Out-Patients Formulary List
Transcript of Out-Patients Formulary List
OUTPATIENTS FORMULARY LIST
September 2021
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Contents How to use the formulary ............................................................... 3
The Schedule V Chronic Conditions ................................................. 5
Dispensing ...................................................................................... 7
1. Gastro-Intestinal System ............................................................. 11
2. Cardiovascular System ................................................................ 21
3. Respiratory System ...................................................................... 35
4. Central Nervous System .............................................................. 43
5. Infections ..................................................................................... 73
6. Endocrine System ........................................................................ 99
7. Obstetrics, Gynaecology, and Urinary-tract Disorders ............. 110
8. Malignant disease and immunosuppression ............................ 112
9. Nutrition and Blood ................................................................... 124
10. Musculoskeletal and Joint Diseases ........................................ 136
11. Eye ........................................................................................... 142
12. Ear, Nose and Oropharynx ...................................................... 145
13. Skin .......................................................................................... 147
14. Anaesthesia ............................................................................. 157
15. Consumables ........................................................................... 159
A1 Borderline Substances ............................................................. 163
Index .......................................................................................... 168
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How to use the formularyNote:
▪ This formulary lists medicinal products that are available within the
National Health Scheme for Out-Patients use.
▪ Medicinal products listed can be issued via a Schedule V Card (Yellow
Card) once Schedule V entitlement is in place or to Pink Card holders if
the respective item is Pink Card Positive.
▪ Certain medicinal products are protocol regulated and will be supplied
only against the relevant approval in addition to the Schedule V Card.
▪ After hours, the Resident Specialist on duty can endorse approval of
protocol-regulated drugs, provided that it is then endorsed by its
respective consultant on the next day.
Prescriber Criteria:
All Medical Practitioners, i.e. doctors working within the National Health
Services and private doctors, can change the dose of treatment for the
following conditions when an item is marked on the formulary as ‘Medical
Practitioners’ or ‘Consultant’. This includes also protocol-regulated items.
(Medicines that require permit/approval)
1. Hypertension
2. Diabetes Mellitus
3. Chronic Heart Failure
4. Asthma
5. Chronic Obstructive Pulmonary Disease
6. Treatment for hypercholesterolaemia under the respective
Schedule V conditions
7. Chronic Mood Disorders
8. Chronic Neurotic Disorders
Abbreviations
A Acute
AG Antimicrobial Guidelines
ATC Anatomical Therapeutic Chemical Classification System
B Both Acute and Chronic
C Chronic
DM Pink Card for Diabetes Mellitus Only
FPOP only From Psychiatric Out-patients Only
HU Hospital Use
MAS Medicines Approval Section
MDHP Mater Dei Hospital Pharmacy
MHCs Mental Health Clinics
MP Medicinal Protocol
N/A Not Applicable
PHCD Primary Health Care Department
SAMOCP Sir Anthony Mamo Oncology Centre Pharmacy
SPBHP Sir Paul Boffa Hospital Pharmacy
SVPRP St Vincent De Paul Residence Pharmacy
TBDF To be dispensed from
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1. ATC Code - The Anatomical Therapeutic Chemical (ATC) classification system.
2. Active Ingredient - The substance in the medicinal product that is pharmaceutically active.
3. Dosage Form and Strength - Describes the physical form and the amount of the active ingredient in the medicinal product.
4. Schedule V Prescriber Criteria - The category of medical practitioners allowed initiating treatment of a particular medicinal product for Schedule V Card entitlement.
5. Protocol - Certain medicinal products are further regulated with a medicinal protocol (patient requires MAS permit). These are marked with a number e.g. MP 177
6. Dispensing Policy - Certain medicinal products can only be dispensed from certain entities.
7. Pink Card - Medicinal products which can be issued to patients in possession of a Pink Card (Schedule II). Pink positive items are marked with ‘A’, ‘B’ or ‘C’.
8. Diabetes Mellitus - Medicinal products which can be issued to patients in possession of a Pink Card for Diabetes Mellitus only.
9. Pink Card Prescriber Criteria - The category of medical practitioners allowed prescribing a particular medicinal product for Pink Card entitlement.
10. Schedule V Entitlement - The Schedule V condition/s for which the medicinal product can be issued via Schedule V entitlement.
11. Formulary Version - The version number is changed with every minor formulary amendment.
12. Formulary Edition - The formulary edition is changed after major amendments (usually twice a year or more).
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The Schedule V Chronic Conditions
The Fifth Schedule of the Social Security Act lists the diseases and conditions
in respect of which free medicines are provided irrespective of financial
position. These are as follows:
1. Malignant Diseases
2. Cardiovascular Diseases:
(a) Chronic Heart Failure
(b) Hypertension
(c) Ischaemic Heart Disease
(d) Cardiac Arrhythmias
(e) Peripheral Vascular Disease
(f) Cerebrovascular Disease
(g) Genetic Dyslipidaemia
3. Respiratory Diseases:
(a) Chronic Respiratory Failure
(b) Cystic Fibrosis
(c) Chronic Obstructive Pulmonary Disease
(d) Chronic Asthma
4. Digestive System Diseases:
(a) Gastro – Oesophageal Reflux Disease
(b) Gastric/Duodenal Ulcers
(c) Inflammatory Bowel Disease
(d) Coeliac Disease
(e) Diverticular Disease requiring Stoma Care
(f) Hirschsprung’s Disease
(g) Imperforate Anus
(h) Small Intestinal Failure
5. Liver Diseases:
(a) Chronic Liver Disease
6. Haematological Diseases:
(a) Inherited Bleeding Disorders
(b) Inherited Haemoglobinopathies
7. Nervous System Diseases:
(a) Epilepsy
(b) Parkinson’s disease
(c) Myasthenia Gravis
(d) Multiple Sclerosis
(e) Motor Neurone Disease
(f) Trigeminal Neuralgia
(g) Huntington’s Chorea
(h) Dementia
(i) Schizophrenia
(j) Psychosis
(k) Chronic Mood Disorders
(l) Chronic Neurotic Disorders
(m) Addiction Disorders
(n) Chronic Psychiatric Disorders starting in Childhood
(o) Chronic Eating Disorders
