netFormulary
 Report : A-Z of formulary items 24/11/2017 03:34:43
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Section Name Details
13.08.01 5-Flurouracil cream  Efudix®
05.03.01 Abacavir 
05.03.01 Abacavir and Lamivudine Kivexa® High Cost Therapy excluded to tariff
06.01.01.02 Abasaglar®  A Biosimilar of Insulin Glargine.
MUST BE PRESCRIBED BY BRAND NAME Recommended in LLR for new patients and those undergoing review of therapy.
10.01.03 Abatacept   Specialist Rheumatology use only
High cost drug excluded to tariff Date of entry of decision to Formulary: July 13 (TA 280)
04.10 Acamprosate  Alcohol dependance
02.08.02 Acenocoumarol  Red traffic light status for new patients but existing patients can continue to be supplied by primary care
11.06 Acetazolamide Slow-release capsules  Often better tolerated but are more expensive than the tablets.
11.06 Acetazolamide Tablets  Used to lower intra-ocular pressure by reduction of aqueous humour production. Usually used on a short-term basis as it has less effect with long-term use; it should only be used long-term in exceptional cases. If used long term appropriate monitoring of electrolytes is recommended.
20 Acetylcysteine   Supported by TAS May 2005 To avoid renal impairment following the use of contrast media
11.08.01 Acetylcysteine 10%  (Preservative free)
11.03.03 Aciclovir Eye Ointment 
13.05.02 Acitretin  For use by Specialist Dermatologists only Pregnancy prevention precautions required
03.01.02 Aclidinium / Formoterol  Duaklir Genuair® Dry Powder Inhaler (DPI) COPD. LAMA /LABA combination for use in line with local guidance only
03.01.02 Aclidinium Bromide  Eklira Genuair® Dry Powder inhaler (DPI) For patients who cannot manage the tiotropium device and in patients with renal impairment (as per Leicestershire Guidance )
13.08.01 Actikerall®  Fluorouracil 0.5%, salicylic acid 10%
06.01.01.01 Actrapid®  Only available in 10ml vials. IV Monograph available through 'Injectable Medicines Guide' link on front page of INsite.
01.05 Adalimumab Gastroenterology Specialist use only in line with NICE TAs below CCG commissioned Date decision added to Formulary: Ulcerative Colitis - May 15
10.01.03 Adalimumab Rheumatology Specialist Rheumatology use only.
High cost drug excluded to tariff For use only in line with NICE TA 130 (RA), TA 383 (AS and non-radiographic axial spondyloarthritis), TA 199 (PSA) and TA 195 (Following failure of a TNF) See links below
13.05.03 Adalimumab Dermatology High Cost Drug excluded to tariff Supported for use in psoriasis in line with NICE TA 146 Also supported for patients with severe hidradentis suppuritiva in line with NICE TA 392 Date of entry of decision to Formulary:September 2016. (Blueteq required) Specialist Dermatology use only
20 Adalimumab (Immunology)  Behcet’s Disease restricted to specialist immunology use only. Off label use
13.06 Adapalene Differin® Topical At UHL initiation by specialist dermatologists only.
09.05.02.02 Adcal®  3rd Choice
09.06.04 Adcal-D3 Dissolve®  Each tablet contains 600mg elemental calcium plus 400iu of vitamin D3 Soluble preparation if both calcium and vitamin D supplementation is required. Reserve for those not able to take chewable preparations as more costly.
09.06.04 Adcal-D3®  Use if both calcium and vitamin D supplementation is required. Each chewable tablet contains 600mg elemental calcium plus 400iu of vitamin D3 with a dose of one twice a day. Also available as a caplet which contains 300mg elemental calcium plus 200iu of vitamin D3 with a dose of two caplets morning and evening.
02.03.02 Adenosine  May cause bronchospasm - avoid in asthmatics. Warn all patients of flushing and a tight feeling in the chest.
13.01 Advasil Conoform®  For the treatment of hypertrophic scars, in line with guidance
11.08.02 Aflibercept  Eylea® For specialist ophthalmology use only in line with NICE TA 294 for wet ARMD / NICE TA 305 for central retinal vein occlusion / NICE TA 409 for branch retinal vein occlusion and NICE TA 346 for Diabetic Macular Oedema High cost drug excluded to tariff. CCG commissioned Date of entry of decision to Formulary: Branch RVO - December 2016 DMO - October 2015 Central RVO - April 2014 ARMD - February 2014
20 Ajmaline   For provocation testing in Brugada syndrome

Specialist cardiology use only in adult and paediatric patients
08.02.04 Alemtuzumab  Supported by TAS in line with NICE TA 312. Blueteq prior approval required before initiation Date decision added to Formulary: August 14
20 Alemtuzumab   For Graft versus Host Disease
06.06.02 Alendronic Acid  70mg weekly for Osteoporosis.
06.06.02 Alendronic Acid effervescent tablet Binosto® Osteoporosis treatment only for patients who cannot swallow alendronic acid tablets. Not for use in patients with a feeding tube
09.06.04 Alfacalcidol  Capsules, oral drops. For treatment of osteodystrophy resulting from renal failure; more potent than calciferol and has a shorter onset and offset of action, making it useful for acute deficiencies. Prescribe as One-Alpha® as non-proprietary capsules more costly.
15.01.04 Alfentanil  Pain management in severe renal impairment in line with palliative care guidance only
15.01.04.03 Alfentanil Rapifen®
02.12 Alirocumab  Praluent® For use by the lipid clinic only. Approved in line with NICE TA 393 (added September 2016)for treating primary non-familial hypercholesterolaemia and mixed dyslipidaemia and primary heterozygous familial hypercholesterolaemia
02.05.05.03 Aliskiren  Aliskiren is available for treatment of hypertension if initiated by appropriate specialists at UHL. GPs may continue prescribing under shared care.
13.05.01 Alitretinoin  Toctino® Specialist dermatologist prescription only. Use supported only in line with NICE TA 177 Pregnancy prevention precautions required High Cost Therapy excluded to tariff.
10.01.04 Allopurinol  Allopurinol and its metabolites are renally excreted and may accumulate if kidney function is impaired. In severe renal insufficiency, it may be advisable to use less than 100 mg per day or to use single doses of 100mg at longer intervals than one day.
06.01.02.03 Alogliptin   DPP-4 inhibitor. Use only as recommended in NICE guidance. Dosage adjustment required in renal impairment. Lower cost preparation.
02.10.02 Alteplase  For use in selected specialist situations including stroke and massive PE. Date of entry of decision to Formulary: September 2012
13.12 Aluminium chloride Driclor® At UHL initiation by specialist dermatologists only
04.09.01 Amantadine 
02.02.03 Amiloride 
03.01.03 Aminophylline  Intravenous use for severe bronchospasm, which has not responded to nebulised salbutamol in asthma or chronic obstructive pulmonary disease (COPD). IV Monograph available through 'Injectable Medicines Guide' link on front page of INsite.
02.03.02 Amiodarone  May be used for all types of paroxysmal tachycardia and atrial or ventricular fibrillation refractory to standard therapy. It is also effective in Wolff-Parkinson-White syndrome. The lowest effective dose should be used for maintenance and careful follow up of patients is mandatory. IV administration allows more rapid loading; with oral therapy the full response may take a week or more to develop. It has a long clearance half-life (several weeks), and intervals of at least 6-8 weeks should be allowed to assess the effect of dosage adjustments during long-term therapy. Its use is limited by potential multiple adverse drug reactions. IV Monograph available through 'Injectable Medicines Guide' link below.
04.02 Amisulpride 

For use on the advice of a specialist in psychiatry.

04.07.04.02 Amitriptyline  Useful for mixed presentation headache. Nortripyline is a less sedative alternative used by local specialists although there is no formal evidence of efficacy; it is more costly than amitriptyline. Use with caution in the prison environment.
02.06.02 Amlodipine  Greater effect on vascular smooth muscle than in the heart and tend not to cause clinical deterioration in heart failure.
09.01.05 Anagrelide 
08.03.04.01 Anastrozole 
09.01.03 Antilymphocyte immunoglobulin (rabbit)  High cost drug excluded to tariff commissioned by NHSE in line with BCSH guidelines only
02.11 Antithrombin III (Kybemin®)   Available only with the agreement of the Haematology Specialist Registrar or Haematology Consultant.
08.02.02 Antithymocyte immunoglobulin (rabbit)  Specialist use only
High cost drug excluded to tariff, commissioned by NHSE in line with BCSH Guidelines only
01.07 Anusol  Anusol is safe and inexpensive and may help to relieve the symptoms associated with haemorrhoids such as pruritus and soreness
02.08.02 Apixaban  For Atrial Fibrillation (AF) use inline with the Leicestershire Algorithms. Date of entry of decision to Formulary: May 2013
02.08.02 Apixaban  For DVT and /or PE use in line with NICE TA 341 only Date of entry of decision to formulary: September 2015
04.09.01 Apomorphine  For use in Parkinson's disease in line with shared care agreement
11.06 Apraclonidine Iopidine®
10.01.03 Apremilast   Supported in line with NICE TA 433 Date of entry of decision to formulary: May 2017
13.05.02 Apremilast  For use by Specialist Dermatologists only Supported for use in line with NICE TA 419 Date of entry of decision to formulary: February 2017
02.08.01 Argatroban  Specialist renal use only. For treatment of HIT or suspected HIT in patients with renal impairment (CrCl <20 ml/min) For CrCl 20-50 ml/min, discuss with an haemostasis and thrombosis clinician
06.05.02 Argipressin  Alternative choice for bleeding oesophageal varices. Administer infusion via a large vein (avoid extravasation as high risk of tissue necrosis) Also supported for use in myomectomy - specialist use only
04.02 Aripiprazole I.M.  Intramuscular preparation available for Rapid Tranquilisation only.
04.02.02 Aripiprazole long-acting injection Abilify Maintena® Specialist in Psychiatry Initiation only
04.02 Aripiprazole Oral  For bipolar disorder restricted to use in line with NICE TA In Schizophrenia as an option if quetiapine causes problems with prolactin, aripiprazole is the drug of choice in these circumstances. Date of entry of decision to Formulary:July 2013
09.06.03 Ascorbic Acid Tablets 
02.09 Aspirin 
04.07.04.01 Aspirin  Available as a soluble tablet which acts more rapidly than standard formulations.
10.02 Ataluren Translarna Duchenne muscular dystrophy in line with NICE HST3
05.03.01 Atazanavir . High Cost Therapy excluded to tariff
05.03.01 Atazanavir with Cobicistat Evotaz® High Cost Therapy excluded to tariff
02.04 Atenolol  Intravenous and liquid preparations available Existing patients can continue receiving tablets UHL also use in post natal patients if not breast feeding
04.04 Atomoxetine  Specialist paediatric initiation only.
02.12 Atorvastatin  20mg once daily 1st choice in line with LMSG guidance
07.01.03 Atosiban   Pre term labour
11.05 Atropine Sulphate  Atropine eye drops or single use eye drops. Used to prevent posterior synechiae in uveitis and iridocyclitis. The effects of atropine can last for up to 14 days. Systemic toxicity from atropine absorption occurs quite often, especially in elderly or very young patients. In particular elderly patients may become confused.
13.02.01 Aveeno Cream®   For use in line with ACBS criteria only. For endogenous and exogenous eczema, xeroderma, ichthyosis and senile pruritus associated with dry skin
13.05.03 Azathioprine  Specialist Dermatology initiation only
13.06 Azelaic Acid 20% Cream Skinoren® Topical At UHL initiation by specialist dermatologists only.
05.01 Aztreonam Cayston® For nebulisation in Cystic Fibrosis. NHSE commissioned
01.05 Balsalazide  Second line in patients not responding to Octasa, particularly with left sided colitis. Specialist initiation only
08.02.02 Basiliximab  Specialist prescribing only in Renal Transplant in line with NICE TA 85 and TA 99
High cost drug excluded to tariff, NHSE commissioned
03.02 Beclometasone Dipropionate Clenil Modulite® CFC-free first choice for children (5-12). For use with Volumatic spacer device
03.02 Beclometasone Dipropionate Qvar® For asthma in over 12 year olds (Use Clenil in children). Markedly better lung deposition and dose is equivalent to approximately twice the dose of CFC–containing inhalers or Clenil. Prescribe by brand.
12.02.01 Beclometasone Nasal Spray 
13.06 Benzoyl Peroxide  Topical
11.04.01 Betamethasone 0.1% with neomycin 0.5% eye drops  Maxitrol can be used if an ointment is required. (Maxitrol eye ointment contains: dexamethasone 0.1% + neomycin sulphate + polymyxin B sulphate) Green traffic light only applies to prescriptions that do not exceed 7 days. January 16 – There is a short term shortage of Maxitrol eye ointment. An alternative steroid eye ointment to prescribe (but without the antimicrobial component) would be betamethasone 0.1% eye ointment for those people where betamethasone 0.1% + neomycin 0.5% eye drops is not appropriate.
13.04 Betamethasone Esters 0.025% Betnovate-RD® Moderately potent.
13.04 Betamethasone Esters 0.1% Betnovate® Potent.
11.06 Betaxolol Hydrochloride  Cardioselective and is slightly less likely to cause bronchospasm in asthmatics. It is also the preferred beta-blocker where a patient has known cardiovascular problems such as AV block, although its effect should still be monitored.
11.08.02 Bevacizumab   Supported by TAS December 2011 for retinopathy of prematurity either first line or as a second line rescue treatment.
High cost drug excluded to tariff
02.12 Bezafibrate  More expensive than fenofibrate.
11.06 Bimatoprost 100 micrograms/ml Lumigan® For use only if patient unable to use single use unpreserved unit doses of bimatoprost 300 micrograms/ml
11.06 Bimatoprost 300 micrograms/ml Lumigan® 3ml eye drop bottles will be discontinued. Please use 'unpreserved unit doses' in their place.
11.06 Bimatoprost 300micrograms/ml and timolol 5mg/ml Ganfort® If a combination product is considered appropriate
12.03.05 BioXtra®  Product of choice to replace Glandosane and Biotene (with the exception stated above)
01.06.02 Bisacodyl  Has a more purgative action than senna. Available in suppository form for rectal use
02.04 Bisoprolol Fumarate 
05.03.03 Boceprevir  Specialist prescribing in Hepatitis C
Commissioned by NHSE in line with NICE TA 253 only Date of entry of decision to Formulary: May 2012 Use superceded by newer drugs for Hepatitis C
20 Bosentan (Rheumatology)  For severe digital ulceration in scleroderma /
Raynaulds restricted to initiation by consultant Rheumatologists.
04.07.04.02 Botulinum Toxin Type A   Botulinum Toxin Type A in line with the NICE TA260 A request form should be completed, see link below. Date of entry of decision to Formulary: September 2012
04.09.03 Botulinum Toxin Type A / B Botox® / Neurobloc® / Xeomin® Supported by Therapeutic Advisory Service and funding supported by Commissioners for
Spasticity - post stroke, Multiple Sclerosis, traumatic or medical brain injury, hereditary spastic paraparesis.
Dystonia - includes cervical dystonia, hemifacial spasm and blepharospasm, tic in ophthalmology.
Bladder - neuropathic bladder, bladder instability, refractory detrusor overactivity, urge incontinence.
Anismus.Anal fissure unresponsive to GTN/ diltiazem ointment
NOT supported for chronic constipation in children

