• Abatacept 250mg injection is approved for:
  • Juvenile idiopathic arthritis in patients aged six years and above (licensed) and under six years. It should only be prescribed with informed consent.
  • People aged 6 years and older to treat polyarticular juvenile idiopathic arthritis (JIA) whose diease has responded inadequately to other DMARDs, including at least one tumour necrosis factor (TNF) inhibitor in accordance with NICE.
  • Rheumatoid arthritis after the failure of a TNF inhibitor in line with NICE.
  • Treatment in adults with severe rheumatoid arthritis not previously treated with DMARDs or after conventional DMARDs only have failed in accordance with NICE.
  • Treatment of severe treatment-resistant morphoea in line with NHS England Clinical Commissioning Policy
  • Treating modertae rheumatoid arthritis after conventional DMARDs have failed in line with NICE
  • Treating idiopathic inflammatory myopathies in adults and children aged 2 and over in line with NHS England Commissioning Policy
• Abatacept 125mg SC injection (prefilled syringe) is approved for moderate to severe rheumatoid arthritis in accordance with NICE.

• 50mg, 100mg and 150mg tablets


• Approved as an options for treating locally advanced or metastatic, hormone receptor-positive, human epidermal growth factor receptor 2 (HER2)-negative breast cancer as first endocrine-based therapy in adults in line with NICE


• Approved with fulvestrant for treating hormone receptor-positive, HER2 negative advanced breast cancer after endocrine therapy in line with NICE 

• Approved for castration-resistant metastatic prostate cancer in line with NICE.
• Approved for treating metastatic hormone-relapsed prostate cancer before chemotherapy is indicated in line with NICE and NHS England Commissioning Policy.

• COUNTY DURHAM  acamprosate, chlordioazepoxide, disulfiram & nalmefene prescribing should be retained within the commissioned service within County Durham.

• 1mg tablets

• second line carbonic anhydrase inhibitor for glaucoma

• T o be diluted to 2.5%
  - approved for the use in the detection of dysplasia/ neoplasia
  in Barrett’s oesophagus

• 600mg effervescent tablets.
•  Green for licensed indications.
•  For use on specialist advice in the treatment of idiopathic pulmonary fibrosis.
• For the prevention of x-ray contrast media induced renal damage .

• Tablets: 200mg, 400mg, 800mg
• Dispersible tablets: 200mg, 400mg, 800mg
• Oral suspension (sugar-free available): 200mg/5ml, 400mg/5ml

• 800mg Tablets
• For the treatment of ophthalmic zoster.

• Injection (for IV infusion): 250mg, 500mg

• 10mg and 25mg capsules 

• Aclidinium 340 microgram/dose & formoterol 12 microgram/dose (equivalent to aclidinium bromide 396 microgram/dose, formoterol fumarate dihydrate 11.8 microgram/dose) inhalation powder (DPI)

Conformable antimicrobial barrier dressing consisting of polyester core between low adherent silver-coated high density polyethylene mesh.

• Specialist initiation only

Knitted fabric of activated charcoal with one-way stretch, with silver residues, within spun-bound nylon sleeve

Polyurethane Foam Film Dressing without Adhesive Border

Non-woven, calcium sodium alginate dressing

Polyamide and Cellulose Contour Bandage, BP 1988

• Adalimumab is approved for:
• The treatment of adults with severe rheumatoid arthritis not previously treated with DMARDs or after conventional DMARDs only have failed in accordance with NICE 
• Rheumatoid arthritis after the failure of a TNF inhibitor in accordance with NICE.
• Treatment of severe active ankylosing spondylitis in adults whose disease has responded inadequately to, or who cannot tolerate, non-steroidal anti-inflammatory drugs in accordance with NICE.
• Psoriatic arthritis in accordance with NICE.
• As a second-line anti-TNF therapy in children with juvenile idiopathic arthritis and uveitis.
• Children and adults aged 2 years and older to treat polyarticular juvenile idiopathic arthritis (JIA) whose disease has responded inadequately to 1 or more DMARD in accordance with NICE.
• Treating moderate rheumatoid arhritis after conventional DMARDs have failed in line with NICE

• Approved for psoriasis in line with NICE.
• Approved for the treatment of moderate to severe hidradenitis suppurativa in line with NICE and NHS England Commissioning Policy
• Approved for the treatment of plaque psoriasis in children and young people in line with NICE 

Biosimilars are available – note that indications can differ between different products – prescribe by brand. Consult with individual trust pharmacy department for details of
preferred biosimilar brand.

• adapalene 0.1%/benzoyl peroxide 2.5% & adapelene 0.3%/benzoyl peroxide 2.5%

• 6mg in 2ml injection
• 25mg in 5ml injection unlicensed
• 30mg in 10ml injection for infusion - NHCT only
• 130mg in 130ml IV infusion unlicensed

• 1 in 1,000 injections in 1ml syringes and 1ml & 10ml ampoules.
• 1 in 10,000 injections in 1ml & 10ml ampoules & syringes.

• with & without masks
• See RightBreathe for options

• NETAG approved for the treatment of depression only following an adequate trial of at least three alternative antidepressant drugs at maximally tolerated doses (as described by NICE and as stated in the BNF).
• Prescribing and monitoring should be initiated by specialist mental health physicians. After a minimum of 12 weeks, prescribing may be transferred to primary care. 

• Alemtuzumab 30mg in 1ml concentrate for IV infusion is approved for use in, lymphocytic leukaemia & prevention of graft vs. host disease in bone marrow transplant patients, and high-risk kidney and pancreas transplantation.

• Alemtuzumab 12mg in 1.2ml concentrate for IV infusion is approved for treating adults with active relapsing– remitting multiple sclerosis in line with NICE and NHS England commissioning policy. 

