North of Tyne Formulary Version 5 4Final

7/23/2019 North of Tyne Formulary Version 5 4Final

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North of Tyne Area Prescribing Committee. Formulary - Version 5.4 July 2014

North of Tyne Area Prescribing Committee

North of Tyne FormularyVersion 5.4 July 2014

This version of the North of Tyne Formulary shows the drugs included in the Drugsand Preparations sections (1-15) plus a section on products used in the treatment ofpoisoning (section 16).

This formulary lists the medicines and related pharmaceutical products that areapproved for use in the North of Tyne NHS area and includes indications as to

the first choice and alternative drugs,

those drugs that are classified as Red hospital only (R), those appropriate

for shared care Amber (A),those products that are unlicensed, but have been approved for use in thelocal health economy by the Area Prescribing Committee (APC)

This version of the document has been updated to include drugs that have beenapproved for use up to the end of July 2014. Further updates will be made to takeaccount of feedback from users and decisions made by the APC and its Formulary

Subcommittee.

In the electronic version of this document most of the drug names are formatted ashyperlinks to the BNF monograph to provide access prescribing and other information.

The formulary is supported by all of the NHS Trusts in Northumberland, NorthTyneside and Newcastle i.e.

Newcastle upon Tyne Hospitals NHS Foundation TrustNHS Newcastle West Clinical Commissioning Group (NHS NWCCG)NHS Newcastle North and East Clinical Commissioning Group (NHS NNECCG)

NHS North Tyneside Clinical Commissioning Group (NHS NTCCG)Northumberland Tyne and Wear NHS Foundation TrustNHS Northumberland Clinical Commissioning Group (NHS NCCG)Northumbria Healthcare NHS Foundation Trust

Information in this document must not be used for promotional activities by thepharmaceutical industry without permission.

CopyrightAll rights reserved. No part of this document may be reproduced, stored in a retrieval

system or transmitted in any form or by any means, without permission.

North of Tyne Area Prescribing Committee 2014


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North of Tyne Area Prescribing Committee. Formulary - Version 5.4 July 2014

Contents

Abbreviations ................................................................................................................................... 3

Contact Details................................................................................................................................ 3

Introduction ..................................................................................................................................... 4

Changes to formulary since previous version 7

Classified Details of Drugs and Preparations

1. Gastro-intestinal System....................................................................................................

2. Cardiovascular System .......................................................................................................

3. Respiratory System ..............................................................................................................

4. Central Nervous System ....................................................................................................

5. Infections .................................................................................................................................

6. Endocrine System.................................................................................................................

7. Obstetrics, Gynaecology and Urinary-Tract Disorders...........................................

8. Malignant Disease and Immunosuppression .............................................................

8

15

29

35

55

66

78

85

9. Nutrition and Blood.............................................................................................................. 96

10. Musculoskeletal and Joint Diseases............................................................................... 10611. Eye Diseases...........................................................................................................................

12. Ear, Nose and Oropharynx ...............................................................................................

13. Skin ............................................................................................................................................

112

120

125

14. Immunological Products and Vaccines......................................................................... 138

15. Anaesthesia............................................................................................................................. 142

16. Treatment of Poisoning...................................................................................................... 148

17. Enteral Nutrition (to be developed)................................................................................

18. Wound Management Products..........................................................................................

150

151

Appendix .................................................................................................................................. 162

Index................................................................................................................................................... 166


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North of Tyne Area Prescribing Committee. Formulary - Version 5.4 July 2014 3

Abbreviations etc.Caps = CapsulesDisp = Dispersiblee/c = Enteric coatedEff = EffervescentInj = Injection

m/r = Modified releaseMicrog = MicrogramSol = SolutionSuppose = SuppositoriesSusp = SuspensionTabs = Tablets

Some products are also marked with a suffix (es) to give additional information:

R Red Drug (hospital only)

A Amber Drug (shared Care)

B Blue Drug (drugs which are initiated by specialists for which information sheets arebeing developed to provide GPs with information to assist with prescribing etc.)

G Green DrugDrugs that may be initiated in primary careonly used with drugswhere there has been some debate as to whether they should be initially prescribedby GPs

s Specialist advice/ initiation- see comments next to each entry

u Unlicensed

r Restricted use (e.g. to a certain consultant or speciality, or in specific clinicalcircumstances)

Abbreviations used to represent different hospitals/trusts/Committees

APC North of Tyne Area Prescribing Committee

NHCT Northumbria Healthcare NHS Foundation Trust

NTW Northumberland Tyne and Wear Trust

NUTH Newcastle upon Tyne Hospitals NHS Foundation Trust

NECS North of England Commissioning Support

Contact Details

For enquiries and queries contact:

Matthew Lowery Newcastle upon Tyne HospitalsNHS Foundation Trust

Tel: 0191 223 [email protected]

Sarah Chandler Northumbria Healthcare NHSFoundation Trust


Matt Haggerty Northumberland, Tyne andWear NHS Foundation Trust

Tel: 0191 [email protected]

Susan Turner North of EnglandCommissioning Support

mailto:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]


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Introduction

The North of Tyne Formulary is produced under the auspices of the North of TyneArea Prescribing Committee (APC). It gives details of medicines that are approved foruse in NHS organisations in Newcastle, North Tyneside and Northumberland.

The range of medicines included in this formulary is intended to encourage safe,effective and economical prescribing. Having a common range of medicines availablefor use in the North of Tyne Area should help ensure seamless prescribing for patientsbetween general practice and hospital trusts, facilitating continuity of treatment andminimising supply problems. It should also help those healthcare professionals thatwork for more than one organisation in the local health economy.

Where appropriate the formulary gives information as to which drugs are regarded asbeing the first choice and alternatives. It is not intended to be a comprehensiveprescribing guide or to replace the BNF or BNF for children. The drug names in theelectronic version are however formatted as hyperlinks to the BNF. As the formularydevelops, further links will be provided to North of Tyne Guidelines etc.

The formulary is a dynamic document that is updated regularly after each APCmeeting. The most up to date version of the formulary is maintained in electronic formon the APCs Internet site:

http://www.northoftyneapc.nhs.uk/formulary/

An up to date version of the formulary may also be located on the individual TrustsIntranet sites, thereby providing links to that Trusts locally adapted electronic versionof the BNF giving additional information and links e.g. to that Trusts policies andguidelines. However, in most organisations this is still in development.

1. Notes on using the formulary

Medicines in the formulary are listed in chapters and subsections that generallycorrespond with those in the BNF. Where possible drug names have been formattedas hyperlinks to BNF monographs. This is to enable users to easily refer to the BNF forinformation on doses, side effects, cautions, contraindications and drug interactions.The Microsoft Word version of this document can also be navigated by using thedocument mapClick on View and then select document map.

Recommended International Non-proprietary Names (INNs) are used throughout thetext, but proprietary names are used for some combination and modified release

products, where brand name prescribing is recommended.

The cheapest available solid dosage form should be used when there are nobioavailablity issues.

Products listed in the formulary are flagged to indicate if they are hospital onlyproducts, suitable for shared care, are unlicensed or have been approved for anunlicensed indication. Hospital doctors should not ask GPs to prescribe hospital onlymedicines (Red drugs) unless there is a very exceptional reason and agreement withthe GP.

