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 Formulary Chapter 13: Skin - Full Chapter
Notes:

Specials Recommended by the British Association of Dermatologists for Skin Disease

Most prescribing uses licensed medicines whose safety and efficacy are assured. For many common dermatological diseases including psoriasis and eczema, the range of licensed medicines is limited. As a result, Dermatology prescribing may rely significantly on unlicensed creams and ointments (known as ‘Specials’) containing tars, dithranol, salicylic acid, steroids and other active constituents in a range of concentrations and bases. This is of particular concern in primary care where lack of effective price controls and a mechanism to ensure independent scrutiny of product quality has increased costs and concern about standards. To address these concerns, and help optimise quality of care, adherence to the revised British Association of Dermatologists (BAD) list of preferred Specials (2018) is encouraged.

 Details...
13.02  Expand sub section  Emollient and barrier preparations
13.02  Expand sub section  Soap substitute
13.02.01  Expand sub section  Emollients
Aqueous Cream BP
View adult BNF View SPC online View childrens BNF
Formulary
Green
  • Due to the SLS content to be used as a soap substitute only.
 
 
Aveeno® (Cream)
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
 
Cetraben®
(Cream and ointment)
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
 
DoubleBase®gel
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
 
E45®
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
 
Emulsifying Ointment BP
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
 
Epaderm® emollient
View adult BNF View SPC online View childrens BNF
Formulary
Green
  • Hydromol® Ointment is made to the same formula and is more cost effective.
 
 
Epimax®
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
Link  MHRA Drug Safety Update: Epimax Ointment and Epimax Paraffin-Free Ointment: reports of ocular surface toxicity and ocular chemical injury
 
Hydromol® ointment
View adult BNF View SPC online View childrens BNF
Formulary
Green
  • This product is also known locally as ‘Emulsifying Ointment RVI
    Formula’. It is softer than emulsifying ointment BP. Epaderm ointment is
    made to the same formula, but is more expensive.
 
 
Hydrous® ointment
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
 
Oilatum® cream
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
 
Oilatum® Junior cream
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
 
Paraffin sterile liquid
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
 
QV®
View adult BNF View SPC online View childrens BNF
Formulary
Green plus
  • Approved for used in radiotherapy only.
 
 
ZeroAQS®
View adult BNF View SPC online View childrens BNF
Formulary
Green
  • SLS free alternative to Aqueous Cream.
 
 
Zerobase®
View adult BNF View SPC online View childrens BNF
Formulary
Green
  • Alternative to Diprobase
 
 
Zerocream®
View adult BNF View SPC online View childrens BNF
Formulary
Green
  • Alternative to E45® Cream.
 
 
Zerodouble® Gel
View adult BNF View SPC online View childrens BNF
Formulary
Green
  • Alternative to Doublebase gel.
 
 
Zeroveen® cream
View adult BNF View SPC online View childrens BNF
Formulary
Green
  • Alternative to Aveeno
 
 
White Soft Paraffin BP
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
 
Yellow Soft Paraffin BP
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
 
AquaGel lubricating jelly
(oil-free)
View adult BNF View SPC online View childrens BNF
Formulary
Green
  • Approved for the relief of dryness of the nose, lips and face when a patient is using oxygen via nasal prongs, CPAP masks etc
 
 
13.02.01  Expand sub section  Emollients - preparations containing urea
Balneum® Plus cream
(Emollient preparation containing Urea)
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
 
Calmurid® emollient
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
 
13.02.01  Expand sub section  Emollients - with antimicrobials to top
Dermol®
View adult BNF View SPC online View childrens BNF
Formulary
Green plus
 
 
Dermol® 500 Lotion
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
 
13.02.01.01  Expand sub section  Emollient bath and shower preparations
 note 

Note: Emollient bath and shower preparations are included in the NHS England guidance Items which should not be routinely prescribed in primary care   

Bath and shower preparations for dry and pruritic skin conditions
Formulary
Black
 
Link  Emollient Prescribing Guideline and Formulary North East North Cumbria
 
Hydromol® bath and shower
View adult BNF View SPC online View childrens BNF
Formulary
Red
  • For inpatient use only as per Trust Moisture-Associated Tissue Damage (MASD) guidelines
 
 
13.02.02  Expand sub section  Barrier preparations
Barrier preparation (Cavilon®Film)
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
 
Dimeticone (Siopel®)
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
 
Drapolene®
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
 
Medi Derma-Pro Foam & Spray Skin Cleanser And Skin Protectant Ointment  (Medi Derma-Pro Foam & Spray Skin Cleanser®)
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
 
Medi Derma-S barrier film  (Medi Derma-S ®barrier film)
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
 
Sorbaderm® cream
View adult BNF View SPC online View childrens BNF
Formulary
Green

  • 2g, 28g & 92g barrier cream, 28ml pump spray, sterile 1ml no
    sting barrier film foam applicator, sterile 3ml no sting
    barrier film foam applicator

 
 
Deegan's ointment
View adult BNF View SPC online View childrens BNF
Unlicensed Drug Unlicensed
Green plus
 
 
Sucralfate cream
View adult BNF View SPC online View childrens BNF
Unlicensed Drug Unlicensed
Red
  • For limited use around gastrostomies when wound breakdown is thought to be aggravated by leakage of gastric acid.
 
 
13.02.02  Expand sub section  Community
13.02.02  Expand sub section  Hospital
13.03  Expand sub section  Topical local anaesthetics and antipruritics to top
Crotamiton (Eurax®)
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
 
Lidocaine 5% ointment
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
 
Lidocaine and prilocaine (EMLA®)
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
 
Menthol and aqueous cream
View adult BNF View SPC online View childrens BNF
Formulary
Green

- available as Dermacool

 
 
13.04  Expand sub section  Topical corticosteriods.
13.04  Expand sub section  Topical corticosteriod preparation potencies
13.04  Expand sub section  Mild
Hydrocortisone 0.5%, 1% & 2.5%
View adult BNF View SPC online View childrens BNF
Formulary
Green
  • Cream and ointment
 
 
Hydrocortisone 1% with Clotrimazole 1% (Canesten HC®)
View adult BNF View SPC online View childrens BNF
Formulary
Green
  • Cream 30g
  • 15g available Over the Counter.
 
