Medicines Formulary

MEDICINES FORMULARY

Medicines formulary between MCHFT and Primary Care as agreed by the Joint Medicines Management Group

Introduction Welcome to the MCHFT Medicines Formulary. The formulary includes medicines that have been approved by the Joint Medicines Management Group (JMMG) for prescribing within the trust. The purpose of the formulary is to ensure prescribing is evidence based and cost effective. All prescribing within the trust (i.e. inpatient, outpatient and FP10HNC prescribing) must comply with the formulary. This will be monitored on a regular basis. Some drugs may appear in more than one section.

The formulary is arranged in sections corresponding to those in the British National Formulary (BNF) as below; INTRODUCTION ...... 2 UPDATES TO THE FORMULARY (LAST UPDATED MAY 2018)...... 4 1. GASTRO-INTESTINAL SYSTEM ...... 6 2. CARDIOVASCULAR SYSTEM ...... 10 3. RESPIRATORY SYSTEM ...... 16 4. CENTRAL NERVOUS SYSTEM ...... 20 5. INFECTIONS ...... 27 6. ENDOCRINE SYSTEM ...... 30 7. OBSTETRICS, GYNAECOLOGY AND URINARY-TRACT DISORDERS ...... 36 8. MALIGNANT DISEASE AND IMMUNOSUPPRESSION ...... 39 9. NUTRITION AND BLOOD...... 47 10. MUSCULOSKELETAL AND JOINT DISORDERS ...... 52 11. EYE ...... 55 12. EAR, NOSE AND OROPHARYNX ...... 59 13. SKIN ...... 61 14. IMMUNOLOGICAL PRODUCTS AND VACCINES ...... 67 15. ANAESTHESIA ...... 68

(Last updated May 2018) Page 1 of 69

i Introduction

Operation of the Formulary

Items available for general prescribing and restricted items are identified according to the following colour coding;

Item Colour Code

Items available for general prescribing Second line/use on specialist advice Consultant prescribing only Removed from the Formulary/Do not prescribe

Where a drug is the subject of a NICE Technology Appraisal (TA) the reference number of the guidance is given below the drug entry. Where a drug has been approved by the Joint Medicines Management Group (JMMG, formerly a committee named JMMC) the month and year of the relevant meeting is also listed below the drug entry.

NICE guidance can be found at; Technology Appraisals (TA) http://www.nice.org.uk/guidance/published?type=ta Clinical Guidelines (CG) http://www.nice.org.uk/guidance/published?type=cg

MHRA Alerts and recalls on drugs and medical devices https://www.gov.uk/drug-device-alerts

Patients taking a non-formulary drug on admission

Treatment with a non-formulary drug may be continued in this instance; however it must be borne in mind that there may be a delay in obtaining a non-formulary drug.

Additions to the formulary

The addition of a new drug or preparation will only be made after approval by the Joint Medicines Management Group. To request an addition to the formulary a New Product Request (NPR) form must be submitted to the JMMG. This form can be found under Frequently Used Forms- Medicines Management on the trust intranet.

New non-formulary drugs required for an individual patient in exceptional circumstances

Such an application for a “one-off” use may be made to the chairperson of the JMMG, if the drug is required before the next JMMG meeting.

Local Health Economy (LHE) Formulary Policy (Vale Royal, South Cheshire and Eastern Cheshire areas).

The LHE Formulary is intended to cover prescriptions written in primary care or recommendations by hospital doctors in respect of outpatients or patients leaving hospital after an admission. This is a good point of reference to confirm the continuation of medicines in Primary Care after initiation at MCHFT.

The Area Prescribing Group (APG) agrees on a formulary status of medicines. These are designated by the following colours:

• Green = Recommended • Green/Yellow = On formulary • Yellow = A second or third line option within a drug group

(Last updated May 2018) Page 2 of 69

• Pink (Specialist Recommendation) = Medicines that can safely be initiated in primary care on the recommendation of a specialist • Pink (Specialist Initiation) = Medicines that require specialist initiation and/or stabilisation before prescribing is transferred to primary care • Pink (Shared Care) = Medicines that require a more formal shared-care approach including regular secondary care review and monitoring • Purple = Consultant/ Specialist only prescribing • Red = Discouraged • Grey = Discouraged; not considered suitable for prescribing • Blue = No formulary decision made / formulary position not yet considered (not to be prescribed until a formulary status has been agreed)

The Formulary is available on the Medicines Management Team website: http://www.centralandeasterncheshiremmt.nhs.uk

(Last updated May 2018) Page 3 of 69

ii Updates to the formulary

UPDATES TO THE FORMULARY 2018

Date BNF Update Details Section See formulary entry for full details May 8.1.5 Avelumab 2018 Obinutuzumab Pembrolizumab 9.6.7 Paravit CF capsules & liquid 13.5.3 Brodalumab April 3.2 Fluticasone furoate/ vilanterol/ umeclidinium inhaler (Trelegy®) 2018 4.7 Methoxyflurane (Penthrox®) 6.1.2.3 Alogliptin 6.4.1.1 Raloxifene(update) Teriparatide (update) 8.1 Tivozanib 8.1.5 Cabozantinib Daratumumab Eribulin Pertuzumab Regorafenib 10.4 Autologous chondrocyte implantation using chondrosphere March 1.2 Eluxadoline to be used as for treating adults with irritable bowel syndrome with 2018 diarrhoea. Treatment pathway link added, as agreed at APG March 2018. 6.2.1 Thyroid (update to formulary status) 6.4.1.2 Medicines Safety Alert: ulipristal acetate (Esmya®). Reclassification of formulary status as GREY (Removed from the Formulary/Do not prescribe) 5.3.3.2 Sofosbuvir–velpatasvir–voxilaprevir 8.1.5 Ibrutinib Ixazomib Pembrolizumab Trastuzumab 11.4.1 Dexamethasone Intravitreal Implant 11.4.2 Adalimumab February 5.1.2.3 Ceftazidime/Avibactam 2018 8.1.5 Ceritinib 5.1.7 Dalbavanacin 8.3.4.1 Fulvestrant 5.3.3.2 Glecaprevir–pibrentasvir 10.1.3 Golimumab 8.1.5 Lenvatinib 3.11 Pirfenidone 8.1.5 Ribociclib

‘Items which should not be routinely prescribed in primary care: Guidance for CCGs’ NHS England 30/11/17. Formulary has been updated with the key recommendations: 2.5.4 Doxazosin MR tablets 2.12 Omega-3-acid ethyl esters 4.3.1 Dosulepin capsules and tablets 15.2 Lidocaine plasters 5% January 4.5.2 Naltrexone–bupropion 2018 8.1.3 Cladribine 8.1.5 Atezolizumab Ibrutinib Palbociclib (Last updated May 2018) Page 4 of 69

Regorafenib Venetoclax 8.2.3 Vismodegib 11.8.2 Nivolumab Aflibercept (Eylea®) December 4.4 Methylphenidate (Xaggitin XL® & Delmosart XL® brands) 2017 8.1.5 Brentuximab vedotin 8.2.3 Nivolumab 10.1.3 Sarilumab

(Last updated May 2018) Page 5 of 69

1 Gastro-Intestinal System 1.1 Dyspepsia and gastro-oesophogeal reflux-disease 1.1.1 Antacids and simeticone MAGNESIUM TRISILICATE MIXTURE SIMETICONE LIQUID SODIUM CITRATE ORAL SOLUTION - OXETACAINE ANTACID SUSPENSION - On Christies recommendation 1.1.2 Compound alginates and proprietary indigestion preparations GAVISCON® ADVANCE SF SUSPENSION and TABLETS GAVISCON® INFANT DUAL-SACHETS GAVISON® SF LIQUID (Aniseed)

1.2 Antispasmodics and other drugs altering gut motility Antimuscarinics DICYCLOVERINE LIQUID and TABLETS HYOSCINE BUTYLBROMIDE INJECTION and TABLETS HYOSCINE HYDROBROMIDE TRANSDERMAL PATCH 1.5MG JMMG Approved Nov 2017 – off-label for symptomatic treatment of severe sialorrhoea in children and adolescents aged 3 years and older with chronic neurological disorders PRIMARY CARE: Pink (Specialist Recommendation) – Agreed at APG Jan 2018 GLYCOPYRRONIUM ORAL LIQUID (320 MICROGRAMS / ML) (SIALANAR®) JMMG Approved Nov 2017 – for symptomatic treatment of severe sialorrhoea in children and adolescents aged 3 years and older with chronic neurological disorders PRIMARY CARE: Pink (Specialist Recommendation) – Agreed at APG Jan 2018 KOLANTICON® GEL Other antispasmodics ALVERINE CITRATE CAPSULES MEBERINE 135mg TABLETS PEPPERMIINT OIL E/C CAPSULES (Mintec®) MEBEVERINE 50mg/5ml LIQUID ELUXADOLINE TABLETS NICE guidance TA471 - for treating irritable bowel syndrome with diarrhoea. JMMG Approved Oct 2017 PRIMARY CARE: Pink (Specialist Initiation as per pathway agreed at APG March 2018)

1.3 Antisecretory drugs and mucosal protectants 1.3.1 H2 receptor antagonists RANITIDINE INJECTION LIQUID and TABLETS RANITIDINE 150mg EFFERVESCENT TABLETS 1.3.2 Selective antimuscarinics – No products on formulary 1.3.3 Chelates and complexes – No products on formulary 1.3.4 Prostaglandin analogues MISOPROSTOL 200microgram TABLETS 1.3.5 Proton pump inhibitors LANSOPRAZOLE CAPSULES OMEPRAZOLE CAPSULES AND INJECTION PANTOPRAZOLE TABLETS ESOMEPRAZOLE CAPSULES - Restricted for use in severe GORD LANSOPRAZOLE ORODISPERSIBLE TABLETS - For use in patients with swallowing difficulties only OMEPRAZOLE DISPERSIBLE TABLETS - For use in patients with swallowing difficulties only RABEPRAZOLE TABLETS

(Last updated May 2018) Page 6 of 69

1.4 Acute Diarrhoea 1.4.1 Adsorbents and bulk-forming drugs – No products on formulary 1.4.2 Antimotility drugs LOPERAMIDE CAPSULES and LIQUID 1.4.3 Enkephalinase inhibitors RACECADOTRIL - JMMC Approved Dec 2012 for treatment of acute diarrhoea in paediatrics

1.5 Chronic bowel disorder 1.5.1 Aminosalicylates BALSALAZIDE 750mg CAPSULES MESALAZINE 1g FOAM ENEMA ( Asacol® or Salofalk®) MESALAZINE 500mg SACHETS (Salofalk®) MESALAZINE 1g M/R SACHETS (Pentasa®) MESALAZINE SUPPOSITORIES MESALAZINE E/C; M/R TABLETS (Octasa®) MESALAZINE 500mg M/R TABLETS (Pentasa®) MESALAZINE 250mg E/C TABLETS (Salofalk®) SULFASALAZINE LIQUID, SUPPOSITORIES and TABLETS MESALAZINE 1200mg M/R TABLETS (Mezavant®) 1.5.2 Corticosteroids PREDNISOLONE 20mg FOAM AEROSOL PREDNISOLONE 20mg in 100ml ENEMA PREDNISOLONE 5mg SUPPOSITORIES BUDESONIDE PROLONGED RELEASE TABLETS (Cortiment®) JMMG Approved November 2016 – secondary care only BUDESONIDE 3mg E/C CAPSULES (Budenofalk®) BUDESONIDE 3mg M/R CAPSULES (Entocort®) 1.5.3 Drugs affecting the immune response AZATHIOPRINE MERCAPTOPURINE METHOTREXATE Cytokine modulators ADALIMUMAB INJECTION - NICE guidance TA187 – Crohn’s disease JMMC Approved Jun 2008 NICE guidance TA329 (includes review of TA140 and TA262) – treatment of moderate to severe ulcerative colitis after failure of conventional therapy JMMC Approved May 2015 INFLIXIMAB - NICE guidance TA163 – Ulcerative colitis (acute exacerbations) NICE guidance TA187 – Crohn’s disease NICE guidance TA329 (includes review of TA140 and TA262) – treatment of moderate to severe ulcerative colitis after failure of conventional therapy JMMC Approved May 2015 GOLIMUMAB- NICE guidance TA329 (includes review of TA140 and TA262) – treatment of moderate to severe ulcerative colitis after failure of conventional therapy JMMC Approved May 2015 VEDOLIZUMAB- NICE guidance TA342 – Moderate to severe active ulcerative colitis JMMC Approved Aug 2015 NICE guidance TA352 – Moderate to severe active Crohn’s disease after prior therapy JMMC Approved Oct 2015 USTEKINUMAB - NICE guidance TA456 – Moderately to severely active Crohn’s disease after previous treatment JMMG Approved Sep 2017 1.5.4 Food allergy - No products on formulary

(Last updated May 2018) Page 7 of 69

1.6 Laxatives 1.6.1 Bulk-forming laxatives ISPAGHULA HUSK SACHETS (Fybogel® orange) METHYLCELLULOSE 500mg TABLETS NOMACOL® PLUS SACHETS NORMACOL® SACHETS 1.6.2 Stimulant laxatives BISACODYL SUPPOSITORIES and TABLETS DOCUSATE SODIUM CAPSULES and LIQUID GLYCEROL SUPPOSITORIES SENNA LIQUID and TABLETS CO-DANTHRAMER CAPSULES and LIQUID - Only for constipation in terminally ill patients of all ages CO-DANTHRUSATE CAPSULES and LIQUID - Only for constipation in terminally ill patients of all ages 1.6.3 Faecal softeners ARACHIS OIL ENEMA (130ML) LIQUID PARAFFIN 1.6.4 Osmotic laxatives LACTULOSE SOLUTION MACROGOL 3350 SACHETS (Laxido®) MOVICOL® PAEDIATRIC SACHETS MOVICOL® HALF SACHETS PHOSPHATE ENEMA (133ml) SODIUM CITRATE (RECTAL) (Micolette®/Micralax®/Relaxit® Micro-enemas) 1.6.5 Bowel cleansing preparations KLEAN-PREP® SACHETS PICOLAX® SACHETS MOVI-PREP® SACHETS – JMMC Approved Oct 2011 1.6.6 Peripheral opiod-receptor antagonists – NALOXEGOL TABLETS- NICE guidance TA345 – Opioid induced constipation JMMC Approved Oct 2015

1.6.7 5HT4 receptor agonists and guanylate cyclase-C receptor agonists LINACLOTIDE CAPSULES- JMMC Approved Feb 2015 – Use in accordance with Area Prescribing Committee (APC) pathway LUBIPROSTONE 24microgram CAPSULES – NICE guidance TA318 – Chronic idiopathic constipation JMMC Approved Oct 2014 PRUCALOPRIDE 2mg TABLETS - NICE guidance TA211 – Constipation (women) JMMC Approved Mar 2011

1.7 Local preparations for anal and rectal disorders 1.7.1 Soothing haemorrhoidal preparations ANACAL® OINTMENT ANUSOL® OINTMENT ANUSOL® SUPPOSITORIES 1.7.2 Compound haemorrhoidal preparations with corticosteroids ANUSOL-HC® OINTMENT SCHERIPROCT® OINTMENT 1.7.3 Rectal sclerosants PHENOL 5% INJECTION OILY GLYCERYL TRINITRATE 0.4% RECTAL OINTMENT 1.7.4 Management of anal fissures GLYCERYL TRINITRATE 0.4% RECTAL OINTMENT (Rectogesic®)

(Last updated May 2018) Page 8 of 69

1.8 Stoma care STOMAHESIVE® PASTE

1.9 Drugs affecting intestinal secretions 1.9.1 Drugs affecting biliary composition and flow URSODEOXYCHOLIC ACID CAPSULES LIQUID and TABLETS 1.9.2 Bile acid sequestrants COLESTYRAMINE SACHETS 1.9.3 Aprotinin - Product no longer used 1.9.4 Pancreatin CREON® 10,000 CAPSULES CREON® 25,000 CAPSULES CREON® 40,000 CAPSULES NUTRIZYM 10® CAPSULES PANCREX®

(Last updated May 2018) Page 9 of 69

2 Cardiovascular system 2.1 Positive inotropic drugs 2.1.1 Cardiac glycosides DIGOXIN INJECTION, LIQUID and TABLETS DIGIFAB® INJECTION - JMMC Approved Sep 2012 2.1.2 Phosphodiesterase type-3 inhibitors ENOXIMONE INJECTION MILRINONE INJECTION

2.2 Diuretics 2.2.1 Thiazides and related diuretics BENDROFLUMETHIAZIDE TABLETS – Indapamide preferred for new patients NICE CG34 CHLORTALIDONE TABLETS – First line option NICE CG34 NB: only 50mg tablets available CYCLOPENTIAZIDE TABLETS INDAPAMIDE 2.5mg TABLETS – First line option NICE CG34 METOLAZONE 5mg TABLETS INDAPAMIDE 1.5mg M/R TABLETS 2.2.2 Loop diuretics BUMETANIDE LIQUID and TABLETS FUROSEMIDE INJECTION, LIQUID and TABLETS 2.2.3 Potassium-sparing diuretics and aldosterone antagonists AMILORIDE LIQUID and TABLETS Aldosterone antagonists SPIRONOLACTONE TABLETS EPLERENONE TABLETS – JMMC Approved Mar 2008 for use in cardiology 2.2.4 Potassium-sparing diuretics with other diuretics Amiloride with thiazides CO-AMILOZIDE TABLETS AMILORIDE 2.5mg & CYCLOPENTHIAZIDE 250microgram TABLETS (Navispare®) Amiloride with loop diuretics BUMETANIDE1mg & AMILORIDE 5mg TABLETS CO-AMILOFRUSE TABLETS 2.2.5 Osmotic diuretics MANNITOL INFUSION 10% and 20% 2.2.6 Mercurial diuretics - No products on formulary 2.2.7 Carbonic anhydrase inhibitors - No products on formulary 2.2.8 Diuretics with potassium – No products on formulary

2.3 Anti-arrythmic drugs 2.3.2 Drugs for arrythmias Supraventricular arrythmias ADENOSINE INJECTION DRONEDARONE 400mg TABLETS - NICE guidance TA197 – Atrial fibrillation JMMC Nov 2011 for secondary care prescribing only Supraventricular and ventricular arrythmias AMIODARONE INJECTION LIQUID and TABLETS FLECAINIDE INJECTION and TABLETS DISOPYRAMIDE CAPSULES INJECTION and TABLETS PROPAFENONE 150mg TABLETS Ventricular arrythmias LIDOCAINE 0.2% in GLUCOSE 5% INFUSION

(Last updated May 2018) Page 10 of 69

2.4 Beta-adrenoceptor blocking drugs ATENOLOL INJECTION, LIQUID and TABLETS BISOPROLOL TABLETS CARVEDIOL TABLETS CO-TENIDONE TABLETS ESMOLOL INJECTION LABETALOL INJECTION and TABLETS METOPROLOL TABLETS PROPRANOLOL CAPSULES, INJECTION and TABLETS PROPRANOLOL 40mg/5ml SF SOLUTION PROPRANOLOL 50mg/5ml SF SOLUTION CELIPROLOL TABLETS METOPROLOL 5mg/5ml INJECTION NEBIVOLOL TABLETS OXPRENOLOL TABLETS PROPRANOLOL 5mg/5ml SF SOLUTION PROPRANOLOL 80mg/5ml SF SOLUTION NADOLOL TABLETS SOTALOL TABLETS

2.5 Hypertension and heart failure 2.5.1 Vasodilator antihypertensive drugs HYDRALAZINE INJECTION and TABLETS SILDENAFIL – JMMC Approved Jan 2011 Pulmonary arterial hypertension in paediatrics TOLAZOLINE INJECTION DIAZOXIDE 50mg/1mL ORAL SOLUTION 2.5.2 Centrally acting antihypertensive drugs CLONIDINE INJECTION MOXONIDINE TABLETS METHYLDOPA TABLETS 2.5.3 Adrenergic neurone blocking drugs GUANETHIDINE INJECTION 2.5.4 Alpha-adrenergic neurone blocking drugs DOXAZOSIN TABLETS Please note: MODIFIED RELEASE formulations appear in the NHSE list of medicines that should not be routinely prescribed in Primary Care. Modified release is MCHFT approved for use in continuation of existing treatment. New patients should not be started at MCHFT. Phaeochromocytoma PHENOXYBENZAMINE INJECTION and TABLETS PHENTOLAMINE INJECTION 2.5.5 Drugs affecting the renin-angiotensin system 2.5.5.1 Angiotensin-converting enzyme inhibitors CAPTOPRIL TABLETS ENALAPRIL TABLETS FOSINOPRIL TABLETS LISINOPRIL TABLETS PERINDOPRIL TABLETS QUINAPRIL TABLETS RAMIPRIL CAPSULES CAPTOPRIL 25mg/5ml SOLUTION 2.5.5.2 Angiotensin-II receptor antagonists CANDESARTAN TABLETS IRBESARTAN LOSARTAN TABLETS VALSARTAN TABLETS SACUBRITIL/VALSARTAN (Entresto®) TABLETS- JMMC Approved Dec 2015 – initiated by cardiology consultants only – MCHfT to maintain supplies NICE guidance TA388- Treating symptomatic chronic heart failure with reduced ejection fraction JMMC Approved May 2016 2.5.5.3 Renin inhibitors ALISKEREN TABLETS - JMMC Approved Jan 2008 for use in cardiology (Last updated May 2018) Page 11 of 69

