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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®)
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Formulary
Red

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

Females of childbearing potential should use highly effective contraception during treatment and for at least 1 week after last treatment.

 
Link  NICE TA807: Roxadustat for treating symptomatic anaemia in chronic kidney disease
 
09.01.01.01  Expand sub section  Oral iron
Ferrous Sulphate
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First Choice
Green

Tablets 200mg (equivalent to 65 mg elemental iron)

 
Ferrous Fumarate
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Formulary
Green

Tablets 210mg (equivalent to 69 mg elemental iron), 322mg (equivalent to 106 mg elemental iron)
Oral solution 140mg/5ml (equivalent to 9 mg/mL elemental iron)

 
 
Sodium Feredetate
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Formulary
Green
Sytron® oral solution contains sodium feredetate trihydrate 41.5 mg/mL equivalent to 5.5 mg/mL elemental iron.
 
Sodifer® oral solution contains sodium feredetate 38 mg/mL equivalent to 5.5 mg/mL elemental iron.
 
Sodifer® is not suitable for babies under 28 days.
 
Link  Medicines for children: Sodium feredetate for the prevention of anaemia
 
Ferric maltol
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Formulary
Do Not Prescribe

Iron Deficiency Anaemia in Adult Patients with Inflammatory Bowel Disease.

 
Link  LSCMMG: Ferric Maltol NMR
 
09.01.01.01  Expand sub section  Iron and folic acid
Iron and Folic Acid (Pregaday®)
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Formulary
Green

Tablets ferrous fumarate 322 mg (equivalent to 106 mg elemental iron) and folic acid 350 microgram

 
 
09.01.01.01  Expand sub section  Compound iron preparations to top
09.01.01.02  Expand sub section  Parenteral iron
 note 

Prescribe parenteral iron products by brand name - important differences between formulations.

Ferric Carboxymaltose (Ferinject®)
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Formulary
Red

Injection 50mg/mL

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

 
Link  MHRA: Ferric carboxymaltose (Ferinject▼): risk of symptomatic hypophosphataemia leading to osteomalacia and fractures
 
Ferric Derisomaltose (Diafer®)
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Formulary
Red

Injection 50mg/mL (2mL ampoule)

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

 
Link  MHRA: Monofer 100mg/ml solution for injection/infusion▼ and Diafer 50mg/ml solution for injection▼: name change from iron isomaltoside to ferric derisomaltose
 
Iron Sucrose (Venofer®)
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Formulary
Red

Injection 100mg/5mL

Second line after Ferinject

For intravenous use only

Do not use in patients with asthma or eczema

 
 
09.01.02  Expand sub section  Drugs used in megaloblastic anaemias
Hydroxocobalamin
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Formulary
Green

Injection 1mg/1mL

1st line treatment in vitamin B12 deficiency.

Amber 0 Following gastric bypass or sleeve gastrectomy.

 
Link  MHRA: Vitamin B12 (hydroxocobalamin, cyanocobalamin): advise patients with known cobalt allergy to be vigilant for sensitivity reactions
 
Cyanocobalamin
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Formulary
Green

Tablets 1mg

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  Maintenance therapy of dietary related insufficiency. 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  MHRA: Vitamin B12 (hydroxocobalamin, cyanocobalamin): advise patients with known cobalt allergy to be vigilant for sensitivity reactions
 
Folic Acid
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Formulary
Green

Tablets 400 microgram, 5mg
Liquid 2.5mg/5mL

Should never be given alone for pernicious anaemia or other megaloblastic anaemias caused by vitamin B12 deficiency (may precipitate subacute combined degeneration of the spinal cord).

