netFormulary
 Report : A-Z of formulary items 15/11/2019 19:09:25
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Section Name Details
13.03 1% Menthol in aqueous cream 
12.02.01 25% glucose with glycerine nasal drops Glycerdex®

For atrophic rhinitis type symptoms

 

05.03.01 Abacavir Ziagen®
05.03.01 Abacavir and Lamivudine Kivexa®
08.03.04.02 Abiraterone Zytiga®
04.10.01 Acamprosate Campral EC®

IRIS/ Detox services to supply/ prescribe in community

06.01.02.03 Acarbose Glucobay®
11.06 Acetazolamide Diamox®
12.01.03 Acetic Acid 2% Earcalm ®

EarCalm should be used for keratin debris removal

Available OTC

Encourage self care

11.08.02 Acetylcholine Chloride Miochol-E®
03.07 Acetylcysteine Tablets 

 

600mg capsules prescribable on SystmOne and more cost effective for primary care

05.03.02.01 Aciclovir 
13.10.03 Aciclovir 

Can be purchased over the counter

11.03.03 Aciclovir eye ointment 3% Zovirax®
13.05.02 Acitretin 
03.01.02 Aclidinium Eklira Genuair®

DPI LAMA

Slow onset of action (30mins)

Asthma - not licensed

COPD - Maintenance not bronchospasm

03.01.04 Aclidinium and formoterol inhaler Duaklir Genuair ®

DPI

Asthma - Not licensed

COPD - adults only

01.05.03 Adalimumab 
10.01.03 Adalimumab Humira®
13.06.01 Adapalene Differin®
13.06.01 Adapalene + Benzoyl peroxide Epiduo®

First line for papulopustular acne

09.05.01.01 Adcal® 
02.03.02 Adenosine Adenocor®

Hospital ONLY

CCU/ITU/Emergency only

 

03.04.03 Adrenaline / epinephrine EpiPen®, Emerade® & Jext®

Emerade - First line autoinjector

  • Available as 500mcg/300mcg & 150mcg
  • Supply minimum of 2 pens

Epipen

  • Available as 300mcg/ 150mcg
  • Supply minimum of 2 pens

Jext

  • Available as 300mcg/ 150mcg
  • Supply minimum of 2 pens
03.04.03 Adrenaline / epinephrine 1 in 1,000 
02.07.03 Adrenaline / Epinephrine 1 in 10,000 (dilute) 

HOSPITAL ONLY

03.01.05 AeroChamber Plus ® 
08.01.05 Afatinib Giotrif®
11.08.02 Aflibercept Eylea®
06.06.02 Alendronic Acid 
09.06.04 Alfacalcidol One-Alpha®

Hydroxylated Vitamin D analogue:

Typically limited to patients with severe renal impairment and requiring supplementation

Plasma calcium concentrations need monitoring due to risk of hypercalcaemia at high doses. Hypercalcaemia is indicator of vitamin D toxicity 

ALL patients receiving pharmacological doses of vitamin D require plasma calcium concentrations checking at intervals (once or twice weekly initially and when nausea and vomiting occurs) 

 

15.01.04.03 Alfentanil Rapifen®
03.04.01 Alimemazine Vallergan®
04.01 Alimemazine 

Sedating antihistamine used in paediatrics

HIGH COST DRUG

 

02.12 Alirocumab Praluent®

HOSPITAL ONLY

Use in line with NICE guidance

GP needs to be informed of use and record as 'Drugs from elsewhere'

10.01.04 Allopurinol 

Do not start allopurinol during an actue attack of gout

06.01.02.03 Alogliptin Vipidia▼®
07.04.05 Alprostadil Caverject®
07.04.05 Alprostadil 3mg/g cream Vitaros®
02.10.02 Alteplase Actilyse®

HOSPITAL ONLY

13.12 Aluminimum Chloride Hexahydrate 20% in Alcoholic Base Driclor®
04.09.01 Amantadine 
05.01.04 Amikacin 

Only to be used on the advice of the microbiologist

02.02.03 Amiloride Hydrochloride 
03.01.03 Aminophylline solution for injection 

Hospital Only

Severe acute exacerbations - IV infusions/ injections

02.03.02 Amiodarone 

Monitoring of patients taking amiodarone

System Reason Monitoring
Thyroid and endocrine Amiodarone is known to affect thyroid function due to iodine content. All patients taking amiodarone must have TFTs checked on a 6 monthly basis, and after discontinuation due to long half life- See SPC for details
Eyes

Most patients develop corneal micro-deposits, which are reversible on stopping treatment. These rarely interfere with vision but can affect night time driving.

If optic neuritis or neuropathy develops treatment must be stopped.

Complete ophthalmic examination is recommended immediately if blurred vision is reported. Otherwise patients will require annual ophthalmic assessments
Electrolyte

Potassium levels

Should be checked before initiating treatment
Chest

Known pulmonary toxicity resulting in dyspnoea and non-productive cough

Chest X ray is required before treatment

Any toxicity is reversed on discontinuation

Liver

Associated with hepatotoxicity

LFTs before treatment and every 6 months whilst taking.

ECG and resuscitation facilities need to be available before administering IV amiodarone

 

 

04.02.01 Amisulpride 

Low incidence of most common side effects, except notably high incidence of prolactin elevation

As with other SGAs hyperglycaemia has been reported with amisulpride. Patients should be monitored for changes in blood glucose and patients with pre-existing diabetes should be advised of the side effects and managed accordingly.

QTc prolongation possible: see above advice for management

01.02 Amitriptyline  

[UNLICENSED USE]

Low dose tricyclic antidepressants can be used for abdominal pain or discomfort in people where antispasmodics, anti-motility and laxatives have failed

04.03.01 Amitriptyline 

Third line for antidepressant use.

Option in treatment resistant depression - Should be initiated by specialist

High incidence of side effects

Can be lethal in overdose, but may be useful in those who responded previously

Some use in anxiety conditions: see anxiety section

Commonly used in primary care for off license uses

Used in palliative care off license for neuropathic pain and abdominal pain associated with neuropathic pain. See Isle of Wight Palliative Care Symptom Control Guidelines 2018

 

04.07.03 Amitriptyline 

First line option

Accepted first line option although off-license indication

Potential for anticholinergic side effects. Review concurrent medicines and risk factors.

02.06.02 Amlodipine 
05.01.01.03 Amoxicillin 
05.02 Amphotericin AmBisome®

Only to be used on the advice of the microbiologist.

08.03.04.01 Anastrozole 
05.02.04 Anidulafungin Ecalta®

Only to be used on the advice of the microbiologist

12.03.01 Antacid with Oxetacaine 

UNLICENSED SPECIAL in primary care.

01.07.02 Anusol HC® Ointment 

First choice ointment

01.07.02 Anusol HC® Suppositories 
02.08.02 Apixaban Eliquis®

Second line to warfarin - First line DOAC in poor renal function

Ensure patient has been properly counselled and received alert card and advice leaflet

04.09.01 Apomorphine 

HIGH COST DRUGS LIST

See CCG high cost drugs list for approved indications.

11.08.02 Apraclonidine Iopidine®
10.01.03 Apremilast Otezla®
04.06 Aprepitant Emend®

Prevention of late onset nausea and vomiting following cisplatin at doses greater then 70mg/m2

Onset is 2-3 days post treatment and very severe.

Approved by Cancer Network evaluation committee

Approved for NSCLC

13.02.01 Aproderm® Colloidal Oat Cream 

See IOW Emollient formulary

Third Line option for Light and Creamy leave on emollients

For mild to moderately dry skin

Good for everyday use

Can be used as soap substitute

Cost effective alternative to Aveeno®

13.02.01 Aproderm® Gel 

See IOW Emollient formulary

First Line option for Gel leave on emollients

For moderately dry skin

Less greasy than ointments

Good for everyday use

Cost effective alternative to Doublebase® and Zerodouble®

13.02.01 Aquamax ® Cream 

See IOW Emollient formulary

First Line option for Light and Creamy leave on emollients

For mild to moderately dry skin

Good for everyday use

Thicker than Epimax

Can be used as soap substitute

01.06.03 Arachis Oil 

Contains Peanut oil

DO NOT USE in patients with PEANUT ALLERGY

For softening impacted faeces

04.02.01 Aripiprazole 
04.02.02 Aripiprazole Abilify Maintena®

300mg & 400mg prolonged release injection

SGA long acting injection

Only for use in patients established on oral aripiprazole but with poor compliance/ adherence

GP should record as 'Drug for elsewhere'

See SPC for more information

[NOT TO BE CONFUSED WITH SOLUTION FOR INJECTION 7.5mg/ml for acute epsiodes.] 
05.04.01 Artemether with lumefantrine Riamet®

For the treatment of malaria.

See trust guidelines for more information.

 

05.04.01 Artesunate 

For the treatment of malaria.

See trust guidelines for more information.

15.02 Articaine Hydrochloride with Adrenaline Septanest®
12.03.05 AS saliva Orthana ® 
02.09 Aspirin (antiplatelet) 
04.07.01 Aspirin 300mg  

Possible option as anti-inflammatory, antipyretic and analgesic for mild to moderate pain.

Doses of 300-900mg every 4-6hours, upto 4g per day.

Preferred option by some patients - Encourage purchased OTC first

Compound OTC products available

05.03.01 Atazanavir Reyataz®
02.04 Atenolol 

Tablets / Liquid

Fourth line choice for hypertension

First line choice for patients with co-morbidities

02.04 Atenolol Injection 

HOPSITAL ONLY

08.01.05 Atezolizumab Tecentriq®
04.04 Atomoxetine Strattera®

Specialist Supervision

Shared care agreement: CNS Stimulants and other drugs for ADHD in children

Unlicensed uses:

Children in dose > 100mg daily

 Adults doses of 120mg daily or higher not licensed

02.12 Atorvastatin 

HIGH INTENSITY STATIN at doses 20mg, 40mg & 80mg

Medium intensity statin at dose of 10mg

First line choice

Aim for >40% reduction in non-HDL cholesterol after 3 months

Primary prevention starting dose for individuals who have 10% or higher QRISK2 score. 20mg

Secondary prevention in people with cardiovascular disease

Exceptions apply for this dose

80mg

Measure LFT's within 3 months of starting and at 12months.

Creatine kinase should be checked if complaints of unexplainable muscle pains and weakness. This does not need to be measured routinely in people who are asymptomatic and on a statin

11.05 Atropine 

Available as Minims single use

07.04.05 Avanafil 
08.01.05 Axitinib Inlyta®
08.01.03 Azacitidine Vidaza®
01.05.03 Azathioprine 

DMARDs Shared care agreement

08.02.01 Azathioprine 
10.01.03 Azathioprine 
05.01.05 Azithromycin 

Not suitable for empiric treatment in adult patients. The formulary choice macrolide is Clarithromycin

10.02.02 Baclofen 
13.02.01 Balneum ® Plus cream 

See IOW Emollient formulary

First Line option for UREA containing emollients

5% urea

Keratin softner for dry scaling conditions

Can cause stinging and irritation. Trial with smallest appropriate packsize first to mimise waste

 

06.01.01.03 BD Microfine Ultra 4mm/32g pen needle 

Second line pen needle for adult diabetes patients that have tried BD Viva and would benefit from a needle with additional bevelling.

06.01.01.03 BD Viva 4mm/32g pen needles 

First line pen needle for all adult diabetes patients using injectible medication.

03.02 Beclometasone 

MDI = Clenil or QVAR : Prescribe by brand

DPI = Easyhaler

Asthma - QVAR twice as potent as clenil. Need to halve dose and prescribe by brand

COPD - Not licensed (MDI/DPI)

03.02 Beclometasone and formoterol Fostair ®

MDI or DPI (Nexthaler)

Asthma - MDI & DPI- Start at 100/6 one puff twice a day and step up. Can be used as MART

COPD - ONLY MDI - Start at 100/6 two puffs twice a day

12.02.01 Beclometasone Dipropionate 
08.01.01 Bendamustine 
02.02.01 Bendroflumethiazide 

First line choice for Thiazides

Monitor U&E's

13.09 Benzalkonium Chloride 0.5% shampoo Dermax®
13.06.01 Benzoyl Peroxide Acnecide®

Start low and increase strength at night

13.06.01 Benzoyl Peroxide 5% with Clindamycin 1% Duac® Once Daily
12.03.01 Benzydamine Difflam®
05.01.01.01 Benzylpenicillin Benzathine 
04.06 Betahistine Dihydrochloride 

Third Line:

  • Meniere's disease - prophylaxis in confirmed diagnosis

 

06.03.02 Betamethasone 
13.04 Betamethasone (as Valerate) 0.025% Betnovate-RD®

Moderately potent

13.04 Betamethasone (as Valerate) 0.1% Betnovate®

Potent

12.01.01 Betamethasone ear drops 
11.04.01 Betamethasone eye drops 
12.02.01 Betamethasone nasal drops 

Licensed for non-infected inflamatory nasal conditions.

08.01.05 Bevacizumab Avastin®
02.12 Bezafibrate 
08.03.04.02 Bicalutamide 
11.06 Bimatoprost 

Prescribe generically

11.06 Bimatoprost with Timolol Ganfort®
06.01.01.02 Biphasic Insulin Aspart NovoMix® 30
06.01.01.02 Biphasic Insulin Lispro Humalog® Mix
06.01.01.02 Biphasic Isophane Insulin Humulin® M3
01.06.02 Bisacodyl 

 STIMULANT LAXATIVE - Short term use advised

 Increases intestinal motility.

 Often cause intestinal cramps.

 Avoid in intestinal obstruction.

 Excess use can cause diarrhoea, hypokalaemia/ electrolyte imbalance. Prolonged use can result in rebound constiaption on discontinuation due  stimulant nature of laxative

Available OTC - For short term relief

02.04 Bisoprolol 

First Line for Heart failure

 

08.01.02 Bleomycin 
08.01.05 Bortezomib Velcade®
04.09.03 Botulinum A toxin Xeomin®
07.04.02 Botulinum toxin 

Botulinum toxin is used for bladder spasms and overactive bladder symptoms as a last resort in Multiple Sclerosis patients.

08.01.05 Brentuximab vedotin Adcetris®
13.06.01 Brimonidine gel Mirvaso®

Persistant facial erythema in rosacea.

 

MHRA/CHM advice: Brimonidine gel (Mirvaso®): risk of systemic cardiovascular effects (June 2017)

Systemic cardiovascular effects including bradycardia, hypotension, and dizziness have been reported after application of brimonidine gel. To minimise the possibility of systemic absorption, it is important to avoid application to irritated or damaged skin, including after laser therapy.

