Chronic hepatitis C in line with the recommendations in NICE TA 75, TA 106 and TA 200. Hepatitis C in children and young people 3-17 NICE TA 300

HIV infection only

HIV infection only

Administered via nebuliser as a mucolytic  - refer to PHT Drug Therapy Guideline 107.03

NHS England low value medication

A prescription for treatment of cold sores should not routinely be offered in primary care as the condition is self-limiting and will clear up on its own without the need for treatment

NHS England low value medication

A prescription for mild infrequent indegestion and heatburn should not routinely be offered in primary care as the condtion is appropriate for self-care

LABA+LAMA. Refer to COPD guidelines

12cm Actico bandages are for use in patients with chronic oedema. 12 cm banadge should be applied to the thigh.

Supply of a single unit only

Light compression Hosiery for early mild chronic oedema with little leg distortion. suitable for chronic oedema, lymphoedema, lipoedema, prophylaxis, maintenence therapy and palliative use.

Available in Below knee and above knee. Wide or regular band. Closed toe and open toe. Various colours and sizes.

Provides strong compression and should be used for maintenance of severe chronic oedema and lymphoedema, where resistant oedema persists, history of recurring ulceration or where lymphatic damage is considerable and use of lower classes has proved ineffective.

Available in Below knee and above knee. Wide or regular band. Closed toe and open toe. Various colours and sizes.

Liner pack available in all sizes, both open and closed toe.

Medium (moderate) compression hosiery

Available in Below knee and thigh length, closed toe and open toe. Various colours and sizes.

Antidote for acute poisoning with various medicines/poisons

_{Note doses are different between chewable tablets and caplets}

Self-administered for anaphylaxis

Emerade, EpiPen, Jext

Prescribe by brand name.

Consultant cardiologist only for diagnosis of Brugada syndrome

NICE TA536: Alectinib for untreated ALK-positive advanced non-small-cell lung cancer

NHS England low value medication

A prescription for the treatment of minor conditions associated with pain, discomfort and mild fever should not routinely be offered in primary care as the condition is appropriate for self-care. (e.g aches and sprains, headache, period pain, back pain).

Primary hypercholesterolaemia or mixed dyslipidaemia

Hyper-absorbent. For use on high exudating wounds where a wear time 5 - 7 days is required.

 Information on restriction - Neonatal unit only

Viridal Duo is used if Caverject is not available

For Pulmonary embolism and acute ischemic stroke.

Aluminium chloride hexahydrate 20% in an alcoholic basis

NHS England low value medication

A prescription for high strength antiperspirants for the treatment of mild to moderate hyperhidrosis should not routinely be offered in primary care as the condition is appropriate for self-care

Includes capsules and syrup

Unlicensed

Prescribe by brand name

Suspension 50mg in 5ml - unlicensed special (paediatrics only)

Unlicensed - Ophthalmology only

unlicensed - Refer to mouthcare guidelines

Includes ointment and suppositories

NHS England low value medicine

A prescription for treatment of haemorrhoids should not routinely be offered in primary care as the condition is self-limiting and will clear up on its own without the need for treatment

VTE prophylaxis following elective hip and knee replacement (full course to be supplied by hospital)

Stroke prevention in non-valvular AF

DVT and PE treatment and secondary prevention

Apraclonidine 0.5% eye drops - short-term adjunctive therapy of chronic glaucoma in patients on maximally tolerated medical therapy who require additional intraocular pressure (IOP) reduction to delay laser treatment or glaucoma surgery.

Apraclonidine 1% single dose - to control or prevent post surgical elevations in intraocular pressure that occur in patients after anterior segment laser surgery.

NHSE funded chemotherapy supportive drug 

PONV following bariatric surgery (off-license)

On the advice of secondary care only

Cows Milk Allergy and malabsorption

ZeroAQS is the lower cost alternative for prescribing in primary care.

Under advice of haematology only.

First line if hyperprolactinaemia caused by other agents.  Schizophrenia in 15-17 year olds (second line) NICE TA 213.  Manic episodes in bipolar disorder in adolescents over 13 NICE TA 292

Falciparum malaria - refer to PHT Adult Antimicrobial Guide

NHS England low value medication

A prescription for the treatment of minor conditions associated with pain, discomfort and mild fever should not routinely be offered in primary care as the condition is appropriate for self-care. (e.g aches and sprains, headache, period pain, back pain).

