BARKING, HAVERING & REDBRIDGE UNIVERSITY NHS TRUST
FORMULARY MARCH 2021 CONTENTS Please use Ctrl + F or the binoculars to search an item
INTRODUCTION 1 1 GASTRO-INTESTINAL SYSTEM 4 2 CARDIOVASCULAR SYSTEM 8 3 RESPIRATORY SYSTEM 19 4 CENTRAL NERVOUS SYSTEM 23 5 INFECTIONS 33 6 ENDOCRINE SYSTEM 39 7 OBSTETRICS, GYNAECOLOGY & URINARY-TRACT DISORDERS 47 8 MALIGNANT DISEASE & IMMUNOSUPPRESSION 52 9 NUTRITION & BLOOD 58 10 MUSCULOSKELETAL & JOINT DISEASE 66 11 EYE 70 12 EAR, NOSE & OROPHARYNX 74 13 SKIN 78 14 IMMUNOLOGICAL PRODUCTS & VACCINES 87 15 ANAESTHESIA 89 POLICY AND GUIDELINES FOR PRESCRIBING FOR SELF, FAMILY, COLLEAGUES AND FRIENDS 93 16 Unlicensed & Specialists Use Drugs Approved by MOG 95
INTRODUCTION
AIM The aim of the formulary is to: promote safe, effective and economic use of drugs rationalise prescribing within the hospitals rationalise the number of preparations stocked by pharmacies, thus reducing stock holding and drug wastage
GUIDELINES FOR USING THIS BOOKLET The text is laid out in the same order as the British National Formulary (BNF). It should be used in conjunction with the current BNF. The Drug Formulary is not intended to be a replacement for it. Drugs can be located using the BNF section number or by the alphabetical list in the index at the back. If the BNF section has not been included, all preparations in that section are non-formulary. Strengths, formulations available, prescribing restrictions and notes for local guidance are included in the main text. The new British Approved Name (BAN) has been used, with the former name in brackets after. In some instances the trade name, indicated by ®, is included where it is necessary or with some compound preparations. Where there are modified release preparations, this is indicated by m/r and enteric coated preparations by e/c. Some sizes or strengths of preparations are currently available only on particular sites. Please refer to the pharmacy for further information. Various guidelines and protocols are referred to in the text. Details are available from pharmacy on request. In general the drugs listed are those stocked in Pharmacy. For requests for non-formulary drugs please refer below.
REQUESTING A DRUG FOR INCLUSION INTO THE FORMULARY The Drug and Therapeutics Committee meets every two months to consider requests from Consultants. A ‘new drug request form’ is available from the Trust Intranet. The Consultant should complete this fully, providinginformation about the intended indication, estimate patient numbers and supply supporting evidence for the inclusion of the drug. The form should be completed and signed by the Consultant, his/her Clinical Director, General Manager and clinical lead pharmacist. Funding will then need to be found. The pharmacy department will then produce an evidence-based evaluation for the Drug and Therapeutics Committee. Managing the entry of new drugs is a Trust requirement as part of its Medicines Management initiative.
INITIATION OF A NON-FORMULARY PREPARATION OR DRUG All preparations initiated within BHR for in- and out-patient prescribing should be from this formulary. According to Trust directives, prescriptions for non-formulary drugs will be queried by pharmacy staff, who will suggest alternatives from the formulary, where appropriate.
REQUESTING URGENT, NON-FORMULARY DRUGS In exceptional circumstances non-formulary drugs may be requested for use by a prescriber. A Principal/ Senior Principal Pharmacist will discuss the circumstances with the relevant Consultant. The pharmacist may authorise use or refer the matter to the Chairman of the Drug and Therapeutics Committee for a decision. If there are significant clinical risks or financial implications, then the matter will be discussed with the relevant Clinical Director. CONTINUATION OF THERAPY Supplies of medication are usually obtained for patients already established on non- formulary preparations. Patients on non-formulary products such as laxatives, indigestion remedies, calcium supplements, OTC analgesia etc., should be switched to an equivalent formulary preparation.
SPECIAL CONSIDERATIONS RESTRICTED DRUGS Where specified, initiation may be by the request of a Specialist. For example, many antibiotics are restricted to Microbiologists only. This is to help prevent resistance emerging and contain costs. MODIFIED RELEASE PREPARATIONS AND PHARMACEUTICAL FORMS In some cases a drug may be approved, but not in all the pharmaceutical forms available: e.g. the oral preparation may be formulary but the injection or the
2 cream, non-formulary. Some modified release preparations are disproportionately costly for the benefit they offer and are therefore not included. SPECIFIC CLINICAL NEEDS Non-formulary drugs for individual patients may be approved via Trust procedure. There will be occasions where a patient’s clinical needs cannot be met by any of the preparations listed. Special requirements must be discussed in the first instance with the Ward/ Liaison pharmacist. This may then be referred to a Senior Principal Pharmacist, who may authorise the approval for purchase. PAYMENT BY RESULTS (PbR) EXCLUSIONS Throughout the formulary some drugs have been labelled with nPbR. Non PbR drugs are those expensive drugs that have been agreed nationally should be reported to the CCGs on a monthly basis and invoiced accordingly. It has been agreed on a London-wide basis that the prescribing of these drugs should be only for NICE indications or for approved licensed indications where NICE has not yet reviewed (see details on the intranet). Before these drugs can be dispensed we must be provided with full patient details, including the clinical indication for the drug. The drugs that are included in this group are:
Anti TNFs e.g. Etanercept, Infliximab Antifibrinolytic drugs and haemostatics e.g. Drotrecogin alfa Torsion dystonia and other involuntary movements e.g. Riluzole and Botulinum Motor Neurone Disease Antifungals e.g. liposomal amphotericin Hepatitis B & C Peginterferon alfa, ribavirin Growth Hormone (Somatropin) Drugs affecting bone metabolism e.g. Teriparatide Immunomodulating drugs e.g. Alpha and Beta Interferon Somastatin analogues e.g. Octreotide Natalizumab Glatiramer Treatment of Macular Degeneration (Age –related) e.g. Lucentis and Avastin Drugs used in neutropenia e.g. Filgastrim Drugs used in metabolic disorders e.g. Laronidase Hyperuricaemia associated with cytotoxic drugs e.g. Rasburicase Immunoglobulins Tisseel
The minimum data set required by CCGs before they will pay for a patient’s treatment is:
Patient name NHS Number Hospital number Diagnosis Cost of drug Strength and form of drug Date dispensed Consultant code/ cost centre
3 CCGs
Unless previously agreed with the CCGs on a named-patient basis, we will only be funded for treatment that has been undertaken in line with NICE guidance and the CCGs will require assurance that prescribing has been in accordance with NICE.
Prescribing of these drugs should only be in accordance with NICE guidance OR for licensed indications that have been approved by the Drugs and Therapeutics Committee.
If a Consultant has a patient whom you believe requires one of these drugs but does not come under NICE or a licensed indication the Chief Pharmacist should be contacted before a request to a CCG or GP is made. Such requests will then be ‘fast-tracked’ to the Drugs and Therapeutics Committee for a decision. MEDICINES INFORMATION SERVICE The Medicines Information service is based at Queen’s Hospital (QH) and may be contacted on extension 3354. It provides a source of up to date medicines information and advice on drug therapy and related areas to all healthcare professionals. The Trust Intranet also provides drug-related information under the section “Medicines Information for Doctors” and carries the Electronic Medicines Compendium
OUT OF HOURS SERVICE The on-call Pharmacist for Queen’s Hospital (QH) and King George Hospital (KGH) can be contacted via Queen’s Hospital (QH) switchboard and/or King George Hospital switchboard outside opening hours.
BHRUT Medicines Optimisation Group Chair: Dr. John McAuley, Consultant Neurologist
EDITORS: Grace Lipinska, Senior Pharmacist (Formulary and Medicines Information)
REVISED: Updated to reflect MOG decisions up to February 2021 (Updated by Monica Patel, Medicines Information 11.03.2021)
2 BHRUT NHS Trust Drug Formulary, Updated March 2021
1 GASTRO-INTESTINAL SYSTEM
Peppermint water 1.1 DYSPEPSIA & GASTRO- (Unlicensed preparation) OESOPHAGEAL REFLUX MOTILITY STIMULANTS DISEASE Metoclopramide 1.1.1 ANTACIDS & DIMETICONE 10 mg tablet, 5 mg/ 5 ml syrup, Magnesium trisilicate mixture 10 mg/ 2 ml injection Asilone ® suspension Domperidone (Aluminium hydroxide, light magnesium 10 mg tablet, 5 mg/ 5 ml suspension, oxide & dimeticone) 30 mg suppositories Notes: Metoclopramide may induce 1.1.2 COMPOUND ALGINATE & dystonic reactions, especially in young PROPRIETARY INDIGESTION children, young adults & the elderly. Use PREPARATIONS of metoclopramide in patients under 20 Gaviscon ® Advance suspension years is not recommended. May cause confusion in the elderly. Avoid in Infant Gaviscon ® oral powder Parkinson’s disease Notes: Magnesium trisilicate should be prescribed when a simple antacid is 1.3 ULCER HEALING DRUGS needed. Gaviscon is an antacid-alginate 1.3.1 H2-RECEPTOR ANTAGONISTS preparation, indicated for treatment of Ranitidine reflux & hiatus hernia. 150 mg tablet, 75 mg/ 5 ml syrup, Caution: Some antacids can contain high 50 mg/ 2 ml injection levels of sodium, e.g magnesium trisilicate mixture. Gaviscon liquid 1.3.3 CHELATES AND COMPLEXES contains about 6 mmol sodium/ 10 ml Sucralfate 1 g tablet, 1 g/ 5 ml suspension 1.2 ANTISPASMODICS & OTHER DRUGS ALTERING GUT Tripotassium dicitratobismuthate (De-Noltab ®) 120 mg tablet MOTILITY (Gastroenterologists only) Atropine sulphate 1.3.5. PROTON PUMP INHIBITORS 600 mcg tablet, 500 mcg/ 5 ml syrup (unlicensed) 1st Choice: Omeprazole 10mg & 20mg (Paediatrics & ENT only) capsules 2nd Choice: Lansoprazole15 mg & 30 Dicycloverine (Dicyclomine) mg capsules 10 mg tablet, 10 mg/ 5 ml syrup Hyoscine butylbromide (Buscopan ® For adults with swallowing difficulties 10 mg tablet, 20 mg/ ml injection or on enteral feeding tubes use Lansoprazole 15 & 30mg FasTabs ® Mebeverine 135 mg tablet, 50 mg/ 5 ml liquid Omeprazole MUPS 10mg & 20mg Peppermint oil 0.2 ml capsule (Paediatric use only)
Esomeprazole 20 mg tablet nPbR = Indicates a drug excluded from HRG tariff price 4 BHRUT NHS Trust Drug Formulary, Updated March 2021
(For patients with erosive oesophagitis 250 mg & 500 mg suppositories who have failed to improve with (Gastroenterologists only) omeprazole) (Pentasa ®) 500 mg m/r tablet, 1g granules Omeprazole 40 mg infusion (Gastroenterologists only) (In accordance with PPI guidelines) (Salofalk®) 3g granules and 1g H. PYLORI ERADICATION THERAPY suppositories (ALL FOR SEVEN DAYS) Octasa® 400mg & 800mg M/R tablets Lansoprazole 30 mg b.d Balsalazide 750 mg capsule Amoxicillin 1g b.d (Gastroenterologists only) Clarithromycin 500 mg b.d Sulfasalazine (Sulphasalazine)Error! or Bookmark not defined. Lansoprazole30 mg b.d 500 mg tablet & e/c tablet, Amoxicillin 1g b.d 250 mg/ 5 ml suspension Metronidazole 400 mg b.d 500 mg suppositories
(Penicillin-allergic patients): Notes: The aminosalicylates, mesalazine Lansoprazole 30 mg b.d & sulfasalazine, may cause blood Clarithromycin 250 mg b.d disorders. See B.N.F. Sulfasalazine may Metronidazole 400 mg b. colour the urine & stain contact lens
1.5.2 CORTICOSTEROIDS 1.4 ACUTE DIARRHOEA Beclometasone 5mg m/r tablet 1.4.2 ANTIMOTILITY DRUGS (Clipper®) Codeine phosphate Budesonide 15 mg & 30 mg tablets, 1mg orodipsersible tablets (Joverza®) 25 mg/ 5 ml syrup (Consultant Gastroenterologists only for the treatment of eosinophilic esophagitis) Co-phenotrope (equivalent to Lomotil ®) 3 mg CR capsules 3 mg Tablet (Consultant Gastroenterologists only) Loperamide 2 mg tablet, 1 mg/ 5 ml syrup Hydrocortisone Note: It is important to rule out infective 10% foam application diarrhoea before prescribing anti- diarrhoeals Prednisolone 25 mg & 5 mg tablet, 2.5 mg & 5 mg e/c tablets, Eluxadoline (Truberzi®) 75mg and 5 mg soluble tablet, 5 mg suppositories, 100mg film-coated tablets 20 mg/ 100 ml retention enema, 20 mg foam application 1.5 TREATMENT OF CHRONIC BOWEL DISORDERS 1.5.1 AMINOSALICYLATES Mesalazine
(Asacol ® MR) 400 mg e/c tablet, 1 g foam enemas, nPbR = Indicates a drug excluded from HRG tariff price 5 BHRUT NHS Trust Drug Formulary, Updated March 2021
1.5.3 Drugs affecting the immune 5 mg tablet, response 5 mg (paediatric) & 10 mg (adult) suppositories Azathiprine Dantron (Danthron) Mercaptopurine Methotrexate 2.5mg tablets and various Co-danthramer strengths of injections 25/200 in 5 ml suspension &
75/1000 in 5 ml (strong) suspension CYTOKINE INHIBITORS (see guidance note below) nPbR Infliximab100 mg IV infusion Co-danthrusate (Remicade®) 50/ 60 capsule nPbR Infliximab Biosimilars 100mg Notes: Co-danthrusate & powder for concentrate for solution for co-danthramer should be restricted for infusion terminally ill patients. Both may colour the (Remsima® & Inflectra®) urine. They should be avoided in (Consultant Gastroenterologists only for incontinent patients, as prolonged contact Crohn’s Disease. All scripts should be may irritate the skin referred to a Senior Principal Pharmacist for approval) Docusate sodium100 mg capsule, 12.5 mg/ 5 ml & 50 mg/ 5 ml oral solution nd nPbR Adalimumab (2 line treatment of Notes: Docusate is frequently under crohn’s disease if infliximab ineffective or prescribed. It is a useful laxative, not tolerated) combining both stimulant & lubricant action Biosimilars: 1st line choice Hyrimoz® Senna 2nd line choice Amgevita® 7.5 mg tablet, 7.5 mg/ 5 ml syrup nPbR Vedolizumab 300mg vial Glycerin 1 g, 2 g & 4 g suppositories
Sodium picosulphate 5 mg/ 5 ml elixir 1.6 LAXATIVES Califig ® syrup (NELMHT only) Note: Before prescribing laxatives consider other contributory factors to 1.6.3 FAECAL SOFTENERS constipation: inadequate fluid intake, Arachis oil enema drugs, lack of exercise & dietary fibre Liquid Paraffin BP oral emulsion 1.6.1 BULK-FORMING LAXATIVES (Consultant Paediatricians only) Ispaghula husk (for Fybogel ®) 3.5 g sachets 1.6.4 OSMOTIC LAXATIVES Notes: Ispaghula husk should be stirred Lactulose 3.35 g/ 5 ml solution into a large glass of water & drunk Liquid paraffin & magnesium immediately. This should not be taken at hydroxide (Milpar ®) oral emulsion) night Macrogols (Movicol ®) 1.6.2 STIMULANT LAXATIVES Laxido® Bisacodyl nPbR = Indicates a drug excluded from HRG tariff price 6 BHRUT NHS Trust Drug Formulary, Updated March 2021
1.6 LOCAL PREPARATIONS Phosphate Enemas (Fletcher’s) FOR ANAL & RECTAL Sodium citrate microenema (Relaxit ®) DISORDERS LOCAL PREPARATIONS FOR ANAL AND RECTAL DISORDERS (Micolette®) 1.6.1 SOOTHING HAEMORRHOIDAL PREPARATIONS 1.6.5 BOWEL CLEANSING Anusol ® SOLUTIONS Cream, ointment & suppositories Citramag ® Magnesium citrate powder 1.7.2 PREPARATIONS WITH CORTICOSTEROIDS Fleet Phospho-soda ®Error! Bookmark Anusol HC ® ointment & suppositories not defined. oral solution 1.7.3 RECTAL SCLEROSANTS Klean-Prep ® oral powder Where Picolax and Citramag have been Phenol oily, B.P injection 5 % ineffective. 1.7.4 Management of anal fissures Moviprep® oral powder 1st Choice: Glyceryl Trinitrate Rectal Picolax ® oral powder ointment 0.4% (Rectogesic®) Sodium picosulfate & magnesium citrate sachets 2nd Choice: Diltiazem 2 % cream (Unlicensed) AMIDOTRIZOATES
Diatrizoates 1.8 STOMA CARE Stomahesive paste Gastrografin® Solution, sodium amidotrizoate 100 mg, meglumine amidotrizoate 660 mg/mL 100ml Bottle 1.9 DRUGS AFFECTING 1.6.6 PERIPHERAL OPIOID- INTESTINAL SECRETION RECEPTOR ANTAGONISTS 1.9.1 DRUGS ACTING ON THE GALL BLADDER Naloxegol 12.5 and 25 mg film-coated Ursodeoxycholic acid tablets 250 mg capsule, 150 mg tablet, 250 mg / 5 ml suspension 1.6.7 5HT4-RECEPTOR AGONISTS 1.9.2 BILE ACID SEQUESTRANTS Prucalopride 1mg and 2mg film coated Colestyramine (Cholestyramine) tablets (as per NICE recommendations) 4 g sachets LAXATIVES GUANYLATE CYCLASE-C Notes: Other drugs should be taken at RECEPTOR AGONISTS least 1 hour before or 4-6 hours after colestyramine to reduce possible Linaclotide 290microgram capsules interference with absorption
nPbR = Indicates a drug excluded from HRG tariff price 7 BHRUT NHS Trust Drug Formulary, Updated March 2021
Colesevelam Hydrochloride 625mg tablets
1.9.4 PANCREATIN
Creon ® 10 000 capsule
2 CARDIOVASCULAR SYSTEM
2.1 POSITIVE INOTROPIC Bendroflumethiazide (Bendrofluazide) DRUGS 2.5 & 5 mg tablets 2.1.1 CARDIAC GLYCOSIDES Notes: Bendroflumethiazide 2.5mg daily Digoxin is the drug of choice for mild-moderate 62.5, 125 & 250 micrograms tablets, hypertension. Allow 4 weeks for maximal 50 micrograms/ ml elixir, antihypertensive effect of bendro- 500 micrograms/ 2 ml & flumethiazide 100 micrograms/ ml injection Notes: Hypokalaemia predisposes to Indapamide 2.5mg & 1.5mg m/r tablets digoxin toxicity. Please note difference in bioavailablity between the formulations. Metolazone 5 mg tablet Use as a guide: 125 mcg tablet = 100 mcg Notes: Use metolazone with caution, elixir = 75 mcg injection especially when combined with loop diuretics. Monitor K+ and renal function DIGOXIN-SPECIFIC ANTIBODY Digifab ® 40mg/vial digoxin immune Fab 2.2.2 LOOP DIURETICS injection (RUM drug) 1st choice: Furosemide 20 mg, 40 mg & 500 mg tablets, Notes: Please refer to Registrar or 20 mg/ 2 ml, 50 mg/ 5 ml & Consultant before issuing. BHR Labs 250 mg/ 25 ml injection, measure digoxin levels in nmol/ L. The 40 mg / 5 ml oral solution manufacturers use ng/ ml in the literature, hence conversion may be required. 2nd choice: Bumetanide 1 mg & 5 mg (new level) ng/ ml= 0.78 X (level) nmol/ L tablets, 1mg/ 5 ml liquid, 2 mg/ 4 ml injection 2.1.2 PHOSPHODIESTERASE Note: At low doses 40 mg furosemide is INHIBITORS equivalent to 1 mg bumetanide
Milrinone 10 mg/ 10 ml injection (RUM drug) 2.2.3 POTASSIUM-SPARING (ITU & Cardiologists only) DIURETICS
Amiloride 2.2 DIURETICS 5 mg tablet, 5 mg/ 5 ml solution
2.2.1 THIAZIDES & RELATED DIURETICS nPbR = Indicates a drug excluded from HRG tariff price 8 BHRUT NHS Trust Drug Formulary, Updated March 2021
Notes: Potassium sparing diuretics such as amiloride are usually necessary only if Amiodarone 100 mg & 200 mg tablets, hypokalaemia develops 150 mg/ 3 ml injection, 300 mg/ 10 ml minijet (Resus. only) ALDOSTERONE ANTAGONISTS 1st choice: Spironolactone 25 mg & 100 Notes: Liver function & thyroid function mg tablets, 25 mg/ 5 ml & 100 mg/ 5 ml tests should be performed at baseline & suspension, 6 monthly thereafter. A chest X-Ray 1 mg/ ml suspension (for paediatrics, should be done before treatment unlicensed) Flecainide 50 mg & 100 mg tablets, 150 mg/ 15 ml injection Notes: Spironolactone is licensed only Disopyramide 100 mg capsule, for congestive cardiac failure, nephrotic 150 mg & 250 mg SR tablets, syndrome, ascites associated with 50 mg/ 5 ml injection cirrhosis or malignancy & primary aldosteronism Propafenone 150 mg tablet Alternative: Eplerenone 25 & 50mg Notes: Disopyramide, flecainide & tablet. For Spironolactone intolerant propafenone should be used under the patients. In view of its high cost it will not guidance of a Consultant Cardiologist replace Spironolactone. only 2.2.4 POTASSIUM-SPARING DRUGS FOR VENTRICULAR DIURETICS WITH OTHER DIURETICS ARRHYTHMIAS Co-amilofruse (amiloride/ furosemide) Lidocaine (Lignocaine) 2.5 mg/ 20 mg & 5 mg/ 40 mg tablet 1% & 2 % injection, Co-amilozide 0.1% & 0.2 %/ glucose 5 % infusion, (amiloride/ hydrochlorothiazide) 100 mg/ 10 ml minijet 2.5 mg/ 12.5 mg & 5mg/ 25 mg tablets Mexiletine 50 mg & 200 mg capsules, Co-triamterzide 250 mg/ 10 ml injection (triamterene/ hydrochlorothiazide) 50 mg/ 25 mg tablet Notes: This category of drugs should be 2.2.5 OSMOTIC DIURETICS used under the guidance of a Consultant Mannitol 10 % & 20 % infusion Cardiologist only
Notes: Crystal formation may occasionally occur in mannitol bags. 2.4 BETA-ADRENOCEPTOR These disappear on gentle warming BLOCKING DRUGS before use
Atenolol 25 mg, 50 mg & 100 mg tablets, 2.3 ANTI-ARRHYTHMIC DRUGS 25 mg/ 5 ml syrup, 5 mg/ 10ml injection
Metoprolol SUPRAVENTRICULAR ARRHYTHMIAS 50 mg tablet, 5 mg/ 5 ml injection Adenosine 6 mg/ 2 ml injection Propranolol 10 mg, 40 mg & 80 mg tablets, Dronedarone 400mg f/c tablets (as per 80 mg & 160 mg SR tablets, NICE recommendations) 1 mg/ ml injection, SUPRAVENTRICULAR & 40 mg/ 5 ml oral solution, VENTRICULAR ARRHYTHMIAS 10 mg/ 5 ml oral solution, 5 mg/ 5 ml oral solution, nPbR = Indicates a drug excluded from HRG tariff price 9 BHRUT NHS Trust Drug Formulary, Updated March 2021
Sotalol 40 mg & 80 mg tablets, 2.5 mg, 5 mg, 10 mg & 20 mg tablets 40 mg/ 4 ml injection Alternative: Ramipril (in accordance Bisoprolol 1.25 mg & 2.5 mg with HOPE guidelines 5 mg & 10 mg tablets 1.25 mg, 2.5 mg & 5 mg & 10 mg tablets Carvedilol 3.125 mg, 6.25 mg, 12.5 mg Captopril & 25 mg tablets 12.5 mg, 25 mg & 50 mg tablets Esmolol 100 mg/ 10 ml injection Notes: First dose hypotension can occur (Theatres only) in patients who are taking high dose Labetalol 50 mg & 100 mg tablets diuretics, volume depleted, on a low- 100 mg/ 20 ml injection sodium diet or with heart failure. The first dose should always be given at night. Caution with potassium-sparing diuretics. Urea & electrolytes should be checked 2.5 DRUGS AFFECTING THE within 1 week of commencing therapy RENIN-ANGIOTENSIN SYSTEM & OTHER 2.5.5.2 ANGIOTENSIN 2 RECEPTOR ANTAGONISTS ANTIHYPERTENSIVES Angiotensin 2 receptor antagonists 2.5.1 VASODILATOR (AR2As) should only be used when ANTIHYPERTENSIVE DRUGS there is intolerance to ACE inhibitors Hydralazine e.g. cough 25 mg & 50 mg tablets, 20 mg/ ml injection TREATMENT OF HYPERTENSION Sodium nitroprusside st 50 mg/ 5 ml intravenous infusion 1 Choice: Candesartan 2 mg, 4 mg & 8mg tablets 2.5.2 CENTRALLY ACTING Alternative: Losartan 25mg, 50mg and ANTIHYPERTENSIVE DRUGS 100mg tablets (Licensed for Hypertensive Methyldopa 250 mg/ 5 ml suspension, patients with left ventricular hypertrophy 125 mg, 250 mg & 500 mg tablet except black patients) 2.5.3 ADRENERGIC NEURONE RENAL PROTECTION IN TYPE 2 BLOCKING DRUGS DIABETIC PATIENTS WITH Guanethidine 10 mg/ ml injection NEPHROPATHY (Day Stay (KGH), Dr Ather & 1st Choice: Losartan (use when Orthopaedic surgeons (OCH) only) intolerant to ACE inhibitors)
2.5.4 ALPHA-ADRENOCEPTOR TREATMENT OF HEART FAILURE BLOCKING DRUGS Sacubitril/Valsartan 24mg/ 26mg, Doxazosin 1 mg, 2 mg & 4 mg tablets 49mg/51mg & 97mg/103mg film coated tablets (Entresto®) Phentolamine 10 mg/ ml injection
2.5.5 DRUGS AFFECTING THE (All AR2As are unlicensed for this RENIN-ANGIOTENSIN SYSTEM indication, ACE inhibitors are 1st 2.5.5.1 ACE (ANGIOTENSIN Choice) CONVERTING ENZYME) INHIBITORS Alternative: Candesartan (use when 1st Choice: Lisinopril intolerant to ACE inhibitors) nPbR = Indicates a drug excluded from HRG tariff price 10 BHRUT NHS Trust Drug Formulary, Updated March 2021
2.5.5.3 RENIN INHIBITORS (Twice daily preparation) 10 mg & 20 mg m/r tablets Aliskiren 150mg & 300mg f/c tablets (Consultant Cardiologists’ and Dr. Fahal’s (Once daily formulation) use only). To be used as a 4th line agent 20 mg, 30 mg & 60 mg m/r tablets after all other antihypertensives have been used at their maximum tolerated Notes: Nifedipine capsules are not doses. Rx must include a consultant recommended by the B.N.F. for angina cardioologists’ signature prophylaxis & hypertension. It should be restricted to treatment of Raynaud’s
phenomenon only. For brands stocked, 2.6 NITRATES, CALCIUM-CHANNEL please ask pharmacy BLOCKERS & POTASSIUM-CHANNEL Verapamil ACTIVATORS 40 mg, 80 mg & 120 mg tablets, 2.6.1 NITRATES 120 mg, 180 mg & 240 mg m/r capsules/ Glyceryl trinitrate (GTN) tablets, 500 micrograms sublingual tablets, 5 mg/ 2 ml injection 400 micrograms/ dose sublingual spray, Note: Verapamil frequently causes 2 mg & 5 mg buccal tablets, constipation & should be prescribed with 50 mg/ 10 ml injection, a laxative, such as senna or docusate 5 mg/ 5 ml injection, sodium 5 mg & 10 mg patch Nimodipine 30 mg tablet, Isosorbide mononitrate 200 micrograms/ ml injection 10 mg & 20 mg tablets & 60mg m/r Note: Nimodipine injection must be tablets administered centrally Note: All other slow-release nitrates are non- formulary 2.6.3 OTHER ANTIANGINAL DRUGS 2.6.2 CALCIUM-CHANNEL BLOCKERS Ivabradine 5mg & 7.5mg tablets Notes: Bioavailability may vary between Note: Approved for 3rd line treatment of different formulations (brands) of stable angina pectoris in patients who are diltiazem, verapamil & nifedipine. intolerant to beta-blockers and diltiazem. However, it is Trust policy to use formulations (brands) for diltiazem Ivabradine should be initiated in primary specified below. care only if there’s access to a Once daily preparations should be used multidiplinary heart failure team. Dose only when compliance is a problem titration and monitoring should be carried out by a heart failure specialist or in Amlodipine 5 mg & 10 mg tablets primary care by either a GP with a special interest in heart failure or a heart failure Diltiazem specialist nurse. (Twice or Three times daily preparation) 60 mg m/r tablet (To be restricted to senior members of (Twice daily preparation: Tildiem Retard) medical Team) 90 mg, 120 mg & 180 mg m/r tablets (Once daily formulation: Adizem XL) Nicorandil 10 mg & 20 mg tablets 120 mg, 180 mg, 200 mg, 240 mg & Ranolazine 375mg, 500mg & 750mg m/r 300mg m/r capsules tablets (as per angina treatment pathway)
Nifedipine 5 mg & 10 mg capsules, nPbR = Indicates a drug excluded from HRG tariff price 11 BHRUT NHS Trust Drug Formulary, Updated March 2021
2.6.4 PERIPHERAL & CEREBRAL VASODILATORS Naftidrofuryl 100 mg capsule Iloprost infusion 50 microgram/ 0.5 ml injection (Unlicensed. Refer to the protocol. For severe Raynaud’s phenomenon & limb- threatening peripheral arterial occlusive disease only) Pentoxifylline (Oxpentifylline) 400mg tablet (Consultant Vascular Surgeons only)
Note: Other peripheral vasodilators are considered less suitable for prescribing by the B.N.F
2.7 SYMPATHOMIMETICS 2.7.1 INOTROPIC SYMPATHOMIMETICS Dobutamine 250 mg/ 20 ml injection
Dopamine 200 mg/ 5 ml injection
Dopexamine 10 mg/ ml strong sterile solution (ITU Consultants only)
Notes: Dopamine must be administered into a major vein. Peripheral infusions may lead to skin necrosis & thrombophlebitis
See following pages for dobutamine & dopamine infusion tables
nPbR = Indicates a drug excluded from HRG tariff price 12 BHRUT NHS Trust Drug Formulary, Updated March 2021
DOBUTAMINE INFUSION CHART Concentration = 250 mg in 100 ml saline or 5 % glucose = 2500 micrograms per ml. Give through a Baxter Floguard pump
mcg/ kg/ min 2.5 3.0 4.0 5.0 6.0 7.0 8.0
Patient's Wt. (kg) infusion rate in ml./hr. (100 ml syringe pump)
55 3.3 4.0 5.3 6.6 7.9 9.2 10. 6
60 3.6 4.3 5.8 7.2 8.6 10.1 11.5
65 3.9 4.7 6.2 7.8 9.4 10.9 12.5
70 4.2 5.0 6.7 8.4 10.1 11.8 13.4
75 4.5 5.4 7.2 9.0 10.8 12.6 14.4
80 4.8 5.8 7.7 9.6 11.5 13.4 15.4
85 5.1 6.1 8.2 10.2 12.2 14.3 16.3
90 5.4 6.5 8.6 10.8 13.0 15.1 17.3
95 5.7 6.8 9.1 11.4 13.7 16.0 18.2
100 6.0 7.2 9.6 12.0 14.4 16.8 19.2
mcg/ kg/ min 9.0 10.0 11.0 12.0 13.0 14.0 15.0
Patient's Wt. (kg) infusion rate in ml./hr. (100 ml syringe pump)
55 11.9 13.2 14.5 15.8 17.2 18.5 19.8
60 13.0 14.4 15.8 17.3 18.7 20.2 21.6
65 14.0 15.6 17.2 18.7 20.3 21.8 23.4
70 15.1 16.8 18.5 20.2 21.8 23.5 25.2
75 16.2 18.0 19.8 21.6 23.4 25.2 27.0
80 17.3 19.2 21.1 23.0 25.0 26.9 28.8
85 18.4 20.4 22.4 24.5 26.5 28.6 30.6
90 19.4 21.6 23.8 25.9 28.1 30.2 32.4
95 20.5 22.8 25.1 27.4 29.6 31.9 34.2
100 21.6 24.0 26.4 28.8 31.2 33.6 36.0
nPbR = Indicates a drug excluded from HRG tariff price 13 BHRUT NHS Trust Drug Formulary, Updated March 2021
When using a 50 ml syringe pump add 250 mg dobutamine to 50 ml normal saline or 5% glucose and halve the above infusion rates.
