispersed in water, milk, yoghurt or fruit juice for administration.
  • 10.01.01 Meloxicam 

    • Restricted to patients where standard NSAIDs have failed to control symptoms

    • NWAFT: non-formulary


     

    08.01.01 Melphalan 
  • For melphalan dose in polycythaemia vera refer to BNF
  • 04.11 Memantine 

    • To be prescribed on the advice of a specialist experienced in the management of dementia in line with NICE TA217 and Shared Care Guideline.

    • Memantine is recommended as an option for managing Alzheimer's disease for people with:

      • moderate Alzheimer's disease who are intolerant of or have a contraindication to AChE inhibitors or

      • severe Alzheimer's disease.



    09.06.06 Menadiol Sodium Phosphate 

    • Water soluble preparation of Vitamin K - to be used in patients with hepatic disease or biliary obstruction (including during pregnancy).

    • CUHFT - Tablets may be crushed and dispersed in water. 

    14.04 Meningitis C and Hib combined Menitorix® Haemophilus influenza type b (Hib) and Meningococcal group C (MenC)

  • In Primary Care - Part of the Routine Childhood Immunisation Schedule (see link)

  • Vaccination for individuals with the following underlying conditions (see link):
    • Asplenia or splenic dysfunction
    • Complement disorders

  • 14.04 Meningococcal A, C, W135, and Y conjugate vaccine Menveo®, Nimenrix®
  • In Primary Care - Part of the UK Routine Childhood Immunisation Schedule

  • Vaccination for individuals with the following underlying conditions (see link):
    • Asplenia or splenic dysfunction
    • Complement disorders

    Red Traffic Light  Not available on the NHS for travel

  • CUHFT - Post splenectomy in line with the "Green Book"
  • 14.04 Meningococcal group B Vaccine Bexsero®
  • In Primary Care - Part of the Routine Childhood Immunisation Schedule (see link)

  • Vaccination for individuals with the following underlying medical conditions (see link):
    • Asplenia or splenic dysfunction
    • Complement disorders

    Red Traffic Light  NOT available on the NHS for travel

  • CUHFT - Specialist initiation
    • In paediatrics: Approved as part of childhood immunisation schedule
    • In adults: Approved post splenectomy as per Department of Health guidance- 2nd dose at one month to be given in primary care.
    • Approved in adults and paediatrics patients receiving eculizumab as per eculizumab SPC. Manufacturer must have proof of vaccination before eculizimab is given.
      * Note current national shortage expected until Oct 2016 therefore DOH recommends priority for childhood immunisation programme. For splenectomy and eculizumab the manufacturer will issue on an individual basis- delivery within 24 hrs.

  • Clinically and financially approved by JDTC as part of splenectomy prophylaxis. First dose in secondary care and scond dose in primary care.
  • 03.08 Menthol and Eucalyptus Inhalation BP 1980  Not to be prescribed on an FP10 in primary care. Consider Self care if needed
    05.04.04 Mepacrine Hydrochloride 
  • Unlicensed.
  • Microbiology recommendation only.
  • 20.01 Mepivacaine 
  • Chiropodists only.
  • 15.02 Mepivicaine 

    • CUHFT Only Restricted Item Off Label Use. Chiropodists Only

    • Non-formulary at all other Trusts


     

    03.04.02 Mepolizumab Nucala®

    For use by specialist respiratory clinician in line with NICE TA 431 to treat severe refractory eosinophilic asthma only.

     

    CUHFT is commissioned as a specialist centre. After disucssion at specialist MDT and regional asthma network. Intention is for first 3 doses to be administered in clinic 2a of CUHFT (supply from central pharmacy) with subsequent doses to be given by local hospital. Application via Blueteq, funding from NHSE.

     

    NWAFT patients initiated in a specialist centre may have continued treatment in NWAFT. The specialist centre Blueteq number must be included when the invoice is submitted, the annual review must be undertaken at the specialist centre and a continuation Blueteq then completed at the specialist centre.

    04.07.02 Meptazinol Meptid®

    • CUHFT: formulary

    • Non-formulary at all other Trusts and in Primary Care.

    • Existing patients to be reviewed in Primary Care or at next routine Pain Clinic appointment

    09.08.01 Mercaptamine 

    • CUHFT only via Lloyds OP. 

    • Non formulary at all other trusts. 


     

    01.05.03 Mercaptopurine 
    • Induction and maintenance of remission Crohn's disease and ulcerative colitis in patients intolerant of azathioprine – unlicensed but in line with national guidelines and shared care.



     

    08.01.03 Mercaptopurine 
  • Classified 'red HOSPITAL only' for the treatment of acute leukaemias, chronic myeloid leukaemia, cancer. See section 1.5.3 for IBD indication.
  • Suspension (Xaluprine) is non-formulary.

  • 05.01.02.02 Meropenem 

    • Penicillin ( beta- lactam) antibiotic.

    • NWAFT- no additional restriction

    • CUH additional info.


      • Microbiology approval required for the 1g TDS dosing regime. Microbiology approval not required for 500mg TDS dosing regime or 500mg QDS dosing regime.

      • The 1g TDS dose can be replaced with 500mg QDS unless used for the below indications:  • Patients with renal impairment • Neonatal and paediatric patients • Cystic fibrosis patients • Patients prescribed meropenem 2g IV TDS for bacterial meningitis or CNS infections • Pseudomonas infections • Acinetobacter infections (as the 500mg QDS dose has been shown to give a similar % time above the MIC to the 1g TDS dose for severe sepsis).  

      • Metronidazole and flucloxacillin are not normally needed with Meropenem. See abbreviated CUH  antibiotic guidelines on trust intranet for full guidance.


    • RPH: Not restricted for use by Thoracic Directorate


     

    01.05 Mesalazine Asacol® MR
    01.05.01 Mesalazine Pentasa®

    •  Mesalazine is 1st line choice of 5-ASA in chronic bowel disorders

    • Remember to prescribe mesalazine by brand.

    • Pentasa is licensed for ULCERATIVE COLITIS patients only. Oral formulations licensed up to 4g once daily or in two or three divided doses.

    • NOTE: different formulations of Pentasa have differing age restrictions within product license. See SPC for further information.

    • NWAFT: Tablets are non-formulary


     

    01.05.01 Mesalazine Salofalk®

     

    • CUHFT: Formulary (First Choice)
      • Mesalazine is 1st line choice of 5-ASA in chronic bowel disorders
      • Remember to prescribe mesalazine by brand. Maintain existing patients on current brand unless it is clinically appropriate to change.
      • Salofalk is licensed for ULCERATIVE COLITIS patients only.
      • NOTE: different formulations of Salofalk have differing age restrictions within product license. See SPC for further information.
    • Non-formulary at all other Trusts.

    June 2020 -  Shortage of Salofalk® (mesalazine) 1g suppositories

    • Salofalk 1g suppositories are out of stock until late July 2020. 
    • Limited supplies of Salofalk 500mg suppositories are currently available with full supply expected by mid-June 2020. 
    • Pentasa 1g suppositories remain available. 
    • The DHSC have produced a medicine supply notification outling actions required to deal with this medication shortage (dated 1st November 2019). See below. 

     

     

    01.05.01 Mesalazine Asacol®

    • Suppositories and Foam enema only. All other formulations for existing patients only.

    • Mesalazine is 1st line choice of 5-ASA in chronic bowel disorders

    • Remember to prescribe mesalazine by brand. Maintain existing patients on current brand unless it is clinically appropriate to change.

    01.05.01 Mesalazine Octasa®

    • Mesalazine is 1st line choice of 5-ASA in chronic bowel disorders

    • Remember to prescribe mesalazine by brand. Maintain existing patients on current brand unless it is clinically appropriate to change.