11.06 Brimonidine Tartrate Alphagan®
11.06 Brimonidine Tartrate 0.2% with Timolol 0.5% Combigan®
11.06 Brinzolamide Azopt®
11.06 Brinzolamide 10mg/ml & brimonidine 2mg/ml Simbrinza®
11.06 Brinzolamide with timolol Azarga®
04.09.01 Bromocriptine 
06.07.01 Bromocriptine 
01.05.02 Budesonide 
03.02 Budesonide and formoterol Symbicort®

DPI

Asthma - Start at 200/6 one puff twice a day and step up. 100/6 and 200/6 can be used as MART.

COPD - 400/12 one puff twice a day.

03.02 Budesonide and formoterol Fobumix Easyhaler®

DPI

Asthma - Start at 80/4.5 one-two puffs twice a day and step up. 80/4.5 and 160/9 can be used as MART.

COPD - 160/4.5 two puffs twice a day or 320/9 one puff twice a day.

03.02 Budesonide and formoterol DuoResp Spiromax®

DPI

Asthma - Start at 160/4.5 one puff twice a day and step up. 160/4.5 can be used as MART.

COPD - 320/9 one puff twice a day.

03.02 Budesonide Easyhaler® 

DPI

Asthma - Prescribe as brand

COPD - Not licensed

02.02.02 Bumetanide 
15.02 Bupivacaine Hydrochloride 
15.02 Bupivacaine with Fentanyl 
04.07.02 Buprenorphine Transdermal 

Useful if oral route not available.

Option for patients intolerant to morphine, codeine, DHC or tramadol.

If failure to respond to modified release morphine this could be used - refer to pain clinic if intolerant or not responding to oral morphine.

Should be initiated with anti-emetic

Buprenorphine 10mcg/hr = 20mg/24hrs morphine equivalent

06.07.02 Buserelin Suprecur®

Endometrosis = Intranasal

Use in IVF requires funding and approval for treatment on NHS via PA/IFR. Prescribing to be fulfilled by specialist

08.03.04.02 Buserelin 
04.01.02 Buspirone Hydrochloride 

Buspirone must be initiated within psychiatry only. Use for short term relief of severe, disabling anxiety. Beware of tolerance and dependence. Consider SSRI for various anxiety disorders

08.01.01 Busulfan 
08.01.05 Cabazitaxel Jevtana®
04.09.01 Cabergoline 
06.07.01 Cabergoline 
20 Caffeine Citrate 

HOSPITAL USE ONLY

Neonatal unit only

09.05.01.01 Calcichew ® 
13.05.02 Calcipotriol 

Needs to be used twice daily to be effective. There is no need to change patients who are stable on topical calcipotriol to calcitriol.

13.05.02 Calcipotriol 50micrograms/g with Betamethasone 0.05% Dovobet®

Dovobet is suitable for the initial topical treatment of stable plaque psoriasis.  Dovobet contains a potent steroid, the use of which carries risks of destabilising psoriasis and side effects from prolonged use.  Use twice daily for up to one month.  Not to be used on the face, but can be used on the scalp.

06.06.01 Calcitonin (salmon) / Salcatonin 
09.06.04 Calcitriol Rocaltrol®
13.05.02 Calcitriol 3micrograms/g Silkis®

Needs to be used twice a day to be effective.

Not to be used on the face

01.01.02 Calcium Carbonate with sodium alginate and sodium bicarbonate Peptac®

 Suitable in pregnancy

 Sugar free

 3.1mmol of sodium per 5ml

09.05.01.01 Calcium Chloride 
08.01 Calcium Folinate 
09.05.01.01 Calcium Gluconate 
13.08.02 Camouflagers Dermablend®
06.01.02.03 Canagliflozin Invokana▼®
02.05.05.02 Candesartan 

First choice in Heart Failure.

08.01.03 Capecitabine Xeloda®
12.03.01 Caphosol ® 

Chemotherapy mouthcare

Usually issued via hospital but supplies may be requested in primary care for certain circumstances.

04.07.03 Capsaicin 

Second Line

Licensed for

  • Post Herpetic Neuralgia
  • Painful diabetic neuropathy under specialist supervision
  • Peripheral neuropathic pain in non-diabetic patients (patches)

If oral treatment not tolerated and/or failure to respond to traditional first and second line treatments

Requires BP monitoring with transdermal use

Advice should be given about handling and hand washing when applying.

Transdermal use: Not to be used on face, scalp or in proximity to mucous membranes 

10.03.02 Capsaicin 
10.03.02 Capsaicin patch Qutenza®
04.07.03 Carbamazepine 

First Line for Trigeminal Neuralgia

___________________________________________

Unlicensed indication (listed in BNF indications):

Diabetes related neruopathic pain

04.08.01 Carbamazepine 
06.02.02 Carbimazole 

HYPERTHYROIDISM

15-40mg daily until euthryoid, then reduce to 5-15mg

Therapy usually given for 12-18 months

If substituting: 1mg carbimazole considered equivalent to 10mg propythiouracil, but dose may need adjusting according to response

03.07 Carbocisteine 

Capsules and Liquid

Sachets are cost effective option for fixed doses

 

11.08.01 Carbomers Clinitas Carbomer OR Viscotears OR Lumecare Carbomer®

Second line for patients presenting with dry eye symptoms who do not use other drops on regular basis and hypromellose has proved ineffective

Available OTC

08.01.05 Carboplatin 
07.01.01 Carboprost Hemabate®
06.01.06 Caresens® N test strips 

To be used with the Caresens<sup>®</sup> N Voice meter for diabetic patients who are visually impaired.

11.08.01 Carmellose 

Preservative free

1% offers cost effective option

See IOW CCG Dry Eye Guidelines:

First choice for patients on preservative containing eye drops/ dry eye causing medications on daily basis and using < 6 drops / day

02.04 Carvedilol 
05.02.04 Caspofungin Cancidas®

Only to be used on the advice of the microbiologist

05.01.02.01 Cefalexin 

Use in accordance with local guidelines

05.01.02.01 Cefixime 
05.01.02.01 Cefotaxime 

Use in accordance with Trust guidelines

05.01.02.01 Ceftazidime 

Use in accordance with Trust guidelines

05.01.02.01 Ceftriaxone 

Suitable for OPAT

 

05.01.02.01 Cefuroxime 

Use in accordance with Trust guidelines

10.01.01 Celecoxib 

 

08.01.05 Ceritinib Zykadia
10.01.03 Certolizumab Pegol Cimzia®
12.01.03 Cerumol ® 

Contains Arachis oil - Peanut allergy

Available OTC - encourage self care

03.04.01 Cetirizine 
13.02.01 Cetraben ® Cream 

See IOW Emollient formulary

First Line option for Rich Cream leave on emollients

For moderately dry skin

Less greasy than ointments

Good for everyday use

Good range of pack sizes

Can be used as soap substitute

08.01.05 Cetuximab Erbitux®
08.01.01 Chlorambucil 
05.01.07 Chloramphenicol 

Use for bacterial meningitis (or enteric fever) in patients with severe penicillin allergy - use in accordance with Trust guidelines. 

Elsewhere / otherwise only to be used after Microbiology approval.

 

11.03.01 Chloramphenicol 

First line for infective conjunctivitis

 

04.10.01 Chlordiazepoxide 

IRIS/DETOX services to prescribe, supply and monitor in the community.

Not to be routinely used for anxiety conditions. If used to be used short term and under specialist advice.

13.11.02 Chlorhexidine 4% 
13.11.02 Chlorhexidine Gluconate 1% cream Hibitane Obstetric®

For healthcare workers to use after washing as a moisturiser.

12.02.03 Chlorhexidine Hydrochloride 0.1%, Neomycin Suphate 0.5% Naseptin®
12.03.04 Chlorhexidine mouthwash 
03.04.01 Chlorphenamine 

Tablets and liquid

 

04.02.01 Chlorpromazine 

FGA with pronounced sedative and moderate antimuscarinic side effects and EPSE.

It also has a moderate incidence of weight gain, hypotension and prolactin elevation.

Tablets are significantly more expensive than liquid, and more expensive than haloperidol

12.03.01 Choline Salicylate Bonjela® Adult
06.05.01 Chorionic Gonadotrophin Pregnyl®
03.02 Ciclesonide Alvesco®

Asthma - Reserved for patients intolerant of other inhaled corticosteroids.

01.05.03 Ciclosporin 

DMARDs shared care agreement

10.01.03 Ciclosporin 
11.08.01 Ciclosporin 0.1% Ikervis ®

Treatment option for severe keratitis in adults with dry eyes not improved by artificial tear treatment.

NICE TA369

09.05.01.02 Cinacalcet Mimpara®

NHSE funded via renal team for patients on dialysis and supplied via Wessex Kidney Centre.

Patients not on dialysis with CKD 4/5 are funded under CCG HCDL.

Please ensure patient clinical situation before accepting prescribing in primary care

 

04.06 Cinnarizine 

First line

  • Labyrinthine vertigo
  • Meniere's disease (short term acute treatment)

Sedating antihistamine

05.01.12 Ciprofloxacin 

Use in accordance with local guidelines.

11.03.01 Ciprofloxacin 
12.01.01 Ciprofloxacin 3mg/ml with dexamethasone 1mg/ml Cilodex®
15.01.05 Cisatracurium Nimbex®
08.01.05 Cisplatin 
04.03.03 Citalopram 

First line = Tablets

Second line = drops - swallowing or compliance issues. Drops require dose adjustment : 4 drops (8mg) = 10mg tablet. Drops can be mixed with water, orange or apple juice before taking

Well tolerated. Good alternative to Fluoxetine especially if there is concomitant agitation. Is associated with QT interval prolongation (see above for advice)

May not be first line choice in older people due to dose restriction of max daily dose of 20mg 

 

05.01.05 Clarithromycin 

Use in accordance with local guidelines.

First choice macrolide 

05.01.06 Clindamycin 

Use in accordance with local guidelines.

04.08.01 Clobazam 
13.04 Clobetasol Propionate 0.05% Dermovate®

Very Potent

13.04 Clobetasone Butyrate 0.05% Eumovate®

Moderately potent

06.05.01 Clomifene Citrate 

Use in IVF or infertility requires funding and approval for prescribing on NHS

04.03.01 Clomipramine 

Third Line choice as antidepressant

Option in treatment resistant depression - initiated by specialist

Second line choice for OCD - See anxiety section

04.08.01 Clonazepam 
02.05.02 Clonidine Catapres®
02.09 Clopidogrel 

Choice ranking - dependent on indication

07.02.02 Clotrimazole 
12.01.01 Clotrimazole 
13.10.02 Clotrimazole 

Can be purchased over the counter

04.02.01 Clozapine 

SPECIALIST ONLY

Requires regular blood monitoring

Requires regular monitoring for serious physical side effects including myocarditis, cardiomyopathy and intestinal obstruction.

GP must be informed of prescription, but not issue. - record as 'drugs from elsewhere'

01.06.05 Clyssie Clyssie®

First line rectal preperation for bowel cleansing prior to flexible sigmoidoscopies.

Patient leaflet

13.09 Coal tar 1% with salicylic acid 0.5% Capasal ®
13.09 Coal Tar 12% Sebco ®

Scalp ointment

13.05.02 Coal tar lotion 5% Exorex®
02.02.04 Co-amilofruse (furosemide and amiloride) 
02.02.04 Co-amilozide 
05.01.01.03 Co-Amoxiclav 
04.09.01 Co-Beneldopa Madopar®
04.09.01 Co-Careldopa Sinemet®
04.09.01 Co-Careldopa and Entacapone Stalevo; Sastravi®
13.06.02 Co-Cyprindiol 

Co-Cyprindiol (cyproterone acetate with ethinylestradiol) is a treatment for severe acne and only in those patients may it also be used as an oral contraceptive (see section 7.3.1).  In those who do not require contraception, Co-cyprindiol should be withdrawn 3-4 cycles after the treated condition has completely resolved.  If ongoing contraception is required, substitution with another COC is likely to maintain the improvement.

Some drugs, including enzyme-inducers and antibiotics, may impair the efficacy of oral contraceptives; see BNF for details.

01.06.02 Co-danthramer 

RESTRICTED USE

Not routinely used - If recommended use should be on the advice of palliative care.

Not listed in IOW Palliative Care symptom control guidelines for constipation

 

01.04.02 Codeine 

NOT TO BE ROUTINELY USED

Risk of addiction.

Uncomplicated ACUTE diarrhoea in adults

Ensure proper assesment to rule out faecal impaction or overflow

 

03.09.01 Codeine Linctus BP 
04.07.02 Codeine Phosphate 

For moderate to severe pain

To be prescribed separately in addition to regular paracetamol, if regular paracetamol not managing pain.

Codeine 30mg = 3mg morphine equivalent

_________

Codeine linctus can be used for dry cough in palliative care. See IOW symtpom guidelines.

10.01.04 Colchicine 

Colchicine is limited by toxicity at higher doses, but is of value in patients with heart failure, and can be given to patients on anticoagulants.

09.06.04 Colecalciferol 

For use where proven symptomatic defciency (<30nmol/L) and rapid correction is justified

Patients post correction or with insufficiency should be encouraged to self manage through sunlight diet and OTC supplements

Where deemed clinically appropriate please ensure licensed products are prescribed.

09.06.04 Colecalciferol and Calcium Carbonate Calcichew-D3 Forte®

First choice in hospital

Patients to be reverted back to pre admission option on discharge, unless no longer clinically indicated.

09.06.04 Colecalciferol and Calcium Carbonate Theical ® Calci-D ® Accrete D3 One a Day®

Once daily dosing

TheiCal widely accepted and good compliance

Reduced pill burden

09.06.04 Colecalciferol and Calcium carbonate Adcal-D3®

Second line Ca/Vit D combination product after OD dosing options exhausted.

 

02.12 Colestyramine 

NICE states:

DO NOT OFFER a bile acid sequestrant for the prevention of cardiovascular disease to any of the following:

  • people who are being treated for primary prevention
  • people who are being treated for secondary prevention
  • people with chronic kidney disease
  • people with type 1 diabetes
  • people with type 2 diabetes.

DO NOT OFFER combination of a bile sequestrant with a statin for the primary or secondary prevention of cardiovascular disease 

01.09.02 Colestyramine powder 
05.01.07 Colistimethate 
01.01.01 Co-magaldrox Maalox®

Low sodium <1mmol/10ml

 

01.01.01 Co-magaldrox 195mg/220mg/5ml oral suspension Sugar free Mucogel®

 Low sodium <1mmol/10ml

 Cost effective option (500ml)

06.04.01.01 Combined continuous HRT patch Evorel® Conti, Femseven Conti
06.04.01.01 Combined continuous HRT tablet Kliofem, Kliovance, Femoston Conti, Premique Low Dose, Elleste Duet Conti
06.04.01.01 Combined cyclical HRT patch Evorel® Sequi, FemSeven Sequi
06.04.01.01 Combined cyclical HRT tablet Elleste-Duet®, Femoston,
09.02.02.01 Compound Sodium Lactate Intravenous Infusion 
02.04 Co-tenidone (atenolol and chlortalidone)  

Option if combination therapy required

05.01.08 Co-trimoxazole 

Use in accordance with local guidelines.

