Formulary Chapter 9: Nutrition and blood - Full Chapter
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Notes: |
This chapter of the formulary is under continual development, please let the team know if you have any comments about the contents: mlcsu.lscformulary@nhs.net.
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Details... |
09.01 |
Anaemias and some other blood disorders |
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09.01.01 |
Iron-deficiency anaemias |
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Roxadustat (Evrenzo®)
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Formulary
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Tablets 20mg, 50mg, 70mg, 100mg, 150mg
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NICE TA807: Roxadustat for treating symptomatic anaemia in chronic kidney disease
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Ferrous Sulphate
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First Choice
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Tablets (equivalent to 65mg iron)
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Ferrous Fumarate (Fersaday®)
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Second Choice
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f/c tablets 322mg (equivalent to 100mg iron)
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Ferrous Fumarate (Galfer®)
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Formulary
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Liquid 140mg/5mL (equivalent to 45mg iron per 5mL)
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Sodium Feredetate
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Formulary
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Liquid 190mg/5mL (equivalent to 27.5mg iron per 5mL) Only for use in neonates (SCBU)
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09.01.01.01 |
Iron and folic acid |
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Iron and Folic Acid (Pregaday®)
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Formulary
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m/r tablets 322mg (equivalent to 100mg iron/350micrograms folic acid)
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09.01.01.01 |
Compound iron preparations |
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09.01.01.02 |
Parenteral iron |
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Ferric Carboxymaltose (Ferinject®)
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Formulary
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Injection 50mg/mL First line choice For use in patients with asthma or eczema For use when total dose infusion is needed
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Iron Sucrose (Venofer®)
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Formulary
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Injection 100mg/5mL
Second line after Ferinject
For intravenous use only Do not use in patients with asthma or eczema
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Iron(III) Isomaltoside (Diafer®)
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Formulary
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Injection 50mg/mL (2mL ampoule) For use by renal unit only - preferred iron parenteral iron preparation for use by renal unit
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09.01.02 |
Drugs used in megaloblastic anaemias |
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Cyanocobalamin (Orobalin®)
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Formulary
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1mg Tablets
for treatment of non-dietary vitamin B12 deficiency when hydroxocobalamin injection is inappropriate or cannot be administered, and in dietary related deficiency only until B12 levels are replete, at which point patients are encouraged to self-care with 50-150mcg tablets daily purchased over the counter.
for maintenance therapy of dietary related insufficiency cyanocobalamin remains designated 'Do not prescribe' and patients are advised to self-care by purchase of 50mcg tablets over the counter.
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LSCMMG: Over the Counter Items that Should not be Routinely Prescribed in Primary Care Policy
NICE NG239: Vitamin B12 deficiency in over 16s: diagnosis and management
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Folic Acid
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Formulary
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Tablets 5mg, 400 microgram
Liquid 2.5mg/5mL
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Hydroxocobalamin
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Formulary
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Injection 1mg/1mL
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09.01.03 |
Drugs used in hypoplastic, haemolytic, and renal anaemias |
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Ravulizumab (Ultomiris®)
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Formulary
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Concentrate for solution for infusion 300mg/3mL, 1,100mg/11mL, 300mg/30mL
Tertiary centres only
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NICE TA698: Ravulizumab for treating paroxysmal nocturnal haemoglobinuria
NICE TA710: Ravulizumab for treating atypical haemolytic uraemic syndrome
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Voxelotor
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Formulary
![NHS England](images/NHSE.gif)
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NICE TA981: Voxelotor for treating haemolytic anaemia caused by sickle cell disease
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Rituximab (For haemolytic anaemia in adults)
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Unlicensed
![High Cost Medicine](images/HCDicon.gif)
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Off-label use for the treatment of autoimmune haemolytic anaemia in adults (AIHA)
Rituximab is recommended as an alternative treatment for adults with AIHA where patients are contraindicated to or fail to respond to standard active treatments (e.g corticosteroids).
Treatment requires initiation and continuation by specilist haematology services.
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Darbepoetin Alfa (Aranesp®)
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Formulary
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Injection prefilled syringe 10micrograms, 30micrograms, 50micrograms
Injection prefilled syringe and SureClick 20micrograms, 40micrograms, 60micrograms, 80micrograms, 100micrograms.
