| Formulary Chapter 19: Miscellaneous Preparations [non-BNF and Unlicensed Drugs] - Full Chapter
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MRI Contrast Media |
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Gadobenate dimeglumine (Multihance ®)
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Formulary
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- for use in the differential diagnosis of liver disease
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Gadobutrol (Gadovist®)
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Formulary
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- Gadolinium based MRI Contrast medium for use as an alternative to Magnevist®. One of the safer gadolinium contrast media with regard to the potential risk of nephrogenic systemic fibrosis.
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Gadofosveset (Vasovist®)
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Formulary
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- Gadolinium (MRI) contrast agent that binds to albumin for use
in MRI angiograms
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Gadoxetic acid (Primovist®)
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Formulary
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- Gadolinium based MRI Contrast medium for use in:
The assessment of hepatic vascular structures and biliary system of potential living, related liver donors.
The detection and characterisation of focal liver lesions using MRI, when standard imaging with other agents has been inconclusive.
- The detection and characterisation of focal liver lesions which
potentially communicate with the biliary system e.g. large liver
cysts.
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Gastrografin
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Formulary
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- A contrast medium for the radiological examination of the gastrointestinal tract
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Meglumine gadoterate (Dotarem®)
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Formulary
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- Gadolinium MRI contrast medium that is licensed for use in children. Gadoterate is considered to be much less likely to cause nephrogenic systemic fibrosis than dimeglumine gadopentetate (Magnevist®), which has previously been used in children.
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| 19 |
Miscellaneous |
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Acetic acid 5%
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Formulary
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- T o be diluted to 2.5%
- approved for the use in the detection of dysplasia/ neoplasia
in Barrett’s oesophagus
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Alkaline Nasal Douche
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Formulary
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Baclofen Intrathecal
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Formulary
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Bisacodyl 0.274% rectal soln
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Formulary
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Clonidine Intrathecal Injection
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Formulary
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Co-Careldopa liquid
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Formulary
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Codeine Phosphate Suppositories
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Formulary
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Diphencyprone in acetone
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Formulary
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Ferric Subsulphate (Monsel’s Soln) 50ml
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Formulary
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Glycopyrrolate 0.5% in Cetomacrogol A
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Formulary
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LAT Gel
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Formulary
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Low dose Naltrexone
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Formulary
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Magnesium sulphate 10% solution for injection pre-filled syringe
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Formulary
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Onasemnogene abeparvovec ( Zolgenmsa®)
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Formulary
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- Approved for the treatment of spinal muscular atrophy in line with NICE
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 NICE HST15: Onasemnogene abeparvovec for treating spinal muscular atrophy
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Phenazopyridine tablets
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Formulary
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Phenol (aqueous) Injection 6%
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Formulary
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Stanozolol 2mg tabs
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Formulary
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Sulphur hexafluoride (Sonovue ®)
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Formulary
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- Sulphur hexafluoride. Available as a kit including one vial of gas, one vial of powder and one pre-filled syringe containing 5ml of solvent. On reconstitution, 1 ml of the resulting dispersion contains 8 microliters of sulphur hexafluoride in the microbubbles, equivalent to 45 microgrammes
- Approved for use in visualising blood vessels in liver and diagnosing cancer, and used for the diagnosis of pancreatic cancers, and also for use when echocardiography images are unsatisfactory for answering the clinical question due to poor definition.
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Volanesorsen (Waylivra®)
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Formulary
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- Approved for treating familial chylomicronaemia syndrome in adults in line with NICE
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NICE HST 13: Volanesorsen for treating familial chylomicronaemia syndrome
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Dialysis Fluids |
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Citrasate®
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Formulary
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PrimsOcal® B22
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Formulary
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Primsocitrate® 18/0
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Formulary
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| 19 |
Probiotics |
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Pro-Prems®
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Formulary
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- Approved for the prevention of necrotising enterocolitis (NEC) in pre-term infants.
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BioGaia®
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Formulary
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Infloran®
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Formulary
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| 19 |
Fillers used in surgery |
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Hyaluronic Acid (Hydrafil Softline Max®)
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Formulary
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Hyaluronic Acid - Perlane (Restylane Perlane® )
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Formulary
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Hyaluronic Acid - Sub Q (Restylane Sub Q ®)
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Formulary
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Juvederm® Ultra 3
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Formulary
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Juvederm® Ultra 4
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Formulary
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Radiesse Voice®
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Formulary
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Bone Morphogenic Proteins (BMP) |
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Dibotermin Alfa (Inductos®)
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Formulary
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Eptotermin alfa (Osigraft®)
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Formulary
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| 19 |
Other |
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Holmium-166 microsphere (QuiremSpheres®)
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Formulary
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- Approved for selective internal radiation therapy for the treatment of unresectable advanced hepatocellular carcinoma in line with NICE
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TA985: Selective internal radiation therapy with QuiremSpheres for treating unresectable advanced hepatocellular carcinoma
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Atidarsagene autotemcel (Libmeldy®)
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Formulary
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- Atidarsagene autotemcel is recommended, within its marketing authorisation, as an option for treating metachromatic leukodystrophy with mutations in the arylsulphatase A (ARSA) gene:
- for children who have late infantile or early juvenile types, with no clinical signs or symptoms
- for children who have the early juvenile type, with early clinical signs or symptoms, and who can still walk independently and have no cognitive decline.
