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Home > Pharmacy Law and Ethics > Unlicensed and Off-Label Medicines

Unlicensed and Off-Label Medicines

General Pharmaceutical Council Guidance for Registered Pharmacies Preparing Unlicensed Medicines

This guidance should be followed if an unlicensed medicine is prepared in a registered pharmacy.

Source: pharmacyregulation.org
Pharmacy Resource: Guidance
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Last Checked: 29/05/14 Link Error: Report It

 

Information and Guidance on the Prescribing and Use of Unlicensed Pharmaceutical Specials
East of England NHS Collaborative Procurement Hub

This document is to be used for information by medical healthcare professionals to provide guidance on the nature, prescribing and supply of special medicines. The objective of the document is to highlight their individual responsibilities, the risks involved and to make an overall contribution to preserving the safety of patients.

Source: eoecph.nhs.uk
Pharmacy Resource: Toolkit
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Last Checked: 28/10/13 Link Error: Report It

 

Information and Guidance on the Prescribing and Use of Unlicensed Pharmaceutical Specials
Produced in collaboration by: East of England NHS Collaborative Procurement Hub and East of England PrescQIPP

The recent contractual changes, introducing the ‘Specials Tariff’ will undoubtedly bring new challenges for colleagues working across Community Pharmacy, especially with the extra administration required, but should also provide better accountability and transparency for those who prescribe specials appropriately.

In order to respond to these changes, and offer support to community pharmacists, the east of England’s PrescQIPP and NHS Collaborative Procurement Hub are pleased to release the Specials Toolkit version.

Source: prescqipp.info
Pharmacy Resource: Toolkit
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Last Checked: 28/10/13 Link Error: Report It

 

The supply of unlicensed medicinal products (“specials”)
Medicines and Healthcare Products Regulatory Agency Guidance Note

This Guidance Note provides advice on the manufacture, importation, distribution and supply of unlicensed medicinal products for human use (commonly described as “specials”) which have been specially manufactured or imported to the order of a doctor, dentist, nurse independent prescriber, pharmacist independent prescriber or supplementary prescriber for the treatment of individual patients.

Source: gov.uk/mhra
Pharmacy Resource: Guidance
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Last Checked: 23/02/15 Link Error: Report It

 

Specials information pack
Barking and Dagenham, Havering and Redbridge Clinical Commissioning Groups

Contents

What is a special?
Where do they come from?
How do I know if it’s unlicensed?
What are Minimum Volumes in Part VIIIB Drug Tariff
What does it mean for prescribers?
I’ve got a patient with swallowing difficulties, what do I do?
The prescription (suggested SOP)
Monographs

Source: redbridgeccg.nhs.uk
Pharmacy Resource: Information Pack
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Last Checked: 04/11/14 Link Error: Report It

 

Royal Pharmaceutical Society Good Practice Guidance: The Procurement and Supply of Pharmaceutical Specials

Our Specials guidance provides good practice advice on the key professional responsibilities for pharmacists when providing advice about or supplying specials, and support in making appropriate choices for their patients. There are patients who do benefit from receiving a special and this guidance will help pharmacists in providing the appropriate product and advice for their patients. We have also produced new guidance to support you with the pharmaceutical issues to consider with crushing, opening or splitting oral dosage forms.

Source: rpharms.com
Pharmacy Resource: Guidance
Register to Access Content: Yes - content available to members of the RPS

Last Checked: 03/04/17 Link Error: Report It

 

Prescribing Specials
Five guiding principles for prescribers

This guidance includes five guiding principles based on good prescribing practice that highlight specific issues to support prescribers in the safe and appropriate use of Specials. Appendix 2 contains a quick practical checklist for prescribers to print out and use as a tool when prescribing.