08.01.05 Crizotinib Xalkori®
13.03 Crotamiton Eurax®

Useful for scabies associated pruritis

09.01.02 Cyanocobalamin 

50mcg tablets are the only licensed oral preparation.

Please see IoW CCG vitamins guidance for more info.

GP- GREY LIST

04.06 Cyclizine 

First line for Opioid induce nausea and vomiting (excluding Palliative care) & Postoperative nausea and vomiting

Second line for motion sickness

Antihistamine antiemetic

Some potential for abuse

 

11.05 Cyclopentolate  

Available as minims single use

08.01.01 Cyclophosphamide 
08.03.04.02 Cyproterone 
06.04.02 Cyproterone Acetate 

ADVICE status for hypersexuality: Treatment should only be commenced with fully informed consent.

Is also licensed for patients with metastatic prostate cancer refractory to gonadorelin analogue therapy, or adjunct in prostate cancer (chapter 8).

And treatment of acne in combination with ethinylestradiol (chapter 13)

08.01.03 Cytarabine 
02.08.02 Dabigatran Pradaxa®

Second line option to warfarin

Ensure patient has been properly counselled and received alert card and advice leaflet

08.01.05 Dacarbazine 
06.07.02 Danazol 

Indications:

Endometriosis, Hereditary angioedema and severe pain and tenderness in benign breast disease.

06.01.02.03 Dapagliflozin Forxiga▼®
07.04.06 Dapoxetine Priligy®
05.01.07 Daptomycin Cubicin®

Only to be used on the advice of the microbiologist.

09.01.03 Darbepoetin Alfa Aranesp®
05.03.01 Darunavir Prezista®
05.03.01 Darunavir and Cobicistat Rezolsta®
08.03.04.02 Degarelix Firmagon®
06.06.02 Denosumab XGEVA®
06.06.02 Denosumab Prolia®
13.02.01 Dermol ® 

Antimicrobial Containing Emollient

Encourage use only when signs of infection or is a frequent complication.

Between infections use standard emollients to reduce potential for resistance

06.05.02 Desmopressin 

Yellow for diabetes insipidus

06.05.02 Desmopressin Noqdirna®

For symptomatic treatment of nocturia due to idiopathic nocturnal polyuria in adults over 65 years.

IMOC approved item November 18

To be used first line over unlicensed formulations.

Initiation and stabilisation in secondary care. Discharge to primary care after mnimum 1 month of treatment and review at 1 month.

07.03.02.01 Desogestrel 
06.03.02 Dexamethasone 

Injection red

11.04.01 Dexamethasone eye drops Maxidex®

Available as Minims single use drops

12.01.01 Dexamethasone with Antibacterial Otomize®
12.01.01 Dexamethasone with Antibacterials (ear) Sofradex®

Use clotrimazole if fungal infection suspected

11.04.01 Dexamethasone with Antibacterials (eye) Sofradex®

See Section 12 (ENT) for ear indications

11.04.01 Dexamethasone with Neomycin and Polymyxin B sulphate Maxitrol®
04.04 Dexamfetamine 

Specialist supervision

Shared care agreement: CNS Stimulants and other drugs for ADHD in children

 

Not licensed for use in adults with refractory ADHD

15.01.04.04 Dexmedetomidine  Dexdor®
04.07.02 Diamorphine Injection 

Used in the following areas

Palliative Care: Preferred option is morphine. Prescribing of this should be done on specialist advice only. If suggested GP may be expected to supply.

Hospital uses: CCU and spinal block

 

04.01.02 Diazepam 

Long acting benzodiazepine - Half life of 20-200 hours (2-5 days)

MHRA DSU - Blood concentration limits of certain drugs. See: Drugs and Driving 2015

Tablet - first line

Third line - if swallowing issues - oral liquid.

N.B.Lorazepam will dissolve or can be sucked and absorbed sublingually.

04.08.02 Diazepam epilepsy

Rectal, liquid, injection (diazemuls)

04.08.03 Diazepam 
10.02.02 Diazepam 
10.01.01 Diclofenac 

For patients under 65 years with no cardiovascular or gastrointestinal risk factors.

 

11.08.02 Diclofenac Voltarol® Ophtha
10.01.01 Diclofenac with Misoprostol Arthrotec 50 and 75®

For continued treatment only

01.02 Dicycloverine 

SECONDARY CARE ONLY

SAFETY CONCERNS ATTACHED

NICE said there is insufficient evidence to demonstrate a significant difference between antispasmodics/ antimuscarinics

However evidence indicates mebeverine may produce less adverse effects and dicycloverine has poor selectivity for intestinal smooth muscle increasing the occurrence of systemic antimuscarinic side effects.

Dicycloverine carries a score of 3 on the anticholinergic burden score

________________________________

HIGH COST ITEM: Other antispasmodics/ antimuscarinics are more cost effective.

Review current patients and assess need to continue.

08.03.01 Diethylstilbestrol 
02.01.01 Digoxin 

 

Hypokalaemia predisposes to digoxin toxicity

For chronic management check serum electrolytes at least every 12 months

 

02.01.01 Digoxin specific antibody fragments Digifab®

FOR LIFE THREATENING DIGOXIN OVERDOSE

Use with caution in the elderly

Hypokalaemia predisposes to digoxin toxicity

For chronic management check serum electrolytes at least every 12 months

Signs of toxicity:

Anorexia Nausea and vomiting Diarrhoea
Abdominal pain Headache Fatigue
Drowsiness Confusion Dizzeness
Delirium Hallucinations Depression
Arrhythmias Heart block  

 

04.07.02 Dihydrocodeine 

For moderate to severe pain.

Prescribe separately in addition to regular paracetamol.

No real benefit over codeine

Some evidence to support modified-release use in patients experiencing euphoria from immediate release, or those suspected of addiction.

Modified Release good for compliance purposes

30mg DHC = 3mg morphine equivalent

02.06.02 Diltiazem 

Prescribe by brand

13.10.04 Dimeticone Hedrin®

Indicated for head lice

Can be purchased over the counter

07.01.01 Dinoprostone Prostin E2®
13.02.01 Diprobase ® Cream 

See IOW Emollient formulary

Third Line option for Rich Cream leave on emollients

For moderately dry skin

Less greasy than ointments

Good for everyday use

13.02.01 Diprobase® LOTION 

See IOW Emollient formulary

First Line option for LOTIONS

For mild dry skin

Not routinely recommended as barrier emollient

 

02.09 Dipyridamole 

If other antiplatelets are not appropriate

02.09 Dipyridamole and Aspirin 

If compliance is a concern - NOTE only contains 25mg of aspirin

06.06.02 Disodium Pamidronate 
02.03.02 Disopyramide 

Antimuscarinic effects can limit use in patients diagnosed with angle-closure glaucoma or prostatic hyperplasia

Monitor for:

Hypotension, hypoglycaemia, ventricular tachycardia or fibrillation or torsades de pointes (discontinue if occurs) and serum potassium

04.10.01 Disulfiram Antabuse®

IRIS/ Detox services to supply/ prescribe in community

13.05.02 Dithranol Ointment BP 
13.05.02 Dithranol Paste BP 
02.07.01 Dobutamine 

HOSPITAL ONLY

08.01.05 Docetaxel Taxotere®
01.06.02 Docusate Norgalax® Micro-enema
01.06.02 Docusate Sodium 100mg capsules 

Stimulant AND softening agent

May have less side effects than other stimulants

 

05.03.01 Dolutegravir 
05.03.01 Dolutegravir, abacavir & lamivudine Triumeq®
04.06 Domperidone 

First line for gastric stasis

Second line for Migraine

MHRA: Risk of cardiac side effects. Lowest possible dose for shortest period.

Adults and adolescents over 12.

Does not cross the blood brain barrier therefore less likely to cause sedation and dystonic reactions

01.02 Domperidone 10mg tablets 

Can be used as gastric stimulant

Use at lowest dose for shortest period possible:

Maximum duration should not usually exceed 7 days

Caution in people with QTc prolongation or concomitant use of QT prolonging drugs

See Chapter 4 nausea and labyrinth disorders for more information

04.11 Donepezil Aricept®
02.07.01 Dopamine 

HOSPITAL ONLY

03.07 Dornase Alfa Pulmozyme®

Cystic Fibrosis patient require repatriation to NHSE

Meds for CF are funded through NHSE.

GP's are not expected to prescribe

11.06 Dorzolomide Trusopt®
11.06 Dorzolomide 2% with Timolol 0.5% Cosopt®
04.03.01 Dosulepin 

NHSE item which should NOT be routinely prescribed in primary care:

Safety concerns:

Tolerability relative to other antidepressants is outweighed by the increased cardiac risk and toxicity in overdose.

Primary care should not initiate any new patients on dosulepin

Primary care clinicians should be encouraged and supported to undertake deprescribing of dosulepin. Reason for continuation if deemed clinically appropriate should be well documented and reviewed regularly. Individuals continuing on dosulepin should receive regular physical health checks.

In exceptional circumstances if primary care is required to take over prescribing it should be done under cooperation agreement and within a multidisciplinary team

13.02.01 DoubleBase ® 

See IOW Emolllient formulary

Third line for Gel leave on emollients

Aproderm® and Zerodouble® as cost effective alternatives.

For moderately dry skin.

Less greasy than ointments. good for every day use

03.05.01 Doxapram Dopram®
02.05.04 Doxazosin 

Fourth choice for hypertension

Non-MR preparations are preferred option.

No clinical benefit to normal release tablets. Normal release tablets offer 24 hour effect

Doxazosin may be useful in patients with co-existing BPH

 

04.03.01 Doxepin 

HIGH COST DRUG LIST - Primary Care

Drug can be prescribed for refractory depression on advice of specialist and read coded:

XaM5Z (- high cost drugs)

See CCG High Cost Drug Policy for further information

08.01.02 Doxorubicin Caelyx®
08.01.02 Doxorubicin 
05.01.03 Doxycycline 

First choice tetracycline

05.04.01 Doxycycline 

For the treatment of malaria.

See trust guidelines for more information.

02.03.02 Dronedarone Multaq®

Licensed for:

Maintenance of sinus rhythm after cardioversion in clinically stable patients with paroxysmal or persistent atrial fibrillation, when alternative treatments are unsuitable

Should be initiated and monitored under specialist supervision.

04.06 Droperidol Xomolix®

For use by anaesthetists in theatre, recovery and ITU only

06.01.02.03 Dulaglutide Trulicity®

For patients that would benefit from a GLP1 agonist but are non-compliant with daily injections.

Not approved for initiation in hospital.

04.03.04 Duloxetine Cymbalta®

Third Line

Possible second line option in patients whith multiple co-morbidities such as anxiety, urinary or stress incontinence and diabetic neuropathy.

See section 04.07.03 for neuropathic pain indication

See chapter 7 for Urinary Incontinence

04.07.03 Duloxetine 

Second Line option

Licensed indication:

  • Diabetic neuropathy

Dose - 60mg daily. Discontinue if inadequate response after 2 months review every 3 months if effective. Max daily divided dose 120mg.

Option for indivudals with co-morbidities such as depressive illness and stress urinary incontinence.

07.04.02 Duloxetine Yentreve®

Indicated for women for the treatment of moderate to severe Stress Urinary Incontinence

06.04.02 Dutasteride Avodart®
07.04.01 Dutasteride and Tamsulosin Combodart®
13.10.02 Econazole Pevaryl®

Can be purchased over the counter

02.08.02 Edoxaban Lixiana®

Second Line DOAC - Second line to apixaban in poor renal function.

Ensure patient has been properly counselled and received alert card and advice leaflet

10.02.01 Edrophonium Chloride 

Unlicensed Special in Primary care

Injection

05.03.01 Efavirenz Sustiva®
13.09 Eflornithine Vaniqa®
06.01.02.03 Empagliflozin Jardiance▼®
05.03.01 Emtricitabine Emtriva®
05.03.01 Emtricitabine 200mg, Rilpivirine 25mg and Tenofovir 245mg Eviplera®
13.02.01 Emulsifying Ointment BP 

See IOW emollient guidelines

First line heavy leave on emollient.

For severe or very dry skin.

Low risk of sensitivites due to no sensitisers and low excipients.

Can be used as soap substitute

02.05.05.01 Enalapril  
02.08.01 Enoxaparin Inhixa® Clexane®

Enoxaparin is now available as Clexane and Inhixa. These are biosimilar medicines and should therefore be prescribed and maintained by brand. Where a switch is required (e.g. with supply problems) please counsel patients as there is a difference in syringe design.

Inhixa is now the brand of choice for new patients however; Clexane is still available for existing patients.

Inhixa administration guide

04.09.01 Entacapone Comtess®

Adjunct to co-beneldopa or co-careldopa in Parkinson's disease with ‘end-of-dose’ motor fluctuations (under expert supervision)

15.01.02 Entonox ® 
08.03.04.02 Enzalutamide Xtandi®
02.07.02 Ephedrine 

HOSPITAL ONLY

12.02.02 Ephedrine 

Avaialble OTC

0.5% and 1% nasal drops

0.1% Spray

13.02.01 Epimax ® Cream 

See IOW Emollient formulary

First Line option for Light and Creamy leave on emollients

For mild to moderately dry skin

Good for everyday use

Can be used as soap substitute

 

08.01.02 Epirubicin 
02.02.03 Eplerenone 

Licensed as:

An adjunct in stable patients with left ventricular ejection fraction<40% with evidence of heart failure, following a myocardial infarction (start treatment within 3-14 days)

An adjunct in chronic mild heart failure with left ventricular ejection fraction<30%

09.01.03 Epoetin alfa Eprex®
09.01.03 Epoetin beta NeoRecormon®
09.01.03 Epoetin Zeta Retacrit®
03.07 Erdosteine Erdotin®

Short course only

09.06.04 Ergocalciferol 
07.01.01 Ergometrine Maleate 
07.01.01 Ergometrine Maleate and Oxytocin Syntometrine®
08.01.05 Eribulin Halaven®
08.01.05 Erlotinib Tarceva®
08.01.05 Erlotinib Tarceva®
05.01.02.02 Ertapenem Invanz®

Only to be used on the advice of the microbiologist

06.01.02.03 Ertugliflozin Steglatro▼®
05.01.05 Erythromycin 

Use in accordance with local guidelines.

