Formulary Chapter 13: Skin - Full Chapter
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Notes: |
This chapter of the formulary is under continual development, please let the team know if you have any comments about the contents: mlcsu.lscformulary@nhs.net.
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Details... |
13.01 |
Management of skin conditions |
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Birch bark extract (Filsuvez Gel®)
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Formulary
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Gel 100mg/1g
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NICE: Birch bark extract for treating epidermolysis bullosa
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HidraWear
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Formulary
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Hidradenitis Suppurativa
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LSCMMG HidraWear Position Statement
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13.01.02 |
Suitable quantities for prescribing |
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13.01.03 |
Excipients and sensitisation |
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13.02 |
Emollient and barrier preparations |
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Please noter that the 'Zero' range of emollients are cheaper in primary care. These are to be advised on the GP referal letters |
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MHRA December 2018:
Emollients: new information about risk of severe and fatal burns with paraffin-containing and paraffin-free emollients
Warnings about the risk of severe and fatal burns are being extended to all paraffin-based emollients regardless of paraffin concentration. Data suggest there is also a risk for paraffin-free emollients. Advise patients who use these products not to smoke or go near naked flames, and warn about the easy ignition of clothing, bedding, dressings, and other fabric that have dried residue of an emollient product on them.
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Emulsifying Ointment BP
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Formulary
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500g
NB: fire hazard - see BNF
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Epimax ®
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Formulary
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Cream 100g, 500g
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Epimax ® ointment
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Formulary
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Ointment
MHRA Drug Safety Update, July 2024: Epimax Ointment and Epimax Paraffin-Free Ointment: reports of ocular surface toxicity and ocular chemical injury
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MHRA: Epimax Ointment and Epimax Paraffin-Free Ointment: reports of ocular surface toxicity and ocular chemical injury
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Epimax Oatmeal®
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Formulary
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Cream 100g, 500g
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ExCetra®
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Formulary
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Liquid paraffin light 105 mg per 1 gram, White soft paraffin 132 mg per 1 gram
Cream 100g, 500g
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Imuderm® emollient
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Formulary
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emollient 500g
(Contains urea 5%)
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Isomol gel ®
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Formulary
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100g, 500g
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Liquid and White Soft Paraffin Ointment (50:50)
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Formulary
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500g
NB: fire hazard - see BNF
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Oilatum®
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Formulary
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Cream 50g, 500g
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ZeroAQS® (Emollient preparation)
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Formulary
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Cream 500g, Similar to aqueous cream but contains no sodium lauryl sulfate.
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13.02.01 |
Emollients - with antimicrobials |
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Dermol®
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Formulary
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Cream 500g
Lotion 500mL Also contains antimicrobials
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13.02.01 |
Preparations containing urea |
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Emollient preparation containing Urea 25% (Flexitol®)
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Formulary
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Heel balm 75g
Specific use only for diabetic patients
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LSCMMG: Over the Counter Items that Should not be Routinely Prescribed in Primary Care Policy
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Flexitol® Cream, Hydromol® Intensive (urea 10%)
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Formulary
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Flexitol is lower cost then Hydromol
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13.02.01.01 |
Emollient bath and shower preparations |
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Emollient bath and shower preparations are no longer recommended. Most emollients can be used as a soap substitute. |
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13.02.02 |
Barrier preparations |
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Conotrane® (Barrier preparation)
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Formulary
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For community use only
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Medi Derma-S
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Formulary
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Spray barrier film
For community use only
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Medihoney®
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Formulary
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Second choice
Cream and sachet
For community use only
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Metanium® (Barrier preparation)
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Formulary
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Ointment For paediatric use only
Tissue Viability Nurse authorisation required for use in adult patients
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Proshield Plus® (For excoriated skin)
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Formulary
