PAD Formulary : Surrey Heartlands
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A-Z of Drugs : A B C D E F G H I J K L M N O P Q R S T U V W X Y Z

Search Results : Pain (Morphine sulfate - Pain )

Records returned : 55 (on 23 Nov 2024 at 08:17:21). .

Drug
Indication
Status
Trust Alignment
Links
Restrictions/Comments
04.07.02
Morphine sulfate
Pain
Green (see narrative)
Formulations :
  • Capsules (slow release)
  • Granules (slow release)
  • Tablets (slow release)
ASPH
RSFT
SASH
SABP
Primary Care
Guidelines BNF SPC
CD
Important
Prescribe modified-release preparations by brand - refer to local guidelines for preferred brands. Zomorph capsules (12-hourly) can be opened for administration in patients unable to swallow the capsules.
04.07.02
Pain
Green (see narrative)
Formulations :
  • Immediate release tablets
  • Oral solution
  • Oro-dispersible
ASPH
RSFT
SASH
SABP
Primary Care
Guidelines BNF SPC
CD
Important
Orodispersible tablets are a cost-effective alternative to oral solution. Reserve oral solution and orodispersible tablets for patients in whom a solid dose form is not suitable.
04.07.02
Pain
Red
Formulations :
  • Injection
  • Solution for infusion
ASPH
RSFT
SASH
SABP
Primary Care
Guidelines BNF SPC
CD
Important
See separate listing for palliative care
04.07.02
Pain
Non Formulary
Formulations :
  • Suppositories
ASPH
RSFT
SASH
SABP
Primary Care
Guidelines BNF SPC
CD
01.04.02
04.07.02
Codeine phosphate
Pain
Green
Formulations :
  • Tablets
ASPH
RSFT
SASH
SABP
Primary Care
Guidelines BNF SPC
Important
Tablets can be dissolved in water (off-label)
04.07.01
Paracetamol
Pain
Green
Formulations :
  • Tablets
ASPH
RSFT
SASH
SABP
Primary Care
Guidelines BNF SPC
Preferred
07.01.01
10.01.01
10.03.02
Ibuprofen
Pain
Green
Formulations :
  • Oral suspension
  • Tablets
ASPH
RSFT
SASH
SABP
Primary Care
Guidelines BNF SPC
04.07.02
Dihydrocodeine tartrate
Pain
Green
Formulations :
  • Oral solution
  • Tablets
ASPH
RSFT
SASH
SABP
Primary Care
Guidelines BNF SPC
CD
04.07.02
Pain
Green (see narrative)
Formulations :
  • Modified release tablets
ASPH
RSFT
SASH
SABP
Primary Care
Guidelines BNF SPC
CD
Important
Consider use if standard release tablets are not tolerated or compliance is an issue.
04.07.02
Tramadol hydrochloride
Pain
Green (see narrative)
Formulations :
  • Modified release capsules
  • Modified release tablets
ASPH
RSFT
SASH
SABP
Primary Care
Guidelines BNF SPC
CD
SA
Important
Branded prescribing is recommended for modified release tramadol. Do not confuse 12 hourly and 24 hourly preparations. Consider tramadol where maximum tolerated doses of codeine / dihydrocodeine are ineffective.
04.07.02
Pain
Green (see narrative)
Formulations :
  • Soluble tablets
ASPH
RSFT
SASH
SABP
Primary Care
Guidelines BNF SPC
CD
Important
Reserved for patients unable to swallow solid dose forms or for administration via an enteral tube. Consider use where maximum tolerated doses of codeine / dihydrocodeine are ineffective.
04.07.02
Pain
Green (see narrative)
Formulations :
  • Oro-dispersible
ASPH
RSFT
SASH
SABP
Primary Care
Guidelines BNF SPC
CD
Important
Reserved for patients unable to swallow solid dose forms or for administration via an enteral tube. Consider use where maximum tolerated doses of codeine / dihydrocodeine are ineffective.
04.07.01
Co-codamol
Pain
Green (see narrative)
Formulations :
  • Tablets
ASPH
RSFT
SASH
SABP
Primary Care
Guidelines BNF SPC
Important
Fixed combinations are less preferable. Low dose (8/500 co-codamol) not recommended. Secondary Care - for A&E / discharge only.
04.07.01
Pain
Green (see narrative)
Formulations :
  • Capsules
ASPH
RSFT
SASH
SABP
Primary Care
Guidelines BNF SPC
Important
Capsules are more costly than tablets in primary care. Fixed combinations are less preferable. Low dose (8/500 co-codamol) not recommended.
04.07.01
Co-dydramol 10/500
Pain
Green (see narrative)
Formulations :
  • Tablets
ASPH
RSFT
SASH
SABP
Primary Care
Guidelines BNF SPC
Important
Fixed combinations are less preferred. RSCH - prescribe as separate components - combination is non-formulary at RSCH. The MHRA advises when prescribing dihydrocodeine with paracetamol, the tablet strength and dose must be clearly indicated
01.04.02
04.07.02
Codeine phosphate
Pain
Green (see narrative)
Formulations :
  • Oral solution
ASPH
RSFT
SASH
SABP
Primary Care
Guidelines BNF SPC
Important
