WORCESTERSHIRE
DRUG FORMULARY
UPDATED – includes APC decisions to February 2010
This Formulary is for use across Worcestershire, both in primary and secondary care. Originating in the Acute Trust, it is now maintained by the Worcestershire Area Prescribing Committee (APC). It is updated following monthly APC meetings and will be regularly reviewed to ensure that the medicines listed are evidence-based and take into consideration recommendations from NICE, MTRAC and APC. Prescribing of medicines within the Acute Trust must be in line with the ‘Strategy for Medicines Use’ in the Acute Trust Medicines Policy.
Where it is specified that an APC guideline must be followed these may be found at: http://www.worcspct.nhs.uk/publications/policies-and-procedures/prescribing.aspx
Notes for Acute Trust Users:
Initiating a new treatment for a patient Trust staff may only initiate treatment with medicines included in the Trust Formulary and Trust staff must comply with any special conditions of use or restrictions noted in the formulary against the medicines.
In emergency situations a Consultant may wish to prescribe a medicine that is not on the formulary. In such circumstances an attempt must be made to contact the Director of Pharmacy who may authorise pharmacy to obtain and supply the medicine. If this is not possible a senior pharmacist may obtain and supply the medicine without authorisation but a retrospective approval must be obtained by following the Trust High Cost Drug Procedure (see Intranet under Clinical departments\Pharmacy). No precedent for further supplies will be set.
If a patient admitted to the Trust is already being treated with a drug not included on the Trust formulary, the patient’s own supply will be used wherever possible. In such circumstances, members of medical, nursing and pharmaceutical staff have responsibility for confirming the authenticity of the medicine.
Requests for Drugs to be Included in the Formulary Consultants only may make applications to the APC for additions to the formulary. These must be made on a standard request form available from the Medicines Information Departments at the Alexandra or Worcester Hospitals.
Junior Doctor Prescribing Junior Doctors wishing to prescribe drugs they are unfamiliar with would normally be expected to seek the advice of their Consultant.
Queries Regarding the Formulary
If you have any queries regarding the Formulary, please contact Nick Hubbard (Director of Pharmacy).
1 EMERGENCY TREATMENT OF POISONING
Paracetamol overdose
Acetylcysteine Methionine (only for patients who refuse IV treatment or are allergic to acetylcysteine)
1 GASTRO-INTESTINAL SYSTEM
1.1 Dyspepsia and gastro-oesophageal reflux disease
Aluminium hydroxide mixture Magnesium trisilicate mixture Algicon products (low sodium) Peptac or Gaviscon products or equivalent Maalox suspension (low sodium) Mucaine suspension (radiotherapy patients)
See BNF for info on sodium content
1.2 Antispasmodics and other drugs altering gut motility
Mebeverine tablets Peppermint oil capsules Dicyclomine tablets Hyoscine butylbromide injection and tablets (tablets are poorly absorbed) Metoclopramide products Domperidone tablets
1.3 Ulcer-healing drugs
1.3.1. H2-receptor antagonists
Cimetidine products Ranitidine products
1.3.3 Selective antimuscarinics
Sucralfate tablets and suspension
1.3.4 Prostaglandin analogues
Misoprostol can prevent NSAID-associated ulcers (See Section 10.1.1)
1.3.5 Proton pump inhibitors
Omeprazole capsules (first line) Lansoprazole capsules and oro-dispersible tablets (not first line) Esomeprazole tablets (severe cases only, initiated in hospital)
H. pylori eradication regimes:
( Amoxycillin 1g bd ) or if ( Metronidazole 400mg bd ) ( Clarithromycin 500mg bd ) penicillin ( Clarithromycin 500mg bd ) ( Lansoprazole 30mg bd ) allergic ( Lansoprazole 30mg bd )
HeliClear (amoxicillin + clarithromycin + lansoprazole) used in Primary Care
2 A PPI can be continued if necessary once daily 1.4 Acute diarrhoea
1.4.1 Adsorbents and bulk-forming drugs
Ispaghula sachets
1.4.2 Antimotility drugs
Loperamide capsules and syrup Codeine phosphate tablets
1.5 Chronic bowel disorders
Infliximab (Crohns NICE guidance and Ulcerative Colitis) Adalimumab (Crohns 2nd line, after infliximab) Prednisolone rectal foam (Predfoam) Prednisolone tablets, soluble tablets and enemas (e/c no longer approved, Feb 2010) Sulphasalazine tablets and e/c tablets Mesalazine tablets, enemas and foam (Mezavant XL 1200mg added to formulary April 2008 for once daily administration) Olsalazine tablets Budesonide capsules and enemas Hydrocortisone rectal foam
1.6 Laxatives
1.6.1 Bulk-forming laxatives
Ispaghula sachets Methylcellulose tablets Sterculia granules
1.6.2 Stimulant laxatives
Senna tablets or syrup Bisacodyl tablets and suppositories Docusate capsules and solution Glycerol suppositories Sodium picosulfate liquid (Paeds) Co-danthramer suspension and capsules (restricted indications - see BNF)
1.6.3 Faecal softeners
Arachis oil enemas
1.6.4 Osmotic laxatives
Lactulose solution Movicol powder (expensive – not 1st line) Micralax or equivalent micro-enema Phosphate enemas
1.6.5 Bowel cleansing solutions (Used prior to colonic surgery, colonoscopy or radiological examination)
Sodium picosulphate powder (Picolax) Fleet Phospho-Soda oral solution Klean-Prep powder
3 1.7 Local preparations for anal and rectal disorders
1.7.1 Soothing haemorrhoidal preparations
Anusol cream and suppositories
1.7.2 Compound haemorrhoidal preparations with corticosteroids
Xyloproct ointment Anusol-HC suppositories Proctosedyl ointment
1.7.4 Management of anal fissures
Glyceryl Trinitrate 0.4% Rectal Ointment
1.8 Stoma care Contact Stoma Care Sister
1.9 Drugs affecting intestinal secretions
Creon
Others available on Consultant request
2 CARDIOVASCULAR SYSTEM
2.1 Positive inotropic drugs
2.1.1 Cardiac glycosides
Digoxin tablets, liquid and injection
2.2 Diuretics
Bendroflumethiazide (bendrofluazide) tablets Furosemide (frusemide) tablets, liquid and injection Bumetanide tablets (2nd line only – in absorption problems) Metolazone tablets (See BNF for guideline) Amiloride tablets Spironolactone tablets Eplerenone tablets (Second-line to spironolactone for heart failure after acute MI with ejection fraction of 40% or less) Co-amilofruse tablets ) Primary Care prefer diuretics Co-amilozide tablets (2nd line) ) to be prescribed separately (a few patients will require a potassium sparing diuretic with a thiazide)
2.3 Anti-arrhythmic drugs
Adenosine injection ) Amiodarone tablets and injection ) Disopyramide capsules and injection ) Flecainide tablets and injection ) Procainamide injection ) CCU protocols Propafenone tablets ) Quinidine tablets ) Bretylium tosilate injection ) Lignocaine injection ) Mexiletine capsules and injection )
4 2.4 Beta-adrenoceptor blocking drugs
