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Nottinghamshire Area Prescribing Committee
Joint Formulary
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 Formulary Chapter 9: Nutrition and blood - Full Chapter
09.01  Anaemias and some other blood disorders
09.01.01  Iron-deficiency anaemias
09.01.01.01  Oral iron
Ferrous Fumarate
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First Choice
Green

Tablets
Oral solution

  • Tablets available as 210mg = 68mg iron
  • Manufacturer states tablets may be crushed or chewed and are almost tasteless
  • Liquid available (Ferrous fumarate 140mg/5ml oral solution, contains 45mg iron in 5ml). 10mls twice daily is the licensed therapeutic dose for adults. However 7.5ml (210mg) three times daily can also be given.
 
Ferrous Sulfate
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First Choice
Green

Tablet

  • 200mg tablets= 65mg iron
 
Ferrous Gluconate
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Second Choice
Green
Tablet
  • 300mg tablet = 35mg of iron. Only use if intolerent of other iron salts (but often no better) 
  •    
    Sodium Feredetate (Sytron®)
    Formulary
    Green

    Oral solution

    • Sodium feredetate 190 mg equivalent to 27.5 mg of iron/5 mL
    • For iron deficiency anaemia in children where ferrous fumarate liquid is not tolerated. (APC Jul 19)
    • Amber 2 Amber 2 - specialist recommendation only for adults

      Link to SPC
     
       
    Ferric maltol (Ferracru®)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Amber 2

    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).
     
    Link  NottsAPC: Anaemia in IBD pathway
       
    09.01.01.01  Iron and folic acid
    09.01.01.01  Compound iron preparations to top
    09.01.01.02  Parenteral iron
    Ferric derisomaltose (Monofer®)
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    Formulary
    Red
    • IV only
    • Previously known as iron isomaltoside
    • At NUH implemented for clinical trials use only
     
    Link  SFH: IV iron index page
    Link  Ideal body weight calculator
    Link  Link to reviews
       
    Iron Dextran (CosmoFer®)
    View adult BNF View SPC online View childrens BNF
    Formulary
  • IV or IM injection
    - Green: IM injection. See for instructions. Only for when no other route possible.
    - Red: IV injection / infusion
     
  • Link  NUH: Cosmofer IV prescription
    Link  SFH: IV Iron index page
    Link  UKMI Q&A: How do I use Cosmofer (iron dextran) total dose infusion for correction of iron deficiency anaemia
       
    Iron Sucrose (Venofer®)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Red
  • 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. 
  • Link  NUH: Intravenous Iron (Venofer) to renal patients in the community
       
    Ferric Carboxymaltose (Ferinject®)
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red
    • 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)
     
    Link  MHRA: Risk of hypophosphataemia and osteomalacia with Ferinject
    Link  NUH: Ferinject vial size optimisation memo
    Link  SFH: IV iron index page
       
    09.01.02  Drugs used in megaloblastic anaemias
    Folic Acid
    View adult BNF View SPC online View childrens BNF
    Formulary
    Green
    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
     
  •    
    Hydroxocobalamin
    (Vitamin B12)
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    Formulary
    Green
    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 
  • Link  COVID19: Advice on managing patients on vitamin B12 during COVID19 (Notts CCG)
    Link  Metabolic diseases guideline (paeds)
    Link  Notts APC: B12 treatment guideline
    Link  Oral B12 supplements to treat deficiency? (requires password) DTB (2019)
    Link  SFH: Metabolic diseases (paeds) - Emergency treatment
       
    09.01.03  Drugs used in hypoplastic, haemolytic, and renal anaemias
    Eculizumab (Soliris®)
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red
    High Cost Medicine
    Homecare

    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) 
    - Approved in accordance with the Clinical Commissioning Policy for the prevention and management of delayed haemolytic transfusion reactions and hyperhaemolysis in patients with haemoglobinopathies.

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

     

     
    Link  NICE HST1: Eculizumab for atypical haemolytic uraemic syndrome
    Link  Commissioning Policy: Eculizumab for the prevention and management of delayed haemolytic transfusion reactions and hyperhaemolysis in patients with haemoglobinopathies
    Link  Commissioning Policy: Eculizumab in the treatment of recurrence of C3 glomerulopathy post-kidney transplant (all ages)
    Link  Commissioning Policy: Eculizumab is NOT routinely commissioned to prevent recurrence of C3 glomerulopathy post kidney transplant
    Link  NICE evidence summary: eculizumab for prevention of C3 glomerulopathy post-transplant
       
    Oxymetholone
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    Restricted Drug Restricted
    Red
    Tablets
    Capsules
  • Unlicensed special - named patient use only
  • Specialist use only for aplastic anaemia 
  • Link  Patient Information Leaflet
       
    09.01.03  Erythropoietin
    Darbepoetin Alfa (Aranesp®)
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red
    High Cost Medicine
    Homecare

    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.
     
    Link  Cost comparison chart of high dose epoetins
    Link  Link to review
    Link  NICE NG8: Anaemia in chronic kidney disease
    Link  NICE TA323: Erythropoiesis‑stimulating agents during chemotherapy
       
    Epoetin alfa (Eprex®)
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red
    High Cost Medicine
    Homecare

    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
     
    Link  Link to reviews
    Link  NICE NG8: Anaemia in chronic kidney disease
    Link  NICE TA323: Erythropoiesis‑stimulating agents during chemotherapy
       
    Epoetin beta (NeoRecormon®)
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red
    High Cost Medicine
    Injection
  • Approved in line with NICE TA323 for treating anaemia in people with cancer having chemotherapy. Also used within haematology and renal.
     
  • Link  Link to reviews
    Link  MHRA: epoetin beta may increase risk of retinopathy in preterm infants
    Link  NICE NG8: Anaemia in chronic kidney disease
    Link  NICE TA323: Erythropoiesis‑stimulating agents during chemotherapy
       
    Methoxy Polyethylene Glycol-Epoetin Beta (Mircera®)
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red
    High Cost Medicine
    Injection
  • NUH only:Restricted for treatment of anaemia in patients with chronic kidney disease. Under evaluation at Ilkeston satellite renal unit - Nov 2008 
  • Link  Link to reviews
       
    09.01.03  Iron overload to top
    Deferasirox (Exjade®)
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    Restricted Drug Restricted
    Red
    High Cost Medicine

    Film coated tablets

    • Dispersible tablet withdrawn in June 2017
    • NUH only
     
    Link  Independent drug reviews
    Link  Link to reviews
       
    Deferiprone (Ferriprox®)
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    Formulary
    Red
    High Cost Medicine
    Tablet
  • NUH only
     
  • Link  Link to reviews
       
    Desferrioxamine Mesilate
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    Formulary
    Red
    High Cost Medicine
    Homecare

    Injection

    • Red: Iron overload
    • See section 18 for poisoning
    • Available through homecare for NUH patients. Please contact pharmacy medicines homecare team for further information
     
    Link  Link to reviews
       
    09.01.04  Drugs used in autoimmune thrombocytopenic purpura
    Anagrelide
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red
    Capsule
  • SFH: On Haematologist advice only. Relatively expensive. Supplies for patients in PT1 trial are supplied 2 for the price of one. 
  •    
    Avatrombopag (Doptelet®)
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    Restricted Drug Restricted
    Red
    High Cost Medicine

    Tablet

    NUH and Nottingham NHS Treatment Centre only:

    • Approved for treating thrombocytopenia in people with chronic liver disease needing a planned invasive procedure, in accordance with TA626, following hepatology MDT approval.
     
    Link  NICE TA626: Avatrombopag for treating thrombocytopenia in people with chronic liver disease needing a planned invasive procedure
       
    Eltrombopag (Revolade®)
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red
    High Cost Medicine

    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.

     
    Link  Link to reviews
    Link  MHRA: eltrombopag interference with creatinine and bilirubin tests
    Link  NICE TAG 293: Eltrombopag for treating chronic ITP
       
    Lusutrombopag (Mulpleo®)
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    Restricted Drug Restricted
    Red
    High Cost Medicine

    Tablet

    NUH and Nottingham NHS Treatment Centre only:

    • Approved for treating thrombocytopenia in people with chronic liver disease needing a planned invasive procedure, in accordance with TA617, following hepatology MDT approval.
     
    Link  NICE TA617: Lusutrombopag for treating thrombocytopenia in people with chronic liver disease needing a planned invasive procedure
       
    Romiplostim (Nplate®)
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    Restricted Drug Restricted
    Red
    High Cost Medicine

    Injection

    • Restricted for use in line with NICE guidance (TAG 221) and NUH guideline
     
    Link  Link to reviews
    Link  NICE TA221: Thrombocytopenic purpura - romiplostim
       
    09.01.05  G6PD deficiency
    09.01.06  Drugs used in neutropenia
     note  It is essential that G-CSF prescribing is by brand to ensure that the correct preparation is selected and given.
    Filgrastim (Nivestim®)
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    First Choice
    Red
    High Cost Medicine
    Injection
  • First choice GCSF
  • At SFH do NOT send patients to retail pharmacies for supplies 
  • Filgrastim (Neupogen®)
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red
    High Cost Medicine
    Injection prefilled syringe
    Injection vial
  • NUH only
  • NUH: Restricted to Paediatric Oncology and in clinical trials in adult oncology/haematology if required 
  •    
    Lenograstim (Granocyte®)
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red
    High Cost Medicine
    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
     
  •    
    Pegfilgrastim (Pelmeg®)
    (Biosimilar)
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red

    Injection prefilled syringe

    Available at NUH only:

    Approved for adult oncology or adult haematology patients as an interim treatment change option during the Covid-19 pandemic as endorsed by NHS England.

