Formulary Chapter 9: Nutrition and blood - Full Chapter
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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. |
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Details... |
09.01 |
Anaemias and some other blood disorders |
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Vonicog alfa injection
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Formulary

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

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NHSE Clinical Commissioning Policy 200801P: Vonicog alfa for the treatment and prevention of bleeding in adults with von Willebrand disease
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09.01.01 |
Iron-deficiency anaemias |
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Ferrous Sulphate tablets 200 mg
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Formulary
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Elemental iron = 65 mg
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Ferrous Fumarate syrup 140 mg/5 mL
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Formulary
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Elemental iron = 45 mg/5 mL
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Ferrous Fumarate tablets 210 mg
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Formulary
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Elemental iron = 68 mg
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Ferrous Fumarate tablets 322 mg
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Formulary
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Elemental iron = 100 mg
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Ferrous Gluconate tablets 300 mg
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Formulary
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Elemental iron = 35 mg
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Sodium Feredetate elixir 190 mg/5 mL
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Formulary
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Elemental iron = 27.5 mg/5 mL
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Ferric Maltol caps (Feraccru®)
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Restricted
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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) andTwo 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.
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SE London APC Recommendation: Ferric maltol (Feraccru) for iron deficiency anaemia in adults with inflammatory bowel disease
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09.01.01.01 |
Iron and folic acid |
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Fefol® m/r caps
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Formulary
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Each tablet contains
Ferrous sulphate 150 mg
Folic acid 500 micrograms
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Ferrograd Folic® tabs
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Formulary
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Each tablet contains
Ferrous fumarate 325 mg
Folic acid 350 micrograms
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Pregaday® tabs
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Formulary
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Each tablet contains
Ferrous fumarate 322 mg
Folic acid 350 micrograms
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09.01.01.02 |
Parenteral iron - USE UNDER SPECIALIST SUPERVISION ONLY |
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Refer to local guidance for preferred use of parenteral iron preparations
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Ferric Carboxymaltose injection (Ferinject®)
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Formulary
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MHRA Nov 20: Ferric carboxymaltose (Ferinject▼): risk of symptomatic hypophosphataemia leading to osteomalacia and fractures
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Ferric Derisomaltose injection (Monofer®)
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Formulary
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Iron Sucrose injection (Venofer®)
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Formulary
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09.01.02 |
Drugs used in megaloblastic anaemias |
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Folic acid tabs, syrup
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Formulary
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Hydroxocobalamin injection
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Formulary
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Folic acid injection
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Unlicensed
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Folated-deficient megaloblastic anaemia; prophylaxis in chronic haemolytic states or in renal dialysis
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09.01.03 |
Drugs used in hypoplastic, haemolytic, and renal anaemias |
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Eculizumab injection (Atypical Haemolytic Uraemic Syndrome [aHUS])
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Formulary


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Approved for:
- Atypical Haemolytic Uraemic Syndrome (aHUS)
- Use in accordance with NHSE SSC 1522 & NICE HST1
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NICE HST1: Eculizumab for treating atypical haemolytic uraemic syndrome
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Eculizumab injection (C3 glomerulopathy post-kidney transplant)
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Restricted


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Approved for:
- Treatment of recurrence of C3 glomerulopathy post-kidney transplant
- Use as per criteria in NHSE Policy 16054/P
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NHSE 16054/P: Eculizumab in the treatment of recurrence of C3 glomerulopathy post - kidney transplant
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Eculizumab injection (Paroxysmal nocturnal haemoglobinuria)
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Restricted
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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
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Eculizumab injection (prevention and management of delayed haemolytic transfusion reactions)
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Formulary


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Approved for prevention and management of delayed haemolytic transfusion reactions and hyperhaemolysis in patients with haemoglobinopathies as per NHSE policy criteria
(see link below)
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NHSE Clinical Comissioning Policy 200602P: Prevention and management of delayed haemolytic transfusion reactions and hyperhaemolysis in patients with haemoglobinopathies
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Emicizumab injection
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Formulary