Atenolol tablets, syrup and injection Propranolol tablets, modified release tablets and injection Metoprolol tablets and injection Labetalol tablets and injection Sotalol tablets (anti-arrhythmic only) Carvedilol tablets (2nd line) Esmolol injection (for short-term treatment of supraventricular arrhythmias) Bisoprolol tablets (1st choice beta-blocker in heart failure) (3rd line for patients with bronchial asthma or COAD where beta-blockers are considered necessary, at Consultant request)
2.5 Drugs affecting the renin-angiotensin system and other antihypertensive drugs
2.5.1 Vasodilator antihypertensive drugs
Hydralazine tablets and injection Sodium nitroprusside injection (ITU)
2.5.2 Centrally-acting antihypertensive drugs
Methyldopa tablets Clonidine tablets (Paeds and migraine)
2.5.3 Adrenergic neurone blocking drugs
Unavailable
2.5.4 Alpha-adrenoceptor blocking drugs
Prazosin tablets Doxazosin tablets and modified release tablets
2.5.5 Drugs affecting the renin-angiotensin system
2.5.5.1 Angiotensin-converting enzyme inhibitors
Ramipril capsules (First choice) Perindopril tablets (may not be initiated in new patients) Lisinopril tablets Enalapril tablets Captopril tablets
2.5.5.2 Angiotensin-II receptor antagonists
Candesartan tablets Irbesartan tablets Losartan tablets Olmersartan medoxomil tablets Valsartan capsules
2.5.6 Ganglion-blocking drugs
Unavailable
2.6 Nitrates, calcium-channel blockers and potassium-channel activators
2.6.1 Nitrates
Glyceryl trinitrate sublingual tablets, spray, buccal tablets and percutaneous adhesive dressings 5 Glyceryl trinitrate infusion Isosorbide mononitrate tablets, modified release tablets and capsules Isosorbide dinitrate intravenous infusion
2.6.2 Calcium-channel blockers
Felodipine tablets Diltiazem tablets and modified release preps ) Modified release preps should Nifedipine capsules and LA tablets ) be prescribed by brand name Amlodipine tablets Verapamil tablets, modified release preps and injection Nimodipine tablets (See BNF for restricted indications)
2.6.3 Potassium-channel activators
Nicorandil tablets Ivabradine (Cardiologists only may prescribe for patients intolerant of betablockers AND a rate-limiting calcium channel blocker - once-daily diltiazem)
2.6.4 Peripheral and cerebral vasodilators
Naftidrofuryl capsules (limited evidence of benefit – Consultant use only)
2.7 Sympathomimetics
2.7.1 Inotropic sympathomimetics
Dobutamine injection ) Dopamine injection ) See CCU/ITU Protocols Isoprenaline injection ) Dopexamine injection )
2.7.2 Vasoconstrictor sympathomimetics
Ephedrine ) Metaraminol ) Methoxamine ) On advice of Consultant Anaesthetist only Noradrenaline/norepinephrine ) Phenylephrine )
2.7.3 Cardiopulmonary resuscitation
Adrenaline/epinephrine
2.8 Anticoagulants and protamine
2.8.1 Parenteral anticoagulants
See posters and guidelines on wards
Heparin sodium IV (Pump Hep) Heparin sodium injection (Multiparin) (not for unstable angina – Specialist use only) Heparin calcium SC (not 1st line – Consultant advice only) Heparin intravenous flush (long lines and central lines only)
Enoxaparin injection (prophylaxis & treatment of VTE, also unstable angina – see guidelines) Fondaparinux (Unstable angina NSTEMI and STEMI) Must only be supplied and used according to a formally approved Trust Guideline for ACS Dalteparin injection (obstetrics only)
Epoprostenol (prostacyclin) injection – (ITU for haemofiltration) 6
2.8.2 Oral anticoagulants
Dabigatran – 2nd line to rivavroxaban for surgical prophylaxis Warfarin tablets Phenindione tablets (available for patients with warfarin intolerance/allergy) Rivaroxaban – for surgical prophylaxis in orthopaedic surgery on hips and knees and surgical prophylaxis for patient unable to have LMWH e.g. needle phobia or not able to self-administer LMWH when there is nobody else able to administer.
2.8.3 Protamine sulphate
Protamine sulphate injection
2.9 Antiplatelet drugs
Aspirin tablets, low dose soluble Clopidogrel tablets (true aspirin allergy or repeated frequent events despite aspirin, post MI or peripheral artery disease; in combination with aspirin in non-ST-segment elevation ACS for 12 months only; in combination with aspirin for 12 months following stenting or angioplasty; NOT APPROVED by APC for use in ST elevation MI ) Dipyridamole tablets Eptifibatide - as an adjunct to PCI; and in the prevention of early MI in patients with unstable angina or NSTEMI Tirofiban injection (Consultant advice only) Abciximab injection(Acute Coronary Syndrome following NICE) Prasugrel – only when used in accordance with NICE TA 182
2.10 Myocardial infarction and fibrinolysis
Streptokinase injection ) See Coronary Care Protocol Alteplase injection ) Tenectaplase )
2.11 Antifibrinolytic drugs and haemostatics
Aprotinin injection - Aprotinin should only be used after careful consideration in individual cases where, for example, the risk of blood loss during surgery is considered to be particularly high (e.g. redo CABG surgery), where there is no suitable alternative, and only when the likely benefits outweigh any risks to individual patients. Evidence has emerged over the last 2 years suggesting that aprotinin may be associated with an increased risk of cardiac and cerebral disorders, as well as all-cause mortality. Tranexamic acid tablets, syrup and injection Ethamsylate injection (Paediatrics)
Drotrecogin alfa (activated) (severe sepsis with multiple organ failure only. ITU Consultants only – 2 signatures required on prescription) 2.12 Lipid-regulating drugs
Cholestyramine powder Bezafibrate tablets Fenofibrate modified release tablets Simvastatin tablets (1st line statin) Pravastatin tablets Fluvastatin capsules Atorvastatin tablets NOT 10mg strength (initiation on low dose atorvasatin is not approved – use simvasatin, therefore atorvastatin 10mg tablets are non-formulary) Ezetimibe tablets (2nd line if statin inappropriate/not tolerated/not working) Nicotinic acid Modified Release tablets (including as Tredaptive) (Restricted to post-MI patients with type2 diabetes and HDL<1 after 3months on optimal statin therapy) Omega-3-acid ethyl esters(Omacor) – as part of a cardiac rehabilitation package but dietary advice must be included to encourage the dietary intake of omega-3 fatty acids in preference to prescribing Omacor Rosuvastatin – only on the recommendation of a consultant lipidologist for the treatment of 7 carefully selected patients; e.g. those in whom response to other statins is not considered adequate, despite maximum tolerated doses of other statins; familial hypercholesterolaemia
2.13 Local sclerosants
Ethanolamine oleate injection
3 RESPIRATORY SYSTEM
Osmohale - approved as a standardised BHR challenge test in secondary care in line with the product’s marketing authorisation
3.1 Bronchodilators
(All devices are available - metered dose inhalers are less expensive than dry powder devices)
Salbutamol inhaler devices, tablets, nebules and injection Combivent nebules Terbutaline inhaler devices, syrup and injection Ipratropium inhaler devices and nebules Oxitropium inhaler devices Salmeterol inhaler devices Formoterol inhaler devices Aminophylline injection and slow release tablets Theophylline paediatric syrup Theophylline modified release capsules
