netFormulary
 Report : A-Z of formulary items 23/09/2018 08:18:40
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Section Name Details
13.05.03 Dupilumab injection 

Approved for treating moderate to severe atopic dermatitis as per NICE technology appraisal guidance (see link below)


12.01.01 Otomize® ear spray  Contains:
  • Dexamethasone 0.1%
  • Neomycin sulphate 3250 units/mL
  • Glacial acetic acid 2%
  • 04.12 3,4 Diaminopyridine tabs  Congenital myaesthenia, Eaton- Lamberts myaesthenic syndrome, multiple sclerosis
    09.08.01 5-Hydroxytryptophan tabs   Inherited metabolic disorders commissioned by NHSE
    13.05.02 5-methoxypsoralen tabs 

    Used in PUVA treatment for psoriasis and vitiligo.

    Dose is dependent upon the patient’s surface area.

    Dose ~ 50 mg/m2

    13.05.02 8-methoxypsoralen bath lotion 1.2% 

    Used in bath PUVA treatments for various skin conditions.

    130 mL bottle is used per bath

    13.05.02 8-methoxypsoralen gel 0.005% 

    Applied topically in PUVA treatment, for psoriasis, vitiligo and alopecia.

    A thin layer is appled to the affected area

    13.05.02 8-methoxypsoralen injection 20 micrograms/mL 

    Used in extracorpeal photopheresis to treat CTCL.

    Also, for psoriasis and vitiligo unresponsive to topical treatment

    13.05.02 8-methoxypsoralen paint 0.15% 

    Applied topically in PUVA treatment, for psoriasis, vitiligo and alopecia.

    A thin layer is appled to the affected area

    13.05.02 8-methoxypsoralen tabs 

    Used in PUVA treatment for psoriasis and vitiligo.

    Dose is dependent upon the patient’s surface area.

    Dose ~ 25 mg/m2

    05.03.01 Abacavir tabs, oral solution 
    05.03.01 Abacavir with lamiviudine generic - Kivexa® brand no longer stocked
    10.01.03 Abatacept injection  Approved as per NICE technology appraisal guidance
    02.09 Abciximab injection  USE UNDER SPECIALIST SUPERVISION ONLY Use as per NICE CG94: ACS and NSTEMI (see link below at end of section)
    05.02.03 Abelcet® injection amphotericin lipid complex
    09.06.07 Abidec® oral drops 
    08.03.04.02 Abiraterone tabs 

    04.10.01 Acamprosate tabs 
    06.01.02.03 Acarbose tabs 
    02.04 Acebutolol tabs 
    10.01.01 Acelofenac tabs 
    02.08.02 Acenocoumarol tabs 
    11.06 Acetazolamide tabs, m/r caps, injection 
    12.01.01 Acetic acid 2% ear spray 
    01.10 Acetic acid 2.5% solution 

    For use in Barrett’s oesophagus endoscopy surveillance. 20 mL of 2.5% solution (prepared from acetic acid 5% solution)

    To be applied topically to the oesophageal mucosa

    11.08.02 Acetylcholine intra-ocular irrigation 1% 
    11.99.99.99 Acetylcysteine eye drops 10%  Dry eye associated with increased mucous production
    03.07 Acetylcysteine injection  For reduction of sputum viscosity - delivered by nebuliser
    03.07 Acetylcysteine injection  For use in paracetamol overdose - follow local guidelines
    03.07 Acetylcysteine injection 

    Approved off-label indication:

    Use prior to HALO radio frequency ablation (RFA) in Barrett’s Oesophagus

    20 Acetylcysteine injection poisoning For use in paracetamol overdose. Follow local protocols and advice from the National Poisons Information Centre
    11.99.99.99 Acetylcysteine preservative-free eye drops 5%  Dry eye associated with increased mucous production
    03.07 Acetylcysteine sachets  For reduction of sputum viscosity
    03.07 Acetylcysteine tabs  For prevention of contrast-induced renal failure in moderate to high risk patients:
  • 600mg twice daily, first dose prior to procedure.
  • Maximum of 4 doses should be given.
  • Use in accordance with guideline at GSTFT
  • 03.11 Acetylcysteine tabs  For use in idiopathic pulmonary fibrosis
    13.10.03 Aciclovir cream 5% 
    11.03.03 Aciclovir eye ointment 3% 
    05.03.02.01 Aciclovir tabs, dispersible tabs, oral suspension, injection  Injection = Red Traffic Light 
    08.04 Acid citrate glucose infusion 

    Anticoagulant used during apheresis

    09.09 Acidophilus extra capsules Lactobacillus acidophilus and Bifido bacteria Treatment of general digestion problems, diarrhoea, and antibiotic associated diarrhoea
    13.05.02 Acitretin caps 

    Approved off-label indication:

    Non-melanoma skin cancer in organ transplant patients

    Dose: 10 - 30 mg daily. Initiate on 10 mg daily and titrate dose down to 10 mg on alternate days or up to a maximum dose of 30 mg daily, based upon side effect profile and response

    13.05.02 Acitretin caps 
    01.05.03 Adalimumab injection IBD Approved as per NICE technology appraisal guidance
    10.01.03 Adalimumab injection rheumatology indications Approved as per NICE technology appraisal guidance
    11.99.99.99 Adalimumab injection uveitis

    Approved for treating non-infectious uveitis as per NICE TA460

    13.05.03 Adalimumab injection Hidradenitis suppurativa

    Approved for hidradenitis suppurativa as per NICE technology appraisal guidance

    13.05.03 Adalimumab injection psoriasis

    Approved as per detail in SE London APC Psoriasis Biological Drug Treatment Pathway (link below)

    In inadequate primary response, the following dose increase is also approved:

    • Dose increase from 40 mg every other week to 40 mg every week (category B* form required)

    See SE London APC Psoriasis Biological Drug Treatment Pathway (link below)

    13.06.01 Adapalene 0.1%, with benzoyl peroxide 2.5% gel 
    13.06.01 Adapalene cream, gel 0.1% 
    09.05.01.01 Adcal® chewable tabs  600mg elemental calcium per tab
    09.05.01.01 Adcal-D3® caplets  Each caplet contains
  • Calcium 300mg (elemental)
  • Colecalciferol 200 units Dose: Two caplets twice a day
  • 09.06.04 Adcal-D3® caplets  Each caplet contains
  • Calcium 300mg (elemental)
  • Colecalciferol 200 units Dose: Two caplets twice a day
  • 09.05.01.01 Adcal-D3® chewable tabs  Each tablet contains
  • Calcium 600mg (elemental)
  • Colecalciferol 400 units Dose: One tablet twice a day
  • 09.06.04 Adcal-D3® chewable tabs   Each tablet contains
  • Calcium 600mg (elemental)
  • Colecalciferol 400 units Dose: One tablet twice a day
  • 09.05.01.01 Adcal-D3® Dissolve  Each tablet contains
  • Calcium 600mg (elemental)
  • Colecalciferol 400 units Dose: One effervescent tablet twice a day
  • 09.06.04 Adcal-D3® effervescent tabs  Each tablet contains
  • Calcium 600mg (elemental)
  • Colecalciferol 400 units Dose: One effervescent tablet twice a day
  • 09.02.02.01 Addiphos injection  

    30 mmol K+ in 20mL

    REFER TO LOCAL TRUST PROTOCOL FOR CONCENTRATED POTASSIUM SOLUTIONS

    09.05.02.01 Addiphos® solution for infusion  USE UNDER SPECIALIST SUPERVISION ONLY 20ml contains:
  • 40mmol Phosphate
  • 30mmol Sodium
  • 30mmol Potassium
  • 05.03.03.01 Adefovir dipivoxil tablets 
    02.03.02 Adenosine injection  USE UNDER SPECIALIST SUPERVISION ONLY
    03.04.03 Adrenaline / epinephrine 1 in 1,000 injection 
    03.04.03 Adrenaline / epinephrine IM injection for self-administration 

    Prescribers should specify the brand to be dispensed

    Brands available:

    • Jext
    • Epipen
    • Emerade

    Refer to product literature for dosing information

    02.07.03 Adrenaline / Epinephrine injection 
    03.04.03 Adrenaline inhaler  Primatene Mist®

    For angioedema Dose: 2-4 sprays to be applied topically, up to hourly as required

    Note: this product is currently not available

    02.11 Adrenaline solution 1mg/ml (1 in 1000) 

    Approved off-label indication:

    Capillary bleeding. Apply gauze soaked in adrenaline solution to the affected area.

    06.01.06 Advantage II®  NOT TO BE USED BY PATIENTS UNDERGOING CAPD
    03.01.05 AeroChamber Plus® spacer device standard, infant, child
    08.01.05 Afatinib tabs 
    11.08.02 Aflibercept intravitreal injection 

    Approved as per NICE technology appraisal guidance

    Refer to APC guidance for Wet Age-Related Macular Degeneration, Diabetic Macular Oedema, Central Retinal Vein Occlusion and Branch Retinal Vein Occlusion (see link below)

    04.01.01 Agomelatine tabs REM behaviour disorder - off-label

    Approved off-label indication:

    • REM behaviour disorder in adults (as a last line option where all other treatments have failed)

    Usual dose = 25 mg to 50 mg nocte

    Sleep centre prescribing use only

    Refer to SE London APC recommendation and REM behaviour disorder pathway (links below) for further information

    04.03.04 Agomelatine tabs  SPECIALIST PRESCRIBING ONLY
    02.03.02 Ajmaline injection 

    Diagnostic test for Brugada syndrome

    Dose: 1 mg/kg (actual body weight) up to a maximum dose of 100 mg

    05.05.07 Albendazole tabs  Multiple infections
    09.02.02.02 Albumin  Albumin, blood and other blood products are supplied from the Blood Trasfusion Laboratory
    06.01.06 Albustix®  Protein detection
    13.04 Alclometasone dipropionate cream, ointment 0.05%  Steroid potency = moderate
    04.10.01 Alcohol infusion 

    RESTRICTED USE

    Acute alcohol withdrawal in patients unable to take chlordiazepoxide.

    Dose = 30 mL of 90% alcohol injection in 500 mL 5% dextrose solution, over a 24 hour period

    08.02.04 Aldesleukin injection 
    08.01.05 Alectinib caps 

    Approved as per NICE Technology Appraisal guidance

    08.02.03 Alemtuzumab injection use in haemato-oncology

    Induction immunosuppression:

    • For human leukocyte antigen antibody incompatible renal transplantation
    • In high risk recipients who have previously exhibited significant donor specific antibody but are presently negative by flow cytometry crossmatch

    Use in accordance with local guideline at GSTFT

    08.02.03 Alemtuzumab injection multiple sclerosis

    06.06.02 Alendronic acid tabs  FIRST-LINE ORAL BISPHOSPHONATE
    09.06.04 Alfacalcidol caps, oral drops, injection 
    04.07.02 Alfentanil injection  USE UNDER SPECIALIST SUPERVISION ONLY
    15.01.04.03 Alfentanil injection 
    07.04.01 Alfuzosin tabs, m/r tabs 
    03.04.01 Alimemazine tabs, oral solution 
    02.12 Alirocumab injection 

    Specialist initiation only

    Restricted to use as per stipulations in NICE guidance (see below)

    02.05.05.03 Aliskiren tabs 

    CONSULTANT SPECIALISTS ONLY

    Treatment of resistant hypertension as a last-line option after all other options stated in the British Hypertension Society guideline that are not contraindicated (including alphablockers, beta-blockers, and potassium-sparing diuretics) have failed or are not tolerated

    13.05.01 Alitretinoin caps 
    12.02.03 Alkaline nasal douche 

    Powder containing:

    • Sodium bicarbonate 20g
    • Sodium chloride 20g
    • Borax 20g

    Indications:

    • Post-operatively after nasal surgery and functional endoscopic sinus surgery.
    • For any condition causing crusting of nasal cavities

    Instructions for use:

    • 5 mL spoonful of powder added to a tumblerful of warm water and mixed well.
    • Small aliquots of the solution are sniffed.
    • Any solution that goes into the throat should not be swallowed
    • Dose = three times daily
    10.01.04 Allopurinol tabs 

    Approved for all licensed indications

    And the following off-label indication (Amber):

    In combination with thiopurines (i.e. azathioprine or mercaptopurine) in the treatment of Crohn’s Disease or Ulcerative Colitis where the patient has shown:

    • Hypermethylation of thiopurine (MeMP: TGN ratio >11:1)
    • Abnormal LFTs secondary to standard thiopurine treatment
    • Other non-myelotoxic side-effects, excluding pancreatitis, on standard thiopurines, which limit dose optimization
    • Dose = Allopurinol 100mg daily 
    • Dose reduction of the thiopurine to approximately 25% of the usual target dose is required to avoid dose-related toxicity. 

    • See information leaflet (link below) for further information 

    03.05.01 Almitrine injection 

    Acute Respiratory Distress Syndrome (ARDS) in combination with Nitric Oxide inhalation:

    Dose: 4-16 micrograms/kg/min by IV injection.

     

    COPD:

    Dose: 8 micrograms/kg/min by IV injection

    09.06.05 Alpha tocopheryl acetate suspension 500 mg/5 mL 
    09.06.05 Alpha tocopheryl tabs, caps  Vitamin E deficiency occurring in malabsorption disorders
    13.05.02.01 Alphosyl 2 in 1® shampoo  alcoholic coal tar extract 5%
    07.01.01.01 Alprostadil injection 
    07.04.05 Alprostadil intracavernosal injection, urethral application 
    02.10.02 Alteplase 2 mg injection Actilyse Cathflo®

    Approved for use in for malfunctioning tunnelled Central Venous Haemodialysis Catheters (CVHC)

    Follow local guideline for use at GSTT amd KCH

    02.10.02 Alteplase injection Off-label use in intrapleural fibrinolysis

    Approved off-label indication:

    • Intrapleural fibrinolysis for complex pleural infection (together with dornase alpha)
    • UNDER SPECIALIST SUPERVISION ONLY
    • Follow local guidelines at GSTT
    • Regimen: Alteplase 10mg in 50ml sodium chloride 0.9% administered intrapleurally Dornase 5mg in sodium chloride 0.9% administered intrapleurally separately
    • Dose: Every 12 hours for a maximum of 3 days
    02.10.02 Alteplase injection catheter directed thrombolysis in DVT - off-label

    Approved off-label indication:

    Catheter directed thrombolysis in acute subclavian and/or iliofemoral deep vein thrombosis (DVT)

    Follow the "Acute Deep Vein Thrombosis Catheter Directed Thrombolysis Protocol" on GTi for dosing and administration

    02.10.02 Alteplase injection licensed use in massive PE and stroke

    USE UNDER SPECIALIST SUPERVISION ONLY

    For use in ischaemic stroke as per NICE TA264 Acute massive pulmonary embolism: Refer to local guidelines

    11.08.02 Alteplase intravitreal injection unlicensed product - submacular haemorrhage

    Treatment of submacular haemorrhage

    13.12 Aluminium chloride hexahydrate 20% Driclor®
    09.05.02.02 Aluminium Hydroxide capsules Alu-Cap®

    01.02 Alverine citrate caps 
    03.02 Alvesco® aerosol powder inhaler ciclesonide

    Specialist recommendation only

    For control of asthma in adults who acquire repeated oropharyngeal candidiasis and/or hoarsness from other inhaled carticosteroids

    04.09.01 Amantadine caps, syrup Parkinson's disease and multiple sclerosis

    Approved for use in:

    05.02.03 AmBisome® injection liposomal amphoteracin Use in accordance with local antifungal guidelines
    08.01 Amifostine injection  Prevention of cumulative renal toxicity associated with repeated administration of cisplatin
    11.03.01 Amikacin 0.4 mg intravitreal injection  Endophthalmitis in beta-lactam allergic patients
    05.01.04 Amikacin injection 
    02.02.03 Amiloride tabs 
    02.02.04 Amiloride with cyclopenthiazide tabs Navispare®
    03.01.03 Aminophylline m/r tabs, injection 
    02.03.02 Amiodarone tabs, injection  PARENTERAL USE UNDER SPECIALIST SUPERVISION ONLY
    04.02.01 Amisulpride tabs, solution  INITIATION BY SPECIALIST ONLY
    01.05 Amitriptyline tabs IBS - off-label

    Approved off-label indication:

    2nd line pharmacological treatment of IBS-D (diarrhoea predmoninant irritable bowel syndrome) after failure of loperamide Dose = 10mg - 30mg at night

    04.07.04.02 Amitriptyline tabs migraine prophylaxis - off-label

    Use for migraine prophylaxis is off-label

    Dose = 10mg at night increasing to 50-75mg at night as per response

    07.04.02 Amitriptyline tabs Nocturnal enuresis

    04.07.03 Amitriptyline tabs, oral solution neuropathic pain

    Use in neuropathic pain is off-label

    Refer to SEL APC neuropathic pain guideline (link below)

    04.03.01 Amitriptyline tabs, oral soution 
    02.06.02 Amlodipine tabs  First-line dihydropyridine calcium channel blocker
    13.10.02 Amorolfine nail lacquer 5% 
    05.01.01.03 Amoxicillin caps, oral suspension, injection  Injection = Red Traffic Light
    11.03.02 Amphotericin 0.15% eye drops  For fungal keratitis with confirm/suspected candida infection
    11.03.02 Amphotericin 5 micrograms intravitreal injection  

    Acute treatment of fungal endogenous endophthalmitis

    08.01.05 Amsacrine injection 
    09.01.04 Anagrelide capsules  USE UNDER SPECIALIST SUPERVISION ONLY
    10.01.04 Anakinra injection Polyarticular acute gout - off-label

    Approved off-label indication (consultant specialists only):

    Polyarticular acute gout and multiple swollen joints where:

    • There have been recurrent acute flares of gout
    • There has been lack of response to, or contra-indications to NSAIDs, colchicine and steroids

    Dose = 100mg daily for 3 days

    See APC recommendation for further information

    10.01.04 Anakinra injection Adult-Onset Still's Disease

    Approved for use as per NHSE policy criteria (see link below)

    Note: Anakinra and Tocilizumab cannot be used concurrently

     

    08.03.04.01 Anastrozole tabs 
    05.02.04 Anidulafungin injection 

    Use in accordance with local antifungal guidelines

    03.01.04 Anoro Ellipta® dry powder inhlaer umeclidinium and vilaterol
    13.08.01 Anthelios XL® melt in cream Sunscreen SPF 50+

    Approved for prescribing for (ACBS):

    Protection from UV radiation in abnormal cutaneous photosensitivity resulting from genetic disorders or photodermatoses, including vitiligo, and those resulting from radiotherapy; chronic or recurrent herpes simplex labialis

    14.05.03 Anti-D (Rh0) Immunoglobulin treatment of ITP - off-label

    Approved off-label use:

    Second-line therapy for the treatment of Idiopathic Thrombocytopenic Purpura (ITP):

    HAEMATOLOGY USE ONLY ONLY

    • Available from Haematology at GSTFT and Pharmacy at KCH
    • Dose: 50-70 micrograms/kg as required – may be as frequent as 2-weekly depending on platelet response
    14.05.03 Anti-D (Rh0) Immunoglobulin injection  Available from labour Wards or Blood Transfusion Units
    01.05.03 Anti-MAP (mycobacterium avium paratuberculosis) therapy clarithromycin, rifabutin and clofazimine

    Specialist gastroenterology use only

    Follow local guidelines for use at GSTT Patient Information Leaflet available on GTi (GSTT intranet)

    Last line option for Crohn's disease patients who have not responded to/have been intolerant of or have a contraindication to treatment options and strategies for Crohn’s disease outlined within the SEL IBD Pathways (including immunosuppressants and biologics) and do not wish to have surgery.

    Regimen:

    • Clarithromycin 250 mg each morning and 500 mg at night
    • Rifabutin 150 mg daily for 1 week, then 150 mg twice daily. If >50kg the dose may be increased to 450mg total daily dose
    • Clofazimine 100 mg daily (unlicensed product) The maximum treatment duration is 2 years
    08.02.02 Antithymocyte immunoglobulin injection (ATG) 

    Approved off-label indication:

    Aplastic anaemia

    08.02.02 Antithymocyte immunoglobulin injection (ATG)  Renal transplantation and graft rejection
    01.07.02 Anusol® ointment, suppositories 
    01.07.02 Anusol-HC® ointment, suppositories 
    02.08.02 Apixaban tabs 

    Amber Traffic Light For treatment and secondary prevention of DVT and PE, and thromboprophylaxis in AF.

    See links at the end of the section for initiation of treatment and transfer of care documents

    Red Traffic Light (hospital only) For prevention of VTE after hip or knee replacement surgery 

    04.09.01 Apomorphine injection, infusion  SPECIALIST INITIATION ONLY
    11.08.02 Apraclonidine eye drops 0.5% chronic glaucoma

    Suitable for GP prescribing if prolonged treatment greater than 3 months is required.

    Initial 3 month supply from hospital

    11.08.02 Apraclonidine eye drops 1% 
    13.05.03 Apremilast tabs  Approved for use (as per criteria in NICE guidance) in:
  • Severe to moderate plaque psoriasis (TA419)
  • Active psoriatic arthritis (TA433)
  • 04.06 Aprepitant caps 

    Approved off-label indication:

    For the treatment of dihydroergotamine induced nausea where domperidone or 5HT3 antagonists have failed or are inappropriate

    For consultant headache specialist use only as per locally approved protocol

    04.06 Aprepitant caps 

    Approved for:

    Prevention of acute and delayed nausea and vomiting associated with highly emetogenic cisplatinbased cancer chemotherapy

    Prevention of nausea and vomiting associated with moderately emetogenic cancer chemotherapy only for subsequent chemotherapy cycles if the standard antiemetic regimen has failed with the initial chemotherapy cycle.

    13.02.01 Aproderm® cream or gel colloidal oat emollient

    Second line option if a cream or gel type emollient is required

    13.02.01 Aproderm® ointment colloidal oat ointment

    Second line option where a greasy emollient is required

    02.11 Aprotinin injection  USE UNDER CONSULTANT SPECIALIST CARDIAC ANAESTHETIST SUPERVISION ONLY

    Refer to advice from CHM
    13.02.01 Aquamax® cream 

    Second line option if a cream or gel type emollient is required

    13.11.05 Aquasept® skin cleanser triclosan 2%
    06.02.02 Aqueous Iodine oral solution Lugol's
    01.06.03 Arachis oil enema 
    02.08.01 Argatroban injection 

    For use under the supervision of a Consultant Haematologist

    For anticoagulation in patients with HIT type 2 undergoing cardiac surgery or have renal failure in a HDU/ITU setting who are not suitable for treatment with fondaparinux

    06.05.01 Arginine injection  Assessment of growth disorders; hyperammonaemia; metabolic alkalosis
    04.02.02 Aripiprazole depot injection 

    SPECIALIST INITIATION

    GPs may be asked to take on prescribing under a the APC shared care agreement

    04.02.01 Aripiprazole tabs  INITIATION BY SPECIALIST ONLY
    08.01.05 Arsenic trioxide injection 

    Approved as per NICE Technology Appraisal guidance

    05.04.01 Artemether with lumefantrine tabs Riamet®
    05.04.01 Artesunate injection 

    At GSTFT, use in accordance with the guideline “Management of Malaria in Adults”

    First-line therapy for severe falciparum malaria in non-pregnant adults

    10.01.01 Arthrotec® tabs  diclofenac + misoprostol
    12.03.05 Artificial saliva spray  The brand in use at each site will depend on local contracts. Contact the pharmacy department for information if required.
  • Glandosane spray
  • Xerotin spray
  • Saliveze spray
  • AS Saliva Orthana
  • 09.06.03 Ascorbic acid injection 
    09.06.03 Ascorbic acid tablets  Approved off-label indication:
  • Treatment of iron overload with desferrioxamine
  • 04.02.03 Asenapine tabs  INITIATION BY SPECIALIST ONLY
    08.01.05 Asparaginase injection  Acute lymphoid leukaemia
    02.09 Aspirin (antiplatelet) tabs 
    04.07.04.01 Aspirin injection 

    SPECIALIST USE ONLY

    Inpatient management of severe withdrawal headache

    Dose = 1g once to three times daily for up to 4 days

    02.09 Aspirin suppositories  Where treatment is imperative and oral treatment is not possible
    04.07.01 Aspirin tabs 
    10.01.01 Aspirin tabs 
    05.03.01 Atazanavir caps 
    02.04 Atenolol tabs, oral solution, injection 
    08.01.05 Atezolizumab injection lung cancer indications

    Approved for use as per NICE technology appraisal guidance below

    08.01.05 Atezolizumab injection urothelial cancer indications

    Approved for use as per NICE technology appraisal guidance below

    04.04 Atomoxetine caps, oral solution 

    INITIATION BY SPECIALIST ONLY

    Treatment of ADHD in children and adults Refer to links in this section for ADHD shared care documentation

    02.12 Atorvastatin tabs 
    07.01.03 Atosiban injection  Tocolysis
    05.04.08 Atovaquone oral suspension  
    15.01.05 Atracurium besilate injection 
    05.03.01 Atripla® tabs  tenofovir disoproxil with emtricitabine and efavirenz No longer stocked. Prescribe Truvada® (tenofovir disoproxil and emtricitabine) and efavirenz as separate preparations
    01.02 Atropine sulphate eye drops 1% off-label use for hypersalivation

    Approved off-label indication:

    For management of drooling of saliva in people with Parkinson's disease or other neurology conditions (sublingual administration).

    • Dose = 4 drops on or under the tongue every 4 hours when required (as per palliative care formulary)
    11.05 Atropine sulphate eye drops/ointment 1% for mydriasis USE UNDER SPECIALIST SUPERVISION ONLY
    15.01.03 Atropine sulphate injection 
    10.01.03 Auranofin tablets  USE UNDER SPECIALIST SUPERVISION ONLY
    08.01.05 Avelumab injection  

     Approved for use as per NICE technology appraisal guidance (see links below):

    08.01.05 Axitinib tabs 

    Approved for use as per NICE technology appraisal guidance (see links below):

    08.01.03 Azacitidine injection  CONSULTANT SPECIALISTS ONLY
    01.05.03 Azathioprine tablets inflammatory bowel disease - off-label

    Approved off-label indication:

    Resistant or frequently relapsing inflammatory bowel disease Dose: 2 mg/kg daily For shared care arrangements, see guideline below

    08.02.01 Azathioprine tabs neurological conditions

    Approved off-label indication:

    Disease modifying and steroid sparing treatment for neurological conditions

    08.02.01 Azathioprine tabs liver transplant & autoimmune hepatitis

    Immunosuppression in liver transplant Red Traffic Light for new patients

    Amber Traffic Light for patients currently receiving prescriptions in primary care (see shared care link below)

    10.01.03 Azathioprine tabs rheumatology

    USE UNDER SPECIALIST SUPERVISION ONLY

    See SE London Shared Care Agreement (link above) for prescribing advice and approved rheumatology indications (including off-label indications)

    13.05.03 Azathioprine tabs immunobullous diseases - off-label Approved off-label indication:
    Severe refractory eczema and immunobullous diseases
    08.02.01 Azathioprine tabs, injection renal transplant

    Immunosuppression in renal transplant

    10mg capsules are also available for patients who require smaller doses (unlicensed product).

    13.06 Azelaic acid 15% gel rosacea

    Second line topical treatment for papulopustular rosacea

    Refer to SE London papulopustular rosacea treatment pathway for further information (link below)

    13.06.01 Azelaic acid cream 20% acne

    12.02.01 Azelastine aqueous nasal spray Rhinolast®
    05.01.05 Azithromycin caps, tabs, oral suspension 
    05.01.09 Azithromycin tabs  

    Approved off-label indication:

    Treatment of tuberculosis in HIV patients

    05.01.05 Azithromycin tabs, caps, oral suspension 

    Approved off-label indication:

    Second-line drug for treatment of Mycobacterium avium complex or M. avium-intracellulare infection in HIV positive patients

    05.01.05 Azithromycin tabs, caps, oral suspension 

    Approved off-label indication:

    Second-line drug for treatment of toxoplasmosis

    05.01.02.03 Aztreonam injection 
    05.01.02.03 Aztreonam nebuliser solution 
    10.02.02 Baclofen intrathecal injection 

    USE UNDER SPECIALIST SUPERVISION ONLY

    10.02.02 Baclofen tablets GHB withdrawal - off-label

    Approved off-label indication:

    Management of acute withdrawal in patients with dependency on gamma-hydroxybutyrate (GHB) and/or its analogues gammabutyrolactone (GBL) and 1,4- butanediol (1,4BD)

    Must be prescribed under the supervision of the Clinical Toxicology team at the Guy’s and St Thomas’ Poisons Unit

    10.02.02 Baclofen tablets, oral liquid 
    13.02.01 Balneum® cream 5% urea

    First line choice if a urea containing emollient is required

    01.05.01 Balsalazide caps  Acute management of ulcerative colitis only
    10.01.03 Baricitinib tabs  Approved as per NICE technology appraisal guidance
    08.02.02 Basiliximab injection  Use as per NICE guidance for immunosuppressive therapy for renal transplantation
    08.02.04 BCG bladder instillation  Use in accordance with the “Protocol for the administration of intravesicular chemo or immuno-therapeutic drugs” at GSTFT
    14.04 BCG vaccine Intradermal
    13.04.02 Beclometasone dipropionate 0.025% cream, ointment  
    12.02.01 Beclometasone dipropionate 50 micrograms nasal spray 

    Beclomethasone nasal spray is reserved for use when a nasal corticosteroid less dependent on CYP3A metabolism is required, e.g. patients taking cobicistat or ritonavir (see MHRA alert below)

    Mometasone, fluticasone propionate and fluticasone furoate are preferred intranasal cotricosteroid sprays for prescribing in SE London.

    See APC allergic rhinitis integrated guideline (link above)

    03.02 Beclometasone dipropionate aerosol inhalers, breath actuated inhalers Clenil modulite and Qvar products

    Beclometasone diproprionate aerosol inhalers should be prescribed by brand name

    Different brands are not dose equivalent

    13.04.03 Beclometasone dipropionate in WSP 0.0025% Propaderm® 1:10

    APC approved Special

    For eczema wet wraps in pediatrics only.

    13.05.01 Beclometasone dipropionate in WSP ointment 0.0025% Propaderm® 1:10

    BAD/APC Approved Special

    For eczema wet wraps in paediatrics only.

    01.05.02 Beclometasone MR tabs Clipper®

    Second-line option (after prednisolone tabs) for active mild or moderate ulcerative colitis

    • As add-on to 5-ASA in patients who have insufficient response to 5-ASA, or
    • As monotherapy where 5-ASA and prednisolone are contraindicated or not tolerated (off-label)
    • Maximum course length = 4 weeks
    03.02 Beclometasone propionate dry powder inhaler Easyhaler beclometasone®
    05.01.09 Bedaquiline tabs Sirturo®

    Specialist TB respiratory consultant use only

    Approved for use in accordance with NHS England Clinical Commissioning Policy F04/P/a

    03.04.02 Bee and wasp allergen extracts Pharmalgen® injection

    SPECIALIST ALLERGIST USE ONLY

    Initial and maintenance subcutaneous immunotherapy treatment of hypersensitivity to wasp or bee venom

    10.01.03 Belimumab injection 

    Approved as per NICE technology appraisal guidance

    Lupus Consultants only 

    08.01.01 Bendamustine injection 

    Approved for use as per indications and criteria in the Cancer Drugs Fund and NICE TA216.

    See also separate NHSE policies for use with rituximab (link below)

     

    02.02.01 Bendroflumethiazide tabs 
    05.01.01 Benzathine penicillin injection 

    Treatment of syphilis in accordance with GUM guidelines.

