• 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

• 20mg powder and solvent for solution for intraocular irrigation

• Acetylcysteine eye drops 5%, hypromellose 0.35% 10ml (includes benzalkonium chloride, disodium edetate)
• Specialist initiation - Only if filamentary keratitis present.

•  
• 200mg
• 400mg
• 800mg
• During Varicella Zoster Immunoglobulin Shortage (Aug 2018):
  •  "off label" use during the shortage of Varicella Zoster Immunoglobulin (VZIG)in patients who are 20+ weeks pregnant.Only to be used as AMBER on specialist advice.
  •  Dose 800mg four times a day from day 7 to 14 after exposure

• Cream 5% 2g, 10g
• Apply to lesions every 4 hours (5 times a day) for 5-10 days

• For patients with manual dexterity problems or an eGFR<30ml/min. 
• Inhalation powder 322 microgram/dose aclidinium

• Injection 40mg prefilled syringe, prefilled pen
• Prescribe by brand. Biosimilar first-line option.  Imraldi^® first line biosimilar across BSW
• For rheumatoid arthritis in accordance with NICE TA375.

• Commissioned by NHS England From Specialist Centres Only for:
  • Juvenile idiopathic arthritis in line with NICE TA373.
  • Paediatric indications where an adult NICE TA is available
• Check Trust contracting arrangements.

• Cream 0.1% 45g
• Gel 0.1% 45g
• For the prevention of relapse.

• Swindon only
• BaNES and Salisbury - not on formulary 
•  1500mg chewable tablets, each containing 1.5g calcium carbonate.

• 6mg in 2ml

• Injection 100 micrograms/ml, 1ml amp, 10ml amp,
• Injection 100 micrograms/ml 3ml, 10ml prefilled syringes

• Aerochamber Plus standard with mask cannot be used without the mask.
• Please prescribe standard device with mouthpiece if the mask is not required.

• Eskazole 400mg tablets (Imported (France)
• Zentel 200mg chewable tablets (Imported (Australia)
• Zentel 400mg chewable tablets (Imported (United States)
• Dermatology use for cutaneous larva migrans

• 12mg/1.2ml infusion

•   Salisbury 
•   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)

Alfentanil is only included on the BSWformulary for palliative care use in primary care when prescribed in SWINDON under specialist recommendation (AMBER TLS).

SAFETY NOTE - Alfentanil is a potent opioid anaesthetic agent that has a lower analgesic potency than fentanyl, but a much more rapid onset of action. Peak analgesic and respiratory depressant effects occur within 90 seconds. Use care when prescribing to ensure the dose is correct as severe harm and death has occurred from dose errors.

Preparations available: 

• 500micrograms in 1mL (available as 1mg/2ml and  5mg/10ml ampoules)
• 5mg in 1ml (THIS IS TEN TIMES THE STRENGTH OF PREPARATION ABOVE. This higher strength preparation will not be widely stocked in clinical settings)

All alfentanil preparations are RED TLS drugs in Wiltshire ans BaNES.

• 75mg/ml, 150mg/ml solution for injection in a pre filled pen
• Consultant Lipid specialist only.
• As an adjunct to diet in primary hypercholesterolaemia or mixed dyslipidaemia: with a statin when LDL-C response to a statin alone is insufficient, and alone or with other lipid-lowering treatments if statins are contraindicated or not tolerated.

• 100mg and 300mg tablets
• The dose of allopurinol should be reduced in patients with renal failure.

• 6.25mg, 12.5mg, 25mg
• Not licensed for monotherapy and no data to support the use of alogliptin with metformin & a sulphonylurea in triple oral therapy
• First line DPP-4 for all new patients who fulfil criteria in accordance with NICE guidance NG28 December 2015
• Most cost-effective gliptin
• Renal Impairment: See SPC for dose adjustments

• RUH only
• Non formulary at GWH and SFT
• 500 micrograms/ml solution for infusion

• 10 microgram, 20 microgram, 40 microgram intracavernosal injection. 
• Please note patients will be taught, in clinic, how to administer the dual chamber system. If this form of Caverject is unavailable, patients should not be switched to other Caverject preparations, unless advised by a specialist, as they will need to be re-trained in how to use the new device.

