Dermatology only

Oscillating Positive Expiratory Pressure (OPEP) device.

Third-line, for patients unsuitable for PARI O-PEP or Aerobika device.

 For initiation by specialist physiotherapist or respiratory clinician only. For airways clearance in selected patients with chronic sputum-producing lung disease, e.g. cystic fibrosis, bronchiectasis, COPD.

All follow up and monitoring of patients, and routine replacement of devices to be carried out in secondary care. 

Primary care prescribing on FP10 only when required for urgent supply of additional/replacement device (Drug Tariff listed approved appliance).

A first-line option for acute otitis externa (refer to South Central Antimicrobial Network Guidelines for Antibiotic Prescribing in the Community 2018) 

Self Care Medicine

 Specialist initation only for idiopathic pulmonary fibrosis

 Can be purchased OTC for cold sores.

 Prescribing by brand name recommended

Licensed for COPD only, not for asthma

Specify brand

Imraldi and Amgevita are black triangle

 Specify brand.

 Specialist centres only for moderate to severe hidradenitis suppurativa - commissioned by NHS England in accordance with NICE TA392.

Amgevita and Imraldi are black triangle

  Mild to moderate papulopustular acne: Epiduo 0.1% gel (adapalene 0.1%/benzoyl peroxide 2.5%)

  Moderate to severe papulopustular acne: Epiduo 0.3% gel (adapalene 0.3%/benzoyl peroxide 2.5%)

Prescribe by brand name (Emerade/Epipen/Jext)

for IM self administration

Oscillating Positive Expiratory Pressure (OPEP) device.

Second-line, for patients unsuitable for PARI O-PEP device.

 For initiation by specialist physiotherapist or respiratory clinician only. For airways clearance in selected patients with chronic sputum-producing lung disease, e.g. cystic fibrosis, bronchiectasis, COPD.

All follow up and monitoring of patients, and routine replacement of devices to be carried out in secondary care. 

Primary care prescribing on FP10 only when required for urgent supply of additional/replacement device (Drug Tariff listed approved appliance).

  For use within Southern Health. Initiated or recommended by a psychiatrist.

A third line option where adverse effects of alternative antidepressants make them unacceptable to patients (sexual dysfunction and sleep disturbance)

 unlicensed

 Not a first line option.

For use only in patients unable to swallow conventional bisphosphonate tablets, and unwilling/unsuitable for treatment with parenteral options.

Viridal Duo® brand preferred for initiation at UHS.

Annotate FP10 prescriptions with 'SLS' for erectile dysfunction

Self Care Medicine. Can be purchased OTC.

 unlicensed

For Lambert-Eaton myasthenic Syndrome

MR tab for existing patients only

May also be used off-label for hypersalivation

Off label use

 For mild, distal fungal nail injections in up to 2 nails.

Can be purchased OTC (Pharmacy only).

 unlicensed

 Restricted as per commissioning policies. 

 unlicensed special

 For treatment of symptoms of oral mucositis and oesophageal lesions causing painful swallowing when recommended by cancer care specialist only.

Replaces Mucaine suspension (discontinued)

 Self Care Medicine

Consultant initiated in severe disease

For chemotherapy-induced nausea/vomiting

Liquid for chemotherapy-induced nausea/vomiting in children 6months - 12years

Ordered through main stores

900g

Ordered via main stores

Specialist use only by Southern Health in accordance with rapid tranquilisation guidelines.

For acute uncomplicated P.falciparum malaria or as oral step down treatment following IV artesunate

EC tablets are not formulary

For use in line with NHSE specialised commissioning criteria

As per NHSE specialised commissioning circular 1614

 Hospital only. High cost in primary care - use Minims formulation.

Also available via MHRA EAMS (1 Sept 2020) for off label use in adults with advanced urothelial carcinoma that has not progressed after an initial course of chemotherapy. 

