North West London Integrated Formulary 22/09/2014

North West London Integrated Formulary PUBLISHED VERSION (v12 18.09.2014)

The Integrated Formulary (IF) is a list of medicines for adult patients and is for use in North West London.

The IF is intended to cover: • prescriptions written in primary care; • prescriptions or recommendations by hospital doctors in respect of outpatients or patients leaving hospital after an admission.

The IF should be taken fully into account by prescribers when exercising their clinical judgement. However, it does not override the individual responsibility of prescribers to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer and informed by the summary of product characteristics of any medicines they are considering.

Medicines recommended by NICE technology appraisal guidance (TAG) are regarded as included in the IF from the date the TAG is published , unless: • the medicine will only be prescribed for hospital inpatients or • it is deemed to be a medicine that should only be prescribed by a hospital specialist (in which case it will be added to the NWL ‘red list’ of medicines that a hospital doctor should not ask a GP to prescribe).

People currently receiving a medicine that is not included in the IF should have the option to continue until they and their clinicians consider it appropriate to stop.

Specialist initiation A number of medicines in the IF are marked ‘specialist initiation’. These words should be interpreted as an attempt to reduce the risk of harm and taken into account by prescribers when exercising their clinical judgement. Appropriate action in response to a ‘specialist initiation’ annotation may lie anywhere in a spectrum between: 1. The medicine should be prescribed by a relevant specialist for at least x months with monitoring of effectiveness and toxicity, until treatment is stable at which point the patient’s GP can be asked whether s/he will take over prescribing, and 2. It is reasonable for a GP to write the first prescription after a telephone conversation with a relevant specialist clinician. Different GPs might reasonably take different decisions regarding whether or when to prescribe, depending on their knowledge and experience. Legal responsibility for prescribing lies with the doctor who signs the prescription. The ‘specialist initiation’ annotations say nothing about who is or is not a relevant specialist in respect of a medicine. It will be reasonable for some of these medicines to be initiated by prescribers from more than one speciality.

Drug name Initiate by (shading indicates that the drug DRAFT Order of BNF chapter BNF section BNF sub-section Formulations specialist Comments appears in more than one preference only? section) co-magaldrox 195/220 Low sodium. Mucogel costs less than Maalox. 1.1 Dyspepsia and gastro-oesophageal 1.1.1 Antacids and Co-magaldrox suspension 1. Gastro-intestinal system Unspecified All prescribers reflux disease simeticone (prescribe Mucogel)

dried aluminium hydroxide 420 Contains simeticone. Costs slightly more than Mucogel 1.1 Dyspepsia and gastro-oesophageal 1.1.1 Antacids and mg, simeticone 135 mg, light 1. Gastro-intestinal system Unspecified All prescribers reflux disease simeticone Asilone® magnesium oxide 70 mg/5 mL

oral suspension, 5% each of Tends to be laxative. Contains approx 6mmol sodium/10ml magnesium trisilicate, light magnesium carbonate, and 1.1 Dyspepsia and gastro-oesophageal 1.1.1 Antacids and Magnesium 1. Gastro-intestinal system sodium bicarbonate in a Unspecified All prescribers reflux disease simeticone trisilicate mixture suitable vehicle with a peppermint flavour

1.1 Dyspepsia and gastro-oesophageal suspension (peppermint or Contains alginate. Contains 6.2mmol sodium in 10ml. 1. Gastro-intestinal system 1.1.2 Compound alginates Unspecified All prescribers reflux disease Peptac ® aniseed)

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Drug name Initiate by (shading indicates that the drug DRAFT Order of BNF chapter BNF section BNF sub-section Formulations specialist Comments appears in more than one preference only? section) tablets, chewable. Alginate containing tablets. Liquid antacid preparations are more effective 1.1 Dyspepsia and gastro-oesophageal 1. Gastro-intestinal system 1.1.2 Compound alginates Unspecified All prescribers than tablets. reflux disease Gastrocote ®

1.1 Dyspepsia and gastro-oesophageal oral powder; Contains alginate and 0.92mmol sodium /dose. 1. Gastro-intestinal system 1.1.2 Compound alginates Unspecified All prescribers reflux disease Gaviscon Infant® tablets 135 mg 1.2 Antispasmodics and other drugs altering Mebeverine 1. Gastro-intestinal system 1.2 Unspecified All prescribers gastric motility hydrochloride e/c capsules 0.2ml Mintec capsules cost less than MR Colpermin capsules 1.2 Antispasmodics and other drugs altering Peppermint oil 1. Gastro-intestinal system 1.2 Unspecified All prescribers gastric motility (prescribe Mintec) tablets 10mg; 1.2 Antispasmodics and other drugs altering Hyoscine 1. Gastro-intestinal system 1.2 injection 20mg in 1ml Unspecified All prescribers gastric motility butylbromide tablets 150mg, 300mg; Ranitidine tablets now cost less than cimetidine tablets. Effervescent 1.3 Anti-secretory drugs and mucosal 1.3.1 H 2- receptor effervescent tablets 150mg; tablets cost much more than plain tablets. 1. Gastro-intestinal system First line All prescribers protectants antagonists Ranitidine oral solution 75mg in 5ml

1.3 Anti-secretory drugs and mucosal 1.3.3 Chelates and tablets 1g; 1. Gastro-intestinal system Unspecified All prescribers protectants complexes Sucralfate suspension 1g in 5ml tablets 20mg, 40mg Costs much more than omeprazole, lansoprazole or pantoprazole. Esomeprazole should only be used for initial treatment (e.g. 8 weeks) of 1.3 Anti-secretory drugs and mucosal 1.3.5 Proton pump See comments Specialist 1. Gastro-intestinal system endoscopically proven severe oesophagitis. Maintenance treatment, if protectants inhibitors Esomeprazole column INITIATION required, can generally be with a low cost PPI.

capsules 10mg, 20mg; Capsules cost much less than dispersible tablets 1.3 Anti-secretory drugs and mucosal 1.3.5 Proton pump dispersible tablets, film- 1. Gastro-intestinal system First line All prescribers protectants inhibitors Omeprazole coated, 10mg, 20mg

1.3 Anti-secretory drugs and mucosal 1.3.5 Proton pump tablets 20mg, 40mg 1. Gastro-intestinal system Unspecified All prescribers protectants inhibitors Pantoprazole orodispersible tablet, 15mg, Capsules cost much less than orodispersible tablets 1.3 Anti-secretory drugs and mucosal 1.3.5 Proton pump 1. Gastro-intestinal system 30mg (Fastab ®); First line All prescribers protectants inhibitors Lansoprazole capsules 15mg, 30mg 1.3 Anti-secretory drugs and mucosal Arrangements for H. pylori testing differ in different parts of NWL 1. Gastro-intestinal system Test for Helicobacter pylori Unspecified All prescribers protectants diabact UBT capsules 2mg; 1. Gastro-intestinal system 1.4 Acute diarrhoea 1.4.2 First line All prescribers Loperamide syrup 1mg in 5ml tablets 2.5/0.025 Codeine Phosphate may also be used as a diarrhoea treatment - see 1. Gastro-intestinal system 1.4 Acute diarrhoea 1.4.2 Second line All prescribers Co-phenotrope section 4.7.2 e/c tablets 400mg (Asacol ® There is no evidence to show that any one oral preparation of mesalazine MR, Octasa® - see is more effective than another; however, the delivery characteristics of oral comments), 800mg (Asacol ® mesalazine preparations may vary. If it is necessary to switch a patient to a MR and Octasa®); different brand of mesalazine, the patient should be advised to report any MR tablets 500mg (Pentasa changes in symptoms ®); MR tablets 1.2g (Mezavant XL - see Octasa is the lowest cost brand and should be prescribed instead of other comments) brands for new patients, and for patients who require a change to their gastro-resistant prolonged Specialist drug regimen. Discretion should be applied in switching patients to Octasa 1. Gastro-intestinal system 1.5 Chronic bowel disorders 1.5.1 Aminosalicylates First line Mesalazine release granules 500mg, 1g INITIATION who have mild and/or stable UC. (Salofalk ®); Mezavant XL should only be considered for select patients experiencing retention enema 1g in 100ml; difficultly with a high pill burden (i.e. >2.4g/daily), since it has a convenient enema 2g in 59ml; once-daily dosing advantage. Since Mezavant XL is almost twice the cost foam enema 1g/application; of Octasa , at the point of maintenance dose prescribing (i.e. ≤2.4g/daily), suppositories 250mg, 500mg, Octasa should be substituted. 1g

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Drug name Initiate by (shading indicates that the drug DRAFT Order of BNF chapter BNF section BNF sub-section Formulations specialist Comments appears in more than one preference only? section) tablets 500mg; Sulfasalazine e/c tablets 500mg; Specialist 1. Gastro-intestinal system 1.5 Chronic bowel disorders 1.5.1 Aminosalicylates Unspecified (Sulphasalazine) suspension 250mg in 5ml; INITIATION suppositories 500mg capsules 250mg Specialist 1. Gastro-intestinal system 1.5 Chronic bowel disorders 1.5.1 Aminosalicylates Unspecified Olsalazine INITIATION capsules 750 mg Specialist 1. Gastro-intestinal system 1.5 Chronic bowel disorders 1.5.1 Aminosalicylates Unspecified Balsalazide INITIATION retention enema, short tube, 20mg in 100ml (as sodium phosphate); foam enema, 20mg per Specialist 1. Gastro-intestinal system 1.5 Chronic bowel disorders 1.5.2 Corticosteroids Prednisolone metered application (as Unspecified sodium metasulphobenzoate); INITIATION suppositories 5mg (as sodium phosphate)

foam, in aerosol pack, 10% as Hydrocortisone Specialist 1. Gastro-intestinal system 1.5 Chronic bowel disorders 1.5.2 Corticosteroids acetate (Colifoam ®) Unspecified acetate INITIATION e/c MR capsules 3mg Causes fewer side-effects than oral prednisolone but may be less Specialist 1. Gastro-intestinal system 1.5 Chronic bowel disorders 1.5.2 Corticosteroids Unspecified effective. Budesonide INITIATION Prescribe by brand name. 1.6 Laxatives - see BNF for comments granules 3.5g/sachet (orange 1. Gastro-intestinal system 1.6.1 Bulk-forming laxatives Unspecified All prescribers on the role of laxatives Ispaghula husk flavoured or plain) tablets total sennosides 1.6 Laxatives - see BNF for comments 7.5mg; 1. Gastro-intestinal system 1.6.2 Stimulant laxatives Unspecified All prescribers on the role of laxatives Senna syrup total sennosides 7.5mg in 5ml suppositories, 1g (infant), 2g 1.6 Laxatives - see BNF for comments 1. Gastro-intestinal system 1.6.2 Stimulant laxatives (child), 4g (adult); Unspecified All prescribers on the role of laxatives Glycerol (glycerin) capsules 100mg; Acts both as a stimulant and a softening agent 1.6 Laxatives - see BNF for comments 1. Gastro-intestinal system 1.6.2 Stimulant laxatives oral solution 12.5mg in 5ml, Unspecified All prescribers on the role of laxatives Docusate sodium 50mg in 5ml capsules 25/200 (dantron 25 Only licensed for constipation in terminally ill patients. mg, poloxamer ‘188’ 200 mg), strong capsules 37.5/500 (dantron 37.5 mg, poloxamer ‘188’ 500 mg); 1.6 Laxatives - see BNF for comments 1. Gastro-intestinal system 1.6.2 Stimulant laxatives Co-danthramer suspension 25/200 (dantron 25 Unspecified All prescribers on the role of laxatives mg, poloxamer ‘188’ 200 mg) in 5ml; strong suspension 75/1000 (dantron 75 mg, poloxamer ‘188’ 1 g) in 5ml

e/c tablets 5mg; 1.6 Laxatives - see BNF for comments suppositories 10mg; paediatric 1. Gastro-intestinal system 1.6.2 Stimulant laxatives Unspecified All prescribers on the role of laxatives Bisacodyl suppositories 5mg.

1.6 Laxatives - see BNF for comments solution 1. Gastro-intestinal system 1.6.4 Osmotic laxatives Unspecified All prescribers on the role of laxatives Lactulose Laxido ® Orange oral powder Laxido Orange costs less than Movicol sachets; 1.6 Laxatives - see BNF for comments Macrogol compound Movicol-Half powder sachets; 1. Gastro-intestinal system 1.6.4 Osmotic laxatives Unspecified All prescribers on the role of laxatives oral powder Movicol Paediatric Plain powder sachets

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Drug name Initiate by (shading indicates that the drug DRAFT Order of BNF chapter BNF section BNF sub-section Formulations specialist Comments appears in more than one preference only? section) 1.6 Laxatives - see BNF for comments enema BP Formula B 1. Gastro-intestinal system 1.6.4 Osmotic laxatives Unspecified All prescribers on the role of laxatives Phosphates enema 1.6 Laxatives - see BNF for comments Micralax Micro- 1. Gastro-intestinal system 1.6.4 Osmotic laxatives Unspecified All prescribers on the role of laxatives enema® 1.6 Laxatives - see BNF for comments 1.6.7 Other drugs used in tablets 1mg, 2mg For use in line with NICE's guidance. 1. Gastro-intestinal system Unspecified All prescribers on the role of laxatives constipation Prucalopride 1.6 Laxatives - see BNF for comments 1.6.7 Other drugs used in capsules 24 microgram For use in line with NICE TA318 1. Gastro-intestinal system Unspecified All prescribers on the role of laxatives constipation Lubiprostone 1.7.1 Soothing Anusol Suppositories, Can be purchased over the counter. 1.7 Local preparations for anal and Anusol 1. Gastro-intestinal system haemorrhoidal Ointment, Cream First line All prescribers rectal disorders prepaarations Ointment (water-miscible), First choice if corticosteroid required 1.7.2 Compound aluminium acetate 3.5%, 1.7 Local preparations for anal and 1. Gastro-intestinal system haemorrhoidal preparations hydrocortisone acetate First line All prescribers rectal disorders Xyloproct ® with corticosteroids 0.275%, lidocaine 5%, zinc oxide 18% Suppositories, cinchocaine Second choice if corticosteroid containing suppositories required (dibucaine) hydrochloride 1mg, prednisolone hexanoate 1.3mg 1.7.2 Compound 1.7 Local preparations for anal and Ointment, cinchocaine 1. Gastro-intestinal system haemorrhoidal preparations Second line All prescribers rectal disorders Scheriproct® (dibucaine) hydrochloride with corticosteroids 0.5%, prednisolone hexanoate 0.19%.

Foam in aerosol pack, 1.7.2 Compound 1.7 Local preparations for anal and hydrocortisone acetate 1%, 1. Gastro-intestinal system haemorrhoidal preparations Unspecified All prescribers rectal disorders Proctofoam HC® pramocaine hydrochloride 1%. with corticosteroids 1.7 Local preparations for anal and 1.7.4 Management of anal rectal cream 2% (unlicensed)) For treatment of anal fissure. Generally not suitable for repeat prescribing 1. Gastro-intestinal system Second line All prescribers rectal disorders fissures Diltiazem rectal ointment 0.4% For treatment of anal fissure. Generally not suitable for repeat prescribing 1.7 Local preparations for anal and 1.7.4 Management of anal 1. Gastro-intestinal system (Rectogesic ®) First line All prescribers rectal disorders fissures Glyceryl trinitrate tablets 150mg; Ursodeoxycholic Specialist 1. Gastro-intestinal system 1.9 Drugs affecting intestinal secretions 1.9.1 capsules 250mg Unspecified acid INITIATION Creon® 10 000 Capsules,e/c granules of pancreatin (pork), providing: protease 600 units, Specialist 1. Gastro-intestinal system 1.9 Drugs affecting intestinal secretions 1.9.4 Unspecified Creon® lipase 10 000 units, amylase INITIATION 8000 units; 25 000 capsules

2. Cardiovascular system tablets 62.5mcg, 125mcg, 250mcg; 2.1 Positive inotropic drugs 2.1.1 Unspecified All prescribers Digoxin elixir 50mcg in 1ml;

2. Cardiovascular system 2.2.1 Thiazides and related tablets 2.5mg; MR tablets Plain tablets cost much less than MR tablets, but both are less than £3.50 2.2 Diuretics First line All prescribers diuretics Indapamide 1.5mg per month 2. Cardiovascular system tablets 50mg 2.2.1 Thiazides and related 2.2 Diuretics Unspecified All prescribers diuretics Chlortalidone 2. Cardiovascular system tablets 2.5mg, 5mg NICE's guideline on hypertension now recommends indapamide or 2.2.1 Thiazides and related chlortalidone rather than bendroflumethiazide or hydrochlorothiazide. 2.2 Diuretics Unspecified All prescribers diuretics Bendroflumethiazide People taking the latter whose BP is stable and well controlled should continue on the drug.

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Drug name Initiate by (shading indicates that the drug DRAFT Order of BNF chapter BNF section BNF sub-section Formulations specialist Comments appears in more than one preference only? section) 2. Cardiovascular system tablets 20mg, 40mg, 500mg; oral solution 20mg in 5ml, 2.2 Diuretics 2.2.2 Loop diuretics Unspecified All prescribers Furosemide 40mg in 5ml, 50mg in 5ml;

2. Cardiovascular system tablets 1mg, 5mg; 1mg costs slightly more than furosemide 40mg 2.2 Diuretics 2.2.2 Loop diuretics Unspecified All prescribers Bumetanide Liquid 1mg in 5ml. 2. Cardiovascular system tablets See comments Specialist For resistent oedema in patients with low eGFR or poor tablet absorbtion 2.2 Diuretics 2.2.2 Loop diuretics Torasemide column INITIATION 2. Cardiovascular system tablets 25mg, 50mg Costs much more than spironolactone. 2.2.3 Potassium-sparing Specialist 2.2 Diuretics diuretics and aldosterone Unspecified Eplerenone INITIATION antagonists 2. Cardiovascular system 2.2.3 Potassium-sparing tablets 25mg, 100mg; 50 mg 2.2 Diuretics diuretics and aldosterone Spironolactone Unspecified All prescribers antagonists 2. Cardiovascular system 2.2.3 Potassium-sparing tablets 5mg; 2.2 Diuretics diuretics and aldosterone Amiloride oral solution 5mg in 5ml Unspecified All prescribers antagonists 2. Cardiovascular system tablets 2.5/25 (amiloride NICE's guideline on hypertension now recommends indapamide or hydrochloride 2.5 mg, chlortalidone rather than bendroflumethiazide or hydrochlorothiazide. hydrochlorothiazide 25 mg), People taking the latter whose BP is stable and well controlled should 2.2 Diuretics 2.2.4 Potassium-sparing diuretics with other diuretics Unspecified All prescribers Co-amilozide 5/50 (amiloride hydrochloride 5 continue on the drug. mg, hydrochlorothiazide 50 mg) 2. Cardiovascular system tablets 2.5/20 (amiloride hydrochloride 2.5 mg, 2.2 Diuretics 2.2.4 Potassium-sparing diuretics withCo-amilofruse other diuretics furosemide 20 mg), 5/40 Unspecified All prescribers (amiloride hydrochloride 5 mg, furosemide 40 mg) 2. Cardiovascular system tablets 150mg, 300mg Specialist 2.3 Anti-arrhythmic drugs 2.3.2 Unspecified Propafenone INITIATION 2. Cardiovascular system tablets 50mg, 100mg; Specialist 2.3 Anti-arrhythmic drugs 2.3.2 Unspecified Flecainide INITIATION 2. Cardiovascular system capsules 100mg, 150mg; Specialist 2.3 Anti-arrhythmic drugs 2.3.2 Unspecified Disopyramide INITIATION 2. Cardiovascular system tablets 100mg, 200mg; Specialist 2.3 Anti-arrhythmic drugs 2.3.2 Unspecified Amiodarone INITIATION 2. Cardiovascular system tablets 40mg, 80mg, 160mg, 2.4 Beta-adrenoceptor blocking drugs 2.4 Sotalol 200mg Unspecified All prescribers 2. Cardiovascular system tablets 5mg 2.4 Beta-adrenoceptor blocking drugs 2.4 Nebivolol Unspecified All prescribers 2. Cardiovascular system tablets 50mg, 100mg, 200mg, 2.4 Beta-adrenoceptor blocking drugs 2.4 Labetalol 400mg; Unspecified All prescribers 2. Cardiovascular system tablets 1.25mg, 2.5mg, 3.75mg and 7.5mg tablets cost more than the other strengths 2.4 Beta-adrenoceptor blocking drugs 2.4 First line All prescribers Bisoprolol 3.75mg, 5mg, 7.5mg, 10mg 2. Cardiovascular system tablets 3.125mg, 6.25mg, Second choice beta-blocker for heart failure. Costs more than bisoprolol 2.4 Beta-adrenoceptor blocking drugs 2.4 Second line All prescribers Carvedilol 12.5mg, 25mg 2. Cardiovascular system tablets 10mg, 40mg, If prescribing propranolol oral liquid, we suggest prescribing the Syprol 80mg,160mg; brand to avoid high cost 'special' preparations being dispensed. MR capsules 80mg, 160mg; 2.4 Beta-adrenoceptor blocking drugs 2.4 Propranolol oral solution (Syprol brand) Unspecified All prescribers 5mg in 5ml, 10mg in 5ml, 50mg in 5ml

2. Cardiovascular system tablets 50mg, 100mg; 2.4 Beta-adrenoceptor blocking drugs 2.4 Metoprolol Unspecified All prescribers

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Drug name Initiate by (shading indicates that the drug DRAFT Order of BNF chapter BNF section BNF sub-section Formulations specialist Comments appears in more than one preference only? section) 2. Cardiovascular system tablets 25mg, 50mg, 100mg; 2.4 Beta-adrenoceptor blocking drugs 2.4 Atenolol syrup 25mg in 5ml; Unspecified All prescribers

2. Cardiovascular system 2.5.1 Vasodilator tablets 25mg, 50mg; 2.5 Hypertension and heart failure Unspecified All prescribers antihypertensive drugs Hydralazine 2. Cardiovascular system 2.5.1 Vasodilator tablets 2.5mg, 5mg, 10mg 2.5 Hypertension and heart failure Unspecified All prescribers antihypertensive drugs Minoxidil 2. Cardiovascular system 2.5.2 Centrally acting tablets 200mcg, 300mcg, 2.5 Hypertension and heart failure Unspecified All prescribers antihypertensive drugs Moxonidine 400mcg 2. Cardiovascular system 2.5.2 Centrally acting tablets 125mg, 250mg, 500mg 2.5 Hypertension and heart failure Unspecified All prescribers antihypertensive drugs Methyldopa 2. Cardiovascular system capsules 10mg 2.5.4 Alpha-adrenoceptor Specialist 2.5 Hypertension and heart failure Unspecified blocking drugs Phenoxybenzamine INITIATION 2. Cardiovascular system tablets 1mg, 2mg, 4mg First choice if an alpha-blocker is needed for hypertension, except in 2.5.4 Alpha-adrenoceptor 2.5 Hypertension and heart failure Doxazosin First line All prescribers phaeochromocytoma. Modified release tablets cost more than plain blocking drugs tablets. 2. Cardiovascular system capsules or tablets 1.25mg, Ramipril capsules cost slightly less than tablets 2.5.5.1 Angiotensin- 2.5 Hypertension and heart failure 2,5mg, 5mg, 10mg First line All prescribers converting enzyme inhibitors Ramipril 2. Cardiovascular system tablets 2.5mg, 5mg, 10mg, 2.5.5.1 Angiotensin- 2.5 Hypertension and heart failure 20mg First line All prescribers converting enzyme inhibitors Lisinopril 2. Cardiovascular system tablets 2mg, 4mg, 8mg Perindopril erbumine costs more than the other ACE inhibitors listed here. 2.5.5.1 Angiotensin- Perindopril 2.5 Hypertension and heart failure Unspecified All prescribers Perindopril arginine (non-formulary) costs much more. converting enzyme inhibitors erbumine 2. Cardiovascular system tablets 2.5mg, 5mg, 10mg, 2.5.5.1 Angiotensin- 2.5 Hypertension and heart failure 20mg Unspecified All prescribers converting enzyme inhibitors Enalapril 2. Cardiovascular system tablets 12.5mg, 25mg, 50mg 2.5.5.1 Angiotensin- 2.5 Hypertension and heart failure Unspecified All prescribers converting enzyme inhibitors Captopril 2. Cardiovascular system tablets 25mg, 50mg, 100mg, NICE's guideline on hypertension now recommends a low cost ARB as an 12.5 mg option for step 1 treatment of people aged under 55, and as a step 2 option 2.5.5.2 Angiotensin-II 2.5 Hypertension and heart failure First line All prescribers for older people or black people of African or Caribbean family origin. receptor antagonists Losartan Losartan is currently the only ARB available generically at low cost.

