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 Formulary Chapter 24: Leeds Children's Hospital Formulary - Full Chapter
Notes:

The Leeds Children's Hospital Formulary is laid out in BNF chapter order. There are custom indexes for the following specialist areas:

Paediatric Intensive Care Unit (PICU)
Neonatal Intensive Care Unit (NICU)
Paediatric Cardiology

Chapter Links...
 Details...
24.04  Expand sub section  Central nervous system (paediatric)
Acrivastine
(paediatrics)
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Formulary
Green
  • See choice of antihistamines in children (link below)  
  •    
    Alimemazine (Vallergan®)
    (paediatrics)
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
  • See choice of antihistamines in children (link below)
  • Alimemazine costs approx. £226/month compared with hydroxyzine (£1.20/month), chlorphenamine and promethazine (approx. £3/month). Prescribers are asked to consider whether there is significant clinical benefit in choosing this agent 
  •    
    Aprepitant
    (paediatrics)
    View SPC online View childrens BNF
    Formulary
    Red
    • For the management of cyclical vomiting in children
    • For chemotherapy induced nausea and vomiting (CINV) in children
     
       
    Ataluren (Translarna®)
    (suspension)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Red
    • for the treatment of Duchenne muscular dystrophy in specific children in line with NICE HST3 and NHSE SSC 1633
     
    Link  NICE HST3: treating Duchenne muscular dystrophy with a nonsense mutation in the dystrophin gene
       
    Cannabidiol (Epidyolex®)
    (paediatrics)
    View adult BNF View SPC online View childrens BNF
    Formulary For use in line with NICE guidance and NHSE commissioning position 
    Link  NICE TA614: Cannabidiol with clobazam for treating seizures associated with Dravet syndrome
    Link  NICE TA615: Cannabidiol with clobazam for treating seizures associated with Lennox–Gastaut syndrome
       
    Carbamazepine (paediatrics)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Amber 2
     
    Link  Amber Drug Guidance - antiepileptics in children
    Link  Drug Safety Update (Dec 12): risk of serious skin reactions
    Link  LTHT: avoid switching between brands of antiepileptics
       
    Cetirizine
    (paediatrics)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Green
  • See choice of antihistamines in children (link below)  
  •    
    Chloral hydrate
    (paediatrics)
    View SPC online View childrens BNF
    Formulary  
    Link  PICU oral and rectal sedation pescribing and administration guide
    Link  BNFC dosing (chloral hydrate)
       
    Chlorpheniramine
    (paediatrics)
    View SPC online View childrens BNF
    Formulary
    • See choice of antihistamines in children (link below)
     
    Link  National Paediatric IV Administration Guide (Medusa) - chlorpheniramine
       
    Chlorpromazine
    (paediatrics)
    View SPC online View childrens BNF
    Formulary  
       
    Clobazam
    (paediatrics)
    View SPC online View childrens BNF
    Formulary
    Amber 2
  • Licensed liquids are listed in the BNFC. These should be used in preference to unlicensed products 
  • Link  Amber Drug Guidance - antiepileptics in children
    Link  BNFC dosing (clobazam)
    Link  NICE TA614: Cannabidiol with clobazam for treating seizures associated with Dravet syndrome
    Link  NICE TA615: Cannabidiol with clobazam for treating seizures associated with Lennox–Gastaut syndrome
       
    Clonazepam (paediatrics)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Amber 2
     
    Link  Amber Drug Guidance - antiepileptics in children
       
    Clonidine (sedation)
    (paediatrics)
    View adult BNF View SPC online View childrens BNF
    Formulary

    Green - tablets

    Grey - oral liquid - restricted for patients unable to swallow solid dosage forms

     
    Link  PICU oral and rectal sedation pescribing and administration guide
       
    Codeine
    (paediatrics)
    View SPC online View childrens BNF
    Restricted Drug Restricted
  • Note MHRA warnings and contraindications for use in paediatric patients - restricted use in children
     
  • Link  BNFC dosing (codeine)
    Link  Drug Safety Update (Apr 15): codeine contraindated for cough/cold in childern
       
