Search This Blog

468x60.

728x90

 


Adult Advanced Life Support Algorithm

Reproduced with the kind permission of the Resuscitation Council (UK) from Resuscitation Guidelines, 2015

Medical emergencies in the community

Overview

Drug treatment outlined below is intended for use by

appropriately qualified healthcare professionals . Only

drugs that are used for immediate relief are shown; advice on

supporting care is not given. Where the patient’s condition

requires investigation and further treatment, the patient

should be transferred to hospital promptly.

Acute coronary syndromes

▶ ANGINA: UNSTABLE

Aspirin dispersible tablets p. 121 (75 mg, 300 mg)

BY MOUTH (DISPERSED IN WATER OR CHEWED)

▶ Adult: 300 mg

▶ PLUS

▶ EITHER Glyceryl trinitrate aerosol spray p. 218

(400 micrograms/metered dose)

SUBLINGUALLY

▶ Adult: 1–2 sprays, repeated as required

▶ OR Glyceryl trinitrate tablets (300 micrograms,

500 micrograms, 600 micrograms)

SUBLINGUALLY

▶ Adult: 0.3–1 mg, repeated as required

▶ MYOCARDIAL INFARCTION: NON-ST-SEGMENT ELEVATION

Treat as for Angina: unstable

▶ MYOCARDIAL INFARCTION: ST-SEGMENT ELEVATION

Aspirin dispersible tablets (75 mg, 300 mg)

BY MOUTH (DISPERSED IN WATER OR CHEWED)

▶ Adult: 300 mg

Glyceryl trinitrate aerosol spray (400 micrograms/metered

dose)

SUBLINGUALLY

▶ Adult: 1–2 sprays, repeated as required

▶ OR Glyceryl trinitrate tablets (300 micrograms,

500 micrograms, 600 micrograms)

SUBLINGUALLY

▶ Adult: 0.3–1 mg, repeated as required

Metoclopramide hydrochloride injection p. 432 (5 mg/mL)

BY INTRAVENOUS INJECTION

▶ Adult 18–19 years (body-weight up to 60 kg): 5 mg

▶ Adult 18–19 years (body-weight 60 kg and over): 10 mg

▶ Adult over 19 years: 10 mg

Diamorphine hydrochloride injection p. 456 (5 mg powder for

reconstitution)

BY SLOW INTRAVENOUS INJECTION (1–2 MG/MINUTE)

▶ Adult: 5 mg followed by a further 2.5–5 mg if necessary

▶ Elderly or frail patients, reduce dose by half

▶ OR Morphine sulfate injection p. 463 (10 mg/mL)

BY SLOW INTRAVENOUS INJECTION (1–2 MG/MINUTE)

▶ Adult: 5–10 mg followed by a further 5–10 mg if

necessary

▶ Elderly or frail patients: reduce dose by half

Oxygen, if appropriate

Airways disease, obstructive

▶ ASTHMA: ACUTE

Regard each emergency consultation as being for severe

acute asthma until shown otherwise; failure to respond

adequately at any time requires immediate transfer to

hospital

▶ EITHER Salbutamol aerosol inhaler p. 252

(100 micrograms/metered inhalation)

BY AEROSOL INHALATION VIA LARGE-VOLUME SPACER

(AND A CLOSE-FITTING FACE MASK IF CHILD UNDER 3 YEARS)

▶ Adult and child: 2–10 puffs each inhaled separately,

repeated every 10–20 minutes or as necessary

▶ OR Salbutamol nebuliser solution (1 mg/mL, 2 mg/mL)

BY INHALATION OF NEBULISED SOLUTION (VIA OXYGEN-DRIVEN

NEBULISER IF AVAILABLE)

▶ Child 4 years and below: 2.5 mg every 20–30 minutes

or as necessary

▶ Child 5–11 years: 2.5–5 mg every 20–30 minutes

or as necessary

▶ Child 12–17 years: 5 mg every 20–30 minutes

or as necessary

▶ Adult: 5 mg every 20–30 minutes or as necessary

▶ OR Terbutaline sulfate nebuliser solution p. 255 (2.5 mg/mL)

BY INHALATION OF NEBULISED SOLUTION (VIA OXYGEN-DRIVEN

NEBULISER IF AVAILABLE)

▶ Child 4 years and below: 5 mg every 20–30 minutes or as

necessary

▶ Child 5–11 years: 5–10 mg every 20–30 minutes or as

necessary

▶ Child 12–17 years: 10 mg every 20–30 minutes or as

necessary

▶ Adult: 10 mg every 20–30 minutes or as necessary

▶ PLUS (in all cases)

▶ EITHER Prednisolone tablets p. 678 (or prednisolone soluble

tablets) (5 mg)

