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 Formulary Chapter 9: Nutrition and blood - Full Chapter
09.01  Anaemias and some other blood disorders
Efmoroctocog alfa
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Red SO
Treatment and prophylaxis of bleeding in haemophilia A (congenital factor VIII deficiency)
 
   
09.01.01  Iron-deficiency anaemias
09.01.01.01  Oral iron
Ferrous Sulphate 200 mg tablets
(Iron deficiency)
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Preferred
 
   
Ferrous Fumarate 210 mg tablets
(Iron deficiency)
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Preferred
 
   
Ferrous Fumarate syrup
(Iron deficiency)
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Second Line
Swallowing difficulties 
   
09.01.01.01  Iron and folic acid
09.01.01.01  Compound iron preparations to top
09.01.01.02  Parenteral iron
Ferric Carboxymaltose
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Red SO
Treatment of iron deficiency when oral iron preparations are ineffective or cannot be used
 
   
Iron dextran intravenous
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Red SO
Treatment of iron deficiency anaemia
 
   
Iron Isomaltoside
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Red SO
Treatment of iron deficiency anaemia
 
   
Iron Sucrose
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Red SO
Treatment of iron deficiency anaemia
 
   
09.01.02  Drugs used in megaloblastic anaemias
Folic acid 400 micrograms
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Preferred

Prevention of neural tube defects in pregnancy

 

 
   
09.01.03  Drugs used in hypoplastic, haemolytic, and renal anaemias
Cytotoxic Drug Hydroxycarbamide (hydroxyurea)
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Red SO
Treatment of polycythemia and sickle cell anaemia
 
   
Eculizumab
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Red SO
Treatment of paroxysmal nocturnal haemoglobinuria
 
   
09.01.03  Erythropoietin
Darbepoetin Alfa
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Red SO
Treatment of anaemia in cancer patients receiving chemotherapy

Treatment of renal anaemia: locally, supplies provided by secondary care
Outside area: SC may be required 

   
Epoetin alfa
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Red SO
Treatment of anaemia in cancer patients receiving chemotherapy

Treatment of renal anaemia: locally, supplies provided by secondary care
Outside area: SC may be required 

   
Epoetin beta
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Red SO
Treatment of anaemia in cancer patients receiving chemotherapy

Treatment of renal anaemia: locally, supplies provided by secondary care
Outside area: SC may be required  

   
Epoetin zeta
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Red SO
Treatment of anaemia in cancer patients receiving chemotherapy

Treatment of renal anaemia: locally, supplies provided by secondary care
Outside area: SC may be required 

   
Methoxy polyethylene glycol-epoetin beta
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Formulary
Red SO
Treatment of anaemia in cancer patients receiving chemotherapy

Treatment of renal anaemia: locally, supplies provided by secondary care
Outside area: SC may be required 

   
09.01.03  Iron overload to top
Deferasirox
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Red SO
Treatment of transfusion related iron overload in thalassaemia major or other anaemias
 
   
Deferiprone (Ferriprox®)
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Red SO
Treatment of iron overload in thalassaemia major

 
   
Desferrioxamine Mesilate
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Red SO
Treatment of iron poisoning or overload, and aluminium overload in dialysis patients
 
   
09.01.04  Drugs used in autoimmune thrombocytopenic purpura
Anagrelide
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Red SO
 
   
Eltrombopag
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Red SO
High Cost Medicine
BlueTeq

Treatment of thrombocytopenia

 
Link  NICE TA293: Eltrombopag for treating chronic immune (idiopathic) thrombocytopenic purpura
   
Rituximab
(unlicensed indication)
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Red SO
High Cost Medicine
BlueTeq

Treatment of idiopathic thrombocytopenic purpura and warm autoimmune haemolytic anaemia

 
   
Romiplostim
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Red SO
High Cost Medicine
BlueTeq

