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A
Step 1: Use a licensed medicine in a
suitable formulation (incl change to Step 2: Use a licensed medicine in an Step 3: LAST RESORT: Use an
Drug
different drug in same therapeutic unlicensed manner unlicensed special
class)
Acetylcysteine Eye Drops 5% Available from Moorfields
Preservative Free
Allopurinol Crush tablets and mix with water. Give Liquid Special
immediately.
Amiloride HCI Crush tablets and disperse in water. Give Liquid Special 5mg/5ml
immediately.
Amiodarone No licensed solution Crush tablets and disperse in water, fruit Liquid special suspensions of varying
juice or jam (to mask bitter taste). Give strength to suit dose required.
immediately
Amisulpride LICENSED liquid available (Solian ®) Unlikely to need: licensed products
available
Amitriptyline LICENSED liquid formulations of varying No suggestions. Unlikely to need to do Unlikely to need: licensed products
strengths available. this available
Amlodipine No licensed solution Crush tablets and disperse in water. Use Liquid special suspensions of varying
immediately as light sensitive strength to suit dose required. 5mg/5ml &
10mg/5ml SUSPENSION included in Part
VIIIB of Drug Tariff from November 2011
Atorvastatin Consider switching to simvastatin: Crush
simvastatin tablets and disperse in water.
Give immediately (light sensitive).
Atorvastatin can be crushed and mixed
with water but not very soluble; residue
left so incomplete dosing and may block
tubes
Atropine Sulphate Eye Drops LICENSED product available from Unlikely to need: licensed preparation
1% Martindale available
Azathioprine No - Cytotoxic drug DO NOT CRUSH 50mg/5ml SUSPENSION included in Part
VIIIB of Drug Tariff from November 2011.
NB: Carers handling the suspension
should wear gloves in case of contact
with the medication
B
Step 1: Use a licensed medicine in a
suitable formulation (incl change to Step 2: Use a licensed medicine in an Step 3: LAST RESORT: Use an
Drug
different drug in same therapeutic unlicensed manner unlicensed special
class)
Bendroflumethazide No licensed solution Crush tablets and mix with water. Give Liquid special suspensions of varying
immediately. strength to suit dose required. 2.5mg/5ml
SUSPENSION included in Part VIIIB of
Drug Tariff from November 2011
Bisacodyl LICENSED suppositories available Unlikely to need: licensed products
available
Bisoprolol Consider switching to alternative Crush tablets finely and mix with water. Liquid special suspensions of varying
betablocker: atentolol (available as Give immediately strength to suit dose required.
LICENSED liquid)
C
Step 1: Use a licensed medicine in a
suitable formulation (incl change to Step 2: Use a licensed medicine in an Step 3: LAST RESORT: Use an
Drug
different drug in same therapeutic unlicensed manner unlicensed special
class)
Calcium Carbonate LICENSED preparations available (Cacit Unlikely to need: licensed products
effervescent tablets and calcichew available
chewable tablets).
Captopril No licensed solution. Captopril tablets: Crush and disperse in Liquid special suspensions of varying
water. Captopril tablets have been given strength to suit dose required. 5mg/5ml
sublingually. To use this route the dose SOLUTION included in Part VIIIB of Drug
should be halved and given twice as Tariff from November 2011
frequently (i.e. 25mg twice daily becomes
12.5mg four times daily. Monitor blood
pressure.
Carbamazepine LICENSED preparations available (liquid,
chewtabs and suppositories).
Carbimazole No Crush tablets and disperse in water. Give
immediately.
Carvedilol Crush tablets and disperse in water. Give
immediately.
Chloral Hydrate NB: drug considered less suitable fro Liquid special suspensions of varying
prescribing. Consider LICENSED Chloral strength to suit dose required. 500mg/5ml
Hydrate 143.3mg/5ml Elixir or switching mixture BP 2000 included in Part VIIIB of
to Triclofos elixir (know to have less GI Drug Tariff from November 2011
disturbance than chloral hydrate)
Chlorothiazide Crush tablets and disperse in water.
