CD&D APC Patient Decision Aids Resource available at: http://medicines.necsu.nhs.uk/guidelines/durham-darlington/
CD&D APC “Do Not Prescribe List” and “Grey List – drugs prescribed under limited circumstances” available at: http://medicines.necsu.nhs.uk/guidelines/durham-darlington/
NHS England Guidance on “Conditions for which over the counter items should not routinely be prescribed” available at: https://www.england.nhs.uk/medicines/conditions-for-which-over-the-counter-items-should-not-routinely-be-prescribed/
County Durham & Darlington Appendix to “Specials Recommended by the British Association of Dermatologists for Skin Disease” can be found:
Area Prescribing Committee website
See local guideline on emollient prescribing for dry skin conditions:
Area Prescribing Committee website
MHRA Drug Safety Update (April 2016): Paraffin-based skin emollients on dressings or clothing: fire risk
Plain Emollients
First choice
Second choice
Third line
Prescribing usually reserved for dermatology services.
As of September 2018 Emollient Bath Additibives are no longer in included in the formulary on then basis of BATHE trial no evidence to support routine use of bath emollients. Also due to risk of slipping due to emollient application in bath.
Dermatology confirmed that they do not routinely prescribe these products.
Plain Emollients
First choice
Second choice
Third line
Prescribing usually reserved for dermatology services.
E45, Diprobase and Epaderm products do not feature on the County Durham and Darlington APC
formulary therefore use should be restricted. If patients are currently prescribed one of these emollients then they should be substituted to another emollient as described below:
1. Patients prescribed Epaderm Ointment should be switched to Hydromol Ointment or Zeroderm
Ointment
2. Patients prescribed Diprobase Cream should be changed to Zerobase Cream as ingredients are similar (there is a higher percentage of liquid paraffin to aid smoothing into sensitive skin)
3. Patients prescribed E45 Cream should be prescribed a suitable emollient from the formulary first line choices listed above, since there is no direct equivalent product
4. Patients prescribed Aveeno should be switched to Zeroveen
5. In addition to this Aqueous Cream is no longer recommended as a “leave on” emollient (Aqueous cream: may cause skin irritation Drug Safety Update)
Any patients using Aqueous Cream as an emollient should be switched to an alternative product. The first choice for this would be Hydromol Ointment as this is also suitable as a soap substitute.
OintmentOTC
Yellow soft paraffin 30%, emulsifying wax 30% & liquid paraffin 40%.
Also used as soap substitute.
CreamOTC
10% liquid paraffin, 10% isopropyl myristate & 0.1% benzalkonium chloride & 0.1% chlorhexidine chloride
Emulsifying ointment 30%, phenoxyethanol 1% & cetostearyl alcoholOTC
50g, 200g and 500g creamOTC
2nd line emollient for use in teenage girls as it contains a rose fragrance which may aid compliance.
OintmentOTC containing titanium oxide 20%, titanium peroxide 5% and titanium salicylate 3% in a basis containing dimeticone, paraffins and benzoin compound tincture
CreamOTC containing benzyl alcohol 0.39%, benzyl benzoate 1.01%, benzyl cinnamate 0.15%, hydrous wool fat (hypoallergenic lanolin) 4%, zinc oxide 15.25%
OTC 2g & 92g barrier cream, 28ml pump spray, sterile 1ml no sting barrier film foam applicator, sterile 3ml no sting barrier film foam applicator
Cream containing dimeticone ‘1000’ 10% & Cetrimide 0.3%. Also contains arachis (peanut) oil
Ointment containing zinc oxide 7.5%, castor oil 50%, arachis (peanut) oil 30.5%, white beeswax 10% and cetostearyl alcohol 2%
Ointment containing 3% benzoin compound tincture in a base containing zinc and castor oil paste and olive oilu
MHRA Drug Safety Update (Aug 2017): Corticosteroids: rare risk of central serous chorioretinopathy with local as well as systemic administration
NICE advise that use of topical antibiotics in children with atopic eczema, including those combined with topical corticosteroids, should be reserved for cases of clinical infection in localised areas and limited to a maximum of two weeks treatment. They should not be put on repeat prescription.
Ointment (clobetasol propionate 0.05%, neomycin sulphate 0.5%, nystatin 100,000 units/g) u
2nd line use only.
100g
Indication: control of eczema that gets infected recurrently.
Unlicensed
Cream, Ointment 30g
1st line use
0.1% cream, ointment, lotion & scalp application
Cream 30g
15g available Over the Counter.
Cream 30g (15g available Over the Counter).