    IM injection only

    04.09.02 Benzatropine injection 
    13.10.02 Benzoic acid ointment, compound BP 
    03.08 Benzoin tincture, compound, BP 
    13.06.01 Benzoyl peroxide 3% with clindamycin 1% gel 
    13.06.01 Benzoyl peroxide 5% with clindamycin 1% gel 
    13.06.01 Benzoyl peroxide cream 4%, 5%, 10% 
    13.06.01 Benzoyl peroxide gel 5% 
    10.03.02 Benzydamine cream  Difflam®
    12.03.01 Benzydamine hydrochloride 0.15% spray Difflam®
    12.03.01 Benzydamine oral rinse 0.15% 
    13.10.04 Benzyl benzoate application BP 25% 
    05.01.01.01 Benzylpenicillin injection Penicillin G
    03.05.02 Beractant endotracheal tube suspension 
    09.06.01 Beta carotene capsules  vitamin A Vitamin A deficiency
    04.06 Betahistine dihydrochloride tabs 
    09.08.01 Betaine tabs, oral powder  Inherited metabolic disorders commissioned by NHSE
    12.01.01 Betamethasone 0.1% & neomycin 0.5% drops 
    11.04.01 Betamethasone 0.1% & neomycin 0.5% eye drops & ointment 
    12.02.01 Betamethasone 0.1% drops 
    11.04.01 Betamethasone 0.1% eye drops & ointment  
    13.04.01 Betamethasone dipropionate 0.05% and salicylic acid 2% scalp application Diprosalic®

    Steroid potency = potent 

    Specialist advice only when initiated in secondary care

    13.04 Betamethasone dipropionate 0.05% and salicylic acid 3% ointment 

    Steroid potency = potent

    Specialist advice only when initiated in secondary care

    13.04.02 Betamethasone dipropionate 0.05% cream, ointment  
    13.04.04 Betamethasone dipropionate 0.064% and clotrimazole 1% cream Lotriderm®

    Steroid potency = potent 

    Specialist advice only when initiated in secondary care

    13.04.01 Betamethasone dipropionate scalp lotion 0.05% 

    Steroid potency = potent 

    Specialist advice only when initiated in secondary care

     

    12.01.01 Betamethasone drops 0.1% 
    12.03.01 Betamethasone soluble tabs 500 micrograms 

    Approved off-label use:

    Oral ulceration and inflammation

    • Dose = 1 tablet dissolved in water used as a mouthwash four times a day
    06.03.02 Betamethasone soluble tabs, injection 
    06.03.02 Betamethasone tabs 
    13.04.04 Betamethasone valerate 0.1% and clioquinol 3% cream, ointment 

    Steroid potency = potent 

    Specialist advice only when initiated in secondary care

    13.04.04 Betamethasone valerate 0.1% and fusidic acid 2% cream Fucibet®

    Steroid potency = potent 

    Specialist advice only when initiated in secondary care

    13.04.04 Betamethasone valerate 0.1% and neomycin sulphate 0.5% cream, ointment 

    Steroid potency = potent 

    Specialist advice only when initiated in secondary care

    13.04 Betamethasone valerate cream, ointment 0.025%  Steroid potency = moderate
    13.04 Betamethasone valerate cream, ointment 0.1% 

    Steroid potency = potent 

    Specialist advice only when initiated in secondary care

    13.04 Betamethasone valerate lotion 0.1% 

    Steroid potency = potent 

    Specialist advice only when initiated in secondary care

    13.04.01 Betamethasone valerate scalp application, cutaneous foam 0.1% 

    Steroid potency = potent 

    Specialist advice only when initiated in secondary care

    11.06 Betaxolol eye drops 0.25%, 0.5% 
    07.04.01 Bethanechol tabs 
    08.01.05 Bevacizumab injection 

    Approved off-label indication:

    Treatment of neurofibromatosis type 2

    For consultant specialists in accordance with a nationally commissioned service protocol

    08.01.05 Bevacizumab injection 

    Approved as per indications in the Cancer Drugs Fund

    11.08.02 Bevacizumab intravitreal injection 1.25 mg in 0.05 mL Approved for:
  • Neovascular glaucoma
  • Rubeosis iridis (iris neovascularisation) not responding to conventional treatment
  • Use prior to vitrectomy surgery in severe proliferative diabetic retinopathy
  • 08.01.05 Bexarotene caps  Use in accordance with LCNDG guidance
    02.12 Bezafibrate tabs, m/r tabs 
    08.03.04.02 Bicalutamide tabs 
    11.06 Bimatoprost 0.3mg & timolol 5mg/mL eye drops Ganfort®

    Treatment of open-angle glaucoma and ocular hypertension when monotherapy alone is not adequate

    Note: preservative-free drops available on request

    11.06 Bimatoprost eye drops 0.1mg/mL 

    Third-line prostaglandin analogue

    A preservative-free preparation of 0.3mg/mL is available on request

    12.03.05 Biotene Oralbalance® saliva replacement gel 
    12.03.05 BioXtra® gel  For Oncology and Palliative Care use only
    06.01.01.02 Biphasic Insulin Aspart NovoMix® 30
    06.01.01.02 Biphasic Insulin Lispro Humalog® Mix
    06.01.01.02 Biphasic Isophane Insulin Humulin® M3
    03.04.02 Birch pollen extract subcutaneous injection Allergovit®

    SPECIALIST ALLERGIST USE ONLY

    Initial therapy (pre-seasonal)

    03.04.02 Birch pollen extract sublingual immunotherapy Oralvac® SPECIALIST ALLERGIST USE ONLY Restricted to paediatric use only
    01.06.02 Bisacodyl tabs, suppositories 
    12.02.03 Bismuth subnitrate & iodoform gauze 
    02.04 Bisoprolol tabs 
    02.08.01 Bivalirudin injection 
    08.01.02 Bleomycin injection 
    08.02.03 Blinatumomab injection 

    Approved for previously treated Philadelphia-chromosome-negative ALL as per NICE TA450

    06.01.06 BM-Accutest®  Glucose monitoring
    08.01.05 Bortezomib injection 

    For relapsed multiple myeloma as per criteria in the Cancer Drugs Fund

    02.05.01 Bosentan tabs digital ulcer disease - off-label

    INITIATION BY SPECIALIST ONLY

    Last-line option, to reduce the number of new digital ulcers in patients with systemic sclerosis and ongoing digital ulcer disease, who:

    • Have a history of multiple digital ulcers
    • Have previously failed treatment with iloprost
    • Use in accordance with local guideline
    02.05.01 Bosentan tabs Fontan circulation - off-label

    Approved off-label indication:

    Patients with a failing Fontan circulation

    Restricted use in patients where there is a suggestion of segmental pulmonary arterial hypertension or failing Fontan only after full discussion and approval from the pulmonary hypertension and congenital heart disease MDT.

    Dose = Bosentan 62.5 mg to 125 mg twice a day.

    11.09 Boston Lens® cleaning solution 
    11.09 Boston Lens® wetting/ soaking solution 
    08.01.05 Bosutinib tabs 

    Approved as per NICE Technology Appraisal guidance

    01.02 Botulinum toxin A Xeomin® - gastroenterology endoscopic indications off-label

    Approved off-label indications (via endoscopic injection):

    Category B* form required for all indications

    Diabetic gastroparesis:

    • Restricted to use where prokinetics have failed
    • Dose = 200 units (50 units into each quadrant)

    Oesophageal spasm:

    • Restricted to use in patients where pharmacological treatment has been ineffective or not tolerated, including calcium channel blockers and nitrates
    • Dose = 100 or 200 units

    Achalasia:

    • Restricted to use in patients where treatment with surgery or pneumatic dilatation is contra-indicated or not appropriate
    • Dose = 100 units
    01.02 Botulinum toxin A Xeomin® - hypersalivation - off-label

    Approved off-label indication:

    Hypersalivation

    Category B* form required

    Restricted to use where antimuscarinics have failed or are inappropriate

    Total dose = 100 units (administered into salivary glands)

    ENT and oral and maxillofacial surgery use only

    01.07.04 Botulinum toxin A Xeomin® - anal-fissures - off-label

    Approved off-label indication:

    Management of anal fissures unresponsive to all other appropriate non-surgical, pharmacological (e.g. topical glyceryl trinitrate, topical diltiazem) and dietary strategies.

    Category B* form required

    See APC recommendation and SE London pathway for the management of anal fissures (links below) for detailed information.

    04.07.03 Botulinum toxin type A Xeomin® - myofascial pain and temporomandibular joint disorder

    Approved off-label indication:

    Myofascial pain in temporomandibular joint disorder:

    Category B* form required

    • Oral and maxillofacial surgery use only
    • Xeomin brand to be used
    • Dose = up to 100 units
    • Restricted to use in patients who fail standard treatments with jaw splints, NSAIDs and jaw exercises
    04.07.04.02 Botulinum Toxin Type A Botox® - migraine Approved for use as per resctritions in the NICE guidance for the use of botulinum toxin in chronic migraine
    04.09.03 Botulinum Toxin Type A Botox® Xeomin® Dysport® To be prescribed by brand, as different preparations are not dose equivalent
    13.12 Botulinum toxin type A  Botox® - hyperhidrosis

    CONSULTANT SPECIALISTS ONLY

    Severe hyperhidrosis of the axillae unresponsive to topical antiperspirant or other antihidrotic treatment

    Category B* form required

    13.12 Botulinum toxin type A Xeomin® - Frey's syndrome

    Approved off-label indication:

    Frey's syndrome

    Use in accordance with local guideline at GSTFT ENT consultants only

    07.04.02 Botulinum toxin type A injection Botox® - overactive bladder

    Approved for (via intravesical injection):

    • Neurogenic detrusor overactivity
    • Overactive bladder
    • Category B* form required
    • Consultant urologists and urogynaecologists only
    04.09.03 Botulinum Toxin Type B NeuroBloc®

    For use as an alternative to Botulinum toxin A in the presence of antibodies to Botulinum toxin A

    Category B* form required

    08.01.05 Brentuximab injection 

    Approved as per NICE Technology Appraisal guidance

    09.09 Brewers Yeast tablets 

    Pseudomembranous colitis.

    Dose:Three tablets 8 hourly for 5-7 days

    11.06 Brimonidine 0.2% & timolol 0.5% eye drops Combigan®
    11.06 Brimonidine eye drops 0.2% 
    11.06 Brinzolamide eye drops 1% 
    11.06 Brinzolamide 1% & timolol 0.5% eye drops Azarga® Decrease of intraocular pressure (IOP) in adult patients with openangle glaucoma or ocular hypertension for whom monotherapy provides insufficient IOP reduction
    11.06 Brinzolamide 10mg/ml & brimonidine 2mg/ml eye drops Simbrinza® For intraocular hypertension and open angle glaucoma where monotherapy is insufficient.
    04.08.01 Brivaracetam tabs, oral solution, injection 

    Initiation by consultant neurologist only

    Adjunctive third line treatment option for partial-onset seizures with or without secondary generalisation in adults

    Not be used concomitantly with levetiracetam as available evidence suggests there is no additional benefit from use of this combination

    Injection = Red

    13.05.03 Brodalumab injection  

    Approved as per detail in SE London APC Psoriasis Biological Drug Treatment Pathway (link below)

    04.09.01 Bromocriptine tabs 
    06.07.01 Bromocriptine tabs 
    01.05.02 Budesonide controlled release caps 

    Only licensed for induction of remission in Crohn's disease

    • Dose = 9mg daily
    • Usual course length = 4-6 weeks
    03.02 Budesonide nebuliser solution 
    01.05.02 Budesonide prolonged release tabs Cortiment MMX®

    Restricted to patients with active ulcerative colitis with insufficient response to 5-ASA who:

    • Would be suitable for beclometasone m/r capsules (Clipper®) but are at increased risk of severe side effects from systemic steroids or
    • Have failed/not tolerated beclometasone m/r treatment

    Course length = up to 8 weeks

    01.05.02 Budesonide rectal foam 

    13.10.04 Bug Busting Kit 
    02.02.02 Bumetanide injection 
    02.02.02 Bumetanide tabs 
    15.02 Bupivacaine 0.1% with fentanyl 2micrograms/mL infusion  For epidural
    15.02 Bupivacaine 0.25% and 0.5% with adrenaline 1 in 200,000 injection 
    15.02 Bupivacaine heavy injection 0.5% 
    15.02 Bupivacaine infusion 0.125% 

    Approved for licensed uses, and the following off-label indication:

    Wound infiltration

    15.02 Bupivacaine infusion 0.125% post-surgery wound infiltration

    Subcutaneous wound infiltration by infusion post surgery

    Use in accordance with local guideline only

    15.02 Bupivacaine injection 0.25%, 0.5% 
    04.10.03 Buprenorphine and Naloxone sublingual tabs  SLAM ONLY
    04.07.02 Buprenorphine patch weekly preparation

    INITIATION BY CONSULTANT ONLY

    Second line option for patients with chronic severe pain who:

    • Cannot tolerate large, oral, regular doses of weak opioids or non-opioid + weak opioid combination analgesics
    • Have conditions where use of anti-inflammatory drugs is not recommended or who have not tolerated such drugs
    04.10.03 Buprenorphine sublingual tabs 
    04.07.02 Buprenorphine sublingual tabs, injection, patches (96 hour) 

    06.07.02 Buserelin injection, nasal spray Suprecur® - gynaecology Pituitary desensitisation in preparation for ovulation induction regimens using gonadotrophins
    08.03.04.02 Buserelin injection, nasal spray Suprefact® - prostate cancer For prostate carcinoma
    04.01.02 Buspirone Hydrochloride tabs  INITIATION BY SPECIALIST ONLY
    08.01.01 Busulfan tabs 
    03.04.03 C1 esterase inhibitor injection 

    Acute attacks of hereditary angioedema, and prophylaxis of attacks as per NHSE Policy 16045/P

    08.01.05 Cabazitaxel injection 

    04.09.01 Cabergoline tabs  SPECIALIST INITIATION ONLY
    06.07.01 Cabergoline tabs 

    Approved off-label indication:

    Breast pain

    Dose = 500 micrograms weekly, or as divided doses on separate days, increased if necessary

    USE ON SPECIALIST ADVICE

    08.01.05 Cabozantinib caps Cometriq

    Approved as per NICE Technology Appraisal guidance (see links below): 

     

    08.01.05 Cabozantinib tablets Cabometyx

    Approved as per NICE Technology Appraisal guidance (see links below): 

     

    13.05.02.01 Cade oil 12% w/w and salicylic acid 6% w/w/ in emulsifying ointment 

    BAD/APC approved Special

    For moderate to severe scalp psoriasis when vitamin D analogues and commercial tar treatments have been ineffective or unsuitable.

    13.05.02 Calamine and Coal Tar ointment BP 
    13.03 Calamine lotion 
    09.05.01.01 Calceos® chewable tabs  Each tablet contains
  • Calcium 500mg (elemental)
  • Colecalciferol 400 units Dose: One tablet twice a day
  • 09.06.04 Calceos® chewable tabs  Each tablet contains
  • Calcium 500mg (elemental)
  • Colecalciferol 400 units Dose: One tablet twice a day
  • 09.05.01.01 Calcichew® chewable tabs  500mg elemental calcium per tab
    13.05.02 Calcipotriol 50micrograms/g and betametasone 0.05% ointment, gel 
    13.05.02 Calcipotriol 50micrograms/g with betamethasone 0.05% cutaneous foam Enstilar®
    13.05.02 Calcipotriol cream, ointment 50micrograms/g 
    13.05.02.01 Calcipotriol scalp solution 50 micrograms/mL 
    06.06.01 Calcitonin (salmon) / Salcatonin nasal spray, injection 
    13.05.02 Calcitriol 3 micrograms/g ointment 
    09.06.04 Calcitriol caps 
    09.05.02.02 Calcium Acetate tablets  Phosex® Calcium 6.2mmol per tab
    09.05.02.02 Calcium Carbonate tablets  Ca2+ 3mmol

    Phosphate binding renal patients

    09.05.02.02 Calcium Carbonate chewable tablets  Adcal®

    Calcium 15mmol per tab

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

    09.05.01.01 Calcium chloride injection 10%  Calcium = 27.3mg/mL
    08.01 Calcium folinate tabs, injection 
    09.05.01.01 Calcium gluconate effervescent tabs   Calcium = 89mg per tab
    13.13 Calcium gluconate gel  For hydrofluoric acid burns
    09.05.01.01 Calcium gluconate injection 10%  Calcium = 8.4mg/mL
    09.05.01.01 Calcium lactate and gluconate syrup  Alliance Calcium Syrup® Calcium = 2.5mmol in 5ml
    08.01 Calcium levofolinate injection 
    09.02.01.01 Calcium Polystyrene Sulphonate enema 30g in methylcellulose solution

    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

    09.02.01.01 Calcium Resonium® Calcium Polystyrene Sulphonate powder
    13.02.01 Calmurid cream 10% urea and 5% lactic acid

    Restricted to use in patients with a confirmed paraffin allergy

    06.01.02.03 Canagliflozin tabs 
    02.05.05.02 Candesartan tabs 
    10.02.02 Cannabis extract oromucosal spray Sativex®

    Treatment of moderate to severe spasticity in multiple sclerosis

    RESTRICTED TO USE BY CONSULTANT SPECIALISTS IN MULTIPLE SCLEROSIS RELATED SPASTICITY

    13.09 Capasal® shampoo salicylic acid 0.5%, coconut oil 1.0%, distilled coal tar 1.0%
    08.01.03 Capecitabine tabs 
  • First-line for metastatic colorectal cancer
  • Third- or fourth-line for locally advanced or metastatic breast cancer (where previous therapy with anthracyclines and taxanes had failed)
  • 04.07.03 Capsaicin 0.075% cream 

    For localised neuropathic pain or for those who wish to avoid or cannot tolerate oral treatment Licensed for post-herpetic neuralgia and diabetic peripheral neuropathy only

    Refer to SEL APC neuropathic pain guideline (link above)

    10.03.02 Capsaicin cream 0.025%
    10.03.02 Capsaicin patch 8% Qutenza ®

    Restricted to Pain Consultants who are trained in the administration of capsaicin patch

    To be used in accordance with a local guideline for last-line treatment of peripheral neuropathic pain in non-diabetic patients either alone or in combination with other medicinal products for pain.

    Restricted to post-herpetic neuralgia (PHN)

    02.05.05.01 Captopril tabs 
    04.07.03 Carbamazepine tabs, liquid neuropathic pain SPECIALIST INITIATION ONLY
  • Use in neuropathic pain is off-label
  • Dose = 100 mg twice daily, increased gradually to a maximum of 200mg three times a day
  • 04.02.03 Carbamazepine tabs, m/r tabs, liquid bipolar disorder INITIATION BY SPECIALIST ONLY
    04.08.01 Carbamazepine tabs, m/r tabs, liquid, suppositories epilepsy

    12.03.01 Carbenoxolone sodium 1% mouthwash granules  Bioplex®
    07.01.01 Carbetocin injection 

    Approved for prevention of uterine atony following caesarean section

    Follow local guideline for use

    06.02.02 Carbimazole tabs  Refer to BNF for CSM advice on neutropenia and agranulocytosis
    03.07 Carbocisteine caps, oral solution 
    11.08.01 Carbomer 980 eye drops 0.2% polyacrylic acid Preservative-free version available on request
    08.01.05 Carboplatin injection 
    07.01.01 Carboprost injection 
    09.02.02.01 Cardioplegia infusion 

    16 mmol K+ in 20mL

    REFER TO LOCAL TRUST PROTOCOL FOR CONCENTRATED POTASSIUM SOLUTIONS

    For myocardial protection during cardiac surgery

    08.01.05 Carfilzomib injection  

    Approved for use as per NICE technology appraisal guidance (see links below):

    11.08.01 Carmellose eye drops 0.5%, 1%  Preservative-free
    08.01.01 Carmustine 0.04% ointment 

    Treatment of mycosis fungoides.

    Continuation of therapy and monitoring is provided by secondary care (PIL available on GTi)

    Restricted to Consultant Dermatologists specialising in the treatment of skin tumours only

    08.01.01 Carmustine implant 
    08.01.01 Carmustine injection  BEAM autograft for lymphoma, uric acid nephropathy, neoplastic disease and metabolic disorders
    12.04 Carnoy’s solution ethanol 60%, chloroform 30%, glacial acetic acid 10% Topical adjuvant for procedures for odontogenic keratocysts
    02.04 Carvedilol tabs  Treatment of NYHA class IV heart failure
    05.02.04 Caspofungin injection  Use in accordance with local antifungal guidelines for:
  • Treatment of invasive candidiasis in adults
  • Treatment of invasive aspergillosis in adults refractory to or intolerant of amphoterocin, lipid formulations of amphoterocin B and/or itraconazole
  • Emperical therapy for presumed fungal infections in febrile, neutropenic adult patients who are refractory to or intolerant of amphoterocin and lipid formulations of amphoterocin
  • 03.04.02 Cat epithelial extract subcutaneous injection Novohelison Depot®

    SPECIALIST ALLERGIST USE ONLY

    Initial and maintenance therapy

    13.05.02.01 Ceanel Concentrate® shampoo cetrimide 10% + undecenoic acid 1% + phenylethyl alcohol 7.5%
    05.01.02.01 Cefalexin capsules, oral suspension 
    05.01.02.01 Cefazolin injection 

    INFECTIOUS DISEASES/MICROBIOLOGY SPECIALIST RECOMMENDATION ONLY

    For proven MSSA bloodstream infection in haemodialysis patients only

    Dose = 2g three days per week after haemodialysis sessions

    05.01.02.01 Cefixime tablets 

    Uncomplicated anogential gonorrhoea only (off-label)

    400 mg as a single dose

    05.01.02.01 Cefotaxime injeciton 
    05.01.02.01 Cefoxitin injection  2nd generation cephalosporin for parenteral administration
    11.03.01 Ceftazidime eye drops 5% 
    11.03.01 Ceftazidime 2mg intravitreal injeciton  Endophthalmitis
    05.01.02.01 Ceftazidime injection 
    05.01.02.01 Ceftazidime with avibactam injection 

    Restricted to:

    • Microbiology recommendation only
    • Infections caused by carbapenem resistant organisms where sensitivity to ceftazidime avibactam has been confirmed

    Approved for infections caused by aerobic Gram negative organisms in adults with limited treatment options (including off-label indications)

    05.01.02.01 Ceftolozane with tazobactam injection 

    Restricted to:

    • Microbiology recommendation only
    • Infections caused by carbapenem resistant organisms where sensitivity to ceftolozane tazobactam has been confirmed

    Approved for infections caused by multidrug resistant Pseudomonas aeruginosa in adults (including off-label indications)

    Note: for respiratory infections double dose may be required (i.e. ceftolozane 2g & tazobactam 1g every 8 hours in normal renal function)

    05.01.02.01 Ceftriaxone injection 
    11.03.01 Cefuroxime 1mg intracameral injeciton 

    Antimicrobial prophylaxis of postoperative endophthalmitis after cataract surgery

    11.03.01 Cefuroxime eye drops 5% 
    05.01.02.01 Cefuroxime injection 
    10.01.01 Celecoxib capsules 
    09.06.07 Centrum® tabs   GUM ONLY
    08.01.05 Ceritinib caps 

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

    10.01.03 Certolizumab pegol injection  Approved for use as per NICE technology appraisal guidance
    12.03.01 Cetalkonium & choline salicylate gel Bonjela®
    03.04.01 Cetirizine tabs, oral solution 
    06.07.02 Cetrorelix injection 

    INITIATION BY CONSULTANT SPECIALIST ONLY

    For the prevention of irreversible premature ovarian failure in women of child bearing age who are at risk due to the use of cyclophosphamide in the treatment of systemic lupus erythematosus, systemic vasculitis and anti-GBM disease

    Use in accordance with local guideline at KCH

    08.01.05 Cetuximab injection colorectal cancer

    Approved for use as per NICE technology appraisal guidance (see links below)

    08.01.05 Cetuximab injection head and neck cancer

    Approved for use as per NICE technology appraisal guidance (see links below)

    04.01.01 Chloral hydrate liquid  INITIATION BY SPECIALIST ONLY
    08.01.01 Chlorambucil tabs 
    12.02.03 Chloramphenicol 1% eye ointment  ENT post surgery - off-label

    Approved off-label indication:

    Topical use post ENT surgery

    Applied twice daily for a short course post-procedure

    05.01.07 Chloramphenicol caps, injection  Injection = Red Traffic Light
    12.01.01 Chloramphenicol ear drops 10% 
    11.03.01 Chloramphenicol eye drops 0.5%, eye ointment 1%  Preservative-free eye drops available on request
    04.01.02 Chlordiazepoxide caps, tabs 

    FIRST LINE FOR ACUTE ALCOHOL WITHDRAWAL

    Refer to local guidelines

    07.04.04 Chlorhexidine 0.02% 
    11.03.02 Chlorhexidine 0.2% eye drops 

    Additional topical treatment for fungal keratitis where there has been insufficient response to natamycin eye drops

    Usual dosing schedule = one drop hourly day and night for 48 hours, then one drop hourly during the day time, gradually reduced to four times a day.

    Usual course length 1 month.

    07.04.04 Chlorhexidine aqueous solution 0.02% 
    11.03 Chlorhexidine digluconate 0.02% eye drops  Acanthamoeba
    12.03.04 Chlorhexidine gluconate mouthwash 0.2% 
    13.11.02 Chlorhexidine gluconate solution 0.5% 
    10.01.03 Chloroquine sulphate tabs  USE UNDER SPECIALIST SUPERVISION ONLY
    05.04.01 Chloroquine tabs, syrup, injection  Injection = Red Traffic Light 
    03.04.01 Chlorphenamine tabs, oral solution, injection 
    04.02.01 Chlorpromazine tabs, syrup 
    02.02.01 Chlortalidone tabs 
    06.05.01 Chorionic gonadotrophin injection 
    11.09 Ciba Vision Miraflow® dialy cleaner  For soft, hard, and gas permeable lenses
    11.04.02 Ciclosporin 0.1% eye drops dry eye disease

    For dry eye disease as per NICE TA369

    Specialist ophthalmologist initiation only

    11.04.02 Ciclosporin 0.1% eye drops atopic & vernal keratoconjunctivitis (AKC & VKC) - off-label

    Approved off-label indication:

    For atopic keratoconjunctivitis (AKC) and vernal keratoconjunctivitis (VKC) in adults and children aged over 4 years, in accordance with APC recommendation

    Specialist ophthalmologist initation and first prescription from hospital

    03.04.02 Ciclosporin caps urticaria - off-label

    Approved off-label indication:

    Chronic urticaria.

    Maximum daily dose of 3mg/kg.

    Treatment should be discontinued if there is insufficient response after 6 weeks.

    Following an initial response, duration of treatment is 3 to 6 months

    Consultant specialists only

    08.02.02 Ciclosporin caps, oral liquid injection renal transplant Immunosuppression in renal transplant
    10.01.03 Ciclosporin caps, oral solution rheumatology USE UNDER SPECIALIST SUPERVISION ONLY
    10.01.03 Ciclosporin caps, oral solution Behcet's Disease

    USE UNDER SPECIALIST SUPERVISION ONLY

    Approved for use in the management of Behcet's Eye Disease. 

    Dose = 2.5-5mg/kg/day

    13.05.03 Ciclosporin caps, oral solution dermatology indications Approved for:
  • Psoriasis
  • Atopic dermatitis
  • 01.05.03 Ciclosporin injection ulcerative colitis - off-label

    Approved off-label indication:

    Severe acute ulcerative colitis refractory to corticosteroid treatment. Dose: 2 mg/kg over 24hours and dose adjusted according to blood-ciclosporin concentration and response

    05.03.02.02 Cidofovir injection 
    01.03.01 Cimetidine tabs 
    09.05.01.02 Cinacalcet tablets secondary hyperparathyroidism in ESRD

    For secondary hyperparathyroidism in end stage renal disease

    Renal consultant initiation only

    09.05.01.02 Cinacalcet tablets primary hyperparathyroidism

    For primary hyperparathyroidism, as per NHSE Policy

    Endocrinology only

    04.06 Cinnarizine tabs 
    02.12 Ciprofibrate tabs 
    11.03.01 Ciprofloxacin eye drops 0.3% 
    05.01.12 Ciprofloxacin injection 
    05.01.12 Ciprofloxacin tabs, oral suspension 
    12.01.01 Ciprofloxacin unit dose ear drops 0.2% 

    15.01.05 Cisatracurium injection  ICU USE ONLY
    08.01.05 Cisplatin injection 
    01.05 Citalopram tabs IBS - off-label

    Approved off-label indication:

    2nd line pharmacological treatment of IBS-C (constipation predmoninant irritable bowel syndrome) after failure of bulk forming laxatives Dose = 10mg - 20mg daily

    04.03.03 Citalopram tabs, oral drops 
    01.06.05 Citrafleet® oral powder 
    01.06.05 Citramag® oral powder 
    08.01.03 Cladribine injection haematology oncology

    For haematology oncology indications

    08.02.04 Cladribine tabs multiple sclerosis

    Approved for use as per NICE technology appraisal guidance (links below)

    05.01.05 Clarithromycin tabs, oral suspension, injection  Injection = Red Traffic Light 
    13.05.02 Clindamycin caps 

    Approved off-label indication:

    Used in combination with rifampicin in the treatment of hidradenitis suppurativa (HS)

    Use in accordance with the local guideline at GSTFT

    05.01.06 Clindamycin caps, injection  Injection = Red Traffic Light
    07.02.02 Clindamycin cream 2%  For bacterial vaginosis in accordance with GUM guidelines
    13.06.01 Clindamycin lotion 1%, topical solution 1%, gel 1% 
    04.08.01 Clobazam tabs 
    13.04.01 Clobetasol priopionate scalp application, shampoo, foam 0.05% 

    Steroid potency = very potent 

    Specialist advice only when initiated in secondary care

    13.04.04 Clobetasol propionate 0.05%, neomycin sulphate 0.5% and nystatin 100 000 units/g cream, ointment Dermovate-NN®

    Steroid potency = potent 

    Specialist advice only when initiated in secondary care

    13.04 Clobetasol propionate cream, ointment 0.05% 

    Steroid potency = very potent

    Specialist advice only when initiated in secondary care

    13.04.04 Clobetasone butyrate 0.05%, oxytetracycline 3% and nystatin 100 000 units/g cream Trimovate® Steroid potency = moderate
    13.04 Clobetasone butyrate cream, ointment 0.05%  Steroid potency = moderate
    05.01.10 Clofazimine caps 
    04.01.01 Clomethiazole caps 
    06.05.01 Clomifene tabs 
    04.01.01 Clomipramine caps Non-REM parasomnia - off-label

    Approved off-label indication:

    • Non-REM parasomnia in adults

    Usual dose = 10 mg to 75 mg nocte

    Sleep centre initiation only

    Refer to SE London APC recommendation and pathway (links below) for further detail

    04.03.01 Clomipramine caps Use in mental health

    INITIATION BY SPECIALIST ONLY

    Approved use includes the following off-label indication:

    Panic disorder - use in accordance with NICE CG113

    04.04 Clomipramine caps cataplexy - off-label

    Approved off-label indication:

    • Cataplexy

    Sleep centre initiation only

    Refer to SE London APC recommendation (link below), shared care agreement and cataplexy treatment pathway (link at end of section) for futher information

    04.07.03 Clonazepam injection unlicensed product

    Neuropathic pain when systemic administration is required in the Palliative Care setting

    04.01.01 Clonazepam tabs Sleep centre use - off-label

    Approved off-label indications:

    • Non-REM parasomnia
    • REM sleep behaviour disorder

    Usual dose = 0.25 mg to 4 mg nocte

    Sleep centre initiation only

    Refer to APC recommendation (link below) and pathways (links above)

    04.02.03 Clonazepam tabs mania - off-label

    Approved off-label indication:

    Mania (off-label)

    Dose = up to 2mg three times a day, tailored to patient response

    INITIATION BY SPECIALIST ONLY

    04.07.03 Clonazepam tabs neuropathic pain - off-label

    Use in neuropathic pain is off-label

    Dose = 0.5mg at night, increased slowly up to 1mg twice daily as per response

    04.08.01 Clonazepam tabs epilepsy

    04.09.04 Clonazepam tabs restless legs syndrome - off-label

    Approved for use in restless legs syndrome (off-label) with the following restrictions:

    • Specialist neurologist or sleep centre use only
    • Refractory cases where dopamine agonists and gabapentin/pregabalin have failed, and insomnia is a significant symptom
    • Dose = 0.25mg to 4mg at night

    Refer to SE London treatment pathway below

    02.05.02 Clonidine patches dyskinesia and dystonia in paediatric patients

    Specialist paediatric neurology prescribing only

    Approved for the treatment of paediatric dystonia/ dyskinesia as an alternative to clonidine liquid (unlicensed special) or clonidine tablets in whom transdermal delivery is more appropriate.

