Tablets 100mg, 200mg, 400mg
M/R tablets 200mg, 400mg
Liquid 100mg/5mL
Suppositories 125mg, 250mg

Epilepsy.

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)

Tablets abacavir 600mg with lamivudine 300mg

 Specialist prescribing only

Osteoporosis after menopause.

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

Tablets 1mg

Second line vitamin K antagonist

Tablets 250mg
 

Capsules

Intravenous infusion 250mg, 500mg

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

Duaklir Genuair inhalation powder 340/12

Licensed for COPD only

Prevention of recurrence of ulcerative colitis following surgery

S/C injection 40mg prefilled syringe and pen

Usually supplied to patients by a home delivery company

REQUIRES BLUETEQ APPROVAL

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

Injection 1 in 1000 1mg/1mL

Tablets 25mg

Major Depressive Episodes.

with prior approval. LSCFT to approve all applications to use - patients currently on treatment can continue.

Concentrate for solution for infusion vials 12mg/1.2ml

For treating relapsing-remitting multiple sclerosis.

Tertiary centre only.

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.

Injection 5mg/10mL, 1mg/2mL
Intensive care injection 5mg/1mL

Pre-filled pen 75mg, 150mg

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

Tablets 6.25mg, 12.5mg, 25mg
 
First line gliptin on LSCMMG pathway

Injection 10 microgram, 20 microgram

Erectile Dysfunction.

Acute ischaemic stroke (NICE TA264)

Follow local policy

Capsules 100mg
Liquid 50mg/5mL

Parkinson's disease (but not drug-induced extrapyramidal symptoms).

Injection 500mg/2mL

  For neutropenia in children undergoing chemotherapy - Manchester protocol

gel 78mg/g

Tablets 100mg, 200mg

On advice of cardiology only

Tablets 10mg, 25mg, 50mg
Liquid 25mg/5mL

Sugar Free oral solution 50mg/5mL

Depression.

Consider overdose risk.

Tablets 10mg, 25mg, 50mg
Liquid 25mg/5mL
Sugar Free oral solution 50mg/5mL

Tablets 5mg, 10mg

First line dihydropyridine

Injection 500mg, 1g

Intravenous infusion 50mg

On advice of Microbiology only.

Solution for injection pre-filled syringes  100mg/0.67mL

Powder for solution for infusion 200mg

 Unlicensed special for treatment of painful swallowing, during/following radiotherapy to the head, neck and chest areas

Ointment, benzyl benzoate 1.25%, bismuth oxide 0.875%, bismuth subgallate 2.25%, hydrocortisone acetate 0.25%, Peru balsam 1.875%, zinc oxide 10.75%.

Do not use for longer than 7 days

Tablets 2.5mg, 5mg

  Apixaban for preventing stroke and systemic embolism in people with non-valvular atrial fibrillation (NICE TA275)

Apixaban for the prevention of venous thromboembolism after total hip or knee replacement in adults (NICE TA245)

Apixaban for the treatment and secondary prevention of deep vein thrombosis and/or pulmonary embolism (NICE TA341)

Eye drops 0.5% 

*under review*

Tablets 10mg, 20mg, 30mg

Capsules 80mg, 125mg

Adjunct treatment to prevent nausea and vomiting associated with moderately and highly emetogenic chemotherapy.

50mg/50ml vials for infusion

250mg/2.5ml concentrate vials for infusion

Prolonged release suspension for injection 400mg

LSCFT initiation only.

Schizophrenia in adult patients stabilised on oral aripiprazole. 

Application from RMO to be sent to Chief Pharmacist and Medical Director requesting its use.

When prescribing, dispensing, or administering, check that the correct preparation is used—the preparation usually used in hospital for the rapid control of an acute episode (solution for injection containing aripiprazole 7.5 mg/mL) should not be confused with depot preparations (powder and solvent for prolonged-release suspension for injection), which are usually used in the community or clinics for maintenance treatment.

Injection 60mg

Consultant Microbiologist request only

Available for ‘named-patient’ use from infectious disease units or specialist tropical disease centres.

Tertiary Centre

Solution for injection

100mg/ml, 40mg/ml

Granules for oral suspension 1000mg, 125mg, 250mg

Ataluren for treating Duchenne muscular dystrphy with a nonsense mutation in the dystrophin gene (replaces HST3) - likely to be tertiary centre only

Tablets atazanavir 300 mg, cobicistat 150 mg

  Specialist prescribing only

Capsules 10mg, 18mg, 25mg, 40mg, 60mg

ADHD

 Restricted to initiation by child or adolescent psychiatrists or paediatricians
experienced in the management of ADHD.

