• Primary Care:  at NHS expense for patients in accordance with the national immunisation programme. Adults over 65 years and at risk groups, as listed in the Green Book, chapter 25.
• Use practice stock and claim on FP34 appendix form. 

•  600 mg of abacavir (as sulfate) and 300 mg lamivudine

• GWH and SFT only
• Non formulary at RUH
• 10mg in 5ml
• Adjunct in percutaneous coronary intervention

• 500mg tablets

•  BaNES and Salisbury for glaucoma
•  Swindon for glaucoma
• 250mg tablets and 250mg MR capsules (NB capsules more costly and stock shortages until at least July 2020)
• Note: at RUH and GWH, acetazolamide is included on the formulary for idiopathic intracranial hypertension as Unlicensed indication
• Note - Private prescription only for prophylaxis of mountain sickness. Not licensed and NOT for prescribing on NHS. For further information see link below 

• Please note: Patients should self-care in the first instance

• 600mg effervescent tablets (licensed) (Swindon only)
• 600mg Tablets (unlicensed)
• 200mg/1ml 10ml ampoules Infusion (Also used for treatment of poisoning)
• Interstitial pneumonia (unlicensed)/ Idiopathic Pulmonary Fibrosis (unlicensed)
• Also used as renal protection before CT scan with contrast agent
• NHS England Specialised Commissioning - Respiratory Interstital Lung Disease Adults

Used at RUH

• 250mg/10ml IV infusion
• 500mg/20ml IV infusion
• 1g/40ml IV infusion

• Capsules 10mg, 25mg
• Consultant Dermatologist Only
• For severe resistant or complicated psoriasis,- not recommended in women of child bearing age.
• Pregnancy Prevention Scheme applies if prescribed in women of child bearing age. Acitretin is highly teratogenic and must not be used by women who are pregnant. The same applies to women of childbearing potential unless strict contraception is practiced 4 weeks before, during and for 3 years after treatment 

• Combination of Formoterol fumarate / Aclidinium (as bromide)
• Breath actuated dry powder MDI 12/340 Genuair device

• 40mg pre-filled pens or pre-filled syringes.
• Prescribe BY BRAND. Biosimilar first-line option. Imraldi^® first-line biosimilar.
• Please note: Adalimumab should be prescribed in accordance with either the BSW STP Ulcerative Colitis Biologic / Biosimilar Commissioning Pathway or the BSW STP Crohn's Disease Biologic / Biosimilar Commissioning Pathway.

• Prescribe by brand. Biosimilar first-line option.  Imraldi® first line biosimilar across BSW
• Injection 40mg pre-filled syringe
• Commissioned by CCG for psoriasis in accordance with NICE TA146.
•  Commissioned by NHS England via specialist centres only for treating moderate to severe hidradenitis suppurativa in accordance with NICE TA392.

• Gel Adapalene 0.1% and Benzoyl Peroxide 2.5% 45g 
• Gel Adapalene 0.3% and Benzoyl Peroxide 2.5% 45g 

•  Tablets 10mg

Epipen® brand (150 microgram and 300microgram devices) is considered the first line Adrenaline Auto Injector (AAI) across BSW.

Jext® brand (150 microgram and 300microgram devices) may also be used across BSW if supply issues necessitate.

Emerade ® brand (150microgram, 300microgram and 500microgram devices) were previously included on the formulary but NOT currently available. See further information below.

Injection technique is device specific. To ensure patients receivethe AAI that they have been trained to use, prescribers should prescribe by brand. Resources to support initial training, or when switching device:

Epipen demo video;  Epipen prescriber checklist; Jext demo video;

• Jext prescriber checklist; 

Additional notes:

All healthcare professionals in primary, secondary or specialist healthcare services who prescribe, supply or administer AAIs, or who advise patients and carers should ensure that:

• When patients next request a prescription, they are reviewed to ensure their AAI  prescription is still appropriate.

• Prescribers issue no more than TWO AAIs per patient (exceptions suggested to this in a 2019 DHSC supply disruption alert are ▪ where schools require separate AAI(s) to be kept on the school premises (e.g. in a medical room) in which case prescribers may need to consider issuing more than two but no more than four AAIs per child; ▪ for the rare scenario where patients might need more than two AAIs prescribed (for example, prior severe reaction resistant to treatment with adrenaline), the prescriber may issue additional AAIs).
• Patients are aware to not expose any brand of AAI to temperatures above 25°C. Storage above 25°C may increase the likelihood of a fault occurring with AAIs.
• Patients use their device(s) as instructed until the expiry date/extended expiry date. N.B. a device expiring in ‘March 2020’ does not expire until 31 March 2020.
• Patients are aware of the signs of anaphylaxis and the actions they should immediately take.

June 2020 -AAIs Supply Issues. 

Emerade® 150, 300 and 500 microgram AAI devices will be

unavailable for the foreseeable future. Patient and/or carers

should return Emerade AAIs to their local pharmacy once they have

obtained a prescription for, and been supplied with, an alternative brand.

While Emerade® remains unavailable, alternative devices should be considered

• Emerade® is the only AAI available in 500microgram formulation but The MHRA note that there is evidence to suggest that a single EpiPen® (300 microgram) or Jext® (300 microgram) device will be a suitable replacement for a single Emerade® 500 microgram device. 

• - GWH
• Non-formulary - Bath
• Non-formulary - Salisbury

• 1 in 10, 000 ampoules and minijet.
• Slow IV inj reserved for severely ill patients where there is doubt about adequacy of the circulation and absorption from the IM site with ECG monitoring.
• Ensure that the correct strength of adrenaline injection is used. 

• 20mg, 30mg, 40mg and 50mg tablets

• For use within RUH
• Approved for use in the diagnosis of Brugada syndrome (unlicensed) by Consultant Cardiologists (for diagnostic use only).

• GWH and SFT
• RUH - Non formulary
• 4.5% & 20% infusions

• Tablets 70mg weekly
• Oral Solution 70mg/100ml (for patients with NG or PEG tubes)

• 1mg in 2ml amp
• 5mg in 10ml amp
• 5mg in 1ml amp intensive care injection

Note - also included as an AMBER TLS drug in SWINDON ONLY for use in palliative care. See here

• Tablets 2.5mg
• Modified-release tablets 10mg

• Oral alitretinoin is licensed for the treatment of severe chronic hand eczema unresponsive to potent topical corticosteroids, in adults.
• Alitretinoin should ONLY be prescribed by dermatologists.
• Prescriptions of alitretinoin for women of childbearing potential should be limited to 30 days of treatment and continuation of treatment requires a new prescription. Ideally, pregnancy testing, issuing a prescription and dispensing of alitretinoin should occur on the same day. Dispensing of alitretinoin should occur within a maximum of 7 days of the prescription.
• Pregnancy is an absolute contraindication to treatment with alitretinoin.
• A treatment course of alitretinoin may be given for 12 to 24 weeks depending on response.
• Discontinuation of therapy should be considered for patients who still have severe disease after the initial 12 weeks of treatment. In the event of relapse, patients may benefit from further treatment courses of alitretinoin. Patients should still be advised to use daily emollients during therapy and once the eczema has cleared.
• Capsules 10mg; 30mg
• Please see links below to risk materials on generic and branded alitretinoin forms
• Use for other indications is via IFR application only to CCG
  

• Swindon area only
• 12.5mg tablets
• The maximum recommended dose is two doses in 24 hours.

