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 Formulary Chapter 20: Unlicensed Medicines / Significant off-label use - Full Chapter
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20  Expand sub section  Unlicensed Medicines
 note 
5-Aminolevulinic acid hydrochloride (Gliolan®)
View adult BNF View SPC online View childrens BNF
Formulary
Red
Powder for oral solution
NUH only
  • Fluorescence guided neurosurgery for high grade malignant brain tumours
  • Authorised prescribers only
  • Licensed product 
  •    
    Acapella®
    View adult BNF View SPC online View childrens BNF
    Formulary
    Red
  • For use by respiratory physiotherapists
  • Oscillating positive expiratory pressure device for mucous clearance
  • Listed in drug tariff - Part IXA-Appliances
     
  •    
    Acetarsol Suppositories
    Restricted Drug Restricted
    Red
    Unlicensed medicine - named patient use only
     
    Link  UKMI Q and A: Can acetarsol be used to treat proctitis
       
    Acetic acid 5% solution
    View adult BNF View SPC online View childrens BNF
    Formulary
    Red

    SFH: Available in:
    - 200ml non-sterile bottles (~£8)
    - 20ml sterile bottles (~£6)

     
       
    Acetic Acid Solution 3%
    (Endoscopy)
    Restricted Drug Restricted
    Red

    NUH only: Unlicensed medicine - named patient use only. Restricted for use by endoscopy

     
       
    ACETYLCYSTEINE
    (Renal protection)
    Formulary
    Red

    Effervescent Tablets-600mg

    • Little evidence of benefit for preventing contrast media induced nephropathy
     
    Link  Link to reviews
    Link  SFH: Renal protection from contrast media information
       
    ACID CITRATE DEXTROSE
    (ACD)
    Restricted Drug Restricted
    Red
    SFH only
  • 500ml bags for cell salvage 
  •    
    ADRENALINE 1:200,000 inj
    Restricted Drug Restricted
    Red
    Unlicensed medicine - named patient use only
    NUH only 
       
    ADRENALINE TOPICAL SOLUTION
    (1 in 1000)
    Restricted Drug Restricted
    Red

    20ml bottle. Unlicensed medicine - named patient use only.

    SFH information only:

    • For use as a haemostatic.
    • Do not apply for long periods. See palliativedrugs.com (password needed) or discuss with Medicines information 3163)
    • In an emergency 1 in 1000 (1mg/ml) ampoules can be used.
     
       
    Ajmaline
    Formulary
    Red
    Injection
  • SFH only for the diagnosis of Brugada Syndrome 
  • Link  SFH: Guide to ajmaline administration
    Link  Link to reviews
       
    Cytotoxic Drug ALTRETAMINE (HEXAMETHYLMELAMINE) Capsules 50 mg
    Restricted Drug Restricted
    Red
    Unlicensed medicine - named patient use only
    NUH only
  • Used for ovarian cancer 
  •    
    ALUM Bladder Irrigation
    Restricted Drug Restricted
    Red
    Unlicensed medicine - named patient use only
    NUH only
  • For treatment of bladder haemorrhage
  • Potash Alum Bladder Irrigation 10% is a concentrated solution and must be diluted to 1% before use 
  • Link  NUH: Potash Alum Bladder Irrigation 10% 100ml information sheet
    Link  SFH: Potash Alum Bladder Irrigation 10% 100ml information sheet
       
    AMANTADINE Injection 200 mg in 500mL
    Restricted Drug Restricted
    Red
    Unlicensed medicine - named patient use only
  • NUH only- restricted for chronic pain
     
  •    
    Amidotrizoates (Gastrografin®)
    Formulary
    Red
    Unlicensed medicine - named patient use only
    Solution
  • Contrast medium for gastrointestinal radiography 
  •    
    Amoxicillin
    (Nebulised)
    Formulary
    Red
  • SFH: All patients on nebulised antibiotics must be referred to a respiratory specialist nurse.  
  • Link  SFH: Nebulised antibiotics guideline
       
    Amphotericin 500mg in 5ml oral soln
    Restricted Drug Restricted
    Red
    Unlicensed medicine - named patient use only
    NUH only 
       
    Aprotinin
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red
    Unlicensed medicine - named patient use only
    500,000 units/50ml Infusion
  • Restricted to patients at high risk of major bleed
    during cardiac surgery

  • NUH only 
       
    Artesunate
    Restricted Drug Restricted
    Red

    Injection

    • Unlicensed medicine - named patient use only
    • Treatment of severe and/or complicated malaria.  See NUH guideline for the management of malaria.

     

     
       
    ASCORBIC ACID Injection 500 mg in 1mL
    Restricted Drug Restricted
    Red
    Unlicensed medicine - named patient use only
    Manufacturer unable to supply JUNE 2011
    NUH only 
       
    ASPARAGINASE (MEDAC) Injection 10000 units
    Formulary
    Red
    Unlicensed medicine - named patient use only
    NUH only 
       
    Aspirin IV (ASPEGIC®)
    (Lysine Acetylsalicylate)
    Restricted Drug Restricted
    Red
    Injection
  • Unlicensed medicine (imported)- named patient use only
  • Restricted to use in cardiac catheter lab for use during coronary interventions
  • Restricted to use by consultant neuroradiologists to prevent or treat device-related thrombus formation during procedures in interventional neuroradiology (for use in patients without prior antiplatelet medication, mainly patients with ruptured brain aneurysms)
  • NUH only 
  •    
    Cytotoxic Drug AZATHIOPRINE Suspension 50 mg in 5mL
    Formulary Unlicensed medicine - named patient use only
  • Amber 1 classification to be considered at next review of Shared Care Protocol (APC Mar 15) 
  • Link  SFH outpatients should be sent to SFH pharmacy for supplies of unlicensed medicines. Don’t prescribe on FP10HP.
       
    Benzbromarone
    Restricted Drug Restricted
    Red

    Tablets 100mg. Unlicensed medicine - named patient use only
    At SFH:

    • Available by import only for consultant rheumatologist prescribing.
    • Requires order form from prescriber for every supply (See instructions)
    • Summary of benzbromarone (from Drugdex)
     
       
    Benzoin Tincture, Compound, BP
    (Friars balsam)
    Formulary
    Red
    Tincture (unlicensed indication)
    Also known as Tinct. Benz. (Tincture of Benzoin)
    SFH: Used in max fax surgery to aid dressing adhesion.  
       
    Betamethasone
    (injection - intraocular use)
    Formulary
    Red
    Unlicensed use 
       
    BEVACIZUMAB 2.5mg/0.1ml syringe
    Restricted Drug Restricted
    Red
    Unlicensed medicine - named patient use only
    NUH only for AMD 
       
    BRILLIANT GREEN 1:500 soln
    Formulary
    Red
    Unlicensed medicine - named patient use only
    NUH only 
       
    Brincidofovir
    Restricted Drug Restricted
    Red

    Tablets, Oral Suspension.
    Unlicensed medicine - named patient use only

    Available at NUH only:

    • Available in accordance with compassionate use scheme for adenovirus infection. Only on consultant decision with microbiology / virology input.
     
