Download Formulary document - Cobham Day Surgery

Epsomedical
Formulary
Joint Medications
Formulary
Version 1.3
February 2016
1.0 GASTRO-INTESTINAL SYSTEM
1.1 Dyspepsia and gastro-oesophageal reflux disease
1.2 Antispasmodics and other drugs altering gut motility
1.3 Antisecretory drugs and mucosal protectants
1.4 Acute diarrhoea
1.5 Chronic bowel disorders
1.6 Laxatives
1.7 Local preparations for anal and rectal disorders
1.8 Stoma care (no entry in the formulary)
1.9 Drugs affecting intestinal secretions
1.1 DYSPEPSIA AND GASTRO-OESOPHAGEAL REFLUX DISEASE
1.1.1 COMPOUND ALGINATES AND PROPRIETARY INDIGESTION PREPARATIONS
GAVISCON®
s/f infant sachets
Advance liquid
(sodium alginate 225mg, aluminium
hydroxide 112.5mg, magnesium
alginate 87.5mg/dose [= half a dual-sachet])
(sodium alginate 500mg, potassium
bicarbonate 100mg, calcium carbonate
100mg/5ml. Contains 2.3 mmol sodium and
1mmol potassium/5ml)
1.2 ANTISPASMODICS AND OTHER DRUGS ALTERING GUT MOTILITY
MHRA Drug Safety Update
Domperidone: risk of cardiac side effects (July 2014)
MHRA Drug Safety Update
Domperidone: small risk of serious ventricular arrhythmia and sudden cardiac death
(May 2012)
Domperidone
Hyoscine butylbromide
Mebeverine hydrochloride
tablets (10mg)
suspension (5mg/5ml)
tablets (10mg)
tablets (135mg)
MHRA Drug Safety Update
Metoclopramide: risk of neurological adverse effects - restricted dose and duration of use
(August 2013)
Metoclopramide
tablets (10mg)
s/f syrup (5mg/5ml)
Peppermint Oil
capsules
1.3 ANTISECRETORY DRUGS AND MUCOSAL PROTECTANTS
1.3.1 H2-RECEPTOR ANTAGONISTS
Ranitidine
tablets (150mg)
effervescent tablets (150mg)
s/f syrup (75mg/5ml)
1.3.2 PROSTAGLANDIN ANALOGUES
Misoprostol
tablets (200micrograms)
1.3.3 PROTON PUMP INHIBITORS
MHRA Drug Safety Update
Proton pump inhibitors in long-term use: recent epidemiological evidence of increased risk
of fracture (April 2012)
MHRA Drug Safety Update
Proton pump inhibitors in long-term use: reports of hypomagnesaemia (April 2012)
Omeprazole
capsules (10mg, 20mg) - 1st line
MUPS®
tablets* (10mg, 20mg)
*Restricted to patients with swallowing problems or enteral tubes
Lansoprazole
capsules (15mg, 30mg)
oro-dispersible tablets* (15mg, 30mg)
*Restricted to patients with swallowing problems or enteral tubes and is the first line for
this group of patients.
1st line H. pylori eradication regime
Amoxicillin
1g bd*
}
Clarithromycin
500mg bd
}
for 7 days
Omeprazole
20mg bd
}
*If penicillin allergic, use metronidazole 400mg bd instead of amoxicillin
2nd line H. pylori eradication regime (used only after 1st line failure)
Oxytetracycline
500mg qds
}
Metronidazole
400mg tds
}
for 14 days
Omeprazole
20mg bd
}
Tripotassium dicitratobismuthate 120mg qds
1.4 ACUTE DIARRHOEA
1.4.1 ANTIMOTILITY DRUGS
Loperamide hydrochloride
capsules (2mg) - 1st line
s/f syrup (1mg/5ml)
Codeine phosphate
tablets (15mg, 30mg)
syrup (25mg/5ml)
1.5 CHRONIC BOWEL DISORDERS
1.5.1 AMINOSALICYLATES
Mesalazine e/c
tablets (OCTASA® MR, 400mg) - 1st line for new patients
e/c tablets (ASACOL® MR, 400 mg, 800mg)
m/r tablets (PENTASA®, 500mg)
foam enema (ASACOL®, 1g)
retention enema (PENTASA®, 1g/100ml)
suppositories (ASACOL®, 500mg)
suppositories (PENTASA®, 1g)
Sulfasalazine
tablets (500mg)
e/c tablets (500mg)
1.5.2 CORTICOSTEROIDS
Budesonide m/r
Hydrocortisone
Prednisolone
capsules (3mg)
foam (10%, 25g)
enemas (20mg/100ml)
foam (20mg, 25g)
1.5.3 DRUGS AFFECTING THE IMMUNE RESPONSE
Restricted to the gastroenterology team:
Azathioprine
Ciclosporin
Mercaptopurine
Methotrexate
tablets (25mg, 50mg)
capsules (DEXCEL brand, 25mg, 50mg, 100mg) - 1st line
for new patients
(NEORAL brand, 25mg, 50mg, 100mg)
tablets (50mg)
tablets (2.5mg) Weekly dose, 2.5 mg tablets only
1.6 LAXATIVES
1.6.1 BULK-FORMING LAXATIVES
Ispaghula husk
1.6.2 STIMULANT LAXATIVES
Bisacodyl e/c
Docusate sodium
Glycerin (Glycerol)
Senna
Sodium picosulfate
s/f granules (3.5g/sachet)
tablets (5mg)
suppositories (5mg, 10mg)
capsules (100mg)
s/f solution (50mg/5ml)
s/f paediatric solution (12.5mg/5ml)
enema (120mg/10g)
suppositories (1g, 2g, 4g)
tablets (Sennoside B 7.5mg)
s/f syrup (Sennoside B 7.5mg/5ml)
elixir (5mg/5ml)
1.6.3 OSMOTIC LAXATIVES
Lactulose
solution (3.35g/5ml)
Liquid paraffin and Magnesium hydroxide emulsion BP
1.6.4 MACROGOLS
LAXIDO®
MOVICOL® PAEDIATRIC PLAIN
oral powder
1.6.5 BOWEL CLEANSING PREPARATIONS
MOVIPREP®
oral powder
PICOLAX®
s/f oral powder
1.6.6 5HT4 – RECEPTOR AGONISTS
Constipation (women)
Prucalopride*
prucalopride (NICE TA211)
tablets (1mg, 2mg)
1.7 LOCAL PREPARATIONS FOR ANAL AND RECTAL DISORDERS
1.7.1 SOOTHING HAEMORRHOIDAL PREPARATIONS
ANUSOL®
cream
ointment
suppositories
1.7.2 COMPOUND HAEMORRHOIDAL PREPARATIONS WITH CORTICOSTEROID
ANUSOL-HC®
ointment
UNIROID- HC®
suppositories (Cinchocaine hydrochloride
hydrocortisone 5mg)
5mg,
1.7.4 MANAGEMENT OF ANAL FISSURES
Glyceryl trinitrate
ointment (0.2%) 1st line treatment of anal fissures
Diltiazem
cream (2%) 2nd line treatment of anal fissures in
patients who are unable to tolerate headache with
GTN
1.8 DRUGS AFFECTING INTESTINAL SECRETIONS
1.8.1 DRUGS AFFECTING BILIARY COMPOSITION AND FLOW
Ursodeoxycholic acid
tablets (150mg)
capsules (250mg)
suspension (250mg/5ml)
1.8.2 BILE ACID SEQUESTRANTS
Colestyramine
1.8.3 PANCREATIN
CREON® 10,000
CREON® 40,000
sachets (4g)
capsules (Providing: protease 600 units, lipase 10,000
units, amylase 8,000 units,)
capsules (Providing: protease 1,600 units, lipase 40,000
units, amylase 25,000 units)
2.0 CARDIOVASCULAR SYSTEM
2.1 Positive inotropic drugs
2.2 Diuretics
2.3 Anti-arrhythmic drugs
2.4 Beta-adrenoceptor blocking drugs
2.5 Hypertension and heart failure
2.6 Nitrates, calcium channel blockers, and other antianginal drugs
2.7 Anticoagulants and protamine
2.8 Antiplatelet drugs
2.9 Lipid-regulating drugs
2.1 POSITIVE INOTROPIC DRUGS
2.1.1 CARDIAC GLYCOSIDES
Digoxin
tablets
(62.5micrograms,
250micrograms)
elixir (250micrograms/5ml)
125micrograms,
2.2 DIURETICS
2.2.1 THIAZIDES AND RELATED DIURETICS
Bendroflumethazide
tablets (2.5mg, 5mg)
Indapamide
tablets (2.5mg)
2.2.2 LOOP DIURETICS
Bumetanide
Furosemide
tablets (1mg)
tablets (20mg, 40mg)
s/f oral solution (5mg/5ml UNLIC, 40mg/5ml)
2.2.3 POTASSIUM-SPARING DIURETICS AND ALDOSTERONE ANTAGONISTS
Amiloride
tablets (5mg)
s/f oral solution (5mg/5ml)
Spironolactone
tablets (25mg, 100mg)
s/f suspension (50mg/5ml)
Eplerenone*
tablets (25mg)
*Restricted to cardiologist initiation only
2.2.4 POTASSIUM-SPARING DIURETICS WITH OTHER DIURETICS
Co-amilofruse 5/40
tablets (Amiloride 5mg, Furosemide 40mg)
Co-amilofruse 2.5/20
tablets (Amiloride 2.5mg, Furosemide 20mg)
2.3 ANTI-ARRHYTHMIC DRUGS
2.3.1 DRUGS FOR ARRHYTHMIAS
Amiodarone Hydrochloride
Flecainide Acetate
Propafenone
tablets (100mg, 200mg)
tablets (50mg, 100mg)
tablets (150mg)
For atropine sulphate see section 15.1.3
For cardiac glycosides see section 2.1.1
For beta-adrenoceptor blockers see section 2.4
For verapamil see section 2.6.2
2.4 BETA-ADRENOCEPTOR BLOCKING DRUGS
Atenolol
tablets (25mg, 50mg, 100mg)
s/f syrup (25mg/5ml)
Bisoprolol Fumarate
tablets (1.25mg, 2.5mg, 5mg)
Carvedilol
tablets (3.125mg, 6.25mg, 12.5mg)
Labetalol hydrochloride
tablets (50mg, 100mg, 200mg)
Metoprolol Tartrate
tablets (50mg)
Propranolol hydrochloride
tablets (10mg, 40mg, 80mg, 160mg)
m/r capsules (80mg, 160mg)
syrup (50mg/5ml)
Sotalol hydrochloride*
tablets (40mg, 80mg)
*Restricted to use for treating ventricular arrhythmias or prophylaxis of supraventricular
arrhthmyias
2.5 HYPERTENSION AND HEART FAILURE
2.5.1 VASODILATOR ANTIHYPERTENSIVE DRUGS
Hydralazine hydrochloride
tablets (25mg)
2.5.2 CENTRALLY ACTING ANTIHYPERTENSIVE DRUGS
Clonidine
tablets (100micrograms)
Methyldopa
tablets (250mg, 500mg)
2.5.3 ALPHA-ADRENOCEPTOR BLOCKING DRUGS
Doxazosin
tablets (1mg, 2mg, 4mg)
2.5.5 DRUGS AFFECTING THE RENIN-ANGIOTENSIN SYSTEM
MHRA Drug Safety Update
Combination use of medicines from different classes of renin-angiotensin system blocking
agents: risk of hyperkalaemia, hypotension, and impaired renal function (July 2014)
2.5.5.1 ANGIOTENSIN-CONVERTING ENZYME INHIBITORS
Post Myocardial Infarction
1st line Ramipril Titrate up to 10mg total daily dose
Captopril
Enalapril
Lisinopril
Perindopril
Ramipril
tablets (12.5mg)
tablets (2.5mg, 5mg, 10mg, 20mg)
tablets (2.5mg, 5mg, 10mg, 20mg)
tablets (2mg, 4mg, 8mg)
capsules (1.25mg, 2.5mg, 5mg, 10mg)
2.5.5.2 ANGIOTENSIN-II RECEPTOR ANTAGONISTS
To be used second line for patients intolerant of ACE inhibitors:
Losartan potassium
tablets (25mg, 50mg) – 1st line ARB for hypertension
Candesartan
tablets (2mg, 4mg, 8mg, 16mg) ARB of choice in heart failure.
Irbesartan
tablets (75mg, 150mg), if losartan or candesartan not
appropriate
2.6 NITRATES, CALCIUM-CHANNEL BLOCKERS, AND OTHER ANTIANGINAL DRUGS
2.6.1 NITRATES
Glyceryl trinitrate s/l
Isosorbide mononitrate
tablets (500micrograms)
aerosol spray (400micrograms/dose)
patches (5mg/24 hours)
tablets (10mg, 20mg)
m/r tablets (60mg)
m/r capsules (25mg, 40mg)
2.6.2 CALCIUM-CHANNEL BLOCKERS
Amlodipine
tablets (5mg, 10mg)
Diltiazem hydrochloride
m/r tablets (60mg)
m/r capsules (TILDIEM® LA, 200mg, 300mg)
m/r tablets (TILDIEM® RETARD, 90mg,120mg)
Nifedipine
Nimodipine
Verapamil
m/r capsules (ADIZEM-XL®, 120mg)
capsules (5mg, 10mg)
m/r tablets (ADALAT® LA, 30mg)
m/r tablets (ADALAT® RETARD, 10mg, 20mg)
m/r tablets (NIFEDIPRESS® M/R, 10mg, 20mg)
tablets (30mg)
tablets (40mg, 120mg)
m/r tablets (SECURON®, 120mg, 240mg)
2.6.3 OTHER ANTIANGINAL DRUGS
Nicorandil*
tablets (10mg, 20mg)
* Reserved for use when other anti-anginals (beta-blockers and calcium channel blockers
are contraindicated, not tolerated or do not fully control symptoms.
