Microsoft word - trust formulary (revised 2013) - 10 2013 update
DRUG FORMULARY
Updated after HEY Drug and Therapeutics Committee meeting Of September 2013
This formulary is used and maintained by Hull and East Yorkshire Hospitals NHS Trust.
It is also used as a formulary by Humber Foundation NHS Trust (HFT) and City Health Care Partnership (CHCP). The formulary has been agreed with Hull Clinical Commissioning Group and East Riding of Yorkshire Clinical Commissioning Group with the expectation that providers within Hull and East Riding will prescribe and recommend drug treatments from those listed in the formulary. A joint formulary is currently in development
Guide:
Bold and highlighted = preferred first line agent Italics = specialist recommendation only
Other agents = can still be used, but are not preferred first line agent
Drugs not listed are considered non formulary, and will not be supplied from hospital pharmacy. Non formulary drugs should not be recommended for initiation in primary care. For further information on formulary process, including application for use of additional agents within individual organisations, see contact details below:
Hull and East Yorkshire Hospitals NHS Trust
Simon Gaines, Senior Principal Pharmacist – Clinical Services Tel. 01482 675587, e-mail [email protected]
Weeliat Chong, Chief Pharmacist Tel. 01482 301727, e-mail [email protected]
Graham Hill / Emma Baggaley, Senior Pharmacist Tel. 01482 344151, e-mail [email protected], [email protected]
Jackie Lyon, Head of Medicines Management, York & Humber CSU Tel. 0148 672029, email [email protected] Marie Miller, Senior Principal Pharmacist – Interface, HEY Tel. 01482 675207 or 674731, e-mail [email protected]Emergency Treatment of Poisoning Charcoal, activated Acetylcysteine Methionine Dehydrated (absolute) alcohol/ethanol Other agents are listed elsewhere in the formulary. CHAPTER 1: GASTRO-INTESTINAL DRUGS 1.1 ANTACIDS Sodium
1.1.1 Aluminium and Magnesium containing Magnesium Trisilicate Aluminium Hydroxide Maalox® Mucaine® Simeticone Infacol® 1.1.2 Sodium Bicarbonate Sodium Bicarbonate 1.1.3 Other drugs for dyspepsia and GORD. Gaviscon Advance® Gaviscon Infant® 1.2 ANTISPASMODICS ANTIMUSCARINICS Hyoscine butylbromide Alverine Citrate Propantheline
Peppermint water MOTILITY STIMULANTS Metoclopramide/Domperidone - see 4.6 1.3 ULCER HEALING DRUGS 1.3.1 H2 receptor antagonists Ranitidine 1.3.3 Chelates and Complexes
1.3.5 Proton pump inhibitors Lansoprazole Omeprazole (Oral ONLY) Pantoprazole (Intravenous ONLY) Esomeprazole 1.4 ANTIDIARRHOEAL DRUGS 1.4.2 Antimotility drugs Loperamide NOT for under 12 years old or breastfeeding mothers
1.5 TREATMENT OF CHRONIC DIARRHOEA AMINOSALICYLATES Mesalazine * Remember to clarify the brand of SR products *
CORTICOSTEROIDS Hydrocortisone 10% foam Hydrocortisone suppository Prednisolone enemas and suppository Budesonide 1.6 LAXATIVES 1.6.1 Bulk forming Fybogel
LOW MOLECULAR WEIGHT HEPARINS Dalteparin treatment, DVT treatment and prophylaxis Bivalirudin Epoprostenol Lepirudin 2.8.2 Oral anticoagulants Warfarin Acenocoumarol DabigatranOrthopaedics / Cardiology/Stroke Physicians Rivaroxaban Available on chairs approvals for patients meeting NICE TA 245, TA275 who are unable to have the trust preferred options 2.8.3 Protamine sulphate Protamine sulphate
2.9 ANTIPLATELET DRUGS Aspirin
Abciximab 2.10.2 FIBRINOLYTIC DRUGS Alteplase
2.11 ANTIFIBRINOLYTIC DRUGS AND HAEMOSTATIC AGENTS Tranexamic Acid
BLOOD PRODUCTS Haematology Department 2.12 LIPID LOWERING DRUGS. ANION EXCHANGE Colestyramine Gemfibrozil Bezafibrate SR as Bezalip® Mono FISH OILS Omega-3-acid ethyl esters (Omacor®) Lipid Specialist & Continuation of treatment only Ezetimibe
2.13 LOCAL SCLEROSANTS Ethanolamine Polidocanol (Scleroven)® Surgery CHAPTER 3: RESPIRATORY SYSTEM
3.1 BRONCHODILATORS 3.1.1.1 Selective 2 Adrenoreceptor Stimulants Short acting Salbutamol
3.1.3 Theophylline * Remember to clarify the brand of SR products * Aminophylline Theophylline
3.1.4 Compound Bronchodilator Preparations Combivent 3.2 CORTICOSTEROIDS Beclometasone (Beclomethasone) Clenil Modulite® (First line in children) Prescribe by brand Qvar® (First line in adults) Prescribe by brand Flutiform® Respiratory Specialist 3.3 CROMOGLICATE AND RELATED THERAPY Nedocromil Sodium Cromoglicate(Sodium Cromoglycate) Respiratory Specialist 3.3.2 Leukotriene receptor antagonists Montelukast PHOSPHODIESTERASE TYPE 4 INHIBITORS 3.3.3 Roflumilast Respiratory medicine for existing patients only in line with NICE TA244 3.4 ANTIHISTAMINES AND RELATED THERAPY 3.4.1 Antihistamines NON-SEDATING ANTIHISTAMINES Cetirizine Fexofenadine
SEDATING ANTIHISTAMINES Chlorphenamine (Chlorpheniramine)
Hydroxyzine Promethazine Alimemazine (Trimeprazine) 3.4.2 Allergen Immunotherapy Omalizumab (Not recommended in children aged 6 to 11 years as per NICE TA201) Grass and tree pollen extracts - Grazax® 3.4.3 Allergic emergencies Adrenaline Epipen Icatibant Immunology C1 Esterase Inhibitor (Berinert®) 3.5 RESPIRATORY STIMULANTS 3.5.1 Respiratory Stimulants Doxapram
3.5.2 Pulmonary Surfactants Poractant 3.7 MUCOLYTICS Dornase alfa by safe and clinically effective practice 3.8 INHALATIONS No recommendations 3.9 ANTITUSSIVES 3.9.1 Cough Suppressants Pholcodine linctus Dextromethorphan
3.9.2 Expectorant & Demulcent Preparations Simple linctus CHAPTER 4: CENTRAL NERVOUS SYSTEM
Many drugs in chapter 4 are initiated on advice of Mental Health specialists (e.g. HFT) and it is expected that patients may be continued on these or treatment may be initiated on them on advice of a Mental Health specialist 4.1 HYPNOTICS AND ANXIOLYTICS 4.1.1 Hypnotics
Temazepam Loprazolam Continuation of GP initiated treatment onlyContinuation of GP initiated treatment only Clomethiazole (Chlormethiazole) These agents will not normally be supplied on discharge
4.1.2 Anxiolytics Buspirone hydrochloride Mental Health advice or Continuation of treatment only 4.1.3 Barbiturates Specialist Use Only & E.E.G.