04.03.03 Escitalopram 

First line option - Tablets (available generically)

Second line - Drops - more expensive than citalopram drops but do not require dose adjustment

01.03.05 Esomeprazole 
02.11 Etamsylate Dicynene®

HOSPITAL ONLY

Licensed for short term blood loss in menorrhagia 

10.01.03 Etanercept Enbrel®
10.01.03 Etanercept Benepali®
05.01.09 Ethambutol  
07.03.01 Ethinylestradiol 20mcg / desogestrel 150mcg Gedarel®, Munalea®
07.03.01 Ethinylestradiol 30mcg / desogestrel 150mcg Gedarel®, Munalea®
07.03.01 Ethinylestradiol 30mcg / levonorgestrel 150mcg Rigevidon®, Microgynon 30®, Levest®Microgynon 30 ED®
15.02 Ethyl Chloride Cryogesic® Spray
07.03.02.02 Etonorgestrel 
08.01.04 Etoposide 
10.01.01 Etoricoxib 

 

08.01.05 Everolimus Afinitor®
02.12 Evolocumab Repatha®

HOSPITAL ONLY

Use in line with NICE guidance

GP need to be informed of use and record as 'Drugs from elsewhere'

08.03.04.01 Exemestane 
02.12 Ezetimibe Ezetrol®
05.03.02.01 Famciclovir Famvir®
10.01.04 Febuxostat Adenuric®

For patients intolerant to allopurinol

02.12 Fenofibrate 
04.07.02 Fentanyl 

Option for use in:

Palliative care

Post-Operative anaesthesia epidurals

Maternity

Not routinely used.

15.01.04.03 Fentanyl 
04.07.02 Fentanyl Transdermal 

Can be considered in specifc patient groups (E.g. Renal Failure) where morphine is not tolerated.

See Palliative Care IOW Symptom Guidelines

Equivalence is brand dependent and opioid tolerance dependent

25mcg/ hr fentanyl patch = ~60mg morphine daily

 

09.01.01.02 Ferric Carboxymaltose Ferinject®
09.01.01.01 Ferrous Fumarate 
Strength (Brand) Dose Elemental iron content
210mg

1 BD-TDS (Treatment)

1 OD-BD (maintenance)

68mg/ tablet
305mg (Galfer)

1 BD (Treatment)

1 OD (maintenance)

100mg/ capsule
322mg (Fersaday)

1 BD (Treatment)

1 OD (maintenance)

100mg / tablet
140mg/5ml solution

10ml BD (Treatment)

5ml OD (Maintenance)

45mg / 5ml

Combination products with ascorbic acid and modified release products are not recommended for prescribing on NHS

09.01.01.01 Ferrous Gluconate 
09.01.01.01 Ferrous Sulphate 
07.04.02 Fesoterodine Toviaz®
03.04.01 Fexofenadine 
05.01.07 Fidaxomicin Dificlir®

Only to be used on the advice of the microbiologist

09.01.06 Filgrastim 
06.04.02 Finasteride 
02.03.02 Flecainide 

Use with caution as may precipitate serious arrhythmias in a small number of patients.

 

01.06.05 Fleet Phospho-soda ® 

Secondary care supplied

13.02.01 Flexitol ® 10% Cream 

See IOW Emollient formulary

Second Line option for UREA containing emollients

10% urea options should be tried after 5% urea not offered complete relief

Keratin softner for dry scaling conditions

Can cause stinging and irritation. Trial with smallest appropriate packsize first to mimise waste

Cost effective alternative to Calmurid

13.04 Flucinolone Acetonide 0.00625% Synalar 1 in 4 Dilution®

Moderately potent

05.01.01.02 Flucloxacillin 
05.02 Fluconazole 
07.02.02 Fluconazole 
08.01.03 Fludarabine Phosphate Fludara®
06.03.01 Fludrocortisone 

Amber for endocrine patients

13.04 Fludroxycortide  Haelan®

Moderate potency

Useful for hands and cracked skin on fingers

12.01.01 Flumetasone 0.02% with Clioquinol 1% 
11.08.02 Fluorescein Sodium 
11.04.01 Fluorometholone FML®
08.01.03 Fluorouracil 
13.08.01 Fluorouracil Efudix®

Indicated for superficial malignant and pre-malignant skin lesions

5% cream (use for 2 weeks, 2 week break, then for a further 2 weeks) 

13.08.01 Fluorouracil Actikerall®

Indicated for low or moderately thick hyperkeratotic actinic keratosis

0.5% solution, with salicylic acid

04.03.03 Fluoxetine 

First line choice capsules (10mg capsule not cost effective)

Second line for liquid - Only for use if compliance or administration issues.

Good in depression and anxiety. Well tolerated, simple dosing. Favourable balance of risks and benefits in depressive illness in under 18's.

Long half life - Consider this when adjusting dose and if patient is an overdose risk

 

04.02.01 Flupentixol 

Most commonly used as depot - see section 04.02.02

Lower incidence of sedation and hypotension than chlorpromazine.

Moderate incidence weight gain, EPSE and prolactin elevation.

04.02.02 Flupentixol Decanoate Depixol®

Test dose: 20mg

Dose range (mg/week) = 12.5-400

Dosing interval: 2-4 weeks

Licensed maximum dose is higher than other depots.

04.02.02 Fluphenazine Decanoate 

Test dose: 12.5mg

Dose range (mg/week) = 6.25-50

Dosing interval: 2-5 weeks

High EPSE incidence

08.03.04.02 Flutamide Drogenil®
12.02.01 Fluticasone furoate Avamys®
03.02 Fluticasone furoate & vilanterol Relvar Ellipta®

DPI

Asthma - 92/22 or 184/22 once daily.

COPD - 92/22 once daily.

12.02.01 Fluticasone Propionate 
12.02.01 Fluticasone Propionate Flixonase Nasule®

Licensed for use with Nasal Polyps

Review if no improvement after 4-6 weeks

03.02 Fluticasone propionate and formoterol Flutiform®

MDI

Asthma- Start at 50/5 two puffs twice a day and step up.

COPD - Not licensed.

03.02 Fluticasone/ Umeclidinium/ vilanterol Trelegy Ellipta®

TRIPLE THERAPY

Consider for compliance and reduce burden of multiple inhalers if established and stable on all three elements.

Not licensed for asthma

Licensed for COPD

Not approved for initiation in hospital.

02.12 Fluvastatin 

Medium intensity statin at 80mg dose

Low intensity statin at dose of 20mg and 40mg.

Lower intensity statins may be preferred in patients with intolerance or side effects

Individuals should be encouraged to try a higher intensity statin after discussion of risk and benefits.

 

 

09.01.02 Folic Acid 
02.08.01 Fondaparinux Arixtra®

HOSPITAL ONLY

ACS only

Fondaparinux treatment should start as soon as possible after diagnosis of an ACS, and continue for 8 days or until discharge. In general, fondaparinux offers similar clinical benefit to enoxaparin, with less bleeding risk (see NICE CG94 for full list of references).

03.01.01.01 Formoterol  

Easyhaler

Fast acting (3 mins) - First choice LABA

COPD - Adults only

03.02 Formoterol fumarate, beclometasone dipropionate and glycopyrronium bromide  

TRIPLE THERAPY

Consider for compliance and reduce burden of multiple inhalers if established and stable on all three elements.

Not licensed for asthma

Licensed for COPD

Not approved for initiation in hospital.

05.01.07 Fosfomycin 

Use in accordance with local guidelines

06.01.06 FreeStyle Libre® 

For Type 1 Diabetes patients who meet the SHIP criteria. To be prescribed on the advice of secondary care following regular reviews to ensure ongoing benefit.

04.07.04.01 Frovatriptan 

Only available as tablets

02.02.02 Furosemide 
11.03.01 Fusidic Acid 

Second line for infective conjunctivitis

13.10.01.02 Fusidic Acid 2% Fucidin®

For Gram positive organisms

04.07.03 Gabapentin 

Third line option

Licensed indication:

  • Peripheral neuropathic pain

Consider trial withdrawal after 6 months to see if can be withdraw, have a reduced dose or is still required

Withdrawal must be tapered

______________________________________________

Potential for dependence, abuse and diversion (MHRA 2014)

MHRA 2017 - Deaths associated with gabapentioids - Gabapentin associated with risk of severe respiratory depression (without concomitant medicines)

04.08.01 Gabapentin 
04.11 Galantamine Gatalin XL ®
05.03.02.02 Ganciclovir Cymevene®

Only to be used on the advice of the microbiologist

08.01.05 Gefitinib Iressa®
09.02.02.02 Gelatin Gelofusine®
12.03.01 Gelclair ® 

Chemotherapy mouthcare

Usually issued via hospital but supplies may be requested in primary care for certain circumstances.

08.01.03 Gemcitabine Gemzar®
05.01.04 Gentamicin 

Generally hospital only but can be used in the community for catheter change prophylaxis in patients who have a history of symptomatic urinary tract infection after catheter change or experience trauma during catheterization.

11.03.01 Gentamicin ophthalmic
06.01.02.01 Gliclazide 

First line sulphonylurea

06.01.02.01 Glimepiride 

Third line sulphonylurea

06.01.02.01 Glipizide 

Second line sulphonylurea

06.01.04 Glucagon GlucaGen® HypoKit

First choice for patients who are at risk of severe hypoglycaemia, pregnant or going on holiday.

06.01.04 GlucoGel ® 
06.01.04 Glucose 20% injection 
09.02.02.01 Glucose Intravenous 
06.01.04 Glucose tablets 
12.03.01 Glycerol dioleate  Episil®

Chemotherapy mouthcare

Usually issued via hospital but supplies may be requested in primary care for certain circumstances.

01.06.02 Glycerol suppositories 

Stimulant local effect - rectal

Consider longer term option for relief once suppository has taken effect

02.06.01 Glyceryl Trinitrate 
01.07.04 Glyceryl Trinitrate 0.4% Rectogesic®

Anal Fissures

03.01.02 Glycopyrronium Seebri breezhaler®

DPI LAMA

Fast onset of action (5mins)

Asthma - Not licensed

COPD - Maintenance not bronchospasm.

03.01.04 Glycopyrronium/ indacaterol inhaler Ultibro Breezhaler®

DPI

Asthma - not licensed

COPD - Adults only

01.05.03 Golimumab 
10.01.03 Golimumab Simponi®
06.05.01 Gonadorelin HRF®
08.03.04.02 Goserelin Zoladex®
04.06 Granisetron 

Short term use

To be supplied by CHemotherapy service at specialist request

03.04.02 Grass and Tree Pollen Extract Pollinex®

HOSPITAL ONLY

03.04.02 Grass pollen extract Grazax®
01.07.01 Haemorrhoid relief ointment 

Available OTC and general sales.

 

 

01.07.01 Haemorrhoid relief suppositories 

Available OTC and general sales

04.02.01 Haloperidol 

First line choice first generation antipsychotic (FGA).

Advantages: Many years experience, lower incidence of sedation, hypotension and anticholinergic activity than other FGA

Disadvantages: Dystonia, sedation, hypotension, prolactin elevation, cardiac side effects, higher risk of EPSE than SGA.

SECONDARY CARE ONLY: Used in conjunction with other medicines for the management of violence and aggression in psychiatric settings (Rapid Tranquilisation)

Used in Palliative care for problems such as nausea and vomiting, agitation & hiccups

See Isle of Wight Palliative Care Symptom Control Guidelines 2018

04.02.02 Haloperidol Haldol Decanoate®

50mg/ml & 100mg/ml injection

Test dose: 25mg

Dose range (mg/week) = 12.5-75

Dosing interval: 4 weekly

If 2 weekly administration preferred - doses should be halved

High incidence of EPSE

[Not to be confused with 5mg/ml used in acute episodes or palliative care]
02.08.01 Heparin 

HOSPITAL ONLY

Any hospital doctor may prescribe.

Primary care prescribing unlikely and would need appropriate support and services established prior to discharge 

11.05 Homatropine 
09.02.02.02 Human Albumin Solution 
10.03.01 Hyaluronidase Hyalase®
02.05.01 Hydralazine 
06.03.02 Hydrocortisone 
12.03.01 Hydrocortisone 

For mouth ulcers

10.01.02.02 Hydrocortisone acetate Hydrocortistab®
06.03.02 Hydrocortisone sodium succinate Solu-Cortef®

Vials require reconstituting with water for injection, patient will need to be appropriately counselled and supplied with needles and syringe.

13.04 Hydrocortisone 1% 

Mild Potency

12.01.01 Hydrocortisone Acetate 1% with Gentamicin 0.3% 
13.04 Hydrocortisone Butyrate Locoid®

Potent

11.04.01 Hydrocortisone eye ointment 
11.04.01 Hydrocortisone Sodium Phosphate 3.35mg/ml Softacort®

Alternative to dexamethasone minims

12.01.01 Hydrocortisone with Antibactrial Otosporin®
13.02.01 Hydromol ® Intensive 

See IOW Emollient formulary

Third Line option for UREA containing emollients

10% urea options should be tried after 5% urea not offered complete relief

Keratin softner for dry scaling conditions

Can cause stinging and irritation. Trial with smallest appropriate packsize first to mimise waste

Cost effective alternative to Calmurid

13.02.01 Hydromol ® Ointment 

See IOW Emollient formulary

Third line for Heavy leave on emollients

For severe and very dry skin.

Low risk of sensitivities. Low excipients

Can be used as soap substitute

09.01.02 Hydroxocobalamin 
08.01.05 Hydroxycarbamide 

Funding positions

NHSE Commissioned:

Essential thrombocythaemia, myelofibrosis or polycythaemia with high risk of complications. 

CCG commissioned:

Sickle Cell Anaemia - Siklos

 

10.01.03 Hydroxychloroquine 
11.08.01 Hydroxypropyl Guar Systane®

Second choice for patients on preservative containing eye drops/ dry eye causing medications on daily basis and using < 6 drops / day

Third line for patients presenting with dry eye symptoms who do not use other drops on regular basis and first and second line options have proved ineffective despite using > 6 times a day

Available as unit dose vials.

Available OTC

03.04.01 Hydroxyzine 

Option for Pruritus

 

10.01 Hylan G-F 20 Synvisc®

(restricted indications - osteoarthritis of the knee)

01.02 Hyoscine Butylbromide 10mg Tablets Buscopan®

Second line after mebeverine

Available OTC - Buscopan Cramps® or Buscopan IBS relief®

04.06 Hyoscine Hydrobromide 

First line - Tablets OTC option for motion sickness

Other indications include:

Patches are option when oral route not available - 1 patch every 72 hours

11.08.01 Hypromellose 

0.5% cost effective option in the community

First line for patients newly presenting with dry eye symptoms who do not use other drops on regular basis.

Available OTC

06.06.02 Ibandronic Acid 
08.01.05 Ibrutinib 
10.01.01 Ibuprofen 

For Patients <65 years with no CV or GI risk factors up to 2400mg daily

For patients with CV risk factors up to 1200mg daily

10.03.02 Ibuprofen gel 

5% and 10% gel

Fenbid preferred brand in primary care.

OTC self care option.

