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THE FIFE FORMULARY

Abbreviated Drug List

APRIL 2004
Version 5

Fife Area Drug & Therapeutics Committee has produced this formulary for use in hospitals and general practice throughout the Kingdom of Fife

Contents Chapter
Notes on Formulary Entries 1. 2. 3. 4. 5. 6. 7. 8. 9. Gastrointestinal System Cardiovascular System Respiratory System Central Nervous System Infections Endocrine System Obstetrics, Gynaecology and Urinary-tract Disorders Malignant Disease and Immunosupression Nutrition and Blood

Page
i 1 2 5 6 9 12 14 16 18 20 21 22 23 26 26 27

10. Musculoskeletal and Joint Diseases 11. Eyes 12. Ear, Nose and Oropharynx 13. Skin 14. Vaccines 15. Anaesthesia 16. Poisoning

The formulary is regularly updated. See www.show.scot.nhs.uk/fifeadtc for the current version.

Notes on Formulary Entries New Layout Drugs considered suitable for general use are have no shading surrounding them while drugs considered for use or initiation by or on the advice of specialists only are contained within a shaded box. These drugs should not normally be prescribed without the advice of a specialist. The restrictions on their use can be found in the A4 full Fife Joint Formulary which should be consulted before prescribing. Monitoring the safety and quality of medicines: New drugs under intensive surveillance (Black Triangle list) Drugs that are under intense surveillance at the time of publication are indicated by the addition of a black triangle next to the entry w. A black triangle will be assigned to a product if the drug is a new active substance. However, a product containing previously licensed active substances may also be monitored if it meets one or more of the following criteria: a new combination of active substances; administration via a novel route or drug delivery system; a significant new indication which may alter the established risk/benefit profile of that drug. The CSM/MCA wish to receive all suspected ADRs associated with these products in order to confirm the risk/benefit profile established during the pre-marketing phase. The black triangle drugs are monitored closely for a minimum of two years and the black triangle symbol is not removed until the safety of the drug is well established. Yellow Cards can be found in: British National Formulary (BNF) Nurse Prescribers' Formulary ABPI Compendium of Data Sheets and Summaries of Product Characteristics MIMS Companion Electronically through www.yellowcard.gov.uk or by calling CSM Scotland on 0131 242 2919

1 1.1

GASTROINTESTINAL SYSTEM Dyspepsia and gastroosphageal reflux disease

1.3.3 Chelates and complexes Tripotassium dicitratobismuthate (Denoltab) Sucralfate 1.3.5 Proton Pump Inhibitors Lansoprazole Omeprazole See Fife Dyspepsia and Helicobacter Pylori Eradication Guidance. 1.4 Acute diarrhoea First line treatment in acute diarrhoea is the correction of fluid and electrolyte imbalance. 1.4.2 Antimotility drugs Loperamide Codeine phosphate Co-phenotrope 1.5 Chronic bowel disorders Hydrocortisone Mesalazine Olsalazine Prednisolone Sulphasalazine 1.6 Laxatives

1.1.1 Antacids and simeticone Aluminium- and magnesiumcontaining antacids Aluminium hydroxide Maalox Mucogel Antacid preparations containing simethicone Asilone Simethicone alone Infacol 1.1.2 Compound alginates and proprietary indigestion preparations Compound alginate preparations Gaviscon Gaviscon Advance Gastrocote 1.2 Antispasmodics and other drugs altering gut motility

1.6.1 Bulk-forming drugs Bran Ispaghula husk 1.6.2 Stimulant laxatives Bisacodyl Co-danthramer Co-danthrusate Docusate sodium Glycerol suppositories Senna Sodium picosulfate 1.6.3 Faecal softener Arachis oil enema

Antimuscarinics Dicyclomine Hyoscine butylbromide Other antispasmodics Mebeverine Peppermint oil Motility stimulants Domperidone Metoclopramide 1.3 Ulcer Healing Drugs 1.3.1 H2-receptor antagonists Cimetidine Nizatidine Ranitidine

1.6.4 Osmotic laxatives Fletchers' Phosphate Enema Lactulose Micralax Micro-enema Movicol 1.6.5 Bowel cleansing solutions Hospital Use Only Fleet Phospho-Soda Klean-Prep Sodium Picosulfate (Picolax) 1.7 Local preparations for oral and rectal disorders

Hospital Initiation Only Nutrizym 22 Pancrease HL 2. 2.1 CARDIOVASCULAR SYSTEM Positive inotropic drugs

2.1.1 Cardiac glycosides Digoxin Digoxin-specific antibody Hospital Use Only Digibind 2.2 Diuretics 2.2.1 Thiazides and related diuretics Bendroflumethiazide Hospital Initiation Only Metolazone Indapamide 2.2.2 Loop Diuretics Furosemide Bumetanide 2.2.3 Potassium-sparing diuretics Amiloride Aldosterone antagonists Spironolactone 2.2.5 Osmotic diuretics Hospital Use Only Mannitol

1.7.1 Soothing haemorrhoidal preparations Anusol Lidocaine 1.7.2 Compound haemorrhodial preparations with corticosteroid Anugesic HC Hydrocortisone Scheriproct 1.7.3 Rectal sclerosants Hospital Use Only Oily phenol injection 1.8 Stoma Care

For further advice on these products, contact the stoma care nurse at Fife Acute Hospitals NHS Trust. 1.9 Drugs affecting intestinal secretions

1.9.1 Drugs affecting biliary composition and flow Hospital Initiation Only Ursodeoxycholic acid. 1.9.4 Pancreatin Creon Pancrex V