    300 microgram per 24 hours patches are available routinely, with 200 microgram per 24 hours and 100 microgram per 24 hours possible for order if required for titration to a specific dose.  All formulations are 7 day patches.

    Refer to the paediatric formulary entry and APC recommendation for detailed information

    02.05.02 Clonidine tabs vasomotor symptoms in menopause

    Treatment of vasomotor symptoms in the menopause where hormonal treatment is ineffective or inappropriate

    Dose = up to 75 micrograms twice a day 

     

    02.05.02 Clonidine tabs sedative in ICU - off-label

    Approved off label indication:

    For use as an opioid sparing co-analgesic and sedative agent when opioid and benzodiazepine requirements are increasing without effect. May also be used as a weaning agent

    Use in accordance with Critical Care Guideline for Clonidine

    02.05.02 Clonidine tabs hypertension

    For use in hypertension

    02.09 Clopidogrel tabs  Use as per NICE CG94: ACS and NSTEMI (see link below at end of section) Use as per NICE TA210: Prevention of occlusive vascular events (see link below at end of section)
    13.04.04 Clotrimazole 1% and hydrocortisone 1% cream Canesten HC® Steroid potency = mild
    07.02.02 Clotrimazole cream 1%, vaginal cream 10%, pessaries 
    13.10.02 Clotrimazole cream, powder 1% 
    13.10.02 Clotrimazole solution 1% 
    12.01.01 Clotrimazole topical solution 1% 
    04.02.01 Clozapine tabs  INITIATION BY SPECIALIST ONLY
    13.05.02 Coal tar (crude) in YSP ointment 1%, 20%, 30% 

    APC approved Special

    For moderate to severe chronic psoriasis when vitamin D analogues and commercial tar treatments have been ineffective or unsuitable.

    13.05.02 Coal tar (crude) in YSP ointment 2%, 5%, 10% 

    BAD/APC approved Special

    For moderate to severe chronic psoriasis when vitamin D analogues and commercial tar treatments have been ineffective or unsuitable.

    13.05.02.01 Coal tar 1% + coconut oil 1% + salicylic acid 0.5% shampoo  Capasal®
    13.05.02.01 Coal tar 2.5% and Lecithin 0.3% scalp lotion Psoriderm®
    13.05.02 Coal tar 6% and Lecithin 0.4% cream Psoriderm®
    13.05.02 Coal Tar Paste BP 
    13.05.02.01 Coal tar scalp pomade coal tar solution BP 6% w/w / salicylic acid 2% w/w in emulsifying ointment

    BAD/APC approved Special

    For moderate to severe scalp psoriasis when vitamin D analogues and commercial tar treatments have been ineffective or unsuitable.

    13.05.02.01 Coal tar solution 12% + salicylic acid 2% + sulphur 4% scalp ointment Sebco® or Cocois®
    13.05.02 Coal tar solution 5% in an emollient basis Evorex®
    13.04.03 Coal tar solution BP 10% w/w in betamethasone valerate 0.025% w/w ointment  

    APC approved Special

    For moderate to severe psoriasis of the trunk and limbs when other treatments such as vitamin D analogues have been ineffective.

    13.04.03 Coal tar solution BP 3.3% w/w and propylene glycol 20% w/w/ in Synalar® gel 

    BAD/APC approved Special

    For very inflamed hyperkeratotic scalp psoriasis.

    13.04.03 Coal tar solution BP 5% w/w in betamethasone valerate 0.025% w/w ointment  

    BAD/APC approved Special

    For moderate to severe psoriasis of the trunk and limbs when other treatments such as vitamin D analogues have been ineffective.

    13.05.02 Coal tar solution BP 6% w/w and salicylic acid 6% w/w in Ung. Merck 

    BAD/APC approved Special

    For moderate to severe chronic psoriasis when vitamin D analogues and commercial tar treatments have been ineffective or unsuitable.

    02.02.04 Co-amilofruse tabs amiloride with furosemide
    02.02.04 Co-amilozide tabs amiloride with hydrochlorothiazide
    05.01.01.03 Co-amoxiclav tabs, oral suspension, injection  Injection = Red Traffic Light
    04.09.01 Co-beneldopa caps, disp tabs, m/r caps 
    05.03.01 Cobicistat tabs 

    15.02 Cocaine 0.25% with adrenaline 0.1% paste  For use in paediatric lacrimal drainage surgery and nasal endoscopy to reduce bleeding
    15.02 Cocaine 10% oromucosal solution 
    15.02 Cocaine mouthwash 2% 
    04.09.01 Co-careldopa and Entacapone tabs 
    04.09.01 Co-careldopa intestinal gel Duodopa®

    RESTRICTED USE - ALL REFERRALS FOR PRESCRIBING SHOULD BE MADE TO PROFESSOR RAY CHAUDHURI AT KCH

    Treatment of advanced levodopa responsive Parkinson’s disease in patients with severe motor fluctuations and hyper-/dyskinesia when available combinations of Parkinson medicinal products have not given satisfactory results.

    Refer to NHSE commissioning criteria

    04.09.01 Co-careldopa tabs, m/r tabs 
    04.07.01 Co-codamol tabs, dispersible tabs paracetamol and codeine Strengths available:
  • Co-codamol 8/500
  • Co-codamol 30/500
  • 13.05.02.01 Coconut oil 25% w/w in emulsifying ointment 

    BAD/APC approved Special

    For scalp psoriasis where commercial preparations have been ineffective.

    13.06.02 Co-cyprindiol 2000/35 tabs Dianette® Refer to BNF for CSM advice (increased risk for thromboembolism)
    09.06.07 Cod liver oil capsules 
    01.06.02 Co-danthramer caps, suspension  Palliative care use only
    01.06.02 Co-danthramer strong caps, strong suspension  Palliative care use only
    03.09.01 Codeine linctus BP 15mg in 5ml
    01.04.02 Codeine tabs 
    04.09.04 Codeine tabs restless legs syndrome - off-label

    Approved for use in restless legs syndrome (off-label) with the following restrictions:

    • Specialist neurologist or sleep centre use only
    • Refractory cases where dopamine agonists and gabapentin/pregabalin have failed and pain is a significant symptom
    • Dose = 30 mg to 90 mg at night

    Refer to SE London treatment pathway below

    04.07.02 Codeine tabs, injection 
    04.07.01 Co-dydramol 10/500 tabs paracetamol and dihydrocodeine
    10.01.04 Colchicine tablets 
    08.04 Cold storage solution  Perfusion solution for liver grafts from Non Heart Beating Donors
    09.06.04 Colecalciferol tabs, caps & oral liquid 

    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

    01.09.02 Colesevelam tabs 

    Approved off-label indication:

    • Diarrhoea caused by bile salt malabsorption e.g. in Crohn’s disease or radiation enteritis
    • Pruritus and hyperlipidaemia in primary biliary cirrhosis

    Consultant hepatologists and gastroenterologists initiation only

    02.12 Colesevelam tabs  CONSULTANT LIPIDOLOGISTS ONLY
  • Fifth-line monotherapy after statins, fibrates, niacin and ezetimibe for patients intolerant of other lipid-lowering drugs
  • Add-on therapy for patients on multiple lipid lowering drugs not achieving LDL-C and total cholesterol serum targets currently defined by the National Service Framework for Cornonary Heart Disease
  • 01.09.02 Colestyramine sachets 
    02.12 Colestyramine sachets 
    05.01.07 Colistimethate sodium dry powder for inhalation Colobreathe®
    05.01.07 Colistimethate sodium injection & nebuliser solution Colomycin®
    10.03.01 Collagenase injection Xiapex® - Dupuytren’s contracture Restricted to surgeons specialising in the treatment of Dupuytren’s contracture, and as per NICE technology appraisal 459
    13.10.05 Collodion Flexible BP 
    01.01.01 Co-magaldrox 195/220 in 5ml oral suspension Mucogel®
    05.03.01 Combivir® tabs zidovudine and lamivudine
    06.01.06 Combur Test® 7  Blood, leucocytes, nitrate, glucose, protein, ketone and pH detection
    01.04.02 Co-phenotrope tabs 
    06.05.01 Corticotrophin releasing hormone injection  Test for adrenal insufficiency
    06.03.02 Cortisone tabs 
    02.04 Co-tenidone tabs  
    02.02.04 Co-triamterzide tabs triamterine with hydrochlorothiazide
    05.04.08 Co-trimoxazole tabs, injection  Injection = Red Traffic Light
    05.01.08 Co-trimoxazole tabs, oral suspension, injection  Injection = Red Traffic Light 
    08.01.05 Crisantaspase injection 
    08.01.05 Crizotinib caps 

    Approved for use as per NICE technology appraisal guidance (see links below):


    13.03 Crotamiton cream 
    13.13 Crystal violet paint  Antiseptic agent for candidal vulvovaginitis
    04.06 Cyclizine tabs, injection  Follow local guidelines for use in post-operative nausea and vomiting
    11.05 Cyclopentolate eye drops 0.5%, 1% 
    08.01.01 Cyclophosphamide injection 

    Approved off-label indication:

    Chronic inflammatory demyelinating polyradiculoneuropathy

    Prescribing restricted to Dr Hadden in accordance with locally agreed protocol

    10.01.05 Cyclophosphamide injection 

    USE UNDER SPECIALIST SUPERVISION ONLY 

    Approved for use in the management of severe refractory Behcet's Disease in accordance with locally agreed protocol

     

     

     

     

    08.01.01 Cyclophosphamide pre-filled syringe 1000mg in 50mL  Chronic lymphocytic leukaemia; lymphomas; solid tumours
    08.01.01 Cyclophosphamide tabs 

    Approved off-label indication:

    Induction of remission in acquired haemophilia

    Dose = 50mg 100mg daily, usual course length 6-8 weeks

    Consultant specialist use only

    08.01.01 Cyclophosphamide tabs, injection 
    06.04.01.01 Cyclo-Progynova® tabs estradiol valerate and norgestrel
    03.04.01 Cyproheptadine tablets 

    Approved off-label indication:

    • Treatment of serotonin syndrome
    • Loading dose of 12 mg, further doses may be given following clinical review

    Prescribing must be initiated under the supervision of the Clinical Toxicology team at the GSTFT Poisons Unit

    03.04.01 Cyproheptadine tabs 
    13.06.02 Cyproterone acetate tabs  Approved off-label indication:
    Treatment of women with severe treament resistant acne only
    Specialist initiation only
    06.04.02 Cyproterone acetate tabs 
    08.03.04.02 Cyproterone acetate tabs 
    08.01.03 Cytarabine injection 
    02.08.02 Dabigatran caps 

    Amber Traffic Light For treatment and secondary prevention of DVT and PE, and thromboprophylaxis in AF

    See links at the end of the section for initiation of treatment and transfer of care documents

     

    Red Traffic Light (hospital only) For prevention of VTE after hip or knee replacement surgery 

    08.01.05 Dabrafenib caps 

    Approved for use as per NICE technology appraisal guidance (see links below):

    08.01.05 Dacarbazine injection 
    05.03.03.02 Daclatasvir tabs 

    08.01.02 Dactinomycin injection 
    09.06.07 Dalivit® oral drops 
    02.08.01 Dalteparin injection  First-line LMWH at GSTFT
    06.07.02 Danazol caps 
    10.02.02 Dantrolene sodium caps 

    10.02.02 Dantrolene sodium injection  Approved off-label indications:
  • Spasticity
  • Urinary incontinence
  • 15.01.08 Dantrolene sodium injection 
    06.01.02.03 Dapagliflozin tabs 
    05.01.10 Dapsone tabs dermatology off-label indications

    Approved off-label indications:

    • Erythema elevatum diutinum
    • Sweet's syndrome
    • Bullous systemic lupus erythematosus
    • Bullous pemphigoid and mucous membrane pemphigoid
    • Hidradenitis suppurativa
    • Pyoderma gangrenosum
    • Subcorneal pustular dermatosis
    • Granuloma faciale
    • Eosinophilic pustular folliculitis
    • Leukocytoclastic vasculitis including Henoch Schonlein purpura
    • Linear IgA disease and chronic bullous disease of childhood

    Prescribing must be initiated and continued by a specialist

    Dose: 50-200 mg daily

    05.01.10 Dapsone tabs licensed indications

    Approved for licensed uses:

    • Leprosy
    • Dermatitis herpetiformis and other dermatoses
    • Prophylaxis of malaria
    • Prophylaxis of Pneumocystis carinii pneumonia in immunodeficient subjects
    05.04.08 Dapsone tabs treatment of pneumocystis pneumonia

    Approved off-label indication:

    Treatment of pneumocystis pneumonia

    05.01.07 Daptomycin injection  Second-line option to vancomycin for patients who have MRSA or VRE infections, when other agents cannot be used and when bactericidal activity is required, for example, for severe infection in highly compromised patients
    08.02.04 Daratumumab injection 

    Approved for use as per NICE technology appraisal guidance (links below)

    09.01.03 Darbepoetin alfa injection  Treatment of anaemia associated with chronic kidney disease
    07.04.02 Darifenacin m/r tablets 
    05.03.01 Darunavir tabs 
    05.03.03.02 Dasabuvir tabs 

    08.01.05 Dasatinib tabs 

    08.01.02 Daunorubicin injection 
    08.01.02 Daunorubicin liposomal injection 
    13.13 Daydrop air freshener  Deodorant
    09.01.03 Deferasirox film coated tabs 

    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

    09.01.03 Deferiprone tabs  Follow NHSE Policy 16070/P when using in chronic inherited anaemias
    02.08.01 Defibrotide infusion 

    USE UNDER SPECIALIST SUPERVISION ONLY Treatment of patients with severe veno-occlusive disease following stem cell transplant in line with NHS England Clinical Commissioning Policy B04/P/c

    08.03.04.02 Degarelix injection 
    09.06.07 DEKAs® Plus liquid, softgels, chewable tablets  Fat soluble vitamin supplement for cystic fibrosis patients
    05.01.09 Delamanid tabs Deltyba®

    Specialist TB respiratory consultant use only

    Approved for use in accordance with NHS England Clinical Commissioning Policy F04/P/a

    05.03.01 Delavirdine tabs  Antiretroviral: 400 mg three times a day. Alternatively 600 mg twice daily
    06.05.02 Demeclocycline caps 
    06.06.02 Denosumab XGEVA®
    06.06.02 Denosumab Prolia®

    Approved as per NICE TA204 and:

    Secondary prevention of osteoporotic fragility fractures in male patients with osteoporosis and a creatinine clearance <30mL/min

    Consultant Specialists only - use in accordance with local guideline

    12.03.03 Dequacaine® lozenges  Contains:
  • Benzocaine
  • Dequalinium
  • 13.02.01 Dermol® 500 lotion 

    First line emollient with antibacterial

    13.02.01.01 Dermol® 600 bath emollient 

    Contains an antimicrobial

    13.02.01 Dermol® cream 

    Second line emollient with antibacterial

    13.04.03 Dermovate® in propylene glycol cream 40% 

    BAD/APC approved Special

    For severe inflammatory disease without hyperkeratosis, or at sensitive skin sites e.g. the vulva

    05.03.01 Descovy® tabs emtricitabine with tenofovir alafenamide
    09.01.03 Desferrioxamine mesilate injection 
    15.01.02 Desflurane volatile liquid 
    06.05.02 Desmopressin injection 

    Approved off-label indication:

    Administered before a kidney biopsy to reduce the risk of bleeding

    06.05.02 Desmopressin nasal spray, tabs, injection 

    Following MHRA safety advice, desmopressin nasal spray must not be prescribed for primary nocturnal enuresis

    Injection = Red Traffic Light

    07.04.02 Desmopressin tabs 
    07.03.02.01 Desogestrel 75 microgram tabs  For women contraindicated to estrogens or intolerant to COC AND fulfil TWO or more of the following criteria:
  • Age <40 years
  • Adherence to the 3 hour window for late pills with the traditional POPs could pose difficulty
  • There has been a failure with one of the traditional POPs in the past
  • Where ovulation suppression is beneficial such as past history of ectopic pregnancy, past history of ovarian cysts and premenstrual syndrome
  • Body mass index >40
  • Established users of Cerazette®
  • 11.04.01 Dexamethasone eye drops 0.1%  Preservative-free eye drops available on request
    10.01.02.02 Dexamethasone injection rheumatology indications
    11.04.01 Dexamethasone injection intracameral use - off-label

    Approved off-label indication:

    Intracameral use in Endoscopic Cyclophotocoagulation (ECP) and cataract surgery where there is increased inflammation

    Dose: 0.4mg peri-operatively

    Only the Hospira AMPOULE (preservative free) formulation is approved for use in this indication

    11.08.02 Dexamethasone intravitreal implant Ozurdex ®

    Approved as per NICE technology appraisal guidance

    Refer to APC guidance for Wet Age-Related Macular Degeneration, Diabetic Macular Oedema, Central Retinal Vein Occlusion and Branch Retinal Vein Occlusion (see link below)

    06.03.02 Dexamethasone tabs, oral solution, injection 
    04.04 Dexamfetamine tabs ADHD

    INITIATION BY SPECIALIST ONLY

    • Treatment of ADHD in children
    • Treatment of ADHD in adults (off-label)

    Refer to links in this section for ADHD shared care documentation

    04.04 Dexamfetamine tabs sleep centre indications

    Approved for:

    • Narcolepsy
    • Idiopathic hypersomnia (off-label)

    Sleep centre initiation only

    GPs can be asked to continue prescribing after 6 months treatment as per SE London shared care agreement (link at end of section)

    Restricted to patients who have not responded to modafinil, or where modafinil is contra-indicated.  Refer to SE London APC narcolepsy treatment pathway and shared care agreement (link below)

    15.01.04.04 Dexmedetomidine injection licensed use

    To be prescribed under the supervision of an ICU consultant

    For sedation of adult ICU patients as a second-line option when firstline options (midazolam, clonidine and propofol) have failed, are contraindicated or not suitable

    15.01.04.04 Dexmedetomidine injection off-label use in awake neurosurgery

    Approved off-label indication:

    Procedural sedation for awake craniotomy and awake spinal surgery (specialist neuro anaesthetist use only)

    • Loading dose: maximum 1.0 micrograms/kg over 10 minutes (reduced to 0.5micrograms/kg in patients ≥65 years)
    • Maintenance infusion of 0.2 to 1.0 microgram/kg/hour during surgery
    09.02.02.02 Dextran 70 intravenous infusion in sodium chloride 0.9%  
    04.07.02 Diamorphine injection 
    06.01.06 Diastix®  Glucose detection
    15.01.04.01 Diazepam injection 
    04.08.02 Diazepam injection, rectal tubes 
    04.01.01 Diazepam tabs Sleep centre use - off-label

    Approved off-label indication:

    • REM behaviour disorder in adults
    • Non-REM parasomnia in adults

    Usual dose = 2 mg to 10 mg nocte

    Sleep centre initiation only

    Refer to SE London APC recommendations (links below) and pathways (links above) for further detail

    10.02.02 Diazepam tabs, injection 
    04.01.02 Diazepam tabs, oral solution, injection, rectal tubes 
    15.01.04.01 Diazepam tabs, syrup, rectal tubes, 
    02.05.01 Diazoxide injection 
    06.01.04 Diazoxide tabs 
    10.04 Dibotermin alfa  InductOs ®

    Can only be used under the supervision of named spinal surgeons only: MR KHAI LAM, MR JONATHAN LUCAS, MR TOM EMBER

    Approved for:

    • Primary lumbar anterior fusions
    • Revision lumbar spinal fusions
    • Complex idiopathic kyphosis or scoliosis (primary or revision)
    • Complex congenital kyphosis or scoliosis (primary or revision)
    11.08.02 Diclofenac 0.1% unit dose eye drops 

    Inhibition of perioperative miosis in cataract surgery only

    15.01.04.02 Diclofenac injection 

    Approved for the treatment or prevention of postoperative pain in the hospital setting

    10.01.01 Diclofenac sodium e/c, m/r & disp tabs, suppositories 

    Approved for all licensed indications, and the following off-label indication:

    Stat rectal dose prior to ERCP for prevention of post-ERCP pancreatitis

    13.08.01 Diclofenac sodium gel 3% Solaraze®

    01.02 Dicycloverine oral solution 
    05.03.01 Didanosine powder  Antiretroviral
    05.03.01 Didanosine tabs, caps 
    08.03.01 Diethylstilbestrol tabs 

    13.04 Diflucortolone valerate oily cream 0.3% 

    Steroid potency = very potent 

    Specialist advice only when initiated in secondary care

    13.04 Diflucortolone valerate oily cream and ointment 0.1% 

    Steroid potency = potent 

    Specialist advice only when initiated in secondary care

    02.01.01 Digoxin specific antibody fragments 
    02.01.01 Digoxin tabs, oral solution, injection 

    When switching from intravenous to oral route may need to increase dose by 20–33% to maintain the same plasma-digoxin concentration

    50 micrograms of oral solution is equivalent to 62.5 micrograms of tablets

    04.07.02 Dihydrocodeine m/r tabs 
    04.07.02 Dihydrocodeine tabs, injection 
    04.07.04.01 Dihydroergotamine injection 

    SPECIALIST USE ONLY

    Inpatient treatment of medical refractory disabling migraine and cluster headaches.

    See dosing protocol from KCH for further information

    04.07.01 Dilofenac sodium tabs, m/r tabs, dispersible tabs, suppositories 
    01.07.04 Diltiazem cream 2% 

    For anal fissure and post-operative anal spasm in high-risk patients following clinical examination.

    Refer to the SE London APC pathway for the management of anal fissures for further information (link below)

    Hospital supply only - 2 tubes are usually sufficient for a treatment course

    02.06.02 Diltiazem tabs, m/r tabs, m/r caps 
    08.02.04 Dimethyl fumarate caps Tecfidera - multiple sclerosis

    13.05.03 Dimethyl fumarate tablets Skilarence - psoriasis Approved for use in psoriasis as per NICE Technology Appraisal guidance
    07.04.04 Dimethyl sulphoxide solution 50% 

    USE ON SPECIALIST ADVICE

    Interstitial cystitis (Hunner’s ulcer)

    07.01.01 Dinoprostone vaginal gel, pessaries 
    01.04 Dioralyte® oral powder 
    09.02.01.02 Dioralyte® sachets 
    13.07 Diphencyclopropenone in acetone 0.00001-6.0% w/v 

    BAD/APC approved Special

    For alopecia areata and resistant viral warts as topical immunotherapy.

    02.09 Dipyridamole tabs, m/r caps, oral suspension  Use as per NICE TA210: Prevention of occlusive vascular events (see link below at end of section)
    06.06.02 Disodium etidronate tabs 
    08.01 Disodium folinate injection 
    06.06.02 Disodium pamidronate injection 

    Approved for licensed use, and the following off-label indication:

    Non-malignant hypercalcaemia - follow local guidelines

    02.03.02 Disopyramide caps, injection  USE UNDER SPECIALIST SUPERVISION ONLY
    03.01.05 DispozABLE® spacer device  Single use device for use in bronchodilation challenge only
    04.10.01 Disulfiram tabs  SPECIALIST INITIATION ONLY
    13.05.02 Dithranol cream 0.1%, 0.25%, 0.5%, 1%, 2% 
  • 0.1–0.5% suitable for overnight treatment
  • 1–2% for max 1hr (consult Dithocream product literature)
  • 13.05.02 Dithranol in Lassar's paste 0.1%, 0.5%, 1%, 2%, 4%, 8%, 10%, 15% w/w 

    BAD/APC approved Special

    For moderate to severe chronic plaque psoriasis when other topical treatments including vitamin D analogues, commercial tar preparations and commercial dithranol preparations have been ineffective or unsuitable

    13.05.02 Dithranol paste BP 0.05% to 10%  dithranol in Lassar's paste
    13.05.02.01 Dithranol pomade 0.4% w/w 

    BAD/APC approved Special

    For moderate to severe scalp psoriasis when vitamin D analogues and commercial tar treatments and commercial commercial dithranol preparations have been ineffective or unsuitable.

    02.07.01 Dobutamine injection  RESTRICTED USE - ICU AND CARDIAC HIGH DEPENDENCY
    08.01.05 Docetaxel injection 
    01.06.02 Docusate sodium caps, liquid 
    01.06.02 Docusate sodium enema 
    03.04.02 Dog epithelial extract subcutaneous injection Novohelison Depot®

    SPECIALIST ALLERGIST USE ONLY

    Initial and maintenance therapy

    05.03.01 Dolutegravir tabs 
    04.06 Domperidone tabs, suspension use as galactagogue - off-label

    Approved off-label indication:

    Treatment of inadequate lactation

    Dose = 10mg three times a day

    04.06 Domperidone tabs, suspension 
    04.01.01 Donepezil tabs REM behaviour disorder - off-label

    Approved off-label indication:

    • REM behaviour disorder in adults

    Usual dose = 5 mg to 10 mg nocte

    Sleep centre initiation only

    Refer to SE London APC recommendation and pathway (links below) for further detail

    04.11 Donepezil tabs 
    02.07.01 Dopamine injection  RESTRICTED USE - ICU AND CARDIAC HIGH DEPENDENCY
    02.07.01 Dopexamine injection  RESTRICTED USE - ICU AND CARDIAC HIGH DEPENDENCY
    03.07 Dornase alfa nebuliser solution  Use under specialist supervision in line with NHS England Commissioning Policy
    03.07 Dornase alfa nebuliser solution 

    Approved off-label indication:

    Severe respiratory failure with tenacious sputum in adult patients receiving ECMO. Either via a nebuliser, or endotracheal instillation

    Maximum 3 doses

    Consultant ICU specialist only

    02.10.02 Dornase alpha nebuliser liquid Off-label use in intrapleural fibrinolysis

    Approved off-label indication:

    • Intrapleural fibrinolysis for complex pleural infection (together with alteplase)

    UNDER SPECIALIST SUPERVISION ONLY Follow local guidelines at GSTT

    Regimen: Dornase 5mg in 50ml sodium chloride 0.9% administered intrapleurally

    Alteplase 10mg in sodium chloride 0.9% administered intrapleurally separately

    Dose: Every 12 hours for a maximum of 3 days

    11.06 Dorzolamide 2% & timolol 0.5% eye drops 

    Treatment of open-angle glaucoma, ocular hypertension, and pseudoexfoliative glaucoma when betablocker alone is not adequate.

    Note: preservative-free drops available on request

    11.06 Dorzolamide eye drops 2%   Note: preservative-free drops available on request
    03.05.01 Doxapram injection 
    02.05.04 Doxazosin tabs hypertension

    MR tabs are non-formulary (see below)

    07.04.01 Doxazosin tabs benign prostatic hyperplasia

    04.03.01 Doxepin caps 
    13.03 Doxepin cream 5% 
    08.01.02 Doxorubicin hydrochloride injection 
    08.01.02 Doxorubicin hydrochloride pegylated liposomal injection 
    05.01.03 Doxycycline caps  
    05.04.01 Doxycycline caps  
    13.06 Doxycycline caps rosacea - off-label

    First line oral antibiotic option for papulopustular rosacea

    Refer to SE London rosacea treatment pathway for further information (link below)

    13.06.02 Doxycycline caps 
    05.01.03 Doxycycline injection 

    Available on ID/Micro recommendation only

    For use in managing infections where doxycycline is clear first choice agent (e.g. Lyme disease, Brucella, Q fever) and the oral route is unavailable or inappropriate

    Dose: 400 mg IV stat, then 200 mg IV once daily

    13.06 Doxycyline 40mg m/r capsules Efracea® - rosacea

    For use in facial rosacea

    Restricted to use as a 2nd line oral antibiotic where there is intolerance (e.g. abdominal pain, nausea) to the first line oral antibiotic choice (either oxytetracyline or doxycycline 100mg)

    Refer to APC recommendation and SE London rosacea treatment pathway for further information (links below)

    13.02.02 Drapolene® cream 
    02.03.02 Dronedarone tabs 
    04.06 Droperidol injection  Prophylaxis and treatment of postoperative nausea and vomiting in accordance with its marketing authorisation.
    03.01.04 Duaklir Genuair® dry powder inhaler aclidinium and formoterol
    06.04.01.01 Duavive® MR tabs Conjugated oestrogens and bazedoxifene

    Secondary care initiation only

    Restricted to use (as per product licence) where progestin containing therapy is not appropriate

    06.01.02.03 Dulaglutide injection 

    Follow SE London APC GLP-1 guidance for criteria for use

    Initiation by specialist only.

    Ongoing supplies can be requested from primary care after the 3 months review using the transfer of care document (links below)

    04.03.04 Duloxetine caps  INITIATION BY SPECIALIST ONLY
    04.07.03 Duloxetine caps neuropathic pain

    For painful diabetic neuropathy

    Refer to SEL APC neuropathic pain guideline (link below)

    07.04.02 Duloxetine caps 

    For stress urinary incontinence in women who prefer pharmacological treatment to surgical management, and in whom conservative treatment has failed

     

    Approved off-label indication:

    Also approved for off-label use for stress-urinary incontinence in men (same dosing as licensed use in women)

    03.02 DuoResp Spiromax® dry powder inhaler budesonide and formoterol Use in COPD restricted to specialist recommendation only
    13.02.01 E45® lotion 

    Second line choice where a lotion type emollient is required

    13.10.02 Econazole nitrate cream 1% 
    07.02.02 Econazole nitrate cream 1%, pessaries 
    09.01.03 Eculizumab injection Paroxysmal nocturnal haemoglobinuria

    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
    09.01.03 Eculizumab injection Atypical Haemolytic Uraemic Syndrome [aHUS]

    Approved for:

    • Atypical Haemolytic Uraemic Syndrome (aHUS)
    • Use in accordance with NHSE SSC 1522 & NICE HST1
    09.01.03 Eculizumab injection C3 glomerulopathy post-kidney transplant

    Approved for:

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

    Third line emollient with antibacterial

    02.08.02 Edoxaban tabs  See links at the end of the section for initiation of treatment and transfer of care documents
    10.02.01 Edrophonium chloride injection 
    15.01.06 Edrophonium Chloride injection 
    11.99.99.99 EDTA eye drops 0.37% Disodium edetate Approved for the following indication:
  • Chelating agent in calcific band keratopathy
  • 11.99.99.99 EDTA eye drops 0.37% Disodium edetate Approved for the following indication:
  • Chelating agent for chemical burns to eye
  • 05.03.01 Efavirenz caps, tabs, oral soultion 
    03.01.02 Eklira Genuair® dry powder inhaler aclidinium
    01.04 Electrolade® oral powder 
    09.02.01.02 Electrolade® oral powder 
    09.01.04 Eltrombopag tablets  Consultant Haematologists specialising in the treatment of ITP only
    09.01.04 Eltrombopag tablets 

    Consultant Specialists only

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

    01.05 Eluxadoline tablets 

    Approved as per NICE technology appraisal guidance:

    3rd line pharmacological treatment of IBS-D (diarrhoea predmoninant irritable bowel syndrome) after failure of loperamide and tricyclic antidepressants

    09.01.03 Emicizumab injection 

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

    15.02 EMLA®cream  Contains:
  • Lidocaine 2.5%
  • Prilocaine 2.5%
  • 13.02.01 Emollin® spray 

    For very painful/fragile skin where there is difficulty with ‘hands-on’ application of creams and ointments only

    06.01.02.03 Empagliflozin tabs 
    05.03.01 Emtricitabine caps, oral solution 
    13.02.01 Emulsifying Ointment BP 

    First line choice if a greasy emollient is required

    02.05.05.01 Enalapril tabs 
    05.03.01 Enfuvirtide injection 
    02.08.01 Enoxaparin injection 
    02.01.02 Enoximone injection  RESTRICTED USE - ICU AND CARDIAC HIGH DEPENDENCY
    04.09.01 Entacapone tabs 

    Entacapone is the first line COMT-inhibitor of choice. 

