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Airedale, Wharfedale and Craven CCG
 
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 Formulary Chapter 9: Nutrition and blood - Full Chapter
Notes:

Specialist Infant Formula Prescribing Guidance

 Details...
09.01  Anaemias and some other blood disorders
 note 
Iron Salt Amount Content of ferrous Iron
Ferrous fumarate 200mg 65mg
Ferrous gluconate 300mg 35mg
Ferrous sulphate 300mg 60mg
Ferrous sulphate (dried) 200mg 65mg

BNF - Iron content of different iron salts

09.01.01  Iron-deficiency anaemias
09.01.01.01  Oral iron
Ferrous Sulphate
View adult BNF View SPC online View childrens BNF  Track Changes
First Choice
Green
  • Ferrous sulphate

 

 
Ferrous Fumarate
View adult BNF View SPC online View childrens BNF  Track Changes
First Choice
Green
  • Ferrous fumarate

 

 
Sodium Feredetate (Sytron®)
View adult BNF View SPC online View childrens BNF  Track Changes
First Choice
Green
  • Sodium feredetate liquid

 

 
Ferrous Gluconate
View adult BNF View SPC online View childrens BNF  Track Changes
Second Choice
Green
  • Ferrous gluconate
 
   
Ferric Maltol (Ferracru®)
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Second Choice
Amber
  • Ferric maltol

Restricted use for the treatment of iron-deficiency anaemia in patients with inflammatory bowel disease only, as an alternative to intravenous iron.

Consultant gastroenterologist recommendation only.

12 week course.

 
   
09.01.01.01  Iron and folic acid
09.01.01.01  Compound iron preparations to top
09.01.01.02  Parenteral iron
Ferric Carboxymaltose (Ferinject®)
View adult BNF View SPC online View childrens BNF  Track Changes
Restricted Drug Restricted
Red
  • Ferric Carboxymaltose

For Consultant Haematologists and Consultant Obstetricians and Gynaecologists use only.

Facilities for cardiopulmonary resuscitation must be at hand.

A single dose of Ferinject should not exceed 1000mg of iron (or 15mg/kg).

Do not administer 1000mg of iron more than once a week.

Administer via IV bolus or IV infusion.

Refer to SPC for rates.

 
   
Iron Dextran (CosmoFer®)
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Restricted Drug Restricted
Red
  • Iron-III Hydroxide Dextran Complex

Consultant Haematologist use only

Facilities for cardiopulmonary resuscitation must be at hand

Dose calculated according to body weight and iron deficit

Cumulative dose administered in single doses of 100mg (may be increased to 200mg) of iron given not more than 3 times a week or

As a total dose infusion up to a total replacement dose of 20mg iron / kg body weight.

Slow IV injection or IV infusion (preferred route) or IM injection

 
   
Iron Sucrose (Venofer®)
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Restricted Drug Restricted
Red
  • Iron-Hydroxide Sucrose Complex

Consultant Haematologist use only

Reserved for patients who need to attend clinic every 4-6 weeks to maintain blood count.

Facilities for cardiopiulmonary resuscitation must be at hand

Dose calculated according to body weight and iron deficit

Cumulative dose administered in single doses of 100mg (may be increased to 200mg) of iron given not more than 3 times a week.

Slow IV injection or IV infusion (preferred route)

 
Link  EMC: Manufacturer’s Summary of Product Characteristics (SPC) (November 2016)
   
09.01.02  Drugs used in megaloblastic anaemias
Folic Acid
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Formulary
Green
  • Folic acid 5mg tablets

For patients with a BMI greater than 30. Consult current guidelines for appropriate dose in other situations.

 

  • Folic acid 400mcg tablets 

For the prevention of neural tube defects in pregnancy to be purchased over the counter by patients where possible. 

 
   
Hydroxocobalamin
(Vitamin B12)
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Formulary
Green
  • Hydroxocobalamin

 

 
   
09.01.03  Drugs used in hypoplastic, haemolytic, and renal anaemias
Eculizumab Injection (Soliris® )
View adult BNF View SPC online View childrens BNF  Track Changes
Restricted Drug Restricted
Red
  • Eculizumab

Specialist Treatment Centre Only

 
Link  NICE HST1: Eculizumab for treating atypical haemolytic uraemic syndrome [January 2015]
   
09.01.03  Erythropoietin
Epoetin alfa (Eprex®)
View adult BNF View SPC online View childrens BNF  Track Changes
Restricted Drug Restricted
Red
  • Epoetin alfa

For the treatment of anaemia in patients undergoing chemotherapy.

Not routinely used for the treatment of anaemia prior to surgery, except in the following circumstances in line with NICE CG24 - Blood Transfusion:

  • The patient meets the criteria to receive a blood transfusion, but declines it because of religious beliefs or other reasons.
  • The appropriate blood type is not available because of the patient's red cell antibodies.

Administered by subcutaneous or intravenous injection.

