netFormulary
 Report : A-Z of formulary items 08/03/2021 10:18:17
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Section Name Details
06.06.02 Alendronic Acid 

The dispersible tablet is not approved for local use.

06.01.01.01 Humalog® Insulin Lispro

Rapid acting insulin analogues


Available as:

  • Vials
  • Cartridges
06.01.01.02 Lantus® Insulin Glargine

Basal insulin

For continuation only


Available as:

  • Cartridges
  • Vials
  • Solostar pre filed pen
06.01.01.02 Levemir® Insulin Detemir

Basal insulin


Available as:

  • Cartridges
  • Flexpen pre-filled pen
06.01.01.02 NovoMix® 30 

Biphasic Insulin Aspart


Available as:

  • Cartridges
  • Flexpen® pre-filled pen
03.01.03 Phyllocontin Continus® Aminophylline

Always prescribe by brand

February 2021:  

Phyllocontin® (aminophylline) Continus 225mg and Phyllocontin® Forte Continus 350mg modified-release tablets are being discontinued in the UK.  
 
Remaining supplies of the 225mg strength are expected to be exhausted by 2nd March 2021 and the 350mg strength are expected to be exhausted by 5th April 2021.
 
Please click here for further information
06.01.01.02 Xultophy® Insulin degludec and liraglutide

Basal insulin with GLP-1 anologue

13.14 2% salicylic acid in white soft paraffin 
13.14 20% propylene glycol in aqueous cream 
14.04 23-valent pneumococcal polysaccharide vaccine Previously known as Pneumovax® II
13.14 40% Dermovate (clobetasol propionate 0.05%) in propylene glycol 
13.14 40% propylene glycol in aqueous cream 
11.11 5 Fluorouracil  intra-ocular injection

 At Ipswich Hospital, this unlicensed special is available as:

  • 5mg/0.2ml
  • 7.5mg/0.3ml

At Colchester Hospital, this unlicensed special is available as:

  • 15mg/0.3ml
20 5 Mop (Methoxypsoralen)  20mg tabs
13.08.01 5-aminolaevulinic acid Ameluz®

This product is for use at Ipswich Hospital by the Dermatology team only.  It is not supplied to patients for use at home.

20 8 Mop (Methoxypsoralen)  

Available as 

  • bath lotion 1.2%
  • emulsion 0.15%
  • 10mg tablets
05.03.01 Abacavir Ziagen®

test

05.03.01 Abacavir and Lamivudine Kivexa®
05.03.01 Abacavir and Lamivudine and Zidovudine Trizivir®
06.01.01.02 Abasaglar® Insulin glargine

Basal insulin


Available as:

  • Cartridges
  • Kwikpen

Note - within North East Essex CCG, the use of biosimilar glargine Semglee has also been approved for use

10.01.03 Abatacept Orencia®
02.09 Abciximab 

Heart centre only

08.03.04.01 Abemaciclib tabs
08.03.04.02 Abiraterone tabs
04.10.01 Acamprosate Campral EC®

Treatment would not be initiated within the acute hospitals but, existing therapy would be continued on and supplies procured if appropriate.

06.01.06 Accu-chek Aviva Expert meter 

Only for Type 1 DM patients using a FreeStyle Accu-Chek Combo / Accu-Chek Insight Insulin Pump


Compatible test strips

  • Accu-chek Aviva strips
06.01.06 Accu-chek Aviva Expert meter 

Hospital recommendation only-  Bolus Advisor


Compatible test strips

  • Accu-chek Aviva Plus strips
06.01.06 Accu-chek Mobile 

For users of Heavy Goods Vehicle (HGV) drivers due to ease of use on long journeys and device is DVLA memory storage compliant.

Compatible test strips


  • Accu-Chek Mobile Test Cassette
06.01.06 Accu-chek Performa Nano 

Compatible strips

  • Accu-chek Performa Test strips
02.08.02 Acenocoumarol 
11.06 Acetazolamide 

Available as 

  • MR tabs
  • IR tabs
11.11 Acetazolamide injection
12.01.01 Acetic Acid 2% Earcalm ®

Avaiable OTC


For mild cases of otitis externa

11.99.99.99 Acetylcholine 1% irrigation  
11.11 Acetylcholine Chloride 1% 

For irrigation

11.08.01 Acetylcysteine 5% 

Ipswich Hospital

Acetylcysteine drops are considered a formulary medicine choice and are available as:

  • drops (Ilube)
  • preservative free drop ( unlicensed unlicensed special)

Colchester Hospital

Acetylcysteine drops are considered a non-formulary medicine

13.10.03 Aciclovir tablets
13.10.03 Aciclovir 5% cream

Can be bought OTC

11.03.03 Aciclovir eye ointment 3% Zovirax®

First choice ophthalmic antiviral therapy

01.01.02 Acidex Advance 
13.05.02 Acitretin 

MHRA:Pregnancy prevention

MHRA: Revised and simplified pregnancy prevention educational materials for healthcare professionals and women

Toxic drug – reserve for use by integrated dermatology service/secondary care prescribers only

03.01.02 Aclidinium Eklira Genuair®

Licensed for adults > 18 years for COPD

03.01.04 Aclidinium and formoterol inhaler Duaklir Genuair ®

Licensed for adults >18 years for COPD

13.08.01 Actikerall ® 

For hyperkeratotic actinic keratosis

06.01.01.01 Actrapid® 

Soluble insulin - first line use within the acute Trust - not for routine use within Primary Care


Available as

  • Vials
01.05.03 Adalimumab 

Any new prescription initiated for adalimumab must be for the biosimilar.

NHS England framework for biosimilar adalimumab for the Eastern Region is as follows:

1st line biosimilar drug=Imraldi (citrate containing injection)

2nd line biosimilar drug=Amgevita (non-citrate injection)

The originator drug Humira must not be initiated in any patient.  Patients who develop an injection site reaction repeatedly must be switched to the non-citrate injection Amgevita.  Patients who develop a system reaction to any biosimilar adalimumab product must be reviewed by the MDT for suitability of adalimumab and must not be switched back to Humira without MDT,  Pharmacy and CCG approval.  An algorithm is being developed to support this (01/07/2019).

10.01.03 Adalimumab 

Any new prescription initiated for adalimumab must be for the biosimilar.

NHS England framework for biosimilar adalimumab for the Eastern Region is as follows:

1st line biosimilar drug=Imraldi (citrate containing injection)

2nd line biosimilar drug=Amgevita (non-citrate injection)

The originator drug Humira must not be initiated in any patient.  Patients who develop an injection site reaction repeatedly must be switched to the non-citrate injection Amgevita.  Patients who develop a system reaction to any biosimilar adalimumab product must be reviewed by the MDT for suitability of adalimumab and must not be switched back to Humira without MDT,  Pharmacy and CCG approval.  An algorithm is being developed to support this (01/07/2019).

13.05.03.02 Adalimumab 

Any new prescription initiated for adalimumab must be for the biosimilar.

NHS England framework for biosimilar adalimumab for the Eastern Region is as follows:

1st line biosimilar drug=Imraldi (citrate containing injection)

2nd line biosimilar drug=Amgevita (non-citrate injection)

The originator drug Humira must not be initiated in any patient.  Patients who develop an injection site reaction repeatedly must be switched to the non-citrate injection Amgevita.  Patients who develop a system reaction to any biosimilar adalimumab product must be reviewed by the MDT for suitability of adalimumab and must not be switched back to Humira without MDT,  Pharmacy and CCG approval.  An algorithm is being developed to support this (01/07/2019).

13.06.01 Adapalene / Benzoyl Peroxide Epiduo®
09.06.04 Adcal D3 dissolvable  Colecalciferol and Calcium Carbonate

Adcal-D3 [chewable] is non-formulary.

The dissolvable tablet is for use in patients with swallowing difficulties or enteral feeding tubes

05.03.03.01 Adefovir Dipivoxil Hepsera®

Not routinely commissioned by NHSE.  Needs IFR approval.

02.03.02 Adenosine injection
02.07.03 Adrenaline / Epinephrine  injection
03.04.03 Adrenaline / Epinephrine Epipen,Jext, Emerade

MHRA:Adrenaline auto-injectors

MHRA: Emerade Recall

Injection technique is device specific. To ensure patients receive the auto-injector device that they have been trained to use, prescribers must prescribe by brand.

03.01.05 AeroChamber Plus ® 

Available with a mask.

Check spacer fits prescribed inhaler(s)

08.01.05 Afatinib tabs
11.99.99.99 Aflibercept 40mg/ml Eylea®
04.03.04 Agomelatine Valdoxan®

Agomelatine is a rarely prescribed and specialist treatment within Mental Health. It would not be initiated within the acute hospitals at Ipswich and Colchester but existing patients admitted to the organisation would have their treatment continued; and supplies procured accordingly if necessary.

02.03.02 Ajmaline injection

unlicensed Unlicensed medicine


 For diagnosis of Brugada syndrome

20 Albendazole 400mg tablets 
08.02.04 Aldesleukin injection
08.02.03 Alemtuzumab injection

MHRA: Serious cardiovascular and immune-mediated adverse reactions: new restrictions to use and strengthened monitoring requirements


09.06.04 Alfacalcidol One-Alpha®
15.01.04.03 Alfentanil injection

Note - occasional use via syringe drivers within Palliative Care (unlicensed usage)

07.04.01 Alfuzosin tabs, MR tabs

Ipswich hospital

Non-formulary

Colchester hospital / NEECCG

Alfuzosin is  a formulary drug   

02.12 Alirocumab Praluent®

Ipswich Hospital

Treatment will only be initiated by a clinical pathologist in the lipid clinic

Colchester Hospital

Alirocumab is considered non-formulary; all perspective patients are referred to the Ipswich lipid clinic 

13.05.01 Alitretinoin Toctino®

MHRA:Pregnancy prevention

MHRA: Revised and simplified pregnancy prevention educational materials for healthcare professionals and women

Toxic drug – reserve for use by integrated dermatology service/secondary care prescribers only. 

Use in adults who have severe chronic hand eczema that is unresponsive to treatment with potent topical corticosteroids

10.01.04 Allopurinol 
06.01.02.03 Alogliptin 

First choice for new initiations


Not licensed for monotherapy

13.05.02 Alphosyl 2 in 1 

Can be bought OTC


Coal tar shampoos should not be used alone for people who have severe scalp psoriasis

07.04.05 Alprostadil injection
07.04.05 Alprostadil urethral stick
07.04.05 Alprostadil 3mg/g cream Vitaros®
02.10.02 Alteplase Actilyse Cathflo®

Thrombolytic treatment of occluded central venous access devices including those used for haemodialysis

See IHT guidance below

02.10.02 Alteplase 
11.11 Alteplase intravitreal injection 

For treating submacular haemorrhage (unlicensed use)

20 ALTRETAMINE (HEXAMETHYLMELAMINE) Capsules 50 mg 
20 ALUMINIUM ACETATE 13% ear drops 
01.02 Alverine citrate 

Available OTC

04.09.01 Amantadine 
05.02 AmBisome Amphotericin

Hospital only guidance



Reserved for specialist use or for use on microbiological advice

Must be prescribed by brand name

See below for IHT medication safety newsletter

02.02.03 Amiloride Hydrochloride tabs,liquid

For hypokalemia in oncology patients only

03.01.03 Aminophylline IV 
02.03.02 Amiodarone tabs
02.03.02 Amiodarone injection
04.02.01 Amisulpride tabs, liquid

Amisulpride is a specialist treatment within Mental Health. It would not be initiated within the acute hospitals at Ipswich and Colchester but existing patients admitted to the organisation would have their treatment continued; and supplies procured accordingly if necessary.

04.03.01 Amitriptyline tabs, liquid

Not reccomended for depression

First line for neuropathic pain

If liquid needed use 50mg/ml (lowest cost)

04.07.03 Amitriptyline 

Unlicensed indication

02.06.02 Amlodipine 
11.03.02 Amphotericin (intravitreal) 

Ipswich Hospital consultant opthalmologist recommendation only

Injection prepared for intravitreal use using Fungizone (non-liposomal amphotericin) injection

11.03.02 Amphotericin 0.15% 

This is a very specialist and restricted product prescribed only in specific circumstances.

The amphotericin 0.15% drops product is an unlicensed "unlicensed special" medicine that would be dispensed by the hospital pharmacy only.

 

08.01.05 Amsacrine injection
13.10.01.01 Anabact metronidazole 0.75% gel For wound care
09.01.04 Anagrelide Xagrid®

Traffic light information

Traffic light Details
Red
  • Essential thrombocythaemia 
  • Within clinical trials
08.03.04.01 Anastrozole 
11.04.02 Antazoline 0.5% with Xylometazoline 0.05% Otrivine-Antistin®

Ipswich Hospital

Otrivine-Antihistin drops are non-formulary

Colchester Hospital

Otrivine-Antihistin drops are a formulary medicine choice

13.08.01 Anthelios XL 
14.05.03 Anti-D (Rh0) Immunoglobulin 
01.07.01 Anusol ® cream, ointment,suppositories

Available OTC


Short term use only

01.07.02 Anusol-HC ointment, suppositories

Available OTC


Short term use only

02.08.02 Apixaban 

Traffic light information

Traffic light Details
Red Prevention of venous thromboembolism in total hip or knee replacement in adults
Green Treatment and secondary prevention of deep vein thrombosis and pulmonary embolism
Blue

Prevention of stroke and systemic embolism in people with non-valvular atrial fibrillation with 1 or more risk factor such as

    • Prior stroke or TIA
    • ≥75yrs
    • Hypertension
    • Diabetes mellitus
    • Symptomatic heart failure
04.09.01 Apomorphine 

MHRA:Minimising risk of cardiac side effects


Very specialist treatment - will only be recommended by specialists within Secondary Care.

Specialist nurse will visit the patient in their home to determine the dosing regimen and will communicate this with the patients GP who will supply the medication

Ongoing care will be supervised by the consultant and the Parkinsons team any change in treatment will be communication to the GP

11.11 Apraclonidine Iopidine®

Available as 

  • 0.5% drops
  • 1% drops
13.05.03 Apremilast Otezla®
04.06 Aprepitant 

Anti-emetic for use with chemotherapy-approved for most emetogenic regime only –cisplatin >60mg/m2 only

01.06.03 Arachis Oil 

Hospital inpatient use only

02.08.01 Argatroban Exembol®

Ipswich Hospital

Argatroban is non-formulary

Colchester Hospital

Argatroban is considered first-line treatment in the management of Heparin-induced Thrombocytopenia

04.02.01 Aripiprazole tabs, orodispersible tabs

Aripiprazole is a specialist treatment within Mental Health. It would not be initiated within the acute hospitals at Ipswich and Colchester but existing patients admitted to the organisation would have their treatment continued; and supplies procured accordingly if necessary.

04.02.02 Aripiprazole depot 

Adminstered once a month

08.01.05 Arsenic Trioxide Trisenox 1mg/ml concentrate for infusion
24.01 Artenusate injection

Held at Colchester Hospital

Antimalarial


Available as 

  • 15 x 60mg vials
15.02 Articaine Hydrochloride with Adrenaline Septanest®

Dental anaesthetic only

12.03.05 AS saliva Orthana ® 

Can be bought OTC



Primary care guidance

ACBS

For patients suffering from dry mouth as a result of having (or having undergone) radiotherapy, or sicca syndrome.

09.06.03 Ascorbic Acid Vitamin C

Available OTC

02.09 Aspirin  dispersable

Aspirin Enteric-Coated tablets are non-formulary. There is no evidence that e/c 75mg aspirin is better than non-e/c 75mg aspirin for reducing GI adverse effects.

04.07.01 Aspirin dispersible tabs,suppositories

Tablets/disp tablets available OTC

Aspirin suppositories have a limited usage (i.e. Stroke patients who require 300mg aspiring daily)

05.03.01 Atazanavir Reyataz®
05.03.01 Atazanavir sulfate and cobicistat Evotaz®
02.04 Atenolol  tabs, liquid
08.02.04 Atezolizumab 
04.04 Atomoxetine caps

MHRA:Risk of psychotic or manic symptoms in children and adolescents

MHRA:Increases in blood pressure and heart rate

02.12 Atorvastatin 
07.01.03 Atosiban 

As a tocolytic to postpone premature labour

Reserved for women with exisiting cardiac problems where the use of nifedipine and magnesium sulfate is contraindicated.

15.01.05 Atracurium injection
15.01.03 Atropine  

Hospital only for anaesthesia

11.05 Atropine 1% 

Available as

  • preservative free drops
  • drops (expensive)
07.04.05 Avanafil 

Ipswich Hospital

Avanafil is a formulary medicine

Colchester Hospital / NEECCG

Avanafil is considered a non-formulary medicine

13.02.01 Aveeno ® cream and lotion

Joint guidance

Usually only on advice from specialist

Restricted to paediatric use where they are unable to tolerate other emollients

 

Primary care guidance

ACBS borderline substance

For patients with

  • Endogenous and exogenous eczema
  • Xeroderma
  • Ichthyosis
  • Senile pruritus associated with dry skin only
13.02.01.01 Aveeno ® bath oil

Primary care guidance

ACBS borderline substance

For patients with

  • Endogenous and exogenous eczema
  • Xeroderma
  • Ichthyosis
  • Senile pruritus associated with dry skin

Usually only on advice from a specialist

Restricted to paediatric use where they are unable to tolerate other emollients

08.01.05 Avelumab injection
08.01.05 Axitinib tabs
08.01.03 Azacitidine injection
01.05.03 Azathioprine 
10.01.03 Azathioprine 
13.05.03 Azathioprine 
13.06.03 Azelaic Acid 15% Finacae®
13.06.01 Azelaic Acid 20% Skinoren®

Can be bought OTC


 Topical antibiotic- causes less skin irritation than topical retinoids or benzoyl peroxide

12.02.01 Azelastine and fluticasone Dymista

Licensed for 12 and over

Ipswich Hospital

Azelastine / fluticasone (Dymista) is a formulary medicines choice

Colchester Hospital

Azelastine / fluticasone (Dymista) is a non-formulary medicine

 


Primary care guidance

Relief of symptoms of moderate-severe perennial allergic rhinitis in patients who have failed to respond to a steroid nasal spray with the addition of an oral antihistamine.

Treatment must be reviewed after 3 months and only continued for patients who are benefitting from it.

11.03.01 Azithromycin 15mg/g 

Ipswich Hospital

Azithromycin 15mg/g eye drops are a formulary medicine

Colchester Hospital

Azithromycin 15mg/g eye drops are non-formulary and are not held by the hospital

24.01 Aztreonam injection

Held at Ipswich Hospital


Available as 

  • 1g
  • 2g

3 days supply available

08.02.04 Bacillis Calmette-Guerin  ImmuCyst, OnocTICE
10.02.02 Baclofen tabs, liquid
10.02.02 Baclofen intrathecal injection

Ipswich Hospital

For specific use within the Pain clinic only

Colchester Hospital

Baclofen intrathecal injection is a non-formulary treatment

12.02.03 Bactroban Nasal Mupirocin 2%

Eradication of nasal carriage of MRSA or in patients who cannot have Naseptin®

11.11 Balanced salt solution 
13.02.01 Balneum ® Plus cream 

Can be bought OTC


 Usually only on advice from specialist

01.05.01 Balsalazide 
10.01.03 Baricitinib Olumiant®
14.04 BCG vaccine diagnostic agent 
14.04 BCG vaccine Intradermal 

An unlicensed BCG vaccine is available as an alternative to the licensed vaccine when this is unavailable due to supply/manufacturing problems

12.02.01 Beclometasone Dipropionate 

Available OTC for 18+ yrs


First choice for nasal spray

POM use -Licensed for 6 and over

10.01 Belimumab Benlysta®

Very specific medicine for treating patients with active, autoantibody-positive systemic lupus erythematosus - very unlikely to be utilised by the Trust

08.01.01 Bendamustine injection
02.02.01 Bendroflumethiazide 
03.04.02 Benralizumab Fasenra

A humanised monoclonal antibody that interferes with interleukin-5 receptor binding, thereby reducing the survival of eosinophils and basophils.

For severe oesinophilic asthma (specilaist use only).

Initiated  from a specialist centre eg Addenbrrokes

20 Benzbromarone 50mg  
13.06.01 Benzoyl Peroxide 5% with Clindamycin 1% Duac® Once Daily
13.06.01 Benzoyl Peroxide, potassium hydroxyquinoline sulfate  Quinoderm®

Available as 

  • benzoyl peroxide 5%  potassium hydroxyquinoline sulfate 0.5%
  • benzoyl peroxide 10%  potassium hydroxyquinoline sulfate 0.5%
12.03.01 Benzydamine Difflam®

Available OTC


Available as 

  • 0.15% mouthwash
  • 0.15% oromucosal spray
04.06 Betahistine Dihydrochloride 
06.03.02 Betamethasone Betnesol®
12.03.01 Betamethasone soluble tablets

Unlicensed indication

Expensive

13.04.03 Betamethasone (as Dipropionate) 0.05% with Salicylic Acid 3% Diprosalic®
13.04.04 Betamethasone (as Valerate) 0.1% with Fucidic Acid 2% Fucibet® cream
13.04 Betamethasone 0.025% cream and ointment
11.04.01 Betamethasone 0.1% 

Available as 

  • 0.1% eye/ear/nose drop
  • 0.1% ointment

Betamethasone is a potent steroid with high penetrance into the anterior chamber.  It is associated with a higher rate of raised introccular pressure leading to glaucoma.  It is reserved for post surgical reduction of inflammation and uveitis.

12.01.01 Betamethasone 0.1% with Neomycin 0.5% ear drops 

 First line For moderate/severe cases

11.04.01 Betamethasone 0.1% with Neomycin 0.5% eye drops Betnesol N®
13.04.04 Betamethasone Dipropionate 0.064% with Clotrimazole 1% Lotriderm® cream
12.01.01 Betamethasone drops eye, ear and nose
11.04.01 Betamethasone eye ointment Betnesol®
12.02.01 Betamethasone Sodium Phosphate eye, ear, nose drops

First choice for nasal drops

13.04 Betamethasone Valerate 0.1% cream, ointment and scalp application
11.06 Betaxolol 
08.01.05 Bevacizumab injection
11.08.02 Bevacizumab intravitreal injection Avastin®
02.12 Bezafibrate 

Only if intolerant to statins

11.06 Bimatoprost eye drops

Available as

  • 100mcg/ml drops
  • 300mcg/ml preservative free drops
11.06 Bimatoprost and Timolol 

Available as 300mcg/0.5% in 

  • drops
  • Preservative drops
12.03.05 Biotene Oralbalance ® 

Can be bought OTC

20 Biotin (Vitamin H)  5mg tablets
06.01.01.02 Biphasic Isophane Insulin Insuman® Comb

Ipswich Hospital

Isophane insulin (Insuman Comb) is a non-formulary medicine

Colchester Hospital

Isophane insulin (Insuman Comb) is considered a formulary medicine; albeit with very limited usage. Treatment is unlikely to be initiated within the acute hospital.

 

NEECCG

Considered a formulary medicine

 

01.06.02 Bisacodyl tablets and suppositories

Available OTC

02.04 Bisoprolol 
08.01.02 Bleomycin injection
08.02 Blinatumomab Blincyto®
05.03.03.02 Boceprevir Victrelis®
14.04 Boostrix-IPV 
08.01.05 Bortezomib injection
08.01.05 Bosutinib tabs
04.09.03 Botulinum Toxin Type A Xeomin®

Brands are not interchangeable

04.09.03 Botulinum Toxin Type A Botox®

Brands are not interchangable


Botox brands for

  • severe blepharospasm
  • hemifacial spasm
  • focal spasticity
  • cervical dystonia
  • anal fissure [unlicensed]
  • overactive bladder (in line with clinical threshold policy 24)
  • migraine (as per NICE TA260)
04.09.03 Botulinum Toxin Type A Dysport®

Brands are not interchangeable


 Dysport brands for

  • severe blepharospasm
  • hemifacial spasm
  • focal spasticity
  • cervical dystonia
  • anal fissure [unlicensed]
04.09.03 Botulinum Toxin Type B NeuroBloc®

MHRA:Serious known risks


Brands are not interchangable

Approved for use in patients with neutralising antibodies to botulinum toxin type A.