Injection 6.75 mg/0.9mL, concentrate for infusion 37.5 mg/5mL 

Uncomplicated premature labour

Second line option when other options have failed or are unsuitable.

Eye drops 1% 

Minims^® 1%

Powder for concentrate for solution for infusion 100mg - for treating Pompe disease - see link below

Tablets 20mg

  NICE TA853 for treating primary chronic immune thrombocytopenia - see link below

Tablets 25mg, 50mg

 Inflammatory bowel disease, Rheumatic diseases, Dermatology.

 Myasthenia Gravis.

 Transplant rejection.

See section 01.05.03 and 13.05.03.

Tablets 25mg, 50mg
Unlicensed indication
Consultant dermatologist or specilaist initiation only
See section 10.1.3

nasal spray 140 microgram per 1 actuation

After tertiary referral only

 in East Lancashire

Capsules 750mg

Tablets 2mg, 4mg

Fostair® / Luforbec® 100mcg beclometasone/6mcg formoterol metered dose inhalation (asthma and COPD)
Fostair® / Luforbec® 200mcg beclometasone/6mcg formoterol metered dose inhalation (asthma only)
Fostair / Luforbec are not recommended for children and young people under 18 years of age

Fostair NEXThaler®
Inhaler 100/6 micrograms per dose (asthma and COPD), 200/6 micrograms per dose (asthma only

Clenil Modulite 50mcg per inhalation, 100mcg per inhalation, 200mcg per inhalation, 250mg per inhalation (asthma only)

Easyhaler 200mcg per inhalation (asthma only)

QVAR® beclometasone inhalers are approximately twice as potent as Clenil Modulite® at the same microgram doses. They are not interchangeable and should be prescribed by brand name. 

QVAR Easi-Breathe 50mg per inhalation, 100mcg per inhalation (asthma / over 12 years only)

QVAR Autohaler 50mcg per inhalation, 100mcg per inhalation (asthma / 5 years and over)

QVAR MDI 50mcg per inhalation, 100mcg per inhalation (asthma / 5years and over).  

Administration of doses above 1000 micrograms (500 micrograms twice daily) should be via a VOLUMATIC spacer device to help reduce side-effects in the mouth and throat.                                                

Tablets 100mg

On advice of Microbiology or a respiratory consultant only.

Tablets 180mg

As monotherapy for patients intolerant to ezetimibe

Tablets 2.5mg, 5mg

(Fasenra®) Solution for injection pre-filled syringes 30mg/1ml and solution for injection pre-filled pen 30mg /1ml

Severe eosinophilic asthma in adults (add-on therapy) - NICE TA565

Injection 600mg, 1.2g

When prescribing, dispensing, or administering, check that this is the correct preparation—benzylpenicillin sodium is a short-acting form of benzylpenicillin and is not interchangeable with benzathine benzylpenicillin.

Injection 4mg/1mL

Tablets 200mg
M/R tablets 400mg

Eye drops 100micrograms/mL (0.01%)
Eye drops 300micrograms/mL (0.03%)
Eye drops - Preservative free 300micrograms/mL (0.03%) - only for patients with a documented allergy to preservatives

Pre-filled syringe/pen 160mg

ICB Commissioned

3mL cartridge 100units/mL
3mL prefilled disposable Pen 100units/mL

First choice in new users

Gel 100mg/1g

Palliative care

Constipation

Tablets 1.25mg, 2.5mg, 3.75mg, 5mg, 7.5mg, 10mg

First line

Powder for solution for injection

 Specialist use only

Injection 100units

For existing patients

Consultant use only

Brands are not interchangeable

Focal Spasticity in Multiple Sclerosis, Contracture of the joint in Multiple Sclerosis.  Focal spasticity, Hand and wrist disability associated with stroke, Blepharospasm, Hemifacial spasm, Spasmodic torticollis. 

 All patients should be tested for sensitivity (diluting the antitoxin if history of allergy).

