| Formulary Chapter 9: Nutrition and blood - Full Chapter
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| Chapter Links... |
 LSCMMG: Bariatric surgery guidelines for prescribing of vitamins and nutritional supplements: Position Statement |
| LSCMMG: Gluten-Free food products: Position Statement |
| LSCMMG: Oral Nutritional Supplements in Primary Care |
| LSCMMG: PKU - Prescribing of Multivitamins & Phenylalanine-free amino acid substitutes for adults and children |
| NICE CG32: Nutrition support for adults: oral nutrition support, enteral tube feeding and parenteral nutrition |
| NICE NG20: Coeliac disease: recognition, assessment and management |
| NICE NG203: Chronic kidney disease: assessment and management |
| Details... |
| 09.01 |
Anaemias and some other blood disorders |
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| 09.01.01 |
Iron-deficiency anaemias |
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Roxadustat (Evrenzo®)
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Formulary
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Tablets 20mg, 50mg, 70mg, 100mg, 150mg
Females of childbearing potential should use highly effective contraception during treatment and for at least 1 week after last treatment.
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 NICE TA807: Roxadustat for treating symptomatic anaemia in chronic kidney disease
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| 09.01.01.01 |
Oral iron |
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Ferrous Sulphate
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First Choice
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Tablets 200mg (equivalent to 65 mg elemental iron)
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Ferrous Fumarate
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Formulary
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Tablets 210mg (equivalent to 69 mg elemental iron), 322mg (equivalent to 106 mg elemental iron)
Oral solution 140mg/5ml (equivalent to 9 mg/mL elemental iron)
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Sodium Feredetate
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Formulary
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Sytron® oral solution contains sodium feredetate trihydrate 41.5 mg/mL equivalent to 5.5 mg/mL elemental iron.
Sodifer® oral solution contains sodium feredetate 38 mg/mL equivalent to 5.5 mg/mL elemental iron.
Sodifer® is not suitable for babies under 28 days.
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Medicines for children: Sodium feredetate for the prevention of anaemia
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Ferric maltol
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Formulary
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Iron Deficiency Anaemia in Adult Patients with Inflammatory Bowel Disease.
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LSCMMG: Ferric Maltol NMR
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| 09.01.01.01 |
Iron and folic acid |
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Iron and Folic Acid (Pregaday®)
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Formulary
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Tablets ferrous fumarate 322 mg (equivalent to 106 mg elemental iron) and folic acid 350 microgram
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| 09.01.01.01 |
Compound iron preparations |
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| 09.01.01.02 |
Parenteral iron |
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Prescribe parenteral iron products by brand name - important differences between formulations. |
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Ferric Carboxymaltose (Ferinject®)
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Formulary
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Injection 50mg/mL
First line choice. Follow Trust protocols.
For use in patients with asthma or eczema.
For use when total dose infusion is needed.
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MHRA: Ferric carboxymaltose (Ferinject▼): risk of symptomatic hypophosphataemia leading to osteomalacia and fractures
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Ferric Derisomaltose
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Formulary
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Injection Diafer® 50mg/mL
Injection Monofer® 100mg/ml
Follow Trust protocols.
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MHRA: Monofer 100mg/ml solution for injection/infusion▼ and Diafer 50mg/ml solution for injection▼: name change from iron isomaltoside to ferric derisomaltose
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Iron Sucrose (Venofer®)
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Formulary
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Injection 100mg/5mL
Second line choice. Follow Trust protocols.
For intravenous use only.
Do not use in patients with asthma or eczema.
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| 09.01.02 |
Drugs used in megaloblastic anaemias |
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Hydroxocobalamin
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Formulary
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Injection 1mg/1mL
1st line treatment in vitamin B12 deficiency.
 Following gastric bypass or sleeve gastrectomy.