BY MOUTH

▶ Child 11 years and below: 1–2 mg/kg (max. 40 mg) once

daily for up to 3 days or longer if necessary; if child has

been taking an oral corticosteroid for more than a few

days, give prednisolone 2 mg/kg (max. 60 mg) once

daily

▶ Child 12–17 years: 40–50 mg once daily for at least 5 days

▶ Adult: 40–50 mg once daily for at least 5 days

▶ OR Hydrocortisone p. 676 (preferably as sodium succinate)

BY INTRAVENOUS INJECTION

▶ Child 17 years and below: 4 mg/kg (max. 100 mg) every

6 hours until conversion to oral prednisolone is

possible; alternative dose if weight unavailable:

▶ Child 1 year and below: 25 mg

▶ Child 2–4 years: 50 mg

▶ Child 5–17 years: 100 mg

▶ Adult: 100 mg every 6 hours until conversion to oral

prednisolone is possible

High-flow oxygen should be given if available (via face mask

in children)

Monitor response 15 to 30 minutes after nebulisation; if any

signs of acute asthma persist, arrange hospital admission.

While awaiting ambulance, repeat nebulised beta2 agonist

(as above) and give with

Ipratropium bromide nebuliser solution p. 246

(250 micrograms/mL)

BY INHALATION OF NEBULISED SOLUTION (VIA OXYGEN-DRIVEN

NEBULISER IF AVAILABLE)

▶ Child 11 years and below: 250 micrograms, repeated every

20–30 minutes for the first 2 hours, then every

4–6 hours as necessary

▶ Child 12–17 years: 500 micrograms every 4–6 hours as

necessary

▶ Adult: 500 micrograms every 4–6 hours as necessary

▶ CROUP

Dexamethasone oral solution p. 675 (2 mg/5 mL)

BY MOUTH

▶ Child 1 month–2 years: 150 micrograms/kg as a single dose

Anaphylaxis

▶ ANAPHYLAXIS

Adrenaline/epinephrine injection p. 222 (1 mg/mL (1 in 1000))

BY INTRAMUSCULAR INJECTION

▶ Child 5 years and below: 150 micrograms (0.15 mL),

repeated every 5 minutes if necessary

▶ Child 6–11 years: 300 micrograms (0.3 mL), repeated every

5 minutes if necessary

▶ Child 12–17 years: 500 micrograms (0.5 mL), repeated

every 5 minutes if necessary; 300 micrograms (0.3 mL)

should be given if child is small or prepubertal

▶ Adult: 500 micrograms (0.5 mL), repeated every

5 minutes if necessary

High-flow oxygen and intravenous fluids should be given

as soon as available.

Chlorphenamine maleate injection p. 283

BY INTRAMUSCULAR OR INTRAVENOUS INJECTION

May help counter histamine-mediated vasodilation and

bronchoconstriction..

Hydrocortisone (preferably as sodium succinate)

BY INTRAVENOUS INJECTION

Has delayed action but should be given to severely affected

patients to prevent further deterioration.

Bacterial infection

▶ MENINGOCOCCAL DISEASE

Benzylpenicillin sodium injection p. 547 (600 mg, 1.2 g)

BY INTRAVENOUS INJECTION (OR BY INTRAMUSCULAR INJECTION IF

VENOUS ACCESS NOT AVAILABLE)

▶ Neonate: 300 mg

▶ Child 1 month–11 months: 300 mg

▶ Child 1–9 years: 600 mg

▶ Child 10–17 years: 1.2 g

▶ Adult: 1.2 g

NOTE A single dose should be given before urgent transfer to

hospital, so long as this does not delay the transfer.

▶ OR if history of allergy to penicillin

Cefotaxime injection p. 527 (1 g)

BY INTRAVENOUS INJECTION (OR BY INTRAMUSCULAR INJECTION IF

VENOUS ACCESS NOT AVAILABLE)

▶ Neonate: 50 mg/kg

▶ Child 1 month–11 years: 50 mg/kg (max. 1 g)

▶ Child 12–17 years: 1 g

▶ Adult: 1 g

NOTE A single dose can be given before urgent transfer to

hospital, so long as this does not delay the transfer.

▶ OR if history of immediate hypersensitivity reaction

(including anaphylaxis, angioedema, urticaria, or rash

immediately after administration) to penicillin or to

cephalosporins

Chloramphenicol injection p. 568 (1 g)

BY INTRAVENOUS INJECTION

▶ Child: 12.5–25 mg/kg

▶ Adult: 12.5–25 mg/kg

NOTE A single dose can be given before urgent transfer to

hospital, so long as this does not delay the transfer.

See also Central nervous system infections, antibacterial

therapy p. 511.

