netFormulary Leeds Formulary NHS
Leeds Teaching Hospitals NHS Trust
Leeds and York Partnership NHS Foundation Trust
Leeds Community Healthcare NHS Trust
NHS Leeds CCG
 
 Search
 Formulary Chapter 99: Miscellaneous Resources - Full Chapter
99.02  Expand sub section  Information on Medicines Resources
 note 

The following information resources have been reviewed by the Leeds Medicines Advice Service and may be helpful in answering questions about medicines in Leeds. We have also provided links to the Medicines Learning Portal, which provides introductory training packages on specific topics.

Don't forget the BNF and BNFc, Leeds Formulary, and your ward or practice pharmacy teams.

If you need further advice within LTHT, or about medicines started by LTHT, ring the Leeds Medicines Advice Service on ext 65377.

**Stock Shortages Advice
(Resources)
Formulary

The following information is provided for the management of current stock shortages where the Leeds Medicines Advisory Service have provided guidance for LTHT. It is not intended to be a comprehensive list of all shortages, or to provide guidance outside of LTHT.

 
Link  DHSC shortage information (registration needed)
Link  Current LTHT stock shortage briefings
Link  Stock shortage - oral ranitidine products (December 2019)
Link  Primary Care guidance - alternatives during ranitidine shortage
Link  Stock shortage - Berinert
Link  Stock shortage - diamorphine 5mg (December 2019)
Link  Stock shortage - Emerade (adrenaline) injections (December 2019)
Link  Stock shortage - mitomycin C (November 2019) (SPS advice)
Link  Stock shortage - sodium thiosulfate 3% in extravasation kits (ongoing July 19)
Link  Stock shortage - urokinase 25,000 units (May 2019)
Link  Stock shortage - water for inhalation (valid July 19)
Link  Recently resolved LTHT stock shortage briefings
Link  Stock shortage - bile acid sequestrants (updated 6 Aug 19)
Link  Stock shortage - Diazemuls (June 2018)
Link  Stock shortage - furosemide 250mg in 25mL injection (December 2019)
Link  Stock shortage - ketamine 200mg in 20mL (August 2019)
Link  Stock shortage - lofepramine (Dec 18)
Link  Stock shortage - phenytoin (Epanutin) liquid (July 2019)
Link  Stock shortage: Epipens (DoH advice on extending expiry) (Sept 18)
   
Core General Resources
(Resources)
Formulary
  • The BNF and BNFc have basic information which will answer most general questions. They are also available as an app for iOS and Android
  • Manufacturers' information is available via their SPCs
  • Your ward or practice pharmacy team will be able to help with most queries - contact details will be on your ward in LTHT
  • The Leeds Medicines Advice Service (ext. 65377) can also help for questions from Leeds Teaching Hospitals staff, or for questions about medicines started by Leeds Teaching Hospitals
  • For introductory training on different aspects of the use of medicines, the Medicines Learning Portal is a useful first port of call
 
Link  Medicines Learning Portal - homepage
   
Adverse drug reaction reporting
(Resources)
View adult BNF View SPC online View childrens BNF
Formulary
  • The BNF and SPCs are useful starting points, but may not have much detail on an adverse reaction and how to manage the problem
  • For patient information, drug-specific information at www.nhs.uk/medicines may be useful
  • An e-learning introductory package is available through the link below on the Medicines Learning Portal
 
Link  Medicines Learning Portal - adverse drug reactions
Link  LTHT: filling in a yellow card
Link  MHRA yellow card scheme
   
Breast feeding and medicines
(Resources)
Formulary
  • The BNF and SPCs (section 4.6) are useful starting points, but can be very cautious.
  • Information from the UK Drugs in Lactation Advisory Service make their advice available via the SPS website. Search for your individual medicine then scroll down to information in breastfeeding. Remember that all guidance only applies to full-term and healthy infants.
  • Lactmed is an American resource that may have some useful content. However, it does have lots of information that may need interpretation.
  • If not clear, or if the baby isn't full-term and healthy, contact the Leeds Medicines Advice Service on ext 65377, or the neonatal pharmacy team.
  • An e-learning introductory package is available on the link below from the Medicines Learning Portal.
 
