In line with NICE

Itracranial hypertension

• Second line in Acute Otitis Externa, as per antimicrobial guidelines
   
   

Hospital Only

• Tablets
• Sachets- available as 200mg powder for oral solution- licensed product.
• Effervescent tablets

• For COPD only

Non-adherent viscose net dressing 99% Manuka honey and 1% Manuka oil.

Type of wound product is suitable for
A primary dressing for low to moderate shallow exuding wound with light slough. Granulating or
epithelialising wounds with clinical signs of infection. Requires a secondary dressing.

Max Duration dressing remains on wound before changing
3-7 Days

Frequency of dressing change
3 to 7 days depending on exudate

Caution/contraindications (when not to use the dressing, patient groups to avoid etc.)
Known allergy to Bee Venom and Honey products
Blood sugars should be monitored in patients with diabetes
Stinging sensation may be experienced. If unacceptable for patient then discontinue.

Rationale for inclusion in formulary
For antimicrobial and de-sloughing properties
Ease of application
Can be cut to size
Easy removal in one piece
Availability of different sizes
Not found to be harmful to peri-wound skin
Malodour
Cost effective

Tracheostomy foam dressing

Type of wound product is suitable for
ActivHeal Foam Tracheostomy dressing has a fenestration, which allows the dressing to fit neatly around a tracheostomy tube. The dressing can also be used around intubation and cannula insertion procedures, external bone fixators and appropriately-sized wound drainage tubes.

Duration dressing remains on wound before changing
Dependant on clinical need and soiling

Frequency of dressing change
Up to 7 days, dependant on clinical need and soiling

Caution/contraindications (when not to use the dressing, patient groups to avoid etc.)
Do not use if reaction to any of its components

Rationale for inclusion in formulary
Specific dressing shaped and able to cut for tracheostomies.
Cost effective

Knitted viscose mesh impregnated with 100% Manuka Honey.

Type of wound product is suitable for
Creates a moist healing environment effectively eliminates odour. Provides anti-microbial action.
Debrides and de-sloughs shallow wounds where the exudate level has started to decrease. Requires secondary dressing

Max Duration dressing remains on wound before changing
Up to 4 days

Frequency of dressing change
Daily in acute infection
Up to 4 days for chronic infection depending on exudate

Caution/contraindications (when not to use the dressing, patient groups to avoid etc.)
Wounds with active blood loss
Known allergies to bee Venom and Honey products
Blood sugars should be monitored in diabetic patients
Stinging sensation may be experienced – discontinue if not tolerant.

Rationale for inclusion in formulary
Anti-microbial and de-sloughing properties for wounds with reduced levels of exudate.
Control of odours
Ease of application and removal in one piece
Can be cut to size
Available to various size
Cost effective

• Hospital only
• Biosimilar brands available:
  • Amgevita®
  • Hulio®
  • Imraldi®
  • Hyrimoz®

Injection technique is device specific. To ensure patients receive the auto-injector device that they have been trained to use, prescribers should prescribe by brand.

Injection technique is device specific. To ensure patients receive the auto-injector device that they have been trained to use, prescribers should prescribe by brand.

• The need for continued bisphosphonate treatment should be re-evaluated periodically particularly after 5 or more years of use

Second line- in children as per guidance

For existing patients only

Hydrocellular foam dressing
Type of wound product is suitable for
Shallow granulating wounds, acute and chronic exuding wounds, full and partial thickness wounds
such as leg ulcer, malignant wound, surgical wound. Primary dressing
Silicone adhesive
Duration dressing remains on wound before changing
Up to 7 days dependent on dressing indicators
Frequency of dressing change
Up to 3 times a week maximum
Caution/contraindications (when not to use the dressing, patient groups to avoid etc.) Do not use with oxidising agents such as hypochlorite solutions or hydrogen peroxide Discontinue if reddening or sensitivity occurs.
Do not cut
Caution under compression where exudate levels are moderate to high
Rationale for inclusion in formulary
Fragile skin with absorbency and conformability, problematic healing wounds. Odour control.

• Cows' Milk Protein Allergy

• Extensively hydrolysed formula

• Capsules
• Syrup- for patients with swallowing difficulties

• Specialist initiation

Supported by RICaD

• ££££

 Following diagnosis of AF- use in line with NICE. Initiation/ recommendation by a clinician who routinely initiates anticoagulants. 

BSSE APC Primary Care Clinical Pathway for Arial Fibrillation Detection and Management
 
  Use following Hip and Knee surgery- full course of treatment supplied on discharge. 
 