3.2 Corticosteroids
(All devices are available - metered dose inhalers are less expensive than dry powder devices)
Beclometasone inhaler devices Budesonide inhaler devices and respules Fluticasone inhaler devices
Compound preparations
Seretide MDI and Accuhaler (fluticasone + salmeterol) Symbicort Turbohaler (budesonide + formoterol) Fostair - beclometasone dipropionate 100 micrograms, formoterol fumarate 6 micrograms metered inhalation NOTE: the limitations of this product must be recognised and communicated to patients
3.3 Cromoglicate therapy and leukotriene receptor antagonists
Sodium cromoglycate inhaler devices Ketotifen capsules, tablets and syrup (Paediatrics) Montelukast tablets (not for routine use) Omalizumab (Restricted use – follow APC Guideline on prescribing and monitoring)
3.4 Antihistamines, hyposensitisation and allergic emergencies
Chlorphenamine (chlorpheniramine) tablets, syrup and injection Cetirizine tablets and solution Loratadine tablets and syrup Promethazine tablets and liquid Hydroxyzine tablets and syrup Alimemazine (trimeprazine) syrup Adrenaline/epinephrine pre-filled syringes (Special order)
3.5 Respiratory stimulants and pulmonary surfactants 8
Caffeine citrate solution and injection (SCBU) Doxapram infusion Poractant alfa (Neonates)
3.6 Oxygen
See BNF
3.7 Mucolytics
Sodium chloride 0.9% sterile solution for nebulisation Carbocisteine (Respiratory Physicians only for COPD with chronic productive cough)
3.8 Aromatic inhalations
Not recommended
3.9 Cough preparations
Simple linctus Codeine linctus Pholcodine linctus
3.10 Systemic nasal decongestants
Not recommended
4 CENTRAL NERVOUS SYSTEM
4.1 Hypnotics and anxiolytics
4.1.1 Hypnotics
(Hypnotics should not generally be prescribed on discharge unless taken regularly prior to admission)
Temazepam tablets and elixir Chloral betaine tablets & chloral hydrate syrup (Welldorm) Clomethiazole (chlormethiazole) capsules & elixir Melatonin - approved for the treatment of sleep disorders in children and adults associated with neurological and/or behavioural problems, including ADHD and autism, and in older adults with dementia where alternative hypnotics have failed. Treatment should be specialist-initiated with transfer to primary care under shared care if specialist and GP in agreement. Promethazine tablets and syrup Zopiclone tablets Zolpidem tablets
4.1.2 Anxiolytics
Diazepam tablets and injection Lorazepam tablets and injection Oxazepam tablets Chlordiazepoxide tablets (alcohol withdrawal) Propranolol tablets Buspirone tablets (Consultant Psychiatrist lead only)
4.2 Drugs used in psychoses and related disorders
9 4.2.1 Antipsychotic drugs
Chlorpromazine tablets, syrup and injection Haloperidol tablets, liquid and injection Flupenthixol tablets Promazine tablets, and suspension Trifluoperazine tablets, modified release capsules and solution Sulpiride tablets Zuclopenthixol tablets Zuclopenthixol acetate injection Benperidol tablets Pericyazine tablets Levomepromazine (methotrimeprazine) injection (Palliative Care) Aripiprazole tablets Amisulpride tablets Clozapine tablets (Consultant Psychiatrist only) Olanzapine tablets Quetiapine tablets (includes Quetiapine XL) Risperidone tablets
Other drugs may be available at the request of Consultant Psychiatrist
4.2.2 Antipsychotic depot injections
Flupentixol decanoate injection Fluphenazine decanoate injection Haloperidol decanoate injection Zuclopenthixol decanoate injection Pipotiazine palmitate injection
4.2.3 Antimanic drugs
Lithium salts - should be prescribed by brand name Lithium carbonate modified release tablets 200mg (Priadel) and 400mg Lithium carbonate 250mg tablets (Camcolit) Lithium citrate 520mg/5ml liquid (Priadel) Valproic acid (as semisodium valproate) tablets 4.3 Antidepressant drugs
4.3.1 Tricyclics and related antidepressants
Amitriptyline tablets and solution Clomipramine capsules Dosulepin (dothiepin) capsules and tablets Imipramine tablets and syrup Lofepramine tablets Trazodone capsules, tablets and liquid
4.3.2 Monoamine-oxidase inhibitors (MAOI’s) Phenelzine tablets
Reversible MAOI
Moclobemide tablets
4.3.3 Selective serotonin re-uptake inhibitors (SSRIs)
Escitalopram – 3rd line use by psychiatry specialist prescribers (see guidelines) Fluoxetine capsules and liquid Citalopram tablets and oral drops Paroxetine tablets and liquid 10 Sertraline tablets
4.3.4 Other antidepressant drugs (not 1st line)
Flupenthixol tablets Mirtazapine tablets Reboxetine tablets Venlafaxine tablets and modified release capsules Duloxetine Not first-line - see APC guidelines for approved indications
4.4 Central nervous stimulants
Dexamphetamine (on Consultant request) Methylphenidate tablets and modified release tablets (on Consultant request) Atomoxetine capsules (on Consultant advice in children 2nd line to methylphenidate)
4.5 Drugs used in the treatment of obesity
Orlistat capsules Sibutramine capsules
Others on Consultant request
4.6 Drugs used in nausea and vertigo
Aprepitant - prevention of acute and delayed nausea and vomiting associated with highly emetogenic chemotherapy after failure of first line anti-emetic options Betahistine tablets Cinnarizine tablets Cyclizine tablets and injection Prochlorperazine tablets, buccal tablets, injection and suppositories Metoclopramide tablets, injection and syrup (not if less than 20 years old) Domperidone tablets and suppositories Promethazine hydrochloride injection Promethazine teoclate tablets (hyperemesis gravidarum) Haloperidol tablets, syrup and injection Methotrimeprazine injection (for syringe drivers) Granisetron tablets and injection (not for routine use - very expensive) Ondansetron tablets, syrup, suppositories and injection (not for routine use - very expensive)
4.7 Analgesics
4.7.1 Non-opioid analgesics
Aspirin tablets dispersible 300mg Paracetamol tablets, dispersible tablets, syrup, injection and suppositories Nefopam tablets and injection
Combination analgesics (Paracetamol and codeine should be prescribed separately if possible) Co-dydramol tablets Co-codamol 8/500 tablets and effervescent tablets Co-codamol 30/500 tablets and effervescent tablets 4.7.2 Opioid analgesics
Dihydrocodeine tablets, syrup and injection Meptazinol injection (Obstetrics) Pethidine injection Morphine tablets, SR tablets, elixir and injection Diamorphine injection 11 Nalbuphine injection Buprenorphine tablets Buprenorphine/Naloxone (Suboxone) – by specialists only for substitution treatment of opioid dependence Tramadol capsules (not first line) and injection Codeine phosphate tablets and injection
Fentanyl patches (for patients unable to tolerate oral morphine preparations as an alternative to a diamorphine syringe driver ) Fentanyl buccal, sublingual and intranasal spray (when prescribed by a palliative care clinician and the use is audited) Oxycodone capsules, modified release tablets and injection (2nd line in cancer pain for patients who, following an adequate trial of morphine, are shown to be morphine- intolerant) Methadone mixture and injection (Community Drugs Team)
