Consider first line dressings appropriate to wound bed type and exudate level

Consider standard interactive dressings first.

Micro-enema

Microlette®, Relaxit® and Micralax®

Hospital use only

Preferred local option

Protective transparent barrier film

Type of wound product is suitable for
Superficial broken skin and abrasions
As a barrier against bodily fluids, prevention of skin damage associated with incontinence
Can be used:
-alongside containment products,
-to prevent friction to vulnerable areas of skin
-on superficial abrasions caused by incontinence
-to protect peri wound from exudate
-to protect against aggressive adhesive products
-to protect the skin surrounding stoma sites

Frequency of use
Every 72 hours

Caution/contraindications (when not to use the dressing, patient groups to avoid etc.)
Do not use on infected skin
Allow product to dry before applying the containment products, dressings or clothing (30 seconds)
Too many layers can make the area of skin feel stiff
Can affect electrode readings in the treated area

Rationale for inclusion in formulary
Available in a foam applicator and spray to aid application
Non sticky after use
Can be used on broken areas of skin
Cost effective, does not require reapplication at every episode of hygiene

Hospital ONLY

£££££

Available via home Care

NHSE commissioned for Juvenile Arthritis and paediatric indications where adult TA available

Commissioned by NHSE or via Cancer Drug Fund

For initiation by specialists in substance misuse

Used alone for short term post op only. Can be used with beta-blocker or other ocular hypotensive
Systemic absorption can give rise to sulphonamide associated side effects

On Specialist Ophthalmologist Recommendation

• First line in Acute Otitis Externa, as per antimicrobial guideline

Brand: Parvolex

Acetylcysteine SF effervescent tabs most cost effective

For COPD only

How to use a Genuair Inhaler

Preferred local option

Cohesive inelastic high compression bandage. Short stretch bandage

Type of wound product is suitable for
Venous leg ulceration
Lymphoedema
Management of chronic oedema

Duration dressing remains on wound before changing
Daily to 7 days

Frequency of dressing change
Dependant on exudate levels if wound present or oedema management.

Caution/contraindications (when not to use the dressing, patient groups to avoid etc.
Not recommended on those patients with an ABPI lower than 0.8. Caution in diabetic patients
Caution when cardiac overload or renal failure present or suspected.

Rationale for inclusion in formulary
Only cohesive short stretch bandage. Nurses competent in its usage.

Preferred local option

Type of wound product is suitable for
Necrotic or sloughy wounds that require hydration and cooling pain relief
Can be used on dry wounds with the backing left in place
Cut to shape of the wound
Requires a secondary dressing
Duration dressing remains on wound before changing
1-3 days if dressings become discoloured or opaque or at first signs of exudate strike through
Frequency of dressing change
If dressing becomes discoloured or opaque or at first signs of exudate strike through. Do not allow to dry out
Caution/contraindications (when not to use the dressing, patient groups to avoid etc.)
Should not be used as a covering for deep narrow cavities or sinuses. Do not use on infected wounds.
Not suitable for heavily exuding wounds, known product or component sensitivity. Not for application on ischaemic wounds.
Rationale for inclusion in formulary
Dry necrotic, sloughy or painful wounds
For ease of application - sheet gel rather than liquid
Can be used prior to larval therapy to maintain moisture levels
Primary dressing

PODIATRY ONLY

Two layer dressing consisting of a polyurethane bacterial barrier membrane with a centrally located hydrophilic pad +/- acrylic adhesive border.

Type of wound product is suitable for
Moderately exuding wounds with signs of granulation, epithelialisation or slough. Can be used as primary or secondary

Duration dressing remains on wound before changing
1-7 days

Frequency of dressing change
Up to 7 days dependent on exudate levels

Caution/contraindications (when not to use the dressing, patient groups to avoid etc.)
Full thickness burns
Surgical implantations

Rationale for inclusion in formulary
Cost effective
Simple to use on the foot and digits
Can be cut to shape

Specialist recommendation only

Preferred local option

100% medical grade Manuka Honey.
Type of wound product is suitable for
Use as topical treatment for infected sloughy shallow or cavity wounds. Primary or addition to other Activon products. Requires secondary dressing.
Max Duration dressing remains on wound before changing
Up to 4 days
Frequency of dressing change
Daily in acute infection
Up to 4 days in chronic infection dependant on exudate
Caution/contraindications (when not to use the dressing, patient groups to avoid etc.)
Wounds with active blood loss
Known allergies to bee Venom and Honey products
Blood sugars should be monitored in diabetic patients
Stinging sensation may be experienced – discontinue if not tolerant.
Rationale for inclusion in formulary
Anti-microbial and de-sloughing properties
Control of odours
Benefit of adding to other action products and increasing honey
Suitable for use in cavities
Cost effective

For specialist use only in line with NICE guidance

£££££

• In line with NICE

Avoid in pregnancy

Use topical retinoids at all stages of acne to help minimise formation of comedones.