  For the treatment and secondary prevention of DVT and/or PE - use in line with NICE. Initiation/ recommendation by a clinician who routinely initiates anticoagulants. Where this is not the patient's GP, transfer to GP should be with the support of RICaD.
RICaD: Apixaban in DVT/ PE

• only PF sympathomimetic

Hydrofibre with silver

Type of wound product is suitable for
Management of clinically infected, sloughy, necrotic or granulating wounds with moderate to heavy exudate.
Moderate to highly exuding wounds.
Aquacel Ag Plus Extra can be used to break down biofilms
Requires a secondary dressing

Duration dressing remains on wound before changing
Dependent upon exudate 1 - 7 days

Frequency of dressing change
Dependent upon level of exudate and clinical presentation

Caution/contraindications (when not to use the dressing, patient groups to avoid etc.)
Should not be used on individuals who are sensitive to or have had an allergic reaction to the dressing or its components.
Not suitable for dry wounds.
No haemostatic properties.

Rationale for inclusion in formulary
Specialist antimicrobial product
Moderate to high exudate levels
Can be used to break down biofilms
Remains intact on wound bed and easily removable in one piece (non dispersible)

The APC's view is that, on clinical grounds, the status of antipsychotic depot injections should be amber with a framework in place in Primary Care before transfer.
HOWEVER, until the commissioning arrangements have been agreed to allow safe transfer of patient care, the status will remain RED.

• In line with NICE

Injection

• Specialist Ophthalmologist Recommendation -used by glaucoma surgeons for neovascular glaucoma.

• Hospital only
• In line with NICE

• Approved on formulary December 2017
• Specialist initiation.
• 3rd line after oral PDE-5 inhibitors failed and patient not responding to or intolerant of alprostadil.
• To be reviewed within 12 months to assess alprostadil supply issues and patent expiry

• 1.5 kcal/mL and 5 g (or more) protein/100 mL
• Second line choice for 200ml ready-made. If powder is not tolerated or contraindicated

• In line with food first
• Not suitable for CKD 4-5, renal pts.
• Not suitable for lactose intolerance
• Not suitable for bile acid malabsorption or fat maldigestion associated with biliary diseases/conditions
• To be made up with whole milk.
• Standard ACBS indications: Disease-related malnutrition, intractable malabsorption, pre-operative preparation of malnourished patients, dysphagia, proven inflammatory bowel disease, following total gastrectomy, short-bowel syndrome, bowel fistula . Use with caution in child 1–6 years.

Tablets 25mg, 50mg
Maintenance of remission of acute ulcerative colitis and Crohn’s disease in adults– unlicensed but in line with national guidelines.
 
For use in Inflammatory Bowel Disease (IBD) as per effective shared care agreement (ESCA). See link below.

Specialist use only for neurological conditions

Supported by ESCA, see link below.

• Do not prescribe azithromycin as stand-alone medication for the indication of gonorrhoea. Refer to GUM clinic for IM ceftriaxone as per current UK guidelines.

• First line for ophthalmic chlamydia

• urea 5%, lauromacrogols 3%

Over the counter preparation suitable for self-care/purchase if appropriate

Specialist initiation for severe brittle asthma/ cystic fibrosis

• Fat and Carbohydrate
• Over one year of age. Metabolic disorder pts
• Also these are the only protein free (containing fat, carbohydrate, vitamins and minerals) powders aimed at children ≥1-year-old and adults with inborn errors of protein metabolism (particularly patients with urea cycle disorders and organic acidaemias). Basecal 100 and Basecal 200 are commonly added as an energy source in low protein module tube feeds. The dose will depend on energy requirements and tolerance to natural protein. It is commonly used in combination with a controlled amount of natural protein e.g. measured dose of standard enteral tube feed. It will help meet essential energy and nutrient requirements. The dose and type of product should always be advised by the specialist dietitian according to the needs of the patient.

Approved April 2019

Hydrocolloid Range with film border

Type of wound product is suitable for
Lightly to moderately exuding wounds

Duration dressing remains on wound before changing
Up to 7 days

Frequency of dressing change
Only when necessary - up to 7 days

Caution/contraindications (when not to use the dressing, patient groups to avoid etc.)
Do not use on third-degree burns. Should not be used on individuals who are sensitive to or have had an allergic reaction to the dressing or its components.

Rationale for inclusion in formulary
Reduced dressing changes. More cost effective. Reduce use of more expensive foam dressings.

