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 Formulary Chapter 9: Nutrition and blood - Full Chapter
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09.01  Expand sub section  Anaemias and some other blood disorders
09.01.01  Expand sub section  Iron-deficiency anaemias
09.01.01.01  Expand sub section  Oral iron
 note 

Combination products and modified release products are not recommended for prescribing on NHS

Ferrous Fumarate
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First Choice
Green
Strength (Brand) Dose Elemental iron content
210mg

1 BD-TDS (Treatment)

1 OD-BD (maintenance)

68mg/ tablet
305mg (Galfer)

1 BD (Treatment)

1 OD (maintenance)

100mg/ capsule
322mg (Fersaday)

1 BD (Treatment)

1 OD (maintenance)

100mg / tablet
140mg/5ml solution

10ml BD (Treatment)

5ml OD (Maintenance)

45mg / 5ml

Combination products with ascorbic acid and modified release products are not recommended for prescribing on NHS

 
Ferrous Sulphate
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Second Choice
Green
 
Ferrous Gluconate
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Formulary
Green
 
Sodium Feredetate
(Sytron®)
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Formulary
Green
 
09.01.01.02  Expand sub section  Parenteral iron
Ferric Carboxymaltose
(Ferinject®) Black Triangle
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Formulary
Red
 
Iron Dextran (CosmoFer®) Black Triangle
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Formulary
Red
 
Iron Isomaltoside
(Monofer®) Black Triangle
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Formulary
Red
 
Iron Sucrose (Venofer®) Black Triangle
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Formulary
Red
 
09.01.02  Expand sub section  Drugs used in megaloblastic anaemias to top
Hydroxocobalamin
(Vitamin B12)
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Formulary
Green

During the COVID-19 pandemic please consider the need for vitamin B12 injections and advise patients to buy supplements over the counter to reduce patient contacts and support social distancing measures.

Ensure the patient has a follow up blood test in the future to identify any that have asoprtion issues.

 
Link  Oral vitamin B12 – what are the prescribing considerations and what formulations are available?
Link  Vitamin B12 Information Leaflet
Link  Vitamin B12 Supplement Algorithm
Folic Acid
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Formulary
Green
 
Cyanocobalamin
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Formulary
Green

50mcg tablets are the only licensed oral preparation.

Please see IoW CCG vitamins guidance for more info.

GP- GREY LIST

 
Link  Oral vitamin B12 – what are the prescribing considerations and what formulations are available?
09.01.03  Expand sub section  Drugs used in hypoplastic, haemolytic, and renal anaemias
09.01.03  Expand sub section  Erythropoietin
Darbepoetin Alfa
(Aranesp®)
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Formulary
Red
High Cost Medicine
 
Epoetin alfa (Eprex®)
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Formulary
Red
High Cost Medicine
 
Epoetin beta
(NeoRecormon®)
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Formulary
Red
High Cost Medicine
 
Epoetin Zeta (Retacrit®)
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Formulary
Red
 
09.01.03  Expand sub section  Iron overload
09.01.04  Expand sub section  Drugs used in autoimmune thrombocytopenic purpura
Eltrombopag
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Formulary
Red
High Cost Medicine
 
Link  Interim Clinical Commissioning Policy: Thrombopoietin receptor agonists as first line therapy for new or relapsed immune thrombocytopenia in adults and children over the age of 1 year during the COVID-19 pandemic
Link  NICE TA293: Eltrombopag for treating chronic ITP
Romiplostim (Nplate®)
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Formulary
Red
High Cost Medicine
 
Link  Interim Clinical Commissioning Policy: Thrombopoietin receptor agonists as first line therapy for new or relapsed immune thrombocytopenia in adults and children over the age of 1 year during the COVID-19 pandemic
Link  NICE TA221: Thrombocytopenic purpura - romiplostim
09.01.05  Expand sub section  G6PD deficiency to top
09.01.06  Expand sub section  Drugs used in neutropenia
Filgrastim
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Formulary
Red
High Cost Medicine
 