 
Hydrocortisone 1% with Miconazole Nitrate 2% (Daktacort®)
View adult BNF View SPC online View childrens BNF
Formulary
Green
  • Cream 30g (15g available Over the Counter) and Ointment 30g
 
Link  MSN/2024/027: Discontinuation of Daktacort 2%/1% cream
 
Hydrocortisone 1%, Oxytetracycline 3%  (Terra-Cortril ®)
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
 
Hydrocortisone Acetate 1% with Fusidic Acid 2% (Fucidin H®)
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
 
Nystaform-HC®
View adult BNF View SPC online View childrens BNF
Formulary
Green
  • Cream and ointment
 
 
Timodine®
View adult BNF View SPC online View childrens BNF
Formulary
Green
  • Cream
 
 
13.04  Expand sub section  Moderate
Betamethasone (as Valerate) 0.025% (Betnovate-RD®)
View adult BNF View SPC online View childrens BNF
Formulary
Green
  • Cream and ointment
 
 
Clobetasone Butyrate 0.05% (Eumovate®)
View adult BNF View SPC online View childrens BNF
Formulary
Green
  • Cream, ointment & scalp application
 
 
Clobetasone butyrate with nystatin and oxytetracycline (Trimovate®)
View adult BNF View SPC online View childrens BNF
Formulary
Green
  • Clobetasone butyrate 500mcg/1g, nystatin 100000iu/1g, oxytetracycline (as oxytetracycline calcium) 30mg/1g
 
 
Fludroxycortide  (Haelan®)
(Tape)
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
 
13.04  Expand sub section  Potent to top
Betamethasone (as Dipropionate) 0.05% with Salicylic Acid 3% (Diprosalic®)
View adult BNF View SPC online View childrens BNF
Formulary
Green
  • Ointment
 
 
Betamethasone (as Valerate) 0.1%
View adult BNF View SPC online View childrens BNF
Formulary
Green
  • Cream, ointment & scalp application
 
 
Betamethasone (as Valerate) 0.1% with Clioquinol 3% (Betnovate C®)
View adult BNF View SPC online View childrens BNF
Formulary
Green
  • Cream and ointment
 
 
Betamethasone (as Valerate) 0.1% with Fucidic Acid 2% (Fucibet®)
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
 
Betamethasone (as valerate) medicated plasters (Betesil®)
View adult BNF View SPC online View childrens BNF
Formulary
Green plus
  • 2.25mg medicated plasters

 

 
 
Flucinolone Acetonide 0.025% with Neomycin Sulphate 0.5% (Synalar N®)
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
 
Fluocinolone Acetonide 0.025% (Synalar®)
View adult BNF View SPC online View childrens BNF
Formulary
Green
  • Cream, ointment & gel
 
 
Fluocinolone acetonide 0.025% with clioquinol 3% (Synalar C®)
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
 
Hydrocortisone Butyrate 0.1% cream (Locoid®)
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
 
Mometasone Furoate 0.1% (Elocon®)
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
 
13.04  Expand sub section  Very Potent
Clobetasol Propionate 0.05% (Dermovate®)
View adult BNF View SPC online View childrens BNF
Formulary
Green
  • Cream, ointment & scalp application
 
 
Clobetasol Propionate with neomycin and nystatin (Dermovate-NN®)
View adult BNF View SPC online View childrens BNF
Formulary
Green
  • Ointment
 
 
13.04.01  Expand sub section  Topical corticosteroid scalp applications
Betamethasone (as Dipropionate) 0.05% with Salicylic Acid 2% (Diprosalic®)
View adult BNF View SPC online View childrens BNF
Formulary
Green
  • Scalp application
 
 
13.04.02  Expand sub section  Topical corticosteroids - for use under specialist supervision only
13.04.03  Expand sub section  Topical corticosteroids - unlicensed specials
13.04.04  Expand sub section  Topical corticosteroids and anti-infective preparations to top
13.04.04  Expand sub section  Very Potent
13.05  Expand sub section  Preparations for eczema and psoriasis
13.05.01  Expand sub section  Preparations for eczema
Alitretinoin (Toctino®)
View adult BNF View SPC online View childrens BNF
Formulary
Red
High Cost Medicine
  • Approved for adults with severe chronic hand eczema that have not responded to potent topical corticosteroids in line with NICE.
 
Link  MHRA Drug Safety Update (July 2021): Oral retinoid medicines (isotretinoin▼, alitretinoin▼, and acitretin▼): temporary monitoring advice during coronavirus (COVID-19) pandemic
Link  MHRA Drug Safety Update (Jun 2019): Oral retinoid medicines▼: revised and simplified pregnancy prevention educational materials for healthcare professionals and women
Link  NICE TA177: Alitretinoin for the treatment of severe chronic hand eczema
 
Ichthammol
(Zinc paste and ichthammol bandage BP 1993)
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
 
Zinc oxide bandage  (Viscopaste®)
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
 
13.05.02  Expand sub section  Preparations for psoriasis
5-Methoxypsoralen 20mg tablets
View adult BNF View SPC online View childrens BNF
Unlicensed Drug Unlicensed
Red
 
 
8-Methoxypsoralen 10mg tablets
View adult BNF View SPC online View childrens BNF
Unlicensed Drug Unlicensed
Red
 
 
Methoxypsoralen 1.2% bath additive
View adult BNF View SPC online View childrens BNF
Unlicensed Drug Unlicensed
Red
 
 
13.05.02  Expand sub section  Topical preparations for psoriasis to top
Calcipotriol 50mcg/g  (Dovonex®)
View adult BNF View SPC online View childrens BNF
Formulary
Green
  • 0.005% Cream and ointment

 
 
Calcipotriol with Betamethasone
View adult BNF View SPC online View childrens BNF
Formulary
Green
  • Calcipotriol 50mcg/1g and betamethasone (as betamethasone dipropionate) 500mcg/1g
    • Gel and ointment (Dovobet®)
      • approved for the treatment of scalp and mild to moderate non scalp plaque psoriasis vulgaris in adults.
    • 60g cutaneous spray (Enstilar®)
      • Approved for the treatment of plaque psoriasis
    • Cream (Wynzora®)
 
 
Coal tar 2% and salicylic acid 2% ointment
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
 
Coal tar in emulsifying ointment solution
View adult BNF View SPC online View childrens BNF
Formulary
Green
  • 1% unlicensedunlicensed
  • 2% unlicensedunlicensed
  • 5% unlicensedunlicensed
 
 
Coal tar lotion 1% (Exorex®)
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
 
Cocois®
(Scalp application)
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
 
Diprosalic ointment
View adult BNF View SPC online View childrens BNF
Formulary
Green

  • 0.05%/3%

 
 
Dithranol pomade
View adult BNF View SPC online View childrens BNF
Formulary
Green

  • 0.2%, 0.4% & 0.6% unlicensedunlicensed

 
 
Sebco® scalp ointment
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
 
Shampoos  (T/Gel®)
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
 
Dithranol in Full Strength Lassar's Paste BP
View adult BNF View SPC online View childrens BNF
Unlicensed Drug Unlicensed
Red

  • 0.1%, 0.2%, 0.4%, 0.6%, 0.8%, 1%, 2%, 4%, 6% & 8%.

