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Adult Joint Formulary Abbreviated List

Adult Joint Formulary Abbreviated List

Adult Joint Formulary Abbreviated list

April 2020

Contents

Chapter Page

Introduction 1

1 Gastro-intestinal system 2

2 Cardiovascular system 4

3 Respiratory system 7

4 Central nervous system 9

5 Infections 13

6 Endocrine system 15

7 Obstetrics, gynaecology and urinary-tract disorders 19

8 Malignant disease and immunosuppression 21

9 Nutrition and blood 23

10 Musculoskeletal and joint diseases 25

11 Eyes 27

12 Ear, nose and oropharynx 30

13 Skin 32

14 Vaccines and immunoglobulins Not included

15 Anaesthesia 35 Introduction

This NHS Ayrshire & Arran Abbreviated Joint Formulary List includes the names of those medicines recommended within the Joint Formulary - formulations are not specified. The medicines included may have prescribing restrictions, which will be indicated using the following abbreviations:

1 First choice within class 2 Second choice within class 3 Third choice within class H Hospital use C Consultant initiation S Specialist initiation

The full version of the NHS Ayrshire & Arran Joint Formulary should be referred to for further information and local prescribing notes or guidelines that are available. The most current advice on individual medicines from the Scottish Medicines Consortium (www.scottishmedicines.org.uk) should also be applied when prescribing. The full version is maintained and available electronically on the NHS Ayrshire & Arran intranet (AthenA). The current British National Formulary or individual Summary of Product Characteristics (www.medicines.org.uk) should be referred to for dosing advice, adverse effects etc.

Information on the following NHS Ayrshire & Arran policies can be located on both the local internet (www.nhsaaa.net) and intranet (AthenA) sites

 Managed Entry of New Medicines Process  Individual Patient Treatment Requests  Formulary Management, including prescribing non-formulary medicines  Prescribing of unlicensed and “off-label use” of medicines

Updates The abbreviated Joint Formulary list will be updated monthly and published on the NHS Ayrshire & Arran internet site. In addition the full version of the NHS Ayrshire & Arran Joint Formulary will be updated and is available electronically on the intranet

For further information contact: [email protected] Tel: 01292 614506

1 First choice within class 2 Second choice within class 3 Third choice within class H Hospital use C Consultant initiation S Specialist initiation NHS Ayrshire & Arran Abbreviated Adult Joint Formulary List April 2020 Page 1 of 35 7.3.4 1: GASTRO-INTESTINAL SYSTEM C telotristat ethyl tablets 1.5 Chronic bowel disorders 1.1.1 Antacids and simeticone aluminium hydroxide (renal only) 10.5.1 Aminosalicylates co-magaldrox 195/220 (Mucogel®) Oral preparations Infacol® (paediatrics only) Prescribe mesalazine preparations by brand name 1.1.2 Alginates 1 C Salofalk® modified release tablets, 1 Peptac® sachets Gaviscon® Infant 2 C Octasa® modified release tablets 2 C Pentasa® sustained release tablets, 1.2 Antispasmodics and other drugs sachets altering gut motility Other aminosalicylates preparations (a) antispasmodics C mesalazine hyoscine butylbromide tablets, C mesalazine foam mebeverine tablets C sulphasalazine peppermint oil capsules

(b) motility stimulants 1.5.2 1 tablets (excludes 25mg strength), 5mg/5ml oral , soluble tablets 1.3 Anti-secretory drugs and mucosal 1 prednisolone foam enema protectants 1 prednisolone retention enema H2- antagonists: S mr capsules, capsules, 1 granules S budesonide prolonged release tablets Proton pump inhibitors: (Cortiment® brand for ulcerative colitis as per lansoprazole SMC restrictions) omeprazole (infusion H) S budesonide rectal foam esomeprazole tablets (refer to full formulary acetate foam enema for prescribing restrictions)

Chelates and complexes 1.6 Laxatives S sucralfate (a) bulk forming laxatives ispaghula husk Drugs for the treatment of peptic ulcers (b) stimulant laxatives (a) ulcers associated with Helicobacter 1 senna pylori bisacodyl

First choice (for 1 week only): co-danthramer (terminally ill patients) lansoprazole or omeprazole docusate sodium + glycerol suppositories

+ clarithromycin (c) faecal softeners Patients allergic to penicillin receive arachis oil enema metronidazole instead of amoxicillin in the above regimen (d) osmotic laxatives lactulose 1.4 Acute diarrhoea Laxido® sachets sodium citrate enema 1 oral rehydration therapy (acute diarrhoea) phosphate enema 1 loperamide capsules codeine phosphate (e) bowel cleansing co-phenotrope 1 Picolax® Fleet Phospho-Soda® 1.4.3 Carcinoid Syndrome Diarrhoea

1 First choice within class 2 Second choice within class 3 Third choice within class H Hospital use C Consultant initiation S Specialist initiation NHS Ayrshire & Arran Abbreviated Adult Joint Formulary List April 2020 Page 2 of 35

Preparations for radiological procedures Refer to local prescribing guideline (ADTC 263) for additional information.

Bowel Imaging Studies Preparation MoviPrep® Standard preparation for CT Colonoscopy Picolax® Standard preparation for Barium Enema Klean-Prep® Standard preparation for MRI Small Bowel. Second line for inpatient Barium Enema if unfit for Picolax®

(f) Peripheral receptor antagonists S methylnaltrexone naloxegol tablets (Moventig®)

1.7 Local preparations for anal and rectal disorders 1 Anusol® Anusol-HC® Scheriproct® ointment, suppositories

1.9 Drugs affecting intestinal secretions 1.9.1 Drugs affecting biliary composition and flow 1 S ursodeoxycholic acid C obeticholic acid tablets (case by case form requires to be completed until protocol available)

1.9.2 Bile acid sequestrants 1 Colestyramine sachets

1.9.4 Pancreatin Creon® Creon® micro (if swallowing problems present) Pancrex V®

1 First choice within class 2 Second choice within class 3 Third choice within class H Hospital use C Consultant initiation S Specialist initiation NHS Ayrshire & Arran Abbreviated Adult Joint Formulary List April 2020 Page 3 of 35 2: CARDIOVASCULAR SYSTEM 2.4 Beta-adrenoceptor blocking drugs Heart failure 2.1.1 Cardiac glycosides 1 tablets 1 tablets 2 S tablets 1 H digoxin injection Hypertension 2.1.2 Phosphodiesterase type 3 inhibitors 1 tablets 1 C H enoximone injection 1 bisoprolol tablets

2.2.1 Thiazide and related diuretics Hypertension in pregnancy – refer to local 1 bendroflumethiazide tablets guidelines 1 indapamide tablets Angina 2.2.2 Loop diuretics 1 atenolol tablets 1 furosemide tablets, injection 1 bisoprolol tablets 2 bumetanide tablets (excludes injection) Post myocardial infarction 2.2.3 Potassium-sparing diuretics and 1 bisoprolol tablets aldosterone antagonists

Anxiety, thyrotoxicosis, essential tremor NYHA class II heart failure and left ventricular systolic dysfunction (LVEF ≤30%) 1 tablets

1 spironolactone tablets Intravenous formulations 2 C eplerenone tablets atenolol injection (as per prescribing H guideline ADTC 129) NYHA class III/IV heart failure H esmolol injection 1 spironolactone tablets H injection

H injection Left ventricular systolic dysfunction accompanied by evidence of heart failure, 2.5.1 Vasodilator antihypertensive drugs both manifesting within 3-14 days of 1 S hydralazine tablets myocardial infarction SH hydralazine injection 1 C eplerenone tablets 2.5.2 Centrally acting anti-hypertensive 2.2.5 Osmotic diuretics drugs mannitol infusion 1 H 1 S tablets

2.3 Anti- arrhythmic drugs 2.5.4 Alpha-adrenoceptor blocking drugs 1 tablets Class 1 anti-arrhythmic (membrane stabilising drugs) 1 S flecainide tablets, injection (H) 2.5.5.1 Angiotensin-converting enzyme 2 S tablets inhibitors 2 SH lidocaine injection 1 lisinopril tablets 1 ramipril capsules, tablets Class II anti-arrhythmics (beta-blockers) 1 bisoprolol tablets Prophylaxis of cardiovascular events or post 2 SH metoprolol injection myocardial infarction with LVF 1 ramipril capsules, tablets Class III anti-arrhythmics 1 S tablets 2.5.5.2 Angiotensin-II receptor antagonists

2 S amiodarone tablets, injection (H) Heart failure or hypertension: 1 losartan tablets Class IV anti-arrhythmics ( channel 1 candesartan tablets blockers S valsartan capsules (post MI only) 1 verapamil tablets, injection (H) Diabetic nephropathy in type 2 diabetes mellitus: Other anti-arrhythmics 1 irbesartan tablets 1 digoxin tablets, injection (H) 1 losartan tablets H adenosine injection

1 First choice within class 2 Second choice within class 3 Third choice within class H Hospital use C Consultant initiation S Specialist initiation NHS Ayrshire & Arran Abbreviated Adult Joint Formulary List April 2020 Page 4 of 35 Neprilysin/ Angiotensin-II receptor 2.7 Sympathomimetics antagonists Sympathomimetics: C sacubitril/ valsartan (Entresto®) – available in line with SIGN 147: Management of 1 H injection chronic heart failure, March 2016 Inotropic sympathomimetics 1 H infusion 1 H infusion 2.6.1 Nitrates 1 glyceryl trinitrate sublingual spray Vasoconstrictor sympathomimetics: (infusion H) 1H injection 1 isosorbide mononitrate tablets, mr 1 H noradrenaline acid tartrate injection tablets Severe orthostatic hypotension 2.6.2 Calcium-channel blockers 1 S tablets (as per SMC advice)

Hypertension 2.8.1 Parenteral anticoagulants 1 amlodipine tablets 1 unfractionated heparin injection Hypertension in pregnancy – refer to local guidelines Prophylaxis of DVT: 1 dalteparin injection Angina – patients not receiving a beta 2 unfractionated heparin - where blocker immediate effect is needed or reversibility is 1 diltiazem mr tablets, mr capsules - appropriate or in patients with CrCl < 30 modified release preparations should be ml/min prescribed by brand name 1 verapamil tablets, mr tablets, mr Unstable angina non ST and ST segment capsules elevation myocardial infarction: 1 2.5mg prefilled syringe Angina – patients receiving a 2 dalteparin injection 1 amlodipine tablets Treatment of Deep Vein Thrombosis and/or Supraventricular arrhythmias Pulmonary Embolism 1 verapamil tablets, injection (H) 1 dalteparin injection 2 unfractionated heparin - where Subarachnoid haemorrhage immediate effect is needed or reversibility is 1 CH nimodipine tablets, infusion appropriate or in patients with CrCl < 30 ml/min Raynaud’s disease 1 nifedipine capsules Other parenteral anticoagulants 1 C H danaparoid injection 2 C H injection 2.6.3 Other anti-anginal drugs C H epoprostenol injection

