2.5mg dose (higher doses are not indicated in hypertension)

• Specialist Ophthalmologist Recommendation

• Specialist Ophthalmologist Recommendation

• Restricted for use by endoscopy only 

Two layer dressing consisting of a polyurethane bacterial barrier membrane with a centrally located hydrophilic pad +/- acrylic adhesive border.

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.)
Full thickness burns
Surgical implantations

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

100% medical grade Manuka Honey.

Type of wound product is suitable for
Use as topical treatment for infected sloughy shallow or cavity wounds. Primary or addition to other Activon products. 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 in chronic infection dependant 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
Control of odours
Benefit of adding to other action products and increasing honey
Suitable for use in cavities
Cost effective

There are currently supply issues with adrenaline autoinjectors (October 2018) - See SPS for updates

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

Injection

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

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

• 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

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

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

2mg/dose foam enema

Approved July 2018

Specialist use only.

Formulary status to be reviewed on publication of NICE TA (expected October 2019)

• 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

• 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 

 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.

• 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

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®

Injection

• 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.