DOPAMINE INFUSION CHART Concentration = 200 mg in 100 ml saline or 5 % glucose = 2000 micrograms per ml. Give through a Baxter Floguard pump
mcg/ kg/ min 2.5 3.0 4.0 5.0 6.0 7.0 8.0
Patient's Wt. (kg) infusion rate in ml./hr.
55 4.1 5.0 6.6 8.3 9.9 11.6 13.2
60 4.5 5.4 7.2 9.0 10.8 12.6 14.4
65 4.9 5.9 7.8 9.8 11.7 13.7 15.6
70 5.3 6.3 8.4 10.5 12.6 14.7 16.8
75 5.6 6.8 9.0 11.3 13.5 15.8 18.0
80 6.0 7.2 9.6 12.0 14.4 16.8 19.2
85 6.4 7.7 10.2 12.8 15.3 17.9 20.4
90 6.8 8.1 10.8 13.5 16.2 18.9 21.6
95 7.1 8.6 11.4 14.3 17.1 20.0 22.8
100 7.5 9.0 12.0 15.0 18.0 21.0 24.0
mcg/ kg/ min 9.0 10.0 11.0 12.0 13.0 14.0 15.0
Patient's Wt. (kg) infusion rate in ml./hr. (100 ml syringe pump) 55 14.9 16.5 18.2 19.8 21.5 23.1 24.8
60 16.2 18.0 19.8 21.6 23.4 25.2 27.0
65 17.6 19.5 21.5 23.4 25.4 27.3 29.3
70 18.9 21.0 23.1 25.2 27.3 29.4 31.5
75 20.3 22.5 24.8 27.0 29.3 31.5 33.8
80 21.6 24.0 26.4 28.8 31.2 33.6 36.0
85 23.0 25.5 28.1 30.6 33.2 35.7 38.3
90 24.3 27.0 29.7 32.4 35.1 37.8 40.5
95 25.7 28.5 31.4 34.2 37.1 39.9 42.8
100 27.0 30.0 33.0 36.0 39.0 42.0 45.0 When using a 50 ml syringe pump add 200 mg dopamine to 50 ml normal saline or 5% glucose and halve the above infusion rates.
nPbR = Indicates a drug excluded from HRG tariff price 14 BHRUT NHS Trust Drug Formulary, Updated March 2021
2.7.2 VASOCONSTRICTOR 60 mg in 0.6 ml prefilled syringe SYMPATHOMIMETICS 80 mg in 0.8 ml prefilled syringe Noradrenaline (Norepinephrine) Error! 100 mg in 1.0 ml prefilled syringe Bookmark not defined. 120 mg in 0.8 ml prefilled syringe 1 mg/ ml (1/1000) injection 150 mg in 1.0 ml prefilled syringe
Notes: Monitor renal function and adjust MetaraminolError! Bookmark not dose if necessary. This should not delay defined. injection 10 mg in 1 ml first dosing, but subsequent dosing must (Unlicensed)) be based on the results. Risk of bleeding is increased in severe renal impairment Phenylephrine 10 mg/ ml (1 %) injection Argatroban Monohydrate 2.7.3 CARDIOPULMONARY (Exembol®)100mg/ml RESUSCITATION Adrenaline (Epinephrine) HIRUDINS 1 mg/ 10 ml minijet Notes: In accordance with the Trust Lepirudin Resuscitation Policy. 50 mg/ ml injection See resuscitation drugs list for BHR. (Haematologists only) Any queries please consult the Resus. HEPARIN FLUSHES Officer. NELMHT: Please refer to own policy Heparinised saline 50 units/ 5 ml injection (Paediatric & Hickman lines only) 2.8 ANTICOAGULANTS & PROTAMINE EPOPROSTENOL 2.8.1 PARENTERAL nPbR Epoprostenol (Flolan®)Error! ANTICOAGULANTS Bookmark not defined. 500 micrograms Heparin sodium 1000 units/ ml, injection (ITU/ HDU patients on 5000 units/ ml, 25,000 units/ ml injection, haemofiltration with low platelets, SCBU, 500 units/ 500 ml sodium chloride 0.9 % Vascular Surgeons, KGH only for infusion Peripheral Vascular Disease, unlicensed) Fondaparinux sodium 5mg/ml injection Heparin calcium injection 0.5ml pre-filled syringe 5000 units/ 0.2 ml prefilled syringe 2.8.2 ORAL ANTICOAGULANTS LOW MOLECULAR WEIGHT HEPARINS Warfarin 1 mg, 3 mg & 5 mg tablets Alternative: Acenocoumarol Dalteparin (Fragmin®) injection (Nicoumalone) 2500units/ml 4ml ampoule 1 mg tablet (for prophylaxis and treatment of thrombosis in children). Alternative: Phenindione 10 mg & 25 (Consultant Haematologists and mg tablets Paediatricians only) Rivaroxaban (Xarelto®) 2.5mg, 10mg, Enoxaparin (Clexane ®) injection 15mg & 20mg film-coated tablet. (For 20 mg in 0.2 ml prefilled syringe thromboprophylaxis following knee and 40 mg in 0.4 ml prefilled syringe hip replacement surgeries, orthopaedics nPbR = Indicates a drug excluded from HRG tariff price 15 BHRUT NHS Trust Drug Formulary, Updated March 2021 use only) & Treatment of VTE by Haematologists only. Also approved for prophylaxis of stroke and systemic Notes: Dipyridamole tablets are embolism in non-valvular atrial fibrillation licensed only for prophylaxis of by Haematologists, Cardiologists and thromboembolism associated with Stroke physicians. Also approved for prosthetic heart valves. prophylaxis of atherothrombotic events Dipyridamole MR is also licensed for the following ACS as per NICE TA 335) secondary prevention of stroke or TIA Apixaban (Elliquis®) 2.5mg & 5mg f/c (used alone or with aspirin) tablets. (For prophylaxis of stroke and Eptifibatide 2mg/ml injection systemic embolism in non-valvular atrial (Consultant Cardiologists only) fibrillation by Haematologists, Prasugrel 5mg & 10mg f/c tablets Cardiologists and Stroke physicians ) (1.For patients who have experienced a Dabigatran (Pradaxa®) 75mg, 110mg & stent thrombosis during clopidogrel 150mg capsules. (For prophylaxis of therapy. stroke and systemic embolism in non- valvular atrial fibrillation by 2. On a consultant decision basis for Haematologists, Cardiologists and Stroke selected high-risk patients with GRACE physicians ) risk score ≥ 140 and low risk of bleeding meeting NICE criteria). Edoxaban (Lixiana®) 60mg f/c tablet
(For preventing stroke and systemic embolism in people with non-valvular Ticagrelor 60mg & 90mg tablets atrial fibrillation & for treating and Notes: To be used according to NICE preventing deep-vein thrombosis and TA236 and NICE TA420 pulmonary embolism as recommended by NICE TA354 & TA355) Abciximab 10 mg/ 5 ml injection 2.8.3 PROTAMINE SULPHATE Refer to protocol Protamine sulphate 10 mg/ ml injection For administration of a bolus dose prior to transfer to the London Chest Hospital for 2.9 ANTIPLATELET DRUGS acute MI patients for primary angioplasty. Aspirin 75 mg dispersible tablet (Consultant Neuro-Radiologist only, for thromoboembolism involving cerebral Notes: There is no evidence to support arteries, unlicensed indication, needs the use of enteric-coated aspirin patient consent) preparations. These preparations are non-formulary. 2.10 MYOCARDIAL INFARCTION Clopidogrel 75 mg tablet & FIBRINOLYSIS Notes: Clopidogrel is restricted for 2.10.2 FIBRINOLYTIC DRUGS intolerance or hypersensitivity to aspirin & for treatment of acute coronary Streptokinase syndrome (ACS) 250,000 units & 1.5 mega units injection Dipyridamole 200 mg m/r capsule, Notes: See B.N.F. for contra-indications 25 mg & 100 mg tablets, to streptokinase. Refer to Trust ICP for 50 mg/ 5 ml suspension (unlicensed) CHD nPbR = Indicates a drug excluded from HRG tariff price 16 BHRUT NHS Trust Drug Formulary, Updated March 2021
Alteplase (Tissue Plasminogen Notes: Ezetimibe is indicated for Activator) (TPA) combination therapy with a statin and in 50 mg injection patients intolerant to statins. 2mg (Actilyse Cathflo) FIBRATES Tenecteplase Bezafibrate 200 mg & 400 mg tablets, 50mg (10,000 units) injection 400 mg m/r tablet
STATINS Urokinase injection 10,000 units & 50,000 units Atorvastatin (Unlicensed import, for unblocking TPN & Hickman lines only) Pravastatin
Rosuvastatin 2.11 ANTIFIBRINOLYTIC DRUGS & HAEMOSTATICS Simvastatin
st 1 Choice: Tranexamic acid Note: Statins, other than atorvastatin, 500 mg tablet, should be taken at night for optimum 250 mg/ 2 ml injection effect
Etamsylate The following table recommends 500 mg tablet dosage advice for drugs which are known to interact with simvastatin, Drotrecogin Alfa (activated) which may result in an increase in risk Recombinant activated Protein C of myopathy or rhabdomyolosis (nPbR Drug)
Simvastatin NICE guidance: Drotrecogin alfa should Interacting drug Prescribing be considered for adults with severe Recommendations sepsis that has resulted in the failure of Erythromycin and Contraindicated. If two or more major organs and who are Clarithromycin unavoidable, suspend receiving optimum intensive care support. Simvastatin during
course of treatment. 2.12 LIPID-REGULATING Ciclosporin Maximum 10mg daily DRUGS Amiodarone Maximum 20mg daily ANION-EXCHANGE RESINS Verapamil Maximum 20mg daily Diltiazem Maximum 40mg daily Colestyramine (Cholestyramine) Warfarin Caution: monitor INR 4 g sachet HIV protease Use Pravastatin Notes: other drugs should be taken at inhibitors least 1 hour before or 4-6 hours after Grapefruit juice AVOID anion-exchange resins to reduce possible interference with absorption Note: The above list is not exhaustive. EZETIMIBE Please refer to the current edition of the BNF for further advice Ezetimibe 10 mg tablets
nPbR = Indicates a drug excluded from HRG tariff price 17 BHRUT NHS Trust Drug Formulary, Updated March 2021
LIPID-MODIFYING DRUG – OTHER
Alirocumab (Praluent®) 75mg/1ml & 150mg/1ml solution for injection pre-filled pen
Evolocumab (Repatha® and Repatha Sureclick) 140mg/1ml solution for injection pre-filled syringes/pre-filled disposable devices
Omega-3-Acid Ethyl Esters (Omacor ®) 1 g capsules)
Approved for anti-retroviral induced hyperlipidemia not responding to statins (GU and HIV initiation only)
2.13 LOCAL SCLEROSANTS
Absolute alcohol injection
Ethanolamine oleate injection
Sodium tetradecyl sulphate 0.5 %, 1 % & 3 % injection
2.14 PRE-ANGIOGRAM Acetylcysteine (Parvolex ®) 2g/ 10 ml injection- Unlicensed use
N-Acetylcysteine 600mg tablets (unlicensed), to be used prophylactically before angiogram and in combination with prednisoloFne and azathioprine for the long-term management of patients with Idiopathic Pulmonary fibrosis. Note: 600 mg Acetylcysteine injection can also be given orally (mixed with cola or orange juice) twice daily for 2 days, in those patients with renal dysfunction. First dose starting evening before angiogram. This is to protect the kidney from damage by the contrast dye. Please refer to ICP for Angiogram
nPbR = Indicates a drug excluded from HRG tariff price 18 BHRUT NHS Trust Drug Formulary, Updated March 2021
3 RESPIRATORY SYSTEM
3.1 BRONCHODILATORS Olodaterol with Tiotropium 2.5/2.5 micrograms/ per dose (Spiolto 3.1.1 ADRENOCEPTOR AGONISTS Respimat) 3.1.1.1 SELECTIVE BETA AGONISTS 2 3.1.2 ANTIMUSCARINIC st 1 Choice: Salbutamol BRONCHODILATORS and 100 micrograms/ dose inhaler (CFC COMBINATIONS Free), 100 micrograms Easibreathe (mdi), Easyhaler, 2.5 mg/ 2.5 ml & 5 mg/ Aclidinium 400 micrograms/metered 2.5 ml nebuliser solution, inhalation powder (Eklira Genuair®) 500 micrograms/ ml injection, 100 micrograms/ dose autohaler, Aclidinium with Formoterol 5 mg/ 5 ml injection for infusion, 340micrograms/ 12 micrograms per dose 2 mg & 4 mg tablets, (Duaklir Genuair) 2 mg/ 5 ml syrup Glycopyrronium Alternative: Terbutaline 50 micrograms/ hard capsule (inhalation 250 micrograms/ dose inhaler, powder) Seebri Breezehaler® 500 micrograms/ dose turbohaler (dpi) (Respiratory Physicians & Paediatricians Ipratropium bromide only) 20 micrograms/ dose inhaler (CFC Free) 250 micrograms/ ml & 500 micrograms/ 2 ml nebuliser solution LONG ACTING BETA2 AGONISTS
1st Choice: Salmeterol Tiotropium 18 micrograms/ capsule (Dry powder for 25 micrograms/ dose inhaler and 50 inhalation) “Spiriva” micrograms/ blister Accuhaler 2.5 micrograms/metered inhalation (in accordance with BTS guidelines) (solution for inhalation) “Respimat”
Alternative: Formoterol (Eformoterol) 6 micrograms & 12 micrograms/ dose Umeclidinium bromide turbohaler 55 micrograms/dose (dpi) (Incruse)
Indacaterol 150 & 300 microgram Umeclidinium with Vilanterol 55/22 inhalation powder capsules (Onbrez®) micrograms per dose (Anoro Ellipta)
Notes: Spacers, autohalers & turbohalers Indacaterol with Glycopyrronium are available for patients who are unable 85/43 micrograms per dose (Ultibro to use aerosol metered dose inhalers Breezehaler) 3.1.3 THEOPHYLLINE Olodaterol 2.5microgram per dose (Striverdi Respimat) Aminophylline (Phyllocontin Continus ®) 225 mg m/r tablet, 250 mg/ 10 ml injection nPbR = Indicates a drug excluded from HRG tariff price 19 BHRUT NHS Trust Drug Formulary, Updated March 2021
Theophylline Budesonide 50 micrograms/ dose & (Uniphyllin Continus ®) 200 micrograms/ dose inhaler, 200 mg, 300 mg & 400 mg m/r tablets 100 micrograms/ dose, 200 micrograms/ dose & (Slo-Phyllin ®) 400 micrograms/ dose turbohaler 60 mg, 125 mg & 250 mg m/r capsule 500 micrograms/ 2ml & 1 mg/ 2 ml Notes: The brand name should be respules specified when prescribing m/r Budesonide & Formoterol preparations of theophylline to distinguish Symbicort ® 100/ 6 & 200/ 6 turbohaler one from another. The different formulations should not be regarded as Duoresp Spiromax160/4.5 & 320/9 interchangeable. micrograms Caution when co-prescribing drugs which can affect metabolism of theophyllines, e.g. cimetidine, erythromycin, warfarin & Fluticasone ciprofloxacin 50 micrograms/ dose, 125 micrograms/ dose & Caffeine citrate 250 micrograms/ dose inhaler 10 mg/ ml solution & injection (as base)
(Unlicensed, neonates only) Fluticasone & formoterol 3.1.5 PEAK FLOW METERS, INHALER Flutiform® 50/5 micrograms, DEVICESError! Bookmark not defined. & 125/5micrograms & 250/10 NEBULISERS micrograms inhalers
Aerochamber Fluticasone & Salmeterol Volumatic Seretide 50, 125, 250 Evohalers Nebuhaler 100, 250micrograms & 500micrograms Haleraid Accuhalers Peak flow meters Fluticasone & Vilanterol 3.2 CORTICOSTEROIDS Relvar Ellipta st 92/22 microgranms per dose 1 Choice in adults: Beclometasone (CFC-free) (QVAR ®) Fluticasone & Umeclidinium & 50 micrograms/ dose & Vilantrerol 100 micrograms/ dose inhaler Trelegy Ellipta® (NOT recommended in children) 92 micrograms/55 micrograms/22
micrograms per dose Beclomethasone & Formoterol Fostair® and Fostair® NEXThaler 100 micrograms/ 6 micrograms/metered 3.3 CROMOGLICATE, inhalation RELATED THERAPY & 200micrograms/6micrograms/metered LEUKOTRIENE RECEPTOR inhalation ANTAGONISTS
Beclometasone & Formoterol & Glycopyrronium Trimbow® 3.3.1 CROMOGLICATE & RELATED 87micrograms/5 micrograms/9 THERAPY micrograms/metered inhalation Sodium cromoglicate 5 mg/ dose inhaler (Paediatricians & nPbR = Indicates a drug excluded from HRG tariff price 20 BHRUT NHS Trust Drug Formulary, Updated March 2021
Respiratory Physicians only) Alternative: Desloratadine (For children 1-5 years of age) Nedocromil sodium 2 mg/ dose inhaler Syrup 2.5mg/5 mL (Respiratory Physicians only) (Licensed for use in children 1-5 years of Notes: Cromoglycate is more effective in age) children than adults. It may be useful in adults with ‘exercise-induced’ asthma Alternative: Fexofenadine 120 mg tablet- Licensed for Seasonal 3.3.2 LEUKOTRIENE RECEPTOR Allergic Rhinitis ANTAGONISTS 180 mg tablet- Licensed for Chronic Montelukast Idiopathic Urticaria 10 mg tablet- Licensed for adults 5 mg chewable tablets- Licensed for 6-14 years of age. SEDATING ANTIHISTAMINES 4mg chewable tablets- Licensed for 2-5 Chlorphenamine (Chlorpheniramine) years of age 4 mg tablet, 2 mg/ 5 ml syrup, Paediatric 4mg granules- Licensed for 10 mg/ ml injection Paediaric patients aged 6 months- 5 years of age Hydroxyzine
10 mg & 25 mg tablets, Notes: Use in accordance with BTS 10 mg/ 5 ml syrup guidelines Promethazine hydrochloride 3.3 Phosphodiesterase type-4 inhibitor 10 mg & 25 mg tablets, 5 mg/ 5ml elixir, 25 mg/ ml injection, Roflumilast 500micrograms fill-coated tablets Alimemazine (Trimeprazine) (For the treatment of COPD- NICE TA 10 mg tablet, 7.5 mg/ 5 ml & 461) 30 mg/ 5 ml syrup
3.4.3 ALLERGIC EMERGENCIES 3.4 ANTIHISTAMINES, AdrenalineError! Bookmark not defined. HYPOSENSITISATION & (Epinephrine) ALLERGIC EMERGENCIES S/C or IM injection 1 in 1,000 (1 mg/ ml), Min-I-Jet ® 1 in 1000 (1 mg/ ml), 3.4.1 ANTIHISTAMINES EpiPen ® IM injection for self-administration, NON-SEDATING ANTIHISTAMINES IV injection 1 in 10,000 (1 mg/ 10 ml) 1st Choice: Cetirizine IV injection 5 mg/ 5 ml (For adults and children 6 years and over) Warning: Note strengths of adrenaline. 10 mg tablet See Anaphylaxis policy for more details 5 mg/ 5 ml oral solution (Not licensed for under 6 years)
nPbR = Indicates a drug excluded from HRG tariff price 21 BHRUT NHS Trust Drug Formulary, Updated March 2021
3.5 RESPIRATORY Sterile Talc powder STIMULANTS & PULMONARY (Unlicensed, Respiratory physicians only) SURFACTANTS Notes: Sterile talc powder administered by doctor, in accordance 3.5.1 RESPIRATORY STIMULANTS with protocol. Usually 4g in 30 ml sodium chloride 0.9 % injection. Doxapram 1000 mg/ 500 ml infusion, Once procedure complete flush with 100 mg/ 5 ml injection 20 ml sodium chloride 0.9 % injection 3.5.2 PULMONARY SURFACTANTS Tetracycline Poractant alfa (Curosurf ®) 500 mg injection 120 mg/ 1.5 ml solution (Unlicensed product for Pleurodesis.