2. Cardiovascular system 2.5.5.2 Angiotensin-II capsules 40mg, 80mg, 160mg 2.5 Hypertension and heart failure Unspecified All prescribers receptor antagonists Valsartan 2. Cardiovascular system tablets 75mg, 150mg, 300mg Generic unlikely before 14.8.12. Possibility that company will obtain 2.5.5.2 Angiotensin-II 2.5 Hypertension and heart failure Unspecified All prescribers additional 6 months protection by getting the drug licensed for use in receptor antagonists Irbesartan children. 2. Cardiovascular system 2.5.5.2 Angiotensin-II tablets 2mg, 4mg, 8mg, 16mg, 2.5 Hypertension and heart failure Unspecified All prescribers receptor antagonists Candesartan 32mg 2. Cardiovascular system tablets 150mg, 300mg Specialist Not included in NICE's clinical guideline on hypertension 2.5 Hypertension and heart failure 2.5.5.3 Renin inhibitors Unspecified Aliskiren INITIATION 2. Cardiovascular system tablets 10mg, 20mg; 2.6 Nitrates, Calcium-channel blockers Isosorbide MR capsules 25mg, 50mg; 2.6.1 Nitrates Unspecified All prescribers and other antianginal drugs mononitrate MR tablets 25mg, 40mg, 60mg 2. Cardiovascular system aerosol spray The tablets should be discarded after 8 weeks in use, so the spray 2.6 Nitrates, Calcium-channel blockers 2.6.1 Nitrates 400mcg/metered spray; Unspecified All prescribers generally provides better value for money. and other antianginal drugs Glyceryl trinitrate tablets 500 micrograms 2. Cardiovascular system tablets 40mg, 80mg,120mg; 2.6 Nitrates, Calcium-channel blockers 2.6.2 Calcium-channel MR capsules 120mg; MR Unspecified All prescribers and other antianginal drugs blockers Verapamil tablets 240mg; oral solution 40mg in 5ml

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Drug name Initiate by (shading indicates that the drug DRAFT Order of BNF chapter BNF section BNF sub-section Formulations specialist Comments appears in more than one preference only? section) 2. Cardiovascular system capsules 5mg, 10mg; Potential confusion between MR brands probably means that a drug that Modified release preparations - does not require modified release formulations, such as amlodipine, is 2.6 Nitrates, Calcium-channel blockers 2.6.2 Calcium-channel prescribers should specify the preferable for treatment of hypertension. If using MR nifedipine, prescribe Unspecified All prescribers and other antianginal drugs blockers Nifedipine brand to be dispensed (see by brand. BNF)

2. Cardiovascular system Standard MR tablets 60mg; Prescribe longer-acting formulations by brand name. Longer-acting formulations - 2.6 Nitrates, Calcium-channel blockers 2.6.2 Calcium-channel prescriber should specify the Unspecified All prescribers and other antianginal drugs blockers Diltiazem brand to be dispensed (see BNF). 2. Cardiovascular system tablets 5mg, 10mg 2.6 Nitrates, Calcium-channel blockers 2.6.2 Calcium-channel Unspecified All prescribers and other antianginal drugs blockers Amlodipine 2. Cardiovascular system tablets 10mg, 20mg 2.6 Nitrates, Calcium-channel blockers 2.6.3 Other antianginal Unspecified All prescribers and other antianginal drugs drugs Nicorandil

2. Cardiovascular system tablets 5mg, 7.5mg 3rd line treatment in patients with refractory angina where re- vascularisation is not appropriate and who continue to suffer from angina 2.6 Nitrates, Calcium-channel blockers 2.6.3 Other antianginal Specialist despite otherwise maximum anti-angina treatment or for patients unable to Unspecified and other antianginal drugs drugs Ivabradine INITIATION tolerate or with a contraindication to beta-blocker or an appropriate calcium channel blocker. In line with NICE guidance TA267 for chronic heart failure. 2. Cardiovascular system tablets 2.6 Nitrates, Calcium-channel blockers 2.6.3 Other antianginal Specialist Unspecified and other antianginal drugs drugs Ranolazine INITIATION 2. Cardiovascular system 2.6.4 Peripheral capsules 100mg 2.6 Nitrates, Calcium-channel blockers vasodilators and related Unspecified All prescribers and other antianginal drugs Naftidrofuryl drugs 2. Cardiovascular system injection syringe 2500 units, Hospital doctors should only ask GPs to prescribe this (1) if a shared care 2.8.1 Parenteral 3500 units, 4500 units, 10,000 Specialist document has been agreed by the hospital and relevant primary care 2.8 Anticoagulants and protamine Unspecified anticoagulants Tinzaparin units, 14,000 units, 18,000 INITIATION organisation or (2) as part of palliative care units 2. Cardiovascular system Subcutaneous injection Hospital doctors should only ask GPs to prescribe this (1) if a shared care 2.8.1 Parenteral Heparin sodium or 5,000units in 0.2ml; pre-filled Specialist document has been agreed by the hospital and relevant primary care 2.8 Anticoagulants and protamine Unspecified anticoagulants calcium syringes 5,000units in 0.2ml, INITIATION organisation or (2) as part of palliative care 2. Cardiovascular system injection syringe 20mg in Hospital doctors should only ask GPs to prescribe this (1) if a shared care 0.2ml, 40mg in 0.4ml, 60mg in document has been agreed by the hospital and relevant primary care 2.8.1 Parenteral 0.6ml, 80mg in 0.8ml, 100mg Specialist organisation or (2) as part of palliative care 2.8 Anticoagulants and protamine Unspecified anticoagulants Enoxaparin in 1ml, 120mg in 0.8ml, 150mg INITIATION in 1ml

2. Cardiovascular system injection syringe 2500 units, Hospital doctors should only ask GPs to prescribe this (1) if a shared care 5000 units, 7500 units, 10,000 document has been agreed by the hospital and relevant primary care 2.8.1 Parenteral Specialist 2.8 Anticoagulants and protamine units, 12,500 units, 15,000 Unspecified organisation or (2) as part of palliative care anticoagulants Dalteparin INITIATION units, 18,000 units

2. Cardiovascular system tablets 10mg, 25mg, 50mg Specialist Intermittent supply problems. INR monitoring required. 2.8 Anticoagulants and protamine 2.8.2 Oral anticoagulants Second line Phenindione INITIATION 2. Cardiovascular system tablets 1mg Specialist INR monitoring required 2.8 Anticoagulants and protamine 2.8.2 Oral anticoagulants Second line Phenindione INITIATION 2. Cardiovascular system capules, 110mg, 150mg NICE TA guidance exists 2.8 Anticoagulants and protamine 2.8.2 Oral anticoagulants Dabigatran etexilate Unspecified All prescribers

2. Cardiovascular system 2.8 Anticoagulants and protamine 2.8.2 Oral anticoagulants Rivaroxaban tablets 15mg, 20mg Unspecified All prescribers NICE TA guidance exists 2. Cardiovascular system 2.8 Anticoagulants and protamine 2.8.2 Oral anticoagulants Apixaban tablets 2.5mg, 5mg Unspecified All prescribers NICE TA guidance exists

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Drug name Initiate by (shading indicates that the drug DRAFT Order of BNF chapter BNF section BNF sub-section Formulations specialist Comments appears in more than one preference only? section) 2. Cardiovascular system tablets 500mcg, 1mg, 3mg, INR monitoring required 2.8 Anticoagulants and protamine 2.8.2 Oral anticoagulants Unspecified All prescribers Warfarin 5mg 2. Cardiovascular system tablets 5mg, 10mg Specialist Use in line with NICE's guidance 2.9 Antiplatelet drugs 2.9 Unspecified Prasugrel INITIATION 2. Cardiovascular system tablets 25mg, 100mg; MR Use in line with NICE's guidance capsules 200mg; 2.9 Antiplatelet drugs 2.9 Unspecified All prescribers Dipyridamole oral liquid 50mg in 5ml

2. Cardiovascular system 2.9 Antiplatelet drugs 2.9 Clopidogrel tablets 75mg Unspecified All prescribers Use in line with NICE's guidance 2. Cardiovascular system tablets dispersible 75mg Enteric coated tablets cost more than dispersible tablets. 2.9 Antiplatelet drugs 2.9 Aspirin Unspecified All prescribers 2. Cardiovascular system Capsules, aspirin 25 mg, Use in line with NICE's guidance 2.9 Antiplatelet drugs 2.9 Unspecified All prescribers Asasantin® Retard dipyridamole 200 mg (m/r) 2. Cardiovascular system tablets 90mg See comments Specialist For use in line with NICE guidance for selected post PCI patients 2.9 Antiplatelet drugs 2.9 Ticagrelor column INITIATION 2.11 Antifibrinolytic drugs and tablets 500mg 2.11 Unspecified All prescribers haemostatics Etamsylate 2. Cardiovascular system 2.11 Antifibrinolytic drugs and tablets 500mg 2.11 Unspecified All prescribers haemostatics Tranexamic acid 2. Cardiovascular system tablets 10mg, 20mg, 40mg, First choice except 1) after an acute coronary syndrome, 2) in most 2.12 Lipid-regulating drugs Statins Unspecified All prescribers Simvastatin 80mg patients with familial hypercholesterolaemia. 2. Cardiovascular system powder 4g per sachet First line resin Colestyramine (Questran Light ®); 2.12 Lipid-regulating drugs Other Unspecified All prescribers (cholestyramine) powder, 4g sachets (Questran ®). 2. Cardiovascular system tablets 5mg, 10mg, 20mg, Rosuvastatin is included for very limited use in line with the protocol below. 40mg Low cost generic rosuvastatin is unlikely to be available before 2017. Generic atorvastatin will be available from May 2012. Rosuvastatin 20mg daily currently costs £338 p.a. in general practice; generic simvastatin 40mg daily costs £15. No published trials demonstrate that rosuvastatin reduces the rate of cardiovascular events when used for secondary prevention.

Rosuvastatin should only be considered in the following circumstances:

1. Adults with familial hypercholesterolaemia, only if the maximum tolerated dose of atorvastatin (check the patient is taking it) fails to achieve the recommended reduction of LDL cholesterol of >50% from the baseline concentration before treatment.

See comments 2. None of simvastatin ( ≥20mg), atorvastatin ( ≥10mg daily) or pravastatin 2.12 Lipid-regulating drugs Statins All prescribers Rosuvastatin column 40mg is tolerated by the patient. Rosuvastatin may or may not be tolerated. Atorvastatin or rosuvastatin could be tried every other day or twice weekly (unlicensed frequency).

3. There is a potentially serious drug interaction (marked with a black dot in the BNF) with simvastatin, atorvastatin and pravastatin, but not with rosuvastatin, that cannot be avoided other than by using rosuvastatin (a clinical pharmacist should be consulted to look for a way of avoiding the interaction other than by using rosuvastatin). In BNF 61 (March 2011) the only drug with a black dot interaction listed for simvastatin, atorvastatin and pravastatin but not rosuvastatin is clarithromycin. It will often be possible to avoid this interaction by using a different antibiotic.

2. Cardiovascular system 2.12 Lipid-regulating drugs Other Colesevelam tablets 625mg Unspecified All prescribers Costs more than colestyramine, but the latter may not be tolerated.

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Drug name Initiate by (shading indicates that the drug DRAFT Order of BNF chapter BNF section BNF sub-section Formulations specialist Comments appears in more than one preference only? section) 2. Cardiovascular system tablets 10mg, 20mg, 40mg, 2.12 Lipid-regulating drugs Statins Unspecified All prescribers Atorvastatin 80mg 2. Cardiovascular system 2.12 Lipid-regulating drugs Statins Pravastatin tablets 10mg, 20mg, 40mg Unspecified All prescribers 2. Cardiovascular system capsules 1g (Omacor ®). For secondary prevention post myocardial infarction (MI) in line with NICE's Omacor ® (omega-3 guideline on secondary prevention of MI, if patients are not able to eat 7g 2.12 Lipid-regulating drugs Other Unspecified All prescribers acid ethyl esters) of omega 3 fatty acid per week.

2. Cardiovascular system capsules (micronised) 67mg, 2.12 Lipid-regulating drugs Fibrates Fenofibrate 200mg, 267mg; Unspecified All prescribers tablets (micronised) 160mg 2. Cardiovascular system tablets 10mg For use in line with NICE's guidance. Drug and Therapeutics Bulletin questioned whether adding ezetimibe to statin treatment is a cost-effective or outcome-based intervention. There 2.12 Lipid-regulating drugs Other Ezetimibe Unspecified All prescribers are no published trials to show it reduces mortality or morbidity. A trial of simvastatin 20mg + ezetimibe 10mg daily in chronic kidney disease was against placebo (Lancet 2011; 377: 2181-92).

2. Cardiovascular system tablets 200mg; MR tablets 2.12 Lipid-regulating drugs Fibrates Unspecified All prescribers Bezafibrate 400mg 3. Respiratory system 150 microgram inhalation ICHT limited release - For maintenance bronchodilator treatment of airflow 3.1.1.1 Selective beta 2 powder, hard capsules; Specialist obstruction in adults with COPD on the recommendation of a respiratory 3.1 Bronchodilators Unspecified agonists Indacaterol 300 microgram inhalation INITIATION physician. powder, hard capsules Only licensed for COPD. 3. Respiratory system Aerosol inhalation 100 micrograms/metered inhalation; Airomir Autohaler (breath- actuated) 100 micrograms/metered 3.1.1.1 Selective beta 2 inhalation; 3.1 Bronchodilators First line All prescribers agonists Salbutamol Ventolin Accuhaler 200micrograms/blister; Pulvinal Salbutamol 200micrograms/dose dry powder inhaler. Nebules, 2.5mg in 2.5ml, 5mg in 2.5ml 3. Respiratory system Turbohaler 500mcg/inhalation; Second choice short-acting beta2 agonist 3.1.1.1 Selective beta 2 Respules 5mg in 2ml 3.1 Bronchodilators Second line All prescribers agonists Terbutaline

3. Respiratory system aerosol inhalation 3.1.1.1 Selective beta 2 25mcg/metered inhalation; 3.1 Bronchodilators Unspecified All prescribers agonists Salmeterol Accuhaler 50mcg/blister; Diskhaler 50mcg/blister 3. Respiratory system Turbohaler 6mcg/inhalation, 3.1.1.1 Selective beta 2 12mcg/inhalation; 3.1 Bronchodilators Unspecified All prescribers agonists Formoterol inhalation capsules 12mcg

3. Respiratory system dry powder inhaler 18mcg The Scottish Medicines Consortium has restricted the Respimat for use in capsule; COPD in patients who have poor manual dexterity and difficulty using the 3.1.2 Antimuscarinic Respimat ® solution for dry powder device. 3.1 Bronchodilators Unspecified All prescribers bronchodilators Tiotropium inhalation 2.5micrograms/metered inhalation

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Drug name Initiate by (shading indicates that the drug DRAFT Order of BNF chapter BNF section BNF sub-section Formulations specialist Comments appears in more than one preference only? section) 3. Respiratory system aerosol inhalation 20mcg/metered inhalation; 3.1.2 Antimuscarinic 3.1 Bronchodilators nebuliser solution 250mcg in Unspecified All prescribers bronchodilators Ipratropium bromide 1ml, 500mcg in 2ml unit dose vials 3. Respiratory system Inhalation powder 50 mcg, For use as a second line option in the maintenance treatment of COPD. 3.1.2 Antimuscarinic Glycopyrronium 3.1 Bronchodilators hard capsule, for use with Second line All prescribers bronchodilators bromide Seebri Breezhaler® device 3. Respiratory system Dry powder inhaler 375 For use as a second line option in the maintenance treatment of COPD. mcgs(= aclidinium 322 3.1.2 Antimuscarinic 3.1 Bronchodilators mcg)/inhalation (delivered Second line All prescribers bronchodilators Aclidinium bromide dose) for use with Eklira Genuair® device 3. Respiratory system MR tablets (Uniphyllin Rate of absorption can vary between brands. Maintain the patient on the Continus) 200mg, 300mg, brand s/he has been stabilised on. 3.1 Bronchodilators 3.1.3 Theophylline Theophylline 400mg; MR capsules 60mg, Unspecified All prescribers 125mg, 250mg (Slo-Phyllin)

3. Respiratory system MR tablets (Phyllocontin) 3.1 Bronchodilators 3.1.3 Theophylline Unspecified All prescribers Aminophylline 225mg, 350mg; 3. Respiratory system spacer devices 3.1.5 Peak flow meters, inhaler devices Drug delivery 3.1.5 Unspecified All prescribers and nebulisers devices 3. Respiratory system Turbohaler 100/6, 200/6, Step down treatment in line with NICE's guidance 3.2 Corticosteroids 3.2 Unspecified All prescribers Symbicort 400/12 3. Respiratory system Accuhaler 100, 250, 500 (dry Step down treatment in line with NICE's guidance. powder breath-actuated disc At the highest dose, Accuhalers (powder devices) cost much less than inhaler containing 50mcg Evohalers (pressurised aerosols) and avoid use of HFA propellants which salmeterol plus are greenhouse gases. 100/250/500mcg fluticasone) Evohaler 50, 125, 250 (aerosol 3.2 Corticosteroids 3.2 Seretide ® containing 25mcg salmeterol Unspecified All prescribers plus 50/125/250mcg fluticasone/metered inhalation)

3. Respiratory system aerosol inhalation, beclometasone dipropionate 3.2 Corticosteroids 3.2 Fostair ® 100mcg, formoterol fumarate Unspecified All prescribers 6mcg per metered inhalation

3. Respiratory system aerosol inhalation 50 and 125 (aerosol containing 5mcg formoterol plus 50/125 mcg fluticasone/metered inhalation. aerosol inhalation 250 (aerosol 3.2 Corticosteroids 3.2 Flutiform ® containing 10mcg formoterol Unspecified All prescribers plus 250 mcg fluticasone/metered inhalation)

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Drug name Initiate by (shading indicates that the drug DRAFT Order of BNF chapter BNF section BNF sub-section Formulations specialist Comments appears in more than one preference only? section) 3. Respiratory system Evohaler ® aerosol inhalation 50mcg/metered inhalation, 125mcg/metered inhalation, 250mcg/metered inhalation; Accuhaler ® 50mcg/blister, 3.2 Corticosteroids 3.2 Fluticasone 100mcg/blister, Unspecified All prescribers 250mcg/blister, 500mcg/blister

3. Respiratory system Turbohaler 100mcg/inhalation, 200mcg/inhalation, 400mcg/inhalation; 3.2 Corticosteroids 3.2 Unspecified All prescribers Budesonide Respules 500mcg in 2ml, 1mg in 2ml

3. Respiratory system CFC-free aerosol inhalation CFC-free beclomethasone inhalers are not interchangeable and should be 50mcg/metered inhalation, prescribed by brand name. Clenil Modulite is probably the best buy for new 100mcg/metered inhalation, prescriptions. 250mcg/metered inhalation (Clenil Modulite ®); CFC-free aerosol inhalation 50mcg/metered inhalation, 100mcg/metered inhalation (Qvar ®); Breath-actuated Beclometasone aerosol inhalation 50 3.2 Corticosteroids 3.2 micrograms/metered Unspecified All prescribers dipropionate inhalation, 100micrograms/metered inhalation (Qvar Autohaler, Qvar Easi-Breathe); Dry powder inhalation 100, 200, 400 micrograms (Pulvinal Beclometasone Dipropionate)

3. Respiratory system dry powder inhaler for patients who cannot take beclometasone, budesonide or fluticasone. 200micrograms/metered inhalation, 400micrograms/metered inhalation

3.2 Corticosteroids 3.2 Mometasone Exceptional case All prescribers

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Drug name Initiate by (shading indicates that the drug DRAFT Order of BNF chapter BNF section BNF sub-section Formulations specialist Comments appears in more than one preference only? section) 3. Respiratory system tablets 20 mg For adults zafirlukast costs less than montelukast 3.03 Cromoglicate and related therapy 3.3.3 Unspecified All prescribers and leukotriene receptor antagonists Zafirlukast 3. Respiratory system tablets 10mg; 3.03 Cromoglicate and related therapy 3.3.3 chewable tablets 4mg, 5mg Unspecified All prescribers and leukotriene receptor antagonists Montelukast granules 4mg 3. Respiratory system tablets 10mg; First line less sedating drug 3.4 Antihistamines, hyposensitisation, 3.4.1 oral solution sugar free First line All prescribers and allergic emergencies Cetirizine 1mg/ml 3. Respiratory system tablets 10mg; syrup 5mg in Second line less sedating drug 3.4 Antihistamines, hyposensitisation, 3.4.1 5ml Second line All prescribers and allergic emergencies Loratadine 3. Respiratory system tablets 10mg, 25mg; elixir 5mg 3.4 Antihistamines, hyposensitisation, Promethazine 3.4.1 in 5ml Unspecified All prescribers and allergic emergencies hydrochloride 3. Respiratory system tablets 10mg, 25mg 3.4 Antihistamines, hyposensitisation, 3.4.1 syrup 10mg in 5ml Unspecified All prescribers and allergic emergencies Hydroxyzine 3. Respiratory system tablets 4mg; syrup 2mg in 5ml; 3.4 Antihistamines, hyposensitisation, 3.4.1 Unspecified All prescribers and allergic emergencies Chlorphenamine 3. Respiratory system pre-filled auto-injector Prescribe using the brand name delivering 150 micrograms (EpiPen Junior. Jext), 300 3.4 Antihistamines, hyposensitisation, Adrenaline/ 3.4.3 micrograms (EpiPen, Jext), Unspecified All prescribers and allergic emergencies epinephrine 500 micrograms (Anapen 500)

3. Respiratory system capsules 375mg; oral liquid For use in line with NICE guidance 3.7 Mucolytics 3.7 Unspecified All prescribers Carbocisteine 250mg in 5ml 3. Respiratory system nebuliser solution Specialist GPs should not be asked to prescribe this unless a local shared care 3.7 Mucolytics 3.7 Unspecified Dornase alfa INITIATION protocol has been agreed. 3. Respiratory system Hypertonic sodium nebuliser solution 3%, 6%, 7% 3.7 Mucolytics 3.7 Unspecified All prescribers chloride 3. Respiratory system Menthol and inhalation 3.8 Aromatic inhalations 3.8 Unspecified All prescribers eucalyptus 3. Respiratory system sugar-free linctus 5mg in 5ml See BNF for limited role 3.9 Cough preparations 3.9.1 Pholcodine Unspecified All prescribers 3. Respiratory system linctus 15mg in 5ml See BNF for limited role 3.9 Cough preparations 3.9.1 Codeine Unspecified All prescribers

3. Respiratory system linctus, linctus paediatric See BNF for limited role 3.9 Cough preparations 3.9.2 Simple Unspecified All prescribers 4. Central nervous system capsules 5mg, 10mg When a short acting hypnotic is indicated NICE recommend the cheapest 4.1 Hypnotics and anxiolytics 4.1.1 Hypnotics Zaleplon Unspecified All prescribers of short-acting benzodiazepine, zaleplon, zolpidem or zopiclone. Zolpidem and zopiclone are currently the lowest cost drugs. 4. Central nervous system tablets 3.75mg, 7.5mg When a short acting hypnotic is indicated NICE recommend the cheapest of short-acting benzodiazepine, zaleplon, zolpidem or zopiclone. Zolpidem 4.1 Hypnotics and anxiolytics 4.1.1 Hypnotics Unspecified All prescribers Zopiclone and zopiclone are currently the lowest cost drugs.

4. Central nervous system tablets 5mg, 10 mg When a short acting hypnotic is indicated NICE recommend the cheapest of short-acting benzodiazepine, zaleplon, zolpidem or zopiclone. Zolpidem 4.1 Hypnotics and anxiolytics 4.1.1 Hypnotics Zolpidem tartrate Unspecified All prescribers and zopiclone are currently the lowest cost drugs.

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Drug name Initiate by (shading indicates that the drug DRAFT Order of BNF chapter BNF section BNF sub-section Formulations specialist Comments appears in more than one preference only? section) 4. Central nervous system tablets 10mg, 20mg; When a short acting hypnotic is indicated NICE recommend the cheapest oral solution 10mg in 5ml of short-acting benzodiazepine, zaleplon, zolpidem or zopiclone. Zolpidem 4.1 Hypnotics and anxiolytics 4.1.1 Hypnotics Unspecified All prescribers Temazepam and zopiclone are currently the lowest cost drugs.