       
    Controlled Drug Bupivacaine 0.1% ,fentanyl 2mcg/ml 50ml
    Formulary
    Red
    Unlicensed medicine - named patient use only
    NUH only 
       
    Caffeine Citrate
    Formulary
    Red
    Injection 5mg/ml BASE (10mg/ml caffeine citrate)
    Oral Solution 5mg/ml BASE (10mg/ml caffeine citrate)
  • Prescribe as "caffeine citrate" (see MHRA warning below).
  • Unlicensed medicine - named patient use only
  • Licensed product of higher strength Peyona = non-formulary 
  • Link  NUH Neonatal monograph
    Link  NUH: Use of caffeine in apnoea of prematurity guideline
    Link  Link to reviews
    Link  MHRA Drug Safety Update (Aug 13): Caffeine for apnoea of prematurity: all products to be named and prescribed as caffeine citrate
    Link  MHRA: safe use of caffeine citrate
       
    Calcium carbonate (Phosphate binder)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Red
    250mg dispersible tablets, unlicensed special
    10% suspension, unlicensed special, manufactured at NUH
    500mg chewable tablets (Tums®)
  • For use in hyperphosphataemia of chronic kidney disease in paediatric patients
  • Phosphate binder, started by paediatric nephrology 
  •    
    CALCIUM CHLORIDE 14.7% 50ml,100ml
    Formulary
    Red
    Unlicensed medicine - named patient use only
    NUH only 
       
    CALCIUM GLUCONATE 10% 50ml,100ml
    Formulary
    Red
    Unlicensed medicine - named patient use only
    NUH only 
       
    Calcium sulfate (Stimulan® Rapid Cure)
    Restricted Drug Restricted
    Red
    Medical Device
    Calcium matrix powder and mixing solution - when mixed the resultant paste is used to make biodegradable, radiopaque beads.
    NUH only - microbiology input required regarding the choice of antibiotic rquired to be mixed with the paste. Restricted to use by the foot and ankle service for diabetic ulcers with underlying osteomyelitis.  
       
    Cannabidiol (CBD)
    Restricted Drug Restricted
    Red

    100mg/1mL oral solution (Epidiolex®)

    Available at NUH only: Approved in accordance with paediatric Early Access Programme (EAP) for patients with Dravet Syndrome (DS) and Lennox-Gastaut Syndrome (LGS).

     
       
    Carbex granules
    Restricted Drug Restricted
    Red
    SFH only
  • Used by x-ray 
  •    
    CARNOY'S soln 100ml
    Restricted Drug Restricted
    Red
    Unlicensed medicine - named patient use only
    NUH only
  • Used post enucleation of keratocystic odontogenic tumours and certain types of unicystic ameloblastoma 
  •    
    Cidofovir ointment
    Restricted Drug Restricted
    Red
    Ointment 1%
    NUH only
    Restricted for severe viral warts or molluscum contagiosum secondary to immunosuppression, unresponsive to standard therapy.
    Manufactured by Pharmacy Non Sterile Production Unit (Unlicensed Product) 
       
    CoaguChek XS PT Test strips
    (for INR testing)
    Restricted Drug Restricted
    Amber 2
  • Amber 2 - specialist recommendation - restricted to patients who have been assessed as suitable for near patient testing by an anticoagulation clinic.
  • Each box contains 24 strips. This is expected to last a patient in excess of 1 year based on average testing frequency.
  • Patients should be advised not to invest in a meter before they have spoken to the anticoagulation clinic
  • CoaguChek meters will not be provided on the NHS - not funded 
  •    
    COAL TAR BP 20% in YSP
    Formulary
    Red
    Unlicensed medicine - named patient use only
    NUH only 
       
    Constrictor rings for erectile dysfunction
    Formulary
    Amber 2
  • Amber 2 - for the patients that meet SLS criteria
  • Grey, non-formulary - if patient does not meet the SLS criteria (see drug tariff for details) 
  • Link  Drug Tariff (see Part IXa - Appliances, Vacuum pumps)
       
    Crystal Violet
    Formulary
    Red
    Unlicensed medicine - named patient use only
    NUH only
    Staining Agent used during endoscopy and colonoscopy.
     
       
    Cytotoxic Drug CYCLOPHOSPHAMIDE
    (Respiratory)
    Restricted Drug Restricted
    Red

    Unlicensed medicine - named patient use only
    SFH only

     

     
    Link  Cyclophosphamide - Regional guideline for the use of IV Cyclophosphamide in auto-immune disorders (East Mids Rheumatology Autoimmune Network - Dec 2017)
       
    Cytotoxic Drug DAUNORUBICIN saline pre-filled syringe
    Formulary
    Red
    High Cost Medicine
    NUH only
  • Unlicensed medicine - named patient use only
  • For use only after IFR approval
    10mg/10ml, 20mg/20ml, 30mg/30ml 
  •    
    DEPIGMENTING CREAM (Pigmanorm®)
    Restricted Drug Restricted
    Red
    Unlicensed medicine - named patient use only
  • Contains Hydroquinone, Tretinoin, Hydrocortisone
    NUH and Treatment Centre use only
  • For dermatologist and burns specialist use only
  • Non formulary at SFH 
  •    
    Dexamethasone eye injection
    Restricted Drug Restricted
    Red
    Unlicensed indication
    SFH only
  • Intravitreal dose is 0.4mg in 0.1ml - i.e. use the injection neat. (Moorfields handbook)
  • Subconjunctival dose is 2mg in 0.5ml - i.e. use the injection neat. (Moorfields handbook)
  • Use the DBL brand (Hospira, Faulding or Mayne are the same) of dexamethasone as it has no preservatives. 
  •    
    Dialyvit®
    Restricted Drug Restricted
    Red
    Tablet (Unlicensed medicine - named patient use only)
    NUH only
  • Restricted for paediatric renal use - paediatric formulation of Dialyvit® has been discontinued (2015)
     
  •    
    Dibotermin Alfa, rhBMP-2 (Inductos®)
    Formulary
    Red
    Kit for implant 12mg
    NUH only
  • Currently suspended in the EU. Further information here
  • Use for spinal surgery is commissioned as per NHS England commissioning policy 16063/P
  • Use for any other indication is not routinely commissioned and requires funding approval from the responsible commissioner
     
  • Link  NHS England Commissioning Policy 16063/P
       
    DIDANOSINE Liquid 10mg in 1ml (after double dilution)
    Formulary
    Red
    Unlicensed medicine - named patient use only
    NUH only
     
       
    DIHYDROERGOTAMINE Injection 1 mg in 1mL
    Formulary
    Red
    Unlicensed medicine - named patient use only
    NUH only
     
       
    DILUENT A (XANTHAN GUM 1%) Suspension 1%
    Formulary
    Red
    Unlicensed medicine - named patient use only
    NUH only
     
       
    DILUENT C susp CAROB BEAN GUM 1% 500ml
    Formulary
    Red
    Unlicensed medicine - named patient use only
    NUH only
     
       
    DIMETHYL SULFOXIDE
    (Extravasation)
    Restricted Drug Restricted
    Red

    Unlicensed medicine - named patient use only
    SFH only

     
       
    DITHRANOL 0.1% /0.25%,0.5%,1%,2%,4%in lassars paste
    Formulary
    Red
    Unlicensed medicine - named patient use only
    NUH only
     
       
    Domperidone
    (Lactation stimulation)
    Formulary
    Green
    Tablet
  • Off label indication. May be considered if benefits outweigh risks when other breastfeeding management techniques (regular feeding/ expressing, attachment optimisation) have failed.
  • Standard letter (print on headed paper) to accompany requests to prescribe.
     
