See Toxbase dosing advice - Buckinghamshire Formulary

Transcription

Buckinghamshire Formulary
Last Updated 10 July 2013
BUCKINGHAMSHIRE HOSPITALS ANTIDOTE LIST
Antidote
Used for
Absolute Alcohol injection, 2mL ampoule
Toxicity with methanol and ethylene glycol
Acetylcysteine injection, 2g vial
Paracetamol overdose
Activated charcoal suspension, 50g/250mL
Reduction of absorption of toxic substances by the GI tract that are adsorbed by charcoal
Atropine injection, 1mg/10mL, 3mg/10mL. 3mg/30mL
toxicity with organophosphates and carbamates
Calcium folinate injection, 50mg/5mL
toxicity with folinic acid antagonists; toxicity with methanol
Calcium folinate injection, 50mg/5mL
Methanol, formic acid
Calcium chloride injection, 10%
Calcium channel blockers
Calcium gluconate gel, 2.5%
prevention of transdermal adsorption of hydrofluoric acid
Dantrolene injection, 20mg vial
Drug induced hyperthermia including neuroleptic malignant syndrome
Desferrioxamine injection, 500mg
toxicity with iron
Diazepam injection, 10mg/2mL
convulsions, hypertonia
Dicobalt Edetate injection, 300mg/20mL
Cyanide
Flumazenil injection, 500micrograms /5mL
Toxicity with benzodiazepines (USE WITH CAUTION)
Glucagon injection, 1mg
Toxicity with beta-blockers
Haloperidol injection, 5mg/1mL
Agitated psychosis
Isoprenaline injection, 2mg/2mL
Toxicity with beta-blockers
Lorazepam injection, 4mg/1mL
status epilepticus
Methionine tablets, 250mg
paracetamol toxicity
Naloxone injection, 400micrograms/1mL
Opioid poisoning
Neostigmine injection, 2.5mg/1mL
Neuromuscular blockade
Paraldehyde injection, 5mL vial
status epilepticus
See
Toxbase
for
dosing
advice
www.toxbase.org
UK National Poisons
Information Service
Penicillamine tablets, 250mg
lead toxicity
Phentolamine injection, 250mg/5mL
Toxicity with alpha adrenergic agents
Phenytoin injection 250mg/5mL
status epilepticus
Phytomenadione injection, 10mg/1mL
Overdose with warfarin
Polyethylene glycol (Moviprep) sachets, 4 sachet pack
whole bowel cleansing
Procyclidine injection, 10mg/2mL
Acute dystonia
Propranolol hydrochloride injection, 1mg/1mL
Toxicity with beta - agonists / theophylline
Protamine injection, 50mg/5mL
Toxicity with heparin
Sodium calcium edetate injection, 1000mg/5mL
Toxicity with lead
BNF CHAPTER and Drug Sub-class
UK National Poisons
Information Service
Tel: 0844 892 0111
Drug
Notes
NOTE 1. Queries please email: [email protected]
2. Items below, in BOLD type, are still subject to clarification and a final decision.
CHAPTER - MISCELLANEOUS
Bone cement low viscosity with gentamicin sterile powder 40g
Bone cement with gentamicin, sterile powder 20g, 40g
Palacos R
Medical Device
Bone cement with gentamicin and vancomycin sterile powder,
Copal G+V
Medical device
Traffic light list: Red
Eptotermin alpha
Osigraft
Restricted - to prescribing by Consultant Orthopaedic surgeons for
treatment of non-union fractures in patients who have been
assessed but found unsuitable for bone autograft. Named patient
approval required. Traffic light list: Red.
Lipiodol injection
Restricted - to prescribing by Radiology team only. Traffic light list:
Red
Patent Blue V 2.5% solution for injection
Unlicensed - Medium Risk
Restricted:
1. For use in Theatre 1 for sentinel node biopsy in breast cancer
surgery and,
2. For use by Plastic surgeons for sentinel node biopsy in
malignant melanoma.
Named patient basis. Traffic light list: Red
Physostigmine injection, 1mg/mL
Restricted for use on St Andrews ward only.
Appendix 8 Wound Management Products
Wound Care Formulary - complete list to be added as Appendix 8
Approved FMG Mar08
Diagnostic Contrast Agents
Iodixanol injection 270, 320 mgI/mL, 100mL
Visipaque®
Restricted - prescribing by Consultant Radiologist only
Gadofosveset
Ablavar®
Unlicensed - Low Risk
Gadoteric acid intravenous injection, 5mL, 10mL, 15mL and 20mL vials, 15mL and 20mL pre-filled Dotarem®
syringes
Restricted - for use as diganostic contrast agent in MRI when
patients have severe renal impairment, in line with MHRA advice.
Gadopentetic acid dimeglumine intravenous injection, 10mL, 15mL and 20mL vials, 10mL and
15mL pre-filled syringes
Magnevist®
Restricted - for use as a diagnostic contrast agent in MRI when
patients have nil, mild or moderate renal impairment, in line with
MHRA advice.
Gadopentetic acid dimeglumine intra-articular injection, 2mmol in 1litre, 20mL pre-filled syringe
Magnevist®
Gadoxetic acid disodium solution for injection, 0.25mmol/mL, PFS
Primovist®
Restricted - prescribing by Radiology team only, for contrastenhanced liver MRI
Sulphur hexafluoride intravenous injection, 8microlitres/mL
Sonovue®
Restricted - for use as a diagnostic contrast agent for Stress
Echocardiography and the LV Endocardial enhancement.
Consultant Cardiologists only. Red traffic light list.
CHAPTER 1 - GASTRO-INTESTINAL SYSTEM
Bismuth subsalicylate suspension
Pepto-Bismol®
Restricted - to prescribing in Primary Care only and in accordance
with the Primary care antibiotics guideline.
Sodium Citrate Mixture 0.3mmol/1mL, 100mL
Available on named patient basis
Aluminium hydroxide / magnesium hydroxide mixture 220mg/195mg in 5mL (co-magaldrox
195/220)
Magnesium Trisilicate Mixture B.P.
Aluminium hydroxide 420mg/simeticone 135mg/light magnesium oxide70mg in 5mL, sugar-free
suspension
Low sodium
Gaviscon tablets
2mmol Na+/tablet
Gaviscon Advance liquid
4.6mmol (106mg) sodium, 2.0mmol (78mg) potassium in 10mL
Gaviscon infant powder 1g
Half a dual sachet equals one dose. 0.92mmol Na+/dose
1.1 DYSPEPSIA AND GASTRO-OESOPHAGEAL REFLUX
DISEASE
1.1.1 Antacids and Simeticone
Aluminium- and Magnesium- containing antacids
Antacid Preparations containing Simeticone
1.1.2 Compound Alginates and Proprietary Indigestion
Preparations
1.2 ANTISPASMODICS AND OTHER DRUGS ALTERING GUT
MOTILITY
Antimuscarinics
Other Antispasmodics
1.3 ANTISECRETORY DRUGS and MUCOSAL PROTECTANTS
1.3.1 H2-Receptor Antagonists
Atropine sulphate tablet 600micrograms
Dicycloverine hydrochloride tablet 10mg
Dicycloverine hydrochloride syrup 10mg/5 mL
Hyoscine butylbromide tablet 10mg
Hyoscine butylbromide injection 20mg/1mL
Propantheline bromide tablet 15mg
Mebeverine hydrochloride tablet 135mg
Peppermint oil 0.2mL enteric coated capsule
Helicobacter Test INFAI®, oral powder
Ranitidine tablet 150mg
Ranitidine effervescent tablet 150mg
Ranitidine syrup 150mg/10mL
Ranitidine i.v. injection 50mg/2mL
Asilone
1.3.2 Selective antimuscarinics
Pirenzepine tablet 50mg
1.3.3 Chelates and complexes
Sucralfate tablet 1g
Sucralfate suspension 1g/5mL
Tripotasssium dicitratobismuthate tablet 120mg
1.3.4 Prostaglandin Analogues
Restricted - Mental Health Trust only. Unlicensed
Antepsin® Liquid preparation only
DeNoltab®
Misoprostol tablet 200micrograms
Both omeprazole and lansoprazole are on the Formulary. As
pricing is dynamic, prescribers will be informed of the current
cheapest option.
1.3.5 Proton Pump Inhibitors
Lansoprazole capsule enclosing e.c. granules 15mg, 30mg
Lansoprazole FasTab (orodispersible tablet) 15mg, 30mg
Lansoprazole suspension 30mg/sachet
Omeprazole capsule 10mg, 20mg
Omeprazole MUPS dispersible 10mg tablet
Omeprazole i.v. infusion and injection 40mg
Restricted - for use in patients who cannot swallow because they
are in ITU or have a NG/PEG tube.
Restricted - for Paediatric use only
Restricted - for use either, after endoscopy which has shown an
ulcer with high risk stigmata or before endoscopy in a clinically
severe bleed when endoscopy cannot be performed within 24
hours. In all other circumstances an oral soluble PPI (Lansoprazole
FasTab) should be used.
1.4 ACUTE DIARRHOEA
1.4.2 Antimotility Drugs
Codeine phosphate tablet 15mg, 30mg
Codeine phosphate linctus 15mg/5mL
Codeine phosphate oral solution 25mg/5mL
Co-phenotrope tablet (diphenoxylate/atropine sulphate 2.5mg/25micrograms)
Loperamide hydrochloride capsule 2mg
Loperamide hydrochloride syrup 1mg/5mL
see section 3.9.1
See section 4.7.2
Immodium®
1.5 CHRONIC BOWEL DISORDERS
1.5.1 Aminosalicylates
Balsalazide disodium capsule 750mg
Mesalazine tablet, enteric coated 400mg
Colazide
1st Choice - Octasa MR®. (bioequivalent to Asacol MR®)
Octasa MR® to be prescribed 1st line instead of Asacol MR®.
Patients stabilised on Asacol MR® should not to be switched
unless prescribed generically.
Mesalazine MR tablet 500mg
Mesalazine MR, enteric coated tablet, 1.2g
Pentasa®
Mezavant XL®
Restricted - Initiation by Consultant Gastroenterologists for
induction and maintenance of remission, in NEW patients with mild
to moderate active ulcerative colitis, when compliance is an issue.
Traffic Light List: Amber initiation.
Mesalazine suppository 250mg, 500mg
Mesalazine foam enema 1g/metered application
Mesalazine retention enema 1g/100mL
Asacol®
Pentasa®
Sulfasalazine tablet 500mg
For Rheumatology see Section 10.1.3, when prescribed by
Rheumatology: Traffic light list: Amber protocol
Sulfasalazine EC f/c tablet 500mg
Sulfasalazine suspension 250mg/5 mL
1.5.2 Corticosteroids
1.5.3 Drugs Affecting the Immune Response
Beclometasone dipropionate MR tablets 5mg
Clipper®
Restricted - Consultant gastroenterologist prescribing only for the
treatment of mild or moderate ulcerative colitis in active phase, as
add-on therapy to 5-ASA containing drugs in patients who are nonresponders to 5-ASA therapy in active phase. TO BE USED ONLY
AFTER A COURSE OF PREDNISOLONE HAS BEEN TRIED.
Budesonide capsule, enclosing EC pellets 3mg
Budenofalk® Restricted - Consultant prescribing only
Hydrocortisone acetate aerosol foam 10%
Prednisolone rectal foam 20mg/metered application
Prednisolone retention enema 20mg/100mL
Prednisolone suppository 5mg
Colifoam®
Predfoam®
Predenema® (long tube and standard tube) Predsol®
Adalimumab injection pre-filled pen or syringe 40mg
FOR ALL PRESCRIBING: NICE compliance form required - see
link from Formulary homepage
1. Restricted - prescribing by Gastroenterologists only in
accordance with NICE TA187 Infliximab (review) and adalimumab
for the treatment of Crohn's disease. Traffic light list: Red.
see section 10.1.3 (for Rheumatology) and 13.5.3 (for
Dermatology)
Iinfliximab i.v. infusion 100mg vial
accordance with NICE TA 163 – Infliximab for the treatment of
acute exacerbations of ulcerative colitis. Traffic light list: Red.
accordance with NICE TA187 - Infliximab (review) and adalimumab
for the treatment of Crohn's disease. Traffic light list: Red.
see section 10.1.3 (for Rheumatology) and 13.5.3 (for
Dermatology)
Azathioprine
Traffic light list: Amber protocol
See section 8.2.1
Mercaptopurine
see section 8.1.3
Methotrexate
see section 10.1.3
1.6.1 Bulk forming laxatives
Isphagula Husk granules 3.5g/sachet
Methylcellulose '450' tablet 500mg
Sterculia granule 62%, 7g sachet
Fybogel® orange flavour only
Celevac®
Normacol®
1.6.2 Stimulant laxatives
Bisacodyl EC tablet 5mg
Bisacodyl suppository 5mg (paediatric), 10mg
Co-danthramer suspension 25/200 in 5mL (Dantron 25mg,Poloxamer '188' 200mg/5mL)
Co-danthramer strong suspension 75/1000 (dantron 75mg/poloxamer '188' 1g in 5mL)
Co-danthrusate 50/60 capsule (dantron 50mg/docusate sodium 60mg)
Co-danthrusate 50/60 suspension (dantron 50mg/docusate sodium 60mg in 5mL)
Docusate sodium capsule 100mg
Docusate sodium oral solution sugar-free 12.5 mg/5 mL, 50mg/5 mL
Glycerin adult suppository 4g
Glycerin child suppository 2g
Glycerin infant suppository 1g
Senna syrup 7.5mg/5 mL
Senna tablet 7.5mg
Sodium picosulphate elixir sugar-free 5mg/5mL
1.5.4 Food Allergy
1.6 LAXATIVES
1.6.3 Faecal softeners
Arachis oil retention enema
1.6.4 Osmotic laxatives
Lactulose solution
Macrogols
Macrogol Oral Powder, compound, sachets
Magnesium Salts
Phosphates (rectal)
Sodium Citrate (rectal)
Movicol Paediatric Plain®
Magnesium hydroxide liquid 415mg/5mL
Phosphate disposable enema (standard tube and long rectal tube)
Sodium citrate (rectal)
1.6.5 Bowel cleansing preparations
Fleet Phospho-soda oral solution 45mL
Macrogols - Klean-Prep®
Macrogols - Moviprep® sachets
Restricted - for use in patients requiring palliative care
Fletcher's®
Replaces Movicol®.
NOTE: Do not confuse with Moviprep® (section 1.6.5)
NOTE: Do not confuse with Moviprep® (section 1.6.5)
Magnesium Hydroxide Mixture BP
Brand stocked depends on contract
Restricted - prescribing by Paediatric team for paediatrics with
bowel obstruction. Traffic light list: Red
NOTE: Do not confuse with Movicol Paediatric Plain® or Macrogol
Oral Powder, compound, sachets (section 1.6.4)
Magnesium citrate oral powder (magnesium carbonate 11.57g, anhydrous citric acid 17.79g per
sachet)
Citramag®
Restricted - prescribing by Renal physicians and
Gastroenterologists for use in patients with chronic kidney disease
(Grade 5 on haemodialysis) prior to endoscopy/colonoscopy when
recommended by renal team. Traffic light list: Red
1.6.6 Peripheral Opioid-Receptor Antagonists
Sodium picosulphate 10mg with magnesium citrate oral powder
Methylnaltrexone bromide injection 12mg/0.6mL
Picolax
Restricted - Florence Nightingale Hospice prescribers only. Traffic
Light List - Red.
For treatment of opioid induced constipation in advanced illness
adult patients who are receiving palliative care, when response to
usual laxative therapy has not been sufficient. Part of a Thames
Valley wide assessment audit to look at the tolerability and
effectiveness of this new drug in the hospice setting. The proposal
is to use this after normal laxatives have been maximised for
resistant cases.
1.6.7 5HT4 receptor agonists
Prucalopride tablet 1mg, 2mg
Restricted - initiation by Gastroenterologists and continuation by
GPs after first hospital review at 4 weeks, in accordance with NICE
TA 211 Prucalopride for the treatment of chronic constipation in
women. A supply of 2 weeks to be provided by the hospital after
the first review at four weeks ie. total of 6 weeks supply from
hospital. Traffic light list: Amber initiation.
1.7 LOCAL PREPARATIONS FOR ANAL AND RECTAL
DISORDERS
1.7.1 Soothing Haemorrhoidal Preparations
1.7.2 Compound Haemorrhoidal Preparations with
Corticosteroids
Anusol cream, ointment, suppository
Proctosedyl ointment
Proctosedyl suppository
Scheriproct ointment, suppository
1.7.3 Rectal Sclerosants
1.7.4 Management of Anal Fissures
Oily Phenol Injection BP 5%, 5mL
Glyceryl Trinitrate 0.4% rectal ointment, 30g
Diltiazem cream 2%
Restricted - to colorectal surgeons and gastroenterologists.
Unlicensed: Low Risk.
Restricted - prescribing by colorectal surgeons for the treatment of
patients with an anal fissure resistant to topical glyceryl trinitrate
0.4% used twice daily or experiencing severe side effects
(headache) from it. Traffic light list: Red.
1.8 STOMA CARE
1.9 DRUGS AFFECTING INTESTINAL SECRETIONS
1.9.1 Drugs Affecting Biliary Composition and Flow
Ursodeoxycholic acid tablet 150mg, 300mg
Ursodeoxycholic acid capsule 250mg
Ursofalk
Ursodeoxycholic acid suspension 250mg/5mL
1.9.2 Bile acid sequestrants
Colestyramine sachet 4g
Also in section 2.12
Pancreatin
Creon 10 000, 25 000
1.9.3 Aprotinin
1.9.4 Pancreatin
CHAPTER 2 - CARDIOVASCULAR SYSTEM
2 CARDIOVASCULAR SYSTEM
Iloprost injection 50micrograms/0.5mL
Unlicensed - High Risk
Restricted - prescribing by Consultant vascular surgeons,
rheumatologists and dermatologists only.
See Clinical Guideline BHT 684.1 Iloprost Infusion Protocol
Lithium chloride injection 0.15mmol/1mL
Restricted - for use in ITU for monitoring cardiac output.
2.1 POSITIVE INOTROPIC DRUGS
2.1.1 Cardiac Glycosides
2.1.2 Phosphodiesterase type-3 Inhibitors
2.2 DIURETICS
2.2.1 Thiazides and Related Diuretics
Digoxin injection 100micrograms/1mL, 500micrograms/2mL
Digoxin elixir 50micrograms/1mL
Digoxin tablets 62.5micrograms, 125micrograms, 250micrograms
Digoxin-specific antibody fragments 40mg
Milrinone injection 10mg/10mL
Bendroflumethiazide tablets 2.5mg, 5mg
Chlorothiazide suspension 250mg/5mL
Indapamide tablet 2.5mg
Do not dilute (from BNF)
Stock held in A&E
Restricted - for ITU only
Unlicensed
Restricted - for use in Paediatrics only. Traffic light list: Red.
For use in accordance with BHT CG Hypertension (awaited)
Metolazone tablet 5mg
2.2.2 Loop Diuretics
2.2.3 Potassium-Sparing diuretics and aldosterone
antagonists
Bumetanide tablet 1mg, 5mg
Bumetanide liquid 1mg/5mL
Bumetanide injection 2mg/4mL
Furosemide tablet 20mg, 40mg, 500mg
Furosemide oral solution 1mg/1mL, 40mg/5mL
Furosemide injection 20mg/2mL, 50mg/5mL, 250mg/25mL
Furosemide injection pre-filled syringe 80mg/8mL
Amiloride hydrochloride tablet 5mg
Amiloride hydrochloride oral solution sugar-free 5mg/5mL
1mg/mL - Unlicensed
Eplerenone tablets 25mg, 50mg
1. To reduce the risk of cardiovascular mortality and morbidity post
myocardial infarction, in accordance with NICE Clinical Guideline
No.48 - Myocardial infarction: Secondary prevention At 12
months post MI, switch to spironolactone 25mg daily.
Restricted - initation by Consultant Cardiologists with continuation
by GPs. Traffic light list: Amber initiation.
2. Intolerance (gynaecomastia) to Spironolactone in male patients
with chronic heart failure (unlicensed indication). See Clinical
Guideline 707.1 for Investigation and Management of Heart Failure
within primary care. Traffic light list: Green
Potassium canrenoate injection 200mg/10mL
Unlicensed - Medium risk
Restricted - Consultant Only Prescribing in ITU or Gastroenterology
Spironolactone tablet 25mg, 100mg
Spironolactone suspension 5mg/5mL, 25mg/5mL, 50mg/5mL
2.2.4 Potassium-Sparing Diuretics with Other Diuretics
Co-amilofruse tablet 2.5mg/20mg, 5mg/40mg
2.2.5 Osmotic Diuretics
Mannitol infusion 10%, 20% , 500mL
2.2.8 Diuretics with Potassium
2.3 ANTI-ARRHYTHMIC DRUGS
2.3.2 Drugs for Arrhythmias
Supraventricular arrhythmias
Supraventricular and ventricular arrhythmias
Ventricular arrhythmias
Bumetanide 500micrograms/potassium 7.7mmol MR tablet (Burinex K®)
see BHT CG 775 Guidelines on the treatment of Atrial Fibrillation
Adenosine i.v. injection 6mg/2mL
Adenosine infusion 130mg in 130mL
Dronedarone tablet 400mg
Amiodarone hydrochloride tablet 100mg, 200mg
Amiodarone hydrochloride i.v.pre-filled syringe 300mg/10mL
Amiodarone hydrochloride sterile concentrate 150mg/3mL for infusion
Disopyramide capsule 100mg
Disopyramide tablet SR 250mg
Disopyramide i.v. injection 50mg/5mL
Flecanide acetate tablet 50mg, 100mg
Flecainide acetate i.v. injection 150mg/15mL
Propafenone hydrochloride tablet 150mg
Lidocaine hydrochloride injection 1%, 2mL, 5mL, 10mL, 20mL
Lidocaine hydrochloride injection 2%, 2mL, 10mL, 20mL
Lidocaine injection pre-filled syringe 2% (100mg/5mL)
Unlicensed: Medium risk
Restricted - prescribing as a 2nd/3rd line medicine by Consultant
Cardiologists only in accordance with NICE TA197 Dronedarone for
the treatment of non-permanent AF and in accordance with BHT
Guideline on prescribing for rhythm control in atrial fibrillation.
Lidocaine/glucose infusion 0.4%/5%
Lidocaine/glucose infusion 0.2%/5%, 500mL
Mexiletine capsule 50mg
Cardiologists to comment please re possible rationalisation.
2.4 BETA-ADRENOCEPTOR BLOCKING DRUGS
Atenolol tablet 25mg, 50mg, 100mg
Atenolol oral solution 25mg/5mL
Atenolol injection i.v. 5mg/10mL
Bisoprolol fumarate tablet 1.25mg, 2.5mg, 5mg, 10mg
Carvedilol - a full evaluation to be undertaken with formulary submission
Esmolol hydrochloride injection concentrate 2.5g/10mL
Labetalol hydrochloride tablet 50mg, 100mg, 200mg, 400mg
Labetalol hydrochloride injection i.v. 100mg/20mL
Metoprolol tartrate tablets 50mg
Metoprolol tartrate injection i.v. 5mg/5mL
Propranolol hydrochloride tablet 10mg, 40mg
Propranolol hydrochloride liquid 50mg/5mL, 10mg/5mL
Propranolol hydrochloride injection i.v. 1mg/1mL
Sotalol hydrochloride tablet 40mg, 80mg
For dilution before infusion
2.5 HYPERTENSION AND HEART FAILURE
2.5.1 Vasodilator Antihypertensive Drugs
Bosentan tablet 62.5mg, 125mg
Diazoxide i.v. injection 300mg/20mL(ITU)
Hydralazine hydrochloride tablet 25mg, 50mg
Hydralazine hydrochloride i.v. injection 20mg
Minoxidil tablet 5mg
Sildenafil tablet 20mg
Sodium nitroprusside i.v. infusion 50mg
2.5.2 Centrally Acting Antihypertensive Drugs
Clonidine hydrochloride tablet 100micrograms
Clonidine hydrochloride i.v. injection 150micrograms/1mL
Methyldopa tablet 125mg, 250mg, 500mg
2.5.3 Adrenergic Neurone Blocking Drugs
Guanethidine monosulphate injection 10mg/1mL
2.5.4 Alpha-Adrenoceptor Blocking Drugs
Doxazosin tablet 1mg, 2mg, 4mg
Doxazosin tablet MR 4mg, 8mg
Restricted - to prescribing by designated Pulmonary Hypertension
centres. Traffic light list: Red
Restricted - ITU only
Use as 4th choice after Diazoxide, Hydralazine and Sodium
Nitroprusside.
Revatio (NOTE: not Viagra brand)
For treatment of pulmonary arterial hypertension. FIRST DOSE
MUST BE GIVEN IN HOSPITAL - risk of first-dose hypotension.
Restricted - initiation by Respiratory consultants in secondary or
tertiary care. Traffic Light List - amber initiation. See European
Society of Caridology guideline on diagnosis and treatment of
pulmonary arterial hypertension, European Heart Journal 2004.
Note: Powder for dilution and use as an infusion
Restricted - prescribing by Chronic Pain Team.
Phaeochromocytoma
Prazosin tablet 500micrograms, 1mg, 2mg,
Terazosin tablet 2mg, 5mg, 10mg
Phenoxybenzamine hydrochloride capsule 10mg
Phenoxybenzamine hydrochloride injection concentrate 100mg/2mL
Phentolamine mesilate i.v. injection 10mg/1mL
Restricted - for use in Urology only
Note: for dilution as infusion
2.5.5 Drugs Affecting the Renin-Angiotensin System
2.5.5.1 Angiotensin-Converting Enzyme Inhibitors (ACE
inhibitors)
2.5.5.2 Angiotensin-II Receptor Antagonists
2.5.5.3 Renin Inhibitors
2.6 NITRATES, CALCIUM-CHANNEL BLOCKERS AND OTHER
ANTIANGINAL
DRUGS
2.6.1 Nitrates
Captopril tablet 12.5mg, 25mg, 50mg
Captopril suspension 1mg/1mL
Lisinopril tablet 2.5mg, 5mg, 10mg, 20mg
Perindopril erbumine tablet 2mg, 4mg, 8mg
Ramipril tablet 1.25mg, 2.5mg, 5mg, 10mg
Ramipril capsule 2.5mg, 5mg, 10mg
Restricted - for use in patients with NG/PEG tube only.
1st Choice ACE Inhibitor
Restricted - to CONTINUATION in patients until reviewed for
switching to Ramipril. Patients should be INITIATED on Ramipril
for all ACE Inhibitor indications.
Angiotensin II Receptor Antagonists are RESTRICTED and only for use in patients intolerant to ACE Inhibitors
Note also these drugs are 10 times more expensive than ACE Inhibitors.
Candesartan cilexetil tablet 8mg
Irbesartan tablet 150mg, 300mg
1st Choice for heart failure and hypertension
Restricted - initiation by Diabetic and Renal teams for use in
diabetic nephropathy in patients intolerant of an ACE inhibitor.
Amber initiation.
Losartan potassium tablet 12.5mg, 25mg, 50mg, 100mg
Restricted - to CONTINUATION in patients with diabetic
nephropathy until reviewed for switching to irbesartan. Patients
should be INITIATED on irbesartan which has a larger evidence
base in early and late diabetic nephropathy.
Valsartan capsule 40mg, 80mg, 160mg
Restricted - initiation by defined Consultants for use in postmyocardial infarction in accordance with Trust guidelines
Glyceryl trinitrate aerosol spray 400micrograms/spray
Glyceryl trinitrate sublingual tablet 500micrograms
Glyceryl trinitrate injection 50mg/50mL
Glyceryl trinitrate transdermal patch 5mg in 24hours, 10mg in 24hours
Isosorbide dinitrate injection 0.05% (500micrograms/1mL)
Isosorbide mononitrate tablet 10mg, 20mg
Isosorbide mononitrate SR tablet 40mg, 60mg
Isosorbide mononitrate SR tablet 60mg
For end stage heart failure
Restricted - only for use if there is a shortage of immediate release
10mg, 20mg and 40mg tablets. Change to SR tablets on a mg to
mg basis. Eg. Isosorbide 20mg twice daily should be changed to
isosorbide SR 40mg daily.
Cardiologists to Comment: Should this be restricted on the
formulary to Consultant Only prescribing for use in nocturnal
angina, heart failure and to aid compliance?
2.6.2 Calcium-Channel Blockers
Amlodipine tablet 5mg, 10mg
Diltiazem hydrochloride MR tablets 60mg
- THREE TIMES DAILY
Diltiazem hydrochloride Slow-Release tablet or capsule, 90mg, 120mg, 180mg
- TWICE DAILY DOSING
Diltiazem hydrochloride Slow-Release tablet or capsule 120mg, 180mg, 200mg, 240mg, 300mg
- ONCE DAILY DOSING
Nifedipine capsule 5mg, 10mg
Nifedipine tablet MR 10mg, 20mg
Nifedipine LA tablet 20mg, 30mg
Nimodipine tablet 30mg
Nimodipine i.v. infusion 200micrograms/1mL
Verapamil hydrochloride tablet 40mg, 120mg
Verapamil hydrochloride tablet SR 120mg, 240mg
Verapamil hydrochloride oral solution 40mg/5mL
Verapamil hydrochloride i.v. injection 5mg/2mL
2.6.3 Other Antianginal Drugs
Ivabradine tablet 5mg, 7.5mg
Adizem SR capsule 90mg, 120mg, 180mg
Viazem XL capsule 120mg, 180mg, 240mg, 300mg
Tildiem LA capsule 200mg
(bd)
(od)
Restricted - initiation by Consultant Cardiologists on name patient
approval until NICE compliance form approved and GP
continuation and in accordance with NICE TA 267 Ivabradine for
treating chronic heart failure. Traffic light list: Amber initiation
Nicorandil tablet 10mg, 20mg
2.6.4 Peripheral Vasodilators and Related Drugs
Naftidrofuryl oxalate capsule 100mg
Restricted - for use in accordance with NICE TA223 - Cilostazol,
naftidrofuryl oxalate, pentoxifylline and inositol
nicotinate for the treatment of intermittent claudication in people
with peripheral arterial disease.
2.7 SYMPATHOMIMETICS
2.7.1 Inotropic Sympathomimetics
Dobutamine injection 250mg/50mL vial
Dopamine hydrochloride sterile concentrate 200mg/5mL
For dilution and use as an infusion
Dopamine hydrochloride strong sterile solution pre-filled syringe, 200mg/5mL, 400mg/10mL For dilution and use as an infusion
Dopexamine hydrochloride strong sterile solution 50mg/5mL
Isoprenaline i.v. injection 2mg/2mL
2.7.2 Vasoconstrictor Sympathomimetics
Ephedrine hydrochloride injection 30mg/1mL
Ephedrine hydrochloride injection pre-filled syringe, 30mg/10mL
Metaraminol injection 10mg/1mL
Noradrenaline acid tartrate/norepinephrine bitartrate 2mg/1mL (equivalent to noradrenaline base
1mg/1mL (1:1000))
Phenylephrine hydrochloride injection 10mg/mLampoule (1%)
For dilution and use as an infusion
Soon to be deleted and replaced by a lower strength
2.7.3 Cardiopulmonary Resuscitation
Adrenaline (Epinephrine)/Epinephrine 1in10 000 dilute injection (100micrograms/1mL) 10mL
2.8 ANTICOAGULANTS and PROTAMINE
2.8.1 Parenteral Anticoagulants
Heparin
Low Molecular Weight Heparins
Heparin calcium s.c. pre-filled syringe 5000units/0.2mL
Heparin sodium s.c. pre-filled syringe 5000units/0.2mL
Heparin sodium for continuous infusion 10 000units/10mL, 20 000units/20mL
Heparin sodium injection 1000units/1mL
Heparin sodium multidose injection 5000units/5mL
Heparin sodium multidose injection 25000units/5mL
Heparin/sodium chloride infusion 1000units/0.9%, 500mL
Dalteparin sodium graduated syringe 10,000units/1mL
Dalteparin sodium s.c. injection pre-filled syringe 2500units/0.2mL, 5000units/0.2mL,
10000units/0.4mL, 12500units/0.5mL, 15000units/0.6mL, 18000units/0.72mL
Calciparine
Restricted - For use in Renal Unit Only as detailed in the Renal Unit
Policy for managing Dialysis Catheters.
To be used for treatment and prevention of DVT and PE.
Treatment doses (exceeding 5000units daily) and all indications for
use within obstetrics and gynaecology are hospital only (Traffic light
list: Red). For amber initiation indications see BHT CG116
Dalteparin for prophylactic use in Surgery, Oncology, Haematology
and Medicine amber initiation guideline. NOTE: for amber
initiation the first 6 weeks supply to be provided by hospital.
Heparinoids
Heparinised saline sterile solution 50units/5mL
Heparin sodium flush sterile solution 200units/2mL
Danaparoid sodium injection 750mg/0.6mL ampoule
Hirudins
Bivalirudin injection 250mg
Restricted - prescribing by Cardiologists only for patients intolerant
to first line treatment options for ACS STEMI and in accordance
with NICE TA 230 Bivalirudin for the treatment of ST-segmentelevation myocardial infarction. Traffic light list: Red
Epoprostenol
Epoprostenol infusion 500micrograms
Restricted - for use on NICU, ITU, SCBU and for treatment of
ischaemic limbs - see hospital protocol. Traffic Light List: Red
Fondaparinux
Fondaparinux sodium 2.5mg/0.5mL prefilled syringe
Restricted - to prescribing by acute medical team for suspected
ACS. Refer to ICP for ACS. Traffic light list: Red
Heparin Flushes
2.8.2 Oral Anticoagulants
Restricted - prescribing only on the advice of a
Consultant Haematologist, for heparin induced thrombocytopenia
(HIT). Traffic light list: Red
Warfarin sodium tablet 500microgram
WARNING: Warfarin sodium 5mg and warfarin sodium
500micrograms must never be written on the same
prescription.