• Short term use only

Potency: Potent

Maximum treatment period 30 days

• Specialist Ophthalmologist Recommendation

• Specialist Ophthalmologist Recommendation

Polyurethane foam dressing with bevelled edges

Type of wound product is suitable for
Moderately exuding wounds with signs of granulation, epithelialisation or slough.
Can be used as primary or secondary

Duration dressing remains on wound before changing
1-7 days

Frequency of dressing change
Up to 7 days dependent on exudate levels

Caution/contraindications (when not to use the dressing, patient groups to avoid etc.)
Do not use with oxidising solutions such as hydrogen peroxide
Full thickness burns
Surgical implantations

Rationale for inclusion in formulary
Simple to use on the foot and digits Can be cut to shape

• Specialist Ophthalmologist Recommendation.
• 2nd line

Approved for

• Palliative Care
• Dental practitioners

For use in H Pylori eradication in penicillin allergy and previous clarithromycin, as per Antimicrobial guidelines.

In line with NICE

Essential protein-free basic products. Necessary for children and adults with inborn errors of protein metabolism who tolerate very little natural protein. 1 slice ordinary bread = 4g protein and is not allowed in low protein diets.

In line with NICE

• Specialist Ophthalmologist Recommendation

• Specialist Ophthalmologist Recommendation

• Specialist Ophthalmologist Recommendation
• 2nd/3rd line

• Hospital only
• In line with NICE

Patches

Recommend 7-day patch

Hospital only- NHSE Commissioned

Over the counter preparation suitable for self-care/purchase if appropriate

• Specialist recommendation
• For delicate areas,face and flexures

• High-energy supplements: fat
• Used as a source of LCT, as an energy supplement and additive to feed to enhance energy density.
• Does not contain protein
• Also this is the only LCT fat source that can be used as a fat energy source in patients with organic acidaemias e.g. propionic acidaemia and methyl malonic acidaemia and urea cycle disorders. It may also be used as part of a modular feed or protein-free energy source. The dose and type of product should always be advised by the specialist dietitian according to the needs of the patient.
• Disease-related malnutrition, malabsorption states, or other conditions requiring fortification with a high fat (or fat and carbohydrate) supplement. Liquid supplements

• Protein, fat, and carbohydrate
• Used on dietetic advice only
• Used where hygiene concerns/infection control – single use sterile dose – where Calogen Extra bottle is not appropriate
• Used where energy, protein and micronutrients required in small volume
• Disease-related malnutrition, malabsorption states, or other conditions requiring fortification with a high fat or carbohydrate (with protein) supplement.
• Not suitable for child under 3 years; use with caution in child 3–6 years. May require dilution for child 3–5 years.

Over the counter preparation suitable for self-care/purchase if appropriate

For existing patients only

Odour absorbent wound contact dressings containing activated charcoal

Type of wound product is suitable for
For the management of moderate to heavily exuding malodorous wounds including
fungating

Duration dressing remains on wound before changing
Up to 7 days

Frequency of dressing change
As exudate level determines

Caution/contraindications (when not to use the dressing, patient groups to avoid etc.)
Known sensitivity to the dressing or its components
As soon as CarboFLEX becomes contaminated with exudate, odour control diminishes
The underlying cause of wound odour should be identified prior to commencement of product

Rationale for inclusion in formulary
CarboFLEX is a layered dressing to provide higher levels of fluid handling
On shallow or cavity wounds with moderate to heavy levels of exudate

Only when used in line with Antimicrobial guidelines 
 
  When used outside Antimicrobial guidelines, on Specialist recommendation.

• CVD risk assessment

Use in line with NICE

In line with NICE

Over the counter preparation suitable for self-care/purchase if appropriate

• Tablets
• Syrup

OTC preparation suitable for self-care/purchase if appropriate

Silicone sheet for scar treatment

Type of wound product is suitable for
Not for use on open wounds- to be applied on healed scar only.
This is not a dressing but a scar treatment

Duration dressing remains on wound before changing
23 hours

Frequency of dressing change
Daily

Caution/contraindications (when not to use the dressing, patient groups to avoid etc.)
Do not use on open or infected wounds. Do not use on skin affected by acne. Discontinue use if a rash or itching occur.

