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Royal United Hospitals Bath NHS Foundation Trust
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Salisbury NHS Foundation Trust
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 Formulary Chapter 9: Nutrition and blood - Full Chapter
Notes:

Nutrition/Blood related Prescribing Guidance

Please see our Prescribing Guidelines page for all prescribing guidance relating to this chapter.

Nutrition/Blood related Shared Care Agreements

Please see our Shared Care Agreements page for all shared care agreements (SCAs) relating to this chapter.

 

Self-care

Many of the products in this chapter are available for purchase over-the-counter, and patients are encouraged to self-care, with the support of their community pharmacist, in the first instance.

For further information on self-care & the NHS, please refer to https://www.england.nhs.uk/medicines/conditions-for-which-over-the-counter-items-should-not-routinely-be-prescribed/

 Details...
09.01  Anaemias and some other blood disorders
 note 

NG8 June 2015 Chronic kidney disease: managing anaemia

09.01.01  Iron-deficiency anaemias
09.01.01.01  Oral iron
 note 

Iron Salt

Dose & frequency

Amount of ferrous iron / day

Ferrous Sulphate Tablets

200mg three times daily

195mg

Ferrous Fumarate Tablets

210mg three times daily

204mg

Ferrous Fumarate Syrup

280mg (10ml) twice daily

180mg

Sodium Feredate Liquid

380mg (10ml) three times daily

165mg

 

Ferrous Fumarate 
(Oral)
View adult BNF View SPC online
First Choice
Green
  • Tablets 322mg (equivalent to 100mg ferrous iron per tablet). 
  • Tablets 210mg (equivalent to 68mg ferrous iron per tablet).
  • Oral solution 140mg/5ml (equivalent to 45mg ferrous iron per 5ml)
 
Ferrous Sulphate 
(Oral)
View adult BNF View SPC online
First Choice
Green
  • Tablets 200mg (equivalent to 65mg ferrous iron per tablet).
 
Sodium Feredetate (Sytron®)
(Liquid)
Formulary
Green
  • BaNES - not on formulary
 
   
09.01.01.01  Iron and folic acid
Iron and Folic Acid
(Pregaday®)
(Oral)
View adult BNF View SPC online
Formulary
Green
  • Tablets containing ferrous fumarate 322mg (equivalent to 100mg of ferrous iron)and folic acid 0.35mg
 
   
09.01.01.01  Compound iron preparations to top
09.01.01.02  Parenteral iron
 note 

MHRA Dec 2014: Intravenous iron and serious hypersensitivity reactions: strengthened recommendations

Ferric Carboxymaltose
(Ferinject®)
(Injection)
View adult BNF View SPC online
Formulary
Red
  • Please note Ferinject is considerably more expensive than Cosmofer.
  • Treatment of iron-deficiency in patients with asthma, allergic eczema or other atopic allergy, when oral iron preparations are ineffective or cannot be used
  •  50mg/ml for slow intravenous injection or intravenous infusion       
  • Anaphylactoid reactions can occur with parenteral administration of iron complexes. Facilities for cardio-pulmonary resuscitation must be at hand.
 
Link  Ferric carboxymaltose: risk of symptomatic hypophosphataemia leading to osteomalacia and fractures
   
Iron Dextran (CosmoFer®)
(Injection )
View adult BNF View SPC online
Formulary
Red
  • SFT and GWH only. Not on formulary at RUH
  • 50mg/ml
  • Anaphylactoid reactions can occur with parenteral administration of iron complexes. Facilities for cardio-pulmonary resuscitation must be at hand.
 
   
Iron Isomaltoside (Monofer®)
(Injection )
View adult BNF View SPC online
Formulary
Red
  • Included on formulary for RUH only - Treatment of iron-deficiency when oral preparations are ineffective and cannot be used
  • GWH/SFT - Not on formulary
  • 100mg/ml for slow intravenous injection or intravenous infusion 
  • Anaphylactoid reactions can occur with parenteral administration of iron complexes. Facilities for cardio-pulmonary resuscitation must be at hand.
 
   
09.01.02  Drugs used in megaloblastic anaemias
 note 

How should severe vitamin b12 deficiency in pregnancy be managed?

Hydroxocobalamin 
(Vitamin B12 Injection)
View adult BNF View SPC online
Formulary
Green
  • 1mg in ml 
  • Intramuscular injection

COVID-19 - BSW medicines management teams support the BSH advice on B12 replacement during the Covid-19 pandemic. See link below. 

 
Link  BSW guidance on B12 supplements during COVID pandemic
   
Cyanocobalamin (Oral Vitamin B12)
View adult BNF View SPC online
Formulary
Green
  •  50microgram tablets
  • For management of diet related Vit B12 deficiency, patients can be advised to purchase cyanocobalamin OTC in line with NHSE guidance.

COVID-19 pandemic - As per BSH advice for Vit B12 replacement there may be situations where oral B12 50-150 micrograms per day may be offered as an alternative to Vit B12 injection. See link below. 

 

 
Link  BSW guidance on B12 supplements during COVID pandemic
   
Folic Acid 
(Oral)
View adult BNF View SPC online
Formulary
Green
  • Tablets: 5mg, 400 micrograms 
  • SF Oral solution: 2.5mg / 5ml
  • Refer to BNF for guidance on the use of folic acid for use in pregnancy for the prevention of neural tube defects.
  • Women with a BMI ≥30 wishing to become pregnant should be advised to take 5mg folic acid supplementation daily, starting at least one month before conception and continuing during the first trimester of pregnancy. (RCOG
 
   
09.01.03  Drugs used in hypoplastic, haemolytic, and renal anaemias
09.01.03  Erythropoietin
Recombinant human erythropoietins
(Non renal indications)
View adult BNF View SPC online
Formulary
Red
High Cost Medicine
  • Non renal indications - Haematology / Oncology
  • Prescriber must specify which epoetin is required
  • For use in patients in accordance with NICE TA323
  • Choice of agent dependent on Trust and procurement costs.
  • Non Formulary at SFT for non renal indications (use darbeopoetin instead)

 

  • NeoRecormon® Prefilled syringes – 500, 1000, 2000, 3000, 4000, 5000, 6000, 10,000, 20,000, 30,000iu
  • Eprex® pre-filled syringes 1000/0.5ml, 2,000/0.5ml, 10,000/1ml, 3,000/0.3ml, 4,000/0.4ml, 5,000/0.5ml, 6,000/0.6ml, 8,000/0.8ml,20,000/0.5m,30,000/0.75ml, 40,000/1ml units 
 
Link  NICE TA323: Erythropoiesis‑stimulating agents during chemotherapy
   
Darbepoetin Alfa ( Non renal indications)
View adult BNF View SPC online
Formulary
High Cost Medicine
  • Red SFT and RUH
  • Amber GWH
  • Non renal indications - Haematology / Oncology
  • Aranesp®Prefilled syringes 10, 15, 20, 30, 40, 50, 60, 80, 100, 150, 130, 300, 500 micrograms
  • SureClick® 20, 40, 60, 80, 100, 150, 300, 500 micrograms
 
Link  NICE TA323 Nov 2014: Erythropoiesis‑stimulating agents (epoetin and darbepoetin) for treating anaemia in people with cancer having chemotherapy
   
Recombinant human erythropoietins
(Renal indications)
View adult BNF View SPC online
Formulary
High Cost Medicine
NHS England
  • Amber GWH
  • Non Formulary at RUH for renal indication (NBT specialist centre)
  • Non Formulary at SFT for renal indication (QAH specialist centre)
  • Commissioned by NHS England (for dialysis-induced anaemia only including via outpatients and only as per NICE CG114 and NICE NG8)
  • Prescriber must specify which epoetin is required
  • Choice of agent dependent on Trust and procurement costs.

