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NHSE specialised commissioned services only. Not commissioned from any acute Trust in Surrey Heartlands.
However, this drug may be used in the emergency treatment of urea cycle disorders in patients on acute admission.
- Not Specified
- Intravenous infusion
- Intravenous injection (IV)
- Tablets
- Intravenous infusion
- Intravenous injection (IV)
- Oral solution
- Tablets
- Infusion
- Vaginal gel
- Powder
- Oral solution
- Tablets
RESTRICTED - requires Hepatologist Specialist approval
- Oral solution
- Tablets
- Oral solution
- Tablets
- Not Specified
- Tablets
- Prophylaxis of depressive episodes in bipolar disorder.
- Prophylaxis of recurrent depression (off-label use).
Initiation and stabilisation by the specialist mental health team for at least 1 month before any request for transfer of prescribing responsibility to primary care.
NOTE - brand prescribing is not required for mood stabilisation. Prescribe generically.
Risk of rash on treatment initiation or after a treatment break.
- Dispersible tablets
- Prophylaxis of depressive episodes in bipolar disorder.
- Prophylaxis of recurrent depression (off-label use).
Initiation and stabilisation by the specialist mental health team for at least 1 month before any request for transfer of prescribing responsibility to primary care.
NOTE - brand prescribing is not required for mood stabilisation. Prescribe generically.
Risk of rash on treatment initiation or after a treatment break.
Reserve for use in patients who are unable to swallow tablets.
- Dispersible tablets
- Tablets
- Injection
- Intramuscular injection (IM)
NHSE Specialist Centres - only commissioned from RSFT in Surrey Heartlands.
SASH - only for use under shared care arrangements with specialist centres.
- Injection
- Capsules
- Oro-dispersible tablets
- Liquid
- Oral solution
- Oral suspension
- Oro-dispersible tablets
- Capsules
Hyperphosphataemia in patients with chronic kidney disease
Not on Surrey Heartlands Trust formularies. Trusts with renal centres (locally this is Epsom, Frimley & Brighton) will retain prescribing responsibility’.
- Not Specified
On recommendation of TVN only
- Eye drops
- Eye drops (preservative free
- unit dose)
- Eye drops
- Eye drops (preservative free)
- Eye drops
- Subcutaneous injection (sc)
- Intravenous infusion
Lecanemab used in Alzheimer’s disease is currently not available in the NHS. Eisai (the manufacturer and market authorisation holder for lecanemab (Leqembi®)) has started to make the drug available for patients to access through independent sector clinics.
The information from NHSE here provides advice for clinical teams who may be asked to support referrals for private treatment or otherwise assess, advise and possibly treat a small number of patients who could present with potential adverse treatment effects, including symptomatic Amyloid-Related Imaging Abnormalities (ARIA).
- Granules
- Tablets
Only commissioned from RSFT.
- Tablets
Principles for shared care found here: https://surrey.res.services/PAD/Profile/NonClinicalProfile/9136
- Tablets
Principles for shared care found here: https://surrey.res.services/PAD/Profile/NonClinicalProfile/9136
- Tablets
- Subcutaneous injection (sc)
Refer to St Luke's Protocols for current indications and further detail.
Filgrastim is the preferred treatment option.
- Tablets
- Tablets
- Tablets
1st month supply from specialist team before request for primary care prescribing.
- Tablets
Off-label use
- Injection
The specialist team should initiate treatment and administer the 1st injection prior to transfer of care.
- Injection
The specialist team should initiate treatment and administer the 1st injection prior to transfer of care.
- Intramuscular injection (IM)
- Subcutaneous injection (sc)
- Subcutaneous injection (sc)
See PAD entry for current shared care document "Precocious puberty"
General principles for shared care found here: https://surrey.res.services/PAD/Profile/NonClinicalProfile/9136
- Subcutaneous injection (sc)
Primary Care prescribing appropriate on recommendation from the specialist team.
- Injection
- Injection
EXISTING patients only. Do not initiate in new patients.
- Injection
- Granules
- Oral solution
- Tablets
- Infusion
- Oral solution
- Subcutaneous injection (sc)
- Tablets
On advice from palliative care specialist team
- Eye drops (unit dose)
- Epidural infusion
- Injection
- Intravenous injection (IV)
NHSE specialised commissioned services only. Not commissioned from any acute Trust in Surrey Heartlands.