08.01.05 Brentuximab vedotin injection
08.01.05 Brigatinib Alunbrig
11.11 Brilliant blue G/bromphenol blue 

Brilliant Peel Dual Dye

11.06 Brimonidine Tartrate 0.2% eye drops
11.06 Brimonidine Tartrate and Timolol 

Available as 0.2% / 0.5%

11.06 Brinzolamide 10mg/ml eye drops

Reserved for patients intolerant of dorzolamide

11.06 Brinzolamide and brimonidine  

Available as 10mg per ml / 2mg per ml

11.06 Brinzolamide and Timolol  

Available as 1% / 0.5%

04.08.01 Brivaracetam 

Ipswich Hospital

Brivaracetam is considered a formulary medicine - to be used only if intolerant to levitiracetam therapy

Colchester Hospital

Brivaracetam is a non-formulary medicine. Therefore, treatment would not be initiated within the acute Trust, but if necessary to ensure patient care, existing therapy would be continued on (and supplies purchased if appropriate).

13.05.03.02 Brodalumab 
11.11 Bromfenac 

900mcg/ml eye drops

04.09.01 Bromocriptine 

Treatment would not usually be initiated within the acute Trust – for continuation of care only

06.07.01 Bromocriptine 

Specialist initiation only

01.05.02 Budesonide modified release- Entocort®

Only if prednisolone unsuitable – very expensive

03.02.01 Budesonide Easyhaler®

Only if beclometasone not suitable.

Licensed for adults and children >6 years

03.02.01 Budesonide Respules®

Adults - may be continued for existing patients only, consider moving to a formulary option at next review

12.02.01 Budesonide Rhinocort Aqua®

Ipswich Hospital

Budesonide nasal spray (Rhinocort Aqua) is non-formulary

Colchester Hospital

Budesonide nasal spray (Rhinocort Aqua) is considered a formulary medicine

01.05.02 Budesonide foam enema Entocort® For temporary use until Hydrocortisone foam enema is back in normal supply
02.02.02 Bumetanide tabs,liquid
15.02 Bupivacaine Hydrochloride 
04.07.02 Buprenorphine patch

 


Hospital only guidance

Initiation

Only to be initiated by either

  • Hospice
  • Palliative care
  • Chronic pain team
  • Consultant signature
04.10.03 Buprenorphine (Espranor ® ) oral lyophilisate tablet

Confirm brand before prescribing. Now available as:
- Subutex® sublingual tablet
- Espranor® (oral lyophilisate) (prescribe by brand)

  • Espranor® and Subutex® are not dose equivalent and are therefore not interchangeable
  • Opioid dependance, after recommendation from specialist service.
  • Please see SPS Espranor (buprenorphine oral lyophilisate) 2mg and 8mg document for further information (please click here)
  • Espranor ® is a restricted item in ESNEFT and will be continued where it is a part of the patients history. 
04.10.03 Buprenorphine (Subutex ® ) sublingual tablet

Confirm brand before prescribing. Now available as:
- Subutex® sublingual tablet
- Espranor® (oral lyophilisate) (prescribe by brand)

  • Espranor® and Subutex® are not dose equivalent and are therefore not interchangeable
  • Opioid dependance, after recommendation from specialist service.
  • Please see SPS Espranor (buprenorphine oral lyophilisate) 2mg and 8mg document for further information (please click here)
04.10.02 Bupropion Hydrochloride Zyban®
06.05.01 Buserelin fertility Fertility monitoring unit only
08.03.04.02 Buserelin injection
08.01.01 Busulfan 
11.11 C2F6 

Arceole ® C2F6

11.11 C3F8 

Arceole ® C3F8

03.04.03 C1 Esterase Inhibitor Berinert®
20 C1esterase inhibitor 
08.01.05 Cabazitaxel Jevtana®
04.09.01 Cabergoline 

Treatment would not usually be initiated within the acute Trust – for continuation of care only

06.07.01 Cabergoline 

Specialist initiation only, unless short course to prevent lactation

08.01.05 Cabozantinib Cometriq®
09.05.01.01 Cacit ® 

One tablet = 12.6mmol calcium

09.05.02.02 Cacit® Calcium Carbonate

One tablet = 12.6mmol calcium

03.05.01 Caffeine Citrate 

Hospital Neonatal use only

Administered by mouth or by intravenous infusion

20 Caffeine oral solution 5mg in 1ml

Low CSF pressure headache

20 Caffeine Sodium Benzoate Injection 

Low CSF pressure headache

09.05.01.01 Calcichew ® 

One tablet = 12.6mmol calcium

09.05.02.02 Calcichew® Calcium Carbonate

One tablet = 12.6mmol calcium

09.06.04 Calci-D® Colecalciferol and Calcium Carbonate

Adcal D3/Calceos 1 tab BD is roughly equivalent to Calci-D 1 OD

Adcal D3/Calceos 1 tab OD is roughly equivalent to Calci-D half tab OD

13.05.02 Calcipotriol ointment

Topical vitamin D

13.05.02 Calcipotriol 50mcg/g with Betamethasone 0.05% ointment,gel and foam

Apply once daily

06.06.01 Calcitonin (salmon) / Salcatonin 

MHRA:Increased risk of cancer with long-term use

09.06.04 Calcitriol 
13.05.02 Calcitriol  ointment

Topical vitamin D

20 Calcitriol 1mcg in 1ml oral solution  
09.05.02.02 Calcium Acetate tabs

Renal use only

One tablet = 6.2mmol calcium

09.05.01.01 Calcium Chloride injection
08.01 Calcium Folinate 
09.05.01.01 Calcium Gluconate 10% injection
08.01 Calcium Levofolinate injection
09.02.01.01 Calcium Resonium® Polystyrene Sulphonate Resins

Discontinue when potassium less than or equal to 5mmol/L

13.02.01 Calmurid ® cream

Usually only on advice from specialist

Can be used as an alternative to paraffin based products

06.01.02.03 Canagliflozin 
02.05.05.02 Candesartan 
10.02.02 Cannabidiol Epidyolex ®

CONSULTANT PRESCRIBING ONLY 

10.02.02 Cannabidiol (Unlicensed formulations) 

CONSULTANT PRESCRIBING ONLY 

10.02.02 Cannabis extract Sativex®

Ipswich Hospital

Cannabis extract (Sativex) has been approved for very limited prescribing within the Pain Clinic

Colchester Hospital

Cannabis extract (Sativex) is strictly a non-formulary medicine

13.09 Capasal ® 

Can be bought OTC

08.01.03 Capecitabine 
12.03.01 Caphosol ® 

Ipswich Hospital

Caphosol mouth rinse is non-formulary

Colchester Hospital

Caphosol mouth rinse is a formulary medicine choice and is utilised within oncology practice

10.03.02 Capsaicin Qutenza®

Ipswich Hospital

Capsaicin (Qutenza) is a very restricted, but agreed formulary medicine

Colchester Hospital / NEECCG

Capsaicin (Qutenza) is a non-formulary medicine

10.03.02 Capsaicin 0.025% cream
04.07.03 Capsaicin 0.075% cream
02.05.05.01 Captopril 

Indications/uses

  • Paediatrics
  • Selected clinical situations- usually advised by specialist
  • Maintenance treatment only
20 CAPTOPRIL Oral Solution 5 mg in 1mL 
04.08.01 Carbamazepine tabs, MR tabs,chewable tabs, liquid, suppositories

MHRA:Risk of serious skin reactions


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Green
  • Trigeminal neuralgia
  • Mania
  • Epilepsy

125mg suppository is approximately equivalent to a 100mg tablet.

Branding specificity only applies for when it is being used for epilepsy

Note: carbamazepine suppositories are very expensive (well over £100 for a box of 5 of each strength - 125mg and 250mg). Therefore, their usage is very restricted and they should only be utilised after due consideration and for the shortest possible time period. 

06.02.02 Carbimazole 

MHRA:Increased risk of congenital malformations; strengthened advice on contraception

MHRA:Risk of acute pancreatitis

03.07 Carbocisteine 

Joint guidance

Stepping down guidance

Please see below for guidance on stepping down carbocisteine for primary and secondary care

Should be stopped if there is no benefit after a 4 week trial

11.08.01 Carbomer Viscotears®

Can be bought OTC


Viscotears Preservative-free drops available for patients with preservative sensitivity.

 

Within NHS North East Essex CCG - Viscotears is non-formulary.

11.08.01 Carbomer 980 eye drops 

Can be bought OTC


Prescribe generically - there are a number of differing products available (e.g. Clinitas carbomer eye gel, Artelac Nighttime eye gel, Viscotears liquid gel, etc)

 

Within NHS North East Essex CCG prescribe as Clinitas carbomer gel

08.01.05 Carboplatin 
07.01.01 Carboprost injection

For severe postpartum haemorrhage unresponsive to ergometrine and oxytocin

06.01.06 CareSens Dual meter  

Only for Type I DM patients requiring tests for both blood glucose and ketones in one meter


Compatible test strips

  • CareSens Pro test strips
  • KetoSens Ketone test strips
08.01.05 Carfilzomib injection

MHRA:Kyprolis▼- Reminder of risk of potentially fatal cardiac events

MHRA: Risk of reactivation of hepatitis B virus

11.08.01 Carmellose 

Can be bought OTC


Available as

  • 0.5% drops
  • 0.5% preservative free drops multi-use bottle
  • 1% drops
  • 1% preservative free multi-use bottle                                      

Within NHS Ipswich and East Suffolk CCG, prescribe as Melopthal:

  • re-sealable and may be used for up to 12 hours
  • Usual supply one box per month. 

 

Within NHS North East Essex CCG, prescribe as:

  • PF Drops carmellose
    • Preservative free with a 60 day expiry. 
  • Carmellose 1% eye drops unit dose preservative free
  • Optive plus is also available for lid margin/meibomian gland disease or lipid deficiency.
08.01.01 Carmustine injection
A2.05.02 Carobel, Instant ®   Only for use in children 3yrs or under
02.04 Carvedilol 
13.02.02 Cavilon Film 

Approved for use within North East Essex CCG only. Cavilon is restricted to stoma patients. 

Stoma wipe (3344E)

28ml pump spray (3346P)

11.11 Ceftazidime 2mg/0.1ml  intravitreal injection

Injection prepared for intravitreal use

11.03.01 Cefuroxime 5% 

This is a specialist product prescribed only in specific circumstances.

The cefuroxime 5% drops product is an unlicensed "unlicensed special" medicine that would be dispensed by the hospital pharmacy only.

This product is stored at Ipswich Hospital Pharmacy only.  Colchester Pharmacy should obtain this from Ipswich Hospital Pharmacy.

24.01 Cefuroxime 5% eye drops

Held at Ipswich Hospital Phamacy


This is a specialist product prescribed only in specified circumstances by an ophthalmologist.

It is an unlicensed special product only dispensed by the hospital pharmacy.

11.11 Cefuroxime 50mg  intracameral injection

For use in ophthalmic theatres

10.01.01 Celecoxib 

Ipswich Hospital

Second-line use to treat Rheumatoid Arthritis and Ankolysing spondylitis only

Colchester Hospital

Celecoxib has limited use as a second line agent.

08.01.05 Cemiplimab 
08.01.05 Ceritinib caps
10.01.03 Certolizumab Pegol 
13.05.03.02 Certolizumab pegol Cimzia 200mg/ml injection
03.04.01 Cetirizine 

Available OTC

06.05.01 Cetrorelix injection Fertility monitoring unit only
08.01.05 Cetuximab Erbitux®
04.01.01 Chloral Hydrate 500mg in 5mL 

unlicensed Unlicensed special

Inpatient use only

20 Chloral hydrate suppositories  
08.01.01 Chlorambucil 
11.03.01 Chloramphenicol 

Can be bought OTC for patients 2+yrs old


Available as

  • 0.5% drops
  • 0.5% preservative free drops
  • 1% ointment
04.01.02 Chlordiazepoxide 

For alcohol withdrawal

Generally used for hospital inpatient only 

See below for IHT guidance

12.03.02 Chlorhexidine mouthwash 

Available OTC

12.03.04 Chlorhexidine mouthwash 
20 Chlorothiazide 250mg in 5mls suspension 
03.04.01 Chlorphenamine 

Available OTC

04.02.01 Chlorpromazine tabs, liquid, injection

Traffic light information

Traffic light Details
Blue Intractable hiccup
Green Mental health disorders
Red Parenteral route

Chlorpromazine treatment is now rarely initiated for its anti-psychotic effect. Existing treatment would be carried on within the acute Trust; the oral formulation occasionally being utilised on a short-term basis to treat intractable hiccups.

04.02.01 Chlorpromazine injection
14.04 Cholera vaccine Dukoral®
12.03.01 Choline Salicylate dental gel

For hospital inpatient use only. 

Available OTC for all other situations

06.05.01 Choriogonadotropin fertility Fertility monitoring unit only
06.05.01 Choriogonadotropin Alfa endocrine
06.05.01 Chorionic Gonadotrophin Choragon®
06.05.01 Chorionic Gonadotrophin Pregnyl®
01.05.03 Ciclosporin injection

UNLICENSED INDICATION


Inflammatory bowel disease.

To be initiated by a Consultant Gastroenterologist.

01.05.03 Ciclosporin oral

UNLICENSED INDICATION


Inflammatory bowel disease.

To be initiated by a Consultant Gastroenterologist.

10.01.03 Ciclosporin 
13.05.03 Ciclosporin 

Use generic ciclosporin

08.02.02 Ciclosporin ( Neoral) caps,liquid
11.99.99.99 Ciclosporin 0.1% Ikervis®

Severe keratitis in dry eye disease that has not responded to treatment with tear substitutes

 

02.06.04 Cilostazol Pletal®

Restricted use for vascular clinic only on both Ipswich and Colchester Hospital sites. 

Prescribing will be restricted to the vascular clinicians only and prescriptions will be dispensed by either Ipwich or Colchester Hospital pharmacies.

09.05.01.02 Cinacalcet Mimpara®

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Cinacalcet is a "Hospital Only Medicine" within ESNEFT and prescribing should be limited within Secondary Care practice. This applies to patients with:

  • Primary hyperparathyroidism or parathyroid carcinoma
  • Secondary hyperparathyroidism in end-stage renal failure

 

04.06 Cinnarizine 
11.11 ciprofloxacin oral

500mg BD for 1-2 weeks

12.01.01 Ciprofloxacin 

Approved for ENT use at Ipswich and Colchester Hospitals

11.03.01 Ciprofloxacin 0.3% 
08.01.05 Cisplatin injection
04.03.03 Citalopram 

MHRA:QT interval prolongation

MHRA:Suspected drug interaction with cocaine


Max. dose for under 65yrs :40mg

Max. dose for 65yrs+: 20mg


10mg tab is equivalent to 4 drops of liquid

20mg tab is equivalent to 8 drops of liquid

01.06.05 Citrafleet  Sodium picosulphate/ magnesium citrate
08.01.03 Cladribine injection
03.02.01 Clenil Modulite Beclometasone

Prescribe by brand


Licensed for adults and children of any age

13.06.01 Clindamycin/ tretinoin gel Treclin®
04.08.01 Clobazam 

Primary care guidance

NHS use restricted to epilepsy only.

Endorse prescription ‘SLS’

13.04 Clobetasol Propionate 0.05% cream, ointment and scalp application, shampoo
13.04.04 Clobetasol Propionate with neomycin and nystatin Dermovate-NN®

Only on advice from specialist

13.04 Clobetasone Butyrate 0.05% cream and ointment

Can be bought OTC for patients ≥12yrs for the following

  • Irritant contact dermatitis
  • Allergic contact dermatitis
  • Insect bite reactions
  • Mild to moderate eczema 

Cannot be used for the face if purchacing OTC 

08.01.03 Clofarabine injection
06.05.01 Clomifene Citrate 

Fertility monitoring unit only 

04.03.01 Clomipramine caps

Clomipramine is a rarely prescribed and specialist treatment. It would not be initiated within the acute hospitals at Ipswich and Colchester but existing patients admitted to the organisation would have their treatment continued; and supplies procured accordingly if necessary.

04.08.01 Clonazepam 
04.08.02 Clonazepam injection

unlicensed Unlicensed medicine

02.05.02 Clonidine injection
02.05.02 Clonidine tabs

For hypertension when other agents have failed or not suitable

02.09 Clopidogrel 
13.10.02 Clotrimazole 1% 

Can be bought OTC

12.01.01 Clotrimazole 1% solution 

Available OTC

04.02.01 Clozapine Clozaril®

MHRA: Potentially fatal risk of intestinal obstruction, faecal impaction, and paralytic ileus


Very specialist drug - strictly under the control of Mental Health Services

02.02.04 Co-amilofruse (furosemide and amiloride) 
04.09.01 Co-Beneldopa caps, dispersible tabs, MR caps
05.03.01 Cobicistat Tybost®
15.02 Cocaine with Adrenaline paste
04.09.01 Co-Careldopa tabs, MR caps
04.09.01 Co-Careldopa and Entacapone 
13.06.02 Co-Cyprindiol 

MHRA:Balance of benefits and risks remains positive


Should be discontinued three to four menstrual cycles after the woman's acne has resolved due to risk of VTE

13.09 Co-Cyprindiol 

MHRA:Balance of benefits and risks remains positive


Co-cyprindiol should be stopped three or four menstrual cycles after the woman's hirsutism has completely resolved because of an increased risk of VTE

01.06.02 Co-danthramer 

Terminally ill patients only

01.06.02 Co-danthrusate 

Terminally ill patients only

01.04.02 Codeine 
03.09.01 Codeine Linctus BP 15mg/5ml
04.07.02 Codeine Phosphate injection
04.07.02 Codeine Phosphate tablets/liquid

MHRA:Restricted use in children because of reports of morphine toxicity

MHRA:Restricted use in children for coughs and colds

10.01.04 Colchicine 

Maximum 6mg /course

Not to be repeated within 3 days

Stop if diarrhea occurs

09.06.04 Colecalciferol 2400 units/ml liquid 

Joint guidance

See below for joint guidance on treating vitamin D deficiency

09.06.04 Colecalciferol 25,000 unit liquid Invita D3®

Joint guidance

See below for joint guidance on treating vitamin D deficiency

 

 

 

09.06.04 Colecalciferol 800 units 
20 Colecalciferol injection  300,000 units in 1ml
02.12 Colesevelam 

Colchester Hospital / NEECCG

Colesevelam is considered non-formulary.

01.09.02 Colestyramine powder 

Other medication should be taken at least 1 hour before or 4-6 hours after colestyramine

10.03.01 Collagenase Xiapex®
01.01.01 Co-magaldrox Mucogel®

Low sodium content

06.04.01.01 Combined continuous HRT patch Evorel® Conti
06.04.01.01 Combined cyclical HRT patch Evorel® Sequi
07.03.01 Combined Hormonal Contraceptives Qlaira®

Ipswich Hospital

Qlaira is a non-formulary medicine

Colchester Hospital / NEECCG

Qlaira is considered a formulary medicine choice - prescribing limited to patients unable to tolerate other oral combined cotraceptives and intrauterine devices

07.03.01 Combined Hormonal Contraceptives NuvaRing®

Ipswich Hospital

NuvaRing is a non-formulary medicine

Colchester Hospital / NEECCG

NuvaRing is considered a formulary medicine choice (prescribing limited to Family Planning Clinics and Primary Care Specialists only)

07.03.01 Combined Hormonal Contraceptives Evra

Ipswich Hospital

Evra is considered a non-formulary medicine

Colchester Hospital / NEECCG

Evra is considered a formulary medicine choice

07.03.01 Combined Hormonal Contraceptives Loestrin 30®

Ipswich Hospital

Loestrin 30 is a non-formulary medicine

Colchester Hospital / NEECCG

Loestrin 30 is considered a formulary medicines choice

07.03.01 Combined Hormonal Contraceptives Norinyl-1®

Ipswich Hospital

Norinyl-1 is considered a non-formulary medicine

Colchester Hospital / NEECCG

Norinyl-1 is considered a formulary medicine choice

13.09 Combined oral contraceptive (COC) 

Drospirenone containing COC [unlicensed indication]

Examples include

  • Lucette ®

  • Daylette ®

13.02.02 Conotrane  

Can be bought OTC


First line primary care

Not stocked at IHT

06.01.06 Contour Next Link meter 

Only for Type I DM patients using a Medtronic insulin pump, communicates with the pump via Bluetooth®.


Compatible test strips

  • Contour Next strips
13.08.02 Covermark ® 
01.09.04 Creon 10,000 
01.09.04 Creon 25,000 
08.01.05 Crisantaspase Erwinase®
08.01.05 Crizotinib caps
13.03 Crotamiton Eurax®

Only if an emollient alone does not provide adequate relief

09.01.02 Cyanocobalamin 

Primary care guidance

SLS restriction

Cyanocobalamin is only available on the NHS to treat or prevent vitamin B12 deficiency in a patient who is a vegan or who has a proven vitamin B12 deficiency of dietary origin

 Endorse prescription ‘SLS’

 Currently available brands may not be suitable for vegans

04.06 Cyclizine tabs, injection

Potential for abuse

06.05.01 Cyclogest pessaries Fertility monitoring unit only
11.05 Cyclopentolate  

Available as

  • 0.5% drops
  • 0.5% preservative free drops
  • 1% drops
  • 1% preservative free drops
08.01.01 Cyclophosphamide tabs,liquid,injection
10.01.03 Cyclophosphamide 

Hospital only guidance

06.04.01.01 Cyclo-Progynova estradiol valerate 2mg + norgestrel 500mcg
08.03.04.02 Cyproterone 
06.04.02 Cyproterone Acetate 
08.01.03 Cytarabine injection
08.01.03 Cytarabine liposomal injection
02.08.02 Dabigatran 

Traffic light information

Traffic light Details
Red

Prevention of venous thromboembolic (VTE) events in adult patients who undergone either:

  • Elective total hip replacement (THR)
  • Total knee replacement (TKR) surgery
Green

Treatment of:

  • Deep vein thrombosis (DVT)
  • Pulmonary embolism (PE)

Prevention of

  • Recurrent DVT
  • Recurrent PE in adults
Blue

Prevention of stroke and systemic embolism in adult patients with nonvalvular atrial fibrillation with one or more of the following risk factors:

  • Previous stroke
  • transient ischemic attack
  • or systemic embolism (SEE),
  • Left ventricular ejection fraction < 40 %
  • Symptomatic heart failure
  • ≥ New York Heart Association (NYHA) Class 2
  • Age ≥ 75 years
  • Age ≥ 65 years associated with one of the following:
    • diabetes mellitus
    • coronary artery disease
    • hypertension
08.01.05 Dabrafenib caps
08.01.05 Dacarbazine injection
05.03.03.02 Daclatasvir  Daklinza®
08.01.05 Dacomitinib Vizimpro
08.01.02 Dactinomycin injection
02.08.01 Dalteparin 

Ipswich Hospital

For use with renal replacement therapy on critical care unit.

