Intravenous infusion 250mg
S/C injection 125mg prefilled syringe pre-filled pen 

Usually supplied to patients by a home delivery company

REQUIRES BLUETEQ APPROVAL

Patients may remain on acarbose but not recommended in new patients.

Tablets 250mg
 

Eye drops

For treatment of filamentary keratitis only

Eklira Genuair® inhalation powder 322micrograms/metered inhalation

Pre-filled syringe or pen

Crohn's disease - NICE TA187

Ulcerative colitis - NICE TA329

High risk patients for prevention of recurrence or upon recurrence of Crohn's Disease following surgery

Solution for injection

Cream 45g

Injection 1 in 1000 1mg/1mL

Tablets 25mg

Major Depressive Episodes.

with prior approval. LSCFT to approve all applications to use - patients currently on treatment can continue.

70mg tablets are once weekly.

First line for osteoporosis.

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.

Tablets 2.5mg
M/R tablets 10mg

Urinary retention.

Suspension 500mg/5mL

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

Alprostadil 3 mg per 1 gram

 Erectile Dysfunction in patients who have not responded to at least 2 other PDE5 inhibitors

 Erectile Dysfunction in patients who are intolerant to or have a contra-indication to PDE5 inhibitors

Urethral sticks 500microgram, 1000microgram

Erectile Dysfunction.

Capsules 60mg

M/R tablets 225mg

Injection 150mg/3mL
Injection 300mg/10mL pre-filled syringe

Tablets 50mg, 100mg, 200mg, 400mg
Liquid 100mg/mL

Schizophrenia.

Tablets 10mg, 25mg, 50mg
Liquid 25mg/5mL
Sugar Free oral solution 50mg/5mL

Use in line with NICE and LSCMMG guidelines.

Palliative care

Neuropathic pain

Eye drops 0.15% preservative free

Unlicensed - Specialist use only

Solution for injection pre-filled syringes  100mg/0.67mL

 Unlicensed special for treatment of painful swallowing, during/following radiotherapy to the head, neck and chest areas

Ointment, benzyl benzoate 1.25%, bismuth oxide 0.875%, bismuth subgallate 2.25%, hydrocortisone acetate 0.25%, Peru balsam 1.875%, zinc oxide 10.75%.

Do not use for longer than 7 days

Tablets 2.5mg, 5mg

  Apixaban for preventing stroke and systemic embolism in people with non-valvular atrial fibrillation (NICE TA275)

Apixaban for the prevention of venous thromboembolism after total hip or knee replacement in adults (NICE TA245)

Apixaban for the treatment and secondary prevention of deep vein thrombosis and/or pulmonary embolism (NICE TA341)

Eye drops 0.5% 

*under review*

Tablets 10mg, 20mg, 30mg

Capsules 80mg, 125mg

Adjunct treatment to prevent nausea and vomiting associated with moderately and highly emetogenic chemotherapy.

50mg/50ml vials for infusion

250mg/2.5ml concentrate vials for infusion

Prolonged release suspension for injection 400mg

LSCFT initiation only.

Schizophrenia in adult patients stabilised on oral aripiprazole. 

Application from RMO to be sent to Chief Pharmacist and Medical Director requesting its use.

When prescribing, dispensing, or administering, check that the correct preparation is used—the preparation usually used in hospital for the rapid control of an acute episode (solution for injection containing aripiprazole 7.5 mg/mL) should not be confused with depot preparations (powder and solvent for prolonged-release suspension for injection), which are usually used in the community or clinics for maintenance treatment.

Tertiary Centre

Solution for injection

100mg/ml, 40mg/ml

Granules for oral suspension 1000mg, 125mg, 250mg

Ataluren for treating Duchenne muscular dystrphy with a nonsense mutation in the dystrophin gene (replaces HST3) - likely to be tertiary centre only

Capsules 10mg, 18mg, 25mg, 40mg, 60mg

ADHD

 Restricted to initiation by child or adolescent psychiatrists or paediatricians
experienced in the management of ADHD.

Injection 6.75 mg/0.9mL, concentrate for infusion 37.5 mg/5mL 

Uncomplicated premature labour

Second line option when other options have failed or are unsuitable.

Eye drops 1% 

Minims^® 1%

Tablets 50mg, 100mg, 200mg

Erectile Dysfunction.

Treatment of erectile dysfunction in adult men who are unable to tolerate sildenafil and tadalafil.

