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 Formulary Chapter 16: Paediatrics - Full Chapter
Notes:

*** WORK WILL BE TAKING PLACE ON THIS CHAPTER w/c 24/01/21***


PLEASE NOTE: THIS CHAPTER IS STILL UNDER CONSTRUCTION 

Where medicines are included in the BSWformulary (for any indication) and are in the BNF for Children (BNF-C), they can be prescribed for a licensed indication within the manufactrer's recommendations using any formulation.

Where medicines are not included and therefore non-formulary (despite being in the BNF-C) they  must be approved for use by the local Formulary team by submitting a Non-Formulary Medicine Request Form or an IFR application for individual patient requests where exceptionality can be shown.

Paediatric drugs are frequently used outside of the SPC since many manufacturers fail to conduct the relevant trials needed to secure licensed use in paediatrics. Prescribers take full responsibility for prescribing products outside the license. However all prescribing should be carried out in the best interest of the child irrespective of license status.

Traffic Light Status Information for Paediatric Chapter

Red Traffic Light

Amber with Shared Care Agreement (SCA)

  • In BNF-C within indication and dose range
  • Unlicensed or Off label use of drug (as per BNF-C definition Guidance on prescribing: BNFC and marketing authorisation)     
  • Require specialist initiation and stabilisation. Ongoing division of responsibility for drug and disease monitoring between specialist and GP detailed in SCA

Amber No Shared Care Agreement (SCA) needed

  • In BNF-C within indication and dose range
  • Considered suitable for GP prescribing following specialist initiation or recommendation. 

Green Traffic Light

  • In BNF-C within indication and dose range
  • Considered suitable for initiation in both primary and secondary care. 


Useful resources

RCPCH and NPPG joint position statement -using standardised strengths of unlicensed liquid medicines

RCPCH and NPPG joint position statement - choosing an oral liquid medicine for children

 

 Details...
16.01  Expand sub section  Gastro-Intestinal (paediatric)
Docusate Sodium
View adult BNF View SPC online
Formulary
traffic lightGreen
  • Paediatric 12.5mg/5ml Oral Solution (licensed from age 6months)
  • 50mg in 5ml oral solution SF (licensed from age 12years)
  • 120mg micro enema (licensed from age 12years)
  • 100mg capsules (licensed from age 12years)
 
 
Esomeprazole
(gastro-resistant granules for oral suspension, sachet)
View adult BNF View SPC online
Formulary
traffic lightGreen
  • 10mg
  • Licensed for Children 1 – 11 years with a bodyweight of ≥10 kg 
  • Used locally for patients with enteral tubes or patients who have not tolerated MUPS
 
 
Gaviscon Infant®
(Powder sachets)
View adult BNF View SPC online
Formulary
traffic lightGreen
  • 1 dose = half a dual sachet
  • Prescribe as doses
 
 
Mercaptopurine
(Tablet)
View adult BNF View SPC online
Formulary
traffic lightRed
  • Note: 10mg strength tablets are unlicensed specials and prohibitively expensive when sourced in primary care. 
  • Use by gastroenterology specialists.
  • 10mg strength tablets are included on the formulary only when used in paediatric patients (alternate dosing using 50mg/100mg should be considered where daily doses between 50 and 100mgs are required for adults).
  • Prescribing in paediatric patients should be retained by secondary care.
 
 
Omeprazole
(4mg/mL Suspension)
View adult BNF View SPC online
Restricted Drug Restricted
traffic lightAmber
High Cost Medicine
  • Omeprazole 4mg/mL powder for oral suspension (Rosemont)
  • RESTRICTED USE - Only for use following specialist recommendation for paediatric patients under 1 year of age or under 10kg whereby dispersible tabs/esomeprazole sachets are not appropriate (i.e. prescribed dose under 5mg or feeding tube in situ). 
  • To support review process of infants receiving doses ≥5mg or those with feeding tubes in situ at 12 months to transition to more cost effective PPI alternatives see link below.
  • Omeprazole suspension is NOT included on the formulary for use outside this cohort (see here).  
 