Respiratory physicians only 3.7 MUCOLYTICS Carbocisteine 375 mg capsules 250mg/5ml syrup (Prescribe according to NICE guidelines) Sodium Chloride 3% and 6% nebuliser solution (Mucoclear®)
3.8 AROMATIC INHALATIONS Benzoin Tincture Compound BP Add one 5ml spoonful to a pint of hot, not boiling water and inhale the vapour
3.9 COUGH PREPARATIONS COUGH SUPPRESSANTS DEMULCENTS Simple linctus BP (sugar free) Pholcodine linctus (sugar free) 5 mg/ 5 ml Codeine linctus BP 15 mg/ 5 ml
Menthol & Eucalyptus Inhalation BP 3.10 SYSTEMIC NASAL DECONGESTANTS Pseudoephedrine 60 mg tablet, 30 mg/ 5 ml elixir
3.11 PRODUCTS FOR PLEURODESIS nPbR = Indicates a drug excluded from HRG tariff price 22 BHRUT NHS Trust Drug Formulary, Updated March 2021
4 CENTRAL NERVOUS SYSTEM
Promethazine hydrochloride Notes: The NELMHT formulary is 10 mg & 25 mg tablets, under revision. If there are any 5 mg/ 5 ml elixir, 25 mg/ ml injection queries regarding psychiatric drugs, please contact the Melatonin 2mg M/R tablet(Circadin®) Principal Pharmacist for Mental (for insomnia and delirium in ICU Health patients)
4.1 HYPNOTICS & 4.1.2 ANXIOLYTICS ANXIOLYTICS Diazepam 4.1.1 HYPNOTICS 2 mg & 5 mg tablets, 2 mg/ 5 ml & 5 mg/ 5 ml syrup, Temazepam (CD) 10 mg/ 2 ml injection, 10 mg tablet, 10 mg/ 5 ml syrup 10 mg/ 2 ml (emulsion) injection, 2.5 mg, 5 mg & 10 mg per dose rectal Zopiclone 3.75 mg & 7.5 mg tablets tubes (solution)
Chlordiazepoxide Zolpidem 5 mg & 10 mg tablets (Psychiatrists only) 5 mg capsule, 10 mg tablet Note: Chlordiazepoxide is the drug of Notes: Hypnotics should be used only choice for control of alcohol withdrawal where insomnia is severe, disabling or Lorazepam where patient is extremely distressed, 1 mg tablet, 4 mg/ ml injection after due consideration to non- pharmacological measures. NICE recommends that they may be prescribed for one to two weeks. Tolerance/ 4.2 DRUGS USED IN dependence develops rapidly PSYCHOSES & RELATED Chloral hydrate DISORDERS 500mg/ 5 ml mixture (unlicensed), 4.2.1 ANTIPSYCHOTIC DRUGS 25 mg, 50 mg & 100 mg suppositories Chlorpromazine (unlicensed) 10 mg, 25 mg, 50 mg & 100 mg tablets, 143 mg/ 5 ml elixir 25 mg/ 5 ml oral solution, 100 mg/ 5 ml (Paediatrics only) syrup, 50 mg/ 2 ml injection Cloral betaine (Welldorm ®) Note: Injection not to be used on 707 mg tablet = 414 mg chloral hydrate psychiatric wards HaloperidolError! Bookmark not defined. ClomethiazoleError! Bookmark not 500 micrograms capsule, defined. 192 mg capsule, 1.5 mg, 5 mg & 10 mg tablets, 250 mg/ 5 ml syrup (edisylate) 10 mg/ 5 ml liquid, 5 mg/ ml, 20 mg/ 2 ml & Note: Clomethiazole should not be used 50 mg/ ml injection for alcohol withdrawal SulpirideError! Bookmark not defined. nPbR = Indicates a drug excluded from HRG tariff price 23 BHRUT NHS Trust Drug Formulary, Updated March 2021
200 mg & 400 mg tablets, (Neurologists for Parkinson’s psychosis 200 mg/ 5 ml oral solution (unlicensed use) & Psychiatrists only) (Psychiatrists only) RisperidoneError! Bookmark not TrifluoperazineError! Bookmark not defined. 1 mg/ ml liquid, defined. 0.5 mg, 1 mg, 2 mg, 3 mg & 4 mg & 1 mg & 5 mg tablets, 1 mg/ 5 ml syrup 6 mg tablets, 1mg and 2mg & 5 mg/ 5 ml oral solution, Orodispersible tablet, 25mg injection 2 mg, 10 mg & 15 mg m/r capsules (Neurologists for Parkinson’s psychosis, (Spansules ®) unlicensed use & Psychiatrists only)
Zuclopenthixol dihydrochlorideError! Notes: The Committee on Safety of Bookmark not defined. Medicines (CSM) has advised that 2 mg, 10 mg & 25 mg tablets risperidone or olanzapine should not be (Psychiatrists only) used for the treatment of behavioural Zuclopenthixol acetateError! Bookmark symptoms of dementia because there is not defined. clear evidence of an increased risk of (Clopixol Accuphase ®) stroke in elderly patients with dementia. 50 mg/ ml & 100mg/ 2 ml injection The mechanism by which these drugs are (Psychiatrists only) associated with stroke is unknown 4.2.2 ANTIPSYCHOTIC DEPOT ATYPICAL ANTIPSYCHOTICS INJECTIONS OlanzapineError! Bookmark not defined. 2.5 mg, 5 mg, 7.5 mg & 10 mg tablets, 4.2.3 ANTIMANIC DRUGS 5 mg, 10 mg,15mg, 20mg oro-dispersible Lithium carbonateError! Bookmark not tablets, defined. 5 mg/ ml injection Camcolit ®Error! Bookmark not defined. (see notes below on tablets & injection) 250 mg & 400 mg tablets tablets: Neurologists for Parkinson’s Priadel ®Error! Bookmark not defined. psychosis, unlicensed use & Psychiatrists 200 mg & 400 mg m/r tablets only, (Psychiatrists only) injection:Psychiatrists only Lithium citrate AmisulprideError! Bookmark not Priadel ® 509 mg/ 5 ml liquid defined. 50 mg & 200 mg tablets, 100 mg/ ml oral solution Note: Lithium carbonate 200 mg is (Psychiatrists only) equivalent to 509 mg lithium citrate
Clozapine 25 mg & 100 mg tablets Valproic acidError! Bookmark not (Psychiatrists only) defined. (Depakote ®) 250 mg & 500 mg e/c tablets Notes: For clozapine, the patient & (Psychiatrists only) Consultant must be registered with the clozapine monitoring system. Notes: Depakote ® is licensed for the Monitoring of white blood cell counts & treatment of manic episodes associated neutrophils is mandatory. with bipolar disorder. This is not for Consult pharmacy for further advice maintenance therapy
QuetiapineError! Bookmark not defined. 25 mg, 100 mg, 150 mg & 200 mg tablets 4.3 ANTIDEPRESSANT DRUGS nPbR = Indicates a drug excluded from HRG tariff price 24 BHRUT NHS Trust Drug Formulary, Updated March 2021
4.3.1 TRICYCLIC & RELATED (Treatment of diabetic neuropathic pain in ANTIDEPRESSANTS adults, after tricyclic antidepressants and as an alternative to pregabalin) AmitriptylineError! Bookmark not FlupentixolError! Bookmark not defined. defined. (Flupenthixol) 10 mg, 25 mg & 50 mg tablets, 500 micrograms & 1 mg tablets 25 mg/ 5 ml & 50 mg/ 5 ml oral solution (Consultant Psychiatrists only)
DosulepinError! Bookmark not defined. MirtazapineError! Bookmark not defined. (DothiepinError! Bookmark not 30mg and 45mg tablets, 15 mg, 30 mg & defined.) 45 mg oro-dispersible tablets 25 mg capsule, 75 mg tablets, (Neurologists & Psychiatrists only) 25 mg/ 5 ml & 75 mg/ 5 ml liquid VenlafaxineError! Bookmark not defined. 37.5 mg & 75 mg tablets, LofepramineError! Bookmark not 75 mg & 150 mg m/r capsules defined. (Consultant Psychiatrists & 70 mg tablet, 70 mg/ 5 ml suspension Dr Quigley for menopausal symptoms in patients on tamoxifen, and/ or who are Imipramine post chemotherapy, unlicensed use) 10 mg & 25 mg tablets, Notes: All antidepressants take up to 25 mg/ 5 ml syrup 14 days or more for full therapeutic effect & adequate doses are needed. RELATED ANTIDEPRESSANTS Of the tricyclics, amitriptyline & dosulepin carry the greatest risk in overdose. 4.3.2 MONOAMINE-OXIDASE SSRI’s have fewer antimuscarinic & INHIBITORS (MAOI’s) cardiotoxic side effects than the tricyclics. However, they must still be used in 4.3.3 SELECTIVE SEROTONIN caution in patients with poorly controlled REUPTAKE INHIBITORS (SSRI’s) epilepsy, cardiac disease & renal or FluoxetineError! Bookmark not defined. hepatic impairment. Caution in 20 mg & 60 mg capsules, pregnancy, consult Medicines 20 mg/ 5 ml liquid Information. SSRI’s are preferred in the elderly. Obtain advice when stopping or SertralineError! Bookmark not defined. changing an antidepressant 50 mg & 100 mg tablets CitalopramError! Bookmark not defined. 4.4 CENTRAL NERVOUS 10mg & 20 mg tablet, 40 mg/ ml liquid SYSTEM STIMULANTS Notes: The dose used for citalopram Dexamfetamine (CD) 5 mg tablet liquid is lower than that given for the (Psychiatrists) tablets. A 20 mg tablet is equivalent to 16 mg (8 drops) of the oral liquid MethylphenidateError! Bookmark not defined. 10 mg tablet, Paroxetine 20 mg & 30 mg tablets, 18 mg & 36 mg m/r tablets (Concerta XL 10 mg/ 5 ml liquid ®Error! Bookmark not defined.) Note: Recommended adult daily dose of (Consultant Paediatricians, Psychiatrists paroxetine for depression is 20 mg only)
4.3.4 OTHER ANTIDEPRESSANTS Duloxetine 30mg & 60mg capsules nPbR = Indicates a drug excluded from HRG tariff price 25 BHRUT NHS Trust Drug Formulary, Updated March 2021
4.5 DRUGS USED IN THE 20 years is not recommended. May TREATMENT OF OBESITY cause confusion in the elderly. Avoid in Parkinson’s disease Methylcellulose 500 mg tablet DomperidoneError! Bookmark not Orlistat 120 mg capsule defined. (Dr Pearson only) 10 mg tablet, 5 mg/ 5 ml suspension, 30 mg suppositories 4.6 DRUGS USED IN NAUSEA Note: Domperidone is less likely to & VERTIGO cause central effects such as sedation & ANTIHISTAMINES dystonic reactions CinnarizineError! Bookmark not defined. 15 mg tablet 5-HT3 ANTAGONISTS 1st Choice: OndansetronError! Bookmark not defined. 4mg & 8 mg tablets, 4 mg/ 5 ml syrup CyclizineError! Bookmark not defined. 4mg/ 2 ml & 8 mg/ 4 ml injection 50 mg tablet, 50 mg/ ml injection 2nd Choice: GranisetronError! Promethazine teoclateError! Bookmark Bookmark not defined. not defined. 25 mg tablet 1 mg tablet, 1 mg/ 5 ml liquid, Promethazine hydrochlorideError! 1 mg/ ml injection Bookmark not defined. (See section 3.4.1 for formulations) Palonosetron with netupitant
PHENOTHIAZINES & RELATED DRUGS 300mg/0.5mg capsules (Akynzeo®) ProchlorperazineError! Bookmark not HYOSCINE defined. Hyoscine hydrobromide 5 mg tablets, 5 mg/ 5 ml syrup, 300 micrograms tablet, 5 mg & 25 mg suppositories, Scopoderm TTS ®Error! Bookmark not 12.5 mg/ ml injection (IM only) defined. 1.5 mg patch Levomepromazine Error! Bookmark not (absorption of 1 mg/ 72 hour) defined.(MethotrimeprazineError! (Unlicensed use to reduce secretions) Bookmark not defined.) 25 mg tablet, 25 mg/ ml injection OTHER DRUGS FOR MÉNIÈRE’S (Oncologists, Haematologists & DISEASE Palliative care team only) BetahistineError! Bookmark not defined. DOMPERIDONE & METOCLOPRAMIDE 8 mg tablets
MetoclopramideError! Bookmark not 4.7 ANALGESICS defined. 10 mg tablet, 5 mg/ 5 ml oral solution, 10 mg/ 2 ml injection Notes: Metoclopramide may induce dystonic reactions, especially in young children, young adults and the elderly. Use of metoclopramide in patients under nPbR = Indicates a drug excluded from HRG tariff price 26 BHRUT NHS Trust Drug Formulary, Updated March 2021
4.7.1 NON-OPIOID ANALGESICS Morphine sulphate slow release (CD)Error! Bookmark not defined. AspirinError! Bookmark not defined. 5 mg, 10 mg, 15 mg, 30 mg, 75mg dispersible tablets 60 mg, 100 mg & 200 mg m/r tablets, 300 mg dispersible tablets 20 mg & 30 mg m/r granules 300mg suppositories 500mg injection (unlicensed) Morphine sulphate oral solution ParacetamolError! Bookmark not (Oramorph ®)Error! Bookmark not defined. defined. (CD) 500 mg tablet & dispersible tablets 10 mg/ 5 ml oral solution 120 mg/ 5 ml & 250 mg/ 5 ml suspension 100 mg/ 5 ml oral concentrated oral 15 mg, 30 mg & solution, 60 mg suppositories (Unlicensed) 10 mg/ 5 ml unit dose vials 125 mg, 240 mg, 500 mg and 1g suppositories Morphine sulphate tablets- immediate 1g/100ml IV infusion release (IV infusion for intra- and post-operative (Sevredol ®)Error! Bookmark not use for patients nil-by-mouth or unable to defined. (CD) 10 mg and 20mg take drugs by other routes) Cyclimorph ®Error! Bookmark not Co-dydramolError! Bookmark not defined. (CD) defined. (dihydrocodeineError! Morphine sulphate (10 mg/ ml) & Bookmark not defined./ paracetamol) 10/ cyclizine (50 mg/ ml) injection 500 tablet BuprenorphineError! Bookmark not Co-codamolError! Bookmark not defined. (CD) (Transtec ®) defined. (codeineError! Bookmark not 300 micrograms injection defined./ paracetamolError! Bookmark 200 micrograms S/L tablet not defined.) 35, 52.5 & 70 micrograms patches 8/ 500 tablet The Transtec patches should be changed 8/ 500 effervescent tablet every 96 hours (4 days). For convenience Co-codamolError! Bookmark not the patch can be changed twice a week defined. (codeine/ paracetamolError! at regular intervals e.g. on Mondays and Bookmark not defined.) 30/ 500 capsule Thursdays. or tablet Note: Use separate tablets of 30mg (Patches: for chronic pain only) codeine and paracetamol where possible BuprenorphineError! Bookmark not as this is much cheaper defined. (CD) (BuTransError! Bookmark not defined.®) 4.7.2 OPIOID ANALGESICS Patches Refer to Management of acute and Change Butrans patch every 7 days. chronic pain in adults policy 5 micrograms/hour 10 micrograms/hour Morphine sulphateError! Bookmark not 20 micrograms/hour defined. injection (CD) (Pain team only) 10mg, 15mg, 20mg and 30mg injection 100mg/ 50ml injection vials Codeine phosphateError! Bookmark not 50mg/ 50ml injection vials for PCA and defined. also pre-prepared as 50mg/50ml PCA 15 mg & 30 mg tablets syringes 25mg/ 5ml syrup nPbR = Indicates a drug excluded from HRG tariff price 27 BHRUT NHS Trust Drug Formulary, Updated March 2021
15mg/ 5ml linctus 30mg/ ml injection (CD) (Unlicensed) Oxycodone hydrochloride- slow Diamorphine hydrochlorideError! release (CD) (OxyContin ®) Bookmark not defined. (CD) 5 mg, 10 mg, 20 mg, 5 mg, 10 mg, 30 mg, 100 mg & 40 mg & 80 mg m/r tablets
500 mg injections Oxycodone injection (CD) (OxyNorm) Dihydrocodeine tartrate 10mg and 20mg injection 30 mg tablet, 10 mg/ 5 ml elixir, (For patients unable to tolerate morphine, 50 mg/ ml injection (CD) in accordance with Trust guidelines) Fentanyl (CD) 25 micrograms/ hour, Oxycodone injection (CD) (Oxynorm) 50 micrograms/ hour, 50mg in 1ml ampoule 75 micrograms/ hour & [Approved for second line use for 100 micrograms/ hour patches intravenous patient-controlled analgesia 200 micrograms, 400 micrograms, 600 (PCA) and restricted to the Paim team] micrograms & 800 micrograms Papaveretum (CD) 15.4 mg/ ml injection Sublingual tablet (“Abstral ®”) 100micrograms & 400micrograms/dose Pethidine hydrochloride (CD) nasal spray 50 mg tablet, 50 mg/ ml & 100 mg/ 2 ml injection (Sublingual tablets are for Palliative care (Injection no longer used in A&E) team prescribing only as per Trust guidelines) Notes: Pethidine is weaker than morphine or diamorphine & has a shorter Notes: Fentanyl patches and sublingual duration of action. It is used mainly in tablet are suitable for use only in those obstetrics as it may cause less patients with unacceptable opioid toxicity, respiratory depression in the neonate. where oral route is unavailable, or when It should not be used for continuous pain recommended by the Palliative care as toxic metabolites may accumulate on team. extended use. Refer to acute, chronic If patients are intolerant to morphine, pain & palliative care guidelines oxycodone should be tried before fentanyl patches are prescribed. Tramadol hydrochloride Each replacement patch should be 50 mg capsules, 50 mg dispersible applied to a non-hairy, different area of tablets, 100 mg & 200 mg m/r capsules & the body. The patches are not suitable for 100 mg/ 2 ml injection patients with chronic skin disorders (Refer to Management of acute and chronic pain policy)
MeptazinolError! Bookmark not defined. Notes: NSAIDs are a useful addition in 200 mg tablet, 100 mg/ ml injection moderate to severe bony or musculo- skeletal pain, except where contraindicated. Enteric coated tablets Oxycodone hydrochlorideError! should not be prescribed prn, as this has Bookmark not defined. oral- immediate a delayed onset of action. release (CD) (OxyNorm ®) Laxatives: Narcotic analgesics will almost 5 mg, 10 mg & 20 mg capsules always require co-prescribing of laxatives 5mg/ 5ml oral solution 50mg/5ml concentrated oral solution nPbR = Indicates a drug excluded from HRG tariff price 28 BHRUT NHS Trust Drug Formulary, Updated March 2021
4.7.3 NEUROPATHIC PAIN Stock will be ordered as needed CarbamazepineError! Bookmark not Fremanezumab (Ajovy) 225mg solution defined., AmitriptylineError! Bookmark of injection in pre-filled pen (Neurology not defined. or Sodium valproateError! Only) Bookmark not defined. (Unlicensed indication)
(see sections 4.3.1 & 4.8.1 for preparations) 4.8 ANTIEPILEPTICS 4.8.1 CONTROL OF EPILEPSY GabapentinError! Bookmark not defined. 100 mg & 300 mg capsules Brivaracetam (Briviact®) 10mg, 25mg, 400mg tablets 50mg, 75mg and 100mg tablets, (Not 1st line for trigeminal neuralgia) 10mg/ml oral solution and 50mg/5ml solution for injection 4.7.4 ANTIMIGRAINE DRUGS ( Brivaracetam can only be initiated by an 4.7.4.1 TREATMENT OF THE ACUTE epileptologist or neurologist with MIGRAINE ATTACK special interest in epilepsy) Notes: Simple analgesic such as Cannabidiol paracetamol or a NSAID is often 100mg per ml oral solution effective. Concomitant antiemetic may be Carbamazepine required 100 mg & 200 mg tablets,
st 200 mg & 400 mg m/r tablets, 1 Choice: Sumatriptan 100 mg/ 5 ml syrup, 50 mg & 100 mg tablets, 125 mg & 250 mg suppositories 6 mg/ 0.5 ml injection Note: Sumatriptan is to be used only Eslicarbazepine 800 mg tablets when treatment with conventional analgesics & antiemetics have failed Oxcarbazepine 150mg, 300mg and 600mg tablets 2nd Choice: ZolmitriptanError! Bookmark not defined. Ethosuximide 2.5 mg tablet 250 mg capsules, 250 mg/ 5 ml syrup 4.7.4.2 PROPHYLAXIS OF MIGRAINE PizotifenError! Bookmark not defined. Gabapentin 100 mg & 300 mg capsules 500 micrograms & 1.5 mg tablets, 400mg tablets 250 micrograms/ 5 ml elixir Lacosamide 50mg, 150mg, 200mg f/c ClonidineError! Bookmark not defined. tablets, 10mg/ml syrup and 10mg/ml 25 micrograms tablet solution for infusion Methysergide 1 mg tablet Lamotrigine (Neurologists only) 25 mg 50 mg & 100 mg tablets 5 mg, 25 mg & 100 mg dispersible PropranololError! Bookmark not defined. tablets (see section 2.4 for formulations) LevetiracetamError! Bookmark not defined. Flunarizine 5mg &10mg tablets 250 mg, 500 mg & 1g tablets 100mg/ml (Consultant Neurologists only) oral solution nPbR = Indicates a drug excluded from HRG tariff price 29 BHRUT NHS Trust Drug Formulary, Updated March 2021
Notes: Levetiracetam is for the Sodium valproateError! Bookmark not treatment of adults as per NICE defined. (Epilim) guidance. This includes patients who 100 mg crushable tablet, 200 mg & 500 have not benefited from treatment with mg e/c tablets, 200 mg/ 5 ml liquid, 400 older antiepileptic drugs, or in whom mg injection, 200 mg, 300 mg & 500 mg older drugs are unsuitable due to contra- m/r tablets indications, interactions or poor Topiramate 25 mg, 50 mg and 100mg tolerability tablets 15mg and 25mg sprinkle capsules (Also for Consultant Paediatrician initiation as add-on treatment for the Vigabatrin 500 mg tablet & sachets control of refractory partial seizures with or without secondary generalisation in Zonisamide 25mg, 50mg and 100mg children already on one or two Capsules anticonvulsants) (Also for Dr. Misbahuddin for treating Perampanel (Fycompa®) 2mg, 4mg, tremor in Parkinson’s disease) 6mg, 8mg, 10mg, 12mg tablets ClobazamError! Bookmark not defined. Phenobarbital (Phenobarbitone) (CD) 10 mg tablet 15 mg & 30 mg tablets, 15 mg/ 5 ml elixir (contains alcohol), ClonazepamError! Bookmark not 50 mg/ 5 ml suspension (alcohol, sugar defined. 1 mg/ ml injection, & colour free, unlicensed preparation. 500 micrograms & 2 mg tablets Used in paediatrics & neonates) 4.8.2 DRUGS USED IN STATUS 15 mg/ ml, 30mg/ ml, 60 mg/ ml & EPILEPTICUS 200 mg/ ml injection DiazepamError! Bookmark not defined. PrimidoneError! Bookmark not defined. (see section 4.1.2 for preparations) 250 mg tablet ClonazepamError! Bookmark not PhenytoinError! Bookmark not defined. defined. 1 mg/ ml injection 25 mg 50 mg & 100 mg & 300 mg capsules, 30 mg/ 5 ml suspension, 250 mg/ 5 ml injection PhenytoinError! Bookmark not defined. 250 mg/ 5 ml injection Note: 90 mg in 15 ml phenytoin (base) suspension is equivalent to 100 mg phenytoin sodium tablet or capsule. ParaldehydeError! Bookmark not Patients admitted on tablets or Infatabs defined. 5 ml injection should remain on these preparations (Consultant Neurologists & Paediatricians only. Dose given diluted with olive oil Rufinamide 100mg, 200mg and 400mg & given rectally as enema) tablets (Specialist Paediatric Consultants Only) Note: For 2nd line treatment of Lennox- 4.9 DRUGS USED IN Gastaut syndrome in children who are PARKINSONISM & RELATED refractory to other treatment and on DISORDERS multiple anti-epileptic agents. 4.9.1 DOPAMINERGIC DRUGS USED GPs will only prescribe once patients IN PARKINSONISM have been stabilised in hospital. nPbR = Indicates a drug excluded from HRG tariff price 30 BHRUT NHS Trust Drug Formulary, Updated March 2021
Co-beneldopaError! Bookmark not “Adartrel” 0.25mg, 0.5mg and 2mg defined. (benserazide hydrochloride & tablets (for the treatment of restless legs levodopa) syndrome) Neurologists’ use only
(Madopar ®Error! Bookmark not Rotigotine transdermal patches defined.) 2mg/24hr, 4mg/24hr and 8mg/24hr 62.5 mg, 125 mg & 250 mg capsules, (for patients with swallowing difficulties) 62.5 mg & 125 mg dispersible tablets (Madopar CR ®) 125 mg m/r capsule Stalevo tablet Co-careldopaError! Bookmark not (Levodopa/Carbidopa/Entacapone) defined. (carbidopa & levodopaError! Bookmark not defined.) Rasagiline 1mg tablet (2nd line in (SinemetError! Bookmark not defined. patients who cannot tolerate Selegiline) LS ®) 62.5 mg tablet (Sinemet 110 ®) 110 mg tablet SelegilineError! Bookmark not defined. 5 (Sinemet Plus ®) 125 mg tablet mg tablet, 10mg/5ml liquid (Sinemet 275 ®) 275 mg tablet (Half Sinemet CR ®) 125 mg m/r tablet 4.9.2 ANTIMUSCAROMOC DRUGS (Sinemet CR ®) 250 mg m/r tablet USED IN PARKINSONISM BenzatropineError! Bookmark not defined. (BenztropineError! Bookmark Duodopa 5/20/ml Intestinal gel not defined.) (CCG’s funding required) 2 mg/ 2 ml injection AmantadineError! Bookmark not defined. OrphenadrineError! Bookmark not 100 mg capsule, defined. 50 mg/ 5 ml syrup 50 mg tablet, 25 mg/ 5 ml liquid
ApomorphineError! Bookmark not Procyclidine defined. 5mg tablets 20 mg/ 2ml & 50 mg/ 5 ml injection 10 mg/ ml pre-loaded pen TrihexyphenidylError! Bookmark not (Consultant Neurologist only) defined.l (BenzhexolError! Bookmark CabergolineError! Bookmark not not defined.) defined. 1 mg tablet (Cabaser ®Error! 2 mg & 5 mg tablets, Bookmark not defined.) 5 mg/ 5 ml syrup EntacaponeError! Bookmark not defined. 4.9.3 DRUGS USED IN ESSENTIAL 200 mg tablet TREMOR, CHOREA, TICS & RELATED Opicapone 50mg capsule DISORDERS Pramipexole 88mcg, 180mcg and HaloperidolError! Bookmark not defined. 700mcg tablet (for treatment of 500 micrograms capsule, Parkinson’s, Consultant Neurologists 1.5 mg, 5 mg, 10 mg, 20 mg tablets, only) 10 mg/ 5 ml liquid, 10 mg/ ml liquid concentrate, Ropinirole 5 mg/ ml injection, “ReQuip” tablet (for treatment of 10 mg/ 2 ml, 10 mg/ 5 ml & idiopathic parkinsons disease) 20 mg/ 2 ml injection “Requip XL” tablet
nPbR = Indicates a drug excluded from HRG tariff price 31 BHRUT NHS Trust Drug Formulary, Updated March 2021 nPbR RiluzoleError! Bookmark not defined. Nicotine 50 mg tablet 2mg and 4mg gum (Nicorette), (Consultant Neurologists only) 2mg lozenges, TetrabenazineError! Bookmark not NiQuitin 1.5mg lozenges defined. 25 mg tablet NiQuitin patches (‘7’, ‘14’, ‘21’), Nicorette10mg/16hr, 15mg/16hr and TORSION DYSTONIAS & OTHER 25mg/16hr patches, INVOLUNTARY MOVEMENTS Nicorette inhalator 15mg cartridge Nicorette nasal spray Botulinum A toxin-Haemagglutinin 500micrograms/metered spray complex Error! Bookmark not Nicorette Quickmist mouthspray defined.(Botox ®Error! Bookmark not 1mg/metered dose defined. 100 unit injection Dysport ®Error! Bookmark not defined. 500 unit injection & Xeomin 100 unit injection) OPIOID DEPENDENCE Ophthalmologists & Neurologists use. MethadoneError! Bookmark not defined. (CD) 1mg/ ml mixture Consultant Gastroenterologists for (Not to be confused with methadone achalasia when surgery is unsuitable linctus 2 mg/ 5 ml for cough) (unlicensed use, needs patient consent) (Specialist advice needed)
Dr Gupta for relief of spasticity in stroke patients as second line therapy 4.11 DRUGS FOR DEMENTIA (unlicensed use, needs patient consent) DonepezilError! Bookmark not defined. 5 Consultant Surgeons & Dermatologists mg & 10 mg tablets for Hyperhidrosis (Community dementia team, Memory (N.B. Dysport is unlicensed for Clinic & Neurologists only) hyperhidrosis, needs patient consent) GalantamineError! Bookmark not defined. 4 mg & 8 mg tablets, nPbR Botulinum B toxinError! Bookmark 4 mg/ ml oral solution not defined. (NeuroBloc ®Error! (Community dementia team, Memory Bookmark not defined.) Clinic & Neurologists only) Dr. Gupta, Dr. McCauley & Prof. Findley for cervical dystonia Memantine resistant to Botox ® and Dysport ® 5mg, 10mg, 15mg & 20mg tablets 10mg/ml oral solution 4.10 DRUGS USED IN SUBSTANCE DEPENDENCE ALCOHOL DEPENDENCE RivastigmineError! Bookmark not defined. ChlordiazepoxideError! Bookmark not 1.5 mg, 3 mg, 4.5 mg & 6 mg capsules, defined. capsules 2 mg/ ml oral solution, 4.6mg/24 hours & (See section 4.1.2 for strengths) 9.5mg/24 hours AcamprosateError! Bookmark not (Community dementia team, Memory defined. 333 mg e/c tablet Clinic & Neurologists only) (Specialist Consultant use only) 4.12 CALCITONIN GENE- CIGARETTE SMOKING RELATED PEPTIDE INHIBITORS
nPbR = Indicates a drug excluded from HRG tariff price 32 BHRUT NHS Trust Drug Formulary, Updated March 2021
Fremanezumab 150mg/ml Pre-filled syringe (Neurology only)
5 INFECTIONS 250/ 125 tablet & dispersible tablet, 5.1 ANTIBACTERIAL DRUGS 500/ 125 tablet, 125/ 31 syrup & 250/ 62.5 syrup, 500 mg/ 100mg & 1000 mg/ 200 mg Notes: Unless otherwise specified, refer Injection to the Trust Antibiotic Guidelines for approved indications Pivmecillinam hydrochloride 200mg tablets 5.1.1 PENICILLINS Notes: Prescribe in accordance with 5.1.1.1 Benzylpenicillin & microbiology guidelines. PhenoxymethylpenicillinError!
Bookmark not defined. (Penicillin V) 5.1.1.4 Antipseudomonal penicillins BenzylpenicillinError! Bookmark not Piperacillin & tazobactamError! defined. 600 mg injection Bookmark not defined. 2.25 g & 4.5 g injection Penicillin VError! Bookmark not defined.
