For use in accordance with NICE TA259 and TA387 reccomendations.

10cm x 6m only: Seek specialist advice for when to use other widths

Available as a latex free option

 Commissioned by NHS England for non-infectious uveitis in line with NICE TA460 at specialist centres only.

Specialist centres in the South region:

• University Hospital Southampton NHS Foundation Trust
• Oxford University Hospitals NHS Foundation Trust
• University Hospital Bristol NHS Foundation Trust
  
  

Colecalciferol with calcium
Alternative preparations are available subject to patient preference

This is no longer licensed but is available through a patient access programme for oncological and transplant indications.

Refer to the medicines management team for commissioning arrangements.

NHS England commissioned for MS (TA312). Also commissioned by NHS England for CLL and pre-transplant immunosuppression (islet transplantation) only if provided at zero drug cost.

For use in osteoporosis

Binosto^® 70mg effervescent tablets are non-formulary - see below

• Dosing adjustment required in renal impairment, see SPC
• The SPC says: "Experience of alogliptin use in clinical trials in patients with congestive heart failure (NYHA functional class III and IV) is limited and caution is warranted in these patients.
• DMAG recommends to avoid alogliptin use in patients with ischaemic heart disease (IHD) and that GPs search for patients on alogliptin with IHD and review them at their next planned review appointment.

NICE CG32 (Feb 2006) Nutrition support in adults

This has a smaller volume and more than 2kcals /ml these can very useful in those who struggle with a larger volume

Must be prescribed by brand.

RBCH: for ocular injection or intravesical administration only

Must be prescribed by brand.

For neutropenic sepsis or on advice of microbiology

Commissioned by NHS England according to agreed Trust Guidelines for fungal infections.

DCHFT: Not routinely stocked.

Commissioned by NHS England as per British Committee for Standards in Haemotology (BCSH) Guidelines.

Not recommended as initial treatments to prevent organ rejection in patients having a kidney transplant as per NICE TA481 and TA482.

Ointment, suppositories.

• On formulary at DCHFT.

• In accordance with NICE TA for prevention of VTE in patients undergoing hip or knee replacement surgery, as per licensed indications.
• • Note routine 1st line option at RBCH and DCH is LMWH

• For prevention of stroke or systemic embolism in patients with AF within NICE TA and local guidance, as per licensed indications.
• For the treatment and secondary prevention of deep vein thrombosis and/or pulmonary embolism in accordance with NICE TA. 

In accordance with NICE guidance.

Prescribe by BRAND

The AproDerm® range is suitable from birth for those suffering from:

Eczema
Psoriasis and
Other Dry Skin Conditions as well as for those requiring a daily moisturiser or pre-bathing emollient

Paraffin free

Self Care Medicine - to be purchased when part of routine skin care in the absence of a moderate to severe skin condition. 

For treatment of Heparin-Induced Thrombocytopaenia (HIT)in critically unwell patients or those with severe renal impairment on advice of Consultant Haematologist.

Red when used in children with neuro-developmental disorders.

Use in accordance with NICE TA292 in moderate to severe manic episodes in adolescents with bipolar 1 disorder.

Commissioned by NHSE in line NICE TA526 recommendations.

This has been re-categorised as "red" for Scurvy only as per DMAG November 2017. 200mg twice a day is the most cost-effective dose.

Approved as Red at RBCH:

• Acute Corneal conditions 500mg twice a day for 6 week course (Eye Consultant only)
• Palliative Care consultant only: Tongue "descaling" where other options insufficient (1/4 x 1g tablet per dose)

Commissioned by CDF in line with CDF criteria and NICE TA492 recommendations.

Commissioned by NHSE in line with NICE TA520 and TA525 recommendations.

Note (July 2018): The European Medicines Agency restricted the use of atezolizumab for untreated urothelial carcinoma. It should now only be used in adults with high levels of PD-L1. 

Cream, colloidal oatmeal in emollient basis
Excipients include benzyl alcohol, cetyl alcohol, isopropyl palmitate

RBCH: Dermatology only

Only to be used under ACBS specified conditions as follows:

Endogenous and exogenous eczema, xeroderma, ichthyosis and senile pruritus associated with dry skin.

Self Care Medicine - to be purchased when part of routine skin care in the absence of a moderate to severe skin condition.

Commissioned by NHSE for the treatment of previously treated (with systemic cytotoxic chemotherapy) metastatic Merkel cell carcinoma in line with NICE TA517.