2.2.8 Diuretics with Potassium No products are recommended. 2.3 Anti-arrhythmic drugs

2.3.2 Drugs for arrhythmias Verapamil

Hospital Initiation Only Amiodarone Disopyramide Flecainide Propafenone Sotalol Hospital Use Only Adenosine (not including Adenoscan) Lignocaine Mexiletine Beta-adrenoceptor blocking drugs Atenolol Bisoprolol w (suitable alternative to atenolol in the presence of heart failure) Hospital Initiation Only Carvedilol Nebivolol Hospital Use Only Esmolol Labetalol Metoprolol Sotalol 2.5 Antihypertensive therapy w 2.4

2.5.5 Drugs affecting the reninangiotensin system 2.5.5.1 Angiotensin-converting enzyme inhibitors Lisinopril Perindopril Ramipril Trandolapril 2.5.5.2 Angiotensin-II receptor antagonists Candesartan Irbesartan Losartan Telmisartan Valsartan 2.6 Nitrates, calcium-channel blockers and potassiumchannel activators

2.6.1 Nitrates Isosorbide mononitrate Glyceryl trinitrate Hospital Use Only Isosorbide dinitrate (not including transdermal spray) 2.6.2 Calcium-channel blockers Amlodipine Diltiazem Nifedipine Verapamil Hospital Use Only Nimodipine 2.6.3. Potassium-channel activators Nicorandil 2.6.4 Peripheral vasodilators and cerebral

2.5.1 Vasodilator antihypertensive drugs Hydralazine Hospital Use Only Sodium nitroprusside 2.5.2 Centrally-acting antihypertensive drugs Hospital Initiation Only Clonidine Moxonidine 2.5.4 Alpha-adrenoceptor blocking drugs Doxazosin (not approved for BPH)

2.6.4.1 Peripheral vasodilators and related drugs Naftidrofuryl oxalate Nifedipine 2.6.4.2 Cerebral vasodilators No products are recommended

2.7 Sympathomimetics Adrenaline 2.7.1 Inotropic sympathomimetics Hospital Use Only Dobutamine Dopamine Dopexamine Isoprenaline 2.7.2 Vasoconstrictor sympathomimetics Hospital Use Only Ephedrine hydrochloride Metaraminol Noradrenaline Phenylephrine 2.8 Anticoagulants and protamine

Specialist Use Only Fondaparinux 2.8.2 Oral anticoagulants Warfarin Phenindione (alternative where warfarin cannot be tolerated) 2.8.3 Protamine sulphate Protamine 2.9 Antiplatelet drugs Aspirin Clopidogrel Dipyridamole 2.10 Fibrinolytic drugs Hospital Use Only Streptokinase Tenecteplase 2.11 Antifibrinolytic drugs and haemostatics Ethamsylate Tranexamic acid Hospital Use Only Aprotinin w

2.8.1 Parenteral Anticoagulants Heparin Low molecular weight heparins (LMWH) Hospital Use Only Dalteparin Enoxaparin Tinzaparin Hiridins and epoprostenol Hospital Use Only Lepirudin Epoprostenol

2.12 Lipid-regulating drugs Anion-exchange resins Colestyramine Colestipol Clofibrate group Bezafibrate Ciprofibrate Fenofibrate Gemfibrozil Statins Atorvastatin Pravastain Rosuvastatin Simvastatin 2.13 Local sclerosants Hospital Use Only Ethanolamine oleate Sodium tetradecyl sulphate

3. 3.1

RESPIRATORY SYSTEM Bronchodilators

3.1.1 Adrenoceptor agonists 3.1.1.1 Selective beta2 agonists Short-acting Salbutamol Terbutaline Long-acting Formoterol Salmeterol 3.1.1.2 Other adrenoceptor stimulants Adrenaline 3.1.2 Antimuscarinic bronchodilators Ipratropium Tiotropium 3.1.3 Theophylline Aminophylline Theophylline 3.1.4 Compound bronchodilator preparations Combivent Ipratropium 20micrograms/ salbutamol 100 micrograms per metered inhalation 3.2 Corticosteroids

Inhaled steroids Beclometasone Budesonide Fluticasone

Systemic steroids Prednisolone Hydrocortisone Compound preparations Seretide Symbicort 3.3 Cromoglycate related therapy and leukotriene receptor antagonists

3.5

Respiratory stimulants and pulmonary surfactants

3.5.1 Respiratory stimulants Hospital Use Only Doxapram 3.5.2 Pulmonary surfactants Hospital Use Only Colfosceril palmitate Poractant 3.7 Mucolytics Carbocisteine Mecysteine hydrochloride 3.8 Aromatic inhalations Menthol crystals 3.9 Cough Preparations

3.3.1 Cromoglicate, related therapy and leukotriene receptor antagonists Cromoglicate sodium Nedocromil sodium inhaler 3.3.2 Leukotriene receptor antagonists Montelukast Zafirlukast 3.4 Antihistamines, hyposensitisation and allergic emergencies

3.9.1 Cough suppressants Pholcodine 3.9.2 Expectorant and demulcent cough preparations Simple linctus 3.10 Systemic nasal decongestants No products are recommended 4. 4.1 CENTRAL NERVOUS SYSTEM Hypnotics and anxiolytics

3.4.1 Antihistamines Non Sedating Cetirizine Loratidine Sedating Alimemazine Chlorphenamine Hydroxyzine Promethazine NEF

3.4.3 Allergic Emergencies Step 1 Adrenaline (Epinephrine) (incl.autoinjector) And then call for help After help called Chlorphenamine Hydrocortisone

4.1.1 Hypnotics Benzodiazepines Nitrazepam Temazepam (tablets) Zolpidem and zopiclone Zolpidem tartrate Zopiclone

Chloral and derivatives Specilaist Initiation Only Chloral hydrate Triclofos elixir 4.1.2 Anxiolytics

Flupentixol decanoate Fluphenazine decanoate Haloperidol decanoate Pipotiazine palmitate Zuclopenthixol decanoate Atypical Antipsychotics Specialist Iniation Only