Chlorpromazine LICENSED oral solutions available Contact sensitisation: do NOT crush Unlikely to need: licensed products
tablets available
Clindamycin Open capsule and disperse contents in
water or mix with grape juice or maple
syrup (to mask unpleasant taste). Give
immediately
Clobazam No licensed solution Crush tablets and mix with water. Give Liquid special suspensions of varying
immediately. NB: tablets taste unpleasant strength to suit dose required. 5mg/5ml &
10mg/5ml solution & suspension included
in Part VIIIB of Drug Tariff from
November 2011
Clomipramine HCI Consider switching to alternative : Open capsule and disperse contents in
amytriptyline, lofepramine, trazodone water. DO NOT Crush the MR tablets.
(available as LICENSED liquids)
Clonazepam No licensed solution Disperse tablets in at least 30mls of water Liquid special suspensions of varying
strength to suit dose required.
500microg/5ml solution & suspension
included in Part VIIIB of Drug Tariff from
November 2011
Coal Tar Paste Consider switching to LICENSED,
commercially available coal tar
preperation if appropriate e.g Carbo-
Dome (coal tar 10%). Cocois scalp
ointment (Coal Tar 12%, Salicylic acid
2%, precipitated sulphur 4%), Psoriderm
cream (coal tar 6%, Lecithin 0.4%)
Coal tar soln 5% Betameth Val. Consider Alphsol HC (coal tar 5%,
0.25% Oint hydrocortisone 0.5%, allantoin 2%)
Co-careldopa Consider switching to LICENSED Co- Crush co-careldopa tablets and disperse Liquid special suspensions of varying
beneldopa - capsules/dispersible tablets. in water. Give immediately as drug will strength to suit dose required.
(GP would need to instigate this change) oxidise. Do NOT crush MR tablets
Co-dydramol Consider switching to co-codamol No suggestions Liquid special suspensions of varying
effervescent tablets or paracetamol strength to suit dose required.
(available as soluble tablets, suspension 10mg/500mg/5ml suspension included in
and suppositories) (with or without Part VIIIB of Drug Tariff from November
dihydrocodeine). 2011
Colecal Not normally initiated in Primary Care, requests from secondary care should be reviewed and refered back to secondary care for
Cyclizine CCI Consider switching to alternative anti- Crush tablets and disperse in water.
emetic: metoclopramide or domperidone Protect from light. Bitter taste
(available as LICENSED liquids)
D
Step 1: Use a licensed medicine in a
suitable formulation (incl change to Step 2: Use a licensed medicine in an Step 3: LAST RESORT: Use an
Drug
different drug in same therapeutic unlicensed manner unlicensed special
class)
Dantrolene No licensed solution Open capsule and disperse contents in Liquid special suspensions of varying
water or mix with orange juice. Give strength to suit dose required.
immediately
Dexamethasone LICENSED liquid available Crush tablets and disperse in water. Unlikely to need: licensed products
available
Diazepam LICENSED preparations available (liquid, Unlikely to need: licensed products
rectal tubes and suppositories). available
Diclofenac LICENSED suppositories and dispersible Unlikely to need: licensed products
tablets available available
Diltiazem No licensed solution For non-MR tablets: crush & disperse
(60mg tablets) Do NOT crush MR
tablets. For MR Capsules: Open
capsules and mix with soft food but DO
NOT crush contents
Diltiazem Hcl For anal fissures consider switching to
Cream/Gel/Ointment 2% licensed Glyceryl trinitrate ointment 0.4%
(Rectogesic)
Dipyridamole LICENSED tablets and suspension Dipyridamole suspension and ordinary Unlikely to need: licensed products
available. If post ischaemic stroke tablets are not licensed for use post available
consider switching to clopidogrel which stroke. (Evidence suggests ineffective).
can be crushed and mixed with water for Open the MR capsules and mix contents
administration (remember to stop aspirin). with water or soft food but DO NOT crush
contents
Dosulepin Dosulepin is no longer recommended for
the treatment of depression due to the
high risk of fatality in overdose and
increased cardiac toxicity. Consider
switching to alternative tricyclic
antidepressant. LICENSED amitriptyline
liquid
E
Step 1: Use a licensed medicine in a
suitable formulation (incl change to Step 2: Use a licensed medicine in an Step 3: LAST RESORT: Use an
Drug
different drug in same therapeutic unlicensed manner unlicensed special
class)
Enalapril No licensed solution Crush tablets and disperse in water. Give Liquid special suspensions of varying
immediately. Possible bitter aftertaste. strength to suit dose required.