    Cyclizine
    (paediatrics)
    View SPC online View childrens BNF
    Formulary  
    Link  National Paediatric IV Administration Guide (Medusa) - cyclizine
       
    Controlled Drug Diamorphine
    (paediatrics)
    View SPC online View childrens BNF
    Formulary
  • MMPS:use of Ayendi intranasal spray in LTHT A&E - see MiDatabank 147233 
  • Link  National Paediatric IV Administration Guide (Medusa) - diamorphine
       
    Domperidone
    (paediatrics)
    View SPC online View childrens BNF
    Formulary  
    Link  Drug Safety Update (Dec 2019) Domperidone for nausea and vomiting: lack of efficacy in children; reminder of contraindications in adults and adolescents
    Link  Drug Safety Update (June 2014) - risks of cardiac side effects
    Link  NPPG interim position statement on the use of domperidone
       
    Eslicarbazepine (paediatrics)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Amber 2
     
       
    Ethosuximide (paediatrics)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Amber 2
     
    Link  Amber Drug Guidance - antiepileptics in children
       
    Fentanyl
    (paediatrics)
    View SPC online View childrens BNF
    Formulary  
    Link  MHRA Drug Safety Update (Oct 18): Transdermal fentanyl patches: life-threatening and fatal opioid toxicity from accidental exposure, particularly in children
    Link  PICU Prescribing and Administration Guide (fentanyl)
       
    Fexofenadine
    (paediatrics)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Green
  • See choice of antihistamines in children (link below)  
  •    
    Fosaprepitant
    (paediatrics)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Red
    • For chemotherapy induced nausea and vomiting (CINV) in children
     
       
    Gabapentin (paediatrics)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Amber 2
     
    Link  MHRA: Drug safety Update (Apr 19) Pregabalin (Lyrica), gabapentin (Neurontin) and risk of abuse and dependence: new scheduling requirements from 1 April
    Link  Amber Drug Guidance - antiepileptics in children
    Link  LTHT: CD prescribing and available pack sizes
    Link  MHRA Drug Safety Update: risk of severe respiratory depression (Oct 17)
       
    Hydroxyzine
    (paediatrics)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Green
  • See choice of antihistamines in children (link below)  
  •    
    Ketamine
    (paediatrics)
    View SPC online View childrens BNF
    Formulary
    Red

    Red - Chronic Pain

    Red - Cancer Pain

     
       
    Lacosamide
    (paediatrics)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Amber 2
     
    Link  Amber Drug Guidance - antiepileptics in children
       
    Lamotrigine (paediatrics)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Amber 2
     
    Link  Amber Drug Guidance - antiepileptics in children
       
    Levetiracetam
    (paediatrics)
    View SPC online View childrens BNF
    Formulary
    Amber 2

    Red - intravenous for status epilepticus

     
    Link  Amber Drug Guidance - antiepileptics in children
    Link  National Paediatric IV Administration Guide (Medusa) - levetiracetam
    Link  Levetiracetam: Leeds CCG commissioning statement
       
    Levomepromazine
    (paediatrics)
    View SPC online View childrens BNF
    Formulary  
       
    Loratadine
    (paediatrics)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Green
    • See choice of antihistamines in children (link below)
     
       
    Lorazepam
    (paediatrics)
    View SPC online View childrens BNF
    Formulary  
    Link  PICU oral and rectal sedation pescribing and administration guide
    Link  Caution in use: lorazepam injection (April 2019)
       
    Melatonin
    (paediatrics)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Amber 2
    Amber2 - Melatonin and Melatonin CR for the treatment of sleep disorders in children and adolescents (link to guidance below)
  • adult indications are listed in Chapter 4 
  • Link  Amber Drug Guidance: Melatonin in Children and Adolescents
    Link  https://www.medicinesforchildren.org.uk/melatonin-sleep-disorders
       
    Controlled Drug Methylphenidate hydrochloride (all brands)
    (paediatrics)
    View SPC online View childrens BNF
    Formulary
    Amber 3
     
