North of Tyne and Gateshead Area Prescribing Committee. Formulary - Version 6.5 October 2016

Serving NHS Organisations in the North of Tyne and Gateshead Area

North of Tyne and Gateshead Area Prescribing Committee

North of Tyne and Gateshead Formulary

Version 6.5 October 2016

This version of the North of Tyne and Gateshead Formulary shows the drugs included in the Drugs and Preparations sections (1-15) plus a section on products used in the treatment of poisoning (section 16). This formulary lists the medicines and related pharmaceutical products that are approved for use in the North of Tyne and Gateshead NHS area and includes indications as to

the first choice and alternative drugs,

those drugs that are classified as ‘Red’ hospital only (R), those appropriate

for shared care ‘Amber’ (A),

those products that are unlicensed, but have been approved for use in the local health economy by the Area Prescribing Committee (APC)

This version of the document has been updated to include drugs that have been approved for use up to the end of October 2016. Further updates will be made to take into account the feedback from users and decisions made by the APC and its Formulary Subcommittee.

In the electronic version of this document most of the drug names are formatted as hyperlinks to the BNF monograph to provide access prescribing and other information.

The formulary is supported by all of the Clinical Commissioning Groups (CCG’s) and NHS Trusts in Gateshead, Newcastle, North Tyneside and Northumberland, i.e. Newcastle upon Tyne Hospitals NHS Foundation Trust Northumberland Tyne and Wear NHS Foundation Trust Northumbria Healthcare NHS Foundation Trust NHS Newcastle Gateshead Clinical Commissioning Group (NHS NGCCG) NHS North Tyneside Clinical Commissioning Group (NHS NTCCG) NHS Northumberland Clinical Commissioning Group (NHS NCCG) Information in this document must not be used for promotional activities by the pharmaceutical industry without permission.

Copyright All rights reserved. No part of this document may be reproduced, stored in a retrieval system or transmitted in any form or by any means, without permission. © North of Tyne and Gateshead Area Prescribing Committee 2016

North of Tyne and Gateshead Area Prescribing Committee. Formulary - Version 6.5 October 2016

Contents

Abbreviations 3

Contact Details 3

Introduction 4

Changes to formulary since previous version 7

Classified Details of Drugs and Preparations

1. Gastro-intestinal System 8

2. Cardiovascular System 16

3. Respiratory System 30

4. Central Nervous System 36

5. Infections 57

6. Endocrine System 68

7. Obstetrics, Gynaecology and Urinary-Tract Disorders 80

8. Malignant Disease and Immunosuppression 87

9. Nutrition and Blood 99

10. Musculoskeletal and Joint Diseases 109

11. Eye 115

12. Ear, Nose and Oropharynx 123

13. Skin 128

14. Immunological Products and Vaccines 141

15. Anaesthesia 145

16. Treatment of Poisoning 150

17. Enteral Nutrition (to be developed) 150

18. Wound Management Products 153

Appendix 162

Index 166

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Abbreviations

Caps = Capsules

Disp = Dispersible

e/c = Enteric coated Eff = Effervescent

Inj = Injection m/r = Modified release Microg = Microgram

Sol = Solution

Suppose = Suppositories

Susp = Suspension Tabs = Tablets

Some products are also marked with a suffix (es) to give additional information:

R Red Drug (hospital only)

A Amber Drug (shared Care)

G+ & B

Green Plus & Blue Drug Drugs which are initiated by specialists for which information sheets are being developed to provide GPs with information to assist with prescribing etc.)

G

Green Drug – Drugs that may be initiated in primary care – only used with drugs where there has been some debate as to whether they should be initially prescribed by GPs

s Specialist advice/ initiation- see comments next to each entry

u Unlicensed

r Restricted use (e.g. to a certain consultant or speciality, or in specific clinical circumstances)

Abbreviations used to represent different hospitals/trusts/Committees

APC North of Tyne Area Prescribing Committee

GHFT Gateshead Health NHS Foundation Trust

NHCT Northumbria Healthcare NHS Foundation Trust

NTW Northumberland Tyne and Wear Trust

NUTH Newcastle upon Tyne Hospitals NHS Foundation Trust

NECS North of England Commissioning Support

Contact Details

For enquiries and queries contact:

Mark Thomas Gateshead Health NHS

Foundation Trust Tel: 0191 445 2818 Mark.Thomas@ghnt.nhs.uk

Matthew Lowery Newcastle upon Tyne Hospitals NHS Foundation Trust

Tel: 0191 223 1386 Matthew.Lowery@nuth.nhs.uk

Sarah Chandler Northumbria Healthcare NHS Foundation Trust

Tel: 0191 293 2729 Sarah.Chandler@nhct.nhs.uk

Ewan Maule

Northumberland, Tyne and Wear NHS Foundation Trust

Tel: 0191 2232678

Ewan.Maule@ntw.nhs.uk Susan Turner North of England Commissioning

Support Tel: 0191 217 2762 Susanturner4@nhs.net

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Introduction The North of Tyne and Gateshead Formulary is produced under the auspices of the North of Tyne and Gateshead Area Prescribing Committee (APC). It gives details of medicines that are approved for use in NHS organisations in Gateshead, Newcastle, North Tyneside and Northumberland. The range of medicines included in this formulary is intended to encourage safe, effective and economical prescribing. Having a common range of medicines available for use in the North of Tyne and Gateshead Area should help ensure seamless prescribing for patients between general practice and hospital trusts, facilitating continuity of treatment and minimising supply problems. It should also help those healthcare professionals that work for more than one organisation in the local health economy. Where appropriate the formulary gives information as to which drugs are regarded as being the first choice and alternatives. It is not intended to be a comprehensive prescribing guide or to replace the BNF or BNF for children. The drug names in the electronic version are however formatted as hyperlinks to the BNF. As the formulary develops, further links will be provided to North of Tyne and Gateshead Guidelines etc. The formulary is a dynamic document that is updated regularly after each APC meeting. The most up to date version of the formulary is maintained in electronic form on the APC’s Internet site: http://www.northoftyneapc.nhs.uk/formulary/

An up to date version of the formulary may also be located on the individual Trust’s Intranet sites, thereby providing links to that Trust’s locally adapted electronic version of the BNF giving additional information and links e.g. to that Trust’s policies and guidelines. However, in most organisations this is still in development. 1. Notes on using the formulary Medicines in the formulary are listed in chapters and subsections that generally correspond with those in the BNF. Where possible drug names have been formatted as hyperlinks to BNF monographs. This is to enable users to easily refer to the BNF for information on doses, side effects, cautions, contraindications and drug interactions. The Microsoft Word version of this document can also be navigated by using the document map – Click on ‘View’ and then select document map. Recommended International Non-proprietary Names (INNs) are used throughout the text, but proprietary names are used for some combination and modified release products, where brand name prescribing is recommended. The cheapest available solid dosage form should be used when there are no bioavailablity issues. Products listed in the formulary are flagged to indicate if they are hospital only products, suitable for shared care, are unlicensed or have been approved for an unlicensed indication. Hospital doctors should not ask GPs to prescribe hospital only medicines (‘Red’ drugs) unless there is a very exceptional reason and agreement with the GP. When prescribing unlicensed medicines it is important that prescribers are aware that they are taking on additional responsibilities regarding the patient’s safety. Further information and guidance can be obtained from individual Trust unlicensed medicines policies.

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2. NICE approved treatments All NICE Technology Appraisals are automatically endorsed by the North of Tyne and Gateshead APC; relevant medicines are incorporated into the formulary and are available for clinicians to prescribe within 90 days of publication by NICE.

3. Requests for products to be included in the formulary Requests for products to be added to the formulary have to be approved by the North of Tyne and Gateshead Area Prescribing Committee. Requests normally have to be made by a consultant, general practitioner or other appropriate senior healthcare professional (e.g. optician, dentist, nurse, podiatrist, dietician or pharmacist) and wherever possible the request should be submitted electronically by email. A copy of the New Product Request Form can be downloaded from the APC’s Internet site: http://www.northoftyneapc.nhs.uk/formulary/ 4. Use of Non-Formulary Medicines GPs and other prescribers in primary care are strongly encouraged to prescribe medicines that are included in the formulary. The formulary is intended to be followed closely in hospitals. Consequently the hospital pharmacies may not stock medicines that are not included in the formulary. However it is recognised there are some circumstances where it will be necessary to use a non-formulary medicine and individual trusts have their own procedures for dealing with this. However, the following principles apply: a) Initiating therapy with a Non-Formulary Medicine In cases where it is considered that there is no formulary medicine appropriate for treating an individual hospital patient, the consultant responsible for the patient’s care should contact a senior pharmacist at the hospital where the patient is being treated. The request will then need to be dealt with in accordance with the hospital trust’s non-formulary request procedure, which may include completion of a non-formulary request form. In exceptional circumstances only, if a hospital doctor wishes a patient’s GP to prescribe a non-formulary drug, then he/she should explain to the GP that the desired treatment is not in the formulary and give the reason(s) why it is being requested instead of a formulary medicine, e.g. if the patient has failed to tolerate or respond to possible formulary alternatives. b) Patients admitted to hospital on Non-Formulary medicines The process for dealing with this issue varies between organisations, as it is largely dependent on how patients’ own medicines are handled. Prescribers should familiarise themselves with systems in their own organisation and act accordingly. In the absence of a system for routinely using patients’ own medicines during hospital stay, consideration should be given to changing to a formulary medicine where this is practicable and not likely to be detrimental to the individual patient’s care. Where it is

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not practicable to change the patient’s medication, a pharmacist should be contacted so that appropriate arrangements for continuing the treatment can be made. When therapy with a non-formulary drug is continued on admission, medication brought into hospital by the patient may be used, provided that it is clearly labelled and appears to be of good quality, in accordance with the hospital trust’s policy. 4. Unlicensed Medicines and Use of Medicines for Unlicensed Indications This formulary contains a number of unlicensed medicines, and medicines that have been approved for unlicensed or ‘off-label’ indications. Their inclusion has been agreed after careful consideration of their benefits versus any known or perceived risks associated with their use by the North of Tyne and Gateshead Area Prescribing Committee (APC) and its Formulary Subcommittee. Many unlicensed medicines are formulations of well -established drugs that are included the BNF, whereas others are products that are less well known, but considered to be of benefit in the treatment of patients with conditions where licensed medicines cannot be used or fail to produce an adequate response. Unlicensed medicines included in the Formulary are marked using the suffix u and those that are considered unsuitable for prescribing by GPs (even if treatment has been started and stabilised by a hospital clinician) are classified as ‘RED’, or hospital only, medicines. When prescribing an unlicensed or a licensed product ‘off-label’ for an unlicensed indication it is important prescribers are aware that it is not only they who take on additional responsibilities regarding the patient’s safety and welfare, but the burden is shared with others involved in supply and administration. Further information and guidance can be obtained from the GMC website

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Changes to the Formulary since previous version (Version 6.4 July 2016)

Section Change Reason for change

1.6.4 Change Movicol Paediatric entry to generic macrogol description APC approval

2.12 Addition of approved indication for evolocumab and NHS England Commissioning Statement

NHS England

3.4.3 Addition of danazol, stanazolol and oxandrolone for the prophylactic treatment of hereditary angioedema

NHS England

4.7.1 Removal of nefopam tablets APC approval

5.1.7 Addition of statement to use most cost effective preparation of fosfomycin sachets APC approval

5.3.1 Addition of Genvoya (elvitegravir, cobicistat, emtricitabine and tenofovir alafenamide) for the treatment of HIV

NHS England Commissioning Policy 16043/P

5.3.1 Addtion of Descovy (emtricitabine and tenofovir alafenamide) for the treatment of HIV

NHS England Commissioning Policy 16043/P

5.3.1 Addition of Odefsey (emtricitabine, rilpivirine and tenofovir alafenamide) for the treatment of HIV

NHS England Commissioning Policy 16043/P

5.3.5 Addition of NHS England Commissioning Statement for palivizumab NHS England

8.1.3 Addition of approved indication for pemetrexed and NHS England Commissioning Statement

NICE TA402 & NHS England

8.1.5 Addition of NHS England Commissioning Statement for ceritinib NHS England

8.1.5 Addition of NHS England Commissioning Statement for trametinib NHS England

8.1.5 Addition of everolimus for the treatment of angiomyolipomas associated with tuberous sclerosis

NHS England

8.1.5 Addition of approved indication for nivolumab and NHS England Commissioning Statement

NICE TA400 & NHS England

8.1.5 Addition of trifluridine-tipiracil hydrochloride for previously treated metastatic colorectal cancer

NICE TA405 & NHS England

8.1.5 Addition of talimogene for the treatment of unresectable metastatic melanoma NICE TA410 & NHS England

8.1.5 Addition of crizotinib for untreated anaplastic lymphoma kinase-positive advanced non-small-cell lung cancer

NICE TA406 & NHS England

8.1.5 Addition of venetoclax for the treatment of adults with CLL. MHRA EAMS 41042/0001

8.1.5 Addition of bosutinib for use in previously treated chronic myeloid leukaemia NICE TA401 8.1.5 Addition of pegaspargase for the treatment of acute lymphoblastic leukaemia NICE TA408

8.1.5 Addition of radium-223 dichloride for the treatment of hormone-relapsed prostate cancer with bone metastases

NICE TA412

8.2.3 Addition of NHS England Commissioning Statement for rituximab NHS England

8.3.4.1 Removal of fulvestrant as not recommended APC approval

8.3.4.2 Addition of NHS England Commissioning Statement for abiraterone NHS England

8.3.4.2 Addition of approved indication for degarelix NICE TA404

9.1.1.1 Addition of ferric maltol (Feraccru) for the treatment of iron deficiency anaemia in patients with irritable bowel disease

APC approval & NTAG

10.1.3 Addition of approved indication for secukinumab NICE TA407

10.2 Addition of ataluren for the treatment of Duchenne muscular dystrophy with a nonsense mutation in the dystrophin gene

NICE HST3 & NHS England

11.5 Addition of phenylephrine hydrochloride & tropicamide for the treatment of mydriasis

APC approval

11.6 Addition of latanoprost UDVs APC approval 11.6 Addition of tafluprost & timolol (Taptiqom) for the treatment of glaucoma APC approval

11.6 Addition of brinzolamide & brimonidine (Simbrinza) for the treatment of glaucoma APC approval 11.8.2.3 Addition of approved indication for aflibercept NICE TA409

13.5.3 Addition of NHS England Commissioning Statement for adalimumab NHS England

13.6.1 Addition of isotretinoin gel for the treatment of acne APC approval 13.6.1 Addition of clindamycin & tretinoin gel for the treatment of acne APC approval 13.6.1 Addition of isotretinoin & erythromycin gel for the treatment of acne APC approval

15.1.4.4 Additional approved indication for dexmedetomidine APC approval

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1. Gastro-Intestinal System

1.1 – Dyspepsia and Gastro-oesophageal Reflux Disease

1.1.1 – Antacids and Dimeticone

1.1.1 - Plain Antacids First Choice Co-magaldrox 195/220 (Mucogel®, Maalox®)

Sugar-free suspension - 195mg magnesium hydroxide & 220mg dried aluminium hydroxide in 5ml -for indigestion. Mucogel is cheaper than Maalox in the community

Sodium citrate 0.3 Molar solution - used in obstetrics for prophylaxis of acid aspiration – see section 15.1.9

Infacol Sugar-free- simeticone 40mg/m l- only approved for use in endoscopy procedures.

1.1.1 - Antacids with Dimeticone Co-simalcite125/500 (Altacite Plus®)

Sugar-free suspension (activated dimeticone 125mg &

hydrotalcite 500mg in 5ml)

1.1.2 – Compound Alginates and Proprietary Indigestion Preparations Peptac® Sugar-free liquid (sodium alginate 500mg, sodium

bicarb. 267mg, calcium carb. 160mg in 10ml - 6.2mmol sodium) - preferred antacid for treating reflux. Use instead of Gaviscon

Infant Gaviscon® Oral sugar-free powder in dual sachets (sodium alginate 225mg, magnesium alginate 87.5mg with colloidal silica and mannitol – sodium content 0.92mmol/dose) - N.B. Each half of the dual-sachet is identified as ‘one dose'. To avoid errors prescribe as ‘dual-sachet' with directions in terms of ‘dose'

1.1.2 - Antacid with Local Anaesthetic

Antacid with Oxetacaine s u Sugar-free suspension (contains aluminium hydroxide mixture

4.75ml, magnesium hydroxide 100mg and oxetacaine [Oxethazaine]

in 5ml) - used to relieve symptoms in patients who have had radiotherapy and may be of value in some patients with acute oesophagitis. Not for routine use as an antacid.

1.2 - Antispasmodics and Other Drugs Altering Gut Motility Antimuscarinic (anticholinergic) Antispasmodics First Choice Dicycloverine (Dicyclomine) 10mg tablets

10mg in 5ml syrup

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Hyoscine Butylbromide 20mg in 1ml injection

– first choice if injection needed 10mg tablets - poorly absorbed

Alternatives Propantheline Bromide 15mg tablets

Atropine Sulphate 600 microgram tablets; 500 microgram in 5ml mixture u

Other Antispasmodics Mebeverine 135mg tablets; 200mg M/R tablets

50mg in 5ml sugar-free liquid

Peppermint oil 0.2ml m/r, e/c capsules (Colpermin)

Motility stimulants Domperidone (also see section 4.6)

10mg tablets; 5mg in 5ml sugar-free suspension

Metoclopramide (also see section 4.6)

10mg tablets; 5mg in 5ml oral solution 10mg in 2ml injection

1.3 - Ulcer Healing Drugs 1.3.1 - H2 Receptor Antagonists

First Choice Ranitidine 150mg & 300mg tablets; 150mg effervescent tablets

150mg in 10ml sugar-free oral solution (contains 7.5%-8%

alcohol & sorbitol) 50mg in 2ml injection - injection mainly used for prophylaxis of stress ulceration

Alternative Cimetidine 200mg & 400mg tablets

200mg in 5ml syrup

1.3.3 – Chelates and Complexes Sucralfate 1g tablets

1g in 5ml suspension

- mainly for prophylaxis of stress ulceration and acute gastrointestinal bleeding

1.3.4 – Prostaglandin Analogues Proton pump inhibitors are usually preferred for the prevention of gastro-intestinal bleeding (better tolerated). Most hospital use of misoprostol is for the induction of labour or termination of pregnancy (unlicensed indications).

Misoprostol 200 microgram tablets

100 microgram tablets s u

- mainly for use in paediatric nephrology at the RVI

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1.3.5 - Proton Pump Inhibitors Preferred Drugs Omeprazole 10mg, 20mg & 40mg capsules

10mg, 20mg & 40mg orodispersible tablets (MUPS) 40mg IV Infusion 40mg Injection (powder for reconstitution)

- for acute Gastrointestinal bleeding see North of Tyne Acid suppression guidelines - omeprazole orodispersible (MUPs) tablets should only be used in patients who cannot swallow capsules or tablets and where lansoprazole orodispersible tablets are unsuitable. - a 10mg in 5ml oral suspension (unlicensed) can be obtained for use in very small children and where a suspension has to be given down a very fine NG tube (below French Size 8)

Lansoprazole 15mg & 30mg capsules 15mg & 30mg orodispersible tablets

- N.B. The orodispersible tablets should only be used in patients who cannot swallow capsules or tablets and for NG/PEG/PEJ use. Omeprazole capsules are currently cheaper than lansoprazole capsules in primary care

1.3.5 – Helicobacter Pylori Eradication

First Choice Regimen

Lansoprazole 30mg (or omeprazole 20mg), clarithromycin 500mg & amoxicillin 1g all twice daily for 7 days. - metronidazole 400mg bd, clarithromycin 250mg bd & lansoprazole 30mg bd should be used instead of amoxicillin in patients who are allergic to penicillins

1.4 – Acute Diarrhoea 1.4.1- Adsorbents and Bulk-Forming Drugs

Adsorbents such as Kaolin are not recommended for acute diarrhoea. Bulk-forming drugs such as methylcellulose and ispaghula (section 1.6.1) are useful in controlling faecal consistency in colostomy and ileostomy, and in controlling diarrhoea associated with diverticular disease.

1.4.2 – Antimotility Drugs First Choice Loperamide 2mg capsules;

2mg Orodispersible tablets s

-approved for use in primary care following specialist initiation in secondary care for patients with high output stoma only 1mg in 5ml sugar-free syrup - to relieve diarrhoea post-surgery following extensive gastrointestinal surgery. A therapeutic test should be carried out and if there is inappropriate response after 5 days, and it should be stopped.

Alternative Codeine Phosphate 15mg, 30mg & 60mg tablets

(see section 4.7.2 for other formulations)

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1.5 - Chronic Bowel Disorders Oral/Parenteral Preparations Aminosalicylates First Choice

Mesalazine

400mg e/c m/r tablets (Octasa MR® ) - approved as first choice 400mg e/c m/r preparation for all new patients. Patients receiving Asacol and Mesren should be switched to Octasa when appropriate.

400mg e/c m/r tablets (Asacol® brand)- to be used for

existing patients who are unable to change to Octasa MR®

500mg m/r (sustained release) tablets (Pentasa®) 1g m/r granules/ sachet - only to be used in patients with difficulty in swallowing Different brands of oral mesalazine are not automatically interchangeable

Alternatives Balsalazide s 750mg capsules

-for use on consultant gastroenterologist advice only

Sulfasalazine 500mg plain & 500mg e/c tablets 250mg in 5ml suspension

Corticosteroids (see section 6.3 for systemic corticosteroids)

First Choice Prednisolone 5mg tablets – See section 6.3

Alternative

Budesonide s 3mg capsules enclosing e/c pellets (Budenofalk)

3mg capsules enclosing e/c m/r pellets (Entocort) -for use on consultant gastroenterologist advice only

Immunosuppressants and Cytokine Inhibitors For use on consultant gastroenterologists advice only

A Azathioprine 50mg tablets

A Mercaptopurine 50mg tablets - unlicensed indication

A Methotrexate 2.5mg tablets - unlicensed indication

RAdalimumab 40mg in 0.8ml vials, pre-filled pens & disposable devices - approved for Crohn’s disease in line with NICE - approved for treating moderately to severely active ulcerative colitis after the failure of conventional therapy

NICE

RGolimumab 50mg injection (prefilled pen & syringe)

- approved for treating moderately to severely active ulcerative colitis after the failure of conventional therapy

NICE

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RInfliximab 100mg vials for intravenous infusion (Remicade®, Inflectra® & Remsima®) - approved for severe Crohn’s disease in line with NICE

- approved for acute exacerbations of ulcerative colitis in line NICE - approved for treating moderately to severely active ulcerative colitis after the failure of conventional therapy

NICE

R Vediolizumab 300mg vial concentrate for IV infusion

- approved for the treatment of moderately to severely active ulcerative colitis in line with NICE

- approved for the treatment of moderately to severe Crohn’s disease in line with NICE

Rectal Preparations Aminosalicylates

Mesalazine

250mg & 500mg & 1g suppositories 1g in 100ml retention enema, 2g in 59ml enema 1g foam enema

Corticosteroids (see section 6.3 for systemic corticosteroids) First Choice

Prednisolone 20mg retention enema, 5mg suppositories

20mg/metered application rectal foam

Alternative Hydrocortisone Acetate

10% rectal foam – 125mg/metered application Application device may be preferred to that for prednisolone foam (Predfoam

®) enema

1.6 – Laxatives 1.6.1 – Bulk-Forming Laxatives First Choice

Ispaghula Husk 3.5g sachets – orange flavour Fybogel preferred

Alternative

Methylcellulose 500mg tablets

1.6.2 - Stimulant Laxatives First Choice

Senna 7.5mg tablets; 7.5mg in 5ml syrup

Alternatives

Docusate sodium 100mg capsules

12.5mg in 5ml & 50mg in 5ml sugar-free solutions -also acts as a faecal softener

Bisacodyl 5mg e/c tablets; 5mg & 10mg suppositories

Glycerol (Glycerin) 1g, 2g & 4g suppositories

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Sodium picosulfate elixir 5mg/5ml elixir -for use as a second line agent in paediatric patients with

constipation when Movicol, lactulose and senna are ineffective as single agent therapy

Co-danthramer r

25/200 suspension, 25/200 capsules (25mg Dantron &

200mg Poloxamer ‘188’ per 5ml/capsule)

37.5/500 strong capsules (37.5mg Dantron & 500mg

Poloxamer ‘188’)

75/1,000 strong suspension (75mg Dantron & 1g

Poloxamer ‘188’ in 5ml)

Co-danthrusate r 50/60 capsules (50mg Dantron & 60mg Docusate sodium)

N.B. Co-danthramer and Co-danthrusate are generally restricted to use in the treatment of constipation in terminally ill patients. A combination of Senna and Docusate is normally preferred.

1.6.3 – Faecal Softeners Docusate Sodium 100mg capsules

12.5mg in 5ml & 50mg in 5ml sugar-free solutions

Arachis Oil Enema Enemas containing 130ml arachis (peanut) oil

1.6.4 – Osmotic Laxatives Lactulose Solution containing 3.1g to 3.7g in 5ml with other

ketoses

Sodium Citrate Micro-Enema 5ml micro-enemas (sodium citrate 450mg together with a

surfactant, glycerol & sorbitol)

Phosphate Enema Enemas (sodium acid phosphate 12.8g + sodium phosphate

10.24g in 128ml)

Macrogol Oral Powder Laxido® - To be used first line,

as considerably cheaper than

other preparations)

Laxido® and Movicol®, - Oral powder in sachets (containing 13.125g macrogol 3350, sodium bicarbonate 178.5mg,

sodium chloride 350.7mg & potassium chloride 46.6mg).

Movicol® Half

Oral powder in sachets (containing 6.563g macrogol ‘3350’,

sodium bicarbonate 89.3mg, sodium chloride 175.4mg, potassium chloride 23.3mg)

Macrogol Paediatric Plain

Oral powder in sachets (containing 6.563g macrogol ‘3350’,

sodium bicarbonate 89.3mg, sodium chloride 175.4mg, potassium chloride 25.1mg) - for use in impaction and for 2nd line use in treating constipation – see local guidelines. If maintenance therapy needed, keep dosage to a minimum

Movicol Oral Liquid r Oral liquid, compound (containing macrogol ‘3350’ (polyethylene glycol ‘3350’) 13.125 g, sodium bicarbonate 178.5 mg, sodium chloride 350.7 mg, potassium chloride 46.6 mg/25 mL) - approved as a second line macrogol laxative for care home residents only.

1.6.5 – Bowel Cleansing Solutions First Choice

Sodium picosulfate (Picolax®, Citrafleet®)

Powder for oral solution. Sachets (sachets containing sod.

picosulfate 10mg & magnesium oxide 3.5g, anhydrous citric acid

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12g)

Alternatives Moviprep®

Powder (lemon-flavoured) in sachets -Sachet A

(containing macrogol ‘3350’ 100g, anhydrous sodium sulphate 7.5g, sodium chloride 2.691g, potassium chloride 1.015g) and

Sachet B (containing ascorbic acid 4.7g, sodium ascorbate 5.9g). For use as a laxative bowel preparation prior to clinical procedures such as colonoscopy. To be used instead of Klean Prep

Fleet Phospho-Soda® Sugar-free oral solution (sodium dihydrogen phosphate

24.4g, disodium phosphate dodecahydrate 10.8g in 45ml)

Klean Prep® (Bowel cleansing solution)

Sachets (containing 59g macrogol [polyethylene glycol] 3350 &

electrolytes.

-dissolved in water to give 1 litre of an iso-osmotic solution

1.6.6 – Peripheral opioid-receptor antagonist Naloxegol

12.5mg & 25mg film coated tablets -recommended as a possible treatment for people with opioid-induced constipations who have had an inadequate response to laxatives NICE

1.6.7 – Other drugs used in constipation Prucalopride

1mg & 2mg tablets f/c (as succinate) - approved the symptomatic treatment of chronic constipation in women whom laxatives fail to provide adequate relief in line with NICE

B Linaclotide 290 microgram capsules - approved for specialist initiation for the symptomatic treatment of moderate-to-severe irritable bowel syndrome with constipation (IBS-C).

Lubiprostone 24 microgram capsules -approved for use as an option for treating chronic idiopathic constipation in adults who have had treatment failures with 2 different classes of laxatives. Initial treatment should only be for 14 days in line with NICE

1.7 – Local Preparations for Anal and Rectal Disorders 1.7.1 – Soothing Haemorrhoidal Preparations Anusol®

Cream both contain a mixture of bismuth Suppositories salts, Peru balsam & zinc oxide

1.7.2 – Compound Haemorrhoidal Preparations with Corticosteroids Anusol HC®

Suppositories contain hydrocortisone acetate, benzyl benzoate, bismuth oxide, bismuth Ointment subgallate, Peru balsam & zinc oxide Max. recommended duration of treatment 7 days

Xyloproct® Ointment containing lidocaine 5%, hydrocortisone acetate

0.275%, aluminium acetate 3.5% & zinc oxide 18% Recommended for short-term use only

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1.7.3 – Rectal Sclerosants Oily Phenol Injection Injection - 5% Phenol in a suitable oil (e.g. almond oil)

1.7.4 –Chronic Anal Fissure

First line

Glyceryl Trinitrate 0.4% ointment (Rectogesic® - licensed)

0.2% ointment u Second line

Diltiazem 2% cream u May cause fewer side effects than glyceryl trinitrate

R Botulinum Toxin r Botulinum A toxin haemagglutinin complex 100 unit vials – see section 4.9.3 for full list of botulinum products - approved for use by specialists as an alternative to surgery in patients failing other treatments. Also approved for use in paediatrics but there must be documented informed consent from patients/ carers

1.9 – Drugs Affecting Intestinal Secretions 1.9.1 – Drugs Affecting Biliary Composition and Flow Ursodeoxycholic Acid 150mg tablets; 250mg capsules; 500mg tablets

250mg in 5ml sugar-free suspension

1.9.2 – Bile Acid Sequestrants Colestyramine 4g sachets

4g sugar-free sachets

-approved for use as treatment for leflunomide toxicity R

Colesevelam 625mg tablets - approved for second line use (after Colestyramine) for the treatment of bile malabsorption that results in diarrhoea

1.9.4 – Pancreatin Creon® 5,000, 10,000 & 25,000 s & 40,000 s capsules

(10,000, 25,000 and 40,000 units lipase activity)- for use on advice of GI/respiratory specialist only

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2. Cardiovascular System

2.1 – Positive Inotropic Drugs 2.1.1 Cardiac Glycosides Digoxin 62.5, 125 & 250 microgram tablets

50 microgram per ml elixir

100 microgram in 1ml u & 500 microgram in 2ml inj. 2.1.1a Digoxin-specific Antibody R Digoxin-specific antibody Vials containing 38mg digoxin-specific antibody

fragments (Fab) for administration by IV infusion - For the treatment of life-threatening digoxin toxicity only, requests must be cleared by appropriate clinician.

2.1.2 – Phosphodiesterase Inhibitors R Milrinone 10mg in 10ml injection

R Enoximone 5mg in 5ml injection

-for use in the treatment of severe heart failure in adults and children to wean from IV milrinone as a bridge to transplant and

to reduce the need for ventricular assist devices (VADs) u

2.2 – Diuretics

2.2.1 – Thiazide and Related Diuretics

First Choice Bendroflumethiazide (Bendrofluazide)

2.5mg tablets - 5mg tablets also available, but not recommended for general use

Alternatives

Indapamide s 2.5mg tablets - Modified release indapamide tablets are not included in this formulary- Treatment should only be on advice from stroke physicians.

Metolazone su 5mg tablets – Treatment should only be on advice from cardiology.

Chlorothiazide su 250mg in 5ml suspension -Treatment should only be on advice from paediatric cardiology.

2.2.2 – Loop Diuretics First Choice Furosemide (Frusemide)

20mg, 40mg & 500mg tablets 40mg in 5ml sugar-free solution

20mg in 2ml, 50mg in 5ml & 250mg in 25ml injections

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Alternative Bumetanide 1mg & 5mg tablets

1mg in 5ml sugar-free solution 2mg in 4ml injection

2.2.3 – Potassium-Sparing Diuretics and Aldosterone Antagonists First Choice

Amiloride 5mg tablets

5mg in 5ml sugar-free solution Alternatives (aldosterone antagonists)

Spironolactone 25mg & 100mg tablets – use is also extended for treatment

in post-acute myocardial infarction patients and patients with mild heart failure. Treatment should only be initiated on the advice of a cardiologist. (Spironolactone is considerably cheaper than eplerenone)

10mg, 25mg & 50mg in 5ml sugar-free suspensions u

Eplerenone s 25mg & 50mg tablets -for use in post-acute myocardial infarction patients with left ventricular dysfunction and heart failure. Only to be used in patients who are unable to tolerate the estrogenic side effects of spironolactone. Treatment should only be on advice from a cardiologist.

2.2.4 – Potassium-Sparing Diuretics with Other Diuretics Co-amilofruse 5/40 tablets (amiloride 5mg + furosemide 40mg)

2.5/20 tablets (amiloride 2.5mg + furosemide 20mg)

Spironolactone &

Chlorothiazide u

Capsules containing Spironolactone and Chlorothiazide in the proportions of 1:10 – used in paediatric cardiology

spironolactone 1mg & chlorothiazide 10mg

spironolactone 2mg & chlorothiazide 20mg spironolactone 3mg & chlorothiazide 30mg spironolactone 5mg & chlorothiazide 50mg spironolactone 10mg & chlorothiazide 100mg

2.2.5 – Osmotic Diuretics Mannitol 10% & 20% intravenous infusions

2.3 – Anti-arrhythmic Drugs 2.3.2 – Drugs for Arrhythmias Supraventricular Arrhythmias

R Adenosine 6mg in 2ml injection, 25mg in 5ml injection u

30mg in 10ml injection for infusion (NHCT only) SPC

130mg in 130ml IV infusion u

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R Regadenoson A myocardial perfusion imaging agent that contains 80micrograms in 1ml (400 micrograms) regadenoson - for radionuclide myocardial perfusion imaging in patients who are unable to undergo adequate exercise stress e.g. for patients with COPD and asthma where dobutamine is indicated and for obese patients who require several vials of adenosine.

Digoxin see section 2.1.1

Supraventricular and Ventricular Arrhythmias Amiodarone 100mg & 200mg tablets; 50mg in 5ml suspension u

150mg in 3ml injection 300mg in 10ml injection (prefilled syringes for CPR)

Flecainide 50mg & 100mg tablets; 5mg in 1ml liquid u

150mg in 15ml injection

R Ajmaline u 50mg in 10ml injection – for the use in the diagnostic testing of Brugada syndrome.

Procainamide 1g in 10ml injection under review

Propafenone 150mg tablets

A Dronedarone 400mg tablets

- approved for patients who are unsuitable for or not tolerant of

amiodarone. Treatment is to be initiated by cardiologists. NICE Linked to Shared Care Guideline

Ventricular Arrhythmias Lidocaine (Lignocaine) 100mg injection, pre-filled syringes

1mg/ml (0.1%) & 2mg/ml (0.2%) IV infusions 500ml)

2.4 – Beta-Adrenoreceptor Blocking Drugs

First Choice Atenolol (cardioselective)

25mg, 50mg & 100mg tablets 25mg in 5ml sugar-free syrup 5mg in 10ml injection

Propranolol (non-cardioselective)

10mg, 40mg, 80mg & 160mg tablets 80mg & 160mg m/r capsules (sustained release) 10mg & 50mg in 5ml sugar-free oral solutions 1mg in 1ml injection

Alternatives

Metoprolol 50mg & 100mg tablets

5mg in 5ml injection

Labetalol 50mg, 100mg & 200mg tablets 100mg in 20ml injection

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Bisoprolol 5mg & 10mg tablets 1.25mg, 2.5mg, 3.75mg & 7.5mg tablets - for use in the treatment of heart failure only. The 5mg and 10mg tablets should be used where possible - cheaper than other strengths

Carvedilol 3.125mg, 6.25mg, 12.5mg & 25mg tablets

- for use in the treatment of heart failure only

Sotalol s 40mg & 80mg tablets - treatment should only be initiated on the advice of cardiology

R Esmolol 100mg in 10ml injection

2.5g in 250ml ready-made intravenous infusion

Nadolol sr 80mg tablets - limited to use by cardiologists in patients with long QT syndrome/idiopathic ventricular fibrillation. - Liquid formulations (unlicensed) can be obtained for use in children if necessary. Treatment should only be on the advice of a cardiologist.

Nebivolol sr 5mg tablets - for specialist use in the treatment of patients who cannot tolerate other beta-blockers. Treatment should only be on the advice of a cardiologist.

Celiprolol sr 200mg tablets - for specialist use in the treatment of patients who cannot tolerate other beta-blockers. Treatment should only be on the advice of a cardiologist.

2.5 – Drugs Affecting the Renin-Angiotensin System and Some Other Antihypertensive Drugs

2.5.1 – Vasodilator Antihypertensive Drugs Hydralazine 25 & 50mg tablets

20mg injection

Minoxidil s 5mg & 10mg tablets - treatment should only be on the advice of a cardiologist/ nephrologist

R Sodium Nitroprusside 50mg injection

R Diazoxide 300mg in 20ml injection

2.5.1a – Treatments for Pulmonary Hypertension R Bosentan

62.5mg & 125mg tablets In line with NHS England Clinical Commissioning Policy

R Iloprost 50 microgram in 0.5ml & 100 microgram in 1ml inj u

10 microgram in 1ml and 20 microgram in 2ml nebules

R Treprostinil u 50mg in 20ml and 100mg in 20ml injections

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R Sildenafil 20mg tablets (Revatio®)

25mg, 50mg and 100mg tablets u

R Tadalafil 20mg tablets - approved for the treatment of pulmonary arterial hypertension (PAH) in adults for whom treatment with sildenafil is not tolerated or effective.

R Macitentan 10mg film coated tablets -approved for the treatment of pulmonary hypertension in adults. In line with NHS England Clinical Commissioning Policy

R Ambrisentan 10mg tablets

- much less likely to cause liver problems than bosentan - for use in pulmonary hypertension where bosentan or sitaxentan has

failed, is not tolerated or not suitable. In line with NHS England Clinical Commissioning Policy

2.5.2 – Centrally Acting Antihypertensive Drugs Moxonidine 200, 300 & 400 microgram tablets

Methyldopa 125mg, 250mg & 500mg tablets

Clonidine 100 microgram tablets s

– treatment should be on the advice of a cardiologist/ nephrologist R 150 microgram in 1ml injection – For use in paediatric cardiac ITU and in adult ITU patients with delirium and agitation, often around extubation.

2.5.4 - Alpha-Adrenoreceptor Blocking Drugs First Choice

Doxazosin 1mg, 2mg & 4mg tablets

- N.B. 4mg m/r & 8mg m/r tablets are not included in this formulary - plain tablets are less expensive

Others (specialist use)

Phenoxybenzamine 10mg capsules; 100mg in 2ml injection

Phentolamine 10mg in 1ml injection

2.5.5 – Drugs Affecting the Renin-Angiotensin System 2.5.5.1 – Angiotensin Converting Enzyme Inhibitors First Choice

Lisinopril 2.5mg, 5mg, 10mg & 20mg tablets

Ramipril 1.25mg, 2.5mg, 5mg & 10mg capsules

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Alternatives Perindopril 2mg, 4mg & 8mg tablets (3rd-line)

- perindopril is third line for all indications including prevention of stroke.

Captopril 2mg capsules u and

5mg in 5ml (1mg/ml) oral suspension s – treatment should only be on the advice of a hospital paediatrician.

Enalapril 2.5mg, 5mg, 10mg & 20mg tablets

– for use in breastfeeding mothers only. Mothers are to be converted to ramipril when no longer breastfeeding.

2.5.5.2 – Angiotensin-II Receptor Antagonists

N.B. These drugs are only approved for use where ACE inhibitors are not tolerated and specific indications where a combination with an ACE inhibitor is required e.g.

in proteinuric renal disease.

First Choice Losartan 12.5mg, 25mg, 50mg & 100mg tablets – to be used

1st line treatment in all new patients.

2.5mg/ml suspension For use as an alternative to crushing tablets for paediatric and adult patients

Alternatives Candesartan 2mg, 4mg, 8mg, 16mg & 32mg tablets

Irbesartan 75mg, 150mg & 300mg tablets – only to be used in the treatment of existing patients

Valsartan 40mg, 80mg & 160mg tablets and capsules

- only to be used in the treatment of existing patients Sacubitril & Valsartan S 24mg/26mg, 49mg/51mg & 97mg/103mg

-approved for the treatment of symptomatic chronic heart

failure with reduced ejection fraction in line with NICE

2.5.5.3 – Renin Inhibitor Aliskiren 150mg & 300mg tablets

- only approved for use in the treatment of hypertension in patients who have failed to respond adequately to, or not tolerated, other treatments (including thiazide diuretics, calcium channel blockers, ACE inhibitors, angiotensin receptor blockers and beta-blockers). Aliskiren has NOT been approved for use in combination with other drugs to maximise suppression of the renin angiotensin system in patients with diabetes and/or renal disease.

2.6 – Nitrates, Calcium-Channel Blockers and Potassium-channel Activators

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2.6.1 – Nitrates Glyceryl Trinitrate

400 microgram/metered dose aerosol spray 5mg & 10mg/day patches for use in cardiothoracic critical care unit 5mg in 5ml , 50mg in 10ml & 50mg in 50ml injections

Isosorbide Dinitrate 10mg in 10ml injection Isosorbide Mononitrate 10mg, 20mg & 40mg tablets, 60mg m/r tablets r

- N.B. The m/r isosorbide mononitrate tablets should only be used in patients when the plain tablets are unsuitable

2.6.2 – Calcium-Channel Blockers Preferred Drugs

Hypertension Amlodipine 5mg & 10mg tablets.

- if a 10mg dose is not tolerated e.g. due to leg/ankle oedema, consider reducing dose before changing to an alternative such as lercanidipine

Angina Diltiazem

60mg m/r tablets Once daily tablets/capsules - Zemtard is the Formulary brand of choice for starting new patients on long acting diltiazem.

Alternatives

Lercanidipine 10mg & 20mg tablets - for use as a 2nd line calcium channel blocker where amlodipine is not tolerated

Nifedipine Once Daily formulations (Preferred)

20mg controlled release tablets (Adalat LA), 30mg & 60mg m/r capsules (Coracten XL) Other Formulations

5mg & 10mg capsules 10mg & 20mg retard tablets

20mg per ml (1mg/drop) drops u

Nimodipine s 30mg tablets – Treatment should be on the advice of

the stroke team/ cardiologist 10mg in 50ml (200 micrograms/ml) for IV infusion

Verapamil 40mg, 80mg, & 120mg tablets, 240mg m/r tablets 40mg in 5ml sugar-free oral solution 5mg in 2ml injection

R Nicardipine 1mg/1ml injection

-approved as second line agent for the treatment of aortic dissection -approved as second line agent for the treatment of pre-eclampsia

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2.6.3 – Other Antianginal Drugs Nicorandil 10mg & 20mg tablets

Ivabradine s 5mg and 7.5mg tablets - for initiation on advice from consultant cardiologists in patients with contra-indications to or intolerance of beta-blockers

- for use in heart failure in line with NICE

Ranolazine s

375mg, 500mg and 750mg prolonged release tablets. -for use in the treatment of angina in those patients for whom other treatments have been unsuccessful. Initial prescribing should be by a consultant cardiologist only

2.6.4 – Peripheral and Cerebral Vasodilators

General Notes

In Raynaud’s phenomenon some patients may require treatment with a vasodilator. Nifedipine may be of use, especially in primary Raynaud’s syndrome.

Naftidrofuryl oxalate 100mg capsules - approved for the treatment of intermittent claudication in

people with peripheral arterial disease in line with NICE

2.7 – Sympathomimetics 2.7.1 – Inotropic Sympathomimetics

R Dobutamine 250mg in 20ml injection, 250mg in 50ml injection

R Dopamine 200mg in 5ml injection

R Isoprenaline sulphate u 100 microgram in 2ml injection, 2mg in 2ml injection

R Dopexamine r 50mg in 5ml injection

R Levosimendan u 12.5mg in 5ml injection for infusion

2.7.2 – Vasoconstrictor Sympathomimetics Noradrenaline (Norepinephrine)

2mg in 2ml & 4mg in 4ml (1 in 1,000) injections

Ephedrine 30mg in 1ml injection R

30mg in 10ml syringeu & 15mg tablets

R Metaraminol u 10mg in 1ml injection

R Phenylephrine 10mg in 1ml injection & 3000mcg in 30ml syringe

Midodrine s 2.5mg & 5mg tablets - for specialisit initiation in treating symptomatic hypotension that has not responded to conventional therapies

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2.7.3 – Cardiopulmonary Resuscitation Adrenaline (Epinephrine)

1 in 1,000 injections in 1ml syringes and 1ml & 10ml ampoules 1 in 10,000 injections in 1ml & 10ml ampoules & syringes. See section 3.4.3 for EpiPens

2.8 – Anticoagulants and Protamine R Defibrotide 200mg in 2.5ml concentrate for solution for infusion

-approved for use in severe veno-occlusive disease following stem cell transplant (subject to NHS England funding)

R Idarucizumab 2.5g/50ml solution for injection/infusion -approved for use as a rapid reversal agent for dabigatran

2.8.1 – Parenteral Anticoagulants First Choice Tinzaparin 2,500 units in 0.25ml, 3,500 units in 0.35ml & 4,500

units in 0.45ml pre-filled syringes - for prophylaxis

10,000 units in 0.5ml, 14,000 units in 0.7ml & 18,000 units in 0.9ml graduated pre-filled syringes - for the treatment of pulmonary embolism and deep vein thrombosis

20,000 units and 40,000 units in 2ml vials Alternatives

Enoxaparin r 40mg in 0.4ml, 60mg in 0.6ml, 80mg in 0.8ml, 100mg in 1ml & 120mg in 0.8ml pre-filled syringes - only for use in the treatment of acute coronary syndromes

Heparin Sodium 50 units in 5ml & 200 units in 2ml

- for flushing cannulae (other dilute Heparin solutions are kept in some units for flushing central venous lines)

1,000 units in 1ml, 5,000 units in 1ml, 5,000 units in 5ml, & 25,000 units in 1ml ampoules

5,000 units in 5ml, 10,000 units in 10ml & 20,000 units in 20ml ampoules for use in infusion pumps (Pump-Hep) Multidose vials containing 5,000 units in 5ml (1,000 units/ml) & 25,000 units in 5ml (5,000 units/ml) & 125,000 units in 5ml (25,000 units/ml) 2,500 & 5,000 units in 1,000ml sodium chloride 0.9% infusion

Fondaparinux s 1.5mg in 0.3ml injection, 2.5mg in 0.5ml injection, 5mg in 0.4ml injection, 7.5mg in 0.6ml injection & 10mg in 0.8ml injection in pre-filled syringes - approved for high risk orthopaedic surgery patients and as an alternative to enoxaparin in line with NICE

R Danaparoid 750 units in 0.6ml injection (1,250 units/ml) -for use on advice from haematologists in patients who develop thrombocytopaenia with heparins - cross reactivity with heparin antibodies is probably <10%

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R Argatroban 250mg injection

- for use on advice of haematologists in patients with heparin induced thromboyctopenia

R Bivalirudin 250mg injection

- approved for preventing thrombosis in patients undergoing percutaneous coronary artery interventions. For use instead of abciximab in some low risk patients. - approved in combination with aspirin and clopidogrel for the treatment of adults with ST segment elevation MI undergoing percutaneous coronary intervention. NICE

R TauroLock® (Taurolidine and Citrate catheter lock solution)

5ml ampoules containing 1.35% taurolidine and 4% sodium

citrate. -for use in the prevention of central intravenous line infections in:

- Haemodialysis patients

- Adult parenteral nutrition patients

- Patients with recurrent line infections

- Immune deficiency unit patients Use in other areas is being evaluated

R TauroHep® (Taurolidine and Citrate catheter lock solution with heparin)

5ml ampoules containing 1.35% taurolidine and 4% sodium

citrate with heparin 500 units/ml -for use in the prevention of central intravenous line infections in:

- Haemodialysis patients

- Adult parenteral nutrition patients

- Patients with recurrent line infections

- Immune deficiency unit patients

Use in other areas is being evaluated

R Epoprostenol 500 microgram injection & 1.5mg injection

R Iloprost 50 microgram in 0.5ml & 100 microgram in 1ml injections - mainly for use in treating pulmonary hypertension – see section 2.5.1a

2.8.2 – Oral Anticoagulants Warfarin 500 microgram, 1mg, 3mg & 5mg tablets

1mg/1ml oral suspension s - for use in paediatric patients on mechanical support using ventricular assistance devices, and for patients with mechanical heart valves or irregular heart rythms who have not been weaned

Phenindione 10mg, 25mg & 50mg tablets

Apixaban 2.5mg & 5mg tablets

-approved for the prevention of stroke and systemic embolism in adult patients with non-valvular AF in line with NICE -approved for the prevention of recurrent deep vein thrombosis and pulmonary embolism in adults in line with NICE

2.5mg tablets -approved for the prevention of venous thromboembolism in patients undergoing elective total knee or hip replacement surgery in line with NICE

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Dabigatran

75mg & 110mg & 150mg capsules - approved for the prevention of venous thromboembolism in patients undergoing elective total knee or hip replacement surgery in line with NICE - approved for the prevention of stroke and systemic embolism in adult patients with non-valvular AF in line with NICE - approved for use prior to cardioversion. -approved for use as a treatment for deep vein thrombosis or pulmonary embolism in line with NICE

Edoxaban

60mg film-coated tablets -approved for the treatment and prevention of recurrent deep vein thrombosis or pulmonary embolism in line with NICE

-approved as a treatment option for preventing stroke and systemic embolism in people with non-valvular atrial fibrillation in line with NICE

Rivaroxaban

10mg tablets - approved for the prevention of venous thromboembolism in patients undergoing elective total knee or hip replacement surgery in line with NICE 10mg, 15mg, 20mg tablets - approved for the prevention of stroke and systemic embolism in adult patients with non-valvular AF in line with NICE - approved for the treatment of DVT and the prevention of recurrent DVT and pulmonary embolism in line with NICE - approved for treating pulmonary embolism and preventing recurrent venous thromboembolism NICE -approved for use in secondary myocardial infarction prevention following acute coronary syndrome with aspirin alone or aspirin with clopidogrel NICE

2.8.3 – Protamine Sulphate Protamine Sulphate 50mg in 5ml injection

2.9 – Antiplatelet Drugs Aspirin 75mg dispersible tablets

(75mg e/c tablets – no longer recommended for use);

500mg in 5ml injection u

- for specialist use in the endovascular treatment of cerebral aneurysms

Alternatives Clopidogrel 75mg tablets

- approved for use in cardiac patients being fitted with stents / acute coronary syndromes and where aspirin is contra-indicated/not tolerated, despite its use in combination with acid suppressants e.g. omeprazole. - approved ischaemic stroke; in peripheral arterial/ multivascular disease; or after MI only if aspirin not suitable in line with NICE - The North of Tyne APC recommends the use of generic 75mg clopidogrel tablets in all the approved indications for clopidogrel. Care should be taken to ensure that the brand supplied is suitable if it is to be packed into monitored dosage systems

R 75mg/5ml suspension u s

- approved for use in paediatric patients with Berlin Heart devices

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Prasugrel s 5mg & 10mg tablets - approved in line with NICE in combination with aspirin for preventing atherothrombotic events in adults with: - acute coronary syndrome; - non-ST segment elevation myocardial infarction (NSTEMI)

-ST segment elevation myocardial infarction having primary or delayed percutaneous coronary intervention (STEMI)

Dipyridamole 200mg m/r capsules

- approved in line with NICE: - in combination with aspirin, after a TIA; or after an ischaemic stroke, only if clopidogrel is unsuitable - as monotherapy, after an ischaemic stroke if aspirin and clopidogrel are unsuitable; or after a TIA if aspirin is unsuitable

50mg in 5ml sugar-free suspension u

100mg tablets

R Abciximab 10mg in 5ml solution for injection

R Tirofiban 12.5mg in 250ml infusions, 12.5mg in 50ml (250 microgram/ml) vials for preparing infusions

Ticagrelor s 90mg tablets - approved for acute coronary syndromes (ACS) in line with NICE

2.10 – Myocardial Infarction and Fibrinolysis N.B. Primary Percutaneous Coronary Intervention (PCI) is now preferred to thrombolysis in patients with myocardial infarction with ST segment elevation (STEMI)

First Choice Streptokinase 250,000, 750,000 & 1,500,000 unit injections

Alternatives R Alteplase 10mg, 20mg & 50mg injections.

