Heparin sodium 1000 units in 1mL (20ml amps no longer available) NUH only: Heparin sodium mucous 1000 units in 1ml (5mL vial) for renal dialysis patients Heparin sodium 1000 units in 1ml (5mL ampoule) preservative free for X-ray only Heparin sodium mucous 5000 units in 1ml for renal dialysis patients Heparin sodium 25000 units in 5mL vial with preservative for renal dialysis patients Heparin calcium injection - prefilled syringes
Two brands now available: Inhixa® and Clexane®. - Inhixa is the preferred brand in Nottinghamshire, but Clexane is still available in primary care for existing patients. - Enoxaparin should be BRAND PRESCRIBED and patients should be maintained on the same brand where possible. If a need to switch arises (eg during supply problems), appropriate patient counselling should occur as there are device differences.
Used for prophylactic use and treatment of DVT and PE.
Injection (secondary care only) SFH only for anticoagulation during PCI as an alternative to abciximab and heparin NUH: Restricted to use in accordance with NICE TAG 230 and CG94. Consultant recommendation only.
Available as: - 1 unit in 1mL (500mL sodium chloride 0.9%) - 10 units in 1mL (5mL ampoule)-prev known as Hepsal - 100 units in 1mL (2mL ampoule)-prev known as Canusal - 100 units in 1mL (500mL sodium chloride 0.9%)
Shouldn't be used for flushing peripheral cannulas- use 0.9% sodium chloride instead.
Previously available at SFH during danaparoid supply problems.
Was discontinued April 2012
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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.
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.
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.
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
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.
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.