Hypoglycaemia

▶ DIABETIC HYPOGLYCAEMIA

Glucose or sucrose

BY MOUTH

▶ Adult and child over 2 years: approx. 10–20 g (110–220 mL

Lucozade ® Energy Original or 100–200 mL

Coca-Cola ®—both non-diet versions or

2–4 teaspoonfuls of sugar or 3–6 sugar lumps)

repeated after 10–15 minutes if necessary

▶ OR if hypoglycaemia unresponsive or if oral route

cannot be used

Glucagon injection p. 724 (1 mg/mL)

BY SUBCUTANEOUS OR INTRAMUSCULAR INJECTION

▶ Child body-weight up to 25 kg: 500 micrograms (0.5 mL)

▶ Child body-weight 25 kg and over: 1 mg (1 mL)

▶ Adult: 1 mg (1 mL)

▶ OR if hypoglycaemia prolonged or unresponsive to glucagon

after 10 minutes

Glucose intravenous infusion p. 1041 (10%)

BY INTRAVENOUS INJECTION INTO LARGE VEIN

▶ Child: 5 mL/kg (glucose 500 mg/kg)

Glucose intravenous infusion (20%)

BY INTRAVENOUS INJECTION INTO LARGE VEIN

▶ Adult: 50 mL

Seizures

▶ CONVULSIVE (INCLUDING FEBRILE) SEIZURES LASTING

LONGER THAN 5 MINUTES

▶ EITHER Diazepam rectal solution p. 343 (2 mg/mL, 4 mg/mL)

BY RECTUM

▶ Neonate: 1.25–2.5 mg, repeated once after

10–15 minutes if necessary

▶ Child 1 month–1 year: 5 mg, repeated once after

10–15 minutes if necessary

▶ Child 2–11 years: 5–10 mg, repeated once after

10–15 minutes if necessary

▶ Child 12–17 years: 10–20 mg, repeated once after

10–15 minutes if necessary

▶ Adult: 10–20 mg, repeated once after 10–15 minutes if

necessary

▶ Elderly: 10 mg, repeated once after 10–15 minutes if

necessary

▶ OR Midazolam oromucosal solution p. 340

BY BUCCAL ADMINISTRATION, REPEATED ONCE AFTER 10 MINUTES IF

NECESSARY

▶ Neonate: 300 micrograms/kg [unlicensed]

▶ Child 1–2 months: 300 micrograms/kg (max. 2.5 mg)

[unlicensed]

▶ Child 3 months–11 months: 2.5 mg

▶ Child 1–4 years: 5 mg

▶ Child 5–9 years: 7.5 mg

▶ Child 10–17 years: 10 mg

▶ Adult: 10 mg [unlicensed]

Approximate Conversions and Units

Conversion of pounds to kilograms

lb kg

1 0.45

2 0.91

3 1.36

4 1.81

5 2.27

6 2.72

7 3.18

8 3.63

9 4.08

10 4.54

11 4.99

12 5.44

13 5.90

14 6.35

Conversion of stones to kilograms

stones kg

1 6.35

2 12.70

3 19.05

4 25.40

5 31.75

6 38.10

7 44.45

8 50.80

9 57.15

10 63.50

11 69.85

12 76.20

13 82.55

14 88.90

15 95.25

Conversion from millilitres

to fluid ounces

mL fl oz

50 1.8

100 3.5

150 5.3

200 7.0

500 17.6

1000 35.2

Length

1 metre (m) = 1000 millimetres (mm)

1 centimetre (cm) = 10 mm

1 inch (in) = 25.4 mm

1 foot (ft) = 12 inches

12 inches = 304.8 mm

Mass

1 kilogram (kg) = 1000 grams (g)

1 gram (g) = 1000 milligrams (mg)

1 milligram (mg) = 1000 micrograms

1 microgram = 1000 nanograms

1 nanogram = 1000 picograms

Volume

1 litre = 1000 millilitres (mL)

1 millilitre (1 mL) = 1000 microlitres

1 pint ≈ 568 mL

Other units

1 kilocalorie (kcal) = 4186.8 joules (J)

1000 kilocalories (kcal) = 4.1868 megajoules (MJ)

1 megajoule (MJ) = 238.8 kilocalories (kcal)

1 millimetre of mercury (mmHg) = 133.3 pascals (Pa)

1 kilopascal (kPa) = 7.5 mmHg (pressure)

Plasma-drug concentrations

Plasma-drug concentrations in BNF publications are

expressed in mass units per litre (e.g. mg/litre). The

approximate equivalent in terms of amount of substance

units (e.g. micromol/litre) is given in brackets.

Prescribing for children:

weight, height, and gender

The table below shows the mean values for weight, height,

and gender by age; these values have been derived from the

UK-WHO growth charts 2009 and UK1990 standard centile

charts, by extrapolating the 50th centile, and may be used to

calculate doses in the absence of measurements. However,

an individual’s weight and height might vary considerably

from the values in the table and it is important to ensure that

the value chosen is appropriate. In most cases the actual

measurement should be obtained as soon as possible and the

dose re-calculated.

