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 Formulary Chapter 9: Nutrition and blood - Full Chapter
Notes:

Review date: July 2022

Non-formulary drugs: Any drug or formulation not listed in the formulary is deemed to be non-formulary.

Off-label use: Drugs are included in the formulary for their licensed indications – where inclusion of off-label use is considered to be included in the formulary this is specifically stated in the formulary entry for the drug N.B. also see Paediatrics note below.

Paediatrics: Drugs are included in the formulary for paediatric use for their BNF for Children recommended indications (indicated by symbol View childrens BNF) which may be off-label, unless otherwise stated. All drugs are deemed to have the same RAG status as they have for adults unless stated otherwise.

NHS England Specialised Commissioning
Drugs carrying the NHS England logo are commissioned by them. Links to key documents, national programmes of care, and clinical reference groups are found below.

NHSE NHS England Specialised Commissioning: Key documents

NHSE NHS England Specialised Commissioning: National programmes of care and clinical reference groups

Chapter Links...
 Details...
09.01  Anaemias and some other blood disorders
09.01.01  Iron-deficiency anaemias
09.01.01.01  Oral iron
 note 

Increasing absorption of iron is not a licensed indication for Ascorbic Acid and is not routinely recommended. To enhance iron absorption, patients should be advised to take iron preparations on an empty stomach. Iron absorption may be increased if a person has a high intake of fish, or red or white meat; decreased if a person has a high intake of phytate (for example from wholegrain cereals), polyphenols (for example from tea and coffee), calcium (for example from dairy products), or if the person is taking medication that raises the gastric pH (for example antacids and proton pump inhibitors).

Ferric Maltol (Ferracru®)
View adult BNF View SPC online
Formulary
Amber Initiated

Hard capsules 30mg (30mg iron)

For treatment of iron deficiency anaemia (IDA) in inflammatory bowel disease (IBD).

The first course of ferric maltol must be supplied in full by the specialist.

GREY for treatment of iron deficiency in adults without inflammatory bowel disease.

 
Link  FERRIC MALTOL hard capsules (Feraccru®) for the treatment of iron deficiency anaemia in adult patients with inflammatory bowel disease, Pan Mersey Area Prescribing Committee policy statement
Link  FERRIC MALTOL hard capsules (Feraccru®) for iron deficiency in adults, Pan Mersey Area Prescribnig Committee policy statement
   
Ferrous Fumarate
View adult BNF View SPC online View childrens BNF
Formulary
Green
Tablets 210mg (68mg iron)
Syrup sugar-free 140mg (45mg iron)/5ml 
   
Ferrous Sulphate
View adult BNF View SPC online View childrens BNF
Formulary
Green
Tablets 200mg (65mg iron) 
   
Sodium Feredetate (Sytron®)
View adult BNF View SPC online View childrens BNF
Formulary
Green
Elixir sugar free 190mg (27.5mg iron)/5ml 
   
09.01.01.01  Compound iron preparations
09.01.01.02  Parenteral iron to top
 note 

Dose calculated according to body weight and iron deficit – consult product literature. Anaphylactic reactions can occur - see link below to MHRA warning and advice.

Ferric Carboxymaltose (Ferinject®)
View adult BNF View SPC online View childrens BNF
Formulary
Red
Injection iron 50mg/ml 
   
Iron Dextran (CosmoFer®)
View adult BNF View SPC online View childrens BNF
Formulary
Red
Injection iron 50mg/ml 
   
Iron Isomaltoside (Diafer®, Monofer®)
View adult BNF View SPC online
Formulary
Red

Injection iron 100mg/ml

Paediatrics: no BNFc entry - seek specialist advice

 
   
Iron Sucrose (Venofer®)
View adult BNF View SPC online View childrens BNF
Formulary
Red
Injection iron 20mg/ml 
   
09.01.02  Drugs used in megaloblastic anaemias
Folic Acid
View adult BNF View SPC online View childrens BNF
Formulary
Green
Tablets 400 micrograms, 5mg
Syrup 2.5mg/5ml

Amber Recommended In paediatrics when used for other medical conditions e.g. sickle cell disease, dialysis.

Prevention of neural tube defects
Women at low risk of neural tube defects are advised to take folic acid 400 micrograms daily before conception and continue until 12 weeks of pregnancy. Women at high risk (including those women with diabetes) should be advised to take folic acid 5mg until week 12 of pregnancy. Women with sickle cell disease should continue taking their normal dose of folic acid 5mg daily (or increase to 5mg daily) and continue this dose throughout pregnancy.  
   
Hydroxocobalamin
View adult BNF View SPC online View childrens BNF
Formulary
Green
Injection 1mg/ml

Amber Recommended  For paediatrics

Hydroxocobalamin has replaced cyanocobalamin as the form of vitamin B12 of choice for therapy; it is retained in the body longer than cyanocobalamin and thus for maintenance therapy can be given at intervals of up to 3 months 
   
Cyanocobalamin
View adult BNF View SPC online View childrens BNF
Formulary
Black

Tablets 50 micrograms
Injection 1mg/ml

Red  Tablets for paediatrics (injection Black for paediatrics)

 
Restricted use Black rating applies to treatment use only. Cyanocobalamin may be recommended by a specialist for short-term administration as part of a diagnostic test

 
   
09.01.03  Drugs used in hypoplastic, haemolytic, and renal anaemias
Eculizumab (Soliris®)
View adult BNF View SPC online View childrens BNF
Formulary
Red
Injection 10mg/ml

Paroxysmal nocturnal haemoglobinuria and atypical haemolytic uraemic syndrome.