 Liquid and capsules (10mg) are unlicensed

 Liquid and capsules (10mg) are unlicensed

 Alternative if benzoyl peroxide not tolerated

 Ophthalmology only

MHRA Drug Safety Update July 2008: prescribe CFC-free beclometasone metered-dose inhalers by brand name to reduce the risk of dosing errors

Note: Potencies and dosing recommendations may vary between brands. Refer to product SPC or BNF for more detailed advice.

MDI brands of choice in the Southampton locality are Soprobec (equivalent to Clenil brand) and Kelhale (equivalent to Qvar brand).

 Kelhale brand is not licensed in children under 18 years.

 Prescribing by brand name recommended

 Pharmalgen brand has been discontinued but may be supplied for selected patients when Alutard brand is not suitable.

 Southern Health use only

 Special Use by Sexual Health Clinics (Solent NHS Trust) ONLY 

For treatment of syphilis as recommended in BASHH Guidelines 2015

 The preparation is strictly for deep intramuscular injection

 Self Care Medicine

For prophylaxis in proven Ménière’s disease

For use as a mouthwash only

A first-line option for acute otitis externa (refer to South Central Antimicrobial Network Guidelines for Antibiotic Prescribing in the Community 2018) 

 For short-term use

For use in line with CDF criteria.

 Commissioned by NHS England for neurofibromatosis by NHS England as per national protocol (see NF2 service specification) at specialist centres only.

Not a first line choice

 Unit dose drops only for patients allergic/intolerant of preservatives, or high risk of developing allergy

Specify brand

 Dermatology only. For severe hyperhidrosis.

 For patients with rosacea who have failed to respond to, or are intolerant of, other options, or have psychological distress due to persistent redness.

Not a first line option

 Prescribing by brand name recommended

For ulcerative colitis

Not initiated in UHS

 Espranor is not interchangeable with other buprenorphine products.

Prescribe by brand name

As part of a smoking cessation programme.

injection for BMT only

 For use as per commissioning criteria set by NHS England

 Homecare use only

Not a first line option in Parkinson’s disease

 Neonatal unit only

For hyperphosphataemia of chronic renal failure in patients undergoing dialysis

Chewable tablets first-line.

Effervescent tablets reserved to aid administration in those unable to take chewable tablets. 

Choose brand with lowest acquisition cost and prescribe by brand name to avoid confusion.

Refer to section 9.6.4 for calcium and vitamin D3.

0.51mmol/ml of Calcium

Specialist recommendation for paediatric patients only.

Licensed as a nutritional supplement, not a medicine.

Primary care to prescribe by brand name.

Not held in stock but available to order through pharmacy

200ml/500ml 

Strawberry/Neutral

 For use by sexual health clinics (Solent NHS Trust) ONLY

For the cutaneous treatment of external genital and perianal warts in immunocompetent patients (adults) when other treatments have failed

 Registered specialist only. See NICE NG144 (section 1.5) for details on who should prescribe.

Schedule 5 controlled drug.

 Salicylic acid 0.5% w/w; coconut oil 1% w/w; distilled coal tar 1% w/w.

 Only for post herpetic neuralgia where other pain relief is inadequate

  Child Health and for patients particularly at risk of hypotension

 To be used in line with DPC dry eye guidelines (link below). 

Clinitas® Gel preferred at UHS

 To be used in line with DPC dry eye guidelines (link below)

 Only for patients allergic/intolerant of preservatives or at high risk of developing allergy

May be prescribed as unit dose (single use) eye drops or multi-dose bottle (various brands available - refer to Drug Tariff for current prices in primary care).

Ordered via main stores

 Specialist use only

 Unlicensed

 Microbiology recommendation only for mycobactrium abcessus respiratory infection in cystic fibrosis

  restricted to microbiology approval/recommendation only

 Consider ExCetra cream as more cost effective alternative to Cetraben cream

Ointment also suitable for use as a soap substitute or as bath additive.

 unlicensed

For alcohol withdrawl

UHS users see local guideline

Available over the counter in primary care

From NHS Logistics.