- approved for acute ischaemic stroke in line with NICE

2mg in 2ml injection u - approved for unblocking intravenous lines, mainly in paediatric dialysis patients

Reteplase 10 unit injection

– preferred for acute treatment of myocardial infarction where streptokinase is unsuitable; used in NUTH.

Tenecteplase 40mg (8,000 unit) and 50mg (10,000 unit) vials both

with prefilled syringe of water for injection - Used in NHCT and by ambulance service

R Urokinase 25,000 unit injection

2.11 – Antifibrinolytic Drugs and Haemostatics Tranexamic Acid 500mg tablets

500mg in 5ml syrup u 500mg in 5ml injection

R Aprotinin u 500,000 units in 50ml (10,000 units/ ml) injection - for limited use in cardiothoracic surgery

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R Aminocaproic acid u 4g in 10ml injection - approved for the use in paediatric patients undergoing extracorporeal membrane oxygenation (ECMO)

Blood Products R Beriplex - P/N® (Dried Prothrombin

Complex) r

250 unit & 500 unit vials - approved for reversing the effects of oral anticoagulants in patients with life or limb threatening bleeding in accordance with a regional protocol

R Octanate 1000 unit vial

- approved for patients with severe Haemophilia A and an inhibitor and in whom there is agreement to undertake immune tolerance induction with a plasma derived product.

R Octaplas & Octaplas LG Solution for infusion containing 45 - 70 mg/mL human plasma proteins

A range of blood factors including factors VII & VIII are stocked at the RVI for use in the treatment of haemophilia etc.

2.12 – Lipid-Regulating Drugs 2.12 – HMG-CoA Reductase Inhibitors See FATS 7 Guidance for recommendations on use First Choice

Atorvastatin 10mg, 20mg, 40mg & 80mg tablets

10mg & 20mg chewable tablets - to be used instead of simvastatin suspension, where solid osage forms cannot be used. People should be assessed for the benefits and risks of treatment, including considering any co-morbidities and preferences of the patient, when deciding about treatment.

Alternatives Simvastatin 10mg, 20mg, 40mg & 80mg tablets

Pravastatin 10mg, 20mg & 40mg tablets

Rosuvastatin r 5mg, 10mg, 20mg & 40mg tablets – strictly limited use on the advice of specialists working in lipid clinics for the treatment of patients with familial hypercholesterolaemia who do not respond adequately or do not

tolerate the maximum doses of other statins.

2.12 – Ezetimibe Ezetimibe 10mg tablets

- approved for use in line with NICE For further information refer to FATS7.

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2.12 – Bile Acid Sequestrants

For initiation in lipid clinic only in patients with familial hypercholesterolaemia and/or those with substantial cardiovascular risk and who are unable to tolerate

existing treatments

Colestyramine (Cholestyramine)

4g sachets & 4g sugar-free sachets

-approved for use as treatment for leflunomide toxicity R Colesevelam 625mg tablets

- approved for use in patients with familial hypercholesterolaemia, with substantial cardiovascular risk and who are unable to tolerate existing treatments, and when colestyramine is not available.

2.12 – Fibric Acid Analogues

For initiation in lipid clinic only in patients with combined hyperlipidaemias and severe hypertriglycerideamia

First Choice

Fenofibrate 67mg, 200mg & 267mg capsules Alternative

Bezafibrate 200mg tablets, 400mg m/r tablets

2.12 – Fish Oils Omega-3-acid ethyl esters 1g capsules

- for the treatment of hypertriglyceridaemia following specialist advice

2.12 – Other Drugs R Alirocumab 75mg/1ml & 150mg/1ml solution for injection in pre-

filled pen -approved for the treatment of primary hypercholesterolaemia

and mixed dyslipidaemia in line with NICE

R Evolocumab 140mg/1ml solution for injection in pre-filled syringe

-approved for the treatment of primary hypercholesterolaemia

and mixed dyslipidaemia in line with NICE -approved for the treatment of homozygous familial hypercholesterolaemia in line with NHS England Commissioning Policy

2.13 – Local Sclerosants Sodium Tetradecyl Sulphate 0.2%, 5ml; 1%, 2ml & 3%, 2ml & 5ml injections

Ethanolamine Oleate 5% injection – 5ml

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2.14 Drugs affecting the ductus arteriosus

Closure of the ductus arteriosus

R Indometacin (Indomethacin)

1mg injection

R Ibuprofen IV (Pedea®) 10mg injection - approved only for use when there is a supply problem with

indometacin u

.

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3. Respiratory System

Choice of inhaler device should be dependent on patient ability to use. Devices should be chosen based on availability for the type of drug to be prescribed, the patient’s ability to use it.

*Important*

Note: All new patients should be started on the updated formulary choices as per local/national guidelines. When inhalers are removed from the formulary, existing, stable, patients should continue to receive the non-formulary device. Treatment should not be changed unless a full face to face review has been conducted.

3.1 – Bronchodilators

3.1.1 – Adrenoceptor Agonists

3.1.1.1 – Selective Beta2 Agonists

Short acting beta agonists First Choice

Salbutamol 100 mcg/puff CFC-free metered dose inhaler (MDI)

& breath actuated CFC-free MDI (Airomir® Autohaler &

Salamol® Easi-Breathe)

Accuhaler® breath actuated dry powder inhaler (DPI) 200 mcg/puff Easyhaler® breath actuated DPI 100 mcg/puff - for use in children only, as a second line treatment after the Accuhaler®. 2.5mg in 2.5ml & 5mg in 2.5ml nebules 2mg in 5ml sugar-free oral solution 500 mcg in 1ml & 5mg in 5ml injections - parenteral use is rarely indicated

Alternative Terbutaline Turbohaler® 500 mcg/puff

500 mcg in 1ml injection Long acting beta agonists (LABA) Salmeterol MDI 25 mcg/puff

Accuhaler® breath actuated DPI 50 mcg/puff

Formoterol Turbohaler® breath actuated DPI 6 mcg & 12 mcg/puff

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3.1.1.2 – Other Adrenoceptor Stimulants

Ephedrines 15mg tablets; 30mg injection

3.1.2 – Antimuscarinic Bronchodilators Short acting muscarinic antagonists Ipratropium

20 mcg/puff CFC free MDI 250 mcg in 1ml & 500 mcg in 2ml nebuliser sol.

Long acting muscarinic antagonists (LAMA) Umeclidinium Incruse Ellipta® umeclidinium 55 mcg per puff

Glycopyrronium Seebri Breezhaler® glycopyrronium 44 mcg per puff

Aclidinium Bromide Genuair® breath actuated DPI

322 mcg/per puff

Tiotropium

Handihaler® breath actuated DPI 18 mcg capsules - also approved for the treatment of asthma (Step 4 of BTS/SIGN guidelines). Treatment should be stopped if not

effective. s u

- for existing COPD patients only and those unable to use the other LAMA devices. - consideration should be given to switching at next review, providing adequate training / counselling is provided in device use.

3.1.3 – Theophylline Seldom indicated. Modified release formulations must be prescribed by brand name. Asthma: consider for patients not controlled on LABA plus inhaled corticosteroid (ICS) discontinue if no benefit see national guidelines. First Choice

Theophylline

200mg m/r, 300mg m/r & 400mg m/r tablets (Uniphyllin®) 60mg, 125mg & 250mg m/r capsules (Slo-Phyllin®) Nuelin SA® tablets can be supplied to continue treatment if needed

Alternatives Aminophylline

100mg & 225mg m/r tablets (Phyllocontin®) 250mg in 10ml injection - COPD: intravenous aminophylline of limited benefit - Injection used in hospital for acute asthma not responding to steroids and continuous inhaled bronchodilators. NB: plasma levels need to be checked before administration if patient has previously taken theophylline/ aminophylline.

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3.1.4 – Compound Bronchodilator Preparations

Combivent® s Nebuliser solution in 2.5ml unit dose vials – isotonic

solution containing ipratropium 500 mcg / salbutamol 2.5mg - only for use when combination product is clearly indicated

First choice LABA/LAMA combination for COPD Ulitbro Breezhaler® Breezhaler® breath actuated DPI

indacaterol 85 mcg/glycopyrronium 43 mcg per puff

Alternative LABA /LAMA combination for COPD

Anoro Ellipta® Ellipta® breath actuated DPI vilanterol 22 mcg/umeclidinium 55 mcg per puff

Duaklir Genuair® Genuair® breath actuated DPI formoterol 12 mcg /aclidinium 340 mcg per puff

3.2 – Corticosteroids Note For COPD patients on the LABA/LAMA combinations who require escalating to

triple therapy with inhaled corticosteroid (ICS) it is appropriate to leave patients on their existing LABA/LAMA and add in a single agent ICS (off label use).

Joint first choices

Budesonide Turbohaler® breath actuated DPI

100, 200 & 400 mcg/dose (100 & 200 mcg/puff CFC-free inhalers) 500 mcg in 2ml & 1mg in 2ml nebuliser susp. R Oral viscous budesonide - 0.5mg or 1mg nebule is added to 13ml of syrup and this is then mixed and swallowed - for the treatment of eosinophilic oesophagitis

Beclometasone (Beclomethasone)

Clenil Modulite®

CFC-Free MDI 50, 100 & 250 mcg/puff - first choice

QVAR® CFC-free MDI & breath actuated MDI 50 mcg & 100 mcg/puff N.B. CFC-Free beclometasone must be prescribed by Brand Name. 50 mcg QVAR is equivalent to 100 mcg for a conventional inhaler & 100 mcg is equivalent to 250 mcg

conventional beclometasone.

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Combination Products

First Choice Budesonide/formoterol Duoresp Spiromax® breath actuated DPI

- first choice budesonide/formoterol preparation

formoterol 4.5mcg/budesonide 160mcg per puff (equivalent to 6 micrograms of formoterol fumarate dihydrate and 200 micrograms of budesonide)

formoterol 9mcg/budesonide 320mcg per puff (equivalent to 12 micrograms of formoterol fumarate dihydrate and 400 micrograms of budesonide)

Symbicort Turbohaler® breath actuated DPI - second choice budesonide/formoterol preparation

formoterol 6mcg/budesonide 100mcg per puff

formoterol 6mcg/budesonide 200mcg per puff formoterol 12mcg/budesonide 400mcg per puff

Second Choice Relvar® Ellipta® breath actuated DPI

vilanterol 22 mcg/fluticasone furoate 92 mcg per puff - licensed for COPD and asthma - N.B. 92 mcg OD of fluticasone furoate is equivalent to the pre-dispensed dose of 250 mcg BD of fluticasone propionate and is therefore considered to be a high dose inhaled corticosteroid

vilanterol 22 mcg/fluticasone furoate 184 mcg per puff - licensed for asthma only -high dose, see above

Flutiform®

CFC-free MDI formoterol 5mcg/fluticasone propionate 50mcg formoterol 5mcg/fluticasone propionate 125mcg

formoterol 10mcg/fluticasone propionate 250mcg - for patients preferring MDIs - approved the use for maintenance treatment of asthma

Third Choice Fostair® CFC-free MDI (Fostiar®)

DPI (Fostair NEXThaler®) formoterol 6mcg / beclometasone dipropionate 100mcg formoterol 6mcg / beclometasone dipropionate 200mcg

- N.B. 100 mcg of beclometasone in Fostair® is equivalent to a 250 mcg dose in a conventional beclometasone metered dose inhaler (e.g. Becloforte, Beclazone and Clenil Modulite).

3.3 – Cromoglicate and Leukotriene Receptor Antagonists 3.3.2 – Leukotriene Receptor Antagonists Montelukast 4mg & 5mg chewable tablets

10mg tablets 4mg paediatric granules (sachets) Review treatment after 6 weeks of initiation and

discontinue if no evidence of improvement. Should typically only be initiated by hospital specialist.

Montelukast is 2nd line after an inhaled corticosteroid for

asthmatic children < 5 years old.

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3.4 – Antihistamines, Hyposensitisation and Allergic Emergencies 3.4.1 – Antihistamines Preferred Drugs Non-sedating

Cetirizine 10mg tablets 5mg in 5ml sugar-free oral solution

Loratadine 10mg tablets

5mg in 5ml syrup Sedating Chlorphenamine (Chlorpheniramine)

4mg tablets, 2mg in 5ml syrup 10mg in 1ml injection

Alternatives Non-Sedating

Desloratadine 5mg tablets 2.5mg in 5ml syrup – Loratadine preferred under review

Fexofenadine 30mg (paediatric), 120mg & 180mg tablets Sedating

Hydroxyzine 10mg & 25mg tablets

10mg in 5ml syrup

Promethazine 10mg & 25mg tablets; 5mg in 5ml sugar-free elixir 25mg in 1ml injection

Alimemazine (Trimeprazine)

10mg tablets 7.5mg in 5ml syrup (+ 30mg in 5ml used for pre-

medication) 3.4.2 – Allergen/Immunotherapy

R Pharmalgen® r Bee or Wasp venom extract -approved for IgE-mediated bee and wasp venom allergy in line with NICE

R Grazax® r Grass pollen extract 75,000 units oral lyophilisates

(freeze-dried tablets)

- for use in adults and children by adult and paediatric immunologists only.

Pollinex® Vaccines Pollinex Grasses and Pollinex Trees initial and extension kits -for use by immunologists.

Pollinex Quattro®

Vaccines u

Vaccine -for specialist use by immunologists (less injections than with conventional Pollinex).

R Omalizumab

150mg injection & 75mg & 150mg prefilled syringes - approved for severe persistent allergic asthma in adults and children (6 years and older) in line with NICE -approved as a possible treatment for people aged 12 years and over with severe chronic spontaneous urticaria in line with NICE

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3.4.3 – Allergic Emergencies Anaphylaxis Adrenaline (Epinephrine) - JEXT® & JEXT junior®

1mg in 1ml (1 in 1,000) injection, 150 & 300 microgram automatic injection devices (Jext junior & Jext) - see section 2.7.3 for other formulations

Adrenaline (Epinephrine) - Emerade®

1mg in 1ml (1:1,000) injection, 500 microgram automatic injection device (0.5ml) -approved for use in the emergency treatment of anaphylaxis for patients with a BMI of >40 or who have required more than one auto-injector previously to control symptoms. Specialist

immunologist initiation only. B

-approved for use by NUTH Community Dental Team in anaphylaxis boxes.

Angioedema

R Icatibant

30mg in 3ml injection - for use on the advice of immunologist in the treatment hereditary angioedema associated with C1-esterase inhibitor.

R Danazol 100mg & 200mg capsules - for use on the advice of an immunologist in the prophylaxis treatment hereditary angioedema associated with C1-esterase

inhibitor deficiency. u

R Stanozolol 50mg tablets - for use on the advice of an immunologist in the prophylaxis treatment hereditary angioedema associated with C1-esterase

inhibitor deficiency. u

R Oxandrolone 2.5mg & 10mg capsules - for use on the advice of an immunologist in the prophylaxis treatment hereditary angioedema associated with C1-esterase inhibitor deficiency when danzol and stanozolol are not available. u

3.5 – Respiratory Stimulants and Pulmonary Surfactants 3.5.1 – Respiratory Stimulant

R Doxapram 2mg per ml 500ml infusion, 100mg in 5ml injection

R Caffeine Citrate u 50mg in 5ml injection (equivalent to 25mg caffeine base

in 5ml [5mg caffeine base/ ml]) 50mg in 5ml oral solution

3.5.2 – Pulmonary Surfactants R Poractant Alfa 120mg in 1.5ml & 240mg in 3ml vials (Curosurf®)

3.6 – Oxygen Oxygen

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3.7 – Mucolytics Carbocisteine 375mg capsules, 250mg in 5ml syrup - for use in COPD

patients in accordance with local guidelines

B Dornase alfa 2.5mg in 2.5ml solution for nebulisation

B Acetylcysteine u 600mg plain and effervescent tablets -for use on specialist advice in the treatment of idiopathic pulmonary fibrosis and for the prevention of x-ray contrast media

induced renal damage Linked to information sheet

R Ivacaftor 150mg film coated tablets -approved for the treatment of cystic fibrosis in patients who have a faulty mutation in the CFTR gene in line with NHS England Clinical Commissioning Policy

Sodium Chloride s 7% solution for nebulisation (Nebusal® - replaces

unlicensed 5% solution and Mucoclear 6% solution) – Treatment initiated by respiratory physician

Mannitol 40mg capsules for inhalation

- approved for treating CF in line with NICE

Mannitol 0mg, 5mg, 10mg, 20mg, 40mg capsules for

inhalation -approved for bronchial provocation testing in patients unable to tolerate the taste of methacholine.

3.8 – Aromatic Inhalations Benzoin Tincture, Compound (Friars’ Balsam)

3.9 – Cough Preparations 3.9.1 – Cough Suppressants Codeine Phosphate 15mg in 5ml linctus – see section 4.7.2 for other preps

Pholcodine 5mg in 5ml sugar-free linctus

3.9.2 – Expectorant and Demulcent Cough Preparations Simple Linctus Simple linctus and Paediatric simple linctus

3.10 – Systemic Nasal Decongestants Pseudoephedrine 60mg tablets

30mg in 5ml elixir 3.11 – Antifibrotics

R Pirfenidone 267mg capsules - approved for idiopathic pulmonary fibrosis in line with NICE

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R Nintedanib (Ofev®) 100mg and 150mg soft capsules -approved for the treatment of idiopathic pulmonary fibrosis in

line with NICE

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4. Central Nervous System

4.1 – Hypnotics and Anxiolytics 4.1.1 – Hypnotics Hypnotics should not be prescribed for more than 10 nights without being reviewed. Use in the elderly is discouraged. Nitrazepam is no longer included in the formulary for use as a hypnotic First Choice

Temazepam 10mg & 20mg tablets

10mg in 5ml oral solution

Alternatives Zopiclone 3.75mg and 7.5mg tablets

Chloral Hydrate 500mg in 5ml mixture

Other Hypnotics Clomethiazole (Chlormethiazole)

192mg capsules 157.5mg in 5ml syrup - chlordiazepoxide is preferred in the management of alcohol withdrawal

B Melatonin

A

First line

2mg modified release tablets Second line

2mg modified release tablets (crushed) Third line

5mg in 5ml solution u

- for the management of sleep – wake disorders in children and young people

Please refer to information sheet for up to date

information regarding approved indications

Promethazine Hydrochloride

10mg & 25mg tablets 5mg in 5ml sugar-free elixir 25mg in 1ml injection

4.1.2 – Anxiolytics Benzodiazepines should not be used as an anxiolytic for more than 4 weeks without being reviewed. Use in the elderly is discouraged. First Choice Diazepam

2mg & 5mg tablets - 2mg tablets are the preferred

strength in primary care.

10mg diazepam tablets should no longer be used. 2mg in 5ml oral solution 2.5mg, 5mg & 10mg rectal solution (rectal tubes) 10mg in 2ml injection (plain & emulsion) - for use in epilepsy (see section 4.8.2)

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Alternatives Chlordiazepoxide 5mg & 10mg capsules

Lorazepam 1mg & 2.5mg tablets

4mg in 1ml injection

4.2 – Drugs Used in Psychoses and Related Disorders 4.2.1 – Antipsychotics Drugs

The traffic light status of the treatment of psychosis and schizophrenia in adults will be reviewed in line with NICE CG178

Typical Antipsychotics Preferred drugs

Sulpiride 200mg & 400mg tablets

200mg in 5ml sugar-free oral solution

Haloperidol 500 microgram capsules; 1.5mg, 5mg & 10mg tablets 1mg in 1ml & 2mg in 1ml oral liquid 5mg in 1ml & 20mg in 2ml injections

Perphenazine 2mg & 4mg tablets

Chlorpromazine 10mg, 25mg, 50mg & 100mg tablets 25mg in 5ml & 100mg in 5ml oral solutions 50mg in 2ml injection

Alternatives Trifluoperazine

1mg & 5mg tablets 1mg in 5ml syrup, 5mg in 5ml oral sugar-free solution

Flupentixol (Flupenthixol)

500 microgram, 1mg & 3mg tablets

Levomepromazine

(Methotrimeprazine) 6mg tablets u, 25mg tablets, 25mg in 1ml injection - for use in palliative care

Atypical Antipsychotics Linked to information sheet Preferred drugs

B Risperidone 500microgram, 1mg, 2mg, 3mg, 4mg & 6mg tablets 1mg per ml liquid 0.5mg, 1mg & 2mg orodispersible tablets (Quicklets®) N.B. The dispersible tablets should only be used in situations where the plain tablets are unsuitable

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B Amisulpride

50mg & 200mg tablets 100mg in 1ml oral solution

Alternatives

R Clozapine 25mg & 100mg tablets - first choice in patients with treatment-resistant schizophrenia

B Quetiapine 25mg, 100mg, 150mg 200mg & 300mg tablets 50mg, 200mg, 300mg & 400mg prolonged release tablets (Seroquel XL®) –this formulation is only approved for use in patients who require an outside carer to administer their medicines, and for short term use when rapid dose titration is considered important e.g. where its use might avoid the need to admit the patient to hospital.

B Olanzapine

2.5mg, 5mg, 7.5mg & 10mg, 15mg & 20mg tablets

5mg, 10mg & 15mg orodispersible tablets r N.B. The orodispersible tablets should only be used in situations where the plain tablets are unsuitable.

10mg injection -for rapid control of agitation and disturbed behaviours in patients with schizophrenia or manic episode, when oral therapy is not appropriate. - the orodispersible tablets and injection are also approved for 2nd/3rd- line use in the management of delirium in critical care

patients – unlicensed indication.

B Aripiprazole 5mg, 10mg, 15mg & 30mg tablets - approved for schizophrenia in people aged 15 to 17 years in line with NICE - approved for moderate to severe manic episodes in young people aged 13 and older with bipolar I disorder NICE

10mg & 15mg orodispersible tablets - For doses over 5mg for those patients who have difficulty swallowing.

1mg/ 1ml oral solution - only for doses of 5mg or less, or when titrating patients on doses of increments of less than 5mg, in patients who have difficulty swallowing tablets.

R 7.5mg/ml IM Injection -approved for use in rapid tranquilisation in patients with acute psychosis. NTW use only

4.2.2 – Antipsychotics Depot Injections First Choice Zuclopentixol Decanoate (Zuclopenthixol Decanoate)

200mg in 1ml & 500mg in 1ml injections

Alternatives Aripiprazole

400mg long acting injection -NTAG approved for the treatment of schizophrenia as per its licensed indication and as outlined in the Guidance on the Use of Antipsychotic Long-acting Injections in the North of England – Guidance

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Flupentixol Decanoate (Flupenthixol Decanoate)

20mg in 1ml, 40mg in 2ml, 50mg in 0.5ml, 100mg in 1ml & 200mg in 1ml injections

Fluphenazine Decanoate

12.5mg in 0.5ml, 25mg in 1ml, 50mg in 0.5ml & 100mg in 1ml injections

Haloperidol Decanoate 50mg in 1ml & 100mg in 1ml injections

Paliperidone

50mg, 100mg & 150mg pre-filled syringe -NTAG approved for the treatment of schizophrenia as per its licensed indication and as outlined in the Guidance on the Use of Antipsychotic Long-acting Injections in the North of England – Guidance

Pipotiazine Palmitate (Pipothiazine Palmitate)

50mg in 1ml & 100mg in 2ml injections

Risperidone (Risperdal Consta)

25mg, 37.5mg and 50mg long acting injections – only for use by psychiatrists in accordance with NTW guidelines

R Zuclopenthixol Acetate r

50mg in 1ml and injection - for short-term use by NTW specialists only

4.2.3 – Antimanic Drugs

Carbamazepine 100mg, 200mg & 400mg tablets 100mg in 5ml sugar-free liquid -see section 4.8.1 for other formulations

A Lithium Carbonate

250mg tablets (6.8 mmol Li+)

200mg & 400mg m/r tablets (5.4 & 10.8 mmol Li+) - Lithium should be prescribed by brand name Link to Shared Care Guideline

A Lithium Citrate 509mg in 5ml liquid (5.4 mmol Li+/5ml)

1,018mg in 5ml liquid (10.8mmol Li+/5ml)

564mg m/r tablets (6 mmol Li+) Link to Shared Care Guideline

Sodium Valproate

200mg, 300mg & 500mg m/r tablets (Epilim Chrono) - used for the prevention and treatment of manic episodes associated with bipolar disorder (unlicensed indication). May be useful in patients unresponsive to lithium. See section 4.8.1 for other sodium valproate formulations.

Valproic Acid (as semisodium valproate)

250mg and 500mg tablets (Depakote®) -Licensed alternative to sodium valproate m/r tablets.

Other anticonvulsant drugs are used in the management of bipolar disorders e.g. Lamotrigine for the depressive phase. Such use is ‘off-licence’.

4.3 – Antidepressant Drugs 4.3.1 – Tricyclic and Related Antidepressant Drugs Antidepressant

Trazodone 50mg & 100mg capsules; 150mg tablets 50mg in 5ml sugar-free liquid

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- Trazodone is widely used off-licence for night sedation and behavioural symptoms of dementia – see section 4.1.1

Other Indications u

Amitriptyline 10mg, 25mg & 50mg tablets

25mg in 5ml sugar-free oral solution

Alternatives

Clomipramine 10mg, 25mg & 50mg capsules

Imipramine 10mg & 25mg tablets; 25mg in 5ml syrup - also approved for the treatment of neuropathic pain u

Lofepramine 70mg tablets

70mg in 5ml sugar-free oral suspension – safer than amitriptyline in overdosage, but not as effective

4.3.2 – Monoamine Oxidase Inhibitors (MAOI)

Phenelzine s 15mg tablets - for use on advice from psychiatrists only

Moclobemide s 150mg tablets - for use on advice from psychiatrists only

4.3.3 – Selective Serotonin Reuptake Inhibitors (SSRIs) Preferred drugs Fluoxetine 20mg capsules

20mg dispersible tablets - first choice for patients unable to use the capsules 20mg in 5ml liquid

Citalopram 10mg, 20mg & 40mg tablets 40mg in 1ml sugar-free oral drops

Paroxetine 10mg, 20mg & 30mg tablets 10mg in 5ml sugar-free oral liquid

Sertraline 50mg & 100mg tablets

4.3.4 Other Antidepressants These drugs are for use in patients not responding adequately to first-line treatments. Venlafaxine 37.5mg & 75mg tablets

75mg & 150mg m/r tablets

B for patients on doses of 300mg/day or more

Linked to information sheet - Patients who are deemed stable on doses of up to 225mg daily of m/r venlafaxine should be switched to the equivalent dose of immediate release venlafaxine - M/R tablets are only to be used in patients currently prescribed doses of 300mg and over and for whom there is no suitable alternative, those who have experienced discontinuation reactions (at any dose), and for patients who need to take the once daily formulation in order to facilitate care visits.

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Mirtazapine 15mg, 30mg & 45mg tablets 15mg, 30mg & 45mg orodispersible tablets - the orodispersible tablets should only be prescribed for use when other formulations are unsuitable (more expensive)

Reboxetine 4mg tablets - not licensed for use in elderly

Duloxetine s 30mg & 60mg capsules - for use on advice of psychiatrists as a 3rd line antidepressant but only for use in patients, who cannot tolerate high-dose (>150mg daily) venlafaxine, or patients with hypertension, established CHD or other cardiovascular risk factors which would make the use of high-dose venlafaxine undesirable. Also approved for third-line use (after drugs such as the tricyclic antidepressants and gabapentin) in the treatment of neuropathic pain on the advice of pain specialists

Agomelatine r 25mg film coated tablets-

- NETAG approved for the treatment of depression only following an adequate trial of at least three alternative antidepressant drugs at maximally tolerated doses (as described by NICE and as stated in the BNF). Prescribing and monitoring should be initiated by specialist mental health physicians. After a minimum of 12 weeks, prescribing may be transferred to primary

care. Linked to information sheet

Vortioxetine 5mg, 10mg & 20mg film-coated tablets

-approved for the treatment of major depressive episodes in adults whose condition has responded inadequately to 2 anti-

depressants within the current episode in line with NICE

4.4 – Central Nervous Stimulants and Other Drugs Used for Attention Deficit Hyperactivity Disorder

Methylphenidate, atomoxetine and dexamfetamine for attention deficit hyperactivity disorder (ADHD) in children and adolescents NICE

A Atomoxetine 10mg, 18mg, 25mg, 40mg, 60mg & 80mg capsules

A Dexamfetamine (Dexamphetamine)

5mg tablets Link to Shared Care Guideline

R For use in narcolepsy for doses > 30mg

B For the in narcolepsy for doses < 30mg

Linked to information sheet

A Methylphenidate 5mg & 10mg tablets; 5mg, 10mg, 20mg, 30mg and 40mg m/r capsules (Medikinet XL®) 10mg, 20mg & 30mg m/r capsules (Equasym XL®), 18mg, 27mg & 36mg m/r tablets (Concerta XL®) -the effects of Equasym XL last for about 8 hours compared with about 12 hours for Concerta XL Link to Shared Care Guideline - also approved for the treatment of narcolepsy in paediatrics - see section 7.4.2 for use in giggle incontinence

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A Lisdexamfetamine 30mg, 50mg and 70mg capsules (Elvanse®) - for third line use and specialist initiation. Should only transferred to GPs after at least 6 month stable symptom control

-approved for the treatment of ADHD in adults

B Modafinil r 100mg tablets – only approved for limited use in the treatment of patients with

narcolepsy Linked to information sheet

R Pitolisant u 20mg tablets -approved for use in patients with narcolepsy who experience

psychomotor side effects with modafinil and dexamfetamine.

4.5 – Drugs Used in the Treatment of Obesity

Only for use in accordance with NICE guidelines NICE

4.5.1 – Anti-Obesity Drugs Acting on the Gastro-Intestinal Tract

Orlistat 120mg capsules

4.5.2 – Centrally Acting Appetite Suppressants

Sibutramine has been withdrawn from the UK market due to evidence that suggests

that there is an increased risk of non-fatal heart attacks and strokes with this medicine that

outweighs the benefits of weight loss.

4.6 – Drugs Used in Nausea and Vertigo Antihistamines Cinnarizine 15mg tablets

Cyclizine 50mg tablets; 50mg in 5ml suspension u

50mg in 1ml injection

Promethazine Hydrochloride

10mg & 25mg tablets; 5mg in 5ml sugar-free elixir 25mg in 1ml injection

Phenothiazines and Related Agents Haloperidol 500 microgram capsules,1.5mg, 5mg & 10mg tablets

1mg in 1ml & 2mg in 1ml oral liquid 5mg in 1ml & 20mg in 2ml injections

Prochlorperazine 5mg tablets; 5mg in 5ml syrup 12.5mg in 1ml injection 3mg tablets (buccal) (Buccastem®) - for the treatment of nausea associated with migraine when the oral route cannot be used due to vomiting.

Levomepromazine (Methotrimeprazine)

6mg tablets u, 25mg tablets 25mg in 1ml injection For use in palliative care

Domperidone and Metoclopramide Metoclopramide 10mg tablets; 5mg in 5ml sugar-free oral solution

10mg in 2ml injection

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Domperidone 10mg tablets 5mg in 5ml sugar-free suspension -approved for use as a galactagogue to re-establish breast-feeding on specialist advice and following a cardiovascular risk

assessment in light of MHRA advice u, s 5HT3 Antagonists

First Choice Ondansetron 4mg & 8mg tablets

4mg in 5ml sugar-free solution 4mg in 2ml & 8mg in 4ml injections 16mg suppositories

4mg and 8mg oro-dispersible tablets/films R -approved for the treatment of post-operative nausea and vomiting in patients who do not require IV access or are nil by mouth -cheapest available formulation should be used

Alternative

R Palonosetron r 250 microgram in 5ml injection, 500 microgram capsules - for 2nd line of treatment for chemotherapy induced nausea vomiting only

Others Hyoscine Hydrobromide

300 microgram oral/sublingual tablets 1mg/72 hour patches - for the management of excessive secretions where tablets are unsuitable

R Aprepitant r 80mg & 125mg capsules - for the prevention of chemotherapy induced nausea and

vomiting (CINV) in high risk patients in accordance with North of England Cancer Network: CINV Guidelines in adult oncology and haematology patients

R Fosaprepitant 150mg injection - for the prevention of chemotherapy induced nausea and

vomiting (CINV) in high risk patients in accordance with North of England Cancer Network: CINV Guidelines in adult oncology and haematology patients

R Nabilone 250 microgram capsules u, 1mg capsules - also approved for very limited use in the treatment of chronic pain (unlicensed indication) that has not responded to other treatments. Treatment must be initiated by pain consultants and reviewed after about one month. Treatment to be stopped immediately in non-responders.

Other Drugs for Menière’s Disease Betahistine 8mg tablets

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4.7 – Analgesics

4.7.1 – Non Opioid Analgesics

First Choice

Paracetamol 500mg plain & soluble tablets

120mg & 250mg in 5ml suspensions (sugar-free) 1g injection for IV infusion - for limited short-term use where oral and rectal routes cannot be used and NSAIDs are not appropriate. - in paediatric areas only, the 50ml formulation should be stocked.

15mg u, 30mg u, 60mg u, 120mg u, 240mg u &

500mg u suppositories used in NUTH Licensed 60mg, 125mg, 250mg & 500mg suppositories are available in primary care

Alternatives Aspirin

300mg dispersible & enteric coated tablets

75mg, 150mg & 300mg u suppositories used in NUTH -licensed 300mg suppositories are available in primary care

NSAIDs Oral NSAIDs (section 10.1.1) such as diclofenac, ibuprofen and naproxen are also used as analgesics – see section 10.1.1. NSAID Injections e.g. parecoxib s injections are also available for use as post-operative analgesics – see section 15.1.4.2

R Nabilone 250 microgram capsules u, 1mg capsules - for very limited use in the treatment of chronic pain (unlicensed indication) that has not responded to other treatments. Treatment must be initiated by pain consultants and reviewed after about one month. Treatment to be stopped immediately in non-responders.

4.7.1.1 – Compound Analgesic Preparations Co-codamol 8/500 8/500 tablets & 8/500 dispersible tablets containing

codeine phosphate 8mg & paracetamol 500mg - while co-codamol 8/500 is commonly used, no advantages over paracetamol have been substantiated. The low dose of codeine may be enough to cause opioid side-effects (in particular, constipation) and can complicate the treatment of overdosage, yet may not provide significant additional relief of pain. Use is therefore discouraged.

4.7.2 – Opioid Analgesics Preferred drugs

Morphine Sulphate 10mg, 20mg & 50mg immediate release tablets 10mg, 30mg, 60mg, 100mg and 200mg m/r capsules (Zomorph) for twice daily administration - this is the preferred formulation

5mg, 10mg, 15mg, 30mg, 60mg, 100mg & 200mg m/r tablets for twice daily administration

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- only for use when Zomorph isn’t unsuitable

10mg in 5ml & 100mg in 5ml (20mg per ml) oral solutions 20mg, 30mg, 60mg, 100mg & 200mg sachets of m/r granules for preparing oral suspensions - only for use when other formulations are unsuitable

5mg u, 10mg, 15mg & 30mg in 1ml & 60mg in 2ml injections

10mg in 1ml u preservative free, 2mg in 5ml u

epidural and 50mg in 50ml PCA injection u are also available

Diamorphine 5mg, 10mg, 30mg, 100mg & 500mg injections

- intranasal diamorphine u R is approved for use in children for

the relief of severe pain due to clinically suspected limb fractures, burns and significant fingertip injuries. Appropriate risk assessments are to be conducted by each organisation in order to determine formulation of choice i.e. ampoules or intranasal spray.

Codeine Phosphate 5mg, 30mg & 60mg tablets 25mg in 5ml syrup

30mg in 1ml injection u & 60mg in 1ml injection

2mg, 3mg, 6mg, 15mg & 30mg suppositories u Alternatives

The use of dihydrocodeine 30mg tablets & 10mg in 5ml oral solution is no longer recommended for regular use. Codeine is the preferred weak opioid analgesic

R Dihydrocodeine r

30mg tablets -approved for use in breast feeding mothers immediately post-delivery/c-section where adequate pain relief has not been achieved using paracetamol and NSAIDs. Patients requiring contunation of dihydrocoeine following discharge (post delivery/c-section) can have dihydrocodeine prescribed in primary care (for short-term use only).

Buprenorphine 200 microgram sublingual tablets

300 micrograms in 1ml injection 5 & 10 microgram/hour transdermal patch (BuTrans®) -patches approved for use in palliative care when fentanyl 12 microgram/hr transdermal patches exceed the patient’s analgesic requirements.

Fentanyl 12, 25, 50, 75 & 100 microgram/hour transdermal

patches - see section 15.4.1.3 for injections

200 microgram lozenges with oromucosal applicator

sr – only approved for limited short-term use in RVI burns unit and for the treatment of very severe incident pain on the advice of pain/palliative care specialists.

100,200,300,400,600,800 microgram sublingual tablets (Abstral) – only approved for patients experiencing incident pain during radiotherapy, restricted to palliative care use only.

Hydromorphone 1.3mg & 2.6mg capsules

2mg, 4mg, 8mg, 16mg & 24mg m/r capsules

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B Methadone 5mg tablets 2mg in 5ml linctus & 5mg in 5ml mixture DTF & 5mg in 5ml sugar free solution

20mg in 1ml concentrated oral solution u 10mg in 1ml injection

Oxycodone r

Under Review

5mg in 5ml & 10mg in 1ml sugar-free oral solutions 5mg, 10mg, 20mg, 40mg & 80mg m/r tablets

(Longtec®) 10mg in 1ml, 20mg in 2ml injection 50mg in 1ml injection -approved for use in controlled circumstances in palliative patients following risk assessment by individual organisations The oral solution should be used instead of immediate release tablets Oxycodone only to be used in patients who are intolerant of morphine

Pethidine 50mg in 1ml & 100mg in 2ml injections

B Tapentadol r 50mg,100mg, 150mg, 200mg and 250mg m/r tablets

50mg and 75mg immediate release tablets - approved for use by chronic pain specialist in adults with severe pain who have been screened for a neuropathic element to their pain and are uncontrolled or experiencing GI side effects on existing therapy.

Tramadol 50mg capsules; 50mg dispersible tablets 100mg in 2ml injection - for use as a 2nd line weak opioid analgesic - only recommended for use in patients where treatment with possible alternatives such as paracetamol, NSAIDs, and codeine is insufficiently effective, not tolerated or considered unsuitable for other reasons. Modified release tramadol is not recommended.

4.7.3 – Neuropathic Pain First Choice Amitriptyline See section 4.3

Second Choice Gabapentin See section 4.8.1

- also approved for hospital use as an adjunct to other treatment in the management of peri/post-operative pain. GPs should not be asked to prescribe gabapentin for this unlicensed indication.

Pregabalin r See section 4.8.1 - restricted to use in the management neuropathic pain as a second choice where treatment with gabapentin has been

unsuccessful or not tolerated.

Alternatives

Carbamazepine See section 4.8.1 -restricted use in treatment of trigeminal neuralgia only

Duloxetine s 30mg & 60mg capsules 30mg & 60mg capsules

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- for third-line use (after drugs such as the tricyclic antidepressants and gabapentin) in the treatment of neuropathic pain on the advice of pain specialists.

Phenytoin See section 4.8.1

B Mexiletine u 200mg & 50mg capsules

- for use in the treatment of neuropathic pain. ECG monitoring is required to be carried out by pain clinic consultants as part of the initiation process of mexiletine, as patients are required for cardiac arrhythmias.

Postherpetic Neuralgia

Capsaicin 0.075% cream – See section 10.3.2

B Lidocaine 5% medicated plasters (700mg lidocaine/plaster) - for use in the treatment of chronic neuropathic pain on the advice of pain specialists only, and subject to an appropriate trial of efficacy in each individual patient

Linked to information sheet

N.B. Other drugs such as Ketamine (see section 15.1.1) may also be advised by

pain/palliative care specialists in the management of neuropathic pain.

4.7.4 – Antimigraine Drugs

4.7.4.1 – Treatment of Acute Migraine Attack

Analgesics

Paracetamol Aspirin Co-codamol 8/500

See section 4.7.1

NSAIDs e.g. Ibuprofen, naproxen diclofenac

See section 10.1.1

5HT1 Agonists First Choice

Sumatriptan 50mg & 100mg tablets; 10mg in 0.1ml nasal spray 6mg in 0.5ml injection (pre-filled syringes)

Alternatives Frovatriptan 2.5mg tablets

Zolmitriptan 2.5mg tablets

Adjunctive Therapy Metoclopramide (used to help promote

absorption of analgesics)

10mg tablets 5mg in 5ml sugar-free syrup See section 4.6 for other formulations

4.7.4.2- Prophylaxis of Migraine

Pizotifen 500 microgram & 1.5mg tablets

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250 microgram in 5ml sugar-free elixir

Sodium Valproate u

100mg crushable tablets, 200mg & 500mg e/c tablets 200mg, 300mg & 500mg m/r tablets (Epilim Chrono). 150mg & 300mg m/r capsules; 500mg & 1000mg m/r granules (Episenta) - for use in those who have difficulty swallowing sodium valproate tablets. May be more convenient to use than large volumes of liquid formulations 200mg in 5ml sugar-free liquid; 400mg in 4ml injection

Propranolol 10mg, 40mg & 80mg tablets

Metoprolol 50mg & 100mg tablets, 200mg m/r tablets

Amitriptyline u

10mg, 25mg & 50mg tablets; 25mg in 5ml sugar-free oral solution

Imipramine

10mg & 25mg tablets; 25mg in 5ml syrup -approved as a second line option in patients unable to tolerate

amitriptyline for the prophylaxis of migraine u

Clonidine 25 microgram tablets - not generally recommended, may aggravate depression/cause insomnia

R Botulinum toxin A

(Botox)

-for the treatment of chronic migraine in line with NICE

4.7.4.2 - Cluster headaches A Lithium Carbonate

250mg tablets (6.8 mmol Li+)

200mg & 400mg m/r tablets (5.4 & 10.8 mmol Li+) - Lithium should be prescribed by brand name. For use in

the treatment of cluster headaches u Link to Shared Care

Guideline

A Lithium Citrate 509mg in 5ml liquid (5.4 mmol Li+/5ml) 1,018mg in

5ml liquid (10.8mmol Li+/5ml) 564mg m/r tablets (6

mmol Li+) - Lithium should be prescribed by brand name.

- for use in the treatment of cluster headaches. u

Link to Shared Care Guideline

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4.8 – Antiepileptics (Anticonvulsants) 4.8.1 – Control of Epilepsy Adapted from Antiepileptic drug (AEDs) options by seizure type NICE

Seizure Type First Line AEDs Adjunctive

AEDs

Other AEDs that may be

considered on

referral to tertiary care

Do not offer

AEDs (may worsen

seizures)

Generalised tonic–clonic

Carbamazepine Lamotrigine

Oxcarbazepineu

Sodium valproate

Clobazam Lamotrigine

Levetiracetam

Sodium valproate

Topiramate

(If there are absence or

myoclonic

seizures, or if JME suspected)

Carbamazepine Gabapentin

Oxcarbazepine

Phenytoin Pregabalin

Tiagabine Vigabatrin

Tonic or

atonic

Sodium

valproate

Lamotrigine Rufinamideu

Topiramateu

Carbamazepine

Gabapentin Oxcarbazepine

Pregabalin Tiagabine

Vigabatrin

Absence

Ethosuximide Lamotrigineu

Sodium valproate

Ethosuximide Lamotrigineu

Sodium valproate

Clobazam Clonazepam

Levetiracetamu Topiramateu

Zonisamideu

Carbamazepine Gabapentin

Oxcarbazepine Phenytoin

Pregabalin

Tiagabine Vigabatrin

Myoclonic

Levetiracetamu

Sodium valproate Topiramateu

Levetiracetam

Sodium valproate Topiramateu

Clobazam

Clonazepam Piracetam

Zonisamideu

Carbamazepine

Gabapentin Oxcarbazepine

Phenytoin Pregabalin

Tiagabine

Vigabatrin

Focal

Carbamazepine

Lamotrigine Levetiracetam

Oxcarbazepine

Sodium valproate

Carbamazepine

Clobazam Gabapentinu

Lamotrigine

Levetiracetam Oxcarbazepine

Sodium valproate Topiramate

Eslicarbazepine

acetate Lacosamide

Phenobarbital

Phenytoin Pregabalin

Tiagabine Vigabatrin

Zonisamide

Perapanel

MHRA guidance Different antiepileptic drugs (AEDs) vary considerably in their characteristics, which influences the risk of whether switching between different manufacturer’s products of a particular drug may cause adverse effects or loss of seizure control. AEDs have been divided into three risk-based categories to help healthcare professionals decide

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whether it is necessary to maintain continuity of supply of a specific manufacturer’s product. Dispensing pharmacists should ensure the continuity of supply of a particular product when the prescription specifies it. If the prescribed product is unavailable, it may be necessary to dispense a product from a different manufacturer to maintain continuity of treatment of that AED. Such cases should be discussed and agreed with both the prescriber and patient (or carer) Usual dispensing practice can be followed when a specific product is not stated.

Category 1 For these drugs it is advised to ensure that the patient is maintained on a specific

manufacturer’s product.

Carbamazepine 100mg, 200mg & 400mg tablet 100mg in 5ml sugar-free liquid 125mg & 250mg suppositories 200mg & 400mg – m/r tablets (Tegretol retard) are available

on consultant request for those in whom conventional Carbamazepine has been shown to be unsuitable

Phenobarbital (Phenobarbitone)

15mg, 30mg & 60mg tablets; 15mg in 5ml elixir; 20mg in 1ml suspension (alcohol free) 15mg in 1ml, 30mg in 1ml & 200mg in 1ml injections

Phenytoin 25mg, 50mg & 100mg capsules (sodium salt) 50mg infatabs (base) 30mg in 5ml suspension (base) – 90mg (15ml) is equivalent to one 100mg phenytoin sodium capsule

250mg in 5ml injection (sodium salt)

Category 2

For these drugs, the need for continued supply of a particular manufacturer’s

product should be based on clinical judgement and consultation with patient and/or carer, taking into account factors such as seizure frequency and treatment

history.

Clobazam s

10mg tablets 1mg in 1ml & 2mg in 1ml suspensions

Clonazepam 500 microgram & 2mg tablets

500 microgram in 5ml sugar-free oral solution u 1mg in 1ml injection

Eslicarbazepine Acetate

800mg tablets - approved for use by specialists only in those patients for whom intolerance of carbamazepine is a major concern and when use of this agent is more cost effective than alternatives available.

Lamotrigine 25mg, 50mg, 100mg & 200mg tablets

5mg, 25mg & 100mg dispersible tablets

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Oxcarbazepine s 150mg, 300mg & 600mg tablets

Perampanel 2mg, 4mg, 6mg, 8mg, 10mg, 12mg tablets. - NETAG approved for partial (focal) seizure epilepsy only when other treatment options recommended by NICE have been tried or fully considered.

B Retigabine 50mg, 100mg, 200mg, 300mg & 400mg tablets - approved for use by specialists in line with NICE

R Rufinamide r 100mg, 200mg & 400mg Tablets & 40mg in 1ml suspension - approved for limited use as a 2nd or 3rd line treatment in patients with Lennox-Gastaut syndrome and related encephalopathies. Should only be used on the advice of paediatric neurologists and other neurologists specialising in the treatment of epilepsy.

Sodium Valproate 100mg crushable tablets, 200mg & 500mg e/c tablets

200mg, 300mg & 500mg m/r tablets (Epilim Chrono) 150mg & 300mg m/r capsules; 500mg & 1000mg m/r granules (Episenta) - for possible use in those who have difficulty swallowing sodium valproate tablets. May be more convenient to use than large volumes of liquid formulations 200mg in 5ml sugar-free liquid; 400mg in 4ml injection

Topiramate s 25mg, 50mg, 100mg & 200mg tablets 15mg, 25mg & 50mg sprinkle capsules

Zonisamide s 25mg, 50mg and 100mg capsules

- for specialist use only in patients that are refractory to treatment with other drugs - use in children is unlicensed

Category 3

For these drugs it is usually unnecessary to ensure that patients are maintained on

a specific manufacturer’s product unless there are specific reasons such as patient anxiety and risk of confusion or dosing errors.

Ethosuximide s 250mg capsules; 250mg in 5ml syrup

Gabapentin 100mg, 300mg & 400mg capsules 600mg & 800mg tablets

250mg in 5ml oral solution u

Lacosamide s 50mg, 100mg, 150mg & 200mg tablets 10mg per ml syrup, 10mg per ml intravenous infusion - on advice from consultant neurologists, in patients that are refractory to treatment with other drugs

Levetiracetam s 250mg, 500mg, 750mg & 1g tablets; 500mg in 5ml liquid 500mg in 5ml (100mg/ml) concentrate for IV infusion

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Pregabalin s 25mg, 50mg, 75mg, 100mg, 150mg, 200mg & 225mg capsules 20mg/1ml oral solution - approved for specialist advice in the management of treatment resistant epilepsy - also approved as a second line agent for General Anxiety Disorder. Although treatment can be given 2-3 times daily, it is

more cost effective to give as a twice daily dose. NICE

A Vigabatrin 500mg tablets; 500mg sugar-free sachets

Linked to Shared Care Guideline

Acetazolamide s 250mg tablets

Stiripentol s 250mg & 500mg capsules 250mg & 500mg powder in sachets – for use as adjunctive therapy of refractory generalised tonic-clonic seizures in children with severe myoclonic epilepsy in infancy

G+ Brivaracetam (subject to categorisation)

10mg, 25mg, 50mg, 75mg & 100mg film-coated tablets -approved for use as adjunctive therapy in patients with severe/intractable partial onset seizures e.g. a sezuire frequency of 1 per week following failure of first-line adjunctive therapy. Response must be assessed within 3-6 months before transferring prescribing to primary or stopping treatment, as appropriate

4.8.2 – Drugs Used in Status Epilepticus First Choice

Diazepam 10mg in 2ml injection (solution & emulsion)

2.5mg, 5mg & 10mg rectal solution (rectal tubes) – see section 4.1.2 for other formulations

B Midazolam 5mg/ml alcohol-free buccal solution (Buccolam®) – 2.5mg, 5mg, 7.5mg and 10mg prefilled oral syringes. - first choice for status epilepticus in children aged 3 months to 18 years

Epistatus 10mg in 1ml (5ml pack) buccal solution u – for use in the treatment of epileptic seizures in infants under 3 months and adults over 18 years of age Linked to information sheet

Injection solutions (section 15.1.4) can also be given buccally

2.5mg in 5ml oral solution u - for use as a sedative. To be used in preference to administering the injection orally -much cheaper.

Alternatives For initiation by neurologists only

Clonazepam s 1mg in 1ml injection

Lorazepam s 1mg & 2.5mg tablets; 4mg in 1ml injection & 2mg/ml

suspension u & 4mg/ml suspension u

– suspensions are only approved for use in paediatrics for buccal administration, patients with status epilepticus in whom buccal

midazolam, rectal paraldehyde orrectal diazepam are ineffective.R

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Paraldehyde s Rectal liquid u

Phenytoin Sodium s 250mg in 5ml injection

4.9 – Drugs Used in Parkinsonism and Related Disorders

4.9.1 - Dopaminergic Drugs

Levodopa plus Decarboxylase Inhibitors Co-beneldopa (benserazide + levodopa, Madopar) – see table for formulations Co-careldopa (carbidopa + levodopa, Sinemet) – see table for formulations

Brand Names Approved Names Form Decarboxylase inhibitor content

Levodopa content

Co-beneldopa Benserazide

Madopar 62.5 Co-beneldopa 12.5/50 capsules & disp. tablets

12.5mg 52mg

Madopar 125 Co-beneldopa 25/100 capsules & disp. tablets

25mg 100mg

Madopar 250 Co-beneldopa 50/200 capsules 50mg 200mg Madopar 125 CR

Co-beneldopa 25/100 m/r controlled

release caps.

