NICE NG8: Anaemia management in people with chronic kidney disease
County Durham and Darlington APC - Guidance for the treatment of Vitamin D insufficiency and deficiency – June 2015
County Durham and Darlington APC - Adult Vitamin D Guideline – Quick Reference Guide Guidance for the treatment of Vitamin D insufficiency and deficiency – September 2017
CD&D Guidelines for Diagnosing and Managing Cows Milk Protein Allergy (CMPA) and Lactose Intolerance
Guidelines for the Supply of Gluten Free Products in Durham and Darlington
CD&D Guidelines for Diagnosing and Managing Cows Milk Protein Allergy (CMPA) and Lactose Intolerance
Guidelines for the Supply of Gluten Free Products in Durham and Darlington
Cumbria Vitamin D Guidelines - Approved for use in Tees CCGs
GP Guidance for the long term follow-up and management of patients who have had Bariatric Surgery
Guidelines for the supply of gluten-free (GF) products in Tees CCGs
North Tees and Hartlepool Adult Dietetic Referral Form
North Tees Pathway for the Management of Undernutrition (Adults)
North Tees Pathway for the Management of Undernutrition (Care Homes)
South Tees GP Guidance on the Monitoring of Oral Nutritional Supplements
South Tees Hospitals Dietary Advice to Help Improve Nutritional Intake
South Tees Hospitals Referral Form for Community Nutrition & Dietetic Services
South Tees Pathway for the Management of Undernutrition (Adults)
South Tees Pathway for the Management of Undernutrition (Nursing/Care Homes)
The County Durham and Tees Valley APC Do Not Prescribe List and Grey List can be accessed online at: https://medicines.necsu.nhs.uk/download/tees-prescribing-grey-list/
CD&D Patient Decision Aids Resource available at: http://medicines.necsu.nhs.uk/guidelines/durham-darlington/
NHS England Guidance on “Conditions for which over the counter items should not routinely be prescribed” available at: https://www.england.nhs.uk/medicines/conditions-for-which-over-the-counter-items-should-not-routinely-be-prescribed/
Prescribing of medicines available to purchase over the counter for self-care
231.5mg capsules
NTAG Sept 2018: The Northern (NHS) Treatment Advisory Group recommends the use of oral Ferric Maltol as an alternative option in patients with mild to moderate IDA with IBD who have been unable to tolerate at least two oral
ferrous salts due to adverse effects after an adequate trial. The recommendation to prescribe Ferric Maltol should be made by an IBD specialist. Feraccru should not be used in patients with inflammatory bowel disease (IBD) flare or in IBD-patients with haemoglobin (Hb).
NTAG Sept 2018: The Northern (NHS) Treatment Advisory Group recommends the use of oral Ferric Maltol as an alternative option in adult patients with mild to
moderate iron deficiency anaemia who have been unable to tolerate at least two oral ferrous salts due to adverse effects after an adequate trial (e.g. 3 months) and who would otherwise be treated with IV iron. The recommendation to prescribe Ferric Maltol should be made by a secondary care specialist experienced in the management of IDA.
The County Durham and Tees Valley APC Do Not Prescribe List and Grey List can be accessed online at: https://medicines.necsu.nhs.uk/download/tees-prescribing-grey-list/
The County Durham and Tees Valley APC Do Not Prescribe List and Grey List can be accessed online at: https://medicines.necsu.nhs.uk/download/tees-prescribing-grey-list/
MHRA Drug Safety Update (Aug 2013) intravenous iron and serious hypersensitivity reactions: new strengthened recommendations to manage and minimise risk
100mg in 5ml injection
Cannot be used for total dose infusion
Maximum 200mg per administration no more than 3 times per week
100ml in 2ml & 500mg in 10ml injections
For use as an alternative to iron dextran or iron sucrose. Approved for use by renal physicians, gastroenterologists and haematologists.
Unlicensed for use in children under 14 years of age. If used in this age-group, use should only be on the advice of a consultant with the informed consent of the patient and/or his/her parents/carers.