From NHS Logistics

 Supported only for licensed indications ( not on NHS for malaria prevention)

Not for use in Covid-19 treatment/prevention outside of clinical trials (see links below). Seek further advice from infection control specialist/pharmacy team.

 Available OTC 

 For adults and children over 16 years only

 Red for renal transplant
 Amber for all other indications

Specify brand

Specify brand

1mg/ml.

 Ophthalmology specialist initiation. Prescribe by brand name (different licensed indication to Ikervis^® brand).

Unlicensed formulation. Restricted use - only when licensed formulation not suitable or unavailable.

For palliative care use only, or as an alternative H2-antagonist when ranitidine is not available, and a proton pump inhibitor is not suitable. 

Check for interactions before prescribing.

For labyrinthine vertigo or acute treatment of Ménière’s disease

Second line where aminoglycosides should not be used

 Prescribe as generic - Dermovate-NN brand discontinued

 Not usually a first-line treatment option. For short-term use only in accordance with product licence (refer to SPC) for treatment of steroid responsive dermatoses where candidal and/or bacterial infection is present, suspected or likely to occur.

Note: nystatin is not effective against dermatophytes and risk of resistance with overuse of topical antibiotics.

 Not supported locally for off label use in chronic wound management (see below)

Amber Recommended for licensed indications (refer to SmPC for details).

   for short-term, off label use in sedation/opioid withdrawal in high care paediatrics in accordance with UHS protocol

  for short-term, off label use in sedation/opioid withdrawal in high care paediatrics in accordance with UHS protocol; oral solution only for use when tablet formulation not suitable

 Can be purchased OTC.

 From British Association of Dermatologists (BAD) Specials List 2014

 Unlicensed

 From British Association of Dermatologists (BAD) Specials List 2014

 Unlicensed

Only as an aid to compliance

 unlicensed

 From British Association of Dermatologists (BAD) Specials List 2014

 Unlicensed

Only for constipation in terminal illness

 unlicensed suppositories

 Products that are UK licensed medicines should be prescribed and supplied wherever possible

injection can be nebulised

First line option in primary care

 Specialist only use for exceptionally heavy menstrual bleeding

Ordered through main stores

200g

 For use as per commissioning criteria set by NHS England

Ordered through main stores

70mls x 24

 For itch after scabies

For use only when patients are unable to receive hydroxocobalamin injections (e.g. during COVID-19).

Available only as nutritional supplement (refer to BNF for prescribing options).

Self Care Medicine: Patients should be recommended to self purchase unless they meet the exception criteria outlined in the NHS England Guidance on conditions for which over the counter items should not routinely be prescribed in primary care (section 4.1.2 Vitamins and Minerals)

 For oral, intramuscular or subcutaneous administration. Note: subcutaneous administration is off label but is established practice in palliative care. 

 For intravenous administration.  Due to safety concerns, intravenous use of cyclizine at UHS is restricted to short-term (i.e. single dose) only.

 Paediatric oncology only

 unlicensed

For thromboprophylaxis when history of heparin-induced thrombocytopenia

 for type 2 diabetes in accordance with NICE technology appraisal guidance (see below)

 for type 1 diabetes in accordance with NICE technology appraisal guidance (see below)

 Specialist use only

 Specialist only, in line with NHSE Clinical Commissioning Policy F03/P/b

For use as per commissioning criteria set by NHS England

 unlicensed

Vitamin and mineral supplements for use when recommended by a specialist in patients with cystic fibrosis.

Specialists to ensure preferred formulation and dose is clearly communicated to primary care prescribers.

For the treatment of SIADH

Osteoporosis.

 First line bath emollient. Fragrance-free.

Also suitable for application to skin after showering.

