Formulary

Guidance

NICE NG136: Hypertension in adults: diagnosis and management
NICE NG106: Chronic heart failure in adults: diagnosis and management
NICE TA388: Sacubitril valsartan for treating symptomatic chronic heart failure with reduced ejection fraction
NICE TA267: Ivabradine for treating chronic heart failure
NICE TA223: Cilostazol, naftidrofuryl oxalate, pentoxifylline and inositol nicotinate for the treatment of intermittent claudication in people with peripheral arterial disease
NICE TA355: Edoxaban for preventing stroke and systemic embolism in people with non-valvular atrial fibrillation
NICE TA275: Apixaban for preventing stroke and systemic embolism in people with nonvalvular atrial fibrillation
NICE TA249: Dabigatran etexilate for the prevention of stroke and systemic embolism in atrial fibrillation
NICE TA256: Rivaroxaban for the prevention of stroke and systemic embolism in people with atrial fibrillation
NICE TA261: Rivaroxaban for the treatment of deep vein thrombosis and prevention of recurrent deep vein thrombosis and pulmonary embolism
NICE TA287: Rivaroxaban for treating pulmonary embolism and preventing recurrent venous thromboembolism
NICE TA210: Clopidogrel and modified-release dipyridamole for the prevention of occlusive vascular events
NICE NG238: Cardiovascular disease: risk assessment and reduction, including lipid modification
NICE TA694: Bempedoic acid with ezetimibe for treating primary hypercholesterolaemia or mixed dyslipidaemia
NICE TA733: Inclisiran for treating primary hypercholesterolaemia or mixed dyslipidaemia
NICE TA393: Alirocumab for treating primary hypercholesterolaemia and mixed dyslipidaemia
NICE TA394: Evolocumab for treating primary hypercholesterolaemia and mixed dyslipidaemia
NICE TA679: Dapagliflozin for treating chronic heart failure with reduced ejection fraction
NICE TA902: Dapagliflozin for treating chronic heart failure with preserved or mildly reduced ejection fraction
NICE TA773: Empagliflozin for treating chronic heart failure with reduced ejection fraction
NICE NG28: Type 2 diabetes in adults: management

Positive Inotropic drugs

Diuretics

Thiazides and related diuretics 
Bendroflumethiazide 2.5mg
Indapamide 2.5mg 

Loop diuretics
Furosemide

Aldosterone antagonists
Spironolactone
Eplerenone

Beta-adrenoreceptor blocking drugs 

Atenolol
Propranolol
Bisoprolol 
Carvedilol

Beta-blockers and ACE inhibitors are first line treatment for heart failure. A Beta-blocker licensed for heart failure should be used eg. Bisoprolol or Carvedilol. Dose titration is required, see below:

Heart failure (target doses of preferred beta-blockers-if tolerated)

Bisoprolol	10mg once a day
Carvedilol	25mg twice a day (in severe heart failure or body weight less than 85kg) 50mg twice a day (body weight over 85 kg)

Alpha-Adrenoreceptor Blockers

Doxazosin
Alpha-blockers are 4th line antihypertensive agents unless there is compelling indication for their use eg. prostatism. 
Do NOT use Doxazosin XL as it is “Double Red”

Angiotensin- converting enzyme inhibitors

Ramipril
Lisinopril
Perindopril erbumine

Angiotensin-II-receptor antagonists

Losartan
Candesartan - drug of choice in heart failure if AIIRA required

Heart failure (target doses of preferred beta-blockers-if tolerated)

Ramipril	5mg twice a day or 10mg once a day
Lisinopril	35mg once a day
Perindopril	4mg once a day
Candesartan	32mg once a day
Losartan	150mg once a day

Nitrates, calcium-channel blockers and potassium channel activators

Nitrates 
Glyceryl Trinitrate (Sublingual spray and tablets)
Monomil XL^® or Chemydur XL^®
Isosorbide mononitrate
Prescribe generically
Standard release preparations should have asymmetric dosing (eg. 8am and 2pm)

Calcium-channel blockers
Amlodipine
Verapamil
Diltiazem M/R
Prescribe by brand, preferred brands are:
Slozem^® - prefered ONCE a day preparation
Viazem XL® - supply problem April 2025
Tildiem^® Retard - prefered TWICE a day preparation 

Other anti-anginal drugs
Nicorandil

Peripheral vasodilators and related drugs

Naftidrofuryl oxalate
NICE TA223 - Naftidrofuryl oxalate is recommended as an option for the treatment of intermittent claudication in people with peripheral arterial disease for whom vasodilator therapy is considered appropriate after taking into account other treatment options.

Anticoagulants

Warfarin

For DOACs check traffic light classification for each indication
Apixaban - Generic tablets are prefered twice a day DOAC
Rivaroxaban - Generic tablets are prefered twice a day DOAC
Dabigatran (generic)

Commissioning recommendations for national procurement for direct-acting oral anticoagulant(s) (DOACs)- January 2024

Antiplatelet drugs

Aspirin 75mg 
Clopidogrel 75mg
Prasugrel
Ticagrelor
Dipyridamole 200mg M/R

Lipid-regulating drugs

Statins 
Atorvastatin
Rosuvastatin tablets
Pravastatin

Ezetimibe
Ezetimibe
Do not prescribe as Ezetrol® brand as it is “Double Red”

Lipid-regulating drugs 
Bempedoic acid
Bempedoic acid and ezetimibe (Nustendi)

Other lipid modifying drugs 
Inclisiran- GREEN (Specialist Recommended)
NHS England » Funding and supply of inclisiran (Leqvio®)

SGLT2 Inhibitors for heart failure

Dapagliflozin
Empagliflozin

Guidance

Asthma guidelines 12 years plus
Asthma Guidelines Paediatrics (≤ 11 years)
Northamptonshire COPD Guidelines
Guide to inhaler dose equivalents when switching patients to formulary choice dry powder inhalers
Inhaler Repeat Durations Guideline
Patient decision aid on asthma inhalers and climate change 
How to use your inhaler | Asthma + Lung UK
How to use a pMDI inhaler with a spacer – single breath and hold
How to use a pMDI inhaler with a spacer – tidal breathing
Inhaled corticosteroid doses for the BTS, NICE and SIGN asthma guideline

 

Bronchodilators   

Short-acting beta2 agonists
Easyhaler Salbutamol^®DPI 100 microgram per inhalation
Low carbon footprint
Salamol^®(Salbutamol) CFC-free pMDI 100microgram per inhalation
Lower carbon footprint compared with generic due to lower volume propellant
Note - Ventolin^® pMDI and generic salbutamol pMDI are DOUBLE RED 
 
Long acting beta2 agonists  
Formoterol Easyhaler®DPI
Low carbon footprint
Olodaterol Soft Mist Inhaler (Striverdi Respimat®)
Low carbon footprint 
Formoterol pMDI
High carbon footprint