Source: webarchive.org.uk
Pharmacy Resource: Guidance
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Last Checked: 23/04/15 Link Error: Report It

 

Use of “Specials” – Guidelines for good practice and points to consider
Derbyshire Medicines Management

Specials are unlicensed medicines and should only be considered when use of a licensed preparation is not possible. Ongoing need should be reviewed and if necessary a change in medication or route of administration should be considered. The alteration of medication formulations (e.g. crushing tablets) to aid administration to patients with swallowing difficulties will render a licensed preparation unlicensed.

Source: derbyshiremedicinesmanagement.nhs.uk
Pharmacy Resource: Guideline
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Last Checked: 18/08/15 Link Error: Report It

 

Medicines Management Team - Community Pharmacy Newsletter
Specials

A special is defined as an unlicensed medicine which is bespoke manufactured for an individual patient. Monitoring of specials, via epact data, has been happening for a long time, but over recent years, costs have escalated dramatically.

Source: derbyshiremedicinesmanagement.nhs.uk
Pharmacy Resource: Newsletter
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Last Checked: 18/08/15 Link Error: Report It

 

Special Order Pharmaceutical Products
A Practical Guide for Prescribers

Produced by NHS North Lancashire Medicines Management Team

This document provides an A-Z list of drugs where:

  • Alternative licensed preparations exist.
  • Drugs that can be crushed or dispersed in water (unlicensed route of administration).
  • Injections that can be given orally/ enterally (unlicensed route of administration).
  • Specials products have been included in the specials tariff – Note, these are still unlicensed and licensed products should be selected first where possible.
Source: northlancshealth.nhs.uk
Pharmacy Resource: Guide
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Last Checked: 28/10/13 Link Error: Report It

 

Specials Prescribing – List of Alternative Products

Source: medicines.necsu.nhs.uk
Pharmacy Resource: List
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Last Checked: 28/10/13 Link Error: Report It

 

A-Z of possible alternatives to using a special

Source: derbyshiremedicinesmanagement.nhs.uk
Pharmacy Resource: List
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Last Checked: 18/08/15 Link Error: Report It

 

Alternative licensed products list

Source: neneccg.nhs.uk
Pharmacy Resource: List
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Last Checked: 29/10/13 Link Error: Report It

 

Medicines Optimisation in Patients with Dysphagia
Keele University

Dysphagia
Assessment & Management
Administration of Medicines
Unlicensed Medicines
Specials
Splitting & Crushing Tablets
Imported Prodcts

Source: dysphagia-medicine.com
Pharmacy Resource: Various
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Last Checked: 28/10/13 Link Error: Report It

 

Guidelines on prescribing for patients with swallowing difficulties
NHS Nene & Corby CCGs

Source: neneccg.nhs.uk
Pharmacy Resource: Guideline
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Last Checked: 29/10/13 Link Error: Report It

 

Flow Chart for Swallowing difficulties
NHS Nene & Corby CCGs

Source: neneccg.nhs.uk
Pharmacy Resource: Flowchart
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Last Checked: 29/10/13 Link Error: Report It

 

CPPE
Safer supply and use of Specials

Learning objectives: On completion of all aspects of this learning programme you should be able to:

  • explain the medicines regulatory framework and how this applies to Specials
  • describe the regulatory standards and guidance governing the prescription, manufacture, preparation and dispensing of unlicensed medicines
  • discuss the common situations in which use of Specials may be indicated, as well as the impact of patient characteristics on the choice and use of Specials
  • engage in shared decision-making about Specials with patients
  • describe the legal and professional responsibilities of prescribers and pharmacists with regard to Specials
  • advise prescribers about the safer use of and the risks associated with the prescribing of Specials
  • ensure the procurement and supply of safe, high-quality Specials that are appropriate to patient needs and represent value for money for the NHS, with consideration of the new reimbursement arrangements.
Source: cppe.ac.uk
Pharmacy Resource: CE / CPD / Learning
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Last Checked: 28/10/13 Link Error: Report It

 

…about licensed, off-label, and unlicensed use

The marketing authorisation (MA) system is the European licensing mechanism for medicines, ensuring their safety, quality, and efficacy

Source: wemerec.org
Pharmacy Resource: Reference Document
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Last Checked: 28/10/13 Link Error: Report It

 

European Alliance for Access to Safe Medicines - When Is a Medicine Not a Medicine?

