University Hospitals Birmingham NHS Foundation Trust

Chapters

StatusDrug nameNICE TAsComments
Status: AmberAcetazolamide

Intercranial hypertension (unlicensed indication)

Status: GreenAmiloride solution

Caution with ACE inhibitors. A weak diuretic.

Status: GreenAmiloride tablets

Caution with ACE inhibitors. A weak diuretic.

Status: GreenBendroflumethiazide tablets

2.5mg dose (higher doses not indicated in hypertension). Most patients do not develop hypokalaemia. Suggest check potassium level one month after initiation and annually thereafter (MeReC 10/94)

Status: GreenBumetanide tablets

Monitor potassium level. Indicated in pulmonary oedema. Need large doses in renal failure

Status: GreenChlortalidone tablets
Status: GreenCo-amilofruse tablets

Combination products should be avoided, unless compliance is an issue

Status: AmberEplerenone tablets
Status: GreenFinerenone (Kerendia®)

Prescribing to be in line with the prescribing support document.

Status: GreenFurosemide injection

Monitor potassium level. Indicated in pulmonary oedema. Need large doses in renal failure

Status: GreenFurosemide oral solution

Monitor potassium level. Indicated in pulmonary oedema. Need large doses in renal failure

Status: GreenFurosemide tablets

Monitor potassium level. Indicated in pulmonary oedema. Need large doses in renal failure

Status: GreenIndapamide tablets

2.5mg tablets only

Status: RedMannitol infusion

Hospital only

Status: AmberMetolazone

Specialist recommendation (unlicensed).

There is now a UK licensed metolazone 5mg tablet available (Xaqua®). There are significant differences in bioavailability between Xaqua® and alternative unlicensed imported metolazone preparations.

Xaqua® tablets have up to approximately twice the bioavailability of other metolazone preparations.

If switching from another metolazone product to Xaqua® tablets or vice versa, a dose adjustment may be necessary, and individualised titration based on patient's response and tolerability is advised.

More information available from Specialist Pharmacy Service (SPS). We are awaiting guidance on switching to the licensed product – in the mean time please ensure that the patients are not inadvertently switched between products.

Status: GreenSpironolactone tablets

Retains potassium. Useful in liver cirrhosis and congestive heart failure with loop diuretic. Monitor potassium levels carefully.

Status: RedSpironolactone tablets

Acne vulgaris in women that warrants treatment with antibiotics (off-label indication)

Drug status key

Formulary drugs are allocated a traffic light status. This provides guidance on where clinical and prescribing responsibilities lie in regard to the initiation and maintenance of prescribing.

Grey

Grey

Positive NICE TA and/or awaiting local clarification on place in therapy. Please contact your medicines optimisation team for more information.

Red

Red

Initiation and maintenance of prescribing by specialists only.

Amber

Amber

Initiation and maintenance of prescribing by specialists and transfer to primary care prescribing when appropriate, or in primary care following a specialists recommendation. Prior to initiation some medicines may require committee agreement or a framework to support safe transfer and maintenance.

Green

Green

Initiation and maintenance of prescribing by specialists, GPs and other qualified clinicians.

Blue

Blue

Under review at University Hospitals Birmingham NHS Foundation Trust.

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