Benzodiazepines Chlordiazepoxide Diazepam Lorazepam Other drugs for anxiety Propranolol 4.2 Drugs used in psychoses and related disorders

Risperdal Consta 4.2.3 Antimanic drugs Specialist Iniation Only Lithium Carbamazepine Semisodium Valproate(Depakote) Lithium products should be prescribed by brand name. 4.3 Antidepressant drugs

4.2.1 Antipsychotic drugs Typical Antipsychotics Initiation for psychosis should be by or in consultation with mental health specialist. Chlorpromazine Haloperidol Promazine Sulpiride Trifluoperazine Zuclopenthixol dihydrochloride Specialist Initiation Only Benperidol Thioridazine Zuclopenthixol acetate Atypical Antipsychotics Specialist Initiation Only Amisulpiride Clozapine Olanzapine Quetiapine Risperidone 4.2.2 Antipsychotic depot injections

4.3.1 Tricyclic and related antidepressant drugs Tricyclics Amitriptyline Clomipramine Dosulepin Imipramine Lofepramine Trimipramine Related antidepressants Trazodone 4.3.2 Monoamine-oxidase inhibitors (MAOI's) Hospital Initiation Only Phenelzine Tranylcypromine Reversible inhibitors of monoamine oxidase Moclobemide 4.3.3 Selective Serotonin re-uptake inhibitors Citalopram Fluoxetine Paroxetine Sertraline

Typical Antipsychotics Specialist Iniation Only

4.3.4 Other Antidepressant Drugs Mirtazapine Reboxetine Venlafaxine Specialist Initiation Only Tryptophan 4.4 Central nervous system stimulants

Dihydrocodeine (not including DF118 Forte) Morphine sulphate (excluding Morcap SR) Oxycodone Pethidine Tramadol oral Hospital Use Only Hydromorphone hydrochloride Fentanyl Tramadol injection 4.7.3 1st Line 2nd Line Neuropathic Pain Amitriptyline Nortriptyline Gabapentin

Specialist Initiation Only Methylphenidate hydrochloride 4.6 Drugs used in nausea and vertigo Betahistine Cinnarizine Domperidone Hyoscine hydrobromide Metoclopramide Prochlorperazine Hospital Use Only Chlorpromazine Cyclizine Granisetron Haloperidol Methotrimeprazine Nabilone Ondansetron Promethazine Tropisetron 4.7 Analgesics

Trigeminal neuralgia Carbamazepine Hospital Use Only Phenytoin 4.7.4 Antimigraine drugs 4.7.4.1 Treatment of acute migraine attack Naratriptan Sumatriptan Zolmitriptan 4.7.4.2 Prophylaxis of migraine Pizotifen Propranolol 4.8 Antiepileptics 4.8.1 Control of epilepsy

4.7.1 Non-Opioid analgesics Paracetamol NPF/ NEF Ibuprofen (low dose) NEF Nefopam NEF Compound analgesic preparations Co-codamol 30/500 Co-dydramol 4.7.2 Opioid analgesics Codeine phosphate Cyclimorph Diamorphine

Carbamazepine Phenobarbitol Phenytoin Sodium valproate Hospital Initiation Only Acetazolamide

Clobazam (Schedule 11. Endorse SLS) Clonazepam Ethosuximide Gabapentin Lamotrigine Levetiracetam w Oxcarbazepine w Pregabalin Primidone Topiramate Vigabatrin 4.8.2 Drugs used in status epilepticus Diazepam Hospital Use Only Clonazepam Lorazepam Paraldehyde Phenytoin 4.8.3 Febrile convulsions Paracetamol Diazepam 4.9 Drugs used in parkinsonism and related disorders

Chlorpromazine Haloperidol Pimozide Primidone Sulpiride Tetrabenazine Torsion dystonias and other involuntary movements Hospital Use Only Botulinum A toxin-haemagglutinin complex 4.10 Drugs used in substance dependence Drugs used in alcohol dependence Disulfiram Acamprosate Drugs used for cigarette smoking Bupropion (Amfembutamone) w Nicotine Products First Line: gum and patches Drugs used in opioid dependence Methadone 1mg/ml mixture

4.9.1 Dopaminergic drugs Co-beneldopa (Madopar) Co-careldopa (Sinemet) Pramipexole Selegiline Hospital Use Only Apomorphine Cabergoline Lisuride Pergolide Ropinirole 4.9.2 Antimuscarinic drugs Benztropine Orphenadrine Procyclidine Trihexyphenidyl 4.9.3 Drugs used in essential tremor, chorea, tics and related disorders Propranolol Hospital Use Only

4.11 Drugs for dementia Specialist Initiation Only Donepezil hydrochloride Galantamine Rivastigmine 5. INFECTIONS

See Fife Antibiotic guidance for management of common infections and serious infections in hospital. 5.1 Antibacterial drugs

5.1.1 Penicillins 5.1.1.1 Benzylpenicillin and phenoxymethylpenicillin Benzylpenicillin Phenoxymethylpenicillin

5.1.1.2 Penicillinase resistant penicillins Flucloxacillin 5.1.1.3 Broad spectrum penicillins Amoxicillin Co-amoxiclav 5.1.1.4 Antipseudomonal penicillins Hospital Use Only Tazocin Timentin 5.1.2 Cephalosporins, cephamycins, and other beta-lactams Cephalosporins and cephamycins Cefaclor Cefalexin Cefadrine Hospital Use Only Cefixime Cefotaxime Ceftazidime Ceftriaxone Cefuroxime Other beta-lactam antibiotics Hospital Use Only Aztreonam Imipenem with cilastatin Meropenem 5.1.3 Tetracyclines Doxycycline Minocycline Oxytetracycline Tetracycline 5.1.4 Aminoglycosides Hospital Use Only

