FORMULARY

link to page 49 link to page 49 link to page 49 link to page 49 link to page 50 link to page 50 link to page 50 link to page 51 link to page 52 link to page 52 link to page 52 link to page 53 link to page 54 link to page 54 link to page 54 link to page 55 link to page 55 link to page 55 link to page 56 link to page 56 link to page 57 link to page 57 link to page 57 link to page 58 link to page 58 link to page 58 link to page 58 link to page 58 link to page 59 link to page 59 link to page 59 link to page 60 link to page 60 link to page 61 link to page 62 link to page 64 link to page 65 EYE
11.3 Anti-Infective Eye Preparations…………………………………………………… Page 49
11.4 Corticosteroids and other Anti-Inflammatory Preparations……………………….. Page 49
11.5 Mydriatics and Cycloplegics………………………………………………………. Page 49
11.6 Treatment and Glaucoma………………………………………………………….. Page 50
11.7 Local Anaesthetics………………………………………………………………… Page 50
11.8 Miscellaneous Ophthalmic Preparations………………………………………….. Page 50
11.9 Contact Lens Solution …………………………………………………………….  Page  51

EAR, NOSE AND OROPHARYNX
12.1 Drugs Acting on the Ear…………………………………………………………… Page 52
12.2 Drugs Acting on the Nose…………………………………………………………. Page 52
12.3 Drugs Acting on the Oropharynx…………………………………………………. Page 53

SKIN PREPARATIONS
13.1  Vehicles and Diluents……………………………………………………………… Page 54
13.2  Emollient and Barrier Preparations……………………………………………….. Page 54
13.3  Local Anaesthetics and Antipruritics……………………………………………… Page 55
13.4  Topical Corticosteroids……………………………………………………………. Page 55
13.5  Preparation for Psoriasis and Eczema…………………………………………….. Page 56
13.6  Preparations for Acne………………………………………………………. ……..  Page 56
13.7  Preparations for Warts and Calluses………………………………………………. Page 57
13.8  Sunscreens and Camouflagers…………………………………………………….. Page 57
13.9  Shampoos and other Scalp Preparations………………………………………….. Page 57
13.10  Anti-Infective Skin Preparations………………………………………………….. Page 57
13.11  Skin Disinfection and Cleansing Agents………………………………………….. Page 58
13.12  Antiperspirants……………………………………………………………………. Page 58
13.13  Wound Management Products…………………………………………………….. Page 58
13.14  Topical Preparations for Circulatory Disorders…………………………………… Page 58
13.15  Miscellaneous Topical Preparations………………………………………………. Page 58

IMMUNOLOGICAL PRODUCTS AND VACCINES
14.4  Vaccines and Antisera…………………………………………………………….. Page 59
14.5  Immunoglobulins……..…………………………………………………………… Page 59

ANAESTHESIA
15.1 General Anaesthesia………………………………………………………………. Page 60
15.2 Local Anaesthesia…………………………………………………………………. Page 61

Formulary Policy………………………………………………………………………….. Page 62
Non-Formulary Product Request Form…………………………………………………… Page 64
New Product Formulary Request Form…………………………………………………… Page 65

Abertawe Bro-Morganwg University NHS Trust Formulary (2008)
4

INTRODUCTION

The purpose of this formulary is to establish a list of drugs for general use by medical staff. The list has
been produced in order to rationalise drug prescribing and economise on expenditure. The majority of
the preparations listed will be routinely stocked by the pharmacy department and the remainder will be
ordered on request.

The contents of this formulary will be under continual review and updated annually. Any suggestions
for improvements are welcomed so that they may be considered for inclusion in the next edition.

To facilitate cross-reference, the same drug classification system as the BNF has been used.

The drug names are in the BAN format with the INN placed afterward, for example
Bendrofluazide (BAN) / Bendroflumethiazide (INN).

Certain drugs have restrictions placed on their use. These can be found in brackets after the drug name

NON-FORMULARY PRESCRIBING

A)
Patients admitted to the hospital already taking non-formulary drugs:-

If the patient is admitted for review of current therapy, then the prescriber will be

encouraged to change to a formulary drug.

If the patient is admitted for other reasons (e.g. surgery whilst taking non-formulary anti-
hypertensive medication), then a small supply will be obtained for that patient only.

B)
In the event of non-formulary drug treatment initiated in the hospital, then the prescribing
doctor will be contacted for consideration of an alternative from the formulary list. If an
alternative is not suitable, then a supply may be obtained on a named-patient basis, only on the
request of a consultant.

A "Non-Formulary Product Request Form" should be completed by the consultant in the
above instance, for monitoring of non-formulary product usage.

These forms are available in the outpatients department and the pharmacy department. The
completed form should accompany the prescription or drug chart when a non-formulary product
is required.

Non-formulary drugs are not routinely stocked by the pharmacy department, and therefore delays
may occur while supplies are purchased.

Consultants may request the addition of a new product to the formulary by completing a "New
Product Request " form. This should be returned to the Pharmacy Department for a product
evaluation.
Abertawe Bro-Morganwg University NHS Trust Formulary (2008)
5

GENERIC PRESCRIBING

Generic prescribing is should be routine practice. However there are products that need to be
prescribed by brand

Please prescribe the following drugs by brand as the use of the generic name could result in
the loss of therapeutic control:
DILTIAZEM : Brands include:- Adizem-SR, Adizem-XL, Angitil SR, Angitil XL, Calcicard CR,
Dilcardia SR, Dilzem SR, Dilzem XL, Slozem, Tildiem, Tildiem LA, Tildiem Retard, Viazem XL,
Zemtard.

CICLOSPORIN : Brands include:- Neoral, Sandimmum.

CARBAMAZEPINE: Brands include:- Tegretol, Tegretol Retard, Teril Retard, Timonil Retard.

LITHIUM CARBONATE: Brands include:- Camcolit, Liskonum, Priadel.

THEOPHYLLINE / AMINOPHYLLINE: Brands include:- Nuelin, Nuelin SA, Slo-Phyllin,
Uniphyllin Continus, Phyllocontin Continus.

NIFEDIPINE: Brands include:- Adalat, Adalat LA, Adalat Retard, Adipine MR, Cardilate MR,
Coracten SR, Coracten XL, Coroday MR, Fortipine LA 40, Hypolar Retard 20, Nifedipress MR,
Nifopress Retard, Slofedipine, Slofedipine XL, Tensipine MR.

SODIUM VALPROATE: Brands include:- Epilim, Epilim Chrono, Epilim Intravenous,
Convulex, Depakote.

MESALAZINE: Brands include:- Asacol MR, Ipocol, Pentasa, Salofalk.

VERAPAMIL : Brands include:- Cordilox, Securon, Half Securon SR, Securon SR, Univer,
Verapress MR, Vertab SR 240.

PHENYTOIN: Brands include:- Epanutin.

CO-BENELDOPA:   Brands include:- Madopar, Madopar CR.

CO-CARELDOPA: Brands include:- Sinemet, Half Sinemet CR, Sinemet CR.

Please prescribe Insulins, HRT Topical Preparation and Oral Contraceptive by brand to
avoid confusion between different products

The Trust has a generic substitution policy which states:-
“The pharmacist may substitute a prescribed drug with its less expensive generic equivalent, where
there is an equivalent therapeutic effect. This will not be done where there is an established difference
in bioavailability, e.g. warfarin, anticonvulsants.”

Abertawe Bro-Morganwg University NHS Trust Formulary (2008)
6

The Drug and Therapeutics Committee would like to thank our colleagues who have helped with the
production of this edition of the Formulary.

We hope that you will find the Formulary useful. To be of value it must be continually revised and
updated and any suggestions for improvements are welcomed, so that they may be included in the next
edition.

For any queries or comments please contact:

Stuart
Evans,
Alan
Clatworthy
Interface/Formulary Pharmacist,

Interface/Formulary Pharmacist,
Pharmacy Dept.West Division

East Division
Morriston Hospital,
Ext.
4068


Coding Abbreviations

S

“Special” product manufactured by the Pharmacy Department
caps

Capsules formulation available
tabs

Tablet formulation available
liq

Liquid formulation available
sol

Soluble tablet formulation available
supps

Suppositories formulation available
pess

Pessaries formulation available
inj

Injection formulation available

Abertawe Bro-Morganwg University NHS Trust Formulary (2008)
7

Abertawe Bro-Morganng University NHS Trust
SAFE PRESCRIBING GUIDANCE

The following aims to guide prescribers through the prescription process. Following this guidance
should save considerable time and effort and reduces risk of errors occurring.

All prescriptions should be written:
CLEARLY.
LEGIBLIBLY.
UNAMBIGOUSLY.
BLOCK CAPITAL LETTERS ONLY.

1.
ON ADMISSION
The admitting doctor should question the patient thoroughly regarding their existing drug
therapy. Any queries should be clarified with the assistance of Pharmacy or the patient’s general
practitioner. The patient must be asked to relate any known drug allergies.

Any drug allergies must be highlighted by:
a.  emphasis in patient’s notes;

b.  entering the allergy and the nature of the allergy on the inpatient medication administration
record (If the patient has no known allergies this information should also be recorded on
the treatment sheet). This section needs to be signed and dated;

c.  the admitting doctor must inform nursing staff of any allergies and this must be
recorded
in the nursing record. All staff need to be alerted to any allergy before administering
any medication.

2.
IN-PATIENT PRESCRIPTIONS
2.1   All medicinal products administered to patients within the Trust must be in accordance with the
clear written instructions of a medical officer or other legally authorised practitioner on an
approved prescription sheet, the only exceptions being those referred to in paragraph 2.9 – verbal
orders.

2.2  The medication administration record must bear patient’s name, address, unit number, and date of
birth, weight, ward and consultant and details of any known drug allergies.

2.3  The prescription, written legibly in the appropriate section of the sheet, must state:

i)  date of commencement of the therapy;

ii)  the name of the drug in CAPITAL LETTERS (using the INN approved name where
appropriate or generic name) or brand names for the following products - diltiazem,
ciclosporin, lithium, theophylline / aminophylline, nifedipine, verapamil, mesalazine,
phenytoin, sodium valproate, carbamazepine, co-beneldopa & co-careldopa) and use the
brand name for all sustained release preparations. Do not use abbreviations for drug
names;

iii)  the dose expressed in metric units. Micrograms and nanograms should be written in full
and not abbreviated. When prescribing medicinal products for children, special precautions
are needed and it is recommended that both the strength and volume of the dose be written;

iv)  The unnecessary use of decimal points should be avoided e.g. 3mg not 3.0mg or
100micrograms not 0.1mg. When decimal points are unavoidable a zero should be written
in front of the decimal point where there is no other figure e.g. 0.5ml not .5ml
Abertawe Bro-Morganwg University NHS Trust Formulary (2008)
8

v)  the route of administration must be clearly indicated. The following are approved
abbreviations for use with the present inpatient medication sheet:-

O
Oral
LE
Left
eye
IM
Intramuscular
RE
Right
eye
IV
Intravenous
I.P.
Intraperitoneal
S.C.
Subcutaneous
Inh

Inhaler
P.R
Per
Rectum
Top
Topical
S.L.
Sub-lingual
I.D.
Intradermal
P.V
Per
Vagina
N.G.
Nasogastric
Neb
Nebuliser

ABBREVIATIONS OTHER THAN THE ABOVE ARE NOT ACCEPTABLE

vi) do NOT use U as an abbreviation, use UNITS

vii) the times/frequency of administration

viii) the signature and bleep number of the prescriber.

2.4  Dosages prescribed “as required/when necessary” must indicate the minimum dose frequency and
indication within a specific period of time and the circumstances under which the drug may be
used.

2.5  Treatment should be reviewed at intervals of no longer than one week, or at the discretion of the
medical officer in charge. Patients on long term depot preparations must be reviewed at intervals
not exceeding three months.

2.6  Treatment to be discontinued must be crossed out through the whole prescription and dated
and initialled by the responsible Medical Officer or authorised practitioner.

2.7  When prescribing intravenous drug therapy, do state, infusion fluid, volume to be given, route
of administration, rate of infusion or duration. Also state drug dose to be added to the required
volume.

2.8  Oxygen therapy should be prescribed in all cases. When prescribing a nebuliser specify
driving gas (air or oxygen).

2.9  Verbal Orders
Under exceptional circumstances, a Medical Officer may give a verbal order to a qualified Nurse
over the telephone. The verbal prescription must be repeated by the Nurse to the Medical Officer
checking, in the presence of a witness, the patient’s name, the drug and dosage, the route, the
prescription, and the time of administration. The name of the Medical Officer must be recorded
on the patient’s Medication Administration Record, stating that it was a verbal message.
Following administration the treatment sheet must be signed by the two nurses. The prescriber
must countersign the prescription within 24 hours (Verbal orders taken should be written in the
once only box). Verbal orders may NOT be used for the administration of Controlled Drugs.

3.
OUTPATIENTS AND PATIENTS BEING DISCHARGED FROM HOSPITALS
When prescribing for outpatients or on discharge points 2.2 to 2.4 should be considered.

3.1  Prescribers must refer to patient’s notes and existing treatment sheets to ensure that the correct
drugs are prescribed and recognise any drug allergies that the patient may have.
Abertawe Bro-Morganwg University NHS Trust Formulary (2008)
9

3.2  Prescriptions must be written with a ball point pen to ensure clarity on all duplicate copies of the
prescription. Patient details must be clear on all prescription copies.

3.3  All prescriptions for patients discharged from hospitals or transferred to other units and
prescriptions for outpatients must be written on the HMR 112(W)or FP 10(HP) or a form
approved by the Drugs and Therapeutics Committee.

3.4  Although directions should preferably be in English without abbreviation it is recognised that
some Latin abbreviations are still used when prescribing.

The following is a list of agreed abbreviations:

a.c.

ante cibum (before food)
b.d.
bis
die
(twice
daily)
o.d.

omni die (daily)

o.m.

omni mane (in the morning)

o.n.

omni nocte (at night)

p.c.

post cibum (after food)

p.r.n.
pro re nata (when required)

q.d.s.
quarter die sumendus (four times daily)

t.d.s.
ter die sumendus (three times daily)

ABBREVIATIONS OTHER THAN THE ABOVE ARE NOT ACCEPTABLE.

3.5  When controlled drugs are prescribed, the following information must be entered on the
prescription form by the prescriber in the prescriber’s own handwriting:-
i)  the prescription must be signed and dated in the doctor’s own handwriting

ii)  the name and address of the patient must be specified

iii)  the name, form, strength, dosage, frequency and route of the preparation must be stated and
the volume, number of units or total quantity of medicinal product required must be
specified in both words and figures in the doctor’s own handwriting.

iv)  the prescription must be in ink or otherwise so as to be indelible.

v)  Addressograph labels may not be used.

(See BNF for more information regarding the writing of controlled drug prescriptions)

3.6  With the exception of the Accident & Emergency Department, where a shorter period of the
smallest possible original pack may be given, an original pack (up to 28 days supply) supply of
medication is usually supplied to patients discharged from the hospital. Outpatients attending
clinics at the hospital may receive an original pack supply provided there is an urgent clinical
need, otherwise patient should be referred back to their general practitioner with a request to
prescribe a class of drug (only refer an individual drug when this is more appropriate). If a
prescription is required for periods exceeding four weeks, a Consultant or Registrar should
endorse it within the clinic.

3.7  A copy of the triplicate discharge form or outpatient prescription will be retained in the hospital
pharmacy following dispensing of the prescription, a second copy will be given to the patient
with the dispensed medication for information for his/her General Practitioner. The remaining
copy will be retained in the appropriate section of the patient’s notes.