    See the Management of Motor Symptoms in Parkinson's Disease SEL pathway (link above) for detailed prescribing advice. 

    05.03.03.01 Entecavir tabs, oral solution 
    08.03.04.02 Enzalutamide caps 
    13.13 Eosin solution 2% w/v 

    BAD/APC approved Special

    For erosive dermatitis.

    05.03.03.02 Epclusa® tabs sofosbuvir and velpatasvir

    02.07.02 Ephedrine injection 
    12.02.02 Ephedrine nasal drops 0.5%, 1% 
    03.01.01.02 Ephedrine tabs 
    13.02.01 Epimax® ointment 

    Second line option where a greasy emollient is required

    13.02.01 Epimax® cream 

    First line option if a cream or gel type emollient is required

    07.04.05 Epinephrine (adrenaline) injection 1 mg/ml 

    Approved off-label indication:

    Drug-induced priapism once physical measures to direct blood from penis and aspiration have failed

    USE UNDER SPECIALIST SUPERVISION ONLY Use with caution – risk of hypertensive crisis. Continual monitoring of blood pressure and pulse is essential.

    • Dose: 10-20 micrograms (0.5-1 mL diluted solution as below) injected into corpus cavernosum after aspiration of blood has failed to produce a response.
    • Dilution: 1 mg in 1 mL epinephrine is diluted to 50 mL with sodium chloride 0.9% (49 mL) to give 20 micrograms/mL solution
    08.01.02 Epirubicin hydrochloride injection 
    02.02.03 Eplerenone tabs 

    For signs and symptoms of heart failure after recent myocardial infarction as per NICE CG172.

    Reserved for patients unable to tolerate spironolactone when used for the treatment of chronic heart failure with left ventricular dysfunction

    09.01.03 Epoetin alfa injection Eprex®

    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

    09.01.03 Epoetin alfa injection  Eprex®, Binocrit® Treatment of anaemia associated with chronic kidney disease
    09.01.03 Epoetin alfa/beta injection 

    Consultant Haematologists only

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

    09.01.03 Epoetin beta injection NeoRecormon®

    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

    09.01.03 Epoetin beta injection  NeoRecormon® Treatment of anaemia associated with chronic kidney disease
    09.01.03 Epoetin zeta injection  Retacrit® Treatment of anaemia associated with chronic kidney disease
    02.08.01 Epoprostenol injection  USE ON SPECIALIST ADVICE ONLY
    02.09 Eptifibatide injection  USE UNDER SPECIALIST SUPERVISION ONLY Use as per NICE CG94: ACS and NSTEMI (see link below at end of section)
    10.04 Eptotermin alfa implant Ossigraft ®

    For named consultants only: MS SARAH PHILIPS, MR GRAEME GROOM, MR MARK PHILIPS, MR OM LAHOTI, MR VENU KAVARTHAPU

     

    Approved for:

    Treatment of non-union tibia (see EMEA product information for licensed restrictions), and humerus, femur, forearm, tibia, mandible and spine

     

    For named consultant only: MR VENU KAVARTHAPU

    Approved for:

    Major foot and ankle surgical reconstruction due to deformity and or instability caused by severe Charcot Arthropathy that has lasted for more than 12 months, with marked bone loss and non-union of the fractures.

    09.06.04 Ergocalciferol injection 

    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

    07.01.01 Ergometrine maleate and oxytocin injection 
    07.01.01 Ergometrine maleate injection 
    08.01.05 Eribulin injection 

    Approved for use as per NICE technology appraisal guidance (see links below):

    08.01.05 Erlotinib tabs 
    05.01.02.02 Ertapenem injection 
    13.06.01 Erythromycin 40mg with zinc acetate 12mg/mL Zineryt® USE ON SPECIALIST ADVICE
    13.06.01 Erythromycin solution 2% 
    01.02 Erythromycin tabs, oral suspension 

    Approved off-label indication:

    Resistant diabetic gastroparesis.

    Dose = 125 mg three times a day before meals

    01.02 Erythromycin tabs, oral suspension, injection 

    Approved off-label indication:

    Prokinetic agent, motility stimulant

    05.01.05 Erythromycin tabs, oral suspension, injection  Injection = Red Traffic Light
    05.01.05 Erythromycin tabs, oral suspension, injection 

    Approved off-label indication:

    Improve gastric motility

    13.06.02 Erythromycin tabs, suspension 
    04.03.03 Escitalopram tabs 

    INITIATION BY SPECIALIST ONLY

    04.08.01 Eslicarbazepine tabs  USE UNDER SPECIALIST SUPERVISION ONLY
    02.04 Esmolol injection  USE UNDER SPECIALIST SUPERVISION ONLY
    06.04.01.01 Estraderm ® patches estradiol
    06.04.01.01 Estradiol 0.06% gel Oestrogel

    For oestrogen deficiency symptoms in postmenopausal women who have experienced adverse reactions to HRT patches, e.g. skin irritation

    First choice topical oestrogen gel for HRT

    See APC recommendation for further information 

    06.04.01.01 Estradiol 0.5mg gel Sandrena®

    For oestrogen deficiency symptoms in postmenopausal women who have experienced adverse reactions to HRT patches, e.g. skin irritation

    Second choice topical oestrogen gel for HRT

    See APC recommendation for further information

    06.04.01.01 Estradiol implants 25mg and 50mg 

    Approved for use in:

    • HRT for estrogen deficiency symptoms in postmenopausal women
    • Prevention of osteoporosis in postmenopausal women at high risk of future fractures who are intolerant of, or contraindicated for, other medicinal products approved for the prevention of osteoporosis

    Dose: 25-100 mg subcutaneously, every 4-8 months

    06.04.01.01 Estradiol tabs 
    07.02.01 Estradiol vaginal ring Estring®
    07.02.01 Estradiol vaginal tabs 10 micrograms Vagifem®
    07.02.01 Estriol intravaginal cream 0.1% and 0.01% Ovestin®, Gynest®
    02.11 Etamsylate tabs 
    10.01.03 Etanercept injection rheumatology indications

    Approved as per NICE technology appraisal guidance

    Biosimilar products available, to be prescribed by brand name.

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

    13.05.03 Etanercept injection psoriasis

    Approved as per detail in SE London APC Psoriasis Biological Drug Treatment Pathway (link below)

    In inadequate primary response, the following dose increase is also approved:

    • Dose increase from 50 mg every week to 50 mg twice a week

    See SE London APC Psoriasis Biological Drug Treatment Pathway (link below)

    Biosimilar products available, to be prescribed by brand name.

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

    09.05.01.02 Etelcalcetide injection 

    Approved for secondary hyperparathyroidism in CKD as per NICE TA448

    05.01.09 Ethambutol injection  

    Approved for use in place of ethambutol tabs for treatment of tuberculosis; only if the oral route is not available or appropriate.

    05.01.09 Ethambutol tabs 
    02.13 Ethanolamine oleate injection 
    07.03.01 Ethinylestradiol 20 micrograms / desogestrel 150 micrograms Gedarel®
    07.03.01 Ethinylestradiol 20 micrograms / norethisterone 1mg Loestrin 20®
    07.03.01 Ethinylestradiol 30 micrograms / desogestrel 150 micrograms Gedarel®
    07.03.01 Ethinylestradiol 30 micrograms / gestodene 75 micrograms Millinette®
    07.03.01 Ethinylestradiol 30 micrograms / levonorgestrel 150 micrograms Rigevidon® Levest®
    07.03.01 Ethinylestradiol 30 micrograms with gestodene 75 micrograms Femodene® ED
    07.03.01 Ethinylestradiol 30 micrograms with levonorgestrel 150 micrograms Microgynon 30 ED®
    07.03.01 Ethinylestradiol 30 micrograms with norethisterone 1.5 mg Loestrin 30®
    07.03.01 Ethinylestradiol 35 micrograms / noresthisterone 1mg Norimin®
    07.03.01 Ethinylestradiol 35 micrograms / noresthisterone 500 micrograms Ovysmen®, Brevinor®
    07.03.01 Ethinylestradiol 35 micrograms / norgestimate 250 micrograms Cilest®
    06.04.01.01 Ethinylestradiol tabs 
    07.03.01 Ethinylestradiol with etonogestrel vaginal ring NuvaRing®

    Restricted to Gynaecology and Sexual Health Clinics

    Refer to BNF for “Risk of venous thromboembolism” notes

    07.03.01 Ethinylestradiol with levonorgestrel Logynon ED®
    07.03.01 Ethinylestradiol with levonorgestrel  TriRegol®
    07.03.01 Ethinylestradiol with norelgestromin patch Evra®

    Restricted to Gynaecology and Sexual Health Clinics

    Refer to BNF for “Risk of venous thromboembolism” notes

    07.03.01 Ethinylestradiol with norethisterone TriNovum®
    08.03.01 Ethinylestradol tabs 
    04.08.01 Ethosuximide caps, elixir  USE UNDER SPECIALIST SUPERVISION ONLY
    15.02 Ethyl chloride spray  FOR DENTAL, OBSTETRICS, AND GYNAECOLOGY USE ONLY
    07.04.05 Etilefrine tabs 

    USE UNDER SPECIALIST SUPERVISION ONLY

    Priapism in sickle cell crisis

    At GSTT refer to the "Sickle Cell Disease Adult Guidelines" for dosing and monitoring

    15.01.01 Etomidate injection 
    07.03.02.02 Etonorgestrel implant  Nexplanon® has replaced Implanon®
    08.01.04 Etoposide caps, injection 
    05.03.01 Etravirine tabs 
    08.01.05 Everolimus tabs breast cancer and renal cancer

    Approved as per NICE TA guidance (see links below)

    08.01.05 Everolimus tabs neuroendocrine tumours

    Approved for use in neuroendocrine tumours as per NICE TA449

    20 Evicel® fibrin sealant 

    Must be used in accordance with a local Trust-approved guideline

    For supportive treatment in surgery for improvement of haemostasis where standard techniques are insufficient

    05.03.01 Eviplera® tenofovir disoproxil with emtricitabine and rilpivirine
    02.12 Evolocumab injection 

    Specialist initiation only

    Restricted to use as per stipulations in NICE guidance (see below)

    06.04.01.01 Evorel® Conti patches estradiol and norethisterone
    06.04.01.01 Evorel® patches estradiol
    06.04.01.01 Evorel® Sequi patches  Combination of estradiol only and estradiol and progesterone patches (sequential use)
    05.03.01 Evotaz tablets® atazanavir with cobicistat
    13.02.01 ExCetra® cream 

    Second line option if a cream or gel type emollient is required

    08.03.04.01 Exemestane tabs 

    Restricted to use in patients intolerant to letrozole or anastrozole

    06.01.02.03 Exenatide prolonged release injection Bydureon▼®

    Follow SE London APC GLP-1 guidance for criteria for use

    Initiation by specialist only.

    Ongoing supplies can be requested from primary care after the 3 months review using the transfer of care document (links below)

    02.12 Ezetimibe tabs 
    05.04.01 Fansidar® tabs pyrimethamine and sulfadoxine
    10.01.04 Febuxostat tabs 
    09.01.01.01 Fefol® m/r caps  Each tablet contains
  • Ferrous sulphate 150 mg
  • Folic acid 500 micrograms
  • 02.06.02 Felodipine m/r tabs  Second line dihydropyridine calcium channel blocker at LGT (after amlodipine)
    06.04.01.01 Femoston® tabs estradiol with dydrogesterone
    06.04.01.01 FemSeven® patches estradiol
    10.01.01 Fenbufen tabs 
    02.12 Fenofibrate tabs 
    04.07.02 Fentanyl injection  USE UNDER SPECIALIST SUPERVISION ONLY
    15.01.04.03 Fentanyl injection 
    04.07.02 Fentanyl patches 
    04.07.02 Fentanyl sublingual tabs, buccal tabs and nasal spray 

    PALLIATIVE CARE ONLY

    Management of breakthrough pain in adult patients already receiving maintenance opioid therapy for chronic cancer pain that is unresponsive to morphine sulphate oral solution

    Use in accordance with local guideline

    09.01.01.02 Ferric Carboxymaltose injection  Ferinject®
    09.01.01.01 Ferric Maltol caps Feraccru® 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.
  • 09.01.01.01 Ferrograd Folic® tabs  Each tablet contains
  • Ferrous fumarate 325 mg
  • Folic acid 350 micrograms
  • 09.01.01.01 Ferrous Fumarate syrup 140 mg/5 mL  Elemental iron = 45 mg/5 mL
    09.01.01.01 Ferrous Fumarate tablets 210 mg  Elemental iron = 68 mg
    09.01.01.01 Ferrous Fumarate tablets 322 mg  Elemental iron = 100 mg
    09.01.01.01 Ferrous Gluconate tablets 300 mg  Elemental iron = 35 mg
    09.01.01.01 Ferrous Sulphate tablets 200 mg  Elemental iron = 65 mg
    07.04.02 Fesoterodine m/r tabs 
    03.04.01 Fexofenadine tabs 
    05.01.07 Fidaxomicin tabs  Restricted to treatment of laboratory-confirmed clostridium difficile infection (CDI) in the following groups:
  • Recurrence following vancomycin treatment
  • Patients who require ongoing concomitant antibiotic treatment
  • Patients who are immunocompromised and who are at risk of a recurrence
  • 09.01.06 Filgrastim injection  

    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)

    06.04.02 Finasteride tabs 
    07.04.01 Finasteride tabs 
    08.02.04 Fingolimod caps 

    02.03.02 Flecainide tabs, injection  USE UNDER SPECIALIST SUPERVISION ONLY
    13.02.01 Flexitol® cream 10% or 25% urea

    Second choice if a urea containing emollient is required

    20 Floseal® haemostatic matrix  Neurosurgery
    05.01.01.02 Flucloxacillin caps, syrup, injection 

    Refer to BNF for advice on colestatic jaundice and hepatic dysfunction with flucloxacillin

    Injection = Red Traffic Light  

    05.02.01 Fluconazole caps, oral suspension, injection  Injection = Red Traffic Light 
    05.02.05 Flucytosine injection 
    05.02.05 Flucytosine tabs  Severe and resistant systemic fungal infections
    07.02.02 Flucytosine/Nystatin Aquagel 1g/100,000 units 

    RESTRICTED TO GUM CONSULTANTS ONLY

    For resistant vulvo-vaginal candidiasis in accordance with GUM guidelines

    08.01.03 Fludarabine tabs, injection 
    13.04.02 Fludrocortide tape 4micrograms/cm2  
    06.03.01 Fludrocortisone tabs 
    15.01.07 Flumazenil injection 
    02.06.02 Flunarizine caps, tabs 

    Approved for:

    • Intermittent claudication
    • Raynaud’s syndrome
    • Prophylaxis of migraine
    • Vertigo

    Protocol for prophyaxis of migraine:

    • Starting dose of 10 mg at night (5mg for patients ≥65 years). Treatment should be discontinued if no significant improvement observed after 2 months.
    • Maintenance treatment should continue at the same daily dose but interrupted by two successive drug-free days every week, e.g. Saturday and Sunday.
    • All patients should have treatment stopped after 6 months and it should only be re-initiated if the patient relapses.
    13.04.02 Fluocinolone acetonide 0.025% cream, gel  
    11.08.02 Fluocinolone intravitreal implant Iluvien®

    Approved as per NICE technology appraisal guidance

    Refer to APC guidance for Wet Age-Related Macular Degeneration, Diabetic Macular Oedema, Central Retinal Vein Occlusion and Branch Retinal Vein Occlusion (see link below)

    11.08.02 Fluorescein sodium eye drops 2% 
    04.12 Fluorescein sodium injection 10% 

    For the visualisation of cerebrospinal fluid rhinorrhoea following endoscopic skull base surgery.

    Maximum dose: 50mg

    Only Martindale brand has QA approval for this intrathecal administration

    11.04.01 Fluorometholone eye drops 0.1% FML®
    11.08.02 Fluorouracil 5mg intravitreal injection  For swelling reduction post trabeculectomy
    13.08.01 Fluorouracil cream 5% Efudix®

    To treat actinic keratosis and basal cell carcinoma of the skin.

    Apply once or twice a day

    08.01.03 Fluorouracil injection oncology indications

    08.01.03 Fluorouracil injection keloid scarring - off-label

    Approved off-label indication:

    Intralesional injection for the treatment of keloid and hypertrophic scarring.

    Use in accordance with locally approved protocol

    Dose: 50 mg per cm2 of lesion

    01.05 Fluoxetine caps IBS - off-label

    Approved off-label indication:

    2nd line pharmacological treatment of IBS-C (constipation predmoninant irritable bowel syndrome) after failure of bulk forming laxatives Dose = 20mg daily

    04.01.01 Fluoxetine caps Non-REM parasomnia - off-label

    Approved off-label indication:

    • Non-REM parasomnia in adults

    Usual dose = 20 mg to 60 mg daily

    Sleep centre initiation only

    Refer to SE London APC recommendation and pathway (links below) for further detail

    04.04 Fluoxetine caps cataplexy - off-label

    Approved off-label indication:

    • Cataplexy

    Sleep centre initiation only

    Refer to SE London APC recommendation (link below), shared care agreement and cataplexy treatment pathway (link at end of section) for futher information

    04.03.03 Fluoxetine caps, liquid licensed indications

    04.02.02 Flupentixol decanoate injection  INITIATION BY SPECIALIST ONLY
    04.03.04 Flupentixol tabs 
    04.02.02 Fluphenazine decanoate injection  INITIATION BY SPECIALIST ONLY
    11.08.02 Flurbiprofen sodium eye drops 0.03% 
    10.01.01 Flurbiprofen tabs 
    08.03.04.02 Flutamide tabs 
    12.02.01 Fluticasone furoate 27.5 micrograms nasal spray 
    12.02.01 Fluticasone propionate 50 micrograms and azelastine 137 micrograms nasal spray Dymista®

    Approved in adults and children from 12 years for moderate to severe seasonal and perennial allergic rhinitis

    Restricted to use where a combination of oral antihistamines and nasal corticosteroids have failed (step 4 of SE London Allergic Rhinitis Pathway - see above for link)

    12.02.01 Fluticasone propionate 50 micrograms nasal spray 
    03.02 Flutiform® aerosol inhaler fluticasone propionate and formoterol Restricted to use in asthma where high strength inhaled corticosteroids are required
    04.03.03 Fluvoxamine tabs  INITIATION BY SPECIALIST ONLY
    09.01.02 Folic acid injection  Folated-deficient megaloblastic anaemia; prophylaxis in chronic haemolytic states or in renal dialysis
    09.01.02 Folic acid tabs, syrup 
    06.05.01 Follitropin alfa injection 
    06.05.01 Follitropin beta injection 
    02.08.01 Fondaparinux injection 

    Use in accordance with NICE CG92: Venousthromboembolism: reducing the risk

     

    Approved off-label indication:

    First-line parenteral anticoagulant in adult patients with HIT and patients with an allergy to heparin

    Use in accordance with local guideline

    09.06.07 Forceval® caps, effervescent tabs  
    13.07 Formaldehyde solution 10% 
    13.07 Formaldehyde solution 4% 

    For warts

    Use daily as a soak diluted 1 part with 3 parts of water to prepare a 1% formaldehyde solution

    03.01.01.01 Formoterol easyhaler 

    Specialist recommendation only

    If long acting beta agonist treatment is required it should generally be delivered via combination devices as per the SE London adult asthma and COPD guidelines

    05.03.01 Fosamprenavir tabs, oral suspension 
    11.03.03 Foscarnet intravitreal injection  Viral retinitis
    05.03.02.02 Foscarnet sodium injection 
    05.01.07 Fosfomycin injection  For treatment of cystic fibrosis pulmonary exacerbations in patients with multiple drug allergies or multiresistant organisms when no other satisfactory licensed alternative is available
    05.01.07 Fosfomycin sachets 

    Treatment of complicated ESBL producing urinary tract infections

    Dose: 3g followed by another 3g 72 hours later (PIL available on GTi)

    02.05.05.01 Fosinopril tabs 
    03.02 Fostair NEXThaler® 100/6 micrograms and 200/6 micrograms dry powder inhaler beclometasone diopropionate and formoterol Use in COPD restricted to specialist recommendation only
    03.02 Fostair® 100/6 and 200/6 micrograms aerosol inhaler beclometasone diopropionate and formoterol Use in COPD restricted to specialist recommendation only
    13.05.02 Fumaric acid tablets Fumaderm®

    Use in accordance with the local guideline at GSTFT

    Treatment of severe, relapsing, chronic plaque psoriasis

    05.02.03 Fungizone® injection amphotericin
    02.02.02 Furosemide tabs, oral solution, injection 
    13.10.01.02 Fusidic acid cream, ointment 2% sodium fusidate
    11.03.01 Fusidic acid eye drops 1% 
    04.07.03 Gabapentin caps pain

    Green Traffic Light Neuropathic pain - refer to SEL APC guideline (link below)

    Red Traffic Light Approved off-label indication:

    • Post-operative pain as a short course supplied by the hospital
    04.07.03 Gabapentin caps vasomotor symptoms in the menopause - off-label

    Approved off-label indication:

    Treatment of vasomotor symptoms in the menopause where hormonal treatment is ineffective or inappropriate

    Dose = starting at 300mg daily increased slowly to a max of 900mg three times a day

    04.08.01 Gabapentin caps epilepsy USE UNDER SPECIALIST SUPERVISION ONLY
    04.09.04 Gabapentin caps restless legs syndrome - off-label

    Approved for use in restless legs syndrome (off-label) with the following restrictions:

    • Specialist neurologist or sleep centre use only
    • In patients intolerant to dopamine agonists, or who have a history of insomnia or compulsive behaviours
    • Dose = 300 mg to 1200 mg at night

    Refer to SE London treatment pathway below

    04.11 Galantamine tabs, m/r tabs, oral solution 
    15.01.05 Gallamine bromide injection 
    05.03.02.02 Ganciclovir injection 
    01.01.02 Gastrocote® tabs  Use is restricted to the Community Health Inclusion Team only
    01.01.02 Gaviscon Advance® suspension 
    08.01.05 Gefitinib tabs 

    Approved for use as per NICE technology appraisal guidance (see links below):

    09.02.02.02 Gelatin intravenous infusion 
    12.03.05 Gelclair® oral rinse gel  For Oncology and Palliative Care use only
    08.01.03 Gemcitabine injection 
    07.01.01 Gemeprost pessary 
    02.12 Gemifibrozil tabs 
    11.03.01 Gentamicin drops 0.3% eye Preservative-free eye drops available on request (1.5% - see below)
    12.01.01 Gentamicin drops 0.3% Ear
    11.03.01 Gentamicin Forte PF eye drops 1.5% 
    05.01.04 Gentamicin injection 
    05.01.04 Gentamicin injection off-label use for soaking penile implants

    Approved off-label indication:

    For soaking penile implants, in combination with rifampicin, before insertion

    Rifampicin 10 mg/ml and gentamicin 1.2 mg/ml solution made from using 50ml sodium chloride 0.9%, rifampicin 600 mg injection and gentamicin 80 mg injection

    05.01.04 Gentamicin injection off-label use in pacemaker surgery

    Approved off-label indication:

    Topical use into the pocket during pacemaker surgery

    05.01.04 Gentamicin injection off-label intratympanic use in ENT surgery

    Approved off-label indication:

    Intra-tympanic injection in unilateral vestibular failure (e.g. Meniere’s Disease, Vestibular Schwannoma).

    Dose: 60 mg to 80 mg gentamicin buffered with 0.5 mL of sodium bicarbonate 8.4% to fill the middle ear

    This procedure is repeated again (at least two hours apart) on the same day. Pretreatment vestibular function testing (caloric testing) must be performed to ensure a normally functioning contralateral labyrinth

    12.01.01 Gentisone HC® ear drops  Contains:
  • Hydrocortisone acetate 1%
  • Gentamicin sulphate 0.03%
  • 05.03.01 Genvoya® tabs elvitegravir, cobicistat, emtricitabine and tenofovir alafenamide
    08.02.04 Glatiramer acetate injection 

    Approved for use as per NICE technology appraisal guidance (see link below) 

    08.02.04 Glatiramer acetate injection 

    Use in accordance with NHS England Commissioning policy for disease modifying therapies for patients with multiple sclerosis (see below) 

    06.01.02.01 Glibenclamide tabs 
    06.01.02.01 Gliclazide tabs 
    08.04 Gliolan powder for oral solution 

     

    06.01.02.01 Glipizide tabs 
    06.01.04 Glucagon injection GlucaGen® HypoKit
    08.01 Glucarpidase injection  Use in accordance with NHS England Clinical Commissioning Policy B15/P/a
    09.02.02.01 Glucose 10% Intravenous infusion 
    09.02.02.01 Glucose 20% Intravenous infusion 
    09.02.02.01 Glucose 5% Intravenous infusion 
    09.02.02.01 Glucose 50% Intravenous infusion 
    06.01.04 Glucose oral gel 40% 
    06.01.06 Glucostix® 
    13.13 Glycerine (sterile)  Often used as a moisturising agent in topical preparations
    13.13 Glycerol  Often used as a moisturising agent in topical preparations
    01.06.02 Glycerol (Glycerin) suppositories 
    01.07.04 Glyceryl trinitrate 0.4% ointment 

    02.06.01 Glyceryl trinitrate tabs, spray, injection, patches 
    07.04.04 Glycine irrigation solution 1.5% 
    13.12 Glycopyrrolate 0.05% w/v in water 

    BAD/APC approved Special

    For hyperhidrosis with an iontophoresis machine.

    13.12 Glycopyrrolate 2% w/w in cetomacrogol cream  

    BAD/APC approved Special

    For disabling facial hyperhidrosis.

    15.01.03 Glycopyrronium bromide injection 
    13.12 Glycopyrronium bromide powder 
    13.12 Glycopyrronium topical solution 0.1% 

    APC approved Special

    To be initiated and used under the supervision of a Dermatologist only

    01.05.03 Golimumab injection ulcerative colitis

    Approved as per NICE technology appraisal guidance 

    10.01.03 Golimumab injection rheumatology indications Approved as per NICE technology appraisal guidance
    06.05.01 Gonadorelin injection 
    06.07.02 Goserelin implant gynaecology indications

    Initiation on recommendation of consultant specialist only

    Hospital use = one month implant (3.6mg) only

    08.03.04.02 Goserelin implant oncology indications

    Initiation on recommendation of consultant specialist only

    Hospital use = one month injection only (3.6mg)

    13.10.01.01 Graneodin® ointment neomycin sulphate 0.25% + gramicidin 0.025%
    04.06 Granisetron tabs, injection 
    04.06 Granisetron transdermal patch 

    Prevention of nausea and vomiting associated with moderately or highly emetogenic chemotherapy

    Restricted to use where where oral antiemetic administration is complicated by factors making swallowing difficult

    03.04.02 Grass and birch pollen mixture extract subcutaneous injection Allergovit®

    SPECIALIST ALLERGIST USE ONLY

    Initial therapy (pre-seasonal)

    03.04.02 Grass and tree pollen extract subcutaneous injection Pollinex®

    SPECIALIST ALLERGIST USE ONLY

    Initial and extension subcutaneous immunotherapy treatment of seasonal allergic hay fever due to grass or tree pollen in patients who have failed to respond to antiallergy drugs

    03.04.02 Grass pollen extract or mixed tree pollen extract subcutaneous injection Allergovit®

    SPECIALIST ALLERGIST USE ONLY

    Initial and maintenance therapy

    03.04.02 Grass pollen extract oral lyophilisates Grazax®

    SPECIALIST ALLERGIST USE ONLY

    For seasonal allergic grass pollen allergy in those who have failed to respond to medication and at least one of the following apply:

    • Monosensitised to grass pollen or polysensitised with symptoms predominantly related to grass pollen allergy;
    • Perennial asthma which would be considered an unacceptable risk for administration of standard subcutaneous immunotherapy (SCIT);
    • A prior severe reaction to grass pollen SCIT;
    • Unable to undertake SCIT for logistical reasons (distance, working hours, etc)
    03.04.02 Grasses and rye pollen extract or tree pollen extract subcutaneous injection Pollinex® Quattro

    SPECIALIST ALLERGIST USE ONLY

    Available on a named-patient basis

    05.02.05 Griseofulvin tabs 
    02.05.03 Guanethidine monosulphate injection 
    15.03 Guanethidine monosulphate injection 

    Approved off-label indication:

    Alternative to conventional sympathetic blockade to relieve pain or maintain blood flow in causalgia due to traumatic nerve damage or central nervous lesions

    PAIN CLINIC ONLY

    04.04 Guanfacine m/r tabs 

    SPECIALIST PRESCRIBING ONLY

    Restricted to use in ADHD in children where methyphenidate and atomoxetine are not suitable, not tolerated or have been ineffective

    13.05.03 Guselkumab injection 

    Approved as per detail in SE London APC Psoriasis Biological Drug Treatment Pathway (link below)

    07.03.03 Gygel® gel 
    07.03.04 GyneFix® intra-uterine device 
    09.08.02 Haem arginate concentrate for intravenous infusion 

    USE UNDER SPECIALIST SUPERVISION ONLY

    Inherited metabolic disorders commissioned by NHSE

    14.04 Haemophilus influenzae type B (Hib) vaccine  Available as combined vaccine. See Diphtheria vaccines.
    03.01.05 Haleraid®  
    04.02.01 Haloperidol caps, tabs, oral liquid, injection 
    04.02.02 Haloperidol deconate injection  INITIATION BY SPECIALIST ONLY
    04.02.01 Haloperidol injection 

    Approved off-label indication:
    Sedation in the ICU

    Restricted to use in accordance with a local critical care guideline

    04.09.03 Haloperidol tabs 
    15.01.02 Halothane volatile liquid 
    05.03.03.02 Harvoni® tabs sofosbuvir and ledipasvir

    11.99.99.99 Healonid GV injection 

    Corneal endothelial protection

    02.08.01 Heparin injection 
    14.04 Hepatitis A vaccine 
    14.05.02 Hepatitis B immunoglobulin 
    14.04 Hepatitis B vaccine 

    At GSTFT, use HBvax PRO® 40 micrograms/mL for renal patients

    Approved off-label use:

    BHIVA guidelines recommend the 40 microgram (double dose) strength of HBV vaccine should be used in HIV-infected patients and given at months 0, 1, 2 and 6

    07.04.04 Hexaminolevulinate bladder instillation Hexvix®

    USE ON CONSULTANT UROLOGIST ADVICE ONLY

    For the detection of bladder cancer, such as carcinoma in-situ, in patients with known bladder cancer or high suspicion of bladder cancer

    13.11.02 Hibiscrub® cleansing solution chlorhexidine gluconate 4%
    13.11.02 Hibitane Obstetric® cream chlorhexidine gluconate 1%
    11.08 Histoacryl skin tissue adhesive  Management of corneal perforations (off-label)
    13.10.05 Histoacryl®  
    11.08.02 Histoacryl® skin adhesive  Approved off-label indication:
    Management of corneal perforations
    06.04.01.01 Hormonin® tabs estradiol
    03.04.02 Horse epithelial extract sublingual immunotherapy Oralvac®

    SPECIALIST ALLERGIST USE ONLY

    Restricted to paediatric use only

    03.04.02 House dust mite extract subcutaneous injection Acaroid®

    SPECIALIST ALLERGIST USE ONLY

    Initial and maintenance therapy

    03.04.02 House Dustmite allergen extract Acarizax 12-SQ HDM oral lyophilisates®

    SPECIALIST ALLERGIST USE ONLY

    Restricted to use in persistent allergic rhinitis due to house dust mite allergy, uncontrolled by conventional treatment (nasal steroids, oral antihistamines ± leukotriene receptor antagonists) in adults and children >5 years

    Acarizax oral lyophysilates is an imported product, licensed for use in Germany for allergic rhinitis due to house dust mite allergy in adults and adolescents aged 12-17, and allergic asthma due to house dust mite allergy in adults

    06.05.01 Human menopausal gonadotrophins menotrophin
    14.05.01 Human normal immunoglobulin injection 

    The Department of Health restricts IVIg use to specific indications in the clinical guidelines for immunoglobulin use.