HIV infection only

Prescribe generically, avoid chewable tablets

May not be suitable for patients with sensitivities to conconut or its derivatives. Consider Tricotex for patients with coconut allergy.

May not be suitable for patients with sensitivities to conconut or its derivatives. Consider Tricotex for patients with coconut allergy.

Secondary Care only Except for Emergency use

Second line for erectile dysfuntion

SLS endorsement required in primary care

Zeroveen is the lower cost alternative for prescribing in primary care.

Category 2

Shared care for long-term prophylaxis in COPD and bronchiectasis only

On microbiology advice only

Contains 5% urea and lauromacrogols. For dry, scaling and itching skin

MDI / Autohaler / Easi-Breathe

Prescribe by BRAND NAME - Kelhale is a cost effective alternative for patients requiring a MDI

MDI and NEXThaler

Asthma Step 3 BTS guidelines for adults over 18, COPD – refer to local guidelines

Unlicensed special listed on BAD specials list 2018

Mild to moderate ulcerative colitis in active phase - full course to be supplied by hospital

For indications and criteria for CDF funding refer to CDF list.

Psychiatry only

Note HIGH COST in primary care

For use within Solent Sexual Health Service Only

Scabies - not first choice

Unlicensed special - Ophthalmology Only

Only for neovascular eye conditions not covered by NICE recommendations.

Category 2

A soft, absorbent polyurethane foam pad with a vapour-permeable film backing and a silicone adhesive border.

A soft, absorbent polyurethane foam pad with a vapour-permeable film backing and a silicone adhesive border.

HIV infection only

NHSE clinical commissioning policy 170131P

ACBS

Mix 25 and Mix 50

Only for use in accordance with SCAN guideline

See Chapter 6.6 or individual drugs : disodium pamidronate, zoledronic acid

Diphtheria, tetanus, pertussis (acellular, component) and poliomyelitis (inactivated) vaccine (adsorbed, reduced antigen(s) content)

For pregnant women at risk of whooping cough

Anal fissure - approved off-licence indication

Refer to list of approved indications

Consultant neurologist only to initiate for patients with refractory epilepsy and where other antiepileptics are contraindicated, ineffective or not tolerated.

Specialist to establish benefit and stabilise dose before request is made to GP to provide ongoing prescriptions.

Secondary Care initiated

MDI / Turbohaler / nebuliser solution

When used for relapses of small bowel Crohn's disease - full course to be supplied by hospital.

Amber Initiated when prescribed for autoimmune hepatitis - course may be continued in primary care.

Alternative to Symbicort for new initiations. Adults only (over 18). Prescribe by brand name

Bupicvacaine 0.25% and 0.5%

Moderate to severe pain

Substance Misuse services only

Moderate to severe chronic pain including cancer pain requiring an opioid analgesic where oral morphine is unsuitable or not tolerated.  Palliative care.    

Change patch every 4 days. 

Prescribe by brand name. In primary care the cost effective brand is Bupeaze

For use by Southern Health as per the anxiety treatment guidelines only

Acute Treatment or Short-term prophylaxis prior to planned procedures for Hereditary Angioedema and Acquired Angioedema in accordance with NHS England commissioning policy.

Prophylactic treatment of hereditary angioedema (HAE) types I and II in accordance with NHS England commissioning policy - specialist centres only (UHS)

Neonatal unit only. Peyona can be used for intravenous infusion and oral administration.

Calcium carbonate 1.25 g (calcium 500 mg), colecalciferol 10 micrograms (400 units) per tablet

Calcium carbonate 1.25 g (calcium 500 mg) colecalciferol 10 micrograms (400 units) per tablet 

Gel can be used on the scalp and body

Secondary Care only

For flexures and vulval psoriasis

Folinic acid rescue. Adjunct to 5-fluorouracil.

Red for renal dialysis patients

Contains 10% urea

 Information on restriction - Only for patients undergoing primary PCI where oral administration of P2Y12 inhibitor is not possible.

Hospital only agent until a shared care guideline is approved

Approved only for use as per NICE criteria

Option for localised neuropathic pain including diabetic neuropathy

Paediatrics only

Includes tablets, MR tablets, liquid and suppositories. (Chewtabs discontinued)

Suppositories are HIGH COST in primary care (£120.00 for 5)

MHRA/CHM Advice on switching:

Category 1: ensure patient is maintained on a specific manufacturer's product. 