  • Link  Link to reviews
    Link  MHRA: Domperisone no longer available without prescription (Sept 14)
    Link  The Breastfeeding Network domperidone information
    Link  UKMI Q&A: Domperidone / metoclopramide for lactation stimulation
       
    DOXYCYCLINE Injection 100 mg in 5mL
    Restricted Drug Restricted
    Red

    Unlicensed medicine - named patient use only

    Available at NUH only:

    • Restricted antibiotic for pelvic inflammatory disease: see local guidelines [NUH guideline]
     
       
    ETHIONAMIDE Tablets 250 mg
    Formulary
    Red
    Unlicensed medicine - named patient use only
    NUH only 
       
    EVEROLIMUS Tablets 250 micrograms,750 micrograms
    Formulary
    Red
    Unlicensed medicine - named patient use only
    NUH only 
       
    FERRIC SUBSULPHATE (monsel's soln)
    Formulary
    Red
    Unlicensed special, 50ml bottle £22.
  • Used intravaginally as a haemostatic.
  • Does not need to be sterile so product can be decanted and the bottle reused until its expiry date.  
  •    
    Fibrin Sealant (Evicel®)
    Restricted Drug Restricted
    Red
    Evicel Kit
    NUH only 
    Link  Haemostatic Agents at NUH
    Link  MHRA Feb 2013: updated guidance on minimising risk of life-threatening and fatal air embolism
    Link  Urgent Product Information - Risk of life-threatening air or gas embolism (Dec12 letter)
       
    Fibrin Sealant (Tisseel®)
    Restricted Drug Restricted
    Red
    Ready to use syringe
    NUH only
     
    Link  Baxter: Risk of air embolism with fibrin sealants (Jan 2013)
    Link  MHRA: Risk of air embolism with fibrin sealants (Feb 2013)
    Link  Haemostatic Agents at NUH
    Link  Tisseel product information
       
    FLUNARIZINE 5mg capsules
    Formulary
    Red
    Unlicensed medicine - named patient use only
    NUH only 
    Link  Link to reviews
    Link  NICE Unlicensed Evidence summary: Flunarizine for migraine prophylaxis
       
    Flutter (Device)
    Formulary
    Red
  • For use by respiratory physiotherapists
  • Oscillating positive expiratory pressure device for mucous clearance
     
  • Link  Link to reviews
       
    GABAPENTIN 6% topical
    Restricted Drug Restricted
    Red
    Unlicensed medicine - named patient use only
    NUH only
    Topical preparation for treatment of vulvodynia. Restricted to pain team and gynaecology specialists.
     
       
    Gas Gangrene Antitoxin
    Formulary
    Red
    Injection 2500 units in 1 mL
    Unlicensed medicine - named patient use only
    NUH only
  • Not for administration to humans. Used for calibrating assays.
  • Only available via NIBSC website.
     
  • Link  NUH Pharmacy: Rare antitoxins and immunoglobulins
       
    Giving sets (IV)
    Formulary At SFH and NUH, IV giving sets do not come from pharmacy 
       
    Giving sets (NG)
    Formulary At SFH, only the following giving sets come from Pharmacy:
  • Flocare infinity pack set – currently keep stock in pharmacy & on wards
  • Flocare universal (with med port) set
  • Flocare NG feeding tube – currently keep stock in pharmacy & on wards
     
  •    
    GLIADEL wafer Carmustine 7.6mg
    Formulary
    Red
    Unlicensed medicine - named patient use only
    NUH only
     
    Link  NICE TA121: Glioma - carmustine implants and temozolomide
       
    GLYCEROL STERILE 30ml
    Formulary
    Red
    NUH only: Unlicensed medicine - named patient use only
  • No longer stocked at SFH - podiatry to purchase own non-sterile version from RDC.
     
  •    
    Glycopyrrolate 0.5% topical solution
    Formulary
    Red
    • SFH information only: Unlicensed Special. Obtain supplies from SFH Pharmacy rather than FP10HP.
     
       
    Haemostatic Agent
    (Quikclot®)
    Restricted Drug Restricted
    Red
    Gauze
    ENT nasal gauze is non formulary
  • Consultant use only- Restricted for use in life threatening haemorrhage
  • At SFH, discuss with Dr Tim Moorby, Consultant Haematologist.
  • Click here for the website
     
  •    
    Haemostatic Agent (Floseal®)
    Restricted Drug Restricted
    Red
    Haemostatic Matrix
    NUH only
    Also approved for NUH ENT specialist use only for the treatment of epistaxis in accordance with local guideline. 
    Link  Haemostatic Agents at NUH
       
    Haemostatic Agent (PuraStat®)
    Restricted Drug Restricted
    Red

    Gel (1ml and 3ml syringes)
    NUH only: Approved for the management of bleeding during endoscopic procedures following either sphincterotomy in ERCP, EMR, ESD and when treated for Upper GI bleed.
    Non pharmacy item, supplied through NHS supplies

     
       
    Haemostatic Agent (Tachosil®)
    Restricted Drug Restricted
    Red
    Medicated sponge - used in liver surgery
    NUH only 
    Link  Haemostatic Agents at NUH
       
    Haemostatic Agent (Willospon®)
    Formulary
    Red
    Gelatine sponge - Anal Tampon
    NUH only
  • For local haemostasis in surgical procedures 
  •    
    HYDROCHLOROTHIAZIDE
    Formulary
    Red
    NUH only
  • Tablet 25mg used for neonatal suspension. Unlicensed.
     
  • Link  MHRA: risk of non-melanoma skin cancer with hydrochlorothiazide
       
    HYDROXYPROGESTERONE 260mg/ml inj
    Formulary
    Red
    Unlicensed medicine - named patient use only
    NUH only
     
       
    Icodextrin solution
    (Adept®)
    Formulary
    Red
    • At SFH approved only for patients undergoing laparoscopic gynaecological surgery with a previous history of adhesion formation or those at high risk of adhesions.
    • Click here for independent reviews
    • Manufacturers information sheet
     
    Link  Link to reviews
       
    i-FACTORTM
    Restricted Drug Restricted
    Red
    Peptide Enhanced Bone Graft
    NUH only
    Approved for use in spinal fusion
    Supplied by Theatre Stores 
       
    Indigo carmine
    Formulary
    Red

    SFH:
    -0.8% sterile solution for use in endoscopy during EMR procedures.
    -Non-sterile solution used as a mucosal dye spray in endoscopic procedures. Obtained through supplies rather than pharmacy.
    NUH: 0.8% sterile injection for use in endoscopy. Supplied by Pharmacy.

     
       
    Iohexol (Omnipaque®)
    Formulary
    Red
    SFH:
  • '140' is used in Endoscopy for ERCP
  • '300' no longer used orally as a bowel contrast in CT colonography as didn't perform as expected 
  • Link  Link to manufacturer SPC (datasheet)
    Link  Link to review
       
    Iopamidol (Niopam®)
    Formulary
    Red

    Injection

    • Radiographic contrast medium
    • licensed medicinal product
     
       
    Joulies Oral Solution
    (phosphate supplementation)
    Restricted Drug Restricted
    Red

    Oral Solution
    Unlicensed medicine - named patient use only

    NUH only: For oral phosphate supplementation in paediatric nephrology where potassium phosphate is contraindicated

     
       
    Lactose powder
    Formulary
    Red
    For hydrogen breath tests in endoscopy. 
       
    LAT gel
    Formulary
    Red
    Gel (unlicensed)
  • SFH only. For use when cleaning/ suturing wounds in children in ED
  • Contains lidocaine 4%, adrenaline 0.1% and tetracaine 0.5% 
  •    
    LEVAMISOLE Tablets 50 mg
    Formulary
    Red
    Unlicensed medicine - named patient use only 
    Link  Medicines for children leaflet: Levamisole for nephrotic syndrome
       
    Levosimendan (Simdax®)
    Restricted Drug Restricted
    Red

    Unlicensed medicine - named patient use only
    Injection - 12.5mg/5mL

    SFH: Not approved for use
    NUH only: Post cardiac surgery as per guideline.

     
    Link  NUH: Guidelines for the use of levosimendan following cardiac surgery
       
    Lipiodol
    Formulary
    Red

    Historically used during endoscopy in conjunction with cyanoacryalate glue.

     
       
    LIQUID PARAFFIN sterile light (20mL or 25ml)
    Formulary
    Red
    Unlicensed medicine - named patient use only 
       
    LITHIUM CHLORIDE
    (For LIDCO calibration)
    Restricted Drug Restricted
    Red

    SFH information only: 

    • For calibration of the ICCU LiDCO machine which is used to monitor cardiac output
    • Usual prescription is "Lithium chloride injection (0.15mmol/ml): 2ml (0.3mmol) IV PRN"
     
       
    LITMUS PAPER
    Restricted Drug Restricted
    Red

    SFH information only:

     
       
    Lubricating gel
    Formulary
    Green
  • Available in 5g sachets and 42g tubes 
  •    
    MAGNESIUM GLYCEROPHOSPHATE powder 350g
    Formulary
    Red
    Unlicensed medicine - named patient use only
    NUH only 
    Link  Link to reviews
       
    MAGNESIUM SULPHATE 10% INFUSION
    Formulary
    Red
    Unlicensed medicine - named patient use only
    NUH only
    See Chapter 9 for other parenteral magnesium preparations
     
       
    Mannitol (Osmohale®)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Red

    Inhalation powder (supplied in hard capsules)

     For use in respiratory clinic for diagnosis.