Treatment of idiopathic thrombocytopenic purpura

 
Link  NICE TA221: Thrombocytopenic purpura - romiplostim
   
09.01.05  G6PD deficiency
09.01.06  Drugs used in neutropenia
Filgrastim
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Red SO
Reduction and treatment of neutropenia and mobilization of peripheral blood progenitor cells
 
   
Lenograstim
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Red SO
Reduction in duration of neutropenia and mobilisation of peripheral blood progenitor cells
 
   
Pegfilgrastim
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Red SO
Reduction in neutropenia
 
   
09.01.07  Drugs used to mobilise stem cells
Plerixafor
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Red SO
Treatment of lymphoma and multiple myeloma
 
   
09.02  Fluids and electrolytes to top
09.02.01  Oral preparations for fluid and electrolyte imbalance
09.02.01.01  Oral potassium
09.02.01.01  Potassium removal
09.02.01.02  Oral sodium and water
09.02.01.02  Oral rehydration therapy (ORT) to top
09.02.01.03  Oral bicarbonate
09.02.02  Parenteral preparations for fluid and electrolyte imbalance
09.02.02.01  Electrolytes and water
09.02.02.01  Intravenous sodium
09.02.02.01  Intravenous glucose to top
09.02.02.01  Intravenous potassium
09.02.02.01  Bicarbonate and lactate
09.02.02.01  Water
09.02.02.02  Plasma and plasma substitutes
09.02.02.02  Plasma substitutes to top
09.03  Intravenous nutrition
09.03  Supplementary preparations
09.04  Oral nutrition
09.04.01  Foods for special diets
Sapropterin Dihydrochloride
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Red SO
Treatment of phenylketonuria and tetrahydrobiopterin deficiency
 
   
09.04.02  Enteral nutrition to top
09.05  Minerals
09.05.01  Calcium and magnesium
09.05.01.01  Calcium supplements
09.05.01.02  Hypercalcaemia and hypercalciuria
Cinacalcet (Mimpara®)
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Amber SC
Secondary hyperparathyroidism in patients with end-stage renal disease on dialysis
 
Link  Cinacalcet - shared care agreement
Link  NICE TA117: Hyperparathyroidism - cinacalcet
   
EtelcalcetideRestricted Item
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Red SO
Secondary hyperparathyroidism in patients with chronic kidney disease on haemodialysis
 
Link  Etelcalcetide for treating secondary hyperparathyroidism
   
09.05.01.03  Magnesium to top
Magnesium Sulphate
Formulary
Red SO
Treatment of acute hypomagnesaemia
 
   
09.05.02  Phosphorus
09.05.02.01  Phosphate supplements
09.05.02.02  Phosphate-binding agents
Lanthanum (Fosrenol ®)
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Amber SC
Hyperphosphataemia in patients on haemodialysis or continuous ambulatory peritoneal dialysis (CAPD)
 
Link  Lanthanum - shared care agreement
   
Sevelamer
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Amber SC
Treatment of hyperphosphataemia in patients with haemodialysis 
Link  Sevelamer - shared care agreement
   
Sucroferric oxyhydroxide (Velphoro®)
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Red SO

Treatment for the control of serum phosphorus levels for chronic kidney disease (CKD) patients on haemodialysis (HD) or peritoneal dialysis (PD)

 
Link  APC DPS to follow
   
09.05.03  Fluoride
09.05.04  Zinc to top
09.05.05  Selenium
Selenium (Selenase®)
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Red SO
Prevention of selenium deficiency in patients receiving parenteral nutrition, treatment of proven selenium deficiency that cannot be cured by nutrition alone
 
   
09.06  Vitamins
09.06.01  Vitamin A
09.06.02  Vitamin B group
09.06.02  Oral vitamin B complex preparations to top
09.06.02  Other compounds
09.06.03  Vitamin C
09.06.04  Vitamin D
Colecalciferol & calcium carbonate tablet (Accrete D3®)
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Preferred
Each tablet contains 1.5 gram calcium carbonate and 400 units colecalciferol
Swallow tablet whole 
   