 

  • NeoRecormon® Prefilled syringes – 500, 1000, 2000, 3000, 4000, 5000, 6000, 10,000, 20,000, 30,000iu
  • Eprex pre-filled syringes 1000/0.5ml, 2,000/0.5ml, 10,000/1ml, 3,000/0.3ml, 4,000/0.4ml, 5,000/0.5ml, 6,000/0.6ml, 8,000/0.8ml,20,000/0.5m,30,000/0.75ml, 40,000/1ml units 
 
Link  NICE NG8 June 2015: Chronic kidney disease: managing anaemia
   
09.01.03  Iron overload to top
Deferasirox 
(Tablet)
View adult BNF View SPC online
Formulary
Red
High Cost Medicine
NHS England
BlueTeq
  • 90mg,180mg,360mg
  • Commissioned by NHS England for iron chelation in thalassaemia and sickle cell anaemia.
 
Link  NHSE Clinical Commissioning policy August 2016: Treatment of iron overload for transfused and non transfused patients with chronic inherited anaemias
   
Desferrioxamine Mesilate
(Injection)
View adult BNF View SPC online
Formulary
Red
High Cost Medicine
NHS England
BlueTeq
  • 500mg, 2g powder for solution for injection vials
  • Commissioned by NHS England for iron chelation in thalassaemia and sickle cell anaemia.   
 
Link  NHSE Clinical Commissioning policy August 2016: Treatment of Iron overload for transfused and non-transfused patinets with chronic inherited anaemias.
   
09.01.04  Drugs used in autoimmune thrombocytopenic purpura
Eltrombopag 
(Tablet)
View adult BNF View SPC online
Third Choice
Red
High Cost Medicine
CCG
Homecare
BlueTeq
  • 25mg, 50mg
  • See MHRA Drug Safety Update July 18 for information on reports of interferance with bilirubin and creatinine
  • Third line options can be considered for patients with symptoms lasting longer than 12 months in whom first and second line treatment options have failed and there are on-going complications from their thrombocytopenia OR where second-line options are contra-indicated.
 
Link  BSW Treatment Pathway for adult patients with immune (idiopathic) thrombocytopaenia purpura (ITP) Nov 2018
Link  MHRA July 18 Eltrombopag (Revolade): reports of interference with bilirubin and creatinine test results
Link  NICE TA293: Eltrombopag for treating chronic ITP
   
Romiplostim 
(Injection)
View adult BNF View SPC online
Third Choice
Red
High Cost Medicine
CCG
Homecare
BlueTeq
  • 250microgram
  • Third line options can be considered for patients with symptoms lasting longer than 12 months in whom first and second line treatment options have failed and there are on-going complications from their thrombocytopenia OR where second-line options are contra-indicated.
  • The CCG needs to be notified of dose increases over 500 micrograms (2 vials) of romiplostim by submitting a new Blueteq form.
 
Link  BSW Treatment pathway for adult patients with immune (idiopathic) thrombocytopenic purpura (ITP) Nov 2018
Link  NICE TA221: Thrombocytopenic purpura - romiplostim
   
Lusutrombopag 
(Tablets)
View adult BNF View SPC online
Formulary
Red
High Cost Medicine
CCG
BlueTeq
  • 3mg film-coated tablets
  • Short-term use for treating severe thrombocytopenia in adults with chronic liver disease needing a planned invasive procedure following NICE TA617.
 
Link  NICE TA617 Lusutrombopag for treating thrombocytopenia in people with chronic liver disease needing a planned invasive procedure Jan 2020
   
Rituximab (Truxima®)
View adult BNF View SPC online
Formulary
Red
High Cost Medicine
CCG
  • 100mg/10ml and 500mg/50ml infusion
  • Prescribe by Brand Biosimilar First Line
  • Also for the treatment of ITP in accordance with the BSW ITP guidelines
 
Link  BSW Treatment pathway for adult patients with immune (idiopathic) thrombocytopenic purpura (ITP) Nov 2018
   
Anagrelide 
(Capsule)
View adult BNF View SPC online
Formulary
Red
  • 500 microgram
  • For the treatment of essential thrombocythaemia
 
   
09.01.05  G6PD deficiency
09.01.06  Drugs used in neutropenia
Filgrastim (Accofil®)
(Injection)
View adult BNF View SPC online
Formulary
Red
High Cost Medicine
NHS England
  •  Pre-filled syring 38 million units (300 micrograms)/0.5 mL and 48 million units (480 micrograms)/0.8 mL
  • Biosimilar GCSF
  • Commissioned by NHS England for neutropenia according to Trust Guidelines. 
 
Link  MHRA - Filgrastim and pegfilgrastim: risk of capillary leak syndrome
   
Lenograstim (Granocyte®)
(Injection)
View adult BNF View SPC online
Formulary
Red
High Cost Medicine
NHS England
  • SFT and RUH
  • GWH - not on formulary
  • Pre-filled syringe 13.4 million-unit (105 micrograms), 33.6 million-unit (263 micrograms)
  • Recombinant human granulocyte-colony stimulating factor (rHuG-CSF)  
  • Commissioned by NHS England for neutropenia according to Trust Guidelines
  • RUH Used for the mobilisation of STEM cells.
 
   
09.01.07  Drugs used to mobilise stem cells
Plerixafor 
(Injection)
View adult BNF View SPC online
Formulary
Red
High Cost Medicine
NHS England
  • RUH and SFT - For use in line with NHS England Policy B04/P/2 January2014 
  • GWH not on formulary
  •  20mg/ml 1.2ml vial

     

 

 
Link  NHSE Clinical Commissioning Policy: Use of Plerixafor for Stem Cell Mobilisation (Update) Jan 2015
   
09.02  Fluids and electrolytes to top
09.02.01  Oral preparations for fluid and electrolyte imbalance
09.02.01.01  Oral potassium
Potassium Chloride (Sando-K®)
(Tablet)
View adult BNF
Formulary
Green
  • Effervescent tablets each containing Potassium chloride 600mg / Potassium bicarbonate 400mg (total potassium 12mmol) per tablet  
 
   
Potassium Chloride (Kay-Cee-L®)
(Liquid)
View adult BNF
Formulary
Green
  • Potassium chloride 375mg/5ml oral solution sugar free (total potassium 1mmol per mL syrup)
  • Contains sorbitol: May cause osmotic diarrhoea
 
   
09.02.01.01  Potassium removal
Polystyrene Sulphonate Resins
(Calcium Resonium®)
(powder)
View adult BNF View SPC online
Formulary
Red
  • Powder calcium polystyrene sulphonate. 
  • Note: Calcium resonium can be taken orally mixed in water (not fruit juice or other potassium containing fluids) or rectally.       
 
   
Sodium Zirconium Cyclosilicate
(Lokelma®)
View adult BNF View SPC online
Formulary
Red
  • 5g and 10g powder for oral suspension
  • For use in line with NICE TA599
 
Link  NICE TA599 Sodium zirconium cyclosilicate for treating hyperkalaemia
   
Patiromer Sorbitex Calcium
(Veltassa®)
View adult BNF View SPC online
Formulary
Red
  • 8.4g, 16.8g, 25.2g powder for oral suspension
  • For use in line with NICE TA623
 
Link  NICE TA623 Patiromer for treating hyperkalaemia
   
09.02.01.02  Oral sodium and water
Sodium Chloride (Slow Sodium®)
(Tablet)
Formulary
Green
  • Modified release tablets containing 600mg sodium chloride (equivalent to 10mmol Sodium)
 
   
09.02.01.02  Oral rehydration therapy (ORT) to top
Oral Rehydration Salts
(Dioralyte® Electrolade®)
View adult BNF View SPC online
Formulary
Self
  • Oral Powder Sachets

     

 
   
09.02.01.03  Oral bicarbonate
Sodium Bicarbonate 
(oral)
Formulary
Amber
  • Capsules: 500 mg (more cost effective) (approx. 6mmol each of sodium and bicarbonate)
  • Tablets: 600mg
  • Paediatric oral solution: unlicensed unlicensed. For Paediatric Consultant prescribing only. 
 