     
    Link  Link to reviews
       
    Methacholine solutions various strengths (Methylcholine, Acetyl-β-methylcholine)
    Formulary
    Red
    Unlicensed medicine - named patient use only
    NUH only
  • Inhalation of nebulised solutions of methacholine chloride are used to provoke bronchoconstriction in the diagnosis of bronchial airway hypersensitivity 
  •    
    METHOCEL 2% eye drops
    Formulary
    Red
    Unlicensed medicine - named patient use only
    NUH only 
       
    Cytotoxic Drug METHOTREXATE
    (Ectopic pregnancy)
    Restricted Drug Restricted
    Red

    Unlicensed medicine - named patient use only

    • Dose is 50mg per square metre given intramuscularly (SFH: See dose calculator)
    • At NUH: Pre-filled syringes stocked in pharmacy - contact pharmacy to arrange a supply. Pharmacy procedure available. Prescribe using dedicated drug chart.
    • At SFH: Supplied from the Aseptic Dispensing Unit (ADU) - contact your ward pharmacist or send the prescription to Pharmacy (between 9-4pm). Full guideline here.
     
    Link  NUH: Ectopic pregnancy guideline
    Link  SFH: Ectopic pregnancy guideline
    Link  SFH: Methotrexate dose calculator
       
    Methylthioninium chloride (Aguettant®)
    (visualisation / staining)
    Restricted Drug Restricted
    Red

    SFH: 1ml 1% for enteral use (not for IV)(unlicensed)
    (See here for the intravenous product.)

    • Also known as 'methylene blue'.
    • Aguettant® available for visualisation (staining)(approx £20 each). Click here for SPC or basic guide.
     
    Link  Memo: Change in Diluent
    Link  MHRA safety update April 2009
       
    Miltefosine
    Restricted Drug Restricted
    Red
    Unlicensed medicine - named patient use only
    Capsule
    NUH only
  • Restricted for treatment of various forms of leishmaniasis

  •  
       
    Controlled Drug MORPHINE 40mg/ml inj pfs
    Formulary
    Red
    Unlicensed medicine - named patient use only
    NUH only 
       
    Controlled Drug MORPHINE 50mg/50ml syringe
    Formulary
    Red
    Unlicensed medicine - named patient use only
    NUH only 
       
    Controlled Drug Morphine epidural 2mg in 10ml
    Formulary
    Red
     
       
    Mydricaine
    Formulary Unlicensed supply available.
    - Number 1 (for children)(not routinely stocked at SFH)
    - Number 2 (for adults)
  • Contents and more info
  •    
    Nifedipine
    (tocolytic)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Red
     
    Link  Discontinuation of immediate release nifedipine (Memo Dec 2018)
    Link  Trial review (2016): Nifedipine vs atosiban for threatened preterm birth (APOSTEL III)
       
    Nitazoxanide
    Restricted Drug Restricted
    Red

    Unlicensed medicine - named patient use only
    Tablets, Suspension
    NUH only for treating various intestinal parasites including cryptosporidiosis on recommendation of microbiology or infectious diseases. In tariff. Prolonged or repeat courses should seek one-off request approval. 

    HCD HCD Excluded from tariff for the treatment of Hepatitis C, but Individual Funding Request must be completed prior to prescribing 

     
       
    Octenisan®
    (Wash, Nasal Gel, Mitts, Shower Caps)
    Formulary
    Green
    • At SFH nasal gel and wash to be used in line with MRSA policy for prophylaxis in high risk group patients. Patient information leaflets and stickers available from Infection Control.
    • At NUH wash to be used in line with Infection Control recommendations. First line for MRSA decolonisation. Chlorhexidine second line in those unable to use Octenisan. Nasal gel available 3rd line (after Bactroban and Naseptin) for patients requiring decolonization.  Nasal gel approved for use in critical care during Bactroban supply problem.
    • Wash Mitts and Shower Caps may be used in community patients unable to use the standard wash on the advice of infection control (APC Sept 14).
     
    Link  Link to reviews
    Link  NUH Octenisan wash poster
    Link  SFH: Prevention against MRSA skin carriage for high risk patients
       
    ORA-PLUS ORAL SUSPENDING VEHICLE
    Formulary
    Red
    Unlicensed medicine - named patient use only
    NUH only 
       
    OXANDROLONE
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red

    Unlicensed medicine - named patient use only
    Tablets 2.5mg
    NUH only for the management of patients with severe burns in adult critical care.

     
    Link  Link to reviews
       
    Oxitriptan
    (5-hydroxytryptophan)
    Restricted Drug Restricted

    Unlicensed medicine - named patient use only
    Capsules 10mg or 20mg

    • Used for Phenylketonuria caused by a deficiency of tetrahydrobiopterin. Treatment involves oral supplementation of tetrahydrobiopterin; in some severe cases, the addition of the neurotransmitter precursors, levodopa and 5-hydroxytryptophan, are also necessary

     For adults under the care of a tertiary metabolic centre.

     For paediatric patients, service delivered through NUH.

     
       
    PAPAVERINE HYDROCHLORIDE (2ML AMPOULE) Inj 40 mg in 1mL
    Formulary
    Red
    Unlicensed medicine - named patient use only
  • At SFH Rarely used in theatres for extravasation and blood vessel spasms and rarely used in cardiac catheter suite as an alternative to adenosine. 
  •    
    PAROMOMYCIN Tablets 250 mg
    Formulary Unlicensed medicine - named patient use only
    NUH only 
       
    PATENT BLUE Injection 2.5%
    Formulary
    Red
    Unlicensed medicine - named patient use.
  • Translation of French SPC
  • MHRA warning of allergies - Feb 2012 
  •    
    PENICILLIN SKIN TEST KIT
    Formulary
    Red
    Unlicensed medicine - named patient use only
    NUH only 
       
    pH indicator paper
    Restricted Drug Restricted
    Green
    • SFH information only: Test strips [see photo] with range 2-9 are used for testing NG tube placement. pH 5.5 or below indicates gastric contents. See nursing procedure N1.
     
       
    PHENOL (AQUEOUS) 5ML Injection 6%
    Formulary Unlicensed medicine - named patient use only
    NUH only 
       
    Phenol 5% in glycerin injection
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red
    SFH: Specialist use only for nerve ablation. 
       
    Pollinex Quattro®
    Restricted Drug Restricted
    Red
    NUH only
    Injection - for moderate/severe rhinoconjunctivitis caused by tree and or grass pollens.
    Restricted to use by Allergy Department 
    Link  Link to reviews
       
    Polydimethylsiloxane
    (Bioplastique)
    Restricted Drug Restricted
    Red

    SFH information only:

    • Can be ordered once divisional manager has approved
    • Bioplastique procedure kit (Vox®) for injecting into vocal cords
     
       
    POTASSIUM ACETATE inj
    Formulary
    Red

    Unlicensed medicine - named patient use only

     
       
    POTASSIUM CANRENOATE Injection 200 mg in 10mL
    Formulary
    Red
    Unlicensed medicine - named patient use only
    NUH only 
       
    Potassium Chloride, Magnesium Sulfate, Calcium Chloride, Sodium Chloride and Glucose Intravenous Infusion
    Restricted Drug Restricted
    Red
    Unlicensed medicine - named patient use only
    Note KCl 0.15% = 20mmol/Litre, 0.3% = 40mmol/Litre
    NUH only: Approved for paediatric oncology patients
    KCl 20mmol in 1000mL (20mmol/litre) with Magnesium sulfate 10mmol, Calcium chloride 0.6mmol, Dex 2.5% & NaCl 0.45%.  
       