4.2 DRUGS USED IN PSYCHOSES AND RELATED DISORDERS 4.2.1 Antipsychotic Drugs Amisulpride Mental Health advice or Continuation of treatment only advice or Continuation of treatment only Mental Health advice or Continuation of treatment only Mental Health advice orContinuation of treatment onlyPsychogeriatrician or Mental Health advice / continuation Neurologists or Mental Health advice / continuationMental Health advice or Continuation of treatment only Mental Health advice or Continuation of treatment only Other agents not recommended and only available if recommended by a Mental Health specialist
4.2.2 Antipsychotic Depot Injections *All agents Specialist Use Only* 4.2.3 Antimanic Drugs Specify brand of product* Lithium Carbonate(Camcolit )Lithium Citrate(Priadel Liquid)
Carbamazepine see section 4.8.1 Valproic acid (as semisodium valproate) (e.g. Depakote®) 4.3 ANTIDEPRESSANTS 4.3.1 Tricyclic and Related Antidepressants Amitriptyline Dosulepin (Dothiepin) Mental Health advice or Continuation of treatment only Mental Health advice or Continuation of treatment only Mental Health advice or Continuation of treatment only Mental Health advice or Continuation of treatment only
RELATED ANTIDEPRESSANTS Trazodone 4.3.2 Monoamine Oxidase Inhibitors No recommendations – only available if recommended by Mental health specialist 4.3.3 SSRIs and related Fluoxetine
4.3.4 Duloxetine (Cymbalta®) Endocrinology/Neurology & Pain Team UseMental Health advice or Continuation of treatment only 4.4 CENTRAL NERVOUS STIMULANTS Atomoxetine Dexamfetamine Methylphenidate Modafinil Lisdexamfetamine Advice or Continuation of Treatment only 4.5 APPETITE SUPPRESSANTS No recommendations 4.5.2 CENTRALLY-ACTING APPETITE SUPPRESSANTS No recommendations 4.6 DRUGS USED IN NAUSEA AND VERTIGO
Cinnarizine
Promethazine Chlorpromazine see 4.2.1 Haloperidol see 4.2.1 Levomepromazine (Methotrimeprazine) see 4.2.1 Prochlorperazine
5-HT3 ANTAGONISTS Ondansetron NEUROKININ RECEPTOR ANTAGONISTS Aprepitant OTHER DRUGS Betahistine Hyoscine Hydrobromide 4.7 ANALGESICS 4.7.1 Non Opioid Analgesics Paracetamol Co-codamol 8/500 Co-codamol 30/500 Ibuprofen see 10.1.1 Paracetamol I/V 4.7.2 Opioid Analgesics
Codeine NOT for under 12 years old or breastfeeding mothers
Tramadol STRONG OPIOIDS
Diamorphine Fentanyl patches Fentanyl patches (chronic non cancer pain) 2nd line after oral morphine failure Fentanyl buccal tablets (Effentora®) by palliative care/Renal/pain specialists 4.7.3 Neuropathic pain Carbamazepine Amitriptyline Sodium Valproate Pain Team – Consultant use only, for chronic neuropathic pain Pain Team – Consultant use only, for chronic neuropathic pain 4.7.4 Antimigraine Drugs 4.7.4.1 Treatment of Acute Migraine Attack Aspirin
4.7.4.2 Prophylaxis of Migraine Propranolol 4.8 ANTI-EPILEPTICS 4.8.1 Control of Epilepsy Phenytoin
Sodium valproate (including S/R e.g. Epilim Chrono®) Carbamazepine Phenobarbital Lamotrigine Levetiracetam Lacosamide Ethosuximide 4.8.2 Drugs Used in Status Epilepticus Lorazepam Phenytoin
Clonazepam Paraldehyde Phenobarbital Midazolam Buccal 4.9 DRUGS IN PARKINSONISM AND RELATED DISORDERS 4.9.1 Dopaminergic Drugs Co-beneldopa (Madopar) Co-careldopa (Sinemet) Duodopa® Amantadine Apomorphine Ropinirole Ropinrole SR Selegiline Levodopa + carbidopa + entacapone (Stalevo ) Rotigotine Patches 4.9.2 Antimuscarinic Drugs Trihexyphenidyl
4.9.3 Drugs Used in Tremor and Related Disorders. Botulinum A Toxin Complex Botulinum B Toxin
4.10 DRUGS USED IN SUBSTANCE DEPENDENCE Alcohol dependence See Guidelines dependence Guidelines Acamprosate Lofexidine Methadone Buprenorphine Mental Health advice or continuation of treatment only Naltrexone Mental Health advice or continuation of treatment only Nicotine patches, nicotine mini lozenges and inhalators Bupropion Varenicline 4.11 DRUGS FOR DEMENTIA Memantine Donepezil Galantamine Galantamine SR. Rivastigmine (oral & patches) CHAPTER 5: INFECTIONS
All drugs in italics must be recommended by a Consultant Microbiologist or Consultant in Infectious Disease, unless otherwise stated. 5.1 ANTIBACTERIAL DRUGS 5.1.1 Penicillins Benzylpenicillin intravenous treatment Penicillin V (Phenoxymethylpenicillin)
5.1.1.2 Penicillinase - resistant Penicillins Flucloxacillin Consultant in Infectious Diseases or Microbiology 5.1.1.3 Broad-Spectrum Penicillins Amoxicillin Co-amoxiclav 5.1.1.4 Antipseudomonal Penicillins Piperacillin/Tazobactam Consultant in Infectious Diseases or Microbiology 5.1.1.5 Mecillinams Pivmecillinam Hydrochloride Consultant in Infectious Diseases or Microbiology
5.1.2 CEPHALOSPORINS AND BETA-LACTAMS CEPHALOSPORINS Cefradine (Cephradine) Cefotaxime intravenous treatment Consultant in Infectious Diseases or Microbiology Consultant in Infectious Diseases or Microbiology Consultant in Infectious Diseases or Microbiology Infectious Diseases Consultants in OUTPATIENTS only 5.1.3 TETRACYCLINES Tetracycline Doxycycline Demeclocycline Consultant in Infectious Diseases or Microbiology recommendation only 5.1.4 AMINOGLYCOSIDES Gentamicin Netilmicin Respiratory specialist (when patient 5.1.5 MACROLIDES Clarithromycin
5.1.6 CLINDAMYCIN Clindamycin Cellulitis (if patient Penicillin sensitive) 5.1.7 OTHER ANTIBIOTICS Sodium Fusidate/ Fusidic Acid Consultant in Infectious Diseases or Microbiology for IV preparation In line with SMC guidance recurrent C.Difficile only