Ergocalciferol Not normally initiated in primary care,
requests from secondary care should be
reviewed and referred back to secondary
care if monitoring or follow up is unclear.
Maintenance doses can be purchased
OTC by patients.
F
Step 1: Use a licensed medicine in a
suitable formulation (incl change to Step 2: Use a licensed medicine in an Step 3: LAST RESORT: Use an
Drug
different drug in same therapeutic unlicensed manner unlicensed special
class)
Ferrous Sulphate - paediatric Consider switching to LICENSED Unlikely to need: licensed products
oral solution Ironorm, fersamal, sytron or galfer available
Flecainide Crush tablets and disperse in de-ionised
water (do not use tap water). May have a
local anaesthetic effect on the tongue.
Use with care
Fludrocortisone Acetate Crush tablets and disperse in water. Give
immediately.
Fluoxetine LICENSED liquid available. Unlikely to need: licensed products
available
Folic Acid LICENSED syrup available (Lexpec Crush tablets and disperse in water. Give Unlikely to need: licensed products
2.5mg/5ml). immediately. available
Furosemide LICENSED liquids available: 20mg/5ml, Unlikely to need: licensed products
40mg/5ml (sugar-free) and 50mg/5ml NB: available
Some brands contain alcohol)
G
Step 1: Use a licensed medicine in a
suitable formulation (incl change to Step 2: Use a licensed medicine in an Step 3: LAST RESORT: Use an
Drug
different drug in same therapeutic unlicensed manner unlicensed special
class)
Gabapentin No Open capsule and dissolve contents in Liquid special suspensions of varying
water or fruit juice or sprinkle onto food strength to suit dose required. 250mg/5ml
(to mask bitter taste). Use immediately as solution & suspension included in Part
drug is rapidly hydrolysed VIIIB of Drug Tariff from November 2011
Ganciclovir eye gel RED Drug - consider referral back to specialist.
Gilbenclamide Crush tablets and mix with water.
Gliclazide For non-MR tablets: Crush well and mix 80mg/5ml SUSPENSION included in Part
with water or orange juice. VIIIB of Drug Tariff from November 2011
Glucose in Glycerol Nasal Glycerdex (LICENSED product) available Unlikely to need: licensed products
Drops available
Glyceryl Trinitrate Ointment For anal fissures consider LICENSED
glyceryl trinitrate ointment 0.4%
(Rectogesic)
Glycopyrronium bromide No licensed solution. Consider switching Liquid special suspensions of varying
to hyoscine hydrobromide patches if strength to suit dose required. 1mg/5ml
appropriate. oral suspension & solution included in
Part VIIIB of Drug Tariff from November
2011
Griseofulvin LICENSED solution available. Unlikely to need: licensed products
Fluconazole also available as a available
LICENSED liquid
H
Step 1: Use a licensed medicine in a
suitable formulation (incl change to Step 2: Use a licensed medicine in an Step 3: LAST RESORT: Use an
Drug
different drug in same therapeutic unlicensed manner unlicensed special
class)
Haloperidol LICENSED liquids available: 1mg/ml & Open capsule and disperse contents in Unlikely to need: licensed products
2mg/ml water. available
Hydrocortisone Crush tablets and disperse in water (NB:
insoluble)
Hydroxychloroquine Crush tablets and mix with water.
Hyoscine Hydrobromide Consider switching to hyoscine Tablets may be sucked or dispersed in
hydrobromide (Scopoderm) 1.5mg patch water. NB: absorption variable.
if appropriate.
Hypromellose eye drops Use 0.3% as LICENSED preparations Unlikely to need: licensed products
available. If preservative free required, available
Hydromoor hypromellose 0.3% single
dose are available
I
Step 1: Use a licensed medicine in a
suitable formulation (incl change to Step 2: Use a licensed medicine in an Step 3: LAST RESORT: Use an
Drug
different drug in same therapeutic unlicensed manner unlicensed special
class)
Imipramine HCI Crush tablets and mix with water. Liquid special suspensions of varying
strength to suit dose required.