When prescribing unlicensed medicines it is important that prescribers are aware that

they are taking on additional responsibilities regarding the patients safe ty. Furtherinformation and guidance can be obtained from individual Trust unlicensed medicinespolicies.
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2. NICE approved treatments

All NICE Technology Appraisals are automatically endorsed by the North of Tyne APC;relevant medicines are incorporated into the formulary and are available for cliniciansto prescribe within 90 days of publication by NICE.

3. Requests for products to be included in the formulary

Requests for products to be added to the formulary have to be approved by the Northof Tyne Area Prescribing Committee.

Requests normally have to be made by a consultant, general practitioner or otherappropriate senior healthcare professional (e.g. optician, dentist, nurse, podiatrist,dietician or pharmacist) and wherever possible the request should be submittedelectronically by email.

A copy of the New Product Request Form can be downloaded from the APCs Internet

site:

http://www.northoftyneapc.nhs.uk/formulary/

4. Use of Non-Formulary Medicines

GPs and other prescribers in primary care are strongly encouraged to prescribemedicines that are included in the formulary.

The formulary is intended to be followed closely in hospitals. Consequently thehospital pharmacies may not stock medicines that are not included in the formulary.However it is recognised there are some circumstances where it will be necessary to

use a non-formulary medicine and individual trusts have their own procedures fordealing with this. However, the following principles apply:

a) Initiating therapy with a Non-Formulary Medicine

In cases where it is considered that there is no formulary medicine appropriate fortreating an individual hospital patient, the consultant responsible for the patients careshould contact a senior pharmacist at the hospital where the patient is being treated.The request will then need to be dealt with in accordance with the hospital trusts non-formulary request procedure, which may include completion of a non-formulary requestform.

In exceptional circumstances only, if a hospital doctor wishes a patients GP toprescribe a non-formulary drug, then he/she should explain to the GP that the desiredtreatment is not in the formulary and give the reason(s) why it is being requestedinstead of a formulary medicine, e.g. if the patient has failed to tolerate or respond topossible formulary alternatives.

b) Patients admitted to hospital on Non-Formulary medicines

The process for dealing with this issue varies between organisations, as it is largelydependent on how patients own medicines are handled. Prescribers should familiarisethemselves with systems in their own organisation and act accordingly.

In the absence of a system for routinely using patients own medicines during hospitalstay, consideration should be given to changing to a formulary medicine where this is
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practicable and not likely to be detrimental to the individual patients care. Where it isnot practicable to change the patients medication, a pharmacist should be contactedso that appropriate arrangements for continuing the treatment can be made.

When therapy with a non-formulary drug is continued on admission, medicationbrought into hospital by the patient may be used, provided that it is clearly labelled andappears to be of good quality, in accordance with the hospital trusts policy.

4. Unlicensed Medicines and Use of Medicines for Unlicensed Indications

This formulary contains a number of unlicensed medicines, and medicines that havebeen approved for unlicensed or off-label indications. Their inclusion has been agreedafter careful consideration of their benefits versus any known or perceived risksassociated with their use by the North of Tyne Area Prescribing Committee (APC) andits Formulary Subcommittee. Many unlicensed medicines are formulations of well -established drugs that are included the BNF, whereas others are products that are lesswell known, but considered to be of benefit in the treatment of patients with conditionswhere licensed medicines cannot be used or fail to produce an adequate response.

Unlicensed medicines included in the Formulary are marked using the suffixu

andthose that are considered unsuitable for prescribing by GPs (even if treatment hasbeen started and stabilised by a hospital clinician) are classified as RED, or hospitalonly, medicines.

When prescribing an unlicensed or a licensed product off-label for an unlicensedindication it is important prescribers are aware that it is not only they who take onadditional responsibilities regarding the patients safety and welfare, but the burden isshared with others involved in supply and administration.

Further information and guidance can be obtained from the GMC website

5. Prescribing of branded generic medicines

Branded generic preparations can be prescribed (where appropriate to do so e.g. oncost grounds) without being specifically listed in the formulary.

This must be in accordance with theNorth of Tyne APC Guidancefor the prescribingof generic medicines.
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Changes to the Formulary since previous version(Version 5.3 May 2014)

Section Change Reason for change

Contactdetails

Contact details for respective trusts updated

1.6.2

Addition of sodium picosulfate elixir for paediatric

patients with constipation APC approval

2.5.1Addition of macitentan for treatment of pulmonaryhypertension in adults

NHS England SSC1425

3.4.3Addition of Emerade (adrenaline) for use in emergencytreatment of anaphylaxis

APC approval

4.6Addition of fosaprepitant for chemotherapy inducednausea and vomiting

APC approval

4.7.2Addition of dihydrocodeine for use in breast feedingmothers immediately post-delivery/c-section

APC approval

5.3.3.2

Addition of sofosbuvir with either daclatastivir /ledipasvir in combination with ribavirin for treatment ofchronic hepatitis C in line with NHS England Early

Access Programme

NHS England SSC1424

6.1.2.3Addition of canagliflozin for use as combinationtherapy treating type 2 diabetes

NICE TA315

8.2.3Addition of alemtuzumab for the treatment of activerelapsingremitting multiple sclerosis

NICE TA312

8.2.4Addition of NHS England Commissioning Policy forfingolimod

NHS England SC1426

10.1.3Addition of approved indications, ankylosingspondylitis and psoriatic arthritis, for certolizumabpegol

APC approval

13.2.1 Addition of Zerodouble gel as emollient APC approval


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1. Gastro-Intestinal System

1.1Dyspepsia and Gastro-oesophageal Reflux Disease

1.1.1Antacids and Dimeticone

1.1.1 - Plain Antacids

First ChoiceCo-magaldrox195/220(Mucogel,Maalox)

Sugar-free suspension - 195mg magnesiumhydroxide & 220mg dried aluminium hydroxide in 5ml-for indigestion.

Mucogel is cheaper than Maalox in the community

Sodium citrate 0.3 Molar solution-used in obstetrics for prophylaxis of acid aspiration seesection 15.1.9

Infacol Sugar-free- simeticone 40mg/m l- only approved for use in

endoscopy procedures.

1.1.1 - Antacids with Dimeticone

Co-simalcite125/500(Altacite Plus)

Sugar-free suspension (activated dimeticone 125mg &hydrotalcite 500mg in 5ml)

1.1.2Compound Alginates and Proprietary Indigestion Preparations

Peptac Sugar-free liquid (sodium alginate 500mg, sodiumbicarb. 267mg, calcium carb. 160mg in 10ml -6.2mmol sodium)

- preferred antacid for treating reflux. Use instead of Gaviscon

Infant Gaviscon Oral sugar-free powder in dual sachets (sodiumalginate 225mg, magnesium alginate 87.5mg withcolloidal silica and mannitolsodium content0.92mmol/dose)

- N.B. Each half of the dual-sachet is identified as one dose'. Toavoid errors prescribe as dual-sachet' with directions in terms ofdose'

1.1.3 -Antacid with Local Anaesthetic

Antacid with Oxetacaines u Sugar-free suspension (contains aluminium hydroxide

mixture 4.75ml, magnesium hydroxide 100mg and oxetacaine[Oxethazaine] in 5ml)-Used to relieve symptoms in patients who have had radiotherapy

and may be of value in some patients with acute oesophagitis. Not

for routine use as an antacid.