Subcutaneous injection of Eprex is contra-indicated in patient with chronic renal failure


 

 
Link  MHRA Drug Safety Update: Recombinant human erythropoietins: very rare risk of severe cutaneous adverse reactions (SCARs) (January 2018)
Link  NICE TA323: Erythropoiesis‑stimulating agents (epoetin and darbepoetin) for treating anaemia in people with cancer having chemotherapy [November 2014]
   
Epoetin beta (NeoRecormon®)
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Restricted Drug Restricted
Red
  • Epoetin beta

By subcutaneous or intravenous injection.
For treating anaemia in patients undergoing chemotherapy By subcutaneous or intravenous injection.

 
Link  MHRA Drug Safety Update: Recombinant human erythropoietins: very rare risk of severe cutaneous adverse reactions (SCARs) (January 2018)
Link  NICE TA323: Erythropoiesis‑stimulating agents (epoetin and darbepoetin) for treating anaemia in people with cancer having chemotherapy [November 2014]
   
Darbepoetin alfa (Aranesp®)
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Restricted Drug Restricted
Red
  • Darbepoetin alfa

For renal patients at Skipton Renal Unit
For treating anaemia in patients undergoing chemotherapy
By subcutaneous or intravenous injection.

 
Link  MHRA Drug Safety Update: Recombinant human erythropoietins: very rare risk of severe cutaneous adverse reactions (SCARs) (January 2018)
Link  NICE TA323: Erythropoiesis‑stimulating agents (epoetin and darbepoetin) for treating anaemia in people with cancer having chemotherapy [November 2014]
   
09.01.03  Iron overload to top
Desferrioxamine mesilate
View adult BNF View SPC online View childrens BNF  Track Changes
First Choice
Red
  • Desferrioxamine
 
Deferasirox (Exjade®)
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Second Choice
Red
  • Desferasirox

Supported for treatment of chronic iron overload. Haematology use only.

Oral iron chelator, is licensed for treatment of iron overload in patients with thalassaemia major in whom desferrioxamine is contra-indicated or is not tolerated.

 
   
Deferiprone
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Second Choice
Red
  • Deferiprone

Oral iron chelator, is licensed for treatment of iron overload in patients with thalassaemia major in whom desferrioxamine is contra-indicated or is not tolerated.

 
   
Dexrazoxane infusion  (Cardiaxane®)
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Formulary
Red
NHS England
BlueTeq
  • Dexrazoxane infusion

For preventing cardiotoxicity in children and young people (< 25 years) receiving high-dose anthracyclines or related drugs for the treatment of cancer.

Haematology / Oncology use only.

Blueteq® registration and approval for use is required for this product before it may be dispensed.

 
   
09.01.04  Drugs used in autoimmune thrombocytopenic purpura
Anagrelide
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Restricted Drug Restricted
Red
  • Anagrelide

Consultant Haematologist only

 

 
   
Eltrombopag (Revolade®)
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Restricted Drug Restricted
Red
  • Eltrombopag

Treatment option for chronic immune (idiopathic) thrombocytopenic purpura in-line with NICE TA293. Consultant haematologist use only.

 
Link  Drug Safety Update: Eltrombopag (Revolade): reports of interference with bilirubin and creatinine test results
Link  NICE TA293: Eltrombopag for treating chronic immune (idiopathic) thrombocytopenic purpura (July 2013)
   
Romiplostim (Nplate®)
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Restricted Drug Restricted
Red
  • Romiplostim

Treatment option for chronic immune (idiopathic) thrombocytopenic purpura in-line with NICE TA221. Consultant haematologist use only.

 
Link  NICE TA221: Romiplostim for the treatment of chronic immune (idiopathic) thrombocytopenic purpura (Updated May 2014)
   
09.01.05  G6PD deficiency
09.01.06  Drugs used in neutropenia
Lipegfilgrastim (Lonquex®)
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Restricted Drug Restricted
Red
  • Lipegfilgrastim

Neutropenia prophylaxis for highly myelosuppressive chemotherapy for patients who do not tolerate daily filgrastim injections.

Restricted to consultant haematologists/oncologist use only.

 
   
Filgrastim (Nivestim®, Zarzio® and Neupogen®)
View adult BNF View SPC online View childrens BNF  Track Changes
Restricted Drug Restricted
Red
  • Filgrastim

Consultant Haematologist, Oncologist and paediatric use only

 

  • Nivestim® is the current biosimilar generic of choice for most indications.
  • Zarzio® is restricted for consultant haematologist use only in patients undergoing stem cell harvesting.
  • Neupogen® For specifically agreed paediatric patients.

Filgrastim must be prescribed by brand – where no brand is specified then the prescriber should be contacted, but Zarzio should be used for most prescriptions other than for specifically agreed paediatrics patients.

 
   
09.01.07  Drugs used to mobilise stem cells
Plerixafor (Mozobil®)
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Restricted Drug Restricted
Red
High Cost Medicine
  • Plerixafor

For use prior to patient transfer to registered tertiary centre for stem cell mobilisation in line with NHS England commissioned position SSC1655.

Blueteq® registration and approval for use is required for this product before it may be dispensed.

 
   
09.02  Fluids and electrolytes to top
09.02.01  Oral preparations for fluid and electrolyte imbalance
09.02.01.01  Oral potassium
Potassium Chloride (Kay-Cee-L® and Sando-K®)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Green
  • Potassium Chloride
 
   
09.02.01.01  Potassium removal
Polystyrene Sulphonate Resins (Calcium Resonium®)
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Formulary
Green
  • Polystyrene Sulphonate Resins
 
   
09.02.01.02  Oral sodium and water
Sodium Chloride
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Green
  • Sodium chloride tablets (600mg)
  • Sodium chloride oral solution

Sodium chloride 5% oral solution can be made up in pharmacy from polyfusors.