Link  Medicines Learning Portal - medicines in breastfeeding
   
Fridges for medicines
(Resources)
Formulary

All medicines fridges should be managed such that the temperatures are kept between 2 and 8C. The following resources should not be used to support poor practice. Inform pharmacy if you have any fridge problems

  • LTHT fridge monitoring forms are available here.
  • SPCs have information on the licensed storage conditions for products. Note that this can vary between different manufacturers of the same product, so take care to pick the right SPC.
  • The SPS website has some information on fridge storage. Search for your medicine, then scroll down to the refrigeration section.
  • Section 4 of the HPA Vaccine Incident Guidance covers actions to take when there have been breaks in the cold chain for vaccines.
  • If not clear, contact the Leeds Medicines Advice Service on ext 65377.
 
   
Interactions
(Resources)
Formulary
  • The BNF and SPCs are useful starting points, but may not have much detail on how likely an interaction is, or how to manage it.
  • Medscape Drug Interaction Checker has lots of information, but is very cautious and will flag up theoretical interactions which may not be relevant in practice.
  • Within LTHT, FirstDatabank interaction checker is available via eMEDs - click on 'reference viewer' and select the interaction checker.
  • If not clear, contact the Leeds Medicines Advice Service on ext 65377.
  • An e-learning introductory package is available on the Medicines Learning Portal through the link below.
 
Link  Medicines Learning Portal - medicines interactions
   
IV administration and compatibility
(Resources)
Formulary
  • The Medusa IV Administration Guide has adult and paediatric versions.
  • Neonatal IV administration monographs are available via the neonatal formulary.
  • Paediatric ICU and paediatric cardiology IV administration monographs are also available via the Leeds Formulary.
  • SPCs may also have some useful information, though this is sometimes limited.
  • If not clear, contact your ward pharmacy team, who may have local information, or the Leeds Medicines Advice Service on ext 65377.
  • An e-learning introductory package is available on the Medicines Learning Portal through the link below.
 
Link  Medicines Learning Portal - IV compatibility
   
Pregnancy and medicines
(Resources)
Formulary
  • The BNF and SPCs (section 4.6) are useful starting points, but can be very cautious.
  • Summaries of information from the UK Teratology Information Service are available at UKTIS.org. Note that these are summaries only, and more information is available via UKTIS themselves.
  • Patient information leaflets are available via BUMPS. The content can be quite detailed, and may need some explanation by a healthcare professional.
  • For complex or retrospective questions, contact UKTIS directly on 0334 8920909.
  • If not clear, contact the Leeds Medicines Advice Service on ext 65377.
  • An e-learning introductory package is available on the link below from the Medicines Learning Portal.
 
Link  Medicines Learning Portal - medicines in pregnancy
   
Renal function and medicines
Formulary

There are a number of different equations that estimate renal function. These are less accurate and less consistent the further away from "average" a patient's parameters are.

  • For the majority of patients and the majority of medicines, the eGFR is suitably accurate to guide dose adjustments in renal impairment.
  • For patients with a BMI less than 18kg/m2 or more than 40kg/m2, or who are over 75 years old, the Cockroft and Gault CrCl equation is most appropriate to guide dose adjustments
  • For medicines that are significantly nephrotoxic, or are significantly renally cleared and have a narrow therapeutic index, and all DOACs, the Cockroft and Gault CrCl equation should be used to guide dose adjustments, irrespective of the patient's characteristics
  • No equation is accurate in patients with unstable renal function

All equations are estimates of renal function, and any dose adjustments must be made considering the individual patient and their clinical presentation

 
Link  MDCalc Cockroft and Gault calculator (preferred resource)
Link  MDCalc revised Schwartz equation (paediatrics)
Link  Medicines Learning Portal - medicines in renal impairment
Link  Drug Safety Update Oct 2019 - prescribing medicines in renal impairmant
Link  BNF advice - prescribing in renal impairment
   
**Calcium** (Calcium is a common search term - consider searching for the salt (e.g. gluconate))
View adult BNF View SPC online View childrens BNF
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