Eye drops 0.2%

Eye drops 10mg/mL (1%)

Eye drops brinzolamide 10mg/mL/brimonidine 2mg/mL

Solution for injection pre-filled syringes 210mg/1.5ml 

Eye drops 0.09%

e/c capsules 3mg
e/c granules 9mg/sachet
Foam enema

First line rectal treatment (foam enema)

Capsules 3mg, Enema

DuoResp Spiromax®  160 micrograms budesonide / 4.5 micrograms formoterol inhalation powder, 320 micrograms budesonide / 9mcg formoterol inhalation powder (asthma and COPD)

Fobumix Easyhaler® 80mcg budesonide / 4.5mcg formoterol per inhalation (asthma / over 18 years only), 160mcg budesonide / 4.5mcg formoterol per inhalation (asthma and COPD / over 18 years only), 320mcg budesonide / 9mcg formoterol per inhalation (asthma and COPD / over 18 years only)

Symbicort Turbohaler® 100mcg budesonide / 6mcg formoterol per inhalation (asthma only), 200mcg budesonide / 6mcg formoterol per inhalation (asthma and COPD), 400mcg budesonide / 12mcg formoterol per inhalation (asthma and COPD)

Symbicort® MDI 100mcg budesonide / 3mcg formoterol per actuation (asthma only), 200mcg budesonide / 6mcg formoterol per actuation (COPD only)

Orodispersible tablets 1mg

Powder for solution for injection 2mg

  Specialist prescribing only 

Injection bupivacaine 5mg/mL / glucose 80mg/mL 4mL

Preparations that should be applied every 3 days (72 hours) include Hapoctasin®.

Preparations that should be applied every 4 days (96 hours) include Bupeaze®, Carlosafine®, Relevtec®, and Transtec®.

Preparations that should be applied every 7 days include Bunov®, Bupramyl®, Butec®, BuTrans®, Panitaz®, Rebrikel®, Reletrans®, and Sevodyne®.

Only for use in patients who are unable to take or tolerate oral medicine (including soluble tablets and liquids) OR where use of the low-dose buprenorphine patches may prevent administration problems for frail, elderly patients in the community.

Do not confuse the formulations of transdermal patches which are available in various strengths as 7-day, 4-day and 3-day patches; prescription by brand name is recommended.

Burosumab is recommended, within its marketing authorisation, as an option for treating X‑linked hypophosphataemia (XLH) in adults.

Berinert®500iu powder and solvent for solution for injection / infusion, 1500iu powder and solvent for solution for injection.

Cinryze® 500iu powder and solvent for solution for injection

Kept in Emergency Departments at RLI and FGH

Tablets 30mg
Prolonged-release injection 600mg/3ml

  Specialist prescribing only

Capsules 250 nanograms

Tablets 475mg

Film coated tablets Calcium acetate, 435 mg equivalent to 110 mg calcium and Magnesium carbonate, heavy 235 mg equivalent to 60 mg magnesium

Tablets 100mg, 300mg

First line gliflozin

Tablets 2mg, 4mg, 8mg, 16mg, 32mg

First line

Restricted to an initial 4-week trial for treatment of moderate to severe spasticity in adults with multiple sclerosis in line with NICE NG144. Treatment may be continued after the 4-week trial as long as the patient has had at least a 20% reduction in spasticity-related symptoms

  for Refractory neuropathic pain

10mg powder and solvent for solution for injection

Cream 0.025%

Patch 179mg (8%)

Treatment of peripheral neuropathic pain in adults either alone or in combination with other medicinal products for the treatment of pain.

For specialist use only

Tablets 100mg, 200mg, 400mg
Prolonged-release tablets 200mg, 400mg
Liquid 100mg/5mL

Tablets 5mg, 20mg

CSM warning: neutropenia and agranulocytosis

Manufacturer advises of the importance of recognising bone marrow suppression induced by carbimazole and the need to stop treatment promptly.

Warn patients that if a sore throat develops, in the first 6-8 weeks of therapy they should stop treatment and seek medical advice.

Capsules 375mg

Injection 250micrograms/1mL

Postpartum haemorrhage.

Preservative free eye drops 0.5%, 1%

Topical adjuvant for procedures for odontogenic keratocysts

 unlicensed

Specialist use only

Infusion 50mg, 70mg

Capsules 250mg, 500mg
Oral suspension 125mg/5ml, 250mg/5ml

Tablets 200mg

**RAG under consultation and awaiting update - Please use local/national antimicrobial guidelines to support prescribing choices. **

Intravenous infusion 600mg

On advice of Microbiology only.

Infusion  2g/0.5g

On advice of Microbiology only.

Injection 250mg, 1g, 2g

On advice of Microbiology only.