In primary care prescribe sodium chloride 1mmol/mL oral solution by brand. Sodium chloride 5mmol/ml can be prescribed as generic.

 
   
09.02.01.02  Oral rehydration therapy (ORT) to top
Oral Rehydration Salts (Dioralyte®)
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Formulary
Green
  • Oral Rehydration Salts
 
   
09.02.01.03  Oral bicarbonate
Sodium Bicarbonate
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Formulary
Green
  • Sodium Bicarbonate

Sodium bicarbonate oral solutions 8.4% are packaged in pharmacy (ANHSFT only)

 
   
09.02.02  Parenteral preparations for fluid and electrolyte imbalance
09.02.02.01  Electrolytes and water
Prismasol
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Restricted Drug Restricted
Red
  • Prismasol 4 (5L)

For use on ICU only for renal patients

 
   
09.02.02.01  Intravenous sodium
Sodium Chloride Intravenous
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
  • Green Sodium Chloride 0.9% Injection (10mL)
  • Green Sodium Chloride 0.9% Infusion (50mL, 100mL, 250mL, 500mL, 1L)
  • Red Sodium Chloride 0.18% Infusion (500mL)
  • Red Sodium Chloride 0.45% Infusion (500mL)
  • Red Sodium Chloride 1.8% Infusion (500mL)
  • Red Sodium Chloride 2.7% Infusion (500mL)
  • Red Sodium Chloride 5% Infusion (500mL)
  • Red Sodium Chloride 30% Injection (10mL) Aseptics only
 
   
Sodium Chloride and Glucose Intravenous Infusion
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Red
  • Sodium Chloride 0.18% Glucose 10% Infusion (500mL)
  • Sodium Chloride 0.18% Glucose 4% Infusion (500mL, 1L)
  • Sodium Chloride 0.45% Glucose 5% Infusion (500mL)
  • Sodium Chloride 0.45% Glucose 2.5% Infusion (500mL)
  • Sodium Chloride 0.45% Glucose 10% Infusion (500mL) (Unlicensed)
  • Sodium Chloride 0.9% Glucose 5% infusion (500mL)

 
Link  Unlicensed Medicines Consultant Request Form (ANHSFT access only)
Link  Unlicensed Medicines Patient Agreement for Use Form (ANHSFT access only)
Link  Unlicensed Medicines Patient Information Leaflet (ANHSFT access only)
Link  Unlicensed Medicines Policy (ANHSFT access only)
   
09.02.02.01  Intravenous glucose to top
Glucose Intravenous
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Red
  • Glucose 5% Infusion (100mL, 250mL, 500mL, 1L)
  • Glucose 10%, 20%, 50% Infusion (500mL)
  • Glucose 50% Injection (50mL)
 
   
09.02.02.01  Intravenous potassium
Potassium Chloride 15% (20mmol in 10ml)
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Restricted Drug Restricted
Red
  • Potassium Chloride 15% (20mmol in 10mL)

Restricted to Children's Unit and Neonatal Unit

 
Controlled Drug ANHST treats this product as a controlled drug. It must be stored in the controlled drug cupboard
   
Potassium Chloride and Glucose Intravenous Infusion
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Red
  • Potassium Chloride 0.15% in Glucose 5% Infusion (1L)
  • Potassium Chloride 0.3% in Glucose 5% Infusion (500mL)

 

Restricted

  • Potassium Chloride 0.6% in Glucose 5% Infusion (500mL)
    This product contains 80mmol K+ per litre for correction of severe hypokalaemia. Concentration exceeds that recommended for peripheral infusion.
  •  Potassium Chloride 0.15% in Glucose 10% Infusion (500mL)
    Ward 21 Maternity use only.
 
   
Potassium Chloride and Sodium Chloride Intravenous Infusion
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Red
  • Potassium Chloride 0.3% in Sodium Chloride 0.9% (500mL, 1L)
  • Potassium Chloride 0.15% in Sodium Chloride 0.9% (1L)

 

Restricted

  • Potassium Chloride 0.6% in Sodium Chloride 0.9% (500mL)

This product contains 80mmol K+ per litre for correction of severe hypokalaemia. Concentration exceeds that recommended for peripheral infusion.

 
   
Potassium Chloride, Sodium Chloride and Glucose Intravenous Infusion
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Red
  • Potassium Chloride 0.3% Sodium Chloride 0.18% Glucose 4% (500mL)
  • Potassium Chloride 0.3% Sodium Chloride 0.45% Glucose 5% (500mL)
  • Potassium Chloride 0.15% Sodium Chloride 0.45% Glucose 5% (500mL)
  • Potassium Chloride 0.15% Sodium Chloride 0.18% Glucose 4% (1L)

Restricted

Potassium 8mmol, Calcium 3mmol in Glucose 10% and Sodium Chloride 0.18% 500mL

For use only under the recommendation of the paediatricians, mainly for patients on ANU but occasionally childrens unit. 

