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{"sheet":"Comepleted Specials top 25 ","index":0,"n_rows":28,"n_cols":16,"rows_kept":28,"cut":false,"hidden":true,"merged":[[9,15,10,15],[12,0,13,0],[12,9,13,9],[12,10,13,10],[12,3,13,3],[12,14,13,14],[12,15,13,15],[9,0,10,0],[9,9,10,9],[9,10,10,10],[9,3,10,3],[9,14,10,14]]}
["Chemical substance/ indication","Drug name/ Special","What is the issue","What is the potential solution- option 1","What is the potential solution- option 2","What is the potential solution- option 3",null,"Cost of preparation","Potential cost pressure or savings/ per dose","Indication (include licenced indication or known use and age range it can be used in)","DT England and Wales","DT Scotland","England Total Items Nov 18- Oct 19","Spend (national) (Current spend on unlicensed version) Nov 18- Oct 19","link to relevant bulletin/ hot topics issue","Tag listing name"]
["Co- proxamol ","Co-Proxamol_Tab 32.5mg/325mg","Unlicensed in the UK.High spend. Unlicensed. Withdrawn from the market across the world. As per NHS England and NHS Clinical Commissioners Policy- Items which should not routinely be prescribed in primary care- this should no longer be prescribed in primary care Safety issue. Drug of limited clinical value. See bulletin 194. ","Stop prescribing, switch to alternative pain relief if still required",null,null,null,"VARIABLE ","Cost pressure","Pain relief ","Special order products ",null,"15, 310","£2.6 m APPROX ","https://www.prescqipp.info/our-resources/bulletins/bulletin-194-co-proxamol/","See separate tab"]
["Melatonin","Melatonin 1mg/ml liquid (colonis)","Newly licensed melatonin 1mg/ml oral solution available. Lots of unlicensed melatonin solution prescribed in children for  sleep disorders. MHRA advise using a licensed medicine off-label in preference to an unlicensed medicine.  Potential for savings or cost pressure depending on preparation and dose used. Doses and preparation choice will need to be optimised.","Review whether melatonin still required or appropriate. Use licenced Slenyto tablets in children ",null,null,null,"£130 for 150ml vs DT special price ","Cost pressure dependant on strength selected ","Licensed for jet lag in adults","n/a",null,"n/a ","Newly licensed","PrescQIPP Melatonin bulletin: https://www.prescqipp.info/our-resources/bulletins/bulletin-108-melatonin-spot-list/  Hot topics: https://www.prescqipp.info/media/4131/newly-licensed-melatonin-preparation-21.pdf ","See separate tab"]
["Melatonin","Melatonin 3mg tablets (Colonis)","Newly licensed immediate release melatonin tablets available. Lots of unlicensed melatonin immediate release tablets and capsules currently used.",null,null,null,null,"£65 for 30","Melatonin 3mg- £65 (30). Circadin MR £15.39 (30)","Licensed for jet lag in adults","n/a",null,{"$f":"2225+1716","v":3941},{"$f":"233961+156903","v":390864},null,"See separate tab"]
["Melatonin","Melatonin 1mg MR & 5mg MR tablets (Flynn Pharma)- Slentyo","Newly licensed melatonin 1mg/ml oral solution available. Lots of unlicensed melatonin solution prescribed in children for  sleep disorders. MHRA advise using a licensed medicine off-label in preference to an unlicensed medicine.  Potential for savings or cost pressure depending on preparation and dose used. Doses and preparation choice will need to be optimised.","Review whether melatonin still required or appropriate. Use licenced Slenyto tablets in children ",null,null,null,"1mg= £41.20 (60), 5mg =£103 (30)","Cost pressure dependant on strength selected "," For the treatment of insomnia in children and adolescents aged 2-18 with Autism Spectrum Disorder (ASD) and / or Smith-Magenis syndrome, where sleep hygiene measures have been insufficient.",null,null,3290,"3mg £401935","PrescQIPP Melatonin bulletin: https://www.prescqipp.info/our-resources/bulletins/bulletin-108-melatonin-spot-list/  Hot topics: https://www.prescqipp.info/media/4131/newly-licensed-melatonin-preparation-21.pdf ","See separate tab"]
["Melatonin","Melatonin_Cap 2mg","High spend. Unlicensed. Limited evidence to support its use. ","Review whether melatonin still required or appropriate. If used for aiding sleep, consider licensed alternatives. ",null,null,null,"VARIABLE ","Licensed Circadin 2mg MR tablets (£15.39- 30). ","Unlicensed, variable uses. ","Special order products ",null,21584,2135562,"PrescQIPP Melatonin bulletin: https://www.prescqipp.info/our-resources/bulletins/bulletin-108-melatonin-spot-list/  Hot topics: https://www.prescqipp.info/media/4131/newly-licensed-melatonin-preparation-21.pdf ","See separate tab"]
["Melatonin","Melatonin_Cap 3mg","High spend. Unlicensed. Limited evidence to support its use. ","Review whether melatonin still required or appropriate. If used for aiding sleep, consider licensed alternatives. ",null,null,null,"VARIABLE ","Licensed Circadin 2mg MR tablets (£15.39- 30). ","Unlicensed, variable uses. ","Special order products ",null,14751,1578922.9497200001,"PrescQIPP Melatonin bulletin: https://www.prescqipp.info/our-resources/bulletins/bulletin-108-melatonin-spot-list/  Hot topics: https://www.prescqipp.info/media/4131/newly-licensed-melatonin-preparation-21.pdf ","See separate tab"]
["Melatonin","Melatonin_Cap 5mg","High spend. Unlicensed. Limited evidence to support its use. ","Review whether melatonin still required or appropriate. If used for aiding sleep, consider licensed alternatives. ",null,null,null,"VARIABLE ","Licensed Circadin 2mg MR tablets (£15.39- 30). ","Unlicensed, variable uses. ","Special order products ",null,6778,578933.11902000022,"PrescQIPP Melatonin bulletin: https://www.prescqipp.info/our-resources/bulletins/bulletin-108-melatonin-spot-list/  Hot topics: https://www.prescqipp.info/media/4131/newly-licensed-melatonin-preparation-21.pdf ","See separate tab"]
["Melatonin","Melatonin_Cap 10mg","High spend. Unlicensed. Limited evidence to support its use. ","Review whether melatonin still required or appropriate. If used for aiding sleep, consider licensed alternatives. ",null,null,null,"VARIABLE ","Licensed Circadin 2mg MR tablets (£15.39- 30). ","Unlicensed, variable uses. ","Special order products ",null,3831,361576.29854000051,"PrescQIPP Melatonin bulletin: https://www.prescqipp.info/our-resources/bulletins/bulletin-108-melatonin-spot-list/  Hot topics: https://www.prescqipp.info/media/4131/newly-licensed-melatonin-preparation-21.pdf ","See separate tab"]
["Sucralfate","Sucralfate_Tab 1g","Licensed Antepsin (sucralfate) 1g Tablets is no longer available.  Antepsin was indicated in adults and adolescents over 14 years old for treatment of duodenal ulcer, gastric ulcer, chronic gastritis. Unlicensed products now being sourced. ","Review continued need. Consider alternative treatment for gastro intestinal ulcer, gastritis ",null,null,null,"VARIABLE ","Cost pressure as unlicensed. Consider oral suspension. Sucralfate 1g/5ml 200ml (£50) ","GI Ulcers, consider alternative drug treatment. E.g. PPI, H2 Antagonist ","Special order products ",null,9325,2107120.7739800001,"none","See separate tab"]
[null,"Sucralfate_Susp 1g/5ml S/F","Sucralfate 1g/5ml oral suspension sugar free is available as a licensed product. ",null,null,null,null,"Variable ","Cost pressure consider licensed product Sucralfate 1g/5ml oral suspension sugar free (200ml - £50)",null,null,null,1332,384214.16906999971]
["Liothyronine ","Liothyronine Sod_Tab 5mcg","Unlicensed strength. Available as Liothyronine 20microgram tablets. Liothyronine is listed on NHS England and NHS Clinical Commissioners Policy- Items which should not routinely be prescribed in primary care- this should no longer be prescribed in primary care.   Licensed in the USA. ","Review to deprescribe and consider for suitability for\nswitching to levothyroxine. Switch all suitable patients to levothyroxine. For patients under the care\nof a relevant specialist, involve them in the decision to switch to levothyroxine.",null,null,null,"Variable","Cost pressure ","Unlicensed ","Special order products ",null,4615,1799594.0176299992,"PrescQIPP Bulletin 121: Switching liothyronine (L-T3) to levothyroxine (L-T4)\nin the management of primary hypothyroidism. https://www.prescqipp.info/our-resources/bulletins/bulletin-121-liothyronine/","See separate tab"]
["Midazolam ","Midazolam_Liq Spec 50mg/5ml","The 50mg/5ml is not available- unlicensed. However, 10mg/ml is available as Epistatus.  or variable doses as Buccolam. This is only licensed for use 18 years and under. Buccolam can be a different strength, caution needs to be exercised due existence of different midazolam salts, e.g. maleate. Not directly interchangeable","Consider licensed alternative e.g. Buccolam (2.5mg/0.5ml,5mg/ml,  7.5mg/1.5ml, 10mg/2ml) or Epistatus 10mg/ml . Review patients the are prescribed 50mg/5ml. Consider review. Where required to continue, discussion option of prescribing in secondary care under specialist. ",null,null,null,"Variable","Cost pressure. This strength is likely to be for Epistatus (midazolam special order product). The current price directly from the manufacturer for 50mg/5ml is £45 for four syringes. They have advised that the pricing for community pharmacies is a bit more complicated because the product is distributed via a third party and   the transfer pricing may not reflect the end price to the market","Epistatus (midazolam 10mg/ml)  is indicated for the treatment of prolonged, acute, convulsive seizures in children and adolescents aged 10 to less than 18 years. Buccolam oromucosal solution is not licensed for use in adults over 18 years. Unlicensed midazolam oromucosal formulations are available and may have different doses. The BNF states that for treatment of febrile convulsions in adults, the dose of buccal midazolam is 10mg, then 10mg after ten minutes if required.3  The NICE clinical guideline on diagnosis and management of epilepsies states that buccal midazolam should be used as first line treatment in children, young people and adults for treating prolonged or repeated seizures and convulsive status epilepticus in the community. Unlicensed preparations should not be necessary, consider prescribing in secondary care","Special order products ",null,5488,1625633.2102000001,"https://www.prescqipp.info/media/1140/b147-buccal-midazolam-spot-list-20.pdf","See separate tab"]
[null,"Midazolam_Oromuc Soln 5mg/1ml Pfos S/F",null,null,null,null,null,"Variable ","Cost pressure",null,null,null,4039,385751.92319999979]
["Phenobarbital","Phenobarb_Liq Spec 50mg/5ml","Unlicensed strength. Phenobarbital 15mg/5ml elixir is available. Contains alcohol, caution to be exercised when it is used. This formulation is licensed, but contains 38% alcohol.\nMHRA/CHM Advice – For Category 1 drugs, doctors are\nadvised to ensure that their patient is maintained on a specific\nmanufacturer’s product","Consider alternative management to epilepsy. If required, consider secondary care to continue prescribing.",null,null,null,"Variable",null,"Often used for management of epilepsy. ",4039,null,3317,1339112.0560500009,"none","See separate tab"]
["Methadone ","Methadone HCl_Oral Soln 1mg/1ml S/F","Unlicensed product being prescribed. To be prescribed as per drug tariff if sugar free required Methadone 1mg/ml oral solution sugar free","Prescribe as Methadone 1mg/ml oral solution sugar free",null,null,null,"Variable ","Cost pressure ","Prescribe as Methadone 1mg/ml oral solution sugar free","Special order products ",null,181781,990050.17035000073,"none","See separate tab"]
["Levomepromazine","Levomeprom Mal_Tab 6mg","Levomepromazine 6mg is not available as a licensed product. Nozinan 25mg tablets available as a licensed product in the UK. Macmillan Cancer Support advise that the 25mg tablets can be quartered for a starting dose of 6.25mg. ","Nozinan 25mg tablets available as a licensed product in the UK. Macmillan Cancer Support advise that the 25mg tablets can be quartered for a starting dose of 6.25mg. ",null,null,null,"Nozinan (£20.26 - 84 tablets)","Cost pressure. Consider licensed alternative. ","Nozinan is a neuroleptic with indications in psychiatry and general medicine, particularly in terminal illness. Clinically it is more sedative and more potent than chlorpromazine in the management of psychotic conditions and in the relief of severe chronic pain.","Special order products ",null,2407,781322.26664000028,"none","See separate tab"]
["Potassium Chloride ","Pot Chlor_Tab 600mg (Pot 8mmol) M/R","Was manufactured as Slow K , which has subsequently been discontinued. ","Consider prescribing Kay-Cee-L liquid (75mg (equiv. to 1 mmol K+) per ml syrup) licensed  for potassium deficiency. (500ml= £8.77) or Sando-K (ach Sando-K® tablet contains potassium 470 mg (12 mmol of K+) and chloride 285mg (8 mmol of Cl-). 100 tabs= £9.95",null,null,null,"Variable ","Cost pressure. Consider licensed alternative which are different strengths. ","Slow K was licensed for correction of hypokalaemia. ","Special order products ",null,3538,749902.1011099997,"none"]
["Phytomenadione","Phytomenadione_Tab 10mg","Oral tablets not licensed, Only available as intravenous preparation which is unlicensed for oral use. ","Oral administration of phytomenadione injection – Konakion MM for adults is not licensed to be administered orally however it is exactly the same formulation as Konakion MM paediatric which is licensed to be used orally. A 1mg capsule is available, but iso only licensed for use in babies. ",null,null,null,"Variable","Cost pressure ","Major bleeding in patients on warfarin","Special order products ",null,5605,734153,"none","See separate tab"]
["Metolazone","Metolazone_Tab 2.5mg","Discontinued from UK.","Consider licensed alternative. If required, consider prescribing to remain with specialist.",null,null,null,"Variable","Cost pressure","Hypertension and oedema ","Special order products ",null,14985,627676,"none","See separate tab"]
["Mexiletine ","Mexiletine HCl_Cap 100mg","Newly licensed mexiletine has recently come on to the market. Namuscla® contains mexiletine hydrochloride. This corresponds to 166.62mg\nmexiletine base, which is equivalent to 200mg mexiletine hydrochloride. Mexiletine is a sodium channel blocker which reduces the delay of muscle relaxation\nand so decreases muscle stiffness","See PrescQIPP - Hot topics - Aug 19 ",null,null,null,"Unlicensed - variable. Licensed: £5,000 for 100 capsules","Cost pressure ","The licensed product is for  It is licensed for\nthe symptomatic treatment of myotonia in adult patients with non-dystrophic myotonic\n(NDM) disorders.","Special order products ",null,1295,595190.67133000004,"https://www.prescqipp.info/umbraco/surface/authorisedmediasurface/index?url=%2fmedia%2f4201%2fprescqipp-hot-topics-namuscla-v12.pdf","See separate tab"]
["Glycopyrronium Bromide","Glycopyrronium Brom_Liq Spec 1mg/5ml","Unlicensed preparation prescribed over the licensed. Prescribe as per Drug Tariff. Glycopyrronium bromide 1mg/5ml oral solution sugar free. ","Use licensed product, prescribed as written in the drug tariff. ",null,null,null,"Unlicensed- Variable. Licensed- 150ml - £91 ","Cost pressure","The licensed product is for symptomatic treatment of severe sialorrhoea (chronic pathological drooling) in children and adolescents aged 3 years and older with chronic neurological disorders.","Special order products ",null,2276,542657.28561000025,"https://www.prescqipp.info/media/1332/b165-glycopyrronium-spot-list-20.pdf ","See separate tab"]
["Cyanocobalamin ","Cyanocobalamin Tab 1mg M/R","B12 in the form of cyanocobalamin has been prescribed to replace b12 in patients orally versus using the injection. In the UK the licensed and recommended treatment for vitamin B12 deficiency is intramuscular hydroxocobalamin injections","The current UK guidelines on B12 deficiency from the British Committee on Standards in Haematology recommend the BNF approach as first line, but add “Oral therapy may be suitable and acceptable provided appropriate doses are taken and compliance is not an issue. ",null,null,null,"Variable ","Cost pressure ","Cyanocobalamin 50 microgram tablets are available as a licensed medicine, but although these are suitable for the treatment of dietary vitamin B12 deficiency, which requires 50-150 micrograms daily, they may not be suitable for the treatment of deficiency due to malabsorption as this tends to require higher doses (500-1000 microgames). ","Special order products ",null,66595,471379.15000999987,"none","See separate tab"]
["Magnesium Glycerophosphate","Mag Glycerophos_Cap 97.2mg","There is no national guideline to support management of hypomagnesaemia. BNF states that to prevent recurrence of the deficit, magnesium may be given by mouth, but there is limited evidence of benefit. Often magnesium glycerophosphate is given orally to manage this, however this is an unlicensed preparation. ","Used licensed product Neomag. magnesium glycerophosphate 1 g is approximately equivalent to Mg2+ 4 mmol or magnesium 97 mg. Each Neomag® chewable tablet contains Mg2+ 4 mmol or magnesium 97 mg.",null,null,null,"Variable. Licensed products in Drug tariff:  Magnesium glycerophosphate (magnesium 97.2mg (4mmol)) chewable tablets sugar free (Neomag) £22.77 - 50. Other magnesium products which are not licensed include Magnesium aspartate (magnesium 10mmol) oral powder sachets (Magnaspartate) £8.95 - 10 sachets and Magnesium glycerophosphate (magnesium 121.25mg/5ml (5mmol/5ml)) oral solution (MagnaPhos) 200ml - £37.87. ","Cost pressure if not prescribed as per BNF ","Neomag 4mmol Chewable Tablets are indicated as oral magnesium supplements for the treatment of patients with chronic magnesium loss or hypomagnesaemia as diagnosed by a doctor.Neomag 4mmol Chewable Tablets are also indicated for adult patients with hypomagnesaemia due to the concomitant administration of loop and thiazide diuretics or other drugs which cause hypomagnesaemia. M","Special order products ",null,3156,470623.71561000025,"https://www.prescqipp.info/media/1644/b159-spot-list-20.pdf","See separate tab"]
["Mepacrine","Mepacrine HCl_Tab 100mg","Unlicensed product. Often prescribed for Giardiasis. ","Consider alternative effective treatments which may include metronidazole (£3.97-21 tabs) or tinidazole (£11.04 - 16 tabs) licensed in the UK. ",null,null,null,"Variable ","Cost pressure","Giardiasis","Special order products ",null,2057,452761.4842099995,"none","See separate tab"]
["Riboflavin ","Riboflavin_Cap 100mg","May be prescribed for metabolic diseases, however no licensed product available. ","If riboflavin is required, consider prescribing remains with specialists. Only supplements available. ",null,null,null,"Variable ","Cost pressure ","Metabolic diseases","Special order products ",null,2413,367284.52269999991,"none","See separate tab"]
["Tacrolimus ","Tacrolimus_Liq Spec 5mg/5ml","No licensed liquid available. Often used post transplant.  ","Consider prescribing to stay with specialist if prescribed for transplant immunosuppression only. NHS Specialised Commissioning drug https://www.england.nhs.uk/wp-content/uploads/2019/04/nhs-england-drugs-list-v14.1.pdf . Where prescribed for alternative indication, you may still wish prescribing to remain with specialist or consider licensed granules for suspension. £356.65- 60 sachets. ",null,null,null,"Variable ","Cost pressure ","Prophylaxis of transplant rejection. ","Special order products ",null,450,330855.78900000005,"none","See separate tab"]
["Paracetamol ","Paracet_Oral Susp 500mg/5ml S/F","Prescribing of unlicensed strength, where there are licensed alternatives as liquids or soluble tablets available. ","Consider licensed Paracetamol 250mg/5ml oral suspension sugar free £2.66- 200ml, or Paracetamol 500mg soluble tablets £1.64- 24 tabs. ",null,null,null,"Variable ","Cost pressure","Pain relief ","Special order products ",null,4203,298471.63460000005,"none","See separate tab"]

{"sheet":"Comp Specials Tag listing names","index":1,"n_rows":169,"n_cols":9,"rows_kept":169,"cut":false,"hidden":true,"merged":[]}
["Tag name","BNF code","BNF name. ",null,null,null,"Full BNF lookup is here",null,"https://www.prescqipp.info/our-resources/data-and-analysis/scorecards/support-tools/"]
["Co-proxamol","0407010Q0AAAAAA","Co-Proxamol_Tab 32.5mg/325mg"]
["Co-proxamol","0407010Q0AAABAB","Co-Proxamol_Susp 32.5mg/325mg/5ml S/F"]
["Co-proxamol","0407010Q0AAACAC","Co-Proxamol_Oral Liq @spec"]
["Co-proxamol","0407010Q0AAADAD","Co-Proxamol_Liq Spec 32.5mg/325mg/5ml"]
["Melatonin ","040101000BBAAA0","N/Centre_Melatonin Cap 3mg"]
["Melatonin ","040101000BBABA0","Earth Force_Melatonin Tab 2.5mg"]
["Melatonin ","040101000BBACA0","N/Centre_Melatonin Tab 2.5mg"]
["Melatonin ","040101000BBADA0","Bio-Melatonin_Tab 3mg"]
["Melatonin ","040101000BBAEA0","Lake_Melatonin + Vit B6 Cap 3mg/5mg"]
["Melatonin ","040101000BBAFA0","Avon Med_Melatonin Tab 3mg"]
["Melatonin ","040101000BBAGA0","N/Centre_Melatonin Tab 5mg"]
["Melatonin ","040101000BBAHA0","Health Aid_Melatonin Tab 3mg"]
["Melatonin ","040101000BBAIA0","Melatonin+_Tab"]
["Melatonin ","040101000BBAJA0","Lake_Melatonin Cap 2mg"]
["Melatonin ","040101000BBAKA0","Melatonine_Tab 2.5mg"]
["Melatonin ","040101000BBALA0","Lake_Melatonin Cap 5mg"]
["Melatonin ","040101000BBAMA0","A/Research_Melatonin Cap 3mg"]
["Melatonin ","040101000BBANA0","Twinlab_Melatonin Tab 2mg M/R"]
["Melatonin ","040101000BBAPA0","Bio-Tech_Melatonin Cap 5mg"]
["Melatonin ","040101000BBAQA0","Masons_Melatonin Ex Strgh Tab 5mg"]
["Melatonin ","040101000BBARA0","Bio-Tech_Melatonin Cap 3mg"]
["Melatonin ","040101000BBASA0","Source Natur_Melatonin Tab 5mg"]
["Melatonin ","040101000BBATA0","Bio-Tech_Melatonin Cap 1mg"]
["Melatonin ","0401010ADAAABAB","Melatonin_Cap 3mg                    @gn"]
["Melatonin ","0401010ADAAACAC","Melatonin_Cap 500mcg"]
["Melatonin ","0401010ADAAADAD","Melatonin_Cap 1mg                    @gn"]
["Melatonin ","0401010ADAAAEAE","Melatonin_Cap 2mg"]
["Melatonin ","0401010ADAAAFAF","Melatonin_Cap 5mg                    @gn"]
["Melatonin ","0401010ADAAAGAG","Melatonin_Tab 5mg                    @gn"]
["Melatonin ","0401010ADAAAHAH","Melatonin_Cap 2.5mg"]
["Melatonin ","0401010ADAAAIAI","Melatonin_Tab 1mg"]
["Melatonin ","0401010ADAAAJAJ","Melatonin_Cap 3mg M/R"]
["Melatonin ","0401010ADAAAKAK","Melatonin_Cap 10mg"]
["Melatonin ","0401010ADAAALAL","Melatonin_Syr 2.5mg/5ml"]
["Melatonin ","0401010ADAAAMAM","Melatonin_Tab Disper 3mg"]
["Melatonin ","0401010ADAAANAN","Melatonin_Tab Subling 3mg"]
["Melatonin ","0401010ADAAAPAP","Melatonin_Tab 300mcg"]
["Melatonin ","0401010ADAAAQAQ","Melatonin_Tab 3mg M/R"]
["Melatonin ","0401010ADAAARAR","Melatonin_Tab 500mcg                 @gn"]
["Melatonin ","0401010ADAAASAS","Melatonin_Tab 500mcg"]
["Melatonin ","0401010ADAAATAT","Melatonin_Liq Spec 2.5mg/5ml"]
["Melatonin ","0401010ADAAAUAU","Melatonin_Cap 4mg"]
["Melatonin ","0401010ADAAAVAV","Melatonin_Tab Subling 2.5mg"]
["Melatonin ","0401010ADAAAWAW","Melatonin_Cap 20mg                   @gn"]
["Melatonin ","0401010ADAAAXAX","Melatonin_Oral Soln 1.25mg/5ml"]
["Melatonin ","0401010ADAAAYAY","Melatonin_Liq Spec 2mg/5ml"]
["Melatonin ","0401010ADAAAZAZ","Melatonin_Oral Soln 12.5mg/5ml"]
["Melatonin ","0401010ADAABABA","Melatonin_Oral Soln 5mg/5ml (Old)"]
["Melatonin ","0401010ADAABBBB","Melatonin_Cap 300mcg"]
["Melatonin ","0401010ADAABCBC","Melatonin_Cap 750mcg M/R"]
["Melatonin ","0401010ADAABDBD","Melatonin_Cap 300mcg M/R"]
["Melatonin ","0401010ADAABEBE","Melatonin_Loz Subling 3mg"]
["Melatonin ","0401010ADAABFBF","Melatonin_Liq Spec 3mg/5ml"]
["Melatonin ","0401010ADAABGBG","Melatonin_Oral Soln 4mg/5ml"]
["Melatonin ","0401010ADAABHBH","Melatonin_Liq Spec 5mg/5ml"]
["Melatonin ","0401010ADAABIBI","Melatonin_Loz 3mg S/F"]
["Melatonin ","0401010ADAABJBJ","Melatonin_Cap 8mg"]
["Melatonin ","0401010ADAABKBK","Melatonin_Tab 2mg"]
["Melatonin ","0401010ADAABLBL","Melatonin_Tab 5mg"]
["Melatonin ","0401010ADAABMBM","Melatonin_Cap 20mg"]
["Melatonin ","0401010ADAABNBN","Melatonin_Cap 1.5mg"]
["Melatonin ","0401010ADAABPBP","Melatonin_Tab 3mg (Old)"]
["Melatonin ","0401010ADAABQBQ","Melatonin_Cap 1mg"]
["Melatonin ","0401010ADAABRBR","Melatonin_Cap 3mg"]
["Melatonin ","0401010ADAABSBS","Melatonin_Cap 5mg"]
["Melatonin ","0401010ADAABTBT","Melatonin_Liq Spec 1mg/5ml"]
["Melatonin ","0401010ADAABUBU","Melatonin_Liq Spec 10mg/5ml"]
["Melatonin ","0401010ADAABVBV","Melatonin_Cap 6mg"]
["Melatonin ","0401010ADAABWBW","Melatonin_Liq Spec 6mg/5ml"]
["Melatonin ","0401010ADAABXBX","Melatonin_Oral Susp 5mg/5ml (Old)"]
["Melatonin ","0401010ADAABYBY","Melatonin_Oral Soln 2mg/5ml"]
["Melatonin ","0401010ADAABZBZ","Melatonin_Oral Susp 2mg/5ml"]
["Melatonin ","0401010ADAACACA","Melatonin_Oral Soln 3mg/5ml"]
["Melatonin ","0401010ADAACBCB","Melatonin_Oral Susp 3mg/5ml"]
["Melatonin ","0401010ADAACCCC","Melatonin_Orodisper Tab 3mg"]
["Melatonin ","0401010ADAACDCD","Melatonin_Oral Soln 10mg/5ml"]
["Melatonin ","0401010ADAACECE","Melatonin_Oral Susp 10mg/5ml"]
["Melatonin ","0401010ADAACFCF","Melatonin_Oral Soln 2.5mg/5ml"]
["Melatonin ","0401010ADAACGCG","Melatonin_Oral Susp 2.5mg/5ml"]
["Melatonin ","0401010ADAACHCH","Melatonin_Cap 2mg M/R"]
["Melatonin ","0401010ADAACICI","Melatonin_Cap 7.5mg"]
["Melatonin ","0401010ADAACJCJ","Melatonin_Oral Soln 7mg/5ml"]
["Melatonin ","0401010ADAACKCK","Melatonin_Oral Susp 15mg/5ml"]
["Melatonin ","0401010ADAACLCL","Melatonin_Oral Susp 7mg/5ml"]
["Melatonin ","0401010ADAACMCM","Melatonin_Cap 7mg"]
["Melatonin ","0401010ADAACNCN","Melatonin_Tab 10mg"]
["Melatonin ","0401010ADAACPCP","Melatonin_Tab 4mg"]
["Melatonin ","0401010ADAACQCQ","Melatonin_Tab 6mg"]
["Melatonin ","0401010ADAACSCS","Melatonin_Oral Soln 8mg/5ml"]
["Melatonin ","0401010ADAACTCT","Melatonin_Oral Dps 1mg/ml"]
["Melatonin ","0401010ADAACWCW","Melatonin_Cap 9mg"]
["Melatonin ","0401010ADAACXCX","Melatonin_Cap 6mg M/R"]
["Melatonin ","0401010ADAACZCZ","Melatonin_Oral Soln 5mg/5ml S/F"]
["Melatonin ","0401010ADAADADA","Melatonin_Oral Soln 5mg/5ml"]
["Melatonin ","0401010ADAADBDB","Melatonin_Oral Susp 5mg/5ml"]
["Melatonin ","0401010ADBCAPAS","VesPro_Melatonin Tab 500mcg"]
["Melatonin ","0401010ADBCAQAI","Natures Bounty_Melatonin Tab 1mg"]
["Melatonin ","0401010ADBCARAV","Source Natur_Melatonin Tab Subling 2.5mg"]
["Melatonin ","0401010ADBCATAX","Natrol_Melatonin Syr 1mg/4ml"]
["Melatonin ","0401010ADBCAVAI","Source Natur_Melatonin Tab 1mg"]
["Melatonin ","0401010ADBCAXAZ","General Nutrit_Melatonin Liq 2.5mg/ml"]
["Melatonin ","0401010ADBCAYBA","Source Natur_Melatonin Oral Liq 1mg/1ml"]
["Melatonin ","0401010ADBCBABD","Life Ext_Melatonin T/R Cap 300mcg"]
["Melatonin ","0401010ADBCBBBE","Life Ext_Melatonin Loz Subling 3mg"]
["Melatonin ","0401010ADBCBCBB","Life Ext_Melatonin Cap 300mcg"]
["Melatonin ","0401010ADBCBDBC","Life Ext_Melatonin T/R Cap 750mcg"]
["Melatonin ","0401010ADBCBEAC","Life Ext_Melatonin Cap 500mcg"]
["Melatonin ","0401010ADBCBFAK","Life Ext_Melatonin Cap 10mg"]
["Melatonin ","0401010ADBCBGAJ","Life Ext_Melatonin T/R Cap 3mg"]
["Melatonin ","0401010ADBCBSBP","Quality Health_Melatonin Tab 3mg"]
["Melatonin ","0401010ADBCBTBR","Now_Melatonin Cap 3mg"]
["Melatonin ","0401010ADBCBUBP","Nature's Blend_Melatonin Tab 3mg"]
["Melatonin ","0401010ADBCBVBP","Natures Bounty_Melatonin Tab 3mg"]
["Melatonin ","0401010ADBCBWBP","Natrol_Melatonin Tab 3mg"]
["Melatonin ","0401010ADBCBXBQ","Life Ext_Melatonin Cap 1mg"]
["Melatonin ","0401010ADBCBYBR","Life Ext_Melatonin Cap 3mg"]
["Melatonin ","0401010ADBCBZBP","Bio-Melatonin_Tab 3mg"]
["Melatonin ","0401010ADBCCABP","Health Aid_Melatonin Tab 3mg"]
["Melatonin ","0401010ADBCCBBR","Icenia_Melatonin Cap 3mg"]
["Melatonin ","0401010ADBCCCBL","Melatonin Ex Strgh_Tab 5mg"]
["Melatonin ","0401010ADBCCDAE","Icenia_Melatonin Cap 2mg"]
["Melatonin ","0401010ADBCCEBS","Icenia_Melatonin Cap 5mg"]
["Sucralfate ","0103030S0AAAAAA","Sucralfate_Tab 1g"]
["Sucralfate ","0103030S0AAADAD","Sucralfate_Oral Susp 1g/5ml S/F","0103030S0AAABAB","Sucralfate_Susp 1g/5ml S/F (Old)"]
["Liothronine ","0602010M0AAADAD","Liothyronine Sod_Tab 5mcg"]
["Liothronine ","0602010M0AAAEAE","Liothyronine Sod_Cap 5mcg"]
["Midazolam ","0401010Q0AAAKAK","Midazolam Mal_Liq Spec 50mg/5ml"]
["Midazolam ","0408020W0AAABAB","Midazolam_Oromuc Soln 5mg/1ml Pfos S/F"]
["Midazolam ","0408020W0AAABAB","Midazolam_Oromuc Soln 5mg/1ml Pfos S/F"]
["Phenobarbital","0408010P0AABQBQ","Phenobarb Sod_Liq Spec 50mg/5ml"]
["Phenobarbital","0408010N0AABQBQ","Phenobarb_Elix 50mg/5ml"]
["Phenobarbital","0408010N0AABUBU","Phenobarb_Elix 50mg/5ml Alcohol Free"]
["Phenobarbital","0408010N0AACLCL","Phenobarb_Liq Spec 50mg/5ml"]
["Phenobarbital","0408010N0AAEUEU","Phenobarb_Oral Soln 50mg/5ml"]
["Phenobarbital","0408010N0AAEVEV","Phenobarb_Oral Susp 50mg/5ml"]
["Phenobarbital","0408010N0AABLBL","Phenobarb_Soln 50mg/5ml"]
["Methadone ","0410030C0AAAFAF","Methadone HCl_Oral Soln 1mg/1ml S/F"]
["Methadone ","0410030C0BCABAF","Martindale_Methadone HCl Mix 1mg/1ml S/F"]
["Methadone ","0410030C0AABDBD","Methadone HCl_Mix 1mg/1ml S/F        @gn"]
["Levomepromazine","0402010K0AAAMAM","Levomeprom Mal_Tab 6mg"]
["Potassium Chloride","0902011U0AAAHAH","Pot Chlor_Tab 600mg (Pot 8mmol) M/R"]
["Potassium Chloride","0902011U0AAAMAM","Pot Chlor_Tab 600mg"]
["Phytomenadione ","0906060Q0AAACAC","Phytomenadione_Tab 10mg"]
["Phytomenadione ","0906060Q0AABCBC","Phytomenadione_Cap 10mg"]
["Metolazone","0202010V0AAABAB","Metolazone_Cap 2.5mg"]
["Metolazone","0202010V0AAAKAK","Metolazone_Liq Spec 2.5mg/5ml"]
["Metolazone","0202010V0AAANAN","Metolazone_Tab 2.5mg"]
["Mexiletine","0203020P0AAAIAI","Mexiletine HCl_Cap 100mg"]
["Mexiletine","0203020P0AAAMAM","Mexiletine HCl_Tab 100mg"]
["Glycopyrronium ","0102000L0AAADAD","Glycopyrronium Brom_Liq Spec 1mg/5ml"]
["Cyanocobalamin ","0901020D0AAAHAH","Cyanocobalamin_Tab 1mg M/R"]
["Cyanocobalamin ","0901020D0BIAAAH","CyanocoMinn_Tab 1mg M/R"]
["Cyanocobalamin ","0901020D0BKAAAH","CyanocoB12_Tab 1mg M/R"]
["Magnesium Glycerophosphate","0905013G0AAA2A2","Mag Glycerophos_Tab 97.2mg"]
["Magnesium Glycerophosphate","0905013G0AAA4A4","Mag Glycerophos_Cap 97.2mg"]
["Magnesium Glycerophosphate","0905013G0AADADA","Mag Glycerophos_Cap 9.72mg"]
["Magnesium Glycerophosphate","0905013G0AADDDD","Mag Glycerophos_Tab Chble 97.2mg (4mmol)"]
["Magnesium Glycerophosphate","0905013G0AADEDE","Mag Glycerophos_Tab Chble 97.2mg S/F"]
["Magnesium Glycerophosphate","0905013G0AABMBM","Mag Glycerophos_Cap 48.6mg"]
["Magnesium Glycerophosphate","0905013G0AACXCX","Mag Glycerophos_Tab 48.6mg"]
["Mepacrine","0504040M0AAAAAA","Mepacrine HCl_Tab 100mg"]
["Mepacrine","0504040M0AAAEAE","Mepacrine HCl_Cap 100mg"]
["Tacrolimus ","0802020T0AAALAL","Tacrolimus_Liq Spec 5mg/5ml"]
["Tacrolimus ","0802020T0AAAYAY","Tacrolimus_Oral Susp 5mg/5ml"]
["Paracetamol ","0407010H0AAAUAU","Paracet_Syr 500mg/5ml"]
["Paracetamol ","0407010H0AACPCP","Paracet_Liq Spec 500mg/5ml"]
["Paracetamol ","0407010H0AADNDN","Paracet_Oral Susp 500mg/5ml"]
["Paracetamol ","0407010H0AADPDP","Paracet_Oral Soln 500mg/5ml S/F"]