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Approved for prophylaxis in people with congenital haemophilia A with factor VIII inhibitors (all ages) as per NHSE policy criteria (see link below)
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Clinical Commissioning Policy: Emicizumab as prophylaxis in people with congenital haemophilia A with factor VIII inhibitors (all ages)
Clinical Commissioning Policy: Emicizumab as prophylaxis in people with severe congenital haemophilia A without factor VIII inhibitors (all ages)
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Rituximab injection (prevention and management of delayed haemolytic transfusion reactions - off-label)
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Formulary

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Approved for prevention and management of delayed haemolytic transfusion reactions and hyperhaemolysis in patients with haemoglobinopathies as per NHSE policy criteria
(see link below)
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NHSE Clinical Comissioning Policy 200602P: Prevention and management of delayed haemolytic transfusion reactions and hyperhaemolysis in patients with haemoglobinopathies
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Susoctocog alfa injection
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Formulary

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Approved for treating bleeding episodes in people with acquired haemophilia A (all ages) as per NHSE policy criteria (see link below)
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Clinical Commissioning Policy: Susoctocog alfa for treating bleeding episodes in people with acquired haemophilia A (all ages) (170061P)
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09.01.03 |
Erythropoietin and darbopoetin |
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Darbepoetin alfa injection
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Formulary
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Treatment of anaemia associated with chronic kidney disease
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Epoetin alfa injection (Eprex®, Binocrit®)
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Formulary
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Treatment of anaemia associated with chronic kidney disease
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Epoetin beta injection (NeoRecormon®)
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Formulary
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Treatment of anaemia associated with chronic kidney disease
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Epoetin zeta injection (Retacrit®)
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Formulary
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Treatment of anaemia associated with chronic kidney disease
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Methoxy Polyethylene Glycol-Epoetin beta injection (Mircera®)
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Restricted
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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
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Epoetin alfa injection (Eprex®)
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Formulary
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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
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Epoetin beta injection (NeoRecormon®)
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Formulary
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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
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Epoetin alfa/beta injection
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Restricted
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Consultant Haematologists only
Use in accordance with local guideline for the treatment of myelodysplastic syndrome (MDS)
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Deferasirox film coated tabs
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Restricted
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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
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Deferasirox: Healthcare professionals booklet from the manufacturers
NHSE 16070/P: Treatment of iron overload for transfused and non transfused patients with chronic inherited anaemias
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Deferiprone tabs
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Formulary
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Follow NHSE Policy 16070/P when using in chronic inherited anaemias
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NHSE 16070/P: Treatment of iron overload for transfused and non transfused patients with chronic inherited anaemias
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Desferrioxamine mesilate injection
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Formulary
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09.01.04 |
Drugs used in autoimmune thrombocytopenic purpura |
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Anagrelide capsules
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Formulary
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USE UNDER SPECIALIST SUPERVISION ONLY
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Avatrombopag tabs
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Formulary

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Approved for use as per NICE Technology Appraisal guidance (see link below)
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NICE TA626: Avatrombopag for treating thrombocytopenia in people with chronic liver disease needing a planned invasive procedure
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Azathioprine tablets (immune thrombocytopenia - off-label )
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Formulary
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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)

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Caplacizumab injection
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Formulary

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Approved for use as per NICE Technology Appraisal guidance (see link below)
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NICE TA667: Caplacizumab with plasma exchange and immunosuppression for treating acute acquired thrombotic thrombocytopenic purpura
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Ciclosporin capsules (immune thrombocytopenia - off-label )
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Formulary
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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)

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Cycloposphamide tablets (immune thrombocytopenia - off-label )
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Formulary
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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)

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Danazol capsules (immune thrombocytopenia - off-label )
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Formulary
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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)

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Dapsone tablets (immune thrombocytopenia - off-label )
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Formulary
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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)

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Eltrombopag tablets
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Restricted

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Consultant Haematologists specialising in the treatment of ITP only
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MHRA Jul 2018: Eltrombopag (Revolade): reports of interference with bilirubin and creatinine test results
NICE TA293: Eltrombopag for treating chronic immune (idiopathic) thrombocytopenic purpura (review of technology appraisal 205)
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Lusutrombopag tabs
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Formulary