25mg 100mg

Co-careldopa Carbidopa Sinemet 62.5 Co-careldopa 12.5/50 tablets 12.5mg 50mg

Sinemet 110 Co-careldopa 10/100 tablets 10mg 100mg

Sinemet Plus Co-careldopa 25/100 tablets 25mg 100mg Sinemet 275 Co-careldopa 25/250 tablets 25mg 250mg

Half Sinemet CR Co-careldopa 25/100 m/r m/r tablets 25mg 100mg Sinemet CR Co-careldopa 50/200 m/r m/r tablets 50mg 200mg

Other Dopaminergic Drugs Ergot derivatives such as bromocriptine and cabergoline can cause fibrotic reactions – baseline tests and monitoring needed – see BNF

B Ropinirole 250 microgram, 1mg, 2mg & 5mg tablets 2mg, 4mg & 8mg modified release tablet – once daily formulation that is only approved for use in Parkinson’s disease patients with proven compliance problems -approved for first line use in patients with restless legs syndrome

Linked to information sheet

B Pramipexole 88, 180 & 700 microgram tablets - approved for 2nd line use in Parkinson’s disease

Linked to information sheet

Selegiline 5mg tablets 10mg in 5ml oral liquid

Bromocriptine 2.5mg tablets

B Rasagiline 1mg tablets Linked to information sheet

B Rotigotine 1mg/24hours, 2 mg/24 hours, 3mg/24hours, 4 mg/24 hours, 6 mg/24 hours, and 8 mg/24 hours, self-adhesive patches - for use on the advice of specialists in the treatment of Parkinson's disease. Mainly for use in patients who have difficulty with

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swallowing. -approved for second line use in patients with restless legs syndrome.

Linked to information sheet R Apomorphine 20mg in 2ml & 50mg in 5ml injections & 30mg in 3ml

pre-filled multiple dose pen injection device 5mg in 1ml pre-filled syringe 10mg lozenges also available (unlicensed) at the RVI

Entacapone 200mg tablets

Stalevo® Tablets containing: 50mg levodopa/12.5mg carbidopa/200mg entacapone

75mg levodopa/18.75mg carbidopa/200mg entacapone 100mg levodopa/25mg carbidopa/200mg entacapone

125mg levodopa/31.25mg carbidopa/200mg entacapone

150mg levodopa/37.5mg carbidopa/200mg entacapone 200mg levodopa/50mg carbidopa/200mg entacapone

R Tolcapone 100mg tablets

Amantadine 100mg capsules; 50mg in 5ml syrup- For use on the advice of neurologists

4.9.2 – Antimuscarinic Drugs Trihexyphenidyl (Benzhexol)

2mg & 5mg tablets; 5mg in 5ml syrup

Orphenadrine 50mg tablets; 25mg in 5ml sugar-free elixir

Procyclidine 5mg tablets 2.5mg in 5ml & 5mg in 5ml sugar-free syrups 10mg in 2ml injection

4.9.3 – Drugs Used in Essential Tremor, Chorea, Tics and Related Disorders

Tetrabenazine s 25mg tablets - For use on the advice of neurologists

R Riluzole 50mg tablets and 5mg/1ml oral suspension -approved for motor neurone disease in line with NICE

-oral suspension approved ONLY when other preparations (including crushing tablets) are not suitable.

Botulinum A Toxin -Haemagglutinin Complex

50 unit injection (Vistabel) sr

100 unit injection (Botox) s

500 unit injection (Dysport) s

- approved as a treatment of overactive bladder in patients who

have failed to respond to conservative therapy and treatment with

at least two anti-muscarinic drugs (unlicensed indication)

-Botox only approved for use in paediatric patients with severe

bladder over-activity and neuropathic bladder who have not

responded to other treatment.

- approved as an alternative to surgery in the treatment of hyperhidrosis affecting the axillae, palms of the hands and soles of the feet which has not responded to treatment such as antiperspirants (use on the hands or feet is unlicensed) - the 50mg injection (Vistabel) is restricted to use in private

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patients receiving aesthetic treatment

Botulinum Toxin Type A

(Xeomin) s

100 units injections – similar potency to Botox, and may be less expensive (depending on price agreements/ contracts), but not licensed for the full range of indications

N.B. Botulinum Toxin Type A products should be prescribed by brand name

Botulinum B Toxin s 2,500 units in 0.5ml, 5,000 units in 1ml & 10,000 units in 2ml injections

Memantine s 10mg tablets -for use as last line drug after other alternatives have been

considered, in the treatment of congenital and acquired nystagmus

4.10 - Drugs Used in Substance Dependence 4.10.1 - Alcohol Dependence

Acamprosate s 333mg e/c tablets

Chlordiazepoxide 5mg & 10mg capsules

Disulfiram s

200mg tablets

Nalmefene s 18mg film coated tablets -approved in line with NICE. Prescribing should be undertaken by a specialist clinician who is providing the appropriate psychosocial support.

4.10.2 - Nicotine Dependence NRT products should be prescribed by brand to ensure the first choice products are supplied

Nicotine

2mg & 4mg sugar-free chewing gum (Nicorette is the

gum of choice) 10mg, 15mg & 25mg/16 hour patches (Nicorette Invisi) 7mg & 14mg & 21mg /24 hour patches (Nicotinell is

the patch of choice as potential savings to be made) 2mg & 4mg lozenges (Niquitin is the lozenge of choice); 2mg sublingual tablets 15mg cartridges for use in inhalator Nicorette Quickmist 1mg per dose 1.5mg & 4mg mini lozenges (NiQuitin Minis Lozenges)

Bupropion (Amfebutamone)

150mg m/r tablets

Varenicline http://www.bnf.org/bnf/bnf/current/doc/106099.htm 500microgram & 1mg tablets - approved in line with NICE

4.10.3 - Opioid Dependence A Buprenorphine 400 microgram, 2mg & 8mg sublingual tablets

- approved for the management of opioid dependence in line

with NICE

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A Suboxone 2mg/500microgram sublingual tablets containing, buprenorphine 2 mg, & naloxone 500 micrograms 8mg/2mg tablets sublingual tablets containing buprenorphine 8 mg & naloxone 2 mg

A Lofexidine 200 microgram tablets

A Methadone 5mg in 5ml oral solution & 5mg in 5ml sugar free solution - approved for the management of opioid dependence in line

with NICE - see section 4.7.2 for other preparations

A Naltrexone 50mg tablets

- approved for the management of opioid dependence in detoxified formerly opioid-dependent people in line with NICE - also approved for use in reducing agitation and/ or self-injurious behaviour in patients with learning disabilities or autism (unlicensed indication). Treatment must be initiated by an appropriate hospital specialist and GPs should only be asked to prescribe it for responders in accordance with a shared care guideline Link to Shared Care Guideline

4.11 - Drugs for Dementia

N.B. Treatment with these drugs should only be initiated by psychogeriatricians and certain neurologists. Linked to information sheet

First Choice

B Donepezil 5mg & 10mg tablets 5mg & 10mg orodispersible tablets - approved in line with NICE

Alternatives

B Rivastigmine 1.5mg, 3mg, 4.5mg & 6mg capsules 4.6mg , 9.5mg and 13.3mg per 24 hour patches - approved in line with NICE - Patches approved for patients unable to tolerate treatment with oral rivastigmine due to nausea and vomiting, and for patients requiring treatment with an acetylcholinesterase inhibitor who are unable to take oral medication e.g. due to swallowing difficulties or ‘nil by mouth’ prior to surgery.

B Galantamine 4mg, 8mg & 12mg tablets 8mg, 16mg & 24mg sustained release capsules; 4mg / ml oral solution - the oral solution is only approved for limited short-term use in the management of hospital patients who are unable to swallow tablets/ capsules. It is not for use in patients whose dementia is so severe that they can no longer swallow tablets

- approved in line with NICE

B Memantine Treatment titration pack. 10mg & 20mg tablets 10mg / ml oral solution B - approved in line with NICE

Linked to information sheet

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5. Infections

Antimicrobial agents should be used according to locally agreed guidelines and restrictions.

5.1 – Antibacterial Drugs 5.1.1 – Penicillins 5.1.1.1 – Benzylpenicillin and Phenoxymethylpenicillin Benzylpenicillin 600mg injection

Phenoxymethylpenicillin (Penicillin V)

250mg tablets 125mg in 5ml & 250mg in 5ml oral solutions

Long Acting Penicillins

R Procaine Penicillin u 1,200,000 units in 2ml injection

Benzathaine Penicillin u 2.4mega unit injection For use in genitourinary medicine

5.1.1.2 – Penicillinase Resistant Penicillins Flucloxacillin 250mg & 500mg capsules

125mg in 5ml & 250mg in 5ml oral solutions 250mg, 500mg & 1g injections

R Temocillin r 1g injection -approved for use only on the advice of microbiologists.

5.1.1.3 – Broad Spectrum Penicillins Amoxicillin 250mg & 500mg capsules; 3g sachets

125mg in 1.25ml paediatric suspension 125mg & 250mg in 5ml sugar-free syrups 250mg, 500mg & 1g injections

Co-amoxiclav Amoxicillin with clavulanic acid: 250/125 & 500/125 tablets 250/125 dispersible tablets 125/31 & 250/62 sugar-free suspensions 400/57 sugar-free suspension (Augmentin Duo®) 500/100 (600mg) & 1,000/200 (1.2g) injections (quantities are indicated in the form co-Amoxiclav x/y where x = mg amoxicillin and y = mg clavulanic acid)

5.1.1.4 – Antipseudomonal Penicillins Piperacillin with Tazobactam

2.25g & 4.5g injections containing piperacillin 2g & tazobactam 250mg/2.25g vial & piperacillin 4g & tazobactam 500mg/4.5g vial

5.1.1.5 – Mecillinams Pivmecillinam 200mg tablets

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5.1.2 – Cephalosporins and other Beta-Lactam Antibiotics Cephalosporins Cefalexin 250mg & 500mg capsules

Cefuroxime 250mg, 750mg & 1.5g injections

Ceftazidime 250mg, 500mg, 1g & 2g injections

Cefotaxime 500mg, 1g & 2g injections

Ceftriaxone 250mg, 1g & 2g injections

Cefixime 200mg tablets

100mg in 5ml paediatric suspension - also approved for the prevention of irinotecan induced diarrhoea,

specialist use only R

R Ceftaroline 600mg injection - approved for use on the advice of microbiology/infectious disease physicians..

R Ceftolozane/tazobactam

(Zerbaxa®)

1.5g injection -approved for use in multiple antibiotic resistant strains of enterobacteriaceae, pseudomonas and acinetobacters on the advice of microbiology/infectious disease physicians.

R Ceftobiprole 500mg injection -approved for the treatment of hospital acquired pneumonia and other infections on the advice of microbiology/infectious disease physicans.

Other Beta-Lactam Antibiotics

R Aztreonam 500mg, 1g & 2g injections 75mg powder for inhalation -approved in line with NHS England specialised commissioning criteria for the treatment of chronic pulmonary Pseudomona aeruginosa infection in patients with cystic fibrosis.

R Doripenem 500mg injection - for use as a 2nd line alternative to meropenem in patients known to be infected with organisms resistant to meropenem, or with those organisms with raised MICs to meropenem. Should only be on the advice of microbiology or infectious disease consultants.

Ertapenem 1g injection

Meropenem 500mg & 1g injections

5.1.3 – Tetracyclines Oxytetracycline 250mg tablets

Doxycycline 50mg & 100mg capsules; 100mg dispersible tablets

Minocycline 50mg & 100mg capsules and tablets

Lymecycline 408mg capsules ( tetracycline 300mg)

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R Tigecycline 50mg injection (Used by NUTH only)

Demeclocycline s 150mg capsules - for the treatment of inappropriate antidiuretic hormone secretion – treatment is initiated by specialists only.

5.1.4 – Aminoglycosides

R Gentamicin 80mg in 2ml & 20mg in 2ml IV/IM injections 5mg in 1ml intrathecal injection

bone cement & beads (for use in orthopaedic surgery) s

80mg in sodium chloride 0.9% (50ml) intravesical installation – for use in recurrent UTI’s, refractory to all other

treatments s

Gentamicin sulphate su Powder for mixing in bone cement to created antibiotic loaded spacers and beads. - for the treatment of patients with infections associated with total knee or hip arthroplasty, and for local antibiotic therapy in other orthopaedic infections

B Nebulised Gentamicin u - for long term therapy in non-cystic fibrosis bronchiectasis usually in patients having > 3 exacerbations per annum with an organism identified as being sensitive to gentamicin.

Linked to information sheet

R Amikacin 100mg in 2ml & 500mg in 2ml injections

R Neomycin 500mg tablets; 1g in 10ml syrup u

R Tobramycin s 80mg in 2ml & 240mg in 6ml injections 300mg in 4ml (Bramitob®) nebuliser solution - only for long-term 2nd line use in the management of chronic pulmonary infection due to Pseudomonas aeruginosa in cystic fibrosis (CF) patients

300mg in 5ml (Tobi®) - only to be used in existing patients as it is cheaper to use Bramitob.

TOBI Podhaler – 28mg capsule plus podhaler - approved for CF patients in line with NICE

Spectinomycin u 2g injection

- only approved for the treatment of gonorrhoea in adults. 5.1.5 – Erythromycin and Related Drugs Preferred Choices Erythromycin 250mg e/c tablets

125mg, 250mg & 500mg in 5ml syrups 1g intravenous injection (as lactobionate)

Clarithromycin 250mg & 500mg tablets 125mg in 5ml & 250mg in 5ml suspensions 500mg injection

Alternative Azithromycin 250mg capsules & tablets

200mg in 5ml suspension

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5.1.6 – Clindamycin Clindamycin 150mg capsules

75mg in 5ml suspension u 300mg in 2ml & 600mg in 4ml injections

5.1.7 – Some Other Antibacterials

Colistin 1,500,000 unit tablets 250,000 units in 5ml syrup 500,000, 1,000,000 & 2,000,000 unit injections

R Colobreathe – 125mg capsule plus Turbospin inhaler – approved for CF patients in line with NICE

Chloramphenicol 250mg capsules 1g injection

R Daptomycin 350mg injection & 500mg injection

R Linezolid 600mg tablets 100mg in 5ml suspension 600mg in 300ml IV infusion

Rifampicin

150mg & 300mg capsules 100mg in 5ml syrup 600mg vials for IV infusion

Fidaxomicin s 200mg tablets

- approved for third line use in the treatment of C. difficile. To be initiated on the recommendation of a consultant microbiologist

Fosfomycin 500mg capsules u R

4g injections R

3g sachets s -sachets can be initiated in primary care for the treatment of UTIs

caused by multi-resistant organisms following advice from microbiology only. Most cost effective option to be used.

Rifaximin s 550mg tablets

-approved as therapy for preventing episodes of overt hepatic encephalopathy in line with NICE

Sodium Fusidate

(Fusidic acid)

250mg film coated tablets 250mg in 5ml suspension (Fusidic Acid) - equivalent in therapeutic effect to 175mg sodium fusidate

Vancomycin 125mg capsules

500mg injection

Teicoplanin 200mg & 400mg injections

20mg in 4ml intrathecal injection u 5.1.8 – Sulphonamides and Trimethoprim Trimethoprim 100mg & 200mg tablets

50mg in 5ml suspension

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Co-trimoxazole (Sulphamethoxazole 5 parts & trimethoprim 1 part)

480 mg tablets (plain or dispersible) 960mg tablets 240mg in 5ml & 480mg in 5ml suspensions 480mg in 5ml ampoules for IV infusion

5.1.9 – Antituberculous Drugs Isoniazid 50mg & 100mg tablets

50mg in 5ml elixir u 50mg in 2ml injection

Rifampicin 150mg & 300mg capsules 100mg in 5ml syrup 600mg injection (for IV infusion)

Rifampicin & Isoniazid

Rifinah 150 tablets – rifampicin 150mg + isoniazid 100mg

Rifinah 300 tablets – rifampicin 300mg + isoniazid 150mg

Rifater Tablets - rifampicin 120mg, isoniazid 50mg & pyrazinamide

300mg

Pyrazinamide u 500mg tablets - licensed formulation discontinued, consider using Rifater where appropriate

Ethambutol 100mg & 400mg tablets

Rifabutin 150mg capsules

Streptomycin 1g injection

5.1.10 – Antileprotic Drugs Dapsone 50mg & 100mg tablets

– used in the treatment of leprosy and some skin conditions (e.g. dermatitis herpetiformis, pemphigoid on the advice of dermatologists)

5.1.11 – Metronidazole Metronidazole 200mg & 400mg tablets

200mg in 5ml suspension 500mg & 1g suppositories 50mg in 10ml injection & 500mg in 100ml IV infusion

5.1.12 – Quinolones First Choice Ciprofloxacin

250mg, 500mg & 750mg tablets 250mg in 5ml suspension 100mg & 200mg, 400mg intravenous infusions

Alternatives Moxifloxacin 400mg tablets

Ofloxacin 200mg & 400mg tablets

200mg in 100ml intravenous infusion - for use in the treatment of pelvic inflammatory disease and chlamydia genital tract infections in accordance with local primary care guidelines

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Levofloxacin 250mg & 500mg tablets 500mg in 100ml intravenous infusion - not normally used in Newcastle’s hospitals

5.1.13 – Urinary-Tract Infections Nitrofurantoin 50mg & 100mg tablets

50mg capsules ) in macrocrystalline form 100mg m/r capsules ) (Macrodantin® & Macrobid®) 25mg in 5ml sugar-free suspension -Liquid presentations of nitrofurantoin are very expensive compared to other solid dosage formulation. Please consider whether capsules can be used

Methenamine Hippurate (Hipprex®)

1g tablets -approved as second line agent for prophylaxis in patients with recurrent UTI’s who have failed long-term antibiotic prophylaxis, have contraindications to antibiotics or breakthrough infection with resistant organisms

5.2 – Antifungal Drugs Amphotericin 50mg injection

50mg liposomal injection (Ambisome®)

R Anidulafungin 100mg injection - approved for the treatment of invasive candidiasis.

R Caspofungin 50mg & 70mg injections

R Micafungin 50mg & 100mg injections - for second line use as an alternative to caspofungin in children and neonates.

Fluconazole 50mg, 150mg & 200mg capsules 50mg in 5ml & 200mg in 5ml suspensions 50mg in 25ml & 200mg in 100ml IV infusions

Flucytosine 500mg tablets u 2.5g in 250ml IV infusion

Itraconazole 100mg capsules 50mg in 5ml oral solution 250mg in 25ml injection for IV infusion

R Posaconazole 200mg in 5ml oral suspension. - approved for the prevention of invasive fungal infection in immunocompromised patients in whom there is a specific risk of aspergillus infection or where fluconazole and itraconazole are not tolerated or are unlikely to be sufficiently effective (largely for secondary prevention) -approved for patients with invasive fungal infections that are not responding to other treatments or where they are not tolerated (largely in place of liposomal amphotericin/ voriconazole)

Griseofulvin 125mg & 500mg tablets - very limited use where terbinafine is contraindicated

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Terbinafine 250mg tablets

Nystatin 100,000 units/ml suspension

R 100,000 unit pessaries u – second line treatment for vaginal non albicans infection, for patients who have not responded to standard treatments such as azoles. Prescribing is restricted to the GUM clinics.

R Voriconazole 50mg & 200mg capsules 200mg vials for IV infusion

5.3 – Antiviral Drugs 5.3.1 – Human Immunodeficiency Virus Nucleoside Reverse Transcriptase Inhibitors

R Abacavir 300mg tablets 100mg in 5ml (20mg per ml) sugar-free oral solution

R Didanosine 100mg & 200mg tablets; 250mg & 400mg e/c caps

R Abacavir & Lamivudine

(Kivexa®)

600mg abacavir/600mg lamivudine tablets

R Lamivudine (3TC) 150mg & 300mg tablets (treatment of HIV) 50mg in 5ml oral solution (HIV)

R Stavudine 20mg, 30mg & 40mg capsules 5mg in 5ml oral solution

R Tenofovir 245mg tablets - approved for chronic hepatitis B in line with NICE

R Triumeq® 600mg abacavir/50mg dolutagrevir/300mg lamivudine

R Zidovudine 100mg & 250mg capsules 50mg in 5ml sugar-free syrup 200mg in 20ml (10mg/ml) concentrate for IV infusion

Protease Inhibitors

R Atazanavir 150mg,200mg & 300mg capsules - for limited use as part of triple therapy where other protease inhibitors are unsuitable

R Darunavir u 300mg, 400mg, 600mg & 800mg tablets

R Fosamprenavir u 700mg tablets

R Nelfinavir 250mg tablets

R Lopinavir & Ritonavir

(Kaletra®)

100mg lopinavir/25mg ritonavir and 200mg lopinavir/50mg ritonavir tablets 400mg lopinavir/100mg ritonavir in 5ml oral solution

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R Indinavir 200mg & 400mg capsules

R Ritonavir 100mg capsules

R Saquinavir 200mg capsules, 200mg gel filled capsules

Non-Nucleoside Reverse Transcriptase Inhibitors

R Efavirenz 50mg, 100mg & 200mg capsules

R Etravirine 100mg tablets & 200mg tablets

R Nevirapine 200mg tablets, 50mg in 5ml suspension

R Rilpivirine 25mg tablets -for patients who, due to renal impairment, require reduced doses that are not able to be accommodated by the fixed combination product.

Other Antiretroviral Agents

R Dolutegravir 50mg film coated tablets - approved for treatment of HIV-1 in adults and adolescents (subject to NHS England funding)

R Enfuvirtide 90mg/ml injection

R Maraviroc 150mg & 300mg tablets - approved For use in the treatment of patients with HIV infections that are resistant to standard therapy in accordance with British HIV Association and EACS guidelines

R Raltegravir 400mg tablets - approved for use in the treatment of patients with HIV infections that are resistant to standard therapy in accordance with British HIV Association and EACS guidelines

Combination Products

R Atripla® Tablets containing efavirenz 600 mg, emtricitabine 200 mg & tenofovir disoproxil (as fumarate) 245 mg

R Combivir®

Tablets containing lamivudine 150mg & zidovudine 300mg

R Descovy®

Tablets containing emtricitabine 200mg & tenofovir alafenamide -in line with NHS England Commissioning Policy

R Eviplera® Tablets containing rilpivirine 25mg, emtricitabine 200mg & tenofovir disoproxil (as fumarate) 245 mg - for use in patients who cannot tolerate Atripla therapy.

R Genvoya® Tablets containing elvitegravir 150mg, cobicistat 150mg, emtricitabine 200mg & tenofovir alafenamide -in line with NHS England Commissioning Policy

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R Odefsey®

Tablets containing emtricitabine 200mg, rilpivirine 25mg & tenofovir alafenamide -in line with NHS England Commissioning Policy

R Stribild® Tablets containing cobicistat 150mg, elvitegravir 150mg, emtricitabine 200mg, tenofovir disoproxil (as fumarate) 245mg

R Trizivir® Tablets containing abacavir 300mg, lamivudine 150mg & zidovudine 300mg

R Truvada® Tablets containing 200mg of emtricitabine & 245mg of tenofovir disoproxil (equivalent to 300mg of tenofovir disoproxil fumarate or 136mg of tenofovir)

5.3.2 - Herpesvirus infections 5.3.2.1 Herpes simplex and varicella–zoster infection First Choice Aciclovir (Acyclovir)

200mg, 400mg & 800mg tablets/dispersible tablets 200mg in 5ml suspension 250mg & 500mg IV infusions

Alternative Valaciclovir 500mg tablets

5.3.2.2 – Cytomegalovirus infections

R Foscarnet Sodium 24mg/ml intravenous infusion (6g in 250ml)

R Ganciclovir 500mg intravenous infusion

R Valganciclovir 450mg tablets, 250mg in 5ml oral solution - this has replaced an unlicensed 450mg in 5ml suspension

R Cidofovir r 375mg in 5ml (75mg/ml) solution for injection. - for use in the prevention and treatment of cytomegalovirus infection and for limited use by ENT Surgeons in the treatment of selected patients with respiratory papillomatosis (an unlicensed indication)

5.3.3 – Viral Hepatitis

R Lamivudine

(3TC)

100mg tablets 25mg in 5ml oral solution - other formulations licensed for use in patients with HIV infection - see section 5.3.2

R Adefovir

10mg tablets - mainly used in combination with lamivudine. Other treatments now preferred for new patients

- approved for chronic hepatitis B in line with NICE

R Entecavir 500 microgram & 1mg tablets - approved for Hepatitis B in line with NICE

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R Tenofovir 245mg tablets - for use in the treatment of chronic hepatitis B. Preferred treatment for many patients and may be used in combination with lamivudine

5.3.3.2 – Chronic hepatitis C

R Boceprevir 200mg capsules - approved in combination with peginterferon alfa and ribavirin for genotype 1 chronic hepatitis C in adults with compensated liver

disease in line with NICE

R Daclatasvir 30mg and 60mg tablets -approved for the treatment of chronic hepatitis C in line with NICE and/or NHS England commissioning policy

R Dasabuvir 250mg tablets -approved for the treatment of chronic hepatitis C in line with NICE and/or NHS England commissioning policy

R Ombitasvir/paritaprevir/

ritonavir (Viekirax)

Tablets containing ombitasvir 12.5mg, paritaprevir 75mg & ritonavir 50mg -approved for the treatment of chronic hepatitis C in line with NICE and/or NHS England commissioning policy

R Simeprevir 150mg capsules -approved for the treatment of chronic hepatitis C in line with NICE and/or NHS England commissioning policy

R Sofosbuvir 400mg film coated tablets -approved for the treatment of chronic hepatitis C in line with NICE and/or NHS England commissioning policy

R Sofosbuvir with

Ledipasvir (Harvoni®)

400mg / 90mg film coated tablets -approved for the treatment of chronic hepatitis C in line with NICE and/or NHS England commissioning policy

R Telaprevir 375mg tablets - approved in combination with peginterferon alfa and ribavirin for genotype 1 chronic hepatitis C in adults with compensated liver disease in line with NICE

5.3.4 – Influenza Virus First Choice Oseltamivir 30mg, 45mg & 75mg capsules

6mg in 1ml (30mg in 5ml) oral suspension - approved for the treatment of influenza in line with NICE

- approved for the prophylaxis of inlfluenza in line with NICE

Alternative Zanamivir 5mg/blister dry powder for inhalation via Diskhaler®

- approved for the treatment of inlfluenza in line with NICE

- approved for the prophylaxis of inlfluenza in line with NICE - for use if there is resistance to oseltamivir

5.3.5 – Respiratory Syncytial Virus

R Palivizumab 50mg & 100mg injections -approved in line with NHS England Commissioning Policy.

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R Ribavirin 6g in 300ml inhalation

1.2g in 12ml IV injection u - for use on specialist microbiological advice e.g. in Lassa fever

200mg tablets and capsules - approved for chronic hepatitis in line with NICE, see peginterferon alfa 2a/2b

- approved treatment for children and young people with chronic

hepatitis C NICE

5.4 – Antiprotozoal Drugs 5.4.1 – Antimalarials

Chloroquine Sulphate 200mg tablets ( 150mg chloroquine base)

68mg in 5ml syrup ( 50mg in 5ml chloroquine) 272.5mg in 5ml injection ( 200mg in 5ml chloroquine)

Mefloquine 250mg tablets

Primaquine u 7.5mg tablets

Proguanil 100mg tablets

Pyrimethamine 25mg tablets

Malarone® Tablets (100mg proguanil & 250mg atovaquone)

Paediatric tablets (proguanil 25mg & atovaquone 62.5mg)

R Artesunate u 60mg injection - approved for severe malaria in in line WHO guidance.

Quinine Quinine sulphate 200mg tablets

Quinine dihydrochloride 300mg in 1ml injection u 5.4.2 – Amoebicides Metronidazole - see section 5.1.11

Diloxanide Diloxanide furoate 500mg tablets – included in North of Tyne antimicrobial guidelines for use after metronidazole in the treatment of amoebic dysentery

5.4.4 – Antigiardial Drugs Metronidazole - see section 5.1.11

Mepacrine u 100mg tablets

5.4.5 Leishmaniacides

R Sodium stibogluconate 100mg/ml injection - approved for the treatment of visceral and cutaneous leishmaniasis

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5.4.8 – Drugs for Pneumocystis Pneumonia

R Pentamidine 300mg injection 300mg in 5ml nebuliser solution

Co-trimoxazole - see section 5.1.8

R Atovaquone 750mg in 5ml sugar-free suspension -approved for use in patients intolerant of co-trimoxazole

5.5 – Anthelmintic 5.5.1 – Drugs for Threadworms

R Albendazole u 400mg chewable tablets

Mebendazole 100mg tablets 100mg in 5ml suspension

Pripsen Sachets - containing piperazine phosphate 4g & sennosides

15.3mg/sachet 5.5.5– Schistosomicides

R Praziquantel Biltricide u 500mg tablets

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6. Endocrine System

6.1 – Drugs Used in Diabetes 6.1.1 – Insulins

Preferred (All Human)

Alternatives (All Human)

Type of prefilled ‘pen’ inj device / Comments

6.1.1.1 – Short acting insulins

Very Rapidly Acting Vial Cartridge Pen

Insulin Aspart (Novorapid®) 10ml 5x3ml* 5x3ml Flexpen®

Insulin Lispro (Humalog®) 10ml 5x3ml 5x3ml Kwikpen®

Insulin Lispro (Humalog 200®) 5x3ml Kwikpen

Rapidly Acting

Human Actrapid 10ml - - Humulin® S 10ml 5x3ml -

R Humulin R® u 500 units/ml 10ml - - For use in a very small number of insulin resistant patients that require very high doses

6.1.1.2 – Intermediate and Long Acting Insulins

NPH (isophane) insulins

Insulatard® 10ml 5x3ml* 5x3ml Innolet

Humulin® I 10ml 5x3ml 5x3ml

Biphasic insulin mixtures

Conventional

Mixtard® 30 10ml 5x3ml* 5x3ml Innolet Humulin® M3 10ml 5x3ml 5x3ml

Analogue

Biphasic Insulin Aspart (NovoMix® 30)

- 5x3ml* 5x3ml Flexpen®

Biphasic Insulin Lispro (Humalog® Mix 25 & Mix 50)

- 5x3ml 5x3ml Kwikpen®

Long acting (basal) insulins

Insulin Glargine (Abasaglar®) – First Choice

5x3ml 5x3ml KwikPen®

Insulin Glargine (Toujeo®) 3 x

1.5ml Solostar®

Insulin Glargine (Lantus®) 10ml 5x3ml 5x3ml Optiset®, OptiClik® &

SoloStar® in line with NICE

Insulin Detemir (Levemir®) - 5x3ml 5x3ml

N.B. Preloaded pens and Innolet devices should only be used where cartridges are not suitable. * For use with Novopen and Novopen Penmate injection devices

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6.1.2 – Oral Antidiabetic Drugs 6.1.2.1 – Sulphonylureas First Choice Gliclazide

40mg & 80mg tablets

Alternatives

Glimepiride

1mg, 2mg, 3mg & 4mg tablets

Tolbutamide 500mg tablets Glibenclamide 2.5mg & 5mg tablets

– not used in Newcastle’s hospitals

6.1.2.2- Biguanides Metformin 500mg & 850mg tablets; 500mg, 750mg & 1000mg m.r.

tablets r 500mg and 1g powder for oral solution in sachets 500mg in 5ml sugar-free oral solution The sachets are preferred to the ready-made oral solution-much cheaper. The once daily m.r. tablets (Glucophage SR)

are only approved for use in patients who have failed to tolerate the conventional tablets despite careful dose titration Metformin is also approved for use in Polycystic Ovary Syndrome

6.1.2.3 – Other Antidiabetic Drugs

B Exenatide r 5 microgram and 10 microgram per dose prefilled injection pens containing a 250microgram/ml solution for subcutaneous injection. - treatment must be initiated by a consultant diabetologist and use is

limited to overweight patients with type 2 diabetes in line with NICE Linked to information sheet

2mg prolonged release injection - approved for use in line with NICE

Liraglutide s

18mg prefilled pen containing a 6mg/ml solution for subcutaneous injection. - approved for type 2 diabetes in line NICE

B Lixisenatide 10 microgram and 20 microgram per dose pre filled injection pens

Pioglitazone

15mg, 30mg & 45mg tablets

Sitagliptin s 25mg, 50mg & 100mg tablets – Treatment must be initiated by a consultant diabetologist

Acarbose s 50mg & 100mg tablets

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Dapagliflozin 5mg & 10mg film coated tablets -approved for treatment of type 2 diabetes in line with NICE

-approved for the treatment of type 2 diabetes as monotherapy in line

with NICE

Canagliflozin 100mg film coated tablets

-approved for combination treatment of type 2 diabetes in line with NICE

-approved for the treatment of type 2 diabetes as monotherapy in line

with NICE

Empagliflozin 10mg & 25mg tablets

-approved in combination therapy for the treatment of type 2 diabetes

in line with NICE

-approved for the treatment of type 2 diabetes as monotherapy in line

with NICE 6.1.4. – Treatment of Hypoglycaemia Glucose (or sugar) 40% oral gel – 9.2g glucose/23g oral ampoule (GlucoGel®,

formerly known as Hypostop®) 25% & 50% injections (also 5% & 10% IV infusions)

Chronic Hypoglycaemia

Glucagon 1mg (1 unit) injection (with syringe)

Diazoxide 50mg tablets (suspensions can be obtained / prepared if

needed)

6.1.5 Treatment of Diabetic Neuropathy First Line

Duloxetine

30mg & 60mg capsules 30mg & 60mg capsules -

Second Line

Amitriptyline See section 4.3

Third Line

Gabapentin See section 4.8.1

– also approved for hospital use as an adjunct to other treatment in the management of peri/post-operative pain. GPs should not be asked to prescribe gabapentin for this unlicensed indication.

Alternatives Tramadol 50mg capsules; 50mg dispersible tablets

100mg in 2ml injection

6.2 – Thyroid and Antithyroid Drugs 6.2.1 – Thyroid Hormones

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First Choice Levothyroxine (Thyroxine)

25, 50 & 100 microgram tablets 25 & 100 microgram in 5ml sugar-free suspensionsu

Alternative

Liothyronine 20 microgram tablets; 20 microgram injection 6.2.2 – Antithyroid Drugs First Choice Carbimazole 5mg & 20mg tablets Alternatives

Propylthiouracil 50mg tablets

R Aqueous Iodine Oral

Solution

Oral solution (Lugol’s Iodine) containing 130mg total iodine/ml (5% iodine & 10% potassium iodide)

R Iopanoic acid u 500mg tablets - approved for use in rapid blockade of thyrotoxicosis in otherwise medically resistant patients prior to surgery/thyroidectomy

R Potassium iodate u 85mg tablets - mainly used by medical physics

Propranolol 80mg m/r capsules

- preferred formulation for relief of thyrotoxic symptoms -see section 2.4 for other formulations

6.3 – Corticosteroids

6.3.1 – Replacement Therapy

Fludrocortisone 100 microgram tablets

Hydrocortisone

10mg & 20mg tablets

10mg in 5ml suspension u 100mg injection (as the sodium succinate)

6.3.2 – Glucocorticoid Therapy First Choice Prednisolone 1mg, 5mg, 25mg & 50mg tablets;

5mg soluble tablets & 1mg/1ml oral solution (Prednisolone

Dompé) -lowest cost formulation to be used when clinically appropriate

Alternatives Dexamethasone 500 microgram & 2mg tablets

2mg in 5ml oral solution; 5mg in 5ml oral solution u 500 microgram soluble tablets 3.3mg/ml and 6.6mg/2ml injection* (both expressed as dexamethasone base)

*PLEASE NOTE* There are two different strength preparations of dexamethasone injection available in the UK (3.8mg/ml and 3.3mg/ml) where traditionaly a 4mg/ml preparation was available and prescribed as such. To avoid confusion the 3.3mg/ml strength is the preparation of choice

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in the acute Trusts. Where previously a 4mg dose would have prescribed it is appropriate to prescribe a 3.3mg dose (or multiples thereof). This is because the range of doses given in clinical practice varies widely and subsequent doses tend to be adjusted to reflect clinical response. If 4mg is required please ensure that the appropriate volume of 3.3mg/ml is (e.g. 1.2ml) prescribed (or mulitples thereof).

Methylprednisolone 2mg, 4mg & 16mg tablets – NHCT 40mg, 125mg, 500mg & 1g injections (as the sodium succinate)

Hydrocortisone 10 & 20mg tablets; 10mg in 5ml suspension u 100mg injection (as the sodium succinate)

Triamcinolone Acetonide 40mg in 1ml intramuscular / intra-articular injection

6.4 – Sex Hormones 6.4.1 – Female Sex Hormones 6.4.1.1 – Oestrogens and Hormone Replacement Therapy (HRT) Oestrogen Only Tablets First Choice Estradiol (Oestradiol) 1mg & 2mg tablets

Alternative Oestrogens, conjugated (Premarin)

625 microgram & 1.25mg tablets

Ethinylestradiol s 2 microgram u & 10 microgram tablets - approved for use on advice from appropriate specialists (mainly endocrinologists)

Patches and Other Formulations Estradiol

Twice weekly matrix patches releasing approximately 25, 50, 75 & 100 microgram/24 hours (e.g. Evorel®) Once weekly matrix patches releasing approx. 50 & 100 microgram estradiol/24 hours (Progynova TS®) 0.1% gel (Sandrena®)

Oestrogen and Progestogen Sequential Combined Therapy (tablets) First Choice Prempak-C®

0.625 & 1.25 tablets (packs of 28 conjugated oestrogen tablets [625 microgram or 1.25mg] + 12 norgestrel 150 microgram tablets)

Alternatives

Elleste Duet® Packs of 16 x 1mg estradiol tablets + 12 x 1mg estradiol

& 1mg norethisterone tablets

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Femoston® 1/10 Packs of 14 estradiol 1mg tablets + 14 tablets containing

estradiol 1mg & dydrogesterone 10mg

Femoston® 2/10 Packs of 14 estradiol 2mg tablets + 14 tablets containing estradiol 2mg & dydrogesterone 10mg

Sequential Combined Therapy (patches) Evorel Sequi® Pack containing 4 patches releasing 50 micrograms

estradiol/24 hours & 4 patches releasing 50 micrograms estradiol and 170 micrograms norethisterone acetate/ 24 hours

Continuous Combined Therapy (tablets)

Low dose Premique low -dose®

0.3mg conjugated oestrogen + medroxyprogesterone acetate 1.5mg tablets.

Standard dose Kliovance®

Tablets containing estradiol 1mg & norethisterone acetate 500 micrograms

High dose Kliofem®

Tablets containing 2mg estradiol & norethisterone acetate 1mg

Continuous Combined Therapy (patches) Evorel Conti® patches Pack containing 8 patches releasing 50 micrograms

estradiol/24 hours & 170 micrograms norethisterone acetate/24 hours

Gonadomimetic Tibolone 2.5mg tablets

Selective Oestrogen Modulator

Raloxifene s 60mg tablets - for use on the advice of specialists in the prevention and treatment of osteoporosis where alternative treatments are inappropriate

6.4.1.2 – Progestogens First Choice Norethisterone 5mg tablets Alternatives Medroxyprogesterone acetate

2.5mg, 5mg & 10mg tablets - sometimes used as a progestogen component of HRT

100mg & 200mg tablets - for use in malignant disease see section 8.3.2.

50mg in ml injection - see sections 7.3.2.2 for use of medroxyprogesterone acetate injection in contraception.

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Progesterone 200mg & 400mg pessaries

50mg in 1ml injection

Ulipristal s 5mg tablets

- approved for the pre-operative treatment of uterine fibroids up to a maximum of four 3 month intermittent courses, as per its product license and reviewed regularly. - approved for the medical treatment of uterine fibroids up to a maximum of four 3 month intermittent courses, as per its product license and reviewed regularly.

6.4.2 – Male Sex Hormones Testosterone and Esters First Choice Testosterone Undecanoate 1g in 4ml (250mg/ml) oily injection (Nebido®) Alternatives

Testosterone gel s

50mg/5g (1%) sachets (Testogel®) 10mg/0.5ml (2%)/ metered dose from pump (Tostran®) 50mg/5g (1%) tubes (Testim®) For use on advice from endocrinologists

Sustanon 250® 1ml injection (testosterone propionate 30mg, testosterone

phenylpropionate 60mg, testosterone isocaproate 60mg & testosterone decanoate 100mg)

Testosterone Undecanoate 40mg capsules

Anti-Androgens

Cyproterone Acetate s 50mg & 100mg tablets

- approved for use on the advice of a urologist

Finasteride 5mg tablets

6.4.4 – Gender Dysphoria – (Unlicensed Indication)

Linked to information sheet

B Goserelin s 3.6mg injection

B Leuprorelin s 11.25mg injection

B Estradiol (Oestradiol) s 1mg & 2mg tablets

B Estradiol s

Twice weekly matrix patches releasing approximately 50, 75 & 100 microgram/24 hours 0.1% gel (Sandrena®) 0.06% gel (Oestrogel®)

B Finasteride s 5mg tablets

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B Cyproterone Acetate s 50mg & 100mg tablets

B Spironolactone s 25mg & 100mg tablets

B Testosterone

Undecanoate s

1g in 4ml (250mg/ml) oily injection (Nebido®)

B Sustanon 250® s 1ml injection (testosterone propionate 30mg, testosterone

phenylpropionate 60mg, testosterone isocaproate 60mg & testosterone decanoate 100mg)

B Testosterone gel s 50mg/5g (1%) sachets (Testogel®)

6.5 – Hypothalamic and Pituitary Hormones and Anti-Oestrogens 6.5.1 – Hypothalamic and Anterior Pituitary Hormones and Anti-Oestrogens

Anti-Oestrogens Clomifene Citrates 50mg tablets – Under review

Anterior Pituitary Hormones

Corticotrophins

R Tetracosactide

(Tetracosactrin)

250 microgram in 1ml injection, 1mg in 1ml depot injection

Gonadotrophins

R Chorionic

Gonadotrophin

1,500 units & 5,000 units injections

R Fertility treatment

B HypogonadismH Linked to information sheet

R Menotrophin

(Menopur®)

(75 units FSH & 75 units LH activity) injection Pre filled syringes

Growth Hormones TA188 Human growth hormone (somatropin) for the treatment of growth failure in children

R Somatropin 1st line

Omnitrope® 5-mg (15-unit) vial (powder with diluent) for use with Omnitrope Pen L® device 3.3 mg (10 units)/ml, 1.5 ml (5-mg, 15-unit) cartridge & 6.7 mg (20 units)/ml, 1.5 ml (10-mg, 30-unit) cartridge - for use with Omnitrope Pen 5® & Omnitrope Pen 10® devices respectively - least expensive formulation of somatropin. Omnitrope should be used in all de novo paediatric patients where possible. 2nd line

Norditropin SimpleXx® 1.5ml cartridges for use in Nordipen® devices - 5mg (15 units), 10mg (30 units) & 15mg (45 units) - 2nd least expensive alternative formulation for patients who cannot

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tolerate omnitrope.

Saizen® 8mg vials (powder with diluent) Saizen® 5.83 mg/ml solution for injection (6mg cartridges), 8 mg/ml solution for injection (12mg and 20mg cartridges) - for use in EasyPod® device - to be used in patients with compliance issues

3rd line

Genotropin Miniquick® syringes - 0.2mg (0.6 units) 0.8mg (2.4 units)1.4mg (4.2 units) 0.4mg (1.2 units) 1mg (3 units) 1.6mg (4.8 units) 0.6mg (1.8 units) 1.2mg (3.6 units) 2mg (6 units) - to be used for patients when travelling.

Zomacton® 12 unit (4mg) injection - Needle free presentation.

1st line: 75% to 85% of total mg usage 2nd line: 15% to 25% of total mg usage 3rd line: up to 5% of total mg usage

TA64 Human growth hormone (somatropin) in adults with growth hormone deficiency

R Somatropin Genotropin® cartridges for use in Genotropin pens - 16 unit (5.3mg) & 36 unit (12mg) in 1ml Genotropin Miniquick® syringes - 0.2mg (0.6 units) 0.8mg (2.4 units)1.4mg (4.2 units) 0.4mg (1.2 units) 1mg (3 units) 1.6mg (4.8 units) 0.6mg (1.8 units) 1.2mg (3.6 units) 2mg (6 units) - To be used for patients when travelling.

Hypothalamic Hormones Gonadorelin 100 microgram in 1ml injection

Protirelin (TRH) 200 microgram in 1ml injection u 6.5.2 – Posterior Pituitary Hormones and Antagonists Posterior Pituitary Hormones Desmopressin 10 microgram/dose nasal spray

R 2.5 & 150 microgram/dose nasal sprays u

100 microgram/ml nasal drops 100 microgram & 200 microgram tablets 120 microgram sublingual tablets

R 4 microg in 1ml inj. & 15 microg in 1ml injection

R Argipressin 20 units in 1ml injection (Synthetic Vasopressin)

R Terlipressin 1mg vials for preparing injection

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Antidiuretic Hormone Antagonists

Demeclocycline s 150mg capsules – Treatment to be initiated by specialist

R Tolvaptan (Jinarc®) 15mg, 30mg, 45mg 60mg & 90mg tablets -approved for the treatment of autosomal dominant polycystic kidney

disease in line with NICE

6.6 – Drugs Affecting the Bone Metabolism 6.6.1 – Calcitonin Calcitonin (Salmon) /

Salcatonin s

400 units in 2ml injection

Teriparatide s 250 microgram/ml prefilled pen - approved for the secondary prevention of osteoporotic fragility fractures in postmenopausal women who are confirmed to have

osteoporosis primary in line with NICE 6.6.2 – Bisphosphonates and Other Drugs Affecting Bone Metabolism Treatment of Hypercalcaemia Preferred Products

R Disodium Pamidronate 30mg injection

R Zoledronic Acid 4mg injection - for use in hypercalcaemia of malignancy and the prevention of skeletal events in patients with metastatic breast cancer. Not approved for preventing skeletal events in patients with prostate cancer. To avoid confusion it is recommended that this product is prescribed by brand name i.e. Zometa®

Alternative Sodium Clodronate 520mg tablets or 800mg tablets Osteoporosis Prevention and Treatment First Choice Alendronate Sodium

10mg tablets (taken daily) 70mg tablets (taken once weekly) – preferred

- approved for the primary prevention of osteoporosis in

postmenopausal women in line with NICE - approved for the secondary prevention of osteoporotic fragility fractures in postmenopausal women who are confirmed to have

osteoporosis primary in line with NICE

Alternatives Risedronate Sodium

5mg tablets (taken daily) 35mg tablets (taken once weekly for osteoporosis) - preferred - approved for the primary prevention of osteoporosis in line with

NICE - approved for the secondary prevention of osteoporotic fragility fractures in postmenopausal women who are confirmed to have

osteoporosis in line with NICE

30mg tablets (for Paget’s disease)

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Strontium Ranelate

2g sachets - approved for the primary prevention of osteoporosis in

postmenopausal women in line with NICE - approved for the secondary prevention of osteoporotic fragility fractures in postmenopausal women who are confirmed to have

osteoporosis in line with NICE – approved for 2nd line use in patients who do not respond adequately to bisphosphonates

Ibandronic Acid 50mg tablets

- for use in the reduction of bone damage in patients with metastatic breast cancer. Not approved for use in the treatment of patients with other forms of cancer (e.g. prostate) or for the treatment of osteoporosis

3mg in 3ml injection

- for use where oral bisphosphonates are not appropriate (not tolerated, contra-indicated because of upper gastro-intestinal problems or insufficiently effective)

R Zoledronic acid 5mg injection - approved for the treatment of Paget’s disease and post-menopausal osteoporosis in those patients where oral risedronate is contraindicated, inconvenient, poorly tolerated or ineffective in reducing bone turnover. Postmenopausal osteoporosis in patients where oral bisphosphonates are contraindicated, not tolerated or where they are ineffective, as reflected by declining bone density measurements. To avoid confusion it is recommended that this product is prescribed by brand name i.e. Aclasta®

Raloxifene s 60mg tablets - not recommend for primary prevention of osteoporosis in

postmenopausal women NICE

- approved for the secondary prevention of osteoporotic fragility fractures in postmenopausal women who are confirmed to have

osteoporosis in line with NICE

- approved for use on the advice of specialists in the prevention and treatment of osteoporosis where alternative treatments are inappropriate

B Denosumab 60mg in 1ml solution in prefilled syringe - approved for use in the treatment of postmenopausal osteoporosis in line with NICE - also approved for male patients who dont tolerate isphosphonates or

strontium ranelate . Linked to information sheet

70mg in 1ml (120mg) vial - approved for the prevention of skeletal-related events in adults with bone metastases from solid tumours in line with NICE - not approved for therapy induced bone loss in non-metastatic prostate cancer NICE

6.7 – Other Endocrine Drugs 6.7.1 – Bromocriptine and Other Dopaminergic Drugs

B Bromocriptine 2.5mg tablets

Cabergoline 500 microgram & 1mg tablets

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6.7.2 – Drugs Affecting Gonadotrophins First choice

Leuprorelin s 3.75mg & 11.25mg pre filled syringes (also see section

8.3.4.2) Alternatives

Goserelin s 3.6mg & 10.8mg injections (also see section 8.3.4.2)

N.B. Leuprorelin is now substantially less expensive than goserelin

Nafarelin s 200 micrograms/dose nasal spray

B Triptorelin s

3.75mg injection (Gonapeptyl Depot®) – approved for use in the treatment of precocious puberty Linked to

information sheet 11.25mg injection (Decapeptyl SR®) – approved for use in the treatment of precocious puberty Linked to

information sheet

Danazol s 100mg & 200mg capsules

Buserelin s 150 micrograms/dose nasal spray

R Cetrorelix 0.25mg injection 3mg vial powder for reconstitution -only approved for the inhibition of premature LH surges in women undergoing controlled ovarian stimulation

6.7.3 – Metyrapone and Trilostane

Metyrapone s 250mg capsules

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7. Obstetrics, Gynaecology and Urinary-Tract Disorders

7.1 – Drugs Used in Obstetrics 7.1.1 – Prostaglandins and Oxytocics

R Dinoprostone 0.75mg in 0.75ml injections 3mg vaginal tablets 10mg pessary

Oxytocin 10 units in 1ml injection

5 units in 50ml syringes u

R Gemeprost 1mg pessaries

Syntometrine® Injection (ergometrine maleate 500 microg & oxytocin 5 units)

Ergometrine 500 micrograms in 1ml injection

R Carboprost 250 micrograms in 1ml injection

7.1.2 - Mifepristone

R Mifepristone 200mg tablets

7.1.3 – Myometrial Relaxants

R Atosiban 6.75mg in 0.9ml injection & 37.5mg in 5ml (7.5mg/ml) concentrate for IV infusion

7.2 – Treatment of Vaginal and Vulval Conditions

Preparations for Vaginal Atrophy

First Choice Estriol (Oestriol)

0.01% cream (Gynest) 80g – preferred choice 0.1% cream (Ovestin)

Alternatives Estradiol (Oestradiol)

10 microgram vaginal tablets

Non hormonal preparations for vaginal atrophy Hyalofemme r

Vaginal moisturiser 30g plus applicator - for restricted use for the relief of symptoms of atrophic vaginitis, in women who have had treatment for gynaecological malignancy and where topical estriol is not a treatment option.

7.2.2 – Anti-infective Drugs

Candidiasis First Choice Clotrimazole 1% cream

2% thrush cream; 10% vaginal cream 100mg & 200mg & 500mg pessaries

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Other Infections Metronidazole 0.75% vaginal gel

Clindamycin 2% vaginal cream

7.3 – Contraceptives 7.3.1 – Combined Hormonal Contraceptives Standard Oestrogen Content (30 or 35 micrograms Ethinylestradiol) First Choice

Rigevidon Ethinylestradiol 30 microgram/levonorgestrel 150 microgram

Alternatives

Microgynon 30 Ethinylestradiol 30 microgram/levonorgestrel 150 microgram

Cilique® Ethinylestradiol 35 microgram/norgestimate 250 microgram

Cilest® Ethinylestradiol 35 microgram/norgestimate 250 microgram

Millinette 30/75® Ethinylestradiol 30 microg. & gestodene 75 microg.

Femodene® Ethinylestradiol 30 microgram/gestodene 75 microgram

Loestrin 30® Ethinylestradiol 30 microg. & norethisterone 1.5mg

Gedarel 30/150® Ethinylestradiol 30 microgram/desogestrel 150 microgram.

