Formulary Chapter 9: Nutrition and blood - Full Chapter
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09.01 |
Anaemias and some other blood disorders |
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Oral Rehydration Salts (Dioralyte®)
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Formulary
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09.01.01 |
Iron-deficiency anaemias |
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Ferrous Sulphate
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First Choice
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- 200mg tablets (65mg iron).
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Ferric maltol 30mg hard capsules (Ferracru®)
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Alternatives
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- For the treatment of iron deficiency anemia in patients with or without inflammatory bowel disease.
- To be initiated by specialist in inflammatory bowel disease or iron deficiency anaemia
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Ferric Maltol for the treatment of iron-deficiency anaemia in Inflammatory Bowel Disease only
Ferric Maltol for the treatment of iron-deficiency anaemia in patients without Inflammatory Bowel Disease
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Ferrous Fumarate
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Alternatives
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- First Choice oral liquid iron preparation - 140mg in 5ml syrup (45mg iron/5ml).
- 210mg tablets (68mg iron/tablet).
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Ferrous Gluconate
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Alternatives
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300mg tablets (35mg iron)
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Sodium Feredetate (Sodium ironedetate, Sytron®)
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Alternatives
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- 190mg in 5ml sugar-free elixir (27.5mg iron/5ml).
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09.01.01.01 |
Iron and folic acid |
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09.01.01.01 |
Compound iron preparations |
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09.01.01.02 |
Parenteral iron |
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Ferric Carboxymaltose 100ml in 2ml & 500mg in 10ml injections (Ferinject®)
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Formulary
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- For use as an alternative to iron dextran or iron sucrose. Approved for
use by renal physicians, gastroenterologists and haematologists.
- Unlicensed for use in children under 14 years of age. If used in this age-group, use should only be on the advice of a consultant with the informed consent of the patient and/or his/her parents/carers.
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Iron Dextran 100ml in 2ml and 500mg in 10ml injections
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Formulary
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Iron Isomaltoside 1000mg in 10ml injection (Monofer®)
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Formulary
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Iron Sucrose 100mg in 5ml injection (Venofer®)
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Formulary
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09.01.02 |
Drugs used in megaloblastic anaemias |
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Folic Acid
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Formulary
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- 400 microgram and 5mg tablets
- 2.5mg in 5ml sugar-free syrup
- 15mg in 1ml injection
unlicensed
- 30mg in 2ml injection
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Hydroxocobalamin 1mg in 1ml injection (Vitamin B12)
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Formulary
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09.01.03 |
Drugs used in hypoplastic, haemolytic, and renal anaemias |
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Eculizumab
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Formulary
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- For use in accordance with NICE and NHS England commissioning policies.
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Clinical Commissioning Policy: Eculizumab in the treatment of recurrence of C3 glomerulopathy postkidney transplant (all ages) Reference: NHS England: 16054/P
NICE HST 1 - Eculizumab for treating atypical haemolytic uraemic syndrome
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Darbepoetin Alfa
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First Choice
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- 10, 15, 20, 30, 40, 50, 60, 80, 100, 150 & 300 microgram injections in prefilled syringes
- 20, 40, 60, 80, 100 & 300 microgram Sureclick® pens - approved for management of cancer treatment-induced anaemia in women receiving platinum-based chemotherapy for ovarian cancer
- Shared care arrangement in place for monitoring to be undertaken in primary care
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NICE CG114: Anaemia in chronic kidney disease
NICE TA323: Erythropoiesis‑stimulating agents during chemotherapy
Shared Care Guidelines for the Monitoring of Erythropoietin (Darbepoetin [Aranesp]) in the Treatment of Patients with Chronic Kidney Disease (CKD
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Epoetin alfa (Eprex®)
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Alternatives
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- Prefilled syringes (various strengths)
- Approved for management of cancer treatment-induced anaemia in
women receiving platinum-based chemotherapy for ovarian cancer
- No longer regularly used in NUTH
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NICE CG114: Anaemia in chronic kidney disease
NICE TA323: Erythropoiesis‑stimulating agents during chemotherapy
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Epoetin beta (NeoRecormon®)
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Alternatives
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- Cartridges for use in RecopensPrefilled syringes
- Approved for management of cancer treatment-induced anaemia
in women receiving platinum-based chemotherapy for ovarian cancer.
- No longer regularly used in NUTH.
