In line with NICE

Itracranial hypertension

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

• 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®

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

Alginate dressing impregnated with 100% Manuka Honey.

Type of wound product is suitable for
Primary dressing for infected, shallow cavity wounds, particularly if necrotic or malodorous with
moderate exudate. Requires secondary dressing.

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

Frequency of dressing change
Daily for acute infection
Up to 4 days for chronic infection/depending upon exudate

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

Rationale for inclusion in formulary
Antimicrobial and de sloughing properties
Absorbent
Malodour
Ease of application and removal in one piece
Can be cut to size
Available in various sizes
Can be shaped to wound size and depth
Cost effective

Type of wound product is suitable for
Wound management by secondary intention on acute, chronic, full thickness or partial
thickness or shallow granulating wounds including pressure ulcers, leg ulcers, diabetic foot ulcers, malignant wounds surgical wounds, malignant wounds donor sites and fungating ulcers
Can be used as a primary or secondary dressing

Duration dressing remains on wound before changing
Can stay in place up to 3-7 days

Frequency of dressing change
Dependent on exudate levels

Caution/contraindications (when not to use the dressing, patient groups to avoid etc.)
In common with all adhesive products, some cases of irritation and/or maceration of the skin may occur.
It should be noted that inappropriate use or too frequent dressing changes, particularly in patients with fragile skin, can result in skin stripping. If this occurs change to the Allevyn gentle border range.
If redness or sensitisation occur, discontinue use
Caution under compression when exudate levels are moderate to high.

Rationale for inclusion in formulary
Can be used for low to moderate exudate levels
Different sizes and shapes available
Cost effective

• Replacement for Calcium Sandoz ^® (discontinued)

Specialist initiation

• For patients who would otherwise use alprostadil injection.

• Capsules
• Syrup- for patients with swallowing difficulties

• Specialist initiation

• ££££

 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

• Infant and child: Hydrolysate formula
• Whey hydrolysate containing lactose. Use in infants (from 6 mths) who have cow’s milk protein intolerance / allergy but no lactose intolerance. Tube or oral feed
• Established cows' milk protein allergy or intolerance. Not suitable for child under 6 months.

Contains 10% urea

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

• Supported by ESCA, see link below.
• use in Tourette's syndrome approved

Please note that commissioning discussion is underway. However the present status is as follows:-

Birmingham and Solihull CCG
 
 Age 6 and over - Solihull practices.  Supported with ESCA

 Age 16 and over - Birmingham practices.  Supported with ESCA

 Age under 16 - Birmingham practices

Sandwell and West Birmingham CCG

 Age 6 and over. Supported with ESCA.  Click here for shared care document for patients seen by Black Country Partnership NHS FT 

• Used in cases where increased protein is required
• 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.
• Not suitable for child under 3 years; use with caution in child 3–6 years

Non adherent Primary Dressing containing metallic silver

Type of wound product is suitable for
For clinically infected shallow, granulating wounds with low exudate. To be used as a primary dressing with a secondary for absorption.

Duration dressing remains on wound before changing
Up to 7 days

Frequency of dressing change
1-7 days, depending on levels of exudate

Caution/contraindications (when not to use the dressing, patient groups to avoid etc.)
Known product or component sensitivity
Must be removed prior to x-ray, ultrasound, diathermy and MRI

Rationale for inclusion in formulary
Used to reduce adherence to wound bed with clinical signs of infection
Most cost effective non adherent dressing containing silver.
Dressing impregnated with neutral triglycerides to prevent penetration of granulation tissue.
Petroleum free.
Specialist Recommendation

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

 £££- Paediatrics only
 £££- Recommended by specialist for oncology use only.

In line with NICE

Hospital only

• In line with NICE

• More than 1.5 kcal/ml and 5g (or more) protein/100ml
• Low energy per serving as a semi-solid supplement where low volume is required only.
• Standard ACBS indications: Disease-related malnutrition, intractable malabsorption, preoperative
  preparation of malnourished patients, dysphagia, proven inflammatory bowel
  disease, following total gastrectomy, short-bowel syndrome, bowel fistula Not suitable for child
  under 3 years; use with caution in child 3–6 years.

• in conjunction with prednisolone (plain tablets, not EC)
• Supported by ESCA , see link below.

• supported by ESCA, see link below

  Tablets/ suspension. When used in line with Primary care antimicrobial guidelines

   Tablets only. For COPD or bronchiectasis patients who have ≥3 exacerbations per year. Off-label use. Supported by RICaD and Guidelines on Respiratory use of long term azithromycin in adults

• 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.

• 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

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

• for specialist initiation: specialist pain clinics, palliative care and for patients with swallowing difficulties
  
  Patches should be prescribed by BRAND

Hospital only- NHSE commissioned

Important protein-free foods to provide important energy, assist dietary adherence and provide variety when natural protein tolerance is very limited. Necessary for children and adults with inborn errors of protein metabolism who tolerate very little natural protein.

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

• Specialist Recommendation

• Protein, fat, and carbohydrate
• Only to be used on dietetic advice for oral and tube feeds
• Used where energy, protein and micronutrients required.
• 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.

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

In line with NICE

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

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

• Off label use of eye drops
• Specialist Recommendation

• Not recommended routinely due to QT prolongation risk

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

• Specialist initiation
• 12 week course

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

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.

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

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

Two layer compression system available in full and reduced compression (Coban Lite). Comprises of a latex free foam padding and cohesive bandage.

Type of wound product is suitable for
Treatment of venous and mixed aetiology leg ulcers

Duration dressing remains on wound before changing
1 to 7 days

Frequency of dressing change
Daily up to weekly dependant on exudate and oedema management.