Age Weight (kg) Height (cm)

Full-term neonate 3.5 51

1 month 4.3 55

2 months 5.4 58

3 months 6.1 61

4 months 6.7 63

6 months 7.6 67

1 year 9 75

3 years 14 96

5 years 18 109

7 years 23 122

10 years 32 138

12 years 39 149

14 year old boy 49 163

14 year old girl 50 159

Adult male 68 176

Adult female 58 164

Recommended wording of cautionary and advisory labels

For details including Welsh Language translation see p. 1588

1 Warning: This medicine may make you sleepy

2 Warning: This medicine may make you sleepy. If this

happens, do not drive or use tools or machines. Do not

drink alcohol

3 Warning: This medicine may make you sleepy. If this

happens, do not drive or use tools or machines

4 Warning: Do not drink alcohol

5 Do not take indigestion remedies 2 hours before or after

you take this medicine

6 Do not take indigestion remedies, or medicines containing

iron or zinc, 2 hours before or after you take this medicine

7 Do not take milk, indigestion remedies, or medicines

containing iron or zinc, 2 hours before or after you take

this medicine

8 Warning: Do not stop taking this medicine unless your

doctor tells you to stop

9 Space the doses evenly throughout the day. Keep taking

this medicine until the course is finished, unless you are

told to stop

10 Warning: Read the additional information given with this

medicine

11 Protect your skin from sunlight—even on a bright but

cloudy day. Do not use sunbeds

12 Do not take anything containing aspirin while taking this

medicine

13 Dissolve or mix with water before taking

14 This medicine may colour your urine. This is harmless

15 Caution: flammable. Keep your body away from fire or

flames after you have put on the medicine

16 Dissolve the tablet under your tongue—do not swallow.

Store the tablets in this bottle with the cap tightly closed.

Get a new supply 8 weeks after opening

17 Do not take more than... in 24 hours

18 Do not take more than... in 24 hours. Also, do not take

more than... in any one week

19 Warning: This medicine makes you sleepy. If you still feel

sleepy the next day, do not drive or use tools or machines.

Do not drink alcohol

21 Take with or just after food, or a meal

22 Take 30 to 60 minutes before food

23 Take this medicine when your stomach is empty. This

means an hour before food or 2 hours after food

24 Suck or chew this medicine

25 Swallow this medicine whole. Do not chew or crush

26 Dissolve this medicine under your tongue

27 Take with a full glass of water

28 Spread thinly on the affected skin only

29 Do not take more than 2 at any one time. Do not take

more than 8 in 24 hours

30 Contains paracetamol. Do not take anything else

containing paracetamol while taking this medicine. Talk to

a doctor at once if you take too much of this medicine,

even if you feel well

32 Contains aspirin. Do not take anything else containing

aspirin while taking this medicine


Abbreviations and Symbols

Internationally recognised units and symbols are used in the

BNF publications where possible.

ACBS Advisory Committee on Borderline Substances, see

Borderline Substances

ACE Angiotensin-converting enzyme

ADHD Attention deficit hyperactivity disorder

AIDS Acquired immunodeficiency syndrome

approx. approximately

AV atrioventricular

AWMSG All Wales Medicines Strategy Group

BAN British Approved Name

BMI body mass index

BP British Pharmacopoeia 2013, unless otherwise stated

BPC British Pharmaceutical Codex 1973 and Supplement 1976,

unless otherwise stated

BRCA breast cancer gene

CAPD Continuous ambulatory peritoneal dialysis

a preparation in Schedule 1 of the Misuse of Drugs

Regulations 2001 (and subsequent amendments). For

regulations see Controlled drugs and drug dependence p. 8.

b preparation in Schedule 2 of the Misuse of Drugs

Regulations 2001 (and subsequent amendments). For

regulations see Controlled drugs and drug dependence p. 8.

c preparation in Schedule 3 of the Misuse of Drugs

Regulations 2001 (and subsequent amendments). For

d

regulations see Controlled drugs and drug dependence p. 8.

preparation in Schedule 4 (Part I) of the Misuse of Drugs

Regulations 2001 (and subsequent amendments). For

e

regulations see Controlled drugs and drug dependence p. 8.

preparation in Schedule 4 (Part II) of the Misuse of Drugs

Regulations 2001 (and subsequent amendments). For

regulations see Controlled drugs and drug dependence p. 8.

m preparation in Schedule 5 of the Misuse of Drugs

Regulations 2001 (and subsequent amendments). For

regulations see Controlled drugs and drug dependence p. 8.

CHM Commission on Human Medicines

CHMP Committee for Medicinal Products for Human Use

CNS central nervous system

CSM Committee on Safety of Medicines (now subsumed under

Commission on Human Medicines)

d. c. direct current

DMARD Disease-modifying antirheumatic drug

DPF Dental Practitioners’ Formulary

DT Drug Tariff price

e/c enteric-coated (termed gastro-resistant in BP)