1 nicorandil tablets

Intolerance or contraindication to beta-blockers and rate limiting calcium channel blockers 1 ivabradine tablets

2.6.4 Peripheral vasodilators Treatment should be reassessed after three months and discontinued if of no benefit. 1naftidrofuryl oxalate capsules

1 First choice within class 2 Second choice within class 3 Third choice within class H Hospital use C Consultant initiation S Specialist initiation NHS Ayrshire & Arran Abbreviated Adult Joint Formulary List April 2020 Page 5 of 35 2.8.2 Oral anticoagulants 2.10.2 Fibrinolytic drugs

Prevention of stroke and systemic embolism in Acute myocardial infarction patients with non-valvular atrial fibrillation 1 H tenecteplase injection Refer to local guidelines on the choice of oral anticoagulants in patients with non-valvular atrial Acute ischaemic stroke fibrillation (ADTC 290) 1 C H alteplase injection 1 edoxaban tablets 1 warfarin tablets Massive pulmonary embolism 1 C H alteplase injection Treatment of Deep Vein Thrombosis and/or Pulmonary Embolism H streptokinase injection Refer to local guidelines on the choice of oral anticoagulants for the treatment of non-pregnant adults with suspected Deep Vein Thrombosis 2.11 Antifibrinolytic drugs and haemostatics and/or Pulmonary Embolism (ADTC 302) or the 1 tranexamic acid tablets, injection (H) ICP for IV Drug User with Suspected DVT (excluding pregnant patients) (ADTC 109) 1 apixaban tablets 2.12 Lipid-regulating drugs 1 warfarin tablets (a) statins 1 simvastatin tablets Prophylaxis of venous thromboembolism in 2 atorvastatin tablets orthopaedics Pravastatin tablets

1 rivaroxaban tablets (b) bile acid sequestrants Use in combination with in Coronary 1 colestyramine sachets Artery Disease C rivaroxaban 2.5mg (Xarelto®) – restricted (c) fibrates to patients with stable coronary artery disease that do 1 fenofibrate tablets not require dual antiplatelet therapy (SMC 2128) d) others 1 C alirocumab injection (case by case form Other indications requires to be completed until protocol available) 1 warfarin tablets 1 C evolocumab 140mg injection (case by case form requires to be completed until protocol 2.8.3 Protamine sulphate available 1 C H protamine sulphate injection

Others 2.13 Local sclerosants 1 C H idarucizumab (Praxbind®) injection/ 1 HS sodium tetradecyl sulphate injection infusion

2.9 Antiplatelet drugs Refer to NHS Ayrshire & Arran anti- guidelines (ADTC 17) – these provide additional information on place in therapy Aspirin dispersible tablets clopidogrel tablets dipyridamole mr capsules – patients after ischaemic stroke or TIA unable to tolerate clopidogrel S ticagrelor tablets

Treatment of high risk unstable coronary syndrome C H tirofiban infusion

1 First choice within class 2 Second choice within class 3 Third choice within class H Hospital use C Consultant initiation S Specialist initiation NHS Ayrshire & Arran Abbreviated Adult Joint Formulary List April 2020 Page 6 of 35 3: RESPIRATORY SYSTEM 3.1.5 Nebuliser diluent 1 sodium chloride nebuliser solution 3.1.1 Adrenoceptor (Sympathomimetics) 3.2 Corticosteroids

(a) short-acting beta2- (a) inhaled corticosteroids (ICS) bronchodilators (SABA) Prescribe these inhalers by brand name. Choice determined by inhaler technique Inhaler preparations 1 (Clenil Modulite®) MDI With the exception of Metered Dose Easyhaler® beclometasone Inhaler (MDI), please prescribe these inhalers by 1 brand name 2 Easyhaler® budesonide

1 salbutamol MDI (b) other corticosteroids 2 Easyhaler® salbutamol 100 micrograms Oral: 3 (Bricanyl®) Turbohaler® 1 prednisolone tablets (excluding 25mg Other formulations tablet strength), 5mg/5ml oral solution, soluble tablets 1 salbutamol nebuliser solution, injection

2 terbutaline nebuliser solution, injection Intravenous injection:

(b) long-acting beta2-agonist bronchodilators 1 hydrocortisone sodium succinate injection (LABA)

Prescribe these inhalers by brand name: (c) combination products (ICS/ LABA 1 Easyhaler® combination inhalers) 2 formoterol MDI (Atimos Modulite®) Asthma (adults) 3.1.2 Antimuscarinic bronchodilators Prescribe these inhalers by brand name. Long acting antimuscarinic (LAMA) inhaler Choice determined by inhaler technique preparations – asthma (adults) 1 beclometasone/ formoterol (Fostair®) 100/6 Prescribe these inhalers by brand name. MDI (including MART regimen), 200/6 MDI 1 tiotropium (Spiriva® Respimat®) 1 / (Relvar® Ellipta®) 92/22, 184/22 strengths Long acting antimuscarinic (LAMA) inhaler preparations – COPD COPD Prescribe these inhalers by brand name. Prescribe these inhalers by brand name. Choice determined by inhaler technique Choice determined by inhaler technique 1 tiotropium (Spiriva® Respimat®) 1 fluticasone/ vilanterol (Relvar® Ellipta®) 1 umeclidinium (Incruse® Ellipta®) 92/22 1 Beclometasone/ formoterol (Fostair®) 100/6 Other formulations MDI 1 ipratropium bromide nebuliser solution – when used long term, this must be administered via d) combination products (ICS/ LABA/LAMA) a mouthpiece COPD Prescribe these inhalers by brand name. 3.1.3 Theophylline Choice determined by inhaler technique (Uniphyllin Continus®) 1 theophylline tablets 1 Beclometasone dipropionate / formoterol 1 H aminophylline injection fumarate dihydrate / glycopyrronium metered

3.1.4 Compound bronchodilator dose inhaler (Trimbow®) – restricted to patients in GOLD Group D, with severe COPD (forced preparations expiratory volume in one second less than 50% none predicted normal)

Combination long acting muscarinic 1 , umeclidinium, antagonists and long acting beta 2 agonist vilanterol (as trifenatate) inhalation (LAMA/ LABA combination) (Trelegy® Ellipta®) – restricted to patients in GOLD Group D, with severe COPD (forced expiratory Prescribe these inhalers by brand name. volume in one second less than 50% predicted Choice determined by inhaler technique normal) 1 umeclidinium / vilanterol (Anoro® Ellipta®) 1 olodaterol/ tiotropium (Spiolto® Respimat®)

1 First choice within class 2 Second choice within class 3 Third choice within class H Hospital use C Consultant initiation S Specialist initiation NHS Ayrshire & Arran Abbreviated Adult Joint Formulary List April 2020 Page 7 of 35 3.3.1 Cromoglicate and related therapy 3.8 Aromatic inhalations none recommended none recommended

3.3.2 receptor antagonists 3.9 Cough preparations 1 montelukast tablets none recommended

3.4.1 3.10 Systemic nasal decongestants Non-sedating antihistamines tablets

1 cetirizine tablets, oral solution 3.11 Antifibrotics 2 loratadine tablets, oral solution C pirfenidone capsules, tablets (as per local guideline) Sedating antihistamines 1 tablets, 2 tablets (Do not prescribe hydroxyzine to people with a prolonged QT interval or risk factors for QT interval prolongation – MHRA warning) 2 tablets, oral solution (alternative in patients where potential QT prolongation with hydroxyzine may be of concern)

3.4.2 Allergen immunotherapy

IgE (immunoglobulin E) mediated asthma C H 1 omalizumab injection (as per local protocol)

Severe refractory eosinophilic asthma C H 1 mepolizumab injection (as per local protocol) C H 2 benralizumab injection (as per local protocol when available)

3.4.3 Allergic emergencies Anaphylaxis adrenaline (includes EpiPen) chlorphenamine injection hydrocortisone injection

Angioedema C C1 esterase inhibitor (Berinert) injection – tertiary centre clinician initiation

3.5.1 Respiratory stimulants S H citrate (Peyona®) oral solution

3.5.2 Pulmonary surfactants C H poractant alfa endotracheopulmonary instillation suspension

3.6 Oxygen oxygen

3.7 Mucolytics 1 acetylcysteine 600 mg effervescent tablets (NACSYS®) (for COPD only – prescribe by brand name C dornase alfa nebuliser solution (for cystic fibrosis only) S mannitol inhalation powder S hypertonic sodium chloride

1 First choice within class 2 Second choice within class 3 Third choice within class H Hospital use C Consultant initiation S Specialist initiation NHS Ayrshire & Arran Abbreviated Adult Joint Formulary List April 2020 Page 8 of 35 4: CENTRAL NERVOUS SYSTEM 4.2.3 Drugs for mania and hypomania 1 C lithium tablets, (Priadel®) 4.1 Hypnotics and anxiolytics 2 C valproic acid (as semisodium 4.1.1 Hypnotics valproate) tablets(Depakote®) 1 no treatment 3 C carbamazepine tablets, liquid 1 3 C tablets, dispersible tablets 2 temazepam  Depakote® should not be used in female Chloral and derivatives children, in female adolescents, in women of Clomethiazole (not for withdrawal) childbearing potential and pregnant women unless alternative treatments are ineffective or 4.1.2 Anxiolytics not tolerated because of its high teratogenic chlordiazepoxide (alcohol withdrawal) potential and risk of developmental disorders diazepam in infants exposed in utero to valproate lorazepam (injection H)  Lamotrigine is indicated for prevention of propranolol depressive episodes in patients with bipolar I disorder who experience predominantly depressive episodes 4.2.1 drugs First generation antipsychotic drugs 4.3 drugs

1 tablets, liquid, injection 4.3.1 Tricyclic and related antidepressant 2 tablets, liquid (except the drugs elderly) C C H acetate injection C (Clopixol Acuphase®) C Second generation antipsychotic drugs 1C tablets, modified release C tablets 2 tablets, orodispersible 4.3.2 Monoamine oxidase inhibitors (MAOIs) tablets, liquid C moclobemide phenelzine 2 C tablets, liquid C

