• For the treatment of iron deficiency anemia in patients with or without inflammatory bowel disease.


• To be initiated by specialist in inflammatory bowel disease or iron deficiency anaemia 

• First Choice oral liquid iron preparation - 140mg in 5ml syrup (45mg iron/5ml).
• 210mg tablets (68mg iron/tablet).

300mg tablets (35mg iron)

• 190mg in 5ml sugar-free elixir (27.5mg iron/5ml).

• For use as an alternative to iron dextran or iron sucrose. Approved for
  use by renal physicians, gastroenterologists and haematologists.
• Unlicensed for use in children under 14 years of age. If used in this age-group, use should only be on the advice of a consultant with the informed consent of the patient and/or his/her parents/carers.

• 400 microgram and 5mg tablets
• 2.5mg in 5ml sugar-free syrup
• 15mg in 1ml injection unlicensed
• 30mg in 2ml injection

• 300mg/30ml solution for infusion
• Approved treating atypical haemolytic uraemic syndrome in adults and children in line with NICE

Paroxysmal nocturnal haemoglobinuria treatment is only commissioned from:

• King’s College Hospital NHS Foundation Trust, London - London and South East
• Leeds Teaching Hospitals NHS Trust - Rest of United Kingdom

• 1080mg/20 solution for infusion
• Approved for the treatment paroxysmal nocturnal haemoglobinuria in adults who have anaemia after at least 3 months of treatment with a C5 inhibitor in line with NICE and NHSE Commissioning Policy.

• Paroxysmal nocturnal haemoglobinuria treatment is only commissioned from:
  
  • King’s College Hospital NHS Foundation Trust, London - London and South East
  • Leeds Teaching Hospitals NHS Trust - Rest of United Kingdom

• 300mg/30ml & 1,100mg/11ml concentrate for solution for infusion
• Approved for the treatment of paroxysmal nocturnal haemoglobinuria in adults in line with NICE
• Approved for the treatment of atypical haemolytic uraemic syndrome in line with NICE
• Paroxysmal nocturnal haemoglobinuria treatment is only commissioned from 
  
  • King’s College Hospital NHS Foundation Trust, London - London and South East
  • Leeds Teaching Hospitals NHS Trust - Rest of United Kingdom

• 20mg, 50mg, 70mg, 100mg and 150mg tablets
• Approved for treating symptomatic anaemia associated with chronic kidney disease in adults in line with NICE

• Prefilled syringes (various strengths)
  
  • Approved for management of cancer treatment-induced anaemia in
    women receiving platinum-based chemotherapy for ovarian cancer
  • No longer regularly used in NUTH

• Cartridges for use in RecopensPrefilled syringes
  
  
  
  
  • Approved for management of cancer treatment-induced anaemia
    in women receiving platinum-based chemotherapy for ovarian cancer.
  
  
  • No longer regularly used in NUTH.
  
  
  
  


• Monitoring: monitoring of erythropeoetin (epoetin beta) in adult patients can be undertaken by GPs under a shared care arrangement 

• 30, 50, 100, 120, 150, 200 & 250 microgram in 0.3ml and 360 microgram in 0.6ml injections in prefilled syringes.
• Approved for use as a longer-acting alternative to darbepoetin in a
  small number of patients receiving peritoneal dialysis.

• Approved for iron chelation in patients with myelodysplastic syndromes (MDS) - (as per NECN Haematology Group Guidelines) and recommended for use in patients when treatment with desferrioxamine is no longer considered to be appropriate due to progressive iron overload despite maximally tolerated doses of desferrioxamine. 
• Approved for the treatment of iron overload for trasnfused and non-tranfused patients with chronic inherited anaemias (all ages) in line with NHSE Specialised Commissioning Policy

• Approved for the treatment of iron overload for trasnfused and non-tranfused patients with chronic inherited anaemias (all ages) in line with NHSE Specialised Commissioning Policy

• For the treatment of thrombocythemiaas a 2nd line agent in patients poorly/non-responsive tohydroxycarbamide therapy.