 
Link  Medicines for children: Folic acid for megaloblastic anaemia caused by folate deficiency and haemolytic anaemia
Link  MHRA: Medicines in pregnancy and breastfeeding: new initiative for consistent guidance; report on optimising data for medicines used during pregnancy
Link  NICE NG247: Maternal and child nutrition: nutrition and weight management in pregnancy, and nutrition in children up to 5 years
Link  UK Chief Medical Officers Chief Nursing Officers and Chief Midwifery Officers - Folic Acid
 
09.01.03  Expand sub section  Drugs used in hypoplastic, haemolytic, and renal anaemias
CrovalimabBlack Triangle (Piasky®)
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Formulary
Red
NHS England
BlueTeq

Solution for injection 340mg/2ml

Specialist initiation only.

 
Link  NICE TA1019: Crovalimab for treating paroxysmal nocturnal haemoglobinuria in people 12 years and over
 
DanicopanBlack Triangle
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Formulary
Red
NHS England
BlueTeq
Tablets 50mg, 100mg
 
Specialist initiation only.
 
Link  NICE TA1010: Danicopan with ravulizumab or eculizumab for treating paroxysmal nocturnal haemoglobinuria
 
IptacopanBlack Triangle (Fabhalta®)
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Formulary
Red
NHS England
BlueTeq
Capsules 200mg
 
Specialist initiation only.
 
Link  NICE TA1000: Iptacopan for treating paroxysmal nocturnal haemoglobinuria
 
Ravulizumab (Ultomiris®)
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Formulary
Red
NHS England
BlueTeq

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

Tertiary centre use only for treating paroxysmal nocturnal haemoglobinuria.

Specialist initiation only.

 
Link  NICE TA698: Ravulizumab for treating paroxysmal nocturnal haemoglobinuria
Link  NICE TA710: Ravulizumab for treating atypical haemolytic uraemic syndrome
 
VadadustatBlack Triangle (Vafseo®)
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Formulary
Red
NHS England
BlueTeq

Capsules 150mg, 300mg

 
Link  NICE TA1035: Vadadustat for treating symptomatic anaemia in adults having dialysis for chronic kidney disease
 
09.01.03  Expand sub section  Erythropoietin
Darbepoetin Alfa (Aranesp®)
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Formulary
Red

Injection prefilled syringe 10micrograms, 30micrograms, 50micrograms
Injection prefilled syringe and SureClick 20micrograms, 40micrograms, 60micrograms, 80micrograms, 100micrograms.

Consultant initiation only

NHSE Dialysis-induced anaemia.

 
Link  MHRA: Recombinant human erythropoietins: new advice for prescribing
Link  MHRA: Recombinant human erythropoietins: treating anaemia in cancer
Link  MHRA: Recombinant human erythropoietins: very rare risk of severe cutaneous adverse reactions (SCARs)
Link  NICE TA323: Erythropoiesis‑stimulating agents (epoetin and darbepoetin) for treating anaemia in people with cancer having chemotherapy
 
Epoetin alfa (Eprex®)
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Formulary
Red

Injection prefilled syringe 10,000units, 40,000units

Consultant initiation only.

NHSE Dialysis-induced anaemia.

 
Link  MHRA: Recombinant human erythropoietins: new advice for prescribing
Link  MHRA: Recombinant human erythropoietins: treating anaemia in cancer
Link  MHRA: Recombinant human erythropoietins: very rare risk of severe cutaneous adverse reactions (SCARs)
Link  NICE TA323: Erythropoiesis‑stimulating agents (epoetin and darbepoetin) for treating anaemia in people with cancer having chemotherapy
 
09.01.03  Expand sub section  Iron overload to top
09.01.04  Expand sub section  Drugs used in autoimmune thrombocytopenic purpura
Anagrelide
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Formulary
Red

Capsules 500 micrograms

Specialist initiation only.

Effective contraception required during treatment.

 
Link  MHRA: Xagrid (anagrelide hydrochloride): Risk of thrombosis, including cerebral infarction, if treatment discontinued abruptly. [also applicable to generic forms]
 
AvatrombopagBlack Triangle (Doptelet®)
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Formulary
Red
BlueTeq

Tablets 20mg

Specialist initiation only.