3 C tablets, orodispersible 4.3.3. Selective re-uptake inhibitors tablets (injection C H) (SSRIs) C H tablets, liquid (use in 1 (tablet, dispersible tablet liquid) conjunction with local protocols) C tablets, liquid citalopram (QTc prolongation risk, including (but also with non-psychotropic C tablets drugs). To be used with caution and ECG monitoring advisable where additional Quetiapine first choice where depot injection is psychotropic commenced or cardiac history) not part of the treatment plan. sertraline Risperidone and aripiprazole second choice, but first choice if depot injection included in the Elderly Mental Health treatment plan. 1 sertraline Choices 1,2,3 also indicated for hospital inpatients for treatment of acute mania. Generalised anxiety disorder Escitalopram

4.3.4 Other antidepressant drugs 4.2.2 Antipsychotic depot injections C duloxetine (Cymbalta®) First generation depot injections 1 C zuclopenthixol decanoate venlafaxine (BP monitoring required at 2 C decanoate baseline, commencement and any dose 3 C increase) C tablet as per SMC restrictions Second generation depot injections 1 C palmitate (Xeplion®, Trevicta®) 2 C aripiprazole (Abilify Maintena®) 3 C risperidone (Risperdal Consta®)

1 First choice within class 2 Second choice within class 3 Third choice within class H Hospital use C Consultant initiation S Specialist initiation NHS Ayrshire & Arran Abbreviated Adult Joint Formulary List April 2020 Page 9 of 35 4.4 CNS stimulants and drugs used for dihydrocodeine (injection H) attention deficit hyperactivity disorder Fentanyl patches S fentanyl sublingual (Abstral®) tablets Special Prescribing Agreements for the following medicines are under development: H Fentanyl injection S hydromorphone C atomoxetine S methadone liquid C dexamphetamine C Zomorph® -recommended brand of oral modified C lisdexamfetamine release morphine C S Oxycodone Longtec® -recommended brand of oral modified 4.5 Drugs used in the treatment of obesity release Oxycodone diet and lifestyle changes Shortec® recommended brand of oral immediate release Oxycodone pethidine

(injection H, excludes modified 4.6 Drugs used in and vertigo release, and oral drop preparations) (a) antihistamines

4.7.3 Neuropathic pain promethazine Refer to local persistent pain guideline b) and related drugs amitriptyline carbamazepine 2 gabapentin 2 pregabalin c) domperidone and metoclopramide metoclopramide 4.7.4 Antimigraine drugs domperidone 4.7.4.1Treatment of acute migraine (a) mild to moderate migraine d) 5HT3 receptor antagonists 1 Aspirin (900mg) OR 1 (S orodispersible film) 1 (400mg) OR 2 (S patch) 1 (1000mg)

e) Neurokinin receptor antagonists (b) severe migraine

aprepitant 3 1 tablets fosaprepitant 2 tablets f) Hyoscine 2 tablets hyoscine hydrobromide 3 zolmitriptan - where oral not appropriate g) Other drugs for Ménière’s disease 3 sumatriptan injection - where oral/nasal not appropriate betahistine

4.7.4.2 Prophylaxis of migraine (adults)

1 propranolol capsules 4.7 Analgesics Also refer to section 15.1.4.2 Peri-operative 2 topiramate tablets analgesics C Botulinum toxin A (Botox®) - Restricted to use as per approved protocol Paracetamol C Erenumab prefilled pen or syringe - Compound analgesic preparations Restricted to use as per approved protocol co-codamol 8/500 co-codamol 30/500 4.7.4.3 Treatment of cluster headache (adults) 4.7.2 Opioid analgesics 1 Sumatriptan

Refer to local pain guidelines for further advice

buprenorphine (Butec®) – for use in patients over 65 years of age only. Prescribe by brand name to avoid codeine phosphate diamorphine

1 First choice within class 2 Second choice within class 3 Third choice within class H Hospital use C Consultant initiation S Specialist initiation NHS Ayrshire & Arran Abbreviated Adult Joint Formulary List April 2020 Page 10 of 35 4.8 Antiepileptic drugs 4.9.3 Drugs used in essential tremor, chorea, 4.8.1 Control of the epilepsies tics, and related disorders carbamazepine chlorpromazine lamotrigine haloperidol S sodium valproate (injection H) propranolol oxcarbazepine tetrabenazine

S second choice agents on specialist Torsion dystonias and other involuntary recommendation movements C H botulinum toxin A (prescribe by brand 4.8.2 Drugs used in status epilepticus name) diazepam rectal solution H lorazepam injection 4.10 Drugs used in substance dependence H phenytoin injection Alcohol dependence 4.8.3 Febrile convulsions diazepam a) alcohol withdrawal paracetamol Use in conjunction with local protocols

4.9 Drugs used in and Outpatients and general practice related disorders 1 chlordiazepoxide capsules

4.9.1 drugs used in In-patients Parkinson’s Disease 1 diazepam tablets 2 chlordiazepoxide capsules (a) -agonists H diazepam injection () 5mg/mL (Diazemuls®) C b) maintenance of abstinence and relapse prevention 1 S acamprosate tablets rotigotine (not first line) 1 S tablets 2 S disulfiram tablets (b) levodopa co-beneldopa (Madopar®) Opioid dependence co-careldopa (Sinemet®) C co-carelopa (Duodopa®) intestinal gel a) acute opioid withdrawal symptoms (case by case form requires to be completed until 1 symptomatic relief protocol available) 1 S tablets c) inhibitors (b) Management of opioid dependence S 1 S methadone 1mg/ml oral solution ® d) Catechol-o-methyltransferase 2 S buprenorphine / naloxone (Suboxone ) inhibitors tablet (as per local guideline) 2 S buprenorphine oral lyophilisate (Espranor®) (as per local guideline) levodopa/ / entacapone (use where compliance issues on taking individual 2 S buprenorphine tablets (as per local components) guideline for patients not requiring supervised administration) e) 3 S buprenorphine prolonged released amantadine solution for injection (Buvidal®)

4.9.2 Antimuscarinic drugs used in parkinsonism (c) Maintenance of abstinence and relapse prevention (injection H) 1 S naltrexone tablets

1 First choice within class 2 Second choice within class 3 Third choice within class H Hospital use C Consultant initiation S Specialist initiation NHS Ayrshire & Arran Abbreviated Adult Joint Formulary List April 2020 Page 11 of 35 (d) Opioid overdose prevention 1 S naloxone injection (Prenoxad®) 2 naloxone hydrochloride dihydrate nasal spray (Nyxoid®)

Nicotine dependence

First line option 1smoking cessation support AND Nicotinell® 7mg, 14mg, 21mg patches

Where dual therapy required: 1 smoking cessation support AND Nicotinell® 7mg, 14mg, 21mg patches AND Nicotinell® 1mg, 2mg lozenges OR Nicotinell® 2mg,4mg gum 2 smoking cessation support AND Nicotinell® 7mg, 14mg, 21mg patches AND ® inhalator OR mouth spray

Second line options varenicline

4.11 Drugs for dementia

For consultant initiation and treatment as per NICE TAG 217

C donepezil C C rivastigmine C

1 First choice within class 2 Second choice within class 3 Third choice within class H Hospital use C Consultant initiation S Specialist initiation NHS Ayrshire & Arran Abbreviated Adult Joint Formulary List April 2020 Page 12 of 35 5: INFECTIONS 5.1.3 Tetracyclines For the management of acne refer to section This section contains the medicines included in 13.6.2 the NHS Ayrshire & Arran antimicrobial doxycycline guidelines, listed according to BNF C S tigecycline classification. The relevant antimicrobial guidelines must be referred to for further information on their place in therapy and any 5.1.4 Aminoglycosides restrictions on use. A full list of antimicrobial gentamicin guidelines for primary and secondary care C tobramycin (respiratory) patients can be found on the NHS Ayrshire & C H dalbavancin infusion - Microbiology or Arran intranet (AthenA) or via MicroGuide. Infectious Disease recommendation as per SMC restrictions Further advice on treatment can be sought from the Consultant Microbiologists 5.1.5 Macrolides C S indicates that should be on erythromycin recommendations of Specialist Consultant such clarithromycin as Microbiology or Infectious Diseases azithromycin C azithromycin injection –Microbiology or 5.1 Antibacterial drugs Infectious Disease recommendation 5.1.1 Penicillins 5.1.6 Clindamycin Benzylpenicillin and C clindamycin phenoxymethylpenicillin benzylpenicillin 5.1.7 Some other antibacterials phenoxymethylpenicillin chloramphenicol C colomycin (respiratory) Penicillinase-resistant penicillins C daptomycin flucloxacillin C fidaxomicin C temocillin injection - Microbiology or C fosfomycin infusion, granules - Infectious Disease recommendation for ESBL Microbiology or Infectious Disease infections only recommendation C linezolid Broad-spectrum penicillins S rifaximin 550mg tablets (Targaxan®) amoxicillin sodium fusidate co-amoxiclav teicoplanin vancomycin Antipseudomonal penicillins piperacillin with tazobactam 5.1.8 Sulfonamides and trimethoprim trimethoprim 5.1.2 Cephalosporins, carbapenems, and C S co-trimoxazole other beta-lactams 5.1.9 Antituberculosis drugs Cephalosporins Seek specialist advice for the management of tuberculosis ceftriaxone rifampicin cefalexin C S (GUM clinic only) cefixime C ethambutol C (respiratory only) ceftazidime C pyrazinamide

Carbapenems 5.1.10 Antileprotic drugs S meropenem injection C dapsone C S doripenem injection 5.1.11 Metronidazole and tinidazole 5.1.2.3 Other beta-lactam antibiotics metronidazole C aztreonam nebuliser solution (as per SMC restrictions) 5.1.12 Quinolones ciprofloxacin levofloxacin C levofloxacin nebuliser solution as per SMC restrictions ofloxacin

1 First choice within class 2 Second choice within class 3 Third choice within class H Hospital use C Consultant initiation S Specialist initiation NHS Ayrshire & Arran Abbreviated Adult Joint Formulary List April 2020 Page 13 of 35 5.1.13 Lower Urinary-tract infections 5.3.3 Viral hepatitis Women (uncomplicated lower UTI) For Hepatitis C – refer to NHS Scotland Clinical Refer to local guidelines available on Guidelines for the treatment of HCV in adults Microguide/ Athena 5.3.4 Influenza Men (uncomplicated lower UTI) For initiation as per national guidance Refer to local guidelines available on oseltamivir Microguide/ Athena inhalation power C zanamivir infusion Pregnancy (uncomplicated lower UTI) Refer to local guidelines available on 5.4 Antiprotozoal drugs Microguide/ Athena 5.4.1 Antimalarials