    SFH: Only available for oncology patients. NOT approved for SFH patients.

     
       
    09.01.07  Drugs used to mobilise stem cells
    Plerixafor (Mozobil®)
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red
    High Cost Medicine
    Injection
  • NUH only
  • Used in the management of failed PBSCT mobilisations- see local guideline 
  • Link  Link to reviews
       
    09.02  Fluids and electrolytes to top
    09.02.01  Oral preparations for fluid and electrolyte imbalance
    09.02.01.01  Oral potassium
    Potassium Chloride (Sando-K®)
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    First Choice
    Green

    Tablet

    • 1 tablet = 12mmol of K+
    • Link to SPC.
     
    Potassium Chloride (Kay-Cee-L®)
    View adult BNF View childrens BNF
    Formulary
    Green

    Syrup

    • 1mL = 1mmol of K+
    • Link to SPC.
     
       
    Potassium Chloride modified release tablets
    View adult BNF View childrens BNF
    Formulary
    Red

    Tablet MR (1 tablet = 8 mmol of K+)

    • RED for use by specialists (APC Sept 2020)
    • Slow K discontinued 2020
    • Available as parallel import, not licensed in UK, which is extremely expensive in primary care (up to £250 per prescription).
    • BNF states that modified release potassium chloride tablets are less suitable for prescribing. Can cause GI side effects (nausea, vomiting, abdominal pains, diarrhoea).
    • Use Sando K or Kay-Cee-L instead
     
       
    09.02.01.01  Potassium removal
    Polystyrene Sulphonate Resins (Calcium Resonium®)
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Amber 2
    • Powder available as a 300g tub, containing a 15g scoop
    • Enema 30g/100ml available on a named patient basis (unlicensed) for use only in patients who are nil by mouth.
    • NG tube administration is perfectly acceptable. Add the 15g to approx 150mL of water. It's like super-fine sand so settles out but resuspends on stirring and does not stick to anything. Flush afterwards, as always.
    • See local guidelines below for dosing and administration information.
    • Primary care prescribing can be undertaken in acute episodes of hyperkalaemia under specialist advice.
     
    Patiromer calcium (Veltassa®)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Red

    Powder for oral suspension

    At NUH: For use in accordance with NICE TA623 for treating hyperkalaemia.

    At SFH: On Consultant Endocrinologist/ renal advice for treating hyperkalaemia in accordance with NICE TA623.

     
    Link  Hyperkalaemia (acute) treatment price comparison
    Link  Link to reviews
    Link  NICE TA623: Patiromer for treating hyperkalaemia
       
    Polystyrene Sulphonate Resins (Resonium A®)
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red

    Powder

    • Contains sodium polystyrene sulfonate.
    • Alternative to calcium resonium if concerned about hypercalcaemia.
     
    Link  Hyperkalaemia (acute) treatment price comparison
       
    Sodium zirconium cyclosilicate (Lokelma®)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Red

    Powder for oral suspension

    • For use in accordance with NICE TA599 for treating hyperkalaemia.
    • At SFH - Endocrine or Renal consultant initiation only. Expensive and benefits over calcium resonium uncertain. 
     
    Link  Hyperkalaemia (acute) treatment price comparison
    Link  NICE TA599: Sodium zirconium cyclosilicate for treating hyperkalaemia
       
    09.02.01.02  Oral sodium and water
    Sodium Chloride (Slow Sodium®)
    Formulary
    Amber 2
    Tablet
  • 600mg of sodium chloride (= 240mg sodium =10mmol of sodium)
  • Note: Dose (see BNF) is usually many tablets a day as each tablet only contains 600mg and a normal daily adult intake is around 6,000mg.
  • Link to SPC 
  •    
    Sodium Chloride 30% oral (5mmol/mL)
    Restricted Drug Restricted
    Red

    Oral solution 30% (5mmol/mL), injection used orally

    • Unlicensed special - named patient use
     
    Link  SFH outpatients should be sent to SFH pharmacy for supplies of unlicensed medicines. Don’t prescribe on FP10HP.
       
    09.02.01.02  Oral rehydration therapy (ORT) to top
    Oral Rehydration Salts (Dioralyte®)
    Formulary
    Green

    Oral powder

    • 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
     
       
    09.02.01.03  Oral bicarbonate
    Sodium Bicarbonate
    (oral)
    Formulary
    Amber 2
    Capsule (500mg = approx. 6 mmol each of Na+ and HCO3-)
    Powder also available (200g tub)
  • Capsules can be opened and the contents dispersed in water.
  • Amber 2: Specialist recommendation
  • Oral liquid 1mmol/ml (8.4%) is available when necessary - not traffic light classified. Licensed product has short expiry when opened.
     
  • Link  Medicines for Children leaflet: Oral Sodium Bicarbonate
    Link  SFH outpatients should be sent to SFH pharmacy for supplies of unlicensed medicines. Don’t prescribe on FP10HP.
       
    09.02.02  Parenteral preparations for fluid and electrolyte imbalance
    09.02.02.01  Electrolytes and water
    09.02.02.01  Intravenous sodium
    Sodium Chloride Intravenous
    Formulary
    Green

    Available in multiple strengths.
    Infusions:

    • Sodium Chloride 0.18% infusion 500ml polyfusor
    • Sodium Chloride 0.45% infusion 500ml bag or polyfusor
    • Sodium Chloride 0.9% infusion 50ml, 100ml, 250ml, 500ml, 1 litre
    • Sodium Chloride 1.8% infusion 500ml
    • Sodium Chloride 2.7% infusion 500ml polyfusor


    Ampoules:

    • Sodium Chloride 0.9% injection 2ml, 5ml, 10ml and 20ml ampoules
    • Sodium Chloride 30% injection - NUH: highly restricted to stock areas in paediatrics (order as a controlled drug) due to risks of calculation and administration errors
    • Green: 0.9% solutions only
     
       
    Sodium Chloride and Glucose Intravenous Infusion
    Formulary
    Red

    Available in multiple strengths

    • Sodium Chloride 0.18% & Dextrose 4% infusion 500ml or 1 litre
    • Sodium Chloride 0.18% & Dextrose 10% infusion 500ml
    • Sodium Chloride 0.45% & Dextrose 2.5% infusion 500ml
    • Sodium Chloride 0.45% & Dextrose 5% infusion 500ml
    • Sodium Chloride 0.9% & Dextrose 5% infusion 500ml
     
       
    09.02.02.01  Intravenous glucose to top
    Glucose Intravenous
    View adult BNF View SPC online View childrens BNF
    Formulary
    Green

    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
     
       
    09.02.02.01  Intravenous potassium
     note 

    Potassium infusion notes

  • Do not exceed an infusion rate of 20mmol/hour (40mmol/hour with ECG monitoring)
  • Maximum concentration through peripheral vein is 40mmol/L (up to 80mmol/L only after discussion with senior medical staff)
  • Always use ready prepared solutions wherever possible
  • Higher concentrations may be given via central lines in authorised areas
  • Refer to Trust potassium policies
    • Potassium Chloride and Glucose Intravenous Infusion
      View adult BNF View childrens BNF
      Formulary
      Red
      Available in multiple strengths
    • Potassium Chloride 10mmol in 500mL with Dextrose 5% (20mmol per litre)
    • Potassium Chloride 10mmol in 500mL with Dextrose 10% (20mmol per litre)
    • Potassium Chloride 20mmol in 500mL with Dextrose 5% (40mmol per litre)
    • Potassium Chloride 20mmol in 500mL with Dextrose 10% (40mmol per litre) NUH only

    • Potassium Chloride 20mmol in 1000mL with Dextrose 5% (20mmol per litre) NUH only

    • Potassium Chloride 40mmol in 500mL with Dextrose 5% (80mmol per litre)
    • Potassium Chloride 40mmol in 1000mL with Dextrose 5% (40mmol per litre)
    •  
         
      Potassium Chloride and Sodium Chloride Intravenous Infusion
      View adult BNF View childrens BNF
      Formulary
      Red
      Available in multiple strengths
    • Potassium Chloride 10mmol in 500mL with Sodium Chloride 0.9% (20mmol/litre)
    • Potassium Chloride 20mmol in 1000mL with Sodium Chloride 0.9% (20mmol/litre)
    • Potassium Chloride 20mmol in 500mL with Sodium Chloride 0.9% (40mmol/litre)
    • Potassium Chloride 40mmol in 1000mL with Sodium Chloride 0.9% (40mmol/litre)
    • Potassium Chloride 60mmol in 1000mL with Sodium Chloride 0.9% (60mmol/litre)
    • Potassium Chloride 40mmol in 500mL with Sodium Chloride 0.9% (80mmol/litre)
    • Potassium Chloride 40mmol in 100mL with Sodium Chloride 0.9% - Central line only - no longer in use. 
    •    
      Potassium Chloride, Sodium Chloride and Glucose Intravenous Infusion
      View adult BNF View childrens BNF
      Formulary
      Red

      Note 0.15% = 20mmol/Litre, 0.3% = 40mmol/L
      Available in multiple strengths:

      • KCl 10mmol in 500mL (20mmol/litre) with Dex 4% & NaCl 0.18%. (NUH only)
      • KCl 10mmol in 500mL (20mmol/litre) with Dex 5% & NaCl 0.45%.
      • KCl 20mmol in 1000mL (20mmol/litre) with Dex 2.5% & NaCl 0.45%. (NUH only)*
      • KCL 60mmol in 3000mL (20mmol/litre) with Dex 2.5% & NaCl 0.45% (NUH only)*
      • KCl 20mmol in 1000mL (20mmol/litre with Dex 4% & NaCl 0.18%.
      • KCl 20mmol in 500mL (40mmol/litre) with Dex 5% & NaCl 0.45%.*
      • KCl 20mmol in 500mL (40mmol/litre) with Dex 4% & NaCl 0.18%. (SFH only)
      • KCl 40mmol in 1000mL (40mmol/litre) with Dex 4% & NaCl 0.18%.
      • KCl 20mmol in 500mL (40mmol/litre) with Dex 5% & NaCl 0.9%.* [SFH guide].
      • KCl 10mmol in 500mL (20mmol/litre) with Dex 5% & NaCl 0.9% [SFH guideline]
        *Unlicensed
       
         
      Potassium Chloride 20mmol in 20ml Water For Injection
      View adult BNF View childrens BNF
      Restricted Drug Restricted
      Red
      Potassium Chloride 20mmol in 20ml Water For Injection - Pre-filled syringe
    • NUH - Cardiac Intensive Care Unit and Cardiac HDU only 
    • Link  NUH: Approved concentrated potassium stockholding areas (version 10 May 2014)
         
      Potassium Chloride 50mmol in 50mL Sodium Chloride 0.9% prefilled syringe
      View adult BNF View childrens BNF
      Restricted Drug Restricted
      Red
      50mmol in 50mL Sodium Chloride 0.9% prefilled syringe
    • NUH and SFH: This concentrated product is restricted to authorised areas, stored segregated from other injectables and treated as a Controlled Drug. See NUH IV guide or SFH Concentrated Potassium policy for details 
    • Link  Link to reviews
      Link  NUH: Approved concentrated potassium stockholding areas (version 10 May 2014)
      Link  NUH: IV guide (blue pages - adults)
         
      Potassium Chloride Concentrate (Sterile)
      View adult BNF View childrens BNF
      Restricted Drug Restricted
      Red
      Potassium Chloride 15% solution (10mL = 20mmol K+)
    • NUH and SFH: This concentrated product is restricted to authorised areas, stored segregated from other injectables and treated as a Controlled Drug. See NUH IV guide or SFH Concentrated Potassium policy for details 
    • Link  NUH: Approved concentrated potassium stockholding areas (version 10 May 2014)
      Link  SFH: Treatment of hypokalaemia
         
      09.02.02.01  Bicarbonate and lactate
      Sodium Bicarbonate
      (injection)
      Formulary
      Red
      • Available in multiple strengths:
        -Sodium Bicarbonate 1.26% 500ml polyfusor
        -Sodium Bicarbonate 1.4% 500ml polyfusor (if not available, use 1.26%)
        -Sodium Bicarbonate 4.2% 10ml ampoules or 500ml polyfusor
        -Sodium Bicarbonate 8.4% 10ml ampoules or 500ml polyfusor
      • Central or peripheral administration? See NUH IV guide or SFH advice.
      • 1.26% and 1.4% are clinically interchangable.
       
      Link  SFH: How to make 1.26% sodium bicarbonate from 8.4%
      Link  Sodium bicarbonate in AKI - Guidance on administration from ThinkKidneys
         
      Compound Sodium Lactate Intravenous Infusion
      (Known as hartmanns solution)
      Formulary
      Red
      • 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%
       
      Link  icare2 - Temporary Change to IV Fluid Supplies from Baxter (Dec 2018)
         
      09.02.02.01  Water
      Water for Injection
      View adult BNF View SPC online View childrens BNF
      Formulary
      Green
      Injection
    • 10ml or 20ml are standard sizes 
    •    
      09.02.02.02  Plasma and plasma substitutes
      Human Albumin Solution
      View adult BNF View SPC online View childrens BNF
      Restricted Drug Restricted
      Red

      Solution 4.5%
      Solution 20%

      • SFH: available on from pharmacy for use in accordance with guidance below
      • NUH:Non-pharmacy item, please contact blood bank for details and availability
       
      Link  SFH: Guidelines for the Use of Human Albumin Solution
         
      Plasma-lyte 148 with Glucose 5%
      View adult BNF View SPC online View childrens BNF
      Restricted Drug Restricted
      Red

      Infusion
      NUH Only - Restricted to PICU

       

       
         
      09.02.02.02  Plasma substitutes to top
      Dextran 70®
      View adult BNF View SPC online View childrens BNF
      Restricted Drug Restricted
      Red
      Infusion in Sodium Chloride 0.9% - may not be available
    • NUH only 
    •    
      Etherified Starch
      (Hetastarch)
      View adult BNF View SPC online View childrens BNF
      Restricted Drug Restricted
      Red
      Infusion
    • Hetastarch 6% in 0.9% sodium chloride 500ml
    • NUH only 
    •    
      Gelatin (Gelaspan®)
      View adult BNF View SPC online View childrens BNF
      Restricted Drug Restricted
      Red
      4% infusion solution
    • SFH only 
    • Link  Link to reviews
         
      Gelatin (Gelofusine®)
      View adult BNF View SPC online View childrens BNF
      Formulary
      Red
      Infusion
    • 500ml and 1 litre bags available 
    •    
      Gelatin (Geloplasma®)
      View adult BNF View SPC online View childrens BNF
      Restricted Drug Restricted
      Red
      Infusion
    • NUH only - According to implementation plan  
    •    
      Plasma-lyte 148
      View adult BNF View SPC online View childrens BNF
      Restricted Drug Restricted
      Red
      Infusion
    • At NUH for use in restriced areas only- according to implementation plan
    • At SFH for use in theatres and ICCU under the direction of practitioners in critical care and anaesthesia. 
    • Link  Link to reviews
         
      09.03  Intravenous nutrition
      Intralipid 20%
      View adult BNF View SPC online View childrens BNF
      Restricted Drug Restricted
      Red

      Injection

      • For emergency management following inadvertent intravenous administration of local anaesthetic
      • NUH: For the location of the Local Anaesthetic Systemic Toxicity Management Boxes see attached guideline
       
      Link  NUH Guideline: Management of Severe Local Anaesthetic Systemic Toxicity (LAST) – Treatment with Lipid Emulsion (Intralipid)
      Link  SFH: LipidRescue guidelines for use in local anaesthetic toxicity
         
      Parenteral Nutrition (TPN or PN)
      View adult BNF View SPC online View childrens BNF
      Restricted Drug Restricted
      Red
      Infusion
      NUH information:
      Adults: referral to the nutrition team (City)/clinical nutrition unit (QMC) if tpn is needed
    • NUH: Adult Parenteral Nutrition Chart
    • NUH: Adult Parenteral Nutrition guidance (excludes critical care)
    • NUH Pharmacy: Requests for PN out of hours procedure
    • Nottingham Children's Hospital: Neonatal PN guideline
    • Nottingham Children's Hospital: Neonatal ICU standard PN chart
    • Nottingham Children's Hospital: Neonatal ICU bespoke PN chart
    • Nottingham Children's Hospital: Parenteral Nutrition guideline (excluding Neonatal Unit)
      SFH information:
    • Contact Pharmacy Sterile Production (ext 3156/3169) for advice
       
    • Link  SFH: Quick Guidance for supply of NICU PN out of hours
      Link  SFH: Pharmacy Parenteral Nutrition out of hours guideline (Adult & Neonate)
      Link  SFH: Adult PN prescription
      Link  SFH: Neonatal PN prescription
      Link  SFH: Information about IV filters
      Link  SFH: Trust Adult TPN guideline
      Link  SFH: Trust Neonatal Parenteral Nutrition Guidelines
         
      09.03  Supplementary preparations
      09.04  Oral nutrition
      09.04.01  Foods for special diets
       note  Consult the dieticians
      Sapropterin Dihydrochloride  (Kuvan®)
      View adult BNF View SPC online View childrens BNF
      Formulary
      Red
      High Cost Medicine

      Dispersible Tablets

      • For treatment of Phenylketonuria in pregnancy only as per Commissioning Policy
       
      Link  Clinical Commissioning Policy: Sapropterin (Kuvan®) For Phenylketonuria: Use in Pregnancy
      Link  Clinical Commissioning Policy: Sapropterin for Phenylketonuria (all ages)- NB not routinely commissioned
      Link  Link to reviews
         
      09.04.02  Enteral nutrition to top
       note  A wide variety of preparations is available for sip-feeding or naso-gastric feeding. The dieticians will be pleased to advise.
      09.05  Minerals
      09.05.01  Calcium and magnesium
      09.05.01.01  Calcium supplements
      Cacit®
      (Calcium carbonate)
      View adult BNF View SPC online View childrens BNF
      Formulary
      Amber 2
      Effervescent tablet 
         
      Calcichew®
      (Calcium carbonate)
      View adult BNF View SPC online View childrens BNF
      Formulary
      Amber 1

      Tablet (chewable)

       
         
      Calcium Chloride
      View adult BNF View childrens BNF
      Formulary
      Red
      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 
    •    
      Calcium Gluconate
      View adult BNF View childrens BNF
      Formulary 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. 
    • Link  NUH: Guideline for the Management of Acute Hyperkalaemia in Adults
      Link  SFH: Treatment of hyperkalaemia
      Link  UKMI Q&A: How is acute hypomagnesaemia treated in adults?
         
      Calcium Syrup (Alliance Pharma)
      View adult BNF View SPC online View childrens BNF
      Restricted Drug Restricted
      Red
      Syrup (0.51mmol of calcium per 1mL)
      Product is a food supplement.
      NUH only: For use where licensed products are not suitable.  
         