Commissioning policy in development. Dysport® should be reserved for use in a) ophthalmology for use in extra ocular muscles b)patients already on therapy who had previously not responded to Botox®
07.03.01 Brevinor® 
11.06 Brimonidine Tartrate  May have a lower incidence of side effects than dipivefrine. It should not be used with antidepressants that interfere with noradrenaline uptake, monoamine-oxidase inhibitors (MAOIs) or antihypertensives.
13.06 Brimonidine Tartrate Gel   For rosacea At UHL for initiation by Dermatologists only
11.06 Brimonidine with timolol Combigan® May be used when three or more eye drop preparations are required to control the condition
11.06 Brinzolamide  Topical use. Almost as effective as treatment with acetazolamide with much reduced systemic side effects. Incidence of topical side effects is relatively low.
11.06 Brinzolamide with brimonidine  Simbrinza® May be used when three or more eye drop preparations are required to control the condition
11.06 Brinzolamide with timolol Azarga® May be used when three or more eye drop preparations are required to manage the condition
04.08.01 Brivaracetam  Specialist initiation only. Third line alternative
01.05 Budesonide  May be used in Crohn’s ileitis on specialist advice only. (95% first pass metabolism so less systemic steroid side effects but potent effects on the bowel) Also licensed for autoimmune hepatitis. Budenofalk is the recommended preparation.
03.02 Budesonide Budesonide Easyhaler® or Pulmicort Turbohaler® Easyhaler® 1st choice as per adult asthma guidelines due to cost. Pulmicort® 2nd choice, alternative device as per adult asthma guidelines due to cost.
03.02.02 Budesonide and formoterol Symbicort® Licensed from 6 years for maintenance therapy (SMART programme from 12). First choice in children 6-18 or in over 12s requiring the SMART programme. Symbicort SMART® programme for flexibly adjusting dose – see supporting information (link below) Licensed for this in those 12 years and over. Prescribe by brand as generic preparations available are a different device and are not interchangeable
03.02.02 Budesonide and Formoterol  DuoResp Spiromax® First choice for patients aged 18 years and older. Prescribe by brand as devices are not interchangeable To be used only in new patients or after a review by a healthcare professional and counselling of patient to ensure appropriate use of the device. There is no MART/SMART® equivalent with DuoResp.
01.05 Budesonide foam enema Budenofalk® Budesonide rectal foam. To be used as an alternative to prednisolone enemas. Please note, predisolone enemas are currently significantly more expensive than budesonide
02.02.02 Bumetanide 
04.07.02 Buprenorphine patches  For patients with stable palliative pain and also in patients with stable chronic non palliative pain who can’t tolerate oral morphine.
04.10 Bupropion Hydrochloride  Only available in primary care and STOP clinics The mode of action of bupropion in smoking cessation is unclear but may involve an effect on noradrenaline and dopamine neurotransmission. It should not be used in patients with a history of seizures, acute alcohol or benzodiazepine withdrawal, hepatic cirrhosis, CNS tumour, eating disorders or bipolar disorder.
03.04.03 C1-Esterase Inhibitor  Berinert® High cost drug excluded to tariff. NHSE commissioned
06.07.01 Cabergoline Dostinex® For suppression of lactation post delivery
06.07.01 Cabergoline Dostinex® For Hyperprolactinaemic disorders only
09.06.04 Cacit D3®  Each sachet of granules contains 500mg elemental calcium plus 440iu colecalciferol. Restricted for those who have had sleeve gastrectomy or gastric bypass bariatric procedures.
13.03 Calamine aqueous cream   Prison use only
13.03 Calamine Lotion  Topical. Avoid on dry flaky skin.
09.06.04 Calceos®  Each tablet contains 500mg elemental calcium plus 400iu of vitamin D3 Alternative choice if both calcium and vitamin D supplementation is required.
09.05.02.02 Calcichew®  Calcium carbonate
13.05.02 Calcipotriol  Vitamin D analogue used in plaque psoriasis affecting up to 40% of skin area. It is more acceptable to patients than dithranol because it is less irritant to 'normal' skin, is odourless and non-staining.
13.05.02 Calcipotriol & Betamethasone Cutaneous Foam Enstilar® To be used in line with the primary care psoriasis pathway
09.06.04 Calcium and Ergocalciferol Tablets  Each tablet contains 97mg elemental calcium plus 400iu of vitamin D2 Can be used if low dose vitamin D only required. Calcium content low.
09.05.01.01 Calcium Gluconate Injection  For acute hypocalcaemia with tetany. Monitor serum-calcium level if more than 10mL is given. Monitor ECG. Do not administer calcium salts in the same intravenous line as bicarbonate solutions.
09.05.01.01 Calcium Gluconate Tablets  1.35mmol/54mg calcium per tablet.
09.02.01.01 Calcium Polystyrene Sulphonate Calcium Resonium® Monitor serum-calcium as patients with chronic renal failure may experience a sudden rise in serum-calcium.
09.05.01.01 Calcium-Sandoz®  Syrup 2.7mmol/108mg calcium in 5mL
06.01.02.03 Canagliflozin Invokana® Canagliflozin should be considered when dapagliflozin and empagliflozin are not suitable or not tolerated Green Traffic Light when used as monotherapy in line with NICE TA 390. Primary care initiation conditional on appropriate competency. Otherwise simple amber Amber Traffic Light Simple amber when used in combination therapy in line with NICE TA 315. Date decision added to Formulary: April 17
02.05.05.02 Candesartan  Hypertension and heart failure but is more expensive than losartan.
10.03.02 Capsacin cream 
  • Green Traffic Light For use in line with NICE CG173 for management of neuropathic pain
  • Green Traffic Light For use in line with NICE CG17 for management of Osteoarthritis
  • 10.03.02 Capsaicin Patch Qutenza® Supported for use by the pain clinic only. For use only in patients with peripheral neuropathic pain (non-diabetic) who have tried and not responded to other pain relief - amitriptyline, gabapentin, pregabalin, duloxetine, oxycodone, tramadol and lidocaine patch

    CCG agreement for pass through payment agreed locally
    04.02.03 Carbamazepine  Specialist in Psychiatry Initiation only.
    04.08.01 Carbamazepine  Alternative for focal (partial) epilepsy and useful if rapid titration is required but is generally less well tolerated.
    06.02.02 Carbimazole  Typical starting doses: Free T4 >30 - Carbimazole 40mg once daily (2x20mg tablets) for 1 month then reduced to 20mg once daily with repeat thyroid function tests at 6 weeks. Free T4 <30 - Carbimazole 20mg once daily.
    03.07 Carbocisteine  May reduce exacerbations in some patients with chronic obstructive pulmonary disease and a chronic productive cough. Therapy should be stopped if there is no benefit after a 4-week trial.
    11.08.01 Carbomers 980 0.2% Gel Clinitas Carbomer Gel® Helps to form a tear film. (Contains cetrimide)
    11.08.01 Carmellose 0.5% plus sodium hyaluronate 0.1% Optive Fusion® (contains purite)
    11.08.01 Carmellose 1% PF Drops® Carmellose 1% (Preservative free)
    02.04 Carvedilol  For use in heart failure only. Initiation and titration should be by a health care professional with experience in managing heart failure.
    07.03.02.01 Cerazette®  Due to cost should be reserved for those who find it difficult to adhere to the strict regime of established POPs
    10.01.03 Certolizumab pegol  Specialist Rheumatology use only
    High cost drug excluded to tariff. Use in line with NICE TA 383 (AS and non-radiographic axial spondyloarthritis), NICE TA 375 and NICE TA 415(Rheumatoid Arthritis) Latter added January 2017 Use in line with NICE TA 445 for psoriatic arthritis. Date of entry to formulary July 17
    13.03 Cetirizine  Systemic. Relatively non-sedating, but in some cases of pruritus it may be less effective than a sedative.
    03.04.01 Cetirizine Hydrochloride  Non sedating
    11.03.01 Chloramphenicol. (Eye drops or Ointment)  Effective, broad-spectrum agent, which may be used for "blind" treatment of infections without increasing resistance to the usual systemic antibiotics. The risk of systemic side effects e.g. agranulocytosis is considered to be extremely small. Also useful for the prevention of opportunistic infections following minor trauma to the eye surface. Eye drops should be stored in the fridge.
    03.04.01 Chlorphenamine injection  Useful as an adjunct to adrenaline in the emergency treatment of anaphylaxis
    03.04.01 Chlorphenamine Maleate  Short-term treatment of acute allergic reactions such as drug rash, insect bites and urticaria. Less effective in rhinitis. Use limited by sedation and psychomotor impairment making it unsuitable as a long-term treatment or in daytime activities such as driving.
    13.03 Chlorpheniramine  Systemic. Sedating.
    03.02 Ciclesonide Alvesco® Restricted to use by Respiratory medicine. For use in patients unable to tolerate other steroid inhalers due to oral thrush
    13.05.03 Ciclosporin  Specialist Dermatology initiation only
    11.08.01 Ciclosporin ophthalmic emulsion  Ikervis® Specialist ophthalmologist initiation for use in line with NICE TA 369 only for treating severe keratitis in adult patients with dry eye disease that has not improved despite treatment with tear substitutes. Date of entry of decision to Formulary: March 2016
    07.03.01 Cilest® 
    09.05.01.02 Cinacalcet   Cinacalcet is used for the treatment of secondary hyperparathyroidism in patients with end stage renal disease on maintenance dialysis therapy in line with NICE TA 117 only. It is restricted to initiation by a specialist nephrologist. High cost drug excluded to tariff for this indication only, commissioned by NHSE
    09.05.01.02 Cinacalcet   For complex primary hyperparathyroidism in adults in line with NHSE policy only.
    High cost drug excluded to tariff for this indication, commissioned by NHSE.
    04.06 Cinnarizine + Dimenhydrinate  Arlevert® For dizziness in Meniere's Disease use only when other medical therapies have failed
    11.03.01 Ciprofloxacin Eye Ointment   Restricted for use in patients who experience adverse effects with chloramphenicol
    04.03 Citalopram  Cost effective choice in patients where QT interval prolongation is not an issue (see MHRA advice below for detail) Maximum daily dose 40 mg for adults; 20 mg for patients older than 65 years; and 20 mg for those with hepatic impairment. Also licensed for panic disorder
    04.03.03 Citalopram 
    06.04.01.01 Climagest®  Sequential combined HRT for women with an intact uterus Now discontinued - Elleste Duet is the alternative choice
    06.04.01.01 Climaval®  Unopposed oestrogen only. For hysterectomised women and non-hysterectomised women following individual risk / benefit assessment. Now discontinued - Elleste Solo is an alternative choice
    13.06 Clindamycin plus Tretinoin Treclin® Topical. Contains retinoid and clindamycin Second line to Epiduo
    04.08.01 Clobazam 
    13.04 Clobetasol Propionate 0.05% Dermovate® Very potent.
    13.04 Clobetasone Butyrate 0.05% Eumovate ® Moderately potent.
    04.03 Clomipramine  For initiation by or on the advice of a specialist in psychiatry. For OCD only in line with NICE CG 31. Not recommended as an initial choice for non specialists.
    04.08.01 Clonazepam  Myoclonic jerks or seizures.
    04.08.01 Clonazepam 
    02.09 Clopidogrel  In line with guidance from the Royal College of Physicians’, LMSG recommends that clopidogrel at a dose of 75mg daily (following initial 300mg loading dose) is used for stroke and TIA patients in sinus rhythm. See link below
    13.10.02 Clotrimazole  Topical treatment.
    04.02 Clozapine  For use on the advice of a specialist in psychiatry.
    Treatment resistant schizophrenia. Classified RED i.e. not suitable for GP prescribing

    13.05.02 Coal tar & salicylic acid cream LPS (150g) 
    13.05.02 Coal tar and salicylic acid ointment LPS (200g) 
    02.02.04 Co-amilofruse 5/40  Amiloride 5mg with furosemide 40mg Proprietary brands are more costly
    02.02.04 Co-amilozide 5/50  Amiloride 5mg with hydrochlorothiazide 50mg; (Moduretic)
    04.09.01 Co-beneldopa   Cheaper than co-careldopa and should be tried first as there is no evidence of benefit of one over the other.
    04.09.01 Co-careldopa  More expensive than co-beneldopa. Reserve for patients who are currently stabilised on it and for patients who don’t respond or tolerate co-beneldopa.
    01.06.02 Co-danthramer  A combination of a stimulant laxative (danthron) and a softening agent (poloxamer 188) which acts within 6-12 hours. It should only be used in terminally ill patients because it is potentially carcinogenic.
    01.04 Codeine Phosphate  Avoid long term use due to possible tolerance/ dependence. Do not use in conditions where inhibition of peristalsis should be avoided, where abdominal distension develops, or in acute diarrhoeal conditions such as ulcerative colitis or antibiotic-associated colitis. Caution: Abuse potential in prisons.
    04.07.02 Codeine Phosphate  15mg and 30mg tablets. Caution: Abuse potential in prisons.
    10.01.04 Colchicine  Acute gout, where NSAIDs are not suitable e.g. those with heart failure, renal impairment or taking anticoagulants. Adverse effects frequently limit its use. In difficult or resistant cases seek specialist advice.
    09.06.04 Colecalciferol  Colecalciferol (vitamin D3) preparations are normally first choice, if oral treatment / supplementation is required for deficiency or insufficiency. Some of these preparations hold a UK marketing license e.g. Fultium-D3, however a number of products are unlicensed. Take care when prescribing twice weekly preparations as there have been reports locally of patients taking these daily despite being informed of correct dosage frequency
    01.09.02 Colesevelam  For bile acid malabsorption (off label use) second line choice for patients who cannot tolerate colestyramine. Specialist gastroenterology initiation only.
    20 Colesevelam   Bile Acid Malabsorption
    Specialist gastroenterology initiation with suggested red traffic light status. Awaiting LMSG traffic light endorsement. Off label use for this indication
    01.09.02 Colestyramine  May help when diarrhoea is associated with bile acid malabsorption, for example due to ileal disease or resection. May reduce absorption of warfarin, digoxin and other drugs. Give these one hour before or 4 hours after colestyramine
    05.01 Colistimethate sodium  Colomycin® powder for reconstitution for nebulisation. Promixin® powder for nebuliser solution. Please ensure colistimethate is prescribed and dispensed by brand. Due to the devises they are used with, they may not be interchangeable.
    Used in bronchiectasis and cystic fibrosis. Latter is high cost drug excluded to tariff, NHSE commissioned.
    Specialist Respiratory prescribing
    See Antimicrobial website for further details
    05.01 Colistimethate sodium  Colobreathe® Dry powder for inhalation, hard capsule For use in cystic fibrosis in line with NICE TA 276 only. High cost drug excluded to tariff, NHSE commissioned. Specialist Respiratory prescribing. Date of entry of decision to Formulary: April 2013
    10.03.01 Collagenase   Specialist use only in line with NICE TA 459 Date of entry of decision to formulary: October 2017
    01.01.01 Co-magaldrox 195/220 (magnesium hydroxide with aluminium hydroxide mixture) Mucogel® Sugar free, low sodium content and suitable for the majority of patients including those with cardiac or hepatic failure. Use with caution in severe renal impairment as aluminium and magnesium may accumulate
    06.04.02 Combodart ®(Dutasteride + Tamsulosin)  In line with pathway
    09.02.02.01 Concentrated Potassium Chloride in ampoules  Restricted in availability to intensive care areas, as it is a high-risk product. It should never be given undiluted. If it is added to IV fluids, thorough mixing is essential to avoid inadvertent administration of high concentrations.
    06.03 Corticosteroids 
    13.03 Crotamiton cream Eurax® Topical.
    04.06 Cyclizine  If nausea or vomiting is unresponsive. Cyclizine has antihistaminic and anticholinergic actions, which may be additive to the other agents listed. Sedative at higher doses.
    11.05 Cyclopentolate Hydrochloride Eye drops.  Longer duration of action, reaching its maximal effect in 30-60 minutes. This lasts for about 45 minutes; complete recovery may take up to 24 hours. It can be used for visualisation of the fundus, refraction studies, or in the treatment of iridocyclitis if the patient is allergic to atropine
    02.08.02 Dabigatran etexilate  For Atrial Fibrillation (AF) use inline with the Leicestershire Algorithms.
    02.08.02 Dabigatran etexilate   Available on request for DVT and PE.
    Use in line with NICE TA 327 Date decision added to Formulary: February 2015
    05.03.03 Daclatasvir   Specialist prescribing in Hepatitis C Commissioned by NHSE in line with NICE TA only Blueteq prior approval required before initiation Date of entry of decision to formulary: February 2016
    08.02.04 Daclizumab   Supported by TAS in line with NICE TA 441 Blueteq prior approval required before initiation Date decision added to Formulary: July 17
    02.08.01 Dalteparin Sodium Fragmin®
    06.01.02.03 Dapagliflozin   Green Traffic Light for use in monotherapy in line with NICE TA 390 Conditional green for use in line with NICE TA 288 as part of combination therapy. Primary care initiation conditional on appropriate competency. Otherwise simple amber Date of entry of decision to Formulary: July 2013
    09.01.03 Darbepoetin Alfa  Aranesp® Specialist prescribing only
    High cost drug excluded to tariff commissioned by NHSE for renal dialysis only, including via outpatients, and only as per NICE NG8
    05.03.01 Darunavir  High Cost Therapy excluded to tariff 2nd line Protease Inhibitor (PI) in patients who have failed at least one PI containing regimen. Recommended to be used in preference to tipranavir where both are an option.
    05.03.01 Darunavir with Cobicistat Rezolsta® High Cost Therapy excluded to tariff
    05.03.03 Dasabuvir   Specialist use in Hepatitis C
    NHSE commissioned in line with NICE TA 365 Blueteq prior approval required before intiation
    Date of entry of decision to Formulary: March 2016
    09.01.03 Deferasirox Exjade® Specialist use
    High cost drug excluded to tariff. Commissioned by NHSE for iron chelation in thalassaemia, sickle cell and Myelodysplastic Syndrome (MDS)
    09.01.03 Deferiprone Ferriprox® Specialist use
    High cost drug excluded to tariff. Commissioned by NHSE for iron chelation in thalassaemia, sickle cell and MDS
    08.03.04.02 Degarelix  Where there is an acute need for immediate testosterone suppression. Recommended as an option for treating advanced hormone-dependent prostate cancer in patients with spinal metastases in line with NICE TA 404.
    06.06.02 Denosumab Prolia® Prescribe in line with NICE TA 204 only
    06.06.02 Denosumab Xgeva® Prescribe in line with NICE TA 265 only Date of entry of decision to Formulary: January 2013
    13.02.01 Dermol®  For use by dermatologist only
    09.01.03 Desferrioxamine mesilate  Specialist use
    High cost drug excluded to tariff. Commissioned by NHSE for iron chelation in thalassaemia, sickle cell and MDS
    06.05.02 Desmopressin DDAVP® Metered dose nasal spray , injection Analogue of vasopressin used to treat severe pituitary (cranial) diabetes insipidus. Ineffective in nephrogenic and partial pituitary diabetes insipidus (when thiazides or chlorpropamide may be effective, seek specialist advice). It has duration of action of up to 20 hours allowing once or twice daily dosing.
    06.05.02 Desmopressin acetate  Amber traffic light for Diabetes Insipidus
    06.03.02 Dexamethasone  For disease suppression. Preferred choice in cerebral oedema as it has less mineralocorticoid activity. Also used in vomiting associated with cancer chemotherapy.
    11.04.01 Dexamethasone Maxidex®
    11.04.01 Dexamethasone 0.1% eye drops Maxidex® Green traffic light only applies to prescriptions that do not exceed 7 days.
    11.04.01 Dexamethasone Intravitreal Implant  Ozurdex® Restricted to ophthalmology CCG commissioned in line with NICE TA Date of entry of decision to formulary: DMO - October 2015
    04.04 Dexamfetamine  Specialist paediatric initiation only.
    06.01.04 Dextrogel ® (oral)  Use if unable to use other forms of oral glucose. Squeeze into the side of the mouth and massage the cheek. Glucose is absorbed from the buccal mucosa. Prescribable by GPs on FP10. Do not use in an unconscious patient as aspiration may occur, with serious consequences. Issued to relatives of patients with a history of serious hypoglycaemia and those who have 'hypoglycaemia unawareness'.
    04.07.02 Diamorphine Hydrochloride (Injection)  Alternative if necessary to give a high dose of opioid via a syringe driver as more soluble than morphine. Schedule 2 Controlled Drug
    04.01.02 Diazepam 
    04.08.02 Diazepam (rectal solution)  Alternative to lorazepam if there is no IV access. Injection by intramuscular route and suppositories are unsuitable due to slow absorption and should not be used.
    10.01.04 Diclofenac  Short term use
    10.01.01 Diclofenac Preparations  Restricted except for short term pre or peri-operative or post-natal use. Recent trial data has shown an increased risk of cardiovascular events in patients treated with diclofenac. One of the Better Care Better Value targets is to reduce the amount of diclofenac prescribed as a percentage of all NSAID prescriptions. Leicestershire primary care has one of the worst ratios in the UK.
  • Contraindicated in patients with established cardiovascular disease. Avoid in patients with risk factors for cardiovascular disease.
  • For patients already taking diclofenac, consider changing to ibuprofen (1200mg per day or less) or naproxen (1000mg per day) if continued use is necessary.
  • 13.08.01 Diclofenac sodium  Solaraze® Primary care product
    Unlikely to be prescribed at UHL
    05.03.01 Didanosine  High Cost Therapy excluded to tariff
    13.04 Diflucortolone Valerate Nerisone®, Nerisone Forte® Nerisone cream and oily cream
    Nerisone Forte oily cream