{"sheet":"Unspecified Top 25","index":2,"n_rows":105,"n_cols":15,"rows_kept":105,"cut":false,"hidden":true,"merged":[]}
["Chemical substance/ indication","Product","What is the issue","Spend (national) (Current spend on unlicensed version)","What is the potential solution","Cost of alternative preparation(s)","Monthly cost per item of alternative","Potential cost pressure or savings/ per dose","Assumptions on savings","Indication (include licenced indication or known use and age range it can be used in)","Total Nic 2018/2019","Items","Average Nic per item","link to relevant bulletin/ hot topics issue","Tag listing name"]
["replaced dee below","TRAMADOL 100MG MODIFIED-RELEASE TABLETS","Undspec cost. Consider review of pain contrrol, Deprescribe where possible. Switch to standard release tablets if required. In exception cosnider a branded generic and prescribe by brand e.g. marol ","Unspec drug code","Deprescribe, switch to standard release or consider branded generic if essential","Tramadol standard release (30-£0.85, 100-£2.83)",null,null,null,"pain",205316,1684,122]
["Tramadol","TRAMADOL 100MG MODIFIED-RELEASE TABLETS","NP8 issue. Only listed as modified release capsules in the Drug Tariff, when prescribed as modified release tablet, this product may be priced as a special.",null,"Review for continued need- deprescribe if no longer needed. Prescrive as modified release capsule in line with product listed in Drug Tariff if needed. If tablets required prescribe by brand name.","TramadolTramadol 100mg modified release capsules  (60=£14.77)",14.77,{"$f":"SUM(K3-(K3/M3)*G3)","v":180459.30065573769},"Each unspecifeied special item is for 60 tablets - I month supply","pain",205316,1684,122]
["Tramadol","TRAMADOL 12 HOUR 100MG MODIFIED RELEASE TABLETS","NP8 issue. Only listed as modified release capsules in the Drug Tariff, when prescribed as modified release tablet, this product may be priced as a special.",null,"Review for continued need- deprescribe if no longer needed. Prescrive as modified release capsule in line with product listed in Drug Tariff if needed. If tablets required prescribe by brand name.","TramadolTramadol 100mg modified release capsules  (60=£14.77)",14.77,45721.558083333337,"Each unspecifeied special item is for 60 tablets - I month supply","Pain",52139,435,120]
["Tramadol","TRAMADOL 200MG MODIFIED-RELEASE TABLETS","NP8 issue. Only listed as modified release capsules in the Drug Tariff, when prescribed as modified release tablet, this product may be priced as a special.",null,"Review for continued need- deprescribe if no longer needed. Prescrive as modified release capsule in line with product listed in Drug Tariff if needed. If tablets required prescribe by brand name.","TramadolTramadol 100mg modified release capsules  (60=£28.93)",28.93,45816.415368421054,"Each unspecifeied special item is for 60 tablets - I month supply","Pain",65878,691,95]
["Tramadol","TRAMADOL 150MG MODIFIED-RELEASE TABLETS","NP8 issue. Only listed as modified release capsules in the Drug Tariff, when prescribed as modified release tablet, this product may be priced as a special.",null,"Review for continued need- deprescribe if no longer needed. Prescrive as modified release capsule in line with product listed in Drug Tariff if needed. If tablets required prescribe by brand name.","TramadolTramadol 100mg modified release capsules  (60=£21.71)",21.71,21228.860898876403,"Each unspecifeied special item is for 60 tablets - I month supply","Pain",28078,316,89]
["Treatment for dry eyes","DUOLUBE EYE OINTMENT","NP8 issue. Not listed in the Drug Tariff. Not licenced  medicinal product or appliance in the UK. Has been priced as a special.","Unspec drug code","Consider self care Consider alternative eye drops for dry eyes that are available in DT","  Hypromellose 0.3% eye drops  10ml =99p",0.99,16067.4696,"Each unspecified item is for 1 bottle","Dry eyes ",16110,43,375]
["Artificial Saliva","ARTIFICIAL SALIVA SPRAY","NP8 issue. Listed in the Drug Tariff  as Artificial Saliva Protective Spray DPF ","Unspec drug code","Consider self care where appropriate. If prescribed, prescribe as written in the DT Artificial Saliva protective spray DPF which is £9.85 for 40ml. Several cost effective brands also available Oralieve Moisturising Mouth Gel (50ml=- £2.96). See Drug Tariff for full list of products. ","Artificial Saliva protective spray DPF which is £9.85 for 40ml",9.85,47651.793818181817,"Assume 1 item is 1 bottel","Dry mouth as a result of having (or having undergone) radiotherapy (ACBS), ",49422,180,275]
[null,"ALBRIGHTS SOLUTION","High spend on a product that requires specialist intiation. No alternative avaialblie. Unspecified drug. ","Unlicensed ","Refer prescribing back tp specialsit for review. If continued need, consider commissioning service locally where specialist prescribes treatment.",null,null,null,"Consider cost of commissioning a service through secondary care vs dispensing in primary care. ","None",124167,127,978]
["replaced- see line 5 above ","TRAMADOL 200MG MODIFIED-RELEASE TABLETS","as above",null,null,"as above",null,null,null,null,65878,691,95]
["replaced- see line 4 above ","TRAMADOL 12 HOUR 100MG MODIFIED RELEASE TABLETS","as above",null,null,"as above",null,null,null,null,52139,435,120]
["replaced -see 8 above ","ARTIFICIAL SALIVA SPRAY","High spend when prescribed generically. ","Unspec drug code","Mulitple alternatives available. Rx by brand- refer to DT for dull list. (e,.g  Oralieve Moisturising Mouth Gel (50ml=- £2.96)","extract from DT for various products ",null,null,null,"Dry mouth as a result of having (or having undergone) radiotherapy (ACBS), ",49422,180,275]
[null,"MORPHINE SULFATE 50MG/50ML SOLUTION FOR INFUSION VIALS","Rx : Morphine sulfate 50mg/50ml solution for infusion vials as per DT? Why is this rx'd as Unsepc ","Unspec drug code",null,null,null,null,null,null,49206,47,1047]
[null,"GLYCINE 10% SOLUTION","Not available in this preperation, made up as a special ","Unlicensed ","If required, specailist to prescribe and continue ",null,null,null,null,"Bladder irrigation during urological surgery, \nIrrigation for transurethral resection of the prostate gland and bladder tumours",38025,42,905]
[null,"CLOBAZAM 5MG/5ML ORAL SOLUTION","Unspec drug. DT name Clobazam 5mg/5ml oral suspension sugar free. Rx by brand, ",null,"Rx by brand vaious in BNF . Zacco 5mg/5ml oral suspension (Thame Laboratories Ltd) £82 150ml -",null,null,null,null,null,34442,180,191]
[null,"LACTIC ACID 10% IN DIPROBASE","Unlicensed cream. ","Unlicensed ","This cream is not on BAD list, not licensed. If requried to continue consider prescribing by specialist",null,null,null,null,null,28600,13,2200]
["Replaced see line 7 above","TRAMADOL 150MG MODIFIED-RELEASE TABLETS","as above",null,null,null,null,null,null,null,28078,316,89]
[null,"ALBRIGHTS ORAL SOLUTION - CITRIC ACID MONOHYDRATE BP 6.6%, SODIUM CITRATE BP 5%, POTASSIUM CITRATE BP 5%, WATER FOR IRRIGATION TO 100%","as above",null,null,null,null,null,null,null,27383,6,4564]
[null,"RAVICTI 1.1G/ML ORAL LIQUID (SWEDISH ORPHAN BIOVITRUM LTD)",null,null,null,null,null,null,null," is indicated for use as adjunctive therapy for chronic management of patients with urea cycle disorders (UCDs) including deficiencies of carbamoyl phosphate synthetase I (CPS), ornithine carbamoyltransferase (OTC), argininosuccinate synthetase (ASS), argininosuccinate lyase (ASL), arginase I (ARG) and ornithine translocase deficiency hyperornithinaemia-hyperammonaemia homocitrullinuria syndrome (HHH) who cannot be managed by dietary protein restriction and/or amino acid supplementation alone.",25247,6,4208]
[null,"MORPHINE SULFATE 10MG/5ML ORAL SOLUTION (MARTINDALE PHARMACEUTICALS LTD) ALCOHOL AND SUGAR FREE","as above",null,null,null,null,null,null,null,25204,40,630]
[null,"UBIDECARENONE 100MG CAPSULES","not licensed. Supplement . Limited evidence for its use. ",null,"Review continued need. If recommended by specialist, cosndier secondary care to continue prescribing. ",null,null,null,null,"Mitochondrial disorders",24825,115,216]
[null,"PENTOSAN POLYSULFATE SODIUM 100MG CAPSULES","elmiron 100 mg hard capsules are available in UK. Other products available for imporrt. ",null,"Review continued need. If recommended by specialist, cosndier secondary care to continue prescribing. ",null,null,null,null,"Bladder pain syndrome",20148,42,480]
[null,"GLYCOPYRRONIUM BROMIDE 600MICROGRAMS/3ML SOLUTION FOR INJECTION AMPOULES","DT Glycopyrronium bromide 600micrograms/3ml solution for injection ampoules. ",null,null,null,null,null,null,null,18682,50,374]
[null,"SODIUM CHLORIDE 5% EYE DROPS","Part IXA-Appliances.  Alissa brnad is what is available in DT . (£25.25 for 10ml, shelf life 90 days ) Othr brands available. ","Unspec drug code","Rx by brand. Review cost effective and consider rx by brand..",null,null,null,null,"Corneal odema, recurrent corneal erosion syndrome",17407,238,73]
[null,"SECUKINUMAB 150MG/1ML SOLUTION FOR INJECTION PRE-FILLED DISPOSABLE DEVICES",null,"Unspec drug code","Review continued need. If recommended by specialist, cosndier secondary care to continue prescribing. BNF states that it should be intiaited by specialist. ",null,null,null,null,"Ankylosing spondylitis, Psoriatic arthritis, psoriatic arthritis with concomitant moderate to severe plaque psoriasis or if inadequate response to anti-TNFα treatment , \nPlaque psoriasis",16454,8,2057]
["replaced - see row 8 above","DUOLUBE EYE OINTMENT","Not available in BNF/ DT . High cost. Not considered a medicinal product or appliance. ","Unspec drug code","Consider alternative eye drops for dry eyes that are available in DT (e.g. hypromellose 0.3%)",null,null,null,null,"Dry eyes ",16110,43,375]
[null,"ELECTROLYTE SOLUTION G",null,null,null,null,null,null,null,null,15700,6,2617]
[null,"DIAZEPAM 2MG/5ML ORAL SOLUTION",null,null,null,null,null,null,null,null,15443,101,153]
[null,"TRIMOVATE CREAM (ENNOGEN HEALTHCARE LTD)",null,null,null,null,null,null,null,null,14131,210,67]
[null,"DERMOVATE 60% IN 40% PROPYLENE GLYCOL",null,null,null,null,null,null,null,null,14044,36,390]
[null,"CLOBAZAM 10MG/5ML ORAL SOLUTION",null,null,null,null,null,null,null,null,13742,93,148]
[null,"LACTIC ACID 10% IN DIPROBASE CREAM",null,null,null,null,null,null,null,null,13582,9,1509]
[null,"GLYCINE 10% SOLUTION HRI FORMULARY",null,null,null,null,null,null,null,null,13437,10,1344]
[null,"ING POWDER",null,null,null,null,null,null,null,null,12911,7,1844]
[null,"CYSTEAMINE 0.55% EYE DROPS",null,null,null,null,null,null,null,null,12856,10,1286]
[null,"GLYCOBROMAG 2MG CAPSULES (TEMAG)",null,null,null,null,null,null,null,null,12004,63,191]
[null,"POTASSIUM ACID PHOSPHATE 5MMOL/5ML LIQUID",null,null,null,null,null,null,null,null,11955,33,362]
[null,"ORAL REHYDRATION SALTS ORAL POWDER WHO FORMULATION",null,null,null,null,null,null,null,null,11201,12,933]
[null,"CHORIONIC GONADOTROPHIN 5,000UNIT POWDER AND SOLVENT FOR SOLUTION FOR INJECTION AMPOULES",null,null,null,null,null,null,null,null,11005,7,1572]
[null,"LIQ-Q10 SYRUP",null,null,null,null,null,null,null,null,11000,10,1100]
[null,"POTASSIUM CITRATE + SODIUM BICARBONATE MIXTURE",null,null,null,null,null,null,null,null,10036,15,669]
[null,"EUMOVATE 0.05% OINTMENT (GLAXOSMITHKLINE UK LTD) WITH COAL TAR SOLUTION 5% W/W",null,null,null,null,null,null,null,null,9597,13,738]
[null,"POTASSIUM CHLORIDE 2MMOL/ML SOLUTION",null,null,null,null,null,null,null,null,9557,7,1365]
[null,"MORPHINE SULFATE 50MG/50ML SOLUTION FOR INFUSION VIALS QUANTUM PHARMA",null,null,null,null,null,null,null,null,9517,8,1190]
[null,"SODIUM PHOSPHATE NEUTRAL (GUYS & ST THOMAS FORMULA) ORAL SOLUTION (GUYS)",null,null,null,null,null,null,null,null,9342,14,667]
[null,"FLUCLOXACILLIN 250MG/5ML ORAL SUSPENSION",null,null,null,null,null,null,null,null,9293,118,79]
[null,"POLYVINYL ALCOHOL 1.4% EYE DROPS",null,null,null,null,null,null,null,null,9203,69,133]
[null,"ARTIFICIAL SALIVA PASTILLES",null,null,null,null,null,null,null,null,8782,47,187]
[null,"KNOX FORMULA MOUTHWASH",null,null,null,null,null,null,null,null,8471,53,160]
[null,"WHITE SOFT PARAFFIN 13.2% / LIQUID PARAFFIN LIGHT 10.5% CREAM",null,null,null,null,null,null,null,null,8402,85,99]
[null,"VALGANCICLOVIR 450MG TABLETS",null,null,null,null,null,null,null,null,8335,18,463]
[null,"MEXILETINE 200MG CAPSULES",null,null,null,null,null,null,null,null,8182,24,341]
[null,"FLUCONAZOLE 200MG/100ML SOLUTION FOR INFUSION VIALS",null,null,null,null,null,null,null,null,8106,8,1013]
[null,"POTASSIUM CHLORIDE 2MMOL IN 1ML STERILE SOLUTION",null,null,null,null,null,null,null,null,8038,6,1340]
[null,"VALGANCICLOVIR 450MG TABS",null,null,null,null,null,null,null,null,7992,10,799]
[null,"Diazepam 2mg/5ml oral solution-200",null,null,null,null,null,null,null,null,7912,36,220]
[null,"POTASSIUM CITRATE 20MMOL PER 5ML (MIXTURE) POTASSIUM CITRATE POWDER PURIFIED WATER",null,null,null,null,null,null,null,null,7723,7,1103]
[null,"BEDROLITE 10%",null,null,null,null,null,null,null,null,7278,2,3639]
[null,"DERMOVATE CREAM 60% IN PROPYLENE GLYCOL",null,null,null,null,null,null,null,null,7248,22,329]
[null,"POTASSIUM CHLORIDE 2MMOL/1ML",null,null,null,null,null,null,null,null,7233,2,3616]
[null,"COW & GATE STERILE WATER",null,null,null,null,null,null,null,null,7183,18,399]
[null,"HYDROUS OINTMENT",null,null,null,null,null,null,null,null,7128,59,121]
[null,"UBIDECARENONE 100MG CAPS",null,null,null,null,null,null,null,null,7125,27,264]
[null,"ST MARKS HOSPITAL FORMULA",null,null,null,null,null,null,null,null,7108,3,2369]
[null,"OLIVE OIL LIQUID, GLYCEROL AND LANOLIN BP",null,null,null,null,null,null,null,null,6960,4,1740]
[null,"COLESTYRAMINE 10% IN CETOMACROGOL A",null,null,null,null,null,null,null,null,6814,9,757]
[null,"COLEVIT D3 3,000 UNITS/ML ORAL SOLUTION",null,null,null,null,null,null,null,null,6785,66,103]
[null,"LOPERAMIDE 1MG IN 1ML SUGAR & GLYCEROL FREE",null,null,null,null,null,null,null,null,6720,10,672]
[null,"REHYDRATION TREATMENT SACHETS WHO FORMULA",null,null,null,null,null,null,null,null,6684,5,1337]
[null,"FLUCLOXACILLIN 250MG/5ML SUSPENSION",null,null,null,null,null,null,null,null,6554,80,82]
[null,"DERMOVATE OINTMENT 50% IN ORABASE",null,null,null,null,null,null,null,null,6397,17,376]
[null,"SODIUM VALPROATE 200MG/5ML ORAL SOLUTION SUGAR FREE COLOUR FREE",null,null,null,null,null,null,null,null,6298,8,787]
[null,"HYDROCORTISONE 1% OINTMENT WITH CLIOQUINOL 3%, LIQUID PARAFFIN 25% WITH WSP",null,null,null,null,null,null,null,null,6000,8,750]
[null,"BETNOVATE 25% OINTMENT IN COAL TAR PASTE",null,null,null,null,null,null,null,null,5921,13,455]
[null,"Mexiletine 200mg capsules-100",null,null,null,null,null,null,null,null,5887,2,2943]
[null,"CREAMY PARAFFIN",null,null,null,null,null,null,null,null,5882,17,346]
[null,"CLONAZEPAM 1MG/1ML SOLUTION FOR INJECTION AMPOULES AND DILUENT",null,null,null,null,null,null,null,null,5844,23,254]
[null,"UREA 10% CREAM",null,null,null,null,null,null,null,null,5833,19,307]
[null,"COLECALCIFEROL 400UNITS/ML ORAL DROPS SUGAR FREE",null,null,null,null,null,null,null,null,5792,27,215]
[null,"ALBRIGHTS SOLUTION (MODIFIED SHOHL'S SOLUTION)",null,null,null,null,null,null,null,null,5753,8,719]
[null,"DERMOVATE 50% CREAM IN PROPYLENE GLYCOL",null,null,null,null,null,null,null,null,5725,21,273]
[null,"THYROXINE 200MCG AMPOULES",null,null,null,null,null,null,null,null,5628,1,5628]
[null,"NEUTRALISATION VACCINE",null,null,null,null,null,null,null,null,5367,11,488]
[null,"PEPPERMINT SOLUTION PHF",null,null,null,null,null,null,null,null,5357,11,487]
[null,"NEUTRAL SODIUM PHOSPHATE",null,null,null,null,null,null,null,null,5344,8,668]
[null,"BETNOVATE 50% COMPOUND OINTMENT",null,null,null,null,null,null,null,null,5254,10,525]
[null,"CALCIUM CARBONATE 1.25G TABLETS",null,null,null,null,null,null,null,null,5223,52,100]
[null,"ISRADIPINE 2.5MG TABLETS",null,null,null,null,null,null,null,null,5214,27,193]
[null,"POTASSIUM CHLORIDE 15% SOLUTION",null,null,null,null,null,null,null,null,5202,8,650]
[null,"Melatonin 1mg tablets-150",null,null,null,null,null,null,null,null,5191,1,5191]
[null,"BETAINE 500MG/ML POWDER FOR ORAL SOLUTION",null,null,null,null,null,null,null,null,5191,1,5191]
[null,"AMBETAMINE 500MG IN 1ML POWDER BOTTLES",null,null,null,null,null,null,null,null,5191,1,5191]
[null,"AMBETAINE 100ML BOTTLES",null,null,null,null,null,null,null,null,5191,1,5191]
[null,"GLYCOBROMAG 1MG CAPSULES (TEMAG)",null,null,null,null,null,null,null,null,5191,39,133]
[null,"STALEVO 150/37.5/200MG/5ML ORAL SUSPENSION",null,null,null,null,null,null,null,null,5120,5,1024]
[null,"CICLOPIROX OLAMINE 1.5% SHAMPOO",null,null,null,null,null,null,null,null,5084,37,137]
[null,"DIAMINOPYRIDINE 20MG TABLETS",null,null,null,null,null,null,null,null,4956,15,330]
[null,"FLECAINIDE 25MG/5ML ORAL SUSPENSION (ROSEMONT)",null,null,null,null,null,null,null,null,4906,13,377]
[null,"MEMANTINE 5MG/ACTUATION ORAL SOLUTION (ACTAVIS)",null,null,null,null,null,null,null,null,4904,50,98]
[null,"EPADERM OINTMENT (MOLNLYCKE HEALTH CARE LTD) WITH 1% HYDROCORTISONE OINTMENT",null,null,null,null,null,null,null,null,4900,7,700]
[null,"STALEVO 100MG/25MG/200MG LIQUID",null,null,null,null,null,null,null,null,4896,8,612]
[null,"RESONIUM A 1G/5ML SUSPENSION",null,null,null,null,null,null,null,null,4754,50,95]
[null,"GENTAMICIN 80MG/2ML SOLUTION FOR INJECTION AMPOULES",null,null,null,null,null,null,null,null,4708,3,1569]
[null,"SODIUM CHLORIDE 3% NEBULES",null,null,null,null,null,null,null,null,4583,6,764]
[null,"COAL TAR SOLUTION 5% SALICYCLIC ACID 2% IN BETNOVATE CREAM",null,null,null,null,null,null,null,null,4576,12,381]

{"sheet":"Sheet2","index":3,"n_rows":7,"n_cols":11,"rows_kept":7,"cut":false,"hidden":true,"merged":[]}
["Unspecified - top 50 grps"]
["Specials - ","25 DT and 25 non-DT "]
[]
[]
[]
[null,"Omeprazole_Oral Susp 10mg/5ml","Unlciensed. Oral formualtions in form of dispersable tabelts available. Consider alternative choices for managament of patients. E.g. gaviscon, ranitidine .Omeprazole 5, 10, 20 , 40mg  per 5ml are available as DT special. (5mg -£63.01- 70ml, 10mg- 75ml-£67.82, 20mg -£89.05- 150ml, 40mg - £10q=1.25- 100ml) ","Unlicensed ","Variable",null,2413,"Drug tariff special order products cost per 1,000 patients",28569,"Review patients requirement. For adults switch to orodisperable preperations. Lansoprazole orodisperable are more cost effective. ","Prescqipp B123. Omeprazole (SPOT-List) https://www.prescqipp.info/our-resources/bulletins/bulletin-123-omeprazole-spot-list/"]
[null,"Omeprazole_Oral Susp 20mg/5ml","As above","As above","As above",null,"As above","Drug tariff special order products cost per 1,000 patients",14135,"as above","Prescqipp B123. Omeprazole (SPOT-List) https://www.prescqipp.info/our-resources/bulletins/bulletin-123-omeprazole-spot-list/"]

{"sheet":"Cover sheet","index":4,"n_rows":36,"n_cols":1,"rows_kept":36,"cut":false,"hidden":false,"merged":[]}
["Specials Database "]
["Version 2.0 | August 2024"]
[]
["This database forms part of the specials webkit and is supported by the Bulletin 301: Specials Prescribing."]
["https://www.prescqipp.info/our-resources/webkits/specials/"]
[]
["This database contains a separate tab for each letter of the alphabet (by product name). In addition, the list of products within each tab is also alphabetical to facilitate easy searching. Ctrl+F can also be used on any individual tab to find keywords, drug names, etc."]
[]
["If a medicine is required, a stepped approach is suggested to choose an appropriate preparation, especially where an adult has difficulties swallowing. A special should only be prescribed when there is no available licensed medicine which fully meets the patient’s clinical needs."]
[]
["For each product listed in this database, up to three prescribing options have been suggested, where applicable. \nOption 1 is to prescribe a licensed medicine in a suitable licensed formulation if there is an ongoing need for treatment (this should include consideration of switching to different drug in same therapeutic class, if appropriate, or switching back to a licensed formulation, for example, if swallowing difficulties have resolved). \nOption 2 is to prescribe a licensed medicine in an unlicensed or off-label manner (e.g. crushing tablets for patients with swallowing difficulties). It may be necessary to import a licensed product if no suitable licensed alternative is available. \nOption 3 is to prescribe a special, but only if a clinical reason exists for not using a licensed product or an off-label product, for example, for a patient requiring unlicensed preservative-free eye drops where there is no suitable licensed alternative."]
[]
["Please note: The recommendations in this database are not applicable for administration via enteral feeding tubes. Please see under additional resources below for more information."]
[]
["Check the correct Drug Tariff for your country to see current prices (links below). Where high-cost products are deemed necessary, prescribing should be regularly reviewed to assess the need for ongoing prescribing. \nNote: the term HIGH COST, when used in the database, takes into account the cost of the usual total daily dose and the cost in comparison to other alternative treatments, where these are available."]
["England and Wales: https://www.drugtariff.nhsbsa.nhs.uk/"]
[]
["Scotland: https://publichealthscotland.scot/services/scottish-drug-tariff/"]
[]
["The prescribing of all unlicensed/off-label products should be regularly reviewed to assess ongoing need. Where treatment is for a limited duration only, a stop date should be included on the prescription to ensure appropriate discontinuation. For treatments recommended by a specialist, the review interval or stop date should be clarified to ensure that treatment does not continue inappropriately."]
[]
["There can be variation in the licensing of different medicines containing the same drug. Always check the indication for prescribing and licensed indications of the available treatment options before switching and consider the individual and their needs, in some therapeutic areas, a particular formulation may be required, especially as the condition progresses. Some patients may also require a particular formulation to ensure compliance."]
[]
["Where an unlicensed medicine has been recommended by a specialist or is prescribed under shared care, any proposed changes should be discussed with them to ensure they are suitable, bearing in mind that the prescriber signing the prescription takes responsibility for the unlicensed/off-label medicine."]
[]
["Additional resources"]
["•\tMore information can be found in the NEWT guidelines, which provide information on the administration of medication to patients with enteral feeding tubes or swallowing difficulties. \n•\tFor administration via an enteral feeding tube, please refer to the NEWT Guidelines, the current edition of the Enteral Feeding Handbook or to your local medicines information service for more information."]
["https://newtguidelines.com/"]
["•\tThe BNF/BNF for Children contain suggestions for alternatives in class under some products that may be available, e.g. a licensed liquid or soluble formulation. "]
["https://bnf.nice.org.uk"]
["•\tIn England, consider items within the NHS England document: Items which should not routinely be prescribed in primary care: policy guidance "]
["https://www.england.nhs.uk/long-read/items-which-should-not-routinely-be-prescribed-in-primary-care-policy-guidance/"]
["•\tPlease refer to any appropriate PrescQIPP resources to support this document, including those in relation to medication review, inappropriate polypharmacy, and low priority prescribing."]
["https://www.prescqipp.info/"]
["•\tPlease refer to the summary of product characteristics for licensed products to assess whether the intended use is licensed or unlicensed/off-label."]
["https://www.medicines.org.uk/emc#gref"]

{"sheet":"A ","index":5,"n_rows":16,"n_cols":10,"rows_kept":16,"cut":false,"hidden":false,"merged":[[0,1,0,4]]}
["KEY","* Drug Tariff (England and Wales) May 24    § NEWT guidelines for administration of medication to patients with enteral feeding tubes or swallowing difficulties, Fourth edition- August 2021\n‡ Enteral Feeding Handbook 3rd edition        ** Scottish Drug Tariff April 24"]
["Chemical substance","What is the issue?","Option 1: Use a licensed medicine in a suitable licensed formulation (incl review ongoing need or change to different drug in same therapeutic class)","Licensed preparation(s) and cost (option 1) per original pack*","Option 2: Use a licensed medicine in an unlicensed manner (e.g. crushing tablets). See NEWT for further information.§ \nNot applicable for enteral feeding tubes, refer to resources§,‡ or local medicines information service for more information","Off-label preparation(s) and cost (option 2) per original pack*","Option 3: Only if clinical reason exists for not using licensed product: Use an unlicensed special","Unlicensed special preparation(s) and cost (option 3) per original pack*","Comments ","Scottish Drug Tariff considerations**"]
["Acetylcysteine 5% Eye Drops Preservative-Free","No preservative-free licensed drops available ","Licensed 5% eye drops available, contain preservative.* Consider if appropriate.","•\tAcetylcysteine 5% eye drops (Ilube)\n£80.95/10ml\t","Not applicable","Not applicable","Various unlicensed specials","Variable, fluctuating and unregulated","Consider preservative-containing drops as the preferred option, if possible."]
["Acetylcysteine, oral ","Unlicensed preparations are being prescribed when there are licensed alternatives available ","Available as licensed capsules, oral powder sachets and effervescent tablets.\nCapsules and sachets HIGH COST","•\tAcetylcysteine 600mg capsules £85.00/30 HIGH COST\n•\tAcetylcysteine 200mg oral powder sachets £112.50/30 HIGH COST\n•\tAcetylcysteine 200mg oral powder sachets sugar-free £112.50/30 HIGH COST\t \n•\tAcetylcysteine 600mg effervescent tablets sugar-free £5.50/30","Not applicable","Not applicable","Various unlicensed specials","Variable, fluctuating and unregulated","Consider licensed formulations. Cost-effective effervescent options available. For administration by mouth, BNF states that expert sources advise use oral granules, or dilute injection solution (200 mg/mL) to a concentration of 50 mg/mL; orange or blackcurrant juice or cola drink may be used as a diluent to mask the bitter taste.","The Scottish Drug Tariff lists:\t\n•\tAcetylcysteine 600mg capsules £101.98/30 HIGH COST"]
["Alendronic acid","Unlicensed preparations are being prescribed when there are licensed alternatives available ","Licensed liquid and effervescent tablets available","•\tAlendronic acid 70mg effervescent tablets sugar-free £11.60/4\n•\tAlendronic acid 70mg tablets £0.95/4\t \n•\tAlendronic acid 70mg/100ml oral solution unit dose sugar-free £31.36/4\n•\tAlendronic acid 70mg/colecalciferol 70 mcg tablets £22.80/4\t\t \n•\tAlendronic acid 70mg/colecalciferol 140 mcg tablets £4.25/4\t","Not applicable","Not applicable","Various unlicensed specials","Variable, fluctuating and unregulated","If 70mg dose required, used licensed products; effervescent tablets represent a cost-effective option for patients with swallowing difficulties. ","The Scottish Drug Tariff lists:\t\n•\tAlendronic acid 70mg tablets £1.93/4 \n"]
["Allopurinol","No licensed liquid available ","No suitable licensed preparation available for patients who are unable to swallow the solid oral dosage form","Not applicable","Tablets can be crushed and mixed with water for oral administration","•\tAllopurinol 100mg tablets £0.71/28\t \n•\tAllopurinol 300mg tablets £0.97/28","The England/Wales Drug Tariff lists the following unlicensed specials with regulated prices:\t \n•\tAllopurinol 100mg/5ml oral solution\n•\tAllopurinol 100mg/5ml oral suspension \n•\tAllopurinol 300mg/5ml oral suspension ","•\tAllopurinol 100mg/5ml oral solution £26.56/100ml\t \n•\tAllopurinol 100mg/5ml oral suspension £23.19/100ml\n•\tAllopurinol 300mg/5ml oral suspension £22.93/100ml",null,"The Scottish Drug Tariff lists:\t \t \t \t \n•\tAllopurinol 100mg tablets £1.20/28\n•\tAllopurinol 300mg tablets £1.80/28 \n•\tAllopurinol 100mg/5ml oral suspension £32.39/150ml"]
["Amiloride ","Unlicensed preparations are being prescribed when there are licensed alternatives available ","Licensed liquid available - HIGH COST\nChange to different drug in same/similar therapeutic class where licensed liquid is available - see BNF.","•\tAmiloride 5mg/5ml oral solution sugar-free £158.85/150ml\t","Tablets can be crushed and mixed with water for oral administration","•\tAmiloride 5mg tablets £15.94/28\t","Various unlicensed specials","Variable, fluctuating and unregulated",null,"The Scottish Drug Tariff lists:\t \t \t \t \n•\tAmiloride 5mg tablets £23.00/28\t"]
["Amiodarone","No licensed liquid available ","No suitable licensed preparation available for patients who are unable to swallow the solid oral dosage form","Not applicable","Tablets can be crushed and mixed with water for oral administration","•\tAmiodarone 100mg tablets £1.82/28\t \n•\tAmiodarone 200mg tablets £1.76/28\t ","The England/Wales Drug Tariff lists the following unlicensed specials with regulated prices:\t \t \n•\tAmiodarone 50mg/5ml oral suspension  \n•\tAmiodarone 100mg/5ml oral suspension","•\tAmiodarone 50mg/5ml oral suspension £25.50/100ml \n•\tAmiodarone 100mg/5ml oral suspension £25.04/100ml ","See NHS England document - Items which should not routinely be prescribed in primary care ","The Scottish Drug Tariff lists:\t \t \t \t \n•\tAmiodarone 100mg tablets £2.24/28\n•\tAmiodarone 200mg tablets £1.96/28\t"]
["Amisulpride","Unlicensed preparations are being prescribed when there are licensed alternatives available ","Licensed liquid available - HIGH COST\nMay need referral to specialist prescriber; suggest change to different drug in same/similar therapeutic class where licensed soluble tablet/liquid is available - see BNF. ","•\tAmisulpride 100mg/ml oral solution sugar-free £98.60/60ml\t","Not applicable ","Not applicable","Various unlicensed specials","Variable, fluctuating and unregulated"]
["Amitriptyline","Unlicensed preparations are being prescribed when there are licensed alternatives available ","Licensed liquid available - HIGH COST (10mg/5ml strength). \nFor some indications, review ongoing need.","•\tAmitriptyline 10mg/5ml oral solution sugar-free £126.10/150ml\n•\tAmitriptyline 25mg/5ml oral solution sugar-free £19.51/150ml \n•\tAmitriptyline 50mg/5ml oral solution sugar-free £18.78/150ml","Tablets can be crushed and dispersed in water for oral administration","•\tAmitriptyline 10mg tablets £0.63/28\n•\tAmitriptyline 25mg tablets £0.64/28\n•\tAmitriptyline 50mg tablets £0.82/28","Various unlicensed specials","Variable, fluctuating and unregulated","Prescribe as licensed oral solution, avoiding the high cost 10mg/5ml strength, if possible. A 10mg dose can be given as 1ml of the 50mg/5ml sugar-free oral solution, if needed.","The Scottish Drug Tariff lists:\t \t \t \t \n•\tAmitriptyline 10mg tablets £1.00/28\n•\tAmitriptyline 25mg tablets £1.12/28\n•\tAmitriptyline 50mg tablets £1.44/28\n•\tAmitriptyline 10mg/5ml oral solution sugar-free £136.47/150ml HIGH COST"]
["Amlodipine","Unlicensed preparations are being prescribed when there are licensed alternatives available ","Licensed liquid available - HIGH COST\nThe 5mg/5ml sugar-free oral suspension is the most cost-effective.","•\tAmlodipine 10mg/5ml oral solution sugar-free £98.37/150ml\t\n•\tAmlodipine 5mg/5ml oral solution sugar-free £76.06/150ml\t\t \n•\tAmlodipine 5mg/5ml oral suspension sugar-free £70.00/150ml","Tablets can be crushed and mixed with water for oral administration. They should be taken immediately as they are light sensitive.","•\tAmlodipine 2.5mg tablets £4.98/28\n•\tAmlodipine 5mg tablets £0.63/28\n•\tAmlodipine 10mg tablets £0.66/28","Various unlicensed specials","Variable, fluctuating and unregulated",null,"•\tAmlodipine 2.5mg tablets £4.98/28\n•\tAmlodipine 5mg tablets £1.00/28\n•\tAmlodipine 10mg tablets £1.12/28\n•\tAmlodipine 5mg/5ml oral solution sugar free £87.15/150ml HIGH COST \n•\tAmlodipine 10mg/5ml oral solution sugar-free £115.73/150ml HIGH COST"]
["Apixaban","No licensed liquid available ","Tablets can be crushed and mixed with water, glucose 5%, apple juice, or apple \npuree for oral administration. This is a licensed use.","•\tApixaban 2.5mg tablets £2.91/60\t \n•\tApixaban 5mg tablets £2.83/56","Not applicable ","Not applicable","Various unlicensed specials","Variable, fluctuating and unregulated",null,"The Scottish Drug Tariff lists:\t \t \t \t \n•\tApixaban 2.5mg tablets £2.91/60\t \n•\tApixaban 5mg tablets £2.83/56"]
["Ascorbic acid","Unlicensed preparations are being prescribed when there are licensed alternatives available ","Licensed chewable tablets are available but review indication for prescribing. \nNot usually recommended to be prescribed on the NHS.","•\tAscorbic acid 50mg tablets £43.86/28\n•\tAscorbic acid 100mg tablets £45.86/28\t\t \n•\tAscorbic acid 200mg tablets £67.70/28\t\t \n•\tAscorbic acid 500mg tablets £47.90/28\t","Not applicable","Not applicable","Various unlicensed specials","Variable, fluctuating and unregulated","Consider licensed formulations.","The Scottish Drug Tariff lists:\t \t \t \t \n•\tAscorbic acid 100mg tablets £56.91/28\t\t \n•\tAscorbic acid 200mg tablets £84.08/28\t\t \n•\tAscorbic acid 500mg tablets £61.39/28\t"]
["Atorvastatin","Unlicensed preparations are being prescribed when there are licensed alternatives available ","Available as a licensed liquid and chewable tablets - HIGH COST\nThe chewable tablets are most cost-effective.","•\tAtorvastatin 10mg chewable tablets sugar-free £13.80/30\t\n•\tAtorvastatin 20mg chewable tablets sugar-free £26.40/30\n•\tAtorvastatin 20mg/5ml oral suspension sugar-free £216.00/150ml\t","Atorvastatin can be crushed and mixed with water for oral administration but it is not very soluble; if a residue is left behind, there will be incomplete dosing. It should be taken immediately as the drug is light sensitive. ","•\tAtorvastatin 10mg tablets £1.29/28\t\n•\tAtorvastatin 20mg tablets £1.26/28\t\n•\tAtorvastatin 30mg tablets £22.01/28\t\n•\tAtorvastatin 40mg tablets £1.68/28\t\n•\tAtorvastatin 60mg tablets £24.98/28\t\n•\tAtorvastatin 80mg tablets £3.15/28\t","The England/Wales Drug Tariff lists the following unlicensed specials with regulated prices: \t \n•\tAtorvastatin 10mg/5ml oral solution \n•\tAtorvastatin 10mg/5ml oral suspension","•\tAtorvastatin 10mg/5ml oral solution £22.33/150ml\n•\tAtorvastatin 10mg/5ml oral suspension £107.76/100ml",null,"The Scottish Drug Tariff lists:\t \t \t \t \n•\tAtorvastatin 10mg tablets £1.11/28\n•\tAtorvastatin 20mg tablets £1.64/28\n•\tAtorvastatin 40mg tablets £1.49/28\n•\tAtorvastatin 80mg tablets £2.64/28"]
["Atropine  sulfate 1% eye drops preservative-free","Unlicensed preparations are being prescribed when there are licensed alternatives available ","Licensed eye drops available - HIGH COST. \nThe preservative-free unit dose eye drops are most cost-effective.","•\tAtropine 1% eye drops £214.04/10ml\t \n•\tAtropine 1% eye drops 0.5ml unit dose preservative-free £17.13/20","Not applicable ","Not applicable","Various unlicensed specials","Variable, fluctuating and unregulated","Check course length and stop once reached."]
["Azathioprine","Unlicensed preparations are being prescribed when there are licensed alternatives available ","Licensed sugar-free oral suspension available - HIGH COST","•\tAzathioprine 10mg/ml oral suspension £250.00/200ml","Tablets should NOT be crushed as they are cytotoxic","Not applicable",null,null,null,"The Scottish Drug Tariff lists:\t \t \t \t \n•\tAzathioprine 50mg/5ml oral suspension 100 ml £73.54/100ml HIGH COST"]