4.7.3 Neuropathic pain
Amitriptyline tablets (see section 4.3.1) Carbamazepine tablets (see section 4.8.1) Gabapentin capsules (see section 4.8.1) Pregabalin (Restricted to 3rd-line use. Prescribers must follow APC guideline)
4.7.4 Antimigraine drugs
4.7.4.1 Treatment of the acute migraine attack
Paracetamol and metoclopramide (Paramax) Sumatriptan tablets, nasal spray and injection
4.7.4.2 Prophylaxis of migraine
Pizotifen tablets and elixir Clonidine tablets Beta blockers (See Section 2.4) Calcium-channel blockers (See Section 2.6.2)
4.8 Antiepileptics
4.8.1 Control of epilepsy
Phenytoin capsules, syrup and IV injection (dose adjustment necessary when changing formulations) Carbamazepine tablets, syrup and suppositories Phenobarbital (phenobarbitone) tablets, elixir and injection Sodium valproate tablets, Chrono tablets, syrup and injection Lacosamide - as an adjunctive therapy in the treatment of partial-onset secondary generalised seizures on a probationary basis. APC has requested a report in Jan-Mar 2010 months from the neurologists, to include the number of people treated with lacosamide, outcomes and the number of patients in whom lacosamide is subsequently stopped. On-going approval for the use of lacosamide will be considered in light of the report. Lamotrigine tablets and dispersible tablets Gabapentin capsules and titration pack Vigabatrin tablets and sachets (Paeds) Clonazepam tablets Ethosuximide capsules and syrup Levetiracetam
4.8.2 Drugs used in status epilepticus
Diazepam injection and rectal solution 12 Clonazepam injection Lorazepam injection Midazolam buccal (unlicensed) Phenytoin injection Paraldehyde
4.9 Drugs used in parkinsonism and related disorders
4.9.1 Dopaminergic drugs used in parkinsonism
Co-careldopa (Sinemet) preparations Co-beneldopa (Madopar) preparations Selegiline tablets Stalevo (levodopa, carbidopa, entacapone in various combinations)
Apomorphine injection ) Entacapone tablets ) Specialist Use Only Pramipexole tablets ) Ropinirole tablets ) Rotigotine patches
Bromocriptine tablets ) NOTE: ergot-derived dopamine receptor agonists have been associated with Cabergoline tablets ) pulmonary, retroperitoneal, and pericardial fibrotic reactions, Specialist Pergolide tablets ) Use Only
4.9.2 Antimuscarinic drugs used in parkinsonism
Procyclidine tablets, syrup and injection Trihexyphenidyl (benzhexol) tablets Orphenadrine tablets
4.9.3 Drugs used in essential tremors, chorea, tics and related disorders
Tetrabenazine tablets Haloperidol tablets or syrup Botulinum A toxin-haemagglutinin complex (Consultant use only including use in a patient pathway second line to local application of diltiazem for anal fissures)
4.10 Drugs used in substance abuse
Acamprosate tablets Chlordiazepoxide tablets and capsules Chlormethiazole (no longer recommended – use chlordiazepoxide) Disulfiram tablets Lofexidine tablets Methadone preparations Nicotine patches (enforced bed-rest only)
4.10.1 Drugs for dementia
Donepezil tablets ) Galantamine tablets ) Specialist advice only – shared care protocol Rivastigmine capsules ) with primary care
5 INFECTIONS
5.1 Antibacterial drugs
5.1.1 Penicillins
13 5.1.1.1 Benzylpenicillin and phenoxymethylpenicillin
Benzylpenicillin injection Penicillin V tablets and elixir
5.1.1.2 Penicillinase-resistant penicillins
Flucloxacillin capsules, syrup and injection
5.1.1.3 Broad-spectrum penicillins
Amoxicillin capsules, suspension and injection Amoxicillin 3g sachets Co-amoxiclav tablets, dispersible tablets, suspension and injection
5.1.1.4 Antipseudomonal penicillin
Tazocin injection Timentin injection
5.1.2 Cephalosporins, cephamycins and other beta-lactams
Cefalexin capsules and suspension Cefuroxime injection Cefotaxime injection Ceftazidime injection Ceftriaxone injection Cefixime oral - for treatment of gonorrhoea by sexually transmitted disease clinics only Meropenem injection (Microbiologist advice or follow protocol if neutropenic patient) Ertapenem injection(For ESBL organisms while supply problems with Meropenen) (Microbiolgist advice) Imipenem injection(For all other patients where a carbapenem is indicated while supply problems with Meropenem) (Microbiologist advice) 5.1.3 Tetracyclines
Oxytetracycline tablets Doxycycline capsules Minocycline capsules
5.1.4 Aminoglycosides
Gentamicin injection Tobramycin injection and nebuliser solution (for Cystic Fibrosis) Neomycin tablets Palacos R + Gentamicin or Septopal Chains
5.1.5 Macrolides
Clarithromycin injection (CAP if NBM only) Clarithromycin suspension and tablets (H. pylori eradication & erythromycin intolerance) Erythromycin stearate tablets Erythromycin ethylsuccinate suspension Erythromycin lactobionate injection (Pregnancy Only) Azithromycin capsules and suspension
5.1.6 Clindamycin
Clindamycin (Usually on Microbiological advice)
5.1.7 Some other antibacterials
14
Sodium fusidate tablets and suspension ) Vancomycin injection ) (Microbiological advice) Teicoplanin injection )
5.1.8 Sulphonamides and trimethoprim
Trimethoprim tablets and syrup Co-Trimoxazole dispersible tablets, syrup and injection (Specific indications only - on Microbiological advice only)
5.1.9 Antituberculous drugs
Rifampicin capsules, syrup and infusion Isoniazid preparations Ethambutol tablets Pyrazinamide tablets
5.1.10 Antileprotic drugs
Dapsone tablets (Consultant Dermatologist advice only)
5.1.11 Metronidazole and tinidazole
Metronidazole tablets, suppositories and infusion
5.1.12 Quinolones
Ciprofloxacin tablets, syrup and injection Moxifloxacin tablets (Communtity Acquired Pneumonia in secondary care) Ofloxacin tablets (Genitourinary only)
5.1.13 Urinary-tract infections
Nitrofurantoin tablets
5.2 Antifungal drugs
Amphotericin lozenges Amphotericin infusion (Microbiological advice only) Amphotericin (liposomal) infusion Nystatin pastilles and suspension Miconazole oral gel (Paediatrics) Fluconazole capsules, syrup and infusion Griseofulvin tablets (not 1st line) Itraconazole capsules (skin and nail infections only) Terbinafine tablets
NB. Should not be used first line in oral or vaginal conditions except in immunocompromised patients
5.3 Antiviral drugs
Aciclovir tablets, syrup and infusion Atripla ) Lamivudine ) Stavudine ) Zidovudine ) See HIV protocols Indinavir ) Saquinavir ) Enfuvirtide injection (2nd line to other HIV therapy as per protocol) 15 Raltegravir An option for the 3rd line treatment, in combination with optimised background therapy, following failure of 1st and 2nd line antiretroviral treatment of HIV infection in adults, based on genotypic resistance profiling. Raltegravir may have advantages in those patients with cardiovascular risks. Tipranavir capsules (3rd/4th line to other HIV therapy) Darunavir (3rd/4th line to other HIV therapy) Kivexa (abacavir/lamivudine) – NOT first line; see APC HIV protocol Oseltamivir capsules and suspension Palivizumab – see West Midlands Regional Commissioning Policy for approved indications Adefovir dipivoxil for Hepatitis B in line with NICE guidance Tenofovir disoproxil for chronic Hepatitis B