3.8  All prescriptions must be written by qualified medical or other legally authorised practitioner.
Nurses are not allowed to copy prescriptions for signature by doctors.
Abertawe Bro-Morganwg University NHS Trust Formulary (2008)
10

4.
It is the responsibility of the prescriber to ensure that the drug, dose, route and frequency
prescribed are appropriate and that there are no known interactions or incompatibilities. If you are
unsure check.

5.
USE OF UNLICENSED MEDICINES AND THE USE OF MEDICINES OUTSIDE OF
PRODUCT LICENCE
Vicarious liability for problems arising from the use of medicine outside of their product
licence or medicines not having a product licence, will be accepted by the Trust if the Trust’s
policy is followed. A copy of the full policy is available from pharmacy.

This policy does not apply to clinical trials.

Key Points of Policy in Summary
1.
Use of licensed medicines outside their Product License.
The Trust will accept liability for problems associated with such use if the use would have
“peer group support”. Peer group support may be determined by a variety of means for
example by the use of literature, standard texts and specialist texts.

2.
Use of Medicine with no UK Product License
The pharmacy will purchase such products, usually on a named prescriber basis, on receipt of a
written request from a consultant. In an emergency this may be supplied retrospectively.
Acceptance of liability by the Trust will also depend on “peer group support” as above.

3.
A “Use of unlicensed medicine” form should be completed and returned to Pharmacy.

Prepared by Stuart J Evans, Interface / Formulary Pharmacist, SwanseaNHS Trust

Reviewed by Swansea NHS Trust DTC – April 2003 (UPDATED February 2004)

Abertawe Bro-Morganwg University NHS Trust Formulary (2008)
11

link to page 12 link to page 13 link to page 12 link to page 13 link to page 12 link to page 14 link to page 12 link to page 14 link to page 13 1. GASTRO-INTESTINAL
SYSTEM

ANTACIDS
TREATMENT OF INFLAMMATORY BOWEL DISEASE
ANTISPASMODICS
LAXATIVES
MOTILITY STIMULANTS
PREPARATIONS FOR HAEMORRHOIDS
ULCER HEALING DRUGS
DRUGS AFFECTING INTESTINAL SECRETIONS
TREATMENT OF ACUTE DIARRHOEA

1.1 ANTACIDS

First Choice
Aluminium hydroxide mixture 4%
Magnesium Trisilicate liquid

Gastrocote tablets
®
Peptac liquid or infant sachets

1.2a ANTISPASMODICS
First Choice
Mebeverine hydrochloride tabelts

Alternatives

Alverine citrate tabelts

Gripe Water

Infacol
Hyoscine butylbromide injection , tablets

Peppermint oil (irritable bowel syndrome only) capsules

1.2b MOTILITY
STIMULANTS
First Choice
Domperidone tablets, liquid & supps
Metoclopramide hydrochloride tablets, liquid & injection

1.3
ULCER HEALING DRUGS
Most duodenal and gastric ulcers are associated with Helicobacter pylori infection.

First Choice Treatment:-
Presence of Helicobacter Pylori :-
1st Choice
Proton Pump Inhibitor at standard dose twice daily
Amoxycillin 1g bd
Clarithromycin 500mg bd
All for 7 days
Penicillin allergic patients
Proton Pump Inhibitor at standard dose twice daily
Metronidazole 400mg bd
Clarithromycin 500mg bd
All for 7 days
Clarithromycin resistance likely :-
Proton Pump Inhibitor at standard dose twice daily
Metronidazole
400mg tds
Amoxycillin
500mg TDS
All for 7 days

Tripotassium dicitratobismuthate (De-Noltab)
Abertawe Bro-Morganwg University NHS Trust Formulary (2008)
12

Absence of Helicobacter Pylori:-,
Proton Pump Inhibitor at standard dose daily until healed.
Proton Pump Inhibitors
Esomeprazole capsules & injection (for use by gastrenterologists and gastric surgeons)

Lansoprazole capsules & sachet(CG17)



Omeprazole tablets & injection(CG17)

H2 - antagonist
Ranitidine tablets, liquid & injection
Alternatives
Misoprostol tablets (Restricted use*)

* Those patients with a clear history of gastric ulceration who definitely need an NSAID
and are negative for Helicobacter pylori.

(CG17) NICE Clinical Guidelines (August 2004) Dyspepsia: Managing dyspesia in adults in
primary care www.nice.org.uk/guidance/index.jsp?action=byID&o=10950

1.4
TREATMENT OF ACUTE DIARRHOEA
Codeine phosphate tablets, liquid & injection

Loperamide capsules, tablets & liquid
Rehydration therapy (Dioralyte®)sachets

1.5
TREATMENT OF INFLAMMATORY BOWEL DISEASE

Aminosalicylates
Mesalazine tablets, foam enema & supps
Sulphasalazine EC.tablets & tablets
Olsalazine capsules & tablets (Consultant request only)
Balsalazide sodium capsules (Consultant request only)

*******Prescribe mesalazine by brand.*******
Immunosuppressant
Prednisolone tablets, Predenema®, supps, Predfoam
Hydrocortisone (Colifoam®) enema
Budesonide capsules MR (Entocort®)(Consultant request only)


Azathioprine
tablets
Infliximab
injection
(40)

(40) - NICE guidance (40) on the use of INFLIXIMAB in the Treatment of Crohn's disease
(April 2002). www.nice.org.uk/guidance/index.jsp?action=byID&o=11454

1.6 LAXATIVES
Osmotic
laxatives

Liquid Paraffin & Magnesium hydroxide oral emulsion liquid

Magnesium hydroxide liquid
Lactulose
liquid
(Not 1st line therapy)

Movicol
®  granules (Chronic constipation - last line Consultant only & Paediatrics)

Enemas
Phosphate enema
Micro-enema
Stimulant laxatives
Bisacodyl tablets & supps
Senna tablets & liquid
Glycerol supps

Abertawe Bro-Morganwg University NHS Trust Formulary (2008)
13

Sodium picosulphate liquid
Co-danthramer caps, liq, strong caps,) for analgesic induced

  strong suspension   ) constipation in terminally

Co-danthrusate caps, liq   ) ill patients only

Faecal softeners
Arachis oil enema
Docusate capsules sodium

Bulk Forming Agents
Ispaghula Husk (Fybogel®) sachets
Sterculia (Normacol®, Normacol Plus® sachets

Bowel preparation prior to endoscopy/colonic surgery
Sodium picosulphate (Picolax®) sachet
Micro-enema
Phosphate enema
Phospho-soda enema (Fleet®) (for use when Picolax® is inappropriate)
Senna Liquid
Klean Prep® (Only when Picolax unavailable)
Moviprep sachets

Treatment of Hepatic Encephalopathy
Lactulose (30-50ml TDS)

1.7
PREPARATIONS FOR HAEMORRHOIDS
1.7.1 Soothing
preparations
Anusol cream & supps

1.7.2
Compound preparations with corticosteroids
®
Xyloproct  ointment
®
Anusol HC  ointment


1.7.3 Rectal
sclerosants
Oily phenol injection 5%w/v

1.7.4.1  Management of anal fissures
Glyceryl Trinitrate 0.4% (Rectogesic) ointment

1.9
DRUGS AFFECTING INTESTINAL SECRETIONS

1.9.1
Drugs affecting biliary composition and flow
Ursodeoxycholic acid (250mg & 300mg)  tablets & capsles

1.9.4 Pancreatic
supplements
®
Creon  10,000; 25,000 capsules
Pancrex-V® capsules & forte tablets

MISCELLANEOUS

Pentoxifylline tablets (Gastro consultant only)
-------------------------------------------------------------------------------------------------------------------------
Abertawe Bro-Morganwg University NHS Trust Formulary (2008)
14

link to page 15 link to page 17 link to page 15 link to page 18 link to page 15 link to page 18 link to page 16 link to page 18 link to page 18 link to page 16 link to page 18 link to page 17 link to page 17 link to page 19 link to page 17 2. CARDIOVASCULAR
SYSTEM

POSITIVE INOTROPIC DRUGS
ANTICOAGULANTS AND PROTAMINE
DIURETICS
ANTI-PLATELET DRUGS
ANTI-ARRHYTHMIC DRUGS
FIBRINOLYTIC DRUGS
BETA-ADRENOCEPTOR BLOCKING DRUGS
ANTIFIBRINOLYTIC DRUGS AND
HAEMOSTATICS
OTHER ANTIHYPERTENSIVE THERAPY
LIPID LOWERING DRUGS
NITRATES, OTHER VASODILATORS AND
LOCAL SCLEROSANTS
CALCIUM CHANNEL BLOCKERS
SYMPATHOMIMETICS

2.1
POSITIVE INOTROPIC DRUGS

2.1.1 Cardiac
glycosides
Digoxin tablets, liquid & injection

Digibind

2.2 DIURETICS

2.2.1
Thiazide and related diuretics

Bendrofluazide / Bendroflumethiazide tablets
Chlorothiazide (Paediatric Directorate only) liquid
Indapamide tablets (in conjunction with perindopril for secondary prevention of strokes only)
Metolazone tablets (reserve for resistant oedema and CCF)

2.2.2
Loop diuretics

Bumetanide tablets & liquid

Frusemide / Furosemide tablets, liquid & injection

2.2.3
Potassium sparing diuretics
Amiloride hydrochloride tablets
Eplerenone tablets(CG48)
Spironolactone tablets(CG5), (liquid -paediatrics only)

2.2.4
Combination potassium sparing diuretics

Co-amilofruse (amiloride 5mg/frusemide 40mg) tablets

Co-amilozide (amiloride / Hydrochlorothiazide) 5/50 or 2.5/25 tablets

2.2.5
Osmotic diuretics
Mannitol
infusion

2.2.8
Diuretics with potassium
Administer potassium separately

2.3
ANTI-ARRHYTHMIC DRUGS
Adenosine
injection
*Amiodarone hydrochloride tablets & injection
*(Shared care protocols should be used if expecting primary care to continue prescribing.)
Atropine sulphate injection.
Bretylium tosilate injection.
Digoxin tabletss, injection & liquid
Disopyramide capsules & injection
Esmolol hydrochloride injection. (Consultant request only)

Flecainide acetate tablets & injection
Lidocaine hydrochloride injection.
Mexiletine hydrochloride capsules & injection
Abertawe Bro-Morganwg University NHS Trust Formulary (2008)
15

Phenytoin sodium injection.
Procainamide hydrochloride injection.
Propafenone hydrochloride injection.
Sotalol hydrochloride tablets & injection
Verapamil hydrochloride tablets, capsules & injections

2.4
BETA-ADRENOCEPTOR BLOCKING DRUGS

(CG34)
Angina/Hypertension

Atenolol tablets, injection & liquids
Bisoprolol fumarate tablets
Labetalol hydrochloride (Hypertension of Pregnancy) tablets & injection
Metoprolol tartrate tablets
Nebivolol tablets (Hypertension only - for use in patients where Beta-blockers have reduced BP but
patient suffering from side effects)
Arrhythmias
Esmolol hydrochloride injection.
Sotalol hydrochloride tablets & injection
Anxiety/Migraine/Thyrotoxicosis
Propranolol hydrochloride tablets, liquid & injection
Heart Failure
Bisoprolol fumarate tablets(CG5)
Carvedilol (HYHA IV only tablets(CG5)

2.5
OTHER ANTIHYPERTENSIVE THERAPY

2.5.1
Vasodilator Antihypertensive drugs
Hydralazine
hydrochloride tablets & injection

Sodium nitroprusside injection(Consultant request only)

Minoxidil tablets (Consultant request only)

2.5.2
Centrally acting Antihypertensive drugs
Methyldopa tablets
Moxonidine tablets (resistant hypertension only)

2.5.3
Adrenergic neurone blocking drugs
Guanethidine monosulphate injection

2.5.4
Alpha-adrenoreceptor blocking drugs
Doxazosin tablets
Phentolamine injection
Phenoxybenzamine hydrochloride capsules & injection (For use in phaeochromocytoma)

2.5.5
Drugs Affecting the Renin-Angiotensin System
(CG34)
2.5.5.1 Angiotensin-Converting Enzyme Inhibitors

Captopril
tablets
(CG5)
(Dose initiation only)

Enalapril tablets(CG5)
Lisinopril
tablets(CG5)
Perindopril tablets (CG5)
Ramipril capsules / tablets(CG5)

(CG34)
2.5.5.2 Angiotensin-ll Receptor Antagonists

Candesartan – heart failure & hypertension (CG5)

Valsartan - Post MI (ACE intolerant / contra-indicated patients

Irbesartan - Diabetic nephropathies (ACE intolerant patients)
Abertawe Bro-Morganwg University NHS Trust Formulary (2008)
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2.5.5.3
Renin inhibitors

Aliskiren tablets (Consultant request only)

2.6.
NITRATES, OTHER VASODILATORS AND CALCIUM CHANNEL
BLOCKERS

2.6.1
Nitrates
Glyceryl Trinitrate tablets 500mcg, buccal tablets, patches, injection & spray
Isosorbide Mononitrate tablets 10mg, 20mg,
Monomax tablets XL® (Isosorbide mononitrate 60mg)

The mononitrate is the active moiety and hence the treatment of choice.

2.6.2
Calcium channel blockers(CG34)
Amlodipine besilate tablets 5mg, 10mg
Diltiazem hydrochloride MR 60mg tablets
Diltiazem long acting (Tildiem capsules LA ®) 200mg; 300mg
Felodipine MR tablets, 2.5mg, 5mg, 10mg
Nifedipine long acting (Adalat LA®) tablets 30mg; 60mg
Nifedipine capsules  (as per Tocolysis protocol only)

Nimodipine tablets & injection  (subarachnoid haemorrhage)

Verapamil hydrochloride tablets & injection
Diltiazem and nifedipine modified release preparations should be prescribed by brand
name.