 
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  (Cablivi ®)
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Formulary
Red
NHS England
BlueTeq

Solution for injection 10mg

Specialist initiation only.

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

Tablets 25mg, 50mg

Specialist initiation only.

Ensure effective contraception during treatment.

 
Link  MHRA: Eltrombopag (Revolade): reports of interference with bilirubin and creatinine test results
Link  NICE TA293: Eltrombopag for treating chronic immune thrombocytopenia
 
Fostamatinib Black Triangle (TAVLESSE ®)
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Formulary
Red
High Cost Medicine
BlueTeq

Film coated tablets, 100mg, 150mg

Specialist initiation only.

Manufacturer advises effective contraception during and for at least 1 month after stopping treatment in females of childbearing potential.

 
Link  NICE TA835: Fostamatinib for treating refractory chronic immune thrombocytopenia
 
LusutrombopagBlack Triangle (Mulpleo®)
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Formulary
Red
BlueTeq

Film coated tablets 3mg

Specialist initiation only.

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

Injection 250 micrograms

Specialist initiation only.

 
Link  NICE TA221: Romiplostim for the treatment of chronic immune thrombocytopenia
 
09.01.05  Expand sub section  G6PD deficiency
09.01.06  Expand sub section  Drugs used in neutropenia
Filgrastim
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Formulary
Red

Injection 12 million units in 0.2mL prefilled syringe, 30 million units & 48 million units in 0.5mL prefilled syringe

Specialist initiation only.

 
Link  MHRA: Filgrastim and pegfilgrastim: risk of capillary leak syndrome
 
Pegfilgrastim
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Formulary
Red

Injection 6mg in 0.6mL prefilled syringe

Specialist initiation only.

 
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 with potassium bicarbonate (Sando-K®)
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First Choice
Green

Effervescent tablets potassium 470 mg (12 mmol of K+) and chloride 285mg (8 mmol of Cl-)

 
Potassium Chloride
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Second Choice
Green

m/r tablets 600mg (potassium 8 mmol)

Avoid unless effervescent tablets or liquid preparations inappropriate.

 
 
Potassium Chloride oral liquid
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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
Calcium polystyrene sulfonate (Calcium Resonium®)
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Formulary
Amber 0

Powder for oral or rectal suspension 99.934% w/w calcium polystyrene sulfonate

Green In East Lancashire

 
 
Patiromer calcium
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Formulary
Red

Oral powder sachets 8.4g, 16.8g

 
Link  NICE TA623: Patiromer for treating hyperkalaemia
 
Sodium zirconium cyclosilicate
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Formulary
Red

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®)
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Formulary
Green

Modified release tablets 600mg (10mmol)

 
Link  Medicines for children: Sodium chloride for hyponatraemia (low levels of sodium in the blood)
 
09.02.01.02  Expand sub section  Oral rehydration therapy (ORT) to top
Oral Rehydration Salts
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Formulary
Green

Dioralyte® sachets
ORS Hydration tablets

 
Link  LSCMMG: Over The Counter (OTC) Items That Should Not Be Routinely Prescribed In Primary Care Policy
Link  Medicines for children: Oral rehydration salts
 
09.02.01.03  Expand sub section  Oral bicarbonate
Sodium Bicarbonate
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Formulary
Green

Capsules 500mg (approx 6 mmol each of Na+ and HCO3-)

 
 
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
09.02.02.01  Expand sub section  Intravenous glucose to top
09.02.02.01  Expand sub section  Intravenous potassium
09.02.02.01  Expand sub section  Bicarbonate and lactate
09.02.02.01  Expand sub section  Water
09.02.02.02  Expand sub section  Plasma and plasma substitutes
09.02.02.02  Expand sub section  Plasma substitutes to top
09.03  Expand sub section  Intravenous nutrition
09.03  Expand sub section  Supplementary preparations
09.04  Expand sub section  Oral nutrition
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
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Formulary
Green

Chewable tablets calcium carbonate 1.25 g (calcium 500 mg or Ca2+ 12.5 mmol)