- Shared care arrangement in place for monitoring to be undertaken in primary care
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NICE CG114: Anaemia in chronic kidney disease
NICE TA323: Erythropoiesis‑stimulating agents during chemotherapy
Shared Care Guidelines for the Monitoring of Erythropoietin (Darbepoetin [Aranesp]) in the Treatment of Patients with Chronic Kidney Disease (CKD)
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Methoxy Polyethylene Glycol-Epoetin Beta (Mircera®, Pegzerepoetin® alfa)
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Alternatives
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- 30, 50, 100, 120, 150, 200 & 250 microgram in 0.3ml and 360 microgram in 0.6ml injections in prefilled syringes.
- Approved for use as a longer-acting alternative to darbepoetin in a
small number of patients receiving peritoneal dialysis.
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09.01.03 |
Iron overload |
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Deferasirox
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Formulary
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- Approved for iron chelation in patients with myelodysplastic syndromes (MDS) - (as per NECN Haematology Group Guidelines) and recommended for use in patients when treatment with desferrioxamine is no longer considered to be appropriate due to progressive iron overload despite maximally tolerated doses of desferrioxamine.
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Desferrioxamine Mesilate
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Formulary
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09.01.04 |
Drugs used in autoimmune thrombocytopenic purpura |
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Anagrelide
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Formulary
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- For the treatment of thrombocythemiaas a 2nd line agent in patients poorly/non-responsive tohydroxycarbamide therapy.
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Avatrombopag (Doptelet®)
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Formulary
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- For the treatment of severe thrombocytopenia in people with chronic liver disease needing a planned invasive procedure in line with NICE
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NICE TA626: Avatrombopag for treating thrombocytopenia in people with chronic liver disease needing a planned invasive procedure
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Eltrombopag
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Formulary
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- For the treatment of adults with chronic immune (idiopathic) thrombocytopenia purpura in line with NICE.
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NICE TA293: Eltrombopag for treating chronic ITP
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Lusutrombopag
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Formulary
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- 3mg film-coated tablets
- Approved as an option for treating severe thrombocytopenia in adults with chronic liver disease having planned invasive procedures in line with NICE
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NICE TA617: Lusutrombopag for treating thrombocytopenia in people with chronic liver disease needing a planned invasive procedure
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Romiplostim
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Formulary
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- For the treatment of adults with chronic immune (idiopathic) thrombocytopenia purpura in line with NICE.
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NICE TA221: Thrombocytopenic purpura - romiplostim
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09.01.06 |
Drugs used in neutropenia |
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Filgrastim (G-CSF) (Neupogen®, Ratiograstim®)
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Formulary
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- Available as Neupogen (original brand) and Ratiograstim – a
biosimilar product.
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Lenograstim (rHuG-CSF) (Granocyte®)
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Formulary
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- 263 microgram (33.6 million units) injection vials
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Lipegfilgrastim (G-CSF)
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Formulary
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Pegfilgrastim (G-CSF)
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Formulary
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09.01.07 |
Drugs used to mobilise stem cells |
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Plerixafor (Mozobil®)
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Formulary
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- Approved by NHS England Specialist Services for stem cell mobilisation for patients with Hodgkin’s disease, Non-Hodgkins lymphoma or multiple myeloma and meet the policy for Haematopoietic Stem Cell Transplantation.
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09.02 |
Fluids and electrolytes |
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09.02.01 |
Oral preparations for fluid and electrolyte imbalance |
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09.02.01.01 |
Oral potassium |
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Potassium Chloride (Sando-K®)
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First Choice
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- Effervescent tablets (12mmol potassium 8 mmol chloride)
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Potasium Chloride
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Alternatives
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- 600mg m/r tablets – (8 mmol potassium)

- For use where the effervescent tablets or syrup are unsuitable
- 5mmol in 5ml sugar-free syrup (Kay-Cee-L)

- 1mmol in 1ml carbohydrate free oral solution
- Approved for use in children with intractable epilepsy being
treated with a ketogenic diet.
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09.02.01.01 |
Potassium removal |
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Calcium Resonium®
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Formulary
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- Powder (Calcium polystyrene sulphonate)
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Patiromer calcium (as Patiromer sorbitex calcium)
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Formulary
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- Approved for the treatment of hyperkalaemia in adults in line with NICE.