 
 
Dithranol with salycyclic acid 0.5%
View adult BNF View SPC online View childrens BNF
Unlicensed Drug Unlicensed
Red

  • 0.1%, 0.2%, 0.4%, 0.6%, 0.8%, 1%, 2%, 4%, 6%, 8% & 16%in emulsifying base.

 
 
Salicylic Acid in emulsifying ointment
View adult BNF View SPC online View childrens BNF
Unlicensed Drug Unlicensed
Green
  • 2%, 5%, 10% and 20%.
 
 
Tar Pomade (6% coal tar solution & 2% salycylic acid in emulsifying ointment)
View adult BNF View SPC online View childrens BNF
Unlicensed Drug Unlicensed
Green
 
 
Zinc and Coal Tar Paste (White's Tar Paste)
View adult BNF View SPC online View childrens BNF
Unlicensed Drug Unlicensed
Green
 
 
Zinc and Salicylic Acid Compound Paste  (Half Strength Lassar's Paste)
View adult BNF View SPC online View childrens BNF
Unlicensed Drug Unlicensed
Green
 
 
13.05.02  Expand sub section  Oral retinoids for psoriasis
Acitretin (Neotigason®)
View adult BNF View SPC online View childrens BNF
Unlicensed Drug Unlicensed
Red
  • 10mg and 25mg capsules 
 
Link  MHRA Drug Safety Update (July 2021): Oral retinoid medicines (isotretinoin▼, alitretinoin▼, and acitretin▼): temporary monitoring advice during coronavirus (COVID-19) pandemic
Link  MHRA Drug Safety Update (Jun 2019): Oral retinoid medicines▼: revised and simplified pregnancy prevention educational materials for healthcare professionals and women
 
Fumaric acid esters
View adult BNF View SPC online View childrens BNF
Unlicensed Drug Unlicensed
Red
  • 30mg & 120mg tablets
 
 
13.05.02.01  Expand sub section  Topical preparations for the scalp
13.05.03  Expand sub section  Drugs affecting the immune response
Abrocitinib (Cibinqo®)
View adult BNF View SPC online View childrens BNF
Formulary
Red
High Cost Medicine
CCG
  • Approved for the treatment of moderate to severe atopic dermatitis in line with NICE



 
Link  MHRA Drug Safety Update (April 2023): Janus kinase (JAK) inhibitors: new measures to reduce risks of major cardiovascular events, malignancy, venous thromboembolism, serious infections and increased mortality
Link  NICE TA814: Abrocitinib, tralokinumab or upadacitinib for treating moderate to severe atopic dermatitis
 
Adalimumab
View adult BNF View SPC online View childrens BNF
Formulary
Red
High Cost Medicine
  • Approved for psoriasis in line with NICE.
  • Approved for the treatment of moderate to severe hidradenitis suppurativa in line with NICE and NHS England Commissioning Policy
  • Approved for the treatment of plaque psoriasis in children and young people in line with NICE 

Biosimilars are available – note that indications can differ between different products – prescribe by brand. Consult with individual trust pharmacy department for details of
preferred biosimilar brand.

 
Link  NICE TA146 Adalimumab for the treatment of adults with psoriasis
Link  NICE TA392: Adalimumab for treating moderate to severe hidradenitis suppurativa
Link  NICE TA455 Adalimumab, etanercept and ustekinumab for treating plaque psoriasis in children and young people
 
Apremilast (Otezla®)
View adult BNF View SPC online View childrens BNF
Formulary
Red
High Cost Medicine
  • 10mg, 20mg & 30mg tablets
  • To be used in accordance with NICE guidance
 
Link  MHRA Drug Safety Update (Jan 2017): Apremilast (Otezla ): risk of suicidal thoughts and behaviour
Link  NICE TA419: Apremilast for treating moderate to severe plaque psoriasis
 
Baricitinib (Olumiant®)
View adult BNF View SPC online View childrens BNF
Formulary
Red
  • Approved for treating moderate to severe atopic dermatitis in adults in line with NICE.
 
Link   NICE TA681: Baricitinib for treating moderate to severe atopic dermatitis
Link  MHRA Drug Safety Update (April 2023): Janus kinase (JAK) inhibitors: new measures to reduce risks of major cardiovascular events, malignancy, venous thromboembolism, serious infections and increased mortality
Link  MHRA Drug Safety Update (Aug 2020): Baricitinib (Olumiant▼): increased risk of diverticulitis, particularly in patients with risk factors
Link  MHRA Drug Safety Update (Mar 2020): Baricitinib (Olumiant▼): risk of venous thromboembolism
 
Bimekizumab  (Bimzelx®)
View adult BNF View SPC online View SMC online View childrens BNF
Formulary
Red
  • 160mg/ml solution pre-filled pen/syringe
  • Approved for the treatment of moderate to severe plaque psoriasis in line with NICE

 

 
Link  NICE TA723: Bimekizumab for treating moderate to severe plaque psoriasis
 
Brodalumab (Kyntheum® )
View adult BNF View SPC online View childrens BNF
Formulary
Red
High Cost Medicine
CCG
  • 210mg/1.5ml solution for injection in pre-filled syringes.
  • Approved for the treatment of moderate to severe plaque psoriasis in line with NICE 



 

 
Link  NICE TA511: Brodalumab for treating moderate to severe plaque psoriasis
 
Certolizumab pegol 
View adult BNF View SPC online View childrens BNF
Formulary
Red
 
Link  NICE TA574: Certolizumab pegol for treating moderate to severe plaque psoriasis
 
Ciclosporin
View adult BNF View SPC online View childrens BNF
Formulary
Amber
  • Capsules & SF Solution 
    See section 8.2.2
 
Link  County Durham and Darlington Shared Care Guideline: Ciclosporin
Link  Tees Valley Shared Care Guideline: Ciclosporin
 
Deucravacitinib (Sotyktu)
View adult BNF View SPC online View childrens BNF
Formulary
Red
High Cost Medicine
CCG
  • 6mg tablets
  • Approved for the treatment of moderate to severe plaque psoriasis in line with NICE
 
Link  NICE TA907: Deucravacitinib for treating moderate to severe plaque psoriasis
 
Dimethyl fumarate (Skilarence®)
View adult BNF View SPC online View childrens BNF
Formulary
Red
High Cost Medicine
  • 120mg tablets
  • Approved for the treatment of moderate to severe plaque psoriasis in line with NICE
 
Link  NICE TA475 Dimethyl fumarate for treating moderate to severe plaque psoriasis
 
Dupilumab (Dupixent®)
View adult BNF View SPC online View SMC online View childrens BNF
Formulary
Red
High Cost Medicine
NHS England
  • 200mg/1.14ml & 300mg/2ml solution for injection
  • Approved for treating moderate to severe atopic dermatitis in adults in line with NICE
 
Link  MHRA Drug Safety Upate (Nov 2022): Dupilumab (Dupixent▼): risk of ocular adverse reactions and need for prompt management
Link  NICE TA534: Dupilumab for treating moderate to severe atopic dermatitis
 
Etanercept (Enbrel®, Benapali® & Erelzi®)
View adult BNF View SPC online View childrens BNF
Formulary
Red
High Cost Medicine
  • Approved for psoriasis in line with NICE
  • Approved for the treatment of plaque psoriasis in children and young people in line with NICE

 

Biosimilars are available – note that indications can differ between different products – prescribe by brand. Consult with individual trust pharmacy department for details of
preferred biosimilar brand.