5.4 Antiprotozoal drugs
Quinine sulphate Pentamidine (Kept in stock - Consultant request only)
All others available on Consultant request/Microbiological advice only
5.5 Anthelmintics
Mebendazole
All others available on Consultant request/Microbiological advice only
Drotrecogin alfa (activated) for severe sepsis – see section 2.11
6 ENDOCRINE SYSTEM
6.1 Drugs used in diabetes
6.1.1 Insulins
SHORT Actrapid Velosulin Insulin Lispro (Humalog) Humulin S Insulin glargine (Lantus)(restricted use only) Insulin detemir (Levemir) (2nd line to glargine) Insulin glulisine (Apidra and Solostar) INTERMEDIATE Insulatard Humulin I
SHORT/INTERMEDIATE MIX Mixtard Humulin M3
INTERMEDIATE TO LONG Monotard Humulin Lente
VERY LONG Ultratard
Available in vials, cartridges and disposable pens Inhaled insulin – before prescribing patients must qualify according to the NICE and APC guidelines
6.1.2 Oral antidiabetic drugs
Gliclazide tablets Glipizide tablets Tolbutamide tablets 16 Metformin tablets (plus slow release tabs, 2nd line, if intolerant to minimum effective dose of standard release tabs) Pioglitazone tablets (1st choice glitazone, new patients should not be initiated on Rosiglitazone) Repaglinide 2nd line add-on therapy to metformin for patients with irregular eating habits where HbA1c<8.5% OR As an alternative to adding a glitazone in patients failing targets on metformin/sulphonylurea treatments (or on metformin alone where standard sulphonylureas have been problematic), where HbA1C<8.5% OR Occasionally as monotherapy in lean type 2 patients where standard sulphonylureas have resulted in pre-prandial hypoglycaemia Sitagliptin (3rd line Type 2 diabetes by diabetologists and GP diabetes specialists) NOTE: FDA warning that acute pancreatitis may occur in some patients using sitagliptin Saxagliptin - initiation by Consultant Diabetologists only as an alternative to sitagliptin, in line with NICE guidance for sitagliptin Acarbose tablets
6.1.2.3 Other antidiabetics Exenatide Inj (Endocrinologists Only and restricted to HGV license holders to avoid initiating insulin, insulin poor responders in terms of escalating dose/excessive weight gain, and patients with BMI >=33 on two oral hypoglycaemics) Liraglutide – Endocrinologists only
6.1.3 Diabetic ketoacidosis
See BNF
6.1.4 Treatment of hypoglycaemia
Dextrose injection 50% Hypostop gel Glucagon injection
6.1.6 Diagnostic and monitoring agents for diabetes mellitus
Blood glucose monitoring
BM-Test 1-44 Medisense G2 Medisense Precision Plus
Urinalysis
Combur-5 Diastix Ketodiastix Multistix SG Multistix 8 SG Multistix GP Nephur 6 Uristix Clinitest (Path lab only)
6.2 Thyroid and antithyroid drugs
Thyroxine tablets Liothyronine sodium injection Carbimazole tablets Propranolol tablets Propylthiouracil tablets
6.3 Corticosteroids
Prednisolone tablets 1mg & 5mg, soluble tablets 5mg (e/c no longer approved, Feb 2010) 17 Hydrocortisone tablets and injection Fludrocortisone tablets Dexamethasone injection, liquid and tablets Methylprednisolone injection (Sodium Succinate) and Depot injection (Acetate) Triamcinolone injection - intra-articular Betamethasone injection
6.4 Sex hormones
6.4.1 Female sex hormones
6.4.1.1 Oestrogens and HRT
HRT for women with uterus
Elleste-Duet (estradiol + norethisterone) Elleste Duet Conti (estradiol + norethisterone) (patients requiring continuous combined therapy only) Prempak-C (conjugated oestrogens + norgestrel)
HRT for women without uterus
Estradiol tablets (Elleste-Solo or equivalent) Estradiol patches (FemSeven or equivalent)
Other oestrogens
Tibolone tablets (for persistent breakthrough bleeding only) Ethinyloestradiol tablets
6.4.1.2 Progestogens
Dydrogesterone tablets Medroxyprogesterone acetate tablets and injection Norethisterone tablets
6.4.2 Male sex hormones and antagonists
Testosterone implant Mesterolone tablets Cyproterone acetate tablets Finasteride tablets
6.4.3 Anabolic steroids
Available on Consultant request
6.5 Hypothalamic and pituitary hormones and anti-oestrogens
Clomiphene citrate Tetracosactrin injection and depot injection Desmopressin tablets, melt, intranasal solution, intranasal spray and injection Terlipressin injection Pegvisomant - acromegaly
6.6 Drugs affecting bone metabolism
6.6.1 Calcitonin
Calcitonin (salmon)/Salcatonin injection
18 6.6.2 Bisphosphonates
Alendronic acid tablets (First choice for prevention and treatment of osteoporosis) Didronel PMO (disodium etidronate + calcium cyclical pack) Disodium pamidronate injection Risedronate sodium tablets Sodium clodronate injection and capsules Strontium ranelate granules (for treatment in patients intolerant or unresponsive to bisphosphonates and For secondary prevention in line with NICE guidance) Zoledronic acid injection (restricted use only – please check with pharmacy for current status)
6.7 Other endocrine drugs
Bromocriptine tablets Danazol capsules Goserelin implant Cabergoline tablets (Specialist use only) Nafarelin nasal spray
Others available on Consultant request
7 OBSTETRICS, GYNAECOLOGY, & URINARY-TRACT DISORDERS
7.1 Drugs used in obstetrics
7.1.1 Prostaglandins and oxytocics
Oxytocin injection Syntometrine injection Ergometrine tablets and injection Carboprost injection Dinoprostone pessaries (Propess) (1st line), tablets / gel (not 1st line). Extra-amniotic injection (Prostin E2) is not recommended by BNF Gemeprost pessaries
7.1.2 Mifepristone
Mifepristone
7.1.3 Myometrial relaxants
Atosiban injection Ritodrine tablets and injection
7.2 Treatment of vaginal and vulval conditions
7.2.1 Preparations for vaginal atrophy Estriol 0.1% cream Premarin cream
7.2.2 Anti-infective drugs
Balance Active Gel – recurrent bacterial vaginosis Clotrimazole cream and pessaries Nystatin cream and pessaries Sultrin cream Metronidazole vaginal gel
7.3 Contraceptives
19
7.3.1 Combined oral contraceptives
Cilest Femodene Marvelon Mercilon Microgynon 30 Norimin Ovysmen Trinordiol TriNovum
7.3.2 Progestogen-only contraceptives
Femulen Micronor Norgeston Mirena intrauterine system
Emergency contraception
Levonelle-2 tablets
7.3.4 Contraceptive devices
GyneFix intra-uterine device
7.4 Drugs used for genito-urinary disorders
7.4.1 Drugs for urinary retention
Prazosin tablets Doxazosin tablets Bethanechol tablets
Alfuzosin tablets and modified release tablets ) Tamsulosin modified release capsules ) 2nd line Terazosin tablets )
7.4.2 Drugs for urinary frequency, enuresis and incontinence
Duloxetine capsules (stress incontinence 2nd line after physio and pelvic floor exercises) Imipramine tablets and syrup Oxybutynin tablets and elixir (NICE first choice) Oxybutynin MR tablets, patches Propantheline tablets Propiverine tablets Solifenacin Tolterodine tablets and modified release capsules
7.4.3 Drugs used in urological pain
Potassium citrate mixture
7.4.4 Bladder instillations and urological surgery
Sodium chloride 0.9% Chlorhexidine 0.02% Sodium hyaluronate (Cystistat) (Specialist use only – limited evidence of benefit) 20
7.4.5 Drugs for erectile dysfunction
