Tablets 100mg, 200mg, 400mg
M/R tablets (Tegretol® Retard) 200mg, 400mg
Chewable tablets (Tegretol® Chewtabs) 100mg, 200mg
Liquid 100mg/5mL
Suppositories 125mg, 250mg

Note: 125mg suppositories are approximately equivalent in therapeutic effect to 100mg tablets (plasma concentration monitoring is recommended

Category 1 - Doctors are advised to ensure that their patient is maintained on a specific manufacturer's product

Different preparations may vary in bioavailability and are therefore not interchangeable, prescriptions should include the brand name.

Medicated plaster 8mg - Each medicated plaster of 4 cm² contains 8 mg 5-aminolevulinic acid, 2 mg per cm²

Alacare plasters are only recommended for single-use treatment of mild actinic keratoses lesions with a maximum diameter of 1.8cm on the face and scalp (hairless areas)

Tablets 50mg - for treating moderate to severe atopic dermatitis

Tablets 100mg - for treating moderate to severe atopic dermatitis

Tablets 200mg - for treating moderate to severe atopic dermatitis

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

Tablets 250mg
M/R capsules 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

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.

Pre-filled pen 75mg, 150mg

Capsules 10mg, 30mg

Consultant dermatologist or specialist only

Pregnancy must be excluded before initiation and before each repeat prescription.
prescriptions for women are limited to 28 days treatment

REQUIRES BLUETEQ APPROVAL

Tablets 6.25mg, 12.5mg, 25mg
 
First line gliptin on LSCMMG pathway

Injection 10 microgram, 20 microgram

Erectile Dysfunction.

Acute ischaemic stroke (NICE TA264)

Follow local policy

Capsules 100mg
Liquid 50mg/5mL

gel 78mg/g

Tablets 100mg, 200mg

On advice of cardiology only

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

Sugar Free oral solution 50mg/5mL

Tablets 5mg, 10mg

First line dihydropyridine

Capsules 500 micrograms

Consultant haemtologist only

Powder for solution for infusion 200mg

Cream, Ointment, Suppositories

Consider OTC/Self care

Injection 50mg/5mL

Pre-filled pen 30mg/3mL

Unit dose eye drops 1% - perioperative use only

*under review*

Tablets 10mg, 20mg, 30mg

Usually supplied to patients by a home delivery company

REQUIRES BLUETEQ APPROVAL

Enema 130mL

Contains nuts - contraindicated in patients with hypersensitivity to nuts

Tablets 5mg,10mg,15mg, 30mg
Dispersible tablets 10mg,15mg
Liquid 1mg/mL

Consultant psychiatrist initiation only

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

 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.

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

Eye/ear/nose drops 0.1%

 in East Lancashire

*under review*

Soluble tablets 500micrograms

Eye drops 0.25%, 0.5%

*under review*

Not listed on East Lancashire formulary

Tablets 200mg
M/R tablets 400mg

Eye drops bimatoprost 300micrograms/mL (0.03%)/timolol 5mg/mL (0.5%)
 Eye drops - preservative free bimatoprost 300micrograms/mL (0.03%)/timolol 5mg/mL (0.5%) - only for patients with a documented allergy to preservatives

Pre-filled pen/syringe 160mg

Usually supplied to patients via a homecare delivery company

Oral gel

Reserved for use in patients with severe dry mouth as a result of an underlying condition or treatment, such as, progressive neurological conditions affecting swallowing (including but not exclusively Parkinson’s disease, Parkinson’s plus conditions, multiple sclerosis etc), Sjogren’s syndrome or after radiotherapy for head and neck cancer. It may also be suitable for end-of-life patients, anyone who is ‘nil by mouth’ or patients who are suffering from a dry mouth as a result of being on a fluid restriction due to cardiac issues. Non-pharmacological interventions should always be first-line

Chewable tablet 262.5mg

For H.pylori eradication therapy only, as part of a defined course

Infusion 250mg

Injection 100 units

Preferred preparation

Consultant use only

Brands are not interchangeable

**under review**

For treatment of primary idiopathic hyperhidrosis and secondary hyperhidrosis.