 
Link  NICE TA103: Psoriasis - efalizumab and etanercept
Link  NICE TA455 Adalimumab, etanercept and ustekinumab for treating plaque psoriasis in children and young people
 
Guselkumab (Tremfya®)
View adult BNF View SPC online View childrens BNF
Formulary
Red
High Cost Medicine
CCG
  • 100mg/1mL solution for injection
  • Approved for the treatment of moderate to severe plaque psoriasis in line with NICE

 

 
Link  NICE TA521: Guselkumab for treating moderate to severe plaque psoriasis
 
Hydroxychloroquine
(Dermatology)
View adult BNF View SPC online View childrens BNF
Formulary
Amber
 
Link  MHRA Drug Safety Update (Feb 2022): Hydroxychloroquine, chloroquine: increased risk of cardiovascular events when used with macrolide antibiotics; reminder of psychiatric reactions
Link  North East and North Cumbria Shared Care Protocol: Hydroxychloroquine for patients within adult services
 
Infliximab (Remsima®, Inflectra®, Remicade®)
View adult BNF View SPC online View childrens BNF
Formulary
Red
High Cost Medicine

  • Approved for psoriasis in line with NICE.

 
Link  NICE TA134: Infliximab for psoriasis
 
Ixekizumab (Taltz®)
View adult BNF View SPC online View childrens BNF
Formulary
Red
High Cost Medicine
  • Approved for the treatment of moderate to severe plaque psoriasis in adults in line with NICE

 

 
Link  NICE TA442 Ixekizumab for treating moderate to severe plaque psoriasis
 
LebrikizumabBlack Triangle (Ebglyss®)
View adult BNF View SPC online View childrens BNF
Formulary
Red
High Cost Medicine
CCG
  • Approved for treating moderate to severe atopic dermatitis in people 12 years and over in line with NICE
 
Link  NICE TA986: Lebrikizumab for treating moderate to severe atopic dermatitis in people 12 years and over
 
Cytotoxic Drug Methotrexate
View adult BNF View SPC online View childrens BNF
Formulary
Amber

 

 
Link  County Durham and Darlington Shared Care Guideline: Methotrexate
Link  MHRA Drug Safety Update (August 2023): Methotrexate: advise patients to take precautions in the sun to avoid photosensitivity reactions
Link  MHRA Drug Safety Update (Sept 2020): Methotrexate once-weekly for autoimmune diseases: new measures to reduce risk of fatal overdose due to inadvertent daily instead of weekly dosing
Link  Tees Valley Shared Care Guideline: Methotrexate
 
Pimecrolimus cream (Elidel®)
View adult BNF View SPC online View childrens BNF
Formulary
Green plus
  • 1% cream
    • Approved of moderate atopic eczema on the face and neck in children between 2 and 16 years in line NICE.
    • Can be initiated by prescribers (including general practitioners) with a special interest and experience in dermatology and only after careful discussion with the patient about the potential risks and benefits of all appropriate second-line treatment options.
 
Link  NICE TA82: Pimecrolimus and tacrolimus for atopic dermatitis (eczema)
 
Risankizumab (Skyrizi®)
View adult BNF View SPC online View childrens BNF
Formulary
Red
High Cost Medicine

  • Approved for the treatment of moderate to severe plaque psoriasis in line with NICE

 
Link  NICE TA596: Risankizumab for treating moderate to severe plaque psoriasis
 
Ritlecitinib (Litfulo®)
View adult BNF View SPC online View childrens BNF
Formulary
Not Recomended
High Cost Medicine
CCG
  • 50mg hard capsules
  • Currently awaiting assessment against NENC ICB ethical framework in December 2024

 

 
Link  NICE TA958: Ritlecitinib for treating severe alopecia areata in people 12 years and over
 
Secukinumab (Cosentyx®)
View adult BNF View SPC online View childrens BNF
Formulary
Red
High Cost Medicine
  • Approved for the treatment of plaque psoriasis in line with NICE.
  • Approved for the treatment of moderate to severe plaque psoriasis in children and young people in line with NICE
  • Approved for treating moderate to severe hidradenitis suppurativa in  line with NICE
 
Link  NICE TA350: Secukinumab for treating moderate to severe plaque psoriasis
Link  NICE TA734: Secukinumab for treating moderate to severe plaque psoriasis in children and young people
Link  NICE TA935: Secukinumab for treating moderate to severe hidradenitis suppurativa
 
Tacrolimus ointment (Protopic® )
View adult BNF View SPC online View childrens BNF
Formulary
Green plus
  • 0.03% & 0.1% ointment
    • Approved for moderate to severe atopic eczema in patients over 2 years in line with NICE.
    • Can be initiated by prescribers (including general practitioners) with a special interest and experience in dermatology and only after careful discussion with the patient about the potential risks and benefits of all appropriate second-line treatment options
 
Link  NICE TA82: Pimecrolimus and tacrolimus for atopic dermatitis (eczema)
 
Tildrakizumab (Ilumetri®)
View adult BNF View SPC online View childrens BNF
Formulary
Red
  • 100 mg solution for injection in pre-filled syringe
  • Approved for the treatment of moderate to severe plaque psoriasis in line with NICE
 
Link  NICE TA575: Tildrakizumab for treating moderate to severe plaque psoriasis
 
Tralokinumab (Adtralza®)
View adult BNF View SPC online View childrens BNF
Formulary
Red
High Cost Medicine
CCG
  • Approved for the treatment of moderate to severe atopic dermatitis in line with NICE



 
Link  MHRA Drug Safety Update (April 2023): Janus kinase (JAK) inhibitors: new measures to reduce risks of major cardiovascular events, malignancy, venous thromboembolism, serious infections and increased mortality
Link  NICE TA814: Abrocitinib, tralokinumab or upadacitinib for treating moderate to severe atopic dermatitis
 
Upadacitinib (Rinvoq®)
View adult BNF View SPC online View childrens BNF
Formulary
Red
High Cost Medicine
CCG
  • Approved for the treatment of moderate to severe atopic dermatitis in line with NICE
 
Link  MHRA: Janus kinase (JAK) inhibitors: new measures to reduce risks of major cardiovascular events, malignancy, venous thromboembolism, serious infections and increased mortality
Link  NICE TA814: Abrocitinib, tralokinumab or upadacitinib for treating moderate to severe atopic dermatitis
 
Ustekinumab (Stelara®)
View adult BNF View SPC online View childrens BNF
Formulary
Red
High Cost Medicine
  • 45mg & 90mg SC injections approved for psoriasis in line with NICE.
  • Approved for the treatment of plaque psoriasis in children and young people in line with NICE
 
Link  MHRA Drug Safety Update (Jan 2015): Ustekinumab (Stelara): risk of exfoliative dermatitis
Link  NICE TA180: Psoriasis - ustekinumab (Updated March 2017)
Link  NICE TA455 Adalimumab, etanercept and ustekinumab for treating plaque psoriasis in children and young people
 
13.05.03.01  Expand sub section  Cytokine modulators (biologic therapies) - eczema
13.05.03.02  Expand sub section  Cytokine modulators (biologic therapies) - psoriasis to top
13.06  Expand sub section  Acne and rosacea
 note 

Note: As per NHS England Guidance the treatment of mild acne is suitable for self-care.