1.2 - Antispasmodics and Other Drugs Altering Gut Motility

Antimuscarinic (anticholinergic) Antispasmodics

First ChoiceDicycloverine(Dicyclomine) 10mg tablets

10mg in 5ml syrup

Hyoscine Butylbromide 20mg in 1ml injectionfirst Choice if injection needed 10mg tablets - poorly absorbed
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Alternatives

Propantheline Bromide 15mg tablets

Atropine Sulphate 600 microgram tablets; 500 microgram in 5ml mixture u

Other Antispasmodics

Mebeverine 135mg tablets; 50mg in 5ml sugar-free liquid

Peppermint oil 0.2ml m/r, e/c capsules (Colpermin)

Motility stimulants

Domperidone(also see section 4.6)

10mg tablets; 5mg in 5ml sugar-free suspension30mg suppositories

Metoclopramide(also see section 4.6)

10mg tablets; 5mg in 5ml oral solution10mg in 2ml injection

1.3 - Ulcer Healing Drugs

1.3.1 - H2 Receptor Antagonists

First ChoiceRanitidine 150mg & 300mg tablets; 150mg effervescent tablets

150mg in 10ml sugar-free oral solution (contains 7.5%-8%alcohol & sorbitol)50mg in 2ml injection- injection mainly used for prophylaxis of stress ulceration

AlternativeCimetidine 200mg & 400mg tablets

200mg in 5ml syrup

1.3.3Chelates and Complexes

Sucralfate 1g tablets1g in 5ml suspension- mainly for prophylaxis of stress ulceration and acutegastrointestinal bleeding

1.3.4Prostaglandin Analogues

Proton pump inhibitors are usually preferred for the prevention of gastro-intestinal bleeding(better tolerated). Most hospital use of misoprostol is for the induction of labour or termination

of pregnancy (unlicensed indications).

Misoprostol 200 microgram tablets

100 microgram tablets s u

- mainly for use in paediatric nephrology at the RVI

1.3.5 - Proton Pump InhibitorsPreferred Drugs

Omeprazole 10mg, 20mg & 40mg capsules10mg, 20mg & 40mg orodispersible tablets (MUPS)40mg IV Infusion

40mg Injection (powder for reconstitution)- for acute Gastrointestinal bleeding see North of Tyne Acidsuppression guidelines
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- omeprazole orodispersible (MUPs) tablets should only be usedin patients who cannot swallow capsules or tablets and wherelansoprazole orodispersible tablets are unsuitable.- a 10mg in 5ml oral suspension (unlicensed) can be obtained foruse in very small children and where a suspension has to begiven down a very fine NG tube (below French Size 8)

Lansoprazole 15mg & 30mg capsules15mg & 30mg orodispersible tablets- N.B. The orodispersible tablets should only be used in patientswho cannot swallow capsules or tablets and for NG/PEG/PEJuse. Omeprazole capsules are currently cheaper thanlansoprazole capsules in primary care

1.3.5Helicobacter Pylori Eradication

First Choice Regimen Lansoprazole 30mg (or omeprazole 20mg),clarithromycin 500mg & amoxicillin 1g all twice dailyfor 7 days.- metronidazole 400mg bd, clarithromycin 250mg bd &lansoprazole 30mg bd should be used instead of amoxicillin in

patients who are allergic to penicillins

1.4Acute Diarrhoea

1.4.1- Adsorbents and Bulk-Forming Drugs

Adsorbents such as Kaolin are not recommended for acute diarrhoea. Bulk-forming drugssuch as methylcellulose and ispaghula (section 1.6.1) are useful in controlling faecalconsistency in colostomy and ileostomy, and in controlling diarrhoea associated withdiverticular disease.

1.4.2Antimotility Drugs

First Choice

Loperamide 2mg capsules;

2mg Orodispersible tabletss

-approved for use in primary care following specialist initiation insecondary care for patients with high output stoma only

1mg in 5ml sugar-free syrup- to relieve diarrhoea post-surgery following extensivegastrointestinal surgery. A therapeutic test should be carried outand if there is inappropriate response after 5 days, and it shouldbe stopped.

Alternative

Codeine Phosphate 15mg, 30mg & 60mg tablets(see section 4.7.2 for other formulations)

1.5 - Chronic Bowel Disorders

Oral/Parenteral Preparations

Aminosalicylates

First Choice

Mesalazine 400mg e/c m/r tablets (Octasa MR)- approved as first choice 400mg e/c m/r preparation for all newpatients. Patients receiving Asacol and Mesren should beswitched to Octasa when appropriate.
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400mg e/c m/r tablets (Asacolbrand)- to be used forexisting patientswho are unable to change to Octasa MR500mg m/r (sustained release) tablets (Pentasa)1g m/r granules/ sachet- only to be used in patients with difficulty in swallowingDifferent brands of oral mesalazine are not automaticallyinterchangeable

Alternatives

Balsalazides 750mg capsules-for use on consultant gastroenterologist advice only

Sulfasalazine 500mg plain & 500mg e/c tablets250mg in 5ml suspension

Corticosteroids (see section 6.3 for systemiccorticosteroids)

First Choice

Prednisolone 5mg tabletsSee section 6.3

Alternative

Budesonides 3mg capsules enclosing e/c pellets (Budenofalk)3mg capsules enclosing e/c m/r pellets (Entocort)-for use on consultant gastroenterologist advice only

Immunosuppressants and Cytokine InhibitorsFor use on consultant gastroenterologists advice only

AAzathioprine

50mg tablets

A Mercaptopurine 50mg tablets- unlicensed indication

A Methotrexate 2.5mg tablets- unlicensed indication

RAdalimumab 100mg vials for intravenous infusion

- approved for Crohns disease in linewith NICE

RInfliximab 100mg vials for intravenous infusion

- approved for severe Crohns disease in line withNICE-approved for acute exacerbations of ulcerative colitis in line

NICE- not approved for sub-acute manifestations of ulcerative colitis

NICERectal Preparations

Aminosalicylates

Mesalazine 250mg & 500mg & 1g suppositories1g in 100ml retention enema, 2g in 59ml enema1g foam enema

Corticosteroids (see section 6.3 for systemiccorticosteroids)First Choice

Prednisolone 20mg retention enema, 5mg suppositories20mg/metered application rectal foam
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Alternative

HydrocortisoneAcetate

10% rectal foam125mg/metered applicationApplication device may be preferred to that for prednisolonefoam (Predfoam

) enema

1.6Laxatives

1.6.1Bulk-FormingLaxatives

First Choice

Ispaghula Husk 3.5g sachetsorange flavour Fybogel preferred

Alternative

Methylcellulose 500mg tablets

1.6.2 - Stimulant Laxatives

First Choice

Senna 7.5mg tablets; 7.5mg in 5ml syrup

Alternatives

Docusate sodium 100mg capsules12.5mg in 5ml & 50mg in 5ml sugar-free solutions-also acts as a faecal softener

Bisacodyl 5mg e/c tablets; 5mg & 10mg suppositories

Glycerol (Glycerin) 1g, 2g & 4g suppositories

Sodium picosulfate elixir 5mg/5ml elixir-for use as a second line agent in paediatric patients with

constipation when Movicol, lactulose and senna are ineffective assingle agent therapy

Co-danthramerr 25/200 suspension, 25/200 capsules (25mg Dantron &200mg Poloxamer 188 per 5ml/capsule)

37.5/500 strong capsules(37.5mg Dantron & 500mgPoloxamer 188)

75/1,000 strong suspension (75mg Dantron & 1gPoloxamer 188in 5ml)

Co-danthrusater 50/60 capsules(50mg Dantron & 60mg Docusate sodium)

N.B. Co-danthramer and Co-danthrusate are generally restricted to use in thetreatment of constipation in terminally ill patients. A combination of Senna andDocusate is normally preferred.

