To relax the abdominal wall in preparation of abdominal wall reconstruction. 300 units to be administered 2 to 4 weeks before the procedure (300 units reconstituted in 150ml sodium chloride 0.9%)

NICE Guidelines:Botulinum toxin type A for the prevention of headaches in adults with chronic migraine

• NICE TA 260

Overactive Bladder algorithm

• Overactive bladder -algorithm FINAL update oct 2015.doc

On Formulary - Approved for use in October 2019 at Drugs and Therapeutics Committee (DTC) - Xeomin brand ONLY

Refer to psychiatric liason nurse for use in essential tremor, chorea, tics anad related disorders

For full monograph see https://www.formularycomplete.com/view/drug/monograph/50676

INJECTION IS HOSPITAL ONLY

see attached

• Epidural Infusion Guidelines

Hospital Only Drug

Ropivacaine admixture is approved for local infiltration of the knee during total knee replacement.
The admixture formulation is 0.2% ropivacaine (200ml bag) with addition of 1mg adrenaline and 30mg ketorolac.

Ropivacaine Admixture

• Ropivacaine mix-dec.doc

Aprepitant for treatment of refractory nausea in Adult Cystic Fibrosis (CF) patients receiving treatment for Non-tuberculosis mycobacterium when other anti-emetics have failed. Initiation will be under recommendation by the Adult CF consultant only, Hospital Only.

Approved at March 2019 DTC 

Should not routinely used for primary prevention of cardiovascular disease.

Enteric coated aspirin should not be used as it has a poor cost:benefit ratio. There is no convincing evidence that it reduces gastrointestinal bleeding (Drug Ther Bulletin, Jan 1997, p.7-8) and it has a lower bioavailability vs dispersable.

Gastroprotection with lansoprazole is advised.

Aspirin has multiple indications, follow the links below for more information

Unstable angina and NSTEMI guidelines

http://www.nice.org.uk/guidance/CG94

Stroke guidelines

http://www.nice.org.uk/Guidance/CG68

STEMI guidelines

http://www.nice.org.uk/guidance/CG167

AF guidelines

http://www.nice.org.uk/guidance/cg180

Hypertension in pregnancy guidelines

http://www.nice.org.uk/guidance/CG107

see attached

• Epidural Infusion Guidelines

Shortage of Fentanyl 2mcg/ml/Bupivacaine 0.1% (250ml & 500ml) Epidural Bags.

Chairs action has been approved to use Fentanyl 2mcg/ml/Levobupivacaine 0.1% (250ml) Epidural Bags as an alternative.

Opioid Conversion Guidelines updated 23.02.16

• Opioid Conversion Guidelines - updated 23 Feb 2016.pdf

The DTC committee have Approved Sub-lingual Fentanyl for the management of pain in adult sickle patients.

INJECTION IS HOSPITAL ONLY

Penthrax Patient Alert Card

• Penthrox Patient Alert Card-Patient Use.pdf

Penthrox (methoxyflurane) 3 mL, inhalation vapour, liquid

Appoved for use at Royal London Emergency Department  conscious adult patients with moderate to severe pain arising from trauma. Use at NUH and WCUH Emmergency Departments for the same indication agreed at Feb 2020 DTC.

  

IV formulation is for HOSPITAL USE ONLY

First line (+/- NSAIDs where appropriate) for pain without neuropathic pain

Note: dose limited to 15mg/Kg for IV dosing in patients less than 50Kg

Hospital Only Drug

Ropivacaine admixture is approved for local infiltration of the knee during total knee replacement.
The admixture formulation is 0.2% ropivacaine (200ml bag) with addition of 1mg adrenaline and 30mg ketorolac.

Ropivacaine Admixture

• Ropivacaine mix-dec.doc

To relax the abdominal wall in preparation of abdominal wall reconstruction. 300 units to be administered 2 to 4 weeks before the procedure (300 units reconstituted in 150ml sodium chloride 0.9%)

NICE Guidelines:Botulinum toxin type A for the prevention of headaches in adults with chronic migraine

• NICE TA 260

Overactive Bladder algorithm

• Overactive bladder -algorithm FINAL update oct 2015.doc

On Formulary - Approved for use in October 2019 at Drugs and Therapeutics Committee (DTC) - Xeomin brand ONLY

 Eptinezumab approved at NEL FPG for preventing migraine in line with NICE TA 871.

• NICE TA 871

​​Rimegepant approved at NEL FPG for treating migraine in line with NICE TA.

-Hospital Only

-Formulary status to be reviewed following development of the NEL migraine pathway

• NICE TA 919

​​Rimegepant approved at NEL FPG for preventing migraine in line with NICE TA.

• NICE TA 906

INJECTION FORMULATION IS FOR HOSPITAL USE ONLY

Treatment of generalised, partial, or other forms of epilepsy.

Sustained-release formulations are preferred as they reduce peak drug concentrations and ensure even plasma concentration sthroughout the day

Medicine Safety Alert Attachec

• Toolkit on the risks of valproate medicines in female patients

• Medicine Safety Alert - Valproate for females of childbearing age.pdf

prophylaxis of cluster headaches (un-licensed)

For full monograph https://www.formularycomplete.com/view/drug/monograph/55808

verapamil

• Verapamil cluster headache SCG.doc

Prescibe under the brand name Lyrica for neuropathic pain unless clinical contraindications or other special needs exist (see guidance from NHS England)

Second line for neuropathic pain if amitriptyline/gabapentin ineffective or patient experiencing unmanageable side effects
 

NICE Guidelines Neuropathic pain in adults: pharmacological management in non-specialist settings

• NICE CG 173

NHS England Guidance On Prescribing & Dispensing Pregabalin

• NHSE Pregabalin Guidance.pdf

There is a national shortage of atracurium besilate injections (all strengths). Based on current demand, it is expected that supplies of atracurium could be exhausted before the end of December. This is an ongoing medicine shortage with no confirmed date for resupply.