250 mg tablet, Temocillin (Negaban®) 1g injection 125 mg/ 5 ml & 250 mg/ 5 ml syrup Benzylpenicillin & procaine 5.1.2 CEPHALOSPORINS penicillinError! Bookmark not defined. CefadroxilError! Bookmark not defined. 1485 mg & 300 mg injection 500 mg capsule, (Unlicensed medicine) CefaclorError! Bookmark not defined. 5.1.1.2 Penicillinase-resistant 125mg/5ml & 250 mg/ 5 ml suspension penicillins CefuroximeError! Bookmark not defined. FlucloxacillinError! Bookmark not 250 mg, 750 mg & 1.5 g injection defined. 250 mg & 500 mg capsules, 125 mg/ 5 ml & 250 mg/ 5 ml syrup, 250 mg & CefotaximeError! Bookmark not defined. 500 mg injection 500 mg & 1 g injection 5.1.1.3 Broad spectrum penicillins CeftazidimeError! Bookmark not defined. AmoxicillinError! Bookmark not defined. 250 mg, 500 mg, 1 g & 2 g injection 250 mg & 500 mg capsules, 500 mg dispersible tablet, CeftriaxoneError! Bookmark not defined. 125 mg/ 5 ml & 250 mg/ 5 ml syrup, 250 mg, 1 g & 2 g injection 250 mg & 500 mg injection, Ceftazidime 2g/ Avibactam 0.5g 3 g sachets injection
Co-amoxiclavError! Bookmark not 3rd Line restricted –Microapproval only defined. (amoxicillin & clavulanic acid)
(Often prescribed as Augmentin ®Error! Ceftolozane/Tazobactam (Zerbaxa®) Bookmark not defined.) nPbR = Indicates a drug excluded from HRG tariff price 33 BHRUT NHS Trust Drug Formulary, Updated March 2021
1g/0.5g powder for concentration for ErythromycinError! Bookmark not solution for infusion defined. OTHER BETA-LACTAM ANTIBIOTICS 250 mg tablet, 1 g injection, 125 mg/ 5 ml & 250 mg/ 5 ml suspension MeropenemError! Bookmark not defined. 500 mg & 1g injection AzithromycinError! Bookmark not ErtapenemError! Bookmark not defined. defined. 1g injection 250 mg capsule, 200 mg/ 5 ml suspension 5.1.3 TETRACYCLINES ClarithromycinError! Bookmark not DoxycyclineError! Bookmark not defined. defined. 250 mg tablets, 125 mg/ 5 ml syrup, 50 mg & 100 mg capsules, 500 mg injection 100 mg dispersible tablets 40mg m/r capsules ( Efracea®) for the Notes: Clarithromycin should be treatment of rosacea – reserved for H.pylori eradication & HIV (Dermatologist’s use only) patients for MAI prophylaxis
First choice: Limecycline 408mg capsule 5.1.6 CLINDAMYCIN
Alternatives: ClindamycinError! Bookmark not defined. MinocyclineError! Bookmark not defined. 150 mg capsule 50 mg & 100 mg tablets, 300 mg/ 2 ml injection 100 mg m/r capsule (Dermatologists only for existing patients or those suffering treatment failure) 5.1.7 SOME OTHER ANTIBACTERIALS OxytetracyclineError! Bookmark not defined. 250 mg tablet ChloramphenicolError! Bookmark not defined. Notes: Tetracyclines must not be given 250 mg capsule, 1 g injection to children under 12 years old or to Sodium fusidateError! Bookmark not pregnant or breast-feeding women defined. 250 mg e/c tablet, Tigecycline 50-mg vial (for multi- 500 mg injection resistant organisms on a consultant microbiologist’s recommendation) Fusidic acidError! Bookmark not defined. 250 mg/ 5 ml suspension 5.1.4 AMINOGLYCOSIDES Note: 750 mg fusidic acid suspension is GentamicinError! Bookmark not defined. equivalent to 500 mg sodium fusidate 80 mg/ 2 ml injection tablet. Monitor LFT’s VancomycinError! Bookmark not AmikacinError! Bookmark not defined. defined. 100 mg/ 2 ml & 500 mg/ 2 ml injection 125 mg capsule (as per C difficile 5.1.5 MACROLIDES treatment guidelines) 500 mg injection nPbR = Indicates a drug excluded from HRG tariff price 34 BHRUT NHS Trust Drug Formulary, Updated March 2021
TeicoplaninError! Bookmark not defined. 5.1.9 ANTITUBERCULOUS DRUGS 200 mg & 400 mg injection EthambutolError! Bookmark not defined. 100 mg & 400 mg tablets Daptomycin 350mg & 500mg injection IsoniazidError! Bookmark not defined. Note: Daptomycin should be reserved for 100 mg tablet, treatment of skin and soft tissue infection, 100 mg/ 5 ml elixir (unlicensed), allergy to Vancomycin and teicoplanin 50 mg/ 2 ml injection bacteraemia and endocarditis & for OPAT (Outpatient Parenteral Antibiotic Therapy) PyrazinamideError! Bookmark not (Unlicensed). defined. 500 mg tablet (Unlicensed) LinezolidError! Bookmark not defined. (Zyvox ®Error! Bookmark not defined.) RifampicinError! Bookmark not defined. 600 mg tablet, 100 mg/ 5 ml suspension, 150 mg & 300 mg capsules, 600 mg infusion 100 mg/ 5 ml syrup, 300 mg/ 5 ml injection ColistinError! Bookmark not defined. Rifampicin & Isoniazid 0.5,1& 2 million unit injection, 150 mg & 100 mg (Rifinah ® 150Error! 1.5 million unit tablet Bookmark not defined.) tablet 300 mg & 150 mg (Rifinah ® 300Error! Rifaximin (Targaxan®) Bookmark not defined.) tablet 550mg tablets (For reduction in recurrence of hepatic Notes: Combination preparations should encephalopathy) be prescribed whenever possible to aid compliance. They should preferably be Fidaxomicin (Dificlir®) given before breakfast 200mg tablets StreptomycinError! Bookmark not For recurrent cases of Clostridium difficile defined. 1 g injection infection (CDI) and severe CDI under strict recommendation of a Consultant Microbiologist) 5.1.10 ANTILEPROTIC DRUGS
DapsoneError! Bookmark not defined. 50 Fosfomycin mg tablet 3g granules sachets
5.1.8 SULPHONAMIDES & 5.1.11 METRONIDAZOLE TRIMETHOPRIM MetronidazoleError! Bookmark not TrimethoprimError! Bookmark not defined. defined. 200 mg & 400 mg tablets, 100 mg & 200 mg tablets, 200 mg/ 5 ml suspension, 50 mg/ 5 ml suspension, 500 mg & 1 g suppositories, 100 mg/ 5 ml injection 500 mg infusion, Co-trimoxazoleError! Bookmark not 0.75 % gel (Metrogel ®) (for malodorous defined. fungating tumours) 480 mg & 960 mg tablets, 0.75% gel (Acea ®) (for acne rosacea, 240 mg/ 5 ml suspension, Dermatologists only) 480 mg/ 5 ml & 960 mg/ 10 ml injection (For PCP manangement & Microbiologist 5.1.12 QUINOLONES initiation only) nPbR = Indicates a drug excluded from HRG tariff price 35 BHRUT NHS Trust Drug Formulary, Updated March 2021
CiprofloxacinError! Bookmark not nPbR Liposomal Amphotericin defined. 50 mg injection (Error! Bookmark not 250 mg & 500 mg tablets, defined.Ambisome ®Error! Bookmark 250 mg/ 5 ml suspension, not defined.) 100 mg/ 50 ml, 200 mg/ 100 ml & (for premature neonates, Microbiologist & 400 mg/ 200 ml infusion Haematologist initiation only)
Levofloxacin 250mg & 500mg tablets nPbR Caspofungin intravenous infusion 500mg/ 100ml injection 50mg vial and 70mg vial
Moxifloxacin 400mg tablet FlucytosineError! Bookmark not defined. 2.5 g/ 250 ml injection Notes: Quinolones should be prescribed with caution in children. Convulsions may GriseofulvinError! Bookmark not be induced in those with or without a defined. history of this. Quinolones have 500 mg tablet, 125 mg/ 5 ml suspension multiple drug interactions (see BNF). N.B. Their absorption is reduced by Itraconazole concomitant administration of antacids, 100 mg capsules, 10 mg/ ml liquid ferrous sulphate, calcium & zinc salts (Haemotologists only)
5.1.13 URINARY TRACT INFECTIONS nPbR Posaconazole CefadroxilError! Bookmark not defined. (see section 5.1.2 for formulations) 200mg/ml suspension
TrimethoprimError! Bookmark not (Haematologists only) defined. Note: Posaconazole is for continuation (see section 5.1.8 for formulations) of treatment after initiation at Bart’s NitrofurantoinError! Bookmark not and the London Hospital defined. (Macrodantin ®Error! Bookmark not defined.) TerbinafineError! Bookmark not defined. 50 mg capsule, 100 mg tablet 250 mg tablet (Dermatologists only) Notes: Avoid Nitrofurantoin in mild renal impairment nPbR Voriconazole 50mg 200mg tablets 200mg intravenous infusion 5.2 ANTIFUNGAL DRUGS 5.3 ANTIVIRAL DRUGS Fluconazole Note: All HIV therapy is for specialist 50 mg, 150 mg & 200 mg capsules, use only 50 mg/ 5 ml & 200 mg/ 5 ml suspension, 50 mg/ 25 ml & 200 mg/ 100 ml injection 5.3.1 HIV NUCLEOSIDE REVERSE AmphotericinError! Bookmark not TRANSCRIPTASE INHIBITORS defined. 50 mg injection (Fungizone ®), (1st line) nPbR AbacavirError! Bookmark not (Amphocil ®), (2nd line to Fungizone ®, defined. 300 mg tablet where renal function has deteriorated) nPbR AbacavirError! Bookmark not defined. 600 mg tablet & Lamivudine nPbR = Indicates a drug excluded from HRG tariff price 36 BHRUT NHS Trust Drug Formulary, Updated March 2021
300 mg (Kivexa Error! Bookmark not 5.3.5 RESPIRATORY SYNCYTIAL defined. ®) VIRUS nPbR Abacavir 300 mg & Lamivudine 150 nPbR PalivizumabError! Bookmark not mg & Zidovudine 300 mg tablet (Trizivir defined. ®Error! Bookmark not defined.) 50 mg & 100 mg IM injection (Paediatrician initiation only) nPbR DidanosineError! Bookmark not defined. 100 mg, 125 mg & 200 mg tablets, 400 mg enteric coated capsules nPbR RibavirinError! Bookmark not defined. (TribavirinError! Bookmark nPbR LamivudineError! Bookmark not not defined.) defined. 100 mg tablet 6 g powder (Paediatrician initiation only) nPbR Entecavir 500micrograms and 1mg 200 mg capsules (Consultant tablet Gastroenterologists only for Oral Solution 50micrograms/ml 1st line treatment of Hepatitis C)
5.3.3.2 Chronic Hepatitis C COVID TREATMENTS nPbR Simeprevir 150mg capsules Remdesivir 100 mg (5mg/ml) nPbR Ledipasvir 90mg/ Sofosbuvir 400mg concentrate for solution for infusion. film-coated tablets (Harvoni®) (In line with Interim NHSE Clinical a) Respiratory & Paediatric teams only Commissioning Statement) nPbR Sofosbuvir 400mg/velpatasvir b) Completion of BLUETEQ application 100mg film-coated tablets (Epclusa®) by team required prior to pharmacy (In line with Interim NHSE Clinical supply Commissioning Statement) c) Store concentrate for solution for nPbR Elbasvir 50mg/ Grazoprevir 100mg infusion in the refrigerator film-coated tablets (Zepatier®) (As per NICE recommendation) 5.4 ANTIPROTOZOAL DRUGS nPbR Sofosbuvir 400mg / Velpatasvir 100mg / Voxilaprevir 100mg film 5.4.1 ANTIMALARIALS coated tablets (Vosevi®) Chloroquine sulphateError! Bookmark (Hepatology consultants only, in line with not defined. NHSE commissioning position/ NICE 250 mg tablet = 155 mg base, guidance) 68 mg/ 5 ml syrup = 50 mg (base)/ 5 ml, 200 mg (base)/ 5 ml injection 5.3.4 INFLUENZA PyrimethamineError! Bookmark not Oseltamivir 75mg capsule defined. 25 mg tablet 60mg/ 5ml suspension (For treatment PyrimethamineError! Bookmark not and prevention of influenza, see defined. (25 mg) with SulfadoxineError! pandemic contingency plan) Bookmark not defined. (500 mg) (Fansidar ®)Error! Bookmark not Zanamivir defined. tablet 5mg inhalation powder 10mg/ml Solution for infusion Quinine dihydrochlorideError! Bookmark not defined. 600 mg/ 2 ml injection
nPbR = Indicates a drug excluded from HRG tariff price 37 BHRUT NHS Trust Drug Formulary, Updated March 2021
300mg/ ml injection Pentamidine isethionateError! (Unlicensed) Bookmark not defined. 300 mg/ 5 ml respiratory solution, MefloquineError! Bookmark not defined. 300 mg injection 250 mg tablet (Restricted to HIV) Atovaquone Error! Bookmark not Primaquine 7.5mg tablet (unlicensed- defined.suspension 750 mg/5ml named patient only)
ProguanilError! Bookmark not defined. 5.5 ANTHELMINTICS 100 mg & atovaquoneError! Bookmark not defined. 250 mg (Malarone ®Error! Bookmark Albendazole not defined.) tablet 400mg tablet (unlicensed – named patient only) Atovaquone liquid 750mg/5ml See Antibiotic Guidelines for approved (Wellvone) indications 3rd line secondary prophylaxis of PCP in HIV patients. (Consultant Microbiologist and GUM Mebendazole Consultants initiation only) 100 mg tablet, (unlicensed) 100 mg/ 5 ml suspension
Quinine sulphateError! Bookmark not defined. 200 mg & 300 mg tablets
5.4.2 AMOEBICIDES
Diloxanide Furoate 500mg tablet
Metronidazole see section 5.1.11 for preparations
5.4.7 DRUGS FOR TOXOPLASMOSIS PyrimethamineError! Bookmark not defined. 25 mg tablet SulfadiazineError! Bookmark not defined. 500 mg tablet, 1g injection
5.4.8 DRUGS FOR PNEUMOCYSTIS PNEUMONIA Co-trimoxazoleError! Bookmark not defined. (See section 5.1.8 for formulations) nPbR = Indicates a drug excluded from HRG tariff price 38 BHRUT NHS Trust Drug Formulary, Updated March 2021
6 ENDOCRINE SYSTEM
6.1 DRUGS USED IN DIABETES 3 ml Novolet pen, Innolet device: Initiation by Diabetes team 6.1.1.1 SHORT-ACTING INSULINS only
SOLUBLE INSULINError! Bookmark not Insuman Basal 100units/ml defined.Error! Bookmark not defined. 3ml cartridges, pre-filled Solostar pen, 5ml vials Actrapid ®Error! Bookmark not defined. (Human) 100 units/ ml injection BIPHASIC INSULINS 10 ml vial, 3 ml cartridge
3 ml disposable pen Biphasic insulin AspartError! Bookmark
not defined. Insuman Rapid 100units/ml cartridge Novomix ®Error! Bookmark not defined. 30, 100 units/ ml injection Insulin AspartError! Bookmark not 3ml cartridge, 3 ml FlexPen defined. NovoRapid ®Error! Bookmark not Biphasic Insulin Isophane defined. 100 units/ ml injection Humulin® M3, 100 units/ml injection 3ml 10 ml vial, 3 ml cartridge, 3 ml FlexPen cartridge, 3ml KwikPen Insuman Comb 15, 100units/ml, 3ml Insulin Glulisine cartridges, pre-filled Solostar pen, 5ml Apidra 100 units/ml injection vials 10ml vial, 3ml cartridge, Solostar Insuman Comb 25, 100 units/ml, 3ml cartridges Insulin LisproError! Bookmark not Insuman Comb 50, 100 units/ml, 3ml defined. cartridges Humalog ®Error! Bookmark not defined. 100 units/ ml injection Biphasic Insulin LisproError! Bookmark 10 ml vial, 3 ml cartridge not defined. 3 ml disposable pen Humalog ® MixError! Bookmark not defined. 25 3 ml cartridge, 3 ml Kwikpen prefilled 6.1.1.2 INTERMEDIATE- & disposable injection devices LONG-ACTING INSULINS Humalog ® Mix 50 ISOPHANE INSULINError! Bookmark not 3 ml disposable Kwikpen prefilled defined. disposable injection devices
Humulin I 100 units/ml, 10ml vials, 3ml Insulin Degludec cartridges, KwikPen Tresiba® Flextouch 100units/ml pre-filled pen, 100units/ml Insulatard ®Error! Bookmark not cartridges, defined. Error! Bookmark not defined. 200units/ml pre-filled pen (initiation by (Human) consultant endocrine only) 100 units/ ml injection 10 ml vial, 3 ml cartridge Insulin Degludec with Liraglutide nPbR = Indicates a drug excluded from HRG tariff price 39 BHRUT NHS Trust Drug Formulary, Updated March 2021
Xultophy® 100units/ml insulin degludec MetforminError! Bookmark not defined. + 3.6mg/ml Liraglutide, 3ml pre-filled pen 500 mg & 850 mg tablets (consultant endocrine only) Glucophage 500mg & 1g sachets Insulin Detemir Gucophage SR (Metformin) 500mg, 750mg & 1g tablets Levemir 100 units/ml injection 6.1.2.3 OTHER ANTIDIABETICS 3ml cartridge, 3ml FlexpenFF AcarboseError! Bookmark not defined. Insulin GlargineError! Bookmark not 50 mg tablet defined. Canagliflozin (Invokana®) 100mg & Lantus ®Error! Bookmark not defined. 300mg f/c tablets 100 units/ ml injection Dapagliflozin (Forxiga®) 5 mg & 10mg 10 ml vial, 3 ml cartridge & Solostar f/c tablets 3 ml OptiSet pen Ertugliflozin (Steglatro®) 5mg & 15mg (Endocrinologists only in accordance tablets with protocol) Empagliflozin (Jardiance®) 10mg &
25mgf/c tablets biosimilar Exenatide (Byetta®) 250micrograms/ml Abasaglar® 100 units/ml, 3ml cartridge injection & pre-filled pen Bydureon® 2 mg powder and solvent for Semglee® 100units/ml, pre-filled pen prolonged-release suspension for
injection Toujeo® 300 units/ml, 1.5ml pre-filled Liraglutide (Victoza®) 6mg/ml injection Solostar pen pen (consultant endocrine 2 x 3ml prefilled pens only) Dulaglutide (Trulicity®) 0.75mg/0.5ml,
1.5mg/0.5ml pre-filled pen Notes: When prescribing insulins, specify the source (e.g. Human), the RepaglinideError! Bookmark not defined. strength of the mixture (e.g. 30) & the 500 micrograms, device required (e.g. 10 ml vial). When 1 mg & 2 mg tablets specifying the dose, please do not abbreviate the word ‘units’. PioglitazoneError! Bookmark not Flexpens have been approved for defined. 15 mg tablet patients unable to use the cartridges on recommendation of the diabetes team Notes: Acarbose, Repaglinide & Pioglitazone are for initiation by 6.1.2 ORAL ANTIDIABETIC DRUGS Consultant Endocrinologists only 6.1.2.1 SULPHONYLUREAS Alogliptin 6.25mg, 12.5mg, 25mg tablets Gliclazide 80 mg tablet Linagliptin 5mg tablets (Can be used in severe renal impairment) GlimepirideError! Bookmark not defined. Sitagliptin 25mg, 50mg & 100mg tablets 1 mg, 2 mg & 3 mg tablets
TolbutamideError! Bookmark not 6.1.4 TREATMENT OF defined. 500 mg tablet HYPOGLYCAEMIA
GlucagonError! Bookmark not defined. 1 6.1.2.2 BIGUANIDES mg injection
nPbR = Indicates a drug excluded from HRG tariff price 40 BHRUT NHS Trust Drug Formulary, Updated March 2021
GlucoGel (23 g) glucose gel Notes: 20 micrograms of Liothyronine is equivalent to 100 micrograms of 6.1.5 TREATMENT OF DIABETIC Levothyroxine (Thyroxine) NEPHROPATHY AND NEUROPATHY 6.2.2 ANTITHYROID DRUGS CarbimazoleError! Bookmark not Pregabalin 25mg, 50mg, 75mg, 100mg, defined. 5 mg & 20 mg tablets 150mg, 200mg, and 300mg capsules. ( to be used second line after PropylthiouracilError! Bookmark not amitriptylline or duloxetine for painful defined. 50 mg tablet diabetic neuropathy) Aqueous IodineError! Bookmark not defined.Error! Bookmark not defined. 6.1.6 DIAGNOSTIC & MONITORING Oral Solution AGENTS FOR DIABETES MELLITUS (Lugol’s SolutionError! Bookmark not defined.) BLOOD GLUCOSE MONITORINGError! Bookmark not defined. Notes: Carbimazole is the antithyroid Advantage II ® Reagent strips drug of choice. Prescribers should be aware of the possibility of carbimazole- URINALYSISError! Bookmark not induced bone marrow suppression. If defined. neutropenia develops, stop the drug Diastix ® immediately Ketodiastix ® Labstix ® Multistix SG ® 6.3 CORTICOSTEROIDS Multistix 10 SG ® 6.3.1 REPLACEMENT THERAPY Multistix GP ® FludrocortisoneError! Bookmark not Multistix 8 SG ® defined. 100 micrograms tablet GLUCOSE TOLERANCE TESTError! 6.3.2 GLUCOCORTICOID THERAPY Bookmark not defined. Anhydrous GlucoseError! Bookmark not PrednisoloneError! Bookmark not defined. 75 g powder defined. 1 mg, 5 mg & 25 mg tablets, 6.2 THYROID & ANTITHYROID 2.5 mg & 5 mg e/c tablets, DRUGS 5 mg soluble tablet 5mg/5ml oral solution 6.2.1 THYROID HORMONES Prednisolone acetateError! Bookmark LevothyroxineError! Bookmark not not defined. defined. (ThyroxineError! Bookmark 25 mg/ ml injection not defined.) DexamethasoneError! Bookmark not 25 & 50 micrograms & defined. 100 micrograms tablets 500 micrograms & 2 mg tablets, 2 mg / 5 ml oral solution, LiothyronineError! Bookmark not 8 mg/ 2 ml injection defined. 20 micrograms tablet, 20 micrograms injection HydrocortisoneError! Bookmark not defined. 10 mg & 20 mg tablets, nPbR = Indicates a drug excluded from HRG tariff price 41 BHRUT NHS Trust Drug Formulary, Updated March 2021
100 mg injection (sodium succinate & Trisequens ®Error! Bookmark not phosphate salts), defined. tablets 25 mg/ ml injection (acetate) BetamethasoneError! Bookmark not Oestrogen & progestogen defined. 500 microgram tablet & soluble (Continuous oral preparations) tablet Women with uterus For use when cyclical bleeding is Methylprednisolone sodium unacceptable. Only for truly menopausal succinateError! Bookmark not defined. women, i.e. >54 years of age or at least (Solu Medrone ®Error! Bookmark not 12 months since last natural bleed defined.) 40 mg, 125mg, 500 mg & 1 g IM and IV Climesse ® tablets Error! Bookmark not injection defined. MethylprednisoloneError! Bookmark not (Use when oestrogen of equine origin is defined. (Depo-Medrone ®Error! not acceptable) Bookmark not defined.) Kliovance ® tablets Error! Bookmark not 40 mg/ ml & 80 mg/ 2 ml defined. IM depot injection (Lower strength HRT. For menopausal Notes: Patients should be issued with symptoms in patients unable to tolerate and carry steroid treatment cards. Climesse ®) Withdrawal of systemic corticosteroids should be gradual in certain patient Oestrogen & progestogen (patches) groups. Refer to B.N.F for further advice Women with uterus Evorel Conti ®Error! Bookmark not 6.4 SEX HORMONES defined. Twice weekly patch 6.4.1 FEMALE SEX HORMONES (For Consultant use in patients meeting 6.4.1.1 OESTROGENS & HORMONE criteria for continuous combined HRT in REPLACEMENT THERAPY whom oral therapy undesirable)
Oestrogen & progestogen Oestrogen only (tablets) (Cyclical oral preparations) Women without uterus Women with uterus 1st Choice: Premarin ®Error! Bookmark not defined. 0.625 mg & 1.25 mg tablets Novofem ®Error! Bookmark not defined. tablets Alternative: Climaval ®Error! Bookmark (Use when oestrogen of equine origin is not defined. 1 mg & 2 mg tablets not acceptable) (Use when oestrogen of equine origin is not acceptable) Premique Cycle ®Error! Bookmark not defined. tablets Oestrogen only (patches) (Use when non-androgenic progesterone Women without uterus is needed) Femseven ® Error! Bookmark not Tridestra ®Error! Bookmark not defined. defined. tablets Once weekly patch (Produces 3 monthly bleeds (Transdermal preparation of choice) For use in peri-menopausal women when monthly bleeds are unacceptable) Evorel ®Error! Bookmark not defined. nPbR = Indicates a drug excluded from HRG tariff price 42 BHRUT NHS Trust Drug Formulary, Updated March 2021
Twice weekly patch TESTOSTERONE & ESTERS (Use when extended dosing range is required or once weekly patches have Testosterone undecanoateError! been unsuccessful) Bookmark not defined.