JMMC Approved Feb 2008 for use in endocrinology

2.6 Nitrates, calcium-channel blockers and other antianginal drugs 2.6.1 Nitrates GLYCERYL TRINITRATE 400microgram S/L SPRAY GLYCERYL TRINITRATE 50mg/50ml INFUSION ISOSORBIDE DINITRATE TABLETS ISOSORBIDE MONONITRATE M/R CAPSULES and M/R TABLETS GLYCERYL TRINITRATE 2mg M/R BUCCAL TABLETS GLYCERYL TRINITRATE 10mg in 24hrs PATCHES GLYCERYL TRINITRATE 5mg in 24hrs PATCHES ISOSORBIDE DINITRATE M/R TABLETS GLYCERYL TRINITRATE 500microgram S/L TABLETS ISOSORBIDE MONONITRATE TABLETS (not M/R) – M/R Preparations preferred as easier to use 2.6.2 Calcium-channel blockers AMLODIPINE DILTIAZEM M/R CAPSULES (Adizem-SR®) - twice daily preparation DILTIAZEM M/R CAPSULES (Angitil SR®) - twice daily preparation DILTIAZEM M/R CAPSULES (Dilzem SR®) - twice daily preparation DILTIAZEM M/R TABLETS (Calcicard-CR®) - twice daily preparation DILTIAZEM M/R TABLETS (Tildiem Retard®) - twice daily preparation DILTIAZEM M/R CAPSULES (Adizem-XL®) – once daily preparation DILTIAZEM M/R CAPSULES (Angitil XL®) - once daily preparation DILTIAZEM M/R CAPSULES (Dilzem XL®) - once daily preparation DILTIAZEM M/R CAPSULES (Slozem®) - once daily preparation DILTIAZEM M/R CAPSULES (Tildiem LA®) - once daily preparation DILTIAZEM M/R CAPSULES (Viazem XL®) - once daily preparation DILTIAZEM 60mg M/R TABLETS NIFEDIPINE10mg CAPSULES NIMODIPINE INFUSION and TABLETS VERAPAMIL INJECTION, LIQUID, M/R CAPSULES, M/R TABLETS and TABLETS FELODIPINE M/R TABLETS LERCANIDIPINE TABLETS 2.6.3 Other antianginal drugs NICORANDIL TABLETS IVABRADINE TABLETS – NICE guidance TA267 – Chronic heart failure JMMC Approved Aug 2013 RANOLAZINE TABLETS - JMMC Approved May 2011 PRIMARY CARE: Pink (Shared Care) in development. Secondary Care to continue supply until Shared Care Pathway has been agreed. 2.6.4 Peripheral vasodilators and related drugs NAFTIDROFURYL CAPSULES - NICE guidance TA223 – Peripheral arterial disease

2.7 Sympathomimetics 2.7.1 Inotropic sympathomimetics ADRENALINE 1 in 1000 (5mg/5ml) INJECTION DOBUTAMINE INJECTION DOPAMINE INJECTION DOPEXAMINE INJECTION ISOPRENALINE INJECTION 2.7.2 Vasoconstrictor sympathomimetics EPHEDRINE INJECTION METARAMINOL INJECTION MIDODRINE TABLETS APG Approved July 2017 – Shared Care Agreement needed for Primary Care prescribing NORADRENALINE INJECTION PHENYLEPHRINE INJECTION 2.7.3 Cardiopulmonary resuscitation ADRENALINE 1 in 10.000 (100microgram/ml) INJECTION

(Last updated May 2018) Page 12 of 69

2.8 Anticoagulants and protamine 2.8.1 Parenteral anticoagulants Heparin HEPARIN SODIUM 1000units/ml INJECTION HEPARIN SODIUM 5000units/ml 5ml VIAL INJECTION HEPARIN SODIUM 5000units/0.2ml INJECTION HEPARIN SODIUM 1000units/ml 5ml VIAL INJECTION HEPARIN SODIUM 500units in 0.9% SODIUM CHLORIDE INFUSION Low molecular weight heparins ENOXAPARIN INJECTION TINZAPARIN INJECTION FONDAPARINUX 2.5mg/0.5ml INJECTION – JMMC Approved Nov 2004 for use in orthopaedics JMMC Approved Feb 2012 for anticoagulation in acute coronary syndrome Heparinoids DANAPAROID INJECTION Argatroban ARGATROBAN 250mg/2.5mL INJECTION- JMMC Approved Oct 2014 Heparin flushes HEPARIN SODIUM 200units/2ml INJECTION HEPARIN SODIUM 50units/5ml INJECTION Epoprostenol EPOPROSTENOL INJECTION 2.8.2 Oral anticoagulants NPSA Alert- Actions that can make anticoagulant therapy safer MCHFT Policies & Procedures – Clinical – Anticoagulation Policy Coumarins and phenindione WARFARIN TABLETS AENOCOUMAROL TABLETS PHENINDIONE TABLETS Dabigatran etexilate (NOAC) DABIGATRAN CAPSULES- NICE guidance TA157 – Venous thromboembolism – (knee and hip replacement surgery) NICE guidance TA249 –Atrial fibrillation JMMC Approved Sep 2012 special requirements for patient counselling and consent JMMC Approved Mar 2013 for use in post hip and knee replacement surgery JMMC Approved May 2013 for use in stroke & systemic embolism NICE guidance T327- Treatment and secondary prevention of deep vein thrombosis and/or pulmonary embolism JMMC Approved April 2015 Apixaban (NOAC) APIXABAN TABLETS - NICE guidance TA245 – Venous thromboembolism – (knee and hip replacement surgery) NICE guidance TA275 - Stroke & systemic embolism (prevention, non-valvular atrial fibrillation) JMMC Approved Mar 2013 for use in post hip and knee replacement surgery JMMC Approved May 2013 for use in stroke & systemic embolism JMMC Approved Feb 2015 for treatment of DVT/PE NICE guidance TA341- Treatment and secondary prevention of deep vein thrombosis and/or pulmonary embolism JMMC Approved Aug 2015 Edoxaban (NOAC) EDOXABAN TABLETS- NICE guidance T354- Treatment and prevention of deep vein thrombosis and/or pulmonary embolism JMMC Approved Oct 2015 Rivaroxaban (NOAC) RIVAROXABAN TABLETS- NICE guidance TA170 – Venous thromboembolism – (knee and hip replacement surgery) NICE guidance TA256 – Atrial fibrillation (stroke prevention) NICE guidance TA261 – Venous thromboembolism JMMC Approved Sep 2012 special requirements for patient counselling and consent JMMC Approved Mar 2013 for use in post hip and knee replacement surgery JMMC Approved May 2013 for use in stroke & systemic embolism JMMC Approved July 2013 for treatment of DVT/PE in patients intolerant of warfarin who would otherwise be treated with enoxaparin JMMC Approved Aug 2013 for treatment and secondary prevention of DVT NICE guidance TA335 – ACS with raised cardiac biomarkers (Last updated May 2018) Page 13 of 69

JMMC Approved Jun 2015 –initiation by consultant cardiologist only 2.8.3 Protamine sulphate PROTAMINE SULPHATE INJECTION 2.8.4 Idarucizumab IDARUCIZUMAB (PRAXBIND®) JMMC Approved Apr 2017 for reversal of dabigatran in major bleeding or emergency surgery. Consultant advice only

2.9 Antiplatelet drugs ASPIRIN 75mg DISPERSIBLE TABLETS CLOPIDOGREL 75mg TABLETS – NICE guidance TA80 – Acute coronary syndromes – See also CG94 NICE guidance TA210 – Vascular disease DIPYRIDAMOLE 200mg M/R CAPSULES - NICE guidance TA210– Vascular disease EPTIFIBATIDE INFUSION and INJECTION - NICE guidance TA47 – Acute coronary syndromes – partially updated by CG94 JMMC Approved Sep 2001 PRASUGREL 10mg TABLETS – NICE guidance TA182 – Acute coronary syndrome JMMC Approved Oct 2014 TICAGRELOR TABLETS– NICE guidance TA236 – Acute coronary syndromes JMMC Approved May 2013 NICE guidance TA420 - Ticagrelor for preventing atherothrombotic events after myocardial infarction JMMC Approved January 2017 ASPIRIN 25mg/DIPYRIDAMOLE 200mg M/R CAPSULE (Asasantin Retard®) ASPIRIN 300mg SUPPOSITORIES - Approval for unlicensed product use JMMC Approved April 2016 DIPYRIDAMOLE LIQUID and TABLETS

2.10 Stable angina, acute coronary syndromes and fibrinolysis 2.10.2 Fibrinolytic drugs STREPTOKINASE INJECTION - NICE guidance TA52 – Myocardial infarction- thrombolysis TENECTEPLASE INJECTION- NICE guidance TA52 – Myocardial infarction- thrombolysis UROKINASE INJECTION ALTEPLASE INJECTION - NICE guidance TA52 – Myocardial infarction- thrombolysis NICE guidance TA264 – Stroke (acute, ischaemic) JMMC Approved for use in stroke Aug 2012

2.11 Antifibrinolytic drugs and haemostatics ETAMSYLATE TABLETS TRANEXAMIC INJECTION and TABLETS FERRIC CHLORIDE 15% SOLUTION FERRIC SUBSULPHATE (MONSEL’S) SOLUTION

2.12 Lipid regulating drugs Statins PRAVASTATIN TABLETS - NICE guidance TA94 – Cardiovascular disease - statins SIMVASTATIN TABLETS - NICE guidance TA94 – Cardiovascular disease - statins ATORVASTATIN TABLETS - NICE guidance TA94 – Cardiovascular disease - statins Bile acid sequestrants COLESTYRAMINE 4g SACHETS COLESTYRAMINE LIGHT 4g SACHETS COLESTIPOL 5g SACHETS Ezetimibe EZETIMIBE TABLETS- (Last updated May 2018) Page 14 of 69

NICE guidance TA385 – treating primary heterozygous-familial and non-familial hypercholesterolaemia JMMC Approved May 2016 Fibrates BEZAFIBRATE 200mg TABLETS BEZAFIBRATE 400mg M/R TABLETS FENOFIBRATE CAPSULES and TABLETS Nicotinic acid group ACIPOMOX Omega-3 fatty acid compounds OMEGA-3-ACID ETHYL ESTERS 1g – Only when patient can’t/won’t tolerate a diet including oily fish Please note: this appears in the NHSE list of medicines that should not be routinely prescribed in Primary Care. Do not prescribe at MCHFT. PCSK9 Inhibitors ALIROCUMAB INJECTION- NICE guidance TA393 – treating primary hypercholesterolaemia or mixed dyslipidaemia JMMC August 2016 – waiting for approval at Area Prescribing Committee EVOLOCUMAB INJECTION- NICE guidance TA394 – treating primary hypercholesterolaemia or mixed dyslipidaemia JMMC August 2016 – waiting for approval at Area Prescribing Committee

2.13 Local sclerosants ETHANOLAMINE OLEATE 5% INJECTION SODIUM TETRADECYL SULPHATE 1% INJECTION SODIUM TETRADECYL SULPHATE 3% INJECTION

(Last updated May 2018) Page 15 of 69

3 Respiratory system 3.1 Bronchodilators 3.1.1 Adrenoceptor agonists 3.1.1.1 Selective beta2 agonists FORMOTEROL FUMARATE 12microgram TURBOHALER® FORMOTEROL FUMARATE 6microgram TURBOHALER® SALBUTAMOL 100microgram AUTOHALER CFC-free (Airomir®) SALBUTAMOL 100microgram INHALER CFC-free SALBUTAMOL 2.5mg/2.5ml NEBULISER SOLUTION SALBUTAMOL 5mg/2.5ml NEBULISER SOLUTION SALBUTAMOL 200microgram ACCUHALER® SALBUTAMOL 2mg/5ml SF LIQUID SALBUTAMOL INJECTION SALMETEROL 25microgram INHALER SALMETEROL 50microgram ACCUHALER® SALMETEROL 50microgram DISKS SALBUTAMOL 100microgram EASI-BREATHE® INHALER SALBUTAMOL 100microgram EASYHALER® TERBUTALINE SULFATE 500microgram TURBOHALER® TERBUTALINE SULFATE 5mg/2ml NEBULISER SOLUTION SALBUTAMOL 200microgram DISKS SALBUTAMOL 400microgram DISKS SALBUTAMOL 95microgram CLICKHALER® TERBUTALINE INJECTION 3.1.1.2 Other adrenoceptor agonists - No products on formulary 3.1.2 Antimuscarinic bronchodilators ACLIDINIUM BROMIDE 375microgram INHALER - JMMC Approved Dec 2014 GLYCOPYRRONIUM 50microgram INHALER (Seebri Breezhaler®) IPRATROPIUM BROMIDE 20microgram INHALER CFC-free IPRATROPIUM BROMIDE 250microgram/1ml NEBULISER SOLUTION IPRATROPIUM BROMIDE 500microgram/2ml NEBULISER SOLUTION TIOTROPIUM 18microgram HANDIHALER® TIOTROPIUM 10microgram BRALTUS ZONDA® INHALER UMECLIDINIUM 55microgram INHALATION POWDER (Incruse ellipta®) 3.1.3 Theophylline AMINOPHYLLINE INJECTION and M/R TABLETS THEOPHYLLINE M/R CAPSULES (Slo-phyllin®) THEOPHYLLINE M/R TABLETS (Nuelin SA®) THEOPHYLLINE M/R TABLETS (Theo-dur®) THEOPHYLLINE M/R TABLETS (Uniphyllin Continus®) 3.1.4 Compound bronchodilator preparations ANORO ELLIPTA® 55/22 (Umeclidinium 55microgram/vilanterol 22microgram) DUAKLIR GENUAIR® 340/12 (Aclidinium 340micrograms/formoterol 12microgram) ULTIBRO BREEZHALER® (Indacaterol 110microgram/glycopyrronium 50microgram) 3.1.5 Peak flow meters, inhaler devices and nebulisers Peak flow meter PEAK FLOW METERS Drug delivery devices AEROCHAMBER® DEVICES - NICE guidance TA10 Asthma (children under 5 ) - inhaler devices NICE guidance TA38 Asthma (older children) - inhaler devices HALERAID® VOLUMATIC® - NICE guidance TA10 Asthma (children under 5 ) - inhaler devices NICE guidance TA38 Asthma (older children) - inhaler devices

3.2 Corticosteroids AERIVIO SPIROMAX® INHALATION POWDER (Salmeterol 50 micrograms; Fluticasone 500 microgram) BECLOMETASONE DIPROPIONATE 100microgram INHALER (Clenil Modulite®) BECLOMETASONE DIPROPIONATE 100microgram AUTOHALER® (Qvar®)

(Last updated May 2018) Page 16 of 69

BECLOMETASONE DIPROPIONATE 100microgram EASI-BREATHE® INHALER (Qvar®) BECLOMETASONE DIPROPIONATE 100microgram INHALER (Qvar®) BECLOMETASONE DIPROPIONATE 200microgram INHALER (Clenil Modulite®) BECLOMETASONE DIPROPIONATE 250microgram INHALER (Clenil Modulite®) BECLOMETASONE DIPROPIONATE 50microgram AUTOHALER® (Qvar®) BECLOMETASONE DIPROPIONATE 50microgram INHALER (Clenil Modulite®) BECLOMETASONE DIPROPIONATE 50microgram INHALER (Qvar®) BUDESONIDE 100microgram TURBOHALER® (Pulmicort®) BUDESONIDE 1mg/2ml RESPULES® BUDESONIDE 200microgram INHALER (Pulmicort®) BUDESONIDE 200microgram TURBOHALER® (Pulmicort®) BUDESONIDE 400microgram TURBOHALER® (Pulmicort®) BUDESONIDE 500microgram/2ml RESPULES® DUORESP SPIROMAX 320/9® (Budesonide 320microgram/formoterol9microgram) FLUTICASONE PROPIONATE 250microgram EVOHALER® FLUTICASONE PROPIONATE 100microgram ACCUHALER® FLUTICASONE PROPIONATE 125microgram EVOHALER FLUTICASONE PROPIONATE 250microgram ACCUHALER® FLUTICASONE PROPIONATE 500microgram ACCUHALER® FLUTICASONE PROPIONATE 50microgram ACCUHALER® FLUTICASONE PROPIONATE 50microgram EVOHALER FLUTIFORM® 50/5 INHALER (Fluticasone propionate 50micrograms; Formoterol fumarate 5microgram) FLUTIFORM® 125/5 INHALER (Fluticasone propionate 125micrograms; Formoterol fumarate 5microgram) FLUTIFORM® 250/10 INHALER (Fluticasone propionate 250micrograms; Formoterol fumarate10microgram) FOSTAIR® 100/6 INHALER (Beclometasone dipropionate 100micrograms; Formoterol fumarate 6micrograms) FOSTAIR® NEXTHALER 100/6 INHALER (Beclometasone dipropionate 100micrograms; Formoterol fumarate 6micrograms) SERETIDE® 100 ACCUHALER® (Fluticasone propionate 100micrograms; Salmeterol 50micrograms) SERETIDE® 125 EVOHALER® (Fluticasone propionate 125micrograms; Salmeterol 25micrograms) SERETIDE® 250 ACCUHALER® (Fluticasone propionate 250micrograms; Salmeterol 50micrograms) SERETIDE® 250 EVOHALER® (Fluticasone propionate 250micrograms; Salmeterol 25micrograms) SERETIDE® 50 EVOHALER® (Fluticasone propionate 50micrograms; Salmeterol 25micrograms) SERETIDE® 500 ACCUHALER® (Fluticasone propionate 500micrograms; Salmeterol 50micrograms) SIRDUPLA® 125/25 (Fluticasone propionate 125micrograms; Salmeterol 25micrograms) SIRDUPLA® 250/25 (Fluticasone propionate 250micrograms; Salmeterol 25micrograms) SYMBICORT® 100/6 TURBOHALER® (Budesonide 100micrograms; Formoterol fumarate 6micrograms ) SYMBICORT® 200/6 TURBOHALER® (Budesonide 200micrograms; Formoterol fumarate 6micrograms ) SYMBICORT® 400/12 TURBOHALER® (Budesonide 400micrograms; Formoterol fumarate 12micrograms ) CICLESONIDE 160microgram INHALER CICLESONIDE 80microgram INHALER FLUTICASONE PROPIONATE 500microgram/2ml NEBULES® MOMETASONE FUROATE 200microgram TWISTHALER® RELVAR ELLIPTA® 92/22 (Fluticasone 92microgram/vilanterol 22microgram)- Relvar Ellipta may be suitable when the patient expresses a preference for the device and/or a once daily dosage regimen. This dosage (92/22) is licensed for use in COPD. RELVAR ELLIPTA® 184/22 (Fluticasone 184microgram/vilanterol 22microgram)- Relvar Ellipta may be suitable when the patient expresses a preference for the device and/or a once daily dosage regimen. This dosage (184/22) is not licensed for use in COPD. TRIMBOW® 87/5/9 (beclometasone 87mcg/formoterol 5mcg/glycopyrronium 9 mcg)- JMMG Approved October 2017 TRELEGY® 92/55/22 (Fluticasone furoate 92mcg/ vilanterol 22mcg/ umeclidinium 55mcg)- JMMG Approved April 2018

3.3 Cromoglicate and related therapy, leukotriene receptor antagonists and phosphodiesterase type-4 inhibitors 3.3.1 Cromoglicate and related therapy SODIUM CROMOGLICATE 5mg INHALER 3.3.2 Leukotriene receptor antagonists MONTELUKAST SACHETS and TABLETS ZAFIRLUKAST TABLETS 3.3.3 Phosphodiesterase type-4 inhibitors – ROFLUMILAST TABLETS NICE guidance TA461 Treating chronic obstructive pulmonary disease JMMG Approved Sep 2017 PRIMARY CARE: Pink (Specialist Initiation)

(Last updated May 2018) Page 17 of 69

3.4 Antihistamines, hyposensitisation and allergic emergencies 3.4.1 Antihistamines Non-sedating antihistamines CETIRIZINE LIQUID and TABLETS LORATADINE LIQUID and TABLETS FEXOFENADINE TABLETS Sedating antihistamines ALIMEMAZINE LIQUID and TABLETS CHLORPHENAMINE INJECTION, LIQUID and TABLETS HYDROXYZINE LIQUID and TABLETS PROMETHAZINE INJECTION, LIQUID and TABLETS 3.4.2 Allergen immunotherapy MEPOLIZUMAB INJECTION NICE guidance TA431treating severe refractory eosinophilic asthma JMMG Approved Mar 2017 not initiated at MCHT (specialist centres only) OMALIZUMAB INJECTION – NICE guidance TA339 previously treated chronic spontaneous urticaria JMMC Approved Sep 2015 RESLIZUMAB INJECTION NICE guidance TA479 treating severe eosinophilic asthma JMMG Approved Nov 2017 not initiated at MCHT (specialist centres only) 3.4.3 Allergic emergencies ADRENALINE 1 in 1000 (1mg/1ml) INJECTION ADRENALINE 150micrograms/0.3ml SYRINGE ADRENALINE 300micrograsm/0.3ml SYRINGE EPIPEN® TRAINER C1-INHIBITOR TIM3 500units

3.5 Respiratory stimulants and pulmonary surfactants 3.5.1 Respiratory stimulants CAFFEINE CITRATE INJECTION and LIQUID DOXAPRAM 100mg/5ml INJECTION DOXAPRAM 1g in GLUCOSE 5% INFUSION 3.5.2 Pulmonary surfactants PORACTANT ALFA SUSPENSION

3.6 Oxygen OXYGEN

3.7 Mucolytics CARBOCISTEINE CAPSULES and LIQUID Hypertonic saline SODIUM CHLORIDE 3% NEBULISER SOLUTION – JMMC Approved July 2012 paediatric use in bronchiolitis SODIUM CHLORIDE 7% NEBULISER SOLUTION – JMMC Approved Mar 2011 for paediatrics to mobilise respiratory tract secretions Mannitol MANNITOL 400microgram INHALATION (Bronchitol®) - JMMC Approved Mar 2013 for use in adult cystic fibrosis patients for continuation of therapy initiated at a tertiary centre

3.8 Aromatic inhalations BENZOIN COMPOUND TINCTURE (Friars balsam)

3.9 Cough preparations 3.9.1 Cough suppressants CODEINE 15mg/5ml LINCTUS PHOLCODEINE LINCTUS SF – when sugar free preparation needed 3.9.2 Demulcent and expectorant cough preparations SIMPLE LINCTUS SF

(Last updated May 2018) Page 18 of 69

3.10 Systemic nasal decongestants – No products on formulary

3.11 Antifibrotics NINTEDANIB - NICE guidance TA379 – Idiopathic pulmonary fibrosis JMMC Approved April 2016 for continuation of supply to patients already on this therapy. Not to be initiated at MCHFT PIRFENIDONE - JMMC Approved September 2013 for continuation of supply to patients already on this therapy. Not to be initiated at MCHFT NICE guidance TA504 - idiopathic pulmonary fibrosis Not to be initiated at MCHFT

(Last updated May 2018) Page 19 of 69

4 Central nervous system 4.1 Hypnotics and anxiolytics 4.1.1 Hypnotics Benzodiazepines NITRAZEPAM SUSPENSION and TABLETS TEMAZEPAM LIQUID and TABLETS Zaleplon, Zolpidem and zopiclone ZOPICLONE TABLETS - NICE guidance TA77 – Insomnia – newer hypnotic drugs Chloral and derivatives CHLORAL HYDRATE 500mg/5ml SOLUTION Melatonin MELATONIN 2mg M/R TABLETS MELATONIN 3mg CAPSULES MELATONIN 2mg CAPSULES 4.1.2 Anxiolytics Benzodiazepines CHLODIAZEPOXIDE CAPSULES DIAZEPAM LIQUID and TABLETS LORAZEPAM INJECTION and TABLETS BUSPIRONE TABLETS 4.1.3 Barbiturates - No products on formulary

