Approved for the treatment and prevention of bleeding in adults with von Willebrand disease as per NHSE policy criteria (see link below)

Approved for:

• Atypical Haemolytic Uraemic Syndrome (aHUS)
• Use in accordance with NHSE SSC 1522 & NICE HST1

Approved for:

• Treatment of recurrence of C3 glomerulopathy post-kidney transplant
• Use as per criteria in NHSE Policy 16054/P

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

Approved for prevention and management of delayed haemolytic transfusion reactions and hyperhaemolysis in patients with haemoglobinopathies as per NHSE policy criteria

(see link below)

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

Approved for prevention and management of delayed haemolytic transfusion reactions and hyperhaemolysis in patients with haemoglobinopathies as per NHSE policy criteria

(see link below)

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

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

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

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

Consultant Haematologists only

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

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

USE UNDER SPECIALIST SUPERVISION ONLY

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

Approved off-label indication:

Treatment of symptomatic acute Immune Thrombocytopenia (ITP)

Dose = 1–2 mg/kg daily, adjusted according to response (maximum 150mg/day)

Refer to SE London APC guidance for management of ITP in adult patients (link below)

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

Approved off-label indication:

Last line treatment for symptomatic acute Immune Thrombocytopenia (ITP)

Dose = 5mg/kg/day for 6 days then 2.5-3mg/kg/day

Refer to SE London APC guidance for management of ITP in adult patients (link below)

Approved off-label indication:

Last line treatment for symptomatic acute Immune Thrombocytopenia (ITP)

Dose = 1-2mg/kg orally daily for a minimum of 16 weeks

Refer to SE London APC guidance for management of ITP in adult patients (link below)

Approved off-label indication:

Last line treatment for symptomatic acute Immune Thrombocytopenia (ITP)

Dose = 200mg 2-4 times daily

Refer to SE London APC guidance for management of ITP in adult patients (link below)

Approved off-label indication:

Last line treatment for symptomatic acute Immune Thrombocytopenia (ITP)

Dose = 75-100mg daily

Refer to SE London APC guidance for management of ITP in adult patients (link below)

Consultant Haematologists specialising in the treatment of ITP only

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

Approved off-label indication:

Treatment of symptomatic acute Immune Thrombocytopenia (ITP)

Dose = Start at 500 mg twice daily, increasing to 1g twice daily if tolerated

Refer to SE London APC guidance for management of ITP in adult patients (link below)

Approved off-label indication:

Treatment of symptomatic acute Immune Thrombocytopenia (ITP)

Dose = 100mg weekly for 4 weeks

Biosimilar products available, to be prescribed by brand name.

Contact pharmacy department for advice on brand for routine prescribing if unsure

Refer to SE London APC guidance for management of ITP in adult patients (link below)

Consultant Haematologists specialising in the treatment of ITP only

Approved off-label indication:

Last line treatment for symptomatic acute Immune Thrombocytopenia (ITP)

Refer to SE London APC guidance for management of ITP in adult patients (link below)

Approved off-label indication:

Last line treatment for symptomatic acute Immune Thrombocytopenia (ITP)

Refer to SE London APC guidance for management of ITP in adult patients (link below)

Consultant Specialists only

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

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)

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

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

MR tabs = 8mmol K⁺ per tab

Syrup = 1mmol/mL K⁺

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

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).

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).

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

Approximately 6mmol HCO₃^- per capsule

20 mmol K⁺ per 1000mL

20 mmol K⁺ in 10mL

REFER TO LOCAL TRUST PROTOCOL FOR CONCENTRATED POTASSIUM SOLUTIONS

30 mmol K⁺ in 20mL

20mL also contains:

• 40mmol Phosphate
• 30mmol Sodium

REFER TO LOCAL TRUST PROTOCOL FOR CONCENTRATED POTASSIUM SOLUTIONS

REFER TO LOCAL TRUST PROTOCOL FOR CONCENTRATED POTASSIUM SOLUTIONS

For myocardial protection during cardiac surgery

16 mmol K⁺ in 20mL

REFER TO LOCAL TRUST PROTOCOL FOR CONCENTRATED POTASSIUM SOLUTIONS

For myocardial protection during cardiac surgery

10 mmol K⁺ in 10mL

REFER TO LOCAL TRUST PROTOCOL FOR CONCENTRATED POTASSIUM SOLUTIONS

10 mmol K⁺ in 10mL

REFER TO LOCAL TRUST PROTOCOL FOR CONCENTRATED POTASSIUM SOLUTIONS

20 mmol K⁺ in 100mL

REFER TO LOCAL TRUST PROTOCOL FOR CONCENTRATED POTASSIUM SOLUTIONS

40 mmol K⁺ in 100mL

REFER TO LOCAL TRUST PROTOCOL FOR CONCENTRATED POTASSIUM SOLUTIONS

20 mmol K⁺ in 50mL

REFER TO LOCAL TRUST PROTOCOL FOR CONCENTRATED POTASSIUM SOLUTIONS

50 mmol K⁺ in 50mL

REFER TO LOCAL TRUST PROTOCOL FOR CONCENTRATED POTASSIUM SOLUTIONS

Local Trust guidance or procedures on the use of Total Parenteral Nutrition should be followed.