•   SFT
•   GWR
•  RUH 
• unlicensed tablets 100mg - Available on a names patient basis only and therefore are considerably more expensive than the suspension.  
• Suspension 500mg in 5ml

• 3mg/g cream for application to tip of penis.
• GWH and SFT only
• Non formulary at RUH

• 10 microgram, 20 microgram, 40 microgram intracavernosal injection.

• Vial 20mg, 50mg

• Flavours: Apple, blackcurrant, orange, strawberry
• 300 kcals 7.8g protein 67g carbohydrate
• 200ml bottle
• Lactose free
• IDDSI level  0

125 ml fluid

28 day supply = 56 bottles, 7000 ml

300 kcals, 12 g protein, 125 ml fluid

IDDSI Level 1 - Slightly thick fluids

 Banes and Wiltshire

 Swindon 

• 475mg capsules

• Capsules 100mg
• Syrup 50mg in 5ml
• For Parkinsons Disease
• 'Off label' for the treatment of fatigue in Multiple Sclerosis according to NICE CG186 Oct14 

• 500mg/2ml

Swindon only

• Paediatric consultant/microbiology advice only
• Monitoring of drug levels required - NOT ROUTINELY STOCKED AT GWH

Non-formulary at BaNES and Salisbury

• Modified release tablets 225mg (Phyllocontin^®) m/r

In asthma - use only at Step 4, after long acting β2 agonists,

leukotriene antagonist and high dose steroids.  Referral may be

preferable. 

• In COPD - Not recommended for routine use. Referral may be

preferable.

• Injection 150mg in 3ml
• Pre-filled syringe 300mg in 10ml
• Note: Should only be used where facilities for cardiac monitoring, defibrillation and cardiac pacing exist.

• Tablets 50mg, 100mg, 200mg, 400mg
• Oral Solution

•  Tablet 10mg, 25mg, 50mg
• 'Off label' use for pain

•  Tablet 10mg, 25mg, 50mg
• 'Off label' use for  neuropathic pain

• Nail lacquer 5%  5ml ,  3ml
• Apply once or twice a week to affected nail for 6 months for fingernails and 12 months for toenails.

• 250mg
• 500mg
• 1g

•  Infusion 50mg
• The National Patient Safety Agency has advised all healthcare staff involved in the use of intravenous amphotericin of the potentially lethal results if non-lipid and lipid formulations of the drug are confused. Caution: double check.

•  Infusion 50mg.
• The National Patient Safety Agency has advised all healthcare staff involved in the use of intravenous amphotericin of the potentially lethal results if non-lipid and lipid formulations of the drug are confused. Caution: double check.

• 500 microgram
• For the treatment of essential thrombocythaemia

• 100mg powder for concentrate for solution for IV infusion
• Treatment of invasive candidiasis in adult non-neutropaenic patients who are unable to tolerate fluconazole or have invasive candidiasis that is resistant to fluconazole as per acute trust guidance.

• Oral suspension: Each 5ml contains 10mg Oxetacaine, Aluminium hydroxide equivalent to 200mg aluminium oxide + 100mg magnesium hydroxide 150ml bottle.
• Not on formulary in GWR and SFT
• RUH only - Antacid and anaesthetic relief of oesophageal pain in palliative care patients (unlicensed)

•  GWH and SFT
•  Bath

• Ointment & suppositories.

• Tablets 2.5mg, 5mg
• For prevention of VTE after total hip or knee replacement in adults.
• Following total hip replacement 2.5mg twice daily for 28 days post op, then stop.
• Following knee replacement 2.5mg twice daily for 14 days post op then stop.

• 0.1% solution

• Titration pack, tablets, f/c, 14-day starter pack of apremilast 4 x 10 mg (pink) with 4 x 20 mg (brown) and 19 x 30 mg (beige).  Otelza
• Tablet, f/c, apremilast 30 mg (beige) x 56 Otelza

• VERY LIGHT MOISTURISER FOR VERY SENSITIVE MILD DRY SKIN, IF ISOMOL GEL HAS BEEN TRIED AND FAILED.
• Branded generic version of Aveeno (cheaper than Aveeno) 
• Patients requiring an emollient who are using medical oxygen therapy should use Aproderm Colloidal as this is a non-paraffin based emollient.

'1' from birth, '2' from 6 months

• 130ml enema.
• Avoid the use of arachis oil in patients with a known nut allergy.

• GWH and RUH only  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. 

• 10mg/10ml infusion

• 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

• 300mg tablets
• Included on formulary for the relief of headache and migraine
• 1-2 tablets (300-600mg) every 3-4 hours as required, to a maximum of 12 tablets (3.6g) daily in divided doses.

• 150mg
• 200mg
• 300mg

• Tablets 25mg, 50mg, 100mg
• Syrup^SF 25mg/5ml

• Tablets 25mg, 50mg, 100mg
• Syrup^SF 25mg/5ml
• Note: Atenolol 25mg once daily increasing to 50mg once daily (unlicensed for this indication, atenolol may be better tolerated than propranolol. Not included in NICE CG150)

• Capsules 10mg, 18mg, 25mg, 40mg, 60mg 

 Note: SCA for Adults link below. SCA for Paeds see Chapter 16

• 10mg, 20mg, 40mg, 80mg
• Primary Prevention: New patients offer atorvastatin 20 mg for the primary prevention of CVD to people who have a 10% or greater 10 year risk of developing CVD. Estimate the level of risk using the QRISK2 assessment tool as per NICE CG below.
• Secondary Prevention: New patients start statin treatment in people with CVD with atorvastatin 80 mg^. Use a lower dose of atorvastatin if any of the following apply: potential drug interactions, high risk of adverse effects, patient preference as per NICE CG below.
• Primary prevention for people with type 1 diabetes as per NICE CG below, start treatment for adults with type 1 diabetes with atorvastatin 20 mg.
• Primary prevention for people with type 2 diabetes as per NICE CG below, Offer atorvastatin 20 mg to people who have a 10% or greater 10?year risk of developing CVD using the QRISK2 assessment tool

• GWH use for the treatment of PJP (Pneumocystis jirovecii pneumonia)

• 25mg in 2.5ml amp
• 50mg in 5ml amp
• 250mg in 25ml vial

•  for use within secondary care
•  very rarely some GPs need to use this for emergencies in primary care.
• 600 micrograms in 1ml amp
• 1mg in 1ml amp
• 1mg in 10ml PFS

• 1mg, 3mg, 5mg and 7mg tablets

• 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

Made with 100 ml whole milk.

316 Calories, 12.6g Protein, 12.5g fat and 27 vitamins and minerals.

IDDSI level 1 - Slightly Thick

•  - BaNES, Salisbury & Swindon (except Swindon patients monitored via the DAWN system and provided with prescriptions by GWH).
•  - GWH - Swindon DAWN patients.
• 25mg & 50mg tablets.
• Please refer to our DMARD Shared Care and Monitoring Guidance for your respective locality for further information.