Caution/contraindications (when not to use the dressing, patient groups to avoid etc.)
Arterial disease
Not to be used with other padding or wadding

Rationale for inclusion in formulary
Two layer compression kit, Once applied the two layers form a band to become a single
layer bandage.
Bandage technique can be adapted to reduce forefoot oedema (Extra training required)

• Tablets
• M/R tablets

Jaundice and Primary Biliary Cholangitis (PBC)

• See Chapter 3 for respiratory specific indications

Commissioned by NHS England for Cystic Fibrosis only

  New patients
 
   Existing patients (initiated prior to April 2013)

100 % cotton short stretch compression bandage

Type of wound product is suitable for
Venous leg ulceration
Varicosis
Management of chronic oedema
Management of primary and secondary lymphoedema
Deep venous thrombosis
Thrombophlebitis

Duration dressing remains on wound before changing
1 to 7 days

Frequency of dressing change
Dependant on exudate levels if wound present or oedema management.

Caution/contraindications (when not to use the dressing, patient groups to avoid etc.)
Advanced Peripheral arterial occlusive disease
Decompensated cardiac insufficiency
Septic phlebitis
Phlegmasia coerula doleris

Rationale for inclusion in formulary
Cotton short stretch bandage. Used by lymphoedema nurse specialists

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

• Specialist Ophthalmologist Recommendation.

In line with NICE

In line with NICE

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 

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

• Commissioned by CCGs, in line with NICE
• Transfer to Primary Care supported by an ESCA. Click here
  to access

• in the treatment of hyponatraemia resulting from inappropriate secretion of antidiuretic hormone. UNLICENSED

Cream containing 25% urea
Type of wound product is suitable for
To moisturise dry skin on the soles of feet
For use on adults and children over 12 years of age
Frequency of use
Reapply daily
Caution/contraindications (when not to use the dressing, patient groups to avoid etc.)
Allergy or hypersensitivity to any of the ingredients, contains beeswax and lanolin
Not to be used on children under 12
Rationale for inclusion in formulary
Treatment of dry skin conditions of the foot. Dermatology approved

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

Important protein-free foods to provide important energy, assist dietary adherence and provide variety when natural protein tolerance is very limited. Necessary for children and adults with inborn errors of protein metabolism who tolerate very little natural protein.

Please note that commissioning discussion is underway. However the present status is as follows:-

Birmingham and Solihull CCG
 
 Age 6 and over - Solihull practices.  Supported with ESCA

 Age 16 and over - Birmingham practices.  Supported with ESCA

 Age under 16 - Birmingham practices

Sandwell and West Birmingham CCG

 Age 6 and over. Supported with ESCA.  Click here for shared care document for patients seen by Black Country Partnership NHS FT 

• Protein and carbohydrate
• This is a source of essential amino acids for use in low protein diets with urea cycle disorders. The dose and type of product should always be advised by the specialist dietitian according to the needs of the patient.
• Hypoproteinaemia, chronic renal failure, wound fistula leakage with excessive protein loss, conditions requiring a controlled nitrogen intake, and haemodialysis. Not suitable for child under 6 months.

Inpatient use and prison settings only

In line with NICE

• 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.

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

• 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.

• Fat and Carbohydrate
• Infant feed - Metabolic disorder pts
• Also protein-free (containing fat, carbohydrate, vitamins and minerals) powder necessary for infants with inborn errors of protein metabolism. It is the only protein-free infant feed for patients with urea cycle disorders and organic acidaemias. It is commonly used in combination with a measured amount of natural protein e.g. expressed breast milk. 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.
• For children requiring additional energy, vitamins, minerals, and trace elements following a protein-restricted diet

• More than 1.5 kcal/mL and 5g (or more) protein/100 mL
• High calorie vegetarian fish oil free
• 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 ; also haemodialysis and CAPD

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

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

• Supported by an ESCA

• Secondary care use only

• Phasic (28-day ‘Every day’ preparation)
• For Synphase failure

Ethambutol liquid 400mg in 5ml (unlicensed)

• Monophasic low strength (21-day preparation)
• For pubertal induction in adolescent patient or premature ovarian failure ONLY

• For induction of puberty in female patients who cannot tolerate or are allergic to first-line patches.
•  2 microgram- unlicensed special

•  Specialist recommendation - 10 microgram ££

MHRA Advice
When prescribing for epilepsy, the potential for clinically relevant differences to exist between different manufacturers’ products is considered to be extremely low. However, consider other patient/carer-related factors, such as negative perceptions about alternative products and/or other issues related to the patient such co-morbid autism, mental health issues, or learning disability.

• Evorel® patch 

• 2nd line to Evorel Sequi®

• for Hyperandrogenism in women (unlicensed)
  
  
• Black listed in NHS primary care

• Capsules
• Suspension- For patients with swallowing difficulties only

Adhesive, waterproof, occlusive tape impregnated with 4mg/cm2 fludroxycortide (topical steroid)
Type of wound product is suitable for
Chronic overgranulation, non acute or weeping.
Duration dressing remains on wound before changing
Cut the tape to size. Apply for 12 hours at a time, remove and discard. Apply to clean, dry skin that is shorn of any hair.
Frequency of dressing change
Apply daily for 12 hours at a time. Maximum treatment time 7 days.

Caution/contraindications (when not to use the dressing, patient groups to avoid etc.)
Chicken pox
Tuberculosis of the skin
Hypersensitivity to any components in the tape (steroid fludroxycortide)
Facial rosacea
Acne vulgaris
Perioral dermatitis
Perianal and genital pruritis
Dermatoses in infants Dermatitis napkin eruption Bacterial, viral and fungal infections
Keep away from the eyes
Avoid prolonged use on the face
Not for untreated bacterial, fungal or viral skin lesions
Rationale for inclusion in formulary
Treatment of overgranulation

Unlicensed medicine