• National Medicine Shortage Atracurium besilate injections (all strengths) Memo.pdf

The trust has received notification from the Department of Health & Social Care regarding a national supply shortage of neuromuscular blocking agents (NMBAs). There is no timeline as to when the shortage will be resolved, it is however, anticipated to continue for some time. Please see the memo attached for further information for this drug shortage.

• Medicine Shortage National Problem with Neuromuscular blocking agents April 2020.pdf

Hospital-Only Drug

The trust has received notification from the Department of Health & Social Care regarding a national supply shortage of neuromuscular blocking agents (NMBAs). There is no timeline as to when the shortage will be resolved, it is however, anticipated to continue for some time. Please see the memo attached for further information for this drug shortage.

• Medicine Shortage National Problem with Neuromuscular blocking agents April 2020.pdf

Remimazolam approved at NEL FPG for sedation during direct current cardioversion (DCCV) at SBH only.

Hospital Only

Approved at NEL FPG for use as a sedative for dental patients in specialist settings. 

As an alternative to general anaesthetics for those requiring rapid recovery from short dental procedures (e.g. patients with physical and cognitive disabilities).

Hospital only (unless prescribed by specialist community dental service).

Hospital-Only Drug

Hospital-Only Drug

For routine reversal of neuromuscular blockade, use the 200mg vial size, to reduce drug wastage. Reserve the 500mg vials for emergency use only.

Shortage of Fentanyl 2mcg/ml/Bupivacaine 0.1% (250ml & 500ml) Epidural Bags.

Chairs action has been approved to use Fentanyl 2mcg/ml/Levobupivacaine 0.1% (250ml) Epidural Bags as an alternative.

The DTC committee have Approved Sub-lingual Fentanyl for the management of pain in adult sickle patients.

Licensed drug and approved for use as adjunctive anti epileptic therapy where all other options have failed for partial onset seizures with or without secondary generalisation in adult and adolescent patients with intractable epilepsy.  The intention is to slowly increase dose and replace therapy of a previous medication.
10mg, 25mg, 50mg, 75mg, 100mg tablets for oral administration
10mg/mL oral solution, 10mg.mL solution for injection /infusion
Starting doses of 10mg once daily increaed to twice daily in two weeks time, then 25mg twice daily to a potential maximum of 100mg twice daily.
Exclusions:

• children under age of 16 years
• CKD patients on dialysis
• Galactose intolerance
• Pregnancy unless clinically necessary i.e. benefit to mother clearly outweighs risk to foetus

Monitor for neutropenia.

Schedule 2 Controlled Drug

Cannabidiol approved at NEL FPG for treating seizures caused by tuberous sclerosis complex in line with NICE TA.

• NICE TA 873

Approved at DTC March 2022 

For use as an anxiolytic contact pyschiatry liason team

The Epilepsies: Diagnosis and Management in Adults and Children in Primary & Secondary Care, March 2021

• Anti Epileptic Drug Shared Care March 2021.pdf

Prescibe under the brand name Lyrica for neuropathic pain unless clinical contraindications or other special needs exist (see guidance from NHS England)

Second line for neuropathic pain if amitriptyline/gabapentin ineffective or patient experiencing unmanageable side effects
 

NICE Guidelines Neuropathic pain in adults: pharmacological management in non-specialist settings

• NICE CG 173

NHS England Guidance On Prescribing & Dispensing Pregabalin

• NHSE Pregabalin Guidance.pdf

INJECTION FORMULATION IS FOR HOSPITAL USE ONLY

Treatment of generalised, partial, or other forms of epilepsy.

Sustained-release formulations are preferred as they reduce peak drug concentrations and ensure even plasma concentration sthroughout the day

Medicine Safety Alert Attachec

• Toolkit on the risks of valproate medicines in female patients

• Medicine Safety Alert - Valproate for females of childbearing age.pdf

Prescibe under the brand name Lyrica for neuropathic pain unless clinical contraindications or other special needs exist (see guidance from NHS England)

Second line for neuropathic pain if amitriptyline/gabapentin ineffective or patient experiencing unmanageable side effects
 

NICE Guidelines Neuropathic pain in adults: pharmacological management in non-specialist settings

• NICE CG 173

NHS England Guidance On Prescribing & Dispensing Pregabalin

• NHSE Pregabalin Guidance.pdf

INJECTION FORMULATION IS FOR HOSPITAL USE ONLY

Treatment of generalised, partial, or other forms of epilepsy.

Sustained-release formulations are preferred as they reduce peak drug concentrations and ensure even plasma concentration sthroughout the day

Medicine Safety Alert Attachec

• Toolkit on the risks of valproate medicines in female patients

• Medicine Safety Alert - Valproate for females of childbearing age.pdf

Daridorexant approved at NEL FPG for treating long-term insomnia in line with NICE TA

Formulary Status: Amber

To be initiated either:

• by or on recommendation of a specialist

• by primary care prescriber with specialist knowledge and/or has received training to prescribe this medicine

**correct as of January 2024- there is no insomnia service across NEL.

• NICE TA 922