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NICE TA623: Patiromer for treating hyperkalaemia
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Resonium A®
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Formulary
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- Powder (Sodium polystyrene sulphonate)
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Sodium zirconium cyclosilicate (Lokelma®)
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Formulary
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- 5g and 10g oral powder
- Approved for the treatment of hyperkalaemia in line with NICE
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NICE TA599: Sodium zirconium cyclosilicate for treating hyperkalaemia
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09.02.01.02 |
Oral sodium and water |
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Sodium Chloride
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Formulary
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- 600mg m/r tablets (Slow Sodium) - approx. 10 mmol sodium & chloride per tablet
- 1mmol / ml oral solution
- Treatment should only be initiated with the advice of a specialist.
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09.02.01.02 |
Oral rehydration therapy (ORT) |
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Dioralyte® Oral Rehydration Salts
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Formulary
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09.02.01.03 |
Oral bicarbonate |
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Sodium Bicarbonate
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Formulary
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- 500mg capsules (500mg contains approx. 6 mmol each ofsodium and bicarbonate)
- 1mmol/ml oral solution
unlicensed
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09.02.02 |
Parenteral preparations for fluid and electrolyte imbalance |
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Steriflex 165®
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Formulary
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- Potassium chloride 0.3% (20mmol); sodium chloride 0.9%; and glucose 5% (500ml bag).
- Approved for diabetic ketoacidosis in paediatric patients
unlicensed.
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09.02.02.01 |
Electrolytes and water |
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Water for Infusion (Viaflo® - FE0304)
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Formulary
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- Approved for use by the North-East Assisted Ventilation Service (NEAVS).
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09.02.02.01 |
Intravenous sodium |
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Sodium Chloride
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Formulary
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- 0.9% injection (5ml, 10ml & 20ml)
- 0.9% IV infusion (100ml, 250ml, 500ml & 1000ml)
- 0.9% irrigation (1000ml & 3000ml)
- 0.45% IV infusion (500ml - Steriflex 2)
- 1.8%, 2.7% & 5% Polyfusor infusion (500ml)
- 30% injection (10ml)
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Sodium Chloride and Glucose
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Formulary
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- 0.9%/5% IV infusion (500ml - Sterfilex 3)
- 0.18%/4% IV infusion (500ml & 1000ml)
- 0.18%/10% IV infusion (500ml - Steriflex 19)
- 0.45%/5% IV infusion (500ml - Steriflex 45)
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09.02.02.01 |
Intravenous glucose |
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Glucose
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Formulary
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- 5% IV infusion (100ml, 250ml, 500ml & 1000ml)
- 10% IV infusion (500ml & 1000ml)
- 20% IV infusion (500ml)
- 50% Injection (50ml)
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09.02.02.01 |
Intravenous potassium |
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Potassium Chloride
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Formulary
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- 15% injection
Restricted
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Potassium Chloride and Glucose
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Formulary
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- 0.15%/5% IV infusion (1000ml - Steriflex 13)
- 0.3%/5% IV infusion (1000ml - Steriflex 16)
- 0.15%/10% IV infusion (500ml - Steriflex 106)
- 0.3%/10% IV infusion (500ml - Steriflex 132)
- 0.6%/5% IV infusion (500ml) - high strength
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Potassium Chloride and Sodium Chloride
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Formulary
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- 0.15%/0.9% IV infusion (1000ml - Steriflex 12)
- 0.3%/0.9% IV infusion (500ml & 1000ml - Steriflex 15)
- 0.45%/0.9% IV infusion (1000ml) - high strength
- 0.6%/0.9% IV infusion - high strength
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Potassium Chloride, Sodium Chloride and Glucose
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Formulary
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- 0.15%/0.45%/5% IV infusion (500ml - Intraven GV332)
- 0.15%/0.18%/4% IV infusion (1000ml - Steriflex 14)
- 0.3%/0.18%/4% IV infusion (1000ml - Steriflex 17)
- 0.3%/0.45%/5% IV infusion (500ml) Paediatrics only
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Potassium Phosphate
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Formulary
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- 17.42% injection
Restricted
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09.02.02.01 |
Bicarbonate and lactate |
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Sodium Bicarbonate
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Formulary
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- 1.26% IV infusion Polyfusor®
- 1.4% IV infusion Polyfusor®
- 2.74% IV infusion Polyfusor®
- 8.4% IV infusion Polyfusor®
- 8.4% injection (10ml & 50ml)
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Sodium Lactate IV infusion
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Formulary
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Water for Injection
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Formulary
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- 2ml, 5ml, 10ml, 20ml, 100ml & 500ml
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Water for Irrigation
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Formulary
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Sterile oral water
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Formulary
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09.02.02.02 |
Plasma and plasma substitutes |
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Human Albumin Solution
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Formulary
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- 4.5% (50ml, 100ml & 500ml)
- 20% (50ml & 100ml)
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Plasma-lyte 148 with Glucose 5%
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Formulary
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- Infusion in a balanced electrolyte solution containing Na+ 140 mmol, K+ 5 mmol, Mg2+ 1.5 mmol, acetate 27 mmol/litre. Gluconate 23 mmol/litre. Note calcium free.