5.1.5 Macrolides Erythromycin Azithromycin Clarithromycin Azithromycin should be used only for indications which require its powerful anti-chlamydial effect. 5.1.6 Clindamycin Hospital Initiation Only Clindamycin (not including vaginal cream) 5.1.7 Some other antibiotics Hospital Use Only Chloramphenicol Colistin Fusidic acid Linezolid Teicoplanin Vancomycin 5.1.8 Sulphonamides and trimethoprim Trimethoprim Hospital Use Only Co-trimoxazole Sulfadiazine Sulfadimidine 5.1.9 Anti-tuberculous agents These drugs will normally be recommended on specialist advice. Rifampicin Recommended for the prevention of secondary cases of meningococcal meningitis and Haemophilus influenzae type b infection. Hospital/Specialist Initiation Only

Amikacin Gentamicin Neomycin Netilmicin Tobramycin

Ethambutol Isoniazid Pyrazinamide Rifabutin Rifater

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Rifinah Rimactazid Streptomycin 5.1.10 Antileprotic drugs Hospital Initiation Only Dapsone 5.1.11 Metronidazole Metronidazole (not including vaginal gel) 5.1.12 Quinolones Ciprofloxacin (excluding 100mg tablets for uncomplicated UTI) Moxifloxacin Norfloxacin Ofloxacin 5.1.13 Urinary-tract infections Nitrofurantoin 5.2 Antifungal drugs Terbinafine Fluconazole Griseofulvin Itraconazole (not approved for fungal nail infections) Hospital Use Only Amphotericin Flucytosine Ketoconazole Nystatin Liposomal amphotericins are restricted for use in systemic mycoses when toxicity precludes the use of conventional amphotericin. 5.3 Antiviral agents

Zalcitabine Zidovudine Protease inhibitors Hospital Use Only Atazanavir Indinavir Ritonavir Saquinavir 5.3.2 Herpesvirus infections 5.3.2.1 Herpes simplex and varicella-zoster Aciclovir Famciclovir (not approved for genital herpes) Valaciclovir 5.3.2.2 Cytomegalovirus infection Hospital Use Only Cidofovir Foscarnet Ganciclovir (including ophthalmic implants) 5.3.4 Influenza Zanamivir Respiratory syncytial virus Hospital Use Only Tribavirin Palivizumab 5.4 Antiprotozoal agents w w

5.4.1 Antimalarials Use on specialist advice Chloroquine Mefloquine Proguanil Hospital Use Only

HIV infection Nucleoside reverse transcriptase inhibitors Hospital Use Only Combivir Didanosine Lamivudine Stavudine

Primaquine Quinine Halofantrine

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For information on malaria prophylaxis or travel advice, health care professionals only can contact Tel 0141 300 1130 or go to www.travax.scot.nhs.uk 5.4.8 Drugs for pneumocystis pneumonia Hospital Use Only

6.1.4 Treatment of hypoglycaemia Glucose Glucagon 6.2 Thyroid and Antithyroid drugs

6.2.1 Thyroid hormones Levothyroxine Hospital Use Only

Co-trimoxazole Pentamidine Atovaquone 5.5 Anthelmintics

Liothyronine 6.2.2 Antithyroid drugs Carbimazole Hospital Use Only Aqueous iodine Propylthiouracil 6.3 Corticosteroids 6.3.1 Replacement therapy Fludrocortisone Hydrocortisone 6.3.2 Glucocorticoid Therapy Dexamethasone Hydrocortisone Prednisolone (including Prednesol) Hospital Use Only Betamethasone Cortisone Methylprednisolone Triamcinolone 6.4 Sex Hormones

5.5.1 Drugs for threadworms Mebendazole Pripsen 6. ENDOCRINE SYSTEM

6.1 Drugs used in diabetes 6.1.1 Insulins See BNF for details. Includes NovoMix 30 w,Insulin lispro, Insulin glargine wand Insulin detemirw. All insulins should be initiated on hospital advice with continuation of prescribing in primary care. 6.1.2 Oral antidiabetic drugs 6.1.2.1 Sulphonylureas Gliclazide Glipizide 6.1.2.2 Biguanides Metformin 6.1.2.3 Other antidiabetic drugs Hospital Use Only Acarbose Nateglinide Pioglitazone Rosiglitazone

6.4.1 Female sex hormones 6.4.1 Female Sex Hormones Tablets are considered the first choice formulation. Patches may be appropriate in Patients in whom there is a clinical need to avoid first pass metabolism of oestrogens

w w

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Patients who cannot tolerate tablets or express a strong preference for patches. Sequential Combined Therapy (cyclical) 1st Line - Tablets 1st Choice C19 Progestogen Elleste Duet (Estradiol/norethisterone 1mg/1mg or 2mg/1mg). OR Prempak-C (Conj equine oestrogen/ Norgesterol 0.625mg/150microgram or 1.25mg/150microgram) Alternative C21 Progestogen Femoston (Estradiol/dydrogesterone. 1mg/10mg; 2mg/10mg; 2mg/20mg) 2nd Line - Patches 1st Choice Evorel Sequi (Estradiol/ Norethisterone 50microgram/170microgram, MX Patch) Continuous Combined Therapy

Evorel Conti (Estradiol/ Norethisterone 50microgram/170microgram MX Patch) Oestrogen only (unopposed) 1st line Tablets 1st Choice Elleste-Solo (Estradiol 1mg or 2mg) Alternative Premarin(Conj. Equine Oestrogens 0.625mg or 1.25mg) 2nd Line Patches 1st Choice Evorel Patch (Estradiol Twice weekly 25microgram;50microgram;75microgram;1 00microgram) Alternative FemSeven Patch (Estradiol weekly 50microgram;75microgram;100microgram) Other products Tibolone Raloxifene Tablets 6.4.1.2Progestogens Norethisterone Hospital Use Only