      Calvive 1000®
      (Formerly Sandocal-1000®)
      View adult BNF View SPC online View childrens BNF
      Formulary
      Amber 2

      Effervescent tablet

      • Sandocal- 1000 name changed to Calvive 1000 April 2020
      • Sandocal-400 - discontinued Nov 2011
       
         
      09.05.01.02  Hypercalcaemia and hypercalciuria
      Bisphosphonates
      View adult BNF View SPC online View childrens BNF
      Formulary
      Red

      See Section 6.6.2

      • Red - all bisphosphonates for the treatment of hypercalcaemia
       
         
      Cinacalcet
      View adult BNF View SPC online View childrens BNF
      Restricted Drug Restricted
      Amber 2
      High Cost Medicine
      Homecare

      Tablet 30mg, 60mg, 90mg

      • Restricted to use in treating secondary hyperparathyroidism in dialysis patients and primary hyperparathyroidism where parathyroidectomy is contraindicated or delayed, see precribing information sheet below. See NICE guidance.
      • Available through homecare for NUH patients. Please contact pharmacy medicines homecare team for further information.
       
      Link  Cinacalcet prescribing information sheet
      Link  Link to reviews
      Link  NICE TA117: Hyperparathyroidism - cinacalcet
         
      Etelcalcetide (Parsabiv®)
      View adult BNF View SPC online View childrens BNF
      Restricted Drug Restricted
      Red

      Injection

      • NUH Approved in accordance with NICE TA448 for treating secondary hyperparathyroidism.
       
      Link  NICE TA448: Etelcalcetide for secondary hyperparathyroidism
         
      09.05.01.03  Magnesium to top
      Magnesium Aspartate (Magnaspartate®)
      View adult BNF View childrens BNF
      First Choice
      Amber 3
      Sachets
    • Amber 3 in line with SFH/NUH guidelines
    • Contain 10mmol magnesium per sachet
    • Link to SPC 
    • Magnesium citrate
      View adult BNF View childrens BNF
      Formulary
      Amber 2
      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. 
    •    
      Magnesium Glycerophosphate
      View adult BNF View SPC online View childrens BNF
      Formulary
      Amber 2
      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
       
    • Link  Link to reviews
      Link  NICE: Evidence Summary: Magnesium glycerophosphate
      Link  NUH: Guideline for the Treatment of Hypomagnesaemia in Adults
         
      Magnesium Hydroxide Mixture BP
      Restricted Drug Restricted
      Amber 2
      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 
    •    
      Magnesium Sulphate
      Formulary
      Red
      Injection 20% (1mL = approx 0.8mmol Mg)
      Injection 50% (1mL = approx 2mmol Mg)
    • See local hypomagnesaemia guidance below
       
    • Link  Hypomagnesaemia guidelines (NUH)
      Link  Hypomagnesaemia guidelines (SFH)
      Link  NUH: Guideline for the management of severe pre-eclampsia and eclampsia
      Link  SFH: Eclampsia and Pre-eclampsia guidance
      Link  SFH: Magnesium for Asthma Guidance
      Link  UKMI Q&A: Can magnesium sulphate be given subcutaneously?
      Link  UKMI Q&A: Magnesium sulphate injection: converting between mM, mg and % w/v.
         
      09.05.02  Phosphorus
      09.05.02.01  Phosphate supplements
      Phosphate supplements (Phosphate-Sandoz®)
      View adult BNF View childrens BNF
      First Choice
      Amber 2
      Effervescent tablet
    • Contains 16.1mmol phosphate, 20.4mmol sodium and 3.1mmol potassium per tablet
    • see local hypophosphataemia or refeeding syndrome (a common cause of hypophosphataemia) guidance below
    • link to SPC 
    • Phosphate Polyfusor®
      View adult BNF View childrens BNF
      Restricted Drug Restricted
      Red

      500ml polyfusor

      • SFH only
      • A 500ml polyfusor contains phosphate 50mmol, potassium 8mmol and sodium 81mmol. See local guidelines regarding dosage required.
      • If Phosphate polyfusor unavailable see guide for using sodium glycerophosphate.
       
         
      Potassium dihydrogen phosphate
      (Potassium acid phosphate)
      Restricted Drug Restricted
      Red
      Injection (contains 10mmol/10ml)
    • NUH and SFH: This concentrated product is restricted to authorised areas, stored segregated from other injectables and treated as a Controlled Drug. See NUH IV guide or SFH Concentrated Potassium policy for details
    • NUH only: Infusion (9mmol in 250 ml sodium chloride 0.9% bag) - ready made bag available from Pharmacy
    • Unlicensed medicine - named patient use only
    • Caution: The rate and concentration recommended for potassium infusions must never be exceeded (see local potassium replacement guidance)
       
    • Link  SFH outpatients should be sent to SFH pharmacy for supplies of unlicensed medicines. Don’t prescribe on FP10HP.
         
      09.05.02.02  Phosphate-binding agents
      Calcium Acetate (Phosex®)
      Restricted Drug Restricted
      Amber 1
      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®
    • Calcium Carbonate (Calcichew®)
      View adult BNF View childrens BNF
      Restricted Drug Restricted
      Amber 1
      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 
    • Calcium Acetate (Renacet®)
      Formulary
      Amber 1
      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 
    •    
      Lanthanum (Fosrenol ®)
      View adult BNF View SPC online View childrens BNF
      Restricted Drug Restricted
      Amber 1
      High Cost Medicine
      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. 
    • Link  Link to reviews
         
      Sevelamer Carbonate
      View adult BNF View SPC online View childrens BNF
      Restricted Drug Restricted
      Amber 1
      High Cost Medicine

      Tablets

      • Prescribe and monitor as per shared care protocol for phosphate binders.
      • Restricted as 2nd 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.
      • In primary care prescribe generically as ‘sevelamer’ – prescriptions will usually be dispensed as sevelamer carbonate, which is considered to be clinically equivalent to sevelamer hydrochloride
       
      Link  Link to reviews
      Link  Nottingham Childrens Hospital: Sevelamer sachets leaflet
         
      Sucroferric oxyhydroxide (Velphoro®)
      View adult BNF View SPC online View childrens BNF
      Restricted Drug Restricted
      Amber 1
      Tablets (chewable)
    • Prescribe and monitor as per shared care protocol for phosphate binders.
    • Restricted as 3rd line phosphate binder only for patients who cannot tolerate sevelamer.  
    • Link  Link to reviews
         
      09.05.03  Fluoride
      Fluoride
      View adult BNF View SPC online View childrens BNF
      Restricted Drug Restricted
      Amber 2
    • 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. 
    • Link  Avoiding tooth decay - Self-care information (Notts APC)
         
      09.05.04  Zinc to top
      Zinc Sulphate (Solvazinc®)
      View adult BNF View SPC online View childrens BNF
      Formulary
      Amber 2
      • Effervescent Tablet 125mg (Solvazinc) contains 45mg zinc
      • Capsule 220mg (unlicensed special - Zincomed) contains 50mg zinc
       
         
      09.05.05  Selenium
      09.06  Vitamins
      09.06.01  Vitamin A
       note  No vitamin-A-only preparation stocked in secondary care although one may be available on special order as mentioned in the BNFc. Contact Medicines Information on 3163 (SFH) or 64185(NUH) if needed.
    • Abidec: 1333 units of vitamin A per 0.6ml dose.
    • Dalivit: 5000 units of vitamin A per 0.6ml dose.
    • Vitamins A and D
      View adult BNF View SPC online View childrens BNF
      Formulary
      Green
      Capsule
    • 1 capsule = vitamin A 4000 units and vitamin D 400 units 
    • Link  NUH: Guideline for the management of children and young people with Cystic Fibrosis
         
      Vitamins A C and D
      (Healthy start children’s vitamin drops)
      View adult BNF View SPC online View childrens BNF
      Formulary
      Green
      Oral drops
    • BNFC: Available free of charge to children under 4 years in families on the Healthy Start Scheme, or alternatively may be available direct to the public—further information for healthcare professionals can be accessed here. Beneficiaries can contact their midwife or health visitor for further information on where to obtain supplies. 
    • Link  Healthy Start scheme
         
      Vitamins C, D and folic acid
      (Healthy start vitamins for women)
      View adult BNF View SPC online View childrens BNF
      Formulary
      Green
      Tablets 
      Link  Healthy Start vitamins: Info for healthcare professionals
         
      09.06.02  Vitamin B group
      Pyridoxine Hydrochloride
      View adult BNF View SPC online View childrens BNF
      Formulary
      Amber 2

      Tablet

      • Tablets disperse in water if needed. Liquid can be made specially if required. See here for general advice on dispersing tablets.
      • NB use for the treatment of PMS is classified grey (see unlicensed section)
       
         
      Thiamine
      View adult BNF View SPC online View childrens BNF
      Formulary
      Green

      Tablet

      • Advice on indication, dose and duration of oral B vitamins see Notts APC Alcohol Dependence Guidelines.
      • Tablets disperse in water if needed. Liquid can be made specially if required. See here for general advice on dispersing tablets.
       