NHS NHSE commissioned drug - see Specialised Commissioning: Key documents 
Link  NICE Highly Specialised Technology HST1: Eculizumab for treating atypical haemolytic uraemic syndrome
   
Hydroxycarbamide (Siklos®)
View adult BNF View SPC online View childrens BNF
Formulary
Red
Tablets 100mg, 1g

For sickle-cell disease only

 
   
09.01.03  Erythropoietin
Darbepoetin Alfa (Aranesp®)
View adult BNF View SPC online View childrens BNF
Formulary
Red
Injection.
Contact Pharmacy Dept. for product availability

NHS NHSE commissioned drug - see Specialised Commissioning: Key documents 
   
Epoetin alfa (Eprex®Binocrit®)
View adult BNF View SPC online View childrens BNF
Formulary
Red
Injection.
Contact Pharmacy Dept. for product availability

NHS NHSE commissioned drug - see Specialised Commissioning: Key documents 
   
Epoetin beta (NeoRecormon®)
View adult BNF View SPC online View childrens BNF
Formulary
Red
Injection.
Contact Pharmacy Dept. for product availability

NHS NHSE commissioned drug - see Specialised Commissioning: Key documents 
   
Epoetin zeta (Retacrit®)
View adult BNF View SPC online View childrens BNF
Formulary
Red
Injection.
Contact Pharmacy Dept. for product availability

NHS NHSE commissioned drug - see Specialised Commissioning: Key documents 
   
09.01.03  Iron overload
Deferasirox (Exjade®)
View adult BNF View SPC online View childrens BNF
Formulary
Red

Tablets 90mg, 180mg, 360mg

The SPC should be consulted before initiating therapy due to the large number of special warnings and precautions in use

NHS NHSE commissioned drug - see Specialised Commissioning: Key documents
For iron chelation in thalassaemia and sickle cell disease

 
   
Deferiprone (Ferriprox®)
View adult BNF View SPC online View childrens BNF
Formulary
Red
Tablets 500mg, 1g
Oral solution 100mg/ml

The SPC should be consulted before initiating therapy due to the large number of special warnings and precautions in use

NHS NHSE commissioned drug - see Specialised Commissioning: Key documents
For iron chelation in thalassaemia and sickle cell disease 
   
Desferrioxamine Mesilate
View adult BNF View SPC online View childrens BNF
Formulary
Red
Injection 500mg, 2g vial

The SPC should be consulted before initiating therapy due to the large number of special warnings and precautions in use

NHS NHSE commissioned drug - see Specialised Commissioning: Key documents
For iron chelation in thalassaemia and sickle cell disease 
   
09.01.04  Drugs used in platelet disorders to top
Anagrelide (Xagrid®)
(Essential thrombocythaemia)
View adult BNF View SPC online View childrens BNF
Formulary
Red
Capsules 500 micrograms 
   
Eltrombopag (Revolade®)
(Thrombocytopenia in chronic hepatitis C)
View adult BNF View SPC online
Formulary
Grey

Tablets 25mg, 50mg, 75mg

Paediatrics: no BNFc entry - seek specialist advice

 
   
Eltrombopag (Revolade®)
(Idiopathic thrombocytopenic purpura)
View adult BNF View SPC online View childrens BNF
Formulary
Red

Tablets 25mg, 50mg, 75mg
 

 
Link  Pan Mersey APC (2019): Eltrombopag Olamine tablets (Revolade®) for chronic immune (idiopathic) thrombocytopenic purpura (ITP)
Link  NICE TA293: Eltrombopag for treating chronic immune (idiopathic) thrombocytopenic purpura (review of technology appraisal 205)
   
Eltrombopag (Revolade®)
(Acquired Severe Aplastic Anaemia)
View adult BNF View SPC online View childrens BNF
Formulary
Black

Tablets 25mg, 50mg, 75mg

 
Link  ELTROMBOPAG film-coated tablets (Revolade®) for Acquired Severe Aplastic Anaemia (SAA): Pan Mersey Area Prescribing Committee Policy Statement
Link  NICE TA382: Eltrombopag for treating severe aplastic anaemia refractory to immunosuppressive therapy (terminated appraisal)
   
Rituximab (Idiopathic thrombocytopenic purpura )
View adult BNF View SPC online View childrens BNF
Formulary
Red

Concentrate for infusion 100mg/10mL, 500mg/50mL 

Idiopathic thrombocytopenic purpura - off-label indication

 
Link  Pan Mersey APC (2019): RITUXIMAB (Truxima®▼, Rixathon®▼) for immune (idiopathic) thrombocytopenic purpura
   
Romiplostim (Nplate®)
(Idiopathic thrombocytopenic purpura)
View adult BNF View SPC online
Formulary
Red

Injection 250 micrograms

Paediatrics: no BNFc entry - seek specialist advice

 
Link  Pan Mersey APC (2019): Romiplostim SC injection (Nplate®) for chronic immune (idiopathic) thrombocytopenic purpura (ITP)
Link  NICE TA221: Romiplostim for the treatment of chronic immune (idiopathic) thrombocytopenic purpura
   
09.01.05  G6PD deficiency
09.01.06  Drugs used in neutropenia
Filgrastim
View adult BNF View SPC online View childrens BNF
Formulary
Red