    • NWAFT: For new patients Octasa is the first line choice. 800mg are huge tablets and are relatively more expensive than 400mg tablets. Both strengths are a better value version of Asacol

    • CUHFT: Non-formulary

    01.05.01 Mesalazine  Mezavant® XL

    • CUHFT: Gastroenterologist initiation only patients for whom compliance with twice daily regimens is poor and significantly frequent relapses result.

    • Mesalazine is 1st line choice of 5-ASA in chronic bowel disorders

    • Remember to prescribe mesalazine by brand. Maintain existing patients on current brand unless it is clinically appropriate to change.

    • Non- formulary at all other Trusts

    08.01 Mesna 
  • Injection can be diluted in a flavoured drink for oral administration as per BNF.
  • 18 Mesna  See also section 8.1
  • Treatment of cyclophosphamide induced haemorrhagic cystitis
  • 06.04.02 Mesterolone Pro-Viron®

    • CUHFT only

    07.03.01 Mestranol / Norethisterone Norinyl-1®
    • Monophasic standard strength (21-day preparations).
    • 21 days:
      • Mestranol 50 micrograms
      • Norethisterone 1 mg
    • Prescribe as Norinyl-1 in Primary Care. 
    13.02.02 Metanium® 

    • CUHFT: For nappy rash only.

    • Non formulary at all other trusts and in Primary Care (consider other formulary choices)

    • Suitable for self-care. Can be purchased from a Community Pharmacist.


     

    02.07.02 Metaraminol 

    unlicensedunlicensed. Use is restricted.



    • RPH: Formulary

    • CUHFT: Restricted to use in:

      • Theatres - for hypotension

      • Priapism



    • NWAFT: Restricted to use in:

      • Critical Care

      • Supervision of Critical Care Outreach Team.



    06.01.02.02 Metformin 

     

    • Standard tablet formulation recommended with slow upward titration of dose.
    • MR tablet for patients with proven GI intolerance, despite slow upward titration of dose.
    • Metformin MR tablets (500mg and 1000mg) should be prescribed as SUKKARTO SR in Primary Care. 
    • Metformin in Pregnancy:
      • NICE guidance states that women with diabetes may be advised to use metformin as an adjunct or alternative to insulin in the preconception period and during pregnancy, when the likely benefits from improved blood glucose control outweigh the potential for harm.
      • See links below for further information. 

    March 2020 - Local shortage of Sukkarto SR 500mg and 1000mg tablets in Primary Care

    • Due to local increase in demand currently there is no stock of Sukkarto SR 500mg and 1000mg tablets available locally in wholesalers.
    • The manufacturer of Sukkarto SR, Morningside, are currently working to replenish our stocks locally and this is expected to be resolved by w/c 21st March 2020.
    • We would recommend that until this shortage has resolved - Metformin m/r tablets should be prescribed generically. 
    06.01.02.02 Metformin Hydrochloride 

    • unlicensed CUHFT only

    • Sachets are to be used instead of metformin liquid

    04.07.02 Methadone 

    • CUHFT: For initiation by pain team only when used as an analgesic.

    • Non-formulary at all other Trusts and in Primary Care

    04.10.03 Methadone 

    • Oral solution 1mg in 1mL

    • For use by psychiatrists/dependence service only

    • Trusts: For continuation of established treatment only. Not currently commissioned to provide specialist prescribing for substance misuse services

    • Treatment to be retained by the specialist dependence service and not prescribed in Primary Care


     

    03.09.01 Methadone Hydrochloride Methadone® Linctus
    01.05.03 Methotrexate 

    Tablets



    • 2.5mg tablets preferred as per NPSA alert

    • 10mg tablets are not recommended in order to reduce the risk from dispensing errors.

    • Cytotoxic, do not crush and disperse in water, liquid (unlicensed) may be available if required.

    08.01.03 Methotrexate 

    • Classified 'red HOSPITAL only' for cancer indications- see sections 10.1.3 and 13.5.3 for rheumatology and psoriasis indications

    • Shared care available for management of sarcoidosis (Amber with SCG)

    10.01.03 Methotrexate 


    • Tablets



      • 2.5mg tablets preferred as per NPSA alert

      • 10mg tablets are not recommended in order to reduce the risk from dispensing errors.

      • Cytotoxic, do not crush and disperse in water. For further information contact pharmacy, Medicines Information, or Medicines Optimisation Team




     



    • CUHFT: FOR ECTOPIC PREGNANCY USE THE 100MG IN 1ML PREPARATION. THE 25MG/ML STRENGTH IS NOT SUITABLE FOR IM DUE TO VOLUME REQUIRED. WORKSHEET IS AVAILABLE IN CYTO'S IF REQUIRED

    11.99.99.99 Methotrexate 

    • For use in eye disorders.

    • Contact Ophthalmogy.

    13.05.03 Methotrexate 

    (Tablets - 2.5mg only)


     


    Star Methotrexate is available as 2.5mg and 10mg tablets. This is a potential cause of confusion and has led to patients taking accidental overdoses. To avoid this only 2.5mg tablets should be prescribed and specified on the prescription. Please specify which day of the week methotrexate should be taken.




    • CUHFT Restricted Item Restricted to consultant dermatologists only.



    • NWAFT - Formulary.


     

    15.01.02 Methoxyflurane Penthrox®

    • NWAFT: restricted to ED use only for moderate to severe pain from trauma where Entonox is contra indicated as per ED protocol.

    • CUHFT: Emergency relief of moderate to severe pain in conscious adult patients with trauma and associated pain within the emergency department related to:


      • Dislocation or fracture or

      • In whom nitrous oxide/oxygen (Entonox®) is contra-indicated* but a rapid onset patient controlled analgesic is required.


    • RPH: Non-formulary

    13.05.02 Methoxypsoralen 

    Tablets (unlicensed): (8-methoxypsoralen 10mg tablets (Puvasoralen®), 5-methoxypsoralen 20mg tablets (Pentaderm®)



    • CUHFT - Restricted Item Restricted

    • Dermatology specialist only

    • Used in photochemotherapy combining long-wave ultraviolet A radiation with a psoralen (PUVA)

    • 8-Methoxypsoralen 20mcg/ml solution for Extra Corporeal Photopheresis in the apharesis clinic– third-line treatment option in chronic Graft versus Host Diseases as per NHSE agreement.

    • Non formulary at all other trusts

    20 Methoxypsoralen  
  • 8-methoxypsoralen 10mg tablets (Puvasoralen®)
  • 5-methoxypsoralen 20mg tablets (Pentaderm®)
  • 0.005% gel.
  • 0.15% emulsion.
  • 1.2% bath lotion.
  • Dermatology specialist only.
  • Used in photochemotherapy combining long-wave ultraviolet A radiation with a psoralen (PUVA)
  • 01.06.01 Methycellulose Celevac®
    13.08.01 Methyl-5-Aminolevulinate Metvix®

    (Cream) Use in combination with photodynamic therapy.



    • CUHFT Restricted Item Restricted to use with photodynamic therapy only

    • Non formulary at all other trusts

    02.05.02 Methyldopa 

     

    • Should only be used for hypertension where other agents have failed or are not suitable.
    • Methyldopa use in pregnancy:
      • Methyldopa may be indicated in the treatment of hypertension or gestational hypertension.
      • Methyldopa is not specifically licensed for the treatment of hypertension in pregnancy. However, the manufacturer states that methyldopa can be used during pregnancy if there is no safer alternative available.
      • NICE guidelines identify labetalol as the preferred antihypertensive for use during pregnancy. 
      • See links below for further information. 
    04.04 Methylphenidate 

     

    • Requires specialist initiation by mental health team
    • MR tablets and MR capsules should always be prescribed by brand and are not interchangeable due to differences in bioavailability.
    • Where methylphenidate MR tablets are required, Xaggitin XL® is the preferred brand.

