• For use by respiratory physiotherapists
• Oscillating positive expiratory pressure device for mucous clearance

Sublingual tablets - unlicensed medicine - named patient use only

Available at NUH only

• For treatment of house dust mite allergic rhinitis in patients aged 6 years and over.
• For use by Allergy Specialists only

SFH: Available in:
- 200ml non-sterile bottles (~£8)
- 20ml sterile bottles (~£6)

NUH only: Unlicensed medicine - named patient use only. Restricted for use by endoscopy

Effervescent Tablets-600mg

• Little evidence of benefit for preventing contrast media induced nephropathy

30ml bottle. Unlicensed medicine - named patient use only.

Unlicensed but listed in the Palliative Care Formulary for use on palliative care advice

SFH information only:

• For use as a haemostatic.
• Do not apply for long periods. See the Palliative Care Formulary (password needed) or discuss with Medicines information 3163.
• In an emergency 1 in 1000 (1mg/ml) ampoules can be used.

Tablets (600mg) - NUH Only - Unlicensed medicine - named patient use only

• Prescribe and monitor as per phosphate binder guidance.
• Generally reserved for short term use in patients with severe and difficult to control hyperphosphataemia.

• Contrast medium for gastrointestinal radiography

• As a non-surgical treatment for the treatment of gynaecomastia as per the Notts APC Gynaecomastia Guideline.

Injection

• Unlicensed medicine - named patient use only
• Treatment of severe and/or complicated malaria.  See NUH guideline for the management of malaria.

Tablets 100mg. Unlicensed medicine - named patient use only
At SFH:

• Available by import only for consultant rheumatologist prescribing.
• Requires order form from prescriber for every supply (See instructions)
• Summary of benzbromarone (from Drugdex)

Tablets, Oral Suspension.
Unlicensed medicine - named patient use only

Available at NUH only:

• Approved for adults in accordance with compassionate use scheme for adenovirus infection. Only on consultant decision with microbiology / virology input.

• Medical Device
• Calcium matrix powder and mixing solution - when mixed the resultant paste is used to make biodegradable, radiopaque beads.
• NUH only - microbiology input required regarding the choice of antibiotic required to be mixed with the paste. Restricted to use by the foot and ankle service for diabetic ulcers with underlying osteomyelitis.

Ointment 1%

• Available at NUH only
  Restricted for severe viral warts or molluscum contagiosum secondary to immunosuppression, unresponsive to standard therapy.
• Manufactured by Pharmacy Non Sterile Production Unit (Unlicensed Product)

Unlicensed medicine - named patient use only
SFH only

• No liquid available. Injection form is packed in bottles for oral use if necessary. Contact SPU (ext 3156). Do NOT send patients to retail pharmacies for supplies

Injection to be used intranasally using nasal atomiser (unlicensed use - named patient only)

Available at NUH only:

• Approved intranasally to provide sedation for children receiving intrathecal administration of nusinersen for Spinal Muscular Atrophy (SMA) – see guideline

For intravenous use in adult Critical Care patients, see formulary entry for dexmedetomidine (section 15.01.04.04)

Unlicensed medicine - named patient use only
SFH only

• In the Extravasation kits click here for extravasation policy

Unlicensed medicine - named patient use only

Available at NUH only:

• Restricted antibiotic for pelvic inflammatory disease: see local guidelines [NUH guideline]

NUH only: Unlicensed medicine - named patient use only

• No longer stocked at SFH - podiatry to purchase own non-sterile version from NHS Supplies.

• SFH information only: Unlicensed Special. Obtain supplies from SFH Pharmacy rather than FP10HP.