Link  Guidance on use of PPIs in Children from (SFT)
 
16.02  Expand sub section  Cardiovascular (paediatric)
Alteplase Actilyse Cathflo
(Powder for reconstitution)
View adult BNF View SPC online
Formulary
traffic lightRed
  • 1 vial with powder contains: 2 mg alteplase (corresponding to 1,160,000 IU)
  • Paediatric central venous catheter management
 
 
Captopril
(Tablets and oral solution)
View adult BNF View SPC online
Formulary
traffic lightAmber
  • 12.5mg, 25mg and 50mg
  • 5mg/5ml and 25mg/5ml SF solution
  • Swindon only
  • Non-formulary in BaNES and Salisbury
 
 
Clonidine
(Tablets/Oral solution)
View adult BNF View SPC online
Formulary
traffic lightRed
  • GWH only for treatment resistant ADHD and severe Tic disorder. Paediatric consultant only.
  • Non-formulary at RUH/SFT
  • 25mcg tablets
  • 50mcg/5ml oral solution
 
 
Enalapril
(Tablets)
View adult BNF View SPC online
Formulary
traffic lightAmber
  • 2.5mg, 5mg, 10mg and 20mg
 
 
Propranolol
(Oral)
View adult BNF View SPC online
Formulary
traffic lightAmber
  • Tablets 10mg, 40mg
  • Liquid
 
 
Chlorothiazide
(Oral solution (various strengths))
View adult BNF View SPC online
Unlicensed Drug Unlicensed
traffic lightAmber
  • Only available as an unlicensed preparation for specialist initiation only.
  • Swindon only
  • Non-formulary in BaNES and Salisbury
 
 
Spironolactone
(Oral suspension)
View adult BNF View SPC online
Unlicensed Drug Unlicensed
traffic lightRed
  • 10mg/5ml and 50mg/5ml (Note: RUH will be moving to standard solution strength in near future).

 
Link  MHRA DSU: Spironolactone and renin-angiotensin system drugs in heart failure: risk of potentially fatal hyperkalaemia—February 2016 article
 
16.03  Expand sub section  Respiratory (paediatric)
Colistimethate Sodium (Promixin®)
(Powder for nebuliser solution)
View adult BNF View SPC online
Formulary
traffic lightRed
  • 1million-units
  • For use in paediatrics only following initiation by specialist
 
 
Prednisolone
(Soluble tablets)
View adult BNF View SPC online
Formulary
traffic lightGreen
  • 5mg
  • For emergency treatment of Croup as per BNF-C
 
 
16.04  Expand sub section  Central Nervous System (paediatric)
Melatonin
(Circadin MR 2mg®)
(Oral)
View adult BNF View SPC online
First Choice
traffic lightRed
  • 2mg MR
  • Melatonin MR 2mg tablets are licensed for use in adults over 55 years. Use in children is an 'off label' use. 
  • Melatonin guidance due Q1 2021.

 

 
Controlled Drug Methylphenidate
(Concerta® XL, Xaggitin XL, Medikinet XL, Equasym® XL)
(Modified release tablets and capsules)
View adult BNF View SPC online
First Choice
traffic lightAmber with Shared Care
  • Xaggitin® XL  Modified release tablet 18mg, 27mg, 36mg, 54mg - First line for new patients as the most cost-effective formulary choice locally
  • Concerta® XL Modified release tablet 18mg, 27mg, 36mg,54mg: existing patients only.
  • Equasym® XL Modified release capsule 10mg, 20mg, 30mg
  • Prescribe by brand Modified release brands provide different release profiles of methylphenidate and switching brands should only be considered following specialist advice.
 
Controlled Drug Methylphenidate
(Immediate release tablets)
View adult BNF View SPC online
First Choice
traffic lightAmber with Shared Care
  • 5mg,10mg, 20mg
 
Controlled Drug Lisdexamfetamine (Elvanse®)
(Capsules)
View adult BNF View SPC online
Second Choice
traffic lightAmber with Shared Care
  • 20mg, 30mg, 40mg, 50mg, 60mg and 70mg
  • Once daily dosing
 
Link  BSW SCA For the treatment of Attention Deficit Hyperactivity Disorder (ADHD) in children and adolescents
Link  NICE NG87 Attention deficit hyperactivity disorder: diagnosis and management Sept 2019
 
Melatonin 5mg/5ml
(Oral solution or suspension (alcohol free))
View adult BNF View SPC online
Second Choice
traffic lightRed
  • Melatonin 5mg/5ml oral solution or suspension (alcohol free) Unlicensed DrugUnlicensed only in line with melatonin policy see here - link to add - 22/02/2020