Antimuscarinic bronchodilators

Short Acting
Ipratropium pMDI
High carbon footprint

Long Acting
Long acting antimuscarinic antagonists (LAMA) are classified:
Green for COPD
Green SR for asthma

Tiotropium DPI
Prescribe by brand, preferred brands are:
Trokide 18microgram
Device (Vertical-inhaler) plus inhalation powder capsules or refill pack of capsules only
Low carbon footprint 
Acopair Neumohaler^®18microgram
Device plus inhalation powder capsules
Low carbon footprint
Tiogiva^®18 microgram 
Device plus inhalation powder capsules or refill pack of capsules only.
Low carbon footprint

Spiriva Respimat^® Soft mist inhaler - Only if unable to use dry powder inhaler.
Low carbon footprint 
Aclidinium DPI (Eklira Genuair^®)
Low carbon footprint

Theophylline

Modified Release Theophylline tablet
Prescribe by brand, preferred brand is:
Uniphyllin Continus^®

Compound bronchodilator preparations: LAMA + LABA

Prescribe by brand, preferred brands are:
Duaklir Genuair^® DPI (340/12)  [Aclidinium bromide (LAMA) and formoterol fumarate (LABA)]
Low carbon footprint
Spiolto Respimat ^®DPI (2.5/2.5) [Tiotropium bromide (LAMA) and olodaterol hydrochloride (LABA)]
Low carbon footprint

Spacer devices

Provide a spacer that is compatible with the person's metered-dose inhaler.
A2A spacer^®
EasyChamber^®
Volumatic^®
Aerochamber Plus ^®

How to use a spacer: 2 techniques
Single breath and hold: How to use a pMDI inhaler with a spacer – single breath and hold
Tidal breathing/multiple breath technique: This is usually recommended if you can’t hold your breath for five seconds after using your inhaler or if you are having an asthma attack. How to use a pMDI inhaler with a spacer – tidal breathing

Corticosteroids

When switching between corticosteroid products be aware of dose inequivalence. See Inhaled corticosteroid doses for the BTS, NICE and SIGN asthma guideline and local Guide to inhaler dose equivalents when switching patients to formulary choice dry powder inhalers

Single component inhaled corticosteroid
Products are only licensed for use in asthma, not COPD.

Prescribe by brand, preferred brands are:
Budesonide Easyhaler^®DPI
Low carbon footprint 
Soprobec^®cfc-free pMDI (Beclometasone dipropionate, standard particle)
High carbon footprint

Combination (LABA/ICS) inhalers  

Dry powder inhalers 
Prescribe by brand, preferred brands are:
Fobumix Easyhaler® (Budesonide and formoterol) 
Low carbon footprint
Shelf life after opening: 4 months
Licensed for:
Asthma from 6 years (fixed dose)
MART and AIR (160/4.5 only) from 12 years
COPD in adults
WockAIR®(Budesonide and formoterol)
Low carbon footprint.
Shelf life after opening: 2 years
Note - WockAIR 160/4.5 is the preferred cost-effective option when used for AIR because of the 2 year shelf life.
Licensed for:
Asthma from 6 years (fixed dose)
MART and AIR (160/4.5 only)  from 12 years
COPD in adults

Fostair 200/6 NEXThaler®(Formoterol and fine-particle beclomethasone) - Only for severe asthma 
Low carbon footprint
Licensed for asthma only in adults.

Pressurised metered dose inhalers (Use with spacer)
Prescribe by brand, preferred brands are:
Bibecfo^® (fine-particle beclomethasone and formoterol)
High carbon footprint.
Luforbec^® (fine-particle beclomethasone and formoterol)
High carbon footprint.
Proxor^® (fine-particle beclomethasone and formoterol)
High carbon footprint.
Symbicort^®100/3 (budesonide and formoterol)
Very high carbon footprint.

Triple therapy ICS/LABA/LAMA
Only to be considered in severe COPD which is not controlled by two inhaled drugs  
For patients already on triple therapy using 2 devices (e.g. LAMA plus LABA/ICS) it may be cost effective to prescribe this as a single fixed dose device.

Prescribe by brand, preferred brand is:
Trimbow NEXThaler^®DPI (88/5/9) (fine-particle beclometasone, formoterol and glycopyrronium)
Licensed for COPD only.
Trimbow^®pMDI (87/5/9) (fine-particle beclometasone, formoterol and glycopyrronium)
Licensed for COPD and Asthma
Trimbow^®pMDI (172/5/9) (fine-particle beclometasone, formoterol and glycopyrronium)
Licensed for Asthma only.

Cromoglicate, related therapy and leukotriene antagonists

Leukotriene antagonists
When used in asthma offer a trial of leukotriene receptor antagonist (LTRA) and review the response to treatment in 8 to 12 weeks. 

Montelukast
Licensed from age 6 months

Antihistamines

Available over the counter for hayfever/seasonal allergic rhinitis  Over The Counter (OTC) Products - When to prescribe

Cetirizine
Loratadine
If liquid required, loratadine more cost-effective than cetirizine
Chlorphenamine

Mucolytics

4 week trial; stop if no benefit seen.
Carbocisteine 375mg capsule
Acetylcysteine sugar free effervescent tablets 600mg preferred if liquid or once daily preparation required 
115mg Na+ per tablet = 1/20th recommended daily intake

Guidance

Guidance on the use of zaleplon, zolpidem and zopiclone for the short-term management of insomnia
Prescribing Guideline for Treatment of Depression in Adults in Primary Care

Hypnotics and Anxiolytics

Insomnia Newer Hypnotic Drugs
NICE TA77 – (April 2004)

• When, after due consideration of the use of non-pharmacological measures, hypnotic drug therapy is considered appropriate for the management of severe insomnia interfering with normal daily life, it is recommended that hypnotics should be prescribed for short periods of time only, in strict accordance with their licensed indications.
• It is recommended that, because of the lack of compelling evidence to distinguish between zaleplon, zolpidem, zopiclone or the shorter acting benzodiazepine hypnotics, the drug with the lowest purchase cost (taking into account daily required dose and product price per dose) should be prescribed.
• It is recommended that switching from one of these hypnotics to another should only occur if a patient experiences adverse effects considered to be directly related to a specific agent. These are the only circumstances in which the drugs with the higher acquisition costs are recommended.
• Patients who have not responded to one of these hypnotic drugs should not be prescribed any of the others.

