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

 Preservative-free unit dose preparations (Minims®) are the preferred formulation in primary care.

 May also be used off-label by sublingual administration for hypersalivation.

  1% multi dose eye drop solution:   Hospital only (due to high cost).

Primary care recommended to use Minims formulation.

 Expected date of UK availability November 2020

Specialist initiation. Second line to alprostadil

Third line therapy for allergic rhinitis where response to treatment with other therapies, including combination of oral antihistamines and intranasal corticosteroids, was inadequate or not tolerated

To be used in line with NHSE specialised commissioning policy

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 the treatment of hereditary angioedema

Specialist use only.
 
Available via MHRA EAMS application for eligible patients.

MHRA EAMS (Feb 2021): Berotralstat in the treatment of hereditary angioedema

 unlicensed

 Use for treatment of oral ulceration or inflammation is off label. For use as a mouthwash only - not to be swallowed.

 For short-term use

Not a first line choice. 

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

Consider only when a statin or other treatments are contra-indicated or not tolerated

 Also approved for off-label use for the treatment of primary biliary cholangitis

Specialist only, in line with NHSE Clinical Commissioning Policy 170131P

Not a first line choice

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

 Eyzeetan® 0.3mg/ml+5mg/ml preservative free eye drop solution: Consider as a more cost-effective alternative other unit drop preparations.

Heart failure - first line

unlicensed

 Specialist use by sexual health clinics (Solent NHS Trust) ONLY.

Treatment of chronic/recurrent vaginal candida for which other treatments (inc.azoles,clotrimazole and nystatin) have failed

For patients managed under a shared care agreement with the Royal Brompton Hospital only

Specialist clinics only

 unlicensed for anal fissures

Specify brand

Specify brand and indication

 Restricted use - discuss with directorate pharmacist

Not a first line option

 For specialist initiation. Use restricted to selected patients. (e.g. inadequate seizure control or where other antiepileptic drugs are contraindicated, not tolerated or inappropriate)

 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

Supported for use in accordance with published NICE TA guidance (see links below) and recommendations in NG28 Type 2 diabetes: management

Note: Canagliflozin for treating diabetic kidney disease is awaiting NICE appraisal (link here).

 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.

  Child Health and for patients particularly at risk of hypotension

For partial seizures and secondary generalised tonic-clonic seizures

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

Note: Optive®/Optho-lique® brands contain a gentle preservative so may be an option if patient is allergic to commonly-used preservatives

 Injection is unlicensed

Heart failure - second line

 Use restricted to Microbiology recommendation only for MSSA bacteraemia in patients with mild penicillin allergy who are not suitable for treatment with flucloxacillin.

SPC and PIL available on MHRA website.

 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

 Use ointment in children under 2 years: Avoid using eye drop preparations in those under 2 years due to boric acid content. Please prescribe/supply ointment preparation instead in this age group until national guidance is available. Please see advice on prescribing boric Acid/ borate' containing products in children.

 Eykappo® 5mg/ml preservative free eye drop solution: Consider as a more cost-effective alternative other unit drop preparations.

 Chloramphenicol 0.5% eye drops (in max. pack size 10 mL) and 1% eye ointment (in max. pack size 4 g) can be sold to the public for treatment of acute bacterial conjunctivitis in adults and children over 2 years; max. duration of treatment 5 days. Conditions for which over the counter items should not routinely be prescribed in primary care.

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

 suppositories are unlicensed 

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

Local West Hants CCG guidance can be found here

injection can be nebulised

First line option in primary care

 Specialist only use for exceptionally heavy menstrual bleeding

 Unlicensed

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).

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

 supported for type 2 diabetes in accordance with NICE technology appraisal guidance (see below) and recommendations in NG28 Type 2 diabetes: management

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

  (NICE TA679) for treating symptomatic chronic heart failure with reduced ejection fraction in adults, only if it is used as an add-on to optimised standard care with:

 Specialist use only

As per NHSE specialised commissioning circular 1614

For use as per commissioning criteria set by NHS England

  Microbiology approval only.

 Not to be used as first-line treatment option.

 Please ensure to read safety precautions and contra-indications of use as per BNF/SPC. MHRA links can be found below.

For the treatment of SIADH

Osteoporosis.

 Note: Contains an antimicrobial. Not recommended for long term use.

Also suitable for use as a soap substitute.

 For palliative care use

 For all other uses

 Neuro ICU consultant only or

 Off-label use for awake craniotomy and paediatric laryngotracheobronchoscopy

Not a first line NSAID

 Restricted to paediatric theatres only, or for adults if ketorolac injection not available.

