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 Formulary Chapter 9: Nutrition and blood - Full Chapter
Notes:

Where a formulary entry does not detail a medicine’s indications for use, the medicine can be assumed to be approved for all licensed indications.

Formulary approved "off-label" use is detailed separately.

 Details...
09.01  Anaemias and some other blood disorders
09.01.01  Iron-deficiency anaemias
09.01.01.01  Oral iron
Ferrous Sulphate tablets 200 mg
View adult BNF View SPC online
Formulary Elemental iron = 65 mg 
   
Ferrous Fumarate syrup 140 mg/5 mL
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Formulary Elemental iron = 45 mg/5 mL 
   
Ferrous Fumarate tablets 210 mg
View adult BNF View SPC online
Formulary Elemental iron = 68 mg 
   
Ferrous Fumarate tablets 322 mg
View adult BNF View SPC online
Formulary Elemental iron = 100 mg 
   
Ferrous Gluconate tablets 300 mg
View adult BNF View SPC online
Formulary Elemental iron = 35 mg 
   
Sodium Feredetate elixir 190 mg/5 mL
View adult BNF View SPC online
Formulary Elemental iron = 27.5 mg/5 mL 
   
Ferric Maltol caps (Feraccru®)
View adult BNF View SPC online
Restricted Drug Restricted
Amber 2
Gastroenterology specialist initiation only Restricted for use as a 3rd line oral iron preparation where:
  • The patient has a diagnosis of IBD and a haemoglobin >95g/L but less than normal range (120g/L in women, 130g/L in men) and
  • Two different oral iron salts have been tried for an adequate period of time but are not tolerated and
  • The next treatment step would otherwise be intravenous iron. 
  • Link  SE London APC Recommendation: Ferric maltol (Feraccru) for iron deficiency anaemia in adults with inflammatory bowel disease
       
    09.01.01.01  Iron and folic acid
    Fefol® m/r caps
    View adult BNF View SPC online
    Formulary Each tablet contains
  • Ferrous sulphate 150 mg
  • Folic acid 500 micrograms 
  •    
    Ferrograd Folic® tabs
    View adult BNF View SPC online
    Formulary Each tablet contains
  • Ferrous fumarate 325 mg
  • Folic acid 350 micrograms 
  •    
    Pregaday® tabs
    View adult BNF View SPC online
    Formulary Each tablet contains
  • Ferrous fumarate 322 mg
  • Folic acid 350 micrograms 
  •    
    09.01.01.02  Parenteral iron - USE UNDER SPECIALIST SUPERVISION ONLY to top
     note  Refer to local guidance for preferred use of parenteral iron preparations
    Ferric Carboxymaltose injection  (Ferinject®)
    View adult BNF View SPC online
    Formulary
    Red
     
       
    Iron Isomaltoside injection  (Monofer®)
    View adult BNF View SPC online
    Formulary
    Red
     
       
    Iron Sucrose injection  (Venofer®)
    View adult BNF View SPC online
    Formulary
    Red
     
       
    09.01.02  Drugs used in megaloblastic anaemias
    Folic acid tabs, syrup
    View adult BNF View SPC online
    Formulary  
       
    Hydroxocobalamin injection
    View adult BNF View SPC online
    Formulary  
       
    Folic acid injection
    View adult BNF View SPC online
    Unlicensed Drug Unlicensed Folated-deficient megaloblastic anaemia; prophylaxis in chronic haemolytic states or in renal dialysis 
       
    09.01.03  Drugs used in hypoplastic, haemolytic, and renal anaemias
    Eculizumab injection (Atypical Haemolytic Uraemic Syndrome [aHUS])
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine
    NHS England
    BlueTeq

    Approved for:

    • Atypical Haemolytic Uraemic Syndrome (aHUS)
    • Use in accordance with NHSE SSC 1522 & NICE HST1
     
    Link  NICE HST1: Eculizumab for treating atypical haemolytic uraemic syndrome
       
    Eculizumab injection (C3 glomerulopathy post-kidney transplant)
    View adult BNF View SPC online
    Restricted Drug Restricted
    Red
    High Cost Medicine
    NHS England
    BlueTeq

    Approved for:

    • Treatment of recurrence of C3 glomerulopathy post-kidney transplant
    • Use as per criteria in NHSE Policy 16054/P
     
    Link  NHSE 16054/P: Eculizumab in the treatment of recurrence of C3 glomerulopathy post - kidney transplant
       
    Eculizumab injection (Paroxysmal nocturnal haemoglobinuria)
    View adult BNF View SPC online
    Restricted Drug Restricted
    Red
    High Cost Medicine

    Paroxysmal nocturnal haemoglobinuria

    • Initiation by Consultant Haematologists Dr Elebute and Professor Judith Marsh at KCH only.
    • Use in accordance with the National Commissioning Group agreement for PNH
     
       
    Emicizumab injection
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine
    NHS England
    BlueTeq

    Approved for prophylaxis in people with congenital haemophilia A with factor VIII inhibitors (all ages) as per NHSE policy criteria (see link below)

     

     
    Link  Clinical Commissioning Policy: Emicizumab as prophylaxis in people with congenital haemophilia A with factor VIII inhibitors (all ages)
       
    Susoctocog alfa injection
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine
    NHS England

    Approved for treating bleeding episodes in people with acquired haemophilia A (all ages) as per NHSE policy criteria (see link below)

     
    Link  Clinical Commissioning Policy: Susoctocog alfa for treating bleeding episodes in people with acquired haemophilia A (all ages) (170061P)
       