Consultant initiation only
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Epoetin alfa (Eprex®)
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Formulary
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Injection prefilled syringe 10,000units, 40,000units
Consultant initiation only
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09.01.03 |
Iron overload |
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Desferrioxamine Mesilate (Desferal®)
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First Choice
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Injection 500mg, 2g vials
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Deferiprone (Ferriprox®)
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Second Choice
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Tablets 500mg
Consultant haematologist only
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Deferasirox (Exjade®)
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Formulary
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Tablets 90mg, 180mg, 360mg
For specialist prescribing by haematologists
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09.01.04 |
Drugs used in autoimmune thrombocytopenic purpura |
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Anagrelide (Xagrid®)
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Formulary
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Capsules 500 micrograms Consultant haemtologist only
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Avatrombopag (Doptelet®)
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Formulary
![ICB](images/ICB.gif)
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Tablets 20mg
NICE TA853 for treating primary chronic immune thrombocytopenia - see link below
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NICE TA626: Avatrombopag for treating thrombocytopenia in people with chronic liver disease needing a planned invasive procedure
NICE TA853: Avatrombopag for treating primary chronic immune thrombocytopenia
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Caplacizumab (Cablivi ®)
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Formulary
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10mg powder and solvent for solution for injection
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NICE TA667: Caplacizumab with plasma exchange and immunosuppression for treating acute acquired thrombotic thrombocytopenic purpura
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Eltrombopag (Revolade®)
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Formulary
![High Cost Medicine](images/HCDicon.gif)
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Tablets 25mg, 50mg Consultant haematologist or specialist in hepatitis C therapy only
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MHRA: Eltrombopag (Revolade): reports of interference with bilirubin and creatinine test results
NICE TA293: Eltrombopag for treating chronic immune thrombocytopenia
NICE TA382: Eltrombopag for treating severe aplastic anaemia refractory to immunosuppressive therapy (terminated appraisal)
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Fostamatinib (TAVLESSE ®)
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Formulary
![ICB](images/ICB.gif)
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Film coated tablets, 100mg, 150mg
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NICE TA935: Fostamatinib for treating refractory chronic immune thrombocytopenia
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Lusutrombopag (Mulpleo®)
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Formulary
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Film coated tablets 3mg
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NICE TA617: Lusutrombopag for treating thrombocytopenia in people with chronic liver disease needing a planned invasive procedure
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Romiplostim (Nplate®)
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Formulary
![High Cost Medicine](images/HCDicon.gif)
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Injection 250 micrograms Consultant haematologist only
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NICE TA221: Romiplostim for the treatment of chronic immune thrombocytopenia
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Rituximab (idiopathic thrombocytopenia in adults)
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Unlicensed
![High Cost Medicine](images/HCDicon.gif)
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Off-label use for the treatment of idiopathic thrombocytopenia in adults.
For use as an alternative 2nd line treatment in adults with ITP following failure of corticosteriod treatment or when corticosteroids and thrombopoietin receptor agonists are contraindicated
Treatment requires initiation and continuation and continuation by specialist haematology services
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09.01.06 |
Drugs used in neutropenia |
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Filgrastim (G-CSF)
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Formulary
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Injection 12 million units in 0.2mL prefilled syringe, 30 million units & 48 million units in 0.5mL prefilled syringe
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MHRA: Filgrastim and pegfilgrastim: risk of capillary leak syndrome
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Pegfilgrastim (Neulasta®)
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Formulary
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Injection 6mg in 0.6mL prefilled syringe
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MHRA: Filgrastim and pegfilgrastim: risk of capillary leak syndrome
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09.01.07 |
Drugs used to mobilise stem cells |
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09.02 |
Fluids and electrolytes |
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09.02.01 |
Oral preparations for fluid and electrolyte imbalance |
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09.02.01.01 |
Oral potassium |
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Potassium Chloride (Sando-K®)
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First Choice
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Effervescent tablets potassium 12mmol
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Potassium Chloride (Kay-Cee-L®)
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Second Choice
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Liquid 1mmol/mL
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Potassium Chloride (Slow-K®)
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Second Choice
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m/r tablets potassium 8mmol