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Skin protectant ointment 115g
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Sorbaderm®
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Formulary
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Available from stores - not supplied from UHMB pharmacy
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Sudocrem® (Barrier preparation)
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Formulary
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Cream 60g For paediatric use only
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13.03 |
Topical local anaesthetics and antipruritics |
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Crotamiton 10% (Eurax®)
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Formulary
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Cream 30g
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Difelikefalin (Kapruvia®)
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Formulary
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Solution for injection 50micrograms/mL
NICE TA890 Difelikefalin for treating pruritus in people having haemodialysis
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NICE TA890: Difelikefalin for treating pruritus in people having haemodialysis
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Levomenthol 0.5%, 1%, 5% cream
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Formulary
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Cream 500g
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13.04 |
Topical corticosteriods. |
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Betamethasone 0.1%
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Formulary
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Scalp application 100mL
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Betamethasone 0.1% (Bettamousse®)
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Formulary
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Foam 100g
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Betamethasone Dipropionate 0.05% with Salicylic Acid 2% (Diprosalic®) (Potency = potent)
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Formulary
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Scalp application 100mL
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Betamethasone Dipropionate 0.05% with Salicylic Acid 3% (Diprosalic®) (Potency = potent)
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Formulary
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Ointment 100g
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Betamethasone Dipropionate 0.064% with Clotrimazole 1% (Lotriderm®)
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Formulary
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Cream 30g
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Betamethasone Valerate 0.025% (Betnovate-RD®) (Potency = moderate)
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Formulary
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Cream 100g
Ointment 100g
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Betamethasone Valerate 0.1% (Betnovate®) (Potency = potent)
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Formulary
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Cream 30g, 100g
Ointment 30g, 100g
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Betamethasone Valerate 0.1% with Fucidic Acid 2% (Fucibet®) (Potency = potent)
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Formulary
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Cream 30g
Preparations containing fusidic acid should not be used in secondary care for in-patients
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Clobetasol propionate (Etrivex®)
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Formulary
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Shampoo, clobetasol propionate 0.05% 125mL
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Clobetasol propionate 0.05% (Clarelux®)
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Formulary
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Scalp application and shampoo
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Clobetasol Propionate 0.05% (Dermovate®) (Potency = very potent)
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Formulary
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Cream 30g, 100g
Ointment 30g, 100g
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Clobetasone 0.05%/Nystatin 100,000u/g/Oxytetracycline 3% (Trimovate®) (Potency - moderate)
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Formulary
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Cream 30g
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Clobetasone Butyrate 0.05% (Eumovate®) (Potency = moderate)
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Formulary
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Cream 30g
Ointment 30g
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Flucinolone Acetonide 0.025% (Synalar®) (Potency = potent)
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Formulary
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Gel 30g
For scalp use only
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Fludroxycortide (Haelan®) (Potency = Moderate)
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Formulary
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Tape 4 micrograms/cm2 7.5cm x 50cm x 200cm
In East Lancashire
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fluocinolone acetonide 0.025% with clioquinol 3% (Synalar C®) (potent corticosteroid with antimicrobials)
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Formulary
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Cream & Ointment
Replaces Betnovate C cream & ointment
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Hydrocortisone 0.5%/ nystatin 100,000units/g /benzalkonium chloride 0.2%/ dimeticone '350' 10% (Timodine®) (Potency = mild)
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Formulary
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Cream 30g
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Hydrocortisone 1% (potency = mild)
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Formulary
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Cream 15g
Ointment 15g
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Hydrocortisone 1% with Clotrimazole 1% (Canesten HC®) (Potency = mild)
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Formulary
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Cream 30g
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Hydrocortisone Acetate 1% with Fusidic Acid 2% (Fucidin H®) (Potency = mild)
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Formulary
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Cream 30g, 60g
Preparations containing fusidic acid should not be used in secondary care for in-patients
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Mometasone Furoate 0.1% (Elocon®) (Potency = potent)
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Formulary
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Cream 30g Ointment 30g
