Hospital only medicine

For treatment guidelines refer to MicroGuide

Refer to Bone and Joint section of body systems on MicroGuide

• Adult emerg guidelines 1.doc

Hospital only medicine.

March 2019 Drug safety update

• Link to update

For how to access MicroGuide App follow link

• Link to App

Avoid use due to increased risk of hepatotoxicity

Hospital only medicine

Including guidance on Multi Drug Resistant TB

• Tuberculosis

For how to access MicroGuide App follow the link

• Link to App

Hospital only medicine

March 2019 Drug safety update

• Link to update

Hospital only medicine

On microbiology advice only

March 2019 Drug safety update

• Link to update

March 2019 Drug safety update

• Link to update

For how to access MicroGuide app follow the link

• Link to App

Hospital only medicine

ceftazidime intravitreal

• Ceftazidime Intravitreal.doc

For Patient Controlled analgesia Trust Policy see link
For Trust Epidural Policy see link

• PCA and NCA Guidelines
• Epidural Continuous Infusion Guidelines
• opioid conversion table August 2017.docx
• Opioid side effects v2.docx
• BH treatment algorithm for pain in adults.pdf

• NSAIDs BH 2014.doc

Oral diclofenac no longer recommended as per MHRA alert. 

Reserved for use as suppositories in maternities and injection for renal colic.

Topical diclofenac may still be used as indicated.

INJECTION FORMULATION IS FOR HOSPITAL USE ONLY

Akis brand of Diclofenac to replace Voltarol on the formulary, Akis does not require a buffer to dilute pior to administration

Approved at NEL FPG October 2022 - Hospital ONLY 

Adalimumab is indicated for treatment of moderate to severe plaque psoriasis in adult patients who are candidates for systemic therapy.
In adult patients, an initial dose of 80 mg administered subcutaneously, followed by 40 mg subcutaneously given every other week starting one week after the initial dose.
The British Association of Dermatology guidance (British Association of Dermatologists guidelines for biologic therapy for psoriasis 2020: a rapid update, Smith et al 2020) recommend that patients with an inadequate response to the 40mg received every other week should receive an increase in dosage to 40mg every week. For needle phobic patients, this can be given as 80mg every other week in practice.
No additional monitoring is required for the escalated dosages.

Approved at NEL FPG (Nov 2022)

Betesil® 2.250mg medicated plaster is the only potent corticosteroid indicated in adults for the treatment of inflammatory skin disorders.

The plaster is licensed to use for a maximum of 30 days at a time, with a maximum of 6 plasters being used at any one time. Plasters may be changed once every 24 hours.

Amber-may be prescribed by or on the advice of a specialist 

Verkazia® (ciclosporin) 1 mg/mL eye drops approved at NEL FPG for  

• Severe Vernal Keratoconjunctivitis (VKC)  

Off-label indications:  

• Severe Atopic Keratoconjunctivitis (AKC),  

• Blepharo-keratoconjunctivitis (BKC) / Ocular Rosacea, 

• Thygeson’s keratitis & Chronic GvHD 

• Dry Eye Disease (DED)/ Keratoconjunctivitis Sicca (KCS) 

Formulary Status: Amber - Specialist initiated 

Approved at NEL FPG in line with NICE TA 824.

Dexamethasone intravitreal implant (Ozurdex) is recommended as an option for treating visual impairment caused by diabetic macular oedema in adults only if their condition has not responded well enough to, or if they cannot have non-corticosteroid therapy.

This is an update and replacement of TA 349

• NICE TA 824

1. For post-operative use in patients with diabetes with Retinopathy undergoing a cataract operation, to reduce the risk of development of diabetic macular oedema (DMO). 
2. Patients should instil one drop into the eye three times a day, commencing on the day prior to surgery, continuing on the day of surgery and for 60 days after the operation. One drop should also be instilled 30-120 minutes prior to surgery.
3. The hospital should supply two bottles (the full two month supply) of eye drops to reduce the risk of non-adherence.
4. Patients would be followed up at two months after the operation.