Alprostadil (Specialist Use Only) Apomorphine sublingual tablets (Specialist Use Only - patients on nitrates unable to have sildenafil) Sildenafil, tadalafil and vardenafil tablets (Specialist Use Only)
8 MALIGNANT DISEASE & IMMUNOSUPPRESSION
8.1 Cytotoxic drugs
Drugs for cytotoxic-induced side-effects
Calcium folinate tablets and injection Mesna tablets and injection
8.1.1 Alkylating drugs
Busulfan tablets Carmustine injection Chlorambucil tablets Cyclophosphamide tablets and injection Estramustine capsules Ifosfamide injection Lomustine capsules Melphalan tablets and injection Thiotepa injection Treosulfan capsules and injection
8.1.2 Cytotoxic antibiotics
Bleomycin injection Dactinomycin injection Daunorubicin injection Doxorubicin injection Doxorubicin pegylated liposomal infusion (NICE guidance) Epirubicin injection Idarubicin capsules and injection Mitomycin injection Mitoxantrone/mitozantrone injection
8.1.3 Antimetabolites
Capecitabine tablets Cladribine injection Cytarabine injection Cytarabine liposomal for intrathecal use Fludarabine tablets (NICE guidance) OR with cyclophosphamide for CLL in patients <70years Fluorouracil injection and cream Gemcitabine injection (NICE guidance) Mercaptopurine tablets Methotrexate tablets and injection Permetrexed – when used according to NICE TA181 Ralitrexed injection (NICE guidance) Tioguanine (thioguanine) tablets
8.1.4 Vinca alkaloids and etoposide
Etoposide capsules and injection Vinblastine injection 21 Vincristine injection Vindesine injection Vinorelbine injection (and oral if single agent or for administration at a different time than other IV agents)
8.1.5 Other antineoplastic drugs
Amsacrine injection Bortezomib (NICE guidance) Dacarbazine injection Hydroxycarbamide/hydroxyurea capsules Imatinib capsules (NICE guidance) Carboplatin injection Cetuximab (NICE guidance when for 1st line metastatic colorectal cancer) Cisplatin injection Dasatinib (for CML only if a patient becomes refractory to imatinib) Nilotinib (for CML only if a patient becomes refractory to imatinib and dasatinib) Procarbazine capsules Razoxane tablets Docetaxel injection (NICE guidance) Paclitaxel injection (NICE guidance) Irinotecan injection (NICE guidance) Trastuzumab injection (NICE guidance) Sunitinib – only when used according to NICE TA179
8.2 Drugs affecting the immune response
8.2.1 Antiproliferative immunosuppressants
Azathioprine tablets
8.2.2. Corticosteroids and other immunosuppressants
Ciclosporin capsules and oral solution
8.2.3 Rituximab and alemtuzimab
Rituximab injection (NICE guidance)
8.2.4 Other immunomodulating drugs
Interferon alfa injection BCG bladder instillation Thalidomide (Specialists following approved safety and therapeutic protocols only. Seek pharmacy advice, a high-cost drug application is required for some indications)
8.3 Sex hormones & hormone antagonists in malignant disease
8.3.1 Oestrogens
Ethinylestradiol tablets
8.3.2 Progestogens
Medroxyprogesterone acetate tablets Megestrol acetate tablets Norethisterone tablets
8.3.4 Hormone antagonists
Tamoxifen tablets 22 Anastrozole tablets Exemestane tablets Letrozole tablets Bicalutamide tablets Cyproterone acetate tablets Flutamide tablets Goserelin implant Octreotide injection
9 NUTRITION AND BLOOD
9.1 Anaemias and some other blood disorders
9.1.1 Iron-deficiency anaemia
Ferrous sulphate tablets Iron and folic acid tablets (Pregaday) Ferrous fumarate syrup Polysaccharide-iron complex elixir Iron sucrose injection (Not for routine use) Iron dextran injection (Not for routine use)
9.1.2 Drugs used in megaloblastic anaemias
Hydroxocobalamin injection Folic acid tablets and injection
9.1.3 Drugs used in hypoplastic, haemolytic, and renal anaemias
Darbopoetin – APC approved in principle (Feb09) the use of darbepoetin in low-risk MDS patients, with agreed positive predictors of response. Agreement of a local service would require a full proposal to be developed and submitted to the PCT for agreement on service delivery. Desferrioxamine Deferasirox – see APC guideline
9.1.4 Drugs used in autoimmune thrombocytopenic purpura
Consultant request
9.2 Fluids and electrolytes
9.2.1 Oral preparations for fluid and electrolyte imbalance
Dioralyte, Rehidrat or Electrolade (Subject to Contract) Potassium chloride effervescent tablets and syrup Slow Sodium tablets Calcium Resonium
9.2.2 Parenteral preparations for fluid and electrolyte imbalance
9.2.2.1 Electrolytes and water
All available
Intravenous potassium
Concentrated potassium solutions (requiring dilution before use) and strong potassium infusions (>40mmol/l) may only be stocked in pharmacy, ITU, HDU, CCU, NICU and Theatre (WRH) as per guidelines from the National Patient Safety Agency. Commercially prepared ready diluted potassium solutions should be used where possible. These are also available out of hours. For further
23 information read ‘Supply, storage and handling of strong potassium infusions and concentrated potassium solutions’ circulated as an addition to the Trust’s Medicines Policy
Potassium chloride and glucose 5% intravenous infusion containing K+ 10mmol/bag 500ml 20mmol/bag 500ml and 1 litre 40mmol/bag 500ml (WRH) and 1 litre
Potassium chloride and glucose 10% intravenous infusion containing K+ 10mmol/bag 500ml (Adult DKA protocol) 20mmol/bag 500ml (WRH)
Potassium chloride and sodium chloride 0.9% intravenous infusion containing K+ 10mmol/bag 500ml 20mmol/bag 500ml and 1 litre 40mmol/bag 500ml and 1 litre 60mmol/bag 1 litre 80mmol/bag 1 litre 100mmol/bag 1 litre (Alex)
Potassium chloride, sodium chloride 0.18% and glucose 4% intravenous infusion containing K+ 10mmol/bag 500ml 20mmol/bag 500ml and 1 litre 40mmol/bag 1 litre
Potassium chloride, sodium chloride 0.45% and glucose 5% intravenous infusion containing K+ 10mmol/bag 500ml (Paediatric DKA protocol) 20mmol/bag 500ml (Paediatric Pyloric Stenosis protocol)
9.2.2.2 Plasma and plasma substitutes
Gelofusine Hespan Dextran 40 & 70 Haemaccel Volulyte (ITU) Volplex
9.3 Intravenous nutrition
24 hours notice required for TPN
9.4 Oral nutrition
Limited range of enteral and supplementary feeds available. For further information contact dietitians who are able to prescribe feeds on the drug chart
9.5 Minerals
Calcium Sandoz tablets and syrup Calcium carbonate tablets (Calcichew or equivalent) Calcium gluconate injection
Others are available on Consultant request NOTE: Hyperphosphataemia in chronic renal failure – prescribing of Lanthanum by confident/competent GPs is supported within the PCT second line following failure/intolerance to Sevelamer
9.6 Vitamins
24 9.6.2 Vitamin B Group
Thiamine tablets 100mg Pyridoxine tablets 10mg and 50mg Vitamin B tablets compound strong High Potency Vitamin B & C injection
Others available on Consultant request
9.6.3 Vitamin C
Ascorbic acid 500mg
9.6.4 Vitamin D
Calcium carbonate and cholecalciferol tablets (Adcal-D3 tablets or Calfovit-D3 granules if patients cannot chew tablets or tolerate Adcal-D3) Calciferol injection and solution (Paediatrics) Alfacalcidol capsules and syrup
9.6.5 Vitamin E
Alpha tocopheryl acetate