Seek specialist advice 5.2 Antifungal drugs 5.4.2 Amoebicides Triazole antifungals Seek specialist advice fluconazole

itraconazole 5.4.3 Trichomonacides voriconazole C Metronidazole C posaconazole tablets

posaconazole infusion (treatment of fungal C 5.4.4 Antigiardial drugs infections and excludes prophylactic treatment) Seek specialist advice Imidazole antifungals Also see section 7.2.2 and 13.10.2 5.4.5 Leishmaniacides Seek specialist advice Polyene antifungals 5.4.6 Trypanocides C liposomal amphotericin (AmBisome®) Seek specialist advice Echinocandin antifungals 5.4.7 Drugs for toxoplasmosis C caspofungin Seek specialist advice C S micafungin

Other antifungals 5.4.8 Drugs for pneumocystis pneumonia terbinafine Seek specialist advice

5.3 Antiviral drugs 5.5 Anthelmintics 5.5.1 Drugs for threadworms 5.3.1 HIV infection mebendazole Refer to NHS Ayrshire & Arran guidelines for the treatment of HIV in adults for the 5.5.2 Ascaricides treatment choices - specialist consultant Seek specialist advice initiation only

C emtricitabine/ tenofovir disoproxil tablets 5.5.3 Drugs for tapeworm infections (Truvada®)- use in combination with safer sex practices Seek specialist advice for pre-exposure prophylaxis (PrEP) to reduce the risk of sexually acquired HIV-1 infection in adults at high risk is restricted to specialist use only by consultants in 5.5.4 Drugs for hookworms Infectious Diseases Seek specialist advice 5.3.2 Herpesvirus infections Herpes simplex and varicella–zoster 5.5.5 Schistosomicides infection Seek specialist advice 5.5.6 Filaricides Cytomegalovirus infection Seek specialist advice S ganciclovir 5.5.7 Drugs for cutaneous larva migrans S valganciclovir Seek specialist advice

5.5.8 Drugs for strongyloidiasis Seek specialist advice

1 First choice within class 2 Second choice within class 3 Third choice within class H Hospital use C Consultant initiation S Specialist initiation NHS Ayrshire & Arran Abbreviated Adult Joint Formulary List April 2020 Page 14 of 35 6: ENDOCRINE SYSTEM (i) DPP-4 inhibitors 6.1 Drugs used in diabetes This class of medicines are not considered the most cost-effective choice when used as first-line therapy, 6.1.1 Insulins S and even when used as 2nd or 3rd line, they may only result in a modest reduction of HbA1c. Patients should be initiated on specialist advice only. initiated on these agents should be reviewed at 6 Choice depends on the particular needs of the months and treatment should only continue if the individual patient, taking into account lifestyle, age, patient has had a beneficial metabolic response (a preference and capabilities. Type of insulin, device reduction of at least 0.5% (5.5mmol/mol) in HbA1c) and needle size should be specified. Care should be taken to write the brand name in full. 1 alogliptin tablets (includes alogliptin/ metformin (Vipdomet®) tablets for those with Insulin preparations currently under review, compliance issues) and so the following is not a complete list 2 sitagliptin tablets (includes sitagliptin/

metformin tablet (Janumet®) for those with Short acting insulins compliance issues) soluble insulin 100units/ml injection S (ii) glitazones (thiazolidinediones) (Actrapid®) 1 pioglitazone tablets S Insulin aspart 100 units/mL solution for injection (Fiasp®) iii) glucagon like peptide (GLP-1) agonists S insulin aspart 100 units/mL solution for Daily preparation injection (NovoRapid®) 1 C exenatide injection S insulin 100 units/ml solution for injection 2 C liraglutide injection (1.8mg dose (Humalog®) excluded)

Insulin glargine NB: Liraglutide (Saxenda® brand) is excluded 1 S 100 units/ml (Abasaglar®) from the formulary, which is only licensed as an adjunct to a reduced-calorie diet and increased 2 C Insulin glargine 300 units/ml (Toujeo®) physical activity for weight management in adults

Insulin degludec (Tresiba®) as per protocol C Weekly preparation once available (under development) Note: SMC approved for use in adults only 1 C semaglutide injection 2 C dulaglutide injection 6.1.3 Insulin Pen needles 1 Omnican® 32G fine pen needles iv) sodium-glucose co-transporter 2 (SGLT2) inhibitor BD Viva® pen needles – alternative in patients using Eli Lilly pen devices  SGLT-2 inhibitors are to be used with caution in cardiovascular conditions due to increased risk of volume depletion. Caution must be exercised when using diuretics concomitantly. 6.1.2 Antidiabetic drugs Hypovolaemia requires correction before initiation with an SGLT2 inhibitor. Refer to SIGN 154 on the pharmacological  SGLT2 inhibitor therapy should be temporarily management of type 2 diabetes discontinued in conditions that may lead to fluid loss e.g. GI illness, in particular those on Biguanides concomitant diuretic therapy 1 metformin tablet  MHRA Drug Safety Update: SGLT2 inhibitors: 2 metformin mr tablet updated advice on the risk of diabetic ketoacidosis, April 2016 Sulphonylureas  MHRA Drug Safety Update: SGLT2 inhibitors: 1 gliclazide tablets updated advice on increased risk of lower-limb 2 tablets amputation (mainly toes), March 2017 1 empagliflozin tablets (includes Synjardy® (includes Synjardy® (empagliflozin/ metformin for those with compliance issues)) 2 dapagliflozin tablets (includes Xigduo® (dapagliflozin/ metformin) for those with compliance issues)

C dapagliflozin - in adults for the treatment of

insufficiently controlled type 1 diabetes mellitus as an adjunct to insulin in patients with BMI ≥27kg/m2, when insulin alone does not provide adequate glycaemic control despite optimal insulin therapy Other antidiabetic drugs 1 First choice within class 2 Second choice within class 3 Third choice within class H Hospital use C Consultant initiation S Specialist initiation NHS Ayrshire & Arran Abbreviated Adult Joint Formulary List April 2020 Page 15 of 35 6.1.4 Treatment of hypoglycaemia

Choice of treatment depends on the clinical situation and includes: glucose (oral) glucagon injection glucose infusion 20%

6.1.6 Diagnostic and monitoring devices for diabetes mellitus Blood Glucose Monitoring meters recommended within the community setting: Adult patient group Meter Test strips Patients undertaking dual glucose 1 4SURE Smart Duo 4SURE blood glucose test strips and ketone testing (type 1 and ketosis prone type 2 diabetes patients) 4SURE ß-ketone test strips Patients undertaking carbohydrate 1 FreeStyle InsuLinx Freestyle Lite test strip counting 2 Accu-Chek Aviva Expert Accu-Chek Aviva blood glucose test strips Type 2 diabetes 1TRUE METRIX TRUE METRIX blood glucose test strips 2 TEE2 Tee2 blood glucose test strips

Specialist initiation Adult patient group Meter Test strips Medtronic insulin pumps 1 CONTOUR NEXT LINK CONTOUR NEXT LINK test strips Accu-Chek Combo insulin pump 1 Accu-Chek Aviva Expert Accu-Chek Aviva blood glucose test strips Accu-Chek Insight insulin pump 1 Accu-Chek Aviva Expert Accu-Chek Aviva blood glucose test strips Patients with visual impairment (type 1 1 GlucoRx Nexus Voice GlucoRx Nexus Test Strips or 2 diabetes) meter Patients unable to self titrate insulin 1 FreeStyle Libre handset FreeStyle Optium blood glucose test doses (type 1 diabetes and ketosis prone strips type 2 diabetes patients) Patients unable to handle individual 1 Accu-Chek Mobile Accu-Chek Mobile test cassette strips and lancets (type 1 or 2 diabetes)

1 First choice within class 2 Second choice within class 3 Third choice within class H Hospital use C Consultant initiation S Specialist initiation NHS Ayrshire & Arran Abbreviated Adult Joint Formulary List April 2020 Page 16 of 35 6.2 Thyroid and antithyroid drugs C

6.2.1 Thyroid and finasteride levothyroxine 1 finasteride S liothyronine (injection H) 2 dutasteride

dutasteride and (Combodart®) 6.2.2 Anti-thyroid drugs 1 carbimazole 6.5 Hypothalamic and pituitary hormones propylthiouracil and anti-oestrogens C H aqueous iodine 6.5.1 Hypothalamic and anterior pituitary 6.3 Corticosteroids hormones and anti-oestrogens 6.3.1 Replacement therapy C clomifene Hydrocortisone (excludes modified-release tablets) Anterior pituitary hormones Corticotrophins for testing H tetracosactide 6.3.2 therapy Gonadotrophins 2mg soluble tablets, C H chorionic gonadotrophin injection 2mg tablets C H follitropin alfa and beta injection hydrocortisone C H choriogonadotropin alfa pre-filled C (Ovitrelle®) syringe prednisolone tablets (excludes 25mg strength), 5mg/5ml oral solution, soluble tablets Growth S Somatropin injection (recommendations 6.4 Sex hormones of specialist consultant at Yorkhill Hospital – 6.4.1 Female sex hormones and their centre provides a shared care protocol) modulators Hypothalamic hormones 6.4.1.1 Oestrogens and HRT H gonadorelin Refer to local HRT guidelines for product choices 1 oral preparations 6.5.2 Posterior pituitary hormones and 2 transdermal patches antagonists

(a) diabetes insipidus desmopressin nasal spray

desmopressin tablets 6.4.1.2 Progestogens and H desmopressin injection receptor modulators norethisterone (b) antidiuretic hormone antagonists progesterone C demeclocycline

Progesterone receptor modulators (c) oesophageal varices C (Esmya®) C H terlipressin

Notes on use regarding Esmya® (Feb 2018) d) idiopathic nocturnal polyuria  The European Medicines Agency (EMA) is C desmopressin 25 microgram, 50 currently reviewing the benefits of ulipristal microgram oral lyophilisate (Noqdirna®) acetate (Esmya®) when used for uterine use in patients aged 65 years and over fibroids following reports of serious – injury. Whilst this review is ongoing do not only initiate or re-start treatment in any patient.  Further information, including guidance for 6.6 Drugs affecting bone metabolism

patients, is available from the MHRA website 6.6.1 and parathyroid hormones

C calcitonin (salmon) 6.4.2 Male sex hormones and antagonists

(Nebido®) injection C testosterone gel C C testosterone tablets

Anti-androgens 1 First choice within class 2 Second choice within class 3 Third choice within class H Hospital use C Consultant initiation S Specialist initiation NHS Ayrshire & Arran Abbreviated Adult Joint Formulary List April 2020 Page 17 of 35 6.6.2 and other drugs affecting bone metabolism

1 tablets, effervescent tablets 2 risedronate sodium tablets H injection (Xgeva®), as per West of Scotland Cancer Network protocol disodium etidronate H disodium pamidronate C ibandronic acid tablets C H ibandronic acid injection raloxifene sodium clodronate C H infusion