1st Line - Tablets 1st Choice C19 Progestogen Kliovance (Estradiol/ norethisterone 1mg/500micrigram) OR Kliofem (Estradiol/ norethisterone 2mg/1mg Alternative C21 Progestogen Femoston-conti (Estradiol / Dydrogesterone 1mg/5mg) or Premique (Conj equine oestrogen/ Medroxyprogesterone 0.625microgram/5mg) Premique Low Dose (Conj equine oestrogen/medroxyprogesterone 0.3mg/1.5mg) 2nd Line - Patches 1st Choice

Hydroxyprogesterone Hexanoate 6.4.2 Male sex hormones and antagonists Hospital Use Only Testosterone Anti-androgens Cyproterone Hospital Use Only Finasteride Dutasteride w

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6.5 Hypothalamic and Pituitary hormones and antioestrogens 6.5.1 Hypothalamic and anterior pituitary hormones and antioestrogens Anti-oestrogens Clomiphene (Clomifene) Anterior pituitary hormones Corticotrophins Hospital Use Only Tetracosactrin (Tetracosactide) Gonadotrophins Hospital Use Only Chorionic gonadotrophin Human menopausal gonadotrophins Urofollitrophin Growth Hormone Somatropin (recombinant human growth hormone) Hypothalamic hormones Hospital Use Only Gonadorelin Protirelin Sermorelin 6.5.2 Posterior pituitary hormones and antagonists Posterior pituitary hormones Argipressin Desmopressin Hospital Use Only Terlipressin Antidiuretic hormone antagonists Hospital Use Only

6.6.1 Calcitonin and teriparatide Hospital Use Only Salcatonin (Calcitonin salmon) Specialist Initiation Only Teriparatide w

6.6.2 Bisphosphonates Also see sections 9.5.1.1 (Calcium supplements) and 9.6.4 (Vitamin D) and Fife Guidance for Treatment of Osteoporosis Alendronic acid Didronel PMO Risedronate Hospital Use Only Disodium etidronate Disodium pamidronate Sodium Clodronate 6.7 Other endocrine drugs

6.7.1 Bromocriptine and other dopaminergic drugs Hospital Use Only Bromocriptine Cabergoline 6.7.2 Drugs affecting gonadotrophins Danazol Gonadorelin analogues Buserelin Hospital Use Only Goserelin Leuprorelin Nafarelin 6.7.3 Metyrapone and Trilostane

Demeclocycline 6.6 Drugs affecting bone metabolism Hospital Use Only Metyrapone Trilostane

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7.

OBSTETRICS, GYNAECOLOGY AND URINARY TRACT DISORDERS Drugs used in Obstetrics

Fungal infections Clotrmazole Miconazole Nystatin Oral fluconazole in a single dose of 150mg is useful in the treatment of recurrent or resistant vaginal candidiasis (see section 5.2). Other infections Aci-Jel Povidone-iodine Sultrin 7.3 Contraceptives See BNF section 7.3.1 Emergency Contraception Levonelle - 2 7.4 Drugs for genito-urinary tract disorders

7.1

7.1.1 Prostaglandins and oxytocics Ergometrine Syntometrine Hospital Use Only Carboprost Dinoprostone (not including PropessRS) Gemeprost Oxytocin 7.1.1.1 Ductus Arteriosus Hospital Use Only Alprostadil 7.1.2 Mifepristone Hospital Use Only Mifepristone 7.1.3 Myometrial relaxants Hospital Use Only Ritodrine Atosiban 7.2 Treatment of vaginal and vulval conditions

7.4.1 Drugs for urinary retention and treatment of benign prostatic hyperplasia Alfuzosin Tamsulosin Terazosin Indoramin. Specialist Initiation Only Finasteride Dutasteride 7.4.2 Drugs for urinary frequency, enuresis and incontinence Tolterodine XL Trospium Oxybutynin Duloxetine 7.4.3 Drugs used in urological pain Alkalinisation of urine Potassium citrate 7.4.4 Bladder instillations and urological surgery Chlorhexidine Hospital Use Only Dimethyl sulfoxide Glycine

7.2.1 Preparations for vaginal atrophy 1st line - creams Ortho-Gynest Cream (Estriol 0.01%) OvestinCream (Estriol 0.1%) line - vaginal tablets Vagifem (Estradiol 25microgram) 7.2.2 Vaginal and vulval infections 2nd

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7.4.5 Drugs for impotence Sildenafil Alprostadil Apomorphine Tadalifil

w w

Daunorubicin DaunoXome Doxorubicin Epirubicin Idarubicin hydrochloride Mitomycin Mitoxantrone 8.1.3 Antimetabolites Specialist Use Only Gemcitabine Hospital Use Only Cladribine Cytarabine Fludarabine (w oral) Fluorouracil Mercaptopurine Methotrexate Tioguanine 8.1.4 Vinca alkaloids and etoposide Hospital Use Only Etoposide Vinblastine Vincristine Vindesine Vinorelbine 8.1.5 Other antineoplastic drugs Hospital Use Only Amsacrine Bortezomib Carboplatin Cisplatin Crisantaspase Dacarbazine Docetaxel Hydroxycarbamide Imatinib Irinotecan Paclitaxel Pentostatin Procarbazine Topotecan Tretinoin w

Restricted by NHS Medical Service Regs Schedule 11. 8. MALIGNANT DISEASE AND IMMUNOSUPPRESSION Cytotoxic drugs

8.1

Drugs for cytotoxic-induced sideEffects Methotrexate-induced mucositis and myelosuppression Hospital Use Only Calcium folinate Urothelial toxicity Hospital Use Only Mesna 8.1.1 Alkylating drugs Hospital Use Only Busulfan Carmustine Chlorambucil Cyclophosphamide Estramustine Ifosfamide Lomustine Melphalan Chlormethine/Mustine Thiotepa Treosulfan 8.1.2 Cytotoxic antibiotics Hospital Use Only Aclarubicin Bleomycin Dactinomycin