      Link  NUH: Acute Alcohol Withdrawal Guideline
      Link  SFH: Wernicke-Korsakoff syndrome - prophylaxis and treatment
      Link  NICE: Alcohol dependence - diagnosis, assessment and management
      Link  NICE: Management of alcohol-related physical complications
         
      Thiamine (Pabrinex®)
      View adult BNF View SPC online View childrens BNF
      Formulary
      Amber 2
      • Intramuscular (IM) Injection = Amber 2 as per Notts APC Alcohol Dependence Guidelines May be administered in primary care by appropriately trained professionals using the correct administration technique.
      • Intravenous (IV) Injection = Amber 2, use as per local alcohol detoxification policies
       
      Link  NUH: Alcohol Withdrawal Guideline
      Link  SFH: Wernicke-Korsakoff syndrome - prophylaxis and treatment
      Link  SFH: Pabrinex dose compilation table
      Link  SFH: Pabrinex IV Infusion Guideline
      Link  NICE: Alcohol dependence - diagnosis, assessment and management
      Link  NICE: Management of alcohol-related physical complications
         
      09.06.02  Oral vitamin B complex preparations to top
      Vitamin B Tablets, Compound Strong
      View adult BNF View SPC online View childrens BNF
      Formulary
      Green

      Tablet

      • For use in alcohol dependence see Notts APC Alcohol Dependence Guidelines. Note that use in alcohol dependence is not well supported by evidence, see RMOC info here and NHS England info here.
      • Tablets disperse in water if needed (may take a few minutes to dissolve). See here for general advice on dispersing tablets.
      • SFH: See Wernicke-Korsakoff Syndrome guideline.
      • NUH: Not used in alcohol detox guidance (consider thiamine and multivitamins as per policy)
       
         
      09.06.02  Other compounds
      09.06.03  Vitamin C
      Ascorbic Acid (Vitamin C)
      View adult BNF View SPC online View childrens BNF
      Formulary
      Green
      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
    • Link  See unexpectedly expensive medicines list
         
      09.06.04  Vitamin D
      Colecalciferol and Calcium Carbonate
      View adult BNF View SPC online View childrens BNF
      First Choice
      Green

      Available as:
      - Calci-D chewable tablets (£2.25pm). (1 tablet od)
      - 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)

       
      Colecalciferol with calcium phosphate (Calfovit D3®)
      View adult BNF View SPC online View childrens BNF
      Formulary
      Green
       
      Link  Link to reviews
      Link  Nottinghamshire vitamin D guidelines
         
      Colecalciferol
      View adult BNF View SPC online View childrens BNF
      Formulary
      Green

      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.

      Low dose for maintenance or prevention (only prescribed in exceptional circumstances where self-care is not possible):
      -Tablet: Stexerol-D3® (1000 units = 25 micrograms), Generic and Desunin® tablets (800 units = 20 micrograms)
      -Capsule: Strivit-D3®, InVita-D3® or Fultium-D3® (800 units = 20 micrograms).
      -Liquid: Fultium-D3® Drops 2740 units/ml. 25ml bottle. 12 drops contain 800 units.

      High dose for treatment of deficiency (see guideline for doses):
      -Capsule: InVita-D3® , Strivit-D3® or Fultium-D3®
      -Liquid: InVita-D3 oral liquid in snap and squeeze ampoules.
      -Tablet: Stexerol-D3®

      • 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).
       
      Link  NICE ES28: Vitamin D, no evidence for preventing/ treating Covid-19
      Link  Nottinghamshire APC Vitamin D guideline - Adults
      Link  Nottinghamshire APC Vitamin D guideline - Children
      Link  Nottinghamshire APC Vitamin D Patient Information Leaflet
      Link  Link to reviews
      Link  NUH: Memo re Desunin use
         
      Alfacalcidol (One-Alpha®)
      View adult BNF View SPC online View childrens BNF
      Restricted Drug Restricted
      Amber 2

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

      • Partially activated vitamin D. Also known as 1-hydroxycholecalciferol
      • On advice of specialist only
      • See Nottinghamshire Vitamin D guidelines - Adults
      • ONE drop of One-Alpha 2microgram/mL oral drops contains 0.1microgram alfacalcidol. (See table of liquid medicines requiring dose adjustment)
      • Costs £5 (capsules) to £30 (drops) per month for 1mcg/day
       
         
      Calcitriol
      View adult BNF View SPC online View childrens BNF
      Restricted Drug Restricted
      Amber 2

      Capsule

       
         
      Ergocalciferol
      (Injection)
      View adult BNF View SPC online View childrens BNF
      Formulary
      Amber 2

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

       
         
      Paricalcitol (Zemplar®)
      View adult BNF View SPC online View childrens BNF
      Restricted Drug Restricted
      Red

      Capsules, Injection

      • NUH only. If needed at SFH, supplied direct to dialysis unit from NUH pharmacy.
      • Decision to prescribe should be made by a consultant nephrologist.
       
      Link  Guidelines for the Management of Chronic Kidney Disease Mineral Bone Disease in Adults
         
      09.06.05  Vitamin E
      Alpha Tocopheryl Acetate
      (Vitamin E)
      View adult BNF View SPC online View childrens BNF
      Formulary
      Amber 2
      • 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
       
      Link  UKMI Q&A: Oral treatments for treating Peyronie’s disease
      Link  UKMI Q&A: Vitamin E for ME review
      Link  UKMI Q&A: Which medicines require extra care when switching between liquid and tablet/capsule formulations?
         
      09.06.06  Vitamin K to top
      Menadiol Sodium Phosphate
      View adult BNF View SPC online View childrens BNF
      Formulary
      Amber 2

      Tablet 10mg  

      • Water soluble preparation of Vitamin K - to be used in patients with hepatic disease or biliary obstruction (including during pregnancy).
      • ~£2.50 per tablet vs phytomenadione ~£1.50 per tablet.
      • Tablets disperse in water if needed. See here for general advice on dispersing tablets. Liquid can be made specially if required - SFH: send patients to KMH pharmacy for supplies
       
      Link  National guidance on vitamin K in obstetric cholestasis: UKMI Q+A
         
      Phytomenadione
      View adult BNF View SPC online View childrens BNF
      Formulary
      Green

      Tablets 10mg (Phyto-K®) (~£1.50 per tablet vs menadiol ~£2.50 per tablet)


      Ampoule 2mg in 0.2ml (Konakion® MM Paediatric)


      Injection 10mg in 1ml (Konakion® MM)


      Gel filled capsules 1mg (Snip-off-tip)(Neokay®)


      Tablets (Vitacon®)  Restricted Restricted 

      • Unlicensed medicine
      • NUH: Only to be used during the supply problem with menadiol 10mg tablets.  For use in patients with Cystic Fibrosis.
       
      Link  NUH: Haemostasis and Thrombosis protocols
      Link  SFH: Anticoagulant clinical guidelines
      Link  UKMI Q&A: Guidance on the use of vitamin K for obstetric cholestasis
      Link  Vitamin K (phytomenadione) pharmacy information
         
      09.06.07  Multivitamin preparations
      Mutivitamin
      View adult BNF View SPC online View childrens BNF
      First Choice
      Green

      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

       
      Multivitamin preparations (Abidec®)
      View adult BNF View SPC online View childrens BNF
      Formulary
      Green

      Drops

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

       
      Link  Abidec and peanut allergy (UKMi Q&A)
         
      Multivitamin preparations (Dalivit®)
      View adult BNF View SPC online View childrens BNF
      Formulary
      Green

      Drops

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

       
         
      09.06.07  Vitamin and mineral supplements and adjuncts to synthetic diets
      Vitamin and mineral supplements (Forceval®)
      View adult BNF View SPC online View childrens BNF
      Formulary
      Green

      Capsule
      Soluble Tablet - Restricted Item Soluble tablet is restricted NUH only: For use within critical care as a micronutrient supplement for patients with a naso-gastric tube who are unable to take oral medication. Marketed as a food supplement.

       
         
      Multivitamin
      (Renavit®)
      View adult BNF View SPC online View childrens BNF
      Restricted Drug Restricted
      Amber 2
      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" 
    • Link  Link to reviews
         
      Multivitamin supplement (DEKAs® )
      Formulary
      Amber 2

      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. 
       
         
      Multivitamin supplement (Paravit-CF®)
      Formulary
      Amber 2

      Capsule, liquid.

      • Restricted for the dietary management of patients with cystic fibrosis on the specific recommendation of a specialist in cystic fibrosis.
       
         
      Vitamin and mineral supplements (Ketovite®)
      View adult BNF View SPC online View childrens BNF
      Formulary
      Amber 2
      Tablet
      Liquid
    • Specialist recommendation only.
    • Second line to Renavit® for vitamin supplementation in dialysis patients.
    • Store in refigerator. 
    •    
      09.07  Bitters and tonics
      09.08  Metabolic disorders
      09.08.01  Drugs used in metabolic disorders to top
      Biotin
      View adult BNF View childrens BNF
      Restricted Drug Restricted

      Tablets
      Injection

      • Unlicensed specials - named patient use only
      • SFH: Available from the paediatric metabolic drug box on NNU
      • NUH: Available from the paediatric metabolic box on D33
      • For paediatric metabolic disorders on specialist advice only
       
      Link  NUH: Dosing and Administration Guideline for Emergency Metabolic Drugs
      Link  SFH: Metabolic diseases (paeds) - Emergency treatment
      Link  SFH: Metabolic diseases guideline (paeds)
         
      Glycerol phenylbutyrate (Ravicti®)
      View adult BNF View SPC online View childrens BNF
      Restricted Drug Restricted
      Red
      NHS England

      Oral Liquid 1.1g/mL

      Available at NUH only:

      • Specialist use only for Urea Cycle Disorders (hyperammonaemia).  To be initiated following advice from a metabolic centre, in accordance with NHS England commissioning.
       