Available via CDF managed access agreement for the treatment of previously untreated (with systemic therapy) metastatic Merkel cell carcinoma - see link below.

NICE CG32 (Feb 2006) Nutrition support in adults www.nice.org.uk/page.aspx?o=cg032niceguideline

Should be prescribed only after nutrition screening has taken place using a validated tool e.g. MUST (Malnutrition Universal Screening Tool)

Adult sip feeds containing 1kcal/ml (Fresubin Original, Ensure, Fortimel, Clinutren ISO) should not be prescribed as they are less cost effective compared to 1.5kcal/ml sip feeds

for Sexual Health indications in Primary Care - see Sexual Health Dorset Guidelines below

with Shared Care Guideline: For bronchiectasis, in line with local shared care guideline

For COPD or other indications.

Consultant microbiologist or specialist use only.

Size: 4mm/32g
Size: 5mm/31g

Pack Size : 90

For use within its licensed indication for COPD

Commissioned by NHS England in line with TA216 and NHSE clinical commissioning policies (see below).

Commissioned by CDF for the treatment of relapsed multiple myeloma in lince with CDF criteria.

Unlicensed

 RBCH: Approved for Eye specialist use in the following indications where there is no licensed product available:

• Iris/drainage angle neovascularization - single injection
• Pre-operative use to reduce the risk of vitreous hemorrhage during vitreoretinal surgery - single injection
• Treatment of choroidal neovascularisation non-age related macular degeneration (AMD) or myopic CNV causes - repeated injection up to maximum frequency of monthly according to condition.
• Treatment of choroidal neovascularisation due to age related macular degeneration where clinical benefit is present but patient falls outside the criteria for licensed drug treatment i.e. better than 6/12

All sizes 

Biatain^® Silicone Lite is a thin and ultra flexible foam dressing with gentle silicone adhesive. It can be used on a wide range of exuding wounds and is to be used whenever a thin foam dressing is needed. Biatain^® Silicone Lite combines superior absorption and increased mobility.

0.01% is only strength on formulary

Choline salicylate dental gel

In accordance with NICE TA (TA129, TA228, TA311) or CDF policy.

Commissioned by NHS England in line with NICE TA401.

Cream, benzoyl peroxide 4% in an aqueous basis
Excipients include cetyl alcohol, fragrance, stearyl alcohol

For use within acne guideline when required in combination with antibioticsFor use within acne guideline when required in combination with antibiotics

Self Care Medicine

Not RBCH

*prescribe by brand to ensure the patient receives the same inhaler at each dispensing*

If generic prescription - patients should be supplied with the combination inhaler they have been using or trained in 

March 2018: Non Formulary for new initiations

Sublingual tablets.

Red for substance misuse as per DMAG March 2018

Cabometyx^®:

• Commissioned by NHSE in accordance with NICE TA463 for the treatment of previously treated advanced renal cell carcinoma.
• Commissioned by CDF in line with CDF criteria and NICE TA542 for the treatment of untreated locally advanced or metastatic renal cell carcinoma.
• Patients initiated on the Named Patient Programme should remain on free of charge stock for the duration of their treatment.

Cometriq^®:

• Commissioned in accordance with NICE TA516 for the first line treatment of medullary thyroid cancer.

One gram of cutaneous foam contains 50 micrograms of calcipotriol (as monohydrate) and 0.5 mg of betamethasone (as dipropionate).

Not stocked at RBCH

2nd line option at RBCH for patients intolerat of Adcal D3

Energy supplement.

To be used under direction of dietitian only.

Paediatric patients: not suitable in children under the age of 3, use with caution in children aged 3-6 years. 

Energy supplement.

Calogen and Calogen extra contain some vitamins & minerals 

To be used under direction of dietitian only.

Dilute before use in child under the age of 5.

 When used as monotherapy or with oral hyperglycaemics in patients with Type 2 Diabetes
 
  When used in combination with insulin

Restrict to where moderate to severe skin condition requires it (not for cradle cap)

Shampoo, coal tar 1%, coconut oil 1%, salicylic acid 0.5%

Self Care Medicine

Commissioned in accordance with NICE TA457.

Reserved for patients with severe eczema and infants under the age of 1 year. 

Emollient bath additive, light liquid paraffin 82.8%

Do not use soap or bubble baths etc when you wash as they can dry out the skin and make it more prone to irritation.