Avoid unless effervescent tablets or liquid preparations inappropriate
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09.02.01.01 |
Potassium removal |
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Patiromer calcium (Veltassa®
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Formulary
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Oral powder sachets 8.4g, 16.8g
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NICE TA623: Patiromer for treating hyperkalaemia
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Polystyrene Sulphonate Resins (Calcium Resonium®)
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Formulary
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Oral powder 300g Enema kit 30g
In East Lancashire
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Sodium zirconium cyclosilicate (Lokelma® )
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Formulary
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Oral powder sachets 5g, 10g
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NICE TA599: Sodium zirconium cyclosilicate for treating hyperkalaemia
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09.02.01.02 |
Oral sodium and water |
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Sodium Chloride (Slow Sodium®)
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Formulary
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m/r tablets 600mg (10mmol)
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09.02.01.02 |
Oral rehydration therapy (ORT) |
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Oral Rehydration Salts (inc Dioralyte®)
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Formulary
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Sachets
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09.02.01.03 |
Oral bicarbonate |
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Sodium Bicarbonate
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Formulary
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Capsules 500mg (6mmol)
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09.02.02 |
Parenteral preparations for fluid and electrolyte imbalance |
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09.02.02.01 |
Electrolytes and water |
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09.02.02.01 |
Intravenous sodium |
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Sodium Chloride and Glucose Intravenous Infusion
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Formulary
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Sodium chloride 0.18% (30mmol/litre)/glucose 4% 500mL & 1L
Sodium chloride 0.18% (30mmol/litre)/glucose 10% 500mL & 1L
Sodium chloride 0.45% (75mmol/litre)/glucose 5% 500mL
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Sodium Chloride Intravenous
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Formulary
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Injection 0.9% 2mL, 5mL, 10mL
Injection 30% (3g/10mL) 10mL
Intravenous infusion 0.18% (30mmol/litre) 500mL Polyfusor®
Intravenous infusion 0.45% (75mmol/litre) 500mL
Intravenous infusion 0.9% (150mmol/litre) 50mL, 100mL, 250mL, 500mL & 1L
Intravenous infusion 1.8% (300mmol/litre) 500mL
Intravenous infusion 2.7% 500mL Polyfusor®
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09.02.02.01 |
Intravenous glucose |
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Glucose Intravenous
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Formulary
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Injection 20% 20mL
Injection 50% 20mL, 50mL
Intravenous infusion 5% 100mL, 250mL, 500mL &1L
Intravenous infusion 10% 500mL & 1L
Intravenous infusion 15% 500mL
Intravenous infusion 20% 500mL
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09.02.02.01 |
Intravenous potassium |
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Potassium Chloride 50mmol in 50mL Sodium Chloride 0.9% prefilled syringe
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Formulary
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High strength intravenous infusion Prefilled syringe 7.5% (1mmol/L) 50mL
Restricted use see UHMB Trust Potassium Policy
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Potassium Chloride and Glucose Intravenous Infusion
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Formulary
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Potassium chloride 0.15% (20mmol/litre)/glucose 5% 1L
Potassium chloride 0.3% (40mmol/litre)/glucose 5% 500mL & 1L
Potassium chloride 0.15% (20mmol/litre)/glucose 10% 500mL
Potassium chloride 0.3% (40mmol/litre)/glucose 10% 500mL
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Potassium Chloride and Sodium Chloride Intravenous Infusion
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Formulary
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Potassium chloride 0.15% (20mmol/litre)/sodium chloride 0.9% 1L
Potassium chloride 0.3% (40mmol/litre)/sodium chloride 0.9% 1L
Potassium chloride 0.6% (80mmol/litre)/sodium chloride 0.9% 500mL & 1L
Restricted use - see UHMB Trust Potassium Policy
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Potassium Chloride, Sodium Chloride and Glucose Intravenous Infusion
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Formulary
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Potassium chloride 0.15% (20mmol/litre)/sodium chloride 0.18%/glucose 4% 1L
Potassium chloride 0.3% (40mmol/litre)/sodium chloride 0.18%/glucose 4% 1L
Potassium chloride 0.15% (20mmol/litre)/sodium chloride 0.45%/glucose 5% 500mL
Potassium chloride 0.3% (40mmol/litre)/sodium chloride 0.45%/glucose 5% 500mL
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09.02.02.01 |
Bicarbonate and lactate |
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Compound Sodium Lactate Intravenous Infusion (Hartmann's ®)
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Formulary
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500mL & 1L
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Sodium Bicarbonate
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Formulary
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Injection 8.4% 10mL Prefilled syringe injection 8.4% 10mL & 50mL Intravenous infusion 1.26%, 1.4% 500mL Polyfusor® Intravenous infusion 8.4% 200mL Polyfusor®
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Water for Injection
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Formulary
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2mL, 5mL, 10mL, 20mL
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09.02.02.02 |
Plasma and plasma substitutes |
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Human Albumin Solution
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Formulary
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Intravenous infusion 4.5% 500mL, 20% 100mL
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09.02.02.02 |
Plasma substitutes |