Rationale for inclusion in formulary
Scar therapy
Silicone sheets have been shown to soften, flatten scarring aiding movement, nerve sensations and function. Self adherent, Re-usable

  Post transplant- if prescribing is NOT established with GP before 1st April 2013
  Post transplant - if prescribing IS established with GP before 1st April 2013

• supported by ESCA, see link below

• Specialist initiation.
• In line with NICE

• Specialist Ophthalmologist recommendation(Corneal consultant)

• Not recommended routinely due to QT prolongation risk

Odour absorbent charcoal dressing

Type of wound product is suitable for
Malodourous wounds such as fungating wounds

Duration dressing remains on wound before changing
Up to 7 days

Frequency of dressing change
1-7 days dependent on exudate levels

Caution/contraindications (when not to use the dressing, patient groups to avoid etc.)
Not indicated as a primary dressing in dry wounds
Store at room temperature
Exudate levels will reduce the effectiveness of the charcoal

Rationale for inclusion in formulary
Clinisorb is an activated charcoal dressing which adsorb toxins removing malodour from the wound
Can be cut to size
Cost effective

MHRA Advice
Care should be taken when switching between oral formulations. The need for continued supply of a particular manufacturer’s product should be based on clinical judgement and consultation with patient and/or carer, taking into account factors such as seizure frequency and treatment history.

• For ovulation induction
• On specialist recommendation
• Generic tablets

Tablets

Pain - off label use according to WM Cares guideline

• Capsules
• M/R capsules
• Dispersible tablets

• Tablets

Strong suspension

Capsules

• tablets
• 25mg/5ml syrup
• Use with caution in patients aged over 65
• Contraindicated in children below the age of 12

• Supported by a RICaD (in development)

Powder

• For patients with poor compliance or absorption problems

Over the counter preparation suitable for self-care/purchase if appropriate

• For glycogen storage disease
• Slow release CHO to prevent hypoglycaemia in GSD
• Slow release carbohydrate to prevent hypoglycaemia in all types of GSD. Cheaper than glycosade and easier to mix. Used in less severe forms of GSD. Between 1 to 2g/kg body weight is prescribed dependent on age, weight and clinical symptoms of hypoglycaemia. Doses may be given at regular intervals during the day and night or at bedtime only. The dose and frequency of dose should always be advised by the specialist dietitian according to the needs of the patient.

• Infant and child: Hydrolysate formula
• Whey hydrolysate. Use in infants who have malabsorption problems and require a peptide and MCT containing feed. Eg after gut surgery. Use as tube or oral feed
• Disaccharide and/or whole protein intolerance, or where amino acids and peptides are indicated in conjunction with medium chain triglycerides.

DACC coated dressings providing antimicrobial properties, available in a pad, gel, gel sheet, ribbon, round swab and rectangular swab

Type of wound product is suitable for
Colonised or clinically infected moist wound, suitable for any wound type

Duration dressing remains on wound before changing
1-3 days

Frequency of dressing change
1-3 days dependent on exudate levels

Caution/contraindications (when not to use the dressing, patient groups to avoid etc.)
Do not use in combination with oils and creams
Known hypersensitivity to ingredients
Not for dry wound
Not for heavily exuding wounds

Rationale for inclusion in formulary
Alternative to available antimicrobials

• To correct cysteine deficiency in homocystinuria
• The only pre-measured sachet of cysteine to correct cysteine deficiency in homocystinuria. The dose and frequency of administration will be determined by the specialist dietitian.
• Nutritional supplement for the dietary management of inborn errors of amino acid metabolism in adults and children from birth.

  Following diagnosis of AF- use in line with NICE. Initiation/ recommendation by a clinician who routinely initiates anticoagulants.  

BSSE APC Primary Care Clinical Pathway for Arial Fibrillation Detection and Management
 
  Use following Hip and Knee surgery- full course of treatment supplied on discharge. 
 
  For the treatment and secondary prevention of DVT and/or PE - use in line with NICE. Initiation/ recommendation by a clinician who routinely initiates anticoagulants. Where this is not the patient's GP, transfer to GP should be with the support of RICaD.
RICaD: Dabigatran in DVT / PE

Use in line with NICE

• Low protein milk for children and adults with phenylketonuria and other disorders of protein metabolism
• Low protein milk (similar energy content to cow’s milk) for children and adults with phenylketonuria and other disorders of protein metabolism.

• For hereditary angioedema (off label use)

For constipation in terminally ill patients only

In line with NICE

See Type 2 diabetes DMMAG Guideline for the choice of oral and non-insulin antihyperglycaemic agents in adults

SLGT2 inhibitors are not to be used in primary care for type 1 diabetes until further local guidance becomes available

 for treating Type 2 diabetes in line with NICE 

 for treating chronic heart failure with reduced ejection fraction

 Specialist centres only for treating Type 1 diabetes as per NICE TA 597: Dapagliflozin with insulin for treating type 1 diabetes

• Specialist recommendation

• First line
• Specialist recommendation
• 100 shades available
• FP10 prescriptions should be endorsed "ACBS"

specialist recommendation for epidermolysis bullosa

short term use only

Over the counter preparation suitable for self-care/purchase if appropriate

• for post corneal implants or OSD
• Use the agent with the lowest acquisition cost

• palliative care only

• Specialist Ophthalmologist Recommendation.