Colchester Hospital

Dalteparin is non-formulary

02.08.01 Danaparoid 

Haematology approval required

06.07.02 Danazol 
10.02.02 Dantrolene tabs
15.01.08 Dantrolene Sodium injection
06.01.02.03 Dapagliflozin 
08.01.05 Daratumumab injection

MHRA:Darzalex▼- Risk of reactivation of hepatitis B virus

09.01.03 Darbepoetin Alfa Aranesp®

Traffic light information

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Red renal patients;all indications
Double Red tumours;all indications
08.03.04.02 Darolutamide Nubeqa
05.03.01 Darunavir Prezista®

MHRA:Avoid use in pregnancy due to risk of treatment failure and maternal-to-child transmission of HIV-1

05.03.01 Darunavir and Cobicistat Rezolsta®

MHRA:Avoid use in pregnancy due to risk of treatment failure and maternal-to-child transmission of HIV-1

05.03.03.02 Dasabuvir Exviera®
08.01.05 Dasatinib tabs
08.01.02 Daunorubicin injection
09.01.03 Deferasirox 
08.03.04.02 Degarelix injection

For the treatment of adult male patients with advanced hormone dependant prostate cancer

13.08.02 Dermacolor ® 
13.02.01 Dermatonics Heel Balm ® 

Inpatient use only on advice from specialist

13.02.01 Dermol ® cream

Can be bought OTC 


Only if infection present or is a frequent complication

13.02 Dermol 500 ® lotion

Can be bought OTC 


Only if infection present or is a frequent complication

13.02.01.01 Dermol 600 ® bath emollient

May be used if recommended by a specialist for infected atopic eczema for 14 days

09.01.03 Desferrioxamine Mesilate 
15.01.02 Desflurane 
06.05.02 Desmopressin injection
06.05.02 Desmopressin tablets
06.05.02 Desmopressin Nasal spray-10mcg/spray
06.05.02 Desmopressin Octim® high dose nasal spray

Ipswich Hospital

Haematology use only

Colchester Hospital

Desmopressin (Octim) is considered non-formulary

20 Desmopressin (high strength)  15mcg in 1ml
07.03.02.01 Desogestrel 75mcg 

The following brands do not contain products derived from peanut or soya oil and have been manufactured in a peanut-free site 

  • Zelleta
  • Cerelle 
  • Feanolla 
  • Aizea 
  • Cerazette  

Please note brands have been listed in order of price. Brands with the lowest acquisition cost should be used where possible.

06.03.02 Dexamethasone  tabs/ dispersible tabs
06.03.02 Dexamethasone injection

Hospital only guidance

Prescribe dexamethasone as 3.3mg (1ml dose) or 6.6mg (2ml dose) except for Oncology / Haematology protocols where the 4mg dose may be more appropriate.

See below for IHT newsletter

10.01.02.02 Dexamethasone 
11.99.99.99 Dexamethasone 700mcg Ozurdex®
11.04.01 Dexamethasone eye drops 

Available as

  • 0.1% drops
  • 0.1% preservative free drops

Dexamethasone is a potent steroid with high penetrance into the anterior chamber.  It is associated with a higer rate of raised intraoccular pressure leading to glaucoma.  Reserved for post surgical reduction of inflammation and uveitis.

11.04.01 Dexamethasone with Antibacterials (eye) Sofradex®

Ipswich Hospital

Sofradex drops for use within the eye is a non-formulary medicine 

Colchester Hospital

Sofradex drops for use within the eye is a formulary medicine choice

11.04.01 Dexamethasone with Neomycin and Polymyxin B sulfate Maxitrol®

Available as

  • drops
  • ointment
04.04 Dexamfetamine tabs
15.01.04.04 Dexmedetomidine  injection
08.01 Dexrazoxane injection
04.07.02 Diamorphine injection
04.07.02 Diamorphine nasal spray 720mcg/actuation

Available as 

720mcg/actuation


For use in children weighing between 12kg and less than 30kg

04.01.01 Diazepam tabs, liquid
04.08.02 Diazepam injection
10.02.02 Diazepam 

Used in hospital setting for muscle spasm

15.01.04.01 Diazepam injection,tablets
06.01.04 Diazoxide 

Ipswich Hospital

Diazoxide is considered a formulary medicine; Specialist initiation only

Colchester Hospital

Diazoxide is considered a non-formulary medicine

20 DIAZOXIDE Suspension 50 mg in 1mL 
10.01.01 Diclofenac suppositories, injection
15.01.04.02 Diclofenac injection
13.08.01 Diclofenac 3% Solaraze®

For diffuse chronic sun damage/mild scaling- use for up to 3 months

05.03.01 Didanosine Videx®
08.03.01 Diethylstilbestrol 
02.01.01 Digoxin tabs, elixir

100mcg/2ml elixir is therapeutically equivalent to 125mcg tablet.

02.01.01 Digoxin injection
02.01.01 Digoxin specific antibody fragments Digifab®
04.07.02 Dihydrocodeine tabs
04.07.02 Dihydrocodeine injection
02.06.02 Diltiazem 

Joint guidance

Colchester Hospital

Preferred brand (Once daily formulation) - Slozem®

Preferred brand ( Twice daily formulation ) - Adizem®

Ipswich hospital / IESCCG

Preferred brands- Once daily

Strength Hospital Primary care
120mg Slozem XL® Zemtard XL®
180mg Slozem XL Zemtard XL®
200mg Slozem XL® Zemtard XL®
240mg Slozem XL® Zemtard XL®
300mg Slozem XL® Zemtard XL®


Preferred brands- Twice daily

Strength Hospital Primary care
60mg Tildiem Retard® Dilcardia SR®
90mg Tildiem Retard Angitil SR®
120mg Tildiem Retard® Angitil SR®
01.07.04 Diltiazem Cream 2% 

Unlicensed med


Only if glyceryl trinitrate tried and not tolerated or ineffective

08.02.04 Dimethyl fumarate caps

Must be prescribed as Tecfidera

13.05.03 Dimethyl fumarate tabs

Must be prescribed as Skilarence

13.10.04 Dimeticone 4% lotion

Can be bought OTC


Use in combination with wet combing

07.01.01 Dinoprostone 

1st line for induction of labour 

See below  for NICE guidelines “Induction of Labour”

Available as

  • 3mg Vaginal tabs
  • PROPESS- 10mg vaginal delivery system
14.04 Diphtheria antitoxin 
14.04 Diphtheria vaccines for Children Under 10 years 
02.09 Dipyridamole 

Dipyridamole is currently considered formulary with some usage within cardiology and Stroke services.

11.11 Disodium Edetate (EDTA) 0.37%  eye drops

Unlicensed special

20 Disodium edetate EDTA 0.37% drops 

Available as 

  • eye drops
  • preservative free eye drops
06.06.02 Disodium Pamidronate 
02.03.02 Disopyramide caps
13.05.02 Dithranol 

Available as 

  • Dithranol 0.1% cream
  • Dithranol 0.25% cream
  • Dithranol 0.5% cream
  • Dithranol 1% cream (Dithrocream® HP)
  • Dithranol 2% cream (Dithrocream® 2%)
  • Dithranol 3%

Use only on advice of a specialist

On initiation prescribe all four (0.25%, 0.5%, 1%, 2%) titration strengths on initial prescription – only one prescription charge for patient

02.07.01 Dobutamine 
08.01.05 Docetaxel 
01.06.02 Docusate caps,solution,enema

Capsules available OTC

05.03.01 Dolutegravir 

MHRA:increased risk of neural tube defects; do not prescribe to women seeking to become pregnant; exclude pregnancy before initiation and advise use of effective contraception

05.03.01 Dolutegravir, abacavir & lamivudine Triumeq®

MHRA:increased risk of neural tube defects; do not prescribe to women seeking to become pregnant; exclude pregnancy before initiation and advise use of effective contraception

04.06 Domperidone tabs,suspension

MHRA:Risk of cardiac side effects

MHRA:Minimising risk of cardiac side effects with apomorphine

MHRA:Domperidone for nausea and vomiting: lack of efficacy in children; reminder of contraindications in adults and adolescents


Use restricted to nausea and vomiting only.

The maximum treatment duration should not usually exceed one week.

04.11 Donepezil Aricept®

Initiated and stabilised by secondary care

02.07.01 Dopamine 
03.07 Dornase Alfa Pulmozyme®

Commissioned by NHSE.

Do not prescribe in primary care for new patients (since April 2013)


At Ipswich hospital - to be supplied by Addenbrokes on homecare

At Colchester hospital - not to be supplied unless confirmation of funding achieved (existing patients should utilise their own previosly funded supply)

11.06 Dorzolomide 2% 

Available as 

  • 2% drops
  • 2% preservative free drops (multiuse bottle)
11.06 Dorzolomide and Timolol  

Available as 2% / 0.5% in

  • drops
  • preservative free drops (multiuse bottle) 
03.05.01 Doxapram 
15.01.07 Doxapram injection
02.05.04 Doxazosin 

MR tablets are non-formulary


Hospital only guidance

Switching from MR to IR

 See below for guidance 

 

Primary care guidance

Switching from MR to IR

Consider one of the following regimens

  1. Give half the dose of modified-release doxazosin as standard doxazosin, i.e. 4mg XL switched to 2mg standard.  There may be some patients who may require a higher dose and subsequent dose titration may be required.
  2. Give the same dose as modified-release doxazosin but there may be some patients who suffer orthostatic hypotension and need a lower dose and subsequent dose titration may be required.
  3. The alternative is to comply with the licensed dosing recommendations and initiate therapy at 1mg daily, increasing at weekly/fortnightly intervals.

See below for more information

07.04.01 Doxazosin 
08.01.02 Doxorubicin 
08.01.02 Doxorubicin Liposomal
08.01.02 Doxorubicin Hydrochloride injection
02.03.02 Dronedarone Multaq®
04.06 Droperidol 

Hospital only – post-operative nausea and vomiting in PCA

06.01.02.03 Dulaglutide 
04.07.03 Duloxetine Cymbalta®

Traffic light information

Traffic light Details
Green

Major depressive episodes - treatment would not be initiated within the acute Trust, but if necessary to ensure patient care, existing therapy would be continued on (and supplies purchased if appropriate)

Blue Neuropathic pain (3rd line)

 

07.04.02 Duloxetine Yentreve®
08.01.05 Durvalumab Imfinzi
06.04.02 Dutasteride Avodart®

Consultant urologist only for following scenarios

      • Intolerant to finasteride

                         or

      • If finasteride is ineffective



02.08.02 Edoxaban 

Traffic light information

Traffic light Details
Green Treating and preventing DVT and PE
Blue Prevention of stroke and systemic embolism with non-valvular atrial fibrillation
20 Edrophonium 10mg/ml injection 
10.02.01 Edrophonium Chloride injection
05.03.01 Efavirenz Sustiva®
13.09 Eflornithine cream

If COCs are contraindicated or have not worked

Discontinue if no benefit is seen within 4 months of starting treatment and refer to secondary care

 

NEECCG - Eflornithine is non-formulary

13.09 Eflornithine cream

Discontinue if no benefit is seen within 4 months of starting treatment and refer to secondary care

05.03.03.02 Elbasvir/Grazoprevir Zepatier®
06.04.01.01 Elleste-Duet estradiol 2mg + norethisterone acetate 1mg

Note- there are 2 preparations with different strengths of estradiol 

06.04.01.01 Elleste-Duet estradiol 1mg+ norethisterone acetate 1mg

Note- there are 2 preparations with different strengths of estradiol 

09.01.04 Eltrombopag tabs

MHRA:Reports of interference with bilirubin and creatinine test results

01.04.02 Eluxadoline 

MHRA:Risk of pancreatitis; do not use in patients who have undergone cholecystectomy or in those with biliary disorders


Ipswich Hospital

the drug is approved and is considered formulary but the Traffic Light status of the product is to be confirmed.

Colchester Hospital

The drug is approved and is considered formulary. Secondary care initiation is followed by a formal review after 4 weeks treatment; at which point prescribing is transferred to Primary Care colleagues if treatment is to continue.

05.03.01 Elvitegravir 
13.03 Emollients 

Pruritus associated with dry skin or for pruritus in otherwise healthy elderly people

Click here to see preparations used as emollients

13.05.01 Emollients 

Click here to see preparations used as emollients

13.08.01 Emollients 

Click here to see preaprations used as emollients


Photograph area before treatment

Refer if there is ulceration or induration

Ensure that the patient is aware it will look much worse before it heals.

13.02.01 Emollin ® 

Flame Flame Flame High fire risk


Only on advice from specialist where

  • Sore and inflamed skin so unable to spread cream/lotion
  • Where access to the affected site is difficult
06.01.02.03 Empagliflozin 
05.03.01 Emtricitabine Emtriva®
05.03.01 Emtricitabine + tenofovir alafenamide Descovy®
05.03.01 Emtricitabine 200mg, Rilpivirine 25mg and Tenofovir 245mg Eviplera®
13.02 Emulsifying Ointment BP 

Can be bought OTC

05.03.01 Enfuvirtide Fuzeon®
02.08.01 Enoxaparin 
02.01.02 Enoximone 

Hospital ITU only

04.09.01 Entacapone 
05.03.03.01 Entecavir Baraclude
08.01.05 Entrectinib Rozlytrek® 100mg and 200mg
08.03.04.02 Enzalutamide caps
02.07.02 Ephedrine 

Hospital ITU or anaesthesia only

12.02.02 Ephedrine nasal drops 

Available OTC

13.02.01 Epimax ® 

Can be bought OTC

Flame Low fire risk


Equivalent to Diprobase® Cream

Can be used as a soap substitute


 

As of March 2020 Epimax cream has been renamed Epimax Original cream.

08.01.02 Epirubicin 
02.02.03 Eplerenone 

Usually specialist initiation within Secondary Care setting, but for heart failure, treatment can also be initiated under the supervision/recommendation of a Consultant Cardiologist, General Practitioners with a Special Interest in Cardiology or Heart Failure Specialist Nurses

09.01.03 Epoetin alfa Eprex®

Traffic light information

Traffic light Details
Red renal patients;all indications
Double Red tumours;all indications
09.01.03 Epoetin beta NeoRecormon®

Traffic light information

Traffic light Details
Red renal patients;all indications
Double Red tumours;all indications
02.08.01 Epoprostenol 

Ipswich Hospital

Neonatal unit use only

Colchester Hospital

Usage limited to Critical Care practice

09.06.04 Ergocalciferol 
20 Ergocalciferol 20,000 units in 1ml oral solution 
07.01.01 Ergometrine injection

Initial management of post partum haemorrage

07.01.01 Ergometrine Maleate and Oxytocin 

Active management of 3rd stage of labour

Initial management of PPH

 

08.01.05 Eribulin injection
06.01.02.03 Ertugliflozin Steglatro

Ipswich diabetes consultants prefer other choices in this class of drugs.  Awaiting cardiovascular outcome data.

13.06.02 Erythromycin 

Only if tetracyclines not tolerated.

13.06.03 Erythromycin  

Only if tetracyclines are contraindicated

02.04 Esmolol injection
07.02.01 Estradiol 10mcg vaginal tablet
08.01.01 Estramustine Phosphate caps
06.04.01.01 Estriol 0.01% cream
07.02.01 Estriol 0.01% cream
06.04.01.01 Estriol 0.1% cream
07.02.01 Estriol 0.1% cream
02.11 Etamsylate 

Palliative care use only

10.01.03 Etanercept 

Prescribing etanercept at Ipswich and Colchester hospitals

  • all patients will receive the biosimilar product (Benapali) in line with nationally agreed guidance; unless clinically inappropriate to do so
  • at Ipswich Hospital, etanercept may be prescribed/initiated both within Dermatology and Rheumatology (Colchester does not have a Dermatology service)
13.05.03.02 Etanercept 

Consultant dermatologists & rheumatologists only


Hospital only guidance

Prescribing etanercept

  • All prescriptions for etanercept must be prescribed by brand name
  • Existing patients currently receiving etanercept will continue to be prescribed Enbrel® unless a switch has been agreed. 
  • New patients will be prescribed Benepali® 

Should patients experience unexpected side effects, lack of tolerance or a symptom flare while using the biosimilar, the originator product i.e Enbrel® should be used

09.05.01.02 Etelcalcetide Parsabiv®
11.11 Ethanol 18%  

Unlicensed special


Preservative free drops

06.04.01.01 Ethinylestradiol 
07.03.01 Ethinylestradiol / levonorgestrel phased pill 

Phasic standard strength with the following strengths for each phase

- 30mcg/50mcg

- 40mcg/75mcg

- 30mcg/125mcg

 

Available as 21 day and 28 day preparations

07.03.01 Ethinylestradiol 20 mcg / drospirenone 3 mg  

 Standard strength


For family planning clinic use only - supplied by IHT

07.03.01 Ethinylestradiol 20 mcg / norethisterone 1mg 

low strength 

07.03.01 Ethinylestradiol 20mcg / desogestrel 150mcg Gedarel®, Mercilon®

Ipswich Hospital

Ethinylestradiol 20mcg / desogestrel 150mcg is a non-formulary medicine

Colchester Hospital / NEECCG

Ethinylestradiol 20mcg / desogestrel 150mcg is considered a formulary medicine choice

07.03.01 Ethinylestradiol 20mcg / gestodene 75 mcg Millinette®, Femodette®, Juliperla®

Ipswich Hospital

Ethinylestradiol 20mcg / gestodene 75 mcg is a non-formulary medicine

Colchester Hospital / NEECCG

Ethinylestradiol 20mcg / gestodene 75 mcg is considered a formulary choice

20 Ethinylestradiol 2mcg tabs 
07.03.01 Ethinylestradiol 30 mcg / drospirenone 3 mg Yasmin®

Ipswich Hospital

Ethinylestradiol 30 mcg / drospirenone 3 mg (Yasmin) is a non-formulary medicine

Colchester Hospital / NEECCG

Ethinylestradiol 30 mcg / drospirenone 3 mg (Yasmin) is considered a formulary medicine choice (to be utilised only if the patient has associated androgenic skin problemns)

07.03.01 Ethinylestradiol 30 mcg /desogestrel 150 mcg 

low strength

07.03.01 Ethinylestradiol 30mcg / gestodene 75 mcg 

standard strength

07.03.01 Ethinylestradiol 30mcg / levonorgestrel 150mcg 

standard strength

07.03.01 Ethinylestradiol 35 mcg / noresthisterone 1mg 

standard strength

07.03.01 Ethinylestradiol 35 mcg / noresthisterone 500mcg 

standard strength 

07.03.01 Ethinylestradiol 35 mcg / norgestimate 250 mcg 

Standard strength 


 For family planning clinic use only - supplied by IHT

 

North East Essex CCG

Ethinylestradiol 35mcg/ norgestimate 250mcg is considered a formulary medicine choice.

04.08.01 Ethosuximide 
15.02 Ethyl Chloride spray
10.01.01 Etodolac MR tabs

Ipswich Hospital

Etodalac is approved for use to treat Rheumatoid Arthritis and Osteoarthritis only

Colchester Hospital / NEECCG

Etodalac is considered a non-formulary medicine

07.03.02.02 Etonorgestrel Nexplanon®

MHRA:Reports of device in vasculature and lung

MHRA: New insertion site to reduce rare risk of neurovascular injury and implant migration


Remove after 3 years

08.01.04 Etoposide caps, injection
10.01.01 Etoricoxib 

MHRA:Revised dose recommendation for rheumatoid arthritis and ankylosing spondylitis


Ipswich Hospital

Second-line use to treat Rheumatoid Arthritis, Osteoparthritis and Ankolysing Spondylitis

Colchester Hospital

Etoricoxib has limited use as a second line agent.

13.02.01 Eucerin ® Intensive 

Usually only on advice from specialist

08.01.05 Everolimus Afinitor®
02.12 Evolocumab Repatha®

Ipswich Hospital

Treatment will only be initiated by a clinical pathologist in the lipid clinic

Colchester Hospital

Evolocumab is considered non-formulary. All persepctive patients are referred to the Ipswich lipid clinic.

06.04.01.01 Evorel Conti estradiol ~50mcg/24hrs + norethisterone acetate ~170mcg/24hrs

Reserved for patients unable to swallow

06.04.01.01 Evorel Sequi  estradiol ~50mcg/24hrs + norethisterone acetate ~170mcg/24hrs
08.03.04.01 Exemestane 
06.01.02.03 Exenatide Byetta▼®

Ipswich Hospital

Exenatide is considered non-formulary

Colchester Hospital

Exenatide is considered a formulary medicine; although rarely used and with treatment initiation by a Consultant Endocrinologist only

06.01.02.03 Exenatide prolonged release Bydureon®

Not for new initiations, treatment continuation only

13.05.02 Exorex Coal tar solution 5%

Can be bought OTC


Coal tar shampoos should not be used alone for people who have severe scalp psoriasis

13.06.03 Eyelid hygiene measures 
02.12 Ezetimibe 

Very limited usage. Only to be utilised in accordance with NICE guidance.

10.01.04 Febuxostat Adenuric®

MHRA: Stop treatment if signs or symptoms of serious hypersensitivity

MHRA: Increased risk of cardiovascular death and all-cause mortality in a clinical trial in patients with a history of major cardiovascular disease

02.06.02 Felodipine 
06.04.01.01 Femoston estradiol 1 mg+ dydrogesterone 10 mg
06.04.01.01 Femoston estradiol 2 mg+ dydrogesterone 10 mg
06.04.01.01 Femseven Conti estradiol ~50mcg/24hrs + levonorgestrel ~7mcg/24hrs

Reserved for patients unable to swallow

06.04.01.01 Femseven Sequi  estradiol ~50mcg/24hrs + levonorgestrel ~10mcg/24hrs
02.12 Fenofibrate 

Only if intolerant to statins

04.07.02 Fentanyl 

MHRA:Potential for life-threatening harm from accidental exposure

 

MHRA:Life-threatening and fatal opioid toxicity from accidental exposure, particularly in children


Reserved for end of life care and patients with Parkinsons / severe dysphagia


Hospital only guidance

Initiation

Only to be initiated by either

  • Hospice
  • Palliative care
  • Chronic pain team
  • Consultant signature
In chronic pain if a dose increase of more than 25mcg/hour is necessary or if an increase 50mcg/hour  is inadequate, contact Chronic Pain team for advice
15.01.04.03 Fentanyl 
04.07.02 Fentanyl sublingual tablets Abstral®

Joint guidance

Low Clinical Value Medicine

Strictly for the management of breakthrough pain for chronic cancer pain

Fentanyl immediate release (Abstral) MUST NOT be initiated within primary care

 

09.01.01.02 Ferric Carboxymaltose Ferinject®

Whereas iron dextran (Cosmofer) is the iron infusion of choice for hospital in-patients for whom discharge is not imminent, ferric carboxymaltose (Ferinject) - with its shorter infusion time - can be utilised in clinical areas with high turnover of patients (e.g. renal, haematology, maternity, etc) and within hospital in-patients areas where a quicker administration of an iron infusion will facilitate discharge (e.g. Emergency Assessment Unit).

 

 

09.01.01.01 Ferrous Fumarate 

The 210mg tab is for primary care use only


Available as

  • 210mg tab
  • 140mg/5ml liquid
  • 322mg tab
09.01.01.01 Ferrous Gluconate 

Avaiable as

  • 300mg tab
09.01.01.01 Ferrous Sulphate 

Available as

  • 200mg tab
07.04.02 Fesoterodine Toviaz®

Ipswich Hospital

Fesoterodine is a non-formulary medicine

Colchester Hospital / NEECCG

Fesoterodine is considered a formulary choice (third line therapy)

03.04.01 Fexofenadine 

Only if other antihistamines ineffective or not tolerated

06.01.01.01 Fiasp® Insulin Aspart

Rapid acting insulin anologue

Note : Faster acting than Novorapid


Available as:

  • Vials
  • Cartridges
  • Flextouch® Pre-filled pen
05.01.07 Fidaxomicin Dificlir®

Traffic light information

Traffic light Details
Green

GreenTreatment of Clostridium difficile infections (CDI) also known as C. difficile associated diarrhoea (CDAD) in adults (third line after metronidazole and vancomycin; following a recommendation from a microbiologist- this may be verbal if patients are in the community)

09.01.06 Filgrastim 
06.04.02 Finasteride 
06.01.06 FineTest Lite  

Compatible strips

  • FineTest Lite Blood Glucose Test Strips
08.02.04 Fingolimod caps

MHRA: Increased risk of congenital malformations; new contraindication during pregnancy and in women of childbearing potential not using effective contraception


Neurology use only

For Relapsing Remitting Multiple Multiple Sclerosis

02.03.02 Flecainide injection
02.03.02 Flecainide tabs
03.01.05 Flo-Tone MDI 
13.04 Flucinolone Acetonide 0.0025% Synalar 1 in 10 Dilution®

Only on advice from specialist

13.04 Flucinolone Acetonide 0.00625% Synalar 1 in 4 Dilution®
12.03.02 Fluconazole  Only if topical ineffective/ inappropriate
11.03.02 Fluconazole 0.2% preservative free 

This is a very specialist and restricted product prescribed only in specific circumstances.

The fluconazole 0.2% drops product is an unlicensed "unlicensed special" medicine that would be dispensed by the hospital pharmacy only.

