Formulary and Prescribing Guidelines

Medicines Management

 

Please click on the heading to view formulary, shared care guidelines and pathways for each BNF chapter.

Chapter 01 - Gastro-intestinal system

BNF chapter/
section
Drug group First line choices Second line choices
1.1 Dyspepsia and GORD Co-magaldrox (prescribe as Mucogel®).
Peptac® Liquid (alternative to Gaviscon® and Gavscon®Advance).
 
 1.2 Antispasmodics and other drugs altering gut motility Mebeverine (prescribe generically)  Hyoscine butylbromide.
Peppermint oil gastro resistant capsules.Alverine (Spasmonal).
1.3.1 H2 receptor antagonists  Ranitidine   
1.3.2 Proton pump inhibitors Omeprazole capsules
Lansoprazole capsules
Pantoprazole tablets.
Lansoprazole (orodispersible tablets) FasTabs® and Losec®MUPS® (dispersible tablets)-for patients with swallowing difficulties only.
1.4 Acute diarrhoea  Loperamide capsules (capsules more cost effective than tablets) Codeine Phosphate
1.5 Chronic bowel disorders Sulphasalazine EC-prescribe as Salazopyrin® EN-Tabs®
Mesalazine-prescribe by brand name. Octasa® MR is our first line brand of oral mesalazine
It is recommended that mesalazine is prescribed by brand name-if 400mg tablets are required Octasa® MR tablets are recommended as they are considered to be bioequivalent to Asacol® MR tablets but more cost effective. It is more cost effective to prescribe 800mg dose as 2 x 400mg Octasa® MR tablets.
1.6.1 Bulk forming laxatives  Ispaghula (prescribe as Fybogel®)  
1.6.2 Stimulant laxatives Senna
Docusate sodium
 
1.6.4 Osmotic laxatives Laxido® Orange oral powder (compound macrogol oral powder)-please note Laxido® is not recommended for children under 12 years  Lactulose
1.7 Local preparations for anal and rectal disorders Anusol-HC® (ointment).
Uniroid HC suppositories.
Glyceryl trinitrate 0.4% ointment (Rectogesic®)- only licensed strength for anal fissure.
 

 

Gastro-intestinal system formulary

 

Chapter 02 - Cardiovascular system

BNF chapter/
section
Drug group First line choices Second line choices
2.1 Cardiac glycosides Digoxin   
2.2.1  Thiazide diuretics  Indapamide.
Chlortalidone (NICE CG Hypertension).
 
2.2.2  Loop diuretics  Furosemide   
2.2.3  Aldosterone antagonist  Spironolactone   
2.3  Anti-arrhythmic drugs  Specialist initiated and usually continued in primary care  
2.4  Beta-adrenoceptor blocking drugs  Atenolol.
Propranolol.
Bisoprolol (heart failure only).
 
2.5.4  Alpha-adrenoceptor blocking drugs  Doxazosin - prescribe as standard release tablets   
2.5.5.1  Angiotensin converting enzyme inhibitors  Ramipril-prescribe as capsules (not tablets). Lisinopril.
Perindopril Erbumine (not arginine). 
 
2.5.5.2  Angiotensin-II receptor antagonists  Losartan.
Candesartan 
Irbesartan.
Valsartan-prescribe as capsules (not tablets) and generically. 
2.6.1  Nitrates  GTN spray-pump spray prescribe as Nitromin®. It is more cost effective to prescribe as 200 dose pack.

Isosorbide mononitrate-prescribe as standard release first line 10mg and 20mg tablets (as ISMO® 10 or ISMO® 20).

Isosorbide mononitrate MR for patients that can’t comply with standard release:
-60mg MR tablets/capsules-Monomil XL® tablets-40mg MR tablets/capsules-Isotard® 40XL tablets
-25mg MR tablets/capsules-Elantan LA®25 capsules
GTN patches-prescribe as Nitro-Dur® 
Standard tablets are more cost effective than MR formulations. Note asymmetric dosing regime. The second dose should be 8hrs after the first e.g. 8am and 4pm to allow for a nitrate free period. 
2.6.2  Calcium-channel blockers  Amlodipine  Diltiazem-branded diltiazem MR preparations are not interchangeable. Angitil SR® is the most cost effective twice daily brand and Zemtard® XL is the most cost effective once daily brand
Nifedipine- branded nifedipine MR preparations are not interchangeable. Coracten SR® is the most cost effective twice daily brand and Adipine® XL is the most cost effective once daily brand 
2.6.3 Other anti-anginal drugs Nicorandil  
2.6.8 Anticoagulants and protamine Warfarin Phenindione-specialist recommendation.
Acenocoumarol-specialist recommendation.
Rivaroxaban-specialist initiation, then shared care.
Dabigatran-specialist initiation, then shared care.
Apixaban-specialist initiation, then shared care.
2.9 Antiplatelet drugs  Aspirin-prescribe as standard not EC tablets.