 
   
09.02.02.01  Bicarbonate and lactate
Compound Sodium Lactate Intravenous Infusion
(Known as Hartmann's solution)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Red

tolterodin 2 mg

tolterodin pfizer 4mg tolterodinhandko.website tolterodin pfizer 4mg
  • Sodium Lactate Compound Infusion (500mL, 1L)
 
   
Sodium Bicarbonate (Min-I-Jet® Sodium Bicarbonate)
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Formulary
Red
  • Sodium Bicarbonate 8.4% Miniject (50mL)

Long-term supply problem (October 2015)

 
   
Sodium Bicarbonate Infusion
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Red
  • Sodium Bicarbonate 1.26% Infusion (500mL)
  • Sodium Bicarbonate 2.7% Infusion (500mL)
  • Sodium Bicarbonate 4.2% Infusion (500mL)
  • Sodium Bicarbonate 8.4% Infusion (200mL)
  • Sodium Bicarbonate 8.4% Injection (10mL)
  • Sodium Bicarbonate 8.4% Injection (100mL)


     

 
   
09.02.02.01  Water
Water for Injection
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Green
  • Water for Injections (5mL, 10mL, 100mL)
 
   
09.02.02.02  Plasma and plasma substitutes
Albumin Solution Human Albumin (Zenalb® and Albunorm® )
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Red
  • Albumin Human Solution 20% (100mL)
  • Albumin Human Solution 4.5% (500mL)
 
   
09.02.02.02  Plasma substitutes to top
Gelatin (Gelaspan®)
View adult BNF View SPC online View childrens BNF  Track Changes
Restricted Drug Restricted
Red
  • Succinylated gelatin

To replace the use of Volpex® for plasma volume replacement.

 
   
09.03  Intravenous nutrition
 note  Formulation of parenteral nutrition use under the recommendation of the pharmacists
Addiphos Solution
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Red
  • Addiphos Solution (20mL)
 
   
Additrace Solution
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Formulary
Red
  • Additrace Solution (10mL)
 
   
Babiven
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Red
  • Babiven Start up
  • Babiven Maintenance
 
   
Intralipid
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Red
  • Intralipid 20% (100mL, 500mL)
 
   
Nutriflex Lipid
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Red
  • Nutriflex Lipid Special Electrolyte Free (1250mL, 1875mL, 2500mL)
  • Nutriflex Lipid Peri (1250mL, 1875mL)
  • Nutriflex Lipid Special (1875mL)

 

 
   
Nutriflex Lipid Plus
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Red
  • Nutriflex Lipid Plus (1875mL)
 
   
Nutriflex Omega Special
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Red
  • Nutriflex Omega Special (1250mL)
 
   
Peditrace Solution
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Formulary
Red
  • Peditrace Solution (10mL)
 
   
Solivito N Injection
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Red
  • Solivito N
 
   
Vaminolact
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Formulary
Red
  • Vaminolact (100mL)
 
   
Vitlipid N Adult
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Red
  • Vitlipid N Adult (10mL)
 
   
Vitlipid N Infant
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Red
  • Vitlipid N Infant (10mL)
 
   
Smofkabiven® Extra Nitrogen
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Restricted Drug Restricted
Red
  • Smofkabiven® Extra Nitrogen

For restricted use by the dietitians for critically ill patients with a BMI >30kg/m2 who require TPN.

 

 
   
09.03  Supplementary preparations
09.04  Oral nutrition
 note  Please see Chapter A2 bordeline substances for all enteral nutrition products
09.04.01  Foods for special diets
09.04.02  Enteral nutrition to top
09.05  Minerals
09.05.01  Calcium and magnesium
09.05.01.01  Calcium supplements
Colecalciferol and calcium carbonate (Adcal D3 ® chewable tablets)
View adult BNF View SPC online View childrens BNF  Track Changes
First Choice
Green
  • Adcal D3®  Chewable tablets (contains a small quantity of soya oil and is therefore contraindicated in patients who are allergic to peanuts and soya) 
  • Calcium carbonate 1500mg (Calcium 600mg Ca2+) 
  • Colecalciferol (Vitamin D3) 10micrograms (400units)

     

 
Colecalciferol and calcium carbonate (Several brands)
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Restricted Drug Restricted
Green

Second choice calcium/colecalciferol preparations.

  • Calceos® (This product contains partially hydrogenated soyabean oil, therefore is contraindicated in patients who are allergic to peanuts or soya)
  • Calcium carbonate 1.25g (Calcium 500mg Ca2+12.5mmol)
  • Colecalciferol 10micrograms (400units)

 

  • Calcichew D3 Forte® chewable tablets
  • Calcium carbonate 1.25g (Calcium 500mg Ca2+12.5mmol)
  • Colecalciferol 10micrograms (400units)

 

  • Calcichew D3® chewable tablets (contains a small quantity of soya oil and is therefore contraindicated in patients who are allergic to peanuts or soya)
  • Calcium carbonate 1.25g (Calcium 500mg Ca2+12.5mmol)
  • Colecalciferol 5micrograms (200units) 

 

  • Cacit D3® sachets
  • Calcium carbonate 1.25 gram (Calcium 500mg)
  • Colecalciferol (440units)
  • Reserved for patients unable to chew or swallow tablets

