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NHS Bath and North East Somerset, Swindon and Wiltshire CCG
Royal United Hospitals Bath NHS Foundation Trust
Great Western Hospitals NHS Foundation Trust
Salisbury NHS Foundation Trust
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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 manufacturer'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...
16.02  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
 
 ....
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.  

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