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 Formulary Chapter 9: Nutrition and blood - Full Chapter
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

For more information about the formulary development process, please see: https://www.lancsmmg.nhs.uk/lancashire-and-south-cumbria-icb-formulary-development/

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09.01  Expand sub section  Anaemias and some other blood disorders
09.01.01  Expand sub section  Iron-deficiency anaemias
RoxadustatBlack Triangle (Evrenzo®)
View adult BNF View SPC online View childrens BNF
Formulary
Red

Tablets 20mg, 50mg, 70mg, 100mg, 150mg

 
Link  NICE TA807: Roxadustat for treating symptomatic anaemia in chronic kidney disease
 
09.01.01.01  Expand sub section  Oral iron
Ferrous Sulphate
View adult BNF View SPC online View childrens BNF
First Choice
Green
Tablets (equivalent to 65mg iron) 
Ferrous Fumarate (Fersaday®)
View adult BNF View SPC online View childrens BNF
Second Choice
Green
f/c tablets 322mg (equivalent to 100mg iron) 
 
Ferrous Fumarate (Galfer®)
View adult BNF View SPC online View childrens BNF
Formulary
Green
Liquid 140mg/5mL (equivalent to 45mg iron per 5mL) 
 
Sodium Feredetate
View adult BNF View SPC online View childrens BNF
Formulary
Green
Sytron® oral solution contains sodium feredetate trihydrate 41.5 mg/mL equivalent to 5.5 mg/mL elemental iron.
 
Sodifer® oral solution contain sodium feredetate 38 mg/mL equivalent to 5.5 mg/mL elemental iron.
 
Sodifer® is not suitable for babies under 28 days.
 
 
09.01.01.01  Expand sub section  Iron and folic acid
Iron and Folic Acid (Pregaday®)
View adult BNF View SPC online View childrens BNF
Formulary
Green
m/r tablets 322mg (equivalent to 100mg iron/350micrograms folic acid) 
 
09.01.01.01  Expand sub section  Compound iron preparations to top
09.01.01.02  Expand sub section  Parenteral iron
Ferric CarboxymaltoseBlack Triangle (Ferinject®)
View adult BNF View SPC online View childrens BNF
Formulary
Red

Injection 50mg/mL

First line choice
For use in patients with asthma or eczema
For use when total dose infusion is needed

 
 
Iron SucroseBlack Triangle (Venofer®)
View adult BNF View SPC online View childrens BNF
Formulary
Red

Injection 100mg/5mL

Second line after Ferinject


For intravenous use only

Do not use in patients with asthma or eczema

 
 
Iron(III) Isomaltoside Black Triangle (Diafer®)
View adult BNF View SPC online View childrens BNF
Formulary
Red

Injection 50mg/mL (2mL ampoule)

For use by renal unit only - preferred iron parenteral iron preparation for use by renal unit

 
 
09.01.02  Expand sub section  Drugs used in megaloblastic anaemias
Cyanocobalamin (Orobalin®)
View adult BNF View SPC online View childrens BNF
Formulary
Green

1mg Tablets

Green  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. 

Do Not Prescribe  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. 

 
Link  LSCMMG: Over the Counter Items that Should not be Routinely Prescribed in Primary Care Policy
Link  NICE NG239: Vitamin B12 deficiency in over 16s: diagnosis and management
 
Folic Acid
View adult BNF View SPC online View childrens BNF
Formulary
Green
Tablets 5mg, 400 microgram
Liquid 2.5mg/5mL 
Link  UK Chief Medical Officers Chief Nursing Officers and Chief Midwifery Officers - Folic Acid
 
Hydroxocobalamin
View adult BNF View SPC online View childrens BNF
Formulary
Green
Injection 1mg/1mL 
 
09.01.03  Expand sub section  Drugs used in hypoplastic, haemolytic, and renal anaemias
Danicopan
View adult BNF View SPC online View childrens BNF
Formulary
Red
NHS England
BlueTeq
Danicopan is recommended, as an add-on to ravulizumab or eculizumab as an option for treating paroxysmal nocturnal haemoglobinuria (PNH) in adults who have residual haemolytic anaemia, only if:
• they have clinically significant extravascular haemolysis while on treatment with a complement component 5 inhibitor (C5 inhibitor) and
• the company provides it according to the commercial arrangement.
 
