In line with NICE

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

• For COPD only

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

In line with NICE

• £££
• Third line option in individuals who have not tolerated first line alendronate tablets and second line risedronate tablets and in whom a bone-sparing agent is still considered clinically necessary.
• The need for continued bisphosphonate treatment should be re-evaluated periodically particularly after 5 or more years of use

• More than 1.5 kcal/mL and 5 g (or more) protein/100 mL
• Alternative to second line supplement choice
• 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.

• Approved at December 2015 APC meeting following a drug application.
  
  Non-formulary if not for ACBS approved indication
  

• Infant and child: Hydrolysate formula
• Whey hydrolysate formula containing lactose. Use in infants (from birth – 6 mths) who have cow’s milk protein intolerance / allergy but no lactose intolerance. Tube or oral feed.
• Established cows' milk protein intolerance, with or without secondary lactose intolerance

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

• 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

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.

• 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

• 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.

• High-energy supplements: fat
• 21% MCT emulsion, used orally and in cooking as an energy source for children and adults on a ketogenic diet

Achalasia

• Use for SWB only in endoscopy
• 100 units

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

• 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

• 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.

SGLT2 inhibitors: updated advice on the risk of diabetic ketoacidosis

In line with NICE

MHRA Alert: SGLT2 inhibitors: updated advice on increased risk of lower-limb amputation (mainly toes) 

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

• High-energy supplements: fat
• 20% LCT emulsion, used as an energy source for children and adults on a ketogenic diet, may be used orally or in cooking
• For use in ketogenic diets. Long chain triglyceride liquid emulsion used as a milk replacement (when diluted) for some patients with PKU on very low protein diets who cannot tolerate other low protein milk replacements. It will help meet essential energy requirements. The dose and type of product should always be advised by the specialist dietitian according to the needs of the patient.

Only when used in line with Antimicrobial guidelines

When used outside Antimicrobial guidelines, on Specialist recommendation.

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

  Post transplant- new patients
  Post transplant-patients initiated pre April 2013

• supported by ESCA, see link below

Only when used in line with Antimicrobial guidelines

When used outside Antimicrobial guidelines, on 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.

• For ovulation induction
• On specialist recommendation
• Generic tablets

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.

Jaundice and Primary Biliary Cholangitis (PBC)

• See Chapter 3 for respiratory specific indications

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

In line with NICE

In line with NICE

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

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.

• 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

• 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.

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

• 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

• 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

• Supported by an ESCA

• Secondary care use only

Ethambutol liquid 400mg in 5ml (unlicensed)

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

•  Specialist recommendation - 10 mcg ££

Second line

• Approved on formulary December 2017
• For the treatment of iron deficiency anaemia (IDA) in patients with inflammatory bowel disease (IBD), unable to tolerate other oral iron formulations.
  
• Supported by a RICaD

  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.

Essential protein-free basic products. Necessary for children and adults with inborn errors of protein metabolism who tolerate very little natural protein. 1 ordinary egg = 6g protein. 100g flour = 10g protein.

As per antimicrobial guidelines

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.

• Discontinued by manufacturer by the end of 2018.

  Fluticasone Evohaler 125, Fluticasone Accuhaler 250