This report examines what can happen when other factors enter the equation. For example, when money clouds the issue. Or when regulatory vagaries or loopholes exist. The EAASM has researched and uncovered a number of disturbing incidences of what can happen when healthcare decisions are made as a result of considerations other than the patient’s best interests. They make shocking reading.

Source: eaasm.eu
Pharmacy Resource: Report
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Last Checked: 28/10/13 Link Error: Report It

 

European Alliance for Access to Safe Medicines Consensus Statement on Unlicensed / Off-Label Medicines

Following the publication of the EAASM report "When is a Medicine Not a Medicine", the Alliance held a stakeholder round-table in London. The main output from the meeting was a Consensus Statement on the patient safety implications around the use of unlicensed and off-label medicines.

Source: eaasm.eu
Pharmacy Resource: Consensus Statement
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Last Checked: 28/10/13 Link Error: Report It

 

Promotion of off-label use of medicines by European healthcare bodies in indications where authorised medicines are available
European Federation of Pharmaceutical Industries and Associations

Any medicine intended for market approval in Europe must undergo a rigorous analysis of its safety and efficacy in the disease population in question. Approval of a medicine comes about after an extensive analysis of the benefit versus the potential risks posed by that medicine in that patient population. The robust European regulations in force are there to safeguard patient safety.

Source: efpia.eu
Pharmacy Resource: Position Paper
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Last Checked: 04/11/13 Link Error: Report It

 

Guidance on Unlicensed and ‘Off-label’ Medicines
NHS Wirral

This document provides guidance on the clinical, prescribing and supply responsibilities of prescribers and pharmacists with regard to the use of unlicensed medicines and 'off-label' use of licensed medicines in primary care throughout Wirral.

Source: mm.wirral.nhs.uk
Pharmacy Resource: Guidance
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Last Checked: 28/10/13 Link Error: Report It

 

Patient Information
Unlicensed Medicine and Specials

Most medicines have a licence, which means that they have gone through successful clinical trials on people.

Source: apsm-uk.com
Pharmacy Resource: Patient Factsheet
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Last Checked: 28/10/13 Link Error: Report It

 

Database of Oral Liquid Formulations

This provides information about pediatric oral liquids and many other practical formulation issues.

This database also contains Standardised formulations for New Zealand: The Extemporaneous Compounding Pharmacists' Group in New Zealand has developed a list of standardised formulations (most of these currently use Ora Products) please refer to the overview document for an explanation of the rationale and process. This list will be continually reviewed and revised.

Source: pharminfotech.co.nz
Pharmacy Resource: Database
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Last Checked: 28/10/13 Link Error: Report It

 

Specially' Manufactured Medicines Database

Where possible commercially available formulations of medicines should be used over crushing tablets/opening capsules or the prescribing of unlicensed specials. If a patient does require a liquid preparation of a medication and there is none available commercially, the medication should be reviewed in the first instance - is the medication necessary, is there an alternative route the medication can be given by e.g. rectal or is there an alternative medication that does have a commerically available liquid. If none of these are an option, the database below offers alternatives to prescribing a specially manufactured liquid e.g. tablets that can be crushed etc.

Source: elmmb.nhs.uk
Pharmacy Resource: Database
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Last Checked: 28/10/13 Link Error: Report It

 

General Medical Council Guidance
Good practice in prescribing and managing medicines and devices - prescribing unlicensed medicines

The term ‘unlicensed medicine’ is used to describe medicines that are used outside the terms of their UK licence or which have no licence for use in the UK.