 

  • Adcal D3® Caplets
  • Calcium carbonate 750mg (Calcium 300mg Ca2+)
  • Colecalciferol (Vitamin D3) 5micrograms (200units)
  • Alternative to Adcal D3 chewable tablets for patients who require a gelatin-free preparation

 

  • Adcal D3 Dissolve® effervescent tablets
  • Calcium carbonate 1.5g (Calcium 600mg Ca2+ 15.1mmol)
  • Colecalciferol (Vitamin D3) 10micrograms (400units)
  • Reserved for patients unable to chew or swallow tablets

 

 
   
Calcium Carbonate
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Formulary
Green
  • Calcium Carbonate
 
   
Calcium Chloride
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Formulary
Red
  • Calcium Chloride 10% Miniject (100mg in 1ml - 0.68mmol/ml) (10ml)
 
   
Calcium Gluconate
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Formulary
Red
  • Calcium Gluconate 10% Injection (0.23mmol/ml) (10mL)
 
   
Calcium Lactate
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Formulary
Green
  • Calcium Lactate
 
   
Calcium Syrup® (Alliance)
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Restricted Drug Restricted
Green
  • Calcium

The use of Alliance Calcium Syrup® is restricted for the treatment of hypocalcaemia in paediatric patients.

Adult patients should receive treatment with chewable or effervescent calcium preparations.

Effervescent calcium tablets should be used for adult patients requiring nasogastric administration.

 
   
Colecalciferol and calcium carbonate (Accrete® )
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Formulary
Green
  • Accrete D3 Film-coated tablets (contraindicated in patients who have a hypersensitivity to the active substances or any of the excipients (including soya or peanuts).
  • Accrete D3 One a Day Chewable tablets
 
   
Sandocal-1000®
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Formulary
Green
  • Sandocal 1000 tablets
  • effervescent, orange flavour
  • calcium lactate gluconate 2.263g, calcium carbonate 1.75g, providing 1g calcium (Ca2+ 25mmol)
 
   
09.05.01.02  Hypercalcaemia and hypercalciuria
Cinacalcet
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Restricted Drug Restricted
Amber
  • Cinacalcet

For Hypercalcaemia of primary hyperparathyroidism or parathyroid carcinoma

 
Link  Cinacalcet Shared Care Guideline (ANHSFT access only)
Link  NICE TA117 Cinacalcet for the treatment of secondary hyperparathyroidism in patients with end-stage renal disease on maintenance dialysis therapy [January 2007]
   
09.05.01.03  Magnesium to top
Magnesium Aspartate (Magnaspartate®)
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Formulary
Green
  • Magnesium L-Aspartate Dihydrate Sachets (10mmol) (Magnaspartate)

 

 
Link  UKMI Q&A: How is acute hypomagnesaemia treated in adults? (January 2016)
   
Magnesium Glycerophosphate
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Formulary
Green
  • Magnesium glycerophosphate chewable tablets - more cost effective
  • Magnesium glycerophosphate oral solution
 
Link  UKMI Q&A: How is acute hypomagnesaemia treated in adults? (January 2016)
   
Magnesium Sulphate
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Formulary
Red
  • Magnesium Sulphate 20% Injection (20mL,50mL)
  • Magnesium Sulphate 50% Injection (50mL)
  • Magnesium Sulphate infusion 20mmol in 100mL sodium chloride 0.9% (Unlicensed)
  • Magnesium Sulphate 50% Injection (5g/10mL) (For aseptics use only)
 
Link  DSU: Magnesium sulfate: risk of skeletal adverse effects in the neonate following prolonged or repeated use in pregnancy (May 2019)
Link  UKMI Q&A: Can magnesium sulphate be given subcutaneously? (August 2016)
Link  UKMI Q&A: How is acute hypomagnesaemia treated in adults? (January 2016)
Link  Unlicensed Medicines Consultant Request Form (ANHSFT access only)
Link  Unlicensed Medicines Patient Agreement for Use Form (ANHSFT access only)
Link  Unlicensed Medicines Patient Information Leaflet (ANHSFT access only)
Link  Unlicensed Medicines Policy (ANHSFT access only)
   
09.05.02  Phosphorus
09.05.02.01  Phosphate supplements
Phosphate (intravenous)
View adult BNF View SPC online View childrens BNF  Track Changes
Restricted Drug Restricted
Red
  • Phosphate polyfuser (intravenous) - Currently unavailable, use sodium glycerophosphate 21.6% instead

There is a national shortage of phosphate polyfusor, which is expected to last until at least October 2020. During this time, sodium glycerophosphate 21.6%, which is available as 20ml ampoules containing 20mmol phosphate will be the product of choice for IV phosphate replacement. It must be diluted in sodium chloride 0.9% or glucose 5% before administration in clinical areas.

Dosing information for the treatment of hypophosphataemia has been updated in the Electrolyte Disturbance Guidelines (Page 10) on Aireshare. 

Prescribing regimens on EPMA have also been accordingly updated.