 For bariatric surgery

 For use by Consultants, or on approval of a Consultant, for patients with BMI>35kg/m2 undergoing obstetric or gynaecological surgery

Noqdirna^® tablets are non-formulary (see below)

 For palliative care use

 For all other uses

 Neuro ICU consultant only or

 Off-label use for awake craniotomy and paediatric laryngotracheobronchoscopy

 Paediatric use only

For the management of acute severe nociceptive pain in an emergency setting (ED)

  Unlicensed special. Restricted use - short term use for postoperative analgesia in children. Second line to ibuprofen and only when licensed options are not suitable. 

Diclofenac not a first line NSAID.

Consider using a preferred NSAID (e.g. ibuprofen or naproxen) or celecoxib ± gastroprotection (e.g. PPI) as alternative

From NHS logistics

For angina if not on beta-blocker

Once daily preparation

Prescribe by brand name

 For head lice.

Self Care Medicine. Can be purchased OTC (e.g. Hedrin^®).

Off-label use

 Dermatology only

 From British Association of Dermatologists (BAD) Specials List 2014

 Unlicensed

 Topical immunotherapy - highly sensitising. To be applied only by trained professionals. Wear gloves when handling.

Only if opening capsules is inappropriate

Liquid is sugar free

 Unlicensed

 From British Association of Dermatologists (BAD) Specials List 2014

 Unlicensed

For the treatment of Human Immunodeficiency Virus (HIV-1) infected adults

Orodispersible  tablets only for patients unable to swallow tablets

 In primary care as a more cost effective alternative to unit dose eye drops. Only for patients allergic/intolerant of preservatives, or high risk of developing allergy

 In primary care as a more cost effective alternative to unit dose eye drops. Only for patients allergic/intolerant of preservatives, or high risk of developing allergy.

Modified release tablets are non-formulary

Dispersible tablets only if cannot swallow caps

Once weekly formulation.

 Dermatology recommendation only

 From British Association Dermatologists (BAD) Specials List 2014

 Unlicensed

Due to cost effectiveness this is the first choice DOAC locally for prevention of stroke and systemic embolism in adult patients with nonvalvular atrial fibrillation (NVAF). See DPC Anticoagulant Decision Aid.

Note: other DOACs may be used if considered more clinically appropriate.

Not held in stock but available to order through pharmacy

100g powder - unflavoured

250ml liquid - Grapefruit/Orange/Pineapple/Summer fruit

 Specialist only, in line with NHSE Clinical Commissioning Policies 16043/P and F/03/P/b

 Specialist use only. Refer to NHS England Drugs List 

 When Zidovudine/lamivudine is unsuitable

 Note: contains an antimicrobial. Not recommended for long-term use.

 Amber for extended thromboprophylaxis
 Amber in pregnancy
 Green for other recognised indications

 Prescribe by brand name and ensure patients are counselled on use of the relevant device. From mid-September 2020 UHS will be using Inhixa brand only.

Arovi, Enoxaparin Becat and Inhixa brands are black triangle

Note: not recommended for treating high-risk hormone-relapsed non-metastatic prostate cancer in adults, in accordance with NICE TA580

 Also suitable for use as soap substitute.

Epimax first line choice as more cost effective.

 Not a first-line option in acne.

Third line on specialist advice

Oral drops (Cipralex^®) are Non Formulary

 Critical care only

 Specify brand

Erelzi is black triangle

For existing patients only. No longer routinely recommended

Rigevidon brand is

Microgynon brand is 

Low strength.

Once weekly formulation.

For use only as an alternative H2-antagonist when ranitidine is not available, and a proton pump inhibitor is not suitable.

First choice fibrate.

Consider only when a statin or other treatments are contraindicated or not tolerated.

Not first line opioid choice

 For cancer care/palliative care specialist initiation only.

Prescribe by brand name.

For the management of breakthrough pain in adult patients using opioid therapy for chronic cancer pain. Only for patients unable to tolerate, or unsuitable for treatment with, oral formulations of other opioids (e.g. morphine, oxycodone).

Drug of choice in antenatal and postnatal women. See local Trust Guideline.