Only original packs to be dispensed
Restricted - for use in Outpatient prescribing and Discharge clinics
only and in accordance with CG Oral Anticoagulants: Warfarin,
Phenindione, Acenocoumarol (Nicoumalone). Traffic light list:
Amber protocol
Warfarin sodium tablet 1mg, 3mg, 5mg
WARNING: Warfarin sodium 5mg and warfarin sodium
500micrograms must never be written on the same
prescription.
Only original packs to be dispensed
Amber protocol
Phenindione tablet 10mg, 25mg, 50mg
Amber protocol
Dabigatran etexilate
Dabigatran etexilate capsule 75mg, 110mg
Restricted to:
1. Prescribing by Orthopaedic team for use in accordance with the
VTE Policy and VTE Risk Assessment for Total Hip and Knee
Replacement (THR and TKR). Traffic Light List: Red
2. Prescribing for stroke prevention in AF with initiation for urgent
cases by Cardiologists, Stroke consultants and Haematologists and
all other patients by NOAC Pharmacist, in accordance with NICE
TA 249. All patients initiated by consultants to be referred to NOAC
for follow-up in accordance with BHT CG 313 Dabigatran for AF AI
guideline. Traffic light list: Amber initiation.
Apixaban
Apixaban tablet 2.5mg, 5mg
Restricted - initiation and continuation by NOAC clinic only for the
prevention of stroke and systemic embolism in patients with AF
when a NOAC is indicated according to the Bucks local criteria and
the patient has had a GI disturbance or bleeding with dabigatran
and rivaroxaban OR the patient is unable to take either dabigatran
or rivaroxaban due to a history of GI bleeding or ulceration.
Rivaroxaban
Rivaroxaban tablet 10mg, 15mg, 20mg
2.8.3 Protamine Sulphate
Protamine sulphate i.v. injection 50mg/5mL
2.9 ANTIPLATELET DRUGS
1. Restricted - prescribing by Haematologists for patients
unsuitable for warfarin for whom dalteparin would otherwise be
considered and only in accordance with NICE TA 261 Rivaroxaban
for the treatment of deep vein thrombosis and prevention of
recurrent DVT and PE and in accordance with BHT CG
Rivaroxaban (awaited) . FOR ALL PRESCRIBING - NICE
compliance form required - see link from Formulary homepage.
Named patient approval only as NICE/HCD compliance form
awaited. Traffic light list: Red
2. Restricted -prescribing for stroke prevention in AF with initiation
for urgent cases by Cardiologists, Stroke consultants and
Haematologists and all other patients by NOAC Pharmacist, in
accordance with NICE TA 256 Atrial fibrillation (stroke prevention) rivaroxaban. All patients initiated by consultants to be referred to
NOAC for follow-up in accordance with BHT CG
Rivaroxaban
for AF AI guideline. Traffic light list: Amber initiation.
Antiplatelet medicines to be prescribed in accordance with BHT CG Antiplatelets for the secondary prevention of occlusive vascular events
Abciximab injection 10mg/5mL
Restricted - prescribing by Consultant Cardiologists for the
prevention of ischaemic cardiac complications in patients
undergoing PCI (balloon angioplasty) and for short-term reduction
of the risk of MI in patients with unstable angina not responding to
full conventional therapy who have been scheduled for PCI.
Aspirin tablet dispersible 75mg, 300mg
Aspirin tablet 300mg
Aspirin EC tablet 300mg
Clopidogrel tablet 75mg
Restricted - Consultant prescribing only when patient cannot
tolerate other forms of aspirin.
see Antiplatelet guideline above
Clopidogrel tablet 300mg
Restricted for use as a loading dose for treatment of ACS and preangioplasty. Only to be prescribed by Cardiology team under
supervision of Cardiology consultants and A&E Emergency
Medicine consultants, Registrars and SHOs. Traffic light list: Red
Dipyridamole MR capsule 200mg
Prasugrel tablet 5mg, 10mg
Restricted - prescribing/initiation by Cardiologists only, with
continuation by GPs if Amber Initiation, in accordance with NICE
TA182 - Prasugrel for the treatment of acute coronary syndromes
with percutaneous coronary intervention BHT CG Antiplatelet
guideline (see above)
Ticagrelor tablet 90mg
Restricted - Prescribing by Cardiology team only in accordance with
BHT CG Antiplatelet guideline, with continuation by GPs. Traffic
light list: Amber initiation
Tirofiban hydrochloride concentrate for i.v. infusion 250micrograms/1mL
For dilution before use as infusion.
Restricted - to be used in accordance with NICE TA 47 - Guidance
on the use of glycoprotein IIb/IIIa inhibitors in the treatment of acute
coronary syndromes, where NICE TA 47 has been partially updated
by NICE CG 94 - Unstable angina and NSTEMI: the early
management of unstable angina and non-ST-segment-elevation
myocardial infarction.
Alteplase infusion 10mg
Restricted - for use in Radiology only.
Alteplase infusion 50mg
1. Restricted - for use in PE
2. Restricted - prescribing by Stroke team and A&E senior
physicians in accordance with NICE TA264 Alteplase for treating
acute ischaemic stroke. Traffic light list: Red
TMB decision Feb 2006: Reteplase to be used for all Myocardial
infarctions
2.10 STABLE ANGINA, ACUTE CORONARY SYNDROMES, AND
FIBRINOLYSIS
2.10.1 Management of stable angina and acute coronary
syndromes.
2.10.2 Fibrinolytic Drugs
Reteplase i.v.injection 10units/vial
Streptokinase injection 250,000 units, 750 000units, 1.5million units
Urokinase injection 5000units, 25 000units
2.11 BLOOD RELATED PRODUCTS
Aprotinin injection 500 000 kallikrein inactivator units/50mL
Tranexamic acid tablet 500mg
Tranexamic acid syrup 500mg/5mL
Tranexamic acid mouthwash 5% (250mg/5mL)
Blood-related products
2.12 LIPID-REGULATING DRUGS
Bile Acid Sequestrants
Tranexamic acid injection 500mg/5mL
Drotrecogin alfa (activated)
see BHT CG 104 Statins and ezetimibe for primary and secondary prevention of cardiovascular
disease.
Colestyramine sachet 4g
TMB decision Feb 2006. Streptokinase not to be used for
myocardial infarction. Retained on formulary for all other licensed
indications
Unlicensed - available on named patient basis for central line
blockages- see hospital protocol.
Unlicensed
see Section 12.3.4
Restricted - in accordance with NICE guidance (see local
guideline)
Ezetimibe
Ezetimibe tablet 10mg
Fibrates
Bezafibrate tablet 200 mg
Bezafibrate tablet MR 400 mg
Atorvastatin tablet 10 mg, 20 mg
Statins
Restricted - either use where there is statin
contraindication/intolerance, as monotherapy, for lipid modification
in primary and secondary prevention of CVD or in secondary
prevention, in combination with simvastatin 40mg (Step 3), as an
alternative to atorvastatin 80mg.
See link above to BHT CG 104 Statins and ezetimibe for primary
and secondary prevention of CVD.
Simvastatin 40 mg is 1st choice statin for primary and secondary
prevention of CVD.
All patients on atorvastatin 10mg or 20mg daily should be switched
to simvastatin 40mg daily.
Atorvastatin tablet 40 mg
prevention of CVD.
Atorastatin tablet 80mg
prevention of CVD.
Restricted - to be initiated by cardiology team only and continued
by GPs. Traffic light list: Amber initiation
If intolerant to atorvastatin 80mg switch to simvastatin 40mg
Pravastatin sodium tablet 40 mg
Restricted - use for lipid modification in primary and secondary
prevention of CVD where simvastatin cannot be used due to
intolerance or drug interactions.
Rosuvastatin tablet 5mg, 10mg, 20mg, 40mg
Restricted - prescribing by Lipid Clinic only for the treatment of
hyperlipidaemia in patients who are intolerant of all high intensity
statins. Named patient approval to be communicated to PCT and
GP. Traffic light list: Amber initiation.
Simvastatin tablet 10 mg, 20 mg
prevention of CVD.
Simvastatin tablet 40 mg
1st Choice statin for primary and secondary prevention of
cardiovascular disease (CVD).
Omega-3 fatty acid compounds
2.13 LOCAL SCLEROSANTS
Omega-3-acid ethyl esters
Omacor®
Restricted - to adjuvant treatment in secondary prevention after
myocardial infarction in addition to other standard therapy in
accordance with NICE clinical guideline No.48.
Ethanolamine oleate injection 5%, 5mL amp
CHAPTER 3 - RESPIRATORY SYSTEM
3 RESPIRATORY SYSTEM
Talc sterile powder for chemical pleurodesis
Methacholine chloride inhalation 32mg/1mL
Unlicensed
Restricted: Resp. Team on named patient basis.
Bronchial provocation testing - Restricted to Respiratory Lab only.
To be used in accordance with BHT SOP for Methacholine
Challenge Testing.
3.1 BRONCHODILATORS
3.1.1 Adrenoreceptor Agonists
3.1.1.1 Selective Beta 2 Agonists
Formoterol fumarate turbohaler 12micrograms/metered inhalation
Salbutamol liquid 2mg/5 mL
Salbutamol MR tablet 4mg, 8mg
Salbutamol injection 500micrograms/1mL
Salbutamol infusion 5mg/5 mL
Salbutamol (evohaler ventolin) (cfc free) inhaler 100micrograms/metered inhalation
Salbutamol breath-actuated inhaler 100micrograms/dose
Salbutamol nebules 2.5 mg/2.5 mL, 5mg/2.5 mL
Salbutamol disc pack 200micrograms; 400micrograms
Salmeterol disc pack 50 micrograms (Serevent Accuhaler)
Salmeterol inhaler 25 micrograms
Terbutaline sulphate injection 500micrograms/1mL
Terbutaline sulphate turbohaler 500micrograms/metered inhalation
Terbutaline sulphate nebuliser solution 5mg/2mL
3.1.1.2 Other Adrenoceptor Agonists
Ephedrine hydrochloride tablet 15 mg
3.1.2 Antimuscarinic Bronchodilators
Ipratropium bromide inhaler 20micrograms/metered inhalation
Ipratropium bromide nebuliser solution 250micrograms/1mL, 500micrograms/2 mL
Oxis®
Restricted - may be used as an alternative to salmeterol for
treatment of COPD.
See Bucks COPD guideline
Dilute before use
Restricted - prescribe aerosol inhaler 1st line and if compliance
problems consider Accuhaler
Restricted - Obstetrics & Gynaecology only.
Restricted - to Spinal Unit for management of postural hypotension
Tiotropium inhalation powder 18micrograms/hard capsule, 30 capsule pack with Handihaler device NOTE: the strength of the tiotropium powder capsule differs
or 30 capsule refill pack
significantly from the strength of tiotropium metered inhalation
solution - ensure correct dose and dose form is prescribed.
Restricted - to be prescribed in accordance with COPD Guideline.
Tiotropium solution for inhalation 2.5micrograms/metered inhalation
3.1.3 Theophylline
Spiriva Respimat®
NOTE: the strength of the tiotropium powder capsule differs
significantly from the strength of tiotropium metered inhalation
solution - ensure correct dose and dose form is prescribed.
Restricted - to be prescribed in accordance with COPD Guideline,
for use in COPD patients who cannot manage to use a tiotropium
handihaler due to low FIV1 or poor manual dexterity.
Aminophylline MR tablet 225mg
Phyllocontin Continus
Aminophylline i.v. injection 250mg/10mL
Aminophylline i.v. injection pre-filled syringe 250mg/10mL
Patients should be maintained on the same brand of theophylline.
Theophylline syrup 60mg/5mL
Restricted - Phone Pharmacy to Order.
Unlicensed - Low risk
Traffic light list: Red, Named patient
Theophylline MR capsule 60mg,125mg, 250mg
Theophylline MR tablet 200mg, 300mg, 400mg
Slo-Phyllin
Uniphyllin Continus
3.1.4 Compound Bronchodilator Preparations
3.1.5 Peak Flow Meters, Inhaler Devices and Nebulisers
Peak flow meter low
Peak flow meter standard
Haleraid and Haleraid 120 and 200
Volumatic Spacer
Volumatic Spacer and mask
Aerochamber infant+mask, child+mask, adult+mask and adult
3.2 CORTICOSTEROIDS
1st Choice
1st Choice
2nd Choice - for patients who cannot manage a Volumatic or if their
inhalers do not fit a Volumatic.
link to Bucks COPD guideline
Beclometasone dipropionate CFC-free (Clenil Modulite) inhaler 50micrograms, 100micrograms,
200micrograms and 250micrograms per metered inhalation
Beclometasone dipropionate Easi-Breathe inhaler, 100micrograms per metered inhalation
Beclometasone dipropionate dry powder for inhalation disk pack 100micrograms, 200micrograms
(with Diskhaler)
Budesonide aerosol 200micrograms per metered inhalation
Budesonide dry powder inhaler 200micrograms, 400micrograms per inhalation
Restrict - prescribe aerosol inhaler first line and if compliance
problems consider Easi-breathe inhaler
Budesonide respules 500micrograms/2mL
Budesonide /formoterol fumarate 100micrograms/6micrograms per metered inhalation,
200micrograms/6micrograms per metered inhalation
Symbicort 100/6 and 200/6 Turbohaler® (dry powder inhalers)
Budesonide /formoterol fumarate 400micrograms/12micrograms per metered inhalation
Symbicort 400/12 Turbohaler® (dry powder inhaler)
Fluticasone propionate aerosol 50micrograms, 125micrograms, 250micrograms/metered
inhalation
Fluticasone propionate powder for inhalation 50micrograms/blister
Flixotide Evohaler® aerosol inhalation
Fluticasone propionate nebules 500micrograms/2mL, 2mg/2mL
Flixotide®
Fluticasone propionate/salmeterol powder for inhalation 250micrograms/50micrograms per blister
Seretide 250 Accuhaler® (dry powder for inhalation)
Fluticasone propionate/salmeterol powder for inhalation 500micrograms/50micrograms per blister
Seretide 500 Accuhaler® (dry powder for inhalation)
Restricted - only for use in accordance with Bucks COPD
guideline.
Fluticasone propionate/salmeterol 50micrograms/25micrograms, 125micrograms/25micrograms,
250micrograms/25micrograms per metered inhalation
Seretide 50 - For treatment of asthma in accordance with British
Guideline on the Management of Asthma revised 2009
Seretide 125 or 250 Evohaler® (aerosol inhalation)
Seretide 125 Evohaler - restricted. May only be used for
continuation of therapy. Not to be initiated as not cost effective
compared to other strengths.
Montelukast chewable tablet 4mg, 5mg
Restrict - Respiratory, ENT and Dermatology teams only
Flixotide Accuhaler® dry powder for inhalation
3.3 CROMOGLICATE AND RELATED THERAPY AND
LEUKOTRIENE RECEPTOR ANTAGONISTS AND OMALIZUMAB
3.3.1 Cromoglicate and Related Therapy
3.3.2 Leukotriene Receptor Antagonists
Montelukast tablet 10mg
3.3.3 Phosphodiesterase type-4 inhibitors
3.4 ANTIHISTAMINES, HYPOSENSITISATION AND ALLERGIC
EMERGENCIES
3.4.1 Antihistamines
Non-sedating Antihistamines
Sedating Antihistamines
Cetirizine hydrochloride oral solution 5mg/5mL
Cetirizine hydrochloride tablet 10mg
Fexofenadine hydrochloride tablet 120mg, 180mg
Loratidine tablet 10mg
Loratidine syrup 5mg/5mL
Alimemazine syrup 7.5mg/5mL, 30mg/5mL
Chlorphenamine maleate tablet 4mg
Chlorphenamine maleate oral solution 2mg/5mL
Chlorphenamine maleate injection 10mg/1mL
Cyproheptadine hydrochloride tablet 4mg
Hydroxyzine hydrochloride tablet 10mg, 25mg
Restricted - Consultant only prescribing
Hydroxyzine hydrochloride syrup 10mg/5mL
Promethazine hydrochloride tablet 10mg, 25mg
Promethazine hydrochloride elixir sugar-free 5mg/5mL
Promethazine hydrochloride injection 25mg/1mL
3.4.2 Allergen Immunotherapy
Bee venom injection 100micrograms per vial
Omalizumab injection 150mg vial
Restricted - prescribing by Consultant Chest Physicians only in
accordance with BHT Clinical Guideline 271.1 Omalizumab for
severe persistent allergic asthma. Traffic Light list: Red
Wasp venom maintenance kit sub-cutaneous injection 120micrograms per vial
3.4.3 Allergic Emergencies
Adrenaline (Epinephrine) hydrochloride injection pre-filled syringe1mg/1mL (1:1000)
Adrenaline (Epinephrine) injection 1 in 1000 (1mg/1mL)
Adrenaline (Epinephrine) i.m. injection 1 in 1000
Adrenaline (Epinephrine) Epipen 300micrograms
Adrenaline (Epinephrine) Epipen 150micrograms
Adrenaline (Epinephrine) 300micrograms (Jext Auto-injector)
3.5 RESPIRATORY STIMULANTS AND PULMONARY
SURFACTANTS
3.5.1 Respiratory Stimulants
3.5.2 Pulmonary Surfactant
Min-I-Jet® Adrenaline 21 gauge needle for i.m. injection for hospital
use only.
To be deleted from Formulary once existing stock is used
Restrict - Self administration only
To be deleted from Formulary once existing stock is used
Restrict - Self administration only
All prescribing to ensure patient has 2 devices. Prescriptions may
be written for up to 2 devices per patient at one time for adults and
children.
Restricted in secondary care to prescribing by middle grade doctors
and above.
Adrenaline (Epinephrine) 150micrograms (Jext Auto-injector) (Child)
All prescribing to ensure patient has 2 devices. Prescriptions may
be written for up to 2 devices per patient at one time for adults and
children.
Restricted in secondary care to prescribing by middle grade doctors
and above.
C1 esterase inhibitor injection 500units
Restricted - prescribed only on advice of A&E consultants in
accordance with criteria defined in MOBBB Policy statement 27 for
acute life threatening attacks of hereditary angioedema only when
symptoms described in policy statement are confirmed to be
present Traffic light list: Red
Caffeine citrate 10mg/mL (equivalent to caffeine 5mg/mL)
Doxapram hydrochloride i.v. injection 100mg/5mL
Doxapram hydrochloride (2mg/mL) in glucose 5% infusion (500mL)
Poractant alfa 80mg/1mL
Restricted - Consultant Paediatrician prescribing in NICU only.
3.6 OXYGEN
3.7 MUCOLYTICS
3.8 AROMATIC INHALATIONS
3.9 COUGH PREPARATIONS
3.9.1 Cough Suppressants
3.9.2 Expectorant and Demulcent Cough Preparations
3.10 SYSTEMIC NASAL DECONGESTANTS
Acetylcysteine tablet 600mg
Unlicensed - low risk
Restricted - prescribing by Respiratory Team. Cardiology team
may prescribe for renoprotection of patients undergoing contrast
enhanced MRI. Traffic light list: Red.
Carbocisteine capsule 375mg
Carbocisteine oral liquid 125mg/5mL
Dornase alfa nebuliser solution 2.5mg/2.5mL (2500units)
Restricted - Respiratory Team
Restricted - Respiratory Team
Traffic Light list: Amber initiation
Sodium chloride 6% nebuliser solution 4mL
MucoClear®
Mannitol 40mg inhalation powder, hard capsule
FOR ALL PRESCRIBING - NICE compliance to be verified
Restricted - to prescribing by Respiratory consultants in
accordance with NICE TA 266 Mannitol as an option for treating
cystic fibrosis in adults.
NOTE: Unlikely to be used in BHT as all adult CF patients are
treated in Oxford or London.
Benzoin Tincture, Compound, BP
RESTRICT - for topical use (aiding dressing adherence)
Codeine phosphate oral solution 15mg/5mL
Pholcodine oral solution sugar-free 5mg/5mL
Codeine Linctus, BP
Pholcodine Linctus BP
Simple linctus, BP
Pseudoephedrine hydrochloride tablet 60mg
Pseudoephedrine hydrochloride elixir 30mg/5mL
CHAPTER 4 - CENTRAL NERVOUS SYSTEM
4.1 HYPNOTICS and ANXIOLYTICS
4.1.1 Hypnotics
Nitrazepam tablet 5mg
Benzodiazepines
Nitrazepam oral suspension 2.5mg/5mL
Temazepam tablet 10mg
Temazepam oral solution sugar-free 10mg/5 mL
Zaleplon, Zolpidem and Zopiclone
Zopiclone tablet 3.75mg, 7.5mg
Restricted - to be used in accordance with NICE Guidance No.77
Chloral and Derivatives
Chloral hydrate mixture 500mg/5mL
Chloral Mixture BP
Welldorm
Chloral hydrate elixir 143.3mg/5mL
Cloral betaine tablet 707mg (=chloral hydrate 414mg)
Chloral hydrate suppositories 50mg, 60mg
Chloral hydrate suppositories 500mg
Clomethiazole
Melatonin
4.1.2 Anxiolytics
Benzodiazepines
Clomethiazole capsule 192mg
Clomethiazole edisylate syrup 250mg (157mg base)/5mL
Promethazine hydrochloride
Melatonin tablet 3mg
Restricted - prescribing by Paediatrics team only for Pre-EEG
sedation. Named patient only. Traffic light list: Red, until Shared
Care Protocol approved
Melatonin liquid 1mg in 1mL
Restricted - prescribing by Paediatrics team only for Pre-EEG
sedation. Named patient only. Traffic light list: Red, until Shared
Care Protocol approved
Chlordiazepoxide hydrochloride tablet 10mg
Chlordiazepoxide hydrochloride capsule 5mg, 10mg
Diazepam tablet 2mg, 5mg, 10mg
Diazepam oral solution 2mg/5mL
Diazepam strong oral solution 5mg/5mL
Diazepam injection (solution) 10mg/2mL
Diazepam injection (emulsion) 10mg/2mL
Diazepam rectal solution 2.5mg/1.25mL, 5mg/2.5mL, 10mg/2.5mL
Lorazepam tablet 1mg; 2.5mg
Lorazepam injection 4mg/1mL
Oxazepam tablet 10mg
Buspirone
Buspirone hydrochloride tablet 5mg, 10mg
4.1.3 Barbiturates
Amobarbital sodium capsule 200mg
Amobarbital sodium/ secobarbital sodium capsule 50mg/50mg
Butobarbital tablet 100mg
4.2 DRUGS USED in PSYCHOSES and RELATED DISORDERS
see Section 3.4.1
Restricted - prescribing by Psychiatric (Oxfordshire Health) team
only.
Restricted - initiation by Psychiatric (Oxfordshire Health) team only.
4.2.1 Antipsychotic Drugs
Benperidol tablet 250micrograms
Chlorpromazine hydrochloride tablet 10mg, 25mg, 50mg, 100mg
Chlorpromazine hydrochloride oral solution 25mg/5mL
Chlorpromazine hydrochloride suspension sugar-free 100mg/5mL
Chlorpromazine hydrochloride injection 25mg/1mL, 50mg/2mL
Flupentixol tablet 3mg
Haloperidol capsule 500micrograms
Haloperidol tablet 1.5mg, 5mg, 10mg
Haloperidol oral solution sugar-free 10mg/5mL
Haloperidol injection 5mg/1mL, 20mg/2mL
Levomepromazine maleate 25mg
Levomepromazine hydrochloride injection 25mg/1mL
Pericyazine tablet 10mg
Pimozide tablet 4mg
Promazine hydrochloride tablet 25mg, 50mg
Promazine hydrochloride oral solution 25mg/5mL, 50mg/5mL
Sulpiride tablet 200mg, 400mg
Sulpiride oral solution sugar-free 200mg/5mL
Thioridazine hydrochloride tablet 10mg, 25mg, 50mg
Trifluoperazine tablet 1mg, 5mg
Trifluoperazine MR capsule 2mg, 10mg, 15mg
Trifluoperazine syrup sugar-free 1mg/5mL
Trifluoperazine oral solution forte 5mg/5mL
Zuclopenthixol acetate injection (oily) 50mg/1mL, 100mg/2mL
Zuclopenthixol tablet 2mg, 10mg, 25mg
Atypical Antipsychotic drugs
Amisulpride tablet 50mg, 200mg
Amisulpride solution 100mg/1mL
Aripiprazole tablet 5mg, 10mg, 15mg, 30mg
Restricted - initiation by Psychiatric (Oxfordshire Health) team only
see Section 4.2.2
Restricted - prescribing by Consultant Psychiatrist (Oxfordshire
Health) only.
Restricted - for use when patient cannot swallow ordinary tablets
Clopixol Acuphase
Restricted - initiation by Consultant Psychiatrist (Oxfordshire
Health) only.
See Section 4.2.2
Restricted - only for use when patient cannot swallow ordinary
tablets
Restricted - Initiation by Psychiatric (Oxfordshire Health) team only.
Traffic light list: Amber recommendation
See NICE TA213 - Aripiprazole for the treatment of schizophrenia
in people aged 15 to 17 years.
Aripiprazole orodispersible tablet 10mg, 15mg
Restricted - initiation by Psychiatric (Oxfordshire Health) team and
only for use when patient cannot swallow ordinary tablets. Traffic
light list: Amber recommendation
Aripiprazole oral solution 1mg/1mL
only for use when patient cannot swallow orodispersible tablets.
Restricted - prescribing by Consultant Psychiatrist (Oxfordshire
Health) only. Traffic light list: Red.
Aripiprazole injection 7.5mg/mL (9.75mg/1.3mL vial)
Clozapine tablet 25mg, 100mg
Clozapine suspension 250mg/5mL
only for use when patient cannot swallow ordinary tablets. Traffic
light list: Red
Olanzapine tablet 2.5mg, 5mg, 7.5mg, 10mg
Note: doses greater than 10mg to be initiated by Consultant
Psychiatrist (Oxfordshire Health) only
Restricted - doses greater than 10mg to be initiated by Consultant
Psychiatrist (Oxfordshire Health) only.
1. Restricted - for use when patient cannot swallow ordinary tablets
2. Restricted - doses greater than 10mg to be initiated by
Consultant Psychiatrist (Oxfordshire Health) only.
Olanzapine tablet 20mg
Olanzapine orodispersible tablet 5mg, 10mg, 15mg
Olanzapine injection 10mg/2mL vial
Restricted - initiation by Psychiatric (Oxfordshire Health) team only
Quetiapine film coated tablet 25mg, 100mg, 150mg, 200mg, 300mg
Quetiapine MR tablet 50mg, 200mg, 300mg, 400mg
Restricted - for use by Oxfordshire Health inpatients only. Switch to
immediate release tablets when maintenance level is reached.
Risperidone tablet 500micrograms, 1mg, 2mg, 3mg, 4mg
Risperidone orodispersible tablet 500micrograms, 1mg, 2mg
Restricted - Traffic light list: Amber recommendation
Restricted - Traffic light list: Amber recommendation but only for
use when patient cannot swallow ordinary tablets
Risperidone liquid 1mg/1mL
4.2.2 Antipsychotic Depot Injections
Flupentixol decanoate i.m. injection (oily) 20mg/1mL, 40mg/2mL
Flupentixol decanoate i.m. injection (oily) 50mg/0.5mL, 100mg/1mL
Flupentixol decanoate i.m. injection 200mg/1mL
Fluphenazine decanoate i.m. injection (oily) 25mg/1mL
Fluphenazine decanoate i.m. injection (oily) 50mg/0.5mL, 100mg/1mL
Haloperidol (as decanoate) i.m. injection (oily) 50mg/1mL
Depixol
Depixol Conc
Depixol Low Volume
Modecate
Modecate Concentrate
Haloperidol (as decanoate) i.m. injection (oily) 100mg/1mL
Pipotiazine palmitate i.m. injection (oily) 50mg/1mL, 100mg/2mL
Risperidone injection 25mg, 37.5mg, 50mg vial
Zuclopenthixol decanoate i.m. injection (oily) 200mg/1mL
Zuclopenthixol decanoate i.m. injection (oily) 500mg/1mL
Traffic light list: Amber initiation
Clopixol
Clopixol Concentrate
4.2.3. Drugs used for Mania and Hypomania
Valproic acid
Valproic acid (as semisodium valproate) EC tablets 250mg, 500mg
Lithium
Lithium carbonate SR tablet 200mg, 400mg
Lithium carbonate tablet 250mg
Lithium carbonate MR tablet 400mg
Lithium citrate liquid sugar-free 520mg (5.4mmol)/5mL
Lithium citrate oral solution 509mg (5.4mmol)/5mL
Lithium chloride injection 0.15mmol/1mL
4.3 ANTIDEPRESSANT DRUGS
4.3.1 Tricyclic and Related Antidepressant Drugs
Tricyclic Antidepressants
Amitriptyline hydrochloride tablet 10mg, 25mg, 50mg
Amitriptyline hydrochloride oral solution 25mg/5mL, 50mg/5mL
Amitriptyline hydrochloride/perphenazine tablet 10mg/2mg, 25mg/2mg
Clomipramine hydrochloride capsule 10mg, 25mg, 50mg
Clomipramine hydrochloride MR tablet 75mg
Depakote
Restricted - for use by Oxfordshire Health only
Priadel®
Camcolit-250®
Camcolit-400®
Priadel®
Li-Liquid®
Restricted - used for cardiac monitoring.
Refer section 2
Dosulepin hydrochloride capsule 25mg
Dothiepin hydrochloride
Restricted - initiation by Pain Consultants only, in accordance with
Neuropathic Pain guideline
Dosulepin hydrochloride tablet 75mg
Dothiepin hydrochloride
Restricted - initiation by Pain Consultants only, in accordance with
Neuropathic Pain guideline
Doxepin hydrochloride capsule 10mg, 25mg, 75mg
Imipramine hydrochloride 10mg, 25mg
Imipramine hydrochloride oral suspension 25mg/5mL
Lofepramine tablet 70mg
Lofepramine oral suspension sugar-free 70mg/5mL
Nortriptyline tablet 10mg, 25mg
Fluphenazine hydrochloride/nortriptyline tablet 500micrograms/10mg
Trimipramine tablet 10mg, 25mg
Related Antidepressants
Trimipramine capsule 50mg
Mianserin hydrochloride tablet 10mg, 30mg
Trazodone hydrochloride capsule 50mg, 100mg
Trazodone hydrochloride tablet 150mg
Trazodone hydrochloride liquid sugar-free 50mg/5mL
4.3.2 Monoamine-Oxidase Inhibitors (MAOIs)
Phenelzine tablet 15mg
Reversible MAOIs
Tranylcypromine tablet 10mg
Moclobemide tablet 150mg, 300mg
4.3.3 Selective Serotonin Re-Uptake Inhibitors
Citalopram tablet 10mg, 20mg, 40mg
Citalopram oral drops sugar-free 40mg/1mL
Fluoxetine capsule 20mg
Fluoxetine liquid 20mg/5mL
Fluvoxamine maleate tablet 50mg, 100mg
Restricted - initiation by Consultant Psychiatrist (Oxfordshire
Health) only.
only
Paroxetine tablet 20mg, 30mg
Paroxetine liquid sugar-free 10mg/5mL
Sertraline tablet 50mg, 100mg
4.3.4 Other Antidepressant Drugs
Agomelatine tablet 25mg
only. Traffic light list: Red
Duloxetine capsule 30mg, 60mg
Duloxetine capsule 60mg
Restricted - for treatment of neuropathic pain. Initiation by the Pain
team only. Traffic light list: Amber reommendation.
See BHT Clinical Guideline 714. Guideline for the management of
neuropathic pain in adults.
Flupentixol tablet 500 micrograms, 1mg, 3mg
Mirtazapine tablet 15mg, 30mg
Mirtazapine orodispersible tablet 15mg, 30mg, 45mg
Mirtazapine oral solution 15mg/1mL
Reboxetine tablet 4mg
Tryptophan tablet 500mg
Venlafaxine hydrochloride tablet 37.5mg, 75mg
Venlafaxine hydrochloride MR capsule 75mg, 150mg
Restricted - only for use when patient cannot take orodispersible
tablets
Restricted - Consultant Only prescribing. See BNF guidelines for
further information.
Restricted - Consultant Only prescribing. See BNF guidelines for
further information.
4.4 CENTRAL NERVOUS SYSTEM STIMULANTS
Atomoxetine capsule 10mg, 18mg, 25mg, 40mg, 60mg, 80mg
Restricted - initiation by Consultant Paediatricians specialising in
childhood behavioural disorders or Child or Adult Mental Health
Specialists with continuation by GPs for the treatment of ADHD in
children over 6 years.. Traffic light list: Amber protocol.
Dexamfetamine sulphate tablet 5mg
When used for the treatment of ADHD in children over 6 years
restricted - to initiation by Consultant Paediatricians specialising in
childhood behavioural disorders or Child or Adult Health Specialist
with continuation by GPs for the treatment of ADHD in children over
6 years.. Traffic light list: Amber protocol.
Methylphenidate hydrochloride tablet 5mg, 10mg, 20mg
Specialist with continuation by GPs for the treatment of ADHD in
Methylphenidate hydrochloride MR tablet 18mg, 27mg, 36mg
Concerta XL®
Methylphenidate hydrochloride SR capsule 10mg, 20mg, 30mg
Equasym XL®
Methylphenidate hydrochloride MR capsules 5mg, 10mg, 20mg, 30mg, 40mg
Medikinet XL®
Modafinil tablet 100mg, 200mg
Traffic light list: Amber initiation.