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13.04 |
Topical corticosteriod preparation potencies |
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Topical corticosteroids are classified according to their potency. Potency is a result of the formulation as well as the corticosteroid. For guidance on quantities to prescribe see BNF. |
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13.04 |
Topical corticosteroids (Potency: Mild) |
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13.04 |
Topical corticosteroids (Potency: Moderate) |
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13.04 |
Topical corticosteroids (Potency: Potent) |
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13.04 |
Topical corticosteroids (Potency: Very Potent) |
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13.04.01 |
Topical corticosteroids – Compound preparations – with antimicrobials |
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13.04.01 |
Topical corticosteroids – Compound preparations – with salicyclic acid |
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13.05 |
Preparations for eczema and psoriasis |
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13.05.01 |
Preparations for eczema |
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Ichthammol with Zinc oxide ( Ichthopaste bandage®)
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Formulary
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7.5cm x 6m
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Alitretinoin (Toctino®)
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Formulary
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Capsules 10mg, 30mg Consultant dermatologist or specialist only Pregnancy must be excluded before initiation and before each repeat prescription. prescriptions for women are limited to 28 days treatment REQUIRES BLUETEQ APPROVAL
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MHRA: Oral retinoid medicines▼: revised and simplified pregnancy prevention educational materials for healthcare professionals and women
NICE TA177: Alitretinoin for the treatment of severe chronic hand eczema
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Zinc oxide 15% and Ichthammol 1% in yellow soft paraffin (Special ointment No1)
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Formulary
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Ointment
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13.05.01 |
Topical preparations for eczema |
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Viscopaste® bandages
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Formulary
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Bandage 7.5cm x 6m
For community use only
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13.05.02 |
Preparations for psoriasis |
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Dimethyl Fumarate (Skilarence®) (moderate/severe plaque psoriasis)
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Formulary
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Tablets 30mg, 120mg
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NICE TA475: Dimethyl fumarate for treating moderate to severe plaque psoriasis
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Ixekizumab (Taltz®)
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Formulary
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80mg/1mL pre-filled pen
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NICE TA442: Ixekizumab for treating moderate to severe plaque psoriasis
NICE TA537: Ixekizumab for treating active psoriatic arthritis after inadequate response to DMARDs
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Methoxypsoralen
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Unlicensed
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Bath lotion 1.2%
Gel 0.005%
Tablets 10mg
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13.05.02 |
Topical preparations for psoriasis |
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Calcipotriol
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Formulary
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Ointment 120g
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Calcipotriol 50micrograms/g with Betamethasone 0.05% (Dovobet®)
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Formulary
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Gel 60g
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Calcipotriol 50micrograms/g with Betamethasone 0.5mg/g (Enstilar®)
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Formulary
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Cutaneous foam
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Coal tar 1% with salicylic acid 2% and precipitated sulfur 4% (Sebco®)
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Formulary
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Scalp ointment 40g
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Coal tar lotion 5% (Exorex®)
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Formulary
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Lotion 100mL
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salicylic acid in emulsifying ointment 2%, 5%, 10%
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Formulary
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Ointment 2%, 5%, 10%
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Tacalcitol 4micrograms/g (Curatoderm®)
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Formulary
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Ointment 100g
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Zinc and Salicylic Acid Paste BP (Lassars Paste)
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Formulary
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Zinc oxide 24% / salicylic acid 2% / starch 24% / white soft paraffin 50%
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Coal Tar 2% and Salicylic Acid Ointment 2% BP (Sloppy Tar) (For scalp use only)
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Unlicensed
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Not all coal tar products are routinely stocked by the pharmacy departments. If the product has to be obtained from a specials manufacturing unit there may be a delay of up to 4 weeks
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Coal tar in emulsifying ointment
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Unlicensed
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1%, 2%, 5%, 10%, 15%, 20%, 25%, 30% 100g Not all coal tar products are routinely stocked by the pharmacy departments. If the product has to be obtained from a specials manufacturing unit there may be a delay of up to 4 weeks.
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Dithranol in Lassar’s Paste
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Unlicensed
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10% (0.1%, 0.25%, 0.5%, 1%, 2%, 4%, 6%, 8% dilutions available from pharmacy) Not all dithranol products are routinely stocked by the pharmacy departments. If the product has to be obtained from a specials manufacturing unit there may be a delay for up to 4 weeks.
