netFormulary
 Report : A-Z of formulary items 26/06/2019 07:55:20
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Section Name Details
09.06.04 Colecalciferol with calcium phosphate Calfovit D3®
20 5-Aminolevulinic acid hydrochloride Gliolan® Powder for oral solution
NUH only
  • Fluorescence guided neurosurgery for high grade malignant brain tumours
  • Authorised prescribers only
  • Licensed product
  • 05.03.01 Abacavir Ziagen®

    Tablet, Oral Solution

    • Restricted to ID / GU Medicine advice only
    • Available through homecare for NUH patients. Please contact pharmacy medicines homecare team for further information
    05.03.01 Abacavir and Lamivudine 

    Tablet

    • Restricted to ID / GU Medicine advice only
    • Prescriptions must state whether Kivexa® brand or the generic preparation should be supplied.
    • Generic should be used unless reason specified by Consultant for using Kivexa
    • Available through homecare for NUH patients. Please contact pharmacy medicines homecare team for further information
    05.03.01 Abacavir and Lamivudine and Zidovudine Trizivir®

    Tablet

    • Restricted to ID / GU Medicine advice only
    • Available through homecare for NUH patients. Please contact pharmacy medicines homecare team for further information
    10.01.03 Abatacept Orencia® Infusion
  • By IV infusion in the treatment of rheumatoid arthritis in line with NICE TA195 and after the failure of conventional disease-modifying anti-rheumatic drugs in line with NICE TA375.
  • Can also be used via the subcutaneous route for Homecare patients (contact the HCD team for more details).
  • Approved in accordance with NICE TA373 and NHS England clinical commissioning policy for the treatment of juvenile idiopathic arthritis in people 6 years and older.
  • 08.01.05 Abemaciclib Verzenios®

    Tablets

    NUH: Approved in accordance with compassionate use scheme for treating Hormone Receptor (HR) positive, HER2 negative metastatic breast cancer in combination with fulvestrant, pre-treated with aromatase inhibitors. (Existing patients only)

    NUH: Approved in accordance with NICE TA579 with fulvestrant for treating hormone receptor-positive, HER2-negative advanced breast cancer after endocrine therapy.

    08.03.04.02 Abiraterone Zytiga® Tablets.
  • Approved in line with NICE TA259 for use by an oncologist for castration resistant metastatic prostate cancer, previously treated with docetaxel.
    Commissioners have confirmed that abiraterone in the above indication is not routinely commissioned in England in patients who have received prior enzalutamide therapy. An exception will be where enzalutamide has had to be stopped within 3 months of its start solely as a consequence of dose-limiting toxicity and in the clear absence of disease progression.
  • Approved in line with NICE TA387 for treating metastatic hormone-relapsed prostate cancer before chemotherapy is indicated
  • At SFH, see link below.
  • Patients commenced on the drug prior to 1st May 2011 are eligible for free of charge stock via a compassionate use programme.
  • 04.10.01 Acamprosate Campral EC®
  • In primary care, GPs/NMPs who have received appropriate training may initiate as per Notts Primary Care Alcohol Community Detox Protocol (see below).
  • Specialist advice of Alcohol and Drug Liaison Team in secondary care
  • 20 Acapella® 
  • For use by respiratory physiotherapists
  • Oscillating positive expiratory pressure device for mucous clearance
  • Listed in drug tariff - Part IXA-Appliances
  • 06.01.02.03 Acarbose Glucobay® Tablet
  • Useful in the occasional overweight patient but limited by gastrointestinal intolerance
  • Amber 2 - as per Nottinghamshire APC diabetes guidance
  • 02.08.02 Acenocoumarol Sinthrome® Tablet
    For patients intolerant of warfarin
    20 Acetarsol Suppositories   Unlicensed medicine - named patient use only
    04.08.01 Acetazolamide 
    • See also section 11.6 for glaucoma indication
    • Specialist initiation only
    • Tablets disperse in water if needed. See here for general advice on dispersing tablets.
    11.06 Acetazolamide Diamox® Tablet 250mg, Capsule MR 250mg, Injection 500mg
  • oral treatments Amber 2 - specialist recommendation for glaucoma. Injection = RED
  • 12.01.01 Acetic Acid 2% Earcalm®

    Spray 2%

    20 Acetic acid 5% solution 

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

    20 Acetic Acid Solution 3% 

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

    11.08.02 Acetylcholine Chloride Miochol-E® Intra-ocular irrigation 1%
    18 Acetylcysteine Parvolex Injection
  • Paracetamol overdose
  • 20 ACETYLCYSTEINE  

    Effervescent Tablets-600mg

    • Little evidence of benefit for preventing contrast media induced nephropathy
    11.08.01 Acetylcysteine 5% eye drops   Unlicensed medicine - named patient use only
  • Preservative free multidose
  • Listed in Drug Tariff specials list
  • confirm preservative free required before prescribing. Ilube available if preserved is acceptable
  • 11.08.01 Acetylcysteine 5% with Hypromellose 0.35% Ilube® Eye drops. £15
  • Ophthalmologist recommendation only for corneal filaments
  • See Eye lubricant guidelines and Eye lubricants table of products.
  • 05.03.02.01 Aciclovir  Tablet,Suspension,Injection
    12.03.02 Aciclovir  See section 5.3.2.1
    13.10.03 Aciclovir 

    Cream 2g, 10g

    • OTC Patients should be advised to purchase over the counter

    • May be prescribed if appropriate to in-patients; patients should be advised on discharge that further supply should be purchased
    20 ACID CITRATE DEXTROSE  SFH only
  • 500ml bags for cell salvage
  • 13.05.02 Acitretin Neotigason® Capsule 10mg, 25mg
  • Dermatology specialist only
  • Prescriptions for females of childbearing potential are only valid for 1 week and the maximum supply can only be 1 month. (Prescribers to indicate women are not of childbearing potential by endorsing prescription "not on PPP" and therefore can recieve more than 1 months supply.) See SPC section 4.6 for more details, or MEP section 3.3.11
  • If needed capsules can be opened and contents sprinkled onto soft food for patients with swallowing difficulties. Shouldn't be handled by women of childbearing potential. More Info
  • 03.01.02 Aclidinium Eklira Genuair® Inhaler 322 microgram.
  • For use in line with Nottinghamshire COPD guidance.
  • COPD: Aclidinium is available as an option for those with device issues with Tiotropium Handihaler or an eGFR <50ml/min. However note that trial data for aclidinium is limited to short-term, placebo-controlled trials and there is little post regulatory information
  • There is only one strength available of this inhaler despite many numbers being mentioned. 400 microgram aclidinium bromide (343 of aclidinium) should be released, but only 375 actually leaves the mouthpiece (322 of aclidinium).
  • 03.01.04 Aclidinium and formoterol inhaler Duaklir Genuair ®
  • For use in line with Nottinghamshire COPD guidance.
  • A5.08.07 Actico® 
  • Direct from RDC in secondary care
  • Available as 6cmx6m, 8cmx6m, 10cmx6m and 12cmx6m
  • A5.03.03 Acticoat Flex 3  On specialist advice only. At NUH, wards to order from Pharmacy for each individual patient. Not available at SFH
  • Available as 5x5cm, 10x10cm, 10x20cm and 20x40cm
  • 13.08.01 Actikerall®  Cutaneous solution
  • For the treatment of actinic keratosis when prescribed in line with the Notts APC Solar Keratosis pathway
  • A5.03.01 Actilite (Honey Dressing)  At NUH: In secondary care, wards to order from Pharmacy for individual patients for use only on recommendation of the Tissue Viability Team.
  • At SFH replaced by Medihoney Tulle in the SFH 2016 dressings formulary.
  • Available as 10x10cm and 10x20cm
  • A5.06.01 Activac 
  • At SFH: order via procurement as per SFH 2016 dressings formulary.
  • 18 Activated charcoal  Suspension 50g in 250ml
  • Reduction of absorption of poisons in the gastro-intestinal system or for active elimination techniques
  • A5.02.04 ActivHeal AquaFiber Rope 
    • NUH: Order direct from NHS supplies (RDC) Available as 2x42cm.
    • SFH: Instead use Aquacel extra ribbon (1x45cm or 2x45 cm)
    A5.03.01 Activon Tulle (Honey Dressing)   At NUH, wards to order from Pharmacy for each individual patient following recommendation of the Tissue Viability Team. Not available at SFH
  • Available as 5x5cm and 10x10cm
  • 01.05.03 Adalimumab 

    SFH

    • Biosimilar Imraldi® is the first line option for new patients
    • Biosimilar Amgevita® can be used second line in those who are unable to tolerate Imraldi®

     

    Injection

    • For use in line with NICE guidance below
    • Available through homecare for NUH patients. Please contact pharmacy medicines homecare team for further information
    10.01.03 Adalimumab 

    Injection SC

    • Restricted for RA and psoriatic arthritis in line with NICE guidance - rheumatology consultants only.
    • In accordance with NICE TA373 and NHS England clinical commissioning for the treatment of juvenile idiopathic arthritis in people 2 years and older.
    • Approved in accordance with NICE TA383 for ankylosing spondylitis and non-radiographic axial spondyloarthritis
    • In accordance with NICE TA375 for the treatment of adults with severe rheumatoid arthritis.
    • NUH only:As per commissioning policy for children with severe refractory uveitis

    Available through homecare for NUH patients.  Please contact pharmacy medicines homecare team for further information.

     

    SFH

    • Biosimilar Imraldi® is the first line option for new patients
    • Biosimilar Amgevita® can be used second line in those who are unable to tolerate Imraldi®
    11.04.02 Adalimumab  Humira®

    Injection

    • NUH Approved in accordance with NICE TA460 for treating non-infectious uveitis
    • Available through homecare for NUH patients. Please contact pharmacy medicines homecare team for further information
    13.05.03 Adalimumab 

    Injection

    • Approved in accordance with NICE TA146 for the treatment of plaque psoriasis
    • Approved in accordance with NICE TA455 for the treatment of plaque psoriasis in children and young people
    • Available through homecare for NUH patients. Please contact pharmacy medicines homecare team for further information
    • SFH information only: Biosimilar Imraldi® is the first line option for new patients. Biosimilar Amgevita® can be used second line in those who are unable to tolerate Imraldi®
    13.06.01 Adapalene Differin® Gel 0.1%
    Cream 0.1%
  • Second generation retinoid, less irritant
  • 13.06.01 Adapalene / Benzoyl Peroxide Epiduo® Gel (0.1% Adapalene / 2.5% Benzoyl Peroxide)
  • for moderate – severe acne as per CKS guidance
  • 05.03.03.01 Adefovir Dipivoxil Hepsera® Tablet- NUH only
  • Also used for Lamivudine resistant hepatitis B
  • Not routinely commissioned, hence an Individual Funding Request is required before commencing treatment. Contact the HCD team for further details.
  • 02.03.02 Adenosine  Injection- secondary care only
    A5.07 Aderma dermal pads  For pressure ulcer prevention.
  • Standard heel pads (£16ea), 10cmx10cm sheet (£4.50ea) and 50x2.5cm strip (£5.50ea)(Reusable and may be cut to size).
  • SFH: Available from Materials Management
  • 08.02.02 AdoPORT® Tacrolimus

    Capsule (Prescribe by brand)
    TWICE DAILY TACROLIMUS

    • NUH: Restricted to use within new patients only in accordance with a phased implementation plan in the following patient groups: Adult renal, Paediatric renal, Ophthalmology (adults), Gastroenterology (adults) and Haematology (adults).
    • Available through homecare for NUH patients. Please contact pharmacy medicines homecare team for further information
    03.04.03 Adrenaline / epinephrine EpiPen®, Jext® & Emerade®

    Available as:

    • Adults: EpiPen® Auto-injector 0.3mg or Jext® 300microgram injection or Emerade® 500microgram injection, 300microgram injection.
    • Children: EpiPen® Jr Auto-injector 0.15mg or Jext® 150microgram or Emerade® 150microgram injection.
    • There are current supply problems (Sept 2018) with adrenaline autoinjectors. Epipen 150microg likely to be unavailable for the forseeable future, but others may now be available. See anaphylaxis UK advice and SPS compilation of current knowledge. Latest info (Oct 2018): Epipen 150microgram dispensing protocol and FAQs.
    • Short dated (current expiry 31/10/2018) Epipen® 300micrograms are available. Further information.
    • Injection technique is device specific. To ensure patients receive the auto-injector device that they have been trained to use, prescribers should prescribe by brand.
    • Instructions for use see SPC or manufacturers websites here: (Epipen®), (Jext®®) or (Emerade®)
    03.04.03 Adrenaline / epinephrine 1 in 1,000  Available as: 1mg in 1ml, (and 5mg in 5ml for ICCU uses)
  • For treatment of anaphylaxis adrenaline is given IM in a dose of 500 micrograms (0.5mL adrenaline injection 1 in 1,000). N.B. dosing differs for self administration - see above
  • Note: For CPR the dose is 10ml of 1:10,000 given IV.
  • At SFH stocked on all wards (in the normal IV drugs cupboard).
  • 02.07.03 Adrenaline / Epinephrine 1 in 10,000 (dilute)  Injection
  • Adult dose is 10ml of 1:10,000 given IV.
  • Note: For anaphylaxis the dose is usually 0.5ml of 1:1,000 given IM. Although this product may be given in some circumstances (see BNF).
  • 03.04.03 Adrenaline / epinephrine 1 in 10,000 (dilute) 
  • Available as ampoules (1ml, 10ml), Minijet® (not at SFH) or prefilled syringe (10ml)
  • IV use of 10ml in anaphylaxis is for experienced specialist only (see BNF) - IM injection of 1:1,000 is first line for anaphylaxis (see above)
  • Note: This product is also used in CPR.
  • 20 ADRENALINE 1:200,000 inj  Unlicensed medicine - named patient use only
    NUH only
    20 ADRENALINE TOPICAL SOLUTION 

    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.
    A5.02.07 Advadraw   In secondary care, wards to order from Pharmacy for each individual patient. At SFH, use only on recommendation of the Tissue Viability Team
  • Available as 5x7.5cm, 10x10cm, 10x15cm and 15x20cm
  • A5.02.07 Advadraw Spiral  In secondary care, wards to order from Pharmacy for each individual patient. At SFH, use only on recommendation of the Tissue Viability Team
  • Available as 0.5x40cm
  • 08.02.02 Advagraf® 

    Capsule MR (Prescribe by brand)
    ONCE DAILY TACROLIMUS

    • NUH: Restricted for new renal transplant patients (part of first line immunosuppresion regimen)
    • Available through homecare for NUH patients. Please contact pharmacy medicines homecare team for further information
    03.01.05 AeroChamber Plus® 
  • For QVAR®, Flutiform®, Sirdupla® and Fostair® metered dose inhalers
  • Adult and children > 5 years = Blue (+/- mask)
  • Child 2-5 years = Yellow
  • Infant (6 months - 2 years) = Orange
  • 03.01.05 AeroTrach Plus® 
    • Anti-static Valved Holding Chamber for tracheostomy patients.
    • Not available on FP10.
    08.01.05 Afatinib Giotrif® Tablets
  • Approved in accordance with NICE TA310 for NSCLC
  • 08.01.05 Aflibercept Zaltrap® Infusion
    Was approved in accordance with the National Cancer Drugs Fund List for the second line treatment of metastatic colorectal cancer. Removed from the CDF list on 12th March 2015. Remains on formulary for patients with funding approved prior to this date.
    NUH: For more information, including criteria, see the DTC website; available here
    11.08.02 Aflibercept Eylea®

    Intravitreal injection 40mg in 1mL
    (Each vial contains 4mg in 0.1ml solution- this contains a usable amount to deliver a dose of 2mg in 0.05ml i.e. treatment for 1 eye. If the patient is having 2 eyes treated, 2 vials must be used)
    Available for use at NUH and SFH in line with NICE for:
    - Age-related Macular Degeneration (AMD) NICE TA294
    - Visual impairment due to macular oedema secondary to central retinal vein occlusion (CRVO) NICE TA305
    - Diabetic Macular Oedema NICE TA346
    - NUH only - Visual impairment in adults caused by macular oedema after branch retinal vein occlusion (BRVO) NICE TA409
    - NUH only - Treating choroidal neovascularization NICE TA486

    20 Ajmaline  Injection
  • SFH only for the diagnosis of Brugada Syndrome
  • 05.05.01 Albendazole  Tablet 400mg (unlicensed import, some products are chewable)
  • Specialist recommendation (discuss specific
    therapies and investigations with a Microbiologist or an Infectious Disease specialist)
  • Available on a named patient basis for certain worm infestations
  • 02.11 Albutrepenonacog alfa Idelvion®

    Non pharmacy item, please contact blood bank for details and availability

    08.01.05 Alectinib Alecensa®

    Capsules

    NUH only: Approved in accordance with compassionate named patient programme for advanced (incurable) non-squamous ALK +ve NSCLC who have progressed/are intolerant to crizoinib or ceritinib.

    NUH only: Approved in accordance with NICE TA536, for untreated ALK-positive advanced non-small-cell lung cancer

    08.02.03 Alemtuzumab Lemtrada®

    Infusion

    • Approved in accordance with NICE TA312 for treating relapsing‑remitting multiple sclerosis. NHS England will fund up to three cycles in accordance with the clinical commisioning policy statement.
    08.02.03 Alemtuzumab MabCampath® Infusion- unlicensed
  • Has historically been used for multiple sclerosis, immunosuppression pre islet transplant and CLL.
  • From August 2012 licensed product no longer available. Available through a patient access programme for haematology and oncology patients. Patient Access Forms
    SFH:
  • Prescribed by haematologists (Patient Access forms need to be completed) and prepared in SPU (See link above)
  • 06.06.02 Alendronic Acid 

    Tablet, effervescent tablet

    • Green - Treatment of post menopausal osteoporosis.
    • Follow local osteoporosis guidelines and NICE guidance.
    • Effervescent tablets (Binosto®) available for patients unable to swallow the tablets. Liquid also available, but less cost effective. 
    • If necessary, tablets disperse in 10 mL of water within 2–5 minutes to give very fine particles that disperse easily (unlicensed). Further general information on dispersing tablets.
    09.06.04 Alfacalcidol One-Alpha®

    Capsule, Oral Drops (expensive) and injection (Red-hospital only)

    15.01.04.03 Alfentanil Rapifen®
  • Injection: 1mg in 2mL, 5mg in 1mL(HIGH STRENGTH)
    Caution: High strength is for ICCU, theatres and on specialist palliative care advice only.
  • Sublingual spray 5mg in 5mL - Hayward house use only - named patient use only
  • 04.07.02 Alfentanyl Sublingual Spray 5 mg in 5mL 
  • Unlicensed medicine - named patient use only
  • For palliative care use only
  • 07.04.01 Alfuzosin Xatral® Tablet
  • If needed normal release tablets can be dispersed in water. Do not crush MR tablets. More Info
  • A5.03.01 Algivon (Honey Dressing)  At NUH: In secondary care, wards to order from pharmacy for individual patients only on recommendation of the Tissue Viability Team.
  • At SFH replaced by Medihoney Apinate in the SFH 2016 dressings formulary.
  • Available as 5x5cm and 10x10cm
  • 03.04.01 Alimemazine  Tablet, syrup
  • Second line to promethazine in both paediatric and dermatology patients
    Cost increase (October 2017):
  • 28 x 10mg tablets cost: £112.85
  • 30mg/5ml solution x 100ml = £243.51
    7.5mg/5ml solution x 100ml = £179.55
  • 02.12 Alirocumab Praluent®

    Injection (pre-filled pen)

    • Approved in line with NICE TA393 for treating primary hypercholesterolaemia and mixed dyslipidaemia. For use under supervision of consultant lipidologists only
    • Available through homecare for NUH and SFH patients.  Please contact pharmacy medicines homecare team for further information.
    13.05.01 Alitretinoin Toctino® Capsules
  • Restricted to use in adult patients with severe chronic hand eczema unresponsive to treatment with potent topical corticosteroids in accordance with NICE TAG 177.
  • Pregnancy prevention precautions to be adhered to. For details see SPC
  • A5.02.05 Allevyn (Tracheostomy) 9 x 9 
    A5.02.05 Allevyn Adhesive   Replaced Activheal Adhesive Foam Sept 2016
    A5.02.03 Allevyn Gentle Border 
  • Replaced Cutimed Siltec B in the SFH 2016 dressings formulary.
  • A5.02.05 Allevyn Non-Adhesive   Replaced Activheal Non Adhesive Foam on Sept 2016
    10.01.04 Allopurinol 

    Tablet

    06.01.02.03 Alogliptin Vipidia®

    Tablets

    09.06.05 Alpha Tocopheryl Acetate 
    • Suspension 500mg of dl-alpha-tocopherol acetate (500 units) in 5ml. (See table of liquid medicines requiring dose adjustment) 
    • Capsules 134mg (of d-alpha-tocopherol = 200 units)
    • Unit converter here. Beware isomer and salt form differences! 100 units = 67mg d-alpha-tocopherol = 91mg dl-alpha-tocopherol = 73mg d-alpha-tocopheryl acetate = 100mg dl-alpha-tocopheryl acetate
    07.01.01.01 Alprostadil Prostin VR® Infusion- secondary care only
    07.04.05 Alprostadil Caverject® Injection, Dual chamber
  • After specialist initiation. Follow DH guidance.
  • First line injectable. Where patients do not respond , or suffer unacceptable side effects, consider Invicorp® (specialist initiation only).
  • 07.04.05 Alprostadil MUSE® Urethral application
  • After specialist initiation. Follow DH guidance
  • 07.04.05 Alprostadil 3mg/g cream Vitaros® After specialist initiation. Follow DH guidance
    02.10.02 Alteplase Actilyse Cathflo® Line lock NUH only
  • Line lock for paediatric haemodialysis patients
  • 02.10.02 Alteplase Actilyse®

    Injection (secondary care only)
    At NUH:

    • 20mg vial restricted for vascular surgery, 50mg vial restricted for Pulmonary Embolism (PE) (specialist advice),
      At SFH:
    • 20mg vial stocked in theatre for femoral arterial thrombolysis. (Can be borrowed by x-ray)
    • 50mg vial stocked in A&E for emergency treatment of massive PE as per BTS guidelines - See SFH protocol.
    • Stroke thrombolysis in ED (kept in a box labelled 'alteplase (stroke thrombolysis)’ in resus). May be used upto 4.5hrs after the onset of symptoms (use after 3 hrs is unlicensed). Use in patients >80yrs may be considered but is unlicensed. See dose table.
    11.99.99.99 Alteplase intravitreal injection  Intravitreal injection 25microgram in 0.1mL
  • Opthalmology specialist at NUH use only
  • Manufactured by Pharmacy Sterile Production Unit (Unlicensed Product) Lower strengths available upon request
  • A2.02.02.03 Altraplen Compact ®  
  • Available in vanilla, banana, and strawberry flavours in 125ml bottles.
  • Starter pack available containing 4 flavours. NOT FOR REPEAT PRESCRIPTION.
  • Clinically lactose free
  • On dietician advice only in secondary care. Not stocked at SFH.
  • Name changed from Nutriplen
  • A2.04.01.02 Altrashot®  
    • On dietician recommendation only
    • Available in vanilla and strawberry flavours in 120ml bottles
    • Once opened Altrashot should be refrigerated and used within 24 hours.
    20 ALTRETAMINE (HEXAMETHYLMELAMINE) Capsules 50 mg  Unlicensed medicine - named patient use only
    NUH only
  • Used for ovarian cancer
  • 20 ALUM Bladder Irrigation  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
  • 09.05.02.02 Aluminium Hydroxide Alu-Cap® Capsules
  • Prescribe and monitor as per shared care protocol for phosphate binders.
  • Generally reserved for short term use in patients with severe and difficult to control hyperphosphataemia.
  • 04.09.01 Amantadine  Capsule, Syrup
  • For initiation in specialist Parkinson's disease clinic only.
  • If needed capsules can be opened and the contents mixed with water. General info on opening capsules.
  • Syrup costs ~£100 per bottle and should only be used for patients with swallowing difficulties if opening capsules isn't appropriate (APC Jan 15).
  • 20 AMANTADINE Injection 200 mg in 500mL  Unlicensed medicine - named patient use only
  • NUH only- restricted for chronic pain
  • 20 Amidotrizoates Gastrografin® Unlicensed medicine - named patient use only
    Solution
  • Contrast medium for gastrointestinal radiography
  • 05.01.04 Amikacin 

    Injection

    11.03.01 Amikacin 

    - Eye drops 2.5% (preservative free)(Unlicensed special)
    - Intravitreal injection 0.4mg in 0.1mL

    • NUH only: Intravitreal injection manufactured by Pharmacy Sterile Production Unit (Unlicensed Products).
    • For guidance on Intravitreal preparations at SFHT see link below
    02.02.03 Amiloride Hydrochloride 

    Tablet, Oral solution (5mg/5ml)

    • Licensed oral solution available (approx £37 per 28 days vs £1.25 for tabs).
    • Tablets disperse in water if necessary (not licensed). See here for general advice on dispersing tablets.
    03.01.03 Aminophylline Phyllocontin Continus®
  • Tablet MR - Restricted for existing patients only, new patients to start on theophylline.
  • Tablets cannot be crushed. Switch to theophylline(100mg aminophylline = 80mg theophylline)
  • Care with dose frequency when switching from modified release preparations to normal release preparations: same total daily dose needs to be given, but split into 3-4 doses
  • Green - adults only, use in children not classified
  • 03.01.03 Aminophylline IV 
  • Secondary care only
  • 05.01.09 Aminosalicylic acid Granupas® Granules, e/c
    NUH:
  • Restricted to respiratory/ID consultant recommendation only, post MDT decision
  • Restricted for use in adult patients with multi-drug-resistant tuberculosis
  • 02.03.02 Amiodarone 

    Tablet, Injection (secondary care only)

    • Tablets disperse in water if needed, more information here.
    • SFH: In an emergency amiodarone injection is stocked in ED majors, ICCU, wards 23 & 24 and CCS
    04.02.01 Amisulpride 

    Tablet, Oral solution.

    • To be initiated on specialist advice only for schizophrenia. Prescribing guidance should accompany request to prescribe.
    04.03.01 Amitriptyline 

    Tablet, Oral solution

    • 10mg/5ml Solution is surprisingly expensive. Use 25mg/5ml or 50mg/5ml where possible

    Grey Traffic Light Not recommended for depression/anxiety
    Amber Traffic Light Dermatology use for the treatment of urticaria and pruritus.

    04.07.03 Amitriptyline  See section 4.3.1 for use as an antidepressant
    Unlicensed indication but accepted practice
    04.07.04.02 Amitriptyline  Unlicensed indication
    02.06.02 Amlodipine 

    Tablet, Oral solution (5mg/5ml or 10mg/5ml)
    1st line choice

    • Licensed oral solution available (approx £115 for 28 days for 10mg dose, DT Mar18)
    • Tablets disperse in water if needed (not licensed). See here for general advice on dispersing tablets.
    11.09 Amo Complete  120mL (for rigid gas permeable or soft lenses)
  • NUH only as per local agreement
  • 05.01.01.03 Amoxicillin  Capsule, Oral suspension (125mg/5ml and 250mg/5ml), Injection
  • If a 3g dose of amoxicillin is required, it is recommended that 6 x 500mg capsules be supplied, to be taken with plenty of fluid over a period of about half an hour. This is considerably less expensive than the use of Amoxil 3g sachets, and less unpleasant to take.
  • Use as prophylaxis for endocarditis is classified red.
  • See local guidelines. [SFH guideline][NUH guideline]
  • 20 Amoxicillin 
  • SFH: All patients on nebulised antibiotics must be referred to a respiratory specialist nurse.
  • 05.02 Amphotericin Fungizone® Approved Clinical Indications:
  • For intravitreal use and for eye/ear drop preparation only
  • Use via intrathecal route on the advice of consultant microbiologist only (NUH only).
  • NB: other amphotericin preparations are used for iv administration
  • 05.02 Amphotericin Abelcet® Infusion
  • Available at NUH only - see restricted antimicrobials list
  • 05.02 Amphotericin AmBisome® Infusion
  • Restricted- see local guidelines
  • See local guidelines. [SFH guideline][NUH guideline]
  • 11.03.02 Amphotericin (eyedrops)  Eye drops 0.15% (preservative free)- Unlicensed.
  • Ophthalmologist recommendation only.
  • Store in the fridge and have a 7 day expiry.
  • SFH: Need to be ordered in especially. Pharmacy stores keep kits which can be made up on ward if necessary until stock comes in (24-48 hours).
  • 11.03.02 Amphotericin (intravitreal)  Intravitreal injection 5 microgram in 0.1mL - Unlicensed
  • NUH: Manufactured by Pharmacy Sterile Production Unit.
  • For guidance on intravitreal preparations at SFHT see link below
  • 20 Amphotericin 500mg in 5ml oral soln  Unlicensed medicine - named patient use only
    NUH only
    05.03.01 Amprenavir Agenerase® Capsule, Oral Solution
  • Restricted to ID / GU Medicine advice only
  • 08.01.05 Amsacrine Amsidine® Infusion
    12.03.01 Anaesthetic throat lozenges Tyrozets®

    Contains benzocaine.

    • OTC Patients should be advised to purchase over the counter

      • May be prescribed if appropriate to in-patients; patients should be advised on discharge that further supply should be purchased
      • SFH guide to all mouthcare products
    09.01.04 Anagrelide  Capsule
  • SFH: On Haematologist advice only. Relatively expensive. Supplies for patients in PT1 trial are supplied 2 for the price of one.
  • 10.01.03 Anakinra Kineret®

    Injection
    Restricted for indications below and RA at NUH only. For use by rheumatology and immunology specialists only.

    • NUH approval for immunology use in:
      - TRAPS (TNF Receptor Associated Periodic Syndrome)
      - Cryopyrin Associated Periodic Syndromes: (1) CINCA (Chronic Infantile Neurologic Cutaneous Articular syndrome - also known as NOMID) (2) Muckle-Wells Syndrome.
      - HIDS (Hyperimmunoglobulinaemia D Syndrome)
      - DIRA (Deficiency of Interleukin-1 Receptor Antagonist)
      - Still’s Disease
      - Schnitzler’s Syndrome
    • NUH approval as per NHSE commissioning policy E03/P/d for the treatment of Juvenile Idiopathic Arthritis (JIA)
    • Available through homecare for NUH patients. Please contact pharmacy medicines homecare team for further information
    08.03.04.01 Anastrozole 

    Tablet

    • Consultant recommendation for breast cancer only
    • No liquid version, but tablets disperse in water (may take up to 20 mins). Ideally do not crush first to avoid dust. This should be avoided by women of child bearing potential and preferably be done in a closed system. [More Info].
    • Note that use for gynaecomastia is classified grey (see Unlicensed section)
    05.02.04 Anidulafungin Ecalta®

    Infusion

    • Approved for use in adults. Not licensed in under 18s.
    • Replacing micafungin as echinodandin of choice. First line use in haematology remains caspofungin [NUH guideline] [SFH guideline]
    12.03.01 Antacid with Oxetacaine  Mouthwash (unlicensed) - Named patient use only
  • Usual dose is 5-10ml slowly sipped and swallowed four times a day.
  • Not routinely stocked at SFH- usually takes 3 days for delivery.
  • SFH guide to all mouthcare products
  • 14.05.03 Anti-D (Rh0) Immunoglobulin  Injection (Rhophylac® and D-Gam®)
  • Non pharmacy item please contact blood bank for details and availability.
  • 02.11 Antithrombin III Kybemin® Non pharmacy item please contact blood bank for details and availability.
    08.02.02 Antithymocyte immunoglobulin (rabbit)  Thymoglobuline® Injection 25 mg- NUH only
  • also known as ATG
  • used for vascular rejection in kidney transplant patients
  • Also used for aplastic anaemia and GVHD post BMT
  • 18 Antivenoms for non-indigenous venomous animals  Discussion with National Poisons Information Service recommended.
  • Not stocked at NUH or SFH
  • Held supra-regionally for treatment of significant envenomation
  • Held by the pharmacy, Royal Liverpool Hospital and Guy’s & St Thomas’ NHS Foundation Trust
  • see European Viper Venom antiserum entry for Viper Berus bite treatment
  • A5.07 Apeel Sterile  Now first line as per SFH 2016 dressings formulary.
  • Available as 5ml sachet and wipe
  • At SFH, supplied by RDC, not pharmacy
  • 02.08.02 Apixaban Eliquis®

    Stroke prevention in non-valvular AF:
    For use in line with Atrial Fibrillation (AF) anticoagulation guideline.
    Treatment of DVT or PE and prevention of recurrent DVT or PE:
     As an option per NICE TA341. See Prescribing Information

    04.09.01 Apomorphine  Injection
  • Specialist initiation only in line with Shared Care Protocol (see below)
  • APO-go helpline: 0844 880 1327 (24 hours a day, 365 days a year)
  • 11.08.02 Apraclonidine Iopidine® Eye drops 0.5%
    Eye drops 1% (preservative free)
  • Specialist recommendation only for treatment of chronic glaucoma.
  • The 1% preservative free version is very expensive (£6.50 per 'single use' bottle.) Only for patients with a known preservative allergy, known ocular surface disease or those with raised intraocular pressure despite treatment with 0.5% drops.
    Short term post operative use is classified RED.
  • 13.05.03 Apremilast Otezla®

    Tablets

    • Approved in accordance with TA419 for treating moderate to severe plaque psoriasis.
    • Approved in accordance with TA433 Apremilast for treating active psoriatic arthritis.
    04.06 Aprepitant Emend®

    Capsules

    • For oncology patients only

    Oral suspension

    • NUH only for paediatric oncology patients
    13.02.01 AproDerm® Isopropyl myristate 15%, liquid paraffin 15%

    Gel

    • Greasy level 3/4
    • Comparable to DoubleBase® and second line to Isomol® gel in line with the Emollient formulary.
    20 Aprotinin  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
    A2.03.01 Aptamil Pepti 1 
    • EHF for dietary management of cows milk allergy.
    • From birth to 6 months
    A2.03.01 Aptamil Pepti 2 
    • EHF for dietary management of cows milk allergy.
    • From 6 months onwards
    A2.03.01 Aptamil Pepti Junior 
    • On dietician recommendation only
    • Cow milk free and lactose free.
    • Previously known as Cow and Gate Pepti-Junior
    A5.02.04 Aquacel 

    - Extra (sheets): 5x5cm, 10x10cm, 15x15cm
    - Ribbon: 1x45cm and 2x45cm

    A5.03.03 Aquacel Ag 

    -Sheets: Aquacel Ag+ Extra (5x5cm, 10x10cm, 15x15cm, 20x30cm)
    -Ribbon: Aquacel Ag+  (1x45cm, 2x45cm)

     

    A5.02.01 Aquaform gel 
  • Replaced ActivHeal Gel on Sept 2016.
  • 13.02.01 Aqueous Cream BP  Cream
  • Removed from emollient formulary March APC 2013. Other creams available as soap substitutes and leave on emollients
  • Aqueous cream may be associated with skin reactions (stinging, burning, itching and redness) when used as a 'leave-on' emollient, often within 20 minutes of application, and especially in children with atopic eczema. See MHRA Drug Safety update March 2013.
  • Do not use on eczema
  • Greasy level 1/4 (least greasy)
  • 22.02 Aqueous cream BP  100g Tube
    500g Tub
    30g Tub
    (SS)
    01.06.03 Arachis Oil 

    Enema

    • DO NOT give to patients with PEANUT ALLERGY
    • Warm before use
    • OTC Patients should be advised to purchase a suitable product over the counter for short term/infrequent constipation

    • May be prescribed if appropriate to in-patients; patients should be advised on discharge that further supply should be purchased
    02.08.01 Argatroban Exembol® Infusion
    NUH only See guideline
    09.08.01 Arginine   Available as:
    -Infusion solution 21.07% 20ml
    -L-arginine oral solution 100 mg/mL (on drug tariff specials list)
    -Tablets
  • All preparations are unlicensed medicine - named patient use only
  • SFH: Available from the paediatric metabolic drug box on NNU
  • NUH: Available from the paediatric metabolic drug box on D33
  • For paediatric metabolic disorders on specialist advice only
  • 04.02.01 Aripiprazole  Tablets, Orodispersible tablets, Injection (secondary care only). Depot injection
  • To be initiated on specialist advice only for:
    -schizophrenia
    -the treatment of moderate to severe manic episodes in Bipolar I Disorder
    -the prevention of a new manic episode in patients who experienced predominantly manic episodes and whose manic episodes responded to aripiprazole treatment.
  • Prescribing guidance to accompany request to prescribe.
  • Solution shouldn't be used routinely as is very expensive (30mg = ~£600 per month!)
  • 04.02.02 Aripiprazole Abilify Maintena® Depot injection
  • Specialist initiation for the maintenance treatment of schizophrenia.
  • 08.01.05 Arsenic Trioxide Trisenox®

    Infusion

    • At SFH: Special approval needed for new starters.Do not authorise before contacting Cancer services pharmacist (3156).
    • NUH only: Approved in accordance with NICE TA526, for treating acute promyelocytic leukaemia
    05.04.01 Artemether/Lumefantrine Riamet®

    20mg/120mg tablets

    • Treatment of acute uncomplicated P falciparum malaria. See NUH guideline for the management of malaria.
    • See local guidelines. [SFH guideline]

     

    20 Artesunate 

    Injection

    • Unlicensed medicine - named patient use only
    • Treatment of severe and/or complicated malaria.  See NUH guideline for the management of malaria.
    15.02 Articaine with Adrenaline Septanest® Injection
  • SFH only
  • Available for Mr Watts for when the extra cost is justified. 46p each (vs 17p for Lignostab A).
  • Latex free
  • click here for Manufacturers data sheet. You will need to log in and find it under 'products'. Username: sfh pw: sherwood
  • 20 ASCORBIC ACID Injection 500 mg in 1mL  Unlicensed medicine - named patient use only
    Manufacturer unable to supply JUNE 2011
    NUH only
    07.04.03 Ascorbic Acid Vitamin C Tablet
  • See full entry in section 9.6.3
  • 09.06.03 Ascorbic Acid Vitamin C Tablet
  • Available as 50mg tablet (May be dispersed in water if needed. See here for general advice on dispersing tablets.) and 1g effervescent tablet.
  • Prescription cost: Pack of 28 tablets - 50mg £14.56, 100mg £14.30, 200mg £19.53 or 500mg £26.87. (1g effervescent £3).
  • Effervescent tablets not prescribable on FP10
  • Available to buy without prescription e.g. 30 x 200mg 99p.
  • Dose for "Furry tongue" is 1/4 effervescent tablet up to qds for up to 1 week. SFH guide to all mouthcare products.
  • 20 ASPARAGINASE (MEDAC) Injection 10000 units  Unlicensed medicine - named patient use only
    NUH only
    04.07.01 Aspirin  Tablet, Tablet e/c, Tablet dispersible, Suppository
    02.09 Aspirin (antiplatelet) 

    Tablets - dispersible and EC, (Suppository - Named patient use)

    • Enteric coated aspirin is second line to dispersible aspirin.
    • EC is not better tolerated and may have an impaired antiplatelet effect. See UKMI Q&A below.
    • In acute situations such as unstable angina or myocardial infarction, a single dose of 300mg soluble aspirin is recommended. This may be sucked or chewed.
    • Life long use of aspirin 75mg is of benefit for all patients with established cardiovascular disease, unless the patient has an adverse effect to it. Review of aspirin for primary prevention (2017)
    • For recommendation for use of aspirin in pregnant women at high risk of pre-eclampsia see NICE CG107.
    20 Aspirin IV ASPEGIC® 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
  • 10.02 Ataluren Translarna®

    Sachets

    • NUH: Approved in accordance with NICE HST3 for the treatment of Duchenne muscular dystrophy resulting from a nonsense mutation in the dystrophin gene, subject to compliance with the managed access agreement with NHS England
    • Available through homecare for NUH patients. Please contact pharmacy medicines homecare team for further information
    05.03.01 Atazanavir Reyataz®

    Capsule

    • Restricted to ID / GU Medicine advice only
    • Available through homecare for NUH patients. Please contact pharmacy medicines homecare team for further information
    05.03.01 Atazanavir sulfate and cobicistat Evotaz®

    Tablet

    • NUH Only Restricted to ID / GU Medicine advice only, in accordance with commissioning approval.
    • Available through homecare for NUH patients. Please contact pharmacy medicines homecare team for further information
    02.04 Atenolol  Tablet, Liquid, (Injection - secondary care only)
    08.01.05 Atezolizumab Tecentriq®

    Infusion

    Available at NUH only:

    • Approved, in accordance with the Cancer Drugs Fund and NICE TA492 for untreated locally advanced or metastatic urothelial cancer when cisplatin is unsuitable.
    • Approved, in accordance with NICE TA520 as an option for treating locally advanced or metastatic non-small-cell lung cancer after chemotherapy
    • Approved, in accordance with NICE TA525 for treating locally advanced or metastatic urothelial carcinoma after platinum-containing chemotherapy.
    • Approved in accordance with NICE TA584 in combination for treating metastatic non-squamous non-small-cell lung cancer
    • Approved in accordance with Early Access to Medicines Scheme (00031/0006) for adults with unresectable locally advanced or metastatic triple-negative breast cancer (TNBC). 
    04.04 Atomoxetine Strattera®

    Capsules

    •  (shared care): Attention Deficit Hyperactivity Disorder (ADHD) in children of 6 years and older and in adolescents as part of a comprehensive treatment program
    • : Patients over 18 years old or under 6 years old
    • Treatment with atomoxetine should only be initiated by a specialist (child and adolescent psychiatrist or paediatrician) with expertise in ADHD following a comprehensive assessment and diagnosis.
    02.12 Atorvastatin 

    Tablet, Chewable tablet

    • Licensed chewable tablets available (approx £26 per month for 20mg vs £0.80 for tablets, DT Mar18).
    • Tablets disperse in water if needed (not licensed). See here for general advice on dispersing tablets.
    07.01.03 Atosiban  Injection- secondary care only
    05.04.08 Atovaquone Wellvone® Suspension
    15.01.05 Atracurium  Injection
    A5.01.01 Atrauman   At NUH ordered via RDC by each ward (not available from pharmacy). Not routinely available at SFH
  • Available as 5x5cm, 7.5x10cm, 10x20cm, 20x30cm
  • A5.03.03 Atrauman AG 
  • GPs may initiate in line with Notts APC guideline for antimicrobial woundcare products.
  • At SFH for use only on recommendation of the Tissue Viability Team - wards to order from Pharmacy for individual patients.
  • At NUH supply is via NHS supply chain.
  • Available as 5x5cm, 10x10cm and 10x20cm
  • 11.05 Atropine 
    • 1% available as Minims® (£15 per 20 Minims). See unexpectedly expensive medicines.
    • 10 ml bottle classified non-formulary GREY (now £130!). Patients unable to use minims should be prescribed cyclopentolate 1% as an alternative.
    • Preservative free multidose preparation is an unlicensed special and classified non-formulary GREY
    • 0.5% drops no longer available.
    15.01.03 Atropine   At SFH available as:
    - Injection 600micrograms in 1mL
    - 1mg in 5 ml prefilled syringe.
    18 Atropine 
  • Antidote for organophosphorus, carbamate insecticides poisoning or nerve agents. Discussion with National Poisons Information Service recommended.
  • Treatment of bradycardia
    See also section 15.1.3
  • 16.01 Autodrop® eye drop device  Available from SFH Pharmacy
  • For helping to line up the eye drop bottle with the eye. Does not help with bottle squeezing.
  • £4.40 each
  • See also Opticare below.
  • 07.04.05 Avanafil  Tablets
  • 2nd line treatment for erectile dysfunction after generic sildenafil for patients that meet SLS criteria
  • 13.02.01 Aveeno® oat based

    Cream

    08.02.03 Avelumab Bavencio®

    Infusion

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

    07.04.05 Aviptadil + phentolamine Invicorp® Injection, Dual chamber
  • Second line to Caverject®.
  • After specialist initiation. Follow DH guidance.
  • 08.02.04 Axicabtagene ciloleucel YESCARTA®

    Infusion

    Available at NUH only: Approved in accordance with NICE TA559 for  treating diffuse large B-cell lymphoma and primary mediastinal large B-cell lymphoma after 2 or more systemic therapies.  Patients will be referred to an appropriate centre to receive treatment.

    Axicabtagene ciloleucel is a chimeric antigen receptor (CAR) T‑cell therapy.

