NHS Fife Formulary Abbreviated List March 2018 - Please Note: This version is current until end of May 2018 An updated pdf file can be accessed ...
←
→
Page content transcription
If your browser does not render page correctly, please read the page content below
NHS Fife Formulary
Abbreviated List
March 2018
Please Note: This version is current until end of May 2018
An updated pdf file can be accessed and downloaded at
www.fifeadtc.scot.nhs.uk/2
Recent formulary updates
Chapter Section Newly added Deleted/changed
2 2.9 S- Prasugrel (Efient®)
3 3.1.2 Fluticasone furoate/vilanterol
trifenatate/umeclidinium
(Trelegy®)
5 5.3.1 H-
Darunavir/cobicistat/emtricitabine
/tenofovir alafenamide
(Symtuza®)
8 8.1.5 H- Pembrolizumab (Keytruda®)
8.2.2 S- Tacrolimus (Adoport®) S- Tacrolimus (Prograf®)
9 9.5.2.1 S- sucroferric oxyhdroxide
(Velphoro®)
13 13.5.2 Calcipotriol 50mcg/g and
betamethasone 0.05% (Enstilar®)
KEY:-
H - Hospital Use Only
S - Specialist Initiation or Recommendation
R - Restricted Use Only - See Full formulary http://www.fifeadtc.scot.nhs.uk/fife-joint-formulary.aspx3
Table of Contents
Introduction ................................................................................... 6
1. Gastrointestinal system ........................................................... 7
1.1 - Dyspepsia and gastro-oesophageal reflux disease ......................... 7
1.2 - Antispasmodics and other drugs altering gut motility ..................... 7
1.3 - Antisecretory drugs and mucosal protectants ................................ 7
1.4 - Acute diarrhoea .......................................................................... 8
1.5 - Chronic bowel disorders .............................................................. 8
1.6 - Laxatives .................................................................................... 9
1.7 - Local preparations for anal and rectal disorders ............................ 9
1.9 - Drugs affecting intestinal secretions ............................................10
2. Cardiovascular System .......................................................... 11
2.1 - Positive inotropic drugs ..............................................................11
2.2 - Diuretics ....................................................................................11
2.3 - Anti-arrhythmic drugs .................................................................11
2.4 - Beta-adrenoceptor blocking drugs ...............................................12
2.5 - Hypertension and heart failure ....................................................12
2.6 - Nitrates, calcium-channel blockers, and other antianginal drugs ....13
2.7 - Sympathomimetics .....................................................................13
2.8 - Anticoagulants and protamine .....................................................14
2.9 - Antiplatelet drugs .......................................................................14
2.10 – Stable angina, acute coronary syndromes and fibronolysis .........14
2.11 - Antifibrinolytic drugs and haemostatics ......................................14
2.12 - Lipid-regulating drugs ...............................................................14
2.13 - Local sclerosants ......................................................................15
3. Respiratory System ............................................................... 16
3.1 - Bronchodilators ..........................................................................16
3.2 - Corticosteroids ...........................................................................17
3.3 - Leukotriene receptor antagonists ................................................18
3.4 - Antihistamines, hyposensitisation and allergic emergencies...........18
3.5 - Respiratory stimulants and Pulmonary surfactants........................19
3.7 - Mucolytics .................................................................................19
3.11 - Antifibrotics .............................................................................19
4. Central Nervous System ........................................................ 20
4.1 - Hypnotics and anxiolytics............................................................20
4.2 - Drugs used in psychoses and related disorders ............................20
4.3 - Antidepressant drugs .................................................................21
4.4 - CNS Stimulants and drugs used for ADHD ...................................21
4.5 - Drugs used in treatment of obesity .............................................22
4.6 - Drugs used in nausea and vertigo ...............................................22
KEY:-
H - Hospital Use Only
S - Specialist Initiation or Recommendation
R - Restricted Use Only - See Full formulary http://www.fifeadtc.scot.nhs.uk/fife-joint-formulary.aspx4
4.7 - Analgesics .................................................................................23
4.8 - Antiepileptics .............................................................................25
4.9 - Drugs used in parkinsonism and related disorders ........................26
4.10 - Drugs used in substance dependence ........................................27
4.11 - Drugs for dementia ..................................................................28
5. Infections ............................................................................. 29
5.1 - Antibacterial drugs .....................................................................29
5.2 - Antifungal drugs ........................................................................31
5.3 - Antiviral Drugs ...........................................................................31
5.4 - Antiprotozoal agents ..................................................................34
5.5 - Anthelmintics .............................................................................34
6. Endocrine System ................................................................. 35
6.1 - Drugs used in Diabetes...............................................................35
6.2 - Thyroid and antithyroid drugs .....................................................37
6.3 - Corticosteroids ...........................................................................37
6.4 - Sex hormones ............................................................................38
6.5 - Hypothalamic and anterior pituitary hormones and anti-oestrogens39
6.6 - Drugs affecting bone metabolism ................................................40
6.7 - Other endocrine drugs................................................................40
7. Obstetrics, gynaecology and urinary tract disorders ................ 42
7.1 - Drugs used in obstetrics .............................................................43
7.2 - Treatment of vaginal and vulval conditions ..................................43
7.3 - Contraceptives ...........................................................................44
7.4 - Drugs for genito-urinary disorders ...............................................45
8. Malignant disease and immunosuppression ........................... 47
8.1 - Cytotoxic Drugs .........................................................................47
8.2 - Drugs affecting the immune response .........................................49
8.3 - Sex hormones and hormone antagonists in malignant disease ......50
8.4 - Bisphosphonates used in malignant disease .................................51
9. Nutrition and blood ............................................................... 52
9.1 - Anaemia and some other blood disorders ....................................52
9.2 - Fluids and Electrolytes ................................................................53
9.4 - Oral Nutrition (ACBS) .................................................................53
9.5 - Minerals ....................................................................................55
9.6 - Vitamins ....................................................................................56
10. Musculoskeletal and joint diseases ......................................... 58
10.1 - Drugs used in rheumatic diseases and gout ...............................58
10.2 - Drugs used for Neuromuscular disorders ...................................59
10.3 - Drugs used in relief of soft tissue inflammation and topical pain
relief .................................................................................................59
11. Eye ...................................................................................... 60
11.3 - Anti-infective eye preparations ..................................................60
11.4 - Corticosteroids and other anti-inflammatory preparations ...........61
11.5 - Mydriatics and cycloplegics .......................................................61
11.6 - Treatment of Glaucoma ............................................................62
KEY:-
H - Hospital Use Only
S - Specialist Initiation or Recommendation
R - Restricted Use Only - See Full formulary http://www.fifeadtc.scot.nhs.uk/fife-joint-formulary.aspx5
11.7 - Local anaesthetics ....................................................................63
11.8 - Miscellaneous ophthalmic preparations ......................................63
12. Ear, nose and oropharynx ..................................................... 65
12.3 - Drugs acting on the oropharynx ................................................66
13. Skin ..................................................................................... 67
13.3 - Topical local anaesthetic and antipruritic preparations ................68
13.4 - Topical Coricosteroids ...............................................................68
13.5 - Preparations for Psoriasis and Eczema .......................................69
13.6 - Acne and Rosacea ....................................................................71
13.7 - Warts and calluses ...................................................................72
13.8 - Sunscreens and Camouflagers ..................................................73
13.9 - Shampoos and other preparations for scalp and hair conditions ..73
13.10 - Anti_infective skin preparations ...............................................74
13.11 - Skin cleansers and Antiseptics .................................................75
13.12 - Antiperspirants .......................................................................75
15. Anaesthesia .......................................................................... 76
15.1 - General Anaesthetia .................................................................76
15.2 - Local Anaesthesia.....................................................................77
KEY:-
H - Hospital Use Only
S - Specialist Initiation or Recommendation
R - Restricted Use Only - See Full formulary http://www.fifeadtc.scot.nhs.uk/fife-joint-formulary.aspxIntroduction
This NHS Fife Abbreviated Formulary List includes the names of
medicines recommended within the Fife Formulary and is
structured in line with the BNF classification. The full version of
the NHS Fife Formulary should be referred to for further
information, local prescribing points or for referral to local and
nationally approved guidelines.