9.6.6 Vitamin K
Phytomenadione injection (Konakion MM available for IM or oral use in Paediatrics) Menadiol sodium phosphate tablets
9.6.7 Multivitamin preparations
Dalivit drops or equivalent
9.7 Bitters and tonics
Not available
9.8 Metabolic disorders
Consultant request
10 MUSCULOSKELETAL AND JOINT DISEASES
10.1 Drugs used in rheumatic diseases and gout
10.1.1 Non-steroidal anti-inflammatory drugs
Aspirin soluble and e/c tablets Ibuprofen tablets and suspension Diclofenac tablets, injection and suppositories Naproxen tablets, suspension and suppositories Mefenamic acid tablets (gynaecology only) Indomethacin capsules, suspension and suppositories ) Sulindac tablets ) Not to be used 1st line Benorilate suspension ) Nabumetone tablets ) Meloxicam tablets ) Etodolac capsules ) In line with NICE guidance only Etoricoxib tablets (1st line CoxII inhibitor – prescribing by Rheumatologists only)
25 Celecoxib capsules (2nd line CoxII inhibitor – prescribing by Rheumatologists only) Arthrotec tablets (diclofenac + misoprostol) Ketoprofen injection
10.1.2 Corticosteroids
10.1.2.1 Systemic corticosteroids
See Section 6.3
10.1.2.2 Local corticosteroid injections
Methylprednisolone acetate Triamcinolone hexacetonide Dexamethasone sodium phosphate (W) Hydrocortisone acetate (W)
Other local injections
Hyaluronan - approved for OA of the shoulder and ankle when used as described in a currently approved APC protocol
10.1.3 Drugs which suppress the rheumatic disease process
Penicillamine tablets Hydroxychloroquine tablets Sulphasalzine e/c tablets Methotrexate tablets Azathioprine tablets Cyclosporin capsules Chloroquine sulphate tablets Leflunomide tablets (2nd line only) Infliximab infusion (NICE guidance) Etanercept injection (NICE guidance) Adalimumab injection (For psoriatic arthritis, 2nd line to etanercept) Rituximab restricted to anti-TNF treatment failures, specialist rheumatologist only
10.1.4 Gout and cytotoxic-induced hyperuricaemia
Allopurinol tablets (not in acute attack) Probenecid tablets Colchicine (acute attack - max dose, see BNF)
NSAIDs - See also Section 10.1.1
10.2 Drugs used in neuromuscular disorders
10.2.1 Drugs which enhance neuromuscular transmission
Edrophonium injection Neostigmine tablets and injection Pyridostigmine tablets Distigmine bromide tablets
10.2.2 Skeletal muscle relaxants
Diazepam preparations Baclofen tablets and syrup Dantrolene capsules Tizanidine tablets (Consultant only)
26 Nocturnal leg cramps
Quinine sulphate tablets
10.3 Drugs for the relief of soft-tissue inflammation
10.3.1 Enzymes
Hyaluronidase injection
10.3.2 Rubefacients and other topical antirheumatics
Not recommended – limited evidence of benefit
Ketoprofen 2.5% gel 100g non-proprietary Piroxicam 0.5% gel 60g non proprietary
11 EYE
11.3 Anti-infective eye preparations
Chloramphenicol drops and ointment Sodium fusidate viscous drops Gentamicin drops Ciprofloxacin drops (W) Ofloxacin drops Framycetin drops and ointment (W) Propamidine drops (W)
Others available dependant on sensitivity results
Aciclovir ointment
11.4 Corticosteroids and other anti-inflammatory preparations
Betamethasone drops Betamethasone with neomycin drops Dexamethasone drops (Maxidex), also minims Maxitrol drops (Dexamethasone, Neomycin and Polymyxin) Clobetasone butyrate drops (A) Prednisolone drops 0.1% and 0.5% Fluoromethalone drops Sodium cromoglycate drops
11.5 Mydriatics and cycloplegics
Atropine drops and ointment Cyclopentolate drops 0.5 & 1% Tropicamide drops 0.5 & 1% Phenylephrine drops Homatropine drops
11.6 Treatment of glaucoma
Betaxolol drops 0.25 & 0.5% Carteolol drops 1 & 2% Brinzolamide drops Timolol drops and long acting gel 0.25 & 0.5% Cosopt drops (dorzolamide + timolol) Pilocarpine drops 0.5, 1, 2 & 4% 27 Pilocarpine long acting gel 1, 2, & 4% Dipivefrine drops Levobunolol drops Adrenaline drops Brimonidine drops ) Latanoprost drops ) 2nd line - Travoprost drops ) Specialist advice Duotrav ) Bimatoprost ) 2nd line - Bimatoprost 0.03%/Timolol 0.5%Ganfort ) Specialist advice Xalacom drops (latanoprost + timolol) Acetazolamide tablets, capsules and injection
11.7 Local anaesthetics
Proxymetacaine Proxymetacaine & fluorescein Amethocaine drops
11.8 Miscellaneous ophthalmic preparations
Bevacizumab – unlicensed treatment of proliferative diabetic retinopathy (PDR) and neovascular glaucoma (NVG) Hypromellose drops (1st line) Lacrilube ointment (2nd line only) Hyaluronic acid (Oxyal), Sodium hyaluronate (Vismed) (only after secondary care recommendation) Polyvinyl alcohol drops Sodium chloride drops Fluorescein drops Sodium hyaluronate injection Carbomer drops (Gel Tears or equivalent) Ketorolac drops Apraclonidine drops Ranibizumab – NICE use, see APC guidelines
12 EAR, NOSE AND OROPHARYNX
12.1 Drugs acting on the ear
12.1.1 Otitis externa
Betamethasone ear drops Betamethasone with neomycin ear drops Clotrimazole ear drops Triamcinolone ear ointment Chloramphenicol ear drops Acetic acid ear spray (Consultant request only)
12.1.2 Otitis media
See BNF
12.1.3 Removal of ear wax
Sodium bicarbonate ear drops Olive oil ear drops
12.2 Drugs acting on the nose
28 12.2.1 Drugs used in nasal allergy
Beclomethasone preparations (1st line) Fluticasone propionate preparations Fluticasone furoate (Avamys) - treatment of allergic rhinitis, both seasonal and perennial, in people aged 6 years and over, Mometasone nasal spray Triamcinolone nasal spray Sodium cromoglycate preparations
12.2.2 Topical nasal decongestants
Sodium chloride nasal drops Ephedrine nasal drops Xylometazoline Adult and Paediatric nasal drops
12.2.3 Nasal preparations for infection and epistaxis
Naseptin nasal cream Mupirocin (Bactroban) (for MRSA)
12.3 Drugs acting on the oropharynx
12.3.1 Drugs for oral ulceration and inflammation
Hydrocortisone pellets Choline salicylate gel Benzydamine oral rinse and spray
12.3.2 Oropharyngeal anti-infective drugs
Nystatin mixture and lozenges Amphotericin lozenges Miconazole oral gel (Paediatrics)
Notes: See also BNF for other infections
12.3.4 Mouthwashes, gargles and dentifrices
Thymol mouthwash solution tablets Hydrogen peroxide mouthwash Chlorhexidine gluconate mouthwash
12.3.5 Treatment of dry mouth
Glandosane spray Saliva Orthana
13 DRUGS ACTING ON THE SKIN
13.2 Emollient and barrier preparations
13.2.1 Emollients
Aqueous cream Emulsifying ointment Aveeno cream Yellow soft paraffin Liquid paraffin 50% in white soft paraffin Cetraben cream Diprobase 29 Doublebase gel E45 cream Epaderm cream Kamillosan (sore nipples) Unguentum M Balneum Plus Calmurid cream Urea 10% cream Dermol lotion
13.2.1.1 Emollient bath additives
Diprobath Oilatum emollient Emulsiderm
13.2.2 Barrier preparations
Zinc and castor oil ointment Sudocrem cream
13.3 Topical local anaesthetics and antipruritics
Calamine lotion Crotamiton (Eurax) ointment and lotion Doxepin cream (not 1st line)
13.4 Topical corticosteroids
Preparations containing the lowest potency at lowest strength should be used 1st line
Mild potency
Hydrocortisone cream or ointment Alphaderm cream (hydrocortisone + urea)