4.2 Drugs used in psychoses and related disorders 4.2.1 Antipsychotic drugs First-generation antipsychotic drugs CHLORPROMAZINE HYDROCHLORIDE 50mg/2ml INJECTION HALOPERIDOL CAPSULES, INJECTION, LIQUID and TABLETS PROMAZINE HYDROCHLORIDE LIQUID and TABLETS BENPERIDOL TABLETS CHLORPROMAZINE LIQUID and TABLETS CHLORPROMAZINE SUPPOSITORIES FLUPENTIXOL 3mg TABLETS SULPIRIDE LIQUID and TABLETS TRIFLUOPERAZINE LIQUID, M/R CAPSULES and TABLETS ZUCLOPENTIXOL INJECTION and TABLETS Second-generation antipsychotic drugs OLANZAPINE INJECTION AMISULPRIDE LIQUID and TABLETS ARIPIPRAZOLE ORODISPERSIBLE TABLETS and TABLETS - NICE guidance TA213 – Schizophrenia in 15-17 year olds NICE guidance TA292 – Bipolar disorder (adolescents) JMMC approved Oct 2013 following initiation in tertiary centre CLOZAPINE TABLETS OLANZAPINE ORODISPERSIBLE TABLETS and TABLETS QUETIAPINE LIQUID, M/R TABLETS and TABLETS RISPERIDONE LIQUID, ORODISPERSIBLE TABLETS and TABLETS 4.2.2 Antipsychotic depot injections FLUPENTIXOL DECANOATE INJECTION FLUPHENAZINE DECANOATE INJECTION HALOPERIDOL DECANOATE INJECTION PIPOTIAZINE PALMITATE INJECTION RISPERIDONE INJECTION ZUCLOPENTIXOL DECANOATE INJECTION 4.2.3 Drugs used for mania and hypomania Valproate VALPROIC ACID as SEMISODIUM VALPROATE TABLETS Lithium MCHFT Policies & Procedures – Clinical - Lithium Policy LITHIUM CARBONATE M/R TABLETS (Priadel®) LITHIUM CARBONATE TABLETS (Camcolit®) LITHIUM CARBONATE M/R TABLETS (Camcolit®) (Last updated May 2018) Page 20 of 69

LITHIUM CARBONATE M/R TABLETS (Lithonate®) LITHIUM CARBONATE M/R TABLETS (Liskonum®) LITHIUM CITRATE 509mg (5.4mmol Li)/5ml SYRUP LITHIUM CITRATE 520mg (5.4mmol Li)/5ml SYRUP

4.3 Antidepressant drugs 4.3.1 Tricyclic and related antidepressant drugs Tricylcic antidepressants AMITRIPTYLINE LIQUID and TABLETS CLOMIPRAMINE CAPSULES IMIPRAMINE TABLETS LOFEPRAMINE LIQUID and TABLETS NORTRIPTYLINE TABLETS TRIMIPRAMINE CAPSULES and TABLETS DOSULEPIN CAPSULES and TABLETS Please note: this appears in the NHSE list of medicines that should not be routinely prescribed in Primary Care. MCHFT approved for continuation in existing, stable patients. Tricyclic-related antidepressants TRAZADONE CAPSULES and LIQUID 4.3.2 Monoamine-oxidase inhibitors – No products on formulary 4.3.3 Selective serotonin re-uptake inhibitors CITALOPRAM ORAL DROPS and TABLETS FLUOXETINE CAPSULES and LIQUID PAROXETINE TABLETS SERTRALINE TABLETS ESCITALOPRAM TABLETS FLUVOXAMINE TABLETS PAROXETINE LIQUID 4.3.4 Other antidepressant drugs MIRTAZAPINE ORODISPERSIBLE TABLETS VENLAFAXINE M/R CAPSULES and TABLETS DULOXETINE CAPSULES FLUPENTIXOL TABLETS 500microgram; 1mg VORTIOXETINE – NICE guidance TA367 – treatment of major depressive episodes JMMC Approved Feb 2014

4.4 CNS stimulants and drugs used for attention deficit hyperactivity disorder METHYLPHENIDATE 20mg M/R CAPSULES - NICE guidance TA98 – Attention deficit hyperactivity disorder (ADHD) ATOMOXETINE CAPSULES ATOMOXETINE LIQUID JMMG Approved Mar 2017 DEXAMFETAMINE1mg/mL Liquid JMMC Approved Jul 2016 DEXAMFETAMINE TABLETS - NICE guidance TA98 – Attention deficit hyperactivity disorder (ADHD) LISDEXAMFETAMINE CAPSULES – JMMC Approved Oct 2014 METHYLPHENIDATE 10mg TABLETS - NICE guidance TA98 – Attention deficit hyperactivity disorder (ADHD) METHYLPHENIDATE 18mg M/R TABLETS – Xaggitin XL® & Delmosart XL® brands JMMG Approved Dec 2017 NICE guidance TA98 – Attention deficit hyperactivity disorder (ADHD) MODAFINIL TABLETS

4.5 Drugs used in the treatment of obesity 4.5.1 Anti-obesity drugs acting on the gastro-intestinal tract ORLISTAT CAPSULES 4.5.2 Centrally acting appetite suppressants – Naltrexone–bupropion NALTREXONE–BUPROPION PROLONGED RELEASE TABLETS- NICE guidance TA494 – for managing overweight and obesity – NOT RECOMMENDED JMMG Approved January 2018 (Last updated May 2018) Page 21 of 69

4.6 Drugs used in nausea and vertigo Antihistamines CINNARIZINE TABLETS CYCLIZINE INJECTION and TABLETS Phenothiazines and related drugs PROCHLORPERAZINE INJECTION, LIQUID and TABLETS LEVOMEPROMAZINE INJECTION and TABLETS Domperidone and metoclopramide DOMPERIDONE LIQUID, SUPPOSITORIES and TABLETS MHRA Alert April 2014 – Restrictions in use and dose of Domperidone METOCLOPRAMIDE INJECTION, LIQUID AND TABLETS MHRA Alert August 2013– Restrictions in use and dose of Metoclopramide 5HT3-receptor antagonists ONDANSETRON INJECTION, LIQUID and TABLETS PALONOSETRON INJECTION – JMMC Approved May 2006 following moderately and highly emetogenic chemotherapy Neurokinin-receptor antagonists APREPITANT CAPSULES – JMMC Approved Oct 2005 following moderately and highly emetogenic chemotherapy AKYNZEO JMMG Approved Sep 2016 Hyoscine HYOSCINE HYDROBROMIDE TABLETS 300microgram HYOSCINE PATCHES Other drugs for Meniere’s disease BETAHISTINE TABLETS

4.7 Analgesics 4.7.1 Non-opiod analgesics and compound analgesic preparations ASPIRIN DISPERSIBLE TABLETS, SUPPOSITORIES and TABLETS CO-CODAMOL 8/500 EFFERVESCENT TABLETS CO-CODAMOL 8/500 TABLETS CO-CODAMOL 30/500 TABLETS CO-DYDRAMOL 10/500 TABLETS PARACETAMOL 1000mg/100ml and 500mg/ 50ml INFUSION PARACETAMOL 120mg SUPPOSITORIES PARACETAMOL 240mg SUPPOSITORIES PARACETAMOL 500mg SUPPOSITORIES PARACETAMOL 120mg/5ml SF SUSPENSION PARACETAMOL 250mg/5ml SUSPENSION PARACETAMOL 500mg TABLETS CAFFEINE and SODIUM BENZOATE 250mg/2ml INJECTION CO-CODAMOL 30/500 EFFERVESCENT TABLETS NEFOPAM TABLETS PARACETAMOL 500mg/5ml SUSPENSION CLONIDINE PATCH (Unlicensed product)- JMMC Approved Jan 2014 for use in one patient only METHOXYFLURANE (Penthrox®) JMMG Approved Apr 2018 – only under the supervision of Emergency Department staff experienced in its use, using a hand-held Penthrox® inhaler device 4.7.2 Opiod analgesics CODEINE PHOSPHATE INJECTION, LIQUID and TABLETS- MHRA Alert July 2013 – Restrictions in use of Codeine in children DIAMORPHINE INJECTION DIAMORPHINE INTRATHECAL INJECTION – JMMC Approved Apr 2008 DIHYDROCODEINE LIQUID and TABLETS FENTANYL MATRIX PATCHES (Fencino®) METHADONE 1mg/ml INJECTION MORPHINE SULPHATE 10mg TABLETS (Sevredol®) MORPHINE SULPHATE LIQUID MORPHINE SULPHATE M/R CAPSULES (Zomorph®) MORPHINE SULPHATE INJECTION MORPHINE SULPHATE 5mg M/R TABLETS (MST Continus®) (Last updated May 2018) Page 22 of 69

OXYCODONE HYDROCHLORIDE M/R TABLETS (Oxycontin®)- JMMC Approved – Orthopaedics enhanced recovery protocol PETHIDINE INJECTION and TABLETS TRAMADOL CAPSULES, INJECTION and M/R TABLETS BUPRENORPHINE PATCHES BUPRENORPHINE 200microgram SUBLINGUAL TABLETS BUPRENORPHINE 300microgram/ml INJECTION CYCLIMORPH® 10 INJECTION CYCLIMORPH® 15 INJECTION FENTANYL BUCCAL TABLETS – JMMC Approved Jul 2009 for use in palliative care and on advice of pain control team. February 2018 amendment: Macmillan/palliative care only. MEPTAZINOL INJECTION METHADONE 10mg/1ml INJECTION METHADONE 35mg/3.5 ml INJECTION METHADONE 50mg/5ml INJECTION METHADONE TABLETS OXYCODONE HYDROCHLORIDE INJECTION OXYCODONE HYDROCHLORIDE 50mg/5ml LIQUID (Oxynorm®) OXYCODONE HYDROCHLORIDE 5mg/5ml SF LIQUID (Oxynorm®) OXYCOCONE 50mg/50mL PCA SYRINGE- JMMC Approved May 2016 TRAMADOL 50mg SOLUBLE TABLETS TRAMADOL M/R 100mg; 200mg TARGINACT® TABLETS 4.7.3 Neuropathic pain GABAPENTIN CAPSULES PREGABALIN – Specialist use in epilepsy and according to neuropathic pain guidelines 4.7.4 Antimigraine drugs 4.7.4.1 Treatment of acute migraine 5HT1-receptor agonists SUMATRIPTAN INJECTION and TABLETS ZOLMITRIPTAN TABLETS – JMMC Approved Jun 2003 ALMOTRIPTAN TABLETS – JMMC Approved May 2014 – single patient 4.7.4.2 Prophylaxis of migraine PIZOTIFEN LIQUID and TABLETS BOTULINUM TOXIN TYPE A – NICE guidance TA260 – Chronic migraine

4.8 Antiepileptic drugs 4.8.1 Control of the epilepsies Brivaracetam BRIVARACETAM – JMMG August 2016 – individual patient request Carbamazepine and related antiepileptics CARBAMAZEPINE LIQUID, M/R TABLETS SUPPOSITORIES and TABLETS OXCARBAZEPINE LIQUID and TABLETS Ethosuximide ETHOSUXIMIDE CAPSULES and LIQUID Gabapentin and pregabalin GABAPENTIN CAPSULES PREGABALIN CAPSULES Lacosamide LACOSAMIDE Lamotrigine LAMOTRIGINE DISPERSIBLE TABLETS and TABLETS Levetiracetam LEVETIRACETAM LIQUID, INJECTION and TABLETS Phenobarbital and primidone PHENOBARBITAL LIQUID and TABLETS PRIMIDONE TABLETS Phenytoin (Last updated May 2018) Page 23 of 69

PHENYOTIN CAPSULES, CHEWABLE TABLETS, INJECTION, LIQUID and TABLETS Retigabine RETIGABINE- NICE guidance TA232-Adjuncive treatment of partial onset seizures in epilepsy JMMC approved April 2015 – not for initiation at MCHFT Rufinamide RUFINAMIDE TABLETS Topiramate TOPIRAMATE SPRINKLE and TABLETS Valproate SODIUM VALPROATE CRUSHABLE TABLETS, INJECTION, LIQUID, M/R TABLETS and TABLETS Vigabatrin VIGABATRIN SACHETS Zonisamide ZONISAMIDE CAPSULES and SUSPENSION Benzodiazepines CLOBAZAM 10mg TABLETS - As adjunct in treatment of epilepsy CLONAZEPAM DROPS, LIQUID and TABLETS Other drugs BIOTIN – JMMC approved Jul 2011 Intractable neo-natal seizures PYRIDOXAL-5-PHOSPHATE – JMMC approved Jul 2011 Intractable neo-natal seizures SULTHIAME- JMMC approved Mar 2014 – Tertiary centre recommended for individual patient. Unlicensed product. 4.8.2 Drugs used in status epilepticus CLONAZEPAM INJECTION DIAZEPAM INJECTION and RECTAL TUBES MIDAZOLAM OROMUCOSAL SOLUTION (Buccolam®) - JMMC Approved Mar 2013 PARALDEHYDE ENEMA PHENOBARBITAL INJECTION PHENYTOIN INJECTION

4.9 Drugs used in Parkinsonism and related disorders 4.9.1 Dopaminergic drugs used in Parkinson’s disease Dopamine-receptor agonists APOMORPHINE INJECTION CABERGOLINE TABLETS PERGOLIDE TABLETS PRAMIPEXOLE TABLETS ROPINIROLE M/R TABLETS and TABLETS ROTIGOTINE PATCHES Levodopa CO-BENELDOPA CAPSULES and DISPERSIBLE TABLETS (Madopar®) CO-CARELDOPA M/R TABLETS and TABLETS With entacapone LEVODOPA, CARBIDOPA & ENTACAPONE TABLETS (Stavelo®) Monoamine-oxidase-B inhibitors RASAGILINE TABLETS SELEGELINE LIQUID, ORODISPERSIBLE TABLETS and TABLETS Catechol-O-methyltransferase inhibitors ENTACAPONE TABLETS 4.9.2 Antimuscarinic drugs used in Parkinsonism PROCYCLIDINE INJECTION, LIQUID and TABLETS TRIHEXYPHENIDYL LIQUID and TABLETS ORPHENADRINE LIQUID and TABLETS 4.9.3 Drugs used in essential tremor, chorea, tics and related disorders PIRACETAM TABLETS RILUZOLE TABLETS- NICE guidance TA20 – Motor neurone disease TETRABENAZINE TABLETS Torsion dystonias and other involuntary movements

(Last updated May 2018) Page 24 of 69

BOTULINUM A TOXIN 100units INJECTION (Botox®) BOTULINUM A TOXIN 500units INJECTION (Dysport®) BOTULINUM A TOXIN 100units INJECTION (Xeomin®) - JMMC Approved Jan 2011

4.10 Drugs used in substance dependence 4.10.1 Alcohol dependence Acamprosate ACAMPROSATE TABLETS Disulfiram DISULFIRAM TABLETS NALMEFENE TABLETS- NICE guidance TA325 – Reducing alcohol consumption in people with alcohol dependence JMMC Approved Feb 2015 – Only for continuity of existing therapy. Not to be initiated at MCHFT 4.10.2 Nicotine dependence Nicotine replacement therapy NICORETTE® INHALATOR NICORETTE® ICY WHITE GUM NICORETTE® INVISI PATCH NICONTINELL® TTS PATCHES NICORETTE® 2mg S/L TABLETS Bupropion BUPROPION TABLETS- NICE guidance TA123 – Smoking cessation JMMC Approved Nov 2014 Varenicline VARENICLINE TABLETS - NICE guidance TA123 – Smoking cessation JMMC Approved Nov 2014

Contact details for smoking cessation services:

Cheshire East: Kickstart 0800 085 8818 www.kickstartcheshire.co.uk

Cheshire West including Vale Royal: Quit51 0800 622 6968 www.quit51.co.uk

4.10.3 Opiod dependence Opiod substitution therapy METHADONE LIQUID 1mg/ml - NICE guidance TA114 – Drug misuse BUPRENORPHINE S/L TABLETS - NICE guidance TA114– Drug misuse METHADONE 10mg/ml SF ORAL CONCENTRATE Adjunctive therapy and symptomatic relief LOFEXIDINE TABLETS Opiod-receptor antagonists NALTREXONE TABLETS - NICE guidance TA115 – Drug misuse

4.11 Drugs for dementia DONEPEZIL ORODISPERSIBLE TABLETS and TABLETS - NICE guidance TA217 – Alzheimer’s disease GALANTAMINE M/R CAPSULES SOLUTION and TABLETS - NICE guidance TA217 – Alzheimer’s disease JMMC Approved Mar 2002 MEMANTINE ORAL DROPS and TABLETS - NICE guidance TA217 – Alzheimer’s disease RIVASTIGMINE CAPSULES, LIQUID and PATCHES - NICE guidance TA217 – Alzheimer’s disease

(Last updated May 2018) Page 25 of 69

(Last updated May 2018) Page 26 of 69

5 Infections – 5.1 Antibacterial drugs -

See MCHFT Antibiotic Policy for general prescribing. Available on trust intranet home page under policies and procedures (select Microguide Viewer http://cms.horizonsp.co.uk/viewer/mcht/adult or use the Microguide App - available via the App Store on most smartphones).

Only additional items approved will appear here.

5.1.2.3 Other beta-lactam antibiotics AZTREONAM LYSINE 75mg POWDER for NEBULISER SOLUTION - JMMC Approved Aug 2014 CEFTAZIDIME/ AVIBACTAM (ZAVICEFTA®) INJECTION- JMMG Approved Feb 2018 Microbiology approved indications only 5.1.3 Tetracyclines TIGECYCLINE INJECTION- JMMC Approved Apr 2014 – Only on recommendation of consultant microbiologist 5.1.7 Some other antibacterials Dalbavanacin DALBAVANACIN (XYDALBA®) INJECTION- JMMG Approved Feb 2018 Microbiology AND Chief Pharmacist approved indications only Fosfomycin FOSFOMYCIN INJECTION- JMMC Approved Nov 2015 on consultant microbiologist recommendation

Polymixins COLISTIMETHATE SODIUM 1.66million units INHALANT CAPSULES (Colobreathe®)- NICE guidance TA276 – Cystic fibrosis (pseudomonal lung infection) JMMC Approved Apr 2014 Rifaximin RIFAXIMIN TABLETS 550mg- NICE guidance TA337 –preventing episodes of overt hepatic encephalopathy JMMC Approved Jun 2015 Pathway approved JMMC Aug 2015

5.2 Antifungal drugs - See MCHFT Antibiotic Policy for general prescribing. Available on trust intranet home page under policies and procedures. Only additional items approved will appear here. 5.2.1 POSACONAZOLE- JMMC Approved Jun 2014 – Only on recommendation of consultant microbiologist 5.2.3 AMPHOTERICIN SUSPENSION- JMMC Approved Nov 2015 for one patient only intolerant to nystatin suspension on recommendation of tertiary centre 5.2.4 ANIDULAFUNGIN INJECTION- JMMC Approved Mar 2014 – Third line treatment. Only on recommendation of consultant microbiologist

5.3 Antivirals 5.3.1 HIV infection - Prescribing by specialist practitioners 5.3.2 Herpesvirus infections 5.3.2.1 Herpes simplex and varicella-zoster infection ACICLOVIR INJECTION SUSPENSION and TABLETS FAMCICLOVIR TABLETS 5.3.2.2 Cytomegalovirus infection - On microbiology advice 5.3.3 Viral hepatitis - (Last updated May 2018) Page 27 of 69

Prescribing by specialist practitioners 5.3.3.1 Chronic hepatitis B ENTECAVIR TABLETS - NICE guidance TA153 – Hepatitis B Prophylaxis of Hepatitis B reactivation while on Rituximab JMMC Approved April 2016 TENOFOVIR - NICE guidance TA173 – Hepatitis B 5.3.3.2 Chronic hepatitis C BOCEPREVIR - NICE guidance TA253 – Hepatitis C (genotype 1) JMMC Approved Nov 2012 DACLATASVIR- NICE guidance TA364 – Hepatitis C JMMC Approved Feb 2016 ELBASVIR-GRAZEPOVIR NICE guidance TA413 – genotype 1 or 4 hepatitis C in adults JMMC Approved November 2016 GLECAPREVIR + PIBRENTASVIR (MAVIRET®) Available only from centres commissioned by NHS England JMMG Approved Oct 2017 NICE guidance TA499 - treating chronic hepatitis C JMMG Approved Feb 2018 LEDIPASVIR – SOFOSBUVIR- NICE guidance TA363 – Hepatitis C JMMC Approved Feb 2016 OMBITASVIR – PARITAPREVIR – RITONAVIR- NICE guidance TA365 – Hepatitis C JMMC Approved Feb 2016 PEGYLATED INTERFERON - NICE guidance TA75 – Hepatitis C - See also TA200 NICE guidance TA106 – Hepatitis C – See also TA200 NICE guidance TA200 – Hepatitis C – Partial update to TA75 and TA106 RIBAVARIN - NICE guidance TA75 – Hepatitis C - See also TA200 NICE guidance TA106 – Hepatitis C - See also TA200 NICE guidance TA200 – Hepatitis C – Partial update to TA75 and TA106 SIMEPREVIR- NICE guidance TA331- Simeprevir for Hepatitis C Available only from centres commissioned by NHS England JMMC Approved May 2015 SOFOSBUVIR- NICE guidance TA330- Sofosbuvir for Hepatitis C Available only from centres commissioned by NHS England JMMC Approved May 2015 SOFOSBUVIR- VELPATASVIR NICE guidance TA430- treating chronic Hepatitis C Available only from centres commissioned by NHS England JMMC Approved Mar 2017 SOFOSBUVIR–VELPATASVIR–VOXILAPREVIR NICE guidance TA507- for treating chronic Hepatitis C Available only from centres commissioned by NHS England JMMG Approved Mar 2018 TELAPREVIR - NICE guidance TA252 – Hepatitis C (genotype 1) JMMC Approved Nov 2012 5.3.4 Influenza OSELTAMIVIR CAPSULES and ORAL SUSPENSION - NICE guidance TA158 – Influenza prophylaxis NICE guidance TA168 – Influenza treatment ZANAMIVIR INHALATION DISCS - NICE guidance TA158 – Influenza prophylaxis NICE guidance TA168 – Influenza treatment 5.3.5 Respiratory syncytial virus PALIVIZUMAB INJECTION – JMMC Approved Nov 2005 JMMC Approved May 2006 review of use (Last updated May 2018) Page 28 of 69