Marvelon® Ethinylestradiol 30 microgram/desogestrel 150 microgram.

Ovysmen® Ethinylestradiol 35 microgram/norethisterone 500 microg.

Yasmin® Ethinylestradiol 30 microgram/drospirenone 3 mg

Lucette® Ethinylestradiol 30 microgram/drospirenone 3mg

Co-cyprindiol Ethinylestradiol 35 microg. & cyproterone acetate 2mg - Co-cyprindiol should be reserved for those women requiring treatment for the androgenic conditions such as severe acne or moderately severe hirsutism. It is recommended that treatment be withdrawn 3 to 4 cycles after the androgenic condition(s) has/have completely resolved and that it is not continued solely to provide oral contraception. Venous thromboembolism occurs more frequently in women taking co-cyprindiol than those taking a low-dose combined oral contraceptive Repeat courses may be given if the androgen-dependent condition(s) recur. Generic co-cyprindiol is much cheaper than Dianette®

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Low Dose Oestrogen Content (20 micrograms Ethinylestradiol) First Choice

Millinette® 20/75 Ethinylestradiol 20 microg. & gestodene 75 microg.

Femodette® Ethinylestradiol 20 microg. & gestodene 75 microg.

Gedarel® 20/150 Ethinylestradiol 20 microg. & desogestrel 150 microg.

Mercilon® Ethinylestradiol 20 microg. & desogestrel 150 microg. tablets

Phased Formulations

Tri-Regol® 6 Ethinylestradiol 30 microg. & levonorgestrel 50 microg. + 5 Ethinylestradiol 40 microg. & levonorgestrel 75 microg. + 10 ethinylestradiol 30 microg. & levonorgestrel 125 microg.

Logynon®

6 Ethinylestradiol 30 microg. & levonorgestrel 50 microg. + 5 Ethinylestradiol 40 microg. & levonorgestrel 75 microg. + 10 ethinylestradiol 30 microg. & levonorgestrel 125 microg.

Transdermal (standard strength)

Evra® Self-adhesive patches releasing approx. 20 micrograms

ethinylestradiol and 150 micrograms norelgestromin/ 24 hours

– for use by a small number of women with gastrointestinal absorption problems or with compliance issues

Vaginal (low strength)

NuvaRing® r Vaginal ring releasing ethinylestradiol approx. 15

micrograms/24 hours and etonogestrel approx.. 120 micrograms/24 hours -to be initiated by a specialist in contraceptive services for patients who are unable to tolerate progesterone-only contraceptives, have experienced skin irritation with the transdermal patch, and are unable to take oral contraceptives due to allergy

Emergency Contraception

Levonorgestrel (Levonelle 1500®)

Pack containing one levonorgestrel 1.5mg tablet

Ulipristal (ellaOne®)

Pack containing one ulipristal acetate 30mg tablet - recommended by NETAG as the preferred drug treatment option for post-coital contraception for patients who present between 72 and 120 hours following unprotected intercourse.

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Levonorgestrel is still recommended for patients who present at up to 72 hours following unprotected intercourse, and the use of ulipristal should be second-line to the use of a copper containing IUCD SPC

7.3.2 – Progestogen-Only Contraceptives

7.3.2.1 – Oral Progestogen-Only Contraceptives

First Choice

Cerelle®Error! Bookmark not defined.

Desogestrel 75 microgram tablets

Cerazette Desogestrel 75 microgram tablets

Alternatives

Femulen® Ethynodiol diacetate 500 microgram tablets

Micronor® Norethisterone 350 microgram tablets

Norgeston® Levonorgestrel 30 microgram tablets

7.3.2.2 – Parenteral Progestogen-Only Contraceptives Etonogestrel 68mg implant (Nexplanon®)

- replaced Implanon and differs in that it is impregnated with radio opaque material.

Medroxyprogesterone acetate

150mg in 1ml depot injection (Depo-Provera®) 104mg/0.65ml S/C injection (Sayana Press®)

7.3.2.3 –Progestogen-Only Intra-Uterine System

Levonorgestrel (Mirena®)

Levonorgestrel 52mg in a T-shaped intra-uterine system - for idiopathic menorrhagia. Especially in women requiring (reversible) contraception. Also used for protection with endometrial hyperplasia during oestrogen replacement therapy. Lasts for up to 5 years- for use in accordance with agreed guidelines

Levonorgestrel (Jaydess®)

Levonorgestrel 13.5mg in a T-shaped intra-uterine system - low dose long acting reversible contraceptive. Lasts for up to 3 years. - not recommended as first line for nulliparous women

7.3.3 – Spermicidal Contraceptives Nonoxynol ‘9’ (Gygel®) 2% gel

7.3.4 – Copper Intrauterine Devices

First Choice

TT380 Slimline® Intrauterine device – replacement every 10 years

Mini TT380 Slimline® Intrauterine device – replacement every 5 years

T-Safe Cu380A® Intrauterine device – replacement every 10 years

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Alternatives Nova T 380® Intrauterine device – replacement every 5 years

7.4 – Drugs for Genito-Urinary Disorders

7.4.1 – Drugs for Urine Retention

Alpha-Blockers

First Choice Tamsulosin 400 microgram m/r capsules

Alternatives

Alfuzosin XL 10mg m/r tablets

-for use on advice of urologists only

Doxazosin 1mg, 2mg & 4mg tablets 7.4.2 – Drugs Used for Urinary Frequency, Enuresis and Incontinence Urinary Incontinence

First Choice

Both first choice agents should be tried sequentially, unless contraindicated, before moving on to second choice treatment options

Oxybutynin 2.5mg & 5mg tablets 2.5mg in 5ml elixir -not appropriate for frail elderly patients or those with cognitive impairment

Tolterodine 1mg & 2mg tablets Second Choice

Darifenacin

7.5mg and 15mg m/r tablets -to be given following tolterodine (when oxybutynin is not appropriate e.g. frail elderly patients or those with cognitive impairment)

Oxybutynin Patch 36mg (releasing approximately 3.6mg in 24 hours) self-

adhesive patch -for patients in whom 2 antimuscarinics have proved efficacious but the side effects are intolerable, or for patients who cannot swallow tablets

Mirabegron

25mg and 50mg m/r tablets -approved for use when antimuscarinics don’t work, are not suitable or

side effects are unacceptable, in line with NICE

Specialist Initiation or GP Initiation (in patients who do not wish to be referred to secondary care and have failed first/second line treatments)

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Fesoterodine s 4mg & 8mg f/c tablets

Solifenacin s 5mg and 10mg tablets

Giggle Incontinence

A Methylphenidate 5mg & 10mg tablets; 10mg, 20mg & 30mg m/r capsules (Equasym XL), 18mg, 27mg & 36mg m/r tablets (Concerta XL) - The effects of

Equasym XL lasts for about 8 hours compared with about 12 hours for Concerta XL - approved for use as a third line option in the treatment of giggle incontinence. Its use should be subject to a therapeutic trial to be reviewed after two months and considered for Shared Care if patients have been shown to respond after the trial period.

Nocturnal Enuresis Desmopressin

100 & 200 microgram tablets 120 microgram sublingual tablets Nasal formulations no longer licensed for treating nocturnal enuresis (see section 6.5.2 for other formulations)

Amitriptyline 10mg, 25mg & 50mg tablets

25mg in 5ml sugar-free oral solution

Imipramine 10mg & 25mg tablets; 25mg in 5ml syrup u 7.4.3 – Drugs Used in Urological Pain Alkalinisation of Urine Potassium Citrate Mixture (potassium citrate 3g & citric acid 500mg in 10ml) Treatment of Interstitial Cystitis

R Pentosan Polysulphate

Sodium u

50mg capsules

Sodium Hyaluronate u (Cystistat®)

40mg in 50ml solution for instillation into the bladder

R Sodium hyaluronate

(1.6%)/ Sodium chondroitin

Sulphate (2%) (Ialuril®)u

50ml solution for instillation into the bladder - second line treatment in patients who have failed Cystistat

R Whitmore cocktail u 60ml bladder installation (Hydrocortisone 100mg/ Heparin Sodium 10,000units/Bupivacaine 50mg in Sodium Chloride 0.9%)

7.4.4 – Bladder Instillations and Urological Surgery

Glycine 1.5% large volume solutions (up to 3 litres)

Sodium Chloride 0.9% large volume solutions (up to 3 litres)

Water Large volumes (up to 3 litres)

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Catheter Patency Solutions

Chlorhexidine 0.02% (1 in 5,000) solution in 100ml sachets

Sodium Chloride 0.9% solution in 100ml sachets

Solution G (Urotainer Twin Suby G®)

2 x 30ml sachets (citric acid 3.23%, magnesium oxide 0.38%,

sodium bicarbonate 0.7%, disodium edetate 0.01%)

Solution R (Urotainer Twin Solution R®)

2 x 30ml sachets (citric acid 6%, gluconolactone 0.6%, magnesium

carbonate 2.8%, disodium edetate 0.01%)

7.4.5 – Drugs for Erectile Dysfunction First Choice

Sildenafil 25mg, 50mg & 100mg tablets - also approved for specialist use in treating pulmonary hypertension

(see section 2.5.1a) R and secondary Raynaud’s disease R

Second Choice Avanafil 50mg, 100mg & 200mg tablets

-approved only for second line use after intolerance to, or failure of, sildenafil

Alternatives

Tadalafil 10mg & 20mg tablets - also approved for specialist use in treating secondary Raynaud’s’ disease R

Alprostadil 10 & 20 microgram dual chamber injections, 10, 20 & 40

microg. Injections, (Caverject®) – Caverject® dual chamber injections are easier to use and less expensive than the vials.

10, 20 and 40 microg starter pack and dual chamber injection (Viridal Duo®) –approved for use whilst supply issues surrounding Caverject are ongoing

3mg/g cream (Vitaros®)

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8. Malignant Disease and Immunosuppression

8.1 – Cytotoxic Drugs

8.1.0 – Drugs for Cytotoxic Induced Side Effects

Dexrazoxane 500mg vials (with diluent) –for use in line with NECN Extravasation

R Glucarpidase -approved for the urgent treatment of methotrexate-induced renal dysfunction (subject to NHS England funding)

Methotrexate-Induced Mucositis and Myelosuppression

Calcium Folinate (Folinic Acid)

15mg tablets 3mg, 15mg, 30mg & 300mg injections

A 1mg per ml mouthwash u can be prepared if needed

Urothelial Toxicity

Mesna 1g in 10ml injection; 400mg tablets

8.1.1 – Alkylating Agents

R Bendamustine 25mg & 100mg injections- For - approved for the first line treatment of CLL (Binet stage B or C) in patients for whom fludarabine combination chemotherapy is not

appropriate in line with NICE - NECDAG approved for use in combination with rituximab for patients with CLL not fit for FCR chemotherapy and not fit for alemtuzumab. - approved for Low Grade Non-Hodgkins Lymphoma in line with NICE - not recommended for (low grade) non-Hodgkin's lymphoma that is refractory to rituximab or a rituximab-containing regimen NICE

R Busulfan (Busulphan) 2mg tablets; 25mg capsules u

60mg in 10ml inj

R Carmustine 100mg injection 7.7mg implants - approved for newly diagnosed glioblastoma multiforme (GBM) in line with NICE

R Chlorambucil 2mg tablets

R Cyclophosphamide 50mg tablets 1g injection

R Estramustine 140mg capsules To be reviewed

R Ifosfamide 2g injection

R Lomustine 10mg u & 40mg capsules

R Melphalan 2mg tablets; 50mg injection

R Thiotepa 15mg injection

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R Treosulfan 5g infusion

8.1.2 – Cytotoxic Antibiotics

R Dactinomycin 500 microgram injection

R Bleomycin 15,000 units injection (strength formerly expressed as 15mg)

- also approved for use in intralesional sclerotherapy in the treatment of low-flow vascular lesions – unlicensed indication

R Daunorubicin 20mg injection, 10mg, 15mg, 35mg & 40mg prefilled

syringes

R Doxorubicin 50mg injection - includes use with DC Beads for use in transcatheter arterial chemoembolisation (TACE) therapy in patients with hepatocellular cancer

20mg & 50mg pegylated liposomal injection - approved for second-line (or subsequent) treatment in advanced ovarian cancer in line with NICE -approved for the treatment of recurrent ovarian cancer in line with NICE

R Epirubicin 50mg & 100mg u injections

R Idarubicin 5mg & 10mg capsules 10mg injection

R Mitomycin 10mg, 20mg & 40mg injections - Also approved for treatment in combination with 5-Fluorouracil for bladder cancer concurrent with radiotherapy.

0.04% preservative free eye drops su

R Mitoxantrone

20mg in 10ml injection

R Pixantrone

29mg powder for reconstitution injection -approved as a possible treatment for adults with multiply relapsed or refractory aggressive non-Hodgkin's B cell lymphoma if they have previously been treated with rituximab and they are having third- or

fourth-line treatment. NICE 8.1.3 – Antimetabolites

R Azacitidine 100mg vial - approved for myelodysplastic syndromes, CLL and AML In line with

NICE

R Capecitabine 150mg & 500mg tablets - approved for dukes c colon cancer in line with NICE

- approved for advanced gastric cancer in line with NICE - approved for metastatic colorectal cancer in line with NICE

R Cladribine (Leustat®) 10mg in 10ml solution for preparing infusions, 2mg in 1ml subcutaneous injection - approved for Hairy Cell Leukemia only

R Cytarabine 100mg in 5ml & 1g in 10ml injections

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50mg vial- Intrathecal injection , cytarabine encapsulated in liposomes

R Fludarabine 10mg tablets; 50mg injection - approved for the second line therapy of B-cell CLL in line with NICE

- not approved for monotherapy in the first line treatment of CLL NICE

R Fluorouracil 2.5g in 50ml & 2.5g in 100ml injections

10mg in 0.4ml subconjunctival injection u

(FOLFIRINOX is approved for the management of selected patients with inoperable pancreatic cancer in patients with performance status 0-1).

R Gemcitabine 200mg & 1g & 2g injection - approved in combination with paclitaxel for metastatic breast cancer in line with NICE - NECDAG approved for the second line treatment of women with partially platinum – sensitive, platinum resistant or platinum refractory advanced ovarian cancer (To be used when liposomal doxorubicin (Caelyx)) is unavailable). - approved for pancreatic cancer in line with NICE -approved for the treatment of recurrent ovarian cancer in line with NICE

R Mercaptopurine

A when used for inflammatory

bowel disease

50mg tablets

20mg in 1ml suspension u

R Methotrexate

A when used in chronic

inflammatory conditions, e.g. Crohn’s disease, rheumatoid arthritis

2.5mg tablets

10mg in 5ml oral solution u

Injections (various strengths) – including prefilled syringesu 5mg in 2ml intrathecal injection

R Tegafur with Uracil

(Uftoral®)

Capsules containing tegafur 100mg & uracil 224mg - approved for metastatic colorectal cancer in line with NICE

R Tioguanine

(Thioguanine)

40mg tablets

50mg in ml suspension u

R Pemetrexed 100mg & 500mg injection - approved for mesothelioma in line with NICE. Funding has to be agreed on an individual patient basis if treatment is not in line with NICE.

- not approved for locally advanced or metastatic NSCLC NICE - approved in combination with cisplatin for the first line treatment of locally advanced or metastatic NSCLC (non-squamous cell histology) in

line with NICE - approved for the maintenance treatment for locally advanced or

metastatic NSCLC (non-squamous cell histology) in line with NICE -approved for maintenance treatment of non-squamous non-small lung

cancer after pemetrexed and cisplatin in line with NICE and NHS England Commissioning Policy

8.1.4 – Vinca Alkaloids and Etoposide

R Etoposide 50mg & 100mg capsules 100mg in 5ml & 500mg in 25ml injections

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R Vinblastine 10mg injection

R Vincristine 2mg in 2ml injection 2mg in 20ml prefilled syringe 2mg in 50ml infusion bags

R Vindesine 5mg injection

R Vinorelbine 20mg, 30mg capsules 10mg in 1ml & 50mg in 5ml injections

8.1.5 – Other Antineoplastic Drugs

R Amsacrine 75mg in 15ml injection

R Arsenic Trioxide 10mg in 10ml ampoule - NECDAG approved relapsed or refractory acute promyelocytic leukaemia (APL).

R Carboplatin 50mg in 5ml & 450mg in 45ml injections

R Bortezomib 3.5mg injection - approved for relapsed multiple myeloma in line with NICE - approved in combination with an alkylating agent and a corticosteroid

for the first-line treatment of multiple myeloma in line with NICE

- approved as induction therapy for multiple myeloma in line with NICE

-approved for the treatment of adults with mantle cell lymphoma that has not been treated before, if haemotopoietic stem cell transplantation

is not suitable, in line with NICE

R Cetuximab 100mg in 20ml & 500mg in 100ml vials for IV infusion - approved for the first-line treatment of metastatic colorectal cancer in

combination with FOLFOX in line with NICE

- monotherapy or combination chemotherapy is not recommended for the treatment of people with metastatic colorectal cancer that has

progressed after first-line chemotherapy NICE - NECDAG approved for K-RAS wild type metastatic colorectal cancer:

- second line use in combination with chemotherapy in patients that have progressed on previous chemotherapy - third line use as a single agent in patients who have failed oxaliplatin- and irinotecan based therapy and who are intolerant to irinotecan

- approved for locally advanced squamous cell carcinoma of the head

and neck in line with NICE - not approved in combination with platinum-based chemotherapy for recurrent and/or metastatic squamous cell cancer of the head and neck

NICE

R Cisplatin 50mg in injection

R Crisantaspase 10,000 units injection – Asparaginase(E-coli) (MEDAC)

R PEG Asparaginase u 3750iu vial – Approved for the treatment of ALL

-approved for the treatment acute lymphoblastic leukaemia in line with

NICE

R Dacarbazine 500mg injection

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R Streptozocin u 1g injection (only available on a named patient basis)

R Tretinoin 10mg capsules

R Irinotecan 40mg in 2ml & 100mg in 5ml injections

R Docetaxel 20mg & 80mg injections - approved for early node-positive breast cancer in line with NICE

- approved for hormone refractory metastatic prostate cancer in line with NICE

R Hydroxycarbamide

(Hydroxyurea)

500mg capsules

500mg in 5ml suspension u

R Mitotane 500mg tablets

R Paclitaxel 30mg in 5ml, 100mg in 16.7ml and 150mg in 25ml concentrate for preparing IV infusion -approved for the treatment of recurrent ovarian cancer in line with NICE

R Abraxane r - 5mg in 1ml powder for suspension for infusion - restricted for use within its current license for metastatic breast cancer patients who cannot tolerate standard taxanes. - approved in combination with a platinum-based compound or platinum-based therapy alone (cisplatin or carboplatin) for first line therapy in ovarian cancer in line with NICE

- approved in combination with a platinum-based drug (carboplatin or cisplatin) for second-line (or subsequent) therapy in ovarian cancer in line with NICE - approved metastatic breast cancer in line with NICE

- not recommended for the adjuvant treatment of women with early node-positive breast cancer NICE

R Procarbazine 50mg capsules

R Trastuzumab 150mg vial for preparing IV infusion - approved for metastatic or locally advanced inoperable gastric cancers

in line with NICE - approved for early stage HER2-positive breast cancer in line with

NICE - approved for advanced HER2-positive breast cancer in line with

NICE - not recommended in combination with an aromatase inhibitor for the first-line treatment in postmenopausal women with metastatic hormone-

receptor-positive breast cancer that overexpresses HER2 NICE

600mg s/c injection - approved by NHS England for HER2-positive breast cancer in line with NECN guidance

R Axitinib

1mg, 3mg, 5mg and 7mg film coated tablets -approved as treatment for adults with advanced renal cell carcinoma

when tyrosine kinase inhibitors or cytokines have not worked NICE

R Afatinib 20mg, 30mg, 40mg, 50mg film coated tablets -approved as a possible treatment for adults with locally advanced or

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metastatic non-small-cell lung cancer if their cancer tests positive for the epidermal growth factor receptor tyrosine kinase (EGFR-TK)

mutation and they have not had an EGFR-TK inhibitor before NICE and additional NHS England criteria

R Imatinib 100mg & 400mg capsules - approved for the first-line management of people with KIT (CD117)-positive unresectable and/or KIT (CD117)-positive metastatic gastrointestinal stromal tumours (GISTs) in line with NICE (

- approved for the adjuvant treatment of gastrointestinal stromal tumours (GISTs) after surgery when there is a high risk relapse of tumour NICE (subject to NHS England funding) - approved for Philadelphia-chromosome-positive CML in the accelerated phase or with blast crisis in line with NICE - standard-dose imatinib is recommended as an option for the first-line treatment of adults with chronic phase Philadelphia-chromosome-positive CML in line with NICE

R Dabrafenib 50mg and 75mg capsules -approved for the treatment of unresectable or metastatic BRAF V600 mutation-positive melanoma in line with NICE (subject to NHS England funding)

R Erlotinib 25mg, 100mg & 150mg tablets - approved for the first line treatment of locally advanced or metastatic NSCLC that has tested positive for mutations to EGFR-TK in line with

NICE - also approved for second line use, as an alternative to docetaxel, in

NSCLC in line with NICE - monotherapy not approved for maintenance after platinum

chemotherapy in advanced or metastatic NSCLC NICE -approved for the treatment of locally advanced or metastatic non-small-cell lung cancer that has already been treated with non-targetted chemotherapy because of delayed confirmation of epidermal growth factor receptor tyrosine kinase (EGFR-TK) mutation status if: -their cancer tests positive for EGFR-TK mutation -it is not know if the cancer is EGFR-TK mutation- positive because of problems with the test, and the cancer is very likely to be EGFR-TK mutation-positive and it responds to the first 2 cycles of treatment with

erlotinib NICE

R Gefitinib 250mg tablets - approved for first line use in locally advanced or metastatic NSCLC

in line with NICE

R Nilotinib 150mg & 200mg capsules - approved for the first-line treatment of adults with chronic phase Philadelphia-chromosome-positive CML in line with NICE

R Oxaliplatin 50mg & 100mg injections - approved for Dukes C colon cancer in combination with 5-fluorouracil

and folinic acid in line with NICE

- approved for advanced and metastatic colorectal cancer in line with

NICE

R Pazopanib 200mg & 400mg tablets - approved for advanced renal cell carcinoma in line with NICE

R Picibanil u 100 microgram injection

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R Sunitinib 50mg 100mg & 400mg capsules - approved for gastrointestinal stromal tumours (GISTs) in line with NICE - approved for advanced and/or metastatic renal cell carcinoma in line with NICE - not approved for second line use in advanced and/or metastatic renal

cell carcinoma NICE

R Temozolomide 5mg, 20mg, 100mg & 250mg capsules

-approve for the treatment of recurrent malignant glioma in line with NICE - approved for newly diagnosed glioblastoma multiforme (GBM) in line with NICE

R Topotecan 0.25mg & 1mg capsules 1mg & 4mg vials - approved for relapsed NSCLC in line with NICE - approved for recurrent or stage IVB cervical cancer in line with NICE - approved for second-line (or subsequent) treatment in advanced ovarian cancer in line with NICE -approved for the treatment of recurrent ovarian cancer in line with NICE

R Ipilimumab 50mg vial for preparing IV infusion - approved for previously treated advanced melanoma in line with

NICE

- approved for previously untreated advanced melanoma in line with NICE

R Pembrolizumab

50mg vial for preparing IV infusion - approved for the treatment of advanced melanoma after disease

progression with ipilimumab NICE -approved for the treatment of advanced melanoma not previously

treated with ipilimumab NICE

R Vemurafenib 240mg tablets - approved melanoma (BRAF V600 mutation positive, unresectable

metastatic) in line with NICE

R Nintedanib (Vargatef®) 100mg and 150mg soft capsules -approved for the treatment of locally advanced, metastatic or locally recurrent non-small-cell lung cancer who have previously been treated

been with first-line chemotherapy NICE

R Idelalisib 100mg & 150mg film coated tablets -approved in combination with rituximab for the treatment of i) Untreated chronic lymphocytic leukaemia in adults with a 17p deletion

or TP53 mutation; NICE or ii) Chronic lympocytic leukaemia in adults when the disease has been

treated bu has relapsed within 24 months NICE

R Panobinostat

10mg, 15mg and 20mg hard capsules -approved in combination with bortezomib and dexamethasone as an

option for the treatment of multiple myeloma in line with NICE

R Ruxolitinib 5mg, 15mg and 20mg tablets -approved for the treatment of disease-related splenomegaly or

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symptoms in adults with primary myelofibrosis, post polycythaemia vera myelofibrosis or post essential thrombocythaemiaa myelofibrosis, only in

people with intermediate-2 or high-risk disease in line with NICE

R Olaparib 50mg capsules -approved for the maintenance treatment of BRCA 1 or 2 mutated, relapsed, platinum-sensitive ovarian, fallopian tube and peritoneal cancer in people whose relapsed disease has responded to platinum-based

chemotherapy in line with NICE

R Cabazitaxel 40mg/1ml concentrate for IV infusion -approved for the treatment of hormone relapsed metastatic prostate

cancer treated with with docetaxel in line with NICE

R Trabectedin 250microgram injection -approved for the treatment of recurrent ovarian cancer in line with

NICE

R Nivolumab 10mg in 1ml concentrate for IV infusion (4ml & 10ml vials) -For the treatment of locally advanced or metastatic squamous non-small cell lung cancer (NSCLC) after prior chemotherapy in adults (subject to NHS England funding) -approved for the treatment of advanced (unresectable or metastatic)

melanoma in adults in line with NICE -approved in combination with ipilimumab for treating advanced

melanoma in line with NICE and NHS England Commissioning Policy

R Ceritinib 150mg capsule -approved for use in previously treated anaplastic lymphoma kinase

positive non-small-cell-lung cancer in line with NICE and NHS England Commissioning Policy

R Trametinib 500microgram and 2mg film coated tablets -approved in combination with dabrafenib for the treatment of

unresectable or metastatic melanoma in line with NICE and NHS England Commissioning Policy

R Everolimus (Votubia®) 2.5mg, 5mg and 10mg capsules -approved for the treatment of angiomyolipomas associated with tuberous sclerosis in line with NHS England Commissioning Policy

R Trifluridine & tipiracil 15mg/6.14mg & 20mg/8.19mg tablets -approved for previously treated metastatic colorectal cancer in adults in

line with NICE and NHS England Commissioning Policy

R Talimogene 106 plaque forming units/1ml & 10

8 plaque forming

units/1ml solution for injection -approved for the treatment of unresectable metastatic melanoma in line

with NICE and NHS England Commissioning Policy

R Crizotinib 200mg & 250mg capsules -approved for use in untreated anaplastic lymphoma kinase-positive

advanced non-small-cell lung cancer in line with NICE and NHS England Commissioning Policy

R Venetoclax 10mg, 50mg & 100mg tablets -approved for the treatment of adult patients with chronic lymphocytic

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leukaemia (CLL) in the presence of 17p deletion or TP53 mutations, and who are unsuitable for or have failed a B-cell receptor pathway inhibitor; and for the treatment of adult patients with CLL in the absence of 17p deletion ot TP53 mutation, and who are unsuitable for or have failed both chemo-immunotherapy and a B-cell receptor pathway inhibitor in line Early Access to Medicines Scientific Opinion

R Bosutinib 100mg & 500mg film coated tablets -approved as an option for the treatment of chronic, accelerated blast phase Philidephia chromosome positive chronic myeloid leukaemia in adults when they have previously had 1 or more tyrosine kinase inhibitor and imatinib, nilotinib and dasatanib are not appropriate in line with

NICE Other

Radium-223 dichloride -approved for the treatment of hormone-relapsed prostate cancer with

bone metastases in line with NICE

8.2 – Drugs Affecting the Immune Response

Linked to Shared care guidelines: Immunosuppressive treatment following paediatric renal transplantation

Immunosuppressive treatment following adult renal transplantation Immunosuppressive treatment following liver transplants

Immunosuppressive treatment following heart and lung transplants

8.2.1 – Antiproliferative Immunosuppressants

A Azathioprine 25mg & 50mg tablets; 50mg in 5ml u suspension 50mg injection

A Mycophenolate Mofetil

250mg capsules; 500mg tablets 1g in 5ml (200mg/ml) oral suspension 500mg vial for preparing IV infusion - approved for child and adolescent renal transplant recipients in line with NICE

A Mycophenolate

Sodium r

180mg & 360mg e/c tablets – 2nd line therapy in patients who do not tolerate mycophenolate mofetil

8.2.2 – Corticosteroids & Other Immunosuppressants Preferred Product for Most Indications

A Ciclosporin (Cyclosporin, Neoral®)

10mg, 25mg, 50mg & 100mg capsules 100mg in 1ml sugar-free oral solution (oily)

Alternatives

R Basiliximab

20mg vial for preparing IV infusion - approved for limited use in adult renal transplant patients with high risk of acute organ rejection - approved for severe graft versus host disease post haematopoietic stem cell transplantation - approved for induction therapy in renal transplantation in children and adolescents in with combinations that include ciclosporin in line with NICE

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Ciclosporin (Sandimmun®)

50mg in 1ml & 250mg in 5ml concentrate (oily) for IV

infusion R Original oral formulations Sandimmun supplied on request for patients who cannot take Neoral

25mg & 100mg capsules u A 100mg in 1ml sugar-free oral solution (oily) A

A Tacrolimus 500 microgram, 1mg & 5mg capsules (Prograf & Adoport)

1mg in 1ml oral suspension u (to replace 0.5mg/ml oral

suspension) 5mg in 1 ml concentrate for preparing IV infusion - approved for renal transplantation in children and adolescents in line with NICE

500microgram, 1mg, 3mg & 5mg m/r capsules (Advagraf) - only approved for use for prophylaxis of organ rejection in kidney and liver transplantation. Advagraf® is approved for use in patients who are currently prescribed Prograf, and de novo patients should be prescribed Adoport®.

A Sirolimus 1mg & 2mg tablets 1mg per ml oral solution - approved for renal transplantation in children and adolescents in line with NICE

R Antithymocyte

Immunoglobulin (Rabbit)

25mg injection – used in the management of transplant rejection

R Antithymocyte

Immunoglobulin (Horse) u

250mg in 5ml injection -NETAG approved for aplastic anaemia in adults

8.2.3 – Anti-lymphocyte monoclonal antibodies

R Rituximab r 100mg in 10ml & 500mg in 50ml concentrate for IV infusion - for musculoskeletal indications see chapter 10 - approved for first line use in NHL in combination with CHOP in line with NICE - approved for maintenance therapy in follicular NHL that has responded to first line induction therapy with rituximab in

combination with chemotherapy in line with NICE - approved for stage III and IV follicular lymphoma in previously

untreated people in line with NICE - approved for replased or refractory follicular NHL in line with NICE - approved for Post-transplant lymphoproliferative disease - approved for first line use in CLL in combination with fludarabine and

cyclophosphamide in line with NICE - approved for combination with fludarabine and cyclophosphamide for

relapsed or refractory CLL in line with NICE - approved for autoimmune haematological conditions (where conventional treatments have failed) – Autoimmune haemolytic anaemia (AIHA), Evans syndrome, pure red cell aplasia (PRCA), acquired haemophilia A & thrombocytopenia purpura (TTP). - approved for vasculitis (including Wegener’s granulomatosis in adults and children) that has not responded adequately to conventional treatment (e.g. corticosteroids, cyclophosphamide)

NICE and additional NHS Englandcriteria.

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- NECDAG approved for the treatment of NLPHL - NECDAG approved for newly diagnosed mantle cell NHL in patients aged <60 years old. - approved in combination with bendamustine for first line use in CLL (Binet stage B or C) in patients for whom fludarabine combination

chemotherapy is not appropriate NICE - NECDAG approved in combination with bendamustine for patients with CLL not fit for FCR chemotherapy or for patients who relapse within 2 years of FCR chemotherapy and not fit for alemtuzumab. - NECDAG approved with salvage chemotherapy for patients relapsing > 12 months post 1st line therapy with R-CHOP - NECDAG approved with a standard NHL induction regimen in patients who cannot be given an anthracycline. Rituximab with other chemotherapy regimens is an alternative treatment option e.g. DECC, CVP for this group of patients, as part of their first line therapy. Also in addition to the MACOP-B regimen for the small number of young patients with DLBCL, subtype Primary Mediastinal B cell Lymphoma - NECDAG approved for the treatment of hairy Cell Leukaemia (HCL) or Hairy cell Leukaemia varian (HCL-v) who: - relapse early after purine analogue therapy (< 2 years post treatment) - are refractory to purine analogues. - NTAG approved for the treatment of immune (idiopathic)

thrombocytopenic purpura (ITP) in adults and children NTAG -approved for the treatment of immunobullous disease in line with NHS England Commissioning Policy

1.4g solution for sc injection - approved for use as maintenance single agent therapy in FL, mantle cell lymphoma, marginal zone lymphoma and lymphoplasmacytic lymphoma in line with NHS ENGLAND SSC1434

R Alemtuzumab r 30mg in 1ml concentrate for IV infusion

- for use in lymphocytic leukaemia & prevention of graft vs. host disease

on bone marrow transplant patients

- approved for use in high-risk kidney and pancreas transplantation

12mg in 1.2ml concentrate for IV infusion - approved as an option for treating adults with active relapsing–

remitting multiple sclerosis in line with NICE (subject to NHS ENGLAND

funding)

R Obinutuzumab 1000mg in 40ml concentrate for IV infusion -for use in chronic lymphocytic leukaemia in combination with

chlorambucil in patients who have co-morbitities that make full‑dose

fludarabine‑based therapy unsuitable for them, only if

bendamustine‑based therapy is not suitable and the company provides

obinutuzumab with the discount agreed in the patient access scheme in

line with NICE (subject to NHS England funding)

R Ofatumumab 100mg in 5ml concentrate for IV infusion - for use in chronic lymphocytic leukaemia in combination with

chlorambucil if the person is ineligible for fludarabine‑based therapy and

bendamustine is not suitable and the company provides ofatumumab

with the discount agreed in the patient access scheme in line with NICE

(subject to NHS England funding) 8.2.4 – Other Immunomodulating Drugs

R Interferon alfa-2b 10 mega units & 30 mega units multidose pen injections

R Peginterferon alfa-2a 135 & 180 microgram injections in prefilled syringes & 135 &180 microgram prefilled pens

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- approved in combination therapy with ribavirin for moderate to severe

chronic hepatitis C in line with NICE

- approved for mild chronic hepatitis C in line with NICE - approved in line with NICE for combination therapy with ribavirin for adults with chronic hepatitis C:

- who have been treated previously with peginterferon alfa and ribavirin in combination, or with peginterferon alfa monotherapy, and whose condition either did not respond to treatment or responded initially to treatment but subsequently relapsed - or who are co-infected with HIV.

- approved for the initial treatment of adults with chronic hepatitis B in

line with NICE - approved treatment for children and young people with chronic

hepatitis C NICE

R Peginterferon alfa-2b 50, 80, 100, 120, & 150 microgram prefilled inj pens - approved for chronic hepatitis C as for peginterferon alfa 2a

R Interferon beta–1a 30 microgram (6 million units) prefilled pen (Avonex) 22 microgram (6 million units) & 44 microgram (12 million units injections -(Rebif), 1.5ml cartridges containing 22 microgram and 44 microgram per 0.5ml for use in Rebismart injection device 20 microgram prefilled pen (Rebidose) - approved for use when

the cartridges and prefilled syringes are unsuitable.

R Peginterferon beta-1a 125 microgram pre-filled pen (Plegridy)

R Interferon beta-1b

Vials for preparing 750 microgram in 3ml injection (Betaferon)

R Interferon beta-1b Vials for preparing 250 microgram in 1ml injection (Extavia)

R Glatiramer 20mg prefilled syringe injection

R Natalizumab 300mg in 15ml (20mg/ml) vial for preparing infusions - approved for rapidly evolving severe relapsing remitting multiple

sclerosis in line with NICE

R Fingolimod 500 microgram capsules - approved for the treatment of highly active relapsing–remitting

multiple sclerosis in line with NICE - approved for patients who have progressed on glatiramer acetate and

for those patients who are at high risk of progressive multifocal leukoencephalopathy (PML) in line withNHS EnglandClinical Commissioning Policy

R BCG Connaught 81mg vial for bladder instillation

R Thalidomide 50mg capsules - approved in combination with an alkylating agent and a corticosteroid

for the first-line treatment of multiple myeloma in line with NICE - approved for the treatment of bleeding from bowel angiodysplasia in patients with an inherited/acquired bleeding disorder on specialist advice only. -approved for the treatment of severe epistaxis as a result of hereditary haemorrhagic telangiectasia (HHT) who have failed all other treatments.

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R Lenalidomide 5mg, 10mg, 15mg, & 25mg capsules - approved for multiple myeloma in line with NICE

- approved for myelodysplastic syndrome with 5q deletion in line with

NICE (subject to NHS ENGLAND funding)

R Mifamurtide 4mg vial - approved for high-grade resectable non-metastatic osteosarcoma in

line with NICE

R Teriflunomide 14mg film coated tablets -approved as a option for treating adults with active relapsing-remitting multiple sclerosis that isn’t highly active or rapidly evolving severe

relapsing-remitting multiple sclerosis NICE

R Dimethyl Fumarate 120mg and 240mg capsules - approved as a option for treating adults with active relapsing-remitting multiple sclerosis that isn’t highly active or rapidly evolving severe relapsing-remitting multiple sclerosis (subject to NHS ENGLAND funding)

NICE (

8.3 – Sex Hormones and Hormone Antagonists in Malignant Disease 8.3.1 – Oestrogens

Diethylstilbestrol s

(Stilboestrol)

1mg tablets – Initiated with specialist advice.

8.3.2 – Progestogens

Medroxyprogesterone acetate 100mg & 200mg tablets 500mg in 2.5ml injections

Megestrol acetate 160mg tablets

Norethisterone 5mg tablets

8.3.4 – Hormone Antagonists

8.3.4.1 – Breast Cancer

NICE – Hormonal therapies for the adjuvant treatment of early oestrogen – receptor positive

breast cancer

Tamoxifen 10mg & 20mg tablets 10mg in 5ml sugar-free oral solution

Anastrozole 1mg tablets

Exemestane s 25mg tablets

Letrozole 2.5mg tablets

8.3.4.2 – Prostate Cancer and Gonadorelin Analogues Gonadorelin Analogues First Choice

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Clinicians are encouraged to prescribe the least expensive product that is clinically appropriate

Leuprorelin Acetate 3.75mg & 11.25mg prefilled syringes

Goserelin 3.6mg & 10.8mg implants

Triptorelin 3mg, 11.25mg and 22.5mg IM injection

Degarelix (Firmagon) 80mg & 120mg vials (with diluent)

- for the first line treatment of advanced hormone dependant prostate cancer with a PSA > 20ng/l at presentation -approved as an option for treating advanced hormone-dependent prostate cancer in people with spinal metastases in line with NICE

Alternatives

Buserelin 5mg in 5ml injection 150 microgram metered dose nasal sprays

Anti-Androgens

R Abiraterone s 250mg tablets - approved for castration-resistant metastatic prostate cancer in line with NICE

-approved for treating metastatic hormone-relapsed prostate cancer before chemotherapy is indicated in line with NICE and NHS England Commissioning Policy

Bicalutamide s 50mg tablets - initiated with specialist advice

Cyproterone Acetate 50mg & 100mg tablets

R Enzalutamide 40mg capsules -approved for use in adults with metastatic hormone-relapsed prostate cancer, who have not had chemotherapy in line with NICE

Flutamide 250mg tablets – under review

8.3.4.3 – Somatostatin Analogues

B Octreotide 50, 100 & 500 microg. in 1ml & 1mg in 5ml injections 10mg, 20mg & 30mg long-acting injections Linked to information sheet

B Lanreotide 30mg long-acting injection 60mg, 90mg & 120mg autogel injections Linked to information sheet

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9. Nutrition and Blood

9.1 – Anaemias and Some Other Blood Disorders

9.1.1 – Iron Deficiency Anaemia

9.1.1.1 – Oral Iron

First Choice

Ferrous Sulphate 200mg tablets (65mg iron)

Alternatives

Ferrous Fumarate 140mg in 5ml syrup (45mg iron/5ml) – First Choice oral liquid iron preparation 210mg tablets (68mg iron/tablet)

Ferrous Gluconate 300mg tablets (35mg iron)

Ferric Maltol

30mg hard capsules -for the treatment of iron deficiency anemia in patients with inflammatory bowel disease

Sodium Feredetate (Sodium Ironedetate, Sytron®)

190mg in 5ml sugar-free elixir (27.5mg iron/5ml)

9.1.1.2 – Parenteral Iron

R Iron Sucrose 100mg in 5ml injection

R Iron Dextran 100ml in 2ml & 500mg in 10ml injections

R Ferric carboxymaltose 100ml in 2ml & 500mg in 10ml injections For use as an alternative to iron dextran or iron sucrose. Approved for use by renal physicians, gastroenterologists and haematologists. Unlicensed for use in children under 14 years of age.

If used in this age-group, use should only be on the advice of a consultant with the informed consent of the patient and/or his/her parents/carers.

R Iron Isomaltoside 1000 1000mg in 10ml injection

9.1.2 – Drugs Used in Megaloblastic Anaemias

Folic Acid 400 microgram & 5mg tablets 2.5mg in 5ml sugar-free syrup

15mg in 1ml injection u

30mg in 2ml injection

Hydroxocobalamin 1mg in 1ml injection

9.1.3 – Drugs Used in Hypoplastic, Haemolytic and Renal Anaemias Epoetin Alfa and Beta First Choice

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A Darbepoetin 10, 15, 20, 30, 40, 50, 60, 80, 100, 150 & 300 microgram

injections in prefilled syringes

20, 40, 60, 80, 100 & 300 microgram Sureclick® pens

- approved for management of cancer treatment-induced anaemia in women receiving platinum-based chemotherapy for ovarian cancer in line with NICE

Alternatives

A Epoetin Alfa r Prefilled syringes (various strengths) - approved for management of cancer treatment-induced anaemia in women receiving platinum-based chemotherapy for ovarian cancer in line with NICE - no longer regularly used in NUTH

A Epoetin Beta r Cartridges for use in Recopens Prefilled syringes - approved for management of cancer treatment-induced anaemia in women receiving platinum-based chemotherapy for ovarian cancer in line with NICE - no longer regularly used in NUTH

A Methoxy polyethylene

glycol-epoetin beta r (Mircera, Pegzerepoetin alfa)

30, 50, 100, 120, 150, 200 & 250 microgram in 0.3ml and 360

microgram in 0.6ml injections in prefilled syringes. - approved for use as a longer-acting alternative to darbepoetin in a small number of patients receiving peritoneal dialysis

R Eculizumab 300mg/30ml injection -for the treatment of aytipcal haemolytic uraemic syndrome in line with NHS England commissioning policy

Iron Overload

Desferrioxamine s

500mg & 2g injections

Deferasirox s 125mg, 500mg & 250mg dispersible tablets Approved for iron chelation in patients with myelodysplastic syndromes (MDS) - (as per NECN Haematology Group Guidelines) and recommended for use in patients when treatment with desferrioxamine is no longer considered to be appropriate due to progressive iron overload despite maximally tolerated doses of desferrioxamine. – Initiated by specialists only

9.1.4 – Drugs Used in Platelet Disorders

R Anagrelide r 500 microgram capsules – for the treatment of thrombocythemia as a 2nd line agent in patients poorly/non-responsive to hydroxycarbamide therapy

R Romiplostim

250 microgram vial - for the treatment of adults with chronic immune (idiopathic)

thrombocytopenia purpura in line with NICE

R Eltrombopag

25mg and 50mg film coated tablets -for the treatment of adults with chronic immune (idiopathic)

thrombocytopenia purpura NICE 9.1.6 – Drugs Used in Neutropenia

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Recombinant Human Granulocyte-Colony Stimulating Factor

R Lipegfilgrastim (G-CSF) 6mg in 0.6ml injection in prefilled syringes

R Pegfilgrastim (G-CSF) 6mg in 0.6ml injection in prefilled syringes

R Filgrastim (G-CSF) 300 microgram (30 million units) injection in 0.5ml syringes and 1ml vials 480 microgram (48 million units) injection in 0.5ml syringes – available as Neupogen (original brand) and Ratiograstim – a biosimilar product

R Lenograstim

(rHuG-CSF)

263 microgram (33.6 million units) injection vials

R Plerixafor (Mozobil)

24mg in 1.2ml injection SPC

-approved by NHS England Specialist Services for stem cell mobilisation for patients with Hodgkin’s disease, Non-Hodgkins lymphoma or multiple myeloma and meet the policy for Haematopoietic Stem Cell Transplantation.

9.2 – Fluids and Electrolytes

9.2.1 – Oral Preparations for Fluid and Electrolyte Imbalance

9.2.1.1 – Oral Potassium First Choice

Sando-K® Effervescent tablets (12mmol potassium 8 mmol chloride) Alternative

Potassium Chloride 600mg m/r tablets – (8 mmol potassium)

- for use where the effervescent tablets or syrup are unsuitable

5mmol in 5ml sugar-free syrup (Kay-Cee-L)

1mmol in 1ml carbohydrate free oral solution R -approved for use in children with intractable epilepsy being treated with a ketogenic diet

Potassium Removal Polystyrene Sulphonate Resins

Calcium Resonium® Powder (Calcium polystyrene sulphonate)

Resonium A® Powder (Sodium polystyrene sulphonate) 9.2.1.2 – Oral Sodium and Water

Sodium Chloride

600mg m/r tablets (Slow Sodium) - approx. 10 mmol sodium

& chloride per tablet

1mmol / ml oral solution s – treatment should only be initiated with the advice of a specialist

Oral Rehydration Salts Dioralyte® Powder (sodium 12 mmol, potassium 4 mmol, chloride 12 mmol,

citrate 2 mmol & glucose 18 mmol (3.56g) / sachet)

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9.2.1.3 – Oral Bicarbonate

Sodium Bicarbonate 500mg capsules (500mg contains approx. 6 mmol each of sodium and bicarbonate)

1mmol/ml oral solution u

9.2.2 – Parenteral Preparations for Fluid and Electrolyte Imbalance

R Steriflex 165 u Potassium chloride 0.3% (20mmol); sodium chloride 0.9%; and glucose 5% (500ml bag) - approved for diabetic ketoacidosis in paediatric patients

9.2.2.1 - Electrolytes and Water

Water for infusion (Viaflo® - FEØ3Ø4)

1000ml bag -approved for use by the North-East Assisted Ventilation Service (NEAVS)

SECTION UNDER DEVELOPMENT

9.2.2.2 – Plasma and Plasma Substitutes

Gelatin Based Solutions http://bnf.org/bnf/bnf/current/5008.htm Succinylated Gelatin

Volplex (or Gelofusine) 4% succinylated gelatin infusion in sodium chloride 0.9%

(500ml bags)

Isoplex 4%succinylated gelatin infusion in a balanced electrolyte solution containing Na+ 145 mmol, K+ 4 mmol, Mg2+ 0.9 mmol, Cl- 105 mmol, lactate 25 mmol/litre – mainly for use in critical

care areas and other situations where the perceived advantages of a balanced electrolyte plasma substitute

are likely to be clinically important. N.B. Not yet cleared

for use in NUTH.

Starch Based Solutions Tetrastarch

Tetraspan 6% & 10% tetrastarch infusions in a balanced electrolyte

solution containing Na+ 140 mmol, K+ 4 mmol, Mg2+ 1 mmol, Cl-

118 mmol, Ca2+ 2.5 mmol, acetate 24 mmol, malate 5 mmol/litre. N.B. contains calcium

Volulyte r 6% tetrastarch infusion in a balanced electrolyte solution

containing Na+ 137 mmol, K+ 4 mmol, Mg2+ 1.5 mmol, Cl- 110 mmol, acetate 34 mmol/litre. N.B. calcium-free. Mainly for use in indications where calcium containing fluids are

unsuitable.

Plasma-Lyte 148 and Plasma-

Lyte & 5% Glucose r

Infusion in a balanced electrolyte solution containing Na+ 140 mmol, K+ 5 mmol, Mg2+ 1.5 mmol, acetate 27 mmol/litre. Gluconate 23 mmol/litre. n.b. calcium free.

Approved for use in paediatric theatres only.

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Phoxilium 1.2mmol/l

phosphate r

A haemofiltration and haemodialysis fluid containing Na+ 140 mmol, K+ 4 mmol, Mg2+ 0.6 mmol, Ca2+ 1.25mmol/l, Cl- 115.9 mmol/l, HCO3

- 30.0mmol/l, HPO42- 1.20mmol/l –

Approved for use in CRRT in patients not requiring

reduced potassium or low bicarbonate.

9.3 – Intravenous Nutrition

Contact Pharmacy for details of Parenteral Nutrition Services

9.4 – Oral Nutrition

9.5 – Minerals 9.5.1 – Calcium and Magnesium 9.5.1.1 – Calcium Supplements

Preferred Preparations

Calcium Carbonate 1.25g chewable tablets (500mg, 12.6 mmol calcium) 2.5g

chewable tablets (1g, 25 mmol calcium)

500mg in 5ml suspension u

Sandocal® tablets and Calcium Sandoz® syrup

Sandocal 1000 tablets (calcium lactate gluconate, calcium carbonate & citric acid providing 1000mg, 25 mmol calcium)

Calcium Sandoz syrup (calcium gluconate & calcium lactobionate providing 108mg, 2.7 mmol calcium in 5ml)

Alternatives

Calcium Gluconate 10% 10ml injection (approx. 2.2mmol, 89mg calcium)

Calcium Chloride 5 mmol in 5ml & 10 mmol in 10ml injections 10% 10ml injection in syringes also used in some resuscitation boxes at Freeman Hospital Under review

9.5.1.2 – Hypercalcaemia and Hypercalciuria Preferred Products

Disodium Pamidronate 30mg injection

R Zoledronic Acid r 4mg injection - for hypercalcaemia of malignancy and the prevention of skeletal events in patients with metastatic breast cancer. Prescribe by brand name (Zometa®) to avoid confusion with a different strength product used to treat osteoporosis and Paget’s disease

Alternatives

Sodium Clodronate 520mg or 800mg tablets

Calcitonin (Salmon)/ Salcatonin

400 units in 2ml injection See section 6.6.1 for 200 units/dose nasal spray

Hyperparathyroidism

R Paricalcitol 1 microgram, 2 micrograms & 4 micrograms capsules & 5 micrograms per ml injection - approved for use in patients with PTH levels < 800mcg/l but whose

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treatment with alfacalcidol is restricted due to a high calcium level.

R Cinacalcet r 30mg, 60mg & 90mg tablets - approved for the treatment of secondary hyperparathyroidism in patients with end stage renal disease on maintenance haemodialysis where parathyroid gland surgery has failed or is inappropriate in line with NICE

- also for short term use to control symptoms prior to a second attempt at more definitive surgery A - For use in patients with primary hyperparathyroidism for whom parathyroidectomy would be indicated based on serum calcium levels, symptoms and end – organ damage, but in whom parathyroidectomy is either not clinically appropriate or is contraindicated. It should be clearly documented as to why surgery is not an appropriate treatment option for the particular patient.

