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Nottinghamshire Area Prescribing Committee
Joint Formulary
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 Formulary Chapter 3: Respiratory system - Full Chapter
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03.04.01  Expand sub section  Antihistamines
03.04.01  Expand sub section  Non-sedating antihistamines
03.04.01  Expand sub section  Sedating antihistamines
Chlorphenamine
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Formulary
Green

Tablet, Liquid, Injection

  • OTC Patients should be advised to purchase a suitable product over the counter first line for hayfever.
  • May be prescribed if appropriate to in-patients; patients should be advised on discharge that further supply should be purchased.
 
Link  SFH: Anaphylaxis full policy
Link  SFH: Anaphylaxis quick guide
   
Hydroxyzine
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Formulary
Green
Tablet (syrup discontinued) 
Link  MHRA: QT prolongation with hydroxyzine
   
Promethazine hydrochloride (Phenergan)
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Formulary

Tablet, Liquid, Injection.

  • OTC Patients should be advised to purchase a suitable product over the counter first line.
  • when used as an antihistamine.
  • for sedation in children (APC Jan 15).
  • See section 4.6 for use as antiemetic.
 
Link  Link to reviews
Link  NICE Evidence summary: Promethazine for rapid tranquillisation in mental health settings
   
Alimemazine
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Formulary
Amber 2

Tablet, Liquid.

  • Second line to promethazine in both paediatric and dermatology patients
    Cost increase (October 2017):
  • 28 x 10mg tablets cost: £112.85
  • 30mg/5ml solution x 100ml = £243.51
    7.5mg/5ml solution x 100ml = £179.55
 
Link  See unexpectedly expensive medicines list
   
 ....
 Non Formulary Items
Clemastine  (Tevegil)

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Non Formulary
Grey
Clemastine liquid no longer available.
 
Cyproheptadine  (Periactin)

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Non Formulary
Grey
For use for the treatment of serotonin syndrome see chapter 18
 
Diphenhydramine  (Nytol)

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Non Formulary
Grey

No formal submission

 
Ketotifen  (Zaditen®)

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Non Formulary
Grey
 
  
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
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Link to adult BNF
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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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