SFH info: Dermatology use only

Gauze
ENT nasal gauze is non formulary

• Consultant use only- Restricted for use in life threatening haemorrhage
• At SFH, discuss with Dr Tim Moorby, Consultant Haematologist.
• Click here for the website

Gel (1ml and 3ml syringes)
NUH only: Approved for the management of bleeding during endoscopic procedures following either sphincterotomy in ERCP, EMR, ESD and when treated for Upper GI bleed.
Non pharmacy item, supplied through NHS supplies

Haemostatic Matrix

Available at NUH only for surgical procedures. (Surgery division approved specialties only, excluding ophthalmology.)

MR Capsule
Unlicensed medicine - named patient use only

• Available at NUH only for cardiac rhythm disorders on the recommendation of a specialist consultant cardiac physiologist.

• At SFH approved only for patients undergoing laparoscopic gynaecological surgery with a previous history of adhesion formation or those at high risk of adhesions.
• Click here for independent reviews
• Manufacturers information sheet

SFH:
-0.8% sterile solution for use in endoscopy during EMR procedures. Supplied by Pharmacy.
-Non-sterile solution used as a mucosal dye spray in endoscopic procedures. Obtained through supplies rather than pharmacy.
NUH: 0.8% sterile injection for use in endoscopy. Supplied by Pharmacy.

Injection

• Radiographic contrast medium
• licensed medicinal product

Oral Solution
Unlicensed medicine - named patient use only

NUH only: For oral phosphate supplementation in paediatric nephrology where potassium phosphate is contraindicated

Unlicensed medicine - named patient use only
Injection - 12.5mg/5mL

SFH: Not approved for use
NUH only: Post cardiac surgery as per guideline.

Historically used during endoscopy in conjunction with cyanoacryalate glue.

SFH information only: 

• For calibration of the ICCU LiDCO machine which is used to monitor cardiac output
• Usual prescription is "Lithium chloride injection (0.15mmol/ml): 2ml (0.3mmol) IV PRN"

SFH information only:

• Litmus paper restricted to NNU use only. MHRA alert on not using litmus for NG tube placement
• Now use pH indicator paper for checking of NG tube placement.

Inhalation powder (supplied in hard capsules)

 For use in respiratory clinic for diagnosis.

• SPC

Unlicensed medicine - named patient use only

• Dose is 50mg per square metre given intramuscularly (SFH: See dose calculator)
• At NUH: Pre-filled syringes stocked in pharmacy - contact pharmacy to arrange a supply. Pharmacy procedure available. Prescribe using dedicated drug chart.
• At SFH: Supplied from the Aseptic Dispensing Unit (ADU) - contact your ward pharmacist or send the prescription to Pharmacy (between 9-4pm). Full guideline here.

SFH: 1ml 1% for enteral use (not for IV)(unlicensed)
(See here for the intravenous product.)

• Also known as 'methylene blue'.
• Aguettant^® available for visualisation (staining)(approx £20 each). Click here for SPC or basic guide.

Available as: Capsules (normal release) and MR tablets (slow release)

• Normal release capsules now available again (Oct 2019)
• APOSTLE III trial used 20 mg nifedipine (two 10 mg capsules) orally in the first hour, followed by 20 mg slow-release nifedipine per 6 h for the next 47hr. 

Capsules 5mg & 10mg

• Available again Oct 2019.
• Immediate release capsules for Raynaud's if MR tablets do not work well enough.
• Much more expensive than MR tablets (~£80 vs ~£5pm).
• Capsules have more side effects than MR tablets. See prescribing advice on CKS.

Available as tablets or suspension.

• Unlicensed medicine - named patient use only.
• Available at NUH only for treating various intestinal parasites including cryptosporidiosis on recommendation of microbiology or infectious diseases. In tariff. Prolonged or repeat courses should seek one-off request approval. 
• HCD Excluded from tariff for the treatment of Hepatitis C, but Individual Funding Request must be completed prior to prescribing. 