Clopidogrel (generic) (please ensure stop date in ACS). 
Prasugrel-specialist initiation (please ensure stop date).
Ticagrelor-specialist initiation (please ensure stop date).
2.12  Lipid regulating drugs  Simvastatin  Pravastatin (consider if side effects or intolerance with simvastatin).
Atorvastatin

 

 

pdf Cardiovascular system formulary (278 KB)

Shared care guidelines

pdf Apixaban (128 KB)

pdf Dabigatran (196 KB)

pdf Rivaroxaban (140 KB)

pdf DVT Pathway (190 KB)

pdf Entresto Precribing (273 KB)

Chapter 03 - Respiratory system

BNF chapter/
section
Drug group First line choices Second line choices
3.1.1.1 Selective beta2 agonists  Short acting-salbutamol.
Longer acting-formoterol.
Short acting-terbutaline.
Longer acting-salmeterol.
3.1.2 Antimuscarinic bronchodilators Ipratropium Bromide Tiotropium-prescribe as Spiriva HandiHaler®.
Tiotropium Spiriva Respimat® is not recommended due to safety concerns-see MHRA guidance 
3.1.3  Theophylline Theophylline and aminophylline MR.
Bioequivalence of different brands of oral theophylline/aminophylline cannot be guaranteed-prescribe by brand name 
 
3.2 Corticosteroids Beclometasone, Clenil Modulite®, Qvar® (twice as potent as Clenil Modulite®)-prescribe by brand name.
Fostair® MDI (beclometasone/formoterol).
Budesonide.
Symbicort Turbohaler® (DPI) (budesonide/formoterol).
Fluticasone.Seretide Evohaler®and Accuhaler®(fluticasone/salmeterol)-COPD.
3.3.2 Leukotriene receptor antagonists Montelukast (generic)   
3.4.1 Antihistamines Chlorphenamine.
Loratadine.
Cetirizine.
Hydroxyzine.
Fexofenadine.
3.7 Mucolytics Carbocisteine 

 

 

pdf Respiratory system formulary (188 KB)

Shared care guidelines

pdf Adult asthma management (256 KB)

pdf Guidelines for the Management of COPD (199 KB)

Chapter 04 - Nervous system

BNF chapter/
section
Drug group First line choices Second line choices
4.1.1 Hypnotics Zopiclone Temazepam
4.1.2  Anxiolytics  Diazepam   
4.2.1 Antipsychotic drugs First line typical-haloperidol
First line atypical-risperidone
Please refer to the  SEPT formulary and prescribing guidelines - section 2: treatment of psychosis
4.2.3 Anti-manic drugs Please refer to the SEPT formulary and prescribing guidelines-section 3: treatment of bipolar affective disorder  
4.3 Antidepressant drugs Fluoxetine-1st line SSRI.
Fluoxetine and paroxetine have a higher propensity fordrug interactions.
It may be appropriate to consider sertraline and citalopram in patients with chronic health problems, as these have a lower propensity for drug interactions.
Please refer to the  SEPT formulary and prescribing guidelines-section 1: treatment of depression
4.4 CNS stimulant and drugs for ADHD Methylphenidate, dexamfetamine and atomoxetine-under shared care following specialist initiation. Please refer to the  SEPT formulary and prescribing guidelines-section 6: treatment of ADHD 
4.5.1 Anti-obesity drugs Orlistat To be used in conjunction with other lifestyle measures and in line with NICE guidance
4.6  Drugs used in nausea  Prochlorperazine.
Choice of agent may depend on cause of nausea and vomiting.
Domperidone.
Metoclopramide.
4.7.1 Non-opoid analgesics and compound analgesics Paracetamol.
Co-codamol (30/500 strength prescribed as Zapain tablets).
 