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13.05.02 |
Oral retinoids for psoriasis |
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Acitretin (Neotigason®)
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Formulary
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Capsules 10mg, 25mg Consultant dermatologist or specialist initiation only Pregnancy must be excluded before initiation and before each repeat prescription. Prescriptions for women are limited to 28 days treatment
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MHRA: Oral retinoid medicines▼: revised and simplified pregnancy prevention educational materials for healthcare professionals and women
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13.05.03 |
Drugs affecting the immune response |
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Abrocitinib (Cibinqo ®)
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Formulary
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Tablets 50mg - for treating moderate to severe atopic dermatitis
Tablets 100mg - for treating moderate to severe atopic dermatitis
Tablets 200mg - for treating moderate to severe atopic dermatitis
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NICE TA814: Abrocitinib, tralokinumab or upadacitinib for treating moderate to severe atopic dermatitis
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Adalimumab (Biosimilars avaliable)
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Formulary
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S/C injection 40mg pre-filled syringe, pre-filled pen Consultant dermatologist or specilaist initiation only Tertiary centre only for hidradenitis suppurativa Usually supplied to patients by a home delivery company REQUIRES BLUETEQ APPROVAL
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MHRA: Tumour necrosis factor alpha inhibitors
NICE TA392: Adalimumab for treating moderate to severe hidradenitis suppurativa
NICE TA455: Adalimumab, etanercept and ustekinumab for treating plaque psoriasis in children and young people
NIE TA146: Adalimumab for the treatment of adults with psoriasis
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Apremilast (Otezla®)
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Formulary
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Tablets 10mg, 20mg, 30mg Usually supplied to patients by a home delivery company REQUIRES BLUETEQ APPROVAL
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MHRA: Apremilast (Otezla ▼): risk of suicidal thoughts and behaviour
NICE TA419: Apremilast for treating moderate to severe plaque psoriasis
NICE TA433: Apremilast for treating active psoriatic arthritis
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Azathioprine
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Formulary
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Tablets 25mg, 50mg Unlicensed indication Consultant dermatologist or specilaist initiation only See section 10.1.3
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LSCMMG: Shared care guideline - Azathioprine
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Baricitinib
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Formulary
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Film-coated tablets 2mg, 4mg
Treatment of atopic dermatitis
Treatment of alopecia areata
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NICE TA681: Baricitinib for treating moderate to severe atopic dermatitis
NICE TA926: Baricitinib for treating severe alopecia areata
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Bimekizumab (Bimzelx ®)
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Formulary
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Pre-filled pen/syringe 160mg
Usually supplied to patients via a homecare delivery company
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NICE TA723: Bimekizumab for treating moderate to severe plaque psoriasis
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Brodalumab (Kyntheum®)
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Formulary
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Solution for injection pre-filled syringes 210mg/1.5ml
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NICE TA511: Brodalumab for treating moderate to severe plaque psoriasis
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Ciclosporin
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Formulary
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Consultant dermatologist or specilaist initiation only To be prescribed generically for dermatology patients See section 10.1.3
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LSCMMG: Shared care guideline - Ciclosporin
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Deucravacitinib (SOTYKTU )
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Formulary
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Film coated tablets 6mg
NICE TA907: Deucravacitinib for treating moderate to severe plaque psoriasis
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NICE TA907: Deucravacitinib for treating moderate to severe plaque psoriasis
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Dupilumab (Dupixent®)
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Formulary
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Pre-filled syringe 300mg/2ml solution for injection
NICE TA648: Dupilumab for treating chronic rhinosinusitis with nasal polyps (terminated appraisal)
NICE TA955: Dupilumab for treating moderate to severe prurigo nodularis
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MHRA: Dupilumab (Dupixent▼): risk of ocular adverse reactions and need for prompt management
NICE TA534: Dupilumab for treating moderate to severe atopic dermatitis
NICE TA955: Dupilumab for treating moderate to severe prurigo nodularis
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Etanercept (Biosimilars avaliable)
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Formulary
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S/C injection 50mg pre-filled syringe, pre-filled pen Consultant dermatologist or specilaist initiation only Usually supplied to patients by a home delivery company REQUIRES BLUETEQ APPROVAL
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MHRA: Tumour necrosis factor alpha inhibitors
NICE TA103: Etanercept and efalizumab for the treatment of adults with psoriasis
NICE TA455: Adalimumab, etanercept and ustekinumab for treating plaque psoriasis in children and young people
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Guselkumab (Tremfya®)
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Formulary
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Solution for injection in pre-filled pen 100mg/1ml
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NICE TA521: Guselkumab for treating moderate to severe plaque psoriasis
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Infliximab (Biosimilars avaliable)
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Formulary
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Intravenous infusion 100mg Consultant dermatologist or specilaist initiation only REQUIRES BLUETEQ APPROVAL
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MHRA: Tumour necrosis factor alpha inhibitors
NICE TA134: Infliximab for the treatment of adults with psoriasis
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Methotrexate
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Formulary
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Consultant dermatologist or specialist initiation only
Methotrexate should be prescribed once weekly as a single dose on the same day each week. If oral methotrexate is prescribed only use the 2.5 mg strength
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LSCMMG: Shared care guideline - Methotrexate
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Pimecrolimus 1% (Elidel®)
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Formulary
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Cream 30g, 60g, 100g
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NICE TA82: Tacrolimus and pimecrolimus for atopic eczema
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Risankizumab (Skyrizi®)
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Formulary
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solution for injection pre-filled syringes, solution for injection pre-filled pen 150mg/mL
NICE TA888 Risankizumab for previously treated moderately to severely active Crohn's disease - see link below
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NICE TA596: Risankizumab for treating moderate to severe plaque psoriasis
NICE TA803: Risankizumab for treating active psoriatic arthritis after inadequate response to DMARDs
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Secukinumab (Cosentyx®)