Potency: very potent

Over the counter preparation suitable for self-care/purchase if appropriate

All forms

• All Strengths. Specialist Recommendation

• DHA supplement for low chain fatty acid and low protein diets
• The only ACBS prescribed DHA supplement for low protein diets. The dose and frequency of administration will be determined by the specialist dietitian.
• Nutritional supplement for the dietary management of inborn errors of metabolism for adults and children from birth.

• tablets
• orodispersible 10mg tablets sugar free (pack of 28)
  
  
  
  

Commissioned by NHS England for Cystic Fibrosis only

  New patients
 
  For existing patients (initiated pre April 2013)

• Specialist Ophthalmologist Recommendation

• Specialist Ophthalmologist Recommendation

Plain tablets only

 Modified release tablets are non formulary.

All spacer devices

• injection
• NOT for monotherapy

• Fat and Carbohydrate
• For renal children with fluid restriction
• Disease-related malnutrition, malabsorption states, or other conditions requiring fortification with a high fat (or fat and carbohydrate) supplement.

In line with NICE

• When finasteride has failed or is contraindicated/not tolerated

  Following diagnosis of AF- use in line with NICE. Initiation/ recommendation by a clinician who routinely initiates anticoagulants. 

BSSE APC Primary Care Clinical Pathway for Arial Fibrillation Detection and Management

 For treating and for preventing recurrent DVT and PE- use in line with NICE. Initiation/ recommendation by a clinician who routinely initiates anticoagulants. Where this is not the patient's GP, transfer to GP should be with the support of RICaD
RICaD: Edoxaban in DVT/PE

• Less than 1 kcal/mL and less than 5 g protein/100 mL
• Amino acid formula (essential and non-essential amino acids)
• Pts with IBD, multiple allergies. For tube feed and oral feeding. Alter concentration of feed to support individual patient’s nutritional needs.
• Short bowel syndrome, intractable malabsorption, proven inflammatory bowel disease, bowel fistula

• If a 40mcg or 80mcg strength required

In line with NICE

See Type 2 diabetes DMMAG Guideline for the choice of oral and non-insulin antihyperglycaemic agents in adults

SLGT2 inhibitors are not to be used in primary care for type 1 diabetes until further local guidance becomes available

For existing patients only.

In line with NICE

  Single use in suspected DVT

  For all other indications.

The APC's view is that on clinical grounds, the status for certain indications approved by APC should be Amber Shared Care, supported by an ESCA. These indications are:

• Deep vein thrombosis (including paediatrics)
• Pulmonary embolism (including paediatrics)
• Intolerance/unsuitable for oral anticoagulants
• Certain cancer patients
• Injectable drug users
• Pregnant women
  HOWEVER, until the commissioning arrangements have been agreed to allow safe transfer of patient care, the status will remain RED (ESCAs to be developed). This should not prevent individuals in primary care providing initial prescriptions in urgent situations e.g. pregnancy where there is a high thrombotic risk.

• Protein, fat, and carbohydrate
• First choice for patients with very high energy requirement eg cystic fibrosis
• In adults with cystic fibrosis, nutritional advice and interventions should be aimed at maintaining a BMI of 22kg/m2 in women and 23kg/m2 in men, as these are associated with better lung function (Nutritional management of CF – Consensus document – 2016)
• Disease-related malnutrition, malabsorption states, or other conditions requiring fortification with a high fat or carbohydrate (with protein) supplement. Not suitable for child under 1 year; use with caution in child 1–6 years.

• Tablets

In line with NICE

Over the counter preparation suitable for self-care/purchase if appropriate

Injection

Topical use for fungating wounds where bleeding is present

• Estradot® patch 

Over the counter preparation suitable for self-care/purchase if appropriate

Second line

In line with NICE

  for hyperandrogenism in women (unlicensed)

Black listed in NHS primary care

Not NHS

• Flavouring preparations
• For flavouring unpalatable flavouring amino acid supplements or feeds in inborn errors of metabolism
• Essential for flavouring different unflavoured amino acid supplements in inborn errors of metabolism particularly for non PKU conditions. They offer common children’s favourite flavours: e.g. orange or raspberry. Flavourings are important, as amino acid formulations are unpalatable and unacceptable particularly for patients with late diagnosed conditions. They cannot be purchased from a supermarket.
• For use with Vitaflo's range of unflavoured protein substitutes for metabolic diseases; not suitable for child under 3 years.