Tablets 25mg, 50mg

Tablets 25mg, 50mg
Unlicensed indication
Consultant dermatologist or specilaist initiation only
See section 10.1.3

nasal spray 140 microgram per 1 actuation

After tertiary referral only

 in East Lancashire

Tablets 2mg, 4mg

The LSCMMG adult asthma guidelines only recommend triple inhalers to be initiated by a clinical expert in primary / secondary care, in those patients who are not adequately controlled with a maintenance combination of a long-acting beta 2-agonist and a high dose (Trimbow 172/5/9) or medium dose (Trimbow 87/5/9) of an inhaled corticosteroid, who have experienced one or more asthma exacerbations in the previous year.

In COPD Trimbow is only recommended for maintenance treatment in adult patients with moderate to severe COPD who are not adequately treated by a combination of an inhaled long-acting beta 2-agonist and corticosteroid.     

Trimbow pMDI 87 micrograms beclometasone/5 micrograms formoterol/9 micrograms glycopyrronium pressurised inhalation, solution (asthma and COPD),

Trimbow pMDI 172 micrograms beclometasone/5 micrograms formoterol/9 micrograms glycopyrronium pressurised inhalation, solution (asthma only),

Trimbow NEXThaler (DPI) 88 micrograms beclometasone /5 micrograms formoterol /9 micrograms glycopyrronium per actuation inhalation powder (COPD only)

Tablets 180mg

As monotherapy for patients intolerant to ezetimibe

Tablets 2.5mg, 5mg

(Fasenra®) Solution for injection pre-filled syringes 30mg/1ml and solution for injection pre-filled pen 30mg /1ml

Severe eosinophilic asthma in adults (add-on therapy) - NICE TA565

Capsules 150mg

Soluble tablets 500micrograms

Unlicensed use

  In East Lancashire

Eye/ear/nose drops betamethasone 0.1%/ neomycin 0.5%

Injection 4mg/1mL

Tablets 10mg, 25mg

Urinary retention.

Eye drops 100micrograms/mL (0.01%)
Eye drops 300micrograms/mL (0.03%)
Eye drops - Preservative free 300micrograms/mL (0.03%) - only for patients with a documented allergy to preservatives

Pre-filled syringe/pen 160mg

ICB Commissioned

3mL cartridge 100units/mL
3mL prefilled disposable Pen 100units/mL

First choice in new users

Gel 100mg/1g

Palliative care

Constipation

Tablets 1.25mg, 2.5mg, 3.75mg, 5mg, 7.5mg, 10mg

First line

Powder for solution for injection

 Specialist use only

Injection 100units

For existing patients

Consultant use only

Brands are not interchangeable

Focal Spasticity in Multiple Sclerosis, Contracture of the joint in Multiple Sclerosis.  Focal spasticity, Hand and wrist disability associated with stroke, Blepharospasm, Hemifacial spasm, Spasmodic torticollis. 

3mg/g gel brimonidine tartrate

 (Only for use in patients with moderate to severe, persistent facial erythema of rosacea)

Eye drops brimonidine 0.2%/timolol 0.5%

*under review*

Not on East Lancashire formulary

Ophthalmic suspension brinzolamide 10mg/timolol 5mg/mL
 
 Second line carbonic anhydrase inhibitor with timolol

Tablets 10mg, 25mg, 50mg, 75mg, 100mg
Oral solution 10mg/1ml

Adjunctive therapy in the treatment of partial-onset seizures with or without secondary generalisation.

19.8mg/0.165ml solution for injection pre-filled syringes 

Tablets 2.5mg

Hyperprolactinaemic disorders.

Healthcare professionals are reminded that bromocriptine should only be used for prevention or suppression of postpartum lactation where medically indicated, in cases such as intrapartum loss, neonatal death, or a mother with HIV infection. It should not be used for routine suppression of lactation, or for relieving symptoms of postpartum breast pain and engorgement. Blood pressure should be carefully monitored, especially during the first days of treatment.

Modified release capsules 4mg (targeted release)

For treating primary IgA nephropathy in accordance with NICE TA937

 Easyhaler 100mcg per inhalation, 200mcg per inhalation, 400mcg per inhalation (asthma only)

Pulmicort® Turbohaler 100mcg per actuation, 200mcg per actuation, 400mcg per actuation (asthma only).                               

Pulmicort® respules 500mcg / 2ml, 1mg / 2ml (asthma / croup)

(Trixeo Aerosphere® )
MDI - Each single actuation (delivered dose, ex-actuator) contains 5 micrograms of formoterol fumarate dihydrate, glycopyrronium bromide 9 micrograms, equivalent to 7.2 micrograms of glycopyrronium, and budesonide 160 micrograms.