    Pregnancy tests
    Restricted Drug Restricted

    SFH information only: Wards/Clinics order direct from NHS supplies.

     
       
    Prism0cal® B22
    Restricted Drug Restricted
    Red

    5 litre bags

    Available at NUH only:

    • Approved for use on PICU for Continuous Renal Replacement Therapy (CRRT)
     
       
    Prismocitrate® 18/0
    Restricted Drug Restricted
    Red

    5 litre bags

    Available at NUH only:

    • Approved for use on PICU for Continuous Renal Replacement Therapy (CRRT)
     
       
    Probiotic (Actimel®)
    Restricted Drug Restricted
    Red

    Drink
    NUH only
    Restricted to prevent antibiotic associated diarrhoea and C.difficile infection in
    patients admitted to the elderly wards at QMC campus. 
    Not supplied by pharmacy.

     
       
    PROCAINAMIDE Capsules 250 mg
    Formulary
    Red
    Unlicensed medicine - named patient use only
    NUH only 
       
    Propranolol
    (Haemangioma)
    Formulary
    Amber 2
    Liquid
  • Nb the 3.75mg/ml strength of the oral solution (Hemangiol) is non formulary (no formal assessment) (APC, Sept14). 
  • Link  SFH: Propranolol for Complicated Infantile Haemangioma guideline
       
    PYRIDOXAL 5 PHOSPHATE Tablets 50 mg
    Formulary Unlicensed medicine - named patient use only
    NUH only 
       
    Quizartinib
    Restricted Drug Restricted
    Red

    Tablet

    Available at NUH only:

    • Available in accordance with compassionate use scheme for relapsed/refractory FLT3-ITD positive AML.
     
       
    Regadenoson
    Restricted Drug Restricted
    Red
     
    Link  Link to reviews
       
    Resuscitation trollies
    Restricted Drug Restricted

    SFH information only:
    Available from MEMD
    -Contains:

    • Adrenaline 1:10,000 x 4
    • Amiodarone 300mg x 1
    • Calcium Chloride 10% /10ml x 1
    • Normal Saline flush (10ml) x 6
    • Adrenaline 1:1000 1mL amps x 10
      For further information of emergency boxes at SFH click here
     
       
    RIBOFLAVIN 50mg tabs
    Formulary Unlicensed medicine - named patient use only
    NUH only 
       
    RIFAMPICIN 300mg inj
    Formulary
    Red
    Unlicensed medicine - named patient use only
    NUH only 
       
    ROBINUL-NEOSTIGMINE inj (1ml)
    Formulary
    Red
    Unlicensed medicine - named patient use only
    NUH only 
       
    SCHILLERS IODINE SOLN 200ml
    Formulary Unlicensed medicine - named patient use only
    NUH only 
       
    SODIUM ACETATE 30% INJ 50ml
    Formulary
    Red
    Unlicensed medicine - named patient use only
    NUH only 
       
    SODIUM ACETATE 40mmol/10ml inj
    Formulary
    Red
    Unlicensed medicine - named patient use only 
       
    SODIUM CHLORIDE 600mg caps
    Formulary Unlicensed medicine - named patient use only
    NUH only
    See also entry for 600mg MR tablets

     
       
    SODIUM GLYCEROPHOSPHATE (10ML) Injection 21.6%
    Formulary
    Red
    Unlicensed medicine - named patient use only 
       
    Sodium Hyaluronate (Hyacyst®)
    Restricted Drug Restricted
    Red

    Bladder instillation
    NUH only

     
       
    Sodium Hyaluronate (SigmaviscTM )
    (Endoscopy)
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red

    Injection

    Available at NUH for Endoscopy use only:
    Non Pharmacy Item - order through NHS Supply Chain.

     
       
    Sodium Hyaluronate 800mg/50mL (1.6%), Sodium Chondroitin Sulfate 1g/50mL (2%) (iAluRil®)
    Restricted Drug Restricted
    Red
    Bladder instillation
    NUH only
    - used by urology: first line agent for recurrent UTIs, where the patient is not suitable for treatment using antimicrobial therapies, and as a 2nd line bladder instillation for painful bladders. 
       
    SODIUM PROPYL HYDROXYBENZOATE
    Formulary Unlicensed medicine - named patient use only
    NUH only 
       
    SODIUM THIOSULFATE Injection
    Formulary
    Red
    Injection
  • 25% used in patients with renal failure calciphylaxis (NB: concentration change).
  • See poisoning section 18 for info on use as an antidote
     
  • Link  NUH: Renal Metabolic Bone Guidelines
       
    SPECTINOMYCIN Injection 2 g
    Formulary

    Unlicensed medicine - named patient use only


    At SFH:
    One vial kept in GU med, one vial kept in pharmacy. Administration guidelines

    Available at NUH:

    • On GU recommendation only - see restricted antimicrobials list   
     
       
    St Mark's solution
    View adult BNF View SPC online View childrens BNF
    Formulary Not for prescribing in Primary Care.
    Also known as rehydration salts or electrolyte mix.
    Patients are advised to purchase the powders from community pharmacies and supermarkets, as it will often work out cheaper than paying for a prescription. 
    Link  UKMI Q&A: What is St Mark’s Electrolyte Mix (solution)?
       
    SUCRALFATE 2g/50ml enema
    Formulary Unlicensed medicine - named patient use only
    NUH only 
       
    Sucrose 24% (Sweat-Ease®)
    Restricted Drug Restricted Unlicensed medicine - named patient use only
    Restricted for neonatal use only
     
    Link  Link to reviews
    Link  SFH guideline for use in neonates
       
    Sultiame 50mg tabs
    Formulary Unlicensed medicine - named patient use only
    NUH only 
       
    TALC BP purified sterile  (Steritalc®)
    Formulary
    Red

    Unlicensed medicine. For pleurodesis.

    • 4g vial (for slurry instillation)
    • 3g poudrage kit with atomiser (for insufflation) (not routinely stocked at SFH but can be ordered)
     
    Link  SFH: Talc for pleurodesis on respiratory wards- Dose and Preparation procedure
    Link  BTS Pleural Disease Guidelines
    Link  UKMI Q&A: Admin of talc for pleurodesis
       
    Tamoxifen
    (Gynaecomastia)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Amber 3
  • As a non-surgical treatment for the treatment of gynaecomastia as per the Nottinghamshire Gynaecomastia Guideline
     
  • Link  Link to reviews
       
    Taurolodine and Citrate 4% (TauroLock®)
    Restricted Drug Restricted Line Lock
    NUH only
    Restricted for prophylaxis of infection in chronic haemodialysis catheters in paediatrics and prophylaxis against catheter related bloodstream infections in parenteral nutrition patients. 
    Link  Link to reviews
       
    TETRAHYDROBIOPTERIN Tablets 10 mg
    Formulary
    High Cost Medicine
    Unlicensed medicine - named patient use only
    NUH only 
       
    THALIDOMIDE Tablets 50 mg
    Formulary
    Red
    Unlicensed medicine - named patient use only
    NUH only
    See Chapter 8 for capsules
     
       
    THEOPHYLLINE liq 50mg/5ml
    Formulary Unlicensed medicine - named patient use only
    NUH only 
    Link  NUH Lite Bite: Importance of Maintaining Brand for Certain Medicines
       
    THIAMINE Injection 100 mg in 1mL
    Formulary
    Red
    Unlicensed medicine - named patient use only
    NUH only 
       
    TICLOPIDINE 250mg tabs
    Formulary Unlicensed medicine - named patient use only
    NUH only 
       
    Timolol topical
    (haemangioma)
    Formulary
    Red
    0.5% ophthalmic gel (Timoptol LA®)
  • Specialist use only for the treatment of infantile haemangioma.
  • Usual dose is BD application to the whole of the haemangioma without occlusion. Usually used for approx 4 months but depends on response. 
  • Link  Link to reviews
       
    TISOPURINE Tablets 100 mg
    Formulary Unlicensed medicine - named patient use only
  • At SFH, available under special circumstances via IDIS drug importers. Usual dose is 100mg od-qds. Further information available from Medicines Information 
  •    
    Tranexamic acid 8% in glycerin 20% nasal spray
    View adult BNF
    Formulary
    Red
    SFH: Only available on special order. Costs around £50 per 20ml bottle.  
       