Chronic Heart Failure-Ivabadine (NICE TA 267)
Ivabradine*
tablets (5mg)
* Restricted to cardiologist initation only for patients that cannot tolerate either betablockers or rate limiting calcium channel blockers (diltiazem/verapamil) and to be used in
line with NICE Clinical Guidelines on the Management of Stable Angina
2.7 ANTICOAGULANTS AND PROTAMINE
2.7.1 ORAL ANTICOAGULANTS
NPSA Warfarin Sodium
tablets (1mg, 3mg, 5mg)
MHRA Drug Safety Update
Dabigatran: risk of serious haemorrhage—need for renal function testing (July 2012)
MHRA Drug Safety Update
Dabigatran: contraindicated in patients with prosthetic heart valve(s) requiring
anticoagulant treatment – risk of thrombosis and haemorrhage (March 2013)
MHRA Drug Safety Update
New oral anticoagulants, apixiban, dabigatran and rivaroxaban: risk of serious
haemorrhage-clarified conditions apply to all three medicines
Atrial fibrillation - dabigatran etexilate (NICE TA249)
Dabigatran
tablets (110mg, 150mg)
Atrial fibrillation (stroke prevention) - rivaroxaban (NICE TA256)
Venous thromboembolism (treatment and long term secondary prevention) - rivaroxaban
(NICE TA261)
Rivaroxaban
tablets (15mg, 20mg)
Stroke and systemic embolism (prevention, non-valvular atrial fibrillation) - apixaban
(NICE TA275)
Apixaban
tablets (2.5mg, 5mg)
2.8 ANTIPLATELET DRUGS
Aspirin
dispersible tablets (75mg, 300mg)
e/c tablets* (75mg)
* Not recommended for initiation
MHRA Drug Saftey Update
Clopidogrel: risk of acquired haemophilia
Clopidogrel
tablets (75mg)
For patients at high risk of developing gastric erosions taking clopidogrel, treat with an H2antagonists such as ranitidine in preference to a PPI. If concomitant use of a PPI is essential,
avoid omeprazole and use lansoprazole.
See South London Cardiac and Stroke Network “Guidance on Prescribing Gastroprotection
for Patients Taking Clopidogrel” at www.slcsn.nhs.uk
Dipyridamole m/r
capsules (200mg)
Dipyridamole
tablets (100mg)*
*Restricted to patients who cannot swallow m/r capsules
2.9 LIPID-REGULATING DRUGS
Statins
Simvastatin
Pravastatin
Atorvastatin
tablets (10mg, 20mg, 40mg)- 1st line
tablets (10mg, 20mg, 40mg)
tablets (10mg, 20mg, 40mg, 80mg)
Hypercholesterolaemia - ezetimibe (NICE TA132)
Ezetimibe*
tablets (10mg)
* Restricted to use in primary hypercholesterolaemia as an add-on therapy when the
maximum dose of statin does not reduce LDL/total cholesterol levels down to target or
when indicated patients are intolerant of statins.
Fibrates
Bezafibrate
Fenofibrate (micronised)
tablets (200mg)
m/r tablets (400mg)
capsules (200mg)
3.0 RESPIRATORY SYSTEM
3.1 Bronchodilators
3.2 Corticosteroids
3.3 Cromoglicate and related therapy and leukotriene receptor antagonists
3.4 Antihistamines, hyposensitisation, and allergic emergencies
3.5 Mucolytics
3.6 Cough preparations
3.7 Systemic nasal decongestants
Asthma (children under 5) - inhaler devices (NICE TA10)
Steroids, bronchodilators – deliver by a pressurised metered dose inhaler with spacer, using
a facemask if necessary. If this not suitable, consider a nebuliser, or a dry powder inhaler in
the over 3s.
Asthma (older children) - inhaler devices (NICE TA38)
Inhaler choice should reflect patient needs:
Steroids – press-and-breathe inhalers with a spacer recommended first line.
Bronchodilators – a wider choice of inhalers, including easily portable ones.
Chronic asthma (in children) - corticosteroids (NICE TA131)
Inhaled corticosteroids – when indicated, use the least costly suitable product.
Inhaled corticosteroid with long-acting beta-2 agonist – when both indicated, a combination
device may be used; use the least costly suitable option
Chronic asthma (in adults) - corticosteroids (NICE TA138)
Inhaled corticosteroids – the least costly suitable product is recommended when indicated.
Inhaled corticosteroid with long-acting beta-2 agonist – a combination device is a
recommended option; use the least costly. Separate inhalers may be suitable on an
individual basis.
NHS London Respiratory Team-Responsible prescribing messages
When prescribing any inhaled medication, ensure that the patient has undergone patientcentred education about the disease and inhaler technique training by a competent trainer.
When prescribing an MDI (except salbutamol), ensure that a spacer is also prescribed and
will be used.
When prescribing high dose inhaled corticosteroids (>1000mcg BDP equivalent), ensure that
the patient is issued an inhaled steroid safety card
3.1 BRONCHODILATORS
3.1.1 ADRENOCEPTOR AGONISTS
3.1.1.1 SELECTIVE BETA2-AGONISTS
Long acting beta2 agonists
CHM advice for the management of chronic asthma – Formoterol and salmeterol should
only be used in patients who regularly use an inhaled corticosteroid and introduced at a low
dose and effect monitored before considering dose increase
Formoterol fumerate*
(Eformoterol fumerate)
Salbutamol (as sulphate)
turbohaler
(6 micrograms/metered inhalation)
(12 micrograms/metered inhalation)
CFC-free inhaler (100micrograms/metered inhalation)
respirator solutions (1mg/ml, 2.5ml; 2mg/ml, 2.5ml)
easy breathe inhaler (100micrograms/metered
inhalation)
accuhaler (200micrograms)
Terbutaline sulphate
turbohaler (500micrograms/metered inhalation)
respules (5mg/2ml)
Salmeterol*
accuhaler (50micrograms)
CFC-free inhaler (25micrograms/metered inhalation)
3.1.2 ANTIMUSCARINIC BRONCHODILATORS
Ipratropium bromide
Tiotropium*
CFC-free inhaler (20micrograms/metered inhalation)
respirator solution (250micrograms/ml, 1ml,2ml)
inhalation powder (18 micrograms)
3.1.3 THEOPHYLLINE
Aminophylline
Theophylline
m/r tablets (PHYLLOCONTIN CONTINUS®, 225mg)
m/r capsules (SLO-PHYLLIN®, 250mg)
m/r tablets (UNIPHYLLIN CONTINUS®, 200mg 300mg,
400mg)
3.1.4 PEAK FLOW METERS, INHALER DEVICES AND NEBULISERS
Peak flow meters
Peak Flow Meter (standard EU (EN13826) scale)
Drug delivery devices
Aerochamber
Aerochamber child
Aerochamber infant
Babyhaler
Volumatic
3.2 CORTICOSTEROIDS
Beclometasone
CLENIL MODULITE®
Budesonide
SYMBICORT®
Fluticasone
SERETIDE®
CFC free inhaler (50 micrograms/metered inhalation,
dipropionate 100 micrograms/metered inhalation)
200 micrograms/metered inhalation,
250micrograms/metered inhalation)
turbohaler (100micrograms/metered inhalation,
200micrograms/metered inhalation,
400micrograms/metered inhalation)
turbohaler(100/6 micrograms:budesonide 80mcg with
formoterol fumerate 4.5mcg/metered inhalation)
(200/6 micrograms:budesonide 160mcg with
formoterol fumerate 4.5mcg/metered inhalation)
(400/12 micrograms: budesonide 320mcg with
formoterol fumerate 9mcg/metered inhalation)
accuhaler (250, 500micrograms)
CFC-free inhaler (50, 125, 250 micrograms)
accuhaler (50mcg of salmeterol with 100, 250,
500micrograms of fluticasone/inhalation)
CFC-free inhaler (25mcg of salmeterol with 50, 125,
250micrograms of fluticasone/metered inhalation)
3.3 CROMOGLICATE AND RELATED THERAPY, LEUKOTRIENE RECEPTOR ANTAGONISTS,
AND PHOSPHODIESTERASE TYPE-4 INHIBITORS
3.3.1 LEUKOTRIENE RECEPTOR ANTAGONISTS
Montelukast
tablets (10mg)
chewable tablets (4mg, 5mg)
3.4 ANTIHISTAMINES, HYPOSENSITISATION AND ALLERGIC EMERGENCIES
3.4.1 ANTIHISTAMINES
Non-sedating antihistamines
Cetirizine hydrochloride
tablets (10mg)
Fexofenadine hydrochloride
Loratadine
Sedating antihistamines
Chlorphenamine malate
(Chlorpheniramine malate)
Hydroxyzine hydrochloride
Promethazine hydrochloride
oral solution (5mg/5ml)
tablets (180mg)
tablets (10mg)
syrup (5mg/5ml)
tablets (4mg)
syrup (2mg/5ml)
tablets (10mg, 25mg)
syrup (10mg in 5ml)
tablets (10mg, 25mg)
s/f elixir (5mg/5ml)
3.4.3 ALLERGIC EMERGENCIES
Adrenaline (Epinephrine) injection (1 in 1000, 1ml)
minijet (1 in 1000, 1ml)
MHRA Drug Safety Alert
Adrenaline auto-injector advice for patients: after every use, an ambulance should be called
even if symptoms are improving, the individual should lie down with legs raised and, if at all
possible, should not be left alone (July 2014)
Adrenaline (Epinephrine)
3.5 MUCOLYTICS
Carbocisteine
autoinjector
(EPIPEN JUNIOR®: 150micrograms)
(EPIPEN®: 300micrograms)
capsules (375mg)
oral liquid (250mg/5ml)
3.6 COUGH PREPARATIONS
3.6.1 COUGH SUPPRESSANTS
Codeine phosphate
linctus (15mg/5ml)
3.7 SYSTEMIC NASAL DECONGESTANTS
Pseudoephedrine
tablets (60mg)
elixir (30mg/5ml)
4.0 CENTRAL NERVOUS SYSTEM
4.1 Hypnotics and anxiolytics – NOT USED
4.2 Drugs used in psychoses and related disorders – NOT USED
4.3 Antidepressant drugs
4.4 CNS stimulants and drugs used for attention deficit hyperactivity disorder – NOT USED
4.5 Drugs used in the treatment of obesity
4.6 Drugs used in nausea and vertigo
4.7 Analgesics
4.8 Antiepileptic drugs
4.9 Drugs used in parkinsonism and related disorders
4.10 Drugs used in substance dependence – NOT USED
4.11 Drugs for dementia – NOT USED
4.3 ANTIDEPRESSANT DRUGS
BASED ON SW LONDON & ST GEORGE’S MENTAL HEALTH NHS TRUST FORMULARY
4.3.1 TRICYCLIC AND RELATED ANTIDEPRESSANT DRUGS
Tricyclic antidepressants
Amitriptyline hydrochloride
Clomipramine hydrochloride
Imipramine hydrochloride
Lofepramine
Nortriptyline
Trimipramine
Related antidepressants
Trazodone*
tablets (10mg, 25mg, 50mg)
syrup (50mg/5ml)
capsules (10mg, 25mg, 50mg)
tablets (10mg, 25mg)
tablets (70mg)
tablets (10mg, 25mg)
tablets (25mg)
capsules (50mg)
capsules (50mg, 100mg)
liquid (50mg/5ml)
4.3.2 SELECTIVE SEROTONIN RE-UPTAKE INHIBITORS
MHRA Drug Safety Update
Citalopram and escitalopram: QT interval prolongation—new maximum daily dose
restrictions (including in elderly patients), contraindications, and warnings (Dec 2011)
Maximum dose = 40mg,
Maximum dose in patients > 65 years or hepatic impairment = 20mg
Citalopram
tablets (10mg, 20mg)
drops (40mg/ml, 15ml)*
*4 drops (8mg) citalopram drops is equivalent in therapeutic effect to a 10mg tablet
Fluoxetine
capsules (20mg)
liquid (20mg/5ml)
Paroxetine
tablets (20mg, 30mg)
syrup (10mg/5ml)
Sertraline
tablets (50mg, 100mg)
4.3.4 OTHER ANTIDEPRESSANT DRUGS
Mirtazapine
tablets (15mg, 30mg, 45mg)
oro-dispersible tablets (15mg, 30mg, 45mg)
Venlafaxine*
m/r capsules (75mg, 150mg)
tablets (37.5mg, 75mg)
m/r tablets (75mg, 150mg, 225mg)
*Use immediate release 1st line.
4.5 DRUGS USED IN THE TREATMENT OF OBESITY
4.5.1 ANTI-OBESITY DRUGS ACTING ON THE GASTRO-INTESTINAL TRACT
Use in accordance with NICE guidance for obesity-NICE clinical guideline 43
MHRA Drug Safety Update
Orlistat: theoretical interaction with antiretroviral HIV medicines (March 2014)
Orlistat*
capsules (120mg)
*For continuation after 3 months if the patient has lost at least 5% of their initial body
weight. Review after 12 months.
