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 Formulary Chapter 15: Anaesthesia - Full Chapter
15.01.04.03  Expand sub section  Opioid analgesics
Alfentanil
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Formulary
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Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • No restriction stated
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • No restriction stated
 
   
Fentanyl
(Injection)
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Formulary
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Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • No restriction stated
  • RNOH:
    • Restricted Only on the recommendation of the Pain Team for patients intolerant to or with contraindications to morphine and oxycodone
  • UCLH:
  • WH:
    • No restriction stated
 
   
Remifentanil
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Restricted Drug Restricted
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Provider notes

  • NMUH:
    • For use in ICU (Intensive Care Unit) ONLY
  • RFL:
    • No restriction stated
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • CD = Controlled drug. The Misuse of Drug Regulations apply. For further details see. Prescribing Guidelines. Ideally, remifentanil should be administered as an infusion, either with a standard syringe driver or as a Target Controlled Infusion using the Minto pharmacokinetic model (with the Alaris PK pump). Remifentanil should be diluted before administration, typically to a concentration of 20 to 40 mcg/ml, though higher concentrations can be used. A recommended induction infusion rate is 0.5 mcg/kg/min or8 ng/ml target for a ventilated patient and the rate halved for maintenance and titrated to clinical need (considerably higher or lower rates may be required). Beware the elderly or those with significant comorbidity when initial rates should be reduced. A dedicated cannula or antireflux valve should be used if an IV cannula is shared with fluids or other drugs. The cannula and giving set should be flushed at the end of use to avoid boluses of remifentanil accidentally being administered postop. Boluses of remifentanil should be administered carefully, by slow injection over a period of 30 to 60seconds.
 
   
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Key
note Notes
Section Title Section Title (top level)
Section Title Section Title (sub level)
First Choice Item First Choice item
Non Formulary Item Non Formulary section
Restricted Drug
Restricted Drug
Unlicensed Drug
Unlicensed
Track Changes
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Link to adult BNF
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Link to children's BNF
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Link to SPCs
High Cost Medicine
High Cost Medicine
Cancer Drugs Fund
Cancer Drugs Fund
NHSE
NHS England
Homecare
Homecare
CCG
CCG

Traffic Light Status Information

Status Description

GP - 1st

Medicines suitable for first-line use within primary care.

Can be initiated within primary care within their licensed indication, in accordance with nationally recognised formularies, for example the BNF, BNF for Children, Medicines for Children or Palliative Care Formulary. Primary care prescribers take full responsibility for prescribing. 

  

GP - 2nd

Medicines suitable for second-line use within primary care.

Can be initiated within primary care within their licensed indication, in accordance with nationally recognised formularies, for example the BNF, BNF for Children, Medicines for Children or Palliative Care Formulary. Primary care prescribers take full responsibility for prescribing. 

  

GP - Amber

Medicines that should be initiated by a specialist. Prescribing can be transferred to primary care once the patient has been stabilised.  

Shared care: For drugs with regular, ongoing need for monitoring and/or assessment of efficacy or toxicity. Prior agreement must be obtained by the specialist from the primary care provider before prescribing responsibility is transferred. The shared care protocol must have been agreed by the relevant secondary care trust Drugs and Therapeutics Committee(s) (DTC) and approved by the North Central London JFC.

Fact sheet: For drugs with some concerns surrounding safety or efficacy but do not require regular monitoring and/or monitoring of effectiveness/toxicity.

  

GP - Red

Medicines which should normally be prescribed by specialists only (hospital only).

For patients already receiving prescriptions in primary care - continue. No new patients to receive prescriptions in primary care.

  

GP - Grey

Medicines on hospital formularies which have not been reviewed for suitability in primary care.  

Black

Medicines not recommended for routine use in primary or secondary care.

Medicines, which the North Central London JFC has actively reviewed and does not recommend for use at present due to limited clinical and/or cost effective data.

  

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