Ointment 30g
Cream (chlorhexidine HCl 1%, nystatin 100,000 units/g & hydrocortisone 0.5%)
2nd line use only.
10mg and 30mg capsules
Approved for use as a treatment option for adults with severe chronic hand eczema that have not responded to potent topical corticosteroids in accordance with NICE guidance.
Scalp Ointment
Coal tar lotion 1% - see Exorex
Coal tar strong solution 1%, 2.5% & 5% in emulsifying
ointment RVI u
Lotion containing prepared coal tar 1% in an emollient basis. Excipients include hydroxybenzoates (parabens) and polysorbate 80.
Pomade containing 6% coal tar solution and salicylic acid 2% in an emulsifying ointment baseu
Paste containing zinc oxide 6%, coal tar 6%, emulsifying wax 5%, starch 38% and yellow soft paraffin 45%.u
0.1%, 0.2%, 0.4%, 0.6%, 0.8%, 1%, 2%, 4%, 6% & 8%u
Unlicensed
0.2%, 0.4%, 0.6%, 0.8%, 1%, 2%, 4%, 6%, 8% & 16% in emulsifying baseu
Unlicensed
Dithranol 1% and salicylic acid 2% in emulsifying ointment 100g
Dithranol 2% and salicylic acid 2% in emulsifying ointment 100g
Dithranol 4% and salicylic acid 2% in emulsifying ointment 100g
Dithranol 8% and salicylic acid 2% in emulsifying ointment 100g
Dithranol 16% and salicylic acid 2% in emulsifying ointment 100g
Indication: Chronic plaque psoriasis predominantly used as short contact treatment for
outpatients coming in for daily treatments
Unlicensed
50 micrograms/g (0.005%) cream & ointment
50 micrograms/ml (0.005%) scalp application
2%, 5%, 10% & 20% in emulsifying ointment
Salicyclic acid 1% in aqueous cream 100g
Salicyclic acid 2% in aqueous cream 100g
All unlicensed
40mg injection (prefilled syringe)
Approved for use in accordance with the following NICE TAs
For treating moderate to severe chronic plaque psoriasis – see NICE TA419
For treating active psoriatic arthritis – see NICE TA433
MHRA Drug Safety Update (Jan 2017): Apremilast (Otezla ▼): risk of suicidal thoughts and behaviour
210mg solution in pre-filled syringe
Approved for use in accordance with the following NICE TAs:
CD&D APC Shared Care Guideline available at: http://medicines.necsu.nhs.uk/guidelines/durham-darlington/transfer-of-prescribing-policies-shared-care-guidelines/
25mg injection (Enbrel® & Benapali®▼)
NTAG April 2016: The Northern (NHS) Treatment Advisory Group recommends the use of etanercept biosimilar Benepali® as an option for use in adults where the originator product (Enbrel®) would normally be prescribed.
Approved for use in accordance with the following NICE TAs:
80mg solution for injection in prefilled pen.
For treating moderate to severe plaque psoriasis – see NICE TA442
Shared Care documents available
See local guideline on emollient Low-dose Methotrexate for Eczema – A Guideline for Paediatric Prescribing – found here
CD&D APC Shared Care Guideline available at: http://medicines.necsu.nhs.uk/guidelines/durham-darlington/transfer-of-prescribing-policies-shared-care-guidelines/
45mg vial
Approved for use in accordance with the following NICE TAs:
MHRA Drug Safety Update (Jan 2015): Ustekinumab (Stelara): risk of exfoliative dermatitis
150mg pre-filled syringe
Approved for use in accordance with the following NICE TAs:
300mg/2ml soln for inj in pre-filled syringe
Approved for use in accordance with the following NICE TAs:
1% topical solution (alcohol – water basis)
1% lotion (aqueous)
Antibacterial agent not for continual use
Topical solution containing erythromycin 4% zinc acetate 1.2% (when reconstituted)
See section 5.1 for systemic antibiotics
Tablets containing cyproterone acetate 2mg & ethinylestradiol 35 micrograms
Generic co-cyprindiol is much cheaper than Dianette®
For use in women only
Capsules - 5mg, 20mg
Isotretinoin is a toxic drug that must only be prescribed by or under the supervision of a consultant dermatologist.