    TRANEXAMIC ACID Oral Solution 500 mg in 5mL
    Formulary Unlicensed medicine - named patient use only
    NUH only 
       
    TRIAMCINOLONE ACETONIDE 0.1% in a protective emollient vehicle  (Oracort® )
    Restricted Drug Restricted Dental Paste
    NUH only
    Restricted for use by the maxillo facial team 
       
    Trisodium Citrate 46.7%
    Restricted Drug Restricted Line Lock
  • Restricted to renal use in patients with tunnelled venous catheters for venous catheters
  • Citra-Lock-S® brand used at NUH and SFH (once Duralock-C stock is exhausted) 
  •    
    TROMETAMOL (THAM) 125ML Injection 3.6% (0.3M)
    Formulary
    Red
    Unlicensed medicine - named patient use only
    NUH only 
       
    TROMETAMOL 0.3Molar (10.5ml) inj
    Formulary
    Red
    Unlicensed medicine - named patient use only
    NUH only 
       
    Trypan blue
    (Oftalblu)
    Restricted Drug Restricted
    Red
    Injection
    SFH only
  • Previously used Vision blue 
  •    
    UBIQUENONE 50mg VIT E 15iu/5ml Liq 10
    Formulary Unlicensed medicine - named patient use only
    NUH only 
       
    Ultravist
    Formulary
    Red
    Injection
    SFH only
     
       
    Vacuum Pumps for Erectile Dysfunction
    Formulary - for patients with established erectile dysfunction who qualify for treatment under the SLS criteria
    , non-formulary - for patients who don’t qualify for treatment under the SLS criteria 
    Link  Drug Tariff (see Part IXa - Appliances, Vacuum pumps)
    Link  Link to reviews
       
    VertebroplasticTM Cement
    Formulary
    Red
    NUH only
    For vertebroplasty, kyphoplasty and vertebral screw augmentation 
       
    VITAMIN A (RETINYL PALMITATE) Injection 100,000 units in 2 mL (VITAMINE A NEPALM)
    Formulary
    Red
    Unlicensed medicine - named patient use only
    Injection
    NUH only 
       
    Water for humidification
    Restricted Drug Restricted SFH only
  • ITU only 
  •    
    Whiteheads varnish
    (Iodoform compound paint)
    Restricted Drug Restricted
    Red
    Unlicensed product
    NUH Only: Restricted for Max Fax use. 
       
    YOHIMBINE Tablets 5.4 mg
    Formulary Unlicensed medicine - named patient use only
    NUH only 
       
    ZINC COMPUND PASTE 500g
    Formulary Unlicensed medicine - named patient use only
    NUH only 
       
    ZINC SULPHATE 1mmol in 10ml inj
    Formulary
    Red
    Unlicensed medicine - named patient use only
    NUH only 
       
     ....
     Non Formulary Items
    Acetylcarnitine

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
    Unlicensed in the UK
    Link  UKMI Q&A: Oral treatments for treating Peyronie’s disease
     
    ACETYLCYSTEINE
    (Cystic fibrosis)

    Non Formulary
    Grey
  • Previously used in the treatment of DIOS in CF (off-label usage). No new patients to be started. Existing patients will be reviewed by secondary care.
  • Link  Link to reviews
     
    ACETYLCYSTEINE
    (Pulmonary fibrosis)

    Non Formulary
    Grey
  • Classified as GREY at APC May 2017 due to a lack of evidence of benefit. The Panther-IPF study found no significant improvements over placebo, but an increased rate of cardiac disorders with acetylcysteine.
  • Patients currently prescribed acetylcysteine for pulmonary fibrosis should be actively reviewed by secondary care.
  • Link  Link to reviews
     
    Actipatch

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
     
    Adcon gel

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
     
    ADEK vitamins

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
    Discontinued 2007
     
    Adrenaline (epinephrine) inhaler  (Primatene Mist®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
     
    Afamelanotide  (Scenesse®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
  • An a-melanocyte-stimulating hormone analogue. Also known as melanotan I. Widely abused to obtain a cosmetic tan.
  • No formal assessment for other indications.
  •  
    ALUMINIUM ACETATE 8% or 13% ear drops

    View adult BNF View SPC online View childrens BNF
    Non Formulary July 2015: Only Tayside pharmaceuticals in Dundee make as a special, but £52 for 8%, and £47 for 13%.
     
    Aminolevulinic acid (PDT)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
  • Unlicensed in the UK
  • Metvix now used for PDT at SFH
  •  
    Anastrozole
    (Gynaecomastia)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
    Limited published evidence to support use in gynaecomastia (APC Sept 15)
     
    ANTI-HUMAN THYMOCYTE GLOBULIN (HORSE) Inj 100 mg in 5mL

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
    No longer used for aplastic anaemia and GVHD post BMT as unavailable. Using rabbit ATG now see Thymoglobuline Unlicensed medicine - named patient use only
     
    Antox tablets

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
    Previously called Bio-antox
     
    Arthroplex®

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
     
    Atopiclair

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
  • Classed as a Medical Device, not a drug.
  • Click here for independent reviews
  •  
    Autologous cartilage cells  (ChrondoCelect®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
    No formal submission
     
    Cytotoxic Drug  AZATHIOPRINE Capsules 10 mg

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
  • Use licensed tablets or 50mg in 5ml suspension
  •  
    BENZOCAINE 150mg/5ml susp

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
  • Use Antacid and Oxetacaine mixture instead
  •  
    Bicaflac®

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
     
    Biclinocillin

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
     
    Biloptin

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
    Discontinued April 2004 by Schering Healthcare
     
    BISOCODYL 0.274% rectal soln

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
     
    Blephaclean®

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
     
    Blephagel®

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
     
    Blephasol®

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
     
    Boric acid ear solution

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
    • Unlicensed special Boric acid 2% in IMS 70% was previously made by non sterile manufacturing unit at SFH on a named patient basis. Now only an aqueous version is available manufactured by QMC specials.
     
    CAFFEINE BASE 10mg/ml

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
    Unlicensed medicine - named patient use only
  • 10mg/ml strength no longer used at NUH- see above
  •  
    CAFFEINE CITRATE 20mg/ml INJ

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
    Unlicensed medicine - named patient use only
  • Licensed product of this strength now available (Peyona), but non-formulary. See above for alternative
  • Link  MHRA letter to healthcare professionals regarding caffeine citrate products
     
    Camphor/menthol/cajuput oil/clove oil  (Tiger Balm)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
    No formal assessment
     
    Cannabis products for medicinal use

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
    • Cannabis products affected by the November 18 re-scheduling may only be prescribed legally by a clinician on the Specialist Register of the General Medical Council, prescribing within their own area of practice and training. More info.
    • Epidiolex® (unlicensed) is the product recommended by the British Paediatric Neurology Association.  Awaiting assesment pending discussion at Trust DTCs
    Link  NHS England info on cannabis for medicinal use
    Link  RCGP: GP guidance on cannabis-based products (Dec 2018)
    Link  UKMI Q & A- interactions with cannabis based medicinal products
    Link  UKMI Q & A-adverse effects & interactions with cannabidiol oil
     
    CAPTOPRIL Tablets 2 mg

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
  • Was historically used in children prior to the availability of a suspension. Now use licensed suspension.
  •  
    CELESTINS ENDO-OESOPHAGEAL TUBE powder

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
     
    CHLOROTHIAZIDE Tablets 500 mg

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
     
    Chondroitin

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
    Link  UKMI Q&A: Chondroitin - drug interactions?
    Link  UKMI Q&A: Chondroitin - what are the adverse effects?
     