• Approved for the treatment of severe thrombocytopenia in people with chronic liver disease needing a planned invasive procedure in line with NICE
• Approved for treating primary chronic immune thrombocytopenia in adults in line with NICE

• 10mg solution for injection
  
  
  
  • Approved with plasma exchange and immunosuppression for treating acute acquired thrombotic thrombocytopenic purpura in adults, and in young people aged 12 years and over who weigh at least 40 kg in line with NICE
  
  
  
  

• For the treatment of adults with chronic immune (idiopathic) thrombocytopenia purpura in line with NICE.

• 3mg film-coated tablets


• Approved as an option for treating severe thrombocytopenia in adults with chronic liver disease having planned invasive procedures in line with NICE

• For the treatment of adults with chronic immune (idiopathic) thrombocytopenia purpura in line with NICE.

• Available as Neupogen (original brand) and Ratiograstim – a
  biosimilar product.

• 263 microgram (33.6 million units) injection vials

• Approved by NHS England Specialist Services for stem cell mobilisation for patients with Hodgkin’s disease, Non-Hodgkins lymphoma or multiple myeloma and meet the policy for Haematopoietic Stem Cell Transplantation.
• Note that there are no commissioned providers in NEY region.

5mmol in 5ml sugar-free syrup (Kay-Cee-L) 

• Powder (Calcium polystyrene sulphonate)

• Approved for the treatment of hyperkalaemia in adults in line with NICE 
• Approved for emergency acute treatment 

• Powder (Sodium polystyrene sulphonate)

• 5g and 10g oral powder 
• Approved for the treatment of hyperkalaemia in adults in line with NICE 
• Approved for emergency acute treatment 

• 600mg m/r tablets (Slow Sodium) - approx. 10 mmol sodium & chloride per tablet
• 1mmol/ml oral solution   
  
  • Treatment should only be initiated with the advice of a specialist.
• 5mmol/1ml oral solution  
  • Treatment should only be initiated with the advice of a specialist in accordance with NPPG/RCPCH Position Statement

• Specialist initiation for use in patients with a short bowel.
• Usually prepared at home

• 500mg capsules (500mg contains approx. 6 mmol each ofsodium and bicarbonate)
• 1mmol/ml oral solution unlicensed

Capsules: 500 mg

• Potassium chloride 0.3% (20mmol); sodium chloride 0.9%; and glucose 5% (500ml bag).
  
  • Approved for diabetic ketoacidosis in paediatric patients unlicensed.
  
  

• Approved for use by the North-East Assisted Ventilation Service (NEAVS)
  • to be prescribed in boxes of 10

• 0.9% injection (5ml, 10ml & 20ml)
• 0.9% IV infusion (100ml, 250ml, 500ml & 1000ml)
• 0.9% irrigation (1000ml & 3000ml)
• 0.45% IV infusion (500ml - Steriflex 2)
• 1.8%, 2.7% & 5% Polyfusor infusion (500ml)
• 30% injection (10ml)

• 0.9%/5% IV infusion (500ml - Sterfilex 3)
• 0.18%/4% IV infusion (500ml & 1000ml)
• 0.18%/10% IV infusion (500ml - Steriflex 19)
• 0.45%/5% IV infusion (500ml - Steriflex 45)

• 5% IV infusion (100ml, 250ml, 500ml & 1000ml)
• 10% IV infusion (500ml & 1000ml)
• 20% IV infusion (500ml)
• 50% Injection (50ml)