4. Central nervous system 4.1 Hypnotics and anxiolytics 4.1.2 Lorazepam tablets 1mg, 2.5mg Unspecified All prescribers 4. Central nervous system tablets 2mg, 5mg, 10mg; oral solution 2mg in 5ml. 4.1 Hypnotics and anxiolytics 4.1.2 Diazepam rectal tubes 2.5mg in 1.25ml, Unspecified All prescribers 5mg in 2.5ml, 10mg in 2.5ml

4. Central nervous system 4.1 Hypnotics and anxiolytics 4.1.2 Chlordiazepoxide capsules 5mg, 10mg Unspecified All prescribers 4.1 Hypnotics and anxiolytics 4.1.2 Buspirone tablets 5mg, 10mg Unspecified All prescribers 4. Central nervous system 4.2 Drugs used in psychoses and tablet 1mg, 5mg; Specialist 4.2.1 Antipsychotic drugs Unspecified related disorders Trifluoperazine oral solution 5mg in 5ml INITIATION 4. Central nervous system 4.2 Drugs used in psychoses and tablets 200mg, 400mg; Specialist 4.2.1 Antipsychotic drugs Unspecified related disorders Sulpiride oral solution 200mg in 5ml. INITIATION 4. Central nervous system tablets 25mg, 100mg 150mg, 4.2 Drugs used in psychoses and 200mg, 300mg; Specialist 4.2.1 Antipsychotic drugs Unspecified related disorders Quetiapine MR tablets 50mg, 200mg, INITIATION 300mg, 400mg 4. Central nervous system tablets 2.5mg, 5mg, 7.5mg, Orodispersible tablets cost more than standard tablets 4.2 Drugs used in psychoses and 10mg, 15mg; 4.2.1 Antipsychotic drugs Unspecified All prescribers related disorders Olanzapine orodispersible tablets 5mg, 10mg, 15mg, 20mg 4. Central nervous system tablets 10mg, 25mg, 50mg, 4.2 Drugs used in psychoses and Chlorpromazine 100mg; Specialist 4.2.1 Antipsychotic drugs Unspecified related disorders hydrochloride oral solution 25mg in 5ml, INITIATION 100mg in 5ml 4. Central nervous system tablets 5mg, 10mg, 15mg, 30mg; 4.2 Drugs used in psychoses and Specialist 4.2.1 Antipsychotic drugs orodispersible tablets 10mg, Unspecified related disorders Aripiprazole INITIATION 15mg oral solution 1mg in 1ml 4. Central nervous system tablets 50mg, 100mg, 200mg, 4.2 Drugs used in psychoses and Specialist 4.2.1 Antipsychotic drugs 400mg; Unspecified related disorders Amisulpride INITIATION oral solution 100mg in 1ml 4. Central nervous system tablets 500micrograms, 1mg, Orodispersible tablets cost much more than standard tablets 2mg, 3mg, 4mg, 6mg, 4.2 Drugs used in psychoses and 4.2.1 Antipsychotic drugs orodispersible tablets Unspecified All prescribers related disorders Risperidone 500micrograms, 1mg, 2mg, 4mg 4. Central nervous system capsules 500 micrograms; tablets 1.5mg, 5mg, 10mg, 4.2 Drugs used in psychoses and 4.2.1 Antipsychotic drugs 20mg; Unspecified All prescribers related disorders Haloperidol oral liquid 10mg in 5ml; injection 5mg in 1ml 4.2 Drugs used in psychoses and tablets 3mg Specialist 4.2.1 Antipsychotic drugs Unspecified related disorders Flupentixol INITIATION 4.2 Drugs used in psychoses and tablets 2mg, 10mg, 25mg Specialist 4.2.1 Antipsychotic drugs Unspecified related disorders Zuclopenthixol INITIATION 4. Central nervous system 4.2 Drugs used in psychoses and tablets 25mg,injection For use in palliative care 4.2.1 Antipsychotic drugs Unspecified All prescribers related disorders Levomepromazine 25mg/ml depot injection 20mg/ml, 4.2 Drugs used in psychoses and 4.2.2 Antipsychotic depot Flupentixol Specialist 100mg/ml, 200mg/ml Unspecified related disorders injections decanoate INITIATION

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Drug name Initiate by (shading indicates that the drug DRAFT Order of BNF chapter BNF section BNF sub-section Formulations specialist Comments appears in more than one preference only? section) depot injection 25mg/ml, 4.2 Drugs used in psychoses and 4.2.2 Antipsychotic depot Fluphenazine Specialist 100mg/ml Unspecified related disorders injections decanoate INITIATION depot injection 50mg/ml, 4.2 Drugs used in psychoses and 4.2.2 Antipsychotic depot Haloperidol (as Specialist 100mg/ml Unspecified related disorders injections decanoate) INITIATION 4.2 Drugs used in psychoses and 4.2.2 Antipsychotic depot injection 50mg, 75mg, 100mg, Specialist Unspecified related disorders injections Paliperidone 150mg INITIATION depot injection 50mg/ml 4.2 Drugs used in psychoses and 4.2.2 Antipsychotic depot Specialist Unspecified related disorders injections Pipotiazine palmitate INITIATION 4.2 Drugs used in psychoses and 4.2.2 Antipsychotic depot depot injection 25mg, 37.5mg, Specialist Unspecified related disorders injections Risperidone 50mg INITIATION depot injection 200mg/ml, 4.2 Drugs used in psychoses and 4.2.2 Antipsychotic depot Zuclopenthixol Specialist 500mg/ml Unspecified related disorders injections decanoate INITIATION 4. Central nervous system 4.2 Drugs used in psychoses and e/c tablets 250mg, 500mg Specialist 4.2.3 Antimanic drugs Unspecified related disorders Valproic acid INITIATION 4. Central nervous system liquid 520mg in 5ml (Priadel Prescribe by brand name 4.2 Drugs used in psychoses and Specialist 4.2.3 Antimanic drugs ®); oral solution 509mg in 5ml Unspecified related disorders Lithium citrate INITIATION (Li-liquid ®); 4. Central nervous system MR tablets 200mg, 400mg Prescribe by brand name 4.2 Drugs used in psychoses and Specialist 4.2.3 Antimanic drugs (Priadel ®, Camcolit ®, Unspecified related disorders Lithium carbonate INITIATION Liskonum®) 4. Central nervous system capsules, 10mg, 25mg, 50mg 4.3.1 Tricyclic and related 4.03 Antidepressant drugs Unspecified All prescribers antidepressant drugs Clomipramine 4. Central nervous system capsules 50mg, 100mg; Not a first line antidepressant 4.3.1 Tricyclic and related 4.03 Antidepressant drugs tablets 150mg; Unspecified All prescribers antidepressant drugs Trazodone liquid 50mg in 5ml 4. Central nervous system tablets 70mg; oral suspension Lower incidence of side effects and less dangerous in overdose than other 4.3.1 Tricyclic and related 4.03 Antidepressant drugs 70mg in 5ml Unspecified All prescribers tricyclic antidepressants, but infrequently associated with hepatic toxicity antidepressant drugs Lofepramine 4. Central nervous system tablets 10mg, 25mg 4.3.1 Tricyclic and related 4.03 Antidepressant drugs Unspecified All prescribers antidepressant drugs Imipramine 4. Central nervous system tablets 10mg, 25mg, 50mg; 4.3.1 Tricyclic and related Amitriptyline 4.03 Antidepressant drugs oral solution 25mg in 5ml, Unspecified All prescribers antidepressant drugs hydrochloride 50mg in 5ml tablets 10mg, 25mg 4.3.1 Tricyclic and related 4.03 Antidepressant drugs Unspecified All prescribers antidepressant drugs Nortriptyline

4. Central nervous system 4.3.2 Monoamine-oxidase tablets 150mg 4.03 Antidepressant drugs Unspecified All prescribers inhibitors Moclobemide

4. Central nervous system 4.3.2 Monoamine-oxidase tablets 15mg Specialist 4.03 Antidepressant drugs Unspecified inhibitors Phenelzine INITIATION 4. Central nervous system tablets 50mg, 100mg 4.3.3 Selective serotonin re- 4.03 Antidepressant drugs Unspecified All prescribers uptake inhibitors Sertraline 4. Central nervous system capsules 20mg; 4.3.3 Selective serotonin re- 4.03 Antidepressant drugs liquid 20mg in 5ml Unspecified All prescribers uptake inhibitors Fluoxetine 4. Central nervous system tablets 10mg, 20mg; 4.3.3 Selective serotonin re- 4.03 Antidepressant drugs Citalopram oral solution 40mg/ml sugar Unspecified All prescribers uptake inhibitors free 4.3.3 Selective serotonin re- tablets 20mg, 30mg 4.03 Antidepressant drugs Unspecified All prescribers uptake inhibitors Paroxetine

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Drug name Initiate by (shading indicates that the drug DRAFT Order of BNF chapter BNF section BNF sub-section Formulations specialist Comments appears in more than one preference only? section) capsules 30mg, 60mg For use in neuropathic pain e.g. In palliative care. Not included in the 4.3.4 Other antidepressant 4.03 Antidepressant drugs Unspecified All prescribers Integrated Formulary for treatment of depression or generalised anxiety drugs Duloxetine disorder. 4. Central nervous system tablets 37.5mg, 75mg; Plain tablets cost less than MR formulations. MR tablets cost much less 4.3.4 Other antidepressant 4.03 Antidepressant drugs MR tablets 75mg, 150mg, 225 Unspecified All prescribers than MR capsules. drugs Venlafaxine mg 4. Central nervous system tablets 15mg, 30mg, 45mg; Orodispersible (soluble) tablets 15mg, 30mg, 45mg 4.3.4 Other antidepressant 4.03 Antidepressant drugs Unspecified All prescribers drugs Mirtazapine

4. Central nervous system tablets 5mg, 10mg; MR Shared care documents are in use in some parts of NWL. capsules 10mg, 20mg, 30mg (Equasym XL); MR capsules Methylphenidate 10mg, 20mg, 30mg, 40mg Specialist 4.4 Central nervous system stimulants 4.4 Unspecified (Medikinet XL); INITIATION hydrochloride MR tablets 18mg, 27mg, 36mg (Concerta XL ®)

4. Central nervous system Capsules, 10mg, 18mg, Specialist Shared care documents are in use in some parts of NWL. 4.4 Central nervous system stimulants 4.4 Unspecified Atomoxetine 25mg, 40mg, 60mg, 80mg INITIATION 4. Central nervous system tablets 5mg Use for ADHD is listed in the BNF but is unlicensed. Dexamfetamine Specialist 4.4 Central nervous system stimulants 4.4 Unspecified Shared care documents are in use in some parts of NWL. sulphate INITIATION 4. Central nervous system tablets Specialist 4.4 Central nervous system stimulants 4.4 Unspecified Modafinil INITIATION 4. Central nervous system capsules 120mg NICE: Prescribe only as part of an overall plan for managing obesity in adults who have: – a BMI of 28.0 kg/m2 or more with associated risk factors, or – a BMI of 30.0 kg/m2 or more. Continue treatment for longer than 3 months only if the person has lost at 4.5 Drugs used in the treatment of least 5% of their initial body weight since starting drug treatment (less strict 4.5.1 Unspecified All prescribers obesity Orlistat goals may be appropriate for people with type 2 diabetes). Continue for longer than 12 months (usually for weight maintenance) only after discussing potential benefits and limitations with the patient. Co-prescribing with other drugs for weight reduction is not recommended.

4. Central nervous system tablets 5mg, buccal tablets 4.6 Drugs used in nausea and vertigo 4.6 Prochlorperazine 3mg; Unspecified All prescribers syrup 5mg in 5ml 4. Central nervous system tablets 10mg; 4.6 Drugs used in nausea and vertigo 4.6 Metoclopramide oral solution 5mg in 5ml; Unspecified All prescribers injection 10mg in 2ml 4. Central nervous system tablets 10mg; 4.6 Drugs used in nausea and vertigo 4.6 Domperidone suspension 5mg in 5ml; Unspecified All prescribers suppositories 30mg 4. Central nervous system tablets 50 mg; 4.6 Drugs used in nausea and vertigo 4.6 Unspecified All prescribers Cyclizine injection 50mg in 1ml 4. Central nervous system Hyoscine tablets 300micrograms For hypersalivation associated with clozapine therapy [unlicensed 4.6 Drugs used in nausea and vertigo 4.6 Unspecified All prescribers indication] hydrobromide 4. Central nervous system Betahistine tablets 8mg 16mg 4.6 Drugs used in nausea and vertigo 4.6 Unspecified All prescribers dihydrochloride

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Drug name Initiate by (shading indicates that the drug DRAFT Order of BNF chapter BNF section BNF sub-section Formulations specialist Comments appears in more than one preference only? section) 4. Central nervous system tablets 4mg, 8mg; Specialist 4.6 Drugs used in nausea and vertigo 4.6 oral solution4mg/5ml; Unspecified Ondansetron INITIATION injection 2mg/ml 4. Central nervous system tablets 500mg; Suppositories cost much more than tablets and liquids 4.7.1 Non-opioid analgesics dispersible tablets 500mg; 4.7 Analgesics and compound analgesic Paracetamol oral suspension sugar free Unspecified All prescribers preparations 120mg in 5ml, 250mg in 5ml

4. Central nervous system tablets 10/500 4.7.1 Non-opioid analgesics 4.7 Analgesics and compound analgesic Co-dydramol Unspecified All prescribers preparations 4. Central nervous system tablets 8/500, 30/500; Dispersible tablets cost more than plain tablets 4.7.1 Non-opioid analgesics dispersible tablets 8/500, 4.7 Analgesics and compound analgesic Unspecified All prescribers Co-codamol 30/500 preparations 4. Central nervous system dispersible tablets 300mg 4.7.1 Non-opioid analgesics 4.7 Analgesics and compound analgesic Aspirin Unspecified All prescribers preparations tablets 30mg 4.7.1 Non-opioid analgesics 4.7 Analgesics and compound analgesic Nefopam Unspecified All prescribers preparations 4. Central nervous system buccal tablets 100micrograms, Buccal tablets and nasal spray are only included for use in palliative care. 200micrograms, Mezolar® is currently the only brand available in the 37.5mcg/hr strength. 400micrograms, 600micrograms, 800micrograms; nasal spray (PecFent) 4.7 Analgesics 4.7.2 Opioid analgesics Fentanyl 100micrograms/spray, Unspecified All prescribers 400micrograms/spray; patches 12mcg, 25mcg, 37.5mcg, 50mcg, 75mcg and 100mcg/hour all for 72 hours

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Drug name Initiate by (shading indicates that the drug DRAFT Order of BNF chapter BNF section BNF sub-section Formulations specialist Comments appears in more than one preference only? section) 4. Central nervous system tablets (Sevredol ® ) 10mg, First line oral strong opioid. 20mg, 50mg ; Reserve MR suspension sachets for people who cannot take MR tablets MR tablets (Morphgesic SR ®) 10mg, 30mg, 60mg, 100mg; MR capsules (Zomorph ®) 10mg, 30mg, 60mg, 100mg, 200mg ; MR capsules (MXL ®) 30mg, 60mg, 90mg, 120mg, 150mg, 200mg ; MR tablets (MST ®) 5mg; 4.7 Analgesics 4.7.2 Opioid analgesics Morphine sulphate oral solution 10mg in 5ml, First line All prescribers 100mg in 5ml; MR suspension 20mg/sachet, 30mg/sachet, 60mg/sachet, 100mg/sachet, 200mg/sachet; suppositories 10mg,15mg, 30mg; injections 10mg/ml, 15mg/ml, 20mg/ml, 30mg/ml

4. Central nervous system injection 5mg, 10mg, 30mg, 4.7 Analgesics 4.7.2 Opioid analgesics Unspecified All prescribers Diamorphine 100mg, 500mg tablets 5mg; Specialist For use in palliative care. 4.7 Analgesics 4.7.2 Opioid analgesics Unspecified Methadone injection 10mg/ml INITIATION 4. Central nervous system capsules 5mg, 10mg, 20mg; Second line strong opioid MR tablets 5mg, 10mg, 20mg, 40mg, 80mg; oral solution 5mg in 5ml, 50mg 4.7 Analgesics 4.7.2 Opioid analgesics Second line All prescribers Oxycodone in 5ml; injection 10mg in 1ml; 50mg in 1ml

4. Central nervous system 50mg, 75mg; MR tablets Included in the IF for restricted use: it should be initiated in secondary care Specialist 4.7 Analgesics 4.7.2 Opioid analgesics 50mg, 100mg, 150mg, Unspecified and only used in line with the protocol approved by that hospital's New Tapentadol INITIATION Tramadol 200mg, 250mg Drugs Panel or equivalent. 4. Central nervous system Capsule 50mg Marol appears to be the cheapest brand of modified release 12 hourly hydrochloride MR tablets 100mg, 150mg, tramadol listed in the BNF. 4.7 Analgesics 4.7.2 Opioid analgesics Unspecified All prescribers 200mg. MR capsules, 50mg, 100mg, 150mg, 200mg 4. Central nervous system 4.7 Analgesics 4.7.2 Opioid analgesics Dihydrocodeine tablets 30 mg Unspecified All prescribers 4. Central nervous system Tablets codeine phosphate 15 4.7 Analgesics 4.7.2 Opioid analgesics Codeine phosphate mg, 30 mg, 60 mg Unspecified All prescribers

17 of 50 North West London Integrated Formulary 22/09/2014

Drug name Initiate by (shading indicates that the drug DRAFT Order of BNF chapter BNF section BNF sub-section Formulations specialist Comments appears in more than one preference only? section) 4. Central nervous system patches '5' patch (releasing 5 micrograms/hour for 7 days), '10' patch (releasing 10 micrograms/hour for 7 days), '20' patch (releasing 20 micrograms/hour for 7 days); patch 35 micrograms/hour, 4.7 Analgesics 4.7.2 Opioid analgesics Buprenorphine 52.5 micrograms per hour; 70 Unspecified All prescribers micrograms per hour all for 96 hours; sublingual tablets 200micrograms, 400micrograms

4. Central nervous system tablets 50mg, 100mg; 4.7.4.1 Treatment of acute migraine injection pre-filled syringe and refill pack 6mg in 0.5ml; 4.7 Analgesics 4.7.4 Antimigraine drugs First line All prescribers Sumatriptan nasal spray 10mg in 0.1ml, 20mg in 0.1ml

4. Central nervous system orodispersible tablets 2.5mg, 4.7.4.1 Treatment of acute migraine 4.7 Analgesics 4.7.4 Antimigraine drugs Unspecified All prescribers Zolmitriptan 5mg 4. Central nervous system tablets 500 micrograms, 1.5 4.7.4.2 Prophylaxis of migraine. Of limited value and may cause weight 4.7 Analgesics 4.7.4 Antimigraine drugs Pizotifen mg Unspecified All prescribers gain (BNF). Beta-blockers, tricyclic antidepressants and some other drugs are also used for preventing migraine. 4. Central nervous system 4.7 Analgesics 4.7.4 Antimigraine drugs Naratriptan tablets 2.5mg Unspecified All prescribers 4.7.4.1 Treatment of acute migraine 4. Central nervous system 4.7 Analgesics 4.7.4 Antimigraine drugs Almotriptan tablets 12.5mg Unspecified All prescribers 4.7.4.1 Treatment of acute migraine 4. Central nervous system tablets 500mg; Specialist 4.8 Antiepileptics 4.8.1 powder 500mg/sachet Unspecified Vigabatrin INITIATION 4. Central nervous system tablets 25mg, 50mg, 100mg, 200mg; Specialist 4.8 Antiepileptics 4.8.1 sprinkle capsules 15mg, Unspecified Topiramate INITIATION 25mg, 50mg

4. Central nervous system tablets 5mg, 10mg, 15mg

Specialist 4.8 Antiepileptics 4.8.1 Unspecified Tiagabine INITIATION

4. Central nervous system ec tablets 200mg, 500mg; MR tablets 200mg, 300mg, 500mg; Specialist 4.8 Antiepileptics 4.8.1 Unspecified Sodium valproate crushable tablets 100mg; INITIATION liquid (sugar-free) 200mg in 5ml; solution 4. Central nervous system tablet 250 mg Specialist 4.8 Antiepileptics 4.8.1 Unspecified Primidone INITIATION 4. Central nervous system capsules 25mg, 50mg, 75mg, For use in line with NICE's guidance 4.8 Antiepileptics 4.8.1 Pregabalin 100mg, 150mg, 200mg, Unspecified All prescribers 225mg, 300mg

18 of 50 North West London Integrated Formulary 22/09/2014

Drug name Initiate by (shading indicates that the drug DRAFT Order of BNF chapter BNF section BNF sub-section Formulations specialist Comments appears in more than one preference only? section) 4. Central nervous system capsules phenytoin sodium 25mg, 50mg, 100mg, 300mg; tablets phenytoin sodium 100mg; Specialist 4.8 Antiepileptics 4.8.1 Phenytoin chewable tablets phenytoin Unspecified 50mg; INITIATION suspension phenytoin 30mg in 5ml

4. Central nervous system tablets 15mg, 30mg, 60mg; Specialist 4.8 Antiepileptics 4.8.1 Unspecified Phenobarbital elixir 15mg/5ml INITIATION 4. Central nervous system tablets 150mg, 300mg, 600mg; Specialist 4.8 Antiepileptics 4.8.1 Unspecified Oxcarbazepine oral suspension 300mg in 5ml. INITIATION

4. Central nervous system tablets 250mg, 500mg, Specialist 4.8 Antiepileptics 4.8.1 750mg, 1g; Unspecified Levetiracetam INITIATION oral liquid 500mg in 5ml; 4. Central nervous system tablets 25mg, 50mg, 100mg, 200mg; Specialist 4.8 Antiepileptics 4.8.1 Unspecified Lamotrigine dispersible tablets 5mg, 25mg, INITIATION 100mg 4. Central nervous system tablets 2mg, 4mg,6mg, 8mg, Specialist 4.8 Antiepileptics 4.8.1 10mg, 12mg Unspecified Perampanel INITIATION 4. Central nervous system capsules 100mg, 300mg, 4.8 Antiepileptics 4.8.1 Gabapentin 400mg. Tablets 600mg Unspecified All prescribers 4. Central nervous system capsules 250 mg Specialist 4.8 Antiepileptics 4.8.1 Unspecified Ethosuximide INITIATION 4. Central nervous system tablet 500micrograms Specialist 4.8 Antiepileptics 4.8.1 Unspecified Clonazepam INITIATION 4. Central nervous system tablets 10mg; Specialist 4.8 Antiepileptics 4.8.1 Unspecified Clobazam INITIATION 4. Central nervous system tablets 100mg, 200mg, 400mg; MR tablets 200mg, 400mg; 4.8 Antiepileptics 4.8.1 Unspecified All prescribers Carbamazepine tablets chewable 100mg, 200mg; liquid 100mg in 5ml 4. Central nervous system tablets 50mg, 100mg, 200mg, Specialist 4.8 Antiepileptics 4.8.1 300mg, 400mg; Unspecified Retigabine INITIATION starter pack 4. Central nervous system tablets 50mg, 100mg, 150mg, Specialist 4.8 Antiepileptics 4.8.1 200mg; Syrup, 50mg in 5ml. Unspecified Lacosamide INITIATION 4. Central nervous system capsules 25mg, 50mg, 100mg Specialist 4.8 Antiepileptics 4.8.1 Unspecified Zonisamide INITIATION 4. Central nervous system tablets 1.25mg, 5mg, 10mg; 4.9 Drugs used in parkinsonism and Specialist 4.9.1 oral liquid 10mg in 5ml Unspecified related disorders Selegiline INITIATION 4. Central nervous system patches 2mg/24hr, 4mg/24hr, 4.9 Drugs used in parkinsonism and Specialist 4.9.1 6mg/24hr, 8mg/24hr Unspecified related disorders Rotigotine INITIATION 4. Central nervous system tablets 250microgram, 500micrograms, 1mg, 2mg, 4.9 Drugs used in parkinsonism and Specialist 4.9.1 5mg; Unspecified related disorders Ropinirole INITIATION MR tablets 2mg, 4mg, 8mg; starter pack; follow-on pack

19 of 50 North West London Integrated Formulary 22/09/2014

Drug name Initiate by (shading indicates that the drug DRAFT Order of BNF chapter BNF section BNF sub-section Formulations specialist Comments appears in more than one preference only? section) 4. Central nervous system tablet 1 mg 4.9 Drugs used in parkinsonism and Specialist 4.9.1 Unspecified related disorders Rasagiline mesilate INITIATION 4. Central nervous system tablets 88microgram, 180micrograms, 350micrograms, 4.9 Drugs used in parkinsonism and 700micrograms; Specialist 4.9.1 Unspecified related disorders Pramipexole MR tablets 260micrograms, INITIATION 520micrograms, 1.05mg, 1.57mg, 2.1mg, 2.62mg, 3.15mg 4. Central nervous system tablets 200mg

