Formulary Search
Search Results : Pain (Pethidine hydrochloride - Pain )
Records returned : 57 (on 20 Oct 2025 at 07:45:31).
Return to search results for ' Pain '.
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Drug
Indication
Status
Restrictions/Comments
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- Injection
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Important
Acute pain, including obstetric analgesia
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- Tablets
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- Tablets
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Tablets can be dissolved in water (off-label)
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- Oral solution
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Important
Codeine phosphate oral solution 25mg/5ml.
Codeine linctus 15mg/5ml is ONLY licensed for cough.
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- Injection
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- Oral solution
- Tablets
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- Modified release tablets
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Consider use if standard release tablets are not tolerated or compliance is an issue.
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- Oral suspension
- Tablets
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- Intravenous infusion
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Restricted for patients where an oral NSAID is not suitable.
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- Tablets
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Preferred
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- Effervescent tablets
- Soluble tablets
- Suppositories
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Important
Reserve for patients who cannot swallow solid dose forms.
Soluble / effervescent preparations have a high sodium content and more expensive than ordinary tablets.
Suppositories for use when oral route is not suitable
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- Oral suspension
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Important
120mg/5ml and 250mg/5ml reserved for patients who cannot swallow solid dose forms or where sodium content of dispersible preparations is a problem.
Non-formulary: Paracetamol oral suspension 500mg/5ml. Much more expensive. Use a soluble formulation.
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- Intravenous infusion
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Important
Prescribe in milligrams for doses <1g.
Review infusion prescriptions after 48-72 hours.
Note risk of overdose with IV paracetamol.
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- Patches
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Important
Prescribe by brand to prevent prescribing, dispensing and administration errors. Care: available as 3-day, 4-day and 7-day patches.
Primary Care - the preferred brand for 7-day patches is BuTec.
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- Sublingual tablets
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Important
Use in patients unable to tolerate oral medications or where morphine is contra-indicated. If this formulation is indicated, prescribing may be initiated and stabilised by a specialist service but has the potential to transfer to primary care WITHOUT a formal shared care agreement. In some circumstances a specialist may recommend that prescribing can be started in primary care
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- Tablets
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Fixed combinations are less preferable. Low dose (8/500 co-codamol) not recommended. Secondary Care - for A&E / discharge only.
SASH: ONLY 30/500 strength is formulary
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- Capsules
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Capsules are more costly than tablets in primary care. Fixed combinations are less preferable. Low dose (8/500 co-codamol) not recommended.
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- Effervescent tablets
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Important
Fixed combinations are less preferable. Low dose (8/500 co-codamol) not recommended. Avoid effervescent formulations (high sodium content and more costly). Reserve for swallowing difficulties or patients with feeding tubes. Secondary Care - for A&E / discharge only.
SASH: ONLY 30/500 strength is formulary
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- Tablets
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Fixed combinations are less preferred. RSCH - prescribe as separate components - combination is non-formulary at RSCH.
The MHRA advises when prescribing dihydrocodeine with paracetamol, the tablet strength and dose must be clearly indicated
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- Immediate release tablets
- Oral solution
- Oro-dispersible tablets
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Important
Orodispersible tablets are a cost-effective alternative to oral solution. Reserve oral solution and orodispersible tablets for patients in whom a solid dose form is not suitable.
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- Capsules (slow release)
- Granules (slow release)
- Tablets (slow release)
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Important
Prescribe modified-release preparations by brand - refer to local guidelines for preferred brands.
Zomorph capsules (12-hourly) can be opened for administration in patients unable to swallow the capsules.
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- Injection
- Solution for infusion
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Important
See separate listing for palliative care
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- Suppositories
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- Tablets
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Important
Reserve for when alternatives are contraindicated or ineffective.
At RSFT - initiation by pain team only.
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- Capsules
- Oral solution
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Important
For patients unable to tolerate / poor response to morphine. Modified-release preparations to be prescribed by brand.