• 250 nanogram & 1 microgram capsules
• 2 microgram/ml sugar-free oral drops – one drop containing approx. 100 nanograms of alfacalcidol 
• 1 microgram in 0.5ml & 2 micrograms in 1ml injections

• 500micrograms in 1ml [ST&S], 1mg in 2ml, 5mg in 10ml & 5mg in 1ml injection ampouless - approved for initiation by specialists in palliative care

• 30mg/5ml syrup.
  
  • see section 03.04.01 for other formulations.

• Approved for adults with severe chronic hand eczema that have not responded to potent topical corticosteroids in line with NICE.

Polyurethane Foam Film Dressing with Adhesive Border

Silicone gel wound contact dressing, with polyurethane foam film backing

Soft silicone wound contact dressing, with central mesh screen, polyurethane foam film backing and adhesive border

• An allopurinol 100mg in 5ml suspension (unlicensed) is also approved for use. 

• 50mg, 150mg and 200mg tablets
• Approved with fulvestrant for treating hormone receptor-positive, HER2-negative, PIK3CA-mutated, locally advanced or metastatic breast cancer in adults in line with NICE

• 500mg in 5ml suspension
• 134mg (200 unit) capsules

• Vitaros® 3mg/g cream
• Muse® 500microgram, and 1mg.

Treatment with alprostadil cream (Vitaros®) is NOT approved for use in County Durham and Tees Valley

• 10mg, 20mg, and 50mg injections.
• Also approved for stoke in accordance with NICE guidance. 
• 2mg in 2ml injection - approved for unblocking intravenous lines, mainly in paediatric dialysis patients.

• Aluminium chloride hexahydrate 20% solution in an alcoholic basis

• Approved for pulmonary hypertension - in accordance with NHS England Commissioning policy. 

• 250mg/10ml injection
• COPD: intravenous aminophylline of limited benefit.
• Injection used in hospital for acute asthma not responding to steroids and continuous inhaled bronchodilators.
• Plasma levels need to be checked before administration if patient has previously taken theophylline/ aminophylline.

• Preferred calcium channel blocker for treating hypertension.
  
  • If a 10mg dose is not tolerated e.g. due to leg/ankle
    oedema, consider reducing dose before changing to an
    alternative such as lercanidipine.
  
  

• 50mg injection (Fungizone®)
• 50mg liposomal injection (Ambisome®)

• Approved for:
  • Juvenile Idiopathic Arthritis (JIA) in line with NICE and NHS England Clinical Commissioning Policy: E03/P/d
  • Periodic Fevers and Autoinflammatory conditions in line with NHS England Clinical Commissioning Policy: 170062P
  • Adult‑onset Still’s disease and systemic juvenile idiopathic arthritis in people 8 months and older in line with NICE
  • Cryopyrin Associated Periodic Syndrome in line with NHSE Service Specification. 
  • The treatment of severe gout in patients who have not responded to other treatment and for patients with pseudogout who have failed to respond to conventional treatment or unable to tolerate conventional treatment.
  • Chronic Infantile Neurocutaneous Arthritis (CINCA) and Muckle-Wells Syndrome (unlicensed indications).
  • Islet cell transplantation as part of a protocol including alemtuzumab and etanercept to improve outcomes (i.e. insulin dependance)
  • Haemophagocytic Lymphohistiocytosis (HLH) for adults and children in all ages

• 200mg powder for solution for infusion

• Approved for reversing anticoagulation from apixaban and rivaroxaban in adults with life-threatening or uncontrolled bleeding in line with NICE

• Specialist use only

• Used to relieve symptoms in patients who have had radiotherapy and may be of value in some patients with acute oesophagitis. Not for routine use as an antacid.

•  ACBS

• Approved for the prevention of RhoD sensitisation in
  women in line NICE.
• Approved for use by haematologists in appropriate patients with immune thrombo-cytopenia. The 1,500 and 5,000 unit vials (WinRho) are much more expensive than the other formulations and should only be used on advice from haematologists. It is the only formulation licensed for use in immune thrombocytopaenia.

• NETAG approved for aplastic anaemia in adults (unlicensed).

• Cream and Suppositories
•  Self Care Medicine: Advise that a prescription for treatment of haemorrhoids should not routinely be offered in primary care as the condition is self-limiting and will clear up on its own without the need for treatment.

• 60mg tablets
• Approved for treating hormone‑relapsed non‑metastatic prostate cancer that is at high risk of metastasising in adults in line with NICE
• Approved for treating hormone-sensitive metastatic prostate cancer in adults in line with NICE, only if:
  
  • docetaxel is not suitable

• 5mg/1ml (20ml) solution for infusion for infusion pumps & 10mg/1ml (3ml) solution for injection cartridges (Dacepton®) - NEW PATIENTS
• 30mg/3ml solution for injection (APO-go®) - Patients commenced on treatment prior to July 2022 can continue on APO-go® (including 50mg/10ml solution for infusion pre-filled syringes for infusion pumps)
• Apomorphine 10mg lozenges are also approved (RVI) Unlicensed

• 0.5% and 1% ophthalmic solution.

• 10mg, 20mg & 30mg tablets
• To be used in accordance with NICE guidance

• For limited use in cardiothoracic surgery.

Soft non-woven pad containing hydrocolloid-fibres with foam layer, without adhesive border

• Not to be prescribed on FP10

• Due to the SLS content to be used as a soap substitute only.

• For use on advice of haematologists in patients with heparin induced thrombocytopenia.

•  CNTW
•  TEWV
• NTAG approved for the treatment of schizophrenia as per its licensed indication and as outlined in the Guidance on the Use of Antipsychotic Long-acting Injections in the North of England.

• Approved for severe malaria in in line WHO guidance.

• Use cheapest
• Available products include
  • AS Saliva Orthana®
  • Biotene Oralbalance® gel
  • BioXtra® Glandosane® spray
  • Malic acid Salivix®
  • Oralieve® Moisturising Spray & Gel 
• Patients should be advised of self-care measures and signposted to purchase over the counter remedies where appropriate.