 
   
Sodium glycerophosphate
View adult BNF View SPC online View childrens BNF  Track Changes
Restricted Drug Restricted
Red
  • Sodium glycerophosphate 21.6% (intravenous) - Use instead of phosphate polyfuser (intravenous) which is currently out of stock

 

Sodium glycerophosphate 21.6%, which is available as 20ml ampoules containing 20mmol phosphate will be the product of choice for IV phosphate replacement during the phosphate polyfuser shortage. It must be diluted in sodium chloride 0.9% or glucose 5% before administration in clinical areas.

Dosing information for the treatment of hypophosphataemia has been updated in the Electrolyte Disturbance Guidelines (Page 10) on Aireshare. 

Prescribing regimens on EPMA have also been accordingly updated.

 
   
Phosphate supplements (Phosphate-Sandoz®)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Green
  • Phosphate-Sandoz
 
   
Sodium Phosphate
View adult BNF View SPC online View childrens BNF  Track Changes
Restricted Drug Restricted
Red ULM
  • Sodium Phosphate 0.5mmol/mL

Reserved for SCBU only - hypophosphataemia in neonates.

 
Link  Unlicensed Medicines Consultant Request Form (ANHSFT access only)
Link  Unlicensed Medicines Patient Agreement for Use Form (ANHSFT access only)
Link  Unlicensed Medicines Patient Information Leaflet (ANHSFT access only)
Link  Unlicensed Medicines Policy (ANHSFT access only)
   
09.05.02.02  Phosphate-binding agents
09.05.03  Fluoride
09.05.04  Zinc to top
Zinc Sulphate (Solvazinc®)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Green
  • Zinc Sulphate
 
   
09.05.05  Selenium
09.06  Vitamins
09.06.01  Vitamin A
Vitamins A and D
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Green
  • Vitamins A & D Capsules

Restricted to patients with malabsorption syndromes.

 
   
Vitamins A, C and D
(Healthy start children’s vitamin drops)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Green
  • Vitamins A, C and D

Via Healthy Start Scheme or purchased over the counter.

 
Link  Healthy Start scheme
   
09.06.02  Vitamin B group
 note 

RMOC Position Statement: Oral vitamin B supplementation (January 2020)

Offer thiamine to people at high risk of developing, or with suspected, Wernicke’s encephalopathy.

Thiamine should be given in doses toward the upper end of the ‘British national formulary’ range.

It should be given orally or parenterally as follows:

• Offer prophylactic oral thiamine to harmful or dependent drinkers:

– if they are malnourished or at risk of malnourishment or

− if they have decompensated liver disease or

− if they are in acute withdrawal or

− before and during a planned medically assisted alcohol withdrawal.

• Offer prophylactic parenteral thiamine followed by oral thiamine to harmful or dependent drinkers:

− if they are malnourished or at risk of malnourishment or

− if they have decompensated liver disease

and in addition

− attend an emergency department or

− are admitted to hospital with an acute illness or injury.

• Offer parenteral thiamine to people with suspected Wernicke’s encephalopathy. Maintain a high level

of suspicion for the possibility of Wernicke’s encephalopathy, particularly if the person is intoxicated.

Parenteral thiamine should be given for a minimum of 5 days, unless Wernicke’s encephalopathy is

excluded. Oral thiamine should follow parenteral therapy.

 

Pyridoxine Hydrochloride
(Pyridoxine)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
  • Green Pyridoxine Oral Solution (100mg/5mL)
  • Green Pyridoxine Tablets (10mg, 50mg)
  • Red Pyridoxine Injection (100mg/2mL)  

 

 
   
Pyridoxal 5 Phosphate
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Red ULM

Following tertiary recommendation only

 
Link  Unlicensed Medicines Consultant Request Form (ANHSFT access only)
Link  Unlicensed Medicines Patient Agreement for Use Form (ANHSFT access only)
Link  Unlicensed Medicines Patient Information Leaflet (ANHSFT access only)
Link  Unlicensed Medicines Policy (ANHSFT access only)
   
Thiamine
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Green
  • Thiamine
 
   
Vitamins B and C (Pabrinex®)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Red
  • Vitamins B and C I/M High Potency Injection
  • Vitamins B and C I/V High Potency Injection
 
   
09.06.02  Oral vitamin B complex preparations to top
Vitamin B complex preparations (Vigranon B®)
View adult BNF View SPC online View childrens BNF  Track Changes
Restricted Drug Restricted
Red
  • Vitamin B

Liquid oral Vitamin B preparation restricted for patients with NG tubes at risk of refeeding syndrome.

(Compound vitamin B is required for NG fed patients they need to be crushed and do not fully dissolve so risk of blocking NG tubes)

 
   
Vitamin B Compound Strong
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Red
  • Vitamin B Compound Strong

NICE CG115/SIGN no longer recommend use of Vitamin B Compound Strong for the prophylaxis of Wernicke’s Encephalopathy or alcohol related peripheral neuropathies.

Vitamin B Compound Strong can be prescribed for patients at risk of refeeding syndrome but only for a 10 day course which will be supplied from the hospital. The discharge letter must be marked to indicate that this treatment should not continue beyond the 10 days. One pack of 28 tablets should be supplied.