IMPLANTS (Restandol® Testocaps) 40 mg capsule Estradiol st 25 mg, 50 mg & 100 mg implants 1 Choice: Testosterone mucoadhesive buccal 30mg m/r tablets (Straint® SR) RaloxifeneError! Bookmark not defined. 2nd Choice: TestosteroneError! 60 mg tablet Bookmark not defined. (For prevention of vertebral fractures in 100 mg & 200 mg implant post-menopausal women at increased risk of osteoporosis & intolerant of HRT) 3rd Choice: Testosterone 50 mg/5 g gel TiboloneError! Bookmark not defined. (Testim Error! Bookmark not defined. ®)- 2.5 mg tablet to be applied topically for hypogonadism (For use in women who exhibit due to testosterone deficiency in men idiosyncratic reactions to oestrogen or in whom oestrogen administration should be Testosterone enantateError! Bookmark avoided. Consultant Gynaecologist only) not defined. 250 mg/ ml injection 6.4.1.2 PROGESTOGENS AND PROGESTERONE RECEPTOR MODULATORS ANTIANDROGENS DydrogesteroneError! Bookmark not Cyproterone acetateError! Bookmark defined. 10 mg tablet not defined. 50 mg & 100 mg tablets Medroxyprogesterone acetate 5 mg & 10 mg tablets FinasterideError! Bookmark not defined. 5 mg tablet NorethisteroneError! Bookmark not defined. 5 mg tablet 6.5 HYPOTHALAMIC & Progesterone PITUITARY HORMONES & ANTI- 200 mg & 400 mg pessaries, OESTROGENS 4 % & 8 % gel, 100 mg/ 2 ml injection (approved for post- 6.5.1 ANTI-OESTROGENS natal depression, unlicensed use) ClomifeneError! Bookmark not defined. Progesterone receptor modulators 50 mg tablet
Ulipristal acetate (Esmya®)* 5mg CORTICOTROPHINS tablets *temporarily withdrawn from market due to safety concerns.See TetracosactideError! Bookmark not MHRA Alert. defined. Synacthen ®Error! Bookmark not 6.4.2 MALE SEX HORMONES & defined. 250 micrograms/ ml injection ANTAGONISTS Synacthen Depot ® 1 mg/ ml IM injection nPbR = Indicates a drug excluded from HRG tariff price 43 BHRUT NHS Trust Drug Formulary, Updated March 2021
Notes: For short Synacthen test for the defined.; LH-RHError! Bookmark not diagnosis of adrenocortical insufficiency. defined.) Give Synacthen ® 250 micrograms by 100 micrograms injection IV/ IM injection. Take blood for cortisol (serum SST tube) pre-injection, ProtirelinError! Bookmark not defined. 30 minutes and 60 minutes. Send all (TRHError! Bookmark not defined.) three samples to biochemistry. 200 micrograms/ 2 ml injection Normal response is a rise of more than 200 nmol/ L to a level of greater than 6.5.2 POSTERIOR PITUITARY 550 nmol/ L HORMONES & ANTAGONISTS GONADOTROPHINS POSTERIOR PITUITARY HORMONES
For use at the Infertility Clinic only VasopressinError! Bookmark not defined. (Synthetic Argipressin) Chorionic gonadotrophinError! 20 units/ ml injection Bookmark not defined. 1500, 2000 & 5000 units injection DesmopressinError! Bookmark not defined. 100 micrograms tablet, Follitropin alfaError! Bookmark not 100 micrograms/ ml intranasal solution, defined. (Gonal-F ®Error! Bookmark 10 micrograms/ metered dose spray, not defined.) 4 micrograms/ ml injection 75 units & 450 units injection TerlipressinError! Bookmark not defined. Follitropin betaError! Bookmark not 1 mg injection defined. (Puregon ®)Error! Bookmark not defined. ANTIDIURETIC HORMONE 50 units injection ANTAGONISTS DemeclocyclineError! Bookmark not Human menopausal gonadotrophins defined. 150 mg capsule GonadotrophinsError! Bookmark not defined.Error! Bookmark not defined. Tolvaptan (Samsca®)15mg & 30mg Menogon ®Error! Bookmark not tablets defined./ Menopur ®Error! Bookmark (Tolvaptanfor the treatment of not defined. injection hyponatreamia secondary to syndrome of inappropriate antidiuretic hormone GROWTH HORMONE secretion is to be prescribed and monitored by Endocrinologists and nPbR SomatropinError! Bookmark not treatment course will not exceed 10 days. defined. A tickbox form is required) 16 units, 18 units & 36 units injection (as per shared care protocol) (Norditropin SimpleXx, NutropinAq, Tolvaptan has also been approved by Saizen, Humatope, Genotropin, NICE TA358 May 2016 for the treatment Omnitrope & Zomactan) of autosomal dominant polycystic kidney HYPOTHALAMIC HORMONES disease. These patients are not being treated at BHRUT at this point, thay are GonadorelinError! Bookmark not being referred to a dedicated clinic at defined. (GnRHError! Bookmark not Royal London Hospital
nPbR = Indicates a drug excluded from HRG tariff price 44 BHRUT NHS Trust Drug Formulary, Updated March 2021
6.6 DRUGS AFFECTING BONE Sodium clodronateError! Bookmark not METABOLISM defined.Error! Bookmark not defined. 400 mg capsule, 6.6.1 CALCITONIN 520 mg & 800 mg tablets (Haematologists & Radiotherapists only) Calcitonin (salmon)Error! Bookmark not defined. (SalcatoninError! Bookmark nPbR Zoledronic acid (Aclasta) not defined.) 5mg in 100ml infusion 50 units/ ml & 100 units/ ml injection (Consultant Rheumatologists and 400 units/ 2 ml injection Orthogeriatricinas only) nPbR Teriparatide Error! Bookmark not defined. Notes: Zoledronic acid is indicated in 250 micrograms/ml injection postmenopausal osteoporitic patients who are intolerant of oral Reference medicine: Forsteo® bisphosphonates and have suffered two Biosimilar: Movymia® fractures despite oral treatment and have a secondary cause for osteoporosis. Consultant Rheumatologists only ( ) 6.6.2 BISPHOSPHONATES Zoledronic acid (Zometa) 4mg vial Alendronic acidError! Bookmark not (Consultant Oncologists only) defined.Error! Bookmark not defined. Notes: Zometa is indicated in oncology (alendronateError! Bookmark not patients for hypercalcaemia of defined.) malignancy. 10 mg tablet (once daily) Denosumab Injection 60mg/ml 1ml pre- 70mg once weekly tablet filled syringe (Prolia®) (Consultant Rheumatologsts and Notes: Daily alendronic acid is reserved Orthogeriatricians or as per NICE for the treatment of osteoporosis in men recommendations) only. Once weekly preparations are unlicensed for this indication Notes: Prolia® is indicated in postmenopausal women at increased risk Risedronate sodium (Actonel®)Error! of fractures who are unable to comply Bookmark not defined. with the special instructions for 5 mg once daily tablet, 35 mg once administering alendronate and either weekly tablet risedronate or ibandronic acid or have an 30mg tablet licensed for treatment of intolerance of, or a contraindication to Paget’s disease of bone 30mg daily for 2 those treatments. months; maybe repeated if necessary after at least 2 months Denosumab 70mg/ml 120mg vial (Xgeva®). (Consultants oncologists only PamidronateError! Bookmark not as per NICE recommendations) defined. disodiumError! Bookmark not defined.Error! Bookmark not defined. Notes: Xgeva® is indicated for the 15 mg injection prevention of skeletal-related events in adults with bone metastases from solid Ibandronic acid 50mg tablets and tumours. concentrate for IV infusion (Bondronat®)
nPbR = Indicates a drug excluded from HRG tariff price 45 BHRUT NHS Trust Drug Formulary, Updated March 2021
6.7 OTHER ENDOCRINE DRUGS 6.7.1 BROMOCRIPTINE & OTHER DOPAMINERGIC DRUGS BromocriptineError! Bookmark not defined. 1 mg, 2.5 mg & 5 mg tablets, 10 mg capsule
CabergolineError! Bookmark not defined. 500 micrograms tablet
6.7.2 DRUGS AFFECTING GONADOTROPHINS DanazolError! Bookmark not defined. 100 mg & 200 mg capsules GoserelinError! Bookmark not defined. (Zoladex ®Error! Bookmark not defined.) 3.6 mg Implant (for prostate & breast cancer, please see section 8.3.4.2) LeuprorelinError! Bookmark not defined. (Prostap SR DCS®Error! Bookmark not defined.) 3.75 mg injection (Gynaecologists only for Endometriosis unresponsive to other treatments)
nPbR = Indicates a drug excluded from HRG tariff price 46 BHRUT NHS Trust Drug Formulary, Updated March 2021
7 OBSTETRICS, GYNAECOLOGY & URINARY-TRACT DISORDERS
7.1 DRUGS USED IN Unlicensed indications) OBSTETRICS MethotrexateError! Bookmark not defined. injection 7.1.1. PROSTAGLANDINS & (Ectopic pregnancy in line with protocol, OXYTOCICS unlicensed indication) CarboprostError! Bookmark not defined. 250 micrograms/ ml injection 7.1.1.1. DUCTUS ARTERIOSUS (Available for patients unresponsive to ergometrine & oxytocin) MAINTENANCE OF PATENCY
DinoprostoneError! Bookmark not AlprostadilError! Bookmark not defined. defined. (Prostin E2 ®Error! Bookmark (Prostin VR ®Error! Bookmark not not defined.) defined.) 3 mg vaginal tablet, 500 micrograms/ ml injection 1 mg & 2 mg vaginal gel CLOSURE 10mg pessary within retrieval device Ibuprofen (Orphan drug) (Propess®) 5 mg/ml injection- (treatment of closing patent ductus arteriosus (PDA) in preterm Notes: Prostin E2 vaginal tablet & newborn infants) indomethacin is no vaginal gel are not bioequivalent longer used because of adverse effects Ergometrine maleateError! Bookmark such as necrotising enterocolitis (NEC). not defined. Ibuprofen has a better side effect profile) 500 micrograms/ ml injection 7.1.2 MIFEPRISTONE Ergometrine & oxytocinError! MifepristoneError! Bookmark not Bookmark not defined. defined. 200 mg tablet (Syntometrine ®Error! Bookmark not defined.) 7.1.3 MYOMETRIAL RELAXANTS 500 micrograms & 5 units/ ml injection Ritodrine hydrochlorideError! GemeprostError! Bookmark not defined. Bookmark not defined. 1 mg pessaries 10 mg tablet, 50 mg/ 5 ml injection AtosibanError! Bookmark not defined. OxytocinError! Bookmark not defined. 37.5 mg/ 5 ml & 6.75 mg/ 0.9 ml injection- (Syntocinon ®Error! Bookmark not (for use in patients with contraindications defined.) to ritodrine) 5 units/ ml & 10 units/ ml injection SalbutamolError! Bookmark not defined. MisoprostolError! Bookmark not defined. (See section 3.1.1.1 for strengths of 100 & 200 micrograms tablets injection) (Induction of Labour, Cervical priming prior to termination, TerbutalineError! Bookmark not defined. Medical termination in 2nd trimester, Post-partum haemorrhage, nPbR = Indicates a drug excluded from HRG tariff price 47 BHRUT NHS Trust Drug Formulary, Updated March 2021
0.5 mg/ ml & 2.5 mg/ 5 ml injection (for Clindamycin phosphateError! management of uterine hyperstimulation Bookmark not defined. (Dalacin ®)Error! during induced labour-unlicensed use) Bookmark not defined. Cream
7.2 TREATMENT OF VAGINAL Metronidazole 0.75% gel (Zidoval®) & VULVAL CONDITIONS (alternative to oral metronidazole for the treatment of bacterial vaginosis) 7.2.1 PREPARATIONS FOR VAGINAL ATROPHY Povidone-iodineError! Bookmark not OESTROGENS, TOPICAL defined. (Betadine ®Error! Bookmark not defined.) EstriolError! Bookmark not defined. 200 mg pessary (G.U. Medicine only) (Ortho-Gynest ®Error! Bookmark not defined.) 7.3 CONTRACEPTIVES 0.01 % Intravaginal cream 7.3.1 COMBINED HORMONAL Conjugated oestrogens (equine)Error! CONTRACEPTIVES Bookmark not defined. LOW STRENGTH (ORAL) (Premarin ®Error! Bookmark not defined.) vaginal cream EthinylestradiolError! Bookmark not defined. & DesogestrelError! Bookmark EstradiolError! Bookmark not defined. not defined. (Vagifem ®Error! Bookmark not Mercilon ®Error! Bookmark not defined. defined.) tablet 25 micrograms vaginal tablets
LOW STRENGTH (VAGINAL) Estradiol (Estring ®Error! Bookmark Ethinylestradiol with Etonogestrel not defined.) NuvaRing® vaginal ring 7.5 micrograms/ 24 hours vaginal ring (Use only when creams or vaginal tablets STANDARD STRENGTH & systemic administration are inappropriate, Consultant Gynaecologists Ethinylestradiol & LevonorgestrelError! only) Bookmark not defined. Levest 150/30 tablet 7.2.2 ANTI-INFECTIVE DRUGS Logynon ® PREPARATIONS FOR VAGINAL & Trinordiol ® tablet VULVAL CANDIDIASIS Ethinylestradiol & NorethisteroneError! ClotrimazoleError! Bookmark not Bookmark not defined. defined. TriNovum ®Error! Bookmark not defined. 100 mg, 200 mg & 500 mg pessaries, tablet 1 %, 2% & 10 % vaginal cream Ovysmen ®Error! Bookmark not defined. tablet (Havering Community only) Econazole nitrateError! Bookmark not defined. 150 mg pessary Ethinylestradiol & NorgestimateError! Bookmark not defined. PREPARATIONS FOR OTHER Cilest ®Error! Bookmark not defined. VAGINAL INFECTIONS tablet nPbR = Indicates a drug excluded from HRG tariff price 48 BHRUT NHS Trust Drug Formulary, Updated March 2021
Ethinylestradiol & Desogestrel LevonorgestrelError! Bookmark not Gedarel ®Error! Bookmark not defined. defined. (Norgeston ®Error! Bookmark tablet not defined.) tablet
Ethinylestradiol & DrospirenoneError! 7.3.2.2 PARENTERAL Bookmark not defined. PROGESTOGEN-ONLY Yasmin ®Error! Bookmark not defined. CONTRACEPTIVES tablet Medroxyprogesterone acetateError! Bookmark not defined. (Depo-Provera ®Error! Bookmark not Ethinylestradiol & Gestodene defined.) 150 mg pre-filled syringe Error! Bookmark not defined.Femodene ®Error! Bookmark Subcutaneous Medroxyprogesterone not defined. tablet acetate ( Sayana Press®) 104mg Millinette ® EtonogestrelError! Bookmark not defined. (Nexplanon ®) Implant Note: Femodene, Gedarel, Mercilon & (Family planning clinics only) Millinette are associated with a higher 7.3.2.3 INTRA-UTERINE incidence of thrombosis & are available PROGESTOGEN-ONLY only for women who have experienced CONTRACEPTIVES problems with other oral contraceptives & who have given their full, informed Mirena ®Error! Bookmark not defined. consent Intrauterine system Jaydess ®Error! Bookmark not defined. EMERGENCY CONTRACEPTION Intrauterine system Levonorgestrel (Levonelle ® 1500)Error! Levosert® Intrauterine system Bookmark not defined. tablet Kyleena® Intrauterine system (Family planning & GUM clinic only)
Ulipristal acetate 30mg (ellaOne®) tablet 7.3.3 SPERMICIDAL 7.3.2 PROGESTOGENError! CONTRACEPTIVES Bookmark not defined.-ONLY Nonoxinol ‘9’ 2% Gel 30g CONTRACEPTIVES (Gygel ®Error! Bookmark not defined.)
7.3.2.1 ORAL PROGESTOGEN-ONLY 7.3.4 CONTRACEPTIVE DEVICES CONTRACEPTIVES GyneFix ® DesogestrelError! Bookmark not defined. (Cerazette ®) Nova-T ® 380 (Dr Hollingworth only) EtynodiolError! Bookmark not defined. 7.4 DRUGS FOR GENITO- (Femulen ®Error! Bookmark not URINARY DISORDERS defined.) tablet 7.4.1 DRUGS FOR URINARY NorethisteroneError! Bookmark not RETENTION defined. (Micronor ®Error! Bookmark not defined.) tablet ALPHA-BLOCKERS nPbR = Indicates a drug excluded from HRG tariff price 49 BHRUT NHS Trust Drug Formulary, Updated March 2021
AlfuzosinError! Bookmark not defined. 25mg and 50mg m/r tablets (Xatral XL ®) 10 mg m/r tablet 7.4.3 DRUGS USED IN UROLOGICAL PAIN IndoraminError! Bookmark not defined. 20 mg tablet Potassium citrateError! Bookmark not defined. TamsulosinError! Bookmark not defined. 3 g granules & mixture BP 400 micrograms m/r capsule Notes: These granules should be taken with plenty of water. Notes: The use of alpha-blockers is Caution: 3 g sachet or 10 ml of mixture associated with postural hypotension, contains 28 mmol of potassium particularly after the first dose. Elderly patients, those with a history of 7.4.4 BLADDER INSTILLATIONS & orthostatic hypotension or those who are UROLOGICAL SURGERY receiving hypotensive therapy are particularly at risk Sodium ChlorideError! Bookmark not PARASYMPATHOMIMETICS defined. 0.9 % (Uro-tainer ®Error! Bookmark not defined.) Bethanechol chloride 10 mg tablet GlycineError! Bookmark not defined. 1.5 Distigmine bromide 5 mg tablet % Irrigation solution
7.4.2 DRUGS FOR URINARY 7.4.5 DRUGS FOR ERECTILE FREQUENCY, ENURESIS & DYSFUNCTION INCONTINENCE AlprostadilError! Bookmark not defined. 1st Choice: Oxybutynin (Caverject ®Error! Bookmark not 2.5 mg & 5 mg tablet, 2.5 mg/ 5 ml elixir defined.) (Urologists only) 5 micrograms, 10 micrograms, 20 micrograms & 40 micrograms injection
nd (Viridal Duo®) starter pack 2 Choices 10 micrograms, 20 micrograms & 40 micrograms starter pack Solifenacin succinate (Vesicare®) (MUSE ®Error! Bookmark not defined.) 5mg and 10mg film-coated tablets (Urologists only) Tolterodine 1mg and 2mg immediate 250 micrograms, 500 micrograms & 1 mg release tablets urethral application
Fesoterodine (Toviaz®) PapaverineError! Bookmark not defined. 4mg and 8mg m/r tablets 30 mg, 40 mg & 80 mg injection (Unlicensed product, Urologists only) Propantheline 15 mg tablet 1st Choice: SildenafilError! Bookmark not defined. 25 mg, 50mg & 100mg Duloxetine 20mg and 40mg capsules tablets (last line for stress urinary incontinence as per NICE) Alternatives treatments
Mirabegron (Betmiga®) nPbR = Indicates a drug excluded from HRG tariff price 50 BHRUT NHS Trust Drug Formulary, Updated March 2021
Tadalafil 2.5mg, 5mg, 10mg & 20mg for erectile dysfunction need to be tablets (1st or 2nd line in patients who endorsed with SLS & signed by require more spontaneity and post Consultant Urologists only. Supply is one prostatectomy). tablet per week, with a maximum of one month supply only Vardenafil 5mg, 10mg & 20mg tablets (Urologists only). To be used 2nd line after Sildenafil in non-responders and PRIAPISM older patients over 70 yrs old. Etilefrine 5mg tablets – unlicensed see Priapism guidelines on the intranet. Notes: Sildenafil is contraindicated in patients receiving nitrates. Prescriptions
nPbR = Indicates a drug excluded from HRG tariff price 51 BHRUT NHS Trust Drug Formulary, Updated March 2021
8 MALIGNANT DISEASE & IMMUNOSUPPRESSION
The drugs in this section are potentially highly toxic and should therefore, be used UROTHELIAL TOXICITY only by clinicians experienced in their use. MesnaError! Bookmark not defined. tablets & For advice on the use of the drugs the injection opinion of a Consultant in radiotherapy and oncology should be 8.1.2 CYTOTOXIC ANTIBIOTICS sought. BleomycinError! Bookmark not defined. A central cytotoxic reconstitution service, injection based in the pharmacy, is in operation DaunorubicinError! Bookmark not and should be always be used. The defined. injection service presents the cytotoxic drug in its DoxorubicinError! Bookmark not final form ready for use, i.e. the exact defined. injection dose required drawn up in a syringe or in EpirubicinError! Bookmark not defined. an infusion bag, labelled with the patient's injection name. IdarubicinError! Bookmark not defined. For advice on the handling of cytotoxic capsules & injection drugs please contact one of the numbers Mitomycin Error! Bookmark not defined. below. injection (Bladder instillation, Consultant Urologists For information about the only) reconstitution service, telephone (Also for Pterygium excision and Ext. 3029 (QH) or 8272 (KGH) trabeculectomy in Ophthalmology – 8.1.1 ALKYLATING AGENTS Consultant Ophthalmologists only) BusulfanError! Bookmark not defined. Mitoxantrone (MitozantroneError! tablets Bookmark not defined.)Error! Bendamustine injection Bookmark not defined. infusion CarmustineError! Bookmark not defined. Pixantrone injection (Pixuvri®) injection (as per NICE 306) ChlorambucilError! Bookmark not defined. tablets Notes: Pixantrone monotherapy is CyclophosphamideError! Bookmark not recommended as an option for treating defined. tablets & injection multiply relapsed or refractory aggressive IfosfamideError! Bookmark not defined. non-Hodgkin’s B-cell lymphoma in injection patients: LomustineError! Bookmark not defined. Who have previously been treated capsules with rituximab and MelphalanError! Bookmark not defined. tablets & injection Who are receiving third- or fourth- line treatment and If the manufacturer provides pixantrone with the discount agreed in the patient access scheme nPbR = Indicates a drug excluded from HRG tariff price 52 BHRUT NHS Trust Drug Formulary, Updated March 2021
8.1.5 OTHER ANTINEOPLASTIC DRUGS 8.1.3 ANTIMETABOLITES nPbR Abemaciclib tablets Azacitidine injection CapecitabineError! Bookmark not nPbR Alectinib capsules defined. tablets nPbR Cladribine tablet & injection AmsacrineError! Bookmark not defined. CytarabineError! Bookmark not defined. infusion injection Altretamine capsules (Radiotherapists only) FludarabineError! Bookmark not defined. injection nPbR AnagrelideError! Bookmark not
FluorouracilError! Bookmark not defined. tablets defined. injection & cream nPbR Bortezomib injection (cream: Dermatologists only) Gemcitabine injection nPbR Carfilzomib infusion MercaptopurineError! Bookmark not defined. tablets nPbR Cetuximab infusion MethotrexateError! Bookmark not defined. tablets, nPbR Crizotinib capsules Injection Pemtrexed Error! Bookmark not defined. nPbR DacarbazineError! Bookmark not injection defined. injection Tegafur With capsules Uracil nPbR Eribulin capsules Tioguanine tablets Liposomal cytarabine – daunorubicin Hydroxycarbamide (Hydroxyurea) injection capsules nPbR Axitinib tablets FOLINIC ACID RESCUE nPbR Ceritinib capsules Calcium FolinateError! Bookmark not nPbR Dasatinib tablets (for defined.Error! Bookmark not defined. nd rd tablets & injection 2 or 3 line treatment of CML in line with Cancer network recommendations) 8.1.4 VINCA ALKALOIDS & ETOPOSIDE nPbR Everolimus tablets
Vinblastine injection nPbR Gilteritinib tablet VincristineError! Bookmark not defined. injection nPbR Ibrutinib capsules Vindesine injection VinorelbineError! Bookmark not defined. nPbR Idelalisib 150mg tablets injection & capsules nPbR Imatinib capsules Notes: Vinca alkaloids should only be given IV. Inadvertent Intrathecal nPbR Ixazomib capsules administration can be fatal nPbR Lapatinib tablets Etoposide capsules & injection nPbR = Indicates a drug excluded from HRG tariff price 53 BHRUT NHS Trust Drug Formulary, Updated March 2021
Notes: CCGs funding is required for DocetaxelError! Bookmark not defined. Lapatinib infusion (Approved 3rd line therapy for metastatic prostate cancer) nPbR Lenvatinib (Kisplyx®) PaclitaxelError! Bookmark not defined. (Lenvima®) capsules infusion Paclitaxel (as albumin-bound nPbR Nilotinib capsules nanoparticles) infusion Cabazitaxel intravenous infusion nPbR Niraparib capsules 40mg/ml nPbR Nintedanib capsules ANTINEOPLASTIC DRUGS – Monoclonal Antibodies nPbR Nivolumab injection nPbR Avelumab injection nPbR Osimertinib tablets nPbR Atezolizumab injection nPbR Pomalidomide capsules nPbR Brentuximab vedotin nPbR Ponatinib tablets injection nPbR Daratumumab injection nPbR Regorafenib tablets nPbR Durvalumab injection nPbR Ribociclib tablets nPbR Nivolumab injection nPbR Obinutuzumab injection nPbR Sorafenib tablets nPbR Ofatumumab injection nPbR Sunitinib capsules nPbR Pembrolizumab injection Notes: CCGs funding is required for nPbR Pertuzumab injection nilotinib, sorafenib and sunitinib nPbR Ramucirumab injection nPbR Venetoclax tablets nPbR Trastuzumab injection
TOPOISOMERASE I INHIBITORS PentostatinError! Bookmark not defined. injection Irinotecan hydrochloride infusion TopotecanError! Bookmark not defined. PLATINUM COMPOUNDS infusion
Carboplatin injection nPbR Thalidomide tablets CisplatinError! Bookmark not defined. (Haematologists only for multiple injection myeloma and myelofibrosis with OxaliplatinError! Bookmark not defined. cytopenias +/- splenomegaly) injection ProcarbazineError! Bookmark not ONCOLYTIC VIRAL THERAPY defined. capsules nPbR Talimogene laherparepvec injection TAXANES TARGETED THERAPY nPbR Radium 223 dichloride injection nPbR = Indicates a drug excluded from HRG tariff price 54 BHRUT NHS Trust Drug Formulary, Updated March 2021
8.2 DRUGS AFFECTING THE nPbR Glatarimer Error! Bookmark not IMMUNE SYSTEM defined. 20mg/L subcut. injection Lenalidomide capsules 8.2.1 ANTIPROLIFERATIVE (3rd line treatment of multiple myeloma, IMMUNOSUPPRESSANTS CCGs funding essential before prescribing) AzathioprineError! Bookmark not nPbR Interferon alfaError! Bookmark not defined. defined. (Roferon A ®Error! Bookmark 25 mg & 50 mg tablets, 50 mg injection not defined.) injection Mycophenolate mofetilError! Bookmark 3, 4.5 & 18 million-units vial, not defined. 3, 4.5 & 9 million-units pre-filled syringe, 250 mg capsule, 500 mg tablet 18 million-units multidose cartridges (Unlicensed use - Treatment of lupus nPbR Interferon beta-1bError! Bookmark nephritis in child- bearing age patients & not defined. (Betaferon ®Error! other autoimmune diseases in similar age Bookmark not defined.) groups) 9.6 million-unit injection (Also for second-line treatment of severe Consultant Neurologists only psoriasis when other treatments have failed – Consultant Dermatologists only) nPbR Peginterferon alfa-2a (Check brands & strengths stocked with nPbR Cladribine Pharmacy) 10mg tablets (Consultant Gastroenterolgist only, for (For the treatment of relapsing-remitting patients with chronic hepatitis B and C) multiple sclerosis – NICE TA493) (Consultant Haematology for patients 8.2.2 CORTICOSTEROIDS & OTHER with polycythaemia vera or essential IMMUNOSUPPRESSANTS thrombocythaemia) PrednisoloneError! Bookmark not defined. nPbR Peginterferon beta-1a (Plegridy®) See section 6.3.2 for preparations) (Consultant Neurologists Only) CiclosporinError! Bookmark not defined. (Cyclosporin) Neoral ®Error! Bookmark not defined. BCG (Bacillus Calmette-Guerin)Error! 10 mg, 25 mg 50 mg & 100 mg capsules, Bookmark not defined.Error! Bookmark 100-mg/ ml oral solution not defined.) (Specialist use only) Bladder installation Ciclosporin 1mg per ml eye drops (Consultant Urologists only) 0.3ml dose units (Ikervis®) Ciclosporin 1mg/ml eye drops 0.3ml dose nPbR Dimethyl Fumarate units (Verkazia®) (Tecfidera®) 120mg & 240mg e/c capsules (Consultant Neurologists only as per 8.2.3 RITUXIMAB NICE TA320) (Skilrance®) 30mg &120mg GR tablets Rituximab Error! Bookmark not for Plaque Psoriasis NICE TA 475 defined.10mg/ml, 10ml and 50ml vial for infusion (for Rheumatoid Arthritis) nPbR Glatiramer acetate 8.2.4 OTHER IMMUNOMODULATING solution for injection DRUGS nPbR = Indicates a drug excluded from HRG tariff price 55 BHRUT NHS Trust Drug Formulary, Updated March 2021
Fampridine 10mg MR tablets 8.3.4 HORMONE ANTAGONISTS (Consultant Neurologists only for 8.3.4.1 BREAST CANCER Episodic ataxia type 2) TamoxifenError! Bookmark not defined. Siponimod (as Siponimod fumaric 10 mg & 20 mg tablets, acid) (Mayzent®) 10 mg/ 5 ml oral solution 0.25mg & 1mg tablets nPbR Fulvestrant 250mg/5ml solution IMMUNOSUPRESSANTS > for injection MONOCLONAL ANTIBODIES > ANTI- AnastrozoleError! Bookmark not defined. LYMPHOCYTE 1 mg tablet
Anti-lymphocyte monoclonal Exemestane 25 mg Error! Bookmark not antibodies defined.tablet (2nd line after 2 – 3yrs of tamoxifen nPbR Alemtuzumab 10mg/ml therapy) concentrate for solution for infusion vials Letrozole 2.5mg tablet nPbR Ocrelizumab 30mg/10ml concentrate for solution for infusion vials Patent Blue V (Sulphan Blue) (Unlicensed product. Diagnostic dye used to stain metastatic lymph nodes in axilla) 8.3 SEX HORMONES & HORMONE ANTAGONISTS IN 8.3.4.2 PROSTATE CANCER & MALIGNANT DISEASE GONADORELIN ANALOGUES Notes: For patients receiving their first 8.3.1 OESTROGENS course of treatment, anti-androgens DiethylstilbestrolError! Bookmark not should be started three days before the defined.Error! Bookmark not defined. gonadorelin analogue & normally (Stilboestrol) continued for three weeks. This will help 1 mg tablet to avoid the tumour ‘flare’ that may occur after commencing gonadorelin therapy 8.3.2 PROGESTOGENSError! Bookmark not defined. Abiraterone (Zytiga®) 250mg tablets Medroxyprogesterone acetateError! (To be funded via Cancer Drugs Fund) Bookmark not defined. 100 mg, 400 mg & 500 mg tablets BicalutamideError! Bookmark not (See section 6.4.1.2 for other strengths) defined. Megestrol acetateError! Bookmark not 50 mg & 150 mg tablets defined. (Urologists only) 40 mg & 160 mg tablets Cyproterone acetateError! Bookmark NorethisteroneError! Bookmark not not defined. defined. 50 mg & 100 mg tablets 5 mg tablet Flutamide 250 mg Error! Bookmark not defined.tablet 8.3.3 ANDROGENS (See section 6.4.2 for preparations) Degarelix injection 120mg vial (with diluent) nPbR = Indicates a drug excluded from HRG tariff price 56 BHRUT NHS Trust Drug Formulary, Updated March 2021
