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 Formulary Chapter 9: Nutrition and blood - Full Chapter
09.02.02  Expand sub section  Parenteral preparations for fluid and electrolyte imbalance
09.02.02.01  Expand sub section  Electrolytes and water
09.02.02.01  Expand sub section  Intravenous sodium
Sodium Chloride 0.9% Injection
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Formulary 2ml amps
5ml amps
10ml amps
20ml amps
 
   
Sodium Chloride 0.9% Infusion
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Formulary 50ml bag
100ml bag
250ml bag
500ml bag
500ml polyfusor
1L bag 
   
Sodium Chloride 0.45% Infusion
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Formulary 500ml bag 
   
Sodium Chloride Polyfusor (500ml)
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Formulary 0.18%
0.9%
1.8%
2.7%
5% 
   
09.02.02.01  Expand sub section  Intravenous glucose
Glucose 5% Intravenous
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Formulary 50ml bag
100ml bag
250ml bag
500ml bag
500ml Polyfusor
1L bag
 
   
Glucose 10% Intravenous
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Formulary 500ml bag
1L bag
 
   
Glucose 15% Intravenous
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Formulary 500ml bag 
   
Glucose 20% Intravenous
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Formulary 500ml bag 
   
Glucose 50% Intravenous
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Formulary 20ml amps
50ml vial
500ml bag 
   
Sodium Chloride 0.18% and Glucose 10% Intravenous Infusion
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Formulary 500ml bag 
   
Sodium Chloride 0.18% and Glucose 4% Intravenous Infusion
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Formulary 500ml bag
1L bag 
   
Sodium Chloride 0.45% and Glucose 10% Intravenous Infusion
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Formulary 500ml bag 
   
Sodium Chloride 0.45% and Glucose 5% Intravenous Infusion
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Formulary 500ml bag
 
   
Sodium Chloride 0.9% and Glucose 5% Intravenous Infusion
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Formulary 500ml bag
1L bag 
   
09.02.02.01  Expand sub section  Intravenous potassium to top
Controlled Drug Potassium Chloride 15% Concentrate BP
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Formulary 10ml amps (Contains 20mmol potassium)

Restricted Item Only the designated areas given in Appendix 1 of the Intravenous Potassium Policy have been authorised to stock and administer strong potassium chloride solutions as indicated. Potassium chloride concentrated solutions must never be transferred between clinical areas

Must be stored in a Controlled Drugs cupboard.

Must NEVER be administered undiluted
(NPSA 'Never Event) 
Link  PAT Intravenous Potassium Policy
   
Controlled Drug Potassium Chloride 3% in Sodium Chloride 0.9%
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Formulary 100ml bag (contains 40mmol potassium)

Restricted Item Only the designated areas given in Appendix 1 of the Intravenous Potassium Policy have been authorised to stock and administer strong potassium chloride solutions as indicated. Potassium chloride concentrated solutions must never be transferred between clinical areas

Order as a Controlled Drug.

Potassium chloride infusion 40mmol in 100ml sodium chloride 0.9% must be
stored in a locked cupboard and kept separate from other infusion bags. 
   
Potassium Chloride 0.15% and Glucose 5% Intravenous Infusion
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Formulary 500ml bag (contains 10mmol of potassium) 
   
Potassium Chloride 0.15% and Sodium Chloride 0.9% Intravenous Infusion
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Formulary 500ml bag (contains 10mmol of potassium) 
   
Potassium Chloride 0.15%, Sodium Chloride 0.45% and Glucose 5% Intravenous Infusion
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Formulary 500ml bag (contains 10mmol of potassium) 
   
Potassium Chloride 0.15% and Glucose 10% Intravenous Infusion
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Formulary 500ml bag (contains 10mmol of potassium)

unlicensedUnlicensed special - manufactured to order and may not always be available 
   
Potassium Chloride 0.15%, Sodium Chloride 0.18% and Glucose 4% Intravenous Infusion
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Formulary 500ml bag (contains 10mmol of potassium) 
   
Potassium Chloride 0.3% and Glucose 5% Intravenous Infusion
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Formulary 500ml bag (contains 20mmol of potassium) 
   
Potassium Chloride 0.3% and Sodium Chloride 0.9% Intravenous Infusion
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Formulary 500ml bag (contains 20mmol of potassium) 
   
Potassium Chloride 0.3%, Sodium Chloride 0.18% and Glucose 4% Intravenous Infusion
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Formulary 500ml bag (contains 20mmol of potassium) 
   
Potassium Chloride 0.3%, Sodium Chloride 0.45% and Glucose 10% Intravenous Infusion
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Formulary 500ml bag (contains 20mmol of potassium)

 
   
Potassium Chloride 0.3%, Sodium Chloride 0.9% and Glucose 5% Intravenous Infusion
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Formulary 500ml bag (contains 20mmol of potassium) 
   
Potassium Chloride 0.3% and Glucose 10% Intravenous Infusion
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Formulary 500ml bag (contains 20mmol of potassium)

unlicensedUnlicensed special - manufactured to order and may not always be available 
   
Potassium Chloride 0.3%, Sodium Chloride 0.45% and Glucose 5% Intravenous Infusion
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Formulary 500ml bag (contains 20mmol of potassium)

unlicensedUnlicensed special - manufactured to order and may not always be available 
   
Potassium Chloride 0.6% and Glucose 5%
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Formulary 500ml bag (contains 40mmol of potassium)

unlicensedUnlicensed special - manufactured to order and may not always be available

Restricted Item 500ml bags containing 40mmol of potassium may be kept as stock in critical
care areas. They will be supplied from the Pharmacy department to other wards
on a named patient basis only. 
   