Restriction: Triple therapy should be reserved for patients who have failed to achieve or maintain an adequate response to an appropriate course of dual therapy.

Tablets, M/R 9 mg

Epidural infusion fentanyl 2micrograms/mL, bupivacaine 0.1% 500mL

Sublingual tablets 200micrograms

See section 4.10 for products used in opioid dependence.

Berinert®500iu powder and solvent for solution for injection / infusion, 1500iu powder and solvent for solution for injection.

Cinryze® 500iu powder and solvent for solution for injection

Kept in Emergency Departments at RLI and FGH

Liquid 50mg/5mL see BNFC
Injection 10mg/1mL see BNFC

For neonatal use

Caffeine citrate 2mg is equivalent to caffeine base 1mg

Injection 100units/1mL

Tablets 475mg

Chewable tablets 1.25g calcium 500mg (12.6mmol)

Effervescent tablets calcium 1000mg (25mmol)

Oral solution 100mg/mL

Cream 0.025%

Patch 179mg (8%)

Treatment of peripheral neuropathic pain in adults either alone or in combination with other medicinal products for the treatment of pain.

For specialist use only

Tablets 100mg, 200mg, 400mg
Prolonged-release tablets 200mg, 400mg
Liquid 100mg/5mL

Tablets 5mg, 20mg

CSM warning: neutropenia and agranulocytosis

Manufacturer advises of the importance of recognising bone marrow suppression induced by carbimazole and the need to stop treatment promptly.

Warn patients that if a sore throat develops, in the first 6-8 weeks of therapy they should stop treatment and seek medical advice.

Capsules 375mg

Injection 250micrograms/1mL

Postpartum haemorrhage.

Preservative free eye drops 0.5%, 1%

Topical adjuvant for procedures for odontogenic keratocysts

 unlicensed

Specialist use only

Palliative care

Pain: Anti-inflammatory

Do not prescribed for Crohn's disease or ulcerative colitis

Tablets 10mg
Liquid 5mg/5mL

First line

Minims^® 0.5% 

Follow local ophthalmology policies

Ear drops 5%

Morecambe bay only

Capsules 5mg, 10mg

Chlordiazepoxide is also used in a reducing regime for the management of acute alcohol withdrawal. See trust Clinical Guidelines.

Cream 5%

Injection 50mg/5mL

Tablets 10mg, 25mg, 50mg, 100mg
Liquid 25mg/5mL, 100mg/5mL

Schizophrenia and other psychoses, mania, anxiety, agitation, violent or dangerously impulsive behaviour, childhood schizophrenia.

 Injection

Capsule

Severe ulcerative colitis

Specialist initiation only

Consultant dermatologist or specilaist initiation only

To be prescribed generically for dermatology patients

See section 10.1.3

Unit dose eye drops 0.3mL

 For adults

Eye drops 0.3%

*under review*

Tablets (as hydrobromide) 10mg, 20mg
Oral drops (as hydrochloride) 40mg/mL (2mg/drop)

8mg oral drops is equivalent to 10mg tablet.

Lower incidence of drug interactions than some other SSRI’s.

First prescribe an SSRI in generic form unless there are interactions with other drugs; consider using citalopram or sertraline because they have less propensity for interactions.

Vaginal cream 2%

Gel 1%

For oncology patients only

Tablets 10mg

Tablets 500micrograms, 2mg
Oral solution 500micrograms/5mL, 2mg/5ml

 for use in all forms of epilepsy and in the treatment of mood disorders

 for the treatment of anxiety (off-label indication)

Clonazepam has been confused with clobazam; care must be taken to ensure the correct drug is prescribed and dispensed. 

Other than epilepsy the use of clonazepam is off-labeL.

Tablets 25 microgram 

Clonidine is considered less suitable for prescribing in hypertension

 Vasomotor symptoms (VMS) associated with menopause

Clotrimazole 1% 20mL

labelled 'solution', not 'ear drops'

 in East Lancashire

1% drops

1%, 2%, 5%, 10%, 15%, 20%, 25%, 30% 100g
Not all coal tar products are routinely stocked by the pharmacy departments. If the product has to be obtained from a specials manufacturing unit there may be a delay of up to 4 weeks.

Capsules 62.5mg (12.5/50), 125mg (25/100), 250mg (50/200)
Dispersible tablets 62.5mg (12.5/50), 125mg(25/100)
Modified-release capsules 125mg (25/100)

Parkinson's disease.