4.6 DRUGS USED IN NAUSEA AND VERTIGO
Antihistamines
Cinnarizine
Cyclizine
Promethazine
Phenothiazines and related drugs
Chlorpromazine hydrochloride
Droperidol
Prochlorperazine
tablets (15mg)
tablets (50mg)
injection (50mg/ml, 1ml)
tablets (10mg, 25mg)
elixir (5mg/5ml)
injection (25mg/ml, 1ml)
tablets (10mg, 25mg, 50mg, 100mg)
syrup (25mg/5ml)
injection (2.5mg/ml, 1ml)
tablets (5mg)
syrup (5mg/5ml)
injection (12.5mg/ml, 1ml)
buccal tablet (3mg)
MHRA Drug Safety Update
Metoclopramide: risk of neurological adverse effects - restricted dose and duration of use
(August 2013)
Domperidone and Metoclopramide
Domperidone
tablets (10mg)
suspension (5mg/5ml)
Metoclopramide hydrochloride
tablets (10mg)
oral solution (5mg/5ml)
injection (5mg/ml, 2ml)
5HT3 antagonists
MHRA Drug Safety Update
Ondansetron: risk of QTc prolongation – important new intravenous dose restriction
(Aug 2012)
Ondansetron
s/f syrup (4mg/5ml)
tablets (4mg, 8mg)
injection (2mg/ml, 2ml; 4mg/ml, 2ml)
Hyoscine
Hyoscine hydrobromide
tablets (300micrograms)
Hyoscine
patches (1mg/72 hours)
Other Drugs for Ménières Disease
Betahistine hydrochloride
tablets (8mg, 16mg)
4.7 ANALGESICS
4.7.1 NON-OPIOID ANALGESICS
Aspirin and compounds containing aspirin
Aspirin
dispersible tablets (75mg, 300mg)
e/c tablets* (75mg, 300mg)
suppositories (300mg)
* Not recommended for initiation
Paracetamol and compounds containing paracetamol
Co-codamol 8/500
tablets (Codeine 8mg, Paracetamol 500mg)
- 1st line formulation
dispersible tablets (Codeine 8mg, Paracetamol 500mg)
Co-codamol 30/500
Co-dydramol 10/500
Paracetamol
tablets (Codeine 30mg, Paracetamol 500mg)
- 1st line formulation
dispersible tablets (Codeine 30mg, Paracetamol
500mg)
tablets (Dihydrocodeine 10mg, Paracetamol 500mg)
tablets (500mg) - 1st line formulation
soluble tablets (500mg)
s/f suspension (120mg/5ml, 250mg/5ml)
suppositories (60mg, 125mg, 240mg, 500mg)
4.7.2 OPIOID ANALGESICS
MHRA Drug Safety Update
Codeine for analgesia: restricted use in children because of reports of morphine toxicity
(July 2013)
Codeine should only be used to relieve acute moderate pain in children older than 12 years
and only if it cannot be relieved by other painkillers such as paracetamol or ibuprofen alone.
Furthermore, a significant risk of serious and life-threatening adverse reactions has been
identified in children with obstructive sleep apnoea who received codeine after
tonsillectomy or adenoidectomy (or both). Codeine is now contraindicated in all children
younger than 18 years who undergo these procedures for obstructive sleep apnoea.
Codeine should not be used by breastfeeding mothers because it can pass to the baby
through breast milk and potentially cause harm.
Buprenorphine
Codeine phosphate
Diamorphine
Dihydrocodeine
Fentanyl
Methadone
Morphine sulphate
patches (TRANSTEC®: 35micrograms, 52.5micrograms,
70micrograms – Change every 4 days)
patches (BUTRANS®: 5micrograms , 10micrograms,
20micrograms - Change every 7 days)
tablets (15mg, 30mg)
syrup (25mg/5ml)
injection (60mg/ml, 1ml)
injection (5mg, 10mg, 30mg, 100mg, 500mg)
tablets (30mg)
liquid (10mg/5ml)
patches
(MATRIX
patches,
12micrograms,
25micrograms,
50micrograms,
75micrograms,
100micrograms)- Change every 3 days
tablets (5mg)
tablets (SEVREDOL®: 10mg, 20mg, 50mg) - 1st line
m/r tablets (MST®: 5mg, 15mg) - 1st line
Oxycodone
Tramadol hydrochloride
m/r capsules (ZOMORPH®: 10mg, 30mg, 60mg, 100mg)
- 1st line
oral solution (10mg/5ml) - 1st line
s/f concentrated oral solution (100mg/5ml)
injection (10mg, 15mg, 30mg)
capsules (5mg, 10mg, 20mg) - 2nd line
m/r tablets ( 5mg, 10mg, 20mg, 40mg, 80mg - 2nd line
injection (10mg/ml, 20mg/2ml) - 2nd line
oral solution (5mg in 5ml) - 2nd line
concentrated oral solution (50mg in 5ml) -2nd line
Pethidine hydrochloride tablets (50mg)
injection (50mg/ml, 1ml, 2ml)
capsules (50mg) - 1st line formulation
dispersible tablets (50mg)
injection (50mg/ml, 2ml)
4.7.3 NEUROPATHIC PAIN
Amitriptyline
Carbamazepine
Gabapentin
Pregabalin
tablets (10mg, 25mg, 50mg)
tablets (100mg, 200mg)
m/r tablets (200mg, 400mg)
s/f liquid (100mg/5ml)
capsules (100mg, 300mg)
capsules (25mg, 50mg, 75mg, 100mg, 150mg, 300mg)
– twice a day dosing is more cost effective
4.7.4 ANTIMIGRAINE DRUGS
4.7.4.1 TREATMENT OF ACUTE MIGRAINE
Sumatriptan
tablets (50mg)
injection (6mg)
nasal spray (10mg/metered spray)
4.7.4.2 PROPHYLAXIS OF MIGRAINE
Clonidine
tablets (25micrograms)
Pizotifen
tablets (500micrograms, 1.5mg)
4.8 ANTIEPILEPTIC DRUGS
4.8.2 DRUGS USED IN STATUS EPILEPTICUS
Clonazepam
injection (1mg/ml)
Diazepam
injection (5mg/ml, 2ml)
injection emulsion (5mg/ml, 2ml)
Midazolam
rectal tubes (2.5mg/1.25ml, 5mg/2.5ml, 10mg/2.5ml)
buccal liquid (10mg/ml, 5ml)
4.9 DRUGS USED IN PARKINSONISM AND RELATED DISORDERS
4.9.1 DOPAMINERGIC DRUGS USED IN PARKINSONISM
Amantadine
capsules (100mg)
Apomorphine hydrochloride
injection (10mg/ml, 5ml) – hospital prescribing only
Co-beneldopa 12.5/50
capsules (MADOPAR® 62.5: Benserazide 12.5mg,
Levodopa 50mg)
dispersible tablets (MADOPAR® 62.5: Benserazide
12.5mg,Levodopa 50mg)
Co-beneldopa 25/100
capsules (MADOPAR® 125: Benserazide 25mg,
Levodopa 100mg)
dispersible tablets (MADOPAR® 125: Benserazide
25mg, Levodopa 100mg)
Co-beneldopa 50/200
capsules (MADOPAR® 250: Benserazide 50mg,
Levodopa 200mg)
Co-beneldopa 25/100
m/r capsules (MADOPAR® CR: Benzerazide 25mg,
Levodopa 100mg)
Co-careldopa 10/100
tablets (SINEMET-110®: Carbidopa 10mg,
Levodopa 100mg)
Co-careldopa 25/100
m/r tablets (HALF SINEMET® CR: Carbidopa 25mg,
Levodopa 100mg)
Co-careldopa 25/250
tablets (SINEMET-275®: Carbidopa 25mg,
Levodopa 250mg)
Co-careldopa 50/200
m/r tablets (SINEMET® CR: Carbidopa 50mg,
Levodopa 200mg)
Co-careldopa 12.5/50
tablets (SINEMET® LS: Carbidopa 12.5mg,
Levodopa 50mg)
Co-careldopa 25/100
tablets (SINEMET-PLUS®: Carbidopa 25mg
Levodopa 100mg)
Entacapone
tablets (200mg)
Pramipexole
tablets (88micrograms, 180 micrograms , 700
micrograms)
Ropinirole
tablets (500micrograms, 1mg, 2mg)
Rotigotine
patches* (2mg, 4mg, 6mg,8mg / 24hours)
Selegiline hydrochloride
tablets (5mg)
STALEVO® 100/25/200
tablets (Levodopa 100mg, Carbidopa 25mg,
Entacapone 200mg)
4.9.2 ANTIMUSCARINIC DRUGS USED IN PARKINSONISM
Procyclidine hydrochloride
tablets (5mg)
syrup (5mg/5ml)
injection (5mg/ml, 2ml)
Trihexyphenidyl hydrochloride
(Benzhexol hydrochloride) tablets (2mg, 5mg)
4.9.3 DRUGS USED IN ESSENTIAL TREMOR, CHOREA, TICS AND RELATED DISORDERS
Haloperidol
tablets (1.5mg, 5mg, 10mg)
capsules (500micrograms
s/f oral liquid (5mg/5ml)
injection (5mg/ml, 1ml)
Primidone (SERB)
tablets (250mg)
5.0 INFECTIONS
5.1 Antibacterial drugs
5.2 Antifungal drugs
5.3 Antiviral drugs
5.4 Antiprotozoal drugs
5.5 Anthelmintics
Refer to Primary Care CCG Infections Guidelines for Adults and Children as appropriate.
5.1 ANTIBACTERIAL DRUGS
5.1.1 PENICILLINS
5.1.1.1 BENZYLPENICILLIN AND PHENOXYMETHYLPENICILLIN
Benzylpenicillin
injection (600mg, 1.2g)
Phenoxymethylpenicillin
tablets (250mg)
oral solution (125mg/5ml, 250mg/5ml)
5.1.1.2 PENICILLINASE-RESISTANT PENICILLINS
Flucloxacillin
capsules (250mg, 500mg)
syrup (125mg/5ml, 250mg/5ml)
injection (250mg, 500mg)
5.1.1.3 BROAD-SPECTRUM PENICILLINS
Amoxicillin
capsules (250mg, 500mg)
s/f suspension (125mg/5ml, 250mg/5ml)
s/f sachets (3g)
injection (500mg)
Co-amoxiclav is not recommended for 1st line use
Co-amoxiclav 250/125
tablets (Amoxicillin 250mg, Clavulanic acid 125mg)
Co-amoxiclav 500/125
tablets (Amoxicillin 500mg, Clavulanic acid 125mg)
Co-amoxiclav 250/62
s/f suspension (Amoxicillin 250mg, Clavulanic acid
62mg/5ml)
Co-amoxiclav 125/31
s/f suspension (Amoxicillin 125mg, Clavulanic acid
31mg/5ml
Co-amoxiclav
injection* (600mg [Amoxicillin 500mg, Clavulanic acid
100mg)
5.1.2 CEPHALOSPORINS, CARBAPENEMS AND OTHER BETA-LACTAMS
5.1.2.1 CEPHALOSPORINS
Cefalexin is not recommended for 1st line use except for UTI in pregnancy
Cefalexin
capsules (250mg, 500mg)
Cefotaxime
Ceftriaxone
Cefuroxime
s/f syrup (125mg/5ml, 250mg/5ml)
injection (500mg, 1g, 2g)
injection (250mg, 1g, 2g)
injection (250mg, 750mg, 1.5g)
5.1.3 TETRACYCLINES
Doxycycline*
capsules (100mg)
dispersible tablets (100mg)
Oxytetracycline*
tablets (250mg)
*In dermatology, 1st line oxytetracycline, 2nd line doxycycline
Lymecycline
capsules (408mg)
5.1.4 AMINOGLYCOSIDES
Gentamicin
5.1.5 MACROLIDES
Clarithromycin
Erythromycin stearate
Ethylsuccinate
Azithromycin*
injection (10mg/ml, 2ml; 40mg/ml, 2ml)
tablets (250mg, 500mg)
suspension (125mg/5ml, 250mg/5ml)
injection (500mg)
tablets (250mg)
suspension (125mg/5ml, 250mg/5ml, 500mg/5ml)
capsules (250mg)
suspension (200mg/5ml)
*Restricted to:
The treatment of chlamydial infections of the genital system;
The treatment of H. influenzae infections causing otitis media, acute lung infections in
children and those with COPD;
Patients with failed compliance or severe intolerance of erythromycin, or in patients
requiring a macrolide who cannot withhold the use of medicines that have significant
interactions with erythromycin and clarithromycin.