5.1.8 SULPHONAMIDES AND TRIMETHOPRIM Trimethoprim
5.1.9 ANTITUBERCULOUS DRUGS Specialist recommendation - See BNF for appropriate drugs
5.1.10 ANTILEPROTIC DRUGS Specialist recommendation - See BNF for appropriate drugs 5.1.11 METRONIDAZOLE Metronidazole 5.1.12 QUINOLONES Ciprofloxacin Ofloxacin Consultant only (after discussion with Microbiology) Or Consultant Respiratory Physician 5.1.13 URINARY TRACT INFECTIONS Nitrofurantoin Trimethoprim see 5.1.8 Methenamine hippurate 5.2 ANTIFUNGAL DRUGS Fluconazole Nystatin oral/topical Amphotericin Haematology or Consultant Microbiologist/Infectious Diseases Haematology or Consultant Microbiologist/Infectious Diseases Amphotericin(lipid complex) Haematology or Consultant Microbiologist/Infectious Diseases Caspofungin Haematology Anidulafungin Voriconazole Clotrimazole Preparations see Section 7.2.2 and 13.10.2 5.3 ANTIVIRAL DRUGS Aciclovir
HUMAN IMMUNODEFICIENCY VIRUS NRTI Didanosine Atripla Abacavir Emtricitabine Lamivudine
PI Amprenavir Atazanavir Indinavir Nelfinavir
NNRTI Efavirenz Etravirine Nevirapine Adefovir dipivoxil Enfuvirtide Maraviroc Raltegravir Foscarnet Ganciclovir Valganciclovir Oseltamivir Prophylaxis during Influenza A outbreaks Zanamivir Palivizumab Entecavir Telaprevir Rilpivirine 5.4 ANTIPROTOZOAL DRUGS Specialist recommendation - See BNF for appropriate drugs – includes tinidazole
Artemether with lumefantine (Riamet ) Consultant in Infectious Diseases 5.5 ANTIHELMINTICS Specialist recommendation - See BNF for appropriate drugs CHAPTER 6: ENDOCRINE SYSTEM
6.1. DRUGS USED IN DIABETES 6.1.1 Insulin 6.1.1.1 Short Acting Insulins Human Actrapid Humulin S Pork Actrapid Humulin R
6.1.2.2 Biguanides Metformin tablets & sachets Metformin SR tablets
6.1.2.3 Other Antidiabetics Lixisenatide Specialist use only as per guidelinesSpecialist use only as per guidelines Specialist use only as per guidelines Pioglitazone/metformin (Competact ) Sitagliptin Saxagliptin Dapagliflozin
6.1.4 Treatment of Hypoglycaemia Dextrose (Hypostop)
Glucagon
8.1 CYTOTOXIC DRUGS All items in italics are Specialist Use ONLY, and should only be prescribed by Consultant Oncologist, Haematologist and their teams. Disodium folinate 8.1.1 Alkylating Agents Cyclophosphamide Bendamustine Busulfan Carmustine Carmustine Implant 8.1.2 Cytotoxic Antibiotics Bleomycin (Caelyx or Myocet® depending on indication) Doxorubicin and DC beads (for precision TACE) Epirubicin 8.1.3 Antimetabolites Mercaptopurine Methotrexate Capecitabine Cladribine Cytarabine Liposomal Cytarabine Fludarabine Gemcitabine Tioguanine (Thioguanine) Pemetrexed Available on chairs approval in accordance with TA 61 8.1.4 Vinca Alkaloids and etoposide Etoposide Vinblastine Vindesine Vinorelbine 8.1.5 Other Antineoplastic agents Azacytidine (Vidaza) Amsacrine Bevacizumab Bexarotene PbR excluded. PCT treatment exemption panel approval required Bortezomib Carboplatin Cetuximab Cisplatin Dacarbazine Dasatinib Docetaxel Erlotinib Gefitinib Hydroxycarbamide (Hydroxurea) Imatinib Irinotecan Ipilimumab Nilotinib Paclitaxel Pazopanib Procarbazine Sunitinib Temozolamide Topotecan Trastuzumab Tretinoin Trabectedin Use in line with NICE TA185 & Cancer Network Guidelines Vemurafenib Use in line with NICE TA269 & Cancer Network Guidelines National Cancer Drugs Fund List 2013 Indication Abiraterone
1st line treatment of metastatic castrate resistant prostate cancer (Mcrpc) in adult men who are asymptomatic, or mildly symptomatic, after failure of androgen deprivation therapy (ADT) in whom chemotherapy is not yet clinically indicated
Axitinib
Option for 2nd line advanced renal cell carcinoma with progression after TKI or a cytokine
Bendamustine
2nd or subsequent line treatment of CLL for patients whom fludarabine combination therapy is not a therapeutic option. Treatment of relapsed low grade NHL in patients unable to receive standard chemotherapy. 1st line treatment of low grade non-hodgkins lymphoma in combination with rituximab Treatment of relapsed low grade/indolent NHL refractory to rituximab based regimens 2nd and subsequent line treatment of mantle cell lymphoma in patients who have not received previous bendamustine 1st line treatment of mantle cell lymphoma in combination with rituximab in patients unsuitable for standard first line treatment Treatment of relapsed multiple myeloma where other treatments are not appropriate
Bevacizumab
Treatment of patients with triple negative metastatic breast cancer and/or prior taxane therapy 1st line treatment of metastatic colorectal cancer. Only to be administered concurrently with chemotherapy, not as single agent maintenance therapy. 2nd line treatment of metastatic colorectal cancer in combination with standard chemotherapy in patients who have not previously received bevacizumab. Only to be administered concurrently with chemotherapy, not as single agent maintenance therapy. 3rd line treatment of metastatic colorectal cancer in combination with standard chemotherapy in patients who have not previously received bevacizumab. Only to be administered concurrently with chemotherapy,not as single agent maintenance therapy. 1st line treatment of advanced (stage IIIc/IV) ovarian cancer, sub-optimally debulked either at primary or delayed primary (interval) surgery (including peritoneal and fallopian tube cancer) OR unsuitable for debulking surgery.