Benzodiazepine indications

• Benzodiazepines are indicated for the short-term relief (two to four weeks only) of anxiety that is severe, disabling, or causing the patient unacceptable distress, occurring alone or in association with insomnia or short-term psychosomatic, organic, or psychotic illness.
• The use of benzodiazepines to treat short-term ‘mild’ anxiety is inappropriate.
• Benzodiazepines should be used to treat insomnia only when it is severe, disabling or causing the patient extreme distress - BNF

Anxiolytics 
Diazepam

Hypnotics 
Zaleplon, zolpidem and zopiclone are non-benzodiazepine hypnotics, but they act as the benzodiazepine receptor.  They are not licensed for long-term use; dependence has been reported in a small number of patients.

Antidepressant drugs

Prescribing Guideline for Treatment of Depression in Adults in Primary Care

First prescribe an SSRI in generic form unless there are interactions with other drugs; consider using citalopram or sertraline because they have less propensity for interactions.
When prescribing antidepressants, be aware that:

• Dosulepin should not be prescribed
• Non-reversible monoamine oxidase inhibitors (MAOIs; for example, phenelzine), combined antidepressants and lithium augmentation of antidepressants should normally be prescribed only by specialist mental health professionals
  

Take into account toxicity in overdose when choosing an antidepressant for patients at significant risk of suicide. Be aware that:

• Compared with other equally effective antidepressants recommended for routine use in primary care, venlafaxine is associated with a greater risk of death from overdose
• Tricyclic antidepressants (TCAs), except for lofepramine, are associated with the greatest risk in overdose.

When prescribing antidepressants for older people:

• Prescribe at an age-appropriate dose taking into account the effect of general physical health and concomitant medication on pharmacokinetics and pharmacodynamics
• Carefully monitor for side effects

Selective serotonin re-uptake inhibitors 
Sertraline
(For patients with co-existing CHD)
Escitalopram
(First line in epilepsy)
Fluoxetine
(First line for <24 years of age) where capsules are unsuitable prescribe as 20mg/5ml oral solution (not SF) or 20mg dispersible tablets

Tricyclic-related antidepressants 
Mirtazapine
(Sedative effect may be beneficial in sleep disturbances)

Other antidepressant drugs 
Third line options after trial of alternative first line option:
Venlafaxine
(monitor BP before and during treatment)
Vortioxetine
(cognitive enhancement independent of depression)
Duloxetine
(if pain a predominant co-morbid symptom)

Drugs used in nausea and vertigo

Dopamine receptor antagonists 
Metoclopramide
Not recommended for patients <20 years

Phenothiazines and related drugs 
Prochlorperazine
Betahistine

Analgesics

Available over the counter Over The Counter (OTC) Products - When to prescribe

Limited amount of evidence that combinations containing low doses of opioid e.g. 8 mg codeine are more effective than aspirin or paracetamol alone. Soluble products not included due to high sodium content.

Non-opioid analgesics and compound analgesic preparations 
Paracetamol tablets  (OTC) 
Co-codamol tablets 8/500 (OTC)

High strength
1st line - Co-codamol tablets 30/500 
2nd line - Co-codamol capsules 30/500
No longer cheaper to prescribe separately
Codeine phosphate

Opioid analgesics 
Morphine
Prescribe by brand, which must stay consistent
Preferred brand – Zomorph^® capsules (twice a day preparation)

Zomorph^® capsules can be swallowed whole or opened and sprinkled on food.
Diamorphine
Fentanyl patches (pack of 5 only) preferred brands Matrifen®, Mezolor® and Opiodur® 
Dexamethasone
Midazolam
Cyclizine
Levomepromazine- for a 6.25mg dose, use a 25mg tablet broken into quarters

Antimigraine drugs

Simple Analgesic plus anti-emetic
Several combination products are available

Triptans 
Reserve triptans for patients in whom adequate doses of analgesics and anti-emetics are not effective.  Monitor patients and review if patient overusing as potential for medication overuse headache.
Sumatriptan 50mg
Naratriptan 2.5mg
Rizatriptan 10mg Orodispersible tablets SF

Guidance

Antimicrobial Clinical Topics page
NICE/UKHSA Summary of antimicrobial prescribing guidance - managing common infections
Penicillin allergy de-labelling guideline

Useful Resources

 NICE/UKHSA Summary of antimicrobial prescribing guidance - managing common infections

See the British National Formulary (BNF) for appropriate use and dosing in specific populations, for example, hepatic impairment, renal impairment, pregnancy and breastfeeding.

Unnecessarily long courses of antimicrobials are one of the factors driving antimicrobial resistance and an increased risk of Clostridioides difficile infection in at-risk populations. Follow national guidance on prescribing the shortest effective course. For example, the NICE/UKHSA summary currently recommends a 5-day course when prescribing for acute sore throat, acute otitis media, sinusitis, acute cough and acute exacerbations of COPD.

Antimicrobial Stewardship resources
TARGET antibiotics toolkit hub 
Discussing antibiotics with patients: Overview 
Leaflets to discuss with patients: How to use these leaflets
Caring for children with coughs leaflet
Learning resources for prescribers: Webinars and webinar recordings 
How to..? Resources (repeat and long term antibiotics)
One-page summary from the University of Bristol ‘Using STARWAVe in practice to predict hospitalisation’: Using the STARWAVe score in clinical practice and recommendations for antibiotic prescribing. 
Antimicrobial stewardship | Topic | NICE - All NICE products on antimicrobial stewardship. Includes guidance, advice and quality standards.
Antimicrobial stewardship: systems and processes for effective antimicrobial medicine use | Guidance NG15  | NICE
UK-AWaRe antibiotic classification - GOV.UK

Antimicrobial Stewardship related Tablet Press Extras
Tablet Press Extra - Implementing Back-up (delayed) antibiotic prescribing
Tablet Press Extra - Shorter courses of antibiotics are better!
Tablet Press Extra - Recurrent UTI

Antibacterials

Penicillins
Phenoxymethylpenicillin (Pen V)
Amoxicillin
Flucloxacillin
Co-amoxiclav - only first choice for human & animal bites, uncomplicated diverticulitis, cellulitis and erysipelas near the eyes or nose, sinusitis (only if systemically very unwell or high risk of complications), community acquired pneumonia (only if high severity in adults or severe in children) and hospital acquired pneumonia (non-severe and not higher risk of resistance).
Pivmecillinam 200mg for lower UTI only (second line).

Cephalosporins
Cefalexin

Tetracyclines 
Doxycycline
Lymecycline

Macrolides
Clarithromycin (first choice macrolide)
Erythromycin (preferred for some indications in pregnancy and breast feeding  - see NICE/UKHSA Summary of antimicrobial prescribing guidance - managing common infections)
Azithromycin - Chlamydia treatment option for pregnant women
Vancomycin - see National Institute for Health and Care Excellence (NICE) guidance [NG199] for Clostridioides difficile infection: antimicrobial prescribing
Trimethoprim – nitrofurantoin is preferred for most patients especially where risk of resistance is high e.g. over 70s. Trimethoprim should only be used in over 70s where sensitivity has been confirmed on MSU.
Metronidazole
Ciprofloxacin* only first choice for acute prostatitis (guided by susceptibilities when available). *See the MHRA January 2024 advice on restrictions and precautions for using fluoroquinolone antibiotics because of the risk of disabling and potentially long-lasting or irreversible side effects.
Nitrofurantoin 50mg capsules
Methenamine Hippurate - Prophylaxis of recurrent urinary tract infections.