Source: gmc-uk.org
Pharmacy Resource: Guidance
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Last Checked: 17/08/15 Link Error: Report It

 

What gives? Non-approved or off-label indications: a panacea or quagmire?

There are many situations in which it is clinically reasonable, and sometimes preferable, to use a medication for a non-approved indication.

Source: albertadoctors.org
Pharmacy Resource: Newsletter
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Last Checked: 28/10/13 Link Error: Report It

 

Ten Common Questions (and Their Answers) About Off-label Drug Use

This article introduces and answers 10 questions regarding OLDU in an effort to clarify the practice's meaning, breadth of application, acceptance, and liabilities.

Source: mayoclinicproceedings.org
Pharmacy Resource: Journal Article
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Last Checked: 28/10/13 Link Error: Report It

 

Crushing Buprenorphine

This item describes (with the aid of photographs) the procedure for crushing and administering supervised buprenorphine doses, as well as briefly discussing the pros, cons and legalities of doing so.

Source: smmgp.org.uk
Pharmacy Resource: Question and Answer
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Last Checked: 28/10/13 Link Error: Report It

 

The Use of Unlicensed Medicines or Licensed Medicines for Unlicensed Applications in Paediatric Practice

This statement, originally produced in 2000, has been updated by the Joint Standing Committee on Medicines, a committee of the Royal College of Paediatrics and Child Health and the Neonatal and Paediatric Pharmacists Group.

Source: rcpch.ac.uk
Pharmacy Resource: Statement
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Last Checked: 28/10/13 Link Error: Report It

 

Legal requirements for children's medicines
Medicines and Healthcare Products Regulatory Agency

Information on PIPs, paediatric studies and variations to children’s medicines.

Documents

  • Legal requirements for children's medicines
  • Implementation of changes to product information
  • Where paediatric data is assessed
Source: gov.uk/mhra
Pharmacy Resource: Various
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Last Checked: 23/02/15 Link Error: Report It

 

Medicines for Children

Medicines information leaflets cover many of the medicines that are prescribed or recommended to children by a pharmacist, doctor or nurse. They answer your questions about how and when to give the medicine, what to do if you forget to give the medicine or give it twice, and any possible side-effects.

Medicines for Children is a partnership programme by the Royal College of Paediatrics and Child Health (RCPCH), Neonatal and Paediatric Pharmacists Group (NPPG), and WellChild.

Source: medicinesforchildren.org.uk
Pharmacy Resource: Medicines Information Leaflets
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Last Checked: 28/10/13 Link Error: Report It

 

Evidence summaries: unlicensed or off-label medicines
National Institute for Health and Care Excellence (NICE)

Evidence summaries: unlicensed or off-label medicines summarise the best available evidence for selected unlicensed or off-label medicines.

Unlicensed or off-label medicines have a valuable role in the care of certain patients when there are no suitable licensed medicines available which meet their needs. However, information for healthcare professionals and patients to decide whether these medicines are safe and effective, and when they are most likely to yield good patient outcomes, can be difficult to find. It is estimated that around 1,000 specific requests for off-label drug use are made to NHS commissioners in England every year.

The strengths and weaknesses of the relevant evidence are critically reviewed, but the summaries do not constitute formal NICE guidance.

Source: nice.org.uk
Pharmacy Resource: Evidence Summaries
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Last Checked: 20/05/15 Link Error: Report It

 

The Royal College of Psychiatrists College Report on the Use of Licensed Medicines for Unlicensed Applications in Psychiatric Practice

Drug treatment is an essential part of much of psychiatric practice, in patients from a wide age range and across many diagnostic groups. Despite the availability of many classes of psychotropic drugs, a substantial proportion of patients will remain troubled by persistent, distressing and impairing symptoms, even after a succession of licensed pharmacological treatments. In this situation, many psychiatrists will consider the prescription of psychotropic drugs outside the narrow terms of their licence, as part of an overall plan of management.

