•   BaNES and Wiltshire - can be initiated in primary care where a healthcare professional feels they have sufficient knowledge to initiate without specialist support 
•   Swindon 

• 5 micrograms/0.02ml. 1.2ml pre-filled pen
• 10 micrograms/0.04ml. 2.4ml pre-filled pen
• Each pack contains one pen containing 60 doses and is sufficient for 30 days  

• Tablets 300mg
• Oral solution 20mg/ml

• 250mg vial, powder for reconstitution. Injection 125mg pre-filled syringe
• Commissioned by CCG for:
  • The treatment of rheumatoid arthritis in line with NICE TA195, 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 individual Trust contracting arrangements.

• 50mg, 100mg, 150mg film coated tablets

• Tablets e/c 333mg
• Use only in the context of supervised withdrawal regime with psychosocial recovery programme. For maintenance of abstinence in alcohol dependent patients.
• See shared care guidelines below for maintenance of abstinence.
• Acamprosate is supported by NICE (CG115) following assisted withdrawal or for harmful drinkers and people with mild alcohol dependence who have requested a pharmacological intervention in combination with an individual psychological intervention.

• 500mg injection

• GWH Obstetric and Gynae OP stock

• 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

• 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 - RUH
• Non-formulary - SFT

• 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 only
• Tablets 12.5mg
• The maximum recommended dose is two doses in 24 hours.

•   SFT
•   GWH
•  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

• 1 vial with powder contains: 2 mg alteplase (corresponding to 1,160,000 IU)
• Paediatric central venous catheter management

• For those who require smaller volumes or with fluid restrictions
• 125ml bottle
• See ONS guidance for full product details (link at top)

120 ml bottle

28 day supply = 28 bottles, 3360 ml

420 kcal, 6 g protein

Recommended dose = 4 x 30 ml / day

IDDSI level 2  - Mildly thick

• 20% aluminium chloride hexahydrate in an alcoholic basis
• Anhydrol Forte^®, 60ml         
• Driclor^® 60ml, 75ml
• Notes: Aluminium chloride is a potent antiperspirant used in the treatment of severe hyperhidrosis.

• 500mg/2ml solution for injection 
• GWH only. For treatment of Acanthamoeba keratitis.
• Non formulary at RUH and SFT

• Tablets 5mg
• Note: Amiloride is a weak diuretic, but is useful for potassium conservation and is the most appropriate alternative to potassium supplements

• 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 GWH 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

• 200mg/10ml concentrate for solution for infusion vials
• For use in combination with axitinib in line with NICE TA645 [Not at SFT]

• 1mg, 3mg, 5mg and 7mg tablets

• Not suitable for people with diabetes, COPD and wounds - due to carbohydrate:protein ratio
• 66g sachet
• See ONS guidance for full product details (link at top)

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 & Wiltshire patients
•  - GWH - Swindon DAWN patients.
• 25mg & 50mg tablets.
• Please refer to our DMARD Shared Care and Monitoring Guidance below for further information.

•   - BaNES & Wiltshire
•   - Swindon DAWN patients
• Please refer to our DMARD Shared Care and Monitoring Guidance for further information (link below)
• 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; beclometasone100 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

• 500microgram soluble tablet  
• A short course of soluble betamethasone (one 500microgram tablet to be dissolved in 10-20mls water and rinsed around the mouth up to four times per day - not to be swallowed) may be prescribed for patients with severe recurrent aphthous ulcers that have not responded to first line options.
• Use for treatment of oral ulceration or inflammation is off label.
• See patient information leaflet below.

• 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, 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.

• 9mg prolonged-release tablets.
• For induction of remission in patients with mild to moderate ulcerative colitis, where 5-ASA treatment is not sufficient.
• 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

• LOW STRENGTH PATCHES
• 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.

• HIGH STRENGTH PATCH
• 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         

• 100mg and 300mg
•   FOR USE IN COMBINATION WITH OTHER ORAL PRODUCTS FOR THE TREATMENT ON TYPE 2 DIABETES
•  IF USED IN COMBINATION WITH INSULIN IN TYPE 2 DIABETES FOLLOWING NICE GUIDANCE ONLY

• Tablets 2mg, 4mg, 8mg, 16mg, 32mg 

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. See BSW migraine pathway below.