4.7.2 Opoid analgesics Weak: codeine, dihydrocodeine Stronger: morphine, fentanyl patches (as the brand name Fencino®).
4.7.3 Neuropathic pain Amitriptyline Gabapentrin.
Pregabalin (prescribed as BD dosing).
4.7.4.1 Antimigraine drugs - acute treatment Aspirin or ibuprofen.
Metoclopramide, domperidone, prochlorperazine.
First line triptan: sumatriptan (generic)
4.7.4.2 Prophylaxis od migraine Propranolol.
Amitriptyline.
Topiramate - specialist initiation.
Sodium valproate - specialist initiation.
4.8 Antiepileptic drugs Management/initiation in secondary care  
4.9 Drugs used in parkinsonism and related disorders Management/initiation in secondary care  
4.10 Drugs used in substance dependence    
4.11 Drugs for dementia Donepezil - under shared care following specialist initiation Galantamine.
Rivastigmine patches - used if excessive GI side-effects and dizziness with oral preparation.
Memantine (moderate to severe dementia).
Under shared care following specialist initiation. 

 

pdf Central nervous system formulary (204 KB)

Shared care guidelines

pdf Melatonin (60 KB)

SEPT formulary and shared care guidelines

pdf Tramadol review guidance (207 KB)

 

Chapter 05 - Infection

Chapter 06 - Endocrine system

BNF chapter/
section
Drug group First line choices Second line choices
6.1 Drugs used in diabetes Please refer to Pharmacological Management of Type 2 Diabetes (excluding insulin) and Pharmacological Management of Diabetes-Insulin Therapy.
6.2.1 Thyroid hormones Levothyroxine  

 

pdf Endocrine system formulary (190 KB)

pdf Guideline for self-monitoring of blood glucose (SMBG) (366 KB)

pdf Insulin Therapy (321 KB)

pdf Interim guidance Blood glucose lowering therapy in adults with type 2 diabetes (273 KB)

Shared care guidelines

pdf Denosumab (134 KB)

 

Chapter 07 - Genito-urinary system

BNF chapter/
section
Drug group First line choices Second line choices
7.2.1 Preparations for vaginal and vulval changes Estriol 0.01% (Gynest®) intravaginal cream.
Estriol 500mcg (Ortho-Gynest®) pessaries.
Estriol 0.1% (Ovestin®) intravaginal cream
7.2.2 Vaginal and vulval infections Clotrimazole 500mg pessary plus clotrimazole 1% cream Oral fluconazole 150mg if treatment failure
7.3.1 Combined hormonal contraceptives: prescribe by brand name  
Type of preparation Formulary brand name
Monophasic low strength  Loestrin 20®.Gedarel® 20/150 (same active ingredients as Mercilon®).  
Monophasic standard strength   Rigevidon® (same active ingredients as Microgynon 30®, Levest® and Ovranette®).
Gedarel® 30/150 (same active ingredients as Marvelon®).Millinette® 30/75 (same active ingredients as Femodene® and Katya 30/75®).  
7.3.2.1  Oral progestogen-only contraceptives  Micronor®  Desogestrel (as the brand name Zelleta® or Nacrez®
7.3.2.2 Parenteral progestogen-only contraceptives Depo-Provera® injection  Nexplanon® implant 
7.3.2.3 Intra-uterine progestogen-only device Mirena®   
7.3.5 Emergency contraception Levonorgestrel (as the brand name Levonelle® 1500). Do not prescribe as Levonelle® One Step, as it is significantly more costly.  Ulipristal acetate (ellaOne®). Emergency contraceptive from 72-120 hours post unprotected intercourse. 
7.4.1 Drugs for urinary retention Tamsulosin MR-prescribe as capsules (not tablets)   
7.4.2 Drugs for urinary frequency, enuresis, and incontinence Oxybutynin immediate release tablets (not suitable for frail older women). Ditropan® (oxybutynin) 2.5mg/5ml elixir if patient unable to swallow tablets.  Tolterodine immediate release tablets.
Darifenacin (Emselex®) modified release tablets-3rd line.
Mirabegron (Betmiga®) sustained release tablets-4th line, unless there is a contra-indication to antimuscarinic agents. 
7.4.5 Drugs for erectile dysfunction Sildenafil (prescribe generically)  

 

pdf Obstetrics Gynaecology and UTIs formulary (191 KB)

pdf OAB medicines pathway (298 KB)  