Source: rcpsych.ac.uk
Pharmacy Resource: Report
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Last Checked: 28/10/13 Link Error: Report It

 

Guidelines for Unlicensed and Off-Label Use of Medicines
Tees, Esk and Wear Valleys NHS Foundation Trust

Appendix 1 Adults; Approved unlicensed and off-label use of medicines
Appendix 2 Children’s and Young Peoples Service; Unlicensed and off-label prescribing guidance
Appendix 3 Mental Health Services for Older People; Unlicensed and off-label prescribing guidance
Appendix 4 Tertiary Care Affective Disorders Service: Approved unlicensed and off-label recommendations
Appendix 5 Substance Misuse Services: Approved Unlicensed and off-label recommendations

Source: tewv.nhs.uk
Pharmacy Resource: Guidelines
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Last Checked: 31/07/14 Link Error: Report It

 

Off-label prescribing: 7 steps for safer, more effective treatment

Psychiatrists often resort to off-label prescribing, not only for insomnia but also to treat schizophrenia-spectrum disorders, unipolar and bipolar affective disorders, anxiety disorders (especially obsessive-compulsive disorder), mental disorders related to general medical conditions, dementia, and personality disorders

Source: currentpsychiatry.com
Pharmacy Resource: Journal Article
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Last Checked: 28/10/13 Link Error: Report It

 

Off-label prescribing in psychiatric practice

This article reviews the nature and extent of this aspect of prescribing, outlines when it may be appropriate and makes recommendations for a suggested procedure when prescribing medication ‘off-label’.

Source: apt.rcpsych.org
Pharmacy Resource: Journal Article
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Last Checked: 28/10/13 Link Error: Report It

 

Statement from the Faculty of Sexual and Reproductive Healthcare Clinical Standards Committee, the Clinical Effectiveness Committee and the Associate Members’ Working Group on the prescription, administration or supply of Contraceptive Medicines for use outside the terms of their licences

There are many generally accepted off licence (“off-label”) usages of contraception.

Source: fsrh.org
Pharmacy Resource: Statement
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Last Checked: 28/10/13 Link Error: Report It

 

Mixing of medicines prior to administration in clinical practice: medical and non-medical prescribing

Following recommendations from the Commission on Human Medicines, medicines regulations were amended in December 2009 to enable doctors and other prescribers to mix medicines themselves and to direct others to mix medicines.

These changes apply not only to palliative care, but to all clinical areas where the mixing of medicines prior to administration is accepted practice and supported by the employer's policies for delivery of healthcare.

The Commission also agreed parameters, principles and key points on mixing of medicines. The intention is to enable accepted good practice to continue.

Source: gov.uk
Pharmacy Resource: Guidance
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Last Checked: 28/10/13 Link Error: Report It

 

Mixing of medicines prior to administration in clinical practice — responding to legislative changes

It is common practice for healthcare professionals to mix one or more medicines together before administration to a patient. This is permissible under medicines legislation where one product is a vehicle for the administration of another. However, mixing two licensed medicines where one is not a vehicle for the administration of the other, results in a new, unlicensed product being produced. Prior to recent legislative changes, the law restricted mixing practice to:

  • Doctors and dentists mixing medicines and then administering to a patient
  • Pharmacists mixing medicines to the specification of a doctor or dentist
  • Holders of a manufacturing licence.

The NPC has produced this resource for both organisations and practitioners. It is not intended that this document replaces any generic guidance or professional codes of conduct from the professional regulatory bodies, but should be read in conjunction with them. It provides advice and tools which will help with the implementation of the guidance points.

Source: webarchive.org.uk
Pharmacy Resource: Guidance
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Last Checked: 23/04/15 Link Error: Report It

 

Use of medicines outside of their UK marketing authorisation in pain management and palliative medicine

This is a consensus document prepared on behalf of the British Pain Society in consultation with the the Association for Palliative Medicine of Great Britain and Ireland.