• 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
• VIZcellulose® 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

•   for meningococcal disease for Penicillin allergic patients
•  for all other indications 
• 500mg
• 1g
• 2g

•  for use in acute trusts
•  for use in primary care as follows:
  • for treatment of cellulitis in the community in BaNES via Virgin Care primary care services 
  • 1g IM STAT used for treatment of pelvic inflammatory disease with high risk of gonococcal infection in conjunction with oral antibiotics as per local primary care antibiotic guidance.
• 250mg, 1g and 2g

• 5% eye drops
• 5% preservative-free eyedrops (GWH only)

• Salisbury only
• Non formulary in BaNES and Swindon
• 100mg and 200mg capsules

• 200mg pre-filled pen or syringe
• For people whose psoriasis has partially responded to the lowest licensed maintenance dose, increasing to the highest licensed dose (400 mg) is not cost effective compared with switching to an alternative biological treatment. Hence only the 200mg maintenance dose has been approved by NICE.

•  Self Care Medicine for primary care.
• Tablets 10mg
• Oral solution^SF 5mg in 5ml

• 143mg/5ml oral solution
• GWH: Paediatric use only
• SFT: used for pre-procedure sedation only.
• Short-term use only. License is for severe insomnia which is interfering with normal daily life and where other therapies have failed. 
• Not to be initiated in primary care.

• 0.5% eye drops
• 0.5% minims available for patients allergic to preservatives, administering more than 6 times a day, undergoing eye surgery
• Eye drops available OTC for adults and children over 2 years

• Capsule 5mg, 10mg
• Use only in the context of supervised withdrawal regime over a period of 5-10 days, with psychosocial recovery programme.

• Sterets Tisept solution 25ml sachets (yellow) 

• 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       

• 10mg, 25mg, 50mg & 100mg capsules.
• 250mg in 5ml ampoules for intravenous infusion.
• Please refer to our DMARD Shared Care and Monitoring Guidance below for monitoring information (not applicable to GWH gastroenterology).

•  10mg, 25mg, 50mg and 100mg capsules

• 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

• 0.1% drops (1 mg/mL eye drops, emulsion)
• Verkazia®  is licensed for the treatment of severe vernal keratoconjunctivitis in children from 4 years of age and adolescents. 
• Ensure correct product is prescribed. Other ciclosporin eyedrops  are available but have different licensing information and TLS. Ikervis® contains the same ingredient but is not licensed in paediatrics. 

• For initiation and follow-on prescribing by an Endocrinology Specialist for the treatment of complex primary hyperparathyroidism
• 30mg, 60mg, 90mg

• Tablet 15mg 

• 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. 
• IV infusion 100mg/50ml, 200mg/100ml, 400mg/200ml

• 2 mg/ml ear drops solution in single-dose container
• Licensed for the treatment of acute otitis externa in adults and children older than 1 year with an intact tympanic membrane
• The ampoule contents should be used immediately after opening the single dose ampoule.
• Each pack contains 15 ampoules
• Salisbury only

• SFT only
• 2mg/ml or 5mg/ml

• Tablets 10mg, 20mg, 40mg
• Oral drops^SF 40mg in 1ml–8mg (4 drops may be considered equivalent to 10mg tablet)
• Note: Fewer drug interactions than fluoxetine or paroxetine. 
• For citalopram, new restrictions on the maximum daily doses now apply:
  • 40 mg for adults;
  • 20 mg for patients older than 65 years;
  • 20 mg for those with hepatic impairment.
• Citalopram has been found to cause a dose-dependent prolongation of the QT-interval. Cases of QT interval prolongation and ventricular arrhythmia including torsade de pointes have been reported during the post-marketing period, predominantly in patients of female gender, with hypokalemia, or with pre-existing QT prolongation or other cardiac diseases. See SPC for further detail. 

• 10mg tablet
• 10mg/10ml solution for infusion
• 10mg/5ml solution for injection
• For specialist use only in accordance with guidance from cancer network or NICE

• 500mg powder for concentrate for solution for infusion vials 
• RED TLS drug but note included for use by community IV services where indicated

•  600mg/4ml
• GWH use as part of treatment protocol for PCP (Pneumocystis jirovecii pneumonia)

• 2% vaginal cream  

• Gel Tretinoin 0.025% and Clindamycin 1% 30g

• Very potent steroid
• 125ml shampoo 500mcg/g

• Very potent steroid
• SFT and GWH only
• NOT for primary care use.
• £87 a pack in primary care (Feb 2020)
• Only available generically. Dermovate NN has been discontinued.

• 20mg/20ml infusion
• ONLY Approved for use in acute myeloblastic leukaemia in accordance with the criteria set out by the NHS England Cancer Drugs Fund

• Capsule 10mg, 25mg, 50mg
• Note: Also used in phobic and obsessional states

• 1mg/ml or infusion of 1mg 
• Discontinued in the UK however an unlicensed import is used by acute trusts. 

• GWH only for treatment resistant ADHD and severe Tic disorder. Paediatric consultant only.
• Non-formulary at RUH/SFT
• 25mcg tablets
• 50mcg/5ml oral solution

• 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.