 

 
 
Atomoxetine
(Oral)
View adult BNF View SPC online
Third Choice
traffic lightAmber with Shared Care
  • 10mg, 18mg, 25mg, 40mg, 60mg, 80mg, 100mg capsules
  • 4mg/1ml oral solution
 
Link  BSW SCA For the treatment of Attention Deficit Hyperactivity Disorder (ADHD) in children and adolescents
Link  NICE NG87 Attention deficit hyperactivity disorder: diagnosis and management Sept 2019
 
Controlled Drug Dexamfetamine Sulphate
(Tablets)
View adult BNF View SPC online
Third Choice
traffic lightAmber with Shared Care
  • 5mg
  • Only for those whose ADHD symptoms are responding to lisdexamfetamine but who cannot tolerate the longer effect profile.
 
Link  BSW SCA For the treatment of Attention Deficit Hyperactivity Disorder (ADHD) in children and adolescents
Link  NICE NG87 Attention deficit hyperactivity disorder: diagnosis and management Sept 2019
 
Hyoscine hydrobromide (Scopoderm®)
(Topical patch)
View adult BNF View SPC online
Formulary
traffic lightAmber
  • 1.5mg patch
  • Unlicensed indication
  • Only licensed from 10 years for travel sickness.
 
 
Levetiracetam
(Tablets and oral solution)
View adult BNF View SPC online
Formulary
traffic lightAmber
  • 250mg, 500mg, 750mg and 1g (category 3 MHRA)
  • Oral solution SF 100mg/ml
  • Granules in sachets 250mg, 500mg and 1000mg Desitrend (second line use only)
 
 
Levetiracetam
(Intravenous infusion)
View adult BNF View SPC online
Formulary
traffic lightRed
  • 100mg/ml 5ml vial
 
 
Controlled Drug Midazolam Maleate Oromucosal
(Epistatus®)
View adult BNF View SPC online
Formulary
traffic lightAmber with Shared Care
  • Epistatus® Oromucosal solution prefilled single syringe 10mg/1ml  (licensed in adolescents from 10 years to less than 18 years
  • unlicensed unlicensed Epistatus® Oromucosal solution 10mg/ml prefilled syringes: 2.5mg/0.25ml, 5mg/0.5ml, 7.5mg/0.75ml.  Individually wrapped in a pack of 4.
  • Do not prescribe Oromucosal solution 10mg/ml multidose 5ml bottle. In primary care, all patients should use the pre-filled syringe format as this is what the specialist primary care nursing team can provide training on for carers/schools/nurseries/after-school clubs etc.
  • Prescribe by BRAND (NB Buccolam brand is a different salt, STRENGTH and volume) 
  • See Shared Care Guidelines: Use of Oromucosal Midazolam as an intervention for prolonged seizures and prevention od Status Epilepticus

Red Swindon only - when used for sedation and pre-med in theatres

 
 
Pizotifen
(Tablets)
View adult BNF View SPC online
Formulary
traffic lightAmber
  • 500microgram tablet
  • 1.5mg tablet
  • Pizotifen is only included for prophylaxis of migraine in paediatrics. See Chapter 4.7.4.2 for BSWformulary choices for migraine in adults.

 

 
Link  Medicines for Children PIL - Pizotifen to prevent migraine headaches
 
Sodium Valproate
(Various formulations)
View adult BNF View SPC online
Formulary
traffic lightAmber
  • Crushable tablets 100mg
  • E/C tablets 200mg, 500mg
  • M/R tablets 200mg, 300mg, 500mg 
  • M/R capsules 150mg, 300mg
  • LiquidSF 200mg/5ml

COVID-19 MHRA have issued guidance - Valproate Pregnancy Prevention Programme: temporary advice for management during coronavirus (COVID-19)

 
Link  Valproate use by women and girls
 
Sodium Valproate
(Intravenous injection)
View adult BNF View SPC online
Formulary
traffic lightRed
  • 400mg

COVID-19 MHRA have issued guidance - Valproate Pregnancy Prevention Programme: temporary advice for management during coronavirus (COVID-19)

 
Link  Valproate use by women and girls
 
Trihexyphenidyl
(Tablets and oral solution)
View adult BNF View SPC online
Formulary
traffic lightAmber
  • 2mg and 5mg tablets
  • 5mg/5ml (200ml)
  • Not licensed for this indication and 'Not Recommended' for children in the SPC but is listed in the BNF-C
 
 
Guanfacine (Intuniv®)
(Tablets)
View adult BNF View SPC online
Formulary
traffic lightRed
  • Use as per NICE NG87
  • Offer guanfacine to children aged 5 years and over and young people if:
    • they cannot tolerate methylphenidate or lisdexamfetamine or
    • their symptoms have not responded to separate 6-week trials of lisdexamfetamine and methylphenidate, having considered alternative preparations and adequate doses.
 