    Link  Amber Drug Guidance - methylphenidate (children and adolescents)
       
    Metoclopramide
    (paediatrics)
    View SPC online View childrens BNF
    Formulary
    Grey
  • Prescribe in line with guidelines and/or Drug Safety Update 
  • Link  MHRA Drug Safety Update (Aug 13); risk of neurological adverse effects
    Link  National Paediatric IV Administration Guide (Medusa) - metoclopramide
       
    Mexiletine (NaMuscla® 167mg capsules)
    ( paediatrics)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Red
    • For use in children with non-dystrophic myotonic disorders in line with NHSE SSC2001
    • This is an unlicensed use of a licensed medicine
     
       
    Mexiletine Hydrochloride (Mexitil® ULM)
    (paediatrics)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Amber 3
    • Unlicensed.
    • For the treatment of chloride channel myotonias (e.g. Thomsen's disease and Becker's generalized myotonia) and sodium channel myotonias (e.g. Paramyotonia congenital). For initiation by paediatric neurology.
     
    Link  Unlicensed medicine: SPC and ULM assessments
       
    Controlled Drug Midazolam (Buccolam® (buccal))
    (paediatrics)
    View SPC online View childrens BNF
    Formulary
    Amber 2
  • From 3 March 2014, Buccolam® will be the product of choice at LTH
  • For further information, contact Medicines Information on ext 65377 (MiDatabank 135935) 
  • Link  Buccal midazolam training package
    Link  How to administer Buccolam syringes
       
    Controlled Drug Midazolam (intravenous)
    (paediatrics)
    View SPC online View childrens BNF
    Formulary  
    Link  PICU Prescribing and Administration Guide (midazolam)
       
    Controlled Drug Morphine
    (paediatrics)
    View SPC online View childrens BNF
    Formulary  
    Link  PICU Prescribing and Administration Guide (morphine)
    Link  Medication Safety Alert: mis-selection of morphine (July 19) (LTHT access only)
       
    Nabilone
    (paediatrics)
    View SPC online View childrens BNF
    Formulary
    Red
     
       
    Nusinersen (Spinraza®)
    (paediatrics)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Red
    • For use in line with NICE guidance below
     
    Link  NICE TA588: Nusinersen for treating spinal muscular atrophy
    Link  MHRA Drug Safety Update (Sep 18) Nusinersen (Spinraza): reports of communicating hydrocephalus; discuss symptoms with patients and carers and investigate urgently
       
    Ondansetron
    (paediatrics)
    View SPC online View childrens BNF
    Formulary  
    Link  Drug Safety Update (Jan 2020) small increased risk of oral clefts following use in the first 12 weeks of pregnancy
       
    Oxcarbazepine (paediatrics)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Amber 2
     
    Link  Amber Drug Guidance - antiepileptics in children
    Link  Drug Safety Update (Dec 12): risk of serious skin reactions
       
    Paracetamol
    (paediatrics)
    View SPC online View childrens BNF
    Formulary
    • Note: risk of error with IV preparations - see guidance below
     
    Link  Warning: Paracetamol, Metronidazole and Sodium Chloride infusions look very similar (Oct 17)
    Link  LTHT Paediatric Acute Pain Management manual
    Link  Paediatric IV paracetamol dosing table (practice within LTHT)
    Link  IV paracetamol in paediatrics - Medicines Safety Alert (LTHT access only)
    Link  May 2014: paediatric paracetamol dosing in acute pain - memo
    Link  The Safe Use of Paracetamol
       
    Perampanel (paediatrics)
    (tablets, oral liquid)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Amber 2
     
    Link  Amber Drug Guidance - antiepileptics in children
       
    Phenobarbital
    (paediatrics)
    View SPC online View childrens BNF
    Formulary
    Amber 2
    • Phenobarbital oral elixir 15mg/5mL contains 38% alcohol - not suitable for children
    • LTHT use an alcohol free 50mg/5mL unlicensed preparation
    • Please ensure the correct dose is prescribed for the child and parents/carers and child are made aware if any changes to the strength being prescribed are made by primary care
     