ECG electrocardiogram

EEG electro-encephalogram

eGFR estimated glomerular filtration rate, see Prescribing in

renal impairment p. 19

f/c film-coated

FSRH Faculty of Sexual and Reproductive Healthcare

G6PD glucose 6-phosphate dehydrogenase

G general sales list

HDLcholesterol

high-density lipoprotein cholesterol

HIV Human immunodeficiency virus

HRT Hormone replacement therapy

i/m intramuscular

i/v intravenous

INR international normalised ratio

JCVI Joint Committee on Vaccination and Immunisation

LDLcholesterol

low-density lipoprotein cholesterol

MAOI Monoamine-oxidase inhibitor

max. maximum

MHRA Medicines and Healthcare products Regulatory Agency

m/r modified-release

NCL no cautionary labels (prescription endorsement made by

prescriber when recommended cautionary labels are not

required)

NHS National Health Service

NICE National Institute for Health and Care Excellence

NPF Nurse Prescribers’ Formulary

NSAID Non-steroidal anti-inflammatory drug

NSTEMI non-ST-segment elevation myocardial infarction

p pharmacy only medicine

PARP poly (ADP-ribose) polymerase

PGD patient group direction

PHE Public Health England (formerly Health Protection Agency

(HPA))

P prescription-only medicine, see Fig. 1 How to use BNF

publications ® trade mark

rINN Recommended International Non-proprietary Name

RSV respiratory syncytial virus

s/c sugar-coated

SLS Selected List Scheme

SMC Scottish Medicines Consortium

SPC Summary of Product Characteristics

spp. species

SSRI Selective serotonin reuptake inhibitor

STEMI ST-segment elevation myocardial infarction

UK United Kingdom

Units for SI units see Prescription writing p. 5

WHO World Health Organization

A limited experience of the use of this product and the MHRA

requests that all suspected adverse reactions should be

reported, see Adverse reactions to drugs p. 12

f drug-class monograph, see How to use BNF Publications,

p. xii

eiiF 1234i drug monograph has a corresponding drug-class

monograph; the page number of the class monograph is

indicated within the tab, see How to use BNF Publications,

g

p. xii

precedes evidence graded content, see How BNF

Publications are constructed p. ix

h to l symbols will be displayed – grades reflect the strengths of

recommendations in evidence graded content, see How

BNF Publications are constructed p. ix

s no price available

Latin abbreviations

Directions should be in English without abbreviation.

However, Latin abbreviations have been used when

prescribing.

The following is a list of appropriate abbreviations. It

should be noted that the English version is not always an

exact translation.

a. c. = ante cibum (before food)

b. d. = bis die (twice daily)

o. d. = omni die (every day)

o. m. = omni mane (every morning)

o. n. = omni nocte (every night)

p. c. = post cibum (after food)

p. r. n. = pro re nata (when required)

q. d. s. = quater die sumendum (to be taken four times daily)

q. q. h. = quarta quaque hora (every four hours)

stat = immediately

t. d. s. = ter die sumendum (to be taken three times daily)

t.i.d. = ter in die (three times daily)

E numbers

The following is a list of common E numbers and the inactive

ingredients to which they correspond.

E102 Tartrazine

E104 Quinoline Yellow

E110 Sunset Yellow FCF

E123 Amaranth

E124 Ponceau 4R

E127 Erythrosine BS

E132 Indigo Carmine

E142 Green S

E171 Titanium Dioxide

E172 Iron oxides, iron hydroxides

E200 Sorbic Acid

E211 Sodium Benzoate

E223 Sodium Metabisulfite

E320 Butylated Hydroxyanisole

E321 Butylated Hydroxytoluene

E322 Lecithins

E420 Sorbitol

E421 Mannitol

E422 Glycerol

E901 Beeswax (white and yellow)

E1520 Propylene Glycol

significant ocular viral infections . inflammatory ocular

conditions (no experience of use). narrow-angle glaucoma

(no experience of use). neovascular glaucoma (no

experience of use). predisposition to bradycardia . predisposition to hypotension . pseudophakia with torn

posterior lens capsule or anterior chamber lenses .risk

factors for cystoid macular oedema .risk factors for iritis . risk factors for uveitis

l SIDE-EFFECTS

▶ Common or very common Dry eye . eye discolouration . eye

discomfort. eye disorders . eye inflammation . headache . hypertension . hypertrichosis . skin reactions . vision

disorders

▶ Uncommon Asthenia . dizziness . madarosis . nausea . retinal haemorrhage

▶ Frequency not known Asthma . bradycardia . dyspnoea . hypotension .reactivation of infection

l PREGNANCY Manufacturer advises use only if potential

benefit outweighs risk.

l BREAST FEEDING Manufacturer advises avoid—present in

milk in animal studies.

l HEPATIC IMPAIRMENT Manufacturer advises use with

caution in moderate-to-severe impairment—no

information available.

l RENAL IMPAIRMENT Use with caution—no information

available.

l PRESCRIBING AND DISPENSING INFORMATION Although

multi-dose bimatoprost eye drops commonly contain

preservatives, preservative-free unit dose vials may be

available.