L-carnitine / levocarnitine in valproate toxicity has a separate formulary entry.
- Capsules
NHSE specialised commissioned services only. Not commissioned from any acute Trust in Surrey Heartlands.
However, this drug may be used in the emergency treatment of urea cycle disorders in patients on acute admission
- Oral solution
NHSE specialised commissioned services only. Not commissioned from any acute Trust in Surrey Heartlands.
However, this drug may be used in the emergency treatment of urea cycle disorders in patients on acute admission
30% paediatric solution (1.5 gram in 5ml)
- Intravenous infusion
- Tablets
- Oral solution
- Inhalation
This drug / device has not been assessed for inclusion on the formulary. Contact Pharmacy for advice.
- Tablets
- Intestinal gel
This product has not been assessed for inclusion on the formulary. Contact your pharmacy team for advice on making an applicationto the APC.
- Eye drops
- Eye drops (preservative free
- unit dose)
- Oral solution
- Tablets
- Infusion
- Not Specified
Nebuliser solution
- Oral solution
This drug (for this indication) has not been assessed for inclusion on the formulary. Contact your pharmacy team for advice on making an application to APC.
- Subcutaneous infusion
- Subcutaneous injection (sc)
- Oral solution
- Tablets
This drug (for this indication) has not been assessed for inclusion on the formulary. Contact your pharmacy team for advice on making an application to APC.
- Tablets
This drug (for this indication) has not been assessed for inclusion on the formulary. Contact your pharmacy team for advice on making an application to APC.
- Tablets
- Injection
- Oral solution
- Subcutaneous infusion
- Tablets
- Intrauterine device (progestogen only)
Levosert
- Intrauterine device (progestogen only)
Mirena
May be particularly useful in women with heavy menstrual bleeding requiring (reversible) contraception.
Option for polycystic ovary syndrome.
RSFT: 2nd line for contraception and heavy menstrual bleeding for use when Benilexa is unsuitable of unavailable.
RSFT: Endometrial protection as part of HRT in both peri and postmenopausal women
- Tablets
Norgeston
progesterone only pill, POP
- Intrauterine device (progestogen only)
Jaydess 13.5mg
SASH: Jaydess is restriced to those patients who require a smaller size / lower dose of levonorgestrel
- Intrauterine device (progestogen only)
Kyleena 19.5mg.
RSFT: Kyleena should only be used in nulliparous patients under 25 years onld and those unable to use the alternative devices.
- Intrauterine device (progestogen only)
Benilexa One Handed
RSFT: 1st line for contraception and treatment of heavy menstrual bleeding for females between the ages of 18 and 45 years.
Option for polycystic ovary syndrome. May be particularly useful in women wih hevy menstrual bleeding requiring (reversible) contraception.
- Not Specified
Prescribe generically.
Not to be prescribed by brand. There are several brands available to purchase over the counter which are considerably more expensive.
- Tablets
Emerres, Emerres Una, Ezinelle, Levonelle, Levonelle One Step, LoviOne, Melkine, Postinor, Upostelle
- Intrauterine device (progestogen only)
Levonorgestrel recommended for replacement every 5 years (off-label use) as per BMS: https://thebms.org.uk/wp-content/uploads/2023/04/14-BMS-TfC-Progestogens-and-endometrial-protection-APR2023-A.pdf
- Mirena - licensed for endometrial protection but only for a duration of 4 years. Agreed to use for a duration of 5 years before replacement (off-label).
- Intrauterine device (progestogen only)
- Intravenous infusion
- Tablets
- Oral solution
- Injection
RSFT: For administration when there is long term absence of enteral route on ICU only. For myxoedema coma only on endocrinologist recommendation
SASH: For myxoedema coma only
- Not Specified
- Infusion
- Injection
- Medicated plaster
Restricted to specialist pain or palliative care teams. See PAD for information requirements on transfer to primary care
- Ointment
5% ointment - relief of pain from pruritis, heamorrhoids etc
- Cream
4% cream - for surface anaesthesia prior to cannulation / venepuncture
- Topical solution
4% topical solution. Unlicensed
- Injection
1% and 2% injection.