    08.01.05 Axitinib Inlyta® Tablet
    Approved in accordance with NICE TA 333 for the treatment of advanced renal cell carcinoma after failue of a first-line kinase inhibitor or cytokine.
    A2.02.01.01 AYMES Complete 
    • Available in banana, chocolate, strawberry, and vanilla flavours
    • Starter pack available containing 1 of each flavour. NOT FOR REPEAT PRESCRIPTION.
    • On dietician recommendation only in secondary care. Not stocked at SFH.
    A2.02.01 AYMES Shake 
  • Available in banana, chocolate, neutral, strawberry and vanilla flavours
  • On dietician recommendation only in secondary care. Not stocked at SFH.
  • Starter pack available containing 1 of each flavour and a shaker. NOT FOR REPEAT PRESCRIPTION.
  • 08.01.03 Azacitidine Vidaza® Injection
  • Approved for use in line with NICE TA218 and. For more information see the D&T website at NUH, or contact Cancer services pharmacist (ext 3156)at SFH.
  • 01.05.03 Azathioprine 

    Tablets

    • Maintenance of remission of acute ulcerative colitis and Crohn’s disease in adults.
    • Amber 1: For use in adults with Inflammatory Bowel Disease as per shared care protocol- see below
    • Amber 1: For use in Inflammatory Bowel disease for children >12 years old as per shared care protocol - see below
    • Liquid (expensive) may be available as an unlicensed special. At SFH send patients to SFH pharmacy for supplies
    01.05.03 Azathioprine  Tablets
  • Amber 1: For use in adults with Auto-immune Hepatitis as per shared care protocol- see below
  • Liquid (expensive) may be available as an unlicensed special. At SFH send patients to SFH pharmacy for supplies
  • 08.02.01 Azathioprine 
    • Approved for use in neuromuscular diseases (e.g. MG, LEMS), inflammatory neuropathies, inflammatory conditions of the central nervous system and autoimmune encephalitis, as per Shared Care Protocol. 
    08.02.01 Azathioprine 

    Tablet, Injection

    • Cytotoxic - do not crush tablets. Liquid (unlicensed special) may be obtained specially if required.
    • For post-transplant immunosuppression, prescribing for existing patients should remain with the current prescriber until repatriation to specialist centre is agreed.
    • Available through homecare for NUH patients. Please contact pharmacy medicines homecare team for further information
    10.01.03 Azathioprine 
    13.05.03 Azathioprine  Tablets
  • Psoriasis and severe refractory eczema [unlicensed indication]
  • Cytotoxic - do not crush tablets. Liquid (expensive unlicensed special) can be specially made if required. SFH only:send patients to SFH pharmacy for supply
  • 20 AZATHIOPRINE Suspension 50 mg in 5mL  Unlicensed medicine - named patient use only
  • Amber 1 classification to be considered at next review of Shared Care Protocol (APC Mar 15)
  • 13.06.01 Azelaic Acid Finacae® 15% gel.
    Restricted to Rosacea.
  • Normally second line, topical metronidazole gel or cream generally preferred
  • 13.06.01 Azelaic Acid Skinoren® 20% cream.
  • Restricted to acne Vulgaris
  • Not to be used first line
  • 11.04.02 Azelastine Optilast®

    Eye drops 0.05%

    • OTC Patients should be advised to purchase a suitable product over the counter first line for allergy symptoms
    12.02.01 Azelastine and fluticasone Dymista
    • To be prescribed in line withNotts APC Allergic rhinitis treatment pathway
    • OTC Patients should be advised to purchase a suitable product over the counter first line

    • May be prescribed if appropriate to in-patients; patients should be advised on discharge that further supply should be purchased
    12.02.01 Azelastine Hydrochloride Rhinolast®

    Nasal spray 140micrograms per spray

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

    • May be prescribed if appropriate to in-patients; patients should be advised on discharge that further supply should be purchased
    05.01.05 Azithromycin 

    Tablet*, Oral suspension (200mg/5ml)

    • Restricted antibiotic: see local guidelines [SFH guideline][NUH guideline]
    • Amber 2 for Cystic Fibrosis and Chronic Chest Infections in children (long term use)
    • Amber 2 for non-CF bronchiectasis (long term use)
    • Amber 2 for patients with recurrent or chronic chest infections/recurrent purulent sputum as a 1-3 month initial trial (advised by a respiratory physician)
    • *Tablets are significantly cheaper than capsules in primary care. It is acceptable to swap between tablets and capsules. Tablets don't have the requirement to take on an empty stomach.
    • GPs may initiate in line with Nottinghamshire Primary Care antimicrobial guidelines.
    11.03.01 Azithromycin Azyter® Eye drops 1.5%
  • On recommendation from ophthalmology:
    - Ophthalmia neonatorum
    - Purulent bacterial conjunctivitis
    - Trachomatous conjunctivitis caused by Chlamydia trachomatis
  • 05.01.02.03 Aztreonam Azactam®

    Injection

    05.01.02.03 Aztreonam nebuliser solution Cayston®
    • For patients with CF only
    • Available through homecare for NUH patients. Please contact pharmacy medicines homecare team for further information
    10.02.02 Baclofen  Tablets or liquid available.
  • Intrathecal injection (NUH only): 3000mcg in 1mL named patient use, 10mg in 5mL (licensed) and 20mg in 20mL (licensed).
  • 13.02.01 Balneum® Plus cream 

    To be prescribed as per Notts APC Emollient Formulary only if using emollient alone has not helped with itching.

    01.05.01 Balsalazide Sodium Colazide® Capsule
  • Amber 2 for ulcerative colitis
  • 10.01.03 Baricitinib Olumiant®

    Tablet

    • Nottinghamshire Treatment Centre and SFHT approved in line with NICE TA466 for moderate to severe rheumatoid arthritis
    13.02.02 Barrier preparation LBF® Barrier Cream, CliniMed
    • Available as barrier cream and film foam aplicators.
    • To be used second line if Medi Derma-S® is not tolerated. 
    13.02.02 Barrier preparation Proshield®
    • Specialist advice only.
    • Available as Proshield®Plus Skin Protectant 115g and as Proshield® Foam&Spray Skin Cleanser.
    13.02.02 Barrier preparation Coloplast Conveen® Prep Wipes 54
    • Restricted to continence teams only.
    13.02.02 Barrier preparation Medihoney®
    • Specialist advice only.
    • Available as barrier cream in 50g tubes and 20x2g sachets.
    13.02.02 Barrier preparation Drapolene®

    Cream

    • For nappy rash only
    • OTC Patients should be advised to purchase a suitable product over the counter

    • May be prescribed if appropriate to in-patients; patients should be advised on discharge that further supply should be purchased
    13.02.02 Barrier preparation Metanium®

    Ointment

    • For nappy rash only
    • Doesn't contain peanut oil
    • OTC Patients should be advised to purchase a suitable product over the counter

    • May be prescribed if appropriate to in-patients; patients should be advised on discharge that further supply should be purchased
    13.02.02 Barrier preparation Cavilon®Film
    • Available as:
      • Spray (supplied from pharmacy at SFH on TVN advice only)
      • Cream:
        - At SFH only available on Dermatologist or TVN recommendation, for use in very severe irritant dermatitis not responding to other preparations.
        - At NUH available from NHS Supply Chain.
      • Foam applicator 1ml or 3ml available from NHS Supply Chain at SFH and NUH (or also Pharmacy at SFH)- Cavilon 1ml applicator is replaced by Cutimed Protect 1ml applicator.
    13.02.02 Barrier preparation Medi Derma-S®
    • Available as barrier cream, non-sting medical barrier film and wipes.
    08.02.02 Basiliximab Simulect® Injection used in renal transplant as per NICE guidelines - NUH only.
    08.02.04 BCG bladder instillation OncoTICE®
    14.04 BCG vaccine diagnostic agent  Injection - Tuberculin PPD 2 units/0.1ml - unlicensed product, SSI brand
    Injection - Tuberculin PPD 10 units/0.1ml - unlicensed product, SSI brand
    14.04 BCG vaccine Intradermal 
    • Injection
    06.01.01.03 BD Viva 
    • Available in the following sizes:
      -4mm/32G, 5mm/31G, 6mm/31G, 8mm/31G
    01.05.02 Beclometasone Clipper® MR Tablets
  • for add-on therapy to high dose oral aminosalicylate to induce remission for adults non-responsive to oral aminosalicylates with a mild to moderate presentation or inflammatory exacerbation of left-sided or extensive ulcerative colitis.
  • Acute courses to induce remission only - not licensed or NICE recommended for maintenance of remission.
  • Added to formulary November APC 2014 in line with NICE CG166: ulcerative colitis
  • 03.02 Beclometasone Clenil Modulite®

    Metered Dose Inhaler - 1st line choice for CFC free inhaled corticosteroid. Strengths of Clenil available 50, 100, 200 and 250 micrograms per metered dose.

    • PRESCRIBE BY BRAND - Clenil Modulite® and QVAR® brands of beclometasone inhalers are not dose equivalent.
    03.02 Beclometasone Qvar®

    Metered Dose Inhalers, Easy-Breathe® inhaler (both available as 50 and 100 micrograms) (Autohalers are less good versions of Easi-Breathe).

    • Not dose equivalent with other brands. When switching a patient with well-controlled asthma from another corticosteroid inhaler, initially a 100-microgram metered dose of Qvar® should be prescribed for:
      - 200/250 micrograms of beclometasone dipropionate or budesonide
      - 100 micrograms of fluticasone propionate
    • When switching a patient with poorly controlled asthma from another corticosteroid inhaler, initially a 100-microgram metered dose of Qvar® should be prescribed for 100 micrograms of beclometasone dipropionate, budesonide, or fluticasone propionate; the dose of Qvar® should be adjusted according to response
    • PRESCRIBE BY BRAND - Clenil Modulite® and QVAR® brands of beclometasone diproprionate inhalers are not dose equivalent.
    03.02 Beclometasone Easyhaler® Dry-powder inhaler available as 200micrograms per dose DPI.
  • DPI option at step 2 on local asthma guidelines
  • 03.02 Beclometasone and formoterol Fostair®

    Available as a Metered Dose or Dry Powder Inhaler (NEXThaler)(100/6 and 200/6).

    • Asthma in adults - More cost-effective than Seretide® therefore first choice at step 3 in local guidelines (when adding a LABA). Combination inhalers preferred as per BTS guidelines.
    • Fostair MDI is licensed for the treatment of COPD in patients with FEV1 ≤50%. If an MDI is required then Fostair 100/6 + spacer should be used. N.B. Seretide MDI not licensed for COPD. See local guidelines.
    • N.B. remember dose adjustment needed if switching from Clenil Modulite® as Fostair's beclometasone component is considered twice as potent as Clenil. See local guideline.
    • MDI or NEXThaler may be used for preventer and reliever therapy (MART®) in patients at step 3 with troublesome or on-going exacerbations - see local guidelines. Patient will need alternative asthma management plan.
    12.02.01 Beclometasone Dipropionate 

    Nasal spray 50micrograms per spray

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

    • Specify sprays containing 200 doses as this is cheaper than a 180 dose unit. (£2.50 vs £6). Prescribe generically.
    • May be prescribed if appropriate to in-patients; patients should be advised on discharge that further supply should be purchased
    05.01.09 Bedaquiline Sirturo®

    Tablet

    NUH: Approved in accordance with NHS England commissioning policy for multi drug resistant tuberculosis (MDR-TB) and extensively drug resistant tuberculosis (XDR-TB).

    03.04.02 Bee and Wasp Allergen Extracts Pharmalgen® Injection
  • NUH Immunology only
  • 10.01 Belimumab Benlysta® Solution for infusion
  • Nottingham NHS Treatment Centre, NUH: Approved in accordance with NICE TA397 - for treating active autoantibody-positive systemic lupus erythematosus.
  • 08.01.01 Bendamustine 

    Infusion

    • Approved in accordance with NICE TA216 for the treatment of chronic lymphocytic leukaemia
    • Also approved in accordance with the National Cancer Drugs Fund List for the indications below where the specified criteria are met:

    -The treatment of Chronic Lymphocytic Leukaemia (2nd, 3rd or 4th line).   Was removed from the CDF list on 4th November 2015. Remains on  formulary for patients with funding approved prior to this date.
    -The first line treatment of low grade lymphoma
    -The treatment of relapsed low grade lymphoma
    -The treatment of rituximab refractory low grade lymphoma Was removed from the CDF list on 12th March 2015. Remains on formulary for patients with funding approved prior to this date.
    -The first line treatment of mantle cell non-Hodgkin's lymphoma
    -The treatment of relapsed mantle cell non-Hodgkin's lymphoma Was removed from the CDF list on 4th November 2015. Remains on formulary for patients with funding approved prior to this date.
    -The treatment of relapsed multiple myeloma
    -If to be funded by the CDF confirm approval on BlueTeq for all new starters NUH: For more information, including criteria, see the DTC website; available here

    • NUH: Bendamustine with rituximab approved in accordance with the clinical commissioning policy for:
      - relapsed and refractory mantle cell lymphoma and
      - for first line treatment of advanced indolent non-Hodgkin's lymphoma
    02.02.01 Bendroflumethiazide 

    Tablet 2.5mg

    • Historically was first choice in hypertension.
    • Tablets disperse in water if needed, click here for more information. See here for general advice on dispersing tablets.
    • For use in heart failure see Heart failure lights
    03.04.02 Benralizumab Fasenra®

    Injection

    Available at NUH Only:

    • Approved in accordance with NICE TA565 for treating severe esoinophilic asthma.
    05.01.01.01 Benzathine Benzylpenicillin  
    • Available as injection 2.4 Mega unit
    • Long acting IM penicillin, similar to procaine benzylpenicillin
    • Preferred option (except for neuro syphillis)
    • Unlicensed medicine - named patient use only
    • For GU Med only.
    04.09.02 Benzatropine  Injection (unlicensed)
  • For the treatment of acute dystonia
  • See section 18 for more information
  • See Toxbase for guidance and dosing information
  • Not routinely stocked at SFH
  • 18 Benzatropine  Injection (unlicensed)
  • For extrapyramidal symptoms / acute dystonic reactions
  • See section 4.9.2
  • See Toxbase for guidance and dosing information
  • Not routinely stocked at SFH
  • 20 Benzbromarone 

    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)
    15.02 Benzocaine 20% Gel Ultracare® Bubble Gum Oral gel
  • NUH: Used in maxillofacial prior to LA injections
  • Non-BNF (OTC)
  • 20 Benzoin Tincture, Compound, BP  Tincture (unlicensed indication)
    Also known as Tinct. Benz. (Tincture of Benzoin)
    SFH: Used in max fax surgery to aid dressing adhesion.
    13.06.01 Benzoyl Peroxide Acnecide®

    Gel 5% in an aqueous gel base

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

    • May be prescribed if appropriate to in-patients; patients should be advised on discharge that further supply should be purchased
    13.06.01 Benzoyl Peroxide 5% with Clindamycin 1% Duac® Once Daily

    Gel

    • Not first line
    • Moderate-severe acne where self-care and benzoly peroxide alone has not been effective
    12.03.01 Benzydamine Difflam®

    Oral rinse, Spray

    • OTC Patients should be advised to purchase over the counter

       

       

    13.10.04 Benzyl Benzoate Application BP 25%  Application
  • Less suitable for prescribing (BNF)
  • Not recommended for treatment of scabies in local guidance
  • Not recommended for children — dilution to reduce irritant effect also reduces efficacy. Some manufacturers recommend application to the body but to exclude the head and neck. However, application should be extended to the scalp, neck, face, and ears (BNF)
  • 05.01.01.01 Benzylpenicillin 

    Injection

    • See local guidelines. [SFH guideline][NUH guideline]
    • NUH OPAT service:Red Traffic Light  24 hour infusions via a continuous infusion pump device. Unlicensed compounded medicine - named patient use only.
    11.03.01 Benzylpenicillin  

    0.3% (5,000 units/ml) PF eye drops (Unlicensed special)

    04.06 Betahistine 

    Tablet

    • Menières disease, vertigo
    • Tablets disperse in water if needed, click here for more information. See here for general advice on dispersing tablets.
    06.03.02 Betamethasone Betnesol®

    Soluble tablets:

    • For use as a mouthwash (unlicensed indication)
    11.04.01 Betamethasone 

    - Eye drops 0.1%
    - Eye ointment 0.1%

    12.01.01 Betamethasone 

    Drops 0.1%

    • Intermittent supply problems
    • £3 per bottle
    12.03.01 Betamethasone  Soluble tablets
    20 Betamethasone  Unlicensed use
    13.04 Betamethasone (as Dipropionate) 0.05% with Salicylic Acid 3% Diprosalic® Ointment, Scalp application
  • Potent
  • 13.04 Betamethasone (as Valerate) 0.025% Betnovate-RD® Cream, Ointment
  • Moderate
  • 13.04 Betamethasone (as Valerate) 0.1% Betnovate® Cream, Ointment, Scalp application, Lotion
  • Potent
  • 11.04.01 Betamethasone 0.1% with Neomycin 0.5% eye drops Betnesol N® Eye drops
  • Specialist only - less suitable for prescribing (BNF) unless post surgery
  • 13.04 Betamethasone Dipropionate 0.064% with Clotrimazole 1% Lotriderm® Cream
  • Useful for vulval dermatoses
  • Potent with antifungal
  • 12.02.01 Betamethasone nasal drops 

    Drops 0.1%

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

    • May be prescribed if appropriate to in-patients; patients should be advised on discharge that further supply should be purchased
    11.06 Betaxolol Betoptic® Beta-blocker
  • 0.5% Eye drops
  • 0.25% preservative free available (but not stocked at SFH)
  • 08.01.05 Bevacizumab Avastin® Infusion
    Only approved in accordance with the National Cancer Drugs Fund List for the indications below where the specified criteria are met:
  • The third line treatment of low grade gliomas of childhood
  • The first line treatment of recurrent or metastatic cervical cancer in combination with chemotherapy
  • The first line treatment of advanced epithelial ovarian, fallopian tube, or primary peritoneal cancer
  • The treatment of advanced breast cancer.
  • >To be removed from the CDF list on 4th November 2015. Remains on formulary for patients with funding approved prior to this date.
  • The first line treatment of advanced colorectal cancer with a single agent fluoropyramidine. To be removed from the CDF list on 12th March 2015. Remains on formulary for patients with funding approved prior to this date.

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

  • The second or third line treatment of advanced colorectal cancer.
  • >To be removed from the CDF list on 4th November 2015. Remains on formulary for patients with funding approved prior to this date.
  • The second line treatment of advanced epithelial ovarian, fallopian tube or primary peritoneal cancer. To be removed from the CDF list on 12th March 2015. Remains on formulary for patients with funding approved prior to this date.

  • NUH: For more information, including criteria, see the DTC website; available here
  • Confirm funding approved on BlueTeq for all new CDF starters. Contact High Cost Drugs or oncology pharmacist for assistance.

  • Link to external medicines reviews here
  • 20 BEVACIZUMAB 2.5mg/0.1ml syringe  Unlicensed medicine - named patient use only
    NUH only for AMD
    11.08.02 Bevacizumab intravitreal injection Avastin® NUH only
    Intravitreal injection (Unlicensed Product)
    1.25mg in 0.05mL or 625micrograms in 0.025mL
    Restricted for;
    1. age related macular degeneration
    2. Diabetic maculopathy and/or proliferative diabetic retinopathy, unresponsive to conventional treatments such as laser, vitrectomy or intravitreal Triamcinolone
    3. Retinal vein occlusions
    4. Retinopathy of prematurity only where treatment is required and laser is not a suitable option
    A5.02.05 Biatain Adhesive  At SFH, wards order direct from RDC. At NUH order from pharmacy
  • Available as 10x10cm (circular), 12.5x12.5cm, 19x 20cm (heel) and 23x23cm (sacral)
  • 08.03.04.02 Bicalutamide  Tablet
  • If needed tablets can be dispersed in water, but this should be avoided by women of child bearing potential. Carers should wear protective clothing to minimise contact with dispersed tablets More Info
  • Amber 2 for advanced prostate cancer
  • 11.06 Bimatoprost 

    Eye drops 0.01%, 0.03%. (£10) 

    • Amber 2 - specialist recommendation for the treatment of glaucoma
    • The 0.01% formulation contains a different concentration of excipients to the 0.03% resulting in greater absorption of the active drug into the eye. Thus the 0.01% formulation is considered to be comparable in IOP-lowering efficacy to the 0.03% formulation. The 0.01% may be associated with a higher risk of preservative- related reactions due to a higher preservative load.
    • Latanoprost preferred (£2pm)
    • Preservative free 0.3% (Lumigan® UDVs or Eyreida® bottles (£12)) are Grey Traffic Light (no formal assessment). Use latanoprost PF UDVs instead.
    11.06 Bimatoprost with Timolol Ganfort®

    Eye Drops (£14pm)

    • Amber 2 - specialist recommendation for the treatment of glaucoma
    • Preservative free UDVs (£18pm) non-formulary - grey (no formal assessment). Use Fixapost® instead (£13.50pm) (see Latanoprost with Timolol below).
    09.08.01 Biotin   Tablets
    Injection
  • Unlicensed specials - named patient use only
  • SFH: Available from the paediatric metabolic drug box on NNU
  • For paediatric metabolic disorders on specialist advice only
  • 12.03.05 BioXtra® 

    Oral gel

    • First line saliva replacement product. To be considered only after full oral assessment and examination, including patient education, and if simple measures eg frequent drinks/ mouthwashes, sugar free gum, sugar free boiled sweets have failed. Discontinue if patient perceives no benefit after 5 days.
    • May be prescribed under ACBS for patients with dry mouth post radiotherapy or sicca syndrome.
    • SFH information: From 11th March 2019 will no longer be supplied from Pharmacy. Instead Oralieve moisturising gel is available from Supply Chain.
    06.01.01.02 Biphasic Insulin Aspart NovoMix® 30
  • 10mL vial, 3mL cartridge, 3mL prefilled pen
  • 06.01.01.02 Biphasic Insulin Lispro Humalog® Mix
  • Available as Mix25 and Mix50.
  • 3mL cartridge, 3mL prefilled pen (KwikPen), Vial (Mix25 only)
  • 06.01.01.02 Biphasic Isophane Insulin Humulin® M3
  • 10mL vial, 3mL cartridge, 3mL prefilled pen
  • 06.01.01.02 Biphasic Isophane Insulin Insuman® Comb
  • Available as Comb 15, Comb 25, and Comb 50
  • 01.06.02 Bisacodyl 

    Tablet
    Suppository

    • OTC Patients should be advised to purchase a suitable product over the counter for short term/infrequent constipation

    • May be prescribed if appropriate to in-patients; patients should be advised on discharge that further supply should be purchased
    01.03.03 Bismuth subsalicylate  Tablets 262.5mg
  • Liquid is non-formulary, black listed in drug tariff
  • Approved for use in line with antimicrobial guidelines for eradication of helicobacter pylori
  • 02.04 Bisoprolol 

    Tablet

    • First line use for heart failure
    • Tablets disperse in water if needed, click here for more information. See here for general advice on dispersing tablets.
    09.05.01.02 Bisphosphonates  See Section 6.6.2
  • Red - all bisphosphonates for the treatment of hypercalcaemia
  • 02.08.01 Bivalirudin Angiox® Injection (secondary care only)
    SFH only for anticoagulation during PCI as an alternative to abciximab and heparin
    NUH: Restricted to use in accordance with NICE TAG 230 and CG94. Consultant recommendation only.
    08.01.02 Bleomycin  Injection
    08.02 Blinatumomab Blincyto® Infusion
    NUH Approved in accordance with NICE TA450 and the Cancer Drugs Fund for previously treated Philadelphia-chromosome-negative acute lymphoblastic leukaemia in adults.
    06.01.06 Blood Glucose Meters 
  • Criteria for formulary inclusion has been developed by multidisciplinary and multi-organisational consultation for assessing meters and test strips to support the use of the most cost effective products. See link below.
  • There may be variations in which meters individual organisations choose based on the criteria. Please check with your CCG medicines management team for the preferred choice of meter and test strip.
  • 05.03.03.02 Boceprevir Victrelis® Capsule
  • NUH: Alternative protease inhibitor for the treatment of Hepatitis C where the clinician feels there are advantages in the individual case over telaprevir / simeprevir.
  • 14.04 Boostrix-IPV  Injection
  • Diphtheria, tetanus, pertussis (acellular, component) and poliomyelitis (inactivated) vaccine (adsorbed, reduced antigen(s) content)
  • Boostrix- IPV or Repevax are used as the vaccine offered to pregnant women to protect their new born from pertussis. See Green book for details
  • 08.01.05 Bortezomib 

    Injection
    Approved for use in accordance with NICE:

    • TA129 for the treatment of progressive multiple myeloma in people who are at first relapse having received one prior therapy and who have undergone, or are unsuitable for, bone marrow transplantation. This indication is associated with a Patient Access Scheme; details can be found here
    • TA228 for the first-line treatment of multiple myeloma if high-dose chemotherapy with stem cell transplantation is considered inappropriate and the person is unable to tolerate or has contraindications to thalidomide
    • TA311 for induction therapy in multiple myeloma before high-dose chemotherapy and autologous stem cell transplantation
    • TA370 for previously untreated mantle cell lymphoma in adults when haematopoietic stem cell transplantation is unsuitable.
      Also approved in accordance with the National Cancer Drugs Fund List for the indication(s) below where the specified criteria are met:
    • The treatment of bortezomib naive relapsed multiple myeloma. Confirm CDF approval is in place before treatment by reference to Blueteq.
      The following indications were removed from the CDF list on 12th March 2015. Treatment remains available for patients with funding approved prior to this date:
    • The treatment of relapsed/refractory mantle cell lymphoma.
    • The treatment of relapsed multiple myeloma that has previously responded to bortezomib.
    • The treatment of relapsed Waldenstrom's Macroglobulinaemia.
      NUH: For more information, including criteria, see the DTC website; available here
    02.05.01 Bosentan 
    • Medicines for pulmonary hypertension are commissioned via specialist centres only, see the policy below.
    • Contact High Cost Drugs pharmacists or Medicines Information for further info.
    • Nottingham NHS Treatment Centre: for the treatment of digital ulceration in systemic sclerosis as per commissioning policy.
    11.09 Boston Advance Cleaner  30mL (for rigid gas permeable lenses)
  • NUH only as per local agreement
  • 11.09 Boston Advance Conditioning Solution   120mL (for rigid gas permeable lenses)
  • NUH only as per local agreement
  • 08.01.05 Bosutinib Bosulif® Tablets
  • Approved in accordance with NICE TA401 for use in chronic, accelerated and blast phase Philadelphia chromosome positive chronic myeloid leukaemia in adults if they have previously had 1 or more tyrosine kinase inhibitors, imatinib/nilotinib/dasatinib are not appropriate and it is discounted.
  • 04.07.04.02 Botulinum Toxin Type A botox® Injection
    Consultant recommendation only - in line with NICE TA260.
  • For other indications see section 4.9.3
  • 04.09.03 Botulinum Toxin Type A Botox® Injection
    Consultant recommendation only
  • Warning: Units are not equivalent to Dysport units. See information on here
  • Classified RED for bladder dysfunction in adults (APC, Jan14)
  • For migraine prophylaxis see section 4.7.4.2.
  • 04.09.03 Botulinum Toxin Type A Dysport® Injection
    Consultant recommendation only
  • Warning: Units are not equivalent to Botox units. See information on here
  • 04.09.03 Botulinum Toxin Type A Xeomin® NUH Only: Injection
    Restricted to adults in accordance with NUH DTC approval April 2013
    Consultant recommendation only
  • Warning: Units are not equivalent to Dysport units. See information on here
  • 13.12 Botulinum toxin type A   Injection
  • Red: Specialist use only for severe hyperhidrosis
  • 04.09.03 Botulinum Toxin Type B NeuroBloc® Injection
    Restricted for patients unresponsive to Botulinum Toxin Type A
    Consultant recommendation only
  • Warning: Units are not equivalent to Botox or Dysport units. See information on here
  • 14.04 Botulism antitoxin 
  • Not routinely stocked at SFHT
  • Contains specific antitoxic globulins that have the power of neutralising the toxins formed by types A,B & E of Clostridium Botulinum
  • See also section 18
  • For post-exposure prophylaxis of botulism and for the treatment of persons thought to be suffering from botulism
  • 18 Botulism antitoxin antidote
  • Not routinely stocked at SFHT
  • Contains specific antitoxic globulins that have the power of neutralising the toxins formed by types A,B & E of Clostridium Botulinum
  • See also section 14.4
  • For post-exposure prophylaxis of botulism and for the treatment of persons thought to be suffering from botulism
  • 08.01.05 Brentuximab vedotin Adcetris®

    Infusion


    NUH only: Approved in line with

    • NICE TA478 for treating relapsed or refractory systemic anaplastic large cell lymphoma.
    • NICE TA524 for treating CD30-positive Hodgkin lymphoma
    • At NUH, confirm funding approved on BlueTeq for all new starters

    SFH

    • Confirm funding approved by contacting the HCD Team on 4660.
    • NICE TA478 for treating relapsed or refractory systemic anaplastic large cell lymphoma.
    • NICE TA524 for treating CD30-positive Hodgkin Lymphoma
    02.14 Bretschneider’s HTK-Solution CUSTODIOL®

    Solution
    (Medical Device - CE marked)

    NUH only: Consultant Cardiac Surgeon use only for minimally invasive procedures when cross clamping of the aorta is required.

    08.01.05 Brigatinib Alunbrig®

    Tablets

    Available at NUH only:

    • Approved as per NICE TA571 for treating ALK-positive advanced non-small cell lung cancer after crizotinib.
    20 BRILLIANT GREEN 1:500 soln  Unlicensed medicine - named patient use only
    NUH only
    11.08.02 Brilliant Peel®   Dye (Unlicensed product)- NUH only
    For use as a dye in the intraoperative staining of internal membrane during macular hole surgey
    13.06.01 Brimonidine gel Mirvaso® 5 mg/g gel
  • An option for who are significantly troubled by severe facial erythema of rosacea and who have not achieved a satisfactory response with other interventions.
  • see BNF recommendation regarding maximum daily amount to be applied
  • added to formulary post May APC 2015
  • 11.06 Brimonidine Tartrate Alphagan® Eye drops 0.2%
    11.06 Brimonidine Tartrate 0.2% with Timolol 0.5% Combigan® Eye drops
  • Amber 2 - specialist recommendation for glaucoma
  • 11.06 Brinzolamide 
  • Eye drops 1%
  • Generic available
  • 11.06 Brinzolamide 1% with Timolol 0.5%  Azarga® Eye drops
    11.06 Brinzolamide 10mg/ml & brimonidine 2mg/ml Simbrinza® Eye drops
  • For patients requiring brinzolamide and brimonidine as separate eye drops
  • 04.08.01 Brivaracetam 

    Tablet, Oral Solution, Injection

    • For the treatment of partial-onset seizures with or without secondary generalisation in adult and adolescent patients from 16 years of age with epilepsy. Use in children is classified Grey (no formal assessment)
    • Prescribing should be transferred to primary care only when stabilised on brivaracetam for 6 months.
    13.05.02 Brodalumab Kyntheum®

    Injection

    Nottingham Treatment Centre and SFH only:  Approved in accordance with NICE TA511 for treating moderate to severe plaque psoriasis.

    13.01 Bromelain NexoBrid® Powder and Gel
  • NUH Only Restricted for Burns and Plastics consultant use only in adults
  • 04.09.01 Bromocriptine 

    For hyperprolactinaemia see section 6.7.1

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

    Tablet 2.5mg

    • Not recommended in post partum lactation suppression: BNF62 - Should not be used postpartum or in puerperium in women with high blood pressure, coronary artery disease, or symptoms (or history) of serious mental disorder; monitor blood pressure carefully (especially during first few days) in postpartum women. Very rarely hypertension, myocardial infarction, seizures or stroke (both sometimes preceded by severe headache or visual disturbances), and mental disorders have been reported in postpartum women given bromocriptine for lactation suppression—caution with antihypertensive therapy and avoid other ergot alkaloids. Discontinue immediately if hypertension, unremitting headache, or signs of CNS toxicity develop
    • Amber 2 - Parkinson's disease see section 4.9.1
    01.05.02 Budesonide Entocort®
  • MR Capsules - once daily administration
  • Prescribe by brand name
  • 01.05.02 Budesonide Cortiment® MR Tablets
  • Restricted to those who have failed to obtain control of their ulcerative colitis using salicylates; but are unable to tolerate or unwilling to take high dose steroids.
  • Clinicians must prescribe by brand (Cortiment®) to ensure the correct preparation of modified release budesonide is dispensed.
  • 01.05.02 Budesonide Budenofalk®
    • Capsules containing EC granules
    • Rectal foam (£40 for 14 doses)
    • Prescribe by brand name
    03.02 Budesonide Pulmicort® Turbohaler (100, 200 and 400 micrograms per dose)
    Respules (0.5mg in 2mL and 1mg in 2mL solutions)
  • SFH only: Nebulised budesonide is not recommended for use in adults. Its use in children should only be following initiation in secondary care (Dr Ward, Dr Ali or a consultant paediatrician).
  • Amber 2 - Nebulised use in Children as stated above
  • Green - Turbohaler, but not first choice
  • 12.02.01 Budesonide 

    Nasal spray 64micrograms per spray

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

    • May be prescribed if appropriate to in-patients; patients should be advised on discharge that further supply should be purchased
    01.05.02 Budesonide 1mg orodispersible tablets sugar free Jorveza 1mg orodispersible tablets®

    Orodispersible tablets

    • Approved for the treatment of eosinophilic esophagitis (EoE) in adults (older than 18 years of age).

    Awaiting NICE TA publication expected in October 2019. 

    03.02 Budesonide and formoterol 

    Available in 4 types. Prescribe all by brand to avoid accidental switching:

    Dry powder inhalers:
    - Fobumix Easyhaler® 80/4.5, 160/4.5, 320/9 micrograms per delivered dose (Cost Effective Inhaler Choice).
    - DuoResp Spiromax® 160/4.5, 320/9 micrograms per delivered dose.
    - Symbicort Turbohaler® 100/6, 200/6, 400/12 micrograms per metered dose; equivalent to 80/4.5, 160/4.5, 320/9 micrograms per delivered dose (the dose that leaves the mouthpiece).

    Metered Dose Inhaler (MDI)
    - Symbicort® pressurised inhalation (200/6 micrograms per dose) - licensed in COPD only.

    Notes applying to all:

    • See Asthma and COPD guidance for place in therapy.
    • All may be used for Maintenance And Reliever Therapy (MART) in patients at step 3 with troublesome or on-going exacerbations - see local guidelines. Symbicort is licensed for MART from age 12, the others from age 18.
    • For regular (non-MART) use, DuoResp and Fobumix (all strengths) are only licensed for adults over 18 years. Symbicort is licensed 6 years and older).
    02.02.02 Bumetanide 

    Tablet, Oral solution (1mg/5ml)*

    • *Oral solution available, but extremely expensive (approx £200 per 28 days vs £1.30 for tablets, DT May18).
    • Tablets disperse in water if needed (not licensed). See here for general advice on dispersing tablets.
    • Injection has been discontinued in the UK, but an unlicensed import may be available. Contact Medicines Information for further info.
    20 Bupivacaine 0.1% ,fentanyl 2mcg/ml 50ml  Unlicensed medicine - named patient use only
    NUH only
    15.02 Bupivacaine and Adrenaline  Injection - Bupivacaine 0.25% and Adrenaline 1 in 200,000
    Injection - Bupivacaine 0.5% and Adrenaline 1 in 200,000
    15.02 Bupivacaine Hydrochloride  Injection 0.25% and 0.5%
    -0.25% bupivacaine given with triamcinolone joint injections (APC Sept 14). 0.5% is unsuitable for this indication- see SPC.
    -For other indications at NUH. Not used at SFHT- levobupivacaine used instead.
    15.02 Bupivacaine Hydrochloride with Glucose Marcain Heavy® Injection - Bupivacaine Hydrochloride 20mg with Glucose 320mg in 4mL
    04.07.02 Buprenorphine Butec® patch Patch (Weekly patch)
  • Not for first line use.
  • Prescribe by brand in primary care.
  • GPs may initiate in line with Notts APC Opioids for persistent non-cancer pain guideline
  • Considered to have a low place in therapy. Only for patients where other options eg codeine, tramadol or low dose morphine have been exhausted. Morphine preferred if a strong opioid needed.
  • When compared to other opiates Butec® patches are relatively weak and expensive
  • 04.07.02 Buprenorphine Temgesic® Tablet sublingual
    04.07.02 Buprenorphine Bupeaze® patch Patch (Twice weekly patch)
  • Not for first line use.
  • Prescribe by brand in primary care.
  • GPs may initiate in line with Notts APC Opioids for persistent non-cancer pain - APC guideline
  • For chronic non-cancer pain, doses greater than 70 micrograms / hour by specialist recommendation or advice only. See Opioids for persistent non-cancer pain - APC guidelines. This does not apply to cancer related pain.
  • May be considered for patients with swallowing difficulties on stable dose of opiates or patients in whom morphine isn't tolerated.
  • 04.10.03 Buprenorphine 

    Confirm brand before prescribing. Now available as:
    - Subutex® sublingual tablet
    - Espranor® ora-dispersible (lyophilisate) (prescribe by brand)

    • Espranor® and Subutex® are not dose quivalent. See guide.
    • Opioid dependance, after recommendation from specialist service.
    • In primary care follow Drug Misuse and Dependence: Guidelines on Clinical Management (orange book)
    04.10.02 Bupropion Hydrochloride Zyban®

    Tablet

    • For use in accordance with Nottinghamshire Smoking Cessation treatment algorithm
    • In secondary care only to be prescribed on the advice of smoking cessation specialist as part of a package of continued care.
    • Off-label use as an option for resistant/refractory depression by specialists in Nottinghamshire Healthcare Trust. BAP guidelines for information.
    06.06.02 Burosumab  Crysvita®

    Subcutaneous injection

    NUH only in collaboration with Birmingham Children's Hospital: Approved in accordance with HST8 for treating X-linked hypophosphataemia in children and young people.

    Available through homecare for NUH patients. Please contact pharmacy medicines homecare team for further information.

    06.07.02 Buserelin  Nasal spray - for endometriosis restricted to NUH only
    Injection - Restricted to Nurture clinic only as per approved guidelines
  • For malignant disease indications See section 8.3.4.2
  • 04.01.02 Buspirone Hydrochloride  Tablets
  • Initiated following specialist psychiatric referral only
  • For use in learning disabilities only.
  • 08.01.01 Busulfan  Tablets 2mg
    NUH only: Infusion, capsules 25mg (unlicensed)
    03.04.03 C1 Esterase Inhibitor Berinert®
  • For the acute treatment of hereditary angioedema (see commissioning policy below)
  • SFH: Non pharmacy item please contact blood bank for details and availability.
  • NUH:
    - Stock holding areas to contact blood bank for details and supply
    - Individual patient prescriptions only supplied through pharmacy
  • 08.01.05 Cabazitaxel Jevtana® Infusion
  • NUH approved in line with NICE TA391 for hormone-relapsed metastatic prostate cancer treated with docetaxel.
    Confirm funding approved on BlueTeq for all new starters
  • 04.09.01 Cabergoline  Tablet
  • Use of Cabergoline is no longer recommended unless the patient is already established on it and attempts to change to alternative therapy have failed.
  • Amber 2: Specialist initation
  • If needed tablets can be dispersed in water. Give immediately and flush well with water. More Info
  • 06.07.01 Cabergoline  Tablet
  • BNF 62 - Suppression of lactation. Although bromocriptine and cabergoline are licensed to suppress lactation, they are not recommended for routine suppression (or for the relief of symptoms of postpartum pain and engorgement) that can be adequately treated with simple analgesics and breast support. If a dopamine-receptor agonist is required, cabergoline is preferred.
  • Amber 2 - Parkinson's disease see section 4.9.1
  • 08.01.05 Cabozantinib Cometriq®

    Capsule

    NUH: Approved in accordance with NICE TA516 for treating medullary thyroid cancer.

    08.01.05 Cabozantinib Cabometyx®

    Film-coated tablets
    NUH Only

    • Approved in accordance with NICE TA463 for previously treated advanced renal cell carcinoma
    • Approved in accordance with NICE TA542 for untreated advanced renal cell carcinoma
    09.05.01.01 Cacit®  Effervescent tablet
    20 Caffeine Citrate  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
  • 13.03 Calamine 

    Cream
    Lotion

    OTC Patients should be advised to purchase over the counter

    • May be prescribed if appropriate to in-patients; patients should be advised on discharge that further supply should be purchased
    09.05.01.01 Calcichew® 

    Tablet (chewable)

    13.05.02 Calcipotriol  Ointment 50micrograms/g (~£7 per 30g)
    Scalp solution 50micrograms/mL (~£56 per 60ml)
    13.05.02 Calcipotriol 50mcg/g with Betamethasone 0.05% Enstilar®

    Foam (60g)

    • Similar price to Dovobet® ointment (£37.21 vs £39.68 Nov 16)
    13.05.02 Calcipotriol 50micrograms/g with Betamethasone 0.05%  Gel, Ointment
  • Consider alternating between calcipotriol and a topical steroid preparation as an alternative.
  • Usual max duration of treatment is 4 weeks.
  • 06.06.01 Calcitonin (salmon) / Salcatonin  Injection
  • For specialist use only following approved guidelines. Secondary care only
  • Classified red for hypercalcaemia of malignancy, Paget's disease of bone, prevention of acute bone loss due to sudden immobility
  • Name changed from salcatonin to calcitonin
  • EMA recommendation limiting long term use of calcitonin
  • Restrictions on use of calcitonin
  • 09.06.04 Calcitriol 

    Capsule

    13.05.02 Calcitriol 3micrograms/g Silkis® Ointment
  • For use in flexures and where Dovonex is causing irritation
  • Short term use for a maximum of 8 weeks
  • 18 Calcium chloride  Discussion with National Poisons Information Service recommended for serious cases
  • calcium channel blocker antidote
  • 10% injection or infusion
  • 09.05.02.02 Calcium Acetate Renacet® Tablets
  • Alternative first line phosphate binder in patients who cannot swallow or cannot obtain Phosex tablets
  • Elemental calcium content of Renacet is less than Phosex, therefore the number of tablets required per meal may be more with Renacet.
  • Link to SPC
  • 09.05.02.02 Calcium Acetate Phosex® Tablets
  • Prescribe and monitor as per shared care protocol for phosphate binders.
  • Generally recommended as first line phosphate binder. More effective than calcichew and less elemental calcium.
  • Link to SPC
  • Current issues have been reported with Phosex® availability. The renal team at NUH recommends that if you are unable to obtain Phosex®, you can switch to Renacet® tablets. The conversion can be made on a one:one basis, meaning that each 1g tablet of Phosex® can be replaced by one 950mg tablet of Renacet®.
  • 09.05.02.02 Calcium Carbonate Calcichew® Tablets
  • Prescribe and monitor as per shared care protocol for phosphate binders.
  • Calcium-based phosphate binders may be used as the initial binder therapy for patients with chronic kidney disease as they are cheap and relatively efficacious, in conjunction with dietary phosphate restriction, to control phosphorus and parathyroid levels.
  • If hypercalcaemia develops with the use of calcium carbonate, it may be necessary to convert to calcium acetate, a non calcium-containing phosphate binder, or a combination of both.
  • Link to SPC
  • 20 Calcium carbonate Phosphate binder 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
  • 09.05.01.01 Calcium Chloride  Injection 10%
  • Red - acute treatment of hypocalcaemia, see local guidance
  • At SFH stocked in key areas for use as part of the cardiac arrest protocol.
  • Link to SPC
  • 20 CALCIUM CHLORIDE 14.7% 50ml,100ml  Unlicensed medicine - named patient use only
    NUH only
    09.05.01.01 Calcium Gluconate  Red Traffic Light  Injection 10%- used for treatment of hyperkalaemia or hypocalcaemia
  • Link to SPC (injection)
    Amber Traffic Light  Effervescent tablet. Not first line calcium supplement.
  • 18 Calcium gluconate   Injection
  • Discussion with National Poisons Information Service recommended for all cases of hydrofluoric acid poisoning and serious cases of calcium channel blocker poisoning
  • See also section 9.5.1.1
  • 20 CALCIUM GLUCONATE 10% 50ml,100ml  Unlicensed medicine - named patient use only
    NUH only
    18 Calcium gluconate gel  2.5% Gel
  • Discussion with National Poisons Information Service recommended in primary care, and for serious cases in secondary care
  • For hydrofluoric acid burns
  • 20 Calcium sulfate Stimulan® Rapid Cure 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.
    09.05.01.01 Calcium Syrup Alliance Pharma Syrup (0.51mmol of calcium per 1mL)
    Product is a food supplement.
    NUH only: For use where licensed products are not suitable.
    A2.04.01.02 Calogen Extra 
    • On dietician recommendation only.
    • Available in neutral and strawberry flavour in 40ml shots
    • Available in neutral and strawberry flavour in 200ml bottles
    • Calogen Extra bottles once opened should be stored in a refrigerator (<5°C) and used within 48 hours. 

    A2.04.01.02 Calogen®  
    • On dietician recommendation only
    • Available in neutral and strawberry flavour in 200ml bottles
    • Available in neutral, strawberry and banana flavour in 500ml bottles
    • Once opened refrigerate and discard after 14 days
    06.01.02.03 Canagliflozin Invokana®

    Tablets

    • Amber 3 - as per Nottinghamshire APC diabetes treatment guideline.
      Notes on licensing:
    • Licensed for initiation in adults aged over 18years.
    • Maximum dose is 100mg daily in patients with GFR <60ml/min and should not be used if GFR is <45ml/min.
    • Due to its mechanism of action, patients taking canagliflozin will test positive for glucose in their urine and are at increased risk of urinary tract infection.
    02.05.05.02 Candesartan 

    Tablets

    • 2nd line choice ARB if patients haven't tolerated an ACE inhibitor. Used to be the most cost-effective ARB but now losartan is.
    • Tablets disperse in water if needed. See here for general advice on dispersing tablets.
    20 Cannabidiol (CBD) 

    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).

    13.09 Capasal® 

    Shampoo 250ml

    • Contains: coal tar 1%, coconut oil 1%, salicylic acid 0.5%
    • OTC Patients should be advised to purchase over the counter

    • May be prescribed if appropriate to in-patients; patients should be advised on discharge that further supply should be purchased
    08.01.03 Capecitabine Xeloda® Tablet
    12.03.01 Caphosol®  Oral rinse, dispersible tablets
  • At SFH supplied from pharmacy.
  • Treatment of oral mucositis.
  • ONLY for oncology patients.
  • Relatively expensive - £35 per box of 30 (£1.14 per dose).
  • SFH guide to all mouthcare products
  • Patient information leaflet for caphosol tablets
  • 05.01.09 Capreomycin Capastat® Injection
    Restricted for use in resistant tuberculosis
    A2.03.01 Caprilon 
  • On dietician recommendation only
  • Paediatric use
  • 04.07.03 Capsaicin  Cream
    See also section 10.3.2
  • 0.075% Axsain® for post-herpetic neuralgia
  • 10.03.02 Capsaicin  Cream 0.025% (Zacin®) for symptomatic relief in osteoarthritis (not first line treatment)
  • See 4.7.3 for post herpetic neuralgia
  • 02.05.05.01 Captopril  Tablets
    Liquid (5mg/5ml and 25mg/5ml, both ~£120 per 100ml bottle. 5mg/5ml not routinely stocked at SFH).
  • Restricted for paediatric use and existing stable adult patients only
  • If needed tablets disperse in water. Flush enteral tubes well after administration. Absorption may be reduced if given via enteral tube that terminates in the jejunum. See here for general info on crushing tablets.
  • 04.02.03 Carbamazepine 
    • For prophylaxis of bipolar disorder. Not recommended for acute mania.
    • No longer recommended under NICE guidance, however BAP Bipolar Guidelines present some useful information on its place in therapy.
    • Consider drug interactions.
    • Modified-release (m.r.) tablets may help reduce incidence of dose-related side-effects.
    04.07.03 Carbamazepine  See section 4.8.1 for use as an antiepileptic
    04.07.03 Carbamazepine  See section 4.8.1 for epilepsy indication
    04.08.01 Carbamazepine 

    Tablet (modified release or standard release), Liquid, Suppository.