{"sheet":"B","index":6,"n_rows":9,"n_cols":10,"rows_kept":9,"cut":false,"hidden":false,"merged":[[0,1,0,4]]}
["KEY","* Drug Tariff (England and Wales) May 24    § NEWT guidelines for administration of medication to patients with enteral feeding tubes or swallowing difficulties, Fourth edition- August 2021\n‡ Enteral Feeding Handbook 3rd edition        ** Scottish Drug Tariff April 24"]
["Chemical substance","What is the issue?","Option 1: Use a licensed medicine in a suitable licensed formulation (incl review ongoing need or change to different drug in same therapeutic class)","Licensed preparation(s) and cost (option 1) per original pack*","Option 2: Use a licensed medicine in an unlicensed manner (e.g. crushing tablets). See NEWT for further information.§ \nNot applicable for enteral feeding tubes, refer to resources§,‡ or local medicines information service for more information","Off-label preparation(s) and cost (option 2) per original pack*","Option 3: Only if clinical reason exists for not using licensed product: Use an unlicensed special","Unlicensed special preparation(s) and cost (option 3) per original pack*","Comments ","Scottish Drug Tariff considerations**"]
["Baclofen ","Unlicensed preparations are being prescribed when there are licensed alternatives available ","Licensed liquid available. The 5mg/5ml sugar-free oral solution is more cost-effective.","•\tBaclofen 5mg/5ml oral solution sugar-free £3.57/300ml\n•\tBaclofen 10mg/5ml oral solution sugar-free £9.10/150ml","Not applicable","Not applicable","Various unlicensed specials","Variable, fluctuating and unregulated",null,"The Scottish Drug Tariff lists:\t \t \t \t \n•\tBaclofen 5mg/5ml oral solution sugar-free £4.95/300ml"]
["Beclometasone, topical (dermatology)","No suitable licensed preparation available","Licensed cream and ointment available","•\tBeclometasone 0.025% cream £71.40/30g\t \n•\tBeclometasone 0.025% ointment £71.40/30g\t \t","Not applicable","Not applicable","The British Association of Dermatologists (BAD) recommends the following unlicensed specials (see here for further information):\n•\tBeclomethasone dipropionate 0.0025% w/w in WSP BP ointment, 100g (formerly known as Propaderm® 1 in 10, mild steroid used for severe and resistant atopic eczema in children).\n\nThe England/Wales Drug Tariff lists the following unlicensed specials with regulated prices:\n•\tBeclometasone 0.0025% in white soft paraffin ","•\tBeclometasone 0.0025% in white soft paraffin £124.12/100g "]
["Bendroflumethiazide","No licensed liquid available","No suitable licensed preparation available for patients who are unable to swallow the solid oral dosage form","Not applicable ","The tablets can be dispersed in water for oral administration. The tablets readily disperse in water within 1 to 5 minutes","•\tBendroflumethiazide 2.5mg tablets £0.55/28\n•\tBendroflumethiazide 5mg tablets £0.67/28 ","The England/Wales Drug Tariff lists the following unlicensed specials with regulated prices:\t\n•\tBendroflumethiazide 2.5mg/5ml oral suspension ","•\tBendroflumethiazide 2.5mg/5ml oral suspension £41.83/150ml ",null,"The Scottish Drug Tariff lists:\t \t \t \t \n•\tBendroflumethiazide 2.5mg tablets £0.96/28\n•\tBendroflumethiazide 5mg tablets £0.98/28 \n•\tBendroflumethiazide 2.5mg/5ml oral suspension £53.86/150ml "]
["Betahistine","No licensed liquid available","No suitable licensed preparation available for patients who are unable to swallow the solid oral dosage form","Not applicable ","The tablets can be crushed and mixed with water for oral administration. ","•\tBetahistine 8mg tablets £3.29/84\t\n•\tBetahistine 16mg tablets £7.16/84\t \n•\tBetahistine 24mg tablets £8.00/84","The England/Wales Drug Tariff lists the following unlicensed specials with regulated prices:\t\t \t \t \n•\tBetahistine 8mg/5ml oral suspension\t","•\tBetahistine 8mg/5ml oral suspension £60.58/200ml ",null,"The Scottish Drug Tariff lists:\t \t \t \t \n•\tBetahistine 8mg tablets £4.30/84 \n•\tBetahistine 16mg tablets £7.78/84"]
["Betamethasone valerate","Unlicensed preparations are being prescribed when there are licensed alternatives available ","Licensed preparations available","•\tBetamethasone valerate 0.025% cream £3.15/100g \n•\tBetamethasone valerate 0.025% ointment £3.15/100g\n•\tBetamethasone valerate 0.1% cream £2.62/30g or £6.10/100g\t \n•\tBetamethasone valerate 0.1% lotion £4.58/100ml\t\n•\tBetamethasone valerate 0.1% ointment £1.60/30g or £5.33/100g\t \n•\tBetamethasone valerate 0.1% scalp application £3.94/100ml\n•\tBetamethasone valerate 2.25mg medicated plasters £13.98/4","Not applicable","Not applicable","The British Association of Dermatologists (BAD) recommends the following unlicensed specials (see here for further information):\n•\tCoal tar solution BP 5% w/w in betamethasone valerate 0.025% w/w ointment. (use for moderate to severe psoriasis of the trunk and limbs when other treatments such as vitamin D analogues have been ineffective).\n\nThe England/Wales Drug Tariff lists the following unlicensed specials with regulated prices:\n•\tCoal tar solution 5% in betamethasone valerate 0.025% ointment ","•\tCoal tar solution 5% in betamethasone valerate 0.025% ointment £36.63/100g",null,"The Scottish Drug Tariff lists:\t \t \t \t \n•\tBetamethasone valerate 0.1% cream £2.57/30g or £4.99/100g\n•\tBetamethasone valerate 0.1% ointment £2.00/30g or £7.00/100g\n"]
["Bisoprolol ","No licensed liquid available","Consider alternative licensed beta -blocker available as a licensed liquid, e.g., atenolol, where appropriate. Do not switch if the indication for treatment is heart failure, as atenolol is not licensed for this indication.","•\tAtenolol 25mg/5ml oral solution sugar-free £10.27/300ml","The tablets can be dispersed in water for oral administration. The lower strengths disperse readily in 1 to 5 mins; the higher strengths may need to be crushed before mixing with water. ","•\tBisoprolol 1.25mg tablets £0.69/28\t \n•\tBisoprolol 2.5mg tablets £0.88/28\t \n•\tBisoprolol 3.75mg tablets £0.78/28\t \n•\tBisoprolol 5mg tablets £0.69/28\t \n•\tBisoprolol 7.5mg tablets £0.82/28\t\n•\tBisoprolol 10mg tablets £0.71/28\t ","The England/Wales Drug Tariff lists the following unlicensed specials with regulated prices:\n•\tBisoprolol 1.25mg/5ml oral solution\n•\tBisoprolol 1.25mg/5ml oral suspension \n•\tBisoprolol 2.5mg/5ml oral solution \n•\tBisoprolol 2.5mg/5ml oral suspension\n•\tBisoprolol 5mg/5ml oral solution \n•\tBisoprolol 5mg/5ml oral suspension (most cost-effective)","•\tBisoprolol 1.25mg/5ml oral solution £37.28/100ml \n•\tBisoprolol 1.25mg/5ml oral suspension £26.52/100ml\n•\tBisoprolol 2.5mg/5ml oral solution £25.20/150ml \n•\tBisoprolol 2.5mg/5ml oral suspension £30.87/100ml \n•\tBisoprolol 5mg/5ml oral solution £30.37/150ml \n•\tBisoprolol 5mg/5ml oral suspension £16.13/100ml ","If an unlicensed liquid is required, bisoprolol 5mg/5ml oral suspension is the most cost-effective option, if appropriate.","The Scottish Drug Tariff lists:\t \t \t \t \n•\tBisoprolol 1.25mg tablets £0.90/28\n•\tBisoprolol 2.5mg tablets  £0.88/28\n•\tBisoprolol 3.75mg tablets  £1.00/28\n•\tBisoprolol 5mg tablets  £0.92/28\n•\tBisoprolol 7.5mg tablets  £1.00/28 \n•\tBisoprolol 10mg tablets £0.95/28\n•\tBisoprolol 2.5mg/5ml oral solution  £35.80/150ml\n•\tBisoprolol 2.5mg/5ml oral suspension  £132.00/100ml HIGH COST"]
["Bumetanide","Unlicensed preparations are being prescribed when there are licensed alternatives available ","Licensed liquid available - HIGH COST\nConsider switching to an alternative loop diuretic available as a licensed liquid, e.g., furosemide, if appropriate.","•\tBumetanide 1mg/5ml oral solution sugar-free £258.00/150ml\t\n•\tFurosemide 20mg/5ml oral solution sugar-free £15.05/150ml\t \n•\tFurosemide 40mg/5ml oral solution sugar-free £19.74/150ml\t \n•\tFurosemide 50mg/5ml oral solution sugar free £20.40/150ml","The tablets can be crushed and mixed with water prior to oral administration. ","•\tBumetanide 1mg tablets £2.05/28\t \n•\tBumetanide 5mg tablets £24.48/28\t","Various unlicensed specials","Variable, fluctuating and unregulated",null,"The Scottish Drug Tariff lists:\t \t \t \t \n•\tBumetanide 1mg tablets £2.46/28\t \n•\tBumetanide 5mg tablets £24.91/28\t \n•\tFurosemide 40mg/5ml oral solution sugar free £19.74/150ml\t"]

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[" ","* Drug Tariff (England and Wales) May 24    § NEWT guidelines for administration of medication to patients with enteral feeding tubes or swallowing difficulties, Fourth edition- August 2021\n‡ Enteral Feeding Handbook 3rd edition        ** Scottish Drug Tariff April 24"]
["Chemical substance","What is the issue?","Option 1: Use a licensed medicine in a suitable licensed formulation (incl review ongoing need or change to different drug in same therapeutic class)","Licensed preparation(s) and cost (option 1) per original pack*","Option 2: Use a licensed medicine in an unlicensed manner (e.g. crushing tablets). See NEWT for further information.§ \nNot applicable for enteral feeding tubes, refer to resources§,‡ or local medicines information service for more information","Off-label preparation(s) and cost (option 2) per original pack*","Option 3: Only if clinical reason exists for not using licensed product: Use an unlicensed special","Unlicensed special preparation(s) and cost (option 3) per original pack*","Comments ","Scottish Drug Tariff considerations**"]
["Calcium and vitamin D","Unlicensed preparations are being prescribed when there are licensed alternatives available ","See under colecalciferol","See under colecalciferol","See under colecalciferol","See under colecalciferol","See under colecalciferol","See under colecalciferol"]
["Calcium carbonate","Unlicensed preparations are being prescribed when there are licensed alternatives available ","Licensed preparations available, including effervescent and chewable tablets. \nFor combination products with colecalciferol/vitamin D, see under colecalciferol.","•\tCalcium carbonate 500mg chewable tablets £3.23/48\n•\tCalcium carbonate 1.25g chewable tablets sugar-free £9.33/100\n•\tCalcium carbonate 1.25g effervescent tablets sugar-free £12.96/76\n•\tCalcium carbonate 1.5g chewable tablets sugar-free £8.70/100\n•\tCalcium carbonate 2.5g chewable tablets sugar-free £14.21/60","Not applicable ","Not applicable","The England/Wales Drug Tariff lists the following unlicensed specials with regulated prices:\t\t \t \t \n•\tCalcium carbonate 500mg/5ml oral suspension \n•\tCalcium carbonate 600mg/5ml oral suspension ","•\tCalcium carbonate 500mg/5ml oral suspension £16.21/100ml \n•\tCalcium carbonate 600mg/5ml oral suspension £23.37/150ml "]
["Candesartan ","No licensed liquid available ","Consider switching to licensed valsartan liquid","•\tValsartan 3mg/ml oral solution £7.20/160ml","Tablets can be crushed and mixed with water for immediate oral administration. Without crushing, they disperse in approximately 5 minutes","•\tCandesartan 2mg tablets £0.76/7\n•\tCandesartan 4mg tablets £0.57/7\t\t\n•\tCandesartan 8mg tablets £1.02/28\n•\tCandesartan 16mg tablets £1.16/28\n•\tCandesartan 32mg tablets £1.35/28","Various unlicensed specials","Variable, fluctuating and unregulated",null,"The Scottish Drug Tariff lists:\t \t \t \t \n•\tCandesartan 2mg tablets £1.20/7\n•\tCandesartan 4mg tablets £1.08/7\t\t\n•\tCandesartan 8mg tablets £1.50/28\n•\tCandesartan 16mg tablets £1.92/28\n•\tCandesartan 32mg tablets £2.00/28"]
["Captopril","Unlicensed preparations are being prescribed when there are licensed alternatives available ","Licensed liquid available - HIGH COST","•\tCaptopril 25mg/5ml oral solution sugar-free £101.00/100ml\t \n•\tCaptopril 5mg/5ml oral solution sugar-free £93.30/100ml","The tablets can be dispersed in water for oral administration. They disperse in 1 to 5 mins. ","•\tCaptopril 12.5mg tablets £1.79/56\t \n•\tCaptopril 25mg tablets £1.48/56\n•\tCaptopril 50mg tablets £1.65/56","Various unlicensed specials","Variable, fluctuating and unregulated",null,"The Scottish Drug Tariff lists:\t \t \t \t \n•\tCaptopril 12.5mg tablets £2.16/56\t \n•\tCaptopril 25mg tablets £1.96/56\n•\tCaptopril 50mg tablets £2.00/56"]
["Carbamazepine","Unlicensed preparations are being prescribed when there are licensed alternatives available ","Licensed liquid available. Dose conversion required if switching from modified-release tablets - see comments for details.","•\tCarbamazepine 100mg/5ml oral suspension sugar-free £10.09/300ml\t","Not applicable ","Not applicable","Various unlicensed specials","Variable, fluctuating and unregulated","Where possible, patients taking carbamazepine for seizures should be maintained on a specific manufacturer's product, due to variability in product characteristics which may  lead to a loss of seizure control when switching between brands/manufacturers. All product switches should be carried out with care and  close monitoring. \nDose conversion: 400mg modified-release tablets BD = 200mg liquid QDS.","The Scottish Drug Tariff lists:\t \t \t \t \n•\tCarbamazepine 100mg/5ml oral suspension sugar-free £11.07/300ml\t"]
["Carbimazole","No licensed liquid available ","No suitable licensed preparation available for patients who are unable to swallow the solid oral dosage form","Not applicable","Tablets can be crushed and dispersed in water for oral administration. Consider using multiples of the 5mg tablets for the 10mg and 15mg doses as this is more cost-effective.","•\tCarbimazole 5mg tablets £1.82/100\t \n•\tCarbimazole 10mg tablets £83.45/100 HIGH COST\t \n•\tCarbimazole 15mg tablets £247.41/100 HIGH COST\n•\tCarbimazole 20mg tablets £2.78/100 ","England/Wales Drug Tariff lists the following unlicensed specials with regulated prices:\n•\tCarbimazole 10mg/5ml oral suspension ","•\tCarbimazole 10mg/5ml oral suspension £88.15/150ml","Consider  licensed tablets over unlicensed capsules, if swallowing difficulties consider crushing tablet . Avoid using the 10mg and 15mg tablets due to high cost.","The Scottish Drug Tariff lists:\t \t \t \t \n•\tCarbimazole 5mg tablets £2.68/100\n•\tCarbimazole 10mg tablets £83.45/100 HIGH COST\t \n•\tCarbimazole 20mg tablets £4.79/100 "]
["Carvedilol","No licensed liquid available ","Consider alternative beta -blocker available as a licensed liquid, e.g., atenolol, where appropriate. \nDo not switch if the indication for treatment is heart failure, as atenolol is not licensed for this indication.","•\tAtenolol 25mg/5ml oral solution sugar-free £10.27/300ml","The tablets can be dispersed in water and taken immediately for oral administration. They disperse within 5 minutes.","•\tCarvedilol 3.125mg tablets £0.88/28\t \n•\tCarvedilol 6.25mg tablets £1.63/28 \n•\tCarvedilol 12.5mg tablets £1.45/28\t \n•\tCarvedilol 25mg tablets £1.26/28\t","The England/Wales Drug Tariff lists the following unlicensed specials with regulated prices:\t \t \t \t \n•\tCarvedilol 5mg/5ml oral suspension ","•\tCarvedilol 5mg/5ml oral suspension £41.46/100ml",null,"The Scottish Drug Tariff lists:\t \t \t \t \n•\tCarvedilol 3.125mg tablets £1.10/28\t \n•\tCarvedilol 6.25mg tablets £1.69/28 \n•\tCarvedilol 12.5mg tablets £1.66/28\t \n•\tCarvedilol 25mg tablets £1.50/28\t"]
["Chloral hydrate","Unlicensed preparations are being prescribed when there are licensed alternatives available ","Licensed liquid available - HIGH COST. \nDrug considered less suitable for prescribing. Liaise with specialist, if applicable, or consider an alternative (see comments). ","•\tChloral hydrate 143.3mg/5ml oral solution BP £244.25/150ml\t \n•\tChloral hydrate 500mg/5ml oral solution £244.25/150ml\t","Not applicable ","Not applicable ","England/Wales Drug Tariff lists the following unlicensed specials with regulated prices:\n•\tChloral hydrate 200mg/5ml oral suspension \n•\tChloral hydrate 1g/5ml oral solution ","•\tChloral hydrate 200mg/5ml oral suspension £70.80/100ml \n•\tChloral hydrate 1g/5ml oral solution £66.16/100ml ","Review indication for and duration of prescribing. Not usually prescribed in primary care. Use in children and adolescents is not generally recommended and should be under the supervision of a specialist. Usual maximum treatment length for adults and children is 2 weeks due to associated risks. The dose should be slowly tapered on withdrawal to prevent delirium. See MHRA/CHM advice: Chloral hydrate, cloral betaine (Welldorm®): restriction of paediatric indication (October 2021)"]
["Chlorothiazide","No licensed liquid available ","No licensed formulation available.","Not applicable","Not applicable","Not applicable","England/Wales Drug Tariff lists the following unlicensed specials with regulated prices:\n•\tChlorothiazide 25mg/5ml oral suspension\n•\tChlorothiazide 150mg/5ml oral suspension\n•\tChlorothiazide 200mg/5ml oral suspension \n•\tChlorothiazide 250mg/5ml oral suspension ","•\tChlorothiazide 25mg/5ml oral suspension £44.49/100ml\n•\tChlorothiazide 150mg/5ml oral suspension £58.47/100ml \n•\tChlorothiazide 200mg/5ml oral suspension £61.78/150ml\n•\tChlorothiazide 250mg/5ml oral suspension £30.29/50ml","The Chlorothiazide 200mg/5ml oral suspension is the most cost-effective product"]
["Chlorpromazine","Unlicensed preparations are being prescribed when there are licensed alternatives available ","Licensed liquid available","•\tChlorpromazine 25mg/5ml oral solution £2.35/150ml \n•\tChlorpromazine 25mg/5ml oral solution sugar-free £3.00/150ml \n•\tChlorpromazine 100mg/5ml oral solution £5.50/150ml ","Not applicable ","Not applicable","Various unlicensed specials","Variable, fluctuating and unregulated",null,"The Scottish Drug Tariff lists:\t \t \t \t \n•\tChlorpromazine 100mg/5ml oral solution £5.50/150ml "]
["Ciclosporin eye preparations","Licensed eye ointment or preservative-free eye drops are not available","Licensed ciclosporin eye drops available, contain preservative. Consider if appropriate.","•\tCiclosporin 0.1% eye drops 0.3ml unit dose £72.00/30","Not applicable","Not applicable","England/Wales Drug Tariff lists the following unlicensed specials with regulated prices:\n•\tCiclosporin 0.05% eye drops 0.4ml unit dose preservative-free\n•\tCiclosporin 0.2% eye ointment \n•\tCiclosporin 0.2% eye ointment preservative-free","•\tCiclosporin 0.05% eye drops 0.4ml unit dose preservative-free £191.46/30 HIGH COST\n•\tCiclosporin 0.2% eye ointment £52.72/3.5g \n•\tCiclosporin 0.2% eye ointment preservative-free £72.69/3.5g","In children with severe vernal keratoconjunctivitis (age from 4 years) treatment should be discontinued after signs and symptoms are resolved, and reinitiated upon their recurrence. [BNFc May 2024]"]
["Ciprofloxacin ear drops","Unlicensed preparations are being prescribed when there are licensed alternatives available ","Licensed ear drops available","•\tCiprofloxacin 2mg/ml ear drops 0.25ml unit dose preservative-free £6.01/15\t ","Not applicable","Not applicable","England/Wales Drug Tariff lists the following unlicensed specials with regulated prices:\n•\tCiprofloxacin 0.3% ear drops (not recommended ahead of the licensed preparation unless there is a specific clinical reason)","•\tCiprofloxacin 0.3% ear drops £33.65/10ml","Check treatment duration and stop as needed."]
["Ciprofloxacin eye drops preservative-free","No licensed 0.2% eye drops ","Ciprofloxacin is available as licensed 0.3% eye drops, contains preservative. \nIf a preservative-free formulation is required, levofloxacin PF eye drops are available.","•\tCiprofloxacin 0.3% eye drops\t £4.70/5ml\n•\tLevofloxacin 5mg/ml eye drops 0.3ml unit dose preservative-free £17.95/30\t \n•\tLevofloxacin 5mg/ml eye drops 0.5ml unit dose preservative-free £15.25/20 \t\n•\tLevofloxacin 5mg/ml eye drops preservative-free £13.46/5ml","Not applicable","Not applicable","Various unlicensed specials","Variable, fluctuating and unregulated","Check treatment duration and stop as needed."]
["Clindamycin","No licensed liquid available ","No suitable licensed preparation available for patients who are unable to swallow the solid oral dosage form. If clinically appropriate an alternative antibiotic may be available in liquid of dispersible tablet formulation.","Not applicable","The capsules can be opened and the contents dispersed in  water or mixed with grape juice or maple  syrup (to mask the unpleasant taste). They should be taken  immediately. \nUse multiples of the 150mg capsules, if possible, as these are more cost-effective.\n","•\tClindamycin 75mg capsules £7.45/24\n•\tClindamycin 150mg capsules £2.54/24\n•\tClindamycin 300mg capsules £34.45/30\n\t \n\n","The England/Wales Drug Tariff lists the following unlicensed specials with regulated prices:\n•\tClindamycin 75mg/5ml oral suspension ","•\tClindamycin 75mg/5ml oral suspension £27.81/100ml","Check treatment duration and stop as needed.","The Scottish Drug Tariff lists:\t \t \t \t \n•\tClindamycin 150mg capsules\t £2.47/24\n•\tClindamycin 300mg capsules\t £30.50/30"]
["Clobazam ","Unlicensed preparations are being prescribed when there are licensed alternatives available ","Licensed liquid available - HIGH COST. ","•\tClobazam 5mg/5ml oral suspension sugar-free £89.96/150ml\t\n•\tClobazam 10mg/5ml oral suspension sugar-free £91.39/150ml\t\t","Tablets can be dispersed or crushed and mixed with water for oral administration.\nTablets are licensed to be crushed and mixed in apple sauce.","•\tClobazam 10mg tablets £4.97/30 ",null,null,"May  be prescribed on the NHS in England and Wales only for the treatment of epilepsy (under the selected list scheme/SLS - see Drug Tariff). \nFor epilepsy, formulation should be consistent to avoid fluctuations in dose.","•\tClobazam 10mg tablets £4.71/30 \n•\tClobazam 5mg/5ml oral suspension sugar-free £89.96/150ml HIGH COST\t\n•\tClobazam 10mg/5ml oral suspension sugar-free £91.39/150ml HIGH COST\t\t"]
["Clobetasol","Unlicensed preparations are being prescribed when there are licensed alternatives available ","Licensed preparations available","•\tClobetasol 0.05% cream £2.69/30g or £7.90/100g\n•\tClobetasol 0.05% ointment £2.69/30g or £7.90/100g\n•\tClobetasol 0.05% scalp application £3.07/30ml or £10.42/100ml \n•\tClobetasol 500micrograms/g foam £11.06/100g\n•\tClobetasol 500micrograms/g shampoo £9.15/125ml\t ","Not applicable.","Not applicable","The British Association of Dermatologists (BAD) recommends the following unlicensed specials (see here for further information):\n•\tSalicylic acid 5% w/w / propylene glycol 47.5% w/w in clobetasol propionate 0.05% (Dermovate®) cream, 100g (very potent steroid; propylene glycol increases penetration of clobetasol propionate (Dermovate®). To use on the palms and/or soles for hyperkeratotic eczema, palmoplantar pustulosis and psoriasis where it is persistent, severe and not responding to clobetasol propionate (Dermovate®) and emollients alone).\n•\tPropylene glycol 40% w/w in clobetasol propionate 0.05% (Dermovate®) Cream, 100g (Very potent steroid. Use for severe inflammatory disease without hyperkeratosis, or at sensitive skin sites, e.g., the vulva).\n\nThe England/Wales Drug Tariff lists the following unlicensed specials with regulated prices:\n•\tPropylene glycol 40% in Clobetasol 0.05% cream ","•\tPropylene glycol 40% in Clobetasol 0.05% cream £34.48/100g\t\n"]
["Clomipramine HCl","Unlicensed preparations are being prescribed when there are licensed alternatives available ","No licensed liquid available","Not applicable","The capsules can be opened and the contents dispersed in water for oral administration ","•\tClomipramine 10mg capsules £3.438/28\t\n•\tClomipramine 25mg capsules £4.55/28\n•\tClomipramine 50mg capsules £7.99/28","Clomipramine 50mg/5ml oral suspension","Clomipramine 50mg/5ml oral suspension £31.00/100ml",null,"The Scottish Drug Tariff lists:\t \t \t \t \n•\tClomipramine 10mg capsules £3.48/28\t\n•\tClomipramine 25mg capsules £5.11/28\n•\tClomipramine 50mg capsules £9.39/28\t"]
["Clonazepam","Unlicensed preparations are being prescribed when there are licensed alternatives available ","Licensed liquid available - HIGH COST.","•\tClonazepam 500micrograms/5ml oral solution sugar-free £74.80/150ml \n•\tClonazepam 2mg/5ml oral solution sugar-free £108.38/150ml\t","Not applicable ","Not applicable","England/Wales Drug Tariff lists the following unlicensed specials with regulated prices:\n•\tClonazepam 250micrograms/5ml oral solution \n•\tClonazepam 250micrograms/5ml oral suspension ","•\tClonazepam 250micrograms/5ml oral solution £80.01/100ml HIGH COST\n•\tClonazepam 250micrograms/5ml oral suspension £289.91/100ml HIGH COST"]
["Clopidogrel","Unlicensed preparations are being prescribed when there are licensed alternatives available ","No suitable licensed preparation available for patients who are unable to swallow the solid oral dosage form","Not applicable","The tablets can be crushed and dispersed in water for oral administration. Most brand disperse in 1 to 5 minutes without crushing. Prescribe as multiples of 75mg tablets, if possible, as this is more cost-effective.","•\tClopidogrel 75mg tablets £1.11/28\n•\tClopidogrel 300mg tablets £142.54/30","The England/Wales Drug Tariff lists the following unlicensed specials with regulated prices:\n•\tClopidogrel 1mg/1ml oral suspension\n•\tClopidogrel 25mg/5ml oral suspension \n•\tClopidogrel 75mg/5ml oral solution\n•\tClopidogrel 75mg/5ml oral suspension ","•\tClopidogrel 1mg/1ml oral suspension £25.83/100ml \n•\tClopidogrel 25mg/5ml oral suspension £282.51/50ml HIGH COST\n•\tClopidogrel 75mg/5ml oral solution £35.29/150ml \n•\tClopidogrel 75mg/5ml oral suspension £34.94/100ml\t",null,"The Scottish Drug Tariff lists:\t \t \t \t \n•\tClopidogrel 75mg tablets £1.60/28\t"]
["Coal tar, topical (dermatology)","Unlicensed preparations are being prescribed when there are licensed alternatives available ","Licensed preparations available","•\tCoal tar 2.5% scalp lotion £4.74/250ml\n•\tCoal tar 4% shampoo £5.04/150ml\t\n•\tCoal tar 6% cream £9.42/225ml \n•\tCoal tar extract 2% shampoo £4.36/125ml or £6.61/250ml\t\n•\tCoal tar solution 5% cutaneous emulsion £8.11/100ml ","Not applicable","Not applicable","The British Association of Dermatologists (BAD) recommends the following unlicensed specials (see here for further information):\n•\tCoal tar solution BP 5% w/w in betamethasone valerate 0.025% w/w ointment, 100g (use for moderate to severe psoriasis of the trunk and limbs when other treatments such as vitamin D analogues have been ineffective).\n•\tCoal tar solution BP 3.3% w/w and propylene glycol 20% w/w in fluocinolone acetonide 0.025% (Synalar®) gel, 100g (use for very inflamed hyperkeratotic scalp psoriasis).\n•\tCoal tar scalp application (‘coal tar pomade’; coal tar solution BP 6% w/w / salicylic acid 2% w/w in emulsifying ointment), 100g (these preparations are used for moderate to severe chronic plaque psoriasis when other topical treatments such as vitamin D analogues and the commercial tar preparation Exorex® 5% lotion (100 ml, £8.11) have been ineffective or unsuitable, where phototherapy is less effective (e.g., lower leg), and where the patient does not wish to take or is unsuitable for systemic treatment. \n•\tCoal tar BP 2% w/w in YSP, 100g (indication as for coal tar scalp application)\n•\tCoal tar BP 5% w/w in YSP, 100g (indication as for coal tar scalp application)\n•\tCoal tar BP 10% w/w in YSP, 100g (indication as for coal tar scalp application)","•\tCoal tar 5% ointment (all bases) £23.71/100g\n•\tCoal tar 10% ointment (all bases) £21.54/100g\n•\tCoal tar solution 5% in betamethasone valerate 0.025% ointment £36.63/100g\t \n•\tCoal tar solution 6%/salicylic acid 2% in ointment £129.78/100g HIGH COST",null,"The Scottish Drug Tariff lists:\t \t \t \t \n•\tCoal tar extract 2% shampoo £4.36/125ml\n•\tCoal tar extract 2% shampoo £6.61/250ml\n•\tCoal tar solution 2% in yellow soft paraffin £130.27/100g HIGH COST"]
["Co-careldopa","No licensed liquid available ","Consider switching to licensed co-beneldopa, which is available as licensed dispersible tablets.                                                                                                                                                                      Conversions suggested in NEWT are:                                                                                                                                                                                                                                                                                                         Sinemet 62.5mg to Madopar 62.5mg dispersible \nSinemet 110mg to Madopar 125mg dispersible \nSinemet plus 125mg to Madopar 125mg dispersible \nSinemet 275mg to 2 x Madopar 125mg dispersible ","•\tCo-beneldopa 12.5mg/50mg dispersible tablets sugar-free £5.90/100\n•\tCo-beneldopa 25mg/100mg dispersible tablets sugar-free £10.45/100\t","The standard-release tablets will disperse in water within 1 to 5 minutes for oral administration. \nThey should be taken immediately as the drug will degrade. \nThe modified-release tablets should not be crushed.","•\tCo-careldopa 10mg/100mg tablets £13.98/100\t \n•\tCo-careldopa 12.5mg/50mg tablets £4.22/90\t \n•\tCo-careldopa 25mg/100mg tablets £6.32/100\t \n•\tCo-careldopa 25mg/250mg tablets £35.02/100","The England/Wales Drug Tariff lists the following unlicensed specials with regulated prices:\t\t \t \t \n•\tCo-careldopa 12.5mg/50mg/5ml oral suspension \n•\tCo-careldopa 25mg/100mg/5ml oral suspension","•\tCo-careldopa 12.5mg/50mg/5ml oral suspension £93.30/100ml HIGH COST\n•\tCo-careldopa 25mg/100mg/5ml oral suspension £51.98/100ml\tHIGH COST","May need specialist input to switch","The Scottish Drug Tariff lists:\t \t \t \t \n•\tCo-careldopa 10mg/100mg tablets £16.08/100\n•\tCo-careldopa 12.5mg/50mg tablets £4.58/90\n•\tCo-careldopa 25mg/100mg tablets £6.32/100\n•\tCo-careldopa 25mg/250mg tablets £40.28/100\t\n•\tCo-careldopa 25mg/100mg/5ml oral suspension £144.32/100 HIGH COST"]
["Colecalciferol","Unlicensed preparations are being prescribed when there are licensed alternatives available ","Various licensed preparations available (including effervescent tablets and liquids), alone or in combination with calcium carbonate and alendronic acid (see under alendronic acid).","•\tColecalciferol 200unit/calcium carbonate 1.25g chewable tablets £7.68/100\t\n•\tColecalciferol 200unit/calcium carbonate 750mg tablets £3.54/112\n•\tColecalciferol 400unit/calcium carbonate 1.25g chewable tablets £4.24/60\t\n•\tColecalciferol 400unit/calcium carbonate 1.5g chewable tablets £4.38/56\n•\tColecalciferol 400unit/calcium carbonate 1.5g effervescent tablets £5.99/56 \n•\tColecalciferol 400unit/calcium carbonate 1.5g tablets £2.95/60\n•\tColecalciferol 400unit capsules £1.85/28\t \n•\tColecalciferol 440unit/calcium carbonate 1.25g effervescent granules sachets £4.06/30\t \t\n•\tColecalciferol 800unit/calcium carbonate 1.25g chewable tablets £4.21/30\t \n•\tColecalciferol 800unit/calcium carbonate 2.5g chewable tablets £7.29/30\n•\tColecalciferol 800unit capsules £3.60/30\n•\tColecalciferol 800unit tablets £5.09/30\t \t \n•\tColecalciferol 880unit/calcium carbonate 2.5g chewable tablets £2.95/30\t\n•\tColecalciferol 1,000unit/calcium carbonate 2.5g chewable tablets £2.50/28\t\n•\tColecalciferol 1,000unit capsules £4.77/30\t \n•\tColecalciferol 1,000unit tablets £2.95/28\t\n•\tColecalciferol 2,400units/ml oral drops sugar-free £3.60/10ml\n•\tColecalciferol 2,740units/ml oral drops sugar-free £10.70/25ml \t\n•\tColecalciferol 3,200unit capsules £13.32/30\n•\tColecalciferol 4,000unit tablets £15.90/70\n•\tColecalciferol 5,600unit capsules £2.50/4\t\n•\tColecalciferol 10,000unit capsules £9.99/20 \n•\tColecalciferol 10,000unit oral drops sugar free £5.85/10ml\n•\tColecalciferol 10,000unit oral solution sugar free £1.55/2.5ml or £5.85/10ml\n•\tColecalciferol 15,000units/5ml oral solution sugar-free £122.40/100ml HIGH COST\n•\tColecalciferol 20,000unit capsules £17.04/15 or £29.00/30\t \n•\tColecalciferol 25,000unit capsules £3.95/3\n•\tColecalciferol 25,000unit tablets £17.00/12\t \n•\tColecalciferol 25,000units/1ml oral solution unit dose ampoules sugar-free £4.45/3\n•\tColecalciferol 50,000unit capsules £4.95/3\n•\tColecalciferol 50,000units/1ml oral solution unit dose ampoules sugar-free £6.25/3","Not applicable ","Not applicable","The England/Wales Drug Tariff lists the following unlicensed specials with regulated prices:\n•\tColecalciferol 5,000units/5ml oral solution \n•\tColecalciferol 10,000units/5ml oral solution\n•\tColecalciferol 20,000units/ml oral solution ","•\tColecalciferol 5,000units/5ml oral solution £27.87/20ml \n•\tColecalciferol 10,000units/5ml oral solution £65.42/20ml \n•\tColecalciferol 20,000units/ml oral solution £82.60/30ml ",null,"•\tColecalciferol 800unit capsules £3.60/30\n•\tColecalciferol 800unit tablets £5.01/30\t \n•\tColecalciferol 20,000unit capsules £29.00/30"]
["Co-proxamol ","No longer licensed in the UK. Only available as a HIGH COST special. Not recommended for prescribing due to safety concerns.","Consider an alternative licensed analgesic available as a licensed liquid or effervescent tablet if needed, e.g., paracetamol or co-codamol, if pharmacological pain management is needed.","For example:\t \t \t \t \n•\tParacetamol 500mg tablets £0.69/32 or £2.16/100\t \n•\tParacetamol 250mg/5ml oral suspension £3.77/100ml\t \n•\tParacetamol 250mg/5ml oral suspension sugar-free £9.08/200ml\t \n•\tParacetamol 500mg effervescent tablets £5.50/100\t \n•\tCo-codamol 8mg/500mg tablets  £0.96/30 or  £3.20/100\t\n•\tCo-codamol 8mg/500mg effervescent tablets £2.84/32 or  £8.88/100\n•\tCo-codamol 15mg/500mg tablets £2.97/100\t\n•\tCo-codamol 30mg/500mg capsules £4.76/100\t \n•\tCo-codamol 30mg/500mg effervescent tablets £2.61/32 or £8.16/100\t \n•\tCo-codamol 30mg/500mg tablets  £1.21/30 or £4.03/100","Not applicable","Not applicable","The England/Wales Drug Tariff lists the following unlicensed specials with regulated prices:\n•\tCo-proxamol 32.5mg/325mg tablets\t","•Co-proxamol 32.5mg/325mg tablets £304.66/100 HIGH COST\t","In England, see NHS England Items which should not routinely be prescribed in primary care policy guidance","For example, the Scottish Drug Tariff lists:\t \t \t \t \n•\tParacetamol 500mg tablets £0.96/32 or £2.88/100\n•\tParacetamol 250mg/5ml oral suspension £4.50/100ml\n•\tParacetamol 250mg/5ml oral suspension sugar-free £3.72/100ml or £5.65/200ml or £14.13/500ml\n•\tParacetamol 500mg soluble tablets £3.28/24 or £13.67/100                                                                                                                                                                                                                                                       •\tParacetamol 500mg capsules £4.80/100\n•\tCo-codamol 8mg/500mg capsules £8.95/32 or £27.76/100\n•\tCo-codamol 8mg/500mg tablets  £3.80/100\t\n•\tCo-codamol 8mg/500mg effervescent tablets £9.03/100\n•\tCo-codamol 15mg/500mg tablets £3.25/100\t\n•\tCo-codamol 30mg/500mg capsules £5.70/100\t \n•\tCo-codamol 30mg/500mg effervescent tablets £9.28/100\n•\tCo-codamol 30mg/500mg tablets £1.21/30 or £4.40/100",null,"N21"]
["Cyanocobalamin","Unlicensed preparations are being prescribed when there are licensed alternatives available ","Licensed tablets and solution for injection available. However, review indication for prescribing and consider switching to hydroxycobalamin (cyanocobalamin is considered less suitable for prescribing). ","•\tCyanocobalamin 50microgram tablets £8.58/50\t\t \n•\tCyanocobalamin 1mg tablets £9.99/30\n•\tCyanocobalamin 1mg/1ml solution for injection ampoules £17.29/5","Not applicable","Not applicable","Various unlicensed specials","Variable, fluctuating and unregulated","Cyanocobalamin solution (any strength) is blacklisted on the NHS in England and Wales and should not be prescribed on an NHS prescription. In Wales, cyanocobalamin tablets may only be prescribed on the NHS for patients who are vegan (check brand is suitable for vegans) or who have a proven vitamin B12 deficiency of dietary origin for the treatment or prevention of vitamin B12 deficiency.","The Scottish Drug Tariff lists:\t \t \t \t \n•\tCyanocobalamin 50microgram tablets £16.07/50\t\t \n•\tCyanocobalamin 1mg/1ml solution for injection ampoules £17.29/5"]
["Cyclizine HCl","No licensed liquid available ","Consider switching to an alternative anti-emetic available as a licensed liquid, e.g., domperidone or metoclopramide (see comments), if appropriate. Metoclopramide is more cost-effective.","•\tDomperidone 1mg/ml oral suspension sugar-free £49.32/200ml\n•\tMetoclopramide 5mg/5ml oral solution sugar-free £18.31/150ml\t","The tablets can be crushed and dispersed in water for oral administration. They should be protected from light. They have a bitter taste.","•\tCyclizine 50mg tablets £3.96/100\t","The England/Wales Drug Tariff lists the following unlicensed specials with regulated prices:\n•\tCyclizine 50mg/5ml oral solution\n•\tCyclizine 50mg/5ml oral suspension","•\tCyclizine 50mg/5ml oral solution £23.63/100ml \n•\tCyclizine 50mg/5ml oral suspension £26.61/100ml ","For metoclopramide see MHRA/CHM advice - Metoclopramide: risk of neurological adverse effects—restricted dose and duration of use (August 2013)\n","The Scottish Drug Tariff lists:\t \t \t \t \n•\tMetoclopramide 5mg/5ml oral solution sugar-free £22.76/150ml\t\n•\tCyclizine 50mg tablets £5.65/100\t\t \n•\tCyclizine 50mg/5ml oral suspension £80.00/100ml HIGH COST"]
[null,null,null,null,null,null,null,null,"For domperidone see MHRA/CHM advice (updated December 2019): Domperidone for nausea and vomiting: lack of efficacy in children; reminder of contraindications in adults and adolescentss"]