 
 
Calcium carbonate with calcium lactate gluconate (Calvive 1000® Effervescent Tablets)
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Formulary
Green

Effervescent tablets calcium 1000mg (25mmol)

 
 
Calcium Gluconate
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Formulary
Red

Injection 10% (calcium 2.25mmol/10mL)10mL amp
Injection 10% 50mL vial

 
Link  MHRA: Calcium chloride, calcium gluconate: potential risk of underdosing with calcium gluconate in severe hyperkalaemia
Link  MHRA: Calcium gluconate injection in small-volume glass containers: new contraindications due to aluminium exposure risk
 
09.05.01.02  Expand sub section  Hypercalcaemia and hypercalciuria
Cinacalcet
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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®)
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Formulary
Red

Injection

 
Link  NICE TA448: Etelcalcetide for treating secondary hyperparathyroidism
 
09.05.01.03  Expand sub section  Magnesium to top
 note 

Magnesium preparations may not be interchangeable due to differences in bioavailability, therefore caution should be exercised when switching preparations to ensure tolerability and to maintain therapeutic effect.

Magnesium Aspartate
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Formulary
Green

Oral powder sachets 10mmol

 
 
Magnesium citrate
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Formulary
Green

Tablets 4mmol

 
 
Magnesium Glycerophosphate
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Formulary
Green

Tablets 4mmol
Oral solution 1mmol/1ml unlicensed-Unlicensed

 
Link  NICE: Preventing recurrent hypomagnesaemia: oral magnesium glycerophosphate
 
Magnesium Sulfate
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Formulary
Red

Injection 50% (magnesium 2mmol/mL) 

 
Link  MHRA: Magnesium sulfate: risk of skeletal adverse effects in the neonate following prolonged or repeated use in pregnancy
 
09.05.02  Expand sub section  Phosphorus
09.05.02.01  Expand sub section  Phosphate supplements
Phosphate oral (Phosphate-Sandoz®)
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First Choice
Green

Effervescent tablets sodium dihydrogen phosphate anhydrous (anhydrous sodium acid phosphate) 1.936 g, sodium bicarbonate 350 mg, potassium bicarbonate 315 mg, equivalent to phosphorus 500 mg (phosphate 16.1 mmol), sodium 468.8 mg (Na+ 20.4 mmol), potassium 123 mg (K+ 3.1 mmol)

 
Phosphate infusion
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Formulary
Red

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

 
 
09.05.02.02  Expand sub section  Phosphate-binding agents
Calcium Acetate
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Formulary
Amber 0

Phosex® tablets contain calcium acetate 1 g (equivalent to calcium 250 mg or Ca2+ 6.2 mmol).
Renacet® tablets contain calcium acetate 475 mg (equivalent to calcium 120.25 mg or Ca2+ 3 mmol).

 
 
Calcium acetate with magnesium carbonate (Osvaren®)
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Formulary
Amber 0

Calcium acetate 435mg (equivalent to 110 mg calcium), Magnesium carbonate heavy 235mg (equivalent to 60 mg magnesium)

 
 
Lanthanum
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Formulary
Amber 0
High Cost Medicine

Chewable tablets 500mg, 750mg, 1000mg

 
 
Sevelamer Carbonate
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Formulary
Amber 0

Tablets 800mg
Oral powder sachets 2.4g

Caution when prescribing - Do not confuse with sevelamer hydrochloride Do Not Prescribe

 
Link   Switching patients from sevelamer hydrochloride (Renagel®) tablets to the generic sevelamer carbonate
 
09.05.03  Expand sub section  Fluoride
Sodium fluoride (Duraphat® (Toothpaste))
View adult BNF View SPC online View childrens BNF
Formulary

Toothpaste 5000ppm (Duraphat®)

Green Restricted On the advice of a secondary care specialist, in patients who have had surgery, radiotherapy and/or chemotherapy, who are unable to access a primary care dentist.