    When used, clinical details need to be submitted to a national database (refer to local Trust guidance for further information)

    14.04 Human Papiloma virus quadravalent vaccine Gardasil® for genital warts - off label

    Approved off-label indication:

    Treatment of recalcitrant anogenital warts in adults

    • Sexual Health specialist use only after approval a local MDT
    • Last line option after imiquimod, podophyllotoxin and cryotherapy

    See APC guidance and HPV treatment pathway for further information

     

    14.04 Human Papiloma virus quadravalent vaccine Gardasil®

    Gardasil® is approved for use within the HPV Vaccination Programme for Men who have sex with men (MSM) as per Public Health England recommendations (see link below).

    10.03.01 Hyaluronidase injection 
    02.05.01 Hydralazine tabs, injection 
    13.04.02 Hydrocortisone 0.25% and crotamiton 10% Eurax-Hydrocortisone®
    13.04.04 Hydrocortisone 0.5%, nystatin 100 000 units/g and benzalkonium chloride 0.2% cream Timodine® Steroid potency = mild
    13.04.04 Hydrocortisone 1% and fusidic acid 2% cream Fucidin H® Steroid potency = mild
    13.04.04 Hydrocortisone 1% and miconazole nitrate 2% cream, ointment Daktacort® Steroid potency = mild
    13.04.04 Hydrocortisone 1% and oxytetracycline 3% ointment Terra-Cortril®

    Approved off-label indication:

    Treatment of over-granulating wounds Restricted to Plastic and Reconstructive Surgery use only

    Steroid potency = mild

    13.04.02 Hydrocortisone 1% and urea 10% cream Alphaderm®

    13.04.02 Hydrocortisone 2.5% cream, ointment  
    10.01.02.02 Hydrocortisone acetate injection 
    10.01.02.02 Hydrocortisone acetate injection 25mg/mL Hydrocortistab® - off-label musculoskeletal use

    Approved off-label use, via intralesional injection, for:

    • Epicondylitis
    • Capsulitis
    • Tendonitis
    • Entrapment nueropathy
    • Plantar fasciitis
    • Impingement syndrome
    • Peripheral neuropathy/neuromas
    • Ligamentous injuries

    Alternative to triamcinolone in cases of previous negative reaction or for use as superficial injections in patients with dark skin

    Dose: 5 mg to 50 mg with a minimum of 4 weeks between injections

    12.03.01 Hydrocortisone buccal tablets 
    13.04 Hydrocortisone butyrate cream 0.1% 

    Steroid potency = potent 

    Specialist advice only when initiated in secondary care

    13.04 Hydrocortisone butyrate lipocream, lotion 0.1% 

    Steroid potency = potent 

    Specialist advice only when initiated in secondary care

    13.04 Hydrocortisone cream, ointment, 0.5%, 1%  Steroid potency = mild
    01.05.02 Hydrocortisone foam enema 
    06.03.02 Hydrocortisone MR tabs Plenadren®

    Consultant specialists only

    Restricted to patients with primary adrenal insufficiency (AI) who have experienced at least two hospital admissions in the last 12 months due to unstable AI.

    Use in secondary AI is not currently recommended

    01.07.02 Hydrocortisone ointment 
    06.03.02 Hydrocortisone tabs, injection  Hydrocortisone sodium succinate is the routine intravenous injectable hydrocortisone for use in inpatients
    13.11.06 Hydrogen peroxide cream 1% 
    12.03.04 Hydrogen peroxide mouth wash BP   Strengths avaialble:
  • 3% (10 volume)
  • 6% (20 volume)
  • 13.11.06 Hydrogen peroxide solution BP 
    13.02.01.01 Hydromol® bath and shower emollient 

    Second line line bath/shower emollient

    13.02.01 Hydromol® ointment 

    Second line option where a greasy emollient is required

    04.07.02 Hydromorphone caps 
    02.03.02 Hydroquinidine slow release caps 

    CARDIAC ARRHYTHMIA SPECIALIST USE ONLY For prevention of recurrent vetricular fibrillation (VF) in Brugada syndrome and short-coupled idiopathic VF

    Dose: 600 mg to 900 mg daily in divided doses

    13.13 Hydroquinone 4% w/w in aqueous cream 

    APC approved Special

    To be initiated and used under the supervision of a Dermatologist only

    13.13 Hydroquinone 5% w/w, hydrocortisone 1% w/w and tretinoin 0.1% w/w in a non-aqueous gel 0.3% w/w 

    BAD/APC approved Special

    For treatment of melasma, in conjunction with a strong sunblock.

    A commercially available similar preparation called Piganorm® may be obtained.

    13.13 Hydroquinone 5% w/w, hydrocortisone 1% w/w cream 

    APC approved Special

    To be initiated and used under the supervision of a Dermatologist only

    09.01.02 Hydroxocobalamin injection 
    09.08.01 Hydroxocobalamin injection  Inherited metabolic disorders commissioned by NHSE
    13.05.03 Hydroxycarbamide caps psoriasis - off-label

    Approved off-label indication:

    Severe refractory psoriasis

    08.01.05 Hydroxycarbamide caps, tabs 

    Red Traffic Light Cancer indications

    Amber Traffic Light Non-cancer licensed indications

    10.01.03 Hydroxychloroquine sulphate tabs 

    USE UNDER SPECIALIST SUPERVISION ONLY

    See SE London Shared Care Agreement (link above) for prescribing advice and approved rheumatology indications (including off-label indications)

    03.04.01 Hydroxyzine tabs, oral solution  Max dose 100mg for adults, 50mg for elderly. Refer to MHRA for recent advice re risks of QT interval prolongation
    10.03.01 Hylan G-F 20 intra-articular injection  Synvisc®, Synvisc-One® USE UNDER SPECIALIST SUPERVISION ONLY
    01.02 Hyoscine butylbromide tabs, injection 
    04.06 Hyoscine hydrobromide 300 microgram chewable tablets Kwells® - clozapine induced hypersalivation - off-label

    Approved off-label indication:

    Clozapine induced hypersalivation

    Dose = 300 micrograms up to three times a day

    15.01.03 Hyoscine hydrobromide injection 
    04.06 Hyoscine hydrobromide patch 
    11.08.01 Hypromellose 0.3% eye drops  Preservative-free version available on request
    11.08.01 Hypromellose eye drops 0.5% 
    06.06.02 Ibandronic acid injection 

    CONSULTANT SPECIALISTS ONLY

    Treatment of osteoporosis in postmenopausal women at increased risk of fracture, who do not tolerate oral bisphosphonates

    08.01.05 Ibrutinib caps 

    Approved for use as per NICE technology appraisal guidance below

    10.01.01 Ibuprofen tabs, suspension 
    10.03.02 Ibuprofen 5 % gel 
    04.07.04.01 Ibuprofen tabs 
    04.07.01 Ibuprofen tabs, suspension 
    03.04.03 Icatibant injection 

    Initiation by consultants specialising in hereditary angioedema only

    Symptomatic treatment of acute attacks of hereditary angioedema (HAE) in adults with C1-esterase inhibitor deficiency. Conditional on the there being a clear rationale for prescribing icatibant instead of C1-esterase inhibitor.

    Use in accordance with local guidelines

    13.05.01 Ichthammol 1% w/w and zinc oxide 15% w/w in YSP 

    BAD/APC Approved Special

    For acutely inflamed atopic eczema.

    08.01.02 Idarubicin hydrochloride caps, injection 
    08.01.05 Idelalisib tabs 

    Approved for use as per NICE technology appraisal guidance (see links below):

    08.01.01 Ifosfamide injection 
    02.05.01 Iloprost injection  

    RESTRICTED USE - CONSULTANT SPECIALIST ONLY

    Treatment of digital ulcer disease

    Use in accordance with local guideline

    02.05.01 Iloprost injection   USE UNDER SPECIALIST SUPERVISION ONLY
  • Treatment of severe peripheral arterial occlusive disease, particularly those at risk of amputation and in whom surgery or angioplasty is not possible
  • Treatment of severe Raynaud’s phenomenon unresponsive to other therapies
  • Treatment of advanced thromboangiitis obliterans (Buerger’s disease) with critical limb ischaemia where revascularisation is not indicated
  • 11.08.01 Ilube® eye drops  Contains:
  • Acetylcysteine 5%
  • Hypromellose 0.35%
  • 08.01.05 Imatinib tabs 
    05.01.02.02 Imipenem with cilastatin injection 
    04.01.01 Imipramine tabs Non-REM parasomnia - off-label

    Approved off-label indication:

    • Non-REM parasomnia in adults

    Usual dose = 50 mg to 300 mg nocte

    Sleep centre initiation only

    Refer to SE London APC recommendation and pathway (links below) for further detail

    04.03.01 Imipramine tabs Mental health use

    INITIATION BY SPECIALIST ONLY

    Approved use includes the following off-label indication:

    Panic disorder - use in accordance with NICE CG113

    04.07.03 Imipramine tabs neuropathic pain

    Use in neuropathic pain is off-label

    Restricted to use where amitriptyline is not tolerated

    • Dose = 10 mg at night
    • May be increased gradually to 75 mg
    07.04.02 Imipramine tabs Nocturnal enuresis

    13.07 Imiquimod cream 5% off-label uses

    Approved off-label indications:

    • Multifocal vulvar intraepithelial neoplasia (VIN) and extensive extramammary Paget disease (EMPD)
    • Treatment of molluscum contagiosum in accordance with BASHH guidelines

    Specialist initiation only

    13.07 Imiquimod cream 5% genital warts

    Specialist initiation only

    Second-line to podophyllotoxin and cryotherapy for the treatment of genital warts

    03.01.02 Incruse Ellipta® dry powder inhaler umeclidinium
    02.02.01 Indapamide tabs, MR tabs 
    13.10.05 Indermil® 
    08.04 Indocyanine green (ICG) dye  Added to 9mTc nanocolloid to improve detection of sentinel nodes. 50 microlitres of 5 mg/mL injected at tumour site, 2 hours before surgery
    10.01.01 Indometacin caps, m/r caps, suppositories  Approved for licensed use, and the following off label indications:
  • Stat rectal dose prior to ERCP for prevention of post-ERCP pancreatitis
  • Chronic paroxysmal hemicrania
  • 04.07.04.01 Indometacin injection 

    SPECIALIST USE ONLY

    For the diagnosis of indometacin sensitive headaches (paroxysmal hemicranias)

    Dose = 100-200mg intramuscular test dose

    07.01.01.01 Indometacin injection 
    02.05.04 Indoramin tabs 
    07.04.01 Indoramin tabs 
    13.11.01 Industrial Methylated Spirit BP 
    01.01.01 Infacol® oral suspension 

    Approved off-label indication:

    Surfactant to improve visualisation in capsule endoscopy

    14.04 Infanrix-IPV®  Adsorbed diphtheria, tetanus, pertussis (acellular, component), and inactivated poliomyelitis vaccine
    08.02.03 Infliximab anti-NMDAR autoimmune encephalitis - off-label

    Approved off-label indication:

    anti-NMDAR autoimmune encephalitis (second line) as per criteria in NHSE Commissioning Policy 170039P

    Biosimilar product to be used and prescribed by brand name.

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

    01.05.03 Infliximab injection cancer immunotherapy related colitis - off-label

    Approved off-label indication:

    Treatment of cancer immunotherapy (ipilimumab, nivolumab and pembrolizumab) related corticosteroid refractory colitis

    • Category B* form required
    • Restricted to use in in patients where conservative measures (e.g. loperamide, fluid replacement, withholding immunotherapy treatment) and high dose intravenous corticosteroids have failed
    • Approved for a maximum of 2 doses at 5mg/kg
    01.05.03 Infliximab injection IBD

    Approved as per NICE technology appraisal guidance

    Biosimilar products available, to be prescribed by brand name. Contact pharmacy department for advice on brand for routine prescribing if unsure

    10.01.03 Infliximab injection rheumatology off-label indications

    Approved off-label indication:

    Severe refractory Behcet's disease including Behcet's Eye disease, pulmonary and peripheral arterial aneurysms

    Restricted to Lupus Consultants in collaboration with a Respiratory Consultant

    To be prescribed as per the Barts Health Satellite Unit Biologic Referal Pathway. Contact formulary team for further info.

    Note: Biosimilar products available, to be prescribed by brand name. Contact pharmacy department if unsure of brands. 

    10.01.03 Infliximab injection licensed rheumatology indications

    Approved as per NICE technology appraisal guidance

    Biosimilar products available, to be prescribed by brand name.

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

    13.05.03 Infliximab injection hidradenitis suppurativa - off-label

    Approved off-label indication:

    Last line treatment for severe hidradenitis suppurativa

    Use in accordance with the local guideline at GSTFT.

    Requires individual funding application for exceptional cases, currently not recommended for routine commissioning

    Biosimilar products available, to be prescribed by brand name.

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

    13.05.03 Infliximab injection psoriasis

    Approved as per detail in SE London APC Psoriasis Biological Drug Treatment Pathway (link below)

    In inadequate primary response, the following off-label dose increase is also approved:

    • Dose increase from 5 mg/kg every 8 weeks to 5 mg/kg every 6 weeks (category B* form required)

    See SE London APC Psoriasis Biological Drug Treatment Pathway (link below)

    Biosimilar products available, to be prescribed by brand name.

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

    14.04 Influenza vaccine  
    13.08.01 Ingenol mebutate 150 micrograms/g, 500 micrograms/g Picato®

    For treating actinic keratosis with small areas of field change up to a maximum of 25cm2

    GPs should not re-treat patients who have a recurrence on the same skin area - to refer to secondary care for re-evaluation due to the small risk of progression to squamous cell carcinoma.

    15.02 Instillagel gel®   Contains (in a sterile lubricant base):
  • Lidocaine 2%
  • Chlorhexidine gluconate 0.25%
  • 06.01.01.01 Insulin 500 units in 1mL Humulin R U-500®

    Concentrated injection

    Restricted use – initiation restricted to named consultants only (Dr David Hopkins, KCH)

    Continuation of supply and monitoring remains the responsibility of the hospital

    06.01.01.01 Insulin Aspart  NovoRapid®
    06.01.01.02 Insulin Degludec Tresiba®

    Specialist initiation only

    Monitoring and continuation of care remains the responsibility of the Specialist for the first 3 months, after which care may be transferred to primary care in accordance with the Transfer of Care document

    Restricted to use in children >1 year and adults with type 1 diabetes where:

    • Both insulin detemir and insulin glargine have been tried and the patient still has poorly controlled diabetes and
    • The next step would otherwise be an insulin pump and
    • Psychosocial or other factors indicate the need for longer duration insulin to facilitate continued treatment and avoid decompensation due to the mismanagement of insulin and
    • There have been frequent emergency admissions
    06.01.01.02 Insulin Detemir Levemir®
    06.01.01.02 Insulin Glargine 100 units/ml Lantus®

    Not for initiation in new patients (use Abasaglar 100 units/mL insulin glargine biosimilar).

    Insulin glargine 100 units/mL to be prescribed by brand name

    Patients whose clinical condition remains stable on Lantus® should continue on their current treatment.

    Blanket switching of patients between different insulin glargine preparations is not supported.

    Refer to SE London APC insulin glargine 100 units/mL biosimilar position statement.

    06.01.01.02 Insulin Glargine 100 units/ml Abasaglar®

    First line insulin glargine 100 unit/mL product when initiating insulin glargine treatment

    Insulin glargine 100 units/mL should be prescribed by brand name

    Patients whose clinical condition remains stable on Lantus® should continue on their current treatment.

    Blanket switching of patients between different insulin glargine preparations is not supported.

    Refer to the SE London APC biosimilar glargine 100 units/mL position statement

    06.01.01.02 Insulin Glargine 300 units/ml Toujeo®

    Specialist initiation only

    Restricted to patients already on long acting insulin analogues (e.g. insulin glargine or detemir) who:

    • Experience painful injections with high volumes (>60 units in a single injection) of their current 100 units/ml long acting insulin analogue and/or
    • Suffer from recurrent episodes of nocturnal hypoglycaemia

    Not bioequivalent to insulin glargine 100 units/ml dose for dose. Switches to Toujeo® from other insulins require dose adjustment (see SPC and below for further information)

    06.01.01.01 Insulin Lispro 100 units/ml Humalog®
    08.02.04 Interferon alfa-2a injection 
    08.02.04 Interferon alfa-2b injection 
    10.01.05 Interferon alpha Behcet's Disease

    USE UNDER SPECIALIST SUPERVISION ONLY 

    Approved for use in the management of Behcet's Disease (including Behcet's Eye disease)

    To be prescribed as per the Barts Health Satellite Unit Biologic Referal Pathway. Contact formulary team for further info.

     

    08.02.04 Interferon beta-1a injection 

    Approved for use as per NICE technology appraisal guidance below (see link below)

    08.02.04 Interferon beta-1a injection 

    Use in accordance with NHSE commissioning policy for disease modifying therapies for patients with multiple sclerosis (see below)

    08.02.04 Interferon beta-1b injection 

    Use in accordance with NHSE commissioning policy for disease modifying therapies for patients with multiple sclerosis (see below)

    08.02.04 Interferon beta-1b injection 

    Approved for use as per NICE technology appraisal guidance below (see link below)

    Note: ONLY Interferon beta‑1b (Extavia) is recommended as an option for treating multiple sclerosis under certain criteria. Interferon beta‑1b (Betaferon) is NOT recommended. 

    08.04 Intrinsic factor caps  Part 2 of Schilling test for vitamin B12 deficiency
    13.13 Iodoform compound paint  Protective covering for wounds and to hold gauze dressings in place
    08.01.05 Ipilimumab injection 
    12.02.02 Ipratropium 21 micrograms nasal spray 
    03.01.02 Ipratropium aerosol inhaler, nebuliser solution 
    03.01.04 Ipratropium with salbutamol nebules Combivent®
    02.05.05.02 Irbesartan and hydrochlorthiazide tabs  Treatment of essential hypertension for patients requiring irbesartan and a thiazide diuretic
    02.05.05.02 Irbesartan tabs 
    08.01.05 Irinotecan Hydrochloride injection 
    09.01.01.02 Iron Isomaltoside injection  Monofer®
    09.01.01.02 Iron Sucrose injection  Venofer®
    05.02.01 Isavuconazole tabs, injection 

    Microbiology consultant recommendation only

    Approved for use in invasive aspergillosis and mucormycosis

    For the treatment of invasive aspergillosis, use is restricted to patients with impaired renal function [CrCl<60mL/min], or in those intolerant or voriconazole

    For use in mucormycosis, use is restricted to patients where amphotericin B is inappropriate

    Refer to local antifungal guidelines

    15.01.02 Isoflurane volatile liquid 
    13.02.01 Isomol® gel 

    First line option if a cream or gel type emollient is required

    05.01.09 Isoniazid tabs, injection 
    06.01.01.02 Isophane Insulin - highly purified animal Hypurin® Bovine Isophane
    06.01.01.02 Isophane Insulin - human sequence Humulin I®, Insulatard®
    02.07.01 Isoprenaline injection 

    Short-term emergency treatment of heart block or severe bradycardia.

    Dose: 0.5 – 10 micrograms/minute

    02.06.01 Isosorbide dinitrate tabs, injection 
    02.06.01 Isosorbide mononitrate tabs, m/r tabs 
    13.06.01 Isotretinoin 0.05% with erythromycin 2% gel 
    13.06.02 Isotretinoin caps dermatology off-label indications

     Approved off label indications:

    1. Hidradenitis suppurativa - prior to biologic treatment

    2. Folliculitis Decalvans - after failure of other conventional treatment e.g topical antibiotics, systemic antibiotics (clindamycin and rifampicin again) and other systemic therapy, such as oral dapsone.

    13.06.02 Isotretinoin caps acne

    13.06.01 Isotretinoin gel 0.05% 
    01.06.01 Ispaghula husk granules 
    05.02.01 Itraconazole caps, oral liquid, injection 

    Refer to BNF for CSM advice on itraconazole and heart failure

    Injection = Red Traffic Light 

    02.06.03 Ivabradine tabs for chronic heart failure

    INITIATION BY CONSULTANT CARDIOLOGISTS ONLY

    Use as per NICE TA267 and SE London APC guidance for treating chronic beart failure Use as per NICE CG126 and SE London APC guidance for treating chronic stable angina

    02.06.03 Ivabradine tabs off-label use for POTS and IST

    Approved off-label indication:

    Postural Orthostatic Tachycardia Syndrome (POTS) and Inappropriate Sinus Tachycardia (IST) where a beta-blocker has failed or is inappropriate

    Initiation and first 3 months supplied by the specialist cardiology clinic at GSTFT or KCH only (see documents below for transfer of care requirements)

    02.06.03 Ivabradine tabs off-label use for ECMO ICU patients only

    SHORT TERM USE IN ICU ONLY Approved off label indication:

    For management of sinus tachycardia in patients undergoing extracorporeal membrane oxygenation (ECMO) and where a beta-blocker is not appropriate.

    13.06 Ivermectin 1% cream  Soolantra® - rosacea

    First line topical choice for papulopustular rosacea

    See APC recommendation and SE London rosacea treatment pathway for further information (links below)

    05.05.07 Ivermectin tabs  Cutaneous larva migrans
    05.05.08 Ivermectin tabs 

    Strongyloidiasis

    Dose: 200 micrograms/kg daily, for 2 days

    08.02.04 Ixazomib caps 

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

    13.05.03 Ixekizumab injection 

    Approved as per detail in SE London APC Psoriasis Biological Drug Treatment Pathway (link below)

    14.04 Japanese viral encephalitis vaccine  Immunisation against Japanese encephalitis for travellers going to high risk areas
    13.13 Jessners solution 

    APC approved Special

    To be initiated and used under the supervision of a Dermatologist only

    05.03.01 Kaletra® tabs, oral solution lopinavir and ritonavir
    10.03.02 Kaolin Poultice 
    15.01.01 Ketamine injection licensed uses

    Approved for all licensed anaesthetic uses

    15.01.01 Ketamine injection off-label indications

    Approved off-label indications:

    Pain and procedural sedation in the emergency department

    • Local use to ensure that principles of safe sedation advised by the Royal College of Anaesthetists and College of Emergency Medicine are in place

     

    Acute refractory analgesia

    • Consultant specialist initiation only
    • Use in accordance with a local guideline

     

    Refractory bronchospasm in acute severe asthma

    • Restricted to use in the ICU only
    • Follow local guideline for use
    15.01.01 Ketamine oral liquid neuropathic pain

    Neuropathic pain

    Consultant pain specialist use only

    • For severe neuropathic pain unresponsive to conventional neuropathic and analgesic agents.
    • Hospital supply only.

    Refer to local guidelines

    15.01.01 Ketamine oral liquid palliaitve care pain

    Complex pain in palliative care

    Consultant palliative care specialist only

    Where the patient’s pain has not responded adequately to or they have not tolerated standard treatments, including optimal use of opioids, non-opioids and co analgesics

     Refer to local guidelines

    07.02.02 Ketoconazole cream 2% 
    13.10.02 Ketoconazole cream 2%, shampoo 2% 
    13.09 Ketoconazole shampoo 2% 
    08.01.05 Ketoconazole tabs 

    Approved off-label indication:

    Management of castration refractory prostate cancer

    Dose = 200-400mg three times daily

    10.01.01 Ketoprofen caps 
    10.03.02 Ketoprofen gel 
    11.08.02 Ketorolac eye drops 0.5% 
    15.01.04.02 Ketorolac trometamol injection 
    06.01.06 Ketostix®  Ketones detection
    03.04.01 Ketotifen tabs, liquid 

    Approved for:

    Food protein gastrointestinal allergies in adults and children aged ≥3 years

    Allergy clinic initiation only

    09.06.07 Ketovite® tabs, liquid 
    01.06.05 Klean-Prep® pseudo-obstruction - off-label

    Approved off-label indication:

    For use in colonic pseudo-obstruction, following resolution by successful colonoscopic decompression or use of neostigmine

    • Dose: Dissolve 1 sachet in 1 litre of water and give 250mL twice a day (discard remainder) until normal food intake is re-established.

    Refer to local guideline at GSTT

    01.06.05 Klean-Prep® 
    06.04.01.01 Kliofem® tabs estradiol and norethisterone
    06.04.01.01 Kliovance® tabs estradiol and norethisterone
    02.04 Labetalol tabs, injection  Injection = Red Traffic Light (hospital only)
    02.06.02 Lacidipine tabs 
    04.08.01 Lacosamide tabs, syrup, injection 

    USE UNDER SPECIALIST SUPERVISION ONLY

    First 2 months supply to come from hospital GP information sheet requires completion for transfer of prescribing

     

    13.05.02 Lactic acid in Diprobase® cream 10% 

    APC approved Special

    For hyperkeratotic disorders (congenital ichthyosis) only.

    01.06.04 Lactulose oral solution 
    05.03.01 Lamivudine tabs, oral solution 
    05.03.03.01 Lamivudine tabs, oral solution 
    04.08.01 Lamotrigine tabs, disp tabs  USE UNDER SPECIALIST SUPERVISION ONLY
    08.03.04.03 Lanreotide injection 

    Red Traffic Light For all new patients

    Amber Traffic Light For existing patients managed in primary care

    01.03.05 Lansoprazole caps  PPI of choice for patients on clopidogrel
    01.03.05 Lansoprazole dispersible tabs 

    Reserved for patients with swallowing difficulties and tube fed patients

    09.05.02.02 Lanthanum carbonate tablets 

    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.

    09.08.01 L-Arginine tabs, injection  Inherited metabolic disorders commissioned by NHSE
    11.06 Latanoprost 0.05mg with timolol 5mg/mL eye drops  Treatment of open-angle glaucoma and ocular hypertension when monotherapy alone is not adequate
    11.06 Latanoprost eye drops 0.05mgs/mL 

    First-line prostaglandin analogue

    A preservative-free preparation (Monopost®) is available on request

    09.08.01 L-carnitine oral solution, chewable tabs, tabs, injection  Inherited metabolic disorders commissioned by NHSE
    09.08.01 L-citrulline oral powder  Inherited metabolic disorders commissioned by NHSE
    12.03.01 Ledermix dental paste  Antiflammatory agent used following dental procedures
    10.01.03 Leflunomide tabs 

    UUSE UNDER SPECIALIST SUPERVISION ONLY

    See SE London Shared Care Agreement (link above) for prescribing advice and approved rheumatology indications (including off-label indications)

    08.02.04 Lenalidomide caps 

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

    08.02.04 Lenalidomide caps 

    Approved off-label indication (consultant haematologist only):

    Treatment of relapsed/refractory B cell and T cell lymphoma in accordance with agreed compassionate use scheme

    09.01.06 Lenograstim injection 
    08.01.05 Lenvatinib caps renal cancer

    Approved as per NICE TA guidance (see links below)

    08.01.05 Lenvatinib injection thyroid cancer - Lenvima

    Approved for use as per NICE technology appraisal guidance below

    08.03.04.01 Letrozole tabs 

    Approved off-label indication:

    Fertility preservation in patients undergoing ovarian stimulation prior to chemotherapy in oestrogen receptor postive breast cancer

    Consultant specialists in oncology and fertility only

    Dose = 5 mg daily for 10-15 days during the course of ovarian stimulation

    08.03.04.01 Letrozole tabs 
    08.03.04.02 Leuprorelin acetate prolonged release injection oncology indications

    Initiation on recommendation of consultant specialist only

    Hospital use = one month injection only (3.75mg) First-line gonadorelin analogue for use in prostate cancer

    06.07.02 Leuprorelin acetate pro-longed release injection gynaecology indications

    Initiation on recommendation of consultant specialist only

    Hospital use = one month implant (3.75mg) only

    04.08.02 Levetiracetam injection 

    Approved off-label indication:

    Status epilepticus

    Restricted to neurology consultant advice only

    04.08.01 Levetiracetam tabs, oral soution, injection  USE UNDER SPECIALIST SUPERVISION ONLY
    11.06 Levobunolol eye drops 0.5% 
    15.02 Levobupivacaine hydrochloride injection 

    INFUSION BAGS ARE NON-FORMULARY

    For use as the initial bolus dose after placement of an epidural catheter and also for certain regional anaesthesia

    11.03.01 Levofloxacin eye drops 0.5%  Preservative-free eye drops available on request for patients with preservative allergies, ocular surface disease and atopy
    05.01.12 Levofloxacin injection 
    05.01.12 Levofloxacin tabs 
    13.03 Levomenthol in aqueous cream 1%, 2%  Itchy skin including pruritus of pregnancy and in the lderly, if adequate emollient alone has been unhelpful. Start with 1% and increase to 2% if tolerated
    04.02.01 Levomepromazine tabs, injection  INITIATION BY SPECIALIST ONLY
    07.03.02.03 Levonorgestrel intrauterine system 13.5mg  Jaydess®

    Approved as an option for:

    Long acting reversible contraception (effective for up to 3 years)

    07.03.02.03 Levonorgestrel intrauterine system 19.5mg  Kyleena®

    Approved as an option for:

    Long acting reversible contraception (effective for up to 5 years)

    07.03.02.03 Levonorgestrel intrauterine system 52 mg Levosert®

    Approved as an option for:

    • Long acting reversible contraception (effective for up to 4 years)
    • Hormonal treatment of heavy menstrual bleeding

    See APC recommendation (link below)

    07.03.02.03 Levonorgestrel intrauterine system 52 mg Mirena®

    Approved as an option for:

    • Long acting reversible contraception (active for up to 5 years)
    • Idiopathic menorrhagia
    • Protection from endometrial hyperplasia during oestrogen replacement therapy
    07.03.05 Levonorgestrel tabs Levonelle® 1500
    02.01.02 Levosimendan infusion 

    RESTRICTED USE - ICU AND LFU

    Adjunctive short-term treatment of acutely decompensated severe chronic heart failure.