l PATIENT AND CARER ADVICE

Changes to eye colour Before initiating treatment, patients

should be warned of a possible change in eye colour as an

increase in the brown pigment in the iris can occur, which

may be permanent; particular care is required in those

with mixed coloured irides and those receiving treatment

to one eye only. Changes in eyelashes and vellus hair can

also occur, and patients should also be advised to avoid

repeated contact of the eye drop solution with skin as this

can lead to hair growth or skin pigmentation.

l NATIONAL FUNDING/ACCESS DECISIONS

LUMIGAN ®

Scottish Medicines Consortium (SMC) decisions

The Scottish Medicines Consortium has advised (March

2013) that bimatoprost 300 micrograms/mL preservativefree eye drops (Lumigan ® single-dose eye drops) are

accepted for restricted use within NHS Scotland for the

reduction of elevated intra-ocular pressure in chronic

open-angle glaucoma and ocular hypertension (as

monotherapy or as adjunctive therapy to beta-blockers) in

adults who have proven sensitivity to benzalkonium

chloride.

l MEDICINAL FORMS There can be variation in the licensing of

different medicines containing the same drug.

Eye drops

EXCIPIENTS: May contain Benzalkonium chloride

▶ Bimatoprost (Non-proprietary)

Bimatoprost 300 microgram per 1 ml Bimatoprost

300micrograms/ml eye drops | 3 ml P £10.30 DT = £10.30

▶ Eyreida (Aspire Pharma Ltd)

Bimatoprost 300 microgram per 1 ml Eyreida 0.3mg/ml eye drops

| 3 ml P £11.71 DT = £11.71

▶ Lumigan (Allergan Ltd)

Bimatoprost 100 microgram per 1 ml Lumigan 100micrograms/ml

eye drops | 3 ml P £11.71 DT = £11.71 | 9 ml P £35.13

Bimatoprost 300 microgram per 1 ml Lumigan 300micrograms/ml

eye drops 0.4ml unit dose | 30 unit dose P £13.75 DT = £13.75

▶ Sturiban (Actavis UK Ltd)

Bimatoprost 300 microgram per 1 ml Sturiban 0.3mg/ml eye drops

| 3 ml P £9.27 DT = £10.30 | 9 ml P £27.81

Bimatoprost with timolol

The properties listed below are those particular to the

combination only. For the properties of the components

please consider, bimatoprost above, timolol maleate p. 1180.

l INDICATIONS AND DOSE

Raised intra-ocular pressure in patients with open-angle

glaucoma or ocular hypertension when beta-blocker or

prostaglandin analogue alone not adequate

▶ TO THE EYE

▶ Adult: Apply once daily

l INTERACTIONS → Appendix 1: beta blockers, non-selective

l NATIONAL FUNDING/ACCESS DECISIONS

GANFORT ® SINGLE USE

Scottish Medicines Consortium (SMC) decisions

The Scottish Medicines Consortium has advised (October

2013) that Ganfort ® unit dose eye drops are accepted for

restricted use within NHS Scotland for the reduction of

intra-ocular pressure in patients with open-angle

glaucoma or ocular hypertension insufficiently responsive

to topical beta-blockers or prostaglandin analogues who

have proven sensitivity to preservatives.

l MEDICINAL FORMS There can be variation in the licensing of

different medicines containing the same drug.

Eye drops

EXCIPIENTS: May contain Benzalkonium chloride

▶ Ganfort (Allergan Ltd)

Bimatoprost 300 microgram per 1 ml, Timolol (as Timolol

maleate) 5 mg per 1 ml Ganfort 0.3mg/ml / 5mg/ml eye drops | 3 ml P £14.16 DT = £14.16 | 9 ml P £38.15

Ganfort 0.3mg/ml / 5mg/ml eye drops 0.4ml unit dose | 30 unit

dose P £17.94 DT = £17.94

Latanoprost

l INDICATIONS AND DOSE

Raised intra-ocular pressure in open-angle glaucoma |

Ocular hypertension

▶ TO THE EYE

▶ Adult: Apply once daily, to be administered preferably

in the evening

IMPORTANT SAFETY INFORMATION

MHRA/CHM ADVICE: LATANOPROST (XALATAN ®): INCREASED

REPORTING OF EYE IRRITATION SINCE REFORMULATION (JULY

2015)

Following reformulation of Xalatan ®, to allow for longterm storage at room temperature, there has been an

1184 Glaucoma and ocular hypertension BNF 78

Eye

11

increase in the number of reports of eye irritation from

across the EU. Patients should be advised to tell their

health professional promptly (within a week) if they

experience eye irritation (e.g. excessive watering) severe

enough to make them consider stopping treatment.