    Cisapride

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
    Discontinued by company
     
    Clevidipine

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
    Link  Link to reviews
     
    CODEINE PHOSPHATE Suppositories 15 mg,2mg,3mg,6mg

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
     
    Copper Histidine

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
    Injection
  • Unlicensed medicine
  •  
    DEFIBROTIDE Capsules 400 mg

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
    High Cost Medicine
  • IFR approval required before initiation
  • Link  Link to reviews
     
    Dexmedetomidine Paediatric

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
    Link  Link to reviews
     
    DHEA
    (Dehydroepiandrosterone)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
    • Also known as prasterone.
    Link  UKMI Q&A: Is there any evidence that DHEA supplementation improves female fertility?
     
    DIAZEPAM Suspension 2.5 mg in 5mL

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
  • Use alternative strength. See other diazepam entries
  •  
    Diphenylcyclopropenone in acetone

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
    Unlicensed special
  • Also known as diphencyprone
  • Solution previously could be made by non sterile manufacturing unit at SFH, may be available on special order
  • Link  Link to reviews
     
    Echinacea

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
    Of no proven value.
  • Review from Science Based Pharmacy. Dec 2010
  • Sarcastic, amusing and educational review in podcast form. See episodes 2 and 18
  •  
    Elastolabo®

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
    No formal submission APC May 2015
     
    Eprodisate disodium

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
     
    Eptotermin Alfa  (Osigraft®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
    High Cost Medicine
    Discontinued July 2014
    Link  Link to reviews
     
    Factor Eight Inhibitor Bypassing Activity  (FEIBA)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
  • Not stocked at SFH. Contact Haematology for advice
  •  
    Controlled Drug  Fentanyl  (Ionsys®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
    Link  Link to reviews
     
    Controlled Drug  Fentanyl and Suxamethonium pre drawn up kits

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
    Link  Link to reviews
     
    Formaldehyde rectal solution
    (Rectal solution)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
    SFH: For gastroenterologist use only for radiation proctitis.
     
    Gamolenic Acid and Evening Primrose Oil

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
    • Unlicenced Evening Primrose oil which contains Gamolenic Acid is available to buy in pharmacies, health food shops and supermarkets for those wanting to take gamolenic acid as a dietary supplement

     

    • OTC Patients should be advised to purchase a suitable product over the counter

     
    Glycerin
    (Lubricant)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
    Used to be used as a lubricant (£4 per bottle). Now use Aquagel (7p per sachet OR 60p per tube)
     
    Glycerin and Ichthammol paste

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
  • Not recommended for thrombophlebitis - see CKS recommendations
  •  
    GLYCERYL TRINITRATE Ointment 0.05%

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
  • Use licensed 0.4% product

  •  
    GLYCERYL TRINITRATE Ointment 0.2%

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
  • Use licensed 0.4% product

  • Link  Link to reviews
    Link  NICE Evidence summary: 0.2% glyceryl trinitrate ointment for chronic anal fissures
     
    Glycopyrronium tablets  (Hyperhidrosis)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
    No formal submission
    Link  Link to reviews
    Link  NICE Evidence Summary: glycopyrronium for hyperhidrosis
     
    Haemostatic Agent  (Surgiflo® with thrombin)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Red
    NUH:Restricted trial use approved for neurosurgery (2013)
     
    Haemostatic Patch  (VerisetTM)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
    Patch
     
    Hydroxyamphetamine 1% eye drops

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
     
    Hylo-Care eye drops

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
    No formal submission
     
    Ibritumomab tiuxetan

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
     
    Injex needle free administration device

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
  • GREY non formulary
  • Link  Link to reviews
     
    Insujet needle free administration device

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
  • No formal submission
  • Link  Link to reviews
     
    Insulin devices - Needle free

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
    Link  Link to reviews
     
    Iopamidol  (Gastromiro®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
     
    IOPANOIC ACID Tablets 500 mg

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
    Unlicensed medicine - named patient use only
  • Discontinued 2012 - NUH and SFHT unable to source an alternative
  •  
    Ixabepilone

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
    Link  Link to reviews
     
    KETANSERIN Injection 10 mg in 2mL

    Non Formulary
    Grey

    Unlicensed medicine - named patient use only

     
    Leicarbon A

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
    Link  Link to reviews
     
    Lidocaine/adrenaline/tetracaine  (LATGEL®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
    Link  Link to reviews
     
    Lorcaserin

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
    Link  Link to reviews
     
    Melagatran

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
     
    Mexiletine

    Non Formulary
    Grey
    • Classified Amber Traffic Light (Amber 2) for ventricular arrhythmias only. Note that monitoring is sometimes required, but this should be confirmed with the initiating specialist for each individual patient.
    • Any other indication is grey, non-formulary.
    • Unlicensed medicine - named patient use only. Discontinued in the UK in June 2008. Available via importers for those patients unable to take alternatives. Injection no longer available.
     
    Mibefradil

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
     
    Miglustat

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
     
    MONOCHLOROACETIC ACID SATURATED soln (5ml)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
     
    Mucaine

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
    Discontinued- use antacid and oxetacaine
     
    Naltrexone
    (MS)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
    Unlicensed dosage and indication not achievable without prescribing expensive "specials"
  • No phase III clinical trials to establish efficacy or safety
  • Link  UKMI Q & A: Low dose naltrexone for MS
     
    NeilMed Sinus Rinse

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
  • Appliance, not listed in drug tariff
  • NUH ENT use this product and advises patients to buy as OTC. GPs are not recommended to prescribe.
  •  
    Optison

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
    Withdrawn 2005
     
    Orascreen

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
     
    Otovent®
    (Autoinflation device)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
    No formal assessement
    Link  UKMI review: Otovent for otitis media with effusion
     
    Oxepa

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
     
    Pegloticase  (Krystexxa)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
    Grey
  • Chronic gout, IV every 2 weeks
  • Link  Link to reviews
    Link  NICE: TA291 - Pegloticase not recommended for severe chronic gout
     
    Phenol liquified BP 80%

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
    April 2014 - Supply problem ongoing.
  • NUH and SFH theatres/clinics now use EZ swabs available from NHS Supplies.
  • NUH: liquified phenol (80% phenol) injection will no longer be stocked in the Trust (2009). Prescribers who used liquified phenol (80% phenol) for toenail ablation should prescribe:
  • Phenol EZ Swabs® - (Individually wrapped ampoules, containing 0.175-0.2ml Liquified Phenol USP 89%). The following areas will hold Phenol EZ Swabs® as stock:
    Theatre 3 QMC campus
    Theatre 8 & Day Surgery NCH campus
    Dermatology Treatment Centre
  •  
    Phoxilium

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
    Link  Link to reviews
     
    PICIBANIL 100mcg inj

    Non Formulary
    Grey
    Unlicensed medicine - named patient use only
    Previously NUH only
     
    Piperaquine with artenimol  (Eurartesim®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary Piperaquine with artenimol is not recommended for the first-line treatment of acute uncomplicated falciparum malaria because there is limited experience of its use in travellers who usually reside in areas where malaria is not endemic. Piperaquine has a long half-life.
    Tablets to be taken at least 3 hours before and at least 3 hours after food.
  • Tablets may be dispersed in water immediately before administration if needed. See here for general advice on dispersing tablets.
  • Link  Link to reviews
     
    PIRENZEPINE 50mg tabs

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
     
    Placebo

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
  • Ben Goldacre 5 minute video explanation of the placebo effect
  •  
    Potassium hydroxide