6.7 Other endocrine drugs

6.7.1 Bromocriptine and other dopaminergic drugs bromocriptine C cabergoline

6.7.2 Drugs affecting gonadotrophins C

Gonadorelin analogues C buserelin nasal spray C goserelin injection C triptorelin (Decapeptyl SR®) injection

6.7.3 C metyrapone

1 First choice within class 2 Second choice within class 3 Third choice within class H Hospital use C Consultant initiation S Specialist initiation NHS Ayrshire & Arran Abbreviated Adult Joint Formulary List April 2020 Page 18 of 35 7: OBSTETRICS, GYNAECOLOGY & 7.3 Contraceptives URINARY- TRACT DISORDERS Refer to West of Scotland Sexual Health MCN clinical guidelines 7.1 Drugs used in obstetrics 7.3.1 Combined hormonal contraceptives 7.1.1 and oxytocics Combined Oral Contraceptives (COCs) H H dinoprostone (excludes 10mg vaginal 7.3.1.1 Monophasic low strength (21-day delivery system) preparations) H (NB: low strength monophasic COCs are considered H gemeprost second line agents as breakthrough bleeding is more H common than with standard strength monophasic H ergometrine/ oxytocin (Syntometrine®) COCs) 1 Gedarel 20/150® (ethinylestradiol 20mcg 7.1.1.1Drugs affecting the ductus arteriosus with 150mcg) tablet Maintenance of patency H alprostadil 7.3.1.2 Monophasic standard strength (21- day preparations) Closure of ductus arteriosus H injection (NB: Monophasic standard strength COCs are considered first line agents) 7.1.2 1 Levest® (ethinylestradiol 30mcg with H S mifepristone levonorgestrel 150mcg) tablet H S mifepristone/ 1 Rigevidon® (ethinylestradiol 30mcg with (Megdabon) combipak levonorgestrel 150mcg) tablet

7.1.3 Myometrial relaxants 2 Brevinor® (ethinylestradiol 35mcg with H salbutamol injection norethisterone 500mcg) tablet

7.2 Treatment of vaginal and vulval 7.3.1.3 Monophasic standard strength (28- conditions day ‘Every day’ preparations) 7.2.1 Preparations for vaginal changes 1 Microgynon 30 ED® (ethinylestradiol 1 Ovestin® 30mcg with levonorgestrel 150mcg) tablet S Ospemifene tablets (Senshio®) Vaginal (low strength) 7.2.2 Vaginal and vulval infections S NuvaRing® (ethinylestradiol with ) Preparations for vaginal and vulval candidiasis 7.3.2 Oral -only contraceptives 1 clotrimazole 1 Noriday® (norethisterone 350 mcg) econazole 2 tablet

Other infections 1 Norgeston® (levonorgestrel 30 mcg) tablet povidone iodine 2 Cerelle® (desogestrel 75mcg) tablet

Bacterial vaginosis 7.3.2.2 Parenteral progestogen- only Refer to primary care empirical antibiotic contraceptives guidelines for further information and Refer to West of Scotland Sexual Health MCN clinical treatment choices guidelines 2 dequalinium chloride vaginal tablets – 1 medroxyprogesterone acetate (Depo- for patients who fail initial treatment options. Provera®) 1 medroxyprogesterone acetate (Sayana® Press) subcutaneous depot injection (Sexual Health clinic or Ayrshire Maternity Unit Day ward initiation for women undertaking self-administration, as per local standard operating procedures)

etonogestrel (Nexplanon®) implant

1 First choice within class 2 Second choice within class 3 Third choice within class H Hospital use C Consultant initiation S Specialist initiation NHS Ayrshire & Arran Abbreviated Adult Joint Formulary List April 2020 Page 19 of 35 7.3.2.3 Intra-uterine progestogen-only Stress urinary incontinence in women device pelvic floor muscle exercises Prescribe by brand name to avoid confusion 1 levonorgestrel (Mirena®) intrauterine 7.4.3 Drugs used in urological pain system (5 year system) C Pentosan polysulfate sodium capsules 1 levonorgestrel (Levosert®) intrauterine (Elmiron®) (case by case form requires to be system (5 year system) completed until protocol available) 2 levonorgestrel (Jaydess®) intrauterine delivery system (3 year system) Alkalinisation of urine 2 levonorgestrel (Kyleena®) intrauterine potassium citrate delivery system (5 year system) sodium bicarbonate

7.3.4 Contraceptive devices 7.4.4 Bladder instillations and urological Refer to West of Scotland Sexual Health MCN clinical guidelines surgery sodium chloride 0.9% for irrigation

7.3.5 Emergency contraception Maintenance of indwelling urinary catheters Copper IUD is more effective than any oral Sodium chloride 0.9% for irrigation method and should be considered as an option Solution G irrigation Solution R irrigation levonorgestrel 1500 mcg tablets (patients presenting within 72 hours of unprotected sexual intercourse) 7.4.5 Drugs for erectile dysfunction ulipristal (EllaOne®) tablets Alprostadil (patients presenting 72 to 120 hours after S alprostadil injection, urethral application unprotected sexual intercourse)

Phosphodiesterase type-5 inhibitors

7.4 Drugs for genito-urinary disorders 1 tablets 2vardenafil tablets (except oro-dispersible 7.4.1 Drugs for urinary retention formulation) a) -blockers 1 tamsulosin (1 in younger men) 2 doxazosin b) 5α-reductase inhibitors 1 finasteride 2 dutasteride c) combination products dutasteride plus tamsulosin (Combodart®) solifenacin plus tamsulosin (Vesomni®)

7.4.2 Drugs for urinary frequency, enuresis and incontinence 1 immediate release tablets 2 solifenacin tablets 3 - should be restricted to third line use in patients who have not responded to treatment with two different antimuscarinics or in whom antimuscarinics are contraindicated. It may also be considered as a first line option where there is concern that patients have a high load. Further information about anticholinergic load can be read in the Scottish Government Polypharmacy Guidance March 2015. 1 First choice within class 2 Second choice within class 3 Third choice within class H Hospital use C Consultant initiation S Specialist initiation NHS Ayrshire & Arran Abbreviated Adult Joint Formulary List April 2020 Page 20 of 35 8: MALIGNANT DISEASE and 8.1.4 Vinca alkaloids and etoposide IMMUNOSUPPRESSION C H etoposide C H vinblastine 8.1 Cytotoxic Drugs C H vincristine Use of these medicines should be in C H vinorelbine accordance with any guidelines/ protocols from 8.1.5 Other antineoplastic drugs West of Scotland Cancer Network. C H abemaciclib tablets Some medicines may require a case by case C H afatinib form to be completed for specific indications C H aflibercept until a protocol is available – refer to local list C H alectinib capsules

Treatment for cytotoxic-induced side C H amsacrine effects C H arsenic trioxide infusion C H atezolizumab infusion Chemotherapy induced mucositis and myelosuppression C H blinatumomab C H calcium folinate C H bortezomib CH folinic acid (as disodium salt) C H bosutinib injection C H brentuximab infusion C H cabazitaxel Urothelial toxicity C H carboplatin C H mesna C H carfilzomib infusion

8.1.1 Alkylating drugs C H ceritinib C H bendamustine (Levact®) C H cetuximab C H busulfan C H cisplatin

C H chlorambucil C H crisantaspase C H crizotinib capsules C H cyclophosphamide C H dacarbazine C H ifosfamide C H daratumumab infusion ( C H melphalan C H dasatinib 8.1.2 Anthracyclines and other cytotoxic C H docetaxel antibiotics C H eribulin C H bleomycin C H erlotinib C H daunorubicin C H everolimus C H Liposomal formulation of C H gemtuzumab ozogamicin infusion daunorubicin/ cytarabine (Vyxeos®) C H hydroxycarbamide C H doxorubicin C H ibrutinib C H epirubicin C H idelalisib C H idarubicin C H imatinib C H mitomycin C H inotuzumab ozogamicin infusion C H mitoxantrone C H irinotecan

C H lorlatinib tablets 8.1.3 Antimetabolites C H midostaurin capsules C H azacitidine C H nilotinib C H capecitabine C H nintedanib C H cladribine C H nivolumab C H cytarabine (excludes lipid formulation) C H osimertinib C H Liposomal formulation of daunorubicin/ cytarabine (Vyxeos®) C H oxaliplatin C H fludarabine C H paclitaxel (includes Abraxane®) C H fluorouracil C H palbociclib capsules C H gemcitabine C H pegasparaginase C H mercaptopurine C H pembrolizumab C H methotrexate C H pertuzumab C H pemetrexed C H ponatinib C H procarbazine 1 First choice within class 2 Second choice within class 3 Third choice within class H Hospital use C Consultant initiation S Specialist initiation NHS Ayrshire & Arran Abbreviated Adult Joint Formulary List April 2020 Page 21 of 35 C H raltitrexed C H teriflunomide tablets – as per local C H ribociclib tablets protocol C H ruxolitinib tablets C H thalidomide C H C H axicabtagene ciloleucel infusion C H trastuzumab (includes subcutaneous C H tisagenlecleucel infusion formulation) C H trastuzumab emtasine (Kadcyla®) BCG bladder instillation C H tretinoin C H Bacillus Calmette-guerin instillation C H trifluridine/ tipiracil tablets (Lonsurf®) (OncoTice)

C H venetoclax tablets 8.3 Sex hormones and hormone antagonists in malignant disease 8.2 Drugs affecting the immune response Use should be in accordance with any 8.2.1 Antiproliferative immunosuppressants guidelines/ protocols from West of Scotland C H azathioprine injection Cancer Network C azathioprine C mycophenolate mofetil 8.3.2 Progestogens C medroxyprogesterone acetate 8.2.2 Corticosteroids and other C immunosuppressants (a) corticosteroids 8.3.4 Hormone antagonists dexamethasone 500 micrograms, 2mg 8.3.4.1 Breast Cancer soluble tablets, 2mg tablets C anastrozole prednisolone tablets (excludes 25mg C H fulvestrant strength), 5mg/5ml oral solution, soluble C letrozole tablets C tamoxifen C exemestane other immunosuppressants C goserelin C tacrolimus (including Envarsus®) C ciclosporin 8.3.4.2 Gonadorelin analogues and C H ciclosporin injection gonadotrophin-releasing hormone antagonists 8.2.3 Anti-lymphocyte monoclonal antibodies Anti-androgen: C H rituximab (includes subcutaneous 1 C bicalutamide formulation) 2 C flutamide C H obinutuzumab C H abiraterone tablets C H ofatumumab C H enzalutamide