     

    06.03.02 Methylprednisolone 

    • IV injection - Solu-Medrone® (methylprednisolone sodium succinate-40mg, 125mg, 500mg, 1g, 2g)

    • IM Depot injection - Depo-Medrone® ( Methylprednisolone acetate 40mg)


    Withdrawal and adrenal suppression in surgery advice now included in BNF monograph.


    Do not use Solu-Medrone 40mg vials in patients with cows’ milk allergy. See MHRA warning for more information.

    10.01.02.02 Methylprednisolone Acetate Depo-Medrone® with Lidocaine

    • NWAFT: Formulary

    • Non formulary at all other Trusts

    10.01.02.02 Methylprednisolone Acetate 

    • Injection 40mg in 1mL

    • Injection 80mg in 2mL


     

    18 Methylthioninium chloride Proveblue®
  • 10ml 0.5% (50mg) for IV use
    - For Methaemoglobinaemia or prior to parathyroid surgery. (approx £50 each)
  • 04.06 Metoclopramide 

    • Primary Care:

      • Metoclopramide is a 1st line formulary choice in Primary Care.

      • Metoclopramide orally are a third line option for moderate symptoms of nausea and vomiting in pregnancy. To only be prescribed for courses of no longer than 5 days then reviewed.



    • Limited efficacy post-operatively

    • Not recommended for patients under 20 years of age due to risk of dystonic reactions. For restrictions for use in younger patients see MHRA guidance below.

    • Metoclopramide should only be prescribed for short-term use (up to 5 days).

    • For adults, the maximum dose in 24 hours is 30 mg (or 0.5 mg per kg bodyweight).

    • Can be given S/C (unlicenced but accepted practice)

    02.02.01 Metolazone 

     

    • Metolazone has been withdrawn from the UK market on commercial grounds and is available on a NAMED PATIENT BASIS only. unlicensed unlicensed. It should only be prescribed when there is no suitable licensed alternative.
    • For most patients a switch to bendroflumethiazide (in combination with a loop diuretic) would be suitable and is supported by the British Society for Heart Failure.
    • Metolazone may be prescribed for renal patients when a high dose of a loop diuretic +/- another thiazide has failed to control fluid retention adequately.
    • Ongoing management and provision of the medicine will need to be discussed with the GP before initiation.
    • Please note - this medication is not commonly prescribed as a daily dose.




     

    02.04 Metoprolol 

    June 2020 - Intermittent supply issues with Metoprolol 50mg and 100mg tablets

    • Aurobindo-Milpharm, the sole supplier in the UK, have a long-term shortage affecting metoprolol 50mg and 100mg tablets; caused by some manufacturers discontinuing the products and others having supply difficulties.
    • They currently have limited stock available; supply is likely to be intermittent for several months.
    • See link to shortage memo below for further information. 
    20 Metreleptin Myalepta

    CUHFT



    • Oct 2018,licensed product supersedes leptin that was the previous product available as free of charge and is no longer available

    • For use by endocrinologists for lipodystrophy, partial lipodystrophy and congential leptin deficiency

    • A compassionate supply of licensed product has been offered for existing pateints who were already receiving leptin until NICE considers this product.

    • Applications to use for any patient would need to be via a chairs action

    05.01.11 Metronidazole 

    • Liquid is not suitable for any enteral tubes that do not end in the stomach (NJ/PEJ/PEGJ) or for patients with diarrhoea. Tablets may be crushed and dispersed in water instead.

    05.04.02 Metronidazole  See section 5.1.11
    05.04.03 Metronidazole  See Section 5.1.11
    05.04.04 Metronidazole  See Section 5.1.11
    13.10.01.02 Metronidazole Anabact®

    • CUHFT Restricted Item For fungating tumours (Metrotop has been dicontinued).

    • NWAFT - Formulary

    13.06.03 Metronidazole 0.75% gel/cream Rozex®

     

    • Recommended for prescribing in Primary or Secondary Care for the management of acne rosacea (including flushing). 
    • CUHFT Restricted Item Gel only has restricted formulary status. Restricted to dermatology only for acne rosacae.
    • NWAFT - Formulary.

     

    13.10.01.02 Metronidazole 0.75% gel/cream Rozex®

     

    • Recommended for prescribing in Primary or Secondary Care for the management of acne rosacea (including flushing). 
    • CUHFT Restricted Item Gel only has restricted formulary status. Restricted to dermatology only for acne rosacae.
    • NWAFT - Formulary.

     

    05.01.11 Metronidazole IV 
    06.07.03 Metyrapone Metopirone®

    • CUHFT only -Restricted for endocrinology use

    • Cushings syndrome.

    • Grey - resistant oedema due to increased aldosterone secretion in cirrhosis, nephrotic syndrome, and congestive heart failure (with glucocorticoid replacement therapy). non formulary at all other Trusts.

    05.02.04 Micafungin Mycamine®

    • CUHFT: Restricted in line with Trust guidelines or on microbiology approval

    • Non-formulary at all other Trusts

    01.06.04 Micolette® Sodium Citrate 

    • Same as Relaxit® and Micralax® brands

    • Enema, sodium citrate 450 mg, sodium lauryl sulfoacetate 45 mg, glycerol 625 mg, together with potassium sorbate and sorbitol in a viscous solution.

    07.02.02 Miconazole Gyno-Daktarin®

    • CUHFT and Primary Care: Formulary

    • Non-formulary at all other Trusts

    12.03.02 Miconazole Daktarin®
  • Oral gel miconazole 24 mg/mL (20 mg/g).
  • 13.10.02 Miconazole Daktarin®
    04.01.02 Midazolam 
    • CPFT only: Alternative injection for rapid tranquillisation if IM lorazepam unavailable. ‘Off-label’ use

     

    04.08.02 Midazolam Injection

    • Low strength midazolam on formulary.

    • To comply with NPSA Rapid Response Report ‘Reducing risk of overdose with midazolam injection in adults’, high strengths midazolam injection(>1mg/ml) is restricted to a limited number of wards who have this on the ward stock list. Other wards, not stocking high strengths midazolam, should NOT borrow from wards that do but should contact pharmacy.


     





     

    04.08.02 Midazolam Epilepsy

    • CUHFT: Buccolam® is on formulary (Epistatus® is restricted to patients needing doses <2.5mg) in whom rectal diazepam is not suitable. For use in both inpatients and outpatients.

    • RPH: Only Buccolam® is on formulary

    • NWAFT: Both Buccolam® (Licensed in infants, toddlers, children and adolescents (to 18 years old)) and Epistatus® are on formulary

    • Epistatus and Buccolam not interchangeable

    • Where there is an urgent clinical need the trusts will initiate. 

    • Where there is no clinical urgency secondary care will provide advice for primary care to initiate.


    CD prescribing regulations apply, although does not need to be entered in CD register or stored in CD cupboard.


     





     

    15.01.04.01 Midazolam 

    • Injection restricted in line with NPSA Rapid Response Report 'Reducing risk of overdose with midazolam injection in adults',

    • CUHFT - High strengths midazolam injections (>1mg/ml) are restricted to a limited number of wards who have this on the ward stock list.

    • NWAFT: There are restrictions on which areas may stock these products

    • RPH: Restricted to specific areas:

      • Midazolam 2mg/ml - Critical care and theatres only

      • Midazolam 5mg/ml - Palliaive care only



    • Wards / clinical areas not stocking high strenghs midazolam, should NOT borrow from wards / areas that do but should contact pharmacy.

    • CPFT - Off-label IM use for rapid tranquillisation if lorazepam injection unavailable due to a manufacturer supply problem (Midazolam IM injection must not be given within 1 hour of unlicensed olanzapine IM injection)


    CD prescribing regulations apply, although does not need to be entered in CD register or stored in CD cupboard.