    Use according to local guideline

    06.02.01 Levothyroxine tabs, oral solution 
    15.02 Lidocaine 2% in Lutrol 24% gel 

    Palliative care recommendation only

    Restricted to use in painful excoriating wounds where more routine methods of managing the pain have been unsuccessful, (i.e. dressings, topical barrier cream, and/or topical morphine)

    Patient information leaflet available on GTi at GSTT

    11.07 Lidocaine 4% & Fluorescein 0.25% preservative-free eye drops  
    15.02 Lidocaine 5% medicated plasters (700mg lidocaine per patch) 

    For treatment of post-herpetic neuralgia in patients unable to take oral neuropathic agents (see section 4.7.3)

    Approved off-label indication:

    Focal peripheral neuropathic pain with allodynia

    12.03.01 Lidocaine 5% ointment 
    15.02 Lidocaine 5% with phenylephrine 0.5% nasal spray co-phenylcaine ENT use only for:
  • Nasal cautery
  • Sinus endoscopy;
  • Flexible laryngoscopy
  • 15.02 Lidocaine gel 2% 
    01.07.01 Lidocaine gel 2%, ointment 5% 
    04.07.04.01 Lidocaine infusion 

    Joint Formulary Committee approved off-label use (specialist headache clinic use only):

    • Short-lasting Unilateral Neuralgiform Headache attacks with conjunctival injection and Tearing (SUNCT)
    • Short-lasting Unilateral Neuralgiform Headache attacks with Cranial Autonomic Symptoms (SUNA)

    See dosing protocol from KCH for further information

    02.03.02 Lidocaine injection  USE UNDER SPECIALIST SUPERVISION ONLY
    15.02 Lidocaine injection peri-operative analgesia - off-label

    Approved off-label indication:

    Use as an infusion for peri-operative analgesia in laparoscopic and open abdominal surgery

    • Stop infusion prior to disharge from the recovery unit
    • Loading dose of 1.5 mg/kg followed by an infusion of 2 mg/kg/hour

    Follow local guideline for use

    15.02 Lidocaine injection licensed use

    15.02 Lidocaine injection 1% and 2% 

    Approved off-label indication:

    For dilution and distension when using a local corticosteroid injection in accordance with locally approved PGD for physiotherapists

    10.01.02.02 Lidocaine injection 1%, 2% off-label use in conjunction with steroid injections

    Approved off-label indication:

    Intra-articular or intralesional injection, as a local anaesthetic prior to local steroid injection

    04.07.04.02 Lidocaine injection 2% chronic headache - off-label

    Approved off-label indication (specialist headache clinic use only):

    Greater occipital nerve block for treatment of chronic headache.

    • Restricted to use where oral and other conventional treatments are insufficient or not tolerated.
    • Dose = 3ml (60mg)
    15.02 Lidocaine spray 10% 
    15.02 Lidocaine topical solution 4% 

    Approved for:

    Nebulisation for comprehensive dynamic airways assessment in complex airways patients

    15.02 Lidocaine with adrenaline injection  
    01.06.07 Linaclotide capsules 

    For treatment of moderate-to-severe IBS with constipation (IBS-C) in adults, in line with APC recommendation (see links below)

    For moderate to severe IBS-C in adults as a second line option if the following recommended by NICE have been ineffective or not tolerated:

    • Antispasmodics or laxatives (not lactulose)

    • Second line tricyclic antidepressants if diarrhoea predominant or SSRIs if constipation predominant

    • If IBS-C more than 12 months and not responding to maximum dose of different laxatives

    Refer to the SEL Irritable Bowel Syndrome Pathway for further detail.

    06.01.02.03 Linagliptin tabs  Reserved for use in patients with severe renal impairment (eGFR <30 mL/min)
    05.01.07 Linezolid tabs, suspension, injection  Refer to BNF for CHM advice for monitoring for optic neuropathy and blood dyscrasias
    06.02.01 Liothyronine tabs, injection 
    13.02.01 Liquid and White Soft Paraffin Ointment (50:50) 

    First line choice if a very greasy emollient is required

    13.13 Liquid paraffin (sterile)  To remove dithranol and crude coal tar from patients
    01.06.04 Liquid paraffin and magnesium hydroxide emulsion 25%/6%  Specialist use only
    11.08.01 Liquid paraffin eye ointment Xialin night®, Lacri-lube®, VitA-POS®
    06.01.02.03 Liraglutide injection 

    Follow SE London APC GLP-1 guidance for criteria for use

    Initiation by specialist only.

    Ongoing supplies can be requested from primary care after the 3 months review using the transfer of care document (links below)

    04.04 Lisdexamfetamine caps 

    INITIATION BY SPECIALIST ONLY

    Treatment of ADHD in children and adults

    Refer to links in this section for ADHD shared care documentation

    02.05.05.01 Lisinopril tabs 
    04.02.03 Lithium carbonate m/r tabs  INITIATION BY SPECIALIST ONLY
    04.02.03 Lithium citrate liquid  INITIATION BY SPECIALIST ONLY
    06.01.02.03 Lixisenatide injection 

    Follow SE London APC GLP-1 guidance for criteria for use

    Initiation by specialist only.

    Ongoing supplies can be requested from primary care after the 3 months review using the transfer of care document (links below)

    12.01.01 Locorten-Vioform® ear drops  Contains:
  • Flumetasone pivalate 0.02%
  • Clipquinol 1%
  • 11.04.02 Lodoxamide eye drops 0.1% 
    04.03.01 Lofepramine tabs, oral suspension 
    04.10.03 Lofexidine tabs 
    08.01.01 Lomustine caps 
    01.04.02 Loperamide caps, tabs, syrup  Capsules = first line
    04.01.01 Loprazolam tabs 
    03.04.01 Loratadine tabs, oral solution 
    04.08.02 Lorazepam injection  The SPC for Ativan® injection supports intravenous and intramuscular use
    15.01.04.01 Lorazepam tabs 
    04.01.02 Lorazepam tabs, injection 
    02.05.05.02 Losartan tabs  First-line ARB for hypertension
    11.04.01 Loteprednol eye drops 0.5% 

    Treatment of post-operative inflammation following ocular surgery

    Approved off-label indication:

    Control of intraocular inflammation in patients with uveitis where the patient is known to be or becomes a steroid responder

    03.01.05 Low range peak flow meter Mini-Wright®
    04.02.01 Loxapine  Adusave 9.1 mg inhalation powder

    USE IS RESTRICTED TO THE SLAM AND OXLEAS TRUSTS ONLY

    For rapid control of mild-moderate agitation in schizophrenia or bipolar disorder in adults 

    13.02.01.01 LPL 63.4% 

    First line bath/shower emollient

    01.06.07 Lubiprostone capsules  Restricted to use as per NICE TA318, and in accordance with SE London APC Chronic Constipation Pathway (see links below)
    04.02.01 Lurasidone tabs 

    INITIATION BY SPECIALIST ONLY

    Restricted to use where a metabolically neutral atypical antipsychotic is required and aripiprazole is not suitable due to contraindication or intolerance

    13.06.02 Lymecycline caps  Alternative choice in patients experiencing intolerance or inefficacy with doxycycline
    01.06.04 Macrogol oral compund powder  For use when other laxatives have failed
    09.05.01.03 Magnesium Aspartate 243mg powder for oral solution Magnaspartate®

    First line oral magnesium replacement treatment at GSTFT

    1 sachet = 10mmol magnesium

    09.05.01.03 Magnesium carbonate capsules  Hypomagnesaemia
    09.05.01.03 Magnesium glycerophosphate liquid  Hypomagnesaemia (prepared on request) Magnesium = 1mmol/mL
    09.05.01.03 Magnesium glycerophosphate tabs 

    Second line oral magnesium replacement treatment at GSTFT

    Magnesium = 4mmol per tab

    09.05.01.03 Magnesium sulfate injection 

    Approved off-label indication:

    Management of eclampsia and pre-eclampsia

    09.05.01.03 Magnesium Sulfate injection 50%  Magnesium = 2mmol/mL
    13.10.05 Magnesium sulphate paste BP 
    01.01.01 Magnesium trisilicate Mixture BP 
    13.10.04 Malathion aqueous liquid 0.5%  First-line for crab lice in accordance with GUM guidelines
    13.10.04 Malathion aqueous liquid 0.5% 
    13.10.04 Malathion aqueous liquid 0.5%  First-line for scabies in accordance with GUM guidelines
    11.03 Malathion Liquid 0.5%  aqueous

    Approved off-label indication:

    Treating lice infested eyelashes and eyebrows (the alcoholic solution is not suitable)

    • Apply to eyelashes & brows using a cotton bud
    • Allow to dry naturally
    • Wash face thoroughly after 12 hours
    • Repeat after 7 days if necessary.
    01.10 Mannitol 2.5% with carob bean gum 0.2% oral solution  For use by Radiology for outlining the small bowel for MRI scans
    03.05.01 Mannitol inhalation powder Osmohale®

    This product is for diagnostic use only

    For identifying bronchial hyperresponsiveness in subjects with a baseline FEV1 of 70% or more of the predicted value.

    03.07 Mannitol inhalation powder Bronchitol®

    02.02.05 Mannitol intravenous infusion  USE UNDER SPECIALIST SUPERVISION ONLY
    05.03.01 Maraviroc tabs 
    05.03.03.02 Maviret® tabs glecaprevir and pibrentasvir

    11.04.01 Maxitrol® eye drops  Contains:
  • Dexamethasone 0.1%
  • Hypromellose 0.5%
  • Neomycin 0.35%
  • Polymyxin B sulphate 6000 units/ml
  • 11.04.01 Maxitrol® eye ointment   Contains:
  • Dexamethasone 0.1%
  • Neomycin 0.35%
  • Polymyxin B sulphate 6000 units/g
  • 04.04 Mazindol tabs 

    SLEEP CENTRE USE ONLY

    Narcolepsy and idiopathic hypersomnia after failure or intolerance to modafinil and amphetamines.

    Dose: 1–4mg daily.

    Subject to production of a shared care agreement and patient information leaflet

    14.04 Measles, Mumps and Rubella (MMR) vaccine 
    05.05.01 Mebendazole tabs, oral suspension 
    05.05.02 Mebendazole tabs, oral suspension 
    05.05.04 Mebendazole tabs, oral suspension 
    01.02 Mebeverine hydrochloride oral suspension 
    01.02 Mebeverine hydrochloride tabs 
    06.01.06 MediSense® Optium H  For blood glucose monitoring on wards and outpatient departments
    07.03.02.02 Medroxyprogesterone acetate IM injection 150mg Depo-Provera®
    07.03.02.02 Medroxyprogesterone acetate SC injection 104mg SAYANA PRESS®
    06.04.01.02 Medroxyprogesterone acetate tabs 
    08.03.02 Medroxyprogesterone acetate tabs 
    10.01.01 Mefenamic acid caps, tabs  In secondary care use on gynaecology advice only for:
  • dysmenorrhoea
  • Menorrhagia
  • 05.04.01 Mefloquine tabs 
    08.03.02 Megestrol acetate tabs 
    01.06.08 Meglumine amidotrizoate with sodium amidotrizoate Gastrografin® - small bowel adhesions - off-label

    Approved for the following off-label indication:

    Management of adhesive small bowel obstruction

    Dose: 100mL

    04.01.01 Melatonin m/r tabs sleep disorders in children - off-label

    SPECIALIST INITIATION ONLY

    Sleep disorders in children (off-label)

    04.01.01 Melatonin m/r tabs, liquid adult sleep clinic use - off-label

    Approved off-label indications:

    • REM sleep behaviour disorder (usual dose 0.5 mg to 16 mg nocte)
    • Non-REM parasomnia (usual dose 0.5 mg to 6 mg nocte)
    • Delayed sleep phase disorder (usual dose 0.5 mg nocte)
    • Non-24 hours sleep-wake disorder (free running disorder) (usual dose 0.5 mg nocte)

    Sleep centre initiation only

    Refer to APC guidance and pathways (links below) for further information

    The liquid (unlicensed preparation) is restricted to use in swallowing difficulties, or in patients on a specific dose that is not practical to be given from the 2mg m/r tabs

    04.01.01 Melatonin tabs (Bio-melatonin brand) adult sleep clinic use

    SLEEP DISORDER CENTRE USE ONLY

    • Restricted to use in adult circadian rhythm disorders where a more sedative and immediate acting melatonin is required

    Refer to APC guidance and pathways (links below) for further information

    10.01.01 Meloxicam tabs 
    08.01.01 Melphalan tabs, injection 
    04.11 Memantine tabs, oral solution 
    04.11 Memantine tabs, oral solution 

    Approved off-label indication:

    Management of behavioural and psychological symptoms in dementia, when nonpharmacological interventions have failed and there is severe distress or risk of harm to the patient or others

    Restricted to Consultant Clinical Gerontologists with a special interest in dementia, Consultants in Mental Health for Older Adults and Consultants in Liaison Psychiatry – prescribing to be continued by consultant

    09.06.06 Menadiol sodium phosphate tabs 
    14.04 Meningococcal ACWY conjugate vaccine Menevo ® Including use for patients being treated with eculizumab
    14.04 Meningococcal group B Vaccine Bexsero® Including use for patients being treated with eculizumab
    14.04 Meningococcal group C  
    14.04 Meningococcal polysaccharide ACWY vaccine 
    03.08 Menthol and Eucalyptus Inhalation BP 1980 
    05.04.04 Mepacrine tabs 

    Giardiasis

    Dose: 100 mg every 8 hours for 5-7 days

    08.02.01 Mepacrine tabs discoid lupus

    Discoid lupus erythematosus (lupus consultants only)

    Dose: from 50 mg three times a week to a maximum dose of 100 mg three times a day

    PIL available on GTi at GSTFT

    03.04.02 Mepolizumab injection 

    For use in asthma within the specialist service as per NICE TA 

    04.07.02 Meptazinol tabs, injection  PAIN TEAM ONLY
    01.05.03 Mercaptopurine tabs IBD - off-label Approved off-label indications:
  • Severe acute inflammatory bowel disease (IBD)
  • Maintenance of remission of IBD For shared care arrangements, see guideline below
  • 08.01.03 Mercaptopurine tabs 
    13.13 Mercurochrome solution 10%  Antiseptic agent used on cuts
    05.01.02.02 Meropenem injection 
    01.05.01 Mesalazine enemas and foam enemas 
    01.05.01 Mesalazine modified release granules 
    01.05.01 Mesalazine MR tabs Asacol®

    Asacol® tablets should only be prescribed for continuation of treatment.

    All new patients requiring 400 mg or 800 mg m/r tablets should be initiated on Octasa® tablets

    01.05.01 Mesalazine MR tabs Octasa®
    01.05.01 Mesalazine MR tabs Mezavant® XL and Pentasa®
    01.05.01 Mesalazine suppositories  
    08.01 Mesna tabs, injection 
    07.03.01 Mestranol 50 micrograms with norethisterone 1 mg Norinyl-1®
    13.02.02 Metanium® ointment 
    02.07.02 Metaraminol injection 

    Acute hypotension.

    In emergency: 0.5-5 mg by intravenous injection, then 15-100mg by intravenous infusion, adjusted according to response.

    07.04.05 Metaraminol injection 10mg/mL 

    Approved off-label indication:

    Drug-induced priapism once physical measures to direct blood from penis and aspiration have failed.

    USE UNDER SPECIALIST SUPERVISION ONLY Use with caution – risk of hypertensive crisis. Continual monitoring of blood pressure and pulse is essential.

    • Dose: 1 mg (1mL diluted solution) metaraminol injected into corpus cavernosum after aspiration of blood has failed to produce a response. Repeat if no response.
    • Dilution: 10 mg in 1mL metaraminol is diluted to 10 mL with sodium chloride 0.9% 9 mL to give 1 mg/mL solution
    06.01.02.02 Metformin tabs 

    Approved off-label indications:

    1. Gestational diabetes - use in accordance with the NICE guidance on diabetes in pregnancy

    2. Polycystic ovary syndrome - Dose = 500 mg twice or three times daily

    06.01.02.02 Metformin tabs, m/r tabs, oral solution  Prescribing of oral solution should be restricted for patients who are unable to swallow tablets
    03.09.01 Methadone hydrochloride linctus 2mg/5ml 

    Approved off-label indication:

    Cough suppressant and treatment of breathlessness in palliative care

    04.10.03 Methadone hydrochloride oral solution 
    04.07.02 Methadone tabs, injection  USE UNDER SPECIALIST SUPERVISION ONLY
    05.01.13 Methenamine hippurate tabs 

    Can be considered third line use for prevention of recurrent UTI in non-pregnant women (if no renal or hepatic impairment) after simple measures for symptom relief and stand-by or post-coital antibiotics have been ineffective.

    Refer to local antimicrobial guidance

    01.05.03 Methotrexate tablets Crohn’s disease - off-label

    Approved off-label indication:

    Crohn’s disease Dose 15-25 mg weekly

    10.01.03 Methotrexate tablets, subcutaneous injection rheumatology indications

    USE UNDER SPECIALIST SUPERVISION ONLY

    See SE London Shared Care Agreement (link above) for prescribing advice and approved rheumatology indications (including off-label indications)

    Refer to BNF for CSM advice

    08.01.03 Methotrexate tabs neurology - off-label

    Approved off-label indication:

    Disease modifying and steroid sparing treatment for neurological conditions

    08.01.03 Methotrexate tabs injection oncology

    For oncology indications

    Refer to BNF for highlighted cautions for blood count, and gastro-intestinal, liver and pulmonary toxicities

    13.05.03 Methotrexate tabs, subcutaneous injection psoriasis Psoriasis
    13.05.03 Methotrexate tabs, subcutaneous injection eczema - off-label

    Approved off-label indication:

    Eczema (adults and paediatrics)

    Note: s/c methotrexate restricted to use in patients with adverse effects from oral methotrexate, or where there is poor compliance or concerns of potential impaired oral absorption.

    09.01.03 Methoxy Polyethylene Glycol-Epoetin beta injection  Mircera®

    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

    15.01.02 Methoxyflurane volatile liquid Penthrox

    Approved for use within the Emergency Department only for:

    Emergency relief of moderate to severe pain in concious adults patients with trauma and associated pain

    13.08.01 Methyl-5-aminolevulinate cream Metvix®

    USE UNDER SPECIALIST SUPERVISION ONLY

    Treatment of actinic keratoses, superficial or nodular basal cell carcinoma and Bowen's Disease.

    01.06.01 Methylcellulose tabs 
    02.05.02 Methyldopa tabs  DRUG OF CHOICE IN PREGNANCY
    01.06.06 Methylnaltrexone bromide injection 

    Prescribing to be under the supervision of a Consultant Specialist

    To be used in accordance with local/Palliative Care Network guidelines

    Last-line pharmacological option for the treatment of opioid-induced constipation in advanced illness patients who are receiving palliative care when response to usual laxative therapy has not been sufficient

    04.04 Methylphenidate tabs, m/r tabs, m/r caps ADHD

    INITIATION BY SPECIALIST ONLY

    Treatment of ADHD in children Treatment of ADHD in adults (off-label)

    Refer to links in this section for ADHD shared care documentation

    Note: extended release formulations to be prescribed by brand, as different formulations are not bioequivalent. Patients should remain on the same m/r brand they are initiated on. 

    m/r brands available:

    • Concerta XL
    • Xenidate XL
    • Matoride XL
    • Delmosart
    • Xaggitin XL 
    • Equasym XL (caps)
    • Medikinet XL (caps)
    04.04 Methylphenidate tabs, m/r tabs, m/r caps sleep centre use - off-label

    Approved off-label indications:

    • Narcolepsy
    • Idiopathic hypersomnia

    Sleep centre initiation only

    GPs can be asked to continue prescribing after 6 months treatment as per SE London shared care agreement (link at end of section)

    Restricted to patients who have not responded to modafinil, or where modafinil is contra-indicated

    Refer to SE London APC narcolepsy treatment pathway (link below) for detailed information

    Extended release formulations to be prescribed by brand, as different formulations are not bioequivalent. Brands available:

    • Concerta XL
    • Xenidate XL
    • Matoride XL
    • Delmosart
    • Xaggitin XL 
    • Equasym XL (caps)
    • Medikinet XL (caps)
    10.01.02.02 Methylprednisolone acetate with lidocaine injection Depo-Medrone® with Lidocaine - off-label musculoskeletal use

    Approved off-label use, via intralesional injection, for:

    • Capsulitis
    • Tendonitis
    • Entrapment neuropathy
    • Impingement syndrome
    • Peripheral neuropathy/neuromas
    • Ligamentous injuries

    Dose: 4mg to 80 mg; minimum of 4 weeks between injections

    10.01.02.02 Methylprednisolone acetate with lidocaine injection Depo-Medrone® with Lidocaine
    04.07.04.02 Methylprednisolone acetate 80mg Depo-Medrone® - chronic headache

    Approved off-label indication (specialist headache clinic use only):

    Greater occipital nerve block for treatment of chronic headache.

    • Restricted to use where oral and other conventional treatments are insufficient or not tolerated.
    • Given in conjunction with with 3ml of lidocaine 2% (i.e. 60mg of lidocaine plus 80mg methylprednisolone acetate)
    06.03.02 Methylprednisolone acetate depot injection Depo-Medrone®
    10.01.02.02 Methylprednisolone acetate injection Depo-Medrone® - off-label musculoskeletal use

    Approved off-label use, via intralesional injection, for:

    • Capsulitis
    • Tendonitis
    • Entrapment neuropathy
    • Impingement syndrome
    • Peripheral neuropathy/neuromas
    • Ligamentous injuries

    Alternative to triamcinolone in cases of previous negative reaction

    Dose: 4 mg to 80 mg; minimum of 4 weeks between injections

    10.01.02.02 Methylprednisolone acetate injection Depo-Medrone®
    06.03.02 Methylprednisolone sodium succinate injection Solu-Medrone® - intratympanic use [off-label]

    Approved off-label indication:

    Intratympanic injection for sudden sensorineural hearing loss or Meniere’s disease

    Dose = 40mg, with a maximum of 3 injections 1 week apart

    Consultant ENT specialist use only

    06.03.02 Methylprednisolone sodium succinate injection Solu-Medrone®
    06.03.02 Methylprednisolone tabs 
    15.02 Methylthioninium chloride injection 

    Approved off-label indication: Methaemoglobinaemia following high doses of prilocaine.

    Dose = 1 mg/kg

    06.02.02 Methylthioninium chloride injection 0.5%, 1%, 2% methylene blue

    Diagnostic agent used for staining parathyroid glands.

    Maximal staining of glands occurs if infused intravenously for 1 hour prior to operation

    Dose: 5 mg/kg actual body weight in 250 mL dextrose/saline

    06.02.02 Methylthioninium chloride injection 2% methylene blue

    For testing intragastric balloon insertions and as a dye for patients with polyps undergoing colonoscopies (Endoscopy/Day Surgery)

    For checking bladder patency secondary to injury during C-sections and checking fallopian tube patency (Birth Centre Theatres)

    04.07.04.02 Methysergide tabs  REQUIRES HOSPITAL SUPERVISION
    04.07.04.01 Metoclopramide tabs  Maximum daily dose of 30mg for a maximum of 5 days. See MHRA davice.
    01.02 Metoclopramide tabs, injection  As per MHRA advice: Maximum daily dose of 30mg for maximum duration of 5 days
    04.06 Metoclopramide tabs, syrup, injection  Daily doses >30 mg and duration >5 days (off-label) may be used for symptom control in palliative care patients only
    02.02.01 Metolazone tabs 

    Resistant oedema in renal impairment.

    Dose = 2.5mg on alternate days to 10mg daily

    02.04 Metoprolol tabs, injection 

    Injection = Red Traffic Light (hospital only)

    Also approved for off-label use as an intravenous infusion:

    • ICU only via local Trust protocol
    • Restricted to use where betablockers licensed for infusion are unavailable
    05.04.02 Metronidazole 10% ointment perianal Crohn's disease and pilonidal sinus disease

    Approved off-label indications:

    • Perianal Crohn’s disease complicated by multiple fissures and/or ulcers.
    • Chronic non-healing pilonidal sinus disease wounds; where initial surgery has been unsuccessful.
    • Dose = a 4-6 week course of twice or three times daily treatment 

    13.10.01.02 Metronidazole gel, cream 0.75% 
    05.01.11 Metronidazole tabs, oral suspension, injection  Injection = Red Traffic Light 
    05.04.02 Metronidazole tabs, oral suspension, suppositories, injection  Injection = Red Traffic Light 
    07.02.02 Metronidazole vaginal gel 0.75%  For bacterial vaginosis in accordance with GUM guidelines
    06.07.03 Metyrapone caps  SPECIALIST SUPERVISION ONLY
    02.03.02 Mexiletine caps congenital myotonia

    USE UNDER SPECIALIST SUPERVISION ONLY Treatment of congenital myotonia

    Dose: initiate at 1.5mg/kg (usually 2-3 divided doses) and increase to 10mg/kg (maximum daily dose of 600mg)

    02.03.02 Mexiletine injection and caps ventricular tachycardia

    USE UNDER SPECIALIST SUPERVISION ONLY Treatment of ventricular tachycardia

    13.10.02 Miconazole nitrate cream 2% 
    07.02.02 Miconazole nitrate intravaginal cream 2%, pessaries 
    12.03.02 Miconazole oral gel  
    04.08.02 Midazolam buccal liquid 

    The first-line product is Buccolam® which is available as 10 mg/2 mL in a pre-filled syringe.

    The dose for patients 10 years and older is 10 mg. If a more specific dose than those available using Buccolam® pre-filled syringes is required a second-line product, Epistatus® (unlicensed product), is available as 50mg/5mL

    15.01.04.01 Midazolam injection 
    02.05.04 Midodrine tabs 

    Orthostatic hypotension

    Consultant recommendation only

    Initiation and first 3 months supplied by the hospital (see documents below for transfer of care requirements)

    02.05.04 Midodrine tabs 

    Approved off-label indication:

    Postural Orthostatic Tachycardia Syndrome (POTS) and Inappropriate Sinus Tachycardia (IST) where fludrocortisone is considered inappropriate or has failed to control symptoms

    Initiation and first 3 months supplied by the specialist cardiology clinic at GSTFT or KCH only (see documents below for transfer of care requirements)

    11.09 Midoptic preservative free saline 
    08.01.05 Midostaurin caps 

    Approved as per NICE Technology Appraisal guidance

    08.02.04 Mifamurtide injection 
    07.01.02 Mifepristone tablets 

    USE UNDER SPECIALIST SUPERVISION ONLY

    Use in accordance with local guideline at KCH

    02.01.02 Milrinone injection  RESTRICTED USE - ICU AND CARDIAC HIGH DEPENDENCY
    13.06.02 Minocycline m/r caps, tabs 

    Specialist prescribing only

    Last line tetracycline option for skin infections where the others have failed, are contraindicated or not tolerated

    Use limited to exceptional circumstances due to risk of serious ADRs (see BNF)

    12.03.05 Minocycline periodontal gel  Gum disease
    02.05.01 Minoxidil tabs  USE ON SPECIALIST ADVICE ONLY
    07.04.02 Mirabegron tabs  Restricted to use as per NICE guidance
    11.99.99.99 Miraflow cleaning solution  Contact lens cleaner
    04.03.04 Mirtazapine tabs, orodispersible tabs  INITIATION BY SPECIALIST ONLY
    01.03.04 Misoprostol tabs GI indications For prophylaxis and treatment of NSAID induced ulcers
    07.01.01 Misoprostol tabs obstetrics indications

    Approved off-label indications:

    • To soften and open the cervix facilitating vaginal termination of pregnancy.
    • Use in ectopic pregnancy and miscarriage

    Use in line with local Trust policies

    07.01.01 Misoprostol vaginal delivery system  Mysodelle®
    11.99.99.99 Mitomycin eye drops 0.04%   Prevention of scar tissue formation following glaucoma filtering surgery
    08.01.02 Mitomycin injection  For intravenous or intravesical administration, depending on indication, as per manufacturer's instructions
    08.01.05 Mitotane tabs 

    Treatment of patients with:

    • Biochemical or radiological evidence of persistent or relapsed adrenocortical carcinoma
    • Apparent complete resection of adrenocortical carcinoma for adjuvant therapy
    08.01.02 Mitoxantrone (Mitozantrone) injection 
    15.01.05 Mivacurium chloride injection 
    03.04.02 Mixed grass pollen extract subcutaneous injection Allergovit®

    SPECIALIST ALLERGIST USE ONLY

    Initial therapy (pre-seasonal)

    03.04.02 Mixed tree pollen, cat epithelial, dog epithelial extract sublingual immunotherapy Oralvac®

    SPECIALIST ALLERGIST USE ONLY

    These five extracts are first line immunotherapy in paediatrics and second line choice after to subcutaneous immunotherapy (SCIT) in adult patients if one of the following apply:

    • A phobia of injections
    • Insurmountable problems with attending clinic for injections (e.g. immobility, working hours)
    • Previous systemic reactions with SCIT
    • Significant risk of systemic reactions from SCIT.
    04.03.02 Moclobemide tabs  INITIATION BY SPECIALIST ONLY
    04.04 Modafinil tabs 

    Sleep centre initiation only

    Symptomatic relief of excessive sleepiness associated with narcolepsy

    Approved off-label indication:

    Idiopathic hypersomnia: Dose = 200 – 400 mg daily.

    Refer to APC recommendation, shared care agreement and treatment pathway for further information (links below)

    12.02.01 Mometasone 50 micrograms nasal spray 
    13.04 Mometasone furoate cream, ointment 0.1% 

    Steroid potency = potent 

    Specialist advice only when initiated in secondary care

    13.04.01 Mometasone furoate scalp lotion 0.1% 

    Steroid potency = potent 

    Specialist advice only when initiated in secondary care

    13.13 Monobenzylether of hydroquinine in cetomacrogol cream A 10%, 20%, 30%, 40%, 50% 

    APC approved Special

    For depigmentation of skin in vitiligo only.

    03.03.02 Montelukast granules 
    03.03.02 Montelukast tabs 
    04.07.02 Morphine 0.1%, 0.2% w/v topical gel 

    CONSULTANT SPECIALISTS ONLY

    Use in accordance with local guideline

    Treatment of pain localised to a cutaneous ulceration in a palliative care setting (PIL available on GTi)

    04.07.02 Morphine salts tabs, m/r tabs, m/r caps, m/r suspension, oral solution, injection  First line strong oral opioid
    03.09.01 Morphine sulphate oral solution 10mg in 5ml 

    Approved off-label indication:

    Cough suppressant and treatment of breathlessness in palliative care

    04.07.02 Morphine suppositories 
    01.06.05 Moviprep® 

    As per consensus guidelines for the safe use of oral bowel cleansing agents in patients:

    • With end-stage chronic kidney disease

    • With congestive cardiac failure on high-dose diuretics

    • Where previous colonoscopy failed to achieve adequate preparation with CitraFleet®

    • With UC or CD requiring surveillance colonoscopy

    11.03.01 Moxifloxacin 0.5% eye drops bacterial keratitis - off-label

    Approved indication (off-label):

    • First line antibiotic in bacterial keratitis where a preservative free formulation is required
    • Hourly dosing may be required on initation (off-label)
    05.01.12 Moxifloxacin tabs  Approved off-label indications:
  • Endogenous and postoperative endophthalmitis and bleb related endophthalmitis in glaucoma (Consultant Ophthalmologists only)
  • Multi-Drug Resistant Tuberculosis (MDRTB) or if the patient is intolerant of standard regimens (Respiratory Consultants only)
  • Recurrent/persistent nongonoccocal urethritis (NGU) as recommended in the British Association for Sexual Health and HIV guidelines (GUM Consultants only)
  • 05.01.12 Moxifloxacin tabs 
    02.05.02 Moxonidine tabs 
    07.03.04 Multiload® Cu375 intra-uterine device 
    15.02 Multi-modal intraarticular injection 

    For pain relief during knee replacement surgery containing:

    • Bupivacaine 0.25% with adrenaline 1:200,000

    • Ketorolac 30 mg

    • Clonidine 0.08 mg

    06.01.06 Multistix 8 SG® 
    09.06.07 Multivitamin tabs 
    12.02.03 Mupirocin 2% nasal ointment  USE ON MICROBIOLOGY/VIROLOGY ADVICE
    13.10.01.01 Mupirocin ointment 2% 
    08.04 Muromonab-CD3 injection monoclonal (OKT3) Liver and renal graft rejection
    08.01.01 Mustine injection  Haematological emergency for a newly diagnosed patient with bulky lymphoma
    08.02.01 Mycophenolate Mofetil tabs, caps, suspension dermatology indications - off-label

    Approved off-label indications (dermatology use only):

    For patients unresponsive or intolerant of standard therapies for:

    • Severe immunobullous disease
    • Atopic dermatitis or psoriasis
    08.02.01 Mycophenolate Mofetil tabs, caps, suspension lupus - off-label

    Approved off-label indication (lupus consultants only):

    Systemic lupus erythematosus and vasculitis (SLE)

    Dose: 1-2 g daily (up to a maximum of 3 g daily)

    For shared care arrangements across primary and secondary care refer to the SE London APC DMARDs in rheumatology shared care prescribing guideline

    08.02.01 Mycophenolate Mofetil tabs, caps, suspension neurological conditions - off-label

    Approved off-label indication:

    Disease modifying and steroid-sparing treatment for neurological conditions

    08.02.01 Mycophenolate Mofetil tabs, caps, suspension, injection liver transplant

    Imunnosupressant in liver transplant patients Red Traffic Light for new patients

    Amber Traffic Light for patients currently receiving prescriptions in primary care (see shared care link below)

    08.02.01 Mycophenolate Mofetil tabs, caps, suspension, injection renal transplant Imunnosupressant in renal transplant patients
    08.02.01 Mycophenolate Sodium tablets renal transplant

    Only approved for continuing treatment of renal transplant patients

    Prescribers who want to initiate mycophenolic acid for other indications must first discuss with, and get agreement from, the patient’s GP about arrangements for ongoing prescribing

    03.04.02 Mycophenolate mofetil tabs, caps urticaria - off-label

    Approved off-label indication:

    Chronic urticaria.