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Formulary
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150mg pre-filled syringe Usually supplied to patients by a home delivery company REQUIRES BLUETEQ APPROVAL Approved as for palmoplantar psoriasis - off-label use
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NICE TA350: Secukinumab for treating moderate to severe plaque psoriasis
NICE TA445: Certolizumab pegol and secukinumab for treating active psoriatic arthritis after inadequate response to DMARDs
NICE TA734: Secukinumab for treating moderate to severe plaque psoriasis in children and young people
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Tacrolimus (Protopic®)
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Formulary
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Ointment 0.03%, 0.1% 30g, 60g Consultant dermatologist or specilaist initiation only
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MHRA: Tacrolimus ointment (Protopic): possible risk of malignancies including lymphomas and skin cancers
NICE TA82: Tacrolimus and pimecrolimus for atopic eczema
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Tildrakizumab (Ilumetri®)
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Formulary
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Solution for injection pre-filled syringes 100mg/1ml
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NICE TA575: Tildrakizumab for treating moderate to severe plaque psoriasis
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Tralokinumab (Adtralza ®)
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Formulary
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Pre-filled syringe 150 mg solution for injection - for treating moderate to severe atopic dermatitis - see link below
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NICE TA814: Abrocitinib, tralokinumab or upadacitinib for treating moderate to severe atopic dermatitis
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Upadacitinib (Rinvoq ®)
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Formulary
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Prolonged release tablets 15mg
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MHRA: Janus kinase (JAK) inhibitors: new measures to reduce risks of major cardiovascular events, malignancy, venous thromboembolism, serious infections and increased mortality
NICE TA814: Abrocitinib, tralokinumab or upadacitinib for treating moderate to severe atopic dermatitis
NICE768: Upadacitinib for treating active psoriatic arthritis after inadequate response to DMARDs
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Ustekinumab (Stelara®)
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Formulary
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Injection 45mg, 90mg pre-filled syringe Consultant dermatologist or specilaist initiation only Usually supplied to patients by a home delivery company REQUIRES BLUETEQ APPROVAL
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NICE TA180: Ustekinumab for the treatment of adults with moderate to severe psoriasis
NICE TA455: Adalimumab, etanercept and ustekinumab for treating plaque psoriasis in children and young people
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Brimonidine Gel (Mirvaso® )
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Restricted
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3mg/g gel brimonidine tartrate
(Only for use in patients with moderate to severe, persistent facial erythema of rosacea)
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Ivermectin cream 1% (Soolantra®) (Rosacea)
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Formulary
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Cream
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NICE: Inflammatory lesions of papulopustular rosacea: ivermectin 10 mg/g cream
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Trifarotene 0.05% Cream (Aklief®)
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Formulary
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For acne
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13.06.01 |
Topical preparations for acne |
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Patients should be referred to their community pharmacist or GP for advice/prescription of topical preparations for acne. |
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13.06.01 |
Benzoyl peroxide and azelaic acid |
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Azelaic Acid 15% (Finacae®)
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Formulary
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Gel 30g
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Azelaic Acid 20% (Skinoren®)
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Formulary
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Cream
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Benzoyl Peroxide 5% (Acnecide®)
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Formulary
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Gel
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Benzoyl Peroxide 5% with Clindamycin 1% (Duac® Once Daily)
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Formulary
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Gel 30g, 60g
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13.06.01 |
Topical antibacterials for acne |
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Erythromycin 40mg with Zinc Acetate 12mg/mL (Zineryt®)
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Formulary
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Lotion 30mL, 90mL
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Clindamycin 1% (Dalacin T®)
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Formulary
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Lotion 30mL, 60mL
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Clindamycin 1% gel
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Formulary
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Gel 1%
For oncology patients only
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13.06.01 |
Topical retinoids and related preparations for acne |
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Adapalene 0.1% (Differin®)
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Formulary
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Cream 45g
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Adapalene 0.1% / Benzoyl Peroxide 2.5% (Epiduo®)
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Formulary
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Gel 45g
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Clindamycin 1%/ tretinoin 0.025% (Treclin®)
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Formulary
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Gel
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13.06.01 |
Other topical preparations for acne |
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13.06.02 |
Oral preparations for acne |
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13.06.02 |
Oral antibiotics for acne |
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Doxycycline
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Formulary
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Capsules 100mg
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Erythromycin
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Formulary
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Tablets 250mg
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Lymecycline
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Formulary
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Capsules 408mg
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Oxytetracycline
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Formulary
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Tablets 250mg
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13.06.02 |
Hormone treatment for acne |
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Co-Cyprindiol
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Formulary
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Tablets cyproterone 2mg / ethinylestradiol 35 micrograms
CSM advice: VTE risk - see BNF
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MHRA: Cyproterone acetate with ethinylestradiol (co-cyprindiol): balance of benefits and risks remains positive
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13.06.02 |
Oral retinoid for acne |
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Isotretinoin
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Formulary
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Capsules 5mg, 20mg
Consultant dermatologist or specialist only
Pregnancy must be excluded before initiation and before each repeat prescription.