     

    02.07.02 Midodrine 


    •  For the management of orthostatic hypotension and neurocardiogenic syncope as per shared care guideline



    08.01.05 Midostaurin Rydapt®

    • Approved for use in line with NICE TA523 for untreated acute myeloid leukaemia. 

    08.02.04 Mifamurtide Mepact®

    • As per NICE TA235 for the treatment of high-grade resectable non-metastatic osteosarcoma.

    07.01.02 Mifepristone Mifegyne®

    • CUHFT: In line with Rosie Hospital guidelines for management of TOP and IUD.

    • NWAFT: Formulary

    • Non-formulary at all other Trusts

    09.08.01 Miglustat Zavesca®

    • CUHFT only

    • Non formulary at all other trusts

    05.01.03 Minocycline 

     

    • CUHFT: used rarely for acne or very rare infections as per infectious diseases only
    • RPH: Not restricted for use by the Thoracic Directorate.
    • Non-formulary at all other Trusts and in Primary Care. 
    • Prescribers in Primary Care should not initiate minocycline for any new patient with acne.
    • Patients currently prescribed minocycline for acne should be reviewed and minocycline deprescribed.
    • For non-acne indications in line with local antimicrobial recommendations for use in secondary care only.



     

    02.05.01 Minoxidil 

    • CUHFT: Must be prescribed in addition to a diuretic and a beta blocker

    • Non formulary at all other Trusts

    07.04.02 Mirabegron Betmiga®
    04.03.04 Mirtazapine 

     

    • May cause sedation and weight gain.
    • An option for patients where one SSRI has failed and a trial of a second SSRI is inappropriate.
    • NWAFT: Restricted to use in palliative care.

    August 2020 - Supply difficulties with Mirtazapine 15mg, 30mg and 45mg oro-dispersible tablets 

    • Accord, 15mg strength is available but supply to wholesalers is restricted and therefore is limited, the 45mg strength are unavailable until October 2020.

    • Almus – all three strengths are unavailable and there is no date for resupply.

    • Aurobindo – stock is available to order via AAH or Sigma.

    • Medreich – 15mg and 45mg are unavailable with further stocks expected the last week of August 2020.

    • Please see link below to Medicine Supply Notification (published 25th June 2020) issued by the DHSC for further information. 
    01.03.04 Misoprostol Cytotec®

    • Not first line for gastro protection.

    • For use in women's health see section 07.01.01

    07.01.01 Misoprostol 

    • NWAFT: Restricted to use in Women's health

    • CUHFT: For use in second trimester termination of pregnancy following diagnosis of foetal abnormality

    • Oral tablet use for this indication is off-label

    • Non formulary at all other Trusts and in Primary Care

    07.04.04 Mitomycin 

    • CUHFT and NWAFT: Formulary

    • Non-formulary at all other Trusts and in Primary Care

    • For alternative off-label indications see section 08.01.02

    08.01.02 Mitomycin 

    • For bladder instillation see section 07.04.04 

    • CUHFT: Non-oncology indications on Formulary Off-Label: 1) Ophthalmologists - to prevent scarring following trabeculectomy. 2) Airway stenosis (in adults)

    20.01 Mitomycin C  Non-oncology indications on Formulary Off-Label:
    1) Ophthalmologists - to prevent scarring following trabeculectomy.
    2) Airway stenosis (in adults)
    08.01.05 Mitotane Lysodren®
    08.01.02 Mitoxantrone  
    15.01.05 Mivacurium Chloride Mivacron®

    • CUHFT - Restricted Item Restricted

    • NWAFT - Formulary

    04.03.02 Moclobemide 

     

    • Requires specialist initiation by mental health team.
    • Note dietary restrictions.

    May 2020 - Shortage of Moclobemide 150mg and 300mg tablets

    • Mylan is currently out of stock of moclobemide (Manerix) 150mg and 300mg tablets with resupply expected by early June for the 150mg tablets and from early July for the 300mg strength from AAH, Alliance Healthcare and Phoenix. 
    • Sandoz is currently out of stock and expects resupply for the 150mg in July 2021 and the 300mg in March 2021.
    • See shortage memo below for further advice relating to this shortage. 

     

    04.04 Modafinil Provigil®

    • RPH: Restricted to the management of Excessive sleepiness associated with narcolepsy and cataplexy in line with the Shared Care Guideline

    • CUHFT: Neurologists/DME - for patients with excessive daytime sleepiness (Hospital Only

    • Non-formulary at all other Trusts 

    08.02.02 Modigraf® 

    Granules (Prescribe by brand).
    TWICE DAILY TACROLIMUS

    • Caution, narrow therapeutic index drug, several brands and formulations available. Must be prescribed, dispensed and administered by brand, switching between brands only to be undertaken under specialist supervision with blood level monitoring.
    • RPH: Supply can be made via homecare.
    • Non-formulary at all other Trusts.
    • Tacrolimus is NHS England commissioned for immunosuppression associated with transplantation.

     

    A5.09 Mollelast® Toe Bandages 
    • Toe caps for oedema and lymphoedema management (refer to appropriate pathway for selection within hosiery guideline). 
    • Highly conformable retention bandage for prevention and management of forefoot and toe oedema and can be used as a retention bandage to hold dressings in place. 
    12.02.01 Mometasone Furoate Nasonex®, Clarinaze® (OTC)

    • Suitable for self care - patients aged 18 years and over may purchase from a Community Pharmacy. 



    • RPH and NWAFT: Formulary.



    • CUHFT: Specialist advice/initiation via Lloyds OP.



    • Non formulary at all other trusts.





     

    13.04 Mometasone Furoate 0.1% Elocon®

    (Cream, Ointment, Scalp lotion)


    Potent



    • Primary Care Specialist Advice only

    03.03.02 Montelukast 
  • For asthma only as per NICE guidelines.
  • At CUHFT initiation by Respiratory Physicians and Paediatricians only.
  • 04.07.02 Morphine and Morphine Salts 

     

    • Oral forms:
      • Prescribe by BRAND name in primary care to prevent confusion between formulations.
      • Morphgesic® SR tablets or Zomorph® capsules are the preferred brand in primary care where a modified release formulations is required (both 12 hourly release)
      • MXL capsules should be used at 24-hourly intervals are restricted to  ARH, Oncologists/Radiology pts (CUHFT only)
    • Injection: Morphine has superseded diamorphine as the end of life choice of opioid in primary and secondary care.
    • Preservative free injection is unlicensed and restricted (Hospital only)
    • Suppositories (non formulary at all Trusts excluding CUHFT).  
    05.01.12 Moxifloxacin 

    • NWAFT: For use in respiratory patients only.

    • CUHFT: Micro or ID consultants only as second line treatment for TB; Respiratory teams for pneumonia for patients allergic to erythromycin/clarithromycin, but NOT in patients with a history of C.difficile or nursed in a bay with C.difficile positive patients.

    • RPH: No restricted for use by Thoracic Directorate or Transplant


     

    09.06.07 Multivitamin  Renavit®

    • CUHFT: Specialist recommendation only. First choice vitamin supplement for dialysis patients.

    • NWAFT: Restricted for renal use

    • RPH: Formulary


    Dietary supplement, listed as a borderline substance in the drug tariff, therefore requires ACBS endorsement on an FP10 prescription if using for "the dietary management of water soluble vitamin deficiency in renal failure patients receiving dialysis"


     

    09.06.07 Multivitamin preparations Abidec®

    • Contains vitamins A, Bs, C and D. See SPC for list of contents and amounts.

    • CUHFT - First line choice multivitamin in neonates; Dalivit for liver and CF patients.