Contact Pharmacy dept. for product availability

NHS NHSE commissioned drug - see Specialised Commissioning: Key documents

 
   
Lenograstim
View adult BNF View SPC online View childrens BNF
Formulary
Red

Contact Pharmacy dept. for product availability

NHS NHSE commissioned drug - see Specialised Commissioning: Key documents

 
   
Pegfilgrastim
View adult BNF View SPC online
Formulary
Red

Contact Pharmacy dept. for product availability

Paediatrics: no BNFc entry - seek specialist advice

NHS NHSE commissioned drug - see Specialised Commissioning: Key documents

 
   
09.01.07  Drugs used to mobilise stem cells
Plerixafor (Mozobil®)
View adult BNF View SPC online
Formulary
Red
Injection 20mg/ml
NHS NHSE commissioned drug - see Specialised Commissioning: Key documents


Paediatrics: no BNFc entry - seek specialist advice 
   
09.02  Fluids and electrolytes
09.02.01  Oral preparations for fluid and electrolyte imbalance to top
09.02.01.01  Oral potassium
Potassium Chloride (Sando-K®)
View adult BNF View SPC online View childrens BNF
Formulary
Green
Effervescent tablets, potassium bicarbonate and chloride (12mmol of K+ and 8 mmol Cl-/tablet)

Amber Patient Retained  For paediatrics 
   
Potassium Chloride (Kay-Cee-L®)
View adult BNF View SPC online View childrens BNF
Formulary
Green
Syrup sugar free potassium chloride (1mmol/ml of each of K+ and Cl-)
Amber Patient Retained  For paediatrics

Oral solution potassium chloride 2mmol/ml- unlicensed preparation
Amber Patient Retained  For paediatrics 
   
09.02.01.01  Potassium removal
PatiromerBlack Triangle
View adult BNF View SPC online
Formulary
Grey

Powder for oral suspension; 8.4g, 16.8g, 25.2g sachets (Veltassa®)

 
Link  Pan Mersey APC (2017). PATIROMER powder for oral suspension (Veltassa®▼) for hyperkalaemia
   
Polystyrene Sulphonate Resins (Calcium Resonium®)
View adult BNF View SPC online View childrens BNF
Formulary
Red
Powder 
   
Polystyrene Sulphonate Resins (Resonium A®)
View adult BNF View SPC online View childrens BNF
Formulary
Red
Powder 
   
Sodium zirconium cyclosilicateBlack Triangle
View adult BNF View SPC online View childrens BNF
Formulary
Red

powder for oral suspension - 5g, 10g sachets (Lokelma®)

 
Link  Pan Mersey APC (2019): SODIUM ZIRCONIUM CYCLOSILICATE powder for oral suspension (Lokelma®▼) for treating hyperkalaemia
Link  NICE TA599 (2019): Sodium zirconium cyclosilicate for treating hyperkalaemia
   
09.02.01.02  Oral sodium and water
Sodium Chloride
View adult BNF View SPC online View childrens BNF
Formulary
Green

Tablets modified-release 600mg (approx. 10mmol each of Na+ & Cl-) Slow Sodium®

 Oral solution (30%) sodium chloride 5mmol/ml (unlicensed preparation)
Amber Patient Retained  For paediatrics
 

 
   
09.02.01.02  Oral rehydration therapy (ORT)
Oral Rehydration Salts (Dioralyte® Dioralyte Relief® Electrolade® )
View adult BNF View SPC online View childrens BNF
Formulary
Green



Amber Initiated  Double strength for use in stoma patients  
Link  Specialist Pharmacy Service: What is St Mark’s Electrolyte Mix (solution)?
   
09.02.01.03  Oral bicarbonate to top
Sodium Bicarbonate
View adult BNF View SPC online View childrens BNF
Formulary
Green
Capsules 500mg (6mmol each of Na+ & HCO3-)



Oral solution Sodium Bicarbonate 1mmol/ml (unlicensed preparation)
Amber Recommended for paediatrics 
   
09.02.02  Parenteral preparations for fluid and electrolyte imbalance
09.02.02.01  Electrolytes and water
 note 

Local arrangements may exist for use of subcutaneously administered fluids (hypodermoclysis) in primary care in specific circumstances e.g. palliative care.

09.02.02.01  Intravenous sodium
Sodium Chloride and Glucose Intravenous Infusion
View adult BNF View SPC online View childrens BNF
Formulary
Red

Contact Pharmacy dept. for prescribing advice and product availability

 
   
Sodium Chloride Intravenous
View adult BNF View SPC online View childrens BNF
Formulary
Red

Contact Pharmacy dept. for prescribing advice and product availability

 
   
09.02.02.01  Intravenous glucose
Glucose Intravenous
View adult BNF View SPC online View childrens BNF
Formulary
Red

Contact Pharmacy dept. for prescribing advice and product availability

 
   
09.02.02.01  Intravenous potassium to top
Potassium Chloride and Glucose Intravenous Infusion
View adult BNF View SPC online View childrens BNF
Formulary
Red

Contact Pharmacy dept. for prescribing advice and product availability

 
   
Potassium Chloride and Sodium Chloride Intravenous Infusion
View adult BNF View SPC online View childrens BNF
Formulary
Red

Contact Pharmacy dept. for prescribing advice and product availability

 
   
Potassium Chloride Concentrate (Sterile)
View adult BNF View SPC online View childrens BNF
Formulary
Red