Local Trust guidance or procedures on the use of Total Parenteral Nutrition should be followed.

Local Trust guidance or procedures on the use of Total Parenteral Nutrition should be followed.

Local Trust guidance or procedures on the use of Total Parenteral Nutrition should be followed.

Local Trust guidance or procedures on the use of Total Parenteral Nutrition should be followed.

Local Trust guidance or procedures on the use of Total Parenteral Nutrition should be followed.

Local Trust guidance or procedures on the use of Total Parenteral Nutrition should be followed.

Local Trust guidance or procedures on the use of Total Parenteral Nutrition should be followed.

Local Trust guidance or procedures on the use of Total Parenteral Nutrition should be followed.

Local Trust guidance or procedures on the use of Total Parenteral Nutrition should be followed.

Local Trust guidance or procedures on the use of Total Parenteral Nutrition should be followed.

Local Trust guidance or procedures on the use of Total Parenteral Nutrition should be followed.

Local Trust guidance or procedures on the use of Total Parenteral Nutrition should be followed.

Local Trust guidance or procedures on the use of Total Parenteral Nutrition should be followed.

Local Trust guidance or procedures on the use of Total Parenteral Nutrition should be followed.

Local Trust guidance or procedures on the use of Total Parenteral Nutrition should be followed.

Local Trust guidance or procedures on the use of Total Parenteral Nutrition should be followed.

Local Trust guidance or procedures on the use of Total Parenteral Nutrition should be followed.

Local Trust guidance or procedures on the use of Total Parenteral Nutrition should be followed.

Local Trust guidance or procedures on the use of Total Parenteral Nutrition should be followed.

Local Trust guidance or procedures on the use of Total Parenteral Nutrition should be followed.

Local Trust guidance or procedures on the use of Total Parenteral Nutrition should be followed.

Local Trust guidance or procedures on the use of Total Parenteral Nutrition should be followed.

Local Trust guidance or procedures on the use of Total Parenteral Nutrition should be followed.

Local Trust guidance or procedures on the use of Total Parenteral Nutrition should be followed.

Local Trust guidance or procedures on the use of Total Parenteral Nutrition should be followed.

For primary hyperparathyroidism, as per NHSE Policy

Endocrinology only

For secondary hyperparathyroidism in end stage renal disease

Renal consultant initiation only

Approved for secondary hyperparathyroidism in CKD as per NICE TA448

Approved for:

• Treatment of calciphylaxis in dialysis patients

Use in accordance with local guidelines

First line oral magnesium replacement treatment at GSTFT

1 sachet = 10mmol magnesium

Second line oral magnesium replacement treatment at GSTFT

Magnesium = 4mmol per tab

Approved off-label indication:

Management of eclampsia and pre-eclampsia

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.

Approved off-label indication:

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

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.

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)

Calcium 15mmol per tab

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

Phosphate binding renal patients

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)

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)

Dose = 180mg daily

Approved for:

Vitamin A deficiency

Vitamin A deficiency

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

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

INITIATION BY SPECIALIST ONLY

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

Although not recommended in the SPC, use with plastic syringes is approved as there are no known clinical risks associated with this use if administered immediately after preparation.

GUM ONLY AT GSTT AND KCH

ICU USE ONLY AT LGT

Restricted to use in cystic fibrosis patients only

Fat soluble vitamin supplement

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)

Inherited metabolic disorders commissioned by NHSE

USE UNDER SPECIALIST SUPERVISION ONLY

Approved as per criteria in NHSE Policy (link below)

Approved for the treatment of nephropathic cystinosis

Approved for treatment of ocular manifestations of cystinosis

Dose = 1 drop up to twelve times a day

Inherited metabolic disorders commissioned by NHSE

Inherited metabolic disorders commissioned by NHSE

Inherited metabolic disorders commissioned by NHSE

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). 

Pseudomembranous colitis.

Dose:Three tablets 8 hourly for 5-7 days

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

Dose: 240 mg twice daily