 Refer to product information or Medusa IV guide for instructions on administration. Must be diluted and buffered prior to administration by IV infusion. Not suitable for IV bolus. 

 Use in children is off label.

Self Care Medicine

Suitable for generic prescribing.

For angina if not on beta-blocker.

Once daily preparation.

Prescribe by brand name

 unlicensed

 Urology specialist only

Pessary off-label use at UHS for outpatient induction of labour (see staffnet for guideline)

 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.

 For short term use

 For specialist use only.

For the treatment of Human Immunodeficiency Virus (HIV-1) infected adults and adolescents over 12 years of age

 unlicensed suppositories. Also used off-label for stimulation of lactation (contra-indicated in patients with known cardiac problems).

Short-term use only. No longer indicated as a motility stimulant.

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

 Consider Isomol or Zerodouble as more cost effective alternatives.

May also be applied before washing, showering or bathing.

Not XL (prolonged-release) tablet

Liposomal is a  high cost drug

 unlicensed

Dispersible tabs only if patient cannot swallow caps.

Second-line to oxytetracycline/lymecycline for acne.

Once weekly formulation.

 Dermatology recommendation only

 From British Association Dermatologists (BAD) Specials List 2014

 Unlicensed

 NICE TA662: Durvalumab in combination for untreated extensive-stage small-cell lung cancer. Terminated appraisal as company withdrew evidence submission

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.

Ordered via main stores

Can be used with levodopa preparations to reduce “off-time” in later Parkinson’s disease

 From British Association of Dermatologists (BAD) Specials List 2014

 Unlicensed

Also off-label for diabetic neuropathy

 For use only in patients intolerant to paraffin-containing products.

Note: MHRA safety warnings re: fire risks also apply to paraffin-free emollients.

 Epimax ointment 1st line as more cost effective option and same active ingredients as Epaderm.

For use as emollient/bath additive or as barrier cream.

If hormonal side effects on spironolactone

To reduce the risk of CV mortality and morbidity in selected patients after recent MI or with CHF

also for paediatric renal patients

Supported for use in accordance with published NICE TA guidance (see links below) and recommendations in NG28 Type 2 diabetes: management

 Not a first-line option in acne.

Third line on specialist advice

Oral drops (Cipralex^®) are Non Formulary

 Critical care only

 Child health only

For children >1 year and >10kg with feeding tubes

  Lansoprazole orodispersible tablets preferred in adults with swallowing difficulties/enteral tube administration.

Specialist use at Solent NHS Trust only

Each pack contains 24 white active tablets and 4 yellow placebo tablets.

Continuous sequential HRT tablet

Continuous combined HRT

 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.

 Gastroenterology specialist initiation only.

Only for patients with IBD unable to tolerate other iron preparations

Each capsule contains 30mg elemental iron

Each tablet contains ferrous fumarate 322mg (equivalent to 100mg elemental iron) and folic acid 0.35mg

Licensed for use in second and third trimester of pregnancy for prophylaxis against iron deficiency and megaloblastic anaemia of pregnancy

 Microbiology recommendation only for first episode of severe Clostridium difficile when concurrent antibiotics cannot be stopped and for second episodes of Clostridium difficile.

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

For COPD use only

 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

 Specialist use only

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

 Use in prolotherapy in the management of SI joint pain is not supported for routine commissioning. Individual patients may be considered via IFR application.

 Prescribing by brand name recommended

Licensed for COPD only, not for asthma

 From British Association of Dermatologists (BAD) Specials List 2014

 Unlicensed

 Dermatology only - for use in iontophoresis, second-line to tap water. To be initiated in secondary care.

 Prescribing by brand name recommended

 For severe sialorrhoea in children and adolescents with chronic neurological disorders.

Note: not licensed in adults.

 Red formulary status for fertility treatment. Specialist prescribing only.

After ondansetron has failed in children receiving chemotherapy and patients with gastrointestinal failure

 Specialist allergy clinics only

 For deep intramuscular injection

Microbiology request only

 Urology specialist only

 Restricted - for specialist cardiac surgery use only. For administration into renal arteries as renal protection during open thoracoabdominal aortic aneurysm repair surgery.

 use for this indication is off label

Classed as a Medical device - CE Marked

 For localised use in the uterus only, for prevention of adhesions. Use products registered as medical devices (i.e. CE marked) or medicines only, e.g. Hyalobarrier^®; Hyaregen^®; Materegen^®.

Modified-release tablets (Plenadren) are non-formulary

 For short-term use

 Available OTC

10 Vol (3%)

20 Vol (6%)

 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