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8.2

Drugs affecting the immune response

8.3.4 8.3.4.1

Hormone antagonists Breast cancer

8.2.1 Proliferative immunosuppressants Hospital Initiation Only Azathioprine Mycophenolate mofetil 8.2.2 Corticosteroids and other immunosuppressants Ciclosporin Prednisolone Cyclosporin products should be prescribed by brand name. Hospital Use Only Tacrolimus 8.2.3 Rituximab Hospital Use Only Rituximab w w

Hospital Initiation Only (a) Neo-adjuvant therapy of postmenopausal breast cancer

Letrozole Tamoxifen Hospital Initiation Only (b) Adjuvant therapy Postmenopausal breast cancer Tamoxifen Anastrozole Premenopausal breast cancer Tamoxifen Goserelin Anastrozole + Goserelin Hospital Initiation Only (c) Metastatic breast cancer No prior adjuvant tamoxifen Letrozole Tamoxifen Prior adjuvant tamoxifen Letrozole Exemestane 8.3.4.2 Prostate cancer and gonadorelin analogues Hospital Use Only Aminoglutethimide Bicalutamide Buserelin Cyproterone Flutamide Goserelin Leuprorelin 8.3.4.3 Somatostatin analogues Hospital Use Only Octreotide

8.2.4 Other Immunomodulating drugs Hospital Use Only Interferon alfa (not approved for nonHodgkins lymphoma or malignant melanoma) 8.3 Sex hormones and hormone antagonists in malignant disease

8.3.1 Oestrogen Hospital Use Only Diethylstilbestrol 8.3.2 Progestogens Hospital Use Only Medroxyprogesterone Megestrol

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9. 9.1

NUTRITION AND BLOOD Anaemia and some other blood disorders

9.2 Fluids and electrolytes 9.2.1 Oral preparations for fluid and electrolyte imbalance 9.2.1.1 Oral Potassium Potassium chloride Potassium Removal Hospital Use Only Calcium polystyrene sulphonate Sodium polystyrene sulphonate 9.2.1.2 Oral sodium and water Hospital Use Only Sodium bicarbonate Sodium chloride Oral rehydration salts Dioralyte 9.2.1.3 Oral bicarbonate Hospital Use Only Sodium bicarbonate 9.2.2 Parenteral preparations for fluid and electrolyte imbalance 9.2.2.1 Electrolytes and water See BNF section 9.2.2.2Plasma and plasma substitutes Hospital Use Only Pentastarch infusions Dextran 40 Dextran 70 Gelofusine 9.3 Intravenous nutrition Use only on specialist advice

9.1.1 Iron deficiency anaemias 9.1.1.1 Oral iron Ferrous fumarate Ferrous gluconate Ferrous sulphate Sodium feredetate (Sytron) Iron and folic acid Pregaday 9.1.1.2 Parenteral iron Iron sorbitol 9.1.2 Drugs used in megaloblastic anaemias Folic acid (400micrograms) Hydroxocobalamin 9.1.3 Drugs used in hypoplastic, haemolytic and renal anaemias Erythropoietin Hospital Use Only Darbepoetin Epoetin alpha and beta Iron Overload Hospital Use Only Desferrioxamine 9.1.6 Drugs used in Neutropenia Hospital Use Only Filgrastim Lenograstim Molgramostim w

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9.5

Minerals

9.6

Vitamins

9.5.1 Calcium and magnesium 9.5.1.1 Calcium Supplements Calcium carbonate Calcium chloride Calcium gluconate Calcium phosphate Calcium Sandoz Sandocal 9.5.1.2 Hypercalcaemia See section 6.6 9.5.1.3 Magnesium Hospital Use Only Magnesium hydroxide Magnesium sulphate 9.5.2 Phosphorus 9.5.2.1 Phosphate Supplements Hospital Use Only Phosphate Sandoz 9.5.2.2 Phosphate-binding agents Hospital Use Only Aluminium hydroxide Calcium acetate Calcium carbonate 9.5.3 Fluoride Hospital Use Only Sodium fluoride 9.5.4 Zinc Zinc sulphate

9.6.1 Vitamin A Hospital Use Only Retinol 9.6.2 Vitamin B group Pyridoxine Thiamine Vitamin B, Compound Vitamin B, compound, strong Hospital Use Only Pabrinex 9.6.3 Vitamin C Ascorbic acid 9.6.4 Vitamin D Alfacalcidol Cholecalciferol (colecalciferol) 10microgram (400units) with (600mg calcium) Calciferol Calcitriol (not approved for use in osteoporosis and not including Calcijex) Calcium with Ergocalciferol Refer to the Fife Guidance on the treatment of Osteoporosis for information on prescribing these products for osteoporosis 9.6.5 Vitamin E Hospital Use Only Alpha tocopheryl acetate 9.6.6 Vitamin K Menadiol sodium phosphate Phytomenadione 9.6.7 Multivitamin preparations Abidec Vitamins capsules

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Vitamin and mineral supplements and adjuncts to synthetic diets Specialist initiation Only Ketovite 9.8 Metabolic disorders

Hospital Use Only Auranofin Azathioprine Ciclosporin Etanercept w Hydroxychloroquine Infliximab w Methotrexate Penicillamine Sodium aurothiomalate 10.1.4 Drugs in the treatment of gout Interval treatment Allopurinol Acute attacks Indometacin Etoricoxib Hospital Use Only Colchicine 10.2 Drugs used in neuromuscular disorders 10.2.1 Drugs which enhance neuromuscular transmission Hospital Initiation Only Pyridostigmine Hospital Use Only Edrophonium Neostigmine 10.2.2 Skeletal muscle relaxants Baclofen Diazepam Quinine