4.9 Drugs used in parkinsonism and Specialist 4.9.1 Unspecified related disorders Entacapone INITIATION

4. Central nervous system tablets 12.5/50, contain levodopa 50mg and carbidopa 12.5mg (Sinemet 62.5 ®); tablets 10/100, contain levodopa 100mg and carbidopa 10mg; tablets 25/250, contain levodopa 250mg and carbidopa 25mg; tablets 25/100, contain 4.9 Drugs used in parkinsonism and levodopa 100mg and 4.9.1 Unspecified All prescribers related disorders Co-careldopa carbidopa 25mg; tablets 25/100, modified- release, contain levodopa 100mg and carbidopa 25mg (Half Sinemet CR ®). tablets 50/200, modified- release, contain levodopa 200mg and carbidopa 50mg (Sinemet CR ®);

4. Central nervous system capsules 12.5/50 contain levodopa 50mg and benserazide 12.5mg; 25/100 contain levodopa 100mg and benserazide 25mg; 50/200 contain levodopa 4.9 Drugs used in parkinsonism and 4.9.1 Co-beneldopa 200mg and benserazide Unspecified All prescribers related disorders 50mg; dispersible tablets 12.5/50, 25/100; MR capsules 25/100 (Madopar CR ®) contain levodopa 100mg and benserazide 25mg

20 of 50 North West London Integrated Formulary 22/09/2014

Drug name Initiate by (shading indicates that the drug DRAFT Order of BNF chapter BNF section BNF sub-section Formulations specialist Comments appears in more than one preference only? section) 4.9 Drugs used in parkinsonism and tablets Specialist 4.9.1 Unspecified related disorders Stalevo INITIATION 4. Central nervous system 4.9 Drugs used in parkinsonism and capsules 100mg Specialist 4.9.1 Unspecified related disorders Amantadine INITIATION 4. Central nervous system 4.9 Drugs used in parkinsonism and tablets 2mg, 5mg; 4.9.2 Unspecified All prescribers related disorders Trihexyphenidyl syrup 5mg in 5ml 4. Central nervous system tablets 5mg; 4.9 Drugs used in parkinsonism and 4.9.2 sugar free syrup 2.5mg in 5ml, Unspecified All prescribers related disorders Procyclidine 5mg in 5ml 4. Central nervous system tablet 50 mg 4.9 Drugs used in parkinsonism and Orphenadrine 4.9.2 Unspecified All prescribers related disorders hydrochloride 4. Central nervous system tablets 50mg For use in line with NICE's guidance. GPs should only be asked to 4.9.3 Drugs used in 4.9 Drugs used in parkinsonism and Specialist prescribe this if a local shared care protocol has been agreed. essential tremor, chorea, Unspecified related disorders Riluzole INITIATION tics, and related disorders 4. Central nervous system tablets 25mg 4.9.3 Drugs used in 4.9 Drugs used in parkinsonism and essential tremor, chorea, Unspecified All prescribers related disorders Tetrabenazine tics, and related disorders 4. Central nervous system 4.10 Drugs used in substance tablets 200mg 4.10.1 Alcohol dependence Unspecified All prescribers dependence Disulfiram 4. Central nervous system tablet 333 mg 4.10 Drugs used in substance Acamprosate 4.10.1 Alcohol dependence Unspecified All prescribers dependence Calcium 4. Central nervous system Tablets, f/c, varenicline (as Note MHRA/CHM advice on association with psychiatric symptoms 4.10 Drugs used in substance 4.10.2 Nicotine dependence tartrate) 500 micrograms , 1 Unspecified All prescribers including suicidal thoughts. dependence Varenicline mg 4. Central nervous system patches (all strengths); In line with local smoking cessation service protocols chewing gum 2mg, 4mg; 4.10 Drugs used in substance sublingual tablet 2mg; 4.10.2 Nicotine dependence Unspecified All prescribers dependence Nicotine lozenge 1mg, 2mg, 4mg; inhalation 10mg; nasal spray 4. Central nervous system 4.10 Drugs used in substance sugar-free oral solution 1mg in Specialist 4.10.3 Opioid dependence Unspecified dependence Methadone 1ml INITIATION 4. Central nervous system Suboxone 4.10 Drugs used in substance Buprenorphine + 2mg/500micrograms; Specialist 4.10.3 Opioid dependence Unspecified dependence naloxone 8mg/2mg sublingual tablets INITIATION 4. Central nervous system 4.10 Drugs used in substance sublingual tablets Specialist 4.10.3 Opioid dependence Unspecified dependence Buprenorphine 400micrograms, 2mg, 8mg INITIATION 4. Central nervous system 4.10 Drugs used in substance tablets 50mg Specialist 4.10.3 Opioid dependence Unspecified dependence Naltrexone INITIATION 4. Central nervous system capsules 1.5mg, 3mg, 4.5mg, Only for use in line with NICE's guidance. Shared care documents have 6mg; oral solution 2mg/ml; Specialist been agreed in some parts of NWL and in these areas GPs should only be 4.11 Drugs used for dementia 4.11 Unspecified Rivastigmine patches 4.6mg/24 hours, INITIATION asked to prescribe the drug in line with the agreement. 9.5mg/24 hours 4. Central nervous system tablets 10mg, 20mg; treatment Only for use in line with NICE's guidance. Shared care documents have initiation pack; oral solution Specialist been agreed in some parts of NWL and in these areas GPs should only be 4.11 Drugs used for dementia 4.11 Unspecified Memantine 5mg/actuation INITIATION asked to prescribe the drug in line with the agreement.

4. Central nervous system tablets 8mg, 12mg; Only for use in line with NICE's guidance. Shared care documents have MR capsules 8mg, 16mg, Specialist been agreed in some parts of NWL and in these areas GPs should only be 4.11 Drugs used for dementia 4.11 Unspecified Galantamine 24mg INITIATION asked to prescribe the drug in line with the agreement. oral solution 4mg in 1ml

21 of 50 North West London Integrated Formulary 22/09/2014

Drug name Initiate by (shading indicates that the drug DRAFT Order of BNF chapter BNF section BNF sub-section Formulations specialist Comments appears in more than one preference only? section) 4. Central nervous system tablets 5mg, 10mg Only for use in line with NICE's guidance. Shared care documents have Specialist been agreed in some parts of NWL and in these areas GPs should only be 4.11 Drugs used for dementia 4.11 Unspecified Donepezil INITIATION asked to prescribe the drug in line with the agreement.

5. Infections Phenoxymethylpenic tablets 250mg; Refer to local anti-bacterial guidelines sugar-free oral solution 125mg 5.1 Antibacterial drugs 5.1.1 Penicillins illin in 5ml, 250mg in 5ml Unspecified All prescribers (penicillin V) 5. Infections capsules 250mg, 500mg; Flucloxacillin liquid is currently expensive. Refer to local anti-bacterial sugar-free oral solution 125mg guidelines 5.1 Antibacterial drugs 5.1.1 Penicillins Unspecified All prescribers Flucloxacillin in 5ml, 250mg in 5ml

5. Infections Tablets 375mg (amoxicillin Refer to local anti-bacterial guidelines 250mg and clavulanic acid 125mg); 625mg (amoxicillin 500mg and clavulanic acid 5.1 Antibacterial drugs 5.1.1 Penicillins Unspecified All prescribers Co-amoxiclav 125mg); suspension 125/31 in 5ml, 250/62 in 5ml, 400/57 in 5ml

5. Infections injection 600mg, 1.2g For suspected meningococcal disease. Refer to local anti-bacterial 5.1 Antibacterial drugs 5.1.1 Penicillins Unspecified All prescribers Benzylpenicillin guidelines 5. Infections capsules 250mg, 500mg; sugar-free oral suspension 125mg in 5ml; sugar-free oral 5.1 Antibacterial drugs 5.1.1 Penicillins Amoxicillin suspension 250mg in 5ml, Unspecified All prescribers paediatric suspension 125mg/1.25 ml; sachets 3g Refer to local anti-bacterial guidelines 5. Infections Pivmecillinam tablets 200mg 5.1 Antibacterial drugs 5.1.1 Penicillins Unspecified All prescribers hydrochloride Refer to local anti-bacterial guidelines 5. Infections capsules 250mg, 500mg; Refer to local anti-bacterial guidelines Cefalexin oral liquid/suspension 125mg 5.1 Antibacterial drugs 5.1.2 Cephalosporins Unspecified All prescribers (cephalexin) in 5ml, 250mg in 5ml 5. Infections 5.1 Antibacterial drugs 5.1.2 Cephalosporins Cefixime tablets 200mg Unspecified All prescribers Refer to local anti-bacterial guidelines tablets 100mg; Refer to local anti-bacterial guidelines Specialist 5.1 Antibacterial drugs 5.1.2 Cephalosporins oral suspension 40mg in 5ml Unspecified Cefpodoxime INITIATION 5. Infections tablets 250 mg Costs much less than tetracycline. Refer to local anti-bacterial guidelines 5.1 Antibacterial drugs 5.1.3 Tetracyclines Oxytetracycline Unspecified All prescribers 5. Infections 5.1 Antibacterial drugs 5.1.3 Tetracyclines Lymecycline capsules 408 mg Unspecified All prescribers Refer to local anti-bacterial guidelines 5. Infections capsules 50mg, 100mg; Capsules cost less than dispersible tablets Refer to local anti-bacterial 5.1 Antibacterial drugs 5.1.3 Tetracyclines Unspecified All prescribers Doxycycline dispersible tablets 100mg; guidelines 5. Infections Demeclocycline capsules 150mg Refer to local anti-bacterial guidelines 5.1 Antibacterial drugs 5.1.3 Tetracyclines Unspecified All prescribers hydrochloride capsules 100mg Specialist Refer to local anti-bacterial guidelines. Included in the Formulary for 5.1 Antibacterial drugs 5.1.3 Tetracyclines Unspecified Minocycline INITIATION respiratory infections on the advice of a specialist, not for acne. 5. Infections e/c tablets 250mg; Refer to local anti-bacterial guidelines sugar-free suspension 125mg 5.1 Antibacterial drugs 5.1.5 Macrolides Unspecified All prescribers Erythromycin in 5ml, 250mg in 5ml, 500mg in 5ml 5. Infections tablets 250mg, 500mg; Refer to local anti-bacterial guidelines 5.1 Antibacterial drugs 5.1.5 Macrolides Unspecified All prescribers Clarithromycin suspension 125mg in 5ml

22 of 50 North West London Integrated Formulary 22/09/2014

Drug name Initiate by (shading indicates that the drug DRAFT Order of BNF chapter BNF section BNF sub-section Formulations specialist Comments appears in more than one preference only? section) 5. Infections tablets 250mg, 500mg; Refer to local anti-bacterial guidelines 5.1 Antibacterial drugs 5.1.5 Macrolides Azithromycin oral suspension 200mg in 5ml Unspecified All prescribers

5. Infections capsules 150mg Refer to local anti-bacterial guidelines 5.1 Antibacterial drugs 5.1.6 Clindamycin Clindamycin Unspecified All prescribers 5. Infections 5.1.7 Some other capsules 125mg, 250mg Refer to local anti-bacterial guidelines 5.1 Antibacterial drugs Unspecified All prescribers antibacterials Vancomycin 5. Infections 5.1.7 Some other tablets 250mg Refer to local anti-bacterial guidelines 5.1 Antibacterial drugs Unspecified All prescribers antibacterials Sodium fusidate 5. Infections tablets 480mg, 960mg; Restricted use - see BNF. Refer to local anti-bacterial guidelines 5.1.8 Sulfonamides and suspension 240mg in 5ml, Specialist 5.1 Antibacterial drugs Unspecified trimethoprim Co-trimoxazole 480mg in 5ml; INITIATION

5. Infections 5.1.8 Sulfonamides and tablets 100mg, 200mg; Refer to local anti-bacterial guidelines 5.1 Antibacterial drugs Unspecified All prescribers trimethoprim Trimethoprim suspension 50mg in 5ml 5. Infections capsules 150mg, 300mg; The norm is for treatment to be prescribed for the person with TB by the combined preparations: Specialist team supervising the treatment. Refer to local anti-bacterial guidelines 5.1 Antibacterial drugs 5.1.9 Antituberculosis drugs Unspecified Rifampicin Rifater, Rifinah 150/100, INITIATION Rifinah 300/150 5. Infections tablets 500mg The norm is for treatment to be prescribed for the person with TB by the Specialist 5.1 Antibacterial drugs 5.1.9 Antituberculosis drugs Unspecified team supervising the treatment. Refer to local anti-bacterial guidelines Pyrazinamide INITIATION 5. Infections tablets 50mg, 100mg The norm is for treatment to be prescribed for the person with TB by the Specialist 5.1 Antibacterial drugs 5.1.9 Antituberculosis drugs Unspecified team supervising the treatment. Refer to local anti-bacterial guidelines Isoniazid INITIATION 5. Infections tablets 100mg, 400mg The norm is for treatment to be prescribed for the person with TB by the Specialist 5.1 Antibacterial drugs 5.1.9 Antituberculosis drugs Unspecified team supervising the treatment. Refer to local anti-bacterial guidelines Ethambutol INITIATION capsules 150mg Specialist 5.1 Antibacterial drugs 5.1.9 Antituberculosis drugs Unspecified Rifabutin INITIATION 5. Infections tablets 200mg, 400mg; Refer to local anti-bacterial guidelines 5.1 Antibacterial drugs 5.1.11 Metronidazole Metronidazole suspension 200mg in 5ml; Unspecified All prescribers suppositories 500mg, 1g 5. Infections tablets 100mg, 250mg, Refer to local anti-bacterial guidelines 5.1 Antibacterial drugs 5.1.12 Quinolones Ciprofloxacin 500mg, 750mg Unspecified All prescribers suspension 250mg in 5ml tablets 250mg, 500mg Specialist Refer to local anti-bacterial guidelines 5.1 Antibacterial drugs 5.1.12 Quinolones Unspecified Levofloxacin INITIATION tablets 400mg Specialist Refer to local anti-bacterial guidelines 5.1 Antibacterial drugs 5.1.12 Quinolones Unspecified Moxifloxacin INITIATION 5. Infections tablets 200mg, 400mg Specialist Refer to local anti-bacterial guidelines 5.1 Antibacterial drugs 5.1.12 Quinolones Unspecified Ofloxacin INITIATION 5. Infections 5.1 Antibacterial drugs 5.1.12 Quinolones Norfloxacin tablets 400mg Unspecified All prescribers Refer to local anti-bacterial guidelines 5. Infections capsules (Macrodantin ®) 50mg, 100mg; 5.1.13 Urinary-tract 5.1 Antibacterial drugs MR capsules 100mg; Unspecified All prescribers infections Nitrofurantoin tablets 50mg, 100mg; suspension 25mg in 5ml Refer to local anti-bacterial guidelines 5. Infections 5.2 Antifungal drugs 5.2 Terbinafine tablets 250mg Unspecified All prescribers 5. Infections suspension 100000units in 1ml 5.2 Antifungal drugs 5.2 Nystatin Unspecified All prescribers 5. Infections capsules 100mg; 5.2 Antifungal drugs 5.2 Unspecified All prescribers Itraconazole oral liquid 10mg in 1ml 5. Infections capsules 50mg, 150mg, 5.2 Antifungal drugs 5.2 Fluconazole 200mg; suspension 50mg in Unspecified All prescribers 5ml, 200mg in 5ml; 5. Infections tablets 250mg, 500mg Costs much more than aciclovir 5.3 Antiviral drugs 5.3.2 Herpesvirus infections Valaciclovir Unspecified All prescribers

23 of 50 North West London Integrated Formulary 22/09/2014

Drug name Initiate by (shading indicates that the drug DRAFT Order of BNF chapter BNF section BNF sub-section Formulations specialist Comments appears in more than one preference only? section) 5. Infections tablets 200mg, 400mg, 800mg; 5.3 Antiviral drugs 5.3.2 Herpesvirus infections Unspecified All prescribers Aciclovir suspension 200mg in 5ml, 400mg in 5ml; 5. Infections dry powder for inhalation For use in line with NICE's guidance 5.3 Antiviral drugs 5.3.4 Influenza Unspecified All prescribers Zanamivir 5mg/blister 5. Infections capsules 30mg, 45mg, 75mg; For use in line with NICE's guidance 5.3 Antiviral drugs 5.3.4 Influenza Unspecified All prescribers Oseltamivir suspension 6mg/ml 5. Infections 5.4 Antiprotozoal drugs 5.4.1 Quinine sulphate tablets 200mg, 300mg Unspecified All prescribers 5. Infections chewable tablets 100mg; 5.5 Anthelmintics 5.5.1 Unspecified All prescribers Mebendazole suspension, 100mg in 5ml 6. Endocrine system Humalog - all formulations Insulin analogues cost significantly more than conventional human insulins. Expenditure can be avoided by ensuring that insulin analogues are only used precisely in line with NICE's current guidelines on type 2 and type 1 diabetes. Prescribers are asked to challenge clinicians who prescribe or 6.1 Drugs used in diabetes 6.1.1.1 Short-acting insulins Unspecified All prescribers Insulin lispro recommend insulin analogues when, according to NICE's current guidance, a less expensive human insulin could have been used. Refer to NICE guidance where appropriate

6. Endocrine system Apidra - all formulations Insulin analogues cost significantly more than conventional human insulins. Expenditure can be avoided by ensuring that insulin analogues are only used precisely in line with NICE's current guidelines on type 2 and type 1 diabetes. Prescribers are asked to challenge clinicians who prescribe or 6.1 Drugs used in diabetes 6.1.1.1 Short-acting insulins Unspecified All prescribers Insulin glulisine recommend insulin analogues when, according to NICE's current guidance, a less expensive human insulin could have been used. Refer to NICE guidance where appropriate

6. Endocrine system NovoRapid - all formulations Insulin analogues cost significantly more than conventional human insulins. Expenditure can be avoided by ensuring that insulin analogues are only used precisely in line with NICE's current guidelines on type 2 and type 1 diabetes. Prescribers are asked to challenge clinicians who prescribe or 6.1 Drugs used in diabetes 6.1.1.1 Short-acting insulins Unspecified All prescribers Insulin aspart recommend insulin analogues when, according to NICE's current guidance, a less expensive human insulin could have been used. Refer to NICE guidance where appropriate

6. Endocrine system Actrapid, Humulin S, Insuman 6.1 Drugs used in diabetes 6.1.1.1 Short-acting insulins Insulin Rapid - all formulations Unspecified All prescribers

6. Endocrine system Insulatard, Humulin I, Insuman 6.1.1.2 Intermediate- and Isophane (NPH) 6.1 Drugs used in diabetes Basal - all formulations Unspecified All prescribers long-acting insulins insulin 6. Endocrine system all formulations Insulin analogues cost significantly more than conventional human insulins. Expenditure can be avoided by ensuring that insulin analogues are only used precisely in line with NICE's current guidelines on type 2 and type 1 6.1.1.2 Intermediate- and diabetes. Prescribers are asked to challenge clinicians who prescribe or 6.1 Drugs used in diabetes Unspecified All prescribers long-acting insulins Insulin glargine recommend insulin analogues when, according to NICE's current guidance, a less expensive human insulin could have been used. Refer to NICE guidance where appropriate

6. Endocrine system all formulations Insulin analogues cost significantly more than conventional human insulins. Expenditure can be avoided by ensuring that insulin analogues are only used precisely in line with NICE's current guidelines on type 2 and type 1 6.1.1.2 Intermediate- and diabetes. Prescribers are asked to challenge clinicians who prescribe or 6.1 Drugs used in diabetes Unspecified All prescribers long-acting insulins Insulin detemir recommend insulin analogues when, according to NICE's current guidance, a less expensive human insulin could have been used. Refer to NICE guidance where appropriate

24 of 50 North West London Integrated Formulary 22/09/2014

Drug name Initiate by (shading indicates that the drug DRAFT Order of BNF chapter BNF section BNF sub-section Formulations specialist Comments appears in more than one preference only? section) 6. Endocrine system Humulin M3, Insuman Comb 6.1.1.2 Intermediate- and Biphasic isophane 15, Insuman Comb 25, 6.1 Drugs used in diabetes Unspecified All prescribers long-acting insulins insulin Insuman Comb 50 - all formulations 6. Endocrine system Humalog Mix25, Humalog Insulin analogues cost significantly more than conventional human insulins. Mix50 - all formulations Expenditure can be avoided by ensuring that insulin analogues are only used precisely in line with NICE's current guidelines on type 2 and type 1 6.1.1.2 Intermediate- and Biphasic insulin diabetes. Prescribers are asked to challenge clinicians who prescribe or 6.1 Drugs used in diabetes Unspecified All prescribers long-acting insulins recommend insulin analogues when, according to NICE's current guidance, lispro a less expensive human insulin could have been used. Refer to NICE guidance where appropriate

6. Endocrine system NovoMix 30 - all formulations Insulin analogues cost significantly more than conventional human insulins. Expenditure can be avoided by ensuring that insulin analogues are only used precisely in line with NICE's current guidelines on type 2 and type 1 6.1.1.2 Intermediate- and Biphasic insulin diabetes. Prescribers are asked to challenge clinicians who prescribe or 6.1 Drugs used in diabetes Unspecified All prescribers long-acting insulins recommend insulin analogues when, according to NICE's current guidance, aspart a less expensive human insulin could have been used. Refer to NICE guidance where appropriate

6. Endocrine system tablets 1mg, 2mg, 3mg, 4mg 6.1 Drugs used in diabetes 6.1.2.1 Sulphonylureas Glimepiride Unspecified All prescribers 6. Endocrine system tablets 80mg 6.1 Drugs used in diabetes 6.1.2.1 Sulphonylureas Gliclazide Unspecified All prescribers 6. Endocrine system tablets 500mg, 850mg; Try conventional tablets before MR tablets. MR tablets 500mg; 6.1 Drugs used in diabetes 6.1.2.2 Biguanides Unspecified All prescribers Metformin oral powder 500mg/sachet, 1g/sachet 6.1.2.3 Other antidiabetic tablets 5mg For use in line with NICE's guidance 6.1 Drugs used in diabetes Unspecified All prescribers drugs Linagliptin 6. Endocrine system tablets 50mg; tablets For use in line with NICE's guidance vildagliptin + metformin 850mg 6.1.2.3 Other antidiabetic 6.1 Drugs used in diabetes (Eucreas 50mg/850mg) or Unspecified All prescribers drugs Vildagliptin metformin 1g (Eucreas 50mg/1g) 6. Endocrine system tablets, 25mg, 50mg, 100mg; For use in line with NICE's guidance 6.1.2.3 Other antidiabetic 6.1 Drugs used in diabetes tablets sitagliptin 50mg + Unspecified All prescribers drugs Sitagliptin metformin 1g 6. Endocrine system 6.1.2.3 Other antidiabetic tablets, 2.5mg, 5mg For use in line with NICE's guidance 6.1 Drugs used in diabetes Unspecified All prescribers drugs Saxagliptin 6. Endocrine system 6.1.2.3 Other antidiabetic tablets 500micrograms, 1mg, For use in line with NICE's guidance 6.1 Drugs used in diabetes Unspecified All prescribers drugs Repaglinide 2mg 6. Endocrine system 6.1.2.3 Other antidiabetic tablets 15mg, 30mg, 45mg For use in line with NICE's guidance 6.1 Drugs used in diabetes Unspecified All prescribers drugs Pioglitazone 6.1.2.3 Other antidiabetic tablets 5mg, 10mg For use in line with NICE's guidance Unspecified All prescribers drugs Dapagliflozin 6. Endocrine system injection 18mg in 3ml pre-filled For use in line with NICE's guidance. Shared care documents have been 6.1.2.3 Other antidiabetic Specialist 6.1 Drugs used in diabetes pens Unspecified agreed in some parts of NWL and in these areas GPs should only be drugs Liraglutide INITIATION asked to prescribe the drug in line with the agreement. 6. Endocrine system 5 microgram/dose prefilled For use in line with NICE's guidance. Shared care documents have been 6.1.2.3 Other antidiabetic pen, 10microgram/dose Specialist agreed in some parts of NWL and in these areas GPs should only be 6.1 Drugs used in diabetes Unspecified drugs Exenatide prefilled pen; INITIATION asked to prescribe the drug in line with the agreement. MR injection 2mg

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Drug name Initiate by (shading indicates that the drug DRAFT Order of BNF chapter BNF section BNF sub-section Formulations specialist Comments appears in more than one preference only? section) 50 micrograms/mL, 10 micrograms/dose prefilled pen. 100 micrograms/mL, 20 micrograms/dose prefilled pen. 6.1.2.3 Other antidiabetic treatment initiation pack, 10 Specialist Unspecified drugs Lixisenatide micrograms/dose prefilled pen INITIATION and 20 micrograms/dose prefilled pen