- Approved for use in paediatric theatres only.
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09.02.02.02 |
Plasma substitutes |
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Dextran 40/Sodium Chloride
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Formulary
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Gelatin (Isoplex®)
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Formulary
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- 4%succinylated gelatin infusion in a balanced electrolyte solution containing Na+ 145 mmol, K+ 4 mmol, Mg2+ 0.9 mmol, Cl- 105 mmol, lactate 25 mmol/litre.
- Mainly for use in critical care areas and other situations where the perceived advantages of a balanced electrolyte plasma substitute are likely to be clinically important. Note Not yet cleared for use in NUTH.
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Gelatin (Volplex® or Gelofusine®)
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Formulary
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- 4% succinylated gelatin infusion in sodium chloride 0.9% (500ml bags)
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Tetrastarch (Tetraspan®)
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Formulary
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- 6% & 10% tetrastarch infusions in a balanced electrolyte solution containing Na+ 140 mmol, K+ 4 mmol, Mg2+ 1 mmol, Cl- 118 mmol, Ca2+ 2.5 mmol, acetate 24 mmol, malate 5 mmol/litre.
Contains calcium
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Tetrastarch (Volulyte®)
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Formulary
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- 6% tetrastarch infusion in a balanced electrolyte solution containing Na+ 137 mmol, K+ 4 mmol, Mg2+ 1.5 mmol, Cl110 mmol, acetate 34 mmol/litre.
Contains calcium.
- Mainly for use in indications where calcium containing fluids are unsuitable
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Phoxilium 1.2mmol/l phosphate
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Restricted
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- A haemofiltration and haemodialysis fluid containing Na+ 140 mmol, K+ 4 mmol, Mg2+ 0.6 mmol, Ca2+ 1.25mmol/l, Cl- 115.9 mmol/l, HCO3 - 30.0mmol/l, HPO4 2- 1.20mmol/l.
- Approved for use in CRRT in patients not requiring reduced potassium or low bicarbonate.
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09.03 |
Intravenous nutrition |
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Please contact Pharmacy for full details of Parenteral Nutrition Services
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09.03 |
Supplementary preparations |
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09.04.01 |
Foods for special diets |
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09.04.02 |
Enteral nutrition |
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09.05.01 |
Calcium and magnesium |
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09.05.01.01 |
Calcium supplements |
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Calcium Carbonate
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First Choice
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- 1.25g chewable tablets (500mg, 12.6 mmol calcium).
- 2.5g chewable tablets (1g, 25 mmol calcium).
- 500mg in 5ml suspension
unlicensed.
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Sandocal-1000®
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First Choice
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- Sandocal 1000 tablets (calcium lactate gluconate, calcium carbonate & citric acid providing 1000mg, 25 mmol calcium).
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Calcium 2.55mmol/5mL syrup
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Alternatives
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Calcium Chloride
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Alternatives
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- 5 mmol in 5ml & 10 mmol in 10ml injections.
- 10% 10ml injection in syringes also used in some resuscitation boxes at Freeman Hospital - under review
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Calcium Gluconate
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Alternatives
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- 10% 10ml injection (approx. 2.2mmol, 89mg calcium).
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09.05.01.02 |
Hypercalcaemia and hypercalciuria |
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Disodium Pamidronate
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First Choice
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Zoledronic Acid (Zometa®)
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First Choice
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- 4mg injection
For hypercalcaemia of malignancy and the prevention of skeletal events in patients with metastatic breast cancer. Prescribe by brand name (Zometa®) to avoid confusion with a different strength product used to treat osteoporosis and Paget’s disease
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Cinacalcet
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Formulary
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- Approved for the treatment of secondary hyperparathyroidism in patients with end stage renal disease on maintenance haemodialysis where parathyroid gland surgery has failed or is inappropriate.