Further prescribing information can also be accessed from the
Fife ADTC website at www.fifeadtc.scot.nhs.uk/
The medicines included in the abbreviated list are those that
are approved as 1st or 2nd choices. Other non-formulary
medicines should normally only be prescribed when formulary
choices have been ineffective, are not tolerated or are
contraindicated.
The medicines are considered for general use unless classified
into one of the following categories:
H - Hospital use only
S - Specialist initiation or recommendation
R - Restricted use only Refer to Full formulary
http://www.fifeadtc.scot.nhs.uk/fife-joint-formulary.aspx
Updates
The abbreviated Joint Formulary list will be updated
electronically bi-monthly and can be accessed via the ADTC
website or via the intranet. www.fifeadtc.scot.nhs.uk/
For further information on the Fife Formulary contact:
Fraser Notman,
Prescribing Support Pharmacist
(01383) 565449.7
1. Gastrointestinal system
1.1 Dyspepsia and gastro-oesophageal reflux
disease
1.1.1 Antacids
Aluminium and magnesium-containing antacids
1st Choice Co-magaldrox (Mucogel® )
1.1.2 Compound alginates and proprietary indigestion
preparations
1st Choice Peptac®
Child Gaviscon Infant® sachets
1.2 Antispasmodics and other drugs altering gut
motility
1st Choice Mebeverine (standard tablets)
2nd Choice Hyoscine butylbromide
Peppermint oil
1.3 Antisecretory drugs and mucosal protectants
1.3.1 H2-receptor antagonists
1st Choice Ranitidine
1.3.3 Chelates and complexes
1st Choice S - Sucralfate
1.3.5 Proton Pump Inhibitors
Omeprazole capsules or Lansoprazole
1st Choice
capsules
H - Pantoprazole (IV)
Eradication of H.Pylori
1st Choice Clarithromycin (500mg twice daily)
plus Amoxycillin (1 gram twice daily)
plus Proton pump inhibitor
Alternatives Metronidazole (400mg twice daily)
plus Amoxicillin (1 gram twice daily)
plus Proton pump inhibitor
Suitable for penicillin allergy
Metronidazole (400mg twice daily)
plus Clarithromycin (500mg twice daily)
plus Proton pump inhibitor
KEY:-
H - Hospital Use Only
S - Specialist Initiation or Recommendation
R - Restricted Use Only - See Full formulary http://www.fifeadtc.scot.nhs.uk/fife-joint-formulary.aspx8
1.4 Acute diarrhoea
Oral Rehydration Therapy
Dioralyte®
st
1 Choice
Antimotility drugs
Loperamide
st
1 Choice
Codeine
nd
2 Choice
1.5 Chronic bowel disorders
1.5.1 Aminosalicylates
Systemic treatment
1st Choice S - Mesalazine (Pentasa®)
S - Mesalazine (Octasa®) [Not for new
initiations only for patients currently on
Asacol®]
Local treatment
S - Mesalazine suppositories (Salofalk®)
S - Mesalazine foam enema (Salofalk®)
S - Mesalazine retention enema (Salofalk ®)
1.5.2 Corticosteroids
Systemic treatment
1st Choice S - Prednisolone (standard tablets)
2nd Choice S - Budesonide (Budenofalk®, Cortiment®)
Local treatment
S - Hydrocortisone foam enema (Colifoam®)
S - Prednisolone Enema (Predsol®)
S - Prednisolone Suppositories
1.5.3 Drugs Affecting Immune response
H - Adalimumab (Humira®)
H - Golimumab (Simponi®)
H - Infliximab (Inflectra®)
H - Vedolizumab (Entyvio®)
KEY:-
H - Hospital Use Only
S - Specialist Initiation or Recommendation
R - Restricted Use Only - See Full formulary http://www.fifeadtc.scot.nhs.uk/fife-joint-formulary.aspx9
1.6 Laxatives
Acute constipation
1st Choice Bisacodyl
2nd Choice Senna
Sodium picosulfate
Glycerol suppositories
Chronic Constipation
Bulk forming Laxative
1st Choice Ispaghula Husk (Ispagel®, Regulan®)
2nd Choice Methylcellulose (Celevac®)
Osmotic Laxative
Macrogols
(Laxido®, Laxido® Paediatric, Cosmacol®-
1st Choice Plain, Cosmacol®- Half)
2nd Choice Lactulose
Opioid induced Constipation
1st Choice Bisacodyl + Docusate sodium
2nd Choice Senna + Docusate sodium
Enemas
1st Choice Sodium citrate
2nd Choice Phosphates (Fletchers®)
1.6.5 Bowel cleansing solutions
H - Macrogols (Moviprep®)
H - Sodium picosulfate (Picolax®)
1.6.6 Peripheral opioid receptor antagonists
S - Methylnaltrexone (Relistor®)
1.6.7 Other drugs used in Constipation
R - Linaclotide (Constella®)
1.7 Local preparations for anal and rectal disorders
1.7.1 Soothing haemorrhoidal preparations
1st Choice Anusol®
Compound haemorrhoidal preparations with
1.7.2 corticosteroids
1st Choice Anusol HC®
2nd Choice Scheriproct®
KEY:-
H - Hospital Use Only
S - Specialist Initiation or Recommendation
R - Restricted Use Only - See Full formulary http://www.fifeadtc.scot.nhs.uk/fife-joint-formulary.aspx10
1.7.3 Rectal sclerosants
H - Oily phenol injection
1.7.4 Management of Anal Fissures
1st Choice Diltiazem 2% (unlicensed)
1.9 Drugs affecting intestinal secretions
1.9.1 Drugs affecting biliary composition and flow
1st Choice S - Ursodeoxycholic acid
2nd Choice S – Obeticholic acid
1.9.2 Bile acid sequestrants
1st Choice Colestyramine
1.9.4 Pancreatin
1st Choice S - Creon®
2nd Choice S - Pancrex V®
KEY:-
H - Hospital Use Only
S - Specialist Initiation or Recommendation
R - Restricted Use Only - See Full formulary http://www.fifeadtc.scot.nhs.uk/fife-joint-formulary.aspx11
2. Cardiovascular System
2.1 Positive inotropic drugs
2.1.1 Cardiac glycosides
Digoxin
H - Digoxin specific antibody (Digifab®)
2.2 Diuretics
2.2.1 Thiazides and related diuretics
1st Choice Bendroflumethiazide
2nd Choice Indapamide 2.5mg
2.2.2 Loop diuretics
1st Choice Furosemide
2nd Choice Bumetanide
2.2.3 Potassium-sparing diuretics and aldosterone antagonists
1st Choice Spironolactone
2nd Choice Eplerenone
2.2.5 Osmotic diuretics
H - Mannitol
2.3 Anti-arrhythmic drugs
2.3.2 Drugs for arrhythmias
Class I anti-arrhythmics (membrane stabilising drugs)
Flecainide
st
1 Choice
S - Propafenone
nd
2 Choice
H - Lignocaine (Lidocaine)
Class II anti-arrhythmics (beta-blockers)
Bisoprolol
st
1 Choice
S - Metoprolol
nd
2 Choice
Class III anti-arrhythmics
S - Amiodarone
st
1 Choice
R - Dronedarone (Multaq®)
nd
2 Choice
Class IV anti-arrhythmics
(calcium channel Verapamil
blockers)
Other anti-arrhythmics Digoxin
H - Adenosine
KEY:-
H - Hospital Use Only
S - Specialist Initiation or Recommendation
R - Restricted Use Only - See Full formulary http://www.fifeadtc.scot.nhs.uk/fife-joint-formulary.aspx12
2.4 Beta-adrenoceptor blocking drugs
Atenolol - hypertension, angina, post-MI
st
1 Choice
nd
Propranolol - anxiety, migraine
2 Choice prophylaxis, thyrotoxicosis, tremor,
oesophageal varices
Carvedilol - heart failure (Class I - IV),
oesophageal varices
Nebivolol - systolic hypertension in the
elderly, stable heart failure in patients
over 70 years
Bisoprolol
S - Labetolol - Pregnancy
S - Metoprolol - renal impairment,
initiation of beta-blockade in coronary care
S - Sotalol (see also section 2.3.2) -
arrhythmias
H - Esmolol - critical care, anaesthesia
2.5 Hypertension and heart failure
2.5.1 Vasodilator antihypertensive drugs
Hydralazine
2.5.2 Centrally-acting antihypertensive drugs
Moxonidine