    09.01.03  Erythropoietin and darbopoetin
     note 


    Darbepoetin alfa injection
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine
    Treatment of anaemia associated with chronic kidney disease 
       
    Epoetin alfa injection  (Eprex®, Binocrit®)
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine
    Treatment of anaemia associated with chronic kidney disease 
       
    Epoetin beta injection  (NeoRecormon®)
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine
    Treatment of anaemia associated with chronic kidney disease 
       
    Epoetin zeta injection  (Retacrit®)
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine
    Treatment of anaemia associated with chronic kidney disease 
       
    Methoxy Polyethylene Glycol-Epoetin beta injection  (Mircera®)
    View adult BNF View SPC online
    Restricted Drug Restricted
    Red
    High Cost Medicine

    CONSULTANT SPECIALISTS ONLY

    Treatment of anaemia associated with chronic kidney disease when the added patient convenience of using a monthly preparation is considered to be justified

     
       
    Epoetin alfa injection (Eprex®)
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine

    Use in accordance with guideline at GSTFT

    Approved off-label use:

    Prophylaxis or treatment of postoperative anaemia in patients declining or not suitable for blood transfusions e.g. Jehovah’s Witnesses

    Dose: as SPC for orthopaedic surgery

     
       
    Epoetin beta injection (NeoRecormon®)
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine

    Use in accordance with guideline at GSTFT

    Approved off-label use:

    Prophylaxis or treatment of postoperative anaemia in patients declining or not suitable for blood transfusions e.g. Jehovah’s Witnesses

    Dose: 600 units per kg weekly, for up to 4 weeks prior to surgery

     
       
    Epoetin alfa/beta injection
    View adult BNF View SPC online
    Restricted Drug Restricted
    Red

    Consultant Haematologists only

    Use in accordance with local guideline for the treatment of myelodysplastic syndrome (MDS)

     
       
    09.01.03  Iron overload
    Deferasirox film coated tabs
    View adult BNF View SPC online
    Restricted Drug Restricted
    Red
    High Cost Medicine

    CONSULTANT HAEMATOLOGISTS ONLY

     

    For treatment of:

    Chronic iron overload from frequent blood transfusions in patients with beta thalassaemia major aged 6 years and older.

    Chronic iron overload due to blood transfusions when desferrioxamine therapy is contraindicated or inadequate in the following patients:

    • With other anaemias
    • Aged 2 to 5 years with beta thalassaemia major with iron overload due to infrequent blood transfusions

    Follow NHSE Policy 16070/P when using in chronic inherited anaemias

     
    Link  Deferasirox: Healthcare professionals booklet from the manufacturers
    Link  NHSE 16070/P: Treatment of iron overload for transfused and non transfused patients with chronic inherited anaemias
       
    Deferiprone tabs
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine
    Follow NHSE Policy 16070/P when using in chronic inherited anaemias 
    Link  NHSE 16070/P: Treatment of iron overload for transfused and non transfused patients with chronic inherited anaemias
       
    Desferrioxamine mesilate injection
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine
     
       
    09.01.04  Drugs used in autoimmune thrombocytopenic purpura to top
    Anagrelide capsules
    View adult BNF View SPC online
    Formulary
    Red

    USE UNDER SPECIALIST SUPERVISION ONLY

     
       
    Eltrombopag tablets
    View adult BNF View SPC online
    Restricted Drug Restricted
    Red
    High Cost Medicine
    CCG

    Consultant Haematologists specialising in the treatment of ITP only

     
    Link  MHRA Jul 2018: Eltrombopag (Revolade): reports of interference with bilirubin and creatinine test results
    Link  NICE TA293: Eltrombopag for treating chronic immune (idiopathic) thrombocytopenic purpura (review of technology appraisal 205)
       
    Lusutrombopag tabs
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine
    CCG

    Approved for use as per NICE Technology Appraisal guidance (see link below)

     
    Link  NICE TA617: Lusutrombopag for treating thrombocytopenia in people with chronic liver disease needing a planned invasive procedure
       
    Romiplostim injection
    View adult BNF View SPC online
    Restricted Drug Restricted
    Red
    High Cost Medicine
    CCG

    Consultant Haematologists specialising in the treatment of ITP only

     
    Link  NICE TA221: Thrombocytopenic purpura - romiplostim
       
    Eltrombopag tablets
    View adult BNF View SPC online
    Restricted Drug Restricted
    Red
    High Cost Medicine
    CCG

    Consultant Specialists only

    Refractory aplastic anaemia in patients who are platelet transfusion dependent and also contraindicated/failed bone marrow transplant.

     
       
    09.01.05  G6PD deficiency
    09.01.06  Drugs used in neutropenia - USE UNDER SPECIALIST SUPERVISION ONLY
    Filgrastim injection
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine

    Biosimilar products available – to be prescribed by brand

    Contact pharmacy for advice on local brands stocked

    Approved off-label use:

    Treatment of myelodysplastic syndrome (MDS) in accordance with a local guideline (Consultant Haematologists only)

     
       
    Lenograstim injection
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine
     
       
    Pegfilgrastim injection
    View adult BNF View SPC online
    Restricted Drug Restricted
    Red
    High Cost Medicine

    HAEMATOLOGY ONLY

    For patients who would require long term therapy with filgrastim or lenograstim

    Biosimilar products available – to be prescribed by brand

    Contact pharmacy for advice on local brands stocked

     
       