4.5 DRUGS USED in the TREATMENT of OBESITY
4.5.1 Anti-Obesity Drugs Acting on the Gastrointestinal
Tract
4.5.2 Centrally Acting Appetite Suppressants
4.6 DRUGS USED in NAUSEA and VERTIGO
Antihistamines
Cinnarizine tablet 15mg
Phenothiazines and related drugs
Domperidone and metoclopramide
5HT 3 antagonists
Cyclizine hydrochloride tablet 50mg
Cyclizine lactate injection 50mg/1mL
Promethazine hydrochloride
Promethazine teoclate tablet 25mg
Chlorpromazine hydrochloride
Prochlorperazine maleate tablet 5mg
Prochlorperazine mesilate syrup 5mg/5mL
Prochlorperazine mesilate i.m. injection 12.5mg/1mL
Prochlorperazine maleate buccal tablet 3mg
Trifluoperazine
Domperidone tablet 10mg
Domperidone suspension sugar-free 5mg/5mL
Domperidone suppository 30mg
Metoclopramide hydrochloride tablet 10mg
Metoclopramide hydrochloride oral solution 5mg/5mL
Metoclopramide hydrochloride injection 10mg/2mL
Ondansetron tablet 4mg, 8mg
Ondansetron injection 4mg/2mL, 8mg/4mL
Ondansetron syrup sugar-free 4mg in 5mL
Ondansetron suppository 16mg
Cannabinoid
Hyoscine
Other drugs for Ménière's disease
see Section 4.2.1
Restricted - only for use when standard tablets or injections are
clinically or practically inappropriate.
Restricted - only for use when standard tablets or injections are
clinically or practically inappropriate.
Nabilone tablet 1mg
Hyoscine hydrobromide tablet 300 micrograms
Hyoscine self-adhesive patch releasing hyoscine approx. 1mg/ 72 hours
4.7 ANALGESICS
4.7.1 Non-Opioid Analgesics and compound analgesic
preparations
see Section 3.4.1
Avomine
see Section 4.2.1
Betahistine dihydrochloride tablet 8mg
Aspirin tablet 300mg
Aspirin tablet dispersible 75mg, 300mg
Aspirin EC tablet 300mg
Aspirin suppository 150mg, 300mg
Paracetamol tablet 500mg
Paracetamol caplets 500mg
Paracetamol soluble tablet 120mg, 500mg
Paracetamol oral suspension sugar-free 120mg/5mL
Paracetamol oral suspension 250mg/5mL
Restricted - for patients with nausea and vomiting - not controlled
by other post-operative nausea and vomiting drugs
Paracetamol suppository 60mg, 120mg, 240mg, 500mg
60mg - Unlicensed - Low Risk
Deleted 1g.
Paracetamol i.v. infusion 500mg/50mL, 1000mg/100mL vial
1. 500mg/50mL Restricted - to prescribing by Paediatricians and
only for patients weighing less than 33kg.
2. Restricted - only to be used when the oral route is not available.
The rectal route is an alternative to the I.V. route where
appropriate. Paracetamol should be written up as po/pr/IV.
Co-codamol 8/500 tablet (codeine phosphate 8mg/paracetamol 500mg)
Restricted - for migraine sufferers only. To be used instead of
Migraleve Yellow tablets (see Section 4.7.4.1)
Co-codamol 30/500 effervescent tablet (codeine phosphate 30mg/paracetamol 500mg)
Restricted - to oral surgery patients and patients who cannot
swallow ordinary tablets.
NOTE: co-codamol 30/500 plain tablets are non-formulary. This
combination should be prescribed separately as paracetamol
tablets and codeine tablets. DTC Sep09
Nefopam hydrochloride tablet 30mg
4.7.2 Opioid Analgesics
Morphine sulphate f/c tablet 10mg, 20mg, 50mg
Morphine sulphate MR capsule 10mg, 30mg, 60mg, 100mg, 200mg
Morphine sulphate MR tablet 5mg, 10mg, 15mg, 30mg, 60mg, 100mg, 200mg
Morphine sulphate oral solution 10mg/5mL
Morphine sulphate concentrated oral solution 100mg/5mL
Morphine sulphate oral solution 10mg/5mL, 20mg/1mL
Sevredol
Zomorph
MST Continus
Morphine sulphate oral solution, 1mg/5mL
Restricted - prescribing by Paediatric team only.
Phone Pharmacy to Order. Traffic light list: Red.
Morphine sulphate MR oral suspension 30mg, 60mg sachets
Morphine sulphate suppository 10mg, 15mg, 30mg
Morphine sulphate injection 1mg/mL
Morphine sulphate injection 5mg/mL
Morphine sulphate injection 10mg/1mL, 15mg/1mL, 30mg/1mL
Morphine sulphate injection 50mg/50mL vial
Oramorph Concentrated Oral Solution
Restricted - for paediatric patients only as it does not contain
alcohol
Restricted - prescribing by Paediatrics team only. Traffic light list:
Red.
Restricted - prescribing by Neonatal doctors and Paediatricians on
NICU only. Traffic light list: Red
Morphine sulphate injection pre-filled syringe 50mg/50mL (with sodium chloride 0.9%)
Morphine sulphate intra-thecal injection
2mg intrathecal injection - Unlicensed - High Risk
Restricted - for spinal use only. Must be used in strict accordance
with Trust Intrathecal Policy
Buprenorphine hydrochloride sub-lingual tablet 200micrograms
Buprenorphine self-adhesive transdermal patches: '35' patch (releasing 35 micrograms/hour for 72 Transtec®
hours), '52.5' patch (releasing 52.5 micrograms/hour for 72 hours) and '70' patch (releasing 70
Restricted - 2nd line prescribable only when patient does not
micrograms/hour for 72 hours)
respond to Fentanyl patches.
Awaiting procedure outlining initiation, dose titration and follow-up
by GP
Codeine phosphate tablet 15mg, 30mg
Codeine phosphate syrup 25mg/5mL
Codeine linctus
Codeine phosphate i.m. injection 60mg/1mL
Dextromoramide tablet 5mg
Diamorphine hydrochloride injection 5mg, 10mg, 30mg, 100mg, 500mg
Dihydrocodeine tartrate tablet 30mg
Dihydrocodeine tartrate oral solution 10mg/5mL
Dihydrocodeine tartrate injection 50mg/1mL
Fentanyl self-adhesive patch releasing 12 micrograms, 25micrograms, 50micrograms,
75micrograms, 100micrograms per hour for 72 hours
Methadone hydrochloride tablet 5mg
Methadone sugar free mixture 1mg/1mL
Methadone hydrochloride injection 10mg/1mL
see Section 3.9.1
Restricted - Palliative Care only
Matrifen® brand restricted for use by Florence Nightingale House
only.
Oxycodone hydrochloride liquid, sugar-free, 5 mg/5 mL
OxyNorm
Use oxycodone liquid (5 mg/5 mL) or concentrate (10 mg/1 mL)
when an immediate release preparation is required. Generally this
is prescribed as a "when necessary (prn)" dose whereas the
OxyContin (oxycodone hydrochloride MR tablets) should be
prescribed as a regular dose.
Oxycodone hydrochloride concentrate, sugar-free 10 mg/1 mL
OxyNorm
Use oxycodone liquid (5 mg/5 mL) or concentrate (10 mg/1 mL)
when an immediate release preparation is required. Generally this
is prescribed as a "when necessary (prn)" dose whereas the
OxyContin (oxycodone hydrochloride MR tablets) should be
prescribed as a regular dose.
Oxycodone hydrochloride injection 10 mg/1 mL, 50mg/1mL
OxyNorm
Place in therapy to be defined.
NOTE: 50mg/mL Restricted - for use by Florence Nightingale
House only.
Oxycodone hydrochloride MR tablets, 5 mg, 10 mg, 20 mg, 40 mg and 80 mg
Longtec ®
Prescribe as a regular dose.
Pethidine hydrochloride tablet 50mg
Pethidine hydrochloride injection 50mg/1mL, 100mg/2mL
Pethidine hydrochloride/promethazine hydrochloride i.m. injection 100mg/50mg in 2mL
Tramadol hydrochloride capsule 50mg
Tramadol hydrochloride soluble tablet 50mg
Tramadol hydrochloride SR tablet 100mg
Tramadol hydrochloride injection 100mg/2mL
4.7.3 Neuropathic Pain
4.7.4 Antimigraine Drugs
4.7.4.1 Treatment of Acute Migraine Attack
Restricted - to patients who cannot swallow ordinary tablet
Consult BNF and BHT CG 714 Neuropathic Pain guideline for further information
Migraleve Pink f/c tablet (buclizine hydrochloride 6.25mg, paracetamol 500mg, codeine phosphate
8mg)
Use co-codamol 8/500 instead - refer to Section 4.7.1
Migraleve Yellow f/c tablet (paracetamol 500mg/codeine phosphate 8mg) - Non-Formulary
Almotriptan f/c 12.5mg tablet
In accordance with BHT CG First and Second line treatments for
migraine.
Sumatriptan (emergency cupboard) sub-cutaneous injection 6mg/0.5mL
Sumatriptan f/c tablet 50mg, 100mg
4.7.4.2 Prophylaxis of Migraine
1st line treatment - Beta-blockers /Tricyclics
Pizotifen sugar coated tablet 1.5mg
Pizotifen tablet 500micrograms
Pizotifen hydrogen malate elixir 250micrograms/5mL
Methysergide tablets 1mg
4.8 ANTIEPILEPTICS
4.8.1 Control of Epilepsy
In accordance with BHT CG First and Second line treatments for
migraine.
Restricted - 3rd line treatment
Restricted - Consultant only prescribing for refractory patients only
Carbamazepine tablet 100mg, 200mg, 400mg
Carbamazepine tablet MR 200mg, 400mg
Carbamazepine liquid sugar-free 100mg/5mL
Carbamazepine suppository 125mg, 250mg
Clobazam tablet 10mg
Clonazepam tablet 500micrograms, 2mg
Clonazepam 500micrograms/5mL oral solution
Unlicensed
Restricted - initiation by Psychiatric (Oxfordshire Health) team only,
for use when patient cannot swallow tablets.
Clonazepam injection
see Section 4.8.2
Oxcarbazepine tablet 150mg
Restricted - prescribing by Oxfordshire Health team in accordance
with NICE TA76 Newer drugs for epilepsy in adults.
Ethosuximide capsule 250mg
Ethosuximide syrup 250mg/5mL
Gabapentin capsule 100mg, 300mg, 400mg
Gabapentin tablet 600mg
Use 300mg capsules wherever possible.
Restricted - only to be used for patients residing in prison
Gabapentin suspension 250mg in 5mL
Unlicensed.
Restricted - only for use in patients who cannot swallow the
capsules.
Lacosamide tablet 50mg, 100mg, 150mg, 200mg
Restricted - initiation by Consultant Neurologists only and
continuation in primary care, for use as an adjunct (add-on)
treatment for refractory epilepsy not controlled by three antiepileptic
agents in combination. Traffic Light List: Amber initiation.
Lamotrigine tablet 25mg, 50mg, 100mg, 200mg
Lamotrigine dispersible tablet 5mg, 25mg, 100mg
Levetiracetam tablets 250mg, 500mg, 750mg, 1g
1. Restricted - Initiation by Neurology Consultants. Traffic Light
List: Amber initiation. See NICE TA 76 The clinical effectiveness
of newer drugs for epilepsy in adults and TA 79 The clinical
effectiveness and cost effectiveness of newer drugs for epilepsy in
children.
2. Restricted - initiation by Consultant Psychiatrist (Oxfordshire
Health)
Levetiracetam oral solution, sugar-free, 100mg/mL
Restricted - Initiation by Neurology Consultants. Traffic Light List:
Amber initiation. See NICE TA 76 The clinical effectiveness of
newer drugs for epilepsy in adults and TA 79 The clinical
children.
Levetiracetam concentrate for intravenous infusion, 500mg/5mL
Phenobarbital tablet 15mg, 30mg, 60mg
Phenobarbital elixir 15mg/5mL
Phenobarbital oral solution alcohol-free 5mg/1mL
Restricted - Initiation by Neurology team. The IV formulation to be
used when oral levetiracetam is not possible. Traffic Light List: Red.
See NICE TA 76 The clinical effectiveness of newer drugs for
epilepsy in adults and TA 79 The clinical effectiveness and cost
effectiveness of newer drugs for epilepsy in children.
Restricted - for use on Paediatric Unit and SCBU
Phenobarbital sodium injection 15mg/1mL, 30mg/1mL, 60mg/1mL, 200mg/1mL
Primidone tablet 250mg
Phenytoin sodium capsule 25mg, 50mg, 100mg, 300mg
Phenytoin sodium tablet 100mg
Phenytoin chewable tablet 50mg
contains phenytoin 50mg (as against phenytoin sodium) care is
needed if change to capsule/tablet containing phenytoin sodium
Phenytoin suspension 30mg/5mL
Suspension of phenytoin 90mg/15mL considered to be approx.
equivalent in therapeutic effect to cap/tab containing phenytoin
sodium 100mg. Care is needed when making changes
Phenytoin sodium injection
Retigabine tablet, 50mg, 100mg, 200mg, 300mg, 400mg
see Section 4.8.2
Restricted - initiation by Consultant Neurologists on named patient
approval basis until NICE compliance form approved, with GP
continuation, and in accordance with NICE TA 232 Retigabine for
the adjunctive treatment of partial onset seizures in epilepsy.
Sodium valproate crushable tablet 100mg
Sodium valproate EC tablet 200mg, 500mg
Sodium valproate MR tablet 200mg, 300mg, 500mg
Sodium valproate oral solution sugar-free 200mg/5mL
Sodium valproate i.v. injection 400mg vial
Topiramate tablet 25mg, 50mg, 100mg and 200mg
Epilim
Topiramate sprinkle capsule 15mg, 25mg and 50mg
Epilim Chrono
1. Restricted - Recommendation by Consultant Neurologists.
Traffic Light List - Amber recommendation. See NICE TA76 The
clinical effectiveness and cost effectiveness of newer drugs for
epilepsy in adults and NICE TA 79 The clinicial effectiveness and
cost effectiveness of newer drugs for epilepsy in children.
2. Restricted - initiation by Consultant Psychiatrist (Oxfordshire
Health)
Restricted - recommendation by Consultant Neurologists. Traffic
Light List - Amber recommendation. See NICE TA76 The clinical
adults and NICE TA 79 The clinicial effectiveness and cost
effectiveness of newer drugs for epilepsy in children.
Vigabatrin f/c tablet 500mg
Vigabatrin powder sugar-free 500mg/sachet
4.8.2 Drugs Used in Status Epilepticus
Zonisamide capsules 25mg, 50mg and 100mg
Restricted - initiation by Neurology team on advice of Consultant
Neurologist. Traffic Light List - Amber Protocol.
Clonazepam i.v. injection 1mg/1mL
Diazepam injection (solution) 10mg/2mL
Diazepam injection (emulsion) 10mg/2mL
Diazepam rectal solution 2.5mg/1.25mL, 5mg/2.5mL, 10mg/2.5mL
Oral preparations see Section 4.8.1
Oral preparations see Section 4.1.2
Midazolam oromucosal solution 5mg/mL prefilled syringe, 0.5mL (2.5mg), 1mL (5mg), 1.5mL
(7.5mg), 2mL (10mg)
Buccolam®
Restricted - prescribing only in accordance with Status epilepticus
algorithm and CG384 Buccal midazolam treatment algorithm, AND
Adults: initiation by Consultant Neurologists only and,
Children: initiation by Consultant Paediatricians and Neurologists,
teams from National Society for Epilepsy Centre and Ridgeway
Partnership (for learning disabiltiy). Traffic light list: Amber
Initiation.
Paraldehyde 50% in sunflower oil enema, 100mL
Paraldehyde injection
Phenytoin sodium injection 250mg/5mL
Co-beneldopa 12.5/50 (benserazide hydrochloride 12.5mg/levodopa 50mg) capsule
Madopar 62.5
Co-beneldopa 12.5/50 (benserazide hydrochloride 12.5mg/levodopa 50mg) dispersible tablet
Madopar Dispersible 62.5
Restricted - only for use in patients who cannot swallow ordinary
capsules
Co-beneldopa 25/100 (benserazide hydrochloride 25mg/levodopa 100mg) capsule
Co-beneldopa 25/100 (benserazide hydrochloride 25mg/levodopa 100mg) dispersible tablet
Madopar 125
Madopar Dispersible 125
Restricted - only for use in patients who cannot swallow the
ordinary capsules
Co-beneldopa 50/200 (benserazide hydrochloride 50mg/levodopa 200mg) capsule
Co-beneldopa MR 25/100 (benserazide hydrochloride 25mg/levodopa 100mg) capsule
Co-careldopa 12.5/50 (carbidopa monohydrate 12.5mg/levodopa 50mg) tablet
Madopar 250
Madopar CR 125
Sinemet 62.5
4.8.3 Febrile Convulsions
4.9 DRUGS USED in PARKINSONISM and RELATED
4.9.1 Dopaminergic Drugs Used in Parkinson's disease
Co-careldopa 10/100 (carbidopa monohydrate 10mg/levodopa 100mg) tablet
Sinemet 110
Sinemet Plus
Sinemet 275
Co-careldopa MR 25/100 (carbidopa monohydrate 25mg/levodopa 100mg) tablet
Half Sinemet CR
Co-careldopa MR 50/200 (carbidopa monohydrate 50mg/levodopa 200mg) tablet
Sinemet CR
Stalevo tablet (levodopa/carbidopa/entacapone) 50mg/12.5mg/200mg, 75mg/18.75mg/200mg,
100mg/25mg/200mg, 125mg/31.25mg/200mg, 150mg/37.5mg/200mg, 200mg/50mg/200mg
Restricted - Consultant Only prescribing
Amantadine hydrochloride capsule 100mg
Amantadine hydrochloride syrup 50mg/5mL
Apomorphine hydrochloride s.c. injection 20mg/2mL, 50mg/5mL
Restricted - to initiation by Consultant Neurologists and
continuation by GPs, for the treatment of Parkinson's disease in
accordance with NICE CG 35. Traffic Light List: Amber protocol.
Apomorphine hydrochloride s.c. injection 30mg/3mL pen injector and 50mg/10mL prefilled syringe. APO-go Pen and PFS
Restricted - to initiation by Consultant Neurologists and
continuation by GPs, for the treatment of Parkinson's disease in
accordance with NICE CG 35. Traffic Light List: Amber protocol.
Bromocriptine
Cabergoline tablet 500micrograms, 1mg, 2mg
Restricted - Consultant only prescribing
see Section 6.7.1
Restricted - initiation by consultant endocrinologists and
continuation by GPs. Traffic light list: Amber recommendation
Selegiline hydrochloride tablet 5mg
Entacapone tablet 200mg
Restricted - Initiation by consultant and continuation by GPs.
Pramipexole tablet 88 micrograms, 180micrograms
Restricted - Initiation by consultant and continuation by GPs.
Ropinirole tablet 1mg, 2mg, 5mg and starter pack (containing 250micrograms, 500micrograms and Restricted - to initiation by Consultant Neurologists or CNS
1mg tablets)
Neurology only and continuation by GPs, for Parkinson's disease
only. (Not to be prescribed for the treatment of Restless Leg
Syndrome)
Ropinirole MR tablet 2mg, 4mg, 8mg
Restricted - initiation by Consultant Neurologists or CNS Neurology
and continuation by GPs for Parkinson's disease only, and only for
patients who meet the criteria defined in the treatment algorithm.
(Not to be prescribed for the treatment of Restless Leg Syndrome).
4.9.2. Antimuscarinic Drugs used in Parkinsonism
Rotigotine patches 2mg/24hours, 4mg/24hours
(1mg/24hours, 3mg/24hours, 6mg/24hours, 8mg/24hours - phone pharmacy to order)
Restricted - to prescribing by Neurology team or PD Nurses for
Parkinson's Disease when there is no other route of administration
possible. Patients are NOT to be discharged on this product.
Strengths other than 2mg and 4mg are Phone Pharmacy to Order.
Tolcapone tablet 100mg
Restricted - Consultant Only prescribing
Orphenadrine hydrochloride s/c tablet 50mg
Orphenadrine hydrochloride oral solution 50mg/5mL
Procyclidine hydrochloride tablet 5mg
Procyclidine hydrochloride oral solution sugar-free 5mg/5mL
Procyclidine hydrochloride injection 10mg/2mL
Trihexyphenidyl hydrochloride tablet 2mg, 5mg
4.9.3 Drugs Used in Essential Tremor, Chorea, Tics and
Related Disorders
Riluzole tablets 50mg
Tetrabenazine tablet 25mg
Benzhexol hydrochloride
Restricted -prescribing by Consultant neurologists only in
accordance with NICE TA 20 Use of riluzole (Rilutek) for the
treatment of motor neurone disease and BHT CG 784 Riluzole Use by Neurology Hospital Only guideline. Traffic light list - Red.
Torsion dystonias and Other Involuntary Movements
Botulinum A toxin-haemagglutinin complex, 500unit vial (Dysport)
Not to be used for the treatment of hyperhidrosis.
1. Restricted - prescribing by Ophthalmology, Consultant
Neurologists and Spinal Unit Specialist Clinic. Traffic light list: Red.
2. Restricted - prescribing by colorectal surgeons. For use
(unlicensed use) when glyceryl trinitrate and diltiazem ointments
have failed, in line with the position statement on the management
of anal fissures produced by the Association of Coloproctology in
2008. Traffic light list: Red.
Botulinum toxin type A complex, 100unit vial (Botox)
1. Restricted - prescribing by Ian Currie, Consultant
Urogynaecologist and Mr Greenland, Consultant Urologist, for
treatment of detrusor overactivity. Traffic light list: Red. Named
patient. Unlicensed use.
2. Restricted - prescribing by Matthew Koshy, Consultant Neurorehabilitation medicine for Spasticity. Traffic light list: Red
1. Restricted - for use by Matthew Koshy, Consultant Neurorehabilitation medicine, for spasticity. Traffic light list: Red.
2. Restricted - for use by Dr Rajan Chinnaya, Spinal team and Mr
Derry, Consultant surgeon in Spinal Injuries. Traffic light list: Red.
Botulinum toxin type A, complex, 100unit vial (Xeomin)
4.10 DRUGS USED in SUBSTANCE DEPENDENCE
4.10.1 Alcohol dependence
4.10.2 Nicotine dependence
Botulinum toxin type B injection 10,000units/2mL
NeuroBloc
Restricted - prescribing by Consultant Neurologists for use
Acamprosate calcium enteric coated tablet 333mg
Disulfiram tablet 200mg
Restricted - initiation by CAMS team only
For Primary Care - select most cost effective nicotine replacement product.
Nicotine"10mg", "15mg","25mg" patch
Nicorette Invisi patches releasing approx. 10mg, 15mg or 25mg
over 16 hours.
Restricted - use in accordance with NRT guideline. All strengths
available for use in Primary Care. In Secondary Care only the
"25mg" patch may be used.
Nicotine "7mg", "14mg", "21mg" patch
NiQuitin patch
Releasing approx. 7mg, 14mg or 21mg over 24 hours
Restricted - for use in Primary Care only
Nicotine lozenge, sugar-free 1.5mg, 4mg
NiQuitin Mini lozenge
Nicotine inhalator 15mg/cartridge, 36 cartridges
Nicorette
Restricted - use in accordance with NRT guideline
Nicotine 1mg, 2mg, 4mg lozenge, sugar-free
Restricted - for use in Primary Care only.
NiQuitin® Minis lozenge 1.5mg and 4mg available for use in
Secondary Care (see entry above)
Nicorette Microtab
Nicotine 2mg sublingual tablet
Nicotine chewing gum, 2mg, 4mg
Nicotine 500micrograms/metered spray
Varenicline tablet 500micrograms, 1mg
Restricted - to be used in accordance with NICE TA 123
Varenicline for smoking cessation and Public Health guidance
Volume 10, 2008, as second line therapy when NRT has failed. 40
patients per year.
Buprenorphine sublingual tablet 400 micrograms
Restricted - initiation by CAMS team in accordance with NICE TA
114 - Methadone and buprenorphine for management of opioid
dependence
Buprenorphine/naloxone sublingual tablet 2mg/500micrograms, 8mg/2mg
Restricted - initiation by CAMS team only
Methadone hydrochloride oral solution 1mg/1mL
Restricted for continuation of patients already on Methadone as
part of their drug withdrawal scheme. For new patients refer to
CDAT. This strength is only to be prescribed for Addicts
Adjunctive therapy and symptomatic treatment
Lofexidine tablet 200micrograms
Restricted - to initiation by CAMS team only
Opioid-receptor antagonists
Naltrexone hydrochloride tablet 50mg
Restricted - prescribing by Oxford Bucks Mental Health Trust
physicians only. Traffic light list: Amber initiation
4.10.3 Opioid dependence
Opioid substitution therapy
4.11 DRUGS for DEMENTIA
All medicines in this section:
Restricted to prescribing by Consultant Psychiatrists or Neurologist (Dr Jackson) only, in accordance with NICE 217 - Donepezil, galantamine, rivastigmine (review) and
memantine for the treatment of Alzheimer's disease.
For all: Traffic light list: Amber protocol. See Shared Care Protocol
Donepezil hydrochloride tablet 5mg, 10mg
Restricted to prescribing by Consultant Psychiatrists or Neurologist
(Dr Jackson) with continuation by GPs, in accordance with NICE
217 - Donepezil, galantamine, rivastigmine (review) and memantine
for the treatment of Alzheimer's disease and the shared care
protocol.
Donepezil hydrochloride orodispersible tablet 5mg, 10mg
protocol, when patient cannot swallow ordinary tablets.
Galantamine tablet 4mg, 8mg,12mg
protocol.
Galantamine MR capsule 8mg, 16mg, 24mg,
protocol.
Galantamine oral solution 4mg/mL
Memantine hydrochloride tablet 10mg, 20mg
protocol.
Memantine hydrochloride oral solution 5mg per actuation, 10mg/mL
Rivastigmine capsule 1.5mg, 3mg, 4.5mg, 6mg
Note: price per pack is the same for all strengths, please dispense
correct strength
Rivastigmine oral solution 2mg/mL
Rivastigmine patches 4.6mg/24hours, 9.5mg/24hours
5.1 ANTIBACTERIAL DRUGS
CHAPTER 5 - INFECTIONS
protocol.
protocol, when patient cannot swallow ordinary capsules.
protocol, when patient is nil by mouth.
Spectinomycin 2g
Restricted - prescribing only by GUM consultants at Shaw and
Brookside Clinics, for the treatment of resistant gonorrhoea in
accordance with BASHH guidelines. Traffic light list: Red
Benzathine penicillin i.m. injection 1.2megaunits, 2.4megaunits
Unlicensed - Medium risk.
Restricted for treatment of syphilis only. Name patient basis.
5.1.1 Penicillins
5.1.1.1 Benzylpenicillin and Phenoxymethylpenicillin
Benzylpenicillin injection 600mg (1mega), 1.2g vials
Phenoxymethylpenicillin syrup 125mg/5mL, 250mg/5mL
Phenoxymethylpenicillin tablet 250mg
5.1.1.2 Penicillinase-Resistant Penicillins
5.1.1.3 Broad Spectrum Penicillins
Flucloxacillin capsule 250mg, 500mg
Flucloxacillin Injection 250mg, 500mg, 1g
Flucloxacillin syrup 125mg/5mL, 250mg/5mL
Temocillin injection 1g
Amoxicillin capsule 250mg, 500mg
Amoxicillin injection 250mg, 500mg
Amoxicillin sucrose free sachet 3g
Amoxicillin sugar free suspension 125mg in 5mL, 250mg in 5mL
Co-amoxiclav tablet 250/125 (amoxicillin 250mg, clavulanic acid 125mg), 500/125 (amoxicillin
500mg, clavulanic acid 125mg)
Co-amoxiclav dispersible tablet 250mg/125mg
Co-amoxiclav suspension 125mg/31mg in 5mL, 250mg/62mg in 5mL
Co-amoxiclav suspension sugar-free 400mg/57mg
Co-amoxiclav injection 500mg/100mg, 1g/200mg
Restricted - Microbiology Approval required. Traffic light list: Red
Product to be discontinued, May10
Augmentin-Duo
5.1.1.4 Antipseudomonal Penicillins
Piperacillin/tazobactam injection 2g/250mg (2.25g), 4g/500mg (4.5g)
Ticarcillin/clavulanic acid injection 3g/200mg (3.2g)
Tazocin
Timentin
Restricted - Microbiology approval required.
5.1.1.5 Mecillinams
Pivmecillinam hydrochloride tablet 200mg
Restricted - Microbiology approval required. Traffic light List: Red
Cefaclor MR tablet 375mg
Restricted - to TTO & Outpatient prescriptions.
Inpatient use restricted to Paediatrics and Obs & Gynae.
5.1.2 Cephalosporins, Carbapenems, and Other BetaLactams
5.1.2.1 Cephalosporins
Cefaclor suspension 125mg/5mL, 250mg/5mL
Cefalexin suspension 125mg/5mL, 250mg/5mL
Inpatient use restricted to Paediatrics. Microbiology approval
required for all other uses.
Cefixime tablet 200mg
Cefixime paediatric oral suspension 100mg/5mL, 50mL, 100mL
Restricted - Paediatrics only. Microbiology approval required for
all other uses.
Cefotaxime injection 500mg
Cefradine capsule 250mg, 500mg
Microbiology approval required for all other uses.
Cefradine injection 500mg, 1g
Restricted - Paediatrics and Obs & Gynae. Microbiology approval
Ceftazidime injection 250mg, 500mg, 1g, 2g
Restricted - Haematology, Paediatrics, respiratory patients (severe
Pseudomonas infections only) and Ophthalmology. Microbiology
approval required for all other uses.
Ceftriaxone injection 250mg, 1g, 2g
Cefuroxime injection 250mg, 750mg, 1.5g
Restricted - Paediatrics; suspected meningitis or meningococcal
septicaemia; serious Orthopaedic infections; cellulitis; pelvis
inflammatory disease and sexually transmitted infections. Also for
Restricted - to Ophthalmology, Paediatrics and Obs & Gynae.
Cefuroxime tablets 125mg, 250mg
Cefuroxime suspension 125mg/5mL
5.1.2.2 Carbapenems
Ertapenem intravenous infusion 1g
Restricted - Microbiology approval required and administration by
OPAT team only. Traffic light list: Red
5.1.2.3 Other Beta-Lactam antibiotics
Meropenem injection 500mg, 1g
Aztreonam injection 1g, 2g
5.1.3 Tetracyclines
Demeclocycline hydrochloride capsule 150mg
Doxycycline capsule 100mg
Doxycycline soluble tablet 100mg
Lymecycline capsule 408mg (=tetracycline 300mg)
Minocycline tablet 50mg, 100mg
Minocycline tablet 50mg, 100mg
Restricted - Microbiology approval required
NOTE: much greater cost - only prescribe when standard oral
formulation is unsuitable
Tetralysal 300
For the treatment of acne
Traffic light list: Green
Restricted - for treatment of dermatological conditions OTHER than
acne in accordance with Dermatology Referral guidelines. Traffic
light list: Amber Initiation
For all other uses - Microbiology approval required
Minocycline SR capsule 100mg
For the treatment of acne
Traffic light list: Green
Minocycline SR capsule 100mg
Restricted - for treatment of dermatological conditions OTHER than
acne in accordance with Dermatology Referral guidelines. Traffic
light list: Amber Initiation
For all other uses - Microbiology approval required
Oxytetracycline tablet 250mg
Restricted - Dermatology only. For all other uses Microbiology
approval required.
Tetracycline hydrochloride tablets 250mg
approval required.
Unlicensed and not currently available
approval required.
Tetracycline injection 500mg
5.1.4 Aminoglycosides
Tigecycline i.v. infusion 50mg
Amikacin injection 500mg/2mL
Restricted - Ophthalmology only. Microbiology approval required
for all other uses.
Can be used to prepare Amikacin ophthalmic preparations
Amikacin paediatric injection 100mg/2mL
Restricted - Microbiology approval required and phone Pharmacy to
order.
Gentamicin injection 20mg/2mL, 80mg/2mL
See BHT Clinical Guideline 48.7 The use of gentamicin in adults.
Gentamicin intrathecal injection 5mg/1mL
Can be used to prepare ophthalmic preparations
Neomycin sulphate tablet 500mg
Restricted - Gastroenterology only
5.1.5 Macrolides
Tobramycin injection 80mg in 2mL
Restricted - For use in Paediatrics only.
See BHT Clinical Guideline 19 Guidelines for the use of
aminoglycosides in neonates and children.
Tobramycin nebuliser solution 300mg/4mL
Bramitob®
Restricted - initiation by consultant Paediatricians specialising in Cystic
Fibrosis for the management of chronic pulmonary infection due to
Pseudomonas aeruginosa in patients with cystic fibrosis aged 6 years and
older if nebulised colistin is not tolerated or if clinical progress is
unsatisfactory.