    At UHL initiation by specialist dermatologists only.
    02.01.01 Digoxin 
    04.07.02 Dihydrocodeine Tartrate  Useful for patients who don’t respond to codeine or who take medicines that prevent codeine from working. Dihydrocodeine syrup 10mg/5ml is available but should only be used if essential as it has a higher acquisition cost than the tablets.
    01.07.04 Diltiazem Cream  For use in patients with anal fissures who do not respond to or cannot tolerate topical glyceryl trinitrate. The cream is available on a named patient basis. This is an unlicensed product but is included in the BNF so is suitable for GPs to prescribe.
    02.06.02 Diltiazem Hydrochloride  Avoid in heart failure because it may further depress cardiac function and cause clinically significant deterioration. Monitor heart rate if co-prescribed with a β-blocker. Prescribe longer acting formulations by brand. Use Angitil SR for twice daily dosing and Viazem XL for once daily.
    08.02.04 Dimethyl Fumarate   Supported in line with NICE TA 320 only. Specialist neurology prescribing Blueteq prior approval required before initiation Date decision added to Formulary: November 2014
    13.10.04 Dimeticone 4% Hedrin® Two treatments 7 days apart.
    07.01.01 Dinoprostone  Propess® For specialist obstetric use only
    02.09 Dipyridamole 
    09.05.01.02 Disodium Pamidronate  Non malignancy
    04.10.01 Disulfiram 
    13.05.02 Dithranol Dithrocream® Very effective but must be applied carefully, as it is very irritant to unaffected skin. Selection of the most appropriate product depends on the severity and the site of the condition. Patients should be advised that dithranol will stain clothing and hair. Start with the lowest strength and gradually progress to higher strengths if necessary, over a period of several weeks. Apply sparingly to the lesions only.
    02.07.01 Dobutamine  Caution in severe hypotension. IV Guide available through 'Injectable Medicines Guide' link on front page of INsite.
    05.03.01 Dolutegravir  High Cost Therapy excluded to tariff Supported in line with NHSE policy only.
    05.03.01 Dolutegravir, Abacavir and Lamivudine Triumeq® High Cost Therapy excluded to tariff Supported in line with NHSE policy only.
    04.06 Domperidone  Acts at the chemoreceptor trigger zone; used for the relief of nausea and vomiting associated with cytotoxic therapy. It is less likely to cause central effects (e.g. sedation and extrapyramidal reactions) because it does not readily cross the blood-brain barrier. It is preferred for patients with Parkinson’s disease or those with a high risk of dystonias. Also has a place in the treatment of non-ulcer dyspepsia. The MHRA has advised that there is a small risk of serious ventricular arrhythmia and sudden cardiac death with domperidone. See link below
    04.11 Donepezil 
    02.07.01 Dopamine Hydrochloride  Contra-indicated in patients with tachyarrhythmias or phaeochromocytoma. IV Guide available through 'Injectable Medicines Guide' link on front page of INsite.
    03.07 Dornase Alfa Pulmozyme® Classified Simple Amber in Leicestershire Traffic Lights For cystic fibrosis. High cost drug excluded to tariff. NHSE commissioned
    11.06 Dorzolamide 
    11.06 Dorzolamide with timolol  Use of generic dorzolamide and timolol eye drops is approved in Leicestershire
    11.06 Dorzolamide with timolol (in unit doses) Cosopt® For use only in patients who require preservative free eye drops and require three or more eye drop preparations to control the condition.
    02.05.04 Doxazosin  Standard release preparation. Modified release preparations are more expensive and offer no clinical advantage over standard release preparations.
    13.06 Doxycyline  Alternative systemic choice to lymecycline
    02.03.02 Dronedarone  MHRA alert below. SCA is being updated to reflect this. Patients already on treatment should have their treatment reviewed at the next routine appointment.
    04.06 Droperidol   Specialist anaesthetics use at UHL as a 3rd line option after cyclizine and ondansetron
    12.03.01 Drugs for oral ulceration and inflammation 
    13.06 Duac gel®  Topical Clindamycin and benzoyl peroxide
    06.01.02.03 Dulaglutide weekly Trulicity® GLP-1 agonist. Once weekly preparation available only in line with NICE NG28 Specialist diabetology initiation at UHL Primary care initiation conditional on appropriate competency. Otherwise simple amber
    07.04.02 Duloxetine  Stress incontinence Also green for use in diabetic neuropathy in line with Leicestershire neuropathic pain guidance
    20 Duloxetine   For Fibromyalgia
    For use by pain clinic only
    02.08.02 Edoxaban  Available on request for treating and preventing DVT and PE in line with NICE: TA 354 Date of entry of decision to formulary: October 2015
    02.08.02 Edoxaban  For Atrial Fibrillation (AF) use inline with the Leicestershire Algorithms. Date of entry of decision to formulary: November 2015
    05.03.01 Efavirenz . High Cost Therapy excluded to tariff
    05.03.01 Efavirenz, Emtricitabine and Tenofovir Disoproxil Atripla® High Cost Therapy excluded to tariff
    05.03.03 Elbasvir and grazoprevir Zepatier® Specialist use in Hepatitis C
    NHSE commissioned in line with NICE TA 413
    Blueteq prior approval required before initiation
    Date of entry of decision to formulary: January 2017
    06.04.01.01 Ellest-Duet Conti®  Continuous combined HRT for women with an intact uterus
    06.04.01.01 Elleste-Duet®  Sequential combined HRT for women with an intact uterus
    06.04.01.01 Elleste-Solo®  Unopposed oestrogen only. For hysterectomised women and non-hysterectomised women following individual risk / benefit assessment.
    09.01.04 Eltrombopag  Specialist haematology initiation only Date of entry of decision to Formulary: October 2013
    05.03.01 Elvitegravir, Cobicistat, Emtricitabine and Tenofovir Alafenamide  Genvoya® High Cost Therapy excluded to tariff
    05.03.01 Elvitegravir, Cobicistat, Emtricitabine and Tenofovir Disoproxil  Stribild®
    06.01.02.03 Empagliflozin   For use in line with NICE TA 336 Primary care initiation conditional on appropriate competency. Otherwise simple amber Date decision added to Formulary: May 15
    05.03.01 Emtricitabine  High Cost Therapy excluded to tariff
    05.03.01 Emtricitabine and Tenofovir Alafenamide Descovy® High cost drug excluded to tariff Restricted, to be used in line with NHSE policy only
    05.03.01 Emtricitabine, Rilpivirine and Tenofovir Alafenamide Odefsey® High cost therapy excluded to tarrif Restricted, to be used in line with NHSE policy only
    05.03.01 Emtricitabine, Rilpivirine and Tenofovir Disoproxil  Eviplera® High Cost Therapy excluded to tariff Only for those intolerant or non responsive to Atripla
    05.03.01 Enfuvirtide  High Cost Drug excluded to tariff
    02.08.01 Enoxaparin Sodium Clexane® For acute coronary syndromes.
    04.09.01 Entacapone  Available as individual component and as combined product.
    Stalevo and Stanek both contain same quantities of carbidopa/entacapone/levodopa.
    UHL currently stocks Stanek
    05.03.03 Entecavir   Specialist prescribing in Hepatitis B
    Commissioned by NHSE in line with NICE TA 153 only
    13.06 Epiduo gel®  Topical Retinoid and benzoyl peroxide
    13.02.01 Epimax®  First choice alternative to Aproderm, Aqueous cream, Aquamax, Diprobase cream, E45 cream, Oilatum cream, ZeroAQS and Zerobase
    24.17 Episil  Paediatric Oncology for severe mucositis after chemotherapy
    Classified as a medical device
    02.02.03 Eplerenone  Evidence supports the use in patients admitted to CCU following an MI with proven left ventricular failure in addition to other treatment. Second line as an alternative to spironolactone in patients who have chronic heart failure or hypertension and suffer from gynaecomastia.
    09.01.03 Epoetin alfa  Binocrit® and Eprex® Specialist prescribing
    High cost drug excluded to tariff commissioned by NHSE for renal dialysis only, including via outpatients, and only as per NICE NG8
    09.01.03 Epoetin beta  Specialist prescribing
    High cost drug excluded to tariff commissioned by NHSE for renal dialysis only, including via outpatients, and only as per NICE NG8
    09.06.04 Ergocalciferol injection  Ergocalciferol injection is restricted for patients unable to tolerate or absorb oral colecalciferol.
    13.06 Erythromycin  Systemic choice in pregnancy.
    04.03 Escitalopram  Green Traffic Light for treatment resistant depression and generalised anxiety disorder only Green Traffic Light All indications except treatment resistant depression and generalised anxiety disorder The MHRA has advised that escitalopram is associated with dose-dependent QT interval prolongation and should not be used in those with: congenital long QT syndrome; known pre-existing QT interval prolongation; or in combination with other medicines that prolong the QT interval. ECG measurements should be considered for patients with cardiac disease, and electrolyte disturbances should be corrected before starting treatment. For escitalopram, the maximum daily dose for patients older than 65 years is now reduced to 10 mg/day.
    04.08.01 Eslicarbazepine 
    06.04.01.01 Estradot®  Unopposed oestrogen only. For hysterectomised women and non-hysterectomised women following individual risk / benefit assessment.
    10.01.03 Etanercept  Rheumatology Specialist Rheumatology use only
    High cost drug excluded to tariff For use only in line with NICE TA 130 (RA), TA 383 (AS and non-radiographic axial spondyloarthritis), TA 199 (PSA) and TA 195 (Following failure of a TNF) See links below
    13.05.03 Etanercept  Dermatology High Cost Drug excluded to tariff Supported in line with NICE TA 103 only Specialist Dermatology use only
    09.05.01.02 Etelcalcetide Parsabiv® High cost drug excluded to tariff. Supported in line with NICE TA 448 only for treatment of secondary hyperparathyroidismin adults with chronic kidney disease on haemodialysis. Specialist renal use only Date decision added to Formulary: October 2017
    04.08.01 Ethosuximide  Alternative to sodium valproate for typical absence seizures.
    15.01 Etomidate  Etomidate-Lipuro® Restricted to anaethetics
    05.03.01 Etravirine   High Cost Therapy excluded to tariff For patients who have resistance to other NNRTI's
    17 Evicel  Fibrin Sealant
    02.12 Evolocumab  Repatha® For use by the lipid clinic only. Approved in line with NICE TA 394 (added September 2016) for treating primary non-familial hypercholesterolaemia and mixed dyslipidaemia and primary heterozygous familial hypercholesterolaemia Use for homozygous familial hypercholesterolaemia is commissioned by NHS England only through established apheresis centres. UHL is not one of these so any request for treatment in this circumstance would need to be referred to one of the following: Central Manchester University Hospitals NHS Foundation Trust; Queen Elizabeth Hospital Birmingham; Royal Brompton and Harefield NHS Foundation Trust; Imperial College NHS Trust and University Hospitals Bristol NHS Foundation Trust.
    06.04.01.01 Evorel®  Unopposed oestrogen only. For hysterectomised women and non-hysterectomised women following individual risk / benefit assessment.
    06.04.01.01 Evorel®Sequi  Sequential combined HRT for women with an intact uterus
    07.03.01 Evra®patch  More costly choice. Reserve as an option for patients with compliance issues with oral combined hormonal contraception
    08.03.04.01 Exemestane 
    06.01.02.03 Exenatide twice-daily Byetta® Twice-daily exenatide is no longer on the formulary for new initiations however may be continued in those who are already benefitting from treatment.
    06.01.02.03 Exenatide weekly Bydureon® GLP-1 agonist. Once weekly preparation available only in line with NICE NG28 Specialist diabetology initiation at UHL Primary care initiation conditional on appropriate competency. Otherwise simple amber
    12.01.03 Exterol®   Ear drops
    Prison use only
    10.01.04 Febuxostat  For use only in line with NICE TA 164 for patients who are intolerant of allopurinol or where allopurinol is contra-indicated.
    07.03.01 Femodene® 
    07.03.01 Femodette® 
    06.04.01.01 FemSeven® Conti Patch  Continuous combined HRT for women with an intact uterus.
    07.03.02.01 Femulen® 
    02.12 Fenofibrate  200mg od dose preferred over other standard regimens as similar efficacy but lower acquisition cost.
    04.07.02 Fentanyl (Patches)  Expensive. Lowest strength patch equivalent to large equivalent dose of oral morphine. Initiation restricted to patients with: Stable palliative pain. Established renal failure in accordance with UHL guidelines. UHL patients with stable chronic non palliative pain on advice of UHL Pain Team. Schedule 2 Controlled Drug
    09.01.01.01 Ferrous Fumarate  210mg (68mg Fe) usual prophylactic dose i daily, treatment dose i 2-3 times daily 322mg (100mg Fe) usual prophylactic dose i daily, treatment dose i twice daily
    09.01.01.01 Ferrous Fumarate Syrup Fersamal® 140mg (45mg iron) /5ml
    09.01.01.01 Ferrous Sulphate  200mg (65mg iron)
    03.04.01 Fexofenadine hydrochloride  For those patients who experience sedation on high doses of other recommended choices only.
    09.01.06 Filgrastim   Specialist use only
    High cost drug excluded to tariff commissioned by NHSE
    06.04.02 Finasteride  
    08.02.04 Fingolimod Gilyena® Specialist Neurology prescribing only in line with NICE TA 254
    High cost drug excluded to tariff (NHSE) Blueteq prior approval required before initiation Date of entry of decision to Formulary: July 2012
    02.03.02 Flecainide  Flecainide is effective in ventricular arrhythmias, but may be particularly useful in junctional arrhythmias including those with an accessory pathway. It should not be used to treat patients with asymptomatic ventricular arrhythmias such as ectopics or non-sustained ventricular tachycardia after myocardial infarction (increased risk of mortality identified).
    17 Floseal  Hemostatic agent
    06.03.01 Fludrocortisone Acetate  Mineralocorticoid for replacement therapy. Required in primary adrenal insufficiency
    04.07.04.02 Flunarizine Sibelium® Unlicensed medication for prophylaxis of migraine in adults. For initiation by secondary care specialist only.
    To be used once other medications have been unsuccessful
    13.04 Fluocinolone Acetonide 0.00625% Synalar 1 in 4 Dilution® Moderately potent.
    11.04.01 Fluocinolone acetonide intravitreal implant  Iluvien Restricted to ophthalmology use in line with NICE TA only Excluded to tariff, CCG funding Date of entry of decision to Formulary: February 2014
    13.04 Fluocinonide 0.05% Metosyn® Potent. Ointment contains lanolin.
    11.08.02 Fluorescein Sodium  Routinely used to detect lesions, such as corneal ulcers and damage caused by foreign bodies. It is non-irritant and washes away from undamaged tissues with water. Fluorescein will stain soft contact lenses.
    09.05.03 Fluoride 
    11.04.01 Fluorometholone FML® Specialist ophthalmology use only
    04.03 Fluoxetine 
    04.03.03 Fluoxetine 
    04.02 Flupentixol  For use on the advice of a specialist in psychiatry for schizophrenia
    04.02.02 Flupentixol Decanoate  Specialist in Psychiatry Initiation only
    04.02.02 Fluphenazine Decanoate  Specialist in Psychiatry Initiation only
    12.02.01 Fluticasone + Azelastine  Dymista® For use in line with allergic rhinitis guideline. For patients who have not responded to other therapies and who would otherwise be considered for Sub Lingual Immunotherapy (SLIT) or a referral to secondary care
    03.02.02 Fluticasone and salmeterol Seretide® ASTHMA: First choice in patients aged 5-12 years, where an ICS/LABA MDI is required. Over 12 years, follow adult guidelines. Compared to other combination products there is less flexibility in dosage adjustment. COPD: Non Formulary for this indication
    12.02.01 Fluticasone Furoate Nasal Spray Avamys® More costly choice than beclometasone.
    02.12 Fluvastatin  For use in renal transplant patients only.
    09.01.02 Folic Acid  Used to correct folate deficiency and to prevent neural tube defects in early pregnancy (in low doses). It should never be given alone in the presence of vitamin B12 deficiency as the anaemia may respond but neuropathy could be precipitated.
    20 Fomepizole   For treatment of ethylene glycol and methanol poisoning
    02.08.02 Fondaparinux Sodium  For HIT
    03.01.01.01 Formoterol Easyhaler® Dry Powder Inhaler (DPI) In asthmatics, formoterol should only be prescribed as part of a combination device (ICS/LABA), and a formoterol single agent inhaler should only be used in the few patients who require ciclesonide as an ICS. For COPD patients, formoterol can be used as a single agent as long as there is no co-existing asthma.
    03.01.01.01 Formoterol Turbohaler® Dry Powder Inhaler (DPI) Alternative device but more costly.
    03.02.02 Formoterol and beclometasone Fostair® ASTHMA: Second line choice where a combination is appropriate in patients 18 and over who can’t utilise the Symbicort Turbohaler® or where there is a preference for an MDI. COPD: Second line choice Fostair® is licensed for use with the AeroChamber Plus spacer device. It is stored in the refrigerator until dispensed after which it is given a 5 month expiry date. Fostair® MART programme for flexibly adjusting dose is available with 100/6 inhaler
    03.02.02 Formoterol and beclometasone Fostair NEXThaler® Dry powder inhaler, available as 200/6 and 100/6. Asthma:To be used in line with Adult asthma guidance and combination inhaler step down guidance. COPD: 200/6 is not licensed for use in COPD. To be used in line with COPD guidance and step down ICS guideline
    05.03.01 Fosamprenavir  High Cost Drug excluded to tariff
    08.03.04.01 Fulvestrant  
    20 Fumaderm  
    02.02.02 Furosemide  IV Guide available through 'Injectable Medicines Guide' link on front page of INsite.
    11.03.01 Fusidic Acid  Formulated as a gel that liquefies slowly once it is in the conjunctival sac. It is used for blepharitis and conjunctivitis caused by staphylococci.
    04.08.01 Gabapentin 
    20 Gabapentin  Congenital nystagmus
    For use by Professor Gottlob only. First line choice except for patients with multiple sclerosis where memantine is first line choice
    04.11 Galantamine  Currently supplied by LPT
    01.01.02 Gastrocote suspension   Prison use only
    01.01.02 Gaviscon Advance  Used only in obstetrics and gynaecology at UHL
    20 GHRH and L Arginine   Specialist endocrinology use only
    Diagnostic test for growth hormone reserve
    08.02.04 Glatiramer Acetate Copaxone® Specialist Neurology prescribing only High Cost Drug excluded to tariff (NHSE) See HSC 2002/004 below for conditions of use Co-paxone 40mg/ml 3 x weekly supported by NHSE and TAS Blueteq prior approval required before initiation
    06.01.02.01 Gliclazide  Mainly metabolised by the liver.
    06.01.02.01 Gliclazide MR Diamicron® MR May be used if hypoglycaemia is a problem as associated with less hypoglycaemia than standard release gliclazide.
    06.01.04 Glucagon (SC/IM/IV)  Alternative to glucose in an unconscious patient, particularly where the intravenous route is not available. Sometimes issued to patients' relatives for emergency use at home.
    01.05 Glucodrate®  Initiation by the UHL Intestinal Failure Team only. For patients with complications due to high output stoma and unable to tolerate St Mark's solution.
    09.02.01.02 Glucodrate®  For initiation by the Leicestershire Intestinal Failure Team only. Second line treatment for patients who cannot tolerate St Mark’s solution.
    06.01.04 Glucose IV  For use in unconscious patients. Give up to 75ml glucose 20% intravenously into a large vein. Avoid extravasation as this is hypertonic and irritant to veins (larger volumes of less concentrated glucose solution may be a safer alternative).
    06.01.04 Glucose oral  Use in conscious patients who are able to swallow. Medicinal glucose in water, tablets (e.g. Dextro Energy, Lucozade) or liquid (Lucozade) are suitable. If available fruit juice is also recommended as firstline treatment.
    01.06.02 Glycerol  Suppositories if rectal use required
    02.06.01 Glyceryl Trinitrate (Buccal tablets) Suscard ® An alternative to GTN infusion for the treatment of unstable angina as they are much cheaper. Once the patient’s condition has been stabilised they should be transferred to standard prophylactic treatment (isosorbide mononitrate).