         
      Sodium Dichloroacetate
      Restricted Drug Restricted

      Powder

      • Unlicensed special, named patient use only
      • Available for pyruvate dehydrogenase deficiency
       
         
      Ubidecarenone
      View adult BNF View SPC online View childrens BNF
      Restricted Drug Restricted
      Amber 2

      Available as:
      -Capsules 10 mg, 30mg
      -Oral Solution 50 mg in 5mL (Ubidecarenone & Vitamin E)

      • Unlicensed medicine - named patient use only
      • Also known as ubiquinone and co-enzyme Q10
      • For paediatric metabolic disorders on specialist advice only
      • For metabolic disorders in accordance with the NHSE Manual for specialised services 18/19
       
      Link  DTB review of co-enzyme Q10 for statin related myopathy
      Link  Link to reviews
         
      09.08.01  Wilsons disease
      Penicillamine
      View adult BNF View SPC online View childrens BNF
      Formulary
      Red
      Tablets
    • See section 10.1.3 for information about use in Rheumatological conditions
    • Red - Treatment of Wilson's disease
       
    •    
      Trientine
      View adult BNF View childrens BNF
      Formulary
      Red

      Capsule (Cufence®) Film Coated Tablet (Cuprior®)

      Available at NUH only:

      • CHM request pharmacy to keep records
      • For the treatment of Wilson disease, in accordance with NHS England Clinical Commissioning Policy. NOTE: Funding only approved by NHSE if shared care agreement for clinical management in place with a Specialist Centre.

      November 2020 – Trientine capsules are supplied under the brand name Cufence®. The dose is now expressed as trientine 200mg base instead of trientine dihydrochloride 300mg salt. See memo sent from Pharmacy to mitigate the risk of dosing errors. 

      April 2021 - Trientine tetrahydrochloride 150mg film coated tablets are now supplied under the brand name Cuprior®. 

       

       
      Link  Clinical Commissioning Policy: Trientine for Wilson disease (all ages)
         
      09.08.01  Carnitine deficiency
      Levocarnitine (Carnitor®)
      View adult BNF View SPC online View childrens BNF
      Formulary
      Amber 2
      High Cost Medicine
      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 
    • Link  NUH: Dosing and Administration Guideline for Emergency Metabolic Drugs
      Link  SFH: Metabolic diseases (paeds) - Emergency treatment
      Link  SFH: Metabolic diseases guideline (paeds)
         
      09.08.01  Fabry's disease
      09.08.01  Gaucher's disease
      09.08.01  Mucopolysaccharidosis I to top
      09.08.01  Pompe disease
      09.08.01  Nephropathic cystinosis
      Mercaptamine (cysteamine) eye drops
      View adult BNF View SPC online View childrens BNF
      Formulary
      Red
      High Cost Medicine

      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.
       
         
      09.08.01  Urea cycle disorders
      Arginine
      View adult BNF View SPC online View childrens BNF
      Restricted Drug Restricted 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 
    • Link  NUH: Dosing and Administration Guideline for Emergency Metabolic Drugs
      Link  SFH: Metabolic diseases (paeds) - Emergency treatment
      Link  SFH: Metabolic diseases guideline (paeds)
      Link  SFH: Metabolic Disorder - Urea Cycle Defects Guideline
         
      Carglumic Acid (Carbaglu®)
      View adult BNF View SPC online View childrens BNF
      Restricted Drug Restricted
      Red
      High Cost Medicine
      Dispersible tablets
      NUH only: Specialist use only for hyperammonaemia, to be initiated following advice from a metabolic centre. 
      Link  Link to reviews
      Link  NUH: Dosing and Administration Guideline for Emergency Metabolic Drugs
      Link  SFH: Metabolic diseases (paeds) - Emergency treatment
      Link  SFH: Metabolic diseases guideline (paeds)
         
      Sodium Benzoate
      Restricted Drug Restricted

      Injection 1 g in 5mL (NUH only:2g in 10mL)
      Oral solution 500mg in 5ml (on drug tariff specials list)

      • Unlicensed specials - 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
       
      Link  NUH: Dosing and Administration Guideline for Emergency Metabolic Drugs
      Link  SFH: Metabolic diseases (paeds) - Emergency treatment
      Link  SFH: Metabolic diseases guideline (paeds)
      Link  SFH: Metabolic Disorder - Urea Cycle Defects Guideline
         
      Sodium Phenylbutyrate
      Formulary
      Red

      Tablets (Ammonaps®) - licensed
      Injection 1g in 5ml - unlicensed special
      Oral liquid 250mg/mL - unlicensed special - NUH only
      (NB Granules - Ammonaps® discontinued Sept 2019)

      • To be initiated on specialist advice only
      • SFH: Available form the paediatric metabolic drug box on NNU
      • NUH: Available from the paediatric metabolic drug box on D33
       
      Link  Link to reviews
      Link  NUH: Dosing and Administration Guideline for Emergency Metabolic Drugs
      Link  SFH: Metabolic diseases (paeds) - Emergency treatment
      Link  SFH: Metabolic diseases guideline (paeds)
      Link  SFH: Metabolic Disorder - Urea Cycle Defects Guideline
         
      09.08.02  Acute porphyrias
      09.08.02  Drugs unsafe for use in acute porphyrias to top
       ....
       Non Formulary Items
      Agalsidase Alfa and Beta  (Fabrazyme®)

      View adult BNF View SPC online View childrens BNF
      Non Formulary
      Grey
      High Cost Medicine
       
      Agalsidase Alfa and Beta  (Replagal®)

      View adult BNF View SPC online View childrens BNF
      Non Formulary
      Grey
      High Cost Medicine
       
      Alglucosidase Alfa  (Myozyme®)

      View adult BNF View SPC online View childrens BNF
      Non Formulary
      Grey
      High Cost Medicine
    • Used in Pompe disease
    •  
      Alpha Tocopherol  (Vedrop®)

      View adult BNF View SPC online View childrens BNF
      Non Formulary
      Grey
       
      Aluminium Hydroxide  (Alu-Cap®)

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

      Capsules

       
      Antithymocyte Immunoglobulin (Equine)

      View adult BNF View SPC online View childrens BNF
      Non Formulary
      Grey
      High Cost Medicine
      Injection
      Named patient use
    • Discontinued, now using Rabbit ATG off label for this indication
    •  
      Asfotase alfa  (Strensiq®)

      View adult BNF View SPC online View childrens BNF
      Non Formulary
      Grey
      High Cost Medicine
      Injection
      NUH: Approved by NHS England for specialist centre use only, in accordance with NICE HST6. NUH to refer patients to specialist centre.
      Link  NICE HST6: Asfotase alfa for treating paediatric-onset hypophosphatasia
       
      Avalglucosidase alfa

      View adult BNF View SPC online View childrens BNF
      Non Formulary
      Grey
      • Avalglucosidase alfa in the treatment of late-onset Pompe disease (LOPD) and infantile-onset Pompe disease (IOPD).  

        Approved as an EAMS March 2021 (04425/0004) for approved eligible sites only; NUH is not an eligible site and would need to refer patients to a specialist centre.

       
      Babiven start up

      View adult BNF View SPC online View childrens BNF
      Non Formulary
      Grey
      Link  Link to reviews
       
      Betaine
      (Homocystinuria)

      View adult BNF View SPC online View childrens BNF
      Non Formulary
      Grey
      Tablet
    • For specialised use only
      Unlicensed medicine
    •  
      Bitters and tonics
      (Gentian mixture alkaline BP)

      View adult BNF View SPC online View childrens BNF
      Non Formulary
      Grey
       
      Bitters and tonics  (Effico®)

      View adult BNF View SPC online View childrens BNF
      Non Formulary
      Grey
       
      Bitters and tonics  (Labiton®)

      View adult BNF View SPC online View childrens BNF
      Non Formulary
      Grey
       
      Bitters and tonics  (Metatone®)

      View adult BNF View SPC online View childrens BNF
      Non Formulary
      Grey
       
      Calcitriol  (Calcijex®)

      View adult BNF View SPC online View childrens BNF
      Non Formulary
      Grey
       
      Calcitriol  (Rocaltrol®)

      View adult BNF View SPC online View childrens BNF
      Non Formulary
      Grey
       
      Calcium acetate  (PhosLo®)

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

      Capsules

      Discontinued May 2015

      Link  Link to reviews
       
      Calcium and Ergocalciferol

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

      Tablet

      Also known as "Ergocalciferol with calcium lactate and calcium phosphate"

       
      Calcium Carbonate with Colecalciferol

      View adult BNF View SPC online View childrens BNF
      Non Formulary
      Grey
      See formulary Adcal-D3® entry above. Other brand names include:
    • Accrete D3®
    • Cacit® D3 effervescent granules sachet
    • Calceos® chewable tablet
    • Calcichew-D3® caplet
    • Calcichew-D3® chewable tablet
    • Calcichew-D3® Forte chewable tablet
    • Evacal D3® chewable tablet
    • Kalcipos-D® chewable tablet
    • Natecal D3® chewable tablet
    • TheiCal-D3® chewable tablet
    •  
      Calcium Salts

      View adult BNF View SPC online View childrens BNF
      Non Formulary
      Grey
      Brands: Everose®, Osvaren®, Calcium 500® and Adcal®
       
      Calcium Salts
      (Calcium lactate)

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

      View adult BNF View SPC online View childrens BNF
      Non Formulary
      Grey
      Brands: Calcium 500 and Adcal®
       
      Calcium-Sandoz®

      View adult BNF View SPC online View childrens BNF
      Non Formulary Syrup
      27.01.15: Calcium-Sandoz Syrup has now been discontinued in the UK. See UKMI link below for advice on alternatives.
    • calcium glubionate 1.09 g, calcium lactobionate 727 mg (calcium 108.3 mg or Ca2+ 2.7 mmol)/5 mL
    • Link  UKMI: Info and advice on Calcium Sandoz shortage
       
      Chenodeoxycholic acid  (Leadiant biosciences)

      View adult BNF View SPC online View childrens BNF
      Non Formulary
      Grey
      High Cost Medicine

      No formal assessment

      NUH: Supported in accordance with Clinical Commissioning Policy:Cholic acid and chenodeoxycholic acid for treating inborn errors of bile acid synthesis (all ages). NUH to refer patients to the specialist centre.