    • May be appropriate for specialist GP to initiate or any GP to prescribe whilst awaiting hospital referral.
    • Chewtabs discontinued.
    • If using carbamazepine, offer controlled-release carbamazepine preparations [NICE 2012]
    • Try not to switch brands. Tegretol is the preferred brand.
    • Suppository 125mg = oral 100mg. Tegretol brand suppositories no longer available, now rebranded as "Essential Pharma" brand and cost £120 for a pack of 5!
    • Suppositories, see UKMI Q+A . SFH: Use of more than a few days must be discussed with MI/Formulary team on x3163
    • Care with dose frequency when switching from modified release preperations to liquid. Same total daily dose needs to be given, but split into 3-4 doses
    20 Carbex granules  SFH only
  • Used by x-ray
  • 06.02.02 Carbimazole  Tablet
  • NB: CSM warning re neutropenia and agranulocytosis
  • Tablets disperse in water if needed. See here for general advice on dispersing tablets.
    Liquid (unlicensed special) is expensive and not stocked at SFH,
  • 03.07 Carbocisteine 

    Capsule, Sachets (750mg/10ml), Oral liquid (250mg/5ml)

    • When no liquid available, capsules can be opened (but only with a sharp knife) and the contents dispersed in water
    • Sachets more cost effective and preferred to liquid.
    • See prescribing guidelines below. Stop if ineffective.
    11.08.01 Carbomer eye drops 

    Eye drops 0.2%

    • Clinitas® carbomer is the current recommended brand for prescribing by GPs. Other non-formulary brands include GelTears®, Viscotears®, Xailin®, Liposic®, Liquivisc®. See Eye lubricant guidelines and Eye lubricants table of products.
    • At NUH & SFH generic carbomer 0.2% eye gel is available.
    • OTC Patients should be advised to purchase a suitable product over the counter

    • May be prescribed if appropriate to in-patients; patients should be advised on discharge that further supply should be purchased
    08.01.05 Carboplatin  Injection
    NUH – Also purchase unlicensed pre-filled bags
    07.01.01 Carboprost Hemabate® Injection- secondary care only
    11.08.01 Carboxymethylcellulose, glycerine & castor oil eye drops Optive Plus® 10ml bottle (6 months expiry)
  • Ophthalmologist recommendation only for meibomean gland deficiency.
  • See Eye lubricant guidelines and Eye lubricants table of products.
  • 08.01.05 Carfilzomib Kyprolis® Infusion
  • NUH approved in line with NICE TA457 for previously treated multiple myeloma
  • 09.08.01 Carglumic Acid Carbaglu® Dispersible tablets
    NUH only: Specialist use only for hyperammonaemia, to be initiated following advice from a metabolic centre.
    11.08.01 Carmellose 

    Available as:
    - Preservative free 10ml bottle (Evolve® carmellose 0.5%, 3 months expiry once opened, £5)
    - Preservative free UDVs (Celluvisc®) 0.5% (£6 per 30) and more viscous 1% (£3 per 30).

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

      • May be prescribed if appropriate to in-patients; patients should be advised on discharge that further supply should be purchased
      • Non formulary brands include Carmize® - See Eye lubricant guidelines and Eye lubricants table of products.
      • SFH advice only: Each dose unit contains 8 drops and can be re-capped and used within 24 hours of opening.
    12.03.01 Carmellose Sodium Orabase® Protective paste
  • SFH guide to all mouthcare products
  • 08.01.01 Carmustine BiCNU® Injection
    08.01.01 Carmustine Gliadel® Implant- NUH only
    Approved in accordance with NICE TA121
    20 CARNOY'S soln 100ml  Unlicensed medicine - named patient use only
    NUH only
  • Used post enucleation of keratocystic odontogenic tumours and certain types of unicystic ameloblastoma
  • A2.05.02 Carobel, Instant®  
  • Paediatric use
  • 02.04 Carvedilol  Tablet
    Second line use for heart failure
    05.02.04 Caspofungin 

    Infusion

    • At NUH: Approved for use in paediatric patients and adult haematology See Haematology guidelines or Microbiology guidelines
    • At SFH: Approved to be used for neutropenic patients with approval of consultant haematologist and microbiologist. Contact High Cost Drugs Team ext 4567 for more information. See local guideline below.
    • See local guidelines. [SFH guideline][NUH guideline]
    07.04.04 Catheter Patency Solutions  Solution
    07.04.04 Catheter Patency Solutions  Solution
    07.04.04 Catheter Patency Solutions  Solution
    100ml bladder washout contains: citric acid 3.23%, magnesium oxide 0.38%, sodium bicarbonate 0.7%, disodium edetate 0.01%
    05.01.02.01 Cefaclor 
    • Used in CF exacerbations at NUH as per CF guideline.
    • Used in treatment of mastoiditis in paediatrics at NUH as per Paediatric Mastioiditis Antibiotic Guideline. Treatment can be up to 4 weeks. 
    • Dose as per cBNF
    05.01.02.01 Cefalexin  Tablets, Capsules
    Liquid (250mg in 5ml)
  • See local guidelines. [SFH guideline][NUH guideline]
  • 05.01.02.01 Cefotaxime 

    Injection

    20 Cefoxitin  Injection
    NUH only: For the treatment of Mycobacterium abcessus infection in paediatric patients with cystic fibrosis. See local guidelines
  • SPC available from NUH Medicines Information
  • 05.01.02.01 Ceftazidime  Injection
  • See local guidelines. [SFH guideline][NUH guideline]
  • 11.03.01 Ceftazidime   Eye drops 5% (preservative free)-NUH only (specialist use)
  • For guidance on intravitreal anti-infections prepared at SFHT see link below
  • 05.01.02.03 Ceftazidime/ avibactam Zavicefta®

    Infusion

    • Restricted antibiotic for adults - Microbiology/Infectious diseases approval only
    • See local guidelines. [NUH guideline]  [SFH guideline]
    05.01.02 Ceftolozane & tazobactam Zerbaxa® Infusion
    NUH only:
  • Microbiology/Infectious diseases approval only
  • See local guidelines. [NUH guideline]
  • 05.01.02.01 Ceftriaxone 

    Injection

    05.01.02.01 Cefuroxime  Injection
  • See local guidelines. [SFH guideline][NUH guideline]
    NUH: Suspension available only for immunology use for drug challenge
  • 11.03.01 Cefuroxime   Unlicensed - Specialist use only.
  • Eye drops 5% (preservative free). £7 each.
  • Expiry is 14 days from defrosting, or 7 days from opening when stored in the fridge (on the ward and at home).
  • Intracameral Injection 3mg in 0.3mL
  • 10.01.01 Celecoxib Celebrex® Cox-2 Inhibitor - osteoarthritis, rheumatoid arthritis Second line to patients unable to tolerate standard NSAID's.
    05.01.04 Cerament® 

    Cerament, Cerament G and Cerament V

    • NUH only: Surgical treatment for complex trauma and orthopaedic patients.
    08.01.05 Ceritinib Zykadia

    Capsules

    • NUH: Approved in accordance with NICE TA395 - for previously treated anaplastic lymphoma kinase positive non-small-cell lung cancer
    • NUH: Approved in accordance with NICE TA500 - for untreated ALK-positive non-small-cell lung cancer
    10.01.03 Certolizumab Pegol Cimzia®

    Injection- secondary care only

    • Approved in accordance with NICE TA375 for the treatment of rheumatoid arthritis. Restricted to adult rheumatology consultants.
    • Approved in accordance with NICE TA383 for ankylosing spondylitis and non-radiographic axial spondyloarthritis
    • Approved in accordance with NICE TA415 for treating rheumatoid arthritis after inadequate response to a TNF-alpha inhibitor

    Nottingham NHS Treatment Centre:

    • Approved in accordance with NICE TA445 for treating active psoriatic arthritis after inadequate response to DMARDs
    • Approved in accordance with NICE TA574 for treating moderate to severe plaque psoriasis

    Not routinely commissioned in paediatrics - IFR approval must be sought before treatment initiation.

    Patient access scheme exists whereby manufacturer funds the cost of the first 12 weeks of treatment. Managed by Healthcare at Home as long as the first 12 weeks are prescribed on one prescription. After that smaller quantities may be prescribed at a time if appropriate.

    03.04.01 Cetirizine 

    Tablets, Oral solution

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

    • May be prescribed if appropriate to in-patients; patients should be advised on discharge that further supply should be purchased
    22.02 Cetraben emollient bath ® additive  500mL Bottle
    (SS)
    13.02.01 Cetraben® 

    Ointment (greasy level 4/4) & cream (greasy level 3/4)

    • Recommended for additional use as soap substitute, including for leg ulcer management
    • The Lotion is non-formulary Grey Traffic Light  no formal assessment
    06.07.02 Cetrorelix Cetrotide® Injection
    Restricted for use by Nurture clinic
    Red - Treatment of infertility
    08.01.05 Cetuximab Erbitux® Infusion
    Approved in accordance with NICE:
  • TA145 for the treatment of locally advanced squamous cell cancer of the head and neck where platinum-based treatment is contraindicated

  • TA439 for previously untreated metastatic colorectal cancer

  • TA473 for treating recurrent or metastatic squamous cell cancer of the head and neck - only if the cancer started in the oral cavity
    Also approved in accordance with the National Cancer Drugs Fund List for the indication(s) below where the specified criteria are met:
  • The second or third line treatment of metastatic colorectal cancer with combination chemotherapy. Was removed from the CDF list on 12th March 2015. Remains on formulary for patients with funding approved prior to this date.
  • The third or fourth line treatment of metastatic colorectal cancer as a single agent. Was removed from the CDF list on 4th November 2015. Remains on formulary for patients with funding approved prior to this date.
    NUH: For more information, including criteria, see the DTC website; available here
  • At NUH, confirm funding approved on BlueTeq for all new CDF starters
  • Patient access scheme exists- at SFH contact Medicines Information for further info
  • 04.01.01 Chloral Hydrate 

    Available as (all unlicensed):

    • Oral solution (sugar free) 500mg/5ml (£42 for 200ml)
    • Syrup 500mg/5ml (£33 for 100ml)
    • Mixture 1g/5ml (NUH only) (£170 for 100ml) Red Traffic Light
    • Mixture 300mg/5ml (NUH only) Red Traffic Light
    • Suppository (NUH only) Red Traffic Light
    • Welldorm 707mg tablets contain 707mg chloral betaine, equivalent to 414mg of chloral hydrate
    • 15mL chloral hydrate 143mg/5mL elixir is approximately equivalent to ONE 707mg chloral betaine tablet. (See table of liquid medicines requiring dose adjustment)
    08.01.01 Chlorambucil  Tablet
    05.01.07 Chloramphenicol  Capsule, injection
  • Restricted antibiotic: see local guidelines
  • See local guidelines. [SFH guideline][NUH guideline]
  • 11.03.01 Chloramphenicol 

    Eye drops 0.5%, Eye ointment 1%, Preservative free drops - Eykappo® 10ml bottle (~£12) or Minims (~£13 for 20) 

    • Most bacterial infections are self-limiting. Mild cases should not need
      treating. They are usually unilateral with yellow-white mucopurulent discharge.
    • See primary care antibiotic guidelines for more information
    • OTC Patients should be advised to purchase over the counter

    • May be prescribed if appropriate to in-patients; patients should be advised on discharge that further supply should be purchased
    04.01.02 Chlordiazepoxide  Capsule.
  • Only for use in alcohol withdrawal.
  • In primary care, GPs/NMPs who have received appropriate training may initiate in line with the Nottinghamshire Primary Care Alcohol Community Detox Protocol (see below)
  • If needed capsules can be opened and contents dispersed in water. More Info
  • 11.03.01 Chlorhexidine  0.02% eye drops
  • Specialist use only for Acanthamoeba keratitis.
  • Unlicensed preparation made by SPU at NUH only.
  • Available from Tayside with a few days delivery delay.
  • 13.11.02 Chlorhexidine 0.015% with Cetrimide 0.15% Tisept® Sachet 25mL (yellow)
    Sachet 100mL (yellow)
  • NUH only
  • 13.11.02 Chlorhexidine 0.05% Unisept® Sachets 25mL
    Sachets 100mL
  • For cleansing and disinfecting wounds and burns and swabbing in obstetrics
  • 12.02.03 Chlorhexidine 0.1% & Neomycin 0.5% nasal cream Naseptin®

    Cream

    • Should not be used in patients with a peanut allergy
    13.11.02 Chlorhexidine 0.5% (Aqueous)  Pink Solution
    13.11.02 Chlorhexidine 2% in Isopropyl Alcohol 70% ChloraPrep® Solution
  • Hospital only (RDC)
    NUH: 26mL presentation is restricted to breast and plastics theatres.
  • 13.11.02 Chlorhexidine 4% 

    Surgical Scrub 500mL
    Surgical Scrub 250mL

    • 1st line for MRSA skin decolonisation. 2nd line is povidone iodine.
    • Brands include Hydrex® and Hibiscrub®
    12.03.02 Chlorhexidine mouthwash  See section 12.3.4
    12.03.04 Chlorhexidine mouthwash  Mouthwash 0.2%, Dental gel
  • SFH guide to all mouthcare products
  • 13.11.02 Chlorhexidine Solution 2.5% (≡ Chlorhexidine 0.5%) (Alcoholic)  Pink Solution in 70% IMS
    Blue Solution in 70% IMS
    Colourless in 70% IMS
  • Hospital only - for pre-operative skin disinfection
  • Brands include Hydrex®
  • 15.02 Chloroprocaine hydrochloride  Ampres® Injection
  • At NUH, approved for spinal anaesthesia for adult patients undergoing sacral neuromodulation. Approved for spinal anaesthesia in adults where the planned surgical procedure is of relatively short duration as per guideline.
  • At SFHFT, approved for short daycase procedures when a short duration of anaesthesia is desired. Outcomes to be audited and use reviewed Feb 2016.
  • 05.04.01 Chloroquine 

    Tablet,Syrup. (Injection is non formulary)

    • For the treatment of malaria
    • Grey for use as malaria prophylaxis during overseas travel is On the Nottinghamshire list of Medicines & Appliances of Limited Clinical Value that should never be prescribed. Patients should be advised to purchase OTC.
    02.02.01 Chlorothiazide 

    Suspension 250mg/5ml for paediatric use only - available as an unlicensed product, more information here.

    03.04.01 Chlorphenamine 

    Tablet, Oral solution, injection

    • OTC Patients should be advised to purchase a suitable product over the counter first line for hayfever

    • May be prescribed if appropriate to in-patients; patients should be advised on discharge that further supply should be purchased
    04.02.01 Chlorpromazine 
  • Tablet, Oral solution, Suppository, Injection (Use of intramuscular chlorpromazine is not recommended - can cause marked postural hypotension)
  • 04.06 Chlorpromazine  See section 4.2.1
  • May be used in the treatment of hiccup
  • 02.02.01 Chlortalidone  Mentioned in the NICE hypertension guidelines (CG127) at a dose of 12.5mg-25mg, but only available as a 50mg tablet.
  • For initiation by specialists in hypertension in patients that cannot tolerate bendroflumethiazide or indapamide.
  • Hygroton® tablets discontinued by manufacturer October 2013. New generic product available as 50mg tabx30=£88.04.
  • 14.04 Cholera vaccine Dukoral® Oral suspension
  • Available on request in secondary care(not routinely stocked)
  • 12.03.01 Choline Salicylate Bonjela® Adult

    Oral gel

    • OTC Patients should be advised to purchase over the counter

      • May be prescribed if appropriate to in-patients; patients should be advised on discharge that further supply should be purchased
      • NB: Bonjela Adult is suitable from 16 years only
    06.05.01 Choriogonadotropin Alfa Ovitrelle® Injection- secondary care only as per approved guidelines
  • Also known as Human chorionic gonadotropin
  • Red - Treatment of infertility
  • 06.05.01 Chorionic Gonadotrophin Pregnyl® Injection- secondary care only as per approved guidelines
  • Also known as Human Chorionic Gonadotrophin; HCG
  • Red - Treatment of Infertility
  • 01.05.03 Ciclosporin 

    Injection, Capsules- Secondary Care only

    • Treatment of ulcerative colitis
    • MHRA specify that ciclosporin must be prescribed and dispensed by brand as bioavailability differences exist between brands.
    • Capimune® is preferred brand for new patients at SFH. For advice on switching see BNF.
    • Relative prices of different brands [Hospital price][GP price]
    08.02.02 Ciclosporin 

    Capsules 25mg, 50mg, 100mg, Oral Solution (Neoral®), Injection (Sandimmune®)

    • MHRA specify that ciclosporin must be prescribed and dispensed by brand as bioavailability differences exist between brands. Neoral is the preferred brand in Nottinghamshire for transplant indications.
    • Relative prices of different brands [Hospital price][GP price]
    • Neoral liquid is equivalent to Neoral capsules. If changing from any other preparation contact Medicines Information, on 3163 for assistance.

    Available through homecare for NUH patients. Please contact pharmacy medicines homecare team for further information

    10.01.03 Ciclosporin 

    See also section 8.2.2

    • MHRA specify that ciclosporin must be prescribed and dispensed by brand as bioavailability differences exist between brands.
    • Capimune® is preferred brand for new patients at SFH. For advice on switching see BNF
    • Relative prices of different brands [Hospital price][GP price]
    • Neoral liquid is equivalent to Neoral capsules. If changing from any other preparation contact Medicines Information for assistance.
    11.99.99.99 Ciclosporin 

    Oily eye drops 2% (Unlicensed Product), formulated in arachis oil. Avoid in peanut allergy
    Eye ointment 0.2% (Unlicensed Vetinary Product, Optimmune®)used only as alternative when 2% drops unavailable. Preservative free but contains lanolin

    • both specialist use at NUH only
    • 2% eye ointment = non-formulary
    • 0.05% preservative free = non-formulary
    • 0.06% preservative free multidose = non-formulary
    • Neoral® for Uveitis Red Traffic Light
    • Ikervis® 0.1% eye drops single use- Subject of NICE TA369 - see link below for information sheet
    • Verkazia® 0.1% eye drops for vernal keratoconjuntivitis = non-formulary
    13.05.03 Ciclosporin 

    Capsules 25mg, 50mg & 100mg (Neoral® or Capimune®), Oral Solution 100mg in 1mL (Neoral®), Infusion (Sandimmun®).

    • Capimune® is preferred brand for new patients at SFH. For advice on switching see BNF
    • MHRA advise prescribe by brand
    • Neoral liquid is equivalent to Neoral capsules. If changing from any other preparation contact Medicines Information for assistance.
    13.07 Cidofovir in Unguentum M  1% cream
  • Specialist only (requires cytotoxic bin)
  • NUH: Manufactured by Pharmacy Non Sterile Production Unit (Unlicensed Product)
  • 05.03.02.02 Cidofovir infusion  Infusion- NUH only
    20 Cidofovir ointment  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)
    09.05.01.02 Cinacalcet Mimpara®

    Tablet 30mg, 60mg, 90mg

    • SFH: Restricted for use on advice of renal consultant as per NICE TA117. Other indications are non-formulary
    • NUH: Restricted to use in treating secondary hyperparathyroidism in dialysis patients and primary hyperparathyroidism where parathyroidectomy is contraindicated or delayed.

    Available through homecare for NUH patients. Please contact pharmacy medicines homecare team for further information

    04.06 Cinnarizine 

    Tablet

    • For vestibular disorders, vertigo, motion sickness
    • Tablets disperse in water if needed (they disperse within 1 minute). See here for general advice on dispersing tablets.
    • OTC Patients should be advised to purchase a suitable product over the counter for travel sickness

    05.01.12 Ciprofloxacin 

    Tablet, Suspension, Infusion

    • First line for Upper UTI in Primary Care as per Antimicrobial Guidelines.
    • Liquid available (250mg in 5ml), but tablets disperse in water if needed. See here for general advice on dispersing tablets.
    • For putting down tubes: Liquid should NOT be used for administration via enteral tubes as the beads can cause blockages. Instead use dispersed tablets. Also stop the feed for at least one hour before and after otherwise ciprofloxacin absorption is markedly reduced.
    • 500mg orally gives equivalent AUC to 400mg IV. 750mg orally gives higher AUC and same peak.
    • See local guidelines. [SFH guideline][NUH guideline][Primary Care guidelines]
    11.03.01 Ciprofloxacin 

    Eye drops 0.3% (Eye ointment 0.3% discontinued 2017)

    • SFH: Consultant request only - use ofloxacin instead if need a quinolone eyedrop.
    12.01.01 Ciprofloxacin Ear Drops Cetraxal®
    08.01.05 Cisplatin  Injection
    04.03.03 Citalopram 

    Tablet, Oral drops

    • Tablets disperse in water if needed. See here for general advice on dispersing tablets.
    • 8mg (4 drops) citalopram 40mg/ml oral drops is equivalent in therapeutic effect to 10mg citalopram tablet.
    01.06.05 Citrafleet® 

    For NUH use only

    Oral powder

    • Traffic light classification= green when used pre-procedure.
    08.01.03 Cladribine  Infusion
  • At NUH, SC cladribine is non-formulary.
  • Use in multiple sclerosis and pulmonary langerhans histiocytosis is not routinely commissioned - IFR approval must be sought before initiation.
  • 08.01.03 Cladribine Mavenclad®

    Tablets

    • NUH: Approved in accordance with NICE TA493 for treating relapsing–remitting multiple sclerosis.
    • Available through homecare for NUH patients. Please contact pharmacy medicines homecare team for further information
    A5.07.03 Claripore  In secondary care should be ordered direct from RDC
  • Plastic perforated tape
  • Available as 1.25cmx9.1m, 2.5cmx9.1m, 5cmx9.1m and 7.5cmx9.1m
  • 05.01.05 Clarithromycin 
  • Usually macrolide of choice
  • Tablet, suspension (125mg in 5ml)
  • Injection - Restricted antibiotic: see local guidelines [SFH guideline][NUH guideline]
  • Use of rifampicin and clarithromycin for hirdradenitis suppurativa should only be initiated by a dermatology specialist
  • A5.02.02 Clearfilm  SFH: Replaced Hydrofilm in the 2016 dressings formulary.
    05.01.06 Clindamycin 

    Capsule, liquid 75mg/5ml (unlicensed- Named patient use),
     Injection

    • Feb 2018: Current supply problems with injection. NUH memo available here.
    • Pseudomembranous colitis is a serious toxic effect of clindamycin
    • 90% bioavailability orally so IV often unnecessary. IV relatively expensive and irritant and potential supply problems until April 2018
    • If needed capsules can be opened and the contents mixed with water, but the contents may smell and taste offensive so mix with orange juice or maple syrup for patients with swallowing difficulties. More Info
    • Traffic Light classification of red when used as prophylaxis for endocarditis
    • See local guidelines. [SFH guideline][NUH guideline]
    07.02.02 Clindamycin Dalacin® Cream 2%
  • For when oral treatment is not appropriate
  • 13.06.01 Clindamycin 1% Dalacin T® Lotion
  • Not first line option
  • 13.06.01 Clindamycin/ tretinoin gel Treclin® Gel (clindamycin 1%/ tretinoin 0.025%)
    A5.08.03 Clinifast  In secondary care direct from RDC. Available as:
  • 3.5cm, red line- 1m length
  • 5cm, green line- 3,5 and 10m lengths
  • 7.5cm, blue line- 3,5 and 10m lengths
  • 10.75cm, yellow line- 1,3,5 and 10m lengths
  • 17.5cm, beige line for adult trunks- 1 and 10m lengths
  • A5.07.03 Clinipore  In secondary care should be ordered direct from RDC
  • Permeable non-woven synthetic adhesive tape
  • Available as 1.25cmx5m, 2.5cmx5m, 5cmx5m, 1.25cmx10m, 2.5cmx10m, 5cmx10m, 7.5cmx10m,
  • A5.02.08 Clinisorb  
    • Wards order direct from NHS supplies (RDC)
    • Available as 10x10cm, 10x20cm and 15x25cm
    04.08.01 Clobazam 

    Tablet, Oral suspension (10mg/5ml)

    • Oral suspension (10mg/5ml) available (approx £95 for 150ml, DT May18)
    • Tablets disperse in water if needed (not licensed). See here for general advice on dispersing tablets.
    • The 5mg/5ml liquid is non-formulary (rationalised to one strength for safety reasons, APC Sept 14)
    • Clobazam is only available on the NHS for the treatment of epilepsy. FP10's should be endorsed 'SLS'.
    13.04 Clobetasol Propionate 0.05% Dermovate® Cream, Ointment, Scalp application, Shampoo (Etrivex®)
  • Very potent
  • 13.04 Clobetasone Butyrate 0.05% Eumovate® Cream, Ointment
  • Moderately potent
  • Recommended in the Solar Keratosis pathway for the treatment of fluorouracil related skin reactions
  • 06.06.02 Clodronate  Capsule-Bonefos®
    Tablet- Loron®
  • Amber 2 - Hypercalcaemia, bone pain associated with metastases
  • Not licensed for osteoporosis
  • 08.01.03 Clofarabine Evoltra®

    Intravenous Infusion- NUH only
    NUH: Approved in accordance with the National Cancer Drugs Fund List for the indication(s) below where the specified criteria are met:

    • The treatment of relapsed/refractory acute lymphoblastic leukaemia
    • The treatment of relapsed/refractory acute myeloblastic leukaemia. Removed from the CDF list January 2019 remains on formulary for patients with funding approved prior to removal.


    NUH: For more information, including criteria, see the DTC website; available here

    • At NUH, confirm funding approved on BlueTeq for all new starters
    05.01.10 Clofazimine  Capsule
  • Specialist use
  • 06.05.01 Clomifene Citrate  Tablet
    Red - Treatment of infertility
    04.03.01 Clomipramine 

    Capsules

    • An alternative to SSRIs in obsessive-compulsive disorder (OCD).
    • MR Capsules are non- formulary.
    • Capsules can be opened and contents mixed with water if needed (unlicensed), click here for more information.
    • MHRA for SPCs
    04.02.03 Clonazepam  Specialist initiation only
  • Not licensed as an antimanic, however, there is published evidence to support its use in the initial stages of mania.
  • Initial dose 1mg nocte, increasing to 4-8mg/day, in divided doses. Clonazepam is a benzodiazepine so prescribe short-term and review regularly.
  • 04.08.01 Clonazepam 

    Tablet, Oral solution (contains alcohol)

    • Tablets can be dispersed in at least 30ml of water if licensed oral solution not suitable  (More Info).
    • Licensed liquid contains ethanol so not suitable for children. If unlicensed liquid required for a child state "ethanol free" on prescription to ensure correct product supplied).
    • GPs may initiate for restless legs as per treatment algorithm
    • Injection: discontinued by manufacturer Oct 2013. If prescribed in adults discuss possible alternatives with neurologists.
    • At SFH injection still on neonatal guidelines, so unlicensed stock is being purchased from IDIS until the guidelines are reviewed.
    02.05.02 Clonidine 

    Tablet
    Injection Catapres® (secondary care only )
    Oral solution 50microgram/5mL (NUH paediatrics only )
    Patches (unlicensed, NUH paediatrics only )

    • Tablets disperse in water if needed. See here for general advice on dispersing tablets.
    • Oral solution restricted to paediatric use at NUH for weaning from sedation and spasticity.
    • Patches restricted to paediatric use at NUH for spasticity.

    Attention Deficit Hyperactivity Disorder (ADHD):
    Specialist only - Should only be used in the context of tertiary services

    02.09 Clopidogrel 

    Tablet

    • If needed tablets can be dispersed in water (unlicensed). More Info
    • In line with guidance from the Royal College of Physicians’, the Nottinghamshire Area Prescribing Committee recommends that clopidogrel at a dose of 75mg daily (following initial 300mg loading dose) is used for stroke and TIA patients in sinus rhythm. See link below
    07.02.02 Clotrimazole 
    • Cream 1% (external treatment)
    • Cream 10% (intravaginal stat treatment)
    • Pessary 500mg (stat treatment). 100mg (6 dose treatment)
    • Pessary in Pregnancy: Manufacturers advise not to use applicator.
    12.01.01 Clotrimazole 

    Note: It's called "Canestan solution 1%" rather than "ear drops". Prescribe as Canestan solution 1% otherwise pharmacies can not find it on their computers.

    13.10.02 Clotrimazole 

    Cream 1% 20g and 50g, Solution 1% 20mL

    • Cutaneous candidiasis - apply until 10 days after lesions healed
    • OTC Patients should be advised to purchase a suitable product over the counter first line

    04.02.01 Clozapine Zaponex® Tablet
  • Prescribe by brand
  • For treatment-resistant schizophrenia. Initiated by consultant psychiatrist only.
  • NUH: For psychotic disorders occurring during the course of Parkinson’s disease.
    24 hour helpline number for ZTAS - 020 7365 5842
  • 20 CoaguChek XS PT Test strips 
  • 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
  • 13.05.02 Coal Tar 10% Carbo-Dome® 10% cream in a water-miscible basis
  • Discontinued (temporarily?) July 2015, due to raw material supply problem
  • 20 COAL TAR BP 20% in YSP  Unlicensed medicine - named patient use only
    NUH only
    13.09 Coal Tar Extract 5% (Alcoholic) Alphosyl 2 in 1®

    Shampoo 125mL

    • OTC Patients should be advised to purchase over the counter

    • May be prescribed if appropriate to in-patients; patients should be advised on discharge that further supply should be purchased
    13.05.02 Coal Tar in Lassars Paste  2%, 4% & 5%
  • NUH: Manufactured by Pharmacy Non Sterile Production Unit (Unlicensed Product)
  • 13.05.02 Coal Tar in Unguentum M  2%, 5% & 10%
  • NUH: Manufactured by Pharmacy Non Sterile Production Unit (Unlicensed Product)
  • 13.05.02 Coal tar lotion 5% Exorex®
  • For the treatment of psoriasis of the skin and scalp in line with NICE guidance
  • 02.02.04 Co-amilofruse (furosemide and amiloride)  Tablet
  • If needed tablets can be dispersed in water. They disperse within 1 minute. More Info
  • 05.01.01.03 Co-Amoxiclav  Tablet (375mg and 625mg), Oral suspension (125/31mg or 250/62mg in 5ml), Injection.
  • CSM has advised that cholestatic jaundice may occur either during or just after treatment with co-amoxiclav. It is more common in patients above the age of 65 years and in males. The duration of treatment should be appropriate to the indication and should not usually exceed 14 days.
  • Dispersible tablets discontinued 2010. For 625mg doses give 10ml of 250/62mg liquid. No liquid equivalent to 375mg dispersible tablets.
  • See local guidelines. [SFH guideline][NUH guideline]
  • 04.09.01 Co-Beneldopa Madopar® Capsule
    Dispersible tablet
    Capsule MR
    05.03.01 Cobicistat Tybost®

    Tablet

    • NUH Only Restricted to ID / GU Medicine advice only, in accordance with commissioning approval.
      Pharmacoenhancing agent - increases systemic levels of co-administered agents that are metabolised by CYP3A.
    • Available through homecare for NUH patients. Please contact pharmacy medicines homecare team for further information
    11.07 Cocaine  Eye drops 4% (preservative free)
  • Restricted: specialist use only
  • Unlicensed medicine - named patient use only
  • Used in diagnosis of Horner’s syndrome
  • 15.02 Cocaine  Nasal spray 10%
    Sterile solution 10% - unlicensed special
    Paste 25% - unlicensed special
  • NUH only
  • 15.02 Cocaine with Adrenaline  Cocaine 6% with Adrenaline 0.05% (Moffat's solution)
    04.09.01 Co-Careldopa Duodopa® Intestinal gel
  • For the treatment of advanced Parkinson's disease in accordance with NHS England commissioning policy.
  • Patients must be assessed by a specialist clinician based at a designated PD MDT at a specialist neurosciences centre (e.g. NUH) that is experienced in all potential advanced PD therapies.
  • Supplied via homecare.
  • Prior approval via Blueteq system required.
  • Only commissioned through specialist centre. Must be prescribed and dispensed at NUH.
  • Patients have a back-up kit in case of failure/unplanned admission. However, 24 hours helpline available on 08004584410
  • 04.09.01 Co-Careldopa Sinemet® Tablet
    Tablet MR
  • If needed standard tablets can be dispersed in water. Do not crush modified release tablets. More Info
  • MSD is updating its manufacturing for Sinemet which will result in changes to the appearance of these products. Other Sinemet tablets remain unchanged. Transition to these new presentions in supply chain is expected to commence in May 2019, followed by Sinemet Plus by Aug 2019.More Info
  • 04.09.01 Co-Careldopa and Entacapone  Tablets (Brand names are Sastravi®, Stanek® and Stalevo®)
  • Specialist initiation only.
  • Combined levodopa, carbidopa & entacapone. Sastravi® and Stanek® are the preferred brands in primary care.
  • Tablets disperse in water if needed. See here for general advice on dispersing tablets.
  • 13.06.02 Co-Cyprindiol 2000/35
    (Cyproterone Acetate 2mg with Ethinylestradiol 35micrograms)
     Dianette®
    Tablet
    note MHRA advice:
    The benefits of co-cyprindiol outweigh the risks in women of reproductive age for the treatment of:
    skin conditions related to androgen sensitivity (eg,severe acne with
    or without seborrhoea)
    hirsutism
  • Co-cyprindiol provides effective contraception in these women. An additional hormonal contraceptive should not be used in combination with co-cyprindiol
  • The need to continue treatment should be evaluated periodically by the treating physician
  • The risk of VTE is rare but this remains an important side effect, and healthcare professionals should themselves be vigilant for signs and counsel patients to remain vigilant for signs and symptoms.
    note Remember that suspected adverse reactions to co-cyprindiol should be reported to us on a Yellow Card (Click Here)
  • CSM Advice: Co-cyprindiol is licensed for use in women with severe acne which has not responded to oral antibacterials and for moderately severe hirsutism; it should not be used solely for contraception. It is contra-indicated in those with a personal or close family history of venous thromboembolism. Women with severe acne or hirsutism may have an inherently increased risk of cardiovascular disease
  • 01.04.02 Codeine  Tablets 15mg, 30mg, Syrup (25mg/5mL)
    04.07.02 Codeine 

    Tablet, Syrup (25mg/5mL), Injection (not recommended as no advantages over morphine and is a CD)

    • Very poor analgesic when used alone. Only use in addition to paracetamol. Works by small amounts (~10%) being converted to morphine (some people do not convert!).
    • New restrictions on use of codeine in children and breastfeeding mothers - see MHRA advice below.
    • Further information about use of codeine in breastfeeding here (UKMI Q&A).
    • Restricted Item NUH Medicines Matters Bulletin regarding Codeine
    10.01.04 Colchicine  Tablet
  • If needed tablets can be dispersed in water. More Info
  • 09.06.04 Colecalciferol 

    OTC Patients should be advised to purchase vitamin D supplements for maintenance and prevention over the counter. See local vitamin D position statements for details and exceptions.

    Available in 4 different forms:
    -Low dose tab/cap: Available as Stexerol® (1000 units = 25 micrograms); Strivit-D3® , InVita-D3® & Fultium-D3® caps, Desunin® tablets (800 units = 20 micrograms).  Tablets can be crushed and dispersed in water if needed. See here for general advice on dispersing tablets. 
    -Low dose liquid: Fultium-D3® Drops 2740 units/ml. 25ml bottle. 3 drops contains 200 units.
    -High dose tab/cap: 20,000 units = 500 micrograms. Available as Aviticol®, Fultium-D3® and Plenachol®.
    -High dose liquid: Invita D3® 25,000 units in a snap and squeeze ampoule.

    • Primary care prescribers encouraged to prescribe by brand name to avoid unlicensed specials being dispensed.
    • Therapeutically equivalent to ergocalciferol (ref: Martindale)
    • For routine dosing schedules see Nottinghamshire guidelines below. Higher doses may be used when a loading dose of Vitamin D is required prior to IV bisphosphonates (see zoledronic acid SPC).
    09.06.04 Colecalciferol and Calcium Carbonate 

    Available as:
    - Calci-D chewable tablets (£2.25pm). (1 tablet od) Must be kept in original container. Not suitable for dosette boxes
    - Adcal D3 caplets (£2.95pm). (2 small caplets bd)
    - Adcal D3 chewable tablets (£3.65pm). (1 tablet bd)
    - Adcal D3 soluble tablets (£5.99pm). (1 tablet bd)

    02.12 Colesevelam 

    Tablet

    • 2nd line for patients with clinically confirmed BAM by SEHCAT testing (except for patients post ileal resection) and problematic diarrhoea causing incontinence or nocturnal frequency.  
    • Only for patients unable to take colestyramine due to unpalatability after a reasonable trial. It is expected that a patient will have tried mixing colestyramine with other liquids such as fruit juice, skimmed milk, thin soup, fruit smoothies if mixing it with water is unpalatable. Colestyramine can also be mixed with pulpy fruits with a high moisture content such as apple sauce. Once the powder has soaked into the liquid it should be thoroughly stirred or shaken and consumed immediately. It will thicken if left for a prolonged period.
    • Colesevelam should not be offered as an alternative to patients experiencing side effects from colestyramine such as constipation and bloating as this is a class effect of bile acid sequestrants.
    • Limited evidence base and significantly more expensive than colestyramine.
    • Secondary care will confirm effectiveness of colesevelam before transfer to primary care. Phone follow up is acceptable.
    • NB colesevelam for hypercholesterolaemia is classified Grey (see below).
    01.09.02 Colestyramine 

    Powder, sugared and sugar free options

    02.12 Colestyramine 

    Powder, sugared and sugar free options

    05.01.07 Colistimethate Promixin®

    Nebule


    Red Traffic Light  For new patients. Not routinely commissioned for indications other than cystic fibrosis - contact pharmacy (at SFH 3163) for more information.
    Amber Traffic Light  For existing patients already receiving supplies from primary care. Repatriation of these patients is not expected.

    • Requires a different nebuliser to the Colomycin brand of colistin which has a shorter administration time. Approximately twice the price of Colomycin.
    • For non-cystic fibrosis bronchiectasis use Colomycin® brand.
    • Available through homecare for NUH patients. Please contact pharmacy medicines homecare team for further information
    05.01.07 Colistimethate  Tablet, Syrup, Injection
  • Restricted antibiotic: see local guidelines
  • 05.01.07 Colistimethate for nebulisation Colomycin® Injection (Colomycin® brand licensed for nebulisation)
  • Approved for CF and non-CF bronchiectasis on specialist initiation.
  • High cost medicine when used in cystic fibrosis only.
  • SFH: All patients on nebulised antibiotics must be referred to a respiratory specialist nurse.
  • SFH Patient Information Leaflet found here
  • 05.01.07 Colistimethate inhaler Colobreathe®

    Inhalation powder, hard capsule with inhaler

    • Available for use in line with NICE for:
      - NUH:treating pseudomonas lung infection in cystic fibrosis NICE TA276
    • For non-cystic fibrosis bronchiectasis use Colomycin® brand.
    • Available through homecare for NUH patients. Please contact pharmacy medicines homecare team for further information
    10.03.01 Collagenase Xiapex® Injection
  • NUH and Nottinghamshire Treatment Centre approved in line with NICE TA459 for treating Dupuytren's contracture
  • 05.01.04 Collatamp EG Sponge 
    • NUH only: Gentamicin impregnated collagen implant - 10cm x 10cm, 5cm x 20cm
    • SFH: Obtained from Theatres Resources (not Pharmacy).
    01.01.01 Co-magaldrox Mucogel®

    Suspension
    Low Sodium

    • Link to SPC
    • OTC Patients should be advised to purchase over the counter

    • May be prescribed if appropriate to in-patients; patients should be advised on discharge that further supply should be purchased
    06.01.06 Combination test strips  Combination urinanalysis test strips available at NUH:
  • Combur7®
  • Combur9®
  • Medi-Test Combi 5S®
  • Multistix SG®
  • Multistix 8SG®
  • Multistix 10SG®
  • KetoDiastix®
    Combination urinanalysis test strips available at SFH:
  • Multistix SG®
  • Multistix 8SG®
  • Multistix GP®
  • 06.04.01.01 Combined continuous HRT patch Evorel® Conti Evorel® Conti patches
  • No bleed products
  • 06.04.01.01 Combined continuous HRT tablet Kliofem, Kliovance, Femoston Conti, Premique low dose

    Kliofem® tablet
    Kliovance® tablet (lower strength than Kliofem®)
    Femoston®-conti tablets
    Premique® tablet discontinued December 2016, now only Premique ® low dose tablet available

    • No bleed products
    06.04.01.01 Combined cyclical HRT patch Evorel® Sequi
  • Evorel® Sequi patches
  • 06.04.01.01 Combined cyclical HRT tablet Elleste-Duet®, Femoston Elleste-Duet®- tablet 1mg and 2mg
    Femoston® 1/10 and 2/10 tablet
    Prempak-C® discontinued January 2017
    A5.08.03 Comfifast  In secondary care direct from RDC. Available as:
  • 3.5cm, red line for small limbs (8 - 15cm circumference)- 1 and 10m lengths
  • 5cm, green line for small/medium Limbs (10 - 25cm circumference)- 1,3,5 and 10m lengths
  • 7.5cm, blue line for large limbs (20 - 45cm circumference)- 1,3,5 and 10m lengths
  • 10.75cm, yellow line for extra large limbs, heads, children's trunks (35 - 65cm circumference)- 1,3,5 and 10m lengths
  • 17.5cm, beige line for adult trunks (50 - 120cm circumference)- 1 and 10m lengths

  • A2.02.01 Complan® Shake 
  • Available flavours are vanilla, strawberry, original,chocolate and banana in boxes of four sachets.
  • Starter pack available containing 1 of each flavour and a shaker. NOT FOR REPEAT PRESCRIPTION.
  • On dietician advice only in secondary care.
  • 09.02.02.01 Compound Sodium Lactate Intravenous Infusion 
    • Hartmann's Solution 500ml or 1 litre
    • Half Strength Hartmann's Solution
    • Dextrose 5% & Half Strength Hartmann's Solution 500ml polyfusor
    • Link to SPC.
    • Hartmann's Solution = Sodium Chloride 0.6%, Sodium Lactate 0.25%, Potassium Chloride 0.04%, Calcium Chloride 0.027%
    20 Constrictor rings for erectile dysfunction 
  • 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)
  • 06.05.01 Corticorelin 
  • Also known as Human Corticotrophin Releasing Hormone (or Factor) - CRH (or CRF).
  • Unlicensed in the UK.
  • SFH: 100microgram/1ml available to order on consultant request, discuss with the Medicines Information Centre (SFH: 3163).
  • 05.01.08 Co-trimoxazole 

    Tablet 480mg (Forte tablet is non formulary), Suspension, Injection

    • NUH: Restrictions in use to preserve remaining stocks see memo
    • SFH: Good oral bioavailabilty. Oral acceptable in most cases. >48 hours IV treatment should be discussed with microbiology.
    • Restricted antibiotic - See local guidelines. [SFH guideline][NUH guideline]
    • Liquid available, but if needed tablets disperse in water to make a fine suspension [picture]. Make sure the tube is flushed well afterwards.
    05.04.08 Co-trimoxazole  See section 5.1.8
    13.08.02 Covermark®  Classic foundation
    Finishing powder
  • Borderline substance
  • For disfiguring skin lesions (birthmarks, mutilating lesions, scars, vitiligo) only - prescription must state 'ACBS'
  • Non-formulary if not for ACBS approved indication
  • 08.01.05 Crisantaspase Erwinase® Injection
  • At SFH, not routinely stocked, but may be ordered in if required.
  • NB: See attached letter - vials of Erwinase® from Batch 160G (see also information on sub-lots) contain crisantaspase 9 200 units, NOT 10 000 units as is the case with all other batches.
  • NB: See attached letters - Notice of special handling instructions. VIALS of ERWINASE® from batch 174G* and batch 180G* should be used with a 5-micron filter needle
  • 08.01.05 Crizotinib Xalkori®

    Capsule

    Approved in accordance with NICE:

    • TA406 for untreated anaplastic lymphoma kinase-positive advanced non-small-cell lung cancer.
    • TA422 for previously treated anaplastic lymphoma kinase-positive advanced non-small-cell lung cancer.
    • TA529 for treating ROS1-positive advanced non-small-cell lung cancer.
    13.03 Crotamiton Eurax®

    Cream
    Lotion

    OTC Patients may be advised to purchase over the counter for short term relief

    • May be prescribed if appropriate to in-patients; patients should be advised on discharge that further supply should be purchased
    20 Crystal Violet  Unlicensed medicine - named patient use only
    NUH only
    Staining Agent used during endoscopy and colonoscopy.
    13.02.02 Cutimed Protect 1ml Applicator   Replaces Cavilon 1ml applicator as per SFH 2016 dressings formulary.
    A5.02.03 Cutimed Siltec  In Secondary Care, wards to order from pharmacy. At SFH, for use only on the advice of a Tissue Viability Nurse
  • Available as 5x6cm, 10x10cm, 15x15cm and 10x20cm
  • A5.02.03 Cutimed Siltec L  At NUH, wards to order from pharmacy. Not available at SFH
  • Available as 5x6cm, 10x10cm and 15x15cm
  • A5.03.04 Cutimed® Sorbact  On specialist advice only. Not routinely available at SFH.
  • Available as 4x6cm, 7x9cm, 10x10cm, 10x20cm, 2x50cm and 5x200cm
  • 04.06 Cyclizine Valoid®

    Tablet, Injection

    • SFH: Cyclizine is now more expensive, £16 per box of 5, previously £3. See price graph
    • If needed tablets can be dispersed in water (unlicensed). NB: They taste bitter. More Info
    • Can be given S/C (unlicensed but accepted practice)
    13.10.04 Cyclomethicone 50% / Isopropyl myristate 50% solution Full Marks solution

    Solution

    • physical insecticide
    • Not suitable for children younger than 2 years of age or people with skin conditions
    • Apply to dry hair, leave for 10 minutes. Comb through hair with comb provided to remove the remains of lice and eggs. Retreat 7 days later.
    • OTC Patients should be advised to purchase over the counter

    • May be prescribed if appropriate to in-patients; patients should be advised on discharge that further supply should be purchased
    11.05 Cyclopentolate   Eye drops 1%
    Eye drops 0.5% (preservative free) (Minims®)
    Eye drops 1% (preservative free) (Minims®)
    08.01.01 Cyclophosphamide  Tablet, Injection
  • No liquid available. At SFH, injection form is packed in bottles for oral use if necessary.Contact SPU (ext 3156). At SFH, do NOT send patients to retail pharmacies for supplies
    SFH:
  • SFH Cyclophosphamide in Myeloma XI trial (See link below for regimens): All cycles should only be screened by SPU permanent pharmacists
  • 10.01.03 Cyclophosphamide  Tablets, Infusion.
  • Liquid (unlicensed special) may be made specially in hospital production units if required. At SFH do NOT send patients to retail pharmacies for supplies
  • 20 CYCLOPHOSPHAMIDE 

    Unlicensed medicine - named patient use only
    SFH only

     

    05.01.09 Cycloserine  Capsule
    Restricted for use in resistant tuberculosis
    18 Cyproheptadine Periactin® Tablets
  • Discussion with National Poisons Information Service recommended
  • For the treatment of serotonin syndrome
  • Link to SPC
  • 08.03.04.02 Cyproterone  Tablet
  • If needed tablets can be dispersed in water, but this should be done in a closed system- put the tablet in an oral syringe and suck up some water to dissolve it. More Info
  • 06.04.02 Cyproterone Acetate  Tablet
  • Monitor LFTs
  • If needed tablets can be dispersed in water, but this should be done in a closed system- put the tablet in an oral syringe and suck up some water to dissolve it. More info on crushing tablets.
  • Amber 2 - Severe hypersexuality and sexual deviation in males
  • 08.01.03 Cytarabine  Injection
    NUH only:
  • Depot Intrathecal Injection (Depocyte®) for lymphomatous meningitis
  • Pre-filled syringes for ALL paediatric patients (Emergency chemotherapy). Unlicensed medicine - named patient use only
  • Pre-filled 20mg in 0.2mL syringes for subcutaneous administration in adult haematology. Unlicensed medicine - named patient use only
  • 02.08.02 Dabigatran Pradaxa®

    Capsules
    Stroke prevention in non valvular AF:
    -As per Atrial Fibrillation (Non-valvular) - anticoagulation choice

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

    Treatment of DVT or PE and prevention of recurrent DVT or PE:
     -Specialist initiation in line with NICE TA327

    • See Prescribing Information
    • For advice regarding switching between anticoagulants check the local guidelines and the SPC.
    08.01.05 Dabrafenib Tafinlar®

    Capsule

    NUH only

    Approved in accordance with: 
    -NICE TA321 for treating unresectable or metastatic BRAF V600 mutation‑positive melanoma. 
    -NICE TA396 for treating unresectable or metastatic melanoma in combination with trametinib.
    -the National Cancer Drugs Fund (until Jan 2019) and NICE TA544 with trametinib for adjuvant treatment of resected BRAF V600 mutation-positive melanoma, where specified criteria are met.