Erythropoietins
See MHRA Drug Safety Update (May 2015) - Epoetin beta (NeoRecormon): increased risk of retinopathy in preterm infants cannot be excluded
10, 15, 20, 30, 40, 50, 60, 80, 100, 150 & 300 microgram injections in prefilled syringes
20, 40, 60, 80, 100 & 300 microgram Sureclick® pens
Commissioner: NHS England – renal dialysis only as per NICE CG114
MHRA Drug Safety Alert (Oct 2017): risk of severe cutaneous adverse reactions
MHRA Drug Safety Update (Jan 2018): Recombinant human erythropoietins: very rare risk of severe cutaneous adverse reactions (SCARs)
Injection - 20,000units, 30,000units, 40,000units
Prescribed in accordance with NICE TA323
MHRA Drug Safety Alert (Oct 2017): risk of severe cutaneous adverse reactions
MHRA Drug Safety Update (Jan 2018): Recombinant human erythropoietins: very rare risk of severe cutaneous adverse reactions (SCARs)
Injection
Prescribed in accordance with NICE TA323
Commissioner: NHS England – renal dialysis only as per NICE CG114
MHRA Drug Safety Alert (Oct 2017): risk of severe cutaneous adverse reactions
MHRA Drug Safety Update (Jan 2018): Recombinant human erythropoietins: very rare risk of severe cutaneous adverse reactions (SCARs)
Tariff Excluded (dialysis-induced anaemia only); NHSE Commissioned
Approved: NICE TA323
Tariff Excluded (dialysis-induced anaemia only); NHSE Commissioned
Approved: NICE TA323
300mg/30ml injection
NICE HST1: Eculizumab for treating atypical haemolytic uraemic syndrome (HST1)
Not approved in accordance with the following NICE TAs:
Commissioner: NHS England
125mg, 180mg, 250mg, and 500mg tablets
Approved for iron chelation in patients with myelodysplastic syndromes (MDS) - (as per NECN Haematology Group Guidelines) and recommended for use in patients when treatment with desferrioxamine is no longer considered to be appropriate due to progressive iron overload despite maximally tolerated doses of desferrioxamine. – Initiated by specialists only
500 microgram capsules
For the treatment of thrombocythaemia as a 2nd line agent in patients poorly/non-responsive to hydroxycarbamide therapy.
25mg, 50mg and 75mg film coated tablets
Approved for use in accordance with the following NICE TAs OR if indication funded from the Cancer Drugs Fund :
• NICE TA293:Eltrombopag for treating chronic immune (idiopathic) thrombocytopenic purpura
250 microgram vial
For the treatment of adults with chronic immune (idiopathic) thrombocytopenia purpura NICE TA221.
3mg film coated tablets
Approved for use in accordance with the following NICE TAs:
20mg film coated tablets
Approved for use in accordance with the following NICE TAs:
6mg in 0.6ml injection in prefilled syringes
Commissioner: NHS England – in accordance with Cancer Network Guidelines
300 microgram (30 million units) injection in 0.5ml syringes and 1ml vials
480 microgram (48 million units) injection in 0.5ml syringes – available as Neupogen (original brand) and Ratiograstim – a biosimilar product
Commissioner: NHS England – in accordance with Cancer Network Guidelines
263 microgram (33.6 million units) injection vials
Commissioner: NHS England – in accordance with Cancer Network Guidelines
24mg in 1.2ml injectiom
Commissioner: NHS England - Policy - B04/P/c
Only if recommended by a specialist
If required pharmacy need notice to obtain
Drug protocol: hypokalaemia (CDDFT intranet access only)
Drug protocol: hyperkalaemia (CDDFT intranet access only)
Potassium Removal Polystyrene Sulphonate Resin
Powder (Calcium polystyrene sulphonate)
Potassium Removal Polystyrene Sulphonate Resins
Powder (Sodium polystyrene sulphonate)
Potassium Removal Polystyrene Sulphonate Resin
Powder (Calcium polystyrene sulphonate)
Sorbisterit® provides an alternative to the existing proprietary product at a lower cost. The dose of Sorbisterit® and the existing proprietary product differ as the strength of the active ingredient varies slightly.
8.4 g powder for oral suspension, 16.8 g powder for oral suspension, and 25.2 g powder for oral suspension.
Approved for use in accordance with the following NICE TAs:
5g and 10g powder sachets for oral suspension
Approved for use in accordance with the following NICE TAs:
8.4g, 16.8g and 25.2g sachets powder for oral suspension
Approved for use in accordance with the following NICE TAs:
MR Tablets - 600mg
Approx. 10 mmol sodium & chloride per tablet
Sachets
Sodium 12 mmol, potassium 4 mmol, chloride 12 mmol, citrate 2 mmol & glucose 18 mmol (3.56g) / sachet
1mmol / ml oral solution
5mmol/5ml oral solution (unlicensed) - Recommended strength in children as per NPPG/RCPCH Position Statement: Using Standardised Strengths of Unlicensed Liquid Medicines in Children.