   
09.02.02  Parenteral preparations for fluid and electrolyte imbalance
09.02.02.01  Electrolytes and water
09.02.02.01  Intravenous sodium
Compound Sodium Lactate Intravenous Infusion
(Hartmann's solution )
Formulary
Red
  • Calcium chloride0.027%, Potassium chloride 0.04% Sodium chloride 0.06% and Sodium lactate 0.25%
 
   
Sodium Chloride and Glucose Intravenous Infusion

Formulary
Red
  • Sodium chloride 0.45% and glucose 2.5% 
  • Sodium chloride 0.18% and glucose 4%  
 
   
Sodium Chloride Intravenous

Formulary
Red
  • IV infusion 0.9% 5ml, 10ml, 20ml ampoules, 50ml vials
  • The terms "saline", "normal saline" and "NS" must not be used to describe sodium chloride 0.9%
Sodium chloride 0.18% 500ml
Sodium chloride 0.45%  500ml
Sodium chloride 0.9% 
50ml, 100ml, 250ml, 500ml, 1 litre
Sodium chloride 1.8% 500ml
  • Note - IV infusion 5ml, 10ml, 20ml ampoules, 50ml vials Green in BaNES.

     

 
   
09.02.02.01  Intravenous glucose to top
Glucose Intravenous

View adult BNF View SPC online
Formulary
Red
  • Glucose 50%: 50ml Min-I-jet
Additional products for infusion available for use in secondary care  
Glucose 5%  100ml, 250ml, 500ml, 1 litre
Glucose 10%  500ml, 1 litre
Glucose 20%  500ml
Glucose 50%  500ml
 
   
09.02.02.01  Intravenous potassium
Potassium Chloride 
View adult BNF
Formulary
Red
  • For the administration of IV Potassium infusions available in the Trust, refer to Trust Policy 
  • Pre-mixed infusion solutions should be used when possible.
  • Medical errors involving Sterile Potassium Chloride Concentrate (20mmol/10ml {15%}) can be potentially fatal.
  • The use of Sterile Potassium Chloride Concentrate (20mmol/10ml {15%}) is restricted to use in areas that require potassium-containing fluids not available as pre-mixed solutions.

 

 

 
Link  NPSA patients safety alert IV potassium 2002
   
09.02.02.01  Bicarbonate and lactate
Sodium Bicarbonate 
(injection)
Formulary
Red
  • Also used for emergency treatment of poisoning
Products for infusion available for use in secondary care
Sodium bicarbonate 1.26% Infusion 500ml
Sodium bicarbonate 8.4% Infusion 200ml
 
   
09.02.02.01  Water
09.02.02.02  Plasma and plasma substitutes
Albumin Solution 
(Isotonic solutions)
View adult BNF View SPC online
Formulary
Red
  • GWH and SFT
  • RUH - Non formulary
  • 4.5% & 20% infusions
 
   
09.02.02.02  Plasma substitutes to top
Gelatin (Gelofusine®)
(Infusion)
View adult BNF View SPC online
Formulary
Red
  • GWH only - for endoscopy use only 
  • RUH/SFT not on formulary
  • Gelofusine® Infusion 500ml, 1 litre            
 
   
09.03  Intravenous nutrition
 note 

Total parenteral nutrition (TPN) should only be prescribed by appropriately trained, healthcare professionals, in line with Trust policy.

Royal United Hospitals Foundation Trust (RUH) info on aseptic services within the trust can be found on the RUH intranet here

Great Western Hospitals NHS Foundation Trust (GWH):

  • TPN should ONLY be prescribed by, or on the advice of, the GWH Parenteral Nutrition team, who can be contacted during normal working hours on 01793-605149.
  • For adults, the decision to initiate intravenous nutrition should NOT be taken outside of normal working hours whilst, for neonates, the decision to initiate intravenous nutrition outside of normal working hours MUST be in line with Trust policy and procedures.
09.03  Thickeners
 note 

BSW Guide to prescribing thickeners in primary care

SPS How can people who need thickened fluids take medicines?

SPS Thickening agents and thickened fluids: do they interact with medicines?

Nutilis Clear®

View adult BNF View SPC online
First Choice
Green
  • 175g tub
 
Resource ThickenUP Clear®

View adult BNF View SPC online
Formulary
Green
  • 127g tub
 
Link  BSW Guide to Prescribing Thickeners for Adults in Primary Care
   
Thick & Easy Clear®

View adult BNF View SPC online
Formulary
Green
  • 126g tub
 
Link  BSW Guide to Prescribing Thickeners for Adults in Primary Care
   
09.04  Oral nutrition
 note 

BSW - COVID nutrition prescribing guidance

Prescribers are reminded that the Advisory Committee on Borderline Substances recommends products on the basis that they may be regarded as drugs for the treatment of specified conditions. Doctors should satisfy themselves that the products can be safely prescribed, that patients are adequately monitored and that, where necessary, expert hospital supervision is available. Prescriptions for products recommended by the Committee should be endorsed "ACBS".

09.04.01  Foods for special diets
 note 

9.4.1 Foods for special diets: Coeliacs.

The BSWFormulary only supports the prescribing of gluten free products listed in the Drug Tariff Part XV and in line with the notes below.

These are ACBS indications (Advisory Committee on Borderline Substances) 

  • BaNES - only for patients who meet the following criteria:

    • A child under 18 years age
    • Vulnerable adult
    • Patients with complex needs
  • Swindon and Wiltshire - those who have a diagnosis of Coeliac disease Dermatitis Herpetiformis or steatorrhea due to gluten sensitivity 

  • Monthly Prescribing Quantities:

     

    Age and Sex Suggested Monthly Units
    Child under 10 years 8
    Child 11-18 years 12
    Female 19 years or above 8
    Male 19 years or above 12

     

    1 unit is equivalent to 400g bread or 400g rolls/bagettes
    2 units is equivalent to 500g bread mix or flour mix
  • Please note this link may also be of use www.coeliac.org.uk
09.04.02  Enteral nutrition to top
 note 

BSW Oral Nutrition Supplements Formulary

Foodlink Complete 
(Powdered MILKSHAKE style ONS)
View adult BNF View SPC online
First Choice
Green
  • First line powdered MILKSHAKE style ONS and also suitable as the first line option where high protein is required. 
  • To be mixed with 200ml full fat milk. Consider whether patient has access to milk and ability to make up the drink with milk. Consider cost to patient. Not suitable for those with lactose intolerance.
  • Flavours: Banana, chocolate, natural, strawberry, vanilla
  • 57g sachets
  • 383 kcal, 19g protein, 200 ml fluid
  • Contains Lactose
  • IDDSI level  0
 
Aymes Shake  (Powdered MILKSHAKE style ONS)
View adult BNF View SPC online
Formulary
Green
  • Powdered MILKSHAKE style ONS (to be mixed with 200ml full fat milk) Consider whether patient has access to milk and ability to make up the drink with milk. Consider cost to patient. Not suitable for those with lactose intolerance.
  • Flavours: Banana, chocolate, neutral, strawberry, vanilla
  • 57g sachets
  • 384 kcal, 16g protein 
  • Contains lactose
  • IDDSI level  1
 
   
Fortisip 
(Ready to drink MILKSHAKE style ONS)
View adult BNF View SPC online
Formulary
Green
  • First Line Ready to drink MILKSHAKE style ONS. 
  • For those unable to use powdered milkshakes but can tolerate larger volumes.
  • Prescribe patient's preferred flavours
  • Flavours: Neutral, vanilla, chocolate, caramel, banana, orange, strawberry, tropical
  • 200ml bottle
  • 300 kcals 11.8g protein,200 ml fluid
  • Lactose free
  • IDDSI level  0
 