• 125 microgram, 250 microgram, 500 microgram, 1000 microgram transurethral delivery system.   

• - GWH - For use by GWH Ophthalmologists for the treatment of submacular haemorrhage, following appropriate training. **Please note this is an off-label indication**.
• Non-formulary - Bath & Salisbury.
• Vial: 10mg

• Not suitable for people with diabetes, COPD and wounds due to carbohydrate:protein ratio
• 200ml bottle
• See ONS guidance for full product details (link at top)

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)

• Cream, ointment & suppositories.

• Tablets 2.5mg, 5mg
• The Traffic Light Status for apixaban depends on the prescribed indication:
  
  
•  Prevention of stroke and systemic embolism in NVAF. (TA275)
•  Treatment and secondary prevention of DVT and/or PE. (TA341)
•  OFF-LABEL treatment of cancer associated thrombosis NOTE: Only for patients seen at the RUH. At other trusts, this would be a RED TLS indication currently. See SCA below.
•  Prevention of VTE after elective hip or knee replacement. (TA245) 
• Following total hip replacement 2.5mg BD for 28 days post op then stop.
• Following knee replacement 2.5mg BD for 14 days post op then stop.

• 1% single use eye drops 
  

   

• 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

• Tablets 300mg
• 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, 80mg, 100mg 

 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

• Solution for intracavernosal injection.
• GWH and SFT only
• Non formulary at RUH

• 200ml bottle
• See ONS guidance for full product details (link at top)

• 57g sachets
• See ONS guidance for full product details (link at top)

• 100mg injection

• 25mg and 50mg tablets
• Chemotherapy/post transplant

• Severe refractory eczema or as a steroid sparing agent (unlicensed use)
• Tablets 25mg; 50mg

• 140micrograms/dose nasal spray 22ml
• Useful option for patients who do not want to try a corticosteroid or have contra-indications to them

• 250mg and 500mg
• 200mg/5ml 

• Tablets 10mg
• Liquid 5mg in 5ml 
• Serious side-effects can follow abrupt withdrawal of baclofen; therapy should be discontinued by gradual dose reduction over at least 1-2 weeks (longer if symptoms occur)
• Bath only - Intrathecal Baclofen - Refer to the NHS Commissioning Board Clinical Policy D04/P/c: Intrathecal baclofen (ITB) 

• 2mg and 4mg tablets
• CCG commissioned as per NICE TA466

• Tuberculline purified protein derivative (PPD) (Mantoux test) - named patient. 

• Prescribe by brand name
• MDI 50mcg and 100mcg
• Clenil^® and Kelhale^® /Qvar^® are first line pMDI low dose ICS for asthma.
•  
  11 May 2020 - BSW Beclometasone PMDIs Shortages Information

• First choice ICS/LABA pMDI for asthma and COPD and the only licensed pMDI for COPD. 

• Aerosol inhalation MDI 120 dose unit beclometasone100 micrograms, formoterol 6 micrograms dose andbeclometasone 200 micrograms, formoterol 6 micrograms dose 

• Adults over 18 years only. (dose = 1-2 puffs twice daily,max 4 puffs twice daily) 

• 200 dose nasal spray, 50 micrograms per spray     
• Beclomethasone is licensed for the prophylaxis and treatment of allergic and vasomotor rhinitis.    
• First line for treatment of allergic rhinits  . OTC for over 18 years.

• 25mg and 100mg infusion
• Also available from NHS England Cancer Drugs Fund

• Aqueous gel 5% 

• oral rinse 0.15% 300ml
• oromucosal spray 0.15% 30ml

• GWH use to treat syphilis in HIV patients by the sexual health team.
• RUH sexual health specialists use this as well for syphilis
• A long acting form of benzylpenicillin administered by deep intramuscular injection. It is usually given as a single dose or weekly for the treatment of syphilis depending on the disease stage and guidelines used.
• 600,000 units or 1.2 MU Injection

•  Salisbury 
•  RUH
•  GWH For use as a mouthwash: dissolve betamethasone (as betamethasone sodium phosphate) 500 microgram soluble tablet in 10ml of water and use as a mouthbath up to five times a day.