8.2.4 Other immunomodulating drugs Gonadorelin analogue: C H interferon alfa-2b injection - – as per 1 C (Prostap® DCS) local protocol 2 C triptorelin C H interferon beta 1a injection C degarelix (Firmagon®) C H peginterferon alfa-2a (Pegasys®)

C H peginterferon alfa-2b (ViraferonPeg®) 8.3.4.3 Somatostatin analogues C H peginterferon beta-1a (Plegridy®) - – as per local protocol Short-acting: C H dimethyl fumarate capsules C octreotide (Tecfidera®) - as per local protocol C pasireotide C H fingolimod capsules - as per local protocol Long-acting: C H glatiramer injection (Brabio®) C octreotide depot (Sandostatin LAR®) C H lenalidomide C H natalizumab infusion - as per local protocol C H ocrelizumab infusion C H panobinostat C H pomalidomide

1 First choice within class 2 Second choice within class 3 Third choice within class H Hospital use C Consultant initiation S Specialist initiation NHS Ayrshire & Arran Abbreviated Adult Joint Formulary List April 2020 Page 22 of 35 9: NUTRITION and BLOOD Management of hyperkalaemia calcium polystyrene sulphonate powder 9.1 Anaemias and some other blood (Calcium Resonium®) disorders sodium polystyrene sulphate powder 9.1.1 Iron-deficiency anaemias (Resonium A®)

9.1.1.1 Oral iron ferrous fumarate tablets, liquid 9.2.1.2 Oral sodium and water ferrous sulphate tablets None recommended sodium feredetate liquid Oral rehydration therapy 9.1.1.2 Parenteral iron oral rehydration salts CKD 3-5 Low Clearance patients 9.2.1.3 Oral bicarbonate 1 C H ferric carboxymaltose (Ferinject®) C sodium bicarbonate Haematology, Gastro-enterology and C potassium bicarbonate Peritoneal Dialysis patients 1 C H iron isomaltoside (Monofer®) 9.2.2 Parenteral preparations for fluid and electrolyte imbalance Others refer to BNF 1 C H iron sucrose (Venofer®) 9.2.2.2 Plasma and plasma substitutes 9.1.2 Drugs used in megaloblastic H Dextran 70 infusion anaemias H Gelatin infusion folic acid tablets hydroxocobalamin 9.3 Intravenous nutrition S Contact the hospital nutrition team for 9.1.3 Drugs used in hypoplastic, advice haemolytic, and renal anaemias 9.4 Oral nutrition C H epoetin beta C H darbepoetin alfa 9.4 Oral nutritional supplements Refer to the separate NHS Ayrshire & Iron overload Arran Oral nutritional supplements 1 C H desferrioxamine injection formulary (adults) – primary care 2 C deferasirox tablets (Exjade®) (as per WoSCAN protocol) 9.5 Minerals

9.1.4 Drugs used in platelet disorders 9.5.1.1 Calcium supplements 1 C H ((case by case form calcium chloride injection requires to be completed until protocol calcium gluconate injection available)) calcium carbonate chewable tablet 2 C H romiplostim (for patients when (Adcal®) eltrombopag not absorbed orally - (case by case S calcium carbonate chewable tablet form requires to be completed until protocol (Calcichew®) available) calcium carbonate effervescent tablets C H anagrelide (Cacit®)

9.1.6 Drugs used in neutropenia 9.5.1.2 and hypercalciuria 1 C filgrastim injection (Zarzio®) C cinacalcet (not for primary 2 C lipegfilgastrim injection (Lonquex®) hyperparathyroidism)

9.5.1.3 Magnesium 9.2 Fluids and electrolytes H magnesium sulphate injection magnesium aspartate dihydrate 9.2.1.1 Oral potassium (Magnaspartate®) Sando-K® effervescent tablets Magnesium glycerophosphate 4mmol Kay-Cee-L® liquid chewable tablets

9.5.2 Phosphorus 9.5.2.1 Phosphate supplements Phosphate-Sandoz®

1 First choice within class 2 Second choice within class 3 Third choice within class H Hospital use C Consultant initiation S Specialist initiation NHS Ayrshire & Arran Abbreviated Adult Joint Formulary List April 2020 Page 23 of 35 9.5.2.2 Phosphate-binding agents 9.6.6 Vitamin K 1S sevelamer carbonate tablets, powder Malabsorption syndromes (water- soluble for solution preparation required): Second/ third line choice depends on menadiol sodium phosphate patient’s blood results/ tolerability Fat soluble formula (not malabsorption): S aluminium hydroxide capsules phytomenadione S calcium acetate tablets (Phosex®) S calcium carbonate chewable tablets (Calcichew®) (renal unit only) 9.6.7 Multivitamin preparations S lanthanum carbonate chewable Abidec drops tablets, oral powder Vitamin capsules BPC S sucroferric oxyhydroxide chewable S Ketovite® tablets S Forceval ® capsules (post bariatric surgery only) 9.5.3 Fluoride sodium fluoride 9.8.1 Drugs used in metabolic disorders 9.5.4 Zinc Gaucher's disease zinc sulphate effervescent 125mg tablets C velaglucerase (case by case form requires 9.6 Vitamins to be completed until protocol available)

9.6.1Vitamin A Urea cycle disorders vitamin A and D capsules C carglumic acid C sodium phenylbutyrate 9.6.2 Vitamin B group H Pabrinex pyridoxine thiamine

9.6.3 Vitamin C ascorbic acid

9.6.4 Refer to NHS Ayrshire & Arran treatment of vitamin D deficiency & insufficiency guideline in adults alfacalcidol tablets, oral drops H alfacalcidol injection colecalciferol 1000 unit and 25,000 unit tablets (Stexerol D3®) cholecalciferol 50,000 units/ml oral solution (InVita D3®), when cannot swallow oral formulations C calcitriol ergocalciferol 300, 000 unit injection calcium with colecalciferol 1 Accrete D3® tablets 2 Adcal D3® chewable tablets Calfovit D3® sachets – where tablet or chewable tablet formulations are unsuitable

9.6.5 Vitamin E alpha tocopheryl acetate

1 First choice within class 2 Second choice within class 3 Third choice within class H Hospital use C Consultant initiation S Specialist initiation NHS Ayrshire & Arran Abbreviated Adult Joint Formulary List April 2020 Page 24 of 35 10: MUSCULOSKELETAL and JOINT Cytokine modulators DISEASES Rheumatoid Arthritis 10.1 Drugs used in rheumatic diseases and All medicines should be prescribed as per the gout local guidelines for the management of 10.1.1 Non-steroidal anti-inflammatory rheumatoid arthritis (adults) drugs 1 C H etanercept prefilled syringe/ pen Ibuprofen tablets (Benepali brand of choice) sodium tablets 1 C H baricitinib tablets (oral treatment) tablets 2 C H adalimumab prefilled syringe/ pen naproxen effervescent tablets (only for (Amgevita® brand of choice) patients unable to swallow naproxen tablets) 2 C H certolizumab prefilled syringe (gynaecological conditions only) 2 C H golimumab prefilled syringe/ pen 2 C H infliximab infusion (Inflectra brand of Cyclo-oxygenase-2-selective inhibitors choice) 2 C H tocilizumab infusion (excludes mr formulation) 2 C H rituximab infusion (Truxima brand of choice) 2 C H sarilumab prefilled syringe/ pen 10.1.2 Corticosteroids 3 C H abatacept infusion, prefilled syringe 10.1.2.1 Systemic corticosteroids 1 prednisolone tablets (excludes 25mg Psoriatic Arthritis strength), 5mg/5ml oral solution, soluble All medicines should be prescribed as per the tablets local guidelines for the management of 1 C methylprednisolone intravenous psoriatic arthritis (adults) injection 1 C apremilast tablets (oral treatment) 1 acetonide intramuscular 1 C H secukinumab prefilled syringe/ pen injection 2 C H etanercept prefilled syringe/ pen 10.1.2.2 Local injections (Benepali brand of choice) 1 C methylprednisolone with lidocaine 3 C H adalimumab prefilled syringe/ pen (Amgevita® brand of choice) (Depo-Medrone® with lidocaine) injection 3 C H golimumab prefilled syringe/ pen 1 C injection 3 C H infliximab infusion (Inflectra brand of 1 S triamcinolone hexacetonide (juvenile choice) idiopathic arthritis only) injection 3 C H certolizumab prefilled syringe 3 C H ustekinumab prefilled syringe 10.1.3 Drugs that suppress the rheumatic disease process Ankylosing Spondylitis * A combination of these medicines may be All medicines should be prescribed as per the used as guided by specialists local guidelines for the management of 1 C methotrexate 2.5mg tablets, pre-filled ankylosing spondylitis (adults) ® pens (Metoject ) 1 C H secukinumab prefilled syringe/ pen 2 C hydroxychloroquine tablets 2 C H etanercept prefilled syringe/ pen 2 C leflunomide tablets (Benepali brand of choice) 2 C sulfasalazine e/c tablets 3 C H adalimumab prefilled syringe/ pen (Amgevita® brand of choice) 3 C azathioprine tablets 3 C H certolizumab prefilled syringe ciclosporin capsules - patients should be 3 C 3 C H golimumab prefilled syringe/ pen maintained on same brand 3 C H infliximab infusion (Inflectra brand of 3 C cyclophosphamide tablets choice) 3 C penicillamine tablets

Still’s disease, including Systemic Juvenile Idiopathic Arthritis (SJIA) and Adult-Onset Still’s Disease (AOSD) C H anakinra injection - as per SMC 2104

1 First choice within class 2 Second choice within class 3 Third choice within class H Hospital use C Consultant initiation S Specialist initiation NHS Ayrshire & Arran Abbreviated Adult Joint Formulary List April 2020 Page 25 of 35 Giant Cell Arteritis (GCA) (adults) C H tocilizumab injection – as per SMC 2014 (case by case form requires to be completed until protocol available)

10.1.4 Gout and cytotoxic-induced hyperuricaemia Acute attacks of gout 1 NSAID e.g diclofenac sodium S colchicine

Long term control of gout 1 allopurinol 2 sulfinpyrazone C febuxostat

10.2 Drugs used in neuromuscular disorders

10.2.1 Drugs that enhance neuromuscular transmission C pyridostigmine bromide

10.2.2 Skeletal muscle relaxants baclofen dantrolene diazepam C

Nocturnal leg cramps quinine sulphate tablets

10.3 Drugs for the relief of soft-tissue disorders and topical pain relief

10.3.2 Rubefacients, topical NSAIDs, capsaicin, and poultices 1 ibuprofen 5% gel 1 2.5% gel

Capsaicin capsaicin 0.075% (Axsain®) (Diabetic neuropathy only) capsaicin 0.025% cream (Zacin®) C H capsaicin cutaneous patch (Qutenza®)