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Approved for use as per NICE Technology Appraisal guidance (see link below)
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NICE TA617: Lusutrombopag for treating thrombocytopenia in people with chronic liver disease needing a planned invasive procedure
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Mycophenolate mofetil tabs, caps (immune thrombocytopenia - off-label )
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Formulary
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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)

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Rituximab injection (immune thrombocytopenia - off-label )
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Formulary

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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)

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Romiplostim injection
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Restricted

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Consultant Haematologists specialising in the treatment of ITP only
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NICE TA221: Thrombocytopenic purpura - romiplostim
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Vinblastine injection (immune thrombocytopenia - off-label )
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Formulary
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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)

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Vincristine injection (immune thrombocytopenia - off-label )
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Formulary
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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)

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Eltrombopag tablets
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Restricted

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Consultant Specialists only
Refractory aplastic anaemia in patients who are platelet transfusion dependent and also contraindicated/failed bone marrow transplant.
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09.01.06 |
Drugs used in neutropenia - USE UNDER SPECIALIST SUPERVISION ONLY |
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Filgrastim injection
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Formulary
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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)
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Lenograstim injection
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Formulary
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Pegfilgrastim injection
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Restricted
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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
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09.01.07 |
Drugs used to mobilise stem cells |
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Plerixafor injection
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Restricted