Traffic light status to be agreed
Tobramycin dry powder for inhalation 28mg/capsule
Tobi Podhaler®
Restricted - initiation by consultant Paediatricians specialising in
Cystic Fibrosis for the management of chronic pulmonary infection
due to Pseudomonas aeruginosa in patients with cystic fibrosis
aged 6 years and older in accordance with NICE TA 276
To be used second line to tobramycin nebuliser solution
(Bramitob®)
Traffic light status to be agreed
Azithromycin capsule 250mg
Restricted - for use by Paediatric, Obstetric & Gynaecology and
Genitourinary medicine consultants only. Microbiology approval
Azithromycin suspension 200mg/ 5mL
Restricted - for use by Paediatric, Obstetric & Gynaecology and
Genitourinary medicine consultants only. Microbiology approval
Clarithromycin i.v. injection 500mg
Clarithromycin suspension 125mg/5mL, 250mg/5mL
Clarithromycin tablet 250mg, 500mg
Erythromycin i.v. infusion 1g
Erythromycin tablet/capsule 250mg, 500mg
Erythromycin suspension 125mg/5mL, 250mg/5mL, 500mg/5mL
Fosfomycin trometamol sachet 3g
Restricted - for use as a prokinetic agent on ICU. Can be filtered
through a 0.2micron filter before addition to the infusion bag
Restricted - Microbiology Approval required. Traffic light list: Red
5.1.6 Clindamycin
Clindamycin capsule 75mg, 150mg
Restricted - Microbiology approval required for use in patients over
85 years of age, but caution in prescribing for any patient over 65
years due to increased risk of Clostridium difficile associated
diarrhoea
Clindamycin injection 300mg/2mL, 600mg/4mL
diarrhoea
diarrhoea. Use in accordance with BHT CG 279 recommended
Empirical Antibiotic Regimens for Common Hospital Infectious
Conditions.
Clindamycin suspension 75mg/5mL
5.1.7 Some Other Antibacterials
Chloramphenicol
Fusidic Acid
Vancomycin and Teicoplanin
Daptomycin
Chloramphenicol capsule 250mg
Chloramphenicol injection 1g
Sodium fusidate tablet 250mg
Fusidic acid suspension 250mg/5mL (equivalent to sodium fusidate 175mg/5mL)
Teicoplanin injection 200mg, 400mg
Vancomycin capsule 125mg
Restricted - Capsules available only for treatment of local GI
pathogens.
See BHT Clinical Guideline 225. Management of clostridium difficile
induced diarrhoea.
Vancomycin injection 500mg, 1g
Daptomycin injection 350mg, 500mg
See BHT Clinical Guideline 241.7 Vancomycin
Restricted - Microbiology approval required. Traffic light list: Red
Linezolid
Linezolid tablet 600mg
Linezolid suspension 100mg/5mL
1. Restricted - Microbiology approval required
Pharmacist to confirm ongoing microbiology approval – especially
for extended periods of treatment. Maximum period of treatment
28 days.
2. Restricted - OPAT prescribers for follow on therapy for the
treatment of skin and soft tissue infections in OPAT patients who
are over 80 years of age and have type 1 penicillin allergy. Traffic
light list: Red
Quinupristin and dalfopristin
Linezolid infusion 2mg/mL, 300mL
Quinupristin mesilate 150mg/dalfopristin mesilate 350mg i.v. infusion
Pharmacist to confirm ongoing microbiology approval – especially
for extended periods of treatment. Maximum period of treatment
28 days.
Polymyxins
Colistin (Colistimethate sodium) injection 500,000units (0.5mega), 1,000,000 unit (1mega)
5.1.8 Sulphonamides and Trimethoprim
Co-trimoxazole tablet 480mg
Restricted - for use in Genitourinary Medicine only. Microbiology
Co-trimoxazole infusion 480mg/5mL
Restricted - for use by Ophthalmology only. Microbiology approval
See BHT Clinical Guideline 374.3 Uveitis
Co-trimoxazole suspension 240mg/5mL, 480mg/5mL
Sulfadiazine tablet 500mg
Trimethoprim i.v. injection 100mg/5mL
Trimethoprim suspension 50mg/5mL
Trimethoprim tablet 100mg, 200mg
5.1.9 Antituberculosis Drugs
Ethambutol hydrochloride tablet 100mg, 400mg
Isoniazid elixir 50mg/5mL (BPC)
Isoniazid injection 50mg/2mL
Isoniazid tablet 50mg, 100mg
Protionamide 250mg tablets
Pyrazinamide tablet 500mg
Not currently available
see Disodium pamidronate
Unlicensed
Restricted - Phone Pharmacy to Order
Unlicensed
Rifabutin 150mg capsule
Rifampicin capsule 150mg, 300mg
Restricted - for use in mycobacterial infections and for
meningococcal contacts. Microbiology approval required for all
other uses.
Rifampicin i.v. injection 300mg
other uses.
Rifampicin infusion 600mg
other uses.
Rifampicin syrup 100mg/5mL
other uses.
Rifampicin/isoniazid tablet 150mg/100mg, 300mg/150mg
Rifinah 150, Rifinah 300
other uses.
Rifampicin 120mg, isoniazid 50mg, pyrazinamide 300mg tablet
Rifater tablet
other uses.
Streptomycin injection 1g
Restricted - for Mycobacterial infections only. Microbiology approval
5.1.10 Antileprotic Drugs
Dapsone tablet 50mg, 100mg
Restricted - Dermatology and GUM. Microbiology approval
5.1.11 Metronidazole and Tinidazole
Metronidazole infusion 500mg/100mL
Metronidazole suppository 500mg, 1g
Metronidazole suspension 200mg/5mL
Metronidazole tablet 200mg, 400mg
5.1.12 Quinolones
Tinidazole tablet 500mg
Restricted - Gastroenterology only. Microbiology approval required
for all other uses.
Ciprofloxacin i.v. 100mg/50mL, 200mg/100mL, 400mg/200mL
Restricted - Urology and respiratory patients where no other
suitable alternative; Ophthalmology and Obstetrics & Gynaecology.
Also restricted for 2nd line use only as per Antibiotic Flashcard or
for use as per specific Trust Guidelines or if approved by
Microbiology.
100mg/50ml available for paediatrics only
Ciprofloxacin 400mg in glucose 5% infusion
Restricted - Urology and respiratory patients where no other
suitable alternative; Ophthalmology and Obstetrics & Gynaecology.
Also restricted for 2nd line use only as per Antibiotic Flashcard or
for use as per specific Trust Guidelines or if approved by
Microbiology.
Ciprofloxacin suspension 250mg/5mL
Inpatient use restricted to Urology and respiratory patients where
no other suitable alternative; Ophthalmology and Obstetrics &
Gynaecology. Also restricted for 2nd line use only as per Antibiotic
Flashcard or for use as per specific Trust Guidelines or if approved
by Microbiology.
Ciprofloxacin tablet 250mg, 500mg
Inpatient use restricted to Urology and respiratory patients where
no other suitable alternative; Ophthalmology and Obstetrics &
Gynaecology. Also restricted for 2nd line use only as per Antibiotic
Flashcard or for use as per specific Trust Guidelines or if approved
by Microbiology.
Where dose is a whole tablet and patient cannot swallow it disperse in water.
Moxifloxacin tablet 400mg
Restricted - Respiratory patients where there is no suitable
alternative and Ophthalmology. For all other uses Microbiology
approval required.
5.1.13 Urinary-Tract Infections
5.2 ANTIFUNGAL DRUGS
5.2.1 Triazole antifungals
Moxifloxacin intravenous infusion 400mg/250mL
Restricted - prescribing by Microbiology or Respiratory Consultants
for the treatment of Community acquired pneumonia (CAP) and
complicated skin and skin structure infections (cSSSI). Traffic light
list: Red
Ofloxacin tablet 200mg, 400mg
Restricted - Genitourinary Medicine, Obstetrics & Gynaecology and
Ophthalmology. For all other uses Microbiology approval required.
Nitrofurantoin capsule/tablet 50mg, 100mg
Tablets may be crushed and mixed with water for administration to
patients unable to take solid dosage forms. (recognised off-license
use)
Nitrofurantoin suspension 25mg/5mL
Nitrofurantoin MR capsule 100mg
Restricted -- to
only
for useunable
in Paediatrics
or when
discharging
patients
Restricted
patients
to tolerate
capsules
or suspension
Methenamine hippurate tablet 1g
Fluconazole capsule 50mg, 150mg, 200mg
Fluconazole infusion 50mg/25mL, 200mg/100mL
Fluconazole suspension 50mg/5mL, 200mg/5mL
Itraconazole capsule 100mg
Restricted - for use by Haematology and Oncology. Microbiology
Restricted - Haematology, Oncology and GUM. Microbiology
Itraconazole oral liquid, sugar free 10mg/1mL
Itraconazole concentrate for intravenous infusion 250mg/25mL
Voriconazole f/c tablet 50mg, 200mg
Restricted – Haematology and Oncology consultants, GUM and
solid organ transplant patients. Microbiology approval required for
all other uses. Traffic light list: Red.
Voriconazole oral suspension 200mg/5mL
all other uses. Traffic light list: Red
Voriconazole i.v. infusion 200mg vial
all other uses. Traffic light list: Red.
See Clinical Guideline BHT 203.3 Guidelines for the use of
antifungal agents in haematology patients.
Amphotericin suspension sugar-free 100mg/1mL
Amphotericin i.v. infusion 50mg (50,000u)
Fungizone
Amphotericin (liposomal) i.v. infusion 50mg
Ambisome.
Restricted – Haematology, Oncology, GUM and solid organ
transplant patients. Microbiology approval required for all other
uses.
Anidulafungin intravenous infusion 100mg
Restricted - prescribing by ITU consultants and Consultant
Microbiologists. See BHT Clinical Guideline 743.1 Guideline on
Appropriate Use of Anidulafungin. Traffic light list: Red.
Caspofungin acetate injection 50mg, 70mg
Restricted - for haematology and oncology use only; otherwise
consult microbiology. 2nd line treatment of invasive candida or
aspergillosis in patients on chemotherapy where there is
unacceptable toxicity from Amphotericin.
Flucytosine i.v. infusion 2.5g/250mL
Restricted - Microbiology approval required and Phone Pharmacy
to Order
Restricted - Paediatrics and Dermatology. Microbiology approval
required for all other uses. Phone Pharmacy to Order
Unlicensed.
5.2.2 Imidazole antifungals
5.2.3 Polyene antifungals
5.2.4 Echinocandin antifungals
5.2.5 Other antifungals
Griseofulvin tablet 125mg, 500mg
Griseofulvin suspension 125mg/5mL
Restricted - Paediatrics and Dermatology. Microbiology approval
required for all other uses. Phone Pharmacy to Order
Terbinafine tablet 250mg
5.3 ANTIVIRAL DRUGS
Restricted - Dermatology. Microbiology approval required for all
other uses.
5.3.1 HIV Infection
Nucleoside Reverse Transcriptase Inhibitors
Prescribing of all HIV drugs restricted to Genitourinary (GUM) consultants only. Traffic light list: Red
Restricted
- Phone
Pharmacy to Order.
Abacavir tablet
f/c 300mg
Abacavir oral solution sugar-free 100mg/5mL
Abacavir/lamivudine 600mg/300mg tablet
Abacavir/lamivudine/zidovudine 300mg/150mg/300mg tablet
Didanosine capsule enclosing EC granules 250mg, 400mg
Lamivudine tablet f/c 100mg
Kivexa®.
Restricted - prescribing by HIV Consultants.
Trizivir®.
Restricted - prescribing by HIV Consultants for HIV co-infection with
Tuberculosis where compliance is an issue.
Restricted - prescribing by Gastroenterologists and GUM
consultants only in accordance with NICE TA 96 Hepatitis B
(chronic) - adefovir, depivoxil and pegylated interferon alpha-2a.
Lamivudine tablet f/c 150mg, 300mg
Lamivudine oral solution 25mg/5mL, 50mg/5mL
Stavudine capsule 30mg, 40mg
Tenofovir disoproxil 245mg tablet
Restricted to the prevention of maternal to foetal HIV transmission.
See protocol by Obs & Paed Depts.
1. Restricted - prescribing by HIV Consultants only for 2nd/3rd line
treatment adults with HIV.
2. Restricted - prescribing for HIV and HepB co-infection.
3. Restricted - for use in patients transferred from another unit.
4. Restricted - to prescribing by Consultant Gastroenterologists or
Associate Specialists of Gastroenterology in conjunction with
Hepatitis B Clinic and in accordance with NICE TA 173 Tenofovir
disoproxil fumarate for the treatment of Hepatitis B and BHT
Clinical Guideline on Hepatitis B. NICE compliance form required
- see link on Formulary homepage. Red Traffic Light List.
Tenofovir disoproxil/emtricitabine 245mg/200mg tablet
Truvada® - Restricted - Phone Pharmacy to Order
Zidovudine capsule 100mg, 250mg
Zidovudine oral solution sugar-free 50mg in 5mL
Zidovudine injection 10mg/1mL
For dilution and use as an i.v. infusion. Restricted to the
prevention of maternal to foetal HIV transmission. See protocol by
Obs & Paed Depts.
Zidovudine/lamivudine 300mg/150mg tablet
Combivir®
1. Restricted – prescribing for the prevention of maternal to foetal
HIV transmission. See protocol by Obs & Paed Depts.
2. Restricted – prescribing for patients treated for PEP (post
exposure prophylaxis), in combination with lopinavir/ritonavir. Initial
5 day treatment, followed by a further 25 days if appropriate
Amprenavir 150mg
Amprenavir oral solution 15mg/1mL
Atazanavir capsule 150mg
HIV Consultants. Treatment of HIV infection in patients intolerant
to other protease inhibitors or with hyperlipidaemia.
Protease Inhibitors
Indinavir capsule 200mg, 400mg
Non-Nucleoside Reverse Transcriptase Inhibitors
Lopinavir/ritonavir tablet 100mg/25mg, 200mg/50mg
Kaletra
Restricted – prescribing for patients treated for PEP (post exposure
prophylaxis), in combination with lopinavir/ritonavir.
Initial 5 day treatment, followed by a further 25 days if appropriate.
Lopinavir/ritonavir oral solution 400mg/100mg
Kaletra®
Restricted – prescribing for patients treated for PEP (post exposure
prophylaxis), in combination with lopinavir/ritonavir.
Initial 5 day treatment, followed by a further 25 days if appropriate.
Nelfinavir tablet f/c 250mg
Restricted - for use in patients who cannot tolerate Efavirenz.
Phone Pharmacy to Order
Ritonavir 100mg capsule
Efavirenz capsule 200mg, 600mg
Efavirenz 600mg / Emtricitabine 200mg / Tenofovir disoproxil 245mg tablet
Nevirapine tablet 200mg
Nevirapine MR capsule 400mg
Nevirapine suspension 50mg/5mL
5.3.2 Herpesvirus Infections
5.3.2.1 Herpes Simplex and Varicella-Zoster Infection
Aciclovir tablet 200mg, 400mg, 800mg
Restricted - Phone Pharmacy to Order 200mg capsule
Atripla®
Tablets can be dispersed in water.
Aciclovir suspension 200mg/5mL
Aciclovir i.v. infusion 250mg, 500mg, 1g
Valaciclovir tablet 200mg
Restricted - Haematology, Oncology, solid organ transplant
patients, GUM, suspected viral encephalitis and Dermatology
(eczema herpeticum cases). For other uses Microbiology approval
5.3.2.2. Cytomegalovirus Infection
Ganciclovir infusion 500mg
Restricted - GUM. Microbiology approval required for all other
uses.
Adefovir dipivoxil tablet 10mg
Restricted - to prescribing by Consultant Gastroenterologists or
Associate Specialists of Gastorenterology in conjunction with
Hepatitis B clinic and in accordance with NICE TA 96 Adefovir
dipivoxil and peginterferon alfa-2a for the treatment of chronic
hepatitis B. Traffic light list: Red.
Entecavir tablet 500microgram, 1mg
FOR ALL PRESCRIBING - NICE Compliance form required - see
link on Formulary homepage.
Restricted
- to prescribing -by
Consultant
Gastroenterologists
or
FOR ALL PRESCRIBING
NICE
compliance
form required - see
link from Formulary homepage. NICE compliance to be verified if
form not yet available.
Restricted - prescribing by Consultant Gastroenterologists and
Associate Specialist Gastroenterology in accordance with NICE TA
252 Telaprevir for the treatment of genotype 1 chronic hepatitis C
and NICE TA 253 Boceprevir for the treatment of genotype 1
chronic hepatitis C and in accordance with BHT CG315 Protease
Inhibitors Telaprevir and Boceprevir for the treatment of Genotype
1 Chronic Hepatitis C. Traffic light list: Red
5.3.3 Viral Hepatitis
5.3.3.1 Chronic Hepatitis B
5.3.3.2 Chronic Hepatitis C
Boceprevir capsule 200mg
Telaprevir tablet 375mg
5.3.4 Influenza
FOR ALL PRESCRIBING - NICE compliance form required - see
Restricted - prescribing by Consultant Gastroenterologists and
Associate Specialist Gastroenterology in accordance with NICE TA
252 Telaprevir for the treatment of genotype 1 chronic hepatitis C
and NICE TA 253 Boceprevir for the treatment of genotype 1
chronic hepatitis C and in accordance with BHT CG315 Protease
Inhibitors Telaprevir and Boceprevir for the treatment of Genotype
1 Chronic Hepatitis C. Traffic light list: Red
Consult appropriate guidelines when prescribing any of the medicines in section 5.3.4:
302 Use of antivirals during seasonal influenza - treatment and prophylaxis adults and children
709A Adult seasonal flu hospital pathway - admission
709B Adult seasonal flu hospital pathway - inpatient management
710 Seasonal flu paediatric hospital pathways
Oseltamivir capsule 30mg, 45mg, 75mg
Restricted - Microbiology approval required except in Pandemic
Influenza setting or when there is a high level of seasonal influenza
circulating.
In Pandemic Influenza restricted to prescribing by Respiratory
Medicine consultants, Microbiologists and GPs when directed by
HPA. For seasonal and swine flu post-exposure prophylaxis and
treatment, see clinical guidelines on the intranet or up to date HPA
guidance.
Oseltamivir suspension, sugar-free 6mg/1mL
Restricted - Only for use in children less than 1 year of age.
Microbiology approval required except in Pandemic Influenza
setting or when there is a high level of seasonal influenza
circulating.
guidance.
Zanamivir dry powder for inhalation disks, 5mg/blister
Restricted - Microbiology approval required except in Pandemic
Influenza setting or when there is a high level of seasonal influenza
circulating.
guidance.
Zanamivir aqueous solution 200mg/20mL
Unlicensed – Medium risk
Available on a named patient basis from manufacturer for patients
who fit the HPA criteria (see BHT CG 302)
Ribavirin inhalation 6g
Nebuliser is stored in the Pharmacy Emergency cupboard with the
vials.
5.3.5 Respiratory Syncytial Virus
Ribavirin tablet 200mg, 400mg
Restricted -prescribing by Consultant Gastroenterologist, Assoc.
Specialist Gastroenterology or Paediatrician for treatment of
chronic hepatitis C in accordance with:
NICE TA75 Hepatitis C - pegylated interferons, ribavirin and alfa
interferons,
NICE TA 106 Peginterferon alfa and ribavirin for the treatment of
mild hepatitis C, and
NICE TA 200 Hepatitis C - peginterferon alfa and ribavirin.
Ribavirin capsule 200mg
Note: More expensive therefore use tablets if available.
Restricted - prescribing as for ribavirin tablets above
Artemether/lumefantrine tablet 20mg/120mg
Tablets may be crushed just before administration.
Restricted - for use by Microbiology and Haematology teams in
patients diagnosed with uncomplicated falciparum malaria and still
able to take oral medication. Traffic light list: Red.
Chloroquine phosphate 250mg (chloroquine base 155mg) tablet
Avloclor
Restricted - for use by Haematology.
Restricted - for use by Haematology and Phone Pharmacy to
Order. Available on named patient basis.
Restricted - Opthalmology use only for the management of ocular
toxoplasmosis. See BHT Clinical Guideline 374.3 Uveitis
see Section 5.1.3
5.4 ANTIPROTOZOAL DRUGS
5.4.1 Antimalarials
Chloroquine sulphate 200mg (chloroquine base 150mg) tablet
Chloroquine sulphate elixir 68mg/5mL (chloroquine base 50mg/5mL)
Chloroquine sulphate injection 200mg/5mL
Mefloquine tablet 250mg
Primaquine tablet 7.5mg
Proguanil hydrochloride tablet 100mg
Pyrimethamine/sulfadoxine tablet 25mg/500mg
Quinine dihydrochloride injection 600mg/2mL
Quinine sulphate tablet 200mg, 300mg
Tetracyclines for treatment of malaria
5.4.2 Amoebicides
Metronidazole
5.4.3 Trichomonacides
5.4.4 Antigiardial Drugs
see 5.1.11
Mepacrine tablet 100mg
5.4.5. Leishmaniacides
5.4.6 Trypanocides
5.4.7 Drugs for Toxoplasmosis
5.4.8 Drugs for Pneumocystis Pneumonia
Pentamidine respirator solution 300mg in 5mL
Pentamidine isetionate injection, 300mg (as nebuliser solution)
Restricted - GUM only.
Restricted - on recommendation of Microbiology team for
prophylaxis of pneumocystis jirovecii (pneumocystis carinii)
pnuemonia, by inhalation of nebulised solution (use suitable
equipment - consult product literature).
CAUTION: Consult product literature as pentamidine isetionate is
toxic and personnel should be adequately protected during
handling and administration.
Mebendazole suspension 100mg in 5mL
Mebendazole tablet 100mg
Ivermectin tablet 3mg
Restricted - prescribing by consultant Dermatologists only or on
approval from Microbiology. Traffic light list: Red.
5.5 ANTHELMINTICS
5.5.1 Drugs for Threadworms
5.5.2 Ascaricides
5.5.3 Drugs for Tapeworm Infections
5.5.4 Drugs for Hookworms
5.5.5 Schistosomicides
5.5.6 Filaricides
5.5.7 Drugs for Cutaneous Larva Migrans
5.5.8 Drugs for Strongyloidiasis
CHAPTER 6 - ENDOCRINE SYSTEM
6.1 DRUGS USED in DIABETES
see BHT CG 667 Type 2 Diabetes Guideline and BHT CG 741 Insulin Wall Chart
Continuous Subcutaneous Insulin Infusion (Insulin Pump Therapy) using short-acting insulins
(soluble insulin, insulin aspart, insulin glulisine and insulin lispro)
Restricted - prescribing by Consultant Diabetologists only. To be
used in accordance with NICE TA151 Continuous subcutaneous
insulin infusion for the treatment of diabetes mellitus (Type 1) and
local clinical guideline (to be finalised). Traffic light list: Amber
initiation.
NOTE: Currently each patient receives funding approval on an
individual basis from the PCT. Pumps and consumables
purchased by PCT. Insulins provided by secondary and primary
care.
Insulin human injection U-500 Concentrated (Humulin R) 500units/mL, 20mL vial
HIGH STRENGTH
HIGH STRENGTH - if prescribing take extreme care.
Restricted - prescribing by Diabetes Team only. Traffic light list:
Red
Soluble Insulin
Insulin soluble (human) 100units/mL
Insulin Aspart
Insulin aspart (recombinant human insulin analogue) 100units/mL
eg. Actrapid (10mL vial), Humulin S (10mL vial, 3mL cartridge),
Insuman Rapid (3mL cartridge)
eg. NovoRapid (10mL vial, 3mL cartridge), NovoRapid FlexPen
prefilled disposable injection device.
6.1.1 INSULINS
6.1.1.1 SHORT ACTING INSULINS
Insulin Glulisine
Insulin glulisine (recombinant human insulin analogue)
eg. Apidra (10mL vial, 3mL cartridge), Apidra Solostar (3mL
prefilled disposable injection device)
NOTE: October 2011 Currently there are supply problems which
are expected to be resolved December 2011. In the interim if
supplies of Apidra are not available switch patients to one of the
other rapid acting analogue insulins - either Humalog (Insulin lispro)
or NovoRapid (Insulin aspart). All three of these insulins are
equipotent on a unit-for unit basis so the patient should be switched
to the equivalent dose of the alternative insulin and given advice
regarding the monitoring of their blood glucose level to adjust their
insulin dose as appropriate.
Insulin Lispro
Insulin lispro (recombinant human insulin analogue)
eg. Humalog (10mL vial, 3mL cartridge), Humalog KwikPen (3mL
Insulin detemir (recombinant human insulin analogue) 100units/mL
eg. Levemir (3mL cartridge, 3mL FlexPen prefilled disposable
injection device)
NOTE: Glargine = 1st choice long-acting insulin analogue.
For place in therapy of insulin detemir see Clinical Guidelines on
intranet: Guidelines for using long acting insulin analogues in
patients with diabetes.
6.1.1.2 INTERMEDIATE- and LONG-ACTING INSULINS
Insulin Detemir
Insulin Glargine
Insulin glargine (recombinant human insulin analogue) 100units/mL
eg. Lantus (10mL vial, 3mL cartridge), Lantus Solostar 3mL
prefilled disposable injection device.
NOTE: Glargine = 1st choice long-acting insulin analogue.
Restricted - Lantus SoloStar Prefilled disposable injection device
for patients on more than 40 units of insulin glargine or unable to
use other pen devices.
(Joint guidance on reducing the use of long-acting insulin
analogues is planned April 09)
Isophane Insulin
Isophane insulin (human) 100units/mL
eg. Insulatard (10mL vial, 3mL cartridge), Insulatard InnoLet
eg. Humulin I (10mL vial, 3mL cartridge), Humulin I-Pen prefilled
disposable injection device.
Humulin I-Pen restricted to Type 2 diabetes patients who cannot
self administer isophane insulin using 10mL vials or 3mL cartridges
and in accordance with NICE CG 87 Type 2 diabetes - newer
agents (a partial update of CG66): short guideline and Bucks Trust
local adaptation.
Biphasic Insulin Aspart
Biphasic insulin aspart (recombinant human insulin analogue) 100units/mL
Biphasic Insulin Lispro
Biphasic insulin lispro (recombinant human insulin analogue) 100units/mL
eg. NovoMix 30 (3mL cartridge, 3mL FlexPen prefilled disposable
injection device)
eg. Humalog Mix25 10mL vial, Humalog Mix25 and Mix50 ( 3mL
cartridge, 3mL KwikPen prefilled disposable injection device)
Humalog Mix25 and Mix50 KwikPen restricted to Type 2 diabetes
patients who cannot self administer isophane insulin using 10mL
vials or 3mL cartridges and in accordance with NICE CG 87 Type 2
diabetes - newer agents (a partial update of CG66): short guideline
and Bucks Trust local adaptation.
BIPHASIC INSULINS
Biphasic Isophane Insulin
Biphasic isophane insulin (human) 100units/mL
eg. Mixtard 30 (10mL vial, 3mL cartridge), Mixtard 30 InnoLet (3mL
NOTE: Mixtard 30 is to be discontinued December 2010
eg. Humulin M3 (10mL vial, 3mL cartridge). Humulin M3 KwikPen
restricted to Type 2 diabetes patients who cannot self-administer
biphasic isophane insulin using 10mL vials or 3mL cartridges and in
accordance with NICE CG 87 Type 2 diabetes - newer agents (a
partial update of CG 66): short guideline and Bucks Trust local
adaptation.
6.1.1.3 Hypodermic Equipment
6.1.2 Antidiabetic Drugs
6.1.2.1 Sulphonylureas
see BHT CG 667 Type 2 Diabetes Guideline
Glibenclamide tablet 2.5mg, 5mg
Gliclazide tablet 80mg
Glimepiride tablet 1mg, 2mg
1st Choice Sulphonylurea
Restricted - Endocrinologist (Dr S Gardner) Consultant Only
prescribing
Tolbutamide tablet 500mg
6.1.2.2 Biguanides
Metformin hydrochloride tablet 500mg, 850mg
Metformin hydrochloride tablet MR 500mg
Metformin hydrochloride oral powder, sugar-free sachets, 500mg
6.1.2.3 Other Antidiabetic drugs
Acarbose tablet 50mg
Restricted - in accordance with NICE CG 66 -Type 2 Diabetes
which recommends MR tablet for second line use after titration with
metformin fails.
Restricted - to patients who cannot swallow metformin
hydrochloride tablets.
BNF advises: the contents of each sachet should be mixed with
150mL of water and taken immediately.
Exenatide injection 5microgram per dose and 10microgram per dose, prefilled pens (60 doses)
NOTE: 5microgram pre-filled pen only, to be used when initiating
treatment in secondary care. 10microgram pre-filled pen to be
used in primary care, and in secondary care only for continuation of
in-patient treatment.
Restricted - Initiation by Diabetes team in accordance with NICE
Clinical Guideline 87 Type 2 Diabetes with the exception of the last
criteria which is changed to: BMI 30-35kg/m2 and insulin is
unacceptable because of occupational implication or weight loss
would benefit other co-morbidities. Also see BHT CG667
Management of people with Type 2 Diabetes and BHT CG83.1
Exenatide (Twice Daily or Once Weekly) for use in Type 2 Diabetes
amber initiation guideline. Traffic light list: Amber initiation
Exenatide modified release injection 2mg vial, once weekly
Restricted - initiation by Diabetes team in accordance with NICE TA
248 Exenatide prolonged-release suspension for injection in
combination with oral antidiabetic therapy for the treatment of type
2 diabetes and BHT CG83 Exenatide (Twice Daily or Once Weekly)
for use in Type 2 Diabetes amber initiation guideline. Also see BHT
CG667 Management of people with Type 2 Diabetes. Traffic light
list: Amber initiation
Liraglutide injection 6mg/mL, 2 x 3mL prefilled pen
Restricted - to prescribing by Diabetologists only, in accordance
with NICE TA 203 Liraglutide for Type 2 diabetes and in line with
BHT Type 2 Diabetes guideline. Traffic light list: Amber protocol.
Use Shared Care Protocol
Pioglitazone tablet 15mg, 30mg, 45mg
Restricted - to be used in accordance with NICE Clinical Guideline
87 Management of Type 2 Diabetes.
Please also note: Rosiglitazone was withdrawn from the market by
the EMEA in Sept 2010. Please follow the advice of the Association
of British Clinical Diabetologists. All patients on rosiglitazone should
have a medication review and the drug should be stopped. All new
patients requiring a thiazolidinedione should be prescribed
Pioglitazone. Prior evidence of heart failure and impairment of left
ventricular function remains a strict contraindication for the use of
thiazolidinediones.
Repaglinide tablet 500micrograms, 1mg, 2mg
Restricted - to Consultant Only prescribing
Rosiglitazone f/c tablet 4mg, 8mg
Rosiglitazone was withdrawn from the market by the EMEA in Sept
2010. Please follow the advice of the Association of British Clinical
Diabetologists. All patients on rosiglitazone should have a
medication review and the drug should be stopped. All new patients
requiring a thiazolidinedione should be prescribed Pioglitazone.
Prior evidence of heart failure and impairment of left ventricular
function remains a strict contraindication for the use of
thiazolidinediones.
Sitagliptin tablet 100mg
Restricted - prescribing by Diabetologists only in accordance with
BHT CG Type 2 Diabetes and NICE CG 87 Management of Type 2
Diabetes as:
2nd line in addition to metformin in patients who suffer from
hypoglycaemia on sulphonylureas and in whom there is a
contraindication to pioglitazone OR in addition to sulphonylureas in
patients intolerant of regular and long-acting metformin and in
whom there is a contraindication to pioglitazone or
3rd line only on occupational grounds to postpone the introduction
of insulin.
Diazoxide tablet 50mg
Restricted to prescribing by Endocrinologists only for the treatment
of intractable hypoglycaemia
6.1.3 Diabetic Ketoacidosis
6.1.4 Treatment of Hypoglycaemia
Glucagon injection 1mg vial
Glucose tablets
Glucose powder
GlucoGel oral gel
Glucotabs
Polycal liquid 200mL
Replaced Hypostop®
Restricted - to patients who cannot use Glucotabs or drink Polycal
liquid.
Restricted - to patients who cannot swallow Glucotabs.
6.1.5 Treatment of Diabetic Nephropathy and Neuropathy
6.1.6 Diagnostic and Monitoring Agents for Diabetes
Mellitus
Blood Glucose Monitoring
Precision Xceed Pro blood test strips
Medisense Control solution (High/low)
For use within secondary care for blood glucose and ketone testing.
Medisense QC solution (high/low)
For use within primary care for blood glucose and ketone testing
Ascensia Contour Microfil test strip
Urinalysis
Clinitest
Diastix
Ketones
Precision Xceed Pro ketone test strips
Traffic Light list: Red
Ketodiastix
Ketostix
Protein
Miscellaneous Test Strips
Glucose Tolerance Test
6.2 THYROID and ANTITHYROID DRUGS
6.2.1 Thyroid Hormones
Albustix
Multistix 8 SG
Multistix 10 SG reagent strips
Multistix GP
Multistix SG
Glucose powder
Restricted - for use on SCBU and NICU
Restricted - for Community Midwives use only
75g lemon or plain flavour for glucose tolerance testing
Levothyroxine sodium tablets (thyroxine sodium) 25micrograms, 50 micrograms, 100micrograms
Levothyroxine sodium oral liquid 50micrograms/5mL
Liothyronine sodium tablet 20 micrograms
Liothyronine sodium injection 20 micrograms
6.2.2 Antithyroid Drugs
Carbimazole tablet 5mg, 20mg
Iodine aqueous solution
Propylthiouracil tablet 50mg
Lugol's Iodine
6.3 CORTICOSTEROIDS
6.3.1. Replacement Therapy
Fludrocortisone acetate tablet 100 micrograms
6.3.2 Glucocorticoid Therapy
Prednisolone EC tablets 2.5mg, 5mg - deleted
Prednisolone tablet 1mg, 5mg, 25mg
Prednisolone soluble tablet 5mg
Betamethasone soluble tablet 500micrograms
Betamethasone injection 4mg/1mL
FMG Apr10 decision: to delete 5mg EC tablet. FMG Aug10
decision: to delete 2.5mg EC tablet.