2.5.4 Alpha-adrenoceptor blocking drugs
Doxazosin (standard tablets)
2.5.5 Drugs affecting the renin-angiotensin system
2.5.5.1 Angiotensin-converting enzyme inhibitors
1st Choice Ramipril
2nd Choice Lisinopril
2.5.5.2 Angiotensin-II receptor antagonists
1st Choice Losartan
2nd Choice Candesartan (1st line choice in heart
failure)
S - Irbesartan (diabetic nephropathy in
Type 2 Diabetes)
S - Telmisartan
Neprilysin/angiotensin-II receptor antagonists
S - Sacubitril/Valsartan (Entresto®)
KEY:-
H - Hospital Use Only
S - Specialist Initiation or Recommendation
R - Restricted Use Only - See Full formulary http://www.fifeadtc.scot.nhs.uk/fife-joint-formulary.aspx13
2.6 Nitrates, calcium-channel blockers, and other
antianginal drugs
2.6.1 Nitrates
Glyceryl trinitrate
st
1 Choice
Isosorbide mononitrate (modified release)
nd
2 Choice
H - Glyceryl trinitrate IV
H - Isosorbide dinitrate IV
2.6.2 Calcium channel blockers
Dihydropyridines
1st Choice Amlodipine
2nd Choice Felodipine
Rate limiting
1st Choice Verapamil
2nd Choice Diltiazem
H - Nimodipine
2.6.3 Other antianginal drugs
1st Choice Nicorandil
2nd Choice S - Ivabradine (Procoralan®)
2.6.4 Peripheral vasodilators and related drugs
1st Choice Nifedipine (standard capsules)
2.7 Sympathomimetics
2.7.1 Inotropic sympathomimetics
H - Dobutamine
H - Dopamine
H - Isoprenaline
2.7.2 Vasoconstrictor sympathomimetics
H - Ephedrine hydrochloride
H - Metaraminol
H - Noradrenaline (Norepinephrine)
H - Phenylephrine
2.7.3 Cardiopulmonary resuscitation
Adrenaline (Epinephrine)
KEY:-
H - Hospital Use Only
S - Specialist Initiation or Recommendation
R - Restricted Use Only - See Full formulary http://www.fifeadtc.scot.nhs.uk/fife-joint-formulary.aspx14
2.8 Anticoagulants and protamine
2.8.1 Parenteral anticoagulants
Heparin
st
1 Choice
S - Dalteparin
H - Epoprostenol
S - Fondaparinux
R - Argatroban
R - Tinzaparin
2.8.2 Oral anticoagulants
Warfarin
st
1 Choice
Rivaroxaban (Xarelto®)
nd
2 Choice
2.8.3 Protamine Sulphate
H - Protamine
2.9 Antiplatelet drugs
Aspirin
st
1 Choice
Clopidogrel
nd
2 Choice
R - Ticagrelor (Brilique®)
S – Prasugrel (Efient®)
2.10 Stable angina, acute coronary syndromes and
fibronolysis
2.10.2 Fibrinolytic Drugs
S - Tenecteplase
H - Alteplase
H - Streptokinase
H - Urokinase
2.11 Antifibrinolytic drugs and haemostatics
Tranexamic acid
2.12 Lipid-regulating drugs
Statins
Atorvastatin
st
1 Choice
Simvastatin
nd
2 Choice
S - Pravastatin
S - Rosuvastatin
Bile acid sequestrants
KEY:-
H - Hospital Use Only
S - Specialist Initiation or Recommendation
R - Restricted Use Only - See Full formulary http://www.fifeadtc.scot.nhs.uk/fife-joint-formulary.aspx15
S - Colestyramine
2.13 Local sclerosants
H - Ethanolamine oleate
H - Sodium tetradecyl sulfate
KEY:-
H - Hospital Use Only
S - Specialist Initiation or Recommendation
R - Restricted Use Only - See Full formulary http://www.fifeadtc.scot.nhs.uk/fife-joint-formulary.aspx16
3. Respiratory System
3.1 Bronchodilators
3.1.1 Adrenoceptor agonists
3.1.1.1 Selective beta 2 agonists
Short-
Metered dose inhaler Dry powder inhaler
acting
(SABA) (MDI) (DPI)
Salbutamol Easyhaler® Salbutamol
Long- MDI DPI
acting
(LABA)
Formoterol
Easyhaler® Formoterol
(Atimos Modulite®)
3.1.1.2 Other adrenoceptor stimulants
Adrenaline (Epinephrine)
3.1.2 Antimuscarinic bronchodilators
Short-acting (SAMA)
Ipratropium
Long-acting (LAMA)
COPD
1st Choice Umeclidinium (Incruse Ellipta®)
(once daily administration)
2
nd
Choice Aclidinium (Eklira Genuair®)
(twice daily administration)
Combination Preparations
Umeclidinium/vilanterol
1st Choice (Anoro Ellipta®)
(once daily administration)
Aclidinium/ formoterol
2nd Choice (Duaklir Genuair®)
(twice daily administration)
KEY:-
H - Hospital Use Only
S - Specialist Initiation or Recommendation
R - Restricted Use Only - See Full formulary http://www.fifeadtc.scot.nhs.uk/fife-joint-formulary.aspx17
Triple Combination
Preparations
Beclometasone
dipropionate/formoterol
fumarate/glycopyrronium
(Trimbow®)
Fluticasone furoate/vilanterol
trifenatate/umeclidinium
(Trelegy®)
Asthma
Tiotropium (Spiriva
Respimat®) - Step 4
3.1.3 Theophylline
Theophylline (preferred brand
for oral products is Uniphyllin®)
H - Aminophylline (IV)
Section deleted 3.1.4
3.1.5 Peak flow meters, inhaler devices and nebulisers
Peak Flow Meters
Standard Range Medi®
Low Range Medi®
Spacer Devices
Spacer Device Compatible MDI
AeroChamber® Plus All MDIs
Atimos Modulite®, Clenil Modulite®,
Volumatic®
Seretide®
3.2 Corticosteroids
MDI DPI
st Beclometasone (Clenil Easyhaler®
1 Choice
Modulite®) Beclometasone
Easyhaler®Budesonide
nd
2 Choice
Compound preparations
MDI DPI
Fostair® 100/6 Relvar Ellipta®
(extra-fine 92 mcg/22 mcg
COPD
beclometasone + (fluticasone furoate + vilanterol)
formoterol)
Asthma Seretide 50 Symbicort Turbohaler®
KEY:-
H - Hospital Use Only
S - Specialist Initiation or Recommendation
R - Restricted Use Only - See Full formulary http://www.fifeadtc.scot.nhs.uk/fife-joint-formulary.aspx18
(5-12 yrs) Evohaler® (fluticasone (>6 years)
propionate+salmeterol)
+/- spacer
1st choice:
Flutiform ® Relvar Ellipta®
Asthma 92 mcg/22 mcg, 184 mcg/22 mcg
(fluticasone propionate +
(12-17 yrs) formoterol) 2nd choice:
Symbicort Turbohaler®
1st choice:
Fostair® 100/6 , Relvar Ellipta®
Asthma 200/6 92 mcg/22 mcg, 184 mcg/22 mcg
Adults (extra-fine 2nd choice:
beclometasone +
formoterol) Fobumix Easyhaler
80/4.5, 160/4.5, 320/9
3.3 Leukotriene receptor antagonists
Montelukast
3.4 Antihistamines, hyposensitisation and
allergic emergencies
3.4.1 Antihistamines
Non -Sedating
Cetirizine
st
1 Choice
Loratadine
nd
2 Choice
S - Fexofenadine
Sedating
Chlorphenamine
st
1 Choice
S - Hydroxyzine
3.4.2 Allergen Immunotherapy
R - Omalizumab (Xolair®)
3.4.3 Allergic Emergencies
Adrenaline (epinephrine)
Epipen®
Chlorphenamine IV
Hydrocortisone IV
H - C1-Esterase Inhibitor
(Berinert P®)
KEY:-
H - Hospital Use Only
S - Specialist Initiation or Recommendation
R - Restricted Use Only - See Full formulary http://www.fifeadtc.scot.nhs.uk/fife-joint-formulary.aspx19
3.5 Respiratory stimulants and Pulmonary
surfactants
3.5.1 Respiratory Stimulants
R - Caffeine citrate injection
20mg/ml (Peyona®)
R - Doxapram (Dopram®)
3.5.2 Pulmonary surfactants
R - Poractant alfa (Curosurf®)
3.7 Mucolytics
Acetylcysteine
st
1 Choice
Carbocisteine
nd
2 Choice
R - Dornase Alfa (Cystic fibrosis)
H - Nebulised hypertonic sodium
chloride 6%
S - Nebulised sodium chloride
0.9%
3.11 Antifibrotics
H - Nintedanib (Ofev®)
H - Pirfenidone (Esbriet®)
KEY:-
H - Hospital Use Only
S - Specialist Initiation or Recommendation
R - Restricted Use Only - See Full formulary http://www.fifeadtc.scot.nhs.uk/fife-joint-formulary.aspx20
4. Central Nervous System
4.1 Hypnotics and anxiolytics
4.1.1 Hypnotics
1st Choice Non-drug treatment e.g.sleep hygiene
2nd Choice Drug treatment