02.08.02 Idarucizumab Praxbind®

Hospital Only

For emergency reversal of dabigatran

08.01.05 Imatinib 

Only Glivec brand is part of the black triangle scheme

13.07 Imiquimod Aldara®
03.01.01.01 Indacaterol Onbrez Breezhaler ®

Asthma - Not licensed

COPD - Adults only

02.02.01 Indapamide 

 

Indapamide is claimed to lower blood pressure with less metabolic disturbance, particularly less aggrevation of diabetes. Can be used in stroke patients with perindopril.

10.01.01 Indometacin 

For patients under 65 years with no cardiovascular or gastrointestinal risk factors.

For moderate to severe inflammation

01.05.03 Infliximab 

BIOSIMILARS available

10.01.03 Infliximab Remicade®
13.08.01 Ingenol mebutate Picato®

For isolated keratosis only

06.01.01.01 Insulin Humulin® S
06.01.01.01 Insulin Actrapid®
06.01.01.01 Insulin Aspart  NovoRapid®
06.01.01.01 Insulin aspart Fiasp®

To be initiated by secondary care, often used for patients using an insulin pump or during pregnancy.

06.01.01.02 Insulin degludec Tresiba®
06.01.01.02 Insulin degludec Tresiba®

High strength insulin, use with caution on specialist advice only.

Not to be started during an inpatient episode

06.01.01.02 Insulin Detemir Levemir®
06.01.01.02 Insulin Glargine Lantus®
06.01.01.02 Insulin Glargine Toujeo®

High strength insulin, use with caution on specialist advice only.

Not to be started during an inpatient episode

06.01.01.02 Insulin Glargine biosimilar 

First choice basal glargine.

06.01.01.01 Insulin Glulisine Apidra®
06.01.01.01 Insulin Lispro 100 units/ml Humalog®
06.01.01.01 Insulin Lispro 200 units/ml Humalog®

High strength insulin, use with caution on specialist advice only.

Not to be started during an inpatient episode

06.01.01.01 Insulin porcine  Hypurin® Porcine Neutral
06.01.01.03 Insupen 4mm/33g pen needle 

Third line pen needle for adult diabetes patients who have tried BD Viva but would benefit from a needle with a finer gauge.

08.02.04 Interferon Alfa 
08.02.04 Interferon Beta Rebif®
06.02.02 Iodine and Iodide 
03.01.02 Ipratropium 

SHORT ACTING antimuscarinic bronchodilator

First line as MDI

Slow onset of action (20mins).

Requires TDS dosing

02.05.05.02 Irbesartan 
08.01.05 Irinotecan Hydrochloride 
09.01.01.02 Iron Dextran CosmoFer®
09.01.01.02 Iron Isomaltoside Monofer®
09.01.01.02 Iron Sucrose Venofer®
05.01.09 Isoniazid 
06.01.01.02 Isophane Insulin Insulatard®
06.01.01.02 Isophane Insulin Humulin® I
06.01.01.02 Isophane Insulin Insuman® Basal
02.07.01 Isoprenaline 

HOSPITAL ONLY

02.06.01 Isosorbide Mononitrate 

Monitor GTN spray use

Modified release preparations are good for maintenence

13.06.01 Isotretinoin Isotrex® gel
13.06.02 Isotretinoin 

Under specialist supervision only.

01.06.01 Ispaghula Husk 3.5g effervescent granules sachets  

 Increase faecal mass to stimulate peristalsis

 Gluten and sugar free

05.02 Itraconazole 
02.06.03 Ivabradine 

Approved for use in combination with standard therapy of beta blocker (unless contraindicated) ACE inhibitor or aldosterone antagonist as a treament option for mild to severe stablechronic heart failure in patients who:

have left ventricular ejection fraction <35%

AND

are in sinus rhythm with heart rate of >75bpm

 

13.06 Ivermectin cream Soolantra®

First line for papulopustular rosacea

08.01.05 Ixazomib Ninlaro®
15.01.01 Ketamine injection 
04.07.03 Ketamine oral solution 

Only when advised by pain clinic

06.07 Ketoconazole Ketoconazole HRA

Treatment of Cushing's syndrome

10.03.02 Ketoprofen 2.5% Oruvail ®, Powergel®
11.08.02 Ketorolac Acular®
02.04 Labetalol 

First line for hypertension in pregnancy

Click on below link for NICE gudiance

NICE CG107 Hypertension in pregnancy: diagnosis and management

02.04 Labetalol Injection 

HOSPITAL ONLY

02.06.02 Lacidipine 
04.08.01 Lacosamide  Vimpat ®
01.06.04 Lactulose 3.1-3.7g/5ml oral solution 

Second choice osmotic laxative

Increases amount of water in large bowel by pulling water in from body

To be taken with plenty of water

Ensure adequate fluid intake especially in the elderly

05.03.01 Lamivudine Epivir®
04.08.01 Lamotrigine 
08.03.04.03 Lanreotide Somatuline Autogel®

NHSE funded

08.03.04.03 Lanreotide Somatuline® LA

NHSE funded

01.03.05 Lansoprazole 

  Orodispersible suitable for Enteral tube dosing and swallowing difficulties

11.06 Latanoprost 

Prescribe generically

Available as UDV's preservative free if on multiple preservative containing drops causing preservative toxicity

11.06 Latanoprost 0.005% with Timolol 0.5% 

Prescribe generically

11.06 Latanoprost 0.005% with Timolol 0.5% 0.2ml unit dose  Fixapost®

Second choice latanoprost/ timolol

10.01.03 Leflunomide 
08.02.04 Lenalidomide 

Subject to individual patient enrolment in REVLIMID Risk Evaluation and Mitigation Strategy (REMS)  

02.06.02 Lercanidipine 

Less ankle oedema experienced

08.03.04.01 Letrozole 
08.03.04.02 Leuprorelin Acetate Prostap® SR
04.08.01 Levetiracetam 
05.01.12 Levofloxacin 

Use in accordance with local guidelines.

04.06 Levomepromazine Nozinan®

Green plus for palliative care

Most commonly used in palliative care for terminal agitation and nausea and vomiting.

See Isle of Wight Palliative Care Symptom Control Guidelines 2018

[Oral dose of 6.25mg should be administered by quartering a 25mg tablet (scored)]

04.06 Levomepromazine 

See palliative care guidelines for dosing and indications

07.03.05 Levonogrestrel 

This can be taken as a single dose. Levonorgestrel is licensed for use within 72 hours of intercourse

07.03.02.01 Levonorgestrel Norgeston®
07.03.02.03 Levonorgestrel  Mirena®

Mirena should be used in preference to an IUD only if heavy periods are a problem

20micrograms/24hrs

07.03.02.03 Levonorgestrel  Jaydess®

13.5mg IUD

06.02.01 Levothyroxine 
02.03.02 Lidocaine 
15.02 Lidocaine  

For neuropathy (limited use)

15.02 Lidocaine 
11.07 Lidocaine 4% with Fluorescein 0.25% Minims®
13.03 Lidocaine/ Prilocaine cream Emla®
01.06.07 Linaclotide Constella®

Consider linaclotide for people with IBS only if:

  • optimal or maximum tolerated doses of previous laxatives from different classes have not helped and

  • they have had constipation for at least 12 months.

    Follow up people taking linaclotide after 3 months.

SMC Advice

06.01.02.03 Linagliptin Trajenta▼®

Useful for renal patients

05.01.07 Linezolid 

Only to be used on the advice of the microbiologist.

06.02.01 Liothyronine 
13.02.01 Liquid and White Soft Paraffin Ointment (50:50) 

See IOW emollient guidelines

First line heavy leave on emollient.

For severe or very dry skin.

Low risk of sensitivites due to no sensitisers and low excipients.

Can be used as soap substitute

06.01.02.03 Liraglutide Victoza®

First choice for patients with established cardiovascular disease as currently the only GLP1 agonist with proven cardiovascular benefits.

04.04 Lisdexamfetamine Elvanse®

Specialist supervision

 

Not licensed for use in adults with ADHD

02.05.05.01 Lisinopril 
04.02.03 Lithium Carbonate 

Brands:

Camcolit - 400mg MR tablets

Liskonium - 450mg MR tablets

Priadel - 200mg MR tablet & 400mg Tablets

04.02.03 Lithium Citrate 

Brands:

Li-Liquid - 509mg/5ml oral solution

Priadel - 520mg/5ml sugar free liquid

06.01.02.03 Lixisenatide Lyxumia▼®
11.04.02 Lodoxamide Alomide®

Alternative to cromoglicate

04.03.01 Lofepramine 

Third line for antidepressant use older people.

Good option for patients with hyponatraemia

Option in treatment resistant depression - Should be initiated by specialist

 

08.01.01 Lomustine 
01.04.02 Loperamide 

  Uncomplicated ACUTE diarrhoea in adults

Ensure proper assesment to rule out faecal impaction or overflow

 

05.03.01 Lopinavir and Ritonavir Kaletra®
03.04.01 Loratadine 
04.01.02 Lorazepam 

Short acting Benzodiazepine - Half life (12-18 hours)

Short term symptomatic treatment of severe disabling anxiety - max 4mg daily in divided doses.

MHRA DSU: Blood concentration limits set for some drugs see: Drugs and Driving

Short term use in insomnia associated with anxiety - max 2mg daily at night

 

 

04.08.02 Lorazepam 

Injection

02.05.05.02 Losartan 

First choice for hypertension.

11.04.01 Loteprednol Lotemax®
04.02.01 Lurasidone Latuda®

Black triangle drug - All adverse events must be reported via yellow card scheme.

Specialist intitation and stabilisation if patient has failed on 2 alternatives and has unacceptable weight gain.

Licensed for Schizophrenia only

 

13.06.02 Lymecycline Tetralysal®300

First step of systemic treatment

 

For 6 months. If treatment fails seek specialist supervision for isotretinoin. 

01.06.04 Macrogol compound oral powder Cosmocol®

 Osmotic Laxative

 Increases amount of water in large bowel by either pulling water in from body or retaining water at point of administration.

 Cosmocol most cost effective brand

 Full range of options

 Three flavour options

________________

 Laxido alternative - but limited range and flavours

01.06.05 Macrogols Moviprep®

Secondary care supplied

01.06.05 Macrogols (polyethylene glycols) Klean-Prep®

Secondary care supplied

09.05.01.03 Magnesium Aspartate Magnaspartate®
01.06.04 Magnesium Hydroxide Mixture BP 

Secondary care use

 

09.05.01.03 Magnesium Sulphate 
02.03 Magnesium Sulphate 50% soultion for Injection 

HOSPITAL ONLY

01.01.01 Magnesium Trisilicate 

Secondary care choice

HIGH SODIM CONTENT: Liquid contains 6mmol sodium/ 10ml

 

 

13.10.04 Malathion 0.5% Derbac-M®

First line for crab lice.

Also indicated for head lice

Can be purchased over the counter

02.02.05 Mannitol 

Hospital ONLY

01.02 Mebeverine 135mg tablets 

 Take 20 minutes before meals

 (Colofac IBS® available OTC)

01.02 Mebeverine 200mg MR Capsules Colofac® MR

If compliance/ timing is an issue

 

06.04.01.02 Medroxyprogesterone Acetate Provera®
07.03.02.02 Medroxyprogesterone Acetate Depo-Provera®
07.03.02.02 Medroxyprogesterone acetate Sayana Press®
10.01.01 Mefenamic Acid 

Dysmenorrhoea and menorrhagia

08.03.02 Megestrol Acetate Megace®
04.01.01 Melatonin  

Secondary care only

Unlicensed use

Circadin (GREEN+) if used in line with license - adult aged 55 years and over for upto 13 weeks.

10.01.01 Meloxicam 
08.01.01 Melphalan 
04.11 Memantine Ebixa®
09.06.06 Menadiol Sodium Phosphate 
01.05.03 Mercaptopurine 

DMARDs shared care agreement

08.01.03 Mercaptopurine 
05.01.02.02 Meropenem Meronem®

Only to be used on the advice of the microbiologist

01.05.01 Mesalazine Preparations 

 

Octasa MR

First line for new patients

Existing patients may be switched if happy to do so or whilst undergoing a dose adjustment due to relapse

First Choice

Asacol May be continued in patients who are stable Second Choice Option
Mezavant XL Once daily dosing for compliance issues Second Choice Option
Pentasa Granules Swallowing problems Third Choice Option
Enemas/ suppostiories Specialist advice Third Line Option

 NB other brands may be requested if patient stable on this treatment

 

08.01 Mesna 
06.01.02.02 Metformin 

Metformin is first choice in most patients.

M/R formulation is reserved for patients intolerant of standard release formulations

04.07.02 Methadone 

FOR Palliative Care Use

See SCA

04.10.03 Methadone 

 

DETOX services to supply/ prescribe and monitor in the community

03.09.01 Methadone Hydrochloride Methadone® Linctus

Palliative care only

15.01.01 Methohexitone 

Second line anaesthetic for ECT after propofol.

 

Unlicensed

01.05.03 Methotrexate 

DMARDs shared care agreement

08.01.03 Methotrexate 
10.01.03 Methotrexate 

Once weekly

02.05.02 Methyldopa 
01.06.06 Methylnaltrexone 12mg/0.6ml injection Relistor®

Sub-cut injection

Palliative Care

Symptom Control Gudelines

 

04.04 Methylphenidate 

Specialist supervision

Shared care agreement: CNS Stimulants and other drugs for ADHD in children

Unlicensed use:

Doses over 60mg not licensed; Doses of concerta XL 54mg not licensed

Children: not licensed in children under 6 years

Adults: Not licensed for use in narcolepsy. Not licensed in adults for ADHD

06.03.02 Methylprednisolone 
10.01.02.02 Methylprednisolone Acetate Depo-Medrone®
10.01.02.02 Methylprednisolone Acetate Depo-Medrone® with Lidocaine
04.06 Metoclopramide 
04.06 Metoclopramide 

First line - migraine

Second line - postoperative nausea and vomiting

MHRA - Risk of neurological adverse effects.

Over 18's only for max 5 days.

Can induce acute dystonic reactions

 

01.02 Metoclopramide 10mg tablets 

Can be used as gastric stimulant [UNLICENSED]

May cause acute dystonic reactions - do not use in people under 20 years

Maximum recommended duration of treatment is 5 days

See Chapter 4 Nausea and labyrinth disorders for further information

02.02.01 Metolazone 

 

Only in patients who are symptomatic despite being prescribed the maximum tolerated dose of bendroflumethiazide.

02.04 Metoprolol 
05.01.11 Metronidazole 

Use in accordance with local guidelines.