Link  NICE NG87 Attention deficit hyperactivity disorder: diagnosis and management Sept 2019
 
Sulthiame
(Unlicensed product)
View adult BNF View SPC online
Unlicensed Drug Unlicensed
traffic lightRed
  • 50mg tablets

RUH ONLY - as adjunctive therapy in pharmaco-resistant paediatric epilepsy where other AEDs have failed at optimal doses.

 
 
16.05  Expand sub section  Infections (paediatric) to top
 note 

See BSW antimicrobial prescribing guidance for information and choice of treatment which is based on age of child.

Amikacin
(Solution for injection)
View adult BNF View SPC online
Formulary
traffic lightRed
  • Swindon only
  • 500mg/2ml
  • Paediatric consultant/microbiology advice only
  • Monitoring of drug levels required - NOT ROUTINELY STOCKED AT GWH
  • Non-formulary at BaNES and Salisbury
 
 
Amoxicillin
(Tablets and oral suspension)
View adult BNF View SPC online
Formulary
traffic lightGreen
  • Capsules 250mg, 500mg 
  • Suspension 125mg/5ml and 250mg/5ml
 
 
Azithromycin
(Tablets and oral solution)
View adult BNF View SPC online
Formulary
traffic lightGreen
  • 250mg and 500mg
  • 200mg/5ml 
 
Link  COVID-19 Therapeutic Alert - Antimicrobials (azithromycin and doxycycline) Not Beneficial in the Management of COVID-19 (SARS-CoV-2) Positive Patients
 
Doxycycline
(Capsules and dispersible tablets)
View adult BNF View SPC online
Formulary
traffic lightGreen
  • 50mg and 100mg
 
Link  COVID-19 Therapeutic Alert - Antimicrobials (azithromycin and doxycycline) Not Beneficial in the Management of COVID-19 (SARS-CoV-2) Positive Patients
 
16.06  Expand sub section  Endocrine (paediatric)
Sodium Bicarbonate 8.4%
View adult BNF View SPC online
Formulary
traffic lightRed
  • 100ml bottle
  • Used as a diluent for dissolving some medicines e.g. omeprazole for oral/enteral use (unlicensed indication)
  • BaNES only
 
 
Sodium Chloride 30% oral solution
Formulary
traffic lightRed
  • GWH - For Consultant prescribing only. 
 
 
Somatropin
(Injection)
View adult BNF View SPC online
Formulary
  • Red at RUH and SFT
  • Amber with Shared Care at GWH
 
Link  GWH shared care agreement for the use of somatropin in children (2011)
Link  NICE TA188 Human growth hormone (somatropin) for the treatment of growth failure in children May 2010
 
Testosterone
(Injection)
View adult BNF View SPC online
Formulary
traffic lightRed
  • 250mg in 1ml
 
 
Zoledronic acid
(Intravenous injection)
View adult BNF View SPC online
Formulary
traffic lightRed
  • 800micrograms/ml (4mg) vial
  • Osteogenesis imperfecta and other low bone mass conditions as per the Bristol Childrens Hospital Guidelines
  • Six monthly infusions
 
 
Freestyle Libre®
(Sensors)
View adult BNF View SPC online
Formulary
traffic lightAmber
  • ONLY to be initiated following specialist recommendation in people with diabetes who fit the NHSE criteria for funding (link below).
  • Freestyle Libre should NOT be initiated by non-specialists in primary care.
  • Freestyle Libre should not be initiated in people with Type 2 Diabetes (T2D) in line with NHSE policy. Exceptions are people with T2D on dialysis or with Cystic Fibrosis, and people with insulin treated T2D living with a learning disability which is recorded on the GPs learning disability register.
  • Specialist teams must provide clinical oversight of a person’s use of Freestyle Libre. Including education for people initiated on Freestyle Libre , a prescribing contract, review of benefits after 6 months and ongoing follow up and review, alongside wider diabetes management.
  • Continuing prescription for long-term use of Freestyle Libre post initial 6 months is contingent upon evidence of agreeing with NHSE conditions for use and that on-going use of Freestyle Libre is demonstrably improving an individual’s diabetes self-management. For example improvement of HbA1c or Time In Range; improvement in symptoms such as DKA or hypoglycaemia; or improvement in psycho-social wellbeing.
  • A Freestyle Libre Sensor lasts for 2 weeks; one month’s supply is 2 sensors