(p) Cerebral Palsy
(q) Narcolepsy
(r) Spinal Cord Pathologies
(s) Congenital indifference to pain
(t) Neuromyelitis Optica
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8. Renal Diseases:
(a) Chronic Kidney Disease
9. Endocrine Diseases:
(a) Diabetes Mellitus
(b) Addison’s Disease
(c) Precocious Puberty
(d) Hypoparathyroidism
(e) Hypopituitarism
(f) Hypogonadism
(g) Enzyme Disorders
(h) Endometriosis and Adenomyosis
(i) Pituitary Adenomas
(j) Benign Prostatic Enlargement
10. Skin Diseases:
(a) Psoriasis
(b) Chronic Immunobullous Disorders
(c) Congenital Ichthyosis
(d) Hidradenitis Suppurativa
(e) Severe Refractory Atopic Dermatitis
(f) Severe Chronic Urticaria
11. Infectious Diseases:
(a) HIV/AIDS and HIV Related Diseases
(b) Hepatitis B & C
(c) Tuberculosis
(d) Hospital Acquired Infections
(e) Leprosy
(f) Polio and Post-Polio Syndrome
(g) Chronic Osteomyelitis
12. Rheumatic Diseases:
(a) Rheumatoid Arthritis
(b) Paget’s Disease
(c) Lupus Erythematosus
(d) Systemic Sclerosis
(e) Dermatomyositis/Polymyositis
(f) Polyarteritis Nodosa
(g) Spondyloarthritis
(h) Crystal Deposition Disease
(i) Polymyalgia Rheumatica
(j) Myalgic Encephalomyelitis
(k) Fibromyalgia
13. Metabolic Disorders:
a) Inborn errors of Metabolism
14. Eye Diseases:
(a) Glaucoma
(b) Vascular Disease of the Retina
15. Immunodeficiency:
(a) Primary Immunodeficiency Disorder
(b) Secondary Immunodeficiency Disorder
16. Chromosome Disorders:
(a) Down Syndrome
(b) Turner Syndrome
(c) Prader-Willi Syndrome
17. Gender Identity & Sex Characteristics Related Conditions
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Dispensing
When dispensing a formulary item, patient should present:
▪ Valid Schedule V card
▪ Prescription (white prescription [DH 46] and/or green prescription [DH
129] + Control card [DH680i])
▪ Patient’s ID card and ID card of person who comes to collect the
medicines on the patient’s behalf
When dispensing a protocol regulated item, patient should present:
▪ Approval form
▪ Valid Schedule V card
▪ Prescription (white form [DH 46] and/or green form [DH 129] + Control
card [DH680i])
▪ Patient’s ID card and ID card of person who comes to collect the
medicines on the patient’s behalf
If an item is added to the Schedule V card in ink and endorsed by the
Consultant, the patient should be directed to the Medicines Approval
Section (POYC), St Luke’s Hospital in order to have the necessary
amendments made to their entitlement documents and POYC records. The
necessary medicinal supplies will be sent to the respective community
pharmacy at the earliest possible. This does not apply to particularly
vulnerable patient groups and conditions requiring urgent treatment e. g.
Malignancy
If a Schedule V card is valid and there is no more space to log in dispensing
entries, patients should not be sent to the Medicines Approval Section
(POYC) [Formerly known as the Schedule V office] for a Continuation
Sheet/Card. Instead, a Continuation Sheet/Card is attached to the Schedule
V card, by the dispenser. The Continuation Sheet/Card is only valid if
attached to the valid issued Schedule V card. Dispensers are to make sure
that they have Continuation Sheets readily available.
If the Schedule V card is expired, the dispenser should dispense the items
once and instruct the patient to fix an appointment with the Consultant for
the renewal. The endorsed Schedule V request can then be left at Mater
Dei Hospital Pharmacy or sent to the Medicines Approval Section (POYC).
If a Schedule V Card Application with the relevant prescriptions is
presented, the dispenser should dispense the items once and instruct the
patient to leave the application at Mater Dei Hospital Pharmacy or send it
to the Medicines Approval Section (POYC).
Protocol Regulated Drugs
The requests for these drugs should be sent to the Medicines Approval
Section (POYC) to be reviewed accordingly. The approval is given according
to the individual protocols and approved for a stated duration (in months
or years) depending on the specific item.
If the approval is expired, the dispenser should dispense the item once and
instruct the patient to fix an appointment with the Consultant for the
renewal requests endorsement. The endorsed request should be left at
Mater Dei Hospital Pharmacy or sent to the Medicines Approval Section
(POYC).
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If a request for a protocol regulated drug with the relevant prescription is
presented, the dispenser may dispense items for one month only if the
item is according to protocol.
Schedule V Cards with Codes Instead of Patient’s Name
Certain Schedule V cards are issued with a code instead of the patient’s
name. The treatment covered by these Schedule V cards should be
dispensed from hospitals only.
Pink Positive Drugs (Drugs available for Schedule II holders)
Pink card positive drugs were classified into acute (A), chronic (C) and both
acute and chronic use (B).
(A) – Items for Acute Use
Medicines are classified as (A) for conditions where treatment should have
a rapid onset and is of short duration.
(C) – Items for Chronic Use
Medicines are classified as being for chronic use if they are utilized for the
treatment of an ongoing or recurring condition.
(B) – Items for Both Acute and Chronic use
Medicines which can be used both for short a duration of use and for an
ongoing or recurrent condition.
Genitourinary (GU) Clinic Entitlement
A legal notice (LN 188/2009) was issued containing a list of medicines that
can be dispensed by the consultant from the GU Clinic.
The legal notice entitled ‘Provision of Medicinal Products through the
Genitourinary Clinic within the Government Health Services Rules’ states
that:
The medicinal products listed in the Schedule shall only be provided by the
consultant to patients attending or who have been referred to the clinic.
The consultant shall:
a. Provide the medicinal products referred to in the Schedule, directly to
patients attending the clinic, and he shall keep a record thereof;
b. Dispense only those amounts which are needed for the period
specified therein;
c. Immediately notify the Authority of any amendment needed in the
Schedule;
d. Inform the Authority of the address of the clinic and of any changes in
such an address;
e. Be responsible for all duties and obligations relating to the provision of
medicinal products to patients under the Act and any regulations or
rules made thereunder, and for standards and conditions issued by the
Authority from time to time in relation to dispensing;
f. Keep such amount of medicinal products as per internal arrangements
with the hospital pharmacy in order to ensure continuation of service
at the clinic;
g. Take all reasonable precautions to ensure appropriate storage and
dispensing of medicinal products;
h. Keep updated, written, and agreed procedures with the hospital
pharmacy supplying the medicinal products.