Codeine phosphate oral solution 25mg/5ml. Codeine linctus 15mg/5ml is ONLY licensed for cough.
04.07.01
Nefopam hydrochloride
Pain
Green (see narrative)
Formulations :
  • Tablets
ASPH
RSFT
SASH
SABP
Primary Care
Guidelines BNF SPC
R
Important
Reserve for when alternatives are contraindicated or ineffective. At RSFT - initiation by pain team only.
04.07.01
Paracetamol
Pain
Green (see narrative)
Formulations :
  • Effervescent tablets
  • Soluble tablets
  • Suppositories
ASPH
RSFT
SASH
SABP
Primary Care
Guidelines BNF SPC
R
Important
Reserve for patients who cannot swallow solid dose forms. Soluble / effervescent preparations have a high sodium content and more expensive than ordinary tablets. Suppositories for use when oral route is not suitable
04.07.01
Pain
Green (see narrative)
Formulations :
  • Oral suspension
ASPH
RSFT
SASH
SABP
Primary Care
Guidelines BNF SPC
R
Important
120mg/5ml and 250mg/5ml reserved for patients who cannot swallow solid dose forms or where sodium content of dispersible preparations is a problem. Non-formulary: Paracetamol oral suspension 500mg/5ml. Much more expensive. Use a soluble formulation.
04.07.01
Co-codamol
Pain
Green (see narrative)
Formulations :
  • Effervescent tablets
ASPH
RSFT
SASH
SABP
Primary Care
Guidelines BNF SPC
Important
Fixed combinations are less preferable. Low dose (8/500 co-codamol) not recommended. Avoid effervescent formulations (high sodium content and more costly). Reserve for swallowing difficulties or patients with feeding tubes. Secondary Care - for A&E / discharge only.
04.07.02
Oxycodone
Pain
Green (see narrative)
Formulations :
  • Capsules
  • Oral solution
ASPH
RSFT
SASH
SABP
Primary Care
Guidelines BNF SPC
CD
Important
For patients unable to tolerate / poor response to morphine. Modified-release preparations to be prescribed by brand
04.07.02
Tramadol hydrochloride
Pain
Green (see narrative)
Formulations :
  • Capsules
ASPH
RSFT
SASH
SABP
Primary Care
Guidelines BNF SPC
CD
Important
Consider use where maximum tolerated doses of codeine / dihydrocodeine are ineffective.
04.07.02
Buprenorphine
Pain
Green (see narrative)
Formulations :
  • Patches
ASPH
RSFT
SASH
SABP
Primary Care
Guidelines BNF SPC
CD
Important
Prescribe by brand. Care: available as 3-day, 4-day and 7-day patches. Refer to Trust / Primary Care Pharmacy advice for locally preferred brands
04.07.02
Oxycodone
Pain
Green (see narrative)
Formulations :
  • Modified release tablets
ASPH
RSFT
SASH
SABP
Primary Care
Guidelines BNF SPC
CD
Important
For use in patients where morphine sulfate is not suitable / not tolerated. Modified-release preparations to be prescribed by brand
04.07.02
Fentanyl
Pain
Blue
Formulations :
  • Patches
ASPH
RSFT
SASH
SABP
Primary Care
Guidelines BNF SPC
CD
Important
Prescribe by brand. Not for use in opioid naïve patients. Limited place in therapy - on specialist advice only
04.07.02
Buprenorphine
Pain
Blue
Formulations :
  • Sublingual tablets
ASPH
RSFT
SASH
SABP
Primary Care
Guidelines BNF SPC
CD
R
Important
Use in patients unable to tolerate oral medications or where morphine is contra-indicated
01.04.02
04.07.02
Codeine phosphate
Pain
Red
Formulations :
  • Injection
ASPH
RSFT
SASH
SABP
Primary Care
Guidelines BNF SPC
CD
04.07.02
Oxycodone
Pain
Red
Formulations :
  • Injection
ASPH
RSFT
SASH
SABP
Primary Care
Guidelines BNF SPC
CD
Important
Alternative for patients unable to tolerate / poor response to morphine. Care with dose conversion.
07.01.01
10.01.01
10.03.02
Ibuprofen
Pain
Red
Formulations :
  • Intravenous infusion
ASPH
RSFT
SASH
SABP
Primary Care
Guidelines BNF SPC
Important
Restricted for patients where an oral NSAID is not suitable.
04.07.02
Meptazinol hydrochloride
Pain
Red
Formulations :
  • Intramuscular injection (IM)
ASPH
RSFT
SASH
SABP
Primary Care
Guidelines BNF SPC
Important
Obstetric analgesia
04.07.02
Pethidine hydrochloride
Pain
Red
Formulations :
  • Injection
ASPH
RSFT
SASH
SABP
Primary Care
Guidelines BNF SPC
CD
Important
Acute pain, including obstetric analgesia
04.07.02
Diamorphine hydrochloride
Pain
Red
Formulations :
  • Injection
ASPH
RSFT
SASH
SABP
Primary Care
Guidelines BNF SPC
CD
Important
Limited stock - restrictions apply. Contact Pharmacy. Safety alert for High Dose
Methoxyflurane
Pain
Red
Formulations :
  • Inhalation
ASPH
RSFT
SASH
SABP
Primary Care
Guidelines BNF SPC
Important
Acute, trauma pain. RSCH - for use during removal of brachytherapy and transperineal prostate biopsies