Colecalciferol & calcium carbonate caplet (Adcal-D3®)
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Preferred
Each caplet contains 750 mg calcium carbonate & 200 units colecalciferol
Swallow caplet whole 
   
Colecalciferol & calcium carbonate chewable tablet (Calci-D®)
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Preferred
Each tablet contains 2.5 gram calcium carbonate and 1,000 units colecalciferol 
   
Colecalciferol & calcium carbonate chewable tablet (Evacal D3®)
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Preferred
Each tablet contains 1.5 gram calcium carbonate & 400 unit colecalciferol 
   
Colecalciferol 20,000 units capsules (Plenachol®, Avitcol®,)
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Preferred
 
   
Colecalciferol 25,000 unit liquid (Invita D3®)
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Preferred
 
   
Colecalciferol 50,000 unit liquid (Invita D3®)
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Preferred
 
   
Ergocalciferol
(High dose)
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Second Line
Oral vitamin D3 (Colecalciferol) is recommended over other forms of vitamin D.
However, oral Ergocalciferol may be appropriate for vegan patients, and Ergocalciferol IM injection may be used where oral absorption is poor
 
   
Paricalcitol (Zemplar®)
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Amber SC
Prevention and treatment of secondary hyperparathyroidism
 
Link  Paricalcitol - shared care agreement
   
09.06.05  Vitamin E
09.06.06  Vitamin K to top
09.06.07  Multivitamin preparations
09.06.07  Vitamin and mineral supplements and adjuncts to synthetic diets
09.07  Bitters and tonics
09.08  Metabolic disorders
09.08.01  Drugs used in metabolic disorders to top
Asfotase alfa
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Red SO
Long-term enzyme replacement therapy in patients with paediatric-onset hypophosphatasia
 
   
Betaine
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Red SO
Adjunctive treatment of homocystinuria
 
   
Biotin (Vitamin H)
(Unlicensed)
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Red SO
Treatment of isolated carboxylase defects and defects of biotin metabolism
 
   
EliglustatRestricted Item
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Red SO
Long-term treatment of adult patients with Gaucher disease type 1 (GD1)
 
Link  NICE HST5: Eliglustat for treating type 1 Gaucher disease
   
Nitisinone
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Red SO
Treatment of hereditary tyrosinaemia type 1
 
   
Sebelipase alfa
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Red SO
Replacement therapy in lysosomal acid lipase deficiency
 
   
Sodium Dichloroacetate
(Unlicensed)
Formulary
Red SO
Treatment of pyruvate dehydrogenase defects
 
   
Ubidecarenone (Ubiquinone, Co-enzyme Q10)
(Unlicensed )
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Red SO
Treatment of mitochondrial disorders in children
 
   
09.08.01  Wilsons disease
Penicillamine
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Amber SC
Treatment of Wilson's disease
Specialist to provide a share care agreement as required 
   
Penicillamine
(children)
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Red SO
Treatment of Cystinuria – dissolution and prevention of cystine stones in children
 
   
Trientine dihydrochloride
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Red SO
Treatment of Wilson’s disease
 
   
Zinc Acetate
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Red SO
Treatment of portal hypertension in children
 
   
09.08.01  Carnitine deficiency
Levocarnitine
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Red SO
Treatment of primary and secondary carnitine deficiency
 
   
09.08.01  Fabry's disease
Agalsidase Alfa
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Red SO
Long-term enzyme replacement therapy in Fabry's Disease (α-galactosidase A deficiency)
 
   
Agalsidase Beta
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Red SO
Long-term enzyme replacement therapy in patients with Fabry's Disease (α-galactosidase A deficiency)
 
   
09.08.01  Gaucher's disease
Imiglucerase
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Red SO
Treatment of Gaucher's disease
 
   
Miglustat
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Red SO
Treatment of type 1 Gaucher's disease and Niemann-Pick type C disease
 