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["KEY","* Drug Tariff (England and Wales) May 24    § NEWT guidelines for administration of medication to patients with enteral feeding tubes or swallowing difficulties, Fourth edition- August 2021\n‡ Enteral Feeding Handbook 3rd edition        ** Scottish Drug Tariff April 24"]
["Chemical substance","What is the issue","Option 1: Use a licensed medicine in a suitable licensed formulation (incl review ongoing need or change to different drug in same therapeutic class).","Licensed preparation(s) and cost (option 1) per original pack*","Option 2: Use a licensed medicine in an unlicensed manner (e.g. crushing tablets). See NEWT for further information.§ \nNot applicable for enteral feeding tubes, refer to resources§,‡ or local medicines information service for more information.","Off-label preparation(s) and cost (option 2) per original pack*","Option 3: Only if clinical reason exists for not using licensed product: Use an unlicensed special","Unlicensed special preparation(s) and cost (option 3) per original pack*","Comments ","Scottish Drug Tariff considerations**"]
["Dabigatran","No licensed liquid available","Consider switching to an alternative DOAC (direct oral anti-coagulant) available in a suitable formulation, if likely to be needed long-term, e.g., rivaroxaban licensed liquid, or apixaban, edoxaban or rivaroxaban.\nThese are all available as tablets that are licensed to be crushed and mixed with water or apple puree immediately prior to use and oral administration. \nApixaban can also be crushed and suspended in water, 5% dextrose in water (D5W), or apple juice for immediate oral administration. Liaise with specialist, if appropriate.","•\tApixaban 2.5mg tablets £2.91/60\t \n•\tApixaban 5mg tablets £2.83/56\t\n•\tEdoxaban 15mg tablets £17.50/0\n•\tEdoxaban 30mg tablets £49.00/28\n•\tEdoxaban 60mg tablets £49.00/28 \n•\tRivaroxaban 1mg/ml oral suspension sugar-free £18.00/100ml\n•\tRivaroxaban 2.5mg tablets £50.40/56\n•\tRivaroxaban 10mg tablets £54.00/30\t \n•\tRivaroxaban 15mg tablets £50.40/28\t \n•\tRivaroxaban 15mg tablets and Rivaroxaban 20mg tablets £88.20/49\t\n•\tRivaroxaban 20mg tablets £50.40/28","Capsules should NOT be opened as this will impact bioavailability.","Not applicable","Various unlicensed specials","Variable, fluctuating and unregulated",null,"The Scottish Drug Tariff lists:\t \t \t \t \n•\tApixaban 2.5mg tablets £2.91/60\t \n•\tApixaban 5mg tablets £2.83/56"]
["Dantrolene ","No licensed liquid available","No suitable licensed preparation available for patients who are unable to swallow the solid oral dosage form","Not applicable","The capsules can be opened, and the contents dispersed in water or acidic fruit juice for oral administration. ","•\tDantrolene 25mg capsules £16.87/100\n•\tDantrolene 100mg capsules £43.07/100\t","The England/Wales Drug Tariff lists the following unlicensed specials with regulated prices:\n•\tDantrolene 25mg/5ml oral suspension \n•\tDantrolene 100mg/5ml oral suspension ","•\tDantrolene 25mg/5ml oral suspension £42.74/100ml\t\n•\tDantrolene 100mg/5ml oral suspension £15.75/100ml ",null,"The Scottish Drug Tariff lists:\t \t \t \t \n•\tDantrolene 25mg/5ml oral suspension £136.00/100ml HIGH COST "]
["Dexamethasone eye drops","Unlicensed preparations are being prescribed when there are licensed alternatives available","Licensed eye drops available, including preservative-free","•\tDexamethasone 0.1% eye drops £1.42/5ml\t\n•\tDexamethasone 0.1% eye drops 0.4ml unit dose preservative-free £11.53/20\n•\tDexamethasone 0.1% eye drops 0.5ml unit dose preservative-free £11.46/20\n•\tDexamethasone 0.1% eye drops preservative-free £9.75/6ml\t","Not applicable ","Not applicable","Various unlicensed specials","Variable, fluctuating and unregulated"]
["Dexamethasone, oral","Unlicensed preparations are being prescribed when there are licensed alternatives available","Licensed liquid (most cost-effective) and soluble tablets available.","•\tDexamethasone 2mg/5ml oral solution sugar-free £42.30/150ml \n•\tDexamethasone 10mg/5ml oral solution sugar-free £156.79/150ml HIGH COST\n•\tDexamethasone 20mg/5ml oral solution sugar-free £42.00/50ml\t \t\n•\tDexamethasone 2mg soluble tablets sugar-free £32.33/50\t \n•\tDexamethasone 4mg soluble tablets sugar free £60.00/50\t\n•\tDexamethasone 8mg soluble tablets sugar-free £120.00/50 HIGH COST\t\n•\tDexamethasone 10mg soluble tablets sugar-free £10.00/10 \t\n•\tDexamethasone 20mg soluble tablets sugar-free £20.00/10","Not applicable ","Not applicable","Various unlicensed specials","Variable, fluctuating and unregulated"]
["Dexamfetamine","Unlicensed preparations are being prescribed when there are licensed alternatives available","Licensed liquid available - HIGH COST","•\tDexamfetamine 5mg/5ml oral solution sugar-free £170.00/150ml HIGH COST\t","Not applicable","Not applicable","Various unlicensed specials","Variable, fluctuating and unregulated","The SPCs say the 5mg, 10mg and 20mg tablets can be halved for ease of swallowing and not to divide into equal doses."]
["Diazepam","Unlicensed preparations are being prescribed when there are licensed alternatives available","Licensed liquid and rectal solution available.","•\tDiazepam 2mg/5ml oral solution sugar free £57.19/100ml\n•\tDiazepam 5mg/2.5ml rectal solution tube £5.85/5\t\n•\tDiazepam 10mg/2.5ml rectal solution tube £8.78/5\t ","Not applicable","Not applicable","The England/Wales Drug Tariff lists the following unlicensed specials with regulated prices:\n•\tDiazepam 2.5mg/5ml oral suspension \n•\tDiazepam 10mg/5ml oral suspension ","•\tDiazepam 2.5mg/5ml oral suspension £68.08/350ml\t\n•\tDiazepam 10mg/5ml oral suspension £178.06/100ml HIGH COST",null,"The Scottish Drug Tariff lists:\t \t \t \t \n•\tDiazepam 2mg/5ml oral solution sugar free £58.79/100ml\n•\tDiazepam 2.5mg/5ml oral suspension £122.40/350ml HIGH COST\n•\tDiazepam 10mg/2.5ml rectal solution tube £8.78/5\t\t\n•\tDiazepam 10mg/5ml oral suspension £119.00/100ml HIGH COST\t"]
["Diazoxide","Unlicensed preparations are being prescribed when there are licensed alternatives available","No licensed liquid available","Diazoxide 50mg tablets £108.61/100 tablets ","NEWT does not recommend crushing tablets ","Not applicable","The England/Wales Drug Tariff lists the following unlicensed specials with regulated prices:\n•\tDiazoxide 50mg/5ml oral suspension\t\n•\tDiazoxide 250mg/5ml oral suspension7","•\tDiazoxide 50mg/5ml oral suspension £40.25/100ml\t\n•\tDiazoxide 250mg/5ml oral suspension £149.48/30ml HIGH COST\n "]
["Diclofenac ","No licensed liquid available.\nLicensed diclofenac suppositories available as alternative formulation.","If topical/oral/rectal preparations are not suitable, consider switching to an alternative NSAID, e.g., ibuprofen (most cost-effective) or naproxen, available as a suitable licensed formulation. Licensed diclofenac suppositories are also available.","For example:\t \t \t \t \n•\tDiclofenac 12.5mg suppositories £0.70/10\n•\tDiclofenac 25mg suppositories £1.24/10\n•\tDiclofenac 50mg suppositories £2.04/10\t \n•\tDiclofenac 100mg suppositories £3.64/10\n•\tIbuprofen 100mg/5ml oral suspension £8.88/500ml\n•\tIbuprofen 200mg orodispersible tablets sugar-free £2.58/12\t\n•\tIbuprofen 200mg/5ml oral suspension sugar-free £3.49/100ml\n•\tIbuprofen 600mg effervescent granules sachets £6.80/20\t\t\t\n•\tNaproxen 125mg/5ml oral suspension sugar-free £110.00/100ml HIGH COST\t \n•\tNaproxen 250mg effervescent tablets sugar-free £52.72/20 HIGH COST\t\n•\tNaproxen 250mg/5ml oral suspension £45.00/100ml HIGH COST\t","Modified-release tablets/capsules should not be crushed/opened.","Not applicable","The England/Wales Drug Tariff lists the following unlicensed specials with regulated prices:\n•\tDiclofenac 50mg/5ml oral suspension","•\tDiclofenac 50mg/5ml oral suspension £45.21/150ml HIGH COST\n",null,"The Scottish Drug Tariff lists:\t \t \t \t \n•\tNaproxen 125mg/5ml oral suspension sugar-free £110.00/100ml HIGH COST\n•\tIbuprofen 100mg/5ml oral suspension £4.64/100ml \t"]
["Dihydrocodeine","Licensed liquid no longer available. Unlicensed preparations are being prescribed.","Consider switching to an alternative analgesic, e.g., licensed codeine liquid","•\tCodeine 15mg/5ml linctus sugar-free £2.25/200ml\n•\tCodeine 15mg/5ml linctus £2.40/200ml\t\n•\tCodeine 25mg/5ml oral solution £6.64/500ml\t","Dihydrocodeine 30mg tablets can be crushed - see Swallowing difficulties","Not applicable","The England/Wales Drug Tariff lists the following unlicensed specials with regulated prices:\n•\tDhydrocodeine 10mg/5ml oral suspension ","•\tDhydrocodeine 10mg/5ml oral suspension £400.47/100ml HIGH COST",null,"The Scottish Drug Tariff lists:\t \t \t \t \n•\tCodeine 15mg/5ml linctus £2.40/200ml\t\n•\tCodeine 25mg/5ml oral solution £6.64/500ml\t"]
["Diltiazem, oral","No licensed liquid available ","No suitable licensed preparation available for patients who are unable to swallow the solid oral dosage form","Not applicable","The modified-release (MR) capsules can be opened and the contents mixed with soft food for administration but the modified-release capsule contents must NOT be crushed. \nAlternatively, switch to diltiazem 60mg modified-release tablets suitable for TDS dosing (total daily dose to be divided to three times daily) and crush and disperse the tablets in water. ","•\tDiltiazem 60mg modified-release tablets £6.80/84\t \t","The England/Wales Drug Tariff lists the following unlicensed specials with regulated prices:\n•\tDiltiazem 60mg/5ml oral suspension ","•\tDiltiazem 60mg/5ml oral suspension £9.84/100ml","Diltiazem capsules/tablets should be prescribed by brand as bioavailability differs between preparations. Monitor if switching between brands.","The Scottish Drug Tariff lists:\t \t \t \t \n•\tDiltiazem 60mg modified-release tablets £9.35/84\t"]
["Diltiazem, rectal cream/ointment","No licensed rectal preparation available","Consider switching to licensed glyceryl trinitrate (GTN) rectal preparation.","•\tGlyceryl trinitrate 0.4% rectal ointment £39.30/30g\t","Not applicable","Not applicable","The England/Wales Drug Tariff lists the following unlicensed specials with regulated prices:\n•\tDiltiazem 0.2% cream HIGH COST\n•\tDiltiazem 2% cream \n•\tDiltiazem 2% ointment ","•\tDiltiazem 0.2% cream £58.53/10g HIGH COST\n•\tDiltiazem 2% cream £13.49/30g \n•\tDiltiazem 2% ointment £13.92/30g ",null,"The Scottish Drug Tariff lists:\t \t \t \t \n•\tGlyceryl trinitrate 0.2% ointment £54.00/30g\n•\tDiltiazem 2% cream 30 gram £50.52/30g\t"]
["Dithranol, topical (dermatology)","Unlicensed preparations are being prescribed.","There are no longer any licensed preparations available.","Not applicable","Not applicable","Not applicable","The British Association of Dermatologists (BAD) recommends the following unlicensed specials (see here for further information):\n•\tDithranol in Lassar's paste 0.1%, 0.5%, 1%, 2%, 4%, 10% and 15% w/w, 100g (dithranol in Lassar’s paste (a combination of salicylic acid and zinc oxide) is effective in moderate to severe chronic plaque psoriasis when other topical treatments (vitamin D analogues, commercial tar preparations and commercial dithranol preparations, e.g., Dithrocream®) have been ineffective or unsuitable, where phototherapy is contraindicated or less effective, e.g., lower leg, and where the patient does not wish to take or is unsuitable for systemic treatment. Treatment is often initiated at Dermatology day treatment centres but may in some cases be continued by patients at home once they have been instructed how to use it safely).\n•\tDithranol scalp application 0.4% w/w (‘dithranol pomade’; dithranol 0.4% w/w, salicylic acid 2% w/w, emulsifying wax BP 25% w/w, liquid paraffin to 100%), 100g (dithranol in Lassar’s paste (a combination of salicylic acid and zinc oxide) is effective in moderate to severe chronic plaque psoriasis when other topical treatments (vitamin D analogues, commercial tar preparations and commercial dithranol preparations, e.g., Dithrocream®) have been ineffective or unsuitable, where phototherapy is contraindicated or less effective, e.g., lower leg, and where the patient does not wish to take or is unsuitable for systemic treatment. Treatment is often initiated at Dermatology day treatment centres but may in some cases be continued by patients at home once they have been instructed how to use it safely).","Variable, fluctuating and unregulated","Dithrocream has been discontinued in all strengths (0.1%, 0.25%, 0.5%, 1.0% and 2.0%)"]
["Donepezil","Unlicensed preparations are being prescribed when there are licensed alternatives available","Licensed liquid and orodispersible tablets available. \nOrodispersible tablets are most cost-effective.","•\tDonepezil 1mg/ml oral solution sugar-free £108.64/150ml HIGH COST\n•\tDonepezil 5mg orodispersible tablets sugar-free £37.32/28\t\n•\tDonepezil 10mg orodispersible tablets sugar free £102.48/28 HIGH COST","Film-coated tablets can be crushed and mixed with water for administration. \nThese have a bitter taste. ","•\tDonepezil 5mg tablets £1.19/28 \n•\tDonepezil 10mg tablets £1.23/28 ","Various unlicensed specials","Variable, fluctuating and unregulated",null,"The Scottish Drug Tariff lists:\t  \n•\tDonepezil 5mg tablets £1.60/28 \n•\tDonepezil 5mg orodispersible tablets sugar-free £37.32/28\n•\tDonepezil 10mg tablets £1.68/28 \n•\tDonepezil 10mg orodispersible tablets sugar-free £102.48/28 HIGH COST"]
["Dosulepin ","No licensed liquid available. ","Review in line with NICE guidance and consider switching to an alternative antidepressant available (following switching guidelines) as suitable licensed formulation,  e.g., citalopram, amitriptyline, fluoxetine, venlafaxine.","•\tAmitriptyline 10mg/5ml oral solution sugar-free £126.10/150ml HIGH COST\t \n•\tAmitriptyline 25mg/5ml oral solution sugar-free £19.51/150ml \n•\tAmitriptyline 50mg/5ml oral solution sugar-free £18.78/150ml\n•\tCitalopram 40mg/ml oral drops sugar-free £14.89/15ml\t\t \n•\tFluoxetine 20mg dispersible tablets sugar free £3.44/28\n•\tFluoxetine 20mg/5ml oral solution £6.73/70ml \n•\tFluoxetine 20mg/5ml oral solution sugar-free £12.95/70ml \n•\tVenlafaxine 37.5mg/5ml oral solution sugar-free £178.00/150ml HIGH COST\n•\tVenlafaxine 75mg/5ml oral solution sugar-free £233.00/150ml HIGH COST","NEWT does not recommend crushing tablets/opening capsules","Not applicable","The England/Wales Drug Tariff lists the following unlicensed specials with regulated prices:\n•\tDosulepin 25mg/5ml oral solution \n•\tDosulepin 75mg/5ml oral solution ","•\tDosulepin 25mg/5ml oral solution £154.30/500ml HIGH COST\n•\tDosulepin 75mg/5ml oral solution £39.68/150ml ","In England, dosulepin should not be routinely prescribed on the NHS, see here","The Scottish Drug Tariff lists:\t \t \t \t \n•\tCitalopram 40mg/ml oral drops sugar-free £11.85/15ml\n•\tFluoxetine 20mg/5ml oral solution £7.58/70ml\n•\tAmitriptyline 10mg/5ml oral solution sugar-free £126.10/150ml HIGH COST"]
["Doxazosin","No licensed liquid available, standard tablets can be dispersed","No suitable licensed preparation available for patients who are unable to swallow the solid oral dosage form","Not applicable","Most standard tablets disperse readily in de-ionised water for oral administration. \nTap water should not be used. \nModified-release tablets should NOT be crushed. \nMultiples of the 4mg tablets are more cost-effective than the 8mg tablets.","•\tDoxazosin 1mg tablets £0.76/28\t \n•\tDoxazosin 2mg tablets £0.78/28\t \n•\tDoxazosin 4mg tablets £0.86/28\t \n•\tDoxazosin 8mg tablets £10.64/28 HIGH COST","The England/Wales Drug Tariff lists the following unlicensed specials with regulated prices:\n•\tDoxazosin 1mg/5ml oral solution\n•\tDoxazosin 1mg/5ml oral suspension\n•\tDoxazosin 4mg/5ml oral solution \n•\tDoxazosin 4mg/5ml oral suspension \t","•\tDoxazosin 1mg/5ml oral solution £23.11/150ml \n•\tDoxazosin 1mg/5ml oral suspension £43.76/100ml \n•\tDoxazosin 4mg/5ml oral solution £23.54/150ml \n•\tDoxazosin 4mg/5ml oral suspension £33.20/150ml ",null,"The Scottish Drug Tariff lists:\t \t \t \t \n•\tDoxazosin 1mg tablets £0.96/28\t \n•\tDoxazosin 2mg tablets £1.06/28\t \n•\tDoxazosin 4mg tablets £1.25/28\n•\tDoxazosin 8mg tablets £10.64/28 HIGH COST"]
["Doxycycline","Unlicensed preparations are being prescribed when there are licensed alternatives available","Licensed dispersible tablets available. \nThe tablets are scored for a 50mg dose.","•\tDoxycycline 100mg dispersible tablets sugar-free £4.91/8\t","Not applicable ","Not applicable","The England/Wales Drug Tariff lists the following unlicensed specials with regulated prices:\n•\tDoxycycline 50mg/5ml oral suspension HIGH COST","•\tDoxycycline 50mg/5ml oral suspension £150.60/100ml HIGH COST","Check treatment stop date"]

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["KEY","* Drug Tariff (England and Wales) May 24    § NEWT guidelines for administration of medication to patients with enteral feeding tubes or swallowing difficulties, Fourth edition- August 2021\n‡ Enteral Feeding Handbook 3rd edition        ** Scottish Drug Tariff April 24"]
["Chemical substance","What is the issue?","Option 1: Use a licensed medicine in a suitable licensed formulation (incl review ongoing need or change to different drug in same therapeutic class)","Licensed preparation(s) and cost (option 1) per original pack*","Option 2: Use a licensed medicine in an unlicensed manner (e.g. crushing tablets). See NEWT for further information§ \nNot applicable for enteral feeding tubes, refer to resources§,‡ or local medicines information service for more information.","Off-label preparation(s) and cost (option 2) per original pack*","Option 3: Only if clinical reason exists for not using licensed product: Use an unlicensed special","Unlicensed special preparation(s) and cost (option 3) per original pack*","Comments ","Scottish Drug Tariff considerations**"]
["Enalapril","No licensed liquid available","Consider switching to rampril or captopril, which are both available as licensed liquids (HIGH COST) for patients unable to swallow the solid oral dosage form.","•\tRamipril 2.5mg/5ml oral solution sugar-free £196.00/150ml\n•\tCaptopril 5mg/5ml oral solution sugar-free £93.30/100ml \n•\tCaptopril 25mg/5ml oral solution sugar-free £101.00/100ml ","The tablets can be crushed and dispersed in water for oral administration.","•\tEnalapril 2.5mg tablets £8.24/28\t \n•\tEnalapril 5mg tablets £0.80/28\t\n•\tEnalapril 10mg tablets £0.67/28\n•\tEnalapril 20mg tablets £0.71/28 ","The England/Wales Drug Tariff lists the following unlicensed specials with regulated prices:\n•\tEnalapril 1.25mg/5ml oral suspension\n•\tEnalapril 5mg/5ml oral solution \n•\tEnalapril 5mg/5ml oral suspension\n•\tEnalapril 10mg/5ml oral suspension ","•\tEnalapril 1.25mg/5ml oral suspension £26.10/150ml \n•\tEnalapril 5mg/5ml oral solution £47.85/150ml\n•\tEnalapril 5mg/5ml oral suspension £22.01/75ml\n•\tEnalapril 10mg/5ml oral suspension £18.76/100ml",null,"The Scottish Drug Tariff lists:\t \t \t \t \n•\tEnalapril 2.5mg tablets £8.24/28\t \n•\tEnalapril 5mg tablets £0.99/28\t\n•\tEnalapril 10mg tablets £1.05/28\n•\tEnalapril 20mg tablets £2.52/28 \n•\tRamipril 5mg/5ml oral solution £61.50/150ml\n•\tRamipril 5mg/5ml oral suspension £122.00/100ml HIGH COST\t"]
["Entacapone","No licensed liquid available","No suitable licensed preparation available for patients who are unable to swallow the solid oral dosage form","Not applicable","The tablets can be crushed and given in jam, honey or orange juice for oral administration. It has a bitter taste. ","•\tEntacapone 200mg tablets £7.91/30\t","Various unlicensed specials","Variable, fluctuating and unregulated",null,"The Scottish Drug Tariff lists:\t \t \t \t \n•\tEntacapone 200mg tablets £7.91/30\t"]
["Eosin 2% solution, topical (dermatology)","No suitable licensed preparation available.","No suitable licensed preparation available ","Not applicable","Not applicable","Not applicable","The British Association of Dermatologists (BAD) recommends the following unlicensed special (see here for further information):\n•\tEosin solution 2% w/v,  100ml (used for ulcerative, erosive or weeping wounds, or inflammatory skin disease, including around stomas, when dressing or device is changed).\n\nThe England/Wales Drug Tariff lists the following unlicensed specials with regulated prices:\n•\tEosin 2% solution ","•\tEosin 2% solution £19.52/100ml ","Consider a licensed product.","The Scottish Drug Tariff lists:\t \t \t \t \n•\tEosin 2% solution £34.00/100ml "]
["Ergocalciferol ","No licensed liquid available","Consider switching to colecalciferol. Various licensed colecalciferol preparations available (including effervescent tablets and liquids), alone or in combination with calcium carbonate.","•\tColecalciferol 200unit/calcium carbonate 1.25g chewable tablets £7.68/100\t\n•\tColecalciferol 200unit/calcium carbonate 750mg tablets £3.54/112\n•\tColecalciferol 400unit/calcium carbonate 1.25g chewable tablets £4.24/60\t\n•\tColecalciferol 400unit/calcium carbonate 1.5g chewable tablets £4.38/56\n•\tColecalciferol 400unit/calcium carbonate 1.5g effervescent tablets £5.99/56 \n•\tColecalciferol 400unit/calcium carbonate 1.5g tablets £2.95/60\n•\tColecalciferol 400unit capsules £1.85/28\t \n•\tColecalciferol 440unit/calcium carbonate 1.25g effervescent granules sachets £4.06/30\t \t\n•\tColecalciferol 800unit/calcium carbonate 1.25g chewable tablets £4.21/30\t \n•\tColecalciferol 800unit/calcium carbonate 2.5g chewable tablets £7.29/30\n•\tColecalciferol 800unit capsules £3.60/30\n•\tColecalciferol 800unit tablets £5.09/30\t \t \n•\tColecalciferol 880unit/calcium carbonate 2.5g chewable tablets £2.95/30\t\n•\tColecalciferol 1,000unit/calcium carbonate 2.5g chewable tablets £2.50/28\t\n•\tColecalciferol 1,000unit capsules £4.77/30\t \n•\tColecalciferol 1,000unit tablets £2.95/28\t\n•\tColecalciferol 2,400units/ml oral drops sugar-free £3.60/10ml\n•\tColecalciferol 2,740units/ml oral drops sugar-free £10.70/25ml \t\n•\tColecalciferol 3,200unit capsules £13.32/30\n•\tColecalciferol 4,000unit tablets £15.90/70\n•\tColecalciferol 5,600unit capsules £2.50/4\t\n•\tColecalciferol 10,000unit capsules £9.99/20 \n•\tColecalciferol 10,000unit oral drops sugar free £5.85/10ml\n•\tColecalciferol 10,000unit oral solution sugar free £1.55/2.5ml or £5.85/10ml\n•\tColecalciferol 15,000units/5ml oral solution sugar-free £122.40/100ml \n•\tColecalciferol 20,000unit capsules £17.04/15 or £29.00/30\t \n•\tColecalciferol 25,000unit capsules £3.95/3\n•\tColecalciferol 25,000unit tablets £17.00/12\t \n•\tColecalciferol 25,000units/1ml oral solution unit dose ampoules sugar-free £4.45/3\n•\tColecalciferol 50,000unit capsules £4.95/3\n•\tColecalciferol 50,000units/1ml oral solution unit dose ampoules sugar-free £6.25/3","Not applicable","Not applicable","The England/Wales Drug Tariff lists the following unlicensed specials with regulated prices:\n•\tErgocalciferol 1,000units/5ml oral solution \n•\tErgocalciferol 3,000units/ml oral solution \n•\tErgocalciferol 6,000units/5ml oral solution\n•\tErgocalciferol 10,000units/5ml oral solution \n•\tErgocalciferol 100,000units/5ml oral solution ","•\tErgocalciferol 1,000units/5ml oral solution £54.65/100ml \n•\tErgocalciferol 3,000units/ml oral solution £41.26/60ml \n•\tErgocalciferol 6,000units/5ml oral solution £23.62/100ml\n•\tErgocalciferol 10,000units/5ml oral solution £26.74/100ml\n•\tErgocalciferol 100,000units/5ml oral solution £37.49/20ml \t","BNF states that ergocalciferol 400 units is equivalent to 10 micrograms; dose expressed as units. Unlicensed solution is HIGH COST.\n","The Scottish Drug Tariff lists:\n•\tColecalciferol 800unit capsules £3.60/30\n•\tColecalciferol 800unit tablets £5.01/30\t \n•\tColecalciferol 20,000unit capsules £29.00/30 \n•\tCalcium and Ergocalciferol tablets £52.70/28"]

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["KEY","* Drug Tariff (England and Wales) May 24    § NEWT guidelines for administration of medication to patients with enteral feeding tubes or swallowing difficulties, Fourth edition- August 2021\n‡ Enteral Feeding Handbook 3rd edition        ** Scottish Drug Tariff April 24"]
["Chemical substance","What is the issue","Option 1: Use a licensed medicine in a suitable licensed formulation (incl review ongoing need or change to different drug in same therapeutic class)","Licensed preparation(s) and cost (option 1) per original pack*","Option 2: Use a licensed medicine in an unlicensed manner (e.g. crushing tablets). See NEWT for further information.§ \nNot applicable for enteral feeding tubes, refer to resources§,‡ or local medicines information service for more information.","Off-label preparation(s) and cost (option 2) per original pack*","Option 3: Only if clinical reason exists for not using licensed product: Use an unlicensed special","Unlicensed special preparation(s) and cost (option 3) per original pack*","Comments ","Scottish Drug Tariff considerations**"]
["Ferrous sulfate","Unlicensed preparations are being prescribed when there are licensed alternatives available","Licensed oral drops available (HIGH COST) or consider switching to ferrous fumarate or ferrous feredetate liquid. Ferrous fumarate liquid is the most cost-effective for patients unable to swallow the solid oral dosage form. ","•\tFerrous fumarate 140mg/5ml oral solution £3.92/200ml\n•\tFerrous fumarate 140mg/5ml oral solution sugar-free £5.33/300ml\t \t\n•\tFerrous sulfate 125mg/ml oral drops sugar-free £30.00/15ml HIGH COST\t\n•\tSodium feredetate (iron 27.5mg/5ml) oral solution sugar-free £14.95/500ml","Crushing tablets not recommended. ","Not applicable","The England/Wales Drug Tariff lists the following unlicensed specials with regulated prices:\n•\tFerrous sulfate 60mg/5ml oral solution ","•\tFerrous sulfate 60mg/5ml oral solution £15.81/100ml","See BNF for elemental iron content and dose conversion."]
["Fexofenadine","No licensed liquid available","Consider switch to alternative antihistamine available as a suitable licensed dosage form, e.g., loratadine oral solution sugar-free.","•\tLoratadine 5mg/5ml oral solution £3.11/100ml\t \n•\tLoratadine 5mg/5ml oral solution sugar-free £3.78/100ml\t \t","The tablets can be crushed and mixed with water for oral administration. Without crushing they disperse in approximately 5 minutes.","•\tFexofenadine 30mg tablets £5.46/60\n•\tFexofenadine 120mg tablets £1.36/30\t \n•\tFexofenadine 180mg tablets £1.82/30\t","The England/Wales Drug Tariff lists the following unlicensed specials with regulated prices:\n•\tFexofenadine 180mg/5ml oral suspension ","•\tFexofenadine 180mg/5ml oral suspension £173.52/100ml HIGH COST",null,"The Scottish Drug Tariff lists:\t \t \t \t \n•\tFexofenadine 120mg tablets £1.80/30\t \n•\tFexofenadine 180mg tablets £2.40/30\n•\tLoratadine 10mg tablets £0.95/30\n•\tLoratadine 5mg/5ml oral solution £4.27/100ml"]
["Flecainide","No licensed liquid available","No suitable licensed preparation available for patients who are unable to swallow the solid oral dosage form","Not applicable","The tablets can be crushed and dispersed in de-ionised water for oral administration. Tap water should not be used. May have a local anaesthetic action on the tongue and should be used with care. ","•\tFlecainide 50mg tablets £2.31/60 \n•\tFlecainide 100mg tablets £3.70/60\t","The England/Wales Drug Tariff lists the following unlicensed specials with regulated prices:\n•\tFlecainide 10mg/5ml oral suspension\n•\tFlecainide 25mg/5ml oral solution \n•\tFlecainide 25mg/5ml oral suspension ","•\tFlecainide 10mg/5ml oral suspension £9.81/100ml \n•\tFlecainide 25mg/5ml oral solution £40.19/300ml \n•\tFlecainide 25mg/5ml oral suspension £17.25/200ml ",null,"The Scottish Drug Tariff lists:\t \t \t \t \n•\tFlecainide 50mg tablets £3.30/60 \n•\tFlecainide 100mg tablets £4.22/60\t\n•\tFlecainide 25mg/5ml oral suspension £46.39/200ml"]
["Fludrocortisone ","Unlicensed preparations are being prescribed when there are licensed alternatives available","Licensed oral solution available - HIGH COST","•\tFludrocortisone 100microgram/ml oral solution sugar free £135.00/50ml HIGH COST","The tablets can be crushed and mixed with water and taken immediately, for oral administration. \nThe tablets are scored.\nThe score line is only to facilitate breaking for ease of swallowing and not to divide into equal doses.  ","•\tFludrocortisone 100microgram tablets £6.00/30","The England/Wales Drug Tariff lists the following unlicensed specials with regulated prices:\n•\tFludrocortisone 100micrograms/5ml oral suspension \n•\tFludrocortisone 50micrograms/5ml oral suspension ","•\tFludrocortisone 50micrograms/5ml oral suspension £28.14/100ml \n•\tFludrocortisone 100micrograms/5ml oral suspension £28.65/100ml",null,"The Scottish Drug Tariff lists:\t \t \t \t \n•\tFludrocortisone 100microgram tablets £5.61/30\t"]
["Fluocinolone, topical (dermatology)","Unlicensed preparations are being prescribed when there are licensed alternatives available","Licensed preparations available","•\tFluocinolone acetonide 0.00625% cream £4.84/50g\t \n•\tFluocinolone acetonide 0.00625% ointment £4.84/50g\n•\tFluocinolone acetonide 0.025% cream £4.14/30g or £11.75/100g \n•\tFluocinolone acetonide 0.025% gel £5.56/30g or £10.02/60g\n•\tFluocinolone acetonide 0.025% ointment £4.14/30g or £11.75/100g\n•\tFluocinonide 0.05% cream £3.96/25g or £13.34/100g\n•\tFluocinonide 0.05% ointment £3.50/25g or £13.15/100g","Not applicable","Not applicable","The British Association of Dermatologists (BAD) recommends the following unlicensed special (see here for further information):\n•\tCoal tar solution BP 3.3% w/w and propylene glycol 20% w/w in fluocinolone acetonide 0.025% (Synalar®) gel, 100g (use for very inflamed hyperkeratotic scalp psoriasis).\n","Variable, fluctuating and unregulated"]
["Fluoxetine ","Unlicensed preparations are being prescribed when there are licensed alternatives available","Licensed liquid and dispersible tablets available. \nThe dispersible tablets are most cost-effective.","•\tFluoxetine 20mg dispersible tablets sugar-free £3.44/28\t\n•\tFluoxetine 20mg/5ml oral solution £6.73/70ml\n•\tFluoxetine 20mg/5ml oral solution sugar-free £12.95/70ml\t","Not applicable","Not applicable","Various unlicensed specials","Variable, fluctuating and unregulated",null,"The Scottish Drug Tariff lists:\t \t \t \t \n•\tFluoxetine 20mg/5ml oral solution £7.58/70ml"]
["Folic acid","Unlicensed preparations are being prescribed when there are licensed alternatives available","Licensed liquid available. \n2.5mg/5ml is most cost effective option.","•\tFolic acid 2.5mg/5ml oral solution sugar-free £9.16/150ml\t  \n•\tFolic acid 5mg/5ml oral solution sugar-free £52.37/150ml HIGH COST","The tablets can be crushed and mixed with water for oral administration. They should be taken immediately.","•\tFolic acid 400microgram tablets £3.27/90\t \n•\tFolic acid 5mg tablets £0.68/28\t ","Various unlicensed specials","Variable, fluctuating and unregulated","The 2.5mg/5ml sugar-free oral solution is more cost-effective than the 5mg/ml strength.","The Scottish Drug Tariff lists:\t \t \t \t \n•\tFolic acid 5mg tablets £1.20/28\t"]
["Fosfomycin ","Unlicensed preparations are being prescribed when there are licensed alternatives available","Licensed granules for oral solution sachets available","•\tFosfomycin 3g granules for oral solution sachets £4.86/1","Not applicable","Not applicable","Various unlicensed specials","Variable, fluctuating and unregulated","Antibacterial, check treatment duration."]
["Furosemide ","Unlicensed preparations are being prescribed when there are licensed alternatives available","Licensed liquid available","•\tFurosemide 20mg/5ml oral solution sugar-free £15.05/150ml\t \n•\tFurosemide 40mg/5ml oral solution sugar-free £19.74/150ml\t \n•\tFurosemide 50mg/5ml oral solution sugar free £20.40/150ml","Not applicable ","Not applicable","The England/Wales Drug Tariff lists the following unlicensed specials with regulated prices:\n•\tFurosemide 5mg/5ml oral solution\n•\tFurosemide 5mg/5ml oral suspension","•\tFurosemide 5mg/5ml oral solution £38.16/150ml \n•\tFurosemide 5mg/5ml oral suspension £425.91/100ml (HIGH COST)","Furosemide 5mg/5ml oral suspension (special) is extremely high cost.","The Scottish Drug Tariff lists:\t \t \t \t \n•\tFurosemide 40mg/5ml oral solution sugar-free £19.74/150ml"]

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["KEY","* Drug Tariff (England and Wales) May 24    § NEWT guidelines for administration of medication to patients with enteral feeding tubes or swallowing difficulties, Fourth edition- August 2021\n‡ Enteral Feeding Handbook 3rd edition        ** Scottish Drug Tariff April 24"]
["Chemical substance","What is the issue?","Option 1: Use a licensed medicine in a suitable licensed formulation (incl review ongoing need or change to different drug in same therapeutic class)","Licensed preparation(s) and cost (option 1) per original pack*","Option 2: Use a licensed medicine in an unlicensed manner (e.g. crushing tablets). See NEWT for further information.§ \nNot applicable for enteral feeding tubes, refer to resources§,‡ or local medicines information service for more information.","Off-label preparation(s) and cost (option 2) per original pack*","Option 3: Only if clinical reason exists for not using licensed product: Use an unlicensed special","Unlicensed special preparation(s) and cost (option 3) per original pack*","Comments ","Scottish Drug Tariff considerations**"]
["Gabapentin ","Unlicensed preparations are being prescribed when there are licensed alternatives available","Licensed liquid available ","•\tGabapentin 50mg/ml oral solution sugar-free £59.71/150ml\t \t","The contents of the capsules can be sprinkled on food or given in fruit juice orally to mask their unpleasant taste. They should be taken immediately as the drug is rapidly hydrolysed.","•\tGabapentin 100mg capsules £1.84/100\t \n•\tGabapentin 300mg capsules £2.30/100\t \n•\tGabapentin 400mg capsules £3.05/100\t","The England/Wales Drug Tariff lists the following unlicensed specials with regulated prices:\n•\tGabapentin 100mg/5ml oral solution\n•\tGabapentin 100mg/5ml oral suspension \n•\tGabapentin 400mg/5ml suspension ","•  Gabapentin 100mg/5ml oral solution £267.55/100ml HIGH COST\t\n•  Gabapentin 100mg/5ml oral suspension £151.62/100ml HIGH COST\n•  Gabapentin 400mg/5ml suspension £123.42/200ml HIGH COST\t\t","Use licensed strength of oral solution ","The Scottish Drug Tariff lists:\t \t \t \t \n•\tGabapentin 100mg capsules £2.89/100\t \n•\tGabapentin 300mg capsules £2.74/100\t \n•\tGabapentin 400mg capsules £3.51/100\n•\tGabapentin 50mg/ml oral solution sugar free £59.71/150ml"]
["Gliclazide","No licensed liquid available","No suitable licensed preparation available for patients who are unable to swallow the solid oral dosage form","Not applicable","Immediate-release (IR) tablets can be crushed well and mixed with water or orange juice for oral administration. \nDo not crush modified-release (MR) tablets. \nSee comments for dose conversion between MR and IR tablets.","•\tGliclazide 40mg tablets £0.95/28\t \n•\tGliclazide 80mg tablets £0.85/28 \n•\tGliclazide 160mg tablets £3.27/28","The England/Wales Drug Tariff lists the following unlicensed specials with regulated prices:\n•\tGliclazide 40mg/5ml oral suspension\n•\tGliclazide 80mg/5ml oral suspension\t","•\tGliclazide 40mg/5ml oral suspension £15.66/100ml \n•\tGliclazide 80mg/5ml oral suspension £14.40/150ml\t","30mg modified-release gliclazide tablet is therapeutically equivalent to 80mg immediate-release.","The Scottish Drug Tariff lists:\t \t \t \t \n•\tGliclazide 40mg tablets £1.38/28\t \n•\tGliclazide 80mg tablets £1.40/28 "]
["Glyceryl trinitrate, topical ointment","Unlicensed preparations are being prescribed when there are licensed alternatives available","Licensed rectal ointment available","•\tGlyceryl trinitrate 0.4% rectal ointment £39.30/30g\t","Not applicable","Not applicable","The England/Wales Drug Tariff lists the following unlicensed specials with regulated prices:\n•\tGlyceryl trinitrate 0.2% ointment ","•\tGlyceryl trinitrate 0.2% ointment £39.02/30g\t",null,"The Scottish Drug Tariff lists:\t \t \t \t \n•\tGlyceryl trinitrate 0.2% ointment £54.00/30g\t"]
["Glycopyrronium bromide, oral","Unlicensed preparations are being prescribed when there are licensed alternatives available","Licensed liquid available for severe sialorrhoea (chronic pathological drooling) in children and adolescents aged 3 years and older with chronic neurological disorders","•\tGlycopyrronium bromide 1mg/5ml oral solution sugar-free £106.01/150ml HIGH COST\n•\tGlycopyrronium bromide 400micrograms/ml (320mcg/ml glycopyrronium) oral solution sugar-free £76.80/60ml HIGH COST","Not applicable","Not applicable","The England/Wales Drug Tariff lists the following unlicensed specials with regulated prices:\n•\tGlycopyrronium bromide 200micrograms/5ml oral solution \n•\tGlycopyrronium bromide 200micrograms/5ml oral suspension  \n•\tGlycopyrronium bromide 500micrograms/5ml oral solution \n•\tGlycopyrronium bromide 500micrograms/5ml oral suspension \n•\tGlycopyrronium bromide 2.5mg/5ml oral solution\n•\tGlycopyrronium bromide 2.5mg/5ml oral suspension\n•\tGlycopyrronium bromide 5mg/5ml oral solution\n•\tGlycopyrronium bromide 5mg/5ml oral suspension ","•\tGlycopyrronium bromide 200micrograms/5ml oral solution £15.80/100ml \n•\tGlycopyrronium bromide 200micrograms/5ml oral suspension £9.59/100ml \n•\tGlycopyrronium bromide 500micrograms/5ml oral solution £9.33/100ml\n•\tGlycopyrronium bromide 500micrograms/5ml oral suspension £32.78/300ml \n•\tGlycopyrronium bromide 2.5mg/5ml oral solution £30.20/100ml \n•\tGlycopyrronium bromide 2.5mg/5ml oral suspension £19.95/200ml \n•\tGlycopyrronium bromide 5mg/5ml oral solution £25.48/100ml\n•\tGlycopyrronium bromide 5mg/5ml oral suspension £10.97/50ml ","BNF for Children: Glycopyrronium bromide tablets and oral solutions are not interchangeable on a microgram-for-microgram basis due to differences in bioavailability. \nSialanar® oral solution has approximately a 25% higher bioavailability and therefore equivalent doses will be lower than for tablets and generic oral solutions. \nSialanar® oral solution contains 400 micrograms/mL of glycopyrronium bromide, which is equivalent to 320 micrograms/mL of glycopyrronium."]
["Glycopyrronium bromide/glycopyrrolate, topical (dermatology)","No suitable licensed preparation available","No suitable licensed preparation available ","Not applicable","Not applicable","Not applicable","The British Association of Dermatologists (BAD) recommends the following unlicensed specials (see here for further information):\n•\tGlycopyrrolate 2% w/w in cetomacrogol cream, 100g (use to treat disabling facial hyperhidrosis).\n\nThe England/Wales Drug Tariff lists the following unlicensed specials with regulated prices:\n•\tGlycopyrronium bromide 0.05% topical solution \n•\tGlycopyrronium bromide 2% in cetomacrogol cream (Formula A)","•\tGlycopyrronium bromide 0.05% topical solution £28.13/500ml \n•\tGlycopyrronium bromide 2% in cetomacrogol cream (Formula A) £141.91/30g HIGH COST"]
["Griseofulvin ","No licensed liquid available","Consider a switch to licensed fluconazole liquid, if patient is unable to swallow the solid oral dosage form.","•\tFluconazole 50mg/5ml oral suspension £28.11/35ml\n•\tFluconazole 200mg/5ml oral suspension £66.42/35ml","The tablets are unsuitable for crushing as the drug is very insoluble.","Not applicable","The England/Wales Drug Tariff lists the following unlicensed specials with regulated prices:\n•\tGriseofulvin 125mg/5ml oral suspension \n•\tGriseofulvin 175mg/5ml oral suspension ","•\tGriseofulvin 125mg/5ml oral suspension £29.33/100ml \n•\tGriseofulvin 175mg/5ml oral suspension £40.99/100ml","Antifungal, check date for treatment discontinuation. Therapy should be continued for at least two weeks after all signs of infection have disappeared [SPC]."]