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Dextran 40®
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Formulary
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Intravenous infusion in glucose 5% 500mL & sodium chloride 0.9% 500mL
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Dextran 70®
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Formulary
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Intravenous infusion in glucose 5% 500mL & sodium chloride 0.9% 500mL
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Gelatin (Gelofusine®)
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Formulary
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Intravenous infusion 500mL
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09.03 |
Intravenous nutrition |
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See UHMB guideline |
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Parenteral Nutrition (TPN or PN)
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Formulary
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Peripheral or Central line
10g, 2500ml volume, Na+ 52.5mmol, K+ 40mmol, Ca2+ 5mmol, Mg2+ 5.5, PO4- 21.2mmol, 1500kcal
Central line only
14g, 2000ml volume, Na+ 70mmol, K+ 60mmol, Ca2+ 7mmol, Mg2+ 8, PO4- 30mmol, 1920kcal
18g, 2000ml volume, Na+ 70mmol, K+ 60mmol, Ca2+ 7mmol, Mg2+ 8, PO4- 30mmol, 1680kcal
Electrolyte free (apart from PO4)
18g electrolyte free, 2000ml volume, central line only, PO4- 6mmol, 1680kcal
Fat free
14g fat free, 2000ml volume, central line only, Na+ 70mmol, K+ 60mmol, Ca2+ 4.5mmol, Mg2+ 5, PO4- 30mmol, 1200kcal
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09.03 |
Supplementary preparations |
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Contact dieticians for advice |
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09.04.01 |
Foods for special diets |
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09.04.02 |
Enteral nutrition |
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09.05.01 |
Calcium and magnesium |
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09.05.01.01 |
Calcium supplements |
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Calcium Carbonate
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Formulary
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Chewable tablets 1.25g calcium 500mg (12.6mmol)
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Calcium Chloride
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Formulary
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Injection (calcium 10mmol/10mL) 10mL amp (unlicensed)
Injection 5mmol/5mL amp
Injection 1g in 10mL (calcium 9.1mmol/10mL) prefilled syringe
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Calcium Gluconate
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Formulary
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Injection 10% (calcium 2.26mmol/10mL)10mL amp
Injection 10% 50mL vial
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Calvive 1000® Effervescent Tablets
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Formulary
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Effervescent tablets calcium 1000mg (25mmol)
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09.05.01.02 |
Hypercalcaemia and hypercalciuria |
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Cinacalcet (Mimpara®)
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Formulary
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Tablets 30mg, 60mg
Consultant endocrinologist initiation only
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NICE TA117: Cinacalcet for the treatment of secondary hyperparathyroidism in patients with end-stage renal disease on maintenance dialysis therapy
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Etelcalcetide (Parsabiv®)
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Formulary
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Injection
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NICE TA448: Etelcalcetide for treating secondary hyperparathyroidism
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09.05.01.03 |
Magnesium |
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See UHMB Guideline on hypomagnesaemia |
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Magnesium Aspartate
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Formulary
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Sachets 10mmol
In East Lancashire
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Magnesium citrate 4mmol tablets
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Formulary
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Magnesium Glycerophosphate
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Formulary
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Tablets magnesium 4mmol Liquid 1mmol/1mL - -Unlicensed
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NICE: Preventing recurrent hypomagnesaemia: oral magnesium glycerophosphate
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Magnesium Sulphate
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Formulary
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Injection 50% (magnesium 2mmol/mL) 2mL, 10mL amps
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09.05.02.01 |
Phosphate supplements |
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Phosphate supplements (Phosphate-Sandoz®)
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First Choice
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Effervescent tablets 500mg (phosphate 16.1mmol)
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Joulies oral phosphate solution (For paediatric use)
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Unlicensed
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Preservative free oral solution Phosphate 0.98 mmol per 1mL Sodium 0.76 mmol per 1mL
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Phosphate infusion
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Unlicensed
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Intravenous infusion (phosphate 50mmol/500mL) 500mL
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09.05.02.02 |
Phosphate-binding agents |
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Calcium Acetate (Phosex®)
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Formulary
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Tablets 1g
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Calcium Acetate (Renacet®)
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Formulary
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Tablets 475mg
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Calcium Salts (Osvaren®)
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Formulary
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Film coated tablets Calcium acetate, 435 mg equivalent to 110 mg calcium and Magnesium carbonate, heavy 235 mg equivalent to 60 mg magnesium