Tablets (multiple strength combinations available).

Parkinson's disease.

Tablets 15mg, 30mg
Liquid 25mg/5mL

Second line

Tablets 500 micrograms

Tablets 625mg

Off licence use for intractable diarrhoea secondary to bile salt malabsorption
Specialist initiation only by gastroenterology

Oral suspension

For community use only

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. 

Palliative care

Nausea and vomiting

Nausea and vomiting in the last days of life

Opioid-induced nausea and vomiting

Minims® 0.5%, 1%

Tablets 50mg

For indications other than oncology

Refer to local guidance

Care when prescribing/selecting strength of syringes - Different strengths available. 

Capsules 25mg

Tablets 5mg, 10mg

Modified-release tablets 7.5mg, 15mg

Urinary frequency, urgency, and incontinence.

Injection 60mg/mL pre-filled syringe

Licensed for treatment of postmenopausal osteoporosis in women at increased risk of fractures and for the treatment of bone loss associated with hormone ablation in men with prostate cancer. See NICE guideline TA204

Treatment of bone loss associated with long-term systemic glucocorticoid therapy in adult patients at increased risk of fracture

Cream 500g

Lotion 500mL

Also contains antimicrobials

Second line

Tablets 100micrograms, 200micrograms
Nasal spray 10micrograms/metered spray

In adults, 1st line tablets, 2nd line nasal/injection (choose most cost effective option), 3rd line desmomelts

Film coated tablets 6mg

 NICE TA907: Deucravacitinib for treating moderate to severe plaque psoriasis

Palliative care

Bowel obstruction - reduction of tumour oedema associated with bowel obstruction

Breathlessness

Corticosteroids in palliative care - Anorexia, Adjuvant analgesic, Nausea and vomiting associated with chemotherapy, Obstructive syndromes, Raised intracranial pressure, Spinal cord compression

Nausea and vomiting - raised Intracranial Pressure

Palliative care emergencies - SVC obstruction AND Metastatic spinal cord compression

Eye drops preservative free 0.1%

 in East Lancashire

*under review*

Intravitreal implant 700micrograms in disposable applicator

REQUIRES BLUETEQ APPROVAL

Eye drops -  dexamethasone 1mg/ml, tobramycin 3mg/ml

 Restricted to post cataract surgery patients who are intolerant to Maxitrol

Morecambe bay only

Injection 100micrograms/mL 2mL & 4mL ampoules

Dexmedetomidine should only be administered by, or under the direct supervision of, personnel experienced in its use, with adequate training in anaesthesia and airway management.

Tablets 2mg, 5mg, 10mg
Liquid 2mg/5mL
Rectal tubes 5mg/2.5mL, 10mg/2.5mL

Anxiety.

Injection (solution) 10mg/2mL
Injection (emulsion) (Diazemuls®)10mg/2mL

Injection 10mg/2mL

Rectal solution tube  5mg/2.5ml, 10mg/2.5ml

Status epilepticus.

 for acute tibia fractures in adults (licensed)

 for non-union long bone fractures (unlicensed)

Tablets e/c 25mg, 50mg
Dispersible tablets 50mg
 
For short term use in breastfeeding mothers only

Eye drops 0.1%
Unit dose eye drops 0.1%

*under review*

 in East Lancashire

Injection 500 micrograms/2mL 

Oral digoxin is the preferred route. Intravenous digoxin should only be used when oral route is unavailable. Digoxin has a narrow therapeutic index and can cause toxicity.

Intravenous infusion 40mg

Cream, Ointment 

unlicensed

Tablets 30mg, 120mg

Lotion 4%

Injection 1mg/mL 0.75mL

Maintaining patency of the ductus arteriosus.

 Unlicensed indication.

Under expert supervision.
This section is not included in the BNF. For the management of ductus arteriosus, see BNF for Children.

Preservative free solution 0.37%

Capsules 100mg, Tablets 250mg prolonged-release

On advice of cardiology only

Infusion

Capsules 100mg, Liquid 12.5mg/5ml (paeds), 50mg/5ml (adult)

Tablets 10mg
Liquid 5mg/5mL

Domperidone is no longer indicated for the relief of nausea and vomiting in children aged under 12 years or those weighing less than 35 kg.

Healthcare professionals are advised to adhere to the licensed dose and to use the lowest effective dose for the shortest possible duration (max. treatment duration should not usually exceed 1 week).