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["KEY","* Drug Tariff (England and Wales) May 24    § NEWT guidelines for administration of medication to patients with enteral feeding tubes or swallowing difficulties, Fourth edition- August 2021\n‡ Enteral Feeding Handbook 3rd edition        ** Scottish Drug Tariff April 24"]
["Chemical substance","What is the issue","Option 1: Use a licensed medicine in a suitable licensed formulation (incl review ongoing need or change to different drug in same therapeutic class)","Licensed preparation(s) and cost (option 1) per original pack*","Option 2: Use a licensed medicine in an unlicensed manner (e.g. crushing tablets). See NEWT for further information.§ \nNot applicable for enteral feeding tubes, refer to resources§,‡ or local medicines information service for more information.","Off-label preparation(s) and cost (option 2) per original pack*","Option 3: Only if clinical reason exists for not using licensed product: Use an unlicensed special","Unlicensed special preparation(s) and cost (option 3) per original pack*","Comments ","Scottish Drug Tariff considerations**"]
["Haloperidol ","Unlicensed preparations are being prescribed when there are licensed alternatives available","Licensed liquid available","•\tHaloperidol 200micrograms/ml oral solution sugar-free £89.90/100ml HIGH COST\n•\tHaloperidol 5mg/5ml oral solution sugar-free £7.51/100ml\n•\tHaloperidol 10mg/5ml oral solution sugar-free £7.64/100ml\t","Not applicable","Not applicable","Various unlicensed specials","Variable, fluctuating and unregulated",null,"The Scottish Drug Tariff lists:\t \t \t \t \n•\tHaloperidol 10mg/5ml oral solution sugar-free £7.59/100ml\t"]
["Hydrochlorothiazide ","Unlicensed preparations are being prescribed as there is no licensed product available in the UK","No licensed product available in UK ","Consider a switch to bendroflumethiazide.","Bendroflumethiazide tablets can be dispersed in water for oral administration if patients are unable to swallow the solid oral dosage form. The tablets readily disperse in water within 1 to 5 minutes","•\tBendroflumethiazide 2.5mg tablets £0.55/28\n•\tBendroflumethiazide 5mg tablets £0.67/28","The England/Wales Drug Tariff lists the following unlicensed specials with regulated prices:\n•\tHydrochlorothiazide 25mg tablets \n","•\tHydrochlorothiazide 25mg tablets £68.77/100 HIGH COST",null,"The Scottish Drug Tariff lists:\t \t \t \t \n•\tBendroflumethiazide 2.5mg tablets £0.96/28\n•\tBendroflumethiazide 5mg tablets £0.98/28\n•\tBendroflumethiazide 2.5mg/5ml oral suspension £53.86/150ml"]
["Hydrocortisone, oral","Unlicensed preparations are being prescribed when there are licensed alternatives available","Licensed soluble/dispersible tablets and granules in capsules (HIGH COST) for opening available ","•\tHydrocortisone 500microgram granules in capsules for opening £33.75/50\n•\tHydrocortisone 1mg granules in capsules for opening £67.50/50 HIGH COST\n•\tHydrocortisone 2mg granules in capsules for opening £135.00/50 HIGH COST\n•\tHydrocortisone 2.5mg muco-adhesive buccal tablets sugar free £7.76/20 \n•\tHydrocortisone 5mg dispersible tablets sugar-free £20.00/30\n•\tHydrocortisone 5mg granules in capsules for opening £337.50/50 HIGH COST\n•\tHydrocortisone 10mg dispersible tablets sugar-free £35.00/30\n•\tHydrocortisone 10mg soluble tablets sugar-free £37.50/30\t\n•\tHydrocortisone 20mg dispersible tablets sugar-free £70.00/30 ","Not applicable","Not applicable","Various unlicensed specials","Variable, fluctuating and unregulated",null,"The Scottish Drug Tariff lists:\n•\tHydrocortisone 2.5mg muco-adhesive buccal tablets sugar free £7.76/20"]
["Hydrocortisone, topical (dermatology)","Unlicensed preparations are being prescribed when there are licensed alternatives available","Licensed topical preparations available.","•\tHydrocortisone 0.1% cream £2.83/15g\n•\tHydrocortisone 0.1% topical emulsion £5.91/100g\n•\tHydrocortisone butyrate 0.1% cream £4.93/100g\n•\tHydrocortisone butyrate 0.1% ointment £4.93/100g\t\n•\tHydrocortisone butyrate 0.1% scalp lotion £6.83/100ml\n•\tHydrocortisone 0.5% ointment £52.55/15g HIGH COST\n•\tHydrocortisone 1% cream £2.47/15g or £4.83/30g or £7.44/50g\t \n•\tHydrocortisone 1% ointment £2.37/15g or £5.16/30g or £8.69/50g\n•\tHydrocortisone acetate 1% cream £3.88/15g\n•\tHydrocortisone 2.5% cream £87.45/15g HIGH COST\n•\tHydrocortisone 2.5% ointment £47.52/15g HIGH COST","Not applicable","Not applicable","The British Association of Dermatologists (BAD) recommends the following unlicensed specials (see here for further information):\n•\tHydroquinone 5% w/w, hydrocortisone 1% w/w and tretinoin 0.1% w/w in a non-aqueous gel, 100g (use to treat melasma, in conjunction with a strong sunscreen, for a maximum of 6 months).\n\nThe England/Wales Drug Tariff lists the following unlicensed specials with regulated prices:\n•Hydroquinone 4% cream","Variable, fluctuating and unregulated","Licensed hydrocortisone 0.5% ointment is HIGH COST. \nThe 2.5% cream and ointment are considerably more expensive than the 1% strength.","The Scottish Drug Tariff lists:\t \t \t \t \n•\tHydrocortisone 0.5% cream £1.56/15g\n•\tHydrocortisone 0.5% ointment £50.60/15g HIGH COST\n•\tHydrocortisone 1% cream £2.36/15g or £5.75/30g\n•\tHydrocortisone 1% ointment £2.86/15g or £5.74/30g\n•\tHydrocortisone 2.5% cream £52.97/15g HIGH COST\n•\tHydrocortisone 2.5% ointment £54.65/15g HIGH COST\n"]
["Hydroquinone, topical (dermatology)","Unlicensed preparations are being prescribed ","No licensed product available","Not applicable","Not applicable ","Not applicable","The British Association of Dermatologists (BAD) recommends the following unlicensed specials (see here for further information):\n•\tHydroquinone 5% w/w, hydrocortisone 1% w/w and tretinoin 0.1% w/w in a non-aqueous gel, 100g (use to treat melasma, in conjunction with a strong sunscreen, for a maximum of 6 months).","•\tHydroquinone 4% cream £36.79/30g","Check treatment stop date- see BAD document."]
["Hydroxycarbamide ","Unlicensed preparations are being prescribed when there are licensed alternatives available","Licensed liquid available - HIGH COST","•\tHydroxycarbamide 500mg/5ml oral solution sugar-free £250.00/150ml HIGH COST","The capsules are cytotoxic and should not be opened","Not applicable","Various unlicensed specials","Variable, fluctuating and unregulated"]
["Hydroxychloroquine ","No licensed liquid available","No suitable licensed preparation available for patients who are unable to swallow the solid oral dosage form","Not applicable","The tablets can be crushed and dissolved in water for oral administration.","•\tHydroxychloroquine 200mg tablets £3.70/60\t  \n•\tHydroxychloroquine 300mg tablets £11.96/30\t","The England/Wales Drug Tariff lists the following unlicensed specials with regulated prices:\n•\tHydroxychloroquine 200mg/5ml oral suspension","•\tHydroxychloroquine 200mg/5ml oral suspension £13.67/100ml",null,"The Scottish Drug Tariff lists:\t \t \t \t \n•\tHydroxychloroquine 200mg tablets £3.70/60\t  "]
["Hyoscine butylbromide","No licensed liquid available","Consider switching to mebeverine licensed liquid if the patient cannot swallow the solid oral dosage form - HIGH COST. \nReview ongoing need regularly to consider switch to licensed tablets (135mg mebeverine tablet is equivalent to 150mg mebeverine liquid).","•\tMebeverine 50mg/5ml oral suspension sugar-free £205.70/300ml HIGH COST","NEWT does not recommend crushing tablets","Not applicable","The England/Wales Drug Tariff lists the following unlicensed specials with regulated prices:\n•\tHyoscine butylbromide 10mg/5ml oral solution \n•\tHyoscine butylbromide 10mg/5ml oral suspension ","•\tHyoscine butylbromide 10mg/5ml oral solution £29.91/100ml \n•\tHyoscine butylbromide 10mg/5ml oral suspension £14.55/100ml ","If an unlicensed special is required, the oral suspension is more cost-effective than the oral solution."]
["Hyoscine hydrobromide","No licensed liquid available","Consider switching to licensed hyoscine hydrobromide patches or chewable tablets, if appropriate (see comments for travel sickness indication)","•\tHyoscine 1mg/72hours transdermal patches £12.87/2\n","The standard tablets may be sucked if the patient is able, and absorbed through the lining of the mouth, although the \nlevel of absorption may vary, particularly in patients with little saliva. ","•\tHyoscine hydrobromide 150microgram tablets £1.84/12\n•\tHyoscine hydrobromide 300microgram tablets £1.84/12\t","The England/Wales Drug Tariff lists the following unlicensed specials with regulated prices:\n•\tHyoscine hydrobromide 300micrograms/5ml oral solution \n•\tHyoscine hydrobromide 300micrograms/5ml oral suspension\n•\tHyoscine hydrobromide 500micrograms/5ml oral solution \n•\tHyoscine hydrobromide 500micrograms/5ml oral suspension","•\tHyoscine hydrobromide 300micrograms/5ml oral solution £13.86/100ml\n•\tHyoscine hydrobromide 300micrograms/5ml oral suspension £13.08/100ml \n•\tHyoscine hydrobromide 500micrograms/5ml oral solution £17.81/100ml \n•\tHyoscine hydrobromide 500micrograms/5ml oral suspension £9.60/100ml (most cost effective)","Treatments for travel sickness should not be prescribed on the NHS and the patient should be advised to purchase these over-the-counter under self-care.","The Scottish Drug Tariff lists:\t \t \t \t \n•\tHyoscine hydrobromide 150microgram tablets £1.84/12\n•\tHyoscine hydrobromide 300microgram tablets £1.84/12\t"]
["Hypromellose eye preparations","Unlicensed preparations are being prescribed when there are licensed alternatives available","Licensed eye drops available (including preservative-free)","•\tHypromellose 0.32% eye drops £4.99/10ml \n•\tHypromellose 0.32% eye drops 0.5ml unit dose preservative-free £16.95/30 ","Not applicable","Not applicable","Various unlicensed specials","Variable, fluctuating and unregulated","Hypromellose 0.32% eye drops, preserved or preservative-free, should be the standard, see here","The Scottish Drug Tariff lists:\t \t \t \t \n•\tHypromellose 0.3% eye drops £1.05/10ml"]

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["KEY","* Drug Tariff (England and Wales) May 24    § NEWT guidelines for administration of medication to patients with enteral feeding tubes or swallowing difficulties, Fourth edition- August 2021\n‡ Enteral Feeding Handbook 3rd edition        ** Scottish Drug Tariff April 24"]
["Chemical substance","What is the issue?","Option 1: Use a licensed medicine in a suitable licensed formulation (incl review ongoing need or change to different drug in same therapeutic class)","Licensed preparation(s) and cost (option 1) per original pack*","Option 2: Use a licensed medicine in an unlicensed manner (e.g. crushing tablets). See NEWT for further information.§ \nNot applicable for enteral feeding tubes, refer to resources§,‡ or local medicines information service for more information.","Off-label preparation(s) and cost (option 2) per original pack*","Option 3: Only if clinical reason exists for not using licensed product: Use an unlicensed special","Unlicensed special preparation(s) and cost (option 3) per original pack*","Comments ","Scottish Drug Tariff considerations**"]
["Ichthammol, topical (dermatology)","Unlicensed preparations are being prescribed ","Zinc Paste and ichthammol bandage available (appliance) ","•\tZinc Paste (6%) and Ichthammol (2%) Bandage BP 1993 7.5cm x 6m £4.01/1","Not applicable","Not applicable","The British Association of Dermatologists (BAD) recommends the following unlicensed specials (see here for further information):\n•\tIchthammol 1% w/w and zinc oxide 15% w/w in YSP, 200g (ichthammol is used to treat acutely inflamed atopic eczema. It is also used in paste bandages (Ichthopaste® £4.01) for chronic lichenified eczema. Treatment is often initiated at Dermatology day treatment centres but may be continued in the community).\n\nThe England/Wales Drug Tariff lists the following unlicensed specials with regulated prices:\n•\tZinc oxide 15% and ichthammol 1% in yellow soft paraffin ","•\tZinc oxide 15% and ichthammol 1% in yellow soft paraffin £20.46/200g ",null,"The Scottish Drug Tariff lists:\t \t \t \t \n•\tZinc oxide 15% and Ichthammol 1% in Yellow soft paraffin £37.61/200g\n•\tZinc oxide 15% and Ichthammol 1% in Yellow soft paraffin £42.40/500g\n•\tIchthammol 1% in Yellow soft paraffin £37.00/100g"]
["Imipramine","Unlicensed preparations are being prescribed when there are licensed alternatives available","Licensed liquid available - HIGH COST","•\tImipramine 25mg/5ml oral solution sugar-free £250.00/150ml HIGH COST","The tablets may be crushed and mixed with water for oral administration","•\tImipramine 10mg tablets £1.39/28\n•\tImipramine 25mg tablets £1.18/28\t","Various unlicensed specials","Variable, fluctuating and unregulated",null,"The Scottish Drug Tariff lists:\t \t \t \t \n•\tImipramine 10mg tablets £1.39/28\n•\tImipramine 25mg tablets £2.20/28\t"]
["Indometacin ","No licensed liquid available.","Consider licensed suppositories or switching to ibuprofen/naproxen in a suitable licensed dosage form if an NSAID is required.","•\tIndometacin 100mg suppositories £17.61/10\t \t\n•\tIbuprofen 200mg orodispersible tablets sugar-free £2.58/12\t\n•\tIbuprofen 200mg/5ml oral suspension sugar-free £3.49/100ml\t \t\n•\tNaproxen 250mg/5ml oral suspension £45.00/100ml\n\t ","Tablets should not be crushed or capsules opened as they are irritant.","Not applicable","The England/Wales Drug Tariff lists the following unlicensed specials with regulated prices:\n•\tIndometacin 25mg/5ml oral suspension ","•\tIndometacin 25mg/5ml oral suspension £29.34/100ml\t",null,"The Scottish Drug Tariff lists:\t \t \t \t \n•\tIndometacin 100mg suppositories 10 suppository £17.61/10\n•\tIbuprofen 100mg/5ml oral suspension sugar-free £4.64/100ml \t"]
["Irbesartan","No licensed liquid available.","Consider switching to licensed valsartan liquid","•\tValsartan 3mg/ml oral solution £7.20/160ml","Tablets can be crushed and mixed with water for immediate oral administration. Without crushing, they disperse in approximately 5 minutes","•\tIrbesartan 75mg tablets £0.73/28\n•\tIrbesartan 150mg tablets £0.90/28\t\t\n•\tIrbesartan 300mg tablets £1.17/28","Various unlicensed specials","Variable, fluctuating and unregulated",null,"The Scottish Drug Tariff lists:\t \t \t \t \n•\tIrbesartan 75mg tablets £1.40/28\n•\tIrbesartan 150mg tablets £1.64/28\t\t\n•\tIrbesartan 300mg tablets £1.91/28"]
["Iron preparations","Unlicensed preparations are being prescribed when there are licensed alternatives available","See under ferrous sulfate","See under ferrous sulfate","See under ferrous sulfate","See under ferrous sulfate","See under ferrous sulfate","See under ferrous sulfate"]
["Isoniazid ","No licensed liquid available.","No suitable licensed preparation available for patients who are unable to swallow the solid oral dosage form","Not applicable","The tablets can be crushed and mixed with water for administration.","•\tIsoniazid 50mg tablets £23.67/56\t\n•\tIsoniazid 100mg tablets £63.58/28\t","The England/Wales Drug Tariff lists the following unlicensed specials with regulated prices:\n•\tIsoniazid 50mg/5ml oral solution ","•\tIsoniazid 50mg/5ml oral solution £48.64/500ml\t","Antimycobacterial, check stop date is clear.\nBNF C: the RCPCH and NPPG recommend that, when a liquid special of isoniazid is required, the following strength is used: 50 mg/5 mL.","The Scottish Drug Tariff lists:\t \t \t \t \n•\tIsoniazid 50mg/5ml oral solution £57.16/500ml\n"]
["Isosorbide mononitrate ","No licensed liquid available.","Consider switching to licensed glyceryl trinitrate (GTN) patch, if appropriate.","•\tGlyceryl trinitrate 5mg/24hours transdermal patches £12.77/28\n•\tGlyceryl trinitrate 10mg/24hours transdermal patches £14.06/28\n","The standard-release tablets can be crushed and dispersed in water; they may have an increased rate of absorption. \nThe modified-release tablets should not be crushed; if they are scored, they can be halved to make them easier for patients to swallow but they must not be crushed or chewed.","•\tIsosorbide mononitrate 10mg tablets £1.17/56\t \n•\tIsosorbide mononitrate 20mg tablets £1.09/56\n•\tIsosorbide mononitrate 40mg tablets £1.15/56\t","The England/Wales Drug Tariff lists the following unlicensed specials with regulated prices:\n•\tIsosorbide mononitrate 20mg/5ml oral suspension ","•\tIsosorbide mononitrate 20mg/5ml oral suspension £15.20/100ml",null,"The Scottish Drug Tariff lists:\t \t \t \t \n•\tIsosorbide mononitrate 10mg tablets £1.38/56\t \n•\tIsosorbide mononitrate 20mg tablets £1.46/56\n•\tIsosorbide mononitrate 40mg tablets £2.00/56"]

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["KEY","* Drug Tariff (England and Wales) May 24    § NEWT guidelines for administration of medication to patients with enteral feeding tubes or swallowing difficulties, Fourth edition- August 2021\n‡ Enteral Feeding Handbook 3rd edition        ** Scottish Drug Tariff April 24"]
["Chemical substance","What is the issue?","Option 1: Use a licensed medicine in a suitable licensed formulation (incl review ongoing need or change to different drug in same therapeutic class)","Licensed preparation(s) and cost (option 1) per original pack*","Option 2: Use a licensed medicine in an unlicensed manner (e.g. crushing tablets). See NEWT for further information.§ \nNot applicable for enteral feeding tubes, refer to resources§,‡ or local medicines information service for more information.","Off-label preparation(s) and cost (option 2) per original pack*","Option 3: Only if clinical reason exists for not using licensed product: Use an unlicensed special","Unlicensed special preparation(s) and cost (option 3) per original pack*","Comments ","Scottish Drug Tariff considerations**"]

{"sheet":"K","index":15,"n_rows":2,"n_cols":10,"rows_kept":2,"cut":false,"hidden":false,"merged":[[0,1,0,4]]}
["KEY","* Drug Tariff (England and Wales) May 24    § NEWT guidelines for administration of medication to patients with enteral feeding tubes or swallowing difficulties, Fourth edition- August 2021\n‡ Enteral Feeding Handbook 3rd edition        ** Scottish Drug Tariff April 24"]
["Chemical substance","What is the issue?","Option 1: Use a licensed medicine in a suitable licensed formulation (incl review ongoing need or change to different drug in same therapeutic class)","Licensed preparation(s) and cost (option 1) per original pack*","Option 2: Use a licensed medicine in an unlicensed manner (e.g. crushing tablets). See NEWT for further information.§ \nNot applicable for enteral feeding tubes, refer to resources§,‡ or local medicines information service for more information.","Off-label preparation(s) and cost (option 2) per original pack*","Option 3: Only if clinical reason exists for not using licensed product: Use an unlicensed special","Unlicensed special preparation(s) and cost (option 3) per original pack*","Comments ","Scottish Drug Tariff considerations**"]

{"sheet":"L","index":16,"n_rows":7,"n_cols":10,"rows_kept":7,"cut":false,"hidden":false,"merged":[[0,1,0,4]]}
["KEY","* Drug Tariff (England and Wales) May 24    § NEWT guidelines for administration of medication to patients with enteral feeding tubes or swallowing difficulties, Fourth edition- August 2021\n‡ Enteral Feeding Handbook 3rd edition        ** Scottish Drug Tariff April 24"]
["Chemical substance","What is the issue?","Option 1: Use a licensed medicine in a suitable licensed formulation (incl review ongoing need or change to different drug in same therapeutic class)","Licensed preparation(s) and cost (option 1) per original pack*","Option 2: Use a licensed medicine in an unlicensed manner (e.g. crushing tablets). See NEWT for further information.§ \nNot applicable for enteral feeding tubes, refer to resources§,‡ or local medicines information service for more information.","Off-label preparation(s) and cost (option 2) per original pack*","Option 3: Only if clinical reason exists for not using licensed product: Use an unlicensed special","Unlicensed special preparation(s) and cost (option 3) per original pack*","Comments ","Scottish Drug Tariff considerations**"]
["Levomepromazine","Licensed liquid available and unlicensed tablets are being prescribed","Licensed tablets and liquid are available","•Levomepromazine 6mg tablets £247.20/28 HIGH COST- see comments\t\n•Levomepromazine 25mg tablets £22.51/84\t \n•Levomepromazine 50mg tablets £34.00/84\n• Levomepromazine hydrochloride 25mg/5ml oral solution sugar free £178.00/100ml HIGH COST","The tablets can be crushed and dispersed in water for oral administration. The tablets disperse immediately.","•\tLevomepromazine 6mg tablets £247.20/28 HIGH COST\t \n•\tLevomepromazine 25mg tablets £22.51/84\t \n•\tLevomepromazine 50mg tablets £34.00/84\t ","The England/Wales Drug Tariff lists the following unlicensed specials with regulated prices:\n•\tLevomepromazine 2.5mg/5ml oral suspension \n•\tLevomepromazine 6mg/5ml oral suspension\t ","•\tLevomepromazine 2.5mg/5ml oral suspension £27.72/100ml \n•\tLevomepromazine 6mg/5ml oral suspension £136.72/100ml\t","Clinical Knowledge Summary for Delirium advises that the licensed 25mg tablets can be quartered for a starting dose of 6.25mg, to avoid the expensive 6mg tablets.","The Scottish Drug Tariff lists: \t \n•\tLevomepromazine 6mg tablets £247.20/28 HIGH COST- see comments\t"]
["Levothyroxine ","Unlicensed preparations are being prescribed when there are licensed alternatives available","Licensed liquid available if tablets are not suitable (do not prescribe unlicensed capsules unless there is a clinical justification). Review liquid prescribing regularly as HIGH COST.","•\tLevothyroxine sodium 25micrograms/5ml oral solution sugar-free £91.29/100ml HIGH COST\n•\tLevothyroxine sodium 50micrograms/5ml oral solution sugar-free £87.24/100ml HIGH COST\n•\tLevothyroxine sodium 75micrograms/5ml oral solution sugar-free £125.00/100ml HIGH COST\n•\tLevothyroxine sodium 100micrograms/5ml oral solution sugar-free £162.19/100 HIGH COST\n•\tLevothyroxine sodium 125micrograms/5ml oral solution sugar-free £185.00/100ml HIGH COST","Tablets can be crushed and mixed with water for oral administration. \nAvoid prescribing 12.5mcg and 75mcg tablets if possible, as these are more expensive. \n25mcg tablets can be halved for a 12.5mcg dose and 25mcg + 50mcg = a more cost-effective 75mcg dose.","•\tLevothyroxine sodium 12.5microgram tablets £15.79/28 HIGH COST\n•\tLevothyroxine sodium 25microgram tablets £0.75/28\t \n•\tLevothyroxine sodium 50microgram tablets £0.64/28\t \n•\tLevothyroxine sodium 75microgram tablets £3.27/28\t\n•\tLevothyroxine sodium 100microgram tablets £0.65/28","Various unlicensed specials","Variable, fluctuating and unregulated","Levothyroxine 25 mcg tablets are scored and can be halved, which is more cost-effective than the 12.5 mcg tablets.","The Scottish Drug Tariff lists: \t \n•\tLevothyroxine sodium 12.5microgram tablets £15.79/28\n•\tLevothyroxine sodium 25microgram tablets £1.13/28\n•\tLevothyroxine sodium 50microgram tablets £0.82/28\n•\tLevothyroxine sodium 75microgram tablets £3.27/28\n•\tLevothyroxine sodium 100microgram tablets £0.95/28\t\n•\tLevothyroxine sodium 25micrograms/5ml oral solution sugar-free £91.29/100ml HIGH COST\n•\tLevothyroxine sodium 50micrograms/5ml oral solution sugar-free £87.24/100ml HIGH COST\n•\tLevothyroxine sodium 100micrograms/5ml oral solution sugar-free £162.19/100ml HIGH COST"]
["Lidocaine, topical","Unlicensed preparations are being prescribed when there are licensed alternatives available","Available as licensed ointment, cream and medicated plasters. The medicated plasters should be restricted to people diagnosed with post-herpetic neuralgia, in whom alternative treatments are contraindicated, not tolerated, or ineffective, due to their cost.","•\tLidocaine 2% cream £3.81/30g\n•\tLidocaine 4% cream £2.98/5g or £14.90/30g\n•\tLidocaine 5% ointment £15.00/15g\n•\tLidocaine 5% medicated plasters £72.40/30 HIGH COST","Not applicable ","Not applicable","The England/Wales Drug Tariff lists the following unlicensed specials with regulated prices:\n•\tLidocaine 2% gel","•\tLidocaine 2% gel £26.76/15ml\n","In England see recommendations and guidance on restricted use  here"]
["Liothyronine","Unlicensed preparations are being prescribed when there are licensed alternatives available","Licensed liothyronine available if a switch to levothyroxine is not appropriate (see comments). Currently, the licensed liothyronine capsules represent a more cost-effective alternative compared to the tablets for the 5mcg and 10mcg strengths and they are bioequivalent.","•\tLiothyronine 5microgram capsules £55.00/28\t\n•\tLiothyronine 5microgram tablets £118.71/28 HIGH COST\t\n•\tLiothyronine 10microgram capsules £65.00/28\t \n•\tLiothyronine 10microgram tablets £152.44/28 HIGH COST\t\n•\tLiothyronine 20microgram capsules £55.00/28\t\n•\tLiothyronine 20microgram tablets £62.32/28 HIGH COST","Not applicable","Not applicable","Various unlicensed specials","Variable, fluctuating and unregulated.","Prescribing of liothyronine should be in line  with PrescQIPP guidance.\nThe BNF states that patients switched from an unlicensed brand to a licensed brand should be monitored (particularly if pregnant or if heart disease is present) as brands without a UK licence may not be bioequivalent.","The Scottish Drug Tariff lists:\t \t \t \t \n•\tLiothyronine 5 microgram tablets £118.71/28 HIGH COST\n•\tLiothyronine 20 microgram tablets £75.00/28 HIGH COST\nScottish position is also included in the PrescQIPP guidance. "]
["Losartan","No licensed liquid available ","Consider switching to licensed valsartan liquid","•\tValsartan 3mg/ml oral solution £7.20/160ml","Tablets can be crushed and mixed with water for immediate oral administration. Without crushing, they disperse in approximately 5 minutes","•\tLosartan 12.5mg tablets £2.07/28\n•\tLosartan 25mg tablets £0.77/28\t\t\n•\tLosartan 50mg tablets £0.86/28\n•\tLosartan 100mg tablets £0.96/28","The England/Wales Drug Tariff lists the following unlicensed specials with regulated prices:\n•\tLosartan 50mg/5ml oral solution \n•\tLosartan 50mg/5ml oral suspension ","•\tLosartan 50mg/5ml oral solution £20.55/100ml\n•\tLosartan 50mg/5ml oral suspension £30.90/150ml",null,"The Scottish Drug Tariff lists:\t \t \t \t \n•\tLosartan 12.5mg tablets £4.05/28\n•\tLosartan 25mg tablets £1.96/28\t\t\n•\tLosartan 50mg tablets £2.24/28\n•\tLosartan 100mg tablets £1.56/28"]