13.10.01.02 Metronidazole topical 0.75% 

For anaerobes

06.07.03 Metyrapone Metopirone®

Under specialist supervision

05.02.04 Micafungin Mycamine®

Only to be used on the advice of the microbiologist

12.03.02 Miconazole Daktarin®
04.08.02 Midazolam Buccolam®

Buccal liq - Unlicensed, Child Health only. See local guidelines

15.01.04.01 Midazolam pre-med
01.10 Midodrine 

Management of acites +/- hepatorenal syndrome

 

07.01.02 Mifepristone Mifegyne®
07.04.02 Mirabegron Betmiga®

Only when antimuscarinics are contraindicated, clinically ineffective despite optimal treatment and/or have unacceptable side effects.

Clinical effectiveness is similar to antimuscarinics but has a different side effect profile.

 

04.03.04 Mirtazapine 

Second line

Weight changes and appetite changes are common side effects

Available as tablets and orodipsersible tablets

Known to cause blood dyscrasias related to bone marrow depression. Patients should be encouraged to report any signs of infection including sore throat and fever whilst on mirtazapine.

01.03.04 Misoprostol 

Not frequently used

SHOULD NOT BE USED in women of child bearing age unless pregnancy has been ruled out. If deemed necessary use should only be offered on the understanding the patient is on effective contraception methods and after risk counselling.

08.01.02 Mitomycin 
08.01.02 Mitoxantrone (Mitozantrone) 
04.04 Modafinil Provigil®

SPECIALIST ONLY

Excessive sleepiness associated with narcolepsy with or without cataplexy

12.02.01 Mometasone Furoate 
13.04 Mometasone Furoate 0.1% Elocon®

Potent

03.03.02 Montelukast 

Prescribe Generically

04.07.02 Morphine Salts 
04.07.02 Morphine Sulfate Modified Release Zomorph®<

Modifed release for chronic pain

Very few patients are unable to tolerate oral morphine

If Zomorph is not tolerated - refer to pain clinic for other options to be considered.

04.07.02 Morphine Sulphate Liquid Oramorph®

For use in acute pain for upto ONE week due to risk of addiction

Can be used short term OR for chronic breakthrough pain to accurately calculate dose of longer acting opiate. This should be stopped once longer acting opiate satbilised. Not to be used routinely.

 

[Legal category: POM for 10mg/5ml; CD2 POM for concentrate 100mg/5ml]

05.01.12 Moxifloxacin 

Use in accordance with community guidelines.

Not routinely used in hospital.

 

02.05.02 Moxonidine 
12.02.03 Mupirocin 2% Bactroban Nasal®

For MRSA only

13.10.01.01 Mupirocin 2% Bactroban®

For MRSA decolonisation

09.06.07 Mutivitamins 

Not routinely used

Exceptions include Individuals with severe malabsorption conditions and on advice of dietician.

Renavit suitable for patients on dialysis to replace water soluble vitamin loss

(Healthy Start Vitamins are not to be prescribed by GP's)

06.07.02 Nafarelin Synarel®

Endometriosis = Intranasal for 6 months

Use in IVF requires funding and apporoval for treatment on NHS via PA/IFR. Prescribing to be fulfilled by specialist.

02.06.04 Naftidrofuryl 

Option for treatment of intermittent claudication in patients with peripheral vascular disease when exercise has not led to satisfactory improvement.

Supervised exercise programme should be offered to all patients with intermittent claudication (NICE) - [2hrs/week for 3 months]

Patients should be assessed after 3-6 months to evaluate any improvement. Treatment should be stopped if no benefit.   

04.10.01 Nalmefene 

IRIS only

04.10.03 Naltrexone Nalorex®

Prescribed and supplied by DETOX services in the community

06.04.03 Nandrolone Deca-Durabolin®

Not routinely used in primary care.

Considered less suitable for prescribing by BNF

10.01.01 Naproxen 

For patients with CV risk factors up to 1000mg daily

04.07.04.01 Naratriptan Naramig®

Only available as tablets

02.04 Nebivolol 
03.03.01 Nedocromil Tilade® CFC-free inhaler
10.02.01 Neostigmine 

Oral (tablets) = High cost item in primary care

05.03.01 Nevirapine Viramune®
02.06.03 Nicorandil 

Third line after failure to stabilise angina with beta-blocker or calcium channel blocker

Monitor for Nicorandil induced ulceration

Nicorandil can cause serious skin, mucosal and eye ulceration including gastrointestinal ulcers which may progress to perforation, haemorrhage, fistula or abscess. STOP treatment if ulceration occurs and consider alternative treatment.

04.10 Nicotine Nicorette® Invisi patches

Supplied via Public Health services in Community

04.10 Nicotine Nicotinell®

Supplied via Publice Health services in the community

02.06.02 Nifedipine 

Prescribe by brand name

Modified release preparations

08.01.05 Nilotinib Tasigna®
02.06.02 Nimodipine Nimotop®

HOSPITAL ONLY

Subarachnoid Bleed

04.01.01 Nitrazepam 

Individuals currently receiving nitrazepam may be continued due to prolonged use.

Reduction with the aim to withdraw should be discussed where possible. If withdrawal is not possible due to dependence, reduction to minimal dose is advised.

New patients should not be initiated unless under psychiatry.

05.01.13 Nitrofurantoin 

Use in accordance with local guidelines.

15.01.02 Nitrous oxide 
08.02.04 Nivolumab Opdivo®
07.03.03 Nonoxinol-9 Gygel 2%®

Spermicidal contraceptives are useful additional safeguards but do not give adequate protection if used alone unless fertility is already significantly diminished. 

They are suitable for use with barrier methods, such as diaphragms or caps; however, spermicidal contraceptives are not generally recommended for use with condoms, as there is no evidence of any additional protection compared with non-spermicidal lubricants.

Spermicidal contraceptives are not suitable for use in those with or at high risk of sexually transmitted infections (including HIV); high frequency use of nonoxinol 9 has been associated with genital lesions, which may increase the risk of acquiring these infections.

02.07.02 Noradrenaline / Norepinephrine 

HOSPITAL ONLY

06.04.01.02 Norethisterone 

Dosing:

Indication Dose and frequency Timing Duration
Endometriosis 10-15mg OD   4-6 months

To ARREST bleeding in:

Dysfunctional uterine bleeding

Menorrhagia

5mg TDS   10 days

To PREVENT bleeding in:

Dysfunctional uterine bleeding

Menorrhagia

5mg BD days 19-26 of cycle 5 days

Dysmenorrhoea

5mg TDS days 5-24 of cycle 3-4 cycles

Contraception

350mcg OD continuously form day 1 of cycle  

 

07.03.02.01 Norethisterone Noriday®
05.02 Nystatin Nystan®
12.03.02 Nystatin Nystan®
11.08.02 Ocriplasmin Jetrea®
08.03.04.03 Octreotide Sandostatin®

NHSE funded

08.03.04.03 Octreotide Sandostatin Lar®

NHSE funded

06.04.01.01 Oestrogen only HRT patch Estradot, Evorel, FemSeven
06.04.01.01 Oestrogen only HRT tablet Elleste-Solo, Premarin
06.04.01.01 Oestrogen only HRT topical gel Oestrogel

Apply gel to clean dry intact area of skin such as arms shoulders or inner thighs. Leave for 5 mins before covering with clothing

Not to be applied on or near breasts or on vulval region

 

07.02.01 Oestrogens- Vaginal tablets Vagifem®

Improve mensopausal atrophic vaginitis

Dosing:

One tablet to be inserted daily for 2 weeks then reduce to 1 tablet twice weekly

07.02.01 Oestrogens, Vaginal Cream Ovestin®

Improve menopausal atrophic vaginitis (short term)

Dosing:

1 applicator daily for 2-3 weeks then twice weekly.

Discontinue every 2-3 months for 4 weeks to reassess need to continue

05.01.12 Ofloxacin 

Use in accordance with community guidelines.

Not routinely used in hospital

 

11.03.01 Ofloxacin Eye drops Exocin®
04.02.01 Olanzapine 

High incidence of metabolic side effects, including weight gain, hyperlipidaemia and hyperglycaemia and diabetes.

Patients with pre-existing diabetes need to monitor for exacerbations and ketoacidosis.

Weight gain can occur as a result of increased appetite. Pateints should be counselled on this and advised on avoiding/ minimising high fat or sugary foods. Weight should be regularly monitored to allow for necessary intervention and reduction of other metabolic side effects

Other side effects include changes in liver function, QTc inteval prolongation and TD with prolonged treatment. See product literature for full information (SPC)

04.02.03 Olanzapine 

Licensed for:

  • Combination therapy in mania
  • Monotherapy for mania
  • Prevention of recurrence in bipolar disorder
  • Control of agitation/ disturbed behaviour in acute mania (IM injection)
04.02.02 Olanzapine Embonate ZypAdhera®

210mg, 300mg & 400mg prolonged release injection

SGA long acting injection - maintenance only (Not to be used for acute episodes)

Test dose not required

Dose dependent on effective oral dose

Dosing interval 2-4 weeks depending on dose.

Dose adjustment required if patient stops or starts smoking whilst on treatment 

08.02.04 Olaparib Lynparza®
12.01.03 Olive Oil Ear Drops 

Available OTC

Encourage self care

Pharmacy First

 

03.01.01.01 Olodaterol Striverdi Respimat®

Asthma - not licensed

COPD - Adults only

01.05.01 Olsalazine 

HIGH COST DRUG LIST

High cost impact on primary care

GP only to take over prescribing if genuine failure on other treatments

03.04.02 Omalizumab Xolair®

HOSPITAL ONLY

01.03.05 Omeprazole 
01.03.05 Omeprazole IV 

HOSPITAL ONLY

04.06 Ondansetron 

Peri and post operative nausea and vomiting

Short term use only

09.02.01.02 Oral Rehydration Salts Dioralyte®

See Chapter 1

04.09.02 Orphenadrine 
05.03.04 Oseltamivir Tamiflu®

For the prevention and treatment of influenza.

Should only be used during flu season

08.02.04 Osimertinib Tagrisso
13.09 Other scalp preparations Cocois®
08.01.05 Oxaliplatin 
04.08.01 Oxcarbazepine Trileptal®
11.07 Oxybuprocaine Minims®
07.04.02 Oxybutynin 

Use immediate release as recommended by NICE

Use of oxybutynin may be limited by side effects. These may be reduced by starting at a lower dose or using a modified release preparation. Alternatives are more expensive, consider cost.

Do not offer oxybutynin IR to frail older women.

Consider falls risk and concomitant anticholinergics/ antimuscarinics (ACB score)

07.04.02 Oxybutynin Hydrochloride Kentera®

Transdermal patch is option for individuals who are unable to tolerate oral medication

04.07.02 Oxycodone 

Third Line option

Patients to be referred to pain clinic if chronic pain.

Not to be prescribed for acute pain.

Used in palliative care

10mg oxycodone = 15mg morphine daily equivalent

07.01.01 Oxytocin Syntocinon®
08.01.05 Pablociclib Ibrance®
08.01.05 Paclitaxel 
08.03.04.01 Palbociclib Ibrance®
04.02.02 Paliperidone Palmitate 

SGA long acting injection

Xeplion® 25mg, 50mg, 75mg and 150mg prolonged release injection

Monthly for patients who have responded to oral paliperidone or risperidone.

Trevicta® 175mg, 263mg, 350mg & 525mg prolonged release injection

Maintenance of patients who are clinically stable on monthly IM paliperidone

See SPC's for more information

01.09.04 Pancreatin Pancrex® V
01.09.04 Pancreatin Creon®
01.09.04 Pancreatin Pancrease® HL
01.09.04 Pancreatin Pancrex®
01.09.04 Pancreatin Nutrizym® 22
01.03.05 Pantoprazole 
01.03.05 Pantoprazole IV 

HOSPITAL ONLY

04.07.01 Paracetamol  

HOSPITAL ONLY

Restricted for patients if oral or rectal route are unavailable or inappropriate.

Dose is weight dependent - see product literature

Conversion to oral should be done as soon as possible

04.07.01 Paracetamol  

First line choice for all analgesia.

Good pain killer if used regularly. Doses should be optimised (used regularly)before progressing to stage of treatment

WHO analgesic ladder

Image

04.07.04.01 Paracetamol 

Analgesia for acute attack

If anti-emetic needed prescribe seperately to allow dose adjustments:

  • Metoclopramide tablets
  • Prochlorperazine as Buccastem tablets (sublingual)

 

04.07.01 Paracetamol and codeine Co-codamol® 30/500

Third line

After:

  • Paracetamol regularly (first) +/- NSAID (if tolerated),
  • Then Paracetamol regularly + PRN codeine separately (second)

8/500 combination consider subtherapeutic therefore consider switching to paracetamol alone.

04.07.01 Paracetamol and dihydrocodeine Co-dydramol®

Fourth line

After:

  • Paracetamol regularly (first) +/- NSAID (if tolerated/ indicated)
  • Paracetamol regularly + codeine PRN separately (second)
  • Paracetamol regulary + DHC PRN separately (third)- If codeine not tolerated

Please note:

Typically prescribed at strength of 10mg/500mg per tablet

New strengths are now available: 20mg/500mg & 30mg/500mg per tablet

Care should be taken when selecting the correct strength. Higher doses should be managed with separate paracetamol and DHC to allow for easy dose adjustment.

15.01.04.02 Parecoxib Dynastat®

Theatres only

09.03 Parenteral Nutrition (TPN or PN) 
04.03.03 Paroxetine 

Second line

Less well tolerated than other SSRI's. Tends to have more interactions.

Wide range of licensed indications

Use in over 18's only

11.08.02 Pegaptanib Sodium Macugen®
08.01.05 Pembrolizumab Keytruda®
08.01.03 Pemetrexed Alimta®
10.01.03 Penicillamine 
01.02 Peppermint Oil 0.2ml e/c Capsules Mintec®

Most cost effective peppermint preparation option

(Mintec® is available OTC)

02.05.05.01 Perindopril erbumine or tert-butylamine 
13.10.04 Permethrin 

First line for scabies.

Also indicated for head lice.

Aqueous preparations preferable.

Can be purchased over the counter

04.07.02 Pethidine 

Not to be considered for routine use.