    09.01.07  Drugs used to mobilise stem cells
    Plerixafor injection
    View adult BNF View SPC online
    Restricted Drug Restricted
    Red
    High Cost Medicine
    NHS England
    BlueTeq

    Consultant Haematologists or Haemato-Oncologists only

    For use in combination with G-CSF to enhance mobilisation of haematopoietic stem cells to the peripheral blood for collection and autologous transplantation in lymphoma and multiple myeloma

    Restricted to patients who have failed previous standard mobilisation attempts

     
    Link  NHSE 16064/P: Use of plerixafor for stem cell mobilisation
       
    09.02  Fluids and electrolytes
    09.02.01  Oral preparations for fluid and electrolyte imbalance to top
    09.02.01.01  Oral potassium
    Potassium Chloride effervescent tabs
    View adult BNF View SPC online
    Formulary 12mmol K+ per tab 
       
    Potassium Chloride MR tabs, syrup
    View adult BNF View SPC online
    Formulary

    MR tabs = 8mmol K+ per tab

    Syrup = 1mmol/mL K+

     
       
    09.02.01.01  Potassium removal
    Calcium Resonium® (Calcium Polystyrene Sulphonate powder)
    View adult BNF View SPC online
    Formulary
    Red
     
       
    Calcium Polystyrene Sulphonate enema (30g in methylcellulose solution)
    View adult BNF
    Unlicensed Drug Unlicensed
    Red

    Hyperkalaemia associated with anuria or severe oliguria, and in dialysis patients

    30 g as a daily retention enema which should be retained for at least 9 hours

     
       
    09.02.01.02  Oral sodium and water
    Patiromer suspension (Veltassa®)
    View adult BNF View SPC online
    Restricted Drug Restricted
    Red

    Approved for use as per NICE Technology Appraisal Guidance (see link below)

    Renal or cardiology recommendation only

    Approved for:

    • Emergency care for acute life-threatening hyperkalaemia.
    • Persistent hyperkalaemia in CKD stage 3b to 5 or heart failure if; K+ ⩾6.0 mmol/L and the patient is unable to take an optimised dose of ACEi or ARB because of hyperkalaemia and they are not on dialysis (stop when ACEi or ARB no longer suitable).

     

     
       
    Sodium Chloride MR tabs
    View adult BNF View SPC online
    Formulary 10mmol Na+ per tab 
       
    Sodium zirconium cyclosilicate suspension (Lokelma®)
    View adult BNF View SPC online
    Formulary
    Red

    Approved for use as per NICE Technology Appraisal Guidance (see link below)

    Renal or cardiology recommendation only

    Approved for:

    • Emergency care for acute life-threatening hyperkalaemia.
    • Persistent hyperkalaemia in CKD stage 3b to 5 or heart failure if; K+ ⩾6.0 mmol/L and the patient is unable to take an optimised dose of ACEi or ARB because of hyperkalaemia and they are not on dialysis (stop when ACEi or ARB no longer suitable).
     
    Link  NICE TA599: Sodium zirconium cyclosilicate for treating hyperkalaemia
       
    09.02.01.02  Oral rehydration therapy (ORT)
    Dioralyte® sachets
    View adult BNF View SPC online
    Formulary  
       
    Electrolade® oral powder
    View adult BNF View SPC online
    Formulary  
       
    Oral Rehydration Salts
    Unlicensed Drug Unlicensed

    For use in short bowel syndrome, high output stomas and small bowel enterocutaneous fistulae.

    For standard ORS dissolve 8 sachets of Dioralyte® in 1 litre of water; for drinking over 24 hours

    For potassium-free ORS use deignated product at local Trust.  Alternatively it could be prepared by dissolving 3.5 g sodium chloride + 2.5g sodium bicarbonate + 20 g glucose to 1 litre of water; for drinking over 24 hours

     
       
    09.02.01.03  Oral bicarbonate to top
    Sodium bicarbonate 500 mg capsules
    View adult BNF View SPC online
    Formulary

    Approximately 6mmol HCO3- per capsule

     
       
    Potassium bicarbonate effervescent tabs
    View adult BNF View SPC online
    Formulary Approximately 6mmol HCO3- and 6.5mmol K+ per tab 
       
    09.02.02  Parenteral preparations for fluid and electrolyte imbalance
    09.02.02.01  Electrolytes and water
    09.02.02.01  Intravenous sodium
    Plasma-Lyte 148 intravenous infusion
    View adult BNF View SPC online
    Restricted Drug Restricted Restricted to use in Critical Care, and intraoperative use in the following procedures:
  • Free flap reconstruction
  • Renal transplant
  • Simultaneous kidney and pancreas transplant 
  •    
    Ringer's Solution for Injection
    View adult BNF View SPC online
    Formulary  
       
    Sodium Chloride 0.18% and glucose 4% Intravenous infusion
    Formulary  
       
    Sodium Chloride 0.45% and glucose 5% Intravenous infusion
    View adult BNF View SPC online
    Formulary  
       
    Sodium Chloride 0.45% intravenous infusion
    Formulary  
       
    Sodium Chloride 0.9% intravenous infusion
    View adult BNF View SPC online
    Formulary  
       
    Sodium Chloride 1.8% intravenous infusion
    View adult BNF View SPC online
    Formulary  
       
    Sodium lactate intravenous infusion compound (Hartmann's)
    View adult BNF View SPC online
    Formulary  
       
    09.02.02.01  Intravenous glucose
    Glucose 5% Intravenous infusion
    View adult BNF View SPC online
    Formulary  
       
    Glucose 10% Intravenous infusion
    View adult BNF View SPC online
    Formulary  
       