04.07.02
Fentanyl
Pain
Red
Formulations :
  • Injection
ASPH
RSFT
SASH
SABP
Primary Care
Guidelines BNF SPC
CD
Important
See separate listing for use in assisted ventilation and anaesthesia
04.07.02
Pain
Red
Formulations :
  • Injection
  • Nasal spray
ASPH
RSFT
SASH
SABP
Primary Care
Guidelines BNF SPC
CD
Un
Important
100mcg in 2ml injection used intranasally in paediatrics for painful procedures.
04.07.02
Alfentanil hydrochloride
Pain
Red
Formulations :
  • Injection
ASPH
RSFT
SASH
SABP
Primary Care
Guidelines BNF SPC
CD
Important
See separate listings for palliative care and use in anaesthesia.
04.07.01
Paracetamol
Pain
Red
Formulations :
  • Intravenous infusion
ASPH
RSFT
SASH
SABP
Primary Care
Guidelines BNF SPC
SA
Important
Prescribe in milligrams for doses <1g. Review infusion prescriptions after 48-72 hours. Note risk of overdose with IV paracetamol.
04.07.02
Tramadol hydrochloride
Pain
Red
Formulations :
  • Injection
ASPH
RSFT
SASH
SABP
Primary Care
Guidelines BNF SPC
CD
04.07.01
Co-dydramol 20/500
Pain
Non Formulary
Formulations :
  • Tablets
ASPH
RSFT
SASH
SABP
Primary Care
Guidelines BNF SPC
Important
Fixed combinations are less preferred. The MHRA advises when prescribing dihydrocodeine with paracetamol, the tablet strength and dose must be clearly indicated
04.07.01
Co-dydramol 30/500
Pain
Non Formulary
Formulations :
  • Tablets
ASPH
RSFT
SASH
SABP
Primary Care
Guidelines BNF SPC
Important
Fixed combinations are less preferred. The MHRA advises when prescribing dihydrocodeine with paracetamol, the tablet strength and dose must be clearly indicated
04.07.02
Tramadol hydrochloride
Pain
Non Formulary
Formulations :
  • Oral solution
ASPH
RSFT
SASH
SABP
Primary Care
Guidelines BNF SPC
CD
04.07.02
Pain
Non Formulary
Formulations :
  • Oral drops
ASPH
RSFT
SASH
SABP
Primary Care
Guidelines BNF SPC
CD
04.07.02
Oxycodone with naloxone
Pain
Non Formulary
Formulations :
  • Not Specified
ASPH
RSFT
SASH
SABP
Primary Care
Guidelines BNF SPC
CD
04.07.02
Fentanyl
Pain
Non Formulary
Formulations :
  • Buccal tablets
  • Buccal/sublingual
  • Nasal spray
  • Sublingual tablets
  • Lozenges
ASPH
RSFT
SASH
SABP
Primary Care
Guidelines BNF SPC
NFD1
CD
Important
Immediate release fentanyl preparations are non-formulary for all pain indications EXCEPT for breakthrough pain in patients receiving opioid therapy for cancer pain.
04.07.03
04.07.04
04.08.01
Pregabalin
Pain
Non Formulary
Formulations :
  • Not Specified
ASPH
RSFT
SASH
SABP
Primary Care
Guidelines BNF SPC
NFD1
Important
Not for chronic or acute, non-malignant pain. See separate formulary entry for use in neuropathic pain
04.08.01
10.02.02
Cannabis (medicinal)
Pain
Non Formulary
Formulations :
  • Not Specified
ASPH
RSFT
SASH
SABP
Primary Care
Guidelines BNF SPC
NFD1
CD
U
04.07.02
Tramadol with paracetamol
Pain
Non Formulary
Formulations :
  • Not Specified
ASPH
RSFT
SASH
SABP
Primary Care
Guidelines BNF SPC
NFD1
CD
Sufentanil
Pain
Non Formulary
Formulations :
  • Sublingual tablets
ASPH
RSFT
SASH
SABP
Primary Care
Guidelines BNF SPC
NFD2
Co-proxamol (Dextropropoxyphene hydrochloride/para
Pain
Non Formulary
Formulations :
  • Not Specified
ASPH
RSFT
SASH
SABP
Primary Care
Guidelines BNF SPC
NFD1
U
Important
No longer licensed because of safety concerns, particularly toxicity in overdose.
04.07.03
04.07.04
04.08.01
Gabapentin
Pain
Non Formulary
Formulations :
  • Not Specified
ASPH
RSFT
SASH
SABP
Primary Care
Guidelines BNF SPC
NFD1
CD
Important
Not for chronic or acute, non-malignant pain. See separate formulary entry for use in neuropathic pain.
04.07.02
Pethidine hydrochloride
Pain
Non Formulary
Formulations :
  • Tablets
ASPH
RSFT
SASH
SABP
Primary Care
Guidelines BNF SPC
CD
04.07.02
Meptazinol hydrochloride
Pain
Non Formulary
Formulations :
  • Tablets
ASPH
RSFT
SASH
SABP
Primary Care
Guidelines BNF SPC
Important
Tablets - Not for chronic or acute, non-malignant pain. Intramuscular injection used in obstetric pain.
04.07.02
Papaveretum
Pain
Non Formulary
ASPH
RSFT
SASH
SABP
Primary Care
Guidelines BNF SPC
04.07.02
Tramadol with Dexketoprofen
Pain
Non Formulary
Formulations :
  • Not Specified
ASPH
RSFT
SASH
SABP
Primary Care
Guidelines BNF SPC
02.09.00
04.07.01
Aspirin
Pain
Non Formulary
ASPH
RSFT
SASH
SABP
Primary Care
Guidelines BNF SPC
Important
This status applies to the use of aspirin for pain. Refer to separate formulary entries for caridology indications.
 

