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Nottinghamshire Area Prescribing Committee
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 Formulary Chapter 9: Nutrition and blood - Full Chapter
09.05.02.02  Expand sub section  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
       
     ....
     Non Formulary Items
    Aluminium Hydroxide  (Alu-Cap®)

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

    Capsules

     
    Calcium acetate  (PhosLo®)

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

    Capsules

    Discontinued May 2015

    Link  Link to reviews
     
    Calcium Salts

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

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
    High Cost Medicine
  • No formal submission
  • Link  Link to reviews
     
    Ferric citrate coordination complex  (Fexeric®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
    No formal assessment
     
    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
     
      
    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

      

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