    Glucose 20% Intravenous infusion
    View adult BNF View SPC online
    Formulary  
       
    Glucose 50% Intravenous infusion
    View adult BNF View SPC online
    Formulary  
       
    09.02.02.01  Intravenous potassium to top
    Potassium chloride 0.15% and sodium chloride 0.9% intravenous infusion
    View adult BNF
    Formulary

    20 mmol K+ per 1000mL

     
       
    Potassium chloride 0.15% and glucose 5% intravenous infusion
    View adult BNF
    Formulary 20 mmol K+ per 1000mL 
       
    Potassium chloride 0.3% and glucose 5% intravenous infusion
    View adult BNF
    Formulary 40 mmol K+ per 1000mL 
       
    Potassium chloride 0.3%, sodium chloride 0.18% and glucose 4% intravenous infusion
    View adult BNF
    Formulary 40 mmol K+ per 1000mL 
       
    Potassium chloride 0.3%, sodium chloride 0.45% and glucose 5% intravenous infusion
    View adult BNF
    Formulary 40 mmol K+ per 1000mL 
       
    Potassium chloride 0.3%, sodium chloride 0.9% intravenous infusion
    View adult BNF
    Formulary 40 mmol K+ per 1000mL 
       
    Potassium chloride strong injection 15%
    Formulary

    20 mmol K+ in 10mL

    REFER TO LOCAL TRUST PROTOCOL FOR CONCENTRATED POTASSIUM SOLUTIONS

     
       
    Addiphos injection  (potassium supplementation)
    View adult BNF
    Formulary

    30 mmol K+ in 20mL

    20mL also contains:

    • 40mmol Phosphate
    • 30mmol Sodium

    REFER TO LOCAL TRUST PROTOCOL FOR CONCENTRATED POTASSIUM SOLUTIONS

     
       
    Cardioplegia Harefield Preparation infusion
    Formulary

    REFER TO LOCAL TRUST PROTOCOL FOR CONCENTRATED POTASSIUM SOLUTIONS

    For myocardial protection during cardiac surgery

     
       
    Cardioplegia infusion
    Formulary

    16 mmol K+ in 20mL

    REFER TO LOCAL TRUST PROTOCOL FOR CONCENTRATED POTASSIUM SOLUTIONS

    For myocardial protection during cardiac surgery

     
       
    Potassium acetate injection
    Formulary

    10 mmol K+ in 10mL

    REFER TO LOCAL TRUST PROTOCOL FOR CONCENTRATED POTASSIUM SOLUTIONS

     
       
    Potassium acid phosphate injection 13.6%
    Formulary

    10 mmol K+ in 10mL

    REFER TO LOCAL TRUST PROTOCOL FOR CONCENTRATED POTASSIUM SOLUTIONS

     
       
    Potassium chloride 1.5% in sodium chloride 0.9% infusion minibag
    Unlicensed Drug Unlicensed

    20 mmol K+ in 100mL

    REFER TO LOCAL TRUST PROTOCOL FOR CONCENTRATED POTASSIUM SOLUTIONS

     
       
    Potassium chloride 3% in sodium chloride 0.9% infusion minibag
    Unlicensed Drug Unlicensed

    40 mmol K+ in 100mL

    REFER TO LOCAL TRUST PROTOCOL FOR CONCENTRATED POTASSIUM SOLUTIONS

     
       
    Potassium chloride 3% in sodium chloride 0.9% prefilled syringe 50mL
    Unlicensed Drug Unlicensed

    20 mmol K+ in 50mL

    REFER TO LOCAL TRUST PROTOCOL FOR CONCENTRATED POTASSIUM SOLUTIONS

     
       
    Potassium chloride 7.5% in sodium chloride 0.9% prefilled syringe 50mL
    Unlicensed Drug Unlicensed

    50 mmol K+ in 50mL

    REFER TO LOCAL TRUST PROTOCOL FOR CONCENTRATED POTASSIUM SOLUTIONS

     
       
    09.02.02.01  Bicarbonate and lactate
    Sodium bicarbonate 1.26% intravenous infusion
    Formulary  
       
    Sodium Bicarbonate 1.4% intravenous infusion
    Formulary  
       
    Sodium Bicarbonate 2.74% intravenous infusion
    Formulary  
       
    Sodium Bicarbonate 8.4% intravenous infusion
    Formulary  
       
    09.02.02.01  Water
    Water for Injections
    Formulary  
       
    09.02.02.02  Plasma and plasma substitutes
    Albumin
    Formulary Albumin, blood and other blood products are supplied from the Blood Trasfusion Laboratory 
       
    09.02.02.02  Plasma substitutes
    Dextran 70 intravenous infusion in sodium chloride 0.9%
    View adult BNF View SPC online
    Formulary  
       
    Gelatin intravenous infusion
    View adult BNF View SPC online
    Formulary  
       
    Pentastarch 10% intravenous infusion in sodium chloride 0.9%
    View adult BNF View SPC online
    Formulary

     
       
    Tetrastarch 6% intravenous infusion in sodium chloride 0.9%  (Voluven®)
    View SPC online
    Formulary

     
       
    09.03  Intravenous nutrition to top
    09.03  Supplementary preparations
    09.04  Oral nutrition
    09.04.01  Foods for special diets
    09.04.02  Enteral nutrition
    09.05  Minerals to top
    09.05.01  Calcium and magnesium
    09.05.01.01  Calcium supplements
    Adcal® chewable tabs
    View adult BNF View SPC online
    Formulary 600mg elemental calcium per tab 
       