•   - BaNES, Salisbury & Swindon (except Swindon patients monitored via the DAWN system and provided with prescriptions by GWH)
•   - Swindon DAWN patients
• Please refer to our DMARD Shared Care and Monitoring Guidance for your respective locality for further information
• 25mg and 50mg tablets

• Non-antibiotic treatment option for rosacea (adults only) and mild to moderate papular-pustular acne of the facial area (age 12 upwards).
• Gel 15% 30g
• Apply twice daily discontinue if no improvement  after 1 month (acne) or 2 months (rosacea) 

• Tablets 250mg
• Oral suspension 200mg/5ml
• Included for primary care use only as an option for the treatment of chlamydia, travellers diarrhoea (private prescription) and certain types of Lyme diease.
• See primary care antibiotic guidance for further advice.
•  For COPD prophylaxis (off-label use), the decision to start azithromycin for several months at a time should be initiated by secondary care once the diagnosis of COPD has been confirmed and all the necessary preliminary investigations (eg CT and sputum cultures) has been done. NOT to be initiated by GPs without specialist input.

• 500mg
• 1g
• 2g

• 750mg capsules.
• Please note: Balsalazide is indicated for the treatment of mild to moderate ulcerative colitis and maintenace of remission, but should ONLY be prescribed for patients not responding to other aminosalicylates. 

• Use within GWH ONLY, not for use by primary care

• Bacillus calmette-guerin vaccine
• The BCG vaccine (which stands for Bacillus Calmette-Guérin vaccine) is not given as part of the routine NHS vaccination schedule. It's given on the NHS only when a child or adult is thought to have an increased risk of coming into contact with TB

• Second line to GlucoRx 
• 4mm/32G, 5mm/31G and 8mm/31G sizes only  

• First choice ICS/LABA DPI for asthma and COPD. 
• Combination of beclometasone and formoterol
• For asthma: dry powder inhaler; beclometasone 100 micrograms,
• formoterol 6 micrograms dose and beclometasone 200 micrograms,
• formoterol 6 micrograms dose 
• For COPD with FEV1<50%: dry powder inhaler; beclometasone
• 100 micrograms, formoterol 6 micrograms dose only in line with 
• the product guidance

• Prescribe by brand name
• Clenil^® Modulite aerosol inhalation MDI 50, 100, 200, 250 micrograms/dose
• Soprobec® aerosal inhalation MDI 50, 100, 200, 250 micrograms/dose
• Soprobec® is directly equivalent to Clenil Modulite®
• Clenil^® and Kelhale^®/Qvar^® are first line pMDI low dose ICS for asthma.

• 11 May 2020 - BSW Beclometasone PMDIs Shortages Information

• Intravenous infusion, powder for reconstitution 120mg vial; 400mg vial
• Commissioned by NHSE at specialist centres e.g RUH
• Non Formulary at GWH and SFT 

• Tablets 2.5mg
• Note: 2.5mg produces a maximal blood pressure lowering effect, with very little biochemical disturbance.

• Gel benzoyl peroxide 5%, clindamycin 1% 25g, 50g
• Apply once daily in the evening.

•     for emergency treatment of meningitis
•     for all other indications
• 600mg vials
• 1.2g vials

• Tablet 8mg, 16mg

• Injection 4mg in 1ml

• Potent steroid for scalps with salicylic acid
• Scalp Application Betamethasone valerate 0.05% & Salicylic Acid 2% 100ml
• For very scaly scalps.

• Potent steroid
• Cream, Ointment 0.1%  30g, 100g

• Potent steroid
• Cream, Betamethasone 0.1%, fusidic acid 2% 30g, 60g

• Potent steroid
• 30g, 100g
• For palmoplantar hyperkeratotic inflammatory disease

• Potent steroid
• 100g

•  5ml nasal drops

• Betamethasone sodium phosphate 0.1% with Neomycin sulfate 0.5% eye drops 

• 50mg and 150mg tablets

• 100microgram/ml ophthalmic drops
• 300microgram/ml preservative free single use eyedrops available where indicated as per BSW glaucoma guidance

• For use within SFT

•  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. 

•  Salisbury
•  Bath and Swindon
• Type 2 diabetes only

• Type 2 diabetes only

• A paste of composition Iodoform 40% w/w, Bismuth Subnitrate 20% w/w and Paraffin Liquid 40% w/w. presented in a labelled aluminium laminated pouch.

• Tablets 1.25mg, 2.5mg, 3.75mg, 5mg, 7.5mg, 10mg
• Note: For heart failure, use should be initiated cautiously, titrated slowly and adequately monitored.

• 15,000 unit powder for injection

• Boostrix-IPV suspension for injection in pre-filled syringe
• Diphtheria, tetanus, pertussis (acellular, component) and poliomyelitis (inactivated) vaccine (adsorbed, reduced antigen(s) content) (schedule between 3yrs & 4/12 to 5 years)

• Formulary at RUH and SFT (under shared care with Southampton)
• Tablets 62.5mg, 125mg
• For digitial ischaemia and ulceration in Raynaud's Disease and scleroderma as per NHSE policy below within Specialist Centres

• Powder for reconstitution 50 unit vial, 100 unit vial, 200 unit vial
• If effective repeat 12 weekly, if ineffective discontinue after 2 cycles.
• See BSW policy and prior approval form for chronic migraine below.

• GWH.
• A specific commissioning policy for the use of this for hyperhydrosis is under development (August 19). Current botulinum policy is found below.
• Botulinum toxin units are not interchangeable from one product to another.  Prescribe by brand as advised by hospital pharmacy department.

• 50mg injection
• Also available from NHS England Cancer Drugs Fund

• 0.2% ophthalmic eye drops
• Note - higher risk of side-effects and sensitivity.

• Brinzolamide 1% with Timolol 0.5% 

• Tablets 10mg, 25mg, 50mg, 75mg, 100mg
• Liquid 10mg/1ml
• IV 10mg/1ml 5ml ampoule
• Brivaracetam recommended as an adjunctive AED treatment for adult patients (≥16 years) with focal-onset seizures.
• Only to be used when first or second line treatments have failed. 

• 1mg, 2.5mg   

• 2mg per actuation white foam, 1 canister (14 days treatment).
• Please note: Budesonide foam enema is ONLY indicated for use second line in patients unable to use / tolerate Colifoam^® enema.

• 3mg gastro-resistant capsules.
• Please note: Budenofalk capsules are available for use for their licensed indications of:
  • induction of remission in patients with mild to moderate Crohn's disease affecting the ileum and/or ascending colon,
  • induction of remmission in patients with active collagenous colitis,
  • autoimmune hepatitis (Swindon ONLY).
• Please prescribe BY BRAND. 

• Budesonide nasal spray 64micrograms / spray 120 dose
• Second line for the treatment of allergic rhinitis
• Licensed for nasal polyps.