2.6.3 Potassium-Channel
Activators
Ivabradine tablets (Consultant Cardiologist request only)

Nicorandil tablets


2.6.4
Peripheral and cerebral vasodilators
2.6.4.1
Peripheral vasodilators and related drugs

Cilostazol tablets

2.7 SYMPATHOMIMETICS
2.7.1
Sympathomimetics with inotropic activity
Dobutamine injection
Dopamine hydrochloride injection

Isoprenaline hydrochloride injection

Dopexamine hydrochloride (ITU use only) injection

2.7.2
Sympathomimetics causing vasoconstriction

Noradrenaline acid tartrate / Norepinephrine bitartrate injection

Adrenaline / Epinephrine injection


Phenylephrine hydrochloride injection

Metaraminol injection

Ephedrine hydrochloride injection

2.8
ANTICOAGULANTS and PROTAMINE
2.8.1 Parenteral
anticoagulants
Heparin calcium
Heparin sodium
Dalteparin (ITU haemofiltration only)
Danaparoid injection– for heparin associated thrombocytopenia
Abertawe Bro-Morganwg University NHS Trust Formulary (2008)
17

Enoxaparin injection
Epoprostenol (Flolan)For maintaining catheter patency sodium chloride injection 0.9% is as
effective as heparin flushes for up to 48 hrs, and is therefore recommended for cannulas intended
to be in place for 48 hrs or less. Heparin flushes are only recommended for cannulas intended to
be in place for longer than 48 hrs.
Fondaparinux injection

2.8.2 Oral
Anticoagulants
First Choice

Warfarin sodium tablets 1mg strength maintenance
Alternatives
Nicoumalone / Acenocoumarol tablets
Phenindione tablets

2.8.3 Protamine
sulphate

2.9 ANTI-PLATELET
DRUGS
Abciximab
(47)
(Restricted to Cardiac unit)
injection
Aspirin tablets(90)

Clopidogrel tablets(80) (90) (aspirin intolerant patients / cardiac stents only / unstable angina)
Dipyridamole(90) tablets tabs,
S/R
Injection available for certain diagnostic purposes such as myocardial perfusion imaging.
Tirofiban(47) injection inj

2.10 FIBRINOLYTIC
DRUGS
Streptokinase (52) injection

Alteplase
(52)
( rt-PA®)
  injection

Tenecteplase (52) injection

Urokinase

2.11
ANTIFIBRINOLYTIC DRUGS and HAEMOSTATICS
Aprotinin injection (Consultant request only)

Drotrecogin alfa (activated) injection (84)

Ethamsylate tablets & injection
Tranexamic acid tablets & injection

2.12
LIPID LOWERING DRUGS

(94)
Statins

1st line: Simvastatin tablets(94)

2nd Line: Atorvastatin tablets(94)

3rd Line: Pravastatin sodium tablets(94)
Rosuvastatin tablets(94)  (limited to specialist lipid clinics only)

(94) - NICE guidance on the use of Statins for the prevention of cardiovascular events in
patients at increased risk of developing cardiovascular disease or those with established
cardiovascular disease (January 2006).
www.nice.org.uk/guidance/index.jsp?action=byID&o=11564

Abertawe Bro-Morganwg University NHS Trust Formulary (2008)
18

Fibrates
1st line
Fenofibrate
®
®
(Lipantil  Micro/ Supralip  160) tablets
2nd line
Bezafibrate 400mg tablets (Bezalip Mono®)
Anion-exchange resins
Cholestyramine-A sachets
Miscellaneous
Ezetimibe tablets(132)
Omacor capsules (post MI use only) (CG48)

2.13 LOCAL
SCLEROSANTS
Ethanolamine oleate injection
Phenol Oily injection
Sodium Tetradecyl Sulphate (STD) injection

NICE Clinical guidelines:

(CG5) NICE Clinical Guidelines (February 2003) Management of chronic heart failure in
adults in primary and secondary care.
www.nice.org.uk/guidance/index.jsp?action=byID&o=10924

(CG34) NICE Clinical Guidelines (June 2006) Hypertension: management of hypertension in
adults in primary care www.nice.org.uk/guidance/index.jsp?action=byID&o=10986

(CG48) NICE Clinical Guidelines (May 2007) Secondary prevention in primary and secondary
care for patients following a myocardial infarction.
www.nice.org.uk/guidance/index.jsp?action=byID&o=11008

NICE Technology Appraisals:

(47) - NICE guidance on the use of glycoprotein IIb/IIIa for the treatment of acute coronary
syndrome (September 2002). www.nice.org.uk/guidance/index.jsp?action=byID&o=11470

(52) - NICE guidance (52) on use of drugs for early thrombolysis in the treatment of acute
myocardial infarction (October 2002).
www.nice.org.uk/guidance/index.jsp?action=byID&o=11480

(80) - NICE guidance on the use of Clopidogrel in the treatment of non-ST-segment elevation
acute coronary syndrome (July 2004).
www.nice.org.uk/guidance/index.jsp?action=byID&o=11536

(84) - NICE Guidance on the use of drotrecogin alfa (activated) for severe sepsis (September
2004) www.nice.org.uk/guidance/index.jsp?action=byID&o=11546

(90) – NICE Guidance on the use of clopidogrel and modified release dipyridamole in the
prevention of occlusive vascular events (May 2005).
www.nice.org.uk/guidance/index.jsp?action=byID&o=11558

(132) – NICE Guidance on the use of Ezetimibe for the treatment of primary (heterozygous-
familial and non-familial) hypercholesterolaemia (November 2007).
www.nice.org.uk/guidance/index.jsp?action=byID&o=11886
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link to page 20 link to page 21 link to page 33 link to page 22 link to page 21 link to page 22 link to page 21 link to page 22 link to page 21 3. RESPIRATORY
SYSTEM

BRONCHODILATORS
OXYGEN
CORTICOSTEROIDS
MUCOLYTICS
CROMOGLICATE AND RELATED THERAPY
AROMATIC INHALATIONS
ALLERGIC DISORDERS
ANTITUSSIVES
RESPIRATORY STIMULANTS AND SURFACTANTS

3.1 BRONCHODILATORS
3.1.1 Selective
Beta2  Adrenoceptor
Stimulants
Eformoterol / Formoterol
®
fumarate
Turbohaler
Salbutamol

inhaler, respirator sol, oral liquid, inj, disks,
breath-actuated inhaler (Easi-Breathe®, Accuhaler,®
®
Autohaler ) CFC-free inhalers
Salmeterol

inhaler,
Accuhaler®, disks
Terbutaline
®
sulphate Turbohaler

3.1.2 Anticholinergic
Bronchodilators
Ipratropium
®
bromide   (inhaler, respirator sol,
Autohaler )

Tiotropium

3.1.3 Theophylline
Bronchodilators
Aminophylline (MR tablets & injection)
Caffeine Citrate (injection) -  (SCBU use only)
Theophylline (Uniphyllin ®) (MR tablets)
Theophylline (Nuelin®) (liquid & tablets)

®
It is recommended that new patients should be prescribed the Uniphyllin  brand of theophylline,
as this allows for maximum flexibility of dosage. Other brands may be obtained for stabilised
patients.

3.1.4
Compound Bronchodilator Preparations

®
Combivent  nebuliser sol.

3.1.5 Inhalation
Devices(10) (38)
Accuhaler ® (salbutamol, salmeterol, fluticasone, seretide)
®
Autohaler  (salbutamol, beclomethasone, ipratropium, oxitropium, QVAR)
®
Clickhaler  (salbutamol, beclomethasone)
Diskhaler ® (salbutamol, beclomethasone, salmeterol, fluticasone)
®
®
Nebuhaler   (terbutaline, budesonide)/ Nebuhaler   paediatric
Peak flow meters

Spinhaler ® (sodium cromoglycate)
®
Turbohaler   (budesonide, terbutaline, eformoterol, Symbicort®)
®
®
Volumatic  (salbutamol, beclomethasone, salmeterol)/ Volumatic   paediatric

(10) - NICE guidance (10) on the use of (devices) in children under the age of 5 years with
chronic asthma (October 2000) has been issued.
www.nice.org.uk/guidance/index.jsp?action=byID&o=11400

(38) - NICE guidance (38) on the use of inhaler devices for the routine treatment of chronic
asthma in older children (aged 5-15 years) (April 2002) has been issued.
www.nice.org.uk/guidance/index.jsp?action=byID&o=11450

Abertawe Bro-Morganwg University NHS Trust Formulary (2008)
20

3.2 CORTICOSTEROIDS(131),(138)
Beclomethasone dipropionate (inhaler, forte inhaler, disks, breath-actuated inhaler (Easi-
®
®
breathe®, Accuhaler®, Autohaler ), CFC-free inhaler) (QVAR  & Clenil also available)
Budesonide
(inhaler,
®
Turbohaler , resp.sol)
Fluticasone propionate  (CFC-free
inhaler,
Accuhaler®,disks, Nebs)

Mometasone   (Twisthaler)

®
Seretide

(CFC-free inhaler, Accuhaler®)

Symbicort

(131) - NICE guidance (138) on the use of Corticosteroids for the treatment of chronic asthma
in children under the age of 12 years (November 2007)
www.nice.org.uk/guidance/index.jsp?action=byID&o=11892

(138) - NICE guidance (138) on the use of Corticosteroids for the treatment of chronic asthma
in adults and children aged 12 years and over (March 2008)
www.nice.org.uk/guidance/index.jsp?action=byID&o=11945

3.3
CROMOGLICATE AND RELATED THERAPY
Sodium cromoglycate (spincaps, inhaler)
Montelukast (Chewable, tablets)

3.4 ALLERGIC
DISORDERS

3.4.1
Antihistamines
Cetirizine hydrochloride (tablets & liquid)
Chlorpheniramine / Chlorphenamine maleate (tablets, liquid & injection)
Cyproheptadine tablets (surgery only)
Fexofenadine (tablets)
Loratadine (liquid & tablets)
Promethazine hydrochloride (tablets, liquid & injection)

Hydroxyzine hydrochloride (tablets & liquid) (Dermatology request only)

3.4.2    Allergen Immunotherapy
Omalizumab(133)

(133) NICE Guidance on the use of omalizumab for severe persistent allergic asthma
(November 2007) www.nice.org.uk/guidance/index.jsp?action=byID&o=11894

3.4.3 Allergic
emergencies

Adrenaline / Epinephrine (injection 1:1000)
Chlorpheniramine / Chlorphenamine maleate (injection)

Hydrocortisone sodium succinate (injection)
Salbutamol (injection)

3.5 RESPIRATORY
STIMULANTS AND SURFACTANTS
3.5.1 Respiratory
Stimulants
Doxapram (infusion, injection)

3.5.2 Respiratory
Surfactants
Beractant - Survant®- (As per Paediatric protocol only)
Poractant alfa - Curosurf ® - (As per Paediatric protocol only)

3.6. OXYGEN

Abertawe Bro-Morganwg University NHS Trust Formulary (2008)
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3.7
MUCOLYTICS
Dornase alfa (nebsules)  (Paediatric consultant request only)

3.8. AROMATIC
INHALATIONS
Benzoin compound tincture (ENT request only)

Menthol and eucalyptus inhalation (ENT request only)

Carbocisteine liquid
®
(Mucodyne )


3.9 ANTITUSSIVES

3.9.1 Cough
Suppressants
Codeine phosphate linctus
Pholcodine (linctus, diabetic linctus)
Methadone hydrochloride 2mg/5ml (linctus)
3.9.2 Demulcents
Simple linctus

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CENTRAL NERVOUS SYSTEM

HYPNOTICS AND ANXIOLYTICS
DRUGS USED IN NAUSEA AND VERTIGO
DRUGS USED IN PSYCHOSES AND RELATED
ANALGESICS
DISORDERS
ANTIDEPRESSANT DRUGS
ANTIEPILEPTIC DRUGS
CENTRAL NERVOUS SYSTEM STIMULANTS
DRUGS USED IN PARKINSONISM AND RELATED
DISORDERS

4.1.
HYPNOTICS AND ANXIOLYTICS

4.1.1 Hypnotics
First Choice
Temazepam (tablets & liquid)
Alternatives
Chloral betaine (tablets & liquid)  (Welldorm®) (Paediatric request only)

Chlormethiazole / Clomethiazole (capsules & liquid)
Chloral hydrate capsules, liquid & supps (Paediatric request only)

Nitrazepam (tablets & liquid)
Zopiclone(77) (tablets)

night sedation not to be routinely prescribed on take home prescriptions

(77) - NICE Guidance on the use of zaleplon, zolpidem and zopiclone for the short-term
management of insomnia (April 2004)  http://www.nice.org.uk/page.aspx?o=113333

4.1.2
Anxiolytics
First Choice
Diazepam (tablets, liquid & injection0
Alternatives
Chlordiazepoxide (tablets)
Beta-blockers e.g. propranolol(tablets)
Buspirone (tablets)
Lorazepam (tablets)
Oxazepam (tablets) (hepatic impairment only)

4.2
DRUGS USED IN PSYCHOSES AND RELATED DISORDERS

4.2.1
Antipsychotic
Drugs
Chlorpromazine
hydrochloride (tablets & liquid)
Haloperidol (tablets, capsule, liquid & injection)
Methotrimeprazine / Levomepromazine (adjunctive treatment in palliative care) (injection &
tablets)
Pericyazine (tablets & liquid)

Perphenazine (tablets)
Promazine (tablets, capsules, liquid & injection)
Sulpiride (tablets)
Thioridazine (tablets & liquid)  (Consultant Psychiatrist use only)

Trifluoperazine (tablets & capsules)
Zuclopenthixol (tablets)
Atypical Antipyschotics
Amisulpiride(43) (tablets)

Aripiprazole (tablets)

Clozapine (43)  (tablets) (Consultant Psychiatrist use only)

Olanzapine(43)  (66) (tablets)

Quetiapine(43) (tablets)

Abertawe Bro-Morganwg University NHS Trust Formulary (2008)
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Risperidone(43)   (tablets & liquid)

Zotepine (tablets)

(43) - NICE guidance (43) on the use of newer (atypical) antipsychotics drugs for the
Treatment of schizophrenia (June 2002). http://www.nice.org.uk/cat.asp?c=32878

4.2.2
Antipsychotic Depot Injections
Flupenthixol decanoate
Fluphenazine decanoate
Haloperidol decanoate
Pipothiazine palmitate
Zuclopenthixol decanoate
Zuclopenthixol acetate

  4.2.3
Antimanic
Drugs

First Choice
Lithium carbonate (MR tablets(Priadel ®), liquid) *(Psychiatrist request only)
Valproic acid (Depakote ®)  (tablets)



Olanzapine (tablets)
Alternative
Carbamazepine (tablets, liquid & supps)

*Lithium should be prescribed by brand name , due to the differences in bioavailability
between the various preparations available.

4.3
ANTIDEPRESSANT DRUGS
4.3.1
Tricyclic And Related Antidepressant Drugs
Amitriptyline hydrochloride
tabs, liq
Clomipramine hydrochloride
caps
Dothiepin / Dosulepin hydrochloride tabs,
caps
Imipramine hydrochloride liq
Lofepramine tabs
Nortriptyline tabs
Trazodone
hydrochloride
caps, liq

  4.3.2
Monoamine-oxidase
Inhibitors

Moclobemide
tabs
Phenelzine (Consultant psychiatrist request only) tabs

4.3.3
SSRIs and related antidepressants
Citalopram tabs
Duloxetine
(3rd line agent and initiated by Secondary Care)
caps
Fluoxetine caps,
liq
Paroxetine tabs, liq
Mirtazepine tabs
Reboxetine tabs
Sertraline tabs
Venlafaxine
(Cefn Coed use only) caps

4.4
CENTRAL NERVOUS SYSTEM STIMULANTS
Modafinil (tablets) (Consultant Neurologist request only)

(98)
*Methyphenidate hydrochloride
  (tablets) (Consultant request only)

*Atomoxetine (98)   (tablets) (Consultant request only)

Abertawe Bro-Morganwg University NHS Trust Formulary (2008)
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*Dexamfetamine (98)   (tablets) (Consultant request only)

*(Shared care protocols should be used if expecting primary care to continue prescribing.)