1st
Zopiclone
Choice
2nd
Temazepam
Choice
Chloral and Derivatives
S - Chloral Hydrate
Melatonin
S - Melatonin MR 2mg tablets
(Circadin®)
4.1.2 Anxiolytics
Acute anxiety
1st Choice Diazepam (long acting)
2nd Choice Lorazepam (short acting)
Other drugs for acute anxiety
Propranolol (standard tablets)
Anxiety Disorders
Non-drug treatment
1st Choice
+/- psychological Fluoxetine
therapies
2nd Choice Sertraline
+/- psychological
Venlafaxine (immediate release)
therapies
S - Pregabalin
4.2 Drugs used in psychoses and related disorders
4.2.1 Antipsychotics in older people with dementia
1st generation S - Chlorpromazine
S - Haloperidol
2nd generation S - Olanzapine
KEY:-
H - Hospital Use Only
S - Specialist Initiation or Recommendation
R - Restricted Use Only - See Full formulary http://www.fifeadtc.scot.nhs.uk/fife-joint-formulary.aspx21
S - Risperidone
S - Aripiprazole
Treatment of
resistant psychoses
S - Clozapine (Zaponex®)
4.2.2 Antipsychotic depot injections
1st generation S - Flupentixol decanoate (Depixol®)
S - Zuclopenthixol decanoate
(Clopixol®)
2nd generation S - Paliperidone (Xeplion®)
S - Aripiprazole (Abilify Maintena®)
4.2.3 Antimanic drugs
S - Lithium (Prescribe by brand name
1st Choice
only prefered brand is Priadel®)
2nd Choice S - Sodium valproate (off label use)
Bi-polar depression
1st Choice S - Quetiapine (immediate release)
2nd Choice S - Lamotrigine
4.3 Antidepressant drugs
4.3.1 Tricyclic and related antidepressant drugs
1st Choice Amitriptyline (neuropathic pain)
Clomipramine (phobia and obsessional
2nd Choice
states)
S - Imipramine
4.3.2 Monoamine-Oxidase Inhibitors (MAOIs)
Initiated by specialists only
4.3.3 Selective Serotonin Re-Uptake Inhibitors (SSRIs)
1st Choice Fluoxetine
2nd Choice Sertraline
4.3.4 Other Antidepressant Drugs
1st Choice Mirtazapine
2nd Choice Venlafaxine (standard tablets)
Phobia and obsessional states
1st Choice Clomipramine
2nd Choice Paroxetine
4.4 CNS Stimulants and drugs used for ADHD
Attention Deficit Hyperactivity disorder (ADHD)
Stimulants
1st Choice S - Methylphenidate - standard tablet,
KEY:-
H - Hospital Use Only
S - Specialist Initiation or Recommendation
R - Restricted Use Only - See Full formulary http://www.fifeadtc.scot.nhs.uk/fife-joint-formulary.aspx22
M/R-M/R product should be prescribed by
brand name Matoride® XL, Equasym XL®,
Medikinet XL ®
2nd Choice S - Lisdexamfetamine (Elvanse®)
Non-stimulants
S - Atomoxetine (Strattera®)
st
1 Choice
2nd Choice H - Guanfacine (Intuniv®)
Melatonin
S - Melatonin 2mg tablets (Circadin®)
Narcolepsy
S - Modafinil (Provigil®)
st
1 Choice
2nd Choice S - Dexamfetamine
4.5 Drugs used in treatment of obesity
1st Choice Diet and lifestyle changes
2nd Choice Orlistat (Xenical®)
4.6 Drugs used in nausea and vertigo
Cyclizine
Domperidone
Haloperidol
Hyoscine hydrobromide
Levomepromazine
Metoclopramide
Prochlorperazine
H - Aprepitant (Emend®)
S - Ondansetron (standard tablets)
Choices for specific indications
Chemotherapy Induced
Highly S - Ondansetron
emetogenic H - Aprepitant (Emend®)
Moderately S - Ondansetron
emetogenic Domperidone
Mildly
Domperidone
emetogenic
Motion Sickness
1st Choice OTC treatment from pharmacy
2nd Choice Cyclizine
KEY:-
H - Hospital Use Only
S - Specialist Initiation or Recommendation
R - Restricted Use Only - See Full formulary http://www.fifeadtc.scot.nhs.uk/fife-joint-formulary.aspx23
N&V in Migraine
1st Choice Metoclopramide
2nd Choice Domperidone
Opioid Induced
1st Choice Haloperidol
Other Vestibular Disorders
1st choice:
Cinnarizine
Acute treatment
2nd choice:
Prochlorperazine
1st choice:
Betahistine
Maintenance
2nd choice:
Cinnarizine
4.7 Analgesics
Non- Opioid analgesics and compound analgesic
4.7.1
preparations
Non-Opioid analgesics
Paracetamol
Ibuprofen (low dose24
S - Fentanyl nasal spray (Pecfent®) -
Palliative Care initiation only
Diamorphine
Tramadol injection
R- Oxycodone 50mg/ml inj (Oxynorm®)
R- Cyclimorph®
R- Pethidine
4.7.3 Neuropathic Pain/ Adjuvants
Tricylcic antidepressants
1st Choice Amitriptyline (off label use)
2nd Choice Imipramine (If amitriptyline is not
tolerated (off label use)
Gabapentinoids
1st Choice Gabapentin
2nd Choice Pregabalin
Trigeminal neuralgia
1st Choice Carbamazepine
2nd Choice Tricyclic antidepressant (TCA)
Gabapentinoid
S - Duloxetine (Cymbalta®)
4.7.4 Antimigraine drugs
4.7.4.1 Treatment of acute migraine attack
Step 1 Aspirin
Ibuprofen
Naproxen
Paracetamol
Anti-emetic
1st Choice Metoclopramide
2nd Choice Domperidone
Step 2
5HT1-receptor agonists
1st Choice Sumatriptan
2nd Choice Rizatriptan
4.7.4.2 Prophylaxis of migraine
Pizotifen
Propranolol
S - Sodium Valproate (off label use)
S - Topiramate
4.7.4.3 Cluster headache and the trigeminal autonomic
KEY:-
H - Hospital Use Only
S - Specialist Initiation or Recommendation
R - Restricted Use Only - See Full formulary http://www.fifeadtc.scot.nhs.uk/fife-joint-formulary.aspx25
cephalalgias
1st Choice Sumatriptan injection (Imigran®)
2nd Choice Zolmitriptan nasal spray (Zomig®) (off
label use)
4.8 Antiepileptics
4.8.1 Control of Epilepsies
Generalised
S - Lamotrigine - for primary generalised
epilepsy (including absences and myoclonus),
1st Choice
partial seizures, secondary generalised tonic-
clonic seizures
S - Sodium Valproate - for primary
generalised epilepsy (including absences and
2nd Choice
myoclonus), partial seizures, secondary
generalised tonic-clonic seizures
Focal
1st Choice S - Levetiracetam - for mycolinic seizures,
focal seizures
2nd Choice S - Carbamazepine - for partial seizures and
secondary generalised tonic-clonic seizures
(Restricted use when 1st line choices have failed or in combination
with a 1st line choice):
S - Brivaracetam
S - Clobazam (Schedule 11 - requires ‘SLS’
endorsement on prescription)
S - Eslicarbazepine
S - Lacosamide
S - Topiramate
(Restricted use for treatment resistant seizures or as adjuncts to
other therapy):
S - Ethosuximide
S - Oxcarbazepine
S - Perampanel (Flycompa®)
S - Phenobarbital
S - Phenytoin
S - Primidone
S - Rufinamide (Inovelon®) (Lennox-
Gastaut syndrome)
S - Vigabatrin (Sabril®) (infantile spasms)
S - Zonisamide (Zonegran®)
4.8.2 Drugs used in status epilepticus
KEY:-
H - Hospital Use Only
S - Specialist Initiation or Recommendation
R - Restricted Use Only - See Full formulary http://www.fifeadtc.scot.nhs.uk/fife-joint-formulary.aspx26
S - Midazolam (Preferred brand Epistatus® -
st
1 Choice buccal, intranasal - both are unlicensed
routes)
Alternative
S - Diazepam rectal tubes
Choices
S - Paraldehyde rectal (unlicensed)
H - Fosphenytoin injection
H - Lorazepam Injection
H - Paraldehyde injection (unlicensed)
H - Phenytoin injection
Community setting
The preferred midazolam product in NHS Fife is
Epistatus®. Patients and carers are trained on the use
of this product. Alternative formulations e.g.