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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
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NHSE Clinical Commissioning Policy 200601P: Use of plerixafor for stem cell mobilisation in adults and children
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09.02 |
Fluids and electrolytes |
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09.02.01 |
Oral preparations for fluid and electrolyte imbalance |
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09.02.01.01 |
Oral potassium |
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Potassium Chloride effervescent tabs
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Formulary
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12mmol K+ per tab
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Potassium Chloride MR tabs, syrup
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Formulary
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MR tabs = 8mmol K+ per tab
Syrup = 1mmol/mL K+
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09.02.01.01 |
Potassium removal |
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Calcium Resonium® (Calcium Polystyrene Sulphonate powder)
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Formulary
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Calcium Polystyrene Sulphonate enema (30g in methylcellulose solution)
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Unlicensed
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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
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09.02.01.02 |
Oral sodium and water |
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Patiromer suspension (Veltassa®)
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Restricted
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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).
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Sodium Chloride MR tabs
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Formulary
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10mmol Na+ per tab
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Sodium zirconium cyclosilicate suspension (Lokelma®)
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Formulary
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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).
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NICE TA599: Sodium zirconium cyclosilicate for treating hyperkalaemia
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09.02.01.02 |
Oral rehydration therapy (ORT) |
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Dioralyte® sachets
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Formulary
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Electrolade® oral powder
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Formulary
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Oral Rehydration Salts
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Unlicensed
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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
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09.02.01.03 |
Oral bicarbonate |
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Sodium bicarbonate 500 mg capsules
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Formulary
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Approximately 6mmol HCO3- per capsule
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Potassium bicarbonate effervescent tabs
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Formulary
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Approximately 6mmol HCO3- and 6.5mmol K+ per tab
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09.02.02 |
Parenteral preparations for fluid and electrolyte imbalance |
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09.02.02.01 |
Electrolytes and water |
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09.02.02.01 |
Intravenous sodium |
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Plasma-Lyte 148 intravenous infusion
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Restricted
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Restricted to use in Critical Care, and intraoperative use in the following procedures:
Free flap reconstruction
Renal transplant
Simultaneous kidney and pancreas transplant
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Ringer's Solution for Injection
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Formulary
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Sodium Chloride 0.18% and glucose 4% Intravenous infusion
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Formulary
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Sodium Chloride 0.45% and glucose 5% Intravenous infusion
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Formulary
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Sodium Chloride 0.45% intravenous infusion
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Formulary
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Sodium Chloride 0.9% intravenous infusion
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Formulary
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Sodium Chloride 1.8% intravenous infusion
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Formulary
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Sodium lactate intravenous infusion compound (Hartmann's)
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Formulary
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09.02.02.01 |
Intravenous glucose |
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Glucose 5% Intravenous infusion
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Formulary
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Glucose 10% Intravenous infusion
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Formulary
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Glucose 20% Intravenous infusion
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Formulary
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Glucose 50% Intravenous infusion
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Formulary
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09.02.02.01 |
Intravenous potassium |
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Potassium chloride 0.15% and sodium chloride 0.9% intravenous infusion
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Formulary
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20 mmol K+ per 1000mL
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Potassium chloride 0.15% and glucose 5% intravenous infusion
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Formulary
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20 mmol K+ per 1000mL
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Potassium chloride 0.3% and glucose 5% intravenous infusion
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Formulary
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40 mmol K+ per 1000mL
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Potassium chloride 0.3%, sodium chloride 0.18% and glucose 4% intravenous infusion
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Formulary
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40 mmol K+ per 1000mL
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Potassium chloride 0.3%, sodium chloride 0.45% and glucose 5% intravenous infusion
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Formulary
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40 mmol K+ per 1000mL
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Potassium chloride 0.3%, sodium chloride 0.9% intravenous infusion
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Formulary
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40 mmol K+ per 1000mL
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Potassium chloride strong injection 15%
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Formulary
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20 mmol K+ in 10mL
REFER TO LOCAL TRUST PROTOCOL FOR CONCENTRATED POTASSIUM SOLUTIONS
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Addiphos injection (potassium supplementation)
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Formulary
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30 mmol K+ in 20mL
20mL also contains:
- 40mmol Phosphate
- 30mmol Sodium
REFER TO LOCAL TRUST PROTOCOL FOR CONCENTRATED POTASSIUM SOLUTIONS
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Cardioplegia Harefield Preparation infusion
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Formulary
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REFER TO LOCAL TRUST PROTOCOL FOR CONCENTRATED POTASSIUM SOLUTIONS
For myocardial protection during cardiac surgery
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Cardioplegia infusion
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Formulary
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16 mmol K+ in 20mL
REFER TO LOCAL TRUST PROTOCOL FOR CONCENTRATED POTASSIUM SOLUTIONS
For myocardial protection during cardiac surgery
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Potassium acetate injection
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Formulary
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10 mmol K+ in 10mL
REFER TO LOCAL TRUST PROTOCOL FOR CONCENTRATED POTASSIUM SOLUTIONS
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Potassium acid phosphate injection 13.6%
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Formulary
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10 mmol K+ in 10mL
REFER TO LOCAL TRUST PROTOCOL FOR CONCENTRATED POTASSIUM SOLUTIONS
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Potassium chloride 1.5% in sodium chloride 0.9% infusion minibag
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Unlicensed
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20 mmol K+ in 100mL
REFER TO LOCAL TRUST PROTOCOL FOR CONCENTRATED POTASSIUM SOLUTIONS
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Potassium chloride 3% in sodium chloride 0.9% infusion minibag
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Unlicensed
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40 mmol K+ in 100mL
REFER TO LOCAL TRUST PROTOCOL FOR CONCENTRATED POTASSIUM SOLUTIONS
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Potassium chloride 3% in sodium chloride 0.9% prefilled syringe 50mL
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Unlicensed
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20 mmol K+ in 50mL
REFER TO LOCAL TRUST PROTOCOL FOR CONCENTRATED POTASSIUM SOLUTIONS
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Potassium chloride 7.5% in sodium chloride 0.9% prefilled syringe 50mL
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Unlicensed
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50 mmol K+ in 50mL
REFER TO LOCAL TRUST PROTOCOL FOR CONCENTRATED POTASSIUM SOLUTIONS
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09.02.02.01 |
Bicarbonate and lactate |
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Sodium bicarbonate 1.26% intravenous infusion
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Formulary
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Sodium Bicarbonate 1.4% intravenous infusion
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Formulary
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Sodium Bicarbonate 2.74% intravenous infusion
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Formulary
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Sodium Bicarbonate 8.4% intravenous infusion
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Formulary
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Water for Injections
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Formulary
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09.02.02.02 |
Plasma and plasma substitutes |
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Albumin
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Formulary
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Albumin, blood and other blood products are supplied from the Blood Trasfusion Laboratory
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09.02.02.02 |
Plasma substitutes |
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Dextran 70 intravenous infusion in sodium chloride 0.9%
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Formulary
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Gelatin intravenous infusion
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Formulary
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Pentastarch 10% intravenous infusion in sodium chloride 0.9%
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Formulary
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Tetrastarch 6% intravenous infusion in sodium chloride 0.9% (Voluven®)
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Formulary
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09.03 |
Intravenous nutrition |
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Addaven (trace element combination)
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Formulary
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Local Trust guidance or procedures on the use of Total Parenteral Nutrition should be followed.