1.6.3Faecal Softeners

Docusate Sodium 100mg capsules12.5mg in 5ml & 50mg in 5ml sugar-free solutions

Arachis Oil Enema Enemas containing 130ml arachis (peanut) oil

1.6.4Osmotic Laxatives
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Lactulose Solution containing 3.1g to 3.7g in 5ml with other ketoses

Sodium Citrate Micro-Enema

5ml micro-enemas (sodium citrate 450mg together with asurfactant, glycerol & sorbitol)

Phosphate Enema Enemas (sodium acid phosphate 12.8g + sodium phosphate10.24g in 128ml)

Macrogol Oral PowderLaxido- To be used firstline, as considerably cheaper

than other preparations)

Movicol

includingMovicol Half andMovicol PaediatricPlain

Laxido and Movicol, - Oral powder in sachets(containing 13.125g macrogol 3350, sodium bicarbonate178.5mg, sodium chloride 350.7mg & potassium chloride

46.6mg).

Movicol Half and Movicol Paediatric PlainOralpowder in sachets(containing 6.563g macrogol 3350,sodium bicarbonate 89.3mg, sodium chloride 175.4mg,

potassium chloride 23.3mg).

Movicol paediatric plain is unflavoured.-for use in impaction and for 2ndline use in treating constipationsee local guidelines.If maintenance therapy needed, keep

dosage to a minimum.

1.6.5Bowel Cleansing Solutions

First Choice

Sodium picosulfate(Picolax, Citrafleet)

Powder for oral solution. Sachets (sachets containing sod.picosulfate 10mg & magnesium oxide 3.5g, anhydrous citric acid12g)

Alternatives

Moviprep Powder (lemon-flavoured) in sachets -Sachet A

(containing macrogol 3350 100g, anhydrous sodium sulphate7.5g, sodium chloride 2.691g, potassium chloride 1.015g) and

Sachet B(containing ascorbic acid 4.7g, sodium ascorbate 5.9g).For use as a laxative bowel preparation prior to clinicalprocedures such as colonoscopy. To be used instead of KleanPrep

Fleet Phospho-Soda Sugar-free oral solution (sodium dihydrogen phosphate24.4g, disodium phosphate dodecahydrate 10.8g in 45ml)

Klean Prep(Bowel cleansing solution)

Sachets (containing 59g macrogol [polyethylene glycol] 3350 &electrolytes.

-dissolved in water to give 1 litre of an iso-osmotic solution

1.6.7Other drugs used in constipation

Prucalopride

B Linaclotide

1mg & 2mg tablets f/c (as succinate)- approved the symptomatic treatment of chronic constipation inwomen whom laxatives fail to provide adequate relief in line withNICE290 microgram capsules- approved for specialist initiation for the symptomatic treatmentof moderate-to-severe irritable bowel syndrome with constipation(IBS-C).

1.7Local Preparations for Anal and Rectal Disorders

1.7.1Soothing Haemorrhoidal Preparations
http://www.medicinescomplete.com/mc/bnf/current/PHP613-lactulose.htmhttp://www.medicinescomplete.com/mc/bnf/current/PHP613-lactulose.htmhttp://www.medicinescomplete.com/mc/bnf/current/PHP641-sodium-citrate-rectal.htm?q=sodium%20citrate&t=search&ss=text&p=2http://www.medicinescomplete.com/mc/bnf/current/PHP641-sodium-citrate-rectal.htm?q=sodium%20citrate&t=search&ss=text&p=2http://www.medicinescomplete.com/mc/bnf/current/PHP631-phosphates-rectal.htm?q=phosphate%20enema&t=search&ss=text&p=2#_hithttp://www.medicinescomplete.com/mc/bnf/current/PHP631-phosphates-rectal.htm?q=phosphate%20enema&t=search&ss=text&p=2#_hithttp://bnf.org/bnf/bnf/60/105996.htm?q=movicol&t=search&ss=text&p=1#_105996http://bnf.org/bnf/bnf/60/105996.htm?q=movicol&t=search&ss=text&p=1#_105996http://www.bnf.org.uk/bnf/bnf/current/127926.htmhttp://www.bnf.org.uk/bnf/bnf/current/128336.htmhttp://www.bnf.org.uk/bnf/bnf/current/128336.htmhttp://www.newcastle-hospitals.org.uk/sys_upl/templates/AssetBrowser/AssetBrowser_disp.asp?ItemID=4722&basketPage=&basketItem=&ABTKeywords=constipation&pgid=1549&tid=146&page=1http://www.newcastle-hospitals.org.uk/sys_upl/templates/AssetBrowser/AssetBrowser_disp.asp?ItemID=4722&basketPage=&basketItem=&ABTKeywords=constipation&pgid=1549&tid=146&page=1http://www.newcastle-hospitals.org.uk/sys_upl/templates/AssetBrowser/AssetBrowser_disp.asp?ItemID=4722&basketPage=&basketItem=&ABTKeywords=constipation&pgid=1549&tid=146&page=1http://www.medicinescomplete.com/mc/bnf/current/PHP595-sodium-picosulfate-non-proprietary.htm?q=sodium%20picosulfate&t=search&ss=text&p=1#PHP595-sodium-picosulfate-non-proprietaryhttp://www.medicinescomplete.com/mc/bnf/current/PHP595-sodium-picosulfate-non-proprietary.htm?q=sodium%20picosulfate&t=search&ss=text&p=1#PHP595-sodium-picosulfate-non-proprietaryhttp://www.bnf.org.uk/bnf/bnf/current/129888.htmhttp://www.bnf.org.uk/bnf/bnf/current/40081.htmhttp://www.medicinescomplete.com/mc/bnf/current/PHP652-klean-prep.htm?q=klean%20prep&t=search&ss=text&p=1http://bnf.org/bnf/bnf/current/204291.htm?q=prucalopride&t=search&ss=text&p=1#_hithttp://bnf.org/bnf/bnf/current/204291.htm?q=prucalopride&t=search&ss=text&p=1#_hithttp://www.medicinescomplete.com/mc/bnf/current/PHP33678-linaclotide.htmhttp://www.medicinescomplete.com/mc/bnf/current/PHP33678-linaclotide.htmhttp://guidance.nice.org.uk/TA211http://guidance.nice.org.uk/TA211http://guidance.nice.org.uk/TA211http://guidance.nice.org.uk/TA211http://guidance.nice.org.uk/TA211http://guidance.nice.org.uk/TA211http://www.medicinescomplete.com/mc/bnf/current/PHP33678-linaclotide.htmhttp://bnf.org/bnf/bnf/current/204291.htm?q=prucalopride&t=search&ss=text&p=1#_hithttp://www.medicinescomplete.com/mc/bnf/current/PHP652-klean-prep.htm?q=klean%20prep&t=search&ss=text&p=1http://www.bnf.org.uk/bnf/bnf/current/40081.htmhttp://www.bnf.org.uk/bnf/bnf/current/129888.htmhttp://www.medicinescomplete.com/mc/bnf/current/PHP595-sodium-picosulfate-non-proprietary.htm?q=sodium%20picosulfate&t=search&ss=text&p=1#PHP595-sodium-picosulfate-non-proprietaryhttp://www.newcastle-hospitals.org.uk/sys_upl/templates/AssetBrowser/AssetBrowser_disp.asp?ItemID=4722&basketPage=&basketItem=&ABTKeywords=constipation&pgid=1549&tid=146&page=1http://www.bnf.org.uk/bnf/bnf/current/128336.htmhttp://www.bnf.org.uk/bnf/bnf/current/128336.htmhttp://www.bnf.org.uk/bnf/bnf/current/127926.htmhttp://bnf.org/bnf/bnf/60/105996.htm?q=movicol&t=search&ss=text&p=1#_105996http://www.medicinescomplete.com/mc/bnf/current/PHP631-phosphates-rectal.htm?q=phosphate%20enema&t=search&ss=text&p=2#_hithttp://www.medicinescomplete.com/mc/bnf/current/PHP641-sodium-citrate-rectal.htm?q=sodium%20citrate&t=search&ss=text&p=2http://www.medicinescomplete.com/mc/bnf/current/PHP641-sodium-citrate-rectal.htm?q=sodium%20citrate&t=search&ss=text&p=2http://www.medicinescomplete.com/mc/bnf/current/PHP613-lactulose.htm