5.1.6 CLINDAMYCIN
Clindamycin
capsules (75mg, 150mg)
syrup (75mg/5ml)*
*Restricted to patients who cannot swallow capsules
5.1.7 SOME OTHER ANTIBACTERIALS
Linezolid*
tablets (600mg) – hospital prescribing only
*Restricted to microbiology recommendation only
5.1.8 SULPHONAMIDES AND TRIMETHOPRIM
Trimethoprim
tablets (100mg, 200mg)
s/f suspension (50mg/5ml)
5.1.9 ANTITUBERCULOUS DRUGS
Ethambutol
Isoniazid
tablets (100mg, 400mg)
tablets (100mg)
elixir* (50mg in 5ml)
*Restricted to patients who cannot swallow tablets
injection (25mg/ml, 2ml)
Pyrazinamide
tablets (500mg)
Rifampicin
capsules (150mg, 300mg)
syrup (100mg/5ml)
infusion (600mg vial)
Rifabutin
capsules (150mg)
RIFATER®
tablets
(Rifampicin
120mg,
Isoniazid
Pyrazinamide 300mg)
RIFINAH® 150/100
tablets (Rifampicin 150mg, Isoniazid 100mg)
RIFINAH® 300/150
tablets (Rifampicin 300mg, Isoniazid 150mg)
5.1.10 ANTILEPROTIC DRUGS
Dapsone
50mg,
tablets (50mg, 100mg) – hospital prescribing only
5.1.11 METRONIDAZOLE AND TINIDAZOLE
Metronidazole
tablets (200mg, 400mg)
suspension (200mg/5ml)
suppositories (500mg, 1g)
infusion (500mg in 100ml)
Tinidazole*
tablets (500mg)
* Restricted to use by gastroenterology only
5.2.12 QUINOLONES
Ciprofloxacin*
tablets (250mg, 500mg)
suspension (250mg/5ml)
infusion (2mg/ml, 50ml, 100ml, 200ml)
* Restricted to microbiology recommendation only
Moxifloxacin*
tablets (400mg) – hospital prescribing only
* Restricted to TB patients who are resistant or unable to take isoniazid and ophthalmology
for exogenous endophthalmitis
Ofloxacin
tablets (200mg, 400mg)
5.1.13 URINARY-TRACT INFECTIONS
MHRA Drug Safety Update
Nitrofurantoin- reminder on precautions for use, especially renal impairment in (elderly
patients)-August 2013
Nitrofurantoin
capsules (50mg, 100mg) – 2nd Line*
s/f suspension (25mg/5ml)
* Trimethoprim (see Section 5.1.8) is 1st line
5.2 ANTIFUNGAL DRUGS
Fluconazole
Itraconazole
Miconazole
Nystatin
Terbinafine
capsules (50mg, 150mg, 200mg)
suspension (50mg/5ml)
capsules (100mg)
liquid (50mg/5ml)
s/f oral gel (24mg/ml, 80g)
suspension (100,000units/ml)
tablets (250mg)
5.3 ANTIVIRAL DRUGS
5.3.2 HERPESVIRUS INFECTIONS
5.3.2.1 HERPES SIMPLEX AND VARICELLA-ZOSTER INFECTION
Aciclovir
tablets/dispersible tablets (200mg, 400mg, 800mg)
– 1st line
s/f suspension (200mg/5ml)
Valaciclovir
tablets (500mg)
5.5 ANTHELMINTICS
5.5.1 DRUGS FOR THREADWORMS
Mebendazole
chewable tablets (100mg)
5.5.2 ASCARICIDES (common roundworm infections)
Mebendazole
chewable tablets (100mg)
5.5.4 DRUGS FOR HOOKWORMS
Mebendazole
chewable tablets (100mg
5.5.5 SCHISTOSOMICIDES (bilharziasis)
Praziquantel
tablets (500mg)
5.5.6 FILARICIDES
Ivermectin
tablets (3mg)
5.5.7 DRUGS FOR CUTANEOUS LARVA MIGRANS (creeping eruption)
Albendazole
tablets (400mg)
6.0 ENDOCRINE SYSTEM - CHAPTER
6 6.1 Drugs used in diabetes
6.2 Thyroid and antithyroid drugs
6.3 Corticosteroids
6.4 Sex hormones
6.5 Hypothalamic and pituitary hormones and anti-oestrogens
6.6 Drugs affecting bone metabolism
6.1 DRUGS USED IN DIABETES
6.1.1 INSULINS
6.1.1.1 SHORT ACTING INSULINS
Soluble Insulin
Insulin Aspart
Insulin Lispro
(HUMAN ACTRAPID®, 10ml vials)
(HUMULIN S®, 10ml vials)
(NOVORAPID®, 10ml vials)
(NOVORAPID®, 3ml cartridges for NOVOPEN® )
(NOVORAPID FLEXPEN®, 3ml prefilled disposable pens)
(HUMALOG®, 10ml vials)
6.1.1.2 INTERMEDIATE AND LONG-ACTING INSULINS
Long acting insulins
Intermediate acting insulins
Isophane Insulin
(INSULATARD®, 10ml vials)
(INSULATARD®, 3ml cartridges for NOVOPEN®)
(INSULATARD INNOLET®, 3ml prefilled disposable injection
devices)
(HUMULIN I®, 10ml vials)
Diabetes (types 1 and 2) - long acting insulin analogues (NICE TA53)
Long acting insulins Use in type 2 diabetes as per NICE CG 87
Insulin Detemir*
Insulin Glargine
(LEVEMIR®, 3ml cartridges for NOVOPEN®)
(LEVEMIR FLEXPEN®, 3ml prefilled disposable pens)
(LANTUS®, 10ml vials)
(LANTUS®, 3ml cartridges for for AUTOPEN®
CLIKSTAR®)
(LANTUS SOLOSTAR®, 3ml prefilled disposable pens)
AND
Biphasic Insulins (also intermediate acting)
Biphasic Insulin Aspart
Biphasic Insulin Lispro
Biphasic Isophane Insulin
(NOVOMIX® 30, 3ml cartridges for NOVOPEN® )
(NOVOMIX 30 FLEXPEN® , 3ml prefilled disposable pens)
(HUMALOG® Mix25, 10ml vials)
(HUMALOG® Mix50 KwikPen, 3ml prefilled disposable pens)
(HUMULIN M3®, 10ml vials)
(HUMULIN M3®, 3ml cartridges)
(HUMULIN M3 KwikPen®, 3ml prefilled disposable pens)
6.1.1.3 HYPODERMIC EQUIPMENT
Autopen 24 injection Device
*Reusable injection device for 3ml cartridges (2-42 units)
*For use with insulin glargine cartridges
6.1.2 ANTIDIABETIC DRUGS
6.1.2.1 SULPHONYLUREAS
tablets (80mg) – 1st line
m/r tablets* (30mg)
* Restricted for patients when drug concordance is a problem
Gliclazide
6.1.2.2 BIGUANIDES
Metformin
tablets (500mg, 850mg) – 1 st line
m/r tablets* (500mg)
* Restricted for patients with intolerable GI side effects
6.1.2.3 OTHER ANTIDIABETIC DRUGS
Type 2 diabetes - Dapagliflozin combination therapy (TA288)
Dapagloflozin
tablets (5mg,10mg)
Pioglitazone for type 2 diabetes mellitus
MHRA Drug Safety Update Insulin combined with pioglitazone: risk of cardiac failure (Jan 2011)
MHRA Drug Safety Update Pioglitazone: risk of bladder cancer (Aug 2011)
Pioglitazone*
tablets (15mg, 30mg)
*Not for new initiations – and only continue after a full risk assessment
Diabetes (type 2) - exenatide (prolonged release) (NICE TA248)
Exenatide*
injection (5 microgram & 10 microgram prefilled pen)
m/r injection (2mg)
*To be prescribed in line with NICE criteria
Diabetes (type 2) - liraglutide (NICE TA203)
Liraglutide*
injection (6mg/ml; 3ml prefilled pen)
*To be prescribed in line with NICE criteria as per local agreed guidance for Anti-diabetic Agents for
Type 2 Diabetes
MHRA Drug Safety Update Dipeptidylpeptidase-4 inhibitors (‘gliptins’): risk of acute pancreatitis
(Sept 2012)
Sitagliptin
tablets (25mg, 50mg, 100mg)
6.1.3 TREATMENT OF HYPOGLYCAEMIA
Glucagon
Glucose
Glucose
injection (1 unit)
injection (20%, 100ml)
powder
gel (23g)
6.1.4 TREATMENT OF DIABETIC NEPHROPATHY AND NEUROPATHY
Duloxetine
capsules (60mg)
6.1.6 DIAGNOSTIC AND MONITORING AGENTS FOR DIABETES MELLITUS
Blood glucose monitoring test strips
GLUCORx NEXUS®
Patient meter
Urinalysis
ALBUSTIX®
COMBUR-3®
COMBUR-7®
COMBUR-9®
KETOSTIX
MULTISTIX 8SG/GP®
NOVA STATSTRIP®
(Protein)
(Glucose, ketones, protein)
(Leucocytes, nitrite, pH, glucose, protein, blood, ketones)
(Glucose, ketones, protein, pH, blood, urobilinogen, nitrite,
bilirubin, leucocytes)
(Glucose, ketones)
(Leucocytes, nitrite, pH, glucose, protein, blood, ketones,
specific gravity)
(Ketones, glucose)
Oral glucose tolerance test
POLYCAL® ORANGE
drink (200ml)
6.2 THYROID AND ANTITHYROID DRUGS
6.2.1 THYROID HORMONES
Levothyroxine sodium (thyroxine)
Liothyronine sodium*
tablets (25micrograms, 50micrograms, 100micrograms)
tablets (20micrograms)
injection (20micrograms)
* Restricted to endocrinologist use only
ANTITHYROID DRUGS
Aqueous iodine
Carbimazole
Propylthiouracil
oral solution (Syn: Lugol's solution)
tablets (5mg, 20mg)
tablets (50mg)
For propranolol see section 2.4
6.3 CORTICOSTEROIDS
6.3.1 REPLACEMENT THERAPY
Fludrocortisone acetate
tablets (100micrograms)
6.3.2 GLUCOCORTICOID THERAPY
Betamethasone sodium phosphate
soluble tablets (500micrograms)
injection (4mg/ml, 1ml)
Dexamethasone
tablets (500micrograms, 2mg)
injection (3.3mg/ml, 1ml)
sugar free oral solution (2mg/5ml)
Hydrocortisone
tablets (10mg, 20mg)
Hydrocortisone acetate
injection (25mg/ml, 1ml) ◪
Hydrocortisone sodium phosphate
injection (100mg/ml, 1ml)
Hydrocortisone sodium succinate
injection (100mg)
Methylprednisolone acetate
depot injection (40mg/ml, 1ml, 2ml,)
Methylprednisolone acetate
depot injection (40mg/ml with lignocaine 10mg/ml; 1ml,
2ml)
Methylprednisolone sodium succinate injection (40mg, 500mg, 1g)
Methylprednisolone
tablets (100mg)
Prednisolone
tablets (1mg, 5mg, 25mg)
e/c tablets* (2.5mg, 5mg)
soluble tablets (5mg)
* For use only in exceptional circumstances – use plain tablets only
Triamcinolone acetonide
injection (10mg/ml, 40mg/ml, 1ml)
6.4 SEX HORMONES
6.4.1 FEMALE SEX HORMONES AND THEIR MODULATORS
6.4.1.1 OESTROGENS AND HRT
ELLESTE-DUET®
Estradiol (oestradiol)
Estradiol (oestradiol)
tablets (1mg)
tablets (1mg, 2mg)
once a week
patches (FEMSEVEN®, 50micrograms/24 hours)
Ethinylestradiol
tablets (2micrograms)
Raloxifene*
tablets (60mg)
*Restricted to post menopausal women at risk of vertebral fractures who are not suitable for other
treatments.
6.4.1.2 PROGESTOGENS AND PROGESTERONE RECEPTOR MODULATORS
Medroxyprogesterone
Medroxyprogesterone acetate
Norethisterone
Progesterone
tablets (5mg, 10mg)
injection (150mg/ml, 1ml)
tablets (5mg) ◪
pessaries (200mg, 400mg, may be used vaginally or rectally)
6.4.2 MALE SEX HORMONES AND ANTAGONISTS
SUSTANON 250®
injection (Testosterone propionate 30mg, testosterone
phenylpropionate 60mg, testosterone isocaproate 60mg/ml,
testosterone decanoate 100mg/ml)
Testosterone (Testogel®)
gel sachets (50mg/5g)
Testosterone enantate
Testosterone (Nebido®)
oily injection 250mg
injection (testosterone undecanoate 250mg/ml, 4ml vial)*
*Restricted to use in patients that have either failed on Sustanon® or require a smoother drug
profile to reduce side effects
Antiandrogens
Finasteride
tablets (5mg)
6.4.3 ANABOLIC STEROIDS
Oxandrolone*
tablets (2.5mg)
*Restricted to use in paediatrics only
6.5 HYPOTHALAMIC & PITUITARY HORMONES & ANTI-OESTROGENS
6.5.1 HYPOTHALAMIC & ANTERIOR PITUITARY HORMONES & ANTI-OESTROGENS
Anti-Oestrogens
Clomifene citrate
tablets (50mg)
Anterior Pituitary Hormones
Corticotrophins
Tetracosactide acetate
(Tetracosactrin)
injection (250micrograms/ml, 1ml)
Tetracosactide acetate with zinc depot
(Tetracosactrin)
injection (1mg/ml, 1ml)
6.5.2 POSTERIOR PITUITARY HORMONES AND ANTAGONISTS
Posterior Pituitary Hormones
Argipressin
(Synthetic Vasopressin)
Desmopressin acetate
Terlipressin
injection (20 units/ml, 1ml)
injection (4micrograms/ml, 1ml)
tablets (200micrograms)
sublingual tablets (120micrograms)
nasal spray (10 micrograms/spray)
injection (1mg in 8.5ml)
Antidiuretic Hormone Antagonists
Demeclocycline
capsules (150mg)
6.6 DRUGS AFFECTING BONE METABOLISM
6.6.1 CALCITONIN AND PARATHYROID HORMONE
Calcitonin (Salmon)(Salcatonin)
Teriparatide (Forsteo®)*
injection (200 units/ml, 2ml)
s/c injection (250micrograms/ml, 3ml prefilled pen)
* Restricted to use by Consultant Rheumatolgists Only.