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List of medicinal products authorized for the purpose of these rules
1. Doxycycline 100mg bd for 7 days. (Occasionally for 14 days in
epididymitis and rarely for 28 days in LGV and Latent Syphilis)
2. Erythromycin 250mg - two tablets daily for 7 days
3. Metronidazole 200mg tablets - 2 tablets daily for 7 days
4. Ceftriaxone 500mg IM injections and 1% lignocaine injection for
dilution to be given as stat dose
5. Spectinomycin 2g IM stat
6. Benzathine Penicillin 1.2 million units IM injections and 1% lignocaine
injection for dilution to be given as stat dose of 2.4 million units.
7. Clotrimazole 100mg pessaries
8. Podophyllotoxin 0.15% cream
9. Podophyllotoxin 0.5% topical solution
10. Aciclovir 200mg to be given as 400mg tds for 7 days for acute episodes
11. Prednisolone 5mg to be given as 20mg tds for 3
12. Amoxicillin 250mg to be given as 500mg tds for 5 days
13. Azithromycin 250mg and 500mg
When dispensing one of the above mentioned drugs, a patient needs only
to present a prescription from GU consultant; there is no need of a
Schedule II card (Pink Card) or a Schedule V card. This applies for the 13
drugs mentioned in the Legal Notice only.
Renewals by Specialists in Family Medicine Working in the Private Sector
Specialists in Family Medicine working in the private sector can apply for
the renewal of Schedule V cards for dyslipidaemia and hypertension
medicines using the Medicines Approval Section (MAS) Application forms.
Renewals will be for patients suffering from Hypertension and/or
Dyslipidaemia as per table below:
Patients with co-morbid conditions (other than hypertension and
dyslipidaemia) necessitating other treatment should still be referred to the
relevant specialist medical professionals as usual. MAS Applications for the
renewal of multiple conditions will not be accepted.
Antibiotics for Treatment of Diabetes Related Infections
The following antibiotics can be prescribed for Diabetes Mellitus Type 1 or
Type 2 by doctors in the community. Prescriptions cannot exceed ten (10)
days duration and the number of episodes should not exceed three per
calendar year. If longer courses are believed to be required, advice from
respective caring physician should be sought. The antibiotics include:
a. Amoxicillin Capsules 250mg, Syrup 125mg/5mL
b. Amoxicillin + Clavulanic Acid Tablets 250mg + 125mg
c. Cefalaxin Capsules 250mg, Syrup 125mg/5mL
d. Doxycycline Capsules 100mg
e. Erythromycin Capsules/Tablets 250mg, Syrup 125mg/5mL
f. Flucloxacillin Capsules 250mg, Syrup 125mg/5mL
g. Metronidazole Tablets 200mg, Suspension 200mg/5mL
h. Nitrofurantoin Tablets 50mg, Syrup 25mg/5mL
Condition Medicines which can be Renewed by Specialists in
Family Medicine Working in the Private Sector
Hypertension Anti-Hypertensive Medicines
Dyslipidaemia Atorvastatin, Bezafibrate, Fenofibrate, Simvastatin,
Rosuvastatin
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Dispensing of Oral Antimalarials to Out-Patients
Oral antimalarials are given free of charge to the following:
1. Persons undertaking missionary service or humanitarian aid abroad.
Claims in this category must be accompanied by:
- A letter by the Head of the organisation explaining the nature
of the mission abroad
- Registration number of the voluntary organisation on the
National VO Register
- Country/countries to be visited during the course of the mission
- Start and end dates of the mission abroad
- Beneficiaries of the project to be undertaken
- Contact details of host person/organisation in country where
mission is to be carried out
2. Adoptive and foster parents who are to travel abroad to adopt or foster
a child.
3. All sportsmen/women representing Malta in official International
Competitions
4. The President of Malta and his Office, the Chief Justice, the Prime
Minister and Parliamentary delegations.
Other Information
Formulary Management
Website: www.pharmaceuticalaffairs.gov.mt
Email: [email protected]
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ATC Code Active Ingredient Dosage Form and Strength
Schedule V Prescriber Criteria
Protocol Pink Card
Pink Card Prescriber Criteria
Schedule V Entitlement
1. Gastro-Intestinal System 1.1 Dyspepsia and gastro-oesophageal reflux disease
1.1.1 Antacids and simeticone A02AX Magnesium
Hydroxide + Aluminium Hydroxide + Simeticone
Oral Liquid Consultants A Medical Practitioners Gastro-Oesophageal Reflux Disease, Malignant Diseases
A02AX Antacid Chewable Tablets
Consultants A Medical Practitioners Gastro-Oesophageal Reflux Disease
1.2 Antispasmodics and other drugs altering gut motility A03BA01 Atropine
Sulphate Tablets 0.5mg Consultant Neurologists,
Consultant Geriatricians, Consultant Paediatricians
MP 13 Cerebral Palsy, Motor Neuron Disease, Myasthenia Gravis
A03BB01 Hyoscine Butylbromide
Injections 20mg
Consultant Palliative Care TBDF Hospitals
only
Malignant Diseases
A03BB01 Hyoscine Butylbromide
Tablets 10mg Consultants A Medical Practitioners Inflammatory Bowel Disease, Malignant Diseases
A03AA04 Mebeverine
Hydrochloride*
Tablets 135mg Consultants C Medical Practitioners Inflammatory Bowel Disease, Malignant Diseases
* Availability temporarily suspended due to problematic sourcing.
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ATC Code Active Ingredient Dosage Form and Strength
Schedule V Prescriber Criteria
Protocol Pink Card
Pink Card Prescriber Criteria
Schedule V Entitlement
1.3 Antisecretory drugs and mucosal protectants 1.3.1 H2-Receptor antagonists
A02BA02 Ranitidine Syrup
75mg/5mL#
Consultant Gastroenterologists, Consultant Geriatricians, Consultant Oncologists, Consultant Paediatric Oncologist, Consultant Paediatricians, Consultant Palliative Care
Spinal Cord Pathologies, Gastric/Duodenal
Ulcers, Gastro-Oesophageal Reflux Disease, Chronic Liver Disease, Malignant Diseases
EXTEMP13
Ranitidine Syrup 75mg/5mL (Extemp - Alcohol free)*
Consultant Paediatricians Spinal Cord Pathologies, Gastric/Duodenal Ulcers, Gastro-Oesophageal Reflux Disease, Chronic Liver Disease, Malignant Diseases
A02BA02 Ranitidine Tablets 150mg*
Consultants B Medical Practitioners Spinal Cord Pathologies, Gastric/Duodenal Ulcers, Gastro-Oesophageal Reflux Disease, Chronic Liver Disease, Malignant Diseases, Lupus Erythematosus, Polyartritis Nodosa, Polymyalgia Rheumatica, Rheumatoid Arthritis, Spondyloarthritis, Systemic Sclerosis
1.3.2 Chelates and complexes A02BX02 Sucralfate Oral Liquid
1g/5mL Consultants C Consultants Gastric/Duodenal Ulcers, Gastro-Oesophageal
Reflux Disease
Availability temporarily suspended due to the current shortage. # Omeprazole MUPS tablets are currently available instead of ranitidine syrup. Omeprazole MUPS tablets should only be used as per SPC.