 

24.01 Flucytosine injection

Held at Ipswich Hospital


Available as 

  • 10mg/ml x 250ml bottles
20 Flucytosine 500mg tablets 
08.01.03 Fludarabine Phosphate Fludara®
06.03.01 Fludrocortisone 
13.04 Fludroxycortide  Haelan® tape

For localized areas of lichen simplex chronicus/thickened skin where penetration of ordinary steroids may be an issue

May help break itch/scratch cycle by covering the affected area

Do not use with other topical steroids

15.01.07 Flumazenil injection
12.01.01 Flumetasone 0.02% with Clioquinol 1% 

Expensive

11.99.99.99 Fluocinolone 190mcg/ml Iluvien®
20 Fluorescein 20% 5ml amps 
11.10 Fluorescein Sodium 

Available as

  • 1% singe use eye drops
  • 2% singe use eye drops
  • 500mg in 5ml injection
  • 1mg ophthalmic strips
11.04.01 Fluorometholone 0.1% FML®

This is a mild steroid prescribed for a wide range of occular surface diseases.

No preservative free formulation available.  For a preservative free mild occular steroid, hydrocortisone or prednisolone 0.5% eye drops are available.

12.01.01 Fluoroquinolone  

Unlicensed product

08.01.03 Fluorouracil injection
13.08.01 Fluorouracil Efudix®

Traffic light information

Traffic light Details
Blue Bowen’s disease
Green Other indications
04.03.03 Fluoxetine caps,dispersible tabs, liquid

Avoid 10mg caps due to high cost

Consider liquid (as oral solution) where doses of 10mg is needed. Please note: suger free version is expensive. Where possible choose the formulation that is not suger free. 

04.02.01 Flupentixol tabs

Flupentixol is a rarely prescribed and specialist treatment within Mental Health. It would not be initiated within the acute hospitals at Ipswich and Colchester but existing patients admitted to the organisation would have their treatment continued; and supplies procured accordingly if necessary.

04.02.02 Flupentixol Decanoate 
04.02.02 Fluphenazine Decanoate 
10.01.01 Flurbiprofen 

Ipswich Hospital

Flurbiprofen is approved for use only to treat scleritis/episcleritis

Colchester Hospital / NEECCG

Flurbiprofen is considered a non-formulary medicine

11.11 Flurbiprofen Sodium 0.3% 

Single use eye drops


Diclofenac 0.1% single use drops may be used if flurbiprofen is not available

08.03.04.02 Flutamide 

North East Essex CCG

Flutamide prescribing responsibility may be taken over by the GP with agreement when clear guidance and monitoring information is provided.

12.02.01 Fluticasone furoate Avamys®

Ipswich Hospital

Fluticasone furoate nasal spray (Avamys) is non-formulary

Colchester Hospital

Fluticasone furoate nasal spray (Avamys) is considered a formulary medicine choice

12.02.01 Fluticasone Propionate Flixonase Nasule®

Licensed for 16 and over

12.02.01 Fluticasone Propionate Nasofan®

Available OTC for >18 years


 POM use- Licensed for 4 and over

03.02.02 Flutiform 125/5 Fluticasone propionate and formoterol

Available as
- MDI
- K-haler (see note below re: discontinuation of the K-haler device)

Licensed for adults and children >12 years

 

February 2021 - All strengths of the K-haler device are being discontinued from the UK market. The 125/5mcg device will be discontinued from April 2021.  

 

 

 

03.02.02 Flutiform 250/10 Fluticasone propionate and formoterol

Licensed for adults and children >12 years

03.02.02 Flutiform 50/5 Fluticasone propionate and formoterol

Available as
- MDI
- K-haler (see note below re: discontinuation of the K-haler device)

Licensed for adults and children >12 years

 

February 2021 - All strengths of the K-haler device are being discontinued from the UK market. The 50/5mcg device will be discontinued from August 2021. 

09.01.02 Folic Acid tabs, liquid

Check vitamin B12 levels in all people before starting folic acid

06.05.01 Follitropin Alfa  endocrine
06.05.01 Follitropin alfa infertility

Available as

  • 300units
  • 450units
  • 900units
06.05.01 Follitropin Alfa and Beta endocrine
24.01 Fomepizole 1g/ml x 1.5ml injection

Held at Ipswich Hospital and not stocked at Colchester Hospital


Available as

  • 1g/ml injections x 1.5ml vial (4 vials available)

Administration details available on Toxbase

02.08.01 Fondaparinux 

Hospital only guidance

 
For unstable angina, non ST-segment elevation myocardial infarction and ST-segment elevation myocardial infarction only
03.01.01.01 Formoterol  Easyhaler®

A LABA should only be used in asthmatic patients with an ICS.

Adults and children >6 years

03.01.01.01 Formoterol  Turbohaler®

A LABA should only be used in asthmatic patients with an ICS.

Adults and children >6 years

 

05.03.01 Fosamprenavir Telzir®
04.06 Fosaprepitant Ivemend®
24.01 Fosfomycin injection

Held at Colchester Hospital


 Available as 

  • 10 x 2g
  • 10 x 4g 
03.02.02 Fostair 100/6 Beclometasone and formoterol

Available as

  • MDI
  • DPI (NEXThaler device)

Licensed for adults >18 years only.

Moderate dose= 2 puffs BD

03.02.02 Fostair 100/6  Beclometasone and formoterol

Available as

  • MDI
  • DPI (NEXThaler device)

Licensed for adults >18 years only.

Low dose= 1 puff BD

03.02.03 Fostair 100/6 Beclometasone and formoterol

Available as

  • MDI
  • DPI (NEXThaler device)

Licensed for adults >18 years only.

03.02.02 Fostair 200/6 Beclometasone and formoterol

Available as

  • MDI
  • DPI (NEXThaler device)

Licensed for adults >18 years only.

06.01.06 Freestyle Freedom Lite 

Omnipod Insulet pump handset/meter. Doubles as a meter and bolus advisor.


Compatible test strips

  • Freestyle lite strips
06.01.06 Freestyle Libre  

IESCCG

Only to be prescribed by GP following a recommendation by the diabetes team at Ipswich hospital

Patients eligible for Freestyle Libre will be reviewed at 6 months by the specialist and then at 6-12 month intervals 

GPs are recommended to prescribe no more than 2 sensors (28 days) 

Please see links below for further information

 

NEECCG

See link to policy below.

06.01.06 Freestyle Optium Neo meter 

Antenatal use only


Compatible test strips

  • Freestyle Optium strips
04.07.04.02 Fremanezumab Ajovy ®
08.03.04.01 Fulvestrant Faslodex®
20 Fumaric acid (Fumaderm) tablets 

Consultant dermatologists only for use in psoriasis

05.02 Fungizone Amphotericin

Hospital only guidance



Not to be given IV

Must be prescribed via brand

For intravitreal use and line-locks

See below for IHT medication safety newsletter

02.02.02 Furosemide tabs, liquid, injection

Approximately 1mg bumetanide is equivalent to 40mg furosemide

11.03.01 Fusidic Acid 1% 
13.10.01.01 Fusidic acid 2% Fucidin®

As resistance is increasing reserve topical antibiotics for very localised lesions

Systematic review indicates topical and oral treatment produces similar results. Do not repeat topical treatment if treatment failure.

04.07.03 Gabapentin 

MHRA:Risk of severe respiratory depression

04.08.01 Gabapentin 

MHRA:Risk of severe respiratory depression

04.11 Galantamine XL 

Initiated and stabilised by secondary care

04.07.04.02 Galcanezumab Emgality
04.07.04.02 Galcanezumab Emgality
05.03.02.02 Ganciclovir 
11.03.03 Ganciclovir 0.15% ophthalmic gel Virgan®

Second line ophthalmic antiviral therapy

08.01.03 Gemcitabine 
20 GEMTUZUMAB - OZOGAMICIN Injection 5 mg 
20 Gentamicin 0.1% cream 

Prophylaxis for exit site infections in CAPD pts allergic to mupirocin

11.03.01 Gentamicin 0.3% 
12.01.01 Gentisone HC Hydrocortisone Acetate 1% with Gentamicin 0.3%

Expensive

08.01.05 Gilteritinib Xospata ®
08.02.04 Glatiramer Acetate injection
06.01.02.01 Gliclazide 

Ipswich Hospital

Note-modified release preparation of gliclazide is not approved

Gliclazide 30mg MR release is approximately equivalent to gliclazide 80mg standard release. 

Note: To ensure adequate distribution of gliclazide levels over 24 hours, when switching from modified release to standard release gliclazide, use the following equivalent dosing:

30mg once daily gliclazide MR= 40mg twice daily gliclazide standard release

60mg once daily gliclazide MR= 80mg twice daily gliclazide standard release

Switching doses of gliclazide MR over 60mg daily to standard release gliclazide should be discussed with the Ipswich Hospital diabetes team

 

06.01.02.01 Gliclazide MR 

Ipswich Hospital

Gliclazide m/r is a non-formulary medicine and a switch process is in place within the acute hospital to change patients to the normal release formulation

Colchester Hospital

Gliclazide m/r is considered a formulary medicine; it is unlikely that treatment would be initiated within the acute hospital but existing treatment would be continued if clinically appropriate. There is no formal switch process in place.

NEECCG

Considered a formulary medicine

06.01.02.01 Glimepiride 
06.01.04 Glucagon GlucaGen® HypoKit

1 unit is equivalent to 1mg

06.01.01.03 GlucoRx Carepoint ® 

Primary care guidance

Available as

  • 4mm/31 gauge
  • 5mm/31 gauge
  • 6mm/31 gauge
  • 8mm/31 gauge
  • 10mm/29 gauge
  • 12mm/29 gauge
06.01.01.03 GlucoRx Carepoint Ultra ® 

Primary care guidance

Available as

    • 4mm/32 gauge

Please note: GlucoRx Carepoint Ultra needle has a higher gauge in the 4mm length than the standard needle. As a result, patients may experience less discomfort when injecting.

06.01.06 GlucoRx Nexus Voice 

For patients with visual impairments


Compatible test strips

  • GlucoRx Nexus strips
06.01.06 GlucoRx Q meter 

Compatible strips

  • Gluco Rx Q® Test Strips
06.01.04 Glucose 20% 100ml infusion 

Hospital use only

06.01.04 Glucose 40% oral gel 

Padiatric inpatient use only

09.02.02.01 Glucose Intravenous 
06.01.04 Glucose power 

Hospital inpatient use only

01.06.02 Glycerol suppositories

Avaiable OTC

20 Glycerol Injection 

Pain formulary only

02.06.01 Glyceryl Trinitrate 
02.06.01 Glyceryl Trinitrate 
02.06.01 Glyceryl Trinitrate 
02.06.01 Glyceryl Trinitrate 
01.07.04 Glyceryl Trinitrate 0.4% 
07.04.04 Glycine irrigation
15.01.03 Glycopyrronium 
01.05.03 Golimumab 
10.01.03 Golimumab 
06.05.01 Gonadorelin injection
20 Gonadorelin (relefact) 100mcg injection 
06.07.02 Goserelin 

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Shared care Prostatic carcinoma
08.03.04.01 Goserelin Zoladex®
08.03.04.02 Goserelin injection
03.04.02 Grass pollen extract Grazax®

Ipswich Hospital

Grazax is considered a non-formulary medicine

Colchester Hospital

Grazax is considered a very restricted but a formulary medicine

02.05.03 Guanethidine Monosulphate Ismelin®

Chronic Pain team at Ipswich hospital only

04.04 Guanfacine 
13.05.03.02 Guselkumab Tremfya

Specialist use only for moderate to severe plaque psoriasis

Homecare delivery for subcutaneous injection

14.04 Haemophilus influenzae type B 
14.04 Haemophilus influenzae type B Combined Vaccine Menitorix®
03.01.05 Haleraid ® 

Available as 

  • Haleraid 120 (for 120 dose MDI)
  • Haleraid 200 (for 200 dose MDI)
04.02.01 Haloperidol 

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  • Mental health disorders
  • Palliative care
Red As per Trusts acute delirium guidance

 


IM and PO doses not interchangeable

04.02.02 Haloperidol decanoate 
02.08.01 Heparin sodium 
14.04 Hepatitis A vaccine 
14.04 Hepatitis A vaccine Single Component Avaxim®
14.04 Hepatitis A vaccine Single Component Epaxal®
14.04 Hepatitis A vaccine Single Component Havrix Monodose®
14.04 Hepatitis A vaccine Single Component Vaqta® Paediatric
14.04 Hepatitis A vaccine with Hepatitis B vaccine  Twinrix®
14.04 Hepatitis A vaccine with typhoid vaccine Hepatyrix®
14.04 Hepatitis A vaccine with typhoid vaccine VIATIM®
14.05.02 Hepatitis B immunoglobulin HBIG

Only to be prescribed after consultation with an Ipswich Hospital microbiologist

14.04 Hepatitis B vaccine 
14.04 Hepatitis B vaccine Single Component Engerix B®
14.04 Hepatitis B vaccine Single Component Fendrix®
14.04 Hepatitis B vaccine Single Component HBvaxPRO®
08.03.04.02 Histrelin injection
06.01.01.02 Humalog® Mix 

Biphasic Insulin Lispro


Available as:

  • Cartridges
  • Pre-filled pen
06.05.01 Human Menopausal Gonadotrophins 
14.04 Human papilloma virus vaccine Gardasil®

ESNEFT Hospital Only Prescribing for Laryngeal Papillomatosis in line wit hthe position statment from the British Laryngological Association (BLA). 

14.04 Human papilloma virus vaccine Cervarix®
14.04 Human papilloma virus vaccine Gardasil®
14.04 Human papilloma virus vaccine (9-valent) Gardasil 9®
06.01.01.02 Humulin® M3 

Isophane Insulin human


Available as:

  • Cartridges
  • Solostar® Pre-filled pen
  • Vials
06.01.01.01 Humulin® S 

Soluble insulin


Available as:

  • Vials
  • Cartridges
10.01 Hyaluronic acid Durolane

Restricted for use by Trauma and Orthopaedic Consultant (Pain Management) for

patients with osteoarthritis in the knees:

-who cannot tolerate analgesia, or for whom analgesia is contra-indicated

-who do not experience clinical improvement but are unfit for surgery

-who with to delay surgery

 

10.03.01 Hyaluronidase injection

For use by ophthalmology and extravasation in paediatrics and neonates only

02.05.01 Hydralazine tabs
02.05.01 Hydralazine injection
06.03.02 Hydrocortisone 

Modified release tablets are not approved

12.03.01 Hydrocortisone Corlan®

MHRA:Should not be used off-label for adrenal insufficiency in children due to serious risks


Available OTC

13.04 Hydrocortisone 0.5% and 1% cream and ointment

Can be bought OTC for patients ≥10yrs for the following

  • Irritant contact dermatitis
  • Allergic contact dermatitis
  • Insect bite reactions
  • Mild to moderate eczema 

Cannot be used for the face if purchacing OTC 


If treating the body use a moderate steroid 1st line.

06.03.02 Hydrocortisone sodium phosphate Efcortesol® injection

Already in solution

06.03.02 Hydrocortisone sodium succinate Solu-Cortef® injection

Requires reconstitution

13.04.04 Hydrocortisone 1% with Clotrimazole 1% Canesten HC cream ®

Can be bought OTC

13.04.04 Hydrocortisone 1% with Miconazole Nitrate 2% Daktacort® cream/ointment

Can be bought OTC


 For seborrheic dermatitis

10.01.02.02 Hydrocortisone acetate 
13.04.04 Hydrocortisone Acetate 1% with Fusidic Acid 2% Fucidin H® cream

Can be bought OTC

01.05.02 Hydrocortisone foam enema Colifoam®
06.03.02 Hydrocortisone MR Plenadren

Ipswich Hospital - Used only following an individual funding request by Ipswich Hospital endocrinologist, approved by CCG.

Colchester Hospital - product is completely Non-Formulary

11.04.01 Hydrocortisone sodium phosphate eye drops 3.35mg/ml Softacort

Ipswich Hospital

Advice from Ophthalmologist:

Softacort is a mild steroid with the lowest published rate of secondary raised intraoccular pressure, which is preservative free. 

Other mild steroid options include prednisolone 0.5% and FML eye drops.  FML is only available as a preserved eye drop and prednisolone 0.5% is available as both preserved and preservative free eye drops

12.03.04 Hydrogen Peroxide 3% 

For post-tonsillectomy haemorrhage

12.03.04 Hydrogen Peroxide 6% 

Acute ulcerative gingivitis

09.01.02 Hydroxocobalamin Vitamin B12
08.01.05 Hydroxycarbamide 

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Red Oncology related indications
10.01.03 Hydroxychloroquine 
11.08.01 Hydroxypropyl Guar Systane®

Ipswich Hospital

The Systane range of products are non-formulary medicines

Colchester Hospital & NEECCG

The Systane range of products (Systane, Systane Balance and Systane Ultra) are considered formulary medicine choices. Systane Ultra is to be initiated by a specilaist opthalmic practitioner.

 

03.04.01 Hydroxyzine 

MHRA:Risk of QT interval prolongation and Torsade de Pointes

01.02 Hyoscine Butylbromide 

MHRA: Serious adverse effects in patients with underlying cardiac disease


Available as

  • Tablets (avaiable OTC)
  • 20mg/ml injection
04.06 Hyoscine Hydrobromide 
15.01.03 Hyoscine Hydrobromide 

Hospital only for anaesthesia

11.08.01 Hypromellose 0.3% 

Can be bought OTC


Available as 

  • drops
  • preservative free drops

Ipswich Hospital

Hypromellose drops are considered a formulary medicines choice

Colchester Hospital & NEECCG

Hypromellose drops are considered a non-formulary medicine

06.06.02 Ibandronic Acid 50mg tablets

Specialist initiation


Reduction of bone damage in bone metastases in breast cancer

06.06.02 Ibandronic Acid injection 

Ipswich Hospital

Ibandronic acid injection is a formulary medicine - for postmenopausal osteoporosis for patients unable to take/intolerant to oral medicines

Colchester Hospital

Ibandronate acid injection is considered non-formulary

08.01.05 Ibrutinib caps
07.01.01.01 Ibuprofen  injection
10.01.01 Ibuprofen 

MHRA:High-dose ibuprofen (≥2400mg/day):small increase in cardiovascular risk


Can be bought OTC

10.03.02 Ibuprofen gel 5% 
08.01.02 Idarubicin caps, injection
02.08 Idarucizumab 

Reversal agent for Dabigatran

08.01.05 Idelalisib tabs
08.01.01 Ifosfamide injection
20 Iloprost  

Available as

  • 100mcg in 1ml
  • 50mcg in 0.5ml
02.06.04 Iloprost injection  

unlicensed Unlicensed medicine

08.01.05 Imatinib tabs, caps
04.03.01 Imipramine tabs, liquid

Liquid is high cost

Maybe used as an alternative to trimipramine

For neuropathic pain if intolerant to amitriptyline

04.07.03 Imiprimine 

Unlicensed indication


Only if intolerant to amitriptyline
13.07 Imiquimod 5% Aldara® cream
13.08.01 Imiquimod 5% Aldara® cream
13.02.01 Imuderm ®  

Can be bought OTC


Equivalent to Balnuem® cream

14.04 Inactivated Influenza Vaccine (Split Virion) 
14.04 Inactivated Influenza Vaccine (Surface Antigen) 
02.02.01 Indapamide (Immediate Release) 

Indapamide Modified Release tablets are considered non-formulary. 

11.11 Indermil 

Tissue adhesive

05.03.01 Indinavir Crixivan®
11.10 Indocyanine green 5mg/ml injection
07.01.01.01 Indometacin injection
10.01.01 Indometacin 

Hospital use only for acute gout

 

 

07.04.01 Indoramin Doralese®

Restricted use - indoramin is unlikely to be initiated within the acute Trust for urinary retention but existing therapy would be continued on if appropriate

 

14.04 Infanrix IPV ® 
14.04 Infanrix-IPV+Hib ® 
01.01.02 Infant Gaviscon ® 

Paediatric patients only

01.05.03 Infliximab Inflectra

Hospital only guidance

Prescribing Infliximab

  • All prescriptions for infliximab must be prescribed by brand name
  • All existing patients currently receiving infliximab will continue to be prescribed Remicade® or Remsima® unless a switch to Inflectra®has been agreed
  • New patients will be prescribed inflectra®

Should patients experience unexpected side effects, lack of tolerance or a symptom flare while using the biosimilar, the originator product i.e Remicade® should be used

10.01.03 Infliximab Inflectra®

Prescribing infliximab at Ipswich Hospital

  • all prescribing of infliximab must be brand specific
  • all patients will receive the biosimilar product (Inflectra) in line with nationally agreed guidance; unless clinically inappropriate to do so

Prescribing infliximab at Colchester Hospital

  • all prescribing of infliximab must be brand specific
  • all patients will receive the biosimilar product (Remsima) in line with nationally agreed guidance; unless clinically inappropriate to do so

 

13.05.03.02 Infliximab Inflectra®

Hospital only guidance

Prescribing Infliximab

  • All prescriptions for infliximab must be prescribed by brand name
  • All existing patients currently receiving infliximab will continue to be prescribed Remicade® or Remsima® unless a switch to Inflectra®has been agreed
  • New patients will be prescribed inflectra®

Should patients experience unexpected side effects, lack of tolerance or a symptom flare while using the biosimilar, the originator product i.e Remicade® should be used

14.04 Influenza vaccine  
13.08.01 Ingenol mebutate Picato®

MHRA: Suspension of the license due to risk of skin malignancy


08.01.05 Inotuzumab ozogamicin Besponsa®
06.01.01.02 Insulatard® Isophane Insulin

Basal Insulin-First Line


Available as:

  • Cartridges
  • Innolet device
06.01.01.01 Insulin Insuman® Rapid

Ipswich Hospital

Soluble insulin (Insuman) is considered a non-formulary medicine

Colchester Hospital

Soluble insulin (Insuman) is considered a formulary medicine; albeit with very limited use in practice. Treatment would not usually be initiated within the acute hospital

 

NEECCG

Considered a formulary medicine

06.01.01.02 Insulin degludec Tresiba®

Ipswich Hospital

Insulin degludec (Tresiba) 200units/ml is a non-formulary medicine

Colchester Hospital

Insulin degludec (Tresiba) 200units/ml is a formulary medicine - but very restricted use; only for patients requiring high doses of insulin therapy to decrease injection volume load

06.01.01.01 Insulin Glulisine Apidra®

Ipswich Hospital

Insulin glulisine is a non-formulary medicine

Colchester Hospital

Insulin glulisine is considered a formulary medicine, although it is not commonly used in practice and treatment must be initiated by the hospital's Diabetes Team

 

NEECCG

Considered a formulary medicine

 

 

06.01.01.01 Insulin Lispro 200 units/ml Humalog®

Ipswich Hospital

Insulin Lispro 200units/ml is considered a non-formulary medicine

Colchester Hospital

Insulin Lispro 200units/ml is considered a formulary medicine, but with very restricted usage. Only for patients requiring high doses of insulin therapy; to decrease injection volume load

NEECCG

Considered a formulary medicine

08.02.04 Interferon Alfa IntronA
08.02.04 Interferon Alfa Roferon-A®
08.02.04 Interferon Alfa Viraferon®
08.02.04 Interferon Beta Avonex®

Only approved for use for patients conforming to national MS trial criteria

08.02.04 Interferon Beta Rebif®

Only approved for use for patients conforming to national MS trial criteria

07.03.02.03 Intra-uterine Progestogen Only System Jaydess®

Ipswich Hospital

Jaydess is a non-formulary medicine

Colchester Hospital / NEECCG

Jaydess is considered a formulary medicines choice (noting that the Kyleena formulation has also recently been approved for use also)

20 IOPANOIC ACID Tablets 500 mg 

For endocrinology team use only

08.01.05 Ipilimumab injection
03.01.02 Ipratropium inhaler
03.01.02 Ipratropium nebules

Only if patient unable to use inhalers / patients with severe disease.