    08.01.05 Dacarbazine  Injection
    05.03.03.02 Daclatasvir  Daklinza® Tablet
    Only commissioned through specialist centre. Must be prescribed and dispensed at NUH.
    Prior approval via Blueteq system required
    Approved in combination with sofosbuvir in accordance with:
  • NICE TA364 for the treatment of chronic hepatitis C
  • commissioning policy (NHS England B07/P/a)
  • 08.02.04 Daclizumab Zinbryta® Injection
    NUH only:
  • Approved in accordance with NICE TA441 for treating relapsing–remitting multiple sclerosis.
  • 08.01.02 Dactinomycin Cosmegen Lyovac® Injection- NUH only
    05.01.07 Dalbavancin 

    Infusion

    • NUH OPAT service only: Restricted antibiotic: see local guidelines [NUH guideline]
    02.08.01 Dalteparin  Injection
  • Restricted use at NUH only.
  • Glass ampoules for latex allergy patients
  • For prophylactic use and treatment of DVT and PE
  • 02.08.01 Danaparoid Orgaran® Injection (secondary care only)
    Specialist use only for HITT
    06.07.02 Danazol  Capsule
    10.02.02 Dantrolene  Capsule
  • If needed capsules can be opened and contents dispersed in water or acidic fruit juice (eg orange). More Info
    Classified as amber 2 for muscle spasticity
  • 18 Dantrolene  See also section 15.1.8
  • Discussion with National Poisons Information Service recommended if treating drug related malignant hyperpyrexia unless due to anaesthetic
  • 15.01.08 Dantrolene Sodium Dantrium Intravenous® Injection
  • NUH: This preparation is stored in the malignant hyperpyrexia boxes in operating theatres (including Main theatre recovery) and other peripheral locations. Action cards in these boxes show locations of further supplies. Backup stocks are available from pharmacy.
  • SFH: Emergency stocks held in Main Theatre, Sherwood Birthing Unit Theatre and Newark theatre only
  • 06.01.02.03 Dapagliflozin Forxiga®

    Tablets

    • Grey- for Type 1 diabetes. Non-formulary (no formal assessment).
    • 10mg tablets not licensed for use in type 1 diabetes.
    • Dosing restriction to 5mg daily and patient education requirements regarding the risk of DKA apply.
    •  Amber 3- for Type 2 diabetes as per Nottinghamshire APC diabetes treatment guideline.
      Notes on licensing:
    • Licensed for initiation in adults between 18 and 75 years only.
    • Forxiga should not be initiated in patients with a GFR < 60 mL/min and should be discontinued if GFR persistently below 45 mL/min. Forxiga has not been studied in severe renal impairment (GFR < 30 mL/min) or end-stage renal disease (ESRD).
    • Due to its mechanism of action, patients taking dapagliflozin will test positive for glucose in their urine and are at increased risk of urinary tract infection.
    05.01.10 Dapsone  Tablet
  • FBC, LFTs & U&Es are required 2 & 4 weeks after initiation then monthly.
  • Restricted for use on dermatology recommendation, microbiology approval or GU/ID use as 2nd line agent for Pneumocystis carnii pneumonia prophylaxis
  • Tablets disperse in water if needed. See here for general advice on dispersing tablets.
  • Amber 2 for Dermatitis herpetiformis
  • 05.01.07 Daptomycin Cubicin® Infusion
  • Regular CPK monitoring required
  • See local guidelines. [SFH guideline][NUH guideline]
  • 08.01.05 Daratumumab Darzalex®

    Infusion

    Available at NUH only:

    • Approved in accordance with the National Cancer Drugs Fund List and NICE TA510 as monotherapy for treating relapsed and refractory multiple myeloma.
    • Approved in accordance with the National Cancer Drugs Fund List and NICE TA573 for use with bortezomib and dexamethsone for previously treated multiple myeloma.

     

    09.01.03 Darbepoetin Alfa Aranesp®

    Injection:
    - Prefilled syringes
    - Prefilled disposable injection device (Aranesp® SureClick)

    • Approved in line with NICE TA323 for treating anaemia in people with cancer having chemotherapy. Also used within haematology and paediatric renal.
    • Available through homecare for NUH patients. Please contact pharmacy medicines homecare team for further information.
    07.04.02 Darifenacin Emselex®

    Tablet

    05.03.01 Darunavir Prezista®

    Tablets, Oral suspension

    • Restricted to ID / GU Medicine advice only
    • Available through homecare for NUH patients. Please contact pharmacy medicines homecare team for further information
    05.03.01 Darunavir and Cobicistat Rezolsta®

    Tablet

    • NUH Only Restricted to ID / GU Medicine advice only, in accordance with commissioning approval.
    • Available through homecare for NUH patients. Please contact pharmacy medicines homecare team for further information
    05.03.03.02 Dasabuvir Exviera® Tablet
    Only commissioned through specialist centre. Must be prescribed and dispensed at NUH.
    Prior approval via Blueteq system required
    Approved in combination with ombitasvir/paritepravir/ritonavir in accordance with:
  • NICE TA365 for the treatment of chronic hepatitis C
  • commissioning policy (NHS England B07/P/a)
  • 08.01.05 Dasatinib Sprycel® Tablets
    Approved in accordance with NICE:
  • TA426 for untreated chronic myeloid leukaemia (chronic-phase Philadelphia-chromosome-positive)
  • TA425 for treating imatinib-resistant or intolerant chronic myeloid leukaemia (chronic or accelerated-phase Philadelphia-chromosome-positive)
    Approved in accordance with the National Cancer Drugs Fund List for the indication(s) below where the specified criteria are met:
    - The treatment of Philadelphia chromosome positive (Ph+) acute lymphoblastic leukaemia. Removed from the CDF list 2015. Remains on formulary for patients with funding approved prior to removal.
    - The treatment of lymphoid blast crisis chronic myeloid leukaemia. Removed from the CDF list 2015. Remains on formulary for patients with funding approved prior to removal.
  • Confirm funding approved on BlueTeq for all new starters
  • NUH: For more information, including criteria, see the DTC website; available here
  • 08.01.02 Daunorubicin  Injection
    20 DAUNORUBICIN saline pre-filled syringe  NUH only
  • Unlicensed medicine - named patient use only
  • For use only after IFR approval
    10mg/10ml, 20mg/20ml, 30mg/30ml
  • A5.07 Debrisoft  On specialist advice only.
  • Available as 10x10cm
  • 09.01.03 Deferasirox Exjade® Dispersible tablet and Film coated tablets
  • Dispersible tablet being withdrawn in June 2017
  • NUH only
  • 09.01.03 Deferiprone Ferriprox® Tablet
  • NUH only
  • 02.10.02 Defibrotide 

    Infusion

    Available at NUH only:

    Approved in accordance with NHS England commissioning policy for severe veno-occlusive disease following stem cell transplant.

    • BlueTeq form required
    08.03.04.02 Degarelix Firmagon® Injection
  • Approved in accordance with NICE TA404
  • 05.01.03 Demeclocycline  Capsule
  • Treatment should only be initiated and reviewed by a consultant endocrinologist or oncologist.
  • For use in SIADH only. SIADH dose differs from antibiotic dose, see BNF.
  • Where specialists have requested a GP prescribe, this should only occur if there is a clearly documented plan giving information on the monitoring and follow up of treatment.
  • A dose of 300mg TDS for 28 days costs around £1000 (DT,June 17)
  • 06.06.02 Denosumab Prolia®
  • For initiation only by osteoporosis specialists in post menopausal women as per NICE guidance for patients in whom IV bisphosphonates aren't suitable.
  • Use in men is awaiting confirmation of secondary care funding at both NUH and SFHFT.
  • Amber Traffic Light (Amber 2) For a limited number of patients (maximum of 5 patients over 12 months) within Rushcliffe CCG.
  • 06.06.02 Denosumab XGEVA®

    Solution for injection

    • Restricted for preventing skeletal related events in adults with bone metastases from breast cancer and from solid tumours other than prostate in accordance with NICE.
    • Denosumab is not recommended for preventing skeletal-related events in adults with bone metastases from prostate cancer, (this is in line with NICE).
    • ONCOLOGY patients treated on WTC: XGEVA brand only. Denosumab and calcium supplements are prescribed on ChemoCare. Pharmacists to screen per SPC. Denosumab stocked on WTC (no need to dispense). Adcal D3 or Calcichew D3 tablets both can be supplied (Chemocare prescriptions can be amended according to the brand availability)

    20 DEPIGMENTING CREAM Pigmanorm® 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
  • 13.08.02 Dermacolor®  Camouflage creme
    Fixing powder
  • Borderline substance
  • For disfiguring skin lesions (birthmarks, mutilating lesions, scars, vitiligo) only - prescription must state 'ACBS'
  • Non-formulary if not for ACBS approved indication
  • 13.02.01 Dermatonics Heel Balm® 

    Balm

    • First line, indicated for dry skin on soles of feet and heel only.
    • In line with the Emollient Formulary.
    15.02 Dermogesic spray  Local anaesthesia for venopuncture in paediatric patients where Ametop and Emla not suitable
  • NUH only
  • 13.02.01 Dermol® 

    Emollient preparation with antimicrobials

    • Dermol® Cream - Greasy level 2/4
    • Dermol® 500 Lotion - Greasy level 1/4 (least greasy)
    • To be prescribed in line with the Emollient Formulary.
    18 Desferrioxamine  Injection
  • Discussion with National Poisons Information Service recommended
  • Iron poisoning
  • Also see section 9.1.3
  • 09.01.03 Desferrioxamine Mesilate 

    Injection

    • Red: Iron overload
    • See section 18 for poisoning
    • Available through homecare for NUH patients. Please contact pharmacy medicines homecare team for further information
    15.01.02 Desflurane Suprane® Anaesthetic
  • Approx 37x the cost per MAC equiv of isoflurane. See cost calculator
  • 06.05.02 Desmopressin  Tablets, S/L tablets, nasal spray, solution, injection.
  • Generic tablets now cover all indications.
  • Brands for specific indications are much more expensive. See BNF.
  • Traffic light classifications:
    Amber Traffic Light - Nasal spray for diabetes insipidus
    Amber Traffic Light - Oral for diabetes insipidus
    Green Traffic Light - Oral for nocturnal enuresis
  • 07.03.02.01 Desogestrel 

    Tablet

    • Available as generic but consider prescribing by brand in patients with soya or nut allergy (some generics may contain ingredients unsuitable for soya or nut allergy sufferers - check individual SPCs)
    • Generic prescribing is most cost effective in primary care.
    • Brands include Cerazette®, Cerelle® and Zelleta®.
    06.03.02 Dexamethasone 

    Tablet, soluble tablets, Injection, Oral solution (expensive - See here)

    Injection:

    • Caution: Different concentrations of dexamethasone injection exist
    • NUH now using Wockhardt 3.3mg/mL 1ml amps - note New 03/10/17: see memo below.
    • S/C use is unlicensed but common practice within palliative care.

    Oral:

    • Normal tablets routinely stocked which disperse easily in water.
    • Soluble tablets are available but are more expensive.
    • Dosing recommendations are usually in terms dexamethasone base (which the tablets are)
    • Classified GREEN for croup as per CKS guidance. Prednisolone is also an option and is stocked more widely.
    10.01.02.02 Dexamethasone  Injection 4mg in 1mL
    Injection 8mg in 2mL
    11.04.01 Dexamethasone 

    - Eye drops 0.1% (~£2)
    - Eye drops preservative free (Eythalm® 6ml bottle ~120 drops, 28 day expiry, ~£10)
    - 0.1% w/v single use eye drops unit dose (Dexafree®, ~£10 for 30 doses)

    20 Dexamethasone eye injection  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.
  • 11.04.01 Dexamethasone intravitreal implant Ozurdex® Implant 700micrograms
  • Approved for use at NUH and SFH for retinal vein occlusion (RVO) in line with NICE TA229.
  • Approved for use at NUH and SFH for diabetic macular oedema (DMO) in line with NICE TA349.
  • Order form for doctor to acquire from SFH Pharmacy
  • NUH Approved in accordance with NICE TA460 for treating non-infectious uveitis
  • 12.01.01 Dexamethasone with Antibacterial Otomize®
    • Ear spray (Dexamethasone 0.1%, Neomycin Sulphate 3250 units per mL & Glacial Acetic Acid 2%)
    • Recommended in the Nottinghamshire Primary Care antimicrobial guidelines for otitis externa. Topical acetic acid 2% should be tried first as per guideline. 
    • £3 per bottle
    12.01.01 Dexamethasone with Antibacterials Sofradex®
    • Sept 2018 - Supply problem
    • Drops (Dexamethasone 0.05%, Framycetin Sulphate 0.5%, Gramicidin 0.005%)
    • Mentioned in the Nottinghamshire Primary Care antimicrobial guidelines for otitis externa.
    • The second line options are not in a particular order and the supply and cost may vary over time.
    • £7.50 per bottle
    11.04.01 Dexamethasone with Neomycin and Polymyxin B sulphate Maxitrol® Eye drops & Eye ointment
  • Opthalmology recommendation only
  • Less suitable for prescribing unless post surgery
  • 04.04 Dexamfetamine  Tablet
    Attention Deficit Hyperactivity Disorder and substance misuse :
    - Specialist use only
    Treatment of Narcolepsy:
    - Non-formulary awaiting submission and local guidance
  • Oral solution is non-formulary (grey, no formal assessment), APC Sept 14.
  • 15.01.04.04 Dexmedetomidine  Dexdor®

    Infusion

    NUH Critical Care Use Only:

    • For SEDATION of adult patients to achieve a RASS score of 0 to -3 ( No deeper than rousable to voice/verbal stimuli)
    • For patients with agitated delirium receiving mechanical ventilation in the intensive care unit, in addition to standard care.
    • For agitated delirium where the cause is due to withdrawal of alcohol

     

    08.01 Dexrazoxane Savene®

    Infusion- NUH only

    • Restricted:Refer to extravasation policy for use in anthracycline cardiotoxicity.
    • Not routinely commissioned for anthracycline cardiotoxicity - IFR approval must be sought before initiation.
    09.02.02.02 Dextran 70®  Infusion in Sodium Chloride 0.9% - may not be available
  • NUH only
  • 20 Dialyvit®  Tablet (Unlicensed medicine - named patient use only)
    NUH only
  • Restricted for paediatric renal use - paediatric formulation of Dialyvit® has been discontinued (2015)
  • 04.07.02 Diamorphine 

    Injection

    • In palliative care should be used 2nd line to morphine when morphine volumes are too large to administer.
    • SFH: Intranasal diamorphine in children and young people in ED


      Red Traffic Light NUH only:

    • For intranasal use in adults with acute painful sickle crisis as per guideline.
    • For intranasal use in paediatric patients within the ED for acute severe pain.
    04.01.02 Diazepam 

    Tablet, Liquid 2mg/5ml. Injection 10mg/2ml.

    • Note: Diazepam injection comes in two forms - solution (IM or IV) and emulsion Diazemuls® (IV only). Emulsion is preferred for IV as it is less irritant to the veins.

    Rectal tube
    Injection

    • Convulsions or agitation related to overdose / poisoning 
    04.08.02 Diazepam epilepsy
    •  See section 4.1.2 for information. 

     

    04.08.03 Diazepam  See section 4.8.2
    10.02.02 Diazepam  See also section 4.1.2
    15.01.04.01 Diazepam 
    • See section 4.1.2 for information.
    18 Diazepam 

    See section 4.1.2 for further information. 

    06.01.04 Diazoxide  Tablet, injection, 50mg/ml suspension (Unlicensed medicine - named patient use only)
    20 Dibotermin Alfa, rhBMP-2 Inductos® 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
  • 10.01.01 Diclofenac 
    • Unless prescribed for agreed restricted patient groups (see below), tablets are non-formulary due to small cardiac risks with diclofenac. Ibuprofen (up to 1200mg/day) or naproxen should be considered instead. See links below.
    • Diclofenac suppositories are neither better tolerated nor more effective than oral NSAIDs
    • Suppositories available as: 12.5mg, 25mg, 50mg, 100mg. Avoid unless PR route is essential.
    • Injection 75mg in 3mL, (and Akis Injection 75mg/mL restricted at NUH for intra-operative analgesia)
    • Tablets 25mg, 50mg available for short term use in breastfeeding women (ibuprofen and diclofenac have the most reassurance of being ok in breastfeeding) and in renal colic.
    • NUH only: Tablets 25mg, 50mg available as a second line NSAID for paediatric patients.
    • Dispersible tablets now discontinued
    11.08.02 Diclofenac Voltarol® Ophtha

    - Eye drops 0.1% single use (preservative free) only (~£30 for 40)
    - Eye drops 0.1% multidose (~£7)(preserved) replaced by ketorolac (~£3) eye drops March 2013. Dec 18: Formulary again while ketorolac unavailable (until March 2019).

    • Amber 2 - Specialist initiation
    18 Dicobalt edetate  Injection
  • Discussion with National Poisons Information Service recommended.
  • SFH stock sodium nitrate and sodium thiosulphate on the poisons unit as alternatives. Contact NPIS for advice if required.
  • NUH stocked in ED
  • Severe poisoning only
  • 05.03.01 Didanosine Videx®

    Tablet,Capsule EC, Powder for suspension (named patient)

    • Restricted to ID / GU Medicine advice only
    • Tablets disperse in water if needed. See here for general advice on dispersing tablets.
    • Dispersible tablets discontinued September 2017, capsules expected to be discontinued Q1 2020
    20 DIDANOSINE Liquid 10mg in 1ml (after double dilution)  Unlicensed medicine - named patient use only
    NUH only
    08.03.01 Diethylstilbestrol  Tablet
  • Restricted for use in Breast and Prostate Cancer
  • 13.04 Diflucortolone 0.1% Nerisone®

    Cream, Oily cream, Ointment

    • Potent
    • Most cost-effective potent steroid except oily cream
    13.04 Diflucortolone 0.3% Nerisone Forte®

    Oily cream, Ointment

    • Very potent
    02.01.01 Digoxin 

    Tablets, Elixir, Injection

    • Bioavailabilites are approximately: Injection 100%, Liquid 75%, Tablets 63%.
    • ONE 62.5microgram tablet is ~ equivalent to 50microgram (1mL) elixir. (See table of liquid medicines requiring dose adjustment) 
    02.01.01 Digoxin specific antibody fragments Digifab®

    Infusion

    • Very rarely needed and extremely expensive (~£1,000 per vial and upto 20 vials may be needed). Discuss with the National Poisons Centre (03448920111) first, then local Medicines Information (SFH: ext 3163 NUH: ext 64185) or the on call pharmacist (via switchboard after 17:30).
    • SFH only: How to get supplies (Pharmacy guide)(A&E guide)
    • DigiFab® replaced Digibind® (Dec 2011).
    18 Digoxin specific antibody fragments Digifab®
  • See section 2.1.1 for information
  • 04.07.02 Dihydrocodeine  Tablet, Tablet MR, Oral solution.
  • Poor analgesic when used alone, probably similar to or theoretically slightly better than codeine, but based on minimal evidence. Only use in addition to paracetamol.
  • 20 DIHYDROERGOTAMINE Injection 1 mg in 1mL  Unlicensed medicine - named patient use only
    NUH only
    05.04.02 Diloxanide 

    Tablet

    • For chronic amoebiasis
    02.06.02 Diltiazem 
    • Once daily preparations preferred. For advice on the most cost-effective brand contact your local Medicines Management Team. At SFH see advice on brand switching.
    • If needed capsules can be opened and beads mixed with water (do not crush). More info.
    • If needed 60mg tablets can be dispersed in water (despite misleadingly being called modified release). More info. See here for general advice on dispersing tablets.
    01.07.04 Diltiazem 2% Cream/Ointment 
    • For anal fissures.
    • Unlicensed - May not be easy to acquire in community.
    • Approx £15 for 30g cream from the hospital pharmacy, £56 from retail pharmacy. 
    • Ointment is approx £23 for 30g from retail pharmacy
    • Dose 2cm bd (or tds). 1 tube lasts one month, store in fridge.
    20 DILUENT A (XANTHAN GUM 1%) Suspension 1%  Unlicensed medicine - named patient use only
    NUH only
    20 DILUENT C susp CAROB BEAN GUM 1% 500ml  Unlicensed medicine - named patient use only
    NUH only
    18 Dimercaprol  Solution for injection
  • Discussion with National Poisons Information Service recommended.
  • Heavy metal poisoning
  • Held supra-regionally for treatment of heavy metal poisoning
  • 08.02.04 Dimethyl fumarate Tecfidera®

    Capsule

    • NUH: Approved in accordance with NICE TA320 for the treatment of adult patients with active relapsing remitting multiple sclerosis (MS).
    • Available through homecare for NUH patients. Please contact pharmacy medicines homecare team for further information
    13.05.02 Dimethyl Fumarate  

    Tablets

    • Nottingham Treatment Centre and SFH only: Approved in accordance with: NICE TA475 for treating moderate to severe plaque psoriasis.
    13.05.02 Dimethyl Fumarate Fumaderm®

    Tablets

    • Unlicensed medicine, not in BNF, imported product - named patient use only
    • Dermatologist use only for existing patients. New patients to be started on the licensed Skilarence® brand.
    • Available as 'Fumaderm Initial' containing 30mg of one ingredient and 'Fumaderm' containing 120mg of one ingredient. Preferably prescribe as number of tablets to be given.
    20 DIMETHYL SULFOXIDE 

    Unlicensed medicine - named patient use only
    SFH only

    07.04.04 DIMETHYL SULPHOXIDE Bladder Instillation 50%  Unlicensed medicine (expensive) - named patient use only in secondary care
  • Details of dose and monitoring are in BNF
  • Red - as per APC May 2014 for interstitial cystitis
  • 13.10.04 Dimeticone Hedrin®

    Lotion 4%

    • a physical insecticide
    • First line for Pediculosis capitis (head lice) in pregnancy (licensed) if wet combing not suitable
    • OTC Patients should be advised to purchase over the counter

    • May be prescribed if appropriate to in-patients; patients should be advised on discharge that further supply should be purchased
    07.01.01 Dinoprostone Prostin E2® Injection
    Vaginal tablet (Prostin E2)
    MR pessaries (Propess)- SFH only
    Vaginal gel- NUH only
    NB: Prostin E2® vaginal gel and vaginal tablets are not bioequivalent. See NUH guidelines.
    08.02.04 Dinutuximab beta 

    Infusion

    NUH: Approved in accordance with NICE TA538 for treating neuroblastoma.

    14.04 Diphtheria antitoxin  Named patient use only
  • Not routinely stocked at SFHT
  • At NUH requires microbiology or infectious diseases approval
  • 02.09 Dipyridamole  Capsule MR
  • Secondary prevention of ischaemic stroke and TIA normally in combination with aspirin for existing patients and those unable to take clopidogrel. See Clopidogrel for TIA position statement
  • If needed capsules can be opened and beads mixed with water (do not crush). Flush enteral tubes well as there is potential for blockage. More Info
  • 11.99.99.99 Disodium Edetate 0.37%   Solution 20mL (preservative free) (Unlicensed Product)
  • Specialist use only
  • At SFH, used by ophthalmology in Daycase. Not routinely stocked, but may be ordered in if needed
  • 02.03.02 Disopyramide 

    Capsule, Tablet MR

    (Injection – Discontinued in 2013)

    04.10.01 Disulfiram Antabuse® Tablet
  • Manufacturing problem expected to persist until April 2017.
  • In primary care, GPs/NMPs who have received appropriate training may initiate as per Notts Primary Care Alcohol Community Detox Protocol. In secondary care on specialist advice of Alcohol and Drug Liaison Team
  • Loading dose not considered necessary
  • 13.05.02 Dithranol Dithrocream® Creams 0.1%, 0.25%, 0.5%, 1% and 2%.
  • Dithranol should not be used in people with acute or pustular psoriasis or inflamed psoriasis.
  • Avoid using dithranol on the face.
  • 13.05.02 Dithranol Micanol® Cream 3%
    20 DITHRANOL 0.1% /0.25%,0.5%,1%,2%,4%in lassars paste  Unlicensed medicine - named patient use only
    NUH only
    18 DMPS (unithiol)  Injection - unlicensed
    Hard capsules - unlicensed
  • Discussion with National Poisons Information Service recommended.
  • Not stocked at NUH or SFH
  • Held supra-regionally for treatment of heavy metal poisoning
  • 18 DMSA (succimer)  Capsules - unlicensed
  • Discussion with National Poisons Information Service recommended.
  • Not stocked at NUH or SFH
  • Held supra-regionally for treatment of heavy metal poisoning
  • 02.07.01 Dobutamine  Infusion (secondary care only)
    08.01.05 Docetaxel Taxotere® Infusion
    01.06.02 Docusate 

    Capsule
    Solution (Utterly unpalatable - only fit for use down tubes.)

    • Probably acts as a softening laxative as well as a stimulant.
    • Time to effect is approximately 24 to 48 hours.
    • OTC Patients should be advised to purchase a suitable product over the counter for short term/infrequent constipation

    • May be prescribed if appropriate to in-patients; patients should be advised on discharge that further supply should be purchased
    01.06.02 Docusate Norgalax® Micro-enema

    Micro enema
    NB: not recommended for children under 12 years old

    • OTC Patients should be advised to purchase a suitable product over the counter for short term/infrequent constipation

    • May be prescribed if appropriate to in-patients; patients should be advised on discharge that further supply should be purchased
    12.01.03 Docusate 0.5% eardrops Waxsol®

    Ear drops

    • OTC Patients should be advised to purchase over the counter

    • May be prescribed if appropriate to in-patients; patients should be advised on discharge that further supply should be purchased
    05.03.01 Dolutegravir 

    Tablet

    • NUH and SFH for use in line with NHS England Commissioning statement
    • Available through homecare for NUH patients. Please contact pharmacy medicines homecare team for further information
    05.03.01 Dolutegravir, abacavir & lamivudine Triumeq®

    Tablet

    • NUH and SFH for use in line with NHS England Commissioning statement
    • Available through homecare for NUH patients. Please contact pharmacy medicines homecare team for further information
    04.06 Domperidone  Tablet, Suspension
  • Nausea and vomiting associated with cytotoxic therapy and nausea caused by dopaminergic drugs and apomorphine.
  • See link below for MHRA advice about dose restrictions and contraindications and SFH memo regarding MHRA guidance in oncology & haematology.
  • Suppositories have now been discontinued.
  • Non-formulary (grey) for promoting tolerance of enteral feeds in children / young people. See NICE evidence summary.
  • 20 Domperidone  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.
  • 04.11 Donepezil 

    Tablet, orodispersible tablet

    • Once a decision has been made to start, the first prescription may be made in primary care.
    • Orodispersible tablets available if tablets cannot be swallowed - Prescribe generically as SUGAR FREE version (because non sugar free version is approx 10 times the price). 
    • If needed tablets can be dispersed in water (not licensed). More Info
    • Oral solution is non-formulary (grey, no formal assessment, APC Sept 14). Orodispersible tablets are more cost-effective.
    02.07.01 Dopamine  Infusion (secondary care only)
    03.07 Dornase Alfa Pulmozyme®

    Nebules
    Red Traffic Light  For new patients.

    • Not routinely commissioned for indications other than cystic fibrosis - contact pharmacy (at SFH 3163) for more information.
    • Also available at NUH for non-CF paediatric patients for short term in-patient use on consultant recommendation only.


    Amber Traffic Light  For existing patients already receiving supplies from primary care. Repatriation of these patients is not expected.

    Available through homecare for NUH patients. Please contact pharmacy medicines homecare team for further information

    11.06 Dorzolomide 
    • Eye drops 2% (~£2)
    • Preservative free eye drops 2%. SFH stock Eydelto® multidose bottle (~£12). Trusopt® brand minims (~£24)(Contact Medicines Management team for most cost-effective brand)
    11.06 Dorzolomide 2% with Timolol 0.5% 
    • Eye drops (~£2)
    • Preservative free eye drops. SFH stock Eylamdo® multidose bottle (~£15). Cosopt® brand (~£29)(Contact Medicines Management team for most cost-effective brand)
    13.02.01 DoubleBase® 

    Gel

    03.05.01 Doxapram Dopram® Injection
    15.01.07 Doxapram Dopram® See section 3.5.1
    02.05.04 Doxazosin 

    Green Traffic Light  Tablet (2mg = 72p for 28. 4mg = 81p for 28)
    Amber Traffic Light  Tablet MR (4mg = £5 for 28. 8mg = £9.98 for 28)

    • Doxazosin may be used as a 4th line option in the management of hypertension when control has not been achieved with other agents.
    • Modifed release (MR) reserved for specialist initiation in patients with difficult to treat hypertension who are unable to tolerate IR doxazosin. MR is on the Nottinghamshire list of Medicines & Appliances of Limited Clinical Value.
    • If switching from MR to IR the dose of standard doxazosin could be re-initiated at 1mg daily, as if newly starting therapy, or at half the modified-release doxazosin dose - see UKMI link below.
    • If needed tablets can be dispersed in de-ionised water. Do not crush MR formulations. More Info
    07.04.01 Doxazosin 

    Tablet

    • See Section 2.5.4 for use as antihypertensive.
    • If needed, tablets disperse in de-ionised water, click here for more information.
    04.03.01 Doxepin  Capsule
  • GreyTraffic Light Not for use as an antidepressant
  • AmberTraffic Light Restricted for dermatology use only for the treatment of urticaria and pruritus.
  • Second line to amitriptyline.
  • See also doxepin cream in topical section.
  • Doxepin and amitriptyline have the most potent antihistamine activity of all tricyclic antidepressants.
  • Cost: £100-150 per box
  • 08.01.02 Doxorubicin Caelyx® Concentrate for intravenous infusion
  • Approved in line with NICE TA389 for treating recurrent ovarian cancer.
    NB: Trabectedin in combination with pegylated liposomal doxorubicin is not recommended for treatment of the first recurrence of platinum-sensitive ovarian cancer.
    Also approved in accordance with the National Cancer Drugs Fund List for the treatment of certain named sarcomas.
    NUH: For more information, including criteria, see the DTC website; available here. Confirm funding approved on BlueTeq for all new starters.
    SFH: Confirm funding by contacting the HCD Team on 4660
  • 08.01.02 Doxorubicin  Injection
    05.01.03 Doxycycline  Capsule, Dispersible Tablet.
  • Can be used if sensitivities state "tetracycline". Including MRSA.
  • See local guidelines. [SFH guideline][NUH guideline]
  • 12.03.01 Doxycycline  Dispersible tablet (unlicensed indication)
  • Disperse in water and use as a mouthwash
  • 12.03.02 Doxycycline  See section 12.3.1
    13.06.02 Doxycycline  Capsules
    Dispersible Tablets
  • See chapter 5.1.3 for more detailed information on antibiotics
  • 20 DOXYCYCLINE Injection 100 mg in 5mL  Unlicensed medicine - named patient use only
    NUH only
    A5.07.01 Dressit  For use when prescribing on FP10 (green) prescriptions only
  • Contains gloves- option of small/medium or medium/large
  • 02.03.02 Dronedarone  Tablets
  • For cardiologist initiation in accordance with NICE guidance (TA197). Patients should be retained by secondary care for at least the first 12 months of treatment.
  • The need for 6 monthly ECGs should be highlighted when shared care is requested and a copy of the patient's recent ECG sent to primary care for comparison purposes.
  • For patients unable to swallow tablets, there are no known problems with dispersing tabs. However, it should be taken with meals- the fed state greatly increases bioavailability. No data is available on administration with enteral feeds - Doctors should be aware of this and efficacy monitored.
  • 04.06 Droperidol Xomolix® Injection 2.5mg/ml
  • For use in PONV.
  • For IV use can be administered undiluted as a slow bolus.
  • 06.01.02.03 Dulaglutide Trulicity®
    • Note: Ready made. No requirement to reconstitute powder.
    04.03.04 Duloxetine Cymbalta®
    • 3rd line option for depression/anxiety
    • Also used for the treatment of urinary incontinence, but preparation and dosage different - see Yentreve (section 7.4.2
    • For side effects in the BNF see Yentreve (section 7.4.2)
    • Be aware of drug interactions
    • Capsules can be opened and the contents mixed with apple sauce or apple juice for patients with swallowing difficulties as long as the beads inside are not crushed. More Info
    04.07.03 Duloxetine 
    • GPs may initiate in line with Notts APC Neuropathic Pain Guidelines.
    • If needed, the capsules can be opened and their contents mixed with apple juice or apple sauce (unlicensed), click here for more information.  
    07.04.02 Duloxetine Yentreve®

    Capsules

    • On recommendation of stress incontinence team.
    • If needed capsules can be opened and beads mixed with apple juice or apple sauce (do not crush). More Info
    13.08.01 Dundee reflective sun creams Dundee Block® Unlicensed medicine - named patient use only
  • Red: sunscreen protection - specialist use only
  • A2.04.01.02 Duocal®  
    • On dietician recommendation only
    A2.04.01.02 Duocal® Super Soluble 
    • On dietician recommendation only 
    • Paediatric use
    A5.02.04 DuoDERM Extra Thin  Replaced Comfeel Plus transparent on Sept 2016.
    A5.02.04 Duoderm Signal Dressing   At NUH available on wards as stock. Not available at SFH, use Comfeel Plus Transparent instead
  • Available as 10cmx10cm and 14cmx14cm
  • 13.05.03 Dupilumab Dupixent®

    Injection - Pre-filled syringe

    Nottingham NHS Treatment Centre and SFH: Approved in accordance with NICE TA534, for treating moderate to severe atopic dermatitis

    08.01 Durvalumab 

    Infusion

    Available at NUH only:

    Approved in accordance with compassionate named patient programme as a consolidation treatment in patients with Stage 3 non-small-cell lung cancer.

    Approved in accordance with the Cancer Drugs Fund and NICE TA578 for treating locally advanced unresectable non-small-cell lung cancer after platinum-based chemoradiation

    06.04.02 Dutasteride 

    Capsule

    • Avoid contact with capsule contents.
    • Use finasteride first line which is supported by the MTOPS and PCPT trials.
    • Patients can be switched from dutasteride to finasteride in primary care if:
      - finasteride hasn't been tried before.
      - the patient has been on dutasteride for more than 3 months.
    • Amber 2 - Benign prostatic hyperplasia.
    A5.02.03 Eclypse Adherent 
  • Replaced by Zetuvit E as per SFH 2016 dressings formulary.
    On specialist advice; second line choice as per SFH 2016 dressings formulary.
  • Available as 10x10cm, 15x15cm, 20x30cm.
  • A5.01.02 Eclypse Non-adherent 
  • Replaced by Zetuvit E as per SFH 2016 dressings formulary.
    On specialist advice; second line choice as per SFH 2016 dressings formulary.
    At SFH, wards to order direct from RDC
    At NUH, can be ordered from Pharmacy if advised by tissue viability
  • Available as 15x15cm, 20x30cm, 60x40cm and 60x70cm boot (for use in exceptional circumstances only)
  • 09.01.03 Eculizumab 

    Infusion

    Available at NUH only

    - Approved in accordance with NICE HST1 for treating atypical haemolytic uraemic syndrome
    -
    Approved in accordance with the Clinical Commissioning Policy in the treatment of recurrence of C3 glomerulopathy post-kidney transplant (all ages) 

    Available through homecare for NUH patients.  Please contact pharmacy medicines homecare team for further information.

     

    02.08.02 Edoxaban Lixiana®

    Treatment of DVT or PE and prevention of recurrent DVT or PE:
     - Specialist initiation in line with NICE TA354. For advice regarding switching between anticoagulants check the local prescribing information and the SPC.

    Stroke prevention in AF:
     For use in line with Atrial Fibrillation (AF) anticoagulation guideline.

    05.03.01 Efavirenz Sustiva®

    Capsule, Tablet, Oral Solution

    • Restricted to ID / GU Medicine advice only
    • Oral solution to be discontinued by the end of October 2015. Sustiva can be administered by capsule sprinkle method. Switching from oral solution to capsule sprinkle method may result in higher drug exposures; therefore patient should be monitored for toxicity during transition period
    • Available through homecare for NUH patients. Please contact pharmacy medicines homecare team for further information
    02.11 Efmoroctocog alfa Elocta®

    Non pharmacy item please contact blood bank for details and availability

     

    Available through homecare for NUH patients. Please contact pharmacy medicines homecare team for further information

    02.11 Eftrenonacog alfa Alprolix®

    Non pharmacy item, please contact blood bank for details and availability.

     

    Available through homecare for NUH patients. Please contact pharmacy medicines homecare team for further information

    05.03.03.02 Elbasvir/Grazoprevir Zepatier® Tablet
    Only commissioned through specialist centre. Must be prescribed and dispensed at NUH.
    Prior approval via Blueteq system required

    Approved in accordance with NICE TA413 for the treatment of chronic hepatitis C and the supporting NHS England commissioning policy.
    A2.01.01.02 Elemental 028® Extra 
    • On dietician recommendation only
    • Liquids available as grapefruit, orange and pineapple, and summer fruits flavours in 250ml cartons
    • Powder available in unflavoured sachets.
    09.01.04 Eltrombopag Revolade®

    Tablet
    At NUH:

    • All patients, for whom treatment with a thrombopoietin (TPO) agonist is being considered, should be discussed at a haematology MDT meeting.
    • Approved for treating chronic immune (idiopathic) thrombocytopenic purpura in adults, in accordance with TA293.
    • Approved for treating chronic immune (idiopathic) thrombocytopenic purpura refractory to other treatments in paediatrics.
      At SFH: supplied via Homecare. Please contact High Cost Drugs Team (4657) if eltrombopag is required.
    01.04.02 Eluxadoline Truberzi®
  • Specialist initiation for use in line with NICE TA471
  • Specialist to supply first month of treatment and review before transfer to primary care.
  • 02.11 Emicizumab Hemlibra®

    Injection

    NUH only: Approved in accordance with the Clinical Commissioning Policy for the prophylaxis in people with cogential haemophilia A with factor VIII inhibitors (all ages).

    Available through homecare for NUH patients.  Please contact pharmacy medicines homecare team for further information.