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Lanthanum (Fosrenol ®)
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Formulary
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Tablets 250mg, 500mg, 750mg, 1000mg
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Sevelamer Carbonate
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Formulary
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Tablets 800mg
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Sevelamer Carbonate (Renvela®)
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Formulary
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Sachets 2.4g
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Sodium fluoride toothpaste 5000ppm (Duraphat® (Toothpaste))
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Formulary
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For treatment of head and neck cancer patients who have had surgery, radiotherapy and/or chemotherapy and are often left with severely dry mouths, restricted mouth opening, and reduced access for toothbrushing or professional dental care.
Should be prescribed on the advice of a secondary care specialist
Prophylaxis of dental caries
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09.05.04 |
Zinc |
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Zinc Sulphate (Solvazinc®)
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Formulary
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Effervescent tablets 125mg
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Paravit CF®
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Formulary
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Paravit-CF is a ‘Food for Special Medical Purposes’ for the dietary management of patients with cystic fibrosis and is reimbursable on FP10. Paravit CF Capsules contain: • Vitamin A 1.5 mg (=5,000IU) • Vitamin D3 37.5 µg (=1,500IU) • Vitamin E 100 µg (=150IU) • Vitamin K 5 mg Paravit CF capsules provide an alternative vitamin supplementation option for Cystic Fibrosis patients, which offers patients a decreased oral medication load whilst also being a cost-effective option. Paravit CF liquid is only available as an option for patients with swallowing difficulties or young children.
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Pyridoxine Hydrochloride (Vitamin B6)
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Formulary
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Tablets 10mg, 50mg
in East Lancashire
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Thiamine (Vitamin B1)
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Formulary
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Tablets 50mg
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Thiamine (Pabrinex®) (Vitamins B & C)
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Formulary
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High potency
Intravenous injection 10mL (2 amps)
Intramuscular injection 7mL (2 amps)
MHRA/CHM advice:serious allergic adverse reactions - see BNF
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MHRA: Pabrinex: allergic reactions
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09.06.02 |
Oral vitamin B complex preparations |
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Vitamin B complex preparations (Vigranon B®)
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Formulary
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Not to be prescribed on TTO
Not for use in alcohol dependence
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Vitamin B Tablets, Compound Strong
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Formulary
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For refeeding and Post Bariatric Surgery only
Refer to local policies
Not for use in alcohol dependence - thiamine may be used
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LSCMMG: Guidelines for the prescribing of nutritional supplements post bariatric surgery
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Ascorbic Acid
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Formulary
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Tablets 50mg, 100mg, 200mg & 500mg Effervescent tablets 1g with zinc
Only to be used for prophylaxis and treatment of scurvy
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Alfacalcidol (One-Alpha®)
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Formulary
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Capsules 250 nanograms, 1 microgram Oral drops 2 micrograms/mL (1 drop = 100 nanograms) For severe renal impairment
Prescribers initiating treatment should indicate monitoring requirements.
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SPS - Alfacalcidol monitoring
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Calcitriol (Rocaltrol®) (1,25-dihydroxycolecalciferol)
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Formulary
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Capsules 250 nanograms
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Colecalciferol
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Formulary
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Follow local protocols
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Colecalciferol 40000 unit (Plenachol®)
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Formulary
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Capsules 40000 units
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Colecalciferol and Calcium Carbonate
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Formulary
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Ergocalciferol
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Formulary
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Injection 300,000 units
Consultant initiation only
Not to be used with plastic syringes
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09.06.04 |
Vitamin D with Calcium |
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09.06.05 |
Vitamin E |
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Alpha Tocopheryl Acetate
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Formulary
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Suspension 500mg/5mL Other preparations may be available but are unlicensed - contact pharmacy for advice
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Menadiol Sodium Phosphate
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Formulary
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Tablets 10mg water soluble preparation for patients with fat malabsorption
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Phytomenadione
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Formulary
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Injection 10mg/1mL (Konakion MM®) for IV injection only, not for IM injection.