    • RPH - Formulary

    • NWAFTRestricted Drug Restricted

    • Can be purchased from a Community Pharmacist. However, if a prescriber has particular concerns that a patient might not be able to, or is unwilling to self-care and treatment with a medication is required, then a prescription (FP10) should be considered.


     

    09.06.07 Multivitamin preparations Dalivit®

    • 0.6ml= 14 drops

    • CUHFT - For liver and CF patients only.

    • Can be purchased from a Community Pharmacist. However, if a prescriber has particular concerns that a patient might not be able to, or is unwilling to self-care and treatment with a medication is required, then a prescription (FP10) should be considered.


     

    09.06.07 Multivitamin preparations Sanatogen A-Z complete®

    • CPFT: Restricted to pateint with an eating disorder.

    • Non formulary in Primary Care: Multivitamins can be purchased from a Community Pharmacist.


     

    12.02.03 Mupirocin 2% Bactroban Nasal®

    • CPFT - Restricted for the treatment of MRSA only

    13.10.01.01 Mupirocin 2% Bactroban®

    • In Primary Care Restricted Item for MRSA Only

    08.02.01 Mycophenolate Mofetil 

     

      • Used off licence in Myaesthenia Gravis (Hospital only)
      • Transplant teams - Immunosuppression following renal/hepatic/multi-visceral transplantation where multiple rejection or drug intolerance to the standard regime is a problem. (New patients should remain hospital only, existing patient can remain under shared care)
        • CUH: Prescribed generically for all transplant patients
      • Systemic autoimmune disease, including SLE. Shared care in place.

    RPH: Available via homecare for transplant patients -Prescribe by BRAND

    08.02.01 Mycophenolate Sodium 

     

      • Myfortic is restricted to use by transplant consultants when patients experience gastric irriation with mycophenolate sodium

     

      • CUH: Ceptava brand

     

      • RPH: Available via homecare for transplant patients

     

      • Prescribe by BRAND



    04.06 Nabilone 

    • CUHFT: Formulary

    • Non-formulary at all other Trusts and in Primary Care

    06.07.02 Nafarelin 

    • CUHFT only for Obstetrics and Gynaecology use.

    • Non formulary at other Trusts

    02.06.04 Naftidrofuryl 

    • Restriced to the treatment of intermittent claudication in people with peripheral arterial disease for whom vasodilator therapy is considered appropriate after taking into account other treatment options as per NICE TA223

    04.10.01 Nalmefene  Selincro®

    • Should only be prescribed in conjunction with continuous psychosocial support provided by the local drug and alcohol services,  focused on treatment adherence and reducing alcohol consumption  and in line with NICE TA325

    01.06.06 Naloxegol Moventig ®

    • Specialist initiation for the treament of opioid induced constipation in line with NICE TA345.

    • Follow local guidance (appendix 2) for the treatment of opioid induced constipation.

    • If naloxegol is being considered, note contraindications/ interactions.

    15.01.07 Naloxone 

    • Primary Care Restricted Item Out of Hours GP Service stock this

    18 Naloxone  Injection
  • For treatment of opioid overdose / poisoning
  • See also section 15.1.7
  • 20.01 Naloxone 
  • Paediatrics and neonates.
  • 04.10.03 Naltrexone 

    • Naltrexone should only be prescribed as a treatment option in detoxified formerly opioid-dependent people who are highly motivated to remain in an abstinence programme (Specialist use) in line with NICE TA115

    • Treatment to be retained by the specialist dependence service and not prescribed in Primary Care

    06.04.03 Nandrolone Deca-Durabolin®
  • CUH only
  • Non formulary at other Trusts.
  • 10.01.01 Naproxen 

    • Suitable alternative to diclofenac when CV risk factors but it is associated with a higher GI risk.

    • May have a lower cardiovascular risk than other NSAIDs and COX2's. Good alternative if ibuprofen is not suitable.

    • EC tablets are non formulary: EC tablets are more expensive. No trial has shown a difference in ulcer rate and there is minimal difference in tolerability.

    • If needed tablets can be crushed and dispersed in water. unlicensed unlicensed

    08.02.04 Natalizumab Tysabri®

    • Approved in accordance with NICE TA127.

    • Note at CUH agreed amongst neurologists and JDTC to administer via extended dosing interval, i.e. instead of every 4 weeks, every 6-8 weeks. There are data to suggest it would not increase relapse rate and there is still high levels of a4integrin receptor occupancy at 8 weeks. There is emerging (but still not statistically significant) evidence that it might reduce the risk of PML in patients with high titres of JC virus. It would be more convenient for patients and would obviously being a cost saving.

    20 Natamycin 5% eye drops  

    JDTC March 2018: Approved for the 1st line treatment for fungal keratitis


     


    Natamycin 5% eye drops are a licensed drug in the U.S


     


    Standard dose: 1 drop every 2 hours during the day between 6 am and 10 pm for 3 days and reduced to 6 times a day for 2 weeks and then 4 times a day for 4-6 weeks


     


    Normal treatment course is 4-6 weeks (1-2 bottles), patient will be regularly reviewed within that time. Hospital only via LLoydsds outpatients

    02.04 Nebivolol 

    • CUHFT and RPH: Restricted those patients intolerant of other beta blockers (e.g. due to Raynauld's disease) as is highly specific.

    • Non formulary at all other Trusts


     

    08.01.03 Nelarabine Atriance®
  • Approved in accordance with the National Cancer Drugs Fund for the treatment of refractory T-cell acute lymphoblastic leukaemia or refractory T-cell lymphoblastic non-Hodgkin's lymphoma.

    For more information see Cancer Drug Fund List

  • 20.01 Neomycin (Nivemycin®) 500mg tablets/Metronidazole 400mg tablets/Macrogols (Moviprep®) sachets  

    JDTC July 2018: Moviprep, neomycin and metronidazole combination ( mechanical bowel preparation and antibiotics)  for elective bowel cancer resections in adults approved for use on day prior to surgery as follows;


    Macrogol (2 x sachet and 2 sachet B- given as A +B)   twice daily


    Neomycin 1g three times daily                 


    Metronidazole 400mg three times daily    


    To be prescribed by surgeon in clinic, dispensed from Lloyds

    05.01.04 Neomycin Sulphate 

    • CUHFT: Formulary (restricted use)

    • Non-formulary at all other Trusts


     

    10.02.01 Neostigmine 
  • If needed tablets can be crushed and dispersed in water. May not be suitable for administration via narrow bore tube.
  • 15.01.06 Neostigmine 
    15.01.06 Neostigmine with Glycopyrronium 

    • CUHFT - Injection neostigmine metilsulfate 2.5 mg

    • NWAFT - Formulary

    • RPH - Formulary

    04.06 Netupitant and Palonosetron Akynzeo®

    • CUHFT: approved for use for chemotherapy induced nausea and vomiting (adults and paediatrics unlicensed unlicensed)

    • NWAFT: approved for use for chemotherapy induced nausea and vomiting - adults only

    • Non-formulary at all other Trusts and in Primary Care 

    13.02.01 Neutrogena Dermatological Cream® 

    • In Primary Care this is self care Self-care Policy choice if a paraffin-free formulation is needed

    • Non formulary at all trusts

    05.03.01 Nevirapine Viramune®

    CUH additional advice



    • Treatment of HIV patients as part of triple therapy regime.

    02.06.03 Nicorandil Ikorel®

    • Restricted to patients whose angina is inadequately controlled by first line anti-anginal therapies, or who have a contraindication or intolerance to first line anti-anginal therapies

    09.06.02 Nicotinamide 

    • CUHFT only

    • Non formulary at all other trusts

    04.10.02 Nicotine 

    • Within the CUHFT and RPH supply is limited to:

      • Those who want to quit AND have been referred to a support service or

      • Patient is admitted to ICU/ NCCU. (Following transfer to a non-intensive care setting Pharmacy will no longer supply NRT unless they have been referred to a support service) or

      • Enforced isolation.