- Also for short term use to control symptoms prior to a second attempt at more definitive surgery.

- Approved for patients with primary hyperparathyroidism for whom parathyroidectomy would be indicated based on serum calcium levels, symptoms and end organ damage, but in whom parathyroidectomy is either not clinically appropriate or is contraindicated. It is not normally commissioned if serum calcium concentration is <2.85mmol/L

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Cinacalcet Shared Care Guidance (March 2020)
NICE TA117: Hyperparathyroidism - cinacalcet
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Etelcalcetide (Parsabiv®)
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Formulary
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- 2.5mg/0.5ml, 5mg/1ml & 10mg/2ml solution for injection
- Approved for the treatment of secondary hyperparathyroidism in line with NICE and NHS England Commissioning Policy
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NICE TA448 Etelcalcetide for treating secondary hyperparathyroidism
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Paricalcitol
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Formulary
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- Approved for use in patients with PTH levels < 800mcg/l but whose treatment with alfacalcidol is restricted due to a high calcium level.
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Calcitonin (Salmon®) (Salcatonin)
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Alternatives
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- 400 units in 2ml injection - see section 6.6.1 for 200 units/dose nasal spray.
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Sodium Clodronate
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Alternatives
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09.05.01.03 |
Magnesium |
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Magnesium Aspartate
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Formulary
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- 6.5g (10 mmol) sachets - first line for the treatment and prevention of magnesium deficiency.
- 614.8mg (2.5mmol) tablets
unlicensed - for second line treatment in patients with short bowel syndrome.
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Magnesium chloride
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Formulary
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- 10 mmol magnesium in 1 litre sodium chloride 0.9% with potassium chloride 0.15% (20 mmol)
unlicensed
- 64mg sustained release tablets (2.6mmol magnesium)
unlicensed
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Magnesium Glycerophosphate
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Formulary
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- 1g (4mmol) chewable tablets
- Use preparation with cheapest acquisition cost.
- Yourmag®
- Magnaphate®
unlicensed
- 1mmol/ml suspension -available if supply problems with tablets
unlicensed.
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Magnesium Sulphate
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Formulary
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- 50% 2ml (4 mmol), 50% 10ml (20 mmol) & 10% 10ml (4mmol) injections
- 60 mmol in 500ml sodium chloride 0.9% infusion
unlicensed
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09.05.02.01 |
Phosphate supplements |
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Phosphate (Solution)
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Formulary
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- 4.15 mmol phosphate in 10ml oral solution
unlicensed
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Phosphate Polyfusor
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Formulary
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- 500ml intravenous infusion containing 50mmol phosphate
per 500ml (PO4 3- 100 mmol, K+ 19 mmol, and Na+ 162 mmol/litre).
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Phosphate-Sandoz®
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Formulary
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- Effervescent tablets (phosphate 16.1 mmol, sodium 20.4mmol & potassium 3.1 mmol / tablet)
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09.05.02.02 |
Phosphate-binding agents |
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Calcium Acetate (Phosex®, Renacet®)
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First Choice
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- Phosex® 1g tablets (containing 250mg, 6.2mmol of calcium)
- Renacet® 475mg (containing 120.25mg, 3mmol of calcium) &
950mg tablets (containing 240.5mg, 6mmol of calcium)
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Calcium Carbonate
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Second Choice
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- 1.25g & 2.5g chewable tablets (Calcichew)
(Other formulations e.g. Remegel, Rennies, Rennie Soft gel and Settler’s. Tums are also stocked at the RVI for use in paediatric renal patients)
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Osvaren®
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Second Choice
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- Tablets containing calcium acetate 435mg & Magnesium carbonate heavy 235mg.
- For use, after calcium carbonate and calcium acetate, but before the
much more expensive sevelamer and lanthanum.
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Sevelamer Carbonate
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Second Choice
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- 800mg f/c tablets.
- 2.4g powder for oral suspension.