    Link  PICU Prescribing and Administration Guide (phenobarbital)
    Link  Amber Drug Guidance - antiepileptics in children
    Link  BNFc (phenobarbital)
    Link  LTHT: avoid switching between brands of antiepileptics
       
    Phenytoin
    (paediatrics)
    View SPC online View childrens BNF
    Formulary
    Amber 2
    • LTHT Oct-Dec 2018: supply shortage of Epanutin suspension - neurology colleagues will assist with appropriate switch if required
     
    Link  PICU Prescribing and Administration Guide (phenytoin)
    Link  Phenytoin Prescribing and Administration Guide (general paediatric medicine)
    Link  Medication Safety Alert: Risk of death and severe harm from error with injectable phenytoin (LTHT access only)
    Link  Amber Drug Guidance - antiepileptics in children
    Link  BNFC dosing (phenytoin)
    Link  LTHT: avoid switching between brands of antiepileptics
    Link  phenytoin infatabs, capsules and liquid have different bioavailabilities
       
    Pregabalin
    (paediatrics)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Amber 2
     
    Link  MHRA: Drug safety Update (Apr 19) Pregabalin (Lyrica), gabapentin (Neurontin) and risk of abuse and dependence: new scheduling requirements from 1 April
    Link  Amber Drug Guidance - antiepileptics in children
    Link  LTHT: CD prescribing and available pack sizes
       
    Primidone
    (paediatrics)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Amber 2
     
    Link  Amber Drug Guidance - antiepileptics in children
    Link  LTHT: avoid switching between brands of antiepileptics
       
    Procyclidine
    (paediatrics)
    View SPC online View childrens BNF
    Formulary  
       
    Promethazine
    (paediatrics)
    View adult BNF View SPC online View childrens BNF
    Formulary
    • see choice of antihistamines in children (link below)
     
       
    Promethazine
    (paediatrics)
    View adult BNF View SPC online View childrens BNF
    Formulary  
    Link  PICU oral and rectal sedation pescribing and administration guide
       
    Rufinamide
    (paediatrics)
    View SPC online View childrens BNF
    Formulary
    Amber 2
  • For the management of seizures associated with Lennox-Gastaut syndrome in chilren 4 years and over 
  • Link  Amber Drug Guidance - antiepileptics in children
       
    Rupatadine
    (paediatrics)
    View adult BNF View SPC online View childrens BNF
    Formulary
    • See choice of antihistamines in children (link below)
     
       
    Sodium Valproate (paediatrics)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Amber 2
    • Epilim LIQUID is sugar free
    • Epilim syrup contains sugar
    • Generic brands - please check
     
    Link  MHRA: Drug safety Update (Apr 19) Valproate medicines and serious harms in pregnancy: new Annual Risk Acknowledgement Form and clinical guidance from professional bodies to support compliance with the Pregnancy Prevention Programme
    Link  MHRA: Valproate medicines: are you in acting in compliance with the pregnancy prevention measures? (Dec 2018)
    Link  Valproate Pregnancy Prevention Programme: actions required now from GPs, specialists, and dispensers (Sep 18)
    Link  MHRA: Valproate medicines (Epilim, Depakote): Pregnancy Prevention Programme materials online (May 18)
    Link  MHRA: Valproate contraindicated in wormen and girls unless conditions met (Apr 18)
    Link  MHRA: Valproate patient leaflet for women and girls (Apr 18)
    Link  Medication Safety Alert - Sodium Valproate (July 18)
    Link  Resources to support female patient safety with valproate
    Link  LTHT: Alternatives for patients with swallowing difficulties
    Link  LTHT: avoid switching between brands of antiepileptics
    Link  MHRA: Carbapenems: concomitant use with valproate not recommended (May 2010)
       
    Stiripentol (capsules/ sachets)
    (paediatrics)
    View SPC online View childrens BNF
    Formulary
    Amber 3
  • sachets and capsules are not bioequivalent - patients need to be maintained on the same preparation
  • some patients open the capsules and dissolve the contents in water; this practice is unlicensed and pre-dates the availability of the sachets
  • if a switch of formulations is required, this should be done under clinical supervision - see amber drug guidance below
     
