North East and North Cumbria Formulary


	North East and North Cumbria ICS Formulary

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Formulary Chapter 16: Emergency Treatment of Poisoning - Full Chapter

Poisoning

Alcohol (Ethanol)
(antidote)

Formulary

Atropine sulphate
(Antidote)

Formulary

Calcium chloride
(antidote)

Formulary

Calcium folinate (Folinic Acid)
(Poisoning)

Formulary

Calcium gluconate
(Poisoning)

Formulary

Calcium gluconate gel
(antidote)

Formulary

Cyproheptadine hydrochloride (Periactin^®)

Formulary

Dantrolene sodium
(Poisoning)

Formulary

Diazepam (emulsion)
(antidote)

Formulary

Flumazenil
(antidote)

Formulary

Glucagon (GlucaGen^® Hypokit)
(Poisoning)

Formulary

Glyceryl Trinitrate

Formulary

Hydroxocobalamin (Cyanokit®)
(antidote)

Formulary

Intralipid

Formulary

Isosorbide dinitrate

Formulary

Lorazepam
(antidote)

Formulary

Macrogol '3350' (Klean-Prep^®)
(Poisoning)

Formulary

MESNA (sodium 2-mercapto-ethanesulphonate)
(antidote)

Formulary

Octreotide
(antidote)

Formulary

Phentolamine
(antidote)

Formulary

Phytomenadione (vitamin K)
(antidote)

Formulary

Pralidoxime Mesylate

Formulary

1g in 5ml injection

Procyclidine
(Poisoning)

Formulary

Protamine Sulphate
(Heparin overdose / reversal)

Formulary

Pyridoxine (high dose)
(antidote)

Formulary

Sodium bicarbonate
(Poisoning)

Formulary

Viper Venom Antivenom
(antiserum / antidote)

Formulary

Body Temperature

Nerve agents

Pesticides

Activated charcoal (Actidose Aqua Advance^®, Carbomix^®)

Formulary

Actidose Aqua Advance® – 50g in 240ml suspension
Carbomix® - 50g powder supplied in a bottle to which
water is added to prepare a suspension

Snake bites and animal stings

Adder Snakebite Antiserum
(European Viper Antiverom)

Formulary

Convulsion

Removal and Elimination

Removal from the Gastro-intestinal tract

Prevention of absorption

Active elimination techniques

Specific Drugs

Alcohol

Analgesics (non-opioid)

Acetylcysteine 2gram in 10ml injection

Formulary

Paracetamol overdose

Methionine 250mg and 500mg tablets

Formulary

Paracetamol overdose

Analgesics (opioid)

Naloxone

Formulary

400 microgram injection – ampoules and prefilled syringes

1.8mg/0.1ml nasal spray (single use)
- approved to offer a more convenient method of administration by non-healthcare professionals from Drug and Alcohol Services in accordance with local written protocols.

Antidepressants

Antimalarials

Beta Blockers

Calcium-channel blockers

Hypnotics and anxiolytics

Iron Salts

Desferrioxamine

Formulary

500mg vials (for preparing injection & oral solution)

Lithium

Phenothiazines and related drugs

Stimulants

Theophylline

Other poisons

Cyanides

Dicobalt edetate

Formulary

300mg in 20ml injection

Sodium nitrite

Formulary

3% 10ml injection (30mg/ml) unlicensed

Sodium thiosulphate

Formulary

25% injection unlicensed
50% injection
Approved for the treatment of caliciphylaxis in patients with End Stage Renal Disease (ESRD)

Ethylene glycol and methanol

Fomepizole

Formulary

100mg in 20ml injection unlicensed

Heavy Metals

Dimercaprol

Formulary

100mg in 2ml injection

Penicillamine

Formulary

125mg & 250mg tablets

Sodium calcium edetate

Formulary

Noxious gases

CS Spray

16.01

Other items

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Key

	Notes
	Section Title (top level)
	Section Title (sub level)
	First Choice item
	Non Formulary section
	Restricted Drug
	Unlicensed
	Display tracking information
	Link to adult BNF
	Link to children's BNF
	Link to SPCs

	Cytotoxic Drug
	Controlled Drug
	High Cost Medicine
	NHS England
	Homecare
	CCG

Traffic Light Status Information

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