Indometacin LICENSED suppositories available. DO NOT crush tablets or open capsules: Unlikely to need: licensed products
Consider switching to paracetamol irritant. available
(available as soluble tablets, suspension
and suppositories) or an alternative
NSAID (ibuprofen suspension
100mg/5ml, diclofenac soluble tablets or
suppositories).(NB: consider GI/CV safety
of different NSAIDs)
Irbesartan No licensed solution Crush tablets and mix with water for Liquid special suspensions of varying
immediate oral administration strength to suit dose required.
K
Step 1: Use a licensed
medicine in a suitable Step 2: Use a licensed
Step 3: LAST RESORT:
Drug formulation (incl change to medicine in an unlicensed
Use an unlicensed special
different drug in same manner
therapeutic class)
Ketamine RED Drug - consider referral back to specialist.
L
Step 1: Use a licensed medicine in a
suitable formulation (incl change to Step 2: Use a licensed medicine in an Step 3: LAST RESORT: Use an
Drug
different drug in same therapeutic unlicensed manner unlicensed special
class)
Levomepromazine Crush tablets and disperse in water. 25mg
tablets are quarter scored scored and can
be split if the patient or carer is able.
Ensure directions are clearly explained to
patient.
Levothyroxine LICENSED liquid formulations of varying Crush tablets and mix with water. Unlikely to need: licensed products
strengths available. Monitor thyroid available
function.
Lidocaine gel LICENSED 5% ointment available or
consider switch to Emla cream (lidocaine
2.5% & prilocaine 2.5%)
Lisinopril Lisiniopril: Crush tablets and disperse in Liquid special suspensions of varying
water. Ramipril: Open capsule and place strength to suit dose required. 5mg/5ml
contents directly into the mouth or onto solution & suspension included in Part
bread or disperse in water or mix with VIIIB of Drug Tariff from November 2011.
apple juice or apple sauce (to mask NB: liquid absorbed less than tablets:
unpleasant taste). Give immediately monitor BP if switching formulations
Lofepramine LICENSED liquid available. Unlikely to need: licensed products
available
Loperamide LICENSED liquid available. Tablets can be crushed and mixed with Unlikely to need: licensed products
water for administration. As a last resort, available
capsules can be opened and dispersed in
water
Lorazepam Consider switching to diazepam if Crush tablets and mix with water. Give Liquid special suspensions of varying
appropriate: LICENSED liquid available. immediately. Tablets may be given strength to suit dose required. 1mg/5ml &
sublingually if patient has sufficiently 500microg/5ml solution & suspension
moist mouth included in Part VIIIB of Drug Tariff from
November 2011
Losartan LICENSED liquid available: 12.5mg/5ml Losartan: Crush tablets and disperse in
or consider switching to alternative ACEI water. Ramipril: Open capsule and place
contents directly into the mouth or onto
bread or disperse in water or mix with
apple juice or apple sauce (to mask
unpleasant taste). Give immediately
M
Step 1: Use a licensed medicine in a
suitable formulation (incl change to Step 2: Use a licensed medicine in an Step 3: LAST RESORT: Use an
Drug
different drug in same therapeutic unlicensed manner unlicensed special
class)
Magnesium Glycerophosphate Magnaphate (magnesium
glycerophosphate 4 mmol (97mg Mg2+)
tablets available. May be chewed or
broken in half or quarters, or crush and
mix with water. LICENSED
Magnaspartate sachets (magnesium
ASPARTATE 10mmol Mg2+) also
available.
Mebeverine LICENSED liquid available. Crush tablets and disperse in water. Unlikely to need: licensed products
available
Melatonin Circadin 2mg MR is the only licensed A liquid special is available in a variety of
melatonin preparation in the UK and is strengths. 5mg/5ml solution & suspension
the preferred prescribing option. If an included in Part VIIIB of Drug Tariff from
immediate release formulation is needed November 2011. Alternatively, open NON-
consider bio-melatonin 3mg, licensed in MR capsules and mix contents with
the EU. See Shared care protocol. NB: water, milk, yoghurt or fruit juice.
Changing between immediate release
and modified release preparations is
not recommended without discussion
with the specialist.