Infusion: 0.15% (10 mmol) potassium chloride & 0.9% sodium chloride 500ml
Infusion: 0.15% (20 mmol) potassium chloride & 0.9% sodium chloride 1000ml
Infusion: 0.15% (10 mmol) potassium chloride & 5% glucose 500ml
Infusion: 0.15% (20 mmol) potassium chloride & 5% glucose 1000ml
Infusion: 0.15% (10 mmol) potassium chloride & 10% glucose 500ml
Infusion:  0.15% (10 mmol) potassium chloride, 0.18% sodium chloride & 4%  glucose 500ml
Infusion:  0.15% (20 mmol) potassium chloride, 0.18% sodium chloride & 4%  glucose 1000ml
Infusion:  0.15% (10 mmol) potassium chloride, 0.9% sodium chloride & 5%  glucose 500ml
Infusion:  0.2% (13.5 mmol) potassium chloride & 0.9% sodium chloride 500ml
Infusion: 0.2% (27 mmol) potassium chloride & 0.9% sodium chloride 1000ml
Infusion:  0.2% (13.5 mmol) potassium chloride & 5% glucose 500ml
Infusion:  0.2% (27 mmol) potassium chloride & 5% glucose 1000ml
Infusion:  0.2% (13.5 mmol) potassium chloride, 0.18% sodium chloride & 4% glucose 500ml
Infusion: 0.2% (27 mmol) potassium chloride, 0.18% sodium chloride & 4% glucose 1000ml
Infusion:  0.3% (20 mmol) potassium chloride & 0.9% sodium chloride 500ml
Infusion: 0.3% (40 mmol) potassium chloride & 0.9% sodium chloride 1000ml
Infusion: 0.3% (20 mmol) potassium chloride & 5% glucose 500ml
Infusion:  0.3% (40 mmol) potassium chloride & 5% glucose 1000ml
Infusion: 0.3% (20 mmol) potassium chloride & 10% glucose 500ml
Infusion:  0.3% (20 mmol) potassium chloride & 20% glucose 500ml
Infusion:  0.3% (20 mmol) potassium chloride, 0.18% sodium chloride & 4% glucose 500ml
Infusion: 0.3% (40 mmol) potassium chloride, 0.18% sodium chloride & 4% glucose 1000ml
Infusion:  0.3% (20 mmol) potassium chloride, 0.45% sodium chloride & 5% glucose 500ml
Infusion:  0.3% (20 mmol) potassium chloride, 0.9% sodium chloride & 5% glucose 500ml
Infusion:  0.6% (40 mmol) potassium chloride & 0.9% sodium chloride 500ml
Infusion:  0.6% (40 mmol) potassium chloride & 5% glucose 500ml

• 1.26% IV infusion Polyfusor^®
• 1.4% IV infusion Polyfusor^®
• 2.74% IV infusion Polyfusor^®
• 8.4% IV infusion Polyfusor^®
• 8.4% injection (10ml & 50ml)

• 500ml & 1000ml

• 2ml, 5ml, 10ml, 20ml, 100ml & 500ml

• 1000ml

• 100ml

• 4.5% (50ml, 100ml & 500ml)
• 20% (50ml & 100ml)

• Infusion in a balanced electrolyte solution containing Na+ 140 mmol, K+ 5 mmol, Mg2+ 1.5 mmol, acetate 27 mmol/litre. Gluconate 23 mmol/litre. Note calcium free.
  
  • Approved for use in paediatric theatres only.
  
  

• 10%/0.9% 

• 4%succinylated gelatin infusion in a balanced electrolyte solution containing Na+ 145 mmol, K+ 4 mmol, Mg2+ 0.9 mmol, Cl- 105 mmol, lactate 25 mmol/litre.
  
  • Mainly for use in critical care areas and other situations where the perceived advantages of a balanced electrolyte plasma substitute are likely to be clinically important. Note Not yet cleared for use in NUTH.
  
  

• 4% succinylated gelatin infusion in sodium chloride 0.9% (500ml bags)

• 6% & 10% tetrastarch infusions in a balanced electrolyte solution containing Na+ 140 mmol, K+ 4 mmol, Mg2+ 1 mmol, Cl- 118 mmol, Ca2+ 2.5 mmol, acetate 24 mmol, malate 5 mmol/litre.
  Contains calcium

• 6% tetrastarch infusion in a balanced electrolyte solution containing Na+ 137 mmol, K+ 4 mmol, Mg2+ 1.5 mmol, Cl110 mmol, acetate 34 mmol/litre.
  Contains calcium.
  
  • Mainly for use in indications where calcium containing fluids are unsuitable
  
  

• A haemofiltration and haemodialysis fluid containing Na+ 140 mmol, K+ 4 mmol, Mg2+ 0.6 mmol, Ca2+ 1.25mmol/l, Cl- 115.9 mmol/l, HCO3 - 30.0mmol/l, HPO4 2- 1.20mmol/l.
  
  • Approved for use in CRRT in patients not requiring reduced potassium or low bicarbonate.
  