May cause irritation, build upfrequency or duration of application over 2-3 weeks.

Hospital use only

There has been a patient-level recall of Emerade 500 micrograms pens. This follows earlier recalls for Emerade 150 and 300 microgram pens. (18 May 2020)

Supplies of Emerade will therefore no longer be available in the UK until technical issues with the pen are resolved.

MHRA - Advice for patients with an Emerade 500 microgram auto-injector letter

Use in line with NICE

Unlicensed

In line with NICE

  Oral preparations
  Injection-hospital only

Hospital only

Hospital only.
Palliative care team recommendation during end of life care only.

Guidance for CCGs: Items which should not be routinely prescribed in primary care

Available in adhesive, non adhesive and gentle
Type of wound product is suitable for
Wound management by secondary intention on acute, chronic, full thickness or partial thickness or shallow granulating wounds including pressure ulcers, leg ulcers, diabetic foot ulcers, malignant wounds surgical wounds, malignant wounds donor sites and fungating ulcers
Can be used as a primary or secondary dressing
Duration dressing remains on wound before changing
Can stay in place up to 3-7 days
Frequency of dressing change
Dependent on exudate levels
Caution/contraindications (when not to use the dressing, patient groups to avoid etc.)
In common with all adhesive products, some cases of irritation and/or maceration of the skin may occur.
It should be noted that inappropriate use or too frequent dressing changes, particularly in patients with fragile skin, can result in skin stripping. If this occurs change to the ALLEVYN® gentle border range.
If redness or sensitisation occur, discontinue use
Caution under compression when exudate levels are moderate to high.
Rationale for inclusion in formulary
Can be used for low to moderate exudate levels
Different sizes and shapes available
Cost effective

Specialist recommendation only

Hydrocellular foam dressing

Type of wound product is suitable for
Shallow granulating wounds, acute and chronic exuding wounds, full and partial thickness wounds
such as leg ulcer, malignant wound, surgical wound. Primary dressing
Silicone adhesive

Duration dressing remains on wound before changing
Up to 7 days dependent on dressing indicators

Frequency of dressing change
Up to 3 times a week maximum

Caution/contraindications (when not to use the dressing, patient groups to avoid etc.)
Do not use with oxidising agents such as hypochlorite solutions or hydrogen peroxide Discontinue if reddening or sensitivity occurs.
Do not cut
Caution under compression where exudate levels are moderate to high

Rationale for inclusion in formulary
Fragile skin with absorbency and conformability, problematic healing wounds. Odour control.

Replacement for Calcium Sandoz® (Discontinued)

In line with NICE No significant clinical benefit when used in combination with Insulin – avoid using together 

Specialist initiation only

For patients who would otherwise use alprostadil injection

Hospital only drug

• More than 1.5 kcal/mL and 5g (or more) protein/100 mL
• Alternative to second line supplement choice
• Standard ACBS indications: Disease-related malnutrition, intractable malabsorption, pre-operative preparation of malnourished patients, dysphagia, proven inflammatory bowel disease, following total gastrectomy, short-bowel syndrome, bowel fistula
• Not suitable for child under 3 years; use with caution in child 3–6 years.

Specialist Recommendation

Hospital use only under microbiological advice

Hospital use only under microbiological advice

Use current status at Place/Trust

Sandwell

 Specialist intiation supported by a RICaD

 Amiodarone RICaD-Sandwell only

Atrial fibrillation : Rhythm control should be used when:
symptomatic; under 65's; first time -lone AF; secondary to treated or corrected precipitant with congestive heart failure. Beta-blockers are first line, amiodarone should be used second line where structural heart disease is present

Check thyroid function and liver function every 6 months
Phototoxicity reactions possible - advise use of wide spectrum sunscreen.
Suspect pneumonitis if new or preogressive shortness of breath or cough develops

Following the policy - Items which should not routinely be prescribed in Primary Care. Patients who are established on Amiodarone should continue their prescriptions as normal

The guidance applies to new patients only

Wolverhampton

Walsall

 Dudley

Supported by ESCA

1st line

Low abuse potential, low cost

Off label use

Hospital only

• solution for injection in cartridge
• solution for infusion (accepted July 2020)