9.5.1.3 – Magnesium

R Magnesium Sulphate 50% 2ml (4 mmol), 50% 10ml (20 mmol) & 10% 10ml (4 mmol) injections

60 mmol in 500ml sodium chloride 0.9% infusion u

R Magnesium Chloride u 10 mmol magnesium in 1 litre sodium chloride 0.9% with potassium chloride 0.15% (20 mmol) 64mg sustained release tablets (2.6mmol magnesium)

Magnesium Aspartate 6.5g (10 mmol) sachets -first line for the treatment and prevention of magnesium deficiency

614.8mg (2.5mmol) tablets u - for 2nd line treatment in patients with short bowel syndrome

Magnesium

Glycerophosphate u

1g (4mmol) chewable tablets (Yourmag® or Magnaphate®) -use preparation with cheapest acquisition cost

1mmol/ml suspension -available if supply problems with tablets

9.5.2 – Phosphorus 9.5.2.1 – Phosphate Supplements

Phosphate Sandoz Effervescent tablets (phosphate 16.1 mmol, sodium 20.4 mmol & potassium 3.1 mmol / tablet)

R Phosphate Solution u 4.15 mmol phosphate in 10ml oral solution

Phosphate Polyfusor® 500ml intravenous infusion containing 50mmol phosphate per 500ml (PO4

3- 100 mmol, K+ 19 mmol, and Na+ 162 mmol/litre)

9.5.2.2 – Phosphate-binding Agents Preferred Preparations

Calcium Acetate s Phosex® 1g tablets (containing 250mg, 6.2mmol of calcium)

Renacet® 475mg (containing 120.25mg, 3mmol of calcium) & 950mg tablets (containing 240.5mg, 6mmol of calcium)

Alternatives

Calcium Carbonate 1.25g & 2.5g chewable tablets (Calcichew) (Other formulations e.g. Remegel, Rennies, Rennie Soft gel and Settler’s

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Tums are also stocked at the RVI for use in paediatric renal patients)

OsvaRen s (formerly named Rephoren)

Tablets containing calcium acetate 435mg & Magnesium carbonate heavy 235mg. - for use, after calcium carbonate and calcium acetate, but before the much more expensive sevelamer and lanthanum

Sevelamer Carbonate s

800mg f/c tablets 2.4g powder for oral suspension - specialist advice

Lanthanum s 500mg, 750mg & 1g chewable tablets - for 3rd line use

9.5.3 – Fluoride

Duraphat® 2800 ppm s Sodium fluoride 0.619% (75ml)

Duraphat® 5000 ppm s Sodium fluoride 1.1% (51g)

Sodium Fluoride Mouthwash r Sodium fluoride 0.05% -approved for use within the dental hospital

9.5.4 – Zinc

Zinc Sulphate(Solvazinc®) Zinc sulphate monohydrate 125mg effervescent tablets (45mg zinc)

9.6 – Vitamins 9.6.1 – Vitamin A

Vitamin A su 20,000 unit injection - for the treatment of night blindness/ vitamin A deficiency as a result of malabsorption in patients with short bowel syndrome, ileal resection or pancreatic insufficiency

Vitamins A & D Capsules containing vitamin A 4000 units, vitamin D 400 units

9.6.2 – Vitamin B Group

Compound Preparation Vitamin B & C Injection (Pabrinex®)

IVHP injection (ascorbic acid 500mg, nicotinamide 160mg, pyridoxine

hydrochloride 50mg, riboflavin 4mg & thiamine hydrochloride 250mg & 1g anhydrous glucose / pair of ampoules)

IMHP injection also used

Pyridoxine 10mg u & 50mg tablets

R Pyridoxal Phosphate u 25mg tablets and 50mg capsules

Thiamine 50mg & 100mg tablets

R Vitamin B compound strong Tablets (nicotinamide 20mg, pyridoxine hydrochloride 2mg,

riboflavin 2mg & thiamine hydrochloride 5mg per tablet) -for short term use in refeeding syndrome only

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9.6.3 – Vitamin C

Ascorbic Acid 50mg, 100mg & 500mg tabs; 500mg in 5ml injection u

9.6.4 – Vitamin D

Alfacalcidol 250 nanogram & 1 microgram capsules 2 microgram/ml sugar-free oral drops – one drop containing approx. 100 nanograms of alfacalcidol 1 microgram in 0.5ml & 2 micrograms in 1ml injections

Ergocalciferol (Calciferol) 250 microg. (10,000 units) & 1.25mg (50,000 units) tablets

-a 3000 units in 1ml suspension u may be supplied if colecalciferol oral solution is not available

7.5mg (300,000 units) in 1ml injection

Colecalciferol

20microgram (800 units) capsules or tablets - for first line use in the long term maintenance treatment of patients with documented vitamin D deficiency following high strength therapy and also for use in patients with symptoms and insufficient levels.

500 microgram (20,000 units) capsules -for use in patients requiring high strength therapy for vitamin D deficiency.

2740iu/ml oral solution (Fultium®-D3 Drops)

1000iu and 3000iu buccal spray (DLux®) u

R

-approved for use in paediatric parenteral nutrition patients with short bowel syndrome and adults with metabolic bone disease who have vitamin D deficiency despite previous treatment.

First choice Calcium carbonate 1.5g & colecalciferol 10micrograms

(400 units) - Accrete ®

Film coated tablet containing calcium carbonate 1.5g and colecalciferol 10 micrograms (400 units)

Second choice

Calcium carbonate 1.5g & colecalciferol 10micrograms

(400 units) - Evacal D3 ®

Chewable tablets containing calcium carbonate 1.5g and colecalciferol 10 micrograms (400 units) -approved as a chewable option and also to be used in patients with peanut and soya allergy

Calcium Phosphate & Vitamin

D (Calfovit D3®

)

Powder in sachets – calcium phosphate 3.1g (1.2g calcium) &

Vitamin D3 800 units

Calcium & Ergocalciferol tablets

Tablets – calcium lactate 300mg, calcium phosphate 150mg (Ca 97mg,

2.4 mmol) & ergocalciferol 10 micrograms (400 units)

9.6.5 – Vitamin E

Alpha Tocopheryl acetate 500mg in 5ml suspension; 134mg (200 unit) capsules

Alpha Tocopheryl

(as tocofersolan) s

50mg in 1ml oral solution - approved for the treatrment of children with vitamin E deficiency due to fat malabsorption syndromes.

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9.6.6 – Vitamin K

First Choice

Phytomenadione (Vitamin K1)

50 microgram in 0.25ml drops (NeoKay®) u

1mg capsule- preferred product for use in neonates

10mg in 1ml injection u 2mg in 0.2ml mixed micelles injection (Konakion® MM Paediatric) – may be taken by mouth as well as being given by IM or IV injection N.B. Phytomenadione 10mg tabs now discontinued

Alternative

Menadiol Sodium Phosphate 10mg tablets - water soluble derivative of vitamin K for use in patients with fat malabsorption, especially in hepatic disease or biliary obstruction including cystic fibrosis patients

9.6.7 – Multivitamin Preparations First Choice

Vitamins BPC Capsules containing ascorbic acid 15mg, nicotinamide 7.5mg,

riboflavin 500 micrograms, thiamine HCl 1mg, vitamin A 2,500 units, & vitamin D 300 units

Alternatives

Abidec® Drops containing in each 0.6ml dose ascorbic acid 50mg, ergocalciferol 400 units, nicotinamide 5mg, pyridoxine HCL 500micrograms, riboflavin 400 micrograms, thiamine 1mg & vitamin A 1,333 units- To be used in

children and adults.

Dalivit® Drops containing in each 0.6ml dose ascorbic acid 50mg, ergocalciferol

400 units, nicotinamide 5mg, pyridoxine HCl 500 micrograms, riboflavin 400 micrograms, thiamine 1mg & vitamin A 5,000 units)- Dalivit drops are to be retained for use in patients requiring a full supplement of vitamin A.

Forceval® sr Capsules & junior capsules -For limited use as a vitamin and mineral supplement in patients with phenylketonuria The capsules are also approved as an oral supplement in burns patients with malnutrition or alcohol dependency and patients with major burns after discontinuation of IV therapy, and have also been approved for use in patients with severe anorexia nervosa. Treatment initiated with specialist advice

Soluble - approved for short term use in patients who are unable to swallow Forceval capsules.

Healthy Start Vitaminsr These formulations are prepared for the NHS and recommended in NICE guidance. DOH offers the Healthy Start Vitamins to pregnant women and children less than 4 years. They are only available through clinics and from midwives and are not prescribable on FP10 prescriptions

Ketovite® s

Tablets and liquid - see BNF for details of content- Treatment initiated with specialist advice

Renavit® Tablets r -water soluble vitamin supplementation therapy for maintenance

haemodialysis patients only.

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9.8 – Metabolic Disorders

9.8.1 – Wilson’s Disease, Carnitine Deficiency and Gaucher’s Disease

9.8.1 – Wilson’s disease and Cystinuria

R Penicillamine 125mg & 250mg tablets - also used for the treatment of cystinuria and rheumatoid arthritis – section 10.1.3

R Tiopronin u 500mg tablets - for use as 2nd line treatment for cystinuria in patients who fail to tolerate/respond to penicillamine.

9.8.1 – Carnitine deficiency

R Carnitine s

(Levocarnitine)

30% oral solution 1g in 5ml injection

9.8.1 – Urea cycle disorders

R Sodium

Phenylbutyrate su

500mg tablets - Licensed formulation marketed as Ammonaps1g in 5ml & 2g in 10ml injections

9.8.1 – Mitochondrial & muscle disorders

Ubiquinone su (Coenzyme Q10, Ubidecarenone)

10mg, 30mg, & 100mg capsules 50mg in 5ml & 30mg in 1ml (150mg in 5ml) oral solution - nutritional supplement and antioxidant approved for use in the management of mitochondrial disorders. -approved for use under specialist consultant supervision in the management of patients with severe hyperlipidaemia who are not tolerating statins due to myopathy. Use in statin induced myopathy is subject to treatment being initiated by a consultant. Lipid clinic initiation only

9.8.1 – Nephropathic cystinosis

R Mercaptamine 50mg & 150mg capsules

9.8.1 - Mucopolysaccharidosis type IV a

R Elosulfase alfa 5mg/5ml concentrate for solution for infusion -approved as a possible treatment for people with mucopolysaccharidosis type IV a (MPS IVa) in line with NICE

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10. Musculoskeletal and Joint Diseases

10.1 – Drugs Used in Rheumatic Diseases and Gout 10.1.1 – Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)

Preferred Drugs

Diclofenac can be used for short term use for post-operative pain.

Long Term use: Ibuprofen low dose – First line treatment

Naproxen low dose – Second line treatment Naproxen high dose – Third line treatment Diclofenac – Fourth line treatment

Ibuprofen 200mg, 400mg & 600mg tablets

100mg in 5ml sugar-free suspension

Naproxen 250mg & 500mg tablets; 125mg in 5ml suspension u 500mg suppositories

Diclofenac 25mg & 50mg e/c tablets; 50mg dispersible tablets 75mg & 100mg m/r tablets or capsules 75mg in 2ml injection (Dyloject) - mainly for use in postoperative analgesia 12.5mg, 25mg, 50mg & 100mg suppositories

Alternatives

Celecoxib 100mg & 200mg capsules

Etodolac 600mg m/r tablets

Indometacin (Indomethacin) 25mg & 50mg capsules; 75mg m/r capsules 25mg in 5ml suspension; 100mg suppositories

Mefenamic Acid 250mg capsules & 500mg tablets

Piroxicam 20mg orodispersible ‘Melt’ tablets - For use in operating theatres and for use in children with juvenile idiopathic rheumatoid arthritis. Older children should be changed to another NSAID when they reach the age of 14 (or earlier if considered appropriate)

Meloxicam 7.5mg & 15mg tablets

Nabumetone 500mg tablets; 500mg in 5ml suspension

Etoricoxib 30mg, 60mg, 90mg & 120mg tablets

Phenylbutazonesr 100mg & 200mg tablets- For use in ankylosing spondylitis

10.1.2.2 – Local Corticosteroid Injections

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Hydrocortisone Acetate 25mg in 1ml injection

Methylprednisolone Acetate 40mg in 1ml depot injection (Depo-Medrone)

Methylprednisolone Acetate & Lidocaine

1ml injection - methylprednisolone acet. 40mg + lidocaine 1% 2ml injection - methylprednisolone acet. 80mg + lidocaine 1%

Prednisolone Acetate 25mg in 1ml depot injection

Triamcinolone Acetonide

40mg in 1ml & 80mg in 2ml intramuscular/ intra-articular injections 10mg in 1ml & 50mg in 5ml intradermal/intra-articular injections

Triamcinolone

Hexacetonide r u

20mg in 1ml intra-articular injection – Paediatric use only

10.1.3 – Drugs Which Suppress the Rheumatic Disease Process Gold Salts

A Sodium Aurothiomalate 10mg, 20mg & 50mg in 0.5ml injections Penicillamine

A Penicillamine 125mg & 250mg tablets Antimalarials

B Hydroxychloroquine 200mg tablets

Drugs Affecting the Immune Response

A Azathioprine See section 8.2.1

A Ciclosporin See section 8.2.2

A Methotrexate See section 8.1.3

A Leflunomide 10mg, 20mg & 100mg tablets

Cytokine Modulators

R Abatacept r 250mg injection - approved for juvenile idiopathic arthritis in patients aged six years and above (licensed) and under six years. It should only be prescribed with informed consent -approved for people aged 6 years and older to treat polyarticular juvenile idiopathic arthritis (JIA) whose diease has responded inadequately to other DMARDs, including at least 1 tumour necrosis

factor (TNF) inhibitor in line with NICE

- approved for rheumatoid arthritis after the failure of a TNF inhibitor in

line with NICE -approved for treatment in adults with severe rheumatoid arthritis not previously treated with DMARDs or after conventional DMARDs only have

failed in line with NICE

125mg injection (prefilled syringe) - approved for moderate to severe rheumatoid arthritis and used in line

with NICE

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R Adalimumab r 40mg injection (prefilled syringe) -approved for treatment in adults with severe rheumatoid arthritis not previously treated with DMARDs or after conventional DMARDs only have

failed in line with NICE

- approved for rheumatoid arthritis after the failure of a TNF inhibitor in

line with NICE - approved for the treatment of severe active ankylosing spondylitis in adults whose disease has responded inadequately to, or who cannot tolerate, non-steroidal anti-inflammatory drugs in line with NICE

- approved for psoriatic arthritis in line with NICE

- approved as second-line anti-TNF therapy in children with juvenile idiopathic arthritis and uveitis. -approved for people aged 2 years and older to treat polyarticular juvenile idiopathic arthritis (JIA) whose disease has responded

inadequately to 1 or more DMARD in line with NICE

R Anakinra r 100mg injection (prefilled syringe) - approved for use by specialists in Systemic onset Juvenile Idiopathic Arthritis (SoJIA) and Chronic Infantile Neurocutaneous Arthritis (CINCA) and Muckle-Wells Syndrome (unlicensed indications) - approved for the treatment of severe gout in patients who have not responded to other treatment and for patients with pseudogout who have failed to respond to conventional treatment or unable to tolerate conventional treatment.

- approved for adult onset still’s disease

R Belimumab 120mg and 400mg IV infusion -approved for the treatment of active autoantibody-positive systemic

lupus erythematosus in line with NICE

R Certolizumab Pegol Each pre-filled syringe contains 200 mg certolizumab pegol in one ml -approved for treatment in adults with severe rheumatoid arthritis not previously treated with DMARDs or after conventional DMARDs only have

failed in line with NICE

- approved for the treatment of severe active ankylosing spondylitis in adults whose disease has responded inadequately to, or who cannot tolerate, non-steroidal anti-inflammatory drugs in line with NICE - for use in psoriatic arthritis

R Etanercept r 10mg (Enbrel®) 25mg injection (Enbrel® & Benepali®) -approved for treatment in adults with severe rheumatoid arthritis not previously treated with DMARDs or after conventional DMARDs only have

failed in line with NICE

- approved for rheumatoid arthritis after the failure of a TNF inhibitor in

line with NICE

- approved for psoriatic arthritis in line with NICE

- approved for the treatment of severe active ankylosing spondylitis in adults whose disease has responded inadequately to, or who cannot tolerate, non-steroidal anti-inflammatory drugs in line with NICE - approved for the treatment of juvenile idiopathic arthritis (JIA) in people 2 years or older whose disease has responded inadequately to, or who are intolerant of methotrexate in line with NICE - approved for the treatment of Juvenile Scleroderma (Its use will be subject to informed consent and specialists using etanercept in this indication should collect data on patient outcomes. If after a six month trial, treatment were found to be beneficial, it would be continued for

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two years. If unsuccessful after six months, treatment should be discontinued). -approved for people aged 2 years and older to treat polyarticular juvenile idiopathic arthritis (JIA) whose diease has responded

inadequately to, or who are intolerant of methotrexate in line with NICE

R Golimumab r 50mg injection (prefilled pen & syringe) - approved for rheumatoid arthritis in line with NICE

- approved for psoriatic arthritis in line with NICE - approved for the treatment of severe active ankylosing spondylitis in adults whose disease has responded inadequately to, or who cannot tolerate, non-steroidal anti-inflammatory drugs in line with NICE -approved for treatment in adults with severe rheumatoid arthritis not previously treated with DMARDs or after conventional DMARDs only have

failed in line with NICE

R Infliximab r 100mg injection (Remicade®, Inflectra® & Remsima®) -approved for treatment in adults with severe rheumatoid arthritis not previously treated with DMARDs or after conventional DMARDs only have

failed in line with NICE

- approved for rheumatoid arthritis after the failure of a TNF inhibitor in

line with NICE

- approved for psoriatic arthritis in line with NICE - approved for JIA in patients who have not responded to etanercept. - approved for Juvenile dermatomyositis and paediatric onset Behcet’s disease where there has been intolerance or lack of response to 1st and 2nd line therapies.

- approved for the treatment of severe active ankylosing spondylitis in adults whose disease has responded inadequately to, or who cannot tolerate, non-steroidal anti-inflammatory drugs in line with NICE

R Rituximab r 100mg in 10ml & 500mg in 50ml concentrate for IV infusion - approved for adults and children with severe systemic lupus

erythematosus who have failed conventional therapies

- approved for rheumatoid arthritis after the failure of a TNF inhibitor in

line with NICE - NETAG approved in combination with methotrexate as first-line biological therapy in cases where there is an absolute contraindication to tumour necrosis factor inhibitors

- NETAG approved for combination with other (non-methotrexate) disease modifying antirheumatic drugs and as monotherapy in cases in which conventional treatment with tumour necrosis factor inhibitors or methotrexate is deemed unsafe.

R Tocilizumab r 80mg in 4ml, 200mg in 10ml & 400mg in 20ml concentrate

for IV infusion - approved for systemic JIA in children and young people aged 2 years and older in line with NICE -approved for people aged 2 years and older to treat polyarticular juvenile idiopathic arthritis (JIA) whose diease has responded inadequately to

previous therapy with methotrexate in line with NICE - NETAG approved as an alternative treatment to anakinra for patients with systemic onset JIA who have already received treatment with etanercept and adalimumab. Not recommended for polyarticular JIA. - approved for rheumatoid arthritis in line with NICE -approved for treatment in adults with severe rheumatoid arthritis not previously treated with DMARDs or after conventional DMARDs only have

failed in line with NICE

162mg subcutaneous injection

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- approved for rheumatoid arthritis in line with NICE

A Sulfasalazine 500mg e/c tablets

R Ustekinumab r 45mg vial - approved for psoriasis in line with NICE

- approved for psoriatic arthritis in line with NICE

R Secukinumab 150mg pre-filled pen/syringe

-approved for active ankylosing spondylitis in line with NICE

Others

Minocycline s 50mg and 100mg capsules and tablets

-this is an unlicensed indication. To be used to treat rheumatoid arthritis who are unable to tolerate biologics and other DMARDs

10.1.4 – Drugs Used in the Treatment of Gout and Cytotoxic Induced Hyperuricaemia

Acute Attacks

NSAIDs – see section 10.1.1

Colchicine 500 microgram tablets Long-term Control of Gout

First Choice

Allopurinol 100mg & 300mg tablets

100mg in 5ml suspension u Alternatives

Febuxostat 80mg & 120mg tablets - approved for patients where allopurinol is not tolerated or

contraindicated SPC in line with NICE

Probenecid su 500mg tablets

Hyperuricaemia Associated with Cytotoxic Drugs First Choice

Allopurinol s 100mg & 300mg tablets

100mg in 5ml suspension su Alternative

R Rasburicase r 1.5mg & 7.5mg vials - prophylactic use in high risk patients only

10.2 – Drugs Used in Neuromuscular Disorders

R Ataluren 125mg, 250mg & 1000mg granules for oral suspension

- approved for the treatment of Duchenne muscular dystrophy with a nonsense mutation in the dystrophin gene in line with NICE HST and NHS England Commissioning Policy

10.2.1 – Drugs which Enhance Neuromuscular Transmission

Anticholinesterases

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R Edrophonium 10mg injection

Neostigmine s 15mg tablets; 2.5mg injection

Pyridostigmine s 60mg tablets & 60mg/5ml suspension

10.2.2 – Skeletal Muscle Relaxants

First Choice

Baclofen 10mg tablets 5mg in 5ml sugar-free liquid 50 microgram in 1ml (test dose), 10mg in 20ml, 10mg in 5ml injections

36mg in 12ml su & 72mg in 12ml su intrathecal injections

Diazepam 2mg & 5mg tablets; 2mg in 5ml syrup 10mg injection (solution & emulsion – Diazemuls) - see section 4.1.2 for other formulations N.B. Diazepam 10mg tablets are no longer included in the Formulary

Alternatives

Dantrolene 25mg capsules

Tizanidine s 2mg & 4mg tablets – for use on advice from neurologists when other treatments are unsuitable

Nocturnal Leg Cramps

Quinine Sulphate 200mg tablets

- MHRA advice now states that quinine should not be used routinely in the treatment of nocturnal leg cramps, and should only be considered when cramps cause regular disruption of sleep. After a period of 4 weeks, treatment should be discontinued if no benefit is gained.

10.3 – Drugs for the Relief of Soft Tissue Inflammation 10.3.1 – Enzymes

Collagenase 900 microgram injection - approved for Dupuytren’s contracture limited to one joint or cord and when the flexion contracture is greater than 40o from the horizontal plane (NETAG).

Hyaluronidase s 1,500 unit injection - for use on advice from specialist

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10.3.2 – Rubefacients and Other Topical Antirheumatics Topical NSAIDs, Counter Irritants etc.

Ibuprofen 5% gel

Capsaicin s 0.075% cream - for use with specialist advice in post-herpetic neuralgia & severe neuropathic pain mainly in diabetes patients

0.025% cream – for symptomatic relief in osteoarthritis

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11. Eye

Preservative Free Eye Drops

Microbial contamination of multidose bottles of eye drops can cause eye infections that may lead to damage of the eye and in extreme cases loss of sight. To minimise the risk, multidose bottles of eye drops contain an antimicrobial preservative such as benzalkonium chloride. The preservatives used in eye drops are normally well tolerated, but they are not completely harmless. They can cause irritation and damage to the corneal epithelium. This risk is understood to be greater in patients with pre-existing damage to the ocular surface and where large quantities of preservative containing eye drops are applied repeatedly over a prolonged period (e.g. if applied more than 4 to 6 times daily for several weeks/ months).

To avoid these problems the use of preservative-free eye drops is recommended in:

Patients who have experienced hypersensitivity reactions or irritation due to preservatives in eye drops.

Patients who have received corneal grafts.

Patients with conditions where there is already damage to the ocular surface as a result of disease or trauma, such as dry eye, blepharitis, ocular burns etc.

Treatment with preservative-free eye drops will usually be initiated by an ophthalmologist and details on their availability and use is available from the pharmacy at Newcastle’s Royal Victoria Infirmary (and on the North of Tyne and Gateshead Area Prescribing Committee’s Website).

11.3 – Topical Anti-infective Preparations

11.3.1 – Antibacterials

Preferred Drug

Chloramphenicol 0.5% eye drops & 1% eye ointment Preservative-free 0.5% preservative-free Minims® - 1st choice

0.5% preservative-free eye drops u

-approved only for patients who are unable to use Minims®due to dexterity problems

Alternatives

Fusidic Acid (Fucithalmic®)

1% eye drops in a gel basis which liquefies on contact with the eye

Ofloxacin 0.3% eye drops

Gentamicin 0.3% eye/ear drops, 0.3% minims

1.5% eye drops with and without preservative u R

R Erythromycin u 0.5% eye ointment

R Benzylpenicillin u 0.3% eye drops

R Cefuroxime u 5% eye drops

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R Povidone Iodine u 5% preservative-free eye drops

Propamidine Isethionate

0.1% eye drops – For use in the treatment of acanthamoeba keratitis – used with PHMB

R Polyhexamethylene

biguanide (PHMB) u

0.02% eye drops –For use in the treatment of acanthamoeba keratitis

11.3.2 – Antifungals

There are currently no licensed topical antifungal agents available for the treatment of eye infections. Products such as those below can be obtained as unlicensed medicines to meet

specific needs on request from an ophthalmologist or microbiologist. Contact pharmacy at the RVI (0191 2825398) for details.

R Natamycin u 5% eye drops

R Amphotericin B u 0.1% & 0.3% preservative free eye drops

R Econazole u 1% in arachis oil eye drops

R Voriconazole u 100 micrograms in 0.1ml (0.1%) preservative free eye drops

11.3.3 – Antivirals

Aciclovir (Acyclovir) 3% eye ointment

R Trifluorothymidine u 1% eye drops

11.4 – Corticosteroids and Other Anti-inflammatory Preparations 11.4.1 – Plain Corticosteroids First Choice

Betamethasone 0.1% eye/ear/nasal drops, 0.1% eye ointment Alternatives

Dexamethasone 0.1% eye drops (Maxidex) Preservative-free

0.1% Minims® - 1st choice

0.1% preservative free eye drops u

-approved only for patients who are unable to use Minims®due to dexterity problems

Fluorometholone sr 0.1% eye drops - for use in patients who experience ocular hypertension with other corticosteroids – treatment to be initiated with the advice of an ophthalmologist

Prednisolone 0.1% su, 0.3% su & 0.5% eye drops,

0.5% minims

0.1%, 0.3%, 0.5% & 1% preservative free eye drops su - treatment to be initiated with the advice of an ophthalmologist

Prednisolone Acetate s 1% eye drops (Pred-Forte) - treatment to be initiated with the advice of an ophthalmologist

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Rimexolone sr 1% eye drops – for use where Fluorometholone (FML) drops (which are much cheaper) are likely to be insufficiently effective - treatment to be imitated with the advice of an ophthalmologist

Loteprednol etabonates 0.5% eye drops - approved as a second line agent to conventional corticosteroid eye drops, treatment to be imitated with the advice of an ophthalmologist only

R Dexamethasone implant 700 microgram intravitreal implant - approved for macular oedema following central retinal vein occlusion in line with NICE

-approved for treating diabetic macular oedema in line with NICE

R Fluocinolone acetonide

implant

190 microgram intravitreal implant - are recommended as a possible treatment for people with chronic diabetic macular oedema who have an artificial lens in their eye if the implant is used in the eye with the artificial lens and their diabetic macular oedema has not got better with other treatments. NICE

11.4.1 – Corticosteroids with Antibacterial Agents First Choice

Betamethasone and Neomycin

Eye drops containing betamethasone sodium phosphate 0.1% and neomycin sulphate 0.5%

Alternatives

Maxitrol® Eye drops & eye ointment containing dexamethasone 0.1%, hypromellose 0.5%, neomycin 0.35% & polymyxin B sulphate 6,000 units/ml (drops)/g (oint.)

Prednisolone and Neomycin

Eye drops containing prednisolone sodium phosphate 0.5% & neomycin sulphate 0.5%

11.4.2 – Other Anti-inflammatory Preparations

Olopatadine 1mg in 1ml (0.1%) eye drops

Otrivine-Antistin® Eye drops containing antazoline sulphate 0.5% + xylometazoline hydrochloride 0.05%

Sodium Cromoglicate 2% eye drops , 2% preservative free eye drops su

- treatment to be imitated with the advice of an ophthalmologist only

R Adalimumab 40mg injection (prefilled syringe) -approved for the treatment of children with Severe Refractory Uveitis in line with Interim NHS England Clinical Commissioning Policy

11.5 – Mydriatics and Cycloplegics

Tropicamide 0.5% & 1% minims

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Cyclopentolate 0.5% & 1% eye drops, 0.5% & 1% minims

Atropine 1% eye drops, 1% minims, 1% eye ointment

1% preservative free eye drops u Phenylephrine 2.5% u eye drops and 2.5% minims

R Phenylephrine and

tropicamide (Mydriasert®)

Ophthalmic insert containing phenylephrine hydrochloride 5.4.mg & tropicamide 280 micrograms -approved for pre-operative mydriasis and diagnostic purposes

R Mydricaine® No 2 0.3ml injection containing procaine HCL 6mg, atropine sulphate 1mg and adrenaline solution (1 in 1,000)

11.6 – Treatment of Glaucoma Miotics

Pilocarpine 0.5%, 1%, 2% & 4% eye drops – pilocarpine is for 1%, 2% & 4% minims - 3rd line use only

Sympathomimetics

Brimonidine 0.2% eye drops

Beta-Blockers

Timolol 0.25% & 0.5% eye drops & 0.2ml unit dose eye drops - Betaxolol, carteolol and long-acting timolol eye drops are not included in the formulary and should not be used for new patients.

Carbonic Anhydrase Inhibitors and Systemic Drugs First Choice

Brinzolamide 1% (10mg per ml) eye drops

Dorzolamide 2% eye drops

Alternative

Acetazolamide 250mg tablets; 500mg injection

Prostaglandin analogues First Choice

Latanoprost 50 micrograms per ml eye drops (2.5ml pack) & 0.2ml unit dose eye drops

Alternative

Bimatoprost 300 micrograms/ml eye drops

Tafluprost s 15 micrograms/ml unit dose eye drops

- approved for use in children and adults. To be initiated by ophthalmologists only and is to be used third line after preservative containing latanoprost and preservative free timolol. The

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ophthalmologists must clearly document that signs and symptoms of preservative intolerance/ allergy have been demonstrated in their patient prior to initiation.

Combination Products

Latanaprost and timolol Eye drops containing latanoprost 50 micrograms & timolol (0.5%) 5mg per ml - for use as a second/third-line agent in patients insufficiently responsive to monotherapy with a prostaglandin analogue or beta blocker

Bimatoprost and timolol Eye drops containing bimatoprost 300 micrograms & timolol

5mg per ml (0.5%) - for use as a second/third-line agent in patients insufficiently responsive to monotherapy with a prostaglandin analogue or beta blocker

Brinzolamide and brimonidine Eye drops containing brinzolamide 10mg per ml &

brimonidine 2mg per ml -approved as a third line agent as an “add-on” in patients at the very end of medical management.

Dorzolamide and timolol Eye drops containing dorzolamide 2% & timolol 5mg per ml

0.5% Unit dose eye drops (preservative free) containing

Dorzolamide 2% & Timolol 0.5% r

- approved for use in patients with confirmed allergy presenting as conjunctival changes or skin allergy. To be initiated by ophthalmologists only. The ophthalmologists must clearly document that signs and symptoms of preservative allergy have been demonstrated in their patient prior to initiation.

Tafluprost and timolol Unit dose eye drops containing tafluprost 15 micrograms &

timolol 5mg per ml (0.5%)

11.7 – Local Anaesthetics

Tetracaine (Amethocaine)

1% minims eye drops

Oxybuprocaine (Benoxinate) 0.4% minims eye drops

Proxymetacaine 0.5% minims eye drops

Lidocaine and Fluorescein Minims eye drops containing lidocaine 4% & fluorescein sodium 0.25%

11.8 – Miscellaneous Ophthalmic Preparations 11.8.1 – Tear Deficiency, Ocular Lubricants and Astringents

First Choice

Hypromellose 0.3% eye drops; 0.3% preservative free eye drops – 1st line Tear-Lac® 2nd line PF Drops®

- treatment to be imitated with the advice of an ophthalmologist only Alternatives

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Carmellose Sodium (PF Drops®)

0.5% & 1% preservative-free eye drops

White soft paraffin (Xailin® Night)

Eye ointment (5g) containing 57.3% white soft paraffin, 42.5% liquid paraffin

Acetylcysteine s u 5% eye drops & preservative free eye drops (Ilube® eye drops containing acetylcysteine 5% and hypromellose 0.35% are available for use in the community) - treatment to be imitated with the advice of an ophthalmologist only

VitA-POS® Eye ointment (5g) containing retinol palmitate (vitamin A) 250iu/g, white soft paraffin, light liquid paraffin, liquid paraffin and wool fat

Duolube® s u Lanolin and preservative free eye ointment containing white soft paraffin and mineral oil - treatment to be imitated with the advice of an ophthalmologist only

Carbomer 980 0.2% ophthalmic gel eye drops and single dose unit eye drops (0.6%) - Viscotears® or GelTears®

Sodium Chloride 0.9% eye drops & minims

5% eye drops 5% preservative-free eye drops (PF drops®)

5% eye ointment u

Sodium hyaluronate 0.1% eye drops (Hylo-Tear®) 0.2% eye drops (Hylo-Forte®)

0.4% unit dose vials (Clinitas® Minims) s - specialist recommendation for the treatment of Keraconjunctiva sicca, post refractive surgery and Corneal healing disorders

R Balanced Salt Solution Sterile solution containing sodium chloride 0.64%, sodium acetate 0.39%, sodium citrate 0.17%, calcium chloride 0.048%, magnesium chloride 0.03%, potassium chloride 0.075% in 15ml bottles and 500ml bags - for intra-ocular or topical irrigation during surgical procedures

Systane 10ml Multidose bottles

0.8ml Preservative free vials Contains hydroxypropyl guar, polyethylene glycol 400, propylene

glycol (and other ingredients)

- Long-acting ocular lubricant used for the treatment of dry eye

syndrome. Liquid formulation which turns into a gel on contact with

eyes providing fast and long lasting relief. The multidose bottle may be

used for up to six months after opening in primary care.

In contact lens wearers, Systane should be applied before inserting

lenses and after removal to extend comfortable wearing times.

Ciclosporin s First Choice

0.1% (1mg/1ml) eye drops (Ikervis®) -approved as a possible treatment for people with dry eye disease that

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has not improved despite treatment with artificial tears NICE

Alternatives

0.2% eye ointment u R

11.8.2 – Ocular Diagnostic and Peri-operative Preparations and Photodynamic Treatment

R Ocriplasmin 2.5mg/ml concentrate for solution for intravitreal injection -approved for use in patients with vitreomacular traction who also have no epiretinal membrane and a hole (up to 400 micrometres) in the centre of their retina or severe sight problems in line with NICE

11.8.2.1 - Diagnostic Preparations

Fluorescein 2% minims eye drops, 1mg ophthalmic strips, Fluorets

10% 5ml & 20% 5ml injections su

R Indocyanine Green u 25mg injection

R Lissamine Green 1.5mg ophthalmic strips

11.8.2.2 - Ocular Peri-operative Drugs

R Diclofenac Sodium r 0.1% eye drops + minims - for post-operative inflammation limited to patients where corticosteroids are unsuitable

Ketorolac Trometamol 0.5% eye drops

R Povidone Iodine u 5% eye drops (for use in eye surgery only)

R Acetylcholine 20mg in 2ml injection

Apraclonidine s 0.5% & 1% eye drops

R Duovisc® u Injection for use in cataract surgery containing VisCoat (1%

sodium hyaluronate) and ProVisc (3% sodium hyaluronate, 4% chondroitin sulphate)

R Hydroxypropylmethyl-

cellulose HV (Oasis®)

2% 2.3ml intraocular injection

R Sodium Hyaluronate 10mg in 1ml bag (Z-Hyalin®, formerly Ophthalin Gelbag®) 14mg in 1ml syringe (Healon GV®)

R Ethanol u 20% eye drops - for use in the debridement of the corneal epithelium in patients with recurrent corneal erosion syndrome.

11.8.2.3 - Subfoveal Choroidal Neovascularisation

R Aflibercept 4mg in 0.1ml injection - approved for wet age related macular degeneration in line with NICE -approved for macular oedema – central retinal vein occlusion NICE

-approved for diabetic macular oedema NICE

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-approved for treating visual impairment caused by macular oedema after branch retinal vein occlusion in line with NICE

R Ranibizumab 10mg in 1ml injection - approved for wet age related macular degeneration in line with NICE - approved for diabetic macular oedema in line with NICE - approved for visual impairment caused by macular oedema secondary to retinal vein occlusion NICE - as a possible treatment for sight problems caused by choroidal neovascularisation in people who also have pathological myopia NICE

R Bevacizumab 1.25mg in 0.5ml syringe - NETAG approved for use in the management of macular oedema secondary to retinal vein occlusion. This is considered a more cost effective treatment option in RVO compared with ranibizumab. - NTAG approved for age related macular degeneration.

R Verteporfin 15mg injection -approved for photodynamic therapy in wet age-related macular degeneration in line NICE

11.8.2.4 – Other Products – Mainly for Treating Ocular Injuries

R Disodium Edetate u 0.37% solution (20ml)

R Sodium Citrate u 10.11% eye drops (equivalent to citrate 6.5%)

R Ascorbic acid u

(Potassium ascorbate)

10% preservative free eye drops

R Tretinoin u

(Retinoic acid)

0.05% eye drops

11.9 Contact Lenses

Contact lenses are only provided on the NHS when there is a medical need. Usually this is when vision cannot be improved with spectacles, but can be improved with contact lenses. The contact lens clinical staff at the RVI will assess eligibility. Examples of eligibility include some disorders of the cornea, very high prescriptions and 'bandage' lenses.

The following contact lens care products stocked for the care of contact lenses for patients attending the ophthalmology department at the RVI. GPs are not allowed to prescribe contact lens solutions on the NHS.

Alcon Optifree® Express system Bausch & Lomb contact lens solutions (Boston) Bausch & Lomb saline (Salette®)

Clens 100® Miraflow® daily cleaner Systane® Oxysept® 1 - Step

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12. Ear, Nose and Oropharynx

12.1 – Drugs Acting on the Ear

12.1.1 – Otitis Externa

Anti-inflammatory Preparations First Choice

Betamethasone 0.1% eye/ear/nose drops (betamethasone sod. phosph.)

Alternative

Prednisolone 0.5% eye/ear drops (prednisolone sodium phosphate)

Anti-infective Preparations

Gentamicin 0.3% eye/ear drops

Chloramphenicol 5% (or 10%) ear drops (in propylene glycol)

Clotrimazole 1% solution (in polyethylene glycol “400”)

Compound Antibacterial / Corticosteroid Preparations First Choice

Gentamicin and Hydrocortisone

Ear drops (Gentisone HC) containing gentamicin 0.3% & hydrocortisone acetate 1%

Alternatives

Sofradex® Eye/ear drops containing dexamethasone 0.05%, framycetin sulphate 0.5% & gramicidin 0.005%

Otomize® Spray containing dexamethasone 0.1%, neomycin 3,250 units/ml & acetic acid 2%

Betamethasone and Neomycin

Eye/ear drops containing betamethasone sodium phosphate 0.1% & neomycin sulphate 0.5%

Otosporin® Ear drops containing hydrocortisone 1%, neomycin sulph. 0.439% & polymyxin B sulph. 10,000 units/ml

12.1.3 – Removal of Ear Wax

Sodium Bicarbonate Ear drops (sodium bicarbonate 5% & glycerol 30%)

Olive Oil Ear drops

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12.2 – Drugs Acting on the Nose

12.2.1 – Drugs Used in Nasal Allergy

Antihistamine

Azelastine 0.1% nasal spray (140 micrograms/metered spray) Corticosteroids

First Choice (in primary care)

Beclometasone 50 microgram/metered dose aqueous nasal spray Alternatives

Mometasone 50 microgram/metered dose nasal spray

Fluticasone Furoate (Avamys)

27.5 microgram / dose nasal spray. N.B. Take care to

avoid confusion with fluticasone propionate

Fluticasone Propionate 50 microgram / dose nasal spray N.B. Take care to avoid confusion with fluticasone

furoate

400 microgram unit dose nasal dropss

- treatment to be with specialist advice only

Betamethasone 0.1% eye/ear/nose drops (betamethasone sod. phos.)

Triamcinolone Acetonide 55 microgram metered dose nasal spray

Other Alternative

12.2.2 – Topical Nasal Decongestants

Sympathomimetic

First Choice

Xylometazoline 0.05% & 0.1% nasal drops, 0.1% nasal spray

Alternative

Ephedrine 0.5% & 1% nasal drops

Antimuscarinic

Ipratropium 21 micrograms/puff metered dose nasal spray

Sodium Chloride

Sodium Chloride 0.9% nasal drops

NeilMed® Sinus Rinse Sachets containing powder for preparing a buffered saline solution for nasal irrigation using the NeilMed Irrigation device. Available as kits containing the irrigation device and

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sachets and separate (isotonic) sachets. N.B NeilMed Sinus

Rinse is classified as a medical device and, as it is not currently included in the Drug Tariff, it cannot be

prescribed on the NHS in primary care

12.2.3 – Nasal Preparations for Infection and Epistaxis

Naseptin® Cream (chlorhexidine HCl 0.1% & neomycin sulph. 0.5%)

Mupirocin 2% nasal ointment (Bactroban) -First Choice for use in

MRSA eradication

R Bismuth Subnitrate and

Iodoform (B.I.P.P.)

Paste 1.25cm x 100cm & 2.5cm x 100cm impregnated gauze

12.3 – Drugs Acting on the Oropharynx 12.3.1 – Drugs for Oral Ulceration and Inflammation

Benzydamine 0.15% oral rinse (mouthwash) & spray

Carmellose Sodium (Orabase®)

Paste containing carmellose sodium 16.7%, pectin 16.7% & gelatin 16.7% in plastibase

Choline Salicylate 8.7% sugar-free gel in a flavoured basis (Bonjela)

Hydrocortisone 2.5mg lozenges (pellets)

Hyaluronan (Gengigel®) 0.2% gel & 0.025% mouthwash - for limited second-line use on specialist advice in the treatment of orofacial granulomatosis, severe oral ulceration and mucositis secondary to immunosuppression where conventional treatments are unsuitable or have failed

R Caphosol® 1 dose=1 x 15ml Caphosol A + 1 x 15ml Caphosol B mixed together - for limited use in patients having chemo-radiotherapy or radiotherapy

to malignancies of the oral cavity, hypopharynx and oro-pharynx. r Drugs for Periodontitis

Doxycycline 20mg tablets

12.3.2 – Oropharyngeal Anti-infective Drugs

Fungal Infections

Nystatin 100,000 units/ml suspension

Miconazole 24mg/ml (20mg/g) sugar-free oral gel;

50mg muco-adhesive buccal tablets r

R

- restricted to use in immunocompromised patients with severe oropharyngeal candidiasis, where the use of other antifungal agents e. g. nystatin, fluconazole is not appropriate and for use on the advice of microbiologists

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R Amphotericin u 100mg/1ml oral suspension - approved for specialist use in chronic mucocutaneous candidiasis

Viral Infections

Aciclovir Tablets & suspension – see section 5.3.2 12.3.3 – Antiseptic Lozenges Sprays and Gels

Cetylpyridinium Chloride 1.4 mg lozenges (Merocet)

Merocaine® Lozenges (benzocaine 10mg + cetylpyridinium Cl 1.4mg)

12.3.4 – Mouthwashes, Gargles and Dentifrices

Chlorhexidine 0.2% mouthwash; 0.2% mint flavoured spray; 1% dental gel;

2% oral gel u - for hospital use in the prevention of ventilator-associated pneumonia in adult patients who are ventilated (for >48 hours)

Hexitidine 0.1% mouthwash

Mouthwash solution tablets

Solution tablets containing antimicrobial, flavouring and colouring agents

Triclosan (Mentadent P®) Toothpaste containing triclosan - for use in MRSA eradication. If Mentadent P is not available, Colgate Total is a suitable alternative

12.3.5 – Treatment of Dry Mouth

Section to be reviewed Saliva Substitutes

First Choice

Saliva Orthana® 50ml spray, 500ml refill (mucin 3.5% - of porcine origin, xylitol 2%, sodium fluoride 4.2mg / litre) – preferred to Glandosane as it is less likely to damage tooth enamel

Alternative Glandosane® Aerosol spray (carmellose sodium, sorbitol, potassium

chloride, sodium chloride, magnesium chloride, calcium chloride & dipotassium hydrogen phosphate)

Other Products for Dry Mouth

Malic Acid (Salivix®) Sugar-free pastilles containing malic acid

Pilocarpine s 5mg tablets – treatment to be initiated with specialist advice

Biotene Oral Balance® Saliva replacement gel - prescribable on the NHS in primary

care as a Borderline Substance

BioXtra® Salivary gel and toothpaste. The gel, but not the toothpaste, is prescribable on the NHS in primary care as a Borderline Substance

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13. Skin

13.2 – Emollients and Barrier Preparations

13.2.1 Emollients Plain Emollients

Aqueous Cream or ZeroAQS

Aqueous Cream: Liquid paraffin 6%, 15% white petroleum jelly & emulsifying wax 9% - due to the SLS content to be used as a soap substitute only

ZeroAQS: Liquid paraffin 6%, white soft paraffin (WSP) 15% & macrogol cetrostearyl ether 1.8% (SLS free)

Aveeno cream Emulsifying ointment 30%, phenoxyethanol 1% & cetostearyl alcohol

Cetraben Liquid paraffin 10.5%, white soft paraffin (WSP) 13.2%

Emulsifying Ointment BP

WSP 50%, emulsifying wax 30% & liquid paraffin 20%

Hydromol® ointment Yellow soft paraffin 30%, emulsifying wax 30% & liquid paraffin 40%. - this product is also known locally as ‘Emulsifying Ointment RVI Formula’. It is softer than emulsifying ointment BP. Epaderm ointment is made to the same formula, but is more expensive.

Dermol cream s 10% liquid paraffin, 10% isopropyl myristate & 0.1%

benzalkonium chloride & 0.1% chlorhexidine chloride

Doublebase gel or Zerodouble gel

15% liquid paraffin & 15% isopropyl myristate

QV cream s 10% light liquid paraffin, 5% white soft paraffin & 10%

glycerol - approved for used in radiotherapy only

Aquamax cream s 8% light liquid paraffin, 20% WSP

- approved for used in radiotherapy only

Epimax cream

Yellow Soft Paraffin

White Soft Paraffin

Paraffin sterile liquid

Hydrous Ointment (Oily Cream)

E45® Cream or ZeroCream

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Diprobase® Cream or Zerobase cream

Urea Containing Emollient

Calmurid® Cream containing urea 10% & lactic acid 5%

13.2.1.1 – Emollient Bath Additives

Zeroneum® Liquid containing soya oil 83.35%

Oilatum® Emollient or Zerolatum

Liquid containing liquid paraffin 63.4% & acetylated wool alcohols 5%

Dermol bath s 25% liquid paraffin, 10% isopropyl myristate & 0.5%

13.2.2 – Barrier Preparations

Sorbaderm® 2g & 92g barrier cream, 28ml pump spray, sterile 1ml no sting barrier film foam applicator, sterile 3ml no sting barrier film foam applicator

Dimeticone (Siopel®) Cream containing dimeticone ‘1000’ 10% & Cetrimide 0.3%. Also contains arachis (peanut) oil

Drapolene® Cream containing benzalkonium chloride 0.01% & Cetrimide 0.2%

Sudocrem® Cream containing benzyl alcohol 0.39%, benzyl benzoate 1.01%, benzyl cinnamate 0.15%, hydrous wool fat (hypoallergenic lanolin) 4%, zinc oxide 15.25%

Zinc and Castor Oil ointment (cream)

Ointment containing zinc oxide 7.5%, castor oil 50%, arachis (peanut) oil 30.5%, white beeswax 10% and cetostearyl alcohol 2%

Deegan’s Ointment su

Ointment containing 3% benzoin compound tincture in a base containing zinc and castor oil paste and olive oil under

review

Metanium® Ointment containing titanium oxide 20%, titanium peroxide

5% and titanium salicylate 3% in a basis containing dimeticone, paraffins and benzoin compound tincture under

review

R Sucralfate u 4% cream - for limited use around gastrostomies when wound breakdown is thought to be aggravated by leakage of gastric acid

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13.3 – Topical Local Anaesthetics and Antipruritics Antipruritics

Calamine Lotion Lotion (calamine 15%, zinc oxide 5%, glycerol 5% bento-nite

3%, sodium citrate 0.5% & liquefied phenol 0.5%)

Crotamiton 10% cream (Eurax)

Menthol in Aqueous cream 1% menthol in aqueous cream. Available as Dermacool

Local Anaesthetics

Lidocaine 5% ointment

13.4 – Topical Corticosteroids

Very Potent

Clobetasol Propionate (Dermovate®)

0.05% cream, ointment & scalp application

Potent

Betamethasone Valerate (Betnovate®)

0.1% cream, ointment, lotion & scalp application

Fluocinolone Acetonide (Synalar®)

0.025% cream, ointment & gel

Hydrocortisone Butyrate (Locoid®)

0.1% cream

With Antimicrobials

Betnovate C ® Cream & ointment (betamethasone 0.1% - as the valerate & clioquinol 3%)

Betnovate N ® Cream & ointment (betamethasone 0.1% - as the valerate & neomycin sulphate 0.5%)

Dermovate NN Ointment (clobetasol propionate 0.05%, neomycin sulphate

0.5%, nystatin 100,000 units/g) u

With Salicylic Acid Diprosalic Ointment - betamethasone 0.05% (as dipropionate) &

salicylic acid 3%: Scalp application - betamethasone 0.05% (as dipropionate) & salicylic acid 2%

Moderately Potent Clobetasone Butyrate (Eumovate®)

Cream & ointment (0.05% clobetasone butyrate)

Betamethasone 0.025% (Betnovate RD®)

Cream & ointment (betamethasone 0.025% - as the valerate)

Fludroxycortide tape Polythene adhesive film impregnated with fludroxycortide

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(Flurandrenolone, Haelan®) (4micrograms/cm2), supplied as 7.5cm wide strips in lengths of 50cm & 2m.

With Antimicrobials

Trimovate® Cream (clobetasone butyrate 0.05%, oxytetracycline 3%, & nystatin 100,000 units/g)

Triadcortyl® u Nystatin, neomycin, gramicidin ointment

- for the treatment of otitis externa in those patients who have ear canal stenosis or who have failed to respond to other first or second line treatments

Mild

Hydrocortisone 0.5%, 1% & 2.5% creams & ointments With Antimicrobials

Canesten HC® Cream (clotrimazole 1% & hydrocortisone 1%)

Daktacort® Cream (miconazole nitrate 2% & hydrocortisone 1%)

Nystaform HC® Cream (chlorhexidine HCl 1%, nystatin 100,000 units/g & hydrocortisone 0.5%)

Timodine® Cream (nystatin 100,000 units/g, benzalkonium chloride 0.1%, hydrocortisone 0.5% & dimeticone ‘350’ 10%)

With Other Ingredients Eurax Hydrocortisone® Cream (crotamiton 10% & hydrocortisone 0.25%)

13.5 – Preparations for Eczema and Psoriasis 13.5.1 – Preparations for Eczema

Zinc Paste and Ichthammol Bandage (Ichthopaste)

R Alitretinoin 10mg and 30mg capsules - approved for adults with severe chronic hand eczema that have not responded to potent topical corticosteroids in line with NICE

13.5.2 – Preparations for Psoriasis Coal Tar Preparations

Coal Tar Coal tar lotion 1% - see Exorex Coal tar strong solution 1%, 2.5% & 5% in emulsifying

ointment RVI u

Coal Tar & Salicylic Acid Ointment containing coal tar 2% & salicylic acid 2%

Coconut oil Compound (Sebco®)

Scalp ointment (Coal tar solution 12%, salicylic acid 2%, precipitated sulphur 4%, in a coconut oil emollient basis) – marketed as Cocois and Sebco (Sebco is recommended as it is less expensive)

Exorex® Lotion containing prepared coal tar 1% in an emollient

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basis. Excipients include hydroxybenzoates (parabens) and polysorbate 80

Tar Pomade (RVI) u

Pomade containing 6% coal tar solution and salicylic acid 2% in an emulsifying ointment base

Zinc and Coal Tar Paste

(White’s Tar Paste) u

Paste containing zinc oxide 6%, coal tar 6%, emulsifying wax 5%, starch 38% and yellow soft paraffin 45%

With Corticosteroid

Alphosyl HC® Cream containing coal tar extract 5%, hydrocortisone 0.5% and allantoin 2%

Dithranol Preparations

Dithranol 0.1%, 0.25%, 0.5%, 1% & 2% creams (Dithrocream®)

0.2%, 0.4% & 0.6% pomade u

R Dithranol in Full Strength

Lassar’s Paste u

0.1%, 0.2%, 0.4%, 0.6%, 0.8%, 1%, 2%, 4%, 6% & 8%

R Dithranol with Salicylic

Acid 0.5% u

0.2%, 0.4%, 0.6%, 0.8%, 1%, 2%, 4%, 6%, 8% & 16% in emulsifying base

Other Topical Preparations

Calcipotriol (Dovonex®)

50 micrograms/g (0.005%) cream & ointment 50 micrograms/ml (0.005%) scalp application

Salicylic Acid 2%, 5%, 10% & 20% in emulsifying ointment u

Zinc and Salicylic Acid Compound Paste, Half

Strength u

Half Strength Lassar’s Paste

Dovobet® Ointment containing betamethasone 0.05% (as dipropionate) and calcipotriol 50 micrograms/g

Gel containing betamethasone 0.05% (as dipropionate) and calcipotriol 50 micrograms/g - For the treatment of scalp and mild to moderate non scalp plaque psoriasis vulgaris in adults.