• 20mg and 40mg tablets
• Approved as an option for treating chronic-phase Philadelphia chromosome-positive chronic myeloid leukaemia without a T315I mutation after 2 or more tyrosine kinase inhibitors in adults, in line with NICE

• Specialist use only

• Dispersible tablets: 75mg

• Approved as an option for treating Duchenne muscular dystrophy resulting from a nonsense mutation in the dystrophin gene in people 2 years and over who can walk - in line with NICE HST22.

To be used in accordance with NHS England Clinical Commissioning Policy (SSC1614).

• 840mg/14ml & 1200mg/20m concentrate for solution for infusion (IV)
• 1875mg/15ml solution for injection (S/C)
• Approved for treating locally advanced or metastatic non-small-cell lung cancer (NSCLC) in adults who have had chemotherapy (and targeted treatment if they have an EGFR- or ALK‑positive tumour).  
• Approved in combination with bevacizumab for treating advanced or unresectable hepatocellular carcinoma (HCC) in adults who have not had previous systemic treatment in line with NICE
• Approved for the treatment of advanced non-small-cell lung cancer in line with NICE
• Approved for untreated PD-L1-positive locally advanced or metastatic urothelial cancer in adults when cisplatin-containing chemotherapy is unsuitable in line with NICE
• Approved for for adjuvant treatment of resected non-small-cell lung cancer in adults in line with NICE
• Approved with carboplatin and etoposide is recommended as an option for untreated extensive-stage small-cell lung cancer in adults in line with NICE
• Approved with nab‑paclitaxel for triple-negative, unresectable, PD‑L1‑positive, locally advanced or metastatic breast cancer in adults who have not had chemotherapy for metastatic disease in line with NICE
• Approved for untreated PD-L1-positive locally advanced or metastatic urothelial cancer in adults when cisplatin-containing chemotherapy is unsuitable in line with NICE

• 10mg, 18mg, 25mg, 40mg, 60mg, 80mg & 100mg capsules
• 4mg/1ml oral solution - approved for patients with more complex needs e.g. younger patients and those with swallowing difficulties.

• 10mg and 20mg chewable tablets
• Note: atorvastatin 10mg and 20mg chewable tablets should be used instead of simvastatin suspension where solid dosage forms cannot be used. 

• Approved for use in patients intolerant of co-trimoxazole

Commissioning: NHS England 

Overview | Autologous chondrocyte implantation using chondrosphere for treating symptomatic articular cartilage defects of the knee | Guidance | NICE

• 100mg powder for concentrate for solution for infusion
• Approved for treating Pompe disease in line with NICE

• 25microgram/phentolamine 2mg solution for injection. 
• Approved as first choice intracavernosal injection option.

• Approved as treatment for adults with advanced renal cell carcinoma when tyrosine kinase inhibitors or cytokines have not worked in line with NICE.

For transplant indications

• 15% (Finacea®) and 20% (Skinoren®) gel 

• 500mg powder vial for infusion

• Restricted for use on microbiology/infectious diseases advice, or as agreed in Trust Guidelines.

• The following baclofen intrachecal injections (unlicensed) are also approved; 36mg in 12ml, and 72mg in 12ml intrathecal injections.

• Sterile solution containing sodium chloride 0.64%, sodium acetate 0.39%, sodium citrate 0.17%, calcium chloride 0.048%, magnesium chloride 0.03%, potassium chloride 0.075% in 15ml bottles and 500ml bags.
• For intra-ocular or topical irrigation during surgical procedures.

Alternatives

• Approved for treating moderate to severe atopic dermatitis in adults in line with NICE.

• Approved for limited use in adult renal transplant patients with high risk of acute organ rejection.
• Approved for severe graft versus host disease post haematopoietic stem cell transplantation.
• Approved for induction therapy in renal transplantation in children and adolescents in with combinations that include ciclosporin in line with NICE.

(BCG Vaccine, Dried/Tub/BCG) 1ml multidose vials containing freeze dried powder for preparing intradermal injections

• Beclomethasone dipropionate 100 microgram/dose & formoterol 6 microgram/dose pressurised metered dose inhaler (pMDI)
• Beclomethasone dipropionate 200 microgram/dose & formoterol 6 microgram/dose pressurised metered dose inhaler (pMDI)

• Beclomethasone dipropionate 100 microgram/dose & formoterol 6 microgram/dose pressurised metered dose inhaler (pMDI)
  
  • Additional treatment option
  
  
  

• Beclomethasone 88 microgram/dose, formoterol 5 microgram/dose & glycopyrronium 9 microgram/dose dry powder inhaler (DPI)

• For use in adults and children by adult and paediatric immunologists only. Only approved for use in accordance with NICE guidance. 

• Approved for treating active autoantibody-positive systemic lupus erythematosus in line with NICE

• Bempedoic acid 180mg & ezetimibe 10mg tablets
• Approved for the treatment of primary hypercholesterolaemia (heterozygous familial and non-familial) or mixed dyslipidaemia in adults in line with NICE and following the statin intensification pathway outlined in NEELI

• Current patients should continue on bendroflumethiazide
• Bendroflumethiazide 5mg tablets are available but not recommended for general use.

• 30mg/1ml solution for injection (pre-filled devices)
• Approved for treating severe eosinophilic asthma in adults in line with NICE and NHS England Commissioning Policy.

• 25mg/ml suspension for intratracheal administration

• 150mg capsule


• Approved for preventing recurrent attacks of hereditary angioedema in people 12 years and older in line with NICE

• Soluble tablets 500 micrograms
• Used as mouth gargle

• Ointment

• Cream, ointment & scalp application

• Alternative choice compound antibacterial/corticosteroid ear drop.

Silicone gel wound contact dressing, with polyurethane foam film backing

Initiate with specialist advice.