Buccolam® pre-filled syringes should not be
prescribed.
4.8.3 Febrile convulsions
1st Choice Midazolam (Preferred brand Epistatus® -
buccal - unlicensed route)
2nd Choice Diazepam (rectal)
4.9 Drugs used in parkinsonism and related
disorders
4.9.1 Dopaminergic drugs used in parkinsonism
Levodopa
S - Co-beneldopa (Madopar®)
S - Co-careldopa (Sinemet®)
Levodopa and carbidopa
S - Co-careldopa intestinal gel
(Duodopa®)
Dopamine agonists
S - Apomorphine
S - Pramipexole
S - Ropinirole
S - Rotigotine (Neupro®)
Other dopaminergic agents
S - Selegiline
S - Stanek®
S - Stalevo® (For patients who are unable
KEY:-
H - Hospital Use Only
S - Specialist Initiation or Recommendation
R - Restricted Use Only - See Full formulary http://www.fifeadtc.scot.nhs.uk/fife-joint-formulary.aspx27
to change to Stanek®)
S - Entacapone (COMT inhibitor) (Normally
prescribed as Stalevo®, but may be used as
entacapone when co-prescribed with other
levodopa therapy)
S - Amantadine
4.9.2 Antimuscarinic drugs used in parkinsonism
1st Choice S - Procyclidine
Drugs used in essential tremor, chorea, tics and related
4.9.3
disorders
Essential Tremor
1st Choice Propranolol (standard tablets)
2nd Choice S - Primidone
Intractable Hiccups
Chlorpromazine
Haloperidol
Torsion dystonias and other involuntary movements
S - Botulinum A toxin (Botox®)
4.10 Drugs used in substance dependence
4.10.1 Alcohol dependence
Alcohol detoxification
Chlordiazepoxide
Vitamin Supplementation
S - Pabrinex®
Thiamine
Alcohol relapse prevention
S - Acamprosate (Campral EC®) +
counselling
S - Disulfiram (Antabuse ®)+counselling
S - Naltrexone +counselling
R - Nalmefene (Selincro®) + psychosocial
support
4.10.2 Nicotine Dependence
Nicotine Replacement Therapy +
1st Choice specialist support
16 hr patch (Nicorette Invisi)
24 hour patch (Nicotinell)
KEY:-
H - Hospital Use Only
S - Specialist Initiation or Recommendation
R - Restricted Use Only - See Full formulary http://www.fifeadtc.scot.nhs.uk/fife-joint-formulary.aspx28
Chewing gum (Nicorette)
Lozenges (Niquitin minis, Nicotinell )
Inhalator (Nicorette)
Varenicline (Champix®)+ Specialist
2nd Choice
support
4.10.3 Opioid dependence
Opioid detoxification
1st Choice Methadone 1mg/ml oral solution
2nd Choice Buprenorphine tablets
R - Buprenorphine/naloxone
(Suboxone®)
R - Buprenorphine (Espranor®)
S - Lofexidine (BritLofex®)
Opioid maintenance prescribing
1st Choice Methadone 1mg/ml oral solution
2nd Choice Buprenorphine tablets
R - Buprenorphine/naloxone
(Suboxone®)
R - Buprenorphine (Espranor®)
Opioid relapse prevention
S - Naltrexone
Reversal of Opioid Overdose
S - Naloxone (Prenoxad®)
Acute benzodiazepine detoxification symptoms
Diazepam
Benzodiazepine Maintenance prescribing
Diazepam
4.11 Drugs for dementia
Mild to moderate
1st Choice S - Donepezil
S - Galantamine
2nd Choice S - Rivastigmine
Moderate
only if Acetylcholinesterase (AChE) inhibitors are not
tolerated or contraindicated
S - Memantine
Severe S - Memantine
KEY:-
H - Hospital Use Only
S - Specialist Initiation or Recommendation
R - Restricted Use Only - See Full formulary http://www.fifeadtc.scot.nhs.uk/fife-joint-formulary.aspx29
5. Infections
5.1 Antibacterial drugs
5.1.1 Penicillins
5.1.1.1 Benzylpenicillin and Phenoxymethylpenicillin
Benzylpenicillin (Penicillin G)
Phenoxymethylpenicillin (Penicillin V)
5.1.1.2 Penicillinase-resistant penicillins
Flucloxacillin
* H - Temocillin
5.1.1.3 Broad-spectrum penicillins
Amoxicillin
Co-amoxiclav
5.1.1.4 Antipseudomonal penicillins
H - Piperacillin withTazobactam
5.1.2 Cephalosporins, carbapenems, and other beta-lactams
5.1.2.1 Cephalosporins
Not recommended for general use in primary care
* = Refer to restricted antimicrobial list
R - Cefalexin
S - Cefixime
* H - Cefotaxime
* H - Ceftazidime
* H - Ceftriaxone
* H - Cefuroxime
5.1.2.2 Carbapenems
* H - Ertapenem
* H - Meropenem
5.1.2.3 Other beta-lactam antibiotics
R - Aztreonam lysine (Cayston®)
5.1.3 Tetracyclines
1st Choice Doxycycline
Oxytetracycline
2nd Choice Lymecycline
* H - Tigecycline
KEY:-
H - Hospital Use Only
S - Specialist Initiation or Recommendation
R - Restricted Use Only - See Full formulary http://www.fifeadtc.scot.nhs.uk/fife-joint-formulary.aspx30
5.1.4 Aminoglycosides
H - Gentamicin
S - Tobramycin nebulised solution
R - Tobramycin powder (TOBI Podhaler®)
5.1.5 Macrolides
Erythromycin
Clarithromycin
Azithromycin
5.1.6 Clindamycin
Clindamycin
5.1.7 Some Other Antibacterials
H - Chloramphenicol
Use on S - Colistimethate Sodium dry powder
Bacteriological nebuliser solution(Proxim®), dry
advice only powder for inhalation (Colobreathe®)
* H - Daptomycin
Use on
Bacteriological R - Fidaxomicin
advice only
Use on R – Fosfomycin trometamol granules
Bacteriological (Monuril®)
advice only H – Fosfomycin infusion (Fomicyt®)
H - Fusidic acid
Use on
Bacteriological S - Linezolid
advice only
S - Rifaximin (Targaxan®)
H - Teicoplanin
H - Vancomycin
5.1.8 Sulfonamides and trimethoprim
Trimethoprim
S - Co-trimoxazole
5.1.9 Antituberculosis drugs
S - Ethambutol
S - Isoniazid
S - Pyrazinamide
S - Rifampicin
S - Rifater® (rifampicin, isoniazid,
KEY:-
H - Hospital Use Only
S - Specialist Initiation or Recommendation
R - Restricted Use Only - See Full formulary http://www.fifeadtc.scot.nhs.uk/fife-joint-formulary.aspx31
pyraziniamide)
S - Rifinah® (rifampicin, isoniazid)
5.1.10 Antileprotic drugs
S - Dapsone
5.1.11 Metronidazole and tinidazole
Metronidazole
5.1.12 Quinolones
Ciprofloxacin
Levofloxacin
Norfloxacin
Ofloxacin
5.1.13 Nitrofurantoin
Nitrofurantoin capsules
5.2 Antifungal drugs