Notes: Approved for first dose treatment only with a switch to Triptorelin or Goserelin 28 days later
Leuprorelin (Prostap SR DCS) 3.75mg prefilled syringe Triptorelin (Decapeptyl® SR) (I/M injection) 3 mg prefilled syringe GoserelinError! Bookmark not defined. (Zoladex ®Error! Bookmark not defined.) 3.6 mg Implant Notes: In-patients should be encouraged to bring in their own supply. Patients on 10.8 mg (3 monthly injections) will receive 3.6 mg & their next injection scheduled to be given in one month
8.3.4.3 SOMATOSTATIN ANALOGUES nPbR OctreotideError! Bookmark not defined. (Sandostatin ®Error! Bookmark not defined.) injection 50 mcg/ ml, 100 mcg/ ml & 500 mcg/ ml
nPbR LanreotideError! Bookmark not defined. Somatuline ® LAError! Bookmark not defined. Somatuline ® AutogelError! Bookmark not defined. (For treatment of acromegaly, neuroendocrine tumours and thyroid tumours) Refer prescriptions to Senior Principal Pharmacist, Clinical Services)
nPbR = Indicates a drug excluded from HRG tariff price 57 BHRUT NHS Trust Drug Formulary, Updated March 2021
9 NUTRITION & BLOOD
9.1 ANAEMIAS & SOME Notes: Ferric maltol is approved as a first OTHER BLOOD DISORDERS line alternative to IV iron for the treatment 9.1.1 IRON DEFICIENCY ANAEMIAS of iron deficiency anaemia in adults with inflammatory bowel disease (IBD). A 9.1.1.1 ORAL IRON course of 12 weeks treatment is required Table: Iron content of different salts
Content of Iron salt Amount ferrous iron 9.1.1.2 PARENTERAL IRON 200 mg 65 mg fumarate Iron dextran Error! Bookmark not 140 mg 45 mg defined. (CosmoFer ®Error! sodium Bookmark not defined.) 190 mg 27.5 mg feredetate 100 mg/ 2 ml IV/ IM injection glycine 141 mg 25 mg Notes: Parenteral Iron therapy is sulphate hazardous. Elevation of Hb is not gluconate 300 mg 35 mg significantly faster by this route. sulphate, 200 mg 65 mg Parenteral iron should be reserved for dried 325 mg 105 mg patients in whom oral therapy or transfusion is inappropriate or where Ferrous sulphateError! Bookmark not compliance is a problem. Oral iron defined. therapy should be continued for at least 200 mg tablet, three months to replenish iron stores 325 mg m/r tablet (Ferrograd ®Error! Bookmark not defined.) Iron Isomaltoside 1000 (Monofer®) Ferrous fumarateError! Bookmark not 50mg/ml & 100mg/ml IV injection defined. (Fersamal ®Error! Bookmark not defined.) Iron carboxymaltose (Ferinject®) 140 mg/ 5 ml syrup 50mg/ml injection Ferrous gluconateError! Bookmark not 9.1.2 DRUGS USED IN defined. MEGALOBLASTIC ANAEMIAS 300 mg tablet Folic acidError! Bookmark not defined. Sodium feredateError! Bookmark not 5 mg tablet defined. (Sytron ®Error! Bookmark 2.5 mg/ 5 ml syrup not defined.) 190 mg/ 5 ml elixir Hydroxocobalamin (Vitamin B12Error! Bookmark not defined.) Error! Bookmark FERROUS SULPHATE & FOLIC ACID not defined. 1000 micrograms/ ml injection Pregaday ®Error! Bookmark not defined. Ferrous fumarate (100 mg iron) & 9.1.3 DRUGS USED IN 350 micrograms folic acid tablet HYPOPLASTIC, HAEMOLYTIC & RENAL ANAEMIAS Ferric Maltol (Ferracru®) 30mg Capsules ERYTHROPOIETIN
nPbR = Indicates a drug excluded from HRG tariff price 58 BHRUT NHS Trust Drug Formulary, Updated March 2021
Erythropoietin betaError! Bookmark not pre-filled syringe for injection defined. (NeoRecormon ®Error! 48 million- units (480 micrograms/0.5ml) Bookmark not defined.) pre-filled syringe for injection 500, 1000, 2000, 4000, 5000 & 10,000 units pre-filled syringes (Consultant Haematologist only, must be approved by Haematology Clinical IRON OVERLOAD Directorate Lead & Senior Principal Pharmacist, Technical Services) nPbR 1st Choice: DesferrioxamineError! Bookmark not defined. 500 mg & 2 g injection 9.2 FLUIDS & ELECTROLYTES 9.2.1.1 ORAL POTASSIUM nPbR 2nd Choice: Deferasirox 125mg, Potassium chlorideError! Bookmark not 250mg, 500mg Dispersible tablets (Haematologists’ use only- where defined. desferrioxamine is contraindicated or inadequate) (Sando K ®Error! Bookmark not defined.) 12 mmol K+ per effervescent tablet nPbR Alternative: DeferiproneError! Bookmark not defined. 500 mg tablet (Kay-Cee-L ®Error! Bookmark not (Haematologists only- use where defined.) 1 mmol/ ml syrup desferrioxamine therapy is (Slow-K ®Error! Bookmark not defined.) contraindicated, has failed or has caused 600 mg or 8 mmol K+ per m/r tablet serious toxicity) (For those intolerant to Sando-K ®) Notes: Slow-K is generally no longer 9.1.4 DRUGS USED IN PLATELET used because it has association with DISORDERS oesophageal or small bowel ulceration
Romiplostim (Nplate®Error! Bookmark not defined.) POTASSIUM REMOVAL 250 microgram s/c injection Calcium polystyrene sulphonateError! ® Bookmark not defined. nPbR Lusutrombopag (Mulpleo ) 3mg powder (Calcium Resonium ®Error! tablets Bookmark not defined.) 30g kit (for rectal administration) Consultant Hepatologists only, for treating thrombocytopenia in people with Notes: U&E’s must be monitored daily. chronic liver disease needing a planned 300g pot invasive procedure (NICE TA 617). Resonium A may be used in patients who have a high calcium. However it is not
recommended for use in patients with 9.1.6 DRUGS USED IN congestive heart failure as it contains NEUTROPENIA sodium. These resins can be given rectally (see BNF for further advice)
nPbR Filgrastim (G-CSFError! Bookmark not defined.)Error! Bookmark not defined. Patiromer calcium (Veltassa®) (Zarzio®) 8.4g oral powder sachets 30 million- units (300 micrograms/0.5ml)
nPbR = Indicates a drug excluded from HRG tariff price 59 BHRUT NHS Trust Drug Formulary, Updated March 2021
16.8g oral powder sachets SODIUM CHLORIDE & GLUCOSEError! Bookmark not defined. Patiromer is to be used only by consultant nephrologists 0.18 % & 4 %: 500 ml & 1000 ml bags 0.45 % & 5 %: 500 ml bags
SODIUM LACTATE INTRAVENOUS Sodium Zirconium Cyclosilicate INFUSION, COMPOUNDError! (Lokelma®) (NICE TA 599) Bookmark not defined. (HARTMANN’S; RINGER-LACTATEError! Bookmark not 5g and 10g sachet defined.Error! Bookmark not defined.) 500 ml & 1000 ml bags
9.2.1.2 ORAL SODIUM AND WATER Plasma-Lyte 1000ml bags Sodium chlorideError! Bookmark not defined. (Slow Sodium ®Error! (In critical care areas i.e. ITU, HDU and Bookmark not defined.) Theartres only) 10 mmol or 600 mg m/r tablet GLUCOSEError! Bookmark not defined. ORAL REHYDRATION SALTSError! 5 %: 100 ml, 250 ml, 500 ml & Bookmark not defined. 1000 ml bags 10 %: 500 ml & 1000 ml bags Sodium chloride & glucose oral 50 %: 50 ml vial & minijet powder (Dioralyte ®Error! Bookmark not defined. sachet) POTASSIUM CHLORIDE & GLUCOSE 5 % INTRAVENOUS INFUSIONError! 9.2.1.3 ORAL BICARBONATE Bookmark not defined. Sodium bicarbonateError! Bookmark 10 mmol K+: 500 ml bag not defined. + + - 20 mmol K : 500 ml & 1000 ml bags Provides 6 mmol each of Na & HCO3 40 mmol K+: 1000 ml bag per 600 mg tablet & 500mg capsules Unlicensed preparation: 9.2.2 PARENTERAL PREPARATIONS 40 mmol K+: 500 ml bag FOR FLUID & ELECTROLYTE POTASSIUM CHLORIDE & SODIUM IMBALANCE CHLORIDE 0.9 %Error! Bookmark not 9.2.2.1 ELECTROLYTES & WATER defined. INTRAVENOUS INFUSION SODIUM CHLORIDEError! Bookmark not 10 mmol K+: 500 ml bag defined. 20 mmol K+: 500 ml & 1000 ml bags 40 mmol K+: 1000 ml bag 0.9 % 2 ml, 5 ml & 10 ml amp, Unlicensed preparations: 50 ml vial, 40 mmol K+: 100 ml (used in KGH ITU) 100 ml, 250 ml, 500 ml & 1000 ml bags, & 500 ml bags 500 ml polyfusor 50 mmol K+: 50ml 60 mmol K+: 1000 ml bag 0.45 %: 500 ml bag 80 mmol K+: 1000 ml bag 0.18 %, 0.9 %, 1.8 %, 5 %: Notes: The above unlicensed 500 ml polyfusors preparations, 40 mmol K+ in 500 ml bag, 60 mmol & 80 mmol K+ in 1000 ml bags are available on consultation with a nPbR = Indicates a drug excluded from HRG tariff price 60 BHRUT NHS Trust Drug Formulary, Updated March 2021
Pharmacist. Refer to Trust Potassium 9.2.2.2 PLASMA & PLASMA Policy for further information. The Policy SUBSTITUTES is also available on the Trust Intranet Albumin solution (Human)Error! Bookmark not defined. POTASSIUM CHLORIDE, SODIUM Isotonic solutions: 4.5 % CHLORIDE 0.18 % & GLUCOSE 4 Concentrated solutions: 20 % %Error! Bookmark not defined. INTRAVENOUS INFUSION Notes: Supply obtained from: Pathology (KGH) 10 mmol K+: 500 ml bag + Pharmacy (Queens) 20 mmol K : 500 ml & 1000 ml bags + 40 mmol K : 1000 ml bag PLASMA SUBSTITUTES
POTASSIUM CHLORIDE, SODIUM CHLORIDE 0.45 % & GLUCOSE 5 Dextran 70 %Error! Bookmark not defined. In 500 ml glucose 5 % or sodium chloride INTRAVENOUS INFUSION 0.9 % infusion Unlicensed preparation: GelatinError! Bookmark not defined. 4 % 20 mmol K+: 500 ml bag (Gelofusine ®Error! Bookmark not (For paediatric DKA patients only) defined.) 500 ml & 1000 ml infusion bags
POTASSIUM CHLORIDE Succinylated gelatine (Gelaspan®) CONCENTRATEError! Bookmark not 500ml & 1L infusion bags defined. 15 %, STERILE Etherified starch 20 mmol K+: 10 ml amp.
Notes: This is available in designated HAEMOFILTRATION FLUIDS areas, but ready mixed bags should be used in the first instance. This is treated Table: Fluids stocked on ITU as a Controlled Drug. See Trust - HC03 Potassium Policy - HCO3 free, buffered, Contains 40 Contains Notes: Potassium Chloride Concentrate mmol/ L Lactate 3 mmol/ L 15% has been approved for specific Lactate indication in Obstetrics. See Fetal Prismasol 20 Medicine GFuidelines HemolactolError! 4Error! mmol Bookmark not Bookmark K+ per SODIUM BICARBONATEError! defined. not 5L bag Bookmark not defined. defined. 1.4 %: 500 ml polyfusor Hemosol LactasolError! B0Error! 4.2 %: 10 ml amp. + 500ml polyfusor & 4.2 % minijet K free Bookmark not Bookmark 8.4 %: 10 ml amp, 50 ml minijet & defined. not 100 ml infusion bottle defined.
WATER FOR INJECTIONError! Buffered Dialysis Solution Bookmark not defined. 2 ml, 5 ml, 10 ml & 20 ml amps. Prism0cal
nPbR = Indicates a drug excluded from HRG tariff price 61 BHRUT NHS Trust Drug Formulary, Updated March 2021
Phosphate Solution for haemodialysis/ 9.5.1.1 CALCIUM (Ca2+) haemofiltration SUPPLEMENTS
Calcium gluconateError! Bookmark not PHOXILIUM 1.2 mmol/l defined. 10 % (2.2 mmol Ca2+/ 10ml) injection Ready-to-use sterile solution for regional citrate anticoagulation Calcium chlorideError! Bookmark not Prismocitrate 10/2 solution defined. 5 mmol/ 10 ml injection, Note: Liaise with the ITU pharmacist if 10 % minijet for Resus. there are any queries on the above Calcium carbonateError! Bookmark not haemofiltration fluidsError! Bookmark defined. (Adcal ®Error! Bookmark not defined. not defined.) 1.5 g chewable tablets, 9.3 INTRAVENOUS NUTRITION 600 mg or 15 mmol Ca2+/ tablet There is a multi-disciplinary nutrition team Notes: Adult Patients admitted with other available to advise on any aspect of brands of calcium (including those with 2+ nutritional care. For information or help 12.6 mmol Ca / tablet), should be bleep the Nutrition Sister/Team or a converted to Adcal. The DTC has Dietitian. approved for pharmacists to change the prescription A Total Parenteral NutritionError! Bookmark not defined. compounding Calcium carbonateError! Bookmark not service is available from the Pharmacy defined. (Cacit ®Error! Bookmark Manufacturing unit. TPN solution not defined.) formulae are based on Kabiven ® range 1.25 g effervescent tablets, 2+ of products. 500 mg or 12.6 mmol Ca / tablet (Paediatric patients) Each TPN solution must be prescribed on a TPNError! Bookmark not defined. Notes: If patients are on Cacit ® tubes, prescription sheet. as part of Didronel PMO ®Error! For advice telephone the Pharmacy Bookmark not defined., they should use Production unit on Ext. 3029 (QH) or their own supply. If this is impossible, 8272 (KGH). Adult TPN is never an then a Cacit tube may be supplied. emergency & need not be initiated Ensure the in-patient chart states ‘as part outside normal hours of Didronel PMO ®’, but on discharge ensure the TTA states patient has OWN supply. If they are on last Cacit tube & do 9.4 ORAL NUTRITION not have another box for discharge, a Notes: For advice & information on the supply of Didronel PMO may be made products available, please consult a Calcium-Sandoz ®Error! Bookmark not dietitian defined. 2.7 mmol (108.3 mg) Ca2+/ 5 ml syrup 9.5 MINERALS (Paediatrics only) Notes: When using the following Cinacalcet Error! Bookmark not defined. supplements, it is essential to monitor 30 mg & 60 mg tablets plasma concentrations of calcium, (Approved for Renal physicians only in phosphate, potassium & other dialysis patients for the treatment of electrolytes nPbR = Indicates a drug excluded from HRG tariff price 62 BHRUT NHS Trust Drug Formulary, Updated March 2021 secondary hyperparathyroidism 9.5.2.2 PHOSPHATE (PO43-) associated with chronic renal failure) BINDING AGENTS
9.5.2.2 HYPERCALCAEMIA Calcium carbonateError! Bookmark not (See section 6.6.2 for preparations) defined. (Adcal ®Error! Bookmark not defined.) 2+ 9.5.1.3 MAGNESIUM (Mg ) 1.5 g chewable tablets, 2+ Magnesium aspartate anhydrate 6.5g 600 mg or 15 mmol Ca / tablet 2+ sachet containing 10mmol of Mg Calcium carbonateError! Bookmark not (Magnaspartate®) defined. (Cacit ®Error! Bookmark not defined.) Magnesium sulphateError! Bookmark 1.25 g effervescent tablets, not defined. 500 mg or 12.6 mmol Ca2+/ tablet 50 % (2 mmol Mg2+/ ml) injection 2 ml & 10 ml amps. 9.5.4 ZINC (Zn2+) SUPPLEMENTS Pre-filled syringes for Resus. Zinc sulphate (Zincomed ®) Magnesium glycerophosphateError! 220 mg (50 mg Zn 2+/ capsule) Bookmark not defined. 4mmol tablet (Unlicensed, named patient only) 9.6 VITAMINS Magnesium oxideError! Bookmark not 9.6.2 VITAMIN B GROUP defined. ThiamineError! Bookmark not defined. 4 mmol (160 mg) capsule (Vitamin B1) (Unlicensed, named patient only) 50 mg & 100 mg tablets Note: Absorption of magnesium is poor Vitamins B & CError! Bookmark not when given orally defined. (Pabrinex ®Error! Bookmark not defined.) 9.5.2.1 PHOSPHATE (PO43-) High potency IV and IM injections SUPPLEMENTS Notes: The CSM warns of potentially PhosphateError! Bookmark not defined.- serious allergic adverse reactions, which Sandoz ®Error! Bookmark not may occur during, or shortly after, defined. 3- administration of Intravenous injection of 16.1 mmol (500 mg) PO4 effervescent Vitamins B & C (Pabrinex ®), See B.N.F tablet PyridoxineError! Bookmark not defined. PhosphatesError! Bookmark not defined. (Vitamin B6) polyfusor 3- 10mg, 20 mg & 50 mg tablets, 50 mmol PO4 / 500 ml infusion 50 mg/ ml injection Addiphos ®Error! Bookmark not defined. 40 mmol PO43- / 20ml solution VITAMIN B COMPLEX PREPARATIONS
Refer to Guidelines for correcting Vitamin B compound strong tablet Hypophosphataemia prior to the introduction of large volumes of feed (IV) Notes: The term Vitamin B complex is a generic one, which embraces various Notes: 20 ml solution of addiphos brand & generic compound formulations contains 30 mmol potassium. This is of Vitamin B treated as a Controlled Drug & kept in designated areas. See Trust Potassium policy 9.6.3 VITAMIN C nPbR = Indicates a drug excluded from HRG tariff price 63 BHRUT NHS Trust Drug Formulary, Updated March 2021
Ascorbic acidError! Bookmark not 9.6.6 VITAMIN K defined. Menadiol sodium phosphateError! 100 mg, 200 mg & 500 mg tablets Bookmark not defined. 1g soluble tablets 10 mg tablet (Water-soluble) 9.6.4 VITAMIN D PhytomenadioneError! Bookmark not Calcium (2.4 mmol) & defined. (Vitamin KError! Bookmark ergocalciferolError! Bookmark not not defined.1) (See under Konakion brands below) defined.Error! Bookmark not defined. (Vitamin D2, Calciferol) (400 units) Phytomenadione tablets Konakion ®Error! Bookmark not defined. ErgocalciferolError! Bookmark not 10 mg tablet (unlicensed) defined. 3000 units/ ml solution (Unlicensed product) Konakion MM ® 10 mg/ ml injection AlfacalcidolError! Bookmark not defined. (Slow IV or IV infusion in (1α-Hydroxycholecalciferol) glucose 5 % only) NOT FOR IM injection (One-Alpha ®Error! Bookmark not Konakion MM Paediatric ®Error! defined.) Bookmark not defined. 0.25 & 1 micrograms capsules 2 mg/ 0.2 ml injection CalcitriolError! Bookmark not defined. (May be administered by mouth, IM or (1,25-Dihydroxycholecalciferol) IV injection) 0.25 micrograms capsule Notes: When Vitamin K is required, Calcium 600 mg or 15.1 mmol & prescribe by brand name to avoid ColecalciferolError! Bookmark not confusion. defined. (Vitamin D3) For prevention of Vitamin K deficiency in 10 micrograms (400 units) tablet malabsorption states, such as biliary obstruction or hepatic disease, the water- Colecalciferol Capsule 20 soluble Vitamin K preparation, menadiol, micrograms/800 units must be used. IM injections are generally inappropriate Colecalciferol tablet 20 micrograms/800 in patients with bleeding disorders units 9.6.7 Multivitamin preparations High dose oral vitamin D 50,000 units tablets (Unlicensed) MultivitaminError! Bookmark not defined. tablet & capsule Adcal-D3 ® and Adcal-D3 Dissolve Abidec ®Error! Bookmark not defined. (Adcal-D3 soluble for those with drops swallowing difficulties) Forceval ®Error! Bookmark not defined. capsule 9.6.5 VITAMIN E (Dietitian recommendation only) Alpha tocopheryl acetateError! KetoviteError! Bookmark not defined. Bookmark not defined.Error! tablet & liquid Bookmark not defined. (Vitamin EError! Bookmark not defined.) 9.8 METABOLIC DISORDERS 500 mg/ 5 ml suspension nPbR = Indicates a drug excluded from HRG tariff price 64 BHRUT NHS Trust Drug Formulary, Updated March 2021
9.8.1 WILSON’S DISEASE
PenicillamineError! Bookmark not defined. 125 mg & 250 mg tablets
Notes: Patients who are penicillin- allergic, may react rarely to penicillamine
Other metabolic disorders.
Biotin 5mg tablet and 5mg/ml injection
nPbR = Indicates a drug excluded from HRG tariff price 65 BHRUT NHS Trust Drug Formulary, Updated March 2021
10 MUSCULOSKELETAL & JOINT DISEASE
10.1 DRUGS USED IN Indometacin (IndomethacinError! RHEUMATIC DISEASES & GOUT Bookmark not defined.)Error! Bookmark not defined. 10.1.1 NON-STEROIDAL ANTI- 25 mg & 50 mg capsules, INFLAMMATORY DRUGS 75 mg m/r capsule, 100 mg suppositories IbuprofenError! Bookmark not defined. 200 mg & 400 mg tablets, Ketoprofen Error! Bookmark not 100 mg/ 5 ml suspension, defined. 800 mg Retard tablets 50 mg & 100 mg capsules, (Rheumatologists only) 100 mg m/r capsule 5 mg/ml injection Mefenamic acidError! Bookmark not (Paediatricians only, for closure of PDA) defined. DiclofenacError! Bookmark not defined. 250 mg capsule, 500 mg tablet, 25mg & 50 mg e/c tablets, (Menorrhagia & Dysmenorrhoea only) 50 mg dispersible tablets, MeloxicamError! Bookmark not defined. 12.5 mg, 25 mg, 50 mg & 7.5 mg & 15 mg tablets 100 mg suppositories, (Rheumatologists only) 100mg SR tablets (Rheumatologists only) NabumetoneError! Bookmark not Note: E/c tablets should not be used defined. PRN, as this has a delayed onset of 500 mg tablet action (Rheumatologists. Arthrotec ®Error! Bookmark not defined. Off label use for pain control by Palliative 50 (Diclofenac 50 mg & Misoprostol Care ) 200 micrograms) tablet NaproxenError! Bookmark not defined. (Rheumatologists, Gastroenterologists & 250 mg tablet & e/c tablet, Geriatricians only) 25 mg/ ml suspension Arthrotec ®Error! Bookmark not defined. 75 (Diclofenac 75 mg & Misoprostol Diclofenac solution for injection 200 micrograms) tablet 75mg/ml (Rheumatologists, Gastroenterologists & (Theatres only) Geriatricians only) PiroxicamError! Bookmark not defined. CelecoxibError! Bookmark not defined. 10 mg & 20 mg capsules 100 mg & 200 mg capsules 20mg (Feldene Melt) tablet (Consultant Rheumatologist, 2nd line within set criteria) ASPIRIN & THE SALICYLATES FlurbiprofenError! Bookmark not AspirinError! Bookmark not defined. defined. 50 mg & 100 mg tablets 300 mg tablet & suppository (Ophthalmologists only) 10.1.2 CORTICOSTEROIDS 10.1.2.1 SYSTEMIC CORTICOSTEROIDS nPbR = Indicates a drug excluded from HRG tariff price 66 BHRUT NHS Trust Drug Formulary, Updated March 2021
(See section 6.3 for preparations) AuranofinError! Bookmark not defined. 3 mg tablet 10.1.2.2 LOCAL CORTICOSTEROID INJECTIONS (Specialist use only) PenicillamineError! Bookmark not defined. 125 mg & 250 mg tablets Hydrocortisone acetateError! Bookmark not defined. Notes: Patients who are hypersensitive (Hydrocortistab ®Error! Bookmark not to penicillin may react rarely to defined.) 25 mg/ ml injection penicillamine Methylprednisolone acetateError! Bookmark not defined. ANTI-MALARIALS (Depo-Medrone ®Error! Bookmark not ChloroquineError! Bookmark not defined.) defined. (see section 5.4.1 for 40 mg/ ml and 80 mg/ 2 ml injection preparations)
Methylprednisolone acetate (Depo- Hydroxychloroquine sulphateError! Medrone ®) with Lidocaine Bookmark not defined. 40 mg (MethylprednisoloneError! 200 mg tablet Bookmark not defined.) & 10 mg DRUGS AFFECTING THE IMMUNE (LidocaineError! Bookmark not RESPONSE defined.)/ ml AzathioprineError! Bookmark not 1ml and 2ml vials defined. Prednisolone acetateError! Bookmark 25 mg & 50 mg tablets not defined. (Deltastab ®Error! CiclosporinError! Bookmark not defined. Bookmark not defined.) (Cyclosporin)Error! Bookmark not 25 mg/ ml injection defined. Triamcinolone acetonideError! (Neoral ®Error! Bookmark not defined.) Bookmark not defined. 25 mg, 50 mg & 100 mg tablets (Adcortyl ®Error! Bookmark not defined.) (Specialist use only) 10mg/ ml injection 1ml and 5ml vials (Intra-articular or Intradermal CyclophosphamideError! Bookmark not administration only) defined. 50 mg tablet (Kenalog ®Error! Bookmark not defined.) (Specialist use only) 40mg/ ml injection LeflunomideError! Bookmark not 1ml vial and 1ml prefilled syringe defined. (Intra-articular or Intramuscular 10 mg, 20 mg & 100 mg tablets administration only) (RA in patients unresponsive to other 10.1.3 DRUGS WHICH SUPPRESS DMARDs, Consultant Rheumatologists THE RHEUMATIC DISEASE PROCESS only) Sodium AurothiomalateError! MethotrexateError! Bookmark not Bookmark not defined.Error! Bookmark defined. not defined. (GoldError! Bookmark not 2.5 mg tablets (Specialist use only) defined.) injection (Contact the Production unit for 10 mg, 20 mg & 50 mg in 0.5 ml injection advice) (Consultant Rheumatologists only) Notes: Methotrexate for Rheumatoid Arthritis is a ONCE WEEKLY DOSE only. nPbR = Indicates a drug excluded from HRG tariff price 67 BHRUT NHS Trust Drug Formulary, Updated March 2021
Refer to Methotrexate policy (Refer to a Senior Principal Pharmacist)
SULFASALAZINE (SULPHASALAZINE) nPbR Ustekinumab (Stelara) SulfasalazineError! Bookmark not 90mg/ml sol (Refer to a Senior Principal Pharmacist) defined. (SulphasalazineError! Bookmark not defined.) PHOSPHODIESTERASE TYPE-4 500 mg e/c tablet, INHIBITORS 250 mg/ 5 ml suspension nPbR Apremilast 10mg, 20mg and CYTOKINE INHIBITORS 30mg tablets nPbR AdalimumabError! Bookmark not PROTEIN KINASE INHIBITORS defined. (Consultant Rheumatologists only) See NPbR Baricitinib (Olumiant®) 2mg and below. 4mg tablets Biosimilars: 1st line choice Hyrimoz® JANUS KINASE (JAK) INHIBITORS 2nd line choice Amgevita® NPbR Tofacitinib (Xeljanz®) 5mg, 10mg tablets nPbR Certolizumab Pegol 200mg/ml solution for injection pre-filled syringes 10.1.4 GOUT & CYTOTOXIC- nPbR EtanerceptError! Bookmark not INDUCED HYPERURICAEMIA defined. 25 mg injection Enbrel® ACUTE ATTACKS OF GOUT nPbR Etanercept BiosimilarsError! High dose NSAIDs: Bookmark not defined. 25 mg injection AspirinError! Bookmark not defined. is not indicated in gout Benepali® ColchicineError! Bookmark not defined. Notes: Adalimumab is an alternative for 500 micrograms tablet etanercept failures or if patient cannot self-inject. Usual starting dose frequency Notes: Maximum total dose of colchicine is every two weeks for treatment of gout is 6 mg nPbR Golimumab 50mg & 100mg solution for injection pre-filled synringes EtoricoxibError! Bookmark not defined. nPbR InfliximabError! Bookmark not 60 mg, 90mg & 120 mg tablets defined. 100 mg IV infusion (Consultant Rheumatologists only for ( Refer to a Senior Principal Pharmacist) acute gouty arthritis and pseudo gout)
LONG-TERM CONTROL OF GOUT nPbR Secukinumab 150mg/ml solution for st injection pre-filled pens/syringes 1 Choice : AllopurinolError! Bookmark not defined. (Refer to a Senior Principal Pharmacist) 100 mg & 300 mg tablets 2nd Choice: Febuxostat 80mg and nPbR TocilizumabError! Bookmark not 120mg tablets defined. 80, 200 and 400mg IV infusion
nPbR = Indicates a drug excluded from HRG tariff price 68 BHRUT NHS Trust Drug Formulary, Updated March 2021
Benzbromarone 100mg e.c tablets NOCTURNAL LEG CRAMPS (Consultant Rheumatologists use only) Quinine sulphateError! Bookmark not Unlicensed defined. 200 mg & 300 mg tablet
HYPERURICAEMIA ASSOCIATED 10.3 DRUGS FOR THE RELIEF WITH CYTOTOXIC DRUGS OF SOFT-TISSUE INFLAMMATION nPbR Rasburicase (Fasturtec®) 10.3.1 ENZYMES 1.5mg and 7.5mg vial for intravenous Hyaluronidase 1500 units Error! infusion. Store in the refrigerator. Bookmark not defined.injection
10.2 DRUGS USED IN 10.3.2 RUBEFACIENTS & OTHER NEUROMUSCULAR DISORDERS TOPICAL ANTIRHEUMATICS Movelat ®Error! Bookmark not defined. 10.2.1 DRUGS WHICH ENHANCE cream & gel NEUROMUSCULAR TRANSMISSION Balmosa ®Error! Bookmark not defined. ANTICHOLINESTERASES cream NeostigmineError! Bookmark not PR Freeze Spray ®Error! Bookmark not defined. 2.5 mg/ ml injection defined. EdrophoniumError! Bookmark not Kaolin PoulticeError! Bookmark not defined. 10 mg/ ml injection defined. 100g, 200g Pyridostigmine 60 mgError! Bookmark not defined. tablet TOPICAL NSAIDS Notes: In line with local policy. 10.2.2 SKELETAL MUSCLE Restricted to patients with local soft RELAXANTS tissue injury or single arthritic joints, in BaclofenError! Bookmark not defined. whom oral NSAIDs are not appropriate & 10 mg tablet, 5 mg/ 5 ml liquid, paracetamol-based drugs are ineffective 50 micrograms/ ml intrathecal injection Ibuprofen 5% gel (Injection: Dr. Ather only.) KetoprofenError! Bookmark not defined. Tablets are also for pain management in 2.5 % gel severe chronic fatigue syndrome grade 4, unlicensed use (Prof. Findley only)
DantroleneError! Bookmark not defined. 25 mg & 100 mg capsules DiazepamError! Bookmark not defined. (See section 4.1.2 for formulations) TizanidineError! Bookmark not defined. 2 mg & 4 mg tablets (Consultant Neurologists & Rehabilitation Medicine Consultant only. Last line after baclofen and diazepam) nPbR = Indicates a drug excluded from HRG tariff price 69 BHRUT NHS Trust Drug Formulary, Updated March 2021
11 EYE
Neomycin sulphateError! Bookmark not 11.3 ANTI-INFECTIVE EYE defined. 0.5 % eye drops, PREPARATIONS eye ointment 11.3.1 ANTIBACTERIALS OfloxacinError! Bookmark not defined. 0.3% eye drops and TTA pack Azithromycin (Azyter®) (Ophthalmologists only) 15mg/g eye drops Notes: Ofloxacin is licensed for external Cefuroxime sodium (Aprokam) Ocular infections, e.g. Conjunctivitis & 50mg powder for solution for injection keratoconjunctivitis, not corneal ulcers vials Polymyxin B sulphateError! Bookmark ChloramphenicolError! Bookmark not not defined. (Polyfax ®Error! defined. Bookmark not defined.) 0.5% eye drops and TTA pack Polymixin B sulphate 10,000units, 1% eye ointment and TTA pack bacitracin zinc 500 units/ gram 0.5% Minims® eye ointment CiprofloxacinError! Bookmark not defined. 0.3% eye drops (Ophthalmologists) 11.3.3 ANTIVIRALS AciclovirError! Bookmark not defined. Notes: Ciprofloxacin licensed for corneal 3% eye ointment and TTA pack ulcers & superficial bacterial infections. Notes: Apply five times daily & continue