(98) - NICE guidance on the use of Methylphenidate, atomoxetine and dexamfetamine for the
treatment of attention deficit hyperactivity disorder in children and adolescents (March
2006) has been issued. www.nice.org.uk/guidance/index.jsp?action=byID&o=11572

4.5.1
Anti-obesity drugs acting on the gastro-intestinal tract
Orlistat(22) caps

(22) - NICE guidance (22) on the use of ORLISTAT for the treatment of Adult obesity (March
2001). www.nice.org.uk/cat.asp?c=15712

4.5.2
Centrally acting appetite suppressants
Rimonabant tabs
Sibutramine(31) caps

(31) - NICE guidance on the use of SIBUTRAMINE for the treatment of Adult obesity
(October 2001).   http://www.nice.org.uk/cat.asp?c=23003

4.6
DRUGS USED IN NAUSEA AND VERTIGO

Betahistine dihydrochloride (tablets)
Cinnarizine (tablets)
Cyclizine (tablets & injection)
Domperidone (tablets, liquid & supps)
Granisetron (injection, tablets & liquid) - (Velindre request only)
Haloperidol (tablets, capsule, liquid & injection)
Methotrimeprazine / Levomepromazine (injection & tablets)
Metoclopramide hydrochloride (tablets, liquid & injection)
Ondansetron (Haematology,Theatres & Oncology request only) (injection, tablets & liquid)
Prochlorperazine (tablets, injection, liquid, supps & buccal)
Promethazine
hydrochloride (injection, tablets & liquid)

4.7 ANALGESICS
4.7.1
Non-opioid
Analgesics

4.7.1.1   Non-narcotic Analgesics for Mild Pain
First Choice
Paracetamol (tablets, soluble.tablets, liquid & supps)
Paracetamol (Acute pain team only) IV
Aspirin (tablets & supps)
Alternatives
Non-steroidal anti-inflammatory drugs e.g. Ibuprofen (See Section 10)
Nefopam hydrochloride (tablets0

4.7.1.2   Compound Analgesics for Mild to Moderate Pain

Co-dydramol
(Paracetamol with dihydrocodeine) ( tablets)
Co-codamol (Paracetamol with codeine) (8/500 tablets / soluble & 30/500 tablets / soluble)

4.7.2
Opioid
Analgesics


4.7.2.1
Analgesics for Moderate to Severe Pain
First Choice
Codeine phosphate (tablets & injection)
Dihydrocodeine tartrate (tablets, liquid & injection)


Alternatives
Aspirin and papaveretum dispersible tablets(ASPAV ®)

Abertawe Bro-Morganwg University NHS Trust Formulary (2008)
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Buprenorphine (s/l tablets, injection & patches)
Meptazinol (tablets & injection)
Tramadol hydrochloride (capsules, S/R & injection)

4.7.2.2

Analgesics
for
Severe
Pain

Morphine (liquid, injection, supps, MST® tablets & sachets, MXL® capsules,

®
Sevredol tabs, Oramorph liquid 10mg/5ml, 30mg/5ml & 100mg/5ml).
Diamorphine hydrochloride (injection)

Pethidine hydrochloride (injection & tablets)
Fentanyl
patches
(Palliative Care and Oncology only)


Hydromorphone hydrochloride  (capsules) (Palliative Care and Oncology only)

Methadone hydrochloride (liquid) (Palliative Care Consultant only)


Oxycodone (Palliative Care, Oncology & Acute Pain Team only) –

(Oxycontin tabs, Oxynorm tabs, liquid IV (palliative care only))
Pentazocine
(tablets)

4.7.3 Trigeminal
Neuralgia

Carbamazepine (tablets & liquid)

Lidocaine 5% medicated plaster (Versatis (Consultant request only- supply to be kept within Trust)

4.7.4 Anti-migraine
Drugs
4.7.4.1   Treatment of Acute Attacks

Aspirin 300mg tablets
Ergotamine
tartrate (tablets & supps) (Consultant request only)

Metoclopramide hydrochloride (tablets, liquid & injection)
Paracetamol (tablets, sol tablets, liquid, supps)
Prochlorperazine (supps)
Sumatriptan (injection & tablets) (Consultant request only)

4.7.4.2

Prophylaxis
of
Migraine

First Choice

Pizotifen (tablets & liquid)

Propranolol (tablets & liquid)

Alternatives
Amitriptyline
hydrochloride (tablets & liquid)

Clonidine
hydrochloride (tablets)



4.8 ANTIEPILEPTIC
DRUGS

4.8.1
Control of Epilepsy

Carbamazepine (tablets & liquid)
Clobazam
(tablets)
(Consultant request only)

Clonazepam (tablets & liquid)

Ethosuximide (capsules)
Gabapentin(76) (79) (capsules)

Lamotrigine(76) (79)   (tablets & liquid) (Consultant request only)
Levetiracetam(76)  (tablets) (Consultant request only)

Phenobarbitone / Phenobarbital (tablets, injection & liquid)
Phenytoin sodium  (capsules, liquid & injection)
Sodium valproate (tablets (SR), injection & liquid)
Tiagabine (76) (79)

(tablets) (Consultant request only)

Topiramate(76) (79)  (tablet, sprinkle caps) (Consultant request only)

(79)

Vigabatrin(76)
(tablets, sachets) (Consultant request only)

Abertawe Bro-Morganwg University NHS Trust Formulary (2008)
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Zonisamide (capsules) (Consultant request only)

(76) - NICE guidance for Newer drugs for epilepsy in adults (March 2004)
http://www.nice.org.uk/page.aspx?o=109115

(79) - NICE guidance for Newer drugs for epilepsy in children (April 2004)
http://www.nice.org.uk/page.aspx?o=113360

4.8.2
Drugs used in Status Epilepticus

Clonazepam (injection)
Diazepam (injection, rectal solution)
Lorazepam (injection)


Paraldehyde
(injection)

Phenobarbitone / Phenobarbital (injection)


Phenytoin sodium  (injection)

4.9
DRUGS USED IN PARKINSONISM and related disorders
4.9.1
Dopaminergic drugs used in Parkinsonism
Apomorphine (injection) (Consultant request only)

Bromocriptine (tablets)
Cabergoline (tablets) (Consultant request only)


Entacapone(tablets)


Lysuride maleate (tablets) (Consultant request only)

Madopar®/Co-beneldopa (levodopa + benserazide) (capsules, soluble, S/R)
Pergolide (tablets)


Pramipexole (tablets) (Consultant request only)


Rasagiline (tablets) (Consultant request only)

Ropinirole (tablets) (Consultant request only)

Rotigotine (patches) (Consultant request only)
Selegiline hydrochloride (tablets & liquids)

Sinemet® /Co-careldopa (levodopa + carbidopa) (tablets, S/R tablets)
Tolcapone (Consultant request only)


4.9.2 Antimuscarinic
drugs used in Parkinsonism
Benzhexol / Trihexyphenidyl hydrochloride (tablets)
Orphenadrine hydrochloride (tablets & liquid)


Procyclidine hydrochloride (tablets & injection)

4.9.3
Drugs Used in Essential Tremor, Chorea, Tics and Related Disorders

Botulinum A Toxin injection (Consultant ophthalmology, Rehabilation& neurology request only)

Botulinum B toxin injection
®
(NeuroBloc ) (Neurology use only)

Haloperidol   (capsule, liquid & injection)
Propranolol (tablets, liquid & injection)
Tetrabenazine (tablets)

Motor Neurone Disease
(20)
*Riluzole (tablets) (Consultant Neurologist request only)


tabs
* (Shared care protocols should be used if expecting primary care to continue prescribing.)

(20) - NICE guidance (20) on the use of RILUZOLE (Rilutek) for the treatment of Motor
Neurone Disease (January 2001). http://www.nice.org.uk/cat.asp?c=14401

4.10
Drugs used in substance dependence
Alcohol Dependence
Acamprosate
Abertawe Bro-Morganwg University NHS Trust Formulary (2008)
27

Disulfiram

Cigarette smoking
Nicotine replacement therapy(39)
Bupropion (Zyban) (39)
Varencicline (Champix) (123)

(39) NICE guidance on the use of bupropion (Zyban) and Nicotine Replacement Therapy for
smoking cessation (March 2002).
http://www.nice.org.uk/guidance/index.jsp?action=byID&o=11452

(123) NICE guidance on the use of varencline for smoking cessation (July 2007).
http://www.nice.org.uk/guidance/index.jsp?action=byID&o=11809

Opioid dependence
Buprenorphine (Suboxone) (114)
Lofexidine
Methadone(114)
Naltrexone(115)

(114) NICE guidance on the use of Methadone and buprenorphine for managing opioid
dependence(January 2007).
http://www.nice.org.uk/guidance/index.jsp?action=byID&o=11606

(115) NICE guidance on the use of Naltrexone for the management of opioid dependence
(January 2007). http://www.nice.org.uk/guidance/index.jsp?action=byID&o=11604

4.11
Drugs for dementia
Donepezil
(111)
hydrochloride
(tablets)
Galantamine(111)
(tablets)

Rivastigamine(111) (capsules, liquid & patch)

(111) - NICE guidance (19) on the use of DONEPEZIL, GALANTAMINE and
RIVASTIGAMINE and memantine for the treatment of Alzheimer's disease
(September 2007). www.nice.org.uk/guidance/index.jsp?action=byID&o=11600

--------------------------------------------------------------------------------------------------------------------------
Abertawe Bro-Morganwg University NHS Trust Formulary (2008)
28

5. INFECTIONS

CATEGORY A – Unrestricted (can be prescribed by all medical staff)
Antibacterials Routes
Antibacterials Routes
Amoxicillin (O/P)
Nitrofurantoin
(O)
Benzylpencillin (P)
Oxytetracycline
(O)
Cefaclor MR
(O)
Penicillin V
(O)
Cefotaxime (P)
Rifampicin
(O)
Cefuroxime (P)
Teicoplanin
(P)
Cephalexin (O)
Temocillin
(P)
Ciprofloxacin (O/P)
Tobramycin
(P)
Clarithromycin
(O)
Trimethoprim
(O/P)
Co-amoxiclav (O/P)
Vancomycin

(P)
Doxycycline (O)
Antifungals
Erythromycin (O/P)
Fluconazole
(O)
Flucloxacillin (O/P)
Ketoconazole
(O)
Fusidate sodium / Fusidic acid
(O)
Griseofulvin
(O)
Gentamicin
(P)
Nystatin
(O)
Metronidazole (O/P/PR)
Terbinafine (O)
Moxifloxacin (O) Antivirals
Neomycin (O)
Aciclovir
(O/P)

29

CATEGORY B – restricted (can be prescribed following discussion with a Consultant)
Antibacterials Routes
***Tigecycline ***
(P)
Amikacin
(P)
***Vancomycin ***
(O)
Azithromycin (O)

***Azlocillin*** (P)

*** Aztreonam ***
(P)

Ceftriaxone (paediatrics only)
(P)

Ceftazidime (P)
Antifungals
Routes
Chloramphenicol
(O/P)
Amphoteracin (B / liposomal)
(P)
Clindamycin
(O/ P)
Caspofungin
(P)
Co-trimoxazole (O/P)
Fluconazole
(P)
Colistin (N)
Flucytosine (P)
***Daptomycin***
(P)
Itraconazole
(O/P)
*** Ertapenem***
(P)
Voriconazole
(O/P)
Ethambutol (O)

Primaxin (Imipenem plus cilastatin) (P)

Isoniazid (O)
Antivirals
Routes
Levofloxacin (O/P)
Adefovir
(O)
***Linezolid***
(O/P)
All HIV antiviral drugs
(O/P)
Meropenem (P)
Amantadine
(O)
Netilmicin (P)
Ganciclovir
(P)
Ofloxacin (O)
Lamivudine
(O)
Pyrazinamide (O)
Ribavirin-aerosol

Rifampicin (P)
Valaciclovir
(GUM only) (O)
Sodium fusidate
(P)

Sulphadimidine (P)

***Synercid(Quinupristin
(P)

/dalfopristin)***
Tazocin (Piperacillin plus
(P)

tazobactam)
*** discuss with Consultant Microbiologist before use.

Key:- O = oral P = parenteral PR = per rectum N = nebulised

30

5.1.3
Tetracyclines

Demeclocycline
hydrochloride (capsules) (inappropriate ADH secretion)

(58) - NICE Guidance on the the use of zanamivir, oseltamivir and amantadine for the
treatment of influenza (February 2003).   www.nice.org.uk/cat.asp?c=58055

(67) - NICE guidance (67) on the use of oseltamivir and amantadine for the prophylaxis of
influenza (September 2003). www.nice.org.uk/cat.asp?c=86770

(75) - NICE guidance (75) on the use of Interferon alfa (pegylated and non-pegylated) and
ribavarin for the treatment of chronic hepatitis C (January 2004)
http://www.nice.org.uk/Docref.asp?d=102243

(96) - NICE guidance (96) on the use of adefovir dipivoxil and peginterferon alfa-2a for the
treatment of chronic hepatitis B (February 2006)   http://www.nice.org.uk/page.aspx?o=ta096

Restricted use for HIV therapy by GUM

Abacavir (capsules & liquid)
Didanosine
®
(DDI ) (tablets)
Efavirenz (capsules)
Indinavir (capsules)
®
Kaletra   (Lopinavir / ritonavir)  (tablets & liquid)
Lamivudine (3TC®)(tablets & liquid)
Nevirapine
(tablets)
Ritonavir  (capsules & liquid)
Stavudine (D4T) (capsules)
Tenofovir disoproxil  (tablets & liquid)
Zalcitabine (DDC)  (tablets)
Zidovudine
®
(AZT ) (capsules, injection & liquid)

5.4 ANTIPROTOZOAL
DRUGS
5.4.1 Antimalarials
Chloroquine (tablets, injection & liquid)
Pyrimethamine and Sulphadoxine tablets (Fansidar®)

Pyrimethamine and Dapsone tablets (Maloprim®)

Proguanil hydrochloride
(tablets)

Quinine
(tablets & injection)

5.4.2
Amoebicides

Metronidazole
(tablets, liquid, injection & supps)

5.4.3
Anthelmintics

Mebendazole (tablets & liquid) (threadworm, roundworm, hookworm and whipworm)

Niclosamide(tablets) (tapeworm) (Available as named patient drug)

Piperazine (sachets) (threadworm, roundworm)

5.4.4 Antigiardial
Drugs
Metronidazole(tablets, liquid, injection & supps)

5.4.8
Drugs for Pneumocystic Pneumonia

Atovaquone (tablets)
Co-trimoxazole (tablets, liquid & injection)
Pentamidine isetionate (injection, neb.sol)

--------------------------------------------------------------------------------------------------------------------------

31

link to page 32 link to page 34 link to page 34 link to page 33 link to page 35 link to page 33 link to page 35 link to page 33 6. ENDOCRINE
SYSTEM

DRUGS USED IN DIABETES
HYPOTHALAMIC AND PITUITARY HORMONES
AND ANTI-OESTROGENS
THYROID AND ANTITHYROID DRUGS
DRUGS AFFECTING BONE METABOLISM
CORTICOSTEROIDS
OTHER ENDOCRINE DRUGS
SEX HORMONES

6.1
DRUGS USED IN DIABETES

6.1.1
Insulin(57)

Routine stock-holding of Insulin consists of Human insulin, but Porcine insulin may be obtained
on request.