For use on advice of specialist

In line with NICE

Use in adults is commissioned by CCGs

Preferred local option

Type of wound product is suitable for
Moderate to heavy exudate, sloughy, necrotic or granulating wounds. Available in rope
for cavities

Duration dressing remains on wound before changing
Maximum 7 days

Frequency of dressing change
1-7 days depends on clinical need

Caution/contraindications (when not to use the dressing, patient groups to avoid etc.)
Not suitable for dry wounds. Non dissolvable. Known product or component sensitivity
Do not cut

Rationale for inclusion in formulary
Aids debridement of slough or necrotic tissue
Remains intact so easily removed in one piece
Absorbs exudate which aids most wound healing facilitating atraumatic dressing change,
Cost effective

Over the counter preparation suitable for self-care/purchase if appropriate

Hospital use only.

Sizes 60-95mm (rising in 5mm)

• Supported by ESCA
• Use in Tourette's syndrome approved

In line with NICE

Dental use only

In line with NICE Highly Specialised Technology guidance 

Please note that commissioning discussion is underway. However the present status is as follows:-

  Age 6 and over - Solihull practices.  Supported with ESCA

 Age 16 and over - Birmingham practices.  Supported with ESCA

 Age under 16 - Birmingham practices

 Supported with an ESCA - Sandwell & West Birmingham CCG for patients seen by the Black Country ADHD Services

Hospital only

Preferred local option

Type of wound product is suitable for
For flat granulating and epithelising wound for non to heavy exudate where adherence may occur. To be used as a primary dressing with a secondary for absorption.

Duration dressing remains on wound before changing
Up to 7 days

Frequency of dressing change
1-7 days, depending on levels of exudate

Caution/contraindications (when not to use the dressing, patient groups to avoid etc.)
Known product or component sensitivity

Rationale for inclusion in formulary
Used to reduce adherence to wound bed. Most cost effective non adherent dressing.
Dressing impregnated with neutraltriglycerides to prevent penetration of granulation tissue.
Petroleum free.

HOSPITAL ONLY

In line with NICE

 £££- Paediatrics only

 £££- Recommended by specialist for oncology use only

In line with NICE

In line with NICE

• Powder 66 g reconstituted with 150ml water provides: protein 10.7 g, carbohydrate 41.5 g, fat 9.7 g, energy 1249 kJ (297 kcal)
• Standard ACBS indications: Disease-related malnutrition, intractable malabsorption, pre-operative preparation of malnourished patients, dysphagia, proven inflammatory bowel disease, following total gastrectomy, short-bowel syndrome, bowel fistula except dysphagia.

• 1.5 kcal/mL and 5g (or more) protein/100 mL
• Second line choice for 200ml ready-made. If powder is not tolerated or contraindicated

Patient to be assessed using the malnutrition universal screening tool (MUST) before initiation of nutritional supplements.

• More than 1kcal/ml and less than 5g protein/100mL
• In line with food first
• Not suitable for CKD 4-5, renal pts
• Not suitable for lactose intolerance
• Not suitable for bile acid malabsorption or fat maldigestion associated with biliary diseases/conditions
• To be made up with whole milk
• Standard ACBS indications: Disease-related malnutrition, intractable malabsorption, pre-operative preparation of malnourished patients, dysphagia, proven inflammatory bowel disease, following total gastrectomy, short-bowel syndrome, bowel fistula . Use with caution in child 1–6 years

Walsall

 Amber Initiation Walsall only 

Wolverhampton

 Amber Shared Care Wolverhampton only

ESCA Azathioprine (Wolverhampton only)

 Sandwell 

 Amber Shared Care Sandwell only

For use in Inflammatory Bowel Disease (IBD) as per effective shared care agreement

ESCA Azathioprine (Sandwell only)

 Dudley 

  Amber Shared Care Dudley only

ESCA Azathioprine (Dudley only)