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ATC Code Active Ingredient Dosage Form and Strength
Schedule V Prescriber Criteria
Protocol Pink Card
Pink Card Prescriber Criteria
Schedule V Entitlement
1.3.3 Prostaglandin analogues A02BB01 Misoprostol Tablets
200mcg Consultant Rheumatologists, Consultant Gastroenterologists, Consultant Obstetrics & Gynaecology, Consultant Cardiologists, Consultant Cardiac Surgeons
MP 132 Ischaemic Heart Disease
1.3.4 Proton pump inhibitors A02BC01 Omeprazole Capsules
20mg Consultants B Medical Practitioners Spinal Cord Pathologies, Gastric/Duodenal
Ulcers, Gastro-Oesophageal Reflux Disease, Chronic Liver Disease, Malignant Diseases, Crystal Deposition Disease, Lupus Erythematosus, Paget's Disease, Polyartritis Nodosa, Polymyalgia Rheumatica, Rheumatoid Arthritis, Spondyloarthritis, Systemic Sclerosis
1.4 Acute diarrhoea 1.4.1 Antimotility drugs
R05DA04 Codeine Phosphate
Tablets 30mg Consultants Motor Neuron Disease, Spinal Cord Pathologies, Trigeminal Neuralgia, Inflammatory Bowel Disease, Inherited Bleeding Disorders, Malignant Diseases, Rheumatoid Arthritis, Spondyloarthritis
A07DA03 Loperamide Hydrochloride
Capsules 2mg Consultants A Medical Practitioners Inflammatory Bowel Disease, Small Intestinal Failure, Diabetes Mellitus Type 1, Diabetes Mellitus Type 2, Malignant Diseases
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ATC Code Active Ingredient Dosage Form and Strength
Schedule V Prescriber Criteria
Protocol Pink Card
Pink Card Prescriber Criteria
Schedule V Entitlement
1.5 Chronic bowel disorders 1.5.1 Aminosalicylates
A07EC02 Mesalazine Foam/ Retention Enema 1g
Consultant Gastroenterologists, Consultant Paediatricians, Consultant Surgeons
Inflammatory Bowel Disease
A07EC02 Mesalazine Suppositories 500mg
Consultant Gastroenterologists, Consultant Paediatricians, Consultant Surgeons
Inflammatory Bowel Disease
A07EC02 Mesalazine (e.g.
Pentacol®, Asacol®, Octasa®, Asacolon®)
Tablets 400mg Consultant Gastroenterologists, Consultant Paediatricians, Consultant Surgeons
C Consultant Gastroenterologists, Consultant Paediatricians, Consultant Surgeons
Inflammatory Bowel Disease
A07EC02 Mesalazine (Active Ingredient Released at pH
≥7)
Tablets 400mg Consultant Gastroenterologists, Consultant Paediatricians, Consultant Surgeons
MP 124 C Consultant Gastroenterologists, Consultant Paediatricians, Consultant Surgeons
Inflammatory Bowel Disease
A07EC02 Mesalazine (Active Ingredient Released from Duodenum to Rectum)
Slow Release Tablets 500mg
Consultant Gastroenterologists, Consultant Paediatricians, Consultant Surgeons
MP 125 Inflammatory Bowel Disease
A07EC02 Sulfasalazine Oral Liquid 250mg/5mL
Consultant Gastroenterologists, Consultant Paediatricians, Consultant Surgeons
MP 186 Inflammatory Bowel Disease
Availability temporarily suspended.
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ATC Code Active Ingredient Dosage Form and Strength
Schedule V Prescriber Criteria
Protocol Pink Card
Pink Card Prescriber Criteria
Schedule V Entitlement
A07EC01 Sulfasalazine Suppositories 500mg
Consultant Gastroenterologists
MP 185 Inflammatory Bowel Disease
A07EC01 Sulfasalazine Tablets 500mg Consultant Gastroenterologists, Consultant Paediatricians, Consultant Surgeons, Consultant Rheumatologists
Inflammatory Bowel Disease, Rheumatoid Arthritis, Spondyloarthritis
1.5.2 Corticosteroids A07EA06 Budesonide Controlled
Release Capsules 3mg
Consultant Gastroenterologists, Consultant Paediatricians, Consultant Surgeons
MP 23 Inflammatory Bowel Disease
A07EA06 Budesonide Enema 2mg/100mL
Consultant Gastroenterologists, Consultant Paediatricians, Consultant Surgeons
MP 24 Inflammatory Bowel Disease
A07EA02 Hydrocortisone Foam Enema 10%
Consultant Gastroenterologists, Consultant Surgeons, Consultant Paediatricians, Consultant Oncologists, Consultant Palliative Care
C Consultant Gastroenterologists, Consultant Surgeons, Consultant Paediatricians, Consultant Oncologists, Consultant Palliative Care
Inflammatory Bowel Disease
Availability temporarily suspended due to problematic sourcing.