 
Link  Alcohol-use disorders: diagnosis, assessment and management of harmful drinking and alcohol dependence (February 2011)
   
09.06.02  Other compounds
09.06.03  Vitamin C
Ascorbic Acid
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Green
  • Ascorbic Acid

To be purchased by the patient over the counter from pharmacies where possible.

 
   
09.06.04  Vitamin D
Colecalciferol (vitamin D3) capsules
View adult BNF View SPC online View childrens BNF  Track Changes
First Choice
Green
  • Colecalciferol 20,000units capsules - for vitamin D deficiency.

Colecalciferol preparations offering doses up to 1000units are available to buy over the counter. All patients should be encouraged to purchase this if appropriate.

 
Colecalciferol (vitamin D3)  (Various)
View adult BNF View SPC online View childrens BNF  Track Changes
Second Choice
Green
  • Colecalciferol

25,000units/1mL solution (InVita-D3) restricted to patients with swallowing difficulties.

Oral Drops (200units per 3 drops)

 
Link  AWC/Bradford CCGs Adults and Adolescents Vitamin D assessment and treatment overview (January 2020)
   
Colecalciferol
(Injections)
View adult BNF View SPC online View childrens BNF  Track Changes

Red ULM
  • Colecalciferol 300,000units/1mL Injections
 
Link  Unlicensed Medicines Consultant Request Form (ANHSFT access only)
Link  Unlicensed Medicines Patient Agreement for Use Form (ANHSFT access only)
Link  Unlicensed Medicines Patient Information Leaflet (ANHSFT access only)
Link  Unlicensed Medicines Policy (ANHSFT access only)
   
Calcium and Ergocalciferol (Tablets)
View adult BNF View SPC online View childrens BNF  Track Changes
Restricted Drug Restricted
Green
  • Calcium and Ergocalciferol (vitamin D2)

Reserved for existing patients only.

 
   
Alfacalcidol
View adult BNF View SPC online View childrens BNF  Track Changes
Restricted Drug Restricted
Green
  • Alfacalcidol (1α-hydroxycholecalciferol)

Restricted to patients with severe renal impairment, who require the hydroxylated derivatives of vitamin D.

 
   
Calcitriol
View adult BNF View SPC online View childrens BNF  Track Changes
Restricted Drug Restricted
Green
  • Calcitriol (1,25-dihydroxycholecalciferol)

Restricted to patients with severe renal impairment, who require the hydroxylated derivatives of vitamin D.

 
   
Ergocalciferol Injection
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Red
  • Ergocalciferol 300,000unit/1mL Injection
 
   
09.06.05  Vitamin E
Alpha Tocopheryl Acetate
(Vitamin E)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Green
  • Alpha Tocopheryl Acetate Suspension (500mg/5mL)

Restricted for patients with malabsorption syndromes only.

Vitamin E capsules (400units) to be purchased by the patients over the counter from pharmacies where possible.

 
   
09.06.06  Vitamin K to top
Menadiol Sodium Phosphate
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Green
  • Menadiol Sodium Phosphate

Vitamin K formulation of choice for obstetric cholestasis (Unlicensed indication) supported by Royal College of Obstetrics Guidance, see below.

 
Link  RCOG Guideline: Obstetric Cholestasis [April 2011]
Link  UKMI Q&A: What guidance is there available on the use of vitamin K for the management of obstetric cholestasis? (January 2017)
   
Phytomenadione
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
  • Green Phytomenadione Capsules (1mg)
  • Red Phytomenadione Injection (2mg/0.2mL) - Konakion MM Paediatric® 
  • Red Phytomenadione Injection (10mg/1mL)
  • unlicensed Unlicensed - Phytomenadione Chewable Tablets (10mg)

1mg may be given as a single intramuscular injection at birth. This prevents vitamin K deficiency bleeding in virtually all babies.

Vitamin K can be given orally for prevention of vitamin K deficiency in haemorrhagic disease of the newborn, where the injection is not appropriate. Two doses of 2mg should be given in the first week. For breast fed babies, a third dose of phytomenadione 2mg is given at one month of age: the third dose is omitted in formula fed babies because formula feeds contain vitamin K.

 

 
Link  Unlicensed Medicines Consultant Request Form (ANHSFT access only)
Link  Unlicensed Medicines Patient Agreement for Use Form (ANHSFT access only)
Link  Unlicensed Medicines Patient Information Leaflet (ANHSFT access only)
Link  Unlicensed Medicines Policy (ANHSFT access only)
   
09.06.07  Multivitamin preparations
Multivitamin preparations (Dalivit® and Abidec®)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Green
  • Dalivit Drops
  • Abidec Drops
 
   
09.06.07  Vitamin and mineral supplements and adjuncts to synthetic diets
Vitamin and mineral supplements (Forceval®)
View adult BNF View SPC online View childrens BNF  Track Changes
Restricted Drug Restricted
Green
  • Forceval Capsules
  • Forceval Soluble Tablets

For the prevention of re-feeding syndrome. Use to be restricted to patients at high risk of re-feeding syndrome for a treatment period of 10 days in-line with NICE guidance.

Forceval Soluble tablets are for patients at risk of re-feeding syndrome who are unable to swallow Forceval capsules.

Forceval capsules contain soya bean oil and should not be taken by patients with soya bean oil or peanut allergy.