Chapter 08 - Malignant disease

BNF chapter/
section
Drug group First line choices Second line choices
8.3 Sex hormones and hormone antagonists in malignant disease Specialist initiation

 

 

pdf Malignant disease and immunosuppression formulary (183 KB)

 

Chapter 09 - Nutrition and blood

BNF chapter/
section
Drug group First line choices Second line choices
9.1.1 Oral iron Ferrous fumarate (ferrous fumarate 210mg (68mg iron) and dried ferrous sulphate 20mmg (65mg iron) considered interchangeable)  
9.1.2 Drugs used in megaloblastic anaemia Folate deficiency anaemia: folic acid.
Vitamin B12 deficiency: hydroxocobalamin. 
 
9.4 Oral nutrition Please refer to Guidelines for the appropriate use of oral nutritional supplements (ONS) in primary care
9.6.4 Vitamin D (with calcium) Calceos tablets chewable (calcium carbonate 1.25g and colecalciferol 10mcg (400units) per tablet)  Higher dose vitamin D preparations may be needed for the treatment of deficiency/insufficiency-please refer to local vitamin D guidelines. 

 

pdf Nutrition and blood formulary (185 KB)

Prescribing guidelines

pdf Gluten-free foods on prescription (120 KB)

pdf Infant formula prescribing guidelines (547 KB)

pdf Quick reference guide to prescribing infant formula (247 KB)

folder Supporting papers for CMPA

pdf Adult Oral Nutritional Supplements Prescribing Guidelines (1.00 MB)

pdf Quick reference guide to ONS prescribing in adults (242 KB)

pdf Vitamin D Guidance (500 KB)

pdf Policy for the prescribing of vitamin D low doses with OTC products (483 KB)

pdf Vitamin D self care leaflet (247 KB)

Chapter 10 - Musculoskeletal system

BNF chapter/
section
Drug group First line choices Second line choices
10.1.1 Non-steroidal anti-inflammatory drugs Ibuprofen.
Naproxen (prescribe as standard tablets, ec tablets are not recommended).
 
10.1.2 Corticosteroids Prednisolone (prescribe as standard tablets, ec tablets are not recommended)  Local injections? 
10.1.3 Drugs that suppress the rheumatic disease process Specialist initiation/recommendation  
10.1.4 Gout and cytotoxic-induced hyperuricaemia Acute attacks of gout: colchicine.
Prophylaxis: allopurinol. 
Febuxostat is an option when allopurinol is not tolerated at an effective dose or for whom allopurinol is contra-indicated. 
10.2.2 Skeletal muscle relaxants Baclofen  Diazepam
10.3.2 Topical NSAIDs, capsaicin Ibuprofen 5% gel (prescribe as brand name Fenbid® gel-100g container is most cost effective)  

 

pdf Musculosketal and joint diseases formulary (186 KB)

Shared care guidelines

pdf Rheumatology methotrexate shared care guidelines (43 KB)

Chapter 11 - Eye

BNF chapter/
section
Drug group First line choices Second line choices
11.3.1 Anti-infective eye preparations-antibacterials Chloramphenicol eye drops 0.5% and eye ointment 1% Fusidic acid modified release eye drops 1%
11.3.3 Anti-infective eye preparations-antivirals Aciclovir eye ointment 3%  
11.4 Corticosteroids and other anti-inflammatory preparations Specialist recommendation and supervision  
11.4.2 Other anti-inflammatory preparations Sodium cromoglicate eye drops 2%  
11.6 Treatment of glaucoma Specialist recommendation   
11.8.1 Tear deficiency, ocular lubricants, and astringents Hypromellose 0.3% eye drops.Clinitas Gel® (carbomer 980 0.2%-most cost effective brand name).  Tear-Lac® if preservative free preparation required

 

 

pdf Eye formulary (186 KB)

 

Chapter 12 - Ear, nose and oropharynx

BNF chapter/
section
Drug group First line choices Second line choices
12.1.1 Otitis externa    
12.1.2 Otitis media Please refer to the  South West Essex Antimicrobial Prescribing Guidance For Primary Care
12.2.1 Drugs used in nasal allergy Beclometasone aqueous nasal spray 50micrograms/actuation   

 

pdf Ear, nose and throat formulary (184 KB)

 

Chapter 13 - Skin

End of Life formulary

Woundcare formulary

Traffic light list for prescribing

Specials

 

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