Botezomib
Treatment of relapsed or refractory multiple myeloma at second and subsequent relapse in patients who are botezomib naïve and where the patient unable to access bortezomib at first relapse. Treatment of relapsed or refractory multiple myeloma at second and susbsequent relapse in patients with previous good response to bortezomib. Treatment of 2nd or subsequent relapse in Refractory Mantle cell Lymphoma, in patients not fit for transplant Treatment of relapsed Waldenstrom’s macroglobulinaemia after previous treatment with standard chemotherapy
Brentuximab
Treatment of relapsed or refractory Hodgkins lymphoma in patients who have failed at least two prior multi-agent chemotherapy regimens and are not ASCT candidates As a bridge to allograft transplant for the treatment of Hodgkin’s
Lymphoma where no other salvage treatment is available As a bridge to allograft transplant for the treatment of anaplastic large cell lymphoma where no other salvage treatment is available
Cabazitaxel
2nd line treatment of advanced castration resistant prostate cancer following docetaxel based regimen 3rd line treatment of advanced castration resistant prostate cancer following docetaxel and abiraterone based treatment
Cetuximab
1st line treatment of metastatic and/or recurrent squamous cell carcinoma of the head and neck Treatment of KRAS wild-type metastatic colorectal cancer in any indication outside of NICE TA176, in patients who have not previously received cetuximab up to progression
Clofarabine
Acute myeloblastic leukaemia in patients with relapsed/refractory disease in whom the intent is to use treatment as a bridge to bone marrow transplantation Acute lymphoblastic leukaemia in patients with relapsed/refractory disease in whom the intent is to use treatment as a bridge to bone marrow transplantation
Crizotinib
In second and subsequent line anaplastic lymphoma kinase (ALK) – positive advanced non -small lung cancer
Dasatinib
Treatment of adults with Philadelphia chromosome positive (Ph+) acute lymphoblastic leukaemia (ALL) with resistance or intolerance to prior therapy including Imatinib Treatment of adults with Philadelphia chromosome positive (Ph+) lymphoid blast CML with resistance or intolerance to prior therapy including Imatinib 2nd line treatment of chronic, accelerated or blast phase CML patients with intolerance to imatinib mesilate, and who are intolerant of nilotinib
Eribulin
Treatment of patients with locally advanced or metastatic breast cancer who have been previously treated with (or unsuitable for ) an anthracycline, a taxane and capecitabine
Everolimus
2nd line treatment of metastatic renal cell carcinoma where disease has progressed on or after treatment with VEGF- targeted therapy or where patient has a contra-indication to or is intolerant of VEGF –targeted therapy 1st line treatment of unresectable or metastatic, well- or moderately-differentiated neuroendocrine tumours of pancreatic origin in adults with progressive disease 2nd line treatment of unresectable or metastatic, well-or moderately-differentiated neuroendocrine tumours of pancreatic origin in adults with progressive disease 2nd line treatment of hormone receptor +ve, HER2 negative advanced breast cancer, in combination with exemestane, in post menopausal women without symptomatic visceral disease after recurrence or progression following a non steroidal aromatase inhibitor who have not received previous exemestane
Imatinib
Adjuvant treatment of gastro-intestinal stromal tumours (GIST), in patients considered high risk of relapse (based on risk criteria or mutation analysis), for up to 3 years
Lapatinib
2nd and subsequent line use in combination with capecitabine for the treatment of patients with locally recurrent or metastatic breast cancer, whose tumours over express HER2(ErbB2) and whose disease has progressed on trastuzumab
Lenalidomide
2nd line treatment of multiple myeloma in patients who have contraindications to the use of bortezomib
Nelarabine
Treatment of refractory T-cell lymphoblastic non-Hodgkin’s Lymphoma as a bridge to bone marrow transplantation Treatment of refractory T-cell acute lymphoblastic leukaemia as a bridge to bone marrow transplantation
Ofatumumab
2nd line treatment of chronic lymphocytic leukaemia (CLL) in patients who are refractory to fludarabine and ineligible/unsuitable for alemtuzumab 2nd line treatment of CLL in patients with p53 mutation who relapse or progress on first line alemtuzumab and are not suitable for fludarabine 3rd line treatment of CLL in patients refractory to fludarabine and alemtuzumab
Pazoponib
Third line treatment of metastatic non-adipocytic soft tissue sarcoma
Pegylated Liposomal
1st line treatment of angiosarcoma, especially cutaneous
Doxorubicin (Caelyx)
2nd line treatment of angiosarcoma, especially cutaneous 1st line treatment of primary sarcoma of the heart and great vessels 1st line treatment of sarcoma in patients with cardiac impairment who need an anthracycline 2nd line treatment of sarcoma in patients with cardiac impairment who need an anthracycline 2nd line treatment of fibromatosis
Pemetrexed
2nd line treatment of patients with locally advanced or metastatic non-small cell lung cancer other than predominantly squamous cell histology in patients who did not receive 1st line pemetrexed e.g. 1st line clinical trial Maintenance treatment of stage IIIB/IV non-squamous non-small cell lung cancer after response to pemetrexed-containing first line therapy
Peptide receptor
Treatment of advanced neuroendocrine tumours i.e. for pNETS
Radionucleotide Therapy
after sunitinib/Chemotherapy, For mid-gut Carcinoid, after
to include Lutetium 177 Octreotate or Yttrium90 octreotide/octreotate Ruxolitinib
1st line treatment of symptomatic splenomegaly in adult patients with primary myelfibrosis, post polycythaemia vera myelofibrosis or post essential thrombocythaemia myelofibrosis. For new patients only 2nd line treatment of symptomatic splenomgaly in adult patients with primary myelfibrosis, post polycythaemia vera myelofibrosis or post essential thrombocythaemia myelofibrosis. For new patients only
Sorafenib
1st line treatment of advanced hepatocellular carcinoma in patients with Childs A disease 1st line treatment of advanced hepatocellular carcinoma in patients with low disease burden Childs B disease Treatment of papillary or follicular thyroid cancer that is inoperable or metastatic disease that is refractory to radioiodine
Sunitinib
1st line treatment of unresectable or metastatic, well-differentiated pancreatic neuroendocrine tumour with disease progression 2nd line treatment of unresectable or metastatic, well-differentiated pancreatic neuroendocrine tumour with disease progression 3rd line treatment of unresectable or metastatic, well-differentiated pancreatic neuroendocrine tumour with disease progression
Temsirolimus
1st line treatment of patients with advanced renal cell carcinoma
(RCC) who have at least three of six prognostic risk factors.