6.1.1.1   Short-Acting Insulin (Soluble insulin, Neutral insulin, Insulin injection)
Human Actrapid®  (vial)
Humulin S®
(vial, cartridge)
Human Velosulin®  (vial)
Insulin Lispro (
®
Humalog )  (vial, cartridge, pen)
Insulin Aspart (NovoRapid®) (vial, cartridge, pen)
Insulin Glulisine (Apidra®) (vial, cartridge, pen)

6.1.1.2   Intermediate Acting Insulin
Insulin Detemir (Levemir®)  (cartridge, pen)
Human Insulatard®(vial, cartridge, pen)
Humulin I ® (vial, cartridge, pen)
Insulin Glargine
(53)
(Lantus®)
(vial, cartridge, pen)

(53) - NICE guidances (53) on Insulin glargine (December 2002).
http://www.nice.org.uk/cat.asp?c=43424

(57) - NICE guidance (57) on the use of continuous subcutaneous insulin infusion for diabetes
(February 2003). http://www.nice.org.uk/cat.asp?c=58194

Biphasic Insulins
Humulin® M3
(vial, cartridge, pen)
Human Mixtard ® 10,20,30,40,50  (penfill)
®
Human Mixtard   30
(vial, InnoLet)
Humalog® Mix 25 & Humalog® Mix 50 (Insulin Lispro)
(cartridge, pen)
NovoMix® 30 (Insulin aspart) (cartridge, pen)

(53) - NICE guidances (53) on Insulin galrgine (December 2002).
http://www.nice.org.uk/cat.asp?c=43424

(57) - NICE guidance (57) on the use of continuous subcutaneous insulin infusion for diabetes
(February 2003). http://www.nice.org.uk/cat.asp?c=58194

(113) - NICE guidance (113) on Inhaled insulin for the treatment of type 1 and 2 diabetes
(December 2006). http://guidance.nice.org.uk/TA113

6.1.2
Oral
Antidiabetic
Drugs

6.1.2.1 Sulphonylureas
Gliclazide ( tablets)
Glimepiride   (tablets) (Consultant specialist only – restricted

Glipizide (tablets)
Tolbutamide
(tablets)


32

6.1.2.2   Biguanides
Metformin hydrochloride (tablets)

6.1.2.3 Other
antidiabetics
Acarbose
(tablets)
Exenatide (injection) – limited as an alternative to insulin in type-2 diabetics on
maximum tolerated oral agents with BMI>27 & HbA1c>9mmol/l
Pioglitazone(63)
(tablets)

Repaglinide (tablets)
Rosiglitazone(63)  (tablets)

(63) -NICE guidances (63) on the use of Glitazones for the treatment of type 2 diabetes (August
2003).   http://www.nice.org.uk/cat.asp?c=83263

6.1.4
Treatment of Hypoglycaemia
Glucose (oral,
iv)
Glucagon® (injection)
Dextrose 40% (Hypostop®)gel

6.2
THYROID AND ANTITHYROID DRUGS

6.2.1 Thyroid
Hormones
Liothyronine sodium  (tablets, injection)
Thyroxine / Levothyroxine sodium (tablets)

®
Thyrogen  (injection) (Resricted to Dr Keston Jones patients)

6.2.2
Antithyroid
Drugs

Carbimazole

(tablets)

Propylthiouracil
(tablets)
Additional therapy
Atenolol   (tablets, liquid & injection)
Iodine aqueous liquid (Lugol's®)

Propranolol hydrochloride
(tablets,
liquid
&
injection)

Potassium Iodide (S) liquid.

6.3 CORTICOSTEROIDS
Betamethasone (injection) (Obstetric request only)

Cortisone acetate
(tablets)

Deflazacort (tablets) (Consultant request only)


Dexamethasone
(tablets, injection & liquid)
Fludrocortisone acetate (tablets)
Hydrocortisone

(tablets, injection & oral pellets)
Methylprednisolone
(tablets & injection)
Prednisolone  (tablets
&
liquid)


6.4 SEX
HORMONES

6.4.1
Female
Sex
Hormones
6.4.1.1   Oestrogens and HRT
Sequential Combined Products
Elleste Duet®tablets
Evorel Sequi® patches

Nuvelle®tablets
Nuvelle®TS patches
Tridestra®  tablets (Consultant request only)

33

Unopposed oestrogen Preparations
Elleste Solo®tablets
Evorel® patches
FemSeven® patches
Oestradiol® implants
Oestrogel®  gel
Continuous Combined Therapy
Kliovance® tablets
Elleste-Duet Conti® tablets
Evorel® Conti patches
Gonadomimetic
Tibolone (tablets)

6.4.1.2   Progestogens
Dydrogesterone (tablets)
Medroxyprogesterone acetate
(tablets)
Norethisterone
(tablets)
Progesterone
(supps & injection)

6.4.2
Male Sex Hormones and Antagonists

Cyproterone acetate (tablets)
Dutasteride   (capsules)
Finasteride    (tablets)
Testosterone (Gel ,implant, injection, patches & tablets)
Mesterolone (tablets)
Nandrolone
(injection)

6.5
HYPOTHALAMIC AND PITUITARY HORMONES and
ANTI-OESTROGENS
6.5.1
Hypothalamic and Anterior Pituitary Hormones and
Anti-Oestrogens
Anti-oestrogens
Clomiphene citrate (tablets) (Specialist request only)

Tamoxifen (tablets & liquid) (Specialist request only)

Gonadotrophins
Chorionic Gonadotrophin (Profasi®) (injection) (Specialist request only)

Follitropin beta (Puregon®) (injection) (Specialist request only)

Menotrophin (Menopur®) (injection) (Specialist request only)

Anterior pituitary hormones
Somatropin (growth hormone) (injection)
(42) (64)
(Consultant request only)


Tetracosactrin
(injection, depot injection)

Hypothalamic hormones
Gonadorelin (LH-RH)
(injection)

Protirelin (TRH)  (injection)

Sermorelin (Geref 50®)(injection)

(42) - NICE guidance(42) on the use of human growth hormone (SOMATROPIN) in
children with growth failure (May 2002) has been issued. www.nice.org.uk/cat.asp?c=32239

(64) - NICE Guidance(64) on human growth hormone (somatropin) in adults with growth
hormone deficiency (August 2003). http://www.nice.org.uk/cat.asp?c=83406

34

6.5.2
Posterior Pituitary Hormones and Antagonists

Desmopressin (tablets, nasal sol, spray & injection)
Demeclocycline hydrochloride (capsules)
Terlipressin
®
(Glypressin ) (injection)

6.6
DRUGS AFFECTING BONE METABOLISM

Osteogenic Protein – 1

6.6.1 Calcitonin
Salcatonin / Calcitonin (Salmon) (injection & nasal spray)
Teriparatide (injection)

6.6.2 Bisphosphonates
®
Didronel   PMO  (tablets)
Alendronic acid (tablets)
Ibandronic acid (injection & tablets)
Pamidronate disodium (injection)
Sodium clodronate  (tablets & capsules)
Strontium Ranelate (Protelos®) (granules)– Agreed 2nd
Line


6.7
OTHER ENDOCRINE DRUGS

6.7.1 Bromocriptine
Bromocriptine (tablets & capsules)
Cabergoline (tablets)
Quinagolide (tablets)

6.7.2
Danazol and Gonadorelin Analogues
Buserelin (nasal spray) (Consultant request only)

Danazol (capsules)
Goserelin implant (Zoladex®)

Leuprorelin injection (Prostap®)

Nafarelin nasal spray (Consultant request only)

Triptorelin injection
(Consultant request only)

6.7.3    Metyrapone and Trilostane
Metyrapone (capsules) (Consultant request only)

--------------------------------------------------------------------------------------------------------------------------

35

link to page 36 link to page 36 link to page 36 link to page 36 link to page 37 7.
OBSTETRICS,GYNAECOLOGY AND URINARY TRACT DISORDERS

DRUGS ACTING ON SMOOTH MUSCLE
CONTRACEPTIVES
TREATMENT OF VAGINAL AND VULVAL
DRUGS FOR GENITO-URINARY DISORDERS
CONDITIONS

7.1
DRUGS ACTING ON SMOOTH MUSCLE
7.1.1
Prostaglandins and Oxytocins
Carboprost injection
Dinoprostone (gel & injection)
Dinoprostone pessaries (Propess®)
Ergometrine maleate  injection
Gemeprost pessary
Oxytocin injection
Syntometrine injection
Ductus arteriosus
Ibuprofen injection (Paediatric request only)
Indomethacin PDA injection (Paediatric request only)


Alprostadil (Prostin VR®) injection (Paediatric request only)

7.1.2 Mifepristone
tablets(Obstetric request only)

7.1.3 Myometrial
Relaxants
Atosiban imjection (Obstetric request only)

Ritodrine hydrochloride injection (Obstetric request only)

7.2
TREATMENT OF VAGINAL and VULVAL CONDITIONS
7.2.1
Preparations for Vaginal Atrophy
Estriol 0.01% (Ortho-gynest®) cream
Estriol 0.1% (Ovestin®) cream
Estradiol (Vagifem®) vaginal tabs
Estradiol 7.5mcg/24hours (Estring®) (Consultant request only)vaginal ring

7.2.2
Anti-Infective
Drugs

Anti-fungal preparations
Clotrimazole (pessary & cream)
Fluconazole (capsules & liquid)
Nystatin   (pessary)
Miconazole  (pessary & cream)
Other vaginal infections
Clindamycin 2% vaginal cream
Povidone-iodine pessary
Zidoval® (Metronidazole Gel) vaginal cream

7.3 CONTRACEPTIVES
7.3.1
Combined Oral Contraceptives
Binovum® (Family Planning Clinic only) tablets
Logynon® (equiv. to Trinordiol® ) (Stocked at Singleton) tablets


Microgynon 30 ®(equiv. to Ovranette®)(Stocked at Singleton) tablets

     Femodene® (Family Planning Clinic only) tablets

Femodette® (Family Planning Clinic & Singleton only) tablets

Marvelon®(Family Planning Clinic & Singleton only) tablets

Mercilon®  tablets

Loestrin 30® (Family Planning Clinic only) tablets

36

Trinovum® (Family Planning Clinic only) tablets

®
Evra Patch
Post-coital contraception
Levonelle-1500 ®  tablets

7.3.2 Progestogen-only Contraceptives
Desogestrel (Cerazette®) tablets
Femulen® tablets

Norgeston® /  Microval® tablets
Noriday® / Micronor®tablets

Medroxyprogesterone acetate injection (Depo-Provera®)

7.3.4
Intra-uterine Contraceptive Devices (Gynaecology & Obstetric request only)
Etonogestrel-releasing implant (Implanon®) (Restricted use)
Levonorgestrel releasing IUS (Mirena® )

7.4
DRUGS FOR GENITO-URINARY DISORDERS
7.4.1
Bladder Outflow Obstruction
Alfuzosin hydrochloride XL tablets
Distigmine tablets

Finasteride tablets (Consultant request only)

Indoramin tablets

Tamsulosin tablets

7.4.2
Drugs for Urinary Frequency, Urgency and Bladder Spasms
First Choice
Oxybutynin hydrochloride (tablets
&
XL
tablets)

Alternatives
Darifenacin tablets – 2nd & 3rd line treatment
Oxybutynin patch (Kentera®) – 2nd & 3rd
line
treatment

Solifenacin tablets (Vesicare®) – 3rd line treatment

Tolterodine (tablets, capsule XL)– 2nd & 3rd line treatment

Trospium tablets – 2nd & 3rd line treatment

7.4.3
Drugs used in urological pain
Potassium
citrate
mixture


7.4.4
Bladder
Washouts

First Choice
Sodium chloride 0.9%
Alternatives
Chlorhexidine U® 0.02% (Consultant request only)
Optiflo G®
Optiflo R®
Mitomycin C (Consultant request only)

7.4.5
Drugs For Impotence
Alprostadil injection (Consultant request only)

Moxisylyte injection (Consultant request only)

--------------------------------------------------------------------------------------------------------------------------

37

link to page 38 link to page 41 link to page 41 link to page 40 8.
MALIGNANT DISEASE AND IMMUNOSUPPRESSION

CYTOTOXIC DRUGS
SEX HORMONES AND ANTAGONISTS IN
MALIGNANCY
DRUGS AFFECTING THE IMMUNE RESPONSE

8.1 CYTOTOXIC
DRUGS
8.1.1 Alkylating
Drugs
Busulphan / Busulfan tablets.
Carmustine injection
Chlorambucil tablets
*Cyclophosphamide
(tablets & injection)
*(Shared care protocols should be used if expecting primary care to continue prescribing.)
Estramustine phosphate capsules
Ifosfamide injection
Lomustine capsules
Melphalan (tablet & injection)
Mustine / Chlomethine hydrochloride injection
Thiotepa injection
Treosulfan (capsules & injections)

Urothelial toxicity
Mesna (tablets & injection)

8.1.2 Cytotoxic
Antibiotics
Bleomycin injection
Dactinomycin injection
Daunorubicin injection.
Doxorubicin hydrochloride injection
Doxorubicin
(91)
hydrochloride injection (peglated liposomal) (Caelyx)


Epirubicin hydrochloride injection
Mitomycin injection
Mitozantrone / Mitoxantrone injection
Idarubicin hydrochloride  (injection & capsules) (Consultant request only)

(91)  – NICE Guidance on the use of paclitaxel, pegylated liposomal doxorubicin
hydrochloride and topotecan for second-line or subsequent treatment of advanced ovarian
cancer (May 2005) http://www.nice.org.uk/page.aspx?o=258944

8.1.3
Antimetabolites
Capecitabine capsules (61) (62) (100) (Hospital only)

Cladribine injections (Consultant Haematologist request only)

.
Cytarabine injection
Fluorouracil (injection & cream)
Fludarabine (injection & tablets) (29)

Gemcitabine injection (25) (26) (116)

Methotrexate (tablets & injection)
Mercaptopurine tablets
Thioguanine tablets

Tegafur with uracil (Uftoral) capsules

Folinic Acid Rescue
Folinic acid (tablets & injection).

38

(25) - NICE guidance (25) on the use of GEMCITABINE for the treatment of pancreatic
cancer (May 2001). http://www.nice.org.uk/cat.asp?c=16789

(26) - NICE guidance (26) on the use of DOCETAXEL, PACLITAXEL,
GEMCITABINE & VINORELBINE for the treatment of non-small cell lung cancer
(June 2001).   http://www.nice.org.uk/cat.asp?c=17338

(29) - NICE guidance on the use of FLUDARABINE for B cell chronic lymphocytic
leulaemia (September 2001) has been issued.   www.nice.org.uk/cat.asp?c=22177

(61) - NICE guidance on the use of CAPECITABINE and TEGAFUR with URACIfor
metastatic colorectal cancer (May 2003).
www.nice.org.uk/guidance/index.jsp?action=byID&o=11500

(62) - NICE guidance (62) on the use of CAPECITABINE for the treatment of locally
advanced or metastatic breast cancer (May 2003). http://www.nice.org.uk/cat.asp?c=70089

(100)  – NICE Guidance (100) on the use of CAPECITABINE and OXALIPLATIN in the
adjuvant treatment of stage III (Dukes' C) colon cancer (April 2006)
www.nice.org.uk/guidance/index.jsp?action=byID&o=11574

(116) - NICE guidance on the use of Gemcitabine for the treatment of metastatic breast cancer
(January 2007). www.nice.org.uk/guidance/index.jsp?action=byID&o=11610

8.1.4.
Vinca Alkaloids and Etoposide

Etoposide (capsules & injection)

Vinblastine sulphate injection
Vincristine sulphate injection
Vindesine sulphate injection
Vinorelbine (injection & tablets) (26) (54)



   (26) - NICE guidance (26) on the use of DOCETAXEL, PACLITAXEL,
GEMCITABINE & VINORELBINE for the treatment of non-small cell lung cancer
(June 2001).   www.nice.org.uk/cat.asp?c=17338

(54) - NICE guidance (54) on the use of VINORELBINE for the treatment of advanced
breast cancer (December 2002) has been issued.
www.nice.org.uk/guidance/index.jsp?action=byID&o=11484

8.1.5
Other Antineoplastic Drugs
Carboplatin injection

Cisplatin
injection

Crisantaspase
injection

Dacarbazine
injection

Docetaxel injection
(26) (30) (109)
(Taxotere®)

Hydroxyurea / Hydroxycarbamide capsules
Imatinib capsules(70) (86)


Irinotecan injection (93)




Oxaliplatin injection (93) (100)

Procarbazine capsules
Paclitaxel injection
(26) (30) (91) (108)
(Taxol®)



Porfimer Sodium (Photofrin) injection
Temozolomide capsules(23)
Topotecan injection (91)