       
      Chenodeoxycholic acid  (Xenbilox®)

      View adult BNF View SPC online View childrens BNF
      Non Formulary
      Grey
      High Cost Medicine

      No formal assessement (APC March 2016)

       
      Colecalciferol
      (With alendronic acid )

      View adult BNF View SPC online View childrens BNF
      Non Formulary
      Grey
       
      Colecalciferol 1,000 units  (Sunvit D3®)

      View adult BNF View SPC online View childrens BNF
      Non Formulary
      Grey
      Tablet (unlicensed)
    • 1,000units = 25micrograms
    • Now use Desunin 800 unit tablets (licensed)
    • Link  Link to reviews
       
      Colecalciferol 10,000units/ml drops  (Thorens®)

      View adult BNF View SPC online View childrens BNF
      Non Formulary
      Grey
      No formal assessment
       
      Colecalciferol 2,400 units/ml drops  (Invita D3® oral drops)

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

      No formal assessment

      • See above formulary entry for Invita D3 25,000u/ml liquid.
       
      Colecalciferol 3,000 units per ml liquid

      View adult BNF View SPC online View childrens BNF
      Non Formulary
      Grey
    • No longer on formulary as other preparations are available at significantly lower cost (~£120 per bottle. This preparation is not recommended in either paediatric or adult vitamin D guidelines.
    • The licensed product (Thame labs) contains nuts and is therefore not suitable for patients with nut allergy.
    • An alternative unlicensed product is available for those with nut allergies - named patient use only. Cost in primary care may differ significantly.
    • 1mL = 3,000 units = 75 micrograms.
    • Link  Link to reviews
      Link  NUH: colecalciferol liquid memo July 2015
       
      Colecalciferol 3200 unit capsules  (Fultium D3®)

      View adult BNF View SPC online View childrens BNF
      Non Formulary
      Grey
      Dosing doesn’t fit with local Vitamin D guidelines. Formulary options for Vitamin D products will be reviewed alongside the guideline update.
       
      Colecalciferol 4000 units  (Desunin®)
      (Tablets)

      View adult BNF View SPC online View childrens BNF
      Non Formulary
      Grey
      No formal assessment. Assessed by September 2016 APC.
       
      Colestilan  (BindRen®)

      View adult BNF View SPC online View childrens BNF
      Non Formulary
      Grey
      High Cost Medicine
    • No formal submission
    • Link  Link to reviews
       
      Compound iron preparations  (Ferrograd C®)

      View adult BNF View SPC online View childrens BNF
      Non Formulary
      Grey
       
      Compound iron preparations  (Givitol®)

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

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

      Tablet

      • Tablets disperse in water if needed. See here for general advice on dispersing tablets.
      • Not recommended for prescribing, and liquid is actually blacklisted. See BNF.
      • Patients with low level deficiencies or dietary deficiencies due to lifestyle choice may be advised to purchase in line with Vit B12 treatment guidance below. If patients are not suitable for self care, instead use hydroxocobalamin injections (See above).
      Link  Notts APC: B12 treatment guideline
      Link  Oral B12 supplements to treat deficiency? (requires password) DTB (2019)
       
      Desferrioxamine Mesilate  (Desferal®)

      View adult BNF View SPC online View childrens BNF
      Non Formulary
      Grey
      Link  Link to reviews
       
      Dextran 40®

      View adult BNF View SPC online View childrens BNF
      Non Formulary
      Grey
      Infusion in Sodium Chloride 0.9%
      Infusion in Glucose 5%
       
      Dextran 70  (RescueFlow®)

      View adult BNF View SPC online View childrens BNF
      Non Formulary
      Grey
       
      Dihydrotachysterol  (AT 10®)

      View adult BNF View SPC online View childrens BNF
      Non Formulary
      Grey
       
      Eliglustat  (Cerdelga®)

      View adult BNF View SPC online View childrens BNF
      Non Formulary
      Grey
      High Cost Medicine
    • No formal submission
    • Link  NICE HST5- Eliglustat for treating type 1 Gaucher disease
       
      Elosulfase alfa  (Vimizim® )

      View adult BNF View SPC online View childrens BNF
      Non Formulary
      Grey
      High Cost Medicine
      Infusion
      NUH: Approved by NHS England for specialist centre use only, in accordance with NICE HST2. NUH to refer patients to specialist centre (Birmingham).
      Link  NICE HST2: Elosulfase alfa for treating mucopolysaccharidosis type IVa
       
      Epoetin theta  (Eporatio®)

      View adult BNF View SPC online View childrens BNF
      Non Formulary
      Grey
       
      Epoetin zeta  (Retacrit®)

      View adult BNF View SPC online View childrens BNF
      Non Formulary
      Grey
       
      Ergocalciferol
      (Oral)

      View adult BNF View SPC online View childrens BNF
      Non Formulary
      Grey
      Ongoing supply problems since May 2010
    • Also known as calciferol or Vitamin D2.
    • Therapeutically equivalent to colecalciferol (ref: Martindale)
    •  
      Etherified Starch
      (Pentastarch)

      View adult BNF View SPC online View childrens BNF
      Non Formulary
      Grey
       
      Etherified Starch  (HAES-steril®)

      View adult BNF View SPC online View childrens BNF
      Non Formulary
      Grey
       
      Etherified Starch  (Hemohes®)

      View adult BNF View SPC online View childrens BNF
      Non Formulary
      Grey
       
      Etherified Starch  (Infukoll®)

      View adult BNF View SPC online View childrens BNF
      Non Formulary
      Grey
       
      Ferric citrate coordination complex  (Fexeric®)

      View adult BNF View SPC online View childrens BNF
      Non Formulary
      Grey
      No formal assessment
       
      Ferric derisomaltose  (Diafer®)

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

      Injection (50mg/mL)

      • Previously known as iron isomaltoside
       
      Ferrous Fumarate  (Fersaday®)

      View adult BNF View SPC online View childrens BNF
      Non Formulary
      Grey
      Discontinued Feb 2017
       
      Ferrous Fumarate  (Fersamal® Syrup)

      View adult BNF View SPC online View childrens BNF
      Non Formulary
      Grey
      Discontinued
       
      Ferrous Fumarate  (Galfer®)

      View adult BNF View SPC online View childrens BNF
      Non Formulary
      Grey
       
      Ferrous Sulphate
      (Feospan)

      View adult BNF View SPC online View childrens BNF
      Non Formulary
      Grey
       
      Ferrous Sulphate  (Ferrograd®)

      View adult BNF View SPC online View childrens BNF
      Non Formulary
      Grey
       
      Ferrous Sulphate  (Ironorm® drops)

      View adult BNF View SPC online View childrens BNF
      Non Formulary
      Grey
       
      Ferumoxytol Injection  (Rienso ®)

      View adult BNF View SPC online View childrens BNF
      Non Formulary
      Grey
    • No formal assessment
    • Marketing authorisation withdrawn March 15- further info

    • Link  Link to reviews
      Link  MHRA: Serious hypersensitivity reactions—contraindicated if any drug allergy (Sept 14)
       
      Filgrastim  (Ratiograstim®)

      View adult BNF View SPC online View childrens BNF
      Non Formulary
      Red
      Injection pre-filled syringes.
    • Use Nivestim brand. May only be used as part of a clinical trial if required
    •  
      Filgrastim  (Zarzio®, Accofil®)

      View adult BNF View SPC online View childrens BNF
      Non Formulary
      Grey
      Nivestim brand is formulation of choice- see above
       
      Galsulfase  (Naglazyme®)

      View adult BNF View SPC online View childrens BNF
      Non Formulary
      Red
      Link  Summary of Product Characteristics: 2011
       
      Gelatin  (Haemaccel®)

      View adult BNF View SPC online View childrens BNF
      Non Formulary
      Grey
       
      Gelatin  (Isoplex®)

      View adult BNF View SPC online View childrens BNF
      Non Formulary
      Grey
       
      Gelatin  (Volplex®)

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

      Non Formulary
      Grey

      Rehydration sachets

      • Withdrawn from the market on 5th February 2018.
      • For adult patients with high stoma output unable to tolerate St Mark’s solution. Glucodrate also replaces "double strength" Dioralyte (10sachets diluted in the required volume). 
      • Listed as a borderline substance in the drug tariff, therefore requires ACBS endorsement on an FP10 prescription.
       