    13.02.01 Emollin® 

    Spray

    • Only as an alternative to WSP products for those with application issues (i.e. hard to reach areas)
    • Amber 3 (GP may initiate in line with Emollient formulary)
    06.01.02.03 Empagliflozin Jardiance®

    Tablets

    • Amber 3 - as per Nottinghamshire APC diabetes treatment guideline.
    • Licensed for initiation in adults aged 18years to 85years.
    • Maximum dose is 10mg daily in patients with GFR <60ml/min and should not be used if GFR is <45ml/min.
    • Due to its mechanism of action, patients taking empagliflozin will test positive for glucose in their urine and are at increased risk of urinary tract infection.
    05.03.01 Emtricitabine Emtriva®

    Capsule, Oral Solution

    • Restricted to ID / GU Medicine advice only
    • Available through homecare for NUH patients. Please contact pharmacy medicines homecare team for further information
    • Emtriva 200mg hard capsule is approximately equivalent to 24mL(240mg) Emtriva 10mg/mL oral solution. (See table of liquid medicines requiring dose adjustment)
    05.03.01 Emtricitabine + rilpivirine + tenofovir alafenamide Odefsey®

    Tablet

    • Restricted to ID / GU Medicine advice only
    • Approved in accordance with commissioning guidance (policy NHS England 16043/P and subsequent Specialised Services Circular 1672)
    • Available through homecare for NUH patients. Please contact pharmacy medicines homecare team for further information
    05.03.01 Emtricitabine + tenofovir alafenamide Descovy®

    Tablet

    • Restricted to ID / GU Medicine advice only
    • Approved in accordance with commissioning guidance (policy NHS England 16043/P and subsequent Specialised Services Circular 1672)
    • Available through homecare for NUH patients. Please contact pharmacy medicines homecare team for further information
    05.03.01 Emtricitabine 200mg, Rilpivirine 25mg and Tenofovir 245mg Eviplera®
    • Restricted to ID / GU Medicine advice only
    • Available through homecare for NUH patients. Please contact pharmacy medicines homecare team for further information
    13.02.01 Emulsifying Ointment BP 

    Ointment

    • Greasy level 4/4 (most greasy)
    • Only the Ovelle® Emulsifying Ointment (£4.15 for 500g) appears listed in the Nov 18 Drug Tariff. Prescribe by brand. 
    02.05.05.01 Enalapril   Tablet
    3rd line choice
  • Tablets disperse in water if needed. See here for general advice on dispersing tablets.
  • A2.03.01 Enfamil AR 
  • On Dietician Advice Only
  • A2.03.01 Enfamil® O-Lac 
  • On Dietician Advice Only
  • 05.03.01 Enfuvirtide Fuzeon®

    Injection

    • Restricted to ID / GU Medicine advice only
    02.08.01 Enoxaparin Inhixa® or Clexane®

    Injection

    • Two brands now available: Inhixa® and Clexane®.
      - Inhixa is the preferred brand in Nottinghamshire, but Clexane is still available in primary care for existing patients.
      - Enoxaparin should be BRAND PRESCRIBED and patients should be maintained on the same brand where possible. If a need to switch arises (eg during supply problems), appropriate patient counselling should occur as there are device differences.
    • Used for prophylactic use and treatment of DVT and PE.
    • For unstable angina - see fondaparinux.
    • SFH: Dosing table and links to guidelines
    • NUH: Dosing guidelines
    02.01.02 Enoximone Perfan® Injection.
  • Secondary Care only. Specialist use for severe heart failure.
  • SFH: Will be in use until stock depleted, after which milrinone will be preferred PDE3 inhibitor. Injection contains propylene glycol and so less ideal for use in neonates.
  • A2.02.02.03 Ensure® Compact 
  • Available in vanilla, café latte, banana and strawberry flavours in 125ml bottles
  • On dietician advice only in secondary care. Not stocked at SFH.
  • A2.02.01.02 Ensure® Plus Juce 
    • Not stocked at SFH
    • Available in apple, fruit punch, lemon & lime, orange, peach and strawberry flavours
    A2.02.01.01 Ensure® Plus Milkshake style 
    • Available flavours are banana, chocolate, coffee, fruits of the forest, neutral, orange, peach, raspberry, strawberry and vanilla.
    • On dietician recommendation only in secondary care. Not stocked at SFH
    A2.02.01 Ensure® Shake 
  • Available flavours are banana, chocolate, strawberry and vanilla.
  • On dietitian recommendation only in secondary care. Not stocked at SFH
  • A2.02.02 Ensure® Plus Fibre 
  • On dietitian recommendation only in secondary care. Not stocked at SFH
  • Available flavours are banana, chocolate, raspberry, strawberry and vanilla.
  • A2.02.01.01 Ensure® Plus Yoghurt style 
    • Available flavours are Strawberry swirl and Orchard peach.
    • On dietician recommendation only in secondary care. Not stocked at SFH
    04.09.01 Entacapone  Tablet
  • Specialist initiation only
  • 05.03.03.01 Entecavir 

    Tablet-NUH only
    Use in accordance with NICE guidance (TA153 & CG165)

    15.01.02 Entonox®  50% nitrous oxide, 50% oxygen
  • Use by community midwives, ambulance crews etc, therefore Green traffic lighted
  • SFH: available to borrow from Ward 31 or 32 if needed.
  • 08.02.02 Envarsus® 

    Tablets MR (Prescribe by brand)
    ONCE DAILY TACROLIMUS

    • NUH: Restricted for adult renal transplant patients (part of first line immunosuppresion regimen) who are unable to use Adoport®, Advagraf®, Prograf®, or Modigraf® due to persistent tremor or other neurological disturbances, that do not resolve with dose modification.
      N.B. Brand prescribe - bioavailability differs to other brands

    Available through homecare for NUH patients. Please contact pharmacy medicines homecare team for further information

    08.03.04.02 Enzalutamide Xtandi® Capsule
  • Approved in line with NICE TA377 for treating metastatic, hormone-relapsed prostate cancer before chemotherapy is indicated.
  • Enzalutamide is routinely commissioned for metastatic hormone-relapsed prostate cancer previously treated with a docetaxel-containing regimen in accordance with NICE TA316.
  • NB: The use of enzalutamide for treating metastatic hormone-relapsed prostate cancer previously treated with abiraterone is not covered by this guidance.
  • Enzalutamide requires National Cancer Drugs Fund approval (until April 2016) for the treatment of chemotherapy naïve castrate-resistant Metastatic Prostate Cancer. Confirm funding is approved on BlueTeq for all new CDF starters.
  • NUH: For more about CDF approved indications, including criteria, see the DTC website; available here
  • SFH: For all new starters contact the oncology pharmacy team (3156) or the HCD Team (4660) to confirm whether CDF approval is required or not.
  • 02.07.02 Ephedrine  Injection (secondary care only)
  • 25p for 30mg
  • 12.02.02 Ephedrine 

    Nasal drops 0.5%
    Nasal drops 1%

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

    • May be prescribed if appropriate to in-patients; patients should be advised on discharge that further supply should be purchased
    08.01.02 Epirubicin  Injection
    02.02.03 Eplerenone  Tablet
  • Second line agent if spironolactone is not tolerated for use within the licensed indication of stable post MI patients with left ventricular dysfunction and clinical evidence of heart failure in line with NICE guidance. Classified Amber 2.
  • Second line aldosterone antagonist if spironolactone is not tolerated for NYHA class II heart failure. Classified amber 2.
  • See Nottinghamshire heart failure lights for more information on hyperkalaemia and dosing.
  • Tablets may be crushed and dispersed in water or mixed in apple sauce. See here for general advice on dispersing tablets.
  • 09.01.03 Epoetin alfa Eprex®

    Injection

    • Approved in line with NICE TA323 for treating anaemia in people with cancer having chemotherapy. Also used within haematology and renal.
    • If prescribing on the ward, confirm dialysis patients are not already receiving it from the dialysis unit.
    • Available through homecare for NUH patients. Please contact pharmacy medicines homecare team for further information
    09.01.03 Epoetin beta NeoRecormon® Injection
  • Approved in line with NICE TA323 for treating anaemia in people with cancer having chemotherapy. Also used within haematology and renal.
  • 02.08.01 Epoprostenol Flolan® Infusion (secondary care only)
  • At SFH restricted to ICCU haemofiltration patients only.
  • Product has been reformulated. Carefully read reconstitution and administration instructions.
  • 02.09 Eptifibatide Integrilin® Injection (secondary care only)
    09.06.04 Ergocalciferol 

    Injection (300,000 units or 600,000 units)

    07.01.01 Ergometrine Maleate  Injection- secondary care only
    07.01.01 Ergometrine Maleate and Oxytocin Syntometrine® Injection- secondary care only
    08.01.05 Eribulin Halaven®

    Injection

    • Approved in accordance with NICE TA423 for treating locally advanced or metastatic breast cancer after two or more chemotherapy regimens
    • Not recommended for treating locally advanced or metastatic breast cancer after one chemotherapy regimen (in accordance with NICE TA515)
    08.01.05 Erlotinib Tarceva® Tablets
  • Approved in accordance with NICE guideline documented below.
  • 05.01.02.02 Ertapenem Invanz® Infusion
  • Restricted antibiotic: see local guidelines
  • 06.01.02.03 Ertugliflozin Steglatro®

     

    Tablets

    Notes on licensing:

    • Licensed for initiation in patients > 18 years. Limited experience in patients > 75 years.
    • Renal impairment (eGFR or CrCl, SPC): 60-89ml/min – no dose adjustment;
      <60ml/min – do not initiate ertugliflozin; <45ml/min- discontinue if eGFR or CrCl is persistently below 45ml/min.
    • Due to its mechanism of action, patients taking canagliflozin will test positive for glucose in their urine and are at increased risk of urinary tract infection.
    05.01.05 Erythromycin  Tablet, Oral suspension (125mg or 250mg in 5ml), Injection Restricted
  • Clarithromycin preferred for most patients
  • Injection is a restricted antibiotic: see local guidelines [SFH guideline][NUH guideline]
  • Prokinetic erythromycin should only be used in critically ill patients when other treatments have failed due to risk of resistance - UKMI Q&A dose advice
  • 11.03.01 Erythromycin  Eye ointment 0.5%
  • Imported (Unlicensed Product)
  • Specialist use only
  • For chlamydia, but see also azithromycin which is licensed and more easily available (or ofloxacin).
  • 13.06.02 Erythromycin  Tablets
  • See chapter 5.1.5 for more detailed information on macrolide antibiotics
  • Erythromycin is a suitable alternative to tetracyclines if they are contraindicated (for example in pregnancy). The dose is usually 500 mg twice a day
  • Alternative to first and second line choices for the treatment of acne in the event of agent failure or intolerance (see previous bullet point)
  • 13.06.01 Erythromycin 40mg with Zinc Acetate 12mg/mL Zineryt® Topical Solution (powder for reconstitution)
  • Not first line option
  • 04.03.03 Escitalopram 
    • Escitalopram (the active isomer of citalopram) may be considered as third-line option in resistant depression/anxiety disorders only
    04.08.01 Eslicarbazepine 

    Tablet and oral suspension

    • Specialist initiation. Patients should be stablised prior to transfer to primary care.
    • Oral suspension available for those unable to swallow tablets
    02.04 Esmolol  Injection (secondary care only)
    01.03.05 Esomeprazole  Capsules
    Tablets
  • Restricted use for Gastro specialists (severe grade III, IV oesophagitis only) when omeprazole and lansoprazole have been tried and failed.
  • Amber 2: Approved only for an 8 week course for severe oesophagitis
  • 10.01.03 Etanercept Enbrel®

    Injection

    • Restricted for adult rheumatology consultants only in line with NICE guidance
    • In accordance with NICE TA373 and NHS England clinical commissioning policy for the treatment of juvenile idiopathic arthritis in people 2 years and older.
    • Approved in accordance with NICE TA383 for ankylosing spondylitis and non-radiographic axial spondyloarthritis
    • Approved in accordance with NICE TA375 for the treatment of adults with severe rheumatoid arthritis.
    • Erelzi®, Benepali® and Enbrel® should not be used interchangeably. Ensure all prescriptions and communications specify brand.
    • Available through homecare for NUH patients. Please contact pharmacy medicines homecare team for further information
    10.01.03 Etanercept Benepali®

    Injection

    • Erelzi®, Benepali® and Enbrel® should not be used interchangeably. Ensure all prescriptions and communications specify brand.

    Nottingham NHS Treatment Centre only:

    • Restricted for adult rheumatology consultants, for the treatment of rheumatoid arthritis, psoriatic arthritis, axial spondylitis and plaque psoriasis, only in line with NICE guidance.
    • In accordance with NICE TA375 for the treatment of adults with severe rheumatoid arthritis.
    • Erelzi®, Benepali® and Enbrel® should not be used interchangeably. Ensure all prescriptions and communications specify brand.

    NUH Only (unlicensed indications):

    • Tumor necrosis factor receptor-1 associated periodic syndrome (TRAPS)
    • Graft versus Host Disease (GVHD), clinical haematology
    10.01.03 Etanercept Erelzi® Injection
    SFH only:
  • Restricted for adult rheumatology consultants, for the treatment of rheumatoid arthritis, psoriatic arthritis, axial spondylitis and plaque psoriasis, only in line with NICE guidance.
  • In accordance with NICE TA375 for the treatment of adults with severe rheumatoid arthritis.
  • Erelzi®, Benepali® and Enbrel® should not be used interchangeably. Ensure all prescriptions and communications specify brand.
  • 13.05.03 Etanercept Enbrel® Injection
    NUH:
  • Approved in line with NICE TA103 for the treatment of adults with psoriasis
  • Approved in line with NICE TA455 for treating plaque psoriasis in children and young people
    SFH: Restricted for dermatology in line with NICE guidance. For patients not covered by NICE guidance, approval must be sought from the budget holder before initiation.
  • 09.05.01.02 Etelcalcetide Parsabiv® Injection
    NUH Approved in accordance with NICE TA448 for treating secondary hyperparathyroidism.
    05.01.09 Ethambutol   Tablet
  • Tablets disperse in water if needed. See here for general advice on dispersing tablets.
  • See local guidelines. [SFH guideline][NUH guideline]
  • 18 Ethanol (alcohol) injection  Injection (unlicensed)
  • Used in the treatment of antifreeze (ethylene glycol) or methanol poisoning
  • Discussion with National Poisons Information Service recommended.
    At SFH:
  • IV ethanol 90%, 20mL vial, kept in A&E, supplied by pharmacy.
  • Vodka 37.5%, supplied from RDC.
    At NUH:
  • injection 5ml kept in A&E and emergency cupboards both sites.
  • 02.13 Ethanolamine Oleate  Injection
    NUH only
    09.02.02.02 Etherified Starch  Infusion
  • Hetastarch 6% in 0.9% sodium chloride 500ml
  • NUH only
  • 06.04.01.01 Ethinylestradiol  Tablet 10mcg
    Tablet 2mcg for paediatric use - named patient use
    07.03.01 Ethinylestradiol / levonorgestrel phased pill 

    Phasic standard strength (21 day preparation)

    • Preferred brand in primary care is TriRegol® which is more cost effective than Logynon®.
    07.03.01 Ethinylestradiol 20 mcg / drospirenone 3 mg   Monophasic low strength (21 day preparation)
    •3rd/4th line agent for women who are intolerant to other progestogens
    •For advice on the most cost-effective brand contact your local Medicines Management team.
    07.03.01 Ethinylestradiol 20 mcg / gestodene 75 mcg 

    Monophasic low strength (21 day preparation)

    • Millinette 20/75® is the preferred brand in primary care.
    • Other less cost effective brands include Femodette® and Sunya 20/75®.
    07.03.01 Ethinylestradiol 20 mcg / norethisterone 1mg 
    • Monophasic low strength (21 day preperation)
    • For advice on the most cost-effective brand contact your local Medicines Management team.
    07.03.01 Ethinylestradiol 20mcg / desogestrel 150mcg 

    Monophasic low strength (21 day preparation)

    • Preferred brand in primary care is Gedarel 20/150® which is more cost effective than Mercilon®.
    07.03.01 Ethinylestradiol 30 mcg / drospirenone 3 mg 

    Monophasic standard strength (21 day preparation)

    • 3rd/4th line agent for women who are intolerant to other progestogens
    • Preferred brands in primary care are Dretine® or Lucette® which are more cost effective than Yasmin®.
    07.03.01 Ethinylestradiol 30mcg / desogestrel 150mcg 

    Monophasic standard strength (21 day preparation)

    • Preferred brand in primary care is Gedarel 30/150® which is more cost effective than Marvelon®.
    07.03.01 Ethinylestradiol 30mcg / gestodene 75 mcg 

    Monophasic standard strength (21 day preparation)

    • Millinette 30/75® is the preferred brand in primary care.
    • Other less cost effective brands include Femodene® and Katya 30/75®.
    07.03.01 Ethinylestradiol 30mcg / levonorgestrel 150mcg 

    Monophasic standard strength combined oral contraceptive (21 day preparation)

    • Preferred brands in primary care are Rigevidon® or Levest®
    • Other less cost effective brands include Microgynon®, Ovranette® and Elevin®.

     

    07.03.01 Ethinylestradiol 35 mcg / noresthisterone 1mg 

    Monophasic standard strength (21 day preparation)

    • For advice on the most cost-effective brand contact your local Medicines Management team. 
    07.03.01 Ethinylestradiol 35 mcg / noresthisterone 500mcg 

    Monophasic standard strength (21 day preparation)

    • For advice on the most cost-effective brand contact your local Medicines Management team
    07.03.01 Ethinylestradiol 35 mcg / norgestimate 250 mcg 

    Monophasic standard strength (21 day preparation)

    • Cilique® is the preferred brand in primary care.
    • Other less cost effective brands include Cilest® and Lizinna®.
    07.03.01 Ethinylestradiol/ etonogestrel Vaginal Delivery System SyreniRing®

    Vaginal Ring

    • Third line after oral contraceptive pills and the contraceptive patch for women who require a non oral method (malabsorption, vomiting, unable to swallow tablets) and require a combined hormonal method of contraception, unless the woman has significant eczema, psoriasis or skin allergy.
    • SyreniRing® may be considered for women unable to find an oral preparation that suits them, particularly if there are issues with cycle control- however other causes of abnormal vaginal bleeding (infection, pregnancy, intrauterine anomaly) should be excluded before starting the vaginal ring.
    • SyreniRing® is significantly more expensive than other methods of combined hormonal contraception (combined pill / patch) and thus is not regarded as suitable for first line use.
    07.03.01 Ethinylestradiol/ etonogestrel Vaginal Delivery System NuvaRing® Vaginal Ring
  • Third line after oral contraceptive pills and the contraceptive patch for women who require a non oral method (malabsorption, vomiting, unable to swallow tablets) and require a combined hormonal method of contraception, unless the woman has significant eczema, psoriasis or skin allergy.
  • Nuvaring® may be considered for women unable to find an oral preparation that suits them, particularly if there are issues with cycle control- however other causes of abnormal vaginal bleeding (infection, pregnancy, intrauterine anomaly) should be excluded before starting the vaginal ring.
  • Nuvaring® is significantly more expensive than other methods of combined hormonal contraception (combined pill / patch) and thus is not regarded as suitable for first line use.
  • 07.03.01 Ethinylestradiol/ norelgestromin patch Evra® Evra®
  • May be of value in women who are poor compliers with oral contraceptives.
  • 08.03.01 Ethinylestradol  See section 06.04.01.01 for HRT uses
    20 ETHIONAMIDE Tablets 250 mg  Unlicensed medicine - named patient use only
    NUH only
    04.08.01 Ethosuximide 
    • Capsule, syrup
    • Absence seizures
    15.02 Ethyl Chloride Cryogesic® Spray Spray
    Restricted for use in well ventilated areas
    March 2017 1000% price rise
    SFH: For testing epidural block height in adults use Deep Freeze® Spray
    15.01.01 Etomidate Etomidate-Lipuro® Injection (Emulsion)
    07.03.02.02 Etonogestrel  Nexplanon® - implant
  • Nexplanon training is required as the insertion device is different to implanon. Prescribers must be re-accredited.
  • £72 each
  • 08.01.04 Etoposide  Infusion, capsules
  • At SFH, injection is packed into bottles by SPU for patients with swallowing difficulties or doses that could not be made by strengths of capsules available.
  • 05.03.01 Etravirine Intelence®

    Tablet

    • Restricted to ID / GU Medicine advice only
    • Available through homecare for NUH patients. Please contact pharmacy medicines homecare team for further information
    13.02.01 Eucerin®Intensive urea 10%

    Lotion

    • Cream = non-formulary
    • Greasy level 1/4 (least greasy)
    • Third line after imuDERM® and Hydromol Intensive®, in line with the Emollient Formulary.
    18 European Viper Venom Antivenom  Vial (for intravenous infusion)
  • Vipera berus (European adder) envenomation
  • Stocked at NUH and KMH A&E (fridge item)
  • The UK Department of Health now supplies (from April 2014) the viper antivenom (antiserum) product ViperaTAb® - for human use only. This product is unlicensed in the UK.
  • 08.01.05 Everolimus Votubia®

    Tablets 2.5mg, 5mg, 10mg

    Available at NUH only:

    • Approved for the treatment of subependymal giant cell astrocytoma (SEGA) associated with tuberous sclerosis complex (TSC) in line with NHS England commissioning policy.
      Blueteq submission required
    • Approved in line with NHSE Commissioning Policy for refactory focal onset seizures associated with tuberous sclerosis complex (ages 2 years and above)

     

    Available through Homecare for NUH patients. Please contact pharmacy medicines homecare team for further information.

    08.01.05 Everolimus Afinitor®

    Tablets 2.5mg, 5mg, 10mg

    • Approved in accordance with NICE TA421; Everolimus with exemestane for treating advanced breast cancer after endocrine therapy.
    • NUH approved in accordance with NICE TA432; Everolimus for advanced renal cell carcinoma after previous treatment.
    • NUH approved in accordance with NICE TA449 for treating unresectable or metastatic neuroendocrine tumours in people with progressive disease
    • NUH approved in accordance with NICE TA498; Everolimus with lenvatinib (Kisplyx®) for previously treated advanced renal cell carcinoma
    20 EVEROLIMUS Tablets 250 micrograms,750 micrograms  Unlicensed medicine - named patient use only
    NUH only
    02.12 Evolocumab Repatha®

    Injection (pre-filled pen, pre-filled syringe)

    • Approved in line with NICE TA394 for treating primary non-familial hypercholesterolaemia and mixed dyslipidaemia and primary heterozygous familial hypercholesterolaemia. For prescribing by consultant lipidologists only.
    • Use for homozygous familial hypercholesterolaemia is commissioned by NHS England only through established apheresis centres. Any request for treatment in this circumstance would need to be referred to one of the following: Central Manchester University Hospitals NHS Foundation Trust; Queen Elizabeth Hospital Birmingham; Royal Brompton and Harefield NHS Foundation Trust; Imperial College NHS Trust and University Hospitals Bristol NHS Foundation Trust.
    • Available through homecare for NUH and SFH patients.  Please contact pharmacy medicines homecare team for further information.
    08.03.04.01 Exemestane  Tablet
  • Restricted to consultant recommendation only
  • Amber 2 for breast cancer after specialist recommendation
  • No liquid version, but tablets dissolve in about 30minutes. Ideally do not crush first. This should be avoided by women of child bearing potential and preferably be done in a closed system. [More Info].
  • 06.01.02.03 Exenatide Byetta®

    Injection

    06.01.02.03 Exenatide prolonged release Bydureon®

    Vial, Pen

    13.02.01 ExoCream® 

    Cream

    • Greasy level 2/4
    02.12 Ezetimibe Ezetrol® Tablet
  • Overused drug. See quick guide.
  • Note: not licensed or evidenced for prevention of CV events.
  • Combined preparation with simvastatin (Inegy®) non-formulary (£11 per month more expensive than single constituents)
  • Tablets disperse in water if needed. See here for general advice on dispersing tablets.
  • 02.11 Factor Eight Inhibitor Bypassing Fraction Feiba®

    Non pharmacy item, please contact blood bank for details and availability

     

    Available through homecare for NUH patients. Please contact pharmacy medicines homecare team for further information

    02.11 Factor VIIa (Recombinant), Eptacog alfa NovoSeven®

    Non pharmacy item please contact blood bank for details and availability.

    • At SFH, one dose is stocked in blood bank. In the event of further doses being required (consultant haematologist request only), contact pharmacy (or on call pharmacist out of hours). See memo for further details.
    • Available through homecare for NUH patients. Please contact pharmacy medicines homecare team for further information
    02.11 Factor VIII NovoEight®

    Non pharmacy item, please contact blood bank for details and availability

     

    Available through homecare for NUH patients. Please contact pharmacy medicines homecare team for further information

    02.11 Factor VIII - Von willebrand factor Type 8Y®

    Non pharmacy item, please contact blood bank for details and availability

    02.11 Factor VIII - Von willebrand factor Wilate®

    Non pharmacy item, please contact blood bank for details and availability

    02.11 Factor VIII + von Willebrand factor Voncento®

    Factor VIII, von willebrand factor - NUH only

    Non pharmacy item please contact blood bank for details and availability

    Available through homecare for NUH patients. Please contact pharmacy medicines homecare team for further information

    05.03.02.01 Famciclovir  Tablets
  • On GUM advice as a 2nd line agent to aciclovir in aciclovir resistant cases of genital herpes.
  • 07.04.04 Farco-Fill® Protect 
    10.01.04 Febuxostat Adenuric® Tablets
  • For use only in line with NICE guidance for patients intolerant of allopurinol (due to adverse effects sufficient to warrant discontinuation, or to prevent full dose escalation for optimal effectiveness) or for whom allopurinol is contraindicated.
  • 02.12 Fenofibrate  Micro Capsule
  • Supralip 160mg is equivalent to 200mg of the other micronised brands.
  • 04.07.02 Fentanyl 

    Patch

    • For patients with swallowing difficulties on stable doses of opiates or on pain team specialist advice when morphine isn't suitable.
    • For chronic non-cancer pain, doses greater than 50 micrograms / hour by specialist recommendation or advice only. See Opioids for persistent non-cancer pain - APC guidelines.
    • Relatively expensive compared to Zomorph®
    • Same side effect profile as morphine, but there is a small chance patients may tolerate one better than the other (but this is likely to be due to giving a relatively smaller dose.)
    • May have a slightly lower constipation effect compared to morphine. See Notts APC laxative guideline (appendix 2).
    • When prescribed specifically as "Matrifen®" or "Mezolar®" in primary care and on hospital outpatient prescriptions, it is significantly cheaper than Durogesic.
    • Fentanyl patch QIPP detail aid and supporting info.
    • For information regarding the safety of cutting fentanyl patches please see the NUH guideline for the management of sedation and analgesia withdrawal.
    • For practical information on changing to and from fentanyl patches see Palliative Adult Network Guidelines on the SFH intranet.
    15.01.04.03 Fentanyl 

    Injection: 100micrograms in 2mL, 500micrograms in 10mL

    Available at NUH only:

    • Red 10micrograms/mL (Unlicensed) for NNU use only for intubation.
    04.07.02 Fentanyl Nasal Spray PecFent®

    Nasal spray:
    - 100 micrograms / spray (~£43 per 8 sprays)
    - 400 micrograms / spray (~£43 per 8 sprays)

    • Restriction: Specialist initiation only for the management of breakthrough pain in adult patients using opioid therapy for chronic cancer pain, when other short-acting opioids are unsuitable
    • Grey Non-formulary for use in non-cancer related pain.
    • On the Nottinghamshire list of Medicines & Appliances of Limited Clinical Value.
    04.07.02 Fentanyl sublingual tablets Abstral®

    Sublingual tablets. £5 each tablet.

    • Restriction: Specialist initiation only for the management of breakthrough pain in adult patients using opioid therapy for chronic cancer pain, when other short-acting opioids are unsuitable
    • Grey Non-formulary for use in non-cancer related pain.
    • On the Nottinghamshire list of Medicines & Appliances of Limited Clinical Value.
    09.01.01.02 Ferric Carboxymaltose Ferinject®
    • NUH only - Approved for use in Obstetrics and Haematology daycase. Local guidelines and audit plans being developed. Also approved for use by renal directorate in Chronic Kidney Disease.
    • SFH: Not available except when intolerant to other options. Discuss with Medicines Information 3163.
    • IV only
    • Cost: 1000mg ~ £200 (twice the price of Cosmofer)
    09.01.01.01 Ferric maltol Ferracru®

    Capsule

    • Specialist initiation for IBD patients in line with ferric maltol treatment algorithm.
    • Primary care should only be requested to prescribe if improvements in FBC/ ferritin are seen after 1 month of treatment.
    • Use in other patients with anaemia is Grey (no formal assessment).
    20 FERRIC SUBSULPHATE (monsel's soln)  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.
  • 09.01.01.01 Ferrous Fumarate  Tablets
    Syrup
  • Tablets available as 210mg = 68mg iron
  • Liquid available (Ferrous fumarate 140mg/5ml syrup, contains 45mg iron in 5ml). 10mls twice daily is the licensed therapeutic dose. However 7.5ml (210mg) three times daily can also be given.
  • 09.01.01.01 Ferrous Gluconate  Tablet
  • 300mg tablet = 35mg of iron. Only use if intolerent of other iron salts (but often no better)
  • 09.01.01.01 Ferrous Sulfate 

    Tablet

    • 200mg tablets= 65mg iron
    07.04.02 Fesoterodine Toviaz®

    Tablet

    03.04.01 Fexofenadine 
    • 180mg tablet available for chronic idiopathic urticaria in adults.
    • 120mg tablet available as a 3rd line agent after cetirizine/ loratadine for allergic rhinitis.
    • OTC Patients should be advised to purchase a suitable product over the counter first line

    20 Fibrin Sealant Evicel® Evicel Kit
    NUH only
    20 Fibrin Sealant Tisseel® Ready to use syringe
    NUH only
    05.01.07 Fidaxomicin Dificlir® Tablets
  • Microbiologist recommendation only for the treatment of recurrent clostridium difficile as per antimicrobial guidelines.
  • Low anticipated numbers per year in primary care (<5)
  • Very expensive (10 day course approx £1350)
  • Fidaxomicin is licensed in UK and available via standard wholesalers, but is unlikely to be stocked in community pharmacies. Supplies may be obtained from hospital pharmacy departments if undue delay in initiation is anticipated
  • 09.01.06 Filgrastim Nivestim® Injection
  • First choice GCSF
  • At SFH do NOT send patients to retail pharmacies for supplies
  • 09.01.06 Filgrastim Neupogen® Injection prefilled syringe
    Injection vial
  • NUH only
  • NUH: Restricted to Paediatric Oncology and in clinical trials in adult oncology/haematology if required
  • 06.04.02 Finasteride  Tablet
  • For use in Benign prostatic hyperplasia only (Amber 3) in line with guideline.
  • If needed tablets can be dispersed in water, but this should be done in a closed system- put the tablet in an oral syringe and suck up some water to dissolve it. More Info on crushing tablets.
  • 08.02.04 Fingolimod 

    Capsules- NUH only

    • Approved for use in line with NICE TA254
    • Available through homecare for NUH patients. Please contact pharmacy medicines homecare team for further information
    A5.03.04 Flaminal® Forte Gel 

    On specialist advice only. Wards to order from Pharmacy for each individual patient.

    • For moderate-heavy exudate.
    • Available as 15g
    • 500g also available at NUH
    A5.03.04 Flaminal® Hydro Gel  

    On specialist advice only. Wards to order from Pharmacy for each individual patient.

    • For low-medium exudate.
    • Available as 15g
    • 500g also available at NUH
    02.03.02 Flecainide 

    Tablet, Injection (secondary care only)

    Tablets disperse in de-ionised water if needed. See here for more information. NB: Crushed tablets have a local anaesthetic effect-use with care in patients with swallowing difficulties.

    • NUH:  Flecainide acetate 25mg/5mL oral solution available for patients under the care of paediatric cardiology. (NB: Rosemont brand NOT suitable for neonates)
    01.06.05 Fleet Phospho-soda®  NUH use only
    Oral solution
  • Traffic light classification= green when used pre-procedure.
  • 13.02.01 Flexitol 25% Urea Heel Balm® 

    Balm 

    • Second line to Dermatonics Heel Balm®, indicated for use on soles of feet and heels only.
    • In line with the Emollient Formulary.
    13.04 Flucinolone 0.025% Synalar®

    Cream, Ointment, Gel

    • Potent
    05.01.01.02 Flucloxacillin  Capsules, injection, oral solution.
  • Oral solution - expensive (Nov 16: 125mg/5ml: £26 for 100ml SF, £2.50 for sugared. 250mg/5ml: £26 for 100ml). See unexpectedly expensive medicines list.
  • CSM has advised that cholestatic jaundice may occur up to several weeks after treatment with Flucloxacillin has been stopped. Administration for more than 2 weeks and increasing age are risk factors. LFT’s should be monitored where prolonged therapy is used.
  • NUH OPAT service:Red Traffic Light  24 hour infusions via a continuous infusion pump device. Unlicensed compounded medicine - named patient use only.
  • See local guidelines. [SFH guideline][NUH guideline]
  • 05.02 Fluconazole  Capsule (50mg, 150mg, 200mg), Oral suspension (expensive), Infusion.
  • NUH: infusion restricted - see trust guidelines
  • See link for interactions of fluconazole.
  • 07.02.02 Fluconazole 
  • See section 5.2
  • 150mg stat dose orally - N.B. contraindicated in pregnancy or breastfeeding
  • see local guidelines
  • 05.02 Flucytosine Ancotil® NUH only
    Infusion, Tablets 500mg (Unlicensed medicine - named patient use only)
  • Restricted for proven systemic yeast infections. Discuss with microbiologist - Serum assays required to minimise toxicity.
  • 08.01.03 Fludarabine Phosphate Fludara® Tablet, Injection
    06.03.01 Fludrocortisone 

    Tablet

    • Tablets disperse in water if needed. See here for general advice on dispersing tablets.
    • Flush well if giving via enteral tube.
    • Florinef® brand discontinued April 2016, but still available generically (£30 for 30 tablets).
    • For postural hypotension and mineralocorticoid replacement.
    13.04 Fludroxycortide  

    Cream 0.0125% - Moderate potency
    Tape 7.5cm x 20cm, 4micrograms per cm2

    • Tape - for chronic localised recalcitrant dermatoses (but not acute or weeping)
    15.01.07 Flumazenil  Injection
  • See poisoning section for further information
  • 18 Flumazenil  Injection
  • Reversal of benzodiazepine effects
  • Discussion with National Poisons Information Service recommended if using for poisoned patient or in cases of severe persistent hypotension
  • Rarely required in benzodiazepine overdose
  • Not to be used in mixed overdose or as a diagnostic test (see toxbase advice)
  • Also see section 15.1.7
  • NUH: kept in anaphylaxis and oversedation boxes as per memo
  • 12.01.01 Flumetasone 0.02% with Clioquinol 1% 

    Drops

    • July 2018 - Supply problem
    • Previously branded as Locorten-Vioform®
    • Mentioned in the Nottinghamshire Primary Care antimicrobial guidelines for otitis externa.
    • The second line options are not in a particular order and the supply and cost may vary over time.
    • £14 per bottle
    20 FLUNARIZINE 5mg capsules  Unlicensed medicine - named patient use only
    NUH only
    13.04 fluocinolone 0.025% with clioquinol 3% Synalar C®

    Cream, Ointment

    • Potent
    • NUH only: During the supply problem (2015) with Trimovate® cream, Synalar® C cream is approved for management of infections in the ear canal where treatment is administered using a wick within ENT outpatients.
    11.04.01 Fluocinolone intravitreal implant Iluvien® Intravitreal Implant 190 micrograms
  • Available for use in line with NICE for Chronic diabetic macular oedema (DMO) NICE TA301
  • NUH prescribing will be undertaken within the ophthalmology department and will be a two consultant decision.
  • SFH prescribing will be at the discretion of the ophthalmology consultant.
  • 13.04 Fluocinonide 0.05% Metosyn® FAPG Cream, Ointment
  • Potent
  • 11.08.02 Fluorescein Anatera® Specialist use only
    Injection 10%:
    - for fluorescein angiography of the ocular fundus
    - for use as a contrast media for confocal laser endomicroscopy (CLE)(Unlicensed indication)
    Injection 20% (Unlicensed Product)
    11.08.02 Fluorescein Sodium  Eye drops 2% (preservative free Minims®)
  • Diagnostic use only
  • Bio Glo 1mg ophthalmic strips have been discontinued

  • 09.05.03 Fluoride 
  • Not routinely stocked in secondary care.
  • Restricted to patients undergoing radiotherapy to head and neck region and who are not registered with a dentist.
  • It is recommended that initiation and ongoing prescribing of high fluoride toothpaste should only be carried out by a dentist.
  • Patients should be encouraged and reminded to register with a dentist as they need a specialist to manage their oral health.
  • See Dental Practitioners Formulary in the BNF for medicines available on prescription
  • See Department of Health guidance for national recommendations.
  • 11.04.01 Fluorometholone FML® Eye drops
    08.01.03 Fluorouracil  Capsule, Injection
    11.99.99.99 Fluorouracil  At NUH: Subconjunctival injection 7.5mg in 0.3mL
  • Specialist use only
  • Manufactured by Pharmacy Sterile Production Unit (Unlicensed Product)
    At SFH: Subconjunctival injection 7.5mg in 0.3mL (Prescribed when 5mg/ 0.2ml is required) or 50mg/1ml prepared by Aseptic dispensing unit (x3169)
  • 13.08.01 Fluorouracil Efudix® Cream 5%
  • For the treatment of actinic keratosis when prescribed in line with the Notts APC Solar Keratosis pathway
  • 04.03.03 Fluoxetine 

    Capsule, dispersible tablets, liquid

    • Long half-life- caution when making dose adjustments and switching to other antidepressants
    • Note drug interactions.
    • 20mg dispersible tablets (Olena® brand) can be halved to give 10mg doses if required
    04.02.01 Flupentixol Depixol® Tablet
  • To be initiated on specialist advice only.
  • Tablets disperse in water if needed. See here for general advice on dispersing tablets.
  • 04.02.02 Flupentixol Decanoate Depixol® Depot injection
  • 200mg/ml low volume injection is more expensive so reserve for higher dose prescriptions (>250mg)
  • 04.02.02 Fluphenazine Decanoate 

    Depot injection

    • Grey Traffic Light  For new patients where treatment duration likely to extend beyond 2018.
    • June 2019 - Supply now stable - overlabelled packs imported from Germany (through Mawdsleys)
    10.01.01 Flurbiprofen 

    Tablet 50mg

    • May be used rarely by NUH ophthalmology consultants for ophthalmic scleritis if usual NSAIDs fail.
    • Costs £54pm for 100mg tds (Other NSAID costs here).
    08.03.04.02 Flutamide  Tablet
  • Amber 2 for advanced prostate cancer
  • 12.02.01 Fluticasone furoate Avamys®

    Nasal Spray 27.5 micrograms per spray

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

    03.02 Fluticasone furoate & vilanterol Relvar Ellipta®

    Dry powder inhaler 92/22 strength only (184/22 is not licensed or indicated for COPD)

    03.02 Fluticasone furoate, umeclidinium & vilanterol inhaler Trelegy Elipta ®

    Dry Powder inhaler

    • Respiratory specialist* initiation only. (APC July18)
    • Restricted use for patients who have received a face to face assessment and review of current therapy by a respiratory specialist* and triple therapy deemed to be appropriate.

    *A respiratory specialist, in this instance, is defined as a doctor or nurse working in a specialist respiratory team or a GP with a special respiratory interest (GPSI).

    03.02 Fluticasone propionate Flixotide® Evohaler (50, 125 and 250 micrograms per dose), Accuhaler (50, 100, 250 and 500 micrograms per dose) and Nebules (250 per 1mL and 1mg per 1mL).
  • SFH: Nebules only to be initiated by Dr Ward, Dr Ali or Dr Noble.
  • Not recommended first line in local asthma or COPD guidance
  • 12.02.01 Fluticasone Propionate 

    Nasal spray 50micrograms per spray

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

    • May be prescribed if appropriate to in-patients; patients should be advised on discharge that further supply should be purchased
    12.02.01 Fluticasone Propionate Flixonase Nasule®
  • Patient should be reviewed as soon as possible and switched to a nasal spray for maintenance therapy
  • 13.04 Fluticasone Propionate Cutivate® Cream 0.05%, Ointment 0.005%
  • Potent
  • 03.02 Fluticasone propionate and formoterol Flutiform® Metered Dose Inhaler (50, 125 and 250 microgram per dose)
  • Cheaper than higher doses of Seretide MDI but only licensed for asthma. Fostair more cost effective at lower steroid doses.
  • Consider for NEW patients requiring a combination inhaler or those patients having a review regarding step down/up.
  • See asthma guidance
  • 03.02 Fluticasone propionate and salmeterol 
    • NEW initiation of fluticasone/salmeterol is not recommended-See asthma guidance and COPD guidance for recommended options.
    • Brands available include: Sereflo®, Sirdupla®, Seretide®, AirFluSal®, Fusacomb Easyhaler®, etc
    • Contact your Medicines Management teams for advice on most cost effective brand.
    20 Flutter Device
  • For use by respiratory physiotherapists
  • Oscillating positive expiratory pressure device for mucous clearance
  • 09.01.02 Folic Acid  Tablet
    Syrup
    Injection - unlicensed special, named patient
  • Tablets disperse in water if needed. See here for general advice on dispersing tablets. Liquid available for paediatrics.
  • SFH: Rheumatology standard regime is: Methotrexate Friday, folic acid 5mg monday. If the patient develops methotrexate side-effects, folic acid is usually increased to 5mg daily, apart from the day of the methotrexate.
  • Recommendations on folic acid regimens for patients on methotrexate for rheumatological conditions can vary. See shared care protocol or consider contacting the patient's specialist for advice if required
  • 08.01 Folinic acid  Available as:
    - Tablet 15mg (£5 each)
    - Injection, 15mg in 2mL, 15mg in 5mL, 300mg in 30mL.
  • Also known as calcium folinate and calcium leucovorin.
  • For Methotrexate rescue or toxicity.
  • 18 Folinic acid  Methotrexate, methanol or formic acid overdose
  • See also section 8.1
  • Discussion with National Poisons Information Service recommended for methanol poisoning
  • Also known as calcium folinate and calcium leucovorin
  • 06.05.01 Follitropin Alfa  Gonal-F® Injection - ampoule and prefilled pen
  • Secondary care only as per approved guidelines
  • Also known as recombinant human follicle stimulating hormone)
  • Red - Treatment of infertility
    Ensure all prescriptions and communications specify brand
  • 06.05.01 Follitropin Alfa biosimilar Bemfola® Injection - pre-filled pen
  • NUH only as per approved guidelines
  • Also known as recombinant human follicle stimulating hormone
  • Red - Treatment of infertility
    Biosimilar - Ensure all prescriptions and communications specify brand.
  • 18 Fomepizole  Injection (unlicensed in UK)
  • See Toxbase and discuss with National Poisons Information Service to ensure appropriate use.
  • Costs around £5,000 per treatment course.
  • 02.08.01 Fondaparinux Arixtra® Injection
  • For patients with ACS/NSTEMI in line with guidelines below.
  • For use within its licensed indication for patients intolerant of heparin or heparinoids (due to HITT or allergy) or where it is inappropriate due to patient beliefs.
  • A2.02.01 Foodlink® Complete 
  • Available in Banana, Chocolate, Vanilla, Natural and Strawberry flavours
  • Starter pack available containing 1 of each flavour plus vanilla with added fibre and a shaker. NOT FOR REPEAT PRESCRIPTION
  • First line product for primary care. Should be made with 200mls of whole milk, can be made with 125mls of whole milk for patients that can only manage small volumes.
  • On dietician recommendation in secondary care- not stocked at SFH.
  • A2.02.01 Foodlink® Complete with Fibre 
  • Available in Vanilla, Banana, Chocolate, Natural and Strawberry flavours to be made with 200mls of whole milk
  • On dietician recommendation in secondary care- not stocked at SFH.
  • A2.02.02 Foodlink® Complete with Fibre   See Powdered ONS
    A5.08.07 Formflex Natural Lantor- sterile  Cannot be prescribed on FP10 (green) prescriptions. In secondary care should be ordered direct from RDC
  • Available as 5cmx2.7m, 7.5cmx2.7m, 10cmx2.7m, 15cmx2.7m and 20cmx2.7m (all double wrapped)
  • A5.08.07 Formflex Natural Lantour- non sterile  Cannot be prescribed on FP10 (green) prescriptions. In secondary care should be ordered direct from RDC
  • Available as 5cmx2.7m, 7.5cmx2.7m, 10cmx2.7m, 15cmx2.7m and 20cmx2.7m
  • 03.01.01.01 Formoterol  
  • Long-acting beta-agonist
  • Formoterol Easyhaler® preferred as more cost effective
  • 03.01.01.01 Formoterol Fumarate Atimos® Modulite MDI
  • For use in line with Nottinghamshire COPD guidance.
  • 03.02 Formoterol fumarate, beclometasone dipropionate and glycopyrronium bromide  

    MDI

    • Respiratory specialist* initiation only. (APC July18)
    • Restricted use for patients who have received a face to face assessment and review of current therapy by a respiratory specialist* and triple therapy deemed to be appropriate.

    *A respiratory specialist, in this instance, is defined as a doctor or nurse working in a specialist respiratory team or a GP with a special respiratory interest (GPSI).

    A2.02.02.01 Forticreme Complete® 
    • On dietician recommendation only
    • Available in forest fruit, vanilla, chocolate and banana flavours in 125g pots.
    • Also known as just 'Forticreme'
    A2.02.01.02 Fortijuce®  
  • Available in forest fruit, lemon, orange, apple, strawberry, blackcurrant and tropical flavours in 200ml bottles
  • Starter pack available containing 6 assorted flavours. NOT FOR REPEAT PRESCRIPTION.
  • A2.02.01.01 Fortini 
    • On Dietician recommendation only
    • Available in strawberry and vanilla flavours
    A2.02.01.01 Fortini compact multifibre 
    • On Dietician recommendation only
    A2.02.02.01 Fortini creamy fruit 
    • Available in 100g pots in two flavours: Berry fruit and Summer fruit flavour
    • On dietician recommendation only
    A2.02.01.01 Fortini multifibre 
    • On Dietician recommendation only
    A2.02.01.01 Fortini multifibre 1.0 
    • On Dietician recommendation only
    A2.02.01.01 Fortini smoothie multifibre 
    • On Dietician recommendation only
    A2.02.02.03 Fortisip Compact Protein 

    125ml bottles

    • Available in vanilla, mocha, bananastrawberry flavours . (Neutral and Hot Tropical Ginger available but not stocked at SFH)
    • On dietician recommendation only
    A2.02.02.03 Fortisip® Compact 
  • Available in neutral, vanilla, mocha, banana, strawberry, apricot, forest fruit and chocolate flavours in 125ml bottles.
  • Starter pack available containing 6 flavours. NOT FOR REPEAT PRESCRIPTION.
  • A2.02.02.03 Fortisip® Compact Fibre 
    • Available in mocha, strawberry and vanilla
    A2.02.01.01 Fortisip® Yoghurt Style 
    • On dietician recommendation only. Ensure® plus Yoghurt style preferred in primary care.
    • Available in raspberry, peach & orange, and vanilla & lemon flavours in 200ml bottles.
    A2.02.01.01 Fortisip® Bottle 
    • On dietician recommendation only in secondary care - Fortisip Compact preferred.
    • Available in neutral, banana, chocolate, toffee, orange, tropical fruit, strawberry and vanilla flavours in 200ml bottles
    A2.02.02 Fortisip® Compact Fibre 
  • On dietitian recommendation only. Not stocked at SFH
  • Available flavours are strawberry and vanilla.
  • 05.03.01 Fosamprenavir Telzir® Tablet, Oral Suspension
  • Restricted to ID / GU Medicine advice only
  • 04.06 Fosaprepitant Ivemend®
  • For oncology patients only (IV prodrug of aprepitant)
  • Stocked on WTC (But has to be booked to the patient when replacing stock for payment purposes)
  • Restricted to use in oncology patients per antiemetic guidelines for these patients (See above)
  • 11.03.03 Foscarnet intravitreal injection 

    2.4mg in 0.1mL (NUH only)

    • Opthalmology use only
    • Manufactured by Pharmacy Sterile Production Unit (Unlicensed Product)
    • Likely indications: acute retinal necrosis or cytomegalovirus retinitis
    05.03.02.02 Foscarnet Sodium Foscavir® Infusion- NUH only
  • Restricted use- see local guidelines
  • 05.01.07 Fosfomycin 

    Sachets

    Amber Traffic Light  Amber 3 (initiate as per APC guideline) for UTIs according to guidelines. See primary care or local guidelines [SFH guidelines][NUH guideline]

    Intravenous infusion (Fomicyt®)

    Red Traffic Light NUH only Restricted antibiotic: see local guidelines. [NUH guideline]

    06.01.06 FreeStyle Libre® 
    • Initiation by Consultant Endocrinologist ONLY.
    • The meter and ONE sensor will be given on initiation with prescribing passed to primary care after this point.
    • Must be reviewed at 6 months by the initiating consultant and continuation criteria met for prescribing to continue long term
    • As per the prescribing inclusion criteria
    A2.02.02 Fresubin® Energy Fibre 
  • On dietitian recommendation only in secondary care. Not stocked at SFH
  • Available flavours are vanilla, banana, strawberry, chocolate, cherry and caramel.
  • A2.02.01.02 Fresubin® Jucy 
  • On dietician recommendation only in secondary care. Not stocked at SFH.
  • Available in apple, orange, pineapple, blackcurrant and cherry flavours
  • 04.07.04.01 Frovatriptan 

    Tablets

    • Third line option if other triptans are not tolerated or ineffective. Long half life may be advantageous in patients with recurrent migraine attacks.
    08.03.04.01 Fulvestrant Faslodex®

    Injection

    • Restricted to consultant recommendation only

    Fulvestrant is not recommended for treating locally advanced or metastatic oestrogen-receptor positive breast cancer in postmenopausal women who have not had endocrine therapy before (NICE TA503).