    Adcal-D3® caplets
    View adult BNF View SPC online
    Formulary Each caplet contains
  • Calcium 300mg (elemental)
  • Colecalciferol 200 units Dose: Two caplets twice a day 
  •    
    Adcal-D3® chewable tabs
    View adult BNF View SPC online
    Formulary Each tablet contains
  • Calcium 600mg (elemental)
  • Colecalciferol 400 units Dose: One tablet twice a day 
  •    
    Adcal-D3® Dissolve
    View adult BNF View SPC online
    Formulary Each tablet contains
  • Calcium 600mg (elemental)
  • Colecalciferol 400 units Dose: One effervescent tablet twice a day 
  •    
    Calceos® chewable tabs
    View adult BNF View SPC online
    Formulary Each tablet contains
  • Calcium 500mg (elemental)
  • Colecalciferol 400 units Dose: One tablet twice a day 
  •    
    Calcichew® chewable tabs
    View adult BNF View SPC online
    Formulary 500mg elemental calcium per tab  
       
    Calcium carbonate effervescent tabs (Cacit 500, Calvive 1000®)
    View adult BNF View SPC online
    Formulary

     

     
       
    Calcium chloride injection 10%
    View adult BNF View SPC online
    Formulary Calcium = 27.3mg/mL 
       
    Calcium gluconate effervescent tabs
    View adult BNF View SPC online
    Formulary Calcium = 89mg per tab 
       
    Calcium gluconate injection 10%
    View adult BNF View SPC online
    Formulary Calcium = 8.4mg/mL 
       
    Calcium lactate and gluconate syrup  (Alliance Calcium Syrup®)
    Unlicensed Drug Unlicensed
    Amber 3
    Calcium = 2.5mmol in 5ml 
    Link  SE London APC: Request to continue prescribing of Alliance Calcium Syrup in primary care
       
    09.05.01.02  Hypercalcaemia and hypercalciuria
    Cinacalcet tablets (primary hyperparathyroidism)
    View adult BNF View SPC online
    Restricted Drug Restricted
    Red
    High Cost Medicine
    NHS England

    For primary hyperparathyroidism, as per NHSE Policy

    Endocrinology only

     
    Link  NHSE Policy 16034/P: Cinacalcet for complex primary hyperparathyroidism in adults
       
    Cinacalcet tablets (secondary hyperparathyroidism in ESRD)
    View adult BNF View SPC online
    Restricted Drug Restricted
    Amber 3
    High Cost Medicine
    CCG

    For secondary hyperparathyroidism in end stage renal disease

    Renal consultant initiation only

     
    Link  SE London Shared Care Agreement: Cinacalcet for Secondary Hyperparathyroidism in Adult End-Stage Renal Disease Established on Dialysis Therapy
    Link  NICE TA117: Cinacalcet for the treatment of secondary hyperparathyroidism in patients with end-stage renal disease on maintenance dialysis therapy
       
    Etelcalcetide injection
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine
    NHS England
    BlueTeq

    Approved for secondary hyperparathyroidism in CKD as per NICE TA448

     
    Link  NICE TA448: Etelcalcetide for treating secondary hyperparathyroidism
       
    Sodium thiosulfate injection 25%
    Formulary
    Red

    Approved off-label indication:

    • Treatment of calciphylaxis in dialysis patients

    Use in accordance with local guidelines

     
       
    09.05.01.03  Magnesium
    Magnesium Sulfate injection 50%
    View adult BNF View SPC online
    Formulary Magnesium = 2mmol/mL  
    Link  MHRA Drug Safety Update May 19: Magnesium sulfate: risk of skeletal adverse effects in the neonate following prolonged or repeated use in pregnancy
       
    Magnesium Aspartate 243mg powder for oral solution (Magnaspartate®)
    View adult BNF View SPC online
    Formulary

    First line oral magnesium replacement treatment at GSTFT

    1 sachet = 10mmol magnesium

     
       
    Magnesium glycerophosphate tabs
    View adult BNF View SPC online
    Formulary

    Second line oral magnesium replacement treatment at GSTFT

    Magnesium = 4mmol per tab

     
       
    Magnesium sulfate injection
    View adult BNF View SPC online
    Formulary

    Approved off-label indication:

    Management of eclampsia and pre-eclampsia

     
       
    Magnesium carbonate capsules
    Unlicensed Drug Unlicensed Hypomagnesaemia 
       
    Magnesium glycerophosphate liquid
    Unlicensed Drug Unlicensed Hypomagnesaemia (prepared on request) Magnesium = 1mmol/mL 
       
    09.05.02  Phosphorus to top
    09.05.02.01  Phosphate supplements
    Addiphos® solution for infusion (phosphate supplementation)
    View adult BNF View SPC online
    Restricted Drug Restricted

    USE UNDER SPECIALIST SUPERVISION ONLY

    20ml contains:

    • 40mmol Phosphate
    • 30mmol Sodium
    • 30mmol Potassium

    Refer to local guidelines for use in phosphate supplementation.  Note that Addiphos constitutes as a concentrated potassium formulation.