   
Ensure Plus 
(Ready to drink MILKSHAKE style ONS)
View adult BNF View SPC online
Formulary
Green
  • For those unable to use powdered milkshakes but can tolerate larger volumes. (220ml bottles)
  • Flavours: Banana, chocolate, coffee, fruits of the forest, neutral, orange, peach, raspberry, strawberry, vanilla, blackcurrant, caramel 
  • 330 kcals 13.8g protein 220 ml fluid
  • Lactose free
  • IDDSI level  0
 
   
Fortisip Compact 
(Ready to drink COMPACT style ONS.)
View adult BNF View SPC online
Formulary
Green
  • First Line Ready to drink COMPACT style ONS.
  • For those who require smaller volumes or with fluid restrictions
  • Flavours: Chocolate, vanilla, banana, strawberry, apricot, forest fruits, mocha 
  • 300 kcals 12g protein, 125 ml fluid
  • Contains lactose
  • 125ml bottle
  • IDDSI level  1
 
   
Altraplen Compact 
(Ready to drink COMPACT MILKSHAKE style ONS)
View adult BNF View SPC online
Formulary
Green
  • Ready to drink COMPACT MILKSHAKE style ONS.
  • For those who require smaller volumes or with fluid restrictions
  • 125ml bottle
  • Flavours: Hazel-chocolate, strawberry, vanilla, banana
  • 300 kcals 12 g protein 125ml fluid
  • Contains lactose 
  • IDDSI level  2
 
   
Aymes ActaSolve Smoothie
(Juice style ONS)
View adult BNF View SPC online
Formulary
Green
  • First Line Juice style ONS. 
  • Not suitable for people with diabetes, COPD and wounds - due to carbohydrate:protein ratio
  • Flavours: Pineapple, mango, peach, strawberry, cranberry 
  • 66g sachet
  • 297 kcals 10.7g protein 150 ml fluid
  • Residual lactose
  • IDDSI level  2
 
   
Fortijuice 
(JUICE style ONS)
View adult BNF View SPC online
Formulary
Amber
  • JUICE style ONS -ready to drink bottle
  • Not suitable for people with diabetes, COPD and wounds due to carbohydrate:protein ratio
  • Flavours: Apple, blackcurrant, forest fruits, lemon, orange, strawberry, tropical
  • 300 kcals, 9.6g protein, 65.4g carbohydrate, 200 ml fluid
  • Residual lactose
  • 200ml bottle
  •  IDDSI level  0
 
   
Altrajuce  
(JUICE style ONS )
View adult BNF View SPC online
Formulary
Amber
  • Flavours: Apple, blackcurrant, orange, strawberry
  • 300 kcals 7.8g protein 67g carbohydrate
  • 200ml bottle
  • Lactose free
  • IDDSI level  0
 
   
Foodlink Complete Powder with Fibre

(Milkshake style PLUS Fibre ONS)
View adult BNF View SPC online
Formulary
Green
  • First Line Milkshake style PLUS Fibre ONS. 
  • Contains fibre, consider for those with constipation
  • Flavours: Banana, chocolate, natural, strawberry, vanilla 
  • 63g sachet
  • 413- 421 kcals, 18.5 - 19.7g protein, 4.5 - 4.7g fibre 200 ml fluid
  • Contains lactose 
  • IDDSI level  0
 
   
Ensure Plus Fibre 
(MILKSHAKE style PLUS FIBRE ONS)
View adult BNF View SPC online
Formulary
Green
  • Contains fibre, consider for those with constipation
  • Flavours: Banana, strawberry, chocolate, raspberry, vanilla
  • 200ml bottle
  • 310 kcals 12.5g protein, 5g fibre, 200 ml fluid
  • Lactose free
  • IDDSI level  1
 
   
Aymes ActaGain 2.4 Maxi

(Ready to drink MILKSHAKE style HIGH Protein ONS)
View adult BNF View SPC online
Formulary
Amber
  • Most cost effective Ready to drink MILKSHAKE style HIGH Protein ONS
  • 200ml bottle
  • Flavours: Vanilla, strawberry
  • 480 kcals 19.2g protein 
  • Contains lactose
  • IDDSI level  3
 
   
Fresubin 3.2 kcal 
(Ready to drink MILKSHAKE style HIGH Protein ONS)
View adult BNF View SPC online
Formulary
Amber
  • Ready to drink MILKSHAKE style HIGH Protein ONS
  • 125ml bottle
  • Flavours: Hazel, mango, vanilla caramel
  • 400 kcals 20g protein, 125ml fluid
  • Residual lactose
  • IDDSI level  3
 
   
Fortisip Compact Protein

(Ready to drink MILKSHAKE style HIGH Protein ONS)
View adult BNF View SPC online
Formulary
Amber
  • Ready to drink MILKSHAKE style HIGH Protein ONS
  • 125ml bottle
  • Flavours: vanilla, strawberry, banana, mocha, peach/mango, berries, neutral, and hot tropical ginger.
  • 300 kcals 18g protein, 125 ml fluid
  • Residual lactose
  • IDDSI level  2
 
   
Nutricrem 
(For Dysphagia Level 4 ONS)
View adult BNF View SPC online
Formulary
Green
  • FIRST LINE for Dysphagia Level 4 ONS
  • Flavours: Chocolate-orange, strawberry, vanilla, mint-chocolate
  • 125g pot (3/day) 
  • 225 kcals 12.5g protein
  • Lactose free
  • IDDSI level  4
 
   
Nutilis Fruit Dessert Level 4

(For Dysphagia Level 4 ONS)
View adult BNF View SPC online
Formulary
Green
  • For Dysphagia Level 4 ONS
  • Flavours: Apple and Strawberry
  • 150g pot (3/day) 
  • 206 kcals 10.5g protein
  • Lactose free
  • IDDSI level  4
 
   
09.05  Minerals
09.05.01  Calcium and magnesium
09.05.01.01  Calcium supplements
Adcal ® 
(Oral)
View adult BNF View SPC online
Formulary
Green
  • Swindon only
  • BaNES and Salisbury - not on formulary 
  •  1500mg chewable tablets, each containing 1.5g calcium carbonate.
 
   
Calcichew ®
(Tablet)
View adult BNF View SPC online
Formulary
Green
  • BaNES and Salisbury only
  • Swindon - not on formulary
  • 500mg chewable tablets, each containing 1.25g calcium carbonate.  
 
   
Calcium 5.1mmol/10ml Syrup
(Alliance Calcium Syrup®)
View adult BNF View SPC online
Formulary
Green
  • Replaces Calcium Sandoz syrup (discontinued)
 
   
Calcium Carbonate with Calcium Lactate Gluconate
(Calvive-1000®)
(Effervescent Tablet)
View adult BNF View SPC online
Formulary
Amber
  • Effervescent tablets containing calcium lactate gluconate & calcium carbonate, 1000mg calcium per tablet   
  • Rebranded April 2020, formerly Sandocal 1000 effervescent tablets. No change to drug composition.
 