• 0.1% eye drops

• Moderate potency steroid
• Cream, Ointment 0.025% 100g
• Apply sparingly once or twice daily

• Potent steroid
• Cream, Ointment Betamethasone (as valerate) 0.1% clioquinol 3% 30g
• Was Betnovate C (discontinued)

• Potent steroid
• Cream Betamethasone diproprionate 0.05%, clotrimazole 1% 30g

• Potent steroid
• Scalp application 0.1% 100ml water miscible in basis containing coconut oil derivative. 
• Well-tolerated if scalp stings easily.

• Ear drops 0.1%  
• Prolonged use of topical corticosteroids should be avoided.
• Betamethasone products for use in nasal allergy please refer to 12.2.1

• 0.5% ophthalmic drops and 0.25% ophthalmic solution

• Only to be prescribed after having had a telephone consultation with a specialist
• 200mg, modified release tablets 400mg (Bezalip mono^®)
• NICE. Do not do recomendation: Do not routinely offer fibrates for the prevention of CVD to any of the following: -people who are being treated for primary prevention -people who are being treated for secondary prevention -people with CKD -people with type 1 diabetes -people with type 2 diabetes.

• Tablets containing bictegravir sodium equivalent to 50 mg of bictegravir, 200 mg of emtricitabine, and tenofovir alafenamide fumarate equivalent to 25 mg of tenofovir alafenamide
• For treatment of HIV-1 in adults in line with NHSE CCP

• 300micrograms and 5mg/ml combination ophthalmic drops

• Saliva replacement oral gel
• 50g
• ACBS

•  Salisbury
•  Bath and Swindon
• Type 2 diabetes only

• Type 2 diabetes only
• NOTE - Insuman Comb 15 cartridge is being discontinued.
• NOTE - Insuman Comb 25 vial is being discontinued.

• 5mg tablets.
• 5mg & 10mg suppositories.

•  - Salisbury & Swindon.
• Non-formulary - BaNES
• 262.5mg chewable tablets.
• Please note: This is ONLY included for use as part of H.pylori eradication therapy, as described above in Section 01.03 Helicobacter pylori infection.
• When used as the bismuth element of H. pylori eradication therapy, the dose of bismuth subsalicylate is 525mg four times daily (prescribe generically).

• Injection, powder for reconstitution 250mg vial
• Anticoagulation during PCI

• 15mg tablets
• Also available from NHS England Cancer Drugs Fund

• 3.5mg infusion
• Also available from NHS England Cancer Drugs Fund

• 100mg, 400mg and 500mg tablets
• Also available from NHS England Cancer Drugs Fund

• Dysport^® injection 300 or 500 unit vial
• Botox^® Injection powder for reconstitution 50 unit vial, 100 unit vial, 200 unit vial
• Xeomin^® Injection powder for reconstitution 50 unit vial, 100 unit vial, 200 unit vial.
• See BSW CCG Botulinum commissioning policy for approved indications on the link below.
• Botox can also be used for migraine in accordance with recommendations of NICE TA 260.
• Xeomin® may be used for chronic sialorrhoea associated with chronic neurological conditions in line with licences and with NICE TA605
• Preparations are not interchangeable and should be used under specialist supervision.
• Commissioned by NHS England for use in focal spasticity in children according to set criteria.

• See BSW CCG Botulinum commissioning policy for approved indications:
• Management of bladder dysfunction in adults not adequately managed with anticholinergics for: Overactive bladder with symptoms of urinary incontinence, urgency and frequency.
• Neurogenic detrusor over-activity with urinary incontinence due to sub-cervical spinal cord injury or MS.

• 30mg, 90mg and 180mg

• 1% eye drops

• ophthalmic drops containing 10 mg/mL of brinzolamide and 2 mg/mL of brimonidine tartrate equivalent to 1.3 mg of brimonidine.