Prescriptions for women are limited to 28 days treatment
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MHRA: Isotretinoin (Roaccutane▼): introduction of new safety measures, including additional oversight of the initiation of treatment for patients under 18 years of age
MHRA: Isotretinoin: risk of serious skin reactions
MHRA: Oral retinoid medicines▼: revised and simplified pregnancy prevention educational materials for healthcare professionals and women
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13.06.03 |
Topical preparations for rosacea |
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13.07 |
Preparations for warts and calluses |
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Salicylic Acid 16.7% with Lactic Acid 16.7% (Salactol®)
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Formulary
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Paint 10mL
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Glutarol 10% solution
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Formulary
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Cutaneous solution 10%
For Primary care use only
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Salicylic Acid 26% (Occlusal®)
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Formulary
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Solution
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Silver Nitrate 75% (AVOCA®)
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Formulary
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Caustic applicator
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Imiquimod 5% (Aldara®)
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Formulary
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Cream
External genital warts and actinic keratosis
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Podophyllotoxin 0.015% (Warticon®)
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Formulary
|
Cream 5g
|
|
13.08 |
Sunscreens and camouflagers |
|
|
Aminolevulinic acid (Ameluz®)
|
Formulary
|
gel 78mg/g
|
|
13.08.01 |
Sunscreen preparations |
|
|
Sunsense® Ultra
|
Formulary
|
Factor 50 lotion 50mL
for ACBS conditions only, otherwise self care
|
|
|
5-aminolevulinic acid (Alacare ®)
|
Formulary
|
Medicated plaster 8mg - Each medicated plaster of 4 cm2 contains 8 mg 5-aminolevulinic acid, 2 mg per cm2
Alacare plasters are only recommended for single-use treatment of mild actinic keratoses lesions with a maximum diameter of 1.8cm on the face and scalp (hairless areas)
|
|
Diclofenac 3% (Solaraze®)
|
Formulary
|
Gel 25g
|
|
Fluorouracil 5% (Efudix®)
|
Formulary
|
Cream 40g
for actinic keratosis
for the treatment of small superficial basal-cell carcinomas in adults
treatment of superficial pre-malignant skin lesions
|
|
Imiquimod (Aldara®)
|
Formulary
|
Cream 5%
for treatment of small superficial basal cell carcinoma in adults
|
|
Methyl-5-Aminolevulinate (Metvix®)
|
Formulary
|
Cream 2g
|
|
Tirbanibulin (Klisyri ®)
|
Formulary
|
Ointment 10 mg/g
Each sachet contains 2.5 mg of tirbanibulin in 250 mg ointment.