Each tablet contains ferrous sulfate 200mg equivalent to 65mg elemantal iron

Specify brand

 Specialist use only

 Unlicensed liquid special 25mg in 5mL restricted to paediatrics unable to swallow until solid dosage forms are suitable.

 Prescribe as generic - Haelan brand discontinued Sept 2016

Minims^®. Preservative-free.

 For deep intramuscular injection

 Prescribing by brand name recommended

 Prescribing by brand name recommended

Higher strength formulation (184/22) licensed only for asthma, not for COPD

For treatment of symptoms of severe chronic rhinosinusitis with nasal polyps as second line option if control with glucocorticoid nasal sprays is insufficient.

 unlicensed in children under 16 years old.

 unlicensed

4 x 125g in stock in pharmacy.

Vanilla/chocolate/forest fruit

Not held in stock but available to order through pharmacy

200ml - Forest Fruit/Vanilla/Chocolate/Strawberry

Not held in stock but available to order through pharmacy

4x125ml - Strawberry/Neutral

200ml stocked in pharmacy.

Summer fruit/berry fruit

Paediatric wards only

Not held in stock but available to order through pharmacy

200ml - Chocolate/Forest Fruit/Vanilla/Strawberry

Not held in stock but available to order through pharmacy

200ml - Chocolate/Orange/Vanilla

Not held in stock but available to order through pharmacy

Vanilla/Strawberry/banana/Mocha

Prescribe as Monuril sachets in primary care

4 x 200ml stocked in pharmacy.

Vanilla/Wild strawberry

For neuropathic pain in accordance with NICE Guidelines

First line if pain is lancinating in nature (‘electric shocks’)

Liquid only for patients unable to swallow tablets

 for use when aciclovir is not available

 Acidex Advance brand first line choice in primary care (prescribe by brand name).

 Specialist use only for multiple sclerosis

Glucose 5% intravenous infusion

Glucose 10% intravenous infusion

Glucose 20% intravenous infusion

Glucose 50% intravenous infusion

 From British Association of Dermatologists (BAD) Specials List 2014

 Unlicensed

 Dermatology only.

 unlicensed use in Crohns disease (off licence indication).

 Specialist use only as per licensed indications

 Specialist allergy clinics only.

Specialist initiation only

In accordance with Shared Care Guidelines 

Ordered via main stores

 Restricted use in primary care. GPs to prescribe only for children for administration by specialist paediatric community nurses.

 Nutrition team only. Patients may prepare themselves following advice and recipe from specialist/nutrition team.

 Unlicensed

Human albumin 4.5% solution

Human albumin 20% solution

 Restricted for use only when standard tablets are not suitable or practical, e.g. infants/young children on doses <5mg.

UHS will only routinely stock lower strengths, i.e. 0.5mg, 1mg and 2mg.

Patients on doses ≥5mg should be switched to standard tablets, which can be divided using a tablet cutter. 

Unlicensed in patients ≥18 years. Discuss options for adult patients unable to swallow tablets with pharmacist.

 For short-term use

 For short-term use

Ordered through main stores

 Unlicensed

 Dermatology only.

 Supported only for use in indications detailed in Shared Care guidelines.

Not for use in Covid-19 treatment/prevention outside of clinical trials (see links below). Seek further advice from infection control specialist/pharmacy team.

 Dermatology only

 To be used in line with DPC dry eye guidelines (link below)

 Specialist use only for osteoporosis.

For patients unable to tolerate oral medication

A first line NSAID, except for gout

Self Care Medicine

 From British Association of Dermatologists (BAD) Specials List 2014

 Unlicensed

 In line with NHS England commissioning criteria

 May be considered as a potential second line alternative when amitriptyline is not suitable/not tolerated

 Prescribe by brand name.

Licensed only for COPD, not for asthma

Not a first line NSAID

 Liquid is unlicensed

Children only

200ml stocked in pharmacy