Mercaptopurine No - Cytotoxic drug DO NOT OPEN
CAPSULES
Metformin LICENSED preparations available Unlikely to need: licensed products
(powder sachets and liquid). Contents of available
the sachet should be mixed with 150ml of
water. Give immediately
Methotrexate No - Cytotoxic drug DO NOT CRUSH
Methyldopa Crush tablets and mix with water. NB:
Tablets are film coated and not very
soluble
Metoprolol Consider switching to alternative For non-MR tablets: Crush and disperse
betablocker: atentolol (available as in water. NB: disperses very slowly.
LICENSED liquid) DO NOT Crush the MR tablets.
Metronidazole LICENSED liquid available. Unlikely to need: licensed products
available
Mexiletine Open capsule and mix contents with
distilled water. May taste unpleasant.
Midazolam for status Buccolam liquid available, LICENSED for Prescribe as EPISTATUS 10mg/ml in
epilepticus use in children ONLY. However, this line with the shared care agreement.
contains Midazolam hydrochloride and Please review quantities prescribed
care is needed when switching salt. (max 5ml per script).
Please continue to prescribe as
EPISTATUS as per shared care
Midodrine RED Drug - consider referral back to specialist.
Mirtazapine LICENSED preparations available Unlikely to need: licensed products
(solution and orodispersible tablets) available
Modafinil Crush tablets and mix with water. Give
immediately.
Morphine LICENSED preparations available Morphine sulphate MR capsules Unlikely to need: licensed products
(solution, sachets and suppositories) (zomorph): Open capsules but DO NOT available
crush contents
N
Step 1: Use a licensed medicine in a
suitable formulation (incl change to Step 2: Use a licensed medicine in an Step 3: LAST RESORT: Use an
Drug
different drug in same therapeutic unlicensed manner unlicensed special
class)
Naproxen Consider switching to paracetamol Crush tablets and disperse in water.
(available as soluble tablets, suspension
and suppositories) or an alternative
NSAID (ibuprofen suspension
100mg/5ml, diclofenac soluble tablets or
suppositories, indometacin
suppositories).(NB: consider GI/CV safety
of different NSAIDs)
Nifedipine Short acting formulations of nifedipine are Consider switching to amlodipine: crush
not recommended for angina or long term amlodipine tablets and disperse in water.
management of hypertension. Give immediately (light sensitive).
Nitrazepam LICENSED liquid available. Alternatively, Unlikely to need: licensed products
consider switching to temazepam available
(LICENSED liquid available)
Nitrofurantoin LICENSED liquid formulation available. For non-MR preparations, open capsules Unlikely to need: licensed products
or crush tablets and mix in water. Do available
NOT open MR capsules
Nystatin_Oral Susp LICENSED liquid formulation available. Unlikely to need: licensed products
100,000u/ml S/F available
O
Step 1: Use a licensed medicine in a
suitable formulation (incl change to Step 2: Use a licensed medicine in an Step 3: LAST RESORT: Use an
Drug
different drug in same therapeutic unlicensed manner unlicensed special
class)
Olanzapine LICENSED orodisperible tablets Unlikely to need: licensed products
available. Can be placed on the tongue or available
dispersed in water, orange juice, milk or
coffee. Olanzapine may be irritant to the
skin and eyes, so take precautions to
avoid contact (e.g. wear gloves).
Omeprazole LICENSED orodispersible tablets Liquid special suspensions of varying
available Disperse in water then mix with strength to suit dose required. 5mg/5ml,
other juice/yoghurt if flavouring required. 10mg/5ml & 20mg/5ml SUSPENSION
(unsuitable for administration via feeding included in Part VIIIB of Drug Tariff from
tubes. If administration via this route November 2011
required, consider switching to
lansoprazole orodispersible tablets).
Oxybutynin LICENSED patches available For non-MR tablets: Crush and mix with
water. Do NOT crush MR tablets
P
Step 1: Use a licensed medicine in a
suitable formulation (incl change to Step 2: Use a licensed medicine in an Step 3: LAST RESORT: Use an
Drug
different drug in same therapeutic unlicensed manner unlicensed special
class)
Paracetamol LICENSED preparations available Unlikely to need: licensed products
(soluble tablets (NB: Sodium content), available
suspension and suppositories).