     
       
    Phosphate intravenous infusion  (Polyfusor®)
    View adult BNF
    Formulary Phosphate = 100mmol/L 
       
    Phosphate-Sandoz ® effervescent tablets
    View adult BNF
    Formulary 1 tablet contains:
  • 16.1mmol Phosphate
  • 20.4mmol Sodium
  • 3.1mmol Potassium 
  •    
    Sodium phosphate enema (Cleen Ready-to-use enema only) (hypophosphataemia in dialysis - off-label)
    View adult BNF View SPC online
    Formulary
    Red

    Approved off-label indication:

    Phosphate supplementation for hypophosphataemia in nocturnal home-haemodialysis patients (for addition into the dialysate ONLY)

     
       
    09.05.02.02  Phosphate-binding agents
     note 
    Calcium Acetate tablets  (Phosex®, Renacet®)
    View adult BNF View SPC online
    First Choice

     
    Sevelamer carbonate tabs, sachets
    View adult BNF View SPC online
    Second Choice
    Red
    High Cost Medicine
    Note: sachets approved for patients with swallowing difficulties only 
       
    Lanthanum carbonate tablets
    View adult BNF View SPC online
    Third Choice
    Red
    High Cost Medicine

    RENAL CONSULTANTS ONLY

    For patients who cannot tolerate calcium containing phosphate binders or have pre existing hypercalcaemia. Not to be used in combination with sevelamer.

     
       
    Sucroferric oxyhydroxide (Velphoro)
    View adult BNF View SPC online
    Fourth Choice
    Red

    RENAL CONSULTANTS ONLY

    Last line treatment option for patients who cannot tolerate calcium containing phosphate binders or have pre existing hypercalcaemia. Not to be used in combination with sevelamer or lanthanum.

    See APC recommendation (link below)

     
    Link  Sucroferric oxyhydroxide (Velphoro® ) 500mg chewable tablets for the treatment of hyperphosphatemia in adult renal dialysis patients
       
    Aluminium Hydroxide capsules (Alu-Cap®)
    View adult BNF View SPC online
    Formulary

     
       
    Calcium Carbonate chewable tablets  (Adcal®)
    View adult BNF View SPC online
    Formulary

    Calcium 15mmol per tab

    Chewable calcium option in patients who do not tolerate calcium acetate. Max dose = 1 tab three times a day

     
       
    Calcium Carbonate tablets  (Ca2+ 3mmol)
    View adult BNF View SPC online
    Unlicensed Drug Unlicensed

    Phosphate binding renal patients

     
       
    09.05.03  Fluoride
    Sodium fluoride tablets  (F- 500 micrograms)
    View adult BNF View SPC online
    Formulary
    Red

     
       
    Sodium fluoride toothpaste 0.619%  (Duraphat® 2800 ppm)
    View adult BNF View SPC online
    Restricted Drug Restricted
    Red

    INITIATION BY DENTAL INSTITUTE ONLY

    Treatment and prevention of dental caries (coronal and root) in adults and children over 10 years old

    For prescribing by oral medicine or dentists only (not for GP prescribing)

     
       
    Sodium fluoride toothpaste 1.1%  (Duraphat® 5000 ppm)
    View adult BNF View SPC online
    Restricted Drug Restricted
    Red

    INITIATION BY DENTAL INSTITUTE ONLY Treatment and prevention of dental adolescents 16 years and older who are at high risk of:

    • Multiple caries
    • Caries due to xerostomia (dry mouth) which may be secondary to radiotherapy of the head and neck areas; Sjögren’s Syndrome; medication currently being taken by the patient or other diseases
    • Osteomyelitis and necrosis following dental extractions,such as patients on intravenous bisphosphonates or those with a history of radiotherapy to the head and neck

    For prescribing by oral medicine or dentists only (not for GP prescribing)

     
       
    09.05.04  Zinc
    Zinc Sulphate effervescent tablets 125mg
    View SPC online
    Formulary Zn2+ = 45 mg per tab 
       
    09.05.05  Selenium to top
    Selenium oral solution
    View adult BNF View SPC online
    Formulary Selenium deficiency in patients with recessive dystrophic bullosa (RDEB) 
       
    09.06  Vitamins
    09.06.01  Vitamin A
    Vitamins A and D capsules
    View adult BNF View SPC online
    Formulary  
       
    Beta carotene capsules  (vitamin A)
    View adult BNF View SPC online
    Unlicensed Drug Unlicensed Vitamin A deficiency 
       
    Vitamin A palmitate injection
    View adult BNF View SPC online
    Unlicensed Drug Unlicensed Vitamin A deficiency 
       
    09.06.02  Vitamin B group
    Thiamine tablets
    View adult BNF View SPC online
    Formulary  
       
    Pabrinex intravenous high potency injection
    View adult BNF View SPC online
    Formulary  
    Link  MHRA Sept 2007: Pabrinex: allergic reactions
       
    Pabrinex intramuscular high potency injection
    View adult BNF View SPC online
    Restricted Drug Restricted SLAM only  
    Link  MHRA Sept 2007: Pabrinex: allergic reactions
       
    Pyridoxine hydrochloride tablets
    View adult BNF View SPC online
    Formulary  
       
    Vitamin B compound strong tablets
    View adult BNF View SPC online
    Formulary  
       
    Nicotinamide tablets
    View adult BNF
    Formulary  
       
    Potassium aminobenzoate capsules  (Potoba®)
    View adult BNF View SPC online
    Restricted Drug Restricted

    Consultants specialising in Peyronie’s disease only

    Treatment of early Peyronie’s disease in patients in the acute phase

    • Initial supply must be made by the hospital
    • Restricted to a maximum of 3 months
    • Dose: 3g three times daily with food
     
       
    Pyridoxine hydrochloride injection 50mg/2 mL
    Unlicensed Drug Unlicensed Antidote for isoniazid poisoning. To be injected intravenously. Refer to TOXBASE for advice  
       