• For use as a second/third-line agent in patients insufficiently responsive
  to monotherapy with a prostaglandin analogue or beta blocker

• 160mg/ml solution pre-filled pen/syringe
• Approved for the treatment of moderate to severe plaque psoriasis in line with NICE

• Approved formulations of Humalog® Mix 25 and Mix 50 include:
  • 5x3ml cartridges
  • 5x3ml Kwikpen®

• 5mg & 10mg tablets.
• 1.25mg, 2.5mg, 3.75mg & 7.5mg tablets - for use in the treatment of heart failure only. The 5mg and 10mg tablets should be used where possible - cheaper than other strengths.

• Also approved for use in intralesional sclerotherapy in the treatment of low-flow vascular lesions. unlicensed indication

• For limited use in some operating theatres only.

• Approved for pulmonary hypertension - in accordance with NHS England Commissioning policy.
• Approved for systemic sclerosis with ongoing digital ulcer disease (to reduce number of new digital ulcers) - in accordance with NHS England Commissioning policy.

• Approved for use in the repair of complex hernia

• Only approved for use in accordance with NICE guidance. 

• Restricted to use in private patients receiving aesthetic treatment.
• Prescribe by brand name.

• 100 unit vials for injection (Botox) – see section 4.9.3

• Prescribe by brand name

• 50mg powder for concentrate for solution for infusion
• Approved for the treatment of relapsed or refractory systemic anaplastic large cell lymphoma in line with NICE and NHS England Commissioning Policy.
• Approved for the treatment of CD30-positive Hodgkin lymphoma in patients:
  • if they have already had autologous stem cell transplant
  • if they have already had at least 2 previous therapies when autologous stem cell transplant or multi-agent chemotherapy are not suitable. 
• Approved for the treatment of CD30-positive cutaneous T-cell lymphoma in line with NICE
• Approved in combination with cyclophosphamide, doxorubicin and prednisone for untreated systmic anaplastic large cell lymphoma in adults in line with NICE

• Approved for treating anaplastic lymphoma kinase (ALK)-positive advanced non-small-cell lung cancer (NSCLC) in adults who have already had crizotinib in line with NICE.
• Approved for treating ALK-positive advanced non-small-cell lung cancer that has not been previously treated with an ALK inhibitor in line with NICE

• Approved for use as adjunctive therapy in patients with severe/intractable partial onset seizures e.g. a sezuire frequency of 1 per week following failure of first-line adjunctive therapy. Response must be assessed within 3-6 months before transferring prescribing to primary or stopping treatment, as appropriate.

• 19.8mg/0.165mL solution for injection (pre-filled syringes)
  • Approved for treating wet age-related macular degeneration in adults in line with NICE

• 2mg foam enema


• Equal first choice with hydrocortisone foam enema  

• Budesonide 160 microgram/dose & formoterol 4.5 microgram/dose (equivalent to budesonide 200 microgram/dose & formoterol fumarate dihydrate 6 microgram/dose) dry powder inhaler (DPI)
• Budesonide 320 microgram/dose & formoterol 9 microgram/dose (equivalent to budesonide 400 microgram/dose & formoterol fumarate dihydrate 12 microgram/dose) dry powder inhaler (DPI)

• Budesonide 80 microgram/dose & formoterol 4.5 microgram/dose (equivalent to budesonide 100 microgram/dose & formoterol fumarate dihydrate 6 microgram/dose) dry powder inhaler - Easyhaler (DPI)
• Budesonide 160 microgram/dose & formoterol 4.5 microgram/dose (equivalent to budesonide 200 microgram/dose & formoterol fumarate dihydrate 6 microgram/dose) dry powder inhaler - Easyhaler (DPI) 
• Budesonide 320 microgram/dose & formoterol 9 microgram/dose (equivalent to budesonide 400 microgram/dose & formoterol fumarate dihydrate 12 microgram/dose) dry powder inhaler - Easyhaler (DPI)

• 2mg powder for solution for injection
• Approved as an option for treating chronic hepatitis D in adults with compensated liver disease in line with NICE and NHSE Specialised Commissioning Policy only if:
  • there is evidence of significant fibrosis (METAVIR stage F2 or above or Ishak stage 3 or above) and
  • their hepatitis has not responded to peginterferon alfa‑2a (PEG‑IFN) or they cannot have interferon-based therapy
• Only available from:
  • The Newcastle Upon Tyne Hospitals NHS Foundation trust

• 0.25% & 0.5% injection 10ml
• 0.25% & 0.5% + adrenaline 1 in 200,000 inj. 10ml
• 0.5% in glucose 8% injection (Marcain Heavy)
• 0.1% & 0.125% unlicensed in sodium chloride 0.9% infusions

• 8mg/0.16ml 16mg/0.32ml, 24mg/0.48ml, 32mg/0.64ml, 64mg/0.18ml, 96mg/0.27ml, 128mg/0.36ml 160mg/0.45ml prolonged-release solution for injection (pre-filled syringes).
  
  • Approved for the treatment of opioid dependance  in adults and adolescents aged 16 years and over, by substance misuse service providers, in line with NTAG and RMOC guidance.
  
  
  

• 10mg, 20mg & 30mg solution for injection


• Approved for treating X-linked hypophosphataemia in children and young people in accordance with NICE

• 150 micrograms per spray; 268 dose spray

• Approvded for the treatment and pre-procedure prevention of angioedema attacks in patients with hereditary angioedema (HAE).


• Approvded for the routine prevention of angioedema attacks in adults and adolescents years old with severe and recurrent attacks of HAE.

• 30mg tablet


• 600mg/3ml prolonged-release suspension for injection


• Approved in combination with rilpivirine (Rekambys) for treating HIV-1 in adults in line with NICE

• 50mg in 5ml injection (equivalent to 25mg caffeine base in 5ml).
• 50mg in 5ml oral solution.