BaNES/Wilts - For use as per Glaucoma guidance 
Swindon - Not on formulary

• 210 mg solution for injection in pre-filled syringe
• Use as per NICE TA

• 1mg oro-dispersible tablets.
• For treatment of eosinophlic oesophagitis.
• Please prescribe BY BRAND.

• 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.
• Please prescribe BY BRAND. 

• Prescribe by brand name
• Easyhaler dry powder for inhalation MDI
• 100 micrograms/dose, 200 micrograms/dose, 400 micrograms/dose
• Turbohaler dry powder inhaler MDI 100 microgram/dose,
• 200 micrograms/dose, 400 micrograms/dose
• Easyhaler Budesonide^® and Pulmicort^® are the first line DPI low dose ICS for asthma. 

• No new prescribing. Existing patients only.
• Can be used in a MART regime. 
• Prescribe by brand.
• Combination of budesonide and formoterol
• Turbohaler dry powder inhaler DPI 100/6; 200/6; 400/12
• Notes: Symbicort Turbohaler is licensed for both asthma and COPD;

• First choice ICS/LABA DPI for asthma.
• Can be used in a MART regime.
• Prescribe by brand
• Combination of budesonide and formoterol fumarate dihydrate
• Breath-actuated dry powder inhaler 80 micrograms/4.5micrograms,160 micrograms/ 4.5 micrograms and 320 micrograms/9 micrograms
• For the treatment of asthma and COPD within product licence
• Most cost effective option July 2018

• Tablets 1mg, 5mg
• Bumetanide is significantly more expensive than Furosemide in primary care.

• 25mg in 10ml (0.25%) amp
• 50mg in 10ml (0.5%) amp
• 75mg in 10ml (0.75%) amp
• GWH only: 0.1% and 0.125% epidural infusion bags used.

• HIGH STRENGTH 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.

•  BaNES
• Swindon/North Wilts: Under review
• Sublingual Tablets 400micrograms, 2mg, 8mg
• For treatment of substance misuse 
• See BaNES CCG shared care for substance misuse on link above
• The recommended criteria for generalist prescribers to prescribe in the field of opioid dependence is that they have completed the RCGP Certificate in the Management of Drug Misuse (part one) and be part of the Local Enhanced Service (LES) for substance misuse
• GPs with Specialist Interest (GPwSI) in substance misuse and specialist prescribers in the field of substance misuse (not LES prescribers) are "secondary care prescribers" for the purpose of these guidelines.
• Supervised Consumption through an accredited pharmacy should be undertaken for a minimum of twelve weeks at the start of methadone and buprenorphine treatment in line with DOH and NICE

• LOW STRENGTH PATCH
• 7 day patch of choice for consistency and safety
• 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.

• For fertility treatment
• 150 micrograms / metered spray

• Tablets 5mg
• No withdrawal effects but response to treatment may take up to 2 weeks

• 60mg/10ml infusion

• 60mg/1.5ml infusion

• 20mg, 40mg and 60mg tablets
• 20mg and 80mg capsules
• Also available from NHS England Cancer Drugs Fund

• BaNES and Salisbury only
• Swindon - not on formulary
• 500mg chewable tablets, each containing 1.25g calcium carbonate.  

• Ointment Calcipotriol 50mcg/g betamethasone diproprionate 500mcg/g 120g  
• Contains a potent steroid which may destabilise psoriasis and increase its severity due to rebound pustulation and inflammation.
• Usual max duration of treatment is 4 weeks. 
• Max 15g daily to no more than 30% of body surface area; max 100g weekly; 75g weekly (child >12 yrs)

• One gram of cutaneous foam contains 50 micrograms of calcipotriol (as monohydrate) and 0.5 mg of betamethasone (as dipropionate).
• Contains a potent steroid which may destabilise psoriasis and increase its severity due to rebound pustulation and inflammation.
• Usual max duration of treatment is 4 weeks. 
• Max 15g daily to no more than 30% of body surface area; max 100g weekly; 75g weekly (child >12 yrs)

• Can be used on the face (with caution) and flexures unlike Dovonex.
• It is recommended that not more than 35% of the body surface be exposed to daily treatment. Not more than 30 g of ointment should be used per day. There is limited clinical experience available for the use of this dosage regimen of more than 6 weeks.