• Nevanac Protocol.docx

see attached

• CF Prescribing Pathway Final Version 5 Dec 2015.doc

0.3% preservative-free eye drops also available

Prednisolone G/R tablets are non-formulary, predisolone normal release should be used instead

Hospital-Only Drug

1% eye ointment also available

Hospital-Only Drug

1% eye ointment also available

Accepted on the DTC but only within a defined QI project.

For Patient Controlled analgesia Trust Policy see link
For Trust Epidural Policy see link

• PCA and NCA Guidelines
• Epidural Continuous Infusion Guidelines
• opioid conversion table August 2017.docx
• Opioid side effects v2.docx
• BH treatment algorithm for pain in adults.pdf

• NSAIDs BH 2014.doc

Oral diclofenac no longer recommended as per MHRA alert. 

Reserved for use as suppositories in maternities and injection for renal colic.

Topical diclofenac may still be used as indicated.

INJECTION FORMULATION IS FOR HOSPITAL USE ONLY

Akis brand of Diclofenac to replace Voltarol on the formulary, Akis does not require a buffer to dilute pior to administration

This medicine is HOSPITAL ONLY.

NB: acetazolamide injection has hospital only status

The 0.01% preparation is equivalent to the multidose 0.03% preparation which is to be discontinued

Alternative to latanaprost for glaucoma

The 0.01% preparation is equivalent to the multidose 0.03% preparation which is to be discontinued

Approved at NEL FPG for diabetic macular oedema.

Barts Health consultants not wish to use it. 

• NICE TA 820

Approved at NEL FPG in line with NICE TA 824.

Dexamethasone intravitreal implant (Ozurdex) is recommended as an option for treating visual impairment caused by diabetic macular oedema in adults only if their condition has not responded well enough to, or if they cannot have non-corticosteroid therapy.

This is an update and replacement of TA 349

• NICE TA 824

Approved via chair's action 15th August 2022 for treating diabetic macular oedema (NICE TA 799)

Hospital Only

Approved via chair's action 15th August 2022 for treating Wet age-related macular degeneration (NICE TA 800)

Hospital Only

• NICE TA 953

NEL FPG Approved to use as per the originator (Lucentis)

The treatment of wet age-related macular degeneration (wAMD), the treatment of visual impairment due to diabetic macular oedema (DMO), the treatment of proliferative diabetic retinopathy, the treatment of visual impairment due to macular oedema secondary to retinal vein occlusion (bRVO or cRVO), the treatment of visual impairment due to choroidal neovascularisation.

Approved at NEL FPG for diabetic macular oedema.

Barts Health consultants not wish to use it. 

• NICE TA 820

Approved via chair's action 15th August 2022 for treating diabetic macular oedema (NICE TA 799)

Hospital Only

Approved via chair's action 15th August 2022 for treating Wet age-related macular degeneration (NICE TA 800)

Hospital Only

NEL FPG Approved to use as per the originator (Lucentis)

The treatment of wet age-related macular degeneration (wAMD), the treatment of visual impairment due to diabetic macular oedema (DMO), the treatment of proliferative diabetic retinopathy, the treatment of visual impairment due to macular oedema secondary to retinal vein occlusion (bRVO or cRVO), the treatment of visual impairment due to choroidal neovascularisation.

THIS DRUG IS FOR HOSPITAL USE ONLY when used for: Reduction of mucus viscosity and facilitate expectoration.
20mg/mL injection can be used for nebulisation (off-label)

Sachets containing 200mg granules for oral administration available (un-licensed)

Systane Balance: For mild to moderate melbomian gland dysfunction, for initiation only by a consultant ophthalmologist, or a GP with a special interest in Ophthalmology with competencies to diagnose the condition. This was for use for up to three months only per treatment. The first month is supplied by secondary care, and the following two months by primary care.

• Adult emerg guidelines 1.doc

0.3% preservative free eye drops also available

see attached

• Adult emerg guidelines 1.doc

For Adult Critical Care Only. Guidance on the use of sodium chloride 5% intravenous infusion for the treatment of:

- Raised intracranial pressure (ICP) post traumatic brain injury

- Severe symptomatic hyponatraemia

• Sodium Chloride 5% Jan 2019.pdf