Specialist use only for neurological conditions

For the treatment of Auto immune haemolytic anaemia

Supported by an ESCA

Supported by an ESCA 

Use 2nd line to retinoids if benzoyl peroxide is not tolerated

 Tablets/ suspension -For Sexual Health (GUM Clinics) in Primary care only   

 IV-For Respiratory Indications

Hospital use only under microbiological advice 

Contains urea 5%, lauromacrogols 3%

Over the counter preparation suitable for self-care/purchase if appropriate

In line with NICE

• Over one year of age. Metabolic disorder pts
• Also these are the only protein free (containing fat, carbohydrate, vitamins and minerals) powders aimed at children ≥1-year-old and adults with inborn errors of protein metabolism (particularly patients with urea cycle disorders and organic acidaemias). Basecal 100 and Basecal 200 are commonly added as an energy source in low protein module tube feeds. The dose will depend on energy requirements and tolerance to natural protein. It is commonly used in combination with a controlled amount of natural protein e.g. measured dose of standard enteral tube feed. It will help meet essential energy and nutrient requirements. The dose and type of product should always be advised by the specialist dietitian according to the needs of the patient

How to use a NEXThaler Inhaler

May 2020 - see Clenil® Modulite® 100mcg (beclometasone): release of batch specific variation

How to use a Metered Dose Inhaler
How to use a Metered Dose Inhaler with a Large Volume Spacer Device
How to use a Metered Dose Inhaler with a Small Volume Spacer Device

How to use a NEXThaler Inhaler

Note:

-Two strengths of Trimbow available 

* Trimbow 172/5/9

* Trimbow 87/5/9

-Trimbow 172/5/9 is licensed for Asthma maintenance therapy only 

Hospital use only under microbiological and Tuberculosis specialist advice 

In line with NICE

In line with NICE

2.5mg dose (higher doses are not indicated in hypertension)

Hospital only

For use by GUM & STD services only

Use in line with NICE TA

For use on the advice of a specialist

Potency - Moderate
Cream
Ointment

Potency - Potent

Restricted to use in inflammatory conditions associated with an infection with confirmed susceptibility to the antimicrobial component.

Use for short periods - typically no more than one week

Short term use only

• High-energy supplements: fat
• 21% MCT emulsion, used orally and in cooking as an energy source for children and adults on a ketogenic diet

On Specialist Ophthalmologist Recommendation

Immediate release formulation

Modified release formulation

2nd line

On Specialist Ophthalmologist Recommendation

Use in line with NICE

BRANDS

• NovoMix 30 FlexPen
• NovoMix 30 Penfill

Insuman comb 25

Insuman comb 50

5mg E/C tablets

10mg Suppository

From 3 month of age

For use by endoscopy speciality at Sandwell and West Birmingham NHS Trust

In line with NICE

Low-protein foods

These products are not available to purchase in supermarkets

They are important to provide essential energy and variety to aid the palatability of low protein diets. They are important for good metabolic control of the patient. Poor access to these products could lead to poor dietary adherence. This will cause poor metabolic control which may lead to irreversible brain damage

The NSPKU guidelines for prescription of low protein foods can be used for other amino acid disorderssuch as MSUD, homocystinuria, tyrosinaemia and pyridoxine response epilepsy

Protein free - necessary for children and adults with inborn errors of protein metabolism who do not tolerate very little natural protein

The specialist dietician will make individual reccomendations based on diagnosis,protein recommendations, weight etc.

• Essential protein-free basic products. Necessary for children and adults with inborn errors of protein metabolism who tolerate very little natural protein. 1 slice ordinary bread = 4g protein and is not allowed in low protein diets

In line with NICE

Providers - NHS hospital trusts

On Specialist Ophthalmologist Recommendation

On Specialist Ophthalmologist Recommendation

On Specialist Ophthalmologist Recommendation

Third line option, after prostaglandin analogues (1st line) and beta-blocker/ prostaglandin analogue plus beta-blocker (2nd line)

For patients in whom monotherapy provides insufficient IOP reduction.

•Initiation by Tertiary Epilepsy Specialist only.
•For adjunctive therapy in the treatment of partial-onset seizures with or without secondary generalisation in adult and adolescent patients from 16 years of age with severe refractory epilepsy warranting tertiary specialist input for patients who have tried three or more AEDs. The patient has used levetiracetam and has documentation of intolerance and patient is using a third line agent (perampanel, zonisamide, lacosamide, eslicarbazepine) which would be replaced by brivaracetam

Supported by an ESCA

In line with NICE

In line with NICE

In line with NICE

• Enema
• CR/MR Capsules

How to use an Easyhaler Inhaler

• Dry powder Inhaler
• Easyhaler
• Prescribe by brand

How to use a Turbohaler Inhaler

How to use an Easyhaler Inhaler

• For treatment of asthma only
• Use lowest effective dose. Consider step down at each review.
• Prescribe by brand to ensure patient receives the device they are used to.
  How to use a Turbohaler Inhaler

Hospital only

Hospital only

For use under specialist addiction services

ONCE A WEEK patch (7-day patch)