These will be managed and phased deletions.
Doses of 2.5mg daily may be given either as 2mg and 3mg on
alternate days or the scored 5mg tablet can be halved.
Cortisone acetate tablet 25mg
Dexamethasone tablet 500micrograms, 2mg
Dexamethasone oral solution sugar-free 2mg/5mL
Dexamethasone injection 4mg/1mL
Hydrocortisone tablet 10mg, 20mg
Hydrocortisone (as sodium phosphate) 100mg/1mL
Hydrocortisone (as sodium succinate) injection 100mg vial
Methylprednisolone tablet 100mg
Methylprednisolone (as sodium succinate) injection 40mg, 125mg, 500mg, 1g
Methylprednisolone acetate injection i.m. aqueous suspension 40mg/1mL, 80mg/2mL
(Efcortesol) (glass amps), in case of latex allergy
Restricted - 100mg tablets prescribing restricted to Consultant
Neurologists
Solu-Medroneonly.
Depo-Medrone
6.4 SEX HORMONES
6.4.1 Female sex hormones and their modulators
6.4.1.1 Oestrogens and HRT
HRT - Conjugated Oestrogens with Progestogen
HRT - Conjugated Oestrogens only
HRT - Estradiol only
Ethinylestradiol
6.4.1.2 Progestogens and progesterone receptor
modulators
Prempak-C 0.625 tablet, 1.25 tablet
Estradiol/norethisterone acetate tablet 2mg/1mg
Estradiol/norethisterone acetate tablet 1mg/500micrograms
Estradiol/norethisterone acetate self-adhesive patch releasing
50micrograms/170micrograms in 24 hours
Oestrogens conjugated tablet 625micrograms, 1.25mg
Estradiol implant 25mg, 50mg, 100mg
Estradiol valerate tablet 1mg, 2mg
Estradiol self-adhesive patch (releasing approx.25micrograms/24hours, 50micrograms/24hours,
75micrograms/24hours, 100micrograms/24hours)
Tibolone tablet 2.5mg
Ethinylestradiol tablet 10 micrograms
Kliofem
Kliovance
Evorel Conti
Evorel
Dydrogesterone tablet 10mg
Medroxyprogesterone acetate tablet 5mg, 10mg
Norethisterone tablet 1mg, 5mg
Progesterone pessary 200mg, 400mg
6.4.2 Male Sex Hormones and Antagonists
Anti-androgens
6.4.3 Anabolic Steroids
Sustanon injection i.m. (oily) 100, 250
Testosterone propionate i.m. injection 100mg/2mL
Testosterone implant 100mg, 200mg
Cyproterone acetate tablet 50mg, 100mg
Finasteride f/c tablet 5mg
Nandrolone decanoate i.m. injection(oily) 50mg/1mL
Oxandrolone tablet 2.5mg
6.5 HYPOTHALAMIC and PITUITARY HORMONE and ANTI6.5.1 Hypothalamic and Anterior Pituitary Hormones and
Anti-Oestrogens
Clomiphene citrate tablet 50mg
Anti-Oestrogens
Restricted - Named Patient basis
Anterior Pituitary Hormones-Corticotrophins
Tamoxifen citrate tablets 20mg, 40mg
Tetracosactide injection 250micrograms/1mL
Tetracosactide acetate injection (aqueous suspension) 1mg/1mL
see section 8.3.4.1
Synacthen
Synacthen Depot
Gonadotrophins
Chorionic gonadotrophin injection 5000units
Restricted - brand depends on availability. Phone Pharmacy to
Order
Gonal-F
Growth Hormone
Follitropin alfa pre-filled pen injection 900units
Somatropin injection
Hypothalamic Hormones
Gonadorelin injection 100micrograms vial
Protirelin (TRH) i.v. injection 200micrograms in 2mL
6.5.2 Posterior Pituitary Hormones and Antagonists
Argipressin (synthetic vasopressin) 20units/1mL
Desmopressin acetate injection 4micrograms/1mL
Desmopressin acetate tablet 100micrograms, 200micrograms
Desmopressin acetate nasal spray 10micrograms/metered spray
eg. Genotropin®, Humatrope®
link from Formulary homepage.
Restricted - prescribing by Consultant Endocrinologists and
Paediatricians only, in accordance with NICE TA 64 Growth
hormone (Somatropin) deficiency (adults) and NICE TA 42 Use of
human growth hormone (somatropin) in children with growth failure
and in accordance with BHT CG268 Somatropin for use in adults
only and BHT CG272 Somatropin for use in Paediatrics. Traffic
light list: Amber initiation (Adults) and Red (New paediatric patients)
Existing paediatric patients to become Red (Hospital only) from
April 2013.
Restricted - HRF brand - Named Patient basis.
Terlipressin i.v. injection 1mg
Restricted - to initiation by Consultant Gastroenterologists for
patients with bleeding varices not amenable to nonpharmacological intervention.
6.6 DRUGS AFFECTING BONE METABOLISM
Links to BHT CG 402 Osteoporosis - Primary fracture prevention guidelines in men and women
over the age of 50 with risk factors and BHT CG 403 Osteoporosis - Secondary fracture prevention
guidelines in men and women over the age of 50 who sustain fragility fracture
6.6.1 Calcitonin and Parathyroid hormone
Calcitonin (salmon) injection 100units/1mL
Calcitonin (salmon) injection 400units/2mL
Teriparatide injection 250micrograms/mL prefilled pen 2.4mL, 3mL
Traffic Light list: Red. APC May10
Traffic Light list: Red. APC May10
Restricted - to prescribing in accordance with BHT CG 403
Osteoporosis – Secondary fracture prevention guidelines in men
and women over the age of 50 who sustain fragility fracture and in
accordance with NICE TA 161 Osteoporosis - secondary
prevention.
6.6.2 Bisphosphonates and other drugs affecting bone
metabolism
Links to: BHT CG 402 Osteoporosis – Primary fracture prevention guidelines in men and women
over the age of 50 with risk factors and BHT CG 403 Osteoporosis – Secondary fracture
prevention guidelines in men and women over the age of 50 who sustain fragility fracture
Bisphosphonates
Alendronic acid tablet 70mg
Disodium etidronate tablet 200mg
Disodium pamidronate infusion 15mg, 30mg, 90mg
Etidronate disodium
Pamidronate disodium
Risedronate tablet 35mg
Restricted - for Spinal use only
see Disodium etidronate
see Disodium pamidronate
Restricted - 2nd line treatment when intolerant to Alendronate.
Sodium clodronate (disodium clodronate) capsule 400mg, 800mg
Zoledronic acid concentrate for i.v. infusion 4mg/5mL
Zometa®
Restricted - for treatment of hypercalcaemia of malignancy
Zoledronic acid i.v. infusion 5mg/100mL
Aclasta®
Restricted - to prescribing by Consultant Rheumatologists and
Endocrinologists in accordance with BHT Clinical Guideline 402
and 403 (see links above) Traffic light list: Red
Denosumab
Denosumab injection pre-filled syringe 60mg/mL
Strontium ranelate
Strontium ranelate granules, 2g sachet
Restricted - to prescribing by Rheumatologists and
Endocrinologists
only, in Rheumatologists
accordance with, and
BHTCare
CG 402
and
403
Restricted to Consultant
of the
Elderly
for treatment of post menopausal osteoporosis to reduce the risk of
vertebral and hip fractures.
6.7 OTHER ENDOCRINE DRUGS
6.7.1 Bromocriptine and Other Dopaminergic Drugs
Bromocriptine tablet 1mg, 2.5mg
Cabergoline tablet 500micrograms, 1mg, 2mg
6.7.2 Drugs Affecting Gonadotrophins
Danazol capsule 100mg, 200mg
Restricted - initiation by consultant endocrinologists and
continuation by GPs. Traffic light list: Amber initiation
Gonadorelin Analogues
Goserelin s.c. implant 3.6mg
Zoladex® (sub-cutaneous injection every 28 days)
When used for treatment of prostate cancer restricted to: neoadjuvant treatment of localised or locally advanced prostate cancer.
Traffic light list: Amber protocol.
see Section: 8.3.4.2
Goserelin s.c. implant 10.8mg
Zoladex LA® (sub-cutaneous injection every 12 weeks)
Restricted to prescribing in Primary care only (not to be prescribed
in Secondary care) and when used for treatment of prostate cancer
restricted to: neo-adjuvant treatment of localised or locally
advanced prostate cancer. Traffic light list: Amber protocol.
Triptorelin m/r intramuscular injection 3mg
Decapeptyl SR® (i.m. injection every 4 weeks)
1. When used for treatment of prostate cancer restricted to:
adjuvant treatment of localised or locally advanced prostate cancer
and the treatment of non-metastatic and advanced, metastatic
disease. Traffic light list: Amber protocol.
2. May be used for treatment of endometriosis and reducing the
size of uterine fibroids on the recomendation of Obs & Gynae team
with continuation by GPs. Traffic light list: Amber initiation
Triptorelin m/r intramuscular injection 11.25mg
Decapeptyl SR® (11.25mg i.m. injection every 3 months)
in Secondary care)
1. When used for treatment of prostate cancer restricted to:
adjuvant treatment of localised or locally advanced prostate cancer
and the treatment of non-metastatic and advanced, metastatic
disease. Traffic light list: Amber protocol.
2. May be used for treatment of endometriosis and reducing the
size of uterine fibroids on the recomendation of Obs & Gynae team
with continuation by GPs. Traffic light list: Amber initiation
6.7.3 Metyrapone
in Secondary care) only for patients who are receiving triptorelin 3
monthly as Shared Care and are deemed suitable for the 6 monthly
injections. When used for treatment of prostate cancer restricted
to: adjuvant treatment of localised or locally advanced prostate
cancer and the treatment of non-metastatic and advanced,
metastatic disease. Traffic light list: Amber protocol.
Metyrapone capsule 250mg
6.7.4 Somatomedins
CHAPTER 7 - OBSTETRICS, GYNAECOLOGY, and URINARY-TRACT DISORDERS
7.1 DRUGS USED IN OBSTETRICS
7.1.1 Prostaglandins and Oxytocics
Carboprost as trometamol salt injection 250micrograms/1mL
Dinoprostone i.v. injection 5mg/0.5mL
Dinoprostone vaginal tablets 3mg
Dinoprostone pessary (within retrieval device) releasing dinoprostone approximately 10mg over
24hours
Ergometrine maleate injection 500micrograms/1mL
Ergometrine maleate/oxytocin injection 500micrograms/5units in 1mL
Oxytocin i.v. injection 5units/1mL, 10units/1mL
7.1.1.1 Ductus arteriosus
7.1.2 Mifepristone
Propess®
Restricted - to prescribing by Obstetrics team for induction of
labour in first time mothers only, in accordance with BHT CG 415
Induction of Labour. Traffic light list: Red.
The dinoprostone 3mg tablet to be used for induction of labour in
women who are giving birth for the second or subsequent time.
Syntometrine
If 10units/mL is to be given as an intramuscular injection this is an
unlicensed use (Low risk) and restricted to Gynaecology team only.
Refer to NICE Clinical Guideline 55: Intrapartum Care. Red traffic
light list.
Indometacin sodium trihydrate injection 1mg
1st Choice
Closure of Ductus Arteriosus - refer to Guidelines on SCBU for
closure of patent ductus arteriosus
Ibuprofen injection 10mg in 2mL
2nd Choice
Restricted - unlicensed, named patient basis
Misoprostol tablets 100micrograms, 200micrograms
Unlicensed (100mg)
Restricted to patients being treated under Cons. Obstetricians for
late foetal death. Please refer to protocol in dispensary.
100micrograms tablet to be purchased from IDIS and recorded in
unlicensed medicine file. Unlicensed Use - see protocol 1/5/03
Mifepristone tablets 200mg
7.1.3 Myometrial relaxants
7.2 TREATMENT of VAGINAL and VULVAL CONDITIONS
7.2.1 Preparations for Vaginal and Vulval changes
7.2.2 Vaginal and Vulval Infections
Vaginal and Vulval Candiasis
Ritodrine hydrochloride injection 50mg/5mL
Terbutaline sulphate injection 500micrograms/1mL
Nifedipine MR tablets 20mg
See section 3.1.1.1
See section 2.6.2
Estriol intravaginal cream 0.01%, 80g
Gynest
Estriol intravaginal cream 0.1%, 15g
Ovestin
Estradiol vaginal tablet 10micrograms, 25 micrograms
Vagifem
Clotrimazole pessaries 100mg, 6's
1st Choice
Clotrimazole pessary 500mg
Clotrimazole cream (topical) 1%
Fluconazole capsule 150mg
Miconazole nitrate pessary 100mg
Miconazole nitrate intravaginal cream 2%
Other Vaginal Infections
Restricted to Family Planning (Dr Curtis) or SMH Obs & Gynae
Consultants only. Refer to Pharmacy for specific supply details and
records to be kept
Diflucan See Section 5.2
2nd Choice
Restricted - Paediatrics and Obstetrics & Gynaecology.
Clindamycin phosphate vaginal cream 2%
Metronidazole vaginal gel 0.75%
Povidone-iodine vaginal cleansing kit 10%
Triple sulfa cream
Sultrin cream
Ethinylestradiol 20micrograms with desogestrel 150micrograms
Ethinylestradiol 20micrograms with gestodene 75micrograms
Gedarel 20/150®
Millinette®20/75
Ethinylestradiol 20micrograms with norethisterone acetate 1mg
Restricted
(Femodette® and Sunya®20/75) - for continuation only
Loestrin 20®
7.3 CONTRACEPTIVES
7.3.1 Combined Hormonal Contraceptives
Monophasic - low strength
Monophasic - standard strength
Ethinylestradiol 30micrograms with desogestrel 150micrograms
Gedarel 30/150®
Ethinylestradiol 30micrograms with drospirenone 3mg
Yasmin®
Restricted
- for continuation only.
Millinette 30/75®
Ethinylestradiol 30micrograms with gestodene 75micrograms
Ethinylestradiol 30micrograms with levonorgestrel 150micrograms
Ethinylestradiol 30micrograms with norethisterone acetate 1.5mg
Rigevidon®
Ovranette®
Loestrin 30®
Ethinylestradiol 35micrograms with norgestimate 250micrograms
Cilest®
Ethinylestradiol 35micrograms with norethisterone 500micrograms
Ovysmen®
Ethinylestradiol 35micrograms with norethisterone 1mg
Norimin®
Mestranol 50micrograms with norethisterone 1mg
Norinyl-1®
Phasic - standard strength
Standard strength phasic preparations are only available for continuation and not for initiation.
Brands include: Triadene®, Logynon®, Logynon ED®, TriRegol®, BiNovum®, Synphase® and
TriNovum®
Transdermal - standard strength
Ethinylestradiol and norelgestromin patch
Evra®
Restricted - for use in patients suffering from malabsorption where
the oral contraceptive may not be effective eg. irritable bowel
disease.
Etynodiol diacetate 500micrograms
Desogestrel 75micrograms
Femulen®
Cerazette®
Restricted - prescribe only for women:
in whom oestrogens are not suitable AND
below 35 years AND
declined or unsuitable for LARCs AND
in whom there is evidence of poor compliance with other pills,
demonstrated by the use of emergency hormonal contraception or
unwanted pregnancy.
OR it may be used prior to using an implant with the same
progestogen in order to ascertain tolerance of that same
progestogen.
Levonorgestrel 30micrograms
Norethisterone 350micrograms
Norgeston®
Micronor®
Medroxyprogesterone acetate i.m. injection 150mg/1mL vial and pre-filled syringe
Depo-Provera
Etonorgestrel 68mg in radiopaque flexible rod
Nexplanon®
7.3.2 Progestogen-Only Contraceptives
7.3.2.1 Oral Progestogen-Only Contraceptives
7.3.2.2. Parenteral Progestogen-Only Contraceptives
Intra-Uterine Progestogen-Only System (Mirena)
Restricted - to Family Planning and Obs & Gynae
Consultants/SPR's only
7.3.4 Contraceptive Devices
Multiload Cu375
Copper IUD (Intra-uterine device)
7.3.5 Emergency Contraception
Levonorgestrel tablet 1.5mg
Ulipristal acetate tablet 30mg
Levonelle 1500®
EllaOne®
Restricted - prescribing in BHT by A&E and GUM consultants and
by GPs and Family Planning Clinics, for the prevention of
pregnancy after unprotected intercourse when patients present at
more than 72 hours and less than 120 hours and an IUD is not a
suitable option.
7.3.2.3 Intra-Uterine Progestogen-Only Device
7.3.3 Spermicidal Contraceptives
7.4 DRUGS for GENITO-URINARY DISORDERS
7.4.1 Drugs for Urinary Retention
Alpha-blockers
Alfuzosin hydrochloride tablet 2.5mg
Alfuzosin hydrochloride MR tablet 10mg
Doxazosin
Indoramin tablet f/c 20mg
Tamsulosin hydrochloride MR capsules 400micrograms
Terazosin to be evaluated for use in Urology only
see Section 2.5.4
Parasympathomimetics
Distigmine bromide tablet 5mg
7.4.2. Drugs for Urinary Frequency, Enuresis and
Incontinence
For further information on the treatment of over-active bladder see Antimuscarinic drug treatment, part of the primary care Urinary Incontinence Pathway.
Darifenacin tablet 7.5mg, 15mg
Oxybutynin hydrochloride tablet 2.5mg, 5mg
Oxybutynin hydrochloride tablet MR, 5mg, 10mg
Restricted - for Spinal use
Restricted - for use on the Spinal Unit or Consultant Only
prescribing when the ordinary tablets are not suitable or there are
problems with compliance.
Oxybutynin hydrochloride elixir 2.5mg/5mL, 5mg/5mL
Propantheline bromide tablet 15mg
Solifenacin succinate tablet 5mg, 10mg
5mg in 5ml - Unlicensed - Low Risk
see Section 1.2
Restricted - prescribing by Urologists and Uro-gynaecologists only,
in accordance with Antimuscarinic drug treatment section of Urinary
Incontinence Pathway.
Tolterodine tartrate f/c tablet 1mg, 2mg
Restricted - 2nd line treatment of bladder instability where
oxybutynin has failed due to adverse effects
Tolterodine tartrate MR capsule 4mg
7.4.3 Drugs Used in Urological Pain
Potassium Citrate oral solution 3g/10mL
7.4.4 Bladder Instillations and Urological Surgery
Alum Bladder washout 10%
Urological Surgery
Sodium Citrate solution, sterile for bladder irrigation, uromatic 1L
Glycine Irrigation sterile solution 1.5%, 2L, 3L
Maintenance of Indwelling Urinary Catheters
Restricted - 2nd line treatment of bladder instability where
oxybutynin has failed due to adverse effects
Chlorhexidine catheter patency solution 0.02%, 100mL
Chlorhexidine sterile solution 0.02% 500mL
Sodium chloride (flowfusor) sterile solution 0.9% 2L
Sodium chloride irrigation 3L bag (new style) uromatic sterile solution 0.9%
Sodium chloride (flowfusor) sterile solution 0.9% 1L
Sodium chloride irrigation 0.9% (pourbottle) 1000mL
Sodium chloride (Urotainer 50mL) 0.9% irrigation
Sodium chloride (Urotainer 100mL) 0.9% irrigation
Solution G catheter patency solution, 100mL
Solution R catheter patency solution, 100mL
Water for irrigation uromatic s/port 1L
7.4.5 Drugs for Erectile Dysfunction
Alprostadil intracavernosal injection 10 micrograms, 20 micrograms
Caverject Dual Chamber
Traffic light list: Red for all psychological indications and AI for all
SLS indications
Alprostadil urethral application 500micrograms
MUSE
Traffic light list: Red for all psychological indications and AI for all
SLS indications
Sildenafil tablets 25mg, 50mg, 100mg
Secondary care: Restricted - to Spinal Patients only, see
Guidelines from DoH. Doses are provided for the initial dose
calibration and then for Spinal In-patients on weekend leave (2
doses per weekend) only.
Tadalafil tablet 2.5mg, 5mg, 10mg, 20mg
Restricted - to 3rd line treatment of ED when both sildenafil and
vardenafil have failed in accordance with ED algorithm. In hospital
to be restricted to use by Spinal patients only on weekend leave.
Vardenafil tablet 5mg, 10mg, 20mg
Restricted - to 2nd line treatment of ED when both sildenafil and
vardenafil have failed in accordance with ED algorithm. In hospital
to be restricted to use by Spinal patients only on weekend leave.
Papaverine injection 30mg/2mL
Papaverine and Phentolamine injection 30mg/1mg in 2mL
Unlicensed
CHAPTER 8 - MALIGNANT DISEASE and IMMUNOSUPPRESSION
8.1 CYTOTOXIC DRUGS
Drugs for Cytotoxic-induced Side-Effects
Methotrexate-induced mucositis and myelosuppression
Please refer to Appendix 11 of the BHT Medicines Policy for full details of policies and procedures for the prescribing, preparation and administration of chemotherapy (including
intrathecal chemotherapy).
Folinic acid tablets 15mg
Restricted - Retain only for Methotrexate rescue therapy (15mg
tabs and injections)
Calcium folinate (folinic acid) injection 15mg/2mL, 30mg/30mL, 50mg/5mL, 100mg/10mL,
300mg/30mL, 350mg/35mL
Calcium levofolinate (levofolinic acid) injection 50mg/5mL, 175mg/17.5mL
Urothelial toxicity
8.1.1 Alkylating Drugs
Mesna tablet f/c 400mg, 600mg
Mesna i.v. injection 400mg/4mL, 1000mg/10mL
Bendamustine injection 25mg, 100mg
Busulfan tablet f/c 2mg
Carmustine iv injection 100mg
Carmustine implant 7.7mg
Chlorambucil f/c tablet 2mg
Cyclophosphamide tablet 50mg
Cyclophosphamide injection 500mg, 1g
Cyclophosphamide injection 4000mg/200mL
Ifosfamide injection 1g, 2g
Lomustine capsule 40mg
FOR ALL PRESCRIBING: NICE compliance to be verified.
Restricted - prescribing by Oncologists only, in accordance with
NICE TA 216 Bendamustine for the first line treatment of chronic
lymphocytic leukaemia. Traffic light list: Red
NICE TA 121 Carmustine implants and temozolomide for the
treatment of newly diagnosed high grade glioma.
When prescribed by Rheumatology: Traffic light list: Red
see Section 10.1.3
When prescribed by Rheumatology: Traffic light list: Red
see Section 10.1.4
Restricted - Unlicensed - High Risk, name patient basis only.
Melphalan tablet 2mg
Melphalan injection 50mg
8.1.2 Anthracyclines and other Cytotoxic Antibiotics
Bleomycin injection 15,000units
Dactinomycin injection 500micrograms
Daunorubicin injection 20mg
Doxorubicin hydrochloride injection 10mg/5mL, 50mg/25mL
Doxorubicin hydrochloride (encapsulated in lipsomes) 20mg, 50mg
Epirubicin hydrochloride injection 10mg/5mL, 50mg/25mL, 100mg/50mL, 200mg/100mL
Idarubicin hydrochloride capsule 5mg, 10mg
Idarubicin hydrochloride injection 5mg, 10mg
Mitomycin injection 2mg, 10mg, 40mg
Doxorubicin Solution for Injection
Use 40mg strength for bladder instillations
Mitoxantrone concentrate for i.v. infusion 20mg/10mL, 25mg/12.5mL
8.1.3 Antimetabolites
Azacitidine injection 100mg vial
Restricted - prescribing by Consultant Haematologists in
accordance with NICE TA 218 Myelodysplastic syndromes Azacitidine. Traffic light list: Red
Capecitabine f/c tablet 150mg, 500mg
1. Restricted - metastatic breast cancer.
2. Restricted - prescribing by Oncologists only, in accordance with
NICE TA 191 Capecitabine for the treatment of advanced gastric
cancer. NICE compliance form required - see link from Formulary
homepage
Cladribine infusion 10mg/10mL
Cytarabine injection 100mg/5mL
Cytarabine injection 500mg/5mL, 1000mg/10mL.
Fludarabine phosphate f/c tablet 10mg
Fludarabine phosphate injection 50mg
Fluorouracil injection 250mg/10mL, 500mg/20mL, 2.5g/100mL
Fluorouracil injection 500mg/10mL, 2.5g/50mL, 5g/100mL
Gemcitabine injection 200mg, 1g
Mercaptopurine tablet 10mg, 50mg
For cancer: 25mg/1mL and
for ophthalmic 50mg/1mL
Restricted - in accordance with NICE guidelines for pancreatic
cancer and Non SCLC with carboplatin
10 mg tablet - Unlicensed - High Risk
Restricted - available on named patient basis.
Mercaptopurine capsule 10mg
Mercaptopurine suspension 50mg/5mL, 100mg/5mL
Methotrexate injection 5mg/2mL, 50mg/2mL
Methotrexate oral formulations
10mg in 5ml and 15mg in 5ml mixture both unlicensed - High Risk
see Section 10.1.3
Pemetrexed injection 500mg
1. Restricted - Consultant Oncologist prescribing only in
accordance with NICE TA 181 Pemetrexed for the first-line
treatment of non-small-cell lung cancer. NICE compliance form
required - see link from Formulary homepage. Traffic light list: Red
NICE TA 190 Pemetrexed for maintenance treatment of non-smallcell lung cancer. NICE compliance form required - see link from
Formulary homepage.
NICE TA 135 Pemetrexed for the treatment of malignant pleural
mesothelioma. NICE compliance to be verified.
Tioguanine tablet 40mg
Tioguanine suspension 50mg/5mL
8.1.4 Vinca Alkaloids and Etoposide
Etoposide capsule 50mg, 100mg
Etoposide concentrate for i.v. infusion 100mg/5mL
Vinblastine sulphate injection 10mg/10mL
Vinblastine sulphate injection 10mg/50mL
Vincristine sulphate injection 1mg/1mL
Vincristine sulphate pre-filled syringe 1mg/20mL, 2mg/mL
Vinorelbine tartrate injection concentrate 10mg/1mL, 50mg/5mL
Vinorelbine capsules 20mg, 30mg, 80mg
Restricted - only to be issued when Pharmacy unable to prepare in
Aseptic Unit.
Restricted - in accordance with NICE guidelines for treatment of
advanced breast cancer.
FOR ALL PRESCRIBING: NICE compliance to be verified.
Restricted - prescribing by Consultant Oncologists (Breast) in
accordance with NICE CG 81 Advanced breast cancer diagnosis
and treatment and TVCN Breast cancer protocol. Traffic light list:
Red
8.1.5 Other Antineoplastic Drugs
Amsacrine
Bevacizumab
Amsacrine infusion 75mg/1.5mL
Bevacizumab concentrate for infusion 100mg/4mL, 400mg/16mL
Restricted - prescribing by Consultant Oncologists
(gastro/colorectal) only in accordance with NICE TA 212
Bevacizumab in combination with oxaliplatin and either fluorouracil
plus folinic acid or capecitabine for the treatment of metastatic
colorectal cancer. Traffic light list: Red.
Bortezomib
Bortezomib injection 3.5mg vial
1. Restricted - prescribing by Haematologists in accordance with
TVCN protocols
2. Restricted - prescribing by Haematologists only in accordance
with NICE TA 228 Bortezomib and thalidomide for the first-line
treatment of multiple myeloma. NICE compliance form required see link from Formulary homepage. NICE compliance to be
verified if form not yet available. Traffic light list: Red
Cetuximab
Cetuximab i.v. Infusion 100mg/20mL, 500mg/100mL
Restricted - prescribing by Consultant Oncologists only, in
accordance with NICE TA 176 Cetuximab for the first line treatment
of metastatic colorectal cancer. Traffic light list: Red.
Crisantaspase
Asparaginase injection 10,000units
Restricted - Haematology Consultants only
Asparaginase E.coli injection 5,000units
Peg-asparaginase 3750units injection
Restricted - Haematology Consultants only
Restricted - Haematology Consultants Treatment of childhood ALL
in MRC UK ALL 2003 trial (inpatients only) Named Patient basis.
Dacarbazine and temozolomide
Dacarbazine injection 200mg, 500mg
Temozolomide capsule 5mg, 20mg, 100mg, 250mg
Hydroxycarbamide
Hydroxycarbamide capsule 500mg
Ipilimumab
Ipilimumab concentrate for IV infusion vial 50mg/10mL, 200mg/40mL
Pentostatin
Pentostatin injection 10mg vial
Platinum compounds
Carboplatin injection 50mg/5mL, 150mg/15mL, 450mg/45mL, 600mg/60mL
1. Restricted - in accordance with NICE guidelines
NICE TA 121 Carmustine implants and temozolomide for the
treatment of newly diagnosed high grade glioma. NICE compliance
to be verified
Hydroxyurea
Restricted - prescribing by ORH Oncology consultants in
accordance with TVCN protocl and NICE TA 268 Ipilimumab for
previously treated advanced (unresectable or metastatic)
melanoma. Traffic light list: Red
Restricted - Initiation by Consultant Haematologists or in specialist
centres
Cisplatin i.v. injection 100mg/100mL
Cisplatin injection 10mg/10mL, 50mg/50mL
Oxaliplatin injection 50mg, 100mg vial
Procarbazine
Procarbazine capsule 50mg
Restricted - in accordance with NICE guidelines.
Protein kinase inhibitors
Erlotinib tablet 25mg, 100mg, 150mg
NOTE: Erlotinib may only be prescribed following prior approval
from PCT.
Restricted - Consultant Oncologist prescribing only, as alternative
to docetaxel for second line treatment of NSCLC in accordance
with NICE TA 162 Erlotinib for the treatment of non-small-cell lung
cancer and TVCN protocol. Traffic light list: Red
Gefitinib tablet 250mg
NICE TA 192 Gefitinib for the first-line treatment of locally
advanced or metastatic non-small-cell-lung cancer.
Imatinib f/c tablet 100mg, 400mg
accordance with NICE TA 251 Dasatanib, standard dose imatinib
and nilotinib for CML (dasatanib not recommended). Traffic light
list: Red
Restricted - Initiation by Haematology/Oncology consultants
1st Line in CmL and GIST. Updated by NICE Oct 2003 & Oct 2004.
Nilotinib capsules 150mg, 200mg
1. Restricted - prescribing by Consultant Haematologists in
accordance with NICE TA 251 Dasatanib, standard dose imatinib
and nilotinib for CML (dasatanib not recommended). Traffic light
list: Red
2. Restricted - prescribing by Consultant Haematologists in
accordance with NICE TA 241 Dasatanib, high dose imatinib and
nilotinib for CML (dasatanib and high dose imatinib not
recommended). Traffic light list: Red
Taxanes
Pazopanib tablet 200mg, 400mg
Restricted - prescribing by Renal Oncologists in accordance with
NICE TA 215 Pazopanib for first line treatment of metastatic renal
cell carcinoma. Traffic light list: Red.
.
Sunitinib tablet 12.5mg, 25mg, 5 mg
1. Restricted - Consultant Oncologist prescribing only, for 1st line
treatment of advanced or metastatic renal cell carcinoma in
accordance with NICE TA 169 Sunitinib for first line treatment of
advanced and/or metastatic renal cell carcinoma, March 2009 and
TVCN protocol. Red traffic light list
2. Restricted - in accordance with NICE TA 179 – Sunitinib for the
treatment of gastrointestinal stromal tumours. Traffic light list: Red
Vemurafenib tablet 240mg
Restricted - prescribing by ORH Oncology consultants in
accordance with TVCN protocl and NICE TA 269 Vemurafenib for
treating locally advanced or metastatic BRAF V600 mutationpositive malignant melanoma. Traffic light list: Red
Docetaxel concentrate for i.v. infusion 20mg/0.5mL, 80mg/2mL
Restricted - in accordance with NICE guidelines. For nsclc - 2nd
line treatment
Restricted - prescribing by Consultant Breast Oncologists in
accordance with TVCN protocol for advanced / metastatic breast
cancer as an alternative to docetaxel. Traffic light list: Red.
Paclitaxel concentrate for i.v. infusion 30mg/5mL, 100mg/16.7mL, 300mg/50mL
Topoisomerase I Inhibitors
Irinotecan hydrochloride concentrate for i.v.infusion 40mg/2mL, 100mg/5mL
Topotecan i.v. infusion 4mg vial
Topotecan capsules 250micrograms, 1mg
link from
homepage
FOR
ALLFormulary
PRESCRIBING:
NICE compliance form required - see
Restricted - prescribing by Consultant Oncologists (Lung) only, in
accordance with NICE TA 184 Topotecan (oral) for treatment of
relapsed small-cell lung cancer. Traffic light list: Red
Trastuzumab
Tretinoin
8.2 DRUGS AFFECTING the IMMUNE RESPONSE
8.2.1 Antiproliferative Immunosuppressants
Trastuzumab i.v. injection 150mg
1. Restricted - for use in accordance with NICE TA34 for advanced
breast cancer. Traffic light list: Red
2. Restricted - for use in accordance with NICE 107 for the
adjuvant treatment of earlystage HER2-positive breast cancer.