Link  NICE TA1010: Danicopan with ravulizumab or eculizumab for treating paroxysmal nocturnal haemoglobinuria
 
Iptacopan
View adult BNF View SPC online View childrens BNF
Formulary
Red
NHS England
BlueTeq
Iptacopan is recommended, within its anticipated marketing authorisation, as an option for treating paroxysmal nocturnal haemoglobinuria (PNH) in adults with haemolytic anaemia.
Iptacopan will be available via the Innovative Medicines Fund (IMF) according to a set of treatment criteria which translates the NICE recommendation into a clinical guide as to use in practice. These treatment criteria can be found on the application form(s) on the Blueteq site.
NHS England will then routinely commission iptacopan in patients with PNH via commissioned centres.
 
Link  NICE TA1000: Iptacopan for treating paroxysmal nocturnal haemoglobinuria
 
Ravulizumab (Ultomiris®)
View adult BNF View SPC online View childrens BNF
Formulary
Red
NHS England

Concentrate for solution for infusion 300mg/3mL, 1,100mg/11mL, 300mg/30mL

Tertiary centres only

 
Link  NICE TA698: Ravulizumab for treating paroxysmal nocturnal haemoglobinuria
Link  NICE TA710: Ravulizumab for treating atypical haemolytic uraemic syndrome
 
Rituximab
(For haemolytic anaemia in adults)
View adult BNF View SPC online View childrens BNF
Unlicensed Drug Unlicensed
Red
High Cost Medicine
BlueTeq

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.

 

 

 
 
09.01.03  Expand sub section  Erythropoietin
Darbepoetin Alfa (Aranesp®)
View adult BNF View SPC online View childrens BNF
Formulary
Red
Injection prefilled syringe 10micrograms, 30micrograms, 50micrograms
Injection prefilled syringe and SureClick 20micrograms, 40micrograms, 60micrograms, 80micrograms, 100micrograms.

Consultant initiation only 
 
Epoetin alfa (Eprex®)
View adult BNF View SPC online View childrens BNF
Formulary
Red
Injection prefilled syringe 10,000units, 40,000units

Consultant initiation only 
 
09.01.03  Expand sub section  Iron overload to top
Desferrioxamine Mesilate (Desferal®)
View adult BNF View SPC online View childrens BNF
First Choice
Red
Injection 500mg, 2g vials 
Deferiprone (Ferriprox®)
View adult BNF View SPC online View childrens BNF
Second Choice
Red
High Cost Medicine
Tablets 500mg

Consultant haematologist only 
 
DeferasiroxBlack Triangle (Exjade®)
View adult BNF View SPC online View childrens BNF
Formulary
Red
High Cost Medicine

Tablets 90mg, 180mg, 360mg

 

For specialist prescribing by haematologists

 
 
09.01.04  Expand sub section  Drugs used in autoimmune thrombocytopenic purpura
Anagrelide (Xagrid®)
View adult BNF View SPC online View childrens BNF
Formulary
Red

Capsules 500 micrograms

Consultant haemtologist only

 
 
AvatrombopagBlack Triangle (Doptelet®)
View adult BNF View SPC online View childrens BNF
Formulary
Red
CCG
BlueTeq

Tablets 20mg

 

Red  NICE TA853 for treating primary chronic immune thrombocytopenia - see link below

 
Link  NICE TA626: Avatrombopag for treating thrombocytopenia in people with chronic liver disease needing a planned invasive procedure
Link  NICE TA853: Avatrombopag for treating primary chronic immune thrombocytopenia
 
Caplacizumab Black Triangle (Cablivi ®)
View adult BNF View SPC online View childrens BNF
Formulary
Red
NHS England

10mg powder and solvent for solution for injection

 
Link  NICE TA667: Caplacizumab with plasma exchange and immunosuppression for treating acute acquired thrombotic thrombocytopenic purpura
 
Eltrombopag (Revolade®)
View adult BNF View SPC online View childrens BNF
Formulary
Red
High Cost Medicine
BlueTeq

Tablets 25mg, 50mg

Consultant haematologist or specialist in hepatitis C therapy only

 
Link  MHRA: Eltrombopag (Revolade): reports of interference with bilirubin and creatinine test results
Link  NICE TA293: Eltrombopag for treating chronic immune thrombocytopenia
Link  NICE TA382: Eltrombopag for treating severe aplastic anaemia refractory to immunosuppressive therapy (terminated appraisal)
 