Trastuzumab injection (34)

39

(23) - NICE guidance (23) on the use of TEMOZOLAMIDE for the treatment of recurrent
malignant glioma (brain cancer) (April 2001)
www.nice.org.uk/guidance/index.jsp?action=byID&o=11421

(26) - NICE guidance (26) on the use of DOCETAXEL, PACLITAXEL, GEMCITABINE &
VINORELBINE for the treatment of non-small cell lung cancer (June 2001).
http://www.nice.org.uk/cat.asp?c=17338

(30) - NICE guidance (30) on the use of TAXANES for Breast Cancer (September 2001).
www.nice.org.uk/guidance/index.jsp?action=byID&o=11435
(34) - NICE guidance (34) on the use of TRASTUZUMAB for the treatment of advanced breast
cancer (March 2002) has been issued.
www.nice.org.uk/guidance/index.jsp?action=byID&o=11445

(54) - NICE guidance (54) on the use of VINORELBINE for the treatment of advanced breast
cancer (December 2002) has been issued. http://www.nice.org.uk/cat.asp?c=44855

(70) - NICE guidance (70) on the use of IMATINIB for chronic myeloid leukaemia (October
2003).   www.nice.org.uk/cat.asp?c 89859

(86) - NICE guidance (86) on the use of IMATINIB for the treatment of unresectable and/or
metastatic gastro-intestinal stromal tumours (October 2004).
http://www.nice.org.uk/page.aspx?o=228026

(91)  – NICE Guidance(91) on the use of PACLITAXEL, PEGYLATED LIPOSOMAL
DOXORUBICIN hydrochloride and TOPOTECAN for second-line or subsequent treatment
of advanced ovarian cancer (May 2005) http://www.nice.org.uk/page.aspx?o=258944

(93) - NICE guidance (93) on the use of IRINOTECAN, OXALIPLATIN and RALTITREXED
for the treatment of advanced colorectal cancer (August 2005 has been issued
www.nice.org.uk/guidance/index.jsp?action=byID&o=11562

(100)  – NICE Guidance (100) on the use of CAPECITABINE and OXALIPLATIN in the
adjuvant treatment of stage III (Dukes' C) colon cancer (April 2006)
www.nice.org.uk/guidance/index.jsp?action=byID&o=11574
(108)  – NICE Guidance (109) on the use of Paclitaxel for the adjuvant treatment of early node-
positive breast cancer (September 2006)
www.nice.org.uk/guidance/index.jsp?action=byID&o=11596
(109)  – NICE Guidance (109) on the use of Docetaxel for the adjuvant treatment of early node-
positive breast cancer (September 2006)
www.nice.org.uk/guidance/index.jsp?action=byID&o=11594

8.2
DRUGS AFFECTING THE IMMUNE RESPONSE
8.2.1
Cytotoxic Immunosuppressants
*Azathioprine (tablets & injection)
*(Shared care protocols should be used if expecting primary care to continue prescribing.)

8.2.2
Corticosteroids and other Immunosuppressants
*Cyclosporin / Ciclosporin (capsules & injection) (Neoral®)


(Sandimmun®- only available in oral form on a named patient basis)
*(Shared care protocols should be used if expecting primary care to continue prescribing.)
Prednisolone tablets

8.2.3.1.1  Rituximab –
Rituximab injection(37) (65)

(37) - NICE guidance on the use of RITUXIMAB for recurrent or refractory stage III or IV
follicular non-Hodgkin's lymphoma (March 2002). www.nice.org.uk/cat.asp?c=29983

40

(65) – NICE Guidance (65) on rituximab for aggressive non-hodgkin's lymphoma (September
2003). http://www.nice.org.uk/cat.asp?c=86763

8.2.4
Interferons Contact pharmacy department  for further information.

(32) - NICE Guidance (32) on the use of Beta Interferon and Gratiramer for the treatment of
Multiple Sclerosis (November 2001). http://www.nice.org.uk/cat.asp?c=27588

8.2.5 Aldesleukin

Aldesleukin
injections
(Named patient basis-Medical Director to agree)

8.3
SEX HORMONES and ANTAGONISTS IN MALIGNANCY
8.3.1 Oestrogens
Ethinyloestradiol / Ethinylestradiol tablets
Stilboestrol / Diethylstilbestrol tablets

8.3.2 Progestogens
Medroxyprogesterone
acetate
(tablets & injection)
Megestrol acetate tablets
Norethisterone tablets

8.3.3
Androgens

Testosterone injection (Virormone®)

Testosterone tablets (Consultant request only)

8.3.4

Hormone
Antagonists

Aminoglutethimide tablets
Anastrozole tablets(112)  (Consultant request only)
Bicalutamide tablets (Consultant request only)
Cyproterone acetate tablets

Exemestane tablets (112)  (Consultant request only)

Flutamide tablets

Goserelin implant (Zoladex®)

Letrozole tablets(112)

Tamoxifen
tablets

(112) - NICE Guidance on the use of Hormonal therapies for the adjuvant treatment of early
oestrogen-receptor-positive breast cancer (November 2006).
www.nice.org.uk/guidance/index.jsp?action=byID&o=11598

Somatostatin analogues
*Lanreotide (Somatuline LA & autogel)
*Octreotide (Sandostatin & Sandostatin LAR)
*(Shared care protocols should be used if expecting primary care to continue prescribing.)

MISCELLANEOUS
Anagrelide tablets (Xagrid®)

--------------------------------------------------------------------------------------------------------------------------

41

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NUTRITION AND BLOOD

ANAEMIAS AND SOME OTHER BLOOD
ORAL NUTRITION
DISORDERS
FLUID AND ELECTROLYTES
MINERALS

INTRAVENOUS NUTRITION
VITAMINS

9.1
ANAEMIAS AND SOME OTHER BLOOD DISORDERS

9.1.1
Iron deficiency anaemias

  9.1.1.1   Oral Iron
Ferrous sulphate tablets
Ferrous fumarate 140mg (45mg iron)/5ml liquid
Ferrous gluconate tablets
Polysaccharide-iron complex liquid (Niferex®)

Sodium ironedetate / Sodium feredetate liquid (Sytron®)

Iron and Folic acid (Pregaday®)

9.1.1.2   Parenteral  Iron
Iron sucrose injection (Venofer®)

Iron dextran tablets (Cosmofer®)

9.1.2
Drugs used in Megaloblastic Anaemias
Hydroxocobalamin injection
Folic acid (tablets, liquid & injection)

9.1.3
Drugs used in hypoplastic, haemolytic and renal anaemias
Darbepoetin alfa injection (Renal Request only)


Desferrioxamine mesilate injection


Epoetin alfa injection (Eprex®) (Renal Request only)


Epoetin beta injection (NeoRecormon®)(Renal Request only)


9.1.6
Drugs used in Neutropenia
Filgrastim (Neupogen®)
} Consultant Oncologist or Haematologist
Lenograstim (Granocyte®) }
request only or as part of approved protocol

Pegfilgrastim (2nd line agent) (Consultant only)   inj

9.2
FLUID AND ELECTROLYTES
9.2.1 Oral
Administration
9.2.1.1   Oral Potassium
Potassium chloride (Sando-k® eff., Slow-k®, Kay-Cee-L® syrup)


Potassium removal
Polystyrene sulphonate powder/enema  (Calcium Resonium®/Resonium A®)

9.2.1.2   Oral Sodium and Water
Sodium chloride S.R. tablets (Slow Sodium®)
Oral Rehydration Salts sachets (Dioralyte® ; Rehidrat®)


9.2.1.3   Oral bicarbonate

Sodium bicarbonate tablets

42

9.2.2
Intravenous Administration

POLICY FOR ORDERING AND STORAGE OF CONCENTRATED
POTASSIUM SOLUTION BY WARDS AND DEPARTMENTS

Background: A number of critical incidents have occurred nationally with concentrated Potassium
Chloride solution.
As a result the National Patient Safety Agency (NPSA) has issued guidelines on its use which are to
be implemented within Swansea NHS Trust.
Whenever possible, commercially prepared ready-to-use diluted Potassium Chloride solutions
should be prescribed. (A list of preparations stocked by Pharmacy is available).

Policy

1.  The ampoules of concentrated Potassium Chloride must be ordered using the controlled drugs
order book.

2.  Concentrated Potassium Chloride solution must be stored in the controlled drugs cupboard
(thus separating it from diluents such as Sodium Chloride solution). Records of receipts and
administration must be kept in the controlled drugs register.

3.  The preparation and administration must always be checked by a second nurse and the nurse
must sign the entry in the controlled drugs register.

4.  Only critical care areas, as defined in the NPSA guidelines will stock concentrated Potassium
Chloride solutions (Appendix 1).

5.  In the event of a patient in a non critical area requiring Potassium Chloride concentrate, the
following options are available:-

-  transfer the patient to a critical care area where appropriate monitoring is available.
-  the prescription to be altered to a commercially prepared dilution (appendix 2).

6.  If concentrated potassium chloride ampoules are required during a cardiac arrest in a non-
critical care area, then the critical care area is authorised to release it at the request of the
doctor leading the arrest team. The procedure is as follows:

-  The ampoules are collected and taken to the arrest area by a nominated member of the
arrest team, informing the critical care area the location of the arrest.
-  At this stage the arrest team member will not be expected to complete all necessary
documentation, but a staff member in the critical care area must immediately record the
supply of the stock in the potassium register.
-  When the arrest call is completed a nominated member of the arrest team must:-
(a)  Return any unused ampoules to the critical care area.
(b)  Reconcile the potassium chloride ampoules used.
(c)  Sign the entry in the potassium register (controlled drug register) in the critical
care area.
-  On each occasion when ampoules of concentrated potassium are used for a cardiac arrest
in a non-critical care area, a Trust incident report form must be completed.

43

Locations approved to hold stock of Concentrated
Potassium Chloride

MORRISTON HOSPITAL

SINGLETON
HOSPITAL
Intensive Therapy Unit

Coronary Care Unit
Intensive Therapy Unit – HDU

High Dependency Unit
Intensive Care Unit

Intensive Care Unit
Plastics – HDU

Neonatal Intensive Care Unit
Burns –ITU (Tempest)

Paediatric High Dependency Unit
(Wd15)
Renal
Ward

Recovery
Main
Theatre

Cardiac Theatres
Cardiac ITU
Cardiac HDU
Cardiac Catheter Lab
CCU
Oakwood HDU
Theatre 14 *
Cardiac Theatres *

* Areas that are not recognised in the NPSA alert as an approved area, but further to risk
assessment, are included in local Trust policy.

Commercially prepared diluted Intravenous Potassium Chloride preparations available at
Morriston

1.  Glucose 10% with 10mmol K 500ml
2.  Sodium Chloride 0.9% with 27mmol K 1L
3.  Glucose 5% with 27mmol K 1L
4.  Sodium Chloride 0.9%40mmol K 1L
5.  Dextrose 5% with 40mmol K 1L

Specialist Bags
1.  Glucose 5% / Sodium Chloride 0.45% with 10mmol K 500ml
2.  Sodium Chloride 0.9% with 13.5 mmol K 500ml
3.  Glucose 10% with 20mmol K 500ml
4.  Sodium Chloride 0.9% with 40mmol K 500ml
5.  Sodium Chloride 0.9% with 50mmol K 50ml
(Controlled drug – available in approved critical care areas)

Commercially prepared diluted preparation available at Singleton

1.  Sodium Chloride 0.9% with 27 mmol K 1 L
2.  Sodium Chloride 0.9% with 40 mmol K 1 L
3.  Glucose 10%. with 10 mmol K 500 ml
4.  Glucose 5% with 27 mmol K 1 L
5.  Glucose 5% with 40 mmol K 1 L
6.  Glucose 4% / Sodium Chloride 0.18% with 13.5 mmol K 500 ml
7.  Glucose 4% / Sodium Chloride 0.18% with 27 mmol K 1 L
8.  Glucose 5% / Sodium Chloride 0.45% with 10 mmol K 500 ml

Specials for Haematology use

44

9.  Sodium Chloride 0.9% with 20 mmol Magnesium and 20 mmol K 1 L
10. Glucose 2.5% / Sodium Chloride 0.45% with 20 mmol K 1 L

9.2.3
Plasma and Plasma Substitutes
Dextran 40  }
in sodium chloride 0.9% or
Dextran 70  }
dextrose 5%.
Gelofusine  (500ml)

9.3 INTRAVENOUS
NUTRITION
Contact pharmacy for advice on individual patient formulations.

9.4   ORAL
NUTRITION
Contact dietitian for guidance on special diets.

9.5  MINERALS

9.5.1
Calcium and Magnesium
9.5.1.1   Calcium supplements

Calcium chloride 10% injection

Calcium gluconate (tablets & injections)
Calcium-Sandoz® liquid
Sandocal®-400 / Sandocal®-1000 eff.tablets
Calcichew® tablets
Calcichew D3 & D3 Forte tablets

9.5.1.2   Hypercalcaemia
Cinacalcet(117) injection (Hospital only)


Disodium pamidronate injection (Severe hypercalcaemia only)


Ibandronic acid (injection & tablet) (Cancer Services Directorate only)

Sodium clodronate (tablet & capsule)
Zoledronic acid 4mg injection(Cancer Services Directorate only)


(117) – NICE guidance (117) on Cinacalcet for the treatment of secondary
hyperparathyroidism in patients with end-stage renal disease on maintenance dialysis therapy
http://guidance.nice.org.uk/TA117

9.5.1.3   Magnesium
Magnesium sulphate injection
Magnesium glycerophosphate tablets
Magnesium oxide
Magnaspart

9.5.2
Phosphorus
9.5.2.1   Phosphate supplements
Phosphate
Sandoz® eff.tablets
Potassium phosphate (injection & polyfusor)

9.5.2.2   Phosphate Binding Agents

Aluminium hydroxide capsules (Alu-Caps®)

Calcium acetate tablets
®
(Phosex ) (Renal Request only)



Calcium carbonate tablets
®
(Titralac®, Calcichew )

Lanthanum tablets (Fosrenol®)

Sevelamer tablets (Renagel®) (Consultant request only)


9.5.3 Fluoride

45

Fluoride

9.5.4 Zinc
Solvazinc®  eff tablets

9.6 VITAMINS
9.6.2
Vitamin B Group
®
Pabrinex  (Vitamins B + C) intravenous injection
Pyridoxine hydrochloride tablets
Thiamine tablets


Vitamin B compound strong tablets


9.6.3 Vitamin
C
Ascorbic acid (tablets & injection)

9.6.4
Vitamin D

Alfacalcidol (capsule & oral drops)
Calciferol / Ergocalciferol injection
Calcitriol capsules

9.6.5 Vitamin
E
Alpha tocopheryl acetate (Ephynal®) (tablets, liquid & injection (SCBU)

9.6.6
Vitamin K
Menadiol
sodium phosphate tablets
Phytomenadione (injection & oral)

9.6.7
Multivitamin
Preparations
Multivitamin drops (Abidec®) liquid
Vitamins BPC capsules
Ketovite (tablets & liquid) (adjunct to synthetic diets only)

Mother & Childrens vitamin drops (Paedriatric request only)


Antox capsules  (Consultant Gastroenterologist / Surgeon request only)

--------------------------------------------------------------------------------------------------------------------------

46

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MUSCULOSKELETAL AND JOINT DISEASE

DRUGS USED IN RHEUMATIC DISEASES AND
DRUGS FOR RELIEF OF SOFT TISSUE
GOUT
INFLAMMATION
DRUGS USED IN NEUROMUSCULAR DISORDERS

10.1
DRUGS USED IN RHEUMATIC DISEASES AND GOUT
10.1.1  Non-steroidal anti-inflammatory drugs
Ibuprofen (tablets & liquid)
Celecoxib tablets (27)  (Consultant request only)
Diclofenac sodium (tablets, supps & injection)
Diclofenac sodium and misoprostol tablets (Arthrotec®)
Etodolac tablets (27)  (Consultant request only)


Etoricoxib tablets (Consultant request only)


Indomethacin (capsules & supps)
Nabumetone (tablets & liquid)
Naproxen (tablets, supps & liquid).
Meloxicam (tablets & supp)(27)  (Consultant request only)


(27) - NICE guidance on the use of Cyclo-oxygenase II Selective Inhibitors, CELECOXIB,
ETODOLAC, MELOXICAM and ROFECOXIB for Rheumatoid Arthritis and
Osteoarthritis (July 2001). http://www.nice.org.uk/cat.asp?c=18033

10.1.2

Corticosteroids

Hydrocortisone acetate (tablets & injection)
Methylprednisolone acetate  (injection)
Prednisolone (tablets & injection)
Trimcinolone (intra-articular injection)


10.1.3   Drugs which suppress the Rheumatic Disease Process

Adalimumab injection (Consultant use only)


*Azathioprine tablets
*Auranofin tablets
*Cyclosporin / Ciclosporin capsules
Etanercept injection (35) (36)  (Consultant use only)

*Hydroxychloroquine sulphate tablets
Infliximab injection (36)

(Consultant use only)
*Leflunomide (Consultant specialist use) tablets
*Methotrexate(tablets, injection)


*Penicillamine tablets
*Sodium aurothiomalate injection
*Sulphasalazine E.C. tablets
*(Shared care protocols should be used if expecting primary care to continue prescribing.)