MHRA Drug Safety Update (Dec 2014): Isotretinoin (Roaccutane): reminder of possible risk of psychiatric disorders
MHRA Drug Safety Update (Oct 2017): Isotretinoin (Roaccutane): rare reports of erectile dysfunction and decreased libido
0.33% gel
Not approved: Brimonidine tartrate for facial erythema in rosacea
MHRA Drug Safety Update (Nov 2016): Brimonidine gel (Mirvaso): risk of exacerbation of rosacea
MHRA Drug Safety Update (June 2017): Brimonidine gel (Mirvaso): risk of systemic cardiovascular effects; not to be applied to damaged skin
75% & 95% applicators – 6 inch & 95% pencils (Caustic pencils). 0.5% solution also available see section 13.11.6
Paint (salicylic acid 16.7% & lactic acid 16.7% in flexible collodion)OTC
Various strength preparations in Emulsifying ointmentu – see section 13.5.2
0.15% cream (Warticon)
To be initiated with specialist advice
5% cream 12 sachet pack
- 2nd line specialist use for treatment of ano-genital warts (mainly in genitourinary medicine [GUM] clinics)
10%, 75% & 90% solutions
90% w/v 10 ml - Used to destroy facial xanthelasmata; highly irritant
Cream (UVB – SPF 30) - mexenone 2%, ethylhexyl pmethoxycinnamate 7.5%, Butylmethoxydibenzoylmethane 4% & titanium dioxide 6.5%
CD&D APC Grey List: Sunscreens are limited to patients that are having treatment that may render them susceptible to sunlight only as per ACBS guidelines.
Lotion (UVA and UVB – SPF 50+ protection) – containing octinoxate 7.5%, oxybenzone 3%, titanium dioxide 3.5% - 125ml pack
CD&D APC Grey List: Sunscreens are limited to patients that are having treatment that may render them susceptible to sunlight only as per ACBS guidelines.
5% cream
For the treatment of superficial malignant and premalignant skin lesions
150 micrograms/g & 500 micrograms/g gel
Guidance for General Practitioners on the use of Ingenol Mebutate
Products from the Dermacolor® Camouflage Crème and Veil cover cream ranges are included in this Formulary. They are classified as borderline substances and can be prescribed on FP10 prescription forms (marked ACBS) for postoperative scars and other deformities and as an adjunctive therapy in the relief of emotional disturbances due to disfiguring skin disease, such as vitiligo.
Tablets containing cyproterone acetate 2mg &
ethinylestradiol 35 micrograms
Generic co-cyprindiol is much cheaper than Dianette
11.5% cream
CD&D APC Grey List: Eflornithine: for use as a second-line treatment of facial hirsutism in patients where co-cyprindiol (Dianette) is ineffective, contra-indicated or considered inappropriate. Treatment should be initiated by or on the specific advice of an appropriate specialist - endocrinologist (or gynaecologist).
Reserve topical antibiotics for very localised lesions to reduce risk of resistance
Ointment (polymyxin B sulph. 10,000 units & bacitracin zinc 500 units/g)
MHRA Drug Safety Update (March 2018): Head lice eradication products: risk of serious burns if treated hair is exposed to open flames or other sources of ignition, eg, cigarettes
2ml, 4ml & 10ml kit
Also approved for use in the treatment of mesh fixation in hernia repair.
4.8 & 9.5 sq cm Haemostatic (collagen sponge coated with
fibrinogen and thrombin) for use in liver and renal surgery
Containing 70% isopropyl alcohol or methylated spirit (e.g. Clini-wipes®, Alcowipes®)
Sterile solution – bottles, 25ml & 100ml sachets (Normasol®) & 45ml plastic ampoules/pods (Miniversol®)
1% chlorhexidine acetate dusting powder
Chlorhexidine Gluconate 0.02% & 0.05% solutions, 25ml & 100ml sachets
0.5% solution in 70% methylated spirit (pink, colourless &
red staining),
2.5% in 70% methylated spirit wipes
0.5% hand rub (contains 70% isopropyl alcohol + emollients)
4% surgical scrub
2% in 70% isopropyl alcohol wipes (Sanicloth® & Clinell®),
skin swabs & skin cleanser
3ml & 10.5ml applicators (Chloraprep®)
Obstetric cream
MHRA Medical Device Alert (November 2012) re: chlorhexidine and risk of anaphylaxis
MHRA Drug Safety Update (November 2014) reminder of the risk of chemical burns in premature infants
Paint containing brilliant green and crystal violetu – for limited use in some operating theatres only
0.5% paintu - for limited use in some operating theatres / critical care areas only
Sterile larvae (maggots) used for the management of sloughy wounds.
CDDFT Intranet link Policy for the use of sterile maggots in wound management within in-patient settings
Aluminium chloride hexahydrate 20% solution in an alcoholic basis (Driclor®, Anhydrol forte®)OTC