Capsules 375mg and syrup 250mg in 5ml

Oral solution 750mg in 10ml sachets are a cost-effective option if liquid is required.

Optive Plus contains castor oil in addition to carmellose and glycerol

Optive Fusion contains hyaluronic acid in addition to carmellose and glycerol

NHS England low value medication

A prescription for treatment of dry or sore eyes should not routinely be offered in primary care as the condition is appropriate for self-care.

Second line agent for heart failure after bisoprolol

Unlicensed special - Ophthalmology only

Resistant pseudomonal infections  - microbiologist recommendation only

Cream, Ointment, Lotion

For use in pregnancy.

Note HIGH COST in primary care.

NHS England low value medicine

A prescription for treatment of conjunctivitis should not be routinely offered in primary care as the condition is sel-limiting and will clear up on its own without the need for treatment

Paediatrics only

For adults travelling to at risk areas

For severe keratoconjuctivitis in children from four years of age and adolescents

Includes tablets and oral solution

NHS England low value medication

A prescription for mild infrequent indegestion and heatburn should not routinely be offered in primary care as the condtion is appropriate for self-care

NHS England low value medication

A prescription for the treatment of travel sickness should not routinely be offered in primary care as the condition is appropriate for self-care.

Intravenous infusion

Unlicensed special listed in Drug Tariff

Paediatrics only

Available in 1m, 3m and 5m lengths.

Sterile activated charcoal cloth. Apply as a secondary dressing over an appropriate primary dressing. Exudate will reduce the dressings effectiveness. Can be cut to size. Can be used in the management of malodourous wounds such as fungating wounds, pressure ulcers, leg ulcers and diabetic foot ulcers.

Sterile activated charcoal cloth. Apply as a secondary dressing over an appropriate primary dressing. Exudate will reduce the dressings effectiveness. Can be cut to size. Can be used in the management of malodourous wounds such as fungating wounds, pressure ulcers, leg ulcers and diabetic foot ulcers.

Psychiatry only: refer to anxiety treatment guidelines

Prescribe generically

10% vaginal cream

200mg pessaries

500mg pessary

NHSE low value medication

A prescription for the treatment of ringworm or athlets foot should not routinely be offered in primary care as the condition is appropriate for self-care

Included on BAD specials list 2014

2.5mg/25mg and 5mg/50mg tablets

Multi-layer compression bandage kit. Bandages of choice for lymphoedema/coedema management.

Coban 2 system is second-line for patients requiring full compression where Actico is considered inappropriate, known latex allergies or slippage may be a concern.

The Coban 2 lite comfort 15cm width bandage should be used for applying reduced compression to the knee and thigh of patients with chronic oedema.

15cm width bandage should be used for applying reduced compression to the knee and thigh of patients with chronic oedema.

Specialist use in line with NHSE Commissioning Policy D04/P/e

Includes capsules and suspension.  Only for treatment of terminally ill patients.

Moderate to severe pain

Symptomatic bile salt salt malabsorption with severe diarrhoea - second line after cholestyramine. Consultant gastroenterologist only.

Sugar-free

Patches only are formulary

Only on specialist initiation where:

• contraception and relief of peri-menopausal symptoms is required 
• As a fourth line option for women with heavy menstrual bleeding

For women with proven lactose allergy or malabsorption problems who cannot take the combined pill.

Absorbant hydrocolldoid dressing with added alginate for absorption, a vapour-permeable film backing and bevelled edge.

Available in 1m, 3m and 5m lengths.

Reusable system (washable) High cotton content. For specialist chronic oedema management.

Restricted use - refer to BNF

DACC-coated, hydrophobic, antimicrobial wound contact layer. Primary dressing for contaminated, colonised or infected superficial or deep wounds including superficial wounds. traumatic, post-operative or dehisced wounds, ulcers and fungal infections in the groin, skin folds or between digits.

Physical (non-chemical) insecticide for managment of head lice.

NHS England low value medication

A prescription for the treatment of head lice should not routinely be offered in primary care as the condition is suitable for self-care

Injection, tablets

Serotonin syndrome

VTE Prophylaxis following elective hip and knee replacement (full course to be supplied by hospital).