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ATC Code Active Ingredient Dosage Form and Strength
Schedule V Prescriber Criteria
Protocol Pink Card
Pink Card Prescriber Criteria
Schedule V Entitlement
A07EA01 Prednisolone Retention Enema 20mg/100mL
Consultant Gastroenterologists, Consultant Surgeons, Consultant Paediatricians, Consultant Oncologists, Consultant Palliative Care
C Consultant Gastroenterologists, Consultant Surgeons, Consultant Paediatricians, Consultant Oncologists, Consultant Palliative Care
Inflammatory Bowel Disease, Malignant Diseases
1.5.3 Drugs affecting the immune response L04AB04 Adalimumab Solution for
Injection in Pre-filled Syringes 40mg
Consultant Dermatologists, Consultant Gastroenterologists, Consultant Paediatrician, Consultant Rheumatologists
MP 307 Hidradenitis Suppurativa, Inflammatory Bowel Disease, Psoriasis, Rheumatoid Arthritis, Spondyloarthritis
L04AX01 Azathioprine Tablets 50mg Consultants Myasthenia Gravis, Inflammatory Bowel Disease, Secondary Immunodeficiency Disorder, Chronic Liver Disease, Malignant Diseases, Chronic Kidney Disease, Chronic Respiratory Failure, Dermatomyositis/ Polymyositis, Lupus Erythematosus, Polyartritis Nodosa, Rheumatoid Arthritis, Severe Refractory Atopic Dermatitis, Spondyloarthritis, Systemic Sclerosis, Chronic Immunobullous Disorders, Psoriasis, Neuromyelitis Optica
L04AD01 Ciclosporin (Cyclosporin)
Capsules 100mg
Consultants MP 46 Inflammatory Bowel Disease, Secondary Immunodeficiency Disorder, Chronic Kidney Disease, Chronic Liver Disease, Malignant Diseases, Rheumatoid Arthritis, Severe Chronic Urticaria, Severe Refractory Atopic Dermatitis, Spondyloarthritis, Psoriasis
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ATC Code Active Ingredient Dosage Form and Strength
Schedule V Prescriber Criteria
Protocol Pink Card
Pink Card Prescriber Criteria
Schedule V Entitlement
L04AD01 Ciclosporin (Cyclosporin)
Capsules 25mg
Consultants MP 46 Inflammatory Bowel Disease, Secondary Immunodeficiency Disorder, Chronic Kidney Disease, Chronic Liver Disease, Malignant Diseases, Rheumatoid Arthritis, Severe Chronic Urticaria, Severe Refractory Atopic Dermatitis, Spondyloarthritis, Psoriasis
L04AD01 Ciclosporin (Cyclosporin)
Oral Solution 100mg/mL
Consultants MP 47 Secondary Immunodeficiency Disorder, Chronic Kidney Disease, Chronic Liver Disease, Rheumatoid Arthritis, Severe Chronic Urticaria, Severe Refractory Atopic Dermatitis, Psoriasis, Malignant Diseases
L01BB02 Mercaptopurine Tablets 50mg Consultants Inflammatory Bowel Disease, Secondary Immunodeficiency Disorder, Chronic Liver Disease, Malignant Diseases, Chronic Kidney Disease
L01BA01/ L04AX03
Methotrexate Tablets 2.5mg Consultants Inflammatory Bowel Disease, Secondary Immunodeficiency Disorder, Chronic Liver Disease, Malignant Diseases, Chronic Kidney Disease, Dermatomyositis/ Polymyositis, Lupus Erythematosus, Polyartritis Nodosa, Polymyalgia Rheumatica, Rheumatoid Arthritis, Severe Refractory Atopic Dermatitis, Spondyloarthritis, Systemic Sclerosis, Psoriasis
1.6 Laxatives 1.6.1 Bulk-forming laxatives
A06AC01 Ispaghula Husk Powder Consultants B Medical Practitioners Motor Neuron Disease, Parkinson's Disease, Spinal Cord Pathologies, Diverticular Disease requiring Stoma Care, Hirschsprung's Disease, Imperforate Anus, Inflammatory Bowel Disease, Polio and Post-Polio Syndrome, Malignant Diseases
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ATC Code Active Ingredient Dosage Form and Strength
Schedule V Prescriber Criteria
Protocol Pink Card
Pink Card Prescriber Criteria
Schedule V Entitlement
1.6.2 Stimulant laxatives A06AB02 Bisacodyl Suppositories
10mg Consultants A Medical Practitioners Multiple Sclerosis, Spinal Cord Pathologies,
Down Syndrome, Hirschsprung's Disease, Polio and Post-Polio Syndrome, Malignant Diseases, Chronic Kidney Disease
A06AB02 Bisacodyl Tablets 5mg Consultants A Medical Practitioners Multiple Sclerosis, Spinal Cord Pathologies, Down Syndrome, Hirschsprung's Disease, Polio and Post-Polio Syndrome, Malignant Diseases, Chronic Kidney Disease
A06AB53 Co-Danthramer Suspension 75/1000 in 5mL
Consultant Haematologists, Consultant Oncologists, Consultant Paediatricians, Consultant Palliative Care
MP 43 Malignant Diseases
A06AA02 Docusate Sodium Tablets 100mg Consultant Oncologist, Consultant Palliative Care
MP 54 Malignant Diseases
A06AX01 Glycerol Adult Suppositories 4g
Consultants A Medical Practitioners Cerebral Palsy, Motor Neuron Disease, Multiple Sclerosis, Parkinson's Disease, Spinal Cord Pathologies, Down Syndrome, Hirschsprung's Disease, Polio and Post-Polio Syndrome, Malignant Diseases, Chronic Kidney Disease
A06AX01 Glycerol Infant Suppositories 1g
Consultants A Medical Practitioners Cerebral Palsy, Motor Neuron Disease, Spinal Cord Pathology, Down Syndrome, Hirschsprung's Disease, Polio and Post-Polio Syndrome, Malignant Diseases, Chronic Kidney Disease
A06AB06 Senna Tablets 7.5mg Consultants A Medical Practitioners Multiple Sclerosis, Spinal Cord Pathologies, Down Syndrome, Hirschsprung's Disease, Imperforate Anus, Polio and Post-Polio Syndrome, Malignant Diseases, Chronic Kidney Disease
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ATC Code Active Ingredient Dosage Form and Strength
Schedule V Prescriber Criteria
Protocol Pink Card
Pink Card Prescriber Criteria
Schedule V Entitlement