    02.02.02 Furosemide  Tablet, liquid, Injection.
  • IV doses of 40mg or 80mg can be slow bolused. Larger doses must be infused at a max rate of 4mg/min. (This advice keeps changing, but it's now in the BNF. Some sources say infuse over 50mg but for no good reason)
  • Liquid: Only 40mg/5mL stocked at SFH (~£20 per bottle). Liquid contains 10% alcohol.
  • 11.03.01 Fusidic Acid  Eye drops 1%
  • Alternative to chloramphenicol for empirical treatment in people who:
    - Are pregnant.
    - Have a personal or family history of blood dyscrasias, such as aplastic anaemia.
    - Are intolerant of chloramphenicol.
    - Need a twice-a-day treatment for infective conjunctivitis
    See CKS topic for more information.
  • Jan 2016: price increased from £2 a tube to £35 a tube!
  • 13.10.01.02 Fusidic Acid 2% topical Fucidin® Cream 15g
    Ointment 15g
  • Reserved for very minor impetigo infections.
  • For short courses only to minimise the development of resistance.
  • See Notts APC antimicrobial guidelines.
  • 04.07.03 Gabapentin 

    Capsule (100mg, 300mg and 400mg strengths), Oral solution (50mg/ml)

    • GPs may initiate in line with Notts APC Neuropathic Pain Guidelines.
    • Tablet is non formulary as is much more expensive than capsules.
    • Oral solution (sugar free) available (>£200 for 28 days at 300mg TDS dose vs approx £4 for capsules, DT May18)
    • If needed capsules can be opened and contents dispersed in water (not licensed). Give immediately due to limited stability. More Info. Mask taste by mixing with orange juice or sprinkling on food.
    • Latest advice on switching between pregabalin and gabapentin for neuropathic pain here (UKMI Q & A) Nov 2014
    04.08.01 Gabapentin 

    Capsule, (Tablet is non formulary), Oral solution (50mg/ml)

    • Specialist initiation
    • Tablet is non formulary as is much more expensive than capsules.
    • Oral solution (sugar free) available (>£200 for 28 days at 300mg TDS dose vs approx £4 for capsules, DT May18).
    • If needed capsules can be opened and contents dispersed in water (not licensed). Give immediately due to limited stability. More Info. Mask taste by mixing with orange juice or sprinkling on food.
    20 GABAPENTIN 6% topical  Unlicensed medicine - named patient use only
    NUH only
    Topical preparation for treatment of vulvodynia. Restricted to pain team and gynaecology specialists.
    16.02 Gadobenic acid MultiHance®

    0.5mmol/mL
    NUH only:

    • 10ml vial
    16.02 Gadobutrol Gadovist®

    1.0 mmol/mL
    At SFH & NUH:

    • 15ml vial
    • 5ml, 7.5ml pre-filled syringe
    • 10ml pre-filled syringe used at SFH & NUH MRI at City campus
    16.02 Gadopentetic acid Magnevist®

    Intra-articular 20ml syringe, 2mmol/l

    • IV version discontinued. See non-formulary section below
    16.02 Gadoteric acid Dotarem® 0.5mmol/mL
    NUH only:
  • 20ml vial
  • 15ml pre-filled syringe
  • 16.02 Gadoxetic acid Primovist® 0.25mmol/mL
  • 10ml pre-filled syringe
  • 04.11 Galantamine 

    Tablet, Capsule MR (preferred brands in primary care are Gazylan® XL or Gatalin® XL)

    • Once a decision has been made to start, the first prescription may be made in primary care.
    05.03.02.02 Ganciclovir Cymevene® Infusion
  • Restricted use- see local guidelines
  • 11.03.03 Ganciclovir eye gel Virgan®
    • Ophthalmology recommendation only
    • Amber 2 - specialist initiation.
    • Courses longer than 21 days or for prophylaxis rather than treatment are off-label use.
    • Ganciclovir eye gel may be an appropriate alternative to now discontinued aciclovir eye ointment - liaise with ophthalmology.
    11.03.03 Ganciclovir intravitreal injection 

    Intravitreal injection

    • Opthalmology use only
    • Manufactured by Pharmacy Sterile Production Unit (Unlicensed Product)
    • Likely indications: acute retinal necrosis or cytomegalovirus retinitis
    • At SFH available as 6mg in 0.3ml (for 2mg doses) and 12mg in 0.3ml (for 4mg doses)(as 0.2ml extra volume counts for the dead space in the needle)
    • At NUH 2mg in 0.1mL available
    20 Gas Gangrene Antitoxin   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.
  • 01.01.02 Gaviscon Advance  Suspension and chewable tablets
  • Specialist recommendation for the treatment of laryngopharyngeal reflux (LPR) symptoms only.
  • 01.01.02 Gaviscon Infant  Oral powder
    08.01.05 Gefitinib Iressa® Tablets
  • Approved in accordance with NICE TA192 for NSCLC
  • Patient access scheme exists. Further information can be found here
  • Gefitinib (Iressa®) is not recommended for treating non small cell lung cancer that has progressed after chemotherapy as per NICE TAG 374

    At SFH:
  • CANNOT be kept as stock in pharmacy. For first cycle, orders can only be processed after purchasing has received a Patient Registration Form (1) signed by the Oncologist.
  • Read Instructions for Dispensary for more detailed information.
  • 09.02.02.02 Gelatin Gelaspan® 4% infusion solution
  • SFH only
  • 09.02.02.02 Gelatin Geloplasma® Infusion
  • NUH only - According to implementation plan
  • 09.02.02.02 Gelatin Gelofusine® Infusion
  • 500ml and 1 litre bags available
  • 12.03.01 Gelclair®  Oral gel - sachets (at SFH usually obtained through supplies rather than pharmacy, but Pharmacy may have stock)
  • Treatment of oral mucositis.
  • ONLY for oncology patients.
  • Relatively expensive - £40 per box of 21 (£2 per dose).
  • Classified as a medical device
  • SFH guide to all mouthcare products
  • 08.01.03 Gemcitabine Gemzar® Injection
  • Gemcitabine in combination with carboplatin is not recommended for treatment of the first recurrence of platinum-sensitive ovarian cancer as per NICE TA389
  • 07.01.01 Gemeprost  Pessary- secondary care only
  • Stored in freezer. Should be allowed to warm upto room temperature for 30 mins before use
  • 08.01.05 Gemtuzumab ozogamicin  Mylotarg®

    Infusion

    NUH only: Approved in accordance with NICE TA545 for untreated acute myeloid leukaemia in people 15 years and over.

    05.01.04 Gentamicin 

    Injection
    Intrathecal Injection (preservative free)
    for MRSA bacteraemia prophylaxis at catheter change in high risk patients only. IM admin on microbiology advice. (APC Sept 14)
    for all other indications

    • NUH use includes off label use with heparin for line locks; for prevention of catheter related bacteraemia in tunneled venous catheters for haemodialysis
    • If using the once daily regimen, doses should be diluted in 100ml of n/saline and given over 1 hr. For conventional (multiple daily) dosing regimens, doses of upto 160mg can be given by bolus injection over 3-5 mins.
    • See local guidelines. [SFH guideline][NUH guideline]
    05.01.04 Gentamicin 

    Use injection 80mg/2ml

    • SFH: All patients on nebulised antibiotics must be referred to a respiratory specialist nurse.
    • SFH: For nebulisation, preservative free is preferred where possible.
    11.03.01 Gentamicin ophthalmic

    Available as:

    • Eye drops 0.3%
    • Eye drops 1.5% (forte)(preservative free - unlicensed). £10 each. Expiry once opened is 7 days when stored in the fridge (on the ward and at home).
    • At NUH amikacin 2.5% (preservative free - unlicensed) is used in place of gentamicin 1.5%.
    12.01.01 Gentamicin  

    Drops 0.3% (10ml bottle ~£2.50)

    20 Giving sets (IV)  At SFH and NUH, IV giving sets do not come from pharmacy
    20 Giving sets (NG)  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
  • 08.02.04 Glatiramer Acetate 

    Injection

    Available at NUH only:

    • Available as 20mg/ml syringes for once daily dosing and as 40mg/ml syringes for three times weekly dosing. Both regimens are cost equivalent and are commissioned.
    • New patients to be initiated on Brabio®, existing Copaxone® patients will remain on Copaxone®.
    • Available through homecare for NUH patients. Please contact pharmacy medicines homecare team for further information
    05.03.03.02 Glecaprevir/Pibrentasvir Maviret®

    Film-coated tablets.
    Only commissioned through specialist centre. Must be prescribed and dispensed at NUH.
    Prior approval via Blueteq system required

    Approved in accordance with NICE TA499 for treating chronic hepatitis C in adults.

    20 GLIADEL wafer Carmustine 7.6mg  Unlicensed medicine - named patient use only
    NUH only
    06.01.02.01 Gliclazide  Tablet
  • Tablets disperse in water if needed. See here for general advice on dispersing tablets. Liquid can be made specially if required.
  • 06.01.02.01 Gliclazide MR  MR tablet
  • Amber 3 - GP's can initiate as per guideline. Available for patients where there are concerns over compliance to standard release regimens as per primary care guidelines
  • 06.01.04 Glucagon GlucaGen® HypoKit Injection
  • Used in the treatment of hypogylcaemia
  • Also used for the treatment of drug induced severe hypotension, heart failure or cardiogenic shock
  • for use as an antidote see section 18
  • 18 Glucagon GlucaGen® Hypokit Injection
  • Discussion with National Poisons Information Service recommended when used as a treatment of poisoning (e.g. beta-blocker poisoning)
    See also section 6.1.4
  • 18 Glucarpidase Carboxypeptidase Injection 1000 units- NUH only
  • Unlicensed medicine - named patient use only. Not routinely stocked at NUH but it can be ordered out-of-hours between the hours of 5pm and 9am through Clinigen and received within 24 hours (see appendix 2 of oncology guideline for pharmacy procedure).
  • Used for treatment of methotrexate-induced renal
    dysfunction and delayed methotrexate excretion. Consultant request only
  • Imported from USA as Voraxaze®
  • 06.01.04 GlucoGel®  Gel
  • Formerly known as Hypostop®
  • 06.01.01.03 GlucoRx Carepoint 
    • Available in the following sizes:
      -4mm/31G, 4mm/32G Ultra, 5mm/31G, 6mm/31G, 8mm/31G, 10mm/29G, 12mm/29G
    09.02.02.01 Glucose Intravenous 

    Available in multiple strengths

    • Dextrose 5% infusion 50ml, 100ml, 250ml, 500ml, 1 litre
    • Dextrose 10% infusion 500ml
    • Dextrose 15% infusion 500ml (not stocked at SFH)
    • Dextrose 20% infusion 500ml
    • Dextrose 30% infusion 500ml (not stocked at SFH)
    • Dextrose 40% infusion 500ml (not stocked at SFH)
    • Dextrose 50% infusion 500ml
    06.01.06 Glucose test strips  NUH only: Reagent strips, for detection of glucose in urine, available at
  • Medi-Test® Glucose
  • Diabur-Test 5000®
  • 13.07 Glutaraldehyde Glutarol®

    Solution (10%)

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

    • May be prescribed if appropriate to in-patients; patients should be advised on discharge that further supply should be purchased
    01.06.02 Glycerol (Glycerin) 

    Suppository

    • OTC Patients should be advised to purchase a suitable product over the counter for short term/infrequent constipation

    • May be prescribed if appropriate to in-patients; patients should be advised on discharge that further supply should be purchased
    12.03.01 Glycerol dioleate  Episil® Oral Spray
  • Treatment of oral mucositis.
  • ONLY for oncology patients.
  • £49.21 per 10mL (£0.75 per dose)
  • Classified as a medical device
  • Click here for independent reviews
  • 20 GLYCEROL STERILE 30ml  NUH only: Unlicensed medicine - named patient use only
  • No longer stocked at SFH - podiatry to purchase own non-sterile version from RDC.
  • 02.06.01 Glyceryl Trinitrate  Available as S/L Tablet, Spray, Patches, Injection.
  • Injection (secondary care only)- Use Polyethylene (PE), giving set for infusion (NOT PVC!).
  • Buccal tablets (Suscard®) discontinued 2008 - Alternatives include IV/sublingual GTN or oral Isosorbide Mononitrate depending on the indication.
  • 18 Glyceryl Trinitrate  Injection
    Treatment of hypertension associated with poisoning or overdoses
  • Injection (secondary care only)- Use Polyethylene (PE), giving set for infusion (NOT PVC!).
  • NUH: Isoket stocked on most wards but GTN stocked in A&E
  • Also see section 2.6.1
  • 01.07.04 Glyceryl Trinitrate 0.4% rectal ointment 

    Ointment

    • Licensed and easily available
    • Costs ~£33 per tube (June 18)
    02.06.01 Glyceryl Trinitrate 2% Ointment 

    Ointment

    Available at NUH only for:

    • Treatment and prevention of digital gangrene in children and young people with severe septic shock (unlicensed indication).
    07.04.04 Glycine  Irrigation solution 1.5%
    20 Glycopyrrolate 0.5% topical solution 
    • SFH information only: Unlicensed Special. Obtain supplies from SFH Pharmacy rather than FP10HP.
    01.02 Glycopyrronium  

    Oral solution (1mg/5ml or 2mg/5ml). Tablets are non-formulary

    Specialist recommendation for management of hypersalivation / upper airway secretions in paediatric patients. Oral solutions listed below are licensed for hypersalivation in children.

    Specialist recommendation for management of hypersalivation in adults with Parkinson’s Disease in line with NICE guidance NG71 (APC Mar19) – off licence indication.

    • Oral solution, use EITHER:
    • - 1mg/5ml glycopyrronium bromide oral solution - Colonis Pharma Ltd (£91 for 150ml, DT Apr19, with 1 month expiry once opened)
    • - Sialanar® 2mg/5ml* glycopyrronium bromide oral solution (£320 for 250ml, DT Apr19, with 2 month expiry once opened). Prescribe by brand name to prevent confusion between strengths.
      *Note that Sialanar® description on packaging and on GP prescribing systems is 320micrograms/mL – this is the amount of glycopyrronium BASE per mL and is equivalent to 400micrograms/mL of the SALT, glycopyrronium bromide. See link below for dosing information for Sialanar®
    • - Switching between strengths is not advised without face to face counselling with the patient / carer.
    • Tablets- not cost-effective. Current patients should be reviewed and switched to oral solution.

    • For information on use in palliative care or hyperhidrosis see other entries.
    13.12 Glycopyrronium  Solution 0.05%
  • Unlicensed special for specialist use only
  • Manufactured by Pharmacy Non Sterile Production Unit (Unlicensed Product) at NUH
  • 15.01.03 Glycopyrronium 

    Injection (200micrograms in 1mL and 600micrograms in 3mL)

    • for palliative care use as a 2nd line option after hyoscine (APC Jan 15). Other indications are classified
    • For information on use in hypersalivation or hyperhidrosis see other entries.
    • May be used in palliative care if supply problems with hyoscine. 20mg hyoscine butylbromide is approximately equal to 200micrograms of glycopyrronium.
    01.05.03 Golimumab Simponi®

    Injection

    SFH: Approved for treating moderately to severely active ulcerative colitis after the failure of conventional therapy as per NICE TA329.

    NUH: Approved for treating moderately to severely active ulcerative colitis after the failure of conventional therapy as per NICE TA329. Prior approval with pharmacy required pending full assessment of local implementation.

    Available through homecare for NUH patients. Please contact pharmacy medicines homecare team for further information

    10.01.03 Golimumab Simponi®

    Injection
    Approved in accordance with:

    • NICE TA220 for psoriatic arthritis
    • NICE TA375 for rheumatoid arthritis
    • NICE TA383 for ankylosing spondylitis
    • NICE TA497 for non-radiographic axial spondyloarthritis
      – rheumatology consultants only.
    06.05.01 Gonadorelin HRF® 100 microgram injection
  • Secondary Care Only - specialist use for diagnostic purposes
  • 08.03.04.01 Goserelin Zoladex® Implant
    See section 08.03.04.02 for prostate cancer and 6.7.2 for gynae and gender dysphoria
  • Restricted to consultant recommendation only
  • Goserelin available for the treatment of breast cancer only. Zoladex brand of goserelin is licensed, but other gonaderelin analogues are not. For all other indications triptorelin should be used
  • 04.06 Granisetron  Tablet, Injection
  • Restricted for oncology and haematology use only, second line after ondansetron
  • N.B. 3.1mg/24hrs transdermal patch (Sancuso®) - is non-formulary, Grey awaiting submission
  • A5.02.04 Granuflex  NUH burns unit only
  • Available as 10x10cm, 15x15cm and 15x20cm
  • 03.04.02 Grass pollen extract Grazax® Tablet - freeze dried. Administered sublingually
  • NUH Immunology only
  • 05.02 Griseofulvin  Tablet
  • For scalp and dermatophyle infections in children
  • 04.04 Guanfacine Intuniv® Tablet
  • For use in paediatrics and adolescents in those requiring a non-stimulant. To be used second line to atomoxetine or as an alternative if atomoxetine is clinically inappropriate.
  • 13.05.03 Guselkumab Tremfya®

    Injection

    Approved in accordance with NICE TA521 for treating moderate to severe plaque psoriasis

    14.04 Haemophilus influenzae type B Combined Vaccine Menitorix® Injection
  • Hib/ Men C
  • For routine childhood immunisations
  • 01.07.01 Haemorrhoid relief ointment 

    eg Anusol®, but other brands also available.

    • OTC Patients should be advised to purchase over the counter

    • May be prescribed if appropriate to in-patients; patients should be advised on discharge that further supply should be purchased
    01.07.01 Haemorrhoid relief suppositories 

    eg Anusol®, but other brands also available.

     

    • OTC Patients should be advised to purchase over the counter

    • May be prescribed if appropriate to in-patients; patients should be advised on discharge that further supply should be purchased
    20 Haemostatic Agent Floseal® Haemostatic Matrix
    NUH only
    Also approved for NUH ENT specialist use only for the treatment of epistaxis in accordance with local guideline.
    20 Haemostatic Agent PuraStat®

    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

    20 Haemostatic Agent Willospon® Gelatine sponge - Anal Tampon
    NUH only
  • For local haemostasis in surgical procedures
  • 20 Haemostatic Agent Tachosil® Medicated sponge - used in liver surgery
    NUH only
    20 Haemostatic Agent  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
  • 03.01.05 Haleraid® 
  • Not available on FP10, patients may be advised to purchase in primary care
  • May be supplied in secondary care to patients with dexterity problems
  • 04.02.01 Haloperidol  Tablet, Capsule, Oral liquid
    Injection : Now only licensed for IM administration. IV administration is unlicensed and ECG monitoring is necessary.
  • Optimum dose of oral haloperidol for the treatment of schizophrenia is less than or equal to 12mg/day. The maximum licensed daily dose in resistant schizophrenia is 30mg/day orally.
  • The maximum licensed daily i.m. dose is 18mg.
  • 04.02.02 Haloperidol Haldol Decanoate® Depot injection
    04.09.03 Haloperidol  See section 4.2.1
    02.08.01 Heparin  Available as:
    - 1 unit in 1mL (500mL sodium chloride 0.9%)
    - 10 units in 1mL (5mL ampoule)-prev known as Hepsal
    - 100 units in 1mL (2mL ampoule)-prev known as Canusal
    - 100 units in 1mL (500mL sodium chloride 0.9%)
  • Shouldn't be used for flushing peripheral cannulas- use 0.9% sodium chloride instead.
  • 02.08.01 Heparin  Heparin sodium 1000 units in 1mL (20ml amps no longer available)
    NUH only:
    Heparin sodium mucous 1000 units in 1ml (5mL vial) for renal dialysis patients
    Heparin sodium 1000 units in 1ml (5mL ampoule) preservative free for X-ray only
    Heparin sodium mucous 5000 units in 1ml for renal dialysis patients
    Heparin sodium 25000 units in 5mL vial with preservative for renal dialysis patients
    Heparin calcium injection - prefilled syringes
    14.04 Hepatitis A vaccine  Injection
  • Havrix Monodose® brand stocked in secondary care.
  • Havrix Junior Monodose available for children
  • SFH - National supply problems - Vaqta® and Avaxim® Adult® may be available
  • NUH Vaqta® available for GU in line with PHE advice (July 17)
  • 14.04 Hepatitis A vaccine with Hepatitis B vaccine  Twinrix® Injection
    14.05.02 Hepatitis B immunoglobulin HBIG Injection - Intramuscular
  • At SFH see microbiology website for further details of how to obtain (look up on A-Z list)
  • At NUH requires microbiology approval. See Microbiology website. If supply already arranged for child of Hep B +ve mother, this stock (from HPA) may be in the Neonatal Unit fridge.
  • 14.04 Hepatitis B vaccine 

    Global shortage of Hepatitis B vaccines. See PHE recommendations on vaccine choice for specific patient groups.

    • Engerix B®
      - 10micrograms in 0.5mL (Paediatric)
      - 20micrograms in 1mL 
    • Fendrix®- For use in renal patients
      - 20micrograms in 0.5mL Prefilled Syringe
    • HBvaxPRO® Injection
      - 5micrograms in 0.5mL (Paediatric)
      - 10micrograms in 1mL (unavailable Jan 2019)
      - 40micrograms in 1mL (for use in renal patients)
    • If being used for the purposes of travel, only available on the NHS for at risk groups- see the Green Book for further information
    05.01.04 Herafill® beads G 

    2.5mg gentamicin per bead (20 beads, 40 beads)

    • NUH only: Surgical treatment for complex trauma and orthopaedic patients.
    13.11.02 Hibitane Obstetric®  Cream
  • NUH only
  • Contains:Chlorhexidine Gluconate Solution 5% (≡ Chlorhexidine Gluconate 1%)
  • 13.10.05 Histoacryl®  Tissue adhesive
    11.05 Homatropine  Eye drops 1%
    Eye drops 2%
  • rarely used at NUH
  • preservative free multidose is a unlicensed special and classfied non-formulary GREY
  • A5.08.04 Hospilite  In secondary care, wards to order direct from RDC.
  • Available as 5cmx4.5m, 7.5cmx4.5m,10cmx4.5m and 15cmx4.5m
  • Not to be used for lower limb bandaging
  • 09.02.02.02 Human Albumin Solution  Solution 4.5%
    Solution 20%
  • Non-pharmacy item at both trusts please contact blood bank for details and availability. SFH: available on the advice of a haematology consultant only via blood bank
  • 02.11 Human Fibrinogen Riastap®

    Non pharmacy item, please contact blood bank for details and availability

    Available through homecare for NUH patients. Please contact pharmacy medicines homecare team for further information

    06.05.01 Human Menopausal Gonadotrophins Menopur® Injection
  • Secondary care use only as per approved guidelines
  • Red - Treatment of infertility
  • 14.04 Human papilloma virus vaccine Cervarix® Prefilled syringe
  • In secondary care, restricted for use in paediatrics when GPs request that vaccination is given in hospital
  • Not routinely stocked at SFHT
  • 14.04 Human papilloma virus vaccine Gardasil®

    Prefilled syringe

    • In secondary care, restricted for use in paediatrics when GPs request that vaccination is given in hospital
    • Vaccine of choice for the national immunisation program (see Green Book).
    • Not routinely stocked in secondary care
    • Red Approved at NUH for use by GU as per agreement with NHSE for MSM.
      Classified as GREY for indications other than immunisation as part of the National Immunisation program.
    10.03.01 Hyaluronidase Hyalase® Injection
  • For the enhancement of permeation of subcutaneous or intramuscular injections, local anaesthetics and subcutaneous infusions; promotes resorption of excess fluids and blood.
  • 02.05.01 Hydralazine  Tablet
  • May be used in combination with a nitrate in the management of heart failure in patients who are intolerant of ACE inhibitors.
  • Tablets disperse in water if needed but this may increase the rate of absorption. See here for general advice on dispersing tablets. Tablets are sugar coated and are likely to block enteral feeding tubes. Blood pressure monitoring recommended.
  • 20 HYDROCHLOROTHIAZIDE   NUH only
  • Tablet 25mg used for neonatal suspension. Unlicensed.
  • 01.05.02 Hydrocortisone Colifoam®

    Foam enema

    • Supply problem since June 2018 - Mylan cannot give an estimate of how long the supply problem will continue for (last checked Mar19).
    • First choice steroid foam enema for IBD. Note mesalazine preparations preferred to steroids overall
    06.03.02 Hydrocortisone 

    Tablet

    • Tablets disperse in water if needed. See here for general advice on dispersing tablets.
    06.03.02 Hydrocortisone Alkindi® granules in capsules
    • Available as 500microgram, 1mg and 2mg capsules.
    • 5mg capsules are Grey. For doses multiple of 5 mg see the entry above on hydrocortisone 10mg tablets. 
    • Restricted for cortisol replacement therapy of infants and young children with adrenal insufficiency where the hydrocortisone 10mg tablets cannot be used, either whole or halved, to administer the required dose. 
    12.03.01 Hydrocortisone Corlan® Pellets 2.5mg
  • SFH guide to all mouthcare products
  • 13.04 Hydrocortisone  Cream (0.5% and 1%), Ointment (0.5% and 1%)
  • Mild
  • 2.5% ointment and cream non-formulary - approximately £20 for 15g as opposed to £2 for 0.5 or 1%. Alternative agents available e.g 1% hydrocortisone (mild) or eumovate (moderate)
  • 10.01.02.02 Hydrocortisone acetate Hydrocortistab® Injection 25mg
  • Supply problem Oct 2015. Still ongoing July.
  • 06.03.02 Hydrocortisone sodium phosphate 

    Injection (ready made liquid)

    • Supply problem appears resolved - March 2019 – See memo
    • Usually use sodium succinate salt (Solu-Cortef®), but sodium phosphate salt available for outpatients who may need to self administer (e.g. addisonian crisis). It is already in solution and doesn't require reconstitution like the sodium succinate salt requires).
    • Self administration guidance is available here and for a video click here.
    06.03.02 Hydrocortisone sodium succinate Solu-Cortef®

    Injection (powder for reconstitution)

    • Self administration guidance is available here and for a video click here.
    • Surgery IV dose advice now within BNF drug monograph
    13.04 Hydrocortisone 1% and oxytetracycline 3% Terra cortril®

    Ointment only (no cream)

    • Mild with antibacterial
    13.04 Hydrocortisone 1% with Clotrimazole 1% Canesten HC® Cream
  • Mild with antifungal
  • 13.04 Hydrocortisone 1% with Miconazole 2% Daktacort®

    Cream, Ointment

    • Mild with antifungal
    12.01.01 Hydrocortisone Acetate 1% with Gentamicin 0.3% 
    • Drops
    • Gentisone HC brand discontinued. Now only available generically
    • Mentioned in the Nottinghamshire Primary Care antimicrobial guidelines for otitis externa.
    • The second line options are not in a particular order and the supply and cost may vary over time.
    • £25 per bottle (July 17)
    13.04 Hydrocortisone Butyrate Locoid® Cream 0.1% (30g and 100g), Lipocream 0.1% (30g), Ointment 0.1% (30g and 100g), Scalp lotion 0.1% (100g)
  • Potent
  • 11.04.01 Hydrocortisone sodium phosphate 0.3% eye drops Softacort®

    Preservative-free single use eye drops (~ £11 for 30).

    • For ocular surface inflammation. 
    12.01.01 Hydrocortisone with Antibacterials Otosporin®
    • Drops (Hydrocortisone 1%, Neomycin Sulphate 3400 units/mL & Polymyxin B Sulphate 10000units/mL)
    • Not included in the current Nottinghamshire Primary Care antimicrobial guidelines due to previous discontinuation in 2014 but will be considered for the next update. 
    • In line with updated PHE guidance. Topical acetic acid 2% should be tried first as per guideline.
    • £7.45 per bottle
    13.04 Hydrocortisone/ nystatin/ chlorhexidine 

    Cream, Ointment

    • Contains: Hydrocortisone 1%, Nystatin 100,000 units/g
      and Chlorhexidine Acetate 1%
    • Mild with antimicrobials
    • Previously known as Nystaform-HC®, but now only available generically
    12.03.04 Hydrogen Peroxide  Mouthwash 3% (10 vols)
  • Usually use chlorhexidine instead, but hydrogen peroxide is acceptable, especially if anaerobic infection suspected.
  • 13.11.06 Hydrogen Peroxide Solution BP  Solution 3% 200mL
    22.02 Hydromol fragrance free ® bath additive  500mL Bottle
    (SS)
    13.02.01 Hydromol® 

    Ointment

    • Greasy level 4/4 (most greasy)
    • Recommended for additional use as soap substitute, including for leg ulcer management
    13.02.01 Hydromol® Intensive urea 10%

    Cream

    • Greasy level 3/4
    A5.02.01 Hydrosorb  At SFH, wards order direct from RDC.
  • Available as 5x 7.5cm and 10x 10cm
  • A5.02.01 Hydrosorb Comfort  At SFH, wards order direct from RDC.
  • Available as 4.5x6.5cm, 7.5x10cm and 12.5x12.5cm
  • 09.01.02 Hydroxocobalamin  IM Injection
  • vitamin B12 of choice for therapy - retained in the body longer
  • SFH: Available from the paediatric metabolic drug box on NNU
  • NUH: Available from the paediatic metabolic drug box on D33
  • 18 Hydroxocobalamin Cyanokit® Injection (for infusion)
  • Used for the treatment of cyanide poisoning
  • Discussion with National Poisons Information Service recommended
    NUH: Kept in A&E
    SFH: One kit kept on ED (Major - Poisons cupboard), can borrow an extra kit from Chesterfield Hospital in the event of needing 2 kits . See guides below
  • 08.01.05 Hydroxycarbamide  Capsule
  • See East Midlands Cancer network guidelines linked above for further information with regards to Hydroxycarbamide place in CML therapy
  • 10.01.03 Hydroxychloroquine  Tablet
  • Tablets disperse in water if needed. See here for general advice on dispersing tablets. Liquid (unlicensed special) can be made specially if required.
  • 13.05.03 Hydroxychloroquine  Tablets
  • Red: Dermatology specialist only
  • 11.08.01 Hydroxyethylcellulose Minims® Artificial Tears Eye drops (preservative free)- NUH only
    20 HYDROXYPROGESTERONE 260mg/ml inj   Unlicensed medicine - named patient use only
    NUH only
    11.08.01 Hydroxypropyl Guar Systane®

    Systane Ultra® and Systane Balance® (with mineral oil). 10ml bottle, 6 months expiry.

    03.04.01 Hydroxyzine  Tablet (syrup discontinued)
    01.02 Hyoscine Butylbromide 

    Tablet, Injection

    • Tablets disperse in water if needed for tube administration (tastes terrible). They take a long time to disperse (30 min) but much quicker if crushed first. See here for general advice on dispersing tablets. Other alternatives may be a liquid (expensive unlicensed special) or consider hyoscine patches or s/c injections.
    • Be aware of potential for abuse. Reports of hyoscine butylbromide being crushed and smoked in prisons (smoking releases scopolamine, a know hallucinogen).
    • Injection cautioned in cardiac disease MHRA Guidance
    04.06 Hyoscine Hydrobromide 

    Patches, Tablets (Kwells® and Joy-Rides®).

    • Patches are 1.5mg total dose, but only release 1mg over 72 hours. Cost £6.50 each = £65 per month.
    • Tablets disperse in water if needed. See here for general advice on dispersing tablets.
    15.01.03 Hyoscine Hydrobromide 

    Injection 400micrograms in 1mL

    • Amber 2: Palliative care use although hyoscine butylbromide generally preferred (less sedating and less expensive).
    • See section 4.6 for sublingual/patch hypersalivation treatment information.
    A5.07.03 Hypafix  In secondary care should be ordered direct from RDC
  • Permeable apertured non-woven synthetic adhesive tape
  • Available as 5cmx5m, 10cmx5m, 2.5cmx10m, 5cmx10m, 10cmx10m,15cmx10m, 20cmx10m and 30cmx10m
  • 11.08.01 Hypromellose 
    • First line ocular lubricants (with preservative):
      • 0.3% (generic £1)
      • 0.5% (Isopto Plain® £1)  
    • Also preservative free available:
      • 0.3% (multi dose bottle - Evolve® Hypromellose - £2, 3 month expiry)
      • 0.3% (preservative free) (unit dose vials, Hydromoor® at NUH)
    • Other brands = non-formulary eg: Artelac®, Lumecare®
    • See Eye lubricant guidelines and Eye lubricants table of products.
    • OTC Patients should be advised to purchase over the counter

    • May be prescribed if appropriate to in-patients; patients should be advised on discharge that further supply should be purchased
    11.08.01 Hypromellose 0.3% with Dextran 70 0.1% Tears naturale®

    Eye drops- NUH only

    • preservative free unit dose is non-formulary
    06.06.02 Ibandronic Acid  50mg tablet (daily)
  • Restricted for oncology patients
  • Amber 2 - Reduction of bone damage in bone metastases in breast cancer
  • 06.06.02 Ibandronic Acid  150mg tablet (monthly)
  • Amber 2 - as per osteoporosis guidelines (possible last line oral option)
  • 06.06.02 Ibandronic Acid injection Bonviva® Injection
    NUH:
  • Restricted for osteoporosis in patients intolerant of oral bisphosphonate or in place of disodium pamidronate, which is unlicensed
    SFH:
  • For initiation only by osteoporosis specialist for patients in whom yearly zoledronic acid isn't suitable.
  • Red - as per local osteoporosis guidance and notes above
  • 08.01.05 Ibrutinib Imbruvica®

    Capsules

    Only to be prescribed by Consultant Haematologists for Lymphoma (See protocol for funding requirement)
    NUH and SFH: Approved in accordance with NICE TA429 for previously treated chronic lymphocytic leukaemia and untreated chronic lymphocytic leukaemia with 17p deletion or TP53 mutation
    NUH and SFH: Approved in accordance with NICE TA491 for treating Waldenstrom’s macroglobulinaemia
    NUH: Approved in accordance with NICE TA502 for treating relapsed or refractory mantle cell lymphoma in adults only if they have had only 1 previous line of therapy
    NUH and SFH: Approved in accordance with the National Cancer Drugs Fund List for the indications below where the specified criteria are met:

    • the treatment of relapsed/ refractory Mantle Cell Lymphoma
    07.01.01.01 Ibuprofen Pedea® injection Intravenous solution, 10mg/2ml
  • For use in neonates for the treatment of PDAs only
  • 10.01.01 Ibuprofen  Tablet, Suspension (100mg/5ml)
  • Good first choice NSAID at doses up to 1200mg. If bigger doses are needed then naproxen is probably a better choice.
  • Usual dose 200-400mg prn up to 1200mg per day. 400mg qds acceptable in the short term. 2400mg per day is associated with CV risks similar to COX2s and diclofenac so try naproxen instead.
  • Nottingham Childrens Hospital: Oral Analgesia guideline
  • 10.03.02 Ibuprofen gel 
  • 5% gel is First Line (10% gel Second Line)
  • Preferred brand in primary care is Fenbid / Fenbid Forte.
  • Of value when only one joint is affected and patient cannot take oral NSAIDs.
  • Costs ~£5 for 100g tube.
  • Systemic side effects are still possible - Covering an area 20x20cm with 10g 5% of gel can give blood levels similar to taking 70mg of ibuprofen orally, and using 10% would probably double this.
  • 03.04.03 Icatibant Firazyr®

    NUH only
    Pre-filled syringe.
    For use in the treatment of acute attacks of hereditary angioedema

    Available through homecare for NUH patients. Please contact pharmacy medicines homecare team for further information

    13.05.01 Ichthammol  Bandage
  • Ichthopaste®
  • 13.05.01 Ichthammol 1% w/w paste  Paste
  • NUH: Manufactured by Pharmacy Non Sterile Production Unit (Unlicensed Product)
  • 20 Icodextrin solution 
    • 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
    08.01.02 Idarubicin Zavedos® Caspule, Injection- NUH only
    02.08 Idarucizumab Praxbind®

    Injection

    • Reversal agent for dabigatran. ~£1000 per dose.
    • On recommendation of haematologist only.
    • At SFH: Available via Blood bank.
    • At NUH: Available via pharmacy.
    11.08 Idebenone Raxone®

    Tablet

    Available at NUH only: Approved in accordance with MHRA Early Access to Medicines Scheme to treat the decline of respiratory function in patients with Duchenne Muscular Dystrophy (DMD) from the age of 10 years who are currently not taking glucocorticoids. EAMS number 46555/0001.

    08.01.05 Idelalisib Zydelig®

    Tablet-NUH and SFH
    Approved for use from Feb 16 in accordance with:

    • NICE TA359 for treating chronic lymphocytic leukaemia.
      Previous use via Cancer Drug Fund approval switches to routine commissioning from Feb 16.

    NUH Only: Approved in accordance with compassionate use scheme for:

    • Adult patients with follicular lymphoma that is refractory to two prior lines of treatment 
    20 i-FACTORTM  Peptide Enhanced Bone Graft
    NUH only
    Approved for use in spinal fusion
    Supplied by Theatre Stores
    08.01.01 Ifosfamide Mitoxana® Injection- NUH only
    02.05.01 Iloprost injection   Injection (unlicensed, secondary care only)
  • Restricted for peripheral vascular and rheumatology use
  • 02.05.01 Iloprost nebules Vantavis® Nebule
  • Restricted for NUH use in pulmonary hypertension on advice of tertiary centre
  • 08.01.05 Imatinib  Tablets
  • TA326 & TA209: for the treatment of unresectable and/or metastatic gastrointestinal stromal tumours and the adjuvant treatment.
  • TA70 & TA251: for chronic myeloid leukaemia.
  • TA425: for high dose therapy for CML - not recommended.
  • TA426: for untreated, chronic-phase Philadelphia-chromosome-positive CML in adults
  • Glivec® brand must be used for Gastrointestinal Stromal Tumours (GIST).
  • SFH: do not authorise before contacting Cancer services pharmacist (3156).
  • 05.01.02.02 Imipenem with Cilastatin  Infusion
    NUH only: For the treatment of Mycobacterium abcessus infection in patients with cystic fibrosis. See local guidelines
    04.03.01 Imipramine 

    Tablet, Oral solution (25mg/5ml)

    • Oral solution, sugar free, available (approx £42 for 150ml vs £1 for tablets, DT May18). Expires 30 days after opening.
    13.07 Imiquimod Aldara® Cream 5%
  • Red: External genital and perianal warts and basal cell carcinoma
  • For anogenital warts, refer to GU Medicine for advice
  • For superficial basal cell carcinoma, only if prescribed by Dermatologist
  • Only for use by a clinician experienced in its use
  • 13.08.01 Imiquimod  Zyclara® Cream 3.75%
  • For the treatment of actinic keratosis when prescribed in line with the Notts APC Solar Keratosis pathway
  • 13.02.01 imuDERM® urea 5%, glycerol 5%

    Cream

    A5.03.02 Inadine  
  • For use in primary care in line with Notts APC guideline for antimicrobial woundcare products.
  • In secondary care, wards to order from Pharmacy for each individual patient.
  • At SFH: use only on recommendation of the Tissue Viability Team.
  • Available as 5x5cm and 9.5x9.5cm
  • 02.02.01 Indapamide  Tablet 2.5mg (preferred)
    Tablet MR 1.5mg
  • First choice in NICE hypertension guidelines. 2.5mg daily (£1pm). (1.5mg MR is also mentioned but costs £4pm.)
  • If needed standard tablets can be dispersed in water for patients with swallowing difficulties or enteral tubes terminating in the stomach. MR tablets should not be crushed. More Info
  • 13.10.05 Indermil®  Tissue adhesive
  • Not available from pharmacy, only RDC
  • 20 Indigo carmine  

    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.

    11.08.02 Indocyanine green 

    Injection 25mg

    Available at NUH:

    • Ophthalmology use for angiography.
    • Neurosurgery use for angiography.
    • Gynaecological surgery by intracervical injection for detection of sentinel lymph nodes.


    N.B. AKORN brand injection no longer used at NUH for intravitreal use

    10.01.01 Indometacin 

    Tablet, Suppositories (100mg)

    • Option as a 3rd choice NSAID after ibuprofen and naproxen.
    13.11.01 Industrial Methylated Spirit BP  70% Bottle
    70% Spray
    14.04 Infanrix hexa  Injection
  • Diphtheria, tetanus, pertussis (acellular component), poliomyelitis (inactivated), and Haemophilus influenzae type b and hepatitis B vaccine
  • Replaces Pedicael and Infanrix IPV+ Hib in routine childhood immunisation programme for babies born after 1st August 2017
  • 14.04 Infanrix IPV®  Injection
  • Adsorbed Diphtheria, Tetanus, Pertussis (Acellular, Component) and Inactivated Poliomyelitis Vaccine (DTaP/IPV)
  • Diphtheria containing vaccine for children under 10 years
  • A2.02.01.01 Infatrini Peptisorb 
    • On Dietician recommendation only
    A2.02.01.01 Infatrini® 
    • On Dietician recommendation only
    01.05.03 Infliximab Remsima® Infusion (Infliximab biosimilar)
  • SFH - Remsima® brand biosimilar to be used for all new patients.
    Red Traffic Light NUH and Nottingham Treatment Centre:
  • Approved for the treatment of Crohn’s disease and ulcerative colitis in adult in line with NICE approved indications.
    Red Traffic Light NUH:
  • Approved for the treatment of Crohn’s disease and ulcerative colitis in paediatric patients.
  • Approved for the treatment of immunotherapy induced colitis in oncology patients who fail to respond to high dose steroids.
    Grey Traffic Light For other indications and specialities, no formal assessment (NUH DTC Mar 15)
    Infliximab biosimilar
  • 01.05.03 Infliximab Remicade® Infusion
  • For use in line with NICE guidance-see below
  • Use 1.2 micron filter when administering.
  • SFH - Remsima® brand biosimilar to be used for all new patients. See entry below.
  • 10.01.03 Infliximab Remicade® Infusion
    Restricted for use in line with NICE guidance(consultant decision)
    Classifed red for rheumatoid arthritis & Crohns disease
  • Approved in accordance with:
    NICE TA375 for rheumatoid arthritis
    NICE TA383 for ankylosing spondylitis
  • NUH approved as per NHSE commissioning policy E03/P/d for the treatment of Juvenile Idiopathic Arthritis (JIA)
  • 13.05.03 Infliximab Remicade® Infusion
  • NICE TA134
    Infliximab is recommended as a possible treatment for adults with plaque psoriasis only if:
  • their condition is very severe and
  • their condition has not improved with other treatments such as ciclosporin, methotrexate or PUVA (psoralen and long-wave ultraviolet radiation), or they have had side effects with these inthe past or there is a medical reason why they should not be given these treatments.
    Infliximab treatment should be continued beyond 10 weeks only if the psoriasis has clearly improved within this time.
  • 14.04 Influenza vaccine   Injection, intranasal vaccine (see below)
  • Intranasal vaccine (Fluenz tetra®) is a live vaccine licensed for children aged 2-18ys and has different contraindications and precautions to vaccines given by injection (see SPC or Green Book).
  • Which flu vaccine should children have: advice available here
  • 13.08.01 Ingenol mebutate Picato® Gel (150 micrograms/g for face and scalp, 500 micrograms/g for trunk and extremities)
  • For the treatment of actinic keratosis when prescribed in line with the Notts APC Solar Keratosis pathway
  • 06.01.01.03 Injection Device Autopen 24 (1 and 2 unit)®
    06.01.01.03 Injection Device ClikStar®
    06.01.01.03 Injection Device NovoPen 5
    06.01.01.03 Injection Device NovoPen Echo®
    06.01.01.03 Injection Device HumaPen Savvio®
    06.01.01.03 Injection Device Autopen Classic (1 and 2 unit)®
    06.01.01.03 Injection Device HumaPen Luxura HD®
    08.01.05 Inotuzumab Ozogamicin  Besponsa®

    Powder for solution for infusion

    Approved in accordance with CDF and NICE TA541 for treating relapsed or refractory B-cell acute lymphoblastic leukaemia.

    A5.01.02 Insight Tracheostomy Dressing 
  • Available as 80x80mm
  • Not available on FP10- for FP10 options see Permafoam and Trachi-Dress
  • 06.01.01.01 Insulin Actrapid® 10mL vial
    06.01.01.01 Insulin Humulin® S 10mL vial
    3mL cartridge (for most Autopen® Classic or HumaPen®)
    06.01.01.01 Insulin Insuman® Rapid 3mL cartridge for ClikSTAR
    3ml disposable pen (Optiset®) discontinued Dec 2011 - only cartridges available
    06.01.01.01 Insulin 500 units in 1mL Humulin R® Kwikpen 3ml (High Strength) disposable pen - unlicenced
  • 20 ml vial discontinued. Transfer patients to Kwikpen.
  • For use by diabetic specialists only.
  • 06.01.01.01 Insulin aspart Fiasp®

    10mL vial
    3mL cartridge
    3mL prefilled pan

    • Different formulation to Novorapid®.
    • Colour of pens, vials and cartridges is changing from yellow to red and yellow- more info
    06.01.01.01 Insulin Aspart  NovoRapid® 10mL vial
    3mL cartridge
    3mL prefilled pen
    1.6ml cartridge (Pumpcart for insulin pump)
  • More expensive than standard insulins, but may be used where the faster onset is necessary in line with Nottinghamshire Diabetes Guidelines
  • 06.01.01.02 Insulin degludec Tresiba®

    Note that there are two strengths of insulin degludec! See link to MHRA warning below. Caution should be exercised when prescribing and dispensing.

    100 units / ml cartridges, 100 units / ml FlexTouch® prefilled pens.

    • Restricted Item Initiation only for patients with:
      • type 1 diabetes currently treated with insulin glargine with recurrent admissions for ketoacidosis treatment due to insulin omission OR with recurrent, particularly nocturnal, severe hypoglycaemia.
      • type 2 diabetes currently treated with insulin glargine where existing basal insulin is running out OR with poor compliance OR requiring flexibility of administration OR with recurrent, particularly nocturnal, severe hypoglycaemia.

    200 units / ml FlexTouch® prefilled pens.

    • Restricted Item Initiation only for patients requiring high doses of insulin that cannot be delivered using the lower strength 
    06.01.01.02 Insulin Detemir Levemir®

    3mL cartridge, 3mL prefilled pen.

    • Restricted for patients as per NICE guidance
    • Amber 2 - On recommendation from specialist clinic only
    06.01.01.02 Insulin Glargine Lantus®

    10mL vial, 3mL cartridge for ClikSTAR, 3mL disposable prefilled pen - Solostar®

    • The first line insulin glargine product for new patients is Semglee® (available as prefilled pen only).
    • Restricted for patients as per NICE guidance
    • Amber 2 - On recommendation from specialist clinic only
    • Semglee®, Abasaglar® and Lantus® should not be used interchangeably. Ensure all prescriptions and communications specify brand.
    06.01.01.02 Insulin Glargine 300 units/ml Toujeo®
    • 300 units per ml (high strength)
    • Prescribe by brand name.
    • Available in two devices:
      • Solostar® disposable pen (1 unit increments and max dose 80units)
      • Doublestar® disposable pen (2 unit increments and max dose 160units)
    • Only for use in patients that would otherwise require insulin 500units/ml
      OR  As 2nd line basal insulin after insulin glargine 100units/ml in patients with poorly controlled diabetes and at least one of the following:
        - requiring twice daily basal insulin (as once daily is insufficiently long acting)
        - lipohypertrophy
        - experiencing nocturnal hypoglycaemia
        - requiring carer administration once a day, where delays in administration are impacting on diabetes control
    06.01.01.02 Insulin Glargine biosimilar 

    3mL prefilled pen

    • First line insulin glargine product for new patients being initiated on insulin glargine or those requiring a medication change.
    • Amber 2 - On recommendation from specialist clinic only.
    • Semglee®, Abasaglar® and Lantus® should not be used interchangeably. Ensure all prescriptions and communications specify brand.
    06.01.01.02 Insulin Glargine biosimilar 

    3mL prefilled pen, 3mL refill cartridge.