Fostamatinib Black Triangle (TAVLESSE ®)
View adult BNF View SPC online View SMC online View childrens BNF
Formulary
Red
CCG
BlueTeq

Film coated tablets, 100mg, 150mg

 
Link  NICE TA935: Fostamatinib for treating refractory chronic immune thrombocytopenia
 
LusutrombopagBlack Triangle (Mulpleo®)
View adult BNF View SPC online View childrens BNF
Formulary
Red
NHS England

Film coated tablets 3mg

 
Link  NICE TA617: Lusutrombopag for treating thrombocytopenia in people with chronic liver disease needing a planned invasive procedure
 
Romiplostim (Nplate®)
View adult BNF View SPC online View childrens BNF
Formulary
Red
High Cost Medicine
BlueTeq

Injection 250 micrograms

Consultant haematologist only

 
Link  NICE TA221: Romiplostim for the treatment of chronic immune thrombocytopenia
 
Rituximab (idiopathic thrombocytopenia in adults)
View adult BNF View SPC online View childrens BNF
Unlicensed Drug Unlicensed
Red
High Cost Medicine
BlueTeq

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

 
 
09.01.05  Expand sub section  G6PD deficiency
09.01.06  Expand sub section  Drugs used in neutropenia
Filgrastim
(G-CSF)
View adult BNF View SPC online View childrens BNF
Formulary
Red
Injection 12 million units in 0.2mL prefilled syringe, 30 million units & 48 million units in 0.5mL prefilled syringe 
Link  MHRA: Filgrastim and pegfilgrastim: risk of capillary leak syndrome
 
Pegfilgrastim (Neulasta®)
View adult BNF View SPC online View childrens BNF
Formulary
Red
Injection 6mg in 0.6mL prefilled syringe 
Link  MHRA: Filgrastim and pegfilgrastim: risk of capillary leak syndrome
 
09.01.07  Expand sub section  Drugs used to mobilise stem cells
09.02  Expand sub section  Fluids and electrolytes to top
09.02.01  Expand sub section  Oral preparations for fluid and electrolyte imbalance
09.02.01.01  Expand sub section  Oral potassium
Potassium Chloride (Sando-K®)
View adult BNF View SPC online View childrens BNF
First Choice
Green
Effervescent tablets potassium 12mmol 
Potassium Chloride (Slow-K®)
View adult BNF View SPC online View childrens BNF
Second Choice
Green
m/r tablets potassium 8mmol

Avoid unless effervescent tablets or liquid preparations inappropriate 
 
Potassium Chloride oral liquid
View adult BNF View SPC online View childrens BNF
Second Choice
Green

Unlicensed potassium chloride oral solutions manufactured within the UK are available via Specials manufacturers, lead times vary.

Care is needed to ensure selection of the most appropriate oral potassium supplement and delivery of the correct dosage.
 
This National Patient Safety Alert provides further background, clinical information and actions for providers.
 
Link  CAS: UPDATE: Discontinuation of Kay-Cee-L (potassium chloride 375mg/ml) (potassium chloride 5mmol/5ml) syrup
 
09.02.01.01  Expand sub section  Potassium removal
Patiromer calcium Black Triangle (Veltassa® View adult BNF View SPC online View childrens BNF Formulary
Red

Oral powder sachets 8.4g, 16.8g

 
Link  NICE TA623: Patiromer for treating hyperkalaemia
 
Polystyrene Sulphonate Resins (Calcium Resonium®)
View adult BNF View SPC online View childrens BNF
Formulary
Amber 0

Oral powder 300g
Enema kit 30g

Green In East Lancashire

 
 
Sodium zirconium cyclosilicateBlack Triangle (Lokelma® )
View adult BNF View SPC online View childrens BNF
Formulary
Red
CCG

Oral powder sachets 5g, 10g

 
Link  NICE TA599: Sodium zirconium cyclosilicate for treating hyperkalaemia
 
09.02.01.02  Expand sub section  Oral sodium and water
Sodium Chloride (Slow Sodium®)
View adult BNF View SPC online View childrens BNF
Formulary
Green
m/r tablets 600mg (10mmol) 
 
09.02.01.02  Expand sub section  Oral rehydration therapy (ORT) to top
Oral Rehydration Salts (inc Dioralyte®)
View adult BNF View SPC online View childrens BNF
Formulary
Green