    Riboflavin ophthalmic topical solution
    Unlicensed Drug Unlicensed For photochemical corneal collagen cross-linking in the management of keratoconus  
       
    Riboflavin tablets
    Unlicensed Drug Unlicensed Riboflavin deficiency 
       
    09.06.03  Vitamin C
    Ascorbic acid tablets
    View adult BNF View SPC online
    Formulary Approved off-label indication:
  • Treatment of iron overload with desferrioxamine  
  •    
    Ascorbic acid injection
    View adult BNF View SPC online
    Formulary  
       
    09.06.04  Vitamin D to top
    Adcal-D3® caplets
    View adult BNF View SPC online
    Formulary Each caplet contains
  • Calcium 300mg (elemental)
  • Colecalciferol 200 units Dose: Two caplets twice a day 
  •    
    Adcal-D3® chewable tabs
    View adult BNF View SPC online
    Formulary Each tablet contains
  • Calcium 600mg (elemental)
  • Colecalciferol 400 units Dose: One tablet twice a day 
  •    
    Adcal-D3® effervescent tabs
    View adult BNF View SPC online
    Formulary Each tablet contains
  • Calcium 600mg (elemental)
  • Colecalciferol 400 units Dose: One effervescent tablet twice a day 
  •    
    Calceos® chewable tabs
    View adult BNF View SPC online
    Formulary Each tablet contains
  • Calcium 500mg (elemental)
  • Colecalciferol 400 units Dose: One tablet twice a day 
  •    
    Colecalciferol tabs, caps & oral liquid
    View adult BNF View SPC online
    Formulary
    Green

    Follow APC guidelines (below) for management of vitamin D deficiency and insufficiency.

    When prescribing treatment, use a licensed preparation (refer to APC guidance for products available)

    In secondary care, contact the pharmacy department for specific brands routinely available

     
       
    Alfacalcidol caps, oral drops, injection
    View adult BNF View SPC online
    Formulary  
       
    Calcitriol caps
    View adult BNF View SPC online
    Formulary  
       
    Ergocalciferol injection
    View adult BNF
    Restricted Drug Restricted

    INITIATION BY SPECIALIST ONLY

    Unlicensed intramuscular injection available as 400,000 units in 2mL (SALF®)

    Dose: 300 000 units as a single dose, repeated 6-monthly

     
       
    Paricalcitol caps, injection
    View adult BNF View SPC online
    Formulary
    Red
     
       
    09.06.05  Vitamin E
    Alpha tocopheryl acetate suspension 500 mg/5 mL
    View adult BNF View SPC online
    Formulary  
       
    Alpha tocopheryl tabs, caps
    View adult BNF
    Unlicensed Drug Unlicensed Vitamin E deficiency occurring in malabsorption disorders 
       
    09.06.06  Vitamin K
    Menadiol sodium phosphate tabs
    View adult BNF View SPC online
    Formulary  
       
    Phytomenadione mixed micelle injection
    View adult BNF View SPC online
    Formulary  
       
    09.06.07  Multivitamin preparations
    Multivitamin tabs
    Formulary  
       
    Vitamin caps BPC
    View adult BNF
    Formulary  
       
    Abidec® oral drops
    View SPC online
    Formulary  
       
    Centrum® tabs
    Restricted Drug Restricted GUM ONLY 
       
    Cod liver oil capsules
    Formulary  
       
    Dalivit® oral drops
    Formulary  
       
    DEKAs® Plus liquid, softgels, chewable tablets
    View adult BNF View SPC online
    Restricted Drug Restricted
    Amber 1

    Restricted to use in cystic fibrosis patients only

    Fat soluble vitamin supplement

     
       
    Forceval® caps, effervescent tabs
    View adult BNF View SPC online
    Formulary  
       
    Ketovite® tabs, liquid
    View adult BNF View SPC online
    Formulary  
       
    Renavit tablets
    Formulary
    Amber 1
    For vitamin replacement in renal dialysis patients 
       
    09.07  Bitters and tonics
    09.08  Metabolic disorders to top
    09.08.01  Drugs used in metabolic disorders
    Hydroxocobalamin injection
    View adult BNF View SPC online
    Formulary
    Red
    Inherited metabolic disorders commissioned by NHSE  
       
    Sapropterin tabs (Use in pregnancy)
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine

    Approved for phenylketonuria in pregnancy as per NHSE guidance (see link below) 

    Use in non-pregnant adults and children is not approved (see NHSE policy 170133P, link below)

     
    Link  NHSCB/E12/p/a: Sapropterin (Kuvan®) For Phenylketonuria: Use in Pregnancy
    Link  NHSE Clinical Commissioning Policy 170133P: Sapropterin for phenylketonuria (all ages)
       
    5-Hydroxytryptophan tabs
    Unlicensed Drug Unlicensed
    Red
    Inherited metabolic disorders commissioned by NHSE  
       
    Betaine tabs, oral powder
    Unlicensed Drug Unlicensed
    Red
    Inherited metabolic disorders commissioned by NHSE 
       
    L-citrulline oral powder
    Unlicensed Drug Unlicensed
    Red
    Inherited metabolic disorders commissioned by NHSE  
       
    Pyridoxal-5-phosphate tablets
    Unlicensed Drug Unlicensed
    Red
    Inherited metabolic disorders commissioned by NHSE  
       
    Pyridoxine phosphate tablets
    Unlicensed Drug Unlicensed
    Red
    Inherited metabolic disorders commissioned by NHSE  
       
    Ubiquinone caps  (Co-enzyme Q10- inherited metabolic disorders)
    Unlicensed Drug Unlicensed
    Red

