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Bedfordshire and Luton Joint Formulary
Bedfordshire Hospitals NHS Foundation Trust
Bedfordshire, Luton and Milton Keynes ICB
Formulary Chapter: 20 - Unlicensed Medicines / Significant off-label use 
Notes:

Any drug not listed on the Formulary should be considered Non-Formulary - Not recommended for prescribing
20 Unlicensed Medicines

Carbex (Granules and Solution)

RED
Formulary

For use in imaging/diagnostic purposes

FOSFOMYCIN Sachets 3g

Amber SPA
Restricted Drug Restricted
3g Sachet

Fosfomycin should be used as last line treatment. A dose should be repeated after 3 days.
Creatinine clearance <80ml/min, including the physiological reduction in the elderly, increases the halflife of fosfomycin therefore repeat after 5 days.

Restricted - to be prescribed on the recommendation of microbiology sensitivity results.
BNF BNFc SPC

Indigo carmine

RED
Restricted Drug Restricted

for Endoscopy Use Only

Mannitol 20% polyfuser (Infusion for ORAL use)

RED
Formulary

Off-label use: Mannitol 20% used to prepare 2.5% solution for small bowel preparation before MRI or CT enterography, in accordance with locally produced protocol.

[DTC Jan 2025]

BNF BNFc SPC

Paromomycin 250 mg
(Tablets / Capsules)

RED
Restricted Drug Restricted

Unlicensed product

Indication: treatment of amoebic liver abscesses to eradicate amoebic cysts.

 

Pegasparagase (Oncasper®)

RED
Formulary

Oncasper® Injection 5mL, equivalent to 3750 iu L-asparaginase

 

 

To be used in accordance with the following NICE TA(s):-

 

NICE TA408: Pegaspargase for treating acute lymphoblastic leukaemia

BNF BNFc SPC

Regadenoson

RED
Restricted Drug Restricted

Restricted use to Imaging Department

St Marks solution

GREEN
Formulary

Please refer to attached sheet for information on how to make up.

On discharge patients will be given a patient information leaflet and will purchase the ingredients for this solution.

BNF BNFc SPC
St Mark’s Solution Protocol, May 2018

Taurolodine and Citrate 4% (TauroLock®)

RED
Restricted Drug Restricted

Approved for use at Bedford Hospital in accordance with Trust Guideline when recomended for use by Vascular Access Nurse

Taurolodine, Citrate 4% and Urokinase 25,000units (TauroLock U25,000®)

RED
Restricted Drug Restricted

Approved for use at Bedford Hospital in accordance with Trust Guideline when recomended for use by Vascular Access Nurse

Recommended at the Luton & Dunstable Hospital only when there is a shortage of urokinase

BNF BNFc SPC

Thiamine Injection 50 mg in 1mL

RED
Restricted Drug Restricted

Replaces IM Pabrinex which is being discontinued (by Dec 2024).

TROMETAMOL (THAM)
(Injection)

RED
Formulary

3.6% or 7.2% depending on availability.

L&D: stocked on NICU

BHT: stocked on Meadowbank

L-ornithine l-aspartate (LOLA)

RED
Restricted Drug Restricted

4th line use in refractory Hepatic Encephalopathy grade 2 to 3 where laxatives have not reduced ammonia level. Under Hepatologist use only.

Dose: 20 g IV over 4 hours until symptoms improve, followed by 20 - 30 g IV infusion over 24 hours.  To continue until resolution of HE or for up to 5 days only.

 

[DTC Approved Oct 23]

Potassium Canrenoate 200 mg in 10mL
(Injection)

RED
Restricted Drug Restricted

Unlicensed

IV equivalent of spironolactone. Used routinely in Neonates for fluid overload/heart failure

Sodium Hyaluronate 800mg/50mL (1.6%), Sodium Chondroitin Sulfate 1g/50mL (2%) (iAluRil®)

RED
Restricted Drug Restricted

Restricted to Consultant Urologist use only, once all other treatments have failed.

Sucrose 24% Oral solution

RED
Restricted Drug Restricted

For restricted use in paediatric and neonatal patients

Included in Trust Guidelines for Paediatric Acute Pain Management - refer to Intranet

 

FERRIC SUBSULPHATE (Monsel's solution) 50ml

RED
Restricted Drug Restricted

Unlicensed special product for use in Colposcopy

Foscarnet
(cream 2% )

RED
Restricted Drug Restricted

Foscarnet cream 2% Unlicensed for GUM specialist use only.