Vandetinib
Treatment of symptomatic, locally advanced (unresectable) or metastatic medullary thyroid cancer.
8.2 DRUGS AFFECTING THE IMMUNE RESPONSE 8.2.1 Cytotoxic Immunosuppressants Azathioprine
8.2.2 Corticosteroids and other immunosuppressants Ciclosporin (Cyclosporin) Prednisolone Sirolimus Specialist Use/Transplant Tacrolimus 8.2.3 Anti-lymphjocyte monoclonal antibodies Rituximab Alemtuzumab Haematologists and Oncologists
8.2.4 Interferons Interferon Peginterferon alfa Natalizumab Fingolimod Use in line with NICE TA228 & Cancer Network Guidelines 8.3 SEX HORMONES AND HORMONE ANTAGONISTS IN MALIGNANT DISEASE
8.3.4 Hormone Antagonists 8.3.4.1 Breast Cancer Tamoxifen Aminoglutethimide Anastrazole Exemestane Letrozole Fulvestrant
8.3.4.2 Prostate Cancer Abiraterone Acetate Cyproterone
Goserelin Flutamide Bicalutamide Degarelix 8.3.4.3 Somatostatin analogues Octreotide Lanreotide CHAPTER 9: NUTRITION AND BLOOD
9.1 ANAEMIAS & SOME OTHER BLOOD DISORDERS 9.1.1.1 Oral Iron Ferrous Sulphate Ferrous Fumarate 9.1.1.2 Parenteral Iron Iron sucrose complex (Venofer®) IV infusion Iron dextran (Cosmofer®) Iron (III) Isomaltoside 1000 (Monofer®) Approved for Renal Medicine & Cardiac Surgery 9.1.2 Drugs used in megaloblastic anaemias Hydroxocobalamin
9.1.3 Drugs used in hypoplastic, haemolytic & renal anaemias Darbepoetin Alfa Epoetin
IRON OVERLOAD Desferrioxamine 9.1.4 Drugs used in platelet disorders Anagrelide Romiplostim Use in line with NICE TA221 & Cancer Network Guidelines 9.1.6 Drugs used in neutropenia Filgrastim Pegfilgrastim Lenograstim
9.2.1.2 Oral Sodium and Water Sodium Chloride ORAL REHYDRATION SALTS Dioralyte 9.2.1.3 Oral Bicarbonate Sodium 9.2.2 Parenteral Fluids. Sodium Chloride 0.9% Dextrose 5% Hartmann’s Solution Ringers Solution Dextrose 4% & Sodium Chloride 0.18% Dextrose 10% & Sodium Chloride 0.18% Dextrose 10% with Potassium
for glucose potassium insulin (GKI) infusion
Dextrose 5% with range of potassium strengths Sodium Chloride 0.9% with range of potassium strengths Potassium Chloride 15% SODIUM BICARBONATE Sodium Bicarbonate 1.26% Sodium Bicarbonate 8.4%
All other fluids only available on specific requests 9.2.2.2 Plasma Substitutes Gelatin (Volplex®)
Hydroxyethyl starch (Voluven®) Albumin Volulyte
9.3 INTRAVENOUS NUTRITION Seek Specialist Advice from nutrition team As contract specified 9.4 ENTERAL NUTRITION Pre-op Seek Specialist Advice from Dietetics department. As contract specified
10.1.1 Non-steroidal anti-inflammatory drugs. Ibuprofen Diclofenac (Dyloject®)
Ketoprofen gel (Ibuprofen gel 5% due to manufacturing problem)
Mefenamic acid Naproxen Celecoxib 10.1.2 Corticosteroids 10.1.2.1 Systemic Corticosteroids
10.1.2.2 Local Corticosteroid injection Dexamethasone sodium phosphate
10.1.3 Drugs which suppress the rheumatic disease process GOLD Sodium Aurothiomalate PENICILLAMINE Penicillamine Dermatology/Rheumatology/Gastroenterology Rheumatologist/Gastroenterologists 10.1.4 Drugs for treatment of gout ACUTE ATTACKS Non-steroidal anti-inflammatory drugs see section 10.1.1 Colchicine
INTERVAL TREATMENT Allopurinol Febuxostat
Probenecid Rasburicase 10. 2 DRUGS USED IN NEUROMUSCULAR DISORDERS 10.2.1 Drugs which enhance neuromuscular transmission ANTICHOLINESTERASES Neostigmine
10.2.2 Skeletal muscle relaxants Baclofen
DRUGS FOR THE RELIEF OF SOFT-TISSUE INFLAMMATION 10.3.1 Enzymes Hyaluronidase
10.3.2 Rubefacients and other topical antirheumatics Capsaicin Cream Transvasin Cream TOPICAL NSAID’S Ketoprofen gel Movelat POULTICES Kaolin poultice CHAPTER 11: EYE
Products identified as specialist use products should only be prescribed after recommendation by a Consultant or Specialist Registrar in Ophthalmology.