Sachets

 
 
09.02.01.03  Expand sub section  Oral bicarbonate
Sodium Bicarbonate
View adult BNF View SPC online View childrens BNF
Formulary
Green
Capsules 500mg (6mmol) 
 
09.02.02  Expand sub section  Parenteral preparations for fluid and electrolyte imbalance
09.02.02.01  Expand sub section  Electrolytes and water
09.02.02.01  Expand sub section  Intravenous sodium
Sodium Chloride and Glucose Intravenous Infusion
View adult BNF View SPC online View childrens BNF
Formulary
Red
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 
 
Sodium Chloride Intravenous
View adult BNF View SPC online View childrens BNF
Formulary
Red
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® 
 
09.02.02.01  Expand sub section  Intravenous glucose to top
Glucose Intravenous
View adult BNF View SPC online View childrens BNF
Formulary
Red
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 
 
09.02.02.01  Expand sub section  Intravenous potassium
Potassium Chloride 50mmol in 50mL Sodium Chloride 0.9% prefilled syringe
View adult BNF View SPC online View childrens BNF
Formulary
Red
Restricted ItemHigh strength intravenous infusion Prefilled syringe 7.5% (1mmol/L) 50mL

Restricted ItemRestricted use see UHMB Trust Potassium Policy 
 
Potassium Chloride and Glucose Intravenous Infusion
View adult BNF View SPC online View childrens BNF
Formulary
Red
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 
 
Potassium Chloride and Sodium Chloride Intravenous Infusion
View adult BNF View SPC online View childrens BNF
Formulary
Red
Potassium chloride 0.15% (20mmol/litre)/sodium chloride 0.9% 1L
Potassium chloride 0.3% (40mmol/litre)/sodium chloride 0.9% 1L
Restricted ItemPotassium chloride 0.6% (80mmol/litre)/sodium chloride 0.9% 500mL & 1L

Restricted Item Restricted use - see UHMB Trust Potassium Policy
 
 
Potassium Chloride, Sodium Chloride and Glucose Intravenous Infusion
View adult BNF View SPC online View childrens BNF
Formulary
Red
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 
 
09.02.02.01  Expand sub section  Bicarbonate and lactate
Compound Sodium Lactate Intravenous Infusion (Hartmann's ®)
View adult BNF View SPC online View childrens BNF
Formulary
Red
500mL & 1L 
 
Sodium Bicarbonate
View adult BNF View SPC online View childrens BNF
Formulary
Red

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®

 
 
09.02.02.01  Expand sub section  Water
Water for Injection
View adult BNF View SPC online View childrens BNF
Formulary
Green
2mL, 5mL, 10mL, 20mL 
 
09.02.02.02  Expand sub section  Plasma and plasma substitutes
Human Albumin Solution
View adult BNF View SPC online View childrens BNF
Formulary
Red
Intravenous infusion 4.5% 500mL, 20% 100mL 
 
09.02.02.02  Expand sub section  Plasma substitutes to top
Dextran 40®
View adult BNF View SPC online View childrens BNF
Formulary
Red
Intravenous infusion in glucose 5% 500mL & sodium chloride 0.9% 500mL 
 
Dextran 70®
View adult BNF View SPC online View childrens BNF
Formulary
Red
Intravenous infusion in glucose 5% 500mL & sodium chloride 0.9% 500mL  
 
Gelatin (Gelofusine®)
View adult BNF View SPC online View childrens BNF
Formulary
Red
Intravenous infusion 500mL  
 
09.03  Expand sub section  Intravenous nutrition
 note  See UHMB guideline
Parenteral Nutrition (TPN or PN)
View adult BNF View SPC online View childrens BNF
Formulary
Red
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

 
 
09.03  Expand sub section  Supplementary preparations
09.04  Expand sub section  Oral nutrition
 note  Contact dieticians for advice
09.04.01  Expand sub section  Foods for special diets
09.04.02  Expand sub section  Enteral nutrition to top
09.05  Expand sub section  Minerals
09.05.01  Expand sub section  Calcium and magnesium
09.05.01.01  Expand sub section  Calcium supplements
Calcium Carbonate
View adult BNF View SPC online View childrens BNF
Formulary
Green

Chewable tablets 1.25g calcium 500mg (12.6mmol)

 
 
