netFormulary NHS
Nottinghamshire Area Prescribing Committee
Joint Formulary
 Formulary Chapter 3: Respiratory system - Full Chapter
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03.04.03  Expand sub section  Allergic emergencies
03.04.03  Expand sub section  Anaphylaxis
Adrenaline / epinephrine (EpiPen, Jext & Emerade)
(for IM self administration)
View adult BNF View SPC online View childrens BNF

Available as:

  • Adults: EpiPen® Auto-injector 0.3mg or Jext® 300microgram injection or Emerade® 500microgram injection, 300microgram injection.
  • Children: EpiPen® Jr Auto-injector 0.15mg or Jext® 150microgram or Emerade® 150microgram injection.
  • There are longrunning supply problems (2018-on) with adrenaline autoinjectors. Please contact your local supplier for availability queries.  See anaphylaxis UK advice 
  • Pharmacies can order a maximum of 2 Epipen® 0.15mg or 0.3mg devices at a time against a valid prescription and some batches have authorised extended expiry dates - details here. Sporadically available now (May 2020)
  • Emerade® (All strengths) unavailable from Dec 2019
  • Jext® 0.3mg UK stock unavailable from Nov 2019. Imported EU stock may be obtainable by special order. Info here. Sporadically available now (May 2020)
  • Injection technique is device specific. To ensure patients receive the auto-injector device that they have been trained to use, prescribers should prescribe by brand.
  • Instructions for use see SPC or manufacturers websites here: (Epipen®), (Jext®®) or (Emerade®)
Link  SFH: Epipen prescribing and dispensing protocol for new patients
Link  NICE 134: Anaphylaxis: Assessment and referral after emergency treatment
Link  MHRA: Guidance for patients (Updated August 2018)
Link  Patient support materials from Epipen manufacturer
Link  Link to reviews
Adrenaline / epinephrine 1 in 1,000
View adult BNF View SPC online View childrens BNF
Available as: 1mg in 1ml, (and 5mg in 5ml for ICCU uses)
  • For treatment of anaphylaxis adrenaline is given IM in a dose of 500 micrograms (0.5mL adrenaline injection 1 in 1,000). N.B. dosing differs for self administration - see above
  • Note: For CPR the dose is 10ml of 1:10,000 given IV.
  • At SFH stocked on all wards (in the normal IV drugs cupboard).
  • Link  Resus Council UK: Anaphylaxis algorithm
    Adrenaline / epinephrine 1 in 10,000 (dilute)
    View adult BNF View SPC online View childrens BNF
    • Available as ampoules (1ml, 10ml), Minijet® (not at SFH) or prefilled syringe (10ml)
    • IV use of 10ml in anaphylaxis is for experienced specialist only (see BNF) - IM injection of 1:1,000 is first line for anaphylaxis (see above)
    • Note: This product is also used in CPR.
    03.04.03  Expand sub section  Angioedema
     Non Formulary Items
    Adrenaline / Epinephrine  (Anapen)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    • Discontinued
    Adrenaline / Epinephrine  (Minijet Adrenaline 1 in 1000)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
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    Traffic Light Status Information

    Status Description


    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.

    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.


    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.