Contact Pharmacy dept. for prescribing advice and product availability

Restricted Use

 
   
09.02.02.01  Bicarbonate and lactate
Sodium Bicarbonate
View adult BNF View SPC online View childrens BNF
Formulary Contact Pharmacy dept. for prescribing advice and product availability 
   
09.02.02.01  Water
Water for Injection
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
   
09.02.02.02  Plasma and plasma substitutes
 note  Contact Pharmacy Dept. for prescribing advice and product availability
09.02.02.02  Plasma substitutes
09.03  Intravenous nutrition to top
 note  Contact Pharmacy Dept. for prescribing advice and product availability
09.03  Supplementary preparations
09.04  Oral nutrition
09.04.01  Foods for special diets
09.04.02  Enteral nutrition
09.05  Minerals to top
 note  Supplementation after bariatric surgery
British Obesity and Metabolic Surgery Society (BOMSS) Guideline (see link below) makes recommendations regarding vitamin and mineral supplementation after bariatric surgery. GPs will receive written confirmation from specialist regarding supplementation regimen for each individual patient.
09.05.01  Calcium and magnesium
09.05.01.01  Calcium supplements
Calcium carbonate
View adult BNF View SPC online View childrens BNF
Formulary
Green

Chewable tablets calcium carbonate 1.25g (calcium 500mg)

Chewable tablets calcium carbonate 1.5g (calcium 600mg) 

Second Choice

Effervescent tablets calcium carbonate 1.25g (calcium 500mg)

Paediatric advice: To achieve a smaller dose from a proportion of Cacit® - dissolve one Cacit tablet in 24mL water to give 12.5mmol of calcium in 25mL (i.e. 0.5mmol/mL) orange flavoured solution. Draw up the correct volume for the prescribed dose. Discard the remaining solution and use a new tablet for the next dose.   

 
   
Calcium lactate gluconate and calcium carbonate  (Sandocal-1000®)
View adult BNF View SPC online View childrens BNF
Formulary
Green

Effervescent tablets 2263 mg of calcium lactate gluconate and 1750 mg of calcium carbonate (equivalent to 1000 mg or 25 mmol of calcium).

 
   
Calcium Syrup
View adult BNF View SPC online View childrens BNF
Formulary
Green

Syrup – Calcium lactate and calcium gluconate (20.4mg of soluble calcium or 0.51mmol of calcium per ml) 

 
   
Calcium Gluconate
View adult BNF View SPC online View childrens BNF
Formulary
Red
Injection calcium gluconate 10% (Ca2+ approx. 225 micromol/ml) 
   
09.05.01.02  Hypercalcaemia and hypercalciuria
Cinacalcet (Mimpara®)
View adult BNF View SPC online
Formulary
Red

Tablets 30mg, 60mg, 90mg

NHS NHSE commissioned drug, hyperparathyroidism in dialysis patients; primary hyperparathyroidism - see Specialised Commissioning: Key documents
Paediatrics: no BNFc entry - seek specialist advice

 
Link  NICE TA117: Hyperparathyroidism - cinacalcet
   
Etelcalcetide (Parsabiv®)
View adult BNF View SPC online
Formulary
Red

Solution for injection; 2.5mg, 5mg, 10mg

Paediatrics: no BNFc entry - seek specialist advice

NHS NHSE commissioned drug, secondary hyperparathyroidism in dialysis patients - see Specialised Commissioning: Key documents

 
Link  NICE TA448: Etelcalcetide for treating secondary hyperparathyroidism
   
09.05.01.03  Magnesium
Magnesium Aspartate (Magnaspartate®)
View adult BNF View SPC online View childrens BNF
First Choice
Amber Initiated
Magnesium aspartate dehydrate equivalent to 243 mg (10 mmol) of magnesium per sachet for oral administration.

Where Magnaspartate® is not suitable e.g. diabetic patients (due to sucrose content), paediatric or other patients where administration volume is restricted, then magnesium glycerophosphate oral preparations (unlicensed special) may be prescribed.

Where magnesium is used for nutritional reasons rather than treatment of a medical condition then nutritional supplements are available for purchase by patients.
 
Magnesium Glycerophosphate
View adult BNF View SPC online View childrens BNF
Formulary
Amber Initiated

Tablets magnesium 97.2mg (4mmol/tablet)
Solution magnesium 24.25mg/ml (1mmol/ml) (unlicensed)
Capsules magnesium 500mg (2mmol)- for paediatrics  (unlicensed)

Of the formulations currently available, tablets have the lower acquisition cost.

Where oral magnesium is for treatment of a medical condition then magnesium aspartate dihydrate (Magnaspartate®) should be prescribed as first choice. Where magnesium is used for nutritional reasons rather than treatment of a medical condition then nutritional supplements are available for purchase by patients.


Where Magnaspartate® is not suitable e.g. diabetic patients (due to sucrose content), paediatric or other patients where administration volume is restricted, then magnesium glycerophosphate oral preparations may be prescribed.