Freestyle Libre 2 - Jan 2021 Update - NHSE link to follow when published

  • The new Freestyle Libre 2 sensor has the added feature of real-time glucose alarms that notify people if glucose goes too low or too high.
  • To manage workload & product supply, Freestyle Libre 2 will be offered to patients who meet the eligibility criteria for Flash at their next routine appointment with their specialist diabetic healthcare professional. In the current climate, we respectfully request that people wait until their next routine appointment with their specialist in 2021 to enquire about the FreeStyle Libre 2 system.
  • Specialist diabetes teams will support people to use the new features included in Freestyle Libre 2 system to better manage their diabetes by supplying an information booklet and signposting to New Starter Clinic online education and support and will supply those using the old Freestyle Libre scanning device with a new Freestyle Libre 2 scanner. People using the Flash App should check that it is updated to the latest version (version 2.5 or above). Details on device compatibility can be found in the compatibility guide on the Abbott website.
 
Link  NHSE Nov 2020 Flash Glucose Monitoring: National Arrangements for Funding of Relevant Diabetes Patients
 
16.07  Expand sub section  Obs, Gyn, and UT (paediatric)
16.08  Expand sub section  Malignant Disease and Immunosuppression (paediatric)
Mercaptopurine
(Tablet)
View adult BNF View SPC online
Formulary
traffic lightRed
    • Note: 10mg strength tablets are unlicensed specials and prohibitively expensive when sourced in primary care. 
    • Oncology specialist use.
    • 10mg strength tablets are included on the formulary only when used in paediatric patients (alternate dosing using 50mg/100mg should be considered where daily doses between 50 and 100mgs are required for adults).
    • Prescribing in paediatric patients should be retained by secondary care.

 

 
 
16.09  Expand sub section  Nutrition and Blood (paediatric)
SMA Althera
View adult BNF View SPC online
First Choice
traffic lightGreen
  • Only to be prescibed in line with BSW CMPA guidance (below) 
  • SMA Althera (suitable from birth) is first line extensively hydrolysed formula (eHF) milk
  • Aptamil Pepti, Alimentum, Nutramigen are alternative eHF options where SMA Althera is not tolerated or on the advice of a dietitian/ allergy specialist.
 
SMA Alfamino
View adult BNF View SPC online
Formulary
traffic lightAmber
  • Only to be prescibed in line with BSW CMPA guidance (below) 
  • AAF are significantly more expensive that eHF. A small number of infants will need an AAF but this should usually be prescribed on the advice of a Consultant Paediatrician, allergy specialist or Paediatric Dietitian 
  • SMA Alfamino (suitable from birth) is first line Amino Acid-based Formula (AAF) milk
  • Neocate LCP, Neocate Junior, Neocate Syneo, Nutramigen Puramino and Elecare are alternative AAF options where SMA Alfamino is not tolerated or on the advice of a dietitian/ allergy specialist. 
 
Link  BSW Cow’s Milk Protein Allergy (CMPA) Diagnosis and Management
 
16.10  Expand sub section  Musculoskeletal (paediatric) to top
Piroxicam
(Orodispersible tablets)
View adult BNF View SPC online
Formulary
traffic lightAmber
  • Swindon only.
  • 20mg melts
  • Third line in children unresponsive to or intolerant of Ibuprofen and Diclofenac.
  • Non-formulary in BaNES and Salisbury
 
 
Triamcinolone hexacetonide
(Solution for injection)
View adult BNF View SPC online
Formulary
traffic lightRed
  • Swindon only.
  • 20mg/ml
  • For intra-articular administration
  • Non-formulary in BaNES and Salisbury
 
 
16.11  Expand sub section  Eye (paediatric)
Ciclosporin (Verkazia®)
(Ophthalmic drops)
View adult BNF View SPC online
Formulary
traffic lightRed
  • 0.1% drops (1 mg/mL eye drops, emulsion)
  • Verkazia®  is licensed for the treatment of severe vernal keratoconjunctivitis in children from 4 years of age and adolescents. 
  • Ensure correct product is prescribed. Other ciclosporin eyedrops  are available but have different licensing information and TLS. Ikervis® contains the same ingredient but is not licensed in paediatrics. 
 