• Note: These are not included in the BSW Vitamin D guidance but may be in use in acute trusts in line with hospital contract
• 20,000 unit, 3200 unit, 800 unit available 
• Licensed for use in children 12-18 years old and adults.
• Please note capsules contain gelatin

• 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. 
• First line choice within GWH

• Chewable tablets containing 500mg / 12.5mmol calcium and 400 units /10micrograms of vitamin D (as vitamin D3) Dose: 1 tablet twice a day
• Not on formulary at GWH

• 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

• This medicinal product has been given authorisation for temporary supply by the UK Department of Health and Social Care and the Medicines and Healthcare products Regulatory Agency. It does not have a marketing authorisation, but this temporary authorisation grants permission for the medicine to be used for active immunisation of individuals aged 18 years and older for the prevention of coronavirus disease 2019 (COVID-19).
• The COVID-19 Vaccine AstraZeneca vaccination course consists of two separate doses of 0.5 ml each. The second dose should be administered between 4 and 12 weeks after the first dose.
• COVID-19 Vaccine AstraZeneca is for intramuscular (IM) injection only, preferably in the deltoid muscle.
• Store in a refrigerator (2 to 8°C).
• For further information see below.

• 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

• 500mg powder for concentrate for solution for infusion vials

• 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
• Prescriber must specify which erythropoietin is required; Choice of agent dependent on Trust and procurement costs.
• For use in accordance with NICE TA323

• 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

• For Cystic Fibrosis patients only
• Multivitamin containing vitamins A, D, E and K for the dietary management of patients with CF on the specific recommendation of a specialist in CF.
• 1-4yrs DEKAs liquid
• 5-8yrs DEKAs liquid or softgel capsules or chewable tablets
• >9yrs DEKAs softgel capsules or chewable tablets

• 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

•   for primary nocturnal enuresis
•   for diabetes insipidus, nocturia caused by MS.
• DDAVP^® tablets (or generic) 100, 200micrograms 
• Desmotabs Tablets (or generic) 200 micrograms 
• Note: nasal spray no longer licensed for primary nocturnal enuresis (bed wetting) due to adverse drug reactions including hyponatraemia.

• Tablets containing 75 microgram desogestrel
• First line choice of oral progestogen-only contraceptive due to the 12 hour window to take the pill.
• Cerelle is most cost effective generic brand (3 x 28 £3.50 December 2018). Cerazette is non-formulary as not cost effective (3 x 28 £8.68 December 2018) 

• 0.1% eye drops

• 700 micrograms intravitreal implant in applicator
• For the treatment of adults with macular oedema following either branch retinal vein occlusion or central retinal vein occlusion ONLY in line with local commissioning criteria and NICE TA229.
• For the treatment of patients with sight problems caused  diabetic macular oedema, in line with NICE TA349.
• For the treatment of patients with non-infectious uveitis, in line with NICE TA460. Only available in specialist centres (not RUH or SFT).

• 3.32 mg of dexamethasone (dexamethasone base) in 1 ml solution for injection which is equivalent to 4 mg dexamethasone phosphate (or 4.3 mg dexamethasone sodium phosphate)
• For use in syringe pumps following advice from palliative care specialists
• See page 89/90 Wessex Palliative Care Handbook (link at start of chapter)

• Dexamethasone 0.05%, framycetin sulfate 0.5%, gramicidin 0.005%  

• Dexamethasone 1 mg/ml with tobramycin 3 mg/ml eye drops.
• Salisbury only
• Non formulary in BaNES and Swindon

• GWH ICU/theatres only 
• 100 micrograms/ml concentrate for solution for infusion, various ampoule sizes

• Currently unavailable (March 2020)
• Use Morphine first line in syringe drivers
• For pain
• 5mg, 10mg, 30mg
• Can be used in syringe drivers
• See page 89/90 Wessex Palliative Care Handbook (link at start of chapter)

• Current supply issues - use Morphine first line
• Community Just In Case Boxes
• For pain

• 2.5mg, 5mg, 10mg

• 2mg, 5mg and 10mg tablets
• 10mg/2ml injection
• 2mg/5ml oral suspension
• 2.5mg, 5mg and 10mg rectal tubes
• For short term use only

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

• Injection (emulsion - Diazemuls^®) 10mg in 2ml
• Injection 5mg/ml

• 12.5mg, 25mg, 50mg and 100mg suppositories
• 75mg in 3ml 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.