• 400 units in 2ml injection

Capsules: 0.25 micrograms, 0.5 micrograms

• Phosex® 1g tablets (containing 250mg, 6.2mmol of calcium) 
• Renacet® 475mg (containing 120.25mg, 3mmol of calcium) &
  950mg tablets (containing 240.5mg, 6mmol of calcium)

• 1.25g chewable tablets (500mg, 12.6 mmol calcium).
• 2.5g chewable tablets (1g, 25 mmol calcium).
• 500mg in 5ml suspension unlicensed.

• Accrete®
  • Film coated tablet containing calcium carbonate 1.5g and colecalciferol 10 micrograms (400 units)
• Adcal D3®
  • Chewable tablet containing calcium carbonate 1.5g and colecalciferol 400 units (contains soya and sucrose)
  • Effervescent tablet containing calcium carbonate 1.5g and colecalciferol 400 units
• Cacit D3®
  • Effervescent granule sachet containing calcium carbonate 1.25g and colecalciferol 440 units
• Calcichew D3 Forte®
  • Chewable table containing calcium carbonate 1.25g and colecalciferol 400 units
• Evacal®
  • Chewable tablet containing calcium carbonate 1.5g and colecalciferol 400 units
    • approved as chewable option and also to be used in patients with peanut and soya allergy 

• Approved for methotrexate-induced mucositis and myelosuppression. The following formulations are approved:
  
  • 15mg tablets.
  • 3mg, 15mg, 30mg, and 300mg injections
  • A calcium folinate 1mg per ml mouthwash can be prepared if needed.unlicensed
  
  

• Injection: 10%, equivalent to calcium 2.25 mmol/10 mL

• Powder (Calcium polystyrene sulphonate)

• Only approved for use in accordance with NICE guidance. 

• 50mg powder for concentrate for solution for injection/infusion
  
  • Approved for bridging therapy in patients who have recently had a coronary stent but require urgent elective surgery
  
  
  

• 100mg/1mL oral solution
  • Approved for use in combination with clobazam for treating seizuires associated with Dravet syndrome in people aged 2 years and older
  • Approved for use in combination with clobazam for treating seizures associated with Lennox-Gastaut syndrome
  • Approved as an add-on treatment option for seizures caused by tuberous sclerosis complex in people aged 2 years and over - in line with NICE TA873.

• For limited use in patients having chemo-radiotherapy or radiotherapy to malignancies of the oral cavity, hypopharynx and oro-pharynx.
• Trusts encouraged to prescribe enough between chemotherapy and radiotherapy appointments in secondary care in anticipation of mucositis developing.

• 1g injection

• Infectious diseases, microbiology or respiratory advice only Only in patients with MDR-TB intolerant of other medication

• 0.025% cream
  
  • approved for use as an adjunct to core treatment for knee and hand osteoarthritis as per NICE
  
  
  

• Carbamazepine 200mg and 400mg MR tablets (Tegretol® retard) are available on consultant request for those in whom conventional carbamazepine has been shown to be unsuitable 

• 375mg capsules.
• 750mg/10ml oral solution in sachets: first choice liquid preparation for adult patients.
• 250mg in 5ml syrup.

• Approved for use in previously treated multiple myeloma in line with NICE and NHSE Commissioning Policy
• Approved in combination with dexamethasone and lenalidomide for previously treated multiple myeloma in line with NICE

• 0.5% and 1% eye drops.

• 30% oral solution
• 1g in 5ml injection

• Chlorhexidine 0.02% (1 in 5,000) solution in 100ml sachets.

• Solution G 2 x 30ml sachets (citric acid 3.23%, magnesium oxide 0.38%,
  sodium bicarbonate 0.7%, disodium edetate 0.01%)

• 1g powder for concentrate for solution for infusion
  
  
  
  • approved for the treatment of infections with gram negative aerobic bacteria in patients with limited treatment options. Only to be used on the advice of mricbiology and ID physicians
  
  
  
  

• Restricted for use on microbiology/infectious diseases advice, or as agreed in Trust Guidelines.

• 2.5g injection
• Approved for use only on the advice of Microbiology/Infectious Diseases for the treatment of infections with carbapenemase-producing organisms for which treatment options are very limited, toxic and not particularly effective.

• Approved for the treatment of hospital acquired pneumonia and other infections on the advice of microbiology/infectious disease physicans.

• Restricted for use on microbiology/infectious diseases advice, or as agreed in Trust Guidelines. 
• Approved for use in primary care (i.e. care homes) to treat patients with conditions such as UTIs and pneumonia, at risk of sepsis in line with local guidance and microbiology input 

• For specialist use in the treatment of patients who cannot tolerate other beta-blockers. Treatment should only be intiated on the advice of a cardiologist. 

• 12.5mg, 25mg, 50mg, 100mg, 150mg and 200mg tablets


• Approved for treating focal onset seizure in epilepsy in line with NICE
  
  
  
  • Patients will be stabilised by the epilepsy specialist prior to transfer to the GP for continuation. This will usually be after 3 months of treatment.
  
  
  
  

• Approved for:
  
  • Adults with severe rheumatoid arthritis not previously treated with DMARDs or after conventional DMARDs only have failed in accordance with NICE.
  • Rheumatoid arthritis after inadequate response to a TNF-alpha inhibitor in accordance with NICE.
  • Severe active ankylosing spondylitis in adults whose disease has responded inadequately to, or who cannot tolerate, non-steroidal anti-inflammatory drugs in accordance with NICE.
  • Psoriatic arthritis in accordance with NICE.
  
  

• 250mg capsules
• Approved for the treatment of inborn errors of bile acid synthesis (all ages) in line with NHS England Commissioning Policy
• Approved for the treatment of Cerebrotendinous Xanthomatosis in line with NHS Commissioning Policy. NHS England will commission this drug for patients who are currently being treated (April 2017)

• Restricted for use on microbiology/infectious diseases advice, or as agreed in Trust Guidelines.