Link  NICE TA369: Ciclosporin for treating dry eye disease that has not improved despite treatment with artificial tears
 
16.12  Expand sub section  Ear, Nose and Oropharynx (paediatric)
Oralvac Compact
(Oral mucosal solution)
View adult BNF View SPC online
Formulary
traffic lightRed
  • Unlicensed named patient product
  • Consultant Specialist initiation only
  • For treatment of severe allergic rhinitis and severe allergic conjunctivitis not responding to standard treatment
 
 
Xylometazone
(Nasal drops)
View adult BNF View SPC online
Formulary
traffic lightGreen
  • Swindon only
  • 500microgram per 1 ml
  • Non-formulary in BaNES and Salisbury
 
 
16.13  Expand sub section  Skin (paediatric)
16.14  Expand sub section  Immunological Products and Vaccines (paediatric)
16.15  Expand sub section  Anaesthesia (paediatric) to top
16.16  Expand sub section  Miscellaneous
Glycopyrronium (Sialanar®)
(Oral solution)
View adult BNF View SPC online
Formulary
traffic lightAmber
  • 320micrograms/ml
  • Licensed for symptomatic treatment of severe sialorrhoea (chronic pathological drooling) in children and adolescents aged 3 years and older with chronic neurological disorders
  • For short term intermittent use
 
Link  BCAP Treatment of Sialorrhoea / Drooling in paediatrics: Cost-effective treatment options 2017
Link  NICE NG62 Cerebral palsy in under 25s: assessment and management Jan 2017
 
LAT gel [Lidocaine 4%, Adrenaline 0.1% and Tetracaine 0.5%,
(3ml sterile gel )
(Topical)
View adult BNF View SPC online
Unlicensed Drug Unlicensed
traffic lightRed
  • Used in accident and emergency departments
 
 
16.17  Expand sub section  Continence and Stoma (paediatric)
 ....
Key
note Notes
Section Title Section Title (top level)
Section Title Section Title (sub level)
First Choice Item First Choice item
Non Formulary Item Non Formulary section
Restricted Drug
Restricted Drug
Unlicensed Drug
Unlicensed
Track Changes
Display tracking information
click to search medicines.org.uk
Link to adult BNF
click to search medicines.org.uk
Link to SPCs
SMC
Scottish Medicines Consortium
Cytotoxic Drug
Cytotoxic Drug
CD
Controlled Drug
High Cost Medicine
High Cost Medicine
Cancer Drugs Fund
Cancer Drugs Fund
NHSE
NHS England
Homecare
Homecare
CCG
CCG
Blueteq
High Cost Drug Approval System

Traffic Light Status Information

Status Description

Traffic LightRed

RED - Hospital only – to be prescribed by a specialist and supplied from secondary care ONLY throughout treatment.  

Traffic LightAmber

Amber medicines are considered suitable for GP prescribing following specialist initiation or recommendation.  

Traffic LightAmber with Shared Care

Shared Care - these medicines require specialist initiation and stabilisation. Ongoing division of responsibility for drug and disease monitoring between specialist and GP by a Shared Care Guideline (SCG). If no SCG in place status reverts to red.  

Traffic LightGreen

These medicines are appropriate for initiation in both primary and secondary care. Prescribing is appropriate within licensed or local recommendations.  

Traffic LightSelf

Suitable for patient to be directed to buy themselves  

Traffic LightGrey

Not currently used. We intend to include this TLS in future to highlight where a decision to use this medicine is under review.   

Traffic LightBlack

(In use from Oct 2020) Used where a decision has been made by the BSW APC not to routinely commission this preparation for its licensed indications. Do not prescribe.   

Traffic LightRed Specialist Centre

Not currently used. We intend to include this TLS in future to highlight where this medicine and indication is ONLY available through a Specialist Centre according to a NICE Highly Specialised Technology or NHSE Specialised Commission Circular / Policy.  

netFormulary