   
Calcium Chloride 
(Injection)
View adult BNF
Formulary
Red
  • Parental preparation - Calcium Chloride Injection
  •  Min-I-jet 10ml           
 
   
Calcium Gluconate 10%
(Injection)
Formulary
Red
  • 10ml ampoule
  • Infusion 50ml         

 

 
   
09.05.01.02  Hypercalcaemia and hypercalciuria
Cinacalcet 
(Tablet)
View adult BNF View SPC online
Formulary
Red
High Cost Medicine
NHS England
  • For initiation and follow-on prescribing by an Endocrinology Specialist for the treatment of complex primary hyperparathyroidism
  • 30mg, 60mg, 90mg
 
   
Cinacalcet 
(Tablet)
View adult BNF View SPC online
Formulary
Red
High Cost Medicine
NHS England
  • Renal Specialist use for the treatment of secondary hyperparathyroidism in patients with end-stage renal disease on dialysis, in line with NICE TA 117
  • Non formulary at RUH for this indication
  • Amber shared care at QAH Portsmouth for SFT patients.
  • 30mg, 60mg, 90mg
 
Link  NICE TA117 Cinacalcet for the treatment of secondary hyperparathyroidism in patients with end-stage renal disease on maintenance dialysis therapy
   
09.05.01.03  Magnesium to top
Magnesium Aspartate
(Magnaspartate®)
(Sachet)
View adult BNF
Formulary
Amber
  • Magnaspartate Sachets each contain 10mmol magnesium (mix with water)
  • Licensed for the treatment and prevention of magnesium deficiency, where clinically indicated in adults, adolescents and children aged 2 years and older. 
 
   
Magnesium Glycerophosphate
(Neomag ®)
(Tablet)
Formulary
  • Amber SFT,GWH & RUH
  • Licensed for the treatment of chronic magnesium loss or hyomagesaemia, where clinically indicated, in adults, adolescents and children aged 4 years and older
  • Also licensed for adult patients with hypomagnesaemia due to the concomitant administration of loop and thiazide diuretics or other drugs which cause hypomagnesaemia.

 

 
   
Magnesium Sulphate

(Injection)
Formulary
Red
  • Injection 10%, 20%, 50% ampoules
  • 20% pre-filled syringes (unlic) included on formulary for maternity use (GWH only) 
 
Link  MHRA Drug Safety Update (May 2019): Magnesium sulfate: risk of skeletal adverse effects in the neonate following prolonged or repeated use in pregnancy
   
09.05.02  Phosphorus
09.05.02.01  Phosphate supplements
Phosphate supplements
(Phosphate-Sandoz®)
(Oral)
View adult BNF
Formulary
Green
  • Effervescent Tablets: 500mg containing the equivalent of 16.1mmol phosphate
 
   
Phosphate Polyfusor ®

(IV)
View adult BNF
Formulary
Red
  • IV infusion 500ml (Polyfusor)
  • National supply problem with Phosphate Polyfusor® which is anticipated to continue until at least October 2020. There is no direct replacement but Glycophos® can be used to provide parenteral phosphate replacement.
 
   
Sodium Glycerophosphate 21.6% Injection
(Glycophos®)
Formulary
Red
  • Used at SFT, GWH, RUH
  • There is a national supply problem with Phosphate Polyfusor® which is anticipated to continue until at least October 2020. There is no direct replacement but Glycophos® can be used to provide parenteral phosphate replacement. Note high sodium content (40mmol/20mL).
 
   
09.05.02.02  Phosphate-binding agents
Aluminium Hydroxide
(Alu-Cap®)
(Capsule)
View adult BNF View SPC online
Formulary

Green Banes and Wiltshire

Amber Swindon 

  • 475mg capsules
 
   
Calcium Acetate 
(Tablet)
Formulary

Amber Swindon

Green  BaNES, Wiltshire 

  • Phosex Calcium acetate 1g tablets
  • Each 1g tablet contains 250mg calcium or 6.2mmol Ca2+.
    Usual dose 4-6 tablets daily according to phosphate levels. 
  • For use as a phosphate binder according to NICE CG 157
 
   
Calcium Carbonate (Calcichew®)
(Tablet)
View adult BNF
Formulary
Green
  • Salisbury and BaNES
  • Calcichew chewable tablet containing 500mg calcium/12.5mmol Ca2+
 
   
Lanthanum (Fosrenol®)
(Tablet)
View adult BNF View SPC online
Formulary
Amber with Shared Care
High Cost Medicine
  • Tablets (chewable) 500mg, 750mg, 1g
  • For intiation by Renal team only (3rd line treatment) as per relevant SCA
 
Link  Lanthanum SCA for BaNES patients seen at NBT
   
Sevelamer Carbonate
(Renvela®)
(Tablet)
View adult BNF View SPC online
Formulary
Amber
High Cost Medicine
  • 800mg tablets
  • Prescribe generically as sevelamer carbonate 800mg (most cost effective choice). The originator brand Renagel® tablets (sevelamer hydrochloride 800mg) is for existing patients only as far less cost-effective.
  • For initiation by Renal team only.
 
   
09.05.03  Fluoride
Fluoride Toothpaste

View adult BNF View SPC online
Formulary
Green
  • Suitable for self care in most instances.
  • Where prescription is required, ONLY for initiation and follow-on prescribing by dentists. Not for GP prescribing - see link below.

 

 
Link  BSW Dental Prescribing (including Fluoride) Statement
   
Fluoride Mouthwash 
View adult BNF View SPC online
Formulary
Green
  • Suitable for self care in most instances.
  • Where prescription is required, ONLY for initiation and follow-on prescribing by dentists. Not for GP prescribing - see link below.
 
Link  BSW Dental Prescribing (including Fluoride) statement
   
09.05.04  Zinc to top
Zinc Sulphate 
(Tablet)
View adult BNF View SPC online
Formulary
Green
  • Effervescent tablets Zinc Sulphate Monohydrate 125mg (equivalent 45mg elemental zinc) 
  • Oral zinc only included on the formulary for treatment of proven zinc deficiency
 
   
09.05.05  Selenium
09.06  Vitamins
09.06.01  Vitamin A
Vitamins A and D capsules BPC

View adult BNF View SPC online
Formulary
Amber
  • Vitamins should not be routinely prescribed in primary care due to limited evidence of clinical effectiveness.
  • The only exception is medically diagnosed deficiency, including for those patients who may have a lifelong or chronic condition or have undergone surgery that results in malabsorption. Continuing need should however be reviewed on a regular basis

 

 
   
09.06.02  Vitamin B group
Pyridoxine Hydrochloride
(Tablet)
View adult BNF View SPC online
Formulary
Green
  • 10mg, 20mg, 50mg Tablets (Vitamin B6)
  • Also used to treat the side effects from some chemotherapy regimes

 

 
   
Thiamine 
( Tablet)
View adult BNF View SPC online
Formulary
Green
  • 50mg,100mg (vitamin B1) tablets
  • NICE CG 100 states: 

    Offer thiamine to people at high risk of developing, or with suspected, Wernicke's encephalopathy. Thiamine should be given in doses toward the upper end of the 'British National Formulary' range.

    Offer prophylactic oral thiamine to harmful or dependent drinkers: if they are malnourished or at risk of malnourishment or, if they have decompensated liver disease or, if they are in acute withdrawal or, before and during a planned medically assisted alcohol withdrawal

    Dose for Mild Deficiency - 25-100mg daily

    Dose for Severe Deficiency - 200-300mg daily in divided doses 

 
Link  NICE CG100: Management of alcohol-related physical complications
Link  NICE CG115: Alcohol dependence - diagnosis, assessment and management
   
Vitamin B & C (Pabrinex®)
(Injection)
View adult BNF View SPC online
Formulary
Red
  • Injection I/M High potency
  • Injection I/V High potency       

 

 
Link  NICE CG100: Management of alcohol-related physical complications
Link  NICE CG115: Alcohol dependence - diagnosis, assessment and management
   
Nicotinamide 
(Tablet / Capsules)
View adult BNF View SPC online
Unlicensed Drug Unlicensed
Red
  • 50mg for dermatology use - see BSWformulary section 13.5.3
  • Tablets 500mg (unlicensed) for oncology use (with radiotherapy & carbogen for bladder cancer) as per NICE NG2
 
   
09.06.02  Oral vitamin B complex preparations to top
Vitamin B Tablets (Compound)
(Tablet)
View adult BNF View SPC online
Formulary
Green
  • ONLY for use in patients with enteral tubes where tablets need to be crushed and flushed down the tube. 