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Additrace (trace element combination)
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Formulary
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Local Trust guidance or procedures on the use of Total Parenteral Nutrition should be followed.

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Cernevit (combined fat and water soluble vitamins)
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Formulary
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Local Trust guidance or procedures on the use of Total Parenteral Nutrition should be followed.

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Kabiven central 11
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Formulary
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Local Trust guidance or procedures on the use of Total Parenteral Nutrition should be followed.

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Kabiven central 14
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Formulary
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Local Trust guidance or procedures on the use of Total Parenteral Nutrition should be followed.

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Kabiven Peripheral 5
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Formulary
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Local Trust guidance or procedures on the use of Total Parenteral Nutrition should be followed.

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Kabiven Peripheral 7
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Formulary
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Local Trust guidance or procedures on the use of Total Parenteral Nutrition should be followed.

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Kabiven Peripheral 9
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Formulary
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Local Trust guidance or procedures on the use of Total Parenteral Nutrition should be followed.

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

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Nutratain (vitamins)
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Formulary
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Local Trust guidance or procedures on the use of Total Parenteral Nutrition should be followed.

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Nutrelyt (trace element combination)
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Formulary
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Local Trust guidance or procedures on the use of Total Parenteral Nutrition should be followed.

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

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

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Nutriflex Peri 11
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Formulary
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Local Trust guidance or procedures on the use of Total Parenteral Nutrition should be followed.

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Nutriflex Peri 14
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Formulary
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Local Trust guidance or procedures on the use of Total Parenteral Nutrition should be followed.

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Nutriflex Peri 9
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Formulary
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Local Trust guidance or procedures on the use of Total Parenteral Nutrition should be followed.

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Nutriflex special (fat free)
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Formulary
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Local Trust guidance or procedures on the use of Total Parenteral Nutrition should be followed.

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

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SMOFkabiven 12 (electrolyte free)
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Formulary
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Local Trust guidance or procedures on the use of Total Parenteral Nutrition should be followed.

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SMOFkabiven 16 (electrolyte free)
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Formulary
|
Local Trust guidance or procedures on the use of Total Parenteral Nutrition should be followed.

|
|
SMOFkabiven 21 (electrolyte free)
|
Formulary
|
Local Trust guidance or procedures on the use of Total Parenteral Nutrition should be followed.

|
|
SMOFkabiven 8 (electrolyte free)
|
Formulary
|
Local Trust guidance or procedures on the use of Total Parenteral Nutrition should be followed.

|
|
SMOFkabiven extra nitrogen 21gN 2025ml (without electrolytes)
|
Formulary
|
Local Trust guidance or procedures on the use of Total Parenteral Nutrition should be followed.

|
|
Solivito (water soluble vitamins)
|
Formulary
|
Local Trust guidance or procedures on the use of Total Parenteral Nutrition should be followed.

|
|
Triomel N9-1070 electrolyte free
|
Formulary
|
Local Trust guidance or procedures on the use of Total Parenteral Nutrition should be followed.

|
|
Vitlipid (fat soluble vitamins)
|
Formulary
|
Local Trust guidance or procedures on the use of Total Parenteral Nutrition should be followed.