09.01.07  Expand sub section  Drugs used to mobilise stem cells
09.02  Expand sub section  Fluids and electrolytes
09.02.01.01  Expand sub section  Oral potassium
Potassium Chloride
(Kay-Cee-L®)
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Formulary
Green
 
Potassium Chloride
(Sando-K®)
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Formulary
Green
 
Potassium Chloride
(Slow-K®)
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Formulary
Green
 
09.02.01.01  Expand sub section  Potassium removal to top
Polystyrene Sulphonate Resins
(Calcium Resonium®)
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Formulary
Yellow
 
09.02.01.02  Expand sub section  Oral sodium and water
Sodium Chloride
(Slow Sodium®)
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Formulary
Green
 
09.02.01.02  Expand sub section  Oral rehydration therapy (ORT)
Oral Rehydration Salts
(Dioralyte®)
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Formulary
Green

See Chapter 1

 
09.02.01.03  Expand sub section  Oral bicarbonate
Sodium Bicarbonate
(oral)
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Formulary
Green
 
09.02.02.01  Expand sub section  Electrolytes and water
09.02.02.01  Expand sub section  Intravenous sodium to top
Ringer's Solution for Injection
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Formulary
Green Hospital
 
Sodium Chloride and Glucose Intravenous Infusion
Formulary
Green Hospital
 
Sodium Chloride Intravenous
Formulary
Green Hospital
 
09.02.02.01  Expand sub section  Intravenous glucose
Glucose Intravenous
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Formulary
Green Hospital
 
09.02.02.01  Expand sub section  Intravenous potassium
Potassium Chloride and Glucose Intravenous Infusion
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Formulary
Green Hospital
 
Potassium Chloride and Sodium Chloride Intravenous Infusion
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Formulary
Green Hospital
 
Potassium Chloride Concentrate (Sterile)
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Formulary
Green Hospital
 
Potassium Chloride, Sodium Chloride and Glucose Intravenous Infusion
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Formulary
Green Hospital
 
09.02.02.01  Expand sub section  Bicarbonate and lactate
Compound Sodium Lactate Intravenous Infusion
(Known as hartmanns solution)
Formulary
Green Hospital
 
Sodium Bicarbonate
(injection)
Formulary
Green Hospital
 
09.02.02.02  Expand sub section  Plasma and plasma substitutes
Human Albumin Solution
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Formulary
Red
 
09.02.02.02  Expand sub section  Plasma substitutes to top
Gelatin (Gelofusine®)
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Formulary
Red
 
09.03  Expand sub section  Intravenous nutrition
Parenteral Nutrition (TPN or PN)
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Formulary
Red
 
Supplementary Preparations
(Addiphos®)
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Formulary
Red
 
Supplementary Preparations
(Additrace®)
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Formulary
Red
 
Supplementary Preparations
(Cernevit®)
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Formulary
Red
 
Supplementary Preparations
(Solivito N®)
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Formulary
Red
 
09.04  Expand sub section  Oral nutrition
09.04.02  Expand sub section  Enteral nutrition
09.05.01.01  Expand sub section  Calcium supplements
Adcal®
(Calcium carbonate)
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First Choice
Green
 
Calcichew ®
(Calcium carbonate)
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First Choice
Green
 
Sandocal 1000 ®
(Effervescent tablets)
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First Choice
Green

Sandocal should be prescribed if the patient cannot tolerate chewable tablets. Consider cost when prescribing 

 
Calcium Chloride
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Formulary
Green Hospital
 
Calcium Gluconate
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Formulary
Green Hospital
 
09.05.01.02  Expand sub section  Hypercalcaemia and hypercalciuria to top
Cinacalcet (Mimpara®)
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Formulary
Yellow
High Cost Medicine
NHS England

NHSE funded via renal team for patients on dialysis and supplied via Wessex Kidney Centre.

Patients not on dialysis with CKD 4/5 are funded under CCG HCDL.