Canesten HC (hydrocortisone + clotrimazole) Daktacort (hydrocortisone + miconazole) (W) (K) Nystaform-HC (hydrocortisone + nystatin + chlorhexidine) (W) (K) Fucidin H (hydrocortisone + fusidic acid) (W) (K) Vioform-Hydrocortisone (hydrocortisone + clioquinol) (W) Timodine cream (hydrocortisone + nystatin + benzylkonium chloride) (W)
Moderate potency
Clobetasone butyrate (Eumovate) Betamethasone cream 0.025% and ointment 0.025% (Betnovate RD)
Trimovate (clobetasone + oxytetracycline + nystatin) cream
Potent
Betamethasone 0.1% cream Hydrocortisone butyrate (Locoid) Fluocinonide (Metosyn) ointment Fluocinolone (Synalar) cream, ointment and gel Fluticasone propionate (Cutivate) cream Mometasone furoate (Elocon)
Betnovate-C (betamethasone + clioquinol) cream and ointment 30 Diprosalic (betamethasone + salicylic acid) ointment and scalp application Fucibet (betamethasone + fusidic acid) Locoid-C (hydrocortisone + chlorquinaldol) cream
Very potent
Clobetasol propionate (Dermovate) ) Hospital Consultant Dermovate-NN (clobetasone propionate + neomycin + nystatin) ) use only Diflucortolone valerate (Nerisone Forte) oily cream and ointment )
13.5 Preparations for eczema and psoriasis
Alphosyl HC cream Dithrocream – potent Adalimumab for psoriasis following NICE, specialist dermatologist only Efalizumab for psoriasis following NICE, specialist dermatologist only Etanercept for psoriasis following NICE, specialist dermatologist only Ustekinumab for psoriasis following NICE, specialist dermatologist only see NICE TA180 Pasta Picis Mitis (Mild Coal Tar paste) Polytar emollient Calcipotriol (Dovonex) cream Use Calcitriol (Silkis) if ointment is required Dovobet – only when used as described in the current APC guidelines Xamiol gel - in the treatment of scalp psoriasis, should only be initiated by a Consultant Dermatologist, or GP with Special Interest, in patients who have demonstrated an inadequate response to first line topical steroids Acitretin capsules ) Alitretinoin ) Cyclosporin capsules ) (Specialist Dermatologist only) Methotrexate tablets ) Tacrolimus ointment (Specialist Dermatologist use only for patients unresponsive to all other therapy) Pimecrolimus cream (as per NICE guidance only) See also Section 13.2
13.6 Acne and rosacea
Benzoyl peroxide gel, 5% and 10% Clindamycin (Dalacin T) topical solution Zineryt (erythromycin) solution Oxytetracycline tablets Minocycline tablets (not 1st line) Erythromycin tablets Isotretinoin capsules (Specialist Dermatologist only) Tretinoin (Retin-A) cream and gel (Dermatologist only) Dianette tablets
13.7 Preparations for warts and calluses
Salactol paint Warticon (genital warts) Fluorouracil cream Imiquimod cream (Specialist Use Only) Silver nitrate caustic sticks
13.8 Sunscreens and camouflages
RoC Total Sunblock UVA + UVB 25 Uvistat UVA + UVB 15
31 13.9 Shampoos and other scalp preparations
Polytar liquid Capasal shampoo Ceanel Concentrate shampoo Ketoconazole shampoo Cocois scalp ointment (W) (K)
13.10 Anti-infective skin preparations
Topical antibiotics not generally recommended - See Section 13.11 Mupirocin ointment Silver sulphadiazine cream Fusidic acid cream Clotrimazole cream Metronidazole gel Miconazole cream Nystatin cream Terbinafine cream Aciclovir cream Malathion (Derbac M) Carbaryl lotion (A) Permethrin cream rinse (head lice) and cream (scabies) - Please check local policy
13.11 Skin disinfectants and cleansers
Sodium chloride 0.9% solution Weak iodine solution Povidone-iodine aqueous and alcoholic solutions, spray and ointment Chlorhexidine cream, aqueous and alcoholic solution Chlorhexidine and cetrimide solution (Savlodil or Tisept) Hydrogen peroxide 1:20 solution Potassium permanganate solution tablets Ster-Zac powder
13.12 Antiperspirants
Aluminium chloride hexahydrate 20% solution – Driclor or equivalent
13.13 Wound management products
Dressings are expensive and have specific uses. See dressings information sheet on ward for choice and use of dressings or discuss with a Trust Tissue Viability representative. The following preparations are included in the Worcestershire Acute, Community and Mental Health Tissue Viability Policy, which contains advice on specific preparations.
Alginate dressings
Algisite M dressing Algisite M Rope Melgisorb Aquacel ribbon
Hydrocolloid dressings
Tegasorb Hydrocoll Hydrocoll thin Duoderm extra thin 32 Granuflex
Hydrogels
Intrasite Nu-gel
Polyurethane foam dressings
Lyofoam extra Allevyn
Vapour permeable adhesive film dressings
Mefilm Cutifilm
Paste bandages
Steripaste Ichthopaste
13.14 Topical circulatory preparations
Lasonil
14 IMMUNOLOGICAL PRODUCTS AND VACCINES
14.4 Vaccines and antisera
See BNF for immunisation schedules and details of individual vaccines
BCG vaccine Diphtheria, tetanus and acellular pertussis vaccine (Infanrix) Diphtheria and tetanus vaccine (child) (only if Infanrix contra-indicated) Diphtheria and tetanus vaccine (adults and adolescents) Diphtheria vaccine (adults and adolescents) Haemophilus influenzae type B vaccine (ACT-HIB) Haemophilus influenzae type B + DTP (ACT-HIB DTP) Hepatitis A vaccine Hepatitis B vaccine MMR (Measles, mumps and rubella) vaccine Meningococcal C vaccine Pneumococcal vaccine Polio vaccine (oral and inactivated) Rubella vaccine Tetanus vaccine Tuberculin PPD (Heaf test)
14.5 Immunoglobulins
Human normal immunoglobulin Others available on request
15 ANAESTHESIA
15.1 General anaesthesia
15.1.1 Intravenous anaesthetics
33 Thiopentone sodium Etomidate emulsion injection Ketamine Propofol
15.1.2 Inhalational anaesthetics
Isoflurane Sevoflurane
Others by Consultant agreement
15.1.3 Antimuscarinic drugs
Atropine sulphate injection Glycopyrronium bromide injection Hyoscine hydrobromide injection
15.1.4 Sedative and analgesic peri-operative drugs
15.1.4.1 Anxiolytics and neuroleptics
Diazepam injection Lorazepam tablets Midazolam injection Temazepam tablets
15.1.4.2 Non-opioid analgesics
Ketorolac injection
15.1.4.3 Opioid analgesics
Alfentanil injection Fentanyl injection Remifentanil injection
15.1.5 Muscle relaxants
Atracurium besilate injection Cisatracurium injection Mivacurium injection Rocuronium bromide injection Vecuronium bromide injection Suxamethonium chloride injection
15.1.6 Anticholinesterases used in anaesthesia
Neostigmine methylsulphate injection Neostigmine + glycopyrronium bromide injection Other drugs for reversal of neuromuscular blockade Suggammadex - for the reversal of neuromuscular block in anaesthesia induced by rocuronium or vecuronium, when suxamethonium is contra-indicated.
15.1.7 Antagonists for central and respiratory depression
Doxapram hydrochloride injection Flumazenil injection Naloxone Adult injection 15.1.8 Drugs for malignant hyperthermia
34 Dantrolene sodium injection
15.2 Local anaesthesia
Lignocaine injection Lignocaine/adrenaline injection Bupivacaine injection Bupivacaine/adrenaline injection Levobupivacaine injection Prilocaine injection Ropivacaine injection Lignocaine/prilocaine cream (Emla) Tetracaine (amethocaine) gel (Ametop) Paeds only formularyworcsacute.DOC\DI
35