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
    Unlicensed special - previously made in non sterile manufacturing unit at SFH
     
    POTASSIUM IODIDE eye drops 5%

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
     
    Potassium Iodide solution

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
     
    Povidone-iodine 10 `/. in Boric acid insufflation

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
     
    Powerbreathe

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
  • Medical device for inspiratory muscle training. Patients should be encouraged to attend pulmonary rehabilitation
  • No formal submission
  • Link  Link to reviews
     
    PreOp ®

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
    Link  Link to reviews
     
    PRILOCAINE (50ML) Injection 0.5%

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
     
    Prismocitrate

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
    Link  Link to reviews
     
    PROCHLORPERAZINE PR 25mg,5mg

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
  • No longer available in the UK
  •  
    Prontoderm Nasal gel

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
    See local MRSA policies for treatment options for MRSA decolonisation/ eradication
    Link  Link to reviews
     
    Pyridoxine
    (PMS)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey

    Awaiting submission for PMS

     
    RC cornet ®

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
    Airway Clearance Device
  • not in drug tariff
  • non-formulary APC May 2014
  •  
    RESPeRATE®

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
  • Medical device marketed for hypertension
  • Insufficient evidence base and not recommended by the British Hypertension Society
  • Link  British Hypertension Society statement on RESPeRATE
    Link  Link to reviews
    Link  UKMi Update on New Devices - RESPeRATE May 2013
     
    Retapamulin ointment

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
    Link  Link to reviews
     
    SACCHAROMYCES BOULARDII 250mg caps

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
    Unlicensed medicine - named patient use only
     
    Shaker
    (Device)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
    Airway Clearance Device
  • not in drug tariff
  • non-formulary APC May 2014
  •  
    Sinurinse®

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
     
    Sipuleucel- T

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
    High Cost Medicine
    No formal submission
    Link  NICE TA322: Sipuleucel-T for prostate cancer
     
    Sodium hyaluronate  (Cystistat®)
    (bladder instillation)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
  • Rejected by the APC September 2013 due to lack of evidence for efficacy.
  • Link  Link to reviews
     
    Sodium hyaluronate injection  (SportVis®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
     
    St Johns Wort

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
  • Useful list of interactions
  •  
    STANOZOLOL 2mg tabs

    Non Formulary Unlicensed medicine - named patient use only
    Discontinued 2015
     
    Sterimar nasal douche

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
  • Patients should buy OTC if needed.
  •  
    Sulfapyridine

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
    Discontinued. Alternative is sulfamethoxypyridazine
     
    SULPHAMETHOXYPYRIDAZINE tabs 500mg

    View adult BNF View SPC online View childrens BNF
    Non Formulary
  • Discontinued, and imported supplies do not appear to be available.
  •  
    Tacrolimus
    (Topical for crohns)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
    0.05% in Ung Merck (over £100 a tube).
     
    Taribavirin

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
    High Cost Medicine
     
    TAUROLIDINE Solution 2 % (nebulised)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
    Unlicensed medicine - named patient use only
  • Used as nebulised therapy in transplant patients with B.cepacia (unlicensed indication for unlicensed product)
  • Typical dose 2ml twice daily via nebuliser.
  • See Leeds guideline for possible use in CF.
  •  
    TheraBite®
    (Jaw Rehabilitation Device)

    Non Formulary
    Grey

    No formal assesment

    • Listed in drug tariff - Part IXA-Appliances
     
    Tissue adhesive for epidural catheters

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
    Link  Link to reviews
     
    Tolevamer

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
     
    Treprostinil

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
    High Cost Medicine
    Link  Link to reviews
     
    Triamcinolone mouthwash

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
    Unlicensed special - previously could be made up in the non sterile manufaturing unit at SFH
     
    UroLift system

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
    No formal assessment
    Link  NICE MTG26: UroLift for treating symptoms of BPH
     
    Vernakalant

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
    Link  Link to reviews
     
    Vibro-Pulse®

    Non Formulary
    Grey
    Device
  • Non-formulary Grey as per APC May 2014. See Midlands Medicines Review
  • Not NHS Device is not prescribable on FP10, but disposable covers which require changing for each new treatment are prescribable on FP10
  • Utilises cycloidal vibration (CV) therapy
  • Link  Link to reviews
    Link  Trent MI: Vibro-Pulse® for cellulitis and venous leg ulcers
     
    VITAMIN A Drops 150000 international units in 1mL

    Non Formulary Unlicensed medicine - named patient use only.
  • Vitamin A is also known as retinol
  • Discontinued in country of origin 2016
  •  
    Vitrimix®

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
    At SFH, all cases should be referred to a dietition/pharmacist for a TPN assessment
     
    Warfarin Suspension 5 mg in 5mL
    (unlicensed special)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
    Unlicensed medicine - named patient use only
  • licensed preparation now available
  •  
    Whitehead’s Varnish

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
    Link  Link to reviews
     
    Ximelagatran

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
  • Withdrawn from market Feb 2006
  •  
    XLS-medical fat binder  (Litramine)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
  • Medical device marketed as a fat binder. Contains Litramine and vitamins A, D and E.
  • Not prescribable (not listed in drug tariff)
  •  
      
    Key
    note Notes
    Section Title Section Title (top level)
    Section Title Section Title (sub level)
    First Choice Item First Choice item
    Non Formulary Item Non Formulary section
    Restricted Drug
    Restricted Drug
    Unlicensed Drug
    Unlicensed
    Track Changes
    Display tracking information
    click to search medicines.org.uk
    Link to adult BNF
    click to search medicines.org.uk
    Link to children's BNF
    click to search medicines.org.uk
    Link to SPCs
    SMC
    Scottish Medicines Consortium
    Cytotoxic Drug
    Cytotoxic Drug
    CD
    Controlled Drug
    High Cost Medicine
    High Cost Medicine
    Cancer Drugs Fund
    Cancer Drugs Fund
    NHSE
    NHS England
    Homecare
    Homecare
    CCG
    CCG

    Traffic Light Status Information

    Status Description

    Grey

    Grey / Non-Formulary: Medicines, which the Nottinghamshire APC has actively reviewed and does not recommend for use at present due to limited clinical and/or cost effective data.
    Grey / Non-Formulary (undergoing assessment): Work is ongoing and will be reviewed at a future APC meeting.
    Grey / Non-Formulary (no formal assessment): APC has not formally reviewed this medicine or indication because it had never been requested for formulary inclusion. Often used for drugs new to market.
      

    Red

    Medicines which should normally be prescribed by specialists only. eg hospital only.
    For patients already receiving prescriptions in primary care - continue. No new patients to receive prescriptions in primary care.
      

    Amber 1

    Medicines that should be initiated by a specialist and prescribed by primary care prescribers only under a shared care protocol, once the patient has been stabilised.
    Prior agreement must be obtained by the specialist from the primary care provider before prescribing responsibility is transferred. The shared care protocol must have been agreed by the relevant secondary care trust Drugs and Therapeutics Committee(s) (DTC) and approved by the Nottinghamshire APC.
      

    Amber 2

    Medicines suitable to be prescribed in primary care / general practice after specialist* recommendation or initiation.
    A supporting prescribing guideline may be requested which must have been agreed by the relevant secondary care trust DTCs and approved by the Nottinghamshire APC.
    *Specialist is defined by the APC as a clinician who has undertaken an appropriate formal qualification or recognised training programme within the described area of practice
      

    Amber 3

    Primary care/ non specialist may initiate as per APC guideline.
    The supporting prescribing guideline must have been agreed by the relevant secondary care trust D&TC(s) and approved by the Nottinghamshire APC.
      

    Green

    Medicines suitable for routine use within primary care.
    Can be initiated within primary care within their licensed indication, in accordance with nationally recognised formularies, for example the BNF, BNF for Children, Medicines for Children or Palliative Care Formulary. Primary care prescribers take full responsibility for prescribing.   

    OTC

      

    netFormulary