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MHRA: Vitamin B12 (hydroxocobalamin, cyanocobalamin): advise patients with known cobalt allergy to be vigilant for sensitivity reactions
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Cyanocobalamin
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Formulary
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Tablets 1mg
Treatment of non-dietary vitamin B12 deficiency when hydroxocobalamin injection is inappropriate or cannot be administered, and in dietary related deficiency only until B12 levels are replete, at which point patients are encouraged to self-care with 50-150mcg tablets daily purchased over the counter.
Maintenance therapy of dietary related insufficiency. Patients are advised to self-care by purchase of 50mcg tablets over the counter.
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LSCMMG: Over the Counter Items that Should not be Routinely Prescribed in Primary Care Policy
MHRA: Vitamin B12 (hydroxocobalamin, cyanocobalamin): advise patients with known cobalt allergy to be vigilant for sensitivity reactions
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Folic Acid
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Formulary
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Tablets 400 microgram, 5mg
Liquid 2.5mg/5mL
Should never be given alone for pernicious anaemia or other megaloblastic anaemias caused by vitamin B12 deficiency (may precipitate subacute combined degeneration of the spinal cord).
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Medicines for children: Folic acid for megaloblastic anaemia caused by folate deficiency and haemolytic anaemia
MHRA: Medicines in pregnancy and breastfeeding: new initiative for consistent guidance; report on optimising data for medicines used during pregnancy
NICE NG247: Maternal and child nutrition: nutrition and weight management in pregnancy, and nutrition in children up to 5 years
UK Chief Medical Officers Chief Nursing Officers and Chief Midwifery Officers - Folic Acid
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| 09.01.03 |
Drugs used in hypoplastic, haemolytic, and renal anaemias |
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Crovalimab (Piasky®)
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Formulary
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Solution for injection 340mg/2ml
Specialist initiation only.
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NICE TA1019: Crovalimab for treating paroxysmal nocturnal haemoglobinuria in people 12 years and over
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Danicopan
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Formulary
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Tablets 50mg, 100mg
Specialist initiation only.
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NICE TA1010: Danicopan with ravulizumab or eculizumab for treating paroxysmal nocturnal haemoglobinuria
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Iptacopan (Fabhalta®)
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Formulary
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Capsules 200mg
Specialist initiation only.
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NICE TA1000: Iptacopan for treating paroxysmal nocturnal haemoglobinuria
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Ravulizumab (Ultomiris®)
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Formulary
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Concentrate for solution for infusion 300mg/3mL, 1,100mg/11mL
Tertiary centre use only for treating paroxysmal nocturnal haemoglobinuria.
Specialist initiation only.
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NICE TA698: Ravulizumab for treating paroxysmal nocturnal haemoglobinuria
NICE TA710: Ravulizumab for treating atypical haemolytic uraemic syndrome
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Rituximab
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Formulary
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Rituximab is recommended as an alternative treatment for adults with autoimmune haemolytic anaemia (AIHA) where patients are contraindicated to or fail to respond to standard active treatments (e.g corticosteroids).  (Unlicensed)
Treatment requires initiation and continuation by specialist haematology services.
All anti-lymphocyte monoclonal antibodies should be given under the supervision of an experienced specialist, in an environment where full resuscitation facilities are immediately available.
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LSCMMG: Rituximab Intravenous Infusion for the Treatment of Autoimmune Haemolytic Anaemia (AIHA) in Adults NMR
MHRA: Rituximab: screen for hepatitis B virus before treatment
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Vadadustat (Vafseo®)
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Formulary
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Capsules 150mg, 300mg
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NICE TA1035: Vadadustat for treating symptomatic anaemia in adults having dialysis for chronic kidney disease
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| 09.01.03 |
Erythropoietin |
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Darbepoetin Alfa (Aranesp®)
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Formulary
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Injection prefilled syringe 10micrograms, 30micrograms, 50micrograms
Injection prefilled syringe and SureClick 20micrograms, 40micrograms, 60micrograms, 80micrograms, 100micrograms.
Consultant initiation only
Dialysis-induced anaemia.
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Epoetin alfa (Eprex®)
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Formulary
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Injection prefilled syringe 10,000units, 40,000units
Consultant initiation only.
 Dialysis-induced anaemia.