Poultices Kaolin poultice

1 First choice within class 2 Second choice within class 3 Third choice within class H Hospital use C Consultant initiation S Specialist initiation NHS Ayrshire & Arran Abbreviated Adult Joint Formulary List April 2020 Page 26 of 35 11: EYES 11.6 Treatment of glaucoma

11.3 Anti-infective eye preparations a) analogue 1 S 50 micrograms/ml eye drops 11.3.1: Antibacterials 1 chloramphenicol eyedrops/ointment 2 S 300 micrograms/ml eye drops 2 fusidic acid eyedrops

propamidine (Brolene®) eyedrops/ Preservative free ointment Restricted to use in patients with a proven S gentamicin eye drops sensitivity to preservatives e.g. benzalkonium chloride Quinolones 1 S latanoprost 50 micrograms/ml 1 S ofloxacin eye drops preservative free eye drops 2 S ciprofloxacin eye drops 2 S bimatoprost 300 micrograms/ml preservative free eye drops 11.3.2: Antifungals Consultant ophthalmology initiation – contact Combination products pharmacy for advice on products available Restricted to use in patients where compliance or the excessive number of drops they need to administer daily is a problem 11.3.3: Antivirals S ganciclovir 0.15% w/w eye gel 1 S latanoprost 50 micrograms/ml with 5mg/ml eye drops 11.4 Corticosteroids and other anti- 2 S bimatoprost 300 micrograms/ml with inflammatory preparations timolol 5mg/ml eye drops (Ganfort®)

11.4.1: Corticosteroids Preservative free combination products S betamethasone eye drops/ointment Restricted to use in patients with a proven S dexamethasone and hypromellose eye sensitivity to preservatives e.g. benzalkonium drops (Maxidex®) chloride S dexamethasone with neomycin eye 1 S latanoprost 50 microgram/ml with drops (Maxitrol®) timolol 5mg/ml preservative free eye drops (Fixapost®) S prednisolone eye drops 2 S bimatoprost 300 micrograms/ml with Intra-vitreal corticosteroids timolol 5mg/ml preservative free eyedrops (Ganfort®) H C dexamethasone (Ozurdex®) (awaiting protocol for use) b) Beta-blockers H C acetonide (Iluvien®) (awaiting protocol for use) 1 S timolol 0.25% eye drops 2 S 0.25%, 0.5% eye drops

11.4.2 Other anti-inflammatory Long acting beta blocker – where preparations compliance an issue 1 sodium cromoglicate eye drops 1 S timolol 0.25% eye gel (Timoptol LA) 2 olopatadine eye drops Preservative free beta-blockers 11.5 Mydriatics and cycloplegics Restricted to use in patients with a proven sensitivity to preservatives e.g. benzalkonium Antimuscarinics: chloride S eye drops/ointment 1 S timolol 0.1% unit dose eye gel S cyclopentolate eye drops (Tiopex) tropicamide eye drops c) Sympathomimetics Sympathomimetic: 1 S 0.2% eye drops S eye drops

1 First choice within class 2 Second choice within class 3 Third choice within class H Hospital use C Consultant initiation S Specialist initiation NHS Ayrshire & Arran Abbreviated Adult Joint Formulary List April 2020 Page 27 of 35 Combination products 11.8 Miscellaneous Ophthalmic Restricted to use in patients where compliance or Preparations the excessive number of drops they need to administer daily is a problem 11.8.1 Tear deficiency, ocular lubricants S brimonidine 0.2% with timolol 0.5% eye and astringents drops (Combigan®) Options for patients with mild to moderate dry S brinzolamide 1% with brimonidine tartrate eyes 0.2% eye drops (Simbrinza®) 1 Hypromellose 0.3% eye drops (preservative free preparations excluded) d) Carbonic anhydrase inhibitors and 2 Carbomer 980 0.2% (Clinitas® Carbomer systemic drugs gel) ophthalmic gel 1 S brinzolamide 10mg/ml eye drops liquid paraffin preservative free eye dorzolamide 2% eye drops 2 S ointment (Lacri-lube®)

Preservative free prostaglandin analogue Preservative-free formulations are available, for Restricted to use in patients with a proven patients in whom the above options are not sensitivity to preservatives e.g. benzalkonium suitable: chloride sodium hyaluronate 0.03% preservative 1 S dorzolamide 2% preservative free eye free eyedrops (HYLO-Fresh®) NB: bottle can drops be used for upto 6 months after opening sodium hyaluronate 0.1% preservative Combination products free eyedrops (HYLO-Tear®) NB: bottle can Restricted to use in patients where compliance or be used for upto 6 months after opening the excessive number of drops they need to liquid paraffin preservative free eye administer daily is a problem ointment (Lacri-lube®) 1 S brinzolamide 1% with timolol 0.5% eye drops Options for patients with severe dry eyes 2 S dorzolamide 2% with timolol 0.5% eye S sodium hyaluronate 0.2% preservative drops free eyedrops (HYLO-Forte®) NB: bottle can be used for upto 6 months after opening

Preservative free combination products S VitA-POS® preservative free eye Restricted to use in patients with a proven ointment sensitivity to preservatives e.g. benzalkonium C ciclosporin eyedrops (Ikervis®) - severe chloride keratitis in adults with dry eye disease which dorzolamide 2% with timolol 0.5% has not improved despite treatment with tear S substitutes preservative free eye drops

11.8.2 Ocular diagnostic and peri-operative Systemic drugs preparations and photodynamic 1 S acetazolamide tablets, modified release treatment capsules S H acetazolamide injection Ocular diagnostic preparations fluorescein sodium eye drops e) Miotics 1 S pilocarpine 2%, 4% eye drops Ocular peri-operative drugs S eye drops Preservative free miotics S cefuroxime injection (Aprokam®) Restricted to use in patients with a proven sensitivity to preservatives e.g. benzalkonium S diclofenac sodium eye drops chloride S sodium eye drops 1 S pilocarpine 2% preservative free eye S trometamol eye drops drops S H Miochol-E® intra-ocular irrigation solution

11.7 Local anaesthetics S H Mydrane® (tropicamide, phenylephrine hydrochloride and lidocaine hydrochloride) S oxybuprocaine eye drops intra-cameral injection S tetracaine eye drops S nepafenac eye drops S lidocaine and fluorescein eyedrops S H sodium hyaluronate injection S proxymetacaine eyedrops S H balanced Salt Solution 1 First choice within class 2 Second choice within class 3 Third choice within class H Hospital use C Consultant initiation S Specialist initiation NHS Ayrshire & Arran Abbreviated Adult Joint Formulary List April 2020 Page 28 of 35 Subfoveal Choroidal neovascularisation C H ranibizumab C H aflibercept

1 First choice within class 2 Second choice within class 3 Third choice within class H Hospital use C Consultant initiation S Specialist initiation NHS Ayrshire & Arran Abbreviated Adult Joint Formulary List April 2020 Page 29 of 35 12: EAR, NOSE and OROPHARYNX 12.2 Drugs acting on the nose

12.1 Drugs acting on the ear 12.2.1 Drugs used in nasal allergy 1 beclometasone dipropionate 50 12.1.1 Otitis externa microgram per actuation nasal spray 1 furoate 27.5 micrograms Anti-inflammatory preparations per actuation nasal spray 1 betamethasone sodium phosphate 0.1% ear drops Anti-histamines 1 azelastine 0.1% nasal spray Antibacterial preparations S ciprofloxacin 2mg/mL ear drops single Combination preparation dose container (Cetraxal®) 1 azelastine hydrochloride 137micrograms plus 50micrograms Anti-inflammatory with anti-bacterial per actuation nasal spray (Dymista®) preparations If ear drum not perforated Nasal polys 1 Otomize® (dexamethasone 0.1%, 1 S betamethasone sodium 0.1% nasal neomycin sulfate 3250units/ml, glacial drops acetic acid 2%) ear spray 1 S fluticasone 400 microgram (Flixonase® 1 Sofradex® (dexamethasone 0.05%, Nasule®) framycetin 0.5%, gramicidin 0.05%) ear drops 12.2.2 Topical nasal decongestants 2 S gentamicin 0.3% with hydrocortisone 1 0.1% nasal drops, nasal 1% ear drops spray

If ear drum perforated or suspected Antimuscarinics perforation – specialist use 1 Ipratropium bromide 21 micrograms per Although contra-indicated by manufacturers due metered dose nasal spray to risk of Ototoxicity, ENT-UK Consensus statement 2007 states safe to use in patients with 12.2.3 Nasal preparations for infection perforated eardrums 1 Naseptin® nasal cream 1S Sofradex® (dexamethasone 0.05%, framycetin 0.5%, gramicidin 0.05%) ear 2 Mupirocin 2% nasal ointment (Bactroban drops (off-label use) Nasal®) - eradication of staphylococci only

Fungal infection suspected 12.3 Drugs acting on the oropharynx 1 clotrimazole 1% solution 12.3.1 Drugs for oral ulceration and inflammation

12.1.2 Otitis media Aphthous ulcers: S ciprofloxacin 3mg/mL with 1 oral rinse dexamethasone 1mg/mL ear drops ± chlorhexidine gluconate (Cilodex®) - treatment of acute otitis media in patients with tympanostomy tubes (AOMT) Betamethasone mouthwash (0.5mg tablet

dissolve in 10ml of water) 12.1.3 Removal of earwax

1 sodium bicarbonate 5% ear drops Oral ulceration 1 olive oil ear drops hydrocortisone sodium succinate 2.5mg lozenge Gelclair® oral gel (use if mouth dry and unable to tolerate Adcortyl®)

12.3.2 Oropharyngeal anti-infective drugs Oral thrush 1 nystatin 100,000 units/ml oral suspension

1 First choice within class 2 Second choice within class 3 Third choice within class H Hospital use C Consultant initiation S Specialist initiation NHS Ayrshire & Arran Abbreviated Adult Joint Formulary List April 2020 Page 30 of 35 12.3.3 Lozenges, sprays and gels No products recommended

12.3.4 , gargles and dentifrices 1 fluoride , mouthwash, gel 1 sodium chloride mouthwash (edentulous) 1 chlorhexidine gluconate mouthwash (patient is dentate and unable to brush teeth or at high risk of secondary bacterial infections)

12.3.5 Treatment of dry mouth 1 Biotene Oral Balance® gel 1 Saliva stimulating tablets (patients with residual salivary function) 2 AS Saliva Orthana® spray

Lip care 1 hydroxymethylcellulose lubricating jelly e.g. KY jelly 2 Biotene Oral Balance® gel