• Preservative-free eye drops are also approved for use:
  
  • 0.5% preservative-free Minims® - first choice.
  • 0.5% preservative-free eye drops unlicensed - approved only for patients who are unable to use Minims®due to dexterity problems
  
  

160 micrograms/g gel

Approved for use in accordance with the following NICE TAs or if the indication is funded from the Cancer Drugs Fund:

• Overview | Chlormethine gel for treating mycosis fungoides-type cutaneous T-cell lymphoma | Guidance | NICE

Commissioner: NHS England

Only to be used in line with a current chemotherapy protocol from the North of England Cancer Alliance in line with the appropriate Network Site Specific Group’s clinical guidelines or chemotherapy algorithm.

• 50mg/5ml ampoules & 400mg/20ml vials.
  
  
  
  • Approved for spinal nerve and peripheral blocks. To be reviewed in April 2022.
  
  
  
  

• Treatment should only be on advice from paediatric cardiology or nephrology specialists

•   Fertility treatment 


•   Hypogonadism 

• See section 8.2.2

• Ikervis® - Approved for the treatment of dry eye disease in adults that has not improved despite treatment with artificial tears in line with NICE
• Verkazia® - Approved for the treatment of severe vernal keratoconjunctivitis in children from 4 years of age and adolescents

Eye drops: 0.3%
Eye ointment (preservative-free): 0.3%

•  2mg/ml (0.2%) ear drops (0.25ml unit dose)

• 250mg, 500mg & 750mg tablets
• 250mg in 5ml suspension

• 10mg in 10ml solution for preparing infusions; 2mg in 1ml subcutaneous injection 
• Approved for Hairy cell leukaemia only.

• 10mg tablets
• Approved for treating highly active multiple sclerosis in adults in line with NICE

• Tablets: 250mg, 500mg
• Oral suspension: 125/5ml, 250mg/5ml

• 1% topical solution (alcohol – water basis)
• 1% lotion (aqueous)

• Injection: 300mg/2ml, 600mg/4ml

• Cream, ointment & scalp application

• Cream, ointment & scalp application

• Alcohol withdrawal - chlordiazepoxide is preferred in the management of alcohol withdrawal.

• Tablets: 50mg

• Clonazepam 500microgram in 5ml sugar-free oral solution is also approved unlicensed

• Clonidine is not generally recommended for migraine prophylaxis; may aggravate depression/cause insomnia.

• For use in paediatric cardiac ITU and in adult ITU patients with delerium and agitation, often around extubation unlicensed.

• Approved for use in cardiac patients being fitted with stents/acute coronary syndromes and where aspirin is contraindicated/not tolerated, despite its use in combination with acid suppressants e.g. omeprazole.
• Approved ischaemic stroke; in peripheral arterial/multivascular disease; or after MI only if aspirin not suitable in line with NICE.
• The North of Tyne APC recommends the use of generic 75mg clopidogrel tablets in all the approved indications for clopidogrel.
• Care should be taken to ensure that the brand supplied is suitable if it is to be packed into monitored dosage systems.

• 1% unlicensed
• 2% unlicensed
• 5% unlicensed

• Injection: 500/100 (600mg), 1000/200 (1.2g)

• Used in lymphoedema
• Specialist use 

• Specialist use only

unlicensed P/F eye drops: 4%

• Co-cyprindiol should be reserved for those women requiring treatment for the androgenic conditions such as severe acne or moderately severe hirsutism. It is recommended that treatment be withdrawn 3 to 4 cycles after the androgenic condition(s) has/have completely resolved and that it is not continued solely to provide oral contraception. Venous thromboembolism occurs more frequently in women taking co-cyprindiol than those taking a low-dose combined oral contraceptive. Repeat courses may be given if the androgen-dependent condition(s) recur.
• Note: generic co-cyprindiol is much cheaper than Dianette®

• Tablets containing cyproterone acetate 2mg & ethinylestradiol 35 micrograms.
• Note: generic co-cyprindiol is much cheaper than Dianette®

• Note: Co-danthramer and Co-danthrusate are generally restricted to use in the treatment of constipation in terminally ill patients. A combination of Senna and Docusate is normally preferred.

• 20 microgram (800 units) capsules or tablets
  
  • For first line use in the long term maintenance treatment of patients with documented vitamin D deficiency following high strength therapy and also for use in patients with symptoms and insufficient levels. 
• 80 microgram (3,200 units) capsules
  
  • For use in patients with malabsorption such as patients who have had bariatric surgery and require higher maintenance doses 
• 500 microgram (20,000 units) capsules.
  • For use in patients requiring high strength therapy for vitamin D deficiency. 
• 2740iu/ml oral solution (Fultium®-D3 Drops) 
• 1000iu and 3000iu buccal spray (DLux®) unlicensed 
  
  • Approved for use in paediatric parenteral nutrition patients with short bowel syndrome and adults with metabolic bone disease who have vitamin D deficiency despite previous treatment.

• Approved for second line use (after Colestyramine) for the treatment of bile malabsorption that results in diarrhoea.

• Also approved for the treatment for leflunomide toxicity 

• 1 million-unit & 2 million-unit vial for nebulisation/intravenous injection
  
  • Nebulised therapy for bronchiectasis 
  • Nebulised therapy for patients on assisted ventilation, patients with tracheostomies and those with persistant bacterial bronchitis 
  • To be used for treatment of Cystic Fibrosis in accordance with NHS England Commissioning Policy/NICE Guidance.
  • Nebulised therapy for CF .
  • Intravenous therapy .
  • Dry powder for inhalation (Colobreath®) .
    
    

• Mucogel is first choice in the community due to cost.   

• Pack of 16 x 1mg estradiol tablets + 12 x 1mg estradiol and 1mg norethisterone tablets

• Evra® are self-adhesive patches releasing approximately 20 micrograms ethinylestradiol and 150 micrograms norelgestromin/24 hours.
  