 
   
Magnesium Sulphate
View adult BNF View SPC online View childrens BNF
Formulary
Red
Intravenous injection 20% (magnesium approx. 0.8mmol/ml), 50% (Mg2+ approx. 2mmol/ml) 
   
Magnesium oxide
View adult BNF View SPC online
Unlicensed Drug Unlicensed
Amber Initiated
Aintree University Hospital only - for high output stomas and short bowel syndrome.
Capsules 160mg (4mmol Mg2+)

Paediatrics: no BNFc entry - seek specialist advice  
   
09.05.02  Phosphorus to top
09.05.02.01  Phosphate supplements
Phosphate Polyfusor®
View adult BNF View SPC online View childrens BNF
Formulary
Red
Intravenous infusion (phosphates 100mmol, K+ 19mmol, Na+ 162mmol/litre) 
   
Phosphate supplements (Phosphate-Sandoz®)
View adult BNF View SPC online View childrens BNF
Formulary
Amber Initiated

Effervescent tablets phosphorus 500 mg (phosphate 16.1mmol) & sodium 468.8mg (Na+ 20.4mmol), potassium 123mg (K+ 3.1mmol)

Paediatric advice: To make an oral solution containing 1mmol/mL of phosphate, dissolve a 500mg Phosphate Sandoz tablet in water and make the resultant solution up to 16 mL. (also contain 1.28mmol/mL sodium and 0.2mmol/mL potassium)

Potassium acid phosphate 1mmol/ml oral solution - for paediatrics (unlicensed preparation)

Sodium acid phosphate 1mmol/ml oral solution - for paediatrics (unlicensed preparation)

 
   
09.05.02.02  Phosphate-binding agents
Calcium Acetate
View adult BNF View SPC online View childrens BNF
First Choice
Amber Initiated

Tablets 475mg, 950mg, 1g

 
Calcium Carbonate
View adult BNF View SPC online View childrens BNF
First Choice
Amber Initiated

Chewable tablets calcium carbonate 1.25g (calcium 500mg) (Calcichew®)

Chewable tablets calcium carbonate 1.5g (calcium 600mg) (Adcal®)
 
Oral mixture calcium carbonate 250mg/5ml(unlicensed) - Paediatric use

Calcium carbonate 500mg (Tums®) - Paediatric use


Calcium Carbonate 680mg (equivalent of 272mg Calcium) and Heavy Magnesium Carbonate 80mg (Rennies®) - Paediatric use

Chewable tablets calcium carbonate 800mg (Remegel®) - Paediatric use (Do not confuse with Renagel®)

NB: Cacit® tablets are NOT suitable as when they disperse in water they provide 500mg calcium as calcium citrate, which is a poor phosphate binder.   

 
Calcium acetate with magnesium carbonate (Osvaren®)
View adult BNF View SPC online
Second Choice
Amber Initiated

Tablets calcium acetate 435mg (calcium 110mg) and magnesium carbonate 235mg (magnesium 60mg)

Paediatrics: no BNFc entry - seek specialist advice

 
   
Lanthanum (Fosrenol ®)
View adult BNF View SPC online
Second Choice
Amber Initiated

Chewable tablets 500mg, 750mg, 1000mg
Lanthanum - only for its licensed indication - control of hyerphosphataemia in patients with chronic renal failure on haemodialysis or continuous ambulatory peritoneal dialysis and in patients with chronic kidney disease not on dialysis who have a serum-phosphate concentration of 1.78 mmol/litre or more that cannot be controlled by a low-phosphate diet.

NHS NHSE commissioned drug - see Specialised Commissioning: Key documents
COMMISSIONED BY NHS ENGLAND FOR PATIENTS RECEIVING RENAL DIALYSIS.
REDfor patients receiving dialysis (newly initiated)

Amber Initiated  for existing patients on dialysis already prescribed in primary care, and in pre-dialysis

Paediatrics: no BNFc entry - seek specialist advice

 
   
Sevelamer
View adult BNF View SPC online View childrens BNF
Second Choice
Amber Initiated

Tablets 800mg
Sevelamer carbonate – licensed for hyperphosphataemia in patients on haemodialysis or continuous ambulatory peritoneal dialysis and in patients with chronic kidney disease not on dialysis who have a serum-phosphate concentration of 1.78 mmol/litre or more that cannot be controlled by a low-phosphate diet.

Sevelamer hydrochloride – licensed for hyperphosphataemia in patients on haemodialysis or continuous ambulatory peritoneal dialysis.

NHS NHSE commissioned drug - see Specialised Commissioning: Key documents
COMMISSIONED BY NHS ENGLAND FOR PATIENTS RECEIVING RENAL DIALYSIS.
REDfor patients receiving dialysis (newly initiated), and paediatrics

Amber Initiated  for existing patients on dialysis already prescribed in primary care, and in pre-dialysis 

 
   
Sucroferric oxyhydroxide
View adult BNF View SPC online
Formulary
Red

Chewable tablets 500mg

Paediatrics: no BNFc entry - seek specialist advice

NHS NHSE commissioned drug - see Specialised Commissioning: Key documents

 
   
09.05.03  Fluoride
Fluorides (Duraphat® (Toothpaste))
View adult BNF View SPC online View childrens BNF
Formulary
Amber Recommended

Toothpaste sodium fluoride 0.619%, 1.1%

On advice from secondary care specialists e.g. following radiotherapy during active management, haematological malignancies or oral dermatological diseases.

See Pan Mersey APC: Guidance for dental prescribing in primary care, below.

 Black DENTAL prescription for conditions managed by dentists; long term treatment should be under patient’s usual dentist, and toothpaste prescribed by the dentist.                          