Use a leave-on emollient as a soap substitute and continue with standard eczema management, including regular leave-on emollients and topical corticosteroids when required

For rheumatoid arthritis in accordance with NICE recommendations (CG79).

ENT use only: Treatent of ear infection

1st line - use licensed ear drops 1st line in ear.

2nd line - use eye drops in the ear - Off label use (UNLICENSED ROUTE)

Excipients include benzyl alcohol, cetostearyl alcohol, polysorbates, propylene glycol
May damage latex condoms and diaphragms

Tubular bandage for fixation/retention and wet and dry wrapping

Red Line 3.5cm x 1m

Green Line 5cm x 1m / 3m / 5m

Blue Line 7.5cm x 1m / 3m / 5m

Yellow Line 10.75 x 1m / 3m / 5m

Beige Line 17.5cm x 1m

Odour control via activated charcoal

CliniSorb is indicated for the management of malodorous wounds. It can be used on fungating wounds and a variety of other chronic wounds with good results.

• CliniSorb can be cut to size if necessary
• CliniSorb can be applied either side down
• A secondary dressing can be applied on top of CliniSorb if appropriate
• CliniSorb can be secured in place using adhesive tape or in a manner appropriate for the indication
• Change when necessary

Tablets.

• In accordance with NICE recommendations for the use of clopidogrel in the treatment of non-ST-segment-elevation in ACS (TA80), clopidogrel should be used for up to 12 months.

• Post stent insertion (unless follows acute coronary syndrome, see above):
  - clopidogrel should be used for 1 month following insertion of non-drug eluting stent.
  - clopidogrel should be used for 12 months following insertion of a drug-eluting stent.

• In accordance with NICE TA210 (Prevention of acute vascular events).
• <a href="http://www.dorsetccg.nhs.uk/Downloads/aboutus/medicines-management/Other%20Guidelines/Generic_clopidogrel_statement%20nov%2009.pdf" target=”_blank”

• Update from the Cardiology Working Group July 2017 : The interaction of omeprazole on the antiplatelet efficacy of clopidogrel is no longer considered clinically significant.

Prescribers should use a LICENSED product (e.g.  Fultium D3^®, Invita D3^®;Desunin^®)

In accordance with local guidance for the management of vitamin D deficiency and insufficiency in adults.

Not at DCHFT and RBCH.

Commissioned by NHS England for use in CF as per policy A01/P/b and NICE TA276.

Adult patients: specialist centre only (University Hospital Southampton)

Paediatric patients: PHFT use in line with network arrangements with UHS.

Not at DCH or RBCH.

The calories are based on a sachet made up with 200ml of full cream milk and contain approx. 385 kcals.

If your patient likes milky drinks prescribe as a supplement to diet 1-2 servings/day.

Not suitable for patient with cow’s milk intolerance or galactosaemia. Not nutritionally complete.

If your patient dislikes milky drinks choose from the juice style supplements instead.

• Protects wound margins and peri-wound skin from external factors including wound exudate, incontinence and friction, caused by urinary and/or faecal incontinence
• Preserves and maintains intact or irritated skin by building a moisture barrier with good permeability to oxygen and water vapour
• Prevention of incontinence dermatitis
• Prevents maceration by providing up to 96 hours of moisture barrier action
• Effective adjunctive skin therapy during treatment of chronic wounds  e.g. venous or arterial, diabetic foot or pressure ulcers, or whenever skin requires a protective shield

Cutimed Sorbact gel dressings reduce bacterial load in a wound by combining Cutimed Sorbact swab with an amorphous hydrogel to support moist wound healing in lower exuding or sloughy wounds. 

Available as 7.5cm x 15cm and 7.5cm x 7.5cm

All sizes approved for addition to the Joint Wound Formulary April 2018

• In accordance with NICE TA for prevention of VTE in patients undergoing hip or knee replacement surgery, as per licensed indications.
  • Note routine 1st line option at RBCH and DCH is LMWH

• For prevention of stroke or systemic embolism in patients with AF within NICE TA and local guidance, as per licensed indications.
• For the treatment and secondary prevention of deep vein thrombosis and/or pulmonary embolism in accordance with NICE TA. 