For information about the icons and status values within this site, please refer to the keys below.

Icon/Links Key

NFD1
Non formulary
NFD2
Not assessed for formulary status. Apply to APC / DTC before use.
CD
Controlled drug. Prescribing and/or storage requirements may apply
R
Restrictions apply
SA
Safety Alert
U
Unlicensed - no UK marketing license in place
Un
Off-label use. Not licensed for this indication.
NHSE
Treatment commissioned by NHS England
CDF
CDF
ICB
Treatment commissioned by the ICB
BlueTeq
BlueTeq form to be completed
NICE
NICE

Traffic Light Status Key

Red
Specialist ONLY drugs - treatment initiated and continued by specialist clinicians
Amber
Prescribing initiated and stabilised by specialist but has potential to transfer to primary care under a formal shared care agreement
Green
GPs (or non-medical prescribers in primary care) are able to take full responsibility for initiation and continuation of prescribing.
Black
Now referred to as "Non Formulary" but some BLACK drugs remain pending review. Not recommended for use in any health setting across Surrey and NW Sussex health economy.
Amber Star
Now referred to as "Blue" but some Amber Star drugs remain pending review. Prescribing initiated and stabliised by specialist but has potential to transfer to primary care WITHOUT a formal shared care agreement. Please note that in some circumstances a specialist may recommend that prescribing can be started in primary care.
Green (see narrative)
GPs (or non-medical prescribers in primary care) are able to take full responsibility for initiation and continuation of prescribing. Please refer to the narrative on the Drug Profile page where additional information may be conveyed as to the place in therapy or restrictions for use that have been locally agreed.
Non Formulary
Not recommended for use in any health setting across Surrey and NW Sussex health economy. (Formerly BLACK traffic light status)
See Below
Please add a description.
N/A
Please add a description.
Blue
Prescribing initiated and stabilised by specialist but has potential to transfer to primary care WITHOUT a formal shared care agreement. Please note that in some circumstances a specialist may recommend that prescribing can be started in primary care.
Green - Black
Now referred to as "Do not initiate in new patients" but some GREEN/BLACK drugs remain pending review. These drugs are NOT for new initiations (BLACK, (now referred to as Non Formulary)) but prescribing for existing patients may continue (GREEN). Please refer to the narrative on the Drug Profile page for further information if required.
See narrative
See narrative - is applied in instances where there may be more than one traffic light status for a drug. This occurs when the traffic light status may differ between specific cohorts of patients e.g. those of childbearing potential and those who are not (in the case of sodium valproate)
Do not initiate in new patients
These drugs are NOT for new initiations (Non Formulary) but prescribing for existing patients may continue (GREEN). Please refer to the narrative on the Drug Profile page for further information if required. (Formerly GREEN/BLACK traffic light status)
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