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Anusol CreamSuppositories

) both contain a mixture of bismuth) salts, Peru balsam & zinc oxide

1.7.2Compound Haemorrhoidal Preparations with CorticosteroidsAnusol HC Suppositories

Ointment

) contain hydrocortisone acetate, benzyl) benzoate, bismuth oxide, bismuth) subgallate, Peru balsam & zinc oxide

Max. recommended duration of treatment 7 days

Xyloproct Ointment containing lidocaine 5%, hydrocortisone acetate0.275%, aluminium acetate 3.5% & zinc oxide 18%Recommended for short-term use only

1.7.3Rectal Sclerosants

Oily Phenol Injection Injection - 5% Phenol in a suitable oil (e.g. almond oil)

1.7.4Chronic Anal Fissure

First line

Glyceryl Trinitrate 0.4% ointment (Rectogesic - licensed)0.2% ointment u

Second line

Diltiazem 2% creamuMay cause fewer side effects than glyceryl trinitrate

RBotulinum Toxinr Botulinum A toxin haemagglutinin complex 100 unit vialssee section 4.9.3 for full list of botulinum products - approved for use by specialists as an alternative to surgery in

patients failing other treatments. Also approved for use in paediatricsbut there must be documented informed consent from patients/carers

1.9Drugs Affecting Intestinal Secretions1.9.1Drugs Affecting Biliary Composition and Flow

Ursodeoxycholic Acid 150mg tablets; 250mg capsules250mg in 5ml sugar-free suspension

1.9.2Bile Acid Sequestrants

Colestyramine 4g sachets4g sugar-free sachets

Colesevelam

625mg tablets

- approved for second line use (after Colestyramine) for thetreatment of bile malabsorption that results in diarrhoea

1.9.4Pancreatin

Creon 5,000, 10,000 & 25,000s & 40,000scapsules(10,000, 25,000 AND 40,000 units lipase activity)- for useon advice of GI/respiratory specialist only
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2. Cardiovascular System

2.1Positive Inotropic Drugs

2.1.1 Cardiac Glycosides

Digoxin 62.5, 125 & 250 microgram tablets50 microgram per ml elixir

100 microgram in 1ml u& 500 microgram in 2ml inj.

2.1.1a Digoxin-specific Antibody

RDigoxin-specificantibody

Vials containing 38mg digoxin-specific antibodyfragments (Fab) for administration by IV infusion - Forthe treatment of life-threatening digoxin toxicity only, requestsmust be cleared by appropriate clinician.

2.1.2Phosphodiesterase Inhibitors

RMilrinone 10mg in 10ml injection

2.2Diuretics

2.2.1Thiazide and Related Diuretics

First Choice

Bendroflumethiazide(Bendrofluazide)

2.5mg tablets- 5mg tablets also available, but not recommended for generaluse

Alternatives

Indapamides 2.5mg tablets- Modified release indapamide tablets are not included in thisformulary- Treatment should only be on advice from strokephysicians.

Metolazonesu 5mg tabletsTreatment should only be on advice from cardiology.

Chlorothiazidesu 250mg in 5ml suspension-Treatment should only be on advice from paediatric cardiology.

2.2.2Loop Diuretics

First Choice

Furosemide (Frusemide) 20mg, 40mg & 500mg tablets40mg in 5ml sugar-free solution20mg in 2ml, 50mg in 5ml & 250mg in 25mlinjections

Alternative

Bumetanide 1mg & 5mg tablets
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1mg in 5ml sugar-free solution2mg in 4ml injection

2.2.3Potassium-Sparing Diuretics and Aldosterone Antagonists

First Choice

Amiloride 5mg tablets5mg in 5ml sugar-free solution

Alternatives (aldosterone antagonists)

Spironolactone 25mg & 100mg tabletsuse is also extended for treatmentin post-acute myocardial infarction patients and patients withmild heart failure. Treatment should only be initiated on theadvice of a cardiologist. (Spironolactone is considerably cheaperthan eplerenone)

10mg, 25mg & 50mg in 5ml sugar-free suspensions u

Eplerenones 25mg & 50mg tablets-for use in post-acute myocardial infarction patients with leftventricular dysfunction and heart failure. Only to be used inpatients who are unable to tolerate the estrogenic side effects ofspironolactone. Treatment should only be on advice from acardiologist.

2.2.4Potassium-Sparing Diuretics with Other Diuretics

Co-amilofruse 5/40 tablets (amiloride 5mg + furosemide 40mg)2.5/20 tablets(amiloride 2.5mg + furosemide 20mg)

Spironolactone &Chlorothiazideu

Capsules containing Spironolactone andChlorothiazide in the proportions of 1:10

used in paediatric cardiologyspironolactone 1mg & chlorothiazide 10mgspironolactone 2mg & chlorothiazide 20mgspironolactone 3mg & chlorothiazide 30mgspironolactone 5mg & chlorothiazide 50mgspironolactone 10mg & chlorothiazide 100mg

2.2.5Osmotic Diuretics

Mannitol 10% & 20% intravenous infusions

2.3Anti-arrhythmic Drugs

2.3.2Drugs for ArrhythmiasSupraventricular Arrhythmias

R Adenosine 6mg in 2ml injection, 25mg in 5ml injection u30mg in 10ml injection for infusion (NHCT only)SPC

130mg in 130ml IV infusion u
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R Regadenoson A myocardial perfusion imaging agent that contains80micrograms in 1ml (400 micrograms) regadenoson- for radionuclide myocardial perfusion imaging in patients whoare unable to undergo adequate exercise stress e.g. for patientswith COPD and asthma where dobutamine is indicated and forobese patients who require several vials of adenosine.