3. Restricted - to prescribing by Consultant Oncologists (Gastro)
only in accordance with NICE TA 208 Trastuzumab for the
treatment of HER-2 positive metastatic gastric cancer. NICE
compliance to be verified. Traffic light list: Red
Tretinoin capsule 10mg
Restricted - as per AmL 15 Trial protocol
Azathioprine tablet 25mg, 50mg
Azathioprine injection 50mg vial
Azathioprine suspension 15mg/5mL
Restricted - Consultant Dermatologist and Rheumatologist
prescribing only. Traffic light list: Red
Mycophenolate mofetil capsule 250mg, tablet 500mg
8.2.2 Corticosteroids and Other Immunosuppressants
Anti-thymocyte immunoglobulin rabbit (atg) infusion 25mg
Restricted - Renal Patients Only, Phone Pharmacy to Order
Anti-thymocyte immunoglobulin equine infusion 100mg/5mL
Anti-lymphocyte globulin equine (alg) infusion 100mg/5mL
Ciclosporin capsule 10mg, 25mg, 50mg, 100mg
Neoral
All products that contain ciclosporin should be prescribed by brand
name to minimise the risk of inadvertent switching between brands,
and to reflect advice in the British National Formulary.
Ciclosporin oral solution sugar-free 100mg/1mL
Ciclosporin concentrate for i.v. infusion 50mg/1mL, 250mg/5mL
Sandimmun
and to reflect advice in the British National Formulary
Tacrolimus capsule 500micrograms, 1mg, 5mg
Prograf®
1. Restricted - to transplant patients on a continuation of supply
basis only.
2. Restricted to prescribing by Consultant Dermatologists (see
Section 13.5.3). Traffic light list: Red
8.2.3 Rituximab and Alemtuzumab
Rituximab concentrate for i.v. infusion 100mg/10mL, 500mg/50mL
1. Restricted - prescribing by Haematologists only, in accordance
with NICE TA 174 Rituximab for first line treatment of chronic
lymphocytic leukaemia.
2. Restricted - prescribing by Haematologists and Oncologists only,
in accordance with NICE TA 193 Rituximab for the treatment of
relapsed or refractory chronic lymphocytic leukaemia.
with NICE TA137 Rituximab for the treatment of relapsed or
refractory stage III or IV follicular non-Hodgkin’s lymphoma (review
of TA 37)
with NICE TA 226 Rituximab for the treatment of follicular nonHodgkins lymphoma (maintenance treatment following response to
first-line chemotherapy)
with NICE TA 243 Follicular lymphoma.
FOR ALL: Traffic light list: Red (Cytotoxics for the treatment of
malignancy)
See Section 10.1.3 (for Rheumatology)
8.2.4 Other Immunomodulating Drugs
Interferon alfa - interferon alfa
Interferon alfa - peginterferon alfa
Interferon alfa-2b injection multidose pen 15million units, 18million units
Intron A
Interferon alfa-2a pre-filled syringe s.c. injection 3million, 4.5million, 6million and 9 million units
Roferon
Peginterferon alfa 2a prefilled syringe, 135micrograms, 180micrograms
Pegasys®
Restricted - prescribing by Gastroenterologists and Associate
Specialist Gastroenterology in accordance with NICE TA 75
Interferon alfa and ribavirin for the treatment of chronic hepatitis,
mild hepatitis C and NICE TA 200 Hepatitis C - peginterferon alfa
and ribavirin.
Peginterferon alfa-2b prefilled pen 50micrograms, 80micrograms, 100micrograms, 120micrograms, ViraferonPeg®
150micrograms
Restricted - prescribing by Gastroenterologists and Associate
Specialist Gastroenterology in accordance with NICE TA 75
Interferon alfa and ribavirin for the treatment of chronic hepatitis,
mild hepatitis C and NICE TA 200 Hepatitis C - peginterferon alfa
and ribavirin.
Interferon beta - interferon beta-1a
Interferon beta-1a i.m. injection 6million units (30micrograms) 0.5mL prefilled syringe
Avonex
FOR ALL PRESCRIBING - NICE compliance to be verified if form
not yet available.
Restricted - prescribing by Neurologists only for RRMS and SPMS
(Mutilple Sclerosis) and in accordance with ABN MS guidelines
2001 and BHT CG MS Algorithm
Interferon beta - interferon beta-1b
Interferon beta-1b s.c. injection 9.6million units (300micrograms) vial
Betaferon - Restricted - for use in patients with Multiple Sclerosis
only in accordance with BHT CG MS Algorithm
Interferon gamma - interferon gamma-1b
Interferon gamma-1b 200micrograms/1mL, 0.5mL vial
BCG Bladder Instillation
Bacillus Calmette-Guérin bladder instillation 81mg vial
ImmuCyst®
Restricted - prescribing by consultant urologists only, for use in
accordance with Bucks best possible practice non muscle invasive
bladder cancer care pathway 2010. Traffic light list: Red.
Fingolimod
Fingolimod capsule 500micrograms
not yet available.
Restricted - prescribing by Neurologists only in accordance with
NICE TA 254 and BHT CG MS Algorithm. Traffic light list: Red
Glatiramer acetate
Glatiramer acetate injection 20mg/mL prefilled syringe
Copaxone
Lenalidomide and thalidomide
Natalizumab
8.3 SEX HORMONES AND HORMONE ANTAGONISTS IN
8.3.1 Oestrogens
8.3.2 Progestogens
8.3.3 Androgens
8.3.4 Hormone Antagonists
8.3.4.1 Breast Cancer
Lenalidomide capsule 5mg, 10mg, 15mg, 25mg
not yet available.
Restricted - Consultant Haematologist prescribing only, for
relapsed or refractory myeloma in accordance with NICE TA 171
Lenalidomide for the treatment of multiple myeloma in people who
have received at least one prior treatment and TVCN protocol.
Red traffic light list.
Thalidomide capsule 50mg
Thalidomide Celgene®
NOTE: Patient, prescriber and supplying pharmacy must comply
with a pregnancy prevention programme. Every prescription must
be accompanied by a complete Prescription Authorisation Form.
1. Restricted -to prescibing by Oncologists only.
2. Restricted - prescribing by Haematologists only in accordance
with NICE TA 228 Bortezomib and thalidomide for the first-line
treatment of multiple myeloma . NICE compliance form required see link from Formulary homepage. Traffic light list: Red
Natalizumab concentrate for intravenous infusion, 300mg in 15mL
Restricted - prescribing by consultant neurologist in accordance
with BHT Clinical Guideline 212.1 Natalizumab for the treatment of
adults with highly active, relapsing, remitting Multiple Sclerosis and
BHT CG MS Algorithm. NOTE: to be dispensed only when funding
confirmation is received for each patient. Named patient basis.
Diethylstilbestrol tablet 1mg, 5mg
Ethinylestradiol
Restricted - Breast and Prostate cancer
Restricted - Prostate cancer
See section 6.4.1.1
Medroxyprogesterone acetate tablet 100mg, 400mg
Medroxyprogesterone acetate i.m. injection 500mg/2.5mL
Megesterol acetate tablet 40mg, 160mg
Norethisterone
Aminoglutethimide tablet 250mg
Anastrozole tablet f/c 1mg
see Section 6.4.1.2
8.3.4.2 Prostate Cancer and Gonadorelin Analogues
Exemestane tablet 25mg
Restricted - prescribing by Consultants in Breast Surgery or Breast
Oncology. Traffic Light list: Amber recommendation.
Letrozole tablet 2.5mg
Restricted - prescribing by Consultants in Breast Surgery or Breast
Oncology. Traffic Light list: Amber initiation.
Tamoxifen tablet 10mg, 20mg
Tamoxifen oral solution 10mg/5mL
Abiraterone acetate tablet 250mg
Bicalutamide f/c tablet 50mg, 150mg
Restricted - prescribing by Consultant Oncologists for patients with
prostate cancer in accordance with NICE TA 259 Abiraterone
acetate for castration-resistant metastatic prostate cancer
previously treated with a docetaxel-containing regime. Traffic light
list: Red
2nd line treatment of advanced prostate cancer.
Note: Flutamide is 1st line treatment for all patients with tumour
flare in advanced prostate cancer.
Cyproterone acetate tablet 50mg,100mg
Flutamide tablet 250mg
1st line treatment for all patients with tumour flare in advanced
prostate cancer.
8.3.4.3 Somatostatin Analogues
Goserelin implant 3.6mg
Zoladex® (sub-cutaneous injection every 28 days)
When used for treatment of prostate cancer restricted to: neoadjuvant treatment of localised or locally advanced prostate cancer.
see Section 6.7.2 (Endocrine uses)
Goserelin implant 10.8mg
Zoladex LA® (sub-cutaneous injection every 12 weeks)
restricted to: neo-adjuvant treatment of localised or locally
advanced prostate cancer. Traffic light list: Amber protocol.
Decapeptyl SR® (i.m. injection every 4 weeks)
When used for treatment of prostate cancer restricted to: adjuvant
treatment of localised or locally advanced prostate cancer and the
treatment of non-metastatic and advanced, metastatic disease.
restricted to: adjuvant treatment of localised or locally advanced
prostate cancer and the treatment of non-metastatic and advanced,
in Secondary care) only for patients who are receiving triptorelin 3
monthly as Shared Care and are deemed suitable for the 6 monthly
injections. When used for treatment of prostate cancer restricted
to: adjuvant treatment of localised or locally advanced prostate
cancer and the treatment of non-metastatic and advanced,
Octreotide injection 50micrograms/1mL, 100micrograms/1mL, 500micrograms/1mL, 1mg/5mL
CHAPTER 9 - NUTRITION and BLOOD
9.1 ANAEMIAS and some OTHER BLOOD DISORDERS
9.1.1 Iron-Deficiency Anaemias
9.1.1.1 Oral Iron
Equivalent to 65mg iron
Equivalent to 68mg iron
Equivalent to 45mg iron in 5mL
Iron and Folic Acid
Ferrous sulphate tablet 200mg
Ferrous fumarate tablet 210mg
Ferrous fumarate syrup 140mg/5mL
Sodium feredetate elixir sugar-free 190mg/5mL (equivalent to 27.5mg iron in 5mL)
Ferrous fumarate/folic acid f/c tablet, 322mg (equivalent to 100mg iron) / 350micrograms
9.1.1.2 Parenteral Iron
Ferric carboxymaltose injection 100mg/2mL, 500mg/10mL
Ferinject
Restricted - prescribing by Haematology team only in accordance
with BHT CG 58 Parenteral Iron for Iron Deficiency Anaemia.
Iron (as iron sucrose) injection 100mg/5mL
Iron (as iron dextran) injection 100mg/2mL
Venofer
CosmoFer
9.1.2 Drugs Used in Megaloblastic Anaemias
Hydroxocobalamin i.m. injection 1mg/1mL
Cyanocobalamin tablet 50micrograms
Folic acid tablet 400 microgram, 5mg
Folic acid sugar-free syrup 2.5mg/5mL
Folic acid injection 15mg/1mL
9.1.3 Drugs Used in Hypoplastic, Haemolytic and Renal
Anaemias
Pregaday
Restricted - in accordance with BNF
Darbepoetin alfa 10,15,20,30,40,50,60,80,100,150 microgram pre-filled syringe
For Oxford Renal patients -Traffic Light list: Red
for all other patients - Traffic light list: Amber initiation.
Restricted - prescribing by Haematologists only, in accordance with
NICE TA 142 Epoetin alfa, epoetin beta and darbepoetin alfa for
cancer treatment-induced anaemia. NICE compliance form
required - see link from Formulary homepage
Epoetin alfa injection pre-filled syringe, 1000units, 2000units, 3000units, 4000units, 5000units,
6000units
Epoetin beta injection pre-filled syringe 500units
Restricted - prescribing by Paediatricians only and only for use in
NICU. Traffic light list: Red
Epoetin beta injection pre-filled syringe 1000units, 2000units, 3000units, 5000units, 6000units
Restricted - paediatric use
Iron Overload
Desferrioxamine mesilate injection 500mg, 2g vial
Iron Overload
9.1.4 Drugs Used in Platelet Disorders
Romiplostim injection 250microgram vial
accordance with NICE TA 221 Romiplostim for the treatment of
chronic immune or idiopathic thrombocytopenic purpura.
Erythropoietin
9.1.5 G6PD Deficiency
9.1.6. Drugs Used in Neutropenia
NOTE: Currently there are national supply issues with filgrastim. Where Ratiograstim was
specified in the formulary this is amended to “bio-similar” filgrastim (eg. Ratiograstim, Tevagrastim
or Nivestim). Pharmacy will endeavour to supply the same brand for each 5 to 7 day course
prescribed. In addition there are supply issues with Neupogen brand of filgrastim and Pharmacy
will retain present stock for stem cell transplant patients and inform Haematology if unable to
supply Neupogen brand.
Filgrastim injection 30 million-units (300 micrograms)/1 mL,
Neupogen®
Restricted - for stem cell harvesting and to be prescribed by brand
name by Consultant Haematologist and Oncologist in accordance
with TVCN protocol and BNF advice. Traffic light list: Red.
Filgrastim injection 30 million-units (300 micrograms)/0.5 mL prefilled syringe, 48 milllion-units (480
micrograms)/0.5
mL30prefilled
syringe
Filgrastim injection
million-units
(300 micrograms)/0.5 mL prefilled syringe, 48 milllion-units (480
micrograms)/0.8 mL prefilled syringe
Neupogen®
Restricted
- fororstem
cell harvesting
and to be-bio-similar
prescribed brands
by brand
Ratiograstim®
Tevagrastim®
or Nivestim®
Restricted - for cytotoxic induced neutropenia and to be prescribed
by brand name by Consultant Haematologist and Oncologist in
accordance with TVCN protocol and BNF advice. Traffic light list:
Red.
9.1.7 Drugs Used to Mobilise Stem Cells
9.2 FLUIDS and ELECTROLYTES
Water irrigation, easy flow 1L
Water (bags) irrigation 3L
Water (flowfusor) 2L
Water pour bottle 1L
9.2.1 Oral Preparations for Fluid and Electrolyte
Imbalance
9.2.1.1 Oral Potassium
Potassium chloride syrup sugar-free 7.5% (1mmol/1mL each of K+ and Cl-)
Potassium chloride MR tablet 600mg (8mmol each of K+ and Cl- )
Potassium removal
Potassium effervescent tablet (12mmol of K+ and 8mmol of Cl-)
Calcium polystyrene sulphonate powder
9.2.1.2 Oral Sodium and Water
Sodium chloride oral solution 30% (contains 5mmol/1mL)
Oral Rehydration Therapy (ORT)
Sodium chloride MR tablet 600mg (approximately 10mmol each of Na+ and Cl-)
Oral rehydration powder sachets
9.2.1.3 Oral Bicarbonate
Sodium bicarbonate tablet 600mg
Restricted to patients who can swallow well and take the tablets
while standing upright
Sando-K
Calcium Resonium
Restricted - for sodium replacement via n/g, n/j tubes
Product in stock depends on manufacturer availability
Sodium bicarbonate capsule 500mg (approx. 6mmol each of Na+ and HCO3-)
9.2.2 Parenteral Preparations for Fluid and Electrolyte
Imbalance
9.2.2.1 Electrolytes and Water
Intravenous Sodium
Sodium acetate injection 30%
Sodium chloride infusion 0.45%, 500mL
Sodium chloride infusion 0.9%, 5mL, 10mL, 20mL amps; 50mL, 100mL vials; 50mL, 100mL,
250mL, 500mL, 1L infusion bags
Sodium chloride infusion 1.8%, 500mL polyfusor
Sodium chloride/glucose infusion 0.18%/4%, 500mL,1L
Sodium chloride/glucose infusion 0.45%/2.5%, 500mL
Sodium chloride/glucose infusion 0.18%/10%, 500mL
Sodium chloride/glucose infusion 0.45%/5%, 500mL
Sodium lactate infusion, compound 500mL, 1L (Hartmanns)
Intravenous Glucose
Glucose infusion 5%, 50mL, 100mL, 250mL, 500mL, 1L
Glucose infusion 10%, 500mL
Glucose infusion 50%, 50mL, 500mL
Glucose pre-filled syringe 50%, 50mL
Intravenous Potassium
Potassium chloride sterile concentrate 15% (2mmol/1mL)
Restricted - for use in adults only
Restricted - to wards eg ITU, HDU and other named wards, in
accordance with Trust Potassium Policy
Potassium chloride/glucose infusion 0.15% (20mmol/litre)/5%, 1L
Potassium chloride/glucose infusion 0.3%(40mmol/litre)/5%, 1L
Potassium chloride/sodium chloride infusion 0.15%/0.9%, 500mL, 1L
Potassium chloride/sodium chloride infusion 0.3% (40mmol/litre)/0.9%, 500mL, 1L
Potassium chloride/sodium chloride infusion 0.6% (80mmol/litre)/0.9%, 1L
Potassium chloride/sodium chloride/glucose infusion 0.15% (20mmol/litre) /0.18%/4%, 500mL, 1L
Potassium chloride/sodium chloride/glucose infusion 0.3% (40mmol/litre)/0.18%/4%. 1L
Bicarbonate and Lactate
Sodium bicarbonate infusion 1.26%, 500mL polyfusor
Sodium bicarbonate i.v. injection 4.2% pre-filled syringe, 500mL polyfusor
Sodium bicarbonate i.v. injection 8.4%, 10mL
Sodium bicarbonate i.v. injection pre-filled syringe 8.4%, 50mL
Water
Water for Irrigation
Water for Injection,1mL, 5mL, 10mL, 20mL amps, 50mL, 100mL vials
9.2.2.2 Plasma and Plasma Substitutes
Dextran 40
Dextran 70
Gelatin
Etherified Starch
Dextran 40 in glucose 5% infusion, 500mL
Dextran 40 in sodium chloride 0.9% infusion, 500mL
Dextran 70 in glucose 5% infusion, 500mL
Dextran 70 in sodium chloride 0.9% infusion, 500mL
Gelofusine i.v. infusion
Tetrastarch (hydroxyethyl starch) 6% in sodium chloride intravenous infusion 0.9%, 500mL bag
For use in non-hypovolaemic patients
Tetrastarch (hydroxyethyl starch) 6% in sodium chloride intravenous infusion 0.6% [containing Na + Volulyte®
For use in hypernatraemic patients with hypovolaemia
137mmol, K+ 4mmol, Mg2+ 1.5mmol, Cl- 110mmol and acetate 34mmol /litre] 500mL bag
9.3 INTRAVENOUS NUTRITION
Supplementary Preparations
9.4 ORAL NUTRITION
9.4.1 Foods for Special Diets
9.4.2 Enteral Nutrition
9.5 MINERALS
9.5.1 Calcium and Magnesium
9.5.1.1 Calcium Supplements
Addiphos solution
Additrace solution
Dipeptiven solution
Peditrace solution
Solivito N solution
Vitlipid N emulsion
Calcium gluconate effervescent tablet 1g
Calcium carbonate 1.25g (equivalent 500mg calcium) chewable tablet (12.6mmol Ca)
Restricted - to be used in accordance with Trust TPN Policy
Calcium carbonate 1.25g (equivalent 500mg calcium) effervescent tablet (12.6mmol Ca 2+)
Calcichew
Cacit
Calcium lactate gluconate/calcium carbonate effervescent tablet (10mmol Ca 2+)
Calcium glubionate/lactobionate syrup 8.1mmol Ca2+ in 15mL
Sandocal 400
Calcium-Sandoz
Parenteral preparations
Calcium gluconate injection 10% (2.2mmol of Ca2+/10mL)
Calcium chloride pre-filled syringe 100mg/1mL (6.8mmol of Ca2+/10mL)
9.5.1.2 Hypercalcaemia and Hypercalciuria
Cinacalcet tablets 30mg, 60mg, 90mg
9.5.1.3 Magnesium
Magnesium sulphate (20mmol/10mL) injection 50%, 5g/10mL, 1g/2mL
Magnesium sulphate pre-filled syringe 5g/10mL (50%)
Restricted - prescribing by Consultant Endocrinologists only in
accordance with NICE TA 117 Hyperparathyroidism - Cinacalcet.
Traffic light list: Red.
Restricted -for cardiac arrest trolleys
9.5.2 Phosphorus
9.5.2.1 Phosphate Supplements
9.5.2.2 Phosphate-binding Agents
Magnesium L Aspartate 6.5g sachet
Treatment of post chemotherapy induced Mg loss in children.
Named Patient. An alternative to Magnesium glycerophosphate
tablets in young children who cannot swallow large tablets.
Magnesium glycerophosphate tablets
Magnesium glycerophosphate liquid 250mg/mL
Unlicensed
Unlicensed
Contains approximately: magnesium 24.25 mg or Mg2+ 1 mmol/mL)
Restricted: to be used as per the restrictions for Magnesium
glycerophosphate tablets when the tablets are impractical to be
used
Buffered phosphate oral solution 0.83mmol/1mL
Phosphate buffered pH 7.4 injection (1.66mmol/2mL)
Phosphate polyfusor 50mmol/500mL
Phosphate Sandoz effervescent tablet (equivalent to phosphate 16.1mmol)
Phosphate Mixture (JR Formula) oral solution 527mmol/litre, 100mL
Calcium acetate (equivalent to 250mg of elemental calcium) tablet 1000mg
Sevelamer tablet 800mg
9.5.3 Fluoride
9.5.4 Zinc
9.5.5 Selenium
9.6 VITAMINS
9.6.1 Vitamin A
Zinc sulphate soluble tablet 125mg (45mg Zn)
Restricted - prescribing by the Renal team only. Traffic light list:
Amber Protocol (shared care protocol awaited).
AquADEKS liquid
Restricted - recommendation by Consultant Paediatricians with
continuation by GPs for cystic fibrosis patients who cannot swallow
tablets.
Vitamin A oral drops 150,000 international units in 1mL
Unlicensed product (Arovit) - Medium risk
Restricted - prescribing by Paediatric team only. Traffic light list:
Amber initiation.
Vitamin A and D capsules 4000units/400units (10micrograms)
Restricted - initiation by Paediatric team with continuation by GPs
for prophylaxis of Vitamin A and D deficiency in paediatric cystic
fibrosis patients.
Healthy Start Children's vitamin drops
Daily dose of 5 drops contains approx. 233micrograms Vitamin A
700units (233micrograms), Vitamin C 20mg and Vitamin D 300units
(7.5microgams)
Restricted to prescribing by Paediatric team, Health Visitors,
Women's and Children's team in accordance with DOH guidance
and the Bucks Vitamin D guidelines. Service commissioned via
BHT via District Nurses. Traffic light list: Red
Healthy Start vitamins for women
Each tablet contains approx. Vitamin C 70mg, Vitamin D
10micrograms and Folic Acid 400micrograms.
Restricted to prescribing by Paediatric team, Health Visitors,
Women's and Children's team in accordance with DOH guidance
and the Bucks Vitamin D guidelines. Service commissioned via
BHT via District Nurses. Traffic light list: Red
9.6.2 Vitamin B Group
Thiamine hydrochloride tablet 50mg, 100mg
Vitamin B & C high potency i.m. injection
Vitamin B & C high potency i.v. injection
Pyridoxine hydrochloride tablet 10mg, 50mg
Pyridoxine hydrochloride injection 25mg in 5mL
Oral Vitamin B Complex Preparations
9.6.3 Vitamin C
Pabrinex®
2nd line
Pabrinex®
1st line
Restricted - Prescribing by Paediatric team only. Traffic light list:
Red.
Nicotinamide tablet 250mg, 500mg
Vitamin B compound strong tablet
Restricted - prescribing by Dermatology team only.
Ascorbic acid tablet 50mg, 200mg, 500mg
Ascorbic acid effervescent tablet 1g
1st Choice of ascorbic acid tablets
Ascorbic acid/zinc effervescent tablet 1g/10mg
Effervescent tablets restricted to ICU
9.6.4 Vitamin D
Calcium and ergocalciferol tablet
Ergocalciferol i.m. injection 7.5mg (300,000units/mL)
Restricted - for use in accordance with BHT CG 785.1 Vitamin D
Testing and Treatment in Adults.
Calcium carbonate and colecalciferol chewable tablet 1.5g/10micrograms
Colecalciferol liquid 3000units/mL
Adcal D3
Unlicensed Restricted - prescribing by Paediatricians under Dr Adlard or Dr
Rastogi's oncology teams in accordance with Oxford treatment
protocol from Endocrinology team. Traffic light list: Red.
Colecalciferol capsule 800IU (equivalent to 20micrograms Vitamin D3)
Fultium-D3®
Restricted - for use in the following groups of vitamin D deficient
patients with osteoporosis, who are not able to take the standard
calcium (600mg) and vitamin D (400 unit) tablet for the prevention
of fragility fractures:
• Patients intolerant of or who have contraindications to calcium
containing products.
• Patients who develop hypercalcaemia after taking calcium
containing products
• Patients with an adequate dietary calcium intake
• Patients with primary hyperparathyroidism who are not candidates
for operative treatment and who have coexisting Vitamin D
deficiency or insufficiency
Colecalcifierol capsules 20,000units
Dekristol® Imported via IDIS
Restricted - for use in accordance with BHT CG 785.1 Vitamin D
Testing and Treatment in Adults.
Alfacalcidol capsule 250nanogram, 1micrograms
Alfacalcidol oral solution sugar-free 2micrograms/1mL
Alfacalcidol i.v. injection 2micrograms/1mL
9.6.5 Vitamin E (Tocopherols)
Vitamin E tablet 50mg, 200mg
Alpha tocopheryl acetate suspension 500mg/5mL
Menadiol sodium phosphate tablet (equivalent to 10mg menadiol phosphate)
9.6.6 Vitamin K
Phytomenadione i.v. injection 10mg/1mL, in a mixed micelles vehicle
Phytomenadione i.v. injection 2mg/0.2mL, in a mixed micelles vehicle
9.6.7 Multivitamin Preparations
Vitamin and Mineral Supplements and Adjuncts to
Synthetic Diets
Multivitamin capsule B.P.C.
Multivitamin oral drops
Forceval capsules
For ORAL treatment of elevated INR phytomenadione injection
2mg/0.2mL (Konakion MM Paediatric) should be prescribed and
administered via the ORAL route.
Konakion MM
Konakion MM Paediatric
May be administered orally
Dalivit
Restricted - for use in accordance with Trust Refeeding Syndrome
clinical guideline. Traffic light list: Red.
Ketovite sugar-free liquid
Ketovite tablet
9.7 BITTER and TONICS
9.8 METABOLIC DISORDERS
9.8.1 Drugs Used in Metabolic Disorders
9.8.2 Acute Prophyrias
CHAPTER 10 - MUSCULOSKELETAL and JOINT DISEASES
10.1 DRUGS USED in RHEUMATIC DISEASES and GOUT
Sodium hyaluronate injection (Durolane) pre-filled syringe, 60mg/3mL
Methylaminolevulinate cream, 2g
Restricted - to prescribing by Consultant Rheumatologists and
Consultant Orthopaedics. Red traffic light list.
Restricted - for use by Dermatology team only.
10.1.1 Non-Steroidal Anti-Flammatory Drugs
Use in accordance with guideline on oral NSAID GI and CV safety based upon MHRA
recommendations (due October 2010).
Ibuprofen is usually the 1st choice NSAID, naproxen is 2nd choice and diclofenac 3rd choice,
although there are exceptions (see indometacin). Refer also to NSAID Usage Advice on page 2 of
BHT Clinical Guideline 49.1 Post-Operative Analgesic Ladder for Adults.
Ibuprofen tablet 200mg, 400mg
Ibuprofen SR tablet 800mg
Ibuprofen suspension, sugar-free 100mg/5mL
1st choice NSAID
Celecoxib capsule 100mg, 200mg
Restricted - to prescribing by Consultant Rheumatologists only
Diclofenac sodium e.c. tablet 25mg, 50mg
3rd choice NSAID
Diclofenac dispersible tablet 46.5mg (equivalent to 50mg diclofenac sodium)
3rd choice NSAID
Restricted to inpatient use when patient cannot swallow
Diclofenac sodium SR tablet 75mg, 100mg
3rd choice NSAID. Used instead of non-SR preparation where long
acting formulation required or if compliance is an issue.
Diclofenac sodium suppository 12.5mg, 25mg, 50mg, 100mg
Diclofenac sodium injection 75mg/3mL ampoule
Diclofenac sodium injection 75mg/2mL vial
Nurofen for Children
Voltarol®
Dyloject®
Unavailable as temporarily withdrawn due to market recall
Restricted - to prescribing by Consultant Anaesthetists in
accordance with:
BHT 55.1 Oral Premedication Prior to Surgery - Adult and
Paediatric patients,
BHT 49.1 Post-Operative Analgesic Ladder for Adults and
BHT 739 Intravenous Dyloject® Injection (Diclofenac 75mg/2mL)
for Post-operative Pain.
Etoricoxib tablet 90mg
Restricted - to use in Rheumatology on the advice of consultant.
To be used when other NSAIDs are proven to be ineffective or
inappropriate for specific ankylosing spondylitis patients. Traffic
light list: Amber recommendation.
Flurbiprofen tablet 50mg, 100mg
Flurbiprofen MR capsule 200mg
Indometacin capsule 25mg
Restricted - to use in Ophthalmology
Restricted - to use in Ophthalmology
1st choice treatment of acute attacks of gout. Also used in
ankylosing spondilitis
1st choice treatment of acute attacks of gout. Also used in
ankylosing spondilitis (more than the non MR product)
Indometacin capsule MR 75mg
Indometacin suspension 25mg/5mL
Mefenamic acid capsule 250mg
Mefenamic acid tablet 500mg
Restricted - for treatment of menorrhagia/dysmenorrhoea by
Obs/Gynae
Restricted - for treatment of menorrhagia/dysmenorrhoea by
Obs/Gynae
Nabumetone tablet f/c 500mg
Naproxen suspension 125mg/5mL
Naproxen tablet 250mg, 500mg
2nd choice NSAID
Hydrocortisone acetate intra-articular/intra-synovial injection 25mg/1mL
Methylprednisolone (Depo-medrone) injection 40mg/1mL, 80mg/2mL
1st choice
10.1.2.1 Systemic Corticosteroids
10.1.2.2 Local Corticosteroid Injections
Triamcinolone acetonide (Adcortyl) intra-articular/intradermal injection 10mg/1mL, 50mg/5mL
Triamcinolone acetonide (Kenalog) intra-articular/i.m. injection 40mg/1mL
2nd choice
10.1.3 Drugs Which Suppress the Rheumatic Disease
Process
Cyclophosphamide tab 50mg and injection 500mg, 1g
For inpatient treatment of systemic vasculitis, lupus nephritis. See
section 8.1.1
When prescribed by Rheumatology: see BHT CG 101.1 Guideline
for the use of oral continuous cyclophosphamide in Rheumatology.
Gold
Penicillamine
Sodium aurothiomalate i.m. injection 10mg/0.5mL, 50mg/0.5mL
Penicillamine tablet 125mg, 250mg
Antimalarials
Chloroquine
see Section 5.4.1
Drugs Affecting the Immune Response
Hydroxychloroquine sulphate f/c tablet 200mg
When prescribed by Dermatology: Traffic light list: Amber initiation.
Azathioprine
see Section 8.2.1
When prescribed by Rheumatology: Traffic light list: Amber protocol
Ciclosporin
see Section 8.2.2
Leflunomide tablet f/c 10mg, 20mg 100mg
Restricted - to initiation by Consultant Rheumatologists. Traffic
light list: Amber protocol
Methotrexate tablet 2.5mg
Cytokine inhibitors
Methotrexate prefilled syringe 50mg/mL available in the following doses:
7.5mg,10mg,12.5mg,15mg, 17.5mg, 20mg, 22.5mg, 25mg
Metoject®
Restricted - prescribing by Consultant Rheumatologists and
Dermatologists only, in accordance with Methotrexate shared care
protocol for patients, on oral methotrexate, with severe GI side
effects despite regular folic acid (5mg, 6 days a week) or nonresponders to oral therapy after an 8-12 week trial, in order to
improve bioavailability. Traffic light list: Amber protocol.
Abatacept intravenous infusion 250mg vial
Restricted - to Rheumatology consultant prescribing only, in
accordance with NICE TA 195 Treatment of rheumatoid arthritis
after the failure of a TNF inhibitor and in accordance with CG 749.5
Biologics for Rheumatoid Arthritis. Traffic light list: Red.
1. Restricted - to Rheumatology consultant prescribing only, in
accordance with NICE TA 130 Rheumatoid arthritis, NICE TA 195
Treatment of rheumatoid arthritis after the failure of a TNF inhibitor
and in accordance with CG 749.5 Biologics for Rheumatoid
Arthritis.
accordance with NICE TA 143 Ankylosing Spondylitis.
3. Restricted - to prescribing by Rheumatology or Dermatology
consultants only, in accordance with NICE TA 199 Etanercept,
Infliximab and Adalimumab for treatment of psoriatic arthritis and in
line with CG 740.3 Biologics for Psoriatic arthritis.
FOR ALL: Traffic light list: Red.
See section 1.5.3 (Gastroenterology) and 13.5.3 (Dermatology)
Certolizumab pegol injection 200mg prefilled syringe.
1. Restricted - prescribing by Consultant Rheumatologists only, in
accordance with NICE TA 186 Certolizumab pegol for treatment of
rheumatoid arthritis and local clinical guideline on rheumatoid
arthritis and in accordance with CG 749.5 Biologics for Rheumatoid
Arthritis. Traffic light list: Red.
Etanercept injection 25mg, 50mg
1. Restricted - to Rheumatology consultant prescribing only in
accordance with NICE TA 35 Etanercept for the treatment of
Juvenile Idiopathic arthritis.
2. Restricted - to Rheumatology consultant prescribing only in
accordance with NICE TA 143 Ankylosing Spondylitis.
line with CG 740.3 Biologics for Psoriatic arthritis.
accordance with NICE TA 130 Rheumatoid arthritis, NICE TA 195
Treatment of rheumatoid arthritis after the failure of a TNF inhibitor
and in accordance with CG 749.5 Biologics for Rheumatoid
Arthritis.