For specialist initiation: specialist pain clinics, palliative care and for patients with swallowing difficulties

Patches should be prescribed by BRAND

Specialist use only

For use in opioid dependence, see section 4.10.3

£££££

Second line

In line with NICE

In line with NICE

Low-protein foods

These products are not available to purchase in supermarkets

They are important to provide essential energy and variety to aid the palatability of low protein diets. They are important for good metabolic control of the patient. Poor access to these products could lead to poor dietary adherence. This will cause poor metabolic control which may lead to irreversible brain damage

The NSPKU guidelines for prescription of low protein foods can be used for other amino acid disorderssuch as MSUD, homocystinuria, tyrosinaemia and pyridoxine response epilepsy

Protein free - necessary for children and adults with inborn errors of protein metabolism who do not tolerate very little natural protein

The specialist dietician will make individual reccomendations based on diagnosis,protein recommendations, weight etc.

• Important protein-free foods to provide important energy, assist dietary adherence and provide variety when natural protein tolerance is very limited. Necessary for children and adults with inborn errors of protein metabolism who tolerate very little natural protein

Over the counter preparation suitable for self-care/purchase if appropriate

Ointment
Scalp solution £££

•4 weeks therapy then assess
Maximum 15g per day or 100g per week.
Step down to calcipotrol oint as per NICE CG153

CALCITONIN (SALMON)/SALCATONIN - Red

CALCITONIN SALMON/ CALCITONIN - Red

Specialist recommendation only.
For delicate areas, face & flexures.

Hospital only

• High-energy supplements: fat
• Used as a source of LCT, as an energy supplement and additive to feed to enhance energy density
• Does not contain protein
• Also this is the only LCT fat source that can be used as a fat energy source in patients with organic acidaemias e.g. propionic acidaemia and methyl malonic acidaemia and urea cycle disorders. It may also be used as part of a modular feed or protein-free energy source. The dose and type of product should always be advised by the specialist dietitian according to the needs of the patient
• Disease-related malnutrition, malabsorption states, or other conditions requiring fortification with a high fat (or fat and carbohydrate) supplement. Liquid supplements

Over the counter preparation suitable for self-care/purchase if appropriate

Oncology and Haematology use only

Hospital use only under Microbiological/Tuberculosis advice only

• Axsain
• Zacin

• Qutenza - PAIN TEAM ONLY

See Chapter 7.4.3 for neuropathic pain

On specialist advice

Tablets

M/R tablets

SF liquid

Suppositories

Tegretol is the preferred brand for new patients however please ensure that existing patients are maintained on a specific manufacturers brand

MHRA Advice
Patients being treated for epilepsy should be maintained on a specific manufacturer's product

 Prescribe as 375 mg caps. Avoid prescribing 750 mg caps

• Capsules
• Oral Solution

Clinitas Gel does not have benzalkonium chloride (BAK) as a preservative. It is preserved with cetrimide.

• High-energy supplements: fat
• 20% LCT emulsion, used as an energy source for children and adults on a ketogenic diet, may be used orally or in cooking
• For use in ketogenic diets. Long chain triglyceride liquid emulsion used as a milk replacement (when diluted) for some patients with PKU on very low protein diets who cannot tolerate other low protein milk replacements. It will help meet essential energy requirements. The dose and type of product should always be advised by the specialist dietitian according to the needs of the patient

In line with NICE

• Used as a feed thickener for infants with GORD and in children with swallowing issues who require thickened fluids
• Used in dysphagic patients or those requiring thickened feeds
• For thickening feeds in the treatment of vomiting

Hospital use only under microbiological advice

Hospital use only under microbiological advice. Blueteq applications required 

Hospital use only under microbiological advice 

Hospital use only under microbiological advice 

 Under OPAT sheme

Hospital use only under microbiological advice 

Injectable - Green under OPAT scheme in Primary Care

Secondary care - for specific indications 

Hospital only

Preferred local option

Specialist recommendation only
Sub compression wadding bandage to pad and shape a limb prior to compression therapy
Type of wound product is suitable for
Provides padding for larger limbs under compression.
Duration dressing remains on wound before changing
Up to 7 days
Frequency of dressing change
Daily up to weekly dependant on exudate and oedema management.
Caution/contraindications (when not to use the dressing, patient groups to avoid etc.)
Advised not to apply directly to skin as can cause irritation.
Rationale for inclusion in formulary
Cost effective for use in larger quantities when used in lymphoedema management.