For aciclovir-resistant Herpes/CMV treatment, as per BHIVA (British HIV Association) guidelines [DTC April 2024]

BNF BNFc SPC

TALC BP purified sterile

RED
Restricted Drug Restricted

For Pleurodesis only

Uromune(R) Vaccine (Uromune®)
(Recurrent UTI)

RED
Restricted Drug Restricted

Restricted use by urologists for recurrent UTI following inclusion/exclusion criteria. [DTC July 2024]

Vaccine contains a suspension of inactivated bacterial cells from selected strains of Escherichia coli, Klebsiella pneumoniae, Proteus vulgaris, and Enterococcus faecalis. 

 

BNF BNFc SPC
Non formulary items

Acetic Acid Solution 3%

 
Non Formulary

ACID CITRATE DEXTROSE

 
Non Formulary

Adcon gel

 
Non Formulary
BNF BNFc SPC

ADRENALINE 1:200,000 inj

 
Non Formulary

ADRENALINE TOPICAL SOLUTION

 
Non Formulary

Ajmaline

 
Non Formulary

ALTRETAMINE (HEXAMETHYLMELAMINE) Capsules 50 mg

 
Non Formulary

ALUM Bladder Irrigation 1%

 
Non Formulary

Bicaflac®

 
Non Formulary
BNF BNFc SPC

Boric acid in IMS ear solution

 
Non Formulary
BNF BNFc SPC

BRILLIANT GREEN 1:500 soln

 
Non Formulary

CALCIUM CHLORIDE 14.7% 50ml,100ml

 
Non Formulary

CALCIUM GLUCONATE 10% 50ml,100ml

 
Non Formulary

Calcium sulfate (Stimulan® Rapid Cure)

 
Non Formulary

CELESTINS ENDO-OESOPHAGEAL TUBE powder

 
Non Formulary
BNF BNFc SPC

CoaguChek test strips

 
Non Formulary

CODEINE PHOSPHATE Suppositories 15 mg,2mg,3mg,6mg

 
Non Formulary
BNF BNFc SPC

Collatamp EG sponge

 
Non Formulary
BNF BNFc SPC

Constrictor rings for erectile dysfunction

 
Non Formulary

Crystal Violet

 
Non Formulary

DAUNORUBICIN saline pre-filled syringe

 
Non Formulary

DEFIBROTIDE Capsules 400 mg

 
Non Formulary
BNF BNFc SPC

DEFIBROTIDE Injection 200 mg

 
Non Formulary

Dexamethasone eye injection

 
Non Formulary

Dexmedetomidine Paediatric

 
Non Formulary
BNF BNFc SPC

DHEA

 
Non Formulary
BNF BNFc SPC

Dialyvit®

 
Non Formulary

DIAZEPAM Suspension 2.5 mg in 5mL

 
Non Formulary
BNF BNFc SPC

Dibotermin Alfa, rhBMP-2 (Inductos®)

 
Non Formulary

DIDANOSINE Liquid 10mg in 1ml (after double dilution)

 
Non Formulary

DIHYDROERGOTAMINE Injection 1 mg in 1mL

 
Non Formulary

DILUENT A (XANTHAN GUM 1%) Suspension 1%

 
Non Formulary

DILUENT C susp CAROB BEAN GUM 1% 500ml

 
Non Formulary

DIMETHYL SULFOXIDE

 
Non Formulary

Diphenylcyclopropenone in acetone

 
Non Formulary
BNF BNFc SPC

DITHRANOL BP 100g

 
Non Formulary
BNF BNFc SPC

DOXYCYCLINE Injection 100 mg in 5mL

 
Non Formulary

Echinacea

 
Non Formulary
BNF BNFc SPC

Elastolabo®

 
Non Formulary
BNF BNFc SPC

Eprodisate disodium

 
Non Formulary
BNF BNFc SPC

Eptotermin Alfa (Osigraft®)

 
Non Formulary
BNF BNFc SPC

ETHIONAMIDE Tablets 250 mg

 
Non Formulary

EVEROLIMUS Tablets 250 micrograms,750 micrograms

 
Non Formulary

Factor Eight Inhibitor Bypassing Activity (FEIBA)

 
Non Formulary
BNF BNFc SPC

Fentanyl and Suxamethonium pre drawn up kits

 
Non Formulary
BNF BNFc SPC

Fibrin Sealant (Evicel®)