6. Endocrine system 6.1.2.3 Other antidiabetic tablets 50mg, 100mg For use in line with NICE's guidance 6.1 Drugs used in diabetes Unspecified All prescribers drugs Acarbose 6. Endocrine system 6.1.2.3 Other antidiabetic tablets 100mg, 300mg For use in line with NICE TA315 6.1 Drugs used in diabetes Unspecified All prescribers drugs Canagliflozin 6. Endocrine system 6.1.4 Treatment of tablets 50mg Specialist 6.1 Drugs used in diabetes Unspecified hypoglycaemia Diazoxide INITIATION 6. Endocrine system 6.1.4 Treatment of injection 1mg 6.1 Drugs used in diabetes Unspecified All prescribers hypoglycaemia Glucagon 6. Endocrine system 6.1.6 Diagnostic and Any listed in the Take cost into account where possible. NICE's guidance on monitoring 6.1 Drugs used in diabetes monitoring devices for Unspecified All prescribers blood glucose should be followed. diabetes mellitus current BNF 6. Endocrine system tablets 20micrograms Liothyronine sodium Specialist 6.2 Thyroid and anti-thyroid drugs 6.2.1 Thyroid hormones Unspecified (L-tri-iodothyronine INITIATION sodium)

6. Endocrine system tablets 25micrograms, Liquid formulations of levothyroxine are expensive. The tablets are small. Levothyroxine 50micrograms, 100microgram 6.2 Thyroid and anti-thyroid drugs 6.2.1 Thyroid hormones Unspecified All prescribers (thyroxine sodium)

6. Endocrine system tablets 50mg See BNF for its role cf carbimazole. Secondary care follow up required. 6.2 Thyroid and anti-thyroid drugs 6.2.2 Antithyroid drugs Propylthiouracil Unspecified All prescribers 6. Endocrine system 6.2 Thyroid and anti-thyroid drugs 6.2.2 Antithyroid drugs Carbimazole tablets 5mg, 20mg Unspecified All prescribers Secondary care follow up required. 6. Endocrine system tablets 100micrograms Fludrocortisone Specialist 6.3 Corticosteroids 6.3.1 Unspecified acetate INITIATION 6. Endocrine system tablets 1mg, 5mg, 25mg; Soluble prednisolone tablets cost more than plain tablets. 6.3 Corticosteroids 6.3.2 Prednisolone tablets soluble 5mg; injection Unspecified All prescribers

6. Endocrine system 6.3 Corticosteroids 6.3.2 Hydrocortisone tablets 10mg, 20mg Unspecified All prescribers 6. Endocrine system tablets 500micrograms, 2mg 6.3 Corticosteroids 6.3.2 Dexamethasone Unspecified All prescribers 6. Endocrine system soluble tablets 500micrograms 6.3 Corticosteroids 6.3.2 Betamethasone Unspecified All prescribers 6. Endocrine system tablets 60mg Not for HRT. For use in line with NICE’s TA guidance 161 on secondary 6.4.1.1 Oestrogens and 6.4 Sex hormones Unspecified All prescribers prevention of osteoporotic fragility fracture in postmenopausal women. HRT Raloxifene 6. Endocrine system 6.4.1.1 Oestrogens and tablets 2.5mg 6.4 Sex hormones Unspecified All prescribers HRT Tibolone 6. Endocrine system 6.4.1.1 Oestrogens and tablets 6.4 Sex hormones Third line All prescribers HRT Angeliq ® 6. Endocrine system 6.4.1.1 Oestrogens and Premique Low Dose; 6.4 Sex hormones Fourth line All prescribers HRT Premique ® Premique

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Drug name Initiate by (shading indicates that the drug DRAFT Order of BNF chapter BNF section BNF sub-section Formulations specialist Comments appears in more than one preference only? section) 6. Endocrine system 6.4.1.1 Oestrogens and tablets 6.4 Sex hormones First line All prescribers HRT Kliofem ® 6. Endocrine system 6.4.1.1 Oestrogens and 1/10 tablets, 2/10 tablets 6.4 Sex hormones Second line All prescribers HRT Femoston ® 6. Endocrine system 6.4.1.1 Oestrogens and tablets 6.4 Sex hormones Second line All prescribers HRT Femoston-conti ® 6. Endocrine system 6.4.1.1 Oestrogens and ‘25’ patch, 50 patch, 75 patch, 6.4 Sex hormones First line All prescribers HRT Evorel ® 100 patch 6. Endocrine system 6.4.1.1 Oestrogens and patches 6.4 Sex hormones First line All prescribers HRT Evorel Sequi ® 6. Endocrine system 6.4.1.1 Oestrogens and patches 6.4 Sex hormones First line All prescribers HRT Evorel conti ® 6. Endocrine system 6.4.1.1 Oestrogens and ‘25’ patch, 37.5 patch, 50 6.4 Sex hormones Second line All prescribers HRT Estradot ® patch, 75 patch, 100 patch 6. Endocrine system 6.4.1.1 Oestrogens and Elleste-Duet 1mg tablets; 6.4 Sex hormones First line All prescribers HRT Elleste-Duet ® Elleste-Duet 2mg tablets 6. Endocrine system 6.4.1.1 Oestrogens and Elleste-Solo 1mg tablets; 6.4 Sex hormones First line All prescribers HRT Elleste-Solo ® Elleste-Solo 2mg tablets 6. Endocrine system 6.4.1.1 Oestrogens and tablets 300micrograms, 6.4 Sex hormones Third line All prescribers HRT Premarin ® 625micrograms, 1.25mg 6. Endocrine system 6.4.1.1 Oestrogens and 1mg tablets, 2mg tablets 6.4 Sex hormones Second line All prescribers HRT Zumenon ® 6. Endocrine system 6.4.1.1 Oestrogens and Gel 0.06% (64 dose pump 6.4 Sex hormones First line All prescribers HRT Oestrogel ® pack) 6. Endocrine system 6.4.1.1 Oestrogens and 0.5mg gel , 1mg gel 6.4 Sex hormones First line All prescribers HRT Sandrena ® 6. Endocrine system 6.4.1.1 Oestrogens and tablets 6.4 Sex hormones First line All prescribers HRT Kliovance ® 6. Endocrine system pessaries 200mg, 400mg; gel Red listed for use associated with IVF. Not for HRT. 6.4 Sex hormones 6.4.1.2 Progestogens Unspecified All prescribers Progesterone 90mg/application 6. Endocrine system 6.4 Sex hormones 6.4.1.2 Progestogens Norethisterone tablets 5mg Unspecified All prescribers Not used in HRT. 6. Endocrine system Medroxyprogesteron tablets 2.5mg, 5mg, 10mg Not used in HRT. 6.4 Sex hormones 6.4.1.2 Progestogens Unspecified All prescribers e acetate 6. Endocrine system Progesterone 100mg capsules , 200mg 6.4 Sex hormones 6.4.1.2 Progestogens capsules Unspecified All prescribers (micronised) 6. Endocrine system capsules 40mg; 6.4.2 Male sex hormones Testosterone Specialist 6.4 Sex hormones injection (oily) 1g in 4ml Unspecified and antagonists undecanoate INITIATION 6. Endocrine system gel 50mg/5g sachet; 6.4.2 Male sex hormones gel 2% (10mg per metered Specialist 6.4 Sex hormones Unspecified and antagonists Testosterone application); INITIATION implant 100mg 6. Endocrine system tablets 5mg 6.4.2 Male sex hormones Specialist 6.4 Sex hormones Unspecified and antagonists Finasteride INITIATION 6. Endocrine system tablets 50mg 6.4.2 Male sex hormones Specialist 6.4 Sex hormones Unspecified and antagonists Cyproterone acetate INITIATION 6. Endocrine system all formulations in BNF For use in line with NICE's guidance. Shared care documents have been 6.5 Hypothalamic and pituitary Specialist 6.5.1 Unspecified agreed in some parts of NWL. GPs should only be asked to prescribe the hormones and anti-oestrogens Somatropin INITIATION drug in line with such agreements. 6. Endocrine system 6.5 Hypothalamic and pituitary tablets 50mg Specialist 6.5.1 Unspecified hormones and anti-oestrogens Clomifene INITIATION

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Drug name Initiate by (shading indicates that the drug DRAFT Order of BNF chapter BNF section BNF sub-section Formulations specialist Comments appears in more than one preference only? section) 6. Endocrine system tablets 100mcg, 200mcg; The nasal spray is no longer licensed for bedwetting/primary nocturnal 6.5 Hypothalamic and pituitary nasal spray 10 micrograms enuresis. 6.5.2 Unspecified All prescribers hormones and anti-oestrogens Desmopressin per metered spray

6. Endocrine system injection 50 units in 1ml, 100 Calcitonin (salmon) units in 1ml, 400 units in 2ml Specialist 6.6 Drugs affecting bone metabolism 6.6.1 Unspecified /salcatonin INITIATION

6. Endocrine system capsules 400mg; tablets Specialist 6.6 Drugs affecting bone metabolism 6.6.2 800mg Unspecified Sodium clodronate INITIATION

tablets 50mg As per licensed indication, in adults for the prevention of skeletal events in Specialist 6.6.2 Unspecified patients with breast cancer and bone metastases. Ibandronic acid INITIATION

6. Endocrine system tablets 10mg, 70mg First line bisphosphonate for osteoporosis (70mg tabs). Use in line with 6.6 Drugs affecting bone metabolism 6.6.2 Alendronic acid Unspecified All prescribers NICE's guidance for primary and secondary prevention of osteoporotic fragility fractures in postmenopausal women 6. Endocrine system tablets 5mg, 30mg, 35 mg Second line bisphosphonate for osteoporosis. Use in line with NICE's guidance for primary and secondary prevention of osteoporotic fragility 6.6 Drugs affecting bone metabolism 6.6.2 Unspecified All prescribers Risedronate sodium fracture in postmenopausal women. Costs more than alendronate for treatment of osteoporosis 6. Endocrine system granules 2g/sachet Not a first or second line choice. Use in line with NICE's guidance for 6.6 Drugs affecting bone metabolism 6.6.2 Strontium ranelate Unspecified All prescribers primary and secondary prevention of osteoporotic fragility fractures in postmenopausal women. 6. Endocrine system injection 60mg in 1ml Specialist For use in line with NICE's guidance. 6.6 Drugs affecting bone metabolism 6.6.2 Unspecified Denosumab INITIATION 6. Endocrine system tablets 500micrograms Specialist 6.7 Other endocrine drugs 6.7.1 Unspecified Cabergoline INITIATION 6. Endocrine system tablets, 1mg, 2.5mg; capsules Specialist 6.7 Other endocrine drugs 6.7.1 Unspecified Bromocriptine 5mg, 10mg INITIATION 6. Endocrine system tablets Specialist 6.7 Other endocrine drugs 6.7.2 Unspecified Quinagolide INITIATION 6. Endocrine system injection 3mg, 3.75mg, Specialist 6.7 Other endocrine drugs 6.7.2 First line Triptorelin 11.25mg INITIATION 6. Endocrine system nasal spray 200mcg/metered Specialist 6.7 Other endocrine drugs 6.7.2 Unspecified Nafarelin spray; INITIATION 6. Endocrine system see section 8.03.4 Specialist 6.7 Other endocrine drugs 6.7.2 Unspecified Leuprorelin acetate INITIATION 6. Endocrine system implant 3.6mg syringe (as acetate); Specialist 6.7 Other endocrine drugs 6.7.2 implant 10.8mg syringe (as Unspecified Goserelin INITIATION acetate). see section 8.3.4 6. Endocrine system capsules 100mg, 200mg Specialist 6.7 Other endocrine drugs 6.7.2 Unspecified Danazol INITIATION 6. Endocrine system nasal spray Specialist 6.7 Other endocrine drugs 6.7.2 150micrograms/metered spray Unspecified Buserelin INITIATION 7. Obstetrics, gynaecology, and Injection, 1ml contains For emergency use. urinary-tract disorders ergometrine maleate 500 7.1 Drugs used in obstetrics 7.1.1 Unspecified All prescribers Syntometrine ® micrograms and oxytocin 5 units. 7. Obstetrics, gynaecology, and injection 500mcg in 1ml For emergency use. 7.1 Drugs used in obstetrics 7.1.1 Unspecified All prescribers urinary-tract disorders Ergometrine 7. Obstetrics, gynaecology, and intravaginal cream 0.01%, 7.2 Treatment of vaginal and vulval 7.2.1 Preparations for urinary-tract disorders 0.1%; Unspecified All prescribers conditions vaginal and vulval changes Estriol pessaries 500micrograms

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Drug name Initiate by (shading indicates that the drug DRAFT Order of BNF chapter BNF section BNF sub-section Formulations specialist Comments appears in more than one preference only? section) 7. Obstetrics, gynaecology, and vaginal tablets10micrograms, urinary-tract disorders 7.2 Treatment of vaginal and vulval 7.2.1 Preparations for vaginal ring 7.5mcg/24hr Unspecified All prescribers conditions vaginal and vulval changes Estradiol (Estring)

7. Obstetrics, gynaecology, and Non hormonal vaginal 7.2 Treatment of vaginal and vulval 7.2.1 Preparations for urinary-tract disorders moisturiser Unspecified All prescribers conditions vaginal and vulval changes Replens 7. Obstetrics, gynaecology, and gel 5ml applicator tubes 7.2 Treatment of vaginal and vulval 7.2.2 Vaginal and vulval urinary-tract disorders Unspecified All prescribers conditions infections Balance Activ Rx ® 7. Obstetrics, gynaecology, and 7.2 Treatment of vaginal and vulval 7.2.2 Vaginal and vulval Non hormonal vaginal Unspecified All prescribers urinary-tract disorders conditions infections Sylk moisturiser 7. Obstetrics, gynaecology, and 7.2 Treatment of vaginal and vulval 7.2.2 Vaginal and vulval vaginal gel 0.75% Unspecified All prescribers urinary-tract disorders conditions infections Metronidazole 7. Obstetrics, gynaecology, and topical cream 1%; urinary-tract disorders 7.2 Treatment of vaginal and vulval 7.2.2 Vaginal and vulval pessaries 150mg, 150mg Unspecified All prescribers conditions infections Econazole nitrate formulated for single-dose therapy 7. Obstetrics, gynaecology, and pessaries 100mg, 200mg, urinary-tract disorders 500mg; 7.2 Treatment of vaginal and vulval 7.2.2 Vaginal and vulval vaginal cream 10%; Unspecified All prescribers conditions infections Clotrimazole topical cream 1%, 2%; pessaries 500mg + cream (topical) 2% 7. Obstetrics, gynaecology, and 7.2 Treatment of vaginal and vulval 7.2.2 Vaginal and vulval vaginal cream 2% Unspecified All prescribers urinary-tract disorders conditions infections Clindamycin 7. Obstetrics, gynaecology, and Yasmin ® costs £14.70 for 3 cycles; Microgynon 30 ® costs £2.82 and urinary-tract disorders Rigevidon ® £1.89. Recent evidence suggests that the risk of venous thromboemblism in association with Yasmin may be slightly higher than previously estimated, and somewhere between that for levonorgestrel- 7.3.1 Combined hormonal 7.3 Contraceptives Yasmin ®; Lucette® Unspecified All prescribers containing pills and that for desogestrel or gestodene-containing pills. contraceptives Because of some limitations in the methodology of these recent studies, further analyses are needed before any firm conclusions can be drawn (MHRA). Lucette® costs less than Yasmin®.

7. Obstetrics, gynaecology, and 7.3.1 Combined hormonal 7.3 Contraceptives Unspecified All prescribers urinary-tract disorders contraceptives TriNovum ® 7. Obstetrics, gynaecology, and 7.3.1 Combined hormonal 7.3 Contraceptives Unspecified All prescribers urinary-tract disorders contraceptives Synphase 7. Obstetrics, gynaecology, and 7.3.1 Combined hormonal 7.3 Contraceptives Unspecified All prescribers urinary-tract disorders contraceptives Norimin ® 7. Obstetrics, gynaecology, and 7.3.1 Combined hormonal urinary-tract disorders 7.3 Contraceptives Unspecified All prescribers contraceptives Microgynon 30 ED ® 7. Obstetrics, gynaecology, and Microgynon 30 ®; Rigevidon® costs less than Microgynon 30 ® or Ovranette ® urinary-tract disorders 7.3.1 Combined hormonal 7.3 Contraceptives Unspecified All prescribers contraceptives Ovranette ®; Rigevidon® 7. Obstetrics, gynaecology, and Gedarel ® 20/150 costs less than Mercilon ® 7.3.1 Combined hormonal Mercilon ®; Gedarel urinary-tract disorders 7.3 Contraceptives Unspecified All prescribers contraceptives ® 20/150 7. Obstetrics, gynaecology, and Gedarel ® 30/150 costs less than Marvelon ® 7.3.1 Combined hormonal Marvelon ®; Gedarel urinary-tract disorders 7.3 Contraceptives Unspecified All prescribers contraceptives ® 30/150 7. Obstetrics, gynaecology, and 7.3.1 Combined hormonal 7.3 Contraceptives Unspecified All prescribers urinary-tract disorders contraceptives Logynon ED ®

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Drug name Initiate by (shading indicates that the drug DRAFT Order of BNF chapter BNF section BNF sub-section Formulations specialist Comments appears in more than one preference only? section) 7. Obstetrics, gynaecology, and TriRegol ® costs less than Logynon ® 7.3.1 Combined hormonal Logynon ®; urinary-tract disorders 7.3 Contraceptives Unspecified All prescribers contraceptives TriRegol ® 7. Obstetrics, gynaecology, and 7.3.1 Combined hormonal 7.3 Contraceptives Unspecified All prescribers urinary-tract disorders contraceptives Loestrin 30 ® 7. Obstetrics, gynaecology, and 7.3.1 Combined hormonal 7.3 Contraceptives Unspecified All prescribers urinary-tract disorders contraceptives Loestrin 20 ® 7. Obstetrics, gynaecology, and Millinette ® 20/75 costs less than Femodette ® 7.3.1 Combined hormonal Femodette®; urinary-tract disorders 7.3 Contraceptives Unspecified All prescribers contraceptives Millinette ® 20/75 7. Obstetrics, gynaecology, and Millinette ® 30/75 costs less than Femodene ® 7.3.1 Combined hormonal Femodene ®; urinary-tract disorders 7.3 Contraceptives Unspecified All prescribers contraceptives Millinette ® 30/75 7. Obstetrics, gynaecology, and 7.3.1 Combined hormonal 7.3 Contraceptives Unspecified All prescribers urinary-tract disorders contraceptives Cilest ® 7. Obstetrics, gynaecology, and 7.3.1 Combined hormonal Brevinor ®; urinary-tract disorders 7.3 Contraceptives Unspecified All prescribers contraceptives Ovysmen ® 7. Obstetrics, gynaecology, and 7.3.1 Combined hormonal 7.3 Contraceptives Unspecified All prescribers urinary-tract disorders contraceptives Binovum 7. Obstetrics, gynaecology, and 7.3.1 Combined hormonal 7.3 Contraceptives Unspecified All prescribers urinary-tract disorders contraceptives Evra® 7. Obstetrics, gynaecology, and tablets 350micrograms; urinary-tract disorders 7.3.2 Progestogen-only injection (oily) norethisterone 7.3 Contraceptives Unspecified All prescribers contraceptives Norethisterone enantate 200mg/ml

7. Obstetrics, gynaecology, and Injection (aqueous 7.3.2 Progestogen-only Medroxyprogesteron urinary-tract disorders 7.3 Contraceptives suspension), 150mg in 1ml Unspecified All prescribers contraceptives e acetate 7. Obstetrics, gynaecology, and tablets 30micrograms; 7.3.2 Progestogen-only urinary-tract disorders 7.3 Contraceptives intra-uterine system Unspecified All prescribers contraceptives Levonorgestrel 20micrograms/24hours 7. Obstetrics, gynaecology, and 7.3.2 Progestogen-only implant 68mg 7.3 Contraceptives Unspecified All prescribers urinary-tract disorders contraceptives Etonogestrel 7. Obstetrics, gynaecology, and 7.3.2 Progestogen-only tablets, 75 micrograms 7.3 Contraceptives Unspecified All prescribers urinary-tract disorders contraceptives Desogestrel 7. Obstetrics, gynaecology, and 7.3.3 Spermicidal gel 2% 7.3 Contraceptives Unspecified All prescribers urinary-tract disorders contraceptives Nonoxinol ‘9’ 7. Obstetrics, gynaecology, and Intra-uterine see BNF for range urinary-tract disorders 7.3 Contraceptives 7.3.4 Contraceptive devices contraceptive Unspecified All prescribers devices 7. Obstetrics, gynaecology, and 7.3.5 Emergency tablets 1.5mg (Levonelle ® First choice if administered within 72 hours of intercourse 7.3 Contraceptives First line All prescribers urinary-tract disorders contraception Levonorgestrel 1500) 7. Obstetrics, gynaecology, and tablets 30mg Levonorgestrel is still the first choice for emergency hormonal urinary-tract disorders contraception if administered within 72 hours of sexual intercourse. If available and suitable, emergency insertion of a copper IUD should also be considered up to 5 days after the earliest likely calculated ovulation. Further evidence is needed before there is a change in practice. In 7.3.5 Emergency particular, a superiority trial would be needed to prove that ulipristal should 7.3 Contraceptives Unspecified All prescribers contraception Ulipristal acetate be used rather than levonorgestrel, compared with which it is less accessible and more costly, and does not have the same safety data. However, ulipristal provides prescribers with a licensed option for use in women presenting 72-120 hours after unprotected intercourse, if insertion of a copper IUD is not feasible. (Drug and Therapeutics Bulletin August 2010). 7. Obstetrics, gynaecology, and 7.4.1 Drugs for urinary MR capsules 400mcg 7.4 Drugs for genito-urinary disorders Unspecified All prescribers urinary-tract disorders retention Tamsulosin

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Drug name Initiate by (shading indicates that the drug DRAFT Order of BNF chapter BNF section BNF sub-section Formulations specialist Comments appears in more than one preference only? section) 7. Obstetrics, gynaecology, and 7.4.1 Drugs for urinary tablets 20mg 7.4 Drugs for genito-urinary disorders Unspecified All prescribers urinary-tract disorders retention Indoramin 7. Obstetrics, gynaecology, and 7.4.1 Drugs for urinary tablets 1mg, 2mg, 4mg 7.4 Drugs for genito-urinary disorders Unspecified All prescribers urinary-tract disorders retention Doxazosin 7. Obstetrics, gynaecology, and tablets 2.5mg; 7.4.1 Drugs for urinary Alfuzosin urinary-tract disorders 7.4 Drugs for genito-urinary disorders M/R tablets 10mg Unspecified All prescribers retention hydrochloride 7. Obstetrics, gynaecology, and 7.4.2 Drugs for urinary capsules 20mg, 40mg urinary-tract disorders 7.4 Drugs for genito-urinary disorders frequency, enuresis, and Duloxetine Unspecified All prescribers incontinence 7. Obstetrics, gynaecology, and M/R tablets 25mg, 50mg Mirabegron is an option for treating the symptoms of overactive bladder 7.4.2 Drugs for urinary urinary-tract disorders only for people in whom antimuscarinic drugs are contraindicated or 7.4 Drugs for genito-urinary disorders frequency, enuresis, and Unspecified All prescribers Mirabegron clinically ineffective, or have unacceptable side effects incontinence 7. Obstetrics, gynaecology, and 7.4.2 Drugs for urinary tablets 2.5mg, 5mg; urinary-tract disorders 7.4 Drugs for genito-urinary disorders frequency, enuresis, and Oxybutynin elixir 2.5mg in 5ml Unspecified All prescribers incontinence 7. Obstetrics, gynaecology, and 7.4.2 Drugs for urinary tablets 1mg, 2mg; Generic tolterodine is likely to be available from September 2012. urinary-tract disorders 7.4 Drugs for genito-urinary disorders frequency, enuresis, and Tolterodine MR tablets 4mg Unspecified All prescribers incontinence 7. Obstetrics, gynaecology, and 7.4.2 Drugs for urinary Tablets 7.5mg M/R tablets urinary-tract disorders 7.4 Drugs for genito-urinary disorders frequency, enuresis, and Darifenacin Unspecified All prescribers incontinence 7. Obstetrics, gynaecology, and 7.4.2 Drugs for urinary tablets 5mg, 10mg urinary-tract disorders 7.4 Drugs for genito-urinary disorders frequency, enuresis, and Solifenacin Unspecified All prescribers incontinence 7. Obstetrics, gynaecology, and soluble tablets (Effercitrate - 1 urinary-tract disorders 7.4.3 Drugs used in tablet equivalent to 5ml 7.4 Drugs for genito-urinary disorders Unspecified All prescribers urological pain Potassium citrate potassium citrate); mixture 1.5g in 5ml 7. Obstetrics, gynaecology, and irrigation 0.9% 100ml 7.4 Drugs for genito-urinary disorders 7.4.4 Bladder instillations Unspecified All prescribers urinary-tract disorders Sodium chloride 7. Obstetrics, gynaecology, and Catheter patency solution 7.4 Drugs for genito-urinary disorders 7.4.4 Bladder instillations Unspecified All prescribers urinary-tract disorders Chlorhexidine 0.02% 7. Obstetrics, gynaecology, and 7.4.5 Drugs for erectile tablets 25mg, 50mg, 100mg See BNF for circumstances under which this can be prescribed on the 7.4 Drugs for genito-urinary disorders First line All prescribers urinary-tract disorders dysfunction Sildenafil NHS. Available generically. 7. Obstetrics, gynaecology, and 7.4.5 Drugs for erectile tablets 5mg, 10mg, 20mg See BNF for circumstances under which this can be prescribed on the 7.4 Drugs for genito-urinary disorders Unspecified All prescribers urinary-tract disorders dysfunction Vardenafil NHS 7. Obstetrics, gynaecology, and tablets 2.5mg, 5mg, 10mg, See BNF for circumstances under which this can be prescribed on the urinary-tract disorders 20mg NHS. The NWLIF New Drugs Panel has not to date received a request 7.4.5 Drugs for erectile 7.4 Drugs for genito-urinary disorders Unspecified All prescribers to support tadalafil use for treatment of the signs and symptoms of benign dysfunction Tadalafil prostactic hyperplasia, so it not included in the Formulary for this indication.