- as an option for the management of severe primary idiopathic hyperhidrosis of the axillae, which does not respond to self-care strategies and topical treatment, and where the cause is NOT due to social anxiety.

- as an option for the management of severe secondary hyperhidrosis of the axillae, which does not respond to self-care strategies and topical treatment, where the cause is NOT due to social anxiety and where the primary condition has been optimally managed as far as reasonable to alleviate the hyperhidrosis.

In order to reduce the potential for antibody formation which reduces the effectiveness of treatment, inject the lowest effective dose at the longest clinically indicated interval

Eye drops 0.2%

Eye drops 10mg/mL (1%)

Eye drops brinzolamide 10mg/mL/brimonidine 2mg/mL

Solution for injection pre-filled syringes 210mg/1.5ml 

Eye drops 0.09%

e/c capsules 3mg
e/c granules 9mg/sachet
Foam enema

First line rectal treatment (foam enema)

Capsules 3mg, Enema

DuoResp Spiromax®  160 micrograms budesonide / 4.5 micrograms formoterol inhalation powder, 320 micrograms budesonide / 9mcg formoterol inhalation powder (asthma and COPD)

Fobumix Easyhaler® 80mcg budesonide / 4.5mcg formoterol per inhalation (asthma / over 18 years only), 160mcg budesonide / 4.5mcg formoterol per inhalation (asthma and COPD / over 18 years only), 320mcg budesonide / 9mcg formoterol per inhalation (asthma and COPD / over 18 years only)

Symbicort Turbohaler® 100mcg budesonide / 6mcg formoterol per inhalation (asthma only), 200mcg budesonide / 6mcg formoterol per inhalation (asthma and COPD), 400mcg budesonide / 12mcg formoterol per inhalation (asthma and COPD)

Symbicort® MDI 100mcg budesonide / 3mcg formoterol per actuation (asthma only), 200mcg budesonide / 6mcg formoterol per actuation (COPD only)

Orodispersible tablets 1mg

Tablets 1mg, 5mg

 Second line treatment - Only if poor response to furosemide

s/l tablets 200micrograms

See section 4.10 for products used in opioid dependence

**under review**

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 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

Eye drops 0.02%

Unlicensed - Consultant ophthalmologist only. Morecambe bay only

* under review*

Cleansing solution, 250mL, 500mL
For use by dermatologists only

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

 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

Cinnarizine 20 mg, Dimenhydrinate 40 mg

Third line

**Under review**

Tablets 10mg, 20mg

Premature ejaculation.

 Unlicensed indication

Lotion 30mL, 60mL

Gel 

Shampoo, clobetasol propionate 0.05% 125mL

Tablets 25 microgram 

Clonidine is considered less suitable for prescribing in hypertension

 Vasomotor symptoms (VMS) associated with menopause

Pessary 500mg
Vaginal cream 10%
Cream 1%

Consider OTC purchase for some conditions.

Injection

LSCFT use only

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

Tablets 62.5mg (12.5/50), 110mg (10/100)
Tablets 125mg (25/100)
Tablets 250mg (50/200)
m/r tablets 125mg (25/100)
m/r tablets 250mg (50/200)

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. 

Tablets 50mg

Eye drops 0.5%, 1%

 in East Lancashire

*under review*

Capsules 110mg, 150mg

Dabigatran etexilate for the prevention of stroke and systemic embolism in atrial fibrillation (NICE TA249)

Dabigatran etexilate for the prevention of venous thromboembolism after hip or knee replacement surgery in adults (NICE TA157)

  Dabigatran etexilate for the treatment and secondary prevention of deep vein thrombosis and/or pulmonary embolism (NICE TA327)   ( East Lancashire only, for this indication)

Anticoagulation where standard options are contra-indicated.
Use only following haematologist advice.

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 5mg, 10mg, 30mg, 100mg, 500mg

**under review**

Tablets 2mg, 5mg, 10mg
Liquid 2mg/5mL
Rectal tubes 2.5mg/1.25mL, 5mg/2.5mL, 10mg/2.5mL

Tablets 50mg

Chronic intractable hypoglycaemia.