Treatment should only be initiated with the advice of a specialist
Contact Pharmacy for Information
Please refer to County Durham & Tees Gluten Free Guidelines
The County Durham and Tees Valley APC Do Not Prescribe List and Grey List can be accessed online at: https://medicines.necsu.nhs.uk/download/tees-prescribing-grey-list/
The County Durham and Tees Valley APC Do Not Prescribe List and Grey List can be accessed online at: https://medicines.necsu.nhs.uk/download/tees-prescribing-grey-list/
The County Durham and Tees Valley APC Do Not Prescribe List and Grey List can be accessed online at: https://medicines.necsu.nhs.uk/download/tees-prescribing-grey-list/
Vitamin and mineral supplements should only be prescribed in line with an ACBS indication, i.e. only in the management of actual vitamin or mineral deficiency; they are not to be prescribed as dietary supplements or as a general “pick-me-up”. If patients still want to take vitamins and minerals for dietary supplementation or as a “pick-me-up” they should be advised that they can be purchased as selfcare over-the-counter.
Some patients may be eligible for NHS Healthy Start vitamins which are specifically designed for pregnancy, breastfeeding and growing children. They are available free of charge from local distribution points. More information is available on the Healthy Start Vitamins website.
Drug protocol: hypocalcaemia (CDDFT intranet access only)
Tablets Effervescent - 1.25g (Cacit)
Sandocal 1000 tablets (calcium lactate gluconate, calcium carbonate & citric acid providing 1000mg, 25 mmol calcium)
Each 5ml contains 2.5mmol of calcium (in form of calcium lactate and calcium gluconate 20.4mg of soluble calcium or 0.51mmol of calcium per ml)u
Drug protocol: hypercalcaemia (CDDFT intranet access only)
4mg injection
- for hypercalcaemia of malignancy and the prevention of skeletal
events in patients with metastatic breast cancer.
Prescribe by brand name (Zometa®) to avoid confusion with a different strength product used to treat osteoporosis and Paget’s disease.
Tablets - 30mg, 60mg, 90mg
Shared care agreement for primary hyperparathyroidism
Tees - Shared Care Protocol (Endocrinology)
Tertiary centre indication:
For the treatment of secondary hyperparathyroidism in patients with end stage renal disease on maintenance haemodialysis where parathyroid gland surgery has failed or is inappropriate. Also for short term use to control symptoms prior to a second attempt at more definitive surgery.
Commissioner: NHS England - NICE TA117
Drug protocol: hypomagnesaemia (CDDFT intranet access only)
6.5g (10 mmol) sachets
-first line for the treatment and prevention of magnesium deficiency
50% 2ml (4 mmol), 50% 10ml (20 mmol) & 10% 10ml (4
mmol) injections
MHRA Drug Safety Update (May 2019): Magnesium sulfate: risk of skeletal adverse effects in the neonate following prolonged or repeated use in pregnancy
Drug protocol: hypophosphatemia (CDDFT intranet access only)
Effervescent tablets (phosphate 16.1 mmol, sodium 20.4 mmol & potassium 3.1 mmol / tablet)
Phosex®
1g tablets (containing 250mg, 6.2mmol of calcium)
Renacet®
475mg (containing 120.25mg, 3mmol of calcium) &
950mg tablets (containing 240.5mg, 6mmol of calcium)
1.25g & 2.5g chewable tablets (Calcichew)
Use after calcium carbonate and calcium acetate, but before the much more expensive sevelamer and lanthanum.
Red when used for indications related to renal dialysis (NHS England funded)
Dental products should only be prescribed by dentists and GPs should not accept requests to prescribe medicines that the dentist could reasonably prescribe themselves, nor accept requests from patients to issue FP10 prescriptions for items prescribed on a private prescription by their dentist. Patients should be advised of self-care measures and signposted to purchase over the counter remedies for dental conditions where appropriate.