Tablets 125mg, 250mg

Suspension 125mg/5mL

Tablets 12.5mg*, 25mg* (*initiation pack) 50mg, 100mg, 150mg, 200mg

S/C injection 200mg prefilled syringe pre-filled pen 

Usually supplied to patients by a home delivery company

REQUIRES BLUETEQ APPROVAL

Liquid 500mg/5mL

Eye drops 0.5%

Eye drops 0.5% - preservative free (only for use in patients with a documented allergy to preservatives)

East Lancashire only - use as by ophthalmology when more than 5 days treatment required post op

Eye ointment 1%

Chloramphenicol eye drops 0.5% can be sold by a community pharmacy to the public  (for people over 2 years of age) for the treatment of acute bacterial conjunctivitis.

Ear drops 5%

Morecambe bay only

Capsules 5mg, 10mg

Chlordiazepoxide is also used in a reducing regime for the management of acute alcohol withdrawal. See trust Clinical Guidelines.

Cream 5%

Injection 50mg/5mL

Tablets 4mg
Liquid 2mg/5mL
Injection 10mg/1mL

Bladder instillation

Interstitial cystitis.

Capsule

Severe ulcerative colitis

Specialist initiation only

Capsules 25mg, 50mg, 100mg

Unit dose eye drops 0.1% 0.3mL

For children and adolescents

Severe ulcerative colitis

Specialist initiation only

Tablets 200mg, 400mg

For use only when other options have proven ineffective. Not a first line option

Intravenous infusion 200mg/100mL, 400mg/200mL

Ciprofloxacin is well absorbed orally; use the intravenous infusion only when the oral route is unavailable.

On advice of Microbiology only.

Tablets 10mg, 20mg

Premature ejaculation.

 Unlicensed indication

Tablets 250mg, 500mg
Liquid 125mg/5ml, 250mg/5mL

Injection 300mg/2mL, 600mg/4mL
 

Vaginal cream 2%

Gel 1%

For oncology patients only

Tablets 10mg

Tablets 500micrograms, 2mg
Oral solution 500micrograms/5mL, 2mg/5ml

 for use in all forms of epilepsy and in the treatment of mood disorders

 for the treatment of anxiety (off-label indication)

Clonazepam has been confused with clobazam; care must be taken to ensure the correct drug is prescribed and dispensed. 

Other than epilepsy the use of clonazepam is off-labeL.

Tablets 25 microgram 

Clonidine is considered less suitable for prescribing in hypertension

 Vasomotor symptoms (VMS) associated with menopause

Clotrimazole 1% 20mL

labelled 'solution', not 'ear drops'

 in East Lancashire

1% drops

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.

Tablets 375mg (250/125), 625mg (500/125)
Oral suspension 125mg/31mg/5ml, 250mg/62mg/5ml, 400mg/57mg/5ml (for paediatric use)

Capsules 62.5mg (12.5/50), 125mg (25/100), 250mg (50/200)
Dispersible tablets 62.5mg (12.5/50), 125mg(25/100)
Modified-release capsules 125mg (25/100)

Parkinson's disease.

Tablets 62.5mg (12.5/50), 110mg (10/100), 125mg (25/100), 275mg (25/250)
Modified-release tablets 125mg (25/100), 250mg (50/200)

Parkinson's disease.

Tablets 30/500 (codeine 30mg/paracetamol 500mg),
tablets effervescent 30/500

Compound analgesic preparations (containing opioids) should not be used routinely. Patients should be given the individual components where possible to allow titration of dose. Where these preparations are used, they should be for short term use only, for relief of moderate pain.

Palliative care

Constipation

Opiod-induced constipation

Tablets 15mg, 30mg
Injection 60mg/1mL
Syrup 25mg/5mL
Linctus, BP 15mg/5mL

Follow local protocols

Tablets 625 mg

Cardiovascular Disease prevention in hyperlipidaemia when the patient is intolerant of all other options.

Powder 4g/sachet

Lipids

Injection 1million unit (Colomycin®)

Bronchiectesis (non cystic fibrosis)

On advice of Microbiology only.

Training and education regarding use of nebuliser to be provided by specialist.

Tablets 80mg/400mg, 160mg/800mg
Oral solution 40mg/200mg/5ml, 80mg/400mg/5ml

 Low dose prophylaxis of pneumocystis jirovecii (Pneumocystis carinii) infections post-transplant.

 Subacute bacterial peritonitis prophylaxis.

On advice of Microbiology only.

**RAGs under consultation and awaiting update - Please use local/national antimicrobial guidelines to support prescribing choices. **

Infusion 480mg/5mL

On advice of Microbiology only.

1mg Tablets

  for 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. 

  for maintenance therapy of dietary related insufficiency cyanocobalamin remains designated 'Do not prescribe' and patients are advised to self-care by purchase of 50mcg tablets over the counter. 