9.8.1 Drugs used in metabolic disorders Wilsons Disease Hospital Use Only Penicillamine Carnitine deficiency Hospital Use Only L-carnitine 10. MUSCULOSKELETAL AND JOINT DISEASES

10.1 Drugs used in rheumatic diseases and gout 10.1.1 Non steroidal antiinflammatory drugs (NSAIDs) Standard NSAIDs 1st Choice Ibuprofen Alternative Diclofenac Naproxen Mefenamic Acid is still used for treatment of dysmenorrhoea Cox II agents Celecoxib Meloxicam Use celecoxib 200mg twice a day in RA patients only 10.1.2.2 Local corticosteroid injections Methylprednisolone Triamcinolone 10.1.3 Drugs which suppress the rheumatic disease process Leflunomide Sulfasalazine w

Hospital Initiation Only Dantrolene

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10.3 Drugs for the relief of softtissue inflammation 10.3.1 Enzymes Hospital Use Only Hyaluronidase

Prednisolone acetate 1% (Predforte) 11.4.2 Other Anti-inflammatory preparations Nedocromil sodium Sodium cromoglicate 11.5 Mydriatics and cycloplegics

10.3.2

Rubefacients Antimuscarinics Cyclopentolate Tropicamide Hospital Initiation Only Atropine Homatropine Sympathomimetics Hospital Initiation Only Apraclonidine Phenylephrine 11.6 Treatment of glaucoma Beta-blockers Hospital Initiation Only Betaxolol Carteolol Levobunolol Timolol Prostaglandin analogues Hospital Initiation Only Bimatoprost Latanoprost Travoprost Sympathomimetics Hospital Initiation Only Brimonidine

Transvasin Movelat Counter-irritant for post herpetic neuralgia Capsaicin Poultices Kaolin poultice 11. EYE

11.3 Anti-infective eye preparations 11.3.1 Antibacterials Chloramphenicol Ciprofloxacin Fusidic acid Gentamicin Ofloxacin Polyfax Propamidine 11.3.2 Antifungal See BNF section 11.3.3 Antivirals Aciclovir 11.4 Corticosteroids and other anti-inflammatory preparations 11.4.1 Corticosteroids Betamethasone Prednisolone Phosphate 0.5% (Predsol) Hospital Initiation Only Betnesol N Fluorometholone Maxidex

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Carbonic anhydrase inhibitors and systemic drugs Hospital Initiation Only Acetazolamide Dorzolamide Miotics Hospital Use Only Pilocarpine eye drops Combination products Hospital Initiation Only Cosopt Xalacom 11.7 Local anaesthetics Tetracaine Proxymetacaine Hospital Use Only Oxybuprocaine (Benoxinate) Cocaine Lidocaine and Fluorescein Proxymetacaine and fluorescein 11.8 Miscellaneous ophthalmic preparations 11.8.1 Tear deficiency, ocular lubricants and astringents Carbomers Hydroxyethylcellulose Hypromellose Ilube Lacri-Lube Polyvinyl alcohol 11.8.2 Ocular diagnostic and perioperative preparations Ocular diagnostic preparations Fluorescein Hospital Use Only Rose bengal

Ocular peri-operative drugs Hospital Initiation Only Flurbiprofen Ketorolac Hospital Use Only Acetylcholine chloride Apraclonidine eye drops Diclofenac 11.9 Contact lenses See BNF section 12. EAR, NOSE AND OROPHARYNX

12.1 Drugs acting on the ear 12.1.1 Otitis externa Aluminium acetate Audicort Betamethasone Betnesol-N Clotrimazole Framycetin Gentamicin Gentisone HC Locorten-Vioform Otomize Otosporin Tri-Adcortyl Otic 12.1.3 Removal of wax Cerumol Sodium bicarbonate 12.2 Drugs acting on the nose 12.2.1 Drugs used in nasal allergy Azelastine Beclometasone Betamethasone Budesonide Fluticasone Nasal Spray Mometasone Nasal Spray Sodium cromoglicate

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12.2.2 Topical nasal decongestants Sympathomimetics Ephedrine Xylometazoline Antimuscarinics Ipratropium 12.2.3 Anti-infective nasal preparations Mupirocin Naseptin 12.3 Drugs acting on the oropharynx 12.3.1 Drugs for oral ulceration and inflammation Adcortyl in Orabase Benzydamine Choline salicylate Hydrocortisone pellets 12.3.2 Oropharyngeal antiinfective drugs Amphotericin Miconazole Nystatin 12.3.3 Lozenges, sprays and gels Not recommended. 12.3.4 Mouthwashes, gargles and dentifrices Chlorhexidine Hydrogen peroxide Sodium chloride 12.3.5 Treatment of dry mouth Artificial saliva 13. SKIN

Keri lotion Oilatum Paraffin, white soft Paraffin, yellow soft Unguentum M 13.2.1.1 Emollient bath additives Alpha-Keri Bath Aveeno Balneum Hydromol Emollient Oilatum Emollient 13.2.2 Barrier preparations Dimeticone Sudocrem Zinc Cream Zinc Ointment 13.3 Topical local anaesthetic and antipruritic preparations Calamine Crotamiton 13.4 Topical corticosteroids Topical corticosteroids can be classified according to their potency: Mildly potent Eurax-hydrocortisone Fluocinolone acetonide 0.0025% (Synalar 1 in 10) Hydrocortisone base or acetate (0.1 2.5%) Mildison Moderately potent Alphaderm Clobetasone butyrate (Eumovate ) Desoximetasone (0.05%) (Stiedex LP) Fluocinolone acetonide 0.00625% (Synalar 1 in 4) Potent Beclometasone dipropionate (Propaderm) Betamethasone dipropionate (Diprosone) Betamethasone valerate Desoximetasone (0.25%) (Stiedex) Diprosalic Fluocinolone acetonide (0.025%) (Synalar) Hydrocortisone butyrate (Locoid) Mometasone (Elocon)