PrescQIPP bulletin 95: Medicines for dental conditions on FP10
The County Durham and Tees Valley APC Do Not Prescribe List and Grey List can be accessed online at: https://medicines.necsu.nhs.uk/download/tees-prescribing-grey-list/
Duraphat®
2800 ppm s Sodium fluoride 0.619% (75ml)
Duraphat®
5000 ppm s Sodium fluoride 1.1% (51g)
Dental products should only be prescribed by dentists and GPs should not accept requests to prescribe medicines that the dentist could reasonably prescribe themselves, nor accept requests from patients to issue FP10 prescriptions for items prescribed on a private prescription by their dentist. Patients should be advised of self-care measures and signposted to purchase over the counter remedies for dental conditions where appropriate.
The County Durham and Tees Valley APC Do Not Prescribe List and Grey List can be accessed online at: https://medicines.necsu.nhs.uk/download/tees-prescribing-grey-list/
Dental products should only be prescribed by dentists and GPs should not accept requests to prescribe medicines that the dentist could reasonably prescribe themselves, nor accept requests from patients to issue FP10 prescriptions for items prescribed on a private prescription by their dentist. Patients should be advised of self-care measures and signposted to purchase over the counter remedies for dental conditions where appropriate.
The County Durham and Tees Valley APC Do Not Prescribe List and Grey List can be accessed online at: https://medicines.necsu.nhs.uk/download/tees-prescribing-grey-list/
Dental products should only be prescribed by dentists and GPs should not accept requests to prescribe medicines that the dentist could reasonably prescribe themselves, nor accept requests from patients to issue FP10 prescriptions for items prescribed on a private prescription by their dentist. Patients should be advised of self-care measures and signposted to purchase over the counter remedies for dental conditions where appropriate.
The County Durham and Tees Valley APC Do Not Prescribe List and Grey List can be accessed online at: https://medicines.necsu.nhs.uk/download/tees-prescribing-grey-list/
Ensure that all prescribing is in-line with an ACBS approved indication.
If patients still want to take a vitamin and mineral preparation for dietary supplementation or as a "pickme-up" they should be advised that they can be purchased as self care over-the-counter with the support of the community pharmacist.
Do not initiate new prescriptions for vitamin and mineral preparations unless they are in-line with an ACBS approved indication.
Some patients may be eligible for NHS Healthy Start vitamins rather than receiving a prescription. They are specifically designed for pregnancy, breastfeeding and growing children and available free of charge from local distribution points.
Vitamin and mineral supplements should only be prescribed in line with an
ACBS indication, i.e. only in the management of actual vitamin or mineral deficiency; they are not to be
prescribed as dietary supplements or as a general “pick-me-up”. If patients still want to take vitamins and minerals for dietary supplementation or as a “pick-me-up” they should be advised that they can be
purchased as selfcare over-the-counter.
Some patients may be eligible for NHS Healthy Start vitamins which are specifically designed for pregnancy, breastfeeding and growing children. They are available free of charge from local distribution points. More information is available on the Healthy Start Vitamins website.
Tablets
NICE clinical guideline 100
Should only be used in secondary care to prevent "re-feeding syndrome".
Not to be used for alcohol related disorders.
RMOC Position Statement Dec 2019: Oral vitamin B supplementation
The County Durham and Tees Valley APC Do Not Prescribe List and Grey List can be accessed online at: https://medicines.necsu.nhs.uk/download/tees-prescribing-grey-list/
IVHP injection (ascorbic acid 500mg, nicotinamide 160mg, pyridoxine
hydrochloride 50mg, riboflavin 4mg & thiamine hydrochloride 250mg &
1g anhydrous glucose / pair of ampoules)
The County Durham and Tees Valley APC Do Not Prescribe List and Grey List can be accessed online at: https://medicines.necsu.nhs.uk/download/tees-prescribing-grey-list/
RMOC Position Statement Dec 2019: Oral vitamin B supplementation
County Durham and Darlington APC - Guidance for the treatment of Vitamin D insufficiency and deficiency – June 2015
County Durham and Darlington APC - Adult Vitamin D Guideline – Quick Reference Guide Guidance for the treatment of Vitamin D insufficiency and deficiency – September 2017
NICE ES28: COVID-19 rapid evidence summary: vitamin D for COVID-19
Available as 800 IU, 3200 IU and 20,000 IU capsules
Vitamin D use the most cost-effective product currently as per the Drug Tariff.
Available as 800 IU tablets
Vitamin D use the most cost-effective product currently as per the Drug Tariff.
Vitamin D use the most cost-effective product currently as per the Drug Tariff.
Vitamin D use the most cost-effective product currently as per the Drug Tariff.