* = Refer to restricted antimicrobial list
Terbinafine
Fluconazole
Griseofulvin
Itraconazole
Nystatin
* H - Liposomal Amphotericin
* H - Anidulafungin
* R - Caspofungin
* H - Posaconazole
* H - Voriconazole
5.3 Antiviral Drugs
5.3.1 HIV Infections
Nucleoside Reverse Transcriptase Inhibitors (NRTIs)
H - Abacavir
H - Didanosine
H - Emtricitabine
H - Evilplera®
H - Lamivudine
H - Stavudine
H - Tenofovir
KEY:-
H - Hospital Use Only
S - Specialist Initiation or Recommendation
R - Restricted Use Only - See Full formulary http://www.fifeadtc.scot.nhs.uk/fife-joint-formulary.aspx32
H - Zidovudine
Protease Inhibitors
H - Atazanavir
H - Darunavir
H - Fosamprenavir
H - Indinavir
H - Lopinavir with Ritonavir
H - Nelfinavir
H - Ritonavir
H - Saquinavir
H - Tipranavir
Non-Nucleotide Reverse Transcriptase Inhibitors
(NNRTIs)
H - Efavirenz
H - Etravirine
H- Nevirapine
H - Rilpivirine
Other Antiretrovirals
H - Enfuvirtide
H - Maraviroc
H - Dolutegravir
H - Raltegravir
Combination Products
H - Atripla®
H - Eviplera®
H - Evotaz®
H - Genvoya®
H - Rezolsta®
H - Stribild®
H - Symtuza®
H - Triumeq®
H - Truvada®
5.3.2 Herpesvirus infections
5.3.2.1 Hepes simplex and varicella-zoster infection
1st Choice Aciclovir
2nd Choice Famciclovir
Valaciclovir
KEY:-
H - Hospital Use Only
S - Specialist Initiation or Recommendation
R - Restricted Use Only - See Full formulary http://www.fifeadtc.scot.nhs.uk/fife-joint-formulary.aspx33
5.3.2.2 Cytomegalovirus infection
Specialist advice H - Ganciclovir (including ophthalmic
only. implants)
Specialist advice
only. H - Valganciclovir
5.3.3 Viral hepatitis
5.3.3.1 Chronic Hepatitis B
H - Peginterferon alfa
H - Adefovir
H - Entecavir
H - Lamivudine
H - Tenofovir
5.3.3.2 Chronic Hepatitis C
H - Peginterferon alfa
H - Ribavirin
+/- In combination with
H - Daclatasvir (Daklinza®)
H - Dasabuvir (Exviera®)
H - Elbasvir 50mg / Grazoprevir
100mg (Zepatier®)
H - Glecaprevir / Pibrentasvir
(Maviret®)
H - Ledipasvir/Sofosbuvir
(Harvoni®)
H - Ombitasvir/ Paritaprevir/
Ritonavir (Viekirax®)
H - Simeprevir (Olysio®)
H - Sofosbuvir (Sovaldi®)
H - Sofosbuvir-Velpatasvir
(Epclusa®)
5.3.4 Influenza
Oseltamivir (Tamiflu®)
Zanamivir (Relenza®)
5.3.5 Respiratory Syncytial Virus
Specialist advice
only.
H - Palivizumab
KEY:-
H - Hospital Use Only
S - Specialist Initiation or Recommendation
R - Restricted Use Only - See Full formulary http://www.fifeadtc.scot.nhs.uk/fife-joint-formulary.aspx34
5.4 Antiprotozoal agents
5.4.1 Antimalarials
Chloroquine
Doxycycline
Mefloquine
Proguanil
Proguanil with Atovaquone
(Malarone®)
H - Artemether with lumefantrine
(Riamet®)
H - Quinine
5.4.8 Drugs for Pneumocystis Pneumonia
Specialist advice
only. H - Co-trimoxazole
Specialist advice
only.
H - Atovaquone
5.5 Anthelmintics
5.5.1 Drugs for Threadworms
Mebendazole
KEY:-
H - Hospital Use Only
S - Specialist Initiation or Recommendation
R - Restricted Use Only - See Full formulary http://www.fifeadtc.scot.nhs.uk/fife-joint-formulary.aspx35
6. Endocrine System
6.1 Drugs used in Diabetes
6.1.1 Insulins
Rapid
Humalog
st
Type 1 1 Choice
Novorapid
nd
2 Choice
R - Humalog 200
Short
Humulin S
st
Type 1 & 2 1 Choice
Actrapid
nd
2 Choice
Intermediate
Humulin I
st
Type 1 & 2 1 Choice
Insulatard
nd
2 Choice
Long
Abasaglar
st
Type 1 1 Choice
Lantus
nd
2 Choice
R - Insulin Glargine (Toujeo®)
R - Levemir
Type 2 Abasaglar
Analogue mix only for Type 1
Humalog Mix 25
st
Type 1 1 Choice
Novomix 30
nd
2 Choice
Type 2 (restricted R - Humalog Mix 50
use)
Human mixed only for Type 2
Humulin M3
st
Type 2 1 Choice
Insuman Comb 25
nd
2 Choice
6.1.1.3 Insulin Pen Needles
Tricare Pen Needles
6.1.2 Other antidiabetic drugs
Biguanide
First step 1st Choice
Metformin
Sulfonylureas
Gliclazide
Glipizide
Step 2 & 3 1st Choice Glitazone
KEY:-
H - Hospital Use Only
S - Specialist Initiation or Recommendation
R - Restricted Use Only - See Full formulary http://www.fifeadtc.scot.nhs.uk/fife-joint-formulary.aspx36
intensification Pioglitazone
Gliptins
1st Choice Alogliptin
2nd Choice Sitagliptin
SGLT-2 Inhibitors (Gliflozins)
1st Choice Empagliflozin
2nd Choice Dapagliflozin
Sulfonylureas
1st Choice Gliclazide
2nd Choice Glipizide
Step 4 if
patients 1st Choice Exenatide (Bydureon®)
Dulaglutide (Trulicity®)
nd
HbA1c not 2 Choice
achieved
Insulins (See section 6.1.1)
6.1.4 Treatment of Hypoglycaemia
Glucose Oral Gel 40%
Glucagon (Glucagen® hypokit)
Oral Glucose
Rapilose® (Unlicensed)
Tolerance test
6.1.6 Monitoring agents for diabetes mellitus
Blood Glucose strips
Type 1 diabetes
Glucomen® Areo sensor strip
(Areo 2k meter)
Aviva strips (Expert meter
only)
Type 2 diabetes
Glucomen® Areo Sensor
TRUEyou®
Ketone strips
Glucomen® Areo 2 Ketone
1st Choice
strips
KEY:-
H - Hospital Use Only
S - Specialist Initiation or Recommendation
R - Restricted Use Only - See Full formulary http://www.fifeadtc.scot.nhs.uk/fife-joint-formulary.aspx37
6.2 Thyroid and antithyroid drugs
6.2.1 Thyroid Hormones
Levothyroxine (standard
1st Choice
tablets)
H - Liothyronine injection
6.2.2 Antithyroid drugs
1st Choice S - Carbimazole
2nd Choice S - Propylthiouracil
H - Aqueous Iodine
(Unlicensed)
Beta Blockers
S - Propranolol (standard
tablets)
6.3 Corticosteroids
6.3.1 Replacement therapy
S - Fludrocortisone (Florinef®)
S - Hydrocortisone
6.3.2 Glucocorticoid therapy
1st Choice Prednisolone (Standard tablets
including soluble tablets)
2nd Choice S - Hydrocortisone
S - Dexamethasone
Orthostatic Hypotension
1st Choice
S - Fludrocortisone
(Florinef®)(off label)
2nd Choice Midodrine (Bramox®)
KEY:-
H - Hospital Use Only