See section 13.5.3 (for Dermatology)
Golimumab prefilled pen or prefilled syinge 50mg
Restricted - prescribing by Consultant Rheumatologists in
accordance with:
1. NICE TA 220 Golimumab for the treatment of psoriatic arthritis
and in accordance with CG 740.3 Biolgoics for Psoriatic Arthritis or
2. NICE TA 225 Golimumab for the treatment of rheumatoid
arthritis after the failure of previous disease-modifying antirheumatic drugs and in accordance with CG 749.5 Biologics for
Rheumatoid Arthritis.
3. NICE TA 233 Golimumab for the treatment of ankylosing
spondylitis
FOR ALL: Traffic light list: Red (anti-TNF)
Infliximab i.v. infusion 100mg vial
Rituximab concentrate for i.v. infusion 100mg/10mL, 500mg/50mL
accordance with NICE TA 195 Treatment of rheumatoid arthritis
after the failure of a TNF inhibitor and in accordance with CG 749.5
Biologics for Rheumatoid Arthritis.
see Section 8.2.3 (for Haematology)
Tocilizumab concentrate for intravenous infusion 80mg/4mL, 200mg/10mL, 400/20mLmg vial
Restricted - to Rheumatology consultant prescribing only, in
accordance with NICE TA 247 Tocilizumab for the treatment of
rheumatoid arthritis.and in accordance with CG 749.5 Biologics for
Rheumatoid Arthritis. Traffic light list: Red
Sulfasalazine EC tablet 500mg
Sulfasalazine EC tablet f/c 500mg
Salazopyrin EN-Tabs
Sulfasalazine suspension 250mg/5mL
Acute Attacks of Gout
Colchicine tablet 500micrograms
Long-term Control of Gout
Allopurinol tablet 100mg, 300mg
Febuxostat tablet 80mg, 120mg
2nd choice for acute attacks of gout (other 2nd choices - diclofenac
or naproxen)
1st choice prophylaxis for gout
Restricted - prescribing when recommended by Rheumatology
team.
Only for the management of chronic hyperuricaemia in gout,
Unlicensed
Sulfasalazine
10.1.4 Gout and Cytotoxic-Induced Hyperuricaemia
Probenecid tablet 500mg
Restricted - Named patient basis only
Rasburicase IV infusion 1.5mg vial
10.1.5 Other Drugs for Rheumatic Diseases
10.2 DRUGS USED in NEUROMUSCULAR DISORDERS
10.2.1 Drugs Which Enhance Neuromuscular
Transmission
Anticholinesterases
Neostigmine bromide tablet 15mg
Restricted - to consultant oncologists and haematologists for
treatment of cytotoxic induced hyperuricaemia
Neostigmine metilsulfate injection 2.5mg/1mL
Edrophonium chloride injection 10mg/1mL
Pyridostigmine bromide tablet 60mg
10.2.2 Skeletal Muscle Relaxants
Baclofen tablet 10mg
Baclofen oral solution 5mg/5mL
Baclofen Intrathecal injection 50micrograms/1mL
Baclofen Intrathecal injection 1000micrograms/1mL (20mL vial), 3000micrograms/1mL (20mL vial),
6000micrograms/1mL (12mL vial); 10mg/20mL, 10mg/5mL and 5mg/20mL
Baclofen Intrathecal injection 6000micrograms/1mL (72mg in 12mL vial)
1st choice skeletal muscle relaxant
Dantrolene sodium capsule 25mg, 100mg
Diazepam
2nd choice skeletal muscle relaxant
see Section 4.1.2
Tizanidine tablet 2mg, 4mg
Restricted - to spinal, rheumatology, neurology and neurorehab
consultant prescribing only
Methocarbamol tablet 750mg
Other Muscle Relaxants
Quinine
Nocturnal Leg Cramps
10.3 DRUGS for the TREATMENT of SOFT-TISSUE DISORDERS
Hyaluronidase injection 1500unit amp
10.3.1 Enzymes
10.3.2 Rubefacients, topical NSAIDs, capsaicin and
poultices
Miscellaneous
Test Dose
Restricted - to Spinal unit. Available on a named patient basis
Restricted - to Spinal unit. Available on a named patient basis
see Section 5.4.1
Algipan ® cream
Kaolin Poultice
Piroxicam gel 0.5%
Menthol 1% in aqueous cream
CHAPTER 11 - EYE
11.1 ADMINISTRATION of DRUGS to the EYE
Antibiotics for Intravitreal Use include Ceftazidime, Cefuroxime, Vancomycin, Amikacin and This is an unlicensed use - High Risk
Amoxicillin. Maybe made up in theatre from stock ampoules.
11.3 ANTI-INFECTIVE EYE PREPARATIONS
11.3.1 Antibacterials
Ceftazidime preservative free eye drops 5%
Cefuroxime preservative free eyedrops 5%
Chloramphenicol eye drops 0.5%, 10mL
Chloramphenicol eye ointment 1%, 4g
Chloramphenicol single use eye drops 0.5%
Chlorhexidine digluconate preservative-free eye drops 0.02%
Restricted - Named patient basis and available at SMH only
Ciprofloxacin eye drops 0.3%, 5mL
Fusidic acid MR eye drops in a gel basis 1%, 5g
Gentamicin eye/ear drops 0.3%, 10mL
Gentamicin drops 1.5% eye drops with OR without preservative
Gentamicin single use eyedrops 0.3%
Neomycin sulphate eye ointment (3,500 units/g) 0.5%
Neomycin sulphate eye drops (3,500 units/mL) 0.5%
Neosporin eye drops (gramicidin 25units, neomycin sulphate 1700units, polymyxin B sulphate
5000units/1mL), 5mL
Ofloxacin ophthalmic solution 0.3%, 5mL
Penicillin eyedrops 5000units/mL. 10,000units/mL
Polihexanide (PHMB) eyedrops 0.02% Preservative Free
11.3.2 Antifungals
11.3.3 Antivirals
2nd Choice quinolone - see ofloxacin below
Restricted - for use by Ophthalmology only
Restricted - Named patient basis
Restricted - if Neomycin drops not suitable - Phone Pharmacy to
Order
Merged - Phone Pharmacy to Order
May be difficult to source as discontinued by Martindale Feb06
1st Choice quinolone
5000units/mL - Unlicensed
10,000units/mL - Unlicensed - High Risk
Restricted - for proven cases of Streptococcus pneumoniae only.
Propamidine Isetionate eyedrops 0.1%, 10mL
Restricted - named patient, consultant only prescribing
Brolene
Vancomycin preservative free eye drops 5%
Clotrimazole preservative free eye drops 1%
2nd Choice antifungal
Restricted - Consultant only prescribing and Phone Pharmacy to
Order
Econazole preservative free eye drops 1%
1st Choice antifungal
Restricted - Consultant only prescribing and Phone Pharmacy to
Order
Amphotericin preservative free eye drops 0.15%, 10mL
Restricted -Microbiology approval required. Named patient basis
and Phone Pharmacy to Order (normally available within one week)
Aciclovir eye ointment 3%, 4.5g
1st Choice antiviral
Ganciclovir eye drops in gel basis 0.15%
Trifluorothymidine eye drops 1%
Trifluorothymidine preservative free eye drops 1%
11.4 CORTICOSTEROIDS and other ANTI-INFLAMMATORY
PREPARATIONS.
Betamethasone sodium phosphate eye/ear/nose drops 0.1%, 5mL, 10mL
Betamethasone sodium phosphate eye ointment 0.1%
Betamethasone sodium phosphate/neomycin sulphate eye drops 0.1%/0.5%, 10mL
Betamethasone sodium phosphate/neomycin sulphate eye ointment 0.1%/0.5%, 3g
Dexamethasone/hypromellose eye drops 0.1%/0.5%, 5mL, 10mL
Dexamethasone sodium phosphate single use eye drops 0.1% (contain disodium edetate)
Restricted - to Consultant Only prescribing when aciclovir has
proved unsuitable. Phone Pharmacy to order
Restricted - to consultant only prescribing when aciclovir has
proved unsuitable. Phone Pharmacy to order
Restricted - Consultant only prescribing when aciclovir has proved
Betnesol-N
1st choice - combined steroid/antibiotic preparation
Maxidex
Dexamethasone preservative free eye drops 0.1%, 10mL
Note: once opened, product expires after 7 days.
Fluorometholone/polyvinyl alcohol eye drop 0.1%/1.4%, 5mL
Hydrocortisone eye ointment 2.5%
Maxitrol eye drops
Maxitrol eye ointment
FmL eyedrops
Prednisolone eye drops 0.01%, 0.03%, 0.1%, 0.3%
Prednisolone sodium phosphate ear/eye drops 0.5%, 10mL
Prednisolone preservative free eye drops 0.03%, 0.1%, 0.3%, 1%
Restricted -for 0.01% and 0.03% Phone Pharmacy to Order
Predsol
Restricted - for 0.03% Phone Pharmacy to Order
2nd choice -steroid/antibiotic combination preparation
Restricted - Consultant to prescribe if Betnesol-N ointment
considered unsuitable.
Prednisolone sodium phosphate single use eye drops 0.5%
Prednisolone acetate eye drops 1%
Prednisolone sodium phosphate/neomycin sulphate 0.5%/0.5% eyedrops
Rimexolone eye drops 1%, 5mL
Pred Forte
Predsol-N
Restricted - Consultant Ophthalmologist only to prescribe for
patients in whom fluorometholone eyedrops (FmL) have not proved
effective or suitable
Intravitreal corticosteroids
Dexamethasone intravitreal implant 700micrograms
11.4.2 Other Anti-Inflammatory Preparations
Antazoline sulphate/xylometazoline hydrochloride eye drops 0.5%/0.05%
Emedastine eye drops 0.05%, 5mL
Lodoxamide ophthalmic solution 0.1%, 10mL
Olopatadine eye drops 1mg/1mL, 5mL
Sodium cromoglicate eye drops 2%
Sodium cromoglicate eye drops preservative free 2%
11.5 MYDRIATICS and CYCLOPLEGICS
Antimuscarinics
Sympathomimetics
11.6 TREATMENT of GLAUCOMA
Beta-Blockers
Atropine sulphate eye drops 0.5%, 10mL
3rd Choice in this section 11.4.2
2nd Choice in this section 11.4.2
1st Choice in this section 11.4.2
Restricted - if for Paediatric use: Consultant Only to prescribe.
Atropine sulphate eye drops 1%, 10mL
Atropine sulphate eye ointment 1%, 3g
Atropine sulphate single use eye drops 1%
Cyclopentolate hydrochloride eye drops 0.5%, 5mL
Cyclopentolate hydrochloride eye drops 1.0%, 5mL
Cyclopentolate hydrochloride single use eye drops 0.5%, 1%
Homatropine hydrobromide eye drops 2%, 10mL
Tropicamide single use eye drops 0.5%, 1%
Phenylephrine hydrochloride single use eye drops 2.5%, 10%
Glycerin BP 100mL
Glycerin eye drops 50%
Mannitol infusion 20%
Betaxolol suspension eye drops 0.25%, 5mL
Carteolol hydrochloride eye drops 1%, 5mL
Timolol eye drops 0.25%, 0.5%, 5mL
Timolol single use eye drops 0.25%, 0.5%
Timolol ophthalmic gel-forming solution 0.25%, 0.5%, 2.5mL
Prostaglandin Analogues
Restricted - prescribing by Consultant ophthalmologists only in
accordance with NICE TA 229 Macular oedema (retinal vein
occlusion) - dexamethasone. Traffic light list:
see Section 2.2.5
If cardio-selectivity required this is 1st Choice, otherwise 3rd choice
beta-blocker eye drop
2nd Choice beta-blocker eye drop
1st Choice beta-blocker eye drop
(Note: to be used in place of timolol eye gel 0.1% (Nyogel®))
Bimatoprost eye drops 100micrograms/1mL, 300micrograms/1mL, 3mL
Lumigan®
2nd Choice of prostaglandin analogues
Bimatoprost/Timolol eye drops 0.3mg/5mg in 1mL
Ganfort®
Restricted - on 6 month trial by Ophthalmology after which the 3
combination products (ie Prostaglandin analogues/Timolol) to be
rationalised.
Latanoprost eye drops 50micrograms/1mL, 2.5mL
Latanoprost/Timolol eye drops 50micrograms/5mg in 1mL, 2.5mL
Sympathomimetics
Carbonic Anhydrase Inhibitors and Systemic Drugs
Tafluprost unit dose eye drops 15micrograms/mL
Saflutan®
Restricted - prescribing by Consultant Ophthalmologists when there
is proven sensitivity to benzalkonium chloride found in other
prostaglandin analogue products. Traffic Light List: Amber
Initiation.
Travoprost/Timolol eye drops 40micrograms/5mg in 1 mL
Duo-Trav®
Restricted - on 6 month trial by Ophthalmology after which the 3
combination products (ie Prostaglandin analogues/Timolol) to be
rationalised.
Brimonidine tartrate eye drops 0.2%, 5mL
Brimonidine tartrate/Timolol eye drops 0.2%/0.5%, 5mL
Alphagan®
Combigan®
Restricted - Consultant Only prescribing - only for use in patients
where compliance is a problem
Dipivefrin hydrochloride eye drops 0.1%, 10mL
Acetazolamide i.v.injection 500mg
Acetazolamide tablet 250mg
Acetazolamide MR capsule 250mg
Brinzolamide eye drops 10mg/1mL, 5mL
Brinzolamide / timolol ophthalmic suspension 10mg/5mg per mL, 5mL
Dorzolamide eye drops 2%, 5mL
Dorzolamide / timolol preservative-free unit dose eye drops 2%/0.5%, 0.2mL
Miotics
11.7 LOCAL ANAESTHETICS
Xalatan®
1st Choice of prostaglandin analogues
Xalacom®
Pilocarpine hydrochloride eye drops 1%, 2%, 4%, 10mL
Pilocarpine nitrate single use eye drops 2%, 4%
Pilocarpine hydrochloride ophthalmic gel 4%, 5g
Lidocaine gel 2%
Diamox SR®
Azopt®
2nd Choice topical carbonic anhydrase inhibitor
Azarga®
Trusopt®
1st Choice topical carbonic anhydrase inhibitors
Cosopt®
Restricted - to prescribing by Ophthalmology team.
Pilogel®
Ophthalmic Consultants Topical application to eye prior to intraocular surgery in Oph. Theatres, Named patient basis, Unlicenced
Lidocaine injection, isotonic 1%
Ophthalmic Consultants Anaesthetic use during intra-ocular
surgery in Oph. Theatres. Named patient basis. Unlicenced
Supplier: Martindale
Cocaine eye drops 4%
Restricted - Consultant Only Prescribing and Phone Pharmacy to
Order
Lidocaine hydrochloride/fluorescein single use eye drops 4%/0.25%
Oxybuprocaine hydrochloride (benoxinate) single use eye drops 0.4%
Proxymetacaine hydrochloride single use eye drops 0.5%
1st Choice local anaesthetic eye drop (see exceptions below)
2nd Choice local anaesthetic eye drop.
In some clinical situations may be considered 1st Choice eg.for use
in paediatrics and to enhance anaesthesia intra-operatively.
Proxymetacaine hydrochloride/fluorescein single use eye drops 0.5%/0/25%
Tetracaine hydrochloride single use eye drops 1%
11.8 MISCELLANEOUS OPHTHALMIC PREPARATIONS
11.8.1 Tear Deficiency, Ocular Lubricants and
Astringents
Prescribing Choices - PRESERVED ocular lubricants
(see Formulary below for complete list and BHT CG 371 Guidelines on ocular lubricant choice in the treatment of dysfunctional tear syndrome (Tear deficiency))
Hypromellose eye drops 0.5%, 10mL
1st Choice - Preserved ocular lubricant - for aqueous deficiency
Carbomer 980 0.2% gel eye drops, 10g
In primary care prescribe: Clinitas Gel®
1st
Choice - Preserved ocular lubricant for Meibomian gland
Systane®
Hydroxypropyl guar eye drops 10mL
2nd Choice - Preserved tear-deficiency preparation
Bottles to be discarded 28 days after opening in accordance with
RPSGB and BNF advice
Licensed Medical Device
Prescribing Choices - PRESERVATIVE-FREE ocular lubricants
Sodium hyaluronate single use eye drops 0.4%, 30
1st Choice - Preservative- Free ocular lubricant
Clinitas® SDU
NOTE:
1. This product differs from Clinitas gel above.
2. Each unit is resealable and may be reused for up to 12 hours for
patients with uncomplicated simple dry eye only. Not to be reused
in patients needing ocular lubricants following eye surgery or with
compromised eyes.
Carmellose sodium single use eye drops 1%, 30
2nd Choice - Preservative-Free ocular lubricant
Hydroxypropyl guar single use eyedrops
3rd Choice - Preservative-Free ocular lubricant
Systane® SDU
Tear Deficiency, Ocular Lubricants and Astringents
Acetylcysteine preservative free eye drops 5%, 10%, 10mL
Acetylcysteine eyedrops 20%, 10mL
Acetylcysteine/hypromellose eye drops 5%/0.35%
Carbomer 980 0.2% gel eye drops, 10g
Carbomer 980 liquid gel single use eye drops 0.2%, 30
Ilube®
In primary care prescribe: Clinitas Gel®
1st Choice - Preserved ocular lubricant for Meibomian gland
Viscotears
Carmellose sodium single use eye drops 0.5%,
Carmellose sodium single use eye drops 0.5%,
Celluvisc® brand restricted - for use by hospital ophthalmology team only
for contact lens diagnostics. For all other indications generic product to be
used. Traffic light list: Red
Carmellose sodium single use eye drops 1%
2nd Choice - Preservative-Free ocular lubricant
Hydroxypropyl guar eye drops 10mL
Systane®
2nd Choice - Preserved ocular lubricant
Bottles to be discarded 28 days after opening in accordance with
RPSGB and BNF advice
Hydroxypropyl guar single use eye drops 0.8mL
3rd Choice - Preservative-Free ocular lubricant
Systane® SDU
Hypromellose eye drops 0.5%, 10mL
1st Choice - Preserved ocular lubricant - for aqueous deficiency
Hypromellose preservative free eye drops 0.3%, 10mL
Note: eyedrops expire one week after opening.
Hypromellose preservative free, single use, eye drops 0.3%, 0.4mL
Restricted - to prescribing by Ophthalmology team only. To be
prescribed only when less than three doses per day are needed,
otherwise the 10mL pres-free bottles are more cost effective.
Amber Traffic Light list. Unlicenced (Moorfields)
Liquid paraffin eye ointment
Paraffin, yellow soft eye ointment, 4g
Lacri-Lube
Simple Eye Ointment
Polyvinyl alcohol eye drops 1.4%
Sodium chloride 0.9%
Sodium chloride single use eye drops 0.9%
Sodium chloride eye drops 5%, 10mL
Sodium hyaluronate single use eye drops 0.4%, 30
Balanced salt solution 15mL, 250mL, 500mL
Balanced salt solution Plus 500mL
11.8.2 Ocular Diagnostic and Peri-Operative Preparations
and Photodynamic Treatment
Fluorescein injection 20%
Ocular Diagnostic Preparations
Fluorescein sodium single use eye drops 2%
Fluorescein ophthalmic strip
Rose bengal single use eye drops 1%
Acetylcholine chloride solution for intra-ocular irrigation 1%, mannitol 3%, 2mL vial
Ocular Peri-Operative Drugs
Apraclonidine hydrochloride single use eye drops 1%
Apraclonidine hydrochloride eye drops 0.5%, 5mL
Diclofenac sodium single use eye drops 0.1%
see Section 13.11.1
Restricted - Named Patient Basis
1st Choice - Preservative- Free ocular lubricant
Clinitas® SDU
NOTE:
1. This product differs from Clinitas gel above.
2. Each unit is resealable and may be reused for up to 12 hours for
patients with uncomplicated simple dry eye only. Not to be reused
in patients needing ocular lubricants following eye surgery or with
compromised eyes.
Restricted - for use by Consultant Ophthalmologist, Larry
Benjamin and may be prescribed by other consultant
ophthalmologists for patients deemed to be at risk.
Iopidine
Iopidine
Restricted - use in theatres and if patient requires preservative free
preparation
Subfoveal choroidal neovascularisation
Diclofenac eye drops 0.1%, 5mL
Restricted - only for use if Ketorolac unavailable
Ketorolac trometamol eye drops 0.5%, 5mL
Note: if used to treat macular oedema this is an unlicensed use and
patient details to be recorded.
Restricted to Miss Moorman's AMD patients in whom funding has
been agreed
1. Restricted - Prescribing by Ophthalmologists only. FOR
PRIVATE PATIENTS ONLY
2. Restricted - Prescribing by Ophthalmologists only, in line with
Thames Valley Macular Group Protocol for treatment of sight
threatening disorders. Traffic light list: Red.
Verteporfin 15mg vial
Bevacizumab intravitreal pre-filled syringe, 2.5mg in 0.1mL
Miscellaneous
Ranibizumab solution for intravitreal injection, 2.3mg/0.23mL
1. Restricted - Prescribing by Ophthalmologists only for the
treatment of Age Related Macular Degeneration (AMD). Intravitreal
use only. Traffic light list: Red
See Guideline: Ranibizumab for the treatment of age-related
macular degeneration (based upon NICE TA 155).
2. Restricted - Prescribing by Ophthalmologists only in
accordance with NICE TA 274 Ranibizumab for the treatment of
Diabetic Macular Oedema (DMO). Intravitreal use only. Traffic
light list: Red
Aprotinin 20units/1mL, 10mL
Restricted - Consultant Only Prescribing and Named Patient basis
only
Botulinum A toxin-haemagglutinin complex, 500unit vial (Dysport only)
Restricted - Ophthalmology consultant only prescribing.
See Section 4.9.3
Restricted - name patient basis, Phone Pharmacy to Order
Ciclosporin eye ointment 0.2%
Disodium edetate eyedrops 0.37%, 20mL
Fluorouracil solution, 50mg/1mL
Fluorouracil solution pre-filled syringes, 10mg in 0.2mL
Restricted - for use in Ophthalmic theatres only
Indocyanine green dye, 25mg in 5mL
Unlicensed - High risk
Restricted - for diagnostic use by Ophthalmology team only. Traffic
light
list: Red
Unlicensed
- High Risk
Mitomycin solution 200 micrograms /1mL (0.02%)
Restricted - Phone Pharmacy to Order, only available at Wycombe
Hospital
Mitomycin solution 400 micrograms /1mL (0.04%)
Restricted - Phone Pharmacy to Order, only available at Stoke
Mandeville Hospital.
Mydricaine No.1 sub-conjunctival injection
Restricted - Paediatric use only
Restricted - to SMH only
Ophthalmology to continue to order
Restricted - for use within Ophthalmology only
Restricted - for use within Ophthalmology only
Mydricaine No.2 sub-conjunctival injection
Potassium ascorbate eye drops 10%
Silicone oil 1000CS, 5 x 15mL and/or 5000CS
Sodium hyaluronate pre-filled syringe 8.5mg/0.85mL
Sodium hyaluronate pre-filled syringe 5mg/0.5mL (Healon 5), 7.7mg/0.55mL (Healon GV)
Tear flow test strips sterile
Triamcinolone acetonide aqueous suspension injection 40mg/1mL
Kenalog
Note: 40mg/1mL for orbital floor/sub Tenon's injection BUT
4mg/0.1mL for intravitreal injection. Both unlicenced uses
Guideline to be provided by Ophthalmic Consultants Sept 06
11.9 CONTACT LENSES
CHAPTER 12 - EAR, NOSE and OROPHARYNX
12.1 DRUGS ACTING on the EAR
12.1.1 Otitis Externa
Astringent Preparations
Anti-Inflammatory Preparations
Montelukast tablet 4mg (chewable), 5mg (chewable), 10mg
Restricted - to Respiratory, ENT and Dermatology teams only
see section 3.3.2
Aluminium acetate ear drops 13%
Betamethasone sodium phosphate ear/eye/nose drops 0.1%, 10mL
Betamethasone sodium phosphate/neomycin sulphate ear/eye/nose drops 0.1%/0.5%, 10mL
Dexamethasone 0.1% /neomycin sulphate (3250units/1mL)/glacial acetic acid 2.0% ear spray,
5mL
Dexamethasone 0.05%/framycetin sulphate 0.5%/gramicidin 0.005% ear/eye drops, 10mL
Otomize
Flumetasone pivalate/clioquinol ear drops 0.02%/1%, 7.5mL
Hydrocortisone acetate/gentamicin sulphate ear drops 1.0%/0.3%
Locorten-Vioform
Gentisone HC
Betnesol-N, Vista-Methasone N
Sofradex
Anti-Infective Preparations
12.1.2 Otitis Media
12.1.3 Removal of Ear Wax
Hydrocortisone 1%/neomycin sulphate 3400units/polymyxin B sulphate 10,000units/1mL ear
drops, 5mL
Prednisolone sodium phosphate ear/eye drops 0.5%, 10mL
Prednisolone sodium phosphate/neomycin sulphate ear/eye drops 0.5%/0.5%
Triamcinolone acetonide 0.1%/gramicidin 0.025%/ neomycin sulphate 0.25%/nystatin
100,000units/g, 10g
Acetic acid 2% spray
Otosporin
Povidone iodine 10% in boric acid powder
Chloramphenicol ear drops 5%, 10mL
Framycetin sulphate
Gentamicin drops 0.3%, 10mL
Neomycin sulphate with corticosteroid
see Dexamethasone (Sofradex) above
also see Hydrocortisone (Gentisone HC) above
see above: Betnesol-N, Otomize, Otosporin, Predsol-N, Tri-Adcortyl
Otic, Vista-Methasone N
Ofloxacin ophthalmic solution 0.3%
Restricted - for the treatment of otitis externa, media and post
grommet surgery - Antibiotic Committee on 19Oct05
Otocomb Otic
EarCalm® spray
Olive Oil ear drops
Sodium bicarbonate ear drops 5%
12.2 DRUGS ACTING on the NOSE
12.2.1 Drugs Used in Nasal Allergy
Corticosteroids
Beclometasone dipropionate aqueous nasal spray 50micrograms/ metered spray
In accordance with Intranasal Corticosteroid guideline
Betamethasone sodium phosphate ear/eye/nose drops 0.1%, 10mL
Vista-Methasone
Dexamethasone isonicotinate/tramazoline hydrochloride 20micrograms/120micrograms per
metered nasal spray
Dexa-Rhinaspray Duo
Fluticasone propionate aqueous nasal spray 50micrograms/metered spray
Flixonase
Fluticasone propionate nasal drops 400micrograms/unit dose, 28 x 0.4mL units
Restricted - Initiation by ENT Consultants and continuation by GPs,
for severe nasal polyposis, refractory to steroid nasal sprays and in
accordance with Intranasal Corticosteroid guideline. Traffic light
list: Amber initiation
Fluticasone furoate nasal spray, 27.5micrograms per metered spray
Avamys
Nasonex
Rynacrom
Mometasone furoate nasal spray 50micrograms/metered spray
Cromoglicate
Sodium cromoglycate aqueous nasal spray 4%
12.2.2 Topical Nasal Decongestants
Sympathomimetics
Ephedrine hydrochloride nose drops 0.5%, 10mL
Xylometazoline hydrochloride nasal drops 0.05%, 0.1%
Xylometazoline hydrochloride nasal spray 0.1%
Ipratropium bromide nasal spray 0.03% (21 micrograms per metered spray)
Others
Sodium Chloride Eye/Ear Drops 0.9%
Sterimar Sea Water Nasal Spray, 100mL
Rinatec
Restricted - Prescribing by ENT Consultants.
Restricted - ENT consultants to prescribe one aerosol unit per
patient only post-surgery.
12.2.3 Nasal Preparations for Infection
Betamethasone sodium phosphate/neomycin sulphate drops for ear/eye/nose 0.1%/0.5%, 10mL
Vista-Methasone N
Nasal staphylococci
Mupirocin nasal ointment 2%, 3g
Bactroban Nasal
2nd Choice
Naseptin
1st Choice
Chlorhexidine hydrochloride/neomycin sulphate 0.1%/0.5% nasal cream, 15g
Epistaxis
12.3 DRUGS ACTING on the OROPHARYNX
12.3.1 Drugs for Oral Ulceration and Inflammation
Corticosteroids
Bismuth subnitrate and iodoform ribbon gauzes, 1.25cmx100cm
Benzydamine hydrochloride oral rinse 0.15%
Difflam
Benzydamine oral spray 0.15%
Orabase protective paste
Hydrocortisone pellet 2.5mg
Corlan
Hydrocortisone suspension 2mg/1mL
Salicylates
Triamcinolone acetonide oral paste 0.1%
Choline salicylate 8.7% oral gel
Adcortyl in Orabase
Bonjela
Tetracycline
Doxycyline capsule
Restricted - available for use as mouthwash
12.3.2 Oropharyngeal Anti-Infective Drugs
Amphotericin lozenge 10mg
Miconazole oral gel sugar-free 24mg/1mL (20mg/g), 80g
Fungilin
Daktarin
Nystatin oral suspension 100,000units/1mL
Nystatin pastille 100,000units
12.3.3 Lozenges and Sprays
Benzocaine/cetylpyridinium lozenge
Merocaine
12.3.4 Mouthwashes, Gargles and Dentrifices
12.3.5 Treatment of Dry Mouth
Amylmetacresol/dichlorobenzyl alcohol lozenge
Strepsils
Chlorhexidine gluconate mouthwash 0.2%
Chlorhexidine oral gel 1.0%
Hexetidine mouthwash 0.1%
Hydrogen peroxide mouthwash BP, 3% (10 vol)
Thymol - mouthwash solution tablets
Plain or Mint flavour available
Tranexamic acid mouthwash 5% (250mg/5mL)
Saliva Artificial Spray
Brand stocked may vary
Oralbalance saliva replacement gel
Biotene Oral Balance
Oraldene
CHAPTER 13 - SKIN
Flammacerium cream 500g
Lubricating gel sachet, 5g
Restricted - for use by Burns Unit only.
Lubricating gel tube, 42g
Silver Nitrate solution 0.5%
Restricted - for use by Burns Unit only.
13.1 MANAGEMENT of SKIN CONDITIONS
13.1.1 Vehicles
13.1.2 Suitable Quantities for Prescribing
13.1.3 Excipients and Sensitisation
13.2 EMOLLIENT and BARRIER PREPARATIONS
13.2.1 Emollients
Non-proprietary emollient preparations
Aqueous cream BP, 30g, 100g, 500g
Coconut oil BPC
Emulsifying ointment BP, 100g, 500g
Hydrous (oily cream) ointment BP
Paraffin liquid/paraffin soft white ointment 50/50
Paraffin soft white, 15g
Only available in 500g pots for dilutions of ointments by pharmacy
Paraffin soft yellow, 15g
Proprietary emollient preparations
Cetraben cream
Diprobase cream 500g (dispenser)
Diprobase ointment 50g
Doublebase gel, 100g, 500g
E45 cream, 50g, 125g, 350g, 500g
Unguentum M cream, 50g, 100g
Restricted - for use as a base for specials
Preparations containing urea
With antimicrobials
Calmurid cream
Dermol 500 lotion
13.2.1.1 Emollient bath and shower preparations
Diprobath bath additive
Oilatum Emollient bath additive (emulsion) 250mL
Oilatum Fragrance Free Junior bath additive 500mL
Oilatum Plus bath additive, 500mL
With antimicrobials
13.2.2 Barrier Preparations
Non-proprietary barrier preparations
Proprietary barrier preparations
Zinc and castor oil ointment, 15g tubes
Zinc compound paste, 50g, 500g
Drapolene cream, 100g
Restricted - for use in Spinal Unit on patients with pressure sores.
1st Choice
Increase in cost pressure to be approved (due to deletion of
Sudocrem)
Metanium ointment, 30g
Sudocrem, 25g, 60g to be deleted
13.3 TOPICAL LOCAL ANAESTHETICS and ANTIPRURITICS
Calamine Lotion
Topical Antihistamines
13.4 TOPICAL CORTICOSTEROIDS
Hydrocortisone
Compound preparations
With Antimicrobials
Crotamiton cream 10%, 30g, 100g
Crotamiton lotion 10%, 100mL
Mepyramine (Anthisan) cream
Hydrocortisone cream 1%
Hydrocortisone ointment 0.5%
Hydrocortisone ointment 1%
Hydrocortisone/Urea cream 1%/10%, 30g, 100g
Hydrocortisone/clotrimazole cream 1%/1%, 30g
Hydrocortisone/miconazole nitrate ointment 1%/2%, 30g
Hydrocortisone acetate /fusidic acid cream 1%/2%, 30g
Beclometasone dipropionate
Restricted for management of extravasation with Taxenes only
(Mild)
(Mild)
(Mild)
Alphaderm® (Moderate)
Canesten HC (Mild)
Daktacort (Mild)
Fucidin H cream (Mild)
Restricted - Dermatology only. Microbiology approval required for
all other uses.
Hydrocortisone acetate /sodium fusidate ointment 1%/2%, 30g
Fucidin H ointment (Mild)
all other uses.