Antifungal drugs

Fluconazole
Itraconazole
Nystatin oral suspension
Treat fungal nail infections only after confirmed mycology. Topical preparations should be purchased rather than prescribed.
Terbinafine

Herpes virus infections

Aciclovir

Influenza management 

Oseltamivir
Zanamivir

Useful Resources

Diabetes (type 1 and type 2) in children and young people: diagnosis and management (NICE, NG18)

Type 1 diabetes in adults: diagnosis and management (NICE, NG17)

Northamptonshire Type 2 diabetes treatment guidance

Type 2 diabetes in adults: management (NICE, NG28)

Northamptonshire guidance on insulin initiation and titration in Type 2 Diabetes

Insulin therapy in type 1 diabetes (NICE)

Insulin therapy in type 2 diabetes (NICE)

Diabetes in pregnancy: management from preconception to the postnatal period  Guidance (NICE, NG3)

Northamptonshire Pen Needles and Safety Needle Devices Guideline

Northamptonshire Guidelines for Blood Glucose and Ketone Monitoring

Menopause (NICE)

Obstetrics and gynaecology | Integrated Care Northamptonshire

Insulins

All insulins must always be prescribed and dispensed by brand name

Rapid-acting insulin (PRESCRIBE BY BRAND ONLY)
Trurapi® (Insulin aspart)
Trurapi® is a biosimilar insulin product to NovoRapid®. 

Fiasp® (Insulin aspart)
Fiasp® is not interchangeable with NoVo Rapid® or Trurapi®, owing to differences in bioavailability. 
Fiasp® has a quicker onset of action and shorter duration than NovoRapid® and Trurapi®

Insulin lispro (Admelog®, Humalog®) 
High strength version of Humalog (200units/ml) is to be prescribed only on Specialist Recommendation (green SR)

Insulin glulisine (Apidra®)

Intermediate-acting insulin (PRESCRIBE BY BRAND ONLY)
Isophane Insulin, human (Humulin® I, Insulatard®) 
Insulatard® Penfill® 100units/ml cartridges are being discontinued, stock anticipated to be discontinued by June 2025.

Long-acting insulin (PRESCRIBE BY BRAND ONLY)
Insulin detemir (Levemir®)

Insulin glargine (Lantus®, Abasaglar®, Semglee®) 
Abasaglar® and Semglee® are biosimilars to Lantus®. They are not dose equivalent to Lantus®.  
High strength Toujeo® (300units/ml) is to be prescribed only on Specialist Recommendation (green SR)

Insulin degludec 
High strength version of Tresiba® (200units/ml) to be prescribed only on Specialist Recommendation (green SR)

Biphasic insulin (PRESCRIBE BY BRAND ONLY)
Biphasic isophane (Humulin® M3) 
Biphasic insulin aspart (NovoMix® 30)
Biphasic insulin lispro (Humalog® Mix)

Hypodermic equipment

Needles
The formulary pen needles of choice are standard screw-on, single-use needles which fit all leading insulin pen devices and GLP-1 pens. Brands of choice are:

GlucoRx CarePoint®: 4mm/31 gauge, 5mm/31gauge, 6mm/31gauge, 8mm/31gauge
GlucoRx CarePoint Ultra®:  4mm Ultra/32gauge
Greenfine®: 4mm/32 gauge, 5mm/31 gauge, 6mm/31 gauge, 8mm/31 gauge

Refer to Northamptonshire Pen Needles and Safety Needle Devices Guideline for further information

Blood glucose meter, test strips, & lancets

For Type 1 and Type 2 diabetic patients that are not on an insulin pump or carbohydrate counting.
First line (will meet the need of majority of patients):

Finetest Lite®
Compatible with Finetest Lite® Or Finetest Lite® Smart (bluetooth enabled) meters. Meter can be ordered from Neon 0800 1313378
Greenlan® lancets

Refer to  Northamptonshire Guidelines for Blood Glucose and Ketone Monitoring for alternative recommendations of strips/meters and further information.

Note - safety lancets are designed so that the sharp retracts after use. These are primarily for the benefit of healthcare workers to avoid needle stick injury, not to be used by patients self- monitoring blood glucose

Continuous Glucose Monitoring (CGM)

The following CGM is available to all type 1 diabetics eligible. Prior Approval required for all other patients. For patients using CGM, the quantity of blood glucose test strips should not exceed 1x50 unless they have an insulin pump. Additional strips should be prescribed as an “acute”. Refer to Northamptonshire Guidelines for Blood Glucose and Ketone Monitoring for further guidance.

Freestyle Libre 2 Plus®
Sensors last 15 days, ensure a maximum of 26 sensors prescribed per patient per year. 
Patients should use Finetest Lite® test strips for one off blood glucose testing. Do not prescribe patients the following test strips: FreeStyle®, Freestyle Optium® or FreeStyle Lite®. 
Dexcom ONE+®: Sensors last 10 days.
Freestyle Libre 3 Plus®: Prior Approval required for all patients

Ketone testing meter
GlucoFix Tech GK® meter: Prescribe GlucoFix Tech® beta-ketone Sensor testing strips

To be issued to all type 1 diabetic patients, and only some type 2 diabetics. Refer to Northamptonshire Guidelines for Blood Glucose and Ketone Monitoring  for further guidance.

Antidiabetic drugs

Sulphonylureas
Gliclazide tablets
40mg and 80mg
160mg strength tablets are more expensive, prescribe 2x80mg tablets instead.
30mg modified -release - may be used if hypoglycaemia is a problem, as associated with less hypoglycaemia than standard release gliclazide. 
60mg modified release significantly more expensive, avoid use.

Biguanides
Metformin tablets 
500mg and 850mg 
1g tablets are significantly more expensive, prescribe as 2x500mg instead.Modified release metformin tablets should only be considered for patients with gastrointestinal intolerance to standard release tablets, despite a slow upward titration of dose. Prescribe generically.
Metformin sachets
500mg and 1g powder sachets more cost effective than oral solution
Metformin oral solution
500mg/5ml - prescribe only if oral powder sachets are not suitable.
850mg/5ml, 1g/5ml strengths are significantly more expensive.