This document summarises the views of the Association for Palliative Medicine (APM) and the British Pain Society in relation to the use of drugs outside of their UK marketing authorisation beyond their product licence in clinical practice.

Source: britishpainsociety.org
Pharmacy Resource: Publication
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Last Checked: 17/07/15 Link Error: Report It

 

Use of medicines outside of their UK marketing authorisation in pain management and palliative medicine – information for patients

This is a consensus document prepared on behalf of the British Pain Society in consultation with the Association for Palliative Medicine of Great Britain and Ireland.

This leaflet explains how some medicines are used differently to how they were originally developed and approved. Sometimes there are clinical situations when the use of medicines outside the terms of their licence (‘off-label’) or the use of unlicensed medicines may be judged to provide you with the best or most suitable treatment.

Source: britishpainsociety.org
Pharmacy Resource: Patient Leaflet
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Last Checked: 17/07/15 Link Error: Report It

 

Statement on the use of unlicensed medicines or licensed medicines for unlicensed uses in critically ill patients
Intensive Care Society

The Intensive Care Society recognizes that both licensed medicines used outside the terms of their Marketing Authorisation and unlicensed medicines are needed for effective treatment of the critically ill. This statement aims to inform and guide health professionals who prescribe, dispense or administer medicines to critically ill patients (and health service managers) about the use of unlicensed medicines or licensed medicines for unlicensed uses in critically ill patients.

Source: ics.ac.uk
Pharmacy Resource: Guidance
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Last Checked: 28/10/13 Link Error: Report It

 

Specials Recommended by the British Association of Dermatologists for Skin Disease
On behalf of the BAD Specials Working Group 2014

Most prescribing uses licensed medicines whose safety and efficacy are assured. For many common dermatological diseases including psoriasis and eczema, the range of licensed medicines is limited. As a result, Dermatology prescribing may rely significantly on unlicensed creams and ointments (known as ‘Specials’) containing tars, dithranol, salicylic acid, steroids and other active constituents in a range of concentrations and bases. This is of particular concern in primary care where lack of effective price controls and a mechanism to ensure independent scrutiny of product quality has increased costs and concern about standards. To address these concerns and help to optimise quality of care, adherence to the revised British Association of Dermatologists (BAD) list of preferred Specials (2014) is encouraged.

Source: bad.org.uk
Pharmacy Resource: Publication
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Last Checked: 15/05/15 Link Error: Report It

 

British Association of Dermatologists’ guidelines for the safe and effective prescribing of azathioprine 2011

6-MP and 6-TG have never found their way into routine dermatological practice and these guidelines relate to azathioprine and its extensive on- and off-label applications for inflammatory dermatoses.

Source: bad.org.uk
Pharmacy Resource: Guideline
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Last Checked: 15/05/15 Link Error: Report It

 

Finasteride for Hair Loss in Women

The role of androgens (testosterone and dihydrotestosterone) in male pattern hair loss is clear, but the role of androgens in female pattern hair loss remains obscure, as many women with female pattern hair loss do not have elevated serum testosterone levels or clinical signs of hyperandrogenism.

Source: dpic.org
Pharmacy Resource: Healthcare Professional Article
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Last Checked: 28/10/13 Link Error: Report It

 

Ophthalmic Specials Guidance
The Royal College of Ophthalmologists and the UK Ophthalmic Pharmacy Group

The Royal College of Ophthalmologists and the UK Ophthalmic Pharmacy Group are concerned about the suitability and the cost of certain unlicensed ophthalmic preparations prescribed and dispensed in primary care.

The General Medical Council’s advises that unlicensed medicines may be prescribed ‘on the basis of an assessment of the individual patient, you conclude, for medical reasons, that it is necessary to do so to meet the specific needs of the patient.’

Following on from the advice by the GMC, the College and the UK OPG have produced the Ophthalmic Specials Guidance.