11.6 TREATMENT OF GLAUCOMA BETA-BLOCKERS Timolol Eye Drops Timolol Gel solution (Long-acting) Betaxolol Eye Drops PROSTAGLANDIN ANALOGUES AND PROSTAMIDES Latanaprost & Latanoprost PF Eye-drops Travoprost Eye drops Bimatoprost & Bimatoprost PF Eye drops Prostaglandin Analogues with Timolol Latanoprost with Timolol Travoprost 40micrograms/Timolol 5mg per ml (DuoTrav®) Bimatoprost with Timolol (Ganfort®) SYMPATHOMIMETICS Brimonidine Eye drops
CARBONIC ANHYDRASE INHIBITORS AND SYSTEMIC DRUGS Acetazolamide Injection and Capsules Dorzolamide Eye Drops Carbonic anhydrase inhibitors with Timolol Dorzolamide 2% / Timolol 0.5% eye drops Brinzolamide 10mg / Timolol 5mg per ml (Azarga®)
MIOTICS Pilocarpine Eye Drops
11.7 LOCAL ANAESTHETICS Tetracaine (Amethocaine) Eye Drops Oxybuprocaine Eye drops Lidocaine (Lignocaine) with Fluorescein Eye Drops Proxymetacaine Eye Drops 11.8 MISCELLANEOUS OPTHALMIC PREPARATIONS 11.8.1 Tear Deficiency, Ocular Lubricants, and astringents Hypromellose Eye Drops Polyethylene Glycol 400 0.4%, propylene glycol 0.3%, hydroxypropyl guar (Systane®) Carmellose (Optive®) eye drops
Liquid Paraffin (Lacrilube ) Eye Ointment Carbomer (Polyacrylic Acid) Liquid Gel Polyvinyl alcohol Ophthalmic Solution Acetylcysteine eye drops (Ilube®) Sodium Hyaluronate (Artelac Rebalance®) Sodium Hyaluronate ( HYLO-forte®) 11.8.2 Ocular Diagnostic and Peri Operative Preparations and Photodynamic Treatment AREDS Formula (e.g. Ocuvite® /Preservision ) Balanced Salt Solution and Balanced salt Solution Plus Diclofenac Ophtha Eye Drops Fluorescein Eye Drops and Fluorets HydroxyPropylMethylCellulose Eye Drops Acetylcholine (Miochol) Eye Drops Potassium Ascorbate Eye Drops Povidone Iodine 5% Minims – for peri-operative use Sodium Hyaluronate pfs (1ml) and (0.5ml) & Greater Viscosity (0.55ml) pfs Sodium hyaluronate + lidocaine (Visthesia ) Verteporfin Aflibercept (Eylea®) Ocriplasmin (Jetrea®)
11.9 CONTACT LENS PREPARATIONS These products are not prescribable under the NHS, unless special exemption is obtained. Various preparations are available for sale. CHAPTER 12: EAR, NOSE, AND OROPHARYNX AS PER BNF, CERTAIN PRODUCTS ARE LICENSED/APPROVED FOR BOTH AURAL AND OCULAR USE. See BNF section 11 for more detail.
12.1 DRUGS ACTING ON THE EAR 12.1.1 Otitis externa. ASTRINGENT PREPARATIONS Aluminium Acetate Ear Drops ANTI-INFLAMMATORY PREPARATIONS Hydrocortisone with Gentamicin Ear Drops (Gentisone HC) Betamethasone Ear Drops Dexamethasone as Otomize Ear Drops Prednisolone Ear Drops
Otosporin ANTI-INFECTIVE PREPARATIONS Gentamicin with Hydrocortisone Ear Drops (Gentisone HC) Clotrimazole
Framycetin as Sofradex Ear Drops 12.1.3 Removal of ear Wax Sodium bicarbonate Ear Drops Olive Oil 12.2 DRUGS ACTING ON THE NOSE 12.2.1 Drugs used in Nasal Allergy ANTIHISTAMINES Azelastine Nasal Spray CORTICOSTEROIDS Beclometasone (Beclomethasone) Drops/ Nasal Spray Budesonide Aqueous aerosol inhalation Fluticasone Furoate (Avamys®)
Mometasone (Nasonex ) Sodium Cromoglicate nasal Spray
Triamcinolone (Nasacort ) Nasal Spray 12.2.2 Topical Nasal Decongestant Ephedrine Nasal Drops
12.3 DRUGS ACTING ON OROPHARYNX 12.3.1 Drugs for oral ulceration and inflammation Benzydamine Mouthwash, Spray Bonjela gel Hydrocortisone Oral pellets 12.3.2 Oropharyngeal Anti-infective Drugs Nystatin Amphotericin Lozenge Miconazole oral gel
12.3.3 Lozenges Sprays and Gels Dequalinium Lozenges
Tyrothricin with Benzocaine (Tyrozets ) 12.3.4 Mouthwashes, gargles and Dentrifices Chloraseptic Spray Chlorhexidine Mouthwash
Gelclair Oral Gel Caphosol
12.3.5 Treatment of Dry Mouth Glandosane Solution Lemon Mouth Freshener Thera-med 2 in 1 Liquid Biotene Oral Balance Gel Pilocarpine tablets CHAPTER 13: SKIN
13.2 EMOLLIENTS AND BARRIER PREPARATIONS 13.2.1 Emollients Aqueous Cream Balneum® Plus Cream Doublebase® Gel Emulsifying ointment in water
Zerocream® (E45 Cream substitute) Zerobase® (Diprobase substitute)
Hydromol Cream and Ointment Liquid Paraffin 50% in Yellow soft paraffin
Eczmol Cream 13.2.1.1 Emollient Bath Additives
Dermol Emollient 13.2.2 Barrier Preparations
Vasogen Cream 13.2.3 Dusting Powders Talc and hexachlorophane Dusting powder Talc Purified powder 13.3 TOPICAL LOCAL ANAESTHETICS AND ANTIPRURITICS Tetracaine (Amethocaine) Cream Calamine Lotion
Crotamiton (Eurax ) Cream and Eurax HC Cream Pain relieving (PR) Aerosol spray Doxepin continuation 13.4 TOPICAL CORTICOSTEROIDS Alclometasone (Modrasone) Ointment 0.05% Betamethasone valerate Cream 0.1%, Cream 0.025% (1 in 4), Ointment 0.1%,
Ointment 0.025% (1 in 4), Foam for scalp (Bettamousse ) Betamethasone Dipropionate Ointment 0.05% Cream 0.05% Clobetasol propionate (Dermovate®) Cream 0.05%, Ointment 0.05%
Clobetasol propionate (Etrivex ) Shampoo 0.05%
Clobetasone butyrate (Eumovate ) Cream 0.05%,