Digoxin see section 2.1.1

Supraventricular and Ventricular Arrhythmias

Amiodarone 100mg & 200mg tablets; 50mg in 5ml suspension u

150mg in 3ml injection300mg in 10ml injection (prefilled syringes for CPR)

Flecainide 50mg & 100mg tablets; 5mg in 1ml liquidu

150mg in 15ml injection

R Ajmaline

u

50mg in 10ml injectionfor the use in the diagnostic testing of Brugada syndrome.

Procainamide 1g in 10ml injection under review

Propafenone 150mg tablets

A Dronedarone 400mg tabletsapproved for patients who are unsuitable for or not tolerant of

amiodarone. Treatment is to be initiated by cardiologists.NICELinked to Shared Care Guideline

Ventricular Arrhythmias

Lidocaine (Lignocaine) 100mg injection, pre-filled syringes1mg/ml (0.1%) & 2mg/ml (0.2%) IV infusions(500ml)

2.4Beta-Adrenoreceptor Blocking Drugs

First Choice

Atenolol(cardioselective)

25mg, 50mg & 100mg tablets25mg in 5ml sugar-free syrup5mg in 10ml injection

Propranolol(non-cardioselective)

10mg, 40mg, 80mg & 160mg tablets80mg & 160mg m/r capsules (sustained release)10mg & 50mg in 5ml sugar-free oral solutions1mg in 1ml injection

Alternatives

Metoprolol 50mg & 100mg tablets5mg in 5ml injection

Labetalol 50mg, 100mg & 200mg tablets100mg in 20ml injection
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Bisoprolol 5mg & 10mg tablets1.25mg, 2.5mg, 3.75mg& 7.5mg tabletsfor use in the treatment of heart failure only.The 5mg and10mg tablets should be used where possible - cheaper thanother strengths

Carvedilol

3.125mg, 6.25mg, 12.5mg & 25mg tabletsfor use in the treatment of heart failure only

Sotalols 40mg & 80mg tabletstreatment should only be initiated on the advice of cardiology

R Esmolol 100mg in 10ml injection2.5g in 250ml ready-made intravenous infusion

Nadololsr 80mg tablets- limited to use by cardiologists in patients with long QTsyndrome/idiopathic ventricular fibrillation.

- Liquid formulations (unlicensed) can be obtained for use inchildren if necessary. Treatment should only be on the advice ofa cardiologist.

Nebivololsr 5mg tabletsfor specialist use in the treatment of patients who cannottolerate other beta-blockers. Treatment should only be on theadvice of a cardiologist.

Celiprololsr 200mg tabletsfor specialist use in the treatment of patients who cannottolerate other beta-blockers. Treatment should only be on theadvice of a cardiologist.

2.5Drugs Affecting the Renin-Angiotensin System and Some OtherAntihypertensive Drugs

2.5.1Vasodilator Antihypertensive Drugs

Hydralazine 25 & 50mg tablets20mg injection

Minoxidils 5mg & 10mg tabletstreatment should only be on the advice of a cardiologist/

nephrologist

R Sodium Nitroprusside 50mg injection

R Diazoxide 300mg in 20ml injection

2.5.1aTreatments for Pulmonary Hypertension

R Bosentan 62.5mg & 125mg tabletsIn line with NHS England Clinical Commissioning Policy

R Iloprost 50 microgram in 0.5ml & 100 microgram in 1ml inj u

10 microgram in 1ml and 20 microgram in 2ml
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nebules

R Treprostinilu 50mg in 20ml and 100mg in 20ml injections

R Sildenafil 20mg tablets (Revatio)

25mg, 50mg and 100mg tablets u

R Tadalafil 20mg tabletsapproved for the treatment of pulmonary arterialhypertension (PAH) in adults for whom treatment withsildenafil is not tolerated or effective.

R Macitentan 10mg film coated tablets-approved for the treatment of pulmonary hypertension inadults. In line with NHS England Clinical CommissioningPolicy

RAmbrisentan 100mg tablets- much less likely to cause liver problems than bosentan - for usein pulmonary hypertension where bosentan or sitaxentan has

failed, is not tolerated or not suitable. In line with NHS EnglandClinical Commissioning Policy

2.5.2Centrally Acting Antihypertensive Drugs

Moxonidine 200, 300 & 400 microgram tablets

Methyldopa 125mg, 250mg & 500mg tablets

Clonidine 100 microgram tabletsstreatment should be on the advice of a cardiologist/nephrologistR150 microgram in 1ml injectionFor use in paediatriccardiac ITU and in adult ITU patients with delirium and agitation,often around extubation.

2.5.4 - Alpha-Adrenoreceptor Blocking Drugs

First Choice

Doxazosin 1mg, 2mg & 4mg tablets- N.B. 4mg m/r & 8mg m/r tablets are not included in thisformulary - plain tablets are less expensive

Others (specialist use)

Phenoxybenzamine 10mg capsules; 100mg in 2ml injection

Phentolamine 10mg in 1ml injection

2.5.5Drugs Affecting the Renin-Angiotensin System

2.5.5.1Angiotensin Converting Enzyme InhibitorsFirst Choice
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Lisinopril 2.5mg, 5mg, 10mg & 20mg tablets

Ramipril 1.25mg, 2.5mg, 5mg & 10mg capsules

Alternatives

Perindopril 2mg, 4mg & 8mg tablets (3rd-line)- perindopril is third line for all indications includingprevention of stroke.

Captopril 2mg capsulesuand 5mg in 5ml (1mg/ml) oral

suspensionsu treatment should only be on the advice of a hospitalpaediatrician.

Enalapril 2.5mg, 5mg, 10mg & 20mg tabletsfor use in breastfeeding mothers only. Mothers are to be

converted to ramipril when no longer breastfeeding.2.5.5.2Angiotensin-II Receptor Antagonists

N.B. These drugs are only approved for use where ACE inhibitors are not toleratedand specific indications where a combination with an ACE inhibitor is required e.g.in proteinuric renal disease.

First Choice

Losartan 12.5mg, 25mg, 50mg & 100mg tabletsto be used1stline treatment in all new patients.

2.5mg/ml suspension For use as an alternative to crushingtablets for paediatric and adult patients

Alternatives

Candesartan 2mg, 4mg, 8mg, 16mg & 32mg tablets

Irbesartan 75mg, 150mg & 300mg tabletsonly to be used in the treatment of existing patients

Valsartan 40mg, 80mg & 160mg tabletsonly to be used in the treatment of existing patients

2.5.5.3Renin Inhibitor

Aliskiren 150mg & 300mg tabletsonly approved for use in the treatment of hypertension inpatients who have failed to respond adequately to, or nottolerated, other treatments (including thiazide diuretics, calciumchannel blockers, ACE inhibitors, angiotensin receptor blockersand beta-blockers). Aliskiren has NOT been approved for use incombination with other drugs to maximise suppression of therenin angiotensin system in patients with diabetes and/or renaldisease.
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2.6Nitrates, Calcium-Channel Blockers and Potassium-channelActivators

2.6.1Nitrates

Glyceryl Trinitrate 400 microgram/metered dose aerosol spray5mg & 10mg/day patches for use in cardiothoracic

critical care unit5mg in 5ml, 50mg in 10ml & 50mg in 50ml injections

Isosorbide Dinitrate 10mg in 10ml injection

Isosorbide Mononitrate 10mg, 20mg & 40mg tablets, 60mg m/r tablets r- N.B. The m/r isosorbide mononitrate tablets should only beused in patients when the plain tablets are unsuitable

2.6.2Calcium-Channel BlockersPreferred Drugs

HypertensionAmlodipine 5mg & 10mg tablets.