  

• Approved for the treatment of hyperphenylalaninaemia in phenylketonuria in line with NICE

• Injection:10% equivalent to calcium 6.8 mmol/10 mL

• Injection: 10%, equivalent to calcium 2.25 mmol/10 mL

• Approved for the treatment of secondary hyperparathyroidism in patients with end stage renal disease on maintenance haemodialysis where parathyroid gland surgery has failed or is inappropriate. 


• Also for short term use to control symptoms prior to a second attempt at more definitive surgery. 


• Approved for patients with primary hyperparathyroidism for whom parathyroidectomy would be indicated based on serum calcium levels, symptoms and end organ damage, but in whom parathyroidectomy is either not clinically appropriate or is contraindicated. It is not normally commissioned if serum calcium concentration is <2.85mmol/L 

• 30mg injection

• 2.5mg/0.5ml, 5mg/1ml & 10mg/2ml solution for injection
• Approved for the treatment of secondary hyperparathyroidism in line with NICE and NHS England Commissioning Policy

• Approved for use in patients with PTH levels < 800mcg/l but  whose treatment with alfacalcidol is restricted due to a high calcium level.

• 400 units in 2ml injection

• 520mg & 800mg tablets

• 6.5g (10 mmol) sachets - first line for the treatment and prevention of magnesium deficiency.
• 614.8mg (2.5mmol) tablets unlicensed - for second line treatment in patients with short bowel syndrome.

• 10 mmol magnesium in 1 litre sodium chloride 0.9% with potassium chloride 0.15% (20 mmol) unlicensed
• 64mg sustained release tablets (2.6mmol magnesium) unlicensed

• 1g (4mmol) chewable tablets 
  
  • Use preparation with cheapest acquisition cost.
  • Yourmag®
  • Magnaphate® unlicensed
  
  
• 1mmol/ml suspension -available if supply problems with tablets unlicensed.

• 50% 2ml (4 mmol), 50% 10ml (20 mmol) & 10% 10ml (4mmol) injections 
• 60 mmol in 500ml sodium chloride 0.9% infusion unlicensed

• 4.15 mmol phosphate in 10ml oral solution unlicensed

• 500ml intravenous infusion containing 50mmol phosphate
  per 500ml (PO4 3- 100 mmol, K+ 19 mmol, and Na+ 162 mmol/litre).

• Effervescent tablets (phosphate 16.1 mmol, sodium 20.4mmol & potassium 3.1 mmol / tablet)

• Tablets containing calcium acetate 435mg & Magnesium carbonate heavy 235mg.
• For use, after calcium carbonate and calcium acetate, but before the
  much more expensive sevelamer and lanthanum.

• Approved for use by haemodialysis or peritoneal dialysis patients who cannot tolerate alternative phosphate binders or where these have been ineffective

• 1.25g & 2.5g chewable tablets (Calcichew)
  (Other formulations e.g. Remegel, Rennies, Rennie Soft gel and Settler’s.
  Tums are also stocked at the RVI for use in paediatric renal patients)

• 800mg f/c tablets.
• 2.4g powder for oral suspension
  
  

• Sodium fluoride 0.619% (75ml) toothpaste (Duraphat® 2800 ppm) 
• Sodium fluoride 1.1% (51g) toothpaste (Duraphat® 5000 ppm) 
• Sodium fluoride 0.05% mouthwash - approved for use within the dental hospital.

• In line with NHS England’s guidance on conditions for which over the counter items should not be routinely prescribed, the ICB does not support the routine prescribing of medicines or preparations for dental conditions (including toothpastes such as Duraphat®, ulcer healing preparations, antibiotics and analgesics) on GP FP10 prescriptions except in the following circumstances:
  • After head and neck cancer treatment on the recommendation of a Head & Neck or Restorative Dental Consultant.
  • For patients receiving palliative care as part of ongoing symptom control.

Dentists must signpost patients to purchase products or issue prescriptions (NHS or private) for medicines to meet the identified dental needs of their patients. If a patient receives treatment as a private patient, they must always be given a private prescription.

• 20,000 unit injection - for the treatment of night blindness/ vitamin A deficiency as a result of malabsorption in patients with short bowel syndrome, ileal resection or pancreatic insufficiency unlicensed.