    02.06.01 Glyceryl Trinitrate (Injection)  Unstable angina not controlled by sublingual GTN (including that following myocardial infarction, MI), also heart failure following MI and hypertension during acute MI. Tolerance develops rapidly, therefore continued need and dosage should be reviewed after 24 hours. Monitor blood pressure during administration. GTN infusion may reduce the effect of standard heparin and an increase in activated partial thromboplastin time (APTT) may be seen when it is discontinued. Close monitoring of APTT is advisable.
    02.06.01 Glyceryl Trinitrate (sublingual spray)  For acute angina. Does not deteriorate and is a useful option for patients who need to use GTN only occasionally.
    01.07.04 Glyceryl trinitrate ointment 0.4%. Rectogesic® Systemic absorption occurs and a minority of patients have to stop treatment due to headaches
    02.06.01 Glyceryl Trinitrate Spray (GTN)  For acute angina. Spray acts within about 2 minutes and is effective for up to 30 minutes.
    10.01.03 Gold sodium aurothiomalate Red Traffic Light  New patients Rheumatology use only Amber Traffic Light  Existing patients to continue injections in primary care under SCA
    01.05 Golimumab   Specialist use only in line with NICE TAs below CCG commissioned Date decision added to Formulary: Ulcerative Colitis - May 15
    10.01.03 Golimumab   Specialist Rheumatology use only
    High cost drug excluded to tariff
    06.07.02 Goserelin  For treatment of endometriosis and preoperative treatment of fibroids.
    08.03.04.02 Goserelin  Subcutaneous injection for patients with a contraindication to intramuscular injection
    03.04.02 Grass pollen extract subcutaneous  Pollinex® Restricted to initiation by specialist allergist / respiratory clinicians in line with criteria below
    03.04.02 Grass pollen extract sublingual Grazax® Restricted to initiation by specialist allergist / respiratory clinicians in line with criteria below. Patients should be assessed at the end of each season to ensure adequate response before continuation
    13.10.02 Griseofulvin  Alternative systemic treatment.
    04.04 Guanfacine  Specialist paediatric initiation only
    06.04.01.01 Gynest®  Cream (0.01%)
    04.06 Haloperidol  Nausea or vomiting induced by opioids in palliative care. There have been shortages recently of haloperidol and also of the alternatives recommended. Therefore check LMSG statement below for alternatives. The statement does not apply to treatment of delirium on ITU at UHL. Relevant clinicians will receive appropriate guidance as required.
    04.02.02 Haloperidol Decanoate  Specialist in Psychiatry Initiation only
    02.08.01 Heparin Sodium  IV full anticoagulation. Prophylaxis
    02.08.01 Heparin Sodium  For flushing of lines
    06.04.01.01 Hormonin®  Unopposed oestrogen only. For hysterectomised women and non-hysterectomised women following individual risk / benefit assessment.
    06.01.01.01 Humalog®  Insulin Lispro rapid acting insulin analogue. Vial, Cartridge + HumaPen, Kwikpen
    06.01.01.01 Humalog® 200 units/ml KwikPen  Double concentrate Insulin Lispro rapid acting insulin analogue. Only available as a KwikPen® Primary care initiation conditional on appropriate competency. Otherwise simple amber Should be reserved for the treatment of patients with diabetes requiring daily doses of more than 20 units of rapid-acting insulin
    06.01.01.02 Humalog® Mix25, Humalog®Mix50  Biphasic Insulin Lispro. Analogue insulin Vial, Cartridge + HumaPen Savvio, KwikPen
    06.01.01.02 Humulin I®  Intermediate Human Isophane Vial, Cartridge + HumaPen Savvio, KwikPen
    06.01.01.01 Humulin S®  Vial, Cartridge + HumaPen Savvio
    06.01.01.02 Humulin® M3  30/70 soluble / isophane Vial, Cartridge + HumaPen Savvio, KwikPen
    02.05.01 Hydralazine Hydrochloride  Useful for hypertensive emergencies in pregnancy. Second line choice after labetalol for pre-eclampsia /eclampsia. Acts about 20 minutes after IV injection (slightly longer if given IM).
    06.03.01 Hydrocortisone  Glucocorticoid for replacement therapy. Also has some mineralocorticoid activity Usual replacement dose is 10mg in morning, 5mg at lunchtime and 5mg in evening. Further dose adjustments are usually based on response.
    13.04 Hydrocortisone 0.5%, 2.5%  Mild potency.
    13.04 Hydrocortisone 1%  Mild.
    01.05 Hydrocortisone Acetate 10% Colifoam® Hydrocortisone foam enema. Does not have the same reach into the colon as budesonide
    13.04 Hydrocortisone Butyrate 0.1% Locoid® Potent.
    01.07 Hydrocortisone cream  Ointment can be used to relieve inflammation. Do not use in the presence of untreated local infection. Avoid prolonged use.
    01.05 Hydrocortisone injection 
    06.03.01 Hydrocortisone Injection Emergency HC Injection Kit Kit for patients with Addison’s disease or high risk due to long term steroid use. Dose to be recommended by specialist, normally 50 or 100mg.
    06.03.02 Hydrocortisone sodium succinate injection  For disease suppression
    13.02.01 Hydromol Ointment®  First choice alternative to Zeroderm
    09.01.02 Hydroxocobalamin Injection  This has now replaced cyanocobalamin as the usual source of B12 as it is excreted much less rapidly allowing maintenance doses to be given at 3-monthly intervals.
    20 Hydroxycobalamin  Cyanokit ® Cyanide poisoning for use in A&E only
    Short shelf life and difficulty in predicting no of vials required.
    03.04.01 Hydroxyine Hydrochloride Atarax®
    11.08.01 Hydroxypropyl guar Systane® (Preservative free)
    13.03 Hydroxyzine  Sedating. May be used for patients with pruritus if itching at night is troublesome.
    01.02 Hyoscine Butylbromide Buscopan® Evidence of efficacy in meta-analyses of trials but oral absorption is poor.
    11.08.01 Hypromellose Eye drops 0.3%  Mucin-like effects and is also of benefit when the watery component of tears is deficient. (May contain BZCL)
    06.06.02 Ibandronic Acid - Oral ibandronate Prevention of skeletal events (pathological fractures, bone complications requiring radiotherapy or surgery) in patients with breast cancer as per NICE CG80
    10.01.01 Ibuprofen  Doses of 400mg only have marginal therapeutic benefit over 200mg doses and are associated with more adverse effects. The suspension is significantly more expensive than tablets. Ibuprofen is also suitable for women who are breast feeding.
    10.03.02 Ibuprofen 5% Gel 
    03.04.03 Icatibant   High cost drug excluded to tariff. NHSE commissioned
    02.11 Idarucizumab  Praxbind For reversal of dabigatran related bleeding only. Not suitable for other DOAC related bleeds. Idarucizumab is available in ED
    13.08.01 Imiquimod 5%  Aldara® Actinic keratoses in line with treatment pathway Red Traffic Light if used to treat Basal cell carcinoma
    02.02.01 Indapamide 2.5mg  If a diuretic is to be initiated or changed. Existing patients should remain on bendroflumethiazide. NB Indapamide MR is not recommended as limited evidence of additional benefits and higher cost.
    10.01.04 Indometacin  Less commonly prescribed.
    20 Infliximab (Immunology)  Behcet’s Disease restricted to specialist immunology use only. Off-label use. Currently using Remicade brand in existing patients and Inflectra to be used in new patients
    01.05 Infliximab (Inflectra®) Gastroenterology Specialist use only for patients with severe active Crohn’s disease in line with NICE TA 187. Supported in line with NICE TA163 for acute exacerbations of ulcerative colitis Prescribe by brand. Inflectra is the recommended choice for new patients CCG commissioned Date decisions added to Formulary: Ulcerative Colitis - May 15
    10.01.03 Infliximab (Inflectra®) Rheumatology Specialist Rheumatology use only
    High cost drug excluded to tariff For use only in line with NICE TA 130 (RA), TA 383 (AS), TA 199 (PSA) and TA 195 (Following failure of a TNF) See links below Prescribe by brand. Biosimilar infliximab (Inflectra) to be used for new patients
    13.05.03 Infliximab (Inflectra®) Dermatology High Cost Drug excluded to tariff Supported for use in line with NICE TA 134 only Specialist Dermatology use only Prescribe by brand. Biosimilar inflectra to be used in new patients.
    13.08.01 Ingenol mebutate Picato®
    06.01.01.02 Insulatard®  Intermediate Human Isophane For use only when the Innolet device is required. Restricted to patients not able to manage less expensive devices
    06.01.01 Insulins 
    06.01.01.02 Insuman Basal®  Vial, Cartridge + ClikSTAR, SoloStar
    06.01.01.01 Insuman Rapid®  Cartridge + ClikSTAR
    08.02.04 Interferon alfa  Specialist prescribing only in Hepatitis B&C High cost drug excluded to tariff. Commissioned by NHSE in line with NICE TA 75 only
    08.02.04 Interferon beta  Specialist Neurology prescribing only
    Includes Avonex®,Rebif® and Betaferon ®(Interferon beta-1b) High cost drug excluded to tariff (NHSE) Blueteq prior approval required before initiation See HSC 2002/004 below for conditions of use
    09.05.01.02 Intravenous saline (0.9%)  See UHL guidelines below
    06.02.02 Iodine and Iodide Aqueous Iodine Oral Solution Preparation for thyroidectomy. Start about 2 weeks preoperatively
    03.01.02 Ipratropium Bromide (MDI) 
    09.01.01.01 Iron and Folic Acid SR Pregaday® For anaemia associated with pregnancy. Routine iron supplementation in pregnancy is no longer considered appropriate; the decision to prescribe should be based on full blood count results. The dose of folic acid in ‘Pregaday’ is insufficient if there is associated megaloblastic anaemia due to folate deficiency.
    09.01.01.02 Iron Isomaltoside Monofer® For IM or IV administration Non-dialysis patients IV Monograph available through 'Injectable Medicines Guide' link available through INsite.
    09.01.01.02 Iron Isomaltoside 1000 Diafer® For anaemia of chronic kidney disease only
    09.01.01.02 Iron Sucrose Venofer® This is administered by slow intravenous injection or intravenous infusion. The BNF recommends a test dose before the first dose. IV Monograph available through 'Injectable Medicines Guide' link on front page of INsite. For home dialysis patients or as an alternative if other choices not appropriate
    13.02.01 Isomol gel®  First choice alternative to Doublebase gel and Zerodouble gel
    Other emollients can be used if directed by dermatology or if first choice options not tolerated. Please see prescribing guidance below
    02.06.01 Isosorbide Mononitrate  Prophylaxis of angina. Give the standard-release version twice a day with the last dose of the day in the early afternoon to allow an adequate nitrate-free period and prevent development of tolerance. Modified release forms should not be used routinely as they are more expensive and tolerance is more likely to develop.
    13.06 Isotretinoin 
    01.06.01 Ispaghula Husk Fybogel® Suitable for long term use. May not have an immediate effect. Adequate fluid intake must be maintained. Mixing ispaghula husk with refrigerated water delays the onset of gelling and may aid administration
    02.06.03 Ivabradine  For patients with angina who cannot tolerate beta blockers, calcium channel blockers or nitrates. Amber traffic light status for chronic heart failure in line with NICE TA267 Date of entry of decision to Formulary: February 2013
    03.07 Ivacaftor   High cost drug excluded to tariff. NHSE commissioned
    13.06 Ivermectin Cream   For rosacea At UHL for initiation by Dermatologists only
    13.05.03 Ixekizumab   Specialist Dermatology use High Cost Drug excluded to tariff For use in line with NICE TA 442 only Date of entry of decision to formulary: July 2017
    13.09 Ketoconazole shampoo  Specialist Dermatology and Prison use only.
    01.06.05 Klean-Prep® 
    06.04.01.01 Kliofem®  Continuous combined HRT for women with an intact uterus
    02.05.01 Labetalol  After bolus injection, the maximum effect usually occurs within five minutes and the effective duration of action is usually about six hours but may be as long as eighteen hours. Alternative choice to sodium nitroprusside for hypertensive crisis. Labetalol can also be used during pregnancy (3rd trimester) for management of severe pre-eclampsia/ eclampsia.
    02.06.02 Lacidipine  Occasionally used by the hypertension clinic.
    04.08.01 Lacosamide 
    11.08.01 Lacri-Lube®  (Preservative free)
    01.06.04 Lactulose  Use as a laxative only where bulking agents and stimulants are unsuitable. Adequate fluid intake It may take 48 hours or more to act. Prescribe as a regular dose, not “when required”. Less suitable for frail elderly patients. Associated with higher rate of faecal incontinence in this group Drug of choice for hepatic encephalopathy. See UHL Guidelines on Acute Liver failure above
    05.03.01 Lamivudine  High Cost Therapy excluded to tariff Also used in treatment of Hepatitis B, commissioned by NHSE in line with NICE CG165 only
    04.08.01 Lamotrigine  First line for focal (partial) epilepsy and alternative to sodium valproate for idiopathic generalised epilepsy; may exacerbate myoclonic seizures. Lamotrigine is generally well tolerated but use has been associated with serious blood disorders and skin reactions. Initiate slowly.
    08.03.04.03 Lanreotide   For Acromegaly Red for new patients
    01.03.05 Lansoprazole  Lansoprazole is unlicensed in children
    01.03.05 Lansoprazole orodispersible Zoton Fastabs® Reserve for patients unable to swallow capsules as cost is higher than capsules. Can also be dispersed in a small amount of water and administered via a naso-gastric tube or oral syringe where appropriate. Lansoprazole fastabs are the first line agent in children who require a PPI via an NG tube or have difficulty swallowing.
    09.05.02.02 Lanthanum   For treatment/prevention of hyperphosphataemia of chronic kidney disease. Restricted to initiation by Specialist nephrologists. High Cost Therapy excluded to tariff for this indication, commissioned by NHSE
    06.01.01.02 Lantus®  Insulin Glargine 100 unit per ml MUST BE PRESCRIBED BY BRAND NAME Recombinant human insulin analogue- long acting. Monophasic. Once daily dosage Vial, Cartridge+ClikSTAR, SoloStar
    11.06 Latanoprost  Patent expiry has resulted in cost reduction. Ensure prescribed generically.
    11.06 Latanoprost with timolol (50 microgram plus 5mg/ml)  For use when a prostaglandin / beta blocker combination is indicated
    05.03.03 Ledipasvir and sofosbuvir  Harvoni® Specialist prescribing in Hepatitis C Commissioned by NHSE in line with NICE TA only Blueteq prior approval required before initiation Date of entry of decision to formulary: February 2016
    09.01.06 Lenograstim  Specialist use only
    High cost drug excluded to tariff commissioned by NHSE
    08.03.04.01 Letrozole 
    06.07.02 Leuprorelin acetate  For treatment of endometriosis and preoperative treatment of fibroids.
    08.03.04.02 Leuprorelin acetate  This preparation can be given by subcutaneous injection for patients with a contraindication to intramuscular injection.
    06.01.01.02 Levemir®  Insulin Detemir. Recombinant human insulin analogue – long acting. Monophasic. Twice daily dosing Cartridge + NovoPen 4, Flexpen Innolet also available but only for patients not able to manage less expensive device
    04.08.01 Levetiracetam  Alternative in focal partial epilepsy and idiopathic generalised epilepsy. Levetiracetam has a different mode of action to lamotrigine and carbamazepine. Intravenous preparation is classified as Red on the Leicestershire traffic lights.
    11.06 Levobunolol Hydrochloride  May be longer acting than other beta-blockers.
    11.03.01 Levofloxacin  (Preservative-free)
    For ophthalmology use only.
    Restricted for use in bacterial keratitis only.
    07.03.05 Levonorgestrel 1500 micrograms Levonelle® 1500 Levonelle 1500® is available for supply on prescription. Levonelle One Step can be sold to women over 16 years.
    20 Levosimendan   Specialist paediatric cardiology use only for patients with low output cardiac syndrome unresponsive to other therapies
    06.02.01 Levothyroxine Sodium Levothyroxine Long half life (about 7 days) so full effects may not be seen for several weeks. Do not monitor or adjust dose more frequently than every 2-3 months
    02.03.02 Lidocaine  Lignocaine is the parenteral drug of choice for ventricular arrhythmias. It has a short half-life (2 hours) and is therefore administered by continuous infusion following a bolus-loading dose. The bolus may need to be repeated at 5-10 minute intervals as drug is redistributed away from the myocardium.
    20 Lidocaine, Adrenaline and Tetracaine Gel (LAT)   For use in A&E only
    01.06.07 Linaclotide   Supported for use in line with IBS algorithm only. Specialist initiation by gastroenterology or functional bowel clinic at UHL
    06.01.02.03 Linagliptin  DPP-4 inhibitor. Use only as recommended in NICE guidance. No dosage adjustment required in renal impairment
    06.02.01 Liothyronine Sodium  For prescription on specialist advice only. Please see LLR guidance. For severe hypothyroidism where a rapid response is required. More potent than thyroxine with a more rapid onset and shorter duration (24-48 hours) of action. Liothyronine 20 micrograms is approximately equivalent to 100 micrograms thyroxine Randomised trials and meta-analyses show no systematic benefit of combined T4/T3 replacement. It may be used occasionally for initiation only by endocrinologists according to strict criteria and discontinuation if no improvement after 12 months. Also used by specialists in psychiatry for treatment of depression where other therapies have failed unlicensed use)
    11.08.01 Liquid paraffin plus Vitamin A eye ointment VitA-POS® (Preservative free)
    06.01.02.03 Liraglutide  GLP-1 agonist. Specialist diabetology initiation at UHL Primary care initiation conditional on appropriate competency.Otherwise simple amber
    04.04 Lisdexamfetamine mesilate  Lisdexamfetamine is a Schedule 2 controlled drug For ADHD refractory to methyphenidate. Specialist initiation only. May also be used as an alternative to a "specials" preparation in patients unable to swallow solid dosage forms. (Off-label use if not refractory to methylphenidate) The capsule can be opened and the entire contents dissolved in a glass of water. See SPC for further detail
    02.05.05.01 Lisinopril  Hypertension and heart failure. In heart failure, target dose is 20mg daily.
    02.05.05.01 Lisinopril + Hydrochlorothiazide  Zestoretic® On advice of the hypertension clinic only
    04.02.03 Lithium  Specialist in Psychiatry Initiation only. BNF recommends to prescribe by brand. Priadel is the brand recommended for new patients due to cost.
    06.01.02.03 Lixisenatide   GLP-1 agonist. Specialist diabetology initiation at UHL Primary care initiation conditional on appropriate competency. Otherwise simple amber
    07.03.01 Loestrim 30® 
    07.03.01 Loestrin 20® 
    04.03 Lofepramine  If a tricyclic is considered appropriate.
    04.03.01 Lofepramine 
    01.04 Loperamide Hydrochloride  Less likely to cause central side effects than codeine and appears to be the most effective drug for controlling diarrhoea in ileostomy and colostomy patients. Should not be used in conditions where inhibition of peristalsis should be avoided, where abdominal distension develops, or in acute diarrhoeal conditions such as ulcerative colitis or antibiotic-associated colitis. The syrup contains saccharin so usually avoided when using loperamide in short bowel / ileostomy patients to control output as can worsen the diarrhoea.
    01.04 Loperamide regular, high dose  Regular high dose loperamide is used for patients with chronic functional diarrhoea and in high output stoma patients. This is unlicensed use and restricted to initiation by hospital specialists in the field.
    05.03.01 Lopinavir with Ritonavir Kaletra® High Cost Drug excluded to tariff
    03.04.01 Loratadine  Non sedating
    04.01.02 Lorazepam  Lorazepam is shorter-acting than diazepam and seems more likely to produce dependence. For this reason it should only be prescribed as an anxiolytic for existing users or where treatment will be for a very short time (e.g. for its amnesic effect when a course of cytotoxic chemotherapy is administered). Lorazepam may occasionally be useful in calming an acutely agitated patient if used with an antipsychotic agent such as haloperidol.