    Dose: 1000 mg twice daily (up to a maximum of 1500 mg twice daily)

    Consultant specialists only

    13.05.01 Mycophenolate mofetil tabs, caps 

    Approved off-label indications:

    • Severe immunobullous disease
    • Severe atopic dermatitis
    • Severe psoriasis

    Reasons for prescribing should be clearly communicated to the patient’s GP

    Restricted to use in patients patients unresponsive or intolerant of standard therapies. Use as a steroid-sparing immunosuppressant

    13.05.03 Mycophenolate mofetil tabs, caps dermatology indications - off-label

    Approved off-label indications:

    • Severe immunobullous disease
    • Severe atopic dermatitis
    • Severe psoriasis

    Reasons for prescribing should be clearly communicated to the patient’s GP

    Restricted to use in patients patients unresponsive or intolerant of standard therapies. Use as a steroid-sparing immunosuppressant

    11.99.99.99 Mydricaine ampoule No. 2 

    ADULT USE ONLY

    Contains:

    • Procaine hydrochloride
    • Atropine sulphate
    • Adrenaline Mydriatic given by subconjunctival injection prior to vitroretinal surgery
    05.03.01 Mylanta extra strength liquid cherry flavour  Antacid, used as a constituent of didanosine solution
    04.06 Nabilone caps 
    04.07.03 Nabilone caps 

    Approved off-label indication:

    For neuropathic pain in patients who have not responded to all other available anti-neuropathic agents (given alone or in combination) or where use of these has induced unmanageable side effects.

    • Dose: 1 mg twice dialy
    • Some patients may use 1 mg when required 2-3 times per week

    CONSULTANT SPECIALISTS ONLY

    10.01.01 Nabumetone tabs, suspension  For palliative care patients with pain relating to soft tissue, visceral or bone inflammation
    02.04 Nadolol tabs  CONGENITAL CARDIOLOGY CLINIC USE ONLY Treatment of catecholaminergic polymorphic ventricular tachycardia (CPVT), Long QT syndrome and refractory ventricular arrhythmias
    06.07.02 Nafarelin nasal spray  Use in controlled ovarian stimulation programmes prior to in-vitro fertilisation
    02.06.04 Naftidrofuryl caps 
    05.01.12 Nalidixic acid tabs 
    04.10.01 Nalmefene tabs 

    INITIATION BY SUBSTANCE MISUSE SPECIALISTS ONLY

    Use in accordance with NICE guidance for reducing alcohol consumption in people with alcohol dependence.

    Nalmefene should only be prescribed in conjunction with continuous psychosocial support focused on treatment adherence and reducing alcohol consumption.

    Patients requiring treatment with nalmefene should be referred to their local drug and alcohol services

    01.06.06 Naloxegol tabs 
    15.01.07 Naloxone hydrochloride injection 
    15.01.07 Naloxone hydrochloride injection opioid induced itching - off-label

    Approved off-label indication (follow local guidelines):

    Subcutaneous or intramuscular use for post-operative opioid induced itching

    04.10.03 Naltrexone tabs 
    06.04.03 Nandrolone injection 
    10.01.01 Naproxen tabs 

    12.02.03 Naseptin® cream 

    USE ON MICROBIOLOGY/VIROLOGY ADVICE Contains:

    • Chlorhexidine hydrochloride 0.1%
    • Neomycin sulphate 0.5%

    Caution: also contains arachis oil (peanut oil)

    08.02.04 Natalizumab injection 

    Use in accordance with NHS England Commissioning policy for disease modifying therapies for patients with multiple sclerosis (see below)

    NAMED SPECIALIST CONSULTANTS ONLY

    11.03.02 Natamycin 5% eye drops 

    First line empiric management of fungal keratitis

    Unlicensed preparation

    Usual dosing schedule = one drop hourly day and night for 48 hours, then one drop hourly during the day time, gradually reduced to four times a day.

    Usual course length 1 month.

    02.04 Nebivolol tabs 
    03.01.05 Nebuhaler® spacer device standard, paediatric
    04.07.01 Nefopam tabs 
    12.02.02 NeilMed® Sinus Rinse Isotonic  Hospital prescribing only
    05.01.04 Neomycin tabs 
    15.01.06 Neostigmine metilsulfate & glycopyrronium bromide injection  
    15.01.06 Neostigmine metilsulfate injection 
    10.02.01 Neostigmine tabs, injection 

    Approved off-label indication (injection):

    Post-operative ileus, ileus and pseudo-obstruction

    Dose: 0.4-0.8 mg/hr as a 24 hour infusion, or a 2mg IV bolus over 3-5 minutes

    Refer to local Trust guidelines

    11.08.02 Nepafenac 1mg/ml eye drops 

    Restricted to the following indication only:

    Reduction in the risk of postoperative macular oedema associated with cataract surgery in diabetic patients

    Full supply to come from hospital on discharge

    05.01.04 Netilmicin injection 
    05.03.01 Nevirapine tabs, m/r tabs, oral suspension  Confirm correct tablet formulation
    02.06.02 Nicardipine injection 
  • Second line option for severe hypertension (after labetalol) in critical care settings only
  • 02.06.02 Nicardipine tabs 
    02.06.03 Nicorandil tabs 
    09.06.02 Nicotinamide tablets 
    04.10.02 Nicotine Replacement Therapy 

    Products available:

    • Nicotinell® patches
    • Nicorette® invisi patches
    • Sublingual tablet
    • Orodispersible film
    • Lozenge
    • Medicated chewing gum
    • Spray
    • Inhalator

    Follow local guidelines for nicotine replacement therapy

    02.12 Nicotinic acid tabs, m/r tabs caps 

    INITIATION BY CONSULTANT SPECIALISTS ONLY

    Note: currently there are no licensed preparations available in the UK

    07.01.03 Nifedipine caps 

    Approved off-label indication

    Tocolysis in preterm labour

    Use in accordance with local procedures and NICE NG25: Preterm labour and birth

    02.06.02 Nifedipine caps, m/r tabs, m/r caps 
    08.01.05 Nilotinib caps 

    02.06.02 Nimodipine tabs, injection 
    03.11 Nintedanib caps Ofev® - idiopathic pulmonary fibrosis

    08.01 Nintedanib caps Ofev®
    08.01.05 Nintedanib caps Vargatef® Non-small-cell lung cancer

    Approved for use in NSCLC as per NICE TA347

    08.01.05 Niraparib caps 

    Approved for use as per NICE technology appraisal guidance (see links below):

    04.01.01 Nitrazepam tabs, oral suspension 
    05.01.13 Nitrofurantoin tabs, caps, oral suspension 
    15.01.02 Nitrous oxide compressed gas 
    08.01.05 Nivolumab injection GSTFT and KCH

    Approved for use as per NICE technology appraisal guidance below

    08.01.05 Nivolumab injection urothelial cancer - GSTFT only

    Approved for use as per NICE technology appraisal guidance below

    08.01.05 Nivolumab injection lung, head and neck cancers - GSTFT only

    Approved for use as per NICE technology appraisal guidance below

    02.07.02 Noradrenaline / Norepinephrine injection 
    07.03.02.02 Norethisterone enantate injection 
    06.04.01.02 Norethisterone tabs 
    05.01.12 Norfloxacin tabs 
    07.03.02.01 Norgeston® tabs 
    07.03.02.01 Noriday® tabs 
    04.03.01 Nortriptyline tabs 
    04.07.03 Nortriptyline tabs 

    Use in neuropathic pain is off label

    Restricted to use where sedation is a significant problem with amitriptyline Refer to SEL APC neuropathic pain guideline (link below)

    07.03.04 Nova-T® 380 intrauterine device 
    13.02.01 Nutraplus® cream 10% urea

    Restricted to use in patients with a confirmed paraffin allergy

    13.10.02 Nystatin 100,000 units/g with chlorhexidine 10mg/g cream Nystaform®
    12.03.02 Nystatin oral suspension 100 000 units/mL 
    05.02.03 Nystatin oral suspension 100,000 units/ml 
    07.02.02 Nystatin pessaries 100,000 units 

    For the treatment of resistant vulvovaginal candida and candida in patients with azole hypersensitivities

    Dose (in accordance with BASHH guidance): 1 to 2 pessaries for 14 nights

    07.02.02 Nystatin vaginal cream 100,000 units / 4g  USE ON SPECIALIST ADVICE
    01.09.01 Obeticholic acid tabs 

    Approved for primary biliary cholangitis as per NICE TA443

     

     

    See MHRA Drug Safety Alert (link below)

    08.02.03 Obinutuzumab injection  Approved for use as per NICE technology appraisal guidance
    13.07 Occlusal® application salicylic acid 26%
    08.02.04 Ocrelizumab injection 

    Approved for use as per NICE technology appraisal guidance (links below)

    11.08.02 Ocriplasmin intravitreal injection 
    12.02.03 Octenidine nasal gel  USE ON MICROBIOLOGY/VIROLOGY ADVICE
    13.11.02 Octenisan® lotion 
    08.03.04.03 Octreotide injection 

    Approved for all licensed indications, and the following off-label uses:

     

    Variceal haemorrhage:

    50 micrograms in 5mL sodium chloride 0.9% bolus IV injection over 2 minutes, then IV infusion of 50 micrograms per hour (500micrograms made up to 50mL with sodium chloride 0.9% and run at 5mL per hour

     

    High output ileostomy, palliative management of intestinal obstruction, diarrhoea associated with malignancy:

    50-200 micrograms subcutaneously three times a day

     

    Chylothorax:

    50-100 micrograms three times a day for up to 14 days

    08.03.04.03 Octreotide injection, depot injection 

    Red Traffic Light For all new patients

    Amber Traffic Light For existing patients managed in primary care

    05.03.01 Odefsey® tabs emtricitabine with rilpivirine and tenofovir alafenamide
    08.02.03 Ofatumumab injection 
    12.01.01 Ofloxacin ophthalmic solution 0.3% 

    Recognised off-label use in the ear:

    Twice a day or three times a day administration

    11.03.01 Ofloxacin opthalmic solution 0.3% 
    05.01.12 Ofloxacin tabs  
    01.07.03 Oily phenol injection BP 
    04.02.01 Olanzapine tabs, orodispersible tabs  INITIATION BY SPECIALIST ONLY
    08.01.05 Olaparib caps, tabs 

    Approved for use as per NICE technology appraisal guidance (see links below)

    Due to differences in dosing and bioavailability, capsules and tablets should not be substituted on a milligram-to-milligram basis. To avoid medication errors, prescribers should specify formulation and dose on each prescription.

    08.01.05 Olaratumab injection  Approved for treating advanced soft tissue sarcoma as per NICE TA465
    13.13 Olive oil  Used to soften the scalp of patients with psoriasis and to prepare ear drops for patients
    12.01.03 Olive Oil ear drops 
    11.04.02 Olopatadine eye drops 0.1% 
    12.03.04 OM1 antimicrobial soution 

    To be used under the supervision of a Consultant in Oral Microbiology or Oral Medicine only

    Treatment of the following conditions where coliforms and other microorganism counts are high and the patient is symptomatic:

    • Exfoliative cheilitis chronic mucocutaneous candidiasis (CMCC)
    • Oral infections caused by Gram negative rods e.g. E. coli & proteus spp.

    PIL available on GTi

    03.04.02 Omalizumab injection urticaria For use in chronic spontaneous urticaria
    03.04.02 Omalizumab injection asthma

    For use in asthma within the specialist service as per NICE TA 

    02.12 Omega-3-Acid Ethyl Esters capsules 

    New patients should only be initiated omega-3 fatty acids by a lipid specialists. The place of omega 3 fatty acids supplements in hypertriglyceridemia is clearly defined in the SE London APC guidance: Management of hypertriglyceridaemia

     

    02.12 Omega-3-Marine Triglycerides capsules  Adjunctive therapy in the reduction of plasma triglycerides in patients with hypertriglyceri-daemia at risk of ischaemic heart disease or pancreatitis
    01.03.05 Omeprazole caps 

    First line oral PPI of choice at all Trusts

    Not to be prescribed for patients on clopidogrel

    01.03.05 Omeprazole dispersible tabs 

    Reserved for patients with swallowing difficulties

    01.03.05 Omeprazole injection  Parenteral PPI of choice at KCH and LGT
    04.06 Ondansetron tabs, injection 
    04.09.01 Opicapone caps 

    Opicapone is approved for use as an adjunctive therapy to levodopa/DOPA decarboxylase inhibitors in adults with Parkinson’s disease and end-of-dose motor fluctuations.

    Opicapone is restricted for use as a 2nd line COMT-inhibitor, where entacapone (first line choice) is ineffective or inappropriate due to swallowing difficulties (entacapone is film coated and a larger tablet) 

    See SEL APC recommendation (link below) and Management of Motor Symptoms in Parkinson's Disease SEL pathway (link above) for further prescribing advice. 

     

    13.13 Orabase protective paste  Mouth ulcers, mucositis
    12.03.01 Orabase® protective paste  Contains:
  • Carmellose sodium 16.7%
  • Pectin 16.7%
  • Gelatin 16.7%
  • 12.03.01 Orahesive® powder   Contains equal parts of:
  • Carmellose sodium
  • Pectin
  • Gelatine
  • 09.02.01.02 Oral Rehydration Salts 

    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

    04.05.01 Orlistat caps Type V hypertriglyceridaemia - off-label

    Approved off-label indication (specialist intiation only):

    Type V hypertriglyceridaemia: Dose = 120 mg three times a day with meals

    04.05.01 Orlistat caps 

    For treatment of obesity. Use in accorandance with NICE guidance (CG189)

    04.09.02 Orphenadrine tabs 
    05.03.04 Oseltamivir caps, oral suspension  Please refer to local guideline at GSTFT
    08.01.05 Osimertinib tabs 
    11.04.02 Otrivine-Antistin® eye drops  Contains:
  • Antazoline sulphate 0.5%
  • Xylometazoline hydrochloride 0.05%
  • 08.01.05 Oxaliplatin injection 
    04.08.01 Oxcarbazepine tabs 
    02.06.04 Oxerutins caps 
    12.03.01 Oxetacaine and antacid suspension 

    Mucositis pain after radiation therapy only

    Use in accordance with the GSTFT guidelines for the management of radiation induced acute effects in the head and neck region

    To be used as a mouthwash and then swallowed.

    02.04 Oxprenolol tabs 
    11.07 Oxybuprocaine 0.4% preservative-free eye drops  
    13.12 Oxybutynin tabs hyperhidrosis – off-label

    Approved off-label indiction:

    Hyperhidrosis where there is failure to respond to a trial of topical antiperspirants or other antihidrotic treatment.

    IR tabs dose = 2.5mg daily – 5mg three times a day

    MR dose = 5-10mg daily.


    Oxybutynin IR preparation 1st line followed by oxybutinin MR preparation or propantheline in case of intolerable adverse effects/inefficacy of oxybutynin IR

    Refer to APC recommendation below

    07.04.02 Oxybutynin tabs, m/r tabs, elixir 
    07.04.02 Oxybutynin transdermal patch  Restricted to use in patients unable to tolerate oral medication only
    04.07.02 Oxycodone caps, m/r tabs, liquid, injection 

    Second line opioid

    Restricted to use where morphine is not tolerated or contra-indicated

    04.09.04 Oxycodone/naloxone SR tabs Targinact® - restless leg syndrome

    Approved for use in restless legs syndrome (off-label) with the following restrictions:

    • Specialist neurologist or sleep centre use only
    • Refractory cases where dopamine agonists and gabapentin/pregabalin have failed and pain is a significant symptom
    • Reserved for patients who have failed to tolerate other opioids for management of pain in restless legs syndrome
    • Dose = 5mg/2.5mg to 60mg/30mg twice daily

    Refer to SE London treatment pathway below

    11.09 Oxysept® 1 Step solution 
    05.01.03 Oxytetracycline tabs 
    13.06 Oxytetracycline tabs rosacea

    First line oral antibiotic option for severe papulopustular rosacea

    Refer to SE London APC rosacea treatment pathway for further information (link below)

    13.06.02 Oxytetracycline tabs 
    07.01.01 Oxytocin injection 
    09.06.02 Pabrinex intramuscular high potency injection  SLAM only
    09.06.02 Pabrinex intravenous high potency injection 
    08.01.05 Paclitaxel albumin injection Abraxane

    Approved as per NICE Technology Appraisal guidance

    08.01.05 Paclitaxel injection 
    10.04 Palacos LV 40  Bone cement for use in orthopaedic surgery
    10.04 Palacos R 40 with gentamicin  Bone cement for use in orthopaedic surgery
    08.01.05 Palbociclib tabs  Approved for use as per NICE technology appraisal guidance below
    04.02.02 Paliperidone palmitate injection 

    INITIATION BY SPECIALIST ONLY

    GPs may be asked to take on prescribing under the APC shared care agreement for the monthly depot preparation only (Xeplion®)

     

    Red Traffic Light

    The 3-monthly preparation (Trevicta® - 175mg, 263mg, 350mg and 525mg strengths) is currently for hospital pescribing only

    01.09.04 Pancreatin capsules Creon®
    01.09.04 Pancreatin capsules Pancrex® V
    01.09.04 Pancreatin capsules Pancrease® HL
    15.01.05 Pancuronium bromide injection 
    08.01.05 Panitumumab injection 

    Approved as per restrictions in the NICE guidance

    08.01.05 Panobinostat caps 

    Approved for use as per NICE technology appraisal guidance (see links below):

    01.03.05 Pantoprazole injection 

    Approved off-label indication:

    Acute upper GI bleed:

    • Use in accordance with guideline at GSTFT
    • Dose: 80 mg followed by an infusion of 8 mg/h for 72 hours
    01.03.05 Pantoprazole injection  Parenteral PPI of choice at GSTFT
    04.07.02 Papaveretum and hyoscine injection 
    04.07.02 Papaveretum injection 
    02.05.01 Papaverine injection  

    RESTRICTED USE – CONSULTANT SPECIALISTS ONLY

    As an intrathecally administered adjunct treatment during aortic aneurysm repair

    Use in accordance with local guideline

    04.07.01 Paracetamol injection 

    Restricted to short-term treatment of moderate pain and fever when administration by the intravenous route is clinically justified

    For patients weighing less than 50 kg:

    • Max dose = 15 mg/kg
    • Minimum dose interval of 4 hours
    • Maximum daily dose must not exceed 60 mg/kg (without exceeding 3g)

     In severe renal insufficiency (creatinine clearance ≤30 mL/min):

    • Minimum dose interval of 6 hours

    Not to exceed 3g as total daily dose in the following patients:

    • Hepatocellular insufficiency
    • Chronic alcoholism
    • Chronic malnutrition or dehydration
    04.07.04.01 Paracetamol tabs, soluble tabs 
    04.07.01 Paracetamol tabs, soluble tabs, oral suspension, suppositories 
    04.08.02 Paraldehyde injection (given as an enema) 
    15.01.04.02 Parecoxib 

    DAY SURGERY ONLY

    Short-term management of acute post-operative pain in patients at risk of gastric ulceration with conventional NSAIDS

    09.06.04 Paricalcitol caps, injection 
    05.04.05 Paromomycin tabs  Leishmaniasis
    04.03.03 Paroxetine tabs, liquid 
    08.03.04.03 Pasireotide injection 

    Approved for:

    • Cushing's Disease Use as per criteria in NHSE Policy 16052/P
    08.01.05 Pazopanib tabs 
    14.04 Pediacel®  Diphtheria, tetanus, pertussis (acellular, component), poliomyelitis (inactivated) and haemophilus type b conjugate vaccine
    08.01.05 Pegaspargase injection 

    Approved for use as per NICE technology appraisal guidance (see links below):

    09.01.06 Pegfilgrastim injection 

    HAEMATOLOGY ONLY

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

    05.03.03.01 Peginterferon alfa-2a injection 
    05.03.03.02 Peginterferon alfa-2a injection 
    08.02.04 Peginterferon alfa-2a injection 

    Approved off-label indication (consultant heamatologist only):

    For patients refractory or intolerant to conventional interferon for myeloproliferative disease.

    Use in accordance with the guideline “Management of Myeloproliferative Disease” at GSTFT

    08.02.04 Peginterferon alfa-2a injection 

    SPECIALIST USE ONLY

    See entry in chapter 5 and NHSE and NICE guidance below

    05.03.03.02 Peginterferon alfa-2b injection 
    08.02.04 Peginterferon alfa-2b injection 

    SPECIALIST USE ONLY

    See entry in chapter 5 and NHSE and NICE guidance below

    08.02.04 Peginterferon beta-1a injection 

    First line disease modifying agent option for multiple sclerosis

    06.05.01 Pegvisomant injection 

    Use under specialist supervision only

    Third line, as per criteria in NHSE policy 16050/P

    08.01.05 Pembrolizumab injection skin cancer indications For skin cancer indications as per NICE technology appraisals below
    08.01.05 Pembrolizumab injection lung cancer indications

    For non-small-cell lung cancer as per NICE Technology appraisals below

    08.01.05 Pembrolizumab injection urothelial cancer indications

    For urothelial cancer indications as per NICE Technology appraisals below

    08.01.03 Pemetrexed injection 

    07.04.03 Penicillamine tabs cystinuria Specialist clinic initiation only Approved for:
  • Cystinuria
  • 09.08.01 Penicillamine tabs Wilsons disease Approved for:
  • Inherited metabolic disorders (NHSE)
  • 10.01.03 Penicillamine tabs rheumatoid athritis USE UNDER SPECIALIST SUPERVISION ONLY Approved for:
  • Severe rheumatoid arthritis
  • 11.03.01 Penicillin eye drops 0.3% 
    05.04.08 Pentamidine isetionate nebuliser solution, injection  Injection = Red Traffic Light
    09.02.02.02 Pentastarch 10% intravenous infusion in sodium chloride 0.9%  

    07.04.04 Pentosan polysulfate sodium caps Elmiron

    For interstitial cystitis

    Dose: 100 mg three times a day

    08.01.05 Pentostatin injection 
    02.06.04 Pentoxifylline liquid osteonecrosis of the jaw (unlicensed product)

    Prevention of osteonecrosis of the jaw. Used in combination with vitamin E capsules

    Restricted to use in patients who cannot take tablets due to swallowing difficulties

    02.06.04 Pentoxifylline tabs osteonecrosis of the jaw - off-label

    Approved off-label indication:

    Prevention of osteonecrosis of the jaw. Used in combination with vitamin E capsules

    02.06.04 Pentoxifylline tabs 
    01.02 Peppermint oil caps 
    01.02 Peppermint water 
    01.01.02 Peptac® suspension 
    01.01 Pepto-Bismol chewable tabs  off-label indication

    Approved off-label indication:

    H. Pylori eradication as per detail in NICE CG184 for bismuth containing regimens.  To be used in combination with a proton pump inhibitor and metronidazole and tetracycline. 

    (see link below for full advice)

    Note: 262.5mg Bismuth subsalicylate/tablet.

    Dose = 2 tablets four times a day for a 1-2 week course

     

    04.08.01 Perampanel tabs 

    SPECIALIST INITIATION ONLY

    First 2 months supply to come from hospital.

    Transfer of Care documentation requires completion before GP will take over prescribing

    11.99.99.99 Perfluoro-N-Octane injection  Aid to ocular surgery
    04.09.01 Pergolide tabs 

    Red Traffic Light For all new patients

    Amber Traffic Light For existing patients managed in primary care

    02.05.05.01 Perindopril erbumine tabs 

    Approved off-label indication:

    Secondary prevention of stroke in combination with indapamide

    13.10.04 Permethrin cream 5% 
    13.10.04 Permethrin cream 5%  Second-line for crab lice in accordance with GUM guidelines
    13.10.04 Permethrin cream rinse 1%  Second-line for scabies in accordance with GUM guidelines
    13.11.06 Permitabs® potassium permanganate 400 mg
    14.04 Pertussis vaccine  Available as combined vaccine. See Diphtheria vaccines
    08.01.05 Pertuzumab injection 

    Approved for use as per NICE technology appraisal guidance (see links below):

    04.07.02 Pethidine tabs, injection 
    04.03.02 Phenelzine tabs  INITIATION BY SPECIALIST ONLY
    02.08.02 Phenindione tabs 
    04.08.01 Phenobarbital tabs, elixir, injection  USE UNDER SPECIALIST SUPERVISION ONLY
    13.13 Phenol 2% w/w in compound zinc paste BP 

    BAD/APC approved Special

    For intractable pruritus ani, unresponsive to moderate strength topical steroid and barrier preparations.

    04.07.03 Phenol 6% aqueous injection 

    Approved for peripheral nerve neurolysis in chronic pain management.

    Pain clinic use only

    Restricted to use where where all standard neuropathic agents (oral and topical) have failed, or are inappropriate due to adverse effects or contra-indications.

    Refer to online guideline for use at GSTT: "Phenol aqueous injection in Chronic Non-malignant Pain"

    10.04 Phenol liquid 80% nail bed ablation in ingrowing toenail Topical application for nail bed ablation in ingrowing toenail
    13.10.04 Phenothrin lotion 0.2%  Third-line for crab lice in accordance with GUM guidelines
    02.05.04 Phenoxybenzamine caps, injection  USE UNDER SPECIALIST SUPERVISION ONLY
    05.01.01.01 Phenoxymethylpenicillin tabs, oral solution Penicillin V
    02.05.04 Phentolamine injection  USE UNDER SPECIALIST SUPERVISION ONLY
    10.01.01 Phenylbutazone tablets 

    Restricted use

    Ankylosing spondylitis

    11.05 Phenylephrine and tropicamide ophthalmic insert Mydriasert® Reserved for patients on the femtosecond laser assisted surgery list requiring pre-operative mydriasis in ophthalmic surgery
    11.05 Phenylephrine hydrochloride eye drops 2.5%, 10% 

    USE UNDER SPECIALIST SUPERVISION ONLY

    Phenylephrine eye drops may be required in combination with tropicamide eye drops for pre-operative mydriasis in opthalmic surgery for certain scenarios e.g. contraindications to Mydrane and Mydriasert

    02.07.02 Phenylephrine injection 
    07.04.05 Phenylephrine injection 10 mg/mL 

    Approved off-label indication:

    Drug-induced priapism once physical measures to direct blood from penis and aspiration have failed.

    USE UNDER SPECIALIST SUPERVISION ONLY Use with caution – risk of hypertensive crisis. Continual monitoring of blood pressure and pulse is essential.

    • Dose: 100-200 micrograms (0.5-1 mL diluted solution as below) injected into corpus cavernosum after aspiration of blood has failed to produce a response.
    • Repeat every 5 – 10 minutes as necessary up to a total dose of 1 mg.
    • Dilution: 10 mg in 1 mL phenylephrine is diluted to 50 mL with sodium chloride 0.9% (49mL) to give 200 micrograms/mL solution
    04.08.02 Phenytoin sodium injection 
    04.08.01 Phenytoin tabs, caps, suspension 
    03.09.01 Pholcodine linctus, BP 5mg in 5ml
    09.05.02.01 Phosphate intravenous infusion  Polyfusor® Phosphate = 100mmol/L
    01.06.04 Phosphates enema 
    09.05.02.01 Phosphate-Sandoz ® effervescent tablets  1 tablet contains:
  • 16.1mmol Phosphate
  • 20.4mmol Sodium
  • 3.1mmol Potassium
  • 09.06.06 Phytomenadione mixed micelle injection 
    01.06.05 Picolax® 
    13.13 Pigmanorm® cream 

    Depigmenting cream, containing:

    • Hydroquinone 5%
    • Tretinoin 0.1%
    • Hydrocortisone 1%
    11.06 Pilocarpine eye drops 1%, 2%, 4%  Preservative-free eye drops available on request (not all strengths available)
    12.03.05 Pilocarpine eye drops 4% dry mouth - off-label

    Approved off-label indication:

    • For symptoms of dry mouth in patients with Sjögren's syndrome or following irradiation for head and neck cancer (alternative when there are supply issues with pilocarpine tabs) Given orally.

    Starting dose = 3 drops of 4% (6mg) three times a day

    12.03.05 Pilocarpine tabs  For symptoms of dry mouth and dry eyes in patients with Sjögren's syndrome
    13.05.03 Pimecrolimus cream 1% eczema

    Use under specialist supervision only

    For moderate atopic eczema

    13.05.03 Pimecrolimus cream 1% psoriasis - off-label

    Approved off-label indication:

    Psoriasis of the face, flexures and genitals

    Use under specialist supervision only

    04.02.01 Pimozide tabs 
    06.01.02.03 Pioglitazone tabs 
    05.01.01.04 Piperacillin with tazobactam injection 
    04.02.02 Pipotiazine palmitate injection  INITIATION BY SPECIALIST ONLY
    03.11 Pirfenidone caps 

    04.04 Pitolisant tablets 

    Sleep centre use only

    • Approved for use in narcolepsy, with or with cataplexy in adults
    • Restricted to use as a last line treatment where modafinil and dexamfetamine or methylphenidate have failed to improve symptoms.