Potassium Chloride 0.6% and Sodium Chloride 0.9%
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Formulary 500ml bag (contains 40mmol of potassium)

unlicensedUnlicensed special - manufactured to order and may not always be available

Restricted Item 500ml bags containing 40mmol of potassium may be kept as stock in critical
care areas. They will be supplied from the Pharmacy department to other wards
on a named patient basis only. 
   
09.02.02.01  Expand sub section  Bicarbonate and lactate
Compound Sodium Lactate Intravenous Infusion
(Hartmann's Solution)
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Formulary 500ml bag
1 litre bag 
   
Sodium Bicarbonate
(Injection)
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Formulary 4.2% 5ml amps unlicensedunlicensed
4.2% 10ml amps unlicensedunlicensed
8.4% 10ml amps 
   
Sodium Bicarbonate (Minijet®)
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Formulary 4.2% 10ml Minijet
8.4% 10ml Minijet
8.4% 50ml Minijet
 
   
Sodium Bicarbonate (Polyfusor®)
(500ml)
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Formulary 1.26%
1.4%
4.2%
8.4% 
   
09.02.02.02  Expand sub section  Plasma and plasma substitutes
Human Albumin Solution
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Formulary note This is a BLOOD product. Obtain from haematology (not pharmacy). 
   
09.02.02.02  Expand sub section  Plasma substitutes
Gelatin (Gelaspan®)
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First Choice  
Gelatin (Gelofusine®)
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Second Choice May be supplied as an alternative to Gelaspan if unavailable 
   
 ....
 Non Formulary Items
Dextran 40®

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Non Formulary
 
Dextran 70®

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Non Formulary
 
Etherified Starch  (HAES-steril®)

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Non Formulary
 
Etherified Starch  (Hemohes®)

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Non Formulary
 
Etherified Starch  (Infukoll®)

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Non Formulary
 
Gelatin  (Geloplasma®)

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Non Formulary
 
Gelatin  (Haemaccel®)

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Non Formulary
 
Gelatin  (Volplex®)

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Non Formulary
 
Hydroxyethyl Starch Products

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Non Formulary e.g. Tetraspan®, Voluven®

Because of the risk of kidney injury and mortality, HES solutions must no longer be used in patients with sepsis, burn injuries or critically ill patients.

HES solutions should only be used for the treatment of hypovolaemia due to acute blood loss when crystalloids alone are not considered sufficient.

There is a lack of robust long-term safety data in patients undergoing surgical procedures and in patients with trauma. The expected benefit of treatment should be carefully weighed against the uncertainties with regard to long-term safety, and other available treatment options should be considered.

HES solutions should be used at the lowest effective dose for the shortest period of time. Treatment should be guided by continuous haemodynamic monitoring so that the infusion is stopped as soon as appropriate haemodynamic goals have been achieved.

HES solutions are now contraindicated in patients with renal impairment or renal replacement therapy. The use of HES must be discontinued at the first sign of renal injury. An increased need for renal replacement therapy has been reported up to 90 days after HES administration. Patients’ kidney function should be monitored after HES administration.

HES solutions are contraindicated in severe coagulopathy. HES solutions should be discontinued at the first sign of coagulopathy. Blood coagulation parameters should be monitored carefully in case of repeated administration.


See EMA Review (via link)
Link  EMA: Hydroxyethyl starch solutions for infusion
 
Hypertonic Solution  (HyperHAES®)

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Non Formulary
 
Plasma-lyte 148

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Non Formulary
 
Ringer's Solution for Injection

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Non Formulary
 
  
Key
note Notes
Section Title Section Title (top level)
Section Title Section Title (sub level)
First Choice Item First Choice item
Non Formulary Item Non Formulary section
Restricted Drug
Restricted Drug
Unlicensed Drug
Unlicensed
Track Changes
Display tracking information
click to search medicines.org.uk
Link to adult BNF
click to search medicines.org.uk
Link to children's BNF
click to search medicines.org.uk
Link to SPCs
SMC
Scottish Medicines Consortium
Cytotoxic Drug
Cytotoxic Drug
CD
Controlled Drug
High Cost Medicine
High Cost Medicine
Cancer Drugs Fund
Cancer Drugs Fund
NHSE
NHS England
Homecare
Homecare
CCG
CCG

Traffic Light Status Information

Status Description

Amber

Drugs designated amber are suitable for shared care arrangements under a shared care protocol. Prescribing may be transferred from secondary to primary care once the patient is stabilised and agreed shared care arrangements have been established. Alternatively primary care may initiate under the supervision of secondary care if this option is given in the shared care document. It is recommended that shared care arrangements should be drawn up following local discussion and agreement by prescribing parties.   

Black

These products have been reviewed by the GM Joint Formulary Group and have been deemed not suitable for prescribing for adults in primary or secondary care within Greater Manchester. These decisions have been made on the basis of safety, efficacy and cost-effectiveness of the products.  

Green

Not used   

Green 1

Drugs designated green1 are suitable for initiation and ongoing prescribing within primary care.   

Green 2

Drugs designated green2 can be initiated by primary care following written or verbal advice from a specialist and then be subsequently safely prescribed in primary care with little or no monitoring required.  

Green 3

Drugs designated green3 are suitable for on-going prescribing within primary care after specialist initiation and an initial review (unless specified) in secondary care. Little or no monitoring is required.  

Grey

Not suitable for routine prescribing but may be suitable for a defined patient population. Whilst prescribers should think very carefully before prescribing or recommending any of the products on the grey list, there may be exceptional instances when the use of one of these products is necessary for a particular patient.   

Red

Drugs designated red are considered to be specialist medicines and prescribing responsibility for these medicines should normally remain with the consultant or specialist clinician. These drugs should not be initiated or prescribed in primary care. It is recommended that the supply of these specialist medicines should be organised via the hospital pharmacy, this may include arranging for supply via a home care company.   

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