ENHT Pharmacy Department – CIP sheet

Drug / Dispensing recommendation
Azarga / Challenge - suggest switch to Cosopt
Ciclosporin / Deximune® brand to be dispensed for all patient EXCEPT renal transplant patients who must stay on their specific brand (usually Neoral®)
Ear drops
Sofradex & Gentisone HC / Suggest switch to Otomize (not fully agreed but no harm in trying!) May be drug sensitivity issues.
Fluticasone/
Flixonase / Nasules – challenge to switch to betamethasone drops. If insisting on nasules dispense only one box
Nasal spray – challenge to switch to mometasone
Hydrocortisone tablets / Adult patient should only have the 20mg tablets. Tablets may be halved and quartered to allow dosing.
Supply maximum 14 days at discharge.
Immunoglobulin / Privigen® should be used for all NEW patients.
Remember to use dose determining weight where applicable.
NOACs
Apixaban, dabigatran,
rivaroxaban / Follow NOAC guidelines for new patients.
TKR and THR patients require full 10 or 28 day courseof dabigatran. Where dose is 150mg dispense 150mg capsules ‘off label’ rather than 2x75mg.
For existing patients on a NOAC for VTE or AF prophylaxis who have no supplies at home supply a maximum 14 days at discharge.
Oxycodone / 2nd line to morphine – only for use if patient is intolerant/allergic to morphine
Phenytoin capsules / Challenge new oral prescriptions. Should use newer agents.
Supply maximum 14 days at discharge
Prednisolone (soluble) / Always use plain tablets dispersed in water for feeding tubes. Older children and any adults with swallowing difficulties should be offered plain tablets dispersed in water initially before supplying soluble.
Renal Dialysis prescriptions / Please refer to Renal Pharmacist to screen
bleep 0931 / 1459
Rifaximin / Supply amaximum 14 days
Solifenacin / Non-formulary.Switch to oxybutinin or tolterodine (1st line)trospium (2nd line), fesoterodine (3rd line)
or mirabegron (4th line)
Symbicort/ Seretide / Non-formulary.
Not for initiation and rarely for continuation.
Needs separate request form completing before supply.
Usual 1st line Fostair or DuoResp Spiromax
Volplex / For use in Critical Care and Theatres only.
Routine fluid for resuscitation on wards is
Hartmanns solution or sodium chloride 0.9%

ENHT Pharmacy Department – Part Pack Initiatives

When ordering for inpatients ensure every effort has been made to obtain PODs.

When ordering or dispensing any CIP item always check patient history: If a recentsupply has been made challenge the ward staff to find it and inform the ward pharmacist or MMPT as appropriate.

Do not dispense more than 2 weeks supply of the drugs tabled below either as inpatient, TTO or outpatient.

To save time and effort whole packs may be issued for other relatively inexpensive items rather than issuing strips for inpatient use.

(Professional opinion and discretion is advised when ordering and supplying any other relatively expensive items)

Drug / Dispensing recommendation
Eplerenone / Do not supply if stock on ward.
Supply maximum 14 days at discharge.
Insulin / Do not supply if ward stock UNLESS the patient is being discharged imminently.
Do not supply more than 2 pre-filled pens per patient unless high dose (confirm with patient/screener) – NB if no change in insulin most patients have supplies at home.
Always use unopened stickers
Linagliptin / Do not supply if stock on ward.
Supply maximum 14 days at discharge.
Sitagliptin / Do not supply if stock on ward.
Supply maximum 14 days at discharge.

Note: This list will expand with future initiatives!