Note: Formulary Traffic Light status for review (Dec 2020)  see RMOC guidance

 
Link  Regional Medicines Optimisation Committee (RMOC) Position Statement Oral vitamin B supplementation in alcoholism November 2019
   
Vitamin B Tablets, Compound Strong
( Tablet)
View adult BNF View SPC online
Formulary
Green
  • Nicotinamide 20mg, pyridoxine 2mg, riboflavine 2mg, thiamine 5mg
  • Not indicated for the prevention of alcohol induced cognitive impairment- use thiamine instead.
  • 10 day course for Refeeding Syndrome.

Note: Formulary Traffic Light status for review (Dec 2020)  see RMOC guidance

 

 
Link  Regional Medicines Optimisation Committee (RMOC) Position Statement Oral vitamin B supplementation in alcoholism November 2019
   
09.06.02  Other compounds
09.06.03  Vitamin C
Ascorbic Acid (Vitamin C)
(Tablet)
View adult BNF View SPC online
Formulary
  •  Red - GWH - For use in Ophthalmology for severe corneal burns.
  •  Non-formulary - SFT & RUH.
  •  Tablets: 500mg.
  •  Effervescent tablets 1g. (Not presribeable on the NHS).
 
   
Ascorbic Acid (Vitamin C)
(Tablet)
View adult BNF View SPC online
Formulary
Green
  • Salisbury not on formulary
  • BaNES not on formulary and not stocked at RUH. Only ordered in for medically diagnosed deficiency (i.e. treatment and prevention of scurvy) 
  • Tablets 50mg, 100mg, 500mg. Effervescent 1g (Not prescribable on NHS)
  • Notes: Deficiency is rare and ascorbic acid is not recommended
  • Vitamins should not be routinely prescribed in primary care due to limited evidence of clinical effectiveness.
  • The only exception is medically diagnosed deficiency, including for those patients who may have a lifelong or chronic condition or have undergone surgery that results in malabsorption. Continuing need should however be reviewed on a regular basis
 
   
09.06.04  Vitamin D
 note 

April 2020 - Vitamin D and COVID-19

With the recent media interest in vitamin D (colecalciferol) and COVID-19, the BSW Medicines Optimisation Team remind prescribers that vitamin D should only be prescribed for proven vitamin D deficiency and only for patients who are classified as high risk for prevention or maintenance of vitamin D deficiency. All other patients should purchase their vitamin D over the counter. Colecalciferol is available at most pharmacies, large supermarkets and health food shops.

Routine monitoring of serum vitamin D levels is also not recommended. Monitoring and prescribing advice can be found in the BSW prescribing guidance 

The British Dietetic Association has advised that you cannot boost your immune system and no specific food or supplement will prevent you catching COVID-19/Coronavirus (https://www.bda.uk.com/resource/covid-19-corona-virus-advice-for-the-general-public.html).

Good hygiene practice remains the best means of avoiding infection. Therefore, patients should be advised to only take vitamin D as recommended by Public Health England (https://www.gov.uk/government/news/phe-publishes-new-advice-on-vitamin-d).

BSW vitamin D guidance: Treatment of vitamin D deficiency in adults 

Which oral vitamin D products are suitable for people with vegetarian or vegan diets?

 

Colecalciferol and calcium carbonate
(Accrete D3®)
(Tablet)
View adult BNF View SPC online
First Choice
Green
  • First line for primary care across BSW
  • Tablet 1.5g (equiv to calcium 600mg)/400iu Dose: 1 tablet twice daily
  • Tablet chewable 2.5g (equiv to calcium 1g)/880iu Dose: 1 tablet once daily
  • Cost effective alternative to Calceos
 
Colecalciferol and calcium carbonate
(Adcal-D3®)
(Oral)
View adult BNF View SPC online
Formulary
Green
  • Caplets containing 300mg/ 7.5mmol calcium and 200 units/5micrograms of vitamin D (as vitamin D3/coleclciferol. Dose: 2 caplets twice daily
  • Chewable tablets containing 600mg/15 mmol calcium and 400 units/ 10micrograms of Vitamin D (as vitamin D3/colecaciferol). Dose: 1 tablet twice daily.
  • Dissolve, effervescent tablets containing 600mg calcium and 400 units of vitamin D (as vitamin D3). Dose: 1 tablet twice daily. 
  •  Swindon: FIRST LINE IN SECONDARY CARE
 
   
Colecalciferol and calcium carbonate
(Calfovit D3®)
(Powder)
View adult BNF View SPC online
Formulary
Green
  • For patients unable to take chewable tablets or capsules.
  • Powder- calcium phosphate (calcium 1.2g/ 30mmmol) and 800 units/20micrograms colecalciferol per sachet.
  • For patients requiring calcium and vitamin D via enteral feeding. Calcium phosphate 1.2g or 30mmmol calcium and colecalciferol 20micrograms or 800 units per sachet. 
  • CALFOVIT D3 is indicated in adults and elderly. The safety and efficacy of CALFOVIT D3 in children has not been established; therefore, CALFOVIT D3 should not be used in this population. No data are available.
 
   
Colecalciferol and Calcium carbonate
(Calcichew-D3® Forte)
(Tablet)
View adult BNF View SPC online
Formulary
Green
  • Not on Swindon formulary
  • Chewable tablets containing 500mg / 12.5mmol calcium and 400 units /10micrograms of vitamin D (as vitamin D3) Dose: 1 tablet twice a day
 
   
Colecalciferol and calcium carbonate
(Calceos®)
(Tablet)
View adult BNF View SPC online
Formulary
Green
  • Chewable tablets containing 500mg/12.5mmol calcium and 400 units/ 10micrograms of Vitamin D (as Vitamin D3/colecalciferol)
  • Dose: 1 tablet twice daily. 
 
   
Alfacalcidol (One-Alpha®)
(Oral)
View adult BNF View SPC online
Formulary
  • Green  Salisbury 
  • Amber with Shared Care  Swindon and BaNES
  • Capsules 250 nanograms, 500 nanograms, 1 microgram
  • Oral drops- 2 micrograms/mL, one drop contains approximately 100 nanograms
  • BaNES : Recommended brand - One- Alpha
  • Note: Patients receiving alfacalcidol or calcitriol should have their plasma calcium levels checked regularly (at intervals recommended by specialist, usually evey 3-6 months)
 
Link  BCAP,SFT,3Ts Alfacalcidol for the treatment of hypocalcaemia Shared Care Document
   
Calcitriol 
(Capsule)
View adult BNF View SPC online
Formulary
Amber
  • 250 nanograms, 500 nanograms
  • For renal indication only. 
  • Note: Patients receiving alfacalcidol or calcitriol should have their plasma calcium levels checked regularly (at intervals recommended by specialist, usually every 3-6 months)
 
   
Colecalciferol  (Fultium D3®)
(capsule)
View adult BNF View SPC online
Formulary
Green
  • Note: These are not included in the BSW Vitamin D guidance but may be in use in acute trusts in line with hospital contract
  • 20,000 unit, 3200 unit, 800 unit available 
  • Licensed for use in children 12-18 years old and adults.
  • Please note capsules contain gelatin

 

 
   
Colecalciferol (Stexerol D3®)
(Tablets)
View adult BNF View SPC online
Formulary
Green
  • 25,000 unit or 1,000 unit.
  • Tablets containing 25,000 units vitamin D3 (625 micrograms) colecalciferol
  • Loading Dose: TWO tablets (50,000 units) per week for 6 weeks
  • Maintenance dose: ONE tablet (25,000 units) monthly (packs of 12) 
  • Tablets containing 1,000 units Vitamin D3 ( 25 micrograms) colecalciferol
  • Maintenance dose: ONE tablet (1,000 units) daily
  • Stexerol film-coated tablets are suitable for vegetarians, certified halal & kosher, peanut oil free, soya oil free, gelatine free, & gluten free. The tablets can be crushed or swallowed whole and can be taken with food. The vitamin D is derived from sheep’s wool so they may not be suitable for vegans but they are suitable for vegetarians.
  • Use as per local vitamin D guidance above.
 