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

|
|
Calcium chloride injection 10%
|
Formulary
|
Calcium = 27.3mg/mL
|
|
Calcium gluconate effervescent tabs
|
Formulary
|
Calcium = 89mg per tab
|
|
Calcium gluconate injection 10%
|
Formulary
|
Calcium = 8.4mg/mL
|
|
Calcium lactate and gluconate syrup (Alliance Calcium Syrup®)
|
Unlicensed
|
Calcium = 2.5mmol in 5ml
|
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)
|
Restricted

|
For primary hyperparathyroidism, as per NHSE Policy
Endocrinology only
|
NHSE Policy 16034/P: Cinacalcet for complex primary hyperparathyroidism in adults
|
Cinacalcet tablets (secondary hyperparathyroidism in ESRD)
|
Restricted

|
For secondary hyperparathyroidism in end stage renal disease
Renal consultant initiation only
|
SE London Shared Care Agreement: Cinacalcet for Secondary Hyperparathyroidism in Adult End-Stage Renal Disease Established on Dialysis Therapy
NICE TA117: Cinacalcet for the treatment of secondary hyperparathyroidism in patients with end-stage renal disease on maintenance dialysis therapy
|
Etelcalcetide injection
|
Formulary


|
Approved for secondary hyperparathyroidism in CKD as per NICE TA448
|
NICE TA448: Etelcalcetide for treating secondary hyperparathyroidism
|
Sodium thiosulfate injection 50%
|
Unlicensed
|
Approved for:
- Treatment of calciphylaxis in dialysis patients
Use in accordance with local guidelines
|
|
|
|
Magnesium Sulfate injection 50%
|
Formulary
|
Magnesium = 2mmol/mL
|
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®)
|
Formulary
|
First line oral magnesium replacement treatment at GSTFT
1 sachet = 10mmol magnesium
|
|
Magnesium glycerophosphate tabs
|
Formulary
|
Second line oral magnesium replacement treatment at GSTFT
Magnesium = 4mmol per tab
|
|
Magnesium sulfate injection
|
Formulary
|
Approved off-label indication:
Management of eclampsia and pre-eclampsia
|
|
Magnesium carbonate capsules
|
Unlicensed
|
Hypomagnesaemia
|
|
Magnesium glycerophosphate liquid
|
Unlicensed
|
Hypomagnesaemia (prepared on request)
Magnesium = 1mmol/mL
|
|
09.05.02 |
Phosphorus |
|
|
09.05.02.01 |
Phosphate supplements |
|
|
Addiphos® solution for infusion (phosphate supplementation)
|
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®)
|
Formulary
|
Phosphate = 100mmol/L
|
|
Phosphate-Sandoz ® effervescent tablets
|
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)
|
Formulary
|
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 |
|
|
|
Calcium Acetate tablets (Phosex®, Renacet®)
|
First Choice
|

|
|
Sevelamer carbonate tabs, sachets
|
Second Choice
|
Note: sachets approved for patients with swallowing difficulties only
|
|
Lanthanum carbonate tablets
|
Third Choice
|
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)
|
Fourth Choice
|
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)
|
Sucroferric oxyhydroxide (Velphoro® ) 500mg chewable tablets for the treatment of hyperphosphatemia in adult renal dialysis patients
|
Aluminium Hydroxide capsules (Alu-Cap®)
|
Formulary
|

|
|
Calcium Carbonate chewable tablets (Adcal®)
|
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)
|
Unlicensed
|
Phosphate binding renal patients
|
|
|
|
|
Sodium fluoride tablets (F- 500 micrograms)
|
Formulary
|