Tablets 5mg, 10mg
Orodispersible tablet 5mg, 10mg

Pulmozyme® 2500 U/ 2.5ml, nebuliser solution

Eye drops 2%

Eye drops - preservative free 2% - only for patients with a documented allergy to preservatives

100mg / 5ml solution for injection

Tablets 1mg, 2mg, 4mg

Doxazosin MR do not prescribe 

Capsules 10mg, 25mg, 50mg

Depressive illness.

Consider overdose risk.

Tablets Doxylamine succinate 10 mg, Pyridoxine hydrochloride 10 mg.

Treatment of nausea and vomiting of pregnancy in women who do not respond to conservative management.

Injection 2.5mg/ml

For the prevention and treatment of post operative nausea and vomiting.
 Restricted use: Theatre use only, when other treatment options are not suitable.

First line spacer device in primary care for ADULTS

For ADULTS only, Paediatric patients should only be prescribed Aerochamber Plus Flow-vu or Volumatic spacers

For use in Paediatric patients in primary and secondary care as a replacement for Aerochamber Plus spacer and in addition to Volumatic spacer

• Small mask (orange)
• Medium mask (yellow)
• Youth mouthpiece (green)
• Adult small mask (purple)

For use with any metered dose inhaler

Capsules (Cymbalta®) 30mg, 60mg

There can be variation in the licensing of different medicines containing the same drug therefore prescribe by brand name.

Third line use within LSCFT.

CAUTION: available as another brand Yentreve for stress urinary incontinence. Recommended that prescriptions state the brand name Cymbalta.

Palliative care

Neuropathic pain

Dutasteride is restricted for a high risk patient group, used in combination with tamsulosin in patients with moderate to severe symptoms (IPSS>12) with larger prostates (>30cc) and elevated PSA (>1.5ng/mL).

Tablets 25mg, 50mg

Consultant haematologist or specialist in hepatitis C therapy only

Tablets 10mg, 25mg

Refer to local guidance

Due to the differences in injectable device, all enoxaparin prescribing should be by brand name.
Switching between brands should be as a last resort after full training in the use of the new device has taken place.
Care when prescribing/selecting strength of syringes - Different strengths available.

Tablets 200mg

Adjunct to co-beneldopa or co-careldopa in Parkinson's disease.

Cream 100g, 500g

Specialist use.
NHSE commissioned drug for digital ulcers and pulmonary arterial hypertension.

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.

Lotion 30mL, 90mL

Tablets 800mg

Adjunctive therapy in adults with partial onset seizures with or without secondary generalisation.

 Capsules 20mg, 40mg

 Gastro-resistant granules sachets 10mg - for paediatric use only

 Injection 40mg

Oestrogel Pump 0.06% pack gel
Sandrena gel sachets 500mcg, 1mg

2nd line agent for patients with allergy/skin reactions to patches.

0.1% vaginal cream, 0.01% vaginal cream

S/C injection 25mg, 50mg vial with diluent and prefilled syringe pre-filled pen 

usually supplied to patients by a home delivery company

REQUIRES BLUETEQ APPROVAL

Injection

Capsules 250mg
Liquid 250mg/5mL

Epilepsy.

Tablets 60mg, 90mg, 120mg

Rheumatology initiation only

Pre-filled pen 140mg

primary hypercholesterolaemia or mixed dyslipidaemia in adults as per NICE TA394

Liquid paraffin light 105 mg per 1 gram, White soft paraffin 132 mg per 1 gram

Cream 100g, 500g

Tablets 10mg

Capsules (micronised) 200mg, 267mg
Tablets (micronised) 160mg

Palliative care

Pain

Injection 50mg/mL

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

Tablets 30mg, 120mg

First line

Tablet 100mg, 200mg

Moderately to severely active ulcerative colitis

Please see chapter 06.01.05

Flexitol is lower cost then Hydromol

Tablets 100micrograms

Fludrocortisone has very high mineralocorticoid activity and insignificant glucocorticoid activity. A combination of hydrocortisone and fludrocortisone are needed in primary adrenal deficiency states.

Injection 500micrograms/5ml

Flumazenil should only be administered by, or under the direct supervision of, personnel experienced in its use.

Capsules 5mg

Specialist consultant use only

Intravitreal implant 190micrograms in a disposable applicator

Eye drops fluoromethalone 0.1%, polyvinyl alcohol 1.4%

 in East Lancashire

*under review*

Capsules 20mg,
Dispersible tablets 20mg (for patients unable to swallow standard capsules),
Liquid 20mg/5mL

First line for children and adolescents.
Higher propensity for drug interactions.