 Swindon

  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

• 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.

• Folinic acid (as Calcium folinate) 7.5mg per 1ml
• Chemotherapy induced mucositis and myelosuppression

please note, may not be stocked at RUH but can be ordered through supplies

• Tablets 2mg, 4mg, 8mg, 16mg, 32mg

• Coal tar distilled 10 mg per 1 gram
• Coconut oil 10 mg per 1 gram
• Salicylic acid 5 mg per 1 gram
• 250ml

• GWH only: Restricted for use in patients undergoing autologous stem cell transplant only. Consultant haematologist prescription only.

• Swindon only - for painful diabetic peripheral polyneuropathy (off-label)
• Cream containing 0.025% capsaicin (Zacin^®)
• For symptomatic relief in osteoarthritis. It may need to be used for 1-2 weeks before pain is relieved

• Swindon only - for painful diabetic peripheral polyneuropathy.
• Cream containing 0.075% capsaicin (Axsain^®)
• For treatment of post herpetic neuralgia (after lesions have healed) & painful diabetic peripheral neuropathy

• Tablet 100mg, 200mg, 400mg
• Tegretol^® m/r tablet 200mg, 400mg.  Prescribe M/R tablet by brand
• Liquid^SF 100mg/ml
• Suppository 125mg, 250mg
• Prescribe generically for non epilepsy indications.
• Carbamazepine may be used for the prophylaxis of bipolar disorder in patients unresponsive to lithium; it seems to be particularly more effective in patients with rapid cycling manic-depressive illness (4 or more episodes per year).

• Tablet 100mg, 200mg, 400mg
• Tegretol^® m/r tablet 200mg, 400mg.  Prescribe M/R tablet by brand (Category 1 MHRA)
• Liquid^SF 100mg/ml
• Suppository 125mg, 250mg
• Prescribe generically for non epilepsy indications.

• Capsules 375mg
• Oral liquid 250mg/5ml
• Sachets 750mg/10ml Sugar free oral solution
• Note: liquid must still be used in patients with feeding tubes

• 0.2% gel 10g
• Suitable for contact lense wearers

• 250micrograms/1ml solution for injection ampoules 
• Indicated for postpartum haemorrhage due to uterine atony in patients unresponsive to ergometrine and oxytocin.

• 10mg, 30mg and 60mg infusion

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

• Tablets 3.125mg,6.25mg,12.5mg,25mg

 Salisbury and BaNES

 Swindon

• Cetrimide 100 mg per 1 ml
• Phenylethyl alcohol 75 mg per 1 ml
• Undecenoic acid 10 mg per 1ml
• 150ml,500ml

• - GWH - For use by Sexual Health team, as a stat dose in combination with azithromycin, for the treatment of gonorrhoea in patients declining IM injection.
• Non-formulary - Bath & Salisbury.
•  200mg tablets.

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

• 250mg
• 750mg
• 1.5g.

•  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 withpoor compliance or patients having side effects on standard inhaledcorticosteroids. For initiation by Respiratory consultant and ongoingprescription by GP

• 25mg, 50mg and 100mg capsules
• For SOLID organ transplant patients continue on brand specifed by the specialist.
• Preparations are not interchangeable.
• NHSE commissioner when ciclosporin used for solid organ transplants. Available from Specialist Centres ONLY.

• 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.

• 75mg

• 1% solution is licensed to be used as ear drops

• Tablets 25mg, 100mg
• Note:  Patients must be registered with the Zaponex^® Treatment Access System (ZTAS). Licensed for treatment resistant schizophrenia.
• The patient, the supervising consultant and the dispensing pharmacy must all be registered with ZTAS. In this formulary area the AWP internal pharmacy is the primary supplier for clozapine for almost all patients.
• Regular (minimum monthly) full blood counts are required prior to and during clozapine treatment, if these are not up-to-date then medication cannot be dispensed.