    • Alternatively, replacement therapies can be purchased through Outpatient pharmacy.

    • Within Primary Care, prescriptions should not be provided unless recommended by a stop smoking service. Patients can purchase NRT products from their Community Pharmacist.

    • CPFT: All NRT products are on formulary. Wards stock:


      • Nicorette® 2mg and 4mg lozenge

      • Niquitin® 14mg and 21mg 24 hour patches

      • Nicorette® 15mg inhalators

      • Please see CPFT Smoke Free Policy and CPFT Nicotine Replacement Therapy Guidelines below.


    • NWAFT:

      • Recommends self-care for all patients.

      • Niquitin CQ patches all strengths available for patients who require them as inpatients. 



    02.12 Nicotinic Acid 

    • CUHFT: Formulary

    • Non formulary at all other Trusts and in Primary Care

    02.06.02 Nifedipine 

    • Different versions of modified- release preparations may not have the same clinical effect.
    • Prescribers should specify the brand to be dispensed.
    • In Primary Care (February 2020) due to stock availability issues the current formulary choices are:  
      • NIFEDIPRESS MR - Available as a 10mg or 20mg modified release tablet. 
      • ADIPINE XL - Available as a 30mg or 60mg prolonged release tablet.
      • For further information see link below. 
    • Brand in acute trusts as purchased . Please check with Pharmacy.
    • Patients receiving nifedipine for the management of Raynaud's phenomenon should be prescribed a modified-release formulation (off-label) vs. immediate release (licensed). This is due to the increased risk of cardiac complications and mortality with the immediate capsule release profile - see LINK
    • Nifedipine use in pregnancy:
      • NICE guidelines state that where labetalol is not an appropriate first-line treatment, nifedipine may be used to treat hypertension in pregnancy. 
      • However, nifedipine is not specifically licensed for the treatment of hypertension in pregnancy.
      • See links below for further information. 
    02.06.02 Nifedipine 
    • Short acting capsules Restricted Item Information on restriction :
      • RPH: Restricted for the treatment of refractory autonomic dysreflexia (Hospital only)

     

     

    07.01.03 Nifedipine 
    20 Nifedipine 20mg/ml oral drops  

    For paediatrics only

    08.01.05 Nilotinib Tasigna®
  • Restricted to imatinib refractory or intolerant patients in treatment of CML.
    li>See EastMidlands Cancer network guidelines linked above for further information with regards to Nilotinib place in CML therapy.
  • Approved as per NICE TA251 and TA241.
  • 02.06.02 Nimodipine 

    • CUHFT and NWAFT: Formulary

      • Injection:Polyethylene, polypropylene, or glass apparatus should be used. PVC should be avoided

      • Tablets: May be crushed or halved but are light sensitive—administer immediately.



    • RPH: Non formulary

    03.11 Nintedanib Ofev®
    •  As per NICE TA 379 for idiopathic pulmonary fibrosis only.
    • Shared care in place to support the monitoring of nintedanib only
    • Prescribing is Hospital only.
    • RPH: Supply is via Homecare.



     

    08.01.05 Niraparib Zejula®

    • Approved for use in accordance with NICE TA528 for maintenance treatment of relapsed, platinum-sensitive ovarian, fallopian tube and peritoneal cancer. 

    09.08.01 Nitisinone Orfadin®

     

      • CUHFT only: Indicated for alkaptonuria and tyrosinaemia. 

     

    04.01.01 Nitrazepam 

    • CPFT and CUHFT only: 3rd line on the advice of mental health team only. Long-acting so risk of accumulation. Avoid use in the elderly.

    • Non formulary at all other Trusts.

    05.01.13 Nitrofurantoin 

     

    • Primary Care and NWAFT: Nitrofurantoin is first line choice for UTI. (Modified release is preferred choice of formulation in primary care and NWAFT. Oral suspension more than £400 for a 300ml bottle).
    • CUHFT: Note - Co-amoxiclav is first line treatment for UTI (see antibiotic guidelines: urology). Nitrofurantoin - modified release is preferred formulation choice for CUHFT.
    • RPH: 3rd line treatment for UTI.
    • Do not use in last trimester of pregnancy.
    • NITROFURANTOIN: CAUTION IN RENAL IMPAIRMENT Contraindicated in most patients with an eGFR<45ml/min.

     

    15.01.02 Nitrous oxide 

    • Formulary at all trusts

    08.02.04 Nivolumab Opdivo ®

     

      • Approved in line with NICE TA400 for treating advanced (unresectable or metastatic) melanoma in adults in combination with nivolumab.




      • Approved in line with NICE TA462 for treating relapsed or refractory classical Hodgkin lymphoma. 




      • Approved in line with NICE TA483 for previously treated squamous non-small-cell lung cancer.

     

      • Approved in line with NICE TA484 for previously treated non-squamous non-small-cell lung cancer. 




      • Approved in line with NICE TA490 for treating squamous cell carcinoma of the head and neck after platinum-bsed chemotherapy. 




      • NOT RECOMMENDED in line with NICE TA530 for treating locally advanced unresectable or metastatic urothelial cancer after platinum-containing chemotherapy. CUHFT compliant. 




      • Approved in line with NICE TA558 for adjuvant treatment of completely resected melanoma with lymph node involvement or metastatic disease.




      • Approved in line with NICE TA581 - Nivolumab with ipilimumab for untreated advanced renal cell carcinoma.




      • CUHFT: Hospital only via Lloyds OP. 
      • CUH: interim approval of limited FOC scheme Nivolumab and Ipilumab combination for MMR colorectal cancer - JDTC/ OSTS Nov 2019




     

    02.07.02 Noradrenaline / Norepinephrine 

    April 2020 - Medicine Supply Notification Noradrenaline 4mg in 4ml ampoule

    • See link below for further information. 
    06.04.01.02 Norethisterone 

    April 2020 - Supply issues with Norethisterone 5mg tablets

    • The manufacturers Sanofi and Wockhardt are reporting that they have no supply of norethisterone 5mg tablets available.
    • Norethisterone 5mg tablets in the brands Utovlan and Primolut N tablets are currently available from Alliance Healthcare. 
    08.03.02 Norethisterone 

    • See section 06.04.01.02 for gynae indications

    • If needed tablets can be crushed (preferably in water to reduce dust production) and dispersed in water.

    07.03.02.01 Norethisterone 350 microgram Noriday®

     

     

    05.01.12 Norfloxacin 

    • CUHFT: Co-amoxiclav is first line treatment for UTI (see antibiotic guidelines); norfloxacin only to be used as second line treatment for patients who are allergic to penicillin (see antibiotic guidelines for full details).

    • Non-formulary at all other Trusts


     

    14.05.01 Normal immunoglobulin for Intravenous use 

    • CUHFT: Refer to local policy.


     



    • NWAFT: Formulary


     



    • RPH: Formulary - Flebogammadif®and Privigen® 
       

    14.05.01 Normal immunoglobulin for Subcutaneous use 

    • CUHFT: Refer to local policy.


     



    • NWAFT: Formulary


     



    • RPH: Formulary - Cuvitru®, Gammanorm® and Hizentra®. Available via homecare for immunology®.

    04.03.01 Nortriptyline 

    • Use as an antidepressant - not recommended for first line use

    • If recommended for prescribing, 50mg tablets in primary care are more expensive than prescribing in combinations of 10mg and 25mg tablets.