Penicillamine Crush tablets and mix with water. Give
immediately.
Perindopril Consider switching to alternative ACEI. Perindopril erbumine: Crush tablets and
mix with water. (NB: perindopril erbumine
2mg ~ 2.5mg perindopril arginine)
Ramipril: Open capsule and place
contents directly into the mouth or onto
bread or disperse in water or mix with
apple juice or apple sauce (to mask
unpleasant taste). Give immediately
Phenobarbitone Consider licensed 15mg/5ml elixir (NB Crush tablets and mix with water. Liquid special suspensions of varying
Contains 38% alcohol) strength to suit dose required. If for
children, prescribe as 50mg/5ml (RDH) or
25mg/5ml (nottingham hospitals) alchol
and sugar free
Phenytoin LICENSED preparations available (liquid 90mg/5ml SUSPENSION included in Part
and chewable tablets). Care is needed VIIIB of Drug Tariff from November 2011
when switching between different
phenytoin preparations
Pilocarpine HCl_Eye Dps 0.5% Available from Moorfields
P/F
Potassium Chloride LICENSED preparations available: Sando Do not crush Slow K which are modified Unlikely to need: licensed products
K effervescent tablets; Kay-Cee-L liquid release. available
(dilute before use).
Pravastatin Crush tablets and disperse in water.
Prednisolone Sod Phos_Eye LICENSED 0.5% and 1% available.
Dps Confirm strength required if different
requested by specialist
Primidone LICENSED 50mg and 250mg tablets Crush tablets (50mg and 250mg tablets Unlikely to need: licensed products
available available) and disperse in water. available
Probenecid Crush tablets and disperse in water.
Procyclidine LICENSED liquid formulations available. Unlikely to need: licensed products
available
Propranolol LICENSED liquid formulations available. Unlikely to need: licensed products
available
Pyridostigmine Bromide Crush tablets and mix with water.
Pyridoxine HCl Crush tablets and mix with water.
Pyrimethamine Crush tablets and mix with water or fruit
juice.
Q
Step 1: Use a licensed medicine in a
suitable formulation (incl change to Step 2: Use a licensed medicine in an Step 3: LAST RESORT: Use an
Drug
different drug in same therapeutic unlicensed manner unlicensed special
class)
Quetiapine No licensed solution For non-MR tablets: Crush and mix with Liquid special suspensions of varying
water or add to soft food (eg yoghurt) (to strength to suit dose required.
mask bitter taste). Give immediately. Do 12.5mg/5ml SUSPENSION included in
NOT crush MR tablets Part VIIIB of Drug Tariff from November
2011
R
Step 1: Use a licensed medicine in a
suitable formulation (incl change to Step 2: Use a licensed medicine in an Step 3: LAST RESORT: Use an
Drug
different drug in same therapeutic unlicensed manner unlicensed special
class)
Ramipril No licensed solution Open capsule and place contents directly Liquid special suspensions of varying
into the mouth or onto bread or disperse strength to suit dose required. 2.5mg/5ml
in water or mix with apple juice or apple & 5mg/5ml solution & suspension
sauce (to mask unpleasant taste). Give included in Part VIIIB of Drug Tariff from
immediately November 2011
Ranitidine LICENSED preparations available: liquid Unlikely to need: licensed products
and effervescent tablets available
S
Step 1: Use a licensed medicine in a
suitable formulation (incl change to Step 2: Use a licensed medicine in an Step 3: LAST RESORT: Use an
Drug
different drug in same therapeutic unlicensed manner unlicensed special
class)
Sertraline Consider switching to alternative SSRI. Crush tablets and disperse in water or mix Liquid special suspensions of varying
Fluoxetine (available as LICENSED with food. Give immediately. NB: tablets strength to suit dose required. 50mg/5ml
liquid) or citalopram (available as taste bitter and have an anaesthetic effect SUSPENSION included in Part VIIIB of
LICENSED oral drops) on the tongue so care should be taken Drug Tariff from November 2011
with hot meals after administration.
Sildenafil Crush tablets and disperse in water.