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Epoetin zeta (Retacrit®)
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Formulary
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**For use in Blackpool Teaching Hospitals NHS Foundation Trust only**
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| 09.01.03 |
Iron overload |
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Desferrioxamine Mesilate
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First Choice
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Injection 500mg, 2g vials
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Deferiprone
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Second Choice
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Tablets 500mg
Consultant haematologist only.
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Deferasirox
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Formulary
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Tablets 90mg, 180mg, 360mg
Consultant haematologist only.
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| 09.01.04 |
Drugs used in autoimmune thrombocytopenic purpura |
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Anagrelide
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Formulary
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Capsules 500 micrograms
Specialist initiation only.
Effective contraception required during treatment.
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MHRA: Xagrid (anagrelide hydrochloride): Risk of thrombosis, including cerebral infarction, if treatment discontinued abruptly. [also applicable to generic forms]
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Avatrombopag (Doptelet®)
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Formulary
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Tablets 20mg
Specialist initiation only.
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NICE TA626: Avatrombopag for treating thrombocytopenia in people with chronic liver disease needing a planned invasive procedure
NICE TA853: Avatrombopag for treating primary chronic immune thrombocytopenia
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Caplacizumab (Cablivi ®)
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Formulary
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Solution for injection 10mg
Specialist initiation only.
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NICE TA667: Caplacizumab with plasma exchange and immunosuppression for treating acute acquired thrombotic thrombocytopenic purpura
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Eltrombopag (Revolade®)
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Formulary
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Tablets 25mg, 50mg
Specialist initiation only.
Ensure effective contraception during treatment.
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MHRA: Eltrombopag (Revolade): reports of interference with bilirubin and creatinine test results
NICE TA293: Eltrombopag for treating chronic immune thrombocytopenia
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Fostamatinib (TAVLESSE ®)
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Formulary
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Film coated tablets, 100mg, 150mg
Specialist initiation only.
Manufacturer advises effective contraception during and for at least 1 month after stopping treatment in females of childbearing potential.
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NICE TA835: Fostamatinib for treating refractory chronic immune thrombocytopenia
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Lusutrombopag (Mulpleo®)
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Formulary
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Film coated tablets 3mg
Specialist initiation only.
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NICE TA617: Lusutrombopag for treating thrombocytopenia in people with chronic liver disease needing a planned invasive procedure
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Romiplostim (Nplate®)
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Formulary
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Injection 250 micrograms
Specialist initiation only.
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NICE TA221: Romiplostim for the treatment of chronic immune thrombocytopenia
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Rituximab
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Unlicensed
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Off-label use for the treatment of idiopathic thrombocytopenia in adults.
For use as an alternative 2nd line treatment in adults with ITP following failure of corticosteriod treatment or when corticosteroids and thrombopoietin receptor agonists are contraindicated
Treatment requires initiation and continuation and continuation by specialist haematology services.
All anti-lymphocyte monoclonal antibodies should be given under the supervision of an experienced specialist, in an environment where full resuscitation facilities are immediately available.
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LSCMMG: Rituximab Intravenous Infusion For treatment of Idiopathic Thrombocytopenia Purpura (ITP) in adults NMR
MHRA: Rituximab: screen for hepatitis B virus before treatment
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| 09.01.05 |
G6PD deficiency |
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| 09.01.06 |
Drugs used in neutropenia |
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Filgrastim
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Formulary
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Injection 12 million units in 0.2mL prefilled syringe, 30 million units & 48 million units in 0.5mL prefilled syringe
Specialist initiation only.
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MHRA: Filgrastim and pegfilgrastim: risk of capillary leak syndrome
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Pegfilgrastim
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Formulary
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Injection 6mg in 0.6mL prefilled syringe
Specialist initiation only.