    • NWAFT and RPH: Non-formulary

    • CUHFT: Restricted to psychiatry initiated only


     

    04.07.03 Nortriptyline 

    • CUHFT: Similar to amitriptyline only less likely to cause drowsiness or anticholinergic side effects.



    • Non-formulary at all other Trusts and in Primary Care (for this indication).

    10.02 Nusinersen Spinraza®

    • CUHFT: As per NHSE clinical commissioning policy available through expanded access program and activity costs funded by NHSE.


      • Intra-thecal administration- only authorised personnel can be involved in the prescribing, administering and treatment of patients

      • Advise patients and their caregivers to seek urgent medical attention if any signs or symptoms of communicating hydrocephalus develop during nusinersen therapy for spinal muscular atrophy. 




    • Approved for use in line with NICE TA588 - Nusinersen for treating spinal muscular atrophy only if:

      • people have pre-symptomatic SMA, or SMA types 1, 2 or 3 and

      • the conditions in the managed access agreement are followed.





    • Non formulary at all other Trusts


     

    13.02.01 Nutraplus® 

    • In Primary Care this is self-care Self-care Policy

    • CUHFT and RPH - Formulary 2nd choice

      • Cream urea 10%

      • Non-paraffin choice



    • NWAFT and CPFT - Non-formulary

    13.04 Nystaform-HC® 

    • NWAFT only

    • Contains: Hydrocortisone 1%, Nystatin 100,000 units/g
      and Chlorhexidine Acetate 1%

    • Mild with antimicrobials

    12.03.02 Nystatin 
  • Oral suspension 100 000 units per mL.
  • Unlicensed for treating candidiasis in neonate.

  • 20 Nystatin 
  • For persistent vaginal candidiasis.
  • 01.09.01 Obeticholic acid Ocaliva®

    • As per NICE TA443 for treating primary biliary cholangitis. 

    08.02.03 Obinutuzumab Gazyvaro ®

     

      • Approved for use in accordance with NICE TA343 for untreated chronic lymphocytic leukaemia in combination with chlorambucil if other conditions make treatment with full-dose fludarabine unsuitable and bendamustine is not suitable.




      • Approved for use in accordance with NICE TA472 - Obinutuzumab with bendamustine for treating follicular lymphoma refractory to rituximab. 




      • Approved for use in accordance with NICE TA513 - Obinutuzumab for untreated advanced follicular lymphoma. 

     

    08.02.04 Ocrelizumab Ocrevus®

     

    • Approved in line with NICE TAs:
      • NICE TA533 for treating relapsing-remitting multiple sclerosis.
      • NICE TA585 for treating primary progressive multiple sclerosis.

     

    12.02.03 Octenidine dihydrochloride  Octenisan®

    • CUHFT and NWAFT: restricted for MRSA decolonisation

    • Non-formulary at all other Trusts

    08.03.04.03 Octreotide Sandostatin Lar®

    • Management of acromegaly only. (Dr. Edwards) (Specialist Initiation).

    • For use in palliative care (specialist initiation).

    • Management of symptomatic/functional neuroendocrine tumours (Hospital only)

    • RPH: Restricted to use in Cystic Fibrosis (Hospital only)

    08.03.04.03 Octreotide Sandostatin®

    • Restricted for use by Gastroenterologists/ Surgeons / Hepatologists.

    • For use in palliative care (specialist initiation). 

    • RPH: Restricted to use in Cystic Fibrosis (Hospital only)

    18 Octreotide  Injection
  • Discussion with National Poisons Information Service recommended if severe refractory hypoglycaemia
  • Sulphonylurea induced hypoglycaemia / poisoning (off-label indication), rarely required
  • for standard uses see section 8.3.4.3
  • 06.04.01.01 Oestrogen only HRT gel Oestrogel ®

     

    • CUHFT only.

     

    • Non formulary at all other trusts.

     

    06.04.01.01 Oestrogen only HRT patch 

     

    • Evorel® and Estradot® are the recommended brands for use in women without a uterus.

    June 2020 HRT Availability:

    • Supplies of Evorel® patches - Evorel 25mcg, 50mcg, 75mcg and 100mcg are in stock and available to order.   
    • Supplies of Estradot® patches -  all strengths are filtering into Alliance and AAH on a weekly basis.



     

    06.04.01.01 Oestrogen only HRT tablet Elleste-Solo ®, Premarin®,Progynova®, Zumenon®,
    • Elleste-Solo®- Tablet 1mg and 2mg (First choice oral estradiol only product).
    • For use in women without a uterus.
    • Elleste Solo: 1mg and 2mg estradiol.
    • Premarin: Conjugated oestrogens 0.3mg, 0.625mg and 1.25 mg.
    • Progynova: 1mg and 2mg estradiol valerate.
    • Zumenon: 1mg and 2mg estradiol.

    June 2020 HRT Shortages: 

    • Current available brands - Beware, there can be variation in the licensing of different medicines containing the same drug:
      • Elleste-Solo® 1mg (Mylan) - out of stock.
      • Elleste-Solo® 2mg tablets (Mylan) - out of stock.
      • Premarin® (conjugated oestrogen) tablets (Pfizer) - Available to order via Alliance HC. 
      • Progynova® 1mg and 2mg tablets (Bayer) – Available to order via Alliance HC only.
      • Zumenon® 1mg and 2mg tablets (Mylan) – Available to order via AAH, Alliance HC and Phoenix. 
    06.04.01.01 Oestrogens only HRT gel Sandrena®

     

    • Available as either 1g or 0.5g single dose sachets.

     

    • For menopausal symptoms, estradiol 1 mg (1 g gel) to be applied once daily over area 1–2 times size of hand.

     

    • Additional cyclical progestogen for 12–14 days of each cycle is recommended in women with a uterus.

     

    • Dose may be adjusted after 2–3 cycles to lowest effective dose (usual dose of estradiol 0.5–1.5 mg (0.5–1.5 g gel) daily)

     

    • Apply gel to intact areas of skin such as lower trunk or thighs, using right and left sides on alternate days.

     

    • Not to be applied on the breasts or face and avoid contact with eyes.

     

    • Allow area of application to dry for 5 minutes and do not wash area for at least 1 hour.

     

     

     

    07.02.01 Oestrogens, Topical 

    • Intravaginal cream: estriol 0.01% (10x weaker than Ovestin®)

    • Prescribe generically

    07.02.01 Oestrogens, Topical Estring®

    • Vaginal Ring (vaginal delivery system): estradiol 7.5mcg/24hr

    07.02.01 Oestrogens, Topical Ovestin®

    • Intravaginal cream

    07.02.01 Oestrogens, Topical Vagifem®

    • Vaginal tablet: estradiol 10mcg

    • For 2nd line use if vaginal cream isn't suitable

    08.02.03 Ofatumumab Arzerra®

    • As per NICE TA344 for untreated chronic lymphocytic leukaemia in combination with chlorambucil if treatments containing fludarabine or bendamustine are not suitable

    • Was previously approved for the treatment of chronic lymphocytic leukaemia as a 2nd or 3rd line indication. Removed from the CDF list on 12th March 2015. Remains on formulary for patients with funding approved prior to this date.



    • TERMINATED APPRAISALS

      • NICE TA469 - Idelalisib with ofatumumab for treating chronic lymphocytic leukaemia (terminated appraisal).

      • NICE TA470 - Ofatumumab with chemotherapy for treating chronic lymphocytic leukaemia (terminated appraisal).



    05.01.12 Ofloxacin 

    • For treatment of pelvic inflammatory disease by Gynaecology and epididymo-orchitis by Urologists.