Fluocinolone acetonide (Synalar ) Cream 0.025%, Gel 0.025%, Ointment 0.025%, Cream 0.00625% (1 in 4), Ointment 0.00625% (1 in 4) Fluticasone propionate (Cutivate), Cream 0.05%, Ointment 0.005% Fludroxycortide (Haelan®) Tape Hydrocortisone Cream 0.5%, 1%, Ointment 0.5%, 1%,
Hydrocortisone Lipocream 1% (Mildison®) Hydrocortisone butyrate (Locoid®) Cream 0.1%, Ointment 0.1%, Lipocream 1% Tri-adcortyl® Cream and Ointment Mometasone With anti-bacterials Betamethasone & clioquinol Cream and Ointment (formerly Betnovate C) Locoid C® Cream and Ointment Fucibet®
13.5 PREPARATIONS FOR ECZEMA AND PSORIASIS. 13.5.1 Preparations for eczema Alitretinoin 13.5.2 Preparations for psoriasis
Alphosyl® Cream and Alphosyl HC Balneum® with Tar Bath oil Calcipotriol Cream and Ointment Calcitriol Ointment Sebco® scalp application Coal Tar preparations: The following “specials” used by Dermatology department: Coal tar solution 5% in betnovate RD ointment
Gockermans ointment (this contains Crude oil tar 2% (or 4% or 6% or 10% or 20%), Zinc Oxide
Newcastle Ointment. Available in a variety of strengths:
Coal tar (9%), Salicyclic acid (3%), Tween (1%), Ung Emuls Compound ointment to 100% Coal tar (12%), Salicyclic acid (2%), Tween (1%), Ung Emuls Compound ointment to 100%
Coal tar (6%), Salicyclic acid (2%), Tween (1%), Ung Emuls Compound ointment to 100%
Coal tar (3%), Salicyclic acid (1%), Tween (1%), Ung Emuls Compound ointment to 100%
Dithranol preparations: Dithrocream® Cream The following “specials” used by Dermatology department:
Dithranol in Lassars paste 0.25%, 0.5%, 0.1%, 1%, 2%, 4%, (w/v)
Dithranol in Salicylic Acid 2% in emulsifying ointment 0.1%, 0.25%, 0.5%, 1%, 2%
Dovobet ointment Dovobet® Scalp Gel Eosin in PMA 0.5% w/v
Methoxypsoralen Paint, Gel and Bath lotion Polytar® Shampoo and Emollient Miconazole Cream 1% and 3% Tazarotene Gel
Dithranol Cream in lipid-stabilised basis (Micanol ) ORAL RETINOIDS FOR PSORIASIS Acitretin Capsule OTHER PREPARATIONS FOR PSORIASIS
Methoxypsoralen Emulsion Methoxypsoralen Bath lotion 13.5.3 Drugs Affecting the Immune Response Ciclosporin (Cyclosporin) Methotrexate Tacrolimus ointment Pimecrolimus cream Adalimumab Etanercept Ustekinumab 13.6 ACNE AND ROSACEA 13.6.1 Topical preparations for acne Benzoyl peroxide Topical gels Benzoyl peroxide and Adalpalene gel - Epiduo® Benzamycin Gel TOPICAL RETINOIDS FOR ACNE Tretinoin Cream & Gel Isotrexin Gel 13.6.2 Oral preparations for acne Isotretinoin Capsule
Co-cyprindiol (Dianette ) Minocycline 13.7 PREPARATIONS FOR WARTS AND CALLUSES Salicyclic acid preparations (Cuplex®, Verrugon®) Salactol® Paint Salatac® Gel GENITAL WARTS Podophyllum preparations Warticon® Solution Imiquimod 13.8 SUNSCREENS AND CAMOUFLAGERS RoC® Total Sunblock Factor 25 Solaraze® Methyl aminolevulinate cream (Metvix®) 13.8.1 Sunscreen Preparations Ingenol Mebutate (Picato®) 13.9 SHAMPOOS AND SOME OTHER SCALP APPLICATIONS Alphosyl® Shampoo and 2 in1 Shampoo Capasal® Shampoo Ketoconazole 2% Shampoo Polytar® and Polytar Plus® Shampoo T/Gel® Shampoo Eflornithine cream
13.10 ANTI-INFECTIVE SKIN PREPARATIONS 13.10.1.1 Antibacterial preparations only used topically Mupirocin Ointment Silver sulfadiazine (sulphadiazine) Cream Polyfax Ointment 13.10.1.2 Antibacterial preparations also used systemically Metronidazole Gel 13.10.2 Antifungal preparations Clotrimazole Cream Econazole Cream Nystatin Cream 13.10.3 Antiviral preparations Aciclovir Cream 13.10.4 Parasiticidal preparations Carbaryl Lotion Use as local policy Malathion Lotion Use as local policy Dimeticone Lotion
Permethrin Cream rinse Use as local policy 13.10.5 Preparations for minor cuts and abrasions Magnesium sulphate Paste Proflavine Antiseptic cream 13.11 DISINFECTANTS AND CLEANSERS See local guidelines from infection control team. Triclosan (Aquasept® Solution/Skinsan Foam) Chlorhexidine Preparations Hydrogen peroxide Preparations Hydrogen peroxide cream (Crystacide®) Industrial Methylated Spirit Preparations Manusept® Solution Phisomed® Cleanser Plaster Remover Potassium permanganate (Permitabs®) Povidone Iodine Preparations Sodium Hypochlorite Preparations 13.11.7 Desloughing agents 13.13 TOPICAL CIRCULATORY PREPARATIONS Hirudoid® Cream Lasonil® Ointment
CHAPTER 14: IMMUNOLOGICAL PRODUCTS AND VACCINES
For guidance on the choice and use of vaccines, see ‘Immunisation against infectious diseases’ a HMSO publication – available online at: http://www.dh.gov.uk/en/Publichealth/Healthprotection/Immunisation/Greenbook/DH_4097254
14.4 VACCINES AND ANTISERA BCG Vaccine Diphtheria Vaccine Diphtheria/Tetanus Vaccine Diphtheria/Tetanus/Pertussis Vaccine Diphtheria Antitoxin Haemophilus Influenzae Type b (Hib) Vaccine Hepatitis A Vaccine Hepatitis B Vaccine Influenza Vaccine Measles/Mumps/Rubella (MMR) Vaccine Meningococcal Vaccine Pertussis Vaccine (Whooping Cough) Pneumococcal Vaccine Poliomyelitis Vaccine Live Poliomyelitis Vaccine Inactivated Rotavirus Vaccine (Rotarix®) Rubella Vaccine Varicella-Zoster Vaccine Varicella Vaccine (Varivax®) Yellow Fever Vaccine 14.5 IMMUNOGLOBULINS Normal Immunoglobulin (Brand dependant upon availability) SPECIFIC IMMUNOGLOBULINS Anti-human Thymocyte Immunoglobulin (Equine) Human Anti-tetanus Immunoglobulin Hepatitis B Immunoglobulin Dr Smithson Anti-D (Rh(o)) immunoglobulin Haematology