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["KEY","* Drug Tariff (England and Wales) May 24    § NEWT guidelines for administration of medication to patients with enteral feeding tubes or swallowing difficulties, Fourth edition- August 2021\n‡ Enteral Feeding Handbook 3rd edition        ** Scottish Drug Tariff April 24"]
["Chemical substance","What is the issue?","Option 1: Use a licensed medicine in a suitable licensed formulation (incl review ongoing need or change to different drug in same therapeutic class)","Licensed preparation(s) and cost (option 1) per original pack*","Option 2: Use a licensed medicine in an unlicensed manner (e.g. crushing tablets). See NEWT for further information.§ \nNot applicable for enteral feeding tubes, refer to resources§,‡ or local medicines information service for more information.","Off-label preparation(s) and cost (option 2) per original pack*","Option 3: Only if clinical reason exists for not using licensed product: Use an unlicensed special","Unlicensed special preparation(s) and cost (option 3) per original pack*","Comments ","Scottish Drug Tariff considerations**"]
["Magnesium glycerophosphate, oral","Unlicensed preparations are being prescribed when there are licensed alternatives available","Available as licensed chewable tablets and liquid.","•\tMagnesium glycerophosphate (magnesium 121.25mg/5ml (5mmol/5ml)) oral solution £37.87/200ml\t\n•\tMagnesium glycerophosphate (magnesium 97.2mg (4mmol)) chewable tablets sugar-free £22.77/50","Not applicable","Not applicable","The England/Wales Drug Tariff lists the following unlicensed specials with regulated prices:\n•\tMagnesium glycerophosphate (magnesium 97.2mg (4mmol)/5ml)) oral solution \n•\tMagnesium glycerophosphate (magnesium 97.2mg (4mmol)/5ml)) oral suspension","•\tMagnesium glycerophosphate (magnesium 97.2mg (4mmol)/5ml)) oral solution £16.31/200ml\n•\tMagnesium glycerophosphate (magnesium 97.2mg (4mmol)/5ml)) oral suspension £2.43/100ml","Review indication for prescribing and whether magnesium supplementation should be purchased over-the-counter if patients are asymptomatic or have sufficient magnesium levels. If an unlicensed liquid is required, the magnesium glycerophosphate (magnesium 97.2mg/5ml (4mmol/5ml)) oral suspension is more cost-effective than the oral solution.","The Scottish Drug Tariff lists:\t \t \t \t \n•\tMagnesium glycerophosphate (magnesium 97.2mg (4mmol)) chewable tablets £22.77/50"]
["Mebeverine, oral","Unlicensed preparations are being prescribed and there are licensed alternatives available.","There is a licensed sugar-free oral suspension available - HIGH COST. \nReview ongoing need regularly to consider switch to licensed tablets (135mg tablet is equivalent to 150mg liquid). \nIf a laxative is also needed, consider mebeverine with ispaghula husk effervescent granules.","•\tMebeverine 50mg/5ml sugar-free oral suspension £205.70/300ml HIGH COST\n•\tMebeverine 135mg tablets £3.47/100\n•\tMebeverine 200mg modified-release capsules £5.71/60\n•\tIspaghula husk 3.5g/mebeverine 135mg sugar-free effervescent granule sachets £9.16/10","Not applicable","Not applicable","Various unlicensed specials","Variable fluctuating and unregulated",null,"The Scottish Drug Tariff lists:\t \t \t \t \n•\tMebeverine 135mg tablets £2.83/15 or £3.47/100\n•\tMebeverine 200mg modified-release capsules £6.70/60"]
["Megestrol acetate","No licensed liquid available.","No suitable licensed preparation available for patients who are unable to swallow the solid oral dosage form","Not applicable","Tablets can be crushed and taken orally in fruit \njuice or jam. Crushing, if carried out by someone other than the patient, should preferably be done in water \nto reduce dust production and exposure. See NEWT for further guidance.","Megestrol 160mg tablets £19.52/30","The England/Wales Drug Tariff lists the following unlicensed specials with regulated prices:\n•\tMegestrol 40 mg tablets","•\tMegestrol 40 mg tablets £195.10/100"]
["Melatonin","Unlicensed preparations are being prescribed when there are licensed alternatives available","There are licensed liquid, immediate-release tablet, modified-release tablet and capsule formulations available, depending on the indication for treatment. \nA cost-effective licensed preparation should be used where possible. \nDiscontinue treatment for jet lag and insomnia with Alzheimer's disease as melatonin should not be prescribed on the NHS for these indications. \nReview and deprescribe modified-release melatonin in adults over 55 years of age after a total of 13 weeks of treatment.","•\tMelatonin 1mg modified-release tablets £41.20/60\t\n•\tMelatonin 1mg tablets £10.89/30\t\n•\tMelatonin 1mg/ml oral solution sugar-free £124.10/150ml HIGH COST\n•\tMelatonin 2mg capsules £57.50/30\t\n•\tMelatonin 2mg modified-release tablets £3.96/30\t \n•\tMelatonin 2mg tablets £10.89/30\n•\tMelatonin 3mg capsules £62.50/30\t \t\n•\tMelatonin 3mg tablets £19.81/30\t \n•\tMelatonin 4mg tablets £10.89/30\t \n•\tMelatonin 5mg capsules £105.00/30 HIGH COST\n•\tMelatonin 5mg modified-release tablets £103.00/30 HIGH COST\n•\tMelatonin 5mg tablets £10.89/30 ","Not applicable ","Not applicable","The England/Wales Drug Tariff lists the following unlicensed specials with regulated prices:\n•\tMelatonin 2.5mg capsules \n•\tMelatonin 3mg modified release capsules \n•\tMelatonin 2mg/5ml oral solution \n•\tMelatonin 2mg/5ml oral suspension \n•\tMelatonin 2.5mg/5ml oral solution \n•\tMelatonin 2.5mg/5ml oral suspension \n•\tMelatonin 3mg/5ml oral solution \n•\tMelatonin 3mg/5ml oral suspension \n•\tMelatonin 4mg/5ml oral suspension \n•\tMelatonin 10mg/5ml oral solution \n•\tMelatonin 10mg/5ml oral suspension \n","•\tMelatonin 2.5mg capsules £122.62/60 HIGH COST\n•\tMelatonin 3mg modified release capsules £84.57/60 HIGH COST\n•\tMelatonin 2mg/5ml oral solution £12.39/100ml \n•\tMelatonin 2mg/5ml oral suspension £16.95/100ml\n•\tMelatonin 2.5mg/5ml oral solution £13.98/100ml\n•\tMelatonin 2.5mg/5ml oral suspension £14.59/100ml\n•\tMelatonin 3mg/5ml oral solution £15.54/100ml\n•\tMelatonin 3mg/5ml oral suspension £20.14/100ml\n•\tMelatonin 4mg/5ml oral suspension £185.70/150ml HIGH COST\n•\tMelatonin 10mg/5ml oral solution £19.15/100ml\n•\tMelatonin 10mg/5ml oral suspension £19.23/100ml","All suitable patients should undergo a two-week drug holiday to assess their need for ongoing treatment.\nThis should take place three months after the commencement of treatment and six-monthly thereafter. \nIf sleep improvements are maintained without melatonin, therapy should be stopped.","The Scottish Drug Tariff lists:\n•\tMelatonin 1mg/ml oral solution sugar free £124.10/150ml HIGH COST\n•\tMelatonin 2mg modified-release tablets £3.96/30\n•\tMelatonin 3mg tablets £14.95/30"]
["Memantine","Unlicensed preparations are being prescribed","Available as licensed tablets, orodispersible tablets and liquid. \nFor patients who are unable to swallow the tablets, the sugar-free oral solution is the most cost-effective choice.","•\tMemantine 10mg orodispersible tablets sugar-free £24.99/28\n•\tMemantine 10mg tablets £1.02/28\n•\t Memantine 10mg/ml oral solution sugar-free £18.90/50ml\n•\t Memantine 20mg orodispersible tablets sugar-free £49.98/28\n•\t Memantine 20mg tablets £1.19/28\t","Memantine tablets can be crushed and dispersed in water for administration","•\tMemantine 10mg tablets £1.02/28\n•\t Memantine 20mg tablets £1.19/28\t","Various unlicensed specials","Variable fluctuating and unregulated","The orodispersible formulations are considerably more expensive and should only be prescribed if the patient is unable to take tablets or licensed oral solution. \nThe oral solution can be diluted in water to aid administration if necessary.","The Scottish Drug Tariff lists:\n•\tMemantine 10mg tablets £1.60/28\n•\tMemantine 10mg/ml oral solution sugar free £45.45/50ml\n•\tMemantine 20mg tablets £1.96/28"]
["Menadiol","No licensed liquid available.","Phytomenadione and menadiol are both forms of vitamin K. \nThe phytomendione 2mg/0.2ml solution for injection is licensed to be used orally in babies for the prophylaxis of vitamin K  deficiency bleeding. \nPhytomenadione is also available as licensed 1mg liquid capsules (the liquid can be squeezed out of the capsule) for the prophylaxis of vitamin K deficiency bleeding in babies.","•\tMenadiol 10mg tablets £236.72/100 HIGH COST\n•\tPhytomenadione 1mg capsules £3.95/12\n•\tPhytomenadione 2mg/0.2ml solution for injection (ampoules) £10.49/5","The liquid capsules can be opened or either strength solution for injection can be used as an oral solution for other indications (off-label). \nCaution with dose if switching between the two solutions for injection.","•\tPhytomenadione 1mg capsules £3.95/12\n•\tPhytomenadione 10mg/1ml solution (ampoules) £10.49/10\n•\tPhytomenadione 2mg/0.2ml solution (ampoules) £10.49/5","Various unlicensed specials","Variable fluctuating and unregulated"]
["Mercaptopurine","Unlicensed preparations are being prescribed","Mercaptopurine is available as a licensed 20mg/ml oral suspension or 50mg tablets. Suspension and tablets are not bioequivalent and switching should be done under specialist supervision.","•\tMercaptopurine 20mg/ml oral suspension £170.00/100ml HIGH COST\n•\tMercaptopurine 50mg tablets £8.45/25","Not recommended to crush tablets as mercaptopurine is cytotoxic","Not applicable","The England/Wales Drug Tariff lists the following unlicensed specials with regulated prices:\n•\tMercaptopurine 10 mg capsules\n•\tMercaptopurine 10 mg tablets","•\tMercaptopurine 10 mg capsules £252.23/50 HIGH COST\n•\tMercaptopurine 10 mg tablets £130.87/100 HIGH COST",null,"The Scottish Drug Tariff lists:\t \t \t \t \n•\tMercaptopurine 50mg tablets £8.73/25"]
["Mesalazine","Unlicensed preparations are being prescribed when there are licensed alternatives available","Mesalazine sachets available. Alternatively, consider rectal administration: enema and suppositories are available\n","•\tMesalazine 500mg gastro-resistant modified-release granules sachets sugar-free £28.74/100\n•\tMesalazine 500mg suppositories £14.81/30\t\n•\tMesalazine 1g gastro-resistant modified-release granules sachets sugar-free £28.74/50\t\n•\tMesalazine 1g modified-release granules sachets sugar-free £30.74/50\t\t\n•\tMesalazine 1g suppositories £40.01/28\t\n•\tMesalazine 1g/100ml enema £17.73/7 \t\n•\tMesalazine 1g/application foam enema £30.17/14\n•\tMesalazine 1.5g gastro-resistant modified-release granules sachets sugar-free £48.85/60\t\n•\tMesalazine 2g modified-release granules sachets sugar-free £73.78/60\t \n•\tMesalazine 2g/59ml enema £29.92/7 \t\n•\tMesalazine 3g gastro-resistant modified-release granules sachets sugar-free £97.70/60\n•\tMesalazine 4g modified-release granules sachets sugar-free £73.78/30","Mesalazine modified release tablets (Pentasa) can be dispersed easily in 50ml of water leaving small beads which must be swallowed whole and administered immediately.\nEnteric coated tablets must not be crushed.","•\tMesalazine 500mg modified-release tablets £30.74/100\t\n•\tMesalazine 1g modified-release tablets £36.89/60\t\n","Various unlicensed specials","Variable, fluctuating and unregulated","Mesalazine should be prescribed by brand name due to differences in bioavailability. Caution is required when switching."]
["Metformin","Unlicensed preparations are being prescribed when there are licensed alternatives available","Licensed oral solutions and powder sachets for oral solution available. \nPowder sachets are most cost-effective, followed by the 500mg/5ml oral solution sugar-free","•\tMetformin 500mg  powder sachets for oral solution sugar free £6.30/30\n•\tMetformin 500mg/5ml oral solution sugar-free £23.20/150ml\n•\tMetformin 850mg/5ml oral solution sugar-free £68.00/150ml\n•\tMetformin 1000mg/5ml oral solution sugar-free £97.08/150ml ","Not applicable ","Not applicable","Various unlicensed specials","Variable, fluctuating and unregulated",null,"The Scottish Drug Tariff lists:\t \t \t \t \n•\tMetformin 500mg/5ml oral solution sugar-free £40.50/150ml\n•\tMetformin 1000mg/5ml oral solution sugar-free £97.08/150ml "]
["Methadone","Unlicensed preparations are being prescribed when there are licensed alternatives available","Licensed liquid available","•\tMethadone 1mg/ml oral solution £0.91/100ml or £4.55/500ml\n•\tMethadone 1mg/ml oral solution sugar-free £0.93/100ml or £4.65/500ml\n•\tMethadone 10mg/ml oral solution sugar-free £12.01/150ml\n•\tMethadone 20mg/ml oral solution sugar-free £24.02/150ml\t \t","Not applicable","Not applicable","Various unlicensed specials","Variable, fluctuating and unregulated","Do not prescribe as  methadone 1mg/ml oral solution colour free sugar free, unless clinically required as this is an unlicensed special","The Scottish Drug Tariff lists:\t \t \t \t \n•\tMethadone 1mg/ml oral solution £4.55/500ml\n•\tMethadone 1mg/ml oral solution sugar-free £4.65/500ml"]
["Methotrexate","Unlicensed preparations are being prescribed when there are licensed alternatives available","Licensed liquid available - HIGH COST","Methotrexate 2mg/ml oral solution sugar free £95.00/35ml or £125.00/65ml HIGH COST\t","Tablets should NOT be crushed. \nTablets can be dispersed in water but due to the cytotoxic nature of methotrexate, this  should be done in a closed system (i.e., syringe  barrel) and gloves and a mask should be worn. \nPregnant women should avoid handling. \nSyringes should be disposed of as cytotoxic waste.","Methotrexate 2.5mg tablets £1.66/28","Various unlicensed specials","Variable, fluctuating and unregulated",null,"The Scottish Drug Tariff lists methotrexate 2.5mg tablets £2.20/28"]
["Methyldopa","No licensed liquid available.","No suitable licensed preparation available for patients who are unable to swallow the solid oral dosage form, consider if another antihypertensive is indicated (see comments).","Not applicable","Crush tablets and mix with water. \nNB: Tablets are film coated and not very \nsoluble, and have an unpleasant taste. See \nNEWT for updated guidance.","•\tMethyldopa 125mg tablets £94.69/56 HIGH COST\n•\tMethyldopa 250mg tablets £22.19/56\t \n•\tMethyldopa 500mg tablets £16.62/56","Various unlicensed specials","Variable, fluctuating and unregulated","Use has decreased markedly, replaced by better-tolerated alternatives. \nHowever, this drug is useful in pregnancy because it has no teratogenic effects.","The Scottish Drug Tariff lists:\n•\tMethyldopa 125mg tablets £120.40/56 HIGH COST\n•\tMethyldopa 250mg tablets £29.52/56\t \n•\tMethyldopa 500mg tablets £21.66/56"]
["Metoclopramide","Unlicensed preparations are being prescribed when there are licensed alternatives available","Licensed liquid available","Metoclopramide 5mg/5ml oral solution sugar-free £18.31/150ml","Not applicable","Not applicable","Various unlicensed specials","Variable, fluctuating and unregulated",null,"The Scottish Drug Tariff lists metoclopramide 5mg/5ml oral solution sugar-free £22.76/150ml"]
["Metolazone","Unlicensed preparations are being prescribed when there are licensed alternatives available","Licensed 5mg tablets available - HIGH COST\nPrescribe as brand name Xaqua to avoid inadvertent switching between brands (as not bioequivalent).","Metolazone 5mg tablets £110.00/20 HIGH COST","The tablets can be  crushed and mixed with water, if the patient has swallowing difficulties. \nN.B. monitor \nthe patient for postural hypotension due to \nincreased bioavailability. A dose reduction \nmay be necessary. See NEWT guidelines for more information","Metolazone 5mg tablets £110.00/20 HIGH COST","Various unlicensed specials","Variable, fluctuating and unregulated","Different brands of metolazone are not bioequivalent. \nPrescribe as brand name Xaqua to avoid inadvertent switching. \nCare is required if switching between the unlicensed preparation and the licensed 5mg tablets. \nIndividualised titration based on patient’s response and tolerability is advised."]
["Metoprolol","No licensed liquid available.","Consider switching to an alternative beta-blocker such as atenolol or propranolol, which are available as licensed liquids.","•\tAtenolol 25mg/5ml oral solution sugar free £10.27/300ml\n•\tPropranolol 10mg/5ml oral solution sugar free £32.64/150ml","Immediate-release tablets can be crushed and mixed with water for administration. \nThey disperse very slowly. \nDO NOT crush the modified-release (MR) tablets. \nRefer to indications and dosing in the BNF to convert to immediate-release tablets.","•\tMetoprolol 25mg tablets £30.65/28 HIGH COST (see comments)\n•\tMetoprolol 50mg tablets £3.37/28 \n•\tMetoprolol 100mg tablets £2.59/28","The England/Wales Drug Tariff lists the following unlicensed specials with regulated prices:\n•\tMetoprolol 12.5mg/5ml oral solution \n•\tMetoprolol 12.5mg oral suspension \n•\tMetoprolol 50mg/5ml oral solution ","•\tMetoprolol 12.5mg/5ml oral solution £24.30/150ml\n•\tMetoprolol 12.5mg oral suspension £5.18/100ml\n•\tMetoprolol 50mg/5ml oral solution £45.45/150ml","The SPC states the 50mg tablet can be divided into equal doses. This is more cost-effective than using the 25mg tablets.","The Scottish Drug Tariff lists:\t \t \t \t \n•\tPropranolol 10mg/5ml oral solution sugar free £32.64/150ml\n•\tPropranolol 40mg/5ml oral solution sugar free £43.53/150ml\n•\tMetoprolol 50mg tablets £3.75/28 \n•\tMetoprolol 100mg tablets £2.75/28"]
["Metronidazole, oral/rectal","Unlicensed preparations are being prescribed when there are licensed alternatives available","Licensed oral suspension and suppositories available","•\tMetronidazole 200mg/5ml oral suspension £64.43/100ml HIGH COST\n•\tMetronidazole 500mg suppositories £15.18/10 \n•\tMetronidazole 1g suppositories £23.06/10","Not applicable ","Not applicable","Various unlicensed specials","Variable, fluctuating and unregulated","Antimicrobial, check stop date.","The Scottish Drug Tariff lists metronidazole 200mg/5ml oral suspension £71.71/100ml HIGH COST"]
["Mexiletine","Unlicensed preparations are being prescribed when there are licensed alternatives available","Licensed capsules available - HIGH COST","Mexiletine hydrochloride 200mg (mexiletine 167mg) capsules £5000/100 HIGH COST","The capsules can be opened, and the  contents dispersed in water for  administration.","Mexiletine hydrochloride 200mg (mexiletine 167mg) capsules £5000/100 HIGH COST","Various unlicensed specials","Variable, fluctuating and unregulated","Review ongoing need regularly as licensed mexiletine costs £5000/100 tablets"]
["Midazolam, oral","Unlicensed preparations are being prescribed when there are licensed alternatives available","Licensed preparations available","•\tMidazolam 2.5mg/0.5ml oromucosal solution pre-filled oral syringes sugar-free £82.00/4\n•\tMidazolam 5mg/0.5ml oromucosal solution pre-filled oral syringes sugar-free £43.75/1\n•\tMidazolam 5mg/1ml oromucosal solution pre-filled oral syringes sugar-free £85.50/4\n•\tMidazolam 7.5mg/0.75ml oromucosal solution pre-filled oral syringes sugar-free £43.75/1\n•\tMidazolam 7.5mg/1.5ml oromucosal solution pre-filled oral syringes sugar-free £89.00/4\t\n•\tMidazolam 10mg/1ml oromucosal solution pre-filled oral syringes sugar-free £45.76/1\n•\tMidazolam 10mg/2ml oromucosal solution pre-filled oral syringes sugar-free £91.50/4","Not applicable","Not applicable","Various unlicensed specials","Variable, fluctuating and unregulated"]
["Midodrine ","Unlicensed preparations are being prescribed when there are licensed alternatives available","Licensed tablets available.","•\tMidodrine 2.5mg tablets £22.51/100\t \n•\tMidodrine 5mg tablets £26.21/100\n•\tMidodrine 10mg tablets £59.00/100","Tablets can be crushed and mixed with  water.\nPlease refer to NEWT guidance. ","•\tMidodrine 2.5mg tablets £22.51/100\t \n•\tMidodrine 5mg tablets £26.21/100\n•\tMidodrine 10mg tablets £59.00/100","Various unlicensed specials","Variable, fluctuating and unregulated",null,"The Scottish Drug Tariff lists:\n•\tMidodrine 2.5mg tablets £22.51/100\t \n•\tMidodrine 5mg tablets £26.21/100"]
["Mirtazapine","Unlicensed preparations are being prescribed when there are licensed alternatives available","Licensed liquid and orodispersible tablets available. \nThe orodispersible tablets are more cost-effective","•\tMirtazapine 15mg orodispersible tablets £1.74/30\t\t \n•\tMirtazapine 15mg/ml oral solution sugar-free £131.04/66ml HIGH COST\n•\tMirtazapine 30mg orodispersible tablets £1.74/30\t \n•\tMirtazapine 45mg orodispersible tablets £2.01/30\t","Not applicable","Not applicable","Various unlicensed specials","Variable, fluctuating and unregulated",null,"The Scottish Drug Tariff lists:\n•\tMirtazapine 15mg orodispersible tablets £2.65/30\n•\tMirtazapine 30mg orodispersible tablets £2.80/30\n•\tMirtazapine 45mg orodispersible tablets £3.10/30"]
["Modafinil","No licensed liquid available.","No suitable licensed preparation available for patients who are unable to swallow the solid oral dosage form","Not applicable","Tablets can be crushed and mixed with water for administration. Should be taken\nimmediately. ","•\tModafinil 100mg tablets £2.09/30\t \n•\tModafinil 200mg tablets £7.44/30","Various unlicensed specials","Variable, fluctuating and unregulated",null,"The Scottish Drug Tariff lists:\n•\tModafinil 100mg tablets £3.02/30\t \n•\tModafinil 200mg tablets £7.44/30"]
["Montelukast","Unlicensed preparations are being prescribed when there are licensed alternatives available","Licensed chewable tablets are most cost-effective. \nAlternatively, licensed granule sachets can be administered either directly into the mouth or mixed with a spoonful of soft food.","•\tMontelukast 4mg chewable tablets sugar-free £0.97/28\t \n•\tMontelukast 4mg granules sachets sugar-free £6.46/28\t \n•\tMontelukast 5mg chewable tablets sugar-free £1.10/28\t","Tablets can be crushed and mixed  with a small amount of soft food such as yogurt, honey, or mashed potato. This should be swallowed straight away, without chewing. - see Medicines for children\n","Montelukast 10mg tablets £1.41/28","Various unlicensed specials","Variable, fluctuating and unregulated",null,"The Scottish Drug Tariff lists:\n•\tMontelukast 4mg chewable tablets sugar-free £1.80/28\t \n•\tMontelukast 4mg granules sachets sugar-free £7.76/28\t \n•\tMontelukast 5mg chewable tablets sugar-free £1.80/28\n•\tMontelukast 10mg tablets £2.05/28"]

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["KEY","* Drug Tariff (England and Wales) May 24    § NEWT guidelines for administration of medication to patients with enteral feeding tubes or swallowing difficulties, Fourth edition- August 2021\n‡ Enteral Feeding Handbook 3rd edition        ** Scottish Drug Tariff April 24"]
["Chemical substance","What is the issue?","Option 1: Use a licensed medicine in a suitable licensed formulation (incl review ongoing need or change to different drug in same therapeutic class)","Licensed preparation(s) and cost (option 1) per original pack*","Option 2: Use a licensed medicine in an unlicensed manner (e.g. crushing tablets). See NEWT for further information.§ \nNot applicable for enteral feeding tubes, refer to resources§,‡ or local medicines information service for more information.","Off-label preparation(s) and cost (option 2) per original pack*","Option 3: Only if clinical reason exists for not using licensed product: Use an unlicensed special","Unlicensed special preparation(s) and cost (option 3) per original pack*","Comments ","Scottish Drug Tariff considerations**"]
["Naproxen","Unlicensed preparations are being prescribed when there are licensed alternatives available","Licensed liquid and effervescent tablets available. The 250mg/5ml oral suspension is more cost-effective. \nConsider ibuprofen suspension, granules or effervescent tablets, which are more cost-effective than naproxen, if clinically suitable.","•\tNaproxen 125mg/5ml oral suspension sugar-free £110.00/100ml HIGH COST\n•\tNaproxen 250mg effervescent tablets sugar-free £52.72/20\n•\tNaproxen 250mg/5ml oral suspension £45.00/100ml\n•\tIbuprofen 200mg orodispersible tablets sugar-free £2.58/12\t \n•\tIbuprofen 200mg/5ml oral suspension sugar-free £3.49/100ml\n•\tIbuprofen 600mg effervescent granules sachets £6.80/20","Not applicable","Not applicable","The England/Wales Drug Tariff lists the following unlicensed specials with regulated prices: \n•\tNaproxen 200mg/5ml oral suspension","•\tNaproxen 200mg/5ml oral suspension £18.10/100ml",null,"The Scottish Drug Tariff lists: \n•\tNaproxen 125mg/5ml oral suspension sugar-free £110.00/100ml HIGH COST"]
["Nicorandil","No licensed liquid available","No suitable licensed preparation available for patients who are unable to swallow the solid oral dosage form","Not applicable","Tablets will disperse in water within 5 minutes and can be given orally","•\tNicorandil 10mg tablets £1.85/60 \t\n•\tNicorandil 20mg tablets £2.54/60  \t","Various unlicensed specials","Variable, fluctuating and unregulated",null,"The Scottish Drug Tariff lists:\t \n•\tNicorandil 10mg tablets £3.60/60 \t\n•\tNicorandil 20mg tablet £4.80/60"]
["Nifedipine","No licensed liquid available. \nShort-acting formulations (including liquids) of nifedipine are not  recommended for angina or the long-term  management of hypertension. ","Consider switching to amlodipine, which is available as a licensed liquid - HIGH COST","•\tAmlodipine 5mg/5ml oral solution sugar-free £76.06/150ml HIGH COST\n•\tAmlodipine 5mg/5ml oral suspension sugar-free £70.00/150ml HIGH COST\n•\tAmlodipine 10mg/5ml oral solution sugar free £98.37/150ml HIGH COST","Nifedipine modified-release (MR) capsules can be opened and the contents taken orally, but the contents must not be crushed (see comments). \nThe immediate-release capsules can be bitten and the contents taken sublingually; however, the use of immediate-release (IR) nifedipine capsules for blood pressure control is not recommended due to the risk of rebound hypertension and tachycardia.","•\tNifedipine 10mg modified-release capsules \t£3.90/60\n•\tNifedipine 20mg modified-release capsules\t£5.41/60\n•\tNifedipine 30mg modified-release capsules\t£4.89/28\n•\tNifedipine 60mg modified-release capsules\t£7.34/28\t\n•\tNifedipine 5mg capsules (immediate-release) £47.83/90\t\n•\tNifedipine 10mg capsules (immediate-release) £65.63/90\t \n ","The England/Wales Drug Tariff lists the following unlicensed specials with regulated prices\n•\tNifedipine 5mg/5ml oral suspension \n•\tNifedipine 10mg/5ml oral suspension ","•\tNifedipine 5mg/5ml oral suspension £32.45/100ml \n•\tNifedipine 10mg/5ml oral suspension £23.74/100ml\n","Treatment with short-acting nifedipine may induce an exaggerated fall in blood pressure and reflex tachycardia, which can cause cardiovascular complications such as myocardial and cerebrovascular ischaemia. Licensed standard release capsules are available. [BNF]","The Scottish Drug Tariff lists: \n•\tNifedipine 5mg capsules (immediate-release) £47.83/90\n•\tNifedipine 10mg capsules (immediate-release) £65.63/90\n•\tAmlodipine 10mg/5ml oral solution sugar free £115.73/150ml HIGH COST"]
["Nitrofurantoin","Unlicensed preparations are being prescribed when there are licensed alternatives available","Licensed liquid available - HIGH COST.\nConsider an alternative antibiotic if sensitivity reports allow, see BNF.","Nitrofurantoin 25mg/5ml oral suspension sugar-free £454.59/300ml","IR capsules can be opened for oral administration. \nDo not crush tablets as nitrofurantoin is irritant.\nDo not open modified-release (MR) capsules.","•\tNitrofurantoin 50mg capsules £2.72/30\n•\tNitrofurantoin 100mg capsules £9.58/30\t","Various unlicensed specials","Variable, fluctuating and unregulated","Review continued need for liquid formulation as considerably more expensive than the tablets/capsules. Check stop date.","The Scottish Drug Tariff lists: \n•\tNitrofurantoin 25mg/5ml oral suspension sugar-free £454.59/300ml HIGH COST\n•\tNitrofurantoin 50mg capsules £4.72/30"]
["Nitrazepam","Unlicensed preparations are being prescribed when there are licensed alternatives available","Licensed liquid available - HIGH COST\nAlternatively, consider switching to temazepam licensed liquid, which is more cost-effective.","•\tNitrazepam 2.5mg/5ml oral suspension £152.00/70ml HIGH COST\n•\tTemazepam 10mg/5ml oral solution sugar-free £206.85/300ml\t HIGH COST","Not applicable","Not applicable","The England/Wales Drug Tariff lists the following unlicensed specials with regulated prices\n•\tNitrazepam 5mg/5ml oral suspension ","•\tNitrazepam 5mg/5ml oral suspension £109.77/100ml","Dosage should be adjusted on an individual basis. If possible, the treatment should be on an intermittent basis. Long-term chronic use is not recommended. [SPC]","The Scottish Drug Tariff lists: \n•\tNitrazepam 2.5mg/5ml oral suspension £152.00/70ml HIGH COST\n•\tTemazepam 10mg/5ml oral solution sugar free £252.17/300ml HIGH COST"]
[null,null,null,null,null,null,null,null,"[panmersey guidance]"]
["Nortriptyline","Unlicensed preparations are being prescribed when there are licensed alternatives available","Nortriptyline is available as a licensed liquid - HIGH COST. \nConsider an alternative tricyclic antidepressant, e.g., amitriptyline 25mg/5ml oral solution sugar-free","•\tNortriptyline 10mg/5ml oral solution sugar-free £246.00/250ml HIGH COST\n•\tAmitriptyline 10mg/5ml oral solution sugar-free £126.10/150ml HIGH COST\n•\tAmitriptyline 25mg/5ml oral solution sugar-free £19.61/150ml\n•\tAmitriptyline 50mg/5ml oral solution sugar-free £18.78/150ml","Not applicable ","Not applicable","Various unlicensed specials","Variable, fluctuating and unregulated","Prescribe amitriptyline as a licensed oral solution, avoiding the high cost 10mg/5ml strength, if possible. A 10mg dose can be given as 1ml of the 50mg/5ml sugar-free oral solution, if needed.","The Scottish Drug Tariff lists: \n•\tAmitriptyline 10mg/5ml oral solution sugar free £126.10/150ml HIGH COST"]
["Nystatin","Unlicensed preparations are being prescribed when there are licensed alternatives available","Licensed liquid available.","•\tNystatin 100,000units/ml oral suspension £1.80/30ml","Not applicable","Not applicable","Various unlicensed specials","Variable, fluctuating and unregulated",null,"The Scottish Drug Tariff lists nystatin 100,000units/ml oral suspension £1.80/30ml"]

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["KEY","* Drug Tariff (England and Wales) May 24    § NEWT guidelines for administration of medication to patients with enteral feeding tubes or swallowing difficulties, Fourth edition- August 2021\n‡ Enteral Feeding Handbook 3rd edition        ** Scottish Drug Tariff April 24"]
["Chemical substance","What is the issue?","Option 1: Use a licensed medicine in a suitable licensed formulation (incl review ongoing need or change to different drug in same therapeutic class)","Licensed preparation(s) and cost (option 1) per original pack*","Option 2: Use a licensed medicine in an unlicensed manner (e.g. crushing tablets). See NEWT for further information.§ \nNot applicable for enteral feeding tubes, refer to resources§,‡ or local medicines information service for more information.","Off-label preparation(s) and cost (option 2) per original pack*","Option 3: Only if clinical reason exists for not using licensed product: Use an unlicensed special","Unlicensed special preparation(s) and cost (option 3) per original pack*","Comments ","Scottish Drug Tariff considerations**"]
["Olmesartan","No licensed liquid available","Consider switching to valsartan licensed liquid if an ACE inhibitor is not clinically suitable (e.g., ramipril or lisinopril licensed liquid).","Valsartan 3mg/ml oral solution £7.20/160ml","Olmesartan tablets can not be crushed. \nConsider switching to losartan, candesartan or irbesartan which can be crushed and mixed with water or given with soft food, for oral administration","•\tLosartan 12.5mg tablets £2.07/28\n•\tLosartan 25mg tablets £0.77/28\n•\tLosartan 50mg tablets £0.86/28\n•\tLosartan 100mg tablets £0.96/28\n•\tCandesartan 2mg tablets £0.76/7\t \n•\tCandesartan 4mg tablets £0.57/7\t \n•\tCandesartan 8mg tablets £1.02/28\n•\tCandesartan 16mg tablets £1.16/28\t\t\n•\tCandesartan 32mg tablets £1.35/28\t\n•\tIrbesartan 75mg tablets £0.73/28\n•\tIrbesartan 150mg tablets £0.90/28\n•\tIrbesartan 300mg tablets £1.17/28\t ","Various unlicensed specials","Variable, fluctuating and unregulated","Review and consider switching to another product in the same medicinal class or an ACEI if a liquid is needed.","The Scottish Drug Tariff lists: \n•\tLosartan 12.5mg tablets £4.05/28\n•\tLosartan 25mg tablets £1.96/28\n•\tLosartan 50mg tablets £2.24/28\n•\tLosartan 100mg tablets £1.56/28\n•\tCandesartan 2mg tablets £1.20/7\t \n•\tCandesartan 4mg tablets £1.08/7\t \n•\tCandesartan 8mg tablets £1.50/28\n•\tCandesartan 16mg tablets £1.92/28\t\t\n•\tCandesartan 32mg tablets £2.00/28\t\n•\tIrbesartan 75mg tablets £1.40/28\n•\tIrbesartan 150mg tablets £1.64/28\n•\tIrbesartan 300mg tablets £1.91/28"]
["Omeprazole","Unlicensed preparations are being prescribed when there are licensed alternatives available","Licensed oral suspensions and dispersible tablets are available. ","•\tOmeprazole 10mg dispersible gastro-resistant tablets £9.30/28\n•\tOmeprazole 20mg dispersible gastro-resistant tablets £13.92/28\n•\tOmeprazole 40mg dispersible gastro-resistant tablets £6.96/7\t\n•\tOmeprazole 1mg/ml oral suspension sugar-free £111.00/75ml HIGH COST\t\n•\tOmeprazole 10mg/5ml oral suspension sugar-free £124.00/75ml HIGH COST\n•\tOmeprazole 20mg/5ml oral suspension sugar-free £234.00/75ml HIGH COST","Not applicable ","Not applicable","Various unlicensed specials","Variable, fluctuating and unregulated","The orodispersible tablets are more cost-effective for patients unable to swallow the solid oral dosage form."]
["Ondansetron","Unlicensed preparations are being prescribed when there are licensed alternatives available","Available as a licensed liquid and orodispersible tablets.  \nThe sugar-free orodispersible films are the most cost-effective.","•\tOndansetron 4mg orodispersible films sugar-free £28.50/10\n•\tOndansetron 4mg orodispersible tablets £38.47/10\t \n•\tOndansetron 4mg/5ml oral solution sugar-free £35.27/50ml\t \n•\tOndansetron 8mg orodispersible films sugar-free £57.00/10\n•\tOndansetron 8mg orodispersible tablets £85.42/10\t \n•\tOndansetron 8mg/5ml oral solution sugar-free £130.46/100ml HIGH COST","Not applicable ","Not applicable","Various unlicensed specials","Variable, fluctuating and unregulated","Ondansetron orodispersible films sugar-free are most cost-effective for patients unable to swallow the solid oral dosage form","The Scottish Drug Tariff lists: \n•\tOndansetron 4mg orodispersible tablets £38.47/10\n•\tOndansetron 8mg orodispersible tablets £85.43/10"]
["Oxybutynin","Unlicensed preparations are being prescribed when there are licensed alternatives available","Licensed sugar-free liquid and patches available - HIGH COST","•\tOxybutynin 2.5mg/5ml oral solution sugar free £198.13/150ml HIGH COST\n•\tOxybutynin 3.9mg/24hours transdermal patches £27.20/8\n•\tOxybutynin 5mg/5ml oral solution sugar free £218.65/150ml HIGH COST","Oxybutynin immediate-release tablets and tolterodine immediate-release tablets can be crushed and mixed with water for oral administration","•\tOxybutynin 2.5mg tablets £1.15/56\t\n•\tOxybutynin 5mg tablets £1.28/56\t\n•\tTolterodine 1mg tablets £1.98/56\n•\tTolterodine 2mg tablets £2.66/56","Various unlicensed specials","Variable, fluctuating and unregulated",null,"The Scottish Drug Tariff lists: \n•\tOxybutynin 2.5mg tablets £1.67/56\n•\tOxybutynin 5mg tablets £1.47/56\n•\tTolterodine 1mg tablets £3.00/56\n•\tTolterodine 2mg tablets £2.66/56"]