Oral Retinoids for Psoriasis

R Acitretin u

10mg & 25mg capsules

Psoralens (used with phototherapy)

R 8-Methoxypsoralen u

(Methoxsalen)

10mg tablets

R 5-Methoxypsoralen u 20mg tablets

R Methoxypsoralen u 1.2% bath additive

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Other treatments

R Fumaric acid esters u 30mg & 120mg tablets

13.5.3 – Drugs Affecting the Immune Response

Methotrexate See section 8.1.3

Ciclosporin See section 8.2.2

R Adalimumab r 40mg injection (prefilled syringe) - approved for psoriasis in line with NICE -approved for the treatment of moderate to severe hidradenitis

suppurativa in line with NICE and NHS England Commissioning Policy

R Etanercept r 25mg injection (Enbrel® & Benapali®) - approved for psoriasis in line with NICE

R Infliximab r 100mg injection (Remicade®, Inflectra® & Remsima®) - approved for psoriasis in line with NICE

R Ustekinumab r 45mg vial - approved for psoriasis in line with NICE - approved for psoriatic arthritis in line with NICE

R Secukinumab 150microgram pre-filled pen & syringe

-approved for the treatment of plaque psoriasis in line with NICE

B Tacrolimus s 0.03% & 0.1% ointment - approved for moderate to severe disease atopic eczema in patients over 2 years in line with NICE

B Pimecrolimus s 1% cream -approved for moderate disease on face and neck for those between 2 and 16 years in line NICE

13.6 – Preparations for Acne

13.6.1 – Topical Preparations Benzoyl Peroxide and azelaic acid

Azelaic Acid 15% gel (Finacea®)

Benzoyl Peroxide 2.5%, 5% & 10% aqueous gel (Panoxyl Aquagel®)

Epiduo® Gel containing adapalene 0.1% and benzoyl peroxide 2.5%

Antibiotics

Clindamycin 1% topical solution (alcohol – water basis) 1% lotion (aqueous)

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Zineryt® Topical solution containing erythromycin 4% zinc acetate 1.2% (when reconstituted)

Erythromycin 2% topical solution (alcoholic)

Topical Retinoids

Adapalene 0.1% gel and cream

Isotretionoin 0.05% gel

Clindamycin & Tretinoin Gel containing clindamycin 1% & tretinoin 0.025%

Isotretinoin & Erythromycin Gel containing isotretionoin 0.05% & erythromycin 2%

13.6.2 – Oral Preparations

R Isotretinoin 5mg & 20mg capsules - isotretinoin is a toxic drug only to be prescribed by or under the supervision of a consultant dermatologist – see BNF and product literature.

Co-cyprindiol Tablets containing cyproterone acetate 2mg & ethinylestradiol 35 micrograms – generic co-cyprindiol is much cheaper than Dianette®

See section 5.1 for systemic antibiotics

13.6.3 – Topical Preparations for Rosacea

Brimonidine Tartate s 0.33% gel - for specialist initiation for the treatment of severe rosacea. Following specialist review of effectiveness, primary care can continue supply.

Ivermectin (Soolantra®) 1% cream -for the treatment of papulopustular rosacea in patients as second line treatment in patient who have failed topical metronidazole

13.7 – Preparations for Warts and Calluses

Salactol® Paint Paint (salicylic acid 16.7% & lactic acid 16.7% in flexible collodion)

Glutaraldehyde Paint 10% Solution (paint) – Glutarol

Salicylic Acid Various strength preparations in Emulsifying ointment – see section 13.5.2

Podophyllotoxin s 0.15% cream (Warticon) – to be initiated with specialist advice

Silver Nitrate 75% & 95% applicators – 6 inch & 95% pencils (Caustic

pencils). 0.5% solution also available see section 13.11.6

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Imiquimod rs 5% cream 12 sachet pack - 2nd line specialist use for treatment of ano-genital warts (mainly in genitourinary medicine [GUM] clinics)

Trichloroacetic Acid u 10%, 75% & 90% solutions

13.8 – Sunscreens and Camouflagers 13.8.1 – Sunscreen Preparations Preferred Products

Uvistat Ultrablock® (Sunblock factor 30)

Cream (UVB – SPF 30) - mexenone 2%, ethylhexyl p-methoxycinnamate 7.5%, Butylmethoxydibenzoylmethane 4% & titanium dioxide 6.5%

Sunsense Ultra® (Sunblock factor 50+)

Lotion (UVA and UVB – SPF 50+ protection) – containing octinoxate 7.5%, oxybenzone 3%, titanium dioxide 3.5% - 125ml pack

Photodamage

Fluorouracil s (Efudix®)

5% cream - for the treatment of superficial malignant and premalignant skin lesions. To be initiated with advice of specialists

Ingenol mebutate 150 micrograms/g & 500 micrograms/g gel

-for the treatment non-hyperkeratotic, non-hypertrophic actinic keratosis in adults

13.8.2 – Camouflaging Preparations

Products from the Dermacolor® Camouflage Crème and Veil cover cream ranges are included in this Formulary. They are classified as borderline substances and can be prescribed on FP10 prescription forms (marked ACBS) for postoperative scars and other deformities and as an adjunctive therapy in the relief of emotional disturbances due to disfiguring skin disease, such as vitiligo.

13.9 – Shampoos and Some Other Preparations for Scalp and Hair

Conditions

Alphosyl 2 in 1® Shampoo containing alcoholic coal tar extract 5%

Polytar Liquid® Shampoo containing a mixture of tar preparations & 0.3% Cade oil

Ketoconazole 2% shampoo (Nizoral®)

Selenium Sulphide 2.5% shampoo (Selsun®)

Simple Shampoo Simple shampoo (Gentle/Frequent) 200ml

Hirsutism

Co-cyprindiol Tablets containing cyproterone acetate 2mg & ethinylestradiol 35 micrograms - generic co-cyprindiol is much cheaper than Dianette

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Eflornithine 11.5% cream

- approved for use as a second-line treatment of facial hirsutism in patients where co-cyprindiol (Dianette) is ineffective, contra-indicated or considered inappropriate. Treatment should be initiated by or on the specific advice of an appropriate specialist - endocrinologist (or gynaecologist)

13.10 – Anti-Infective Skin Preparations 13.10.1 – Antibacterial Preparations 13.10.1.1 – Antibacterial Preparations Only Used Topically

Mupirocin Ointment s 2% ointment (Bactroban) - to be initiated with advice from specialist

Polyfax® Ointment Ointment (polymyxin B sulph. 10,000 units & bacitracin zinc 500 units/g)

Silver Sulfadiazine 1% Cream (Flamazine®)

R Nitrofurazone Soluble su 0.2% Ointment – for limited use in burns/ plastic surgery patients only

13.10.1.2 – Antibacterial Agents Also Used Systemically

Fusidic Acid

2% cream, gel & ointment

Metronidazole Gel 0.75% cream & gel, 13.10.2 – Antifungal Preparations (Topical)

First Choice

Miconazole Nitrate 0.16% Dual Action Spray powder

Alternatives

Ketoconazole 2% cream & shampoo

Nystatin Nystatin cream & ointment have now been discontinued

Terbinafine 1% cream

Amorolfine 5% nail lacquer cream – for use in primary care only

13.10.3 – Antiviral Preparations

Aciclovir (Acyclovir) 5% cream

13.10.4 – Parasiticidal Preparations Head lice First line

Dimeticone (Hedrin®) 4% lotion (50ml)

Second line

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Malathion 0.5% lotion (aqueous), 0.5% lotion (alcoholic)

Scabies/Crab lice Permethrin

5% skin cream; 1% cream rinse

13.10.5 – Preparations for Minor Cuts and Abrasions etc. Antiseptic Creams / Ointments

Drapolene® Cream (cetrimide 0.2%, benzalkonium chloride 0.01%)

Proflavine cream Oily emulsion containing 0.1% Proflavine hemisulphate –

for limited use in hospitals Preparations for Boils

Magnesium Sulphate Paste (dried magnesium sulphate 45g, glycerol 55g & phenol 500mg

per 100.5g) Collodion

Flexible Collodion 2.5% castor oil & colophony 2.5% in a collodion base Skin tissue Adhesives

Enbucrilate Tissue adhesives (Liquiband®, Liquiband Optima®, Indermil X-Fine, Histoacryl Blue®)

Glues / sealants for intra-operative use

Bioglue® For use in neurosurgery and vascular surgery

Floseal® matrix sealant

Evicel® Human Fibrin Glue 2ml & 5ml kit

Tisseel® Lyo Fibrin Glue 2ml, 4ml & 10ml kit - also approved for use in the treatment of mesh fixation in hernia repair

R TachoSil 4.8 & 9.5 cm 2 Haemostatic (collagen sponge coated with fibrinogen and thrombin) for use in liver and renal surgery

Artiss fibrin sealant 2ml, 4ml & 10ml prefilled syringe.

- for use in plastic surgery to close dead spaces, adhere skin graft, close simple wounds and stabilise bone grafts.

e) For Use ENT surgery & Epistaxis

R Bismuth Subnitrate and Iodoform (B.I.P.P.)

Paste 1.25cm x 100cm & 2.5cm x 100cm impregnated gauze

13.11 – Disinfectants and Cleansers 13.11.1 – Alcohols, Saline and water

Alcohol Impregnated Wipes Containing 70% isopropyl alcohol or methylated spirit (e.g. Clini-wipes®, Alcowipes®)

Methylated Spirit 70% liquid & 70% spray

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(industrial) Skin Preparation Swabs Containing 70% isopropyl alcohol (Sterets®)

Alcohol Hand Rub Gel Sodium Chloride 0.9% Sterile solution – bottles, 25ml & 100ml sachets

(Normasol®) & 45ml plastic ampoules/pods (Miniversol®)

Water for Irrigation (Sterile) 13.11.2 – Chlorhexidine Salts

In June 2014 information was published highlighting the risk of severe chemical injuries associated with the use of both alcohol-based and water-based chlorhexidine solutions for skin disinfection in premature infants. This was based on Yellow Card reports and reports identified in the literature. A European review has since considered the MHRA evidence together with additional information from spontaneous reporting and published literature The risk appears to be higher in infants born before 32 weeks of gestation than in full term infants and in the first 2 weeks of life than in later life.

Advice for healthcare professionals:

When using alcohol-based or water-based chlorhexidine solutions on premature infants, bear in mind the risk of severe chemical injuries.

Use the minimum amount of chlorhexidine solution required and do not allow the solution to pool. Remove any excess solution and any soaked materials, drapes, or gowns from the skin.

Use single-use containers where possible. There is a danger of accidentally using too much solution from a multiple-use container.

Monitor patients frequently to detect and manage cutaneous side effects at an early stage.

Please report any adverse events through the Yellow Card Scheme:www.mhra.gov.uk/yellowcard

Chlorhexidine (CX Antiseptic Powder®)

1% chlorhexidine acetate dusting powder

Chlorhexidine Gluconate 0.02% & 0.05% solutions, 25ml & 100ml sachets 0.5% solution in 70% methylated spirit (pink, colourless & red staining), 2.5% in 70% methylated spirit wipes 0.5% hand rub (contains 70% isopropyl alcohol + emollients)

4% surgical scrub 2% in 70% isopropyl alcohol wipes (Sanicloth

® & Clinell

®),

skin swabs & skin cleanser 3ml & 10.5ml applicators (Chloraprep®) Obstetric cream

Prontosan® s Solution containing Betaine 0.1% (surfactant) and Polyhexanide 0.1% (a chlorhexidine polymer). Mainly for use from 40ml plastic ampoules. Also available as a gel. Prontosan - to be prescribed/ used only on the advice of tissue viability specialists

13.11.3 Cationic Surfactants, Soaps and Other Antiseptics

Mediscrub® Scrub containing 2% polymeric biguanide hydrochloride

Octenisan® Body wash containing octenidine - used in some trusts as an alternative to chlorhexidine scrub and

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Triclosan skin cleanser in MRSA prophylaxis/eradication

13.11.4 Chlorine and Iodine

Iodine Containing Preparations

Povidone Iodine 2.5% dry powder spray 10% alcoholic solution

7.5% surgical scrub10% antiseptic solution (aqueous) Chlorinated Products

Sodium

Hypochlorite u

1% sterilising solution

Sodium dichloroisocyanurate

500mg & 5g solution tablets: granules

13.11.5 – Phenolics

Hexachlorophene and Triclosan

Triclosan (Aquasept®, Manusept®, & Skinsan®)

1% or 2% skin cleanser 0.5% hand rub

13.11.6 – Astringents, Oxidisers and Dyes

Hydrogen Peroxide 10 volume (3%) & 20 volume (6%) solutions

Potassium Permanganate 400mg solution tablets

5% solution u under review Silver Nitrate 0.5% solutions – used on advice from dermatologists

Under review R Bonney’s Blue u Paint containing brilliant green and crystal violet – for limited

use in some operating theatres only

R Crystal Violet u 0.5% paint

- for limited use in some operating theatres / critical care areas only

Magenta paint BPC su

(Castellani’s paint)

Paint containing magenta 0.4%, boric acid 0.8%, phenol 0.004%, resorcinol 8%, acetone and alcohol (or industrial methylated spirit) – unlicensed under review

13.11.7 – Preparations for Promotion of Wound Healing

See Section 18

LarvE Sterile larvae (maggots) used for the management of sloughy wounds

13.12 – Antiperspirants

Aluminium Chloride (Driclor®, Anhydrol forte®)

Aluminium chloride hexahydrate 20% solution in an alcoholic basis

Botulinum A Toxin 100 unit vials for injection (Botox) – see section 4.9.3

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Haem -agglutinin complex s - For limited use as an alternative to surgery in some patients.

Glycopyrrolate su 1% cream – To be initiated by specialist

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14. Immunological Products and Vaccines

Please refer to the DoH Green Book on vaccines for the most up to date

information on the recommended preparations and use.

14.4 – Vaccines and Antisera

For use in line with formal DOH guidance

Bacillus Calmette-Guérin Vaccine (BCG Vaccine, Dried/Tub/BCG)

1ml multidose vials containing freeze dried powder for preparing intradermal injections

Tuberculin Purified Protein Derivative

(Tuberculin PPD) u

20 units/ml (2 units/0.1-ml dose) (for routine use), 1.5-ml vial; 100 units/ ml (10 units/0.1-ml dose), 1.5-ml vial Dose: By intradermal injection, for Mantoux test, 2 units (0.1 ml of 20 units/ml strength) for routine Mantoux test; if first test is negative and a further test is considered appropriate 10 units (0.1 ml of 100 units/ml strength). The tuberculin PPD currently supplied is unlicensed in the UK.

Botulism Antitoxin

1 vial of Botulism antitoxin trivalent (equine) A B & E 5000 units injection normally stocked at Newcastle General Hospital for emergency use. If required, contact pharmacy.

Diphtheria/Tetanus/Pertussis (Acellular, Component), Poliomyelitis (inactivated) and Haemophilus Type b Conjugate Vaccine (adsorbed) (DTaP/IPV/Hib)

0.5ml vial

Adsorbed Diphtheria, Tetanus, Pertussis (Acellular, Component)

Adsorbed Diphtheria, Tetanus, Pertussis (Acellular, Component) and Inactivated Poliomyelitis Vaccine, (dTaP/IPV or DTaP/IPV)

0.5ml prefilled syringe

Adsorbed Diphtheria (low dose),

Tetanus, Pertussis (Acellular, Component) and Inactivated Poliomyelitis Vaccine (dTaP/IPV or DTaP/IPV)

0.5ml prefilled syringe

Adsorbed Diphtheria (low dose), Tetanus and Inactivated Poliomyelitis Vaccine

0.5ml prefilled syringe

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Haemophilus Influenzae type b conjugated vaccine

Vial with syringe containing diluent (0.5ml)

Haemophilus Influenzae type b & Meningococcal Group C Conjugate Vaccine (Menitorix)

Vial with syringe containing diluent (0.5ml) - also approved for immune testing in non CF bronchiectasis patients

Hepatitis A Vaccine 720 ELISA units in 0.5ml prefilled syringe for use in children aged 1-15 years (Havrix Monodose Junior). 1440 ELISA units in 1ml prefilled syringe for use in adults (Havrix Monodose).

Hepatitis B Vaccine (High Strength)

40 microgram/ml – only licensed for use in dialysis and predialysis patients

Hepatitis B Vaccine Hepatitis B surface antigen 10 micrograms/ml

0.5ml (paediatric) & 1ml (adult) prefilled syringes (HBvaxPRO) - preferred product:

20 micrograms/ml 0.5ml (paediatric) & 1ml (adult) vials prefilled syringes (Engerix B) also available

Hepatitis A & B Vaccine 1ml syringe (Adult Twinrix) & 0.5ml syringe (Paediatric Twinrix)

Human Papilloma Virus Vaccine 0.5ml prefilled syringe – Cervarix® brand

For the prevention of cervical cancer (Gardasil brand is available for limited uses i.e. for giving protection against cancer in patients with Fanconi anaemia use in children with HIV infection and infections with other blood borne viruses)

Influenza Vaccine 0.5ml prefilled syringes containing either split viron or surface antigen vaccine. -The formulary includes both standard influenza vaccine and pandemic influenza vaccine

Fluenz nasal spray Suspension of live, attenuated influenza virus. 0.2ml nasal applicator

Japanese Encephalitis Vaccine su Vials

Measles, Mumps & Rubella Vaccine, Live (MMR [live])

Powder and solvent for suspension for injection in pre-filled syringe (0.5ml)

Meningococcal A, C, W135 & Y Vaccine (ACWY Vax)

Powder and solvent for suspension for injection in pre-filled syringe (0.5ml)

Meningococcal A, C, W135 & Y conjugate Vaccine (Menveo)

Powder and solvent for suspension for injection in pre-filled syringe (0.5ml)

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Meningococcal Group C Conjugate Vaccine

0.5ml prefilled syringe

Pneumococcal Polysaccharide Vaccine (Pneumovax II)

0.5ml vial

- also approved for immune testing in non CF bronchiectasis patients

Pneumococcal Polysaccharide Conjugate Vaccine (adsorbed)

(Prevenar)

0.5ml prefilled syringe

Poliomyelitis Vaccine, Inactivated 0.5ml prefilled syringe

- not for routine use, use combined vaccines

Rabies Vaccine Vial with syringe containing diluent - used in hospitals for post exposure management (on advice from infectious diseases specialists) and for pre-exposure prophylaxis in those at high risk – e.g. in travellers – prescribed on a private prescription

Tetanus Vaccine Adsorbed 0.5ml injection – immunology use only - for primary immunisation against tetanus in previously unimmunised adults and children over 10 years, 3 doses of diphtheria (low dose), tetanus & inactivated poliomyelitis vaccine at monthly intervals are now recommended.

Typhoid Vaccine (vi Polysaccharide)

0.5 ml prefilled syringe

R Varicella Zoster Vaccine - for limited use only

Yellow Fever Vaccine Live Available only to designated Yellow Fever Vaccination centres

14.5 – Immunoglobulins Normal Immunoglobulin (Human normal Immunoglobulin, HNIG)

Normal Immunoglobulin injections

For Deep Intramuscular Injection

250mg & 750mg vials - Available from the Centre

for Infections and other regional Health Protection Agency offices. For Subcutaneous Administration

800mg in 5ml and 1,600 mg in 10ml vials (Subcuvia) for SC infusion. Can IM if SC route not available (replaces Gammabulin). 250mg, 750mg & 1500mg vials (Subgam) – mainly for use in Northumbria Healthcare Trust

For Intravenous Administration

2.5g, 5g & 10g for IV infusions (Flebogamma, Octagam 5% & 10%, & Vigam) 5g in 50ml, 10g in 100ml & 20g in 200ml IV infusions (Privigen – replaces Sandoglobulin) 1g, 2.5g, 5g, 10g & 20g for IV infusions (Kiovig). The brand supplied and strengths available may change from time to time.

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Specific Immunoglobulins

Tetanus Immunoglobulin (HTIG) 250 units in 1ml injection

Anti – D (Rho) Immunoglobulin

1,500 units in 2ml prefilled syringes (Rhophylac®

) 1,500 unit (300 microgram) & 5,000 unit (1mg)

vials (WinRho®

) s

- approved for the prevention of RhoD sensitisation in

women in line NICE

- also approved for use by haematologists in appropriate patients with immune thrombo-cytopenia. The 1,500 and 5,000 unit vials (WinRho) are much more expensive than the other formulations and should only be used on advice from haematologists. It is the only formulation licensed for use in immune thrombocytopaenia.

Varicella-Zoster Immunoglobulin

R Hepatitis B Immunoglobulin su 200 international units injection (for infant use)

3g injection (for use in liver unit / critical care)

3g injection has been discontinued, replaced with Hepatect.

HEPATECT 500 international units injection and 2000

international units injection.

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15. Anaesthesia

15. 1 – General Anaesthesia 15.1.1 – Intravenous Anaesthetics First Choice

Propofol 1% (10mg/ml) injections (Propofol Lipuro®) available as 200mg in 20ml ampoules, 500mg in 50ml and 1g in 100ml bottles 1% (10mg/ml) 50ml (500mg) prefilled syringes for use in Diprifusor pumps (Diprivan®) 2% (20mg/ml) injection - 1g in 50ml bottles for ITU use only

Others

Etomidate 20mg in 10ml injection

Ketamine 200mg in 20ml (10mg/ml), 500mg in 10ml (50mg/ml) & 1g in 10ml (100mg/ml) injections

50mg in 5ml oral solution u - often used as an analgesic in the management of neuropathic

pain by specialist pain teams R

- also for palliative care A

Thiopental Sodium (Thiopentone)

500mg in 20ml injection

15.1.2 – Inhalational Anaesthetics First Choice

Isoflurane Others

Nitrous Oxide

Entonox 50% nitrous oxide and 50% oxygen mixture used for analgesia

R Sevoflurane

R Halothane u For use in elective and emergency airway anaesthesia only

(mainly paediatrics)

R Desflurane For use in neurosurgery patients as an alternative to sevoflurane

or desflurane and in the following groups of patients as an alternative to sevoflurane/ isoflurane in

Bariatric surgery.

Prolonged procedures over 2 hours e.g. oesophagectomy.

Surgery in the elderly where there are concerns of cognitive

impairment

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Major surgery in the elderly with or without cognitive

dysfunction

Subject to the following limitations: Desflurane is not for use in day surgery unless the patient is

morbidly obese.

There is no role at present for its use in paediatrics or cardio-thoracic surgery.

Desflurane must be used in conjunction with low fresh gas

flow. Its use should be monitored and audited.

15.1.3 – Antimuscarinic Pre-medication Drugs

Atropine Sulphate 600 microgram injection 1mg in 5ml and 3mg in 30ml injections in prefilled syringes used in cardiac resuscitation

Glycopyrronium Bromide

200 microgram in 1ml & 600 microgram in 3ml injections

Hyoscine Hydrobromide

400 microgram injection

15.1.4 – Sedative and Analgesic Pre-operative Drugs 15.1.4.1 – Anxiolytics and Neuroleptics Benzodiazepines

Diazepam 2mg, 5mg tablets – 10mg tablets should no longer be used.

2mg in 5ml oral solution 10mg in 2ml injection (plain & emulsion) - For use in epilepsy see section 4.8.2 and use in anxiety see section 4.1.2

Midazolam 5mg in 5ml (1mg/ml) injection – for general use

10mg in 2ml & 10mg in 5ml injections - these higher strengths are restricted to use in general anaesthesia, intensive care, palliative medicine and where its use has been formally risk assessed and agreed, for example, where syringe drivers are used 50mg in 50ml prefilled syringes - ITU use only

2.5mg in 1ml oral solution u

R Intranasal midazolam 40mg/ml + lidocaine 20mg/ml - approved for use prior to cannulation for adult patients with special needs receiving dental treatment under IV sedation.

Temazepam (see section 4.1.1)

Lorazepam (see section 4.1.2) Phenothiazine

Alimemazine (Trimeprazine)

30mg in 5ml syrup – see section 3.4.1 for other formulations

15.1.4.2 – Non Opioid Analgesics

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Diclofenac 75mg in 2ml injection (Dyloject) - mainly for use in postoperative analgesia – see section 10.1.1 for other formulations

R Parecoxib 40mg injection - for peri-operative use only.

Ketorolac Trometamol 10mg in 1ml & 30mg in 1ml injections - The use of is no longer recommended, other parenteral analgesics are now preferred

15.1.4.3 – Opioid Analgesics (see section 4.7.2 for other opioid analgesics)

Alfentanil s 1mg in 2ml, 5mg in 10ml & 5mg in 1ml injections - approved for initiation by specialists in palliative care

R Fentanyl 100 microgram in 2ml & 500 microgram in 10ml injections

2.5mg in 50ml (50 micrograms/ml) syringe u 2 micrograms/ml with levobupivacaine 0.1% in sodium

chloride 0.9% infusion, 100ml, 250ml & 500ml u

4 micrograms/ml with levobupivacaine 0.125% in sodium

chloride 0.9% infusion, 500ml (RVI) u

Remifentanil 1mg, 2mg & 5mg injections 15.1.4.4 – Other drugs for sedation

R Dexmedetomidine 100 micrograms in 1ml injection approved for use in patients: -with traumatic brain injury, have no respiratory problems but require prolonged ventilatory support due to severe agitation, confusion and requirement for propofol/midazolam; and -who are difficult to sedate e.g. with overdose of MDMA/PMA/”legal highs” or who have pre-existing drug or alcohol dependence or who have failed conventional methods of treatment.

100 micgrograms in 1ml injection (intranasal) u

-approved for pre-operative sedation in anxious children at risk of respiratory depression in whom midazolam is contraindicated or those who have failed pre-operative sedation with other agents.

15.1.5 – Muscle Relaxants (Neuromuscular Blocking Drugs)

R Atracurium 25mg in 2.5ml, 50mg in 5ml & 250mg in 25ml injection

R Cisatracurium 20mg in 10ml (2mg/ml) & 150mg in 30ml (5mg/ml) injections

R Mivacurium 10mg in 5ml & 20mg in 10ml injections

R Pancuronium 4mg in 2ml injection

R Rocuronium 50mg in 5ml injection

Suxamethonium 100mg in 2ml injection

R Vecuronium 10mg in 5ml injection

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R Papaverine 30mg in 2ml injection u 15.1.6 – Anticholinesterases Used in Anaesthesia

R Edrophonium 10mg in 1ml injection

R Glycopyrronium &

Neostigmine

Glycopyrronium 500 microgram & neostigmine 2.5mg in 1ml injection (Robinul – neostigmine)

R Neostigmine 2.5mg in 1ml injection

R Physostigmine u 1mg in 1ml injection

R Sugammadex 200mg in 2ml & 500mg in 5ml injections - only approved for the emergency reversal of blockade in cases of failed intubation in patients who are undergoing rapid sequence induction anaesthesia with rocuronium because of contra-indications to suxamethonium.

15.1.7 – Antagonists for Central and Respiratory Depression

R Doxapram

see section 3.5.1

100mg in 5ml injection 2mg/ml 500ml intravenous infusion in glucose 5%

Flumazenil 500 microgram in 5ml injection

Naloxone 400 microgram in 1ml injection (ampoules and syringes) 15.1.8 – Drugs for Malignant Hyperthermia

R Dantrolene Sodium 20mg injection

15.1.9 – Prophylaxis of acid aspiration

R Sodium Citrate 0.3 Molar peppermint flavoured solution (50ml packs)

15.2 – Local Anaesthesia Lidocaine (Lignocaine)

Injections (plain) 0.5% 10ml 1% 2ml, 5ml, & 10ml (10mg/ml) 2% 2ml, 5ml & 20ml injection (20mg/ml) 5% 2ml Heavy injection (50mg/ml)

5% 10ml injection (50mg/ml) u Injections (with Adrenaline) 1% & adrenaline 1 in 200,000, 20ml 2% & adrenaline 1 in 200,000, 20ml 2% & adrenaline 1 in 80,000, 2ml cartridges Topical preparations 1% & 2% gel with chlorhexidine 0.25% 4% topical solution (some packs unlicensed)5% ointment Metered dose spray (10mg/spray)

2% spray u

100mg lollipops u

Lidocaine 4%, adrenaline 0.1% & tetracaine 0.5% (LAT

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gel®) u

- approved for use in anaesthetising lacerations <4cm in length,

particularly in the paediatric population – not to be used in children

weighing under 15kg. R Bupivacaine 0.25% & 0.5% injection 10ml

0.25% & 0.5% + adrenaline 1 in 200,000 inj. 10ml 0.5% in glucose 8% injection (Marcain Heavy)

0.1% & 0.125% u in sodium chloride 0.9% infusions

R Levobupivacaine 0.25%, 25mg in 10ml & 0.5%, 50mg in 10ml & 0.75%, 75mg in 10ml injections &

R 0.625mg/ml & 1.25mg/ml infusion bags

- for local infiltration in hip and knee replacement surgery.

Mepivacaine 3% 2.2 ml cartridges

Prilocaine 0.5% 10ml injection u, 1% 20ml injection 4% 2ml injection (cartridges)

R 2% 5ml injection (cartridges) - only to be used in patients undergoing spinal anaesthesia for day

surgery where the procedure is anticipated to last longer than 90

minutes.

3% & felypressin injection (cartridges)

Tetracaine (Amethocaine) 4% gel (Ametop)

R LMX4® Cream (lidocaine 4%) – LMX4 is not associated with methaemoglobinemia, a systemic side effect of Emla.

EMLA® Cream (lidocaine 2.5% & prilocaine 2.5%)

R Cocaine 4% nasal solution (drops) u

25% paste (1g syringe pack) u

4% solution with adrenaline u

Procaine s 1% 5ml injection u, 2% 2ml injection,

0.1% 500ml infusion u

Lidocaine & Phenylephrine (Co-phenylcaine Forte)

5% lidocaine & 0.5% phenylephrine solution with

applicator, or nasal spray (50ml) u

Ethyl Chloride Spray

PR Freeze spray Spray

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16. Treatment of Poisoning

16.1 – Removal and Elimination 16.1.1 - Emetic

The use of emetics such as Ipecacuanha Mixture is no longer recommended 16.1.2 – Prevention of Absorption

Activated Charcoal Actidose Aqua Advance® – 50g in 240ml suspension Carbomix® - 50g powder supplied in a bottle to which water is added to prepare a suspension

16.2 – Agents Used in Poisoning Due to Specific Drugs 16.2.1 – Paracetamol Poisoning Acetylcysteine 2g in 10ml injection

Methionine 250mg & 500mg tablets 16.2.2 – Analgesics (Opioid) Naloxone 400 microgram injection – ampoules and prefilled syringes 16.2.3 – Iron Salts Desferrioxamine 500mg vials (for preparing injection & oral solution)

16.3 – Agents Used in Poisoning by Other Agents 16.3.1 – Cyanides Dicobalt Edetate 300mg in 20ml injection

Sodium Nitrite 3% 10ml injection (30mg/ml) u

Sodium Thiosulphate 50% 10ml injection (500mg/ml) u 16.3.2 – Heavy Metals

Dimercaprol 100mg in 2ml injection

Penicillamine 125mg & 250mg tablets

Sodium calcium edetate

1g in 5ml injection

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16.3.3 – Pesticides etc.

16.3.3.1 – Paraquat Poisoning

Activated Charcoal - see 16.1.2 – Given with a laxative

16.3.3.2 – Organophosphorus Insecticides

Pralidoxime Mesylate 1g in 5ml injection

16.3.4 – Snake Bite Adder Snakebite Antiserum (European Viper Antivenom) 16.3.5 – Ethylene Glycol and Methanol

Fomepizole u 100mg in 20ml injection

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17. Nutrition Products

Fortisip Compact® Protein 9.6g, carbohydrate 29.7g, fat 9.3g per 100ml,

240kcal/100ml. Fortisip Compact is not Kosher or Halal approved. - approved for use in patients with renal failure and when a lower fluid volume is indicated.

Pro-Cal Shot® Liquid formulation of the nutritional supplement Pro-Cal. Approved for use in colo-rectal surgery patients in an enhanced

recovery programme. More convenient to use than Pro-Cal

powder.

Resource® Protein Isotonic nutritional supplement with increased levels of protein, energy and other nutrients. Claimed to have better palatability

and tolerability than some other similar nutritional products.

ProZero® Carbohydrate 8.1g, fat 3.8g, energy 278kJ - approved for children with metabolic disorders

Infatrini peptisorb® Protein 2.6g, carbohydrate 10.3g, fat 5.4g per 100ml,

100kcal/100ml.

Parenteral Nutrition Products

Babiven Maintenance su Parenteral nutrition solution containing amino acids, glucose

and minerals for use in parenteral nutrition for babies.

Smofkabiven® Emulsion for infusion (TPN), consisting of three chambers - only approved for use as a second line agent, when the current contracted product is unavailable.

Section Under Development

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18. Wound Management Products

Chapter 18 contains the full list of products contained on the North of Tyne APC formulary. Subsets of chapter 18 have been produced by the TVN teams from both NHCFT and NUTH and are distributed accordingly. 18.1 Basic Wound Contact Dressings

18.1.1 Low Adherence Dressings

Knitted Viscose Primary Dressing BP 1993

Tricotex® Warp knitted fabric manufactured from bright viscose monofilament. - low adherence wound contact layer.

Paraffin Gauze Dressing BP 1993

Paranet®

Other

Atrauman® Non-adherent knitted polyester primary dressing

impregnated with neutral triglycerides. - abrasions, burns.

18.1.1 Absorbent Dressings Absorbent Perforated Dressing with Adhesive Border

Mepore® Low adherence dressing consisting of viscose and rayon

absorbent pad with adhesive border.

Absorbent Perforated Plastic Film Faced Dressing Low adherence dressing consisting of 3 layers

Solvaline N® r

Low adherence dressing consisting of 3 layers - for post-operative and low exudates wounds; low adherence property and low absorption capacity. - restricted to podiatry and primary care use. Alternative to melolin for practice nurses.

Eclypse Adherent® r Soft silicone wound contact layer with absorbent pad and

film-backing - restricted to use in heavily exudating wounds that require multiple dressing changes.

Absorbent Cellulose Dressing with Fluid Repellent Backing Mesorb® Cellulose wadding pad with gauze wound contact layer

and non-woven repellent backing. - postoperative use for heavily exuding wounds.

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KerraMax Care®

18.2 Advanced Wound Dressings

18.2.1 Hydrogel dressings

Hydrogel Sheet Dressings ActiFormCool® Hydrogel sheets which have fixed structure, such

products have limited fluid handling capacity. - moderate exuding wounds.

Hydrogel Application (amorphous) Intrasite Gel® A ready mixed hydrogel containing modified carmellose

polymer applied directly into the wound. 8g only - for dry, sloughy or necrotic wounds

18.2.2 Vapour-permeable films and membranes

Vapour-permeable Adhesive Film Dressing, BP 1993

(Semi-permeable Adhesive Dressing)

Opsite Flexifix® Unsterile film dressing on a roll.

Tegaderm® r - restricted to IV/sc dressing and podiatry use only

With Absorbent Pad Vapour-permeable Adhesive Film Dressing with absorbent pad Opsite plus®

Opsite Post Op®

18.2.3 Soft Polymer Dressings Urgotul® Non-adherent soft polymer wound contact dressing

- dry or lightly exuding wounds

Telfa Clear® Clear non-adherent wound contact layer - available from NHS supply chain via the Total Dressings Scheme (Currently Northumbria only)

Adaptic Touch® Non adherent soft silicone wound contact dressing

With Absorbent Pad Allevyn Gentle®

Soft gentle wound contact dressing with polyurethane foam film backing

Allevyn Gentle Lite® r Soft gentle wound contact dressing with polyurethane

foam film backing - restricted to podiatry use only

Allevyn Gentle Border® Silicone gel wound contact dressing with polyurethane

foam film backing

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Mepilex® Absorbent soft silicone dressing with polyurethane film

Mepilex Border®

With soft silicone border

Mepilex Transfer® Soft silicone exudates transfer dressing

18.1.4 Hydrocolloid dressings

Without Adhesive Border

Comfeel Plus Transparent® Hydrocolloid dressing containing carmellose sodium and

calcium alginate.

DuoDerm Extra Thin® Sterile, thin, hydrocolloid dressing. - minimally exuding wounds.

DuoDerm Signal® Hydrocolloid dressing with “Time to change” indicator.

- pressure ulcers, burns.

Hydrocolloid Fibrous Dressing Aquacel® Soft sterile non-woven pad containing hydrocolloid fibres.

Ribbon. - moderate to heavily exuding wounds.

Aquacel Extra® Soft sterile non-woven pad containing hydrocolloid fibres. - moderate to heavily exuding wounds.

18.2.5 Foam Dressings Polyurethane Foam Film Dressing, Sterile without Adhesive Border. Polymem® - moderate to heavy exuding wounds

18.2.6 Alginate dressings

Plain Alginate Melgisorb® Alginate containing hydrocolloid dressing sterile.

Sorbsan Ribbon with Probe®

18.3 Antimicrobial Dressings 18.3.1 Honey Sheet Dressing L-Mesitran Hydro®

(formerly Mesitran®) Hydrogel, semi-permeable dressing impregnated with medical grade honey, without adhesive border. - pressure ulcer, fungating wounds, donor sites.

L-Mesitran Border® (formerly Mesitran® Border)

Hydrogel, semi-permeable dressing impregnated with medical grade honey, with adhesive border.

L-Mesitran Net® (Formerly Mesitran® Mesh)

Hydrogel, non-adherent wound contact layer, without adhesive border

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Algivon® Absorbent, sterile, non-adherent calcium alginate

dressing impregnated with medical grade manuka honey.

Honey Based Topical Application

L-Mesitran® Ointment containing 47% medical grade honey

L-Mesitran Soft® Ointment containing 40% medical grade honey

18.3.2 Iodine Iodoflex® Paste iodine 0.9% as cadexomer-iodine in a paste basis

with gauze backing. 5g unit, 10g unit, 17g unit. - for chronic exuding wounds. - max single application 50g. Max weekly application 150g. - duration up to 3 months in any single course of treatment. - cautions: Severe renal impairment or history of thyroid disorders - contra-indications: avoid in thyroid disorders, in those receiving lithium, in pregnancy and breast feeding and in children.

Iodosorb® Ointment, iodine 0.9% as cadexomer-iodine in an ointment basis. 10g - uses for chronic exuding wounds. - max single application 50g. Max weekly application 150g. - duration up to 3 months in any single course of treatment. - cautions: Severe renal impairment or history of thyroid disorders - contra-indications: avoid in thyroid disorders, in those receiving lithium, in pregnancy and breast feeding and in children.

Povidone-Iodine Fabric Dressing

Inadine® - wound contact layer for abrasions and minor burns - cautions: iodine may be absorbed particularly in large wounds. - contra-indications: severe renal impairment, pregnancy, breast feeding.

18.3.3 Silver Low Adherence Dressings

Acticoat® s Three-layer antimicrobial barrier dressing consisting of a polyester core between low adherent silver-coated high density polyethylene mesh. - specialist use only.

Acticoat Flex 3® s Conformable antimicrobial barrier dressing consisting of a polyester core between low adherent silver-coated high density polyethylene mesh (for 3-day wear). - specialist use only.

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Acticoat Flex 7® s Conformable antimicrobial barrier dressing consisting of a polyester core between low adherent silver-coated high density polyethylene mesh (for 7-day wear). - specialist use only.

With charcoal

Actisorb Silver 220®

Knitted fabric of activated charcoal, with one-way stretch, with silver residues within spun-bonded nylon sleeve.

Soft polymer Dressings

Urgotul SSD®

With silver sulphadiazine. - antimicrobial dressing for dry or lightly exuding wounds.

Alginate Dressings

Silvercel® Sterile hydrocolloid and alginate dressing impregnated

with silver. - antimicrobial dressing for moderate to heavily exuding wounds.

Tegaderm Alginate Ag Calcium alginate dressing.

18.3.4 Other Antimicrobials

Flaminal®

Alginate containing hydrogels with glucose peroxidase and lactoperoxidase enzymes with antimicrobial properties. For use as an alternative to some silver or iodine containing products Forte gel, 15g and 50g. - for use on moderately to heavily exuding wounds.

Hydro gel, 15g and 50g. - for use on lightly to moderately exuding wounds.

Prontosan Wound Gel®

A ready mixed hydrogel containing betaine surfactant and polyhexanide. 30ml

Prontosan Irrigant® 20ml pods and 100ml bottle

18.4 Specialised Dressings 18.4.1 Protease modulating matrix dressings

Promogran Prisma Matrix® r Sterile, collagen and oxidised regenerated cellulose matrix. - chronic wounds free of necrotic tissue and infection - podiatry use only

18.5 Adjunct Dressings and Appliances 18.5.2 Wound Drainage Pouches Draina S®

Eakin®

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18.5.3 Topical negative pressure therapy

KCI VAC negative pressure

Renasys Go® Topical Negative Pressure

Pico®

18.7 Wound Care Accessories 18.7.1 Dressing Packs Non-Drug Tariff Specification Sterile Dressing Pack

First Choice on FP10

Polyfield Nitrile Patient Pack

Contains powder free nitrile gloves, laminate sheet, polythene sterile field, non-woven swabs, towel, polythene disposable bag, apron. -cheaper than Dressit®, lamiate sheet for kneeling on.

Second Choice on FP10

Dressit®

Contains vitrex gloves, large apron, disposable bag, paper towel, soft swabs, absorbent pad and sterile field.

Soft drape® Universal dressing pack, latex free; includes ivtrex gloves - available from NHS supply chain via the Total Dressings Scheme (Currently Northumbria only)

Sterile Gloves

18.7.2 Woven and Fabric swabs Non-woven fabric swab Non-woven fabric swab Sterile

Non-sterile

Appeel® single use wipes - removes adhesive build up without damaging skin.

18.7.3 Surgical adhesive tapes Permeable Apertured Non-woven Synthetic Adhesive Tape, BP 1988 Mefix®

Hypafix®

Scanpore® tape - primary care only

Transpore® tape - secondary care only

18.8 Bandages

Bandages and adhesives

According to their structure and performance bandages are used for dressing retention, for support and for compression.

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18.8.2 Light-weight conforming bandages

Knitted Polyamide and Cellulose Contour Bandage BP1988 K-Band®

Actiwrap Latex-free Bandage®

18.8.3 Tubular Bandages and Garments

Elasticated Tubular Bandages BP1993

Elasticated Viscose Stockinette

Cotton Stockinette Bleached BP1988

Ribbed cotton and viscose surgical tubular stockinette BP1988

Full Comfi range (Synergy Health)

- available from NHS supply chain via the Total Dressings Scheme (Currently Northumbria only)

Full Clini range (CliniSupplies)

18.8.4 Support bandages Knitted Elastomer and Viscose Bandage

K-Lite®

18.8.6 Cohesive bandages

Cohesive extensible bandages These adhere to themselves, but not to the skin, and are useful for providing support for sports

use where ordinary stretch bandages might become displaced and adhesive bandages are inappropriate. Care is needed in their application, since the loss of ability for movement

between turns of the bandage to equalise local areas of high tension carries the potential for

creating a tourniquet effect. They should not be used if arterial disease is suspected.

18.8.7 Compression bandages Short stretch compression bandages Actico®

Comprilan®

Sub-compression wadding bandage Profore #1® also available as latex free

18.8.8 Multi-layer compression bandaging

Four layer systems

Profore®

also available as latex free

Profore Lite®

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Two layer system Coban 2®

Coban 2 Lite

K-Two®

18.8.9 Medicated bandages

Zinc Paste Bandage (Viscopaste PB7®)

Open-wove bleached cotton bandage impregnated evenly with a paste containing zinc oxide 6%

Zinc Paste and Ichthammol Bandage (Ichthopaste)

Open-wove bleached cotton bandage impregnated evenly with a paste containing zinc oxide 6% and ichthammol 2%

Medicated stocking

Zipzoc® 4 pouch carton, 10 pouch carton

18.9 Compression Hosiery and Garments 18.9.1 Graduated compression hosiery

First Choice

Activa® hosiery Full range

Second Choice

Medi® hosiery

Full range

18.10 Other wound products not listed in BNF, but on Drug Tariff or available from NHS Supply Chain.

Actiglide® Product to aid the application of compression hosiery

- restricted to leg ulcer management only - available on FP10

Kerraped® A shoe to accommodate bulky bandages and offload pressure from the front of the foot. ] - restricted to leg ulcer management only. - available on FP10

Limbo® Transparent limb-shaped plastic cover with flexible seal at the opening. - restricted to leg ulcer management only. - keep leg dressings dry during bathing/showering - available on FP10

Seal Tight® Transparent limb-shaped plastic cover with flexible seal at the opening. - restricted to leg ulcer management only. - keep leg dressings dry during bathing/showering - available on FP10

Debrisoft® - debridement of supifical wounds

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Sorbaderm® 2g & 92g barrier cream, 28ml pump spray, sterile 1ml no sting barrier film foam applicator, sterile 3ml no sting barrier film foam applicator.

Products also in Dermatological section of Formulary and BNF 13.1.2

13.11.1 Skin cleansers and antiseptics Sodium Chloride Irripod® 0.9% Solution sterile, 25 x 20ml

Miniversol® 0.9% Solution sterile, 30 x 45ml unit and 30x100ml unit dose vials (pods)

13.11.7 Desloughing Agents

Biobag® s

Sterile larvae (maggots) sealed in a finely woven polyester pouch with PVA foam spacers. - specialist use only

Larvae300® s Free range larvae with a retention net kick pack. - specialist use only

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Appendix

This section lists some products that have been approved for prescribing/use by the North of Tyne Area Prescribing Committee, but do not fit into existing sections of the Formulary. Some will be added to additional sections as these are developed.

MRI Contrast Media

Gadobutrol (Gadovist®) Gadolinium based MRI Contrast medium for use as an

alternative to Magnevist®. One of the safer gadolinium contrast

media with regard to the potential risk of nephrogenic systemic fibrosis.

Gadobenate dimeglumine (Multihance®)

- for use in the differential diagnosis of liver disease

Gadofosveset (Vasovist®) Gadolinium (MRI) contrast agent that binds to albumin for use

in MRI angiograms

Gadoxetic acid® (Primovist)

Gadolinium based MRI Contrast medium for use in:

The assessment of hepatic vascular structures and biliary

system of potential living, related liver donors. The detection and characterisation of focal liver lesions

using MRI, when standard imaging with other agents has

been inconclusive. The detection and characterisation of focal liver lesions which

potentially communicate with the biliary system e.g. large liver cysts.

Gastrografin A contrast medium for the radiological examination of the gastrointestinal tract.

Meglumine gadoterate (Dotarem)

Gadolinium MRI contrast medium that is licensed for use in

children. Gadoterate is considered to be much less likely to

cause nephrogenic systemic fibrosis than dimeglumine gadopentetate (Magnevist®), which has previously been used

in children.

Miscellaneous

Sonovue®

Sulphur hexafluoride. Available as a kit including one vial of

gas, one vial of powder and one pre-filled syringe containing

5ml of solvent. On reconstitution, 1 ml of the resulting dispersion contains 8 microliters of sulphur hexafluoride in the

microbubbles, equivalent to 45 microgrammes - approved for use in visualising blood vessels in liver and diagnosing cancer, and used for the diagnosis of pancreatic cancers, and also for use when echocardiography images are unsatisfactory for answering the clinical question due to poor definition.

Acetic acid 5%u To be diluted to 2.5%

- approved for the use in the detection of dysplasia/ neoplasia in Barrett’s oesophagus

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Dialysis Fluids

Citrasate A sodium citrate based dialysate with a citrate concentration of

0.8mmol/l – approved for use in place of standard dialysate formulations for patients in whom anticoagulation is problematic or contraindicated.

Primsocitrate 18/0 Citrate containing anticoagulant solution containing 18mmol/L

citrate, 140mmol/l sodium and 86mmol/l chloride - approved for regional anticoagulation using citrate in continuous renal replacement therapies (CRRT)

PrimsOcal B22 A calcium free dialysate containing 22mmol/l bicarbonate, 3mmol/l lactate, 140mmol/l sodium, 4mmol/l potassium,

0.75mmol/l magnesium, 120.5mmol/l chloride and 6.1mmol/l

glucose - approved for regional anticoagulation using citrate in continuous renal replacement therapies (CRRT)

Probiotics

VSL#3®

Probiotic containing high concentration of lyophilised bacteria

NEW -approved for use under the supervision of a physician for the maintenance of remission of ileoanal puchitis only in adults as induced by antibiotics

R BioGaia® - approved for prophylaxis against necrotising enterocolitis in pre-term infants

R Infloran® - approved for prophylaxis against necrotising enterocolitis in pre-term infants

Wound Care Products

R Xelma® Amelogenin containing wound treatment that helps provide an

extra cellular matrix protein. - approved for specialist use in the treatment of hard to heal leg ulcers that have not responded to standard therapies. Use should be targeted to ulcers >10cm2 in area and those > 12 months duration. Prescriptions should be signed by an appropriate consultant vascular surgeon (or dermatologist). NOT to be used to treat diabetic foot ulcers.

R Integuseal IS 100 Sterile, film forming cyanocrylate liquid, provided in a ready-to-

use applicator - approved for preoperative preparation of the saphenous vein harvest site

Gentafleece Collagen based medical device containing gentamicin - used during surgical procedures for its haemostatic and antibiotic properties. Less expensive than Collatamp-G.

Chlorhexidine impregnated sponge (Biopatch®)

An antiseptic hydrophilic wound dressing that is applied to the venous catheter insertion sites for lines expected to be in situ for greater than 72 hours in critical care areas.

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Fillers etc, used in Surgery

Hyaluronic Acid injection – (Hydrafil Softline Max®)

Hyaluronic acid injection (replacement for Hylaform Plus®).

- approved for use in ENT surgery as a bulking agent in the posterior tracheal wall around the tracheo-oesophageal fistula in the occasional patient with leakage around Blom-Singe valves.(Discontinued Sep 2010)

Hyaluronic Acid – Perlane (Restylane Perlane®)

Hyaluronic acid injection - Viscoelastic gel tissue filler

- approved for use in patients with mechanical ptosis with acute facial nerve palsies

Hyaluronic Acid – Sub Q (Restylane Sub Q®)

Hyaluronic acid injection - Viscoelastic gel tissue filler

- approved for use in augmentation of orbital volume after removal of the eye in patients who have already had other volume enhancement surgery

Juvederm® Ultra 3 Hyaluronic acid injection- Viscoelastic gel tissue filler that contains a local anaesthetic.

- onlyapproved for procedures that are not available on the NHS.

Juvederm® Ultra 4 Hyaluronic acid injection - Viscoelastic gel tissue filler that contains a local anaesthetic.

- approved for use for volumising and correction of deeper folds and wrinkles, including enhancing volume in the cheeks and chin. - only approved for procedures that are not available on the NHS.

Radiesse Voice® u Calcium hydroxylapatite injection – pack contains a 1ml percutaneous needle, for use as a vocal cord medialisation injection only by ENT.

- only approved for use in patients who are anticipated to have a longer life expectancy as it has a longer duration of action.

Bone Morphogenic Proteins (BMP) R Dibotermin Alfa s

(Inductos®)

Inductos contains 1.5mg/ml of dibotermin alfa.

- approved for use in spinal fusion procedures: In patients who have failed previous spinal fusion surgery and in patients undergoing spinal fusion surgery where there is a very high risk of non-union.

R Eptotermin alfa s

(Osigraft®)

Each vial contains 1g of powder with 3.3mg of eptotermin alfa. - approved for use in the treatment of the non-union of the tibia only.

Others R Indigo Carmine su 20mg in 5ml & 40mg in 5ml solution/injection

- approved for facilitating the identification of malignant and premalignant lesions during colonoscopy

R Methylthioninium 10ml amp 0.5% injection (Proveblue) & 1% injection

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Chloride s (Aggutenent)

R Patent Blue V

Sodium s u r

5mg in 2ml injection - restricted to use in sentinel lymph node biopsies.