6.6.2 BISPHOSPHONATES AND OTHER DRUGS AFFECTING BONE METABOLISM
Osteoporosis - primary prevention (NICE TA160)
Osteoporosis - secondary prevention including strontium ranelate (NICE TA161)
MHRA Drug Safety Update
Bisphosphonates: atypical femoral fractures (Jun 2011
Alendronic acid
tablets (70mg) – 1st line bisphosphonate for Osteoporosis,
prescribe 70mg weekly dose
Risedronate sodium
tablets (5mg, 35mg) – 2nd line bisphosphonate for
osteoporosis, prescribe 35mg weekly dose
MHRA Drug Safety Update
Denosumab: fatal cases of severe symptomatic hypocalcaemia, and risk of hypocalcaemia at any
time during treatment – monitoring recommended (Oct 2012)
MHRA Drug Safety Update
Denosumab 60 mg: rare cases of atypical femoral fracture with long-term use
Osteoporotic fractures - denosumab (NICE TA204)
Denosumab subcutaneous
injection (60mg/ml, 1ml prefilled syringe)
MHRA Drug Safety Update
Strontium ranelate (Protelos): should not be used in patients with current or previous venous
thromboembolism (VTE) or temporary or permanent immobilisation because of risk of VTE. Rare
serious skin reactions may occur within the first week of treatment (May 2012)
Strontium ranelate*
sachets (2g) Not for initiation
*Restricted to patients intolerant to or contra-indicated to alendronate or risedronate
MHRA Drug Safety Update
Strontium ranelate (Protelos): risk of serious cardiac disorders—restricted indications, new
contraindications, and warnings (April 2013)
European Medicines Agency recommends that Protelos/Osseor remain available but with further
restrictions
6.7 OTHER ENDOCRINE DRUGS
6.7.1 BROMOCRIPTINE AND OTHER DOPAMINERGIC DRUGS
Cabergoline
tablets (500micrograms)
7.0 OBSTETRICS, GYNAECOLOGY AND URINARY-TRACT DISORDERS - CHAPTER 7
7.2 Treatment of vaginal and vulval conditions
7.3 Contraceptives
7.4 Drugs for genito-urinary disorders
7.2 TREATMENT OF VAGINAL AND VULVAL CONDITIONS
7.2.1 PREPARATIONS FOR VAGINAL AND VULVAL CHANGES
Topical HRT Estriol (oestriol)
Estradiol (oestradiol)
PREMARIN®
intravaginal cream (0.01%, 80g)
vaginal tablets (10micrograms)
vaginal cream
(Conjugated oestrogens 625micrograms/g, 42.5g)
7.2.2 VAGINAL AND VULVAL INFECTIONS
Fungal Infections Preparations for vaginal and vulval candidiasis
Clotrimazole
cream (1%, 20g)
pessaries (100mg, 200mg, 500mg)
Miconazole nitrate
intravaginal cream (2%, 78g)
Econazole nitrate
single dose pessary (150mg)*
* Restricted to GU medicine only Other Infections
Clindamycin
Lactic acid 4.9%/glycogen 0.1%
Metronidazole (ZIDOVAL®)
cream (2%, 40g)
vaginal gel (5ml)
vaginal gel (0.75%, 40g)
7.3 CONTRACEPTIVES
7.3.1 COMBINED HORMONAL CONTRACEPTIVES
MHRA Drug Safety Update
Combined hormonal contraceptives and venous thromboembolism: review confirms risk is small—
consider risk factors and remain vigilant for signs and symptoms
MHRA Drug Safety Update
St John’s wort: interaction with hormonal contraceptives, including implants—reduced
contraceptives, including implants – reduced contraceptive effect (March 2014)
Oral (low and standard strength)
Monophasic
Ethinylestradiol 20micrograms,
Desogestrel 150micrograms
tablets
Ethinylestradiol 20micrograms,
Norethisterone acetate 1mg
tablets
Ethinylestradiol 30micrograms,
Desogestrel 150micrograms
tablets
Ethinylestradiol 30micrograms,
Gestodene 75micrograms
tablets
Ethinylestradiol 30micrograms,
Levonorgestrel 50micrograms
tablets
Ethinylestradiol 30micrograms,
Norethisterone acetate 1.5mg
tablets
Ethinylestradiol 35micrograms,
Norgestimate 250micrograms
tablets
Ethinylestradiol 35micrograms,
Norethisterone 500micrograms
tablets
Monophasic every day
Ethinylestradiol 30micrograms,
Levonorgestrel 150micrograms
tablets +7 inactive
Phasic
Ethinylestradiol 30/40/30 micrograms,
Levonorgestrel 50/75/125micrograms
tablets
7.3.2 PROGESTOGEN-ONLY CONTRACEPTIVES
7.3.2.1 ORAL PROGESTOGEN-ONLY CONTRACEPTIVES
Desogestrel 75micrograms
Norethisterone 350micrograms
tablets
tablets
7.3.2.2 PARENTERAL PROGESTOGEN-ONLY CONTRACEPTIVES
Long-acting reversible contraceptive
DEPO-PROVERA®
NEXPLANON®
injection (Medroxyprogesterone acetate 150mg/ml, 1ml)
subdermal implant (Etonogestrel 68mg/rod)
7.3.2.3 INTRA-UTERINE PROGESTOGEN-ONLY DEVICE
MIRENA®
intra uterine system
(Levonorgestrel 20 micrograms/24 hours)
7.3.3 SPERMICIDAL CONTRACEPTIVES
GYGEL®
gel (Nonoxinol "9"2%, 30g)
7.3.4 CONTRACEPTIVE DEVICES
Intra-Uterine Devices
MULTILOAD® CU375
NOVA-T® 380
T-SAFE® CU 380 A
TT 380® Slimline
7.3.5 EMERGENCY CONTRACEPTION
Levonorgestrel 1.5mg tablet
Ulipristal acetate 30mg tablet
7.4 DRUGS FOR GENITO-URINARY DISORDERS
7.4.1 DRUGS FOR URINARY RETENTION
Alpha-blockers
Alfuzosin hydrochloride
Tamsulosin hydrochloride
m/r tablets (10mg)
m/r capsules (400micrograms)
7.4.2 DRUGS FOR URINARY FREQUENCY, ENURESIS, AND INCONTINENCE
Urinary Incontinence
1st line
Oxybutynin
Tolterodine
tablets (2.5mg, 5mg)
syrup (2.5mg/5ml)
tablets (1mg, 2mg)
2nd line
Fesoterodine
Oxybutynin
Tolterodine
Trospium
Trospium
Solifenacin
Oxybutynin
*Restricted to patients who respond
anticholinergic agents
m/r tablets (4mg, 8mg)
m/r tablets (5mg, 10mg)
m/r capsules (4mg)
m/r capsules (60mg)
tablets (20mg)
tablets (5mg, 10mg) Not for initiation
patches (36mg [released at 3.9mg/24hours])*
to, but are intolerant of, oral oxybutynin or other oral
Overactive bladder - mirabegron (NICE TA290)
Mirabegron
tablets (25mg, 50mg)
(if anti-muscarinics are unsuitable)
7.4.3 DRUGS USED IN UROLOGICAL PAIN
Alkalinisation of urine
Potassium citrate
mixture BP (Potassium Citrate 30%, Citric acid monohydrate
5%, in a suitable vehicle with a lemon flavour)
capsules (500mg)
powder (100g)
Sodium bicarbonate
7.4.4 BLADDER INSTILLATIONS AND UROLOGICAL SURGERY
Urological surgery
Glycine
Formalin (buffered)
irrigation
10%
solution (1.5%, 3litre)
solution (60ml container drawn up into 50ml bladder
syringe)
Maintenance of indwelling urinary catheters
Catheter patency solutions
Sodium chloride 0.9%
Solution G
sachets (URO-TAINER M®, 100ml)
sachets (URO-TAINER® TWIN SUBY G; citric acid 3.23%,
magnesium oxide 0.38%, sodium bicarbonate 0.7%,
disodium edentate 0.01%, 2 x 30ml)
7.4.5 DRUGS FOR ERECTILE DYSFUNCTION
In accordance with current Department of Health prescribing guidance on impotence treatments.
Drug treatments for erectile dysfunction may only be prescribed on the NHS under certain
circumstances. Arrangements are in place for when the condition is causing severe distress. The
following criteria should be considered when assessing distress:
 Significant disruption to normal social and occupational activities
 A marked effect on mood, behaviour, social and environmental awareness
 A marked effect on interpersonal relationships.
Alprostadil
Alprostadil
Alprostadil
injection (CAVERJECT®; 40micrograms)
dual chamber cartridges (CAVERJECT® DUAL CHAMBER;
10micrograms, 20micrograms)
urethral application (MUSE®; 250micrograms,
500micrograms, 1mg)
Phosphodiesterase type-5 inhibitors
Sildenafil
Tadalafil
DOH advise one PDE-5 inhibitor a week
tablets (25mg, 50mg, 100mg) - 1st line
tablets (10mg, 20mg)
8.0 MALIGNANT DISEASE AND IMMUNOSUPPRESSION
8.2 Drugs affecting the immune response
8.3 Sex hormones and hormone antagonists in malignant disease
8.2 DRUGS AFFECTING THE IMMUNE RESPONSE
8.2.1 ANTIPROLIFERATIVE IMMUNOSUPPRESSANTS
Azathioprine
Mycophenolate mofetil
tablets (25mg, 50mg)
capsules (250mg)
tablets (500mg)
suspension (1g/5ml)
8.2.2 CORTICOSTEROIDS AND OTHER IMMUNOSUPPRESSANTS
Ciclosporin (Cyclosporin)
capsules (NEORAL; 25mg, 50mg, 100mg)
DEXCEL; 25mg, 50mg, 100mg) 1st line for new patients
8.3 SEX HORMONES AND HORMONE ANTAGONISTS IN MALIGNANT DISEASE
8.3.4.2 GONADORELIN ANALOGUES & GONADOTROPHIN-RELEASING HORMONE ANTAGONISTS
Gonaderelin analogues
Goserelin
Leuprorelin acetate
Bicalutamide
Cyproterone acetate
implant (3.6mg)
injection (3.75mg)
tablets (50mg, 150mg)
tablets (50mg)
9.0 NUTRITION AND BLOOD - CHAPTER 9
9.1 Anaemias and some other blood disorders
9.2 Fluids and electrolytes
9.3 Intravenous nutrition
9.4 Oral nutrition
9.5 Minerals
9.6 Vitamins
9.7 Bitters and tonics
9.8 Metabolic disorders
9.1 ANAEMIAS AND SOME OTHER BLOOD DISORDERS
9.1.1 IRON-DEFICIENCY ANAEMIAS
9.1.1.1 ORAL IRON
Ferrous fumarate
Ferrous sulfate
Sodium feredetate (ironedetate)
tablets (210mg, equivalent to 68mg iron) -1st line
syrup (140mg/5ml, equivalent to 45mg iron/5ml)
tablets (200mg, equivalent to 65mg iron)
s/f elixir (SYTRON® 190mg/5ml, equivalent to 27.5mg
iron/5ml)
9.1.2 DRUGS USED IN MEGALOBLASTIC ANAEMIAS ◪
Cyanocobalamin
Folic acid
Hydroxocobalamin
tablets (50micrograms)
tablets (400micrograms, 5mg)
s/f syrup (2.5mg/5ml)
injection (1mg/ml, 1ml)
9.2 FLUIDS AND ELECTROLYTES
9.2.1 ORAL PREPARATIONS FOR FLUID AND ELECTROLYTE IMBALANCE
9.2.1.1 ORAL POTASSIUM
Potassium chloride
m/r tablets (600mg, 8mmol K+ , 8mmol Cl - /tablet)
s/f syrup (KAY-CEE-L® 75mg/ml, 1mmol K+ and Cl - /ml)
SANDO-K® effervescent tablets (K+ 470mg, 12mmol K+ and
8mmol Cl - /tablet)
Management of hyperkalaemia
Calcium polystyrene sulphonate
powder (CALCIUM RESONIUM®; 300g)
9.2.2 PARENTERAL PREPARATIONS FOR FLUID AND ELECTROLYTE IMBALANCE
9.2.2.1 ELECTROLYTES AND WATER
Intravenous sodium
Sodium chloride
Sodium chloride 0.18%
intravenous infusion
Sodium chloride 0.45%
intravenous infusion
Sodium chloride 0.9%
intravenous infusion
intravenous infusion
intravenous infusion
intravenous infusion
Sodium chloride 1.8%
intravenous infusion
(500ml; containing 15mmol each of Na+ and Cl- )
(500ml; containing 37.5mmol each of Na+ and Cl- )
(100ml; containing 15mmol each of Na+ and Cl- )
(250ml; containing 37.5mmol each of Na+ and Cl- )
(500ml; containing 75mmol each of Na+ and Cl- )
(1000ml; containing 150mmol each of Na+ and Cl- )
(500ml; containing 150mmol each of Na+ and Cl- )
Sodium chloride and glucose
Sodium chloride 0.9% and Glucose 5%
intravenous infusion
Sodium chloride 0.45% and Glucose 2.5%
intravenous infusion
(500ml, 1000ml)
(500ml)
Compound sodium lactate
Compound sodium lactate (Syn: Hartmanns)
intravenous infusion
intravenous infusion
(500ml; containing 65.5mmol Na+ , 2.5mmol K+ ,
1mmol Ca2+, 14.5mmol HCO3 - , 55.5mmol Cl- )
(1000ml; containing 131mmol Na + , 5mmol K + ,
2mmol Ca 2+ , 29mmol HCO3 - , 111mmol C1 - )
Intravenous glucose
Glucose 5%
Glucose 10%
Glucose 20%
Glucose 50%
intravenous infusion
intravenous infusion
intravenous infusion
intravenous infusion
Intravenous potassium
Potassium chloride and glucose
Potassium Chloride 0.15% and Glucose 5%
(50ml, 100ml, 250ml, 500ml, 1000ml)
(500ml, 1000ml)