|
|
|
13.09 |
Shampoos and other preparations for scalp and hair conditions |
|
|
Capasal®
|
Formulary
|
Shampoo 250mL
|
|
Coal Tar Shampoo
|
Formulary
|
|
LSCMMG: Over the Counter Items that Should not be Routinely Prescribed in Primary Care Policy
|
Ketoconazole 2%
|
Formulary
|
Shampoo 120mL
|
LSCMMG: Over the Counter Items that Should not be Routinely Prescribed in Primary Care Policy
|
13.09 |
Hirsutism |
|
|
13.09 |
Androgenetic alopecia |
|
|
13.10 |
Anti-infective skin preparations |
|
|
13.10.01 |
Antibacterial preparations |
|
|
13.10.01.01 |
Antibacterial preparations only used topically |
|
|
Mupirocin 2% (Bactroban®)
|
Formulary
|
Cream 15g
|
|
Silver Sulfadiazine 1% (Flamazine®)
|
Formulary
|
Cream 50g
|
|
13.10.01.02 |
Antibacterial preparations also used systemically |
|
|
Fusidic Acid 2%
|
Formulary
|
Cream 15g Ointment 15g
|
|
Metronidazole 0.75% gel
|
Formulary
|
Gel 30g
|
|
13.10.02 |
Antifungal preparations |
|
|
Clotrimazole 1%
|
Formulary
|
Cream 20g
|
|
Miconazole 2%
|
Formulary
|
Cream 30g
|
MHRA: Topical miconazole, including oral gel: reminder of potential for serious interactions with warfarin
|
Terbinafine 1% cream
|
Formulary
|
Cream 15g
|
|
13.10.03 |
Antiviral preparations |
|
|
Aciclovir 5%
|
Formulary
|
Cream 2g, 10g
|
|
13.10.04 |
Parasiticidal preparations |
|
|
Ivermectin
|
Formulary
|
Tablets 3mg For hyperkeratotic (crusted or Norwegian) scabies unresponsive to topical treatment alone.
|
|
|
|
13.10.04 |
Head lice |
|
|
|
13.10.04 |
Benzyl benzonate |
|
|
|
|
Dimeticone (Hedrin®)
|
Formulary
|
Lotion 4%
|
LSCMMG: Over the Counter Items that Should not be Routinely Prescribed in Primary Care Policy
|
13.10.04 |
Malathion |
|
|
Malathion 0.5% (Derbac-M®)
|
Formulary
|
Liquid in an aqueous basis 50mL, 200mL
|
|
|
Permethrin 5% (Lyclear® Dermal Cream)
|
Formulary
|
Dermal cream 30g
|
|
|
13.10.05 |
Preparations for minor cuts and abrasions |
|
|
Magnesium Sulphate Paste BP
|
Formulary
|
50g
|
|
|
13.10.05 |
Skin tissue adhesive |
|
|
13.11 |
Skin cleansers, antiseptics, and desloughing agents |
|
|
|
Skin cleansers and antiseptics listed in BNF sections 13.11.1 - 13.11.5 are obtained from stores |
|
Octenisan® (Antimicrobial wash)
|
Formulary
|
|
|
13.11.01 |
Alcohols and saline |
|
|
13.11.02 |
Chlorhexidine salts |
|
|
Chlorhexidine gluconate 4% (Hibiscrub®)
|
Formulary
|
Cleansing solution, 250mL, 500mL For use by dermatologists only
|
|
Chlorhexidine Gluconate Cream (Hibitane Obstetric®)
|
Formulary
|
Cream 5%
|
|
|
|
13.11.03 |
Cationic surfactants and soaps |
|
|
13.11.04 |
Iodine and Chlorine |
|
|
|
13.11.06 |
Oxidisers, and dyes |
|
|
Hydrogen Peroxide 1% (Crystacide®)
|
Formulary
|
Cream 25g
|
|
Potassium Permanganate (Permitabs®)
|
Formulary
|
Solution tablets 400mg
Primary Care : Potassium permanganate should always be prescribed for a named patient by a primary care prescriber, experienced in the treatment of dermatological conditions and use of potassium permanganate.
Secondary Care:- Potassium permanganate concentrate should always be prescribed for a named patient by a specialist in dermatology, a clinician working under the guidance of a dermatologist, or specialist tissue viability staff only.
Note: A risk assessment must be completed if potassium permanganate is to be used in a patient's home
|
BAD and NHS England & NHS Improvement guidance on the safe use of potassium permanganate soaks
NHS Central alerting system
|
13.11.07 |
Desloughing agents |
|
|
Sterile Larvae (Maggots) (LarvE®)
|
Formulary
|
Available to order for named patients
|
|
13.11.07 |
Desloughing agents |
|
|
13.11.07 |
Growth factor |
|
|
|
Botulinum toxin type A
|
Formulary
|
For treatment of primary idiopathic hyperhidrosis and secondary hyperhidrosis.
- as an option for the management of severe primary idiopathic hyperhidrosis of the axillae, which does not respond to self-care strategies and topical treatment, and where the cause is NOT due to social anxiety.
- as an option for the management of severe secondary hyperhidrosis of the axillae, which does not respond to self-care strategies and topical treatment, where the cause is NOT due to social anxiety and where the primary condition has been optimally managed as far as reasonable to alleviate the hyperhidrosis.