Possible for patients who cannot tolerate any other opiates

Hospital Only for maternity

04.08.01 Phenobarbital 

Child health and existing patients only

04.08.02 Phenobarbital injection 
01.07.03 Phenol, Oily 

Secondary care only

Submucosal Injection

High risk of irritation, ulceration and tissue necrosis

05.01.01.01 Phenoxymethylpenicillin 
11.05 Phenylephrine Hydrochloride 
11.05 Phenylephrine Hydrochloride with Tropicamide Mydriasert®
11.05 Phenylephrine Hydrochloride with Tropicamide and Lidocaine 

For cataract surgery

04.08.01 Phenytoin 
04.08.02 Phenytoin Sodium Epanutin® Ready Mixed Parenteral
03.09.01 Pholcodine Linctus, BP 
09.05.02.01 Phosphate Polyfusor ® 
09.05.02.01 Phosphate supplements Phosphate-Sandoz®
01.06.04 Phosphates (Rectal) 

Third line following failure of other treatments at adequate doses

All patients must be properly assessed for suitability

09.06.06 Phytomenadione 
01.06.05 Picolax ® 

Secondary Care supplied

11.06 Pilocarpine 

Available as preservative free

13.05.03 Pimecrolimus Elidel®
06.01.02.03 Pioglitazone Actos®
06.01.02.03 Pioglitazone and Metfomin Competact®

Competact should be used when both metformin and pioglitazone are required and where compliance is an issue. This can be a more cost effective option than the separate components 

05.01.01.04 Piperacillin and Tazobactam 

Restricted. Except where indicated in antimicrobial guidelines

04.02.02 Pipotiazine Palmitate Piportil® Depot

Test dose: 25

Dose range (mg/week) = 12.5-50

Dosing interval: 4 weeks

Possible lower incidence of EPSE

[N.B not listed in current BNF]

03.11 Pirfenidone Esbriet®
10.03.02 Piroxicam 

Prescribe generically

10.01.01 Piroxicam Melt 

For children only

05.01.01.05 Pivmecillinam Hydrochloride Selexid®
04.07.04.02 Pizotifen 
09.02.01.01 Polystyrene Sulphonate Resins Calcium Resonium®
11.08.01 Polyvinyl Alcohol Liquifilm Tears or Sno Tears®

Second line for patients presenting with dry eye symptoms who do not use other drops on regular basis and hypromellose has proved ineffective

Available OTC

03.05.02 Poractant Alfa Curosurf®
01.01.02 Potassium Bicarbonate with Sodium Alginate Gaviscon Advance®

Secondary care choice

Pateints can be changed to 1st and 2nd line choices on discharge

2.3mmol Na+ and 1mmol K+/ 5ml

01.01.02 Potassium Bicarbonate with Sodium Alginate Acidex Advance®<

Sugar Free

2.3mmol Na/5ml

09.02.01.01 Potassium Chloride Sando-K®
09.02.01.01 Potassium Chloride Kay-Cee-L®
09.02.01.01 Potassium Chloride Slow-K®
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) 
09.02.02.01 Potassium Chloride, Sodium Chloride and Glucose Intravenous Infusion 
13.11.06 Potassium Permanganate Permitabs®
13.11.04 Povidone-Iodine Betadine® or Videne®

May produce systemic adverse effects, such as metabolic acidosis, hypernatraemia and renal impairment, if applied to large wounds or burns.

04.09.01 Pramipexole 
02.09 Prasugrel Efient®

Use within NICE guidance

02.12 Pravastatin  

LOW INTENSITY STATIN:

Use of higher intensity statins are advised for optimal outcomes. Low intensity statin may be preferred in patients who have intolerance or side effects.

Change to higher intensity statin should be encourage at medication reviews following discussion of potential risks and benefits.

06.03.02 Prednisolone 
10.01.02.01 Prednisolone 

A steroid card should be given where appropriate.

Withdraw long term (>3 weeks) steroids gradually.

Offer prophylactic bone protection in patients likely to be on more than three months treatment.

12.01.01 Prednisolone ear drops Predsol®
11.04.01 Prednisolone eye drops 

Also available as Predforte 1% and preservative free

 

01.05.02 Prednisolone ORAL 

 

 

01.05.02 Prednisolone Rectal Preparations 

HIGH COST DRUG LIST

Foam enemas 20g - High cost impact on primary care

04.07.03 Pregabalin 

Fourth line for neuropathic pain

Licensed indication:

  • Peripheral and central neuropathic pain

Consider trial withdrawal every 6 months to see if can withdraw, lower dose or if still required

Must be tapered withdrawal

________________________________

Poteniates effects of opioids and alcohol

Fast acting so may cause euphoria.

Potential for dependence, diversion or abuse (MHRA 2014) 

MHRA warning 2017 - deaths attributed to gabapentinoids.

 

04.08.01 Pregabalin 
15.02 Prilocaine Hydrochloride Citanest®
05.04.01 Primaquine 

For the treatment of malaria.

See trust guidelines for more information.

04.08.01 Primidone 

Existing patients only

05.01.01.01 Procaine Penicillin G Injection  

For the management of syphilis - follow most up-to-date BASHH guidelines

04.06 Prochlorperazine 

Second line for:

  • Opioid induced nausea and vomiting (not palliative care)
  • Labyrinthine vertigo
  • Meniere's Disease (acute short term treatment)

Prochlorperazine has risk of acute dystonic reactions.

Long term use may cause TD in elderly

04.09.02 Procyclidine 
06.04.01.02 Progesterone Cyclogest®

Considered less suitable for prescribing in BNF

Any indication related to IVF or fertility should be in line with funding and approval via PA/IFR and prescribing should be fulfilled by specialist

05.04.01 Proguanil Hydrochloride with Atovaquone 

For the treatment of malaria.

See trust guidelines for more information.

03.04.01 Promethazine Phenergan®

Commonly used as sleep aid due to sedating properties. Sedation required in some allergic conditions

Used for travel sickness

04.06 Promethazine Hydrochloride Phenergan
04.01.01 Promethazine Hydrochloride 
15.01.01 Propofol 
02.04 Propranolol 

Tablets / Liquid / MR capsules

04.01.02 Propranolol 

Licensed for use in anxiety with symptoms such as palpatations, sweating and tremor

40mg daily increased to 40mg three times a day if needed

Caution with use in younger people - Overdose risk.

04.07.04.02 Propranolol 
04.09.03 Propranolol 
06.02.02 Propylthiouracil 

HYPERTHYROIDISM:

200-400mg daily in divided doses until euthyroid, then reduce to 50-150mg daily and reduce to maintenance dose.

If substituting: Carbimazole 1mg is considered to be equivalent to 10mg propythiouracil but dose may need adjusting according to repsonse.

02.08.03 Protamine Sulphate 

HOSPITAL ONLY

Any hospital doctor may prescribe - Unlikely to be administered in primary care

06.05.01 Protirelin TRH

for endocrine testing only

11.07 Proxymetacaine Minims®
11.07 Proxymetacaine 0.5% with Fluorescein Sodium 0.25% Minims®
01.06.07 Prucalopride Resolor®

In the absence of evidence for long term efficacy a trial discontinuation after 6-12 months can be considered.

10.02.01 Pyridostigmine Bromide Mestinon®

Liquid option is unlicensed special in primary care

05.01.09 Pyridoxine Hydrochloride 

Isoniazid induced neuropathy.

Prophylaxis 10-20mg daily

Treament 50mg three times a day

04.02.01 Quetiapine 

IR tabletsPreferred first line choice

XL tablets 

Option for compliance

GP's to prescribe as guided by Optimize Rx for most cost effective options

 

04.02.03 Quetiapine 

Licensed for:

  • Treatment of mania in bipolar disorder
  • Treatment of depression in bipolar disorder
  • Prevention of mania and depression in bipolar disorder
06.07.01 Quinagolide Norprolac®
05.04.01 Quinine 

For the treatment of malaria.

See trust guidelines for more information.

10.02.02 Quinine 

Quinine sulphate may reduce nocturnal leg cramps in about 25% of ambulatory patients

Review regularly. Monitor for unwanted side effects including arrhythmias and blood disorders. Highly toxic in overdose.

Stop if no noticeable benefit.

Provide information of self management of cramp via non-pharmacological methods

13.02.01 QV ® LOTION 

See IOW Emollient formulary

First Line option for LOTIONS

For mild dry skin

Not routinely recommended as a barrier emolloient

Contains parabens

01.03.05 Rabeprazole Pariet®
05.03.01 Raltegravir Isentress ®
08.01.03 Raltitrexed Tomudex®
02.05.05.01 Ramipril 
11.08.02 Ranibizumab Lucentis®
01.03.01 Ranitidine 

Heal Gastric and duodenal ulceration by reducing gastric acid output

Relieve GORD symptoms

Should not normally be used for Zollinger-Ellison syndrome because PPIs are more effective

UNLICENSED- Prophylaxis of NSAID-related gastric or duodenal ulceration, and stress  ulceration.

02.06.03 Ranolazine Ranexa®

Limited role in stable angina where beta blockers and/or calcium channel blockers are contraindicated, not tolerated or ineffective

SMC decided ranolazine should NOT be recommended for use within NHS Scotland

SMC decision 2012

04.09.01 Rasagiline 
10.01.04 Rasburicase Fastertec®
01.04 Rehydration Sachets 

Available OTC

For electrolyte replacement

15.01.04.03 Remifentanil Ultiva®
06.01.02.03 Repaglinide Prandin®
08.03.04.01 Ribociclib Kisqali®
05.01.09 Rifampicin 

HOSPITAL ONLY

 

This antimicrobial is approved for:

  • Mycobacterial infections 
  • Infective endocarditis
  • Other uses require approval or prescribing by:
    • Microbiology/ID consultant or registrar
    • Paediatric ID consultant or registrar
05.01.09 Rifampicin 

COMMUNITY ONLY

For meningococcal prophylaxis

(see trust guidelines for details)

All other indication Hospital Use Only

05.01.09 Rifampicin and Isoniazid Rifinah® 300
05.01.09 Rifampicin and Isoniazid and Pyrazinamide Rifater®
05.01.07 Rifaximin Targaxan®
04.09.03 Riluzole Rilutek®
09.02.02.01 Ringer's Solution for Injection 
06.06.02 Risedronate 
04.02.01 Risperidone 
04.02.02 Risperidone Risperdal Consta®

SGA long acting injection

25mg, 37.5mg & 50mg prolonged relase injection

Test dose not required

For use in patients who are tolerant and have responded to risperidone.

Dose dependent on oral dose of risperidone taken

Dose range = 12.5-50 mg/week

Dosing interval: 2 weeks

Drug release delayed by 2-3 weeks therefore oral ripseridone is required to continue until IM at effective levels.

04.02.03 Risperidone 

Licensed for:

  • Moderate to severe manic episodes associated with bipolar disorder
05.03.01 Ritonavir Norvir®
08.02.03 Rituximab 

Truxima and Rixathon brands are part of the black triangle scheme

10.01.03 Rituximab (rheumatology) MabThera®
02.08.02 Rivaroxaban Xarelto®

Second line option to warfarin

Ensure patient has been properly counselled and received alert card and advice leaflet

04.11 Rivastigmine 
04.07.04.01 Rizatriptan Maxalt®
Formulation Strength Pack size
Tablets 10mg 3 tabs/ 6 tabs
  5mg 6 tabs
Orodispersible tablets 10mg 3 tabs / 6 tabs
Oral lyophilisate (Maxalt Melts)  10mg 3 tabs / 6 tabs 

 

03.03.03 Roflumilast Daxas®

Consultant initiation and continuation only

09.01.04 Romiplostim Nplate®
04.09.01 Ropinirole 
11.08.02 Rose Bengal Minims® Rose Bengal
02.12 Rosuvastatin 

HIGH INTENSITY STATIN - At doses 10mg, 20mg or 40mg

Medium intensity statin at 5mg dose

Second line choice

Aim for >40% reduction in non-HDL cholesterol after 3 months

Primary prevention starting dose for individuals who have 10% or higher QRISK2 score. 10mg

Secondary prevention in people with cardiovascular disease

Exceptions apply for this dose

40mg

Measure LFT's within 3 months of starting and at 12months.

Creatine kinase should be checked if complaints of unexplainable muscle pains and weakness. This does not need to be measured routinely in people who are asymptomatic and on a statin

04.09.01 Rotigotine 
08.01.05 Ruxolitinib Jakavi®
02.05.05.02 Sacubitril valsartan Entresto®
03.01.01.01 Salbutamol 

Safest and most effective SABA.

Consider need for breath actuated product. Non-breath actuated inhalers are more cost effective.

Available as MDI/ DPI and nebules

13.07 Salicyic Acid in White Soft Paraffin 
12.03.05 Saliveze ® 
12.03.05 Salivix ® 
03.01.01.01 Salmeterol Soltel®

Soltel - cost effective MDI option

Slower onset of action than SABA (20 mins).

COPD - Adults only

09.05.01.01 Sandocal 1000 ® 

Sandocal should be prescribed if the patient cannot tolerate chewable tablets. Consider cost when prescribing 

06.01.02.03 Saxagliptin Onglyza®
01.07.02 Scheriproct ® suppositories 

First choice suppositories

01.07.02 Scheriproct® ointment 
04.09.01 Selegiline Hydrochloride 
01.06.02 Senna 

 STIMULANT LAXATIVE - Short term use advised

 Increase intestinal motility.

 Often cause intestinal cramps.

 Avoid in intestinal obstruction.

 Excess use can cause diarrhoea, hypokalaemia/ electrolyte imbalance. Prolonged use can result in rebound constipation on discontinuation due  stimulant nature of laxative

 Available OTC for short term relief

 Available as Tablets or liquid

04.03.03 Sertraline 

First line  -  only available as tablets

Good safety profile - option if history of cardiac illness due to lesser effect on QTc interval

09.05.02.02 Sevelamer Hydrochloride  

Hyperphosphataemia in patients on haemodialysis or peritoneal dialysis

07.04.05 Sildenafil 
13.10.01.01 Silver Sulfadiazine Flamazine®

For Gram negative organisms

02.12 Simvastatin 

High intensity statin at dose of 80mg

( MHRA - 80mg dose is associated with increased risk of myopathy.)

Medium intensity statin at doses of 20mg and 40mg

Low intensity at dose of 10mg

Patients who are stable on low/medium intensity statins should be encouraged to switch to a high intensity statin or dose for optimal prevention.

 

06.01.02.03 Sitagliptin Januvia®
10.01.03 Sodium aurothiomalate Myocrisin®

View to change to Amber on review of DMARDs SCA

09.02.01.03 Sodium Bicarbonate 
09.02.02.01 Sodium Bicarbonate 
12.01.03 Sodium Bicarbonate 

Available OTC

Encourage self care

Pharmacy First

09.02.01.02 Sodium Chloride Slow Sodium®
12.02.02 Sodium chloride 0.9% 

Available OTC

Pharmacy First

09.02.02.01 Sodium Chloride and Glucose Intravenous Infusion 
09.02.02.01 Sodium Chloride Intravenous 
01.06.04 Sodium Citrate 

Third line choice

To be used after failure of other treatments at adequate doses.

Patient needs proper assessment for suitability

03.03.01 Sodium Cromoglicate 
11.04.02 Sodium Cromoglicate 

Available as preservative free unit dose vials.

These may be suitable for individuals on multiple eye products and sensitivity to preservatives or dry eye induced by preservatives.