Note - 0.5% injection also used at RSFT and SASH
- Oromucosal spray
- Gel
- Medicated plaster
Off-label use. Trusts must ensure that appropriate durations can be supplied without requests to primary care for further supply
- Medicated plaster
Post herpetic neuralgia only. Acute Trusts are restricted to Pain Team initiation only
- Spray
This product has not been assessed for addition to formulary. Contact pharmacy for advice.
Note - this is a P medicine which is available to purchase from a Pharmacy.
- Cartridges
- Injection
2% lidocaine and 1:80,000 adrenaline in a 2.2mL cartridge
- Cartridges
- Injection
2% lidocaine and 1:80,000 adrenaline in a 2.2ml cartridge
2% lidocaine and 1:80,000 adrenaline in a 1.8ml cartridge
Lidocaine 400mg/Adrenaline (base) 100microg/20ml inj vials
Lidocaine 200mg/Adrenaline (base) 100microg/20ml inj vials
- Gel
Urethral application
- Gel
Urethral application
- Nasal spray
Lidocaine 5% / phenylephrine 0.5% nasal spray.
Anaesthesia before nasal surgery, endoscopy, laryngoscopy or removal of foreign bodies from the nose.
ASPH - Restricted to ENT at SPH.
- Nasal spray
- Cream
For anaesthesia before minor skin procedures and venepuncture.
- Spray
This product has not been assessed for addition to formulary. Contact pharmacy for advice.
Note - this is a P medicine which is available to purchase from a Pharmacy.
- Gel
Unlicensed.
SASH - For ED use only. First line treatment for children aged 1 year and over with wounds less than 5cm who are able to tolerate local anaesthetic injection with suitable wounds that require suturing.
Paediatric use only
- Capsules
- Tablets
- Tablets
- Infusion
- Suspension
- Tablets
- Oral suspension
- Tablets
- Infusion
- Suspension
- Tablets
- Tablets
The specialist team should initiate treatment and prescribe at least 1 month of linzagolix prior to transfer of care.
- Tablets
- Not Specified
- Intravenous injection (IV)
- Oral solution
The oral solution has not been reviewed for addition to the formulary. Please contact your Pharmacy Team for advice.
- Capsules
- Tablets
Initiation by consultant endocrinologists and stabilisation for at least 3 months before requesting shared care.
Capsules are considerably lower cost than the tablets in Primary Care.
Patients receiving tablets in primary care may be switched to capsules (licensed and bioequivalent).
Principles for shared care found here: https://surrey.res.services/PAD/Profile/NonClinicalProfile/9136
- Oral solution
The oral solution has not been reviewed for addition to the formulary. Please contact your Pharmacy Team for advice.
- Capsules
- Tablets
Initiation by consultant endocrinologists and stabilisation for at least 3 months before requesting shared care.
Capsules are considerably lower cost than the tablets in Primary Care.
Patients receiving tablets in primary care may be switched to capsules (licensed and bioequivalent).
Principles for shared care found here: https://surrey.res.services/PAD/Profile/NonClinicalProfile/9136
- Oral solution
The oral solution has not been reviewed for addition to the formulary. Please contact your Pharmacy Team for advice.
- Capsules
- Oral solution
The oral solution has not been reviewed for addition to the formulary. Please contact your Pharmacy Team for advice.
- Capsules
- Oral solution
The oral solution has not been reviewed for addition to the formulary. Please contact your Pharmacy Team for advice.
- Capsules
- Tablets
Initiation by consultant psychiatrists / specialist mental health team only
- Oral solution
The oral solution has not been reviewed for addition to the formulary. Please contact your Pharmacy Team for advice.
- Liquid
Prescribe on advice from specialist e.g. dietitian
- Subcutaneous injection (sc)
- Not Specified
- Subcutaneous injection (sc)
- Capsules
Adult ADHD - to be diagnosed, initiated and stabilised on ADHD medication by a SABP specialist before shared-care can be requested.
See PAD entry for current shared care document "CNS stimulants in ADHD shared care - May 2016"
Patients transitioning from children's services can continue to be managed under existing arrangements
General principles for shared care found here: https://surrey.res.services/PAD/Profile/NonClinicalProfile/9136
- Capsules
Stable patients (cohort 1) = BLUE (with specialist team initiation) where:
- open-access discharge has been accepted by GP practice under the LCS from SABPFT.
- and the treatment is stabilised, prior to transfer of care.