Personal Best Peak Flow Meter

Peak flow meter that has some advantages over the Mini-Wright peak flow meter at no extra cost.

Sucrose 24% solutionu 24% solution - used as an analgesic in neonates whilst carrying out painful procedures such as heel prick testing

R Taurolidine 2%

solution u

- approved for use in washing out the chest cavity prior to lung transplantation and nebulisation post transplant.

R Biotin u

5mg tablets - approved for the treatment of multiple carboxylase deficiency. Only to be initiated by a specialist

R l-lysine 2.5%, l-arginine

2.5% infusion u

- used for renal protection in patients receiving lutetium 177 dotatate therapy (approved by the Cancer Drug Fund.)

DC Beads 75-150 micron and 100-300 micron - for the treatment of malignant hypervascularised tumour(s) using the TACE procedure

Coagucheck XS INR test strips

INRatio2 INR test strips

North of Tyne and Gateshead Area Prescribing Committee. Formulary - Version 6.5 October 2016

17 2

Index

—3— 3TC. see Lamivudine, 66

—5— 5HT3 Antagonists, 46

5-Methoxypsoralen, 138

—8— 8-Methoxypsoralen, 138

—A— Abacavir, 66 Abacavir & lamivudine, 66 Abacavir, Lamivudine & Zidovudine. see

Trizivir Abasaglar. see Insulin glargine Abatacept, 116 Abbreviations, 3 Abciximab, 27 Abidec, 113 Abilfy Maintena. see Aripiprazole long

acting injection, 41 Abilify. see Aripiprazole Abiraterone, 104 Abstral. see Fentanyl sublingual Acamprosate, 58 Acarbose, 73 Accrete D3. see Calcium carbonate 1.5g &

colecalciferol 10micrograms , see Calcium carbonate 1.5g & colecalciferol 10micrograms

Acetazolamide

anti-epileptic, 54 epilepsy, 55 glaucoma, 125

Acetic acid 5%

Barrett's oesophagus, 168 Acetylcholine, 128 Acetylcysteine, 37

eye drops, 127 paracetamol poisoning, 156

Aciclovir, 68

cream, 142 eye ointment, 123 oropharyngeal infections, 133

Acitretin, 138 Aclasta. see Zoledronic Acid Acne, 139 acquired nystagmus. See memantine Actemra. See Tocilizumab

Actico, 165 Acticoat, 162 Acticoat Flex 3, 162 Acticoat Flex 7, 163 Actidose-Aqua Advance. see Activated

charcoal ActiformCool, 160 Actiglide, 166 Actilyse. see Alteplase Actinomycin D. see Dactinomycin, 92 Actiq. see Fentanyl lozenges Actisorb Silver 220, 163 Activa hosiery, 166 Activated Charcoal

paraquat poisoning, 157 poisoning, 156

Actiwrap Latex-free Bandage, 165 Actonel. see Risedronate Actos. see Pioglitazone Actrapid insulin, 72 Acular. see Ketorolac Acyclovir, see aciclovir, 68

cream, 142 eye ointment, 123 oropharyngeal infections, 133

Adalat. see Nifedipine Adalimumab

inflammatory arthritic conditions, 117 Inflammatory bowel disease, 11 psoriasis, 139 Severe Refractory Uveitis, 124

Adapalene, 140 Adapalene and benzoyl peroxide. see

Epiduo Adaptic Touch, 160 Adcortyl injection. see Triamcinolone

acetonide Adefovir, 68 Adenocor. see Adenosine Adenoscan. see Adenosine Adenosine, 17 Adenuric. See febuxostat Adgyn. see Estradiol Adizem. see Diltiazem Adrenaline

allergic emergencies, 36 CPR, 24

Adriamycin. see Doxorubicin Adsorbed Diphtheria (low dose), Tetanus

and Inactivated Poliomyelitis Vaccine, 147

Advagraf. see Tacrolimus Afatinib, 95 Aflibercept, 128 Aggrastat. see Tirofiban Agomelatine, 44 Ajmaline, 18

North of Tyne and Gateshead Area Prescribing Committee. Formulary - Version 6.5 October 2016

17 3

Albendazole, 71 Alcobon. see Flucytosine Alcohol

hand rub gel, 144 impregnated wipes, 143

Alcohol Dependence, 58 Alcowipes. see Alcohol impregnated wipes,

143 Aldactone. see Spironolactone Aldara. see Imiquimod Aldomet. see Methyldopa Alemtuzumab, 101 Alendronate sodium, 81 Alfacalcidol, 112 Alfentanil, 153 Algivon, 162 Alimemazine

allergy, 35 in anaesthetics, 152

Alimta. see Pemetrexed Alirocumab, 29 Aliskiren, 21 Alitretinoin, 137 Alkalinisation of urine, 89 Alkeran. see Melphalan Alkylating agents, 91 ALL. See pegasparinase Allergen Immunotherapy, 35 Allevyn Gentle, 160 Allevyn Gentle Border, 160 Allevyn Gentle Lite, 160 Allopurinol, 119 Aloxi. see Palonosetron Alpha tocopheryl acetate, 112 Alpha Tocopheryl as tocofersolan, 112 Alpha-blockers

hypertension, 20 treatment of urine retention, 88

Alphagan. see Brimonidine Alphosyl 2 in 1 shampoo, 141 Alphosyl HC cream, 138 Alprostadil, 90

Altacite plus. see Co-simalcite, 8 Alteplase, 27 Aluminium chloride hexahydrate, 145 Amantadine

parkinsonism, 57 Amaryl. see Glimepiride AmBisome. see Amphotericin, 65 Ambrisentan, 20 Amethocaine

eye drops, 126 gel for local anaesthesia, 155

Ametop. see Tetracaine Amfebutamone, 58 Amias. see Candesartan Amikacin, 62 Amikin. see Amikacin Amiloride, 17 Amiloride and Frusemide. see Co-

amilofruse

Aminocaproic acid, 28 Aminoglycosides, 62 Aminophylline, 32 Aminosalicylates, 11, 12 Amiodarone, 18 Amisulpride, 41 Amitiza. See lubiprostone Amitriptyline

antidepressant, 43 enuresis, 89 migraine prophylaxis, 51 neuropathic pain, 49

Amitrylptilline. See diabetic neuropathy Amlodipine, 22 Amoebicides, 70 Amorolfine

skin preparations, 142 Amoxil, 60 Amphotericin, 65

eye drops, 123 oral suspension, 133

Amsacrine, 94 Amsidine. see Amsacrine Anaemias, 105 Anaesthesia, 151 Anaesthetics

general, 151 local, 154 local - ophthalmic, 126

Anafranil. see Clomipramine Anagrelide, 106

Anakinra, 117 Anal and rectal disorders, 14 Anal fissure, 15 Analgesics, 47

compound preparations, 47 non-opioid, 47 non-opioid in anaesthetics, 152 opioid, 47 opioid in anaesthetics, 153 opioid -treatment of poisoning by, 156

Anastrozole, 103 Ancotil. see Flucytosine Androcur. see Cyproterone acetate Androgens. see Male sex hormones Anexate. see Flumazenil Angiox. See bivalirudin Anhydrol Forte, see aluminium chloride,

145 Anidulafungin, 65 Antabuse. see Disulfiram Antacid with oxetacaine, 8 Antacids

with alginates and other ingredients, 8 with Dimeticone, 8 with local anaesthetic, 8

Antepsin. see Sucralfate Anterior pituitary hormones, 79 Anti – D (Rho) immunoglobulin, 150 Anti-androgens, 78

North of Tyne and Gateshead Area Prescribing Committee. Formulary - Version 6.5 October 2016

17 4

Antibacterial / corticosteroid

ear preparations, 130 eye preparations, 124

Antibacterial drugs, 60 Anticoagulants, 24 Anticonvulsants, 52 Antidepressants, 42 Antidiarrhoeal drugs, 10 Anti-emetics, 45 Antiepileptics, 52 Antifibrinolytic drugs, 27 Antifungal drugs

eye preparations, 123 skin preparations, 142 systemic, 65 vaginal infections, 84

Antihistamines

general use, 35 nausea etc., 45

Antihypertensive therapy, 19 Antileprotic drugs, 64 Antilymphocyte immunoglobulin, see

antithymocyte immunoglobulin, 100 Antimalarial drugs

malaria prophylaxis and treatment, 70 rheumatoid arthritis, 116

Antimigraine drugs, 50 Antimuscarinic drugs

bronchodilators, 32 gastrointestinal antispasmodic, 8 parkinsonism, 57 premedication, 152 urinary incontinence, 88

Antinauseants, 45 Anti-obesity drugs, 45 Anti-oestrogens, 79 Antipruritics, 136 Antipsychotics, 40 Antispasmodics and other drugs altering

gut motility, 8 Antithymocyte Immunoglobulin (Horse),

100 Antithymocyte immunoglobulin (Rabbit),

100 Antithyroid drugs, 75 Antituberculous drugs, 64 Antiviral drugs, 66

eye, 123 skin preparations, 142

Anusol, 14 Anusol HC, 14 Anxiolytics, 39 Apixaban, 25 APO-go. see Apomorphine Apomorphine

parkinonism, 57 Appetite suppressants, 45 Apraclonidine, 128 Aprepitant, 46 Apresoline. see Hydralazine Aprotinin, 27

Aprovel. see Irbesartan Aquacel, 161 Aquacel Extra, 161 Aquasept. see triclosan Aqueous Cream, 134 Aqueous iodine solution, 75 Arachis oil enemas, 13 Aramine. see Metaraminol Aranesp. see Darbepoetin

Arava. see Leflunomide Arcoxia. see Etoricoxib Aredia. see Disodium Pamidronate Argatroban, 25 Argipressin, 80 Aricept. see Donepezil Arimidex. see Anastrozole Aripiprazole, 41 Aripiprazole long acting injection, 41 Arixtra. see Fondaparinux Aromasin. see Exemestane Arrhythmias, drugs for, 17 Arsenic Trioxide, 94 Artensuate

antimalarial, 70 Artificial tears

Carbomer 980, 127 Artiss fibrin sealant, 143 Arythmol. see Propafenone, see

Propafenone Arzerra. see Ofatumumab Asacol. see Mesalazine Ascorbic acid, 112

eye drops, 129 Asparaginase. see Crisantaspase, 94 Aspart insulin, 72 Aspirin

analgesia, 47 antiplatelet, 26

Ataluren, 119 Atarax. see Hydroxyzine Atazanavir, 66 Atenolol, 18 Ativan. see Lorazepam Atomoxetine, 44 Atorvastatin, 28 Atosiban, 84 Atovaquone, 71 Atracurium, 153 Atrauman, 159 Atropine

eye preparations, 125 oral, 9

Atropine sulphate

in anaesthesia, 152 Atrovent. see Ipratropium Attention Deficit Hyperactivity Disorder, 44 Aubagio. see Teriflunomide Augmentin, 60 Avanafil, 90 Avaxim. see Hepatitis A vaccine Aveeno cream, 134

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Avelox. see Moxifloxacin Avloclor. see Chloroquine Avonex. see Interferon beta Axitinib, 95 Axsain. see Capsaicin Azacitidine, 92 Azactam. see Aztreonam Azathioprine, 99

inflammatory bowel disease, 11 Azelaic Acid, 139 Azelastine, 131 Azilect. see Rasagiline Azithromycin, 62 AZT. see Zidovudine Aztreonam, 61

—B— Babiven, 158 Baclofen, 120 Bactrim. see Co-trimoxazole Bactroban. see Mupirocin Balanced Salt solution, 127 Balsalazide, 11 Baraclude. see Entecavir Basiliximab, 99 Bausch & Lomb

contact lens solutions, 129 saline, 129

BCG Connaught, 102 BCG SSI, see BCG vaccine, 147 Beclazone. see Beclometasone Becloforte. see Beclometasone Beclometasone

inhaled (asthma management), 33 nasal spray, 131

Beclometasone and Eformoterol, 34 Beclomethasone. see beclometasone Beconase. see Beclometasone, nasal

spray Becotide. see Beclometasone Bee or Wasp venom extract. see

Pharmalgen, 35

Behcets disease. see infliximab

Belimumab, 117 Bendamustine, 91 Bendrofluazide. see Bendroflumethiazide,

16 Bendroflumethiazide, 16

Benlysta. see Belimumab Benoxinate see Oxybuprocaine, 126 Benzathaine penicillin, 60 BenzhexolseeTrihexyphenidyl, 57 Benzoin tincture, compound, 37 Benzoyl Peroxide, 139 Benzydamine, 132 Benzylpenicillin, 60

eye drops, 122 Beriplex - P, 28 Beta-Blockers, 18

eye drops, 125 Beta-cardone. see Sotalol Betaferon. see Interferon beta-1b, see

Interferon beta Betahistine, 46 Betaloc. see Metoprolol Betamethasone

ear drops, 130 eye drops, 123 nasal drops, 131 skin preparations, 136 with calcipotriol. See Dovobet

Betamethasone and Clioquinol. see Betnovate C

Betamethasone and Neomycin

cream & ointment. see Betnovate N, 136 ear drops, 130 eye drops, 124

Betamethasone dipropionate and Salicylic acid. see Diprosalic

Betamethasone valerate, 136 Betmiga. see mirabegron Betnesol. see Betamethasone Betnesol-N. see Betamethasone &

Neomycin Betnovate C, 136 Betnovate N, 136 Betnovate RD. see Betamethasone skin

preparations, 136 Betnovate. see Betamethasone valerate,

136 Bevacizumab, 129 Bezafibrate, 29 Bezalip. see Bezafibrate Bicalutamide, 104 Bicarbonate

oral, 108 BiCNU. see Carmustine Bile acid sequestrants, 29 Biltricide. see Praziquantel Bimatoprost, 125 Bimatoprost and timolol eye drops, 126 Biobag. see Sterile larvae BioGaia, 169 Bioglue, 143 Biopatch, 169 Biorphen. see Orphenadrine Biotene oral balance, 133 Biotin, 171 BioXtra, 133 Biphasic insulin aspart, 72 BIPP. see Bismuth subnitrate & Iodoform,

132, 143 Bisacodyl, 12 Bismuth subnitrate and iodoform, 132, 143 Bisoprolol, 19 Bisphosphonates, 81 Bivalirudin, 25 Bladder instillations, 89 Bleomycin, 92 Blood Products, 28

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17 6

BMP-2. See Dibotermin Alfa BMP-7. See Eptotermin alfa Boceprevir, 69 Bondronat. see Ibandronic acid Bone Metabolism, drugs affecting, 81 Bonefos. see Sodium clodronate Bonjela. see Choline salicylate, 132 Bonney’s blue, 145 Bonviva. see Ibandronic acid Bortezomib, 94 Bosentan, 19 Bosulif. see Bosutinib Bosutinib, 99 Botox. see Botulinum A toxin Botulinum A toxin

anal fissure, 15 dystonias, 57 hyperhidrosis, 145

Botulinum B toxin, 58 Botulinum toxin A

Dysport, 51 Botulinum toxin type A, 58 Botulism Antitoxin, 147 Bowel cleansing solutions, 13 Bramitob. See Tobramycin Brevibloc. see Esmolol Bricanyl. see Terbutaline Bridion. See Sugammadex Brilliant green and crystal violet paint. see

Bonney’s blue Brimonidine, 125 Brimonidine Tartate, 140 Brintellix. see Vortioxetine

Brinzolamide and brimonidine eye drops, 126

BritLofex. see Lofexidine Brivaracetam, 55 Briviact. see Brivaracetam Brolene. see Propamidine isethionate Bromocriptine

in endocrinology, 82 parkinsonism, 56

Bronchodilators, 31

antimuscarinic, 32 sympathomimetic, 31 Theophylline & Aminophylline, 32

Brufen. see Ibuprofen Budenofalk

see budesonide, 11 Budesonide

asthma, 33 inflammatory bowel disease, 11

Budesonide and Eformoterol, 34 Bulk forming laxatives, 12 Bumetanide, 17 Bupivacaine, 155 Buprenorphine

analgesic, 48 opioid dependence, 58

Bupropion, 58 Burinex. see Bumetanide

Buscopan. see Hyoscine butylbromide Buserelin, 83, 104 Busulfan, 91 Busulphan. see Busulfan, 91 Bydureon. See exenatide Byetta. see Exenatide

—C— Cabazitaxel, 98 Cabergoline

in endocrinology, 82 Caelyx. see Liposomal Doxorubicin Caffeine citrate, 36 Calamine lotion, 136 Calcichew. see calcium carbonate Calciferol. see Ergocalciferol, 112 Calcipotriol, 138

with betamethasone. See Dovobet Calcitonin (Salmon), 81

bone metabolism, 81 hypercalcaemia, 109

Calcium & ergocalciferol tablets, 112 Calcium acetate, 110 Calcium carbonate

calcium supplement, 109 phosphate binding, 110

Calcium carbonate & vitamin D3, 112 Calcium carbonate 1.5g & colecalciferol

10micrograms, 112 Calcium channel blockers, 22 Calcium chloride, 109 Calcium folinate, 91 Calcium gluconate, 109 calcium hydroxylapatite. See Radiesse

Voice Calcium leucovorin. see Calcium folinate Calcium polystyrene sulphonate, 107 Calcium Resonium, 107 Calcium Sandoz, 109 Calcium supplements, 109 Calfovit D3. see Calcium carbonate

&vitamin D3 Calmurid, 135 Calpol. see Paracetamol Calsynar. see Calcitonin (Salmon) Camcolit. see Lithium carbonate Camouflaging preparations, 141 Campath. see Alemtuzumab Campral. see Acamprosate Campto. see Irinotecan Canagliflozin, 74 Cancidas. see Caspofungin Candesartan, 21 Canesten. see Clotrimazole Canesten HC, 137 Capecitabine, 92 Caphosol, 132 Capsaicin, 50, 121 Captopril, 21 Carace. see Lisinopril

North of Tyne and Gateshead Area Prescribing Committee. Formulary - Version 6.5 October 2016

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Carbamazepine

anti-epileptic, 53 mania, 42 trigeminal neuralgia, 49

Carbimazole, 75 Carbocisteine, 37 Carbomer 980, 127 Carbomix. see Activated charcoal Carboplatin, 94 Carboprost, 84 Cardene. see Nicardipine Cardicor. see Bisoprolol Cardiovascular system, 16 Cardura. see Doxazosin Carmellose sodium, 132 Carmellose Sodium, 127 Carmustine, 91 Carnitine, 114 Carnitor. see Carnitine Carvedilol, 19 Casodex. see Bicalutamide Caspofungin, 65 Castellani’s paint. see Magenta paint, see

Magenta paint Catapres. see Clonidine Caustic pencils, 140 Caverject. see Alprostadil CCNU. see Lomustine Cefalexin, 61 Cefixime, 61 Cefotaxime, 61 Ceftaroline, 61 Ceftazidime, 61 Ceftobiprole, 61 Ceftolozane/tazobactam, 61

Ceftriaxone, 61 Cefuroxime, 61

eye drops, 122 Celebrex. see Celecoxib Celecoxib, 115 Celectol. see Celiprolol Celevac. see Methylcellulose Celiprolol, 19 Cellcept. see Mycophenolate mofetil Celsentri. see Maraviroc Central Nervous System, 39 Cephalexin. see Cefalexin Cephalosporins, 61 Ceporex. see Cefalexin Cerazette, 87 Cerelle, 87 Ceritinib, 98 Certolizumab pegol

ankylosing spondylitis, 117 psoriatic arthritis, 117 rheumatoid arthritis, 117

Cervarix. see Human papilloma virus vaccine

Cetirizine, 35 Cetraben, 134 Cetrorelix, 83

Cetrotide. See cetrorelix Cetuximab, 94 Cetylpyridinium chloride, 133 Champix. see Varenicline Charcoal, activated, 156, 157 Chirocaine. see Levobupivacaine Chloral hydrate, 39 Chlorambucil, 91 Chloramphenicol

ear drops, 130 eye preparations, 122 systemic, 63

Chlordiazepoxide

alcohol dependence, 58 anxiolytic, 40

Chlorhexidine

bladder irrigation, 90 dusting powder, 144 mouth infections, 133

Chlorhexidine impregnated, 169 Chlorhexidine, Nystatin and

Hydrocortisone. see Nystaform HC Chlormethiazole. see Clomethiazole, 39 Chloromycetin. see Chloramphenicol Chloroquine, 70 Chlorothiazide, 16 Chlorothiazide and spironolactone, 17 Chlorphenamine, 35 Chlorpheniramine, 35 Chlorpromazine, 40 Cholestagel. see colesvelam Choline salicylate, 132 Chorionic gonadotrophin

fertility, 79 hypogonadism, 79

Chronic bowel disorders, 11 Chronic migraine. See botulinum toxin A Cialis. see Tadalafil Ciclosporin, 99

eye preparations, 127 Sandimmun, 100 skin conditions, 139

Cidofovir, 68 Cidomycin. see Gentamicin Cilest, 85 Cilique, 85 Cimetidine, 9 Cimzia. See Certolizumab pegol Cinacalcet, 110 Cinnarizine, 45 Cipramil. see Citalopram Ciprofloxacin, 64 Ciproxin. see Ciprofloxacin Circadin. see Melatonin Cisatracurium, 153 Cisplatin, 94 Citalopram, 43 Citanest. see Prilocaine Citrasate, 169 Cladribine, 92 Claforan. see Cefotaxime

North of Tyne and Gateshead Area Prescribing Committee. Formulary - Version 6.5 October 2016

17 8

Clarithromycin, 62 Clarityn. see Loratadine Clens 100, 129 Clexane. see Enoxaparin Clindamycin

skin preparations, 139 systemic, 63 vaginal cream, 85

Clindamycin & Tretinoin, 140 Clinitas, 127 Clini-wipes. see Alcohol impregnated

wipes, 143 Clobazam, 53 Clobetasol propionate, 136 Clobetasone butyrate, 136 Clobetasone butyrate, Oxytetracycline and

nystatin. see Trimovate Clodronate, 109 Clomethiazole, 39 Clomid. see Clomifene Clomifene, 79 Clomiphene. see Clomifene, 79 Clomipramine, 43 Clonazepam

epilepsy, 53 status epilepticus, 55

Clonidine

migraine prophylaxis, 51 other specialist uses, 20

Clopidogrel, 26 Clopixol Accuphase. see Zuclopentixol

Acetate, 42 Clopixol. see Zuclopentixol decanoate, 41 Clotrimazole

ear infections, 130 vaginal infections, 84

Clotrimazole & Hydrocortisone cream. see Canesten HC, 137

Clozapine, 41 Clozaril. see Clozapine Cluster headaches. See Lithium Coagucheck XS, 171 Coal tar, 137 Coal tar & salicylic acid ointment, 137 Coal tar strong solution in emulsifying

ointment, 137 Co-amilofruse, 17 Co-amoxiclav, 60 Coban, 166 Coban 2 Lite, 166 Co-beneldopa, 56 Cocaine

local anaesthetic, 155 Co-careldopa, 56 Co-codamol, 47

migraine, 50 Cocois see Coconut compound ointment,

137 Coconut compound ointment (Sebco), 137 Co-cyprindiol

acne, 140

contraception, 85 hirsutism, 141

Co-danthramer, 13 Co-danthrusate, 13 Codeine Phosphate

cough, 37 diarrhoea, 10 pain, 48

Coenzyme Q10. See Ubiquinone Colazide. see Balsalazide Colchicine, 119 Colecalciferol, 112 Colesevelam

anti-diarrhoeal, 15 lipid lowering, 29

Colestyramine

anti-diarrhoeal, 15 leflunomide toxicity, 29 lipid lowering, 29

Colifoam. see Hydrocortisone acetate Colistimethate sodium. see Colistin Colistin, 63 Collagenase, 120 Collodion, 143 Colobreathe. see Colistimethate sodium Colofac. see Mebeverine Colomycin. see Colistin Colpermin. see Peppermint oil

Co-magaldrox, 8 Combivent nebuliser solution, 33 Combivir, 67 Comfeel Plus Transparent, 161 Comfi range, 165 Comprilan, 165 Comtess. see Entacapone Concerta XL. see Methylphenidate Constella. See linaclotide Contraceptives

combined hormonal, 85 oral, 85 progestogen only, 87 spermicidal, 87

Copaxone. see Glatiramer Co-phenylcaine Forte, 155 Co-phenylcaine, see Lidocaine and

phenylephrine, 155 Copper intrauterine devices, 87 Coracten. see Nifedipine Cordarone-X. see Amiodarone Cordilox. see Verapamil Corgard. see Nadolol Corlan. see Hydrocortisone lozenges Coro-Nitro. see Glyceryl trinitrate Corsodyl. see Chlorhexidine Corticosteroids

dermatological preparations, 136 ear preparations, 130 eye drops, 123 inflammatory bowel disease, 11, 12 local injections, 115

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systemic, 75 Corticotrophins, 79 Cosentyx. See Secukinumab, See

Secukinumab

Co-simalcite, 8 Cosmofer. see Iron dextran Co-trimoxazole, 64

pneumocystis pneumonia, 71 Cough suppressants, 37 Coversyl. see Perindopril Cozaar. see Losartan Creon, 15 Crestor. see Rosuvastatin Crisantaspase, 94 Crixivan. see Indinavir Crizotinib, 98 Crotamiton, 136 Crotamiton and hydrocortisone. see Eurax

Hydrocortisone CRRT. See PrimsOcal B22, See

Primsocitrate 18/0 Crystal violet, 145 Cubicin. see Daptomycin Curosurf. see Poractant alfa CX antiseptic powder, 144 Cyanide poisoning, 156 Cyclizine, 45 Cyclogest. see Progesterone Cyclopentolate, 125 Cyclophosphamide, 91 Cyclosporin. see Ciclosporin, 99 Cyklokapron. see Tranexamic acid Cymbalta. see Duloxetine Cymevene. see Ganciclovir Cyprostat. see Cyproterone acetate Cyproterone acetate

male hypersexuality, 78, 79 prostate cancer, 104

Cyproterone acetate and Ethinylestradiol. see Co-cyprindiol

Cysticide. see Praziquantel Cystistat

see Sodium hyaluronate bladder instillation, 89

Cystrin. see Oxybutynin Cytarabine, 92 Cytomegalovirus immunoglobulin, 150 Cytomegalovirus infections, 68 Cytosar. see Cytarabine Cytotec. see Misoprostol Cytotoxic drugs, 91 Cytotoxic immunosuppressants, 99

—D— Dabigatran, 26 Dabrafenib, 96 Dacarbazine, 94 Daclatasvir, 69 Dacsabuvir, 69

Dactinomycin, 92 Daklinza. see Daclatasvir Daktacort, 137 Daktarin, 142

Dalacin. see Clindamycin Dalacin T. see Clindamycin, skin

preparations Dalivit, 113 Danaparoid, 24 Danazol

Endometriosis, 83 Hereditary Angioedema, 36

Danol. see Danazol Danol. see Danazol, 36 Dantrium. see Dantrolene Dantrolene

malignant hyperthermia, 154 muscle relaxation, 120

Dantron and docusate sodium. see Co-danthrusate, 13

Dantron and poloxamer. see Co-danthramer

Dapagliflozin, 74 Dapsone, 64 Daptomycin, 63 Daraprim. see Pyrimethamine Darbepoetin, 106 Darifenacin, 88 Darunavir, 66 Daunorubicin, 92 DaunoXome. see Daunorubicin DC Beads, 171 DDAVP. see Desmopressin DDI. see Didanosine Debrisoft, 166 Decadron. see Dexamethasone Decapaptyl SR. see Triptorelin Deegan’s Ointment, 135 Deferasirox, 106 Defibrotide, 24 Defitelio. see Defibrotide Degarelix, 104 Deltacortril. see Prednisolone Demeclocycline, 62, 81 Dementia, 59 Denosumab, 82 Depakote. see Valproics Acid Depixol. see Flupentixol Depocyte. See cytarabine Depo-Medrone with lidocaine, 116 Depo-Medrone. see Methylprednisolone

acetate depot injection, 116 Depo-Provera see Medroxyprogesterone

acetate, 87 Derbac M. see Malathion Dermacolor, 141 Dermacool, see Menthol in aqueous

cream, 136 Dermol bath, 135 Dermovate NN, 136 Dermovate. see Clobetasol propionate, 136

North of Tyne and Gateshead Area Prescribing Committee. Formulary - Version 6.5 October 2016

18 0

Descovy, 67 Desferal. see Desferrioxamine Desferrioxamine

iron overload, 106 iron poisoning, 156

Desflurane, 151 Desloratadine, 35 Desmopressin, 80

enuresis, 89 Desmospray. see Desmopressin Desmotabs. see Desmopressin Destolit. see Ursodeoxycholic acid Dexamethasone

eye drops, 123 systemic therapy, 75

Dexamethasone implant, 124 Dexamfetamine, 44 Dexamphetamine

see Dexamfetamine, 44 Dexdor. see Dexmedetomidine Dexmedetomidine, 153 Dexrazoxane, 91 Diacomit. see Stiripentol Diamicron. see Gliclazide Diamorphine, 48 Diamox. see Acetazolamide Dianette, see Co-cyprindiol, 85, 140, 141 Diazepam

anxiolytic, 39 in anaesthetics, 152 muscle relaxation, 120 status epilepticus, 55

Diazoxide, 19, 74 Dibenyline. see Phenoxybenzamine Dibotermin Alfa, 170 Diclofenac, 115

eye drops, 128 injection, 153

Diclomax. see Diclofenac Dicobalt edetate, 156 Dicyclomine, 8 Dicycloverine, 8 Didanosine, 66 Diethylstilbestrol, 103 Differin. see Adapalene Difflam. see Benzydamine Dificlir. See Fidaxomicin Diflucan. see Fluconazole Digibind. see Digoxin-specific antibody Digoxin, 16 Digoxin-specific antibody, 16 Dihydrocodeine, 48 Diloxanide, 70 Diltiazem, 22

anal fissure, 15 Dilzem-XL. see Diltiazem, 22 Dimercaprol, 156 Dimethyly Fumarate, 103 Dimeticone, 142

containing antacid, 8 cream, 135

Dinoprostone, 84 Dioctyl. see Docusate sodium Dioralyte, 107 Diovan. see Valsartan Diphtheria (low dose), tetanus, acellular

pertussis and inactivated polio vaccine, 147

Diphtheria, tetanus, acellular pertussis and inactivated polio vaccine, 147

Diphtheria, tetanus, acellular pertussis, inactivated polio and Haemophilus influenzae type b vaccine, 147

Diprivan. see Propofol Diprobase cream, 135 Diprosalic, 136 Dipyridamole, 27 Disipal. see Orphenadrine

Disodium edetate, 129 Disodium pamidronate, 81, 109 Disprol. see Paracetamol Distamine. see Penicillamine Disulfiram, 58 Dithranol

cream, 138 in Lassar’s paste, 138 with salicylic acid in emulsifying base,

138 Dithrocream, 138 Ditropan. see Oxybutynin Diuretics, 16

combinations with potassium conserving, 17

loop, 16 potassium sparing, 17 thiazide, 16

Dixarit. see Clonidine DLux. see Colecalciferol, 112 Dobutamine, 23 Dobutrex. see Dobutamine Docetaxel, 95 Docusate sodium, 12, 13 Dolmatil. see Sulpiride Dolutegravir, 67 Domperidone

anti-emetic, 45 as gastro-intestinal prokinetic agent, 9 breastfeeding, 45

Donepezil, 59 Dopacard. see Dopexamine Dopamine, 23 Dopaminergic drugs, 56 Dopexamine, 23 Dopram. see Doxapram Doribax. see Doripenem Doripenem, 61 Dornase alfa, 37 Dorzolamide, 125

Dorzolamide and Timolol eye drops, 126 Dotarem, 168 Doublebase gel, 134 Dovobet, 138

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Dovonex. see Calcipotriol Doxapram, 36, 154 Doxazosin

hypertension, 20 urine retention, 88

Doxorubicin, 92 Doxycycline, 61

periodontitis, 132 Draina S, 163 Drapolene, 135, 143 Dressit, 164 Driclor, 145 Drogenil. see Flutamide Dronedarone. See DTIC. see Dacarbazine, 94 ductus arteriosus. See ibuprofen iv Dulcolax. see Bisacodyl Dulcolax Pico Liquid. see Sodium

picosulfate elixir Duloxetine.

depression, 44 diabetic neuropathy, 74 neuropathic pain, 49

DuoDerm Extra Thin, 161 DuoDerm Signal, 161 Duolube, 127 Duovisc, 128 Dupuytren's contracture. See collagenase Duraphat, 111 Duraphat

®. See

Durogesic. see Fentanyl patches Dyloject. see Diclofenac Dynastat. see Parecoxib Dyspepsia and gastro-oesophageal reflux

disease, 8 Dysport. see Botulinum A toxin

—E— E45, 134 Eakin, 163 Ear wax removal, 130 Ear, drugs acting on, 130 Ecalta. See Anidulafungin Eclypse Adherent, 159 Econazole

eye drops, 123 Eculizumab, 106 Eczema, 137 Edoxaban, 26 Edronax. see Reboxetine Edrophonium

enhancing neuromuscular transmission, 120

in anaesthetics, 154 Edurant. see Rilpivirine Efavirenz, 67 Efcortelan. see Hydrocortisone Efexor. see Venlafaxine Efient. see Prasugrel

Eflornithine, 142 Eformoterol, 31 Efudix. see Fluorouracil Elantan. see Isosorbide mononitrate Eldepryl. see Selegiline Eldisine. see Vindesine Elidel. see Pimecrolimus Elite, 129 EllaOne. see Ulipristall Elleste duet, 76 Elleste Solo. see Estradiol Elosulfase alfa, 114 Eloxatin. see Oxaliplatin Eltrombopag, 106 Eltroxin. see Thyroxine Elvanse. see Lisdexamfetamine Elvitegravir, cobicistat, emtricitabine &

tenofovir alafenamide. see Genvoya Emend. see aprepitant Emerade. see Adrenaline, allergic

emergencies, 36 Emetic, 156 EMLA, 155 Emollients, 134 Empagliflozin, 74 Emselex. see Darifenacin Emtricitabine & Tenofovir. see Truvada Emtricitabine & tenofovir alaenamide. see

Descovy Emtricitabine, rilpivirine & tenofovir

alafenamide. see Odefsey Emulsifying ointment BP, 134 Emulsifying ointment RVI formula. see

Hydromol ointment, 134 Enalapril, 21 Enbucrilate, 143 Endocrine system, 72 Endoxana. see Cyclophosphamide Enfuvirtide, 67 Engerix B. see Hepatitis B vaccine Enoxaparin, 24 Enoximone, 16 Entacapone, 57 Entecavir, 68 Enterocort

see budesonide, 11 Entonox, 151 Entresto. see Sacubitril & Valsartan Entyvio. see Vedolizumab Enuresis, 88 Enzalutamide, 104 eosinophilic oesophagitis, 33 Epaderm. see Hydromol ointment, 134 Epanutin. see Phenytoin Ephedrine

nasal drops, 131 systemic, 32 vasocontrictor, 23

Ephynal. see Alpha tocopheryl acetate Epiduo, 139 Epilim. see Sodium valproate

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Epimax cream, 134 Epinephrine (adrenaline)

allergic emergencies, 36 CPR, 24

Epirubicin, 92 Episenta. see Sodium valproate Epivir. see Lamivudine Eplerenone, 17 Epoetin

alfa, 106 beta, 106

Epoprostenol, 25 Eprex. see Epoetin alfa Eptotermin alfa, 170 Equasym XL. see Methylphenidate Erbitux. see Cetuximab Erectile dysfunction, 90 Ergocalciferol, 112 Ergometrine, 84 Erlotinib, 96 Ertapenem, 61 Erwinase. see Crisantaspase Erythrocin. see Erythromycin Erythromycin, 62

eye ointment, 122 skin preparations, 140

Erythromycin and zinc acetate. see Zineryt Esbriet. see Pirfenidone Eskazole. see Albendazole Eslicarbazepine Acetate, 53 Esmeron. see Rocuronium Esmolol, 19 Estracyt, 91 Estradiol

implants, 76, 78 tablets, 76, 78 transdermal patches, 76, 78 vaginal tablets for atrophic vaginitis, 84

Estramustine, 91 Estriol, 84

Etanercept musculoskeletal, 117 psoriasis, 139

Ethambutol, 64 Ethanol 20% eye drops, 128 Ethanolamine oleate, 29 Ethinylestradiol, 76 Ethosuximide, 54 Ethyl chloride spray, 155 Ethynodiol acetate, 87 Etodolac, 115 Etomidate, 151 Etonogestrel, 87 Etoposide, 93 Etoricoxib, 115 Etravirine, 67 Eucardic. see Carvedilol Eudemine. see Diazoxide Euglucon. see Glibenclamide Eumovate. see Clobetasone butyrate, 136 Eurax. see Crotamiton

Eurax Hydrocortisone, 137 European viper antivenom, 157 Everolimus, 98 Eviplera, 67 Evista. see Raloxifene Evolocumab, 29 Evorel. see Estradiol transdermal Evorel Conti patches, 77 Evorel Sequi, 77 Evra, 86 Exelon. see Rivastigmine Exemestane, 103 Exenatide, 73 Exjade. see Deferasirox Exocin. see Ofloxacin Exorex, 137 Extavia. see Interferon beta-1b, see

Interferon beta Extencilline, 60 Exviera. see Dasabuvir Eylea. see Aflibercept Ezetimibe, 28 Ezetrol. see Ezetimibe

—F— Faecal softeners, 13 Farydak. see Panobinostat Fasturtec. see Rasburicase Febuxostat, 119 Feldene. see Piroxicam Female sex hormones, 76 Femara. see Letrozole Femodene, 85 Femodette, 86 Femoston, 77 Femulen, 87 Fenofibrate, 29 Fentanyl

injections, 153 lozenges, 48 sublingual tablets, 48 transdermal patches, 48

Feraccru. see Ferrous maltol Ferinject. see Ferric carboxymaltose Ferric carboxymaltose, 105 Ferric maltol, 105 Ferrous fumarate, 105 Ferrous gluconate, 105 Ferrous sulphate, 105 Fersamel. see Ferrous fumarate Fesoterodine, 89 Fexofenadine, 35 Fibric acid analogues, 29 Fibrinolytic drugs, 27 Fibro-vein. see Sodium tetradecyl sulphate Fidaxomicin, 63 Filgrastim, 107 Finasteride, 78 Fingolimod, 102 Firazyr. see Icatibant, 36

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Firmagon. See Degarelix Fish oils, as lipid regulators, 29 FK-506. see Tacrolimus Flagyl. see Metronidazole Flamazine. see Silver sulfadiazine Flaminal, 163 Flebogamma. see Human normal

immunoglobulin Flecainide, 18 Fleet phospho-soda, 14 Flexible collodion, 143 Flixonase. see Fluticasone nasal spray,

see Fluticasone nasal spray Flolan. see Epoprostenol Flomax MR. see Tamsulosin Florinef. see Fludrocortisone Floseal matrix sealant, 143 Floxapen, 60 Fluanxol. see Flupentixol Flucloxacillin, 60 Fluconazole, 65 Flucytosine, 65 Fludara. see Fludarabine Fludarabine, 93 Fludrocortisone, 75 Fludroxycortide tape, 136 Fluenz nasal spray, 148 Fluids and electrolytes, 107 Flumazenil, 154 Fluocinolone acetonide

diabetic macular oedema, 124 topical corticosteroid, 136

Fluorescein

eye preparations, 128 injections, 128

Fluorets, 128 Fluorometholone eye drops, 123 Fluorouracil, 93

cream, sun damage, 141 Fluoxetine, 43 Flupenthixol. see Flupentixol Flupenthixol decanoate. see Flupentixol

decanoate, 42 Flupentixol, 40 Flupentixol decanoate, 42 Fluphenazine decanoate, 42 Flurandrenolone. see Fludroxycortide, 136 Flutamide, 104 Fluticasone

nasal spray, 131 Fluticasone and formoterol. see Flutiform Flutiform, 34 FML. see Fluorometholone Folic acid, 105 Folinic acid. see calcium folinate, 91 Fondaparinux, 24 Forceval, 113

anorexia nervosa, 113 Formoterol, 31 Forsteo. see Teriparatide Fortisip Compact, 158

Fortum. see Ceftazidime Forxiga. see Dapagliflozin Fosamax. see Alendronate sodium Fosamprenavir, 66 Fosaprepitant, 46 Foscarnet, 68 Foscavir. see Foscarnet Fosfomycin, 63 Fosrenol. see Lanthanum Fostair, 34 Friars' Balsam. see Benzoin tincture,

compound Frovatriptan, 50 Fru-Co. see Co-amilofruse Frumil. see Co-amilofruse Frusemide. see Furosemide, 16 Fucidin. see Fusidic acid Fucithalmic. see Fusidic acid Fulcin. see Griseofulvin Full Clini range, 165 Full Marks. see Phenothrin, 142 Fultium. see Colecalciferol, 112 Fungillin. see Amphotericin Fungizone. see Amphotericin Furosemide, 16 Fusidic acid. see Sodium fusidate

eye drops, 122 skin preparations, 142

Fuzeon. see Enfuvirtide Fybogel. see Ispaghula husk

—G— Gabapentin. See diabetic neuropathy

anti-epileptic, 54 neuropathic pain, 49, 74

Gadobenate dimeglumine, 168 Gadobutrol, 168 Gadofosveset, 168 Gadovist, 168 Gadoxetic acid, 168 Galantamine, 59 Galenphol. see Pholcodine Galfer. see Ferrous fumarate Gamanil. see Lofepramine Ganciclovir, 68 Gargles, 133 Gastrografin, 168 Gaviscon Infant, 8 Gaviscon, see Peptac, 8 Gazyvaro. see Obinutuzumab G-CSF, 107 Gedarel 30/150, 85 Gedarel

® 20/150, 86

Gefitinib, 96 Gelatin, plasma expander, 108 Gelofusine. see Succinylated gelatin GelTears see Carbomer 980, 127 Gemcitabine, 93 Gemeprost, 84

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Gemzar. see Gemcitabine Gengigel, 132 Genotropin. see Somatropin Gentafleece, 169 Gentamicin, 62

ear drops, 130 eye preparations, 122

Gentamicin and Hydrocortisone

ear drops, 130 Gentian violet. see Crystal violet Genticin. see Gentamicin Gentisone HC ear drops, 130 Genvoya, 67 Gilenya. See fingolimod Gilurytmal. See Ajmaline Giotrif. see Afatinib GIST. See imatinib Glandosane, 133 Glatiramer, 102 Glaucoma treatment, 125 Glibenclamide, 73 Gliclazide, 73 Glimepiride, 73 Glivec. see Imatinib Glucagon, 74 Glucarpidase, 91 Glucobay. see Acarbose Glucocorticoid therapy, 75 GlucoGel see glucose gel, 74 Glucophage. see Metformin Glucose

hypoglycaemia treatment, 74 Glucose and Electrolyte powder. see

Dioralyte Glutaraldehyde 10% paint, 140 Glutarol. see Glutaraldehyde paint, 140 Glycerin. see Glycerol Glycerol

suppositories, 12 Glyceryl trinitrate

anal fissure, 15 angina, 22

Glycine, bladder irrigation, 89 Glycopyrrolate cream, 146 Glycopyrronium & neostigmine, 154 Glycopyrronium Bromide

anaesthesia, 152 Glypressin. see Terlipressin Glytrin. see Glyceryl trinitrate Gold salts, 116 Golimumab, 118

Inflammatory bowel disease, 11 Rheumatology, 118

Gonadorelin, 80 Gonadotrophins, 79 Gonapeptyl Depot. see Triptorelin Goserelin

endometriosis, 78, 83 prostrate cancer, 104

gout. inra Gout, 119

Granocyte. see Lenograstim Grass pollen extract. see Grazax, 35 Grazax, 35 Griseofulvin, 65 Grisovin. see Griseofulvin Growth Hormone, 79 Gygel, see Nonoxynol ‘9’, 87

—H— H2 receptor antagonists, 9 Haelan tape. see Fludroxycortide tape, 136 Haemophilus influenzae type b and

meningitis C vaccine, 148 Haemophilus influenzae type b and

meningococcal group C vaccine, 148 Haemorrhoids, 14 Haldol. see Haloperidol Half strength Lassar’s paste, 138 Haloperidol

anti-emetic, 45 antipsychotic, 40

Haloperidol decanoate, 42 Halothane, 151 Hand rub gel, 144 Havrix. see Hepatitis A Vaccine Haycrom. see Sodium cromoglicate HBvaxPRO. see Hepatitis B vaccine Heaf (multiple puncture) test, 147 Heaf test, 147 Healon GV. see Sodium hyaluronate, eye Healonid 5. see Sodium hyaluronate, eye Healthy Start Vitamins, 113 Heavy metal poisoning, 156 Hedrin. See Dimeticone Helicobacter pylori eradication, 10 Hemabate. see Carboprost Heminevrin. see Clomethiazole Heparin, 24 Hepatitis A & B vaccine, 148 Hepatitis A vaccine, 148 Hepatitis B, 68

vaccine, 148 vaccine (High strength), 148

Hepsera. see Adefovir Herceptin. see Trastuzumab Hexachlorophene, powder, 145 Hexitidine, 133 Hiberix. see Haemophilus Influenzae type b

vaccine High strength fluoride. See Duraphat high strength fluoride toothpaste. See

Duraphat Hipprex. see Methenamine Hippurate Histoacryl Blue, 143 HMG-CoA reductase inhibitors, 28 Hormone antagonists

in malignant disease, 103 Hormone replacement therapy, 76 HRF. see Gonadorelin, see Gonadorelin

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HRT. see Hormone replacement therapy, 76

Humalog mix, 72 Human immunodeficiency virus, 66 Human normal immunoglobulin, 149 Human papilloma virus vaccine, 148 Humulin insulins, 72 Hyalase. see Hyaluronidase Hyalofemme, 84 Hyaluronan, 132 Hyaluronic Acid injection

ENT surgery, 170 Hyaluronidase, 120 Hycamtin. see Topotecan Hydrafil Softline Max, 170 Hydralazine, 19 Hydrea. see Hydroxycarbamide Hydrocortisone

for disease suppression, 76 lozenges/pellets, 132 replacement therapy, 75 skin preparations, 137

Hydrocortisone acetate

injection, 116 rectal foam, 12

Hydrocortisone butyrate, 136 Hydrocortisyl. see Hydrocortisone Hydrogen peroxide

solutions, 145 Hydromol ointment, 134 Hydromorphone, 48 Hydrous ointment, 134 Hydroxocobalamin, 105 Hydroxycarbamide, 95 Hydroxychloroquine, 116 Hydroxypropylmethyl- cellulose HV (Oasis),

128 Hydroxyurea. see Hydroxycarbamide, 95 Hydroxyzine, 35 Hyoscine butylbromide, 9 Hyoscine hydrobromide

anti-emetic, 46 injection, 152

Hypafix, 164 Hypercalcaemia and hypercalciuria, 109 Hyperparathyroidism. see cinacalcet Hypertension in pregnancy. See enalapril Hypnomidate. see Etomidate Hypnotics, 39 Hypnovel. see Midazolam Hypoglycaemia, 74 Hypostop see glucose gel, 74 Hypothalamic and pituitary hormones, 79 Hypothalamic hormones, 80

—I— Ialuril, 89 Ibandronic acid, 82 Ibuprofen

NSAID, 115 topical, 121

Ibuprofen IV, 30 Icatibant, 36 Ichthopaste. see Zinc Paste and

Ichthammol Bandage Idarubicin, 92 Idarucizumab, 24 Idelalisib, 97 Ifosfamide, 91 Ikorel. see Nicorandil Iloprost, 19, 25 Iluvien. see Fluocinolone acetonide implant Imatinib, 96 Imdur. see Isosorbide mononitrate Imigran. see Sumatriptan Imipramine

antidepressant, 43 enuresis, 89 migraine prophylaxis, 51 neuropathic pain, 43

Imiquimod, 141 Imlygic. see Talimogene ImmunCyst. see BCG Connaught Immunoglobulins, 149

anti-D Anti – D (Rho) Immunoglobulin (Rho), 150

antithymocyte, 100 cytomegalovirus, 150 human normal, 149 tetanus, 150 varicella, 150

Immunological products and vaccines, 147 Immunosuppressants, 99 Imodium. see Loperamide Imodium Instants. See loperamide Impotence, 90 Imuran. see Azathioprine Inadine, 162 Incivo. see Telaprevir Incontinence, 88 Indapamide, 16 Inderal. see Propranolol Indermil X-Fine, 143 Indigo Carmine, 170 Indinavir, 67 Indocid. see Indomethacin Indocid PDA. see Indometacin: closure of

ductus arteriosus Indocyanine green, 128 Indometacin, 115

Closure of ductus arteriosus, 30 Indomethacin. see Indometacin, 115 Inductos. See Dibotermin Alfa Infacol, 8 Infanrix IPV + Hib. see

Diphtheria/tetanus/acellular pertussis/inactivated polio vaccine/Haemophilus influenzae type b

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Infanrix-IPV. see Diphtheria, tetanus, acellular pertussis & inactivated polio vaccine

Infant Gaviscon, 8 Infatrini peptisorb, 158 Infections, treatment of, 60 Infliximab

Inflammatory bowel disease, 12 psoriasis, 139 Rheumatoid arthritis etc., 118

Infloran, 169 Influenza vaccine, 148 Ingenol mebutate, 141 Inlyta. see Axitinib Innohep. see Tinzaparin INRatio2, 171 Inspra. see Eplerenone Insulatard insulins, 72 Insulin detemir, 72 Insulin glargine, 72 Insulins, 72 Integuseal IS 100, 169 Intelence. see Etravirine Interferon alfa-2b, 101 Interferon beta-1a, 102 Interferon beta-1b, 102 Intranasal diamorphine

u, 48

Intranasal midazolam, 152 Intrasite Gel, 160 Intrauterine devices, 87 Intraval. see Thiopental sodium Intravenous fluids, 108 Intravenous nutrition, 109 intravitreal, 124 Intron. see Interferon alfa Invanz. see Ertapenem Invirase. see Saquinavir Invokana. see Canagliflozin Iodine solution, aqueous, 75 Iodine, Lugol’s, 75 Iodoflex, 162 Iodosorb, 162 Iopanoic acid, 75 Iopidine. see apraclonidine Ipecacuanha emetic mixture, 156 Ipilimumab, 97 Ipral. see Trimethoprim Ipratropium

bronchodilator, 32 nasal spray, 131

Irbesartan, 21 Iressa. see gefitinib Irinotecan, 95 Iron deficiency anaemia, 105 Iron dextran, 105 Iron overload, 106 Iron poisoning, 156 Iron preparations, 105 Iron sucrose, 105 Isentress. see Raltegravir Ismo. see Isosorbide mononitrate

Isoflurane, 151 Isoniazid, 64 Isoplex, 108 Isoprenaline, 23 Isopropyl alcohol, 143 Isordil. see Isosorbide dinitrate Isosorbide dinitrate, 22 Isosorbide mononitrate, 22 Isotretinoin, 140 Isotretinoin & Erythromycin, 140 Isotretinoin gel, 140 Isotrex. see Isotretinoin, see Isotretionoin

gel Isotrexin. see Isotretinoin & Erythromycin Ispaghula husk

diarrhoea etc., 10 laxative, 12

Istin. see Amlodipine Itraconazole, 65 Ivabradine, 23 Ivacaftor, 37 Ivemend. see Fosaprepitant Ivermectin, 140

—J— Jakavi. see Ruxolitinib Januvia. See sitagliptin Japanese Encephalitis Vaccine, 148 Jaridance. see Empagliflozin Jaydess. see Levonorgestrel intra-uterine

system, 87 Jetrea. see Ocriplasmin Jevtana. see Cabazitaxel Jext Junior. see Adrenaline, allergic

emergencies, 36 Jext. see Adrenaline, allergic emergencies,

36

JIA. See infliximab Jinarc. see Tolvaptan Juvederm Ultra 3, 170 Juvederm

® Ultra 4, 170

Juvenile dermatomyositis. See infliximab juvenile idipathic arthritis. see abatacept

—K— Kaletra. see Lopinavir & ritonavir, 66 Kalydeco. see Ivacaftor Kaolin, 10 Kay-Cee-L. see Potassium chloride, 107 K-Band, 165 Kefadim. see Ceftazidime Keflex. see Cefalexin Kemadrin. see Procyclidine Kenalog. see Triamcinolone acetonide Kentera. see Oxybutynin Patch Keppra. see Levetiracetam Kerramax, 160 Kerraped, 166