• No new prescribing. Existing patients only.
• Low strength can be used in a MART regime.
• Prescribe by brand.
• Combination of budesonide and formoterol fumarate dihydrate
• Dry Powder Inhaler 320micrograms/9 micrograms (equivalent to 400/12)
• and 160micrograms/4.5 micrograms (equivalent to 200/6)
• For the treatment of asthma and COPD within product licence

• Respiratory solution 500 micrograms per 2ml, 1mg per 2ml

• 0.25% w/v
• 0.5% w/v
• 1 in 200,000 

• 0.5% solution for injection, 4ml ampoule
• Not routinely stocked at RUH

• Patch 5 microgram/hour for 7 days 
• Patch 10 microgram/hour for 7 days
• Patch 15 micrograms/hour for 7 days
• Patch 20 microgram/hour for 7 days
• Only to be used in patients with cognitive deficit or swallowing difficulties, after a trial of soluble/liquid medication. Zomorph capsules can be opened up for ease of swallowing.
• Buprenorphine patches are NOT suitable, or licensed, for management of acute / intermittent pain.
• Patients and/or their carers neeed to be aware that these patches need to be applied at appropriate seven-day intervals. Remember to remove the old patch before application of new patch. Avoid use of multiple patches.

• Patch 35 microgram/ hour, for 4 days
• Patch 52.5 microgram/ hour, for 4 days
• Patch 70 microgram/ hour, for 4 days
• Only to be used in patients with cognitive deficit or swallowing difficulties, after a trial of soluble/liquid medication. Zomorph capsules can be opened for ease of swallowing.
• Buprenorphine patches are not suitable for management of acute / intermittent pain.
• Patients and/or their carers need to be aware that these patches need to be applied at appropriate 96 hour intervals (or 4 days). Remember to remove the old patch before application of new patch. Avoid use of multiple patches.

• Tablets m/r, f/c 150mg
• CSM advice: Bupropion is contra-indicated in patients with a history of seizures or of eating disorders, a CNS tumour, or who are experiencing acute symptoms of alcohol or benzodiazepine withdrawal.

June 2020 - Out of stock until end November 2020. See MHRA Supply Disruption Alert

• 100microgram and 150microgram nasal spray

• 2mg tablets

• Injection podwer for reconstitution, 500 unit vial

  Acute Treatment or Short-term prophylaxis prior to planned procedures for Hereditary Angioedema and Acquired Angioedema In accordance with NHS England commissioning policy May only be initiated by (or on advice of) Specialist Centres Drug costs for emergency use in other hospitals will be reimbursed through the Specialist Centre Prophylactic treatment of hereditary angioedema (HAE) types I and II In accordance with NHS England commissioning policy in patients who fail, are intolerant or have contra-indications to oral prophylactic therapies. May only be supplied by Specialist Centres Prior approval must be given via Blueteq system

• 500 micrograms    
• Shared care agreement in development

• 20mg, 40mg and 60mg tablets

• Scalp solution, calcipotriol 50 micrograms/ml
• Ointment 50micrograms/g: Note this is not licensed in under 18 years
• First Line Calcipotriol Ointment 50mcg/g 30g Dovonex^®
• Apply Calcipotriol thickly twice a day maximum of 100g per week
• Second Line - If very itchy or inflamed consider adding in a steroid as a separate product e.g Eumovate or Betnovate RD:
• Calcipotriol Ointment 50mcg/g 30g Dovonex^® PLUS Eumovate Cream OR
• Calcipotriol Ointment 50mcg/g 30g Dovonex^® PLUS Betnovate RD Cream
• Apply calcipotriol in the mornings thickly and steroid in the evenings thinly.
• Gradually reduce the steroid and increase the calcipotriol to twice daily
•  Note: When preparations used together, maximum total calcipotriol 5mg in any one week (eg. scalp solution 60ml with cream/ointment 30g OR cream/ointment 60g with scalp solution 30ml)

• Indications: Topical treatment of scalp psoriasis in adults. Topical treatment of mild to moderate “non-scalp” plaque psoriasis vulgaris in adults.
• Contains a potent steroid which may destabilise psoriasis and increase its severity due to rebound pustulation and inflammation.
• The recommended treatment period is 4 weeks for scalp areas and 8 weeks for “non-scalp” areas. If it is necessary to continue or restart treatment after this period, treatment should be continued after medical review and under regular medical supervision.
• The maximum daily dose should not exceed 15 g. The body surface area treated with calcipotriol containing medicinal products should not exceed 30 %

• 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)

• Replaces Calcium Sandoz syrup (discontinued)

• Salisbury and BaNES
• Calcichew chewable tablet containing 500mg calcium/12.5mmol Ca2+

• Parental preparation - Calcium Chloride Injection
•  Min-I-jet 10ml           

• 10ml ampoule
• Infusion 50ml         

•  
•  IF USED IN COMBINATION WITH INSULIN IN TYPE 2 DIABETES FOLLOWING NICE GUIDANCE ONLY
• 100mg,300mg
• Renal Impairment: See SPC for dose adjustments

• Tablets 2mg, 4mg, 8mg, 16mg, 32mg 

BaNES only - Candesartan has been approved for prophylaxis of chronic migraine (unlicensed indication) only when recommended by a specialist. Recommended dose 2mg daily increased by 2mg weekly if needed to max 8mg BD. Patient information leaflet here (Mar 2020 updated guidance to be uploaded)

• 150mg and 500mg tablets

• Cream containing 0.075% capsaicin (Axsain^®)   
• For the treatment of post herpetic neuralgia (after lesions have healed) & painful diabetic peripheral neuropathy sparingly up to 3-4 times a day.
• The recommended duration of use in the first instance is 8 weeks, since there is no clinical trial evidence of efficacy for treatment of more than 8 weeks duration. After this time, it is recommended that the patient's condition should be fully clinically assessed prior to continuation of treatment, and regularly re-evaluated thereafter, by the supervising consultant.

• Pain clinic use only as per local policy below.  

• 12.5mg, 25mg and 50mg
• 5mg/5ml and 25mg/5ml SF solution

Swindon only

Non-formulary in BaNES and Salisbury

• Tablets 100mg, 200mg, 400mg

• 5mg, 20mg
• CSM warning: Neutropenia and agranulocytosis. Doctors are reminded of the importance of recognising bone marrow suppression induced by carbimazole and the need to stop treatment promptly.
• Initiate following discussion with/at the point of referral to a specialist.
• Monitor for signs of infection and warn patients to report sore throat or other signs of infection. Counsel patient of possible risk of skin rash or agranulocytosis.  
• Discuss any course of treatment over 3 years with a specialist.  
• 5mg carbimazole is equivalent to 50mg propylthiouracil

• 0.2% gel 10g

• 150mg/15ml, 450mg/45ml, 50mg/5ml and 600mg/60ml infusion

• Carmellose 0.5ml, glycerol 1%, castor oil 0.25% 10ml

• 1% drop 10ml
• Cellusan is the most cost-effective preservative-free carmellose preparation in primary care
• Swindon only - Use Celluvisc SDUs in secondary care.

• 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.