Injection 20mg/1mL, 40mg/2mL
Concentrate injection 50mg/0.5mL, 100mg/1mL

Maintenance in schizophrenia and other psychoses. 

Maintenance in schizophrenia and other psychoses. 

Licensed product no longer available. Where patients have deteriorated following a switch to an alternative depot antipsychotic a request can be made to use the unlicensed product should be made to the Lead Pharmacist in the locaility. 

Flixotide Evohaler®  50mcg per actuation, 125mcg per actuation, 250mcg per actuation.

Flixotide Accuhaler® 50mcg per actuation, 100mcg per actuation, 250mcg per actuation, 500mcg per actuation. 

The maximum licensed dose in children is 200 micrograms twice daily.

Administration of doses above 1000 micrograms (500 micrograms twice daily) should be via a spacer device to help reduce side-effects in the mouth and throat. 

Relvar Ellipta® 92 micrograms fluticasone /22 micrograms vilanterol inhalation powder (asthma and COPD)

Relvar Ellipta® 184 micrograms fluticasone /22 micrograms vilanterol inhalation powder (asthma only)

AirFlu Sal Forspiro® 50mcg salmeterol / 500mcg fluticasone per actuation (asthma and COPD / adults only)

AirFluSal® MDI 25mcg salmeterol / 125mcg fluticasone per inhalation (asthma / adults only), 25mcg salmeterol / 250mcg fluticasone per inhalation (asthma / adults only)

Seretide Accuhaler® (asthma and COPD) 50mcg salmeterol / 100mcg fluticasone per actuation, 50mcg salmeterol / 250mcg fluticasone per actuation, 50mcg salmeterol / 500mcg fluticasone per actuation

Seretide Evohaler® (asthma only) 25mcg salmeterol / 50mcg fluticasone per actuation, 25mcg salmeterol / 125mcg fluticasone per actuation, 25mcg salmeterol / 250mcg fluticasoneper actuation

Sirdupla®  (asthma only) 25mcg salmeterol / 125mcg fluticasone per inhalation, 25mcg salmeterol / 250mcg fluticasone per inhalation 

Nasal spray 50microgram per dose

Injection 1.5mg in 0.3mL, 2.5mg in 0.5mL, 5mg in 0.4mL, 7.5mg in 0.6mL, 10mg in 0.8mL

Solution for infusion 240mg/ml + 12mg/ml

Parkinson's disease.

Pre-filled pens/ pre-filled syringes 225mg/1.5ml solution for injection  

Injection 

Cream 15g
Ointment 15g

Capsules 100mg, 300mg, 400mg

Epilepsy.

m/r capsules 8mg, 16mg, 24mg
Oral liquid 4mg/1ml

Eye gel 5g (1.5mg/g)

Oral powder sachets

For paediatric use only

Sachets

 in East Lancashire

Eye/ear drops 0.3%

Preservative free eye drops 1.5%

Unlicensed - consultant ophthalmologist only

Tablets 1mg, 2mg, 3mg, 4mg

Second line

Prescribing of Ogluo devices should be reserved for patients for whom the preparation and administration of conventional glucagon kits presents a barrier to effective treatment of hypoglycaemia and a risk to patient welfare.

Cutaneous solution 10%

For Primary care use only

Infusion

Ointment

First Line

Hard capsule 44 micrograms per inhalation with Seebri Breezhaler^® device

Bevespi Aerosphere 7.2 micrograms glycopyrronium /5 micrograms formoterol pressurised inhalation, suspension

Licensed for COPD only

Oral Liquid

Hypersalivation in adults and children with neurological conditions [Non-Parkinson's disease]
Use most cost-effective product. Care should be taken when prescribing as different strengths of liquid are available.

For Hypersalivation in adults with Parkinson's Disease, see chapter 4.

Prevention of recurrence of ulcerative colitis following surgery

Implant 3.6mg, 10.8mg

Solution for injection in pre-filled pen 100mg/1ml

Injection 5mg/1mL

Injection for rapid tranquilisation.

Haloperidol injection should be used in combination with promethazine injection for rapid tranquillisation.

This preparation is usually used in hospital for the rapid control of an acute episode and should not be confused with depot preparations of haloperidol decanoate which are usually used in the community or clinics for maintenance treatment.

Palliative care

Care in the last weeks or days of life - Nausea and vomiting in the last days of life AND Agitation/terminal restlessness in the last days of life

Nausea and vomiting

Opioid-induced nausea and vomiting

The following information should be used in conjunction with NICE CG184 

*In January 2024, the MHRA published a Drug Safety Update on fluoroquinolone antibiotics. These must now only be prescribed when other commonly recommended antibiotics are inappropriate. NICE is assessing the impact of this warning on recommendations in this guideline.