(500ml)
(500ml)
intravenous infusion
(500ml; containing 10mmol each of K+ and Cl- )
(1000ml; containing 20mmol each of K+ and Cl- )
Potassium Chloride 0.3% and Glucose 5%
intravenous infusion
(1000ml; containing 40mmol each of K+ and Cl - )
Potassium chloride and sodium chloride
Potassium chloride 0.15% and Sodium chloride 0.9%
intravenous infusion
(500ml; containing 10mmol K+ , 75mmol Na+ , and
85mmol Cl- )
(1000ml; containing 20mmol K+ , 150mmol Na+ and
170mmol Cl- )
Potassium chloride 0.3% and Sodium chloride 0.9%
intravenous infusion
(1000ml; containing 40mmol K+ , 150mmol Na+ and
190mmol Cl- )
Potassium chloride 0.45% and Sodium chloride 0.9%
intravenous infusion
(1000ml; containing 30mmol K+ , 75mmol Na+ , and
105mmol Cl- )
Potassium chloride 0.6% and Sodium chloride 0.9%
intravenous infusion
(500ml; containing 40mmol K+ , 75mmol Na+ , and
115mmol Cl- )
Potassium chloride, sodium chloride and glucose
Potassium chloride 0.15%, Sodium chloride 0.45% and Glucose 5%
intravenous infusion
(500ml; containing 10mmol K + , 37.5mmol Na+ ,
and 10mmol Cl - )
Bicarbonate and lactate
Sodium bicarbonate
intravenous infusion
intravenous infusion
(1.26%, 500ml; containing 75mmol each of Na+ and
HCO3 - )
(8.4%, 200ml; containing 200mmol each of Na+ and
HCO3 - )
Injections
Sodium bicarbonate
Sodium chloride
9.5 MINERALS
injection (MINIJET®syringe; 8.4%, 10ml) UNLIC
injection (4,2%, 10ml) injection (8.4%, 10ml)
injection (0.9%, 5ml, 10ml)
injection (30%, 10ml) UNLIC THAM
injection (Trometamol 7.2%, 5ml)
9.5.1 CALCIUM AND MAGNESIUM
9.5.1.1 CALCIUM SUPPLEMENTS
Oral preparations
Calcium carbonate
tablets (CALCICHEW®1.25g; containing 500mg calcium or
12.5mmol Ca2 + /tablet)
effervescent tablets (CACIT®, 1.25g; containing 500mg
calcium or 12.5mmol Ca2 + /tablet)
9.6 VITAMINS
9.6.2 VITAMIN B GROUP
Hydroxocobalamin
injection (1mg/ml, 1ml)
9.6.4 VITAMIN D
Alfacalcidol
capsules (250nanograms, 1microgram)
oral drops (2micrograms/ml) UNLIC
Colecalciferol (Dekristol)
Colecalciferol (Pro D3)
Colecalciferol (Desunin)
capsules (20,000units) Contains peanut oil
capsules (20,000 units) For patients with a peanut allergy
tablets (800 units) UNLIC
injection (300,000units/ml, 1ml) UNLIC
solution (3000units/ml)
With calcium
ADCAL-D3®
tablets (Calcium carbonate 1.5g[600mg calcium]
colecalciferol 10micrograms [400 units]/tablet)
ADCAL-D3® DISSOLVE
effervescent (Calcium carbonate 1.5g[600mg calcium]
tablets* (colecalciferol 10micrograms [400 units]/tablet)
*Restricted for patients with enteral tubes or with swallowing problems
CALCICHEW-D3® FORTE
tablets (Calcium carbonate 1.25g [500mg calcium]
colecalciferol 10micrograms [400units]/tablet)
9.6.6 VITAMIN K
Menadiol sodium phosphate
tablets (10mg)
Emergencies Phytomenadione injection (KONAKION® MM 10mg/ml, 1ml)*
*By slow IV injection or intravenous infusion in 50ml glucose 5%. (Not for IM injection)
Phytomenadione
injection (KONAKION® MM Paediatric 10mg/ml, 0.2ml)*
*For oral, IM or IV injection
10.0 MUSCULOSKELETAL AND JOINT DISEASES
10.1 Drugs used in rheumatic diseases and gout
10.2 Drugs used in neuromuscular disorders
10.3 Drugs for the treatment of soft-tissue disorders and topical pain relief
10.1.1 NON-STEROIDAL ANTI-INFLAMMATORY DRUGS (For other analgesics see section 4.7)
MHRA advice for all NSAIDs
Due to the CV risk and GI toxicity, all NSAIDS including COX 2 inhibitors should be prescribed at the
lowest effective dose and for the shortest duration.
The decision to prescribe an NSAID should be based on an assessment of a patient’s individual risk
factors, including any history of cardiovascular and gastrointestinal illness.
Naproxen and low-dose ibuprofen are considered to have the most favourable thrombotic
cardiovascular safety profiles of all non-selective NSAIDs
A patient’s need for symptomatic relief and response to treatment should be re-evaluated
periodically
MHRA Drug Safety Update
Diclofenac: new contraindications and warnings after a Europe-wide review of cardiovascular safety
(July 2013)
Ibuprofen
Naproxen
tablets (200mg, 400mg) - 1 st Line NSAID
m/r tablets (800mg)
syrup (100mg/5ml)
tablets (250mg, 500mg) - 2 nd Line NSAID
Other NSAIDs
Diclofenac*
dispersible tablets (50mg)
e/c tablets (25mg, 50mg)
m/r tablets (75mg)
injection (25mg/ml, 3ml)
suppositories (12.5mg, 25mg, 50mg, 100mg)
*Oral diclofenac is restricted to use for severe pain only and where a risk assessment has been
undertaken.
Indometacin
Mefenamic acid
capsules (25mg)
capsules (250mg)
tablets (500mg)
COX II’s
Celecoxib
capsules (100mg, 200mg)
NB: Celecoxib should be used with caution. It is recommended that celecoxib should NOT be used in
the following patients: i) Patients with established ischaemic heart disease, peripheral vascular
disease or cerebrovascular disease. ii) Patients at risk from cardiovascular disease iii) Patients on low
dose aspirin for cardiovascular prophylaxis.
For topical preparations see section 10.3.2
10.1.2 CORTICOSTEROIDS
10.1.2.1 SYSTEMIC CORTICOSTEROIDS
Prednisolone
tablets (1mg, 5mg, 25mg)
e/c tablets (2.5mg, 5mg)
soluble tablets (5mg, as sodium phosphate)
10.1.2.2 LOCAL CORTICOSTEROID INJECTIONS
Dexamethasone
Hydrocortisone acetate
Methylprednisolone acetate
Methylprednisolone acetate
Triamcinolone acetonide
injection (3.3mg/ml, 1ml)
injection (25mg/ml, 1ml)
injection (40mg/ml, 1ml, 2ml,)
injection (40mg/ml with lignocaine 10mg/ml; 1ml, 2ml)
injection (10mg/ml, 1ml)
10.1.3 DRUGS THAT SUPPRESS THE RHEUMATIC DISEASE PROCESS
Gold Sodium aurothiomalate
injection (20mg/ml, 0.5ml; 100mg/ml, 0.5ml)
Antimalarials
Chloroquine sulphate
Hydroxychloroquine sulphate
tablets (250mg)
tablets (200mg)
Immunosuppressants
Azathioprine
Ciclosporin
Methotrexate*
* Shared care guidelines available
tablets (25mg, 50mg)
capsules (25mg, 50mg, 100mg)
tablets (2.5mg)
METOJECT PENS* (7.5mg in 0.15ml, 10mg in 0.2ml, 12.5mg
in 0.25ml,15mg in 0.3ml, 17.5mg in 0.35ml, 20mg in 0.4ml,
25mg in 0.5ml)
*For subcutaneous injection only
Mycophenolate
Leflunomide*
* Shared care guidelines available
capsules (250mg)
tablets (500mg)
suspension (1g/5ml)
tablets (10mg, 20mg)
Sulfasalazine
Sulfasalazine e/c
tablets (500mg)
Rheumatoid arthritis - adalimumab, etanercept and infliximab (NICE TA130)
Partially updates TA36
Ankylosing spondylitis - adalimumab, etanercept and infliximab (NICE TA143)
Psoriasis - adalimumab (NICE TA146)
Rheumatoid arthritis - certolizumab pegol (NICE TA186)
Rheumatoid arthritis - drugs for treatment after failure of a TNF inhibitor (NICE TA195)
Replaces TA36,TA126,TA141
Psoriatic arthritis - golimumab (NICE TA220)
Rheumatoid arthritis (after failure of previous anti-rheumatic drugs) - golimumab (NICE TA225)
Ankylosing spondylitis - golimumab (NICE TA233)
Rheumatoid arthritis - tocilizumab (NICE TA247) Update to TA198
Rheumatoid arthritis - abatacept (2nd line) (rapid review of NICE TA234) (NICE TA280)
Vasculitis- rituximab (NICE TA308)
10.1.4 GOUT AND CYTOTOXIC-INDUCED HYPERURICAEMIA
Acute Attacks
MHRA Drug Safety Update
Colchicine: reminder on risk of serious and fatal toxicity in overdose (Nov 2009)
Colchicine
Indometacin
Interval treatment
tablets (500micrograms)
capsules (25mg)
suppositories (100mg)
Allopurinol
tablets (100mg, 300mg)
Hyperuricaemia - febuxostat (NICE TA164)
MHRA Drug Safety Update
Febuxostat: stop treatment if signs or symptoms of serious hypersensitivity (eg, serious skin
reactions or systemic hypersensitivity) occur (Jun 2012)
Febuxostat*
tablets (80mg, 120mg)
10.2 DRUGS USED IN NEUROMUSCULAR DISORDERS
10.2.2 SKELETAL MUSCLE RELAXANTS
Baclofen
Dantrolene sodium
Diazepam
Tizanidine
tablets (10mg)
s/f liquid (5mg/5ml)
capsules (25mg)
tablets (2mg, 5mg, 10mg)
oral solution (2mg/5ml)
injection (5mg/ml, 2ml)
injection (emulsion) (5mg/ml, 2ml)
rectal tubes (2.5mg/1.25ml, 5mg/2.5ml, 10mg/2.5ml)
tablets (2mg, 4mg)
Nocturnal leg cramps
MHRA Drug Safety Update
Quinine: not to be used routinely for nocturnal leg cramps (Jun 2010)
Quinine sulphate*
tablets (200mg, 300mg)
*Not recommended for new initiation
10.3 DRUGS FOR THE TREATMENT OF SOFT-TISSUE DISORDERS AND TOPICAL PAIN RELIEF
10.3.1 ENZYMES
Hyaluronidase
injection (1500 units)
10.3.2 RUBEFACIENT, TOPICAL NSAIDS, CAPSAICIN, AND POULTICES
Topical NSAIDs and counter irritants
Ibuprofen
Piroxicam
gel (5%, 100g)
gel (0.5%, 60g)
11.0 EYES
11.3 Anti-infective eye preparations
11.4 Corticosteroids and other anti-inflammatory preparations
11.5 Mydriatics and cycloplegics
11.6 Treatment of glaucoma
11.7 Local anaesthetics
11.8 Miscellaneous ophthalmic preparations
Eye preparations will be prescribed generically.
Indications for prescription of unpreserved eye drops
Preservative-free (PF) eye drops may be indicated
 when preservative sensitivity is suspected. NB that diagnosis and the decision to prescribe PF eye
drops are based on clinical opinion alone
 during or immediately after invasive surgery (because this may allow fluid to penetrate into the
anterior chamber)
 Following surgery in which the corneal integrity is breached e.g. refractive surgery, corneal
transplant surgery
 if frequency of eye drop use raises concern about cumulative exposure to preservatives
 in ocular surface disease Unit dose eye drops may also be indicated
 when the product is only commercially available in a preservative-free formulation
 when the treatment is for a very limited period only e.g. atropine for refraction
 on safety grounds in the case of toxic medication e.g. atropine
11.3 ANTI-INFECTIVE EYE PREPARATIONS
11.3.1 ANTIBACTERIALS
Chloramphenicol
Ciprofloxacin
Fusidic acid
Gentamicin
Ofloxacin
eye drops (0.5%) minims
eye ointment (1%)
eye drops (0.3%)
m/r eye drops (1%)
eye drops (0.3%)
eye drops (0.3%)
11.3.2 ANTIVIRALS
Aciclovir
eye ointment (3%)
11.4 CORTICOSTEROIDS AND OTHER ANTI-INFLAMMATORY PREPARATIONS
11.4.1 CORTICOSTEROIDS
Betamethasone
BETNESOL-N®
Dexamethasone
Sodium phosphate
MAXIDEX®
MAXITROL®
MAXITROL®
Prednisolone
Fluorometholone
Rimexolone*
eye drops (0.1%)
eye ointment (0.1%)
eye drops (Betamethasone 0.1%, Neomycin 0.5%)
minims (0.1%)
eye drops (Dexamethasone 0.1%, Hypromellose 0.5%)
eye drops (Dexamethasone 0.1%, Neomycin 0.35%.
Polymyxin 6000U/ml, Hypromellose 0.5%)
eye ointment (Dexamethasone 0.1%, Neomycin 0.35%,
Polymyxin 6000U/g)
eye drops (0.5%, 1%) eye drops
eye drops (Fluorometholone 0.1%, Polyvinyl alcohol 1.4%)
eye drops (1%)
*Second line use to prednisolone 1% or for patients with a known susceptability to developing raised
intraocular pressure.