In line with NICE

Low-protein foods

These products are not available to purchase in supermarkets

They are important to provide essential energy and variety to aid the palatability of low protein diets. They are important for good metabolic control of the patient. Poor access to these products could lead to poor dietary adherence. This will cause poor metabolic control which may lead to irreversible brain damage

The NSPKU guidelines for prescription of low protein foods can be used for other amino acid disorderssuch as MSUD, homocystinuria, tyrosinaemia and pyridoxine response epilepsy

Protein free - necessary for children and adults with inborn errors of protein metabolism who do not tolerate very little natural protein

The specialist dietician will make individual reccomendations based on diagnosis,protein recommendations, weight etc.

• Essential protein-free basic products. Necessary for children and adults with inborn errors of protein metabolism who tolerate very little natural protein. 2 regular Weetabix = 4.5g protein and this protein amount is more than the amount of protein that may be tolerated

Specialist/hospital use only

Available via Home Care

OTC preparation suitable for self-care/purchase if appropriate

• Capsules
• Oral Solution- Green for children and those unable to swallow

More greasy option

Over the counter preparation suitable for self-care/purchase if appropriate

For specialist use only

Only with positive culture/sensitivity data

Adjunct in acute alcohol withdrawal

• Contains arachis (peanut) oil, not siutable for patients with allergy to peanuts
• Patients with soya allergy should also avoid Naseptin^®

Green for treatments NHS funded

Supported by an ESCA

Provides short term analgesic effects. Avoid excessive use or use under dentures as may itself cause ulceration

For patients over 16 years only

Specialist recommendation only
Silicone sheet for scar treatment
Type of wound product is suitable for
Not for use on open wounds- to be applied on healed scar only.
This is not a dressing but a scar treatment
Duration dressing remains on wound before changing
23 hours
Frequency of dressing change
Daily
Caution/contraindications (when not to use the dressing, patient groups to avoid etc.)
Do not use on open or infected wounds. Do not use on skin affected by acne. Discontinue use if a rash or itching occur.
Rationale for inclusion in formulary
Scar therapy
Silicone sheets have been shown to soften, flatten scarring aiding movement, nerve sensations and function. Self adherent, Re-usable

Specialist use only for neurological conditions

Supported by an ESCA 

• Specialist Opthalmologist Initiation
• Treatment of severe vernal keratoconjunctivitis (VKC) in children from 4 years of age and adolescents

NHSE funded for dialysis only

All prescribing retained by secondary care

In line with NICE TA117

Specialist Ophthalmologist recommendation (Corneal consultant)

For existing patients only on consultant ophthalmologist advice

Licensed product for topical treatment of acute otitis externa (AOE)

Risk of QT prolongation

Specialist initiation-12 week course.

Preferred local option

Elasticated Sub bandage lining

Type of wound product is suitable for
To be used under retention and compression bandages when conformity is required
Can be used for wet/dry wrapping.

Duration dressing remains on wound before changing
As required

Frequency of dressing change
As required

Caution/contraindications (when not to use the dressing, patient groups to avoid etc.)
Ensure the correct size for a limb is selected

Rationale for inclusion in formulary
Cost effective choice when conformity to a limb is required

Preferred local option

Permeable non woven, synthetic adhesive tape for securing bandages

Frequency of dressing change
Determined by wound type and dressing change

Caution/contraindications (when not to use the dressing, patient groups to avoid etc.)
None listed

Rationale for inclusion in formulary
Available on drug tariff, cost effective and evaluated as meeting the requirements of a tape including adherence.

Potency - very potent

Short term use only unless under supervision of a dermatologist

Cream
Ointment
Scalp application

On specialist advice

MHRA Advice
Care should be taken when switching between oral formulations. The need for continued supply of a particluar manufacturer's product should be based on clinical judgement and consultation with patient and/or carer, taking into account factors such as seizure frequency and treatment history

Use only on advice of specialist

Only with positive culture/sensitivity data

Sandwell only -

Over the counter preparation suitable for self-care/purchase if appropriate

Contains peanut oil

Capsules

M/R capsules

Dispersible tablets

Hospital only:
10% solution
25% paste
5% nasal solution

Tablets

M/R tablets

In line with NICE

Providers -  NHS hospital trusts

Prescribe as GENERIC

Capsules 50/60

Avoid long term use due to possible dependence

Tablets

25mg/5ml syrup

Use with caution in patients aged over 65

Contraindicated in children below the age of 12

Please follow Optimise Rx for most cost effective brand

Please see guidance below to support prescribing

Please prescribe generically as listed below

Oral Capsules or Tablets
Colecalciferol 800unit capsules
Colecalciferol 800unit tablets
Colecalciferol 1,000unit capsules
Colecalciferol 1,000unit tablets
Colecalciferol 3,200unit capsules
Colecalciferol 4,000unit tablets
Colecalciferol 20,000unit capsules
Colecalciferol 25,000unit tablets
Colecalciferol 40,000unit capsules