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

10%
(0.1%, 0.25%, 0.5%, 1%, 2%, 4%, 6%, 8% dilutions available from pharmacy)
Not all dithranol 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 for up to 4 weeks.

Palliative care

Constipation

Opioid-induced constipation

Palliative care

Nausea and vomiting

Injection

Eye drops dorzolamide 2%/timolol 0.5%
 Eye drops - preservative free dorzolamide 2%/timolol 0.5% - only for patients with a documented allergy to preservatives.
 
 First line carbonic anhydrase inhibitor with timolol

Tablets and Capsules

Dosulepin may continue to be prescribed for existing patients, RAG rating Amber 0 – please refer to the guideline below.  Patients should be regularly reviewed with a view to stopping or reducing doses due to the ongoing risk of cardiovascular events and risks associated with overdose. Elderly patients are particularly susceptible to many of these side-effects.

Tablets 1mg, 2mg, 4mg

Doxazosin MR do not prescribe 

capsules 25mg, 50mg

Tablets Doxylamine succinate 10 mg, Pyridoxine hydrochloride 10 mg

Pre-filled pen 0.75mg/0.5mL, 1.5mg/0.5mL

First line GLP-1 agonist

Pre-filled syringe 300mg/2ml solution for injection

 NICE TA648: Dupilumab for treating chronic rhinosinusitis with nasal polyps (terminated appraisal)

 NICE TA955: Dupilumab for treating moderate to severe prurigo nodularis

tablets 15mg, 30mg, 60mg
 
Edoxaban for preventing stroke and systemic embolism in people with non-valvular atrial fibrillation (NICE TA355)

Edoxaban for treating and for preventing deep vein thrombosis and pulmonary embolism (NICE TA354)   ( East Lancashire only, for this indication)

 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

Heel balm 75g

Specific use only for diabetic patients

Tablets 10mg, 25 mg

First line gliflozin

Tablets 2.5mg, 5mg, 10mg, 20mg

Restricted to use in post natal women when used in line with NG133

ICU use only.

Ointment

MHRA Drug Safety Update, July 2024: Epimax Ointment and Epimax Paraffin-Free Ointment: reports of ocular surface toxicity and ocular chemical injury

Tablets 25mg, 50mg

Heart failure

Injection 500micrograms

 Restricted drug - specialist initiation only.
  Unlicensed use.
NHSE commissioned for digital ulcers and pulmonary arterial hypertension

Concentrate for solution for infusion.

100mg

Pre-filled syringe 70mg, 140mg

Pre-filled pen 70mg, 140mg

Injection 500micrograms/1mL

Postpartum haemorrhage.

Tablets 5mg, 15mg

Restriction - only to be used as second line

Tablets 5mg, 10mg, 20mg

Injection 100mg/10mL
Infusion 2.5g in 250mL

Bijuve® is an alternative when other HRT treatments have not been tolerated or when Femoston-Conti® is being considered OR
> Bijuve replaces HRT regimens where separate oestrogen and micronised progesterone are used (single hormone products used in combination are more expensive than Bijuve®).

Vaginal tablets 10microgram

0.03mg  pessaries, 0.5mg pessaries

S/C injection 50mg pre-filled syringe, pre-filled pen

Consultant dermatologist or specilaist initiation only
Usually supplied to patients by a home delivery company

REQUIRES BLUETEQ APPROVAL

Tablets 10micrograms, 50micrograms

Implant 68mg

The doctor or nurse administering (or removing) the system should be fully trained in the technique.

Tablets 2mg

For the treatment of ulcerative colitis in accordance with NICE TA956

Prevention of cardiac events in patients with CHD and a history of ACS, in combination with a statin

prolonged-release suspension for injection in pre-filled pen (BCise) 2mg

Third line GLP-1 agonist

Tablets 20mg, 40mg

Oral solution 2.2 mg/mL 

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.