   
Velaglucerase alfa
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Red SO
Treatment of Gaucher’s disease type 1 in children
 
   
09.08.01  Mucopolysaccharidosis I to top
Elosulfase alpha
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Red SO
Treatment of mucopolysaccharidosis type IVa
 
   
Galsulfase
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Red SO
Treatment of Mucopolysaccharidosis VI
 
   
Idursulfase
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Red SO
Treatment of mucopolysaccharidosis II
 
   
Laronidase
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Red SO
Treatment of mucopolysaccharidosis 1
 
   
09.08.01  Pompe disease
Alglucosidase Alfa
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Red SO
Long term enzyme replacement therapy in Pompe disease
 
   
09.08.01  Nephropathic cystinosis
Mercaptamine
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Red SO
Treatment of nephropathic cystinosis
 
   
Mercaptamine (cysteamine) eye drops
(Unlicensed)
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Red SO
Treatment of cystinosis
 
   
09.08.01  Urea cycle disorders
Arginine
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Red SO
Acute/maintenance treatment of hyperammonaemia in:
carbamylphosphate synthetase deficiency, ornithine carbamyl transferase deficiency, citrullinaemia, arginosuccinic aciduria
 
   
Arginine
(Unlicensed)
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Red SO
Treatment of urea cycle disorders
 
   
Carglumic Acid
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Red SO
Treatment of hyperammonaemia
 
   
Sodium Benzoate
(Unlicensed)
Formulary
Red SO
Treatment of hyperammonaemia due to urea cycle disorders and non-ketotic hyperglycinaemia
 
   
Sodium Phenybutyrate
Formulary
Red SO
Adjunct in long-term treatment of urea cycle disorders. It is indicated as adjuvant in all patient with neonatal onset disease and in those with late onset disease who have a history of hyperammonaemic encephalopathy
 
   
09.08.02  Acute porphyrias
Haem arginate (Human hemin)
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Red SO
 
   
09.08.02  Drugs unsafe for use in acute porphyrias to top
 ....
 Non Formulary Items
Afamelanotide  (Scenesse®)
(Unlicensed)

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Non Formulary
Red SO
High Cost Medicine
Erythropoietic Protoporphyria
 
Ascorbic Acid
(Vitamin C)

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Non Formulary
Black BL

Blacklisted when co-prescribed with iron

Advice: Lack of evidence to support prescribing of vitamin C with iron

 
Colecalciferol 1,000 unit capsule  (Aviticol®)

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Non Formulary
Non Formulary
Public Health England has advised that all adults should consider taking Vitamin D supplementation, especially in the winter months.

Advice: The APC considers it appropriate that patients are asked to purchase low dose supplements for prevention of vitamin D deficiency or maintenance of vitamin D levels following high dose treatment

 
Colecalciferol 1,000 unit tablet  (Sterexol D3®)

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Non Formulary
Non Formulary
Public Health England has advised that all adults should consider taking Vitamin D supplementation, especially in the winter months.

Advice:
The APC considers it appropriate that patients are asked to purchase low dose supplements for prevention of vitamin D deficiency or maintenance of vitamin D levels following high dose treatment

 
Colecalciferol 20,000 unit capsule  (Fultium D3®)

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Non Formulary
Non Formulary
More cost-effective products are available
 
Colecalciferol 25,000 unit tablet  (Stexerol®)

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Non Formulary
Non Formulary
More cost-effective products are available
 
Colecalciferol 3200 unit capsule  (Fultium D3®)

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Non Formulary
Non Formulary
More cost-effective products are available
 
Colecalciferol 800 unit capsule  (Fultium D3®)

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Non Formulary
Non Formulary
Public Health England has advised that all adults should consider taking Vitamin D supplementation, especially in the winter months.