(35) - NICE guidance (35) on the use of ETANERCEPT for the treatment of juvenile idiopathic
arthritis (March 2002). www.nice.org.uk/guidance/index.jsp?action=byID&o=11446

(36) - NICE guidance (36) on the use of ETANERCEPT and INFLIXIMAB for the treatment of
rheumatoid arthritis (March 2002) has been issued. http://www.nice.org.uk/cat.asp?c=35993

10.1.4   Drugs Used in the Treatment of Gout
Acute attack
Colchicine tablets
Indomethacin (capsules & supps)
Naproxen (tablets, liquid & supps)

47

Prophylaxis
Allopurinol tablets
Azapropazone (capsules & tablets) (Consultant request only)


Hyperuricaemia associated with cytotoxic drugs
Rasburicase injection (Fasturtec®)


10.2
DRUGS USED IN NEUROMUSCULAR DISORDERS
10.2.1   Drugs which enhance neuromuscular transmission
Distigmine bromide(tablets & injection)


Edrophonium chloride injection
Neostigmine bromide (tablets & injection)
Pyridostigmine bromide tablets

10.2.2   Skeletal Muscle relaxants
Baclofen (tablets & liquid)
Dantrolene sodium (capsules & injection)
Diazepam (tablets & injections)
Tizanidine tablets(Consultant request only)

10.3
DRUGS FOR RELIEF OF SOFT TISSUE INFLAMMATION
10.3.1 Enzymes
Hyaluronidase injection

10.3.2  Topical antirheumatics
Ibuprofen 10% gel (Ibugel Forte)
Felbinac gel

Capsaicin
Capsaicin cream

--------------------------------------------------------------------------------------------------------------------------

48

link to page 49 link to page 50 link to page 49 link to page 49 link to page 50 link to page 49 link to page 51 link to page 50 11. EYE

ANTI-INFECTIVE EYE PREPARATIONS
LOCAL ANAESTHETICS
CORTICOSTEROIDS AND OTHER ANTI-
MISCELLANEOUS OPHTHALMIC PREPARATIONS
INFLAMMATORY PREPARATIONS
MYDRIATICS AND CYCLOPLEGICS
CONTACT LENS SOLUTION
TREATMENT OF GLAUCOMA

‘S’ refers to preparations which may be manufactured by the Pharmacy Dept

11.3
ANTI-INFECTIVE EYE PREPARATIONS

11.3.1 Antibacterials
Cefuroxime (S) drops
Chlorhexidine 0.02% eye drops (named patient)
Chloramphenicol (ointment, drops, minim)
Ciprofloxacin drops
Fusidic acid drops
Gentamicin (ointment, drops, minim)
Ofloxacin drops
Polymyxin B sulphate (Polyfax) eye ointment

11.3.3   Antiviral

Aciclovir
ointment

11.4
CORTICOSTEROIDS and other ANTI-INFLAMMATORY
PREPARATIONS
11.4.1 Corticosteroids
Betamethasone (ointment & eye drops)
Dexamethasone (Maxidex®) (eye drops & minims)
Fluorometholone eye drops
Hydrocortisone acetate ointment
Hydrocortisone and neomycin (Neo-Cortef®)(ointment & drops)
Maxitrol® drops
Prednisolone (drops & minims)
Prednisolone and Neomycin drops
Rimexolone drops

11.4.2  Other anti-inflammatory preparations
Antazolone sulphate 0.5% eye drops
Emedastine 0.05% eye drops
Nedocromil eye drops

Olopatadine 0.1% eye drops

Levocabastine eye drops

Lodoxomide 0.1% eye drops

Sodium cromoglycate 2% (ointment & eye drops)

11.5
MYDRIATICS and CYCLOPLEGICS
Atropine sulphate (ointment, eye drops & minims)
Cyclopentolate hydrochloride (eye drops & minims)
Homatropine hydrobromide minims
Mydriasert Ophthalmic insert (Phenylephrine & Tropicamide)
Phenylephrine hydrochloride (eye drops & minims)
Tropicamide (eye drops & minims)

49

11.6
TREATMENT OF GLAUCOMA

Adrenaline (neutral) 1% eye drops
Acetazolamide (tablets, SR & injections).
Betaxolol hydrochloride (eye drops M/R, minims 0.25%)
Bimatoprost eye drops
Brimonidine tartrate eye drops 0.2%
Brinzolamide eye drops
Carteolol hydrochloride eye drops 1%; 2%
Dipivefrine eye drops
Dorzolamide eye drops 2%
Dorzolamide pres-free – reserve for preservative intolerant patients
Levobunolol hydrochloride (eye drops & minims 0.5%)
Pilocarpine (eye drops 1%, 2%, 3%, 4%)
Pilogel® 4% gel (Consultant request only)



Timolol maleate (eye drops & minims 0.25%)
Latanoprost eye drops
Travoprost eye drops
Travoprost pres-free – reserve for preservative intolerant patients

Combination products
®
Xalacom  (latanoprost / timolol) eye drops

®
DuoTrav  (travoprost / timolol) eye drops

®
Combigan  (brimonidine / timolol) eye drops

®
Co-Sopt  (dorzolamide/timolol) eye drops

®
Co-Sopt  pres-free –reserve for preservative intolerant patients eye drops
®
Ganfort  (bimatoprost / timolol) eye drops

11.7 LOCAL
ANAESTHETICS

Lidocaine eye drops
Oxybuprocaine 0.4% minims
Proxymetacaine hydrochloride (eye drops & minims)
Proxymetacaine and fluorescein (S) (eye drops & minims)
Tetracaine 0.5% / 1% minims

11.8
MISCELLANEOUS OPHTHALMIC PREPARATIONS
11.8.1   Preparations for Tear Deficiency
Acetylcysteine eye drops (Ilube®)

Carbomer 980 0.2% eye drops
®
(Viscotears )

®
Celluvisc minims
Hypromellose (eye drops & minims)
Isopto Alkaline Hypromellose eye drops

Liquid paraffin (Lacri-lube®) ointment
®
Oculotect   eye drops

Polyvinyl alcohol (Liquifilm®)

Sodium Hyaluronate 0.18% eye drops (Vismed®  & Hyoscan)(consultant initiation only)
Tears Naturale®  eye drops

Viscotears® eye drops

11.8.2   Other Preparations
Acetylcholine (Miochol®) irrigation
Apraclonidine eye drops

Balanced salt solution


Diclofenac 0.1% eye drops
Ketorolac  (Acular®) eye drops

50

Sodium chloride eye drops 0.9%, 5%
Diagnostic Preparations
Fluorescein sodium minims
Rose Bengal minims
Viscolastics
Sodium Hyaluronate  (Provisc®)
Duovisc®
Haelan GV®
}Selected cases
Viscoat®

}only
Verteporfin injection(68)  (specialist request only)

Ranibizumabinjection (Lucentis®) (specialist request only)

(68) - NICE guidance (68) on the use of photodynamic therapy for age-related macular
degeneration (September 2003). http://www.nice.org.uk/cat.asp?c=86772

11.9
Contact Lens Solution (Paediatrics - Mr. Laws only)

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51

link to page 52 link to page 53 link to page 52 12.
EAR, NOSE AND OROPHARYNX

DRUGS ACTING ON THE EAR
DRUGS ACTING ON THE OROPHARYNX
DRUGS ACTING ON THE NOSE

12.1
DRUGS ACTING ON THE EAR

‘S’ refers to preparations which may be manufactured by the Pharmacy Dept

12.1.1   Otitis Externa
Anti-inflammatory Preparations
Betamethasone sodium phosphate 0.1% ear / nose / eye drops
Prednisolone sodium phosphate 0.5% ear / eye drops
Anti-infective Preparations
Betamethasone and neomycin drops
Chloramphenicol 5% / 10% ear drops
Clioquinol with flumethasone (Locorten-Vioform® ) drops
Clotrimazole 1% (Canesten® solution
Dexamethasone and neomycin (Otomize®) spray
Gentamicin 0.3% ear /eye drops
Gentamicin and hydrocortisone (Gentisone HC®) drops
Glycerin and Ichthamol drops
Iodine & Boric Acid (S) powder
Neomycin and Triamcinolone (Audicort®) drops

Neomycin and hydrocortisone (Neocortef®)drops

Compound Anti-infective Preparations
Otosporin drops
Sofradexdrops
Tri-Adcortyl Otic ointment

12.1.3   Removal of Ear Wax
Cerumol®drops
Sodium bicarbonate drops

12.2
DRUGS ACTING ON THE NOSE

12.2.1   Drugs used in Nasal Allergy
Azelastine (Rhinolast®) nasal spray
Beclomethasone dipropionate aqueous (Beconase®) nasal spray
Budesonide (Rhinocort®) nasal spray

Fluticasone (Flixonase®) nasal spray
Mometasone furoate (Nasonex®) nasal spray

Sodium cromoglycate (Rynacrom®) nasal spray
Triamcinolone (Nasocort®) nasal spray

12.2.2

Topical
Nasal
Decongestants
Ephedrine hydrochloride drops
Ipratropium bromide nasal spray

Xylometazoline hydrochloride drops

12.2.3.   Anti-infective Nasal Preparations
Betamethasone and Neomycin ointment (Betnesol-N®)

Mupirocin nasal ointment (MRSA only)

Naseptin ® cream

52

12.3
DRUGS ACTING ON THE OROPHARYNX
12.3.1   Drugs used for Oral Ulceration and Inflammation
Benzydamine (Difflam®)mouthwash, spray
Carmellose sodium (Orabase®)
Choline salicylate gel (Bonjela®/Teejel®)

Gelclair®

Hydrocortisone oral pellets 2.5mg

Triamcinolone paste (Adcortyl in Orabase®)

Sucralfate liquid.

12.3.2   Oropharyngeal Anti-infective Drugs
Amphotericin lozenges
Miconazole gel
Nystatin (pastilles & liquid)

12.3.3  Lozenges and Sprays
Strepsils® lozenges

12.3.4  Mouthwashes, Gargles and Dentrifices
Chlorhexidine gluconate (Corsodyl®) mouthwash / spray
Hexetidine (Oraldene®) mouthwash / gargle
Hydrogen Peroxide 6% mouthwash

12.3.5   Treatment of Dry Mouth
Glandosane® artificial saliva spray
Pilocarpine tablets (Salagen®)

----------------------------------------------------------------------------------------------------

53

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PREPARATIONS

VEHICLES AND DILUENTS
SHAMPOOS AND OTHER SCALP PREPARATIONS
EMOLLIENT AND BARRIER PREPARATIONS
ANTI-INFECTIVE SKIN PREPARATIONS
LOCAL ANAESTHETICS AND ANTIPRURITICS
SKIN DISINFECTION AND CLEANSING AGENTS
TOPICAL CORTICOSTEROIDS
ANTIPERSPIRANTS
PREPARATIONS FOR PSORIASIS AND ECZEMA
WOUND MANAGEMENT PRODUCTS
PREPARATIONS FOR ACNE
TOPICAL PREPARATIONS FOR CIRCULATORY
DISORDERS
PREPARATIONS FOR WARTS AND CALLUSES
MISCELLANEOUS TOPICAL PREPARATIONS
SUNSCREENS AND CAMOUFLAGERS



‘S’ refers to preparations which may be manufactured by the Pharmacy Dept.

13.1
VEHICLES and DILUENTS
Aqueous cream
Cetomacrogol
(Formula
A)
Emulsifying ointment
Unguentum Merck
White Soft Paraffin
Wool Alcohols ointment
Yellow Soft Paraffin

13.2
EMOLLIENT and BARRIER PREPARATIONS
13.2.1   Emollients
Aveeno® cream / lotion
Cetraben® Emollient cream

Dermol 500/200 lotion / shower emollient
Diprobase ointment / cream
E 45 ® cream
Epaderm®ointment
Eucerin Intensive cream / Lotion
Hewletts® cream
Sudocrem®cream
Zinc and castor oil ointment

Emollient bath additives
Balneum®  bath oil
Balneum with Tar®bath oil
Balneum Plus® bath oil
Diprobath ® bath oil
Emulsifying ointment

Oilatum Emollient® bath oil
Oilatum Plus ® bath oil

13.2.2
Barrier Preparations
Drapolene® cream
Kamillosan® ointment
Metanium® ointment
Siopel ® cream
Sprilon®spray
Sudocrem® cream
Conotrane®cream

54

13.3
LOCAL ANAESTHETICS AND ANTIPRURITICS

Amethocaine 4% (Ametop®)gel
Aqueous Calamine cream
Balneum Plus®cream
Calamine lotion / oily cream
Crotamiton 10% cream (Eurax®)

Emla® cream
Lignocaine 5% ointment (Xylocaine® )

Instillagel® gel

13.4   TOPICAL CORTICOSTEROIDS(81)
Mild Potency
Eurax HC® cream
Fluocinolone 1 in 10 dilution (Synalar® 1 in 10) cream
Hydrocortisone 1% cream / ointment

Hydrocortisone 0.5% cream / ointment

Moderately potent
Alphaderm® cream
Betamethasone 1 in 4 dilution (Betnovate®RD) cream / ointment

Clobetasone butyrate (Eumovate®) cream / ointment

Desoxymethasone 0.05% (Stiedex® LP Oily cream) oily cream / scalp lotion
Fluocinolone 1in 4 dilution (Synalar 1® in 4) cream / ointment
Flurandrenolone / Fludroxycortide (Haelan®) cream / ointment
Potent
Betamethasone valerate (Betnovate®) cream / ointment / scalp app
Diflucortolone 0.1% (Nerisone®) oily cream
Diprosalic®  ointment / scalp app