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MHRA: Filgrastim and pegfilgrastim: risk of capillary leak syndrome
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| 09.01.07 |
Drugs used to mobilise stem cells |
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| 09.02 |
Fluids and electrolytes |
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| 09.02.01 |
Oral preparations for fluid and electrolyte imbalance |
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| 09.02.01.01 |
Oral potassium |
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Potassium chloride with potassium bicarbonate (Sando-K®)
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First Choice
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Effervescent tablets potassium 470 mg (12 mmol of K+) and chloride 285mg (8 mmol of Cl-)
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Potassium Chloride
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Second Choice
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Modified-release tablets 600mg (potassium 8mmol)
Avoid unless effervescent tablets or liquid preparations inappropriate.
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Potassium Chloride oral liquid
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Second Choice
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Unlicensed potassium chloride oral solutions manufactured within the UK are available via Specials manufacturers, lead times vary.
Care is needed to ensure selection of the most appropriate oral potassium supplement and delivery of the correct dosage.
This National Patient Safety Alert provides further background, clinical information and actions for providers.
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CAS: UPDATE: Discontinuation of Kay-Cee-L (potassium chloride 375mg/ml) (potassium chloride 5mmol/5ml) syrup
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| 09.02.01.01 |
Potassium removal |
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Calcium polystyrene sulfonate (Calcium Resonium®)
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Formulary
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Powder for oral or rectal suspension 99.934% w/w calcium polystyrene sulfonate
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Patiromer calcium
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Formulary
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Oral powder sachets 8.4g, 16.8g
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NICE TA623: Patiromer for treating hyperkalaemia
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Sodium zirconium cyclosilicate
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Formulary
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Oral powder sachets 5g, 10g
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NICE TA599: Sodium zirconium cyclosilicate for treating hyperkalaemia
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| 09.02.01.02 |
Oral sodium and water |
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Sodium Chloride (Slow Sodium®)
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Formulary
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Modified release tablets 600mg (10mmol), 1mmol/ml oral solution, 5mmol/ml oral solution
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Medicines for children: Sodium chloride for hyponatraemia (low levels of sodium in the blood)
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| 09.02.01.02 |
Oral rehydration therapy (ORT) |
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Oral Rehydration Salts
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Formulary
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Dioralyte® sachets
ORS Hydration tablets
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LSCMMG: Over The Counter (OTC) Items That Should Not Be Routinely Prescribed In Primary Care Policy
Medicines for children: Oral rehydration salts
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| 09.02.01.03 |
Oral bicarbonate |
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Sodium Bicarbonate
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Formulary
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Capsules 500mg (approx 6 mmol each of Na+ and HCO3-)
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| 09.02.02 |
Parenteral preparations for fluid and electrolyte imbalance |
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| 09.02.02.01 |
Electrolytes and water |
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| 09.02.02.01 |
Intravenous sodium |
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| 09.02.02.01 |
Intravenous glucose |
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| 09.02.02.01 |
Intravenous potassium |
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| 09.02.02.01 |
Bicarbonate and lactate |
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| 09.02.02.01 |
Water |
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| 09.02.02.02 |
Plasma and plasma substitutes |
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| 09.02.02.02 |
Plasma substitutes |
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| 09.03 |
Intravenous nutrition |
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| 09.03 |
Supplementary preparations |
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| 09.04 |
Oral nutrition |
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| 09.04.01 |
Foods for special diets |
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| 09.04.02 |
Enteral nutrition |
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| 09.05 |
Minerals |
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| 09.05.01 |
Calcium and magnesium |
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| 09.05.01.01 |
Calcium supplements |
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Calcium Carbonate
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Formulary
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Chewable tablets calcium carbonate 1.25 g (calcium 500 mg or Ca2+ 12.5 mmol)
Chewable tablets calcium carbonate 1.5 g (calcium 600 mg or Ca2+ 15 mmol)
Effervescent tablets calcium carbonate 1.25mg (calcium 500 mg or Ca2+ 12.5 mmol)
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Calcium carbonate with calcium lactate gluconate (Calvive 1000® Effervescent Tablets)
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Formulary
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Effervescent tablets calcium 1000mg (25mmol)
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Calcium Chloride
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Formulary
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Injection 10mmol/10mL amp
Injection 6.8mmol/10mL prefilled syringe (1g in 10mL)
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MHRA: Calcium chloride, calcium gluconate: potential risk of underdosing with calcium gluconate in severe hyperkalaemia
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Calcium Gluconate
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Formulary
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Injection 10% (calcium 2.25mmol/10mL)10mL amp
Injection 10% 50mL vial
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MHRA: Calcium chloride, calcium gluconate: potential risk of underdosing with calcium gluconate in severe hyperkalaemia
MHRA: Calcium gluconate injection in small-volume glass containers: new contraindications due to aluminium exposure risk
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| 09.05.01.02 |
Hypercalcaemia and hypercalciuria |
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Cinacalcet
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Formulary
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Tablets 30mg, 60mg
Consultant endocrinologist initiation only.