RIBAVARIN CAPSULES INHALATION and TABLETS

5.4 Antiprotozoal drugs 5.4.1 Antimalarials Artesunate ARTESUNATE INJECTION JMMC Approved March 2016 now first line treatment Chloroquine CHLOROQUINE INJECTION and TABLETS Mefloquine MEFLOQUINE TABLETS Primaquine PRIMAQUINE TABLETS Proguanil PROGUANIL TABLETS MALARONE TABLETS Pyrimethamine PYRIMETHAMINE TABLETS Quinine QUININE DIHYDROCHLORIDE INJECTION – no longer recommended 5.4.2 Amoebicides - No products on formulary 5.4.3 Trichomonacides - No products on formulary 5.4.4 Antigiradial drugs – No products on formulary 5.4.5 Leishmaniacides - No products on formulary 5.4.6 Trypanocides – No products on formulary 5.4.7 Drugs for toxoplasmosis - No products on formulary 5.4.8 Drugs for pneumocystis pneumonia - ATOVAQUONE SUSPENSION PENTAMIDINE INJECTION and NEBULISER SOLUTION

5.5 Anthelmintics 5.5.1 Drugs for threadworms MEBENDAZOLE PIPERAZINE 5.5.2 Ascaricides - No products on formulary 5.5.3 Drugs for tapeworm infections - No products on formulary 5.5.4 Drugs for hookworms - No products on formulary 5.5.5 Schistosomicides - No products on formulary 5.5.6 Filaricides - No products on formulary 5.5.7 Drugs for cutaneous larva migrans - No products on formulary 5.5.8 Drugs for strongyloidiasis - No products on formulary

(Last updated May 2018) Page 29 of 69

6 Endocrine system 6.1 Drugs used in diabetes 6.1.1 Insulins 6.1.1.1 Short acting insulins ACTRAPID® (INSULIN SOLUBLE) 100units/ml INJECTION VIAL APIDRA® (INSULIN GLULISINE) 300units/ 3ml SOLOSTAR® PEN APIDRA® (INSULIN GLULISINE) 100units/ml INJECTION VIAL APIDRA® (INSULIN GLULISINE) 300units/3ml CARTRIDGES HUMALOG® (INSULIN LISPRO) 300units/3ml CARTRIDGE HUMALOG® (INSULIN LISPRO) 300units/3ml KWIK PEN HUMALOG® (INSULIN LISPRO) 300units/3ml HUMULIN S® (INSULIN SOLUBLE) 100units/ml INJECTION VIAL HUMULIN S® (INSULIN SOLUBLE) 300units/3ml CARTRIDGES HYPURIN® BOVINE NEUTRAL INSULIN 100units/ml INJECTION VIAL HYPURIN® PORCINE NEUTRAL INSULIN 100units/ml INJECTION VIAL INSULIN PRE-FILLED SYRINGE 50units in 50mL- JMMC Approved July 2013 NOVORAPID® (INSULIN ASPART) 300units/3ml FLEXPEN® NOVORAPID® (INSULIN ASPART) 100units/ml INJECTION VIAL FIASP® (INSULIN ASPART) 100units/ml FLEXTOUCH PEN JMMG Approved September 2017 PRIMARY CARE: Pink (Specialist Recommendation) HUMALOG® (INSULIN LISPRO) 600units/3ml KWIK PEN JMMC Approved April 2016 TRESIBA® (INSULIN DEGLUDEC)300units/3mL CARTRIDGE- APC approved for nocturnal hypoglycaemia unresponsive to other treatment 6.1.1.2 Intermediate and long acting insulins ABASAGLAR® (INSULIN GLARGINE) 300units/3ml CARTRIDGE- JMMC Approved April 2016 ABASAGLAR® (INSULIN GLARGINE) 300units/3ml KWIKPEN- JMMC Approved April 2016 HUMALOG® MIX 25 (INSULIN BIPHASIC LISPRO) 300units/3ml CARTRIDGE HUMALOG® MIX 25 (INSULIN BIPHASIC LISPRO) 300units/3ml KWIKPEN HUMALOG® MIX 25 (INSULIN BIPHASIC LISPRO) 300units/3ml PREFILLED PEN HUMALOG® MIX 50 (INSULIN BIPHASIC LISPRO) 300units/3ml CARTRIDGE HUMALOG® MIX 50 (INSULIN BIPHASIC LISPRO) 300units/3ml KWIKPEN HUMALOG® MIX 50 (INSULIN BIPHASIC LISPRO) 300units/3ml PREFILLED PEN HUMULIN I® (INSULIN ISOPHANE) 100units/ml INJECTION VIAL HUMULIN I® (INSULIN ISOPHANE)) 300units/3ml CARTRIDGE HUMULIN M3® (INSULIN BIPHASIC ISOPHANE) 100units/ml INJECTION VIAL HUMULIN M3® (INSULIN BIPHASIC ISOPHANE) 300units/3ml CARTRIDGE HUMULIN M3® (INSULIN BIPHASIC ISOPHANE) 300units/3ml KWIKPEN HUMULIN M3® (INSULIN BIPHASIC ISOPHANE) 300units/3ml PREFILLED PEN HYPURIN® BOVINE ISOPHANE INSULIN 100units/ml INJECTION VIAL HYPURIN® BOVINE LENTE INSULIN 100units/ml INJECTION VIAL HYPURIN® PORCINE ISOPHANE INSULIN 300units/3ml CARTRIDGES INSULATARD® (INSULIN ISOPHANE)100units/ml INJECTION VIAL INSULATARD® (INSULIN ISOPHANE) 300units/3ml CARTRIDGE INSULATARD® (INSULIN ISOPHANE) 300units/3ml INNOLET® INSUMAN® COMB 15 (INSULIN BIPHASIC ISOPHANE) 300units/3ml OPTISET® PEN INSUMAN® COMB 25 (INSULIN BIPHASIC ISOPHANE) 300units/3ml OPTISET® PEN INSUMAN® COMB 50 (INSULIN BIPHASIC ISOPHANE) 300units/3ml CARTRIDGE INSUMAN® COMB 50 (INSULIN BIPHASIC ISOPHANE) 300units/3ml OPTISET® PEN LEVEMIR® (INSULIN DETEMIR) 300units/3ml CARTRIDGE LEVEMIR® (INSULIN DETEMIR) 300units/3ml FLEXPEN® LEVEMIR® (INSULIN DETEMIR) 300units/3ml INNOLET® NOVOMIX® 30 (INSULIN BIPHASIC ASPART) 300units/3ml CARTRIDGE NOVOMIX® 30 (INSULIN BIPHASIC ASPART) 300units/3ml PREFILLED PEN LANTUS® (INSULIN GLARGINE) 100units/ml INJECTION VIAL – NICE guidance TA53 – Diabetes (types 1 and 2) – long acting insulin analogues LANTUS® (INSULIN GLARGINE) 300units/3ml CARTRIDGE – NICE guidance TA53 – Diabetes (types 1 and 2) – long acting insulin analogues LANTUS® (INSULIN GLARGINE) 300units/3ml OPTICLIK® CARTRIDGE – NICE guidance TA53 – Diabetes (types 1 and 2) – long acting insulin analogues (Last updated May 2018) Page 30 of 69

LANTUS® (INSULIN GLARGINE) 300units/3ml OPTISET® PEN – NICE guidance TA53 – Diabetes (types 1 and 2) – long acting insulin analogues LANTUS® (INSULIN GLARGINE) 300units/3ml SOLOSTAR® PEN – NICE guidance TA53 – Diabetes (types 1 and 2) – long acting insulin analogues TOUJEO® (INSULIN GLARGINE) 300units/mL 1.5mL SOLOSTAR® PEN JMMC Approved April 2016 6.1.1.3 Hypodermic equipment Injection devices AUTOPEN® 24 1-21units INSULIN PEN (3ml green) AUTOPEN® 24 2-42units INSULIN PEN (3ml blue) AUTOPEN® 24 INSULIN PEN 2unit 3ml AUTOPEN® CLASSIC 1-21units INSULIN PEN (3ml) AUTOPEN® CLASSIC 2-42units INSULIN PEN (3ml) CLIKSTAR® INSULIN PEN HUMAPEN® SAVVIO INSULIN PEN NOVOPEN® 3 DEMI 0.5unit dosage Max 35units NOVOPEN® 4 1unit dosage Max 60units Lancets, needles, syringes and accessories B-D MICROFINE+ INSULIN SYRINGES 0.3ml 8mm 30G B-D MICROFINE INSULIN SYRINGE U100 0.5ml 12.7mm 29G B-D MICROFINE INSULIN SYRINGE U100 0.3ml (short needle) B-D MICROFINE INSULIN SYRINGE U100 0.5ml 8mm 30G B-D MICROFINE+ PEN NEEDLE 12.7mm 29G B-D MICROFINE PEN NEEDLE 5mm 31G B-D MICROFINE+ PEN NEEDLE 8mm 31G B-D SAFE CLIP NEEDLE CLIPPER NOVOFINE® NEEDLES 12mm 28G NOVOFINE® NEEDLES 6mm 31G NOVOFINE® NEEDLES 8mm 30G PENFINE® NEEDLES 8mm 31G UNIFINE® PENTIPS 6mm 31G UNIFINE® PENTIPS 8mm 31G ACCU-CHEK® MULTICLIX LANCETS ACCU-CHEK® SOFTCLIX LANCETS FREESTYLE® LANCETS MEDISENSE® THIN LANCETS ONE TOUCH® ULTRASOFT LANCETS UNILET® GP SUPERLITE LANCETS 6.1.2 Antidiabetic drugs 6.1.2.1 Sulfonylureas GLIBENCLAMIDE TABLETS GLICLAZIDE M/R TABLETS and TABLETS GLIMEPIRIDE TABLETS GLIPIZIDE TABLETS TOLBUTAMIDE TABLETS 6.1.2.2 Biguanides METFORMIN M/R TABLETS, SOLUTION and TABLETS 6.1.2.3 Other antidiabetic drugs PIOGLITAZONE TABLETS ACARBOSE TABLETS ALOGLIPTIN TABLETS – JMMG Approved April 2018 CANAGLIFLOZIN- NICE guidance TA315 – Canagliflozin in combination therapy for type 2 diabetes JMMC Approved – Sep 2014 NICE Guidance TA390 _ Type 2 diabetes in adults JMMC Approved – July 2016 DAPAGLIFLOZIN TABLETS – NICE guidance TA288 – Type 2 diabetes Dapagliflozin combination therapy JMMC Approved Sep 2013 NICE Guidance TA390 - Type 2 diabetes in adults JMMC Approved – July 2016 NICE Guidance TA288 - Type 2 diabetes Dapagliflozin combination therapy UPDATE JMMC Approved – January 2017 NICE Guidance TA418 – Type 2 diabetes Dapagliflozin in triple therapy JMMC Approved – January 2017

(Last updated May 2018) Page 31 of 69

EMPAGLIFLOZIN- NICE guidance TA336 – Empagliflozin in combination therapy for treating type 2 diabetes JMMC Approved – Jun 2015 NICE Guidance TA390 _ Type 2 diabetes in adults JMMC Approved – July 2016 EXENATIDE INJECTION - NICE guidance TA248 – Diabetes (type 2) JMMC Approved Jun 2007 JMMC Feb 2009 Approved for Diabetic Specialist Nurses to recommend to GPs for prescribing EXENATIDE WEEKLY INJECTION - JMMC Approved Feb 2012 LINAGLIPTIN TABLETS - JMMC Approved Mar 2012 REPAGLINIDE TABLETS – JMMC Approved Sep 2007 SAXAGLIPTIN TABLETS SITAGLIPTIN TABLETS – JMMC Approved Oct 2008 preferred choice in triple therapy VILDAGLIPTIN TABLETS – JMMC Approved Oct 2008 preferred choice in dual therapy DULAGLUTIDE ONCE WEEKLY INJECTION - JMMC Approved Dec 2015 – MCHfT to maintain supplies until approved for use in Primary Care LIRAGLUTIDE 18mg/3ml PRE-FILLED PEN- NICE guidance TA203 – Diabetes (type 2) JMMC Approved Mar 2010 XULTOPHY® (LIRAGLUTIDE/INSULIN DEGLUDEC) PRE-FILLED PEN JMMG Approved Sep 2017 – Only on specialist advice PRIMARY CARE: Pink (Specialist Recommendation) 6.1.4 Treatment of hypoglycaemia GLUCAGON INJECTION GLUCOSE GEL and POWDER LUCOZADE Chronic hypoglycaemia DIAZOXIDE TABLETS DIAZOXIDE 50mg/ml LIQUID- JMMC Approved June 2013 for hyperinsulinism 6.1.6 Diagnostic and monitoring devices for diabetes mellitus Blood monitoring ACCU-CHEK® ACTIVE GLUCOSE TEST STRIPS ACCU-CHEK® AVIVA® TEST STRIPS FREESTYLE LITE® TEST STRIPS FREESTYLE OPTIUM BETA-KETONE TEST STRIPS- JMMC Approved November 2015 – use in paediatrics only MEDISENSE® OPTIUM TEST STRIPS ONE TOUCH ULTRA® TEST STRIPS PRECISION® XCEED PRO TEST STRIPS PRECISION® XCEED PRO BETA KETONE TEST STRIPS- JMMG Approved August 2016 – Only for patients with Diabetic Keto-Acidosis GLUCOMEN LX KETONE MONITORING STRIPS JMMC Approved March 2016 – for use in pregnancy GLUCOMEN AREO KETONE TEST STRIPS JMMG Approved June 2017 – for use in pregnancy Urinalysis DIASTIX® TEST STRIPS KETO-DIASTIX® TEST STRIPS KETOSTIX® TEST STRIPS

6.2 Thyroid and antithyroid drugs 6.2.1 Thyroid hormones LEVOTHYROXINE TABLETS LIOTHYRONINE TABLETS LEVOTHYROXINE SUSPENSION – Patients with swallowing difficulties only LIOTHYRONINE INJECTION THYROID TABLETS- ERFA thyroid (unlicensed): JMMG Approved March 2018. To be used in established patients only. No new patients to be commenced or switched to this product. 6.2.2 Antithyroid drugs (Last updated May 2018) Page 32 of 69

CARBIMAZOLE TABLETS IODINE AQUEOUS SOLUTION PROPYLTHIOURACIL TABLETS

6.3 Corticosteroids 6.3.1 Replacement therapy FLUDROCORTISONE TABLETS 6.3.2 Glucocorticoid therapy BETAMETHASONE INJECTION, SOLUBLE TABLETS and TABLETS CORTISONE ACETATE TABLETS DEXAMETHASONE INJECTION, LIQUID and TABLETS HYDROCORTISONE INJECTION and TABLETS METHYLPREDNISOLONE SODIUM SUCCINATE INJECTION METHYLPREDNISOLONE TABLETS PREDNISOLONE SOLUBLE TABLETS and UNCOATED TABLETS- note EC tablets no longer used

6.4 Sex hormones 6.4.1 Female sex hormones and their modulators 6.4.1.1 Oestrogens and HRT Conjugated oestrogens with progestogen PREMIQUE® TABLETS PREMPAK-C® TABLETS Estradiol with progestogen CLIMAGEST® TABLETS EVOREL® CONTI PATCHES FEMOSTON® TABLETS FEMOSTON®-CONTI TABLETS KLIOFEM® TABLETS KLIOVANCE® TABLETS NUVELLE® TABLETS TRIDESTRA® TABLETS Conjugated oestrogens only OESTROGENS CONJUGATED TABLETS Estradiol only ESTRADIOL VALERATE 1mg TABLETS (Climaval®) ESTRADIOL 1mg TABLETS (Elleste-Solo®) ESTRADIOL PATCHES (Estraderm MX®) ESTRADIOL PATCHES (Estradot®) ESTRADIOL PATCHES (Evorel®) ESTRADIOL VALERATE 1mg TABLETS (Progynova®) ESTRADIOL VALERATE 2mg TABLETS (Progynova®) ESTRADIOL PATCHES (Progynova® TS) Estradiol, estriol and estrone HORMONIN® TABLETS Tibolone TIBOLONE TABLETS Ethinyloestradiol ETHINYLOESTRADIOL TABLETS Raloxifene RALOXIFENE TABLETS - NICE guidance TA161 – Osteoporosis - secondary prevention 6.4.1.2 Progestogens and progesterone receptor modulators MEDROXYPROGESTERONE ACETATE TABLETS NORETHISTERONE TABLETS PROGESTERONE PESSARIES ULIPRISTAL ACETATE TABLETS 5mg- JMMC Approved May 2016 Removed from Formulary following APG discussion 13/3/18. Following the introduction of temporary safety measures issued by MHRA on 09/02/2018, Esmya (ulipristal acetate) should not be initiated for treatment in new users or those who have previously completed one of more treatment courses. 6.4.2 Male sex hormones and antagonists Testosterone and esters SUSTANON 250® INJECTION TESTOSTERONE GEL SACHETS

(Last updated May 2018) Page 33 of 69

TESTOSTERONE ENANTATE INJECTION TESTOSTERONE IMPLANT TESTOSTERONE PATCHES – JMMC Approved Oct 2007 TESTOSTERONE UNDECANOATE CAPSULES and INJECTION Dutasteride and finasteride FINASTERIDE TABLETS DUTASTERIDE CAPSULES 6.4.3 Anabolic steroids OXANDROLONE- JMMC Approved June 2013 for Turner’s syndrome

6.5 Hypothalamic and pituitary hormones and anti-oestrogens 6.5.1 Hypothalamic and anterior pituitary hormones and anti-oestrogens Anti-oestrogens CLOMIFENE TABLETS Anterior pituitary hormones HUMAN CHORIONIC GONADOTROPHIN 5000units INJECTION (Pregnyl®) MENOTROPHIN INJECTION PROTIRELIN INJECTION TETRACOSACTIDE INJECTION GONADORELIN INJECTION SOMATROPIN CARTRIDGES and VIAL - NICE guidance TA64 – Growth hormone deficiency (adults) NICE guidance TA188 – Human growth hormone (somatropin) for the treatment of growth failure in children 6.5.2 Posterior pituitary hormones and antagonists DESMOPRESSIN NASAL SOLUTION, NASAL SPRAY and TABLETS TERLIPRESSIN INJECTION ARGIPRESSIN INJECTION DESMOPRESSIN 120microgram S/L TABLETS DESMOPRESSIN 4microgram/ml INJECTION TOLVAPTAN- NICE guidance TA358 – Autosomal dominant polycystic kidney disease JMMC Approved Jan 2016 DESMOPRESSIN 15microgram/ml INJECTION

6.6 Drugs affecting bone metabolism 6.6.1 Calcitonin and parathyroid hormone CALCITONIN INJECTION and NASAL SPRAY TERIPARATIDE INJECTION - NICE guidance TA161 – Osteoporosis-secondary prevention 6.6.2 Bisphosphonates and other drugs affecting bone metabolism Bisphosphonates ALENDRONIC ACID (as ALENDRONATE SODIUM) 70mg TABLETS - NICE guidance TA160 – Osteoporosis – primary prevention NICE guidance TA161 – Osteoporosis-secondary prevention DISODIUM PAMIDRONATE INJECTION RISEDRONATE 35mg TABLETS - NICE guidance TA160 – Osteoporosis – primary prevention NICE guidance TA161 – Osteoporosis-secondary prevention DISODIUM ETIDRONATE - NICE guidance TA160 – Osteoporosis – primary prevention NICE guidance TA161 – Osteoporosis-secondary prevention IBANDRONIC ACID TABLETS – IBANDRONIC ACID INJECTION – NICE guidance TA464 - Bisphosphonates for treating osteoporosis JMMG Approved Oct 2017 SODIUM CLODRONATE CAPSULES and TABLETS ZOLEDRONIC ACID 4mg/5ml INJECTION – JMMC Approved Oct 2002 ZOLEDRONIC ACID 5mg/100ml INJECTION - JMMC approved Mar 2009 Denosumab DENOSUMAB - NICE guidance TA204 – Osteoporotic fractures (Last updated May 2018) Page 34 of 69

NICE guidance TA265 – prevention of skeletal related events in adults with bone metastases JMMC Approved Oct 2011 JMMC Approved May 2013 Strontium ranelate STRONTIUM RANELATE SACHETS – NICE guidance TA160 – Osteoporosis – primary prevention NICE guidance TA161 – Osteoporosis-secondary prevention

6.7 Other endocrine drugs 6.7.1 Bromocriptine and other dopaminergic drugs CABERGOLINE TABLETS BROMOCRIPTINE CAPSULES and TABLETS QUINAGOLIDE TABLETS JMMG Approved Sep 2017 6.7.2 Drugs affecting gonadotrophins DANAZOL CAPSULES CETRORELIX INJECTION - JMMC Approved Jan 2013 Gonadorelin analogues BUSERELIN INJECTION TRIPTORELIN INJECTION - JMMC Approved Feb 2012 for treatment of precocious puberty 6.7.3 Metyrapone METYRAPONE CAPSULES 6.7.4 Somatomedins - No products on formulary

(Last updated May 2018) Page 35 of 69

7 Obstetrics, gynaecology and urinary-tract disorders 7.1 Drugs used in obstetrics 7.1.1 Prostaglandins and oxytocics CARBOPROST INJECTION DINOPROSTONE INJECTION, PESSARIES and VAGINAL GEL - Dinoprostone pessaries JMMC Approved Aug 2011 ERGOMETRINE INJECTION GEMEPROST PESSARIES OXYTOCIN INJECTION OXYTOCIN & ERGOMETRINE INJECTION (Syntometrine®) 7.1.1.1 Drugs affecting the ductus arteriosus ALPROSTADIL INJECTION IBUPROFEN 10mg/2mL INJECTION – JMMC Approved May 2006 IBUPROFEN 20mg/2mL INJECTION – JMMC Approved Dec 2013 7.1.2 Mifeprostone MIFEPROSTONE 7.1.3 Myometrial relaxants Atosiban ATOSIBAN INJECTION and INFUSION PROGESTERONE 200MG PESSARY JMMC Approved Sep 2016 7.2 Treatment of vaginal and vulval conditions 7.2.1 Preparations for vaginal and vulval discharges ESTRADIOL 25microgram VAGINAL TABLETS (Vagifem®) ESTRADIOL 0.01% VAGINAL CREAM (Gynest®) ESTRADIOL 0.1% VAGINAL CREAM (Ovestin®) ESTRADIOL 500microgram PESSARIES (Ortho-Gynest®) ESTRADIOL VAGINAL RING 7.2.2 Vaginal and vulval infections Fungal infections CLOTRIMAZOLE 10% VAGINAL CREAM CLOTRIMAZOLE PESSARIES CLOTRIMAZOLE 2% THRUSH CREAM ECONAZOLE 1% CREAM ECONAZOLE 150mg PESSARY MICONAZOLE 100mg PESSARIES MICONAZOLE 1200mg OVULE MICONAZOLE 2% VAGINAL CREAM Other infections CLINDAMYCIN 2% VAGINAL CREAM METRONIDAZOLE 0.75% VAGINAL GEL (Zidoval®)