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["KEY","* Drug Tariff (England and Wales) May 24    § NEWT guidelines for administration of medication to patients with enteral feeding tubes or swallowing difficulties, Fourth edition- August 2021\n‡ Enteral Feeding Handbook 3rd edition        ** Scottish Drug Tariff April 24"]
["Chemical substance","What is the issue?","Option 1: Use a licensed medicine in a suitable licensed formulation (incl review ongoing need or change to different drug in same therapeutic class)","Licensed preparation(s) and cost (option 1) per original pack*","Option 2: Use a licensed medicine in an unlicensed manner (e.g. crushing tablets). See NEWT for further information.§ \nNot applicable for enteral feeding tubes, refer to resources§,‡ or local medicines information service for more information.","Off-label preparation(s) and cost (option 2) per original pack*","Option 3: Only if clinical reason exists for not using licensed product: Use an unlicensed special","Unlicensed special preparation(s) and cost (option 3) per original pack*","Comments ","Scottish Drug Tariff considerations**"]
["Perindopril","No licensed liquid available","Consider switching to an alternative ACE inhibitor that is available as a licensed liquid, e.g., rampiril or lisinopril - HIGH COST\nOr switch to valsartan 3mg/ml oral solution. \nIf liquid is likely to be needed long term, valsartan is the most cost-effective option.","•\tRamipril 2.5mg/5ml oral solution sugar free £196.00/150ml HIGH COST\n•\tLisinopril 5mg/5ml oral solution sugar free £218.00/150ml HIGH COST\n•\tValsartan 3mg/ml oral solution £7.20/160ml ","Perindopril (as erbumine) tablets can be crushed and mixed with water for oral administration. \nIf switching from perindopril arginine to erbumine, 2.5mg perindopril arginine is equivalent to 2mg perindopril erbumine.\nA dose adjustment is required as they are not bioequivalent.","•\tPerindopril erbumine 2mg tablets £0.93/30\n•\tPerindopril erbumine 4mg tablets £1.09/30\n•\tPerindopril erbumine 8mg tablets £1.48/30","The England/Wales Drug Tariff lists the following unlicensed specials with regulated prices:\t \n•\tPerindopril erbumine 4mg/5ml oral solution\n•\tPerindopril erbumine 4mg/5ml oral suspension ","•\tPerindopril erbumine 4mg/5ml oral solution £19.13/150ml\n•\tPerindopril erbumine 4mg/5ml oral suspension £20.06/100ml","Note: 2.5mg perindopril arginine is \nequivalent to 2mg perindopril erbumine","The Scottish Drug Tariff lists: \n•\tRamipril 5mg/5ml oral solution £61.50/150ml\n•\tRamipril 5mg/5ml oral suspension £122.00/100ml HIGH COST\n•\tPerindopril erbumine 2mg tablets £0.93/30\n•\tPerindopril erbumine 4mg tablets £1.09/30\n•\tPerindopril erbumine 8mg tablets £1.48/30"]
["Phenobarbital","Unlicensed preparations are being prescribed when there are licensed alternatives available","Available as a licensed liquid.\nContains 38% alcohol - not  suitable for young children and neonates and others for whom  formulations containing alcohol would not be suitable.","•\tPhenobarbital 15mg/5ml elixir £83.00/500ml HIGH COST","Crush the tablets and mix with water prior to administration.\nConsider multiples of 30mg tablets as more cost effective.","•\tPhenobarbital 15mg tablets £21.98/28\n•\tPhenobarbital 30mg tablets £0.82/28\n•\tPhenobarbital 60mg tablets £7.15/28","The England/Wales Drug Tariff lists the following unlicensed specials with regulated prices:\t \n•\tPhenobarbital 50mg/5ml oral solution \n•\tPhenobarbital 50mg/5ml oral suspension","•\tPhenobarbital 50mg/5ml oral solution £108.68/150ml HIGH COST\n•\tPhenobarbital 50mg/5ml oral suspension £84.97/100ml HIGH COST\n","The RCPCH and NPPG position statement \n'Choosing an Oral Liquid Medicine for Children'\nstates that recommended practice in the UK is to use an ethanol-free unlicensed phenobarbital 50 mg/5 mL liquid for children when an oral liquid is required. \nPhenobarbital Elixir BP (15 mg/5 mL) contains 38% v/v of ethanol (alcohol),  so there is potential for accumulation when ingested repeatedly, especially in young children with low or immature metabolic capacity. \nDifferent formulations of oral preparations may vary in bioavailability. Patients should be maintained on a specific manufacturer's product. Where an unlicensed liquid is needed, the oral suspension is more cost-effective.","The Scottish Drug Tariff lists:\t \n•\tPhenobarbital 15mg/5ml elixir £83.01/500ml HIGH COST\n•\tPhenobarbital 50mg/5ml oral solution £142.88/150ml HIGH COST"]
["Phenol, topical (dermatology)","Unlicensed preparations are being prescribed in varying strengths. Costs can be unpredictable","No suitable licenced formulation available. Consider alternative treatments",null,"Not applicable","Not applicable","The British Association of Dermatologists (BAD) recommends the following unlicensed specials (see here for further information):\n•\tPhenol 2% w/w in compound zinc paste BP, 50g (used for intractable pruritus ani, unresponsive to moderate strength topical steroid and barrier preparations).","Variable, fluctuating and unregulated"]
["Phenytoin","Unlicensed preparations are being prescribed when there are licensed alternatives available","Licensed liquid and chewable tablets available. \nThe liquid is more cost-effective.","•\tPhenytoin 30mg/5ml oral suspension £4.27/500ml\n•\tPhenytoin 50mg chewable tablets £13.18/200","Not applicable","Not applicable","The England/Wales Drug Tariff lists the following unlicensed specials with regulated prices:\n•\tPhenytoin 90mg/5ml oral suspension","•\tPhenytoin 90mg/5ml oral suspension £34.28/500ml ","Different formulations of oral preparations may vary in bioavailability. Patients being treated for epilepsy should be maintained on a specific manufacturer's product."]
["Phosphate solution (oral)","Unlicensed preparations are being prescribed when there are licensed alternatives available","Licensed effervescent tablets available","•\tSodium dihydrogen phosphate anhydrous 1.936g effervescent tablets £19.39/100\n•\tSodium dihydrogen phosphate anhydrous 340mg/sodium bicarbonate 250mg suppositories £8.20/10\n•\tSodium dihydrogen phosphate anhydrous 680mg/sodium bicarbonate 500mg suppositories £8.20/10\n•\tSodium dihydrogen phosphate dihydrate 18.1%/disodium hydrogen phosphate dodecahydrate 8% 133ml enema £3.87/1\n•\tSodium dihydrogen phosphate dihydrate 542mg/ml/disodium hydrogen phosphate dodecahydrate 240mg/ml oral solution sugar free £4.79/90ml","Not applicable ","Not applicable","The England/Wales Drug Tariff lists the following unlicensed specials with regulated prices:\n•\tSodium dihydrogen phosphate dihydrate 780mg/5ml oral solution","•\tSodium dihydrogen phosphate dihydrate 780mg/5ml oral solution £32.99/100ml "]
["Phytomenadione","No licensed liquid available.","The 2mg/0.2ml solution for injection is licensed to be used orally in babies for the prophylaxis of vitamin K deficiency bleeding. \nPhytomenadione is also available as licensed 1mg liquid capsules (the liquid can be squeezed out of the capsule) for the prophylaxis of vitamin K deficiency bleeding in babies.","•\tPhytomenadione 1mg capsules £3.95/12\n•\tPhytomenadione 2mg/0.2ml solution (ampoules) £10.49/5","The liquid capsules can be opened or either strength solution for injection can be used as an oral solution for other indications (off-label)","•\tPhytomenadione 1mg capsules £3.95/12\n•\tPhytomenadione 10mg/1ml solution (ampoules) £10.49/10\n•\tPhytomenadione 2mg/0.2ml solution (ampoules) £10.49/5","Various unlicensed specials","Variable, fluctuating and unregulated"]
["Pilocarpine HCl eye drops 0.5% preservative-free","Unlicensed preparations are being prescribed when there are licensed alternatives available","Licensed eye drops, including preservative-free single use vials, available","•\tPilocarpine hydrochloride 1% eye drops £24.32/10ml\t \n•\tPilocarpine hydrochloride 2% eye drops £30.63/10ml\t \n•\tPilocarpine hydrochloride 4% eye drops £31.10/10ml \n•\tPilocarpine nitrate 2% eye drops 0.5ml unit dose preservative-free £13.74/20\t","Not applicable","Not applicable","Various unlicensed specials","Variable, fluctuating and unregulated",null,"The Scottish Drug Tariff lists:\t \n•\tPilocarpine hydrochloride 1% eye drops £24.32/10ml\t \n•\tPilocarpine hydrochloride 2% eye drops £31.75/10ml\t \n•\tPilocarpine hydrochloride 4% eye drops £31.10/10ml "]
["Pizotifen","No licensed liquid available.","No suitable licensed preparation available for patients who are unable to swallow the solid oral dosage form","Not applicable","Crush the tablets and mix with water prior to administration","•\tPizotifen 500micogram tablets £1.52/28 \n•\tPizotifen 1.5mg tablets £1.93/28 ","The England/Wales Drug Tariff lists the following unlicensed specials with regulated prices:\n•\tPizotifen 250micograms/5ml oral solution \n•\tPizotifen 250micograms/5ml oral suspension ","•\tPizotifen 250micograms/5ml oral solution £277.03/100ml HIGH COST\n•\tPizotifen 250micograms/5ml oral suspension £38.70/100ml","If liquid required, the unlicensed oral suspension is the most cost effective option, or consider alternative treatment.","The Scottish Drug Tariff lists:\n•\tPizotifen 500micogram tablets £2.01/28 \n•\tPizotifen 1.5mg tablets £3.06/28 "]
["Potassium Chloride","Unlicensed preparations are being prescribed when there are licensed alternatives available","Licensed preparations available","•\tPotassium chloride 375mg/5ml (potassium 5mmol/5ml) oral solution sugar-free £10.15/500ml\t\n•\tPotassium chloride 600mg/potassium bicarbonate 400mg (total potassium 12mmol) effervescent tablets £9.95/100  ","Not applicable ","Not applicable","Various unlicensed specials","Variable, fluctuating and unregulated"]
["Pravastatin","No licensed liquid available","Consider switching to licensed simvastatin liquid (HIGH COST) or atorvastatin chewable tablets. \nAtorvastatin chewable tablets are most cost-effective, if the patient has swallowing difficulties.","•\tSimvastatin 20mg/5ml oral suspension sugar free £203.00/150ml HIGH COST\n•\tSimvastatin 40mg/5ml oral suspension sugar free £285.00/150ml HIGH COST\n•\tAtorvastatin 10mg chewable tablets sugar free £13.80/30\t \n•\tAtorvastatin 20mg chewable tablets sugar free £26.40/30","Crush the tablets and mix with water prior to administration. \nThe drug is very soluble.","•\tPravastatin 10mg tablets £1.48/28\n•\tPravastatin 20mg tablets £1.62/28\n•\tPravastatin 40mg tablets £1.91/28","Various unlicensed specials","Variable, fluctuating and unregulated",null,"The Scottish Drug Tariff lists:\n•\tPravastatin 10mg tablets £2.00/28\n•\tPravastatin 20mg tablets £2.30/28\n•\tPravastatin 40mg tablets £2.60/28\t"]
["Prednisolone (oral)","Unlicensed preparations are being prescribed when there are licensed alternatives available","Licensed oral solution and soluble tablets available","•\tPrednisolone 5mg soluble tablets £51.02/30 \n•\tPrednisolone 5mg/5ml oral solution unit dose £13.82/10\n•\tPrednisolone 10mg/ml oral solution sugar free £55.50/30ml","Many brands of tablets will disperse easily in water within one to five minutes.\nDo not crush the enteric-coated tablets.","•\tPrednisolone 500microgram tablets £10.20/28\n•\tPrednisolone 1mg tablets £0.67/28\n•\tPrednisolone 2mg tablets £10.20/28\n•\tPrednisolone 2.5mg tablets £3.94/28\n•\tPrednisolone 3mg tablets £11.85/28\n•\tPrednisolone 5mg tablets £0.75/28\n•\tPrednisolone 10mg tablets £9.70/28\n•\tPrednisolone 20mg tablets £19.46/28\n•\tPrednisolone 25mg tablets £50.00/56\n•\tPrednisolone 30mg tablets £29.12/28","Various unlicensed specials","Variable, fluctuating and unregulated",null,"The Scottish Drug Tariff lists:\n•\tPrednisolone 1mg tablets £1.10/28\n•\tPrednisolone 5mg tablets £1.24/28\n•\tPrednisolone 5mg soluble tablets £55.20/30\n•\tPrednisolone 5mg/5ml oral solution unit dose £13.82/10\n•\tPrednisolone 25mg tablets £42.35/56\n•\tPrednisolone 30mg tablets £29.12/28"]
["Prednisolone sodium eye drops preservative-free","Unlicensed preparations are being prescribed when there are licensed alternatives available","Licensed eye drops, including preservative-free, available","•\tPrednisolone acetate 1% eye drops £1.82/5ml or £3.66/10ml\n•\tPrednisolone sodium phosphate 0.5% ear/eye drops £2.57/10ml\n•\tPrednisolone sodium phosphate 0.5% eye drops 0.5ml unit dose preservative-free £13.50/20","Not applicable","Not applicable","The England/Wales Drug Tariff lists the following unlicensed specials with regulated prices:\n•\tPrednisolone sodium phosphate 0.1% eye drops","•\tPrednisolone sodium phosphate 0.1% eye drops £49.03/10ml "]
["Pregabalin","Unlicensed preparations are being prescribed when there are licensed alternatives available","Licensed liquid available","Pregabalin 20mg/ml oral solution sugar free £87.41/473ml HIGH COST","Open the capsules and dissolve the contents in water for administration. The capsule contents may have an unpleasant taste.","•\tPregabalin 25mg capsules £1.20/56\t\n•\tPregabalin 50mg capsules £1.66/84\n•\tPregabalin 75mg capsules £1.32/56\t\n•\tPregabalin 100mg capsules £1.90/84\n•\tPregabalin 150mg capsules £1.76/56\t\n•\tPregabalin 200mg capsules £2.57/84\n•\tPregabalin 225mg capsules £1.91/56\t\n•\tPregabalin 300mg capsules £2.43/56","The England/Wales Drug Tariff lists the following unlicensed specials with regulated prices:\n•\tPregabalin 75mg/5ml oral suspension","•\tPregabalin 75mg/5ml oral suspension £40.82/100ml",null,"The Scottish Drug Tariff lists: \n•\tPregabalin 20mg/ml oral solution sugar-free £87.41/473ml HIGH COST\n•\tPregabalin 25mg capsules £1.70/56\t\n•\tPregabalin 50mg capsules £24.00/84\n•\tPregabalin 75mg capsules £1.32/56\t\n•\tPregabalin 100mg capsules £2.13/84\n•\tPregabalin 150mg capsules £2.07/56\t\n•\tPregabalin 200mg capsules £3.70/84\n•\tPregabalin 225mg capsules £2.35/56\t\n•\tPregabalin 300mg capsules £2.43/56"]
["Primidone","No licensed liquid available","No suitable licensed preparation available for patients who are unable to swallow the solid oral dosage form","Not applicable","Tablets can be dispersed in 10ml of water for oral administration (they will disperse in 2 to 5 minutes)","•\tPrimidone 50mg tablets £108.77/100\t\n•\tPrimidone 250mg tablets £75.72/100\t","The England/Wales Drug Tariff lists the following unlicensed specials with regulated prices:\t \n•\tPrimidone 50mg/5ml oral suspension\n•\tPrimidone 62.5mg/5ml oral suspension\n•\tPrimidone 250mg/5ml oral suspension  ","•\tPrimidone 50mg/5ml oral suspension £13.38/150ml\n•\tPrimidone 62.5mg/5ml oral suspension £16.70/100ml\n•\tPrimidone 250mg/5ml oral suspension £119.45/150ml ",null,"The Scottish Drug Tariff lists: \n•\tPrimidone 50mg tablets £101.49/100\t\n•\tPrimidone 250mg tablets £101.23/100"]
["Procyclidine","Unlicensed preparations are being prescribed when there are licensed alternatives available","Licensed liquid available","•\tProcyclidine 2.5mg/5ml oral solution sugar-free £45.92/150ml\n•\tProcyclidine 5mg/5ml oral solution sugar-free £68.00/150ml","Not applicable","Not applicable","Various unlicensed specials","Variable, fluctuating and unregulated","Consider using a lower volume of the higher strength if possible as more cost effective"]
["Promazine","Unlicensed preparations are being prescribed when there are licensed alternatives available","Licensed liquid available - HIGH COST\nConsider using a lower volume of the higher strength if possible as more cost effective.","•\tPromazine 25mg/5ml oral solution £60.19/150ml HIGH COST\n•\tPromazine 50mg/5ml oral solution £75.36/150ml HIGH COST","Not applicable ","Not applicable","Various unlicensed specials","Variable, fluctuating and unregulated","First generation antipsychotic so may be more suitable drugs available. Consider if specialist review is needed.\n"]
["Propranolol","Unlicensed preparations are being prescribed when there are licensed alternatives available","Licensed liquid available or consider switching to licensed atenolol liquid, which is more cost-effective.","•\tPropranolol 5mg/5ml oral solution sugar-free £26.49/150ml\n•\tPropranolol 10mg/5ml oral solution sugar-free £32.64/150ml \n•\tPropranolol 40mg/5ml oral solution sugar free £43.53/150ml\n•\tPropranolol 50mg/5ml oral solution sugar-free £47.64/150ml\t\t\n•\tAtenolol 25mg/5ml oral solution sugar-free £10.27/300ml\t","Not applicable ","Not applicable","Various unlicensed specials","Variable, fluctuating and unregulated",null,"The Scottish Drug Tariff lists: \n•\tPropranolol 10mg/5ml oral solution sugar-free £32.64/150ml \n•\tPropranolol 40mg/5ml oral solution sugar-free £43.53/150ml"]
["Propylene glycol, topical (dermatology)","No suitable licensed preparation available","No suitable licensed preparation available","Not applicable","Not applicable","Not applicable","The British Association of Dermatologists (BAD) recommends the following unlicensed specials (see here for further information):\n•\tPropylene glycol 20% w/w in aqueous cream, 100g (as a moisturiser, to use on very dry skin conditions, including on the palms and soles. Works well as a barrier, enhances penetration of other treatments like topical steroids. Use when urea-based preparations are ineffective, unsuitable or not tolerated).\n•\tPropylene glycol 40% w/w in aqueous cream, 100g (indication as for propylene glycol 20% w/w in aqueous cream).\n•\tPropylene glycol 50% w/w in water, 100ml (as a humectant, to use on very dry skin conditions, including hereditary hyperkeratotic diseases. Works well as a barrier, enhances penetration of other treatments like topical steroids. Use when urea-based preparations are ineffective, unsuitable or not tolerated).\n•\tSalicylic acid 5% w/w / propylene glycol 47.5% w/w in clobetasol propionate 0.05% (Dermovate®) cream, 100g (very potent steroid; propylene glycol increases penetration of clobetasol propionate (Dermovate®). To use on the palms and/or soles for hyperkeratotic eczema, palmoplantar pustulosis and psoriasis where it is persistent, severe and not responding to clobetasol propionate (Dermovate®) and emollients alone).\n•\tPropylene glycol 40% w/w in clobetasol propionate 0.05% (Dermovate®) Cream, 100g (very potent steroid. Use for severe inflammatory disease without hyperkeratosis, or at sensitive skin sites, e.g., the vulva).\n\t\nThe England/Wales Drug Tariff lists the following unlicensed specials with regulated prices:\n•\tPropylene glycol 40% in clobetasol 0.05% cream\n","•\tPropylene glycol 40% in clobetasol 0.05% cream £34.48/100g\n"]
["Pyridostigmine bromide","Unlicensed preparations are being prescribed when there are licensed alternatives available","Licensed liquid available (HIGH COST), if licensed capsules are unsuitable","•\tPyridostigmine bromide 12mg/1ml oral solution sugar-free £90.00/150ml HIGH COST\n•\tPyridostigmine bromide 60mg tablets £15.40/200\t","Not applicable ","Not applicable","The England/Wales Drug Tariff lists the following unlicensed specials with regulated prices:\t \n•\tPyridostigmine bromide 20mg/5ml oral suspension\n•\tPyridostigmine bromide 30mg/5ml oral suspension\n•\tPyridostigmine bromide 50mg/5ml oral suspension ","•\tPyridostigmine bromide 20mg/5ml oral suspension £26.11/100ml\n•\tPyridostigmine bromide 30mg/5ml oral suspension £14.87/50ml \n•\tPyridostigmine bromide 50mg/5ml oral suspension £75.13/100ml ",null,"The Scottish Drug Tariff lists pyridostigmine bromide 60mg tablets £19.33/200\t"]
["Pyridoxine HCl","No licensed liquid available","No suitable licensed preparation available for patients who are unable to swallow the solid oral dosage form","Not applicable","Tablets can be crushed and mixed with water for oral administration","•\tPyridoxine 10mg tablets £19.33/28\n•\tPyridoxine 50mg tablets £15.73/28","The England/Wales Drug Tariff lists the following unlicensed specials with regulated prices:\t \n•\tPyridoxine 100mg/5ml oral solution\n•\tPyridoxine 100mg/5ml oral suspension","•\tPyridoxine 100mg/5ml oral solution £18.48/100ml \n•\tPyridoxine 100mg/5ml oral suspension £13.15/50ml\t",null,"The Scottish Drug Tariff lists pyridoxine 50mg tablets £17.84/28"]

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["KEY","* Drug Tariff (England and Wales) May 24    § NEWT guidelines for administration of medication to patients with enteral feeding tubes or swallowing difficulties, Fourth edition- August 2021\n‡ Enteral Feeding Handbook 3rd edition        ** Scottish Drug Tariff April 24"]
["Chemical substance","What is the issue?","Option 1: Use a licensed medicine in a suitable licensed formulation (incl review ongoing need or change to different drug in same therapeutic class)","Licensed preparation(s) and cost (option 1) per original pack*","Option 2: Use a licensed medicine in an unlicensed manner (e.g. crushing tablets). See NEWT for further information.§ \nNot applicable for enteral feeding tubes, refer to resources§,‡ or local medicines information service for more information.","Off-label preparation(s) and cost (option 2) per original pack*","Option 3: Only if clinical reason exists for not using licensed product: Use an unlicensed special","Unlicensed special preparation(s) and cost (option 3) per original pack*","Comments ","Scottish Drug Tariff considerations**"]
["Quetiapine","Unlicensed preparations are being prescribed when there are licensed alternatives available","Licensed liquid available - HIGH COST","•\tQuetiapine 20mg/ml oral suspension sugar-free £199.00/150ml","Not applicable ","Not applicable","The England/Wales Drug Tariff lists the following unlicensed specials with regulated prices: \n•\tQuetiapine 12.5mg/5ml oral suspension \n•\tQuetiapine 25mg/5ml oral suspension  \n•\tQuetiapine 50mg/5ml oral suspension ","•\tQuetiapine 12.5mg/5ml oral suspension £18.71/100ml \n•\tQuetiapine 25mg/5ml oral suspension £44.29/150ml \n•\tQuetiapine 50mg/5ml oral suspension £15.78/100ml","There are several other second-generation antipsychotics in the same class but would need specialist input to switch and ensure patient remains compliant.","The Scottish Drug Tariff lists:\t \t \n•\tQuetiapine 12.5mg/5ml oral suspension £36.58/150ml \n•\tQuetiapine 25mg/5ml oral suspension £46.95/150ml \n•\tQuetiapine 50mg/5ml oral suspension £137.00/100ml HIGH COST\t"]
["Quinine sulfate","No licensed liquid available","No suitable licensed preparation available for patients who are unable to swallow the solid oral dosage form","Not applicable","The tablets can be crushed well and dispersed in a large volume (e.g., 200mL) of water for oral administration. They have a bitter taste, which may be masked by mixing with syrup. They should only be used if absolutely necessary and swallowing problems are likely to be long term and review in line with NICE guidelines","•\tQuinine sulfate 200mg tablets £6.88/28 \n•\tQuinine sulfate 300mg tablets £2.41/28","The England/Wales Drug Tariff lists the following unlicensed specials with regulated prices:\t \n•\tQuinine sulfate 200mg/5ml oral suspension\n•\tQuinine sulfate 300mg/5ml oral suspension\t","•\tQuinine sulfate 200mg/5ml oral suspension £46.20/100ml \n•\tQuinine sulfate 300mg/5ml oral suspension £37.17/150ml\t",null,"The Scottish Drug Tariff lists: \n•\tQuinine sulfate 200mg tablets £7.65/28 \n•\tQuinine sulfate 300mg tablets £3.65/28"]

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["KEY","* Drug Tariff (England and Wales) May 24    § NEWT guidelines for administration of medication to patients with enteral feeding tubes or swallowing difficulties, Fourth edition- August 2021\n‡ Enteral Feeding Handbook 3rd edition        ** Scottish Drug Tariff April 24"]
["Chemical substance","What is the issue?","Option 1: Use a licensed medicine in a suitable licensed formulation (incl review ongoing need or change to different drug in same therapeutic class)","Licensed preparation(s) and cost (option 1) per original pack*","Option 2: Use a licensed medicine in an unlicensed manner (e.g. crushing tablets). See NEWT for further information.§ \nNot applicable for enteral feeding tubes, refer to resources§,‡ or local medicines information service for more information.","Off-label preparation(s) and cost (option 2) per original pack*","Option 3: Only if clinical reason exists for not using licensed product: Use an unlicensed special","Unlicensed special preparation(s) and cost (option 3) per original pack*","Comments ","Scottish Drug Tariff considerations**"]
["Ramipril","Unlicensed preparations are being prescribed when there are licensed alternatives available","Licensed liquid available - HIGH COST. \nOr consider switching to valsartan 3mg/ml oral solution if liquid is likely to be needed long term, as it is more cost-effective as a liquid.","•\tRamipril 2.5mg/5ml oral solution sugar free £196.00/150ml \n•\tValsartan 3mg/ml oral solution £7.20/160ml","The tablets can be crushed and dispersed in water or the capsules can be opening and the contents placed directly into the mouth, onto bread, dispersed in water, or mixed with apple juice or  apple sauce (to mask the unpleasant taste), for oral administration.\nGive immediately","•\tRamipril 1.25mg capsules £1.05/28\t\t \n•\tRamipril 1.25mg tablets £1.27/28\t \n•\tRamipril 2.5mg capsules £0.99/28\t \n•\tRamipril 2.5mg tablets £1.19/28\t \n•\tRamipril 5mg capsules £0.99/28\t \n•\tRamipril 5mg tablets £1.09/28\t\n•\tRamipril 10mg capsules £1.05/28\t \n•\tRamipril 10mg tablets £1.30/28","The England/Wales Drug Tariff lists the following unlicensed specials with regulated prices: \n•\tRamipril 10mg/5ml oral suspension","•\tRamipril 10mg/5ml oral suspension £265.55/100ml HIGH COST",null,"The Scottish Drug Tariff lists:\t \t \n•\tRamipril 1.25mg capsules £1.48/28\t\t \n•\tRamipril 1.25mg tablets £1.50/28\t \n•\tRamipril 2.5mg capsules £1.42/28\t \n•\tRamipril 2.5mg tablets £1.40/28\t \n•\tRamipril 5mg capsules £1.46/28\t \n•\tRamipril 5mg tablets £1.40/28\t\n•\tRamipril 10mg capsules £1.52/28\t \n•\tRamipril 10mg tablets £1.80/28\t\n•\tRamipril 5mg/5ml oral solution £61.50/150ml HIGH COST\n•\tRamipril 5mg/5ml oral suspension £122.00/100ml HIGH COST"]
["Risperidone","Unlicensed preparations are being prescribed when there are licensed alternatives available","Licensed liquid and orodispersible tablets available. The liquid is more cost-effective.","•\tRisperidone 500microgram orodispersible tablets sugar-free £17.13/28 \n•\tRisperidone 1mg/ml oral solution sugar-free £3.00/100ml\t\t\n•\tRisperidone 1mg orodispersible tablets sugar-free £24.82/28\t \n•\tRisperidone 2mg orodispersible tablets sugar-free £38.18/28\t \n•\tRisperidone 3mg orodispersible tablets sugar-free £36.24/28\t \n•\tRisperidone 4mg orodispersible tablets sugar-free £46.68/28\t","Not applicable","Not applicable","Various unlicensed specials","Variable, fluctuating and unregulated","Risperidone 1mg/ml oral solution sugar-free is most cost-effective for patients who are unable to swallow the solid oral dosage form.","The Scottish Drug Tariff lists risperidone 1mg/ml oral solution sugar-free £4.00/100ml\t "]
["Rivaroxaban","Unlicensed preparations are being prescribed when there are licensed alternatives available","Licensed liquid available.\nTablets are also licensed to be crushed and mixed with water or apple puree immediately prior to use and administered orally.","•\tRivaroxaban 1mg/ml oral suspension sugar-free £18.00/100ml\n•\tRivaroxaban 2.5mg tablets £50.40/56\n•\tRivaroxaban 10mg tablets £54.00/30\t \n•\tRivaroxaban 15mg tablets £50.40/28\t \n•\tRivaroxaban 20mg tablets £50.40/28","Not applicable ","Not applicable","Various unlicensed specials","Variable, fluctuating and unregulated"]

{"sheet":"S","index":23,"n_rows":18,"n_cols":11,"rows_kept":18,"cut":false,"hidden":false,"merged":[[0,1,0,4]]}
["KEY","* Drug Tariff (England and Wales) May 24    § NEWT guidelines for administration of medication to patients with enteral feeding tubes or swallowing difficulties, Fourth edition- August 2021\n‡ Enteral Feeding Handbook 3rd edition        ** Scottish Drug Tariff April 24"]
["Chemical substance","What is the issue?","Option 1: Use a licensed medicine in a suitable licensed formulation (incl review ongoing need or change to different drug in same therapeutic class)","Licensed preparation(s) and cost (option 1) per original pack*","Option 2: Use a licensed medicine in an unlicensed manner (e.g. crushing tablets). See NEWT for further information.§ \nNot applicable for enteral feeding tubes, refer to resources§,‡ or local medicines information service for more information.","Off-label preparation(s) and cost (option 2) per original pack*","Option 3: Only if clinical reason exists for not using licensed product: Use an unlicensed special","Unlicensed special preparation(s) and cost (option 3) per original pack*","Comments ","Scottish Drug Tariff considerations**"]
["Salicylic acid, topical (dermatology)","Unlicensed preparations are being prescribed when there are licensed alternatives available","Licensed preparation available","•\tSalicylic acid 2% ointment £12.49/450g","Not applicable","Not applicable","The British Association of Dermatologists (BAD) recommends the following unlicensed specials (see here for further information):\n•\tSalicylic acid 5% w/w / propylene glycol 47.5% w/w in clobetasol propionate 0.05% (Dermovate®) cream, 100g (very potent steroid; propylene glycol increases penetration of clobetasol propionate (Dermovate®). To use on the palms and/or soles for hyperkeratotic eczema, palmoplantar pustulosis and psoriasis where it is persistent, severe and not responding to clobetasol propionate (Dermovate®) and emollients alone).\n•\tDithranol in Lassar's paste 0.1%, 0.5%, 1%, 2%, 4%, 10% and 15% w/w, 100g (dithranol in Lassar’s paste (a combination of salicylic acid and zinc oxide) is effective in moderate to severe chronic plaque psoriasis when other topical treatments (vitamin D analogues, commercial tar preparations and commercial dithranol preparations, e.g., Dithrocream®) have been ineffective or unsuitable, where phototherapy is contraindicated or less effective, e.g., lower leg, and where the patient does not wish to take or is unsuitable for systemic treatment. Treatment is often initiated at Dermatology day treatment centres but may in some cases be continued by patients at home once they have been instructed how to use it safely).\n•\tDithranol scalp application 0.4% w/w (‘dithranol pomade’; dithranol 0.4% w/w, salicylic acid 2% w/w, emulsifying wax BP 25% w/w, liquid paraffin to 100%), 100g (dithranol in Lassar’s paste (a combination of salicylic acid and zinc oxide) is effective in moderate to severe chronic plaque psoriasis when other topical treatments (vitamin D analogues, commercial tar preparations and commercial dithranol preparations, e.g., Dithrocream®) have been ineffective or unsuitable, where phototherapy is contraindicated or less effective, e.g., lower leg, and where the patient does not wish to take or is unsuitable for systemic treatment. Treatment is often initiated at Dermatology day treatment centres but may in some cases be continued by patients at home once they have been instructed how to use it safely).\n•\tSalicylic acid 2% w/w and sulfur 2% w/w in aqueous cream, 100g (Use for hyperkeratotic psoriasis, hyperkeratotic eczema, viral warts, lichen simplex, ichthyosis, keratodermas, callus, keratosis pilaris and other hyperkeratotic conditions where emollients and commercial preparations are ineffective. Commercial preparations may be urea-based  or salicylic-acid based (e.g. Salactol TM paint (16.7% salicylic acid with 16.7% lactic acid; 10 ml, £2.09)). There are also commercial preparations of 2% salicylic acid in emulsifying ointment which contain wool alcohols (lanolin). Salicylic acid 2% with sulfur 2% in aqueous cream is a helpful treatment for facial seborrhoeic dermatitis).\n•\tSalicylic acid 5%, 10% and 20% w/w in emulsifying ointment, 100g (indication as for salicylic acid 2% w/w and sulfur 2% w/w in aqueous cream).\n\nThe England/Wales Drug Tariff lists the following unlicensed specials with regulated prices:\n•\tCoal tar solution 6%/salicylic acid 2% in ointment \n•\tSalicylic acid 10% in aqueous cream BP \n•\tSalicylic acid 10% ointment \n•\tSalicylic acid 2%/sulfur 2% in Aqueous cream \n•\tSalicylic acid 2% in aqueous cream BP \n•\tSalicylic acid 20% ointment \n•\tSalicylic acid 5% cream\n•\tSalicylic acid 5% ointment \n•\tZinc and salicylic acid paste BP ","The England/Wales Drug Tariff lists the following unlicensed specials with regulated prices:\n•\tCoal tar solution 6%/salicylic acid 2% in ointment £129.78/100g \n•\tSalicylic acid 10% in aqueous cream BP £23.18/100g \n•\tSalicylic acid 10% ointment £19.03/100g \n•\tSalicylic acid 2%/sulfur 2% in Aqueous cream £71.89/100g \n•\tSalicylic acid 2% in aqueous cream BP £25.60/100g\n•\tSalicylic acid 20% ointment £26.65/100g \n•\tSalicylic acid 5% cream £26.17/100g\n•\tSalicylic acid 5% ointment £16.97/100g\t\n•\tZinc and salicylic acid paste BP £26.95/100g\n",null,"The Scottish Drug Tariff lists:\t \t \t \t \n•\tSalicylic acid 2% in Aqueous cream £42.00/100g\n•\tSalicylic acid 2% ointment £12.49/450g\n•\tSalicylic acid 5% in Aqueous cream £42.00/100g\n•\tSalicylic acid 5% in Emulsifying ointment £131.80/100g\n•\tSalicylic acid 5% in Yellow soft paraffin £34.36/100g\n•\tSalicylic acid 10% in Aqueous cream £62.00/100g \n•\tSalicylic acid 10% in Emulsifying ointment £133.76/100g\n•\tSalicylic acid 10% in Yellow soft paraffin £36.42/100g"]
["Sertraline","No licensed liquid available.","Consider switching to an alternative SSRI available in a suitable licensed formulation if tablets cannot be tolerated, e.g., citalopram oral drops or fluoxetine liquid or dispersible tablets. \nFluoxetine dispersible tablets are the most cost-effective, followed by citalopram oral drops.","•\tCitalopram 40mg/ml oral drops sugar-free £14.89/15ml\t\t \n•\tFluoxetine 20mg dispersible tablets sugar free £3.44/28\n•\tFluoxetine 20mg/5ml oral solution £6.73/70ml \n•\tFluoxetine 20mg/5ml oral solution sugar-free £12.95/70ml","Tablets can be crushed and dispersed in water or mixed  with food and taken immediately, for oral administration. \nNB: tablets taste bitter and have an anaesthetic effect  on the tongue so care should be taken with  hot meals after administration.","•\tSertraline 25mg tablets £16.54/28 (see comments)\t \n•\tSertraline 50mg tablets £0.89/28\t\n•\tSertraline 100mg tablets £1.10/28 \n•\tSertraline 150mg tablets £13.50/30\n•\tSertraline 200mg tablets £18.00/30","Various unlicensed specials","Variable, fluctuating and unregulated","If switching antidepressants, follow suitable guidelines.\n\nNote, if patients are able to take 2 x 100mg or 1 x 50mg + 1 x 100mg, this is more cost effective; the  50mg tablet is scored and can be divided into equal doses, see SPC ","The Scottish Drug Tariff lists: \n•\tCitalopram 40mg/ml oral drops sugar-free £11.85/15ml\t\t \n•\tFluoxetine 20mg/5ml oral solution £7.58/70ml \n•\tSertraline 25mg tablets £16.54/28 (see comments)\t \n•\tSertraline 50mg tablets £1.60/28\t\n•\tSertraline 100mg tablets £1.80/28\n•\tSertraline 50mg/5ml oral suspension £28.68/150ml"]
["Sildenafil","Unlicensed preparations are being prescribed when there are licensed alternatives available","Licensed liquid available but it is only licensed for pulmonary arterial hypertension. \nFor erectile dysfunction, option 2 is preferred as it is more cost-effective (both off-label choices)","•\tSildenafil 10mg/ml oral suspension sugar-free £186.75/90ml as Revatio or £186.75/122ml as Rosemont brand - HIGH COST","Tablets can be crushed and dispersed in water for oral administration for erectile dysfunction. The 20mg tablets should be avoided if possible as they are considerably more expensive.","•\tSildenafil 20mg tablets £446.33/90 - HIGH COST (licensed for treatment of pulmonary hypertension)\n•\tSildenafil 25mg tablets £0.65/4\t \n•\tSildenafil 50mg tablets £0.66/4 \n•\tSildenafil 100mg tablets £0.72/4\t","The England/Wales Drug Tariff lists the following unlicensed specials with regulated prices: \t \n•\tSildenafil 10mg/5ml oral suspension\n•\tSildenafil 25mg/5ml oral suspension\t","•\tSildenafil 10mg/5ml oral suspension £80.37/100ml\n•\tSildenafil 25mg/5ml oral suspension £77.95/100ml\t","Check prescribing indication before review. Different brands are licensed for different indications. Sildenafil as Revatio® or Granpidam® are for the treatment of pulmonary hypertension.","The Scottish Drug Tariff lists: \n•\tSildenafil 25mg tablets £1.01/4\n•\tSildenafil 50mg tablets £1.03/4\n•\tSildenafil 100mg tablets £1.08/4"]
["Simvastatin","Unlicensed preparations are being prescribed when there are licensed alternatives available","Licensed liquid available but consider switching to atorvastatin chewable tablets, as these are more cost-effective.","•\tAtorvastatin 10mg chewable tablets sugar-free £13.80/30 \n•\tAtorvastatin 20mg chewable tablets sugar-free £26.40/30\t \n•\tSimvastatin 20mg/5ml oral suspension sugar-free £203.00/150ml HIGH COST\n•\tSimvastatin 40mg/5ml oral suspension sugar-free £285.00/150ml HIGH COST","Not applicable","Not applicable","Various unlicensed specials","Variable, fluctuating and unregulated","Review treatment against current guidelines."]
["Sirolimus, topical (dermatology)","Unlicensed preparations are being prescribed when there are licensed alternatives available","Licensed gel available","•\tSirolimus 2mg/g gel £400.00/10g HIGH COST","Not applicable","Not applicable","The British Association of Dermatologists (BAD) recommends the following unlicensed specials (see here for further information):\n•\tSirolimus 0.1% and 0.5% in WSP, 30g (use for facial angiofibromata in tuberose sclerosis).","Variable, fluctuating and unregulated","Specialist initiation and review recommended. NICE guidance expected September 2024."]
["Sodium bicarbonate","Unlicensed preparations are being prescribed when there are licensed alternatives available","Licensed liquid, powder, tablets and capsules available ","•\tSodium bicarbonate 420mg/5ml (1mmol/ml) oral solution sugar-free £39.80/100ml or £199.20/500ml HIGH COST\n•\tSodium bicarbonate 500mg capsules £3.28/56\t \n•\tSodium bicarbonate 500mg gastro-resistant capsules £18.75/100\t\n•\tSodium bicarbonate 600mg tablets £26.79/100\n•\tSodium bicarbonate powder £2.89/300g\t","Not applicable ","Not applicable","Various unlicensed specials","Variable, fluctuating and unregulated",null,"The Scottish Drug Tariff lists:\t \t \t \n•\tSodium bicarbonate 500mg capsules £4.46/56\t \n•\tSodium bicarbonate 600mg tablets £26.79/100"]
["Sodium chloride eye drops/ointment","Unlicensed preparations are being prescribed when there are licensed alternatives available","Licensed preservative-free eye drops and ointment available in different strengths. \nAdvise patient to purchase over-the-counter as part of self-care if prescribed for mild-moderate cases of dry eyes. \nEnsure local dry eyes pathway is followed, if available.","•\tAabChlor Sodium Chloride 5% £17.83/10ml\n•\tAacEdem Sodium Chloride 5% £17.83/10ml\t \t \n•\tAcuSal 5% preservative-free £15.98/10ml\n•\tAddLube Sodium Chloride 0.9% preservative-free single dose unit £6.53/20 x 0.5ml\n•\tAeon preservative-free £23.00/10ml\n•\tDROPtonic 5% preservative free £15.95/10ml\n•\tHypersal 5% £25.25/10ml\n•\tNaCl 5% (Essential Pharmaceuticals Ltd) preservative-free single dose unit £14.95/20 x 0.45ml\n•\tNatklor 5% preservative-free £24.50/10ml\n•\tODM5 preservative-free £24.00/10ml \n•\tPF Drops Sodium Chloride 5% preservative-free £25.20/10ml\n•\tSodiEye 5% preservative-free £15.98/10ml or £14.95/20 x 0.5ml\n•\tSodium Chloride 5% (Alissa Healthcare) £25.25/10ml\n•\tXailin Wash preservative-free £6.05/20 x 5ml\n•\tSodiEye 6% (preservative-free) ointment £18.92/5g\n•\tSodium Chloride 5% (Alissa Healthcare) preservative free £22.50/5g\n•\tSodium Chloride 5% eye ointment £74.28/3.5g\n•\tSodium chloride 0.9% eye drops 0.5ml unit dose preservative-free £7.43/20","Not applicable ","Not applicable","Various unlicensed specials","Variable, fluctuating and unregulated","Most products are listed as appliances in the Drug Tariff. \nConsider therapeutic indication before review. \n5% sodium chloride is a hypertonic solution for the temporary relief of corneal oedema symptoms, also available as an ointment,  0.9% sodium chloride is a treatment option for dry eyes, see pathway and purchase over-the-counter as part of self-care if prescribed for mild-moderate cases of dry eyes."]
["Sodium chloride, oral","Unlicensed preparations are being prescribed when there are licensed alternatives available","Licensed liquid and modified-release tablets available","•\tSodium chloride 1.46g/5ml (5mmol/ml) oral solution £22.46/100ml\n•\tSodium chloride 292.5mg/5ml (1mmol/ml) oral solution £33.16/100ml\n•\tSodium chloride 600mg modified-release tablets £9.20/100\t","Not applicable","Not applicable","The England/Wales Drug Tariff lists the following unlicensed specials with regulated prices:\n•\tSodium chloride 1.17g/5ml (4mmol/ml) oral solution\n•\tSodium chloride 1.5g/5ml (5.13mmol/ml) oral solution ","•\tSodium chloride 1.17g/5ml (4mmol/ml) oral solution £8.54/100ml\n•\tSodium chloride 1.5g/5ml (5.13mmol/ml) oral solution £19.24/100ml",null,"The Scottish Drug Tariff lists:\t \t \t \t \n•\tSodium chloride 1.46g/5ml (5mmol/ml) oral solution £19.55/100ml"]
["Sodium cromoglicate 2% eye drops","Unlicensed preparations are being prescribed when there are licensed alternatives available","Licensed eye drops available, including preservative-free","•Sodium cromoglicate 2% eye drops £4.71/13.5ml\n•Sodium cromoglicate 2% eye drops preservative-free £3.80/10ml \t\n•Sodium cromoglicate 2% eye drops 0.3ml unit dose preservative-free £11.70/30","Not applicable ","Not applicable","Various unlicensed specials","Variable, fluctuating and unregulated","Licensed for allergic conjunctivitis and seasonal keratoconjunctivitis, so may not need prescribing all year round.","The Scottish Drug Tariff lists:\t\n•\tSodium cromoglicate 2% eye drops £2.74/5ml \t \t \t \n•\tSodium cromoglicate 2% eye drops £3.50/10ml\t \n•\tSodium cromoglicate 2% eye drops £5.00/13.5ml \n"]
["Solifenacin","No licensed liquid available.","Consider switching to alternative such as licensed oxybutynin liquid or patches - HIGH COST\n","•\tOxybutynin 2.5mg/5ml oral solution sugar-free £198.13/150ml HIGH COST\n•\tOxybutynin 5mg/5ml oral solution sugar-free £218.65/150ml HIGH COST\n•\tOxybutynin 3.9mg/24hours transdermal patches £27.20/8\t","Oxybutynin immediate-release tablets and tolterodine immediate-release tablets can be crushed and mixed with water for oral administration","•\tOxybutynin 2.5mg tablets £1.15/56\t\n•\tOxybutynin 5mg tablets £1.28/56\t\n•\tTolterodine 1mg tablets £1.98/56\n•\tTolterodine 2mg tablets £2.66/56","Various unlicensed specials","Variable, fluctuating and unregulated","Switch to an alternative drug in the same class (see BNF and option 2).","The Scottish Drug Tariff lists: \n•\tOxybutynin 2.5mg tablets £1.67/56\n•\tOxybutynin 5mg tablets £1.47/56\n•\tTolterodine 1mg tablets £3.00/56\n•\tTolterodine 2mg tablets £2.66/56"]
["Sotalol","No licensed liquid available.","Consider switching to alternative beta-blocker available as a licensed liquid, e.g., atenolol or propranolol. \nLicensed atenolol liquid is more cost-effective.","•\tAtenolol 25mg/5ml oral solution sugar-free £10.27/300ml\n•\tPropranolol 5mg/5ml oral solution sugar-free £26.49/150ml\n•\tPropranolol 10mg/5ml oral solution sugar-free £32.64/150ml\n•\tPropranolol 40mg/5ml oral solution sugar free £43.53/150ml\t \n•\tPropranolol 50mg/5ml oral solution sugar-free £47.64/150ml","Not applicable ","Not applicable","Various unlicensed specials","Variable, fluctuating and unregulated",null,"The Scottish Drug Tariff lists: \n•\tPropranolol 10mg/5ml oral solution sugar free £32.64/150ml\n•\tPropranolol 40mg/5ml oral solution sugar free £43.53/150ml"]
["Spironolactone","No licensed liquid available.","No suitable licensed preparation available for patients who are unable to swallow the solid oral dosage form","Not applicable","Tablets can be crushed and mixed with water for oral administration","•\tSpironolactone 12.5mg tablets £21.82/28\t \n•\tSpironolactone 25mg tablets £1.97/28\t \n•\tSpironolactone 50mg tablets £3.57/28 \n•\tSpironolactone 100mg tablets £4.51/28\t","The England/Wales Drug Tariff lists the following unlicensed specials with regulated prices:\n•\tSpironolactone 5mg/5ml oral suspension\n•\tSpironolactone 25mg/5ml oral suspension \n•\tSpironolactone 50mg/5ml oral solution \n•\tSpironolactone 5omg/5ml oral suspension \t","•\tSpironolactone 5mg/5ml oral suspension £12.75/125ml\n•\tSpironolactone 25mg/5ml oral suspension £21.30/125ml\n•\tSpironolactone 50mg/5ml oral solution £15.60/20ml\n•\tSpironolactone 50mg/5ml oral suspension £22.19/125ml"," "," The Scottish Drug Tariff lists: \n•\tSpironolactone 25mg tablets £1.97/28\n•\tSpironolactone 50mg tablets £4.03/28\n•\tSpironolactone 100mg tablets £4.51/28\n•\tSpironolactone 25mg/5ml oral suspension £125.00/125ml HIGH COST\n•\tSpironolactone 50mg/5ml oral suspension £130.00/125ml HIGH COST"," "]
["Sucralfate, oral and rectal","Unlicensed preparations are being prescribed when there are licensed alternatives available","Licensed liquid available - HIGH COST","•\tSucralfate 1g/5ml oral suspension sugar free £224.35/200ml HIGH COST","Not applicable","Not applicable","The England/Wales Drug Tariff lists the following unlicensed specials with regulated prices:\n•\tSucralfate 2g/20ml enema","•\tSucralfate 2g/20ml enema £16.20/20ml\n\n\n"]
["Sucralfate, topical (dermatology)","No suitable licensed topical preparation available","No suitable licensed topical preparation available","Not applicable","Not applicable","Not applicable","The British Association of Dermatologists (BAD) recommends the following unlicensed specials (see here for further information):\n•\tSucralfate 4% in emulsifying ointment, 50g (use for flexural healing wounds. Especially useful in rectal or gynaecological cancer patients, post-radiotherapy and chemotherapy. Also useful for peristomal and perianal erosion and leaking fistulae).","Variable, fluctuating and unregulated"]
["Sulfur, topical (dermatology)","No suitable licensed topical preparation available","No suitable licensed topical preparation available","Not applicable","Not applicable","Not applicable","The British Association of Dermatologists (BAD) recommends the following unlicensed specials (see here for further information):\n•\tSalicylic acid 2% w/w and sulfur 2% w/w in aqueous cream, 100g (Use for hyperkeratotic psoriasis, hyperkeratotic eczema, viral warts, lichen simplex, ichthyosis, keratodermas, callus, keratosis pilaris and other hyperkeratotic conditions where emollients and commercial preparations are ineffective. Commercial preparations may be urea-based or salicylic-acid based (e.g. Salactol TM paint (16.7% salicylic acid with 16.7% lactic acid; 10 ml, £2.09)). There are also commercial preparations of 2% salicylic acid in emulsifying ointment which contain wool alcohols (lanolin). Salicylic acid 2% with sulfur 2% in aqueous cream is a helpful treatment for facial seborrhoeic dermatitis).\n\nThe England/Wales Drug Tariff lists the following unlicensed specials with regulated prices:\n•\tSalicylic acid 2%/sulfur 2% in aqueous cream ","The England/Wales Drug Tariff lists the following unlicensed specials with regulated prices:\n•\tSalicylic acid 2%/sulfur 2% in Aqueous cream £71.89/100g "]
["Sunscreen, reflectant (dermatology)","Unlicensed preparations are being prescribed ","No suitable licensed preparation available","Not applicable","Not applicable","Not applicable","The British Association of Dermatologists (BAD) recommends the following unlicensed specials (see here for further information):\n•\tReflectant (Dundee) sunscreens – coffee, coral pink, beige, 50g (used to treat photosensitivity disorders where the patient is sensitive to visible light, most commonly solar urticaria and porphyrias, particularly erythropoietic protoporphyria).","Variable, fluctuating and unregulated"]