    • Reserved for existing patients only.
    • Amber 2 - On recommendation from specialist clinic only
    • Semglee®, Abasaglar® and Lantus® should not be used interchangeably. Ensure all prescriptions and communications specify brand.
    06.01.01.01 Insulin Glulisine Apidra® 10mL vial
    3mL cartridge for ClikSTAR (OptiPen phased out Dec 2011)
    3ml pre-filled pen SoloSTAR (Optiset phased out Dec 2011)
  • Nottinghamshire diabetes guidelines
  • 06.01.01.01 Insulin Lispro 100 units/ml Humalog® 10mL vial
    3mL cartridge
    3mL prefilled pan (KwikPen)
  • More expensive than standard insulins, but may be used where the faster onset is necessary in line with diabetes guidelines
  • 06.01.01.01 Insulin Lispro 100 units/ml Humalog Kwikpen Junior®

    3mL prefilled pen (Junior KwikPen)

    • Delivers insulin in half unit increments (to a maximum of 30 units)
    06.01.01.01 Insulin porcine  Hypurin® Porcine Neutral 10mL vial
    3ml cartidge (for Autopen® Classic)
  • Existing patients only
  • 06.01.01.02 Insulin Zinc suspension Hypurin®Bovine Lente 10mL vial, 3ml cartridges.
  • Existing patients only.
  • Discontinued 2017 - possible availability until 2019
  • 08.02.04 Interferon Alfa-2a Roferon-A®

    Injection: as Vial, Cartridge, Prefilled syringe

    • At SFH not routinely stocked, but may be available on request
    • NB. different brands have different licensed indications
    • Roferon-A Prefilled Syringe 3miu and 6miu expected discontinuation date Sep 19
    • Roferon-A Prefilled Syringe 4.5miu expected discontinuation date Nov 19
    08.02.04 Interferon Beta-1a Avonex®

    Injection

    Approved in accordance with NICE TA527 for treating multiple sclerosis.

    Available through homecare for NUH patients. Please contact pharmacy medicines homecare team for further information

    08.02.04 Interferon Beta-1a Rebif®

    Injection:6 mega units in 0.5mL Prefilled syringe

    NUH only: Approved in accordance with NICE TA527 for treating multiple sclerosis.

    Available through homecare for NUH patients. Please contact pharmacy medicines homecare team for further information

    08.02.04 Interferon beta-1b Extavia®

    Injection

    NUH only (via homecare): Approved in accordance with NICE TA527, for treating multiple sclerosis.

    09.03 Intralipid 20%  Injection
  • For emergency management following inadvertent intravenous administration of local anaesthetic
  • 07.03.04 Intra-uterine Contraceptive Devices  Choice up to individual organisation. Multiload® Cu375NB preferred at NUH, but not routinely stocked. At SFH, Nova-T is stocked.
    07.03.02.03 Intra-uterine Progestogen Only System Mirena®

    Intra-uterine system

    • Prescribe by brand name to reduce risk of confusion between products.
    07.03.02.03 Intra-uterine Progestogen Only System Kyleena®
    • Low-dose levonorgestrel releasing IUS effective for 5 years. Only licensed for contraception.
    • Prescribe by brand name to reduce risk of confusion between products.

     

    07.03.02.03 Intra-uterine Progestogen Only System Jaydess®

    Intra-uterine system

    • For contraception only (APC July 2014).
    • Not recommended as first choice contraceptive for nulliparous women due to limited clinical experience.
    • Prescribe by brand name to reduce risk of confusion between products.
    07.03.02.03 Intra-uterine Progestogen Only System Levosert®
    • Levonorgestrel releasing IUS licensed for contraception and Heavy Menstrual Bleeding. 
    • May offer a cost- saving when used as an alternative to Mirena.
    • Prescribe by brand name to reduce risk of confusion between products.

     

    06.02.02 Iodine and Iodide  Oral Solution (Unlicensed)- Secondary Care only
  • Also known as Lugol's iodine
  • Used as a diagnostic agent in oesophageal cancer at NUH
  • A5.03.02 Iodoflex  On specialist advice. At NUH, wards to order from Pharmacy for each individual patient. Not routinely available at SFH.
  • Available as 5g and 10g
  • A5.03.02 Iodosorb  On specialist advice. At SFH for use only on recommendation of the Tissue Viability Team.
  • In secondary care, wards to order from Pharmacy for each individual patient.
  • Available as 10g ointment and 3g powder (powder not routinely available at SFH)
  • 20 Iohexol Omnipaque® 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
  • 20 Iopamidol Niopam®

    Injection

    • Radiographic contrast medium
    • licensed medicinal product
    08.01.05 Ipilimumab Yervoy®

    Intravenous Infusion

    Available at NUH only:

    • Approved in accordance with NICE TA268 - for previously treated advanced (unresectable or metastatic) melanoma
    • Approved in accordance with NICE TA319 for previously untreated advanced (unresectable or metastatic) melanoma
    • Approved in line with NICE TA400 for treating advanced (unresectable or metastatic) melanoma in adults in combination with nivolumab. Funding available by CDF for this combination until routine commissioning.
    • Approved in accordance with the National Cancer Drugs Fund List and NICE TA581 with nivolumab for untreated advanced renal cell carcinoma
    03.01.02 Ipratropium  Inhaler - preferrable to use with spacer, Autohaler, Nebules.
  • Short-acting antimuscarinic
  • 12.02.02 Ipratropium Bromide Rinatec® Nasal spray 0.03%
    02.05.05.02 Irbesartan  Tablets
  • For use in type 2 diabetic patients with hypertension and renal disease who have not tolerated the use of ACE-inhibitor
  • Tablets disperse in water if needed but they are poorly soluble. See here for general advice on dispersing tablets.
  • 08.01.05 Irinotecan Hydrochloride  Infusion
    NUH – Also purchase unlicensed pre-filled bags
    09.01.01.02 Iron Dextran CosmoFer®
  • IV or IM injection
    - Green: IM injection. See for instructions. Only for when no other route possible.
    - Red: IV injection / infusion
  • 09.01.01.02 Iron Isomaltoside Monofer®
  • IV only
    At NUH implemented for clinical trials use only
  • 09.01.01.02 Iron Sucrose Venofer®
  • For intermittant IV use only - Cannot be used for Total Dose Infusion.
  • Max 200mg per administration
  • Not for IM use
  • For use when intolerable of other forms of parenteral iron.
  • 05.02 Isavuconazole Cresemba® Capsules, Powder for Infusion
  • Available at NUH only - see restricted antimicrobials list
    IV isavuconazole must be administered using a giving set with an in-line filter – See NUH antimicrobial website for further information.
  • 15.01.02 Isoflurane  Anaesthetic
    13.02.01 Isomol® Liquid paraffin 15%, isopropyl myristate 15%

    Gel

    • Greasy level 3/4
    • Comparable to DoubleBase® gel. 
    05.01.09 Isoniazid  Tablet
    Elixir 50mg/5ml (unlicensed)
    Injection
  • See local guidelines. [SFH guideline][NUH guideline]
  • 06.01.01.02 Isophane Insulin Hypurin® Bovine Isophane 10mL vial
  • Existing patients only
  • Discontinued 2017 - possible availability until 2018
  • 06.01.01.02 Isophane Insulin Hypurin® Porcine Isophane 10mL vial, 3ml cartridge
  • Existing patients only
  • 06.01.01.02 Isophane Insulin Insulatard® 10mL vial, 3mL cartridge, InnoLet.
    06.01.01.02 Isophane Insulin Humulin® I 10mL vial, 3mL cartridge, 3mL prefilled pen (KwikPen)
    06.01.01.02 Isophane Insulin Insuman® Basal 5ml vial, 3mL cartridge for ClikSTAR, 3ml disposable pen - Solostar®
    02.07.01 Isoprenaline 

    Injection (secondary care only)

    • Named patient use (unlicensed)
    • (SFH) Isoprenaline Sulphate 2.25mg in 2ml available from ICCU and Cardiac Cathether Suit
    • Isoprenaline hydrochloride 1mg is equivalent to isoprenaline sulphate 1.125mg (from UCL guide). 
    02.06.01 Isosorbide Dinitrate  Injection- Isoket® (secondary care only)
  • At SFH injection is restricted for intracoronary use on Cardiac Catheter Suite. (For IV use GTN)
  • 02.06.01 Isosorbide Mononitrate  Tablet
  • Short acting preparations should be prescribed asymmetrically to reduce the risk of nitrate tolerance
  • Tablets disperse in water if needed. Do not crush MR preperations. See here for general advice on dispersing tablets.
  • 02.06.01 Isosorbide Mononitrate MR 

    Tablet

    • Long acting, once daily preparation
    • Preferred brands in primary care are Tardisc or Monomil
    13.06.02 Isotretinoin  Capsules
  • Red - Dermatology specialist only
  • Prescriptions for females of childbearing potential are only valid for 1 week and the maximum supply can only be 1 month. (Prescribers to indicate women are not of childbearing potential by endorsing prescription "not on PPP" and therefore can recieve more than 1 months supply.) See SPC section 4.4 for more details, or MEP section 3.3.12
  • SFH info - Peanut allergy: Roche brand, Ennogen brand and Ranbaxy brands are contraindicated in patients with peanut or soya allergy. Alliance generic version contains soya oil (small possibility of cross reaction if peanut allergic - See SPC). Cheapest will be dispensed unless "allergy to peanuts or - give Alliance brand only" is stated on the prescription.
  • 01.06.01 Ispaghula Husk 

    Granules

    • Adequate fluid intake is important to prevent obstruction (6 – 8 cups per day) and not to be taken immediately before bed.
    • Not suitable for frail patients who are unlikely to be able to drink the required volume of fluid.
    • Note: The fluid is quite thick and should be taken as soon as possible as it gets thicker on standing.
    • Time to effect is approximately 48 – 72 hours.
    • OTC Patients should be advised to purchase a suitable product over the counter for short term/infrequent constipation

    • May be prescribed if appropriate to in-patients; patients should be advised on discharge that further supply should be purchased
    05.02 Itraconazole  Capsule, Liquid
    02.06.03 Ivabradine  Tablet
  • Cardiology initiation only.
  • Cardiology specialist initiation only in line with NICE Clinical Guidance on stable angina for patients who remain symptomatic despite maximal doses of other anti-anginal medication.
  • Tablets can be dispersed in water if needed. See here for general advice on dispersing tablets.
  • 02.06.03 Ivabradine  Tablets
  • NICE TA 267: Ivabradine is recommended as an option for treating chronic heart failure for people:
    - with NYHA class II to IV stable chronic heart failure with systolic dysfunction and
    - who are in sinus rhythm with a heart rate of 75 bpm or more and
    - who are given ivabradine in combination with standard therapy including beta-blocker therapy, ACE inhibitors and aldosterone antagonists, or when beta-blocker therapy is contraindicated or not tolerated and
    - with a left ventricular ejection fraction of 35% or less.
  • Initiation:
    Amber 2 - specialist intiation. In line with NICE recommendations, Ivabradine for heart failure should be initiated by a heart failure specialist with access to a multidisciplinary heart failure team. Dose titration and monitoring should be carried out by a heart failure specialist, or in primary care by a heart failure specialist nurse. Ivabradine should only be initiated after a stabilisation period of 4 weeks on optimised standard therapy with ACE inhibitors, beta-blockers and aldosterone antagonists.
  • Titration and more information: See Nottinghamshire Heart failure lights.
  • Tablets can be dispersed in water if needed. See here for general advice on dispersing tablets.
  • 03.07 Ivacaftor 

    Tablets (supplied through homecare), Sachets

    • NUH:Approved in accordance with the commissioning policy for treatment of cystic fibrosis (CF) in patients aged two years and over who have at least one copy of nine named gene mutations (G551D, G178R, S549N, S549R, G551S, G1244E, S1251N, S1255P, G1349D) causing their cystic fibrosis.
    • - Cystic fibrosis in patients with the R117H gene mutation.
    • Available through homecare for NUH patients. Please contact pharmacy medicines homecare team for further information
    13.10.04 Ivermectin  Tablets 3 mg,6mg
  • Unlicensed medicine - named patient use only
  • Dermatology specialist only
  • SFH: Contact medicines information (3163)
  • 13.06 Ivermectin cream Soolantra®
  • 1% cream
  • 08.01.05 Ixazomib Ninlaro®

    Capsules

    • Approved in accordance with the National Cancer Drugs Fund List and NICE TA505 with lenalidomide and dexamethasone for treating relapsed or refractory multiple myeloma.
    13.05.02 Ixekizumab Taltz®

    Injection

    • Nottingham NHS Treatment Centre:
    • Approved for adults in accordance with NICE TA442 for treating moderate to severe plaque psoriasis.
    • Approved in accordance with NICE TA537 for treating active psoriatic arthritis after inadequate response to DMARDs.
    • SFH:  Used in accordance with NICE TA442.  However not routinely stocked therefore contact the high cost drugs team on ext 4660
    14.04 Japanese Encephalitis Vaccine Ixiaro® Injection
  • Not available on the NHS. May be given via private prescription if required for travel
  • Not routinely stocked in secondary care
  • 20 Joulies Oral Solution 

    Oral Solution
    Unlicensed medicine - named patient use only

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

    A5.08.04 K- Lite  In secondary care, wards to order direct from RDC
  • Available as 5cmx4.5m. 7cmx4.5m, 10cmx4.5m and 15cmx4.5m
  • A5.08.04 K- Lite Long  In secondary care wards to order direct from RDC
  • Available as 10cm x 5.25m
  • 13.08.02 Keromask®  Masking cream
    Finishing powder
  • Borderline substance
  • For disfiguring skin lesions (birthmarks, mutilating lesions, scars, vitiligo) only - prescription must state 'ACBS'
  • Non-formulary if not for ACBS approved indication
  • 15.01.01 Ketamine injection 
  • 3 strengths available: 10mg/ml (200mg/20ml), 50mg/ml (500mg/10ml) and 100mg/ml (1g/10ml)
  • NUH:Once existing stock of other strengths exhausted NUH will only use 500mg/10mL injection.
  • Classified Amber 2 for subcutaneous use initiated by Palliative Care Team in line with the palliative care formulary (PCF).
  • 04.07.03 Ketamine oral solution  Oral Solution 50mg/5ml - unlicensed product.
  • At SFH: Available as 300ml bottles, orange flavour (Or on request: 100ml vanilla )
  • From Dec 2015 classified as a schedule 2 controlled drug.
  • Restricted for pain management service or on the advice of palliative care team only.
  • Prescribing for patients under the care of palliative care teams may be continued by primary care after specialist initiation (classified Amber Traffic Light). Prescribing for other patients should remain in secondary care (classifed Red Traffic Light).
  • SFH outpatients should be sent to SFH pharmacy for supplies of unlicensed medicines. Don’t prescribe on FP10HP.
  • 13.09 Ketoconazole 

    Shampoo 2% 120mL

    • OTC Patients should be advised to purchase over the counter

    • May be prescribed if appropriate to in-patients; patients should be advised on discharge that further supply should be purchased
    13.10.02 Ketoconazole 

    Cream 2% 30g

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

    06.01.06 Ketones test strips 

    Reagent strips, for detection of ketones in urine, available at NUH:

    • Ketostix®

    Reagent strips, for detection of ketones in urine, available at SFH:

    • Ketostix®
    • Ketur Test®

    Reagent strips, for detection of ketones in blood, available at SFH:

    • Freestyle Optium H® β-ketone

    Reagent strips, for detection of ketones in blood, available at NUH:

    • FreeStyle Precision Pro ß-Ketone Test Strips
    11.08.02 Ketorolac Acular®

    Eye drops 0.5% 5ml. Preserved. (~£3)

    • Amber 2 specialist initiation - adult ocular surgery patients post-operatively
    15.01.04.02 Ketorolac Toradol® Injection
  • Hospital Only. Injection available for IV and IM use only. Tablets are non-formulary
  • NUH: Used at QMC campus
  • 11.04.02 Ketotifen Ketofall® Ketofall® preservative free UDVs
    A5.08.08 K-Flex Long 
  • Direct from RDC in secondary care
  • Available as 10cmx7m
  • A5.08.08 K-Four Reduced Compression® 
  • Direct from RDC in secondary care
  • Available as >18cm
  • A5.08.08 K-Four® 
  • Direct from RDC in secondary care
  • Available as 18-25cm, 25-30 cm and >30cm
  • A2.03.02 Kindergen®  
    • On dietician recommendation only
    A5.08.02 Knitband  Replaces Easifix K as per SFH 2016 dressings formulary.
    A5.08.08 Ko-Flex 
  • Direct from RDC in secondary care
  • Available as 10cmx6m
  • 4th layer of K-Four kit
  • A5.08.08 K-Plus Long 
  • Direct from RDC in secondary care
  • Available as 10cmx10.25m
  • A5.08.08 K-Plus® 
  • Direct from RDC in secondary care
  • Available as 10cmx8.7m
  • 3rd layer of K-Four kit
  • A5.08.08 K-ThreeC®  
  • Direct from RDC in secondary care
  • Available as 10cmx3m
  • Part of the K-Four system for ankles >25cm
  • A5.08.08 K-Two Reduced ® 
  • Direct from RDC in secondary care
  • Available as 18-25cm (10cm width) and 25-32 cm (10cm width)
  • A5.08.08 K-Two® 
  • Direct from RDC in secondary care
  • Available as 18-25cm (10cm width) and 25-32 cm (10cm width)
  • 02.04 Labetalol 

    Tablet, (Injection - secondary care only)

    • Tablets disperse in water if needed but administer immediately as the drug is sensitive to oxidisation. See here for general advice on dispersing tablets.
    • Temporary supply expected problems until mid-May 2019 - UKMI Advice Here
    • SFH: Localised advice Here
    04.08.01 Lacosamide  
    • Tablets, Syrup, Infusion.
    • Intractable partial epilepsy in adults when other adjuvant agents have failed or have not been tolerated.
    • Secondary care to prescribe the first six months of treatment, but GPs may then continue prescriptions.
    20 Lactose powder  For hydrogen breath tests in endoscopy.
    01.06.04 Lactulose 

    Solution

    • Lactulose is not recommended for treatment of constipation in adults because many patients find it unpalatable.
    • Docusate is a similar softening laxative which is more palatable.
    • Lactulose is still included in the formulary for other indications e.g. hepatic encephalopathy.
    • Lactulose is commonly underdosed. BNF dose: constipation: 15ml bd and adjust according to patient needs. (May take up to 48hours to act)
    • OTC Patients should be advised to purchase a suitable product over the counter for short term/infrequent constipation

    • May be prescribed if appropriate to in-patients; patients should be advised on discharge that further supply should be purchased
    05.03.01 Lamivudine Epivir®

    Tablet, Oral Solution

    • For HIV infection in combination with other antiretroviral drugs
    • Restricted to ID / GU Medicine advice only
    • Available through homecare for NUH patients. Please contact pharmacy medicines homecare team for further information
    05.03.01 Lamivudine Zeffix®

    Tablet, Oral Solution- NUH only

    • For chronic hepatitis B infection
    • Restricted to ID / GU Medicine advice only
    • Available through homecare for NUH patients. Please contact pharmacy medicines homecare team for further information
    04.02.03 Lamotrigine  Specialist initiation only
    Lamotrigine is now licensed for the prevention of depressive episodes in patients with bipolar I disorder who experience predominantly depressive episodes. A slow six week dose titration regimen is recommended in BNF/product SPC to reduce the risk of serious skin rash. Lower doses are required when co-prescribing with valproate.
    04.08.01 Lamotrigine 
    • Tablet, dispersible tablet
    • May be appropriate for specialist GP to initiate or any GP to prescribe whilst awaiting hospital referral
    08.03.04.03 Lanreotide Somatuline Autogel®

    Injection - Prefilled syringe.

    • Restricted for use in Neuroendocrine Tumours and Acromegaly- Consultant endocrinologist and oncologist request only.
    • At SFH: Patient access scheme exists - first dose is replaced for free. Contact Pharmacy stores or Medicines Information for further information.
    01.03.05 Lansoprazole 
    • Capsules first line. 15mg and 30mg (approx £2/month).
    • Capsules can be opened and beads swallowed without crushing, or can be mixed with food or drink.
    • FasTab (approx £5/month) restricted for use in patients with swallowing difficulties or who are on enteral tube feeding. They are also licensed to be given via a NG tube or oral syringe if diluted in 5-10ml water.
    • OTC Patients may be advised to purchase a suitable product over the counter

    09.05.02.02 Lanthanum Fosrenol ® Tablet (chewable), oral powder
  • Prescribe and monitor as per shared care protocol for phosphate binders
  • Restricted as 3rd line phosphate binder: used for patients intolerant of calcium containing phosphate binders or those with baseline hypercalcaemia or who develop hypercalcaemia and/or suppressed PTH levels on calcium containing binder therapy.
  • 08.01.05 Lapatinib Tyverb® Tablets
  • Approved in accordance with the National Cancer Drugs Fund List for the indication(s) below where the specified criteria are met:
  • The treatment of advanced breast cancer. To be removed from the CDF list on 12th March 2015. Remains on formulary for patients with funding approved prior to this date.
  • NUH: For more information, including criteria, see the DTC website; available here
  • Confirm funding approved on BlueTeq for all new starters.
  • At SFH, contact High Cost Drugs team (ext 4657).
  • Direct discount Patient access scheme applies.
  • 20 LAT gel  Gel (unlicensed)
  • SFH only. For use when cleaning/ suturing wounds in children in ED
  • Contains lidocaine 4%, adrenaline 0.1% and tetracaine 0.5%
  • 11.06 Latanoprost 

    Eye drops 0.005%

    • Preserved latanoprost is generic and now first choice (£2pm).
    • Preservative free (Monopost®) available for patients who require a preservative free prostaglandin (in unequivocal preservative toxicity / allergy cases)(£8pm).
    11.06 Latanoprost with Timolol 
    • Prescribe generically (£2.50pm).
    • Xalacom® brand is Non-formulary (£14pm)
    • For preservative free use Fixapost ® UDVs (£13.50)
    05.03.03.02 Ledipasvir and Sofosbuvir Harvoni® Tablet
    Only commissioned through specialist centre. Must be prescribed and dispensed at NUH.
    Prior approval via Blueteq system required
    Approved in accordance with:
  • NICE TA363 for the treatment of chronic hepatitis C
  • commissioning policy (NHS England B07/P/a)
  • 10.01.03 Leflunomide  Tablet
    08.02.04 Lenalidomide 

    Capsules.


    Also approved in accordance with the National Cancer Drugs Fund List:

    • For the second line treatment of multiple myeloma where the specified criteria are met. Was removed from the CDF list on 4th November 2015. Remains on formulary for patients with funding approved prior to this date.
    • For the treatment of myelodysplastic syndromes (MDS) associated with a deletion 5q abnormality where the specified criteria are met.
    • Available at NUH only with dexamethasone for multiple myeloma after 1 treatment with bortezomib
    • Available at NUH only with dexamethasone for previously untrated multiple myeloma.
    • Confirm funding approved on BlueTeq for all new CDF starters.
    • Prescription authorisation and records needed
    • Patient access scheme exists
    • Hepatic disorders: See company mailing and MHRA advice.

    At NUH:
    For more information, including criteria, see the DTC website; available here


    At SFH:

    • On receipt of prescriptions contact HCD team (4657) before screening. Please see procedure in S:/staff/HCD folder.
    • Lenalidomide in Myeloma XI trial (See link below for regimens): may be screened by any pharmacist who has completed the oral chemotherapy validation.
    09.01.06 Lenograstim Granocyte® Injection prefilled syringe
    Injection vial - used in clinical trials
  • NUH only
  • NUH: Granocyte® (lenograstim) should only be used as part of a specific protocol for the mobilisation of stem cells; consult clinical haematology for prescribing advice.
  • NUH: Used in paediatrics for cytotoxic induced neutropenia
  • 08.01.05 Lenvatinib Lenvima®

    Capsules (Prescribe by brand)

    Approved in accordance with NICE TA535 for treating differentiated thyroid cancer after radioactive iodine.

    Approved in accordance with the Cancer Drugs Fund and NICE TA551 (expected entry in to baseline commissioning on 19th March 2019) for untreated advanced hepatocellular carcinoma

    08.01.05 Lenvatinib Kisplyx®

    Capsule (Prescribe by brand)

    NUH: Approved with everolimus (Afinitor®) for previously treated advanced renal cell carcinoma in accordance with NICE TA498.

    02.06.02 Lercanidipine  tablets
  • Second line option. Amlodipine first line
  • 08.03.04.01 Letrozole  Tablet
  • Restricted to consultant recommendation only
  • Amber 2 for breast cancer
  • A5.07.03 Leukoplast Sleek  In secondary care should be ordered direct from RDC
  • Available as 2.5cmx5m, 5cmx5m, 7.5cmx5m, 10cmx5m and latex free versions in 1.25cmx5m
    2.5cmx5m, 5cmx5m and 7.5cmx5m.
  • 08.03.04.02 Leuprorelin Acetate Prostap® 3 Injection 11.25mg- 3 monthly
  • Triptorelin is GnRH analogue of choice for all indications except breast cancer. Leuprorelin for SC injection is restricted to patients in whom IM injections should be avoided, eg those on anticoagulants (May 2014).
  • 20 LEVAMISOLE Tablets 50 mg  Unlicensed medicine - named patient use only
    04.08.01 Levetiracetam 

    Tablet, Oral solution, Infusion, Granules

    • Resticted for neurology and paediatric use only
    • Contact your medicines management team for the most cost effective formulation if patients are unable to swallow tablets. Tablets disperse in water if needed but have a bitter taste. See here for general advice on dispersing tablets.
    • When given IV, required dose of concentrate for infusion should be diluted in 100ml of sodium chloride 0.9% and given over 15 minutes.
    • Levels not usually needed. [More details here]
    • SFH palliative care specialists may recommend levetiracetam in a subcutaneous syringe driver over 24 hours for selected patients. The PO:SC dose ratio is 1:1 and WFI is used as a diluent. Due to a lack of official compatibility data it is usually be administered alone in it's own syringe driver. Seek pharmacy advice before using any combination in a single driver.
    15.02 Levobupivacaine Chirocaine® Available as:
    - Injection 25mg/10mL (0.25%)
    - Injection 50mg/10mL (0.5%)
    - Injection 75mg/10mL (0.75%)
    - Epidural 250mg/200mL (0.125%) (200mL)
  • NUH only: Injections are also available from Fresenius Kabi for restricted areas (see memo)
  • SFH only: Fresenius Kabi stock preferred. Use Chirocaine® for Paeds and Opthalmology.
  • 15.02 Levobupivacaine with Fentanyl  Available as:
    - Epidural - Levobupivacaine 0.1% with Fentanyl 2micrograms in 1mL (250mL)
    - Epidural - Levobupivacaine 0.1% with Fentanyl 2micrograms in 1mL (prefilled syringe - 50mL - obstetric use at NUH only.
    09.08.01 Levocarnitine Carnitor® Formerly known as carnitine
    Tablets
    Paediatric solution 300mg in 1mL
    Oral liquid 100mg/ml
  • Amber 2 (specialist recommendation)- Oral licensed products for the treatment of carnitine deficiency
  • Injection 200mg in 1mL - red traffic light classification. SFH: available from the paediatric metabolic drug box on NNU. NUH: available from the paediatric metabolic box on D33
  • 05.01.12 Levofloxacin 

    Tablet, Infusion
    Oral Solution (NUH Only) - Unlicensed medicine - named patient use only

    • May be prescribed in primary care following reported sensitivities
    • Tablets disperse in water if needed but some brands have a flaky coating which makes this difficult and it takes a few minutes for the coating to dissolve when mixed with water. See here for general advice on dispersing tablets.
    • Oral bioavailability is 99%. Always use oral when route available.
    • See local guidelines. [SFH guideline][NUH guideline][Primary Care guidelines]
    • May not be used for inhalation in Cystic Fibrosis without an individual funding request being approved.
    •   NUH Only oral solution for acute mastoiditis in paediatric patients who have a severe penicillin allergy
    05.01.12 Levofloxacin Quinsair®

    Nebules

    NUH: Approved in accordance with the NHS England commissoning policy (NHS England Reference: 170078P) for chronic Pseudomonas lung infection in cystic fibrosis (adults).

    11.03.01 Levofloxacin  Eye drops (0.5%) preservative free single use.
  • Restricted for use where preservative free 4-fluoroquinolone prep required.
  • 13.03 Levomenthol  

    Cream 

    • Try an emollient cream first- creams for itching can work better if kept cold in the fridge.
    • At SFH: Dermacool® 1% 500g (~£20)
    • At NUH: manufactured by Pharmacy Non Sterile Production Unit
    04.02.01 Levomepromazine  See entry in
    section 4.6

    04.06 Levomepromazine  -Tablets 25mg. £0.26 per tablet (scored for doses of 12.5mg and can be quartered for doses of 6.25mg)
    -Tablets 6mg. £2.40 per tablet! NUH only (Unlicensed- named patient use only).
    -Injection
  • Palliative care use only
  • Tablets disperse in water if needed. See here for general advice on dispersing tablets.
  • Used to be called methotrimeprazine
  • 07.03.05 Levonorgestrel 

    Tablet

    • First choice emergency contraception is insertion of a copper intrauterine device. Refer to family planning services where appropriate.
    • If this is declined, choice of oral emergency contraception should be based on FSRH guidance - see algorithm on page 10.
    • Preferred brand for emergency contraception in primary care is Upostelle®. Other less cost effective brands include Levonelle®, Ezinelle® and Melkine®.
    20 Levosimendan Simdax®

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

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

    06.02.01 Levothyroxine 

    Tablets, Oral solution

    • Tablets disperse in water if needed (not licensed). See here for general advice on dispersing tablets.
    • Oral solution is available, but very expensive (approx £150+ per month). Click here for more info.
    • IV thyroxine no longer available. See below entry for IV liothyronine.
    02.03.02 Lidocaine  Secondary Care only
    Injection
    Minijet 2%
    Infusion (in 5% glucose)
    15.02 Lidocaine  Injection 0.5%, 1% and 2%
    15.02 Lidocaine  

    Medicated plasters (Ralvo® is preferred brand in primary care)

    • Amber Amber 2 - on Pain Management Service recommendation only for localised neuropathic pain due to post herpetic neuralgia (PHN) only where oral treatments and capsaicin have been ineffective or are contraindicated. See Neuropathic Pain Guideline.
    • Red Red - for other conditions, may only be prescribed in exceptional circumstances and by pain specialist doctors.
    • On the Nottinghamshire list of Medicines & Appliances of Limited Clinical Value.
    15.02 Lidocaine 

    Spray 10%

    Supply problems until at least March 2018. UKMI Guidance

    15.02 Lidocaine 
  • 15g tube (£5)
  • For external use on nipples, genitals, gums etc.
  • For intact skin use EMLA® or Ametop® instead.
  • Weaker versions which may be more appropriate for mouth ulcers are dentinox teething gel (0.33% lidocaine) or Instillagel (2% lidocaine, tastes foul)
  • 15.02 Lidocaine  Topical solution 4%
  • Unlicensed special
  • Current SFH supplier manufactures a red solution (March 2017)
  • 12.03.01 Lidocaine 10% mouth spray 

    unlicensed indication

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

    • May be prescribed if appropriate to in-patients; patients should be advised on discharge that further supply should be purchased
    15.02 Lidocaine 2.5% with Prilocaine 2.5% EMLA®

    Cream

    • EMLA licensed for all ages except pre-term neonates- see SPC for dosing advice, Ametop licensed for >1 month old. EMLA apply for 1 - 5hr, then remove before use. 
    15.02 Lidocaine 4% cream LMX4®
    • For local anaesthesia only
    15.02 Lidocaine 5% and Phenylephrine 0.5%  Topical solution (with nasal applicator)
    12.03.01 Lidocaine 5% ointment 

    15g tube (£5)

    • For external use on nipples, genitals, gums etc.
    • For intact skin use EMLA® or Ametop® instead.
    • Weaker versions which can also be used for mouth ulcers are dentinox teething gel (0.33% lidocaine) or Instillagel (2% lidocaine, tastes foul)
    • OTC Patients should be advised to purchase a suitable product over the counter

      • SFH guide to all mouthcare products
    12.03.01 Lidocaine and Cetylpyridinium Dentinox® Teething Gel

    Gel - Lidocaine 0.33% and Cetylpyridinium Chloride 0.1%

      • OTC Patients should be advised to purchase over the counter

     

     

    12.03.01 Lidocaine and Chlorhexidine Instillagel®

    Contains Lidocaine 2%, Chlorhexidine 0.25%

    • In the mouth is an unlicensed indication and it tastes foul.
    • Other versions which can be used for mouth ulcers are dentinox teething gel (0.33% lidocaine) or in extreme circumstance 5% lidocaine ointment.
    • OTC Patients should be advised to purchase a suitable product over the counter

    • May be prescribed if appropriate to in-patients; patients should be advised on discharge that further supply should be purchased
    12.03.01 Lidocaine and Phenylephrine Cophenalcaine® Spray- specialist use only
    15.02 Lidocaine with Adrenaline Xylocaine®

    Injection - Lidocaine 1% with Adrenaline 1 in 200,000

    Injection - Lidocaine 2% with Adrenaline 1 in 200,000
    Injection - Lidocaine 0.5% with Adrenaline 1 in 200,000 - unlicensed special as product discontinued

    • During supply problems adrenaline can be added to the lidocaine. To 20ml of lidocaine (either 1% or 2%) add 1ml of 1 in 10,000 adrenaline to give 1:200,000 adrenaline).
    • Bupivacaine and adrenaline may be an alternative.
    15.02 Lidocaine with Adrenaline Lignospan® Injection - Lidocaine 2% with Adrenaline 1 in 80,000
    15.02 Lidocaine2% with Chlorhexidine 0.25% Instillagel®, Hydrocaine®
    • Contact Medicines management team for most cost effective brand.
    • At SFH, Hydrocaine gel is used which is available via stores (not Pharmacy)
    01.06.07 Linaclotide 

    Capsules

    • Supply problem in UK until mid May 2019.
    • Indicated for patients with moderate to severe IBS-C which has not responded adequately to or can not tolerate all other suitable treatment options as per algorithm.
    • Initiated and prescribed by consultant gastroenterologist for the first 8 weeks of treatment.
    • Consultant gastroenterologist to review at 8 weeks to assess efficacy and tolerability.
    • Consultant gastroenterologist to complete audit form for each patient (one year audit starting from May 2014).
    • GP to be requested to prescribe ongoing treatment after 8 weeks if patient gaining significant benefit.
    • GP to review patient every 3 months and stop linaclotide if patient no longer benefiting from treatment.
    06.01.02.03 Linagliptin Trajenta®

    Tablets

    05.01.07 Linezolid  Tablet, Infusion
  • Restricted antibiotic - microbiologist recommendation only
  • CHM advice: Full blood counts to be monitored weekly (see SPC for details - click yellow link below the drug name)
  • CHM advice: Severe optic neuropathy may occur rarely, particularly if linezolid is used for longer than 28 days. Advise patients to report any visual symptoms immediately. Patients who require >28 days therapy should have regular formal visual assessments
  • See local guidelines. [SFH guideline][NUH guideline]
  • 06.02.01 Liothyronine (IV) 

    Injection (for tablets see non-formulary section below)

    • Expensive (£376 per 20microgram dose). For hypothyroid crisis should only be used request of consultant endocrinologist. Levothyroxine has very long half life (~7 days) so temporary IV replacement if NBM is not needed. 

    Available at NUH only:

    • For use for temporary replacement of levothyroxine, when scheduled to have nuclear medicine scan of the thyroid gland and it is not possible to come off oral levothyroxine.
    20 Lipiodol 

    Historically used during endoscopy in conjunction with cyanoacryalate glue.

    08.01.02 Liposomal Cytarabine-Daunorubicin Vyxeos®

    Infusion

    Available at NUH only: Approved in accordance with the Cancer Drugs Fund and NICE TA552 (expected entry in to baseline commissioning from 19th March 2019) for untreated acute myeloid leukaemia.

    13.10.05 LiquiBand®  Tissue adhesive
  • Available from RDC, not Pharmacy
  • 13.02.01 Liquid and White Soft Paraffin Ointment (50:50)  Ointment
  • Greasy level 4/4 (most greasy)
  • 20 LIQUID PARAFFIN sterile light (20mL or 25ml)  Unlicensed medicine - named patient use only
    A2.04.01.02 Liquigen®  
    • Paediatric use
    • On dietician recommendation only
    06.01.02.03 Liraglutide Victoza®

    Injection as 6mg/ml prefilled pen

    • Amber 2 - Specialist initiation for the treatment of diabetes in line with Nottinghamshire APC diabetes treatment guidelines.
    • Prescribe by brand (Victoza®) to avoid patients inadvertently receiving a different product licensed for obesity
    • Restricted to dose of 1.2mg only (1.8mg dose is non-formulary and classified grey, Nov 18 APC)
    • Use for the treatment of obesity is non-formulary and classified grey (no formal assessment).
    04.04 Lisdexamfetamine Elvanse® Tablets
    -for use within NottsHC and Community Paediatrics at SFH trust only.
    - at other organisations i.e NUH. Internal funding has not been approved. No new patients to be started.
    02.05.05.01 Lisinopril 

    Tablet, Oral solution (5mg/5ml)
    2nd line choice

    • Tablets disperse in water if needed (not licensed). See here for general advice on dispersing tablets.
    • Oral solution available but very expensive (>£300 for 28 days, DT May18).
    04.02.03 Lithium Carbonate Priadel® Tablet MR 200mg (5.4mmol Li+), 400mg (10.8mmol Li+)
  • Preferred brand for new patients
  • Prescribing guidance should accompany request for primary care to prescribe.
  • 20 LITHIUM CHLORIDE 

    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"
    04.02.03 Lithium Citrate 

    Available as:

    - Priadel® Liquid 520mg (approx 5.4mmol Li+) in 5ml.
    - Li-Liquid® Liquid 509mg (5.4mmol Li+) in 5ml. (Not stocked at SFH)

    • Prescribe the (Li-Liquid/Priadel Liquid brands) liquid formulation as a twice daily dose to minimise peak plasma levels. See table of liquid medicines requiring dose adjustment 
    • Prescribing guidance should accompany request for primary care to prescribe.
    • Approx equivalents, but avoid unecessary switching: Li-Liquid 509mg/5ml = Priadel Liquid 520mg/5ml = Priadel 200mg tablet.
    20 LITMUS PAPER 

    SFH information only:

    06.01.02.03 Lixisenatide Lyxumia®

    Subcutaneous injection

    A2.03.01 Locasol® 
  • On Dietician Advice only
  • 11.04.02 Lodoxamide Alomide®

    Eye drops 0.1%

    OTC Patients should be advised to purchase a suitable product over the counter first line for allergy symptoms

    04.03.01 Lofepramine 

    Tablet
    Oral suspension

    • Lofepramine is safer in overdose and less cardiotoxic than older TCADs and is the first-choice agent in this section.
    • Supply issue for tablets (December 2018). Consider switch to liquid formulation until tablets available.
    04.10.03 Lofexidine BritLofex®

    Tablet

    • Short-term use in opioid detoxification.
    • Temporary withdrawal may lead to stock shortages - May 2018
    08.01.01 Lomustine  Capsule (Unlicensed)
    01.04.02 Loperamide 
  • Capsule and syrup (1mg in 5ml) available.
  • Paediatric liquid special (unlicensed) available on request. Not traffic light classified. NUH only use their Non Sterile Manufacturing (NSM) 1mg in 1mL suspension in neonates.
  • 05.03.01 Lopinavir and Ritonavir Kaletra®

    Tablet, Liquid

     

    Available through homecare for NUH patients. Please contact pharmacy medicines homecare team for further information

    03.04.01 Loratadine 

    Tablet, Syrup

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

    • May be prescribed if appropriate to in-patients; patients should be advised on discharge that further supply should be purchased
    04.01.02 Lorazepam 

    Tablet, oral solution (see below), Injection.

    • Tablets dissolve under the tongue if the patient has a sufficiently moist mouth (ref. NEWT Guide to enteral feeding and swallowing difficulties). Licensed oral solution (1mg/1mL) available if absolutely necessary, but is expensive (>£100 for 150ml), expires 3 months after first opening.
    • Tablets disperse in water if needed. See here for general advice on dispersing tablets.
    • The Genus brand is preferred if sublingual administration or doses of 500 micrograms are required (tablets are scored). (Supply problems Nov 2018 - other scored brands available but disperse slower)
    • Store injection in fridge.
    • Dilute Ativan® UK brand with an equal volume of WFI or 0.9% NaCl before i.m. injection. Hospira and Baxter brands (unlicensed imports from US) should NOT be diluted before IM administration - see individual box leaflets.
    04.08.02 Lorazepam 
    15.01.04.01 Lorazepam  Injection 4mg/ml, tablets, oral solution (see bleow).
  • Tablets dissolve under the tongue if the patient has a sufficiently moist mouth (ref. NEWT Guide to enteral feeding and swallowing difficulties). Licensed oral solution (1mg/1mL) available if absolutely necessary, but is expensive (>£100 for 150ml), expires 3 months after first opening.
  • Tablets disperse in water if needed. See here for general advice on dispersing tablets. Unlicensed liquid special can be made specially if required.
  • See here for other uses.
  • 18 Lorazepam 

    Injection

    • Convulsions or agitation related to overdose / poisoning.
    • See section 4.1.2 for other indications or more details
    02.05.05.02 Losartan 

    Tablets, Oral suspension (2.5mg/ml)

    • 1st line choice ARB if patients haven't tolerated an ACE inhibitor
    • Licensed for Renal protection in type 2 diabetic patients with nephropathy (macroalbuminuria) (unlike candesartan).
    • Oral suspension available (£53 for 200ml, DT May18).
    • Tablets disperse in water if needed (not licensed). See here for general advice on dispersing tablets.
    11.04.01 Loteprednol Lotemax® Eye drops 0.5%
  • Post-operative inflammation following occular surgery in patients with glaucoma or known steroid responder
  • A2.06.02 Low protein / phenylalanine free foods 
  • Discuss with Dietitian
  • A2.07 Low protein / phenylalanine free foods 
  • Discuss with Dietitian
  • A2.07 Low protein / phenylalanine free foods 
  • Discuss with Dietitian
  • 20 Lubricating gel 
  • Available in 5g sachets and 42g tubes
  • 03.07 Lumacaftor + Ivacaftor Orkambi® Tablets
    NUH only: Approved in accordance with compassionate use scheme for the treatment of cystic fibrosis
    04.02.01 Lurasidone Latuda® Tablets
  • To be intiiated on specialist advice for the long-term treatment of “non-treatment resistant” schizophrenia where patients have not been able to tolerate other antipsychotics, including a trial on aripiprazole or where patients have a preference for this drug.
  • 08.03.04.03 Lutetium (177Lu) oxodotreotide Lutathera®

    Infusion - radiopharmaceutical

    NUH: Approved in accordance with NICE TA539 for treating unresectable or metastatic neuroendocrine tumours.  Patients will be referred to Birmingham to receive treatment.

    05.01.03 Lymecycline  Capsule
    13.06.02 Lymecycline Tetralysal®300

    Capsule

    A5.02.05 Lyofoam T SSL 
  • Available as 9x6.5cm
  • Not available on FP10- for FP10 options see Permafoam and Trachi-Dress
  • 18 Macrogol '3350' Klean-Prep® Oral powder (polyethylene glycol)
  • Discussion with National Poisons Information Service recommended
  • Used for whole bowel irrigation for agents not bound by activated charcoal e.g. iron, lithium
  • Also used for whole bowel irrigation for bodypackers and for slow release medicines
  • for standard uses see section 1.6.5
  • 01.06.04 Macrogol oral powder  OTC Patients should be advised to purchase a suitable product over the counter for short term/infrequent constipation. May be prescribed if appropriate to in-patients; patients should be advised on discharge that further supply should be purchased.
    • Preferred adult brands in primary care are Laxido® and Cosmocol®.
    • Preferred paediatric brand in primary care is Laxido® Paediatric Plain.
    • Movicol® is less cost effective.
    01.06.05 Macrogols Moviprep® Restricted to use as bowel prep prior to colonoscopy. Oral powder sachets.
  • Traffic light classification = green when used pre-procedure.
  • Patient guides for procedures at different times of the day: [Morning] [Afternoon] [Evening]
  • 01.06.05 Macrogols Klean-Prep® Oral powder
  • Traffic light classification = green when used pre-procedure.
  • 09.05.01.03 Magnesium Aspartate Magnaspartate® Sachets
  • Amber 3 in line with SFH/NUH guidelines
  • Contain 10mmol magnesium per sachet
  • Link to SPC
  • 09.05.01.03 Magnesium citrate  Tablet (unlicensed special)
  • Available at SFH, but magnaspartate now preferred as per SFH hypomagnesaemia guideline
  • Contains 6.2mmol magnesium per 150mg tablet (MagAsorb®)
  • No liquid available, but tablets disperse in water if needed. See here for general advice on dispersing tablets. Alternatively use magnesium hydroxide mixture.
  • May be available via retail chemists, but will need to be told it comes from "Lamberts Healthcare" and the cost can be extortionate.
  • 09.05.01.03 Magnesium Glycerophosphate  Chewable Tablet
  • For existing patients with short bowel or new patients who cannot tolerate magnesium aspartate. Gastro consultant recommended.
  • Contains 4mmol magnesium per tablet
  • Suspension (e.g. 4mmol/5ml) can be made in non-sterile manufacturing at NUH (unlicensed)
  • Tablets disperse in water if needed. See here for general advice on dispersing tablets.
  • See NUH hypomagnesaemia guideline below
  • 20 MAGNESIUM GLYCEROPHOSPHATE powder 350g  Unlicensed medicine - named patient use only
    NUH only
    09.05.01.03 Magnesium Hydroxide Mixture BP   Liquid
  • Contains 14 mmol magnesium in 10ml
  • Restricted to use as an option if patients are unable to take tablets for magnesium replacement
  • Non-formulary for treatment of constipation
  • 09.05.01.03 Magnesium Sulphate  Injection 20% (1mL = approx 0.8mmol Mg)
    Injection 50% (1mL = approx 2mmol Mg)
  • See local hypomagnesaemia guidance below
  • 20 MAGNESIUM SULPHATE 10% INFUSION  Unlicensed medicine - named patient use only
    NUH only
    See Chapter 9 for other parenteral magnesium preparations
    01.01.01 Magnesium Trisilicate Mixture BP 

    Suspension

    • Link to SPC
    • OTC Patients should be advised to purchase over the counter

    • May be prescribed if appropriate to in-patients; patients should be advised on discharge that further supply should be purchased
    13.10.04 Malathion 0.5% Derbac-M®

    Aqueous solution 50mL

    June 2019 - Recently reformulated, so manufacturer awaiting MHRA authorisation. Unavailable to order until at least August 2019.