13.06.01  Expand sub section  Topical preparations for acne
13.06.01  Expand sub section  Benzoyl peroxide and azelaic acid
Adapalene and benzoyl peroxide (Epiduo® Gel)
View adult BNF View SPC online View childrens BNF
Formulary
Green
  • adapalene 0.1%/benzoyl peroxide 2.5% & adapelene 0.3%/benzoyl peroxide 2.5%
 
 
Azelaic Acid
View adult BNF View SPC online View childrens BNF
Formulary
Green
  • 15% (Finacea®) and 20% (Skinoren®) gel 
 
 
Benzoyl Peroxide 5% Gel (Acnecide®)
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
 
Benzoyl Peroxide 5% with Clindamycin 1% (Duac® )
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
 
13.06.01  Expand sub section  Topical antibacterials for acne
Clindamycin  (Dalacin T®)
View adult BNF View SPC online View childrens BNF
Formulary
Green
  • 1% topical solution (alcohol – water basis)
  • 1% lotion (aqueous)
 
 
Erythromycin 40mg with Zinc Acetate 1.2% topical solution (Zineryt®)
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
 
13.06.01  Expand sub section  Topical retinoids and related preparations for acne to top
Adapalene 0.1% gel and cream (Differin®)
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
 
Tretinoin 0.025% with Clindamycin 1% gel (Treclin® )
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
 
Tretinoin with antibacterial Aknemycin® Plus
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
 
13.06.01  Expand sub section  Other topical preparations for rosacea
Brimonidine Tartate 0.33% gel (Mirvaso®)
View adult BNF View SPC online View childrens BNF
Formulary
Green
  • For specialist initiation for the treatment of severe rosacea. Following specialist review of effectiveness, primary care can continue supply.
 
Link  MHRA Drug Safety Update (June 2017): Brimonidine gel (Mirvaso): risk of systemic cardiovascular effects; not to be applied to damaged skin
Link  MHRA Drug Safety Update (Nov 2016): Brimonidine gel (Mirvaso): risk of exacerbation of rosacea
 
Ivermectin 1% cream (Soolantra®)
View adult BNF View SPC online View childrens BNF
Formulary
Green
  • For the treatment of papulopustular rosacea in patients as second line treatment in patient who have failed topical metronidazole.
 
 
13.06.02  Expand sub section  Oral preparations for acne
Spironolactone
View adult BNF View SPC online View childrens BNF
Formulary
Red
 
 
13.06.02  Expand sub section  Oral antibiotics for acne
Lymecycline
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
 
Doxycycline
(Capsules)
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
 
13.06.02  Expand sub section  Hormone treatment for acne
Co-Cyprindiol 2000/35
(Cyproterone Acetate 2mg with Ethinylestradiol 35micrograms)

View adult BNF View SPC online View childrens BNF
Formulary
Green
  • Tablets containing cyproterone acetate 2mg & ethinylestradiol 35 micrograms.
  • Note: generic co-cyprindiol is much cheaper than Dianette®
 
 
Co-Cyprindiol 2000/35
(Cyproterone Acetate 2mg with Ethinylestradiol 35micrograms)

View adult BNF View SPC online View childrens BNF
Formulary
Green

  • Tablets containing cyproterone acetate 2mg & ethinylestradiol 35 micrograms
    generic co-cyprindiol is much cheaper than Dianette®

 
 
13.06.02  Expand sub section  Oral retinoid for acne to top
Isotretinoin capsules
View adult BNF View SPC online View childrens BNF
Formulary
Red
  • 5mg, 10mg, 20mg & 40mg capsules
  • Isotretinoin is a toxic drug only to be prescribed by or under the supervision of a consultant dermatologist – see BNF and product literature.
  • Drug Safety Updates can be found via the following link:
 
 
13.06.03  Expand sub section  Rosacea
13.06.03  Expand sub section  Rosacea with symptoms of flushing, erythema (without inflammation), telangiectasia, and rhinophyma
13.06.03  Expand sub section  Papulopustular rosacea
13.06.03  Expand sub section  Ocular rosacea
13.07  Expand sub section  Preparations for warts and calluses to top
Formaldehyde 
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
 
Glutaraldehyde 10% paint (Glutarol®)
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
 
Imiquimod 
View adult BNF View SPC online View childrens BNF
Formulary
Red
 
 
Salicylic Acid
(in emulsifying ointment)
View adult BNF View SPC online View childrens BNF
Formulary
Green

See section 13.5.2

 
 
Salicylic Acid 16.7% with Lactic Acid 16.7% Paint (Salactol®)
View adult BNF View SPC online View childrens BNF
Formulary
Green

In flexible collodion

 
 
Silver Nitrate 75% & 95% applicators
View adult BNF View SPC online View childrens BNF
Formulary
Green
  • 6 inch applicator
  • 95% pencils
  • 0.5% solution 
 
 
Trichloroacetic Acid
View adult BNF View SPC online View childrens BNF
Unlicensed Drug Unlicensed
Green
  • 10%, 75% & 90% solution.
 
 
13.07  Expand sub section  Anogenital warts
Podophyllotoxin 0.15% cream (Warticon®)
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
 
Imiquimod 5% cream (Aldara®)
View adult BNF View SPC online View childrens BNF
Formulary
Green plus
  • Second line specialist use for treatment of ano-genital warts (mainly in genitourinary medicine [GUM] clinics).
  • Green For the management of actinic keratosis.
 