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["KEY","* Drug Tariff (England and Wales) May 24    § NEWT guidelines for administration of medication to patients with enteral feeding tubes or swallowing difficulties, Fourth edition- August 2021\n‡ Enteral Feeding Handbook 3rd edition        ** Scottish Drug Tariff April 24"]
["Chemical substance","What is the issue?","Option 1: Use a licensed medicine in a suitable licensed formulation (incl review ongoing need or change to different drug in same therapeutic class)","Licensed preparation(s) and cost (option 1) per original pack*","Option 2: Use a licensed medicine in an unlicensed manner (e.g. crushing tablets). See NEWT for further information.§ \nNot applicable for enteral feeding tubes, refer to resources§,‡ or local medicines information service for more information.","Off-label preparation(s) and cost (option 2) per original pack*","Option 3: Only if clinical reason exists for not using licensed product: Use an unlicensed special","Unlicensed special preparation(s) and cost (option 3) per original pack*","Comments ","Scottish Drug Tariff considerations**"]
["Tacrolimus, oral","Unlicensed preparations are being prescribed when there are licensed alternatives available","Tacrolimus is available as licensed granules for oral suspension - HIGH COST. \nHowever, these are not interchangeable with other formulations (including specials). \nDue to the differences in bioavailability, switching should be carried out under specialist supervision only.","•\tTacrolimus 0.2mg granules sachets sugar-free £71.30/50 HIGH COST\n•\tTacrolimus 1mg granules sachets sugar-free £356.65/50 HIGH COST\t","Not applicable","Not applicable","The England/Wales Drug Tariff lists the following unlicensed specials with regulated prices:\n•\tTacrolimus 5mg/5ml oral suspension ","•\tTacrolimus 5mg/5ml oral suspension £214.17/100ml","Tacrolimus should be prescribed by brand name due to differences in bioavailability.","The Scottish Drug Tariff lists:\t \t \t \t \n•\tTacrolimus 5mg/5ml oral suspension £210.47/100ml"]
["Tacrolimus, topical (dermatology)","Unlicensed preparations are being prescribed when there are licensed alternatives available","Licensed preparations available","•\tTacrolimus 0.03% ointment £23.33/30g or £42.55/60g\n•\tTacrolimus 0.1% ointment £17.08/30g or £34.16/60g","Not applicable ","Not applicable","The British Association of Dermatologists (BAD) recommends the following unlicensed specials (see here for further information):\n•\tTacrolimus 0.1% and 0.3% w/w in Orabase, 50g (use for ulcerative and erosive inflammatory and mucosal skin disease including around stomas)","Variable, fluctuating and unregulated\t \t \t \n",null,"The Scottish Drug Tariff lists:\t \t \t \t \n•\tTacrolimus 0.1% ointment £15.59/30g or £35.28/60g"]
["Tamoxifen","Unlicensed preparations are being prescribed when there are licensed alternatives available","Licensed liquid available - HIGH COST","•\tTamoxifen 10mg/5ml oral solution sugar-free £110.88/150ml HIGH COST\t","Disperse the tablets in water. They will disperse within 2-5 minutes. \nOr disperse in water and mix with jam or yoghurt for patients with swallowing difficulties. \nCrushed tablets must be handled with care. Avoid the dust being inhaled, coming into contact with the skin, etc. Wear gloves, mask, and eye protection when crushing tablets.\nAvailable as: 10mg, 20mg or 40mg. The 20mg are most cost effective. ","•\tTamoxifen 10mg tablets £33.80/30\n•\tTamoxifen 20mg tablets £1.85/30  \n•\tTamoxifen 40mg tablets £98.93/30    \n","Various unlicensed specials","Variable, fluctuating and unregulated",null,"The Scottish Drug Tariff lists:\n•\tTamoxifen 10mg tablets £46.54/30\n•\tTamoxifen 20mg tablets £3.42/30  \n•\tTamoxifen 40mg tablets £95.17/30    "]
["Tamsulosin","No licensed liquid available","No suitable licensed preparation available for patients who are unable to swallow the solid oral dosage form","Not applicable","Consider an alternative alpha-blocker, e.g., immediate-release doxazosin tablets, which disperse readily in de-ionised water for oral administration. \nSee NEWT for more info. \nDoxazosin 8mg are not recommended, as multiples of the 4mg tablets represent a more cost-effective choice. \nIf there is no suitable alternative, the contents of tamsulosin capsules may be mixed with cold water and swallowed whole so as to not affect the modified-release properties.","•\tTamsulosin 400microgram modified-release capsules £1.57/30\t\n•\tDoxazosin 1mg tablets £0.76/28\t \n•\tDoxazosin 2mg tablets £0.78/28\t  \n•\tDoxazosin 4mg tablets £0.86/28\n•\tDoxazosin 8mg tablets £10.64/28 HIGH COST","The England/Wales Drug Tariff lists the following unlicensed specials with regulated prices:\t \t \t \n•\tTamsulosin 400micrograms/5ml oral solution \n•\tTamsulosin 400micrograms/5ml oral suspension\n\nHowever, if an unlicensed liquid is required, doxazosin represents a more cost-effective choice:\n•\tDoxazosin 1mg/5ml oral solution\n•\tDoxazosin 1mg/5ml oral suspension\n•\tDoxazosin 4mg/5ml oral solution\n•\tDoxazosin 4mg/5ml oral suspension","•\tTamsulosin 400micrograms/5ml oral solution £65.24/100ml HIGH COST\n•\tTamsulosin 400micrograms/5ml oral suspension £96.35/100ml HIGH COST\n•\tDoxazosin 1mg/5ml oral solution £23.11/150ml \n•\tDoxazosin 1mg/5ml oral suspension £43.76/100ml\n•\tDoxazosin 4mg/5ml oral solution £23.54/150ml \n•\tDoxazosin 4mg/5ml oral suspension £33.20/150ml ",null,"The Scottish Drug Tariff lists: \n•\tTamsulosin 400microgram modified-release capsules £2.10/30\t\n•\tDoxazosin 1mg tablets £0.96/28\t \n•\tDoxazosin 2mg tablets £1.06/28\t  \n•\tDoxazosin 4mg tablets £1.25/28\n•\tDoxazosin 8mg tablets £10.64/28"]
["Temazepam","Unlicensed preparations are being prescribed when there are licensed alternatives available","Licensed liquid available - HIGH COST. ","•\tTemazepam 10mg/5ml oral solution sugar free £206.85/300ml HIGH COST","Consider switching to zolpidem if continued treatment is required. Zolpidem tablets can be crushed and mixed with water prior to oral administration ","•\tZolpidem 5mg tablets £1.47/28\n•\tZolpidem 10mg tablets £1.35/28","Various unlicensed specials","Variable, fluctuating and unregulated","Check treatment duration, it is not recommended to use temazepam for longer than 4 weeks. ","The Scottish Drug Tariff lists:\t \t \t \t \n•\tTemazepam 10mg/5ml oral solution sugar-free £252.17/300ml HIGH COST\n•\tZolpidem 5mg tablets £2.24 /28\n•\tZolpidem 10mg tablets £1.68/28"]
["Terbinafine","No licensed liquid available","No suitable licensed preparation available for patients who are unable to swallow the solid oral dosage form","Not applicable","Tablets can be crushed and mixed with water for oral administration.","•\tTerbinafine 250mg tablets £1.15/14 ","The England/Wales Drug Tariff lists the following unlicensed specials with regulated prices: \t \t \n•\tTerbinafine 250mg/5ml oral suspension\t","•\tTerbinafine 250mg/5ml oral suspension £20.78/50ml","Check treatment duration","The Scottish Drug Tariff lists: \n•\tTerbinafine 250mg tablets £1.80/14"]
["Thiamine","No licensed liquid available","No suitable licensed preparation available for patients who are unable to swallow the solid oral dosage form","Not applicable","Tablets can be crushed and dispersed in water for oral administration","•\tThiamine 50mg tablets £2.56/100 \n•\tThiamine 100mg tablets £3.33/100","The England/Wales Drug Tariff lists the following unlicensed specials with regulated prices:\n•\tThiamine 50mg/5ml oral suspension\t \t \t \n•\tThiamine 100mg/5ml oral solution\n•\tThiamine 100mg/5ml oral suspension","•\tThiamine 50mg/5ml oral suspension £13.32/100ml\n•\tThiamine 100mg/5ml oral solution £17.74/100ml\n•\tThiamine 100mg/5ml oral suspension £23.95/100ml ",null,"The Scottish Drug Tariff lists: \t \n•\tThiamine 50mg tablets £3.38/100 \n•\tThiamine 100mg tablets £6.00/100"]
["Ticagrelor","Unlicensed preparations are being prescribed when there are licensed alternatives available","Ticagrelor 90mg orodispersible tablets available.","•\tTicagrelor 90mg orodispersible tablets sugar-free £54.60/56 ","For patients taking the 60mg dose, the tablets can be crushed and dispersed in water for oral administration","•\tTicagrelor 60mg tablets £54.60/56 \n•\tTicagrelor 90mg tablets £54.60/56 ","Various unlicensed specials","Variable, fluctuating and unregulated"]
["Tizanidine","No licensed liquid available","No suitable licensed preparation available for patients who are unable to swallow the solid oral dosage form","Not applicable","Tablets can be crushed and mixed with water for oral administration. Multiples of the 2mg tablets represent a more cost-effective choice than the 4mg tablets.","•\tTizanidine 2mg tablets £6.89/120\t \n•\tTizanidine 4mg tablets £36.17/120 HIGH COST","The England/Wales Drug Tariff lists the following unlicensed specials with regulated prices:\t \t \t \t \n•\tTizanidine 2mg/5ml oral solution \n•\tTizanidine 2mg/5ml oral suspension","•\tTizanidine 2mg/5ml oral solution £8.12/100ml \n•\tTizanidine 2mg/5ml oral suspension £11.78/100ml ",null,"The Scottish Drug Tariff lists: \t \n•\tTizanidine 2mg tablets £10.51/120\t \n•\tTizanidine 4mg tablets £48.60/120 HIGH COST"]
["Tolterodine","No licensed liquid available","Consider switching to licensed oxybutynin liquid (HIGH COST) or patches, if appropriate.","•\tOxybutynin 2.5mg/5ml oral solution sugar free £198.13/150ml HIGH COST\t \n•\tOxybutynin 3.9mg/24hours transdermal patches £27.20/8\n•\tOxybutynin 5mg/5ml oral solution sugar free £218.65/150ml HIGH COST\t","Tolterodine immediate-release tablets and oxybutynin immediate-release tablets can be crushed and mixed with water for oral administration","•\tOxybutynin 2.5mg tablets £1.15/56\t\n•\tOxybutynin 5mg tablets £1.28/56\t\n•\tTolterodine 1mg tablets £1.98/56\n•\tTolterodine 2mg tablets £2.66/56","The England/Wales Drug Tariff lists the following unlicensed specials with regulated prices:\t \t \t \n•\tTolterodine 2mg/5ml oral suspension","•\tTolterodine 2mg/5ml oral suspension  £38.58/100ml ",null,"The Scottish Drug Tariff lists: \n•\tOxybutynin 2.5mg tablets £1.67/56\t\n•\tOxybutynin 5mg tablets £1.47/56\n•\tTolterodine 1mg tablets £3.00/56\n•\tTolterodine 2mg tablets £2.66/56\t"]
["Topiramate","Unlicensed preparations are being prescribed when there are licensed alternatives available","Licensed liquid (HIGH COST) and capsules available. \nThe capsules can be opened and the content sprinkled onto a teaspoon of soft food that does not require chewing. \nThis is a licensed use and the capsules are a more cost-effective choice.","•\tTopiramate 50mg/5ml oral suspension sugar free £216.00/150ml HIGH COST\n•\tTopiramate 100mg/5ml oral suspension sugar-free £312.00/280ml HIGH COST\t\n•\tTopiramate 15mg capsules £14.79/60\n•\tTopiramate 25mg capsules £22.18/60\n•\tTopiramate 50mg capsules £36.45/60","Not applicable ","Not applicable","The England/Wales Drug Tariff lists the following unlicensed specials with regulated prices: \t \t \t \n•\tTopiramate 25mg/5ml oral suspension","•\tTopiramate 25mg/5ml oral suspension £9.67/100ml\t","All switches should be carried out with care and close monitoring if used for the control of seizures due to differences in bioavailability between different brands/products. Prescribing for this indication should be by brand name to avoid inadvertent switching."]
["Tranexamic acid","No licensed liquid available","No suitable licensed preparation available for patients who are unable to swallow the solid oral dosage form","Not applicable","The tablets can be crushed and mixed with water for oral administration","•\tTranexamic acid 500mg tablets £5.10/60\t","The England/Wales Drug Tariff lists the following unlicensed specials with regulated prices:\t \t \t \n•\tTranexamic acid 250mg/5ml oral suspension \n•\tTranexamic acid 500mg/5ml oral solution \n•\tTranexamic acid 500mg/5ml oral suspension","•\tTranexamic acid 250mg/5ml oral suspension £37.95/60ml \n•\tTranexamic acid 500mg/5ml oral solution £25.64/100ml \n•\tTranexamic acid 500mg/5ml oral suspension £24.67/100ml",null,"The Scottish Drug Tariff lists: \n•\tTranexamic acid 500mg tablets £5.69/60\n•\tTranexamic acid 500mg/5ml oral solution £56.19/100ml HIGH COST\n•\tTranexamic acid 500mg/5ml oral suspension £134.00/100ml HIGH COST"]
["Trazodone","Unlicensed preparations are being prescribed when there are licensed alternatives available","Licensed liquid available.","•\tTrazodone 50mg/5ml oral solution sugar free £8.88/120ml\n•\tTrazodone 100mg/5ml oral solution sugar-free £271.67/120ml HIGH COST","Not applicable ","Not applicable","Various unlicensed specials","Variable, fluctuating and unregulated"," The 50mg/ml sugar-free oral solution represents the most cost-effective choice. The 100mg/5ml strength is HIGH COST.","The Scottish Drug Tariff lists:\t \t \t \t \n•\tTrazodone 50mg/5ml oral solution sugar free £15.00/120ml"]
["Tretinoin, topical (dermatology)","No suitable licensed preparation available","Tretinoin available as a licensed topical preparation with erythromycin","•\tTretinoin 0.025%/erythromycin 4% solution £7.05/25ml","Not applicable","Not applicable","The British Association of Dermatologists (BAD) recommends the following unlicensed specials (see here for further information):\n•\tHydroquinone 5% w/w, hydrocortisone 1% w/w and tretinoin 0.1% w/w in a non-aqueous gel, 100g (use to treat melasma, in conjunction with a strong sunscreen, for a maximum of 6 months).","Variable, fluctuating and unregulated","Check treatment duration"]
["Triamcinolone, topical (dermatology)","No suitable licensed preparation available","No suitable licensed preparation available ","Not applicable","Not applicable","Not applicable","The British Association of Dermatologists (BAD) recommends the following unlicensed specials (see here for further information):\n•\tTriamcinolone acetonide 0.1% w/w in Orabase, 50g (use for ulcerative and erosive inflammatory and mucosal skin disease including around stomas)","•\tTriamcinolone 0.1% oromucosal paste £28.53/5g "]
["Trichloroacetic acid","No suitable licensed preparation available","No suitable licensed preparation available","Not applicable","Not applicable","Not applicable","The British Association of Dermatologists (BAD) recommends the following unlicensed specials (see here for further information):\n•\tTrichloroacetic acid 90% w/w, 10ml (used to destroy facial xanthelasmata)","Variable, fluctuating and unregulated"]
["Trihexylphenidyl HCl","Unlicensed preparations are being prescribed when there are licensed alternatives available","Licensed liquid available - HIGH COST","•\tTrihexyphenidyl 5mg/5ml oral solution £105.28/200ml HIGH COST","Tablets can be dispersed in water for oral administration.","•\tTrihexyphenidyl 2mg tablets £3.59/84\t \n•\tTrihexyphenidyl 5mg tablets £18.85/84","The England/Wales Drug Tariff lists the following unlicensed specials with regulated prices: \t \t \t \n•\tTrihexyphenidyl 2mg/5ml oral solution\n•\tTrihexyphenidyl 2mg/5ml oral suspension","•\tTrihexyphenidyl 2mg/5ml oral solution £25.84/200ml\n•\tTrihexyphenidyl 2mg/5ml oral suspension £220.04/300ml HIGH COST","If an unlicensed liquid is required, the 2mg/5ml oral solution is more cost-effective than the oral suspension.","The Scottish Drug Tariff lists: \n•\tTrihexyphenidyl 2mg tablets £8.06/84\n•\tTrihexyphenidyl 5mg tablets £23.71/84"]
["Trimethoprim","Unlicensed preparations are being prescribed when there are licensed alternatives available","Licensed liquid available","•\tTrimethoprim 50mg/5ml oral suspension sugar-free £4.73/100ml\t","Not applicable","Not applicable","Various unlicensed specials","Variable, fluctuating and unregulated",null,"The Scottish Drug Tariff lists:\t \t \t \t \n•\tTrimethoprim 50mg/5ml oral suspension sugar-free £7.37/100ml\t"]

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["KEY","* Drug Tariff (England and Wales) May 24    § NEWT guidelines for administration of medication to patients with enteral feeding tubes or swallowing difficulties, Fourth edition- August 2021\n‡ Enteral Feeding Handbook 3rd edition        ** Scottish Drug Tariff April 24"]
["Chemical substance","What is the issue?","Option 1: Use a licensed medicine in a suitable licensed formulation (incl review ongoing need or change to different drug in same therapeutic class)","Licensed preparation(s) and cost (option 1) per original pack*","Option 2: Use a licensed medicine in an unlicensed manner (e.g. crushing tablets). See NEWT for further information.§ \nNot applicable for enteral feeding tubes, refer to resources§,‡ or local medicines information service for more information.","Off-label preparation(s) and cost (option 2) per original pack*","Option 3: Only if clinical reason exists for not using licensed product: Use an unlicensed special","Unlicensed special preparation(s) and cost (option 3) per original pack*","Comments ","Scottish Drug Tariff considerations**"]
["Ursodeoxycholic acid","Unlicensed preparations are being prescribed when there are licensed alternatives available","Licensed liquid available","•\tUrsodeoxycholic acid 250mg/5ml oral suspension sugar-free £26.98/250ml","Tablets can be crushed and mixed with water for oral administration, but they have limited solubility\nCapsules can be opened and the contents mixed with a small amount of soft food such as yoghurt or jam. Make sure it is swallowed without chewing. See medicines for children leaflet","•\tUrsodeoxycholic acid 150mg tablets £34.39/60\n•\tUrsodeoxycholic acid 250mg tablets £18.00/60\n•\tUrsodeoxycholic acid 250mg capsules £8.48/60\n•\tUrsodeoxycholic acid 300mg tablets £63.69/60\n•\tUrsodeoxycholic acid 500mg tablets £80.00/100","Various unlicensed specials","Variable, fluctuating and unregulated",null,"The Scottish Drug Tariff lists: \n•\tUrsodeoxycholic acid 150mg tablets £34.59/60\n•\tUrsodeoxycholic acid 250mg capsules £13.20/60\n•\tUrsodeoxycholic acid 300mg tablets £63.69/60"]

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["KEY","* Drug Tariff (England and Wales) May 24    § NEWT guidelines for administration of medication to patients with enteral feeding tubes or swallowing difficulties, Fourth edition- August 2021\n‡ Enteral Feeding Handbook 3rd edition        ** Scottish Drug Tariff April 24"]
["Chemical substance","What is the issue?","Option 1: Use a licensed medicine in a suitable licensed formulation (incl review ongoing need or change to different drug in same therapeutic class)","Licensed preparation(s) and cost (option 1) per original pack*","Option 2: Use a licensed medicine in an unlicensed manner (e.g. crushing tablets). See NEWT for further information.§ \nNot applicable for enteral feeding tubes, refer to resources§,‡ or local medicines information service for more information.","Off-label preparation(s) and cost (option 2) per original pack*","Option 3: Only if clinical reason exists for not using licensed product: Use an unlicensed special","Unlicensed special preparation(s) and cost (option 3) per original pack*","Comments ","Scottish Drug Tariff considerations**"]
["Valproic acid","No licensed liquid available","Consider a switch to sodium valproate liquid or granule sachets. However, first discuss with initiating clinician as valproic acid and sodium valproate are not directly interchangeable and a slightly higher (approximately 10%) dose of sodium valproate may be needed.","•\tSodium valproate 200mg/5ml oral solution £9.33/300ml\t \n•\tSodium valproate 200mg/5ml oral solution sugar-free £7.52/300ml\t\n•\tSodium valproate 50mg modified-release granules sachets sugar-free £30.00/30\n•\tSodium valproate 100mg modified-release granules sachets sugar-free £30.00/30\n•\tSodium valproate 250mg modified-release granules sachets sugar-free £30.00/30\n•\tSodium valproate 500mg modified-release granules sachets sugar-free £30.00/30\n•\tSodium valproate 750mg modified-release granules sachets sugar-free £30.00/30\n•\tSodium valproate 1000g modified-release granules sachets sugar-free £30.00/30\t","Not applicable","Not applicable","Various unlicensed specials","Variable, fluctuating and unregulated",null,"The Scottish Drug Tariff lists:\t \t \t \t \n•\tSodium valproate 200mg/5ml oral solution sugar-free £11.85/300ml\t"]
["Venlafaxine","Unlicensed preparations are being prescribed when there are licensed alternatives available","Licensed liquid available - HIGH COST","•\tVenlafaxine 37.5mg/5ml oral solution sugar-free £178.00/150ml \n•\tVenlafaxine 75mg/5ml oral solution sugar-free £233.00/150ml ","Not applicable","Not applicable","Various unlicensed specials","Variable, fluctuating and unregulated","When switching between modified- and immediate-release preparations, please ensure that the correct dosage frequency is prescribed to achieve equivalence."]
["Verapamil","Unlicensed preparations are being prescribed when there are licensed alternatives available","Licensed liquid available - HIGH COST","•\tVerapamil 40mg/5ml oral solution sugar-free £158.85/150ml ","Not applicable ","Not applicable","Various unlicensed specials","Variable, fluctuating and unregulated","When switching between modified- and immediate-release preparations, please ensure that the correct dosage frequency is prescribed to achieve equivalence."]
["Vitamin D (with or without calcium)","Unlicensed preparations are being prescribed when there are licensed alternatives available","See under colecalciferol "," "]

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["KEY","* Drug Tariff (England and Wales) May 24    § NEWT guidelines for administration of medication to patients with enteral feeding tubes or swallowing difficulties, Fourth edition- August 2021\n‡ Enteral Feeding Handbook 3rd edition        ** Scottish Drug Tariff April 24"]
["Chemical substance","What is the issue?","Option 1: Use a licensed medicine in a suitable licensed formulation (incl review ongoing need or change to different drug in same therapeutic class)","Licensed preparation(s) and cost (option 1) per original pack*","Option 2: Use a licensed medicine in an unlicensed manner (e.g. crushing tablets). See NEWT for further information.§ \nNot applicable for enteral feeding tubes, refer to resources§,‡ or local medicines information service for more information.","Off-label preparation(s) and cost (option 2) per original pack*","Option 3: Only if clinical reason exists for not using licensed product: Use an unlicensed special","Unlicensed special preparation(s) and cost (option 3) per original pack*","Comments ","Scottish Drug Tariff considerations**"]
["Warfarin","No licensed liquid available","Warfarin is available as a licensed liquid - HIGH COST. \nAlternatively, consider switching to a DOAC (direct oral anti-coagulant) available in a suitable formulation, if likely to be needed long-term, e.g., rivaroxaban licensed liquid, or apixaban, edoxaban or rivaroxaban, which are all available as tablets that are licensed to be crushed and mixed with water or apple puree immediately prior to use and oral administration. Apixaban can also be crushed and suspended in water, 5% dextrose in water (D5W), or apple juice for immediate oral administration. Liaise with specialist, if appropriate.","•\tApixaban 2.5mg tablets £2.91/60\t \n•\tApixaban 5mg tablets £2.83/56\t\n•\tEdoxaban 15mg tablets £17.50/10\n•\tEdoxaban 30mg tablets £49.00/28\n•\tEdoxaban 60mg tablets £49.00/28 \n•\tRivaroxaban 1mg/ml oral suspension sugar-free £18.00/100ml\n•\tRivaroxaban 2.5mg tablets £50.40/56\n•\tRivaroxaban 10mg tablets £54.00/30\t \n•\tRivaroxaban 15mg tablets £50.40/28\t \t\n•\tRivaroxaban 20mg tablets £50.40/28\n• Warfarin 1mg/ml oral suspension sugar free £187.00/150ml ","Not applicable ","Not applicable","Various unlicensed specials","Variable, fluctuating and unregulated",null,"The Scottish Drug Tariff lists:\t \t \t \t \n•\tApixaban 2.5mg tablets £2.91/60\t \n•\tApixaban 5mg tablets £2.83/56"]

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["KEY","* Drug Tariff (England and Wales) May 24    § NEWT guidelines for administration of medication to patients with enteral feeding tubes or swallowing difficulties, Fourth edition- August 2021\n‡ Enteral Feeding Handbook 3rd edition        ** Scottish Drug Tariff April 24"]
["Chemical substance","What is the issue?","Option 1: Use a licensed medicine in a suitable licensed formulation (incl review ongoing need or change to different drug in same therapeutic class)","Licensed preparation(s) and cost (option 1) per original pack*","Option 2: Use a licensed medicine in an unlicensed manner (e.g. crushing tablets). See NEWT for further information.§ \nNot applicable for enteral feeding tubes, refer to resources§,‡ or local medicines information service for more information.","Off-label preparation(s) and cost (option 2) per original pack*","Option 3: Only if clinical reason exists for not using licensed product: Use an unlicensed special","Unlicensed special preparation(s) and cost (option 3) per original pack*","Comments ","Scottish Drug Tariff considerations**"]

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["Chemical substance","What is the issue","Option 1: Use a licensed medicine in a suitable licensed formulation (incl review ongoing need or change to different drug in same therapeutic class)","Licensed preparation(s) and cost (option 1) per original pack*","Option 2: Use a licensed medicine in an unlicensed manner (e.g. crushing tablets). See NEWT for further information.§ \nNot applicable for enteral feeding tubes, refer to resources§,‡ or local medicines information service for more information","Off-label preparation(s) and cost (option 2) per original pack*","Option 3: Only if clinical reason exists for not using licensed product: Use an unlicensed special","Unlicensed special preparation(s) and cost (option 3) per original pack*","Comments ","Scottish Drug Tariff considerations**","* Drug Tariff (England and Wales) May 24\n\n§ NEWT guidelines for administration of medication to patients with enteral feeding tubes or swallowing difficulties, Fourth edition- August 2021\n\n‡ Enteral Feeding Handbook 3rd edition\n\n** Scottish Drug Tariff April 24"]

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["KEY","* Drug Tariff (England and Wales) May 24    § NEWT guidelines for administration of medication to patients with enteral feeding tubes or swallowing difficulties, Fourth edition- August 2021\n‡ Enteral Feeding Handbook 3rd edition        ** Scottish Drug Tariff April 24"]
["Chemical substance","What is the issue?","Option 1: Use a licensed medicine in a suitable licensed formulation (incl review ongoing need or change to different drug in same therapeutic class)","Licensed preparation(s) and cost (option 1) per original pack*","Option 2: Use a licensed medicine in an unlicensed manner (e.g. crushing tablets). See NEWT for further information.§ \nNot applicable for enteral feeding tubes, refer to resources§,‡ or local medicines information service for more information.","Off-label preparation(s) and cost (option 2) per original pack*","Option 3: Only if clinical reason exists for not using licensed product: Use an unlicensed special","Unlicensed special preparation(s) and cost (option 3) per original pack*","Comments ","Scottish Drug Tariff considerations**"]
["Zinc, topical (dermatology)","Unlicensed preparations are being prescribed when there are licensed alternatives available","Licensed zinc and castor oil available","•\tZinc and Castor oil ointment £5.14/500g\t","Not applicable","Not applicable","The British Association of Dermatologists (BAD) recommends the following unlicensed specials (see here for further information):\n•\tIchthammol 1% w/w and zinc oxide 15% w/w in YSP, 200g (ichthammol is used to treat acutely inflamed atopic eczema. It is also used in paste bandages (Ichthopaste® £3.45) for chronic lichenified eczema. Treatment is often initiated at Dermatology day treatment centres but may be continued in the community).\n•\tDithranol in Lassar's paste 0.1%, 0.5%, 1%, 2%, 4%, 10% and 15% w/w, 100g (dithranol in Lassar’s paste (a combination of salicylic acid and zinc oxide) is effective in moderate to severe chronic plaque psoriasis when other topical treatments (vitamin D analogues, commercial tar preparations and commercial dithranol preparations, e.g., Dithrocream®) have been ineffective or unsuitable, where phototherapy is contraindicated or less effective, e.g., lower leg, and where the patient does not wish to take or is unsuitable for systemic treatment. Treatment is often initiated at Dermatology day treatment centres but may in some cases be continued by patients at home once they have been instructed how to use it safely).\n•\tDithranol scalp application 0.4% w/w (‘dithranol pomade’; dithranol 0.4% w/w, salicylic acid 2% w/w, emulsifying wax BP 25% w/w, liquid paraffin to 100%),100g (dithranol in Lassar’s paste (a combination of salicylic acid and zinc oxide) is effective in moderate to severe chronic plaque psoriasis when other topical treatments (vitamin D analogues, commercial tar preparations and commercial dithranol preparations, e.g., Dithrocream®) have been ineffective or unsuitable, where phototherapy is contraindicated or less effective, e.g., lower leg, and where the patient does not wish to take or is unsuitable for systemic treatment. Treatment is often initiated at Dermatology day treatment centres but may in some cases be continued by patients at home once they have been instructed how to use it safely).\n•\tPhenol 2% w/w in compound zinc paste BP, 50g (used for intractable pruritus ani, unresponsive to moderate strength topical steroid and barrier preparations).\n\nThe England/Wales Drug Tariff lists the following unlicensed specials with regulated prices:\n•\tZinc oxide 15% and Ichthammol 1% in Yellow soft paraffin \n•\tZinc and Salicylic acid paste ","Variable, fluctuating and unregulated",null,"The Scottish Drug Tariff lists:\t \t \t \t \n•\tZinc and Castor oil ointment £6.50/500g\n•\tZinc oxide 15% and Ichthammol 1% in Yellow soft paraffin £37.61/200g\n•\tZinc oxide 15% and Ichthammol 1% in Yellow soft paraffin £42.40/500g "]
["Zolpidem","No licensed liquid available","No suitable licensed preparation available for patients who are unable to swallow the solid oral dosage form","Not applicable","Tablets can be crushed and mixed with \nwater for oral administration","•\tZolpidem 5mg tablets £1.47/28\t\n•\tZolpidem 10mg tablets £1.35/28\t","Various unlicensed specials","Variable, fluctuating and unregulated",null,"The Scottish Drug Tariff lists:\t \t \t \t \n•\tZolpidem 5mg tablets £2.24/28\t\n•\tZolpidem 10mg tablets £1.68/28\t"]
["Zonisamide","Unlicensed preparations are being prescribed when there are licensed alternatives available","Licensed liquid available - HIGH COST","•\tZonisamide 100mg/5ml oral suspension £181.90/250ml\t ","Not applicable ","Not applicable","Various unlicensed specials","Variable, fluctuating and unregulated","Where possible, patients taking antiepileptics for seizures should be maintained on a specific manufacturer's product, due to variability in product characteristics which may lead to a loss of seizure control when switching between brands/manufacturers. All product switches should be carried out with care and close monitoring."]
["Zopiclone","No licensed liquid available","Consider switching to licensed temazepam liquid - HIGH COST ","•\tTemazepam 10mg/5ml oral solution sugar free £206.85/300ml","Consider switching to zolpidem tablets, which can be crushed and mixed with water for oral administration.","•\tZolpidem 5mg tablets £1.47/28\n•\tZolpidem 10mg tablets £1.35/28","The England/Wales Drug Tariff lists the following unlicensed specials with regulated prices:\n•\tZopiclone 3.75mg/5ml oral solution \n•\tZopiclone 3.75mg/5ml oral suspension \n•\tZopiclone 7.5mg/5ml oral solution \n•\tZopiclone 7.5mg/5ml oral suspension","•\tZopiclone 3.75mg/5ml oral solution £29.98/150ml \n•\tZopiclone 3.75mg/5ml oral suspension £23.80/100ml \n•\tZopiclone 7.5mg/5ml oral solution £27.69/100ml \n•\tZopiclone 7.5mg/5ml oral suspension £43.56/100ml\t",null,"The Scottish Drug Tariff lists: \n•\tTemazepam 10mg/5ml oral solution sugar-free £252.17/300ml HIGH COST\n•\tZolpidem 5mg tablets £2.24/28\n•\tZolpidem 10mg tablets £1.68/28"]