12.02.02 Ipratropium Bromide 
02.05.05.02 Irbesartan 
08.01.05 Irinotecan Hydrochloride injection

MHRA:Onivyde (irinotecan, liposomal formulations): reports of serious and fatal thromboembolic events

09.01.01.01 Iron and Folic Acid Pregaday®

Antenatal clinics only

09.01.01.02 Iron Dextran CosmoFer®

Hospital only guidance

Iron Dextran (Cosmofer) is the iron infusion of choice for hospitalised patients for whom discharge from hospital is not imminent. It is administered as an infusion over approximately 4-6hours and required initial careful monitoring for sensitivity reactions.

Dose calculator

Click here to open up Cosmofer calculator

09.01.01.02 Iron Sucrose Venofer®
08.02.03 Isatuximab injection
15.01.02 Isoflurane 
13.02.01 Isomol ® 

Can be bought OTC

Flame Low fire risk


Equivalent to Doublebase®

Can be used as a soap substitute


 

As of March 2020 Isomol gel was renamed Epimax Isomol gel.

20 Isoniazid 50mg / 5ml oral solution 
02.07.01 Isoprenaline 

unlicensed Unlicensed medicine

02.06.01 Isosorbide Dinitrate 

Specialist cardiology use only

02.06.01 Isosorbide Mononitrate MR tablets, MR capsules, tablets

XL preparations are for once daily administration.

Note: 60mg XL tablets can be halved to make a 30mg XL once daily dose

13.06.02 Isotretinoin 

MHRA:Pregnancy prevention

MHRA:Risk of serious skin reactions

MHRA:Risk of psychiatric disorders

MHRA:Rare reports of erectile dysfunction and decreased libido

MHRA: Revised and simplified pregnancy prevention educational materials for healthcare professionals and women


Hospital only guidance

Pregnancy Prevention Programme (PPP)

All prescriptions for females of childbearing age should be endorsed with either "On PPP" or "Not PPP"

On PPP

  • Prescriptions must be dispensed  and collected within 7 days of the date written on the script
  • A maximum of 28 days can be supplied
  • Where the time has passed a new prescription should be obtained from the clinic.

Not PPP

  • Prescriptions can be dispensed as normal 
  • No restriction on the quantity supplied (up to 2months given at a time)
13.06.01 Isotretinoin with antibacterial Isotrexin®
01.06.01 Ispaghula Husk 

Adequate fluid intake must be maintained to avoid intestinal obstruction.

Should not be taken before going to bed

02.06.03 Ivabradine 
13.10.04 Ivermectin tablets

unlicensed Unlicensed medicine


See link below for prescribing advice

13.06.03 Ivermectin cream Soolantra®
08.01.05 Ixazomib Ninlaro®
13.05.03.02 Ixekizumab 
13.08.02 Keromask ® 
15.01.01 Ketamine injection 
13.09 Ketoconazole Nizoral®

Can be bought OTC

10.03.02 Ketoprofen 2.5% Oruvail ®, Powergel®

Ipswich Hospital

Ketoprofen 2.5% gel is non-formulary

Colchester Hospital / NEECCG

Ketoprofen 2.5% gel is considered a formulary medicine choice.

11.11 Ketorolac 0.5% eye drops
11.04.02 Ketotifen 0.25mg/ml Ketofall

Approved for Ipswich Hospital and Colchester Hospital

Preferred choice of preservative-free mast cell stabiliser antihistamine eye drops

06.01.06 KEYA Smart Blood glucose and ketone meter 

Hospital recommendation only
Measures glucose and ketones in one strip


Compatible test strips

  • KEYA test strips
01.06.05 Klean-Prep ® 

For use in renal failure (eGFR< 45ml/min)

13.14 Kligman’s formula 
06.04.01.01 Kliofem estradiol 2mg + norethisterone acetate 1mg
06.04.01.01 Kliovance estradiol 1mg + norethisterone acetate 500mcg
02.04 Labetalol 

Used for hypertension in pregnancy 

04.08.01 Lacosamide  
01.06.04 Lactulose 

Available OTC

05.03.01 Lamivudine Epivir®

Indicated for HIV infection in combination with other antiretroviral drugs.  Also indicated for chronic hepatitis B infection.

05.03.03.01 Lamivudine Zeffix®
05.03.03.01 Lamivudine Zeffix

Indicated for chronic hepatitis B infection. Also indicated for HIV infection in combination with other antiretroviral drugs.

04.08.01 Lamotrigine 

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Green
  • Bipolar disorder- hospital initiated and stabilised, then GP to continue
  • Epilepsy
03.04.03 Lanadelumab 

For preventing recurrent attacks of hereditary angioedema

06.01.01.03 Lancets 

Primary care guidance

Only prescribe lancets which cost less than £3 per 100 lancets

See below for formulary choices

Options include

  • Advocate®
  • Agamatrix®;
  • Apollo twist®
  • Caresens®
  • Droplet®
  • FastClix®
  • GlucoRx®
  • GlucoZen®
  • GreenLan®
  • IME-DC®
  • Microdot®
  • Millward Steri-Let®
  • Mylife lancets®
  • Mylife multicolour®
  • Omnican Lance Soft®
  • OneTouch Delica®
  • Palmdoc Lancets®
  • Palmdoc iCare Advanced®
  • TRUEplus Lancets®
  • Vitrex soft®
08.03.04.03 Lanreotide Somatuline Autogel®

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Shared care
  • Acromegaly - fine control of growth hormone levels after surgery/radiotherapy
Red
  • Neuroendocrine tumours
  • Thyrotrophic adenomas
01.03.05 Lansoprazole caps

Lansoprazole is the Proton-Pump-Inhibitor of choice for patients on clopidogrel treatment.

01.03.05 Lansoprazole  orodispersible and Zoton®

Joint guidance

Orodispersible tablets

Reserved for patients with swallowing difficulties

Paediatric use- see below for IHT prescribing guidance

09.05.02.02 Lanthanum Fosrenol ®

Hyperphosphataemia in established renal failure on dialysis

08.01.05 Lapatinib 
08.01 Larotrectinib VITRAKVI ®
11.06 Latanoprost 50mcg/ml eye drops

MHRA:Increased reporting of eye irritation since reformulation


Available as

  • eye drops
  • preservative free eye drops
11.06 Latanoprost and Timolol  

Available as 0.005% / 0.5%

13.02.02 LBF Barrier film applicators

Available as

  • 1ml
  • 2ml

For use around wounds

13.02.02 LBF Barrier cream 2g sachet

For use on intact but vulnerable skin

13.02.02 LBF Barrier film spray 30ml

For use on broken skin

05.03.03.02 Ledipasvir and Sofosbuvir Harvoni®
10.01.03 Leflunomide 
08.02.04 Lenalidomide  caps
08.01.05 Lenvatinib Lenvima®
02.06.02 Lercanidipine 
08.03.04.01 Letrozole 
08.03.04.01 Letrozole 

ESNEFT: Letrozole for ovulation induction for subfertility. 

06.07.02 Leuprorelin 

First line for gynaecology e.g. endometriosis, endometrial thinning

08.03.04.02 Leuprorelin Acetate injeciton
20 LEVAMISOLE Tablets 50 mg 
04.08.01 Levetiracetam tabs, liquid
04.08.01 Levetiracetam injection
15.02 Levobupivacaine 

May be less cardiotoxic than (racemic) bupivacaine.

Only to be used in higher risk procedures e.g. where >20ml 0.5% bupivacaine would be required. 

11.03.01 Levofloxacin 0.5% 

Available as

  • 0.5% drops
    • Use if administering less than 6x/day
    • If higher frequency is required then use preservative free
  • 0.5% preservative free drops
    • For use where 
      • Administering drops every 1 – 2 hours during the first few days of treatment where preservatives may cause further inflammation.
      • Who have known allergy to preservatives
04.06 Levomepromazine tabs, injection

Palliative care use

07.03.05 Levonorgestrel 1.5mg 

MHRA:Advice on interactions with hepatic enzyme inducers and contraceptive efficacy


Can be used up to 72 hours after unprotected intercourse

06.02.01 Levothyroxine 

Note: levothyroxine liquid is very expensive compard to oral tablet therapy and so must only be prescribed in justifiable circumstances

02.03.02 Lidocaine 
15.02 Lidocaine injection
15.02 Lidocaine 4% topical cream
11.11 Lidocaine 4% Fluorescein 0.25% 

Single use eye dops

15.02 Lidocaine 4%, adrenaline 1:1000, tetracaine 0.5% LAT Single use only Use within 24 hours of opening For use in the Paediatric Emergency Department (Ipswich Hospital) as a local anaesthetic for wounds less than 5cm requiring suturing, in children over 1 year
15.02 Lidocaine 5% and Phenylephrine 0.5% 
12.03.01 Lidocaine and Hydrocortisone mouthwash 

Hospital use only

Unlicensed special (made in the pharmacy manufacturing unit at IHT)

04.07.03 Lidocaine plasters 

Green for its licensed indication ONLY: Post Herpatic Neuralgia

For any other indication this is considered NON-FORMULARY

15.02 Lidocaine with Adrenaline injection
15.02 Lidocaine2% with Chlorhexidine 0.25% Instillagel®
01.06.07 Linaclotide Constella®

Joint guidance

Prescribing and Monitoring

For the symptomatic treatment of moderate to severe irritable bowel syndrome with constipation (IBS-C) in adults where the patient’s symptoms have failed to resolve with:

  • Optimal or maximum tolerated doses of laxatives from at least three different classes trailed for 2 months each
  • Patient has had constipation for at least 12 months

GP to review after 4 weeks and if they have not experienced improvement in their symptoms they should be re-examined and the benefit and risks of continuing treatment reconsidered.

06.01.02.03 Linagliptin 

Reserved for patients with fluctuating renal function 

06.02.01 Liothyronine injection 

Very speciailist use - only utilised within the Critical Care setting as part of agreed organ donor optimisation pathways

 

 

06.02.01 Liothyronine tabs 

Joint guidance

Note: Armour thyroid must never be prescribed

Liothyronine is classed as medicine of low clinical value by NHSE
Initiation
Liothyronine is only to be used following a successful 3 month trial by an endocrinology consultant. Please see below for further guidance
Existing patients
Existing patients should be screened by endocrinology to determine the suitability of continuing liothyronine. GP should fill out the questionnaire( see below) and send it to the endocrine team for review who will advise the GP of the next steps.
13.02.01 Liquid and White Soft Paraffin Ointment (50:50) 

Flame Flame Flame High fire risk

11.08.01 Liquid Paraffin eye ointment 

Can be bought OTC


Available as

  • Preservative-free drops
    • prescribe as Xalin Night
11.08.01 Liquid Paraffin eye ointment with retinol palmitate 

HYLO Night ® eye ointment (preservative free)

04.04 Lisdexamfetamine caps
02.05.05.01 Lisinopril 
04.02.03 Lithium Carbonate tabs

Must be maintained on same brand

04.02.03 Lithium Citrate liquid

Must be maintained on same brand

Lithium carbonate 200mg is approximately equivalent to lithium citrate 509mg

Most lithium tablets are modified-release therefore when being given as a liquid the total daily dose will need to be given in divided doses.

06.01.02.03 Lixisenatide 

Ipswich Hospital/IESCCG

Lixisenatide is considered non-formulary

Colchester Hospital/NEECCG

Lixisenatide is considered a formulary medicine

04.03.01 Lofepramine tabs, liquid

Lofepramine is a rarely prescribed and specialist treatment. It would not be initiated within the acute hospitals at Ipswich and Colchester but existing patients admitted to the organisation would have their treatment continued; and supplies procured accordingly if necessary.

08.01.01 Lomustine caps

check if this is ULM as well

01.04.02 Loperamide 

MHRA:Serious cardiac adverse reactions with high doses of loperamide associated with abuse or misuse 


Available OTC


Doses of upto 16mg QDS can be used for stoma patients

05.03.01 Lopinavir and Ritonavir Kaletra®
03.04.01 Loratadine 

Available OTC

04.01.01 Lorazepam tabs

Tablets can be used sublingually

04.08.02 Lorazepam 

For status epilepticus, rapid tranquilisation and sedation

15.01.04.01 Lorazepam 
08.01 Lorlatinib Lorviqua
02.05.05.02 Losartan 
11.11 Loteprednol 0.5% eye drops
03.01.05 Low range peak flow meter Pocket peak®

Specify as "low range peak flow meter" on prescription 

06.02.02 Lugols 
09.01.04 Lusutrombopag tablets Mulpleo ®

MHRA:Reports of interference with bilirubin and creatinine test results

13.06.02 Lymecycline Tetralysal®300
13.06.03 Lymecycline 

Unlicensed indication


Use only if compliance is a problem

01.06.04 Macrogol oral powder 

Available OTC

09.05.01.03 Magnesium Glycerophosphate NeoMag ®

4mmol chewable tablets

20 Magnesium glycerophosphate liquid  
01.06.04 Magnesium Hydroxide Mixture BP 

Available OTC

09.05.01.03 Magnesium Sulphate injection

MHRA:Risk of skeletal adverse effects in the neonate following prolonged or repeated use in pregnancy


Available as

  • 50% amps
  • 20% amps (for maternity use only)
01.01.01 Magnesium Trisilicate 

Available OTC 

02.02.05 Mannitol 

Hospital ITU only


For cerebral oedema

03.07 Mannitol inhalation Bronchitol ®

Cystic Fibrosis Only

05.03.01 Maraviroc Celsentri®
14.04 Measles, Mumps and Rubella Vaccine, Live (MMR) 
01.02 Mebeverine tablets

Available OTC


The modified-release MR preparation is not approved for prescribing and is considered Non-Formulary.

06.04.01.02 Medroxyprogesterone Acetate Provera®
07.03.02.02 Medroxyprogesterone Acetate Depo-Provera®

repeated every 12 weeks

07.03.02.02 Medroxyprogesterone acetate Sayana Press®

Ipswich Hospital

Sayana Press is a non-formulary medicine

Colchester Hospital

Syana Press is considered a formulary medicine choice

08.03.02 Medroxyprogesterone Acetate Provera®

North East Essex CCG

Medroxyprogesterone (Provera) is considered a medicine that requires specialist initiation for oncology related indications.

10.01.01 Mefenamic Acid 

For menorrhagia

08.03.02 Megestrol Acetate tabs, suspension
04.01.01 Melatonin  

Traffic light information

Traffic light Details
Shared care

Sleep disorders in children and adolescents with neurological/neurodevelopmental disorders including

  • Attention deficit hyperactivity disorder (ADHD)
  • Autism
  • Visual impairment

The brand Slenyto available as 1mg and 5mg MR tablets has a license for use in children aged 2-18 for specific indications - refer to the SPC www.medicines.org.uk/emc

Red

ITU use only

Upon discharge from ITU melatonin should be stopped and another more suitable hypnotic e.g.zopiclone should be prescribed.

Double Red All adult patients including for use in Primary insomnia in the over 55s

 


 Available as 

  • Licensed products
    • 1mg/ml oral solution (unlicensed in children - caution contains alcohol, propylene glycol and sorbitol).
    • 1mg MR tabs
    • 2mg MR tabs (unlicensed in children)
    • 3mg tabs (unlicensed in children) 
    • 5mg MR tabs
  • Unlicensed products are high cost
10.01.01 Meloxicam 

Ipswich Hospital

Meloxicam is considered a formulary medicine

Colchester Hospital / NEECCG

Meloxicam is considered a non-formulary medicine

08.01.01 Melphalan tabs
04.11 Memantine 

Initiated and stabilised by secondary care

At Ipswich Hospital, memantine liquid is non-formulary.  Orodispersible tablets are formulary and are used as an alternative to liquid.

09.06.06 Menadiol Sodium Phosphate tabs

Water soluble vitamin K preparation.

Preparation of choice for patients with biliary obstruction or hepatic disease.

14.04 Meningococcal A, C, W135, and Y conjugate vaccine Menveo®
14.04 Meningococcal group B Vaccine Bexsero®
14.04 Meningococcal group C conjugate vaccine 
14.04 Meningococcal group C conjugate vaccine Menjigate Kit®
14.04 Meningococcal polysaccharide A, C, W135 and Y vaccine ACWY Vax®
06.05.01 Menotrophin injection
06.05.01 Menotrophin injection

Fertility monitoring unit only


Avaiable as

  • 600 units
  • 1200 units
13.03 Menthol 1% in aqueous cream 

For pruritus in pregnancy if standard emollients do not work

13.03 Menthol 5% in aqueous cream 

For use if Menthol 1% in aqueous cream fails

20 Mepacrine 100mg 
15.02 Mepivacaine 3% injection
04.07.02 Meptazinol 

200mg meptazinol is equivalent to approximately to 8mg morphine

01.05.03 Mercaptopurine 

Treatment of inflammatory bowel disease

20 Mercaptopurine 10mg tablets 
01.05.01 Mesalazine 

Joint guidance

Must be prescribed by brand

Different brands and formulations of mesalazine are not interchangeable

If prescribed generically clarify preparation required with the prescriber

If patients are prescribed non-formulary brands e.g patients who have moved recently or admitted into hospital- please discuss with gastroenterology before changing brand

The following mesalazine preparations are considered formulary:

Formulation Approved brands
Tablets
  • 400mg m/r tablets (Octasa®)
  • 500mg m/r tablets (Pentasa®)
  • 800mg m/r tablets (Asacol®) - strictly for patients requiring 4.8g mesalazine daily (to reduce tablet load)
Granules 500mg sachets (Salofalk®)
Suppositories 1000mg suppositories (Pentasa®)
Retention Enema 1000mg retention enema (Pentasa®)
Foam enema 1000mg foam enema (Salofalk®)
08.01 Mesna tabs,liquid,injection
02.07.02 Metaraminol 
20 Metaraminol 10mg in 1ml injection 
06.01.02.02 Metformin 

Available as 

  • Tablets
  • 500mg/ml liquid
06.01.02.02 Metformin modified release 

Prescribe only if intollerent to stardard release metformin

04.07.02 Methadone 

At Colchester hospital/North East Essex CCG, the use of methadone within analgesic practice is limited to specialist use within Palliative Care.

04.10.03 Methadone 1mg/ml

Can be prescribed for pallative care


Note: To be prescribed by the addiction services for all non-pain or palliative indications

01.05.03 Methotrexate 

Hospital only guidance

Inpatient drug charts prescribing advice

  • It is prescribed weekly
  • If patient is taking folic acid, it must be given a minimum 24 hours after the methotrexate dose 
  • Endorse the chart with "CYTOTOXIC"
  • Quantity of 2.5mg tablets needed for each dose is specified e.g 4*2.5mg for 10mg dose
  • Allergy box has the following wording " Not for trimethoprim. Please check interactions with methotrexate before prescribing any new medicines".
  • Check bloods
    • eGFR
    • FBC
    • LFTs

Charts must be validated by a pharmacist before a supply can be made

Note: STP-wide Shared Care Guideline are in place relating to the use of methotrexate within Inflammatory Bowel Disease patients. These guidelines are available via the respective Clinical Commissioning Group websites.

 

Primary care guidance

Risk of overdose

Please check records/clinic letters to ensure the patient is not receiving any injectable methotrexate in secondary care

01.05.03 Methotrexate injection

IESCCG/Ipswich Hospital

Methotrexate injection is hospital only

NEECCG/Colchester

Hospital Methotrexate injection is shared care

Primary care guidance (IESCCG)

Safety

Please ensure medical records are up to date and methotrexate is noted as a regular medicine. This will ensure drugs that significantly interact e.g. trimethoprim are not prescribed.

07.05 Methotrexate gynaecology
10.01.03 Methotrexate 

Hospital only guidance

Inpatient drug charts prescribing advice

  • It is prescribed weekly
  • If patient is taking folic acid, it must be given a minimum 24 hours after the methotrexate dose 
  • Endorse the chart with "CYTOTOXIC"
  • Quantity of 2.5mg tablets needed for each dose is specified e.g 4*2.5mg for 10mg dose
  • Allergy box has the following wording " Not for trimethoprim. Please check interactions with methotrexate before prescribing any new medicines".
  • Check bloods
    • eGFR
    • FBC
    • LFTs

Charts must be validated by a pharmacist before a supply can be made

See below for IHT newsletters

 

Primary care guidance

Risk of overdose

Please check records/clinic letters to ensure patient is not receiving any injectable methotrexate in secondary care

10.01.03 Methotrexate injection

Ipswich Hospital

The use of methotrexate syringes within rheumatology is considered "hospital-only"

Colchester Hospital / NEECCG

The use of methotrexate syringes within rheumatology and other disorders is allowable within Primary Care under agreed Shared Care Guidance.

11.99.99.99 Methotrexate 

Injection prepared for intravitreal use

13.05.03 Methotrexate 

Hospital only guidance

Inpatient drug charts prescribing advice

  • It is prescribed weekly
  • If patient is taking folic acid, it must be given a minimum 24 hours after the methotrexate dose 
  • Endorse the chart with "CYTOTOXIC"
  • Quantity of 2.5mg tablets needed for each dose is specified e.g 4*2.5mg for 10mg dose
  • Allergy box has the following wording " Not for trimethoprim. Please check interactions with methotrexate before prescribing any new medicines".
  • Check bloods
    • eGFR
    • FBC
    • LFTs

Charts must be validated by a pharmacist before a supply can be made

See below for IHT newsletters

 

Primary care guidance

Risk of overdose

Please check records/clinic letters to ensure patient is not receiving any injectable methotrexate in secondary care

04.07 Methoxyflurane Penthrox®

For use by Suffolk Ambulance Rescue Service (SARS) only

13.08.01 Methyl-5-Aminolevulinate Metvix®

This product is for use at Ipswich Hospital by the Dermatology team only.  It is not supplied to patients for use at home.

02.05.02 Methyldopa tabs

For hypertension when other agents have failed or not suitable

01.06.06 Methylnaltrexone Relistor®

At both Ipswich and Colchester Hospital sites, for specific use within the Hospice environments and Palliative care patients only

04.04 Methylphenidate Hydrochloride MR tabs

Must be prescribed by brand

Must be maintained on same brand

06.03.02 Methylprednisolone tabs

For use in MS relapse

10.01.02.02 Methylprednisolone Acetate Depo-Medrone®
04.06 Metoclopramide 

MHRA:Risk of neurological adverse effects


Not licensed for people under 20 years old and is known to cause oculogyric crisis, especially in young adults

Should not be prescribed for longer than 5 days

02.02.01 Metolazone 

unlicensed Unlicensed medicine

 

02.04 Metoprolol 
13.06.03 Metronidazole 0.75%  Rozex® gel or cream
06.07.03 Metyrapone Metopirone®

Note: this treatment is very expensive and when appropriate, must only be initiated by a Consultant specialist

Ipswich Hospital

Metyrapone is considered a formulary medicine

Colchester Hospital

Metyrapone is considered a non-formulary medicine

12.03.02 Miconazole Daktarin®

MHRA:Significant interaction with warfarin


Available OTC

13.10.02 Miconazole 2% 

Can be bought OTC

04.08.02 Midazolam buccal solution
15.01.04.01 Midazolam 1mg/ml pre-med

Caution-check strength of preparation carefully.  High strength midazolam injection 10mg/2ml is available for palliative care use.

20 MIDAZOLAM buccal  
02.07.02 Midodrine 
08.01.05 Midostaurin Rydapt
07.01.02 Mifepristone tabs

For termination of pregnancy

CD- Treated as a controlled drug in Ipswich Hospital

07.04.02 Mirabegron Betmiga®

MHRA:Risk of severe hypertension and associated cerebrovascular and cardiac events


For use in overactive bladder syndrome when antimuscarinics are clinically ineffective, contraindicated or have unacceptable side effects.

07.03.02.03 Mirena® Intra-uterine Progestogen Only System

MHRA:Levonorgestrel-releasing intrauterine systems: prescribe by brand name

04.03.04 Mirtazapine tab, orodispersible tabs
07.01.01 Misoprostol  tabs

Hospital only guidance

Gynaecology use only

Given orally or vaginally for the induction of labour (Unlicensed indication).

Can be used sublingually/rectally in postpartum haemorrhage when oxytocin, ergometrine and carboprost are not available or are inappropriate

08.01.02 Mitomycin 
11.11 Mitomycin C 

Unlicensed special


 Available as

  • injection
  • 0.04% preservative free eye drops
08.01.02 Mitoxantrone (Mitozantrone) 
15.01.05 Mivacurium injection
04.03.02 Moclobemide tabs

Moclobemide is a rarely prescribed and specialist treatment within Mental Health. It would not be initiated within the acute hospitals at Ipswich and Colchester but existing patients admitted to the organisation would have their treatment continued; and supplies procured accordingly if necessary.