• 50mg Powder for conc for soln for infusion
• 70mg Powder for conc for soln for infusion
• Indicated for the treatment of invasive candidiasis. Treatment of invasive aspergillosis in patients refractory to or intolerant of amphotericin and/or itraconazole. Empirical therapy for presumed fungal infections in febrile neutropenic patients. Used as per microbiology advice only.

• Capsules 250mg, 500mg
• Tablets 250mg, 500mg.
• Oral suspension 125mg/5ml and 250mg/5ml
• For use in UTIs please see local Primary Care Antibiotic Guidance

• 250mg
• 500mg
• 1g
• 2g
• 2000mg surefuser device over 24hrs via local Outpatient Parenteral Antibiotic Treatment (OPAT) services (acute trusts).

• 250mg
• 750mg
• 1.5g.

• - GWH ONLY.
•  Non-formulary - RUH and SFT
•  3mg in 0.3ml pre-prepared injection.
•  50mg vial.

• 150mg capsules

• Prefilled syringe 200mg.
• Use in accordance with NICE guidance and local pathways for RA, AS or PSA.
• Not routinely commissioned by NHS England for paediatric indications - see NHS England drugs list. 

• 100mg/20ml and 500mg/100ml infusion
• Also available from NHS England Cancer Drugs Fund

•  1g injection

• 1% eye ointment
• Eye ointment available OTC for adults and children over 2 years

• Surgical scrub 4% w/v in surfactant solution (pink)
• Obstetric Cream , chlorhexidine gluconate solution 5%
• Hard surface wipes
• Sterile topical solution sachets for irrigation
• 0.5% w/v in 70% industrial methylated spirits for preop skin use.
• Hand Rub 
• Sterile 0.015% w/v with cetrimide 0.15% (yellow) 25ml sachets
• Chlorhexidine gluconate 4% surgical scrub is used for pre-operative hand and skin preparation and for general hand disinfection.
• A 5-7 day course of mupirocin 2% ointment or cream and chlorhexidine wash is used to decolonise patients with MRSA.

• Contains arachis oil: Should be avoided in peanut or soya allergy
• To avoid the development of resistance, the treatment course should not exceed 7 days and the course not repeated on more than one occasion  

• 10mg powder for reconstitution

• Only available as an unlicensed preparation for specialist initiation only.

Swindon only

Non-formulary in BaNES and Salisbury

• 25mg,50mg,100mg tablets
• 25mg/5ml solution SF
• 25mg/5ml syrup
• 100mg/5ml solution

• This vaccine is not indicated for most travellers

• Not on formulary GWH
• prefilled syringe 6500 unit/0.5ml (250 micrograms/0.5ml) 
• Female infertility       

•  Salisbury ONLY 
• Non-formulary BaNEs & Swindon
• For persistent asthma in exceptional cases e.g in patients with
• poor compliance or patients having side effects on standard inhaled
• corticosteroids. For initiation by Respiratory consultant and ongoing
• prescription by GP

• Infusion 50mg/ml

• 25mg, 50mg and 100mg capsules
• Indicated for bone marrow stem cell transplant.
• The brand to be dispensed should be specified by the prescriber due to differences in bioavailability.
• Preparations are not interchangeable.
• RUH and SFT - Neoral

• 0.1% drops (1 mg/mL eye drops, emulsion)
• Note - Ensure correct product is prescribed; available products have different licensing information and TLS. 
• Ikervis ® is licensed for the treatment of severe keratitis in adult patients with dry eye disease, which has not improved despite treatment with tear substitutes.
• Verkazia®  is licensed for the treatment of severe vernal keratoconjunctivitis (VKC) in children from 4 years of age and adolescents. See here

•  GWH ONLY: for licensed indications:  Treatment of severe psoriasis in patients in whom conventional therapy is inappropriate or ineffective and for patients with severe atopic dermatitis when systemic therapy is required
•  for SFT/RUH and for use in all unlicensed indications
• Capsules 10mg; 25mg; 50mg;

•  IV infusion 75mg/ml, 5ml vial

• 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

• Only to be used in line with local primary care antibiotic guidance indications.
• The EMA’s Pharmacovigilence Risk Assessment Committee has recommended restricting fluoroquinolones following a review of disabling & potentially long-lasting side-effects. See link above for further information. 
• Tablets 250mg, 500mg
• Oral suspension 250mg/5ml

• 0.3% eye drops
  
  
•  Salisbury
•  RUH and GWH - For corneal crystallisation and endophthalmitis
  

• GWH ENT use eye drops in the ear (off-label)

• 10mg/10ml, 50mg/50ml and 100mg/100ml infusion

• Sachet containing citric acid anhydrous 17.79 gram & magnesium carbonate heavy 11.57 gram.

• Tablets 250mg, 500mg
• Oral suspension (SF) 125mg/5ml, 250mg/5ml

• RUH only
• Used in combination with lenalidomide and pomalidomide as per DTC899
• 250mg and 500mg tablets

•  75mg
• 150mg
• For use in primary care as per local antibiotic guidance for unresolving cellulitis.
• GWH use as part of treatment protocol for PCP (Pneumocystis jirovecii pneumonia)
• High risk for clostridium difficile disease. Clindamycin is associated with Clostridium difficile diarrhoea, which limits its use. Patients should discontinue treatment immediately if diarrhoea develops.

• 10% aqueous Solution
• Topical antibiotics should not be used in isolation; use in combination with retinoids or benzoyl peroxide topically if possible.
• Resistance is more likely with topical antibiotics and topical clindamycin can cause resistance to oral erythromycin. Only use topical clindamycin if retinoids/BPO aren't tolerated and the patient does not want to take an oral antibiotic (or has contra-indications).

• 10mg (Category 2 MHRA)
• Endorse SLS when used for epilepsy.
• Clobazam oral suspension 5mg or 10mg/5ml is available but is expensive. Use only if no other option is suitable and there are significant swallowing problems.

   

• Very potent steroid
• Cream 0.0525%, Ointment 0.05375% 30g, 100g
• Scalp Application 0.05% 30ml, 100ml

• Moderate potency steroid
• Cream, Ointment 0.05% 30g, 100g
• Apply sparingly up to twice a day
• Note: Clobetasone butyrate (Eumovate^®) cream can be sold over the counter for short-term symptomatic treatment & control of patches of eczema & dermatitis (but not seborrhoeic dermatitis) in adults and children over 12 years.   

•  50mg       
• Note: Clomifene is only indicated for patients in whom ovulatory dysfunction has been demonstrated and other causes of infertility have been excluded or adequately treated.

Prescribing should fall within NICE CG156:
• Do not offer oral ovarian stimulation agents(such as clomifene citrate, anastrozole or letrozole) to women  with unexplained infertility, and
• For women who are taking clomifene citrate, do not continue treatment for longer than 6 months.
In accordance with the product SPC, 3 courses should constitute an adequate trial.
Due to the limited length of time it is used and that patients are likely to be receiving ongoing care in a specialist setting the number of requests to pick up this prescribing in primary care should be minimal.

• Tablet 500 microgram, 2mg (Category 2 MHRA)
• For injection see 4.8.2 

• Clonidine 25microgram tablets (central acting alpha adrenergic agonist) for the management of vasomotor symptoms in menopause, particularly flushing.
• Designated less suitable for prescribing in the BNF because of significant side effects.