Palliative care

Nausea and vomiting

Nausea and vomiting in the last days of life

Opioid-induced nausea and vomiting

Minims® 0.5%, 1%

Capsules 250mg

On advice of Microbiology or a respiratory consultant only.

Tablets 50mg, 100mg

See section 06.04.02 for non-oncology indications.

Powder for concentrate for solution for infusion 500mg

On advice of Microbiology only.

Anticoagulation where standard options are contra-indicated.
Use only following haematologist advice.

Capsules 25mg

Tablets 5mg, 10mg

Tablets 50mg, 100mg

On advice of Microbiology only.

Tablets 25mg, 50mg

Treatment of long-term insomnia

Tablets 400mg, 600mg, 800mg
Oral suspension 100mg/mL (only available when tablets are unsuitable)

  Specialist prescribing only

Tablets cobicistat 150 mg, darunavir (as darunavir ethanolate) 800 mg, emtricitabine 200 mg, tenofovir alafenamide (as tenofovir alafenamide fumarate) 10 mg

  Specialist prescribing only

Injection 60mg/mL pre-filled syringe

Licensed for treatment of postmenopausal osteoporosis in women at increased risk of fractures and for the treatment of bone loss associated with hormone ablation in men with prostate cancer. See NICE guideline TA204

Treatment of bone loss associated with long-term systemic glucocorticoid therapy in adult patients at increased risk of fracture

Tablets 500micrograms, 2mg
Liquid 2mg/5mL, 500micrograms/5mL, 10mg/5mL

Eye drops 0.1%

 in East Lancashire

*under review*

Single dose - preservative free drops 0.1% - for use in theatre or clinic before a procedure if a single dose is needed.

Eye drops dexamethasone 0.1%, neomycin 3500u/g, polymixin B sulfate 6000units/g

Eye ointment dexamethasone 0.1%, neomycin 3500u/g, polymixin B sulfate 6000units/g

 in East Lancashire

*under review*

Tablets 5mg, 10mg, 20mg

ADHD

Injection 5mg, 10mg, 30mg, 100mg, 500mg

**under review**

Tablets 2mg, 5mg, 10mg
Liquid 2mg/5mL
Rectal tubes 5mg/2.5mL, 10mg/2.5mL

Anxiety.

Palliative care

Seizures

Tablets 50mg

Chronic intractable hypoglycaemia.

Suppositories 12.5mg, 25mg, 50mg, 100mg

For short term treatment of post-op pain, renal colic and lithotripsy only

For short term treatment of post-op pain (Akis^®)
 

Injection 75mg/1mL

Morecambe bay only

Tablets 1mg, 5mg

Injection 500 micrograms/2mL 

Oral digoxin is the preferred route. Intravenous digoxin should only be used when oral route is unavailable. Digoxin has a narrow therapeutic index and can cause toxicity.

Intravenous infusion 40mg

Cream, Ointment 

unlicensed

Capsules e/c 120mg, 240mg

Also see section 13.05.02.

Bladder instillation 50% 50mL

Interstitial cystitis.

 Unlicensed

Propess VDS 10mg
Prostin E2 vaginal gel 1mg, 2mg
Prostin E2 vaginal tabs 3mg

Induction of labour.

Tablets 25mg, 100mg
M/R capsules 200mg

Preservative free solution 0.37%

Capsules 100mg, Tablets 250mg prolonged-release

On advice of cardiology only

Infusion

Capsules 100mg, Liquid 12.5mg/5ml (paeds), 50mg/5ml (adult)

Tablets dolutegravir (as dolutegravir sodium) 50mg, Lamivudine 300mg

  Specialist prescribing only

Palliative care

Nausea and vomiting

Injection

Pulmozyme® 2500 U/ 2.5ml, nebuliser solution

Eye drops 2%

Eye drops - preservative free 2% - only for patients with a documented allergy to preservatives

100mg / 5ml solution for injection

Tablets 1mg, 2mg, 4mg

Doxazosin MR do not prescribe 

Capsules 10mg, 25mg, 50mg

Depressive illness.

Consider overdose risk.

Capsules 50mg, 100mg
Dispersible tablets 100mg

  Specialist prescribing only when used for treatment of malaria

Tablets Doxylamine succinate 10 mg, Pyridoxine hydrochloride 10 mg.

Treatment of nausea and vomiting of pregnancy in women who do not respond to conservative management.

Injection 2.5mg/ml

For the prevention and treatment of post operative nausea and vomiting.
 Restricted use: Theatre use only, when other treatment options are not suitable.