04.04 Modafinil tabs

Letter to Healthcare professional: Potential risk of congenital malformations during pregnancy


12.02.01 Mometasone Furoate 

Available OTC

13.04 Mometasone Furoate 0.1% cream, ointment and scalp lotion

Use ONCE daily

03.03.02 Montelukast Singulair®

MHRA:reminder of the risk of neuropsychiatric reactions

Adults – see asthma pathway 

Children over 5 years: see asthma pathway 

Children under 5 years: see asthma pathway 

Child 13-18 years:see asthma pathway 

04.07.02 Morphine sulphate MR caps

Prescribe by brand

  • are available in 12-hourly and 24-hourly formulations which are not interchangable 
  • minimise the risk of mistakes
  • in line with the Specialist Pharmacy Services (SPS) guidance on Which medicines should be considered for brand-name prescribing in primary care? (please click here)
04.07.02 Morphine sulphate intrathecal injection
04.07.02 Morphine sulphate injection
04.07.02 Morphine sulphate liquid

Available as

  • 10mg/5ml
  • 20mg/ml - CD schedule 2
04.07.02 Morphine sulphate suppositories

Ipswich Hospital and Colchester Hospital

Morphine suppositories are non-formulary and are not utilised within the acute hospital

15.01.04.03 Morphine sulphate Epidural injection
10.03.02 Movelat Topical gel / cream

North East Essex CCG

Movelat is a Non-Formulary medicine. It is available OTC.

02.05.02 Moxonidine 

For hypertension when other agents have failed or not suitable

09.06.07 Multivitamin preparations Abidec®
09.06.07 Multivitamin preparations Dalivit®
09.06.07 Multivitamins 

Can be bought OTC

13.10.01.01 Mupirocin  Bactroban® cream, ointment

Reserved for treating MSRA

10.01.03 Mycophenolate Oral

MHRA:Updated contraception advice for male patients

10.01.03 Mycophenolate 

MHRA:Updated contraception advice for male patients

13.05.03 Mycophenolate 

MHRA:Updated contraception advice for male patients


Severe refractory eczema [unlicensed indication]

08.02.01 Mycophenolate Mofetil caps, tabs

MHRA:Updated contraception advice for male patients


Traffic light information

Traffic light Details
Shared care Patients being prescribed in primary care prior to April 2013 only
Red New patients only
08.02.01 Mycophenolate Sodium tabs

MHRA:Updated contraception advice for male patients


Also known as Mycophenoloic Acid

Mycophenolic acid 720 mg is approximately equivalent to mycophenolate mofetil 1g but avoid unnecessary switching because of pharmacokinetic differences.

20 Mydricaine No. 2 injection 
06.05.01 Nafarelin nasal spray Fertility monitoring unit only
02.06.04 Naftidrofuryl 
04.10.01 Nalmefene 

Prescribed by Turning Point

01.06.06 Naloxegol 

At both Ipswich and Colchester hospitals, strictly as a possible treatment for opioid-induced constipation in adults whose constipation has not adequately responded to laxatives; in accordance with NICE TA345. Specialist/Consultant initiation only.

15.01.07 Naloxone injection

PSA: Support to minimise the risk of distress and death from inappropriate doses of naloxone

PSA: Risk of distress and death from inappropriate doses of naloxone in patients on long-term opioid/opiate treatment

04.10.03 Naltrexone Nalorex®
10.01.01 Naproxen 
12.02.03 Naseptin  Chlorhexidine Hydrochloride 0.1%, Neomycin Suphate 0.5%

For eradication and prevention of nasal carriage of staphylococci

Avoid in the following groups due to arachis oil content

  • Nut allergy
  • Soya allergy
11.03.02 Natamycin 5% 

This is a very specialist and restricted product prescribed only in specific circumstances.

The natamycin 5% drops product is an unlicensed "unlicensed special" medicine that would be dispensed by the hospital pharmacy only.

A small supply is held in stock at Ipswich hospital on behalf of both sites.

 

24.01 Natamycin 5% eye drops

Held at Ipswich Hospital


NB – these can be sight-saving in certain types of fungal eye infections, so will need to be couriered ASAP

06.01.02.03 Nateglinide 
02.04 Nebivolol 

Cardiology initiation only

08.01.03 Nelarabine 
05.03.01 Nelfinavir Viracept®
11.04.02 Neodocromil 2% Rapitil®
10.02.01 Neostigmine injection
10.02.01 Neostigmine tablets
15.01.06 Neostigmine metisulfate injection
15.01.06 Neostigmine metisulfate with Glycopyrronium injection
11.11 Nepafenac  

Only for postoperative macular oedema associated with cataract surgery in diabetic patients


Available as

  • 1mg/ml
05.03.01 Nevirapine Viramune®
02.06.03 Nicorandil 

MHRA:Risk of gastrointestinal ulceration

04.10.02 Nicotine replacement therapy 
02.06.02 Nifedipine tablets and modified release preparations

Non-MR capsules not recommended for hypertension

07.01.01 Nifedipine gynaecology

Unlicensed use

Used as tocolytic to postpone premature labour 

08.01.05 Nilotinib 
02.06.02 Nimodipine tablets, injection

Therapy strictly reserved for the treatment of subarrachnoid haemorrhage - hospital only supply

08.01.05 Niraparib  caps
08.02.04 Nivolumab 
07.03.01 nomegestrol acetate and beta estradiol  Zoely®

Ipswich Hospital

Nomegestrol acetate and beta estradiol (Zoely) is strictly considered a non-formulary medicine (classifed as "Double Red" - no prescribing allowed at all)

Colchester Hospital

Nomegestrol acetate and beta estradiol (Zoely) is considered a restricted and quite specialist formulary medicine

02.07.02 Noradrenaline / Norepinephrine 

Hospital ITU or anaesthesia only

06.04.01.02 Norethisterone 
07.03.02.01 Norethisterone 350mcg 
07.03.02.02 Norethisterone enantate Noristerat®

repeated every 8 weeks

14.05.01 Normal Immunoglobulin Gammaplex®
  • Gammaplex is one of two formulary brand choices of IV normal immunoglobulin (the other brand is Privigen).
  • Gammaplex is used for acute Class 1 indications unless intolerant and for all newly initiated long term neurological conditions
  • Prescribe immunoglobulins on the designated administration chart for immunoglobulins
  • Remember to record the patient's weight
14.05.01 Normal immunoglobulin for Intravenous use Privigen
  • Privigen is one of two formulary brand choices for IV normal immunoglobulin (Gammaplex 10% is the alternative choice)
  • It should not be used for new acute short term class 1 conditions or newly initiated treatment for long term neurological conditions.  Gammaplex should be prescribed in these instances.
  • Existing patients on long term replacement therapy should be maintained on the original brand prescribed unless a switch to another brand has been agreed
  • Privigen can also be used for patients unable to tolerate Gammaplex
  • Ensure prescribing is in line with specific recommendations
  • Prescribe on immunoglogulin specific drug chart
  • Remember to record patient's body weight
14.05.01 Normal immunoglobulin for Subcutaneous use 
  • Cuvitru is the 1st line subcutaneous immunoglobulin brand choice. 
  • Existing patients on long term replacement therapy should be maintained on the original brand prescribed unless a switch to Cuvitru has been agreed
  • Ensure prescribing is in line with approved indications. 
  • Prescribe on immunoglobulin specific drug administration chart. 
  • Remember to record patient's body weight.
06.01.01.01 NovoRapid® Insulin Aspart

Rapid acting insulin anologue- First line


Available as:

  • Vials
  • Cartridges
  • Flexpen ( pre-filled pen)
A2.05.02 Nutilis Clear Nutilis®

Available as: 175g tin with a 1.25g scoop - first line choice.

Also available as 1.25g sachets - do not prescribe as not cost-effective.

12.03.02 Nystatin 
08.02.03 Obinutuzumab injection
08.02.04 Ocrelizumab Injection
11.99.99.99 Ocriplasmin 0.5mg/0.2ml  Jetrea®
12.02.03 Octenidine  Nasal gel

Use in the following cases:

  • If patient cannot use naseptin due to nut/soya allergy 

                      AND

  • If bactroban not available
08.03.04.03 Octreotide Sandostatin®

Traffic light information

Traffic light Details
Shared care
  • Acromegaly - fine control of growth hormone levels after surgery/radiotherapy
Red
  • Neuroendocrine tumours
  • Prevention of complications following pancreatic surgery - commissioned by NHSE
08.03.04.03 Octreotide Sandostatin Lar®

 

 Colchester Hospital / NEECCG

Traffic light information

Traffic light Details
Shared care
  • Gastroenteropancreatic Neuroendocrine Tumours
06.04.01.01 Oestrogen only HRT patch Estradot, Evorel
06.04.01.01 Oestrogen only HRT tablet Elleste-Solo, Premarin
06.04.01.01 Oestrogens for HRT FemSeven® Sequi
07.02.01 Oestrogens, Topical Estring®

Ipswich Hospital

Estring is a non-formulary medicine

Colchester Hospital / NEECCG

Estring is considered a formulary choice (albeit very rarely utilised)

08.02.03 Ofatumumab injection
11.03.01 Ofloxacin 0.3% Ophthalmic

Suitable for milder infections

04.02.01 Olanzapine tabs, orodispersible tabs
08.02.04 Olaparib caps

Available as tabs and caps which are not interchangeable due to differences in bioavailability

See below for further information 

12.01.03 Olive Oil Ear Drops 

Available OTC

11.04.02 Olopatadine 1mg/ml Opatanol®
03.04.02 Omalizumab Xolair®
13.05.03 Omalizumab 
05.03.03.02 Ombitasvir/ paritaprevir/ ritonavir Viekirax®
02.12 Omega-3-Acid Ethyl Esters Omacor®

Ipswich Hospital

Treatment initiation via the Lipid clinic only

Secondary prevention of cardiovascular disease and in hypertriglyceridaemia (patients initiated prior to Feb 2009 may be continued)

Colchester Hospital

Omacor treatment is considered non-formulary. Colchester Hospital does not have a specialist lipid clinic. North East Essex CCG has a scheme to encourage de-prescribing (when appropriate) of this treatment which is classed as a "Drug of Limited Clinical Value".

01.03.05 Omeprazole caps

Both oral omeprazole and oral lansoprazole are utilised without any real preference being specified.

01.03.05 Omeprazole IV 

Ipswich Hospital

Intravenous omeprazole is restricted to Paediatric patients only.

Colchester Hospital

Intravenous omeprazole is the formulary injectable Proton-Pump-Inhibitor for both adults and paediatrics.

04.06 Ondansetron tablets, injection, suppositories,orodispersible films

MHRA: Small increased risk of oral clefts following use in the first 12 weeks of pregnancy


Traffic light information

Traffic light Details
Green Hospital initiated, GP continued for palliative care only.
Red All other indications
04.09.01 Opicapone 

Traffic light information

Traffic light Details
Green To be used where entacapone or tolcapone are not suitable due to side effects or lack of efficacy

Colchester Hospital

Opicapone is considered a non-formulary medicine

09.02.01.02 Oral Rehydration Salts Electrolade®

Can be bought OTC

04.05.01 Orlistat 

Used as an adjunct in the management of obesity in patients with

  • BMI of ≥ 30 kg/m2, 

                   OR 

  • BMI of ≥ 28 kg/m2 in the presence of other risk factors.

Treatment with orlistat may also be used to maintain weight loss rather than to continue to lose weight.

Discontinuation of treatment with orlistat should be considered after 12 weeks if weight loss has not exceeded 5% since the start of treatment.

04.09.02 Orphenadrine 
08.02.04 Osimertinib tabs
12.01.01 Otomize Dexamethasone ,Acetic acid and Neomycin
08.01.05 Oxaliplatin 
11.11 Oxybuprocaine 0.4% 

Single use eye drops

07.04.02 Oxybutynin 
07.04.02 Oxybutynin Hydrochloride patch

 

Reserved for patients who cannot tolerate oral medication

04.07.02 Oxycodone MR tabs

Only if morphine is not tollerated or ineffective

Once daily preparation has not been approved for use

Prescribe by brand

  • are available in 12-hourly and 24-hourly formulations which are not interchangable 
  • minimise the risk of mistakes
  • in line with the Specialist Pharmacy Services (SPS) guidance on Which medicines should be considered for brand-name prescribing in primary care? (please click here)
04.07.02 Oxycodone IR capsules

Hospital only guidance

Not for inpatient use (risk of mix up with MR tablets)

04.07.02 Oxycodone injection

Available as

  • 10mg/ml - 1ml amps
  • 10mg/ml - 2ml amps
  • 50mg/ml amps
04.07.02 Oxycodone liquid

Available as

  • 5mg/5ml
  • 10mg/ml
13.06.03 Oxytetracycline  
13.06.03 Oxytetracycline  
07.01.01 Oxytocin IV injection

Active management of the 3rd stage of labour

Initial management of postpartum haemorrhage (PPH)

07.01.01 Oxytocin IV infusion

Induction and augmentation of labour

Postpartum Haemorrhage (PPH)

09.06.02 Pabrinex® Vitamin B and C
08.01.05 Paclitaxel 
08.01.05 Paclitaxel - Albumin Bound Formulation Abraxane®
08.03.04.01 Palbociclib Ibrance
04.02.02 Paliperidone depot 

MHRA:Risk of intraoperative floppy iris syndrome in patients undergoing cataract surgery

01.09.04 Pancrex® V powder, caps
15.01.05 Pancuronium injection
08.01.05 Panitumumab Vectibix®
08.01.05 Panobinostat Farydak®
01.03.05 Pantoprazole IV 

Hospital only guidance

Prescribing information.

On endoscopist recommendation only

  • 40mg daily (for up to 5 days) until oral administration possible

                                                      or

  • 80mg stat followed by an infusion of 8mg/hr for 72 hours.

Step down to oral Omeprazole once complete.

NOTE: Pantoprazole IV is not currently utilised at Colchester Hospital and is considered Non-Formulary at this site. Intravenous omeprazole is the preferred injectable Proton-Pump-Inhibitor at Colchester.

20 PAPAVERINE 60mg in 1ml injection 

Available for accidental injection of thiopentone

04.07.01 Paracetamol 

Can be bought OTC

04.07.01 Paracetamol suspension

Can be bought OTC


Available as

  • 120mg/5ml
  • 250mg/5ml
  • 500mg/5ml -expensive

Some preparations contain sorbitol- can cause diarrhoea

04.07.01 Paracetamol suppositories

Note - the 1g suppositories are very expensive and are not recommended for use.

Only to be used if tablets/liquid not appropriate; and as a possible alternative if the IV route (if unavailable)

04.07.01 Paracetamol soluble tabs

Can be bought OTC


Caution: high salt content
04.07.01 Paracetamol injection
04.07.02 Paracetamol and codeine Co-codamol® 8/500

Can be bought OTC (max 3 days usage)

Longer courses should be prescribed

04.07.02 Paracetamol and codeine Co-codamol® 30/500

Ipswich Hospital

The combination formulation is considered Non-formulary. Treatment must be prescribed as the individual components.

 

Colchester Hospital

Co-codaml 30/500 is considered formulary with no requirement to prescribe by seperate ingredients.

04.08.02 Paraldehyde enemas

Ipswich Hospital and Colchester Hospital

The use of paraldehyde to treat status epilepticus within the paediatric setting is an agreed treatment option 

20 Paraldehyde / olive oil 50/50 Enema 
09.03 Parenteral Nutrition (TPN or PN) 
04.03.03 Paroxetine tabs, liquid
20 Patent blue V 2.5% solution 
08.01.05 Pazopanib tabs
14.04 Pediacel ® 
08.02.04 Peginterferon Alfa Pegasys®
08.02.04 Peginterferon Beta-1a Plegridy®
08.01.05 Pembrolizumab injection
08.01.03 Pemetrexed injection
10.01.03 Penicillamine 
08.01.05 Pentostatin injection
01.02 Peppermint Oil 

Available OTC

01.01.02 Peptac ® 
04.08.01 Perampanel Fycompa®

Ipswich Hospital

Formulary Medicine - Indicated for the adjunctive treatment of partial-onset seizures with or without secondarily generalised seizures in adult and adolescent patients from 12 years of age with epilepsy.

Colchester Hospital

Perampanel is a non-formulary medicine. Therefore, treatment would not be initiated within the acute Trust, but if necessary to ensure patient care, existing therapy would be continued on (and supplies purchased if appropriate).

11.11 Perfluorodecalin liquid

F-Decalin®

04.09.01 Pergolide 

Ipswich Hospital

Pergolide is considered a formulary medicine

  • Parkinsons Disease - for continuation therapy only (would not be initiated)
  • Restless Legs Syndrome: specialist initiation only (unlicensed indication)

Colchester Hospital

Pergolide is considered non-formulary

13.10.04 Permethrin 5% Cream

Can be bought OTC

13.10.04 Permethrin 5% cream

Can be bought OTC

08.01.05 Pertuzumab Perjeta®
04.07.02 Pethidine injection
15.01.04.03 Pethidine injection
04.03.02 Phenelzine tabs

Phenelzine is a rarely prescribed and specialist treatment within Mental Health. It would not be initiated within the acute hospitals at Ipswich and Colchester but existing patients admitted to the organisation would have their treatment continued; and supplies procured accordingly if necessary.

02.08.02 Phenindione 
04.08.01 Phenobarbital 
04.08.01 Phenobarbital alcohol free mixture

unlicensed Unlicensed special

Initiation in neonates only.

04.08.01 Phenobarbital injection

Note: phenobarbital injection is also occasionally utilised subcutaneously to treat seizures within the palliative care setting

01.07.03 Phenol, Oily 

Not suitable for nut allergy sufferers

Either arachis (peanut) or almond oil is used depending on the source of the product

02.05.04 Phenoxybenzamine Hydrochloride 

Hypertension in phaeochromocytoma

20 Phenylbutazone 100mg 
02.07.02 Phenylephrine 

Hospital ITU or anaesthesia only

11.10 Phenylephrine Hydrochloride 

Available as 

  • 2.5% single use drops
  • 10% single use drops
04.08.01 Phenytoin 

100mg solid dosage form is equivalent to 90mg (15ml) liquid

04.08.02 Phenytoin injection

Hospital only guidance

Phenytoin naive patients

Ensure loading dose is calculated correctly

Once loaded 100mg TDS may be prescribed

Patients already on phenytoin

No loading dose is required

100mg TDS may be prescribed


PAL filter may remain in situ for upto 96 hours

03.09.01 Pholcodine Linctus, BP 

For hospital inpatient use.

Please recommend OTC in community

09.05.02.01 Phosphate Polyfusor ® 
09.05.02.01 Phosphate supplements Phosphate-Sandoz®
01.06.04 Phosphates (Rectal) Fleet® Ready to use Enema
09.06.06 Phytomenadione tab/caps/injection

Preparation of choice for anticoagulant induced haemorrhage

20 Phytomenadione (Konakion®) 10mg capsules/tablets 

Preparation should only be used if licensed Vitamin K is not available 

Please note prices between tablets and capsules may vary and the formulation with the lowest acquisition cost should be used  

01.06.05 Picolax Sodium picosulphate/ magnesium citrate
11.06 Pilocarpine eye drops

Available as 

  • 1% eye drops
  • 2% eye drops
  • 2% preservative free
  • 4% eye drops
13.05.03 Pimecrolimus cream
06.01.02.03 Pioglitazone 

MHRA:Risk of cardiac failure

MHRA:Risk of bladder cancer

In view of the above MHRA alerts, the use of pioglitazone treatment is limited. New patients should ideally not be initiated on therapy; existing patients will continue treatment after appropriate clinical review. 

04.02.02 Pipotiazine Palmitate 

NEECCG

Pipotiazine Palmitate is non-formulary

03.11 Pirfenidone Esbriet®

Initiated by tertiary centre

10.03.02 Piroxicam 0.5% gel

Ipswich Hospital

Piroxicam 0.5% gel is a formulary medicine

Colchester Hospital

Piroxicam 0.5% gel is a non-formulary medicine

04.07.04.02 Pizotifen 

Specialist recommendation only - evidence of its efficacy is limited

09.08.01 PKU 2 gel Strensiq®
09.08.01 PKU gel Strensiq®
14.04 Pneumococcal polysaccharide conjugate vaccine (adsorbed) Prevenar 13®
14.04 Pneumococcal polysaccharide conjugate vaccine (adsorbed) Synflorix®
11.11 Polihexanide 0.02% (PHMB) 

Unlicensed special


Preservative free eye drops

14.04 Poliomyelitis Vaccine Inactivated (Salk) 
14.04 Poliomyelitis Vaccine Live (oral)  
06.01.06 Polycal ® 
20 Polyhexyethylene (Polihexanide) Biguanide 0.05% Eye drops 
14.04 Polysaccharide Typhoid Vaccine Typherix®
14.04 Polysaccharide vaccine for injection Typhim Vi®
14.04 Polysaccharide vaccine with hepatitis A vaccine 
13.09 Polytar ® 

Can be bought OTC

11.08.01 Polyvinyl Alcohol 1.4% eye drops

Can be bought OTC

 

NHS North East Essex CCG - Polyvinyl alcohol eye drops are considered a non-formualry medicine.

08.02.04 Pomalidomide 
03.05.02 Poractant Alfa Curosurf®
11.99.99.99 Potassium Ascorbate (Ascorbic acid) 

IHT Ophthalmology Consultant

Severe chemical burns are thankfully rare

Patients need to replenish the ascorbate that disappears in alkali injuries to prevent the cornea melting. They also need sodium Citrate to reduce neutrophil activity again protecting against melting. They also get lots of topical steroid and may need surgery but it’s the availability of the rare drops that often impact the prognosis.

 

Within 12 hours of injury patients need:

  • Potassium ascorbate 10% QDS (for 3 days) If unavailable Oral ascorbate 2g BD is an alternative
  • Sodium Citrate 10% Hourly for 2 days then QDS for 7 days
09.02.01.01 Potassium Chloride Sando-K®

One tablet = 12mmol potassium

09.02.01.01 Potassium Chloride Kay-Cee-L®

One ml = 1mmol potassium

09.02.02.01 Potassium Chloride and Glucose Intravenous Infusion  
09.02.02.01 Potassium Chloride and Sodium Chloride Intravenous Infusion 
09.02.02.01 Potassium Chloride Concentrate (Sterile) 

CD Treated as a controlled drug at IHT

09.02.02.01 Potassium Chloride, Sodium Chloride and Glucose Intravenous Infusion 
07.04.03 Potassium Citrate 
13.11.06 Potassium Permanganate Permitabs®

PSA:Risk of death or serious harm from accidental ingestion of potassium permanganate preparations

11.11 Povidone iodine 5% 

Single use eye drops

11.03.01 Povidone iodine 5% preservative free eye drops 
04.09.01 Pramipexole tabs, MR tabs
02.09 Prasugrel 
20 Praziquantel 500mg tablets 
01.05.02 Prednisolone retention enema
01.05.02 Prednisolone tablets

Joint guidance

Enteric coated tablets are not approved for use within the acute Trust and throughout the CCGs

Prednisolone 25mg tablets are not approved for routine use (due to high cost) but may be utilised in rare patients requiring daily doses of 50mg daily (or more) to reduce tablet load

Prednisolone soluble tablets are considered non-formulary due to their high cost and the fact that normal prednislone tablets can be crushed and dispersed to good effect

06.03.02 Prednisolone tablets

Enteric coated tablets are not approved for use within the acute Trust and throughout the CCGs

Prednisolone 25mg tablets are not approved for routine use (due to high cost) but may be utilised in rare patients requiring daily doses of 50mg daily (or more) to reduce tablet load

Prednisolone soluble tablets are considered non-formulary due to their high cost and the fact that normal prednislone tablets can be crushed and dispersed to good effect

10.01.02.02 Prednisolone 
11.04.01 Prednisolone eye drops 

Available as

  • 0.5% eye drops
  • 0.5% preservative free drops
  • 1% eye drops

Prednisolone 0.5% is a mild steroid used for a wide range of occular surface diseases.