Stroke prevention in non-valular AF

DVT and PE treatment and secondary prevention

Dermatitis herpetiformis - dermatology only

HIV infection only

Commisioned by NHS England for iron chelation in thalassaemia, sickle cell and rare inherited anaemias (Policy 16070/P)

Vitamin and mineral supplements for use when recommended by a specialist in patients with cystic fibrosis 

May be initiated in primary care or first injection in secondary care

Prescribe by brand name (Prolia)

For use by Solent Sexual Health Service only

White soft paraffin 10% in liquid paraffin and coconut oil

Sublingual tablets are second line

Children - CAMHS initiation only

CAMHS Shared care agreement for Hampshire will be available on iDOCs

Adults - diagnosis and treatment initiation via Hampshire ADHD service (provided by Surrey and Borders Partnership NHSFT)

Awaiting shared care guidelines

For paediatric emergency use only

Refer to Drug Therapy Guideline

Contact directorate pharmacist for advice/orders

NHS England are responsible for commissioning use in complex spinal surgery at specialist centres (Policy 16063/P)

Knee and hand OA

NHS England low value medication

A prescription for the treatment of minor conditions associated with pain, discomfort and mild fever should not routinely be offered in primary care as the condition is appropriate for self-care. (e.g aches and sprains, headache, period pain, back pain).

Cyanide poisoning

HIV infection only

For cardiac glycoside (digoxin) toxicity

Non MR tablets only

60mg tablets - prescribe generically

Dilzem SR, Adizem SR, Tildiem Retard (twice daily dosage).

Different versions of modified-release preparations containing more than 60mg diltiazem hydrochloride may not have the same clinical effect. To avoid confusion between these different formulations of diltiazem, prescribers should specify the brand to be dispensed.

For use in dermatology only.

Diphenylcyclopropenone (DCP) is a highly sensitising agent used to treat alopecia areata and resistant viral warts as topical immunotherapy. It should be applied only in Dermatology departments by a trained professional.

Unlicensed special on BAD list

Secondary Care only

Urology only

Dithranol 0.4% w/w, salicylic acid 2%, emulsifying wax 25% , liquid paraffin to 100%

Unlicensed special on BAD list

Includes capsules and oral solution (Stimulant/softener)

NHS England low value medication

A prescription for infrequent constipation should not routinely be offered in primary care as the condtion is appropriate for self-care

HIV infection only NHSE commissioning policy B06/p/a 

Alzheimers Disease

Dementia associated with Parkinsons disease or Lewy bodies - Priorities Committee Policy Statement 25

For use in line with NHSE policy 190137P

Modified release tablets are NON-FORMULARY

For dermatology use only - pruritus

Second-line option strictly in accordance with the criteria in NICE TA 197

For type 2 diabetes

To aid debriding, promote granulation, occlusive barrier.

For light to medium exuding wounds ONLY. Ensure correct size is applied; overlap the wound by at least 2 cm . odour from dressing constituents can be a concern to patients.

Not suitable for infected wounds unless oberved frequently. Not indicated routinely on diabetic foot wounds - contact local diabetic/foot protection team for advice.

To aid debriding, promote granulation, occlusive barrier.

For light to medium exuding wounds ONLY. Ensure correct size is applied; overlap the wound by at least 2 cm . odour from dressing constituents can be a concern to patients.

Not suitable for infected wounds unless oberved frequently. Not indicated routinely on diabetic foot wounds - contact local diabetic/foot protection team for advice.

A highly absorbent, non-woven, sliver gelling fibre dressing. Use as a primary dressing for moderately to high exuding wounds where there is infection.

A highly absorbent, non-woven, sliver gelling fibre dressing. Use as a primary dressing for moderately to high exuding wounds where there is infection.

A highly absorbent, non-woven, sliver gelling fibre dressing. Use as a primary dressing for moderately to high exuding wounds where there is infection.

A highly absorbent, non-woven, sliver gelling fibre dressing. Use as a primary dressing for moderately to high exuding wounds where there is infection.

Zerocream is a lower cost alternative for primary care prescribing

Stroke prevention in non-valvular AF

DVT and PE treatment and secondary prevention

50:50 liquid paraffin/white soft paraffin aerosol spray

HIV infection only

HIV infection only

HIV infection only

Prescribe by BRAND name

Continue the brand the patient has been initiated on.

Chronic hepatitis B in line with NICE TA 153

Second-line for the renal transplant (when other preparations have unacceptable side effects).  Used under the advice of renal transplant specialists ONLY.

Included in BAD specials list 2014

NHS England low value medicine

A prescription for coughs, colds and nasal congestion should not routinely be offered in primary care as the condition is self-limiting and will clear up on its own without the need for treatment.