Please ensure patient clinical situation before accepting prescribing in primary care

 

 
Link  NHSE Clinical Commissioning Policy: Cinacalcet for complex primary hyperparathyroidism in adults
Link  NICE TA117: Hyperparathyroidism - cinacalcet
09.05.01.03  Expand sub section  Magnesium
Magnesium Aspartate
(Magnaspartate®)
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Formulary
Green
 
Magnesium Sulphate
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Formulary
Red
 
09.05.02.01  Expand sub section  Phosphate supplements
Phosphate Polyfusor ®
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Formulary
Red
 
Phosphate supplements
(Phosphate-Sandoz®)
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Formulary
Green
 
09.05.02.02  Expand sub section  Phosphate-binding agents
Sevelamer Hydrochloride
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Formulary
Yellow
High Cost Medicine
NHS England

Hyperphosphataemia in patients on haemodialysis or peritoneal dialysis

Generic prescribing more cost effective

 
09.06  Expand sub section  Vitamins
09.06.02  Expand sub section  Vitamin B group to top
Thiamine
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Formulary
Green

In line with NICE guidance, oral thiamine should be prescribed for the prevention of WE to harmful or dependent drinkers in whom any of the following apply:

  • They are malnourished or at risk of malnourishment
  • They have decompensated liver disease 
  • They are in acute withdrawal
  • Before and during a planned medically assisted alcohol withdrawal

The recommended dose is 200 to 300 mg daily in divided doses.

Thiamine should be continued for as long as malnutrition is present and/or during periods of continued alcohol consumption.

Following successful alcohol withdrawal, thiamine should be continued for 6 weeks. If after this time the patient remains abstinent and has regained adequate nutritional status, thiamine should be discontinued. Thiamine should be restarted if the patient starts drinking again. Continuing need for thiamine should be reviewed at appropriate intervals which may depend on individual patient circumstances.

For further advice, please see the RMOC vitamin B supplementation in alcoholism

 
Link  NICE CG100: Management of alcohol-related physical complications
Link  NICE CG115: Alcohol dependence - diagnosis, assessment and management
Link  RMOC Oral vitamin B supplementation in alcoholism
Vitamin B & C high potency injection
(Pabrinex®)
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Formulary
Red
 
Link  NICE CG100: Management of alcohol-related physical complications
Link  NICE CG115: Alcohol dependence - diagnosis, assessment and management
09.06.02  Expand sub section  Oral vitamin B complex preparations
Vitamin B Tablets, Compound Strong
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Formulary
Green

Due to a lack of evidence on their efficacy and safety, vitamin B complex preparations (vitamin B compound and vitamin B compound strong tablets) should not be prescribed for prevention of Wernicke’s Encephalopathy (WE) in alcoholism.

  • Vitamin B complex preparations should not be prescribed for preventing deficiency or for maintenance treatment following treatment for deficiency.
  • Vitamin B complex preparations should not be prescribed as dietary supplements. Patients who wish to use them for dietary supplementation should be advised to purchase them over the counter.
  • Vitamin B compound strong tablets may be prescribed on a short-term basis (10 days) for patients at risk of refeeding syndrome. This also applies to patients who are not harmful or dependent drinkers.

In rare cases where there might be a justifiable reason for prescribing vitamin B complex e.g. medically diagnosed deficiency or chronic malabsorption, vitamin B compound strong and not vitamin B compound should be prescribed as it represents better value for money.

For further advice, please see the RMOC Oral vitamin B supplementation in alcoholism

 

 
Link  RMOC Oral vitamin B supplementation in alcoholism
09.06.02  Expand sub section  Other compounds
09.06.04  Expand sub section  Vitamin D
Colecalciferol and Calcium Carbonate
(Theical ® Calci-D ® Accrete D3 One a Day®)
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First Choice
Green

Once daily dosing

TheiCal widely accepted and good compliance

Reduced pill burden

 
Colecalciferol and Calcium Carbonate
(Calcichew-D3 Forte®)
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First Choice
Green Hospital

First choice in hospital

Patients to be reverted back to pre admission option on discharge, unless no longer clinically indicated.

 
Colecalciferol and Calcium carbonate
(Adcal-D3®)
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Second Choice
Green

Second line Ca/Vit D combination product after OD dosing options exhausted.

