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

  Moderate - severe atopic dermatitis which has not responded to dupilumab, or in those who qualify for, but are unsuitable for, dupilumab. MEC/DPC: not supported other than in exceptional circumstances (use IFR process for eligible patients)

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

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.

 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

 Microbiology recommendation only

 Microbiology recommendation only

  restricted to microbiology approval/recommendation only

unlicensed

 Ophthalmology only

 unlicensed

 Capsules on microbiology advice only

unlicensed

 Ophthalmology only

From NHS Logistics.

From NHS Logistics.

From NHS Logistics.

 unlicensed

 Child Health only

  Specialist initiation only. For add on treatment in severe asthma as a steroid sparing agent.

Prescribe by brand name

1mg/ml

Prescribe by brand name (different licensed indication to Verkazia® brand)

 For use as per commissioning criteria set by NHS England

 Endocrinologist use only

Second line when aminoglycosides should not be used.

Tablets and oral drops are not dose-equivalent

 Liquid is unlicensed

In combination with primaquine (off-label use)

 Liquid is unlicensed

 Unlicensed

 Specialist microbiology/TB service recommendation only

 Southern Health only

 unlicensed

 Specialist use only for treatment resistant schizophrenia

2%, 5% and 10%

 From British Association of Dermatologists (BAD) Specials List 2014

 Unlicensed

 From British Association of Dermatologists (BAD) Specials List 2014

 Unlicensed

 From British Association of Dermatologists (BAD) Specials List 2014

 Unlicensed

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

 Unlicensed

 For use as per specialist commissioning criteria set by NHS England

Only for constipation in terminal illness

Second line

   Second line to colestyramine for treatment of diarrhoea associated with bile acid malabsorption (off label use) - specialist diagnosis and recommendation only

 Cancer care only, for gut sterilisation prior to BMT

Limited usage - contact Care Group Pharmacist

For existing patients only. No longer routinely recommended

Ordered through main stores

200g

 For use as per commissioning criteria set by NHS England

Pfizer-BioNTech mRNA COVID-19 vaccine (BNT162b2)  

• Authorisation for temporary supply (DHSC/MHRA)

 AstraZeneca’s Covid-19 vaccine (ChAdOx1-S [recombinant])  

• Authorisation for temporary supply (DHSC/MHRA)

  Please see our home page: 'Covid-19 Resources' for useful guidance links.

Ordered via main stores

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

Self Care Medicine: Not usually suitable for prescribing on the NHS. 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)

Unit dose drops preservative-free.

 Specialist microbiology/TB service recommendation only

 For use only when recommended by microbiology/infectious disease consultant

  For long-term prophylaxis of hereditary angioedema.

Notify consultant IMMEDIATELY diagnosis suspected

 Supported by DPC Feb 2014 for use when recommended by a specialist for select patients who have failed or are not considered suitable for other treatment options.

Note: for patients with concomitant depression/anxiety, 'off label' use of SSRIs would be preferred.

 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 specialist use only in line with NHS England Clinical Commissioning Policy (170132P).

metastases

 Specialist use by Sexual Health Clinics (Solent NHS Trust) ONLY 

For treatment of bacterial vaginosis (when other treatments have failed)

 For bariatric surgery

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

150mcg per metered dose nasal spray for Von Willebrand's disease 

 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.

For neuropathic pain in accordance with NICE Guidelines

 Specialist use only for atopic dermatitis in eligible adult patients (see NICE TA534) - commissioned by CCGs.

Commissioned by NHS England for adolescent patients 12 to 18 years if the patient is seen within a specialist treatment centre (e.g. specialised paediatric dermatology and/or paediatric allergy) and meets the criteria set out in NICE TA534. Also available via MHRA EAMS for patients aged 6 to 11 years with severe atopic dermatitis who are candidates for systemic therapy and where existing therapies are not advisable. Note: use in children

 Currently non-formulary for severe asthma (awaiting NICE TA guidance - due Jan 2021)

 Currently non-formulary for treating chronic rhinosinusitis with nasal polyps. NICE TA648 - terminated appraisal.

 for atypical haemolytic uraemic syndrome (see NICE HST1 guidance)

 Non-formulary for relapsing NMO (see NICE TA647 terminated appraisal link below).

 Only when other available options are inappropriate or ineffective

Restricted to patients as per NHS England commissioning policies

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

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

 Specialist only, in line with NHSE Clinical commissioning policy 16043/P

 Specialist only, in line with NHSE Clinical Commissioning Policy 16043/P

 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.

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 transdermal delivery systems (TDSs) comprising

a) 4 EVOREL 50 TDSs, each containing:

• 3.2 mg of estradiol hemihydrate

b) 4 EVOREL CONTI TDSs, each containing:

• 3.2 mg of estradiol hemihydrate
• 11.2 mg of norethisterone acetate

Continuous combined HRT

 Countess Mountbatten House use only

unlicensed

 Specify brand.

Benepali and Erelzi are black triangle

Use for acne is off label

Only to be inserted and removed by trained professionals

For use as per commissioning criteria set by NHS England

 Specialist use only

 Similar to Cetraben cream

Mainly reserved as an adjunct to statins for patients with primary hypercholesterolaemia.

  Adult Acute Pain Team only

For painful procedures

Fentanyl lozenge with oromucosal applicator

 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).

previously known as 'iron isomaltoside'. Name changed in Sept 2020

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

 Specialist use only

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

 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

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