   
Colecalciferol 25,000 unit
(Invita D3)
(Liquid)
View adult BNF View SPC online
Formulary
Green
  • Licensed for use in children 0-18 years old and adults with swallowing difficulties.
  • May be mixed with a small amount of cold or lukewarm food immediately before administration. 
  • Use as per local vitamin D guidance above.
 
   
09.06.05  Vitamin E
Alpha Tocopheryl Acetate
(Vitamin E Oral)
View adult BNF View SPC online
Formulary
  • Green  SFT
  • Amber  GWH
  • Red RUH 
  • unlicensed unlicensed tablets 100mg - Available on a names patient basis only and therefore are considerably more expensive than the suspension.  
  • Suspension 500mg in 5ml
 
   
09.06.06  Vitamin K to top
Phytomenadione (Konakion® MM)
(Injection)
View adult BNF View SPC online
Formulary
Green
  • Injection 10mg in 1 ml 
  • Fat soluble formula (not malabsorption)
  • Can be given orally for patients on warfarin at risk of bleeding with high INR. See reversal guidance in chapter 2.8.3
 
   
Phytomenadione (Konakion® MM Paediatric)
(Injection)
View adult BNF View SPC online
Formulary
Green
  • Paediatric preparation
  • 2mg in 0.2ml
  • Fat soluble formula (not malabsorption)
  • Can be given orally for patients on warfarin at risk of bleeding with high INR. See reversal guidance in chapter 2.8.3
 
   
Menadiol Sodium Phosphate
(Tablet)
View adult BNF View SPC online
Formulary
Green
  • 10mg
  • Menadiol sodium phosphate is water soluble and is included for use where patients have fat malabsorption.
  • Water soluble and should be used to prevent vitamin k deficiency in malabsorption syndromes. Not licensed to reverse over anticoagulation with oral anticoagulants.
 
   
Phytomenadione 
(Tablet)
View adult BNF View SPC online
Unlicensed Drug Unlicensed
Red
  • 10mg tablets
  • Note added June 2020: The licensed 10mg tablets have been discontinued by the manufacturer. Unlicensed forms including tablets and casules may be available from special-order manufacturers. Prescribing of these for new patients should be retained by secondary care. Advice for existing patients on phytomenadione in primary care can be discussed with BSW medicines optimisation team bswccg.prescribing@nhs.net
 
   
09.06.07  Multivitamin preparations
Valupak OAD Multivitamin & Minerals
(Oral)
View adult BNF View SPC online
First Choice
Green
  • Tablets
  • Contains minerals and vitamins       
  • First choice multivitamin and mineral product 
  • Do not confuse with Valupak multivitamin tablets (without minerals)  
 
Multivitamin preparations
(Abidec®)
(drops )
View adult BNF View SPC online
Formulary
Green
  • Contains less vitamin A than Dalivit®.
  • For neo-nates prescribe as per SCBU guidelines.
  • Substitute with Dalivit® if Abidec® unavailable - Dalivit® dose should not exceed 0.3ml daily in neo-nates.   
 
   
Multivitamin preparations
(Dalivit®)
(drops)
View adult BNF View SPC online
Formulary
Green
  • Used for cystic fibrosis patients and adults, as Abidec® is not suitable for anyone > 12years.   
 
   
Vitamins A C and D 
(Healthy start children’s vitamin drops)
View adult BNF View SPC online
Formulary
Green
  • Oral drops vitamin A 5000 units, vitamin D 2000 units, ascorbic acid 150mg/ml 
  • Notes:
  • Available direct to the public from maternity and child health clinics.
  • Healthy Start products are available free of charge to pregnant women and children under 4 years of age in families receiving income support or income based job seekers allowance under the 'Healthy Start' scheme. See www.healthystart.nhs.uk for full details. 

 

 
   
Vitamins C, D and folic acid
(Healthy start vitamins for women)
View adult BNF View SPC online
Formulary
Green
  • Tablets vitamin C 70mg, vitamin D3 10 micrograms, folic acid 400 micrograms
  • Notes:
  • Available direct to the public from maternity and child health clinics.
  • Healthy Start products are available free of charge to pregnant women and children under 4 years of age in families receiving income support or income based job seekers allowance under the 'Healthy Start' scheme. See www.healthystart.nhs.uk for full details. 

 

 
   
Paravit CF 
(Oral)
View adult BNF View SPC online
Formulary
Green
  • For Cystic Fibrosis patients only
  • Softgel capsules or liquid.
  • Paravit-CF is a ‘Food for Special Medical Purposes’ containing vitamins A, D, E and K for the dietary management of patients with CF on the specific recommendation of a specialist in CF.
    Paravit CF capsules provide an alternative vitamin supplementation option for CF patients, which offers patients a decreased oral medication load whilst also being a cost-effective option.
    Paravit CF liquid is only available as an option for patients with swallowing difficulties or young children.
 
   
DEKAs Plus (Multivitamin containing vitamins A, D, E and K for patients with CF)
(Oral liquid, softgel capsules, chewable tablets)
Formulary
Amber
  • For Cystic Fibrosis patients only
  • Multivitamin containing vitamins A, D, E and K for the dietary management of patients with CF on the specific recommendation of a specialist in CF.
  • 1-4yrs DEKAs liquid
  • 5-8yrs DEKAs liquid or softgel capsules or chewable tablets
  • >9yrs DEKAs softgel capsules or chewable tablets
 
   
Mutivitamin tablets

View adult BNF View SPC online
Formulary
Red
  • GWH only

 

 
   
09.06.07  Vitamin and mineral supplements and adjuncts to synthetic diets
Multivitamin  (Renavit®)
(Tablet)
View adult BNF View SPC online
Formulary
Amber with Shared Care
  • Tablets containing vitamins B1, B2, B3, B5, B6, B8, B9, B12
  • For BaNES patients seen by renal specialist team at NBT as per SCA. 
  • Vitamin deficiencies are common in patients with renal disease due to dietary restrictions, changes to metabolism and vitamin loss during dialysis.
  • Renavit® should only be initiated by a renal dietician- ongoing prescribing in primary care is acceptable.
  • Haemodialysis: 1 tablet post dialysis 3 times a week Peritoneal Dialysis: 1 tablet daily
 
Link  BCAP -Renavit initiated by Renal Dietician Shared Care
   
Vitamin and mineral supplements
(Forceval Soluble®)
(Tablet)
View adult BNF View SPC online
Formulary
Green
  • Forceval® soluble is taken in 125- 200ml of water.
  • Take after food.
  • Forceval Soluble is suitable for adults and children over 12 years of age.
  • Contains both fat and water-soluble vitamins and minerals. The resulting solution may therefore be cloudy, this is perfectly normal.
 
   
Vitamin and mineral supplements
(Forceval®)
(Capsule)
View adult BNF View SPC online
Formulary
Green
  • Capsules
  • Contains minerals and vitamins       
  • Forceval® is for use only if there is concern about the adequacy of micronutrient intake.   
  • Capsules contain soya bean oil. Patients allergic to peanut or soya should therefore not take this medicine (EMC Nov 14)
 
   
Vitamin and mineral supplements
(Ketovite®)
(Oral)
View adult BNF View SPC online
Formulary
Green
  • As a therapeutic supplement for the prevention of vitamin deficiency in conditions such as galactosaemia, disaccharide intolerance, phenylketonuria and other disorders of carbohydrate or amino acid metabolism, as well as in patients who are on restricted, specialised or synthetic diets.
  • In order to achieve complete vitamin supplementation Ketovite Tablets should be used in conjunction with Ketovite Liquid.
 
