HIGHLAND FORMULARY INTRODUCTION

Background

The Highland Formulary is a limited list of medicines approved for local use in hospitals and primary care. The choice of Formulary medicines is made on the basis of clinical effectiveness, cost-effectiveness, comparative safety and patient acceptability, and covers all prescribers.

Using the Highland Formulary

Formulary medicines are generally presented according to the original BNF classification. Most entries contain relevant Formulary information about the medicine such as dose, place in therapy and additional prescribing guidance.  Further product information is available in the BNF and in the Summary of Product Characteristics (SPC), which may be available on http://www.medicines.org.uk/.

The Formulary is updated bimonthly. Changes are notified in the eFormulary Update sent to those on the Formulary distribution list; please email the Formulary Assistant to be added to this list (nhsh.formulary@nhs.scot). This version contains all updates to the Formulary and also includes electronic links to guidelines and other websites.

Using the Highland Formulary

Formulary medicines are generally presented according to the original BNF classification. Most entries contain relevant Formulary information about the medicine such as dose, place in therapy and additional prescribing guidance.  Further product information is available in the BNF and in the Summary of Product Characteristics (SPC), which may be available on www.medicines.org.uk.

The Formulary is updated bimonthly. Changes are notified in the eFormulary Update sent to those on the Formulary distribution list; please email the Formulary Assistant to be added to this list (nhsh.formulary@nhs.scot).  The updated version of the Formulary is available on the Intranet (http://intranet.nhsh.scot.nhs.uk) and website (www.nhshighland.scot.nhs.uk) and on the Treatments and Medicines (TAM) app (http://tam.nhsh.scot/). This version contains all updates to the Formulary since the printing of this edition and also includes electronic links to guidelines and other websites.

Formulary management

The Formulary is produced under the auspices of the TAM Subgroup of the NHS Highland Area Drug and Therapeutics Committee (ADTC).  The contents reflect wide consultation with practitioners.  Output from the Scottish Medicines Consortium, local and national advice on medicines in relation to clinical effectiveness, cost-effectiveness, comparative safety and patient acceptability together with the work of special interest groups in Highland and clinical networks, are also taken into account.  If you wish to request a change or addition to the Formulary refer to the flowchart of the assessment process. For further information or to provide feedback, which is always welcome, please email the Formulary Pharmacist at: nhsh.formulary@nhs.scot

Guidance

See Therapeutic Guidelines. Those working in Argyll and Bute Health and Social Care Partnership (H&SCP) should follow Greater Glasgow and Clyde (GG&C) adult medicines formulary (http://www.ggcprescribing.org.uk/). For emergency sedation prescribers in Argyll and Bute should follow NHS Highland policies.

Medicines in children

Unless otherwise stated, the doses given are for adults with normal hepatic and renal function. Consult the BNF for Children for advice on prescribing for children and local paediatric drug guidelines on the Hospital Paediatrics section of the intranet.

Drug names

ADTC supports a policy of generic prescribing for the majority of medicines.  It is noted that in some cases, the generic versions of a medicine may not have the exact same indications listed on the market authorisation as the original branded medicine, but as bioequivalence to the original branded medicine must have been demonstrated as part of the generic market authorisation process, ADTC considers that any additional risks of prescribing and dispensing the medicine generically are negligible.  Exceptions to the generic prescribing policy are:

  • when the pharmacokinetic profiles of different brands of the same medicine differ widely
  • medicines with a narrow therapeutic index, where any variation in the drug concentration in the blood increases the risk of toxicity or treatment failure for the patient.

Where Formulary medicines should be prescribed by brand name, this will be indicated in the prescribing notes of the Highland Formulary.  This advice does not override an individual clinician’s decision to prescribe what they believe to be the most appropriate treatment. 

Medicines Information

Reference is made throughout the Formulary to information and advice available from Medicines Information. This service can be accessed as follows:

Argyll and Bute H&SCP:

Royal Alexandra Hospital, tel: 0141 887 9111 (switchboard), e-mail: medinfo@ggc.scot.nhs.uk.

Highland H&SCP:

Raigmore Hospital, tel: 01463 704000 e-mail: nhshighland.medicineinformation@nhs.scot.

Adverse drug reactions

All suspected serious adverse drug reactions to any drugs/vaccines/complementary remedies; all adverse reactions (including those considered to be non-serious) suspected to be associated with black triangle medicines; and all adverse reactions that occur in children associated with either established or new medicines and vaccines should be reported by healthcare professionals and patients to the Medicines and Healthcare Products Regulatory Agency (MHRA).  The black triangle symbol  indicates that the MHRA is intensively monitoring the safety of that product.  Yellow report cards can be found at the back of the BNF or reports can be submitted online at http://www.yccscotland.scot.nhs.uk/Pages/default.aspx.

NHS Highland Minor Ailments Service Formulary

This Formulary is used within community pharmacies in NHS Highland to support the Minor Ailments Service (MAS) which allows eligible patients to register with and use a community pharmacy as the first port of call for advice and for treatment of common illnesses on the NHS.  The Pharmacist advises, prescribes or refers the patient according to their needs.  Medicines included in the NHS Highland MAS Formulary are listed in Chapter 17 and the full formulary is available on the Community Pharmacy website page for Highland.

Disclaimer

While every effort has been made to ensure that the information contained within the Formulary is accurate, no responsibility or liability can be accepted by those involved in its production for any loss, injury or damage which is suffered as a consequence of any errors, omissions or inaccuracies contained within it. In particular, prescribers should always check the suitability of the drug and dosage based on the information provided by the manufacturer.

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