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NICE TA117: Cinacalcet for the treatment of secondary hyperparathyroidism in patients with end-stage renal disease on maintenance dialysis therapy
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Etelcalcetide (Parsabiv®)
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Formulary
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Injection
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NICE TA448: Etelcalcetide for treating secondary hyperparathyroidism
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| 09.05.01.03 |
Magnesium |
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Magnesium preparations may not be interchangeable due to differences in bioavailability, therefore caution should be exercised when switching preparations to ensure tolerability and to maintain therapeutic effect. |
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Magnesium Aspartate
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Formulary
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Oral powder sachets 10mmol
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Magnesium citrate
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Formulary
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Tablets 4mmol
First line magnesium replacement choice in patients with a bowel stoma.
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Magnesium Glycerophosphate
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Formulary
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Tablets 4mmol
Oral solution 1mmol/1ml -Unlicensed
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NICE: Preventing recurrent hypomagnesaemia: oral magnesium glycerophosphate
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Magnesium Sulfate
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Formulary
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Injection 50% (magnesium 2mmol/mL)
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MHRA: Magnesium sulfate: risk of skeletal adverse effects in the neonate following prolonged or repeated use in pregnancy
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| 09.05.02 |
Phosphorus |
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| 09.05.02.01 |
Phosphate supplements |
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Phosphate oral (Phosphate-Sandoz®)
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First Choice
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Effervescent tablets sodium dihydrogen phosphate anhydrous (anhydrous sodium acid phosphate) 1.936 g, sodium bicarbonate 350 mg, potassium bicarbonate 315 mg, equivalent to phosphorus 500 mg (phosphate 16.1 mmol), sodium 468.8 mg (Na+ 20.4 mmol), potassium 123 mg (K+ 3.1 mmol)
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Phosphate infusion
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Formulary
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Intravenous infusion (phosphate 50mmol/500mL) 500mL
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Phosphate oral (Joulies phosphate oral solution)
(For paediatric use)
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Unlicensed
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Oral solution phosphate 0.98mmol/ml (sodium 0.76 mmol per 1mL)
For paediatric use only.
Available from special order manufacturers.
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| 09.05.02.02 |
Phosphate-binding agents |
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| 09.05.03 |
Fluoride |
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| 09.05.04 |
Zinc |
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| 09.05.05 |
Selenium |
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| 09.06 |
Vitamins |
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To avoid potential toxicity, the content of all vitamin preparations, particularly vitamin A, should be considered when used together with other supplements. |
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| 09.06.01 |
Vitamin A |
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Vitamin A supplementation should only be initiated or recommended by specialists.
Excessive doses may be teratogenic.
In view of evidence suggesting that high levels of vitamin A may cause birth defects, women who are (or may become) pregnant are advised not to take vitamin A supplements (including tablets and fish liver oil drops), except on the advice of a doctor or an antenatal clinic; nor should they eat liver or products such as liver paté or liver sausage. |
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Vitamin A and D Capsules
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Formulary
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Vitamin A 4000 units and vitamin D 400 units
Unlicensed.
Prescribing only following specialist initiation or recommendation.
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Vitamin A Palmitate injections
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Formulary
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100,000 units / 2 ml
Unlicensed.