Epimax is a cost effective alternative to Diprobase cream

Left ventricular dysfunction (LVEF <40%) and clinical evidence of heart failure after recent myocardial infarction. NYHA class II CHF and left ventricular systolic dysfunction (LVEF <30%) in addition to standard optimal therapy.

Microbiology recommendation only

GUM only

Refer to MHRA and local advice concerning QT prolongation and  dose restrictions

Includes tablets and capsules

 Information on restriction - Gynaecology use only

Prescribe by brand name

Consilient brand = Triregol

Second line use

Millinette 20/75 is preferred brand for prescribing

Consilient brand = Gedarel 30/150

Consilient brand = Rigevidon

Capsules are HIGH COST in primary care

MHRA advice on switching:

Category 3: usually unnecessary to ensure that patients are maintained on a specific manufacturer's product unless there are specific concerns, such as patient anxiety and risk of confusion or dosing errors.

HIV infection only

Cost effective alternative to Cetraben cream

Twice daily injection - type 2 diabetes

For infected/heavily exudating wounds. Do NOT use on dry or low exudating wounds. Requires a secondary dressing.

Apply in a cavity wound or on shallow wounds. Should overlap the wound margins.

Apply in a cavity wound or on shallow wounds. Should overlap the wound margins.

For infected/heavily exudating wounds. Do NOT use on dry or low exudating wounds. Requires a secondary dressing.

Option if allopurinol contraindicated or not tolerated.  Refer to local guidance on management of gout.

Mixed dyslipidaemia unresponsive to statins

Restricted to use in patients unable to receive Monofer® e.g. renal patients requiring doses of up to 1g to be given by an IV bolus and paediatrics

NHS England low value medication

A prescription for the treatment of mild to moderate hay fever should not routinely be offered in primary care as the condition is appropriate for self-care

Under advice of microbiology only.

Liquid for use in infants and children unable to swallow tablets

Contains 25% urea

Resistant candida, with specialist advice

Previously Locorten-Vioform

First line agent in general population

20mg capsules are the most cost-effective presentation for doses of 20mg, 40mg and 60mg.

Oral solution 20mg in 5ml can be used for patients with swallowing difficulties or if a 10mg dose is required.

Psychiatry only

Modecate is going to be discontinued and will no longer be available after the end of 2018.

New patients should not be initiated on Modecate and existing patients will need to be identified and an alternative treament prescribed.

Second-line corticosteroid for allergic rhinitis.

Second Line - Dermatology and Paediatrics only

At high doses of Seretide, Accuhalers are significantly cheaper than MDIs and should be prescribed in preference to MDIs where possible.

Sirdupla and Sereflo - alternative combination inhaler for asthma only – prescribe by brand name. Note, only licensed for patients >18 years

For use in patients with a previous history of heparin induced thrombocytopenia (HIT) for thromboprophylaxis

Under advice of haematology for use in treatment of HIT (off-label use)

HIV infection only

CMV retinitis

Community multi-resistant Extended-spectrum Beta-lactamase (ESBL) E. coli UTI - on advice from microbiology. 

Restricted prescribing as per Microguide or NICE prescribing guidance

Category 2

Alzheimers Disease

Dementia associated with Parkinsons disease or Lewy bodies - Priorities Committee Policy Statement 25

Cost effective brands for prescribing in primary care are Galazemic or Gazylan XL

Used to absorb large amounts of exudate. Not to be used as primary dressing. If used in leg management always pad OUTSIDE the bandage to maintain adequate pressures (if compression to the leg).

Can be cut to size.

via nebuliser for non-CF bronchiectasis - refer to shared care agreement

plain tablets - not MR

Beta-blocker overdose

Category 1 acceptable

Only for patients unable to self administer

Refer to local guidance on preferred products.

300mcg tablets are cheaper than 500mcg in primary care

LAMA in capsule for inhalation via Breezhaler device. Refer to COPD guidelines

Unlicensed special on BAD list and in Drug Tariff

For chemotherapy induced nausea and vomiting

CAMHS Shared care agreement for Hampshire will be available on iDOCs

Havrix, Avaxim, Vaqta, Vaqta Paediatric

For adults and children travelling to at risk areas - prescribe by brand name and check appropriate dose.

Hepatyrix, ViATIM

For adults travelling to at risk areas

For use in routine immunisation programme - 12-13 years old, girls only