Red Prophylaxis of dental caries. clinicians other than dentists working in primary care should not prescribe high strength fluoride toothpaste where dentists could reasonably treat the patient.

 
Link  LSCMMG: Fluoride High Strength Toothpastes: Position Statement
Link  LSCMMG: Sodium fluoride toothpaste NMR
 
09.05.04  Expand sub section  Zinc to top
Zinc Sulfate
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Formulary
Green

Effervescent tablets 125mg

Zinc inhibits the absorption of copper, thereby reducing copper levels and potentially causing copper deficiency. The risk of copper deficiency is greater with higher doses of zinc and with long-term treatment, particularly if zinc deficiency is no longer present. Signs of copper deficiency include neurological and haematological symptoms.

 
 
09.05.05  Expand sub section  Selenium
09.06  Expand sub section  Vitamins
 note 

To avoid potential toxicity, the content of all vitamin preparations, particularly vitamin A, should be considered when used together with other supplements.

Paravit CF®
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Formulary
Amber 0

Capsules (vitamin A 4000 IU, vitamin D3 1500 IU, vitamin E 150 IU, vitamin K 5 mg)
Liquid (vitamins A, D, E and K)

Vitamin supplement in cystic fibrosis on the specific recommendation of a cystic fibrosis specialist.

Paravit CF liquid is only available as an option for patients with swallowing difficulties or young children.

Reimbursable on FP10.

 
 
09.06.01  Expand sub section  Vitamin A
09.06.02  Expand sub section  Vitamin B group
Pyridoxine Hydrochloride
(Vitamin B6)
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Formulary
Amber 0

Tablets 10mg, 50mg

Prolonged use of pyridoxine in a dose of 10 mg daily is considered safe but the long-term use of pyridoxine in a dose of 200  mg or more daily has been associated with neuropathy. The safety of long-term pyridoxine supplementation with doses above 10 mg daily has not been established.

 
Link  NICE NG33: Tuberculosis
 
Thiamine (Vitamin B1)
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Formulary
Green

Tablets 50mg, 100mg

 
 
Thiamine with ascorbic acid (Vitamins B&C)
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Formulary
Red

Intravenous high potency concentrate for solution for infusion (5ml+5ml)
Intramuscular high potency solution for injection (5ml+2ml)

 
Link  MHRA: Pabrinex: allergic reactions
 
09.06.02  Expand sub section  Oral vitamin B complex preparations to top
Vitamin B complex
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Formulary

Green Restricted Re-feeding syndrome in line with NICE CG32

Amber 0 Post-gastric bypass

Do Not Prescribe All other indications

 
Link  NICE CG32: Nutrition support for adults: oral nutrition support, enteral tube feeding and parenteral nutrition
 
09.06.02  Expand sub section  Other compounds
09.06.03  Expand sub section  Vitamin C
Ascorbic Acid (Vitamin C)
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Formulary
Tablets 50mg, 100mg, 200mg & 500mg
 
Green Restricted Prevention and treatment of scurvy
 
Do Not Prescribe All other indications
 
Link  LSCMMG: Over the Counter Items that Should not be Routinely Prescribed in Primary Care Policy
 
09.06.04  Expand sub section  Vitamin D
Alfacalcidol (One-Alpha®)
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Formulary
Amber 0

Capsules 250 nanograms, 500 nanograms, 1 microgram
Oral drops 2 micrograms/mL (1 drop contains approximately 100 nanograms alfacalcidol)

For patients with severe renal impairment requiring vitamin D therapy.

Secondary care prescribers initiating treatment should clearly outline monitoring requirements when transferring prescribing responsiblity to primary care.

 
Link  SPS - Alfacalcidol monitoring
 
Colecalciferol
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Formulary
Multiple

Colecalciferol 400 units is equivalent to 10 micrograms.

For recommendations on the use of vitamin D please consult the LSCMMG Vitamin D position statement.