15.1.7 Antagonists for central and respiratory depression Flumazenil Injection Naloxone Injection 15.1.8 Drugs used for malignant hyperthermia Dantrolene Sodium Injection 15.2 LOCAL ANAESTHESIA LIDOCAINE (LIGNOCAINE) Lidocaine (Lignocaine) Injection Lidocaine (Lignocaine) Plaster (Versatis ) Neuropathic pain in line with NICE CG96 Lidocaine 2.5% and prilocaine 2.5% (Emla ) Topical Cream Tetracaine 4% (Ametop ) Topical Gel
Instillagel Gel Lidocaine (Lignocaine) Topical Spray BUPIVACAINE Bupivacaine Injection Levo-bupivacaine Injection. PRILOCAINE Prilocaine Injection Hyperbaric
ROPIVACAINE Ropivacaine Injection and Epidural Infusion OTHER Cocaine
APPENDIX 2: BORDERLINE SUBSTANCES
A2.1 Enteral Feeds Nutrison Nutrison Multifibre Nutrison Soya Nutrison Energy Nutrison Energy Multifibre Nutrison Protein Plus Nutrison Protein Plus Multifibre A2.2 Nutritional Supplements Fortijuice Fortisip Fortisip Multifibre Fortisip Yogurt Style Forticreme Fortisip Extra Renilon A2.3 Specialised Formulas for Specific Clinical Conditions A2.4 High Energy Supplements Calogen Protifar Scandishake A2.5 Feed additives VSL#3
APPENDIX 8: WOUND MANAGEMENT PRODUCTS SUBSTANCES AND ELASTIC HOSIERY
See separate local policy/formulary on Tissue Viability intranet site at:http://intranet/tissueviability/ The Trust Wound Formulary is listed on this link: http://intranet/tissueviability/woundFormulary.asp For quick reference, the dressings groups and products in current use are: Interactive Dressings (stocked by pharmacy). Alginate Sorbsan Flat(Replaces Kaltostat range). Sorbsan Ribbon Hydrogel ActivHeal (Replaces Intrasite range). Intrasite Gel Restricted to use by Radiotherapy only Hydrocolloid Duoderm Aquacel Rope Aquacel Ribbon Aquacel Sheets Odour Absorbent Clinisorb Odour Absorbent – Combination Carboflex Antimicrobials – Polihexanide and betaine Based Prontosan wound irrigation Tissue Viability Nurse/Vascular Nurse/Podiatry specialist Prontosan Gel X Tissue Viability Nurse/Vascular Nurse/Podiatry specialist Antimicrobials – Iodine Based Inadine IodosorbTissue Viability Nurse/Vascular Nurse/Podiatry specialist Antimicrobials – Silver based Aquacel Ag Acticoat Flex 3 Tissue Viability Nurse/Vascular Nurse/Podiatry specialist Askina Calgitrol thin 5cm x 5cm Podiatry specialist Askina Calgitrol Paste 15 g
Low adherant dressings Jelonet Scar Treatment Cica-care Restricted to use by dermatology/plastics only Restricted to use by max fax/plastics only Larval therapy Larvae Tissue Viability Nurse/Vascular Nurse/Podiatry specialist
FORMULARY APPENDIX 1 – Products which are not currently listed in the BNF Bone cements Eptotermin (Osteogenic protein) Elastoviscous polymers for the treatment of pain in osteoarthritis Hylan G-F 20 injection (Synvisc ) Fibrin sealants Tisseel® fibrin sealant DEVICES – Products licensed as devices (not drugs) – approved since April 2007 Perflutren lipid microspheres (Luminity ) Cardiology Cyclo-Taurolidine and Citrate 4% (TauroLock ) Medicinal products for diagnostic use only Regadenoson
Contrast Media Agents
Gadoteridol (Prohance ) Radiology Gadoxetic For use in breast reconstruction only. FORMULARY APPENDIX 2 – DRUGS RECOMMENDED IN NICE TA WHICH ARE NOT IN FORMULARY NICE TA EXPLANATION
Renal transplant operations are not performed by
Renal transplant operations are not performed by
Immunosuppressive Regimens for Children and
Adolescents TA 235 Osteosarcoma - Mifamurtide
Recommended for treatment in specified children, adolescents and young adults. This cohort of patients are referred to specialist provider.
TA 282 Pirfenidone for treating idiopathic
Unlicensed Drugs – Please see http://intranet/pharmacy/pdf/unlicensedmedslist0909.pdf
Exercise and depression Exercise referral and the treatment of mild or moderate depressionInformation for GPs and healthcare practitionersThere is a substantial body of evidence to show a causal link between physical activity and reduced clinically defined depression, and comparative studies have demonstrated that exercise can be as effective as medication or psychotherapy. Trea
Part 2 THE FAMILY Chapter 8 FERTILITY, CONTRACEPTION AND THE FAMILY Brigid McEwen Irenaeus said in the 2nd century, "God's greatest glory is man fully alive", and as he, being a pupil of Polycarp who was himself a pupil of John the Evangelist, was only a few steps from the Lord, I like to think he knew what he was talking about. As John Paul II says in Familiaris Consortio,