    04.08.02 Lorazepam IV 
    02.05.05.02 Losartan Potasium  Hypertension and heart failure. Also licensed for diabetic nephropathy in type 2 diabetes.
    11.04.01 Loteprednol Etabonate Lotemax® Specialist ophthalmology use only
    01.06.07 Lubiprostone   For use in line with NICE TA 318 and LMSG Chronic Constipation guidance only. Date decision added to Formulary: September 2014
    04.02 Lurasidone  Schizophrenia in adults aged 18 years and over. For those who do not respond to or do not tolerate aripiprazole, or those who are not suitable for clozapine.
    13.06 Lymecycline  Systemic antibiotic. Do not use during pregnancy. Branded products may be lower cost in primary care.
    01.06.04 Macrogol Oral Powder, Compound  Cost of brand varies according to setting. Primary Care: Laxido is currently the first line brand in primary care for adults. Use Laxido paediatric in children. Brand prescribing is preferred in primary care as lower cost than generic. Secondary care: Movicol is currently the brand of choice. Macrogol oral powder compound is more costly than lactulose at usual starting doses so review regularly, chronic use may only require one sachet on alternate days.
    09.05.01.03 Magnesium Aspartate Dihydrate (Magnaspartate®)  Contains 10 mmols (243 mg) of magnesium per sachet. Each sachet of Magnaspartate can be dissolved in 50-200mL water, tea or orange juice. For those on fluid restriction / St Marks' regime mix in less than 100ml. This is equivalent to 2.5 of the unlicensed Magnesium glycerophosphate 4mmol tablets. These will be restricted to use by the specialist nutrition team at UHL on request for named patients who are not responding to Magnaspartate.
    09.05.01.03 Magnesium Hydroxide Mixture  14mmol Mg2+/10mL
    09.05.01.03 Magnesium Sulphate Injection  IV Monograph available through 'Injectable Medicines Guide' link on front page of INsite.
    20 Magnesium Sulphate IV   Consultant use only for life threatening asthma in line with BTS guidelines
    13.10.04 Malathion  Derbac-M is an alternative for treatment of scabies and is the treatment of choice in pregnancy, during breast feeding and for infants under 2 months. Treatment of choice for pubic lice.
    03.07 Mannitol   High cost drug excluded to tariff. NHSE commissioned Date of entry of decision to Formulary: February 2013
    05.03.01 Maraviroc  High Cost Therapy excluded to tariff For use in treatment experienced adult patients infected with only CCR5-tropic HIV-1 virus.
    07.03.01 Marvelon® 
    05.05 Mebendazole 
    01.02 Mebeverine Hydrochloride  Provides relief of abdominal pain by relaxing smooth muscle in irritable bowel disease. Useful to treat colicky pain in diverticular disease.
    07.03.02.02 Medroxyprogesterone acetate Depo-Provera® Preparation for intramuscular administration
    07.03.02.02 Medroxyprogesterone acetate Sayana Press® Given by subcutaneous injection
    Licence allows for self administration
    06.04.01.02 Medroxyprogesterone Acetate Injection Depo-Provera® Long acting injection. Derivative of the natural hormone progesterone. NB: Reduction of menstrual bleeding is an unlicensed indication. Long term (>2years) use has been linked to an increased risk of osteoporosis. Also used for contraception.
    04.01.01 Melatonin  Classified as simple amber for indications included in LMSG guidance. Melatonin is classified as RED for circadian asynchrony in patients on HDU / ITU at UHL. It is also classified as RED for use for Huntington's Disease and learning disability. Circadin® (Melatonin) is not supported for its licensed indication of primary insomnia in patients over 55 due to lack of evidence for effectiveness. This includes circadian asynchrony in elderly institutionalised patients. However this product may be used off label for other approved indications as specified above
    04.11 Memantine  See SCA for further detail
    20 Memantine   For use by Professor Gottlob only
    Supported for use for acquired nystagmus in 2002. Also supported for use in congenital nystagmus. This would be first line for those with multiple sclerosis and second line after gabapentin for remaining patients.
    09.06.06 Menadiol Sodium Phosphate  Tablets. Water soluble vitamin K derivative, which is preferable to oral phytomenadione in the presence of fat malabsorption, for example in cholestasis.
    03.04.02 Mepolizumab Nucala® Asthma. For use by specialist respiratory clinician in line with NICE TA 431 to treat severe refractory eosinophilic asthma only. Date of entry of decision to Formulary: March 2017
    07.03.01 Mercilon® 
    01.05 Mesalazine  Use in maintenance to reduce relapse once the acute attack is controlled. Maintenance is more effective at higher doses (at discretion of specialist). May be used in mild attacks of acute colitis. Can also be of some value in Crohn’s ileo-colitis or small bowel Crohn’s disease. Avoid in renal impairment even if mild. Mesren MR brand has now been discontinued and replaced by Octasa. This brand is the recommended choice. Both 400mg and 800mg tablets are available. Salofalk granules are an alternative choice. Mesalazine rectal is the route of choice in proctitis / proctosigmoiditis in relapse (Rectal mesalazine is Simple Amber and does not require a SCA)
    13.02.02 Metanium®Ointment 
    06.01.02.02 Metformin Hydrochloride  Drug of choice for obese/ overweight patients Gastro intestinal adverse events can be reduced by a gradual dose titration, e.g. 500mg od for 7 days, 500mg bd for 7 days, 1000mg am 500mg pm for 7 days etc. to maximal tolerated dose.
    06.01.02.02 Metformin Hydrochloride MR  For patients who are unable to tolerate GI side effects despite dose titration. A 750mg tablet and a 1000mg are now available and are less costly than using multiples of the 500mg tablet.
    10.01.03 Methotrexate  Subcutaneous Specialist Rheumatology use only
    13.05.03 Methotrexate  Subcutaneous Specialist Dermatology prescribing
    13.05.03 Methotrexate Oral Specialist Dermatology initiation only (Amber traffic light for rheumatology - see 10.01.03). The BNF recommends that only one strength of methotrexate tablet (usually 2.5 mg) is prescribed and dispensed.
    01.06.06 Methylnaltrexone Bromide   For use only the recommendation of the palliative care team.
    04.04 Methylphenidate  Specialist paediatric initiation only. Prescribe methylphenidate modified release by brand; different brands have specific release characteristics which may be tailored to individual patient circumstances (Equasym XL, Medikinet XL, Concerta XL). Methylphenidate immediate release preparations are interchangeable and can be prescribed generically.
    06.03.02 Methylprednisolone sodium succinate injection  For disease suppression when larger doses of corticosteroid are required.
    04.06 Metoclopramide Hydrochloride  For symptoms associated with gastro-duodenal, hepatic and biliary disease because it acts directly on the gastro-intestinal tract. Can cause dystonic reactions in young adults. The MHRA have advised that the maximum dose in adults in 24 hours is 30mg. The usual dose is 10mg up to three times a day. Treatment should be limited to a maximum of 5 days.
    02.02.01 Metolazone  Oedema resistant to large doses of loop diuretics alone. This product has been discontinued by the manufacturers but imported sources are now available. Local specialist opinion is to use bendroflumethiazide as an alternative in line with the recommendations of the British Society for Heart Failure.
    02.03.02 Mexiletine Hydrochloride  Resembles lignocaine but can be given orally as well as by injection.
    04.03 Mianserin  As an option a)If the patient is on specific concurrent medication likely to interact with usual choices. b)In resistant depression as augmentation therapy. See NICE guidance below. For initiation by or on the advice of a specialist in psychiatry.
    01.06.04 Micro-enema  "Micolette" or "Relaxit"
    07.03.01 Microgynon 30®  Generic equivalents may have a slightly lower cost acquisition e.g. Levest®, Rigevidon®. Check prices regularly as they do fluctuate.
    07.03.02.01 Micronor® 
    04.08.02 Midazolam  IM or buccal midazolam can be given as an alternative to lorazepam if there is no IV access. This is an unlicensed indication. A licensed product, Buccolam, is now available for treatment of prolonged, acute, convulsive seizures in infants, toddlers, children and adolescents (from 3 months to < 18 years) For infants between 3-6 months of age treatment should be in a hospital setting where monitoring is possible and resuscitation equipment is available.
    07.04.02 Mirabegron   Use in overactive bladder in line with NICE TA 270 only for patients who have been fully assessed and have failed to benefit from anticholinergics, or are intolerant of them. Date of entry of decision to Formulary: July 2013
    04.03 Mirtazapine 
    06.01.01.02 Mixtard® 30 (Discontinued Dec 2010)  Biphasic Isophane Insulin. Human. This insulin is being discontinued by the manufacturers. Guidelines for switching are avaiable below.
    04.03 Moclobemide  Reversible monoamine-oxidase inhibitor (RIMA) For initiation by or on the advice of a specialist in psychiatry.
    Not recommended as an initial choice for non specialists.
    04.04 Modafinil Provigil® For treatment of narcolepsy only. Restricted to initiation by Specialist at Sleep Clinic
    03.03.02 Montelukast 
    04.07.02 Morphine  Schedule 2 Controlled Drug
    01.06.05 Moviprep 
    02.05.02 Moxonidine  For initiation by hypertension clinic only.
    09.06.07 Multivitamin and mineral supplement Forceval® For use in gastric bypass / BPD/DS bariatric surgery on the recommendation of a dietician, please see link below. (BPD = biliopancreatic diversion; DS = sleeve gastrectomy with duodenal switch). Forceval soluble is recommended for 8 weeks post surgery. One pack will be supplied on discharge from UHL with the second pack supplied by the GP as an acute prescription. This should be reviewed at 8 weeks and switched to the capsule formulation which has a lower cost. Only patients who are unable to tolerate capsules should be prescribed the soluble preparation after 8 weeks. Forceval and Forceval Soluble can be used in inpatients in line with the out of hours enteral feeding tube guidelines only (see below).
    09.06.07 Multi-vitamin Drops 
    13.10 Mupirocin Cream Bactroban® Good activity against Gram-positive organisms including MRSA (methicillin-resistant Staph. aureus). This may occasionally be recommended by microbiologists for the treatment of MRSA infected wounds.
    20 Mycophenolate   Interstitial lung diseases (Connective tissue disease related ILD) unresponsive to other immunosuppressives