See link below for AWP Procedure for the care of patients taking clozapine in primary care settings during the COVID-19 pandemic

• Coal Tar solution 5% emulsion 100ml, 250ml
• Useful for guttate psoriasis. Dilute with water to form an emulsion. Apply a thin layer twice or three times a day. Also useful applied to scaly scalps overnight.

• 2.5mg /25mg (amiloride /hydroclorothiazide)
• 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.  
• Note: BaNES only - Co-amilozide included for ENT indications relating to balance e.g Menieres

• Tablets 250/125, 500/125.
• Oral suspension (SF) 125/31 in 5ml, 250/62 in 5ml.
• 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 use of
  co-amoxiclav. The risk of acute liver toxicity was about 6 times greater
  with co-amoxiclav than wth 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.

• GWH A&E only 

• Sinemet-62.5^,  Sinemet 110 (10/100) Sinemet Plus (25/100), Sinemet-275 tablet
• Half Sinemet CR m/r tablet 25/100
• Sinemet CR m/r tablet 50/200.

• Coal tar solution 120 mg per 1 gram
• Salicylic acid 20 mg per 1 gram
• Sulfur precipitated 40 mg per 1 gram
• 40g,100g

• 15mg & 30mg tablets.
• 60mg tablets (Salisbury & Swindon ONLY).
• Please note: Codeine can cause sedation and constipation, and there is a risk of dependence with long term use. It should be reserved for short courses, and is best avoided in stoma patients.

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

• 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.

• 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.

• 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

• 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

• 625mg tablets.
• Please note: Colesevelam is included for the treatment of diarrhoea associated with bile salt malabsorption (off label) only in patients unable to tolerate colestyramine. Please refer to our Colesevelam Shared Care Agreement for further information.
• Please note: Colesevelam has not been approved for the treatment of hypercholesterolaemia.

SUPPLY ISSUES WITH COLESTYRAMINE 

Jan 2020 - BaNES, West Wilts and Swindon patients - Temporary change in TLS from AMBER with SCA 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 capsule 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.

• 4g sachet.
• Please note: Sugar- fee sachets are more expensive.

SUPPLY ISSUES WITH COLESTYRAMINE 

Jan 2020 - BaNES, West Wilts and Swindon patients - 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 capsule 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.

•  Dry powder for inhaler and hard capsule 1.66 million units/capsule

• 1million-units
• For use in paediatrics only following initiation by specialist

• estradiol 1mg and norethisterone acetate 500micrograms

•  300 micrograms conj. oestrogens and 1.5mg medroxyprogesterone acetate

• Patches 50 micrograms estradiol 170 micrograms norethisterone
• Change Twice a week

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

• Transdermal patch containing 6 mg norelgestromin and 600 micrograms ethinyl estradiol
• Restricted for use in women who are likely to comply poorly with combined oral contraceptives

• Tablets containing ethinylestradiol 30 micrograms and levonorgestrel 150 micrograms (21 beige tabs); lactose (7 white tabs) 3 x 28 £2.99 December 2018.

• Calcium chloride0.027%, Potassium chloride 0.04% Sodium chloride 0.06% and Sodium lactate 0.25%

• Not on formulary Salisbury or Swindon 
• For Corticotrophin releasing Hormone (CRH) test which is a dynamic endocrine test
• Powder and solvent
• 100microgram used as an intravenous injection as a single dose

• Tablets 480mg, 960mg
• Suspension 240mg/5ml, 480mg/5ml
• Included in primary care antibiotic guidance as an alternative option for the treatment of acute exacerbations of COPD
• Otherwise used as recommended by a microbiologist.

• Classic Foundation and Finishing Powder

• Eurax Cream 10% , 30g, 100g
• Apply twice or three times daily.

• 50microgram, 100microgram, 1mg 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. 