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| 09.06.02 |
Vitamin B group |
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| 09.06.02 |
Oral vitamin B complex preparations |
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| 09.06.02 |
Other compounds |
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| 09.06.03 |
Vitamin C |
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| 09.06.04 |
Vitamin D |
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| 09.06.04 |
Vitamin D with Calcium |
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| 09.06.05 |
Vitamin E |
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| 09.06.06 |
Vitamin K |
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| 09.06.07 |
Multivitamin preparations |
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| 09.06.07 |
Vitamin and mineral supplements and adjuncts to synthetic diets |
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| 09.07 |
Bitters and tonics |
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| 09.08 |
Metabolic disorders |
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Contact pharmacy for advice |
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| 09.08.01 |
Drugs used in metabolic disorders |
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Asfotase alfa (Strensiq® )
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Formulary
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Solution for injection
Tertiary Centre Only.
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NICE: Asfotase alfa for treating paediatric-onset hypophosphatasia
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Avalglucosidase alfa (Nexviadyme ®)
|
Formulary
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Powder for concentrate for solution for infusion 100mg
Under expert supervision.
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NICE TA821: Avalglucosidase alfa for treating Pompe disease
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Eladocagene exuparvovec (Upstaza®)
|
Formulary
|
Solution for infusion 2.8 × 1011 vector genomes (vg)/0.5 mL
Tertiary Centre Only.
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Eplontersen (Wainzua®)
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Formulary
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Solution for injection 45 mg/0.8 ml
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NICE TA1020: Eplontersen for treating hereditary transthyretin-related amyloidosis
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Lumasiran (Oxlumo ®)
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Formulary
|
Solution for injection 94.5mg/0.5mL
Tertiary Centre Only.
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NICE HST25: Lumasiran for treating primary hyperoxaluria type 1
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Pegunigalsidase alfa (Elafbrio®)
|
Formulary
|
Concentrate for solution for infusion 20mg/10ml, 5mg/2.5ml
Under expert supervision.
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NICE TA915: Pegunigalsidase alfa for treating Fabry disease
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Vutrisiran (Amvuttra ®)
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Formulary
|
Under expert supervision.
Females of childbearing potential should use effective contraception during treatment; if conception is planned, vutrisiran and vitamin A supplementation should be stopped and vitamin A levels monitored - consult product literature.
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NICE TA868: Vutrisiran for treating hereditary transthyretin-related amyloidosis
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| 09.08.01 |
Wilsons disease |
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Penicillamine
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Formulary
|
Tablets 125mg, 250mg
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LSCMMG: Penicillamine shared care guideline
|
| 09.08.01 |
Carnitine deficiency |
|
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Levocarnitine
|
Formulary
|
Injection 1g in 5mL
Capsules 500mg
Oral solution paediatric 1.5g/5ml
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Medicines for children: Carnitine for metabolic disorders
|
| 09.08.01 |
Fabry's disease |
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| 09.08.01 |
Gaucher's disease |
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| 09.08.01 |
Mucopolysaccharidosis I |
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| 09.08.01 |
Pompe disease |
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| 09.08.01 |
Nephropathic cystinosis |
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| 09.08.01 |
Urea cycle disorders |
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| 09.08.02 |
Acute porphyrias |
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| 09.08.02 |
Drugs unsafe for use in acute porphyrias |
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| .... |
Key |
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Restricted Drug |
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Unlicensed |
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Link to adult BNF
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Link to children's BNF
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Link to SPCs
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Scottish Medicines Consortium |
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Cytotoxic Drug |
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Controlled Drug |
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High Cost Medicine
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Cancer Drugs Fund
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Homecare |
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ICB commissioned |
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NHS England commissioned |
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Blueteq form needed |
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Low carbon footprint |
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Medium carbon footprint |
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High carbon footprint |
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| Status |
Description |
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Green:
Appropriate for initiation and ongoing prescribing in both primary and secondary care.
Generally, little or no routine drug monitoring is required. |
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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.
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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. |
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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. |
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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. |
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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). |
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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. |
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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.
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Refer to local guidance. |
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