Injection 2mg/0.2mL (Konakion MM Paediatric®)
Konakion MM Paediatric® may be administered by mouth, by IM injection or by IV injection - see UHMB guideline for administration of vitamin k to neonates
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09.06.07 |
Multivitamin preparations |
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Multivitamin preparations (Abidec®)
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Formulary
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Vitamins A, B group, C and D
Oral drops
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Multivitamin preparations (Dalivit®)
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Formulary
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Vitamins A, B group, C and D
Oral drops
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Mutivitamin (Vitamins BPC capsules)
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Formulary
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LSCMMG: Over the Counter Items that Should not be Routinely Prescribed in Primary Care Policy
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Renavit®
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Formulary
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Dietary management of water-soluble vitamin deficiency in adults with renal failure on dialysis For G.P prescribing
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09.06.07 |
Vitamin and mineral supplements and adjuncts to synthetic diets |
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Vitamin and mineral supplements (Forceval, & Forceval Soluble®)
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Formulary
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Tablets On dieticians request only for patients with swallowing difficulties or enteral feeding tubes
Post-surgery if gastric bypass
For use post bariatric surgery please consult link below
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LSCMMG: Guidelines for the prescribing of nutritional supplements post bariatric surgery
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Vitamin and mineral supplements (Ketovite®)
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Formulary
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Tablets
Liquid
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09.08 |
Metabolic disorders |
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Contact pharmacy for advice |
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Eladocagene exuparvovec (Upstaza®)
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Formulary
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Solution for infusion 2.8 x 10^11 Vector genomes/0.5mL
Tertiary Centre Only HST26 Eladocagene exuparvovec for treating aromatic L-amino acid decarboxylase deficiency - See link below
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NICE: Eladocagene exuparvovec for treating aromatic L-amino acid decarboxylase deficiency
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09.08.01 |
Drugs used in metabolic disorders |
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Asfotase alfa (Strensiq® )
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Formulary
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Tertiary Centre
Solution for injection
100mg/ml, 40mg/ml
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NICE: Asfotase alfa for treating paediatric-onset hypophosphatasia
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Avalglucosidase alfa (Nexviadyme ®)
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Formulary
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Powder for concentrate for solution for infusion 100mg - for treating Pompe disease - see link below
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NICE TA821: Avalglucosidase alfa for treating Pompe disease
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Pegunigalsidase alfa (Elafbrio®) (2 mg/mL concentrate for solution for infusion)
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Formulary
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For treating Fabry disease
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NICE TA915: Pegunigalsidase alfa for treating Fabry disease
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Vutrisiran (Amvuttra ®)
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Formulary
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for NICE TA868 Vutrisiran for treating hereditary transthyretin-related amyloidosis
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NICE TA868: Vutrisiran for treating hereditary transthyretin-related amyloidosis
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Penicillamine
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Formulary
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Tablets 125mg
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LSCMMG: Shared care guideline - Penicillamine
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09.08.01 |
Carnitine deficiency |
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L-Carnitine (Carnitor®) (Levocarnitine)
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Formulary
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Injection 1g in 5mL
Paediatric use only
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09.08.01 |
Gaucher's disease |
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09.08.01 |
Mucopolysaccharidosis I |
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09.08.01 |
Nephropathic cystinosis |
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09.08.01 |
Urea cycle disorders |
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09.08.02 |
Acute porphyrias |
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09.08.02 |
Drugs unsafe for use in acute porphyrias |
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.... |
Non Formulary Items |
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Key |
![Restricted Drug](images/restricted_new.jpg) |
Restricted Drug |
![Unlicensed Drug](images/unlicensed.gif) |
Unlicensed |
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Link to adult BNF
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Link to children's BNF
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Link to SPCs
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Scottish Medicines Consortium |
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Cytotoxic Drug |
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Controlled Drug |
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High Cost Medicine |
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Cancer Drugs Fund |
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NHS England |
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Homecare |
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ICB |
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Low carbon footprint |
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Medium carbon footprint |
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High carbon footprint |
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Status |
Description |
![Green](images/TrafficLightsGreenV2.gif)
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Green:
Appropriate for initiation and ongoing prescribing in both primary and secondary care.