All courses are 7 days.

Flush 50units/5mL

Arterial line patency. ICU use only.

 Hidradenitis Suppurativa 

3mL cartridge AutoPen® or HumaPen®
3mL prefilled disposable Humalog®Mix50 KwikPen®

Second line biphasic short-acting analogue insulin (Humalog Mix Kwikpen)

10mL vial
3mL cartridge for AutoPen® or HumaPen®
3mL prefilled disposable Humulin I® KwikPen®

First line isophane insulin (Humulin I Kwikpen)

Tablets 25mg, 50mg

Heart failure

Initiated in hospital or under specialist supervision.

Granules in capsules for opening 0.5mg, 1mg, 2mg

For replacement therapy of adrenal insufficiency in children and adolescents (from birth to <18 years old)

Treatment of congenital adrenal hyperplasia (CAH) in adolescents aged 12 years and over and adults.

Injection 100mg/1mL

Injection 100mg vial

Tablets 10mg, 25mg

Tablets 300micrograms
Patch 1mg/72hours

Palliative care

Respiratory tract secretions in the last days of life

Injection 3mg/3mL pre-filled syringe

Alternative monthly bisphosphonate when alendronic acid is not appropriate.

Tablets 200mg, 400mg, 600mg
M/R tablets 800mg
Liquid 100mg/5mL

 Solution for infusion 400mg/100mL

gel 10%

Primary Care only  - prescribe as Fenbid Forte gel

30mg solution for injection in pre-filled syringe

Kept in Emergency Departments at RLI and FGH

Solution for injection/infusion 2.5 g/50 mL

Rapid reversal of anticoagulant effects of dabigatran  

Pulmonary hypertension

For use by specialist centres only.
NHSE commissioned

Cream 5%

for treatment of small superficial basal cell carcinoma in adults

emollient 500g

(Contains urea 5%)

Tablets 2.5mg and 1.5mg MR
First line diuretic for hypertension

Prevention of recurrence of ulcerative colitis following surgery

Intravenous infusion 100mg

Consultant dermatologist or specilaist initiation only

REQUIRES BLUETEQ APPROVAL

100iu/mL  pre-filled pens

Intra-uterine system 20 micrograms/24 hours

Mirena is effective for 5 years and Levosert is effective for 6 years when used for contraception and 5 years when used for menorrhagia.

Also known as Lugol's solution

Thyrotoxicosis (pre-operative).

Nebuliser solution 250micrograms/1mL, 500micrograms/2mL
Metered dose inhaler 20micrograms/inhalation

Treatment of Stroke related dysphagia 

Injection 50mg/mL (2mL ampoule)

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

Tablets 10mg, 20mg
M/R tablets 60mg
LA capsules 25mg, 50mg

Tablets 5mg, 7.5mg

80mg/1mL pre-filled pen

Tablets 200mg

Specilaist use only.

Eye drops 0.5%

*under review*

 in East Lancashire

Eye drops (preservative free) 250micrograms/mL

Should only be prescribed when:

• a patient has tried at least 2 alternative eye preparations for seasonal allergic conjunctivitis
• and/or the patient is sensitive to preservatives

*under review*

 in East Lancashire

Tablets 100mg, 200mg

Tablets 50mg, 100mg, 150mg, 200mg
Oral solution 50mg/5ml

Epilepsy.

Liquid 3.35g/5mL

Consider OTC purchase for some conditions

Tablets 25mg, 50mg, 100mg, 200mg

Dispersible tablets 5mg, 25mg, 100mg

Bipolar disorder.

Prevention of depressive episodes in adult patients with bipolar I disorder who experience predominantly depressive episodes.

Dose titration required. See BNF/SPC for further information on titration, titration with valproate, and tritration with enzyme inducing drugs.
Consider withdrawal if rash or signs of hypersensitivity syndrome develop. See BNF/SPC for more detail.

300mg solution for injection in pre-filled syringe

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

Unit dose eye drops 0.2mL Latanoprost 50micrograms/ml, Timolol 5mg/ml

This has been approved only for patients with documented preservative allergy.

NHSE commissioned for children / young adults aged 12-18 years

Tablets 10mg, 20mg

A second line dihydropyridine calcium channel blocker when amlodipine is not tolerated (e.g. where patients develop significant ankle oedema)

Concentrate for solution for infusion 500mg/5ml

 Specialist use in palliative care.