7.3 Contraceptives 7.3.1 Combined hormonal contraceptives Monophasic low strength (21 day preparations) FEMODETTE® TABLETS LOESTRIN 20® TABLETS MILLINETTE® 20/75 TABLETS Monophasic standard strength (21 day preparations) CILEST® TABLETS GEDAREL® 30/150 TABLETS LOESTRIN 30®TABLETS MICROGYNON 30® TABLETS MILLINETTE® 30/75 TABLETS NORIMIN® TABLETS RIGEVIDON® TABLETS YASMIN® TABLETS Monophasic standard strength (28 day ‘every day’ preparations) FEMODENE® ED TABLETS

(Last updated May 2018) Page 36 of 69

MICROGYNON 30 ED® TABLETS ZOELY® TABLETS Phasic standard strength (21 day preparations) LOGYNON® TABLETS TRIREGOL® TABLETS Phasic standard strength (28 day ‘every day’ preparations) LOGYNON ED® TABLETS Transdermal standard strength EVRA® PATCHES 7.3.2 Progestogen-only contraceptives 7.3.2.1 Oral progestogen-only contraceptives FEMULEN® TABLETS NORGESTON® TABLETS MICRONOR® TABLETS 7.3.2.2 Parenteral progestogen-only contraceptives ETONROGESTREL ROD IMPLANT (Nexplanon®) MEDROXYPROGESTERONE ACETATE 150mg/ml INJECTION 7.3.2.3 Intra-uterine progestogen-only device MIRENA® IU SYSTEM 7.3.3 Spermicidal contraceptives NONOXINOL-9 2% GEL (Gygel®) 7.3.4 Contraceptive devices Intra-uterine devices FLEXI T® 300 MULTILOAD® Cu250 SHORT MULTILOAD® Cu375 NOVA T® 380 T-SAFE® Cu 380A TT 380® SLIMLINE Other contraceptive devices Diaphragm flat spring 7.3.5 Emergency contraception Hormonal methods LEVONORGESTREL 1500microgram TABLET ULPRISTAL ACETATE 30mg TABLET

7.4 Drugs for genito-urinary disorders 7.4.1 Drugs for urinary retention Alpha-blockers ALFUZOSIN M/R TABLETS and TABLETS TAMSULOSIN CAPSULES 7.4.2 Drugs for urinary frequency, enuresis and incontinence Urinary incontinence DARIFENACIN M/R TABLETS DULOXETINE CAPSULES OXYBUTININ LIQUID, M/R TABLETS and TABLETS SOLIFENACIN TABLETS TROSPIUM 60mg M/R TABLETS FESOTERODINE M/R TABLETS FLAVOXATE TABLETS MIRABEGRON TABLETS- NICE guidance TA290 - Overactive bladder JMMC approved Oct 2013 OXYBUTININ PATCHES OXYBUTININ BLADDER INSTILLATION TOLTERODINE M/R TABLETS and TABLETS TROSPIUM 20mg TABLETS 7.4.3 Drugs used in urological pain Alkalinisation of urine EFFERCITRATE TABLETS POTASSIUM CITRATE MIXTURE 7.4.4 Bladder instillations and urological surgery Urological surgery PURISOLE® FLOWFUSOR® (Last updated May 2018) Page 37 of 69

SODIUM CHLORIDE 0.9% FLOWFUSOR® WATER FLOWFUSOR® ALUM 10% BLADDER IRRIGATION – Specialist use in urology to control bleeding 7.4.5 Drugs for erectile dysfunction Alprostadil ALPROSTADIL PELLETS (Muse®) ALPROSTADIL INJECTION (Caverject®) Phosphodiesterase type-5 inhibitors SILDENAFIL TABLETS VARDENAFIL TABLETS Papaverine and phentolamine PAPAVERINE INJECTION

(Last updated May 2018) Page 38 of 69

8 Malignant disease and immunosuppression 8.1 Cytotoxic drugs Treatment for cytotoxic induced side effect DEXRAZOXANE INJECTION Chemotherapy-induced mucositis and myelosuppression CALCIUM FOLINATE/FOLINIC ACID INJECTION and TABLETS Chemotherapy-induced neutropenic infection and nephrotoxicity MESNA INJECTION 8.1.1 Alkylating Drugs BENDAMUSTINE INJECTION - NICE guidance TA216 – Leukaemia (lymphocytic) JMMC Approved Jan 2013 JMMC Approved Jan 2014 – unlicensed indication for relapsed CLL ESMO guidelines BUSULFAN TABLETS CHLORAMBUCIL TABLETS CYCLOPHOSPHAMIDE INJECTION and TABLETS CYCLOPHOSPHAMIDE INJECTION- JMMC Approved May 2015 for treatment of vasculitis (unlicensed indication) IFOSFAMIDE INJECTION LOMUSTINE CAPSULES MELPHALAN TABLETS TREOSULFAN CAPSULES and INJECTION 8.1.2 Anthracyclines and other cytotoxic antibiotics BLEOMYCIN INJECTION DOXORUBICIN INJECTION - NICE guidance TA91 – Ovarian cancer (advanced) EPIRUBICIN INJECTION IDARUBICIN CAPSULES MITOMYCIN INJECTION MITOXANTRONE INJECTION PIXANTRONE- NICE guidance TA306 – Lymphoma (non-Hodgkin’s, relapsed, refractory) JMMC Approved Apr 2014 8.1.3 Antimetabolites AZACITADINE INJECTION - NICE guidance TA218 – Myelodysplastic syndrome CAPECITABINE TABLETS - NICE guidance TA61 – Colorectal cancer NICE guidance TA100 – Colon cancer (adjuvant) NICE guidance TA191 – Gastric cancer (advanced) NICE guidance TA263 – Breast cancer (metastatic first line) JMMC Approved Jun 2008 CLADRIBINE INJECTION CLADRIBINE TABLETS NICE guidance TA493 – for treating relapsing–remitting multiple sclerosis JMMG Approved Jan 2018 – MS not treated at MCHFT CYTARABINE INJECTION- JMMC Approved subcutaneous route Jul 2015 FLUDARABINE INJECTION and TABLETS - NICE guidance TA29 – Leukaemia (lymphatic) NICE guidance TA119 – Leukaemia (lymphatic) FLUOROURACIL INJECTION GEMCITABINE INJECTION - NICE guidance TA25 – Pancreatic cancer NICE guidance TA116 – Breast cancer JMMC Approved Jun 2008 MERCAPTOPURINE TABLETS METHOTREXATE INJECTION and TABLETS PEMETREXED INJECTION - NICE guidance TA135 - Mesothelioma (Last updated May 2018) Page 39 of 69

NICE guidance TA181 – Lung cancer (non-small-cell, first line treatment) NICE guidance TA190 – Lung cancer (non-small-cell, maintenance) JMMC Approved Sep 2010 NICE guidance TA402 – locally advanced or metastatic non-squamos, non-small cell lung cancer JMMC Approved November 2016 RALTITREXID INJECTION TIOGUANINE TABLETS TEGAFUR with GIMERACIL and OTERACIL CAPSULES (TEYSUNO®) - JMMC Approved Sep 2012. Authorisation for use required for each patient 8.1.4 Vinca alkaloids and etoposide ETOPOSIDE CAPSULES and INJECTION VINBLASTINE INJECTION VINCRISTINE INJECTION VINORELBINE INJECTION – JMMC Approved May 2006 8.1.5 Other antineoplastic drugs ASPARAGINASE INJECTION PEGASPARGASE INJECTION – NICE guidance TA408 – Acute lymphoblastic leukaemia JMMG Approved December 2016 - not initiated at MCHT Afatinib AFATINIB INJECTION – NICE guidance TA310 – Lung cancer (non-small cell, EGFR mutation positive) JMMC Approved Jun 2014 Avelumab AVELUMAB INJECTION – NICE guidance TA517 – for treating metastatic Merkel cell carcinoma JMMG Approved May 2018 – not initiated at MCHFT Atezolizumab ATEZOLIZUMAB INJECTION – NICE guidance TA492 – for untreated locally advanced or metastatic urothelial cancer when cisplatin is unsuitable JMMG Approved Jan 2018 – not initiated at MCHFT

Belimumab BELIMUMAB INJECTION- NICE guidance TA397 - active autoantibody-positive systemic lupus erythematosus in adults. JMMG Approved August 2016 Bevacizumab BEVACIZUMAB INJECTION - NICE guidance TA263 – Breast cancer (metastatic first line) Bortezomib BORTEZOMIB INJECTION - NICE guidance TA129 – Multiple myeloma NICE guidance TA228 – Multiple myeloma (first line) NICE guidance TA311 – Multiple myeloma (induction therapy) JMMC Approved Mar 2010 JMMC Approved Jun 2014 JMMC Approved March 2016 – VR-CAP regime Bosutinib BOSUTINIB TABLETS- Nice guidance TA401- previously treated chronic myeloid leukaemia JMMG Approved November 2016 Cabozantinib CABOZANTINIB - NICE guidance TA463 - for previously treated advanced renal cell carcinoma JMMG Approved September 2017 – renal cell not treated at MCHFT NICE guidance TA516 - for treating medullary thyroid cancer JMMG Approved May 2018 – Thyroid cancer not treated at MCHFT Carfilzomib CARFILZOMIB INJECTION- NICE guidance TA457 - Previously treated multiple myeloma JMMG Approved September 2017 Brentuximab vedotin BRENTUXIMAB VEDOTIN - (Last updated May 2018) Page 40 of 69

NICE guidance TA446- Treating CD30-positive Hodgkin lymphoma in adults JMMG Approved August 2017 NICE guidance TA478- Treating relapsed or refractory systemic anaplastic large cell lymphoma JMMG Approved December 2017 Ceritinib NICE guidance TA395 – Advanced anaplastic lymphoma kinase (ALK) positive non-small cell lung cancer JMMG Approved Sep 2016 NICE guidance TA500 – untreated ALK-positive non-small-cell lung cancer JMMG Approved Feb 2018 Cetuximab CETUXIMAB INJECTION – Cancer drug fund approved JMMC Approved May 2014 NICE guidance TA439 – Untreated metastatic colorectal cancer JMMG Approved May 2017 – not initiated at MCHFT NICE guidance TA473 – treating recurrent or metastatic squamous cell cancer of the head & neck. JMMG Approved Oct 2017 – Squamous cell cancer of head and neck not treated at MCHFT Crizotinib CRIZOTINIB CAPSULES- Cancer drug fund approved JMMC Approved Sep 2014 NICE guidance TA406 - untreated anaplastic lymphoma kinase-positive advanced non-small-cell lung cancer JMMC Approved Dec 2016 NICE guidance TA422 - treated anaplastic lymphoma kinase-positive advanced non-small-cell lung cancer in adults JMMC Approved Feb 2017 Eribulin ERIBULIN INJECTION NICE guidance TA423 –locally advanced or metastatic breast cancer after 2 or more chemotherapy regimens JMMC Approved Feb 2017- not initiated at MCHT NICE guidance TA515 – for treating locally advanced or metastatic breast cancer after 1 chemotherapy regimen - NOT RECOMMENDED JMMG Approved May 2018 Dacarbazine and temozolomide DACARBAZINE INJECTION Daratumumab DARATUMUMAB INJECTION NICE guidance TA510 – monotherapy for treating relapsed and refractory multiple myeloma JMMG Approved May 2018 Everolimus EVEROLIMUS TABLETS NICE guidance TA421 – with exemestane for treating advanced breast cancer after endocrine therapy JMMC Approved Feb 2017- not initiated at MCHT NICE guidance TA432 – advanced renal cell carcinoma after previous treatment JMMC Approved Apr 2017- not initiated at MCHT NICE guidance TA449 – Treating unresectable or metastatic neuroendocrine tumours in people with progressive disease JMMG Approved Aug 2017 Hydroxycarbamide HYDROXYCARBAMIDE CAPSULES Ibrutinib IBRUTINIB – Unlicensed product available on compassionate grounds JMMC Approved Oct 2014 NICE guidance TA429 – previously treated chronic lymphocytic leukaemia and untreated chronic lymphocytic leukaemia with 17p deletion or TP53 mutation JMMG Approved Mar 2017 NICE guidance TA491 - for treating Waldenstrom’s macroglobulinaemia JMMG Approved Jan 2018 NICE guidance TA502 – for treating relapsed or refractory mantle cell lymphoma JMMG Approved March 2018 Ipilimumab IPILIMUMAB 5mg/mL INJECTION - NICE guidance TA319 – Previously untreated advanced melanoma JMMC Approved Oct 2014 (Last updated May 2018) Page 41 of 69

Ixazomib IXAZOMIB CAPSULE - NICE guidance TA505 – with lenalidomide and dexamethasone for treating relapsed or refractory multiple myeloma JMMG Approved March 2018 lenvatinib LENVATINIB CAPSULE - NICE guidance TA498 with everolimus for previously treated advanced renal cell carcinoma JMMG Approved Feb 2018 – Renal cell carcinoma not treated at MCHFT Olaratumab OLARATUMAB - NICE guidance TA465 - in combination with doxorubicin for treating advanced soft tissue sarcoma JMMG Approved Sep 2017 – not initiated at MCHFT Osimertinib OSIMERTINIB TABLETS - NICE guidance TA416 - locally advanced or metastatic EGFR T790M mutation-positive non- small-cell lung cancer JMMG Approved January 2017 Panitumumab PANITUMUMAB INJECTION – NICE guidance TA439 – Untreated metastatic colorectal cancer JMMG Approved May 2017 – not initiated at MCHFT Pembrolizumab PEMBROLIZUMAB INJECTION – NICE guidance TA428 – treating PD-L1-positive non-small-cell lung cancer after chemotherapy JMMG Approved March 2018 NICE guidance TA447 – for untreated PD-L1-positive metastatic non-small-cell lung cancer JMMG Approved March 2018 NICE guidance TA519 – for treating locally advanced or metastatic urothelial carcinoma after platinum-containing chemotherapy JMMG Approved May 2018 – not initiated at MCHFT Pentostatin PENTOSTATIN INJECTION Pertuzumab PERTUZUMAB INJECTION NICE guidance TA424 - neoadjuvant treatment of HER2-positive breast cancer JMMC Approved February 2017 - not initiated at MCHFT NICE guidance TA509 - with trastuzumab and docetaxel for treating HER2-positive breast cancer JMMG Approved May 2018 CARBOPLATIN INJECTION- NICE guidance TA55 – Ovarian cancer - Updated by TA91 JMMC Approved Jun 2008 CISPLATIN INJECTION – NICE guidance TA55 – Ovarian cancer - Updated by Ta91 JMMC Approved Jun 2008 OXALIPLATIN INJECTION- NICE guidance TA100 – Colon cancer (adjuvant) JMMC Approved Sep 2009; EOX regime Jul 2011 Procarbazine PROCARBAZINE CAPSULES Protein kinase inhibitors DABRAFENIB CAPSULES – NICE guidance TA321 - unresectable or metastatic BRAF V600 mutation-positive melanoma JMMC Approved Dec 2014 – maintenance of therapy initiated at tertiary centre DASATINIB TABLETS NICE guidance TA425 - treating imatinib-resistant or intolerant chronic myeloid leukaemia NICE guidance TA426 - untreated chronic myeloid leukaemia JMMC Approved Mar 2017 ERLOTINIB TABLETS - NICE guidance TA162 – Lung cancer (non-small-cell) NICE guidance TA258 – Lung cancer (non small cell, EGFR-TK mutation positive) JMMC Approved March 2016 – Erlotinib is now a second line option for patients whose EGFR TK result was delayed. EVEROLIMUS TABLETS- JMMC Approved Apr 2014 – Pancreatic neuroendocrine tumour GEFITINIB TABLETS - NICE guidance TA192 – Lung cancer (non-small-cell, first line) (Last updated May 2018) Page 42 of 69

JMMC Approved Nov 2012 IDELALISIB – Cancer Drug Fund Approved – relapsing/refractory Chronic Lymphatic leukaemia JMMC Approved Dec 2014 Untreated Chronic Lymphatic Leukaemia/Relapsed treated Chronic Lymphatic leukaemia JMMC Approved Jan 2016 IMATINIB TABLETS - NICE guidance TA70 – Leukaemia (chronic myeloid) – Partial update by TA241 and TA251 NICE guidance TA86 - Gastrointestinal stromal tumours – Partial update by TA209 NICE guidance TA241 – Leukaemia (chronic myeloid) update to 1.3 of TA70 NICE guidance TA251 – Leukaemia (chronic myeloid, first line) NICE guidance TA326 – Adjuvant treatment of gastro-intestinal stromal tumours JMMC Approved Feb 2015 NICE guidance TA425 - treating imatinib-resistant or intolerant chronic myeloid leukaemia NICE guidance TA426 - untreated chronic myeloid leukaemia JMMC Approved Mar 2017 LAPATINIB TABLETS NILOTINIB CAPSULES - NICE guidance TA241 – Leukaemia (chronic myeloid) NICE guidance TA251- Leukaemia (chronic myeloid, first line) – Under patient access scheme JMMC Approved Jan 2013 Philadelphia chromosome positive CML NICE guidance TA425 - treating imatinib-resistant or intolerant chronic myeloid leukaemia NICE guidance TA426 - untreated chronic myeloid leukaemia JMMC Approved Mar 2017 NINTEDANIB- NICE guidance TA347 – Previously treated locally advanced, metastatic or locally recurrent non-small-cell lung cancer JMMC Approved Sep 2015 PALBOCICLIB- NICE guidance TA495 - Palbociclib with an aromatase inhibitor for previously untreated, hormone receptor-positive, HER2-negative, locally advanced or metastatic breast cancer JMMG Approved Jan 2018 PONATINIB- JMMC Approved Apr 2014- Chronic myeloid leukaemia JMMG Approved Aug 2017 - Treating chronic myeloid leukaemia and acute lymphoblastic leukaemia REGORAFENIB- NICE guidance TA488 – for previously treated unresectable or metastatic gastrointestinal stromal tumours JMMG Approved Jan 2018 NICE guidance TA514 – for previously treated advanced hepatocellular carcinoma - NOT RECOMMENDED JMMG Approved May 2018 RIBOCICLIB- NICE guidance TA496 – Ribociclib with an aromatase inhibitor for previously untreated, hormone receptor-positive, HER2-negative, locally advanced or metastatic breast cancer JMMG Approved Feb 2018 - not initiated at MCHT RUXOLITINIB TABLETS- JMMC Approved Jan 2013 NICE guidance TA386 – Disease related splenomegaly in adults with primary myelofibrosis JMMC Approved Jan 2016 SUNITINIB CAPSULES- JMMG Approved Aug 2017 NICE guidance TA449 – Treating unresectable or metastatic neuroendocrine tumours in people with progressive disease SORAFENIB TABLETS - NICE guidance TA189 – Hepatocellular carcinoma (advanced and metastatic) NICE guidance TA474 – Treating advanced hepatocellular carcinoma JMMG Approved Nov 2017 Talc sterile TALC STERILE Taxanes CABAZITAXEL NICE guidance TA391 – Hormone relapsed metastatic prostate cancer JMMC Approved Oct 2016 DOCETAXEL INJECTION - NICE guidance TA101 – Prostate cancer (hormone-refractory) NICE guidance TA109 – Breast cancer (early) – Updated by CG80 JMMC Approved Jan 2007 PACLITAXEL INJECTION – (Last updated May 2018) Page 43 of 69

NICE guidance TA55 – Ovarian cancer – Updated by TA91 NICE guidance TA91 – Ovarian cancer (advanced) PACLITAXEL AS ALBUMIN-BOUND NANOPARTICLES – NICE guidance TA476– with gemcitabine for untreated metastatic pancreatic cancer JMMG Approved Oct 2017 - MCHFT not commissioned to administer nab-paclitaxel Tivozanib TIVOZANIB CAPSULES NICE guidance TA512 – for treating advanced renal cell carcinoma JMMG Approved May 2018 - not initiated at MCHFT Topoisomerase inhibitors IRINOTECAN INJECTION - JMMC Approved Sep 2009 PEGYLATED LIPOSOMAL IRINOTECAN JMMG Approved May 2017 - not initiated at MCHFT NICE Guidance TA440 – treating pancreatic cancer after gemcitabine Trastuzumab TRASTUZUMAB INJECTION - NICE guidance TA34 – Breast cancer NICE guidance TA107 – Breast cancer (early) NICE guidance TA208 – Gastric cancer (HER2-positive metastatic) JMMC Approved Nov 2013 – Subcutaneous form of the injection NICE guidance TA458 – for treating HER2-positive advanced breast cancer after trastuzumab and a taxane JMMG Approved March 2018 Tretinoin TRETINOIN CAPSULES Trifluridine-tipiracil TRIFLURIDINE-TIPIRACIL TABLETS- NICE guidance TA405 – previously treated colorectal cancer in adults JMMC Approved November 2016 Venetoclax VENETOCLAX TABLETS- NICE guidance TA487 – for treating chronic lymphocytic leukaemia JMMG Approved January 2018 Vismodegib VISMODEGIB CAPSULES- NICE guidance TA489 – for treating basal cell carcinoma – NOT RECOMMENDED JMMG Approved January 2018