 
 
Colecalciferol and Calcium Carbonate
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Formulary
Green

**Product choices to be confirmed with ICB. To be updated when resolved**

 
 
Ergocalciferol
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Formulary
Amber 0

Injection 300,000 units/1ml

For the correction of deficiency and insufficiency in high-risk, symptomatic patients as a short-course treatment.

Ergocalciferol 400 units is equivalent to 10 micrograms.

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
09.06.06  Expand sub section  Vitamin K
Menadiol Sodium Phosphate
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Formulary
Green

Tablets 10mg

Water soluble preparation for the prevention of vitamin K deficiency in malabsorption syndromes.

 
 
09.06.07  Expand sub section  Multivitamin preparations
Multivitamin (Renal - Renavit®)
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Formulary
Amber 0

Tablets vitamins B and C

Dietary management of water-soluble vitamin deficiency in renal failure patients on dialysis. Not suitable for use in children.
Initiation by a renal consultant/SpR.

 
Link  LSCMMG: Renal Vitamins (Renavit®) NMR
 
Multivitamin drops (Paediatrics - Abidec®, Dalivit®)
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Formulary
Green

Oral drops vitamins A, B group, C and D

The vitamin concentrations of Abidec® and Dalivit® vary, consult product literature for more information.

 
 
Mutivitamin
(BPC capsules)
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Formulary
Green

Capsules

 
Link  LSCMMG: Over the Counter Items that Should not be Routinely Prescribed in Primary Care Policy
 
09.06.07  Expand sub section  Vitamin and mineral supplements and adjuncts to synthetic diets
Taurine
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Formulary
Do Not Prescribe

Taurine deficiency in CF liver disease

 
 
09.07  Expand sub section  Bitters and tonics
09.08  Expand sub section  Metabolic disorders to top
 note  Contact pharmacy for advice
09.08.01  Expand sub section  Drugs used in metabolic disorders
Asfotase alfaBlack Triangle (Strensiq® )
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Formulary
Red
NHS England
BlueTeq

Solution for injection

Tertiary Centre Only.

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

Powder for concentrate for solution for infusion 100mg

Under expert supervision.

 
Link  NICE TA821: Avalglucosidase alfa for treating Pompe disease
 
Eladocagene exuparvovecBlack Triangle (Upstaza®)
View adult BNF View SPC online View childrens BNF
Formulary
Red
NHS England
BlueTeq

Solution for infusion 2.8 × 1011 vector genomes (vg)/0.5 mL

Tertiary Centre Only.

 
 
EplontersenBlack Triangle (Wainzua®)
View adult BNF View SPC online View childrens BNF
Formulary
Red
NHS England
BlueTeq

Solution for injection 45 mg/0.8 ml

 
Link  NICE TA1020: Eplontersen for treating hereditary transthyretin-related amyloidosis
 
Pegunigalsidase alfaBlack Triangle (Elafbrio®)
View adult BNF View SPC online View childrens BNF
Formulary
Red
NHS England

Concentrate for solution for infusion 20mg/10ml, 5mg/2.5ml

Under expert supervision.

 
Link  NICE TA915: Pegunigalsidase alfa for treating Fabry disease
 
VutrisiranBlack Triangle (Amvuttra ®)
View adult BNF View SPC online View childrens BNF
Formulary
Red
NHS England
BlueTeq

Solution for injection pre-filled syringe 25mg/0.5ml 

Under expert supervision.

Females of childbearing potential should use effective contraception during treatment; if conception is planned, vutrisiran and vitamin A supplementation should be stopped and vitamin A levels monitored - consult product literature.

 
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, 250mg

 
Link  LSCMMG: Penicillamine shared care guideline
 
09.08.01  Expand sub section  Carnitine deficiency
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
 ....
Key
Restricted Drug Restricted Drug
Unlicensed Drug 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
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
ICB
Green Low Carbon

Low carbon footprint

Amber Medium Carbon

Medium carbon footprint

Red High carbon footprint

High carbon footprint

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