Cream & Ointment

Replaces Betnovate C cream & ointment

Minims^® 1%, 2%

Injection 10% for WAMD clinic use only

Injection 20%

Cream 40g

  for actinic keratosis

   for the treatment of small superficial basal-cell carcinomas in adults

 treatment of superficial pre-malignant skin lesions

Capsules 20mg

Premature ejaculation.

 Unlicensed indication

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

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

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

Injection 

Cream 15g
Ointment 15g

Capsules 100mg, 300mg, 400mg

Category 3 - It is usually unecessary to ensure that patients are maintained on a specific manufacturer's product as therapeutic equivalence can be assumed

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

Aerosol spray 400micrograms/dose
Patches 5mg/24h, 10mg/24h

Patches should only be considered in patients unable to comply with or tolerate oral isosorbide mononitrate.

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.

Pre-filled syringe or pen

Moderate to severe active ulcerative colitis

S/C injection 50mg, 100mg, prefilled syringe pre-filled pen 

Usually supplied to patients by a home delivery company

REQUIRES BLUETEQ APPROVAL

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

Tablets 1.5mg, 5mg, 10mg
Capsules or tablets 500micrograms
Liquid 2mg/mL

Injection 50mg/1mL, 100mg/1mL

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

Hypertension

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)

 Eye drop - 2 week course only

1 ml eye drops, solution contains 3.35 mg of hydrocortisone sodium phosphate.

Tablets 10mg, 20mg

Tablets 200mg, 300mg

Eye ointment preservative free

2nd line to Hydramed Night

Palliative care

Bowel obstruction - colic associated with bowel obstruction AND GI secretions associated with bowel obstruction

Respiratory tract secretions in the last days of life

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

Injection 50mg/mL (2mL ampoule)

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

 unlicensed

Isotonic aqueous nasal spray

For use post-op follow local protocols

*under review*

Granules 3.5g

Consider OTC purchase for some conditions

Tablets 150mg
Granules sachets 13.4mg, 25mg, 50mg, 75mg

Tablets 3mg

For hyperkeratotic (crusted or Norwegian) scabies unresponsive to topical treatment alone.

80mg solution for injection prefilled syringe; prefilled pen

Tablets 200mg

Specilaist use only.

Eye drops 0.5%

*under review*

 in East Lancashire

Tablets 100mg, 200mg

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

For existing patients only

Tablets 50mg, 100mg, 150mg, 200mg

 Oral solution 50mg/5ml

Category 3 - It is usually unecessary to ensure that patients are maintained on a specific manufacturer's product as therapeutic equivalence can be assumed

Palliative care

Constipation

Tablets 25mg 50mg, 100mg
Dispersible tablets 5mg, 25mg, 100mg

Category 2 - Doctors should use clinical judgement when deciding whether to switch between different manufacturer's products

CSM advice: blood disorders - see BNF

Capsules 15mg, 30mg
Orodispersible tablets 15mg, 30mg

First line

Orodispersible tablets are for paediatric use and adults with swallowing difficulties only

Patients taking more than 30mg daily of lansoprazole are considered to be on high dose treatment. When reducing doses, please choose the lowest effective dose to
control symptoms.

10mL vial
3mL cartridge for OptiPen® Pro 1
3mL prefilled disposable pen SoloSTAR®

Lantus® brand is not a preferred product in the LSCMMG antihyperglycaemics guideline. Biosimilars of Insulin glargine are also available for the treatment of NEW patients and patients assessed to need a medication change. Treatment should normally be started with the least expensive drug.

Eye drops 50micrograms/mL (0.005%)/ timolol 0.5%

Injection 1g in 5mL

 Paediatric use only

Tablets 10mg, 20mg

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

Unit dose - preservative free eye drops levobunolol 0.5%/polyvinyl alcohol 1.4%

*under review*

Not listed on East Lancashire formulary

eye drops 0.5%

preservative-free eye drops 0.5% - reserved for patients with a documented allergy to preservatives or for intensive use

 *under review*

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

Tablets 30 micrograms

Ventricular arrhythmias

For cardiology/ICU use only

5% Medicated Plasters

Use outside of the license of post-herpetic neuralgia for the treatment of localised neuropathic pain with predominance of allodynia and/or hyperalgesia and dysesthesias unresponsive to other neuropathic agents.