First line spacer device in primary care for ADULTS

For ADULTS only, Paediatric patients should only be prescribed Aerochamber Plus Flow-vu or Volumatic spacers

For use in Paediatric patients in primary and secondary care as a replacement for Aerochamber Plus spacer and in addition to Volumatic spacer

• Small mask (orange)
• Medium mask (yellow)
• Youth mouthpiece (green)
• Adult small mask (purple)

For use with any metered dose inhaler

Capsules (Cymbalta®) 30mg, 60mg

There can be variation in the licensing of different medicines containing the same drug therefore prescribe by brand name.

Third line use within LSCFT.

CAUTION: available as another brand Yentreve for stress urinary incontinence. Recommended that prescriptions state the brand name Cymbalta.

Capsules 20mg, 40mg

Moderate to severe stress urinary incontinence.

 There can be variation in the licensing of different medicines containing the same drug therefore prescribe by brand name.

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

tablets 15mg, 30mg, 60mg
 
Edoxaban for preventing stroke and systemic embolism in people with non-valvular atrial fibrillation (NICE TA355)

Edoxaban for treating and for preventing deep vein thrombosis and pulmonary embolism (NICE TA354)   ( East Lancashire only, for this indication)

Tablets 600mg

  Specialist prescribing only

Tablets 25mg, 50mg

Consultant haematologist or specialist in hepatitis C therapy only

Heel balm 75g

Specific use only for diabetic patients

Tablets 10mg, 25 mg

First line gliflozin

Capsules 200mg

Bluteq required if prescribing for pre-exposure prophylaxis (PrEP).

  Specialist prescribing only

Tablets 200mg emtricitabine and tenofovir alafenamide fumarate equivalent to 10 mg of tenofovir alafenamide,
200 mg of emtricitabine and tenofovir alafenamide fumarate equivalent to 25 mg of tenofovir alafenamide

  Specialist prescribing only

Tablets 2.5mg, 5mg, 10mg, 20mg

Restricted to use in post natal women when used in line with NG133

ICU use only.

Tablets 500micrograms, 1mg

  Specialist prescribing only

Cream 100g, 500g

Specialist use.
NHSE commissioned drug for digital ulcers and pulmonary arterial hypertension.

Injection 300,000 units

Consultant initiation only

Plastic syringes can be used 'off label' providing the injection is administered immediately after being drawn up into the syringe.

Tablets 5mg, 15mg

Restriction - only to be used as second line

Tablets e/c 250mg
Suspension 125mg/5mL, 250mg/5mL

Tablets 5mg, 10mg, 20mg

Generalised Anxiety Disorder,
Major depressive illness.

In depression, escitalopram is only licensed for major depressive episodes.

Available for consultant initiation in generalised anxiety disorder but only after sertraline has been tried.

Injection 100mg/10mL
Infusion 2.5g in 250mL

Bijuve® is an alternative when other HRT treatments have not been tolerated or when Femoston-Conti® is being considered OR
> Bijuve replaces HRT regimens where separate oestrogen and micronised progesterone are used (single hormone products used in combination are more expensive than Bijuve®).

Vaginal tablets 10microgram

2nd line agent - only to be considered in women who are unable to use estriol pessaries.

S/C injection 25mg, 50mg vial with diluent and prefilled syringe pre-filled pen 

usually supplied to patients by a home delivery company

REQUIRES BLUETEQ APPROVAL

Injection

Tablets 10micrograms, 50micrograms

Capsules 250mg
Liquid 250mg/5mL

Epilepsy.

Tablets 60mg, 90mg, 120mg

Rheumatology initiation only

Tablets 100mg, 200mg

  Specialist prescribing only

Prevention of cardiac events in patients with CHD and a history of ACS, in combination with a statin

Tablets 25mg

Tablets 10mg

M/R tablets 2.5mg, 5mg, 10mg 

Capsules (micronised) 200mg, 267mg
Tablets (micronised) 160mg

Palliative care

Pain

Injection 50mg/mL

First line choice
For use in patients with asthma or eczema
For use when total dose infusion is needed

Modified-release tablets 4mg, 8mg

Urinary frequency, urgency, and incontinence.

Injection 100 units/mL,
Penfill® cartridge for Fiasp® devices
Flextouch® prefilled disposable injection devices
Fiasp® and NovoRapid® are not interchangeable due to differences in bioavailability.