PHFT: 

For treatment of cellulitis when approved by microbiology

For treatment of bone and joint infections (including spinal abscess, discitis, osteomyelitis and septic arthritis) when approved by microbiology and who are suitable for discharge and:

• Compliance with daily IV or oral antibiotics is likely to be an issue and are therefore at risk of treatment failure and readmission
• Discharge with an IV cannula is likely to be a risk e.g. IVDU
• Is likely to decline treatment / self-discharge and therefore likely to have repeated readmissions
• Are identified as suitable for early discharge in which oral antibiotics would not be appropriate and were not requiring any other medical/therapy interventions.

for DVT in patients who are intravenous drug users.

Specialist initiation:

Please use in accordance with the relevant local shared care guidance.

for specialist indications, e.g. prevention of clotting in the extracorporeal circuit during haemodialysis, not listed above

• RBCH and PGH.
• DCHFT: Dalteparin not routinely used.

 When used with oral hyperglycaemics in patients with Type 2 Diabetes
 
  When used with insulin in patients with Type 2 Diabetes

Commissioned by NHS England (for dialysis-induced anaemia including via outpatients and only as per NICE CG114) and Trust Guidelines.

Treatment of hepatitis C commissioned in line with latest rate card from NHS England.

Commissioned by NHS England for iron chelation in thalassaemia and sickle cell - policy in progress.

Nov 18: Approved for use at RBCH as 2nd line agent - application for Green status is pending DMAG approval. 

An alternative to Flexitol® with 25% Urea content

Lotion, benzalkonium chloride 0.1%, chlorhexidine hydrochloride 0.1%, liquid paraffin 2.5%, isopropyl myristate 2.5%

Excipients include cetostearyl alcohol

Injections.

Stock update (5mg and 10mg injections) 14/8/2018

Accord are still out of stock of diamorphine 5mg and 10mg injection, but have advised that new stock of both strengths will be available during the w/c 27th August. There are further deliveries scheduled for both strengths through September, October and the coming months. Wockhardt still have supplies available, but as previously advised they cannot support the full demand for primary and secondary care.

Therefore, it is expected that this supply issue should hopefully be resolved by early September. Until this time therefore please continue with the management plan as previously stated – primary care and drug misuse centres will be able to continue to order diamorphine in line with historical demand.

Recommended local action - primary care - Although you will be able to access diamorphine as per historical demand, we would encourage prescribers to be aware of the supply issues and reduce prescribing where appropriate. Please order responsibly during this time, in line with historical demand and do not stock pile to avoid lengthening the stock shortage. In the case that diamorphine cannot be accessed, please refer to the clinical guidance issued by UKMI which provides more information on suggested alternatives to diamorphine.

15/6/17
The medicines team has been made aware of shortages of some strengths of Diamorphine ampoules, in some areas. 

In order that patients are able to access essential palliative care medicines, it is recommended that prescribers and palliative care staff check availability with local pharmacies before sending patients or relatives to collect prescriptions.
Where possible and appropriate, prescriptions should be written to order the strengths that are available. Prescribers may need to amend prescriptions accordingly. The diamorphine prescription may need to be written on a separate prescription to other palliative care medicines. 

Nurses and carers are reminded to carefully check ampoule strengths if doses need to be made up from smaller amps, or where wastage of parts of larger amps needs to occur, following best practice when wasting part amps.

If diamorphine is unavailable, then prescribers are advised to convert to Morphine, using the conversion tables in the front of the BNF or on bnf.org
Seek the advice of local pharmacies and the listed palliative care pharmacies in the out of hours period. 

Tablets, syrup.

Commissioned by NHS England for Cystic Fibrosis in line with policy A01/P/b.

 Amber if provided by primary care for Cystic Fibrosis prior to April 2013.

 For patients initiated after April 2013, Dornase Alfa is restricted to supply from secondary care.

• Adult patients: specialist centre only (University Hospital Southampton)
• Paediatric patients: PHFT use in line with network arrangements with UHS.

Not at DCH or RBCH.

Gel, isopropyl myristate 15%, liquid paraffin 15%

Self Care Medicine - to be purchased when part of routine skin care in the absence of a moderate to severe skin condition. 

In accordance with NICE TA91 or CDF policy.

Gel, benzoyl peroxide 5%, clindamycin 1% (as phosphate) in an aqueous basis
Excipients include disodium edetate

For use within acne guideline when required in combination with antibiotics

Self Care Medicine

Choice should be based on selecting the most cost-effective option.

For paediatric patients. 

PHT only: Only on direction of Consultant Oncologists, for adult patients with with stage 3 NSCLC who have not progressed following definitive, platinum-based, concurrent chemoradiation therapy (cCRT).