• Tablet 50mg

• Community Just In Case Boxes
• For nausea and vomiting

• 500mg,1g and 2g injection 

• 50mg

• Capsules 110mg, 150mg
• The Traffic Light Status for dabigatran depends on the prescribed indication:
  
  
•  Prevention of stroke and systemic embolism in NVAF. (TA249)
•  Treatment and secondary prevention of DVT and/or PE. (TA327)
  
•  Prevention of VTE after elective hip or knee replacement. (TA157)

• 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

•  20mg vial

•  for the treatment of dermatitis herpetiformis for stable patients.
•  for unlicensed indications.
• GWH use for the treatment of PCP (Pneumocystis jirovecii pneumonia)
• 50mg
• 100mg
• Needs monitoring as per DMARD shared care agreement on link below

• Use with microbiology advice only
• GWH/RUH only

•  SFT and RUH
•  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

•  Tablet contains 800 mg of darunavir (as ethanolate) and 150 mg of cobicistat

• 20mg, 50mg, 80mg, 100mg and 140mg tablets

• 90mg,180mg,360mg
• Commissioned by NHS England for iron chelation in thalassaemia and sickle cell anaemia.

• 80mg and 120mg infusion

• 150mg Capsules
• Only on formulary to treat Syndrome of Inappropriate Anti-Diuretic Hormone (SIADH). 
• Not on formulary for treatment of infections.

• 60mg in 1ml injection 
• Indication on formulary: Treatment of osteoporosis in postmenopausal women. In postmenopausal women Prolia significantly reduces the risk of vertebral, non-vertebral and hip fractures. Treatment of bone loss associated with long-term systemic glucocorticoid therapy in adult patients at increased risk of fracture.
• New monitoring - check calcium levels: before each dose and, in patients predisposed to hypocalcaemia within two weeks after the initial dose. If any patient presents with suspected symptoms of hypocalcaemia during treatment calcium levels should be measured. Consider monitoring calcium levels more frequently in patients with risk factors for hypocalcaemia (eg, severe renal impairment, creatinine clearance <30ml/min).
• The optimal total duration of antiresorptive treatment for osteoporosis (including both denosumab and bisphosphonates) has not been established. The need for continued treatment should be re-evaluated periodically based on the benefits and potential risks of denosumab on an individual patient basis, particularly after 5 or more years of use

• 10mg vaginal tablet
• Dequalinium is suitable for initiating in primary care for the treatment of bacterial vaginosis where first line treatment (metronidazole) is not effective or not tolerated, ideally following discussion with a gynaecologist or GUM specialist. 

• Use after other emollients have been tried and failed to control symptoms. Expensive emollient.
• 25% urea
• Available as: 75g and 200g pack sizes.
• Preparations containing lauromacrogols and/or urea are useful to stop itching or aid hydration.

• CONTAINS ANTIMICROBIALS
• Use long-term if needed to prevent frequent skin infections, or for handwashing for carers with occupational irritant hand dermatitis.
• Use short-term if there is a single episode of infection. Not for repeat prescription.
• Cream 100g, 500g pump
• Contains benzalkonium Cl and chlorhexidine HCL
• Lotion 500ml pump
• Can be used as hairwash and soap substitute
• Contains benzalkonium Cl and chlorhexidine HCL

• 240ml

• Injection 4 micrograms in 1ml

• 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.

• Injection 5mg, 10mg, 30mg, 100mg, 500mg 
• For use in Palliative Care see chapter 21

• 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)

• Very potent steroid
• Oily cream, Ointment 0.3% 15g
• Use for palms and soles. For severe and resistant dermatoses.

• 250 micrograms/ml 2ml ampoule

• Tablets 30mg
• Oral solution 10mg/5ml
• The efficacy of dihydrocodeine does not increase above a certain dose, but the risks of side effects and dependence increase. Do not prescribe more than a 30mg per dose.
• For post-operative analgesia on discharge.
• Short-term use only.   