 
Non Formulary

Fibrin Sealant (Tisseel®)

 
Non Formulary

FLUCYTOSINE Tablets 500 mg

 
Non Formulary
BNF BNFc SPC

FLUNARIZINE 5mg capsules

 
Non Formulary

GABAPENTIN 6% topical

 
Non Formulary

Gas Gangrene Antitoxin

 
Non Formulary

GLIADEL wafer Carmustine 7.6mg

 
Non Formulary
NICE TA121: Glioma (newly diagnosed and high grade) - carmustine implants and temozolomide

Glycerin

 
Non Formulary
BNF BNFc SPC

Glycerin and Ichthammol paste

 
Non Formulary
BNF BNFc SPC

Glycerol dioleate (Episil®)

 
Non Formulary
BNF BNFc SPC

GLYCEROL STERILE 30ml

 
Non Formulary

GLYCERYL TRINITRATE Ointment 0.05%

 
Non Formulary
BNF BNFc SPC

GLYCERYL TRINITRATE Ointment 0.2%

 
Non Formulary
BNF BNFc SPC

Glycopyrronium tablets (Hyperhidrosis)

 
Non Formulary
BNF BNFc SPC

Haemostatic Agent

 
Non Formulary

Haemostatic Agent (Floseal®)

 
Non Formulary

Haemostatic Agent (Surgiflo® with thrombin)

 
Non Formulary
BNF BNFc SPC

Haemostatic Agent (Tachosil®)

 
Non Formulary

Haemostatic Agent (Willospon®)

 
Non Formulary

human coagulation factor VIII (Wilate®)

 
Non Formulary
BNF BNFc SPC

HYDROCHLOROTHIAZIDE

 
Non Formulary

Hydroxyamphetamine 1% eye drops

 
Non Formulary
BNF BNFc SPC

HYDROXYPROGESTERONE 260mg/ml inj

 
Non Formulary

Ibritumomab tiuxetan

 
Non Formulary
BNF BNFc SPC

Icodextrin solution

 
Non Formulary

INDIGO CARMINE Injection 0.8 %

 
Non Formulary

Indigo carmine solution

 
Non Formulary
BNF BNFc SPC

IOPANOIC ACID Tablets 500 mg

 
Non Formulary
BNF BNFc SPC

Ixabepilone

 
Non Formulary
BNF BNFc SPC

KETANSERIN Injection 10 mg in 2mL

 
Non Formulary

Lactose powder

 
Non Formulary

LAT gel

 
Non Formulary

Leicarbon A

 
Non Formulary
BNF BNFc SPC

LEVAMISOLE Tablets 50 mg

 
Non Formulary

Lipiodol

 
Non Formulary

LIQUID PARAFFIN sterile light (25ml)

 
Non Formulary

Lithium chloride 1.5mmol/10ml solution for injection ampoules (LiDCO Ltd)

 
Non Formulary

LITMUS PAPER

 
Non Formulary

Lorcaserin

 
Non Formulary
BNF BNFc SPC

Lubricating gel

 
Non Formulary

LUMINITY®

 
Non Formulary
BNF BNFc SPC

MAGNESIUM GLYCEROPHOSPHATE powder 350g

 
Non Formulary

MAGNESIUM SULPHATE 10% INFUSION

 
Non Formulary

Melagatran

 
Non Formulary
BNF BNFc SPC

METHOCEL 2% eye drops

 
Non Formulary

Methylthioninium chloride (methylene blue (Aguettant®))

 
Non Formulary

Mibefradil

 
Non Formulary
BNF BNFc SPC

Miglustat

 
Non Formulary
BNF BNFc SPC

Miltefosine

 
Non Formulary

MONOCHLOROACETIC ACID SATURATED soln (5ml)

 
Non Formulary
BNF BNFc SPC

MORPHINE 40mg/ml inj pfs

 
Non Formulary

Morphine epidural 2mg in 10ml

 
Non Formulary

Mucaine

 
Non Formulary
BNF BNFc SPC

Mydricaine

 
Non Formulary

NeilMed Sinus Rinse

 
Non Formulary
BNF BNFc SPC

Nitazoxanide

 
Non Formulary

Optison

 
Non Formulary
BNF BNFc SPC

ORA-PLUS ORAL SUSPENDING VEHICLE

 
Non Formulary

Orascreen

 
Non Formulary
BNF BNFc SPC

Otovent®

 
Non Formulary
BNF BNFc SPC

OXANDROLONE Tablets 2.5 mg

 
Non Formulary
BNF BNFc SPC

Oxepa

 
Non Formulary
BNF BNFc SPC

Oxitriptan

 
Non Formulary

PAPAVERINE HYDROCHLORIDE (2ML AMPOULE) Inj 40 mg in 1mL

 
Non Formulary

PATENT BLUE Injection 2.5%

 
Non Formulary

Pegloticase (Krystexxa)