Calcium Chloride
View adult BNF View SPC online View childrens BNF
Formulary
Red
Injection (calcium 10mmol/10mL) 10mL amp (unlicensed)
Injection 5mmol/5mL amp
Injection 1g in 10mL (calcium 9.1mmol/10mL) prefilled syringe 
 
Calcium Gluconate
View adult BNF View SPC online View childrens BNF
Formulary
Red
Injection 10% (calcium 2.26mmol/10mL)10mL amp
Injection 10% 50mL vial 
 
Calvive 1000® Effervescent Tablets
View adult BNF View SPC online View childrens BNF
Formulary
Green

Effervescent tablets calcium 1000mg (25mmol)

 
 
09.05.01.02  Expand sub section  Hypercalcaemia and hypercalciuria
Cinacalcet (Mimpara®)
View adult BNF View SPC online View childrens BNF
Formulary
Red
Tablets 30mg, 60mg

Consultant endocrinologist initiation only 
Link  NICE TA117: Cinacalcet for the treatment of secondary hyperparathyroidism in patients with end-stage renal disease on maintenance dialysis therapy
 
Etelcalcetide (Parsabiv®)
View adult BNF View SPC online View childrens BNF
Formulary
Red

Injection

 
Link  NICE TA448: Etelcalcetide for treating secondary hyperparathyroidism
 
09.05.01.03  Expand sub section  Magnesium to top
 note  See UHMB Guideline on hypomagnesaemia
Magnesium Aspartate
View adult BNF View SPC online View childrens BNF
Formulary
Green

Sachets 10mmol

 
 
Magnesium citrate 4mmol tablets
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
 
Magnesium Glycerophosphate
View adult BNF View SPC online View childrens BNF
Formulary
Green

Tablets magnesium 4mmol
Liquid 1mmol/1mL - unlicensed-Unlicensed

 
Link  NICE: Preventing recurrent hypomagnesaemia: oral magnesium glycerophosphate
 
Magnesium Sulphate
View adult BNF View SPC online View childrens BNF
Formulary
Red
Injection 50% (magnesium 2mmol/mL) 2mL, 10mL amps 
 
09.05.02  Expand sub section  Phosphorus
09.05.02.01  Expand sub section  Phosphate supplements
Phosphate supplements (Phosphate-Sandoz®)
View adult BNF View SPC online View childrens BNF
First Choice
Green
Effervescent tablets 500mg (phosphate 16.1mmol) 
Joulies oral phosphate solution
(For paediatric use)
View adult BNF View SPC online View childrens BNF
Unlicensed Drug Unlicensed
Red
Preservative free oral solution
Phosphate 0.98 mmol per 1mL
Sodium 0.76 mmol per 1mL 
 
Phosphate infusion
View adult BNF View SPC online View childrens BNF
Unlicensed Drug Unlicensed
Red

Intravenous infusion (phosphate 50mmol/500mL) 500mL

 
 
09.05.02.02  Expand sub section  Phosphate-binding agents
Calcium Acetate (Phosex®)
View adult BNF View SPC online View childrens BNF
Formulary
Amber 0

Tablets 1g

 
 
Calcium Acetate (Renacet®)
View adult BNF View SPC online View childrens BNF
Formulary
Amber 0

Tablets 475mg

 
 
Calcium Salts (Osvaren®)
View adult BNF View SPC online View childrens BNF
Formulary
Amber 0

Film coated tablets Calcium acetate, 435 mg equivalent to 110 mg calcium and Magnesium carbonate, heavy 235 mg equivalent to 60 mg magnesium

 
 
Lanthanum (Fosrenol ®)
View adult BNF View SPC online View childrens BNF
Formulary
Amber 0
High Cost Medicine

Tablets 250mg, 500mg, 750mg, 1000mg

 
 
Sevelamer Carbonate
View adult BNF View SPC online View childrens BNF
Formulary
Amber 0

Tablets 800mg

 
 
Sevelamer Carbonate (Renvela®)
View adult BNF View SPC online View childrens BNF
Formulary
Amber 0

Sachets 2.4g

 
 
09.05.03  Expand sub section  Fluoride
Sodium fluoride toothpaste 5000ppm (Duraphat® (Toothpaste))
View adult BNF View SPC online View childrens BNF
Formulary
Green Restricted

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

 Red Prophylaxis of dental caries

 

 
 
09.05.04  Expand sub section  Zinc to top
Zinc Sulphate (Solvazinc®)
View adult BNF View SPC online View childrens BNF
Formulary
Green
Effervescent tablets 125mg 
 
09.05.05  Expand sub section  Selenium
09.06  Expand sub section  Vitamins
Paravit CF®
View adult BNF View SPC online View childrens BNF
Formulary
Amber 0
CCG

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.