8.2 Drugs affecting the immune response 8.2.1 Antiproliferative immunosuppressants AZATHIOPRINE INJECTION, LIQUID and TABLETS MYCOPHENOLATE MOFETIL MYCOPHENOLIC ACID ( as MYCOPHENOLATE SODIUM) 8.2.2 Corticosteroids and other immunosuppressants CICLOSPORIN - Patients should be stabilised on a particular brand of ciclosporin as switching between formulations without close monitoring may lead to clinically important changes in blood ciclosporin concentration. SIROLIMUS LIQUID and TABLETS TACROLIMUS CAPSULES - MHRA/CHM advice. Oral tacrolimus products: prescribe and dispense by brand name only (June 2012) TACROLIMUS INJECTION 8.2.3 Anti-lymphocyte monoclonal antibodies ALEMTUZUMAB INJECTION JMMC Approved Apr 2009 Authorisation for use required for each patient BLINATUMOMAB NICE guidance TA450 – for previously treated Philadelphia-chromosome-negative acute lymphoblastic leukaemia JMMG Approved Aug 2017 - not initiated/treated at MCHT NIVOLUMAB INJECTION – NICE guidance TA417 – for previously treated advanced renal cell carcinoma JMMG Approved Jan 2017 - not initiated at MCHT NICE guidance TA462– for treating relapsed or refractory classical Hodgkin lymphoma. JMMG Approved Sep 2017 - not initiated at MCHT (Last updated May 2018) Page 44 of 69

NICE guidance TA483 – For previously treated squamous non-small-cell lung cancer JMMG Approved Dec 2017 NICE guidance TA484– for previously treated non-squamous non-small-cell lung cancer JMMG Approved Dec 2017 - not initiated at MCHT NICE guidance TA490– for treating squamous cell carcinoma of the head and neck after platinum-based chemotherapy JMMG Approved Jan 2018 - not initiated at MCHT OBINUTUZUMAB- NICE guidance TA344 – in combination with chlorambucil for untreated chronic lymphatic leukaemia JMMC Approved Sep 2015 NICE guidance TA472 – with bendamustine for treating follicular lymphoma refractory to rituximab JMMG Approved Nov 2017 NICE guidance TA513– for untreated advanced follicular lymphoma JMMG Approved May 2018 OFATUMUMAB INJECTION- NICE guidance TA343 – in combination with chlorambucil or bendamustine for untreated chronic lymphatic leukaemia JMMC Approved Sep 2015 RITUXIMAB INJECTION - NICE guidance TA65 – Non-Hodgkin’s lymphoma NICE guidance TA137 - Lymphoma (follicular non-Hodgkin’s) NICE guidance TA174 – Leukaemia (chronic lymphocytic, first line) NICE guidance TA193 – Leukaemia (chronic lymphocytic, relapsed) NICE guidance TA226 – Lymphoma (follicular non-Hodgkin’s) NICE guidance TA243 – Follicular lymphoma NICE guidance TA308 – Vasculitis JMMC Approved Jun 2014 8.2.4 Other immunomodulating drugs Interferon alfa INTERFERON ALFA INJECTION Interferon beta INTERFERON BETA INJECTION BCG bladder instillation BACILLUS CALMETT-GEURIN (BCG) BLADDER INSTILLATION Daclizumab DACLIZUMAB INJECTION NICE guidance TA441 – relapsing-remitting multiple sclerosis JMMG Approved May 2017 – not initiated at MCHFT Dimethyl fumarate DIMETHYL FUMARATE CAPSULES- NICE guidance TA320 – relapsing-remitting multiple sclerosis JMMC Approved Nov 2014 – not initiated at MCHFT Lenalidomide and thalidomide LENALIDOMIDE CAPSULES - NICE guidance TA171 - Multiple myeloma JMMC Approved Apr 2010 NICE guidance TA322 – Myelodysplastic Syndrome JMMC Approved Dec 2014 POMALIDOMIDE CAPSULES- JMMC Approved Feb 2014 NICE guidance TA427 – multiple myeloma previously treated with lenalidomide and bortezomib JMMC Approved Mar 2017 THALIDOMIDE TABLETS - NICE guidance TA228 – Multiple myeloma (first line) Natalizumab NATALIZUMAB INJECTION - NICE guidance TA127 – Multiple sclerosis

8.3 Sex hormones and hormone antagonists in malignant disease 8.3.1 Oestrogens DIEHTYLSTILBOESTROL TABLETS 8.3.2 Progestogens MEDROXYPROGESTERONE ACETATE TABLETS MEGESTROL ACETATE TABLETS

(Last updated May 2018) Page 45 of 69

8.3.4 Hormone antagonists 8.3.4.1 Breast cancer ANASTRAZOLE TABLETS – NICE guidance TA112 – Breast cancer (early) hormonal treatments EXEMESTANE TABLETS – NICE guidance TA112 – Breast cancer (early) hormonal treatments LETROZOLE TABLETS – NICE guidance TA112 – Breast cancer (early) hormonal treatments TAMOXIFEN TABLETS FULVESTRANT INJECTION- JMMC Approved May 2006 NICE guidance TA503 - Fulvestrant for untreated locally advanced or metastatic oestrogen- receptor positive breast cancer - NOT RECOMMENDED JMMG Approved Feb 2018 8.3.4.2 Gonadorelin analogues and gonadotrophin-releasing hormone antagonists Gonadorelin analogues BUSERELIN INJECTION GOSERELIN IMPLANTS LEUPRORELIN INJECTION Shared Care Agreement APG Approved July 2017 Anti-androgens BICALUTAMIDE TABLETS CYPROTERONE TABLETS ABIRATERONE TABLETS – NICE guidance TA259 – Prostate cancer ( metastatic, castration resistant) JMMC Approved Nov 2012 NICE guidance TA387 – treating metastatic hormone-relapsed prostate cancer before chemotherapy is indicated JMMC Approved May 2016 DEGARELIX INJECTION- JMMC Approved Dec 2013 ENZALUTAMIDE CAPSULES – NICE guidance TA316 - metastatic hormone-relapsed prostate cancer previously treated with a docetaxel-containing regimen JMMC Approved Oct 2014 Cancer drug fund - metastatic castrate resistant prostate cancer pre-chemotherapy JMMC Approved Oct 2014 FLUTAMIDE TABLETS 8.3.4.3 Somatostatin analogues OCTREOTIDE INJECTION - OCTREOTIDE LAR – JMMC approved Feb 2009 LANREOTIDE INJECTION – JMMC Approved Nov 2001

(Last updated May 2018) Page 46 of 69

9 Nutrition and blood 9.1 Anaemias and some other blood disorders 9.1.1 Iron deficiency anaemias 9.1.1.1 Oral iron FERROUS FUMARATE CAPSULES SYRUP and TABLETS FERROUS FUMARATE & FOLIC ACID TABLETS (Pregaday®) FERROUS SULFATE M/R TABLETS and TABLETS SODIUM FEREDETATE LIQUID FERROUS GLUCONATE TABLETS FERRIC MALTOL CAPSULES (Feraccru®) JMMG Approved July 2017 - Gastroenterology consultant use only PRIMARY CARE: Pink (Specialist Initiation) (Approved in patients with IBD that have tried 2 oral agents previously, meet the criteria of the Feraccru® product licence and would have otherwise been eligible for an iron infusion. The first month should be supplied from Secondary Care with the remaining being supplied by Primary Care. A specialist review would be required to continue for longer than 6 months. Gastro team will need to document in their letter to the GP when to monitor and what actions should be taken) 9.1.1.2 Parenteral iron IRON III-HYDROXIDE DEXTRAN COMPLEX 100mg/2ml INJECTION (Cosmofer®) IRON-HYDROXIDE SUCROSE COMPLEX 100mg/5ml INJECTION (Venofer®) FERRIC CARBOXYMALTOSE INJECTION 50mg/ml Injection (Ferinject®) - JMMC Approved for use when Cosmofer or Venofer is contra-indicated IRON ISOMALTOSIDE 100mg/ml INJECTION (Monofer®) JMMG Approved for use instead of Ferinject® - June 2017 9.1.2 Drugs used in megaloblastic anaemias FOLIC ACID LIQUID and TABLETS HYDROXOCOBALAMIN INJECTION 9.1.3 Drugs used in hypoplastic, haemolytic and renal anaemias Erythropoetins EPOETIN ALFA INJECTION - NICE guidance TA142 – Anaemia (cancer - treatment induced) EPOETIN BETA INJECTION - NICE guidance TA142 – Anaemia (cancer - treatment induced) DARBEPOETIN ALFA INJECTION - NICE guidance TA142 – Anaemia (cancer - treatment induced) Iron overload DESFERRIOXAMINE 2g INJECTION Paroxysmal nocturnal haemoglobinuria and atypical haemolytic uraemic syndrome ECULIZUMAB- JMMC Approved April 2015 9.1.4 Drugs used in platelet disorders Idiopathic thrombocytopenic purpura ELTROMBOPAG TABLETS NICE guidance TA293 – Thrombocytopenic purpura. JMMC Approved Nov 2013 ROMIPLOSTIM INJECTION - NICE guidance TA221 – Thrombocytopenic purpura. JMMC Approved Feb 2012 Essential thrombocythaemia ANAGRELIDE CAPSULES 9.1.6 Drugs used in neutropenia FILGRASTIM INJECTION LENOGRASTIM INJECTION PEGFILGRASTIM INJECTION 9.1.7 Drugs used to mobilise stem cells – No products on formulary

9.2 Fluids and electrolytes 9.2.1 Oral preparations for fluid and electrolyte imbalance 9.2.1.1 Oral potassium POTASSIUM CHLORIDE 1mmol/ml SF SYRUP

(Last updated May 2018) Page 47 of 69

SANDO-K® EFFERVESCENT TABLETS Management of hyperkalaemia POLYSTYRENE SULFONATE RESINS (Calcium Resonium®; Resonium A®) 9.2.1.2 Oral sodium and water Sodium chloride SODIUM CHLORIDE 5mmol/ml ORAL SOLUTION SODIUM CHLORIDE 600mg M/R TABLETS (Slow Sodium®) Oral rehydration therapy (ORT) DIORALYTE® SACHETS 9.2.1.3 Oral bicarbonate SODIUM BICARBONATE 500mg CAPSULES SODIUM BICARBONATE 600mg TABLETS SODIUM BICARBONATE 1mmol/ml ORAL SOLUTION SODIUM BICARBONATE POWDER 9.2.2 Parenteral preparations for fluid and electrolyte imbalance 9.2.2.1 Electrolytes and water Intravenous sodium SODIUM CHLORIDE 0.18% INFUSION 500ml SODIUM CHLORIDE 0.45% INFUSION 500ml SODIUM CHLORIDE 0.9% INFUSION 100ml, 250ml, 500ml 1Litre SODIUM CHLORIDE 1.8% INFUSION 500ml Intravenous sodium with other ingredients SODIUM CHLORIDE 0.18%, GLUCOSE 4% INFUSION 500ml, 1Litre SODIUM CHLORIDE 0.45%, GLUCOSE 5% INFUSION 500ml SODIUM CHLORIDE 0.9%, GLUCOSE 5% INFUSION 500ml, 1Litre SODIUM LACTATE COMPOUND INFUSION (HARTMANNS) 500ml, 1Litre Intravenous glucose GLUCOSE 10% INFUSION 250ml, 500ml GLUCOSE 15% INFUSION 500ml GLUCOSE 20% INFUSION 500ml GLUCOSE 5% INFUSION 100ml, 250ml, 500ml, 1Litre GLUCOSE 50% INJECTION 50ml Intravenous potassium GLUCOSE 10%, SODIUM CHLORIDE 0.45%, POTASSIUM 10mmol 500ml POTASSIUM CHLORIDE 0.15%, SODIUM CHLORIDE 0.45%, GLUCOSE 5% INFUSION 500ml POTASSIUM CHLORIDE 0.3%% SODIUM CHLORIDE 0.18%, GLUCOSE 4% INFUSION 1Litre POTASSIUM CHLORIDE 0.15% SODIUM CHLORIDE 0.9% 500ml, INFUSION 1Litre POTASSIUM CHLORIDE 0.3%, GLUCOSE 10% INFUSION 500ml POTASSIUM CHLORIDE 0.3%, GLUCOSE 5% INFUSION 500ml, 1Litre POTASSIUM CHLORIDE 0.3%, SODIUM CHLORIDE 0.9% INFUSION 500ml, 1Litre POTASSIUM CHLORIDE 0.3% SODIUM CHLORIDE 0.9% GLUCOSE 5% 500ml - JMMC Approved Feb 2016 POTASSIUM CHLORIDE 0.6%, SODIUM CHLORIDE 0.9% INFUSION 500ml POTASSIUM CHLORIDE 3% SODIUM CHLORIDE 0.9% 100ml INFUSION- CCU, HDU and ICU only SODIUM CHLORIDE 0.45%, GLUCOSE 5% POTASSIUM CHLORIDE 0.15% 500mL- JMMC Approved July 2013 SODIUM CHLORIDE 0.45%, GLUCOSE 5% POTASSIUM CHLORIDE 0.3% 500mL- JMMC Approved July 2013 Bicarbonate and lactate SODIUM BICARBONATE 1.26% INFUSION 500ml SODIUM BICARBONATE 1.4% INFUSION 500ml SODIUM BICARBONATE 4.2% INFUSION 500ml SODIUM BICARBONATE 4.2% INJECTION 10ml SODIUM BICARBONATE 8.4% INFUSION 200ml SODIUM BICARBONATE 8.4% INJECTION 10ml SODIUM BICARBONATE 8.4% MINIJET 50ml Water WATER FOR INJECTION 2ml, 5ml, 10ml, 20ml, 100ml 9.2.2.2 Plasma and plasma substitutes GELOFUSINE® INFUSION 500ml

9.4 Oral nutrition 9.4.1 Foods for special diets FORTISIP® COMPACT VANILLA MODULEN® IBD ORAL POWDER (Last updated May 2018) Page 48 of 69

SIMILAC HIGH ENERGY INFANT FORMULA - JMMC Approved Mar 2011 SIMILAC ALIMENTUM- JMMC Approved Jan 2014 WYSOY® LOCASOL – for hypercalcaemia in neonates JMMC Approved Sep 2015 MCT PEPDITE 0-2 MCT PEPDITE 2+ NUTAMIGEN POWDER PHYLEX-VITS CACHETS PREGESTIMIL POWDER 9.4.2 Enteral nutrition CALOGEN® EXTRA SHOTS CAROBEL INSTANT® POWDER (135g) DUOCAL® SUPER SOLUBLE POWDER (400g) ENSURE® COMPACT- JMMC Approved Nov 2014 – patients who require smaller volumes than standard Ensure® plus ENSURE® PLUS MILKSHAKE STYLE (220ml) ENSURE® PLUS FIBRE (200ml) ENSURE® PLUS JUCE (220ml) ENSURE® PLUS YOGHURT STYLE (220ml) JEVITY® READY to HANG 1.0kcal/ml JEVITY®READY to HANG 1.2kcal/ml JEVITY® READY to HANG 1.5kcal/ml NEOCATE® POWDER NEPRO® LIQUID 500ml NUTILIS® COMPLETE NUTRIPREM 2 OSMOLITE® READY to HANG PAEDIASURE® LIQUID PAEDIASURE® PLUS LIQUID PAEDIASURE® PLUS with FIBRE LIQUID POLYCAL® LIQUID 200ml RESOURCE® THICKEN UP CLEAR – JMMC Approved Oct 2011 THICK and EASY (225g) ELEMENTAL 028® LIQUID (250ml) - on recommendation of dietician ELEMENTAL 028® EXTRA LIQUID (250ml) - on recommendation of dietician ENSURE® PLUS READY to HANG - on recommendation of dietician INFATRINI PEPTISORB - on recommendation of dietician- JMMC Approved Jun 2014 JEVITY® PLUS HP (500ml) - on recommendation of dietician JEVITY® PROMOTE READY to HANG (1Litre) - on recommendation of dietician NESTLE CLINICAL NUTRITION® FLAVOURING - on recommendation of dietician NUTRAMIGEN AA – children with multiple food allergies- JMMC Approved Oct 2014 PAEDIASURE® PEPTIDE (200ml) - on recommendation of dietician PERATIVE® READY to HANG - on recommendation of dietician POLYCAL® POWDER - on recommendation of dietician RESOURCE® 2 FIBRE - on recommendation of dietician RESOURCE® OPTIFIBRE - on recommendation of dietician VITAL 1.5Kcal/ml – on recommendation of dietician

9.5 Minerals 9.5.1 Calcium and magnesium 9.5.1.1 Calcium supplements Oral preparations CALCIUM CARBONATE 1.25g (500mg CALCIUM) CHEWABLE TABLETS (Calcichew®) SANDOCAL®-1000 EFFERVESCENT TABLETS CALCIUM SANDOZ® SYRUP (2.7mmol Calcium/5ml) Parenteral preparations CALCIUM CHLORIDE 10% INJECTION CALCIUM GLUCONATE 10% INJECTION 9.5.1.2 Hypercalcaemia and hypercalciuria

(Last updated May 2018) Page 49 of 69

Hypercalciuria CINACALCET - NICE guidance TA117 – Hyperparathyroidism ETELCALCETIDE NICE guidance TA448 – treating secondary hyperparathyroidism JMMG Approved Aug 2017 – renal use only, not treated at MCHFT 9.5.1.3 Magnesium MAGNESIUM GLYCEROPHOSPHATE CHEWABLE TABLETS 1g (4mmol) MAGNESIUM SULPHATE 50% INJECTION 9.5.2 Phosphorus 9.5.2.1 Phosphate supplements PHOSPHATE INFUSION 10mmol in 500ml PHOSPHATE-SANDOZ® EFFERVESCENT TABLETS JOULIES SOLUTION 9.5.2.2 Phosphate binding agents SEVELAMER SACHETS and TABLETS LANTHANUM TABLETS 9.5.3 Fluoride - No products on formulary 9.5.4 Zinc ZINC SULPHATE CAPSULES and EFFERVESCENT TABLETS

9.5.5 Selenium- No products on formulary

9.6 Vitamins 9.6.1 Vitamin A - No products on formulary 9.6.2 Vitamin B group PABRINEX® IV HIGH POTENCY INJECTION PYRIDOXINE TABLETS THIAMINE TABLETS VITAMIN B COMPOUND STRONG TABLETS Please note: NICE no longer recommends vitamin B Co (strong) for patients with alcohol use disorders. Agreed at APG May 2017 9.6.3 Vitamin C ASCORBIC ACID TABLETS ASCORBIC ACID EFFERVESCENT TABLETS- Use in sexual health only 9.6.4 Vitamin D ADCAL-D3® CHEWABLE TABLETS ALFACALCIDOL CAPSULES and DROPS CALCEOS® CHEWABLE TABLETS CALCICHEW D3® FORTE CHEWABLE TABLETS CALCITRIOL CAPSULES CALCIUM and ERGOCALCIFEROL TABLETS COLECALCIFEROL CAPSULES (Fultium®/Pro D3®) and TABLETS (Desunin®) CACIT D3 ERRERVESCENT GRANULE – Use in swallowing difficulties 9.6.5 Vitamin E VITAMIN E CAPSULES 9.6.6 Vitamin K MENADIOL SODIUM PHOSPHATE TABLETS PHYTOMENADIONE TABLETS PHYTOMENADIONE INJECTION 9.6.7 Multivitamin preparations DALIVIT® DROPS FORCEVAL® CAPSULES I CAPS® KETOVITE® LIQUID and TABLETS PARAVIT CF CAPSULES and LIQUID JMMG Approved May 2018 – CF Paediatric patients only PRIMARY CARE: Awaiting decision

(Last updated May 2018) Page 50 of 69

PRESERVISION® LUTEINE CAPSULES

Prescribing Removed from formulary as per APG Nov 2017. Click here for a link to the Primary Care Commissioning Policy - Age-Related Macular DegenerationCommunication - Sept 2017.pdf Document VITAMIN CAPSULES ABIDEC® DROPS- JMMC Approved July 2013 – individual patient only

9.7 Bitters and tonics - No products on formulary

9.8 Metabolic disorders 9.8.1 Drugs used in metabolic disorders Carnitine deficiency L-CARNITINE 30% Oral solution - JMMC Approved Mar 2013 9.8.2 Acute porphyrias HAEM ARGINATE 250mg/10ml INFUSION (Normosang®)

(Last updated May 2018) Page 51 of 69

10 Musculoskeletal and joint disorders 10.1 Drugs used in rheumatic diseases and gout 10.1.1 Non-steroidal anti-inflammatory drugs CELECOXIB 100mg & 200mg CAPSULES Second-line NSAID when a COX-II NSAID is indicated DICLOFENAC SUPPOSITORIES and TABLETS MHRA Alert June 2013– Restrictions in use of Diclofenac DICLOFENAC 75mg/3ml INJECTION MHRA Alert June 2013– Restrictions in use of Diclofenac ETORICIXIB TABLETS 120mg- JMMC Approved – Orthopaedics enhanced recovery protocol IBUPROFEN LIQUID, M/R TABLETS and TABLETS INDOMETACIN SUPPOSITORIES MEFENAMIC ACID TABLETS NAPROXEN TABLETS IBUPROFEN 100mg/5ml SACHETS IBUPROFEN 200mg MELTLETS 10.1.2 Corticosteroids 10.1.2.1 Systemic corticosteroids PREDNISOLONE UNCOATED TABLETS 10.1.2.2 Local corticosteroid injections METHYLPREDNISOLONE ACETATE INJECTION TRIAMCINOLONE INJECTION 10.1.3 Drugs that suppress the rheumatic disease process Gold SODIUM AUROTHIOMALATE INJECTION Penicillamine PENICILLAMINE TABLETS Antimalarials HYDROXYCHLOROQUINE TABLETS Drugs affecting the immune response METHOTREXATE INJECTION and TABLETS LEFLUNOMIDE TABLETS Cytokine modulators ADALIMUMAB INJECTION - NICE guidance TA130 – Rheumatoid arthritis NICE guidance TA143 – Ankylosing spondylitis NICE guidance TA195 – Rheumatoid arthritis – drugs for treatment after failure of a TNF inhibitor NICE guidance TA199 – Psoriatic arthritis ETANERCEPT INJECTION - NICE guidance TA35 – Arthritis (juvenile idiopathic) NICE guidance TA130– Rheumatoid arthritis NICE guidance TA143 – Ankylosing spondylitis NICE guidance TA195 – Rheumatoid arthritis – drugs for treatment after failure of a TNF inhibitor NICE guidance TA199 – Psoriatic arthritis JMMC Approved Jun 2002 for use in rheumatology JMMC Approved Jul 2016 Use of biosimilar product (Benepali®) INFLIXIMAB INFUSION - NICE guidance TA130– Rheumatoid arthritis NICE guidance TA195 – Rheumatoid arthritis – drugs for treatment after failure of a TNF inhibitor NICE guidance TA199 – Psoriatic arthritis JMMC Approved Jun 2002 for use in rheumatology JMMC Approved Oct 2015 Use of Infliximab biosimilar products in new patients and on existing patients after consent given. ABATACEPT INJECTION – NICE guidance TA195 – Rheumatoid arthritis – drugs for treatment after failure of a TNF inhibitor JMMC Approved Apr 2009 NICE guidance TA234 Rheumatoid arthritis – abatacept 2nd line JMMC Approved Sep 2013 NICE guidance TA373 – Juvenile idiopathic arthritis JMMC Approved March 2016