|
|
Sodium fluoride toothpaste 0.619% (Duraphat® 2800 ppm)
|
Restricted
|
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)
|
Restricted
|
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)
|
|
|
Zinc Sulphate effervescent tablets 125mg
|
Formulary
|
Zn2+ = 45 mg per tab
|
|
09.05.05 |
Selenium |
|
|
Selenium oral solution
|
Formulary
|
Selenium deficiency in patients with recessive dystrophic bullosa (RDEB)
|
|
|
|
Vitamins A and D capsules
|
Formulary
|
|
|
Beta carotene capsules (Erythropoietic protoporphyria )
|
Unlicensed
|
Dose = 180mg daily
|
|
Beta carotene capsules (vitamin A)
|
Unlicensed
|
Approved for:
Vitamin A deficiency
|
|
Vitamin A (retinol) palmitate injection
|
Unlicensed
|
Vitamin A deficiency
|
|
|
Thiamine tablets
|
Formulary
|
|
|
Pabrinex intravenous high potency injection
|
Formulary
|
|
MHRA Sept 2007: Pabrinex: allergic reactions
|
Pabrinex intramuscular high potency injection
|
Restricted
|
SLAM only
|
MHRA Sept 2007: Pabrinex: allergic reactions
|
Pyridoxine hydrochloride tablets
|
Formulary
|
|
|
Vitamin B compound strong tablets
|
Formulary
|
|
|
Nicotinamide tablets
|
Formulary
|
|
|
Potassium aminobenzoate capsules (Potoba®)
|
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
|
Antidote for isoniazid poisoning. To be injected intravenously.
Refer to TOXBASE for advice
|
|
Riboflavin ophthalmic topical solution
|
Unlicensed
|
For photochemical corneal collagen cross-linking in the management of keratoconus
|
|
Riboflavin tablets
|
Unlicensed
|
Riboflavin deficiency
|
|
|
Ascorbic acid tablets
|
Formulary
|
Approved off-label indication:
Treatment of iron overload with desferrioxamine
|
|
Ascorbic acid injection
|
Formulary
|
|
|
09.06.04 |
Vitamin D |
|
|
Adcal-D3® caplets
|
Formulary
|
Each caplet contains
Calcium 300mg (elemental)
Colecalciferol 200 units
Dose: Two caplets twice a day
|
|
Adcal-D3® chewable tabs
|
Formulary
|
Each tablet contains
Calcium 600mg (elemental)
Colecalciferol 400 units
Dose: One tablet twice a day
|
|
Adcal-D3® effervescent tabs
|
Formulary
|
Each tablet contains
Calcium 600mg (elemental)
Colecalciferol 400 units
Dose: One effervescent tablet twice a day
|
|
Calceos® chewable tabs
|
Formulary
|
Each tablet contains
Calcium 500mg (elemental)
Colecalciferol 400 units
Dose: One tablet twice a day
|
|
Colecalciferol tabs, caps & oral liquid
|
Formulary
|
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
|
Formulary
|
|
|
Calcitriol caps
|
Formulary
|
|
|
Ergocalciferol injection
|
Restricted
|
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.
|
|
Paricalcitol caps, injection
|
Formulary
|
|
|
|
|
|
Alpha tocopheryl acetate suspension 500 mg/5 mL
|
Formulary
|
|
|
Alpha tocopheryl tabs, caps
|
Unlicensed
|
Vitamin E deficiency occurring in malabsorption disorders
|
|
|
Menadiol sodium phosphate tabs
|
Formulary
|
|
|
Phytomenadione mixed micelle injection
|
Formulary
|
|
|
09.06.07 |
Multivitamin preparations |
|
|
Multivitamin tabs
|
Formulary
|
|
|
Vitamin caps BPC
|
Formulary
|
|
|
Abidec® oral drops
|
Formulary
|
|
|
Centrum® tabs
|
Restricted
|
GUM ONLY AT GSTT AND KCH
ICU USE ONLY AT LGT
|
|
Cod liver oil capsules
|
Formulary
|
|
|
Dalivit® oral drops
|
Formulary
|
|
|
DEKAs® Plus liquid, softgels, chewable tablets
|
Restricted
|
Restricted to use in cystic fibrosis patients only
Fat soluble vitamin supplement
|
|
Forceval® caps, effervescent tabs
|
Formulary
|
|
|
Ketovite® tabs, liquid
|
Formulary
|
|
|
Renavit tablets
|
Formulary
|
For vitamin replacement in renal dialysis patients
|
|
|
09.08 |
Metabolic disorders |
|
|
09.08.01 |
Drugs used in metabolic disorders |
|
|
Hydroxocobalamin injection
|
Formulary
|
Inherited metabolic disorders commissioned by NHSE
|
|
Sapropterin tabs (Use in pregnancy)
|
Formulary
|
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)
|
NHSCB/E12/p/a: Sapropterin (Kuvan®) For Phenylketonuria: Use in Pregnancy
NHSE Clinical Commissioning Policy 170133P: Sapropterin for phenylketonuria (all ages)
|
5-Hydroxytryptophan tabs
|
Unlicensed
|
Inherited metabolic disorders commissioned by NHSE
|
|
Betaine tabs, oral powder
|
Unlicensed
|
Inherited metabolic disorders commissioned by NHSE
|
|
L-citrulline oral powder
|
Unlicensed
|
Inherited metabolic disorders commissioned by NHSE
|
|
Pyridoxal-5-phosphate tablets
|
Unlicensed
|
Inherited metabolic disorders commissioned by NHSE
|
|
Pyridoxine phosphate tablets
|
Unlicensed
|
Inherited metabolic disorders commissioned by NHSE
|
|
Ubiquinone caps (Co-enzyme Q10- inherited metabolic disorders)
|
Unlicensed
|
Inherited metabolic disorders commissioned by NHSE
|
|
|
Penicillamine tabs (Wilsons disease)
|
Formulary
|
Approved for:
Inherited metabolic disorders (NHSE)
|
|
Trientine dihydrochloride tabs
|
Formulary


