Highland Formulary information (Formularies)

TAM (Treatments and Medicines) NHS Highland
NHS Highland

Background

The Highland Formulary is a limited list of medicines approved for use in hospitals and primary care in the Highland Health and Social Care Partnership (HHSCP). The choice of Formulary medicines is made on the basis of clinical effectiveness, cost-effectiveness, comparative safety, patient acceptability and environmental impact, and covers all prescribers.

Using the Highland Formulary

Formulary medicines are generally presented according to the legacy BNF classification.  Most entries contain relevant Formulary information about the medicine such as place in therapy and additional prescribing guidance.  Further product information is available in the BNF and in the Summary of Product Characteristics (SPC), which may be available on www.medicines.org.uk.

Formulary management

The Formulary is produced under the auspices of the TAM Subgroup of the NHS Highland Area Drug and Therapeutics Committee (ADTC).  The contents reflect wide consultation with practitioners.  Output from the Scottish Medicines Consortium, local and national advice on medicines in relation to clinical effectiveness, cost-effectiveness, comparative safety, patient acceptability and environmental impact together with the work of special interest groups in Highland and clinical networks, are also taken into account.  If you wish to request a change or addition to the Formulary refer to the flowchart of the assessment process. For further information or to provide feedback, which is always welcome, please email the Formulary Pharmacist at: nhsh.formulary@nhs.scot

Argyll and Bute

Those working in Argyll and Bute Health and Social Care Partnership (H&SCP) should follow Greater Glasgow and Clyde (GG&C) adult medicines formulary (http://www.ggcprescribing.org.uk/). For emergency sedation prescribers in Argyll and Bute should follow NHS Highland rapid tranquilisation guideline.

Medicines in children

Unless otherwise stated, the doses given are for adults with normal hepatic and renal function.  Consult the BNF for Children for advice on prescribing for children and local paediatric drug guidelines on the Hospital Paediatrics section of the intranet.

Drug names

ADTC supports a policy of generic prescribing for the majority of medicines.  It is noted that in some cases, the generic versions of a medicine may not have exactly the same indications listed on the market authorisation as the original branded medicine, but as bioequivalence to the original branded medicine must have been demonstrated as part of the generic market authorisation process, ADTC considers that any additional risks of prescribing and dispensing the medicine generically are negligible.  Exceptions to the generic prescribing policy are:

  • when the pharmacokinetic profiles of different brands of the same medicine differ widely
  • medicines with a narrow therapeutic index, where any variation in the drug concentration in the blood increases the risk of toxicity or treatment failure for the patient.
  • where there is an overriding difference in cost, environmental impact or patient acceptability between products. 

Where Formulary medicines should be prescribed by brand name, this will be indicated in the prescribing notes of the Highland Formulary.  This advice does not override an individual clinician’s decision to prescribe what they believe to be the most appropriate treatment. 

Medicines Information

Reference is made throughout the Formulary to information and advice available from Medicines Information. This service can be accessed as follows:

Adverse drug reactions

These can be reported by any healthcare professionals and by patients to the Medicines and Healthcare Products Regulatory Agency (MHRA).  Yellow report cards can be found at the back of the BNF or reports can be submitted online at:  http://www.yccscotland.scot.nhs.uk/Pages/default.aspx.

Report: 

  • All suspected serious adverse drug reactions to any drugs / vaccines / complementary remedies
  • All adverse reactions suspected to be associated with black triangle medicines (including those considered to be non-serious)
  • All adverse reactions that occur in children associated with either established or new medicines and vaccines

The black triangle symbol indicates that the MHRA is intensively monitoring the safety of that product.  

NHS Pharmacy First Scotland

This Formulary is used by community pharmacies in NHS Highland to support the Minor Ailments Service (MAS), which allows eligible patients to register with and use a community pharmacy as the first port of call for advice and for treatment of common illnesses on the NHS.  The Pharmacist advises, prescribes or refers the patient according to their needs.  Medicines included in the NHS Pharmacy Scotland approved list is available on the Community Pharmacy Scotland webpage and on TAM.

Disclaimer

While every effort has been made to ensure that the information contained within the Formulary is accurate, no responsibility or liability can be accepted by those involved in its production for any loss, injury or damage which is suffered as a consequence of any errors, omissions or inaccuracies contained within it.  In particular, prescribers should always check the suitability of the drug and dosage based on the information provided by the manufacturer.

Access to medicines in NHS Highland

Addition of medicines to the Highland Formulary

Form for addition of medicines to the Highland Formulary (NHS Highland Intranet access required)

Unlicensed use of medicines

Medicines included in the Formulary are supported by a valid SPC and the indications and/or dosing information reflect those in the corresponding Market Authorisations (formerly known as Product Licences). Where an unlicensed drug is included in the Formulary, this is indicated.  Where the Formulary suggests a use (or route) that is outside the licensed indication of a product (‘off-label' use), this too is indicated. Unlicensed or off-label use of medicines should only be necessary if the clinical need cannot be met by licensed medicines.