    Starting criteria: A patient with Interstitial lung disease of the ‘non-specific interstitial pneumonitis’ or connective tissue disease related variety, or severe refractory cryptogenic organising pneumonia - Response to other immunosuppressives such as prednisolone, cyclophosphamide or azathiaprine -Inability to continue with other immunosuppressives due to cumulative toxicities - Recommendation from Interstitial lung disease MDT - No contraindications

    Stopping criteria: - Intolerance of medication - Deterioration in symptoms, pulmonary function testing and radiographically
    20 Mycophenolate mofetil  Specialist Rheumatology prescribing for severe lupus, severe polymyositis, systemic vasculitis.

    For use in patients who have not responded to other treatment options. Recommendation that protocol is developed and that use is subject to agreement by 2 consultants from differing specialities where possible
    20 Mycophenolate mofetil   Specialist haematology use in graft versus host disease in bone marrow transplant
    08.02.01 Mycophenolic acid Myfortic® Specialist renal use in renal transplant only
    04.10.01 Nalmefene  For use in line with NICE TA 325 Date decision added to Formulary: February 2015
    01.06.06 Naloxegol   Use only in line with NICE guidance Date of entry of decision to formulary: October 2015
    15.01.07 Naloxone Hydrochloride 
    20 Naltrexone  Pruritis in chronic liver disease if other therapies have not been effective
    10.01.01 Naproxen  Naproxen tablets/EC tablets
    10.01.04 Naproxen 
    08.02.04 Natalizumab  Tysabri® Specialist Neurology prescribing only in line with NICE TA 127. High cost drug excluded to tariff (NHSE) Blueteq prior approval required before initiation
    11.03 Natamycin 5%  For use by specialist ophthalmologists Only for treatment of fungal keratitis (fusarium species)
    06.01.02.03 Nateglinide  Prandial glucose regulator. May offer advantage to patients who require flexibility with mealtimes. Alternative is Repaglinide (although this is not recommended outside the age range 18-75 years).
    05.03.01 Nevirapine . High Cost Therapy excluded to tariff. Generic product supported for once daily administration.
    07.03.02.02 Nexplanon®  Subdermal implant
    02.06.03 Nicorandil  A potassium channel activator used for the prophylaxis of angina where calcium channel blockers, beta blockers or nitrates are either contraindicated, not tolerated or if symptoms are not adequately controlled.
    04.10 Nicotine Replacement Therapy  Long-Acting: ≥ 10 cigarettes per day – NiQuitin Patch 21mg/24 hours applied daily < 10 cigarettes per day – NiQuitin Patch 14mg/24 hours applied daily In pregnant women recommend removing for 8 hours over night Short-Acting:
  • NiQuitin Mini Lozenge 4mg One lozenge dissolved in the mouth whenever there is an urge to smoke (maximum 15 lozenges per 24 hours)
  • NiQuitin Strips 2.5mg Oral Film One strip to be dissolved in the mouth every 1-2 hours when there is an urge to smoke (maximum 15 strips per 24 hours)
  • Nicorette Inhalator 15mg Use whenever there is an urge to smoke (maximum 6 cartridges per day equivalent to approximately 48 x 5 minute sessions) Caution may be restricted in the prison environment.
  • Nicorette Quickmist 1mg/spray Mouthspray Use 1-2 sprays whenever there is an urge to smoke (maximum 4 sprays per hour and 64 sprays per 24 hours)
  • Full range available through the STOP! Clinics and primary care prescribers. Also available from community pharmacists under an enhanced service agreement .
    02.06.02 Nifedipine   Once or twice daily preparations
    For use in Obstetrics, Nephrology, Raynauld’s syndrome. Also available for emergency treatment of hypertension in acute medical and cardiology settings
    07.01.03 Nifedipine capsule  Only for use as a tocolytic in line with trust guidance on pre-term labour.
    03.11 Nintedanib  In line with NICE TA 379 only by specialist Respiratory Consultants. Date of entry of decision to Formulary: April 2016
    20 Nintedanib   Supported in line with NICE TA 379 Date added April 2016
    05.01 Nitrofurantoin 
  • Second line choice, reserved for patients resistant to trimethoprim in uncomplicated UTI
  • Capsules are the preferred option
  • Tablets are reserved for enteral tube administration
  • Nitrofurantoin 25mg/5ml suspension significantly more expensive. Please refer to pharmacy for more information
  • 06.04.01.02 Norethisterone  Derivative of testosterone. May have androgenic side effects
    07.03.02.01 Norgeston® 
    07.03.02.01 Noriday® 
    07.03.01 Norimin® 
    07.03.01 Norinyl-1® 
    14.05 Normal Immunoglobulin  Gamunex® Intravenous infusion High cost drug excluded to tariff. Commissioned by NHSE only in line with Department of Health Clinical Guidelines for Immunoglobulin use For patients being treated for CIDP only
    14.05 Normal Immunoglobulin  Hizentra® Subcutaneous Infusion High cost drug excluded to tariff. Commissioned by NHSE only in line with Department of Health Clinical Guidelines for Immunoglobulin use
    14.05 Normal Immunoglobulin  Octagam 10%® Intravenous infusion High cost drug excluded to tariff. Commissioned by NHSE only in line with Department of Health Clinical Guidelines for Immunoglobulin use First choice for new patients
    14.05 Normal Immunoglobulin  Vigam® Intravenous infusion High cost drug excluded to tariff. Commissioned by NHSE only in line with Department of Health Clinical Guidelines for Immunoglobulin use
    14.05 Normal Immunoglobulin  Subgam® Subcutaneous Infusion High cost drug excluded to tariff. Commissioned by NHSE only in line with Department of Health Clinical Guidelines for Immunoglobulin use
    14.05 Normal Immunoglobulin  Gammanorm® Subcutaneous Infusion High cost drug excluded to tariff. Commissioned by NHSE only in line with Department of Health Clinical Guidelines for Immunoglobulin use
    14.05 Normal Immunoglobulin  Intratect® Intravenous infusion High cost drug excluded to tariff. Commissioned by NHSE only in line with Department of Health Clinical Guidelines for Immunoglobulin use
    14.05 Normal Immunoglobulin  Privigen® Intravenous infusion High cost drug excluded to tariff. Commissioned by NHSE only in line with Department of Health Clinical Guidelines for Immunoglobulin use
    14.05 Normal Immunoglobulin  Subcuvia 16%® Subcutaneous Infusion High cost drug excluded to tariff. Commissioned by NHSE only in line with Department of Health Clinical Guidelines for Immunoglobulin use
    14.05 Normal Immunoglobulin  Flebogamma® Intravenous infusion High cost drug excluded to tariff. Commissioned by NHSE only in line with Department of Health Clinical Guidelines for Immunoglobulin use
    14.05 Normal Immunoglobulin IQYMUNE® Intravenous infusion High cost drug excluded to tariff. Commissioned by NHSE only in line with Department of Health Clinical Guidelines for Immunoglobulin use First choice for new patients. Long term patients on established therapy should remain on existing product and only be switched by prescribing clinician.
    06.01.01.02 NovoMix® 30  Biphasic Insulin Aspart. Analogue insulin. Cartridge + NovoPen 4, Flexpen
    06.01.01.01 NovoRapid®  Insulin Aspart rapid acting insulin analogue. 3ml Penfill® Cartridge + Novopen 4, FlexPen 1.6ml PumpCart® Cartridge for use in Accu-Chek Insight SC insulin pump
    02.11 NovoSeven®  Available only with the agreement of the Haematology Specialist Registrar or Haematology Consultant.
    07.03.01 Nuvaring®  More costly choice. Reserve as an option for patients with compliance issues with oral combined hormonal contraception.
    01.09.01 Obeticholic acid  For specialist hepatology use only in line with NICE TA443 to treat primary biliary cholangitis. Blueteq prior approval required before initiation Date of entry to formulary July 17
    11.08.02 Ocriplasmin  High cost drug excluded to tariff. CCG commissioned Date of entry of decision to Formulary: January 2014
    08.03.04.03 Octreotide   For Acromegaly Red for new patients
    11.03.01 Ofloxacin  Choice for contact lens related infections. These need specialist attention due to the high risk of resistant pseudomonas.
    04.02 Olanzapine 

    For use on the advice of a specialist in psychiatry. Also licensed for treatment of mania.
    Long-term safety and tolerability of olanzapine: Following long-term (>24 weeks) treatment with olanzapine, the types of metabolic changes seen in young people aged 12−18 years are similar to those seen in adults. However, the magnitude of changes in parameters such as body weight and some blood lipid levels appears to be greater in young people

    04.02.02 Olanzapine embonate (olanzapine pamoate) Zypadhera® For use by specialists in psychiatry only
    12.01.03 Olive Oil  Warm before use.
    02.12 Omacor  Omacor is classified as Simple AMBER on the Leicestershire traffic light system for use in hypertriglyceridemia. Initiation is limited to the lipid clinic at UHL but may then be continued in primary care. It is classified as BLACK for other uses
    03.04.02 Omalizumab Xolair® Asthma. For use by specialist respiratory clinicians only for patients attending difficult asthma clinic. Prescribing only in line with NICE TA 278. Blueteq prior approval required before initiation Date of entry of decision to Formulary: April 2013
    03.04.02 Omalizumab Xolair® Chronic spontaneous urticaria in line with NICE TA 339 only. AT UHL prescribing is through the allergy clinic at Glenfield Date of entry of decision to formulary: September 2015
    05.03.03 Ombitasvir, paritaprevir, and ritonavir  Viekirax® Specialist prescribing in Hepatitis C
    NHSE commissioned in line with NICE TA only with or without Dasabuvir Blueteq prior approval required before initiation Date of entry of decision to formulary: February 2016
    01.03.05 Omeprazole  Use if lansoprazole is not tolerated. Licensed for use in paediatrics. Capsules have a lower cost than tablets and should be considered first.
    01.03.05 Omeprazole IV  Used in specific indications where an oral PPI can’t be given (e.g. ulcer with no bleeding, prophylaxis, oesophagitis) Used in certain patients with bleeding peptic ulcers on specialist advice only. IV monographs available through 'Injectable Medicines Guide' link on front page of INsite.
    04.06 Ondansetron  Use for chemotherapy induced nausea based on emetegenicity of the regime. Given on day of chemotherapy only or for an additional two doses if indicated. For radiotherapy induced nausea given daily during treatment if radiation to susceptible area (e.g. lower abdomen). Long term administration for chemotherapy or continuation for delayed emesis not recommended. Melts have significantly higher cost than tablets - "Films" preferred if unable to swallow tablets. IV Monograph available through 'Injectable Medicines Guide' link on front page of INsite. The new maximum single intravenous dose of ondansetron for the management of chemotherapy-induced nausea and vomiting (CINV) in adults is now 16 mg (infused over at least 15 minutes)- See MHRA advice via link below
    11.08.01 Optive Plus®  (Contains purite)
    04.05.01 Oristat Xenical®
    04.05 Orlistat  Prescribe in line with NICE guidance. Treatment with orlistat should be discontinued after 12 weeks if less than 5% of the body weight has been lost since the start of therapy.
    06.04.01.01 Ortho-Gynest®  Pessary 500 microgram. Oestrogen only
    09.05.02.02 Osvaren®   Calcium acetate 435mg (equivalent to 110 mg calcium) Magnesium carbonate 235mg (equivalent to 60 mg magnesium)
    06.04.01.01 Ovestin®  Oestrogen only
    07.03.01 Ovranette® 
    07.03.01 Ovysmen® 
    20 Oxandrolone  Prophylaxis of acute attacks in hereditary angioedema
    Third line after danazol and stanozolol when stanozolol is unavailable.
    04.08.01 Oxcarbazepine 
    11.07 Oxybuprocaine Hydrochloride 
    07.04.02 Oxybutynin Hydrochloride  Has a smooth muscle relaxant activity in addition to its anticholinergic action. Usefulness is often limited by side effects. Do not offer oxybutynin IR to frail, elderly patients
    07.04.02 Oxybutynin Hydrochloride XL 
    07.04.02 Oxybutynin Patch Kentera® For use only in patients who cannot take oral medication
    04.07.02 Oxycodone  For patients with palliative pain and also in patients with chronic non palliative pain on advice of UHL Pain Team. Schedule 2 Controlled Drug Specify either immediate release or modified release on the prescription to avoid confusion between preparations. NB Generic modified release preparations are labelled by the companies as Prolonged release. We are aware that this may cause some confusion and have raised with the MHRA
    04.07.02 Oxycodone + naloxone Targinact® Initiation restricted to recommendation of a UHL pain consultant or palliative care consultant for patients who are significantly affected by opiod-induced constipation in whom laxatives have not worked or produced unacceptable side effects. Schedule 2 Controlled Drug
    13.06 Oxytetracycline  Systemic antibiotic. Do not use during pregnancy.
    09.06.02 Pabrinex® IV  High dose Vitamin B and C intravenous injection IV Monograph available through 'Injectable Medicines Guide' link on front page of INsite
    05.03.05 Palivizumab Synagis® Respiratory syncytial virus (RSV) prophylaxis
    High cost drug excluded to tariff commissioned by NHSE