Where a GP practice has not signed up to the LCS or a patient does not meet the criteria in the LCS (cohort 1), those patients will remain under shared care.
See here for ADHD shared care agreements (LCS and non-LCS)
General principles for shared care can be found here: https://surrey.res.services/PAD/Profile/NonClinicalProfile/9136
- Capsules
Patients currently receiving specialist treatment for other mental health or neurological comorbidities (cohort 2) = AMBER (shared care)
Where a GP practice has not signed up to the LCS or a patient does not meet the criteria in the LCS (cohort 2), those patients will remain under shared care.
See here for ADHD shared care agreements (LCS and non-LCS)
General principles for shared care can be found here: https://surrey.res.services/PAD/Profile/NonClinicalProfile/9136
- Capsules
Complex patients (cohort 3) = Red (will remain with the specialist service)
- Tablets
- Tablets
- Oral solution
- Tablets
- Modified release tablets
- Tablets
Prescribe by BRAND. Lithium carbonate and lithium citrate are not equivalent.
Initiation and stabilisation by the specialist mental health team for at least 1 month before any request to transfer prescribing responsibility to primary care.
SASH- (Tablets non-formulary)
- Modified release tablets
- Tablets
Prophylaxis of recurrent depression
Prescribe by BRAND. Lithium carbonate and lithium citrate are not equivalent.
Initiation and stabilisation by the specialist mental health team for at least 1 month before any request to transfer prescribing responsibility to primary care.
- Modified release tablets
- Tablets
Prescribe by BRAND. Lithium carbonate and lithium citrate are not equivalent.
Initiation and stabilisation by the specialist mental health team for at least 1 month before any request to transfer prescribing responsibility to primary care.
SASH- (Tablets non-formulary)
- Liquid
- Oral solution
Prescribe by BRAND. Lithium carbonate and lithium citrate are not equivalent.
Initiation and stabilisation by the specialist mental health team for at least 1 month before any request to transfer prescribing responsibility to primary care.
- Liquid
- Oral solution
Prophylaxis of recurrent depression.
Prescribe by BRAND. Lithium carbonate and lithium citrate are not equivalent.
Initiation and stabilisation by the specialist mental health team for at least 1 month before any request to transfer prescribing responsibility to primary care.
- Liquid
- Oral solution
Prescribe by BRAND. Lithium carbonate and lithium citrate are not equivalent.
Initiation and stabilisation by the specialist mental health team for at least 1 month before any request to transfer prescribing responsibility to primary care.
- Eye drops
Sodium cromoglycate 2% eye drops or olopatadine eye drops may be a suitable alternative.
- Oral suspension
- Tablets
- Capsules
- Capsules
- Tablets
- Oro-dispersible tablets
- Capsules
- Oro-dispersible tablets
- Tablets
- Oral solution
- Tablets
- Oral solution
Loratadine 5mg/5ml oral solution sugar free is the preferred option in patients unable to swallow tablets.Available to buy over the counter.
Exceptions may apply see Guidelines on PAD
- Tablets
Prescribe generically.
Available to buy over the counter.
Exceptions may apply see Guidelines on PAD
- Oral solution
- Tablets
Advise patient that these products can be purchased over the counter for short-courses required for acute urticaria
- Tablets
SASH - for use in patients with decompensated liver disease.
Tablets may be used sublingually.
- Injection
SASH- If patient presents with delirium tremens and oral lorazepam is ineffective, parenteral lorazepam can be given.
- Tablets
For short term use only
Do not offer a benzodiazepine for the treatment of any anxiety disorder in primary or secondary care except as a short-term measure (2-4 weeks) during crisis. Follow the advice in the BNF on the use of a benzodiazepine in this context.
Avoid in the elderly
Beware of MHRA advice on coprescribing of benzodiazepines and opioid and risk of death
- Tablets
- Tablets
- Injection
- Tablets
- Injection
- Tablets
- Tablets
- Tablets
MHRA alert: Hydrochlorothiazide risk of non-melanoma skin cancer
- Eye drops
- Not Specified
- Not Specified
- Tablets
Initiation by a Mental Health specialist and stabilisation for a minimum of 1 month before any request to transfer prescribing responsibility.
- Tablets
Hepatology use only - treating thrombocytopenia in people with chronic liver disease needing a planned invasive procedure as per NICE TA617
- Not Specified
- Not Specified
- Capsules