    • CUHFT additional advice: Clinic 1A/ID, Injection is non formulary at CUHFT

    • RPH: Non-formulary


     

    11.03.01 Ofloxacin Eye drops Exocin®

    • Eye drops 0.3%

    • NWAFT - Formulary

    • CUHFT - Restricted use

    • RPH -  Specialist advice

    05.01.12 Ofloxacin IV 

    • NWAFT: Formulary (restricted use)

    • Non-formulary at all other Trusts


     

    13.02.01 Oilatum® 

     

    • Primary Care and NWAFT only. 
    • Cream
    • Junior Cream
    • Use Emollients Safely There is a fire risk associated with all emollients whether they contain paraffin or not.

     

    01.07.03 Oily phenol injection BP 
    04.02.01 Olanzapine 

    • CPFT: unlicensed unlicensed Short acting IM injection available for rapid tranquillisation.

    • Olanzapine IM injection must not be given within 1 hour of any parenteral benzodiazepine (including lorazepam IM injection and midazolam IM injection)

    • Non-formulary at all other Trusts and in Primary Care

    04.02.01 Olanzapine 

     



    • For mental health conditions - requires specialist initiation by mental health team

    • CUHFT: use in line with Trust guidelines on delirium and dementia in older patients.

    • RPH: For management of delirium in critical care.

    • NWAFT: Restricted to use in palliative care
       


    NeLM in-Focus review: metabolic adverse effects with atypical antipsychotics. Bottom line: Emerging data suggest that the risks of adverse metabolic effects, including hyperglycaemia, diabetes, weight gain and dyslipidaemia, are greater with olanzapine than other atypical antipsychotics (with the exception of clozapine).


     


     

    08.01.05 Olaparib Lynparza®

     

    • Approved as per NICE TA381 for maintenance treatment of relapsed, platinum-sensitive, BRCA mutation-positive ovarian, fallopian tube and peritoneal cancer after response to second-line or subsequent platinum-based chemotherapy.
    • Approved as per NICE TA598 for maintenance treatment of BRCA mutation-positive advanced ovarian, fallopian tube or peritoneal cancer after response to first-line platinum-based chemotherapy. 
    • Olaparib access programme (FOC) – Maintenance treatment of BRCA-mutated ovarian, fallopian tube and peritoneal cancer after response to first-line platinum-based chemotherapy.

     

    12.01.03 Olive Oil Ear Drops 

    • Suitable for self-care. Recommend patient (where willing and able)purchases from a Community Pharmacy

    11.04.02 Olopatadine Optanol®
    • To be used in allergic conjunctivitis where over the counter medication is ineffective or contraindicated.
    03.04.02 Omalizumab 
  • Asthma- commissioned by NHSE.
  • Chronic urticaria - commissioned by CCG: Approved for use in line with NICE TA339
  • Tariff excluded. Group Prior Approval submission via Blu-teq required.

    CUH: Approved for use for dermatology, allergy and immunology clinics.
  • 05.03.03.02 Ombitasvir, Paritaprevir and Ritonavir Viekirax®

     



    • Used in accordance with treatment options and run rates as established for the Eastern Liver Network ODN. All second and third line treatments must be discussed regionally for approval. Further information can be found at www.easternliver.net.



    • Commissioning policy NHS England B07/P/a and NICE TA 365 Commissioned for use in: Genotype 1a with compensated cirrhosis in combination with dasabuvir and ribavirin for 12 weeks (note 12 week regimen unlicensed). • Genotype 1b with compensated cirrhosis in combination with dasabuvir and ribavirin for 12 weeks. 



    • Prior approval via Blueteq system required. Supplied via Lloyds at CUH.


     


     

    01.03.05 Omeprazole 

     

    • CAPSULE is the first line solid oral PPI of choice.
    • Both omeprazole and lansoprazole are first line choices for GPs.
    • Omeprazole is licensed for use in pregnancy. Please see link below for further information. 

     

    01.03.05 Omeprazole IV 

    • NWAFT: Formulary (infusion 1st line)

    • CUHFT: Bolus injection for PAEDIATRIC use only (Unlicensed).

    04.06 Ondansetron 

    • CUHFT:

      • For COD, D9, C10 and C2 following protocol.

      • General theatres: For post-op nausea and vomiting in adults and children - see protocol

      • Neurotheatres

      • Rapid opiate detoxification programme for 5 patient days per annum.

      • For Pain Clinic, protocol for vomiting with Ketamine Infusion for back pain.

      • For Rosie Theatre Recovery for post-op nausea and vomiting.

      • Patches have been agreed on Formulary for oncology only.

      • For the off label indication of diarrhoea predominant IBS (tablet). Prescribing for this indication should remain in secondary care.



    • NWAFT and RPH: Formulary

    • MHRA guidance - the maximum single intravenous dose of ondansetron for the management of chemotherapy-induced nausea and vomiting in adults is 16 mg (infused over at least 15 minutes)

    • In secondary care the syrup and orodispersible film are available but are much more expensive than tablets. If needed tablets can be crushed and dispersed in water.

    • Primary care:

      • Ondansetron orally is a third line option for moderate symptoms of nausea and vomiting in pregnancy (unlicensed unlicensed). To only be prescribed for courses of no longer than 5 days then reviewed. 

      • All other indications NON-FORMULARY. 



    04.09.01 Opicapone 

     

    • NWAFT only (HOSPITAL ONLY): For use when patients cannot be stabilised on entacapone and does not meet the criteria below in relation to persistent diarrhoea.
    • Specialist Initiation (CUHFT and NWAFT) 2-month trial by secondary care for continuation in primary care only For patients with Parkinson’s and motor fluctuations who are eligible for a 2 month trial of opicapone will necessarily first have had a trial of entacapone, and will have experienced the unacceptable adverse effect of persistent diarrhoea causing incontinence, or frequent passing of loose stool disturbing sleep or lifestyle, as defined by Bristol stool chart 6/7, which resolves when stopping entacapone.
    • Non-formulary at all other Trusts.
    09.02.01.02 Oral Rehydration Salts Dioralyte®

    • Consider self-care

    04.05.01 Orlistat 

    • Recommend self-care: Can be purchased from a Community Pharmacist (Alli 60mg capsules)

    • Primary Care: Orlistat should only be considered on prescription (where the patient is not willing or able to self-care) after dietary, exercise and behavioural approaches have been tried for at least 3 months and evaluated through a weight management programme (Tier 2/3).

    • CUHFT: Endocrinologists and the Diabetologists for use in selected obese patients to assist weight loss.

    • Non-formulary at all other Trusts

    04.09.02 Orphenadrine 

    • CUHFT and NWAFT: Formulary for use in Parkinson's Disease

    • RPH: Non-formulary

    • CPFT: Formulary for the management of extrapyramidal side effects

    • More likely to cause insomnia.

    • Now only available as a liquid formulation

    • More expensive than alternatives (procyclidine and trihexyphenidyl)


     

    05.03.04 Oseltamivir Tamiflu®

    • Recommended as per NICE TA168 and TA158

    • Concentration of suspension is 6mg/ml - see MHRA link below.

    • CUHFT - supplied through inpatients pharmacy only.


     


     

    08.01.05 Osimertinib Tagrisso®
  • As per NICE TA416.
  • Also approved in accordance with the National Cancer Drugs Fund List.
    For more information see Cancer Drug Fund List
  • 12.01.02 Otovent® Auto inflation Device

    • Auto inflation device.



    • In Primary Care this is self-care Self-care Policy where patient is willing and able.



    • Indicated for otitis media with effusion. 



    • Children - Recommended. Please see link below to C&P CCG Grommets & Adenoidectomy (Surgical Treatment of Otitis Media) Policy. 



    • Adult - Not Recommended (Self Care).

    08.01.05 Oxaliplatin 
  • As per NICE TA100 in the adjuvant treatment of stage 3 (Dukes' C) colon cancer.
  • 2nd line treatment in metastasising colorectal cancer when therapy with 5FU alone has failed.