1.6.3 Osmotic laxatives A06AD11 Lactulose Syrup
3.35g/5mL Consultants Cerebral Palsy, Chronic Mood Disorders,
Chronic Neurotic Disorders, Chronic Psychiatric Disorders Starting in Childhood, Cystic Fibrosis, Huntington's Chorea, Motor Neuron Disease, Multiple Sclerosis, Parkinson's Disease, Psychosis, Schizophrenia, Spinal Cord Pathologies, Down Syndrome, Hirschsprung's Disease, Imperforate Anus, Polio and Post-Polio Syndrome, Chronic Liver Disease, Malignant Diseases, Chronic Kidney Disease
A06AD Osmotic Laxative for Constipation (Currently macrogol 3350 with potassium chloride, sodium bicarbonate and sodium chloride)
Oral Liquid Consultants A Medical Practitioners Malignant Diseases, Spinal Cord Pathologies
A06AG11 Micro-Enemas (Currently Sodium Citrate Compound)
Micro-Enema Consultant Oncologists MP 130 TBDF SAMOC P only
Malignant Diseases
A06AG01 Phosphate Enema Consultants A Medical Practitioners Cerebral Palsy, Motor Neuron Disease, Multiple Sclerosis, Parkinson's Disease, Spinal Cord Pathologies, Imperforate Anus, Malignant Diseases
V3.0 September 2021
20 1. Gastro-Intestinal System
ATC Code Active Ingredient Dosage Form and Strength
Schedule V Prescriber Criteria
Protocol Pink Card
Pink Card Prescriber Criteria
Schedule V Entitlement
1.7 Drugs affecting intestinal secretions 1.7.1 Drugs affecting biliary composition and flow
A05AA02 Ursodeoxycholic Acid
Tablets 150mg Consultant Gastroenterologists, Consultant Oncologists, Consultant Paediatricians
Chronic Liver Disease, Malignant Diseases
A05AA02 Ursodeoxycholic Acid
Capsules 250mg
Consultant Gastroenterologists, Consultant Oncologists, Consultant Paediatricians
Chronic Liver Disease, Malignant Diseases
1.7.2 Bile acid sequestrants C10AC01 Colestyramine Powder Consultants C Medical Practitioners Chronic Liver Disease, Genetic Dyslipidaemia,
Ischaemic Heart Disease, Inflammatory Bowel Disease, Malignant Diseases
1.7.3 Pancreatin A09AA02 Pancreatin Capsules
(Creon 10,000U)
Consultants Enzyme Disorders, Malignant Diseases, Cystic Fibrosis
A09AA02 Pancreatin Capsules (Creon 25,000U)
Consultants Enzyme Disorders, Malignant Diseases, Cystic Fibrosis
V3.0 September 2021
21 2. Cardiovascular System
ATC Code Active Ingredient Dosage Form and Strength
Schedule V Prescriber Criteria
Protocol Pink Card
Pink Card Prescriber Criteria
Schedule V Entitlement
2. Cardiovascular System 2.1 Positive inotropic drugs
2.1.1 Cardiac glycosides C01AA05 Digoxin Oral Solution
0.05mg/mL Consultants C Consultants Chronic Heart Failure
C01AA05 Digoxin Tablets 0.0625mg
Consultants C Medical Practitioners Cardiac Arrhythmias, Chronic Heart Failure
C01AA05 Digoxin Tablets 0.25mg
Consultants C Medical Practitioners Cardiac Arrhythmias, Chronic Heart Failure
2.2 Diuretics 2.2.1 Thiazides and related diuretics
C03AA01 Bendroflumethiazide (Bendrofluazide)
Tablets 2.5mg Consultants, Specialist Family Medicine PHCD [Hypertension Only]
C Medical Practitioners Chronic Heart Failure, Hypertension, Chronic Kidney Disease
C03AA01 Bendroflumethiazide (Bendrofluazide)
Tablets 5mg Consultants, Specialist Family Medicine PHCD [Hypertension Only]
C Medical Practitioners Chronic Heart Failure, Hypertension, Chronic Kidney Disease
C03BA08 Metolazone Tartrate
Tablets 5mg Consultant Cardiac Surgeons, Consultant Physicians
MP 128
Chronic Heart Failure, Hypertension, Chronic Kidney Disease
2.2.2 Loop diuretics C03CA02 Bumetanide Tablets 1mg Consultants, Specialist
Family Medicine PHCD [Hypertension Only]
C Medical Practitioners Chronic Heart Failure, Hypertension, Chronic Liver Disease, Malignant Diseases, Chronic Kidney Disease, Chronic Obstructive Pulmonary Disease, Chronic Respiratory Failure
V3.0 September 2021
22 2. Cardiovascular System
ATC Code Active Ingredient Dosage Form and Strength
Schedule V Prescriber Criteria
Protocol Pink Card
Pink Card Prescriber Criteria
Schedule V Entitlement
C03CA02 Bumetanide Tablets 5mg Consultants, Specialist Family Medicine PHCD [Hypertension Only]
C Medical Practitioners Chronic Heart Failure, Hypertension, Chronic Liver Disease, Malignant Diseases, Chronic Kidney Disease, Chronic Obstructive Pulmonary Disease, Chronic Respiratory Failure
C03CA01 Furosemide Syrup 1mg/mL Consultants
Chronic Heart Failure, Chronic Liver Disease, Malignant Diseases, Chronic Kidney Disease, Chronic Respiratory Failure
C03CA01 Furosemide Tablets 40mg Consultants, Specialist Family Medicine PHCD [Hypertension Only]
C Medical Practitioners Chronic Heart Failure, Hypertension, Chronic Liver Disease, Malignant Diseases, Chronic Kidney Disease, Chronic Obstructive Pulmonary Disease, Chronic Respiratory Failure
2.2.3 Potassium-sparing diuretics and aldosterone antagonists C03DA01 Spironolactone Tablets 25mg Consultants, Specialist
Family Medicine PHCD [Hypertension Only], Consultants Endocrinology (Transgender MDT)
C Medical Practitioners Chronic Heart Failure, Chronic Kidney Disease, Chronic Liver Disease, Gender Identity & Sex Characteristics Related Conditions, Hidradenitis Suppurativa, Hypertension, Malignant Diseases
C03DA01 Spironolactone Tablets 100mg Consultants, Specialist Family Medicine PHCD [Hypertension Only], Consultants Endocrinology (Transgender MDT)
Chronic Heart Failure, Chronic Kidney Disease, Chronic Liver Disease, Gender Identity & Sex Characteristics Related Conditions, Hidradenitis Suppurativa, Hypertension, Malignant Diseases