13.2 Emollient and barrier preparations 13.2.1 Emollients Aqueous cream Calmurid Dimeticone Diprobase E45 Emulsifying ointment Hydromol Kamillosan

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Hospital Use Only Fluticasone cream only (Cutivate) Very potent Clobetasol propionate (Dermovate) Topical corticosteroids with antibacterials Mildly potent Canesten HC Daktacort Fucidin H Nystaform HC Moderately potent Trimovate Potent Betnovate-C Fucibet Lotriderm Synalar C 13.5 Preparations for psoriasis and eczema 13.5.1 Preparations for eczema Ichthammol 13.5.2 Preparations for Psoriasis Topical preparations Alphosyl HC Calcipotriol Carbo-Dome Coal tar Cocois Dithranol Polytar emollient Pragmatar Psoralen paint Psorin Salicylic Acid Oral retinoids for psoriasis Hospital Use Only Acetretin

13.5.3 Drugs affecting the immune response Hospital Use Only Ciclosporin Methotrexate Tacrolimus Ointment Pimecrolimus 1% cream See Full formauley for prescribing requirements 13.6 Preparations for acne 13.6.1 Topical preparations for acne Benzoyl peroxide Clindamycin (not including vaginal cream) Duac Erythromycin Isotretinoin gel Quinoderm Tretinoin Zineryt 13.6.2 Oral preparations for acne Dianette Erythromycin Minocycline Oxytetracycline Oxytetracycline is the tetracycline of first choice in acne. Hospital Use Only Isotretinoin 13.7 Preparations for warts and calluses Salactol Silver nitrate Anogenital Warts Podophyllotoxin Podophyllum 13.8 Sunscreens and camouflaging preparations

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13.8.1 Sunscreen preparations Roc Total Sunblock (UVB-SPF > 25) E45 Sun sunblock (UVB-SPF 15) Uvistat ultrablock (UVB-SPF 30) Uvistat lipscreen (UVB-SPF 15) 13.8.2 Camouflagers Covermark Veil 13.9 Shampoos and other scalp preparations Alphosyl 2 in1 Capasal Ceanel Concentrate Coal tar Polytar Povidone iodine Selenium sulphide 13.10 Anti-infective skin preparations 13.10.1 Antibacterial preparations 13.10.1.1 Topical only Mupirocin Silver sulfadiazine In Acute Trust prescribe on the advice of the Tissue Viability Nurse only Hospital Use Only Graneodin 13.10.1.2 Topical and systemic Chlortetracycline Fusidic acid Metronidazole (not including Rozex or Zidoval ) 13.10.2 Antifungal preparations Clotrimazole Econazole ) Griseofulvin Miconazole Nystaform Nystatin Terbinafine 13.10.3 Antiviral preparations

Aciclovir Idoxuridine Penciclovir 13.10.4 Parasiticidal preparations Benzyl benzoate Carbaryl Malathion Permethrin Phenothrin 13.10.5 Preparations for minor cuts and abrasions Magnesium sulphate Povidone-iodine 13.11 Skin cleansers and anitseptics 13.11.1 Alcohols and saline Industrial methylated spirits Sodium chloride Surgical spirit 13.11.2 Chlorhexidine salts Chlorhexidine Chlorhexidine/Cetrimide 13.11.3 Cationic surfactants and soaps See BNF section 13.11.4 Chlorine and iodine Povidone-iodine 13.11.5 Phenolics See BNF section 13.11.6 Astringents, oxidisers and dyes Hydrogen peroxide Potassium permanganate Zinc sulphate 13.11.7 Desloughing agents Aserbine Hioxyl Specialist Use Only Varidase topical 13.12 Antiperspirants Aluminium chloride hexahydrate 13.13 Wound management See BNF section

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Fife Acute Hospitals NHS Trust has a Wound Management Formulary. Refer to this for advice on the use of wound management products within the hospital setting. 14. IMMUNOLOGICAL PRODUCTS AND VACCINES

15.1.4 Sedative and analgesic perioperative drugs 15.1.4.1 Anxiolytics and neuroleptics Hospital Use Only Alimemazine Clomethiazole Chlorpromazine Diazepam Lorazepam Midazolam Temazepam tablets 15.1.4.2 Non opioid analgesics Hospital Use Only Diclofenac Ketorolac injection Tenoxicam injection 15.1.4.3 Opioid analgesics Hospital Use Only

14.4 Vaccines and Antisera See BNF section 15 15.1 ANAESTHESIA General anaesthetics

15.1.1 Intravenous anaesthetics Hospital Use Only Etomidate Ketamine Propofol Thiopental 15.1.2 Inhalational anaesthetics Hospital Use Only Desflurane Entonox/Equanox Halothane Isoflurane Nitrous oxide Sevoflurane 15.1.3 Antimuscarinic premedication drugs Hospital Use Only Atropine Glycopyrronium Hyoscine hydrobromide

Alfentanil Fentanyl injection Morphine Pethidine Remifentanil 15.1.5 Muscle relaxants Non depolarising Hospital Use Only Atracurium Mivacurium Pancuronium Rocuronium Vecuronium Depolarising Hospital Use Only Suxamethonium

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15.1.6 Anticholinesterases used in anaesthesia Hospital Use Only Edrophonium Neostigmine Robinul-Neostigmine 15.1.7 Antagonists for central and respiratory depression Hospital Use Only Doxapram Flumazenil Naloxone 15.1.8 Antagonists for malignant hyperthermia Hospital Use Only Dantrolene 15.2 Local anaesthesia Hospital Use Only Tetracaine gel Bupivacaine Cocaine Emla Levobupivicaine Lidocaine Phenol Prilocaine Procaine 16. EMERGENCY TREATMENT OF POISONING

See BNF Section for details

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