 
 
09.06.01  Expand sub section  Vitamin A
09.06.02  Expand sub section  Vitamin B group
Pyridoxine Hydrochloride
(Vitamin B6)
View adult BNF View SPC online View childrens BNF
Formulary
Amber 0

Tablets 10mg, 50mg

Green  in East Lancashire

 
 
Thiamine
(Vitamin B1)
View adult BNF View SPC online View childrens BNF
Formulary
Green
Tablets 50mg 
 
Thiamine (Pabrinex®)
(Vitamins B & C)
View adult BNF View SPC online View childrens BNF
Formulary
Red
High potency

Intravenous injection 10mL (2 amps)
Intramuscular injection 7mL (2 amps)

MHRA/CHM advice:serious allergic adverse reactions - see BNF 
Link  MHRA: Pabrinex: allergic reactions
 
09.06.02  Expand sub section  Oral vitamin B complex preparations to top
Vitamin B complex preparations (Vigranon B®)
View adult BNF View SPC online View childrens BNF
Formulary
Red

Not to be prescribed on TTO

Not for use in alcohol dependence

 
 
Vitamin B Tablets, Compound Strong
View adult BNF View SPC online View childrens BNF
Formulary
Red

For refeeding and Post Bariatric Surgery only

Refer to local policies

Not for use in alcohol dependence - thiamine may be used

 
Link  LSCMMG: Guidelines for the prescribing of nutritional supplements post bariatric surgery
 
09.06.02  Expand sub section  Other compounds
09.06.03  Expand sub section  Vitamin C
Ascorbic Acid
View adult BNF View SPC online View childrens BNF
Formulary
Green

Tablets 50mg, 100mg, 200mg & 500mg
Effervescent tablets 1g with zinc

Only to be used for prophylaxis and treatment of scurvy

 
 
09.06.04  Expand sub section  Vitamin D
Alfacalcidol (One-Alpha®)
View adult BNF View SPC online View childrens BNF
Formulary
Amber 0

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.

 
Link  SPS - Alfacalcidol monitoring
 
Calcitriol (Rocaltrol®)
(1,25-dihydroxycolecalciferol)
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Formulary
Amber 0

Capsules 250 nanograms

 
 
Colecalciferol
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Formulary
Green

Follow local protocols

 
 
Colecalciferol 40000 unit  (Plenachol®)
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Formulary
Green
Capsules 40000 units

 
 
Colecalciferol and Calcium Carbonate
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Formulary
Green
 
 
Ergocalciferol (RPH Pharmaceuticals)
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Formulary
Amber 0

Injection 300,000 units

Consultant initiation only

Plastic syringes can be used 'off label' providing the injection is administered immediately after being drawn up into the syringe.

 
 
09.06.04  Expand sub section  Vitamin D with Calcium
09.06.05  Expand sub section  Vitamin E to top
Alpha Tocopheryl Acetate
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Formulary
Amber 0

Suspension 500mg/5mL

Other preparations may be available but are unlicensed - contact pharmacy for advice

 
 
09.06.06  Expand sub section  Vitamin K
Menadiol Sodium Phosphate
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Formulary
Green

Tablets 10mg

water soluble preparation for patients with fat malabsorption

 
 
Phytomenadione
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Formulary 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 
 
09.06.07  Expand sub section  Multivitamin preparations
Multivitamin preparations (Abidec®)
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Formulary
Green
Vitamins A, B group, C and D

Oral drops 
 
Multivitamin preparations (Dalivit®)
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Formulary
Green
Vitamins A, B group, C and D

Oral drops 
 
Mutivitamin
(Vitamins BPC capsules)
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Formulary
Green
 
Link  LSCMMG: Over the Counter Items that Should not be Routinely Prescribed in Primary Care Policy
 
Renavit®
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Formulary
Green

Dietary management of water-soluble vitamin deficiency in adults with renal failure on dialysis
For G.P prescribing

 
 
