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Nottinghamshire Area Prescribing Committee
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 Formulary Chapter 15: Anaesthesia - Full Chapter
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15.01.07  Expand sub section  Antagonists for central and respiratory depression
Doxapram (Dopram®)
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Formulary
Red
See section 3.5.1 
   
Flumazenil
(anaesthesia)
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Formulary
Red
Injection
  • See poisoning section for further information 
  •    
    Naloxone
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    Formulary
    Green
    Injection 400mcg/ml
    Injection 40mcg/2ml (unlicensed)
     
    Link  NUH Lite Bite: Adult Naloxone Guidelines Reminder (August 20)
    Link  NUH memo: Long term supply problem with Naloxone Minijet
    Link  NUH: Guideline for the use of naloxone in adults
    Link  Safety alert: Risk of death with naloxone in long term opioid patients
    Link  SFH: Naloxone infusion guidance
    Link  UKMI Q&A further reading on naloxone usage
       
    Naloxone pre-filled syringes (Prenoxad®)
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    Formulary
    Green

    Prefilled syringes (2mg/2ml)

    • As of October 2017, all Prenoxad syringe packaging is being labelled as 0.91mg/ml, rather than 1mg/ml. The use of the product and dose is unchanged.

    At SFH:

    • On the advice of the Drug and Alcohol Liason Team (DALT) only for patients at high risk of opioid overdose at discharge. DALT will provide patient training. Usually supply one syringe on discharge.

    In Nottingham City CCG:

    • Available as part of 1 year pilot for the treatment of opioid overdose in a non-medical setting. Classified as Green for duration of pilot.
    • Prescribers should be satisfied that the patient has undergone appropriate training from the Health Shop (able to produce certificate) or similar organisation. Most patients will be supplied via PGD by substance misuse services, but small numbers of patients may require a prescription from GP.
     
    Link  Guides and Information leaflets - Naloxone pre-filled syringes
       
     ....
     Non Formulary Items
    Naloxone nasal spray  (Nyxoid®)

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    Non Formulary
    Grey

    No formal assessment

     
      
    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

    Grey

    Grey / Non-Formulary: Medicines, which the Nottinghamshire APC has actively reviewed and does not recommend for use at present due to limited clinical and/or cost effective data.
    Grey / Non-Formulary (undergoing assessment): Work is ongoing and will be reviewed at a future APC meeting.
    Grey / Non-Formulary (no formal assessment): APC has not formally reviewed this medicine or indication because it had never been requested for formulary inclusion. Often used for drugs new to market.
      

    Red

    Medicines which should normally be prescribed by specialists only. eg hospital only.
    For patients already receiving prescriptions in primary care - continue. No new patients to receive prescriptions in primary care.
      

    Amber 1

    Medicines that should be initiated by a specialist and prescribed by primary care prescribers only under a shared care protocol, once the patient has been stabilised.
    Prior agreement must be obtained by the specialist from the primary care provider before prescribing responsibility is transferred. The shared care protocol must have been agreed by the relevant secondary care trust Drugs and Therapeutics Committee(s) (DTC) and approved by the Nottinghamshire APC.
      

    Amber 2

    Medicines suitable to be prescribed in primary care / general practice after specialist* recommendation or initiation.
    A supporting prescribing guideline may be requested which must have been agreed by the relevant secondary care trust DTCs and approved by the Nottinghamshire APC.
    *Specialist is defined by the APC as a clinician who has undertaken an appropriate formal qualification or recognised training programme within the described area of practice
      

    Amber 3

    Primary care/ non specialist may initiate as per APC guideline.
    The supporting prescribing guideline must have been agreed by the relevant secondary care trust D&TC(s) and approved by the Nottinghamshire APC.
      

    Green

    Medicines suitable for routine use within primary care.
    Can be initiated within primary care within their licensed indication, in accordance with nationally recognised formularies, for example the BNF, BNF for Children, Medicines for Children or Palliative Care Formulary. Primary care prescribers take full responsibility for prescribing.   

    OTC

      

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