Further information concerning the use of unlicensed medicines in NHS Highland can be found on the NHS Highland intranet

Prescribing medicines outside the terms of their Market Authorisation alters (and may increase) the prescriber's professional responsibility and potential liability; see advice at www.gov.uk/drug-safety-update.  The prescriber should be able to justify and feel competent in using such medicines. Prescribers have a responsibility to advise patients of the status of the product being provided.  Prescribers and those dispensing unlicensed medicines or medicines used off-label are advised to consult the current BNF and/or contact the lead pharmacist for your area or Medicines Information (nhshighland.medicineinformation@nhs.scot) for further information.

Homeopathy

NHS Highland does not support the commissioning or funding of homeopathy therapies.

Extract  from Highland NHS Board minutes 5th October 2010:

"Following discussion, the Board concluded that there was settled, clear and unambiguous clinical opinion that homeopathic treatments should not be used in the NHS. An important factor in the decision was the fact that patients offered an ineffective treatment, such as homeopathy, might then delay getting the most appropriate help for their condition, with possible serious
consequences."

Further information:

Good prescription writing guidelines

Also refer to ‘Prescription writing’ section in current BNF and General Medical Council guidance ‘Good practice in prescribing and managing medicines and devices’.

NHS Highland statement of guiding principles for prescribing

  1. Prescribing should be based on safety, efficacy and cost-effectiveness.
  2. Medicines should be prescribed only when they are necessary and, in all cases, the benefit of administering the medicine should be considered in relation to the risk involved.
  3. The Highland Formulary should constitute the core of all prescribing. It is based upon current evidence, national guidance, local expertise and patient acceptability.
  4. Cost-effectiveness matters. As a guiding principle, the most cost-effective medication should be prescribed for a patient. Specifically, prescribers should not prescribe drugs, medicines or appliances whose cost or quantity, in relation to any patient, is in excess of that which is reasonably necessary for the proper treatment of that patient. Such prescribing denies resource for other essential services.
  5. The ‘approved’ (non-proprietary or generic) name of a medicine should be used unless there are important differences in formulation and/or bioavailability. Where a generic product is not considered suitable and it is desirable to recommend a particular brand of a drug, this is specified in the Highland Formulary.
  6. Prescribers should always prescribe within their clinical competency.
  7. When prescribing, clinicians must avoid making assumptions about people with protected characteristics eg gender, age, black and ethnic minority people, and must be alert to any specific considerations required.

Unnecessary or cost-ineffective prescribing cannot be justified:

  • unnecessary prescribing exposes patients to risk without benefit
  • cost-ineffective prescribing deprives patients in need of new, effective but expensive medicines with the potential to extend life and/or improve quality of life.

Standard Formulary abbreviations

 

ACBS 

Advisory Committee on Borderline Substances

ACE

angiotensin-converting enzyme

ALT    

alanine aminotransferase

BMI    

body mass index

CD2/CD3

preparations subject to prescription requirements of the Misuse of Drugs Regulations; see BNF

CNS

central nervous system

COC

combined oral contraceptive

COPD

chronic obstructive pulmonary disease

COX-2

cyclo-oxygenase-2

CSM

Committee on the Safety of Medicines

CVD

cardiovascular disease

DPP-4

dipeptidylpeptidase-4

DVT    

deep vein thrombosis

DXA

dual-energy x-ray absorptiometry

e/c

enteric-coated

ECG   

electrocardiogram

eGFR

estimated glomerular filtration rate

ESR    

erythrocyte sedimentation rate

FBC

full blood count

FEV

forced expiratory volume

GI

gastro-intestinal

GLP-1

glucagon-like peptide-1

GORD

gastro-oesophageal reflux disease

Hb

haemoglobin

HbA1C

glycosylated haemoglobin

HIS

Health Improvement Scotland

Hp

Helicobacter pylori

HRT

hormone replacement therapy

IM

intramuscular

IHD

ischaemic heart disease

INR 

international normalised ratio

IV

intravenous

LFT

liver function test

MAS

Minor Ailments Service

MHRA

Medicines and Healthcare Products Regulatory Agency

MI

myocardial infarction

m/r

modified-release

MRSA

methicillin-resistant Staphylococcus aureus

NICE  

National Institute for Health and Care Excellence

NNT   

number needed to treat

NSAID

non-steroidal anti-inflammatory drug

OTC

available for purchase in pharmacies; may be available in other retail outlets

PE

pulmonary embolism

PPI

proton pump inhibitor

S

for initiation only on the advice of, or prescription by, a hospital specialist

SIGN  

Scottish Intercollegiate Guidelines Network

SLS

selected list scheme

SMC

Scottish Medicines Consortium

SPC

Summary of Product Characteristics

TIA

transient ischaemic attack

TFT

thyroid function test

TPN

total parenteral nutrition

U&E

urea and electrolytes

WCC

white cell count

▼

newly licensed medicine under intensive monitoring by CSM/MHRA

>

Greater than

<

Less than