Source: rcophth.ac.uk
Pharmacy Resource: Guidance
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Last Checked: 29/05/14 Link Error: Report It

 

Guidance on the use of antipsychotics for conditions other than schizophrenia
Dorset Clinical Commissioning Group

Source: dorsetccg.nhs.uk
Pharmacy Resource: Guideline
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Last Checked: 28/10/13 Link Error: Report It

 

Coventry & Warwickshire Area Prescribing Committe Drug Positioning Statement
Melatonin (Circadin® and unlicensed products)

Source: coventrywarksapc.nhs.uk
Pharmacy Resource: Drug Positioning Statement
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Last Checked: 28/10/13 Link Error: Report It

 

Recommended Melatonin Products List

Recommended melatonin product(s) - CAMHS / LD Sleep Disorders

Source: coventrywarksapc.nhs.uk
Pharmacy Resource: Resource Document
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Last Checked: 28/10/13 Link Error: Report It

 

Examination of the Evidence for Off-Label Use of Gabapentin

The intent of this review is to tie the media concerns to clinical evidence obtained from a thorough literature review so that managed care pharmacists and physicians will be better prepared to address the subject of appropriate use of gabapentin.

Source: amcp.org
Pharmacy Resource: Journal Article
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Last Checked: 18/02/15 Link Error: Report It

 

Oral N-acetylcysteine for Idiopathic Pulmonary Fibrosis
UK Medicines Information

The cause of idiopathic pulmonary fibrosis (IPF) is not known. Possible causes are dysregulated wound healing and abnormal fibrotic reaction following repeated lung injury. The clinical course of IPF can be unpredictable with acute exacerbations.

Source: evidence.nhs.uk
Pharmacy Resource: Report
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Last Checked: 28/10/13 Link Error: Report It

 

Midodrine for Orthostatic Hypotension
UK Medicines Information

Studies of midodrine for the treatment of orthostatic hypotension (OH) are not particularly robust, but the evidence base for other drugs currently used to treat OH is no better, and probably worse than that for midodrine.

Source: evidence.nhs.uk
Pharmacy Resource: Report
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Last Checked: 28/10/13 Link Error: Report It

 

Oral Pentosan for Painful Bladder Syndrome/Interstitial Cystitis
UK Medicines Information

Painful bladder syndrome/interstitial cystitis (PBS/IC) is characterised by remissions and exacerbations, which makes it difficult to assess the real impact of any treatment. There is also a lack of consensus on diagnosis.

Source: evidence.nhs.uk
Pharmacy Resource: Report
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Last Checked: 28/10/13 Link Error: Report It

 

Sildenafil in Esophageal Motility Disorders

Recently it has been speculated that phosphodiesterase type 5 (PDE5) inhibitors, specifically sildenafil, may be helpful in treating some esophageal motility disorders.

Source: dpic.org
Pharmacy Resource: Healthcare Professional Article
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Last Checked: 28/10/13 Link Error: Report It

 

Off-Label: Technically Unproven, But Not Out of Bounds

Today, the concept of prescribing a medication off-label is far from a rogue decision by a practitioner when it comes to choosing the best course of treatment for patient care. Indeed, it is not uncommon or new for ophthalmic drugs, technically unproven as a Food & Drug Administration (FDA) approved indications, to be prescribed off-label.

Source: revoptom.com
Pharmacy Resource: Journal Article
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Last Checked: 28/10/13 Link Error: Report It

 

Nurse and midwife independent prescribing of unlicensed medicines
Nursing and Midwifery Council Circular

On 21 December 2009 legislation was amended to allow nurse and midwife independent prescribers to prescribe unlicensed medicines for those in their care on the same basis as doctors, dentists and supplementary prescribers.

Source: nmc.org.uk
Pharmacy Resource: Prescribing Circular
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Last Checked: 18/08/15 Link Error: Report It

 

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