• 1% cream 20g
• 10% vaginal cream 5g 
• 500mg pessary 
• Patients should be advised that clotrimazole products might damage latex condoms and diaphragms.

• Cream 1% 20g  

• Alphosyl 2 in 1^®
• 250ml

• 2.5mg/20mg, 5mg/40mg, (amiloride/furosemide)
• Note: Combination diuretics are not generally recommended, as the individual components cannot be adjusted independently. Restrict use to patients at risk of hypokalaemia, or if compliance problems. 

• 500/100
• 1000/200
• Do not prescribe with metronidazole, unless very significant faecal contamination of abdominal cavity identified during surgery.
• Cholestatic jaundice can occur either during or shortly after
  the use of co-amoxiclav. The risk of acute liver toxicity is about
  6 times greater with co-amoxiclav than with amoxicillin.
  Cholestatic jaundice is more common in patients above the
  age of 65 years and in men.
• The duration of treatment should not usually
  exceed 14 days.

• Capsule 62.5mg, 125mg, 250mg
• Dispersible tablet 62.5mg, 125mg
• M/R capsule 125mg.

• GWH only
• Sterile oromucosal solution 10% 
• For topical use only. Not for injection or to be taken.
• Cocaine Hydrochloride Solution is indicated to provide local anaesthesia and vasoconstriction of accessible mucous membranes prior to surgery especially in the oral, laryngeal, and nasal cavities.

• Prescribe as Sastravi^® brand (Bioequivalent and more cost effective). Sastravi exactly the same strengths as Stalevo - see below:
  • Tablets 50mg levodopa, 12.5mg carbidopa, 200mg entacapone
  • Tablets 75mg levodopa, 18.75mg carbidopa, 200mg entacapone
  • Tablets 100mg levodopa, 25mg carbidopa, 200mg entacapone
  • Tablets 125mg levodopa, 31.25mg carbidopa, 200mg entacapone
  • Tablets 150mg levodopa, 37.5mg carbidopa, 200mg entacapone
  • Tablets 175mg levodopa, 43.75mg carbidopa, 200mg entacapone
  • Tablets 200mg levodopa, 50mg carbidopa, 200mg entacapone

• Tablets cyproterone 2000mcg ethinyl estradiol 35mcg per tablet (prescribe generically, previous brand name Dianette)

• Tablet 15mg, 30mg, 60mg
• Oral solution 25mg in 5ml
• Useful for the relief of mild to moderate pain but is too constipating for long-term use

• 500 microgram tablets
• The dose of colchicine in acute gout is 1mg initially followed by 500 micrograms every 2-3 hours until relief of pain is obtained or vomiting or diarrhoea occurs or until a total dose of 6mg (12 tablets) has been reached. The course should not be repeated within 3 days.

• Non formulary BaNES.
• 20,000 unit, 3200 unit, 800 unit available 
• Licensed for use in children 12-18 years old and adults.
• Please note capsules contain gelatin

• BaNES and Swindon - first line for primary care
• Salisbury - non formulary
• 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

• Salisbury- First line calcium and vitamin D product in primary care.
• Swindon- For existing patients only.
• Chewable tablets containing 500mg/12.5mmol calcium and 400 units/ 10micrograms of Vitamin D (as Vitamin D3/colecalciferol)
• Dose: 1 tablet twice daily. 

• 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.

• 5g sachet.

SUPPLY ISSUES WITH COLESTYRAMINE 

Jan 2020 - BaNES, West Wilts and Swindon patients - Temporary change in TLS from AMBER to GREEN While Colestyramine is unavailable, RUH gastroenterologists have provided interim advice and guidance for local GPs to prescribe suitable alternatives in primary care for patients with bile acid malabsorption disorders.  Gastroenterology recommends GPs consider prescribing one of the two following options:

- Colesevelam 625mg tablets - One tablet OD or

- Colestipol 5g sachet - 1 sachet OD

as per BNF instructions, particularly around timings of other medications. Then increase the dose incrementally at weekly intervals to control symptoms up to the maximum dose as recommended in the BNF. If the alternatives aren’t effective, then GP should consider prescribing Loperamide and consider alternative diagnoses +/- secondary care referral where appropriate.

• Powder 4g sachet (Note: The sugar free sachet is less cost effective)
• Should only be used for lipid-lowering in exceptional circumstances and be initiated by a consultant. It remains useful in the small number of patients for whom statins cannot be used.

•  RUH CF patients (seen at BRI hospital) TLS Red for management of acute and chronic CF infections 
   
•  RUH only: Nebulised- NON-CF patients chronically colonised with P.aeruginosa Prescribe as Colomycin® brand along with sodium chloride ampoules for reconstitution as detailed in SCA (below)
  
  
•  GWH for use in bronchiectasis and existing CF patients (usually nebulised).
•   GWH for use in new CF patients (usually nebulised).
•  GWH use IV for treatment of carbapenemase-producing Enterobacteriaceae
  
  
• 500,000 units
• 1 million units
• 2 million units

• Suspension^SF 195/220 (low sodium, bowel neutral). 

• 2mg estradiol and 1mg norethisterone
• 1 prescription charge. 

• 1mg estradiol + 5mg dydrogesterone
• 0.5mg estradiol + 2.5mg dydrogesterone (low dose)

• Tablets estradiol (1mg, 2mg) with 1mg norethisterone acetate
• 2 prescription charges

• Tablets (1mg or 2mg) estradiol with 10mg dydrogesterone 

• Multiphasic pills containing ethinylestradiol 30 micrograms, levonorgestrel 50 micrograms;  ethinylestradiol 40 micrograms, levonorgestrel 75 micrograms; ethinylestradiol 30 micrograms, levonorgestrel 125 micrograms; 7 inactive lactose tablets. 3 x 28 tablets.

• Ethinylestradiol 15 micrograms/24 hours with Etonogestrel 120micrograms/24 hours. 3 ring pack. 1 ring to be inserted into the vagina, removed on day 22; subsequent courses after 7 day ring-free interval.
• May be considered in women:
• with GI disturbance /malabsorption.
• getting persistent breakthrough bleeding with COCP (good cycle control).
• who have difficulties swallowing pills, and are not keen on other methods of contraception.
• getting hormonal side effects with COCP (relatively low oestrogen exposure).

• 100g, 500g
• Benzalkonium chloride, cetrimide
• Nappy rash or for use in elderly in nursing homes

• 480mg/5ml
• 960mg/10ml

• 480mg/5ml
• 960mg/10ml

• 200mg and 250mg tablets
• Also available from NHS England Cancer Drugs Fund

• For use within the RUH
• For treatment of gastric variceal bleeding

• Tablet 50mg
• Injection 50mg in 1ml

• For nausea and vomiting
• 50mg/ml
• Can be used in syringe drivers check compatibility
• See page 89/90 Wessex Palliative Care Handbook (link at start of chapter)

• 0.5% and 1% ophthalmic drops
• 0.5% and 1% minims

• 50mg tablets

• 50mg and 100mg tablets

• 100mg/5ml, 500mg/25ml, 1g/10ml, 2g/20ml and 500g/5ml injection

• 110mg, 150mg
• For the primary prevention of venous thromboembolic events (VTE) in adults who have undergone elective total hip replacement or total knee replacement surgery in accordance with NICE TA below. 