7. Obstetrics, gynaecology, and Injection 5microgram, See BNF for circumstances under which this can be prescribed on the urinary-tract disorders 10microgram, 20 microgram, NHS 40microgram (Caverject ®); cartridges 10microgram, 20microgram (Caverject ® 7.4.5 Drugs for erectile 7.4 Drugs for genito-urinary disorders Dual cartridge); Unspecified All prescribers dysfunction Alprostadil urethral application 125micrograms, 250micrograms, 500micrograms, 1mg (Muse ®)

8. Malignant disease and tablets 50mg Specialist GPs should only prescribe if they have agreed shared care arrangements. 8.1 Cytotoxic drugs 8.1.3 Unspecified immunosuppression Mercaptopurine INITIATION

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Drug name Initiate by (shading indicates that the drug DRAFT Order of BNF chapter BNF section BNF sub-section Formulations specialist Comments appears in more than one preference only? section) 8. Malignant disease and capsules 500mg GPs should only prescribe if they have agreed shared care arrangements. Specialist immunosuppression 8.1 Cytotoxic drugs 8.1.5 Unspecified Hydroxycarbamide INITIATION 8. Malignant disease and capsules 250mg; GPs should only prescribe if they have agreed shared care arrangements. immunosuppression tablets 500mg; There is a move towards ICHT supplying this to renal transplant recipients 8.2 Drugs affecting the immune Mycophenolate Specialist 8.2.1 suspension 1g in 5ml; Unspecified (via a home supply arrangement). Must be prescribed by brand name; response INITIATION mofetil change of brand necessitates blood level checks.

8. Malignant disease and 8.2 Drugs affecting the immune tablets 25mg, 50mg Specialist GPs should only prescribe if they have agreed shared care arrangements. 8.2.1 Unspecified immunosuppression response Azathioprine INITIATION 8. Malignant disease and capsules 500micrograms, GPs should only prescribe if they have agreed shared care arrangements. immunosuppression 1mg, 3mg, 5mg There is a move towards ICHT supplying this to renal transplant recipients 8.2 Drugs affecting the immune Specialist 8.2.2 (prescribe by brand name) Unspecified (via a home supply arrangement). Must be prescribed by brand name; response Tacrolimus INITIATION change of brand necessitates blood level checks.

8. Malignant disease and capsules 10mg, 25mg, 50mg, GPs should only be asked to prescribe the drug in line with a shared care 8.2 Drugs affecting the immune Specialist immunosuppression 8.2.2 100mg; oral solution 100mg/ml Unspecified agreement. response Ciclosporin INITIATION 8. Malignant disease and 8.3 Sex hormones & hormone tablets 160mg Specialist 8.3.2 Progestogens Unspecified immunosuppression antagonists in malignant disease Megestrol acetate INITIATION 8. Malignant disease and tablets 100mg, 200mg, 400mg 8.3 Sex hormones & hormone Medroxyprogesteron Specialist immunosuppression 8.3.2 Progestogens Unspecified antagonists in malignant disease e acetate INITIATION 8. Malignant disease and tablets 5mg immunosuppression 8.3 Sex hormones & hormone 8.3.2 Progestogens Unspecified All prescribers antagonists in malignant disease Norethisterone

8. Malignant disease and injection 50mcg/ml, GPs should only be asked to prescribe this 1) if a local shared care immunosuppression 100mcg/ml, 200mcg/ml, protocol has been agreed, 2) in palliative care 8.3 Sex hormones & hormone 8.3.4.3 Somastatin Specialist 500mcg/ml; Unspecified antagonists in malignant disease analogues Octreotide INITIATION depot injection 10mg, 20mg, 30mg 8. Malignant disease and 8.3 Sex hormones & hormone injection 3mg, 3.75mg, Specialist 8.3.4 Hormone antagonists Unspecified immunosuppression antagonists in malignant disease Triptorelin 11.25mg, 22.5mg INITIATION 8. Malignant disease and 8.3 Sex hormones & hormone tablets 10mg, 20mg, 40mg Specialist 8.3.4 Hormone antagonists Unspecified immunosuppression antagonists in malignant disease Tamoxifen INITIATION 8. Malignant disease and 8.3 Sex hormones & hormone injection 3.75, 11.25mg Specialist 8.3.4 Hormone antagonists Unspecified immunosuppression antagonists in malignant disease Leuprorelin INITIATION 8. Malignant disease and tablets 2.5mg 8.3 Sex hormones & hormone Specialist immunosuppression 8.3.4 Hormone antagonists Unspecified antagonists in malignant disease Letrozole INITIATION 8. Malignant disease and 8.3 Sex hormones & hormone implant 3.6mg, 10.8mg Specialist 8.3.4 Hormone antagonists Unspecified immunosuppression antagonists in malignant disease Goserelin INITIATION 8. Malignant disease and 8.3 Sex hormones & hormone tablets 250mg Specialist 8.3.4 Hormone antagonists Unspecified immunosuppression antagonists in malignant disease Flutamide INITIATION 8. Malignant disease and tablets 25mg 8.3 Sex hormones & hormone Specialist immunosuppression 8.3.4 Hormone antagonists Unspecified antagonists in malignant disease Exemestane INITIATION 8. Malignant disease and tablets 50mg, 100mg 8.3 Sex hormones & hormone Specialist immunosuppression 8.3.4 Hormone antagonists Unspecified antagonists in malignant disease Cyproterone acetate INITIATION 8. Malignant disease and 8.3 Sex hormones & hormone tablets 50mg, 150mg Specialist 8.3.4 Hormone antagonists Unspecified immunosuppression antagonists in malignant disease Bicalutamide INITIATION 8. Malignant disease and 8.3 Sex hormones & hormone tablets 1mg Specialist 8.3.4 Hormone antagonists Unspecified immunosuppression antagonists in malignant disease Anastrazole INITIATION 9. Nutrition and blood tablets 210mg (68mg iron); 9.1.1 Iron-deficiency 9.1 Anaemias and other blood disorders syrup 140mg in 5ml (45mg First line All prescribers anaemias Ferrous fumarate iron in 5ml).

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Drug name Initiate by (shading indicates that the drug DRAFT Order of BNF chapter BNF section BNF sub-section Formulations specialist Comments appears in more than one preference only? section) 9. Nutrition and blood Sodium feredetate Elixir 190mg in 5ml (27.5mg 9.1.1 Iron-deficiency iron in 5ml). 9.1 Anaemias and other blood disorders Unspecified All prescribers anaemias (sodium iron edetate) 9. Nutrition and blood Tablets ferrous fumarate equivalent to 100mg iron + 9.1.1 Iron-deficiency 9.1 Anaemias and other blood disorders folic acid 350micrograms Unspecified All prescribers anaemias Iron & folic acid (Pregaday ®)

9. Nutrition and blood 9.1.1 Iron-deficiency tablets 200mg (65mg iron) Ferrous fumarate tablets 210mg cost less per tablet 9.1 Anaemias and other blood disorders Unspecified All prescribers anaemias Ferrous sulphate 9. Nutrition and blood 9.1.1 Iron-deficiency tablets 300mg (35mg iron) Cost more per tablet than ferrous fumarate or ferrous sulphate tablets 9.1 Anaemias and other blood disorders Unspecified All prescribers anaemias Ferrous gluconate 9. Nutrition and blood injection 1mg in 1ml 9.1.2 Drugs used in 9.1 Anaemias and other blood disorders Unspecified All prescribers megaloblastic anaemias Hydroxocobalamin 9. Nutrition and blood tablets 400micrograms, 5mg; 9.1.2 Drugs used in sugar-free syrup 2.5mg in 5ml 9.1 Anaemias and other blood disorders Unspecified All prescribers megaloblastic anaemias Folic acid

9. Nutrition and blood 9.1.2 Drugs used in tablets 50 micrograms 9.1 Anaemias and other blood disorders Unspecified All prescribers megaloblastic anaemias Cyanocobalamin 9. Nutrition and blood MR tablets 600mg contain approximately 10mmol each of Specialist 9.2 Fluids and electrolytes 9.2.1 Unspecified Sodium chloride sodium and chloride ions INITIATION

9. Nutrition and blood capsules 500mg Specialist 9.2 Fluids and electrolytes 9.2.1 Unspecified Sodium bicarbonate INITIATION 9. Nutrition and blood capsules 500mg Potassium Specialist 9.2 Fluids and electrolytes 9.2.1 Unspecified bicarbonate INITIATION 9. Nutrition and blood Tablets effervescent, Potassium; potassium bicarbonate and 9.2 Fluids and electrolytes 9.2.1 chloride, containing 12mmol Unspecified All prescribers Sando-K ® potassium and 8mmol chloride per tablet. 9. Nutrition and blood MR tablets 600mg (Slow-K ®) Avoid using modified release preparations unless soluble tablets or liquid containing 8mmol potassium preparations are inappropriate. and 8mmol chloride; syrup (Key-Cee-L ®) 9.2 Fluids and electrolytes 9.2.1 Unspecified All prescribers Potassium chloride containing 5mmol potassium and 5mmol chloride in 5ml

9. Nutrition and blood Oral rehydration Electrolade ® oral powder 9.2 Fluids and electrolytes 9.2.1 sachets Unspecified All prescribers salts

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Drug name Initiate by (shading indicates that the drug DRAFT Order of BNF chapter BNF section BNF sub-section Formulations specialist Comments appears in more than one preference only? section) 9. Nutrition and blood tablets, film-coated, calcium carbonate 1.25g, providing 500mg or 12.5mmol calcium per tablet (Calcium-500); tablets, chewable, calcium carbonate 1.25g, providing 500mg or 12.5mmol calcium per tablet (Calcichew ®); tablets, chewable, calcium carbonate 2.5g, providing 1g or 25mmol calcium per tablet 9.5 Minerals 9.5.1 Calcium salts (Calcichew Forte ®); Unspecified All prescribers tablets, effervescent, calcium salts providing 1g or 25mmol calcium per tablet (Sandocal 1000 ®); syrup, calcium salts providing 108.3mg or 2.7mmol calcium per 5ml (Calcium-Sandoz ®)

9. Nutrition and blood tablets 800mg Should normally be supplied by the renal unit. To control Specialist hyperphosphataemia in dialysis patients with severe hyperparathyroidism 9.5 Minerals 9.5.2 Unspecified Sevelamer INITIATION who become hypercalcaemic on calcium containing phosphate binders.

9. Nutrition and blood effervescent tablets containing 16.1mmol phosphate, 20.4mmol sodium and Specialist 9.5 Minerals 9.5.2 Unspecified Phosphate-Sandoz ® 3.1mmol potassium per tablet INITIATION (Phosphate Sandoz ®).

9. Nutrition and blood tablets 500mg, 750mg, 1g Should normally be supplied by the renal unit. To control hyperphosphataemia in dialysis patients with severe hyperparathyroidism. Lanthanum Specialist 9.5 Minerals 9.5.2 Unspecified To replace high dose sevelamer (2.4g tds) in patients who cannot tolerate INITIATION carbonate calcium carbonate. Calcium carbonate is used first-line.

9. Nutrition and blood effervescent tablets 125mg 9.5 Minerals 9.5.4 Unspecified All prescribers Zinc sulphate (45mg zinc) 9. Nutrition and blood capsules vitamin A 4000 units, 9.6 Vitamins 9.6.1 Vitamin A Unspecified All prescribers Vitamins A and D vitamin D 400 units 9. Nutrition and blood tablets containing nicotinamide 20mg, pyridoxine Vitamin B compound hydrochloride 2mg, riboflavin 9.6 Vitamins 9.6.2 Vitamin B group Unspecified All prescribers strong 2mg and thiamine hydrochloride 5mg.

9. Nutrition and blood Thiamine (Vitamin tablets 50mg, 100mg 9.6 Vitamins 9.6.2 Vitamin B group Unspecified All prescribers B1) 9. Nutrition and blood 9.6 Vitamins 9.6.2 Vitamin B group Pabrinex ® I/M High Potency Injection Unspecified All prescribers 9. Nutrition and blood Pyridoxine tablets 10mg, 20mg, 50mg 9.6 Vitamins 9.6.2 Vitamin B group hydrochloride Unspecified All prescribers (Vitamin B6) 9. Nutrition and blood tablets 50mg, 200mg, 500mg 9.6 Vitamins 9.6.3 Vitamin C Ascorbic acid Unspecified All prescribers

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Drug name Initiate by (shading indicates that the drug DRAFT Order of BNF chapter BNF section BNF sub-section Formulations specialist Comments appears in more than one preference only? section) 9. Nutrition and blood Ergocalciferol injection 300,000 units in 1ml Availability of this UK licensed product is sporadic. Refer to local guidance on vitamin D products. 9.6 Vitamins 9.6.4 Vitamin D (calciferol, vitamin Unspecified All prescribers D2) 9. Nutrition and blood capsules 800 units (Fultium ®), Also refer to local guidance on vitamin D products. tablets 800 units (Desunin ®), Pro D3 is not a licensed medicine but a nutritional supplement. 20,000 units (Dekristol, Pro D3 unlicensed); oral liquid 3,000 units in 1ml (unlicensed), 2,000 units in Colecalciferol 1ml (Pro D3 liquid, 9.6 Vitamins 9.6.4 Vitamin D (Cholecalciferol, unlicensed), 10,000 units in Unspecified All prescribers 1ml (Zymad, unlicensed); vitamin D3) dispersible tablets 1,000 units (Vigatoletten, unlicensed); injection 300,000 units in 1ml (unlicensed)

9. Nutrition and blood Powder, calcium phosphate 3.1 g (calcium 1.2 g or Ca2+ 9.6 Vitamins 9.6.4 Vitamin D Calfovit D3® 30mmol), colecalciferol 20 Unspecified All prescribers micrograms (800 units)

9. Nutrition and blood Calcitriol (1,25- Capsules, 250 nanograms, 500 nanograms 9.6 Vitamins 9.6.4 Vitamin D dihydroxycolecalcife Unspecified All prescribers rol) 9. Nutrition and blood chewable tablets, contain calcium carbonate 1.25 g 9.6 Vitamins 9.6.4 Vitamin D Calceos (calcium 500 mg/12.5 mmol), Unspecified All prescribers colecalciferol 10 micrograms (400 units), 9. Nutrition and blood capsules 250 nanograms, 500 Alfacalcidol (1-alpha- nanograms, 1mcg; oral drops 2mcg/ml 9.6 Vitamins 9.6.4 Vitamin D hydroxycolecalcifero Unspecified All prescribers l)

9. Nutrition and blood caplets, calcium carbonate 750 mg (calcium 300 mg/7.5 9.6 Vitamins 9.6.4 Vitamin D Adcal-D3 ® mmol), colecalciferol 5 Unspecified All prescribers micrograms (200 units),

9. Nutrition and blood tablets, calcium carbonate 1.5g (calcium 9.6 Vitamins 9.6.4 Vitamin D Accrete D3 ® 600mg/15mmol), colecalciferol Unspecified All prescribers 10 micrograms (400 units)

9. Nutrition and blood suspension 500mg in 5ml Alpha tocopheryl Specialist 9.6 Vitamins 9.6.5 Vitamin E Unspecified acetate INITIATION 9. Nutrition and blood injection 10mg in 1ml, 2mg in 9.6 Vitamins 9.6.6 Vitamin K Unspecified All prescribers Phytomenadione 0.2ml 9. Nutrition and blood Menadiol sodium tablets 10mg 9.6 Vitamins 9.6.6 Vitamin K Unspecified All prescribers phosphate

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Drug name Initiate by (shading indicates that the drug DRAFT Order of BNF chapter BNF section BNF sub-section Formulations specialist Comments appears in more than one preference only? section) 9. Nutrition and blood capsules, ascorbic acid 15 mg, nicotinamide 7.5 mg, 9.6.7 Multivitamin riboflavin 500micrograms, 9.6 Vitamins Unspecified All prescribers preparations Vitamins thiamine hydrochloride 1mg, vitamin A 2500 units, vitamin D 300 units 9. Nutrition and blood 9.6.7 Multivitamin tablets; See BNF for indications. 9.6 Vitamins Unspecified All prescribers preparations Ketovite liquid 9. Nutrition and blood capsules, soluble tablets Capsules are a licensed medicine. Soluble tablets are a food supplement. 9.6.7 Multivitamin 9.6 Vitamins Unspecified All prescribers Soluble tablets are an option for patients with swallowing difficulties. preparations Forceval ® 9. Nutrition and blood 9.6.7 Multivitamin oral drops 9.6 Vitamins Unspecified All prescribers preparations Dalivit ® 9. Nutrition and blood 9.6.7 Multivitamin oral drops Includes arachis (peanut) oil 9.6 Vitamins Unspecified All prescribers preparations Abidec ® 10. Musculoskeletal and joint tablets 200mg, 400mg; Of NSAIDs, ibuprofen is associated with the lowest risk of GI adverse 10.1 Drugs used in rheumatic disease 10.1.1 Non-steroidal anti- diseases MR tablets 800mg; First line All prescribers events. MR tablets cost more than conventional tablets. and gout inflammatory drugs Ibuprofen syrup 100mg in 5ml 10. Musculoskeletal and joint 10.1 Drugs used in rheumatic disease 10.1.1 Non-steroidal anti- tablets 250mg, 500mg Second line All prescribers diseases and gout inflammatory drugs Naproxen 10. Musculoskeletal and joint capsules 100mg, 200mg See note on cardiovascular safety, above. NICE's clinical guidelines on diseases 10.1 Drugs used in rheumatic disease 10.1.1 Non-steroidal anti- osteoarthritis and rheumatoid arthritis recommend co-prescribing a low Unspecified All prescribers and gout inflammatory drugs Celecoxib cost proton pump inhibitor if a COX-2 inhibitor such as celecoxib is used.

10. Musculoskeletal and joint injection 10mg in 1ml, 40mg in 10.1 Drugs used in rheumatic disease Triamcinolone diseases 10.1.2 Corticosteroids 1ml Unspecified All prescribers and gout acetonide 10. Musculoskeletal and joint injection methylprednisolone diseases acetate 40mg + lidocaine 10mg in 1ml, 10.1 Drugs used in rheumatic disease Methylprednisolone injection methylprednisolone 10.1.2 Corticosteroids Unspecified All prescribers and gout acetate + lidocaine acetate 80mg + lidocaine 20mg in 2ml

10. Musculoskeletal and joint injection 40mg in 1ml, 80mg in 10.1 Drugs used in rheumatic disease Methylprednisolone diseases 10.1.2 Corticosteroids 2ml Unspecified All prescribers and gout acetate 10. Musculoskeletal and joint injection 25mg in 1ml 10.1 Drugs used in rheumatic disease Hydrocortisone diseases 10.1.2 Corticosteroids Unspecified All prescribers and gout acetate 10. Musculoskeletal and joint 10.1 Drugs used in rheumatic disease injection 4mg in 1ml 10.1.2 Corticosteroids Unspecified All prescribers diseases and gout Dexamethasone 10. Musculoskeletal and joint 10.1.3 Drugs that suppress tablets 125mg, 250mg 10.1 Drugs used in rheumatic disease Specialist diseases the rheumatic disease Unspecified and gout Penicillamine INITIATION process 10. Musculoskeletal and joint 10.1.3 Drugs that suppress tablets 2.5mg, 10mg Ensure NPSA guidance is followed. GPs should only prescribe if they have 10.1 Drugs used in rheumatic disease Specialist diseases the rheumatic disease Unspecified agreed shared care arrangements. GPs should not be asked to prescribe and gout Methotrexate INITIATION process methotrexate for treatment of cancers 10. Musculoskeletal and joint 10.1.3 Drugs that suppress tablets 200mg 10.1 Drugs used in rheumatic disease Hydroxychloroquine Specialist diseases the rheumatic disease Unspecified and gout INITIATION process sulphate 10. Musculoskeletal and joint 10.1 Drugs used in rheumatic disease 10.1.4 Gout and cytotoxic- tablets 100mg Unspecified All prescribers diseases and gout induced hyperuricaemia Sulphinpyrazone 10. Musculoskeletal and joint tablets 80mg, 120mg For use in line with NICE'S guidance TA164. Only for patients who are 10.1 Drugs used in rheumatic disease 10.1.4 Gout and cytotoxic- diseases Unspecified All prescribers intolerant of allopurinol or for whom allopurinol is contra-indicated. and gout induced hyperuricaemia Febuxostat 10. Musculoskeletal and joint 10.1 Drugs used in rheumatic disease 10.1.4 Gout and cytotoxic- tablets 500micrograms Unspecified All prescribers diseases and gout induced hyperuricaemia Colchicine

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Drug name Initiate by (shading indicates that the drug DRAFT Order of BNF chapter BNF section BNF sub-section Formulations specialist Comments appears in more than one preference only? section) 10. Musculoskeletal and joint 10.1 Drugs used in rheumatic disease 10.1.4 Gout and cytotoxic- tablets 100mg, 300mg Unspecified All prescribers diseases and gout induced hyperuricaemia Allopurinol 10. Musculoskeletal and joint tablets 60mg 10.2 Drugs used in neuromuscular 10.2.1 Drugs that enhance Pyridostigmine Specialist diseases Unspecified disorders neuromuscular transmission bromide INITIATION 10. Musculoskeletal and joint tablets 15mg 10.2 Drugs used in neuromuscular 10.2.1 Drugs that enhance Neostigmine Specialist diseases Unspecified disorders neuromuscular transmission bromide INITIATION 10. Musculoskeletal and joint 10.2 Drugs used in neuromuscular 10.2.2 Skeletal muscle capsules 25mg, 100mg Specialist Unspecified diseases disorders relaxants Dantrolene INITIATION 10. Musculoskeletal and joint 10.2 Drugs used in neuromuscular 10.2.2 Skeletal muscle tablets 10mg; Unspecified All prescribers diseases disorders relaxants Baclofen oral solution 5mg in 5ml 10. Musculoskeletal and joint 10.2 Drugs used in neuromuscular 10.2.2 Skeletal muscle tablets 2mg,4mg Unspecified All prescribers diseases disorders relaxants Tizanidine 10. Musculoskeletal and joint gel 0.5% 10.3 Drugs for the relief of soft-tissue diseases 10.3.2 Unspecified All prescribers inflammation and topical pain relief Piroxicam 10. Musculoskeletal and joint gel 5% 10.3 Drugs for the relief of soft-tissue diseases 10.3.2 Unspecified All prescribers inflammation and topical pain relief Ibuprofen 10. Musculoskeletal and joint cream diseases 10.3 Drugs for the relief of soft-tissue Diethylamine 10.3.2 Unspecified All prescribers inflammation and topical pain relief salicylate (Algesal ®)

10. Musculoskeletal and joint cream 0.025%, 0.075% Note relatively high cost. 10.3 Drugs for the relief of soft-tissue diseases 10.3.2 Unspecified All prescribers inflammation and topical pain relief Capsaicin 11. Eye eye drops 0.5%; In primary care, reserve single use drops (Minims®) for when a eye ointment 1%; preservative free preparation is required. 11.3 Anti-infective eye preparations 11.3.1 Antibacterials Chloramphenicol Single Use Drops Minims® First line All prescribers 0.5% 20x0.5ml - see comments 11. Eye 11.3 Anti-infective eye preparations 11.3.1 Antibacterials Fusidic acid MR gel 1% Second line All prescribers 11. Eye eye drops 0.3% Specialist 11.3 Anti-infective eye preparations 11.3.1 Antibacterials Second line Ofloxacin INITIATION 11. Eye Preservative free drops Reserved as third line for occasions when a preservative free quinolone Single use units 0.5% 30x Specialist preparation is required. 11.3 Anti-infective eye preparations 11.3.1 Antibacterials Third line Levofloxacin 0.5ml only on formulary- INITIATION see comments 11. Eye drops 0.3% Specialist 11.3 Anti-infective eye preparations 11.3.1 Antibacterials Unspecified Gentamicin INITIATION 11. Eye eye ointment 3% Specialist 11.3 Anti-infective eye preparations 11.3.3 Antivirals Unspecified Aciclovir INITIATION 11. Eye drops (for ear, eye or nose) Choice dependant on severity of condition and steroid potency required. 0.1%; Licensed preservative free product not available 11.4 Corticosteroids & other anti- Specialist 11.4.1 Corticosteroids eye ointment 0.1%; Unspecified inflammatory preparations Betamethasone INITIATION

11. Eye eye drops 0.1%; Choice dependant on severity of condition and steroid potency required. 11.4 Corticosteroids & other anti- Specialist In primary care, reserve single use drops (Minims®) for when a 11.4.1 Corticosteroids Dexamethasone Single Use Drops Minims® Unspecified inflammatory preparations 0.1% 20x0.5ml INITIATION preservative free preparation is required.