 
Non Formulary
BNF BNFc SPC
NICE TA291: Pegloticase not recommended for severe chronic gout

PENICILLIN SKIN TEST KIT

 
Non Formulary

pH indicator paper

 
Non Formulary

PHENOL (AQUEOUS) 5ML Injection 6%

 
Non Formulary

Phenol liquified BP 80%

 
Non Formulary
BNF BNFc SPC

Phoxilium

 
Non Formulary
BNF BNFc SPC

PICIBANIL 100mcg inj

 
Non Formulary

Piperaquine with artenimol (Eurartesim®)

 
Non Formulary
BNF BNFc SPC

PIRENZEPINE 50mg tabs

 
Non Formulary
BNF BNFc SPC

Placebo

 
Non Formulary
BNF BNFc SPC

Pollinex Quattro®

 
Non Formulary

Polydimethylsiloxane

 
Non Formulary

POTASSIUM ACETATE injs

 
Non Formulary

Potassium hydroxide

 
Non Formulary
BNF BNFc SPC

POTASSIUM IODIDE eye drops 5%

 
Non Formulary
BNF BNFc SPC

Potassium Iodide solution

 
Non Formulary
BNF BNFc SPC

Povidone-iodine 10 `/. in Boric acid insufflation

 
Non Formulary
BNF BNFc SPC

Pregnancy tests

 
Non Formulary

PreOp ®

 
Non Formulary
BNF BNFc SPC

PRILOCAINE (50ML) Injection 0.5%

 
Non Formulary
BNF BNFc SPC

Prismocitrate

 
Non Formulary
BNF BNFc SPC

Probiotic (Actimel®)

 
Non Formulary

PROCAINAMIDE Capsules 250 mg

 
Non Formulary

PROCHLORPERAZINE PR 25mg,5mg

 
Non Formulary
BNF BNFc SPC

PYRIDOXAL 5 PHOSPHATE Tablets 50 mg

 
Non Formulary

RC cornet ®

 
Non Formulary
BNF BNFc SPC

Resuscitation trollies

 
Non Formulary

Retapamulin ointment

 
Non Formulary
BNF BNFc SPC

RIBOFLAVIN 50mg tabs

 
Non Formulary

RIFAMPICIN 300mg inj

 
Non Formulary

ROBINUL-NEOSTIGMINE inj (1ml)

 
Non Formulary

SACCHAROMYCES BOULARDII 250mg caps

 
Non Formulary
BNF BNFc SPC

SCHILLERS IODINE SOLN 200ml

 
Non Formulary

Secretin

 
Non Formulary
BNF BNFc SPC

Shaker

 
Non Formulary
BNF BNFc SPC

Sinurinse®

 
Non Formulary
BNF BNFc SPC

Sipuleucel- T

 
Non Formulary
BNF BNFc SPC
NICE TA332: Sipuleucel-T for treating asymptomatic or minimally symptomatic metastatic hormone-relapsed prostate cancer

SODIUM ACETATE 30% INJ 50ml

 
Non Formulary

SODIUM ACETATE 40mmol/10ml inj

 
Non Formulary

SODIUM CHLORIDE 600mg caps

 
Non Formulary

SODIUM CHLORIDE neb soln 5% 100ml

 
Non Formulary
BNF BNFc SPC

SODIUM CHLORIDE nebuliser soln 4% 100ml

 
Non Formulary
BNF BNFc SPC

SODIUM CHLORIDE Solution 7 % Nebules (Nebusal® - see section3 now)

 
Non Formulary
BNF BNFc SPC

SODIUM GLYCEROPHOSPHATE (10ML) Injection 21.6%

 
Non Formulary

Sodium hyaluronate (Cystistat®)

 
Non Formulary
BNF BNFc SPC

Sodium Hyaluronate (Hyacyst®)

 
Non Formulary

Sodium hyaluronate injection (SportVis®)