04.07.03 Pregabalin 

Traffic light information

Traffic light Details
Blue

Neuropathic pain

  • Only if gabapentin not tolerated.
  • Caution: pregabalin use in people with a history of substance misuse.
  • Prescribe twice daily where possible

Prescribe generically

Green Generalise anxiety disorder

Adjunctive therapy in adults with partial seizures with or without secondary generalisation

 

 

14.04 Prevenar 13 ® 
15.02 Prilocaine Hydrochloride 1% injection
04.08.01 Primidone 
20 Probenecid 500mg tablets 
08.01.05 Procarbazine caps
04.06 Prochlorperazine  injection

Caution: can cause extrapyramidal side effects.

Increased risk of drug-induced parkinsonism in the elderly particularly after prolonged use.

04.06 Prochlorperazine tablets,buccal tablets

Tablets available as 

  • 5mg- upto TDS dosing

Buccal tablets available as 

  • 3mg- upto BD dosing

Caution: can cause extrapyramidal side effects.

Increased risk of drug-induced parkinsonism in the elderly particularly after prolonged use.

04.09.02 Procyclidine injection
04.09.02 Procyclidine tabs, liquid
06.04.01.01 Progynova HRT
06.05.01 Progynova fertility Fertility monitoring unit only
06.06.02 Prolia® Denosumab

MHRA:Osteonecrosis of the external auditory canal

MHRA: Osteonecrosis of the jaw


Note two different brands

Prolia is indicated for 

  • Treatment of osteoporosis in postmenopausal women and in men at increased risk of fractures
  • Treatment of bone loss associated with hormone ablation in men with prostate cancer at increased risk of fractures

For osteoporosis-NICE TA204

Ipswich Hospital/IESCCG

Denosumab (for osteoporosis) is considered a "hospital-only" medicine

Colchester Hospital/NEECCG

Denosumab (for osteoporosis) is available for Primary Care prescribing under a Shared Care Agreement

04.06 Promethazine Hydrochloride Phenergan

Mixed formulary:

Blue: for insomnia, N&V, vertigo, labyrinthine disorders;

Green: for mental health indication

NON-FORMULARY: for motion sickness and allergies (OTC)

 

02.03.02 Propafenone 
11.11 Propamidine 0.1% Brolene
15.01.01 Propofol 

Available as

  • 1%
  • 2%
  • Monitor serum lipid concentration if risk of fat overload or if sedation longer than 3 days
02.04 Propranolol 
04.07.04.02 Propranolol 

Other beta blockers without partial agonism may also be used e.g. atenolol [unlicensed indication] and metoprolol.

06.02.02 Propylthiouracil 
13.02.02 Proshield Plus cream & spray

For severe moisture excoriation

                      or

Only if LBF spray tried and failed


Can be used as an alternative to paraffin based products

 

02.08.03 Protamine Sulphate 

Haematology approval required

06.05.01 Protirelin Thyrotropin-releasing hormone

For TRH test

11.11 Proxymetacaine 0.5% 

Single use eye drops

01.06.07 Prucalopride Resolor®

Treatment of chronic constipation in women

20 Pyrazinamide tablets 500mg 
10.02.01 Pyridostigmine Bromide tabs, MR tabs
20 PYRIDOXAL PHOSPHATE Tablets 50 mg 
09.06.02 Pyridoxine Hydrochloride 
04.02.01 Quetiapine immediate release
06.07.01 Quinagolide 

Specialist initiation only

10.02.02 Quinine 

MHRA:Reminder of dose-dependent QT-prolonging effects; updated medicine interactions

03.02.01 Qvar Beclometasone

Prescribe by brand


Avaiable as

  • MDI device
  • Autohaler (BAA)

Licensed for adults and children >12 years

QVAR is approximately half the dose of clenil

14.04 Rabies vaccine Rabipur®
14.04 Rabies vaccine 
06.04.01.01 Raloxifene Hydrochloride 
05.03.01 Raltegravir Isentress ®
08.01.03 Raltitrexed injection
02.05.05.01 Ramipril 
11.99.99.99 Ranibizumab 10mg/ml Lucentis®
01.03.01 Ranitidine tabs

Available OTC

01.03.01 Ranitidine injection 25mg/ml
01.03.01 Ranitidine suspension 75mg/5ml

Reserved for patients with swallowing difficulties or paediatrics

15.01.09 Ranitidine tablets, injection
02.06.03 Ranolazine Ranexa®

add-on therapy for the symptomatic treatment of patients with stable angina pectoris who are inadequately controlled or intolerant to first-line antianginal therapies (such as beta-blockers and/or calcium antagonists).

22 Rarely Used or Urgent Access Drugs 
Drug Indication Presentation Recommended stock Availability
Acetylcysteine Paracetamol 200mg/ml, 10ml amps 20 amps ED or emergency drugs cupboard
Activated charcoal Many oral poisons 50g pack 7 packs ED or emergency drugs cupboard
Atropine Bradycardia 600mcg/ml, 1mp amp 10 amps ED or emergency drugs cupboard
Calcium Chloride calcium channel blockers 10ml amp 6 amps ED or emergency drugs cupboard
Calcium Gluconate gel Hydrofluoric acid 25 pack 1 pack ED or emergency drugs cupboard
Dicobalt Edetate Acetylcysteine 15mg/ml, 20ml amp 6 amps ED or emergency drugs cupboard
Hydroxocobolamin Acetylcysteine 5g pack (Cyanokit®) 2 packs ED or emergency drugs cupboard
Sodium Nitrite Acetylcysteine 3% (30mg/ml), 10ml amp 5 amps ED or emergency drugs cupboard
Sodium Thiosulphate Acetylcysteine 50% (500mg/ml), 10ml amp 5 amps ED or emergency drugs cupboard
Flumazenil Over sedation with benzodiazepines 100mcg/ml, 5ml amp 5 amps ED or emergency drugs cupboard
Glucagon Beta-blockers 1mg vial *STORE IN FRIDGE* 50 vials ED or emergency drugs cupboard
Intralipid 20% Severe systemic local anaesthetic toxicity 100ml or 250ml of 20% solution or 500ml of 20% solution 1.5 litres ED
Methylthioninium Chloride Methaemoglobinaemia 0.5%, 10ml amps 5 amps ED or emergency drugs cupboard
Naloxone Opioids 400mcg/ml, 1ml amps 30 amps ED or emergency drugs cupboard
Procyclidine injection Dystonic reactions 5mg/ml, 2ml amps 5 amps ED or emergency drugs cupboard
Sodium Bicarbonate 8.4% TCAs & class 1a & 1c antiarrhythmic drugs 200ml polyfusor 3 polyfusors ED or emergency drugs cupboard
Sodium Bicarbonate isotonic 1.26% or 1.4% Urinary Alkanisation 500ml polyfusor 12 polyfusors ED or emergency drugs cupboard
Vipera Tab European adder 10ml amps *STORE IN FRIDGE* 2 amps ED or emergency drugs cupboard
Calcium folinate Methotrexate 10mg/ml, 30ml amp 15 amps ED or emergency drugs cupboard
Cyproheptadine Serotonin syndrome 4mg tablet 30 tablets ED or emergency drugs cupboard
Dantrolene Neuroleptic malignant syndrome 20mg vial 48 amps ED or emergency drugs cupboard
Dantrolene Other drug-related hyperpyrexia 20mg vial 36 amps ED or emergency drugs cupboard
Desferrioxamine Iron 500mg vial 40 vials ED or emergency drugs cupboard
Digifab® Digoxin 40mg vial 10 vials ED or emergency drugs cupboard
Fomepizole Ethylene glycol 5mg/ml, 20ml amp 25 amps ED or emergency drugs cupboard
Ethanol Ethylene glycol 1g/ml, 1.5ml vial 4 vials ED or emergency drugs cupboard
Idarucizumab Dabigatran 2.5g/50ml vials 2 vials ED or emergency drugs cupboard
Cyproheptadine Gut decontamination 4 sachets 12 sachets ED or emergency drugs cupboard
Mesna Cyclophosphamide 400mg tablet, 1g/10ml amp Variable ED or emergency drugs cupboard
Octreotide Sulphonylureas 50mcg/ml, 1ml amp 5 amps ED or emergency drugs cupboard
Phentolamine Digital ischaemia related to epinephrine 10mg/ml, 1ml amp 5 amps ED or emergency drugs cupboard
Phytomenadione Vitamin K anticoagulants 10mg tablet or 10mg/ml, 1ml amp 2 tablets, 10 amps ED or emergency drugs cupboard
Protamine sulphate Heparin 10mg/ml, 5ml amp 10 amps ED or emergency drugs cupboard
Pyridoxine Isoniazid Isoniazid 100 amps ED or emergency drugs
04.09.01 Rasagiline 

Must only be initiated by Specalists/Consultants working within Neurology.

10.01.04 Rasburicase 

Oncology & Haematology consultants only

04.03.04 Reboxetine Edronex®

Reboxetine is a rarely prescribed and specialist treatment within Mental Health. It would not be initiated within the acute hospitals at Ipswich and Colchester but existing patients admitted to the organisation would have their treatment continued; and supplies procured accordingly if necessary.

01.03 Regimen 1 
Drug Dose Duration
Omeprazole 20mg BD 7 days
Amoxicillin 1g BD
Clarithromycin 500mg BD

Interactions with clarithromycin

Inhibits metabolism of theophylline; consider reducing total daily dose of theophylline by up to 50%

Increased risk of myopathy with statins; avoid concomitant use

01.03 Regimen 2 

Penicillin allergic patients

Drug Dose Duration
Omeprazole 20mg BD 7 days
Clarithromycin 250mg BD
Metronidazole 400mg BD

 

Interactions with clarithromycin

Inhibits metabolism of theophylline; consider reducing total daily dose of theophylline by up to 50%

Increased risk of myopathy with statins; avoid concomitant use

01.03 Regimen 3 

Gastro recommended regimen 

Regimen 3 may consist of a combination of the drugs listed. Doses,duration and any further information will be provided by a gastroenterologist

Drug Dose Duration
Tinidazole To be provided by gastroenterology To be provided by gastroenterology
Tetracycline
Levofloxacin
Colloidal bismuth subcitrate (Gastrodenol)

 

08.01.05 Regorafenib tabs
03.02.02 Relvar Ellipta 184/22 Fluticasone furoate & vilanterol

On specialist recommendation only (for asthma)
Licensed for adults and children >12 years (for asthma)

03.02.02 Relvar Ellipta 92/22 Fluticasone furoate & vilanterol

Reserved for patients intolerant to Fostair or Flutiform
Licensed for adults and children >12 years (for asthma)

03.02.03 Relvar Ellipta 92/22 Fluticasone furoate & vilanterol

Licensed for adults >18 years only (for COPD)

15.01.04.03 Remifentanil 

May have a role in haemodynamically challenging patients and in procedures not associated with severe post-op pain

14.04 Repevax ® 
09.02.01.01 Resonium A® Polystyrene Sulphonate Resins

Contains sodium rather than calcium – useful for where there is hypercalcaemia as well hyperkalaemia

04.08.01 Retigabine 

Discontinued by manufacturer, see below for further information.

14.04 Revaxis ® 
24.01 Riamet tabs

Held at Colchester Hospital


Antimalarial

08.03.04.01 Ribociclib tabs
20 Riboflavin (Vitamin B2) tablets 200mg 
11.11 Riboflavin 0.1% eye drops  MedioCROSS D

As per NICE interventional procedures guidance 466

05.01.07 Rifaximin Targaxan®

Reduction in recurrence of episodes of overt hepatic encephalopathy in patients ≥ 18 years of age

05.03.01 Rilpivirine hydrochloride Edurant®
11.04.01 Rimexolone 1% 

Parallel import only

Not readily available

09.02.02.01 Ringer's Solution for Injection 
13.05.03.02 Risankizumab Skyrizi
06.06.02 Risedronate 

Treatment has limited use in practice - it is second line treatment only utilised if patients are intolerant to alendronic acid therapy

04.02.01 Risperidone tabs

MHRA:Risk of intraoperative floppy iris syndrome in patients undergoing cataract surgery

04.02.02 Risperidone Risperdal Consta®

MHRA:Risk of intraoperative floppy iris syndrome in patients undergoing cataract surgery

05.03.01 Ritonavir Norvir®

MHRA: Interaction with levothyroxine leading to reduced thyroxine levels

08.02.03 Rituximab 

Hospital only guidance

Must be prescribed by brand name

See IHT newsletter below for further information

Existing patients

Continue using MabThera® unless a switch has been agreed (NB-subcutaneous MabThera will remain the same in NHL)

New patients

New patients requiring IV rituximab will be prescribed Truxima®.

See IHT newsletter below for further information

10.01.03 Rituximab (rheumatology) 

Prescribing rituximab at Ipswich and Colchester hospitals

  • all patients will receive the biosimilar product (Truxima) in line with nationally agreed guidance; unless clinically inappropriate to do so
02.08.02 Rivaroxaban 

MHRA:increase in all-cause mortality, thromboembolic and bleeding events in a clinical trial after transcatheter aortic valve replacement

MHRA: Reminder that 15 mg and 20 mg tablets should be taken with food


Traffic light information

Traffic light Details
Red

Prevention of venous thromboembolism (VTE) in adult patients undergoing either:

  • Elective hip surgery
  • Knee replacement surgery.
Green

For use in acute coronary syndrom (ACS)

Treatment of

  • Deep vein thrombosis (DVT)
  • Pulmonary embolism (PE)

Prevention of recurrent

  • Deep vein thrombosis (DVT)
  • Pulmonary embolism (PE)
Blue

Prevention of stroke and systemic embolism in adult patients with non-valvular atrial fibrillation with one or more  of the following risk factors:

  • Congestive heart failure
  • Hypertension
  • Age ≥ 75 years
  • Diabetes mellitus
  • Prior stroke
  • Priortransient ischaemic attack
04.09.01 Rivastigmine 

Capsules licensed for Parkinson’s dementia.

Patch to be considered (off label) if patient unable to tolerate GI side effects or poor swallow.

May also improve symptoms of delirium/hallucinations associated with Parkinson's dementia.

04.11 Rivastigmine 

Initiated and stabilised by secondary care

15.01.05 Rocuronium injection
03.03.03 Roflumilast Daxas®
09.01.04 Romiplostim injection
04.09.01 Ropinirole tabs, MR tabs
15.02 Ropivacaine Hydrochloride 2mg/ml infusion
02.12 Rosuvastatin 

3rd Line option when patients are unable to tolerate simvastatin or atorvastatin.

Rosuvastatin patients admitted to hospital falling outside of this guidance will have their treatment reviewed to atorvastatin in line with the agreed Pharmacy Therapeutic Substitution process.

14.04 Rotavirus vaccine Rotarix®
04.09.01 Rotigotine patches

Rotigotine patches are very expensive and must be issued sparingly when being utilised within the acute setting as a temporary alternative to oral Parkinsons therapy in Nil-by-Mouth patients.

08.01.05 Ruxolitinib tabs
02.05.05.02 Sacubitril valsartan Entresto®

Joint guidance

Criteria for use

For treating symptomatic chronic heart failure with reduced ejection fraction, only in people who meet the following criteria:

  • New York Heart Association (NYHA) class II to IV symptoms
  • Ventricular ejection fraction of 35% or less
  • Taking a stable dose of angiotensin‑converting enzyme (ACE) inhibitors or angiotensin II receptor‑blockers (ARBs).

Initial supply, monitoring and dose titration by hospital, moved to primary care once stable

04.09.01 Safinamide 

This is a restricted drug available for specialist consultant initiation only on both hospital sites.  Prescribing should remain in secondary care until such a time when the patient becomes stable on treatment.

03.01.01.01 Salbutamol DPI- Easyhaler®

Not stocked at IHT

03.01.01.01 Salbutamol  intravenous
03.01.01.01 Salbutamol 2.5mg and 5mg nebulisers

Only if patient unable to use inhalers / patients with severe disease.

03.01.01.01 Salbutamol MDI
13.07 Salicylic Acid Duofilm®

Caution with diabetic patients or others with poor circulation, care and close monitoring is needed.

Counsel patient that topical salicylic acid may require administration for up to 12 weeks and can cause local skin irritation.

13.08.01 Salicylic acid 2%  ointment Only on advice from secondary care/integrated dermatology service
09.05.01.01 Sandocal-1000 ® 
05.03.01 Saquinavir Invirase®
10.01.03 Sarilumab 
06.01.02.03 Saxagliptin 

For treatment continuation or new initiations requiring monotherapy

01.07.02 Scheriproct ®  ointment, suppositories

Short term use only

13.05.02 Sebco ® Coal tar solution 12%

Can be bought OTC


Coal tar shampoos should not be used alone for people who have severe scalp psoriasis

10.01.03 Secukinumab  
13.05.03.02 Secukinumab 
04.09.01 Selegiline Hydrochloride tabs, lyophilisate

10mg tablet equivalent to 1.25mg lyophilisate

06.01.02.03 Semaglutide Omzempic

Initial supply of 4 weeks to be made by the hospital with extra information provided to the patient by the specialist (see below)

06.01.01.02 Semglee® Insulin glargine

For new initiations for patients requiring glargine


Available as:

  • Pre-filled pens
01.06.02 Senna tabs, syrup

Available OTC

03.02.02 Seretide 50 Fluticasone propionate and salmeterol

Paediatric use only
Licenced for children >5 years


Adults - may be continued for existing patients only, consider moving to a formulary option at next review

04.03.03 Sertraline tabs
09.05.02.02 Sevelamer Carbonate Renvela®

Hospital only guidance

Therapeutic substitution

Patients using sevelamer hydrochloride (Renagel®) can be therapeutically substituted to sevelamer carbonate (Renvela®) without any dose ajustment

15.01.02 Sevoflurane 

Restricted usage only

11.11 SF6 

Arecole ® SF6

07.04.05 Sildenafil 
11.11 Silicone oil 
13.10.01.01 Silver Sulfadiazine Flamazine®

For wound care

05.03.03.02 Simeprevir Olysio®
03.09.02 Simple Linctus, BP 

Available OTC

02.12 Simvastatin 

Interactions with simvastatin

Interacting drugs Max dose of simvastatin
Bezafibrate
Ciprofibrate
10mg
Amiodarone
Amlodipine
Ranolazine
Verapamil
Diltiazem
Elbasvir
Grazoprevir
20mg
Lomitapide
Ticagrelor
40mg
Itraconazole
Ketoconazole
Posaconazole
Erythromycin
Clarithromycin
Telithromycin
HIV protease inhibitors (eg, nelfinavir)
Nefazodone
Ciclosporin
Danazol
Gemfibrozil
Contraindicated with simvastatin
08.02.04 Siponimod Mayzent Tablets
08.02.02 Sirolimus Rapamune®

Immunosuppression in liver and kidney allograft recipients


Traffic light information

Traffic light Details
Shared care Patients being prescribed in primary care prior to April 2013 only
Red New patients only

 

06.01.02.03 Sitagliptin Januvia®

Treatment would not usually be initiated within the acute Trust - existing treatment would be continued on if appropriate

13.02.01.01 Soap substitutes 

Click here to see preparations used as soap substitutes

20 Sodium benzoate  

Available as

  • 500g in 5ml liquid
  • 500mg tablets
  • IV 2g in 10ml
09.02.01.03 Sodium Bicarbonate caps,tabs
09.02.01.03 Sodium Bicarbonate infusion
12.01.03 Sodium Bicarbonate 

Available OTC

03.01.05 Sodium Chloride 
09.02.01.02 Sodium Chloride Slow Sodium®
12.02.02 Sodium chloride 0.9% 

Can also be bought OTC

03.07 Sodium chloride 3% (Hypertonic) 

Ipswich Hospital

Formulary medicine - only to be used if patients are sensitive to 7% preparation

Colchester Hospital

Sodium chloride 3% (hypertonic) is considered to be non-formulary

11.08.01 Sodium Chloride 5% 

Available as

  • eye ointment
  • preservative free drops
20 Sodium chloride 5% eye oint 
03.07 Sodium chloride 6% (hypertonic) MucoClear®

Ipswich Hospital

MucoClear is a non-formulary medicine

Colchester Hospital

Mucoclear is considered a formulary medicine

03.07 Sodium chloride 7% (Hypertonic) 
09.02.02.01 Sodium Chloride and Glucose Intravenous Infusion 
09.02.02.01 Sodium Chloride Intravenous 
01.06.04 Sodium Citrate micro-enema

Available OTC

11.99.99.99 Sodium Citrate 

IHT Ophthalmology Consultant

Severe chemical burns are thankfully rare

Patients need to replenish the ascorbate that disappears in alkali injuries to prevent the cornea melting. They also need sodium Citrate to reduce neutrophil activity again protecting against melting. They also get lots of topical steroid and may need surgery but it’s the availability of the rare drops that often impact the prognosis.

 

Within 12 hours of injury patients need:

  • Potassium ascorbate 10% QDS (for 3 days) If unavailable Oral ascorbate 2g BD is an alternative
  • Sodium Citrate 10% Hourly for 2 days then QDS for 7 days
01.01.01 Sodium citrate  mixture

Hospital inpatient use for acid aspiration prophylaxis only.

01.01.02 Sodium citrate 8.8% (0.3M) 

Maternity use only

06.06.02 Sodium Clodronate 

Specialist initiated


Bone pain only

11.04.02 Sodium Cromoglicate 

Can be bought OTC

09.01.01.01 Sodium Feredetate Sytron®
11.08.01 Sodium Hyaluronate 

Can be bought OTC


 Available as

  • 0.1% drops (e.g. Optive Fusion)
  • 0.15% preservative free drops (HyaBak)
  • 0.2% drops (e.g. Blink Intensive)
  • 0.3% preservative free gel (e.g. Vismed)
  • 0.4% preservative free drops (e.g. Clinitas Multi)
11.11 Sodium hyaluronate  intra-occular solution

Available as 

  • 1.2% strength (Amvisc brand)
  • 1.6% strength (Amvisc Plus brand)

 

11.11 Sodium hyaluronate 2%/sorbitol 4%  intra-occular solution

For corneal surgery

 

11.08.01 Sodium Hyaluronate and trehalose Thealoz Duo

Can be bought OTC

20 Sodium phenylbutyrate  

Available as 

  • tablets - 500mg
  • powder - 250mg in 1ml
  • injection - 2g in 10ml
01.06.02 Sodium Picosulfate liquid
04.08.01 Sodium Valproate EC tabs, MR tabs, liquid

MHRA:Contraindicated in women and girls of childbearing potential unless conditions of Pregnancy Prevention Programme are met

MHRA: Pregnancy prevention programme: updated educational materials


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Green
  • Bipolar disorder- hospital initiated and stabilised, then GP to continue (unlicensed indication)
  • Epilepsy

 

Primary care guidance

Identification and review of patients

Prescribers in primary care should use searches available on the clinical system to identify patients of childbearing age using valproate. 

Patients who have not had a Risk Acknowledgment Form filled out should seek specialist advice or refer where appropriate

IESCCG-Please see guidance below for further information

04.08.01 Sodium Valproate Intravenous

MHRA:Contraindicated in women and girls of childbearing potential unless conditions of Pregnancy Prevention Programme are met

MHRA:Pregnancy Prevention Programme materials online


If patients are being converted from oral to IV use the same dose

09.02.01.01 Sodium zirconium cyclosilicate Lokelma ®

Discontinue when potassium less than or equal to 5mmol/L

Sodium zirconium cyclosilicate (Lokelma®) can be used in outpatient care for patients with persistent hyperkalaemia and chronic kidney disease stage 3b to 5 or heart failure, if they:

  • have a confirmed serum potassium level of at least 6.0 mmol/litre
  • are not taking an optimised dosage of renin-angiotensin-aldosterone system (RAAS) inhibitor because of hyperkalaemia, and
  • are not on dialysis.
05.03.03.02 Sofosbuvir Sovaldi®
05.03.03.02 Sofosbuvir/velpatasvir/voxilaprevir Vosevi
12.01.01 Sofradex   Dexamethasone, Framycetin and Gramicidin
07.04.02 Solifenacin Vesicare®

Ipswich Hospital

Solifenacin is considered a non-formulary medicine

Colchester Hospital / NEECCG

Solifenacin is considered a formulary choice (second line treatment)

06.05.01 Somatropin 

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Red
  • Neuroendocrine tumours
  • Prevention of complications following pancreatic surgery
Shared care
  • Treatment of growth failure in children 
  • Growth hormone replacement in adult growth hormone deficiency
08.01.05 Sorafenib tabs
02.04 Sotalol 
11.08.01 Soybean oil unit dose eye drops Emustil®

Ipswich Hospital

Emustil 7% preservative free drops are non-formulary

Colchester Hospital

Emustil 7% preservative free drops are considered a formulary medicines choice

03.01.05 Space Chamber Plus Compact® 

Available with a mask.