 
   
Fluorides (En-De-Kay® (Oral Drops))
View adult BNF View SPC online View childrens BNF
Formulary
Amber Recommended

Oral drops SF sodium fluoride 550 micrograms (fluoride 250 micrograms/drop [0.15ml)

See Pan Mersey APC: Guidance for dental prescribing in primary care, below
 

 
   
Fluorides (En-De-Kay® (Tablet))
View adult BNF View SPC online View childrens BNF
Formulary
Amber Recommended

Tablets sodium fluoride 1.1mg (fluoride 500 micrograms) children 3-6 yrs; sodium fluoride 2.2mg (fluoride 1mg) 6+ yrs

See Pan Mersey APC: Guidance for dental prescribing in primary care, below
 

 
   
09.05.04  Zinc
Zinc Sulphate (Solvazinc®)
View adult BNF View SPC online View childrens BNF
Formulary
Amber Recommended

Effervescent tablets 125mg (45mg zinc)

Amber Initiated Paediatrics: in neonates

 
   
09.05.05  Selenium and copper to top
Selenium oral
View adult BNF View SPC online
Formulary
Amber Initiated
Oral solution 50 micrograms/ml

Paediatrics: no BNFc entry - seek specialist advice 
   
Selenium parenteral (Selenase®)
View adult BNF View SPC online
Formulary
Red
Injection 50 micrograms/ml

Use only in patients receiving prolonged parenteral nutrition

Paediatrics: no BNFc entry - seek specialist advice 
   
Copper oral (Biocare®)
View adult BNF
Unlicensed Drug Unlicensed
Red
Tablets copper gluconate 8mg
For use in patients post bariatric surgery (Aintree)

Paediatrics: no BNFc entry - seek specialist advice 
   
09.06  Vitamins
 note  Supplementation after bariatric surgery
British Obesity and Metabolic Surgery Society (BOMSS) Guideline (see link below) makes recommendations regarding vitamin and mineral supplementation after bariatric surgery. GPs will receive written confirmation from specialist regarding supplementation regimen for each individual patient.
09.06.01  Vitamin A
 note 

Deficiency of vitamin A is rare in UK. Supplementation should not be routinely prescribed. Consult Pharmacy for product advice.


Vitamins A and D
View adult BNF View SPC online View childrens BNF
Formulary
Amber Recommended
Capsules vitamin A 4000 IU (also contains vitamin D); Halibut-liver oil
Capsules BPC 1973, vitamin A 4000 IU, vitamin D 400 IU (10 micrograms).

Prescribe generically 
   
Vitamins A C and D
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Unlicensed Drug Unlicensed
Green
Oral drops, vitamin A 5000 IU, vitamin D 2000 IU (50 micrograms) ascorbic acid 150mg/ml; Healthy Start Children’s Vitamin Drops

Where available.

 
   
09.06.02  Vitamin B group
Pyridoxine Hydrochloride (vitamin B6)
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Green

Tablets 10mg, 50mg

 
   
Thiamine (vitamin B1)
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Formulary
Green
Tablets 50mg ,100mg 
   
Thiamine (vitamin B1) (Pabrinex®)
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Formulary
Red
Intravenous injection high potency

Paediatrics: no BNFc entry - seek specialist advice 
   
Riboflavin (Vitamin B2)
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Unlicensed Drug Unlicensed
Red
Tablets 50mg
For mitochondrial disorders
 
   
09.06.02  Oral vitamin B complex preparations
Vitamin B Tablets (Compound)
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Formulary
Black
 
   
Vitamin B Tablets, Compound Strong
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Formulary

Re-feeding syndrome
Green up to 10 day-only course for those at risk of re-feeding syndrome.
Red NHS Halton CCG

All other indications
Black

 
   
09.06.02  Other compounds to top
Potassium aminobenzoate
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Formulary
Amber Recommended
Capsules 500 mg; Envules ® 3 g

For use in Peyronie's disease - see section 7.4.5

Paediatrics: no BNFc entry - seek specialist advice 
   
09.06.03  Vitamin C
Ascorbic acid
(All indications except scurvy)
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Formulary
Black

Tablets 50mg 100mg, 200mg, 500mg

All indications except treatment and prevention of scurvy. Increasing absorption of iron is not a licensed indication for ascorbic acid and is not recommended. To enhance iron absorption, patients should be advised to take iron preparations on an empty stomach. Iron absorption may be increased if a person has a high intake of fish, or red or white meat; decreased if a person has a high intake of phytate (for example from wholegrain cereals), polyphenols (for example from tea and coffee), calcium (for example from dairy products), or if the person is taking medication that raises the gastric pH (for example antacids and proton pump inhibitors).

 
Link  PAN MERSEY AREA PRESCRIBING COMMITTEE PRESCRIBING POLICY STATEMENT: ASCORBIC ACID
   
Ascorbic Acid
(Prevention and treatment of scurvy)
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Green

Tablets 50mg 100mg, 200mg, 500mg

Black  All other indications. Co-administration with oral iron replacement therapy: Increasing absorption of iron is not a licensed indication for ascorbic acid and is not recommended. To enhance iron absorption, patients should be advised to take iron preparations on an empty stomach. Iron absorption may be increased if a person has a high intake of fish, or red or white meat; decreased if a person has a high intake of phytate (for example from wholegrain cereals), polyphenols (for example from tea and coffee), calcium (for example from dairy products), or if the person is taking medication that raises the gastric pH (for example antacids and proton pump inhibitors).