250 nanogram & 1 microgram capsules
2 microgram/ml sugar-free oral drops – one drop
containing approx. 100 nanograms of alfacalcidol
1 microgram in 0.5ml & 2 micrograms in 1ml injections
For use in primary care:
• Accrete D3
• Evacal
For use in secondary care:
• Adcal D3 tablets and caplets
• Calcichew D3 Forte® tablets
(alternative to Adcal D3)
1.5g (600mg Ca) 400 units
Alternatives
• Calfovit D3 sachets
Calcium phosphate 3.1g (1.2g calcium) & Vitamin D3 800 units
• Calcium & Ergocalciferol Tablets:
Calcium lactate 300mg, calcium phosphate 150mg (Ca 97mg, 2.4 mmol) & ergocalciferol 10 micrograms (400 units)
Film coated tablet containing calcium carbonate 1.5g and colecalciferol 10 micrograms (400 units)
Calcium + Vitamin D use the most cost-effective product currently as per the Drug Tariff.
Chewable tablets containing calcium carbonate 1.5g and
colecalciferol 10 micrograms (400 units)
-approved as a chewable option and also to be used in patients with
peanut and soya allergy
Calcium + Vitamin D use the most cost-effective product currently as per the Drug Tariff.
Tablets and Caplets - for use in secondary care
Calcium + Vitamin D use the most cost-effective product currently as per the Drug Tariff.
Tablets - for use in secondary care
Calcium + Vitamin D use the most cost-effective product currently as per the Drug Tariff.
Powder in sachets – calcium phosphate 3.1g (1.2g calcium) &
Vitamin D3 800 units
Tablets – calcium lactate 300mg, calcium phosphate 150mg (Ca 97mg,
2.4 mmol) & ergocalciferol 10 micrograms (400 units)
e.g. Calcichew D3, Calcium and ergocalciferol tablets
A daily dose of 800 units of vitamin D is required to prevent fractures
The County Durham and Tees Valley APC Do Not Prescribe List and Grey List can be accessed online at: https://medicines.necsu.nhs.uk/download/tees-prescribing-grey-list/
Tablets - 10mg
Water soluble derivative of vitamin K for use in patients with fat malabsorption, especially in hepatic disease or biliary obstruction including cystic fibrosis patients.
- 50 microgram in 0.25ml drops (NeoKay®)u
- 1mg capsule = Preferred product for use in neonates
- 10mg in 1ml injectionu
- 2mg in 0.2ml mixed micelles injection (Konakion® MM Paediatric) N.B. May be taken by mouth as well as being given by IM or IV injection
N.B. Phytomenadione 10mg tabs now discontinued
Drug protocol: administration of vitamin K (CDDFT intranet access only)
Flowchart for Neonatal Vitamin K prophylaxis (CDDFT intranet access only)
DropsOTC
Drops containing in each 0.6ml dose ascorbic acid 50mg, ergocalciferol 400 units, nicotinamide 5mg, pyridoxine HCL 500micrograms, riboflavine 400 micrograms, thiamine 1mg & vitamin A 1,333 units- To be used in children and adults.
TabletsOTC
Vitamins BPC
Capsules containing ascorbic acid 15mg, nicotinamide 7.5mg, riboflavine 500 micrograms, thiamine HCl 1mg, vitamin A 2,500 units, & vitamin D 300 units
Capsules & junior capsulesOTC
-For limited use as a vitamin and mineral supplement in patients with
phenylketonuria The capsules are also approved as an oral supplement
in burns patients with malnutrition or alcohol dependency and patients
with major burns after discontinuation of IV therapy, and have also been
approved for use in patients with severe anorexia nervosa and in patients with re-feeding syndrome.. Treatment initiated with specialist advice.
SolubleOTC
- approved for short term use in patients who are unable to swallow Forceval capsules
DropsOTC containing in each 0.6ml dose ascorbic acid 50mg, ergocalciferol 400 units, nicotinamide 5mg, pyridoxine HCl 500 micrograms, riboflavine 400 micrograms, thiamine 1mg & vitamin A 5,000 units).
Dalivit drops are to be retained for use in patients requiring a full supplement of vitamin A.
Commissioner: NHS England – via specialist services only
Approved for paediatric patients with homocysteine remethylation defect. Liquid product is unlicensed
Infusion solution 21.07% 20ml
For paediatric metabolic disorders on specialist advice only