• At SFH nasal gel and wash to be used in line with MRSA policy for prophylaxis in high risk group patients. Patient information leaflets and stickers available from Infection Control.
• At NUH wash to be used in line with Infection Control recommendations. First line for MRSA decolonisation. Chlorhexidine second line in those unable to use Octenisan.
• Nasal gel available 3^rd line (after Bactroban and Naseptin) for patients requiring decolonization.  Nasal gel approved for use in critical care during Bactroban supply problem.
• Wash Mitts and Shower Caps may be used in community patients unable to use the standard wash on the advice of infection control (APC Sept 14).

Unlicensed medicine - named patient use only
Tablets 2.5mg
NUH only for the management of patients with severe burns in adult critical care and the adult burns unit.

Unlicensed medicine - named patient use only
Capsules 10mg or 20mg

• Used for Phenylketonuria caused by a deficiency of tetrahydrobiopterin. Treatment involves oral supplementation of tetrahydrobiopterin; in some severe cases, the addition of the neurotransmitter precursors, levodopa and 5-hydroxytryptophan, are also necessary

 For adults under the care of a tertiary metabolic centre.

 For paediatric patients, service delivered through NUH.

• SFH information only: Test strips [see photo] with range 2-9 are used for testing NG tube placement. pH 5.5 or below indicates gastric contents. See nursing procedure.

SFH information only:

• Can be ordered once divisional manager has approved
• Bioplastique procedure kit (Vox®) for injecting into vocal cords

Unlicensed medicine - named patient use only

SFH information only: Wards/Clinics order direct from NHS supplies.

5 litre bags

Available at NUH only:

• Approved for use on PICU for Continuous Renal Replacement Therapy (CRRT)

5 litre bags

Available at NUH only:

• Approved for use on PICU for Continuous Renal Replacement Therapy (CRRT)

Drink
NUH only
Restricted to prevent antibiotic associated diarrhoea and C.difficile infection in
patients admitted to the elderly wards at QMC campus. 
Not supplied by pharmacy.

Capsules 50mg

Unlicensed medicine - named patient use only
NUH only

• Unlicensed medicine.
• For use at SFH by cardiology consultant only.

Tablet

Available at NUH only:

• Available in accordance with compassionate use scheme for relapsed/refractory FLT3-ITD positive AML.

SFH information only:
Available from MEMD
-Contains:

• Adrenaline 1:10,000 x 4
• Amiodarone 300mg x 1
• Calcium Chloride 10% /10ml x 1
• Normal Saline flush (10ml) x 6
• Adrenaline 1:1000 1mL amps x 10
  For further information of emergency boxes at SFH click here

Tablets

Unlicensed medicine - named patient use only
NUH only

Bladder instillation
NUH only

Unlicensed medicine - named patient use only

• At SFH: One vial kept in GU med, one vial kept in pharmacy. Administration guidelines.
• Available at NUH: On GU recommendation only - see restricted antimicrobials list   

• Not for prescribing in Primary Care.
• Also known as rehydration salts or electrolyte mix.
• Patients are advised to purchase the powders from community pharmacies and supermarkets, as it will often work out cheaper than paying for a prescription.
• At SFH: For inpatients, the solution should be prepared by the nurses on the ward as per the UKMi document. Glucose powder and sodium bicarbonate powder available from pharmacy, salt from kitchens.

Suppositories - Unlicensed medicine - named patient use only

Available at NUH only:

• Approved in accordance with the Trust’s unlicensed medicines policy for consultant use only for refractory proctitis in adult patients with either ulcerative colitis or Crohn’s disease.  

Unlicensed medicine. For pleurodesis.

• 4g vial (for slurry instillation)
• 3g poudrage kit with atomiser (for insufflation) (not routinely stocked at SFH but can be ordered)

• As a non-surgical treatment for the treatment of gynaecomastia as per the Notts APC Gynaecomastia Guideline.
• Ensure adequate calcium intake and vitamin D levels should be maintained above 50nmol/L.  Patients can be advised to purchase vitamin D supplements and provided with the Vitamin D Patient Information Leaflet.

Unlicensed medicine - named patient use only
NUH only
See Chapter 8 for capsules