 
Non Formulary
BNF BNFc SPC

SODIUM PROPYL HYDROXYBENZOATE

 
Non Formulary

SODIUM THIOSULPHATE Injection

 
Non Formulary

SPECTINOMYCIN Injection 2 g

 
Non Formulary

SPIRONOLACTONE Liquid

 
Non Formulary

St Johns Wort

 
Non Formulary
BNF BNFc SPC

STANOZOLOL 2mg tabs

 
Non Formulary

Sulfapyridine

 
Non Formulary
BNF BNFc SPC

SULPHAMETHOXYPYRIDAZINE tabs 500mg

 
Non Formulary
BNF BNFc SPC

Sultiame 50mg tabs

 
Non Formulary

Tacrolimus

 
Non Formulary
BNF BNFc SPC

Taribavirin

 
Non Formulary
BNF BNFc SPC

TAUROLIDINE Solution 2 % (nebulised)

 
Non Formulary
BNF BNFc SPC

TETRAHYDROBIOPTERIN Tablets 10 mg

 
Non Formulary

THALIDOMIDE Tablets 50 mg

 
Non Formulary

THEOPHYLLINE liq 50mg/5ml

 
Non Formulary

TICLOPIDINE 250mg tabs

 
Non Formulary

Timolol topical

 
Non Formulary

TISOPURINE Tablets 100 mg

 
Non Formulary

Tissue adhesive for epidural catheters

 
Non Formulary
BNF BNFc SPC

Tolevamer

 
Non Formulary
BNF BNFc SPC

TRANEXAMIC ACID Oral Solution 500 mg in 5mL

 
Non Formulary

Treprostinil

 
Non Formulary
BNF BNFc SPC

TRIAMCINOLONE ACETONIDE 0.1% in a protective emollient vehicle (Oracort® )

 
Non Formulary

Triamcinolone mouthwash

 
Non Formulary
BNF BNFc SPC

Trisodium Citrate 46.7%

 
Non Formulary

Trypan blue

 
Non Formulary

UBIDECARENONE & VITAMIN E (LIQ-10) Oral Solution 50 mg in 5mL

 
Non Formulary

UBIQUENONE 50mg VIT E 15iu/5ml Liq 10

 
Non Formulary

Ultravist

 
Non Formulary

Vernakalant

 
Non Formulary
BNF BNFc SPC

VertebroplasticTM Cement

 
Non Formulary

VITAMIN A Drops 150000 international units in 1mL

 
Non Formulary

VITAMIN A PALMITATE(AQUASOL A) Injection 50000 units in 1 mL

 
Non Formulary

Vitrimix®

 
Non Formulary
BNF BNFc SPC

Warfarin Suspension 5 mg in 5mL

 
Non Formulary
BNF BNFc SPC

Water for humidification

 
Non Formulary

Whitehead’s Varnish

 
Non Formulary
BNF BNFc SPC

Ximelagatran

 
Non Formulary
BNF BNFc SPC

XLS-medical fat binder (Litramine)

 
Non Formulary
BNF BNFc SPC

YOHIMBINE Tablets 5.4 mg

 
Non Formulary

ZINC COMPUND PASTE 500g

 
Non Formulary

ZINC SULPHATE 1mmol in 10ml inj

 
Non Formulary

DEPIGMENTING CREAM (Pigmanorm®)

DNP
Non Formulary

Do Not Prescribe 

Must not be prescribed on FP10 or outpatient prescriptions

[DTC July 2024]

SUCRALFATE 2g/50ml enema

DNP
Non Formulary

Do not prescribe. The oral suspension can be administered rectally. See protocol on the suspension.

Classifications
GREEN
May be initiated in any care setting
Amber SPA
Specialist to advise therapy and provide first 28 days supply, continuation in Primary Care
Amber SPIS
Specialist to initiate and stabilise medicine prior to continuation in Primary Care
SCG
To be prescribed as per Shared Care Guidance. If no SCG in place status reverts to red.
RED
Red medicines are designated as specialist only medicines which should only be prescribed by a specialist, usually within secondary care (either due to the requirement for specialist knowledge, long-term monitoring requirements, or restrictions that mean medicine supplies are only available to hospitals).
DNP
A decision has been made either locally and/or nationally not to routinely commission this preparation. Do not prescribe.
SELF
To be purchased over the counter. May be prescribed for chronic, long term conditions or on admission to hospital if essential.