(Last updated May 2018) Page 52 of 69

ADALIMUMAB INJECTION – NICE guidance TA373 – Juvenile idiopathic arthritis JMMC Approved March 2016 APREMILAST TABLETS NICE guidance TA419 – Moderate to severe plaque psoriasis JMMC Approved Feb 2017 NICE guidance TA433 – Active psoriatic arthritis JMMC Approved Apr 2017 CERTOLUZIMAB PEGOL - NICE guidance TA415-severe active rheumatoid arthritis in adults who have had a TNF alpha inhibitor JMMC Approved November 2016 NICE guidance TA445- active psoriatic arthritis after inadequate response to DMARDs JMMG Approved June 2017 ETANERCEPT INJECTION – NHS England commissioned- Juvenile Idiopathic Arthritis continuing into adulthood JMMC Approved Aug 2015 NICE guidance TA373 – Juvenile idiopathic arthritis JMMC Approved March 2016 GOLIMUMAB INJECTION - NICE guidance TA220 – Psoriatic arthritis NICE guidance TA225 – Rheumatoid arthritis (after the failure of previous anti-rheumatic drugs) NICE guidance TA233 – Ankylosing spondylitis JMMC Approved Mar 2012 NICE guidance TA497– treating non-radiographic axial spondyloarthritis JMMG Approved Feb 2018 RITUXIMAB INJECTION - NICE guidance TA195 – Rheumatoid arthritis – drugs for treatment after failure of a TNF inhibitor SARILUMAB INJECTION - NICE guidance TA485 - Treating moderate to severe rheumatoid arthritis JMMG Approved Dec 2017 SECUKINUMAB INJECTION- NICE guidance TA407 – active ankylosing spondylitis after treatment with NSAIDs or TNF-alpha inhibitors JMMG Approved November 2016 NICE guidance TA445- active psoriatic arthritis after inadequate response to DMARDs JMMG Approved June 2017 TOCILIZUMAB INJECTION - NICE guidance TA247 – Rheumatoid arthritis NICE guidance TA238 – Arthritis (juvenile idiopathic, systemic) JMMC Approved Dec 2010 NHS England commissioned- Juvenile Idiopathic Arthritis continuing into adulthood JMMC Approved Aug 2015 NICE guidance TA373 – Juvenile idiopathic arthritis JMMC Approved March 2016 Janus kinase inhibitors BARICITINIB TABLETS JMMG Approved Sep 2017 NICE guidance TA466 – Treating moderate to severe rheumatoid arthritis TOFACITINIB TABLETS JMMG Approved Nov 2017 NICE guidance TA480– Treating moderate to severe rheumatoid arthritis 10.1.4 Gout and cytotoxic-induced hyperuricaemia Acute attack of gout COLCHICINE TABLETS Long term control of gout ALLOPURINOL TABLETS RASBURICASE INJECTION – JMMC Approved Sep 2012 JMMC Guidelines approved Nov 2014 BENZBROMARONE TABLETS – JMMC Approved Jul 2011 Authorisation required for each patient FEBUXOSTAT TABLETS - NICE guidance TA164 – Hyperuricaemia JMMC Approved Jan 2011 10.1.5 Other drugs for rheumatic diseases – No products on formulary

(Last updated May 2018) Page 53 of 69

10.2 Drugs used in neuromuscular disorders 10.2.1 Drugs that enhance neuromuscular transmission Anticholinesterases EDROPHONIUM INJECTION PYRIDOSTIGMINE TABLETS NEOSTIGMINE TABLETS 10.2.2 Skeletal muscle relaxants BACLOFEN LIQUID and TABLETS DANTROLENE CAPSULES TIZANIDINE TABLETS Nocturnal leg cramps QUININE SULPHATE TABLETS

10.3 Drugs for the treatment of soft-tissue disorders and topical pain relief 10.3.1 Enzymes HYALURONIDASE INJECTION COLLAGENASE CLOSTRIDIUM HISTOLYTICUM (XIAPEX®) NICE guidance TA459- treating Dupuytren's contracture. JMMG Approved Oct 2017 10.3.2 Rubefacients, topical NSAIDs, capsaicin and poultices Topical NSAIDs IBUPROFEN 5% GEL MOVELAT® GEL Capsaicin CAPSAICIN CREAM 0.025%; 0.075% Poultices KAOLIN POULTICE SACHETS

10.4 Autologous chondrocyte implantation AUTOLOGOUS CHONDROCYTE IMPLANTATION NICE guidance TA508- for treating symptomatic articular cartilage defects of the knee JMMG Approved May 2018 – Not for use at MCHFT (Tertiary Centres only)

(Last updated May 2018) Page 54 of 69

11 Eye 11.3 Anti-infective eye preparations 11.3.1 Antibacterials CEFTAZIDIME EYE DROP KIT CEFUROXIME 5% EYE DROPS CEFUROXIME 50mg INTRACAMERAL INJECTION- JMMC Approved March 2015 CHLORAMPHENICOL 0.5% EYE DROPS with preservative CHLORAMPHENICOL 0.5% MINIMS® CHLORAMPHENICOL 1% EYE OINTMENT CIPROFLOXACIN 0.3% EYE DROPS and EYE OINTMENT FUSIDIC ACID 1% EYE DROPS (Fucithalmic®) GENTAMICIN FORTE 1.5% EYE DROPS with preservative GENTAMICIN FORTE 1.5% EYE DROPS preservative free LEVOFLOXACIN 0.5% EYE DROPS with preservative (Oftaquix®) LEVOFLOXACIN 0.5% EYE DROPS preservative free (Oftaquix®) OFLOXACIN 0.3% EYE DROPS WITH PRESERVATIVE (Exocin®) PROPAMIDINE 0.1% EYE DROPS with preservative (Brolene®) TEICOPLANIN 1% EYE DROP KIT VANCOMYCIN 5% EYE DROPS 11.3.2 Antifungals AMPHOTERACIN EYE DROP KIT ECONAZOLE 1% EYE DROPS VORICONAZOLE EYE DROPS 11.3.3 Antivirals ACICLOVIR 3% EYE OINTMENT GANCICLOVIR 0.15% EYE GEL – when treatment with aciclovir has failed. Approved as first line during supply problems with aciclovir.

11.4 Corticosteroids and other anti-inflammatory preparations 11.4.1 Corticosteroids BETAMETHASONE 0.1% EYE OINTMENT BETAMETHASONE 0.1% EYE/EAR/NOSE DROPS BETAMETHASONE & NEOMYCIN EYE/EAR/NOSE DROPS (Betnesol N®) DEXAMETHASONE 0.1% EYE DROPS with preservative (Maxidex®) DEXAMETHASONE 0.1% EYE drops preservative free DEXAMETHASONE 0.1% MINIMS® DEXAMETHASONE, NEOMYCIN & POLYMIXIN EYE DROPS and EYE OINTMENT (Maxitrol®) DEXAMETHASONE & TOBRAMYCIN EYE DROPS (Tobradex®) FLUOROMETHOLONE 0.1% EYE DROPS (FML®) PREDNISOLONE 0.1% EYE DROPS with preservative PREDNISOLONE 0.5% EYE/EAR DROPS with preservative (Predsol®) PREDNISOLONE 0.5% MINIMS® PREDNISOLONE 1% EYE DROPS with preservative (Pred Forte®) PREDNISOLONE 0.1% EYE DROPS preservative free PREDNISOLONE 0.5% EYE DROPS preservative free PREDNISOLONE 1% EYE DROPS preservative free RIMEXOLONE 1% EYE DROPS (Vexol®) Intravitreal corticosteroids DEXAMETHASONE 700microgram INTRAVITREAL IMPLANT - NICE guidance TA229 – Macular oedema (retinal vein occlusion) JMMC Approved Aug 2012 NICE guidance TA349 - Diabetic Macular Oedema JMMC Approved Aug 2015 – pathway and Blueteq template required NICE guidance TA460 –treating non-infectious uveitis. JMMG Approved March 2018 FLUOCINOLONE ACETONIDE INTRAVITREAL IMPLANT- NICE guidance TA301 – Diabetic Macular Oedema JMMC Approved Feb 2014 11.4.2 Other anti-inflammatory preparations AZELASTINE 0.05% EYE DROPS (Optilast®) LODOXAMIDE 0.1% EYE DROPS (Alomide®) NEDOCROMIL SODIUM 2% EYE DROPS (Raptil®) OLOPATADINE 1mg/ml EYE DROPS (Opatanol®) (Last updated May 2018) Page 55 of 69

SODIUM CROMOGLICATE 2% EYE DROPS with preservative CICLOSPORIN 1mg/mL EYE DROPS JMMC Approved Jan 2016 – Secondary care use only SODIUM CROMOGLICATE 2% EYE DROPS preservative free - JMMC Approved Oct 2012 ADALIMUMAB- NICE guidance TA460 –treating non-infectious uveitis. JMMG Approved March 2018

11.5 Mydriatics and cycloplegics Antimuscarinics ATROPINE 1% EYE DROPS with preservative ATROPINE 1% MINIMS® CYCLOPENTOLATE 0.5% EYE DROPS with preservative (Mydrilate®) CYCLOPENTOLATE 0.5% MINIMS® CYCLOPENTOLATE 1% EYE DROPS with preservative (Mydrilate®) CYCLOPENTOLATE 1% MINIMS® HOMATROPINE 1% EYE DROPS with preservative TROPICAMIDE 0.5% EYE DROPS with preservative (Mydriacyl®) TROPICAMIDE 0.5% MINIMS® TROPICAMIDE 1% EYE DROPS with preservative (Mydriacyl®) TROPICAMIDE 1% MINIMS® Sympathomimetics PHENYLEPHRINE 10% MINIMS® PHENYLEPHRINE 2.5% MINIMS® Combined Products MYDRANE INJECTION – (Tropicamide/Phenylephrine/Lidocaine|) JMMC Approved Jul 2016 11.6 Treatment of glaucoma Beta-blockers BETAXOLOL 0.25% EYE DROPS with preservative BETAXOLOL 0.25% SINGLE DOSE EYE DROPS BETAXOLOL 0.5% EYE DROPS with preservative CARTEOLOL 1% EYE DROPS CARTEOLOL 2% EYE DROPS LEVOBUNOLOL 0.5% EYE DROPS (Betagan®) TIMOLOL 0.25% EYE DROPS with preservative TIMOLOL 0.25% LA EYE DROPS with preservative (Timoptol LA®) LEVOBUNOLOL 0.5% SINGLE DOSE EYE DROPS preservative free TIMOLOL 0.25% SINGLE DOSE EYE DROPS preservative free TIMOLOL 0.5% SINGLE DOSE EYE DROPS preservative free Prostaglandin analogues and prostamides BIMATOPROST 300microgram/ml EYE DROPS (Lumigan®) BIMATOPROST 100microgram/ml EYE DROPS (Lumigan®) - BIMATOPROST & TIMOLOL EYE DROPS (Ganfort®) LATANOPROST 50microgram/ml EYE DROPS LATANOPROST 50microgram/ml EYE DROPS (Preservative free)- JMMC Approved Jan 2014 LATANOPROST & TIMOLOL EYE DROPS (Xalacom®) TAFLUPROST 15microgram/mL EYE DROPS preservative free (Saflutan®) TAFLUPROST 15 micrograms/ml + TIMOLOL 5 mg/ml EYE DROPS preservative free (Taptiqom®) TRAVOPROST 40microgram/ml EYE DROPS with preservative Sympathomimetics BRIMONIDINE 0.2% EYE DROPS with preservative BRIMONIDINE & TIMOLOL EYE DROPS (Combigan®) APRACLONIDINE 0.5% EYE DROPS Carbonic anhydrase inhibitors and systemic drugs ACETAZOLAMIDE INJECTION, M/R CAPSULES and TABLETS BRINZOLAMIDE 10mg/ml EYE DROPS BRINZOLAMIDE & TIMOLOL EYE DROPS (Azarga®) BRINZOLAMIDE + BRIMONIDINE EYE DROPS 10 mg/mL + 2 mg/mL (Simbrinza®) DORZOLAMIDE 2% EYE DROPS with preservative DORZOLAMIDE 2% EYE DROPS preservative free DORZOLAMIDE & TIMOLOL EYE DROPS (Cosopt®) DORZOLAMIDE & TIMOLOL SINGLE USE EYE DROPS (Cosopt®) Miotics (Last updated May 2018) Page 56 of 69

PILOCARPINE 1% EYE DROPS with preservative PILOCARPINE 2% EYE DROPS with preservative PILOCARPINE 2% EYE MINIMS® PILOCARPINE 4% EYE DROPS with preservative PILOCARPINE 4% EYE DROPS preservative free PILOCARPINE 4% OPHTHALMIC GEL with preservative (Pilogel®)

11.7 Local anaesthetics OXYBUPROCAINE 0.4% MINIMS® PROXYMETACAINE 0.5%, FLUORESCEIN 0.25% MINIMS® PROXYMETACAINE 0.5% MINIMS® TETRACAINE 0.5% MINIMS® TETRACAINE 1% MINIMS® COCAINE 4% EYE DROPS

11.8 Miscellaneous ophthalmic preparations 11.8.1 Tear deficiency, ocular lubricants and astringents

Pharmacological Management of Dry Eye TPF refers to products which are completely preservative free PPF indicates those products which are ‘pseudo’ preservative free i.e. contain a preservative which is converted to natural tear components upon contact with the ocular surface

First Line HYPROMELLOSE 0.5% Drops (Isopto Plain® ) POYLVINYL ALCOHOL 1.4% Drops (Sno Tears®)

Second Line CARBOMER 0.2% Gel (Clinitas® Gel) CARBOMER 0.2% Gel (PPF) (Xailin® Gel) CARMELLOSE 1% Drops (TPF) (Melophthal®)

Night -Time Lubricants PARAFFIN/MINERAL OIL/LANOLIN Ointment (TPF) (Xailin Night®) PARAFFIN/VITAMIN A Ointment (TPF) (Vita-POS® Gel) CARBOMER 0.2%/LIPIDS Gel (Artelac Nightime® Gel)

Third Line SODIUM HYALURONATE 0.15% Drops (PPF) (Artelac Rebalance®) HYDROXYPROPYL GUAR Drops (Systane®) HYDROXYPROPYL GUAR/SORBITOL Drops (Systane Ultra®) CARMELLOSE 0.5%/CASTOR OIL (PPF) (Optive Plus®) CARMELLOSE 0.5%/SODIUM HYALURONATE 0.1% Drops (PPF) (Optive Fusion®)

Fourth Line SODIUM HYALURONATE 0.2% Drops (TPF) (HYLO-Forte®) SODIUM HYALURONATE 0.4% Drops (TPF) (Clinitas Soothe®) SOYBEAN OIL/PHOSPHOLIPID EMULSION (TPF) (Emustil®) SODIUM HYALURONATE 0.15%/XANTHAN GUM 1% Gel (TPF) (Lubristil®) HYDROXYETHYLCELLULOSE 0.45%/SODIUM CHLORIDE 0.35% Drops (TPF) (Minims® Artificial Tears)

JMMC Approved Aug 2014

Other Products BALANCED SALT SOLUTION POTASSIUM ASCORBATE EYE DROPS (Last updated May 2018) Page 57 of 69

POVIDONE IODINE 5% EYE DROPS SODIUM CHLORIDE 0.9% MINIMS® ACETYLCYSTEINE 5% EYE DROPS preservative free ACETLYCYSTEINE 5%, HYPROMELLOSE 0.35% EYE DROPS with preservative (Ilube®) CICLOSPORIN 0.2% EYE OINTMENT CICLOSPORIN 2% EYE DROPS preservative free GLYCERIN 10% EYE DROPS SODIUM CHLORIDE 5% EYE DROPS SODIUM CHLORIDE 5% EYE OINTMENT

11.8.2 Ocular diagnostic and peri-operative and photodynamic treatment ACETLYCHOLINE 1% INTRAOCULAR IRRIGATION 10mg/ml (Miochol-E®) APRACLONIDINE 1% EYE DROPS preservative free 0.25ml (Iopidine®) DICLOFENAC SODIUM 0.1% SINGLE DOSE EYE DROPS (Voltarol® Ophtha) FLUORESCEIN SODIUM 1% MINIMS® FLUORESCEIN SODIUM 2% MINIMS® FLUORESCEIN SODIUM 20% INJECTION FLUORESCEIN STRIPS KETOROLAC 0.5% EYE DROPS with preservative NEPAFANAC EYE DROPS- JMMC Approved Feb 2015 – MCHFT to provide full course SODIUM HYALURONATE 1% SYRINGE (BD OVD) SODIUM HYALURONATE 7.7mg/0.55ml ( Healon GV) SODIUM HYALURONATE 8.5mg.0.85ml (Healon) VISCOAT® 0.75ml DISODIUM EDETATE 0.37% SOLUTION preservative free Subfoveal choroidal neovascularisation AFLIBERCEPT INTRAVITREAL INJECTION 40mg/ml- NICE guidance - TA294 Macular degeneration (wet age-related) 1st line JMMC Approved Oct 2013 NICE guidance – TA305 Macular oedema (central retinal vein occlusion) JMMC Approved Apr 2014 NICE guidance TA346 - visual impairment caused by diabetic macular oedema JMMC Approved Aug 2015 – pathway and Blueteq template required NICE guidance TA409 - visual impairment caused by macular oedema after branch retinal vein occlusion JMMG Approved November 2016 NICE guidance TA486 – Treating choroidal neovascularisation in adults JMMG Approved January 2018 BEVACIZUMAB 1.25mg/0.05ml INTRAVITREAL SYRINGE- Primary care commissioned service OCRIPLASMIN 0.5mg/0.2mL INTRAVITREAL INJECTION- NICE guidance - TA297 Vitreomacular traction JMMC Approved Jan 2014 RANIBIZUMAB 3mg/0.3ml INJECTION – NICE guidance TA155 – Macular degeneration (age-related) Primary care commissioned service NICE guidance TA274 – Macular oedema (diabetic) NICE guidance TA283 – Macular oedema ( retinal vein occlusion) JMMC Approved Oct 2013

11.8.3 Miscellaneous HOLOCLAR NICE guidance – TA467 treating limbal stem cell deficiency after eye burns. Not treated at MCHFT JMMG Approved Oct 2017

(Last updated May 2018) Page 58 of 69

12 Ear, nose and oropharynx 12.1 Drugs acting on the ear 12.1.1 Otitis externa Anti-inflammatory preparations FLUMETASONE 0.02% CLIOQUINOL 1% EAR DROPS 7.5mL (Formerly Locorten Vioform®) GENTISONE® HC EAR DROPS OTOMIZE® EAR SPRAY SOFRADEX® EAR DROPS CIPROFLOXACIN 0.3% / DEXAMETHASONE 0.1% EAR DROPS (CILODEX®) JMMG Approved Nov 2017 – Only on specialist advice PRIMARY CARE: Pink (Specialist Recommendation) – Agreed at APG Jan 2018 12.1.3 Removal of ear wax OLIVE OIL EAR DROPS SODIUM BICARBONATE EAR DROPS

12.2 Drugs acting on the nose 12.2.1 Drugs used in nasal allergy Antihistamines AZELASTINE AQUEOUS 140microgram/spray NASAL SPRAY Corticosteroids BECLOMETASONE 50micrograms/spray AQUEOUS NASAL SPRAY BUDESONIDE 64microgram/spray AQUEOUS NASAL SPRAY FLUTICASONE 50microgram/spray AQUEOUS NASAL SPRAY FLUTICASONE 400microgram/dose NASAL DROPS (Nasules®) MOMETASONE 50microgram/spray AQUEOUS NASAL SPRAY 12.2.2 Topical nasal decongestants Sympathomimetics EPHEDRINE 0.5% NASAL DROPS EPHEDRINE 1% NASAL DROPS SODIUM CHLORIDE 0.9% NASAL DROPS XYLOMETAZOLINE 0.05% NASAL DROPS XYLOMETAZOLINE 0.1% NASAL DROPS XYLOMETAZOLINE 0.1% NASAL SPRAY Antimuscarinic IPRATROPIUM 21microgram/spray NASAL SPRAY 12.2.3 Nasal preparations for infection BIPP GAUZE Nasal staphylococci MUPIROCIN 2% NASAL OINTMENT NASPETIN® NASAL CREAM

12.3 Drugs acting on the oropharynx 12.3.1 Drugs for oral ulceration and inflammation BENZYDAMINE ORAL RINSE and SPRAY BONJELA® ORAL GEL GELCLAIR® SACHETS HYDROCORTISONE 2.5mg OROMUCOSAL TABLETS LIDOCAINE 10% SPRAY TRIAMCINOLONE 0.1% ORAL PASTE 12.3.2 Oropharyngeal anti-infective agents MICONAZOLE 20mg/g ORAL GEL NYSTATIN 100,000units/ml SUSPENSION 12.3.4 Mouthwashes, gargles and dentrifices CHLORHEXIDINE GLUCONATE DENTAL GEL and MOUTHWASH HEXETIDINE MOUTHWASH (Oraldene®) HYDROGEN PEROXIDE MOUTHWASH MOUTHWASH TABLETS 12.3.5 Treatment of dry mouth Local treatment AS SALIVA ORTHANA® BIOTENE ORALBALANCE® GEL BIOXTRA® GEL (Last updated May 2018) Page 59 of 69