S - Specialist Initiation or Recommendation
R - Restricted Use Only - See Full formulary http://www.fifeadtc.scot.nhs.uk/fife-joint-formulary.aspx38
6.4 Sex hormones
6.4.1 Female sex hormones
Sequential combined therapy (cyclical)(For use in a
woman with an intact uterus)
Tablets
1st Choice Elleste Duet®(estradiol 1mg or
2mg, norethisterone 1mg)
2nd Choice Femoston® (Estradiol 1mg or 2mg
+ dydrogesterone 10mg)
R-Tridestra®(Estradiol 2mg,
medroxyprogesterone acetate
20mg)
Patches
Evorel Sequi®(estradiol
1st Choice 50mcg/24hrs +Norethisterone
170mcg/24hrs)
FemSeven Sequi® (estradiol
2nd Choice 50mcg/24hrs, levonorgestrel
10mcg/24hrs)
Continuous combined therapy (For use in a woman
with an intact uterus)
Tablets
1st Choice Kliovance®(estradiol 1mg +
norethisterone 500mcg)
Kliofem®(estradiol 2mg +
norethisterone 1mg)
Premique® Low dose (Oestrogen
2nd Choice (equine) + medroxyprogesterone
acetate)
Tibolone (Livial®)
Patches
Evorel Conti® (estradiol
1st Choice 50mcg/24hrs + norethisterone
170mcg/24hrs)
2nd Choice FemSeven Conti®(estradiol
50mcg/24hrs + levonorgestrol
KEY:-
H - Hospital Use Only
S - Specialist Initiation or Recommendation
R - Restricted Use Only - See Full formulary http://www.fifeadtc.scot.nhs.uk/fife-joint-formulary.aspx39
7mcg/24hrs)
Oestrogen only (only for use in women who have had a
hysterectomy or have a Mirena® IUS in situ)
Tablets
1st Choice Elleste - Solo® (estradiol 1mg or
2mg)
Patches
1st Choice Evorel®(estradiol 25mcg-
100mcg/24hrs)
2nd Choice Estradot®(estradiol 25mcg-
100mcg/24hrs)
Transdermal Gel
R - Oestrogel® (estradiol 0.06%)
6.4.1.2 Progestogens
1st Choice Norethisterone
2nd Choice Medroxyprogesterone acetate
Progesterone receptor modulators
S - Ulipristal 5mg tablets
(Esmya®)
6.4.2 Male sex hormones and antagonists
Testosterone and esters
1st Choice S - Testogel®
2nd Choice S - Nebido® injection
Anti-androgens
Cyproterone
5α-reductase inhibitors
1st Choice Finasteride
2nd Choice S - Dutasteride (Avodart®)
6.5 Hypothalamic and anterior pituitary hormones
and anti-oestrogens
Hypothalamic and anterior pituitary hormones and
6.5.1
anti-oestrogens
Anti-Oestrogens
1st Choice Clomifene
2nd Choice Tamoxifen
KEY:-
H - Hospital Use Only
S - Specialist Initiation or Recommendation
R - Restricted Use Only - See Full formulary http://www.fifeadtc.scot.nhs.uk/fife-joint-formulary.aspx40
Anterior Pituitary Hormones
H - Tetracosactide 250mcg/ml
(Synacthen®)
Gonadotrophins
S - Somatropin (genotropin®)
Hypothalamic hormones
H - Gonadorelin
6.5.2 Posterior pituitary hormones and antagonists
Desmopressin tablets
Desmomelt®
H - Terlipressin
H - Tolvaptan (Jinarc®)
Antidiuretic hormone antagonists
H - Demeclocycline
6.6 Drugs affecting bone metabolism
Bisphosphonates and other drugs affecting bone
metabolism
1st Choice Alendronic acid
2nd Choice Risedronate
S - Denosumab 60mg/ml
(Prolia®)
3rd Choice H - Zoledronic acid IV infusion
H - Teriparitide (Forsteo®)
Malignancies
H - Denosumab 70mg/ml
(Xgeva®)
H - Disodium pamidronate IV
infusion
S - Ibandronic acid tablets
50mg
H - Sodium clodronate
H - Zoledronic acid IV infusion
6.7 Other endocrine drugs
6.7.1 Bromocriptine and other dopaminergic drugs
1st Choice S - Cabergoline
2nd Choice S - Quinagolide
KEY:-
H - Hospital Use Only
S - Specialist Initiation or Recommendation
R - Restricted Use Only - See Full formulary http://www.fifeadtc.scot.nhs.uk/fife-joint-formulary.aspx41
6.7.2 Drugs affecting gonadotrophins
S - Danazol
Gonadorelin Analogues
1st Choice S - Triptorelin (Decapeptyl®)
2nd Choice S - Leuprorelin (Prostap®)
S - Goserelin (Zoladex®)
S - Nafarelin (Synarel®)
KEY:-
H - Hospital Use Only
S - Specialist Initiation or Recommendation
R - Restricted Use Only - See Full formulary http://www.fifeadtc.scot.nhs.uk/fife-joint-formulary.aspx42
7. Obstetrics, gynaecology and urinary
tract disorders
Menstrual Disorders
Dysmenorrhoea
st Simple analgesia e.g. Paracetamol,
1 Choice
NSAID (excluding Mefenamic Acid)
Combined Oral Contraceptive
nd
2 Choice
Levonorgestrel (Mirena® IUS)
Medroxyprogesterone Acetate
(Depo-Provera®)
Progesterone only pill
Etonogestrel (Nexplanon®)
Endometriosis
Simple analgesia e.g. Paracetamol,
1st Choice
NSAID (excluding Mefenamic Acid)
Combined Oral Contraceptive
nd
2 Choice
Levonorgestrel (Mirena® IUS)
Medroxyprogesterone Acetate
(Depo-Provera®)
H -Triptorelin (Decapeptyl®)
Frequent Irregular periods
Contraception required
st Combined Oral Contraceptive or
1 Choice
Cerelle®
Levonorgestrel (Mirena® IUS)
nd
2 Choice
Medroxyprogesterone Acetate
(Depo-Provera®)
Progesterone only pill
Etonogestrel (Nexplanon®)
Contraception not required
Norethisterone
st
1 Choice
Menorrhagia
Tranexamic Acid
st
1 Choice
Ibuprofen
Combined Oral Contraceptive
nd
2 Choice
Levonorgestrel (Mirena® IUS)
Medroxyprogesterone Acetate
(Depo-Provera®)
KEY:-
H - Hospital Use Only
S - Specialist Initiation or Recommendation
R - Restricted Use Only - See Full formulary http://www.fifeadtc.scot.nhs.uk/fife-joint-formulary.aspx43
7.1 Drugs used in obstetrics
7.1.1 Prostaglandins and oxytocics
H - Carboprost (Hemabate®)
H - Dinoprostone ( Prostine E2®,
Propess®)
Ergometrine
H - Gemeprost
H - Misoprostol vaginal delivery
system (Mysodelle®)
H - Misoprostol tablets (Cytotec®)
(off label use)
H - Oxytocin (Syntocinon®)
Syntometrine®
7.1.1.1 Ductus arteriosus
H - Alprostadil
H - Ibuprofen injection (Pedea®)
7.1.2 Mifepristone
H - Mifepristone (Mifegyne®)
R - Mifepristone + Misoprostol
(Medabon®)
7.1.3 Myometrial relaxants
H - Atosiban (Tractocile®)
H - Salbutamol injection
H - Terbutaline injection