Advice:
The APC considers it appropriate that patients are asked to purchase low dose supplements for prevention of vitamin D deficiency or maintenance of vitamin D levels following high dose treatment

 
Colecalciferol 800 unit tablet  (Desunin®)

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Non Formulary
Non Formulary
Public Health England has advised that all adults should consider taking Vitamin D supplementation, especially in the winter months.

Advice:
The APC considers it appropriate that patients are asked to purchase low dose supplements for prevention of vitamin D deficiency or maintenance of vitamin D levels following high dose treatment

 
Compound iron preparations  (Ferrograd C®)

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Non Formulary
Black BL

No therapeutic advantage, lower iron absorption

Advice: Consider ferrous fumarate (or ferrous sulphate/ferrous gluconate if intolerance to ferrous fumarate)

 
Ferric maltol

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Non Formulary
Black BL
Use formulary choice for the treatment of iron deficiency
 
Ferrous Fumarate tablets/capsules
(Iron deficiency)

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Non Formulary
Non Formulary
All formulations except 210 mg tablets & syrup
 
Ferrous Sulphate  (eg: Ferrograd®, Feospan®, Fefol®)
(modified release )

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Non Formulary
Black BL

No therapeutic advantage, lower iron absorption

Advice: Consider ferrous fumarate (or ferrous sulphate/ferrous gluconate if intolerance to ferrous fumarate)

 
Fibrin sealants

Non Formulary
Red SO
High Cost Medicine
Treatment of haemostasis
 
Fluoride mouthwash  (Duraphat®, En-De-Kay®, FluoriGard® )

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Non Formulary
Black BL

If appropriate these should be prescribed by dentists

Advice: Ask patient to obtain from dentist

 
Fluoride oral drops  (En-De-Kay® )

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Non Formulary
Black BL

If appropriate these should be prescribed by dentists

Advice: Ask patient to obtain from dentist

 
Fluoride tablets  (En-De-Kay®, Fluor-a-day®, FluoriGard®)

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Non Formulary
Black BL

If appropriate these should be prescribed by dentists

Advice: Ask patient to obtain from dentist

 
Fluoride toothpaste  (Duraphat® )

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Non Formulary
Black BL

If appropriate these should be prescribed by dentists

Advice: Ask patient to obtain from dentist

 
fluorides gel  (FlouriGard® )

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Non Formulary
Black BL

If appropriate these should be prescribed by dentists

Advice: Ask patient to obtain from dentist

 
Iron & folic acid  (e.g: Pregaday®, Galfer FA®, Ferrograd folic®,Fefol®)

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Non Formulary
Black BL
Prevention of neural tube defects in pregnancy

Advice: Intended for patient to purchase
If a treatment dose of iron is required, formulary choices may be prescribed

 
Iron MR & Folic Acid  (e.g: Ferrograd Folic®,Fefol ®)

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Non Formulary
Black BL

No therapeutic advantage of MR formulations, lower iron absorption

Advice: Consider ferrous fumarate (or ferrous sulphate/ferrous gluconate if intolerance to ferrous fumarate) with separate folic acid

 
Multivitamin & mineral preparations
(All oral brands & formulations)

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Non Formulary
Black BL

Intended for patients to purchase

Acceptable to prescribe only on advice of specialist/dietician for specific clinical indication

 
Multivitamin drops  (Abidec®, Dalivit®)

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Non Formulary
Black BL

Intended for patients to purchase except for premature babies until their first birthday

Advice: Healthy start vouchers are available where appropriate

Vitamin Drops for neonates prescribing criteria
Infants born

On neonatal unit

At discharge:

Unfortified breast milk: 50 micrograms folic acid daily until discharge

Only if BMF will not be used: 0.6ml Abidec® Multivitamin Drops®

EBM + fortifier, Nutriprem 1, Term formula: 0.3ml - Abidec Multivitamin Drops® or Dalivit® Oral Drops® - daily

Breast-feeding: 0.6ml Abidec® once daily until 1st birthday

Nutriprem 2: No vitamin supplementation

Term infant formulas: Abidec Multivitamin Drops® or 0.3ml Dalivit Oral Drops® daily until 1st birthday

 

Where infants are on breast milk and formula, for example EBM and Nutriprem 1 or breast feeding and Nutriprem 2, a pragmatic decision based on proportion of each should be made.  If uncertain seek dietetic advice or err on the side of caution and prescribe the higher level.  