• 500mg and 1g infusion
• 100mg and 200mg injection

• 500microgram powder for reconstitution

• SFT and GWH only and restricted for use on the advice of a haematologist for the treatment/prophylaxis of thromboembolic disease in patients with a history of heparin-induced thrombocytopenia
• Non formulary at RUH
• 750 units/0.6ml solution for injection ampoules

• Swindon and Salisbury
•  BaNES
• 25mg and 100mg capsules
• Liver function tests should be performed before commencing dantrolene, and then repeated on discharge from hospital (or 6 weeks after starting therapy) and then at 3 monthly intervals. 

• 5mg, 10mg
•  
•  IF USED IN COMBINATION WITH INSULIN IN TYPE 2 DIABETES FOLLOWING NICE GUIDANCE ONLY
•  IF USED IN COMBINATION WITH INSULIN IN TYPE 1 DIABETES FOLLOWING NICE GUIDANCE ONLY. NOTE: Only the 5mg strength is licensed for this indication.
• NOTE - GPs will need to prescribe ketone test strips for type 1 diabetes patients to use whilst on dapagliflozin
• Renal Impairment: See SPC for dose adjustments

• for licensed conditions RUH/SFT
• for licensed conditions GWH, shared care agreement in process.
•  for unlicensed indications
• Tablets 50mg, 100mg
• Licensed for the treatment of dermatitis herpetiformis 
• Maximum  daily dose 300mg
• Restricted for use on dermatology recommendation.
• Tablets disperse in water if needed. 

• 100mg/5ml and 400mg/20ml infusion
• ONLY available from NHS England Cancer Drugs Fund

• 400mg
• 600mg
• 800mg

•  Tablets 250mg

• 20mg infusion

• 200mg (80 mg/mL concentrate for solution for infusion)
• For the treatment of veno-occlusive disease in accordance with treatment of possible hepatic veno-occlusive disease as noted in link below
• Formulary at RUH for this indication

• Swindon: multivitamin containing vitamins A, D, E and K for the dietary management of patients with cystic fibrosis on the specific recommendation of a specialist in cystic fibrosis.
• 1-4yrs DEKAs liquid
• 5-8yrs DEKAs liquid or softgel capsules or chewable tablets
• >9yrs DEKAs softgel capsules or chewable tablets

• Capsules 150mg      
• Used in the treatment of hyponatraemia resulting from inappropriate secretion of antidiuretic hormone (SIADH). Requires specialist initiation.

• Each vial contains 120 mg of denosumab in 1.7 mL of solution (70 mg/mL).
• Indication on formulary: Prevention of skeletal related events (pathological fracture, radiation to bone, spinal cord compression or surgery to bone) in adults with advanced malignancies involving bone.
• Not to be prescribed in primary care. 
• New monitoring - Monitoring of calcium levels should be conducted (i) prior to the initial dose of XGEVA, (ii) within two weeks after the initial dose, (iii) if suspected symptoms of hypocalcaemia occur Additional monitoring of calcium level should be considered during therapy in patients with risk factors for hypocalcaemia, or if otherwise indicated based on the clinical condition of the patient.

• Camouflage Cream and Fixing Powder

• Benzalkonium chloride 0.5% 250ml 

• 500mg, 2g powder for solution for injection vials
• Commissioned by NHS England for iron chelation in thalassaemia and sickle cell anaemia.   

• SFT only - for the treatment of mild haemophilia A or von Willebrand's disease. Consultant haematologist use only.
• Non formulary at RUH and GWH
• For non-haematology indications, please see chapter 6.5.2

• Nasal spray 10 micrograms per metered spray 60 dose unit
• Nasal spray no longer licensed for primary nocturnal enuresis (bed wetting) due to adverse drug reactions including hyponatraemia.
• DDAVP^®/Desmopressin Intranasal Solution is indicated for:
  • The diagnosis and treatment of vasopressin-sensitive cranial diabetes insipidus.
  • The treatment of nocturia associated with multiple sclerosis where other treatments have failed.
  • Establishing renal concentration capacity.

• For specific indications
• Tablets 500 microgram, 2mg
• Oral solution 2mg/5ml
• 3.32 mg of dexamethasone (dexamethasone base) in 1 ml solution for injection
• 6.64 mg of dexamethasone (dexamethasone base) in 2 ml solution for injection
• Injection  (BCAP only) Each ml of solution for injection contains 4.00 mg of dexamethasone phosphate (as 4.37 mg dexamethasone sodium phosphate) equivalent to 3.32 mg of dexamethasone base.

• - Bath & Swindon
• Non formulary - Salisbury
• 0.1% preservative free eye drops in 0.5ml unit doses

• For specific indications
• Tablets 500 microgram, 2mg

• Dexamethasone 0.1%, neomycin sulfate 3250 units/ml, glacial acetic acid 2%

• Dexamethasone 1 mg/gram with neomycin 3500 units/gram and polymyxin B sulfate 6000 unit per 1 gram in 3.5g eye ointment
• Dexamethasone 1 mg/ml with hypromellose 5 mg/ml with neomycin (as neomycin sulfate) 3500 units/ml with polymyxin B sulfate 6000 units/ml in 5ml eye drops

• 5mg
• Only for those whose ADHD symptoms are responding to lisdexamfetamine but who cannot tolerate the longer effect profile.
• Local SCA being amended to include this drug (Feb 2020)

• Injection 5mg, 10mg, 30mg, 100mg, 500mg 
• For use in Palliative Care see chapter 20

• Currently unavailable (March 2020)
• Use Morphine first line in syringe drivers
• For pain relief
• 100mg and more in a syringe driver (where low volume required) on advice of palliative care specialist 

• Tablets 2mg, 5mg, 10mg
• Oral Solution 2mg in 5ml,
• Suppositories

• 5mg/ml Intravenous injection (emulsion) (Diazemuls^®)

• 10mg in 2ml Injection (emulsion - Diazemuls^®) 

• Tablets 2mg, 5mg, 10mg
• Oral Solution 2mg in 5ml,

• 50mg
• For the treatment of recurrent or chronic intractable hypoglycaemia caused by insulinoma or other tumour.

•  GWH ONLY - For the short-term prevention & treatment of post - operative pain.
• Non- formulary at RUH and SFT
• 75mg in 1ml injection.
• Cardiovascular risk is higher with diclofenac than other non-selective NSAIDs and similar to selective COX-2 inhibitors.
• Diclofenac should be used for short courses only.