 
Link  PAN MERSEY AREA PRESCRIBING COMMITTEE PRESCRIBING POLICY STATEMENT: ASCORBIC ACID
   
09.06.04  Vitamin D
Alfacalcidol
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Formulary
Green
Red Triangle Take care when prescribing and dispensing
Using the integral dropper, ONE drop of One-Alpha 2 micrograms/mL oral drops contains 100 nanograms alfacalcidol.[SPS (2018)]
Capsules 250 nanograms, 500 nanograms, 1 microgram
Oral drops sugar free 2 micrograms/ml

Amber Initiated Paediatrics

 
   
Colecalciferol
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Formulary
Green

Oral drops

50,000 international units in 1ml

25,000 international units in 1ml

10,000 international units in 1ml

2,740 international units in 1ml (400 international units in 6 drops)

2,400 international units in 1ml (400 international units in 6 drops)

 

Capsules

50,000 international units

40,000 international units

20,000 international units

800 international units 

 

Tablets

25,000 international units

1000 international units

800 international units

 

 
   
Calcitriol
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Amber Initiated
Capsules 250 nanograms, 500 nanograms 
   
Paricalcitol (Zemplar®)
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Formulary
Amber Initiated

Capsules 1 microgram, 2 micrograms, 4 micrograms

Paediatrics: no BNFc entry - seek specialist advice

 
   
09.06.04  Vitamin D with Calcium
Colecalciferol and calcium
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Green

Sachets calcium carbonate 1.25g (calcium 500mg), colecalciferol 11 micrograms (440 international units)

 
   
Colecalciferol and Calcium Carbonate
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Green

Chewable tablets, calcium carbonate 2500mg (equivalent to 1000mg calcium) /colecalciferol 1,000unit (equivalent to 25 micrograms)

 
   
Colecalciferol and Calcium Carbonate
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Formulary
Green

Caplets calcium carbonate (calcium 500mg), colecalciferol 10 micrograms (400 international units)

Caplets calcium carbonate (calcium 300mg), colecalciferol 5 micrograms (200 international units)

 
   
Colecalciferol and Calcium Carbonate
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Green

Chewable tablets or effervescent tablets calcium carbonate 1.5g (calcium 600mg), colecalciferol 10 micrograms (400 international units)

 
   
Colecalciferol and Calcium Carbonate
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Formulary
Green

Chewable tablets calcium carbonate 1.25g (calcium 500mg), colecalciferol 10 micrograms (400 international units)

 
   
Colecalciferol and calcium phosphate
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Formulary
Green

Sachets calcium phosphate 3.1g (calcium 1.2g), colecalciferol 20 micrograms (800 international units)

 
   
09.06.05  Vitamin E
 note 

There is limited evidence for the value of dietary supplementation with oral vitamin E

Parenteral Vitamin E contact Pharmacy dept. for advice (Consultant use only)

Alpha Tocopheryl Acetate
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Formulary
Amber Recommended
Suspension 100mg/ml 
   
Alpha Tocopheryl Acetate
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Unlicensed Drug Unlicensed
Amber Recommended
Capsules 75 IU, 200 IU, 400 IU

Vita-E 200 (D-Alpha Tocopherol) Capsules  
   
09.06.06  Vitamin K to top
 note 

Essential for the production of blood clotting factors, antagonises effects of oral anticoagulants.

Red Triangle Take care when prescribing and dispensing
Vitamin K is available as phytomenadione (fat-soluble) or menadiol (water-soluble). The indications are different for each, as are the formulations available. It is important to specify which form of vitamin K, as well as which formulation, is required.[SPS (2018)]

Menadiol Sodium Phosphate
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Formulary
Amber Initiated

Tablets menadiol phosphate 10mg

Not to be confused with Menadione®

Not to be prescribed as Vitamin K

Length of treatment to be clearly stated

 
   
Phytomenadione (Vitamin K1)
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Formulary
Amber Initiated
Konakion® MM Injection 10 mg/ml
Green For emergency use in Primary care. Used in primary care anticoagulant services.
Konakion® MM Paediatric Injection 10 mg/ml
May be administered by mouth, IM or IV injection
Green For emergency use in Primary care.
Neokay® Capsules 1 mg
Length of treatment to be clearly stated
Menadione®
Unlicensed Drug Unlicensed drug
Tablets 10 mg
NB not to be confused with menadiol sodium phosphate
Vitamin K deficiency in cystic fibrosis adults and children
Length of treatment to be clearly stated
 
   
09.06.07  Multivitamin preparations
Multivitamin preparations (Abidec®)
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Formulary
Green
Drops (paediatrics); Abidec® - contains arachis (peanut) oil 
   
Multivitamin preparations (Dalivit®)
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Formulary
Green

Drops (paediatrics)

 
   
Mutivitamin
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Formulary
Green

Capsules, tablets

 
   
Vitamins A,D,E,K
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Formulary
Amber Recommended

Paravit CF® Liquid

Paravit CF® Capsules (suitable age 4 and above)

Guideline – Nutritional Management of Cystic Fibrosis. September 2016. 