      Haem Arginate  (Normosang®)

      View adult BNF View SPC online View childrens BNF
      Non Formulary
      Grey
      High Cost Medicine

      Infusion

      For advice and supplies the telephone numbers to contact National Acute Porphyria Service (NAPS) both in and out of working hours are:

      • In working hours for known patients:
        • Kings College Hospital London (NAPC for England/Scotland) 020 32995776
        • University Hospital Wales Cardiff (NAPC for Wales) 029 20746588
      • Out of working hours or for new patients:
        • Emergency Service (24 hours a day, 7 days a week) should be contacted via the University of Wales Switchboard (02920 747747) who will provide contact details for the on-call Porphyria Team.
      • Please notify your clinical pharmacist or the out of hours on-call pharmacist if supplies are required. 
      • The NUH Pharmacy Medicines Finance Team should also be notified if haem arginate supplies are obtained from NAPS for NUH patients to ensure appropriate follow up. Use as recommended by NAPS is supported by DTC.
      Link  UKMI Q&A: Use of haem arginate (human hemin) in acute porphyria
      Link  BIMDG (British Inherited Metabolic Disease Group) protocol: Adult emergency management of acute porphyria
      Link  BIPNET (British and Irish Porphyria Network) Clinical Guidelines
       
      Cytotoxic Drug  Hydroxycarbamide  (Siklos®)

      View adult BNF View SPC online View childrens BNF
      Non Formulary
      Grey
       
      Hypertonic Solution  (HyperHAES®)

      View adult BNF View SPC online View childrens BNF
      Non Formulary
      Grey
       
      Idursulfase  (Elaprase®)
      (Infusion)

      View adult BNF View SPC online View childrens BNF
      Non Formulary
      Grey
      High Cost Medicine
       
      Imiglucerase  (Cerezyme®)

      View adult BNF View SPC online View childrens BNF
      Non Formulary
      Grey
      High Cost Medicine
       
      Iron and Folic Acid  (Ferrograd Folic®)

      View adult BNF View SPC online View childrens BNF
      Non Formulary
      Grey
      Tablet
       
      Iron and Folic Acid  (Pregaday®)

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

      Tablet

      Unavailable until at least Oct 2020

       
      Iron and Folic Acide  (Fefol®)

      View adult BNF View SPC online View childrens BNF
      Non Formulary
      Grey
       
      Iron and Folic Acide  (Galfer FA®)

      View adult BNF View SPC online View childrens BNF
      Non Formulary
      Grey
       
      Laronidase  (Aldurazyme®)

      View adult BNF View SPC online View childrens BNF
      Non Formulary
      Grey
      High Cost Medicine
       
      Lipegfilgrastim  (Lonquex®)

      View adult BNF View SPC online
      Non Formulary
      Grey
      High Cost Medicine

      Injection prefilled syringe

       
      Magnesium Chelate

      View adult BNF View SPC online View childrens BNF
      Non Formulary
      Grey
      Tablet 150mg
       
      Mercaptamine  (Cystagon®)

      View adult BNF View SPC online View childrens BNF
      Non Formulary
      Red
      High Cost Medicine
       
      Migalastat  (Galafold®)

      Non Formulary
      Grey
      High Cost Medicine
      Capsules
      NUH: Approved by NHS England for specialist centre use only, in accordance with NICE HST4. NUH to refer patients to specialist centre (Birmingham).
      Link  NICE HST4: Migalastat for treating Fabry disease
       
      Miglustat  (Zavesca®)

      View adult BNF View SPC online View childrens BNF
      Non Formulary
      Grey
      High Cost Medicine
       
      Multivitamin eye supplements

      View adult BNF View SPC online View childrens BNF
      Non Formulary
      Grey
      • Many brands containing lutein include: ICaps®, Macushield®, MaculEH Light®, Ocuvite®, PreserVision®, Vitalux Plus®, Viteyes®.
      • Ocular supplements are on the Nottinghamshire list of Medicines & Appliances of Limited Clinical Value that should never be prescribed due to insufficient evidence to support effectiveness at reducing progression of AMD, October 2017.
      • Can be purchased over the counter.
      Link  PrescQIPP review- vitamins for AMD
       
      Nicotinamide

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

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

      View adult BNF View SPC online View childrens BNF
      Non Formulary
      Grey
    • No formal submission
    • Contains zinc, copper, manganese, sodium, potassium, chromium and ferrous gluconate
    •  
      Other Compounds  (Potaba®)

      View adult BNF View SPC online View childrens BNF
      Non Formulary
      Grey
      Link  UKMI Q&A: Oral treatments for treating Peyronie’s disease
       
      Pegfilgrastim  (Neulasta®)

      View adult BNF View SPC online View childrens BNF
      Non Formulary
      Red
      High Cost Medicine

      Injection

      • Pegfilgrastim (Neulasta®) should no longer be prescribed for oncology or haematology patients unless part of a clinical trial where costs are re-imbursed or during Covid-19 pandemic to reduce the number of district nurse visits. For NUH see biosimilar Pegfilgrastim (Pelmeg®) entry.
      • Not currently funded by NHSE (May 2020)
      • Use Nivestim® instead.
      Link  London New Drugs Group Briefing
       
      Polysaccharide Iron Complex  (Miferex®)

      View adult BNF View SPC online View childrens BNF
      Non Formulary
      Grey
       
      Potasium Chloride  (Klofer®)

      View adult BNF View SPC online View childrens BNF
      Non Formulary
      Grey
       
      Potassium Bicarbonate
      (Potassium effervescent tablets)

      View adult BNF View SPC online View childrens BNF
      Non Formulary
      Grey
       
      Preparations  (Forceval Protein Powder®)

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

      View adult BNF View SPC online View childrens BNF
      Non Formulary
      Grey
       
      Ringer's Solution for Injection

      View adult BNF View SPC online View childrens BNF
      Non Formulary
      Grey
      • Ringer's solution for infusion = Sodium Chloride 0.86%, Potassium Chloride 0.03%, Calcium chloride dihydrate 0.033% (Link to SPC)
      • Do not confuse with Ringer's lactate solution, also known as Hartmann's solution.

       

       
      Sebelipase alfa  (Kanuma®)

      View adult BNF View SPC online View childrens BNF
      Non Formulary
      Grey
      No formal assessment (APC Nov 2015)
       
      Selenium  (Selenase®)

      View adult BNF View SPC online View childrens BNF
      Non Formulary
      Grey
       
      Sevelamer Hydrochloride  (Renagel®)

      View adult BNF View SPC online View childrens BNF
      Non Formulary
      Grey
      High Cost Medicine

      Tablets

      • Interchangeable with carbonate salt which is more cost-effective if prescribed generically. See entry above. Switch confirmed by NUH renal team Jan 17.
      Link  Link to reviews
       
      Sodium Bicarbonate  (Min-I-Jet® Sodium Bicarbonate)

      View adult BNF View SPC online View childrens BNF
      Non Formulary
      Grey
       
      Sodium chloride liquid (5mmol/5mL) SodiClor®

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

      GREY non-formulary

      Recommended strength is 5mmol/mL (30%) as per RCPCH guidance

       
      Tetrastarch  (Tetraspan®)

      View adult BNF View SPC online View childrens BNF
      Non Formulary
      Grey
    • Product withdrawn June 2013 following MHRA recall and marketing authorisation suspension
    • see additional information under volulyte entry
    •  
      Tetrastarch  (Venofundin®)

      View adult BNF View SPC online View childrens BNF
      Non Formulary
      Grey
    • Product withdrawn June 2013 following MHRA recall and marketing authorisation suspension
    • see additional information under volulyte entry
    •  
      Tetrastarch  (Volulyte®)

      View adult BNF View SPC online View childrens BNF
      Non Formulary
      Grey
    • Product withdrawn June 2013 following MHRA recall and marketing authorisation suspension
    • See information below
    • Link  MHRA: Hydroxyethyl starch - Advice for healthcare professionals Dec 14
      Link  MHRA: Drug alert and recall
      Link  MHRA: Hydroxyethyl starch - suspension of licences (June 2013)
      Link  SFH: Memo April 2013- Removal of Volulyte (HES 6%) from ICCU stocks
       
      Tetrastarch  (Voluven®)

      View adult BNF View SPC online View childrens BNF
      Non Formulary
      Grey
    • Product withdrawn June 2013 following MHRA recall and marketing authorisation suspension
    • see additional information under volulyte entry
    • Link  Link to reviews
       
      Trisodium Edetate  (Limclair®)

      View adult BNF View SPC online View childrens BNF
      Non Formulary
      Grey
       
      Velaglucerase alfa  ( VPRIV®)
      (Infusion)

      View adult BNF View SPC online View childrens BNF
      Non Formulary
      Grey
      High Cost Medicine
       
      Vitamin B complex preparations  (Vigranon B®)

      View adult BNF View SPC online View childrens BNF
      Non Formulary
      Grey
      Syrup
    • Can't be prescribed on FP10 prescription (blacklisted)
    •  
      Vitamin B Tablets (Compound)

      View adult BNF View SPC online View childrens BNF
      Non Formulary
      Grey
       
      Vitamins A and D
      (Halibut-liver oil)

      View adult BNF View SPC online View childrens BNF
      Non Formulary
      Grey
       
      Vitamins A and D  (Halycitrol®)

      View adult BNF View SPC online View childrens BNF
      Non Formulary
      Grey
       
      Zinc Acetate  (Wilzin®)

      View adult BNF View SPC online View childrens BNF
      Non Formulary
      Grey
       
        
      Key
      note Notes
      Section Title Section Title (top level)
      Section Title Section Title (sub level)
      First Choice Item First Choice item
      Non Formulary Item Non Formulary section
      Restricted Drug
      Restricted Drug
      Unlicensed Drug
      Unlicensed
      Track Changes
      Display tracking information
      click to search medicines.org.uk
      Link to adult BNF
      click to search medicines.org.uk
      Link to children's BNF
      click to search medicines.org.uk
      Link to SPCs
      SMC
      Scottish Medicines Consortium
      Cytotoxic Drug
      Cytotoxic Drug
      CD
      Controlled Drug
      High Cost Medicine
      High Cost Medicine
      Cancer Drugs Fund
      Cancer Drugs Fund
      NHSE
      NHS England
      Homecare
      Homecare
      CCG
      CCG

      Traffic Light Status Information

      Status Description

      Grey

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

      Red

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

      Amber 1

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

      Amber 2

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

      Amber 3

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

      Green

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

      OTC

        

      netFormulary