2.2.4 Potassium-sparing diuretics with other diuretics C03EA01 Amiloride +
Hydrochlorothiazide Tablets 5mg + 50mg
Consultants, Specialist Family Medicine PHCD [Hypertension Only]
C Medical Practitioners Chronic Heart Failure, Hypertension, Malignant Diseases, Chronic Kidney Disease
V3.0 September 2021
23 2. Cardiovascular System
ATC Code Active Ingredient Dosage Form and Strength
Schedule V Prescriber Criteria
Protocol Pink Card
Pink Card Prescriber Criteria
Schedule V Entitlement
C03EB01 Co-amilofruse (Amiloride + Furosemide
[Frusemide])
Tablets 5mg + 40mg
Consultant Cardiologists, Consultant Cardiac Surgeons
MP 82
Chronic Heart Failure
2.3 Anti-arrhythmic drugs C01BD01 Amiodarone HCl Tablets 200mg Consultants Cardiac Arrhythmias, Chronic Heart Failure
C01BA03 Disopyramide Tablets 100mg Consultants C Consultants Cardiac Arrhythmias
C01BC04 Flecainide Tablets 100mg Consultants Cardiac Arrhythmias
C01BB02 Mexiletine Capsules 200mg
Consultant Cardiologists MP 142
Cardiac Arrhythmias
C01BC03 Propafenone Tablets 150mg Consultant Physicians, Consultant Cardiologists
MP 169
Cardiac Arrhythmias
2.4 Beta-adrenoceptor blocking drugs C07AB03 Atenolol Tablets 25mg
or Scored Tablets 50mg
Consultants, Specialist Family Medicine PHCD [Hypertension Only]
C Medical Practitioners Cardiac Arrhythmias, Chronic Kidney Disease, Chronic Neurotic Disorders, Hypertension, Ischaemic Heart Disease, Malignant Diseases
C07AB03 Atenolol Tablets 100mg Consultants, Specialist Family Medicine PHCD [Hypertension Only]
C Medical Practitioners Cardiac Arrhythmias, Chronic Kidney Disease, Chronic Neurotic Disorders, Hypertension, Ischaemic Heart Disease, Malignant Diseases
C07AG02 Carvedilol Tablets 6.25mg
Consultants
Chronic Heart Failure, Hypertension, Ischaemic Heart Disease, Chronic Kidney Disease
C07AG02 Carvedilol Tablets 25mg Consultants
Chronic Heart Failure, Hypertension, Ischaemic Heart Disease, Chronic Kidney Disease
C07AG01 Labetalol Hydrochloride
Tablets 100mg Consultants, Specialist Family Medicine PHCD [Hypertension Only]
C Hospital Doctors Hypertension, Ischaemic Heart Disease, Chronic Kidney Disease
Officially deleted. Available until stocks last.
V3.0 September 2021
24 2. Cardiovascular System
ATC Code Active Ingredient Dosage Form and Strength
Schedule V Prescriber Criteria
Protocol Pink Card
Pink Card Prescriber Criteria
Schedule V Entitlement
C07AG01 Labetalol Hydrochloride
Tablets 200mg Consultants, Specialist Family Medicine PHCD [Hypertension Only]
C Hospital Doctors Hypertension, Ischaemic Heart Disease, Chronic Kidney Disease
C07AB02 Metoprolol Tartrate
Scored Tablets 100mg
Consultants
Cardiac Arrhythmias, Hypertension, Ischaemic Heart Disease, Chronic Psychiatric Disorders Starting in Childhood, Chronic Kidney Disease
C07AA05 Propranolol Hydrochloride
Oral Solution 1mg/mL
Consultant Paediatricians, Consultant Psychiatrists
Cardiac Arrhythmias, Chronic Psychiatric Disorders Starting in Childhood, Chronic Liver Disease
C07AA05 Propranolol Hydrochloride
Tablets 10mg Consultants, Specialist Family Medicine PHCD [Hypertension Only]
C Medical Practitioners Addiction Disorders, Cardiac Arrhythmias, Chronic Kidney Disease, Chronic Liver Disease, Chronic Mood Disorders, Chronic Neurotic Disorders, Chronic Psychiatric Disorders Starting in Childhood, Dementia, Down Syndrome, Hypertension, Hypopituitarism, Ischaemic Heart Disease, Malignant Diseases, Psychosis, Schizophrenia, Turner Syndrome
C07AA05 Propranolol Hydrochloride
Tablets 40mg Consultants, Specialist Family Medicine PHCD [Hypertension Only]
C Medical Practitioners Addiction Disorders, Cardiac Arrhythmias, Chronic Kidney Disease, Chronic Liver Disease, Chronic Mood Disorders, Chronic Neurotic Disorders, Chronic Psychiatric Disorders Starting in Childhood, Dementia, Down Syndrome, Hypertension, Hypopituitarism, Ischaemic Heart Disease, Malignant Diseases, Psychosis, Schizophrenia, Turner Syndrome
C07AA07 Sotalol Tablets 80mg Consultants Cardiac Arrhythmias
V3.0 September 2021
25 2. Cardiovascular System
ATC Code Active Ingredient Dosage Form and Strength
Schedule V Prescriber Criteria
Protocol Pink Card
Pink Card Prescriber Criteria
Schedule V Entitlement
2.5 Hypertension and heart failure 2.5.1 Vasodilator antihypertensive drugs
L04AX04 Sildenafil Tablets 20mg Consultant Respiratory Physicians, Consultant Cardiologists, Consultant Paediatricians, Consultant Rheumatologists
MP 181 Chronic Heart Failure, Chronic Respiratory Failure, Systemic Sclerosis
C02DB02 Hydralazine Tablets 25mg Consultants, Specialist Family Medicine PHCD [Hypertension Only]
C Medical Practitioners Chronic Heart Failure, Hypertension
2.5.2 Centrally acting antihypertensive drugs C02AC01 Clonidine
Hydrochloride Tablets 100mcg
Consultants C Consultants Addiction Disorders, Hypertension, Chronic Psychiatric Disorders Starting in Childhood
C02AB Methyldopa Tablets 250mg Consultants, Specialist Family Medicine PHCD [Hypertension Only]
C Medical Practitioners Hypertension
2.5.3 Alpha-adrenoceptor blocking drugs C02CA04 Doxazosin Tablets 1mg Consultants, Specialist
Family Medicine PHCD
Hypertension
C02CA04 Doxazosin Tablets 2mg Consultants [Hypertension Only], Specialist Family Medicine PHCD [Hypertension Only], Consultant Urologists
C Consultant Urologist Hypertension, Benign Prostatic Enlargement
C02CA04 Doxazosin Tablets 4mg Consultants, Specialist Family Medicine PHCD