• Capsules containing vitamin A 4000 units, vitamin D 400 units

• 25mg tablets unlicensed
• 50mg capsules unlicensed

• 10mg unlicensed
• 50mg tablets

Injection: 50 mg/2 mL

• 50mg & 100mg tablets

• IVHP injection (ascorbic acid 500mg, nicotinamide 160mg, pyridoxine
  hydrochloride 50mg, riboflavin 4mg & thiamine hydrochloride 250mg &
  1g anhydrous glucose / pair of ampoules) 
• IMHP injection also used

• Tablets (nicotinamide 20mg, pyridoxine hydrochloride 2mg, riboflavin 2mg & thiamine hydrochloride 5mg per tablet).
  
  

• 50mg, 100mg, 200mg & 500mg tabs
• 500mg in 5ml injection unlicensed

• 250 nanogram & 1 microgram capsules
• 2 microgram/ml sugar-free oral drops – one drop containing approx. 100 nanograms of alfacalcidol 
• 1 microgram in 0.5ml & 2 micrograms in 1ml injections

Capsules: 0.25 micrograms, 0.5 micrograms

• 20 microgram (800 units) capsules or tablets
  
  • For first line use in the long term maintenance treatment of patients with documented vitamin D deficiency following high strength therapy and also for use in patients with symptoms and insufficient levels. 
• 80 microgram (3,200 units) capsules
  
  • For use in patients with malabsorption such as patients who have had bariatric surgery and require higher maintenance doses 
• 500 microgram (20,000 units) capsules.
  • For use in patients requiring high strength therapy for vitamin D deficiency. 
• 2740iu/ml oral solution (Fultium®-D3 Drops) 
• 1000iu and 3000iu buccal spray (DLux®) unlicensed 
  
  • Approved for use in paediatric parenteral nutrition patients with short bowel syndrome and adults with metabolic bone disease who have vitamin D deficiency despite previous treatment.

• 250 microg. (10,000 units) & 1.25mg (50,000 units) tablets.
  
  • A 3000 units in 1ml suspension (unlicensed) may be supplied if colecalciferol oral solution is not available.
  
  
• 7.5mg (300,000 units) in 1ml injection.

• Accrete®
  • Film coated tablet containing calcium carbonate 1.5g and colecalciferol 10 micrograms (400 units)
• Adcal D3®
  • Chewable tablet containing calcium carbonate 1.5g and colecalciferol 400 units (contains soya and sucrose)
  • Effervescent tablet containing calcium carbonate 1.5g and colecalciferol 400 units
• Cacit D3®
  • Effervescent granule sachet containing calcium carbonate 1.25g and colecalciferol 440 units
• Calcichew D3 Forte®
  • Chewable table containing calcium carbonate 1.25g and colecalciferol 400 units
• Evacal®
  • Chewable tablet containing calcium carbonate 1.5g and colecalciferol 400 units
    • approved as chewable option and also to be used in patients with peanut and soya allergy 

• Calcium lactate 300mg, calcium phosphate 150mg (Ca 97mg, 2.4 mmol) & ergocalciferol 10 micrograms (400 units).

• 50mg in 1ml oral solution - approved for the treatrment of children with vitamin E deficiency due to fat malabsorption syndromes.

• 500mg in 5ml suspension
• 134mg (200 unit) capsules

Injection: 100mg/2ml

• 10mg tablets - water soluble derivative of vitamin K for use in patients with fat malabsorption, especially in hepatic disease or biliary obstruction including cystic fibrosis patients.

• Drops containing in each 0.6ml dose ascorbic acid 50mg, ergocalciferol
  400 units, nicotinamide 5mg, pyridoxine HCl 500 micrograms, riboflavin
  400 micrograms, thiamine 1mg & vitamin A 5,000 units)
  
  • Dalivit drops are to be retained for use in patients requiring a full supplement of vitamin A.
  
  

• Drops containing in each 0.6ml dose ascorbic acid 50mg, ergocalciferol
  400 units, nicotinamide 5mg, pyridoxine HCL 500micrograms, riboflavin
  400 micrograms, thiamine 1mg & vitamin A 1,333 units.
  To be used in children and adults.