Primary premature ejaculation in men.

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, 50mg, 70mg

Under 16 years - hard capsules 20mg, 30mg, 40mg, 50mg, 60mg, 70mg
  

M/R tablets 400mg

Liquid 520mg/5mL

Tablets 200micrograms

**under review**

Tablets 10mg
Liquid 5mg/5mL

First line

Tablets 12.5mg, 25mg, 50mg, 100mg

First line

Solution for injection  94.5mg/0.5mL

 Tertiary Centre only for NICE HST25 Lumasiran for treating primary hyperoxaluria type 1 - See link below

Film coated tablets 3mg

Injection 100 units/mL,

Solution for injection in vial

Solution for injection in cartridge

KwikPen® solution for injection in pre-filled pen

Junior KwikPen® solution for injection in pre-filled pen

Insulin Lispro (Lyumjev®) is recommended for the treatment of diabetes mellitus in adults who are suitable for Humalog® and their diabetes cannot be adequately managed with alternative formulary choices and at least one of the following applies:

-Where the prescriber believes a faster onset of action would be beneficial to the patient
- Where a patient requires ‘tight’ control of blood sugar levels
- Where a patient has rapid post-meal increase in blood sugar levels

powder for oral solution

Prescribe by brand. Follow local protocols

Inhalation powder, hard capsule with device 40mg

Spray barrier film

For community use only

Tablets 5mg, 10mg

Children with learning disabilities

Children with ADHD

Children and adolescents with Autism Spectrum Disorder (ASD) and / or Smith-Magenis syndrome

Cerebral palsy

Children with complex neurodevelopmental disorders that the specialist considers eligible

Initiation of melatonin must be by a specialist in the indication being prescribed for and have a clear plan for review.

Prescribing and review of melatonin in children must follow the principles outlined in the Melatonin Pathway (Children)

Primary insomnia in those over 55

Sleep problems in patients with dementia associated with Alzheimer’s

Colonis liquid 1mg/ml and 3mg tablets for all indications, including insomnia and jet lag

Tablets 10mg
Oral drops 10mg/mL
Note: 5mg = 10 drops

Primary care prescribers may start treatment with memantine without taking advice from a specialist clinician where an AChEI is already prescribed.   as per LSCMMG guidance.

(Nucala®) solution for injection pre-filled syringe 40mg / 0.4ml, 100mg powder for solution for injection, solution for injection pre-filled pen 100mg / 1ml, solution for injection in pre-filled syringe 100mg / 1ml

Severe eosinophilic asthma in adults - NICE TA671

Severe hypereosinophilic syndrome in adults. Appraisal terminated. NICE TA846

Tablets 50mg

Mesalazine products should be prescribed by brand.
Formulary options include:
Pentasa liquid enema and suppositories.
Salofalk foam enema and suppositories.
Octasa suppositories.

Tablets 5mg
Injection 10mg/1mL

Methadone, when used as an analgesic, should be initiated by specialists in palliative care only

see section 4.10 for products used in opioid dependence

**under review**

2.5mg tablets, Prefilled syringes and pens (various strengths)

Crohn's disease.
Methotrexate should be prescribed once weekly as a single dose on the same day each week.
If oral methotrexate is prescribed only use the 2.5 mg strength

Consultant dermatologist or specialist initiation only

Methotrexate should be prescribed once weekly as a single dose on the same day each week. If oral methotrexate is prescribed only use the 2.5 mg strength

Tablets 125mg, 250mg, 500mg

Tablets 5mg, 10mg, 20mg
M/R tablets 18mg, 27mg, 36mg, 54mg
M/R capsules 5mg, 10mg, 20mg, 30mg, 40mg, 50mg, 60mg

All brands are formulary - choice of brand to made by specialist

For adult patients under the care of Psychiatry UK in South Cumbria, please prescribe as Xaggatin XL in primary care

Injection
(Methylprednisolone 80mg/2mL with lidocaine 20mg/2mL)