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Sucroferric oxyhydroxide (Velphoro®)
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Third Choice
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- Approved for use by haemodialysis or peritoneal dialysis patients who cannot tolerate alternative phosphate binders or where these have been ineffective
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Lanthanum (Fosrenol ®)
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Third Choice
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Sodium Fluoride
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Formulary
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- Sodium fluoride 0.619% (75ml) toothpaste (Duraphat® 2800 ppm)

- Sodium fluoride 1.1% (51g) toothpaste (Duraphat® 5000 ppm)

- Sodium fluoride 0.05% mouthwash - approved for use within the dental hospital.
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09.05.04 |
Zinc |
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Zinc Sulphate (Solvazinc®)
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Formulary
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Zinc Sulphate 220mg capsules
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Formulary
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Vitamin A
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Formulary
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- 20,000 unit injection - for the treatment of night blindness/ vitamin A deficiency as a result of malabsorption in patients with short bowel syndrome, ileal resection or pancreatic insufficiency
unlicensed.
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Vitamins A and D
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Formulary
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- Capsules containing vitamin A 4000 units, vitamin D 400 units
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Pyridoxal Phosphate
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Formulary
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- 25mg tablets
unlicensed
- 50mg capsules
unlicensed
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Pyridoxine Hydrochloride (Pyridoxine)
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Formulary
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- 10mg
unlicensed
- 50mg tablets
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Thiamine
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Formulary
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NICE CG100: Management of alcohol-related physical complications
NICE CG115: Alcohol dependence - diagnosis, assessment and management
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Vitamin B & C injection (Pabrinex®)
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Formulary
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- IVHP injection (ascorbic acid 500mg, nicotinamide 160mg, pyridoxine
hydrochloride 50mg, riboflavin 4mg & thiamine hydrochloride 250mg & 1g anhydrous glucose / pair of ampoules)
- IMHP injection also used
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NICE CG100: Management of alcohol-related physical complications
NICE CG115: Alcohol dependence - diagnosis, assessment and management
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09.06.02 |
Oral vitamin B complex preparations |
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Vitamin B Tablets, Compound Strong
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Formulary
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- Tablets (nicotinamide 20mg, pyridoxine hydrochloride 2mg, riboflavin 2mg & thiamine hydrochloride 5mg per tablet).
- For short term use in refeeding syndrome only.
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Ascorbic Acid (Vitamin C)
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Formulary
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- 50mg, 100mg, 200mg & 500mg tabs
- 500mg in 5ml injection
unlicensed
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Alfacalcidol
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Formulary
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- 250 nanogram & 1 microgram capsules
- 2 microgram/ml sugar-free oral drops – one drop containing approx. 100 nanograms of alfacalcidol
- 1 microgram in 0.5ml & 2 micrograms in 1ml injections
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Colecalciferol
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Formulary
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- 20microgram (800 units) capsules or tablets
- For first line use in the long term maintenance treatment of patients with documented vitamin D deficiency following high strength therapy and also for use in patients with symptoms and insufficient levels.
- 500 microgram (20,000 units) capsules
- For use in patients requiring high strength therapy for vitamin D deficiency.
- 2740iu/ml oral solution (Fultium®-D3 Drops)
- 1000iu and 3000iu buccal spray (DLux®)
unlicensed 
- Approved for use in paediatric parenteral nutrition patients with short bowel syndrome and adults with metabolic bone disease who have vitamin D deficiency despite previous treatment.
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Colecalciferol 25,000 unit liquid (Invita D3® )
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Formulary
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Ergocalciferol (Calciferol)
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Formulary
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- 250 microg. (10,000 units) & 1.25mg (50,000 units) tablets.
- A 3000 units in 1ml suspension (
unlicensed) may be supplied if colecalciferol oral solution is not available.
- 7.5mg (300,000 units) in 1ml injection.
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Calcium Carbonate 1.5g and Colecalciferol 10micrograms (400iu) (Accrete®)
|
Formulary
|
- First Choice combination
- Film coated tablet containing calcium carbonate 1.5g and colecalciferol 10 micrograms (400 units)
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Calcium Carbonate 1.5g and Colecalciferol 10micrograms (400iu) (Evacal®)
|
Formulary
|
- Second Choice combination
- Chewable tablet containing calcium carbonate 1.5g and colecalciferol 10 micrograms (400 units) - approved as chewable option and also to be used in patients with peanut and soya allergy.