    See APC recommendation for further information

    05.01.01.05 Pivmecillinam tabs 
    08.01.02 Pixantrone injection 
    04.07.04.02 Pizotifen tabs, elixir 
    09.02.02.01 Plasma-Lyte 148 intravenous infusion  Restricted to use in Critical Care, and intraoperative use in the following procedures:
  • Free flap reconstruction
  • Renal transplant
  • Simultaneous kidney and pancreas transplant
  • 09.01.07 Plerixafor injection 

    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

    13.03 Pliazon® cream 

    Hospital supply only

    For skin reactions associated with Epidermal Growth Factor Receptor (EGFR) targeted therapies for patients with metastatic colorectal cancer

    14.04 Pneumococcal vaccine 
    13.07 Podophyllotoxin cream 0.15% Warticon®
    13.07 Podophyllotoxin paint 25% in bezoin compound tincture  For anogenital wards To be applied once a week
    13.07 Podophyllotoxin Paint, Compound, BP 
    13.07 Podophyllotoxin solution 0.5% Warticon® licensed uses

    13.07 Podophyllotoxin solution 0.5% Warticon® for molluscum contagiosum - off-label

    Approved off-label indication:

    Treatment of molluscum contagiosum in accordance with BASHH guidelines

    14.04 Poliomyelitis vaccine   Available as combined vaccine. See Dipththeria vaccines.
    12.02.03 Polyfax ® eye ointment 

    USE ON MICROBIOLOGY/VIROLOGY ADVICE only - for eradication of nasal carriage of MRSA

    Contains:

    • Polymixin B sulphate 10 000units/g
    • Bacitaricin zinc 500 units/g

    Instructions:

    • Eye ointment is used in the nose
    • A matchhead size portion to be applied into each nostril
    • Close nostrils to spread the ointment throughout the nares
    • Dose = 2-3 times daily
    • Continue treatment for 5-7 days
    13.10.01.01 Polyfax® ointment polymyxin B sulphate ointment + bacitracin zinc
    11.03 Polyhexamethylene biguanide 0.02% (PHMB) eye drops  Acanthamoeba
    13.05.02 Polytar Emollient® bath additive 
    13.05.02.01 Polytar® liquid 
    11.08.01 Polyvinyl alcohol eye drops 1.4% 
    08.02.04 Pomalidomide caps 

    08.01.05 Ponatinib tabs 

    Approved for CML and ALL as per NICE TA451

    05.02.01 Posaconazole suspension, tabs 

    NOTE – tablet and liquid formulations are not directly interchangeable and have differing dosing regimens for the licensed indications

    Use in accordance with local antifungal guidelines

    Approved for:

    • Invasive fungal infections refractory to standard antifungals
    • Primary prophylaxis in patients who are at high risk of invasive fungal infections
    • Secondary prophylaxis in patients successfully treated with posaconazole for an invasive fungal infection
    09.02.02.01 Potassium acetate injection 

    10 mmol K+ in 10mL

    REFER TO LOCAL TRUST PROTOCOL FOR CONCENTRATED POTASSIUM SOLUTIONS

    09.02.02.01 Potassium acid phosphate injection 13.6% 

    10 mmol K+ in 10mL

    REFER TO LOCAL TRUST PROTOCOL FOR CONCENTRATED POTASSIUM SOLUTIONS

    09.06.02 Potassium aminobenzoate capsules  Potoba®

    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
    11.99.99.99 Potassium ascorbate eye drops  Chemical burns to eye
    09.02.01.03 Potassium bicarbonate effervescent tabs  Approximately 6mmol HCO3- and 6.5mmol K+ per tab
    02.02.03 Potassium canrenoate injection 

    Aldosterone antagonist.

    Alternative to oral spironolactone

    09.02.02.01 Potassium chloride 0.15% and sodium chloride 0.9% intravenous infusion 

    20 mmol K+ per 1000mL

    09.02.02.01 Potassium chloride 0.15% and glucose 5% intravenous infusion  20 mmol K+ per 1000mL
    09.02.02.01 Potassium chloride 0.3% and glucose 5% intravenous infusion  40 mmol K+ per 1000mL
    09.02.02.01 Potassium chloride 0.3%, sodium chloride 0.18% and glucose 4% intravenous infusion  40 mmol K+ per 1000mL
    09.02.02.01 Potassium chloride 0.3%, sodium chloride 0.45% and glucose 5% intravenous infusion  40 mmol K+ per 1000mL
    09.02.02.01 Potassium chloride 0.3%, sodium chloride 0.9% intravenous infusion  40 mmol K+ per 1000mL
    09.02.02.01 Potassium chloride 1.5% in sodium chloride 0.9% infusion minibag 

    20 mmol K+ in 100mL

    REFER TO LOCAL TRUST PROTOCOL FOR CONCENTRATED POTASSIUM SOLUTIONS

    09.02.02.01 Potassium chloride 3% in sodium chloride 0.9% infusion minibag 

    40 mmol K+ in 100mL

    REFER TO LOCAL TRUST PROTOCOL FOR CONCENTRATED POTASSIUM SOLUTIONS

    09.02.02.01 Potassium chloride 3% in sodium chloride 0.9% prefilled syringe 50mL 

    20 mmol K+ in 50mL

    REFER TO LOCAL TRUST PROTOCOL FOR CONCENTRATED POTASSIUM SOLUTIONS

    09.02.01.01 Potassium Chloride effervescent tabs  12mmol K+ per tab
    09.02.01.01 Potassium Chloride MR tabs, syrup 

    MR tabs = 8mmol K+ per tab

    Syrup = 1mmol/mL K+

    09.02.02.01 Potassium chloride strong injection 15% 

    20 mmol K+ in 10mL

    REFER TO LOCAL TRUST PROTOCOL FOR CONCENTRATED POTASSIUM SOLUTIONS

    07.04.03 Potassium citrate 1080mg MR tabs Urocit K®

    For cystinuria clinic use only

    Usual dose range: 2-6 tablets per day

    07.04.03 Potassium Citrate Mixture BP oral solution 
    07.04.03 Potassium citrate sachets Cystopurin®
    06.02.02 Potassium Iodate tabs 

    Protection of thyroid function during radioactive iodine therapy

    Dose: 130 mg daily

    13.11.04 Povidone-iodine alcoholic tincture 10% 
    13.11.04 Povidone-iodine antiseptic solution 10% 
    11.08.02 Povidone-iodine eye drops 5% 
    13.11.04 Povidone-iodine skin cleanser solution 4% 
    13.11.04 Povidone-iodine surgical scrub 7.5% 
    04.01.01 Pramipexole tabs REM behaviour disorder - off-label

    Approved off-label indication:

    • REM behaviour disorder in adults

    Usual dose = 88 micrograms to 540 micrograms nocte

    Sleep centre initiation only

    Refer to SE London APC recommendation and pathway (links below) for further detail

    04.09.04 Pramipexole tabs restless legs syndrome Immediate release preparation only
    04.09.01 Pramipexole tabs, m/r tabs Parkinson's disease

    06.03.02 Prasterone caps DHEA Treatment of adrenal insufficiency Dose: 25-50 mg daily
    02.09 Prasugrel tabs 
    02.12 Pravastatin tabs 
    05.05.03 Praziquantel tabs 

    Tapeworm infection

    Dose: single dose of 10-20 mg/kg after a light breakfast

    05.05.05 Praziquantel tabs 

    Bilharziasis

    Dose: 40 mg/kg in 2 divided doses 4-6 hours apart on one day (60 mg/kg in 3 divided doses on one day for S. japonicum infections)

    02.05.04 Prazosin tabs 
    07.04.01 Prazosin tabs 
    12.01.01 Prednisolone 0.5% & neomycin sulphate 0.5% ear drops 
    12.01.01 Prednisolone ear drops 0.5% 
    11.04.01 Prednisolone eye drops 0.5%, 1%  Preservative-free eye drops 0.5% available on request
    01.05.02 Prednisolone tabs, retention enema, rectal foam, suppositories  Prednisolone enteric coated tablets are non-formulary
    06.03.02 Prednisolone tabs, soluble tabs  Prednisolone enteric coated tablets are non-formulary
    04.07.03 Pregabalin caps neuropathic pain

    Third line choice for neuropathic pain after amitriptyline and gabapentin

    Refer to SEL APC neuropathic pain guideline (link below)

    04.08.01 Pregabalin caps epilepsy USE UNDER SPECIALIST SUPERVISION ONLY
    04.09.04 Pregabalin caps restless legs syndrome - off-label

    Approved for use in restless legs syndrome (off-label) with the following restrictions:

    • Specialist neurologist or sleep centre use only
    • In patients intolerant to dopamine agonists, or who have a history of insomnia or compulsive behaviours
    • Reserved for patients intolerant to gabapentin for this indication
    • Dose = 25 mg to 300 mg at night

    Refer to SE London treatment pathway below

    09.01.01.01 Pregaday® tabs  Each tablet contains
  • Ferrous fumarate 322 mg
  • Folic acid 350 micrograms
  • 06.04.01.01 Premarin® tabs conjugated oestrogens
    06.04.01.01 Premique® Low Dose tabs conjugated oestrogens and medroxyprogesterone Menopausal symptoms and secondline prevention of postmenopausal osteoporosis in women where other therapies are ineffective or inappropriate
    06.04.01.01 Premique® tabs conjugated oestrogens and medroxyprogesterone
    06.04.01.01 Prempak-C® tabs conjugated oestrogens and norgestrel
    15.02 Prilocaine 2% with glucose 60mg/mL Prilotekal®

    Restricted to areas that have a locally approved guideline in place

    For intrathecal anaesthesia in accordance with cervical cerclage guideline at GSTFT

    15.02 Prilocaine injection 1% 
    15.02 Prilocaine with felypressin injection 
    05.04.01 Primaquine tabs 
    05.04.01 Primaquine tabs 

    PCP treatment in accordance with BHIVA guidelines

    Dose: 15-30 mg once daily

    05.04.01 Primaquine tabs 

    Prevention of subsequent relapse of non-falciparum malaria

    Dose: Orally 15 mg daily for 14 days following the treatment of P. vivax and P. ovale malaria.

    Please seek expert advice for G6PD deficient individuals and cases where relapse occurs despite primaquine therapy

    04.08.01 Primidone tabs  USE UNDER SPECIALIST SUPERVISION ONLY
    10.01.04 Probenecid tabs penicillin augmentation in syphilis

    Approved for use in:

    • Late latent syphilis and neurosyphilis in conjuction with penicillin treatments (either amoxicillin or procaine pneicillin G) as per BASHH guidance.

    Dose = 500mg qds for duration of penicillin use

    10.01.04 Probenecid tabs  Approved for:
  • Prevention of nephrotoxicity associated with cidofovir
  • Prophylaxis of gout in cases resistant to allopurinol
  • 02.03.02 Procainamide injection  USE UNDER SPECIALIST SUPERVISION ONLY
    15.02 Procaine injection 
    05.01.01.01 Procaine Penicillin G injection 

    Approved (as per BASHH guidance) for:

    • Early syphilis; dose = 600,000 units daily (i.m) for 10 days
    • Late latent, cardiovascualar and gummatous syphilis; dose = 600,000 units daily (i.m) for 14 days
    • Neurosyphilis, dose = 1.8 to 2.4 million units (i.m.) daily with probenecid 500mg qds for 14 days
    08.01.05 Procarbazine caps 
    04.07.04.01 Prochlorperazine suppositories 
    04.06 Prochlorperazine tabs, buccal tabs, syrup, injection 
    04.02.01 Prochlorperazine tabs, injection 
    01.07.02 Proctofoam HC® foam 
    04.09.02 Procyclidine tabs, syrup, injection 
    13.10.05 Proflavine cream, BPC  
    06.04.01.02 Progesterone (micronised) oral caps Utrogestan®

    06.04.01.02 Progesterone pessaries Cyclogest®

    Approved off-label indication:

    Assisted conception Dose: 400 mg twice daily

    06.04.01.02 Progesterone pessaries Cyclogest®
    05.04.01 Proguanil hydrochloride tabs 
    05.04.01 Proguanil hydrochloride with atovaquone tabs 
    04.02.01 Promazine hydrochloride tabs 
    04.06 Promethazine tabs, elixir, injection 
    03.04.01 Promethazine tabs, oral solution, injection 
    02.03.02 Propafenone tablets  USE UNDER SPECIALIST SUPERVISION ONLY
    11.03.01 Propamidine isetionate eye drops 0.1% 
    01.02 Propantheline bromide tabs gastroenterology and neurology use

    Approved for use in:

    • Symptom control in GI disorders characterised by smooth muscle spasm
    • Reducing adverse effects pyridostigmine (e.g. abdombinal cramps) in myaesthenia gravis patients: Usual dose = 15 mg to 30 mg three times a day
    13.12 Propantheline bromide tabs hyperhidrosis

    Use in accordance with formulary recommendation below

    For hyperhidrosis where there is failure to respond to a trial of topical antiperspirants or other antihidrotic treatment

    Oxybutynin IR preparation 1st line followed by oxybutinin MR preparation or propantheline in case of intolerable adverse effects/inefficacy of oxybutynin IR

    15.01.01 Propofol injection 
    04.07.04.02 Propranolol tabs migraine prophylaxis
    02.04 Propranolol tabs, MR caps, oral solution, injection 
    13.02.01 Propylene glycol 20% w/w in aqueous cream (100g) 

    BAD/APC approved Special

    As a moisturiser, to use on very dry skin conditions.

    06.02.02 Propylthiouracil tabs 
    02.08.03 Protamine sulphate injection 
    05.01.09 Protionamide tabs, injection  Drug resistant tuberculosis
    06.05.01 Protirelin injection 
    11.07 Proxymetacaine 0.5% preservative-free eye drops  
    01.06.07 Prucalopride tablets 

    Approved as per criteria in NICE TA211 and SE London Chronic Constipation Pathway (see links below)

    Restricted to use where at least two laxatives from different classes, at the highest tolerated recommended doses for at least 6 months, has failed to provide adequate relief and invasive treatment for constipation is being considered

    Following the licence extension, the SE London APC have approved use in men under the same criteria as NICE TA211

    03.10 Pseudoephedrine hydrochloride tabs. oral liquid 
    05.01.09 Pyrazinamide tabs  Treatment of tuberculosis in combination with other drugs
    10.02.01 Pyridostigmine bromide tabs 
    09.08.01 Pyridoxal-5-phosphate tablets   Inherited metabolic disorders commissioned by NHSE
    09.06.02 Pyridoxine hydrochloride injection 50mg/2 mL  Antidote for isoniazid poisoning. To be injected intravenously. Refer to TOXBASE for advice
    09.06.02 Pyridoxine hydrochloride tablets 
    09.08.01 Pyridoxine phosphate tablets   Inherited metabolic disorders commissioned by NHSE
    05.04.07 Pyrimethamine tablets  Use in accordance with protocol for the treatment of Toxoplasma gondii at GSTFT. Should be co-prescribed with calcium folinate 15 mg once daily to counteract myelosuppressive effects of pyrimethamine Dose: 200 mg loading dose followed by 50 mg once daily (<60 kg) or 75 mg once daily (>60 kg), for 6 weeks
    05.04.07 Pyrimethamine tabs 

    Use in accordance with protocol for the treatment of Toxoplasma gondii at GSTFT

    Dose: 200 mg loading dose followed by 50 mg once daily (60 kg), for 6 weeks

    Should be co-prescribed with calcium folinate 15 mg once daily to counteract myelosuppressive effects of pyrimethamine

    11.09 Quattro® multipurpose solution 
    04.02.01 Quetiapine tabs  INITIATION BY SPECIALIST ONLY
    10.02.02 Quinine bisulphate tabs 
    05.04.01 Quinine dihydrochloride injection 
    05.04.01 Quinine sulphate tabs 
    10.02.02 Quinine sulphate tabs 
    13.02.01 QV® lotion 

    First line choice where a lotion type emollient is required

    14.05.02 Rabies immunoglobulin 
    14.04 Rabies vaccine 
    06.04.01.01 Raloxifene tabs 
    05.03.01 Raltegravir tabs  Both once daily (1200 mg daily) and twice daily (400 mg twice daily) regimens are approved
    02.05.05.01 Ramipril tabs, caps  ACE inhibitor of choice at KCH
    11.08.02 Ranibizumab intravitreal injection 

    Approved as per NICE technology appraisal guidance

    Refer to APC guidance for Wet Age-Related Macular Degeneration, Diabetic Macular Oedema, Central Retinal Vein Occlusion and Branch Retinal Vein Occlusion (see link below)

    01.03.01 Ranitidine tabs, injection 
    02.06.03 Ranolazine m/r tabs  INITIATION BY CONSULTANT CARDIOLOGISTS ONLY For ongoing symptoms in chronic stable angina despite the use of first-line therapies such as beta-blockers or calcium channel blockers Ranolazine may be particularly useful where the use of other antianginal therapies is limited by bradycardia (heart rate <50 beats per minute) or hypotension (systolic blood pressure <90mmHg), as it has little effect on heart rate or blood pressure. It may also be useful where first-line anti-anginal therapies are contraindicated or not tolerated
    04.09.01 Rasagiline tabs 

    INITIATION BY SPECIALIST ONLY

    Treatment for early Parkinson’s disease.

    To be used as monotherapy and gradually withdrawn when more symptomatic treatments are required.

    Not to be used in combination with levodopa

    10.01.04 Rasburicase injection 
    04.03.04 Reboxetine tabs  INITIATION BY SPECIALIST ONLY
    13.08.01 Reflective (Dundee) sunscreens - coffee, coral, pink, beige  

    BAD/APC approved Special

    For photosensitivity disorders where the patient is sensitive to visible light, most commonly solar urticaria and porphyrias, particularly erythropoietic protoporphyria.

    08.01.05 Regorafenib tabs  Approved for use as per NICE technology appraisal guidance below
    03.02 Relvar Ellipta® dry powder inhlaer fluticasone furoate and vilaterol

    Asthma:

    Restricted to use where a single daily dose is preferable for assisting with adherence to the treatment regimen

     

    COPD:

    Preferred treatment option in patients requiring triple therapy (LAMA, LABA and ICS) in conjunction with umeclidinium inhalation powder (specialist recommedation only)

    15.01.04.03 Remifentanil injection 
    15.01.04.03 Remifentanil PCA 

    Restricted to consultant anaesthetists only

    For labour pain in accordance with approved guideline at LGT

    09.06.07 Renavit tablets  For vitamin replacement in renal dialysis patients
    06.01.02.03 Repaglinide tabs 
    14.04 Repevax®  Adsorbed diphtheria (low dose), tetanus, pertussis (acellular, component), and inactivated poliomyelitis vaccine
    03.04.02 Reslizumab injection 

    For use in asthma within the specialist service as per NICE TA

    14.04 Revaxis®  Adsorbed diphtheria (low dose), tetanus and inactivated poliomyelitis vaccine
    05.03.01 Rezolsta® tabs darunavir with cobicistat
    05.03.03.02 Ribavirin caps, tabs off-label use in chronic hepatitis E

    Approved off-label indication:

    Treatment of chronic hepatitis E virus infection in transplant recipients patients. 

    Daily Ribavirin dose = 1,000 mg (patients <75kg) or 1,200mg (patients ≥75kg). For patients with a creatinine clearance less than or equal to 50ml/min please refer to the SPC (link below) for recommended dose adjustments. 

    05.03.03.02 Ribavirin caps, tabs 
    08.01.05 Ribociclib tabs 

    Approved for use as per NICE technology appraisal guidance below

    09.06.02 Riboflavin ophthalmic topical solution  For photochemical corneal collagen cross-linking in the management of keratoconus
    09.06.02 Riboflavin tablets  Riboflavin deficiency
    05.01.09 Rifabutin caps 
    13.05.02 Rifampicin caps 

    Approved off-label indication:

    Used in combination with clindamycin in the treatment of hidradenitis suppurativa (HS)


    Use in accordance with the local guideline at GSTFT

    05.01.09 Rifampicin caps, syrup 

    Red Traffic Light For treatment of tuberculosis

    Amber Traffic Light For treatment of non-tuberculosis infections

    05.01.09 Rifampicin injection 
    05.01.09 Rifampicin injection  off-label use for soaking penile implants

    Approved off-label indication:

    For soaking penile implants, in combination with gentamicin before insertion. Rifampicin 10 mg/ml and gentamicin 1.2 mg/ml solution made from using 50ml sodium chloride 0.9%, rifampicin 600 mg injection and gentamicin 80 mg injection

    05.01.09 Rifater® tabs  Each tablet contains:
  • Rifampicin 120 mg
  • Isoniazid 150 mg
  • Pyrazinamide 300 mg
  • 05.01.07 Rifaximin tabs Targaxan®

    Initiation by gastroenterology only

    Prescribing responsibility to remain with secondary care for the first 6 months GPs can be requested to take over prescribing after 6 months using the SE London Transfer of Care Agreement

    05.01.09 Rifinah® 150/100 tabs  Each tablet contains:
  • Rifampicin 150 mg
  • Isoniazid 100 mg
  • 05.01.09 Rifinah® 300/150 tabs  Each tablet contains:
  • Rifampicin 300 mg
  • Isoniazid 150 mg
  • 05.03.01 Rilpivirine tabs 
    04.09.03 Riluzole tabs 
    09.02.02.01 Ringer's Solution for Injection 
    06.06.02 Risedronate tabs 
    06.06.02 Risedronate, calcium carbonate and colecalciferol tabs  
    04.02.02 Risperidone depot injection  INITIATION BY SPECIALIST ONLY
    04.02.01 Risperidone tabs, liquid, orodispersible tabs  INITIATION BY SPECIALIST ONLY
    05.03.01 Ritonavir caps, oral solution 
    08.02.03 Rituximab injection haematological malignancies

    Use approved as per NICE TA guidance links below.

    Biosimilar products available, to be prescribed by brand name.

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

    See also separate NHSE policies for use with bendamustine (link below)

    08.02.03 Rituximab injection renal transplant - off-label

    Approved off-label indications:

    • Management of antibody mediated rejection in adult renal transplant patients
    • For ABO blood group and HLA antibody incompatible renal transplantation

    Use in accordance with local guidelines at GSTFT Biosimilar products available, to be prescribed by brand name.

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

    08.02.03 Rituximab injection TTP - off-label

    Approved off-label indication (haematology only):

    Thrombotic thrombocytopenic purpura (TTP) with neurological, cardiac or renal pathology

    Dose = 375 mg/m2 every 7 days for 4 doses

    Biosimilar products available, to be prescribed by brand name.

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

    10.01.03 Rituximab injection rheumatology - off-label indications

    Approved off-label indications:

    Treatment of resistant acute autoimmune connective tissue disorders (CTDs) such as:

    • Systemic lupus erythematosus (SLE) - Blueteq application required
    • Inflammatory myopathies
    • Sjogren’s syndrome
    • Systemic vasculitides
    • IgG4-related disease (as per NHSE Policy 16057/P)
    • Behcet's Disease; including Behcet's Eye disease (as per Barts Health Satellite Unit Biological Referal Process)

    Restricted to Lupus Consultants only

    Reserved for patients with severe active autoimmune diseases that have failed to respond to or are intolerant of at least two immunosuppressants (azathioprine, methotrexate, mycophenolate or cyclophosphamide), each having been taken for at least three months

    Biosimilar products available, to be prescribed by brand name.

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

    10.01.03 Rituximab injection ANCA vasculitis

    Approved as per NICE technology appraisal guidance below

    Biosimilar products available, to be prescribed by brand name.

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

    10.01.03 Rituximab injection rheumatology - licensed indications

    Approved as per NICE technology appraisal guidance below

    Biosimilar products available, to be prescribed by brand name.

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

    11.99.99.99 Rituximab injection neuromyelitis optica - off-label

    Approved off-label indication:

    Neuromyelitis optica as per NHS England service specification D04/S(HSS)/b

    Category B* form required

    First 2 courses given and funded by NHS England commissioned centres. If ongoing care is needed it may be given locally via local funding

    Biosimilar products available, to be prescribed by brand name.

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

    13.05.03 Rituximab injection dermatology indications

    Approved off-label indication:

    Severe immunobullous disease

    Use in accordance with the local guideline at GSTFT

    Biosimilar products available, to be prescribed by brand name.

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

    08.02.03 Rituximab subcutaneous injection haematological malignancies

    Maintenance single agent treatment (as per NHSE circular) for:

    • Follicular Lymphoma
    • Mantle cell lymphoma
    • Marginal zone lymphoma
    • Lymphoplasmacytic lymphoma

    Biosimilar products available, to be prescribed by brand name.

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

    02.08.02 Rivaroxaban tabs licensed uses

    Amber Traffic Light For treatment and secondary prevention of DVT and PE, thromboprophylaxis in AF, and preventing adverse outcomes after acute management of ACS.

    See links at the end of the section and below for initiation of treatment and transfer of care documents

     

    Red Traffic Light (hospital only) For prevention of VTE after elective hip or knee replacement surgery

    02.08.02 Rivaroxaban tabs orthopaedic off label use Approved off-label indication:
  • Thromboprophylaxis post pelvic ring/acetabular fracture as an alternative to Low Molecular Weight Heparin Full course of up to 90 days to be prescribed and provided by the hospital. Dose as per thromboprophylaxis post elective orthopaedic surgery (10mg daily)
  • 04.11 Rivastigmine caps, oral solution, patches  Mild to moderate dementia in Alzheimer’s disease, in patients that are intolerant to, or do not have a sustained response to, donepezil
    04.07.04.01 Rizatriptan wafers 
    15.01.05 Rocuronium bromide injectiom 
    03.03.03 Roflumilast tablets  Approved as per NICE technology appraisal 461
    09.01.04 Romiplostim injection  Consultant Haematologists specialising in the treatment of ITP only
    04.09.04 Ropinirole tabs restless legs syndrome Immediate release preparation only
    04.09.01 Ropinirole tabs, m/r tabs Parkinson's disease

    15.02 Ropivacaine injection 
    11.08.02 Rose Bengal eye drops 1% 
    02.12 Rosuvastatin tabs  Initiation on the recommendation of a Consultant in the Lipid Clinic, Diabetes Unit, HIV Unit or Cardiology only Restricted to use for:
  • Familial hyperlipidaemia (FH), where other statins have failed to achieve a >50% fall in LDL cholesterol. These patients should be under the care of a lipid clinic
  • Second line for patients requiring ‘high intensity statin’ post ACS, with contraindications or drug interactions that prevent the use of high doses of atorvastatin
  • Third line for patients with CVD or diabetes requiring substantial falls in cholesterol to achieve the minimum QoF audit standard (total cholesterol <5mmol/L and LDL <3mmol/L) with previous failure to tolerate up titrated doses of / or max doses of atorvatatin, and where pravastatin is unlikely to deliver the lipid lowering potency required to reach these target levels
  • 04.01.01 Rotigotine patch REM behaviour disorder - off-label

    Approved off-label indication:

    • REM behaviour disorder in adults

    Usual dose = 1 mg - 3 mg /24hr patch daily

    Sleep centre initiation only

    Refer to SE London APC recommendation and pathway (links below) for further detail

    04.09.01 Rotigotine patches Parkinson's disease

    SPECIALIST INITIATION ONLY

    Treatment of the signs and symptoms of early-stage idiopathic Parkinson’s disease as monotherapy (i.e. without levodopa) or in combination with levodopa (i.e. over the course of the disease) through to late stages when the effect of levodopa wears off or becomes inconsistent and fluctuations of the therapeutic effect occur.

    04.09.04 Rotigotine patches restless legs syndrome

    Restricted to use in restless legs syndrome in patients where who have experiences augmentation of symptoms with oral dopamine agonists or where there is a predominant presence of daytime symptoms

    08.01.05 Ruxolitinib tabs 

    Approved for use as per NICE technology appraisal guidance (see links below):

    02.05.05 Sacubitril and valsartan tabs 

    Heart failure specialist initiation only

    Follow SE London APC prescribing guidance and NICE TA388

    13.07 Salactol® paint salicylic acid 16.7%, lactic acid 16.7%
    13.07 Salatac® gel salicylic acid 12.0%, lactic acid 4.0%
    03.01.01.01 Salbutamol aerosol inhaler, easyhaler, nebules, injection, m/r tablets, oral solution 
    07.01.03 Salbutamol injection  Use in accordance with local guidelines
    13.06.01 Salicylic acid 2% w/w and sulphur 2% w/w in aqueous cream 

    BAD/APC approved Special

    For scaly, inflamed conditions of the face or scalp, such as treatment of seborrhoeic dermatitis.

    13.04.03 Salicylic acid 5% w/w / propylene glycol 47.5% w/w in Dermovate®cream 

    BAD/APC approved Special

    For use on the palms and/or soles for hyperkeratotic eczema, palmoplantar pustulosis and psoriasis which has not responded to Dermovate and emollients alone.

    13.05.02 Salicylic acid in emulsifying ointment 1%, 3%, 30%, 50%, 70% 

    APC approved Special

    For hyperkeratotic psoriasis, hyperkeratotic eczema, viral warts, lichen simplex, ichthyosis, keratodermas, callus, keratosis pilaris and other hyperkeratotic conditions where emollients and commercial preparations are ineffective only.

    13.05.02 Salicylic acid in emulsifying ointment 2%, 5%, 10%, 20% 

    BAD/APC approved Special

    For hyperkeratotic psoriasis, hyperkeratotic eczema, viral warts, lichen simplex, ichthyosis, keratodermas, callus, keratosis pilaris and other hyperkeratotic conditions where emollients and commercial preparations are ineffective only.

    13.07 Salicylic acid in WSP 5%  May be used on an ad-hoc basis for
    any skin condition for its keratolytic
    effect
    09.05.01.01 Sandocal® 1000 effervescent tabs 
    09.08.01 Sapropterin tabs 

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

    05.03.01 Saquinavir caps, tabs 
    10.01.03 Sarilumab pre-filled pen or syringe  Approved as per NICE Technology Appraisal guidance
    01.09.04 Secretin ampoules  Diagnostic agent for pancreatic disease
    10.01.03 Secukinumab injection ankylosing spondylitis & psoriatic arthritis Approved as per NICE technology appraisal guidance
    13.05.03 Secukinumab injection psoriasis

    Approved as per detail in SE London APC Psoriasis Biological Drug Treatment Pathway (link below)

    03.01.02 Seebri Breezhaler® dry powder inhaler glycopyrronium
    04.09.01 Selegiline hydrochloride tabs, liquid  SPECIALIST INITIATION ONLY
    09.05.05 Selenium oral solution  Selenium deficiency in patients with recessive dystrophic bullosa (RDEB)
    13.10.02 Selenium sulphide shampoo 2.5% Selsun®

    Approved off-label indication:

    Pityriasis versicolor

    13.05.02.01 Selsun® shampoo selenium sulphide 2.5%
    01.06.02 Senna granules 
    01.06.02 Senna tabs, syrup 
    06.05.01 Sermorelin injection 
    04.01.01 Sertraline tabs Non-REM parasomnia - off-label

    Approved off-label indication:

    • Non-REM parasomnia in adults

    Usual dose = 25 mg to 150 mg daily

    Sleep centre initiation only

    Refer to SE London APC recommendation and pathway (links below) for further detail

    04.03.03 Sertraline tabs licensed use

    09.05.02.02 Sevelamer carbonate tabs, sachets  Note: sachets approved for patients with swallowing difficulties only
    15.01.02 Sevoflurane volatile liquid anaesthetic use

    RESTRICTED USE AT KCH

    15.01.02 Sevoflurane volatile liquid refractory acute severe asthma - off-label

    Approved off-label indication:

    • Refractory acute severe bronchospasm or asthma in the ICU where all agents on the BTS guideline have failed
    02.05.01 Sildenafil tabs as 25mg tablets

    Approved off-label indication:

    Raynaud’s secondary to scleroderma in patients that are contraindicated to or have failed other treatment options

    • Use in accordance with local guideline
    • RESTRICTED USE – CONSULTANT SPECIALISTS ONLY
    07.04.05 Sildenafil tabs  First-line PDE5 inhibitor for the treatment of erectile dysfunction
    02.05.01 Sildenafil tabs - generic Fontan circulation - off-label

    Approved off-label indication:

    Patients with a failing Fontan circulation

    Restricted use in patients where there is a suggestion of segmental pulmonary arterial hypertension or failing Fontan only after full discussion and approval from the pulmonary hypertension and congenital heart disease MDT.

    Dose = Sildenafil 12.5mg to 100mg three times a day.

    Only generic sildenafil tablets should be supplied for this indication.

    02.05.01 Sildenafil tabs -