11. Eye eye drops 0.1% Choice dependant on severity of condition and steroid potency required. Evidence suggests fluorometholone less likely to raise intra-ocular 11.4 Corticosteroids & other anti- Specialist 11.4.1 Corticosteroids Unspecified pressure (IOP). inflammatory preparations Fluorometholone INITIATION Licensed preservative free product not available

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Drug name Initiate by (shading indicates that the drug DRAFT Order of BNF chapter BNF section BNF sub-section Formulations specialist Comments appears in more than one preference only? section) 11. Eye Choice dependant on severity of condition and steroid potency required. 11.4 Corticosteroids & other anti- Hydrocortisone Specialist 11.4.1 Corticosteroids eye ointment 0.5%, 1% Unspecified Licensed preservative free product not available inflammatory preparations acetate INITIATION 11. Eye eye drops 0.5% Usually reserved for post-cataract surgery. Choice dependant on severity 11.4 Corticosteroids & other anti- Specialist 11.4.1 Corticosteroids Unspecified of condition and steroid potency required. inflammatory preparations Loteprednol INITIATION Licensed preservative free product not available 11. Eye drops (for ear or eye) Choice dependant on severity of condition and steroid potency required. prednisolone sodium In primary care, reserve single use drops (Minims®) for when a 11.4 Corticosteroids & other anti- Specialist preservative free preparation is required. 11.4.1 Corticosteroids Prednisolone phosphate 0.5%; Unspecified inflammatory preparations Single Use Drops Minims® INITIATION Prednisolone 1% drops are non-formulary 0.5% 20x0.5ml 11. Eye Dexamethasone with drops dexamethasone Not for routine use 0.1%, neomycin 0.35%, 11.4 Corticosteroids & other anti- 11.4.1 Corticosteroids - neomycin and Specialist polymyxin B sulphate 6000 Unspecified inflammatory preparations with antibacterial polymyxin B units/ml (Maxitrol®) INITIATION sulphate 11. Eye drops dexamethasone Not for routine use 11.4 Corticosteroids & other anti- 11.4.1 Corticosteroids - Dexamethasone with Specialist 0.1%, tobramycin 0.3% Unspecified inflammatory preparations with antibacterial tobramycin INITIATION 11. Eye eye drops 2% 13.5ml, 2% 13.5ml bottles cost less than 10ml bottles in primary care. 11.4 Corticosteroids & other anti- 11.4.2 Other anti- Sodium preservative free single use First line All prescribers inflammatory preparations inflammatory preparations cromoglicate drops 11. Eye eye drops 2% Use where twice daily administration overcomes compliance issues or 11.4 Corticosteroids & other anti- 11.4.2 Other anti- First line All prescribers problems related to preservative load in susceptible patients cf four times inflammatory preparations inflammatory preparations Nedocromil sodium daily dosing of sodium cromoglicate. 11. Eye eye drops, antazoline 11.4 Corticosteroids & other anti- 11.4.2 Other anti- sulphate 0.5%, First line All prescribers inflammatory preparations inflammatory preparations Otrivine-Antistin ® xylometazoline hydrochloride 0.05% 11. Eye eye drops 1mg in 1ml 11.4 Corticosteroids & other anti- 11.4.2 Other anti- Second line All prescribers inflammatory preparations inflammatory preparations Olopatadine 11. Eye eye drops 0.1% 11.4 Corticosteroids & other anti- 11.4.2 Other anti- Third line All prescribers inflammatory preparations inflammatory preparations Lodoxamide

11. Eye 11.5 Mydriatics and Single use drops (Minims®) Specialist 11.5 Mydriatics and cycloplegia Unspecified cyclopegics Atropine sulphate 1% INITIATION 11. Eye eye drops 0.5%, 1% 11.5 Mydriatics and Specialist 11.5 Mydriatics and cycloplegia Single use drops (Minims®) Unspecified cyclopegics Cyclopentolate INITIATION 0.5%, 1%. 11. Eye 11.5 Mydriatics and eye drops 1% Specialist 11.5 Mydriatics and cycloplegia Unspecified cyclopegics Homatropine INITIATION 11. Eye 11.5 Mydriatics and Single use drops (Minims®) Specialist 11.5 Mydriatics and cycloplegia Unspecified cyclopegics Phenylephrine 2.5%, 10% INITIATION 11. Eye Single use drops (Minims®) 11.5 Mydriatics and Specialist 11.5 Mydriatics and cycloplegia eye drops, 0.5%, 1%. Unspecified cyclopegics Tropicamide INITIATION 11. Eye eye drops 0.25%, 0.5%; Reserve eye gel preparation (once daily preparation) where compliance unit dose eye drops 0.25%, issues . 0.5% - preservative free; 11.6 Treatment of glaucoma- Specialist 11.6 Treatment of glaucoma eye gel 0.25%, 0.5%; unit First line beta blockers Timolol INITIATION dose eye gel 0.1% - preservative f ree

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Drug name Initiate by (shading indicates that the drug DRAFT Order of BNF chapter BNF section BNF sub-section Formulations specialist Comments appears in more than one preference only? section) 11. Eye 11.6 Treatment of glaucoma- eye drops 0.5% Specialist 11.6 Treatment of glaucoma Second line beta blockers Betaxolol INITIATION 11. Eye 11.6 Treatment of glaucoma- eye drops 0.5% Specialist 11.6 Treatment of glaucoma Second line beta blockers Levobunolol INITIATION 11. Eye eye drops 11.6 Treatment of glaucoma- 50micrograms/1ml, Specialist 11.6 Treatment of glaucoma prostaglandin analogues 50micrograms/1ml, First line Latanoprost INITIATION and prostamides preservative free single use drops 11. Eye eye drops 100micrograms/ml, 11.6 Treatment of glaucoma- 300micrograms/ml, Specialist 11.6 Treatment of glaucoma prostaglandin analogues Second line Bimatoprost 300micrograms/ml INITIATION and prostamides preservative free single use drops 11. Eye eye drops 40micrograms/ml 11.6 Treatment of glaucoma- Specialist 11.6 Treatment of glaucoma prostaglandin analogues Third line Travoprost INITIATION and prostamides 11. Eye Unit dose eye drops 15 11.6 Treatment of glaucoma- Specialist 11.6 Treatment of glaucoma prostaglandin analogues micrograms/ml Third line Tafluprost INITIATION and prostamides 11. Eye eye drops, latanoprost 50 Combination eye drops to be used where compliance issues can be 11.6 Treatment of glaucoma- Latanoprost and micrograms, timolol Specialist resolved with combinations drops 11.6 Treatment of glaucoma Unspecified combination preparation timolol 5mg/ml. INITIATION

11. Eye eye drops, bimatoprost Combination eye drops to be used where compliance issues can be 300micrograms/ml, timolol resolved with combinations drops 11.6 Treatment of glaucoma- Specialist 11.6 Treatment of glaucoma 5mg/ml Unspecified combination preparation Ganfort ® INITIATION preservative free single use drops 11. Eye eye drops, travoprost Combination eye drops to be used where compliance issues can be 11.6 Treatment of glaucoma- 40micrograms, timolol Specialist resolved with combinations drops 11.6 Treatment of glaucoma Unspecified combination preparation DuoTrav® 5mg/ml INITIATION

11. Eye eye drops 0.2% 11.6 Treatment of glaucoma- Specialist 11.6 Treatment of glaucoma Unspecified sympathomimetics Brimonidine INITIATION 11. Eye eye drops, brimonidine Combination eye drops to be used where compliance issues can be 11.6 Treatment of glaucoma- tartrate 0.2%, timolol 0.5% Specialist resolved with combinations drops 11.6 Treatment of glaucoma Unspecified combination preparation Combigan ® INITIATION

11. Eye 11.6 Treatment of glaucoma- eye drops 2% Specialist 11.6 Treatment of glaucoma carbonic anhydrase First line Dorzolamide INITIATION inhibitors 11. Eye 11.6 Treatment of glaucoma- eye drops 10mg/ml Specialist 11.6 Treatment of glaucoma carbonic anhydrase Second line Brinzolamide INITIATION inhibitors 11. Eye eye drops, dorzolamide 2%, Combination eye drops to be used where compliance issues can be 11.6 Treatment of glaucoma- timolol 0.5% Specialist resolved with combinations drops 11.6 Treatment of glaucoma Unspecified combination preparation Cosopt ® INITIATION

39 of 50 North West London Integrated Formulary 22/09/2014

Drug name Initiate by (shading indicates that the drug DRAFT Order of BNF chapter BNF section BNF sub-section Formulations specialist Comments appears in more than one preference only? section) 11. Eye eye drops, brinzolamide Combination eye drops to be used where compliance issues can be 11.6 Treatment of glaucoma- 10mg/ml, timolol 5mg/ml Specialist resolved with combinations drops 11.6 Treatment of glaucoma Unspecified combination preparation Azarga ® INITIATION

11. Eye tablets 250mg; MR 11.6 Treatment of glaucoma- Specialist 11.6 Treatment of glaucoma systemic carbonic capsules 250mg Unspecified Acetazolamide INITIATION anhydrase inhibitor 11. Eye eye drops 1%, 2%, 4% Note that gel is non-formulary 11.6 Treatment of glaucoma- Unit dose Minims ® eye Specialist 11.6 Treatment of glaucoma Unspecified miotics Pilocarpine drops pilocarpine nitrate 2% INITIATION

11. Eye eye drops 0.3%; Preservative free drops cost more than preservative-containing drops. eye drops 0.5% (Isopto Reserve the former for when it is important to avoid preservative or reduce Plain ®); preservative load. eye drops 1% (Isopto 11.8 Miscellaneous ophthalmic 11.8.1 First line All prescribers preparations Hypromellose Alkaline ®); Preservative free unit dose eye drops 0.3% (e.g. Lumecare, Hydromoor)

11. Eye 11.8 Miscellaneous ophthalmic eye drops 5% with 11.8.1 Second line All prescribers preparations Acetylcysteine hypromellose 0.35% 11. Eye eye drops 1.4% 11.8 Miscellaneous ophthalmic 11.8.1 Liqufilm Tears® 15ml Second line All prescribers preparations Polyvinyl alcohol Sno Tears® 10ml 11. Eye Simple Eye Ointment, liquid 11.8 Miscellaneous ophthalmic paraffin 10%, wool fat 10%, 11.8.1 Second line All prescribers preparations Yellow Soft Paraffin in yellow soft paraffin.

11. Eye Eye ointment, with white Xailin® is the cheaper option and has been formulated to be technically, 11.8 Miscellaneous ophthalmic 11.8.1 soft paraffin (Lacri-Lube ® Second line All prescribers clinically and biologically equivalent to Allergan's Lacri-Lube® Eye preparations Liquid paraffin and Xailin®) Ointment 11. Eye Eye drops 0.5% (Optive®); Unit dose preparation is a licensed preservative free preparation. Reserve 11.8 Miscellaneous ophthalmic 11.8.1 Single use unit dose drops Third line All prescribers for when it is important to avoid preservative or reduce preservative load. preparations Carmellose 0.5% , 1% 11. Eye Single Use Drops Minims® Licensed preservative free preparation. Reserve for when it is important to 11.8 Miscellaneous ophthalmic 11.8.1 Hydroxymethylcellulose Artificial Tears 20x0.5ml Third line All prescribers avoid preservative or reduce preservative load. preparations 11. Eye Single use Minims ® eye 11.8 Miscellaneous ophthalmic 11.8.1 drops 0.9% Third line All prescribers preparations Sodium chloride 11. Eye eye drops 0.2% Viscotears® brand preserved with cetrimide not benzalkonium chloride so 11.8 Miscellaneous ophthalmic 11.8.2 Second line All prescribers may be considered where benzalkonium intolerance or toxicity is preparations Carbomer 980 (GelTears®, Viscotears®) suspected 11. Eye eye drops 0.1% (Hylo-Tear These are licensed preservative free preparations. Reserve for when it is 11.8 Miscellaneous ophthalmic 11.8.2 ®), 0.2% (Hylo-Forte ®) Third line All prescribers important to avoid preservative or reduce preservative load. preparations Sodium hyaluronate 11. Eye Single use Minims ® eye 11.8 Miscellaneous ophthalmic 11.8.2 Ocular diagnostic Unspecified All prescribers preparations preparations Fluorescein sodium drops 1%, 2% 11. Eye eye drops 0.5% 11.8.2 Ocular peri-operative 11.8 Miscellaneous ophthalmic Specialist preparations and Unspecified preparations Ketorolac INITIATION photodynamic treatment

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Drug name Initiate by (shading indicates that the drug DRAFT Order of BNF chapter BNF section BNF sub-section Formulations specialist Comments appears in more than one preference only? section) 11. Eye eye drops 5%; Used for corneal oedema. Unlicensed "special" 11.8 Miscellaneous ophthalmic 11.8.2 Ocular diagnostic Sodium chloride- Specialist eye ointment 5% Unspecified preparations preparations hypertonic INITIATION 12. Ear, nose, and oropharynx drops (for ear or eye), dexamethasone 0.05%, 12.1 Drugs acting on the ear 12.1.1 Otitis externa Unspecified All prescribers Sofradex ® framycetin sulphate 0.5%, gramicidin 0.005%. 12. Ear, nose, and oropharynx ear drops, hydrocortisone 1%, neomycin sulphate 3400 units, 12.1 Drugs acting on the ear 12.1.1 Otitis externa Unspecified All prescribers Otosporin ® polymyxin B sulphate 10,000 units/ml. 12. Ear, nose, and oropharynx ear spray, dexamethasone 0.1%, neomycin sulphate 3250 12.1 Drugs acting on the ear 12.1.1 Otitis externa Unspecified All prescribers Otomize ® units/ml, glacial actetic acid 2%. 12. Ear, nose, and oropharynx ear drops flumetasone pivalate 12.1 Drugs acting on the ear 12.1.1 Otitis externa Locorten-Vioform ® 0.02%, clioquinol 1% Unspecified All prescribers

12. Ear, nose, and oropharynx ear drops, hydrocortisone Prefer anti-infectives that are not used systemically - see BNF 12.1 Drugs acting on the ear 12.1.1 Otitis externa Gentisone HC ® acetate 1%, gentamicin 0.3% Unspecified All prescribers (as sulphate) 12. Ear, nose, and oropharynx 12.1 Drugs acting on the ear 12.1.1 Otitis externa Clotrimazole solution 1% Unspecified All prescribers 12. Ear, nose, and oropharynx drops (for ear, eye or nose), betamethasone sodium 12.1 Drugs acting on the ear 12.1.1 Otitis externa Unspecified All prescribers Betnesol-N ® phosphate 0.1%, neomycin sulphate 0.5% 12. Ear, nose, and oropharynx Betamethasone drops (for ear, eye or nose) 12.1 Drugs acting on the ear 12.1.1 Otitis externa 0.1%. Unspecified All prescribers sodium phosphate 12. Ear, nose, and oropharynx ear drops 5% 12.1 Drugs acting on the ear 12.1.3 Removal of ear wax Sodium bicarbonate Unspecified All prescribers

12. Ear, nose, and oropharynx ear drops 12.1 Drugs acting on the ear 12.1.3 Removal of ear wax Olive oil Unspecified All prescribers 12. Ear, nose, and oropharynx aqueous nasal spray 12.2.1 Drugs used in nasal Beclometasone 12.2 Drugs acting on the nose 50micrograms per metered First line All prescribers allergy dipropionate spray, nose drops 12. Ear, nose, and oropharynx nasal spray 100micrograms per metered spray; aqueous 12.2.1 Drugs used in nasal nasal spray 12.2 Drugs acting on the nose Second line All prescribers allergy Budesonide 64micrograms/metered spray

12. Ear, nose, and oropharynx aqueous nasal spray 4% 12.2.1 Drugs used in nasal Sodium 12.2 Drugs acting on the nose Unspecified All prescribers allergy cromoglicate 12. Ear, nose, and oropharynx nasal spray 27.5 micrograms Costs less than fluticasone propionate nasal spray. 12.2.1 Drugs used in nasal 12.2 Drugs acting on the nose per metered spray Unspecified All prescribers allergy Fluticasone furoate 12. Ear, nose, and oropharynx nasal spray 50 microgram - 12.2.1 Drugs used in nasal Fluticasone 12.2 Drugs acting on the nose metered spray Unspecified All prescribers allergy propionate 12. Ear, nose, and oropharynx nasal spray 12.2.1 Drugs used in nasal 12.2 Drugs acting on the nose 140micrograms/metered spray Unspecified All prescribers allergy Azelastine 12. Ear, nose, and oropharynx nasal spray 50 micrograms - 12.2.1 Drugs used in nasal 12.2 Drugs acting on the nose metered spray Unspecified All prescribers allergy Mometasone furoate

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Drug name Initiate by (shading indicates that the drug DRAFT Order of BNF chapter BNF section BNF sub-section Formulations specialist Comments appears in more than one preference only? section) 12. Ear, nose, and oropharynx 12.2.2 Topical nasal nasal drops, 0.9%. 12.2 Drugs acting on the nose Unspecified All prescribers decongestants Sodium chloride 12. Ear, nose, and oropharynx nasal spray 0.03% 12.2.2 Topical nasal 12.2 Drugs acting on the nose (21micrograms per metered Unspecified All prescribers decongestants Ipratropium bromide spray) 12. Ear, nose, and oropharynx nasal drops 0.5% 12.2.2 Topical nasal Ephedrine 12.2 Drugs acting on the nose Unspecified All prescribers decongestants hydrochloride 12. Ear, nose, and oropharynx nasal cream, chlorhexidine Use in line with Infection Control policies 12.2 Drugs acting on the nose 12.2.3 Nasal preparations for infection Naseptin ® hydrochloride 0.1%, neomycin Unspecified All prescribers sulphate 0.5% 12. Ear, nose, and oropharynx 12.2 Drugs acting on the nose 12.2.3 Nasal preparations for infection Mupirocin nasal ointment 2%. Unspecified All prescribers Use in line with Infection Control policies 12. Ear, nose, and oropharynx oral paste 12.3.1 Drugs for oral 12.3 Drugs acting on the oropharnyx Unspecified All prescribers ulceration and inflammation Orabase ® 12. Ear, nose, and oropharynx oromucosal tablets 2.5mg 12.3.1 Drugs for oral 12.3 Drugs acting on the oropharnyx Unspecified All prescribers ulceration and inflammation Hydrocortisone 12. Ear, nose, and oropharynx oral rinse 0.15%; spray 0.15% 12.3.1 Drugs for oral Benzydamine 12.3 Drugs acting on the oropharnyx Unspecified All prescribers ulceration and inflammation hydrochloride 12. Ear, nose, and oropharynx 12.3.2 Oropharyngeal anti- oral suspension 100,000units 12.3 Drugs acting on the oropharnyx Unspecified All prescribers infective drugs Nystatin in 1ml 12. Ear, nose, and oropharynx 12.3.2 Oropharyngeal anti- oral gel 24mg in 1ml 12.3 Drugs acting on the oropharnyx Unspecified All prescribers infective drugs Miconazole 12. Ear, nose, and oropharynx 12.3.4 Mouthwashes, solution tablets 12.3 Drugs acting on the oropharnyx Unspecified All prescribers gargles, and dentifrices Mouthwash 12. Ear, nose, and oropharynx solution 6% (20 volume) 12.3.4 Mouthwashes, 12.3 Drugs acting on the oropharnyx Unspecified All prescribers gargles, and dentifrices Hydrogen peroxide 12. Ear, nose, and oropharynx mouthwash 0.2%; dental gel 12.3.4 Mouthwashes, Chlorhexidine 12.3 Drugs acting on the oropharnyx 1% Unspecified All prescribers gargles, and dentifrices gluconate 12. Ear, nose, and oropharynx 12.3.5 Treatment of dry pastilles ACBS 12.3 Drugs acting on the oropharnyx Unspecified All prescribers mouth Salivix ® 12. Ear, nose, and oropharynx 12.3.5 Treatment of dry tablets 5mg 12.3 Drugs acting on the oropharnyx Unspecified All prescribers mouth Pilocarpine 12. Ear, nose, and oropharynx aerosol spray ACBS 12.3.5 Treatment of dry Artficial Saliva - 12.3 Drugs acting on the oropharnyx Unspecified All prescribers mouth Glandosane ® 12. Ear, nose, and oropharynx Artficial Saliva - saliva replacement gel 12.3.5 Treatment of dry 12.3 Drugs acting on the oropharnyx Unspecified All prescribers mouth Biotene Oralbalance ® 13. Skin cream For use as a soap substitute only. 13.2 Emollients & barrier preparations 13.2.1 Emollients Aqueous Cream BP Unspecified All prescribers 13. Skin Emulsifying ointment First line as a For use as a soap substitute only. 13.2 Emollients & barrier preparations 13.2.1 Emollients soap substitute All prescribers Ointment BP only 13. Skin Cetomacrogol cream 13.2 Emollients & barrier preparations 13.2.1 Emollients First line All prescribers Formula A 13. Skin cream 13.2 Emollients & barrier preparations 13.2.1 Emollients Zerocream® Second line All prescribers 13. Skin cream Third line as an emollient and soap substitute 13.2 Emollients & barrier preparations 13.2.1 Emollients ZeroAQS® Third line All prescribers

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Drug name Initiate by (shading indicates that the drug DRAFT Order of BNF chapter BNF section BNF sub-section Formulations specialist Comments appears in more than one preference only? section) 13. Skin cream; A third line emollient 13.2 Emollients & barrier preparations 13.2.1 Emollients Third line All prescribers Diprobase® ointment 13. Skin cream A third line emollient 13.2 Emollients & barrier preparations 13.2.1 Emollients Cetraben® Third line All prescribers 13. Skin cream 100g Specialist A third line emollient 13.2 Emollients & barrier preparations 13.2.1 Emollients Third line Unguentum M® INITIATION 13. Skin gel A third line emollient 13.2 Emollients & barrier preparations 13.2.1 Emollients Doublebase® Third line All prescribers 13. Skin Hydrous Ointment ointment 13.2 Emollients & barrier preparations 13.2.1 Emollients First line All prescribers BP 13. Skin ointment; bath and shower 13.2 Emollients & barrier preparations 13.2.1 Emollients Second line All prescribers Hydromol® emollient 13. Skin bath emollient 13.2 Emollients & barrier preparations 13.2.1 Emollients Dermalo® First line All prescribers 13. Skin bath emollient 13.2 Emollients & barrier preparations 13.2.1 Emollients Zerolatum® Second line All prescribers 13. Skin bath emollient 13.2 Emollients & barrier preparations 13.2.1 Emollients Oilatum® Third line All prescribers bath oil Second or third 13.2 Emollients & barrier preparations 13.2.1 Emollients All prescribers Balneum Plus® line 13. Skin cream urea 10% 13.2 Emollients & barrier preparations 13.2.1 Emollients Hydromol® Intensive First line All prescribers