DPP4 inhibitors (gliptins) 
Not to be used with GLP1 
Sitagliptin
Generic sitagliptin/metformin combination tablet is a cost-effective choice if both drugs are required

SGLT2 inhibitors
Dapagliflozin tablets

Thiazolidinediones
Pioglitazone tablets
Do not prescribe pioglitazone combination products

Thyroid and Antithyroid drugs

Thyroid hormones

Levothyroxine sodium tablets
Tablets disperse in water if needed (off-label use) 
12.5microgram tablets are significantly more expensive.

Levothyroxine sodium oral solution
Expensive, only use if no alternative option. Tablets can be dispersed in water.

Liothyronine
Double Red – Prior Approval needed
To be prescribed in line with RMOC guidance for patients who have had an inadequate response to thyroxine alone. Ongoing monitoring will be required by secondary care.

Antithyroid drugs

Carbimazole tablets
Prescribe in 5mg and 20mg tablet strengths to make up the dose. 10mg and especially 15mg tablets are significantly more expensive.

Propylthiouracil tablets
100mg tablets are significantly more expensive, prescribe 2x50mg tablets instead.

Corticosteroids

Replacement Therapy

Fludrocortisone tablets

Hydrocortisone tablets 
2.5mg, 5mg and 15mg strengths are significantly more expensive. 10mg tablets can be halved or quartered.

Hydocortisone granules in capsules (Alkindi®)
For paediatric use
Double Red – Prior Approval needed

Hydrocortisone soluble tablets 
Expensive 

Glucocorticoid Therapy

Prednisolone tablets
10mg, 20mg, 25mg, 30mg strength tablets are significantly more expensive and should only be prescribed for patients requiring long-term high-dose steroid therapy to reduce pill-burden, not for short-term use or as part of a reducing course. 
Standard tablets can be crushed and dispersed in water for administration. Avoid prescribing soluble tablets which are significantly more expensive. 
Enteric coated prednisolone tablets offer limited benefits over the standard tablets and therefore should not be prescribed
Prednisolone mouthwash tablet - Patient Information Leaflet

Prednisolone oral solution
Very expensive, only use if the standard tablets (undispersed or dispersed) are not suitable.

Dexamethasone tablets
4mg strength significantly more expensive, prescribe two 2mg tablets.

Dexamethasone oral solution
Expensive

Betamethasone sodium phosphate soluble tablets

Methylprednisolone oral tablets

Methylprednisolone suspension for injection

Sex Hormones

Female sex hormones

Oestrogens and HRT

Local Oestrogen

Consider local oestrogen first where urogenital symptoms of perimenopause/menopause are present. Consider prescribing topical vaginal oestrogen (off-label indication) for patients with recurrent urinary tract infections, who are experiencing perimenopause or menopause, or who have already experienced menopause if behavioural and personal hygiene measures alone are not effective or not appropriate.

Some preparations contain arachis oil which is contraindicated in those with a peanut allergy. Refer to the relevant SPC for further information.

Estriol vaginal cream: 1mg/g (0.1%) strength is the cost-effective option. Prescribe generically.

Estradiol pessaries: Prescribe generically

Estriol pessaries: Imvaggis®

Estriol vaginal gel: Blissel®

Estradiol vaginal delivery system: Estring®

Oestrogen only HRT

Oestrogen only HRT is suitable for women without a uterus. For women with a uterus, combine oestrogen only HRT with a separate progestogen, or opt for a combined HRT product.

Estradiol tablets: Elleste Solo® 

Estradiol valerate tablets: Progynova®

Estradiol tablets: Zumenon®

Estradiol transdermal patches: Estraderm MX®, Estradot®, Evorel®, FemSeven®, Progynova TS®

Estradiol transdermal gel: Oestrogel®

Estradiol transdermal gel sachets: Sandrena®

Estradiol transdermal spray: Lenzetto®

Conjugated Oestrogens tablets: Premarin® - oestrogen in this is from pregnant horse urine (equine oestrogen) which may not be acceptable by all patients

Sequential (cyclical) combined HRT

Estradiol with norethisterone patches: Evorel Sequi®

Estradiol / Norethisterone tablets: Elleste Duet®

Estradiol / Norethisterone tablets: Novofem®

Estradiol / Norethisterone tablets: Trisequens®

Estradiol / Dydrogesterone tablets: Femoston®

Continuous combined HRT

Estradiol / Norethisterone tablets: Kliofem®

Estradiol / Norethisterone tablets: Kliovance®

Estradiol / Norethisterone tablets: Elleste Duet Conti®

Estradiol valerate / Medroxyprogesterone tablets: Indivina®

Estradiol / Progesterone capsules: Bijuve®

Estradiol / Dydrogesterone tablets: Femoston-conti®

Conjugated Oestrogens / Medroxyprogesterone m/r tablets: Premique Low Dose® - oestrogen in this is from pregnant horse urine (equine oestrogen) which may not be acceptable by all patients

Other HRT preparations

Tibolone tablets: Prescribe generically

Testosterone

Testosterone gel 2% - Tostran® 60g cannister
Testosterone gel 16.2mg/g - Testogel® 2.5g sachets

Progestogens and progesterone receptor modulators

Medroxyprogesterone acetate tablets: Provera®

Medroxyprogesterone acetate injection: Sayana Press®

Medroxyprogesterone acetate injection: Depo-Provera®

Norethisterone tablets

Progesterone micronised capsules: Prescribe generically

Male Sex Hormones and antagonist

Testosterone for hypogonadism in males - Primary Care Guideline

Anti-androgens

Finasteride tablets 5mg
Dutasteride capsules 500mcg - Prescribe generically

Hypothalamic and pituitary hormones and anti-oestrogens

Anterior pituitary hormones: Prescribe by brand, as advised by specialist.

Osteoporosis

Bisphosphonates and other drugs affecting bone metabolism

Evaluate the continued need for a bisphosphonate at 5 years

Alendronic acid tablets

Alendronic acid effervescent tablets: Binosto® - only prescribe if standard release tablets are not suitable

Risedronate sodium tablets

 

 

Guidance

Overactive Bladder Prescribing Pathway
Guidelines for drugs and devices used in the treatment of erectile dysfunction
Overview | Mirabegron for treating symptoms of overactive bladder | Guidance | NICE
Overview | Urinary incontinence and pelvic organ prolapse in women: management | Guidance | NICE
FSRH Clinical Guideline: Emergency Contraception

Urinary frequency, enuresis and incontinence

Antimuscarinics (systemic) - Consider high anticholinergic burden
Solifenacin 5mg-10mg - prefered once a day preparation
Tolterodine immediate-release 1mg - 2mg - prefered twice a day preparation
Fesoterodine MR 4mg - 8mg - prefered modified release preparation

Beta3-Adrenoceptor agonists 
Mirabegron - Option only if antimuscarinic drugs are ineffective, contraindicated or not tolerated. See NICE TA290 and local OAB guidance.