GLANDOSANE SPRAY® SALIVIX PASTILLES® Systemic treatment PILOCARPINE 5mg TABLETS

(Last updated May 2018) Page 60 of 69

13 Skin 13.2 Emollient and barrier preparations 13.2.1 Emollients NPSA Alert – Fire Hazard with Paraffin Based Skin Products on Dressings and Clothes Non-proprietary emollient preparations EMULSIFYING OINTMENT HYDROUS OINTMENT (OILY CREAM) LIQUID PARAFFIN 50% in WHITE SOFT PARAFFIN PARAFFIN YELLOW SOFT PROPYLENE GLYCOL 40% in UNGUENTUM M® Proprietary emollient preparations AVEENO® CREAM CETRABEN® CREAM DIPROBASE® CREAM DOUBLEBASE® GEL E45 CREAM EPADERM® OINTMENT HYDROMOL® CREAM LIPOBASE® CREAM UNGUENTUM M® CREAM Preparations containing urea AUADRATE® CREAM BALNEUM® PLUS CREAM With antimicrobials DERMOL® CREAM DERMOL® 600 LOTION 13.2.1.1 Emollient bath and shower preparations AQUEOUS CREAM AVEENO® BATH OIL BALNEUM® BATH OIL BALNEUM® PLUS BATH OIL DIPROBATH® E45® BATH OIL HYDROMOL® EMOLLIENT INFACARE® BABY BATH ULTRA MILD OILATUM® EMOLLIENT OILATUM GEL With antimicrobials DERMOL LOTION DERMOL® 600 BATH EMOLLIENT OILATUM ®PLUS EMOLLIENT 13.2.2 Barrier preparations Non-proprietary barrier preparations ZINC & CASTOR OIL OINTMENT Proprietary preparations CONOTRANE® CREAM DRAPOLENE® CREAM METANIUM® OINTMENT SPRILON® SPRAY SUDOCREM®

13.3 Topical local anaesthetics and antipruritics CALAMINE LOTION CROTAMITON CREAM and LOTION (Eurax®) LEVOMENTHOL CREAM

13.4 Topical corticosteroids Potency - mild HYDROCORTISONE 0.1% CREAM HYDROCORTISONE 0.5% OINTMENT HYDROCORTISONE 1% CREAM and OINTMENT HYDROCORTISONE 2.5% OINTMENT

(Last updated May 2018) Page 61 of 69

Potency – mild with antimicrobial DAKTACORT® CREAM and OINTMENT ECONACORT CREAM FUCIDIN H® CREAM NYSTAFORM-HC® CREAM and OINTMENT TIMODINE® CREAM Potency - moderate ACLOMETASONE DIPROPIONATE 0.05% CREAM and OINTMENT (Modrasone®) BETAMETHASONE VALERATE 0.025% CREAM and OINTMENT (Betnovate-RD®) CLOBETASONE BUTYRATE 0.05% CREAM and OINTMENT (Eumovate®) FLUDROXYCORTIDE TAPE (Haelan®) CALMURID HC® CREAM Potency – moderate with antimicrobial TRIMOVATE® CREAM Potency - potent BETAMETHASONE VALERATE 0.1% CREAM, LOTION, OINTMENT and SCALP APPLICATION (Betnovate®) BETAMETHASONE DIPROPIONATE 0.05% CREAM and OINTMENT (Diprasone®) DIFLUCORTOLONE VALERATE 0.1% CREAM and OILY CREAM (Nerisone®) DIPROSALIC® OINTMENT FLUOCINOLONE ACETONIDE 0.025% CREAM and GEL (Synalar®) FLUOCINONIDE FAPG 0.05% CREAM (Metosyn®) MOMETASONE FUROATE 0.1% CREAM, LOTION and OINTMENT (Elocon®) BETNOVATE 25% in COAL TAR PASTE Potency – potent with antimicrobial AUREOCORT® OINTMENT FUCIBET® CREAM BETAMETHASONE and CLIOQUINOL CREAM and OINTMENT BETAMETHASONE and NEOMYCIN CREAM and OINTMENT LOTRIDERM® CREAM Potency – very potent CLOBETASOL PROPIONATE 0.05% CREAM, OINTMENT and SCALP APPLICATION (Dermovate®) DIFLUCORTOLONE VALERATE 0.3% OILY CREAM and OINTMENT (Nerisone Forte®) CLOBETASOL 50% in WHITE SOFT PARAFFIN DERMOVATE CREAM 25%, PROPYLENE GLYCOL 40% in UNG MERK DERMOVATE OINTMENT 25%, SALICYLIC ACID 10% in UNG MERK

13.5 Preparations for eczema and psoriasis 13.5.1 Preparations for eczema Oral retinoid for eczema ALITRETINOIN CAPSULES - NICE guidance TA177 – Eczema (chronic) JMMC approved Oct 2009 13.5.2 Preparations for psoriasis DIMETHYL FUMERATE TABLETS - NICE guidance TA475 - Treating moderate to severe plaque psoriasis JMMG approved Nov 2017 Vitamin D and analogues CALCIPOTRIOL CREAM, OINTMENT and SCALP SOLUTION (Dovonex®) CALCITRIOL OINTMENT (Silkis®) DOVOBET® GEL and OINTMENT TACALCITOL 4microgram/g OINTMENT (Curatoderm®) TAZAROTENE GEL (Zorac®) Tars COCOIS® SCALP OINTMENT EXOREX® LOTION POLYTAR® EMOLLIENT PSORIDERM® BATH EMULSION SEBCO SCALP OINTMENT COAL TAR 5% in YELLOW SOFT PARAFFIN COAL TAR SOLUTION 5% in BETNOVATE RD OINTMENT Dithranol DITHRANOL 0.1% CREAM (Dithrocream®) DITHRANOL 0.25% CREAM (Dithrocream®) DITHRANOL 0.5% CREAM (Dithrocream®) DITHRANOL 1% CREAM (Dithrocream®) (Last updated May 2018) Page 62 of 69

DITHRANOL 2% CREAM (Dithrocream®) Salicylic acid LAN VAS SAL SALICYLIC ACID 10% in AQUEOUS CREAM SALICYLIC ACID 10% in WHITE SOFT PARAFFIN SALICYLIC ACID 20% in AQUEOUS CREAM SALICYLIC ACID 20% in EMULSIFYING OINTMENT SALICYLIC ACID 5% in AQUEOUS CREAM SALICYLIC ACID 5% in WHITE SOFT PARAFFIN SCC SAL CAP OINTMENT SCC SAL OINTMENT ZINC & SALICYLIC ACID PASTE (Lassar’s paste) Salicylic acid with tar COAL TAR SOLUTION 3%, SALICYLIC ACID 10% in UNG MERK COAL TAR SOLUTION 3%, SALICYLIC ACID 5% in UNG MERK COAL TAR SOLUTION 5%, SALICYLIC ACID 5% in UNG MERK COAL TAR 10%, SALICYLIC ACID 2% in EMULSIFYING OINTMENT SALICYLIC ACID 2%, COAL TAR SOLUTION 2% in EMULSIFYING OINTMENT SALICYLIC ACID 2%, COAL TAR SOLUTION 5% in EMULSIFYING OINTMENT Oral retinoids for psoriasis ACITRETIN CAPSULES Other preparations CHLORMETHINE 0.01% OINTMENT HYDROQUINONE MONOBENZYL ETHER 20% in LIPOBASE® – JMMC Approved Dec 2008 FUMADERM TABLETS- JMMC Approved Mar 2011 13.5.3 Drugs affecting the immune response AZATHIOPRINE CICLOSPORIN METHOTREXATE - WEEKLY PIMECROLIMUS CREAM TACROLIMUS 0.03% OINTMENT (Protopic) - NICE guidance TA82 – Atopic dermatitis (eczema) TACROLIMUS 0.1% OINTMENT (Protopic) - NICE guidance TA82 – Atopic dermatitis (eczema) SIROLIMUS 0.1% In White Soft Paraffin JMMC Approved March 2016 – individual patient requests needed Cytokine modulators ADALIMUMAB INJECTION - JMMC Approved Jun 2008 JMMG Approved Sep 2016 – hidradenitis suppurativa NICE guidance TA455 – treating plaque psoriasis in children and young people. JMMG Approved Sep 2017 – not treated at MCHFT EFALIZUMAB INJECTION - JMMC Approved Jul 2008 ETANERCEPT INJECTION - NICE guidance TA103 – Psoriasis JMMC Approved Sep 2007 JMMC Approved Jul 2016 – use of biosimilar product (Benepali®) NICE guidance TA455 – treating plaque psoriasis in children and young people. JMMG Approved Sep 2017 – not treated at MCHFT INLFLIXIMAB INJECTION - NICE guidance TA134 – Psoriasis IXEKIZUMAB - NICE guidance TA442 –Moderate to severe plaque psoriasis JMMG Approved June 2017 SECUKINUMAB- NICE guidance TA350 – Moderate to severe plaque psoriasis in adults JMMC Approved Aug 2015 USTEKINUMAB INJECTION - NICE guidance TA180 – Psoriasis JMMC Approved Oct 2009 NICE guidance TA340 – Active psoriatic arthritis in adults JMMC Approved Aug 2015 NICE guidance TA455 – treating plaque psoriasis in children and young people. JMMG Approved Sep 2017 – not treated at MCHFT

(Last updated May 2018) Page 63 of 69

13.6 Acne and rosacea 13.6.1 Topical preparations for acne Benzoyl peroxide and azelaic acid AZELAIC ACID CREAM (Skinoren®) BENZOYL PEROXIDE 4% CREAM (Brevoxyl®) BENZOYL PEROXIDE 10% GEL (PanOxyl®) BENZOYL PEROXIDE 5% GEL (PanOxyl®) QUINODERM® CREAM DUAC® GEL Topical antibacterials for acne CLINDAMYCIN LOTION and SOLUTION ERYTHROMYCIN TOPICAL SOLUTION Topical retinoids and related preparations for acne ISOTRETINOIN 0.05% GEL (Isotrex®) TRETINOIN 0.025%GEL (Retin-A®) TRETINOIN BLEACHING CREAM 13.6.2 Oral preparations for acne Oral antibacterials for acne DOXYCYCLINE LYMECYCLINE ERYTHROMYCIN – Only for children under 12 years of age Hormone treatment for acne CO-CYPRINDOL 2000/35 TABLETS Oral retinoid for acne ISOTRETINOIN CAPSULES

13.7 Preparations for warts and calluses SALACTOL® PAINT Anogenital warts IMIQUIMOD 5% CREAM (Aldara®) PODOPHYLLOTOXIN 0.15% CREAM (Warticon®) SILVER NITRATE 75% CAUSTIC APPLICATOR SILVER NITRATE 95% CAUSTIC APPLICATOR PODOPHYLLOTOXIN 0.5% SOLUTION (Condyline®)- JMMC Approved April 2013 – temporary replacement for Warticon PODOPHLLUM 25% in COMPOUND BENZOIN TINCTURE PODOPHLLUM 40% in COMPOUND BENZOIN TINCTURE

13.8 Sunscreens & camouflagers 13.8.1 Sunscreen preparations UVISTAT® SPF 30 SUN CREAM Photodamage DICLOFENAC SODIUM 3% GEL (Solaraze®) ACTIKERALL® SOLUTION - JMMC Approved Nov 2012 METHYL-5-AMINOLEVULINATE (Metvix®) Cream - JMMC Approved Jun 2005 13.8.2 Camouflagers PIGMANORM CREAM ® JMMG Approved Jun 2017

13.9 Shampoos and other preparations for scalp and hair conditions Shampoos ALPHOSYL 2 in 1® SHAMPOO CAPASAL® SHAMPOO KETOCONAZOLE 2% SHAMPOO POLYTAR® SHAMPOO POLYTAR PLUS® LIQUID SELENIUM 2.5% SHAMPOO (Selsun®) Hirsuitism EFLORNITHINE 11.5% CREAM (Vaniqa®)- JMMC approved August 2006

13.10 Anti-infective skin preparations (Last updated May 2018) Page 64 of 69

13.10.1 Antibacterial preparations 13.10.1.1 Antibacterial preparations only used topically MUPIROCIN 2% CREAM and OINTMENT (Bactroban®) OCTENILIN® WOUND GEL- JMMC approved June 2016 – use in paediatric CF patients OCTENISAN- JMMG approved August 2016 SILVER SULFADIAZINE 1% CREAM (Flamazine®) TRICLOSAN FOAM - SKINSAN® 13.10.1.2 Antibacterial preparations also used systemically FUSIDIC ACID CREAM (Fucidin®) METRONIDAZOLE CREAM and GEL SODIUM FUSIDATE 2% OINTMENT (Fucidin®) 13.10.2 Antifungal preparations AMOROLFINE 5% NAIL LACQUER (Loceryl®) CLOTRIMAZOLE 1% CREAM, POWDER, SPRAY and SOLUTION MICONAZOLE 2% CREAM NYSTAFORM® CREAM TERBINAFINE 1% CREAM 13.10.3 Antiviral preparations ACICLOVIR 5% CREAM 13.10.4 Parasiticidal preparations FULL MARKS LOTION MALATHION 0.5% LIQUID and LOTION 13.10.5 Preparations for minor cuts and abrasions Preparations for boils MAGNESIUM SULPHATE PASTE Skin tissue adhesive LIQUIBAND® TISSUE ADHESIVE

13.11 Skin cleansers, antiseptics and desloughing agents 13.11.1 Alcohols and saline SODIUM CHLORIDE 0.9% SOLUTION 13.11.2 Chlorhexidine Salts CHLORHEXIDINE ACETATE 0.02% SOLUTION CHLORHEXIDINE ACETATE 0.05% SOLUTION CHLORHEXIDINE ACETATE 1% DUSTING POWDER CHLORHEXIDINE GLUCONATE 0.05% SACHETS (Unisept®) CHLORHEXIDINE GLUCONATE 0.5% SOLUTION (Hydrex®) CHLORHEXIDINE GLUCONATE 0.02% SPRAY (Hydrex® HS) CHLORHEXIDINE GLUCONATE 0.5% PUMP SPRAY (Hydrex®) CHLORHEXIDINE GLUCONATE 1% OBSTETRIC CREAM 13.11.3 Cationic surfactants and soaps - No products on formulary 13.11.4 Iodine POVIDONE-IODINE 10% ANTISEPTIC SOLUTION POVIDONE-IODINE 2.5% DRY POWDER SPRAY POVIDONE-IODINE 7.5% SURGICAL SCRUB 13.11.5 Phenolics - No products on formulary 13.11.6 Oxidisers and dyes HYDROGEN PEROXIDE 1% CREAM (Crystacide®) HYDROGEN PEROXIDE 3% SOLUTION (10vols) HYDROGEN PEROXIDE 6% SOLUTION (20vols) POTASSIUM PERMANGANATE SOLUTION TABLETS (Permitab®) 13.11.7 Desloughing agents - No products on formulary

13.12 Antiperspirants ALUMINIUM CHLORIDE HEXAHYDRATE 20% ROLL-ON SOLUTION GLYCOPYRROLATE 1% in AQUEOUS CREAM – JMMC Approved Dec 2008 GLYCOPYRRONIUM BROMIDE 1mg/5ml SOLUTION (Last updated May 2018) Page 65 of 69

GLYCOPYRRONIUM BROMIDE 0.05% AQUEOUS SOLUTION PROPANTHELINE TABLETS JMMG Approved Oct 2017 PRIMARY CARE: Pink (Specialist Recommendation)

13.13 Topical circulatory preparations HIRUDOID® CREAM and GEL

(Last updated May 2018) Page 66 of 69

14 Immunological products and vaccines 14.4 Vaccines and antisera BCG Vaccines BCG INTRADERMAL VACCINE Diagnostic agents TUBERCULIN PPD RT 23 10units/0.1ml INJECTION TUBERCULIN PPD RT 23 2units/0.1ml INJECTION Diphtheria vaccines DIPHTHERIA (low dose), TETANUS and POLIO VACCINE (Revaxis®) DIPHTHERIA, TETANUS, PERTUSSIS, POLIO and HIB VACCINE (Pediacel®) DIPHTHERIA (low dose), TETANUS, PERTUSSIS and POLIO VACCINE (Repevax®) DIPHTHERIA, TETANUS, PERTUSSIS and POLIO VACCINE (Infanrix-IPV®) Haemophilus type b conjugate vaccines HIB and MENIGOCOCCAL GROUP C VACCINE Hepatitis A vaccines HEPATITIS A VACCINE HEPATITIS A & B VACCINE ADULT and PAEDIATRIC (Twinrix®) Hepatitis B vaccine HEPATITIS B VACCINE 10microgram/0.5mL (Engerix B® Paediatric) HEPATITIS B VACCINE 10microgram/mL (HBvaxPRO®) HEPATITIS B VACCINE 20microgram/mL (Engerix B®) Human papillomavirus vaccines HUMAN PAPILLOMAVIRUS VACCINE (Cervarix® Gardasil®) Influenza vaccines INFLUENZA VACCINE Measles vaccine MEASLES, MUMPS and RUBELLA VACCINE Meningococcal vaccines MENINGOCOCCAL C VACCINE MENINGOCOCCAL GROUPS ACWY VACCINE Pneumococcal vaccines PNEUMOCOCCAL POLYSACCHARIDE VACCINE (Pneumovax® II) PNEUMOCOCCAL POLYSACCHARIDE CONJUGATE VACCINE (Prevenar 13®) Rotavirus vaccine ROTAVIRUS VACCINE (Rotarix®) Typhoid vaccines TYPHOID VACCINE (Typhim Vi®) Varicella zoster vaccines VARICELLA ZOSTER VACCINE Snake bites EUROPEAN VIPER VENOM ANTISERUM

14.5 Immunoglobulins 14.5.1 Normal immunoglobulin For intravenous use NORMAL IMMUNOGLOBULIN 5% (Octagam®; Vigam®) 14.5.2 Disease-specific immunoglobulins Tetanus TETANUS IMMUNOGLOBULIN

14.6 International travel – No products on formulary

(Last updated May 2018) Page 67 of 69

15 Anaesthesia 15.1 General anaesthesia 15.1.1 Intravenous anaesthetics Drugs used for intravenous anaesthesia ETOMIDATE 20mg/10ml INJECTION KETAMINE INJECTION PROPOFOL 1% PROPOFOL 2% THIOPENTAL INJECTION PROPOFOL LIPURA – JMMC Approved Jul 2009 for use in paediatric ENT patients 15.1.2 Inhalation anaesthetics Volatile liquid anaesthetics DESFLURANE ISOFLURANE SEVOFLURANE 15.1.3 Antimuscarinic drugs ATROPINE INJECTION GLYCOPYRRONIUM BROMIDE INJECTION HYOSCINE HYDROBROMIDE INJECTION 15.1.4 Sedative and analgesic peri-operative drugs 15.1.4.1 Benzodiazepines MIDAZOLAM 1mg/ml INJECTION - MCHFT Policies & Procedures – Clinical – Use of Midazolam for Conscious Sedation of Adults During Clinical Procedures MIDAZOLAM 10mg/2ml INJECTION – Palliative care use in syringe drivers 15.1.4.2 Non-opiod analgesics KETOROLAC INJECTION 15.1.4.3 Opiod analgesics ALFENTANIL INJECTION FENTANYL INJECTION REMIFENTANIL INJECTION 15.1.4.4 Other drugs for sedation - DEXMEDETOMIDINE INJECTION JMMG Approved May 2017 for rousable sedation on ITU. Consultant use only. 15.1.5 Neuromuscular blocking drugs Non-depolarising neuromuscular blocking drugs ATRACURIUM INJECTION CISTRACURIUM INJECTION MIVACURIUM INJECTION PANCURONIUM INJECTION ROCURONIUM INJECTION VECURONIUM INJECTION Depolarising neuromuscular blocking drugs SUXAMETHONIUM INJECTION 15.1.6 Drugs for reversal of neuromuscular blockade Anticholinesterases EDROPHONIUM INJECTION GLYCOPYRRONIUM & NEOSTIGMINE INJECTION NEOSTIGMINE INJECTION Other drugs for reversal of neuromuscular blockade SUGAMMADEX INJECTION - JMMC Approved Jul 2009 for reversal when intubation has failed and Rocuronium or Vecuronium was used during the attempted intubation 15.1.7 Antagonists for central and respiratory depression FLUMAZENIL INJECTION NALOXONE INJECTION 15.1.8 Drugs for malignant hyperthermia DANTROLENE INJECTION

15.2 Local anaesthesia Bupivacaine (Last updated May 2018) Page 68 of 69

BUPIVACAINE 0.1% INFUSION BUPIVACAINE 0.1% & FENTANYL 0.0002% INFUSION BUPIVACAINE 0.125% INFUSION BUPIVACAINE 0.125% & FENTANYL 0.0002% INFUSION BUPIVACAINE 0.25%, ADRENALINE 1:200,000 INJECTION BUPIVACAINE 0.5%, ADRENALINE 1:200,000 INJECTION BUPIVACAINE 0.75% INJECTION BUPIVACAINE 20mg, GLUCOSE 320mg/4ml SPINAL INJECTION Levobupivacaine LEVOBUPIVACAINE INJECTION – JMMC Approved Feb 2012 Lidocaine LAT GEL – JMMC Approved Jul 2005 LIDOCAINE 0.5% INJECTION LIDOCAINE 1% INJECTION LIDOCAINE 1%, ADRENALINE 1:100,000 INJECTION LIDOCAINE 1%, ADRENALINE 1:200,000 INJECTION LIDOCAINE 2% INJECTION LIDOCAINE 2%, ADRENALINE 1:100,000 INJECTION LIDOCAINE 2%, ADRENALINE 1:200,000 INJECTION LIDOCAINE 2%, ADRENALINE 1:80,000 CARTRIDGES LIDOCAINE 4% TOPICAL SOLUTION LIDOCAINE 4% CREAM (LMX 4®) – JMMC Approved Dec 2010 for paediatric use in non-elective patients LIDOCAINE 5%, PHENYLEPHRINE 0.5% NASAL SPRAY LIDOCAINE PLASTERS 5% – JMMC Approved Sep 2009 Please note: this appears in the NHSE list of medicines that should not be routinely prescribed in Primary Care. MCHFT approved for use within its licenced indication if commenced by a specialist and there is a discussion with the GP. Mepivacaine MEPIVACAINE 2%, ADRENALINE 1:100,000 CARTRIDGES MEPIVACAINE 3% CARTRIDGES Prilocaine EMLA® CREAM PRILOCAINE 1% INJECTION Ropivacaine ROPIVACAINE INFUSION and INJECTION Tetracaine TETRACAINE 4% GEL (Ametop®) Other preparations COCAINE 10% NASAL SOLUTION COCAINE 5% NASAL SOLUTION ETHYL CHLORIDE SPRAY MYDRICAINE No1 INJECTION MYDRICAINE No2 INJECTION ADRENALINE 1:1000 SOLUTION MYDRICAINE APF INJECTION PHENOL 5% in GLYCEROL INJECTION PHENOL 6% AQUEOUS INJECTION

(Last updated May 2018) Page 69 of 69