for at least three days after complete Ciprofloxacin 3mgml & Dexametasone healing 1mg/ml ear drops
Levofloxacin 5mg/ml Preservative free Ganciclovir 0.15% eye gel eye drops PREPARATIONS FOR THE TREATMENT OF KERATITIS Notes: Licensed for aotitis media in patients with Polyhexamethylene biguanide (PHMB) tympanostomy tubes & acute otitis 0.02% eye drops externa Natamycin 5% Eye drops
Fusidic acidError! Bookmark not defined. 1% m/r eye drops and TTA pack 11.4 CORTICOSTEROIDS & (Fucithalmic ®Error! Bookmark not OTHER ANTI defined.) INFLAMMATORY (Ophthalmologists only) PREPARATIONS GentamicinError! Bookmark not defined. 11.4.1 CORTICOSTEROIDS 0.3% ear/eye drops & Minims ® BetamethasoneError! Bookmark not nPbR = Indicates a drug excluded from HRG tariff price 70 BHRUT NHS Trust Drug Formulary, Updated March 2021
defined. (Betnesol ®Error! Bookmark Hydrocortisone 3.35mg/ml eye drops, not defined.) solution in single-dose container 0.1% ear/ eye/ nose drops (Softacort®) 0.1% eye ointment Betamethasone 0.1% with INTRAVITREAL CORTICOSTEROIDS neomycinError! Bookmark not defined. 0.5% (Vista-Methasone N ®Error! Ozurdex®Error! Bookmark not defined. Bookmark not defined.) ear/ eye/nose Dexamethasone intravitreal implant drop 700micrograms (Ophthalmologists only) (Maxidex ®Error! Bookmark not defined.) DexamethasoneError! Bookmark not 11.4.2 OTHER ANTI-INFLAMMATORY defined. 0.1% & PREPARATIONS Hypromellose 0.5% eye drops and TTA (Otrivine-Antistin ®Error! Bookmark not pack defined.) & Minims Antazoline sulphateError! Bookmark not (Maxitrol ®)Error! Bookmark not defined. defined. 0.5% & XylometazolineError! Dexamethasone 0.1%, neomycin 0.35% Bookmark not defined. 0.05% eye & polymyxin B sulphate 6000 units/ml eye drops and TTA pack drops & eye ointment (Sofradex ®Error! Bookmark not LodoxamideError! Bookmark not defined.) Dexamethasone 0.05%, defined. 0.1% eye drops (Ophthalmologists only) framycetin 0.5% & gramicidin 0.005% ear/ eye drops and TTA pack Sodium cromoglicateError! Bookmark FluorometholoneError! Bookmark not not defined.Error! Bookmark not defined. defined. (FML ®Error! Bookmark not 2% eye drops defined.) NedocromilError! Bookmark not defined. Fluorometholone 0.1%, polyvinyl alcohol 2% eye drops (Liquifilm®) 1.4% eye drops) Ketotifen 0.25mg/ml preservative free Prednisolone sodium phosphateError! eye drops Bookmark not defined. (Predsol ®Error! Bookmark not defined.) 11.5 MYDRIATICS & 0.5% ear/eye drops & Minims® CYCLOPLEGICS Prednisolone acetateError! Bookmark Atropine sulphateError! Bookmark not not defined. (Pred Forte ®Error! defined. 0.5% eye drops Bookmark not defined.) 1% eye drops, ointment & Minims® 1% eye drops CyclopentolateError! Bookmark not (Predsol N ®Error! Bookmark not defined. defined.) PrednisoloneError! 0.5% and 1% eye drops Bookmark not defined. 0.5% & 0.5% and 1% Minims® neomycin 0.5% ear/eye drops HomatropineError! Bookmark not RimexoloneError! Bookmark not defined. defined. 1% & 2% eye drops 1% eye drops TropicamideError! Bookmark not (Ophthalmologists only) defined. 0.5% & 1% eye drops & Minims®
SYMPATHOMIMETICS nPbR = Indicates a drug excluded from HRG tariff price 71 BHRUT NHS Trust Drug Formulary, Updated March 2021
PhenylephrineError! Bookmark not (AcetazolamideError! Bookmark not defined. defined.) 250 mg tablet & 2.5% and 10% Minims® SR capsule *(Ophthalmologists only) Phenylephrine hydrochloride 5.4mg & rd Tropicamide 280 micrograms 3 LINE EYE DROPS (Mydriasert® ophthalmic insert) Travatan®Error! Bookmark not defined. (Travaprost 40micrograms/ml) 2.5ml eye drops 11.6 DRUGS FOR THE Azopt® (Brinzolamide) 10mg/ml eye TREATMENT OF GLAUCOMA drops st 1 LINE EYE DROPS Azarga® (Brinzolamide 10mg, timolol a. * Lumigan Error! Bookmark not 5mg/ml) defined. ® (Bimatoprost 100 & 300 BETA-BLOCKERS micrograms/ml) b. * Ganfort (Bimatoprost 300 micrograms/ml & Timolol 5mg/ml) BetaxololError! Bookmark not defined. c. * Timolol LA ®Error! Bookmark not (Betoptic ®Error! Bookmark not defined. (TimololError! Bookmark defined.) not defined.) 0.25%, 0.5% 0.25% m/r & 0.5% eye drops LevobunololError! Bookmark not nd defined. (Betagan ®Error! Bookmark 2 LINE EYE DROPS not defined.) and a. * Xalatan ®Error! Bookmark not 0.5% polyvinyl alcohol (Liquifilm®) eye defined. (LatanoprostError! drops and Minims Bookmark not defined.) Note: Use dorzolamide drops 0.005%Error! Bookmark not (Trusopt ®) where beta blockers are defined. contra-indicated or not effective alone b *Xalacom ®Error! Bookmark not defined. (Latanoprost & Timolol c. * Cosopt ®Error! Bookmark not 11.7 LOCAL ANAESTHETICS defined. OxybuprocaineError! Bookmark not (Dorzolamide 2 % & Timolol 0.5%) defined. 0.4 % Minims ® d. * Trusopt ®Error! Bookmark not defined. (DorzolamideError! Proxymetacaine 0.5 % Minims ®Error! Bookmark not defined.) 2% Bookmark not defined. e. * Alphagan ®Error! Bookmark not ProxymetacaineError! Bookmark not defined. (BrimonidineError! defined. 0.5 % & Bookmark not defined.) 0.2% FluoresceinError! Bookmark not defined. f. *Combigan ® (Brimonidine 0.2% & 0.25 % Minims ® timolol 0.5%) f. *Pilocarpine ®Error! Bookmark not Tetracaine hydrochlorideError! defined. 1%, 2%, 4% Bookmark not defined. (Amethocaine hydrochlorideError! Bookmark not ORAL TREATMENTS defined.) * Diamox ®Error! Bookmark not defined. 0.5 % & 1 % Minims ® & * Diamox SR ®Error! Bookmark not defined. nPbR = Indicates a drug excluded from HRG tariff price 72 BHRUT NHS Trust Drug Formulary, Updated March 2021
11.8 MISCELLANEOUS 11.8.2 OCULAR DIAGNOSTIC & OPHTHALMIC PREPARATIONS PERI-OPERATIVE PREPARATIONS & PHOTODYNAMIC TREATMENT 11.8.1 TEAR DEFICIENCY, OCULAR OCULAR DIAGNOSTIC LUBRICANTS & ASTRINGENTS PREPARATIONS HypromelloseError! Bookmark not Fluorescein Error! Bookmark not defined. 0.3%, 0.5% eye drops, defined.sodium 0.3% preservative free eye drops (Unlicensed) 1 % & 2 % Minims ® & 1 mg strips (Unlicensed) 2% eye drops OCULAR PERI-OPERATIVE DRUGS
CarbomersError! Bookmark not defined. Acetylcholine chloride (Miochol-E (Viscotears ®Error! Bookmark not ®)Error! Bookmark not defined.Error! defined.) Bookmark not defined. 0.2 % liquid gel & Preservative-free dose 1% Intra-ocular irrigation units (Ophthalmologists only) (Ophthalmologists only) Apraclonidine (Iopidine ®)Error! Bookmark not defined. Carmellose Error! Bookmark not defined. 0.5 % & 1 % ophthalmic solution Sodium (Ophthalmologists only) 1% eye drops in dose units (CelluviscError! Bookmark not Diclofenac sodiumError! Bookmark not defined.®) defined. 0.1 % unit dose eye drops (single use) 0.5% eye drops + glycerol (Optive®) (Ophthalmologists only) Hydroxypropyl guar, Polyethylene Ketorolac 0.5 % eyeError! Bookmark glycol 400 propylene glycol 0.3% not defined. drops (Systane®)Error! Bookmark not defined. (Ophthalmologists only) 10ml bottle and 0.8ml minims Nepafenac 1mg/ml eye drops Liquid paraffinError! Bookmark not (for reducing the risk of postoperative defined. (Lacri-Lube ®Error! Bookmark macular oedema in diabetic patients not defined.) undergoing cataract surgery) eye ointment OPTHALMIC VISCOELASTIC DEVICE Polyvinyl alcohol Healon® Sodium Hyaluronate 1% (Liquifilm®) eye drops Healon 5® Sodium Hyaluronate 2.3% Healon GV® Sodium Hyaluronate 1.4% Potassium ascorbateError! Bookmark (Ophthalmologists only) not defined. 10% eye drops (unlicensed) RUM drug Sodium chlorideError! Bookmark not SUBFOVEAL CHOROIDAL defined. NEOVASCULARISATION 0.9 % eye drops (Minims ®) Ranibizumab (Lucentis) Balanced salt solutionError! Bookmark Aflibercept (Eylea®) not defined. Bevascizumab (Avastin) (unlicensed)
nPbR = Indicates a drug excluded from HRG tariff price 73 BHRUT NHS Trust Drug Formulary, Updated March 2021
( Cons. Ophthamologist only for diagnosis and Vascular Neurosurgeons treatment of age-related macular for Intracranial Aneurysms) degeneration in patients that meet NICE criteria)
Indocyanine Green (ICG) injection (Approved for Consultant Ophthalmologist’s use for choroid related
12 EAR, NOSE & OROPHARYNX
12.1 DRUGS ACTING ON THE HydrocortisoneError! Bookmark not EAR defined. 1% & gentamicinError! Bookmark not defined. 0.3% 12.1.1 OTITIS EXTERNA ear drops (Gentisone HC ®Error! ANTI-INFLAMMATORY PREPARATION Bookmark not defined.) BetamethasoneError! Bookmark not Hydrocortisone 1%, neomycin 3400 defined. (Betnesol ®Error! Bookmark units & polymyxin B 10000 units/ ml not defined.) (Otosporin ®Error! Bookmark not 0.1% ear/ eye/ nose drops defined.) PrednisoloneError! Bookmark not Prednisolone 0.5 % & neomycin 0.5 % defined. (Predsol ®) (Predsol-N ®Error! Bookmark not 0.5% ear/ eye drops defined.)
ANTI-INFLAMMATORY PREPARATION ANTI-INFECTIVE PREPARATIONS WITH ANTIBACTERIAL Chloramphenicol 5% BetamethasoneError! Bookmark not Ear drops defined. 0.1% & neomycinError! Bookmark not defined. Clioquinol (Locorten-Vioform ®) 0.5% ear/ eye/ nose drops Ear drops (Vista-Methasone N ®Error! Bookmark Clotrimazole (Canesten) not defined.) Error! Bookmark not defined.1% solution Dexamethasone 0.05%, framycetin 0.5% & gramicidin 0.005% ear/ eye drops (Sofradex ®)Error! Bookmark not (Sofradex ®Error! Bookmark not defined. defined.) Dexamethasone 0.05%, framycetin 0.5% & gramicidin 0.005% ear/ eye drops Dexamethasone 0.1% & neomycin 3250 units/ml ear spray (Otomize ®Error! Gentamicin (Genticin) 0.3% eye/ ear Bookmark not defined.) drops FlumetasoneError! Bookmark not defined. 0.02% & clioquinolError! Bookmark not defined. 1% ear drops (Locorten-Vioform ®Error! Bookmark not defined.) nPbR = Indicates a drug excluded from HRG tariff price 74 BHRUT NHS Trust Drug Formulary, Updated March 2021
(Gentisone HC ®Error! Bookmark not Triamcinolone acetonideError! defined.) GentamicinError! Bookmark Bookmark not defined. not defined. 0.3 % & (Nasacort ®)Error! Bookmark not HydrocortisoneError! Bookmark not defined. 55 mcg/ dose nasal spray defined. 1 % ear drops Dexamethasone isonicotinateError! NeomycinError! Bookmark not defined. Bookmark not defined. (Predsol-N ®) ear/ eye drops, (Dexa-Rhinaspray Duo ®Error! (Otosporin ®) ear drops, Bookmark not defined.) (Vista-Methasone N ®) ear/ eye/ nose 20mcg/ dose nasal spray drops, Sodium cromoglicateError! Bookmark
(Otomize ®) ear spray not defined.Error! Bookmark not defined. 12.1.2 OTITIS MEDIA (Rynacrom ®Error! Bookmark not defined.) 4 % nasal spray Boric acidError! Bookmark not defined. powder – not from pharmacy Second Line (for chronic discharge from ear Once existing formulary treatments and secondary to chronic otitis media, self -care options have been exhausted. ENT Surgeons only, unlicensed) 12.1.3 REMOVAL OF EAR WAX Fluticasone with azelastine 50microgram/137microgram per Sodium bicarbonateError! Bookmark actuation not defined. BPC ear drops Dymista® Cerumol ®Error! Bookmark not defined. ear drops- unsuitable for patients with nut allergy DRUGS USED FOR NASAL CRUSTING (2nd line after sodium bicarbonate ear drops have failed. Contains arachis Glucose in Glycerol 25% nasal drops (peanut) oil) (unlicensed) (ENT consultants use only) Note: 2nd line treatment of nasal crusting 12.2 DRUGS ACTING ON THE in patients with vasculitis after saline NOSE douche in combination with steroid inhalers 12.2.1 DRUGS USED IN NASAL ALLERGY BeclometasoneError! Bookmark not defined. dipropionate 12.2.2 TOPICAL NASAL 50 mcg/ dose nasal spray DECONGESTANTS (First line) Ephedrine hydrochlorideError! BetamethasoneError! Bookmark not Bookmark not defined. defined. (Betnesol ®) 0.5% & 1% drops 0.1 % ear/ eye/ nose drops Fluticasone furoate (Avamys®) Sodium chlorideError! Bookmark not 27.5mcg/dose/dose nasal spray defined. 0.9 % drops MometasoneError! Bookmark not XylometazolineError! Bookmark not defined. (Nasonex ®Error! Bookmark defined. not defined.) 0.05% paediatric drops, 50 mcg/ dose nasal spray 0.1% drops & spray (adult)
nPbR = Indicates a drug excluded from HRG tariff price 75 BHRUT NHS Trust Drug Formulary, Updated March 2021
Ipratropium bromideError! Bookmark HydrocortisoneError! Bookmark not not defined. defined. (Rinatec ®Error! Bookmark not 2.5 mg pellets defined.) 0.03% nasal spray SALICYLATESError! Bookmark not NASAL STAPHYLOCOCCI defined. Mupirocin Error! Bookmark not defined. Choline SalicylateError! Bookmark not 2% (Bactroban Nasal ®Error! Bookmark defined. Dental Gel, BP not defined.) ointment (Bonjela ®Error! Bookmark not As per MRSA Policy (May 2007) defined.) Not for children <16 years If MRSA positive:
st 12.3.2 OROPHARYNGEAL 1 Choice: Apply to both nostrils three ANTI-INFECTIVE DRUGS times daily for one week and re-swab 48 hours post-treatment. AmphotericinError! Bookmark not Negative screen result- stop treatment defined. (Fungilin ®) Positive screen result- continues 10 mg lozenges th treatment until 7 day then rescreen 48 MiconazoleError! Bookmark not defined. hours post-treatment. (Daktarin ®Error! Bookmark not defined.) Alternative: Polyfax (Polymixin Sulphate 20mg/g oral gel and Bacitracin) if Mupiricin (Bactroban) resistant. Nystatin 100,000 units/mlError! Bookmark not EPISTAXIS defined. oral suspension ChlorhexidineError! Bookmark not 12.3.4 MOUTHWASHES, GARGLES defined. 0.1% & Neomycin 0.5% & DENTIFRICES cream (Naseptin ®Error! Bookmark not defined.)- Contains Arachis (Peanut Oil.) Chlorhexidine gluconateError! Unsuitable for nut allergy sufferers Bookmark not defined. 0.2% mouthwash (From general stores, Bismuth Subnitrate & IodoformError! not pharmacy) Bookmark not defined. Paste 1% dental gel Hydrogen Peroxide Solution 3% (10 12.3 DRUGS ACTING ON THE vol) OROPHARYNX Mouthwash effervescent tabletsError! Bookmark not defined. 12.3.1 DRUGS FOR ORAL ULCERATION & INFLAMMATION 12.3.5 TREATMENT OF DRY MOUTH Benzydamine hydrochloride Artificial salivaError! Bookmark not 0.15%Error! Bookmark not defined. defined. oral spray Difflam ®Error! Bookmark not defined. oral rinse Difflam ® spray (Paediatrics only) Treatment of bony cavities post Carmellose (Orabase ®) paste removal of odontegenic keratocyst. CORTICOSTEROIDS
nPbR = Indicates a drug excluded from HRG tariff price 76 BHRUT NHS Trust Drug Formulary, Updated March 2021
Carnoy’s solution (unlicensed product) (For use by Oral and Maxillofacial Consultants only)
nPbR = Indicates a drug excluded from HRG tariff price 77 BHRUT NHS Trust Drug Formulary, Updated March 2021
13 SKIN (Dermatologists only)
Dermol 500® Lotion (Occupational 13.2 EMOLLIENT & BARRIER Health use only) PREPARATIONS Note: please check availability of pack Oilatum ®Error! Bookmark not defined. sizes with the pharmacy emollient Aquamax™ cream Baby bathError! Bookmark not defined. Cetraben ®Error! Bookmark not defined. 13.2.2 BARRIER PREPARATIONS cream Zinc & castor oil ointment, BPError! Bookmark not defined. Hydromol ®Error! Bookmark not defined. Metanium ®Error! Bookmark not defined. ointment ointment Emulsifying ointment, BPError! Sudocrem ®Error! Bookmark not Bookmark not defined. defined. cream
Liquid & white soft paraffin 50%Error! Conotrane ®Error! Bookmark not Bookmark not defined. defined. cream Unguentum M ®Error! Bookmark not Drapolene ®Error! Bookmark not defined. cream defined. cream White soft paraffinError! Bookmark not Sprilon ®Error! Bookmark not defined. spray defined. Yellow soft paraffin Error! Bookmark not 13.3 TOPICAL LOCAL defined. ANAESTHETICS & Note: Aqueous cream and emulsifying ANTIPRURITICS ointment are useful as soap substitutes CalamineError! Bookmark not defined. lotion (from general stores) 13.2.1.1 EMOLLIENT BATH ADDITIVES CrotamitonError! Bookmark not defined. 10% cream (Eurax ®Error! Bookmark Balneum Plus ®Error! Bookmark not not defined.) defined. bath treatment DoxepinError! Bookmark not defined. 5% Emulsiderm ®Error! Bookmark not cream (Dermatologists only) defined. Dermol 200 ®Error! Bookmark not defined. shower emollient (Dermatologists only) Dermol 600 ®Error! Bookmark not defined. bath emollient nPbR = Indicates a drug excluded from HRG tariff price 78 BHRUT NHS Trust Drug Formulary, Updated March 2021
13.4 TOPICAL units/g, benzalkonium chloride 0.2% & CORTICOSTEROIDS dimethicone ‘350’ 10%) cream
Note: Relative potencies of topical Vioform-Hydrocortisone ®Error! corticosteroids: Bookmark not defined. Mild: hydrocortisone 0.1-2.5% (hydrocortisone 1% & clioquinolError! Moderate: clobetasone butyrate 0.05% Bookmark not defined. 3%) Potent: betamethasone valerate 0.1% cream & ointment & hydrocortisone butyrate Notes: Corticosteroids should be applied Very potent:clobetasol propionate 0.05% once or twice daily & should be used for not more than 5-7 days, unless advised. Hydrocortisone 0.5%, 1% & 2.5% cream The more potent the preparation the & ointment more sparingly it should be applied
HYDROCORTISONE COMPOUND HYDROCORTISONE BUTYRATE 0.1 % PREPARATIONS Locoid ®Error! Bookmark not defined. Alphaderm ®Error! Bookmark not lipocream, ointment & scalp application defined. (hydrocortisone 1% & ureaError! (Dermatologists only) Bookmark not defined. 10%) cream Locoid C ®Error! Bookmark not defined. Canesten HC ®Error! Bookmark not (with chlorquinaldol 3 %) cream & defined. (hydrocortisone 1% & ointment (Dermatologists only) clotrimazoleError! Bookmark not defined. 1%) cream ALCLOMETASONE DIPROPRIONATEError! Bookmark not Daktacort ®Error! Bookmark not defined. defined. (hydrocortisone 1% & miconazoleError! Modrasone ®Error! Bookmark not Bookmark not defined. 2%) cream-store defined. (alclometasone diproprionate in fridge 0.05 %) cream & ointment ointment-store at room temperature (Dermatologists only)
Eurax-Hydrocortisone ®Error! BETAMETHASONE ESTERSError! Bookmark not defined. (hydrocortisone Bookmark not defined. 0.25% & crotamitonError! Bookmark not Error! Bookmark not defined. defined. Betnovate ® 10%) cream (betamethasone valerate 0.1%) cream, ointment & scalp application Fucidin H ®Error! Bookmark not defined. Error! Bookmark not defined. (hydrocortisone 1% & fusidic acidError! Betnovate-RD ® Bookmark not defined. 2%) cream & (betamethasone valerate 0.025%) cream ointment & ointment Nystaform-HC ®Error! Bookmark not Betnovate-C ®Error! Bookmark not defined. (hydrocortisone 0.5%, defined. (betamethasone valerate 0.1% & nystatinError! Bookmark not defined. clioquinol 3%) cream & ointment 100,000 units/g & chlorhexidine Diprosalic ®Error! Bookmark not defined. hydrochloride 1%) cream & ointment (betamethasone dipropionate 0.05 %) Timodine ®Error! Bookmark not defined. with salicylic acid 3 % ointment, (hydrocortisone 0.5%, nystatin 100,000 with salicylic acid 2 % scalp application
nPbR = Indicates a drug excluded from HRG tariff price 79 BHRUT NHS Trust Drug Formulary, Updated March 2021
Lotriderm ® (betamethasoneError! Bookmark not defined. dipropionate 0.05% & clotrimazoleError! Bookmark not defined. 1%)Error! Bookmark not defined. cream (Dermatologists only) FuciBET ®Error! Bookmark not defined. (betamethasone valerate 0.1% & fusidic acidError! Bookmark not defined. 2%) cream (Dermatologists only)
CLOBETASONE PROPIONATEError! Bookmark not defined. 0.05% Dermovate ®Error! Bookmark not defined. cream, ointment & scalp application
nPbR = Indicates a drug excluded from HRG tariff price 80 BHRUT NHS Trust Drug Formulary, Updated March 2021
Etrivex® shampoo (for psoriasis) nystatin 100,000 units/g) ointment & cream CLOBETASONE BUTYRATE 0.05%Error! Bookmark not defined. Notes: The use of topical antimicrobial agents is to be discouraged as this can Error! Bookmark not defined. Eumovate ® cream & cause sensitisation & contribute towards ointment bacterial resistance Trimovate ®Error! Bookmark not defined. (with oxytetracyclineError! Bookmark not 13.5 PREPARATIONS FOR defined. 3% & ECZEMA AND PSORIASIS nystatinError! Bookmark not defined. 100,000 units/g) cream 13.5.1 PREPARATIONS FOR ECZEMA (Dermatologists only) Glycerin of IchthammolError! Bookmark not defined. liquid Note: Trimovate ® stains clothing (Unlicensed) Oral retinoid for eczema FLUDROXYCORTIDEError! Bookmark not defined. Alitretinoin (Toctino®) 10mg & 30mg (FLURANDRENOLONEError! Bookmark capsules not defined.) (Dermatologists only as per NICE, it is recommended for the treatment of severe Haelan ®Error! Bookmark not defined. tape chronic hand eczema that has not (Dermatologists only) responded to potent topical corticosteroids TA 177) FLUOCINOLONE ACETONIDEError! Bookmark not defined. 13.5.2 PREPARATIONS FOR Synalar ®Error! Bookmark not defined. 0.025% PSORIASIS cream & gel 5-MethoxypsoralenError! Bookmark not defined. FLUOCINONIDE 0.05%Error! Bookmark 20 mg tablet- not in the BNF not defined. (Dermatologists only) Error! Bookmark not defined. Metosyn ® cream & 8-MethoxypsoralenError! Bookmark not ointment defined. 10 mg tablet, 0.15 % emulsion (paint) MOMETASONE FUROATEError! & 1.2 % bath lotion- not in the BNF Bookmark not defined. Notes: Methoxypsoralen preparations Elocon ®Error! Bookmark not defined. are unlicensed preparations, which are in 0.1% cream & ointment the exempt list of the Trust Unlicensed (Dermatologists only) Medicines Policy. They are treated as named patient items. (For use with PUVA TRIAMCINOLONE ACETONIDEError! by Dermatologists only) Bookmark not defined. 0.1% Aureocort ® (with chlortetracycline 3%) Calcitriol 3micrograms/g ointment Ointment Silkis® (Dermatologists only) (Dermatologists only) Tri-Adcortyl ®Error! Bookmark not defined. (with Dovobet® ointment and gel gramicidin 0.025%, neomycin 0.25% & (betamethasone as dipropionate 0.05% and Calcipotriol 50micrograms/g) nPbR = Indicates a drug excluded from HRG tariff price 81 BHRUT NHS Trust Drug Formulary, Updated March 2021
MethotrexateError! Bookmark not Enstilar® cutaneous foam defined. 2.5 mg tablets (betamethasone dipropionate (Dermatologists only) 500micrograms/g and Calcipotriol Warning: Methotrexate is given once 50micrograms/g) weekly for this indication. Follow Trust Methotrexate policy TAZAROTENE Tacrolimus (Protopic)Error! Bookmark not Tazarotene 0.05%Error! Bookmark not defined. defined. gel 0.03% & 0.1% ointment (Dermatologists only, 2nd line) (Dermatologists only)
COAL TARError! Bookmark not defined. nPbR Adalimumab Sebco ®Error! Bookmark not defined. nPbR Brodalumab scalp ointment (Compound Coconut ointment) nPbR DupilumabError! Bookmark not defined. Polytar Emollient ®Error! Bookmark not defined. bath additive nPbR EtanerceptError! Bookmark not defined. Notes: Polytar Emollient® contains arachis (peanut) oil nPbR Guselkumab Alphosyl HC ®Error! Bookmark not nPbR InfliximabError! Bookmark not defined. defined. (with hydrocortisone 0.5%) cream nPbR Ixekizumab ( Rheumatology & Dermatology use) DITHRANOL nPbR Risankizumab 75mg solution for DithranolError! Bookmark not defined. injection in pre-filled syringe (Dithrocream ®Error! Bookmark not defined.) nPbR Tildrakizumab 0.1%, 0.25% & 2% cream nPbR Ustekinumab 90mg/ml injection (Dermatologists only) 0.5ml (45mg) vial ACITRETIN 13.6 ACNE & ROSACEA AcitretinError! Bookmark not defined. (Neotigason ®)Error! Bookmark not Azelaic acidError! Bookmark not defined. defined. 25% cream 10 mg & 25 mg capsules (Consultant Dermatologist only for (Hospital only medicine, Dermatologists melasma. Unlicensed indication) only) Benzoyl peroxideError! Bookmark not defined. 13.5.3 DRUGS AFFECTING THE 2.5% & 5% gel IMMUNE RESPONSE Clindamycin phosphateError! Ciclosporin (Cyclosporin) Error! Bookmark not defined. (Dalacin T Bookmark not defined.Error! Bookmark ®Error! Bookmark not defined.) not defined.(Neoral ®Error! Bookmark 1% lotion not defined.) 25 mg, 50 mg & 100 mg capsules Clindamycin 1% & benzoyl peroxide (Dermatologists only) 5% (Duac ®) topical Gel nPbR = Indicates a drug excluded from HRG tariff price 82 BHRUT NHS Trust Drug Formulary, Updated March 2021
Zineryt ®Error! Bookmark not defined. Notes: Formaldehyde foot wash is (erythromycin 40 mg/ml & zinc acetate 12 extemporaneously prepared in pharmacy mg/ml)Error! Bookmark not defined. topical lotion SILVER NITRATEError! Bookmark not defined. 75% sticks AdapalineError! Bookmark not defined. 0.1% gel (Differin®) ANOGENITAL WARTS Adapaline 0.1% & benzyl peroxide ImiquimodError! Bookmark not defined. 2.5% gel (Epiduo®) (Aldara ®Error! Bookmark not defined.) (Dermatologists only) 5% cream TretinoinError! Bookmark not defined. (GUM clinic for genital & perianal warts (Retin-A ®Error! Bookmark not when all other drug treatments have defined.) failed. Dermatologists for last line 0.025% cream & 0.01% gel treatment for anogenital warts only) (Dermatologists only) PODOPHYLLUMError! Bookmark not defined. 13.6.2 ORAL PREPARATIONS FOR ACNE Condyline ®Error! Bookmark not defined. 0.5% solution CyproteroneError! Bookmark not TTA pack available defined. 2 mg & ethinyloestradiol 35 (GUM only) micrograms tablets (Dianette ®Error! Bookmark not defined.) Warticon ®Error! Bookmark not defined. (Dermatologists only) 0.15% cream TTA pack available IsotretinoinError! Bookmark not (GUM only) defined. 5 mg & 20 mg capsules (Roaccutane ®Error! Bookmark not Warticon ®Error! Bookmark not defined. defined.) (Hospital only medicine) 0.5% solution for men (with mirror for (Dermatologists only) women- Warticon Fem®) (GUM only) 13.7 PREPARATIONS FOR WARTS & CALLUSES 13.8 SUNSCREENS & CAMOUFLAGERS SALICYLIC ACIDError! Bookmark not 13.8.1 SUNSCREEN PREPARATIONS defined. RoC Total SunblockError! Bookmark not Cuplex ®Error! Bookmark not defined. defined.Error! Bookmark not defined. ® 11% gel Occlusal ®Error! Bookmark not defined. Ingenol mebutate (Picato®)150 26% application micrograms/g & 500 micrograms/g gel
Duofilm ®Error! Bookmark not defined. CAMOUFLAGERS 16.7% paint Verrugon ®Error! Bookmark not defined. HydroquinoneError! Bookmark not 50% ointment defined. 2 % and 5% cream (GUM clinic only) Unlicensed product and short expiry date (Dermatologists only) FORMALDEHYDEError! Bookmark not defined. 13.9 SHAMPOOS & OTHER nPbR = Indicates a drug excluded from HRG tariff price 83 BHRUT NHS Trust Drug Formulary, Updated March 2021
PREPARATIONS FOR SCALP Silver sulfadiazine (Error! Bookmark not defined.Flamazine ®Error! Selsun ®Error! Bookmark not defined. Bookmark not defined.) shampoo 1 % cream Capasal ®Error! Bookmark not defined. shampoo 13.10.2 ANTIFUNGAL PREPARATIONS Polytar ®Error! Bookmark not defined. liquid ClotrimazoleError! Bookmark not defined. 1 % Notes: Polytar ® contains arachis cream, dusting powder & solution (peanut) oil KetoconazoleError! Bookmark not Nizoral ® (KetoconazoleError! defined. 2 % cream Bookmark not defined.) Error! Bookmark (Dermatologists only) not defined. shampoo MiconazoleError! Bookmark not defined. (Daktarin ®Error! Bookmark not (Dermatologists only) defined.) 2 % cream
13.10 ANTI-INFECTIVE SKIN TerbinafineError! Bookmark not defined. PREPARATIONS 1% cream (Dermatologists only) 13.10.1 ANTIBACTERIAL PREPARATIONS 13.10.3 ANTIVIRAL PREPARATIONS Fusidic acid (Fucidin ®) AciclovirError! Bookmark not defined. 5 2%Error! Bookmark not defined. cream % cream & ointment Notes: Aciclovir cream should be used (Dermatologists or Microbiologists only) five times a day at the first sign of any MetronidazoleError! Bookmark not symptoms for 5 to 10 days. It is not very defined. effective once vesicles have appeared. (Metrogel ®Error! Bookmark not Confirm whether systemic treatment is defined.) 0.75% gel more appropriate (For acne rosacea, Dermatologists only) 13.10.4 PARASITICIDAL (Metrotop ®)Error! Bookmark not PREPARATIONS defined. 0.8% gel (Malodorous tumours & skin ulcers) For treatment of scabies- refer to infection control policy MupirocinError! Bookmark not defined.