• - Salisbury & Swindon.
• - RUH - Oral diclofenac is only included on the formulary for maternity services for a short course of inpatient treatment post delivery.
• 25mg & 50mg gastro-resistant tablets
• Cardiovascular risk is higher with diclofenac than other non-selective NSAIDs and similar to selective COX-2 inhibitors.
• Oral diclofenac should be used for short courses only

• Gel 3% 50g, 100g Solaraze^®
• Prescribe by brand
• Apply thinly twice daily for 60-90 days, maximum 8g daily

• 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
• Only for use in line with NHSE commissioning (see link below)

• 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.
• Docusate acts as a softener and also has relatively weak stimulant properties.

•  Tablets 50mg

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

• Tablet 10mg
• Suspension 5mg in 5ml
• Domperidone should be used at the lowest effective dose for the shortest possible duration
• Recommended adult dose for GI pain in palliative care is 10mg TDS. Higher doses should only be considered under specialist palliative care services.

• 200mg in 5ml

• Nebuliser solution 2500 units in 2.5ml 

• Notes:

• A Jet Nebuliser used exclusively for dornase alfa is required for administration
• To improve pulmonary function in cystic fibrosis patients with a FVC of greater than 40% predicted.
• Use on specialist respiratory advice only.
• Requirement for dornase alfa should be reviewed every 3 days.

• 5ml ophthalmic drops

• 1mg, 2mg, 4mg
• Use only if diuretics, beta-blockers, CCBs and ACEI fail or are unsuitable.  
• Note: Doxazosin m/r is not included as it is less cost-effective

•  For eczema associated pruritis only
•  for off-label use
•  Cream (30g)
• Specialist use only for "off label" urticaria. Apply thin film three or four times a day. Maximum 3g per application

• 20mg/10ml and 50mg/25ml infusion
• Also available from NHS England Cancer Drugs Fund

• Capsules 100mg
• 100mg once a day for 3 months then review

• Tablets 400mg
• In line with NHSE guidance (June 2019) prescribers should not initiate dronedarone in primary care for any new patient. If there is a clinical need for dronedarone to be prescribed it must be in line with individual trust Shared Care Agreements - see links below.

•   BaNES and Wiltshire - can be initiated in primary care where a healthcare professional feels they have sufficient knowledge to initiate without specialist support 
•   Swindon 

• 0.75mg/0.5ml, 1.5mg/0.5ml, 3mg/0.5ml, 4.5mg/0.5ml prefilled pen.
• Each pen delivers ONE dose. One pack contains 4 pens which is sufficient for 4 weeks

• Capsules 30mg and 60mg
• The starting and recommended maintenance dose is 60 mg once daily with or without food. 
• 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 neuropathic pain

• 50 mg/mL concentrate for solution for infusion
  
  

• Included on formulary as a diagnostic agent for myasthenia gravis.  

• SFT only
• Commissioning policy in development (August 2019)
• maximum supply of 30g per month
• Discontinue if no beneficial effects are noticed within four months of commencing therapy
• Hirsutism may be self-managed with mechanical and cosmetic means at no cost to the NHS
• It is important that the patient is properly assessed and underlying causes addressed as hirsutism can result from serious medical conditions or from medication.
• Eflornithine does not offer permanent hair removal, it slows hair growth such that users require less frequent hair removal by other methods (e.g. shaving, plucking, waxing). Hair removal will need to continue (regrowth occurs within 8 weeks).

• 25mg, 50mg
• See MHRA Drug Safety Update July 18 for information on reports of interferance with bilirubin and creatinine
• Third line options can be considered for patients with symptoms lasting longer than 12 months in whom first and second line treatment options have failed and there are on-going complications from their thrombocytopenia OR where second-line options are contra-indicated.

• Capsules 200mg
• Oral solution 50mg/5ml

•  Emtriciciabine 200mg, rilpivirine 25mg, tenofovir 245mg

• GREASY MOISTURISER FOR SEVERE DRY SKIN
• Ointment 500g

• Injection 100mg in 20ml
• SFT and GWH only. Non formulary at RUH.

220 ml bottle

Provides 330 kcal, 13.8 g protein, 220 ml fluid

IDDSI Level 0 - Thin fluids

• 220ml bottles
• See ONS guidance for full product details (link at top)

•  200mg
• Notes: Entacapone is licensed for use as an adjunct to co-beneldopa or co-careldopa for patients with Parkinson’s disease who experience ‘end-of-dose’ deterioration and cannot be stabilized on these combinations. It is important thtn Entacapone and co-beneldopa or co-careldopa are taken together at the same time of day.

• 100mg, 200mg capsules 
• Use in line with NICE TA643 and 644

• 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)

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

•  Powder for reconstitution 500 micrograms

• Injection containing ergometrine maleate 500 micrograms and oxytocin 5 units in 1ml