Dalivit Oral Drops® are not licensed in children under 6 weeks

 
Multivitamin including lutein  (e.g.PreserVision®, Vitalux Plus®)

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Non Formulary
Black BL
Intended for patients to purchase
 
Multivitamin including lutein & zeaxanthin  (e.g.ICaps®,Macushield®,Ocuvite®,MaculEH®
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Non Formulary
Black BL

Intended for patients to purchase

 
Multivitamin preparations
(All oral brands & formulations)

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Non Formulary
Black BL

Intended for patients to purchase

Advice:
Prescribe treatment doses of individual vitamins for specific deficiencies

 
Vitamin B Tablets (Compound)

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Non Formulary
Black BL

No clear place in therapy for any condition

Advice: If a vitamin B complex preparation is needed (e.g. in alcoholism) - consider Vitamin B compound strong tablets

 
Vitamins capsules A C and D

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Non Formulary
Black BL

Blacklisted when prescribed as a "pick me up", i.e. no deficiency has been proven and only for ACBS indications

Advice: Prescribe specific vitamin for any identified deficiency as appropriate

 
  
Key
note Notes
Section Title Section Title (top level)
Section Title Section Title (sub level)
First Choice Item First Choice item
Non Formulary Item Non Formulary section
Restricted Drug
Restricted Drug
Unlicensed Drug
Unlicensed
Track Changes
Display tracking information
click to search medicines.org.uk
Link to adult BNF
click to search medicines.org.uk
Link to children's BNF
click to search medicines.org.uk
Link to SPCs
SMC
Scottish Medicines Consortium
Cytotoxic Drug
Cytotoxic Drug
CD
Controlled Drug
High Cost Medicine
High Cost Medicine
Blueteq
High Cost Drug Approval System

Traffic Light Status Information

Status Description

Preferred

Clinicians are free to prescribe these drugs. They are regarded as cost effective choices which have evidence to support their use.  

Second Line

These drugs should only be prescribed in the scenarios described in the formulary after preferred drug(s) have been ruled out.  

Non Formulary

Non-formulary choice - the vast majority of a patient’s needs should be met by use of formulary preferred choices and second line options when appropriate. Therefore the Clinician should only use a non-formularly drug if this can be justified and it is recommended that all such instances are recorded in the patient record.  

Green SA

Specialist Advised – Specialists may simply advise a patient’s GP to initiate these drugs themselves after they have made an initial assessment. Note: SA drugs can be initiated by the specialist according to patient need and also depending on local commissioning arrangements which may mandate, through the contract between provider and commissioner, that all SA drugs are treated as SI.  

Green SI

Specialist Initiation - These drugs must be initiated, i.e. the first dose prescribed, by the specialist and then may be continued when appropriate by the patient’s GP following communication from the specialist.  

Amber SC

Shared Care - Responsibility for prescribing may be transferred from secondary to primary care with the agreement of an individual GP and when agreed shared care arrangements have been established. The specialist MUST stabilize the patient before asking for care to be transferred. Only specialists should initiate these drugs. Prescribing should be transferred to GPs according to an Shared Care Agreement [SCA]   

Red SO

Specialist Only - These drugs are deemed to be not appropriate for prescribing by GPs. Specialists should not ask GPs to prescribe these drugs.   

Black BL

Black Listed Medicines - These drugs are considered inappropriate for prescribing in Coventry & Warwickshire as they are either not cost-effective or of proven benefit or both.   

Not Recommended

Not Recommended - These are drugs that are not recommended for use.  

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