Urinary retention

Alpha-adrenoceptor blockers
Doxazosin tablets (not m/r)
If 8mg required prescribe as 2 x 4mg
Tamsulosin 400mcg m/r capsules

Contraceptives, combined

Combined oral contraceptive content	Available products. Preferred formulary choices in bold	Notes
Ethinylestradiol 30 micrograms and levonorgestrel 150 micrograms	Levest® Rigevidon® Maexeni® Ovranette® Microgynon 30® Microgynon 30 ED®	Progestogen dominant pill
Ethinylestradiol 35 micrograms and norethisterone 500 micrograms	Brevinor®	Oestrogen dominant pill
Ethinylestradiol 30 micrograms and desogestrel 150 micrograms	Cimizt 30/150® Gedarel 30/150® Marvelon®	Consider in mild acne Note: MHRA advice on risk of VTE
Ethinylestradiol 20 micrograms and desogestrel 150 micrograms	Bimizza® Gedarel 20/150® Mercilon®	Note: MHRA advice on risk of VTE
Ethinylestradiol 30 micrograms and gestodene 75 micrograms	Millinette 30/75® Katya 30/75® Femodene®	Improved cycle control Note: MHRA advice on risk of VTE
Ethinylestradiol 20 micrograms and gestodene 75 micrograms	Millinette 20/75® Sunya® Akizza® Femodette®	Note: MHRA advice on risk of VTE
Ethinylestradiol 30 micrograms and Levonorgestrel 50 micrograms Ethinylestradiol 40 micrograms and Levonorgestrel 75 micrograms Ethinylestradiol 30 micrograms  and Levonorgestrel 125 micrograms	TriRegol® Logynon®	Tri-phasic preparation Improved cycle control but requires better compliance
Ethinylestradiol 35 micrograms and norgestimate 250 micrograms	Lizinna® Cilique®
Co-cyprindiol 2000/35 (cyproterone acetate 2mg, ethinylestradiol 35 micrograms)	Clairette® Dianette® Co-cyprindiol 2000/35	Severe acne, moderately severe hirsuitism. Should not be prescribed for the sole purpose of contraception. Prescriptions should be endorsed with the female symbol ♀ or CC

The risk of VTE in association with drospirenone-containing pills, including Yasmin, is higher than that for levonorgestrel-containing ‘second generation’ pills and may be similar to the risk for ‘third-generation’ pills that contain desogestrel or gestodene. See full MHRA warning
If Yasmin^® equivalent is still needed, please prescribe as Yacella^® , or Dretine^®  brand (Ethinylestradiol 30 micrograms, Drospirenone 3mg)

Contraceptive, emergency

For choice of product see decision making algorithm in FSRH guideline on Emergency Contraception
Ulipristal acetate 30mg
Available OTC as ellaOne® from all pharmacies
Levonorgestrel 1500 micrograms
Available OTC as Levonelle One Step® from all pharmacies for over-16s.  
Available from many pharmacies under PGD, including for under 16s

Contraception, oral progestogen-only

Desogestrel 75 microgram Prescribe generically
Desogestrel has a 12-hour missed pill window and may be useful where poor compliance is likely.  However, it is only recommended for use in women who cannot tolerate oestrogen-containing contraceptives or in whom these preparations are contraindicated.

Erectile dysfunction

Guidelines for drugs and devices used in the treatment of erectile dysfunction
Sildenafil
“SLS” criteria no longer apply to generic sildenafil.  
Max 8 tablets per month 
Tadalafil 10mg, 20mg PRN (not daily)
“SLS” criteria apply.  
Max 8 tablets per month
Tadalafil 5mg DAILY
2.5mg is double red
“SLS” criteria apply.

Guidance

BSG Guidelines for the Management of Iron Deficiency Anaemia in Adults
www.healthystart.nhs.uk
Guidelines for the management of Vitamin D deficiency and insufficiency in children, adolescents and adults
Adults- Nutrition and Dietetics
Paediatric- Nutrition and Dietetics
Vitamin D Guidance in Adult and Children
Vitamin D Insufficiency-Patient Leaflet

Anaemias

Iron deficiency anaemia  
Iron (oral): once daily (or alternate day) dosing
Monitor the haematological response and modify as appropriate.
Ferrous sulphate 200mg tablets (65mg elemental iron)
Ferrous fumarate 210mg tablets (69mg elemental iron)
Ferrous fumarate 322mg tablets (106mg elemental iron) High elemental iron content; side effects more likely.
Ferrous gluconate 300mg tablets (37mg elemental iron) Consider using if GI tolerability issues persist even with alternate daily dosing of above preparations.
Ferrous fumarate 140mg/5ml oral solution
BSG Guidelines for the Management of Iron Deficiency Anaemia in Adults

Vitamin Deficiency

Vitamin D 
For the management of insufficiency (serum 25(OH)D 25-50nmol/L) and the routine prophylaxis of deficiency, vitamin D should be purchased OTC or, if eligible, obtained free of charge, or at a reduced cost, via the government’s “Healthy Start” schemewww.healthystart.nhs.uk
This includes prevention of deficiency in pregnant women, including those with high BMI and in other at risk groups. 
For the treatment of deficiency ( serum 25(OH)D <25nmol/L) vitamin D may be provided via NHS prescription.   
See Vitamin D guidelines for formulary preparations Guidelines for the management of Vitamin D deficiency and insufficiency in children, adolescents and adults

Vitamin D with calcium  
Accrete D3^®one a day chewable tablets (colecalciferol 880unit/calcium carbonate 1g tablets)
Accrete D3 ^® film-coated tablets (swallowed whole or halved) (Colecalciferol 400unit/Calcium carbonate 1.5g tablets)
Evacal D3^®chewable tablets (Colecalciferol 400unit/Calcium carbonate 1.5g chewable tablets) If a twice daily chewable tablet is needed

Non-steroidal Anti-inflammatory Drugs

NICE Guidance: Osteoporosis. Consider topical NSAID if needed and no contra-indications (particularly if hand or knee involvement)
Available over the counter Over The Counter (OTC) Products - When to prescribe

NPAG does not recommend the use of coxibs. In high GI risk patients where simple analgesics provide inadequate relief then prescribe a traditional NSAID with Lansoprazole 15-30mg daily.