  
  
  • Approved for use by a small number of women with gastrointestinal absorption problems or with compliance issues.
  
  
  
  

First Choice

• Rigevidon® (ethinylestradiol 30 microgram/levonorgestrel 150microgram)

Alternatives

• Cilique® (ethinylestradiol 35 microgram/norgestimate 250microgram)
• Femodene® (ethinylestradiol 30 microgram/gestodene 75 microgram)
• Femodene® ED (ethinylestradiol 30 microgram/gestodene 75 microgram)
• Gedarel 30/150® (ethinylestradiol 30 microgram/desogestrel 150 microgram)
• Levest® (ethinylestradiol 35 microgram/norgestimate 250microgram)
• Lizinna® (ethinylestradiol 35 microgram/norgestimate 250 microgram)
• Loestrin 30® (ethinylestradiol 30 microgram/ norethisterone 1.5mg)
• Lucette® (ethinylestradiol 30 microgram/drospirenone 3mg)
• Marvelon® (ethinylestradiol 30 microgram/desogestrel 150 microgram)
• Microgynon® 30 (ethinylestradiol 30 microgram/levonorgestrel 150 microgram)
• Microgynon® ED (ethinylestradiol 30 microgram/levonorgestrel 150 microgram)
• Millinette 30/75® (ethinylestradiol 30 microgram/ gestodene 75 microgram)
• Ovranette® (ethinylestradiol 30 microgram/levonorgestrel 150microgram)
• Ovysmen® (ethinylestradiol 35 microgram/norethisterone 500 microgram

Absorbent Perforated Dressing with Adhesive Border

• 480mg in 5ml ampoules for IV infusion

• 480mg tablets, 960mg tablets
• 240mg in 5ml & 480mg in 5ml suspensions.

• Comirnaty^® Original / Omicron BA.4-5
• Comirnaty^® 10 Concentrate for children
• Comirnaty^® 3 (THREE) Concentrate
• VidPrevtyn Beta^®
• Spikevax^® Original/Omicron BA.4-5

• Approved in accordance with NICE and NHS England Commissioning Policy.

• For limited use in some operating theatres/critical care areas only.

• 0.5% and 1%.

• 250mg capsules Infectious diseases
• microbiology or respiratory advice only

• Approved for use on the advice of a urologist.

• Only approved for use in accordance with NICE guidance. 

• 150mg subcutaneous injection
  • Approved for the treatment of highly active relapsing-remitting mutiple sclerosis that has failed to respond to other treatment in adults in line with NICE and NHS England Commissioning Policy. 
  • Subject to restricted use by EMA

• Drops containing in each 0.6ml dose ascorbic acid 50mg, ergocalciferol
  400 units, nicotinamide 5mg, pyridoxine HCl 500 micrograms, riboflavin
  400 micrograms, thiamine 1mg & vitamin A 5,000 units)
  
  • Dalivit drops are to be retained for use in patients requiring a full supplement of vitamin A.
  
  

• For use on the advice of an immunologist in the prophylaxis, treatment hereditary angioedema associated with C1-esterase inhibitor deficiency.
   

• 5mg and 10mg tablets
  
  • Approved for treating type 2 diabetes in adults   
  • Approved for the treatment of chronic kidney disease in adults in line with NICE and NTAG 

• 10, 15, 20, 30, 40, 50, 60, 80, 100, 150 & 300 microgram injections in prefilled syringes 


• 20, 40, 60, 80, 100 & 300 microgram Sureclick® pens - approved for management of cancer treatment-induced anaemia in women receiving platinum-based chemotherapy for ovarian cancer 

• Monitoring: monitoring of erythropeoetin (darbepoetin) in adult patients can be undertaken by GPs under a shared care arrangement 

• MR Tablets - 7.5mg, 15mg

• Approved for use in accordance with NICE and NHS EnglandCommissioning Policy

• Daunorubicin 44mg/cytarabine 100mg powder for solution for infusion


• Approved for untreated acute myeloid leukaemia in line with NICE

Polyester fibres with bound edges and knitted outer surface coated with polyacrylate

• Specialist initiation only

• Approved to arterialise earlobe capillary blood to facilitate capillary blood testing

• Approved formulations include 80mg and 120mg vials (with diluent).
• Approved for the first line treatment of advanced hormone dependant prostate cancer with a PSA > 20ng/l at presentation 
  
  • -approved as an option for treating advanced hormone-dependent prostate cancer in people with spinal metastases in line with NICE.
  
  

• Approved for adult patients requiring multivitamin and mineral supplementation with Cystic Fibrosis

• Approved for use at Newcastle in paediatric and adult congenital cardiac surgery.

• To be used in accordance with NHS England Commissioning Policy 

• Denosumab 70mg in 1ml (120mg) vial is approved for the prevention of skeletal-related events in adults with bone metastases from solid tumours in line with NICE 
  • Note: denosumab is not approved for therapy induced bone loss in non- metastatic prostate cancer (NICE).
    
    
    
• North Cumbria only
  • New patients        
  • Exisiting patients  

Silicone gel

• Burns Team and scar clinic initiation only

• Approved for the treatment of iron overload for trasnfused and non-tranfused patients with chronic inherited anaemias (all ages) in line with NHSE Specialised Commissioning Policy

• The following desmopressin  formualtions are approved for use:
  
  • 10 microgram/dose nasal spray.
  •  2.5 & 150 microgram/dose nasal sprays (unlicensed).
  • 100 microgram & 200 microgram tablets.
  • 120 microgram sublingual tablets.
  •  4 microgram in 1ml injection and 15 microgram in 1ml injection

• Oral lyophilisates: 25microgram, 50 microgram

• 500microgram & 2mg tablets
• 500microgram soluble tablets
• 2mg in 5ml oral solution and 5mg in 5ml oral solution  is also approved. unlicensed
• 20mg/5ml oral solution 
• Approved for use in patients requiring high dose to reduce pill burden

First choice

Unit dose vials (Minims®)

Alternative

Eye drops (unlicensed) - only for patients who are unable to use Minims® due to dexterity problems

• Note: there are two different strength preparations of dexamethasone injection available in the UK (3.8mg/ml and 3.3mg/ml) where traditionaly a 4mg/ml preparation was available and prescribed as such. To avoid confusion the 3.3mg/ml strength is the preparation of choice in the acute Trusts. Where previously a 4mg dose would have prescribed it is appropriate to prescribe a 3.3mg dose (or multiples thereof). This is because the range of doses given in clinical practice varies widely and subsequent doses tend to be adjusted to reflect clinical response. If 4mg is required please ensure that the appropriate volume of 3.3mg/ml is (e.g. 1.2ml) prescribed (or mulitples thereof).