Infusion 1.25mg/mL 100mL & 200ml
Injection, 2.5mg/mL, 5mg/mL and 7.5mg/mL

Second line

Cream 500g

Tablets 25mg
Tablets 6.25mg 
Injection 25mg/1mL

For palliative care use only.
Nausea and vomiting and agitation/terminal restlessness in the last days of life.

 for schizophrenia (new patients)

Tablets 1.5mg

Emergency contraception.

5% Medicated Plasters

Post Herpetic Neuralgia

 For off-label indications.

In UHMB, only indicated (off-label) use endorsed by UHMB acute pain team is for prescribing in rib fractures

Maximum of 4 weeks supply to be given on discharge and not to be continued in primary care.

If required for longer than 4 weeks then GP should refer to chronic pain team for review and not issue a prescription

Any other off label use must be on the advice of the acute pain team and must only be prescribed by secondary care.

For use in Palliative care/EoL settings discuss with the Palliative Care team.

Injection 0.5%, 1%, 2% 

Injection 1% / 1:200,000 20mL
Injection 2% / 1:200,000 20mL

Injection 2% / 1:80,000 2mL cartridge (for dental use)

Lidocaine 25mg/1g, Prilocaine 25mg/1g cream

 for licensed indications.

 for specific indications within hospital Trusts, including:
MBHT - for use in theatres for grommet insertion (unlicensed use).
ELHT - to help with irritation caused by use of Aldara cream in women with Vulval intraepithelial neoplasia.

Tablets 5mg

Second line gliptin on LSCMMG pathway for patients with renal impairment.
 
  

Tablets 20micrograms

 
  Liothyronine monotherapy for the management of chronic hypothyroidism – primary and secondary care.

  Resistant depression

  Liothyronine therapy commenced in the private sector

 For the treatment of acute conditions where thyroid replacement is needed rapidly, for a limited period and/or where a drug with shorter half-life is required

  Add-on treatment for refractory hypothyroidism – existing patient (RED RAG for Pennine only for this indication)

  Add-on treatment for refractory hypothyroidism despite adequate replacement with levothyroxine – new patients (RED RAG for Pennine only for this indication)

Injection 6mg/mL pre-filled pen

Second line GLP-1 agonist, if daily administration preferred.
Prescribe by brand.

Adult Hard Capsules 30mg, 50 mg and 70mg (Elvanse Adult)

Hard capsules 20mg, 30mg, 40mg, 50mg, 60mg, 70mg (Elvanse)

Lisdexamfetamine (Elvanse) is recommended for use in the treatment of ADHD in children and young adults only in complex patients who meet both of the following criteria.
- extenuating circumstances exist which mean that a patient would not reliably receive all the required doses of dexamfetamine throughout the day and requires a once daily dose of lisdexamfetamine to support adherence
- treatment has been agreed through the internal governance arrangements of the trust.
  

Modified-release tablets 400mg

Treatment and prophylaxis of mania, bipolar disorder and recurrent depression. Aggressive or self-mutilating behaviour.

Liquid 520mg/5mL

Treatment and prophylaxis of mania, bipolar disorder and recurrent depression. Aggressive or self-mutilating behaviour.

Capsules 2mg

First line

Tablets 10mg
Liquid 5mg/5mL

First line

Injection 4mg/1mL

Status epilepticus.

Palliative care

Breathlessness

Breathlessness in the last days of life

Insomnia (short term use).

Eye drops 0.5% (5mg/ml)

Restricted to second line use or if clinical condition warrants.

Tablets 18.5mg, 37mg, 74mg

Schizophrenia in adults aged 13 and over.

LSCFT initiated only

Lurasidone will be supplied by the specialist service for the duration of the treatment course.
Primary care initiation or continuation of treatment is not recommended unless exceptional circumstances such as specialist GP.
Lurasidone may only be prescribed in the following circumstances:
1. The patient has previously had a trial of and has not responded to aripiprazole
2. The patient does not fulfil the treatment resistance criteria as outlined in NICE Clinical Guideline 178 for the initiation of prescribing of clozapine
3. The patient has:
a. a metabolic disorder, diabetes or obesity or
b. pre-existing risk factors for metabolic disease, diabetes or obesity
All requests for lurasidone will be screened by LSCFT

Powder for oral solution

Prescribe the most cost effective brand

Sachets 10mmol

 In East Lancashire

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

Tablets 135mg, MR capsules 200mg

Second choice

Cream and sachet

For community use only