• Different versions of MR preparations containing more than 60 mg diltiazem hydrochloride may not have the same clinical effect. To avoid confusion between these different formulations of diltiazem, prescribers should specify the brand to be dispensed.
• Once daily prep - Viazem XL® available as 120mg, 180mg, 240mg, 300mg, 360mg capsules. Please note Slozem (previous OD preferred brand) discontinued Jan 2020 due to manufacturing issues.  
• Twice daily prep - Angitil® SR available as 90mg, 120mg, 180mg capsules.

• 120mg and 240mg capsules
• NB Tecfidera brand only licensed for Multiple Sclerosis
• Check full blood counts before prescribing dimethyl fumarate and then every 6 to 12 months. Stop treatment immediately if progressive multifocal leukoencephalopathy is suspected.

• GWH existing patients only
• Not stocked at RUH or SFT

• GWH and SFT
• note - off label use

• SFT only
• Cream or ointment
• NOT for use in primary care- use epimax as an alternative instead.

• 0.37% eyedrop Unlicensed
• RUH and GWH - for chelation of cornea for calcific band keratopathy.
• Not on formulary at SFT

• Capsules 100mg
• Tablets modified release 250mg

• Tablets 200mg

• Cream: 0.1% 50g  0.25% 50g  , 0.5% 50g (Dithrocream Forte)  , 1% 50g (Dithrocream HP)
•  2% 50g (Dithrocream 2%) (Prescription only)
• For psoriasis. Increase strength gradually. Stains clothes

• Various concentrations of infusion

• Paediatric 12.5mg/5ml Oral Solution (licensed from age 6months)
• 50mg in 5ml oral solution SF (licensed from age 12years)
• 120mg micro enema (licensed from age 12years)
• 100mg capsules (licensed from age 12years)

• 50 mg dolutegravir and 300 mg lamivudine

•  when used within licensed indication which is SHORT –TERM relief of symptoms of nausea and vomiting in adults and adolescents over 12 years and weighing more than 35 kg. For use in GI pain in palliative care see Chapter 21
  
•  for longer-term or off-label use

• Tablet 10mg
• Suspension 5mg in 5ml
• Prescribe in line with MHRA advice and BSW domperidone guidance (links below)

•   BaNES
•   Swindon
•   Wiltshire
• 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

• Tablets 15mg,30mg,60mg
• The Traffic Light Status for edoxaban depends on the prescribed indication:
   
•  Prevention of stroke and systemic embolism in people with nonvalvular AF. (TA355) 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. 
•  Treatment and secondary prevention of DVT and/or PE. (TA354)
  
•  OFF-LABEL treatment of cancer associated thrombosis NOTE: Only for patients seen at the RUH. At other trusts, this would be a RED TLS indication currently. See SCA below.

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

•  Tablets 50mg/100mg

• 10mg and 25mg
•  FOR USE IN COMBINATION WITH OTHER ORAL PRODUCTS FOR THE TREATMENT OF TYPES 2 DIABETES
•  IF USED IN COMBINATION WITH INSULIN IN TYPE 2 DIABETES FOLLOWING NICE GUIDANCE ONLY

•  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
• 200ml bottle
• See ONS guidance for full product details (link at top)

•   500 micrograms
•   1mg

• 40mg tablets

• Nasal drops 0.5%
• 1% 10ml     

• CREAM FOR MILD TO MODERATE DRY SKIN
• Cream 100g and 500g flexi dispenser which can be used instead of a pump by care homes.
• Contains the same ingredients as Cetraben^® but is more cost effective choice

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® ExCetra Cream (previously ExCetra Cream)

• VERY LIGHT MOISTURISER FOR MILD DRY SKIN
• 500g flexi dispenser which can be used instead of a pump by care homes
• Low paraffin content (15%)
• Primary care Doublebase^® gel alternative
• Useful for dermatitis of the hands and as a light moisturiser for the body

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® Isomol Gel (previously Isomol Gel)

• Tablet 25mg, 50mg
• Use within licensed indication in line with NICE.
• Eplerenone is only indicated as an adjunct in stable patients with left ventricular dysfunction with evidence of heart failure, following acute myocardial infarction. Start within 3-14 days of event.

• Injection 500 micrograms in 1ml