11.4.2 OTHER ANTI-INFLAMMATORY PREPARATIONS
Olopatadine
OTRIVINE -ANTISTIN®
Sodium cromoglicate
eye drops (1mg/ml)
eye drops (Xylometazoline 0.05%, Antazoline 0.5%)
eye drops (2%)
11.5 MYDRIATICS AND CYCLOPLEGICS
Antimuscarinics
Atropine sulphate
Cyclopentolate hydrochloride
Homatropine hydrobromide
Tropicamide
eye drops (1%)
minims (1%)
eye drops (1%)
minims (0.5%, 1%)
eye drops (2%)
minims (0.5%, 1%)
Sympathomimetics
Phenylephrine hydrochloride
minims (2.5%, 10%)
11.6 TREATMENT OF GLAUCOMA
Miotics
Pilocarpine
Sympathomimetics
eye drops (2%, 4%)
minims (2%)
Brimonidine
Brimonidine 0.2%
Timolol 0.5%
)
)
eye drops (0.2%)
eye drops
Beta-blockers
Betaxolol hydrochloride
Levobunolol hydrochloride
Timolol maleate
Timolol maleate
Timolol maleate
TIMOPTOL-LA®
eye drops (0.5%)
eye drops (0.5%)
eye drops (0.25%, 0.5%)
unit dose eye drops (0.25%, 0.5%)
unit dose eye gel (0.1%)
eye drops (0.25%, 0.5%)
Carbonic anhydrase inhibitors and systemic drugs
Acetazolamide
Dorzolamide hydrochloride
Dorzolamide hydrochloride
Brinzolamide
tablets (250mg)
m/r capsules (250mg)
eye drops (2%)
unit dose eye drops (2%)
eye drops (10mg/ml)
Combination
Brinzolamide hydrochloride 2%,Timolol maleate 0.5%
Dorzolamide hydrochloride 2%, Timolol maleate 0.5%
Dorzolamide hydrochloride 2%, Timolol maleate 0.5%
eye drops
eye drops
unit dose eye drops
Prostaglandin analogue
Latanoprost
Latanoprost
Bimatoprost
Travaprost
Tafluprost
eye drops (50 micrograms/ml) - 1st line
unit dose eye drops (50 microgram/ml)
eye drops (100 micrograms/ml, 300 micrograms/ml)
unit dose eye drops (300 micrograms/ml)
eye drops (40 micrograms/ml)
unit dose eye drops (15 micrograms/ml)
Combination
Travoprost 40micrograms, Timolol 5mg/ml
Bimatoprost 300mcg/ml, Timolol 5mg/ml
Bimatoprost 300mcg/ml, Timolol 5mg/ml
eye drops
eye drops
unit dose eye drops
11.7 LOCAL ANAESTHETICS
Tetracaine hydrochloride
(Amethocaine hydrochloride)
Proxymetacaine hydrochloride
minims (1%)
minims (0.5%)
11.8 MISCELLANEOUS OPHTHALMIC PREPARATIONS
11.8.1 TEAR DEFICIENCY, OCULAR LUBRICANTS AND ASTRINGENTS
Artificial tears
minims
(Hydroxyethylcellulose 0.44%)
Carbomer ‘980’ [Polyacrylic acid]
eye drops
0.2%
Hypromellose
eye drops
(0.3%) (0.5%)
ILUBE®
eye drops
(Acetylcysteine 5%, Hypromellose 0.35%)
LACRI-LUBE® eye ointment (White soft paraffin 57.3%, liquid paraffin 42.5%, wool alcohols 0.2%)
Carmellose sodium
unit dose eye drops (0.5%, 1%)
11.8.2 OCULAR DIAGNOSTIC, PERI-OPERATIVE PREPARATIONS AND PHOTODYNAMIC TREATMENT
Ocular diagnostic Preparations
Fluoroscein sodium
Fluoroscein
Trypan (Vision) blue
injection
ophthalmic strips
sterile solution
(20%)
(1mg)
(0.1%)
Ocular peri-operative drugs
Apraclonidine
Balanced salt
Flurbiprofen
Hydroxypropylmethylcellulose
Ketorolac
MIOCHOL E®
Povidone Iodine
Sodium hyaluronate
ophthalmic solution
(1%)
single dose units
solution
(15ml, 500ml)
unit dose eye drops
(Flurbiprofen sodium 0.03%,
Polyvinyl alcohol 1.4%)
pre-filled syringes
(2%, 2ml)
eye drops
(0.5%)
solution
(Acetylcholine 1%, Mannitol 3%, 2ml)
minims (5%)
(10mg/ml, 0.75ml pre-filled syringe)
12.0 EAR, NOSE AND OROPHARYNX
12.1 Drugs acting on the ear
12.2 Drugs acting on the nose
12.3 Drugs acting on the oropharynx
12.1 DRUGS ACTING ON THE EAR
12.1.1 OTITIS EXTERNA
Anti-inflammatory preparations
Betamethasone
sodium phosphate
Prednisolone
sodium phosphate
ear drops (0.1%)
ear drops (0.5%)
Anti-infective preparations
Clioquinol 1%, Flumethasone pivalate 0.02%
ear drops
Clotrimazole
solution (1%)
Gentamicin
ear drops (0.3%)
GENTISONE HC®
ear drops (Gentamicin sulphate 0.3%, Hydrocortisone
acetate1%)
OTOMIZE®
ear spray (Dexamethasone 0.1%, Neomycin sulphate 3250
units/ml, glacial acetic acid 2%)
SOFRADEX®
ear drops (Dexamethasone sodium metasulphobenzoate
0.05%, Framycetin sulphate 0.5%, Gramicidin 0.005%)
TRI-ADCORTYL ® (Substitute)
ointment (Triamcinolone Acetonide 1mg/g, Gramicidin
0.25mg/g, Neomycin base (as sulphate) 2.5mg/g, Nystatin
100,000 units/g)
12.1.3 REMOVAL OF EAR WAX
Olive oil
EXTEROL®
Sodium bicarbonate
ear drops (10ml)
ear drops (Urea-hydrogen peroxide complex 5% in glycerol)
ear drops BP (5%)
12.2 DRUGS ACTING ON THE NOSE
12.2.1 DRUGS USED IN NASAL ALLERGY
Beclometasone
Dipropionate
Mometasone
aqueous nasal spray (50mcg/metered spray) - 1st line
nasal spray (50micrograms/metered spray) - 2nd line
Fluticasone
Propionate
Betamethasone
sodium phosphate
nasal spray (0.05%=50mcg/metered spray) - 3rd line
nasal drops (0.1%)
12.2.2 TOPICAL NASAL DECONGESTANTS
Sodium chloride
nasal drops (0.9%, 10ml)
Antimuscarinic
Ipratropium bromide
nasal spray (0.03%=21micrograms/metered spray)
Sympathomimetics
Ephedrine hydrochloride
Xylometazoline
nasal drops (0.5%)
nasal drops (0.1%)
nasal spray (0.1%)
paediatric nasal drops (0.05%)
12.2.3 NASAL PREPARATIONS FOR INFECTION
BETNESOL N®
nasal drops (Betamethasone sodium phosphate 0.1%,
Neomycin sulphate 3250 u/g)
Nasal Staphylococci
NASEPTIN®
cream (Chlorhexidine 0.1%, Neomycin 0.5%)
Mupirocin*
nasal ointment (2%) (as calcium salt in white soft paraffin)
*Consultant microbiologist recommendation for nasal treatment of MRSA as per protocol ONLY
Epistaxis
Bismuth iodoform paraffin paste
(B.I.P.P.)
gauze (1.25cm x 100cm)
12.3 DRUGS ACTING ON THE OROPHARYNX
12.3.1 DRUGS FOR ORAL ULCERATION AND INFLAMMATION
Benzydamine hydrochloride
Hydrocortisone sodium succinate
Choline salicylate
ORABASE®
oral rinse (0.15%)
oral spray (0.15%)
pellets (2.5mg)
oral gel (BONJELA® 8.7%)
protective paste
12.3.2 OROPHARYNGEAL ANTI-INFECTIVE DRUGS
Miconazole
Nystatin
s/f oral gel (24mg/ml=20mg/g)
suspension (500,000units/5ml)
12.3.3 LOZENGES AND SPRAYS DEQUACAINE
DEQUACAINE
lozenges (Benzocaine, dequalinium)
12.3.4 MOUTHWASHES, GARGLES AND DENTIFRICES
Chlorhexidine gluconate
dental gel (1%)
mouthwash (0.2%)
Mouthwash effervescent tablets
12.3.5 TREATMENT OF DRY MOUTH
Local treatment
Artifical saliva
BIOTENE ORALBALANCE®/BIOXTRA
oral spray (SALIVA ORTHANA® )
saliva replacement gel
13.0 SKIN
13.1 Management of skin conditions
13.2 Emollient and barrier preparations
13.3 Topical local anaesthetics and antipruritics
13.4 Topical corticosteroids
13.5 Preparations for eczema and psoriasis
13.6 Acne and rosacea
13.7 Preparations for warts and calluses
13.8 Sunscreens and camouflagers
13.9 Shampoos and other preparations for scalp and hair conditions
13.10 Anti-infective skin preparations
13.11 Skin cleansers, antiseptics, and desloughing agents
13.12 Antiperspirants
13.13 Topical circulatory preparations (none in the Formulary)
13.14 Miscellaneous products
13.1 MANAGEMENT OF SKIN CONDITIONS
13.1.1 VEHICLES
TALC
dusting powder (300g)
13.2 EMOLLIENT AND BARRIER PREPARATIONS
13.2.1 EMOLLIENTS
MHRA Drug Safety Update
Aqueous cream: may cause skin irritation, particularly in children with eczema, possibly due to
sodium lauryl sulfate content (Mar 2013)
Aqueous
CETRABEN®
DERMOL 500®
DIPROBASE®
DOUBLEBASE®
E45®
Emulsifying*
Epaderm®*
HYDROMOL® *
Liquid paraffin in White soft paraffin*
Yellow soft paraffin*
ZeroAQS®
Zerocream®
Zerodouble®
cream BP
emollient cream
lotion
cream
gel
cream
ointment BP
ointment
ointment
ointment
cream
cream
gel
(30g, 100g, 500g)
(50g, 150g, 500g)
(500ml) [with antimicrobials]
(50g, 500g)
(100g, 500g)
(50g, 500g)
(500g)
(125g, 500g)
(125g, 500g)
(50% w/w, 500g)
(15g)
(100g, 500g)
(50g, 500g)
(100g, 475g)
Zerobase®
Zeroderm®*
cream
ointment
(50g, 500g)
(125g, 500g)
*NPSA Warning re Paraffin based products – bandages, dressings and clothing in contact with
these products are easily ignited with a cigarette or naked flame.