Check spacer fits prescribed inhaler(s).

Dishwasher safe

02.02.03 Spironolactone 

MHRA:Risk of hyperkalaemia

20 SPIRONOLACTONE Liquid  

Available as

  • 25mg in 5ml
  • 50mg in 5ml
03.01.05 Standard range peak flow meter Airzone®

Specify as "standard range peak flow meter" on prescription 

05.03.01 Stavudine Zerit®
07.04.04 Suby G Catheter Patency Solutions
01.03.03 Sucralfate tablets
01.03.03 Sucralfate suspension

Note: sucralfate liquid is cheaper than the liquid and should be used in preference to a tablet where possible. 

01.03.03 Sucralfate  enema (unlicensed)

For radiation proctitis

15.01.09 Sucralfate tablets

unlicensed Unlicensed medicine

09.05.02.02 sucroferric oxyhydroxide tabs

Hospital only guidance

Initiation

Only for dialysis patients as per SPC and only as a third line agent in those patients unable to tolerate or adhere to the large tablet burden of sevelamer and lanthanum carbonate.

15.01.06 Sugammadex injection
01.05.01 Sulfasalazine tabs, suspension, E/C tabs

Joint guidance

Only use if intolerant to non-enteric coated tablets

Patients can be switched without having to contact the consultant if shared care has been initiated with non-EC tablets

10.01.03 Sulfasalazine tabs,suspension, E/C tabs

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Shared care
  • Rheumatoid arthritis
  • Psoriatic arthritis
  • Other autoimmune conditions

Joint guidance

Only use if intolerant to non-enteric coated tablets

Patients can be switched without having to contact consultant if shared care has been initiated with non-EC tablets

04.02.01 Sulpiride tablets, liquid

Sulpiride is a specialist treatment within Mental Health. It would not be initiated within the acute hospitals at Ipswich and Colchester but existing patients admitted to the organisation would have their treatment continued; and supplies procured accordingly if necessary.

04.07.04.01 Sumatriptan tabs,nasal spray, injection

Consider combining 5HT receptoragonist with either NSAID or paracetamol

08.01.05 Sunitinib caps
13.08.01 Sunsense ® Ultra 
09.03 Supplementary Preparations Addiphos®
09.03 Supplementary Preparations Additrace®
15.01.05 Suxamethonium Chloride injection
08.02.02 Tacrolimus 

Must be prescribed by brand

Immunosuppression in liver and kidney allograft recipients


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Shared care Patients being prescribed in primary care prior to April 2013 only
Red New patients only

 

Available as

  • Prograf
    • Immediate release preparation
    • Taken twice daily
  • Advagraf
    • Modified release
    • Taken once daily
13.05.03 Tacrolimus ointment

MHRA:Possible risk of malignancies


Available as 

  • 0.03%
  • 0.1%
08.02.02 Tacrolimus modified release Envarsus

For prophylaxis of transplant rejection in adult kidney transplant patients

ONCE DAILY tacrolimus dosing

Patients maintained on Prograf or Advograf will require dose conversion when switching to Envarsus. This would be equivalent to 30% less than the Prograf or Advograf maintenance dose

07.04.05 Tadalafil once daily 

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Traffic light Details
Green For patients post radical prostatectomy or external beam radiotherapy for prostate cancer, with good pre-op erectile function (IIEF >16/25) and good unilateral/bilateral nerve spare.
Double Red
  • All other erectile dysfunction patients
  • Treatment of the signs and symptoms of benign prostatic hyperplasia in adult males.

IESCCG policy:

For the ‘green’ indication, tadalafil should be initiated by the hospital specialist and a 2 week prescription given. After 2 weeks the GP can then continue prescribing.

The patient should be reviewed by the hospital specialist at 3 months and if tadalafil once daily has been effective, the specialist should advise the GP to change the patient to PRN sildenafil.

The hospital specialist should explain the change to patient. If tadalafil has not been effective - the specialist should advise the GP on alternative treatments. This may include continuing tadalafil once daily for a further 6-9 months (this would be a very small number of patients).

Tadalafil daily should not be continued for longer than a year in any patient.

07.04.05 Tadalafil prn 
11.06 Tafluprost 15mcg/ml eye drops

Available as preservative free drops

11.06 Tafluprost and Timolol 

Ipswich Hospital

The tafluprost/timolol combination eye drop is a formulary medicine choice - available as 15mcg per ml / 0.5%

Colchester Hospital

The tafluprost/timolol combination eye drop is a non-formulary medicine

20 TALC BP purified sterile  

Hospital only guidance

Prescribing guidance

Talc for Pleurodesis

08.03.04.01 Tamoxifen 
07.04.01 Tamsulosin 
04.07.02 Targinact (Oxycodone/Naloxone) Targinact®
06.01.06 TEE 2+ 

Compatible strips

  • TEE 2 test strips
08.01.03 Tegafur with Uracil caps
05.03.03.02 Telaprevir Incivo®
04.01.01 Temazepam tablets, liquid

Note liquid is expensive

08.01.05 Temozolomide caps
08.01.05 Temsirolimus injection
02.10.02 Tenecteplase Metalyse®

For ED use only in selected patients with acute coronary occlusion when timely access to Primary Percutaneous Coronary Intervention (PPCI) is unavailable.

05.03.01 Tenofovir 245mg, Efavirenz 600mg and Emtricitabine 200mg Atripla®
05.03.01 Tenofovir alafenamide, elvitegravir, cobicistat & emtricitabine Genvoya®
05.03.03.01 Tenofovir disoproxil Viread

Indicated for chronic hepatitis B infection. Also indicated for HIV infection in combination with other antiretroviral drugs

05.03.01 Tenofovir Disproxil Viread®

Indicated for HIV infection in combination with other antiretroviral drugs. Also indicated for chronic hepatitis B infection.

05.03.03.01 Tenofovir Disproxil Viread®
05.03.01 Tenofovir, cobicistat, elvitegravir & emtricitabine Stribild®
02.05.04 Terazosin 

First dose effect

First dose may cause collapse due to hypotensive effect (therefore should be taken at bedtime). Patient should be warned to lie down if symptoms such as dizziness, fatigue or sweating develop, and to remain lying down until the effects subside

07.04.01 Terazosin 

Restricted usage - terazosin is unlikely to be initiated within the acute Trust for urinary retention but existing therapy will be continued on if appropriate

13.10.02 Terbinafine 1% cream 

Can be bought OTC

13.10.02 Terbinafine tablets  

Primary care guidance

Treating Fungal Nail Infection

If antifungal treatment is indicated, confirm diagnosis (positive microscopy or positive culture) via mycology result before initiating treatment

It is not recommended to combine topical treatment and oral drug treatment.

Usual course length 3 months

Perform LFT prior to treatment and monitor periodically


Amorolfine nail lacquer is available OTC for mild cases and for treatment of max. 2 nails. It should not be prescribed as there is a lack of evidence.

03.01.01.01 Terbutaline Nebulisers

Reserved for patients intolerant or allergic to salbutamol where a patient is unable to use inhalers or has severe disease

03.01.01.01 Terbutaline DPI

Reserved for patients intolerant or allergic to salbutamol.

Licensed for adults and children >5 years

07.01.03 Terbutaline SC injection

MHRA:Restricted use for tocolysis in premature labour


Unlicensed use

  • External cephalic version
  • Management of hyperstimulation with oxytocin
08.02.04 Teriflunomide tabs
06.06.01 Teriparatide injection

For treatment of osteoporosis

Ipswich Hospital/IESCCG

Teriparatide is considered a hospital-only medicine ony - Hospital Rheumatology Consultant initiation only

Colchester Hospital/NEECCG

Teriparatide is available for prescribing within Primary Care under Shared Care Agreement

06.05.02 Terlipressin injection
20 Terracortril (Oxytetracycline + Hydrocortisone)  Overgranulation
16.01 Test Flame

Flame A flame

FlameFlameFlame Three flames

06.04.02 Testogel Testosterone gel

50mg/5g gel sachet

06.04.02 Testosterone injection Sustanon 250®
06.04.02 Testosterone undecanoate Restandol Testocaps®
06.04.02 Testosterone undecanoate Nebido® injection
14.05.02 Tetanus immunoglobulin 
04.09.03 Tetrabenazine Xenazine® 25

Treatment must be initiated by a Neurology Specialist.

15.02 Tetracaine (Amethocaine) Ametop® 4% gel
11.11 Tetracaine 1% 

Single use eye drops

06.05.01 Tetracosactide Synacthen®
09.02.02.02 Tetrastarch Volulyte®
08.02.04 Thalidomide caps
20 Tham injection 7% 
09.06.02 Thiamine 
20 THIAMINE Injection 100 mg in 1mL 
15.01.01 Thiopental injection

Papaverine HCl available for accidental intraarticular injection of thiopentone

08.01.01 Thiotepa injection
06.05.01 Thyrotropin Alfa 

Restricted to oncology and endrocrinology use only

04.08.01 Tiagabine 

Ipswich Hospital

Tiagabine is considered a formulary medicine

Colchester Hospital

Tiagabine is a non-formulary medicine. Therefore, treatment would not be initiated within the acute Trust, but if necessary to ensure patient care, existing therapy would be continued on (and supplies purchased if appropriate).

06.04.01.01 Tibolone 
02.09 Ticagrelor 
13.05.03.02 Tildrakizumab Ilumetri 100mg/ml injection
11.06 Timolol  

Ipswich Hospital

Available preparations are: 

  • 0.25% drops
  • 0.25% preservative free drops (multidose bottle)

Note: 0.5% formulation not approved at Ipswich hospital

Colchester Hospital

Available preparations are:

  • 0.25% drops
  • 0.25% preservative free drops
  • 0.5% drops
  • 0.5% preservative free drops
  • 0.25% gel solution
  • 0.5% gel solution
11.06 Timolol 0.1% 

Low strength beta-blocker

08.01.03 Tioguanine caps, suspension
03.01.02 Tiotropium Spiriva® Respimat

On specialist recommendation (asthma)


May be continued for existing patients only, consider moving to a formulary option at next review (COPD)

02.09 Tirofiban 

Cardiology approval only

11.11 Tisseel  glue

Solutions for sealant

08.01.05 Tivozanib Capsules
10.02.02 Tizanidine 
10.01.03 Tocilizumab 

MHRA: Rare risk of serious liver injury including cases requiring transplantation

01.05.03 Tofacitinib 
10.01.03 Tofacitinib 

MHRA: Restriction of 10 mg twice-daily dose in patients at high risk of pulmonary embolism while safety review is ongoing

04.09.01 Tolcapone 

Ipswich Hospital

Tolcapone is a formulary medicine

Colchester Hospital

Tolcapone is considered a non-formulary medicine

07.04.02 Tolterodine modified release
07.04.02 Tolterodine immediate release

Use in preference to modified release where possible due to lower cost

06.05.02 Tolvaptan Jinarc®

 

Very specialist use within Renal Services only - in strict accordance with the NICE guidance relating to the treatment of Autosomal Dominant Polycystic Kidney Disease

13.05.01 Topical corticosteroids  

Click here to see corticosteroids

13.05.02 Topical corticosteroids  

Click here to see corticosteroids


Topical corticosteroids are only suitable for treating localized psoriasis.

They should only be applied once daily.

Very potent topical steroids under specialist supervision only

04.07.04.02 Topiramate 

Contra-indicated in pregnancy and in women of child-bearing potential for migraine prophylaxis if not using an effective method of contraception.

Patients on long term treatment should be regularly weighed and monitored for continued weight loss.

If clinically significant weight loss occurs, consider stopping treatment.

Topiramate is associated with depression.

04.08.01 Topiramate 
08.01.05 Topotecan caps, injection
06.04.02 Tostran Testosterone gel

2% gel

06.01.01.02 Toujeo® Insulin Glargine

Basal insulin


Available as:

  • Solostar® pre filled pen

Red Triangle Caution-High strength:300 units/ml - to be used only in patients requiring high doses of insulin therapy; to decrease injection volume load

08.01.05 Trabectedin injection
04.07.02 Tramadol caps, MR tabs

Caution when using modified release preparations as some preparations are for once daily dosing

08.01.05 Trametinib tabs
02.11 Tranexamic Acid 
12.03.04 Tranexamic Acid Mouthwash 5% 

unlicensed Unlicensed medicine

For use in Radiotherapy or oncology

12.03.04 Tranexamic Acid Topical Solution 

unlicensed Unlicensed medicine

For use in Palliative Care

08.01.05 Trastuzumab 
08.01.05 Trastuzumab emtansine 
11.06 Travoprost 40mcg/ml eye drop
11.06 Travoprost and Timolol 

Available as 40mcg per ml / 0.5%

04.03.01 Trazodone tabs, caps, liquid

Trazodone treatment would not be initiated within the acute Trust, but if necessary to ensure patient care, existing therapy would be continued on (and supplies purchased if appropriate

Note: the liquid formulation is expensive and therefore must only be used in appropriate circumstances

03.02.03 Trelegy 

Components

    • fluticasone furoate - 92 micrograms
    • umeclidinium - 55 micrograms
    • vilanterol - 22 micrograms

Once daily dosing

08.01.01 Treosulfan caps, injection
06.01.01.02 Tresiba® Insulin degludec

Basal insulin


Available as:

  • Cartridges
  • FlexTouch pre-filled pen
06.03.02 Triamcinolone acetonide intra-articular/ intramuscular injection

Hospital only guidance

Indications

For adult use only.
Unlicensed use for patients with complications post breast reconstruction surgery

10.01.02.02 Triamcinolone Acetonide Adcortyl®

Note there are two brands


May be used by intravitreal injection (unlicensed indication)

10.01.02.02 Triamcinolone Acetonide Kenalog®

Note there are two brands

12.02.01 Triamcinolone Acetonide Nasacort®

Ipswich Hospital

Triamcinolone acetonide nasal spray (Nasocort) is non-formulary

Colchester Hospital

Triamcinolone acetonide nasal spray (Nasocort) is considered a formulary medicine

06.03.02 Triamcinolone hexacetonide  injection

For paediatric use only 

04.02.01 Trifluoperazine tabs, liquid

Trifluoperazine is a rarely prescribed and specialist treatment within Mental Health. It would not be initiated within the acute hospitals at Ipswich and Colchester but existing patients admitted to the organisation would have their treatment continued; and supplies procured accordingly if necessary.

08.01.03 Trifluridine with tipiracil tabs
04.09.02 Trihexyphenidyl 
03.02.03 Trimbow 

Components

    • beclometasone dipropionate - 100 micrograms
    • glycopyrronium - 10 micrograms
    • formoterol fumarate - 6 micrograms

Twice daily dosing

13.04.04 Trimovate ® antifungal and antibacterial

Currently only available as an unlicensed medicine

 

06.07.02 Triptorelin Decapeptyl SR ®

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Red Gynaecological indications
Shared care Prostate cancer
08.03.04.02 Triptorelin Gonapeptyl Depot®
11.10 Tropicamide 

Hospital clinic use only


Avaiable as

  • 0.5% single use drops
  • 1% single use drops
11.11 Tropicamide0.2mg/phenylephrine 3.1mg/lidocaine 10mg/ml  intracameral injection

Mydrane ®

07.04.02 Trospium immediate release

Rarely used treatment but does not cross the blood-brain barrier so perhaps fewer central side effects compared to other antimuscarinics - second/third line treatment

07.04.02 Trospium MR 

Ipswich Hospital / NEECCG

Trospium MR is considered a formulary medicine

Colchester Hospital

Trospium MR is considered a non-formulary medicine

11.11 Trypan blue Vioron®
14.04 Typhoid Live Oral vaccine Vivotif®
07.03.05 Ulipristal 

Can be used up to 120 hours after unprotected intercourse

13.02.01 Ultrabase ® 

Can be bought OTC

Flame Low fire risk

03.01.02 Umeclidinium Incruse Ellipta®

Licensed for adults >18 years for COPD

03.01.04 Umeclidinium & vilanterol Anoro Ellipta®

Licensed for adults >18 years for COPD

03.01.03 Uniphyllin® Continus 

Always prescribe by brand

02.10.02 Urokinase 

Used for clearing PICC line blockage

Thrombolytic treatment of occluded central venous access devices including those used for haemodialysis

See IHT guidance below

07.04.04 Urotainer Sodium chloride 0.9%
01.09.01 Ursodeoxycholic acid tablets, liquid

Initiated by specialist

Avoid 500mg tabs due to higher cost

Liquid reserved for patients with swallowing difficulties.

01.05.03 Ustekinumab Gastroenterology

MHRA:Risk of exfoliative dermatitis

10.01.03 Ustekinumab  Rheumatology
13.05.03.02 Ustekinumab 

MHRA:Risk of exfoliative dermatitis

13.08.01 Uvistat ® 
07.04.05 Vacuum Pumps for erectile dysfunction 

Vacuum pumps listed in the Drug Tariff may be recommended by a specialist 

The products can ordered on an FP10 (ie prescribed "on the NHS") only if the patient meets the following criteria

a) a man who is suffering from any of the following -

  • diabetes
  • multiple sclerosis
  • Parkinson's disease
  • poliomyelitis
  • prostate cancer
  • severe pelvic injury
  • single gene neurological disease
  • spina bifida
  • spinal cord injury;

or

(b) a man who is receiving treatment for renal failure by dialysis

or

(c) a man who has had the following surgery

  • prostatectomy
  • radical pelvic surgery
  • renal failure treated by transplant.

If a patient has one of the above and is using the pump for the treatment of erectile dysfunction, the prescriber should endorse the FP10 with "SLS".

Practices should ensure the patient has received counseling from the specialist on how to operate the pump.

06.04.01.01 Vagifem  Estradiol
05.03.02.02 Valganciclovir 
04.02.03 Valproic Acid Depakote®

MHRA:Contraindicated in women and girls of childbearing potential unless conditions of Pregnancy Prevention Programme are met

MHRA: Pregnancy prevention programme: updated educational materials


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Green Unlicensed indication

Hospital initiated and stabilised, then GP prescribed for acute hypomania within bipolar disorder, mood stabilisation in bipolar disorder

 

Primary care guidance

Identification and review of patients

Prescribers in primary care should use searches available on the clinical system to identify patients of childbearing age using valproate. 

Patients who have not had a Risk Acknowledgment Form filled out should seek specialist advice or refer where appropriate

IESCCG-Please see guidance below for further information

11.11 Vancomycin 1mg/0.1ml  intravitreal injection

Injection prepared for intravitreal use

(pre-filled syringes available from pharmacy)

08.01.05 Vandetanib tabs

See below for further information for educational material for the following areas

  • Serious risks for adults paedeatric patients
  • DOsing and monitoring guidance for paediatric patients

 

07.04.05 Vardenafil Levitra®
04.10.02 Varenicline Champix®

Smoking cessation-must have level 3 smoking cessation support

14.04 Varicella Zoster vaccine Zostavax®
14.05.02 Varicella-Zoster immunoglobulin VZIG

Only to be prescribed after consultation with an Ipswich Hospital microbiologist

14.04 Varicella-zoster vaccine Varilrix®
14.04 Varicella-zoster vaccine Varivax®
06.05.02 Vasopressin  Argipressin

Hospital use only - for organ preservation and critical care use

15.01.05 Vecuronium injection
01.05.03 Vedolizumab 
13.08.02 Veil ® 
08.01.05 Vemurafenib tabs
04.03.04 Venlafaxine MR caps

Avoid MR tabs (higher cost)

04.03.04 Venlafaxine IR tabs
02.06.02 Verapamil injection
02.06.02 Verapamil modified release tablets, solution
06.01.02.03 Victoza® Liraglutide

Must be prescribed by brand

04.08.01 Vigabatrin 
08.01.04 Vinblastine Sulphate 
08.01.04 Vincristine Sulphate injection
08.01.04 Vindesine Sulphate injection
08.01.04 Vinflunine injection
08.01.04 Vinorelbine caps
08.01.05 Vismodegib caps
09.06.07 Vitamin and mineral supplements Ketovite®

Can be bought OTC


Ketovite capsules, tablets and liquid are not interchangable

09.06.07 Vitamin and mineral supplements Forceval®

Can be bought OTC

09.06.02 Vitamin B Tablets, Compound Strong 
03.01.05 Volumatic ® 

Available with a mask.

Check spacer fits prescribed inhaler(s)

11.03.02 Voriconazole 1% 

This is a very specialist and restricted product prescribed only in specific circumstances.

The voriconazole 1% drops product is an unlicensed "unlicensed special" medicine that would be dispensed by the hospital pharmacy only.

04.03.03 Vortioxetine 

If a patient is admitted on this treatment and initiated by the mental health trust, Vortioxetine can continue.

02.08.02 Warfarin 

Primary care guidance

Warfarin supply

Note only 0.5mg,1mg,3mg are approved for local use

There is a risk of overdose/underdose due to confusion between 0.5mg and 5mg tablets

If patients are using 5mg tablets, consideration must be given to discontinue this strength and to prescribe 1mg and 3mg tablets to make up the required dose

 

 

Hospital only guidance

Ipswich hospital

IHT (and WSH) only keep 1mg and 3mg. Patients requiring half mg doses will need 0.5mg strength prescribed and supplied in primary care following discharge

Colchester hospital

The 500microg (0.5mg) strength is available and considered a formulary medicine

09.02.02.01 Water for Injection 
06.06.02 XGEVA® Denosumab

MHRA:Osteonecrosis of the external auditory canal

MHRA: Osteonecrosis of the jaw

MHRA:Denosumab (Xgeva▼) for giant cell tumour of bone: risk of clinically significant hypercalcaemia following discontinuation

MHRA:Denosumab (Xgeva▼) for advanced malignancies involving bone: study data show new primary malignancies reported more frequently compared to zoledronate


Note two different brands

XGEVA is indicated for 

  • Prevention of skeletal related events in patients with bone metastases from solid tumours
12.02.02 Xylometazoline Otrivine®

Avaiable OTC


Avaiable as

  • 0.1% nasal spray and drops,
  • 0.05% paediatric nasal drops
13.02 ZeroAQS ® 

Can be bought OTC

13.02.01 Zeroderm ® 

Can be bought OTC

Flame Flame Flame High fire risk


Equivalent to Hydromol ointment (lanolin free) and Epaderm ointment

05.03.01 Zidovudine Retrovir®
05.03.01 Zidovudine and lamivudine 
09.05.04 Zinc Sulphate 

Available as

  • Effervescent Tablets
  • Capsules
06.06.02 Zoledronic Acid 5mg injection

Note 2 different strengths of Zolendronic acid


 For osteoporosis and Paget's disease

06.06.02 Zoledronic Acid 4mg injection

Note 2 different strengths of Zolendronic acid


For oncology related indications

04.07.04.01 Zolmitriptan Tabs, orodispersable tabs, nasal spray

Consider combining 5HT receptoragonist with either NSAID or paracetamol

04.01.01 Zolpidem tabs

MHRA:Risk of drowsiness and reduced driving ability

 

Last line 'Z' drug to use

 

04.08.01 Zonisamide 
04.01.01 Zopiclone tabs
04.02.01 Zuclopenthixol tablets

Zuclopenthixol tablets are a rarely prescribed and specialist treatment within Mental Health. It would not be initiated within the acute hospitals at Ipswich and Colchester but existing patients admitted to the organisation would have their treatment continued; and supplies procured accordingly if necessary.

04.02.02 Zuclopenthixol Acetate 
04.02.02 Zuclopenthixol Decanoate