•  Swindon - Pre-operative & immediately post - operatively. For short-term pain relief in episcleritis, cornial abrasion or foreign bodies. Avoid single use except in allergy to preservatives
• RUH (Single use eye drops 0.1%)
• Non formulary in Salisbury

• 75mg in 3ml injection
• As recommended by palliative care specialists
• Can be used in syringe drivers
• See page 89/90 Wessex Palliative Care Handbook (link at start of chapter)

• 1mg and 5mg tablets

• Tablets 62.5 micrograms, 125 micrograms, 250 micrograms
• Elixir 50 micrograms/ml

• 40mg powder for solution for infusion vials DigiFab^®
• Note: For reversal of life-threatening digoxin overdose

• Tablets 60mg
• Although the means of formulation has called for the strict designation ‘modified-release’ the duration of action corresponds to that of tablets requiring administration 3 times daily.

• 2% ointment.
• 2% cream.
• Please note: This is for use second- line for the treatment of chronic anal fissures, after GTN 0.4% ointment, prior to considering surgery, with maximum duration of use of 8 weeks. (Unlicensed).
• Please note: 2% ointment is more cost-effective in primary care, whilst 2% cream is more cost-effective in secondary care.

• Tablets 30mg, 120mg 
• NICE TA 475 guidance Dimethyl fumarate for treating moderate-to-severe plaque psoriasis (Sept 2017)
• The brand Fumaderm was previously used before the licensed product beccame available in the UK. There may still be some existing patients on this imported product, who will be reviewed by their specialist.

• Prostin E2^® dinoprostone 3mg vaginal tablets
• Prostin E2^®  dinoprostone 400micrograms per 1ml, 800micrograms per 1ml vaginal gel. 
  NB Prostin E2 vaginal tablets and vaginal gel are not bioequivalent. 
• Propess^® dinoprostone 10mg vaginal pessaries with retrieval device. 

• 20mg/4.5ml infusion

Checking if being used locally as specialist

• 100mg tablet
• 200mg MR capsule

• 15mg, 30mg, 60mg, 90mg 
• For multiple myeloma and treatment of hypercalcaemia.           

• 0.5ml,1.0ml

• Restricted: Specialist Prescribing Only. Various forms as per BAD specials list.
• See section 13.14 for BAD specials information

• 250mg in 20ml
• 250mg in 50ml

• 100mg capsules.
• 50mg in 5ml oral solution SF.
• 120mg micro enema.

• 50 mg dolutegravir (as sodium), 600 mg of abacavir (as sulfate) and 300 mg of lamivudine

• for short-term use/ 1 week
• for long-term use (off-label)
• Tablet 10mg
• Suspension 5mg in 5ml
• Suppository 30mg (only available as unlicensed import)
• Domperidone is the antiemetic of choice in Parkinsons Disease
• Domperidone should be used at the lowest effective dose for the shortest possible duration (max. treatment duration should not normally exceed 1 week);

•    BaNES area
•   Swindon area
•    Wiltshire area
• Tablet 5mg, 10mg

• 50mg/5ml

• 2% eye drops

• Injection 100mg in 5ml

• Tablets 1mg, 2mg, 4mg.
• Only prescribe generic immediate-release formulations. 

• 10mg/5ml, 50mg/25ml, 100mg/50ml and 200mg/100ml injection

• 50mg
• 100mg

• 50mg and 100mg

• GWH only for short-term peri-operative use on the advice of a consultant anaesthetist

• Capsules 30mg, 60mg
• Useful for mixed anxiety and depression.
• AWP guidance suggests it should not be prescribed except where other treatments are poorly tolerated or ineffective if being used for depression alone.
• Ensure you have chosen the correct product as Duloxetine comes in different strengths and forms which have different license indications.
• Hyponatraemia has been reported with duloxetine, and may be due to a syndrome of inappropriate anti-diuretic hormone secretion (SIADH). The majority of cases of hyponatraemia were reported in the elderly, especially when coupled with a recent history of, or condition pre-disposing to, altered fluid balance. Caution is required in patients at increased risk for hyponatraemia, such as elderly, cirrhotic, or dehydrated patients, or patients treated with diuretics.

• Capsules 30mg, 60mg
• For the treatment of diabetic peripheral neuropathic pain
• Discontinue if inadequate response after 2 months, review treatment every 3 months.
• Ensure you have chosen the correct product as Duloxetine comes in different strengths and forms which have different license indications.
• Hyponatraemia has been reported with duloxetine, and may be due to a syndrome of inappropriate anti-diuretic hormone secretion (SIADH). The majority of cases of hyponatraemia were reported in the elderly, especially when coupled with a recent history of, or condition pre-disposing to, altered fluid balance. Caution is required in patients at increased risk for hyponatraemia, such as elderly, cirrhotic, or dehydrated patients, or patients treated with diuretics.

• 300mg in 2ml solution for injection in a pre-filled syringe
• Use as per NICE TA

• 15mg,30mg,60mg
• For treating and for preventing DVT and PE. Use as per NICE TA below
• For stroke prevention in non-valvular AF. Use as per NICe TA below 
• Note: For NVAF, choice of DOAC should be based on individual patient characteristics. See here for example decision making tool. If clinically appropriate, edoxaban may be considered first line based on lowest acquisition cost (Aug 2019). 

• Capsules 50mg, 100mg, 200mg
• Tablets 600mg
• Oral solution (SF) 30mg/ml

•  Tablets 50mg/100mg

• 
•  IF USED IN COMBINATION WITH INSULIN IN TYPE 2 DIABETES FOLLOWING NICE GUIDANCE ONLY
• 10mg, 25mg
• Renal impairment: See SPC for dose adjustments

•  Emtricitabine/Tenofovir alafenamide 200mg/10mg or 200mg/25mg 

•  Rilpivirine 25mg, emtricitabine 200mg tenofovir alafenamide (TAF) 25mg

• 2.5mg, 5mg, 10mg and 20mg

200 ml bottle.

28 day supply =  56 bottles, 12,320 ml

300 kcals, 10.6 g protein, 71.9 g carbohydrate

NOT SUITABLE FOR PEOPLE WITH COPD OR DIABETES

IDDSI level 1 - Slightly thick fluids

Consider for patients with constipation.

200 ml bottle

28 day supply = 56 bottles, 11,200 ml

310 kcals, 13 g protein, 5.0 g fibre, 200ml fluid

IDDSI Level 1 - Thin fluids

• 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

•   500 micrograms
•   1mg

• Injection 30mg in 1ml
• Tablets 30mg for treatment of persistent (12 hours) and orthostatic hypotension, refractory to fluid bolus, during attempts to mobilise patients following spinal anaethesia for total hip or total knee arthroplasty

• GREASY MOISTURISER FOR SEVERE DRY SKIN
• YSP 30%, LP 40%, emulsifying wax 30%
• 500g or 125g pack sizes available

• CREAM FOR MILD TO MODERATE DRY SKIN
• 500g flexi-dispenser which can be used by care homes. No pump pack available.
• Primary Care Diprobase^®alternative

March 2020 - EPIMAX® name change

Minor name changes covering part of the EPIMAX® range came into effect in the March 2020 Drug Tariff. For the next 12 months, the products will occupy a dual listing on the drug tariff, such that prescriptions written under both the new and old name can be reimbursed. Despite the new names and associated change in the appearance of the labels, the product itself remains unchanged. 

EPIMAX® Original Cream (previously Epimax Cream)