 
13.08  Expand sub section  Sunscreens and camouflagers
13.08.01  Expand sub section  Sunscreen preparations
 note 

Note: Only to be prescribed as per ACBS criteria:

  • When prescribed for skin protection against ultraviolet radiation and/or visible light in abnormal cutaneous photosensitivity causing severe cutaneous reactions in genetic disorders (including xeroderma pigmentosum and porphyrias), severe photodermatoses (both idiopathic and acquired) and in those with increased risk of ultraviolet radiation causing severe adverse effects due to chronic disease (such as haematological malignancies), medical therapies and/or procedures.
  • Conditions for which over the counter items should not routinely be prescribed in primary care: Guidance for CCGs
Anthelios Sunscreen Lotion
(SPF 50+)
View adult BNF View SPC online View childrens BNF
Formulary
Green
  •  ACBS
 
 
Uvistat Sun Cream®
(SPF 30)
View adult BNF View SPC online View childrens BNF
Formulary
Green
  •  ACBS



 

 
 
13.08.01  Expand sub section  Photodamage
Cytotoxic Drug Actikerall®
(Fluorouracil/ salicylic acid)
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
 
Diclofenac 3% in sodium hyaluronate (Solaraze)
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
 
Cytotoxic Drug Fluorouracil (Efudix®)
(5% cream)
View adult BNF View SPC online View childrens BNF
Formulary
Green

  • For the treatment of superficial malignant and premalignant skin lesions.

 
 
Tirbanibulin ▼Black Triangle
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
 
Imiquimod  (Zyclara®)
(Actinic Keratosis)
View adult BNF View SPC online View childrens BNF
Formulary
Green plus
 
 
13.08.02  Expand sub section  Camouflagers to top
 note 

Products from the Dermacolor® Camouflage Crème and Veil cover cream ranges are included in this Formulary. They are classified as borderline substances and can be prescribed on FP10 prescription forms (marked ACBS) for postoperative scars and other deformities and as an adjunctive therapy in the relief of emotional disturbances due to disfiguring skin disease, such as vitiligo.

13.09  Expand sub section  Shampoos and other preparations for scalp and hair conditions
Betamethasone 0.05%, salicylic acid 2% (Diprosalic ® )
(Scalp application)
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
 
Betamethasone 0.1%
(Scalp application)
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
 
Capasal®
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
 
Clobetasol 0.05%
(Scalp application)
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
 
Coal Tar Extract 5% shampoo (Alphosyl 2 in 1®)
(Alcoholic)
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
 
Eucerin 5% Dry Scalp Shampoo
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
 
Ketoconazole 2% shampoo (Nizoral®)
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
 
Oilatum shampoo
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
 
Selenium Sulphide 2.5% shampoo (Selsun®)
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
 
Shampoo Cetrimide with undecanoic acid Ceanel Concentrate®
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
 
Shampoos (Dermax®)
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
 
Simple shampoo
(Gentle/frequent)
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
 
13.09  Expand sub section  Hirsutism
Co-Cyprindiol 2000/35
(Cyproterone Acetate 2mg with Ethinylestradiol 35micrograms)

View adult BNF View SPC online View childrens BNF
Formulary
Green
  • Tablets containing cyproterone acetate 2mg & ethinylestradiol 35 micrograms.
  • Note: generic co-cyprindiol is much cheaper than Dianette®
 
 
Eflornithine 11.5% cream (Vaniqa®)
View adult BNF View SPC online View childrens BNF
Formulary
Green plus
  • **UNDER REVIEW**
  • Approved for use as a second-line treatment of facial hirsutism in patients where co-cyprindiol is ineffective, contra-indicated or considered inappropriate. Treatment should be initiated by or on the specific advice of an appropriate specialist - endocrinologist (or gynaecologist).
 
 
13.09  Expand sub section  Androgenetic alopecia
13.09  Expand sub section  Dandruff, psoriasis, seborrhoeic dermatitis of the scalp
13.09  Expand sub section  Hirsutism-Postmenstrual women to top
13.10  Expand sub section  Anti-infective skin preparations
13.10.01  Expand sub section  Antibacterial preparations
13.10.01.01  Expand sub section  Antibacterial preparations only used topically
Mupirocin 2% Ointment (Bactroban®)
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
 
Silver Sulfadiazine 1% cream (Flamazine®)
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
 
Potassium Iodide capsules
View adult BNF View SPC online View childrens BNF
Restricted Drug Restricted
Red
  • Unlicensed Drug Unlicensed
  • Potassium Iodide 60mg and 300mg capsules
  • Approved for neutrophilic dermatoses (Sweet syndrome and pyoderma gangrenosum) and panniculitis (including erythema nodosum and nodular vasculitis)
  • Dermatology only
 
 
Nitrofurazone 0.2% Ointment
View adult BNF View SPC online View childrens BNF
Unlicensed Drug Unlicensed
Red
  • For limited use in burns/plastic surgery patients only.
 
 
13.10.01.02  Expand sub section  Antibacterial preparations also used systemically
Fusidic Acid 2%
View adult BNF View SPC online View childrens BNF
Formulary
Green
  • Cream and ointment
 
 
Metronidazole 0.75%
View adult BNF View SPC online View childrens BNF
Formulary
Green

Cream & gel

 
 
13.10.02  Expand sub section  Antifungal preparations to top
Clotrimazole 1% cream
View adult BNF View SPC online View childrens BNF
Alternatives
Green
 
 
Ketoconazole
View adult BNF View SPC online View childrens BNF
Alternatives
Green
  • 2% cream
  • shampoo
 
 
Miconazole 2% cream
View adult BNF View SPC online View childrens BNF
Alternatives
Green
 
Link  MHRA Drug Safety Update (June 2016): Topical miconazole, including oral gel: reminder of potential for serious interactions with warfarin
 
Terbinafine 1% cream
View adult BNF View SPC online View childrens BNF
Alternatives
Green
 
 
13.10.03  Expand sub section  Antiviral preparations
Aciclovir 5% cream
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
 
13.10.04  Expand sub section  Parasiticidal preparations
13.10.04  Expand sub section  Scabies
Ivermectin
View adult BNF View SPC online View childrens BNF
Formulary
Green
  • 3mg tablets 
    • Approved for the treatment of scabies in accordance with DHSC Medicine Supply Notification
    • Note: The licensed preparation is currenly only avialable from Alliance.   
 