This is an unlicensed medicine supplied as part of an 'early access to medicines' (EAMS) scheme until NICE assessment. Prescribers must make patients aware of this & the implications for future funding. 

Commissioned by NHS England for aHUS as per NHS England Policy E03/PS(HSS)/a: On recommendation from Newcastle specialist centre only.

Also commissioned by NHS England for paroxysmal nocturnal haemoglobinuria as per NHS National Specialised Commissioning Team (NSCT) Service Specification.

• For prevention of stroke or systemic embolism in patients with AF within NICE TA and local guidance, as per licensed indications.
• For the treatment and secondary prevention of deep vein thrombosis and/or pulmonary embolism in accordance with NICE TA. 

Eflornithine 11.5% for facial hirsutism in women. Refer to local guideline.

Excipients include cetostearyl alcohol, hydroxybenzoates, stearyl alcohol.

Treatment of hepatitis C commissioned in line with latest rate card from NHS England.

If patient dislikes or does not tolerate Modulen IBD then trial of Elemental 028 extra can be considered

Available in 2 flavours or the unflavoured one can be made more palatable using the flavour modjuls

Use liquid E028 for patients who need to take product away from home or who dislike the taste of powdered E028

Short bowel syndrome, intractable malabsorption, inflammatory bowel disease, bowel fistulae.

Commissioned by NHSE to prevent or reduce the frequency of bleeding episodes in people with haemophilia A who have factor VIII inhibitors in accordance with Clinical Commissioning Policy 170067/P via haemophilia comprehensive care centres only.

For use in proven lactose intolerance (not suitable for use in cow's milk allergy).

If used for temporary lactose intolerance after a bout of gastroenteritis, it should only be used for 6-8 weeks before titrating back onto standard infant formula. 

Injection.
Specialist initiation.

 for DVT in patients who are intravenous drug users.

for use in accordance with the relevant local shared care guidance.

for specialist indications, e.g. prevention of clotting in the extracorporeal circuit during haemodialysis, not listed above.

• DCHFT: Dalteparin not routinely used.

NICE CG32 (Feb 2006) Nutrition support in adults

This has a smaller volume and more than 2kcals /ml these can very useful in those who struggle with a larger volume

NICE CG32 Nutrition support in adults

For use predominantly with patients with swallowing problems/dysphagia although can be useful for those with taste fatigue with sip feeds

NICE CG32 Nutrition support in adults

Should be prescribed only after nutrition screening has taken place using a validated tool e.g. MUST (Malnutrition Universal Screening Tool) 

Useful for those patients with preference to juice /dislike to milk. However note these are less cost effective in terms of calorie and protein content than milk based sips.

These are not suitable for those with an allergy to cow’s milk.

Should be prescribed only after nutrition screening has taken place using a validated tool e.g. MUST (Malnutrition Universal Screening Tool) 

Useful for patients with taste changes e.g. as a side effect to cancer treatments

  NICE CG32 Nutrition support in adults

Should be prescribed only after nutrition screening has taken place using a validated tool e.g. MUST (Malnutrition Universal Screening Tool) 

Restrict use to those patients with increased protein requirement. Use only under direction of dietitian. Not to be used for those with renal insufficiency.

Generic product should be used where possible.

Gel, adapalene 0.1%, benzoyl peroxide 2.5%
Excipients include disodium edetate, polysorbate 80, propylene glyc

For use within acne guideline when required in combination with antibiotics

Self Care Medicine

Not DCHFT and RBCH.

Commissioned in accordance with NICE TA423 and TA515.

All products should be prescribed by brand. Biosimilar should be used where possible.

RED, Initiation by lipid specialist – this can be by written or verbal approval to other secondary care consultant clinicians. A copy of any letters should be forwarded to the patient’s GP.

Commissioned by CCG in accordance with NICE TA 394 for primary non-familial hypercholesterolaemia or mixed dyslipidaemia and primary heterozygous familial hypercholesterolaemia.

Commissioned by NHS England via specialist centres only for homozygous familial hypercholesterolaemia.

Capsules / Tablets

• Specialist initiation.

Syrup and Tablets

DCHFT & Poole ONLY: On advice of Consultant Microbiologist ONLY for the treatment of recurrent Clostridium difficile infection.

Commissioned by NHS England for treatment of MS at approved centres in accordance with NICE TA254.

alginate with glucose oxidase and lactoperoxidase, for lightly to moderately exuding wounds