Injection: 3.3 mg/1 mL, 4 mg/1 mL, 6.6 mg/2 mL, 8 mg/2 mL 

• 5mg, 10mg and 20mg tablets
  • ADHD
  • Narcolepsy
  • Doses up to 60mg daily 

• 100 micrograms in 1ml injection approved for use in patients:
  
  
  
  
  • with traumatic brain injury, have no respiratory problems but require prolonged ventilatory support due to severe agitation, confusion and requirement for propofol/midazolam; and
  
  
  • who are difficult to sedate e.g. with overdose of MDMA/PMA/”legal highs” or who have pre-existing drug or alcohol dependence or who have failed conventional methods of treatment.
  
  
  • Paediatric patients undergoing cardiac surgery with a high risk of post-operative Junctional Ectopic Tachyarrhythmia (JET) or those suitable for fast-track surgery.
  
  
  
  


• 100 micgrograms in 1ml injection (intranasal) unlicensed route
  
  
  
  
  • approved for pre-operative sedation in anxious children at risk of respiratory depression in whom midazolam is contraindicated or those who have failed pre-operative sedation with other agents.
  
  
  
  

• 10%/0.9% 

• Diazepam 2mg tablets: are the preferred strength in primary care. 
• Diazepam 10mg tablets: should no longer be used. 
• Diazepam 10mg in 2ml injection: only approved for use in epilepsy (see section 4.8.2).
• Diazepam 2 mg/5ml oral solution: swallowing difficulties

• Note: diazepam 10mg tablets are no longer on the formulary. 

• Diazoxide suspensions can be obtained/prepared if needed. unlicensed

• Oral diclofenac is restricted to short-term use for post operative pain.
• If long-term use is required diclofenac is only approved for 4th line treatment (see below):
  
  • Ibuprofen low dose – first line treatment.
  • Naproxen low dose – second line treatment.
  • Naproxen high dose – third line treatment.
  • Diclofenac – fourth line treatment.

Tablets: 25mg, 50mg

The use of oral diclofenac is restricted. It can be used short-term for post operative pain, or as a fourth line choice for long-term use.

• Topical formulations are NOT on the formulary

Injection: 75 mg/3 ml

• 300mg in 20ml injection

• 50mcg/1ml solution for injection
• Approved for pruritus in adults with chronic kidney disease having haemodialysis in line with NICE

For the treatment of life threatening digoxin toxicity only, requests must be cleared by an appropriate clinician.

• Note: the use of dihydrocodeine 30mg tablets & 10mg in 5ml oral solution is no longer recommended for regular use. Codeine is the preferred weak opioid analgesic.
• Dihydrocodeine is only approved for use in breast feeding mothers immediately postdelivery/ c-section where adequate pain relief has not been achieved using paracetamol and NSAIDs. Patients requiring contunation of dihydrocodeine following discharge (post delivery/c-section) can have dihydrocodeine prescribed in primary care (for short-term use only).

• Preferred calcium channel blocker for angina.
• Zemtard® is the formulary brand of choice for starting new patients on long acting diltiazem.

• 100mg in 2ml injection

• 120mg tablets
• Approved for the treatment of moderate to severe plaque psoriasis in line with NICE

• 20mg/4.5mL concentrate for solution for infusion 
• Approved for the treatment of high-risk neuroblastoma in people aged 12 months and over in line with NICE

• Only approved for use in accordance with NICE guidance.
• 50mg in 5ml sugar free suspension alos avialable unlicensed.

• COUNTY DURHAM  acamprosate, chlordioazepoxide, disulfiram & nalmefene prescribing should be retained within the commissioned service within County Durham.

• 0.2%, 0.4% & 0.6% unlicensed

• Film-coated tablet containing dolutegravir sodium equivalent to 50 mg dolutegravir and 300 mg lamivudine

Tablets - 10mg Suspension - 5mg/5ml

MHRA Drug Safety Alert (May 2014): Domperidone: risk of cardiac side effects
MHRA Drug Safety Update (Dec 2019): Domperidone for nausea and vomiting: lack of efficacy in children; reminder of contraindications in adults and adolescents

• Only approved for use in accordance with NICE guidance. 

• Eye drops and unit dose eye drops
• Approved for use in patients with confirmed allergy presenting as
  conjunctival changes or skin allergy. To be initiated by ophthalmologists
  only. The ophthalmologists must clearly document that signs and
  symptoms of preservative allergy have been demonstrated in their
  patient prior to initiation.

• 100mg in 5ml injection
• 2mg/ml 500ml intravenous infusion in glucose 5%
  see section 03.05.01

• 1mg, 2mg and 4mg tablets

• MR formulations are not approved

• 50mg and 100mg capsules 


• 100mg/5ml injection   unlicensed
  
  
  
  • approved as sclerosing agent for lymphatic malformations in children
  
  
  
  

Super absorbent hydroconductive dressing with absorbent, cross-action structures of viscose, polyester and cotton

• Approved for patients who are unsuitable for or not tolerant of amiodarone. Treatment should be initiated by a cardiologist.