In order to reduce the potential for antibody formation which reduces the effectiveness of treatment, inject the lowest effective dose at the longest clinically indicated interval
|
LSCMMG: Botulinum Toxin Type A
|
13.13 |
Topical circulatory preparations |
|
|
13.14 |
dermatology specials |
|
|
.... |
Non Formulary Items |
|
Key |
|
Restricted Drug |
|
Unlicensed |
|
Link to adult BNF
|
|
Link to children's BNF
|
|
Link to SPCs
|
|
Scottish Medicines Consortium |
|
Cytotoxic Drug |
|
Controlled Drug |
|
|
High Cost Medicine |
|
Cancer Drugs Fund |
|
NHS England |
|
Homecare |
|
ICB |
|
Low carbon footprint |
|
Medium carbon footprint |
|
High carbon footprint |
|
Status |
Description |
|
Green:
Appropriate for initiation and ongoing prescribing in both primary and secondary care.
Generally, little or no routine drug monitoring is required. |
|
Green (Restricted):
Appropriate for initiation and ongoing prescribing in both primary and secondary care provided:
Additional criteria specific to the medicine or device are met, or
The medicine or device is used following the failure of other therapies as defined by the relevant LSCMMG pathway.
Generally, little or no routine drug monitoring is required.
|
|
Red medicines:
Medicine is supplied by the hospital for the duration of the treatment course.
Primary care initiation or continuation of treatment is not recommended unless exceptional circumstances such as specialist GP.
Red medicines are those where primary care prescribing is not recommended. These treatments should be initiated by specialists only and prescribing retained within secondary care. They require specialist knowledge, intensive monitoring, specific dose adjustments or further evaluation in use. If however, a primary care prescriber has particular specialist knowledge or experience of prescribing a particular drug for a particular patient it would not always be appropriate for them to expect to transfer that prescribing responsibility back to secondary care. There should be a specific reason and a specific risk agreement, protocol and service set up to support this.
Primary care prescribers may prescribe RED medicines in exceptional circumstances to patients to ensure continuity of supply while arrangements are made to obtain ongoing supplies from secondary care. |
|
Amber level 0:
Suitable for prescribing in primary care following recommendation or initiation by a specialist.
Little or no specific monitoring required.
Patient may need a regular review, but this would not exceed that required for other medicines routinely prescribed in primary care.
Brief prescribing document or information sheet may be required.
Primary care prescribers must be familiar with the drug to take on prescribing responsibility or must get the required information.
When recommending or handing over care, specialists should ask primary care prescribers to take over prescribing responsibility, and should give enough information about the indication, dose, monitoring requirements, use outside product licence and any necessary dose adjustments to allow them to confidently prescribe. |
|
Amber level 1 (with shared care):
Suitable for prescribing in primary care following recommendation or initiation by a specialist.
Minimal monitoring required.
Patient may need a regular review, but this would not exceed that required for other medicines routinely prescribed in primary care.
Full prior agreement about patient’s on-going care must be reached under the shared care agreement.
Primary care prescribers are advised not to take on prescribing of these medicines unless they have been adequately informed by letter of their responsibilities with regards monitoring, side effects and interactions and are happy to take on the prescribing responsibility. A copy of locally approved shared care guidelines should accompany this letter which outlines these responsibilities. Primary care prescribers should then tell secondary care of their intentions as soon as possible by letter so that arrangements can be made for the transfer of care. |
|
Amber level 2 (with shared care and enhanced service):
Initiated by specialist and transferred to primary care following a successful initiation period.
Significant monitoring required on an on-going basis.
Full prior agreement about patient’s on-going care must be reached under the shared care agreement.
Suitable for enhanced service.
These medicines are considered suitable for GP prescribing following specialist initiation of therapy, as per shared care document which will be sent out with the request to prescribe, with on-going communication between the primary care prescriber and specialist. Amber Level 2 medicines require significant monitoring for which an enhanced service may be suitable. (Subject to local commissioning agreements). |
|
Do not prescribe: NOT recommended for use by the NHS in Lancashire and South Cumbria.
Includes medicines that NICE has not recommended for use and terminated technology appraisals, unless there is a local need. |
|
Grey medicines:
Medicines which have not yet been reviewed or are under the review process.
GPs and specialists are recommended not to prescribe these drugs.
This category includes drugs where funding has not yet been agreed.
|
|
Refer to local guidance and local commissioning arrangements |
|
|
|