1 First choice within class 2 Second choice within class 3 Third choice within class H Hospital use C Consultant initiation S Specialist initiation NHS Ayrshire & Arran Abbreviated Adult Joint Formulary List April 2020 Page 31 of 35 13: SKIN Potent corticosteroid: 0.1% cream, 13.2.1 Emollients (moisturisers) ointment (available as generic preparation or 1 Hydromol® ointment branded Betnovate®) Zeroveen ® cream - useful for application to 0.025% (Synalar®) face gel Doublebase® gel (excludes Dayleve gel) mometasone furoate 0.1% cream, QV® cream ointment, (available as generic preparation or Elocon®) white soft paraffin 50%/ liquid paraffin betamethasone diproprionate 0.05%/ 50% 3% (Diprosalic®) ointment Zerobase® cream betamethasone valerate 0.1% (Betacap®) scalp solution 13.2.1.1 Emollient bath and shower

preparations Very potent corticosteroid: Hydromol® emollient bath and shower propionate 0.05% cream, emollient ointment, scalp application (available as QV® wash, bath oil generic preparation or branded Dermovate®)

Bath and shower preparations with antimicrobials Topical corticosteroid with antimicrobials Oilatum Plus® bath additive Mild potency Dermol® 500 & 600 lotion (excludes hydrocortisone 1%, clotrimazole 1% Dermol® 200) (Canesten HC®) cream hydrocortisone 1%, 2% (Daktacort®) cream, ointment 13.2.2 Barrier preparations hydrocortisone 1%, fusidic acid 2% 1 Conotrane® cream (Fucidin H®) cream (NB: caution with use due Sudocrem® cream to increased risk of antibiotic resistance) zinc & castor oil ointment hydrocortisone 0.5%, nystatin 100,000 units/g (Timodine®) cream

Skin Protectors Moderate potency Cavilon® cream, sachet and spray butyrate 0.05%, oxytetracycline 3%, nystatin 100,000units/ g (Trimovate®) cream 13.3 Topical local anaesthetics and antipruritics Potent calamine cream betamethasone valerate 0.1%, clioquinol crotamiton cream 3% cream, ointment menthol 1% in aqueous cream betamethasone valerate 0.1%, fusidic acid 2% (Fucibet®) cream (Note: consider for a maximum of 14 days as longer use increases the risk of antibiotic resistance) 13.4 Topical corticosteroids flucinolone acetate 0.025%, clioquinol 3% (Synalar C®) cream, ointment Mild corticosteroid:

1 hydrocortisone 0.5%, 1% cream, ointment 13.5 Preparations for eczema and psoriasis Moderately potent corticosteroid: 13.5.1 Preparations for eczema 0.05% cream, ichthammol 1% ointment/ ointment (available as generic preparation or zinc paste bandages branded Eumovate®) wet wraps using Comfifast bandages betamethasone valerate 0.025% (Betnovate-RD®) cream, ointment (note if ZipZoc® bandage 100g sizes required, then Betnovate-RD® is the most cost effective option)

1 First choice within class 2 Second choice within class 3 Third choice within class H Hospital use C Consultant initiation S Specialist initiation NHS Ayrshire & Arran Abbreviated Adult Joint Formulary List April 2020 Page 32 of 35 13.5.2 Preparations for psoriasis Topical antibacterials for acne Zineryt® topical solution Vitamin D and analogues Duac® Once daily gel calcitriol ointment calcipotriol ointment, scalp solution (avoid application to the face) 13.6.2 Oral preparations for acne calcipotriol and betamethasone Oral antibacterials for acne diproprionate (Dovobet®) ointment, gel 1oxytetracycline (NB: should only use for a maximum of 4 weeks (scalp) or 8 weeks (“non-scalp” areas), see full 1 lymecycline formulary for additional notes) 2 doxycycline

Tars 2 erythromycin

Exorex® lotion Hormone treatment for acne Psoriderm® cream Co-cyprindiol ( 2mg, Sebco® scalp ointment ethinylestradiol 35micrograms) tablets

Dithranol Oral for acne Dithrocream® cream C H isotretinoin capsules

Oral for psoriasis 13.6.3 Topical preparations for rosacea azelaic acid (Finacea®) gel C H acitretin capsules metronidazole 0.75% cream, gel 13.5.3 Drugs affecting the immune response brimonidine gel (moderate to severe persistent facial erythaema associated with rosacea) C ciclosporin capsules, oral solution ivermectin cream (moderate to severe C methotrexate tablet, injection inflammatory lesions of rosacea where other topical treatments are unsuitable or ineffective). S tacrolimus ointment

Cytokine modulators 13.7 Preparations for warts and calluses C H adalimumab (Amgevita® brand of Glutarol® solution choice) Veracur® gel (as per local protocols; for hidradenitis Occlusal® application suppurativa -case by case form requires to be completed until protocol available) Posafillin® ointment C H etanercept injection (Benepali® brand Salatac® gel of choice) (as per local protocols) Anogenital warts C H ixekizumab injection (case by case form 1 podophyllum solution requires to be completed until protocol S imiquimod cream restricted to Sexual Health available) initiation S camellia sinensis (green tea leaf 13.6 Acne and rosacea extract) (Catephen®) ointment – restricted to 13.6.1 Topical preparations for acne Sexual Health initiation

Benzoyl peroxide and azelaic acid 13.8 Sunscreens and camouflagers 1 benzoyl peroxide (use 2.5% or 5% depending on tolerability) 13.8.1 Sunscreen preparations Only preparations with SPF above 30 should be Topical retinoids and related preparations prescribed for acne Sunsense® Ultra Lotion (SPF 50+) adapalene cream Uvistat® cream (SPF 30 or 50) adapalene 0.1% and benzoyl peroxide 2.5% (Epiduo®) gel Photodamage erythromycin 2%, isotretinoin 0·05% 1 diclofenac gel 3% (Solaraze®) (Isotrexin®) gel S 2 fluorouracil cream (Efudix®) tretinoin 0.025%, clindamycin (as S fluorouracil 0.5% / salicylic acid 10% phosphate) 1% (Treclin®) gel cutaneous solution (Actikerall®)

S imiquimod cream (Aldara®)

C H methyl aminolevulinate cream 1 First choice within class 2 Second choice within class 3 Third choice within class H Hospital use C Consultant initiation S Specialist initiation NHS Ayrshire & Arran Abbreviated Adult Joint Formulary List April 2020 Page 33 of 35 13.9 and other preparations for 13.11 Skin cleansers, antiseptics and scalp and hair conditions desloughing agents Capasal® Refer to Control of Infection manual shampoo 13.11.6 Oxidisers and dyes Sebco® scalp ointment potassium permanganate tablets (refer to Hirsutism separate guidelines) eflornithine cream hydrogen peroxide cream

13.10 Anti-infective skin preparations 13.12 Antiperspirants aluminium chloride hexahydrate 13.10.1 Anti-bacterial preparations

Topical antibiotics 13.13.1 Wound management products mupirocin cream, ointment Refer to separate primary and secondary silver sulfadiazine cream wound care guidelines/ formulary, available fusidic acid cream on AthenA metronidazole cream

13.10.2 Antifungal preparations Yeast infections 1 clotrimazole cream 2 miconazole cream

Dermatophyte infections 1 terbinafine cream amorolfine cream, nail lacquer

13.10.3 Antiviral preparations aciclovir cream, tablets penciclovir cream (labial herpes simplex only)

13.10.4 Parasiticidal preparations Refer to local treatment guidelines for further information Scabies permethrin 5% dermal cream malathion 0.5% aqueous liquid

Head lice: malathion 0.5% aqueous liquid dimethicone 4% lotion (Hedrin®) dimeticone 92% dual formula spray (NYDA®)

13.10.5 Preparations for minor cuts and abrasions magnesium sulphate paste

1 First choice within class 2 Second choice within class 3 Third choice within class H Hospital use C Consultant initiation S Specialist initiation NHS Ayrshire & Arran Abbreviated Adult Joint Formulary List April 2020 Page 34 of 35 15: ANAESTHESIA SH mivacurium injection SH cisatracurium injection 15.1 General anaesthesia 1 S H sodium citrate liquid Depolarising neuromuscular blocking drugs 15.1.1 Intravenous anaesthetics 1 SH suxamethonium chloride injection 1 S H propofol injection 2 S H injection S H thiopental injection 15.1.6 Drugs for reversal of neuromuscular S H etomidate injection blockade 1 SH neostigmine with glycopyrronium 15.1.2 Inhalational anaesthetics bromide injection 1 SH 2 SH sugammadex injection 2 SH desflurane SH 15.1.7 Antagonists for central and 15.1.3 Inhalation analgesia respiratory depression

S H Entonox® or Equanox® (containing Opioid 50% nitrous oxide and 50% oxygen) 1 naloxone injection 15.1.3 Antimuscarinic drugs Benzodiazepine antagonist H atropine sulphate injection flumazenil injection H glycopyrronium bromide injection 1

H hyoscine hydrobromide injection Respiratory stimulants

H doxapram injection 15.1.4 Sedative and analgesic peri- operative drugs

15.1.4.1 Benzodiazepines 15.1.8 Drugs for malignant hyperthermia 1 C H dantrolene sodium injection Pre-operative sedation H diazepam tablets, oral solution, injection, rectal solution tubes 15.2 Local anaesthesia S H temazepam tablets, oral solution S H lorazepam tablets 1 Tetracaine gel (Ametop®) ® 2 Emla cream (containing lidocaine 2.5% Intravenous sedation (specialist training and prilocaine 2.5%) required) S H midazolam injection SH lidocaine injection SH lidocaine with adrenaline injection 15.1.4.2 Peri-operative analgesics SH lidocaine with phenylephrine SH prilocaine hydrochloride injection Non-opioid analgesics SH prilocaine hydrochloride (Prilotekal® S H diclofenac sodium injection hyperbaric solution for injection) S H ketorolac trometamol injection SH bupivacaine with glucose (Marcain® Heavy) Opioid analgesics SH levobupivacaine Also refer to section 4.7 S H alfentanil injection lidocaine patches (post herpetic neuralgia only) S H fentanyl injection S mepivacaine injection (podiatry use only) S H remifentanil injection

H Paracetamol infusion

15.1.5 Neuromuscular blocking agents Non-depolarising neuromuscular blocking drugs 1 SH rocuronium bromide injection 2 SH vecuronium bromide SH atracurium besilate injection

1 First choice within class 2 Second choice within class 3 Third choice within class H Hospital use C Consultant initiation S Specialist initiation NHS Ayrshire & Arran Abbreviated Adult Joint Formulary List April 2020 Page 35 of 35

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