- if a 10mg dose is not tolerated e.g. due to leg/ankleoedema, consider reducing dose before changing to analternative such as lercanidipine

AnginaDiltiazem 60mg m/r tablets

Once daily tablets/capsules- Zemtard is the Formulary brand of choice for startingnew patients on long acting diltiazem.

Alternatives

Lercanidipine 10mg & 20mg tabletsfor use as a 2ndline calcium channel blocker where amlodipineis not tolerated

Nifedipine Once Daily formulations (Preferred)20mg controlled release tablets (Adalat LA), 30mg &

60mg m/r capsules (Coracten XL)Other Formulations5mg & 10mg capsules10mg & 20mg retard tablets

20mg per ml (1mg/drop) drops u

Nimodipines 30mg tabletsTreatment should be on the advice ofthe stroke team/ cardiologist10mg in 50ml (200 micrograms/ml) for IV infusion

Verapamil 40mg, 80mg, & 120mg tablets, 240mg m/r tablets40mg in 5ml sugar-free oral solution5mg in 2ml injection
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2.6.3Other Antianginal Drugs

Nicorandil 10mg & 20mg tablets

Ivabradines 5mg and 7.5mg tabletsfor initiation on advice from consultant cardiologists in patientswith contra-indications to or intolerance of beta-blockers- for use in heart failure in line with NICE

Ranolazines 375mg, 500mg and 750mg prolonged release tablets.-for use in the treatment of angina in those patients for whomother treatments have been unsuccessful. Initial prescribingshould be by a consultant cardiologist only

2.6.4Peripheral and Cerebral Vasodilators

General Notes

In Raynauds phenomenon some patients may require treatment with a vasodilator.

Nifedipinemay be of use, especially in primary Raynauds syndrome.

Naftidrofuryl oxalate 100mg capsules- approved for the treatment of intermittent claudication in people

with peripheral arterial disease in line with NICE

2.7Sympathomimetics

2.7.1Inotropic Sympathomimetics

R Dobutamine 250mg in 20ml injection,250mg in 50ml injection

R Dopamine 200mg in 5ml injection

R Isoprenaline sulphateu 100 microgram in 2ml injection, 2mg in 2ml injection

R Dopexaminer 50mg in 5ml injection

R Levosimendanu 12.5mg in 5ml injection for infusion

2.7.2Vasoconstrictor Sympathomimetics

Noradrenaline(Norepinephrine) 2mg in 2ml & 4mg in 4ml (1 in 1,000) injections

Ephedrine 30mg in 1ml injection R

30mg in 10ml syringeu& 15mg tablets

R Metaraminolu 10mg in 1ml injection

R Phenylephrine 10mg in 1ml injection & 3000mcg in 30ml syringeu

Midodrinesu 5mg tablets

- for limited specialist use in treating symptomatic hypotensionthat has not responded to conventional therapies
http://www.bnf.org/bnf/bnf/current/27014.htmhttp://www.bnf.org/bnf/bnf/current/27014.htmhttp://www.bnf.org/bnf/bnf/current/129514.htmhttp://www.bnf.org/bnf/bnf/current/129514.htmhttp://publications.nice.org.uk/ivabradine-for-treating-chronic-heart-failure-ta267http://publications.nice.org.uk/ivabradine-for-treating-chronic-heart-failure-ta267http://publications.nice.org.uk/ivabradine-for-treating-chronic-heart-failure-ta267http://bnf.org/bnf/bnf/current/202731.htmhttp://bnf.org/bnf/bnf/current/202731.htmhttp://bnf.org/bnf/bnf/current/202731.htmhttp://bnf.org/bnf/bnf/current/60478.htm#_60478http://bnf.org/bnf/bnf/current/60478.htm#_60478http://guidance.nice.org.uk/TA223http://guidance.nice.org.uk/TA223http://www.bnf.org/bnf/bnf/current/2734.htmhttp://www.bnf.org/bnf/bnf/current/2734.htmhttp://www.bnf.org/bnf/bnf/current/2736.htmhttp://www.bnf.org/bnf/bnf/current/2736.htmhttp://www.bnf.org/bnf/bnf/current/2741.htmhttp://www.bnf.org/bnf/bnf/current/2741.htmhttp://www.bnf.org/bnf/bnf/current/2756.htmhttp://www.bnf.org/bnf/bnf/current/2756.htmhttp://www.bnf.org/bnf/bnf/current/2756.htmhttp://www.bnf.org/bnf/bnf/current/2756.htmhttp://www.bnf.org/bnf/bnf/current/2731.htmhttp://www.bnf.org/bnf/bnf/current/2731.htmhttp://www.bnf.org/bnf/bnf/current/2752.htmhttp://www.bnf.org/bnf/bnf/current/2752.htmhttp://www.bnf.org/bnf/bnf/current/2758.htmhttp://www.bnf.org/bnf/bnf/current/2758.htmhttp://www.bnf.org/bnf/bnf/current/2758.htmhttp://www.bnf.org/bnf/bnf/current/2752.htmhttp://www.bnf.org/bnf/bnf/current/2731.htmhttp://www.bnf.org/bnf/bnf/current/2756.htmhttp://www.bnf.org/bnf/bnf/current/2756.htmhttp://www.bnf.org/bnf/bnf/current/2741.htmhttp://www.bnf.org/bnf/bnf/current/2736.htmhttp://www.bnf.org/bnf/bnf/current/2734.htmhttp://guidance.nice.org.uk/TA223http://bnf.org/bnf/bnf/current/60478.htm#_60478http://bnf.org/bnf/bnf/current/202731.htmhttp://publications.nice.org.uk/ivabradine-for-treating-chronic-heart-failure-ta267http://www.bnf.org/bnf/bnf/current/129514.htmhttp://www.bnf.org/bnf/bnf/current/27014.htm


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2.7.3Cardiopulmonary Resuscitation

Adrenaline(Epinephrine)

1 in 1,000 injections in 1ml syringes and 1ml & 10mlampoules1 in 10,000 injections in 1ml & 10ml ampoules &syringes. See section 3.4.3 for EpiPens

2.8Anticoagulants and Protamine

2.8.1Parenteral Anticoagulants

First Choice

Tinzaparin 2,500 units in 0.25ml, 3,500 units in 0.35ml & 4,500units in 0.45ml pre-filled syringes- for prophylaxis

10,000 units in 0.5ml, 14,000 units in 0.7ml & 18,000units in 0.9ml graduated pre-filled syringes- for the treatment of pulmonary embolism and deep vein

thrombosis20,000 units and 40,000 units in 2ml vials

Alternatives

Enoxaparinr 40mg in 0.4ml, 60mg in 0.6ml, 80mg in 0.8ml,100mg in 1ml & 120mg in 0.8ml pre-filled syringes- only for use in the treatment of acute coronary syndromes

Heparin Sodium 50 units in 5ml & 200 units in 2ml- for flushing cannulae (other dilute Heparin solutions are kept insome units for flushing central venous lines)