    Supported in line with JVCI guidance From 16/17 season Blueteq prior approval required before initiation
    01.09.04 Pancreatin Creon® 10000 Derived from porcine origins. Some patients may object to use of it on religious grounds
    04.07.01 Paracetamol  Soluble paracetamol tablets should only be used if essential as they have a higher cost than standard preparations. They should be used with caution in patients with hypertension due to the sodium content.
    04.07.04.01 Paracetamol  Available as a soluble tablet which acts more rapidly than standard formulations.
    04.07.01 Paracetamol and codeine Co-codamol® 8/500 Caution: Abuse potential in prisons.
    04.07.01 Paracetamol and codeine Co-codamol® 30/500 Soluble tablets should only be used if essential as they have a higher acquisition cost than standard preparations. Caution: Abuse potential in prisons.
    04.03 Paroxetine  Specialist use for the treatment of OCD
    08.02.04 Peginterferon alfa   Hepatitis B&C treatment
    High cost drug excluded to tariff. Commissioned by NHSE in line with NICE TA75, TA96, TA106, TA200, TA 300, CG165
    08.02.04 Peginterferon beta 1a Plegridy ® Specialist Neurology prescribing only
    High cost drug excluded to tariff (NHSE) Two weekly administration See HSC 2002/004 for conditions of use
    01.01.02 Peptac 
    01.03.03 Pepto Bismol   For use only on the recommendation of a specialist as part of an eradication regimen for resistant H pylori
    04.08.01 Perampanel 
    02.05.05.01 Perindopril erbumine  Initiation restricted on the advice of a senior cardiologist to patients where hypotension is a significant issue with 1st line choices or in hypotensive patients as a first line choice.
    13.10.04 Permethrin dermal cream  Treatment of choice in children over 2 months and under 6 months as low toxicity, non-irritant.
    04.07.02 Pethidine Hydrochloride  For use in obstetrics only as it is associated with less respiratory depression in the neonate than morphine. Schedule 2 Controlled Drug
    04.03 Phenelzine  For initiation by or on the advice of a specialist in psychiatry. Option in PTSD
    04.08.01 Phenobarbital 
    11.05 Phenylephrine Hydrochloride  Single use eye drops. Phenylephrine can be used alone or in conjunction with the other agents to produce wide mydriasis.
    04.08.01 Phenytoin  3rd line drug due to long term side effects. Also indicated in the management of seizure activity following brain injury.
    04.08.02 Phenytoin IV 
    09.05.02.02 Phosex®  Calcium Acetate
    01.06.04 Phosphate enema  Rectal Use. UHL stock Fleet phosphate enemas (replacing phosphate enemas, standard tube) due to lower cost.
    09.05.02.01 Phosphate Polyfusor  Infusion contains 50 mmol phosphate in 500 ml, also 81 mmol sodium and 9.5 mmol potassium.
    09.05.02.01 Phosphate-Sandoz®  Effervescent tablets. 16.1 mmol phosphate, 20.4 mmol sodium and 3.1 mmol potassium per tablet
    09.06.06 Phytomenadione (Vitamin K1) Konakion® Injection For reversal of warfarin overdose, the oral and IV forms are very similar in onset and magnitude of effect. If oral route use required use paediatric vitamin K injection (Konakion MM Paediatric 2mg/0.2ml)NB:unlicensed use IV Monograph available through 'Injectable Medicines Guide' link on front page of INsite. RED TL status For newborn Green status
    11.06 Pilocarpine 
    13.05.03 Pimecrolimus Elidel® Tacrolimus and pimecrolimus can be considered as options to treat moderate or severe atopic eczema if other treatments have been tried and in line with NICE recommendations. They are not suitable for treatment of mild atopic eczema. The EMEA has recommended greater caution in the way these medicines are used in order to reduce potential risks of skin cancer and lymphoma as far as possible.
    06.01.02.03 Pioglitazone  See prescribing points.
    04.08.01 Piracetam 
    03.11 Pirfenidone   For treatment of idiopathic pulmonary fibrosis in line with NICE TA 282 only. For use by specialist respiratory physicians only High Cost Therapy excluded to tariff commissioned by NHSE Blueteq prior approval required before initiation Date of entry of decision to Formulary: July 2013 November 14: Not supported by TAS for patients with FVC 80-90%
    09.01.07 Plerixafor   Specialist haematology use only
    High cost drug excluded to tariff. Commissioned by NHSE in line with policy below only
    13.07 Podophyllotoxin Warticon®
    13.07 Podophyllotoxin 0.15% cream Warticon® For ano-genital warts. Screen for other sexually transmitted disease.
    20 Pollinex   Specialist allergist use only in line with criteria
    13.10 Polyfax   For facial burns for adults and children.
    13.05.01 Polytar Emollient ®  Bath additive containing coal tar. Use 2-4 capfuls in bath water. Bathe for 20 minutes.
    13.05.02 Polytar Emollient® (500ml) 
    13.05.02 Polytar liquid ®(250mL)  Can be used as a shampoo
    11.08.01 Polyvinyl Alchohol 1.4% Sno Tears ® Help to form a tear film. (Contains BZCL)
    03.05.02 Poractant Alfa   Specialist prescribing only High cost drug excluded to tariff commissioned by NHSE
    09.02.01.01 Potassium Bicarbonate Potassium effervescent tablets For hyperchloraemic acidosis only e.g. in renal tubular acidosis. They do not contain chloride and are not suitable for routine treatment of hypokalaemia.
    09.02.01.01 Potassium Chloride Sando-K® Effervescent tablets. 12mmol K+ and 8mmol Cl-per tablet.
    09.02.01.01 Potassium Chloride Slow-K® Slow-release tablets 600mg. 8mmol K+ and Cl- per tablet. These should be taken while sitting or standing with fluid during meals. Avoid in patients that may have an oesophageal or intestinal stricture as they can cause local ulceration.
    09.02.01.01 Potassium Chloride Syrup Kay-Cee-L® 1mmol K+ and Cl- per mL
    13.05.01 Potassium permanganate tablets for solution  Wet dressings or soaks: 1 tablet dissolved in 4 litres water gives a concentration of approx. 1:10,000. Baths: add several tablets to the bath water.
    Caution stains skin and clothing.
    09.05.02.01 Potassium Phosphate Injection  Ampoules restricted to Intensive Care areas due to the risks associated with concentrated potassium solutions.
    04.09.01 Pramipexole  Treatment of Parkinson’s disease and restless leg syndrome. Modified release (MR)is much more expensive than intermediate release (IR). It is restricted to initiation only on consultant recommendation after a trial with the immediate release pramipexole has not been tolerated. Treatment should then be reviewed to establish additional benefits and if none are apparent then the patient should revert to the IR. Patients established on therapy who have demonstrated benefit on MR should not be switched to IR.
    02.09 Prasugrel  For ACS In line with Shared Care Agreement (SCA)and UHL guidance Date decision added to Formulary: September 2014
    02.12 Pravastatin Sodium  Low intensity statin with alternative metabolic pathway for use in patients who do not tolerate simvastatin. Also suitable for patients in allogeneic stem cell transplants due to lower level of interactions.
    01.05 Prednisolone  Use for acute treatment of severe ulcerative colitis either alone or in combination with mesalazine if not controlled by mesalazine or sulphasalazine. Treatment of choice for inducing remission in active Crohn’s. The potential advantage of soluble or enteric coated preparations to reduce the risk of gastric ulcers is speculative. They are considerably more costly. Prednisolone EC tablets are not routinely stocked at UHL. Prednisolone soluble can be up to 200 times more costly than plain tablets depending on the setting. Plain tablets can be crushed and dispersed (unlicensed).
    06.03.02 Prednisolone  For disease suppression. Enteric coated tablets are not routinely stocked at UHL. The potential advantage of soluble or enteric coated preparations to reduce the risk of gastric ulcers is speculative. They are considerably more costly. Prednisolone soluble can be up to 200 times more costly than plain tablets depending on the setting. Plain tablets can be crushed and dispersed (unlicensed).
    11.04.01 Prednisolone 0.5% eye drops  Used in preference to prednisolone acetate 1% for conditions in which less ocular penetration is required (such as allergic conjunctivitis). Green traffic light only applies to prescriptions that do not exceed 7 days.
    11.04.01 Prednisolone 0.5% with neomycin 0.5% eye drops  Green traffic light only applies to prescriptions that do not exceed 7 days.
    11.04.01 Prednisolone 1.0% eye drops  Should not be used for more than 10 days except under strict ophthalmic supervision with regular checks for intraocular pressure.
    01.05 Prednisolone Foam Enemas Predfoam® Please note, significantly more expensive than budesonide foam enemas. Should be used by, or on advice from GI specialist only
    01.07 Prednisolone suppositories  Suitable for proctitis
    04.08.01 Pregabalin  Green Traffic Light when prescribed in line with neuropathic pain guidelines. Amber Traffic Light simple amber when used for refractory epilepsy or generalised anxiety disorder
    06.04.01.01 Premarin®  Unopposed oestrogen only. For hysterectomised women and non-hysterectomised women following individual risk / benefit assessment.
    06.04.01.01 Premique®  Continuous combined HRT for women with an intact uterus
    15.02 Prilocaine Hydrochloride   Spinal anaesthesia for day case surgery
    04.08.01 Primidone 
    04.06 Prochlorperazine  Nausea associated with vertigo. Avoid in the elderly during very hot or very cold weather (risk of hyper- or hypothermia)
    04.09.02 Procyclidine Hydrochloride  Drug induced parkinsonian symptoms. Injection acts quickly and is effective in relieving acute dystonic reactions caused by dopamine- blocking agents including antipsychotics and metoclopramide.
    04.02 Promazine Hydrochloride  Short term adjunctive management of psychomotor agitation Option for the treatment of agitation in the elderly but see also guidance on treatment of behavioural disturbance in dementia below.
    04.01.01 Promethazine   NICE recommends a sedating antihistamine is suitable for treating insomnia in patients who maybe prone to the development of tolerance and addiction
    02.04 Propranolol Hydrochloride  Less cardioselective and shorter acting than atenolol. Drug of choice for thyrotoxic crisis and portal hypertension. Dose requirements may differ considerably between individuals because of variable first-pass hepatic metabolism.
    04.07.04.02 Propranolol immediate release  Avoid abrupt withdrawal.
    06.02.02 Propranolol IV  Can be given I.V in doses of 1mg up to 5mg in thyrotoxic crisis. Hydrocortisone and aqueous iodine should also be given (seek specialist advice)
    See also section 2.4
    06.02.02 Propylthiouracil 
    02.08.03 Protamine sulphate  IV Monograph available through 'Injectable Medicines Guide' link on front page of INsite.
    02.11 Prothrombin Complex Concentrate  Available only with the agreement of the Haematology Specialist Registrar or Haematology Consultant.
    11.07 Proxymetacaine Hydrochloride  Causes less stinging than oxybuprocaine and may be more suitable for children.
    01.06.07 Prucalopride  For use in line with NICE TA 211 and LMSG Chronic Constipation guidance only. Audit requirement
    09.06.02 Pyridoxine Hydrochloride Tablets  Vitamin B6
    04.02 Quetiapine   Immediate release tablets only. For use on the advice of a specialist in psychiatry in line with NICE Clinical Guideline for Bipolar Disorder only.
    10.02.02 Quinine Sulphate 300mg   For leg cramps.
    Review benefits regularly.
    05.03.01 Raltegravir  High Cost Therapy excluded to tariff
    02.05.05.01 Ramipril  Hypertension and heart failure. In heart failure, target dose is 10mg daily.
    11.08.02 Ranibizumab  Lucentis® For use by specialist ophthalmologists in line with NICE TA 155, TA 274, TA 283 or TA 298 - see links below. High cost drug excluded to tariff. Date of entry of decision to Formulary: Pathological myopia - Feb 2014 RVO - August 2013 DMO - May 2013
    01.03.01 Ranitidine (including soluble tablets)  Reduce dose in renal or hepatic impairment. Monitor INR with oral anticoagulants
    02.06.03 Ranolazine  For use in line with NICE CG 126. Ranolazine may be initiated in primary care but use should be audited. Second appointment recommended to assess effect and titrate dose if necessary one month after initiation.
    04.09.01 Rasagiline 
    10.01.04 Rasburicase  Specialist prescribing only
    High cost drug excluded to tariff commissioned by NHSE
    09.02.02.01 Ready-diluted potassium in IV fluid  0.15% contains 20mmol in 1L 0.3% contains 40mmol in 1L
    15.01.04 Remifentanil   For specialist anaesthetic use only
    04.08.01 Retigabine  Retigabine is due to be withdrawn in 2017. Existing patients to have therapy reviewed by a specialist and no new patients to start therapy with retigabine. The MHRA have restricted retigabine to last-line use, after reports of pigment changes in ocular tissue, skin, lips or nails.
    05.03.05 Ribavirin  High cost drug excluded to tariff commissioned by NHSE

    Supported in line with NICE TA 75, 106, 200
    11.08.02 Riboflavin Eye Drops VibeX® Peri-operative use during corneal collagen cross linkage surgery
    05.01 Rifaximin   Specialist hepatologist initiation only for hepatic encephalopathy Date decision added to Formulary: June 15
    05.03.01 Rilpivirine  High Cost Therapy excluded to tariff As part of triple therapy if intolerant or non responsive of efavirenz/ Atripla.
    04.09.03 Riluzole Rilutek®
    11.04.01 Rimexolone   Discontinued in UK. Contact ophthalmology service for alternative.
    06.06.02 Risedronate Sodium  Daily (5mg) or weekly (35mg) for Osteoporosis. If intolerant or unable to comply with alendronic acid (as per NICE recommendations) Due to lower incidence of gastric side effects should be used in preference to alendronic acid for those with a history of peptic ulceration. Also available for treatment of Paget’s disease.
    04.02 Risperidone 
    04.02.02 Risperidone Risperdal Consta® Specialist in Psychiatry Initiation only.
    05.03.01 Ritonavir . High Cost Therapy excluded to tariff
    08.02.03 Rituximab   Specialist use only
    Supported in line with NICE TA 308 only
    High Cost Drug excluded to tariff, commmissioned by NHSE for this indication
    13.05.03 Rituximab  Specialist Dermatology use only High Cost Drug excluded to tariff For use in immunobullous diseases in line with NHSE policy 16035/P only
    10.01.03 Rituximab (Truxima®) Rheumatology Specialist Rheumatology use only
    High cost drug excluded to tariff, CCG commissioned. In Rheumatology indications the biosimilar Truxima should be used for all new treatment courses Use in SLE commissioned by NHSE in line with policy below only
    02.08.02 Rivaroxaban  For Atrial Fibrillation (AF) use in line with the Leicestershire Algorithms. Date of entry of decision to Formulary: August 2012
    02.08.02 Rivaroxaban  For DVT and PE use in line with SCA. Patients should be referred to the anticoagulant clinic for counselling. Date of entry of decision to Formulary: PE - September 2013 DVT - October 2012
    04.11 Rivastigmine 
    04.07.04.01 Rizatriptan Wafers  Dissolves on the tongue without water, which is convenient to take and rapidly absorbed. Due to high cost, restricted preparations should be reserved for occasions where oral administration is problematic.
    15.01.05 Rocuronium  
    03.03.03 Roflumilast Daxas® For use in COPD in line with NICE TA 461 only
    09.01.04 Romiplostim  Specialist haematology initiation only
    04.09.01 Ropinirole  Simple amber for treatment of Parkinson’s disease and restless leg syndrome. Ropinirole XL is available as a generic preparation. UHL will prescribe generically, primary care may specify a brand according to price.
    15.02 Ropivacaine Hydrochloride   For awake shoulder surgeries (Brachial plexus block)
    02.12 Rosuvastatin  High intensity statin with alternative metabolic pathway for use in patients with ACS who do not tolerate atorvastatin.
    04.09.01 Rotigotine  For treatment of Parkinson’s disease and restless leg syndrome. Available as a first line choice for prescribing by specialists experienced in the treatment of Parkinson's disease (Neurologists and Geriatricians)
    04.08.01 Rufinamide 
    02.05.05.02 Sacubitril Valsartan Entresto® For use by Heart Failure Clinic in line with NICE TA 388 only. If initiated by Heart Failure Clinic, GPs may continue prescribing under shared care
    04.09.01 Safinamide Xadago® For treatment of Parkinson’s disease Specialist neurology use only
    13.07 Salactol®  For common or planar warts. If there is no response after several months consider cryotherapy.
    03.01.01.01 Salbutamol Easyhaler® Salbutamol Easyhaler (DPI) should be used in patients on other DPIs
    03.01.01.01 Salbutamol (MDI)  Salbutamol MDI should be used in patients on other MDIs
    09.05.01.01 Sandocal-1000®  Effervescent tablets. 25mmol/1000mg calcium per tablet.
    09.05.01.01 Sandocal-400®  Effervescent tablets. 10mmol/400mg calcium per tablet
    13.05.02 Sebco®  At UHL for initiation by specialist dermatologists only.
    10.01.03 Secukinumab  Specialist Rheumatology Use
    For use in line with NICE TA 407
    First line choice for ankylosing spondylitis on cost grounds