Oral Solution
Colecalciferol 2,740units/ml oral drops sugar free
Colecalciferol 10,000units/ml oral drops sugar free
Colecalciferol 10,000units/ml oral solution sugar free
Colecalciferol 15,000units/5ml oral solution
Colecalciferol 25,000units/1ml oral solution unit dose ampoules sugar free
Colecalciferol 50,000units/1ml oral solution unit dose ampoules sugar free


Licensed brands currently available (updated March 2017)
Aviticol 800 IU Capsules
Aviticol 1,000 IU Capsules (Listed in the Drug Tariff)
Aviticol 20,000 IU Capsules

Desunin 800 IU Tablets (Listed in the Drug Tariff)
Desunin 4,000 IU Tablets (Listed in the Drug Tariff)

Fultium-D3 800 IU Capsules (Listed in the Drug Tariff)
Fultium-D3 3,200 IU Capsules (Listed in the Drug Tariff)
Fultium-D3 20,000 IU Capsules (Listed in the Drug Tariff)
Fultium-D3 2740 IU/ml oral drops, solution (Listed in the Drug Tariff)

InVita D3 800 IU Capsules
InVita D3 2,400 IU/ml oral drops, solution
InVita D3 25,000 IU oral solution (Listed in the Drug Tariff)
InVitaD3 50,000 IU oral solution (Listed in the Drug Tariff)

Plenachol 20,000 IU Capsules
Plenachol 40,000 IU Capsules (Listed in the Drug Tariff)

Stexerol-D3 1,000 IU Tablets (Listed in the Drug Tariff)
Stexerol-D3 25,000 IU Tablets (Listed in the Drug Tariff)

STRIVIT-D3 800 IU Capsules

THORENS 10 000 IU/ml oral drops, solution (Listed in the Drug Tariff)
THORENS 25 000 IU/2.5 ml oral solution

Supported by a RICaD (In development)

Hospital use only under microbiological advice 

In line with NICE

BRANDS

• Elleste-Duet
• Prempak-C

Hospital use only

Hospital only- NHSE Commissioned

Over the counter preparation suitable for self-care/purchase if appropriate

• Slow release CHO to prevent hypoglycaemia in GSD
• Slow release carbohydrate to prevent hypoglycaemia in all types of GSD. Cheaper than glycosade and easier to mix. Used in less severe forms of GSD. Between 1 to 2g/kg body weight is prescribed dependent on age, weight and clinical symptoms of hypoglycaemia. Doses may be given at regular intervals during the day and night or at bedtime only. The dose and frequency of dose should always be advised by the specialist dietitian according to the needs of the patient
• For glycogen storage disease

• Infant and child: Hydrolysate formula
• Whey hydrolysate. Use in infants who have malabsorption problems and require a peptide and MCT containing feed. Eg after gut surgery
• Use as tube or oral feed
• Disaccharide and/or whole protein intolerance, or where amino acids and peptides are indicated in conjunction with medium chain triglycerides

In line with NICE

Over the counter preparation suitable for self-care/purchase if appropriate

Vapour-permeable adhesive film

Type of wound product is suitable for
Dry non infected wounds, retention of lines, fixation of secondary dressings, protection of intact skin, protection of skin against friction, protection of newly epithelialized wounds

Duration dressing remains on wound before changing
Up to 7 days

Frequency of dressing change
Up to 7 days

Caution/contraindications (when not to use the dressing, patient groups to avoid etc.)
Clinically infected wounds, bleeding or exuding wounds

Rationale for inclusion in formulary
Retention of lines, protection of intact skin, fixation of other dressings. Waterproof

Tablets

Injection - for use in palliative care only

Branded preservative free drops i.e. single use drops should be prescribed where available as manufactured 'specials' cost significantly more and don't have a product license.
Restricted to patients needing preservative free.