Must be commenced by a healthcare professional who is appropriately trained and experienced in the initiation of insulin.
Insulin Aspart (Fiasp®) is recommended for the treatment of diabetes mellitus in adults who are suitable for NovoRapid® and their diabetes cannot be adequately managed with alternative formulary choices and at least one of the following applies:
- where the prescriber believes a faster onset of action would be beneficial to the patient
- where a patient requires ‘tight’ control of blood sugar levels
- where a patient has rapid post meal increase in blood sugar levels

Tablet 100mg, 200mg

Moderately to severely active ulcerative colitis

Please see chapter 06.01.05

Capsules 500 micrograms

Injection 250mg, 500mg, 1g

Cholestatic jaundice and hepatitis may occur very rarely, up to two months after treatment with flucloxacillin has been stopped. Administration for more than 2 weeks and increasing age are risk factors. Manufacturer advises:

- flucloxacillin should not be used in patients with a history of hepatic dysfunction associated with flucloxacillin
- flucloxacillin should be used with caution in patients with hepatic impairment
- careful enquiry should be made about hypersensitivity reactions to beta-lactam antibacterials.

Tablets 100micrograms

Fludrocortisone has very high mineralocorticoid activity and insignificant glucocorticoid activity. A combination of hydrocortisone and fludrocortisone are needed in primary adrenal deficiency states.

Injection 500micrograms/5ml

Flumazenil should only be administered by, or under the direct supervision of, personnel experienced in its use.

Capsules 5mg

Specialist consultant use only

Intravitreal implant 190micrograms in a disposable applicator

Eye drops fluoromethalone 0.1%, polyvinyl alcohol 1.4%

 in East Lancashire

*under review*

Cream 40g

  for actinic keratosis

   for the treatment of small superficial basal-cell carcinomas in adults

 treatment of superficial pre-malignant skin lesions

Capsules 20mg

Premature ejaculation.

 Unlicensed indication

Tablets 500microgram, 1mg, 3mg

Schizophrenia and psychoses.

 for depression

Insomnia (short term use).

Flutiform® 50mcg fluticasone / 5mcg formoterol (asthma 5 years and above), 125 mcg fluticasone /5 mcg formoterol (asthma 12 years and above), 250mcg fluticasone / 10mcg formoterol per actuation (asthma adults only)

(Trelegy Elipta®) Dry powder inhaler - Fluticasone furoate 92 microgram per 1 dose, Umeclidinium bromide 65 microgram per 1 dose, Vilanterol (as Vilanterol trifenatate) 22 microgram per 1 dose

Restriction: Triple therapy should be reserved for patients who have failed to achieve or maintain an adequate response to an appropriate course of dual therapy. The restriction should be the same for all triple inhalers for use in COPD. 

Nasal drops 400micrograms/unit dose 
 
Consider alternative treatment if no improvement after 4–6 weeks

Prescribe by brand.

Oxis 6 Turbohaler^® 6micrograms/inhalation
Oxis 12 Turbohaler^® 12micrograms/inhalation
Easyhaler^® 12 micrograms/metered inhalation
Atimos Modulite^® 12 micrograms/metered inhalation

To be used as 1st line LABA when used in combination with ICS for asthma (combination inhalers preferred)

On advice of Microbiology only.

Film coated tablets, 100mg, 150mg

Pre-filled pens/ pre-filled syringes 225mg/1.5ml solution for injection  

Tablets 20mg, 40mg, 500mg
Liquid 20mg/5mL, 40mg/5mL, 50mg/5mL

First line treatment

 Furosemide 500mg tablets in East Lancashire

Eye drops 1% in gel basis (liquefies on contact with eye)
 
Second line - Restricted use

Capsules 100mg, 400mg, 400mg

Palliative care

Neuropathic pain

Solution for injection pre-filled pens  120mg/1ml

For NICE TA659: Galcanezumab for preventing migraine

Eye gel 5g (1.5mg/g)

Oral powder sachets

For paediatric use only

Sachets

 in East Lancashire

Injection 20mg/2mL (paediatric), 80mg/2mL

**RAG under consultation and awaiting update - Please use local/national antimicrobial guidelines to support prescribing choices. **

pre-filled syringe 20mg/1ml, 40mg/1ml

Tablets 80mg
M/R tablets 30mg

First choice

Tablets 4g

Consider OTC purchase

Suppositories 1g, 2g, 4g

Aerosol spray 400micrograms/dose
Patches 5mg/24h, 10mg/24h

Patches should only be considered in patients unable to comply with or tolerate oral isosorbide mononitrate.

Irrigation solution 1.5%

Bladder irrigation.

Oral Liquid for hypersalivation in adults with Parkinson's Disease.