13. Skin cream urea 10% 13.2 Emollients & barrier preparations 13.2.1 Emollients Aquadrate® First line All prescribers 13. Skin cream urea 10% 100g 13.2 Emollients & barrier preparations 13.2.1 Emollients Calmurid® Second line All prescribers cream urea 5%, Second or third 13.2 Emollients & barrier preparations 13.2.1 Emollients All prescribers Balneum Plus® lauromacrogols 3% line 13. Skin Dermatonics® Heel cream urea 25% 13.2 Emollients & barrier preparations 13.2.1 Emollients Unspecified All prescribers Balm 13. Skin cream, lotion benzalkonium 13.2 Emollients & barrier preparations 13.2.1 Emollients Unspecified All prescribers Dermol® chloride 0.1% 13. Skin ointment 13.2 Emollients & barrier preparations 13.2.2 Barrier preparations Metanium ® Unspecified All prescribers 13. Skin cream 13.2 Emollients & barrier preparations 13.2.2 Barrier preparations Conotrane ® Unspecified All prescribers 13. Skin 13.3 Topical local anaesthetics and cream 10% 13.3 Unspecified All prescribers antipruritics Crotamiton 13. Skin 13.3 Topical local anaesthetics and cream 5% 13.3 Unspecified All prescribers antipruritics Doxepin 13. Skin 13.3 Topical local anaesthetics and cream 2% 13.3 Unspecified All prescribers antipruritics Levomenthol 13. Skin cream 1%, 1st line mild corticosteroid 13.4 Topical corticosteroids 13.4 First line All prescribers Hydrocortisone ointment 1% 13. Skin Clobetasone cream 0.05%; 1st line moderate potency corticosteroid 13.4 Topical corticosteroids 13.4 ointment 0.05% (Eumovate ®) First line All prescribers butyrate 13. Skin cream 0.1%; ointment 0.1%; 1st line potent corticosteroid 13.4 Topical corticosteroids 13.4 Mometasone furoate First line All prescribers 13. Skin Hydrocortisone cream 0.1% Potent 13.4 Topical corticosteroids 13.4 ointment 0.1% Unspecified All prescribers butyrate scalp lotion 0.1% 13. Skin Fluticasone cream 0.05% Potent 13.4 Topical corticosteroids 13.4 ointment 0.005% Unspecified All prescribers propionate

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Drug name Initiate by (shading indicates that the drug DRAFT Order of BNF chapter BNF section BNF sub-section Formulations specialist Comments appears in more than one preference only? section) 13. Skin cream 0.1%; ointment 0.1%; Potent lotion 0.1%; scalp application 0.1% Betamethasone scalp application 0.1% (Betacap ®) is a 1st line potent (Betacap ®); foam scalp corticosteroid scalp application. Betamethasone (as application 0.1% 13.4 Topical corticosteroids 13.4 (Bettamousse ®); Unspecified All prescribers Betamethasone medicated plasters should only be used in place of cream valerate) cream 0.025%; ointment or ointment when they are required because of the site of application or 0.025%; when there is another clear clinical benefit. medicated plasters 2.25mg

13. Skin cream 0.025%; ointment Synalar 1 in 10 Dilution - mild 0.025%; Synalar 1 in 4 Dilution - moderate gel 0.025% (Synalar ®) Synalar - potent Fluocinolone cream 0.00625% (Synalar 1 in 13.4 Topical corticosteroids 13.4 4 Dilution®); Unspecified All prescribers acetonide ointment 0.00625% (Synalar 1 in 4 Dilution®); cream 0.0025% (Synalar 1 in 10 Dilution®) 13. Skin cream 0.05%; Very potent Clobetasol ointment 0.05%; 13.4 Topical corticosteroids 13.4 Unspecified All prescribers propionate scalp application 0.05% (Dermovate ®) 13. Skin Diflucortolone oily cream 0.3%; ointment Very potent 13.4 Topical corticosteroids 13.4 0.3% (Nerisone Forte ®) Unspecified All prescribers valerate 13. Skin ointment, betamethasone Potent; with salicylic acid 0.05%, salicylic acid 3%; 13.4 Topical corticosteroids 13.4 Diprosalic ® scalp application, Unspecified All prescribers betamethasone 0.05%, salicylic acid 2% 13. Skin cream, hydrocortisone 1%, Moderate potency; with urea 13.4 Topical corticosteroids 13.4 Unspecified All prescriber Alphaderm® urea 10% 13. Skin cream Mild potency; with antifungal Clotrimazole 1%, hydrocortisone 1%, clotrimazole 1% 13.4 Topical corticosteroids 13.4 hydrocortisone 1% Unspecified All prescribers (Canestan HC ®) 13. Skin Hydrocortisone 1%, cream & ointment Mild potency; with antifungal hydrocortisone 1%, 13.4 Topical corticosteroids 13.4 miconazole 2% miconazole nitrate 2% Unspecified All prescribers (Daktacort ®) 13. Skin Fusidic acid 2%, cream, hydrocortisone acetate Mild potency; with antibiotic 1%, fusidic acid 2% 13.4 Topical corticosteroids 13.4 hydrocortisone 1% Unspecified All prescribers (Fucidin H ®) 13. Skin cream, hydrocortisone 0.5%, Mild potency; with antimicrobials nystatin 100000 units/g, 13.4 Topical corticosteroids 13.4 Timodine® benzalkonium chloride solution Unspecified All prescribers 0.2%, dimeticone ‘350’ 10%

13. Skin cream, clobetasone butyrate Moderate potency; with antimicrobials 0.05%, oxytetracycline 3%, 13.4 Topical corticosteroids 13.4 Unspecified All prescribers Trimovate® nystatin 100 000 units/g

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Drug name Initiate by (shading indicates that the drug DRAFT Order of BNF chapter BNF section BNF sub-section Formulations specialist Comments appears in more than one preference only? section) 13. Skin cream, betamethasone 0.1%, Potent corticosteroid; with antibiotic fusidic acid 2%; 13.4 Topical corticosteroids 13.4 Fucibet ® Lipid cream betamethasone Unspecified All prescribers 0.1%, fusidic acid 2%

13. Skin cream, betamethasone Potent corticosteroid; with antifungal Specialist 13.4 Topical corticosteroids 13.4 dipropionate 0.064%, Unspecified Lotriderm ® INITIATION clotrimazole 1%. 13. Skin cream & ointment Potent corticosteroid; with antibiotic betamethasone betamethasone 0.1%, Specialist 13.4 Topical corticosteroids 13.4 neomycin sulphate 0.5% Unspecified 0.1%, neomycin INITIATION sulphate 0.5% 13. Skin cream & ointment Potent corticosteroid; with antimicrobial betamethasone betamethasone 0.1%, 13.4 Topical corticosteroids 13.4 Unspecified All prescribers 0.1%, clioquinol 3% clioquinol 3%

13. Skin fludroxycortide Only for use when tape (rather than cream or ointment) is required 13.4 Topical corticosteroids 13.4 Haelan® Tape Unspecified All prescribers because of the site of application or because there is another clear clinical benefit. 13. Skin ointment & gel, Not for continued use. Course of 4 weeks only. Subsequent repeat 13.5 Preparations for eczema and 13.5.2 Preparations for betamethasone 0.05%, courses should only be initiated by a specialist after an interval of 4 weeks. First line All prescribers psoriasis psoriasis Dovobet ® calcipotriol 50micrograms/g

13. Skin 13.5 Preparations for eczema and 13.5.2 Preparations for ointment 4 micrograms/g Second line All prescribers psoriasis psoriasis Tacalcitol 13. Skin scalp ointment, coal tar Coal tar, salicylic solution 12%, salicylic acid 13.5 Preparations for eczema and 13.5.2 Preparations for 2%, precipitated sulphur 4% in Unspecified All prescribers psoriasis psoriasis acid and sulphur a coconut oil emollient basis (Sebco ®) (Sebco®). 13. Skin Scalp lotion (Shampoo) Coal 13.5 Preparations for eczema and 13.5.2 Preparations for tar 2.5%, Lecithin 0.3% Unspecified All prescribers psoriasis psoriasis Psoriderm 13. Skin Calcitriol (1,25- ointment 3micrograms/g 13.5 Preparations for eczema and 13.5.2 Preparations for Unspecified All prescribers psoriasis psoriasis dihydroxycolecalcife rol) 13. Skin ointment 50 micrograms/g; 13.5 Preparations for eczema and 13.5.2 Preparations for scalp solution Unspecified All prescribers psoriasis psoriasis Calcipotriol 50micrograms/ml 13. Skin bath additive 13.5 Preparations for eczema and 13.5.2 Preparations for Unspecified All prescribers psoriasis psoriasis Polytar Emollient ® 13. Skin cream 0.1%, 0.25%, 0.5%, 13.5 Preparations for eczema and 13.5.2 Preparations for Specialist 1%, 2% (Dithrocream ®); Unspecified psoriasis psoriasis Dithranol INITIATION cream 1%, 3% (Micanol ®) 13. Skin 13.5 Preparations for eczema and 13.5.2 Preparations for gel 0.05% Third line All prescribers psoriasis psoriasis Tazarotene 13. Skin ointment 0.03%, 0.1% 13.5 Preparations for eczema and 13.5.3 Drugs affecting the Specialist Unspecified psoriasis immune response Tacrolimus INITIATION 13. Skin 13.5 Preparations for eczema and 13.5.3 Drugs affecting the cream 1% Specialist Unspecified psoriasis immune response Pimecrolimus INITIATION

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Drug name Initiate by (shading indicates that the drug DRAFT Order of BNF chapter BNF section BNF sub-section Formulations specialist Comments appears in more than one preference only? section) 13. Skin aqueous gel 2.5%, 5%, 10% For mild acne (PanOxyl ® Aquagel); 13.6.1 Topical preparations 13.6 Acne and rosacea gel in aqueous alcoholic base Unspecified All prescribers for acne Benzoyl peroxide 5%, 10% (Panoxyl ®); cream 4% (Brevoxyl ®) 13. Skin 13.6.1 Topical preparations cream 20% For mild acne 13.6 Acne and rosacea Unspecified All prescribers for acne Azelaic acid 13. Skin 13.6.1 Topical preparations cream 0.1%; For mild to moderate acne 13.6 Acne and rosacea Unspecified All prescribers for acne Adapalene gel 0.1% 13. Skin 13.6.1 Topical preparations gel adapalene 0.1%, benzoyl For mild to moderate acne 13.6 Acne and rosacea Unspecified All prescribers for acne Epiduo® peroxide 2.5% 13. Skin 13.6.1 Topical preparations gel 0.05% 13.6 Acne and rosacea Unspecified All prescribers for acne Isotretinoin 13. Skin cream benzoyl peroxide 5%, With antimicrobial; for mild to moderate acne 13.6.1 Topical preparations potassium hydroxyquinoline 13.6 Acne and rosacea Unspecified All prescribers for acne Quinoderm® sulphate 0.5%

13. Skin 13.6.1 Topical preparations gel benzoyl peroxide 5%, When possible use non-antibiotic antimicrobials rather than antibiotics. For 13.6 Acne and rosacea Unspecified All prescribers for acne Duac® Once Daily clindamycin 1% mild to moderate acne. 13. Skin 13.6.1 Topical preparations topical solution 1%; lotion 1% When possible use non-antibiotic antimicrobials rather than antibiotics. 13.6 Acne and rosacea Unspecified All prescribers for acne Clindamycin 13. Skin solution 2% (Stiemycin ®); When possible use non-antibiotic antimicrobials rather than antibiotics. 13.6.1 Topical preparations topical solution, erythromycin Included in the Formulary for use by pregnant women only. 13.6 Acne and rosacea Unspecified All prescribers for acne Erythromycin 40mg, zinc acetate 12mg/ml (Zineryt ®) 13. Skin 13.6.1 Topical preparations solution tretinoin 0.025%, When possible use non-antibiotic antimicrobials rather than antibiotics. 13.6 Acne and rosacea Unspecified All prescribers for acne Aknemycin® Plus erythromycin 4% 13. Skin 13.6.1 Topical preparations gel 4% 13.6 Acne and rosacea Unspecified All prescribers for acne Nicotinamide 13. Skin tablets, cyproterone acetate See BNF. Prescribing this by the approved name co-cyprindiol rather than 13.6 Acne and rosacea 13.6.2 Co-cyprindiol 2mg, ethinylestradiol Unspecified All prescribers by the brand name Dianette® reduces the cost. 35micrograms 13. Skin 13.7 Preparations for warts and caustic pencil 13.7 Unspecified All prescribers callouses Silver nitrate 13. Skin paint, salicylic acid 16.7%, 13.7 Preparations for warts and 13.7 lactic acid 16.7% in flexible First line All prescribers callouses Salactol ® collodion 13. Skin gel, salicylic acid 11%, lactic 13.7 Preparations for warts and 13.7 acid 4% in a collodion basis First line All prescribers callouses Cuplex ® 13. Skin 13.7 Preparations for warts and solution 10% 13.7 Second line All prescribers callouses Glutaralaldehyde 13. Skin 13.7 Preparations for warts and solution salicylic acid 26% 13.7 Third line All prescribers callouses Occlusal® 13. Skin 13.7 Preparations for warts and cream 5% For external genital and perianal warts only 13.7 Unspecified All prescribers callouses Imiquimod 13. Skin 13.8 Sunscreens and camouflagers 13.8.1 Sunsense® Ultra lotion SPF 50+ Unspecified All prescribers Sunscreens - ACBS 13. Skin 13.8 Sunscreens and camouflagers 13.8.1 Anthelios® cream SPF50+ Unspecified All prescribers Sunscreens - ACBS. For darker skin types. 13. Skin gel 3% in a sodium 13.8 Sunscreens and camouflagers 13.8.1 Photodamage Diclofenac sodium hyaluronate basis (Solaraze ®) Unspecified All prescribers

13. Skin cream 5% Specialist Usual duration of initial therapy, 3-4 weeks. 13.8 Sunscreens and camouflagers 13.8.1 Photodamage Unspecified Fluorouracil INITIATION 13. Skin solution, fluorouracil 0.5%, Specialist 13.8 Sunscreens and camouflagers 13.8.1 Photodamage Unspecified Actikerall® salicylic acid 10% INITIATION

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Drug name Initiate by (shading indicates that the drug DRAFT Order of BNF chapter BNF section BNF sub-section Formulations specialist Comments appears in more than one preference only? section) 13. Skin liquid 13.9 Shampoos and other preparations 13.9 First line All prescribers for scalp and hair conditions Polytar ® 13. Skin shampoo 13.9 Shampoos and other preparations 13.9 Second line All prescribers for scalp and hair conditions T/Gel® 13. Skin shampoo 13.9 Shampoos and other preparations 13.9 Second line All prescribers for scalp and hair conditions Alphosyl 2 in 1 ® 13. Skin shampoo 13.9 Shampoos and other preparations 13.9 Third line All prescribers for scalp and hair conditions Capasal ® 13. Skin shampoo 2.5% 13.9 Shampoos and other preparations 13.9 First line All prescribers for scalp and hair conditions Selenium sulphide 13. Skin shampoo 2% 13.9 Shampoos and other preparations 13.9 Second line All prescribers for scalp and hair conditions Ketoconazole 13. Skin cream 11.5% Recommend restrict prescribing to facial hirsuitism in women in whom alternative drug therapy cannot be used. The patient should have tried 13.9 Shampoos and other preparations 13.9 Unspecified All prescribers other hair removal methods and be aware that other methods will need to for scalp and hair conditions Eflornithine be used in conjunction with eflornithine. Discontinue use if no improvement noticed after 4 months. 13. Skin cream 2%; ointment 2% 13.10 Anti-infective skin preparations 13.10.1 Mupirocin Unspecified All prescribers 13. Skin cream 1% 13.10 Anti-infective skin preparations 13.10.1 Silver sulfadiazine Unspecified All prescribers 13. Skin cream, gel 0.75% Prescribe by brand name. The different brands have different licensed 13.10 Anti-infective skin preparations 13.10.1 Unspecified All prescribers Metronidazole indications. 13. Skin cream 2%; ointment 2% Prefer an antibacterial that is not used systemically where possible, to 13.10 Anti-infective skin preparations 13.10.1 Unspecified All prescribers Fusidic acid minimise the development of resistant organisms. 13. Skin cream 2% 13.10 Anti-infective skin preparations 13.10.2 Miconazole nitrate Unspecified All prescribers 13. Skin cream 1% 13.10 Anti-infective skin preparations 13.10.2 Terbinafine Unspecified All prescribers 13. Skin cream 2% 13.10 Anti-infective skin preparations 13.10.2 Ketoconazole Unspecified All prescribers 13. Skin cream 1%; spray 1% 13.10 Anti-infective skin preparations 13.10.2 Unspecified All prescribers Clotrimazole solution 1%

13. Skin cream 5% Best applied at the earliest possible stage, usually when prodromal 13.10 Anti-infective skin preparations 13.10.3 Unspecified All prescribers Aciclovir changes of sensation are felt. 13. Skin cream rinse 1%; cream 5% 13.10 Anti-infective skin preparations 13.10.4 Permethrin Unspecified All prescribers 13. Skin liquid 0.5% 13.10 Anti-infective skin preparations 13.10.4 Malathion Unspecified All prescribers 13. Skin application 25% 13.10 Anti-infective skin preparations 13.10.4 Benzyl benzoate Unspecified All prescribers 13. Skin cream 1% Limit to short term use, e.g. up to 3 weeks. 13.11 Skin cleansers, antiseptics, and 13.11.6 Unspecified All prescribers desloughing agents Hydrogen peroxide 13. Skin 20% roll-on applicator Guidance on usage is at www.sweathelp.com Aluminium chloride 13.12 Antiperspirants. 13.12 Unspecified All prescribers hexahydrate

14. Immunological products and injection, Typherix® 14.4 Vaccines and antisera 14.4 Unspecified All prescribers vaccines Typhoid vaccine injection, Typhim Vi®

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Drug name Initiate by (shading indicates that the drug DRAFT Order of BNF chapter BNF section BNF sub-section Formulations specialist Comments appears in more than one preference only? section) 14. Immunological products and 20 units per ml (2 units in vaccines Tuberculin Purified 0.1ml); 100 units per ml (10 units in 14.4 Vaccines and antisera 14.4 Unspecified All prescribers Protein Derivative 0.1ml) (Tuberculin PPD ) 14. Immunological products and Poliomyelitis suspension (named patient Only for use during outbreaks vaccines 14.4 Vaccines and antisera 14.4 supply) Unspecified All prescribers vaccine, live (orall) 14. Immunological products and Pneumococcal injection (Pneumovax ® II) vaccines 14.4 Vaccines and antisera 14.4 polysaccharide Unspecified All prescribers vaccine 14. Immunological products and Pneumococcal injection (Prevenar 13 ®) vaccines polysaccharide 14.4 Vaccines and antisera 14.4 Unspecified All prescribers conjugate vaccine (adsorbed) 14. Immunological products and Injection, ACWY Vax® vaccines Meningococcal 14.4 Vaccines and antisera 14.4 polysaccharide A, C, Unspecified All prescribers W135 and Y vaccine 14. Immunological products and Meningococcal injection vaccines group C conjugate vaccine with 14.4 Vaccines and antisera 14.4 Unspecified All prescribers Haemophilus Influenza type B vaccine 14. Immunological products and Meningococcal injection vaccines 14.4 Vaccines and antisera 14.4 group C conjugate Unspecified All prescribers vaccine 14. Immunological products and Measles, mumps live vaccine vaccines 14.4 Vaccines and antisera 14.4 and rubella (MMR) Unspecified All prescribers vaccine 14. Immunological products and Influenza vaccine, vaccines 14.4 Vaccines and antisera 14.4 Unspecified All prescribers seasonal 14. Immunological products and Human papilloma pre-filled syringe 0.5ml vaccines 14.4 Vaccines and antisera 14.4 (Cervarix ®) Unspecified All prescribers virus vaccine 14. Immunological products and vaccines 14.4 Vaccines and antisera 14.4 Hepatitis B vaccine Unspecified All prescribers

14. Immunological products and injection 20mg in 1ml, 1ml pre- vaccines Hepatitis A with filled syringe (Twinrix ® Adult); 14.4 Vaccines and antisera 14.4 0.5ml pre-filled syringe Unspecified All prescribers hepatitis B vaccine (Twinrix ® Paediatric)

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Drug name Initiate by (shading indicates that the drug DRAFT Order of BNF chapter BNF section BNF sub-section Formulations specialist Comments appears in more than one preference only? section) 14. Immunological products and injection, Hepatyrix® vaccines Hepatitis A vaccine 14.4 Vaccines and antisera 14.4 Unspecified All prescribers With typhoid vaccine

14. Immunological products and injection (Avaxim®, Vaqta® vaccines 14.4 Vaccines and antisera 14.4 Hepatitis A vaccine Paediatric) Unspecified All prescribers 14. Immunological products and Haemophilus injection vaccines 14.4 Vaccines and antisera 14.4 influenzae type B Unspecified All prescribers vaccine (HiB) 14. Immunological products and Diphtheria, tetanus, injection vaccines pertussis, inactivated poliomyelitis and Haemophilus 14.4 Vaccines and antisera 14.4 Unspecified All prescribers influenza type b Conjugate vaccine (absorbed) - DTaP/IPV/Hib (Pediacel ®) 14. Immunological products and Diphtheria, tetanus, injection vaccines pertussis and inactivated 14.4 Vaccines and antisera 14.4 Unspecified All prescribers poliomyelitis (absorbed) - DTaP/IPV 14. Immunological products and injection vaccines Diphtheria (low dose), tetanus, pertussis and 14.4 Vaccines and antisera 14.4 Unspecified All prescribers inactivated poliomyelitis (absorbed) vaccine 14. Immunological products and Diphtheria (low injection vaccines dose), tetanus and 14.4 Vaccines and antisera 14.4 inactivated Unspecified All prescribers poliomyelitis vaccine 14. Immunological products and Bacillus Calmette-Guerin vaccines 14.4 Vaccines and antisera 14.4 BCG intradermal Vaccine (Live) Intradermal Unspecified All prescribers injection

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Drug name Initiate by (shading indicates that the drug DRAFT Order of BNF chapter BNF section BNF sub-section Formulations specialist Comments appears in more than one preference only? section) 14. Immunological products and Tetanus injection vaccines 14.5 Immunoglobulins 14.5 Unspecified All prescribers immunoglobulin 15. Anaesthesia Hyoscine injection 400micrograms in 15.1 General anaesthesia 15.1.3 Antimuscarinic drugs 1ml, 600micrograms in 1ml Unspecified All prescribers hydrobromide 15. Anaesthesia Glycopyrronium injection 200micrograms in 1ml, 600micrograms in 3ml 15.1 General anaesthesia 15.1.3 Antimuscarinic drugs bromide Unspecified All prescribers (Glycopyrrolate) 15. Anaesthesia injection 1mg/ml 5ml For use in palliative care. See palliative care section in the BNF and the ampoules For use in NPSA Rapid Response Report on reducing risk of overdose with 15.1 General anaesthesia 15.1.4.1 Benzodiazepines Unspecified Midazolam palliative care midazolam injection in adults. Ensure that flumazenil is available where midazolam is used. 15. Anaesthesia injection 30mg/ml 15.1.4.2 Non-opioid Ketorolac Specialist 15.1 General anaesthesia Unspecified analgesics trometamol INITIATION injection 500micrograms/ml For use only in palliative care. For use only in Specialist 15.1 General anaesthesia 15.1.4.3 Opioid analgesics (2ml ampoules) Alfentanil palliative care INITIATION 15. Anaesthesia 15.1.7 Antagonists for Naloxone injection 400micrograms in 15.1 General anaesthesia central and respiratory 1ml Unspecified All prescribers depression hydrochloride 15.1.7 Antagonists for injection 100micrograms/ml Ensure that flumazenil is available where midazolam is used. 15.1 General anaesthesia central and respiratory Flumazenil 5ml ampoules Unspecified All prescribers depression 15. Anaesthesia plasters 5% (700mg/plaster) BNF62 lists the price as £72.40 for 30 plasters. The Scottish Medicines Consortium has accepted the plasters for restricted use for treatment of Specialist postherpetic neuralgia in patients who are intolerant of first-line systemic 15.2 Local anaesthesia 15.2 Unspecified Lidocaine INITIATION therapies or when they have been ineffective. May also be useful for complex pain in palliative care.

15. Anaesthesia Gel containing lidocaine Lidocaine with hydrochloride 2% and 15.2 Local anaesthesia 15.2 chlorhexidine gluconate Unspecified All prescribers chlorhexidine 0.25%, 6ml, 11ml syringe (Instillagel ®). 15. Anaesthesia Lidocaine ointment 5% 15.2 Local anaesthesia 15.2 Unspecified All prescribers hydrochloride 15. Anaesthesia cream, lidocaine 2.5%, 15.2 Local anaesthesia 15.2 Unspecified All prescribers EMLA® prilocaine 2.5%, Appendix 2 Borderline substances A2.4.2 Fibre, vitamin and 450mg tablets ACBS Indications Dietary management of water-soluble vitamin deficiency A2.4 Feed supplements Unspecified All prescribers mineral supplements Renavit® in adults with renal failure on dialysis

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