Ibuprofen available OTC
Naproxen
Avoid M/R preparations and E/C versions as they are considerably more expensive without additional benefits. 
Diclofenac

There are now concerns about the cardiovascular safety which appear to have a similar risk to coxibs

Drugs for the Relief of Soft-tissue Inflammation
Fenbid Gel^®  - only prescribe for long-term conditions as available OTC
(Ibuprofen 5% gel but should prescribe as Fenbid^® 100g)

Guidance

Guidance on the use of eye lubricants for dry eye conditions in primary care
Glaucoma Prescribing Guidelines
Over The Counter (OTC) Products - When to prescribe

 

Antibacterials

Available over the counter Over The Counter (OTC) Products - When to prescribe

Chloramphenicol 0.5% eye drops or 1% eye ointment — First Line
Available OTC for acute bacterial conjunctivitis in adults and children over 2 years  
Fusidic Acid 1% MR eye drops

Corticosteroids

Corticosteroid eye preparations - should usually be prescribed on specialist recommendation

Other Anti-inflammatory Preparations

Available over the counter Over The Counter (OTC) Products - When to prescribe

Sodium cromoglicate 2% eye drops 13.5ml
Available OTC in 10ml for acute seasonal and perennial allergic conjunctivitis 
Azelastine 0.05% eye drops
Antazoline 0.5% with xylometazoline 0.05% eye drops (Otrivine Antistin^®)

Treatment of Glaucoma

Eye preparations for glaucoma should be prescribed on specialist recommendation. 
Glaucoma Prescribing Guidelines

Miscellaneous Ophthalmic Preparations

Advise self-care where possible and advise patient to purchase preparations OTC  Over The Counter (OTC) Products - When to prescribe
See ‘Guidance on the Use of Eye Lubricants for Dry Eye Conditions in Primary Care’ (‘Ocular Lubricant Guidelines’) 

Ocular Lubricants

Standard Formulations	Available OTC AaproMel® Hypromellose 0.3% or 0.5% eye drops 10ml (hypromellose) one-month expiry Clinitas® Carbomer 0.2% eye gel 10g (carbomer 980) one-month expiry Eyeaze® Carmellose 0.5% preservative free eye drops 10ml (carmellose) three-month expiry
Preservative Free Formulations (consider as detailed in Guidelines above)	Available OTC Eyeaze® Carmellose 0.5% preservative free eye drops 10ml (carmellose) three-month expiry Hy-Opti® 0.1% 10ml (sodium hyaluronate) six-month expiry Eyeaze® 0.1% or Eyeaze Lyte® 0.1% (sodium hyaluronate) – three-month expiry Hy-Opti® 0.2% 10ml (sodium hyaluronate) six-month expiry Eyeaze® 0.2% or Eyeaze Lyte® 0.2% (sodium hyaluronate) – three-month expiry
High Viscosity Formulations (for use at night in addition to daytime treatment)	Available OTC Hylo Night® preservative free eye ointment 5g (retinol palmitate with WSP, LLP, LP, and wool fat) six-month expiry Xailin Night® eye ointment 5g (liquid paraffin with WSP and wool alcohols) two-month expiry

Guidance

Mild to moderate hay fever/seasonal rhinitis is listed by NHS England as a condition where OTC medicines should not routinely be prescribed in primary care. Most patients should be able to relieve symptoms with OTC treatments

See Tablet Press Extra ‘Hay Fever Treatment Update - OTC’ 
Over The Counter (OTC) Products - When to prescribe

Otitis Externa

Available over the counter Over The Counter (OTC) Products - When to prescribe
First use simple oral analgesia

Acetic Acid 2% ear spray 5ml (Earcalm® spray) 
Acetic Acid 2%/Dexamethasone 0.1%/Neomycin 0.5% ear spray 5ml (Otomize® ear spray)

Drugs acting on the Nose

Available over the counter Over The Counter (OTC) Products - When to prescribe

Drugs used in nasal allergy

Corticosteroids
Beclometasone 50mcg/dose aqueous nasal spray 200 sprays - First Line 
Budesonide 64mcg/dose nasal spray 120 sprays 
Fluticasone furoate 27.5mcg/dose 120 sprays
Mometasone furoate 50micrograms/dose nasal spray

Topical Nasal Decongestants
Sodium chloride 0.9% nasal drops 10ml

Nasal Preparations for Infection (nasal staphylococci)

Chlorhexidine 0.1% and neomycin 0.5% nasal cream (Naseptin^®)

Drugs for Oral Ulceration and Inflammation

Available over the counter Over The Counter (OTC) Products - When to prescribe

Chlorhexidine gluconate 0.2% mouthwash 300ml (Corsodyl^®) 
Benzydamine 0.15% mouthwash sugar free 300ml (Difflam^®)

Oropharyngeal Anti-infective Drugs - Fungal Infections

Miconazole 20mg/g oromucosal gel sugar free 80g (Daktarin^®)
Available OTC in 15g size
Nystatin 100,000 units/ml oral suspension 30ml

Treatment of Dry Mouth (artificial saliva products)

Saliveze^® mouth spray 50ml
Artificial Saliva Gel (Biotene Oralbalance^®) 50g

Guidance

Emollients and risk of severe and fatal burns: new resources available - GOV.UK 
Guidance on conditions for which over the counter items should not routinely be prescribed in primary care
Northamptonshire Emollients Guidelines
Over The Counter (OTC) Products - When to prescribe
Northamptonshire Dressings Formulary
Psoriasis Guidelines

Emollient and Barrier Preparations

There is no advantage in prescribing these products by generic name. Choice is largely based on patient preference.

Emollients 
All Available over the counter see Over The Counter (OTC) Products - When to prescribe

There is a risk of severe and fatal burns with ALL emollients. See MHRA/CHM advice (updated May 2021)
Emollients - risk of severe and fatal burns with paraffin-containing and paraffin-free emollients.
Emollients and risk of severe and fatal burns: new resources available - GOV.UK 

Mild dry skin is listed by NHS England as a condition where OTC medicines should not routinely be prescribed in primary care. Most patients should be able to relieve symptoms with OTC treatments. Emollients can continue to be prescribed for patients with long term dermatological conditions such as eczema and psoriasis. 
Guidance on conditions for which over the counter items should not routinely be prescribed in primary care

See Northamptonshire  Northamptonshire Emollients Guidelines

Emollients for Mild Dry Skin

Creams containing paraffin	Epimax® Moisturising Cream Flexi-dispenser 500g Zerocream® Pump 500g
Creams/lotions containing Colloidal Oatmeal	Epimax® Oatmeal Cream Flexi-dispenser 500g Zeroveen® Pump 500g
Rich creams for mild dry skin	Zeroguent Cream® 500g

Aveeno preparations are Borderline Substances and have been classed as Double Red. Traffic lights drugs
Aveeno preparations are available OTC

Emollients for Moderately Dry Skin

Creams containing paraffin	Epimax® Original Cream Flexi-dispenser 500g Zerobase® Cream Pump 500g  Epimax Excetra® Cream Flexi-dispenser 500g
Gels containing paraffin	Epimax Isomol® Gel Flexi-dispenser 500g Zerodouble® Gel
Creams containing urea	ImuDERM® Emollient 5% Urea pump 500g

Emollients for Severe Dry Skin

Ointments containing paraffin

Epimax® Ointment 500g Zeroderm® Ointment 500g Epimax ® Ointment can harm the eyes if used on the face. Do not prescribe these  ointments for use on the face. Tell patients to wash their hands and avoid touching their eyes after using these products. See MHRA advice

Creams containing Urea 5% and Lauromacrogols 3%

Balneum Plus® Cream 500g or 100g – use for itch if emollient alone not helped

Sprays containing paraffin

Emollin® Spray 240ml Use only when unable to use other preparations or where application without touching skin is necessary. Highly flammable.