Shortec is the preferred immediate-release brand for prescribing in Primary Care.
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- Modified release tablets
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Important
For use in patients where morphine sulfate is not suitable / not tolerated.
Modified-release preparations to be prescribed by brand.
Longtec is the preferred modified-release brand for prescribing in Primary Care.
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- Injection
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Important
Alternative for patients unable to tolerate / poor response to morphine.
Care with dose conversion.
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- Capsules
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Important
Consider use where maximum tolerated doses of codeine / dihydrocodeine are ineffective.
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- Modified release capsules
- Modified release tablets
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Important
Branded prescribing is recommended for modified release tramadol. Do not confuse 12 hourly and 24 hourly preparations.
Consider tramadol where maximum tolerated doses of codeine / dihydrocodeine are ineffective.
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- Soluble tablets
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Important
Reserved for patients unable to swallow solid dose forms or for administration via an enteral tube.
Consider use where maximum tolerated doses of codeine / dihydrocodeine are ineffective.
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- Oro-dispersible tablets
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Important
Reserved for patients unable to swallow solid dose forms or for administration via an enteral tube.
Consider use where maximum tolerated doses of codeine / dihydrocodeine are ineffective.
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- Injection
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- Oral solution
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- Oral drops
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- Patches
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Important
Not for use in opioid naïve patients. Limited place in therapy - on specialist advice only.
Prescribe as Matrifen brand in Primary Care.
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- Injection
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Important
See separate listing for use in assisted ventilation and anaesthesia
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- Injection
- Nasal spray
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Important
100mcg in 2ml injection used intranasally in paediatrics for painful procedures.
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- Buccal tablets
- Buccal/sublingual
- Lozenges
- Nasal spray
- Sublingual tablets
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Important
Immediate release fentanyl preparations are non-formulary for all pain indications EXCEPT for breakthrough pain in patients receiving opioid therapy for cancer pain.
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- Injection
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Important
See separate listings for palliative care and use in anaesthesia.
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- Injection
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Important
Limited stock - restrictions apply. Contact Pharmacy.
Safety alert for High Dose
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- Oral solution
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Important
On advice of Pain Team, Consultant Anaesthetist, Intensivist only.
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- Injection
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Important
On advice of Pain Team, Consultant Anaesthetist, Intensivist only.
Note - injection may be used sublingually or by buccal route (off-label use)
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- Intramuscular injection (IM)
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Important
Obstetric analgesia
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- Tablets
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Important
Tablets - Not for chronic or acute, non-malignant pain.
Intramuscular injection used in obstetric pain.
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- Inhalation
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Important
Acute, trauma pain.
RSFT - for
- Use during removal of brachytherapy
- Transperineal prostate biopsies
- Pain management by the acute pain team for adult non-obstetric patients
- Procedural pain relief in gynaecological outpatients excluding obstetrics or paediatrics patients
- Pain management during invasive procedures undertaken in the radiology suite
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- Not Specified
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Important
This status applies to the use of aspirin for pain.
Refer to separate formulary entries for caridology indications.
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- Not Specified
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- Tablets
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Important
Fixed combinations are less preferred.
The MHRA advises when prescribing dihydrocodeine with paracetamol, the tablet strength and dose must be clearly indicated
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Formulations :
- Tablets
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Important
Fixed combinations are less preferred.
The MHRA advises when prescribing dihydrocodeine with paracetamol, the tablet strength and dose must be clearly indicated
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- Not Specified
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Important
No longer licensed because of safety concerns, particularly toxicity in overdose.
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- Not Specified
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Important
Not for chronic or acute, non-malignant pain. See separate formulary entry for use in neuropathic pain.
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- Not Specified
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- Not Specified
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Important
Not for chronic or acute, non-malignant pain. See separate formulary entry for use in neuropathic pain
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- Sublingual tablets
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- Not Specified
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- Not Specified
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