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NICE HST18: Atidarsagene autotemcel for treating metachromatic leukodystrophy
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Biotin 5mg tablets
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Formulary
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Chlorhexidine impregnated sponge (Biopatch® )
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Formulary
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Citric Acid
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Formulary
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- 0.6mmol/L solution
- Approved for use to assist in the identification of silent aspiration in stroke patients.
- Temporary approval subject to evaluation being carried out after 6 months
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DC beads
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Formulary
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Deep Heat® Max Strength
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Formulary
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- Approved to arterialise earlobe capillary blood to facilitate capillary blood testing
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Gentafleece®
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Formulary
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Integuseal® IS 100
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Formulary
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l-lysine 2.5%, l-arginine 2.5%
(Infusion)
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Formulary
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Methylthioninium Chloride
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Formulary
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Nexobrid
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Formulary
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- Enzyme-based debriding agent for the removal of eschar in adults with deep partial and full thickness thermal burns
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Tauroldine 2% solution
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Formulary
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Transvasin® Heat Rub Cream
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Formulary
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- Approved to arterialise earlobe capillary blood to facilitate capillary blood testing
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Xelma®
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Formulary
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Del Nido Cardioplegia Solution
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 Unlicensed
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- Approved for use at Newcastle in paediatric and adult congenital cardiac surgery.
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Indigo Carmine
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Unlicensed
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Patent Blue V Sodium
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Unlicensed
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Sucrose 24% solution
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Unlicensed
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Key |
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Restricted Drug |
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Unlicensed |
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Link to adult BNF
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Link to children's BNF
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Link to SPCs
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Cytotoxic Drug |
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Controlled Drug |
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High Cost Medicine |
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NHS England |
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Homecare |
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ICB |
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Low carbon footprint |
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Medium carbon footprint |
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High carbon footprint |
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| Status |
Description |
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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. |
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Drugs initiated by hospital specialist, but where continuing treatment by GPs may be appropriate under a shared care arrangement. These medicines are considered suitable for primary care prescribing following specialist initiation of therapy and stabilisation, with ongoing communication between the primary care prescriber and specialist as set out in the associated shared care guideline (SCG). Shared care should be initiated by the specialist, which includes consultant, suitably trained specialist non-medical prescriber or GPwER within a secondary, tertiary, or primary care clinic.
The specialist should send the primary care prescriber a copy of the NENC Clinical Effectiveness and Governance (CEG) Subcommittee approved SCG to sign. The primary care prescriber should sign the SCG or indicate reasons why they are unable to accept the agreement and return a copy back to the specialist, as soon as possible.
SCGs are available or are being developed for most of the drugs listed as AMBER. |
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Drugs normally recommended or initiated by a hospital specialist who is a prescriber, a GP with an extended role [GPwER], or a specialist within primary care which can be safely maintained in primary care and monitored in primary care. In some cases, a further restriction for use may be defined. The primary care prescriber must be familiar with the drug to take on prescribing responsibility or must obtain the required information from the specialist. Therefore, provision of additional information, or an information leaflet, may be appropriate in some cases to facilitate continuing treatment by primary care prescriber or provide information re stopping criteria.
These are considered suitable for primary care prescribing following specialist assessment and recommendation of therapy, with ongoing communication between the primary care prescriber and specialist, if necessary.
In some case these drugs require specialist initiation and short to medium term monitoring of efficacy or toxicity until the patient’s dose is stable. Following specialist review the patient may be transferred to primary care for ongoing prescribing. Ongoing prescribing by primary care can include, if required, additional dose titrations and assessment of efficacy, with ongoing communication between the primary care prescriber and specialist, if necessary.
If the drug requires urgent initiation, it is expected that the specialist undertakes the initial prescribing responsibility for an appropriate period of time, usually a minimum of 28 days. A GREEN+ drug can only be recommended to primary care for initiation if does not need to be initiated within 28 days. |
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Medicines suitable for initiation, ongoing prescribing and discontinuation in all care settings, subject to appropriate communication between those responsible. |
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UNDER REVIEW: drugs whose current formulary status or RAG status is currently under review. |
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Drugs that have been considered by the NENC Clinical Effectiveness and Governance (CEG) Subcommittee (or other approved body) and are not approved for prescribing within the North East and North Cumbria ICS. These may also include all medicines with a “not NHS” or “DLCV” classification in the BNF, those agents as included within the NICE “Do not do” list, and those agents included with the NHS England: Items which should not routinely be prescribed in primary care. |
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