• Approved for adult patients requiring multivitamin and mineral supplementation with Cystic Fibrosis

• Approved for adult patients requiring multivitamin and mineral supplementation with Cystic Fibrosis

• Capsules
  
  • For limited use as a vitamin and mineral supplement in patients with phenylketonuria The capsules are also approved as an oral supplement in burns patients with malnutrition or alcohol dependency and patients with major burns after discontinuation of IV therapy, and have also been approved for use in patients with severe anorexia nervosa. Treatment initiated with specialist advice.
• Soluble
  
  • Approved for short term use in patients who are unable to swallow
    Forceval capsules.

• Water soluble vitamin supplementation therapy for maintenance haemodialysis patients only.

• 40mg/ml & 100mg/ml solution for injection
• Approved for the treatment of paediatric-onset and juvenile-onset hypophosphatasia in line with NICE and NHS England Commissioning Policy

• Subcutaneous copper histidinate injections
• Approved for presymptomatic neonates with classical Menkes disease in line with NHSE Specialised Commissioning Policy
• The following providers are commissioned to provide this service within North East:
  • The Newcastle upon Tyne Hospitals NHS Trust

• 20mg/10ml concentrate for solution for infusion
• Approved for long-term enzyme replacement therapy in Wolman disease (rapidly progressive lysosomal acid lipase deficiency), only if people are aged 2 years or under when treatment starts, in line with NICE and NHSE Specialised Commissioning Policy.
• Services are only commissioned at:
  • Birmingham Women and Childrens NHS Foundation Trust
  • Great Ormond Street Hospital for Children NHS Foundation Trust
  • Manchester University Hospitals NHS Foundation Trust

• 10mg, 30mg, & 100mg capsules 
• 50mg in 5ml & 30mg in 1ml (150mg in 5ml) oral solution
  
  • nutritional supplement and antioxidant approved for use in the
    management of mitochondrial disorders.
• Approved for use under specialist consultant supervision in the
  management of patients with severe hyperlipidaemia who are not tolerating statins due to myopathy. Use in statin induced myopathy is subject to treatment being initiated by a consultant. 
• Lipid clinic initiation only

• 10mg powder for solution for infusion
• Approved for treating alpha-mannosidosis in line with NICE and NHS England Specialised Commissioning Policy

• 250mg capsules
• Approved for the treatment of inborn errors of bile acid synthesis (all ages) in line with NHS England Commissioning Policy
• Approved for the treatment of Cerebrotendinous Xanthomatosis in line with NHS Commissioning Policy. NHS England will commission this drug for patients who are currently being treated (April 2017)

• 125mg & 250mg tablets - also used for the treatment ofcystinuria and rheumatoid arthritis – section 10.1.3

• 300mg capsules
  
  • Approved for the treatment of Wilsons disease in line with NHS England Commissioning Policy. NHS England will commission the treatment for patients who are currently being treated (April 2017)

• 500mg tablets - for use as 2nd line treatment for cystinuria in
  patients who fail to tolerate/respond to penicillamine unlicensed.

• 30% oral solution
• 1g in 5ml injection

• Approved for the treatment of Fabry's disease in line with NICE 

• 20mg/10ml concentrate for solution for infusion
• Approved for treating Fabry disease in line with NICE and NHSE Specialised Commissioning guidance

• 400iu injection

• 5mg/5ml concentrate for solution for infusion:
  • treating mucopolysaccharidosis type 4A in people of all ages

• 100mg powder for concentrate for solution for infusion
• Approved for treating Pompe disease in line with NICE

• 105mg powder for concentrate for solution for infusion vials
• Approved with with miglustat (Opfolda) for treating late-onset Pompe disease in adults in line with NICE and NHSE Specialised Commissioning guidance

For information only - as there are no providers within the North East & Cumbria area that are commissioned to provide this service

• 500mg tablets - Licensed formulation marketed as Ammonaps
• 1g in 5ml & 2g in 10ml injections

• Approved for treating acute hepatic porphyria (AHP) in adults and young people aged 12 and older in line with NICE, only if:
  
  
  
  • they have clinically confirmed severe recurrent attacks (4 attacks or more within 12 months) and
  
  
  • the company provides it according to the commercial arrangement.