Bevespi Aerosphere 7.2 micrograms glycopyrronium /5 micrograms formoterol pressurised inhalation, suspension

Licensed for COPD only

Oral Liquid

Hypersalivation in adults and children with neurological conditions [Non-Parkinson's disease]
Use most cost-effective product. Care should be taken when prescribing as different strengths of liquid are available.

For Hypersalivation in adults with Parkinson's Disease, see chapter 4.

Prevention of recurrence of ulcerative colitis following surgery

Implant 3.6mg, 10.8mg

Tablets 1mg
Injection 1mg/1ml, 3mg/3ml

Nausea & vomiting post operatively or chemotherapy induced.
Second line 5HT3 anatagonist.

M/R tablets 1mg, 2mg, 3mg, 4mg

For use in children and adolescents 6 - 17 years for whom stimulants are not suitable, not tolerated or have shown to be ineffective.

Specialist initiation only.

Solution for injection in pre-filled pen 100mg/1ml

Tablets 1.5mg, 5mg, 10mg
Oral liquid 10mg/5mL, 5mg/ 5mL

Schizophrenia and other psychoses, mania, anxiety.

Injection 50mg/1mL, 100mg/1mL

Maintenance in schizophrenia and other psychoses.

When prescribing, dispensing or administering, check that this is the correct preparation—this preparation is used for maintenance treatment and should not be used for the rapid control of an acute episode.

Injection 1000units/1mL, 10 000units/10mL, 20 000units/20mL

79,000 - 316,000 cells/cm2 living tissue equivalent

3mL cartridge AutoPen® or HumaPen®
3mL prefilled disposable Humalog®Mix25 KwikPen®

Second line biphasic short-acting analogue insulin (Humalog Mix Kwikpen)

Injection 75units FSH/75units LH amp with solvent

10mL vial
3mL cartridge for AutoPen® or HumaPen®
3mL prefilled disposable Humulin I® KwikPen®

First line isophane insulin (Humulin I Kwikpen)

Tablets 25mg, 50mg

Heart failure

Initiated in hospital or under specialist supervision.

Granules in capsules for opening 0.5mg, 1mg, 2mg

For replacement therapy of adrenal insufficiency in children and adolescents (from birth to <18 years old)

Treatment of congenital adrenal hyperplasia (CAH) in adolescents aged 12 years and over and adults.

Injection 100mg/1mL

Injection 100mg vial

Tablets 10mg, 25mg

Tablets 300micrograms
Patch 1mg/72hours

Palliative care

Respiratory tract secretions in the last days of life

Injection 3mg/3mL pre-filled syringe

Alternative monthly bisphosphonate when alendronic acid is not appropriate.

Tablets 200mg, 400mg, 600mg
M/R tablets 800mg
Liquid 100mg/5mL

 Solution for infusion 400mg/100mL

gel 10%

Primary Care only  - prescribe as Fenbid Forte gel

30mg solution for injection in pre-filled syringe

Kept in Emergency Departments at RLI and FGH

Solution for injection/infusion 2.5 g/50 mL

Rapid reversal of anticoagulant effects of dabigatran  

Pulmonary hypertension

For use by specialist centres only.
NHSE commissioned

Cream 5%

for treatment of small superficial basal cell carcinoma in adults

Powder for concentrate for solution for infusion 11mg

Specialist centre only

Pre-filled syringe 284mg/1.5ml

Included in NHS England HCD list to facilitate prescribing in secondary care until primary care prescribing is established.

Intravenous infusion 100mg
Pre-filled pen 120 mg solution for injection
Pre-filled syringe 120 mg solution for injection

Use in high risk patients for prevention of recurrence or upon recurrence of Crohn's Disease following surgery.

Crohn's disease - NICE TA187

Acute exacerbations of Ulcerative Colitis - NICE TA163

Moderate to severe active ulcerative colitis - NICE TA329

Intravenous infusion 100mg, 120mg/ml pre-filled pen

REQUIRES BLUETEQ APPROVAL

10mL vial
3mL cartridge for NovoPen®

Second line isophane insulin (Insulatard penfill)

For supply via secondary care only with Blueteq approval.

Classified as  Red in secondary care and
 in Primary Care

Intra-uterine system 20 micrograms/24 hours

Effective for 8 years when used for contraception. Length of effectiveness differs when used for menorrhagia (see BNF).

Intra-uterine device system 19.5mg

Consider in  nulliparous patients. Effective for 5 years.

Also known as Lugol's solution

Thyrotoxicosis (pre-operative).

Nebuliser solution 250micrograms/1mL, 500micrograms/2mL
Metered dose inhaler 20micrograms/inhalation