Review treatment and prescribe a different formulation

if necessary.

l CONTRA-INDICATIONS Active herpes simplex keratitis . history of recurrent herpetic keratitis associated with

prostaglandin analogues

l CAUTIONS Angle-closure glaucoma (no experience of use) . aphakia . asthma . chronic obstructive pulmonary disease . compromised respiratory function . congenital glaucoma

(no experience of use). contact lens wearers . do not use

within 5 minutes of thiomersal-containing preparations . history of significant ocular viral infections . inflammatory

ocular conditions (no experience of use). narrow-angle

glaucoma (no experience of use). neovascular glaucoma

(no experience of use). peri-operative period of cataract

surgery . pseudophakia with torn posterior lens capsule or

anterior chamber lenses .risk factors for cystoid macular

oedema .risk factors for iritis .risk factors for uveitis

l SIDE-EFFECTS

▶ Common or very common Eye discolouration . eye

discomfort. eye disorders . eye inflammation . vision

disorders

▶ Uncommon Dry eye .rash

▶ Rare or very rare Asthma . chest pain . dyspnoea . unstable

angina

▶ Frequency not known Arthralgia . dizziness . headache . myalgia . ophthalmic herpes simplex . palpitations

l PREGNANCY Manufacturer advises avoid.

l BREAST FEEDING May be present in milk—manufacturer

advises avoid.

l PRESCRIBING AND DISPENSING INFORMATION Although

multi-dose latanoprost eye drops commonly contain

preservatives, preservative-free unit dose vials may be

available.

l PATIENT AND CARER ADVICE

Changes in eye colour Before initiating treatment, patients

should be warned of a possible change in eye colour as an

increase in the brown pigment in the iris can occur, which

may be permanent; particular care is required in those

with mixed coloured irides and those receiving treatment

to one eye only. Changes in eyelashes and vellus hair can

also occur, and patients should also be advised to avoid

repeated contact of the eye drop solution with skin as this

can lead to hair growth or skin pigmentation.

l NATIONAL FUNDING/ACCESS DECISIONS

MONOPOST ®

Scottish Medicines Consortium (SMC) decisions

The Scottish Medicines Consortium has advised (June 2013)

that Monopost ® is accepted for restricted use within NHS

Scotland for the reduction of elevated intra-ocular

pressure in patients with open-angle glaucoma and ocular

hypertension who have proven sensitivity to

benzalkonium chloride.

l MEDICINAL FORMS There can be variation in the licensing of

different medicines containing the same drug.

Eye drops

EXCIPIENTS: May contain Benzalkonium chloride

▶ Latanoprost (Non-proprietary)

Latanoprost 50 microgram per 1 ml Latanoprost 50micrograms/ml

eye drops | 2.5 ml P £12.48 DT = £7.92

▶ Medizol (Medicom Healthcare Ltd)

Latanoprost 50 microgram per 1 ml Medizol 0.005% eye drops | 2.5 ml P s DT = £7.92

▶ Monopost (Thea Pharmaceuticals Ltd)

Latanoprost 50 microgram per 1 ml Monopost 50micrograms/ml

eye drops 0.2ml unit dose | 30 unit dose P £8.49 DT = £8.49 | 90 unit dose P £25.47 DT = £25.47

▶ Xalatan (Pfizer Ltd)

Latanoprost 50 microgram per 1 ml Xalatan 50micrograms/ml eye

drops | 2.5 ml P £12.48 DT = £7.92

Latanoprost with timolol

The properties listed below are those particular to the

combination only. For the properties of the components

please consider, latanoprost p. 1184, timolol maleate

p. 1180.

l INDICATIONS AND DOSE

Raised intra-ocular pressure in patients with open-angle

glaucoma and ocular hypertension when beta-blocker or

prostaglandin analogue alone not adequate

▶ TO THE EYE

▶ Adult: Apply once daily

l INTERACTIONS → Appendix 1: beta blockers, non-selective

l MEDICINAL FORMS There can be variation in the licensing of

different medicines containing the same drug.

Eye drops

EXCIPIENTS: May contain Benzalkonium chloride

▶ Latanoprost with timolol (Non-proprietary)

Latanoprost 50 microgram per 1 ml, Timolol (as Timolol maleate)

5 mg per 1 ml Latanoprost 50micrograms/ml / Timolol 5mg/ml eye

drops | 2.5 ml P £14.32 DT = £6.57

▶ Fixapost (Thea Pharmaceuticals Ltd)

Latanoprost 50 microgram per 1 ml, Timolol (as Timolol maleate)

5 mg per 1 ml Fixapost 50micrograms/ml / 5mg/ml eye drops 0.2ml

unit dose | 30 unit dose P £13.49

▶ Medox (Medicom Healthcare Ltd)

Latanoprost 50 microgram per 1 ml, Timolol (as Timolol maleate)

5 mg per 1 ml Medox 50micrograms/ml / 5mg/ml eye drops | 2.5 ml P s DT = £6.57

▶ Xalacom (Pfizer Ltd)

Latanoprost 50 microgram per 1 ml, Timolol (as Timolol maleate)

5 mg per 1 ml Xalacom eye drops | 2.5 ml P £14.32 DT = £6.57

Tafluprost

l INDICATIONS AND DOSE

Raised intra-ocular pressure in open-angle glaucoma |

Ocular hypertension

▶ TO THE EYE

▶ Adult: Apply once daily, to be administered preferably

in the evening

l CAUTIONS Angle-closure glaucoma (no experience of use) . aphakia . asthma . chronic obstructive pulmonary disease . compromised respiratory function . congenital glaucoma