13.2.1.1 EMOLLIENT BATH AND SHOWER PREPARATIONS
OILATUM®
OILATUM ®
emollient bath additive (250ml)
shower gel (150g)
13.2.2 BARRIER PREPARATIONS
CAVILON®
METANIUM®
SUDOCREM®
foam applicator (1ml)
spray (28ml) - for large areas
ointment (30g)
cream (125g)- for babies only
13.3 TOPICAL LOCAL ANAESTHETICS AND ANTIPRURITICS
Calamine
Crotamiton
Menthol 1% in aqueous
lotion (200ml)
cream (10%, 30g)
cream (100g)
13.4 TOPICAL CORTICOSTEROIDS
Atopic dermatitis (eczema) - topical steroids (NICE TA81)
Mild potency
Hydrocortisone
cream (0.5%, 1%, 15g)
ointment (0.5%, 1%, 30g)
With antimicrobials (for short term use only)
CANESTEN-HC®
DAKTACORT®
FUCIDIN H®
TERRA-CORTRIL®
TIMODINE®
Moderate potency
cream (Hydrocortisone 1%, Clotrimazole 1%, 30g)
cream (Hydrocortisone 1%, Miconazole nitrate 2%, 30g)
ointment (Hydrocortisone 1%, Miconazole nitrate 2%, 30g)
cream (Hydrocortisone acetate 1%, Fusidic acid 2%)
ointment (Hydrocortisone 1%, Oxytetracycline 3%)
cream (Hydrocortisone 0.5%, Nystatin 100,000 units/g)
BETNOVATE-RD®
EUMOVATE®
HAELAN®
cream (Betamethasone valerate 0.025% = 1 in 4 dilution of
BETNOVATE cream, 100g)
ointment (Betamethasone valerate 0.025% = 1 in 4 dilution
of BETNOVATE ointment, 100g)
cream (Clobetasone butyrate 0.05%, 30g, 100g)
ointment (Clobetasone butyrate 0.05%, 30g, 100g)
adhesive tape (Fludroxycortide (Flurandrenolone) 4
micrograms/cm2, 200cm)
With antimicrobials (for short term use only)
TRIMOVATE®
cream (Clobetasone butyrate 0.05%, Oxytetracycline
(calcium salt) 3%, Nystatin 100,000 units/g, 30g)
Potent
Betamethasone valerate
Betamethasone valerate
BETNOVATE®
DIPROSONE®
ELOCON®
SYNALAR®
cream (0.1%, 30g, 100g)
ointment (0.1%, 30g, 100g)
scalp application (Betamethasone valerate 0.1%)
cream (Betamethasone dipropionate 0.05%)
ointment (Betamethasone dipropionate 0.05%)
cream (Mometasone furoate 0.1%, 30g)
ointment (Mometasone furoate 0.1%, 30g)
cream (Fluocinolone acetonide 0.025%, 30g)
gel (Fluocinolone acetonide 0.025%, 30g)
Compound preparations
DIPROSALIC®
ointment (Betamethasone dipropionate 0.05%, Salicylic acid
3%, 30g, 100g)
With antimicrobials
FUCIBET®
LOTRIDERM®
cream (Betamethasone valerate 0.1%, Clioquinol 3%, 30g)
ointment (Betamethasone valerate 0.1%, Clioquinol 3%,
30g)
ointment (Betamethasone valerate 0.1%, Neomycin
sulphate 0.5%, 30g)
cream (Betamethasone valerate 0.1%, fusidic acid 2%, 30g)
cream (Betamethasone dipropionate 0.064%, Clotrimazole
1%, 30g)
Very potent
DERMOVATE®
cream (Clobetasol propionate 0.05%, 30g, 100g)
ointment (Clobetasol propionate 0.05%, 30g, 100g)
With antimicrobials
cream (Clobetasol propionate 0.05% Neomycin sulphate
0.5%, Nystatin 100,000units/g, 30g)
ointment (Clobetasol propionate 0.05%, Neomycin sulphate
0.5%, Nystatin 100,000units/g, 30g)
13.5 PREPARATIONS FOR ECZEMA AND PSORIASIS
13.5.1 PREPARATIONS FOR ECZEMA
13.5.2 PREPARATIONS FOR PSORIASIS UNLIC
Topical Preparations for Psoriasis
BETNOVATE 1 IN 4
with 5% Coal Tar solution in WSP
CARBO-DOME®
Calcipotriol
DOVOBET®
SEBCO® scalp
ointment (80g)
cream (10% coal tar solution, 100g)
ointment (50micrograms/g, 120g)
gel (betamethasone 0.5% calcipotriol 50micrograms/g, 60g)
ointment (betamethasone 0.5% calcipotriol
50micrograms/g, 30g)
ointment (40g)
13.5.3 DRUGS AFFECTING THE IMMUNE RESPONSE
Ciclosporin (cyclosporin)
Methotrexate
capsules (25mg, 50mg, 100mg)
tablets (2.5mg)
Shared care guidelines available
Mycophenolate
capsules (250mg)
tablets (500mg)
suspension (1g/5ml)
Atopic dermatitis (eczema) - pimecrolimus and tacrolimus (NICE TA82)
Pimecrolimus and tacrolimus for atopic eczema
Pimecrolimus
Tacrolimus
Cytokine modulators
cream (1%, 30g)
ointment (0.03%, 30g; 0.1%, 30g)
Psoriasis - adalimumab (NICE TA146)
Psoriasis - efalizumab and etanercept (NICE TA103) -Efalizumab – drug withdrawn
Psoriasis - infliximab (NICE TA134)
Psoriasis - ustekinumab (NICE TA180)
Psoriatic arthritis - etanercept, infliximab and adalimumab (NICE TA199) Replaces TA104, TA125
MHRA Drug Safety Update
Tumour necrosis factor alpha inhibitors: risk of tuberculosis—screen all patients before starting
treatment and monitor them closely (July 2014)
13.6 ACNE AND ROSACEA
13.6.1 TOPICAL PREPARATIONS FOR ACNE
Topical Antibacterials for Acne
DUAC ONCE DAILY®
Clindamycin phosphatealcoholic
Clindamycin phosphate
gel (Benzyl peroxide 5%, clindamycin 1%, 25g)
solution (1%, 30ml)
aqueous lotion (1%, 30ml)
13.6.2 ORAL PREPARATIONS FOR ACNE
Hormone Treatment for Acne
MHRA Drug Safety Update
Cyproterone acetate with ethinyloestradiol (co-cyprindiol)—balance of benefits and risks remains
positive; updated prescribing advice is provided (June 2013)
DIANETTE®*
tablets (Co-cyprindiol 2000/35=Cyproterone acetate 2mg,
Ethinylestradiol 35micrograms)
*Restricted to the treatment of moderate to severe acne after topical therapy or systemic antibiotic
treatment have failed
Oral Retinoid for Acne
Isotretinoin
capsules (10mg, 20mg)
13.7 PREPARATIONS FOR WARTS AND CALLUSES
SALACTOL®
Silver nitrate
paint (16.7% Salicylic acid, 16.7% Lactic acid, in flexible
collodion, 10ml)
applicator (75%)
13.8 SUNSCREENS AND CAMOUFLAGERS
13.8.1 SUNSCREEN PREPARATIONS
Sunscreen factor 30 (UVISTAT)
cream (125g)
Photodamage
Diclofenac sodium (Solaraze®)
Fluorouracil
ACTIKERALL
gel (3%, 25g)
cream (5%, 20g) - for pre-malignant conditions
solution (fluorouracil 0.5%, salicylic acid 10%)
13.9 SHAMPOOS AND OTHER PREPARATIONS FOR SCALP AND HAIR CONDITIONS
POLYTAR®
liquid (150ml)
13.10 ANTI-INFECTIVE SKIN PREPARATIONS
13.10.1 ANTIBACTERIAL PREPARATIONS
13.10.1.1 ANTIBACTERIAL PREPARATIONS ONLY USED TOPICALLY
Silver sulfadiazine
(Silver sulphadiazine)
Mupirocin*
cream (1%, 50g)
ointment (2%, 15g)
* Restricted to dermatology or on microbiology recommendation for MRSA
ANTIBACTERIAL PREPARATIONS ALSO USED SYSTEMICALLY
Fusidic acid
Metronidazole (ANABACT)
cream (2%, 15g)
gel (0.75%, 15g)
13.10.2 ANTIFUNGAL PREPARATIONS
Clotrimazole
Ketoconazole
Miconazole nitrate
Terbinafine
cream (1%, 20g)
solution (1%, 20ml)
shampoo (2%, 120ml)
cream (2%, 30g)
cream (1%, 15g)
13.10.3 ANTIVIRAL PREPARATIONS
Aciclovir
13.10.4 PARASITICIDAL PREPARATIONS
cream (5%, 2g, 10g)
Benzyl benzoate
Ivermectin
Dimeticone
Malathion
Permethrin
application (25%, 500ml)
tablets (3mg)
lotion (HEDRIN® 4%, 50ml) [Headlice]
aqueous solution (DERBAC-M ® 0.5%, 50ml)
dermal cream (5%, 30g) [Scabies]
cream rinse (1%, 59ml) [Headlice]
13.10.5 PREPARATIONS FOR MINOR CUTS AND ABRASIONS
Magnesium sulphate
SAVLON® ANTISEPTIC
Enbucrilat* tissue
*Restricted to endoscopy unit
paste BP (25g)
cream (15g)
adhesive (500mg in 0.5ml)
13.11 SKIN CLEANSERS, ANTISEPTICS, AND DESLOUGHING AGENTS
13.11.1 ALCOHOLS AND SALINE
Sodium chloride
Spirit, methylated industrial BP
Spirit, methylated mineralised
Sodium chloride
sachets (0.9%, 25ml)
irrigation solution (0.9%, 1 litre pour bottles)
(70%, 200ml spray, 500ml)
(500ml)
spray (0.9%, 240ml)
13.11.2 CHLORHEXIDINE SALTS
Chlorhexidine
Chlorhexidine
Chlorhexidine gluconate
HIBISOL®
HIBITANE® obstetric
Red staining dye
sachets (Chlorhexidine gluconate 0.05%, 25ml, 100ml)
alcoholic solution (Clear 0.5% in 70% spirit, pink 0.5% in 70%
spirit)
cleansing solution (4%) CX® dusting powder (Chlorhexidine
Acetate 1%)
solution (Chlorhexidine 0.5% in IPA 70%)
cream (Chlorhexidine gluconate 1%)
(10ml, for use with Chlorhexidine clear)
13.11.4 IODINE
Povidone iodine
alcoholic solution (10%, 500ml)
antiseptic solution (10%, 500ml)
surgical scrub (7.5%, 500ml)
dry powder spray (2.5%)
13.11.6 OXIDISERS AND DYES
Hydrogen peroxide
cream (10%, 25g)
Hydrogen peroxide
Potassium permanganatesolution
solution (3% [10vol])
tablets (400mg)
13.12 ANTIPERSPIRANTS
Glycopyrrolate
tablets (1mg)
13.13 MISCELLANEOUS PREPARATIONS
Dapsone
tablets (50mg, 100mg)
Topical preparations for Podiatry:
Hydrogen peroxide
Phenol BP
solution (10 volume [3%], 10ml)
liquid (10ml)
14.0 IMMUNOLOGICAL PRODUCTS AND VACCINES
Not used
15.0 ANAESTHESIA
15.1 General Anaesthesia
15.2 Local Anaesthesia
15.1 GENERAL ANAESTHESIA
15.1.1 INTRAVENOUS ANAESTHETICS
Barbiturates
Thiopental sodium (thiopentone)
injection (500mg)
Other intravenous anaesthetics
Propofol
injection (10mg/ml, 20ml, 50ml)
15.1.2 INHALATIONAL ANAESTHETICS
Volatile liquid anaesthetics
Sevoflurane*
(250ml)
*Restricted to anaesthesia in day case, paediatrics, elderly orthopaedic and major ENT surgery
Medical Gases (e.g. Nitrous Oxide, Entonox) are not included specifically in the above list, but are
available.
15.1.3 ANTIMUSCARINIC DRUGS
Atropine sulphate
Glycopyrronium bromide
Hyoscine hydrobromide
injection (600micrograms/ml, 1ml)
pre-filled syringe (600micrograms/ml, 1ml)
pre-filled syringe (1mg/10ml)
injection (200micrograms/ml, 3ml)
injection (400micrograms/ml, 1ml)
15.1.4 SEDATIVE AND ANALGESIC PERI-OPERATIVE DRUGS
15.1.4.1 BENZODIAZEPINES
Diazepam
Lorazepam
Temazepam
injection (5mg/ml, 2ml)
Injection emulsion (5mg/ml, 2ml)
injection (4mg/ml, 1ml)
tablets (10mg, 20mg)
oral solution (10mg/5ml)
Ketorolac trometamol
injection (30mg/ml, 1ml)
For NSAIDS see section 10.1.1
15.1.4.2 OPIOID ANALGESICS
Alfentanil
Fentanyl
injection (500micrograms/ml, 2ml; 5mg/ml, 1ml)
injection (50micrograms/ml, 2ml, 10ml)
For other opioid analgesic preparations see section 4.7.2
15.1.5 NEUROMUSCULAR BLOCKING DRUGS
Non-depolarising
Atracurium besilate
Mivacurium
Rocuronium bromide
injection (10mg/ml, 2.5ml, 5ml)
injection (2mg/ml, 5ml)
injection (10mg/ml, 5ml)
Depolarising
Suxamethonium
injection (50mg/ml, 2ml)
pre-filled syringe (50mg/ml, 2ml)
15.1.6 DRUGS FOR REVERSAL OF NEUROMUSCULAR BLOCKADE
Anticholinesterases
With glycoprronium
Glycopyrronium/Neostigmine
injection (Glycopyrronium bromide 500micrograms,
Neostigmine metisulfate 2.5mg /ml, 1ml)
Other drugs for reversal of neuromuscular blockade
Sugammadex
injection (100mg/ml, 2ml, 5ml)
15.1.7 ANTAGONISTS FOR CENTRAL AND RESPIRATORY DEPRESSION
Naloxone
Flumazenil
injection (400micrograms/ml, 1ml)
injection (100micrograms/ml, 5ml)
15.1.8 DRUGS FOR MALIGNANT HYPERTHERMIA
Dantrolene
injection (20mg vial)
15.2 LOCAL ANAESTHESIA
Adrenaline (epinephrine) topical solution
(1 in 1000)
Articaine hydrochloride with Adrenaline
Injection
(Articaine hydrochloride 40mg/ml,
adrenaline 1 in 100,000 [10microgram/ml],
2.2ml cartridge)
Bupivacaine
injection
(0.25%, 0.5%, 10ml)
Bupivacaine and adrenaline (epinephrine)
injection
Levobupivacaine
Lidocaine (Lignocaine)
Lidocaine (Lignocaine)
(Bupivacaine 0.5%, Adrenaline 1 in 200,000,
10ml)
injection
(2.5mg/ml, 5mg/ml, 7.5mg/ml, 10ml
ampoule)
injection
(0.5%, 10ml, 20ml)
injection
(1%, 5ml, 20ml vial, 20ml ampoule)
injection
(2% 5ml, 20ml vial)
gel
(2% with Chlorhexidine gluconate 0.25%)
ointment
(5%)
spray
(10%)
medicated plaster* (5%, 14cm x 10cm)
*Restricted to recommendation by a pain specialist for patients who are unable to take oral
medication because of medical conditions/disability. Discontinue if no response after 4 weeks.
Lidocaine (Lignocaine) with adrenaline
injection (Lidocaine (Lignocaine) 1%, Adrenaline 1:200,000, 20ml vial)
injection (Lidocaine (Lignocaine) 2%, Adrenaline 1 in 100,000, 20ml preservative free)
injection (Lidocaine (Lignocaine) 2%. Adrenaline 1:200,000, 20ml vial)
injection cartridge (standard) (Lidocaine (Lignocaine) 2%, Adrenaline 1:80,000, 2.2ml)
Lidocaine (Lignocaine) with adrenaline
injection cartridge (standard) (Lidocaine (Lignocaine) 2%, Adrenaline 1:80,000, 2.2ml)
Mepivacaine
injection cartridge (3%)
Prilocaine
injection (1%, 50ml)
Prilocaine preservative free
injection (2%, 5ml)
Prilocaine with felypressin
injection cartridge (3%)
Ropivacaine
injection (2mg/ml, 10ml; 7.5mg/ml, 10ml)
Tetracaine (Amethocaine)
gel (4%, 1.5g (AMETOP)
EMLA® cream (5g, 30g)
Other local anaesthetics (special ENT preparations)
Cocaine
Lidocaine (Lignocaine) and Phenylephrine
BASIC PATIENT CARE ITEMS
Acetone
Arachis Oil
INFACARE®
BABY BATH UNLIC Liquid
Paraffin sterile
Lubricating jelly (K-Y jelly®)
Plastic dressing spray (OPSITE®)
Plaster remover
Talc dusting powder
Water for inhalation for humidifiers (2litre)
nasal spray (10%)
nasal spray (Lignocaine 5% w/v, Phenylephrine
0.5%)