Simvastatin Suspension not cost-effective; consider if Crush tablets and disperse in water. Give
still clinically appropriate immediately (light sensitive).
Sodium Bicarbonate Open capsules and mix contents with Consider Sodibic (sodium bicarbonate)
water 420mg/5ml oral solution, available from
Arjun
Sodium Chloride liquid Consider Sodi Chlor 1mmol/ml (8.4%) or
Sodi Chlor 5mmol/ml (29.5%) available
from Arjun
Sodium chloride for inhalation Consider switching to Nebusal 7%
Sodium chloride 5% Available from Moorfields. Lasts 7 days
Preservative Free Drops after opening. Included in Part VIIIB of
Drug Tariff from November 2011
Sodium Chloride Eye Drops Minims sodium chloride are available.
0.9% Preservative Free May not be cost-effective depending on
amount used and frequency of
administration.
Sodium Chloride Eye Ointment Available from Moorfields. Lasts 28 days
5% after opening.
Sodium Valproate LICENSED preparations available (liquid Unlikely to need: licensed products
and crushable tablets) (crush tablets and available
mix with water or soft food (eg yoghurt or
jam) (to mask bitter taste))
Sotalol Consider switching to alternative Crush tablets and mix with water Unlikely to need: licensed products
betablocker: atentolol or propranolol available
(available as licensed liquids)
Spironolactone Crush tablets and disperse in water. Liquid special suspensions of varying
strength to suit dose required. 25mg/5ml
& 50mg/5ml SUSPENSION included in
Part VIIIB of Drug Tariff from November
2011
T
Step 1: Use a licensed medicine in a
suitable formulation (incl change to Step 2: Use a licensed medicine in an Step 3: LAST RESORT: Use an
Drug
different drug in same therapeutic unlicensed manner unlicensed special
class)
Tamoxifen LICENSED liquid formulation available. Unlikely to need: licensed products
available
Terbinafine Crush tablets and mix with water.
Thiamine Crush tablets and disperse in water.
Thioridazine Review continuing need Some brands of thioridazine tablets will
disperse in water, others will not.
Tizanidine Crush tablets and mix with water.
Topiramate LICENSED sprinkle capsules available Crush tablets and disperse in water (NB Unlikely to need: licensed products
(sprinkle contents on food or mix with bitter taste) available
water)
Tranexamic acid No licensed solution Crush tablets and mix with water. Give Liquid special suspensions of varying
immediately strength to suit dose required
Trihexyphenidyl HCL LICENSED liquid formulation available Unlikely to need: licensed products
available
U, V, W & Z
Step 1: Use a licensed medicine in a
suitable formulation (incl change to Step 2: Use a licensed medicine in an Step 3: LAST RESORT: Use an
Drug
different drug in same therapeutic unlicensed manner unlicensed special
class)
Urea_Oint 25% Consider Flexitol / Dermatonics heel balm
(Urea 25% balm)
Ursodeoxycholic Acid LICENSED liquid available Crush tablets and mix with water. Unlikely to need: licensed products
available
Valproic Acid Consider switching to LICENSED Epilim
liquid 200mg/5ml. NB: there are
pharmacokinetic differences; take care
when switching.
Vancomycin Injection can be diluted with 30ml water
and used orally
Venlafaxine No licensed solution For non MR tablets: crush and mix with Liquid special suspensions of varying
water or jam. MR capsules: Open capsule strength to suit dose required
and mix with smooth food eg yoghurt. NB:
DO NOT crush contents
Verapamil LICENSED liquid available For non-MR tablets: Crush and mix with Unlikely to need: licensed products
water. They have a bitter taste and local available
anaesthetic effect on the mouth. Do NOT
crush MR tablets or open the capsules.
Warfarin No licensed solution Crush tablets and mix with water. Monitor Liquid special suspensions of varying
INR closely if changing preparation strength to suit dose required
patients receive
Zopiclone Consider switching to temazepam Tablets UNSUITABLE for crushing or Liquid special suspensions of varying
(available as LICENSED liquid). NB: as dissolving strength to suit dose required.
this is a controlled drug, a GP should 3.75mg/5ml solution & suspension
instigate this change included in Part VIIIB of Drug Tariff from
November 2011