    Inherited metabolic disorders commissioned by NHSE

     
       
    09.08.01  Wilsons disease
    Penicillamine tabs (Wilsons disease)
    View adult BNF View SPC online
    Formulary
    Red
    Approved for:
  • Inherited metabolic disorders (NHSE) 
  •    
    Trientine dihydrochloride tabs
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine
    NHS England
    BlueTeq

    USE UNDER SPECIALIST SUPERVISION ONLY

    Approved as per criteria in NHSE Policy (link below)

     
    Link  NHSE Clinical Commissioning Policy 170094P: Trientine for Wilson disease (all ages)
       
    Zinc acetate caps
    View adult BNF View SPC online
    Formulary
    Red
    USE UNDER SPECIALIST SUPERVISION ONLY 
       
    09.08.01  Carnitine deficiency
    L-carnitine oral solution, chewable tabs, tabs, injection
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine
    Inherited metabolic disorders commissioned by NHSE 
       
    09.08.01  Nephropathic cystinosis
    Mercaptamine caps (Cystagon®)
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine

    Approved for the treatment of nephropathic cystinosis

     
       
    Mercaptamine 0.55% preservative free eye drops
    View adult BNF View SPC online
    Unlicensed Drug Unlicensed
    Red

    Approved for treatment of ocular manifestations of cystinosis

    Dose = 1 drop up to twelve times a day

     
       
    09.08.01  Urea cycle disorders to top
    Glycerol phenylbutyrate oral liquid (Ravicti®)
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine

    Inherited metabolic disorders commissioned by NHSE

     
       
    Sodium phenylbutyrate tabs, oral solution
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine

    Inherited metabolic disorders commissioned by NHSE

     
       
    L-Arginine tabs, injection
    Unlicensed Drug Unlicensed
    Red
    Inherited metabolic disorders commissioned by NHSE  
       
    Sodium benzoate tabs, injection
    Unlicensed Drug Unlicensed
    Red
    Inherited metabolic disorders commissioned by NHSE  
       
    Sodium phenylbutyrate injection
    Unlicensed Drug Unlicensed
    Red
    High Cost Medicine

    Inherited metabolic disorders commissioned by NHSE

     
       
    09.08.02  Acute porphyrias
    Haem arginate concentrate for intravenous infusion
    View adult BNF View SPC online
    Restricted Drug Restricted
    Red
    High Cost Medicine

    USE UNDER SPECIALIST SUPERVISION ONLY

    Inherited metabolic disorders commissioned by NHSE.

    Includes off-label use for prevention of porphyrias at a maximum single dose of 3mg/kg per week (in accordance with NHSE comissioning criteria). 

     
       
    09.09  Miscellaneous preparations
    Acidophilus extra capsules (Lactobacillus acidophilus and Bifido bacteria)
    Formulary Treatment of general digestion problems, diarrhoea, and antibiotic associated diarrhoea 
       
    Brewers Yeast tablets
    Formulary

    Pseudomembranous colitis.

    Dose:Three tablets 8 hourly for 5-7 days

     
       
    Ubiquinone tabs (Co-enzyme Q10 - xeroderma pigmentosum)
    Unlicensed Drug Unlicensed

    For patients with xeroderma pigmentosum, who have progressed neurodegeneration resulting in significant morbidity.

    Dose: 240 mg twice daily

     
       
     ....
     Non Formulary Items
    Luetin antioxidants  (e.g. Icaps, Occuvite)

    Non Formulary
    Grey
    Link  SE London Position Statement (not recommended for prescribing in SE London: Lutein and Antioxidants for Age Related Macular Degeneration
     
    Sapropterin tabs  (Use in non-pregnant adults and children)

    View adult BNF View SPC online
    Non Formulary
    Grey
    Use in non-pregnant adults and children is not approved. See NHSE policy 170133P, (link below)

    Link  Clinical Commissioning Policy 170133P: Sapropterin for phenylketonuria (all ages)
     
      
    Key
    note Notes
    Section Title Section Title (top level)
    Section Title Section Title (sub level)
    First Choice Item First Choice item
    Non Formulary Item Non Formulary section
    Restricted Drug
    Restricted Drug
    Unlicensed Drug
    Unlicensed
    Track Changes
    Display tracking information
    click to search medicines.org.uk
    Link to adult BNF
    click to search medicines.org.uk
    Link to SPCs
    SMC
    Scottish Medicines Consortium
    Cytotoxic Drug
    Cytotoxic Drug
    CD
    Controlled Drug
    High Cost Medicine
    High Cost Medicine
    Cancer Drugs Fund
    Cancer Drugs Fund
    NHSE
    NHS England
    Homecare
    Homecare
    CCG
    CCG

    Traffic Light Status Information

    Status Description

    Red

    Specialist or hospital prescribing only. The responsibility for prescribing, monitoring, dose adjustment and review should remain with the specialist or hospital. In very exceptional circumstances a specialist may discuss individual patient need for a RED drug to be prescribed by a GP and the GP should consider informing the Medicines Management team before a decision is made to prescribe for individual patients.   

    Amber 1

    Treatment can be initiated in primary care after a recommendation from an appropriate specialist  

    Amber 2

    Specialist initiation followed by maintenance prescribing in primary care  

    Amber 3

    Specialist initiation with ongoing monitoring required. After dose stabilisation GPs can be requested to take over prescribing responsibilities using the approved APC shared care documentation  

    Green

    Specialist and non-specialist initiation  

    Grey

    Not recommended for prescribing  

    netFormulary