Fluticasone (Cutivate®) cream / ointment

Fluocinolone (Synalar®) cream / ointment / gel
Fluocinonide (Metosyn®) cream / intment
Hydrocortisone butyrate (Locoid®) scalp lotion / lipocream / cream / ointment
Mometasone furoate (Elocon) cream / ointment / scalp lotion
Very potent
Clobetasol propionate (Dermovate®) cream / ointment / scalp app
Diflocortolone valerate (Nerisone Forte®) oily cream / ointment

(81) - NICE guidance for Frequency of application of topical corticosteriods for eczema
(August 2004) www.nice.org.uk/guidance/index.jsp?action=byID&o=11540

Combination corticosteroids with antimicrobials
Aureocort® cream / ointment

Betnovate-C ® cream / ointment

Canesten HC® cream

Daktacort® cream / ointment

Fucibet® cream

Fucidin H® cream / ointment / gel
Locoid C®   cream / ointment

Nystaform HC®  cream / ointment

Synalar-C® cream
Timodine® cream

Trimovate® cream
Vioform-Hydrocortisone®  cream / ointment

13.5
PREPARATIONS FOR PSORIASIS AND ECZEMA

55

Topical Preparations
Alphosyl ® cream / shampoo
Alphosyl HC ® cream
Cade oil compound ointment
Calcipotriol (Dovonex®) cream / ointment / scalp
Calcitriol (Silkis®) ointment
Clinitar® (coal tar extract cream 1%)
Coal tar and Salicylic acid(S) ointment
Crude coal tar (S) liquid
Dithranol (Dithrocream®;Micanol®) cream
Dithranol in Lassar's paste (S)
Dithranol in paraffin base ointment
Dovobet® ointment
Exorex® lotion
Lassar's paste
Oilatum® Plus

Pimecrolimus cream
(82)
(Elidel®)

Polytar Emollient® bath oil
Salicylic acid BP 2% ointment
Sebco® scalp ointment
Tacalcitol ointment (Curatoderm®)

Tacrolimus ointment
(82)
(Protopic®)

Tar pomade ointment

Tazarotene (Zorac®)gel

(82) - NICE guidance for atopic dermatitis (eczema) - pimecrolimus and tacrolimus (No. 82)
(August 2004) www.nice.org.uk/guidance/index.jsp?action=byID&o=11538

Oral Preparations
Acitretin capsules (Neotigason®) (Consultant Dermatologist request only

Cyclosporin / Ciclosporin capsules
Methotrexate tablets

Eflaizumab injection (Raptiva®)
Fumaric acid ester

13.6
PREPARATIONS FOR ACNE
13.6.1   Topical Acne Preparations
Adapalene gel
Benzoyl Peroxide 5%, 10% lotion
Clindamycin lotion / cream
Istretinion 0.05% gel (Isotrexin®)
Nicotinamide 4% gel (Nicam® ( formerly Papulex®))

Tretinoin gel (Retin A®)

13.6.2  Oral Acne Preparations
Dianette® tablets
Erythromycin tablets

Isotretinoin tablets (Roaccutane®) (Consultant Dermatologist use only)

Lymecycline capsules (Tetralysal®)

Minocycline tablets (Minocin® MR)

Oxytetracycline tablets

13.7
PREPARATIONS FOR WARTS AND CALLUSES

Imiquimod cream (Aldara®)

56

Podophyllotoxin 0.5% solution (Condyline®)

Podophyllin 25% in Compound Benzoin (S) tincture
Salactol®  paint
Trichloracetic acid (S) solution

13.8
SUNSCREENS and CAMOUFLAGERS

ROC ® Total sunblock cream
Spectraban®  lotion

13.8.1 Sunscreen
Preparations

Methylaminolevulinate (Metvix) cream

Solaraze® Gel

13.9
SHAMPOOS AND OTHER PREPARATIONS FOR SCALP & HAIR
CONDITIONS
Capasal ®
Ceanel Concentrate®
Cocois scalp application
Eflornithine 11.5% cream
Ketoconazole shampoo
Polytar® shampoo
Polytar AF® shampoo
Selenium sulphide 2.5% (Selsun®)
T-Gel®shampoo

13.10   ANTI-INFECTIVE SKIN PREPARATIONS
13.10.1   Antibacterial Preparations
Cicatrin® powder
Framycetin gauze dressing (SofraTulle®)

Fusidic acid cream / ointment / gel
Metronidazole 0.8% gel
Mupirocin ointment
Silver sulphadiazine cream

13.10.2 Antifungal Preparations

Clotrimazole cream / powder / spray, sol
Miconazole cream
Nystatin cream / oint
Nystaform®cream

13.10.3 Antiviral Preparations
Aciclovir cream

13.10.4 Parasiticidal Preparations
Benzyl

Benzoate
application

Malathion 0.5% liquid
Permethrin (Lyclear® )   }As per National Assembl y

Phenothrin lotion (Full Marks®) }Recommendations

13.10.5  Preparations For Minor Cuts and Abrasions
Povidone-Iodine ointment
Drapolene® cream
Hydrogen peroxide (Crystacide®)cream
Magnesium Sulphate paste

57

13.11 SKIN DISINFECTION AND CLEANSING AGENTS

Biopatch (chlorhexidine time released patch) patch
Chlorhexidine gluconate solution
Chlorhexidine Obstetric (Hibitane®) cream
Hydrogen Peroxide solution
Industrial Methylated Spirits 70% spirit
Iodine (weak) solution
Potassium Permanganate (Permitabs®)
Povidone Iodine (Betadine®) solution / spray

13.11.7 Desloughing Agents

Hydrogen Peroxide 1.5% (Hioxyl®) cream
Varidase Topical®

13.12 ANTIPERSPIRANTS
Aluminium chloride hexahydrate 20% solution

13.13 WOUND MANAGEMENT PRODUCTS
Refer to Dressing policy document.

13.14
TOPICAL PREPARATIONS FOR CIRCULATORY DISORDERS
Lasonil® ointment

13.15
MISCELLANEOUS TOPICAL PREPARATIONS
Arachis oil

Eucalyptus/turpentine oil
Silver nitrate sticks
Dermagraft® (Consultant request only-Diabetic foot ulcers)
Fluorouracil 5% cream (Efudix®)

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58

link to page 59 link to page 59 14.
IMMUNOLOGICAL PRODUCTS AND VACCINES

VACCINES AND ANTISERA
IMMUNOGLOBULINS

14.4
VACCINES AND ANTISERA
BCG intradermal vaccine (10 doses)
BCG Percutaneous (for infants)
Diphtheria / Tetanus (paediatric)
Diphtheria / Tetanus (adult & adolescents)
Diphtheria (low dose)
DTP & Hib vaccine
Haemophilus Influenzae type B vaccine (Hibtiter®)

Hepatitis A vaccine
Hepatitis B vaccine
Hib /DTP Combi pack
Influenza vaccines
Meningitis C vaccine
MMR Vaccine
Pneumococcal vaccine (Pneumovax®) (Consultant request only)
Poliomyelitis vaccine (oral, live 10 doses, single dose)
Rubella vaccine (live attenuated- 0.5,5ml)
Tetanus adsorbed vaccine BP (0.5,5ml)
Triple vaccine (Diphtheria, tetanus and pertussis) (Trivax-AD®)
Tuberculin PPD 10 units/ml, 100 units/ml, 1000 units/ml, 100,000 units/ml.
Yellow Fever vaccine (for Central Clinic only)

14.5 IMMUNOGLOBULINS

These are available from the PHLS on request.
Tetanus immunoglobulin (Humotet®)

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59

link to page 60 link to page 61 15. ANAESTHESIA

GENERAL ANAESTHESIA
LOCAL ANAESTHESIA

15.1 GENERAL
ANAESTHESIA
15.1.1   Intravenous Anaesthetics
Propofol injection
Thiopentone / Thiopental sodium injection

Etomidate injection

Ketamine injection

Midazolam injection

15.1.2   Inhalational Anaesthetics
Entonox
Isoflurane
Nitrous Oxide
Sevoflurane (Day surgery cases / Paediatric request only)

15.1.3   Antimuscarinic premedication drugs
Atropine sulphate injection

Glycopyrronium bromide (Robinul®) injection

Hyoscine hydrobromide injection

15.1.4   Sedative and Analgesic perioperative drugs
15.1.4.1   Anxiolytics and Neuroleptics
Diazepam (tablets, injection, liquid, rectal tube)
Lorazepam tablets / injection (Consultant request only)
Midazolam injection
Promethazine hydrochloride (tablets, injection, liquid)
Temazepam (tablets, liquid)
Trimeprazine / Alimemazine tartrate (tablets, liquid)

15.1.4.2   Non-opioid Analgesics
Diclofenac
sodium
(tablets, MR tablets, injection, supps)
Ketorolac injection

15.1.4.3

Opioid
Analgesics

Alfentanil injection
Diamorphine hydrochloride injection

Fentanyl injection

Morphine sulphate injection

Pethidine hydrochloride injection

Tramadol hydrochloride injection

Remifentanil
injection (Theatres & Burns ITU only)

15.1.5   Muscle Relaxants
Atracurium besilate injection

Mivacurium injection

Rocuronium bromide injection (Ophthalmology request only)

Suxamethonium chloride injection

Vecuronium bromide injection

Cisatracurium injection

Pancuronium brmide injection

60

15.1.6   Anticholinesterases Used in Surgery
Neostigmine metilsulfate injection

Neostigmine and glycopyrronium injection (Robinul -Neostigmine®)

Physostigmine injection

15.1.7   Antagonists for Central and Respiratory Depression

Doxapram hydrochloride injection

Naloxone hydrochloride injection

Flumazenil injection

15.1.8   Antagonists for Malignant Hyperthermia
Dantrolene
sodium injection

15.2 LOCAL
ANAESTHESIA
Amethocaine (Ametop®)gel
Bupivacaine hydrochloride injection
Cocaine (nasal anaesthetic) paste
Cocaine 5% & Adrenaline 1:2000 gel (A&E & ENT use only)

Co-phenylcaine nasal solution (ENT request only)
Levobupivacaine injection
Lignocaine / Lidocaine hydrochloride (injection, gel, oint, topical solution)
Lignocaine with prilocaine cream (Emla®)

Prilocaine hydrochloride injection

PREPARATIONS AVAILABLE FOR EMERGENCY TREATMENT OF POISONING
Acetylcysteine injection

Activated charcoal powder (Carbomix ®)

Desferrioxamine injection

Dicobalt edetate injection

Dimercaprol injection

Methionine tablets
Naloxone injection
Sodium thiosulphate injection

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61

Formulary Policy

Introduction

The formulary was established as a list of drugs for general use by medical staff. The list
has been produced in order to rationalise drug prescribing, economise on expenditure and
promote evidence based prescribing.

The majority of the preparations listed will be routinely stocked by the pharmacy department
and the remainder will be ordered on request.

Certain drugs have restrictions placed on their use. These can be found in brackets after the
drug name in the formulary. A copy of the formulary is available in paper format from each
pharmacy department or is updated regularly on MOCIS
(http://138.5.36.203/pharmacy/Formulary2003-PDF%20Version.pdf)

NON-FORMULARY PRESCRIBING

A. Patients admitted to the hospital already taking non-formulary drugs
If the patient is admitted for review of current therapy, then the prescriber will be
encouraged to change to a formulary drug.

If the patient is admitted for other reasons supply should be continued using either
patients own or Trust stock. If using patients own please ensure adequate supplies
available on discharge.

B.
In the event of a non-formulary drug treatment being initiated in the hospital
then the prescribing doctor will be contacted for consideration of an alternative from
the formulary list. If an alternative is not suitable, then a supply may be obtained on a
named-patient basis, only on the request of a Consultant.

A “Non-formulary Product Request Form” (see Appendix 1) should be completed by the
consultant for monitoring of non-formulary product usage.

The completion of a non-formulary product request form should NOT delay a patients
treatment and form can be completed retrospectively.

Remember non-formulary drugs are not routinely stocked by the pharmacy department
and therefore delays may occur while supplies are purchased.
If this is the case the pharmacy department will inform prescriber that patient will miss
dosages and discuss an alternative therapy.

C. High cost non-formulary drugs
These include all non-formulary drugs costing >£500 per patient. These drugs should be
referred to Mr John Calvert, Deputy Medical Director for approval before pharmacy
can supply. If unsure speak to the Formulary Pharmacist or Chief Pharmacist.

62

Managed Entry of New Drugs

Only consultant grade staff may request the addition of a new product to the Trust
formulary by completing a “New Product Request” form (see Appendix 3). This will be
returned to the formulary pharmacist and a product evaluation of evidence, safety and
financial implication to both primary and secondary care will be considered.

The product evaluation will be sent to the requesting consultant for comments. This may then
be discussed at Division level or by the Trust Prescribing Advisory Group or by Swansea
Medicines Partnership Group, depending on the cost implications and likely location of use
(see algorithm for more information (Appendix 2).

Should a drug cost the Trust more than £5,000 per annum it is anticipated that a business
case be developed by the Division in conjunction with a pharmacist.

Monitoring formulary adherence:

Formulary adherence will be monitored using two systems:
1. Completed non-formulary request form
2. Retrospective non-formulary drug issues reports.

Reviews will be undertaken every 3 months and sent to Clinical Director and Clinical chairs for
the divisions.

Maintenance and Production of the formulary

The formulary will be updated after each Trust Prescribing Advisory Group and placed on
MOCIS.

A paper copy will be produced every two years.

Copies of the formulary will be distributed to all new doctors via postgraduate.

Contacts:
Stuart J Evans, Interface / Formulary Pharmacist,

Agreed by : Swansea NHS Trust Prescribing Advisory Group, September 2004

Review: March 2005

63

REQUEST FOR NON-FORMULARY PR0DUCTS
West Division
Please complete this form if a supply of a non-formulary product is required for
a patient.

PRODUCT:____________________________________________________________

DOSAGE:__________________________________________________________

PATIENT INITIAL:______________________D.O.B.:_______________________

HOSPITAL NUMBER:________________________________________________

APPROXIMATE NO. OF DAYS SUPPLY REQUIRED:______________________

CONSULTANT:_____________________________________________________

WARD OR DEPARTMENT:____________________________________________

HOSPITAL:_________________________________________________________

DIVISION:__________________________________________________________

CONSULTANT
SIGNATURE:_______________________________DATE:___________________

Non-Formulary products are not routinely stocked by the Pharmacy. Please return this
completed from to Mr Stuart J Evans, Interface/Formulary pharmacist, Abertawe Bro-
Morgannwg University NHS Trust, West Division, Pharmacy, Morriston Hospital, as
soon as possible to avoid delay in supply of the product.

64

NEW PRODUCT FORMULARY REQUEST
TO BE COMPLETED BY THE REQUESTING CONSULTANT

CONSULTANT ___________________________________________________

DIVISION
___________________________________________________

PRODUCT
___________________________________________________

INDICATION FOR USE:_______________________________________________

Average Cost of
Number of patients
Course__________________________
to be treated annually____________________

DECLARATION OF INTEREST: ________________________________________

__________________________________________________________________

REASON FOR REQUEST:

a)
No alternative therapy is available.

b)
Advantages to existing treatment:___________________________________

__________________________________________________________________

__________________________________________________________________

Existing Formulary product which may be replaced by new product:

_______________________________________________________________________

*Please enclose any relevant information which may support your request*

SIGNED: __________________________
DATE:  ___________________________
(Requesting Consultant)

PLEASE RETURN THE COMPLETED FROM TO:

Mr Stuart J Evans, Interface/Formulary pharmacist, Abertawe Bro-Morgannwg
University NHS Trust, West Division, Pharmacy, Morriston Hospital.

65

Document Outline

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