  • Link  Amber Drug Guidance - stiripentol
    Link  https://www.medicinesforchildren.org.uk/search-for-a-leaflet/stiripentol-for-preventing-seizures
       
    Sumatriptan
    (paediatrics)
    View SPC online View childrens BNF
    Formulary
    Amber 1
     
    Link  Amber Drug Guidance - sumatriptan (paediatrics)
       
    Tiagabine (paediatrics)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Amber 2
     
    Link  Amber Drug Guidance - antiepileptics in children
       
    Tizanidine
    (paediatrics)
    View SPC online View childrens BNF
    Formulary
    Amber 2
    • Non-formulary for the treatment of cerebral palsy spasticity in children (unlicensed use)
     
    Link  Amber Drug Guidance - tizanidine
       
    Topiramate (migraine)
    (paediatrics)
    View SPC online View childrens BNF
    Formulary
    Multiple
    • First line: capsules
    • Second line: capsules opened and sprinkled (where licensed)
    • Third line: oral liquid (Rosemont)

    Amber1 - paediatric migraine

    Amber2 - epilepsy in children

     
    Link  Amber Drug Guidance - antiepileptics in children
    Link  Amber Drug Guidance - topiramate (paediatric migraine)
       
    Vigabatrin (paediatrics)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Amber 2
     
    Link  Amber Drug Guidance - antiepileptics in children
    Link  Drug Safety Update (Nov 09): use in infantile spasms: risk of movement disorders and MRI abnormalities
       
    Zolmitriptan
    (paediatrics)
    View SPC online View childrens BNF
    Formulary
    Amber 1
     
    Link  Amber Drug Guidance - zolmitriptan for paediatric migraine
       
    Zonisamide
    (paediatrics)
    View SPC online View childrens BNF
    Formulary
    Amber 2
     
    Link  Amber Drug Guidance - antiepileptics in children
       
     ....
     Non Formulary Items
    Sulthiame
    (paediatrics)

    Non Formulary
     
      
    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
    click to search medicines.org.uk
    Link to adult BNF
    click to search medicines.org.uk
    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

    Green

    Medicines which are appropriate for initiation and ongoing prescribing in both primary and secondary care.  

    Amber 1

    Amber Level 1- Specialist Recommendation
    These medicines are considered suitable for GP prescribing following specialist recommendation.
     
    There is no requirement for full Amber Drug Guidance. Generic Amber Level 1 Drug Guidance detailing responsibilities and information sources is available here
      

    Amber 2

    Amber Level 2- Specialist Initiation but no monitoring requirements
    These medicines are considered suitable for GP prescribing following specialist initiation, including titration of dose and assessment of efficacy.
    Some Amber Level 2 products will have an associated Amber Level 2 Drug Guidance document, available by clicking on the traffic light symbol to the right of the drug name. If this is not available, generic Amber Level 2 Drug Guidance is available here  

    Amber 3

    Amber Level 3- Specialist Initiation with ongoing monitoring requirements (Full Amber Drug Guidance required)
    Medicines that should be initiated by a specialist, and which require significant monitoring on an ongoing basis. Full agreement to share the care of each specific patient must be reached under the amber drug agreement, and Amber Drug Guidance must be provided to the GP (available by clicking on the traffic light symbol to the right of the drug name).   

    Red

    Guidance on the responsibilities for Red Drugs can be found here. Red Drugs would usually by prescribed by the hospital for the duration of the course. Primary care prescriber initiation or continuation of treatment not recommended except by Specialist GP and community paediatric prescribing.   

    Grey

    Grey Drugs are locally-agreed medicines which are only recommended for restricted use within the Leeds Health Economy.   

    Black

    These drugs are not recommended for use within the Leeds Health Economy  

    Multiple

    Products shown as blue have different Traffic Light List classifications dependent on indication. See the accompanying text next to the product for further information the indications for which it has a Traffic Light List classification.  

    netFormulary