09.06.07  Expand sub section  Vitamin and mineral supplements and adjuncts to synthetic diets
Vitamin and mineral supplements (Forceval, & Forceval Soluble®)
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Formulary
Green

Tablets

On dieticians request only for patients with swallowing difficulties or enteral feeding tubes

Amber 0 Post-surgery if gastric bypass

For use post bariatric surgery please consult link below

 
Link  LSCMMG: Guidelines for the prescribing of nutritional supplements post bariatric surgery
 
Vitamin and mineral supplements (Ketovite®)
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Formulary
Green
Tablets
Liquid 
 
09.07  Expand sub section  Bitters and tonics
09.08  Expand sub section  Metabolic disorders to top
 note  Contact pharmacy for advice
Eladocagene exuparvovecBlack Triangle (Upstaza®)
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Formulary
Red
NHS England

 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

 
Link  NICE: Eladocagene exuparvovec for treating aromatic L-amino acid decarboxylase deficiency
 
09.08.01  Expand sub section  Drugs used in metabolic disorders
Asfotase alfaBlack Triangle (Strensiq® )
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Formulary
Red
NHS England

Tertiary Centre

Solution for injection

100mg/ml, 40mg/ml

 
Link  NICE: Asfotase alfa for treating paediatric-onset hypophosphatasia
 
Avalglucosidase alfa (Nexviadyme ®)
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Formulary
Red
NHS England

Powder for concentrate for solution for infusion 100mg - for treating Pompe disease - see link below

 
Link  NICE TA821: Avalglucosidase alfa for treating Pompe disease
 
Pegunigalsidase alfaBlack Triangle (Elafbrio®)
(2 mg/mL concentrate for solution for infusion)
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Formulary
Red

For treating Fabry disease

 
Link  NICE TA915: Pegunigalsidase alfa for treating Fabry disease
 
VutrisiranBlack Triangle (Amvuttra ®)
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Formulary
Red
NHS England

25mg solution for injection in pre-filled syringe

Red for NICE TA868 Vutrisiran for treating hereditary transthyretin-related amyloidosis

 
Link  NICE TA868: Vutrisiran for treating hereditary transthyretin-related amyloidosis
 
09.08.01  Expand sub section  Wilsons disease
Penicillamine
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Formulary
Amber 2

Tablets 125mg

 
Link  LSCMMG: Shared care guideline - Penicillamine
 
09.08.01  Expand sub section  Carnitine deficiency
L-Carnitine (Carnitor®)
(Levocarnitine)
View adult BNF View SPC online View childrens BNF
Formulary
Red

Injection 1g in 5mL

Restricted Item Paediatric use only

 
 
09.08.01  Expand sub section  Fabry's disease
09.08.01  Expand sub section  Gaucher's disease to top
09.08.01  Expand sub section  Mucopolysaccharidosis I
09.08.01  Expand sub section  Pompe disease
09.08.01  Expand sub section  Nephropathic cystinosis
09.08.01  Expand sub section  Urea cycle disorders
09.08.02  Expand sub section  Acute porphyrias to top
09.08.02  Expand sub section  Drugs unsafe for use in acute porphyrias
 ....
 Non Formulary Items
  
Key
note Notes
Section Title Section Title (top level)
Section Title Section Title (sub level)
First Choice Item First Choice item
Non Formulary Item Non Formulary section
Restricted Drug
Restricted Drug
Unlicensed Drug
Unlicensed
Track Changes
Display tracking information
click to search medicines.org.uk
Link to adult BNF
click to search medicines.org.uk
Link to children's BNF
click to search medicines.org.uk
Link to SPCs
SMC
Scottish Medicines Consortium
Cytotoxic Drug
Cytotoxic Drug
CD
Controlled Drug
High Cost Medicine
High Cost Medicine
Cancer Drugs Fund
Cancer Drugs Fund
NHSE
NHS England
Homecare
Homecare
CCG
CCG
Green Low Carbon

Low carbon footprint

Amber Medium Carbon

Medium carbon footprint

Red High carbon footprint

High carbon footprint

Traffic Light Status Information

Status Description

Green

Green: Appropriate for initiation and ongoing prescribing in both primary and secondary care. Generally, little or no routine drug monitoring is required.  

Green Restricted

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.   

Red

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

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

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

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

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

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.   

Multiple

Refer to local guidance.  

netFormulary