Link  DHSC Medicine Supply Notification - Permethrin 5% w/w cream
 
Permethrin 5% (Lyclear® Dermal Cream)
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
 
13.10.04  Expand sub section  Head lice
Dimeticone 4% lotion (Hedrin®)
View adult BNF View SPC online View childrens BNF
First Choice
Green
 
Malathion 0.5% solution (aqueous)
View adult BNF View SPC online View childrens BNF
Second Choice
Green
 
 
Permethrin 1% (Lyclear® Creme Rinse)
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
 
13.10.04  Expand sub section  Crab lice to top
Permethrin 5% (Lyclear® Dermal Cream)
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
 
13.10.04  Expand sub section  Benzyl benzonate
13.10.04  Expand sub section  Carbaryl
13.10.04  Expand sub section  Dimeticone
13.10.04  Expand sub section  Malathion
13.10.04  Expand sub section  Permethrin to top
13.10.04  Expand sub section  Phenothrin
13.10.05  Expand sub section  Preparations for minor cuts and abrasions
Bismuth Subnitrate and Iodoform (B.I.P.P.) Paste
View adult BNF View SPC online View childrens BNF
Formulary
Red
  • For use in ENT surgery & epistaxis
    1.25cm x 100cm & 2.5cm x 100cm impregnated gauze
 
 
Drapolene® cream
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
 
Enbucrilate
View adult BNF View SPC online View childrens BNF
Formulary
Green
  • See 13.10.05 skin tissue adhesives (Liquiband®, Liquiband Optima®, IndermilX-Fine, Histoacryl Blue®)
 
 
Lanolin Cream
View adult BNF View SPC online View childrens BNF
Formulary
Not Recomended
 
 
Magnesium Sulphate Paste BP
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
 
13.10.05  Expand sub section  Collodion
Collodion Flexible BP
View adult BNF View SPC online View childrens BNF
Formulary
Green
  • 2.5% castor oil & colophony 2.5% in a collodion base.
 
 
13.10.05  Expand sub section  Skin tissue adhesive
Fibrin sealant (Artiss®)
View adult BNF View SPC online View childrens BNF
Formulary
Red
  • 2ml, 4ml & 10ml prefilled syringe.
  • For use in plastic surgery to close dead spaces, adhere skin graft, close simple wounds and stabilise bone grafts.
 
 
Fibrin sealant (Bioglue®)
View adult BNF View SPC online View childrens BNF
Formulary
Red
  • For use in neurosurgery and vascular surgery.
 
 
Fibrin sealant (Evicel® Human Fibrin Glue)
View adult BNF View SPC online View childrens BNF
Formulary
Red

2ml and 5ml kit

 
 
Fibrin sealant (Floseal® Matrix sealant)
View adult BNF View SPC online View childrens BNF
Formulary
Red
 
 
Fibrin sealant (Tisseel Lyo® Fibrin Glue)
View adult BNF View SPC online View childrens BNF
Formulary
Red
  • 2ml, 4ml & 10ml kit
  • Also approved for use in the treatment of mesh fixation in hernia repair.
 
 
Histoacryl Blue®
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
 
Indermil X-Fine®
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
 
LiquiBand Optima®
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
 
LiquiBand®
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
 
TachoSil®
View adult BNF View SPC online View childrens BNF
Formulary
Red
  • 4.8 & 9.5 cm 2 Haemostatic (collagen sponge coated with fibrinogen and thrombin) - for use in liver and renal surgery.
 
 
13.11  Expand sub section  Skin cleansers, antiseptics, and desloughing agents to top
Gigasept PA
(Solution)
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
 
Lubricating jelly
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
 
Plaster remover
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
 
13.11.01  Expand sub section  Alcohols and saline
Alcohol hand rub gel
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
 
Alcohol impregnated wipes
View adult BNF View SPC online View childrens BNF
Formulary
Green

Containing 70% isopropyl alcohol or methylated spirit (e.g. Clini-wipes®, Alcowipes®)

 
 
Industrial Methylated Spirit BP
(Solution & spray)
View adult BNF View SPC online View childrens BNF
Formulary
Green

70% liquid & 70% spray

 
 
Isopropyl alcohol 70% Skin Preparation Swabs (Sterets®)
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
 
Sodium Chloride 0.9%
View adult BNF View SPC online View childrens BNF
Formulary
Green
  • Sterile solution – bottles
  • 25ml & 100ml sachets(Normasol®)
 
 
Water for Irrigation
(Sterile)
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
 
13.11.02  Expand sub section  Chlorhexidine salts
 note 

In June 2014 information was published highlighting the risk of severe chemical injuries associated with the use of both alcohol-based and water-based chlorhexidine solutions for skin disinfection in premature infants. This was based on Yellow Card reports and reports identified in the literature. A European review has since considered the MHRA evidence together with additional information from spontaneous reporting and published
literature The risk appears to be higher in infants born before 32 weeks of gestation than in full term infants and in the first 2 weeks of life than in later life.

Advice for healthcare professionals:

 When using alcohol-based or water-based chlorhexidine solutions on premature infants, bear in mind the risk of severe chemical injuries.
 Use the minimum amount of chlorhexidine solution required and do not allow the solution to pool. Remove any excess solution and any soaked materials, drapes, or gowns from the skin.
 Use single-use containers where possible. There is a danger of accidentally using too much solution from a multiple-use container.
 Monitor patients frequently to detect and manage cutaneous side effects at an early stage.
 Please report any adverse events through the Yellow Card Scheme:www.mhra.gov.uk/yellowcard

Chlorhexidine 0.015% with Cetrimide 0.15%
(Solution)
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
 
Chlorhexidine Gluconate
View adult BNF View SPC online View childrens BNF
Formulary
Green
  • 0.05% solutions, 25ml & 100ml sachets 
  • 0.5% solution in 70% methylated spirit (pink, colourless & red staining)
  • 2.5% in 70% methylated spirit wipes
  • 0.5% hand rub (contains 70% isopropyl alcohol + emollients)
  • 4% surgical scrub
  • 2% in 70% isopropyl alcohol wipes (Clinell®)
  • Skin swabs & skin cleanser
  • 3ml & 10.5ml applicators (Chloraprep®)
  • 1% Obstetric cream
 
Link  MHRA Drug Safety Update (November 2012): Chlorhexidine: reminder of potential for hypersensitivity
 
Prontosan
View adult BNF View SPC online View childrens BNF
Formulary
Green
  • Solution containing Betaine 0.1% (surfactant) and Polyhexanide 0.1% (a chlorhexidine polymer). Mainly for use from 40ml plastic ampoules.
    Also available as a gel. 
  • To be prescribed/used only on the advice of tissue viability specialists.
 
 
13.11.03  Expand sub section  Cationic surfactants and soaps
Infacare Baby Bath Additive
View adult BNF View SPC online View childrens BNF
Formulary
Green
  • Secondary care use only
 
 
Mediscrub®
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
 
Octenisan® wash
View adult BNF View SPC online View childrens BNF
Formulary
Green

  • Used in some trusts as an alternative to chlorhexidine scrub and Triclosan skin cleanser in MRSA prophylaxis/eradication on secondary care advice.

 
 
13.11.04  Expand sub section  Iodine and Chlorine
Povidone-Iodine
View adult BNF View SPC online View childrens BNF
Formulary
Green
  • 2.5% dry powder spray
  • 10% alcoholic solution
  • 7.5% surgical scrub
  • 10% antiseptic solution (aqueous)
  • 0.35% sterile aqueous solution Red Traffic Light
    • approved for use in the prevention of surgical site infection in arthroplasty. 