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Ketalar. see Ketamine Ketamine, 151 Ketoconazole

shampoo, 141 skin preparations, 142

Ketorolac trometamol

eye drops, 128 injection, 153

Keytruda. see Pembrolizumab

Kineret. see Anakinra Kiovig. see Human normal immunoglobulin Kivexa. see Abacavir & lamivudine Klaricid. see Clarithromycin Klean prep, 14 Kliofem, 77 Kliovance, 77 K-Lite, 165 Konakion. see Phytomenadione K-Two, 166

—L— Labetalol, 18 Lacosamide, 54 Lactulose, 13 Lamisil. see Terbinafine Lamivudine

Hepatitis B, 68 HIV infection, 66

Lamotrigine, 53 Lanoxin. see Digoxin Lanreotide, 104 Lansoprazole, 10 Lanthanum, 111 Lantus. see Insulin glargine Lanvis. see Tioguanine Largactil. see Chlorpromazine Lariam. see Mefloquine Larvae300. see Sterile larvae Lasix. see Furosemide Lasoride. see Co-amilofruse LAT gel, 154 Latanoprost, 125 Latanoprost and timolol, 126 Laxatives, 12

bowel cleansing solutions, 13 bulk forming, 12 faecal softeners, 13 osmotic, 13 stimulant, 12

Ledclair. see Sodium calcium edetate Ledermycin. see Demeclocycline

Leflunomide, 116 leishmaniasis. See sodium stibogluconate Lemtrada. see Alemtuzumab Lenalidomide, 103 Lenograstim, 107 Lercanidipine, 22 Letrozole, 103 Leukeran. see Chlorambucil

Leukotriene receptor antagonists, 34 Leuporelin, 78 Leuprorelin

endometriosis, 83 prostate cancer, 104

Leustat. see Cladribine Levact. see Bendamustine Levemir. see Insulin detemir Levetiracetam, 54 Levobupivacaine, 155 Levocarnitine, 114 Levofloxacin, 65 Levomepromazine, 40

anti-emetic, 45 Levonelle 1500. see Levonorgestrel Levonorgestrel, 87

emergency contraception, 86 intra-uterine system, 87

Levosimendan, 23 Levothyroxine, 75 Lichen sclerosis. See Dermovate NN Lidocaine

anti-arrhythmic, 18 local anaesthetic, 154 ointment, 136

Lidocaine 4% cream, 155 Lidocaine and fluorescein, 126 Lidocaine and phenylephrine, 155 Lidocaine and prilocaine. see EMLA Lignocaine

antiarrhythmic, 18 local anaesthetic, 154 ointment, 136

Li-Liquid. see Lithium citrate Limbo, 166 Linaclotide, 14

irritable bowel syndrome with constipation, 14

Linezolid, 63 Lioresal. see Baclofen Liothyronine, 75 Lipantil micro. see Fenofibrate Lipegfilgrastim, 107 Lipid regulating drugs, 28 Lipitor. see Atorvastatin Liposomal Doxorubicin, 92 Lipostat. see Pravastatin Liquiband, 143 Liraglutide, 73 Lisdexamfetamine

ADHD, 45 Lisinopril, 20 Lissamine green, 128 Lithium carbonate, 42 Lithium Carbonate

cluster headaches, 51 Lithium citrate, 42 Lithium Citrate

cluster headaches, 51 Livial. see Tibolone Lixiana. see Edoxaban

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Lixisenatide, 73 l-lysine 2.5%, l-arginine 2.5%, 171 L-Mesitran Border, 161 L-Mesitran Hydro:, 161 L-Mesitran Net, 161 L-Mesitran Soft Ointment, 162 LMX4, 155 Local anaesthetics, 154

Lidocaine ointment, 136 Loceryl. see amorolfine Locoid. see Hydrocortisone butyrate, 136 Lodine SR. see Etodolac Loestrin 30, 85 Lofepramine, 43 Lofexidine, 59 Logynon, 86 Lomustine, 91 Loniten. see Minoxidil Lonquex. see Lipegfilgrastim Lonsurf. see Trifluridine & tipiracil Loop diuretics, 16 Loperamide, 10 Lopinavir & ritonavir, 66 Loratadine, 35 Lorazepam, 40, 152

status epilepticus, 55 Loron. see Sodium clodronate Losartan, 21 Losec. see Omeprazole Lotemax. See Loteprednol Loteprednol etabonate

corticosteroid eye drops, 124 Lubiprostone, 14 Lucentis. see Ranibizumab Lucette, 85 Lumigan. see Bimatoprost Lustral. see Sertraline Lutrelef. see Gonadorelin Lyclear. see Permethrin Lymecycline, 61 Lynparza. see Olaparib Lyrica. see Pregabalin Lysodren. See mitotane Lyxumia. see Lixisenatide

—M—

Maalox. see Co-magaldrox MabThera. see Rituximab Macitentan, 20 Macrobid. see Nitrofurantoin Macrodantin. see Nitrofurantoin Macrogol oral powder, 13 Macrogol Paediatric Plain, 13 Macrolides. see Erythromycin & related

drugs, 62 Madopar. see Co-beneldopa Magenta paint, 145 Magnesium aspartate, 110 Magnesium chloride, 110 Magnesium glycerophosphate, 110

Magnesium sulphate

magnesium supplement, 110 paste, 143

Magnesium supplements, 110 Magnesium with potassium IV infusion

see Magnesium chloride, 110 Malarone, 70 Malathion, 143 Male sex hormones, 78 Malic acid pastilles, 133 Malignant disease, 91 Manerix. see Moclobemide Mannitol.

bronchial provocation testing, 37 cystic fibrosis, 37 diuretic, 17

Mantoux test, 147 Maraviroc, 67 Marcain. see Bupivacaine Marvelon, 85 Maxidex. see Dexamethasone eye drops Maxitrol, 124 Maxolon. see Metoclopramide Measles, mumps & rubella vaccine, 148 Mebendazole, 71 Mebeverine, 9 Medi hosiery, 166 Mediscrub, 144 Medroxyprogesterone acetate, 77

contraceptive, 87 in malignant disease, 103

Mefenamic acid, 115 Mefix, 164 Mefloquine, 70 Megace. see Megestrol acetate Megaloblastic anaemias, 105 Megestrol acetate, 103 Meglisorb, 161 Meglumine gadoterate, 168 Mekinist. see Trametinib Melatonin, 39 Meloxicam, 115 Melphalan, 91 Memantine, 58

dementia, 59 Menadiol sodium phosphate, 113 Menière’s Disease, 46 Meningococcal A, C, W135 & Y conjugate

Vaccine (Menveo), 148 Meningococcal A, C, W135 & Y Vaccine,

148 Meningococcal C conjugate vaccine, 149 Menitorix, see Haemophilus Influenzae

type b and meningitis C conjugate vaccine, 148

Menopur. see Menotrophin Menotrophin, 79 Mentadent P. see Triclosan toothpaste,

133 Menthol in aqueous cream, 136 Menveo, 148

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Mepacrine, 70 Mepact. see Mifamurtide Mepilex, 161

Border, 161 Mepilex Transfer, 161 Mepivacaine, 155 Mepore, 159 Merbentyl. see Dicycloverine Mercaptamine, 114 Mercaptopurine, 93

inflammatory bowel disease, 11 Mercilon, 86 Merocaine, 133 Merocet. see cetylpyridinium chloride Meronem. see Meropenem Meropenem, 61 Mesalazine, 11, 12 Mesna, 91 Mesorb, 159 Mesren mr. see mesalazine Mestinon. see Pyridostigmine Metalyse. see Tenecteplase Metanium, 135 Metaraminol, 23 Metformin, 73 Methadone

analgesia, 49 use in substance dependence, 59

Methenamine Hippurate, 65 Methionine, 156 Methotrexate

cancer, 93 inflammatory bowel disease, 11 rheumatoid arthritis, 116 skin conditions, 139

Methotrimeprazine. see Levomepromazine, 40, 45

Methoxsalen. see 8-Methoxypsoralen Methoxy polyethylene glycol-epoetin beta,

106 Methoxypsoralen, 138 Methylated Spirit, 143 Methylcellulose

diarrhoea etc., 10 laxative, 12

Methyldopa, 20 Methylphenidate

ADHD, 44 narcolepsy, 44

Methylprednisolone

injections (depot), 116 injections (systemic), 76

Methylprednisolone acetate and Lidocaine, 116

Methylprednisolone acetate depot injection, 116

Methylthioninium Chloride, 170 Metoclopramide

anti-emetic, 45 as GI prokinetic agent, 9 migraine, 50

Metolazone, 16 Metoprolol, 18

migraine prophylaxis, 51 Metronidazole

amoebicide, 70 anaerobic infections, 64 antigiardial, 70 gel, 142 vaginal gel, 85

Metrotop. see Metronidazole gel Metyrapone, 83 Mexiletine

neuropathic pain, 50 Miacalcic. see Calcitonin (Salmon) Micafungin, 65 Miconazole

buccal infections, 132 Miconazole & hydrocortisone. see

Daktacort, 137 Miconazole Nitrate, 142 Microgynon 30, 85 Micronor, 87 Midamor. see Amiloride Midazolam

anaesthetics, 152 epilepsy, 55

Midodrine, 23 Mifamurtide, 103 Mifegyne. see Mifepristone Mifepristone, 84 Migard. see Frovatriptan Migraine, 50 milk replacement

ProZero, 158 Millinette 30/75, 85 Milrinone, 16 Milton. see Sodium hypochlorite, 145 Mimpara. see Cinacalcet Minerals, 109 Mini TT380 Slimline, 87 Minims saline. see Sodium chloride Miniversol, 144, 167 Minocin. see Minocycline Minocycline

DMARD, 119 treatment of infections, 61

Minoxidil, 19 Miochol E. see Acetylcholine Miotics, 125 Mirabegron, 88 Miraflow daily cleaner, 129 Mirapexin. see Pramipexole Mircera, 106 Mirena. see Levonorgestrel intra-uterine

system, 87 Mirtazapine, 44 Mirvaso. see Brimonidine Tartate Misoprostol, 9 Mitomycin, 92

bladder cancer, 92 Mitotane, 95

North of Tyne and Gateshead Area Prescribing Committee. Formulary - Version 6.5 October 2016

19 0

Mitoxana. see Ifosfamide Mitoxantrone, 92 Mivacron. see Mivacurium Mivacurium, 153 Mixtard insulins, 72 MMR II Vaccine, 148 Mobic. see Meloxicam Moclobemide, 43 Modafinil, 45 Modecate. see Fluphenazine decanoate Modified fluid gelatin see Succinylated

gelatin, 108 Molipaxin. see Trazodone Mometasone nasal spray, 131 Monit. see Isosorbide mononitrate Monoamine oxidase inhibitors, 43 Monotrim. see Trimethoprim Montelukast, 34 Morphine, 47 Motilium. see Domperidone Mouthwash solution tablets, 133 Mouthwashes, gargles and dentifrices, 133 Mouthwashes, Gargles and Dentifrices,

133 Movantik. See naloxegol Movicol Half, 13 Movicol Oral Liquid, 13 Moviprep, 14 Moxifloxacin, 64 Moxonidine, 20 Mozobil. see Plerixafor, 107 MST. see Morphine Mucaine. see Antacid with oxetacaine Mucodyne. see Carbocisteine

Mucogel. see Co-magaldrox, 8 Mucolytics, 37 Multaq. See Dronaderone Multihance, 168 Multiple carboxylase deficiency

Biotin, 171 Multivitamin capsules/tablets. see Vitamins

BPC capsules / tablets, 113 Multivitamin preparations, 113 Multivitamins. See Abidec Mupirocin

nasal ointment, 132 ointment, 142

muscle relaxant. See Papaverine Muscle relaxants (skeletal), 120 Myambutol. see Ethambutol Mycamine. See micafungin Mycobutin. see Rifabutin Mycophenolate mofetil, 99 Mycophenolate sodium, 99 Mydriatics, 124 Mydricaine No 2, 125 Mydrilate. see Cyclopentolate Myfortic. see Mycophenolate sodium Myleran. see Busulphan Myocrisin. see Sodium aurothiomalate Myometrial relaxants, 84

—N— Nabilone

anti-emetic, 46 chronic pain, 47

Nabumetone, 115 N-Acetylcysteine, see acetylcysteine, 37 Nadolol, 19 Nafarelin, 83 Naftidrofuryl oxalate, 23

peripheral arterial disease, 23 Nalmefene, 58 Nalorex. see Naltrexone Naloxegol, 14 Naloxone

in anaesthetics, 154 opioid poisoning, 156

Naltrexone, 59 Naprosyn. see Naproxen Naproxen, 115 Narcan. see Naloxone narcolepsy. see dexamfetamine Nardil. see Phenelzine Nasacort. see Triamcinolone acetonide

nasal spray Nasal Allergy, 131 Nasal decongestants

systemic, 37 topical, 131

Naseptin, 132 Nasonex. see Mometasone Natalizumab, 102 Natamycin eye drops, 123 Natrilix. see Indapamide Natulan. see Procarbazine Navelbine. see Vinorelbine Nebcin. see Tobramycin Nebido. see Testosterone undecanoate Nebilet. see Nebivolol Nebivolol, 19 Nebulised Gentamicin, 62 Nebusal. See sodium chloride nebuliser

solution Negaban, 60 NeilMed Sinus Rinse, 131 Nelfinavir, 66 Neoclarityn. see Desloratadine NeoKay. see Phytomenadione Neo-Mercazole. see Carbimazole Neomycin, 62 Neoral. see Ciclosporin NeoRecormon. see Epoetin beta Neostigmine, 154

myasthenia gravis, 120 Neotigason. see Acitretin Neulasta. see Pegfilgrastim Neupogen. see Filgrastim Neupro. see Rotigotine Neuroleptics. see Antipsychotics Neuromuscular Disorders, 119 Neurontin. see Gabapentin

North of Tyne and Gateshead Area Prescribing Committee. Formulary - Version 6.5 October 2016

19 1

neuropathic pain. see mexiletine Nevirapine, 67 New product request forms, 5 Nexplanon. See etonogestrel Nicardipine, 22 Nicorandil, 23 Nicorette. see Nicotine Nicorette Quickmist. See Nicotine Nicotine, 58 Nicotinell. see Nicotine Nifedipine, 22 Nilotinib, 96 Nimbex. see Cisatracurium Nimodipine, 22 Nimotop. see Nimodipine Nintedanib, 38, 97

cancer, 97 idiopathic pulmonary fibrosis, 38

NiQuitin. see Nicotine Nitrates, 22 Nitrazepam, 39 Nitrofurantoin, 65 Nitrofurazone, 142 Nitrolingual. see Glyceryl trinitrate Nitrous Oxide, 151 Nivaquine. see Chloroquine Nivolumab, 98 Nizoral. see Ketoconazole Nolvadex. see Tamoxifen Non-formulary medicines, 5

initiating therapy with, 5 patients admitted on, 5

Non-nucleoside reverse transcriptase inhibitors, 67

Nonoxynol ‘9’, 87 Non-steroidal anti-inflammatory drugs, 115 Non-woven fabric swab, 164 Noradrenaline, 23 Norcuron. see Vecuronium Norditropin. see Somatropin Norepinephrine, 23 Norethisterone, 77

contraceptive, 87 in malignant disease, 103

Norgeston, 87 Normasol, 144 Norvir. see Ritonivir Nova T 380, 88 Novantrone. see Mitozantrone Novomix, 72 Novopen, 72 Novorapid, 72 Noxafil. see Posaconazole Nozinan. see Levomepromazine Nplate. see romiplostim NSAIDs, 115

analgesia, 47 NSCLC. See gefitinib Nucleoside reverse transcriptase inhibitors,

66 Nuelin. see Theophylline, 32

Nutrition

intravenous, 109 Nutrition and blood, 8, 105, 158, 168, 172 NuvaRing, 86 Nystaform HC, 137 Nystan. see Nystatin Nystatin

oral, 66 oral suspension, 132 skin preparations. Discontinued

Nystatin pessaries, 66 Nystatin, benzalkonium chloride and

hydrocortisone. see Timodine

—O— Obesity, treatment of, 45 Obinutuzumab, 101 Obstetrics, gynaecology and urinary-tract

disorders, 84 Ocriplasmin, 128 Octagam. see Human normal

immunoglobulin Octanate

antihaemophila agent, 28 Octaplas & Octaplas LG, 28 Octasa MR. see Mesalazine Octenidine. see Octenisan Octenisan, 144 Octreotide, 104 Oculotect. see Povidone iodine Odefsey, 68 Oestradiol. see Estradiol Oestriol. see Estriol, 84 Oestrogens, 76

in malignant disease, 103 Oestrogens, conjugated, 76 Ofatumumab, 101 Ofev. see Nintedanib Ofloxacin, 64 Ofloxacin, eye drops, 122 Oilatum emollient, 134, 135 Oily cream. see Hydrous ointment, 134 Oily Phenol injection, 15 Olanzapine, 41 Olaparib, 98 Olive oil ear drops, 130 Olopatadine, 124 Olysio. see Simeprevir Omalizumab, 35 Omega-3-acid ethyl esters, 29 Omeprazole, 10 Oncovin. see Vincristine Ondansetron, 46 One-alpha. see Alfacalcidol Opatanol. see Olopatadine Opdivo. see Nivolumab Ophthalin. see Sodium hyaluronate, eye Opioid Dependence, 58 Opsite Flexifix, 160 Opsite plus, 160

North of Tyne and Gateshead Area Prescribing Committee. Formulary - Version 6.5 October 2016

19 2

Opsite Post Op, 160 Opsumit. see Macitentan Opticrom. see Sodium cromoglicate Optifree Express, 129 Orabase. see Carmellose sodium, 132 Oral contraceptives, 85 Oral ulceration and inflammation, 132 Oral viscous budesonide, 33 Oraldene. see Hexitidine Oramorph. see Morphine Orencia. see abatacept Organophosphorus insecticide poisoning,

157 Orgaran. see Danaparoid Orlistat, 45 Oropharynx, drugs acting on, 132 Orphenadrine, 57 Ortho-Gynest. see Estriol Oseltamivir, 69 Osigraft. See Eptotermin alfa Osmotic laxatives, 13 Osvaren, 111 otitis externa. See triadcortyl Otitis externa, 130 Otomize, 130 Otosporin, 130 Otrivine. see Xylometazoline Otrivine-Antistin eye drops, 124 Ovarian cancer. See gemcitabine Ovysmen, 85 Oxaliplatin, 96 Oxandrolone, 36 Oxcarbazepine, 54 Oxetacaine. see Antacid with oxetacaine Oxybuprocaine, 126 Oxybutynin, 88 Oxybutynin Patch, 88 Oxycodone, 49 OxyContin. see Oxycodone Oxygen, 36 OxyNorm. see Oxycodone Oxysept 1 step, 129 Oxytetracycline, 61 Oxytocin, 84 Ozurdex. see Dexamethasone implant

—P— Pabrinex. see Vitamin B & C injection Paclitaxel, 95 PAH. See tadalafil Pain Cocktail. see Methadone:analgesia Palexia. see Tapentadol Paliperidone long acting injection, 42 Palivizumab, 69 Palladone. see Hydromorphone Palladone SR. see Hydromorphone Palonosetron, 46 Pamidronate, 81, 109 Panadol. see Paracetamol Pancreatic cancer. See fluouracil

Pancreatin, 15 Pancuronium, 153 Panobinostat, 97 Panoxyl Aquagel see Benzoyl peroxide,

139 Papaverine, 154 Papilloma virus vaccine, see Human

papilloma virus vaccine, 148 Paracetamol, 47

migraine, 50 poisoning, 156

Paracetamol and Codeine. see Co-codamol

Paraffin

soft white, 134 soft yellow, 134 sterile liquid, 134

Paraldehyde, 56 Paranet, 159 Paraplatin. see Carboplatin Paraquat poisoning, 157 Parecoxib, 153 Paricalcitol, 109 Parkinsonism, 56 Parlodel. see Bromocriptine Paroxetine, 43 Partobulin. see Anti – D (Rho)

immunoglobulin Parvolex. see Acetylcysteine Patent Blue V Sodium, 171 Pavulon. see Pancuronium Pazopanib, 96 Pedea. See Ibuprofen IV Pediacel. see Diphtheria/tetanus/acellular

pertussis/inactivated polio vaccine/Haemophilus influenzae type b

PEG Asparginase, 94 Pegasys. see Peginterferon Pegfilgrastim, 107 Peginterferon alfa-2a, 101 Peginterferon alfa-2b, 102 Peginterferon beta-1a, 102 pegzerepoetin alfa. see Methoxy

polyethylene glycol-epoetin beta Pembrolizumab, 97 Pemetrexed, 93 Penicillamine

heavy metal poisoning, 156 rheumatoid arthritis, 116 Wilson’s disease, 114

Penicillin G. see Benzylpenicillin, 60 Penicillin V. see Phenoxymethylpenicillin,

60 Penicillinase resistant penicillins, 60 Penicillins, 60

Antipseudomonal, 60 Penmate, 72 Pentacarinat. see Pentamidine Pentamidine, 71 Pentasa. see Mesalazine Pentasa sachets. see mesalazine

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Pentosan polysulphate, 89 Peppermint oil, 9 Peptac, 8 Perampanel, 54 Perfalgan. see Paracetamol Perfan. see Enoximone Perindopril, 21 Periostat. see Doxycycline - periodontitis Permethrin, 143 Perphenazine, 40 Persantin. see Dipyridamole Personal Best Peak Flow Meter, 171 Pesticides, poisoning with, 157 Pethidine, 49 Pharmalgen, 35 Pharmorubicin. see Epirubicin Phenelzine, 43 Phenergan. see Promethazine Phenindione, 25 Phenobarbital, 53 Phenobarbitone see phenobarbital, 53 Phenol, oily injection, 15 Phenoxybenzamine, 20 Phenoxymethylpenicillin, 60 Phentolamine, 20 Phenylbutazone

ankylosing spondylitis, 115 Phenylephrine

eye drops, 125 injection, 23

Phenylephrine and tropicamide

ophthalmic insert, 125 Phenytoin

epilepsy, 53 neuropathic pain, 50 status epilepticus, 56

PHMB. see Polyhexamethylene biguanide Pholcodine, 37 Phosex. see Calcium acetate Phosphate Polyfusor, 110 Phosphate Sandoz, 110 Phosphate solution, 110 Phosphate supplements, 110 Phosphate-binding agents, 110 Phosphates enema, 13 Phospho-soda, 14 Phoxilium 1.2mmol/l phosphate, 109 Phyllocontin. see Aminophylline, 32 Physeptone. see Methadone Physiotens. see Moxonidine Physostigmine, 154 Phytomenadione, 113 Picato. see Ingenol mebutate Picibanil, 96 Pico, 164 Picolax, 13 Pilocarpine

for xerostomia, 133 glaucoma treatment, 125

Pimecrolimus, 139 Pioglitazone, 73

Piperacillin with tazobactam, 60 Piperazine phosphate. see Pripsen Piportil. see Pipotiazine palmitate Pipothiazine palmitate. see Pipotiazine

palmitate, 42 Pipotiazine palmitate, 42 Pirfenidone, 37 Piriton. see Chlorphenamine Piroxicam

melt tablets, 115 Pitolisant, 45 Pituitary hormones, 79 Pivmecillinam, 60 Pixantrone, 92 Pixuvri. see Pixantrone Pizotifen, 50 Plaquenil. see Hydroxychloroquine Plasma substitutes, 108 Plasma-Lyte 148 and Plasma-Lyte & 5%

Glucose, 108 Plavix. see Clopidogrel Plegridy. see Peginterferon beta-1a Plerixafor, 107 Pneumococcal conjugate vaccine, 149 Pneumococcal polysaccharide vaccine,

149 Pneumocystis Pneumonia, drugs for, 71 Pneumovax II, 149 Podophyllotoxin, 140 Poisoning, treatment of, 156 Poliomyelitis vaccine, 149 Pollinex Quattro, 35 Pollinex vaccines, 35 Polyacrylic acid. see Carbomer ‘980’, 127 Polyfax ointment, 142 Polyfield Nitrile Patient Pack, 164 Polyhexamethylene biguanide, 123 Polymem, 161 Polytar liquid, 141 Ponstan. see Mefenamic acid Poractant alfa, 36 Posaconazole, 65 Posterior pituitary hormones, 80 postmenopausal osteoporosis. See

Densoumab Potassium

oral, 107 Potassium channel activators, 23 Potassium chloride

oral, 107 Potassium citrate, 89 Potassium iodate, 75 Potassium permanganate, 145 Potassium removal, 107 Potassium sparing diuretic combinations,

17 Potassium sparing diuretics, 17 Povidone iodine, 128

skin preparations, 145 Povidone Iodine

eye drops, 123

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PR Freeze spray, 155 Pradaxa. see Dabigatran Pralidoxime mesylate, 157 Praluent. see Alirocumab Pramipexole, 56 Prasugrel, 27 Pravastatin, 28 Praxbind. see Idarucizumab Praziquantel, 71 Precortisyl. see Prednisolone Predfoam. see Prednisolone, 11, 12 Pred-forte. see Prednisolone acetate eye

drops Prednisolone

ear drops, 130 eye drops, 123 inflammatory bowel disease, 11 inflammatory bowel disease rectal

preparations, 12 systemic therapy, 75

Prednisolone acetate

depot injection, 116 eye drops, 123

Prednisolone and Neomycin

eye drops, 124 Predsol. see Prednisolone Predsol-N. see Prednisolone & Neomycin Pregabalin, 55

neuropathic pain, 49 Pregnyl. see Chorionic gonadotrophin Premarin, 76 Premique low -dose, 77 Prempak-C, 76 Prevenar, 149 Prezista. see Darunavir Priadel. see Lithium carbonate Prilocaine, 155 Prilocaine 2%, 155 Priloketal. See Prilocaine Primacor. see Milrinone Primaquine, 70 Primolut N. see Norethisterone Primovist, see gadoxetic acid, 168 PrimsOcal B22, 169 Primsocitrate 18/0, 169 Prioderm. see Malathion Pripsen, 71 Privigen. see Human normal

immunoglobulin ProBanthine. see Propantheline Probenecid, 119 Procainamide, 18 Procaine, 155 Procaine penicillin, 60 Pro-Cal Shot, 158 Procarbazine, 95 prochlorperazine. See Buccastem Prochlorperazine

anti-emetic, 45 Procoralan. see Ivabradine Procyclidine, 57

Profasi. see Chorionic gonadotrophin Proflavine cream, 143 Profore, 165 Profore #1, 165 Profore Lite, 165 Progesterone, 78 Progestogen-only contraceptives, 87 Progestogens, 77

in malignant disease, 103 Prograf. see Tacrolimus Proguanil, 70 Proguanil and atovaquone. see Malarone Progynova TS. see Estradiol, 76, 78 Prolia. See Denosumab Promethazine

allergy, 35 anti-emetic, 45 hypnotic, 39

Promogran Prisma Matrix, 163 Pronestyl. see Procainamide Prontosan Irrigant, 163 Prontosan Wound Gel, 163 Propafenone, 18 Propamidine isethionate, 123 Propantheline, 9 Propofol, 151 Propofol Lipuro. see Propofol Propranolol, 18

hyperthyroidism, 75 migraine prophylaxis, 51

Propylthiouracil, 75 Proscar. see Finasteride, see Finasteride Prostaglandins, 84 Prostap 3. see Leuprorelin Prostap SR. see Leuprorelin Prostin E2. see Dinoprostone Protamine sulphate, 26 Protease inhibitors, 66 Protelos. see Strontium ranelate Prothrombin complex concentrate. see

Beriplex-P Protirelin, 80 Proton pump inhibitors, 10 Protopic. see Tacrolimus Provera. see Medroxyprogesterone acetate Provigil. see Modafinil Proxymetacaine, 126 Prozac. see Fluoxetine ProZero®, 158 Prucalopride, 14

chronic constipation in women, 14 Pseudoephedrine, 37 Psoriasis, 137, 139 Pulmicort. see Budesonide Pulmonary surfactants, 36 Pulmozyme. see Dornase alfa Puri-Nethol. see Mercaptopurine Pyrazinamide, 64 Pyridostigmine, 120 Pyridoxal phosphate, 111 Pyridoxine, 111

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19 5

Pyrimethamine, 70

—Q— Quellada M. see Malathion Questran. see Colestyramine Quetiapine, 41 Quinine

malaria treatment, 70 night cramps, 120

Quixil human fibrin glue, 143 QV cream, 134

—R— Rabies vaccine, 149 Radiesse Voice®, 170 Radium-223 dichloride, 99 Raloxifene, 77, 82 Raltegravir, 67 Ramipril, 20 Ranibizumab, 129 Ranitidine, 9 Ranolazine, 23 Rapamune. see Sirolimus Rapifen. see Alfentanil Rapilysin. see Reteplase Rasagiline, 56 Rasburicase, 119 Rasilez. see Aliskiren Rastinon. see Tolbutamide Ratiograstim. see Filgrastim Rebetol. see Ribavirin Rebif. see Interferon beta Reboxetine, 44 Reductil. see Sibutramine Regadenoson, 18 Rehydration salts, 107 Relenza. see Zanamivir Relifex. see Nabumetone Remegel, 110 Remifentanil, 153 Reminyl. see Galantamine Remodulin. see Treprostinil Renasys Go, 164 Renavit, 113 Renin inhibitors, 21 Rennies, 110 Renvela. See sevelamer carbonate Reopro. see Abciximab Repatha. see Evolocumab Rephoren, see Rephoren, 111 Requip. see Ropinirole Resolor. See prucalopride Resonium A, 107 Resource Protein, 158 Respimat. see Tiotropium Respiratory stimulants, 36 Respiratory syncytial virus, 69 Respiratory system, 31

Reteplase, 27 Retigabine, 54 Retinol see Vitamin A, 111 Retrovir. see Zidovudine Revatio. see Sildenafil Revaxis. see Diphtheria (low dose),

tetanus, acellular pertussis & inactivated polio vaccine

Revaxis. see Adsorbed Diphtheria (low dose), Tetanus and Inactivated Poliomyelitis Vaccine

Reverse transcriptase inhibitors, 66 Revlimid. see Lenalidomode Revolade. see Eltrombopag Reyataz. see Atazanavir Rheumatic diseases and gout

drugs used in, 115 Rhinolast. see Azelastine Rhophylac. see Anti – D (Rho)

immunoglobulin rHuG-CSF. see Lenograstim, 107 Ribavirin, 70 Rifabutin, 64 Rifadin. see Rifampicin Rifampicin

non tuberculous infections, 63 tuberculosis, 64

Rifampicin and isoniazid, 64 Rifater, 64 Rifaximin, 63 Rifinah. see Rifampicin with Isoniazid Rigevidon, 85 Rilpivirine, 67 Rilpivirine&Emtricitabine & Tenofovir. see

Eviplera Rilutek. see Riluzole Riluzole, 57 Rimactane. see Rifampicin Rimactazid. see Rifampicin with Isoniazid Rimexolone, 124 Rinatec. see Ipratropium nasal spray Risedronate, 81 Risperdal Consta. see Risperidone long-

acting injection Risperidone, 40

long-acting injection, 42 Ritalin. see Methylphenidate Ritonavir, 67 Rituximab

lymphoma & lymphoproliferative conditions, 100

rheumatoid arthritis and autoimmune diseases, 118

Rivaroxaban, 26 Rivastigmine, 59 Rivotril. see Clonazepam RoActemra. See Tocilizumab Robinul. see Glycopyrronium Robinul – neostigmine. see

Glycopyrronium with neostigmine

Rocephin. see Ceftriaxone

North of Tyne and Gateshead Area Prescribing Committee. Formulary - Version 6.5 October 2016

19 6

Rocuronium, 153 Roferon. see Interferon alfa Rogitine. see Phentolamine Romiplostim, 106 Ropinirole

Parkinson’s disease, 56 Restless legs syndrome, 56

Rosuvastatin, 28 Rotigotine

Parkinson’s disease, 56 Restless legs syndrome, 56

Rubefacients, 121 Ruxolitinib, 97

—S— Sacubitril & Valsartan, 21 Saflutan. See tafluprost Salactol paint, 140 Salagen. see Pilocarpine Salamol. see Salbutamol Salazopyrin. see Sulfasalazine Salbutamol, 31

Easyhaler, 31 Salcatonin. see Calcitonin (salmon), 81,

109 Salette, 129 Salicylic acid, 138, 140 Salicylic acid and Lactic acid. see Salactol Salicylic acid in emulsifying ointment, 138 Saliva Orthana, 133 Salivix. see Malic acid pastilles, 133 Salmeterol, 31 Sandimmun. see Ciclosporin Sandocal, 109 Sandoglobulin. see Human normal

immunoglobulin Sando-K, 107 Sandostatin. see Octreotide Sandrena. see Estradiol, transdermal, 76,

78 Sanomigran. see Pizotifen Saquinavir, 67 Savene. See dexrazoxane Scandonest. see Mepivacaine Scanpore tape, 164 Schistosomicides, 71 Sclerosants

Local, 29 Scopoderm. see Hyoscine hydrobromide Seal Tight, 166 Sebco see Coconut compound ointment,

137 Secukinumab

ankylosing spondylitis, 119 psoriasis, 139

Securon SR. see Verapamil Selective serotonin reuptake inhibitors, 43 Selegiline, 56 Selenium sulphide, 141

Selexid, 60 Selincro. see Nalmefene Selsun. see Selenium sulphide Senna, 12 Senokot. see Senna sentinel lymph node. See Patent Blue Septrin. see Co-trimoxazole Septrin Forte. See Co-trimoxazole Serc. see Betahistine Serenace. see Haloperidol Serevent. see Salmeterol Seroquel. see Quetiapine Seroxat. see Paroxetine Sertraline, 43 Settler’s Tums, 110 Sevelamer Carbonate, 111 Sevoflurane, 151 Sex Hormones

in malignant disease, 103 Shampoos, 141 Sibutramine, 45 Sildenafil, 90

erectile dysfunction, 90 pulmonary hypertension, 20 Raynauds disease, 90

Silver nitrate

solutions, 145 sticks & applicators, 140

Silver sulfadiazine, 142 Silvercel, 163

Simbrinza. See brinzolamide and

brimonidine Simeprevir, 69 simeticone. See Infacol Simple linctus, 37 Simple Shampoo, 141 Simponi. See Golimumab Simulect. see Basiliximab Simvastatin, 28 Sinemet. see Co-careldopa Singular. see Montelukast Siopel. see Dimeticone cream Sirolimus, 100 Sitagliptin, 73 Skin preparation swabs, 144 Skin, drugs acting on, 134 Skinsan. see triclosan Slo-phyllin. see Theophylline, 32 Slow sodium. see Sodium chloride, 107 Slow-K. see Potassium chloride Smofkabiven

®

TPN, 158 Smoking cessation, 58 Snakebite antiserum, 157 Sodium aurothiomalate, 116 Sodium bicarbonate

ear drops, 130 oral, 108

Sodium calcium edetate

heavy metal poisoning, 156 Sodium chloride, 127, 131

North of Tyne and Gateshead Area Prescribing Committee. Formulary - Version 6.5 October 2016

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bladder irrigation (large volume, 89 bladder irrigation (small volume), 90 irrigation solution, 144 oral, 107

Sodium Chloride

Minoversol, 167 nebuliser solution, 37

Sodium citrate, 129

micro-enema, 13 solution, 154

Sodium clodronate, 81, 109 Sodium cromoglicate

eye drops, 124 Sodium dichloroisocyanurate, 145 Sodium feredetate, 105 Sodium fluoride mouthwash, 111 Sodium fusidate, 63 Sodium heparin, 24

Sodium hyaluronate. See Clinitas

bladder instillation, 89 eye, 128

Sodium hyaluronate (1.6%)/ Sodium chondroitin. See Ialuril

Sodium hypochlorite, 145 Sodium ironedetate. see Sodium

feredetate, 105 Sodium nitrite, 156 Sodium nitroprusside, 19 Sodium phenylbutyrate, 114 Sodium picosulfate elixir, 13 Sodium picosulphate, in Picolax, 13 Sodium polystyrene sulphonate, 107 Sodium stibogluconate, 70 Sodium tetradecyl sulphate, 29 Sodium thiosulphate, 156 Sodium valproate

anti-epileptic, 53 bipolar disorder, 42

Sodium Valproate, 54 Sodium, oral, 107 Sofosbuvir, 69 Sofradex ear drops, 130 Soft drape, 164 Soft paraffin

white, 134 yellow, 134

Solian. see Amisulpride Solifenacin, 89 Soliris. see Eculizumab Solu-Cortef. see Hydrocortisone Solu-Medrone. see Methylprednisolone Solution G, 90 Solution R, 90 Solvaline N, 159 Solvazinc. see Zinc sulphate Somatropin, 79 Somatuline. see Lanreotide Sonovue, 168

diagnosing pancreatic cancer, 168 viualising blood vessels, 168

Soolantra. see Ivermectin

Sorbaderm, 167 Sorbsan

Ribbon with Probe, 161 Sotacor. see Sotalol Sotalol, 19 Sovaldi. see Sofosbuvir Spectinomycin, 62 Spedra. see Avanafil Spermicidal contraceptives, 87 Spiriva. see Tiotropium Spironolactone, 17, 79 Spironolactone & chlorothiazide, 17 Sporonox. see Itraconazole Stalevo, 57 Stanozolol, 36 Starch based plasma substitutes, 108 Status epilepticus, 55 Stavudine, 66 STD. see Sodium tetradecyl sulphate Stelara. See Ustekinumab, See

Ustekinumab Stelazine. see Trifluoperazine Stemetil. see Prochlorperazine Sterets. see Skin preparation swabs, 144 Steriflex 165, 108 Sterile Gloves, 164 Sterile larvae, 167 Stimulant laxatives, 12 Stiripentol, 55 Strattera

see Atomoxetine, 44 Streptase. see Streptokinase Streptokinase, 27 Streptomycin, 64 Streptozocin, 95 Stribild, 68 Strontium ranelate, 82 Stugeron. see Cinnarizine Subcuvia, 149 Sublimaze. see Fentanyl Suboxone, 59 Subutex. see Buprenorphine, opioid

dependence Suby G. see solution G, 90 Succinylated gelatin, 108 Sucralfate, 9 Sucrose 24% solution, 171 Sudafed. see Pseudoephedrine Sudocrem, 135 Sugammadex, 154 Sulfasalazine, 119

inflammatory bowel disease, 11 Sulphonylureas, 73 Sulpiride, 40 Sulpitil. see Sulpiride Sumatriptan, 50 Sunitinib, 97 Sunscreening preparations, 141 Suprax. see Cefixime Suprecur. see Buserelin Suprefact. see Buserelin

North of Tyne and Gateshead Area Prescribing Committee. Formulary - Version 6.5 October 2016

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Suscard Buccal. see Glyceryl trinitrate Sustanon, 78, 79 Sustiva. see Efavirenz Sutent. see Sunitinib Suxamethonium, 153 Sweet-Ease. See Sucrose 24% solution Symbicort, 34 Synacthen. see Tetracosactide Synagis. see Palivizumab Synalar. see Fluocinolone acetonide, 136 Synarel. see Nafarelin Synkavit. see Menadiol sodium phosphate Syntocinon. see Oxytocin Syntometrine, 84 Systane, 127, 129 Sytron. see Sodium feredetate

—T— TachoSil, 143 Tacrolimus

ointment, 139 systemic, 100

Tadalafil, 20, 90 Tafinlar. see Dabrafenib Tafluprost, 125

Tafluprost and timolol eye drops, 126 Tagamet. see Cimetidine Talimogene, 98 Tambocor, 18, see Flecainide Tamiflu. see Oseltamivir Tamoxifen, 103 Tamsulosin, 88 Tapentadol, 49

Taptiqom. See tafluprost and timolol Tar pomade, 138 Tarceva. see Erlotinib Targocid. see Teicoplanin Tarivid. see Ofloxacin Tasigna. see Nilotinib Tasmar. see Tolcapone TauroHep, 25 Taurolidine, 25 Taurolidine 2% solution, 171 TauroLock, 25 Tavanic. see Levofloxacin Taxol. see Paclitaxel Taxotere. see Docetaxel Tecfidera. see Dimethyl Fumarate Teejel. see Choline salicylate, 132 Tegaderm, 160 Tegaderm Alginate Ag, 163 Tegafur with Uracil, 93 Tegretol. see Carbamazepine Teicoplanin, 63 Telaprevir, 69 Telfa Clear, 160 Telfast. see Fexofenadine Telzir. see Fosamprenavir Temazepam, 39, 152 Temgesic. see buprenorphine

Temocillin, 60 Temodal. see Temozolomide Temozolomide, 97 Tenecteplase, 27 Tenofovir

hepatitis B, 69 HIV infection, 66

Tenofovir & Cobicistat & Elvitegravir & Emtricitabine. see Stribild

Tenormin. see Atenolol Terbinafine

skin preparations, 142 tablets, 66

Terbutaline, 31 Teriflunomide, 103 Teriparatide, 81 Terlipressin, 80 Tertroxin. see Liothyronine Testim. See Testosterone gel Testogel. see Testosterone, gel Testosterone, 78 Testosterone undecanoate, 78, 79 Testosterone, gel, 78, 79 Tetanus immunoglobulin, 150 Tetanus vaccine adsorbed, 149 Tetrabenazine, 57 Tetracaine

eye drops, 126 gel for local anaesthesia, 155

Tetracosactide, 79 Tetracosactrin. see Tetracosactide, 79 Tetracyclines, 61 Tetralysal. See Lymecycline Tetraspan, 108 Tetrastarch, 108 Thalidomide, 102 Theophylline, 32 Thiamine, 111 Thiamine compound strong. see Vitamin B

compound strong Thiazide & related diuretics, 16 Thioguanine. see Tioguanine, 93 Thiopental, 151 Thiopentone see Thiopental, 151 Thiotepa, 91 Threadworms, 71 Thymoglobuline. see antithymocyte

immunoglobulin Thyroid hormones, 74 Thyroxine, 75 Tibolone, 77 Tigecycline, 62 Tildiem. see Diltiazem Timodine cream, 137 Timolol, 125 Timoptol. see Timolol Tinzaparin, 24 Tioguanine, 93 Tiopronin, 114 Tiotropium, 32 Tirofiban, 27

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Tisseel fibrin glue, 143 Tisseel

® Lyo Fibrin Glue

mesh fixation in hernia repair, 143 Tivicay. see Dolutegravir Tizanidine, 120 Tobi. see Tobramycin TOBI Podhaler. See Tobramycin Tobramycin, 62 Tocilizumab, 118 Tocino. See Alitretinoin Tocopheryl acetate, 112 Toctino. See Alitretinoin Tolbutamide, 73 Tolcapone, 57 Tolvaptan, 81

Autosomal dominant polycystic kidney disease, 81

Topical Negative Pressure, 164 Topiramate, 54 Topotecan, 97 Toujeo. see Insulin glargine Toviaz. see fesoterodine t-PA. see Alteplase Trabectedin, 98 Tracleer. see Bosentan Tracrium. see Atracurium Tractocile. see Atosiban Tramadol

analgesia, 49 diabetic neuropathy, 74

Trametinib, 98 Trandate. see Labetalol Tranexamic acid, 27 Transiderm nitro. see Glyceryl trinitrate Translarna. see Ataluren Transpore tape, 164 Trastuzumab, 95 Trasylol. see Aprotinin Trazodone, 42 Treclin. see Clindamycin & Tretinoin Treosulfan, 92 Treprostinil, 19 Tretinoin

cancer, 95 eye drops, 129

TRH. see Protirelin, 80 Triadcortyl

otitis externa, 137 Triadcortyl®

otitis externa, 137 Triamcinolone acetonide, 76

injection, 116 nasal spray, 131

Triamcinolone hexacetonide

injection, 116 Tribavirin. see Ribavirin, 70 Trichloroacetic acid, 141 Triclosan

skin cleanser, 145 toothpaste, 133

Tricotex, 159

Tricyclic and related antidepressants, 42 Trifludridine & tipiracil, 98 Trifluoperazine, 40 Trifluorothymidine eye drops, 123 Trigeminal neuralgia, 49 Trihexyphenidyl, 57 Triiodothyronine. see Liothyronine Trileptal. see Oxcarbazepine Trimeprazine

allergy, 35 in anaesthetics, 152

Trimethoprim, 63 Trimopan. see Trimethoprim Trimovate, 137 Triptorelin

precocious puberty, 83 prostate cancer, 104

Tri-Regol, 86 Trisenox. see Arsenic Trioxide Tritace. see Ramipril Triumeq, 66 Trizivir, 68 Trobalt. See retigabine Tropicamide, 124 Trusopt. see Dorzolamide Truvada, 68 Tryptizol. see Amitriptyline T-Safe Cu380A, 87 Tsybari. Natalizumab TT380 Slimline, 87 Tuberculin PPD, 147 Twinrix. see Hepatitis A and B vaccine Tygasil. see Tigecycline Typhim Vi. see Typhoid vaccine (vi

polysaccharide) Typhoid vaccine (vi Polysaccharide), 149

—U— Ubidecarenone. See Ubiquinone Ubiquinone, 114 Uftoral. see Tegafur with uracil Ukidan. see Urokinase Ulcer healing drugs, 9 Ulipristal

emergency contraception, 86 uterine fibroids, 78

Ultiva. see Remifentanil Uniphyllin. see Theophylline, 32 Urea cream. see Calmurid, 135 Urgotul, 160 Urgotul SSD, 163 Urinary frequency, 88 Urinary-tract infections, 65 Urine alkalinisation, 89 Urine retention, 88 Urokinase, 27 Urometexan. see Mesna Urotainer Solution R. see Solution R, 90 Ursodeoxycholic acid, 15 Ursofalk. see Ursodeoxycholic acid

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Ustekinumab, 119, 139 Utovlan. see Norethisterone Uvistat Ultrablock cream, 141

—V— Vaccines, 147 Vagifem. see Estradiol vaginal tablets Vaginal Atrophy, 84 Vaginal infections, 84 Valaciclovir, 68 Valcyte. see Valganciclovir Valdoxan. see Agomelatine Valganciclovir, 68 Valium. see Diazepam Vallergan. see Alimemazine Valoid. see Cyclizine Valproic Acid, 42 Valsartan, 21 Valtrex. see Valaciclovir Vancocin. see Vancomycin Vancomycin, 63 Vaniqa. see Eflornithine Varenicline, 58 Vargatef. see Nintedanib Varicella zoster

vaccine, 149 Varicella zoster immunoglobulin, 150 Vasodilators

Peripheral and Cerebral, 23 Vasopressin. see Argipressin, 80 Vasovist, 168 Vecuronium, 153 Vedolizumab, 12 Vedrop. see Alpha tocopheryl as

tocofersolan Velbe. see Vinblastine Velcade. see Bortezomib Vemurafenib, 97 Venclexta. see Venetoclax Venetoclax, 98 Venlafaxine, 43 Venofer. see Iron sucrose Ventavis. see Iloprost Ventolin. see Salbutamol Vepesid. see Etoposide Verapamil, 22 Vermox. see Mebendazole

Verteporfin, 129 Vesanoid. see Tretinoin Vesicare. see solifenacin Vexol. see Rimexolone Vfend. see Voriconazole Vibramycin. see Doxycycline Victoza. See liraglutide Victrelis. see Boceprevir Videx. see Didanosine Viekirax, 69 Vigabatrin, 55 Vigam. see Human normal immunoglobulin Vimpat. see Lacosamide

Vinblastine, 94 Vinca alkaloids, 93 Vincristine, 94 Vindesine, 94 Vinorelbine, 94 Viracept. see Nelfinavir Viraferon. see Interferon alfa Viraferon Peg. see Peginterferon Viramune. see Nevirapine Virazole. see Ribavirin Viread, 69, see Tenofovir Viridal Duo. see Alprostadil Viscopaste PB7. see Zinc Paste Bandage Viscotears see Carbomer 980, 127 Vistabel. see Botulinum A toxin Vista-methasone. see Betamethasone Vista-methasone N. see Betamethasone &

Neomycin Vistide. see Cidofovir

Visudyne. see Verteporfin Vitamin B & C injection, 111 Vitamin B compound strong, 111 Vitamin B1. see Thiamine Vitamin B12. see Hydroxocobalamin, 105 Vitamin B6. see Pyridoxine Vitamin C, 112 Vitamin D, 112 Vitamin E, 112 Vitamin K, 113 Vitamin K1. see Phytomenadione Vitamins A, 111 Vitamins A & D, 111 Vitamins BPC, 113 Vitaros. see Alprostadil Volibris. see Ambrisentan Volmax. see Salbutamol Volplex, 108 Voltarol. see Diclofenac Voltarol-ophtha, 128 Volulyte, 108 Voraxaze. see Glucarpidasene Voriconazole, 66

eye drops, 123 Vortioxetine, 44 Votubia. see Everolimus VSL#3, 169

—W— Wakix. see Pitolisant Warfarin, 25 Warticon. see Podophyllotoxin, 140 Warts and calluses, 140 Water for infusion, 108 Water for irrigation, 144 Water, bladder irrigation, 89 Welldorm. see Chloral betaine & hydrate Wellferon. see Interferon alfa Wellvone. see Atovaquone White soft paraffin, 127, 134

North of Tyne and Gateshead Area Prescribing Committee. Formulary - Version 6.5 October 2016

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White’s Tar Paste see Zinc and coal tar paste, 138

Whitmore cocktail

bladder instillation, 89 Wilson’s disease, 114 WinRho. see Anti – D (Rho)

immunoglobulin Wound Management Products, 159

—X— Xagrid. see Anagrelide Xailin

® Night. see White soft paraffin

Xalatan. see Latanoprost Xalkori. see Crizotinib Xarelto. see Rivaroxaban Xelma, 169 Xeloda, 92, see Capecitabine Xenazine. see Tetrabenazine Xenical. see Orlistat Xeplion. see Paliperidone, 42 Xolair. see Omalizumab, 35 Xtandi. see Enzalutamide Xylocaine. see Lidocaine Xylometazoline, 131 Xyloproct, 14

—Y— Yasmin, 85 Yellow fever vaccine, 149 Yellow soft paraffin, 134 Yervoy. see ipilimumab Yondelis. see Trabectedin

—Z— Zanaflex. see Tizanidine Zanamivir, 69 Zanidip. see Lercanidipine Zantac. see Ranitidine Zarontin. see Ethosuximide Zavedos. see Idarubicin Zebinix. See Eslicarbazepine Zeffix. see Lamivudine Zelboraf. see Vemurafenib Zerbaxa. see Ceftolozane/tazobactam Zerit. see Stavudine Zerobase cream, 135 Zerodouble gel, 134

Zestril. see Lisinopril Zevtera. see Ceftobiprole Z-Hyalin. see Sodium hyaluronate, eye Ziagen. see Abacavir

Zidoval. see Metronidazole vaginal gel Zidovudine, 66 Zidovudine & lamivudine. see Combivir Zinacef. see Cefuroxime Zinamide. see Pyrazinamide Zinc & coal tar & paste, 138 Zinc and castor oil, 135 Zinc and salicylic acid compound paste,

half strength, 138 Zinc Paste and Ichthammol Bandage

eczema, 137 medicated bandages, 166

Zinc Paste Bandage, 166 Zinc sulphate, 111 Zinc supplements, 111 Zineryt, 140 Zinforo. see Ceftaroline Zipzoc, 166 Zirtec. see Cetirizine Zispin. see Mirtazapine Zithromax. see Azithromycin Zofran. see Ondansetron Zoladex. see Goserelin Zoledronic acid, 109

hypercalcaemia, 81 osteoporosis, 82 Paget’s disease, 82

Zolmitriptan, 50 Zomacton. see Somatropin Zometa. see Zoledronic

acid:hypercalcaemia Zomig. see Zolmitriptan Zonisamide, 54 Zopiclone, 39 Zoton. see Lansoprazole Zovirax. see Aciclovir Zuclopentixol Acetate, 42 Zuclopentixol decanoate, 41 Zyban. see Bupropion Zydelig. see Idelalisib Zydol. see Tramadol Zykadia. see Ceritinib Zyloric. see Allopurinol Zyprexa. see Olanzapine Zytiga. see Abiraterone Zyvox. see Linezolid