Emollients with Anti-bacterial

Dermol® 500 lotion pump 500ml Use for washing only when infection is present or recurrent. Avoid regular use. Use should be targeted and short term. Avoid adding to repeat prescription. Revert to non-antimicrobial containing emollient once condition is controlled

Paraffin Free Emollient

Epimax® Paraffin Free Ointment 500g Epimax ® Paraffin-Free Ointment can harm the eyes if used on the face. Do not prescribe these ointments for use on the face. Tell patients to wash their hands and avoid touching their eyes after using these products. See MHRA advice.

Soap Substitutes

ZeroAQS® 500g (Does not contain sodium lauryl sulphate) Aqueous cream 500g (Contains sodium lauryl sulphate) Emulsifying ointment 500g

Bath and Shower Additives 

As per NHSE recommendations prescribers in primary care should not initiate bath and shower preparations for any new patients. However, where clinically advised by a specialist and appropriate, prescribing may continue.

Bath and shower additives have not been included in this formulary due to lack of evidence of efficacy.

Any emollient (except white soft paraffin) can be used as a soap substitute. This can be applied prior to washing and directly afterwards onto damp skin. They provide greater moisturising than emollients marketed specifically as bath or shower preparations that don’t have enough contact with the skin. The use of bath emollients/oils and shower products are not routinely recommended for the majority of dermatological conditions as they are less effective than alternatives.

There is an exception where a bath additive may be beneficial to patients and should be made available:
Balneum Plus Bath Oil should only be prescribed for managing itch that remains a problem despite optimum topical therapy. 

Barrier Creams

See  Northamptonshire Dressings Formulary

Topical Corticosteroids

Hydrocortisone preparations
Prices vary considerably between pack sizes
Prescribe 1% preparations as multiples of 30g, not 50g.
Hydrocortisone 2.5% is much more expensive than 1% and is Double Red. Traffic lights drugs
Consider clobetasone preparations if hydrocortisone 1% is not effective.

Mild potency steroids	Hydrocortisone 1% cream/ointment - available OTC
Moderate potency steroids	Betametasone 0.025% cream/ointment (Betnovate® RD) Clobetasone butyrate 0.05% cream/ointment (Eumovate®) -15g cream available OTC
Potent steroid	Betamethasone 0.1% cream/ointment (Betnovate®)
Very potent steroid	Clobetasol propionate 0.05% cream/ointment (Dermovate®)
Mild steroids with anti-fungal	Hydrocortisone 1%/miconazole 2% cream/ointment (Daktacort ® ) -15g cream available OTC Hydrocortisone 1%/clotrimazole1% cream (Canesten HC ® ) -15g available OTC

Preparations for Eczema and Psoriasis

Psoriasis Guidelines

Acne and Rosacea

For full acne guidance refer to NICE guideline NG198

Managing Acne Vulgaris
12-week course of 1 of the following first-line treatment options: 

Any acne severity
A fixed combination of topical adapalene with topical benzoyl peroxide.
A fixed combination of topical tretinoin with topical clindamycin

Mild to moderate acne severity
A fixed combination of topical benzoyl peroxide with topical clindamycin

Moderate to severe acne severity
A fixed combination of topical adapalene with topical benzoyl peroxide, together with either oral lymecycline or oral doxycycline.
Topical azelaic acid with either oral lymecycline or oral doxycycline

Acne severity	Treatment option	Drug choices
Any	Fixed combination of topical adapalene with topical benzoyl peroxide	0.1% adapalene with 2.5% benzoyl peroxide gel (Epiduo®) 0.3% adapalene with 2.5% benzoyl peroxide gel (Epiduo®)
Any	Fixed combination of topical tretinoin with topical clindamycin	0.025% tretinoin with 1% clindamycin gel (Treclin®)
Mild to moderate	Fixed combination of topical benzoyl peroxide with topical clindamycin	3% benzoyl peroxide with 1% clindamycin gel (Duac® Once Daily) 5% benzoyl peroxide with 1% clindamycin gel (Duac® Once Daily)
Moderate to severe	Oral antibiotic (in combination with a fixed combination of topical adapalene with topical benzoyl peroxide)	Lymecycline 408mg capsule daily Doxycycline 100mg capsule daily
Moderate to severe	Topical azelaic acid (with either oral lymecycline or oral doxycycline)	15% azelaic acid gel (Finacea®) 20% azelaic acid cream (Skinoren®)

Preparations for Warts and Callouses

Available over the counter Over The Counter (OTC) Products - When to prescribe 
Salicylic acid with lactic acid (Salatac^® gel or Salactol^® paint)

Shampoos and other preparations for Scalp and Hair Conditions

Available over the counter Over The Counter (OTC) Products - When to prescribe
Coal tar with salicylic acid and sulfur ointment (Cocois^® ointment)
Ketoconazole 2% shampoo

Antibacterial preparations

Fusidic acid 2% cream (Fucidin® cream) - up to 10 days only to prevent resistance
Metronidazole 0.75% cream or gel (Rozex^® brand)
Silver sulfadiazine 1% cream (Flamazine^® cream) - for infection in burns wounds

Antifungal preparations

Available over the counter Over The Counter (OTC) Products - When to prescribe
Clotrimazole 1% cream
Miconazole 2% cream (Daktarin^® cream)

Fungal nail infections
Fungal nail infections are listed by NHS England as a condition where OTC medicines should not routinely be prescribed in primary care. 
Fungal nail preparations are Double Red Traffic lights drugs

Parasiticidal preparations

Available over the counter Over The Counter (OTC) Products - When to prescribe
Dimeticone 4% lotion 
Malathion 0.5% liquid
Permethrin 1% liquid

Skin Cleansers, Antiseptics and Desloughing Agents

Alcohols and Saline
Irripod^® saline solution 20ml x 25

Oxidisers and Dyes

Potassium permanganate 0.1% solution diluted 1 in 10 to provide a 0.01% solution

Continence

Continence Appliances Prescribing Guidelines and Formulary[pdf] 205KB

Dressings

Northamptonshire Dressings Formulary [pdf] 463KB

Stoma

Formulary for Northamptonshire Stoma Care Products[pdf] 226KB