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Calcium Phosphate 3.1g and Colecalciferol 20micrograms (800iu) (Calfovit D3®)
|
Formulary
|
- Second choice combination
- Powder in sachets – calcium phosphate 3.1g (1.2g calcium) & Vitamin D3 800 units
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Calcium and Ergocalciferol Tablets
|
Formulary
|
- Second choice combination
- Calcium lactate 300mg, calcium phosphate 150mg (Ca 97mg, 2.4 mmol) & ergocalciferol 10 micrograms (400 units).
|
|
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Alpha Tocopherol (Vedrop®)
|
Formulary
|
- 50mg in 1ml oral solution - approved for the treatrment of children with vitamin E deficiency due to fat malabsorption syndromes.
|
|
Alpha Tocopheryl Acetate (Vitamin E)
|
Formulary
|
- 500mg in 5ml suspension
- 134mg (200 unit) capsules
|
|
09.06.06 |
Vitamin K |
|
|
Phytomenadione
|
First Choice
|
- 50 microgram in 0.25ml drops (NeoKay®)
unlicensed
- 1mg capsule- preferred product for use in neonates
- 10mg in 1ml injection
unlicensed
- 2mg in 0.2ml mixed micelles injection (Konakion® MM
Paediatric) – may be taken by mouth as well as being given by IM or IV injection
|
|
Menadiol Sodium Phosphate
|
Second Choice
|
- 10mg tablets - water soluble derivative of vitamin K for use in patients with fat malabsorption, especially in hepatic disease or biliary obstruction including cystic fibrosis patients.
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|
09.06.07 |
Multivitamin preparations |
|
|
Mutivitamins BPC
|
First Choice
|
- Capsules containing ascorbic acid 15mg, nicotinamide 7.5mg, riboflavin 500 micrograms, thiamine HCl 1mg, vitamin A 2,500 units, & vitamin D 300 units
|
|
Dalivit®
|
Formulary
|
- Drops containing in each 0.6ml dose ascorbic acid 50mg, ergocalciferol
400 units, nicotinamide 5mg, pyridoxine HCl 500 micrograms, riboflavin 400 micrograms, thiamine 1mg & vitamin A 5,000 units)
- Dalivit drops are to be retained for use in patients requiring a full supplement of vitamin A.
|
|
Healthy Start Vitamins
|
Formulary
|
- These formulations are prepared for the NHS and recommended in NICE guidance. DOH offers the Healthy Start Vitamins to pregnant women and children less than 4 years. They are only available through clinics and from midwives and are not prescribable on FP10 prescriptions
|
|
Abidec®
|
Alternatives
|
- Drops containing in each 0.6ml dose ascorbic acid 50mg, ergocalciferol
400 units, nicotinamide 5mg, pyridoxine HCL 500micrograms, riboflavin 400 micrograms, thiamine 1mg & vitamin A 1,333 units. To be used in children and adults.
|
|
09.06.07 |
Vitamin and mineral supplements and adjuncts to synthetic diets |
|
|
DEKAs® Essentials multivitamins
|
Formulary
|
- Approved for adult patients requiring multivitamin and mineral supplementation with Cystic Fibrosis
|
|
DEKAs® Plus multivitamins
|
Formulary
|
- Approved for adult patients requiring multivitamin and mineral supplementation with Cystic Fibrosis
|
|
Forceval®
|
Formulary
|
- Capsules & junior capsules
- For limited use as a vitamin and mineral supplement in patients with phenylketonuria The capsules are also approved as an oral supplement in burns patients with malnutrition or alcohol dependency and patients with major burns after discontinuation of IV therapy, and have also been approved for use in patients with severe anorexia nervosa. Treatment initiated with specialist advice.
- Soluble
- Approved for short term use in patients who are unable to swallow
Forceval capsules.
|
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Ketovite®
|
Formulary
|
|
|
Renavit® tablets
|
Formulary
|
- Water soluble vitamin supplementation therapy for maintenance haemodialysis patients only.
|
|
|
09.08 |
Metabolic disorders |
|
|
09.08.01 |
Drugs used in metabolic disorders |
|
|
Ubiquinone (Coenzyme Q10, Ubidecarenone)
|
Formulary
|
- 10mg, 30mg, & 100mg capsules
- 50mg in 5ml & 30mg in 1ml (150mg in 5ml) oral solution
- nutritional supplement and antioxidant approved for use in the
management of mitochondrial disorders.
- approved for use under specialist consultant supervision in the
management of patients with severe hyperlipidaemia who are not tolerating statins due to myopathy. Use in statin induced myopathy is subject to treatment being initiated by a consultant.