|
USE UNDER SPECIALIST SUPERVISION ONLY
Approved as per criteria in NHSE Policy (link below)
|
NHSE Clinical Commissioning Policy 170094P: Trientine for Wilson disease (all ages)
|
Zinc acetate caps
|
Formulary
|
USE UNDER SPECIALIST SUPERVISION ONLY
|
|
09.08.01 |
Carnitine deficiency |
|
|
L-carnitine oral solution, chewable tabs, tabs, injection
|
Formulary
|
Inherited metabolic disorders commissioned by NHSE
|
|
09.08.01 |
Nephropathic cystinosis |
|
|
Mercaptamine caps (Cystagon®)
|
Formulary
|
Approved for the treatment of nephropathic cystinosis
|
|
Mercaptamine 0.55% preservative free eye drops
|
Unlicensed
|
Approved for treatment of ocular manifestations of cystinosis
Dose = 1 drop up to twelve times a day
|
|
09.08.01 |
Urea cycle disorders |
|
|
Glycerol phenylbutyrate oral liquid (Ravicti®)
|
Formulary
|
Inherited metabolic disorders commissioned by NHSE
|
|
Sodium phenylbutyrate tabs, oral solution
|
Formulary
|
Inherited metabolic disorders commissioned by NHSE
|
|
L-Arginine tabs, injection
|
Unlicensed
|
Inherited metabolic disorders commissioned by NHSE
|
|
Sodium benzoate tabs, injection
|
Unlicensed
|
Inherited metabolic disorders commissioned by NHSE
|
|
Sodium phenylbutyrate injection
|
Unlicensed
|
Inherited metabolic disorders commissioned by NHSE
|
|
09.08.02 |
Acute porphyrias |
|
|
Haem arginate concentrate for intravenous infusion
|
Restricted
|
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
|
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
|
|
SE London Position Statement (not recommended for prescribing in SE London: Lutein and Antioxidants for Age Related Macular Degeneration
|
Mercaptamine 3.8 mg in 1mL eye drops (Cystadrops®)

|
Non Formulary
|
Not approved for funding on the NHS as per NHS England Commissioning Policy 200807P (see link below) |
NHS England Clinical Commissioning Policy 200807P: Mercaptamine hydrochloride viscous eyedrops for corneal cystine deposits in people aged older than 2 years (not approved for commissioning)
|
Sapropterin tabs (Use in non-pregnant adults and children)

|
Non Formulary
|
Use in non-pregnant adults and children is not approved. See NHSE policy, (link below) |
Clinical Commissioning Policy 200805P: Sapropterin for phenylketonuria (all ages)
|
|
Key |
|
|
Cytotoxic Drug
|
|
Controlled Drug
|
|
High Cost Medicine
|
|
Cancer Drugs Fund
|
|
NHS England |
|
Homecare |
|
CCG |
|
Traffic Light Status Information
Status |
Description |

|
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.
|

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

|
Specialist initiation followed by maintenance prescribing in primary care |

|
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 |

|
Specialist and non-specialist initiation |

|
Not recommended for prescribing |
|
|
|