(no experience of use). contact lens wearers . history of

significant ocular viral infections . inflammatory ocular

conditions (no experience of use). narrow-angle glaucoma

(no experience of use). neovascular glaucoma (no

experience of use). pseudophakia with torn posterior lens

capsule or anterior chamber lenses .risk factors for cystoid

macular oedema .risk factors for iritis .risk factors for

uveitis

l SIDE-EFFECTS

▶ Common or very common Dry eye . eye discolouration . eye

discomfort. eye disorders . eye inflammation . headache . vision disorders

▶ Uncommon Hypertrichosis

▶ Frequency not known Asthma exacerbated . dyspnoea

l PREGNANCY Manufacturer advises avoid unless potential

benefit outweighs risk—toxicity in animal studies.

BNF 78 Glaucoma and ocular hypertension 1185

Eye

11

l BREAST FEEDING Manufacturer advises avoid—present in

milk in animal studies.

l HEPATIC IMPAIRMENT Manufacturer advises caution (no

information available).

l RENAL IMPAIRMENT Use with caution—no information

available.

l PRESCRIBING AND DISPENSING INFORMATION Although

multi-dose tafluprost eye drops commonly contain

preservatives, preservative-free unit dose vials may be

available.

l PATIENT AND CARER ADVICE

Changes to eye colour Before initiating treatment, patients

should be warned of a possible change in eye colour as an

increase in the brown pigment in the iris can occur, which

may be permanent; particular care is required in those

with mixed coloured irides and those receiving treatment

to one eye only. Changes in eyelashes and vellus hair can

also occur, and patients should also be advised to avoid

repeated contact of the eye drop solution with skin as this

can lead to hair growth or skin pigmentation.

l MEDICINAL FORMS There can be variation in the licensing of

different medicines containing the same drug.

Eye drops

EXCIPIENTS: May contain Disodium edetate

▶ Saflutan (Santen UK Ltd)

Tafluprost 15 microgram per 1 ml Saflutan 15micrograms/ml eye

drops 0.3ml unit dose | 30 unit dose P £12.20 DT = £12.20

Tafluprost with timolol 30-Mar-2016

The properties listed below are those particular to the

combination only. For the properties of the components

please consider, tafluprost p. 1185, timolol maleate p. 1180.

l INDICATIONS AND DOSE

Raised intra-ocular pressure in open-angle glaucoma and

ocular hypertension when beta-blocker or prostaglandin

analogue alone not adequate

▶ TO THE EYE

▶ Adult: Apply 1 drop once daily

l INTERACTIONS → Appendix 1: beta blockers, non-selective

l PATIENT AND CARER ADVICE

Driving and skilled tasks Blurred vision may affect

performance of skilled tasks (e.g. driving or operating

machinery).

l NATIONAL FUNDING/ACCESS DECISIONS

Scottish Medicines Consortium (SMC) decisions

The Scottish Medicines Consortium has advised (September

2015) that Taptiqom® (tafluprost with timolol) is accepted

for restricted use within NHS Scotland, within the licensed

indications, in patients who have proven sensitivity to

preservatives.

l MEDICINAL FORMS There can be variation in the licensing of

different medicines containing the same drug.

Eye drops

EXCIPIENTS: May contain Disodium edetate

▶ Taptiqom (Santen UK Ltd)

Tafluprost 15 microgram per 1 ml, Timolol (as Timolol maleate)

5 mg per 1 ml Taptiqom 15micrograms/ml / 5mg/ml eye drops 0.3ml

unit dose | 30 unit dose P £14.50 DT = £14.50

Travoprost

l INDICATIONS AND DOSE

Raised intra-ocular pressure in open-angle glaucoma |

Ocular hypertension

▶ TO THE EYE

▶ Adult: Apply once daily, to be administered preferably

in the evening

l CAUTIONS History of significant ocular viral infections . angle-closure glaucoma (no experience of use). aphakia . asthma . chronic obstructive pulmonary disease . compromised respiratory function . congenital glaucoma

(no experience of use). contact lens wearers . inflammatory ocular conditions (no experience of use). narrow-angle glaucoma (no experience of use). neovascular glaucoma (no experience of use). pseudophakia with torn posterior lens capsule or anterior

chamber lenses .risk factors for cystoid macular oedema . risk factors for iritis .risk factors for uveitis

l SIDE-EFFECTS

▶ Common or very common Dry eye . eye discolouration . eye

discomfort. eye disorders

▶ Uncommon Cataract. cough . eye inflammation . hair

changes . headache . nasal complaints . palpitations . seasonal allergy . skin reactions .throat irritation . vision

disorders

No comments:

Post a Comment

اكتب تعليق حول الموضوع

mcq general

 

Search This Blog