Lipid clinic initiation only
|
|
Chenodexoycholic acid (Xenbilox®)
|
Formulary
|
- 250mg capsules
- Approved for the treatment of Cerebrotendinous Xanthomatosis in line with NHS Commissioning Policy. NHS England will commission this drug for patients who are currently being treated (April 2017)
- Approved for the treatment of inborn errors of bile acid synthesis (all ages) in line with NHS England Commissioning Policy
|
|
|
Penicillamine
|
Formulary
|
- 125mg & 250mg tablets - also used for the treatment ofcystinuria and rheumatoid arthritis – section 10.1.3
|
|
Trientine Dihydrochloride
|
Formulary
|
- 300mg capsules
- Approved for the treatment of Wilsons disease in line with NHS England Commissioning Policy. NHS England will commission the treatment for patients who are currently being treated (April 2017)
|
|
Tiopronin
|
Unlicensed
|
- 500mg tablets - for use as 2nd line treatment for cystinuria in
patients who fail to tolerate/respond to penicillamine unlicensed.
|
|
09.08.01 |
Carnitine deficiency |
|
|
Carnitine (Levocarnitine)
|
Formulary
|
- 30% oral solution
- 1g in 5ml injection
|
|
|
Migalastat (Galafold ®)
|
Formulary
|
- Approved for the treatment of Fabry's disease in line with NICE
|
Highly specialised technologies guidance HST4: Migalastat for treating Fabry disease
|
09.08.01 |
Gaucher's disease |
|
|
Imiglucerase (Cerezyme®)
|
Formulary
|
|
|
09.08.01 |
Mucopolysaccharidosis I |
|
|
Elosulfase alfa
|
Formulary
|
- 5mg/5ml concentrate for solution for infusion -approved as a possible treatment for people with mucopolysaccharidosis type IV a (MPS IVa).
|
NICE HST 2 - Elosulfase alfa for treating mucopolysaccharidosis type IVa
|
|
09.08.01 |
Nephropathic cystinosis |
|
|
Mercaptamine
|
Formulary
|
|
|
09.08.01 |
Urea cycle disorders |
|
|
Sodium Phenylbutyrate
|
Unlicensed
|
- 500mg tablets - Licensed formulation marketed as Ammonaps
- 1g in 5ml & 2g in 10ml injections
|
|
09.08.02 |
Acute porphyrias |
|
|
09.08.02 |
Drugs unsafe for use in acute porphyrias |
|
|
.... |
Key |
|
|
Cytotoxic Drug
|
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Controlled Drug
|
|
High Cost Medicine
|
|
Cancer Drugs Fund
|
|
NHS England |
|
Homecare |
|
CCG |
|
Traffic Light Status Information
Status |
Description |

|
Drugs for hospital use only. The responsibility for initiation and monitoring treatment should rest with an appropriate hospital clinician and the drug should be supplied through the hospital throughout the duration of treatment.
In some very exceptional circumstances (e.g. due to distance from the hospital, storage, supply or mobility/transport problems) it may be appropriate for the GP to be asked to prescribe a Red drug. This should be negotiated on an individual patient basis and should only be done with the GP’s prior informed agreement where the roles of the GP and hospital services are clearly defined and agreed. The GP should not feel under pressure to prescribe in these circumstances.
|

|
Drugs initiated by hospital specialist, but where continuing treatment by GPs may be appropriate under a shared care arrangement.
The specialist should send the GP a copy of the shared care agreement to sign. The GP should sign the shared care agreement, or indicate they do not want to be part of such an agreement, and return a copy back to the specialist. Shared care guidelines are available or are being developed for most of the drugs listed as Amber.
If no shared care guideline is available, the hospital specialist should provide the patient’s GP with sufficient information and support to allow treatment to be continued and managed safely in primary care. |

|
Drugs normally recommended or initiated by hospital specialist, but where the provision of an information leaflet may be appropriate to facilitate continuing treatment by GPs. Many of these information sheets are in the process of development. |

|
Drugs where prescribing by GPs is appropriate. Drugs not classified as Red, Amber or Green Plus (formerly blue in North of Tyne) are generally classified as ‘Green’ by default. The Green drugs listed here include those products normally initiated by hospital specialists where there was a need for discussion and debate as to the category in which they should be placed. |
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