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.

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

 unlicensed

 Prescribing by brand name recommended

200/6 strength licensed for asthma only, not for COPD

First line for adults in nasal allergy

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

 Available OTC

 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

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)

Not a first line option in Parkinson’s disease

For ileo-caecal disease

 Prescribing by brand name recommended

 Obstetrics only

0.125%, 0.25% and 0.5%

Not initiated in UHS

Prescribe by brand name

Not initiated in UHS

 Specialist use only in accordance with NICE HST8 guidance 

 For use as per commissioning criteria set by NHS England

Hyperprolactinaemia

 From British Association of Dermatologists (BAD) Specials List 2014

 Unlicensed

Chewable tablets first-line. Effervescent and film-coated tablets reserved to aid administration in those unable to take chewable tablets. 

Note that different formulations have different amounts of colecalciferol and calcium.

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

Preferred brands in primary care: Accrete D3 or TheiCal D3

 unlicensed

  Formerly Sandocal^®

Chewable tablets first line.

folinic acid rescue

 Powder for oral or rectal suspension

6 x 40ml stocked in pharmacy

 As advised by specialist service.

Borderline substances (ACBS).

 Restricted use.

Use is supported only for spasticity in patients with multiple sclerosis in accordance with NICE guidelines NG144.

Must be initiated and supervised by a physician with specialist expertise in treating spasticity due to multiple sclerosis.

For secondary care prescribing only until shared care guidelines have been developed and approved.

  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). 

Contains 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.

 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

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

 Paediatrics

  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 Policy F03/P/b

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

 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.

Ensure patients are counselled on use of the relevant device.

Arovi, Enoxaparin Becat and Inhixa brands are black triangle

 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

  Child Health only

 Specify brand

Erelzi is black triangle

For existing patients only. No longer routinely recommended

Rigevidon brand is

Microgynon brand is 

Low strength.

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).

 Gastroenterology specialist initiation only.

Only for patients with IBD unable to tolerate other iron preparations

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

for men with a significantly enlarged prostate

 Specialist use only.

Treatment of choice for actinic keratoses - recommended by Community Dermatology services (see guidance here).

 consider oral solution as a more cost effective alternative to 10mg capsules

 For deep intramuscular injection

 Product has been discontinued in UK, supplies expire in Aug 2020

 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

 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

As per DPC Shared Care Guidelines (pending publication)

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

10 Vol (3%)

20 Vol (6%)

 Fragrance-free.

IM injection preferred over oral administration for non-dietary vitamin B12 deficiency

 Supported only for 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.

 Unlicensed

  For use in line with DPC dry eye guidelines (link below)

Preservative-free

Contains retinol palmitate (vitamin A), liquid paraffin and wool fat.

Previously known as VitA-POS eye ointment.

Tablets/patch may also be used off-label for hypersalivation

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

For prevention of skeletal events in patients with breast cancer and bone metastases.

 'Off label' use for post-menopausal women with breast cancer who are assessed by a specialist to be at sufficient risk of breast cancer recurrence. Refer to DPC shared care guidance: Adjuvant Bisphosphonates for Early Breast Cancer Feb 2018

For osteoporosis

 For use as per commissioning criteria set by NHS England

•  On  Consultant Haematologist advice only (refer to UHS guideline).
• When rapid reversal of dabigatran is required for emergency surgery/urgent procedures or in life-threatening or uncontrolled bleeding.

Refer to UHS Iloprost Intravenous Infusion Guidelines

For anogenital warts.

 Not supported for treatment of actinic keratoses.

 Unlicensed

Not held in stock but available to order through pharmacy

100ml/200ml/500ml - Unflavoured

 Specify brand.

Specify brand (e.g. Remicade®, Remsima®, Inflectra®, Flixabi®, Zessly®)