 
 
Sodium Hypochlorite Solution 1%
View adult BNF View childrens BNF
Unlicensed Drug Unlicensed
Green
  • 1% sterilising solution.
 
 
13.11.05  Expand sub section  Phenolics to top
13.11.06  Expand sub section  Oxidisers, and dyes
Hydrogen Peroxide Solution BP
View adult BNF View childrens BNF
Formulary
Green
  • 10 volume (3%) & 20 volume (6%) solutions.
 
 
Potassium Permanganate
Formulary
Red
  • 5% solution unlicensedunlicensed
  • 400mg tablets  
  • Potassium permanganate not to be issued on repeat prescription 
 
Link  Inadvertent oral administration of potassium permanganate
 
Silver nitrate 0.5% Solution
(UNDER REVIEW)
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
 
Bonney's Blue Paint
(Brilliant green & crystal violet)
View adult BNF View SPC online View childrens BNF
Unlicensed Drug Unlicensed
Red
  • For limited use in some operating theatres only.
 
 
Crystal Violet 0.5% Paint
View adult BNF View SPC online View childrens BNF
Unlicensed Drug Unlicensed
Red
  • For limited use in some operating theatres/critical care areas only.
 
 
Magenta Paint BPC (Castellani's paint)
(UNDER REVIEW)
View adult BNF View SPC online View childrens BNF
Unlicensed Drug Unlicensed
Red

Paint containing magenta 0.4%, boric acid 0.8%, phenol 0.004%, resorcinol 8%, acetone and alcohol (or industrial methylated spirit).

 
 
13.11.07  Expand sub section  Desloughing agents
13.11.07  Expand sub section  Growth factor
13.12  Expand sub section  Antiperspirants
Aluminimum Chloride  (Driclor®, Anhydrol Forte®)
View adult BNF View SPC online View childrens BNF
Formulary
Green
  • Aluminium chloride hexahydrate 20% solution in an alcoholic basis
 
 
Botulinum toxin type A
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Formulary
Red
 
 
Haem-agglutinin complex
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Formulary
Green plus
  • For limited use as an alternative to surgery in some patients.
 
 
Glycopyrrolate 1% cream
View adult BNF View SPC online View childrens BNF
Unlicensed Drug Unlicensed
Green plus
  •  To be initiated by specialist.
 
 
13.13  Expand sub section  Topical circulatory preparations to top
13.14.01  Expand sub section  Emollients and barriers
13.14.02  Expand sub section  Steroid combinations
13.14.03  Expand sub section  Tars
13.14.04  Expand sub section  Ichthammol
13.14.05  Expand sub section  Dithranol preparations to top
13.14.06  Expand sub section  Keratolytics
13.14.07  Expand sub section  Miscellaneous
Difelikefalin (Kapruvia®)
View adult BNF View SPC online View childrens BNF
Formulary
Red
High Cost Medicine
NHS England
  • 50mcg/1ml solution for injection
  • Approved for pruritus in adults with chronic kidney disease having haemodialysis in line with NICE
 
 
 ....
 Non Formulary Items
Amorolfine 5% nail lacquer cream  (Loceryl®)

View adult BNF View SPC online View childrens BNF
Non Formulary
Not Recomended
Baricitinib  (Olumiant®)

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Non Formulary
Black
  • Not approved for the treatment of severe alopecia areata
Link  NICE TA926: Baricitinib for treating severe alopecia areata
Dupilumab  (Dupixent®)

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Non Formulary
Black
High Cost Medicine
NHS England
  • Not approved for treating moderate to severe prurigo nodularis in adults when systemic treatment is suitable 
Link  MHRA Drug Safety Upate (Nov 2022): Dupilumab (Dupixent▼): risk of ocular adverse reactions and need for prompt management
Link  NICE TA955: Dupilumab for treating moderate to severe prurigo nodularis
Minoxidil

View adult BNF View SPC online View childrens BNF
Non Formulary
Not Recomended
  
Key
note Notes
Section Title Section Title (top level)
Section Title Section Title (sub level)
First Choice Item First Choice item
Non Formulary Item Non Formulary section
Restricted Drug
Restricted Drug
Unlicensed Drug
Unlicensed
Track Changes
Display tracking information
click to search medicines.org.uk
Link to adult BNF
click to search medicines.org.uk
Link to children's BNF
click to search medicines.org.uk
Link to SPCs
Cytotoxic Drug
Cytotoxic Drug
CD
Controlled Drug
High Cost Medicine
High Cost Medicine
NHSE
NHS England
Homecare
Homecare
CCG
CCG

Traffic Light Status Information

Status Description

Red

Drugs for hospital use only. The responsibility for initiation and monitoring treatment should rest with an appropriate hospital clinician and the drug should be supplied through the hospital throughout the duration of treatment. In some very exceptional circumstances (e.g. due to distance from the hospital, storage, supply or mobility/transport problems) it may be appropriate for the GP to be asked to prescribe a Red drug. This should be negotiated on an individual patient basis and should only be done with the GP’s prior informed agreement where the roles of the GP and hospital services are clearly defined and agreed. The GP should not feel under pressure to prescribe in these circumstances. For all RED drugs automatically added to the formulary in response to a positive NICE TA: Prescribers need to ensure that local Trust new drug governance procedures and pharmacy processes are followed before any prescribing.  

Amber

Drugs initiated by hospital specialist, but where continuing treatment by GPs may be appropriate under a shared care arrangement. The specialist should send the GP a copy of the shared care agreement to sign. The GP should sign the shared care agreement, or indicate they do not want to be part of such an agreement, and return a copy back to the specialist. Shared care guidelines are available or are being developed for most of the drugs listed as Amber. If no shared care guideline is available, the hospital specialist should provide the patient’s GP with sufficient information and support to allow treatment to be continued and managed safely in primary care.  

Green plus

Drugs normally recommended or initiated by a specialist (hospital or GP with an extended role https://www.rcgp.org.uk/gpwer), but can be safely maintained in primary care with very little or no monitoring required. In some cases there may be a further restriction for use outlined - these will be defined in each case. Provision of additional information, or an information leaflet, may be appropriate in some cases to facilitate continuing treatment by GPs.  

Green

Drugs where prescribing by GPs is appropriate. Can be initiated and prescribed in all care settings, and if appropriate, discontinued without recourse to secondary care.  

Black

NOT APPROVED: Drugs that have been considered by NTAG or the NENC ICB Medicines Subcommittee (or other approved body) and are not approved for prescribing within the North East and North Cumbria.   

Brown

UNDER REVIEW: drugs whose current formulary status or RAG status is currently under review.  

Not Recomended

NOT REVIEWED: Drugs that haven not been reviewed yet. This usually means that an application is in progress. These drugs are not normally considered appropriate for prescribing in the North East and North Cumbria until such time that a decision is taken on their formulary status.  

netFormulary