 
   
09.06.07  Vitamin and mineral supplements and adjuncts to synthetic diets
B Complex plus C Water soluble vitamins (Renavit®)
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Formulary
Amber Recommended

tablets; Borderline Substance for vitamin supplementation in renal dialysis patients

Paediatrics: no BNFc entry - seek specialist advice

 
   
Vitamin and mineral supplements (Forceval Soluble®)
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Formulary
Green

For use in tube fed patients, those with swallowing difficulties and those post bariatric surgery

Paediatrics: no BNFc entry - seek specialist advice

 
   
Vitamin and mineral supplements (Forceval®)
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Formulary
Green
Capsules; Forceval®; Forceval® Junior 
   
Vitamin and mineral supplements (Ketovite®)
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Formulary
Green
Tablets; Liquid 
   
09.07  Bitters and tonics
09.08  Metabolic disorders
09.08.01  Drugs used in metabolic disorders to top
 note 

Contact Hospital Pharmacy dept. for prescribing advice and product availability

NHS NHSE commissioned - see Specialised Commissioning: Key documents.

No primary care prescribing.

 

09.08.01  Wilsons disease
09.08.01  Carnitine deficiency
09.08.01  Fabry's disease
09.08.01  Gaucher's disease
09.08.01  Mucopolysaccharidosis I to top
09.08.01  Pompe disease
09.08.01  Nephropathic cystinosis
09.08.01  Urea cycle disorders
Sodium Phenylbutyrate
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Formulary
Red

Oral granules 483mg/g (Pheburane®)

Oral granules 940mg/g (Ammonaps®)Tablets 500mg (Ammonaps®)Oral solution 1250mg / 5mL (Ambutyrate® - unlicensed)
NHS NHSE commissioned drug - see Specialised Commissioning: Key documents

 
   
09.08.02  Acute porphyrias
 note 

Contact Pharmacy dept. for prescribing advice and product availability

09.08.02  Drugs unsafe for use in acute porphyrias to top
 ....
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
Cancer Drugs Fund
Cancer Drugs Fund
NHSE
NHS England
Homecare
Homecare
CCG
CCG

Traffic Light Status Information

Status Description

Green

Medicines considered suitable for non-specialist prescribing in primary or secondary care.  

Amber Recommended

Requires specialist assessment to enable patient selection.  Amber Recommended medicines must meet criteria: (1) Requires specialist assessment to enable patient selection (2) Following specialist assessment, the medicine is suitable for prescribing in Primary Care.  

Amber Initiated

Amber Initiated. Requires specialist initiation of prescribing. Prescribing to be continued by the specialist until stabilisation of the dose is achieved and the patient has been reviewed. Amber Initiated medicines must meet criteria: (1) Requires specialist assessment to enable patient selection (2) Medicine is suitable for on-going prescribing in Primary Care (3) Requires short to medium term specialist prescribing and monitoring of efficacy or toxicity until the patient’s dose and condition is stable   

Amber Retained

Amber Patient Retained. Requires specialist initiation of prescribing. Prescribing to be continued by specialist until stabilisation of the dose is achieved and the patient had been reviewed. Patient remains under the care of specialist (ie not discharged) as occasional specialist input may be required. Amber Patient Retained medicines must meet criteria: (1)Requires specialist assessment to enable patient selection (2)Medicine is suitable for on-going prescribing in Primary Care (3) Requires short to medium term specialist prescribing and monitoring of efficacy or toxicity until the patient’s dose and condition is stable (4) May require occasional specialist input indefinitely and therefore the patient should not be discharged from specialist care   

Amber

Medicines recommended or initiated by specialists in primary or secondary care. Non-specialist prescribing in primary care may follow according the RAG criteria. In process of being superceded by Amber Recommended, Amber Initiated and Amber Patient Retained.  

Purple

Shared Care. Medicines are considered suitable for Primary Care prescribing and/or management, following specialist initiation of therapy, with on-going communication between the Primary Care prescriber and specialist, within the framework of a Shared Care Agreement. Medicines designated as requiring Shared Care require on-going input from both Specialist and Primary Care clinicians and patients should not be discharged from Specialist care. Where prescribing and monitoring are required under shared care, it is implicit that the responsibility for both of these tasks rests with the prescriber. A Shared Care Agreement will always be available for Shared Care medicines and this document will include a Shared Care Agreement pro-forma which will be completed by all involved clinicians. This pro-forma will record agreement to take on defined aspects of care e.g. monitoring and/or on-going prescribing for the individual patients. A policy detailing clinician responsibilities in Shared Care Agreements must be referred to in all cases of Shared Care. All drugs to be included in this category must meet Shared Care criteria 1 to 3: SC1 Requires specialist assessment to enable patient selection and also initiation, stabilisation and review of treatment and the patient`s condition. SC2 Prescribing and/or management of the drug in Primary Care with specialist support and input, within the framework of the Shared Care Agreement is safe and convenient and that there is an appropriate mechanism for individual patient access in Primary Care. SC3 Requires specific long-term monitoring (blood test or other measurement) for adverse effects and / or efficacy of the drug to be completed in Primary Care, and requires on-going specialist support for the dose changes or management of adverse effects. Monitoring is required on a regular basis (typically four times a year). Implicit in any shared care agreement is the understanding that participation is at the discretion of the Primary Care prescriber subject to their clinical confidence.   

Red

Primary care prescribing of these medicines is NOT recommended. These treatments should be initiated by specialists only; ongoing prescribing is retained within secondary care.   

Black

Not recommended for use. Deviation from the policy may be considered on an individual basis where exceptional circumstances exist.   

Grey

Not recommended for use at this time. Deviation from the policy may be considered on an individual basis where exceptional circumstances exist. Further guidance will be issued when more information or evidence is made available.  

netFormulary