   
Vitamin and mineral supplements
(Sanatogen A-Z Complete®)
View adult BNF View SPC online
Formulary
Green
  • Salisbury only
  • BaNES or Swindon Non formulary
 
   
09.07  Bitters and tonics
09.08  Metabolic disorders
09.08.01  Drugs used in metabolic disorders to top
Biotin  
(Injection,Tablet)
View adult BNF View SPC online
Restricted Drug Restricted
Red
  • unlicensed unlicensed GWH only
  • SFT and RUH Non formulary 
  • Tablets: 5mg
  • Injection: 5mg/ml
  • Restricted - to prescribing by Consultant Paediatricians on the recommendation of tertiary Paediatric Specialists only. 
 
   
09.08.01  Wilsons disease
09.08.01  Carnitine deficiency
Carnitine 
(Liquid)
View adult BNF View SPC online
Formulary
Red
High Cost Medicine
  • GWH only
  • RUH and SFT non formulary
  • 100mg / ml (10 x 10ml single dose)
  • Commissioned by NHS England for carnitine deficiency when supplied in secondary care, as per NHS England service specification. For initiation by specialist centres only.
 
   
09.08.01  Fabry's disease
09.08.01  Gaucher's disease
09.08.01  Mucopolysaccharidosis I to top
09.08.01  Pompe disease
09.08.01  Nephropathic cystinosis
09.08.01  Urea cycle disorders
Arginine  
(Oral, Injection)
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Restricted Drug Restricted
Red
  • GWH and RUH only unlicensed unlicensed
  • SFT - non formulary
  • Tablets: 500 mg
  • Oral solution: 50mg/ml
  • Powder:100g
  • Injection: 500mg/ml
  • For paediatric prescribing only. 
  • Restricted - to initiation by Consultant Paediatricians for the treatment of metabolic disorders on the advice of tertiary centres in accordance with NHS England commissioning of highly specialised metabolic disorder services. 
 
   
Sodium Benzoate  
(Oral)
Restricted Drug Restricted
Red
  • GWH and RUH only unlicensed unlicensed
  • SFT - non formulary
  • Tablets: 500 mg
  • Capsules: 50mg, 250mg, 400mg, 500mg
  • Oral solution: 100mg/ml, 200mg/ml, 300mg/ml
  • For paediatric consultant prescribing only
  • Restricted - to initiation by Consultant Paediatricians for the treatment of metabolic disorders on the advice of tertiary centres in accordance with NHS England commissioning of highly specialised metabolic disorder services. 
 
   
Sodium Phenylbutyrate

(Injection/Oral)
Restricted Drug Restricted
Red
  • GWH and RUH only unlicensed unlicensed
  • SFT - non formulary
  • 200mg/ml 5ml ampoules
  • 500mg tablet (Ammonaps®)
  • Restricted - to initiation by Consultant Paediatricians for the treatment of metabolic disorders on the advice of tertiary centres in accordance with NHS England commissioning of highly specialised metabolic disorder services. 
 
   
09.08.02  Acute porphyrias
09.08.02  Drugs unsafe for use in acute porphyrias to top
 ....
 Non Formulary Items
Antithymocyte Immunoglobulin (Equine)


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Non Formulary
High Cost Medicine
 
Compound iron preparations
(Ferrograd C®)

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Non Formulary
 
Compound iron preparations
(Givitol®)

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Non Formulary
 
Deferiprone (Ferriprox®)

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Non Formulary
Link  NHSE Clinical commissioning policy August 2016: Treatment of iron overload for transfused and non-transfused patients with chronic inherited anaemias
 
Dextran 70 ®


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Non Formulary
 
Eculizumab 

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Non Formulary
High Cost Medicine
 
Etelcalcetide 
(Injection)

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Non Formulary
Red Specialist Centre
High Cost Medicine
NHS England
BlueTeq

Commissioned by NHS England in line with NICE TA448 for treating secondary hyperparathyroidism via specialist centres only. For initiation and follow-on prescribing by a Renal specialist for the treatment of secondary hyperparathyroidism in adults with chronic kidney disease on haemodialysis, in line with NICE TA448. Used if cinacalcet is not suitable.

Link  NICE TA448 June 2017: Etelcalcetide for treating secondary hyperparathyroidism
 
Ferric maltol (Ferracru®)

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Non Formulary
 
Ferrous Gluconate 

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Non Formulary
 
Haem Arginate (Normasang)
(Human Hemin Infusion)

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Non Formulary

Commissioned by NHS England (for hepatic porphyria) according to NHS England Service Specification. For highly specialised criteria only. 

 
Hydroxycarbamide (Siklos®)

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Non Formulary
 
Iron and Folic Acide
(Fefol®)

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Non Formulary
 
Iron Sucrose (Venofer®)

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Non Formulary
 
Lipegfilgrastim (Lonquex®)

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Non Formulary
High Cost Medicine
  • Not routinely commissioned by NHS England (for neutropenia). As per IFR approval
 
Mercaptamine (Cystagon)
(Oral)

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Non Formulary

Commissioned by NHS England (for nephropathic cystinosis) as per NHS England Service Specification according to highly specialised criteria.

 
Multivitamins and dietary supplements for AMD


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Non Formulary

Prescribing of nutritional supplements for age-related macular degeneration is not recommended by BSWCCG and these products are non-formulary.

This includes brands such as ICaps, Macushield, Ocuvite, Viteyes, MaculEH light, PreserVision, Vitalux

There is currently insufficient evidence to recommend the use of nutritional supplements in the primary prevention of macular degeneration.

If patients wish to purchase preparations they should note that not all products available contain the same amount of ingredients and these are not licensed medicines.

  • Preservision or Viteyes original capsules closely match the formulation used in the AREDS study. These are not suitable for smokers or recent ex-smokers.
  • Viteyes2 closely matches the AREDS2 formulation (no betacarotene).

 

 

 
Oxymetholone  

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Non Formulary
 
Pegfilgrastim (Neulasta®)

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Non Formulary
High Cost Medicine
  • Not routinely commissioned by NHS England (for neutropenia). As per IFR approval
 
Plasma-lyte 148 

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Non Formulary
 
Polysaccharide Iron Complex
(Miferex®)

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Non Formulary
 
Polystyrene Sulphonate Resins
(Resonium A®)
(Powder)

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Non Formulary
 
Riboflavin 50mg tabs


Unlicensed Drug Unlicensed

Self Care SELF PURCHASE ONLY

March 2020 - Please note Some UK Guidelines advise that riboflavin 400mg OD may be useful in preventing migraines. This recommendation refers to self-purchase only from reputable health food shops. There is no licensed riboflavin product in the UK and prescribing on FP10 may incur costs of up to £500 per item. Larger, robust trials are required to conclusively establish its role in migraine prevention.

 
Trientine Dihydrochloride


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Non Formulary
Red Specialist Centre
High Cost Medicine
NHS England

Commissioned by NHS England and therefore should be issued by specialist care, specifically for Trientine. It should only be prescribed by local hospitals in agreement with specialist centres and in line with national policy.https://www.england.nhs.uk/wp-content/uploads/2018/12/Trientine-for-Wilson-disease-all-ages-1.pdf

 
  
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

Red

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

Amber

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

Amber 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.  

Green

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

Self

Suitable for patient to be directed to buy themselves  

Grey

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

Black

(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.   

Red 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