On specialist ophthalmologist recommendation

Hospital use only under microbiological and Tuberculosis specialist advice 

Commissioned by NHSE
Hospital only

• Low protein milk for children and adults with phenylketonuria and other disorders of protein metabolism
• Low protein milk (similar energy content to cow’s milk) for children and adults with phenylketonuria and other disorders of protein metabolism

Hospital only

Hospital use only under microbiological advice 

Blueteq /prior approval form

Commissioned by NHSE
Hospital only

Hospital use only under microbiological and Tuberculosis specialist advice 

Treatment of hyponatraemia resulting from inappropriate secretion of antidiuretic hormone, if fluid restriction alone does not restore sodium concentration or is not tolerable

Area 1

Area 2

Area 2

Notes about medicines

• Specialist recommendation

• First line
• Specialist recommendation
• 100 shades available
• FP10 prescriptions should be endorsed "ACBS"

Preferred local option

Podiatry recommendation only

Cream containing 25% urea

Type of wound product is suitable for
To moisturise dry skin on the soles of feet
For use on adults and children over 12 years of age

Frequency of use
Reapply daily

Caution/contraindications (when not to use the dressing, patient groups to avoid etc.)
Allergy or hypersensitivity to any of the ingredients, contains beeswax and lanolin
Not to be used on children under 12

Rationale for inclusion in formulary
Treatment of dry skin conditions of the foot. Dermatology approved

Emollient lotion containing an antimicrobial
Type of wound product is suitable for
For dry and pruritic skin conditions including eczema and dermatitis. Can be applied to skin as an emollient or used as a soap substitute
Frequency of use
Reapply daily
Caution/contraindications (when not to use the dressing, patient groups to avoid etc.)
Allergy or hypersensitivity to any of the ingredients, contains benzalkonium chloride,
0.1%, chlorhexidine hydrochloride 0.1%, liquid paraffin, isopropyl myristate. Should not be used unless infection is present or is a frequent complication
Rationale for inclusion in formulary
Treatment of dry skin requiring antimicrobial properties
Dermatology approved

For short term use only

Over the counter preparation suitable for self-care/purchase if appropriate

HOSPITAL ONLY

 Paediatric Nocturnal enuresis

 Diabetes Insipidus

Low-protein foods

These products are not available to purchase in supermarkets

They are important to provide essential energy and variety to aid the palatability of low protein diets. They are important for good metabolic control of the patient. Poor access to these products could lead to poor dietary adherence. This will cause poor metabolic control which may lead to irreversible brain damage

The NSPKU guidelines for prescription of low protein foods can be used for other amino acid disorderssuch as MSUD, homocystinuria, tyrosinaemia and pyridoxine response epilepsy

Protein free - necessary for children and adults with inborn errors of protein metabolism who do not tolerate very little natural protein

The specialist dietician will make individual reccomendations based on diagnosis,protein recommendations, weight etc.

• Important protein-free foods to provide important energy, assist dietary adherence and provide variety when natural protein tolerance is very limited. Necessary for children and adults with inborn errors of protein metabolism who tolerate very little natural protein

For resistant nausea and vomiting only

£££££

For use on the advice of a specialist

Branded preservative free drops i.e. single use drops should be prescribed where available as manufactured 'specials' cost significantly more and don't have a product license

Restricted to patients needing preservative free

For use on the advice of a specialist

For post corneal transplants or OSD

Use the agent  with the lowest acquisition cost

Steroid- antibiotic combination eye drops are only recommended for use under close specialist supervision and after ocular surgery.

On specialist ophthalmologist recommendation

Please note that commissioning discussion is underway. However the present status is as follows:-

  Age 6 and over - Solihull practices.  Supported with ESCA

  Age 16 and over - Birmingham practices.  Supported with ESCA

 Age under 16 - Birmingham practices

  Supported with an ESCA - Sandwell & West Birmingham CCG for patients seen by the Black Country ADHD Services

• Protein and carbohydrate
• This is a source of essential amino acids for use in low protein diets with urea cycle disorders. The dose and type of product should always be advised by the specialist dietitian according to the needs of the patient
• Hypoproteinaemia, chronic renal failure, wound fistula leakage with excessive protein loss, conditions requiring a controlled nitrogen intake, and haemodialysis
• Not suitable for child under 6 months

Inpatient use and prison settings only

Inpatient use and prison settings only

£££££

Short term use only

Assess CVD risk

Not first line NSAID

For patients with swallowing difficulties

Renal colic and severe acute painful conditions

Post operative use only then switch to oral ibuprofen or naproxen.

For use on advice of specialist

Restricted to patients who need preservative free

For oncological treatment by an experienced specialist

Use only if still symptomatic despite optimal treatment of HF with atrial fibrillation

Take special care in elderly who may be more susceptible to digitalis toxicity