 

 
Colecalciferol
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Formulary
Green

For use where proven symptomatic defciency (<30nmol/L) and rapid correction is justified

Patients post correction or with insufficiency should be encouraged to self manage through sunlight diet and OTC supplements

Where deemed clinically appropriate please ensure licensed products are prescribed.

 
Alfacalcidol
(One-Alpha®)
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Formulary
Green

Hydroxylated Vitamin D analogue:

Typically limited to patients with severe renal impairment and requiring supplementation

Plasma calcium concentrations need monitoring due to risk of hypercalcaemia at high doses. Hypercalcaemia is indicator of vitamin D toxicity 

ALL patients receiving pharmacological doses of vitamin D require plasma calcium concentrations checking at intervals (once or twice weekly initially and when nausea and vomiting occurs) 

 

 
Calcitriol (Rocaltrol®)
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Formulary
Red
 
Ergocalciferol
(Injection)
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Formulary
Red
 
09.06.06  Expand sub section  Vitamin K
Phytomenadione
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Formulary
Green
 
Menadiol Sodium Phosphate
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Formulary
Yellow
 
09.06.07  Expand sub section  Multivitamin preparations to top
Mutivitamins
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Formulary
Green

Not routinely used

Exceptions include Individuals with severe malabsorption conditions and on advice of dietician.

Renavit suitable for patients on dialysis to replace water soluble vitamin loss

(Healthy Start Vitamins are not to be prescribed by GP's)

 
09.06.07  Expand sub section  Vitamin and mineral supplements and adjuncts to synthetic diets
Vitamin and mineral supplements
(Forceval®)
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Restricted Drug Restricted
Green

Recommended post bariatric surgery

 
Vitamin and mineral supplements
(Ketovite®)
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Restricted Drug Restricted
Green plus

Prevention of vitamin deficiency in disorders of carbohydrate or amino-acid metabolism

Adjunct in restricted, specialised, or synthetic diets

 
 ....
Key
note Notes
Section Title Section Title (top level)
Section Title Section Title (sub level)
First Choice Item First Choice item
Non Formulary Item Non Formulary section
Restricted Drug
Restricted Drug
Unlicensed Drug
Unlicensed
Track Changes
Display tracking information
click to search medicines.org.uk
Link to adult BNF
click to search medicines.org.uk
Link to children's BNF
click to search medicines.org.uk
Link to SPCs
SMC
Scottish Medicines Consortium
Cytotoxic Drug
Cytotoxic Drug
CD
Controlled Drug
High Cost Medicine
High Cost Medicine
Cancer Drugs Fund
Cancer Drugs Fund
NHSE
NHS England
Homecare
Homecare
CCG
CCG

Traffic Light Status Information

Status Description

Green

Drugs that may be initiated, stabilised and maintained by primary, secondary or tertiary care Secondary and tertiary care prescribing may be continued by primary care. [this does not indicate first/second line choice]  

Green Hospital

Items used by the Hospital but would not normally be continued into primary care. Primary care prescribers can change to GREEN first or second.   

Green plus

Initiation of drugs by primary care following written advice from secondary/ tertiary care advice.  

Yellow

Drugs that may be continued in primary care following initiation and stabilisation in secondary/tertiary care  

Amber

Items requiring a shared care agreement. These items should be initiated and stabilised by secondary or tertiary care. The GP should only be asked to take over prescribing through a formal shared care agreement. Secondary care will be expected to continue prescribing until the agreement is made.  

Red

Hospital/ Trust ONLY. These are items the secondary and tertiary care are responsible for prescribing and will need to continue to prescribe for long term maintenance. These items will NOT be prescribed in primary care. But primary care should be informed the patient is receiving these items. This will include NHSE funded items requiring repatriation.  

GP - Black

Items covered by NHSE ‘Should not prescribe in primary care list’ – See CCG policy on Drugs of limited clinical value  

GP - Grey

Grey List: Items covered by NHSE ‘Should not prescribe in primary care list’ that are not to be routinely prescribed but may be suitable in a defined population – See CCG policy on Drugs of limited clinical value  

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