1,000 units in 1ml, 5,000 units in 1ml, 5,000 units in5ml, & 25,000 units in 1ml ampoules5,000 units in 5ml, 10,000 units in 10ml & 20,000units in 20ml ampoules for use in infusion pumps(Pump-Hep)Multidose vials containing 5,000 units in 5ml (1,000units/ml) & 25,000 units in 5ml (5,000 units/ml) &125,000 units in 5ml (25,000 units/ml)2,500 & 5,000 units in 1,000ml sodium chloride 0.9%infusion

Fondaparinuxs 1.5mg in 0.3ml injection, 2.5mg in 0.5ml injection,5mg in 0.4ml injection, 7.5mg in 0.6ml injection &10mg in 0.8ml injection in pre-filled syringes- approved for high risk orthopaedic surgery patients and as analternative to enoxaparin in line withNICE

R Danaparoid 750 units in 0.6ml injection (1,250 units/ml)-for use on advice from haematologists in patients who developthrombocytopaenia with heparins - cross reactivity with heparinantibodies is probably


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R Bivalirudin 250mg injection- approved for preventing thrombosis in patients undergoingpercutaneous coronary artery interventions. For use instead ofabciximab in some low risk patients.- approved in combination with aspirin and clopidogrel for thetreatment of adults with ST segment elevation MI undergoingpercutaneous coronary intervention.NICE

R TauroLock(Taurolidine and Citratecatheter lock solution)

5ml ampoules containing 1.35% taurolidine and 4% sodiumcitrate.-for use in the prevention of central intravenous line infectionsin:

Haemodialysis patients

Adult parenteral nutrition patients

Patients with recurrent line infections

Immune deficiency unit patientsUse in other areas is being evaluated

R TauroHep

(Taurolidine and Citratecatheter lock solution withheparin)

5ml ampoules containing 1.35% taurolidine and 4% sodiumcitrate with heparin 500 units/ml-for use in the prevention of central intravenous line infections in:

Haemodialysis patients

Adult parenteral nutrition patients

Patients with recurrent line infections

Immune deficiency unit patients

Use in other areas is being evaluated

REpoprostenol 500 microgram injection & 1.5mg injection

RIloprost 50 microgram in 0.5ml & 100 microgram in 1ml

injections- mainly for use in treating pulmonary hypertension see section2.5.1a

2.8.2Oral Anticoagulants

Warfarin 500 microgram, 1mg, 3mg & 5mg tablets

1mg/1ml oral suspension s

- for use in paediatric patients on mechanical support usingventricular assistance devices, and for patients with mechanicalheart valves or irregular heart rythms who have not been weaned

Phenindione 10mg, 25mg & 50mg tablets

Apixaban 2.5mg tabletsapproved for the prevention of venous thromboembolism inpatients undergoing elective total knee or hip replacement

surgery in line withNICE2.5mg & 5mg tabletsapproved for the prevention of stroke and systemic embolismin adult patients with non-valvular AF in line withNICE

Dabigatran 75mg & 110mg & 150mg capsules- approved for the prevention of venous thromboembolism in

patients undergoing elective total knee or hip replacementsurgery in line with NICE- approved for the prevention of stroke and systemic embolism in
http://www.medicines.org.uk/EMC/medicine/16741/SPC/Angiox+250mg+powder+for+concentrate+for+solution+for+injection+or+infusion/http://www.medicines.org.uk/EMC/medicine/16741/SPC/Angiox+250mg+powder+for+concentrate+for+solution+for+injection+or+infusion/http://guidance.nice.org.uk/TA230http://guidance.nice.org.uk/TA230http://guidance.nice.org.uk/TA230http://www.bnf.org/bnf/bnf/current/2789.htmhttp://www.bnf.org/bnf/bnf/current/2789.htmhttp://www.bnf.org/bnf/bnf/current/2789.htmhttp://www.bnf.org/bnf/bnf/current/128452.htmhttp://www.bnf.org/bnf/bnf/current/128452.htmhttp://www.bnf.org/bnf/bnf/current/128452.htmhttp://www.bnf.org/bnf/bnf/current/2792.htmhttp://www.bnf.org/bnf/bnf/current/2792.htmhttp://www.bnf.org/bnf/bnf/current/2797.htmhttp://www.bnf.org/bnf/bnf/current/2797.htmhttp://www.medicinescomplete.com/mc/bnf/current/217724.htmhttp://www.nice.org.uk/guidance/TA245http://www.nice.org.uk/guidance/TA245http://publications.nice.org.uk/apixaban-for-preventing-stroke-and-systemic-embolism-in-people-with-nonvalvular-atrial-fibrillation-ta275http://publications.nice.org.uk/apixaban-for-preventing-stroke-and-systemic-embolism-in-people-with-nonvalvular-atrial-fibrillation-ta275http://www.bnf.org/bnf/bnf/current/201055.htmhttp://www.bnf.org/bnf/bnf/current/201055.htmhttp://publications.nice.org.uk/dabigatran-etexilate-for-the-prevention-of-venous-thromboembolism-after-hip-or-knee-replacement-ta157http://publications.nice.org.uk/dabigatran-etexilate-for-the-prevention-of-venous-thromboembolism-after-hip-or-knee-replacement-ta157http://publications.nice.org.uk/dabigatran-etexilate-for-the-prevention-of-venous-thromboembolism-after-hip-or-knee-replacement-ta157http://www.bnf.org/bnf/bnf/current/201055.htmhttp://publications.nice.org.uk/apixaban-for-preventing-stroke-and-systemic-embolism-in-people-with-nonvalvular-atrial-fibrillation-ta275http://www.nice.org.uk/guidance/TA245http://www.medicinescomplete.com/mc/bnf/current/217724.htmhttp://www.bnf.org/bnf/bnf/current/2797.htmhttp://www.bnf.org/bnf/bnf/current/2792.htmhttp://www.bnf.org/bnf/bnf/current/128452.htmhttp://www.bnf.org/bnf/bnf/current/2789.htmhttp://guidance.nice.org.uk/TA230http://www.medicines.org.uk/EMC/medicine/16741/SPC/Angiox+250mg+powder+for+concentrate+for+solution+for+injection+or+infusion/


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adult patients with non-valvular AF in line withNICE- Also approved for use prior to cardioversion.

Rivaroxaban 10mg tabletsapproved for the prevention of venous thromboembolism inpatients undergoing elective total knee or hip replacementsurgery in line withNICE10mg, 15mg, 20mg tabletsapproved for the prevention of stroke and systemic embolism inadult patients with non-valvular AF in line withNICE- approved for the treatment of DVT and the prevention ofrecurrent DVT and pulmonary embolism in line withNICE- approved for treating pulmonary embolism and preventingrecurrent venous thromboembolismNICE

2.8.3Protamine Sulphate

Protamine Sulphate 50mg in 5ml injection

2.9Antiplatelet DrugsFirst ChoiceAspirin 75mg dispersible tablets

(75mg e/c tabletsno longer recommended for use);

500mg in 5ml injectionu- for specialist use in the endovascular treatment of cerebralaneurysms

AlternativesClopidogrel 75mg tablets

- approved for use in cardiac patients being fitted with stents /acute coronary syndrome

Documents

North of Tyne Formulary Version 5 4Final