7.2 Treatment of vaginal and vulval conditions
7.2.1 Preparations for vaginal atrophy
Ovestin® cream (estriol 0.1%)
st
1 Choice
Vagifem® vaginal tablets
7.2.2 Vaginal and vulval infections
Fungal infections
Clotrimazole
st
1 Choice
Fluconazole (oral)
Other vaginal infections
Metronidazole tablets
st
1 Choice
Clindamycin cream (Dalacin®)
nd
2 Choice
Metronidazole gel 0.75% (Zidoval®)
KEY:-
H - Hospital Use Only
S - Specialist Initiation or Recommendation
R - Restricted Use Only - See Full formulary http://www.fifeadtc.scot.nhs.uk/fife-joint-formulary.aspx44
7.3 Contraceptives
7.3.1 Combined Hormonal Contraceptives
Levonorgestrel or norethisterone
containing preparations
1st Choice Rigevidon® (Equivalent to Microgynon
30® and Ovranette®)
2nd Choice
Ethinylestradiol
with norgestimate
Cilique® (Equivalent to Cilest®)
Ethinylestradiol
with norethisterone
Loestrin 20®
Loestrin 30®
Ethinylestradiol Gedarel® (20/150) (Equivalent to
with desogestrel Mercilon®)
Gedarel® (30/150) (Equivalent to
Marvelon®)
Ethinylestradiol Millinette® (20/75) (Equivalent to
with gestodene Femodette®)
Millinette® (30/75) (Equivalent to
Femodene®)
R - Triregol® (Equivalent to Logynon®)
Ethinylestradiol
with norgestimate
Transdermal
R - Evra®
7.3.2 Progesterone only contraceptives
7.3.2.1 Oral progesterone-only contraceptives
Norethisterone 350mcg (Noriday®)
st
1 Choice
Desogestrel 75mcg (Cerelle® -
Equivalent to Cerazette®)
7.3.2.2 Parenteral progesterone-only contraceptives
Injectable Medroxyprogesterone acetate (Depo-
preparation Provera®) - IM injection
Medroxyprogesterone acetate
(Sayana Press®) - SC injection
Implant Etonogestrel (Nexplanon®)
7.3.2.3 Intra-uterine progesterone - only system
Levonorgestrel 52mg (Mirena®IUS)
st
1 Choice
2
nd
Choice Levonorgestrel 13.5mg (Jaydess®
IUS)
KEY:-
H - Hospital Use Only
S - Specialist Initiation or Recommendation
R - Restricted Use Only - See Full formulary http://www.fifeadtc.scot.nhs.uk/fife-joint-formulary.aspx45
7.3.3 Spermicidal contraceptives
Nonoxinol ‘9’ 2% (Gygel®)
7.3.4 Intrauterine contraceptives
TT 380® Slimline
1st Choice (For uterine length 6.5cm to 9cm; replace every
10 years)
UT 380 Standard® (Equivalent to Nova®
2nd Choice T 380) (For uterine length 6.5cm to 9cm;
replace every 5 years)
Mini TT 380® Slimline
(For minimum uterine length 5cm; replace
every 5 years)
UT 380 Short®
(For uterine length 5cm – 7cm; replace every 5
years)
7.3.5 Emergency contraception
0- 120 Hours Ulipristal 30mg (Ella-One®)
0 - 72 Hours Levonorgestrel 1.5mg (Upostelle®)
7.4 Drugs for genito-urinary disorders
Drugs for Urinary Retention
7.4.1 Alpha-blockers
Tamsulosin M/R 400mcg Capsules
st
1 Choice
Alfuzosin M/R 10mg Tablets
nd
2 Choice
5α reductase inhibitors
Finasteride
st
1 Choice
S - Dutasteride (Avodart®)
nd
2 Choice
7.4.2 Drugs for urinary frequency , enuresis and incontinence
Urge incontinence
Tolterodine (standard tablets)
st
1 Choice
Solifenacin (Vesicare®)
nd
2 Choice
R - Mirabegron ( Betmiga®)
H - Botulinium toxin type A 50, 100
200 units/Vial (Botox®)
Stress Incontinence
Pelvic floor muscle exercises
st
1 Choice
Duloxetine (Yentreve®)
nd
2 Choice
Nocturnal enuresis
Desmopressin tablets
KEY:-
H - Hospital Use Only
S - Specialist Initiation or Recommendation
R - Restricted Use Only - See Full formulary http://www.fifeadtc.scot.nhs.uk/fife-joint-formulary.aspx46
Desmomelt® tablets
S - Imipramine
Renal Colic
1st Choice Diclofenac (IM injection)
2nd Choice Morphine
7.4.3 Drugs used in urological pain
Alkanisation of Urine
Potassium citrate mixture
7.4.4 Bladder instillations and urological surgery
Dissolution of encrustation in catheter
Solution G
Dissolution of blood clots following urological surgery
Sodium chloride 0.9%
H - Glycine
Painful bladder syndrome/Interstitial cystitis
H - Sodium hyaluronate (Cystistat®)
st
1 Choice
nd H - Sodium chondroitin sulphate
2 Choice
(Uracyst®)
H - Sodium hyaluronate/ sodium
chondroitin sulphate (Ialuril®)
Treatment of or prevention of recurrence of bladder
tumours
H - BCG (bacillus calmette-guérin)
bladder instillation
(ImmuCyst®/Oncotice®)
H - Mitomycin-C (Mitomycin C
Kyowa®, Mito-In®)
7.4.5 Drugs for erectile dysfunction
Phosphodiesterase type-5 inhibitors (PDE5i)
Sildenafil SLS
st
1 Choice
Tadalafil 10mg, 20mg (Cialis®) SLS
nd
2 Choice
R - Vardenafil (Levitra®) SLS
S - Alprostadil [Caverject® Dual
Chamber (2.5 - 20mcg), Viridal Duo
(20mcg-40mcg)] SLS
S - Alprostadil cream (Vitaros®)
S - Alprostadil urethral sticks
(Muse®)
KEY:-
H - Hospital Use Only
S - Specialist Initiation or Recommendation
R - Restricted Use Only - See Full formulary http://www.fifeadtc.scot.nhs.uk/fife-joint-formulary.aspx47
8. Malignant disease and
immunosuppression
8.1 Cytotoxic Drugs
Drugs for cytotoxic-induced side-effects
H - Calcium folinate (folinic acid)
H - Mesna
8.1.1 Alkylating Drugs
R - Bendamustine
H - Busulfan
H - Chlorambucil
H - Cyclophosphamide
H - Ifosfamide
H - Melphalan
8.1.2 Anthracyclines and other cytotoxic antibiotics
H - Bleomycin
H - Daunorubicin
H - Doxorubicin
H - Epirubicin
H - Idarubicin
H - Mitomycin
H - Mitoxantrone
8.1.3 Antimetabolites
R - Azacitidine
H - Capecitabine
H - Cladribine (Leustat®, Litak ®)
H - Cytarabine
R - Fludarabine
H - Fluorouracil
H - Gemcitabine
H - Mercaptopurine (Puri-Nethol®,
Xalpurine®)
S - Methotrexate
R - Pemtrexed
H - Raltitrexed
H - Tioguanine
KEY:-
H - Hospital Use Only
S - Specialist Initiation or Recommendation
R - Restricted Use Only - See Full formulary http://www.fifeadtc.scot.nhs.uk/fife-joint-formulary.aspxYou can also read