09.01.01.01 Sodium Feredetate Sytron®
05.01.07 Sodium fusidate 

Use on the advice of the microbiologist

11.08.01 Sodium Hyaluronate Blink Intensive®

Preservative free

0.2%

See IOW CCG Dry Eye Guidelines:

First choice for patients on preservative containing eye drops/ dry eye causing medications on daily basis

and

using > 6 drops / day

11.08.01 Sodium Hyaluronate 0.4% Clinitas®

Second line for patients on preservative containing eye drops/ dry eye causing medications on daily basis

and

using > 6 drops / day

Available as preservative Multi dose 10ml bottle that is sterile for 3 months after opening 

and preservative free unit dose vials

 

07.04.04 Sodium Hyaluronate 1.6%, Sodium Chondroitin Sulfate 2% and calcium chloride 0.87% iAluril®

For use in patients with interstitial cystitis symptoms.

Efficacy to be reviewed after 6 weeks treatment.

11.08.01 Sodium Hyaluronate and trehalose Thealoz Duo®

 

Option for dry eye following failure on item on dry eye guidance

 

02.05.01 Sodium nitroprusside 
01.06.02 Sodium Picosulfate 5mg/5ml sugar free oral solution 

STIMULANT LAXATIVE - short term use only

Increase intestinal motility.

Often cause intestinal cramps.

Avoid in intestinal obstruction.

Excess use can cause diarrhoea, hypokalaemia/ electrolyte imbalance. Prolonged use can result in rebound constiaption on discontinuation due  stimulant nature of laxative

Useful option for children

02.13 Sodium Tetradecyl Sulphate Fibro-Vein®
04.08.01 Sodium Valproate 

EMA/MHRA 2018 Guidance on use of Sodium Valproate in Women of Child Bearing Age

Supplies may only be issued following agreement under PREVENT programme (valproate pregnancy prevention programme)

Any current patients not complying with PREVENT will require referral to specialist for assessment and possible change of medication

07.04.02 Solifenacin Vesicare®
07.04.02 Solifenacin and Tamsulosin Vesomni®

For patients with mixed symptoms due to BPH (WISE: weak stream, intermittent or interrupted stream, straining to void and poor emptying) and overactive bladder or storage symptoms (FUN: frequency, urgency with or without incontinence and nocturia)

06.05.01 Somatropin 

For proven primary and secondary hypo- pituitarism [CCG]

NHSE FUNDED as growth hormone in adults - Except in proven primary and secondary hypopituitarism

08.01.05 Sorafenib Nexavar®
02.03.02 Sotalol  
02.02.03 Spironolactone 
12.02.02 Sterimar® 

Available OTC

02.10.02 Streptokinase 

HOSPITAL ONLY

01.03.03 Sucralfate 

Unlicensed Special - High Cost item to Primary care.

15.01.06 Sugammadex Bridion®

Isle of Wight NHS Sugammadex protocol

01.05.01 Sulfasalazine 

Failure on 2 forms of mesalazine

DMARD's Shared Care Agreement

10.01.03 Sulfasalazine 
04.02.01 Sulpiride 

FGA with relatively low incidence of common side effects except prolactin elevation -high incidence

 

04.07.04.01 Sumatriptan 
Formulation Available Strength Pack sizes
Tablets 100 mg 6 tabs
  50mg 6 tabs
Nasal spray 10mg 2 unit doses
  20mg 2 unit doses or 6 unit doses
Sub Cut injection 6mg/0.5ml prefilled pen 2 disposable injections
  6mg/0.5ml prefilled syringe with device

2 disposable devices

(Refill available)

Nasal spray if patient vomiting

04.07.04.03 Sumatriptan injection 
13.08.01 Sunsense ® Ultra 

SPF 50

09.03 Supplementary Preparations Addiphos®
09.03 Supplementary Preparations Additrace®
09.03 Supplementary Preparations Cernevit®
09.03 Supplementary Preparations Solivito N®
15.01.05 Suxamethonium Chloride 
13.05.03 Tacrolimus Protopic®
07.04.05 Tadalafil 

For patients with combined LUTS/BPH & ED (Erectile dysfunction). No need to prescribe separately PDE5 and alpha-blocker. Cialis 5mg once daily will treat both conditions.

11.06 Tafluprost (Preservative Free) 15micrograms/ml Saflutan®
08.03.04.01 Tamoxifen 
07.04.01 Tamsulosin 

Combination therapy in BPH with 5-alpha reductase inhibitors is called for under the following conditions:

Moderate to severe symptoms and where monotherapy with either tamsulosin or finasteride has failed

Patients with large prostate > 30g and symptomatic

Patients with PSA > 1.4 and moderate to severe LUTS

04.07.02 Tapentadol Palexia®

For Specialist Chronic Pain team initiation only

06.01.06 Tee2® test strips 

First line for type 2 diabetes patients.

Type 1 diabetes patients can use the strips that best suit their needs.

05.01.07 Teicoplanin Targocid®

Use in accordance with trust guidelines

Suitable for OPAT

04.01.01 Temazepam 
02.10.02 Tenecteplase Metalyse®

HOSPITAL ONLY

05.03.01 Tenofovir 245mg, Efavirenz 600mg and Emtricitabine 200mg Atripla®
05.03.01 Tenofovir and Emtricitabine Truvada®
05.03.01 Tenofovir Disproxil Viread®
13.10.02 Terbinafine 1% cream 

Can be purchased over the counter

03.01.01.01 Terbutaline Bricanyl®

Available as DPI

06.05.02 Terlipressin Glypressin®
06.04.02 Testosterone 16.2mg/g gel Testogel® Pump

One actuation = 1.25g = 20.25mg testosterone.

Usual dose = 2.5g (40.5mg testosterone) daily = two actuations.

Max dose = 5g (81mg testosterone) daily = four actuations.

06.04.02 Testosterone 20mg/g (2%) gel  Tostran®

One actuation = 0.5g = 10mg testosterone

Usually dose is 3g (60mg testosterone) daily = 6 actuations

06.04.02 Testosterone and Esters Sustanon 250®

IM injection

Androgen Deficiency

06.04.02 Testosterone undecanoate 250mg/ml injection Nebido®
11.07 Tetracaine Minims® Amethocaine
15.02 Tetracaine  Ametop®
13.03 Tetracaine gel Ametop®
06.05.01 Tetracosactide Synacthen®
08.02.04 Thalidomide 

Subject to individual patient enrolment in Thalomid Risk Evaluation and Mitigation Strategy (REMS)  

03.01.03 Theophylline Slo-Phyllin®

Brands are not interchangeable

See prescribing guidance

09.06.02 Thiamine 
06.04.01.01 Tibolone Livial®

Gonadomimetic

Licensed for short term treatment of symptoms of Oestrogen deficiency and oesteoporosis prophylaxis.

02.09 Ticagrelor Brilique®

Use within NICE guidance

05.01.03 Tigecycline Tygacil®

Only to be used on the advice of the microbiologist

11.06 Timolol 

Available as drops and long acting once daily (LA) gel forming solution

03.01.02 Tiotropium 

First Line LAMA

    Asthma COPD
DPI Braltus® 10mcg Not licensed LAMA COPD maintenance - not bronchospasm. Slow onset of action (30mins)
DPI Spiriva Respimat® 2.5mcg Adjunct to ICS + LABA for maintenance in patients who have suffered 1+ severe excerbations in the last year. Adults only. LAMA COPD maintenance - not bronchospasm. Slow onset of action (30mins)

 

03.01.04 Tiotropium & olodaterol ® Spiolto Respimat

MDI

Asthma - Not licensed

COPD - adults only

10.02.02 Tizanidine 
05.01.04 Tobramycin 

Only to be used on the advice of the microbiologist

10.01.03 Tocilizumab RoActemra®
06.01.02.01 Tolbutamide 

For selected patients with renal insufficiency and some elderly patients

07.04.02 Tolterodine Neditol XL®

Cost effective first line option

Use immediate release first then M/R if compliance or dosing regimen an issue

 

04.07.04.02 Topiramate 
04.08.01 Topiramate 
08.01.05 Topotecan Hycamtin®
04.07.02 Tramadol 

Short term use only

Caution should be exercised when using tramadol due to its unquine pharmacokinetics.

This can lead to an unpredictable response and side effects such as confusion, hallucinations and falls.

Should be avoided in older people.

50mg tramadol = 5mg morphine equivalent 

02.11 Tranexamic Acid 
08.01.05 Trastuzumab Herceptin®
11.06 Travoprost 

Prescribe generically

11.06 Travoprost with Timolol 

Prescribe generically

04.03.04 Trazodone 

Third line tablets and capsules for antidepressant use.

Option in older people with depression.

Less anticholinergic and cardiotoxic than TCA's. Useful when sedation is needed

Liquid is expensive and should be reviewed for alternative options and reserved for genuine clinical need

 

 

11.08 Triamcinolone Kenalog®

Unlicensed route

10.01.02.02 Triamcinolone Acetonide Kenalog®

For local inflammation of joints and soft tissue

10.01.02.02 Triamcinolone hexacetonide 
04.02.01 Trifluoperazine 

HIGH COST ITEM in primary care

Difficult to obtain supplies.

High incidence of EPSE and prolactin elevation, but low to moderate incidence for other side effects

08.01.05 Trifluridine-tipiracil Lonsurf®
04.09.02 Trihexyphenidyl 
05.01.13 Trimethoprim 

Use in accordance with local guidelines

Antimicrobial resistance is common: review treatment once sensitivity results available

08.03.04.02 Triptorelin Gonapeptyl Depot®
11.05 Tropicamide Mydriacyl®
07.04.02 Trospium 
06.07.02 Ulipristal Esmya®

5mg tablets

Pre-operative and intermittent treatment of moderate to severe symptoms of uterine fibroids

See Chapter 7 for EHC dosages.

07.03.05 Ulipristal EllaOne®

Please see EllaOne prescribing Flowchart

Ulipristal acetate can be used up to 5 days after intercourse

03.01.02 Umeclidinium Incruse Ellipta®

DPI LAMA

Slow onset of action (30mins)

Asthma - Not licensed

COPD - Maintenance not bronchospasm

03.01.04 Umeclidinium & vilanterol Anoro Ellipta®

DPI

Asthma - Not licensed

COPD - adults only

01.07.02 Uniroid HC ® Suppositories 
01.07.02 Uniroid HC® Ointment 
12.01.03 Urea Hydrogen peroxide Exterol ® Otex®

Available OTC

Encourage Self Care

06.05.01 Urofollitropin 
02.10.02 Urokinase 

HOSPITAL ONLY

01.09.01 Ursodeoxycholic acid 
13.08.01 Uvistat ® 

SPF 30 or 50

05.03.02.01 Valaciclovir Valtrex®
05.03.02.02 Valganciclovir Valcyte®

Only to be used on the advice of the microbiologist

04.02.03 Valproic Acid Depakote®
05.01.07 Vancomycin 

Use in accordance with trust guidelines.

Oral use only for Clostridium difficile infection.

04.10.02 Varenicline Champix®

With counselling

Community pharmacy PGD in place for community use

Patients should be referred to Health and Wellbeing at Public health for community supplies

Not suitable for initiation in hospital

06.05.02 Vasopressin Pitressin®
01.05.03 Vedolizumab 
04.03.04 Venlafaxine 

Third Line option

Tend to be less well tolerated than SSRI's and have higher acquisition costs, depending on product/ brand available

Useful in depression and anxiety.

02.06.02 Verapamil 
04.07.04.03 Verapamil 
04.08.01 Vigabatrin Sabril®
06.01.02.03 Vildagliptin 
08.01.04 Vincristine Sulphate 
08.01.04 Vindesine Sulphate Eldisine®
08.01.04 Vinorelbine 
09.06.07 Vitamin and mineral supplements Ketovite®

Prevention of vitamin deficiency in disorders of carbohydrate or amino-acid metabolism

Adjunct in restricted, specialised, or synthetic diets

09.06.07 Vitamin and mineral supplements Forceval®

Recommended post bariatric surgery

09.06.02 Vitamin B & C high potency injection Pabrinex®
09.06.02 Vitamin B Tablets, Compound Strong 

For use in refeeding syndrome or deficiency states.

05.02 Voriconazole Vfend®

Only to be used on the advice of the microbiologist

NHSE commission item - Repatriated prescribing costs to NHSE

 

04.03.04 Vortioxetine 

Third line for antidepressant use for major depression in adults who have failed to respond adequately to 2 antidepressants within the current episode.

 

02.08.02 Warfarin 

Ensure patient has been appropriately counselled and has a copy of the yellow card for their records

06.01.06 Wavesense Jazz® test strips 

Second line for type 2 diabetes patients.

Type 1 diabetes patients can use the strips that best suit their needs.

05.03.04 Zanamivir inhalation Relenza®

Severely immunocompromised patients 5yr or where oseltamivir resistance suspected

Should only be used during flu season

13.02.01 ZeroAQS® 

See IOW Emollient formulary

Second Line option for Light and Creamy leave on emollients

For mild to moderately dry skin

Good for everyday use

Can be used as soap substitute

Cost effective alternative to Aqueous Cream. Less sensitisers

13.02.01 Zerobase ® Cream 

See IOW Emollient formulary

Second Line option for Rich Cream leave on emollients

For moderately dry skin

Less greasy than ointments

Good for everyday use

13.02.01 Zerocream ® 

See IOW Emollient formulary

First Line option for Light and Creamy leave on emollients

For mild to moderately dry skin

Good for everyday use

Can be used as soap substitute

Cost effective alternative to E45

13.02.01 Zeroderm ® Ointment 

See IOW Emollient Formulary

Second line Heavy leave on emollient

For severe and very dry skin. Low risk of sensitivites, low excipients

13.02.01 Zerodouble ® Gel  

See IOW Emollient formulary

Second Line option for Gel leave on emollients

For moderately dry skin

Less greasy than ointments

Good for everyday use

Cost effective alternative to Doublebase® and Aproderm® Gel

 

05.03.01 Zidovudine Retrovir®
13.02.02 Zinc and Caster Oil Ointment BP 
06.06.02 Zoledronic Acid 
04.07.04.01 Zolmitriptan 
Formulation Strength Pack size
Tablets 2.5mg 6 tablets
  5mg 6 tablets
Orodispersible tablets 2.5mg 6 tablets
  5mg 6 tablets
Nasal Spray 5mg 6 unit doses

Nasal spray if patient vomiting

04.01.01 Zolpidem 
04.08.01 Zonisamide Zonegran®
04.01.01 Zopiclone 
04.02.01 Zuclopenthixol Clopixol®

Most commonly used as a depot. See section 04.02.02

Moderate side effects across all common FGA side effects

04.02.02 Zuclopenthixol Decanoate Clopixol®

Test dose: 100mg

Dose Range (mg/week) = 100-600

Dosing interval: 2-4 weeks

Some evidence zuclopenthixol is better in agitated or agressive patients. Some debate around it having a slightly better efficacy than other FGA depots

 

Isle of Wight