(Bactroban ®) 2%Error! Bookmark not 1st Choice: Malathion (Derbac-M defined. ointment ®Error! Bookmark not defined.) Notes: Bactroban ointment contains 0.5 %Error! Bookmark not defined. macrogol. Manufacturers advise caution liquid (in aqueous base) in renal impairment, may sting (First line) Polymyxin B sulphateError! Bookmark Alternative: PermethrinError! Bookmark not defined. (Polyfax ®)Error! Bookmark not defined. (Lyclear ®)Error! Bookmark not defined. ointment (Microbiologists not defined. only) 1 % cream rinse & 5 % dermal cream (Dermatologists & Microbiologists only)
nPbR = Indicates a drug excluded from HRG tariff price 84 BHRUT NHS Trust Drug Formulary, Updated March 2021
Alternative: IvermectinError! Bookmark Octenisan ® not defined. 3 mg tablet (Unlicensed medicine, named patient. 13.11.6 ASTRINGENTS, OXIDISERS & Dermatologists & Microbiologists for DYES resistant scabies only) Hydrogen peroxideError! Bookmark not Notes: There is a Regional policy for the defined. treatment and prevention of head lice. 3 % w/ v (10 vols) solution Compliance with manufacturers’ Hydrogen peroxide 1% creamError! instructions for these preparations is Bookmark not defined. especially important Potassium permanganateError! 13.10.5 PREPARATIONS FOR MINOR Bookmark not defined. CUTS & ABRASIONS 400 mg solution tablets ProflavineError! Bookmark not defined. cream, BPC (Dermatology Use Only)
Magnesium sulphate paste, BPError! Bookmark not defined. 13.11.7 DESLOUGHING AGENTS Flexible Collodion, BP- Sterile LarvaeError! Bookmark not Contraindications: allergy to colophony in defined. (maggotsError! Bookmark not elastic adhesive plaster and tapeError! defined.) therapy Bookmark not defined.
13.11 SKIN CLEANSERS & 13.12 ANTIPERSPIRANTS ANTISEPTICS Error! Bookmark not defined.Aluminium 13.11.1 ALCOHOLS & SALINE chloride hexahydrateError! Bookmark Sodium Chloride 0.9 % Error! Bookmark not defined. not defined. (Driclor ®) 20 % application 25 ml sterile sachets 13.12 WOUND MANAGEMENT 13.11.2 CHLORHEXIDINEError! PRODUCTS Bookmark not defined. SALTS Notes: In line with local policy. Hydrex ®Error! Bookmark not defined. Products are sourced differently across the sites. Other dressings may be 13.11.4 IODINE COMPOUNDSError! available from clinical supplies (Havering) Bookmark not defined. or central stores (KGH) Videne ®Error! Bookmark not defined. 13.13.1 ALGINATE DRESSINGS
13.11.5 PHENOLICS KaltostatError! Bookmark not defined. ® (TRICLOSANError! Bookmark dressing not defined.) Kaltostat ® wound packing Aquasept ®Error! Bookmark not defined. Sorbsan ®Error! Bookmark not defined. 2 % skin cleanser Sorbsan ® ribbon Sorbsan ® packing
13.13.2 FOAM DRESSINGS Allevyn ® nPbR = Indicates a drug excluded from HRG tariff price 85 BHRUT NHS Trust Drug Formulary, Updated March 2021 adhesive, cavity, sacral, thin & heel Palacos R with gentamicin ®Error! Lyofoam ®Error! Bookmark not defined. Bookmark not defined. dressing Collatamp G ®Error! Bookmark not Tielle ®Error! Bookmark not defined. defined. dressing Geliperm ®Error! Bookmark not defined. wet dressing Cavi-Care ®Error! Bookmark not defined. Haemostatic Adsorbant Gauze 13.13.3 HYDROGEL DRESSINGS Horsley’s Bone waxError! Bookmark not defined. Granugel ®Error! Bookmark not defined. (Unlicensed) Intrasite ® gelError! Bookmark not defined. 13.14 TOPICAL CIRCULATORY 13.13.4 HYDROCOLLOID DRESSING PREPARATIONS Granuflex ®Error! Bookmark not defined. Hirudoid ®Error! Bookmark not defined. bordered dressing & paste 0.3 % cream
13.13.6 LOW ADHERENCE
DRESSING & WOUND CONTACT
MATERIALS Povidone-iodineError! Bookmark not defined. fabric dressing
13.13.7 ODOUR ADSORBENT DRESSING DenidorError! Bookmark not defined. ® (CharcoalError! Bookmark not defined.) dressing 13.13.9 MEDICATED BANDAGES Zipzoc ® Error! Bookmark not defined.tubular bandage (Dermatologists only)
13.13.10 OTHER WOUND MANAGEMENT PRODUCTS Opsite ®Error! Bookmark not defined. plastic spray Bactigras ®Error! Bookmark not defined. (chlorhexidineError! Bookmark not defined. acetate tulle)
13.13.11 THEATRE PRODUCTS
Palacos LV with gentamicin ®Error! Bookmark not defined. nPbR = Indicates a drug excluded from HRG tariff price 86 BHRUT NHS Trust Drug Formulary, Updated March 2021
14 IMMUNOLOGICAL PRODUCTS & VACCINES
Hepatitis AError! Bookmark not defined. 14.4 VACCINES & ANTISERA vaccine (Havrix Monodose® for Occ. Health use only) Notes: For up to date vaccine information, please refer to Hepatitis A and B vaccine www.dh.gov.uk/ “Green Book” (search for immunisation) Hepatitis BError! Bookmark not defined. BCG (Bacillus Calmette-GuerinError! vaccine (Engerix B®) Bookmark not defined.)Error! Bookmark not defined. vaccine (for chest clilnic and Hepatitis B paediatric vaccine occ. Health use only) InfluenzaError! Bookmark not defined. Notes: It is essential to use the supplied vaccine diluent to reconstitute Diphtheria, tetanus, pertussis Measles, Mumps & Rubella (MMRError! (acellular) and inactivated polioError! Bookmark not defined.)Error! Bookmark Bookmark not defined. (DtaP/IPV) not defined. vaccine (Infanrix IPV ®) Vaccine (LIVE) MMRvaxPro® Priorix®
Meningitis C conjugateError! Bookmark not defined. vaccine Meningitec®, Diphtheria, tetanus, pertussis Menjugate Kit®, NeisVac C® (acellular) and inactivated polioError! Bookmark not defined. (dtaP/IPV) Meningococcal groups A CWYError! vaccine (Repevax ®) Bookmark not defined. vaccine
Pneumococcal polysaccharideError!
Bookmark not defined. vaccine Notes: These are interchangeable in the (Pneumovax II ® vaccineError! childhood immunisation scheme. Use for Bookmark not defined.) children aged 3 to 10. Notes: Pneumovax II ® is for children Diphtheria, tetanus and inactivated over 2 years of age polio Pneumococcal polysaccharide Haemophilus influenzae type B conjugated vaccine (Prevenar ®Error! (HibError! Bookmark not defined.)Error! Bookmark not defined.) Bookmark not defined. vaccine Notes: Prevenar ® is for children under 2 years of age Haemophilus influenzae type b conjugate vaccine and Meningoccocal Group C Conjugate vaccine TyphoidError! Bookmark not defined. (Menitorix®) vaccine
Varicella-zosterError! Bookmark not defined. vaccine (Varilix®▼ , Varivax®▼ nPbR = Indicates a drug excluded from HRG tariff price 87 BHRUT NHS Trust Drug Formulary, Updated March 2021
Anti-tetanus ImmunoglobulinError! Bookmark not defined. Hepatitis B immunoglobulin
(available from Public Health Laboratory)
Anti-hepatitis ImmunoglobulinError! Bookmark not defined. (Available from Public Health Laboratory)
Anti-D Immunoglobulin 500 & 1500 units injection
DIAGNOSTIC TESTS Tuberculin PPD 2TUError! Bookmark not defined. injection There is no licensed preparation currently available. Contact Chest Clinic for advice. For chest clinic and occ. Health use only
Notes: * used for Mantoux test
14.5 IMMUNOGLOBULINS nPbR Normal ImmunoglobulinError! Bookmark not defined.Error! Bookmark not defined. For intravenous use (Please refer to pharmacy for brands & strengths stocked)
Notes: Please refer to BHRUT Demand management Plan for Immunoglobulin Use (link) Immunoglobulin request form and Immunoglobulin Follow Up form available on the intranet (link) Use must be approved by Panel before supply from Pharmacy.
Specific Immunoglobulins Consult Microbiologist to arrange if indicated.
Tetanus Immunoglobulin (Antitetanus Immunoglobulin Injection)
nPbR = Indicates a drug excluded from HRG tariff price 88 BHRUT NHS Trust Drug Formulary, Updated March 2021
15 ANAESTHESIA
15.1 GENERAL ANAESTHESIA 15.1.4 SEDATIVE & ANALGESIC 15.1.1 INTRAVENOUS ANAESTHETICS PERI-OPERATIVE DRUGS Thiopental sodiumError! Bookmark not 15.1.4.1 ANXIOLYTICS & defined. 500 mg injection NEUROLEPTICS EtomidateError! Bookmark not defined. DiazepamError! Bookmark not defined. 20 mg/10 ml injection (See section 4.1.2 for preparations) KetamineError! Bookmark not defined. LorazepamError! Bookmark not defined. injection 4 mg/ml injection 10 mg/ml, 100 mg/ml, 50 mg/ml MidazolamError! Bookmark not defined. PropofolError! Bookmark not defined. 10 mg/2ml & 10 mg/5ml injection injection 10mg/ml, 500 mg/50ml, 200mg/20ml ClonidineError! Bookmark not defined. Propofol 1% injection (Diprifusor 150 micrograms/ml injection ®Error! Bookmark not defined. (Anaesthetists for inadequate sedation in TCI System) ITU, with high dose midazolam and (for endarterectomies anaesthetised by opioids, unlicensed use) Dr. Igielman & Dr. Khalil only) 15.1.4.2 NON-OPIOID ANALGESIC 15.1.2 INHALATIONAL DiclofenacError! Bookmark not defined. ANAESTHETICS 12.5 mg, 25 mg, 50 mg & 100 mg IsofluraneError! Bookmark not suppositories, defined. 75 mg/ 2ml injection (Maximum treatment for 2 days) SevofluraneError! Bookmark not defined. ®) EnfluraneError! Bookmark not defined. Methoxyflurane (Penthrox Inhaler) 999mg per 1g HalothaneError! Bookmark not defined. For use in ED only. 15.1.3 ANTIMUSCARINIC DRUGS Atropine sulphateError! Bookmark not 15.1.4.3 OPIOID ANALGESICS defined. AlfentanilError! Bookmark not defined. 600 micrograms/ml injection (CD) Glycopyrronium bromideError! 1 mg/ 2 ml, 5 mg/ ml & Bookmark not defined. 500 micrograms/ ml injection 200 micrograms/ml & FentanylError! Bookmark not defined. 600 micrograms/3ml injection (CD) Hyoscine hydrobromideError! 100 micrograms/ 2 ml & Bookmark not defined. 500 micrograms/ 10 ml injection 400 micrograms/ ml injection RemifentanilError! Bookmark not defined. (CD) 1 mg & 2 mg injection nPbR = Indicates a drug excluded from HRG tariff price 89 BHRUT NHS Trust Drug Formulary, Updated March 2021
(For Neurosurgery in accordance with NaloxoneError! Bookmark not defined. protocol) 400 micrograms/ml injection, Morphine sulphateError! Bookmark not 40 micrograms/ 2ml injection defined. (CD) (Check availability of neonatal, 2 mg/ ml injection (50 ml vials for PCA) 40 micrograms/ 2ml injection with the Pharmacy) 15.1.5 MUSCLE RELAXANTS NON-DEPOLARISING MUSCLE 15.1.8 DRUGS FOR MALIGNANT RELAXANTS HYPERTHERMIA AtracuriumError! Bookmark not defined. DantroleneError! Bookmark not defined. 25mg/ 2.5 ml & 50mg/ 5 ml injection 20 mg injection PancuroniumError! Bookmark not defined. 4mg/ 2 ml injection 15.2 LOCAL ANAESTHESIA RocuroniumError! Bookmark not Cocaine hydrochlorideError! Bookmark defined. 50mg/ 5 ml injection not defined. 10 % solution (Unlicensed) (Theatres only, Critical areas and A&E) Lidocaine Error! Bookmark not VecuroniumError! Bookmark not defined.(LignocaineError! Bookmark not defined. 10 mg injection defined.) 0.5 % injection (20 ml) DEPOLARISING MUSCLE RELAXANTS 1 % injection (2 ml, 5 ml, 10 ml & 20 ml) 2 % injection (2 ml, 5 ml & 20 ml) SuxamethoniumError! Bookmark not 4% topical solution, defined. 50 mg/ml injection 4% jet spray (for anaesthesia of vocal cords for patients undergoing ENT/ 15.1.6 DRUGS FOR REVERSAL OF Maxillo-facial surgery), NEUROMUSCULAR BLOCKADE 10% spray, NeostigmineError! Bookmark not 2% gel defined. 2.5 mg/ml injection 700mg (5%) medicated plaster (Palliative care use only) Robinul-Neostigmine ®Error! Bookmark not defined. 1 ml injection (Please check sizes stocked on hospital (Neostigmine 2.5 mg & glycopyrronium site) 500 micrograms)
Lidocaine 4%, Adrenaline 0.1%, Other drugs for reversal of Tetracaine 0.5% (LAT) gel (unlicensed) neuromuscular blockade
Sugammadex 100mg/ml injection
15.1.7 ANTAGONISTS FOR CENTRAL & RESPIRATORY DEPRESSION DoxapramError! Bookmark not defined. 2mg/ ml infusion, 100 mg/5ml injection, Notes: Only the injection is licensed for post-operative respiratory depression FlumazenilError! Bookmark not defined. 500 micrograms/5ml injection nPbR = Indicates a drug excluded from HRG tariff price 90 BHRUT NHS Trust Drug Formulary, Updated March 2021
LidocaineError! Bookmark not defined. 1 2.5mg/ml, 5mg/ml & % (10 mg/ ml) with adrenaline 1 in 7.5mg/ml (10ml amp) 200,000Error! Bookmark not defined. (5 micrograms/ ml) (Xylocaine ®)Error! Epidural infusion: Bookmark not defined. 1.25mg/ml (100ml and 200ml) 20 ml injection Unlicensed formulations: LidocaineError! Bookmark not defined. 2 Levobupivicaine 0.1% with Fentanyl % (20 mg/ ml) with adrenaline 1 in 2mcg in 1 ml (500ml infusion) 200,000Error! Bookmark not defined. Levobupivicaine 0.1% with Fentanyl (5 micrograms/ ml) (Xylocaine ®)Error! 4mcg in 1 ml (500ml infusion) Bookmark not defined. Levobupivicaine 0.1% with Fentanyl 20 ml injection 5mcg in 1 ml (200ml infusion) Lidocaine 5 % with phenylephrine 0.5 % solution Prilocaine 1 % injectionError! Bookmark (ENT only)Error! Bookmark not not defined. defined. PrilocaineError! Bookmark not defined. Lidocaine with prilocaineError! 30mg/ ml with octapressinError! Bookmark not defined. Bookmark not defined. (felypressin) 0.03 (Emla ®)Error! Bookmark not defined. units/ ml injection cream Lidocaine with chlorhexidine MepivacaineError! Bookmark not gluconateError! Bookmark not defined. 3 % injection defined.Error! Bookmark not defined. (Chiropody, Colposcopy unit, and Dr (Instillagel ®Error! Bookmark not Jenine Bignall use ONLY ) defined.) in sterile lubricant TetracaineError! Bookmark not defined. BupivacaineError! Bookmark not (AmethocaineError! Bookmark not defined. defined.) 4 % 0.1 % infusion (100 ml) Ametop ®Error! Bookmark not defined. 0.25 % & 0.5 % injection (10 ml) gel (Marcain ®Error! Bookmark not defined.) Ethyl chloride BPError! Bookmark not 0.25 % & 0.5 % injection defined. spray (Marcain Heavy ®Error! Bookmark not defined.) 0.5 % injection ABLATIVE NERVE BLOCK (Unlicensed products) BupivacaineError! Bookmark not defined.Error! Bookmark not defined. 6 % phenolError! Bookmark not with adrenalineError! Bookmark not defined. in water defined. 5 % phenol in glycerinError! Bookmark BupivacaineError! Bookmark not not defined. defined. 0.125 %Error! Bookmark not 6 % phenol, Niopam 300Error! defined. with Bookmark not defined. 40 %, in sodium fentanylError! Bookmark not defined. 2 chloride 0.9 % micrograms/ ml
(Unlicensed)
Levobupivacaine
Injections: nPbR = Indicates a drug excluded from HRG tariff price 91 BHRUT NHS Trust Drug Formulary, Updated March 2021
nPbR = Indicates a drug excluded from HRG tariff price 92 BHRUT NHS Trust Drug Formulary, Updated March 2021
BARKING, HAVERING & REDBRIDGE HOSPITALS NHS TRUST
POLICY AND GUIDELINES FOR PRESCRIBING FOR SELF, FAMILY,
COLLEAGUES AND FRIENDS
Under normal circumstances, prescribers should not prescribe for themselves or family, but it is recognised that there are occasions when it may be necessary to prescribe for yourself or immediate family in order to remain at work. In which case the following guidance should be followed:
1. EMERGENCY PRESCRIBING FOR SELF AND FAMILY
1.1 GMC Standard (April 1998) Doctors should not treat themselves or their families
It is good practice for doctors and their families to be registered with a general practitioner outside the family, who takes responsibility for their health care.
This gives the doctor and family members ready access to objective advice and avoid the conflicts of interest that can arise when doctors treat themselves or those close to them.
From time to time, sad cases occur where a doctor’s loss of objectivity in treating a family member results in misconduct; or where self-medication – for example, with Controlled Drugs – leads to drug misuse.
It is hard to lay down an absolute rule: it makes sense for a doctor to treat minor ailments, or take emergency action where necessary.
But doctors should avoid treating themselves or close family members wherever possible. This is a matter of common sense as well as good medical practice.
1.2 Prescribing should only be for immediate family, i.e. self, spouse, children, directly from the hospital pharmacy and not on FP10 (HP) forms.
1.3 Prescribing should normally be for acute illness only, not regular medication e.g. infections, acute pain, headache, hayfever etc. In emergency other medication e.g. insulin, inhalers may be prescribed, but this should not be a regular occurrence.
1.4 Prescribing should be short-term i.e. a maximum of 7 days treatment.
1.5 Prescribing should follow Barking, Havering & Redbridge Trust Formulary guidelines i.e. non-Formulary medicines will not be ordered for personal use by medical staff.
1.6 Controlled drugs may not be prescribed.
1.7 Drugs with potential for misuse may not be prescribed e.g. hypnotics, sedatives. nPbR = Indicates a drug excluded from HRG tariff price 93 BHRUT NHS Trust Drug Formulary, Updated March 2021
1.8 In an emergency, prescribers ideally should be seen in A/E and obtain a prescription with an A/E record number.
1.9 Charges: Normal prescription charges per item with no exemption.
2. PRESCRIBING FOR COLLEAGUES AND STAFF
2.1 Prescribing for colleagues and staff without a consultation and examination is not deemed good practice and is not in accordance with GMC advice on Good Clinical Practice. Such prescribing should not take place except as part of a regular consultation and follow-up.
3. PRESCRIBING FOR FRIENDS
3.1 Such prescribing is not allowed unless that person is a bona-fida patient seen at a normal consultation.
4. FP10(HP) FORMS
4.1 The costs of all items dispensed are charged to the Trust.
4.2 FP10(HP) forms are returned to the Trust and audited.
4.3 If doctors are found to have prescribed for themselves for an un-registered person outside these guidelines, they may be charged the cost of the prescription.
4.4 Consistent abuse of these guidelines will be a disciplinary matter.
5. NON-EMERGENCY PRESCRIBING
Non-emergency prescribing for regular medication for self and family is not permitted within the Trust.
Approved by MOG: Via Monthly Medicines Optimisation Group Meetings Review Date: Ongoing review
nPbR = Indicates a drug excluded from HRG tariff price 94 BHRUT NHS Trust Drug Formulary, Updated March 2021
16 Unlicensed & Specialists Use Drugs Approved by MOG
Diphenylcyclopropenone/diphencypro Ruxolitinib (INC424) ne (DPCP/DCP) “Incyte®” 5mg tablets (For alopecia areata after topical and lesional steroids) Dr. Wade’s use only nd (Approved for 2 line compassionate treatment in patients with high risk Idarucizumab 2.5g/50ml solution for myelofibrosis) injection/infusion (Praxbind®) Requested by Dr. K Saja (Cons. Haematologist) 5-aminolevulinic acid 30mg/ml powder for oeral solution (5-ALA) (Gliolan®) Intrathecal Fluorescein Sodium
(For diagnosis of CSF leak by Dr. P Chatrath Consultant ENT surgeon)
Sativex “Cannabis Extract” Oromucosal Spray (For muscle spasticity, to be funded by Neurosciences directorate) (For Dr. A Chaudhuri’s use only)
ThalidomideError! Bookmark not defined. tablets (Haematologists only for multiple myeloma and myelofibrosis with cytopenias +/- splenomegaly)
Peginterferon alfa-2a (Pegasys®) (Consultant Haematology for patients with polycythaemia vera or essential thrombocythaemia)
nPbR Bevacizumab (Avastin®) (For the treatment of neovascular glaucoma and non-NICE indicated choroidal neovascular membranes in non-wet age related macular oedema or non-myopia for patients under the age of 50 years) Ophthalmologists Only
nPbR = Indicates a drug excluded from HRG tariff price 95