    Date of entry of decision to formulary: December 2016 For use in line with NICE TA 445 for psoriatic arthritis. Date of entry of decision to formulary July 17 First line choice for patients without concomitant moderate to severe plaque psoriasis on cost grounds(maintenance dose 150mg monthly)
    13.05.03 Secukinumab  Dermatology High Cost Drug excluded to tariff Supported by TAS in line with NICE TA 350 Date of entry of decision to formulary: October 2015
    04.09.01 Selegiline  
    04.02.03 Semisodium Valproate Depakote® Mania in bipolar disorder. Specialist in Psychiatry Initiation only.
    01.06.02 Senna 
    04.03 Sertraline  Higher cost than citalopram. The cost of sertraline has increased significantly due to fluctuating supply problems. Consider citalopram as first line in new patients unless inappropriate e.g. patients with QT prolongation.
    09.05.02.02 Sevelamer Carbonate Renvela® For treatment/prevention of hyperphosphataemia of chronic kidney disease. Restricted to initiation by Specialist nephrologists. High Cost Therapy excluded to tariff for this indication, commissioned by NHSE
    07.04.05 Sildenafil Viagra® Sildenafil generic is first line choice due to lower cost. Prescribing of branded product on NHS limited to specific patient groups only however this no longer applies to the generic product - see link below to Amendment to Regulations. SLS endorsement is not required In UHL prescribing limited to specialist urology and diabetes erectile dysfunction clinics.
    20 Sildenafil (PAH)  For Pulmonary Arterial Hypertension in adults restricted to initiation by consultants at Adult Congenital Heart Disease Centre in line with NHSE policy and shared care agreement with Sheffield. Continuation of supply should be undertaken by Sheffield through homecare
    NB use of generic preparation 25mg, 50mg, 100mg tablets is significantly lower than the branded Revatio.
    20 Sildenafil (Rheumatology)  For severe digital ulceration in scleroderma /
    Raynaulds restricted to initiation by consultant Rheumatologists.
    NB use 25mg, 50mg, 100mg tablets only
    13.10 Silver Sulfadiazine Flamazine® Used to prevent and treat infection in burns. It has good activity against Gram-negative organisms, including Pseudomonas sp. It is not a cost-effective treatment for minor burns where the skin is not broken.
    05.03.03 Simeprevir  Specialist prescribing in Hepatitis C
    Commissioned by NHSE in line with NICE TA only. Genotype 4 patients require Blueteq prior approval before initiation Date decision added to Formulary: May 15
    11.08.01 Simple eye ointment BP  A bland ointment, which can be used on dry eyes at night, or applied when corneal drying must be avoided in anaesthetised or unconscious patients. (Preservative free)
    02.12 Simvastatin 
    06.01.02.03 Sitagliptin  DPP-4 inhibitor. For use only as recommended in NICE guidance. Dosage adjustment required in renal impairment
    12.01.03 Sodium Bicarbonate ear drops BP 
    20 Sodium Butyrate enema   Distal ulcerative colitis
    09.02.01.02 Sodium Chloride Slow Sodium® Slow-release tablets 600mg. Approximately 10 mmol Na+ and Cl- per tablet.
    11.08.01 Sodium Chloride 0.9%  Single use eye drops. Sterile solution for irrigation. These preparations are commonly used to remove irritants and foreign bodies from the eye. They are also useful as irrigation where eyelid disease prevents secretion by meibomian glands. A new (sealed) pack of irrigation solution should be used for each patient to prevent cross-contamination. Any contents remaining after use should be discarded.
    11.08.01 Sodium chloride 5%  (Preservative free) Drops and ointment available
    11.04.02 Sodium Cromoglicate  Contain benzalkonium chloride as a preservative; soft contact lens wearers should avoid them.
    09.01.01.01 Sodium Feredetate Syrup Sytron® 190mg (27.5mg iron)/5ml
    05.01 Sodium fusidate Fusidic acid Oral and Intravenous See antimicrobial website. Restricted antibiotic, microbiology approval needed
    11.08.01 Sodium hyaluronate 0.1% Hylo-Tear® For severe dry eye (Preservative free)
    11.08.01 Sodium hyaluronate 0.2% Hylo-Forte® (Preservative free)
    02.05.01 Sodium Nitroprusside  Recommended choice for hypertensive crisis Starts to act within a few minutes. Blood pressure can be readily controlled by adjusting the infusion rate. It can be used in dissecting aortic aneurysm in combination with a beta-blocker to prevent an increase in heart rate.
    04.01.01 Sodium Oxybate  For initiation by sleep clinic at UHL only
    01.06.05 Sodium Picosulfate 
    09.02.01.01 Sodium Polystyrene Sulphonate Resonium A®
    04.08.01 Sodium Valproate  First line for all types of idiopathic generalised epilepsy. Avoid in women of reproductive age as it is the most teratogenic anticonvulsant.
    05.03.03 Sofosbuvir  Specialist prescribing in Hepatitis C NHSE commissioned in line with NICE TA only Blueteq prior approval required before initiation Date decision added to Formulary: May 15
    05.03.03 Sofosbuvir/valpatasvir Epclusa® Specialist prescribing in Hepatitis C NHSE commissioned in line with NICE TA only Blueteq prior approval required before initiation Date decision added to Formulary: March 17
    07.04.02 Solifenacin Succinate  May be preferable where urgency is a major symptom or where the option of variable dosing is an advantage.
    06.05.01 Somatropin   Supported in line with NICE guidance only
    02.02.03 Spironolactone  NICE recommends in patients with heart failure due to left ventricular systolic dysfunction who remain moderately to severely symptomatic despite optimal therapy of ACE inhibitors and β blocker. Specialist advice should be sought as monitoring required. Can also be used when an aldosterone antagonist is clearly indicated (e.g. primary hyperaldosteronism or treatment of oedema and/or ascites in hepatic cirrhosis).
    17 Staloral   Sublingual treatment for grass pollen allergies
    20 Stanozolol   Prophylaxis of acute attacks in hereditary angioedema
    Second line after danazol.
    Supported by TAS Feb 15 for prescribing by Dr Duddridge via FP10
    13.10 Stellisept 
    06.06.02 Strontium Ranelate  If intolerant to both alendronate and risedronate. Severe allergic reactions have been reported. Advise patients to stop taking if skin rash develops and consult their doctor. The MHRA has advised that strontium ranelate should not be used in patients with current or previous venous thromboembolism (VTE) or temporary or permanent immobilisation because of risk of VTE. Rare serious skin reactions may occur within the first weeks of treatment. See link below for further details
    09.05.02.02 Sucroferric oxyhydroxide Velphoro® For treatment/prevention of hyperphosphataemia of chronic kidney disease. Restricted to initiation by Specialist nephrologists. High Cost Therapy excluded to tariff for this indication, commissioned by NHSE
    13.02.02 Sudocrem® 
    15.01.06 Sugammadex  Supported for emergency use only. Not for routine use
    01.05 Sulfasalazine EC  For acute treatment of extensive or severe ulcerative colitis. Introduce gradually to avoid nausea and vomiting. Small doses given more often may be beneficial. Warn male patients of the possibility of reversible infertility. Monitor blood counts during prolonged use (initially monthly then 3-monthly) Monitor liver function monthly for the first 3 months, monitor renal function at regular intervals. Urine and some soft contact lenses may be stained orange.
    10.01.01 Sulindac  For patients on lithium therapy if an NSAID is considered essential. Other NSAIDs may raise lithium levels and precipitate toxicity.
    04.02 Sulpiride  If for use in schizophrenia or psychoses–to be initiated after discussion with specialist
    04.07.04.01 Sumatriptan (nasal spray and injection)  Due to high cost, restricted preparations should be reserved for occasions where oral administration is problematic. Nasal spray is less costly than injection.
    04.07.04.01 Sumatriptan (oral)  Prescribe generically. In trials, oral sumatriptan 50mg and 100mg strengths showed similar onset, analgesic efficacy and tolerability but the response to the 50mg strength was less consistent.
    13.08.01 Sunsense® Ultra   Approved for patients who have a photosensitive disorder with widespread dysplastic lesions and/or a history of skin cancer At UHL restricted to specialist Dermatology, Oncology or Paediatric prescribing only
    06.04.02 Sustanon 250®  3-weekly injection
    11.08.01 Systane® Ultra  (Preservative free)
    11.08.01 Systane®Balance  (contains polyquaternium-1)
    For treatment of meibomian gland disease
    17 TachoSil   Absorbable fibrin sealant patch Supported for use in liver and cardiothoracic surgery only
    08.02.02 Tacrolimus Adoport®, Prograf® or Modigraf® Immunosuppression post renal transplant - prescribe by brand name only as different brands are not interchangeable. Specialist renal initiation only
    Shared care request is mandatory
    13.05.03 Tacrolimus Protopic® Tacrolimus and pimecrolimus can be considered as options to treat moderate or severe atopic eczema if other treatments have been tried and in line with NICE recommendations. They are not suitable for treatment of mild atopic eczema. The MHRA has issued a reminder of the need for caution in use due to a possible risk of malignancies including lymphomas and skin cancers.
    08.02.02 Tacrolimus SR Envarsus® Once daily preparation. Prophylaxis of transplant rejection in adult kidney transplants. Must be prescribed by brand and not interchangeable with other brands. Total required daily dose is different to other brands of tacrolimus so must not be substituted with other brands
    07.04.05 Tadalafil   For Erectile Dysfunction for patients who have not responded to sildenafil or to vardenafil (Green on traffic lights for this indication). NHS limitations on groups and frequency of prescribing apply. Once daily dosage is not approved for this indication. Following radical prostatectomy specialist use only by Andrology service. Scripts for this indication will be annotated as "Andrology" by the prescriber.(Classified Red on traffic light list).
    08.03.04.01 Tamoxifen 
    07.04.01 Tamsulosin Hydrochloride  
    04.07.02 Tapentadol SR  Supported for use by or under the guidance of pain clinic clinicians only for chronic pain in patients requiring opiates but not responding as expected to morphine. Immediate release preparation in acute pain not supported Also supported for use in cancer pain for the same place in therapy as above.
    13.05.02 Tar cream LPS (150g) 
    05.03.03 Telaprevir  Specialist prescribing in Hepatitis C
    High cost drug excluded to tariff. Commissioned by NHSE in line with NICE TA 252 only Date of entry of decision to Formulary: May 2012 Use superceded by newer drugs for Hepatitis C
    04.01.01 Temazepam  For patients who cannot tolerate other choices or who have previously responded to treatment. The exemptions applied to Temazepam as a schedule 3 controlled drug have been removed. Temazepam should now be treated as a full CD. This includes ordering, storage, destruction and register requirements. In addtion there is a need for prescriptions to be written in words and figures and, in the hospital setting, the TTO letter should be printed and countersigned by the prescriber.
    02.10.02 Tenecteplase   Replaces Reteplase which has been discontinued Treatment of STEMI
    05.03.01 Tenofovir Disoproxil . High Cost Therapy excluded to tariff
    05.03.01 Tenofovir Disoproxil and Emtricitabine Truvada® High Cost Drug excluded to tariff
    13.10.02 Terbinafine  Topical treatment - alternative to clotrimazole
    03.01.01.01 Terbutaline Sulphate Turbohaler® Second choice, for those who cannot tolerate salbutamol. Similar efficacy to salbutamol but a more expensive option.
    08.02.04 Teriflunomide  Aubagio® Specialist Neurology prescribing only in line with NICE TA 303
    High Cost Drug excluded to tariff (NHSE) Blueteq prior approval required before initiation Date of entry of decision to Formulary: April 2014
    06.06.02 Teriparatide   For use in line with NICE guidance only for 18 months treatment
    06.05.02 Terlipressin Glypressin® First choice for bleeding oesophageal varices. Administered by intermittent injection. Also used for hepatorenal syndrome in patients with cirrhosis
    06.04.02 Testosterone Enantate Injection 
    06.04.02 Testosterone Gel  Testogel and Tostran are stocked by UHL.
    06.04.02 Testosterone Undecanoate Nebido®
    15.02 Tetracaine  Ametop®
    11.07 Tetracaine Hydrochloride  Produces a greater degree of anaesthesia than the other two agents and may be suitable for minor surgical procedures.
    06.05.01 Tetracosactide Synacthen® Analogue of corticotrophin (ACTH). Diagnostic agent for adrenocortical insufficiency Ideally this should be given where a resuscitation trolley is available as, although rare, anaphylaxis has previously been described. There has previously been concern over the use of Synacthen in patients with asthma. Whilst these concerns appear to be largely unsubstantiated, please refer to the position statement below for more information.
    09.02.02.02 Tetraspan  For treatment of imminent or manifest hypovolaemia and shock
    09.06.04 Theical-D3®  NB Once daily dosing Each tablet contains 1000mg elemental calcium plus 880iu of vitamin D3 Lower cost choice
    03.01.03 Theophylline Uniphyllin Continus® Oral slow release tablets.
    03.01.03 Theophylline Slo-Phyllin® Oral slow release capsules.
    09.06.02 Thiamine  Vitamin B1
    04.08.01 Tiagabine 
    02.09 Ticagrelor  For treatment ACS In line with NICE TA236 and UHL guidance. For prevention of atherothrombotic events in line with NICE TA420. On consultant cardiologist authorisation only.
    11.06 Timolol 0.1% gel Tiopex® For use in patients who require preservative free timolol. This product is used once daily.
    20 Timolol gel 0.5% Timoptol LA® Small infantile haemangiomas. Specialist initiation as per GOSH guidelines.
    11.06 Timolol Maleate 
    03.01.02 Tiotropium Handihaler® For COPD patients. Restricted ItemIn UHL restricted to initiation by respiratory physicians.
    03.01.02 Tiotropium Respimat® Metered Dose Inhaler (MDI) Amber Traffic Light Simple amber for Asthma Green Traffic Light For COPD patients in line with Leicestershire prescribing aid
    03.01.02 Tiotropium Braltus Zonda® For COPD patients in line with Leicestershire prescribing aid. Not licensed for use in asthma
    03.01.02 Tiotropium / Oldaterol  Spiolto Respimat® Metered Dose Inhaler (MDI) COPD. LAMA /LABA combination for use in line with local guidance only
    05.03.01 Tipranavir . High Cost Therapy excluded to tariff Third line therapy
    17 Tisseel   Fibrin sealant
    20 Tissue Plasminogen Activator (tPa) - Alteplase  Massive submacular haemorrhage. Restricted to use by consultant retinal ophthalmologists only.
    05.01 Tobramycin  Bramitob® Nebuliser solution for inhalation in cystic fibrosis High cost drug excluded to tariff, NHSE commissioned. Specialist Respiratory prescribing See Antimicrobial Website for further information.
    05.01 Tobramycin  Tobi ® podhaler Dry powder for inhalation For use in cystic fibrosis in line with NICE TA 276 only. High cost drug excluded to tariff, NHSE commissioned.
    Specialist Respiratory prescribing Date of entry of decision to Formulary: April 2013
    10.01.03 Tocilizumab   IV: Specialist Rheumatology use only in line with NICE TA 247
    High cost drug excluded to tariff Subcutaneous preparation also supported
    04.09.01 Tolcapone 
    07.04.02 Tolterodine IR  
    07.04.02 Tolterodine Tartrate XL  Reserve for patients who cannot tolerate the side effects of oxybutynin. Option if once daily dosage is essential for compliance
    06.05.02 Tolvaptan  Specialist renal use Commissioned by CCGs in line with NICE TA 358 only Date of entry of decision to formulary: January 2016
    12.02.02 Topical nasal decongestants 
    04.07.04.02 Topiramate  More expensive than propranolol. Teratogenic-avoid in women of child bearing age.
    04.08.01 Topiramate 
    02.02.02 Torasemide  For consultant cardiologist signature only
    06.01.01.02 Toujeo®  Insulin Glargine 300 units per ml. MUST BE PRESCRIBED BY BRAND NAME First line concentrated insulin of choice in insulin resistant patients requiring large amounts of insulin. Please take extra care in prescribing
    04.07.02 Tramadol  Schedule 3 Controlled drug (exempt from Safe Custody Regulations). In chronic non palliative pain use only if weak opioids or NSAIDS have proved problematical or pain is uncontrolled. Avoid in elderly patients. Use of tramadol should be limited to the lowest effective dose for the shortest possible time. Also used for post-operative patients orally or parenterally. Upon discharge, review dose/use and limit supply. For prison use: Use with caution, treated with full CD regulations in this setting. Only prescribe as 24 hour preparation.
    02.11 Tranexamic Acid  Inhibits activation of plasminogen. Used to prevent bleeding or treat bleeding associated with excessive fibrinolysis. Intravenous use as an antidote to thrombolytics is restricted to hospital use.
    06.01.01.02 Tresiba®  Insulin Degludec
    For use in specific patient groups only in line with agreed algorithm.
  • Conditional Green traffic light status for GPs who have completed appropriate training.
  • Amber traffic light status for those without additional training.
  • 09.08.01 Trientine   Wilson’s disease in patients intolerant of penicillamine
    04.09.02 Trihexyphenidyl (Benzhexol) 
    06.07.02 Triptorelin  Preferred gonadotrophin choice for endometriosis and preoperative treatment of fibroids Also supported for use for precocious puberty
    08.03.04.02 Triptorelin  Intramuscular injection available as a one, three and six monthly preparation. Patients in primary care with a stable PSA may be switched to the six monthly preparation even if this is different from that recommended by secondary care.
    11.05 Tropicamide  Single use eye drops. Produces rapid-onset mydriasis of short duration, maximal effect after 40-60 minutes. Recovery occurs over 6-8 hours. It produces some cycloplegia and is used to visualise the fundus for short procedures.
    07.04.02 Trospium Chloride 20mg  Has fewer drug interactions and less cognitive side effects so may be more suitable for elderly patients. Currently Flotros brand has a lower cost in primary care than other preparations.
    07.03.05 Ulipristal Acetate ellaOne® For use after 72 hours (3 days) to 120 hours (5 days) of unprotected sexual intercourse or contraceptive failure only. Use before 72 hours for patients at high risk of pregnancy restricted to Mr Oloto for trial period. After taking ulipristal for emergency contraception a woman should not start a hormonal contraceptive method for at least 5 days and be advised to use barrier methods or to abstain from sex until effective hormonal contraceptive cover has been achieved. See FSRH statement below for further detail.
    01.05 Ustekinumab Gastroenterology Specialist use only in line with NICE TA below CCG commissioned Date decision added to Formulary: Crohns Disease - October 17
    13.05.03 Ustekinumab Dermatology High Cost Drug excluded to tariff Specialist Dermatology use only Supported for use in line with NICE guidance as an alternative to other approved biologic agents. Supported for sequential use in patients who have not tolerated approved biologic agents
    10.01.03 Ustekinumab (Rheumatology)  Specialist Rheumatology use in line with NICE TA 340 Date of entry of decision to formulary: September 2015
    06.04.01.01 Vagifem® 
    02.05.05.02 Valsartan  May be used for post-MI heart failure if intolerant of an ACE inhibitor. Use is not recommended for other indications as it is more expensive than recommended choices.
    07.04.05 Vardenafil Levitra® Prescribing on NHS limited to specific patient groups only In UHL prescribing limited to specialist urology and diabetes erectile dysfunction clinics. Second line choice after sildenafil where these products appropriate to use.
    04.10 Varenicline  Only available in primary care and STOP clinics. Varenicline is a selective nicotine receptor partial antagonist and is currently extensively monitored by the MHRA for suicidal behaviour. If suicidal thoughts, depressed mood or agitiation develop, medical advice should be sought promptly and treatment discontinued. Patients with a history of psychiatric illness should not be prescribed varenicline.
    01.05 Vedolizumab   Specialist gastroenterology use only in line with NICE TA 342 and NICE TA 352 Date of entry of decision to formulary: Crohn's - November 2015 Ulcerative colitis - September 2015
    04.03 Venlafaxine  Third line only. Please note that venlafaxine twice daily tablets should be considered first as they have a lower cost acquisition than Sustained Release once daily preparations. For doses >300mg traffic light status is Amber
    02.03.02 Verapamil  Preferred choice in asthma
    07.04.01 Vesomni® (Tamsulosin+solifenacin)  In line with pathway
    09.06.02 Vitamin B Tablets (Compound Strong) 
    09.06.07 Vitamin Capsules BPC  Or equivalent
    09.06.01 Vitamins A and D Capsules BPC 
    04.03 Vortioxetine  Third line only Date of entry of decision to formulary: February 2016
    02.08.02 Warfarin  Within UHL give 1mg tablets to all patients initiated on warfarin.
    Patients already established on warfarin should receive the strengths of tablets they are used to.
    11.08.01 Xailin Night® eye ointment  Contains white soft paraffin, white mineral oil and lanolin alcohols. (Preservative free).
    06.01.02.03 Xultophy®  Liraglutide plus Degludec insulin Specialist diabetology initiation at UHL
    Primary care initiation conditional on appropriate competency. Otherwise simple amber
    05.03.01 Zidovudine  High Cost Therapy excluded to tariff
    05.03.01 Zidovudine and Lamivudine  High Cost Therapy excluded to tariff Generic combination has a lower cost than the individual components prescribed separately
    13.05.01 Zinc Paste and Ichthammol Bandage BP  'Ichthopaste', 'Ichthaband' impregnated with paste containing:Ichthammol 2%, Zinc oxide 15%
    09.05.04 Zinc Sulphate  Each tablet contains 45mg Zn2+
    09.05.04 Zinc sulphate mixture LPS  105mg/5mL Zn2+
    06.06.02 Zoledronic Acid Aclasta®
    04.07.04.01 Zolmitriptan (nasal spray)  Due to high cost, restricted preparations should be reserved for occasions where oral administration is problematic.
    04.07.04.01 Zolmitriptan (oral)  Prescribe generically.
    04.01.01 Zolpidem  May be considered if patient experiences hangover effect with zopiclone.
    04.08.01 Zonisamide 
    04.01.01 Zopiclone  As with benzodiazepines avoid prolonged use (risk of tolerance and withdrawal symptoms).
    04.02 Zuclopenthixol  For use on the advice of a specialist in psychiatry
    04.02.02 Zuclopenthixol Decanoate  Specialist in Psychiatry Initiation only.
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