Generally, little or no routine drug monitoring is required. |
![Green Restricted](images/TrafficLightsGreenRestricted.gif)
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Green (Restricted):
Appropriate for initiation and ongoing prescribing in both primary and secondary care provided:
Additional criteria specific to the medicine or device are met, or
The medicine or device is used following the failure of other therapies as defined by the relevant LSCMMG pathway.
Generally, little or no routine drug monitoring is required.
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![Red](images/TrafficLightsRedV2.gif)
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Red medicines:
Medicine is supplied by the hospital for the duration of the treatment course.
Primary care initiation or continuation of treatment is not recommended unless exceptional circumstances such as specialist GP.
Red medicines are those where primary care prescribing is not recommended. These treatments should be initiated by specialists only and prescribing retained within secondary care. They require specialist knowledge, intensive monitoring, specific dose adjustments or further evaluation in use. If however, a primary care prescriber has particular specialist knowledge or experience of prescribing a particular drug for a particular patient it would not always be appropriate for them to expect to transfer that prescribing responsibility back to secondary care. There should be a specific reason and a specific risk agreement, protocol and service set up to support this.
Primary care prescribers may prescribe RED medicines in exceptional circumstances to patients to ensure continuity of supply while arrangements are made to obtain ongoing supplies from secondary care. |
![Amber 0](images/TrafficLightsAmberAm0.gif)
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Amber level 0:
Suitable for prescribing in primary care following recommendation or initiation by a specialist.
Little or no specific monitoring required.
Patient may need a regular review, but this would not exceed that required for other medicines routinely prescribed in primary care.
Brief prescribing document or information sheet may be required.
Primary care prescribers must be familiar with the drug to take on prescribing responsibility or must get the required information.
When recommending or handing over care, specialists should ask primary care prescribers to take over prescribing responsibility, and should give enough information about the indication, dose, monitoring requirements, use outside product licence and any necessary dose adjustments to allow them to confidently prescribe. |
![Amber 1](images/TrafficLightsAmber1V2.gif)
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Amber level 1 (with shared care):
Suitable for prescribing in primary care following recommendation or initiation by a specialist.
Minimal monitoring required.
Patient may need a regular review, but this would not exceed that required for other medicines routinely prescribed in primary care.
Full prior agreement about patient’s on-going care must be reached under the shared care agreement.
Primary care prescribers are advised not to take on prescribing of these medicines unless they have been adequately informed by letter of their responsibilities with regards monitoring, side effects and interactions and are happy to take on the prescribing responsibility. A copy of locally approved shared care guidelines should accompany this letter which outlines these responsibilities. Primary care prescribers should then tell secondary care of their intentions as soon as possible by letter so that arrangements can be made for the transfer of care. |
![Amber 2](images/TrafficLightsAmber2V2.gif)
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Amber level 2 (with shared care and enhanced service):
Initiated by specialist and transferred to primary care following a successful initiation period.
Significant monitoring required on an on-going basis.
Full prior agreement about patient’s on-going care must be reached under the shared care agreement.
Suitable for enhanced service.
These medicines are considered suitable for GP prescribing following specialist initiation of therapy, as per shared care document which will be sent out with the request to prescribe, with on-going communication between the primary care prescriber and specialist. Amber Level 2 medicines require significant monitoring for which an enhanced service may be suitable. (Subject to local commissioning agreements). |
![Do Not Prescribe](images/TrafficLightsDNPv2.gif)
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Do not prescribe: NOT recommended for use by the NHS in Lancashire and South Cumbria.
Includes medicines that NICE has not recommended for use and terminated technology appraisals, unless there is a local need. |
![Grey](images/TrafficLightsGreyV2.gif)
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Grey medicines:
Medicines which have not yet been reviewed or are under the review process.
GPs and specialists are recommended not to prescribe these drugs.
This category includes drugs where funding has not yet been agreed.
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![Multiple](images/TrafficLightsBlueMultiV2.gif)
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Refer to local guidance and local commissioning arrangements |
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