    • Traditional insecticide
    • For crab lice, head lice, and scabies
    • OTC Patients should be advised to purchase over the counter

    • May be prescribed if appropriate to in-patients; patients should be advised on discharge that further supply should be purchased
    02.02.05 Mannitol 

    May 2018: 15% available (was previously 20% as standard)

    • Infusion- due to the risk of crystallization use an administration set with an in-line filter (most of them contain filters).
    • Solution - used in radiology at NUH, named patient use only.
    20 Mannitol Osmohale®

    Inhalation powder (supplied in hard capsules)

     For use in respiratory clinic for diagnosis.

    03.07 Mannitol inhalation Bronchitol ®

    Dry powder for inhalation
    NUH: Restricted for cystic fibrosis in line with NICE guidance and commissioning policy

    Available through homecare for NUH patients. Please contact pharmacy medicines homecare team for further information

    05.03.01 Maraviroc Celsentri®

    Tablet

    • Restricted to GU med only
    • NUH approved for adults
    • Available through homecare for NUH patients. Please contact pharmacy medicines homecare team for further information
    A2.04.01.01 maxijul® Super Soluble 
  • On dietician advice only
  • 50grams is approximately 5 heaped dessert spoons OR 11-12 heaped teaspoons
  • 14.04 Measles, Mumps and Rubella Vaccine, Live (MMR)  Injection
  • Brands include Priorix, MMRVaxPro.
  • The vaccines are interchangable in the schedule.
  • 05.05.01 Mebendazole 

    Tablet
    Suspension

    • OTC Patients should be advised to purchase over the counter for adults and children over 2 years

    01.02 Mebeverine 

    Tablet, 135mg tablets only.

    • Tablets can be crushed and dispersed in water if needed (not licensed). Bitter taste will need masking. See here for general advice on dispersing tablets.
    • Note that a licensed oral suspension is available but is extremely expensive (>£600 for 28 days, DT May18).
    A5.03.01 Medihoney 
  • Replaced Activon in the SFH 2016 dressings formulary.
  • A5.03.01 Medihoney Apinate 
  • Replaced Algivon (Alginate) in the SFH 2016 dressings formulary.
  • A5.03.01 Medihoney Tulle  
  • Replaced Actilite in the SFH 2016 dressings formulary.
  • 08.03.02 Medroxyprogesterone Provera®

    Tablet

    • Tablets disperse in water if needed. See here for general advice on dispersing tablets. If crushing do so in water to reduce production of dust
    • Amber 2 for endometrial, prostate, breast and renal cell cancer
    06.04.01.02 Medroxyprogesterone Acetate Provera® Tablet
    07.03.02.02 Medroxyprogesterone Acetate Depo-Provera® Intramuscular injection
  • Green - when used as per UK Medical Eligibility Criteria
  • full counselling backed by the patient information leaflet required
  • 07.03.02.02 Medroxyprogesterone acetate Sayana Press® Subcutaneous injection
  • See link below for a "Quick Guide" to administration. More detailed instructions are in the Patient Information Leaflet.
  • 05.04.01 Mefloquine Lariam®

    Tablet

    • For the treatment of malaria only.
    • Grey for use as malaria prophylaxis during overseas travel is On the Nottinghamshire list of Medicines & Appliances of Limited Clinical Value that should never be prescribed. Supply is only available through private prescription.
    • May induce potentially serious neuropsychiatric disorders.
    08.03.02 Megestrol Megace®

    Tablet

    • If needed tablets can be dispersed in water. More Info
    • 40mg tablets discontinued March 2008. 160mg tablets still available, and are scored.
    • Amber 2 for endometrial and breast cancer
    04.01.01 Melatonin Adult Critical Care Capsules 1mg, 2mg, 3mg, 5mg, 10mg (all unlicensed)
    NUH only:
  • Review prior to discharge from Critical Care.
  • If needed capsules can be opened and the contents dispersed in water, milk, yoghurt or fruit juice for administration (More Info)
  • 04.01.01 Melatonin 

    MR tablets (Circadin® brand only)

    • Specialist initiation for the treatment of sleep regulation in adults with a learning disability and behaviour that challenges as per NICE guideline 11.
    • Prescribing should be retained by secondary care until effectiveness is established and only transferred to primary care if a continued need is demonstrated after review.
    • not approved for dementia-reviewed and turned down Nov 2017. 
    04.01.01 Melatonin  MR tablets (Circadin® brand only)
  • Specialist initiation for the treatment of REM sleep disorders in patients with Parkinson's Disease in line with NICE Guideline 71; Parkinson's Disease in adults

  • 04.01.01 Melatonin Paediatrics
    • M/R tablets (Circadin®), Capsules 2mg, 3mg, 5mg, 10mg (unlicensed), Liquid 1mg/ml (unlicensed).
      For paediatric consultant use only.
    • On FP10 the most cost-effective option is 2mg MR tablets. These may be crushed or halved but this will destroy the MR properties.
    • For supplies through hospital pharmacies, unlicensed immediate release capsules are preferred and if needed these can be opened and the contents dispersed in water, milk, yoghurt or fruit juice for administration (More Info). For children in whom prolonged release is absolutely necessary then the more expensive 2mg MR tablets are available but these are only suitable for children who can swallow tablets. There is no longer a MR product available suitable for children with swallowing difficulties.
    • Melatonin for primary insomnia in adults is non formulary (see below).
    • Nottingham Childrens Hospital: Melatonin Guideline
    • At SFH send patients to SFH pharmacy for supplies of unlicensed medicines
    04.07.04.03 Melatonin 
  • 10mg daily of immediate release preparation should be used as this dose is supported by trial evidence.
  • 08.01.01 Melphalan  Tablet, Injection
  • For melphalan dose in polycythaemia vera refer to BNF
  • 04.11 Memantine 

    Tablet, orodispersible tablet (Valios®)

    • If a patient has swallowing difficulties, orodispersible tablets are more cost effective than liquid preparations.
    • Once a decision has been made to start, the first prescription may be made in primary care.
    • For people not taking an acetylcholinesterase inhibitor, treatment with memantine should be initiated by specialists in the care of patients with dementia.
    • Memantine is now recommended for people with an established diagnosis of Alzheimer’s disease who are already taking an acetylcholinesterase inhibitor if they have moderate or severe disease (NICE 2018). Primary care prescribers may start treatment with memantine in these patients without taking advice from a specialist clinician.
    09.06.06 Menadiol Sodium Phosphate 

    Tablet

    14.04 Meningococcal A, C, W135, and Y conjugate vaccine Menveo®or Nimenrix ® Injection
  • Post splenectomy and as part of routine childhood immunisations in line with the "Green Book"
  • 14.04 Meningococcal group B Vaccine Bexsero® Injection
    - Contained in the routine childhood immunisation schedule
    - NUH only for adult and paediatric patients receiving eculizumab for atypical Haemolytic Uraemic Syndrome (aHUS)
    - for patients with asplenia or splenic dysfunction
    14.04 Meningococcal group C conjugate vaccine  Injection
    Brands include: Meningitec, Menjugate, Neisvac-C

  • Meningitec brand no longer recommended for routine primary immunisation of infants as per advice in DOH 'green book' and Public Health England link below.
  • 14.04 Meningococcal polysaccharide A, C, W135 and Y vaccine ACWY Vax® Injection
  • Not routinely stocked at SFHT
  • 05.04.04 Mepacrine Hydrochloride  Tablet (unlicensed)
    15.02 Mepivacaine Scandonest Plain® Injection
    03.04.02 Mepolizumab Nucala® Injection
    NUH only: Approved in accordance with TA431 for treating severe refractory eosinophilic asthma
    09.08.01 Mercaptamine (cysteamine) eye drops  

    0.11% and 0.55% (both only preservative free formulations)

    • Unlicensed medicine - named patient use only
    • Available at NUH only for use for nephropathic cystinosis in line with NHS England highly specialised criteria.
    01.05.03 Mercaptopurine  Tablets, suspension.
  • Maintenance of remission of acute ulcerative colitis and Crohn’s disease in adults – unlicensed but in line with national guidelines
  • Suspension (Xaluprine®) (expensive) only for patients where tablets are not suitable (i.e. small doses in paediatrics)
  • Amber 1: For use in Inflammatory Bowel Disease as per shared care protocol
  • 08.01.03 Mercaptopurine  Tablet, Suspension.
  • Classified red for the treatment of acute leukaemias, chronic myeloid leukaemia, cancer. See section 1.5.3 for IBD indication.
  • Suspension (Xaluprine®) (expensive) only for patients where tablets are not suitable (i.e. small doses in paediatrics)
  • 05.01.02.02 Meropenem Meronem® Injection
  • See local guidelines. [SFH guideline][NUH guideline]
  • 01.05.01 Mesalazine Octasa® Tablets 400mg & 800mg
  • Remember to prescribe mesalazines by brand but Octasa® is effectively interchangable with Asacol® - See price comparison graph.
  • 800mg are huge tablets and are relatively more expensive than 400mg tablets.
  • This drug has monitoring requirements - See BNF.
  • 01.05.01 Mesalazine 
    • First choice suppository.
    • Tablets for existing patients only - Octasa® brand preferred for new patients as it's similar but cheaper.
    • This drug has monitoring requirements - See BNF
    01.05.01 Mesalazine Pentasa® Tablet, Granules, Retention enema, suppositories
  • Oral formulations licensed up to 4g once daily or in two or three divided doses.
  • This drug has monitoring requirements - See BNF
  • 01.05.01 Mesalazine Salofalk® Tablets, Granules M/R, Enema, Foam enema.
  • Licensed up to 3g/day once daily.
  • 08.01 Mesna  Tablet, Injection
  • Tablets and injection available. Injection can be diluted in a flavoured drink for oral administration- see BNF
  • At SFH, for dosage instructions in non-cancer indications refer to specific guidelines: cyclophosphamide (rheumatology) or cyclophosphamide (respiratory)
  • 18 Mesna  See also section 8.1
  • Treatment of cyclophosphamide induced haemorrhagic cystitis
  • 02.07.02 Metaraminol  Injection 10mg/1ml (secondary care only)
  • Unlicensed.
  • 06.01.02.02 Metformin 

    Tablet (£4pm), Tablet MR (£9pm)(for patients with proven GI intolerance), liquid 500mg/5ml (£27pm (1g bd)).

    • Tablets can be crushed (they are VERY hard) and dispersed in water. Uncrushed they take ~1 hour to dissolve). See here for general advice on dispersing tablets. Do NOT crush modified release tablets.
    • Oral powder discontinued April 2014.
    • Sukkarto SR is preferred modified release brand in primary care.
    • Grey Metformin MR classified as grey for polycystic ovary syndrome
    20 Methacholine solutions various strengths Methylcholine, Acetyl-β-methylcholine 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
  • 04.07.02 Methadone  Tablet, Liquid
  • For initiation by pain team only when used as an analgesic
  • 04.10.03 Methadone 

    Oral solution 1mg in 1mL

    • Opioid dependance, after recommendation from specialist service.
    • In primary care follow Drug Misuse and Dependence: Guidelines on Clinical Management (orange book) 
    05.01.13 Methenamine Hippurate Hiprex® Methenamine may be advised by:
  • Urologists or Infectious Diseases physicians (Amber 2 classification),
    if there are no suitable alternative therapies, due to:
  • Multi-resistant organisms,
  • Allergies, contraindications, or side-effects with prophylactic antibiotics,
  • High-risk patients for whom prophylactic antibiotics are not appropriate e.g. C.difficile carriage.
    Treatment should stop after 6 months and patient should be referred back to the advising Specialist if relapses or side-effects occur. Please refer to BNF for dosing advice.
  • 18 Methionine  Tablet
  • No longer available in the UK. Seldom used for the treatment of paracetamol poisoning
  • Discussion with National Poisons Information Service recommended
  • Follow advice on Toxbase if patient has a reaction to acetylcysteine.
  • 20 METHOCEL 2% eye drops  Unlicensed medicine - named patient use only
    NUH only
    01.05.03 Methotrexate 

    Tablets

    • 2.5mg tablets preferred as per NPSA alert
    • Cytotoxic, do not crush and disperse in water, liquid may be available if required.
    • Amber 1 for inflammatory bowel disease as per the shared care protocol below
    • NUH: Metoject® injection available for paediatric patients - routinely supplied via homecare (prescribe by brand and generic name)
    • Available through homecare for NUH patients. Please contact pharmacy medicines homecare team for further information
    08.01.03 Methotrexate  Tablet 2.5mg, Injection
  • Liquid can be made obtained if required.
  • Classified red for cancer indications- see sections 10.1.3 and 13.5.3 for rheumatology and psoriasis indications
  • 10.01.03 Methotrexate 

    Tablet 2.5mg
    Tablet 10mg - Restricted for paediatric use only.
    Injection- secondary care only (as prefilled syringes/pens)

    • Cytotoxic, do not crush and disperse in water, liquid may be obtained if required.
    • Tablets classified Amber 1 when used ONCE weekly in line with Shared Care Protocol (see below). Twice weekly dosing (for any indication) is classified red.
    • SFH: Zlatal® syringes used first line, Metoject® available for patient's who are either needlephobic or unable to inject the syringe due to dexterity issues. Nordimet® pen available for patients unable to use Metoject® pen.
    • NUH: Metoject® injection available for paediatric patients - routinely supplied via homecare (prescribe by brand and generic name).
    • Available through homecare for NUH patients. Please contact pharmacy medicines homecare team for further information
    11.99.99.99 Methotrexate 
    • For use in Uveitis
    • Available through homecare for NUH patients. Please contact pharmacy medicines homecare team for further information
    13.05.03 Methotrexate  Tablets (2.5mg only)
  • Methotrexate is available as 2.5mg and 10mg tablets. This is a potential cause of confusion and has led to patients taking accidental overdoses.
    To avoid this only 2.5mg tablets should be prescribed and specified on the prescription
  • Amber 1 (shared care) - Patients with severe psoriasis or eczema unresponsive to conventional therapy, when used ONCE weekly in line with Shared Care Protocol (see below). Twice weekly dosing (for any indication) is classified red.
  • NUH: Metoject® injection available for paediatric patients - routinely supplied via homecare (prescribe by brand and generic name)
  • 20 METHOTREXATE  Unlicensed medicine - named patient use only
  • Dose is 50mg per square metre given intramuscularly (See dose calculator)
  • At NUH: Supplied from the Sterile Production Unit (SPU) - contact your ward pharmacist to arrange a supply which in normal Pharmacy opening hours can take up to 4 hours to prepare. For out of hours (Evenings, weekends and bank holidays) contact the on call pharmacist to discuss when a supply can be arranged. Should be prescribed on specific 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.
  • 09.01.03 Methoxy Polyethylene Glycol-Epoetin Beta Mircera® Injection
  • NUH only:Restricted for treatment of anaemia in patients with chronic kidney disease. Under evaluation at Ilkeston satellite renal unit - Nov 2008
  • 04.07 Methoxyflurane Penthrox®

    Inhalation vapour.

    • NUH Only: Emergency relief of moderate to severe pain in the Emergency Department.
    13.05.02 Methoxypsoralen  8-methoxypsoralen 10mg tablets (Puvasoralen®). Also known as methoxsalen.
    5-methoxypsoralen 20mg tablets (Pentaderm®)
  • Unlicensed medicine
  • Dermatology specialist only
  • Used in photochemotherapy combining long-wave ultraviolet A radiation with a psoralen (PUVA)
  • 13.08.01 Methyl-5-Aminolevulinate Metvix® Cream
  • Red: Use in combination with photodynamic therapy in specialist centres
  • 02.05.02 Methyldopa  Tablet
  • Should only be used for hypertension when other agents have failed or aren't suitable.
  • Tablets disperse in water if needed. Flush tube well to prevent blockage. See here for general advice on dispersing tablets.
  • 04.04 Methylphenidate 

    Tablet, Tablet MR (Delmosart®-preferred MR brand, Concerta® XL), Capsule MR (Medikinet® MR, Equasym® MR).

    PRESCRIBE BY BRAND. Different versions of MR preparations may not have the same clinical effect.

    •  (shared care): Attention Deficit Hyperactivity Disorder (ADHD) in children of 6 years and older and in adolescents as part of a comprehensive treatment program.
    •  Patients 18 years and older, or under 6 years old.
    • Treatment with methylphenidate should only be initiated by a specialist (child and adolescent psychiatrist or paediatrician) with expertise in ADHD following a comprehensive assessment and diagnosis.
    • Ritalin® and Medikinet® tablets are scored and may be halved. The contents of Equasym XL® capsules, and Medikinet XL® capsules can be sprinkled on a tablespoon of soft food (e.g. apple sauce or yoghurt), then swallowed immediately without chewing.
    06.03.02 Methylprednisolone 

    Tablets
    IV injection - formally known as Solu-Medrone® (40mg, 125mg, 500mg, 1g, 2g)

    • For Hikma brand injection, dilution instructions are misleading, follow the blue IV guide (UCL) or Medusa
    • For IM Depot injection - Depo-Medrone® (40mg) see BNF section 10.1.2
    10.01.02.02 Methylprednisolone Acetate Depo-Medrone® Injection 40mg in 1mL
    Injection 80mg in 2mL
    10.01.02.02 Methylprednisolone Acetate Depo-Medrone® with Lidocaine Injection
    18 Methylthioninium chloride Proveblue®

    10ml 0.5% (50mg) for IV use. 
    (SFH: Another version also available as 1ml 1% for enteral (not for IV) use. See here.)

    • Also known as "methylene blue"
    • Used for methaemoglobinaemia (licensed) or prior to parathyroid surgery (unlicensed) - speak to Medicines Information for details (SFH: 3163).
    • Approx £50 per vial
    20 Methylthioninium chloride Aguettant®

    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.
    04.06 Metoclopramide  Tablet, Liquid, Injection
  • Nausea and vomiting, post cytotoxic treatment
  • Limited efficacy post-operatively
  • Not recommended for patients under 20 years of age due to risk of dystonic reactions. For restrictions for use in younger patients see MHRA guidance below.
  • Metoclopramide should only be prescribed for short-term use (up to 5 days).
  • For adults, the maximum dose in 24 hours is 30 mg (or 0.5 mg per kg bodyweight).
  • Can be given S/C (unlicenced but accepted practice)
  • The MHRA dose restrictions for metoclopramide do not apply to palliative care as the guidance only covers the licensed indications.(Ref:www.palliativedrugs.com)
  • 02.02.01 Metolazone 

    Tablet

    • Discontinued on the UK market 2012 but an unlicensed import may be available for use by secondary care. Unlicensed imported tablets require hospital prescription (not GP) and maybe very expensive to supply via retail chemists.
    • For patients in whom bendroflumethiazide is not suitable, See Nottinghamshire Heart Failure Lights.
    • Tablets disperse in water if needed. See here for general advice on dispersing tablets.
    02.04 Metoprolol  Tablet, (Injection - secondary care only)
    (Tablet MR is non formulary)
  • Heart failure- third line, where there is a perceived need to use a short acting cardioselective beta-blocker. Consideration should be given to switching to a once daily beta blocker once patient is stable
  • Tablets disperse in water if needed. Do not crush or disperse MR tablets. See here for general advice on dispersing tablets.
  • 05.01.11 Metronidazole  Tablet, Suspension, Infusion, Suppository
  • Liquid not suitable for any enteral tubes that do not end in the stomach (NJ/PEJ/PEGJ) or for patients with diarrhoea
  • Metronidazole 200mg/5ml liquid is expensive. See unexpectedly expensive medicines list.
  • A 2g stat dose should be prescribed as 5x400mg tablets
  • Tablets disperse in water if needed (but tastes terrible). See here for general advice on dispersing tablets.
  • See local guidelines. [SFH guideline][NUH guideline]
  • 05.04.02 Metronidazole  See section 5.1.11
    05.04.03 Metronidazole  See Section 5.1.11
    05.04.04 Metronidazole  See Section 5.1.11
    07.02.02 Metronidazole Zidoval® Vaginal gel 0.75%
  • For when oral treatment is not appropriate. £5 per tube vs £1 for oral.
  • 13.10.01.02 Metronidazole topical 0.75% 
  • For malodorous tumours and ulcers: Anabact® 0.75% brand.
  • 13.10.01.02 Metronidazole topical 0.75% 
  • For rosacea: Gel/cream: Acea® or Rozex® brands usually cheapest.
  • Other more expensive brands include (non-formulary): Zyomet gel, Metrosa gel, Rosiced cream, Metrogel, Metrotop, Noritate.
  • 06.07.03 Metyrapone Metopirone® Capsule
    Restricted for endocrinology use only
    Amber 2 - Cushings syndrome
    Grey - resistant oedema due to increased aldosterone secretion in cirrhosis, nephrotic syndrome, and congestive heart failure (with glucocorticoid replacement therapy)
    05.02.04 Micafungin Mycamine®

    Infusion

    • At NUH: removed from formulary as of 6th June 2016.
    • At SFH: not routinely stocked. Available on Microbiologist request only.
    • See local guidelines. [SFH guideline][NUH guideline]
    • Prescriber checklist available via the SPC - see risk materials link at the top of the SPC.
    01.06.04 Micolette® Sodium Citrate 

    Micro-Enema

    • Same as Relaxit® and Micralax® brands (QMC use Micralax)
    • OTC Patients should be advised to purchase a suitable product over the counter for short term/infrequent constipation

    • May be prescribed if appropriate to in-patients; patients should be advised on discharge that further supply should be purchased
    12.03.02 Miconazole Daktarin®

    Oral gel

    • See link for interactions of miconazole.
    • OTC Patients should be advised to purchase a suitable product over the counter first line

    13.10.02 Miconazole 

    Cream 2% 30g

    • Cutaneous candidiasis - apply until 10 days after lesions healed
    • OTC Patients should be advised to purchase a suitable product over the counter first line

    04.08.02 Midazolam  Buccal Liquid: two strengths available, prescribe by brand:
    - 5mg/ml, BUCCOLAM® (prefilled syringes 2.5mg, 5mg, 7.5mg, 10mg).
    - 10mg/ml, EPISTATUS® (bottle - unlicensed). (EPISTATUS® Prefilled syringes are non-formulary).
  • Use in paediatric patients should be in accordance with Notts APC paediatric guideline.
  • If patients are switched to the more cost effective Buccolam in primary care, advice should be clearly documented and the approved information leaflet given to patients
  • CD prescribing regulations apply, although does not need to be entered in CD register or stored in CD cupboard.
  • Patient info leaflets: Prefilled syringes or Bottle.
  • 15.01.04.01 Midazolam pre-med

    Injection: 2mg in 2mL, 5mg in 5ml, 10mg in 5mL, 10mg in 2mL, 50mg in 10ml, 50mg in 50ml.

    • See section 04.08.02 for buccal use in epilepsy.
    • NUH: see controlled drugs policy for information regarding ordering Midazolam in approved stockholding areas. See NUH Memo
    • Conscious sedation: use lower strength 5mg in 5ml only, and only in approved areas (see NPSA alert ). Higher strength products are restricted to critical care or palliative care patients only.
    • Amber 2 - palliative care use
    • Red - all other indications
    02.07.02 Midodrine  Tablets 2.5 mg, 5mg.
  • 2015: Now available as a licensed product Bramox®
  • Jan 2016: Amber Traffic Light GPs can continue supplies, see GP information sheet.
  • Consultant initiation only when fludrocortisone ineffective for orthostatic hypotension.
  • NUH: Used by renal for resistant dialysis related hypotension, generally given pre-haemodialysis and as a top up dose during haemodialysis. May also be used for those with chronic hypotension (usually due to dialysis related autonomic neuropathy). Fludrocortisone would not be effective in patients with established renal failure.
  • Tablets disperse in water if needed. See here for general advice on dispersing tablets.
  • 08.01.05 Midostaurin Rydapt®

    Capsules

    NUH only: Approved in accordance with NICE TA523, for untreated acute myeloid leukaemia

    08.02.04 Mifamurtide Mepact® Intravenous infusion
  • Approved in accordance with NICE TA235 for the treatment of high-grade resectable non-metastatic osteosarcoma
  • 07.01.02 Mifepristone  Tablet
  • To be ordered in CD book
  • 02.01.02 Milrinone Primacor® Injection.
  • Secondary care only. Specialist use for severe heart failure.
  • SFH: Preferred PDE3 inhibitor. However will not be stocked until enoximone stock depleted due to infrequent use. Until then supplies to be obtained on an as required basis - contact pharmacy (3166) during working hours or on call pharmacist out of hours.
  • 20 Miltefosine  Unlicensed medicine - named patient use only
    Capsule
    NUH only
  • Restricted for treatment of various forms of leishmaniasis

  • 02.05.01 Minoxidil  Tablets
  • May be used in severe hypertension where other medication is unable to achieve control.
  • Should not be used as monotherapy but in conjunction with a diuretic and beta-blocker.
  • Manufacturing problem with 2.5mg tablets expected to persist until March 2014. Other strengths unaffected

  • 07.04.02 Mirabegron Betmiga®

    Tablets

    04.03.04 Mirtazapine  Tablet, Orodisperible tablet, Oral solution
  • May cause sedation and weight gain.
  • Mirtazapine may be useful for SSRI-intolerant patients.
  • 01.03.04 Misoprostol  Tablet
    Not first line for gastro protection.
    07.01.01 Misoprostol  Tablets
  • Unlicensed use
  • 08.01.02 Mitomycin 
    11.99.99.99 Mitomycin  Available as:
    - Eye drops 0.04%(preservative free) (Multi dose bottles)- NUH only
    - Solution for sub-conjunctival use 0.2mg in 1mL
    - Solution for sub-conjunctival use 0.4mg in 1mL (and several other concentrations at KMH aseptic unit)
  • Sub-conjunctival injection manufactured by Pharmacy Sterile Production Unit (Unlicensed Products)
  • 08.01.02 Mitoxantrone (Mitozantrone)  Infusion
    15.01.05 Mivacurium Mivacron® Injection
    04.03.02 Moclobemide 
  • Need washout period if switching from another antidepressant
  • Tablets disperse in water if needed. See here for general advice on dispersing tablets.
  • GPs may prescribe only after initiation and stabilisation by NHCT
  • 04.04 Modafinil 

    Tablet

    • Restricted for initiation by specialists for treatment of excessive sleepiness associated with narcolepsy (only licensed indication).
    • Unlicensed indications (e.g. fatigue in MS) are non-formulary and classified grey.
    08.02.02 Modigraf® 

    Sachets (Prescribe by brand)
    TWICE DAILY TACROLIMUS

    • Restricted to paediatric renal patients or for tube administration
    • Available through homecare for NUH patients. Please contact pharmacy medicines homecare team for further information
    A2.03.02 Modulen IBD®  
    • On dietician recommendation only
    12.02.01 Mometasone Furoate 

    Nasal spray 50micrograms per spray

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

    • It is more cost effective to prescribe generically rather than as brand e.g. Nasonex.
    13.04 Mometasone Furoate 0.1% Elocon® Cream, Ointment, Scalp lotion
  • Potent
  • 03.03.02 Montelukast Singulair® Tablet
    Chewable tablet
    Granules
    02.11 Moroctocog alfa Refacto®

    Non pharmacy item, please contact blood bank for details and availability

     

    Available through homecare for NUH patients. Please contact pharmacy medicines homecare team for further information

    04.07.02 Morphine 

    - Normal release (~4 hours effect): Tablet (Sevredol®), Oral solution (e.g. Oramorph®), NUH only: Low strength concentration of oral solution (100micrograms/mL - unlicensed)
    - Slow release (~12hr effect): Zomorph® Capsule MR 10mg, 30mg, 60mg, 100mg, 200mg, (MST® Tablet MR 5mg and 15mg ONLY, 15mg not available at NUH), Injection.

    • First line strong opioid
    • Prescribe by brand name
    • For chronic non-cancer pain, doses greater than 60mg every 12 hours by specialist recommendation or advice only. See Opioids for persistent non-cancer pain APC guidelines.
    • Low strength concentration of oral solution (100micrograms/mL) for use as per Nottingham Children's Hospital: Oral Analgesia Guideline.
    • If needed Zomorph capsules can be opened and beads mixed with semi solid food (puree, jam, yoghurt). Do not crush the beads. More Info on opening capsules
    • The beads can also go down via NG or PEG tubes of a diameter of more than 16Fr with an open distal end or lateral pores. Flush the tube with 30ml to 50ml of water.
    • Always give prophylactic laxatives with regular opioids.
    20 MORPHINE 40mg/ml inj pfs  Unlicensed medicine - named patient use only
    NUH only
    20 MORPHINE 50mg/50ml syringe  Unlicensed medicine - named patient use only
    NUH only
    20 Morphine epidural 2mg in 10ml 
    12.03.04 Mouth Swabs 

    Lemon and Glycerin mouth swabs used at NUH
    MOI-stik used at SFH

    05.01.12 Moxifloxacin  Tablet, Injection
  • Restricted antibiotic: See local guidelines. [SFH guideline][NUH guideline]
  • 02.05.02 Moxonidine  Tablet
  • Restricted for resistant or refractory cases
  • Tablets disperse in 50mL water if needed. Disperse well before administering to prevent tube blockage. See here for general advice on dispersing tablets.
  • 09.06.07 Multivitamin   Tablet
  • Specialist recommendation only.
  • First choice vitamin supplement for dialysis patients.
  • Store at room temperature.
  • Dietary supplement, listed as a borderline substance in the drug tariff, therefore requires ACBS endorsement on an FP10 prescription if using for "the dietary management of water soluble vitamin deficiency in renal failure patients receiving dialysis"
  • 09.06.07 Multivitamin preparations Abidec®

    Drops

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

    09.06.07 Multivitamin preparations Dalivit®

    Drops

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

    09.06.07 Multivitamin supplement DEKAs®

    DEKAs®Essential Capsules, DEKAs®Plus Softgels, DEKAs®Plus Chewable Tablets, DEKAs®Plus Liquid.

    • Restricted for the dietary management of patients with cystic fibrosis on the specific recommendation of a specialist in cystic fibrosis.
    • Dietary supplement, listed as a borderline substance in the drug tariff, therefore requires ACBS endorsement on an FP10 prescription.
    • The vitamin content in each formulation is variable. 
    09.06.07 Multivitamin supplement Paravit-CF®

    Capsule, liquid.

    • Restricted for the dietary management of patients with cystic fibrosis on the specific recommendation of a specialist in cystic fibrosis.
    13.10.01.01 Mupirocin 2% Bactroban® Ointment 2%; Cream 2% (cream not stocked at SFH)
  • Second line for bacterial skin infections
  • Reserve for treating MRSA infection or colonisation
  • Only to be used to treat other bacterial skin infections when other topical agents have failed or are contra-indicated
  • Use the nasal ointment if using for peritoneal dialysis site prophylaxis/treatment
  • 12.02.03 Mupirocin 2% nasal ointment Bactroban Nasal®

    Nasal ointment

    • For eradication therapy (patients with confirmed MRSA), mupirocin 2% nasal ointment is applied three times a day to both nostrils for 5 days. At NUH this is with Octenisan body wash (once a day for 5 days including hair wash on 2 of the 5 days). At SFH this is with chlorhexidine 4% body wash (once a day for 5 days including hair wash on 2 of the 5 days).
    • Used in preference of bactroban ointment at Peritoneal Dialysis sites to prevent infections (unlicensed indication) - glycerin based, therefore doesn't damage the PD catheter.
    09.06.07 Mutivitamin 

    Tablet, Capsule

    • Standard one-a-day preparation
    • List of multivitamin contents
    • Tablets disperse in water if needed. See here for general advice on dispersing tablets.
    • Multivitamins may be prescribed in the NHS to prevent or treat deficiency but not as dietary supplements
    • SFH - Change Vitamin Caps to Multivitamin tablets for inpatients. 

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

    08.02.01 Mycophenolate Mofetil 

    Capsule 250mg, Tablet 500mg, Oral Suspension, Infusion

    • Used off licence in Myaesthenia Gravis (MG)
    • Approved for use in Uveitis
    • Approved for use at NUH in neuromuscular diseases (e.g. MG, LEMS), inflammatory neuropathies, inflammatory conditions of the central nervous system and autoimmune encephalitis.
    • At NUH and SFH, generic stocked - no need for brand continuity, although NUH haematology currently like to standardise on Myfenax® brand.
    • Available through homecare for NUH patients. Please contact pharmacy medicines homecare team for further information
    08.02.01 Mycophenolic acid (sodium) 

    Tablet EC (as sodium salt)

    • Used in renal transplant patients at NUH - prescribe by brand and generic to avoid confusion with mycophenolate mofetil.
    • Myfortic® was the original brand but now other brands exist.
    • Mycophenolic acid 720mg (tablets) is approximately equivalent to mycophenolate mofetil 1g (liquid). (See table of liquid medicines requiring dose adjustment)

     

    • Available through homecare for NUH patients.  Please contact pharmacy medicines homecare team for further information.
    20 Mydricaine  Unlicensed supply available.
    - Number 1 (for children)(not routinely stocked at SFH)
    - Number 2 (for adults)
  • Contents and more info.
  • A5.01.01 N/A Ultra  At NUH ordered via RDC by each ward (not available from pharmacy). Not routinely available at SFH
  • Available as 9.5x9.5cm, 19x9.5cm, 19x19cm
  • 10.01.01 Nabumetone  Tablet
    02.04 Nadolol  Tablet
  • For patients with Long QT syndrome. Use in other indications is classified grey (APC Nov 14).
  • The only beta blocker suitable for some patients in long QT syndrome.
  • 06.07.02 Nafarelin  Nasal spray
  • Restricted for use by Nurture clinic
  • Red - Treatment of infertility, restricted to Nuture clinic
  • 02.06.04 Naftidrofuryl 

    Capsules
    For use in line with NICE guideline (TAG 223)

    04.10.01 Nalmefene  Tablets
  • Specialist initiation by community based specialist alcohol services in line with NICE TA325 . GPs are not expected to prescribe in County CCGs (prescribing should remain with CRI) but GPs in City CCG may be requested to prescribe after initiation by alcohol service.
  • 01.06.06 Naloxegol  Tablet
  • Specialist initiation for the treament of opioid induced constipation in line with NICE TA345.
  • Follow local guidance (appendix 2) for the treatment of opioid induced constipation.
  • If naloxegol is being considered, note contraindications/ interactions (See SPC).
  • May be crushed and dispersed in water for oral or NG use.
  • Costs £51 per month. See laxative prices).
  • 15.01.07 Naloxone  Injection 400mcg/ml
    Injection 40mcg/2ml (unlicensed)
    18 Naloxone  Injection
  • For treatment of opioid overdose / poisoning
  • See also section 15.1.7
  • 15.01.07 Naloxone pre-filled syringes Prenoxad®

    Prefilled syringes (2mg/2ml)

    • As of October 2017, all Prenoxad syringe packaging is being labelled as 0.91mg/ml, rather than 1mg/ml. The use of the product and dose is unchanged. Link for further information

    At SFH:

    • On the advice of the Drug and Alcohol Liason Team (DALT) only for patients at high risk of opioid overdose at discharge. DALT will provide patient training. Usually supply one syringe on discharge.

    In Nottingham City CCG:

    • Available as part of 1 year pilot for the treatment of opioid overdose in a non-medical setting. Classified as Green for duration of pilot.
    • Prescribers should be satisfied that the patient has undergone appropriate training from the Health Shop (able to produce certificate) or similar organisation. Most patients will be supplied via PGD by substance misuse services, but small numbers of patients may require a prescription from GP.
    04.10.01 Naltrexone  Tablet
  • Some brands are licensed for treatment of alcohol dependence.
  • In primary care, GPs/NMPs who have received appropriate training may initiate as per Notts Primary Care Alcohol Community Detox Protocol.
  • In secondary care on specialist advice of Alcohol and Drug Liaison Team.
  • 04.10.03 Naltrexone Nalorex®

    Tablet

    • Opioid dependence, after recommendation from specialist service.
    • In primary care follow Drug Misuse and Dependence: Guidelines on Clinical Management (Orange Book)
    10.01.01 Naproxen 

    Tablets, soluble tablets.

    • Good 2nd line choice after ibuprofen.
    • Usual dose: 250mg prn, max 5x a day (or 250-500mg bd)
    • May have a lower cardiovascular risk than other NSAIDs and COX2's. Good alternative if ibuprofen is not suitable.
    • EC tablets are more expensive (£10pm v £3). No trial has shown a difference in ulcer rate and there is minimal difference in tolerability [See trial data].
    04.07.04.01 Naratriptan 

    Tablets

    08.02.04 Natalizumab Tysabri® Infusion- NUH only
  • Approved in accordance with NICE TA127
  • 04.07.01 Nefopam 

    Tablet.

    • On pain team/ renal consultant advice only. Only to be considered if paracetamol, NSAIDs and opioids are unsuitable. Unknown efficacy (see Cochrane review) and has many side effects eg nausea, nervousness, anticholinergic side effects (dry mouth, constipation, blurred vision urinary retention, light headedness, reduced cognition, hypotension etc.). Such effects are particularly bad in the elderly - who are prone to falls [See Prescqipp].
    • Manufacturers advise not to crush or disperse the tablets for patients with swallowing difficulties as drug has a local anaesthetic effect. For patients with enteral tubes use tablets dispersed in water immediately prior to administration. See here for general advice on dispersing tablets.
    • No longer very expensive. See historical cost of nefopamCost of common analgesics.
    08.01.03 Nelarabine Atriance® Intravenous infusion
    Approved in accordance with the National Cancer Drugs Fund for the treatment of refractory T-cell acute lymphoblastic leukaemia or refractory T-cell lymphoblastic non-Hodgkin's lymphoma
    NUH: For more information, including criteria, see the DTC website; available here
    Confirm funding approved on BlueTeq for all new starters
    SFH: Ensure CDF funding approved by contacting the HCD Team on 4660.
    A2.03.01 Neocate Active 
  • Will be discontinued in 2018 and replaced by Neocate Junior
  • On dietician recommendation only
  • Paediatric use
  • A2.03.01 Neocate Advance 
  • Will be discontinued in 2018 and replaced by Neocate Junior
  • Paediatric use
  • A2.03.01 Neocate Junior 
  • 400g tin
  • Replaces Neocate Advance and Active which will be discontinued in 2018.
  • Unflavoured stocked at SFH. Strawberry and vanilla also available on request.
  • A2.03.01 Neocate LCP 
  • Paediatric use
  • A2.03.01 Neocate Syneo® 
    • Paediatric use 
    • second line amino acid formula on recommendation from a specialist (including dietician)
    11.04.02 Neodocromil 

    Eye drops 2%

    10.02.01 Neostigmine  Tablet
    Injection- secondary care only
  • Tablets disperse in water if needed but they may not be suitable for administration via narrow bore tube. See here for general advice on dispersing tablets.
  • Classified as amber 2 for myasthenia gravis
  • 15.01.06 Neostigmine  Injection
    15.01.06 Neostigmine with Glycopyrronium  Injection
    A2.03.02 Nepro HP® 
    • On dietician recommendation only.
    • Only available as Ready to Hang (RTH) 500ml bag. 
    08.03.04.01 Neratinib  Tablets. Unlicensed medicine - named patient use only
    NUH only: Approved in accordance with compassionate named patient programme for patients with HER2+ve metastatic breast cancer, following disease progression on trastuzumab and trastuzumab emtansine.
    04.06 Netupitant and Palonosetron Akynzeo®

    NUH:

    Approved for the following:

    - Prevention of acute and delayed nausea and vomiting associated with highly emetogenic cisplatin-based cancer chemotherapy.

    - Prevention of acute and delayed nausea and vomiting associated with moderately emetogenic cancer chemotherapy.

    Approved for adult Oncology patients only

    05.03.01 Nevirapine 

    Tablet, Suspension, MR Tablet

    • Prescriptions must state whether Viramune® brand or the generic preparation should be supplied.
    • Available through homecare for NUH patients. Please contact pharmacy medicines homecare team for further information
    02.06.02 Nicardipine  Injection
    NUH: PICU and NNU use only for hypertensive crisis or uncontrolled hypertension.
    02.06.03 Nicorandil  Tablet
  • Do not use as first-line treatment for angina in line with NICE and MHRA guidance.
  • See recent warnings regarding risk of serious skin, mucosal, and eye ulceration, which persists unless treatment is discontinued.
  • Tablets disperse in water if needed. See here for general advice on dispersing tablets.
  • 04.10.02 Nicotine 
  • For use in accordance with Nottinghamshire Smoking Cessation treatment algorithm
    Products usually available in secondary care:
  • Inhalator (starter (£4 for 4) and refill packs (£15 for 20)
  • Chewing gum (2mg and 4mg)
  • Lozenge (1mg, 2mg and 4mg)
  • Patches: Nicotinell 24hr patches (7mg, 14mg, and 21mg) and Nicorette 16 hour patches (10mg, 15mg and 25mg)
    Other products may be available in primary care:
  • Microtab 2mg
  • Lozenge 1mg
  • Oral spray 1mg (Quickmist)
  • Nasal spray 500mcg
  • Patches- NiQuitin CQ 24 hour patches (7mg,14mg,21mg)
  • 02.06.02 Nifedipine 

    Oral formulations
    Drops 20mg/ml (unlicensed) are for named patient use only

    • For advice on the most cost-effective brand contact your local Medicines Management team. At SFH see advice on brand switching
    • If needed Coracten MR capsules can be opened and beads mixed with water (do not crush). However consider changing to a long acting calcium antagonist such as amlodipine which disperses in water. See here for general advice on dispersing tablets.
    • SFH: April 2019 - supply problems of multiple strengths and formulations. Supplies are being reserved for obstetric indications. Consider alternatives, typically amlodipine.
    20 Nifedipine 
    08.01.05 Nilotinib Tasigna® Capsule
    Approved in accordance with NICE:
  • TA425 for chronic- or accelerated-phase Philadelphia-chromosome-positive CML in adults
  • TA426 for untreated chronic-phase Philadelphia-chromosome-positive CML in adults
  • Must not be prescribed on FP10s as there is a Patient Access Scheme in operation. Can be supplied via Homecare as long as the PAS is transferred.
  • At SFH patients are supplied via Homecare.
  • See EastMidlands Cancer network guidelines linked above for further information with regards to Nilotinib place in CML therapy
  • 02.06.02 Nimodipine  Tablet
  • Injection- use Polyethylene (PE) giving set for infusion (NOT PVC!). See further info.
  • Specialist use in secondary care only
  • Tablets disperse in water if needed but administer immediately as rapid degredation occurs. See here for general advice on dispersing tablets.
  • 03.11 Nintedanib Vargatef® Capsules
    NUH only
  • With docetaxel for locally advanced, metastatic or locally recurrent non-small cell lung cancer of adenocarcinoma histology after first-line chemotherapy in line with NICE TA347.
    Ensure all prescriptions specify brand.
  • 03.11 Nintedanib Ofev®

    Capsule
    NUH only: Approved in accordance with NICETA379 for treating idiopathic pulmonary fibrosis.
    Ensure all prescriptions specify brand.

    Available through homecare for NUH patients. Please contact pharmacy medicines homecare team for further information

    08.02.04 Niraparib Zejula®

    Capsules

    NUH only: Approved in accordance with NICE TA528 for maintenance treatment of relapsed, platinum-sensitive ovarian, fallopian tube and peritoneal cancer.

    20 Nitazoxanide 

    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 

    05.01.13 Nitrofurantoin 

    MR capsules, capsules, tablets

    • In primary care (and at SFH), MR capsules recommended in antimicrobial guidelines. If immediate release are to be used, prescribe tablets in primary care, and capsules in secondary care (different pricing).
    • Oral suspension is £450 a bottle! For people that need suspension consider alternative options (see links below). Also see unexpectedly expensive medicines list.
    • First line for Lower UTI, UTI in pregnancy. See Primary Care Antimicrobial Guidelines
    • Contraindicated in most patients with an eGFR<45ml/min, but see MHRA (link below) and local guidance for exceptions. [SFH advice][NUH advice]
    • If used long term for prophylaxis monitor full blood count, renal function and liver function tests every 3-6 months
    • Advise the patient on the risk of pulmonary and hepatic fibrosis, peripheral and optic neuropathy and the symptoms to report if they develop during treatment
    • See local guidelines. [SFH guideline][NUH guideline]
    15.01.02 Nitrous oxide  Anaesthetic
    08.02.04 Nivolumab Opdivo®

    Infusion

    Available at NUH only:

    • Approved in accordance with NICE TA384 for treating advanced (unresectable or metastatic) melanoma
    • Approved in accordance with NICE TA400 for treating advanced melanoma in combination with Ipilimumab. Funding available from CDF for this combination until routine commissioning.
    • Approved in accordance with NICE TA417 for previously treated advanced renal cell carcinoma
    • Approved in accordance with NICE TA462 for treating relapsed or refractory classical Hodgkin lymphoma.
    • Approved in accordance with NICE TA490 for treating squamous cell carcinoma of the head and neck after platinum-based chemotherapy.
    • Approved in accordance with NICE TA483 for previously treated squamous non-small-cell lung cancer
    • Approved in accordance with NICE TA484 for previously treated non-squamous non-small-cell lung cancer
    • Nivolumab is not recommended for treating locally advanced unresectable or metastatic urothelial cancer after platinum-containing chemotherapy as per NICE TA530. 
    • Approved in accordance with NICE TA558 for adjuvant treatment of completely resected melanoma with lymph node involveme