Hydrocortisone/clioquinol cream 1%/3%, 30g
Vioform-Hydrocortisone (Mild)
Beclometasone dipropionate cream and ointment 0.025%
Beclometasone dipropionate in White Soft Paraffin ointment 0.00625%, 0.0025%
Propaderm cream and ointment (Potent)
Propaderm 1 in 4 Dilution ointment in White Soft Paraffin
Propaderm 1 in 10 Dilution ointment in White Soft Paraffin
Betamethasone esters
with salicylic acid
with antimicrobials
Clobetasol propionate
Clobetasone butyrate
with antimicrobials
Fludroxycortide
Betamethasone dipropionate ointment 0.05%
Betamethasone valerate cream and ointment 0.1%
Betamethasone valerate lotion 0.1%
Betamethasone valerate scalp application 0.1%
Diprosone
Betnovate cream and ointment (Potent)
Betnovate lotion (Potent)
Betnovate scalp application (Potent)
Betamethasone valerate cream and ointment 0.025%, 100g
Betamethasone dipropionate/ salicylic acid ointment 0.05%/3%
Betamethasone valerate/clioquinol 0.1%/3% ointment and cream
Betamethasone valerate/neomycin sulphate 0.1%/0.5% cream
Betnovate RD cream and ointment (Moderately Potent)
Diprosalic ointment (Potent)
Betnovate C ointment and cream (Potent)
Betnovate N cream (Potent)
Betamethasone valerate/fusidic acid cream 0.1%/2%
FuciBET cream (Potent)
all other uses.
Betamethasone dipropionate/clotrimazole cream 0.064%/1%
Lotriderm cream
(Potent)
Dermovate cream and ointment (Very Potent)
Dermovate scalp application (Very Potent)
Dermovate NN cream and ointment (Very Potent)
Clobetasol propionate cream and ointment 0.05%, 30g, 100g
Clobetasol propionate scalp application 0.05%
Clobetasol propionate 0.05%/neomycin sulphate 0.5%/nystatin 100,000units/g cream and
ointment, 30g
Clobetasone butyrate cream and ointment 0.05%, 30g, 100g
Clobetasone butyrate 0.05%/oxytetracycline 3%/nystatin 100,000units/g cream, 30g
Fludroxycortide cream 0.0125%, 60g
Fludroxycortide 4micrograms/cm²
Eumovate cream and ointment (Moderately Potent)
Trimovate cream (Moderately Potent)
Haelan cream (Moderately Potent)
Haelan tape (Moderately Potent)
Fluocinolone
Fluocinolone acetonide cream, gel and ointment 0.025%, 30g
Fluocinolone acetonide ointment 0.00625%
Fluocinolone acetonide cream 0.0025%
Synalar cream, gel and ointment (Potent)
Synalar 1 in 4 Dilution ointment (Moderately Potent)
Synalar 1 in 10 Dilution cream (Mild)
Mometasone
Mometasone furoate cream and ointment 0.1%, 30g, 100g
Elocon cream and ointment (Potent)
Zinc Paste and Icthammol bandage BP
Alitretinoin capsules 10mg, 30mg
see Dressings A8.2.9
Restricted - prescribing by Dermatology consultants only, in
accordance with NICE TA 177 Alitretinoin for the treatment of
chronic hand eczema. Traffic light list: Red.
13.5 PREPARATIONS for ECZEMA and PSORIASIS
13.5.1 Preparations for eczema
Topical preparation for eczema
Oral retinoid for eczema
13.5.2 Preparations for Psoriasis
Topical preparations for Psoriasis
Vitamin D and analogues
Tars - non-proprietary preparations
Tars - proprietary preparations
Tars - bath preparations
Fumaric acid esters (Fumaderm) 120mg tablet and Fumaderm Initial 30mg tablet
Dermatology Consultants only. For severe psoriasis in patients
unresponsive to or intolerant of other systemic treatments. Named
patient. Traffic Light list: Red.
8-Methoxypsoralen bath lotion
Unlicensed
Cade Oil ointment 200g
Betamethasone 0.05%/calcipotriol 50micrograms/g ointment, 60g
Dovobet®
In secondary care restricted - to prescribing by Dermatology team.
Dovobet® ointment may be therapeutically substituted with betamethasone
Calcipotriol cream and ointment 50micrograms/g
Calcipotriol scalp solution 50micrograms/mL
Calcitriol ointment 3micrograms/g, 100g
Coal Tar and Salicylic Acid ointment BP
Coal tar solution/salicylic acid in aqueous cream 3%/3%, 500g
Dovonex
Coal tar (crude) in white soft paraffin 1%, 2%, 5%,10%, 15%
Coal tar extract 1% lotion
Coal tar extract 1% cream
Coal tar solution 12%/ salicylic acid 2%/ precipitated sulphur 4% in coconut emollient scalp
ointment
Coal tar solution 2.5%/ arachis (peanut) oil extract of coal tar 7.5%/ tar 7.5%/ cade oil 7.5%/ liquid
paraffin 35%, 500mL
Silkis®
Molloy's Mix
Exorex
Clinitar
Restricted - 2nd choice if Exorex lotion unsuitable
Sebco
Polytar Emollient bath additive
Tars - with corticosteroids
Dithranol - Non-proprietary preparations
Coal tar extract 5%/ hydrocortisone 0.5%/ allantoin 2% cream
Dithranol in Lassar's paste 0.1%,0.25%, 0.5%, 1%, 2%
Alphosyl HC cream (potency: mild)
Note: Phone Pharmacy to check availability of strength required
Dithranol - Proprietary preparations
Dithranol cream 0.1%, 0.25%,0.5%, 1% 2%
Salicylic acid
Dithranol cream 1% and 3% in lipid-stabilised basis, 50g
Salicylic acid in white soft paraffin ointment 2%, 5%, 10%
Salicylic acid in Unguentum 5%, 10%
Dithrocream
Restricted - 0.1% and 0.25% - Phone Pharmacy to Order
Micanol
Zinc and Salicylic Acid paste BP (Lassar's paste)
Oral Retinoids for Psoriasis
Acitretin capsule 10mg, 25mg
Methoxypsoralen (puvapsoralen) liquid 1.12%
8-Methoxypsoralen (8-MOP) 10mg capsule
Dose: 0.6mg/kg,
Capsules
UVA,
Unlicensed1 -hour
Highpre
Risk
8-Methoxypsoralen (8-MOP) 10mg tablet
5-Methoxypsoralen (5-MOP) 20mg tablets
13.5.3 Drugs Affecting the Immune Response
Restricted - only for use in patients who cannot take the capsules.
Dose: 0.6mg/kg,
Dose: 1.2mg/kg,
Tablets 2.5 hours pre UVA
Capsules requested to replace tabs
5-Methoxypsoralen (5-MOP) 20mg capsule
Not available yet
Ciclosporin capsule
see Section 8.2.2
Efalizumab injection 125mg vial
Restricted - Dermatology Consultant only prescribing.
NOTE: following suspension of the marketing authorisation for
efalizumab NICE has temporarily withdrawn its guidance on the use
of efalizumab for plaque psoriasis. See NICE TA 103 Etanercept
and Efalizumab for the treatment of adults with Psoriasis. Traffic
light list: Red.
Pimecrolimus cream 1% 30g
Restricted - prescribing by Consultant Dermatologists only for use
in accordance with NICE guidelines No.82 Pimecrolimus and
tacrolimus for atopic dermatitis. Traffic light list: Amber initiation
Tacrolimus ointment 0.03%, 0.1%
Cytokine modulators
Tacrolimus capsules 500micrograms, 1mg
Prograf®
see Section 8.2.2
Restricted - to prescribing by Consultant Dermatologists.
1. Restricted - to prescribing by Dermatology consultants only, in
accordance with NICE TA 146 Adalimumab for the treatment of
Psoriasis. Traffic light list: Red.
line with BHT 740.2 Adalimumab, Etanercept or Infliximab for the
treatment of Psoriatic arthritis. Traffic light list: Red.
See section 1.5.3 (Gastroenterology) and 10.1.3 (Rheumatology)
Etanercept injection 25mg, 50mg
1. Restricted - to Dermatology or Rheumatology consultant
prescribing only in accordance with NICE TA 199 Etanercept,
2. Restricted - to Dermatology consultant prescribing only in
accordance with NICE TA 103 Etanercept and Efalizumab for the
treatment of adult with Psoriasis. Consultant to confirm NICE
criteria are met using NICE compliance form. Traffic light list: Red.
See section 10.1.3 ( for Rheumatology)
13.6 ACNE and ROSACEA
13.6.1 Topical Preparations for Acne
Benzoyl Peroxide and Azelaic Acid
Topical Antibacterials for Acne
Topical Retinoids and Related Preparations for Acne
Infliximab i.v. infusion 100mg vial
1. Restricted - prescribing by Dermatologists only, in accordance
with NICE TA 134 Infliximab for the treatment of Psoriasis. Traffic
light list: Red.
2. Restricted - Rheumatology or Dermatology consultant
prescribing only in accordance with NICE TA 199 Etanercept,
See Section 10.1.3 (for Rheumatology) and 1.5.3 (for
Gastroenterology)
Ustekinumab injection 90mg/mL, 45mg in 0.5mL
Restricted - prescribing by Consultant Dermatologists only, in
accordance with NICE TA 180 Ustekinumab for the treatment of
adults with moderate to severe Psoriasis. Traffic light list: Red.
Benzoyl peroxide cream 5%, 40g
Benzoyl peroxide aqueous gel 2.5%, 5%
Benzoyl peroxide cream 4%, 40g
Benzoyl peroxide/potassium hydroxyquinoline sulfate cream 5%/0.5%, 50g and 10%/0.5%, 25g,
50g
Azelaic acid cream 20%, 30g
PanOxyl
PanOxyl Aquagel
Brevoxyl®
Quinoderm®
Azelaic acid gel 15%, 30g
Clindamycin topical solution 1%
Clindamycin lotion 1%
Adapalene gel 0.1%
Isotretinoin gel 0.05%, 30g
Skinoren®
Finacea®
Dalacin T
Dalacin T
Isotrex
Tretinoin lotion 0.025%, 100mL
13.6.2 Oral Preparations for Acne
13.7 PREPARATIONS for WARTS and CALLUSES
Co-cyprindiol 2000/35 (cyproterone acetate/ ethinylestradiol 2mg/35micrograms) tablet
Isotretinoin capsule, 5mg, 10mg, 20mg
Dianette
Note: 5mg discontinued.
Diphencyprone solution (strength ranging 0.001% - 6%)
Restricted - Dermatology consultants only. Unlicensed - Moderate
risk. Traffic light list: Red.
Occlusal
1st Choice
2nd Choice (see above)
Avoca
Salicylic acid 26% application
Formaldehyde solution BP
Silver nitrate/potassium nitrate 95%/5% caustic pencil
Silver nitrate applicator 75%, 95%
Anogenital warts
Imiquimod cream 5%
Podophyllin Paint, Compound BP (podophyllum resin 15% in compound benzoin tincture)
Podophyllin Paint, Compound BP (podophyllum resin 25% in compound benzoin tincture)
Podophyllotoxin cream 0.15%
Podophyllotoxin solution in alcoholic basis 0.5% (blue)
13.8 SUNSCREENS and CAMOUFLAGERS
13.8.1 Sunscreen Preparations
Photodamage
Aldara
Warticon cream
Restricted - GUM use only
Available in both male and female packs (Warticon)
Podophyllotoxin solutions 0.5%
Condyline
Trichloroacetic acid 80%
Sunsense Ultra Lotion, SPF60, 125mL
Uvistat ultrablock, water-resistant cream
Factor 30
Diclofenac sodium 3% in a sodium hyaluronate gel basis, 50g
Solaraze®
To be used in accordance with CG365 Treatment of Actinic
Keratoses.
Fluorouracil cream 5%
Efudix®
To be used in accordance with the CG365 Treatment of Actinic
Keratoses.
Fluorouracil/salicyclic acid 0.5%/10% solution, 25mL
Actikerall®
To be used in accordance with CG365 Treatment of Actinic
Keratoses.
Arachis oil
Ketoconazole shampoo 2%
Coal tar 1%/ coconut oil 1%/ salicylic acid 0.5% shampoo
Restricted - prescribing for adults only.
Nizoral
Capasal
Coal tar extract shampoo 2%, 125mL, 250mL
T/Ggel®
Coal tar solution 12%/ salicylic acid 2%/ precipitated sulphur 4% in coconut emollient scalp
ointment
Polytar liquid, 150mL
Sebco - see Section 13.5.2
Calcium gluconate skin gel 2.5%
Mupirocin ointment 2%, 15g
Restricted - for use in A&E and Plastics for burns only
Bactroban
For MRSA eradication see hospital policy
13.8.2 Camouflagers
13.9 SHAMPOOS and OTHER PREPARATIONS for SCALP and
Other scalp preparations
Androgenetic alopecia
13.10 ANTI-INFECTIVE SKIN PREPARATIONS
13.10.1 Antibacterial preparations
13.10.1.1 Antibacterial Preparations Only Used Topically
Polymyxin B sulphate/bacitracin zinc ointment 10,000units/500units/g
13.10.1.2 Antibacterial Preparations Also Used
Systemically
Silver sulfadiazine cream 1%, 50g, 250g, 500g
Flamazine
Fusidic acid cream 2%, 15g
all other uses.
all other uses.
Restricted - Surgical Directorate only
Sodium fusidate ointment 2%, 15g
Gentamicin sulphate beads 7.5mg/bead, chain of 30 beads
Metronidazole cream 0.75%
Metronidazole gel 0.75%, 40g
13.10.2 Antifungal Preparations
Clotrimazole cream 1%
Clotrimazole powder 1%
Clotrimazole solution 1%
Ketoconazole cream 2%, 30g
Miconazole nitrate cream 2%, 30g
Miconazole nitrate dual action spray powder 0.16%, 100g
Terbinafine hydrochloride cream 1%, 15g
Undecenoates cream (zinc undecenoate 20%/undecenoic acid 5%), 25g
Nizoral
Daktarin
Daktarin
Lamisil
Mycota® cream
Undecenoates powder (zinc undecenoate 20%/ undecenoic acid 2%), 70g
Mycota® powder
Undecenoates spray application (undecenoic acid 3.9%/dichlorophen 0.4%), 100mL
Mycota® spray application
13.10.3 Antiviral Preparations
Aciclovir cream 5%, 2g, 10g
13.10.4 Parasiticidal Preparations
Malathion aqueous liquid 0.5%, 50mL
Permethrin cream rinse 1% in base containing isopropyl alcohol 20%
Permethrin cream 5%, 30g
Phenothrin lotion 0.2% in base containing isopropyl alcohol 69.3%, 50mL
Derbac-M
Lyclear Creme Rinse
Lyclear Dermal Cream
Full Marks - Treatment of choice January 05
13.10.5 Preparations for Minor Cuts and Abrasions
Proflavine cream BPC
Restricted - restriction to be clarified after discussion with
prescribers
Preparations for boils
Magnesium Sulphate Paste BP, 25g
Collodion
Skin Tissue Adhesive
13.11 SKIN CLEANSERS, ANTISEPTICS, and DESLOUGHING
Collodion flexible BP
Enbucrilate sterile tissue adhesive 500mg unit
Octenidine solution
13.11.1 Alcohols and Saline
13.11.2 Chlorhexidine Salts
with Cetrimide
Industrial methylated spirit 70%, 95%, 500mL bottles
Isopropyl alcohol 70%
Surgical Spirit BP, 100mL
Alcohol hand rubs, 50mL, 500mL free-standing and 500mL wall mounted bottles
Sodium chloride sterile solution 0.9%, 25mL, 100mL, 1L
Octenisan
Restricted - to prescribing by Microbiologists, Paediatrics (NICU)
and the Burns team for MRSA decolonisation in premature babies
and patients with severe burns or in patients unable to tolerate
chlorhexidine. Traffic Light List: Red.
See hospital policy on hand disinfection
Chlorhexidine gluconate 2% in 70% IPA, 3mL
ChloraPrep®
Restricted - to areas where central venous catheters, mid and PIC
lines are inserted.
Chlorhexidine 2% in 70% IPA, 200mL
Restricted - only for disinfection prior to orthopaedic surgery.
Chlorhexidine acetate sterile solution 0.05%, 1L
Chlorhexidine acetate 0.02%, 1L
Chlorhexidine gluconate 0.5% in 70% IMS, 500mL (colourless)
Chlorhexidine gluconate 0.5% in 70% IMS, spray(pink) and refill for Cx1 spray
Chlorhexidine acetate dusting powder 1%
Chlorhexidine gluconate cleansing solution 4% in surfactant solution
Chlorhexidine gluconate obstetric cream 1%
Chlorhexidine gluconate sterile solution 0.05%, 25mL sachet
Chlorhexidine gluconate/cetrimide sterile solution 0.015%/0.15%, 25mL sachet
Hibitane Obstetric
Unisept
Tisept
13.11.3 Cationic Surfactants and Soaps
Eusol and paraffin equivalent lotion
Povidone-iodine antiseptic paint 10%, 8mL
Povidone-iodine alcoholic solution 10%, 500mL
Povidone-iodine antiseptic solution 10%, 500mL
Povidone-iodine dry powder spray 2.5%, 150g
Povidone-iodine ointment 10%, 20g, 80g
Povidone-iodine surgical scrub 7.5%, 500mL
Restricted - for use on leg ulcers
13.11.5 Phenolics
Triclosan skin cleanser 2%, 500mL
Triclosan 2% bath solution
Sterillium-rub hand disinfectant solution - available at Wycombe only. Decision across
Trust awaited as due for discussion by Infection Control
Aquasept
Ster-Zac Bath Concentrate
13.11.6 Oxidisers and Dyes
Aluminium Acetate 8% ear drops
Unlicensed - Risk Assessment required
Brilliant Green and Crystal Violet Paint (Bonnies Blue)
13.11.4 Iodine
Restricted - for use by Theatres and A&E only
Product to be discontinued, May10
13.11.7 Desloughing agents
13.12 ANTIPERSPIRANTS
Hydrogen Peroxide Solution BP, 3% (10 volume)
Potassium permanganate solution tablet 400mg
Permitabs
Benzoic acid 0.15%/ malic acid 2.25%/ propylene glycol 40%/ salicylic acid 0.0375% solution,
500mL
Aserbine
Aluminium chloride hexahydrate alcoholic application 20%, 60mL
Driclor
Glycopyrronium bromide powder 3g
For iontophoresis
13.13 TOPICAL CIRCULATORY PREPARATIONS
CHAPTER 14 - IMMUNOLOGICAL PRODUCTS and VACCINES
14.1 ACTIVE IMMUNITY
14.2 PASSIVE IMMUNITY
14.3 STORAGE and USE
14.4 VACCINES and ANTISERA
H1N1 Flu Vaccine
Anthrax vaccine
BCG vaccines
Intradermal
Restricted - for use in accordance with guidance defined by the
DOH National Pandemic Flu Campaign.
Bacillus Calmette-Guérin Vaccine, 10dose
Currently the Evans brand is not available. We have SSI brand.
Reconstitute with solvent supplied (Diluted Sauton SSI) Dose
0.1mL except children younger than 1 year: 0.05mL
Diagnostic Agents
Diphtheria vaccines
Diphtheria vaccines for children under 10years
Diphtheria vaccines for children over 10years and adults
Haemophilus Influenzae Type B conjugate vaccine
combined vaccines
Hepatitis A vaccine
single component
with Hepatitis B
with Typhoid
Hepatitis B vaccine
single component
Tuberculin PPD RT 23 SSI 2 T.U./0.1mL
Tuberculin PPD RT SSI 10 T.U./0.1mL
Diphtheria, Tetanus, Pertussis (Acellular, Component), Poliomyelitis (inactivated) and Haemophilus Pediacel
Type b Conjugate
Vaccine
(adsorbed)
Adsorbed
Diphtheria
[low dose],
Tetanus, Pertussis (Acellular, Component) and Inactivated
Repevax - for children 3-10 years
Poliomyelitis Vaccine
Adsorbed Diphtheria [low dose], Tetanus and Inactivated Poliomyelitis Vaccine
Revaxis
Haemophilus influenzae type B and Neisseria meningitidis group C vaccine
Menitorix.
Hepatitis A monodose i.m. injection 1440 Elisa units/1mL
Hepatitis A monodose i.m. injection 720 Elisa units/1mL
Havrix Monodose
Havrix Junior Monodose
Hepatitis A and B vaccine 720units/20micrograms per 1mL
Twinrix
Twinrix Paediatric (0.5mL)
Hepatitis A with Typhoid vaccine
Hepatitis B vaccine i.m. injection 10micrograms/0.5mL(paed) and 20micrograms/1mL
Hepatitis B vaccine 10micrograms/1mL
Engerix B
HBvaxPRO
Human papilloma virus vaccines
Human papilloma virus vaccine
Influenza vaccines
Influenza vaccine-inactivated i.m. injection 0.5mL
Cervarix
Restricted - for use in girls aged 12-18 years.
Brand is selected each September to meet DoH guidelines.
Occupational Health run an immunisation programme for staff each
winter
Measles, Mumps and Rubella (MMR) vaccine
Measles, mumps and rubella (MMR) vaccine injection
MMR Vaccine
Meningococcal Group C conjugate vaccine
Brand available depends on supplier
Meningococcal polysaccharide A, C, W135 and Y vaccine (ACWY Vax)
Restricted - Occupational Health
Pneumococcal polysaccharide vaccines
Pneumovax II
Poliomyelitis Vaccine, Inactivated (Salk)
Restricted - available on named patient basis, Phone Pharmacy to
Order
Meningococcal vaccines
Meningococcal Group C conjugate vaccine
Pertussis vaccine
Pneumococcal vaccine
Poliomyelitis vaccines
Inactivated (Salk)
Rabies vaccine
Rabies vaccine injection
Rubella vaccine
Tetanus vaccines
Typhoid vaccines
Varicella-zoster vaccine
Typhoid vaccine (polysaccharide) vaccine for injection
Varicella-zoster virus (Oka strain) vaccine
Varicella-zoster virus (Oka/Merck strain) vaccine
Yellow Fever vaccine
Yellow fever vaccine, live
14.5 IMMUNOGLOBULINS
Brand available depends on supplier
Varilrix
Varivax
Please Note: Thames Valley Audit forms need to be completed, one sheet per patient
14.5.1 Normal Immunoglobulin
Normal Immunoglobulin - Intramuscular
Normal Immunoglobulin i.m. injection
Normal Immunoglobulin - Intravenous
Normal Immunoglobulin for Intravenous Use
The Department of Health restricts Ig use to specific indications,
details of all patients are
submitted by the Trust to the national database
Restricted - Consultants only may prescribe, and ALL requests for
Ig MUST be made using the Bucks Ig form (link). All blue/grey
uses are non-formulary and must be approved by the Ig Panel.
Refer to DOH Guideline for Ig Use 2nd edition for further
details.
Red DOH indications on the formulary:
Primary and secondary antibody deficiency states: Primary
immunodeficiencies, Thymoma with immunodeficiency, HSCT in
primary immunodeficiencies, Specific antibody deficiency (all long
term)
Haematology: Alloimmune thrombocytopenia (foetomaternal/neonatal) (long term), Haemolytic disease of the newborn
(short term), Immune thrombocytopenic purpura (acute and
persistent, excluding chronic) (short term)
Neurology: Chronic inflammatory demyelinating
polyradiculoneuropathy (only red if life threatening), Guillain-Barré
syndrome, Paraprotein-associated demyelinating neuropathy (IgM,
IgG or IgA) (all short term)
Others: Kawawsaki disease, Toxic epidermal necrolysis, Stevens
Johnson syndrome (all short term)
For guidance on administration refer to the Injectables Guide and
product information.
All immunoglobulins Traffic light list: Red
Subgam® may be given (unlicensed use) as an alternative to
tetanus immunoglobulin which may be difficult to obtain. See HPA
guidance.
14.5.2 Disease-specific Immunoglobulins
Hepatitis B
Hepatitis B Immunoglobulin
At SMH phone laboratories to check availability
Tetanus
Tetanus Immunoglobulin i.m. injection pre-filled syringe 250units
NOTE: May be difficult to obtain. See HPA guidance. Normal
immunoglobulin, Subgam®, may be given as an alternative
(unlicensed use).
Varicella Zoster
Varicella-Zoster Immunoglobulin i.m. injection
14.5.3 Anti-D (Rho) Immunoglobulin
Anti-D (Rh o ) Immunoglobulin
The supply of Varicella Zoster immunoglobulin (VZIg) is controlled
by the Health Protection Agency (HPA) Centre for Infections (CFI).
Anti-D (RhO) Immunoglobulin
Restricted - Phone Pharmacy to Order. At SMH phone laboratories
to check availability
14.7 INTERNATIONAL TRAVEL
CHAPTER 15 - ANAESTHESIA
15.1 GENERAL ANAESTHESIA
15.1.1 Intravenous anaesthetics
Thiopental sodium i.v. injection 500mg vial
Etomidate injection 20mg/10mL
Ketamine injection 200mg/20mL, 500mg/10mL
Propofol injection (1%) 200mg/20mL, 500mg/50mL
Propofol injection (2%) 1000mg/50mL
Propofol injection pre-filled syringe 500mg/50mL
15.1.2 Inhalational anaesthetics
Volatile Liquid Anaesthetics
Nitrous Oxide
15.1.3 Antimuscarinic Drugs
Hypnomidate
Restricted - treated as a CD in this Trust. Order, store and record
all issues as per a controlled drug.
Restricted - ITU use only
Desflurane
Isoflurane
Sevoflurane
Nitrous oxide
Entonox (50% nitrous oxide/50% oxygen)
Atropine sulphate injection 400micrograms/1mL, 600micrograms/1mL, 1mg/mL
Atropine sulphate injection pre-filled syringe 600micrograms/1mL
Atropine sulphate injection pre-filled syringe 1mg/5mL, 1mg/10mL, 3mg/10mL
Glycopyrronium bromide injection 200micrograms/1mL, 600micrograms/3mL
Glycopyrronium bromide tablets 1mg, 2mg
See National Resus Guidelines
See section 15.1.6 for glycopyrronium with neostigmine metilsulfate
Restricted - prescribing by consultant Paediatricians only. Supply
on a named patient basis. Traffic light list: Red.
Hyoscine hydrobromide s.c./i.m. 400micrograms/1mL, 600micrograms/1mL
15.1.4 Sedative and Analgesic Peri-Operative Drugs
15.1.4.1 Benzodiazepines
Midazolam injection i.v. injection 2mg/2mL, 5mg/5mL
Midazolam injection i.v. injection 50mg/50mL
For ICU / HDU use 50mg/50mL vial
Restricted - use of all 5mg/mL and 2mg/mL strengths is restricted
to anaesthesia and intensive care sedation and in clinical
areas/situations where its use has been formally risk assessed.
Restricted - use of all 5mg/mL and 2mg/mL strengths is restricted
to anaesthesia and intensive care sedation and in clinical
areas/situations where its use has been formally risk assessed.
15.1.4.2 Non-Opioid Analgesics
Parecoxib injection 40mg vial
Restricted - for prescribing by Anaesthetists only. For use in
theatres only for intraoperative treatment of post-op pain in
accordance with Trust guideline.
15.1.4.3 Opioid Analgesics
Alfentanil i.v.injection 5mg/10mL, 1mg/2mL
Alfentanil intensive care injection 5mg/1mL
Fentanyl i.v. injection 100micrograms/2mL, 500micrograms/10mL
Remifentanil i.v. injection 1mg, 2mg vial
15.1.4.4 Other Drugs for Sedation
15.1.5 Neuromuscular Blocking Drugs
Non-Depolarising Neuromuscular Blocking Drugs
Depolarising Neuromuscular Blocking Drugs
Restricted to prescribing by Consultant Anaesthetists only.
1. Use in accordance with CG 735.1 Guidelines for the use of
Intravenous (IV) infusion of remifentanil for sedation in the general
ICU. Use to be recorded and reviewed on the Remifentanil
Sedation in Adult Patients on ITU - Compliance Form
2. Use in accordance with BHT CG 23 Guideline for Remifentanil
PCA in Labour
All uses - Traffic light list: Red
There are currently no drugs in this section on the Buckinghamshire Formulary
Atracurium besilate i.v. injection 25mg/2.5mL, 50mg/5mL, 250mg/25mL
Cisatracurium i.v. injection 10mg/5mL
Mivacurium i.v. injection 10mg/5mL
Pancuronium bromide i.v. injection 4mg/2mL
Rocuronium bromide i.v. injection 50mg/5mL
Vecuronium bromide i.v. injection 10mg
Suxamethonium chloride injection 100mg/2mL
Restricted - for use in accordance with the Oxford organ retrieval
protocol
Suxamethonium chloride injection PFS 100mg/2mL
15.1.6 Drugs for reversal of neuromuscular blockade
Anticholinesterases
Edrophonium chloride i.v. injection 10mg/1mL
Neostigmine metilsulfate i.v. injection 2.5mg/1mL
Neostigmine metilsulfate/glycopyrronium bromide i.v. injection 2.5mg/500micrograms in 1mL
Other drugs for reversal of neuromuscular blockade
Sugammadex injection 200mg/2mL, 500mg/mL
15.1.7 Antagonists for Central and Respiratory
Depression
Flumazenil i.v. injection 500micrograms/5mL
15.1.8 Drugs for Malignant Hyperthermia
Dantrolene sodium i.v. injection 20mg
Naloxone hydrochloride injection 40micrograms/2mL, 400micrograms/1mL
Restricted - prescribing by Anaesthetics team for reversal of
neuromuscular blockade caused by vecuronium bromide or
rocuronium bromide in accordance with BHT CG151 Sugammadex
for reversal of Neuromuscular blockade in Theatres. Replacement
of stock only on receipt of completed audit form for a previous
patient. Traffic light list: Red.
400micrograms/1mL restricted for use in Emergency Treatment of
Poisoning and Overdosage.
15.2 LOCAL ANAESTHESIA
Bupivacaine hydrochloride
Bupivacaine hydrochloride epidural injection 0.25%, 10mL
Double wrapped ampoules are available
Bupivacaine hydrochloride epidural injection 0.5%, 10mL
Double wrapped ampoules are available
Bupivacaine hydrochloride/glucose epidural injection 5mg/80mg in 1mL, 4mL amp
Marcain Heavy
Bupivacaine hydrochloride/Adrenaline (Epinephrine) epidural injection 0.25%/1:200 000, 10mL
Bupivacaine hydrochloride with Adrenaline
Bupivacaine hydrochloride/Adrenaline (Epinephrine) epidural injection 0.5%/1:200 000, 10mL
Bupivacaine hydrochloride with Fentanyl
Bupivacaine hydrochloride with fentanyl epidural infusion 0.1%/2micrograms in 1mL, 100mL,
500mL
Unlicensed -Medium Risk
Levobupivacaine
Levobupivacaine injection 25mg/10mL (0.25%)
Restricted - Consultant Anaesthetists for use in theatres for
surgical anaesthesia where large doses (more than 100mg) are
required.
Levobupivacaine injection 50mg/10mL (0.5%)
Restricted - Consultant Anaesthetists for use in theatres for
surgical anaesthesia where large doses (more than 100mg) are
required.
Lidocaine(Lignocaine) hydrochloride
Lidocaine hydrochloride injections
Note: Lidocaine hydrochloride and/or Adrenaline injection entries on JAC Pharmacy
Computer may require further clarification.
Lidocaine hydrochloride injection 0.5%, 10mL
Lidocaine hydrochloride injection 1%, 2mL, 5mL, 10mL, 20mL
Lidocaine hydrochloride injection 2%, 2mL, 5mL, 20mL amp and vial
Lidocaine hydrochloride epidural injection 1%, 10mL
Lidocaine hydrochloride multidose injection 1%, 20mL
Lidocaine hydrochloride multidose injection 2%, 20mL
Lidocaine hydrochloride injections with Adrenaline
Lidocaine hydrochloride/Adrenaline (Epinephrine) cartridge injection 2%/ 1:80 000, 2.2mL
Lidocaine hydrochloride/Adrenaline (Epinephrine) injection 0.5%/ 1:200 000, pre-filled syringe
Lidocaine hydrochloride/Adrenaline (Epinephrine) injection 0.5%/ 1:200 000, 10mL,
Lidocaine hydrochloride/Adrenaline (Epinephrine) injection 1%/ 1:200 000, 10mL
Lidocaine hydrochloride/Adrenaline (Epinephrine) injection 2%/ 1:200 000, 10mL
Lidocaine hydrochloride/Adrenaline (Epinephrine) multidose injection 1%/ 1:200 000, 20mL
Lidocaine for Surface Anaesthesia
Lidocaine sterile solution 4%
Lidocaine aerosol spray 10%
Lidocaine ointment 5%
Lidocaine hydrochloride/chlorhexidine gluconate solution 2%/0.25% in sterile lubricant basis, 6mL, Instillagel
11mL syringe
Lidocaine with prilocaine
Lidocaine/prilocaine cream 2.5%/2.5%
Lidocaine for ear, nose and oropharyngeal use
Lidocaine hydrochloride/phenylephrine hydrochloride topical solution 5%/0.5%, 5%/0.25%, 2.5mL
Mepivacaine hydrochloride
Mepivacaine hydrochloride injection 3% (30mg/mL), 2.2mL cartridge
Prilocaine hydrochloride
Dental Use
Prilocaine hydrochloride injection 1% (10mg/1mL), 50mL multidose vial
Prilocaine hydrochloride/felypressin cartridge injection (3%) 60mg/0.06units in 2mL cartridge and
self-aspirating cartridge
Tetracaine
Other Local Anaesthetics
Cocaine hydrochloride sterile solution 10%
Ethyl chloride spray
Phenol in water injection 6%, 5mL
EMLA
Citanest with Octapressin
Restricted - for use in the treatment of Chronic Pain only

See Toxbase dosing advice - Buckinghamshire Formulary

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