 
   
Vitamin and mineral supplements (Ketovite®)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Green
  • Ketovite Liquid
  • Ketovite Tablets
 
   
Vitamin Tablets
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Green
  • Vitamin Tablets

Patients should purchase over the counter from pharmacies.

 
   
09.07  Bitters and tonics
09.08  Metabolic disorders
09.08.01  Drugs used in metabolic disorders to top
Sodium Dichloroacetate
View adult BNF View SPC online View childrens BNF  Track Changes
Restricted Drug Restricted
Green
  • Dichloroacetate Sodium

For metabolic disorders only usually in paediatric patients.

 
   
Carglumic Acid
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Red
  • Carglumic acid

In current use for treatment of inborn errors of metabolism.

 
   
09.08.01  Wilsons disease
09.08.01  Carnitine deficiency
Levo-Carnitine
View adult BNF View SPC online View childrens BNF  Track Changes
Restricted Drug Restricted
Red
  • Levo-Carnitine

 

 
   
09.08.01  Fabry's disease
09.08.01  Gaucher's disease
09.08.01  Mucopolysaccharidosis I to top
09.08.01  Pompe disease
09.08.01  Nephropathic cystinosis
Mercaptamine
View adult BNF View SPC online View childrens BNF  Track Changes
Restricted Drug Restricted
Red
  • Mercaptamine
 
   
09.08.01  Urea cycle disorders
Arginine
View adult BNF View SPC online View childrens BNF  Track Changes
Restricted Drug Restricted
Red
  • Arginine

 
   
Sodium Benzoate
View adult BNF View SPC online View childrens BNF  Track Changes
Restricted Drug Restricted
Red ULM
  • Sodium Benzoate

 
Link  Unlicensed Medicines Consultant Request Form (ANHSFT access only)
Link  Unlicensed Medicines Patient Agreement for Use Form (ANHSFT access only)
Link  Unlicensed Medicines Patient Information Leaflet (ANHSFT access only)
Link  Unlicensed Medicines Policy (ANHSFT access only)
   
Sodium Phenylbutyrate
View adult BNF View SPC online View childrens BNF  Track Changes
Restricted Drug Restricted
Red ULM
  • Sodium Phenylbutyrate
 
Link  Unlicensed Medicines Consultant Request Form (ANHSFT access only)
Link  Unlicensed Medicines Patient Agreement for Use Form (ANHSFT access only)
Link  Unlicensed Medicines Patient Information Leaflet (ANHSFT access only)
Link  Unlicensed Medicines Policy (ANHSFT access only)
   
09.08.02  Acute porphyrias
Haem Arginate (Normasang®)
(human hemin)
View adult BNF View SPC online View childrens BNF  Track Changes
Restricted Drug Restricted
Red
  • Haem Arginate

Only to be used following advice, authorisation and supply from the National Acute Porphyria Service (NAPS).

NAPS provides clinical advice and support as well as authorisation and provision of haem arginate treatment 24 hours a day, seven days per week. The out of hours service is provided in rotation from one of the three centres and can be contacted through the University Hospital of Wales switch board: 029 20747747

For further information, and to obtain supply, see the link to NAPS below.

 
Link  National Acute Porphyria Service website
Link  Urgent Haem Arginate Pharmacy Request Form
   
09.08.02  Drugs unsafe for use in acute porphyrias to top
 ....
Key
note Notes
Section Title Section Title (top level)
Section Title Section Title (sub level)
First Choice Item First Choice item
Non Formulary Item Non Formulary section
Restricted Drug
Restricted Drug
Unlicensed Drug
Unlicensed
Track Changes
Display tracking information
click to search medicines.org.uk
Link to adult BNF
click to search medicines.org.uk
Link to children's BNF
click to search medicines.org.uk
Link to SPCs
Cytotoxic Drug
Cytotoxic Drug
CD
Controlled Drug
High Cost Medicine
High Cost Medicine
Cancer Drugs Fund
Cancer Drugs Fund
NHSE
NHS England
Homecare
Homecare
CCG
CCG

Traffic Light Status Information

Status Description

Green

Green - Drugs suitable for generalised use in accordance with position summary. Inform primary care of need to prescribe using a TTO chart if in patient or Treatment Advice Note (TAN) if Outpatient.   

Amber

Amber - these drugs require specialist initiation or recommendation  

Amber SCG

Amber Share Care - Drugs suitable for generalist use, in accordance with position summary, normally following specialist initiation and stabilisation. Ongoing division of responsibility for drug and disease monitoring between specialist and GP by a Shared Care Guideline (SCG). If no SCG in place status reverts to red.  

Red

Red - Drugs for specialist use only, in accordance with position summary. GP’s should not be asked to prescribe these products.  

Red ULM

Red ULM - Unlicensed medicines for specialist use only, in accordance with position summary. GP’s should not be asked to prescribe these products.  

Grey

Grey drugs - No formal commissioning position. Check appropriate CCG /NHSE commissioning list or contact CCG/NHSE Medicines Management team for advice. Fill in individual funding request for appropriate CCG/NHSE. This will need to be signed by the Chief Pharmacist and a copy of the relevant DTC submission attached.   

Black

Black - Drugs not routinely commissioned so should not usually be prescribed  

netFormulary