Hypertension
V3.0 September 2021
26 2. Cardiovascular System
ATC Code Active Ingredient Dosage Form and Strength
Schedule V Prescriber Criteria
Protocol Pink Card
Pink Card Prescriber Criteria
Schedule V Entitlement
C04AX02 Phenoxybenzamine Capsules 10mg
Consultant Anaesthetists, Consultants Endocrinology & Diabetes, Consultant Intensivists, Consultant Oncologists
MP 238
Chronic Kidney Disease, Malignant Diseases
C02CA01 Prazosin Hydrochloride
Tablets 1mg Consultant Physicians, Consultant Cardiologists, Consultant Cardiac Surgeons
MP 166
Chronic Heart Failure
2.5.4 Drugs affecting the renin-angiotensin system 2.5.4.1 Angiotensin-converting enzyme inhibitors
C09AA01 Captopril Tablets 25mg Consultants C Medical Practitioners Chronic Heart Failure, Hypertension, Ischaemic Heart Disease, Diabetes Mellitus Type 1, Diabetes Mellitus Type 2, Chronic Kidney Disease
C09AA02 Enalapril Tablets 5mg Consultants, Specialist Family Medicine PHCD [Hypertension Only]
C Medical Practitioners Chronic Heart Failure, Hypertension, Ischaemic Heart Disease, Diabetes Mellitus Type 1, Diabetes Mellitus Type 2, Chronic Kidney Disease
C09AA02 Enalapril Tablets 20mg Consultants, Specialist Family Medicine PHCD [Hypertension Only]
C Medical Practitioners Chronic Heart Failure, Hypertension, Ischaemic Heart Disease, Diabetes Mellitus Type 1, Diabetes Mellitus Type 2, Chronic Kidney Disease
C09AA03 Lisinopril Tablets 5mg Consultants, Specialist Family Medicine PHCD [Hypertension Only]
Chronic Heart Failure, Hypertension, Ischaemic Heart Disease, Diabetes Mellitus Type 1, Diabetes Mellitus Type 2, Chronic Kidney Disease
C09AA03 Lisinopril Tablets 10mg Consultants, Specialist Family Medicine PHCD [Hypertension Only]
Chronic Heart Failure, Hypertension, Ischaemic Heart Disease, Diabetes Mellitus Type 1, Diabetes Mellitus Type 2, Chronic Kidney Disease
V3.0 September 2021
27 2. Cardiovascular System
ATC Code Active Ingredient Dosage Form and Strength
Schedule V Prescriber Criteria
Protocol Pink Card
Pink Card Prescriber Criteria
Schedule V Entitlement
C09AA04 Perindopril Tablets 4mg Consultants, Specialist Family Medicine PHCD [Hypertension Only]
Chronic Heart Failure, Hypertension, Ischaemic Heart Disease, Diabetes Mellitus Type 1, Diabetes Mellitus Type 2, Malignant Diseases, Chronic Kidney Disease
2.5.4.2 Angiotensin-II receptor antagonists C09CA03 Angiotensin-II
Receptor Anatagonists (Currently Valsartan)
Tablets Consultant Physicians, Consultant Cardiologists, Consultant Cardiac Surgeons, Specialist Family Medicine PHCD [Hypertension Only]
MP 9
Chronic Heart Failure, Hypertension, Ischaemic Heart Disease, Diabetes Mellitus Type 1, Diabetes Mellitus Type 2, Chronic Kidney Disease
2.6 Nitrates, calcium-channel blockers, and other antianginal drugs 2.6.1 Nitrates
C01DA02 Glyceryl Trinitrate
Sublingual tablets 500mcg
Consultants C Medical Practitioners Ischaemic Heart Disease
C01DA02 Glyceryl Trinitrate
Transdermal Patches 5mg/24hrs
Consultant Physicians, Consultant Cardiologists, Consultant Cardiac Surgeons
Ischaemic Heart Disease
C01DA02 Glyceryl Trinitrate
Transdermal Patches 10mg/24hrs
Consultant Physicians, Consultant Cardiologists, Consultant Cardiac Surgeons
Ischaemic Heart Disease
C01DA08 Isosorbide Dinitrate
Tablets 10mg Consultants C Medical Practitioners Chronic Heart Failure, Ischaemic Heart Disease, Chronic Liver Disease
C01DA14 Isosorbide Mononitrate
Tablets 20mg Consultant Physicians, Consultant Cardiologists, Consultant Cardiac Surgeons, Consultant Gastroenterologists
Chronic Heart Failure, Ischaemic Heart Disease, Chronic Liver Disease
V3.0 September 2021
28 2. Cardiovascular System
ATC Code Active Ingredient Dosage Form and Strength
Schedule V Prescriber Criteria
Protocol Pink Card
Pink Card Prescriber Criteria
Schedule V Entitlement
C01DA14 Isosorbide Mononitrate
Tablets SR 60mg
Consultant Physicians, Consultant Cardiologists, Consultant Cardiac Surgeons
Chronic Heart Failure, Ischaemic Heart Disease
2.6.2 Calcium-channel blockers C08CA01 Amlodipine Tablets 5mg Consultants, Specialist
Family Medicine PHCD [Hypertension Only]
Hypertension, Ischaemic Heart Disease, Malignant Diseases, Chronic Kidney Disease, Lupus Erythematosus, Systemic Sclerosis
C08CA01 Amlodipine Tablets 10mg Consultants, Specialist Family Medicine PHCD [Hypertension Only]
Hypertension, Ischaemic Heart Disease, Malignant Diseases, Chronic Kidney Disease, Lupus Erythematosus, Systemic Sclerosis
C08DB01 Diltiazem Tablets 60mg Consultants, Specialist Family Medicine PHCD [Hypertension Only]
Cardiac Arrhythmias, Hypertension, Ischaemic Heart Disease, Chronic Kidney Disease, Systemic Sclerosis
C08CA05 Nifedipine Modified Release Tablets 10mg
Consultants, Specialist Family Medicine PHCD [Hypertension Only]
Hypertension, Chronic Kidney Disease
C08CA05 Nifedipine Tablets/ Capsules 10mg#
Consultants
Chronic Kidney Disease, Lupus Erythematosus, Systemic Sclerosis
C08DA01 Verapamil Slow-Release Tablets 240mg
Consultant Physicians, Consultant Cardiologists, Consultant Cardiac Surgeons
Cardiac Arrhythmias
C08DA01 Verapamil Tablets 40mg Consultants, Specialist Family Medicine PHCD [Hypertension Only]
C Medical Practitioners Cardiac Arrhythmias, Hypertension, Ischaemic Heart Disease, Chronic Kidney Disease
# Officially deleted. Available until stocks last.
V3.0 September 2021
29 2. Cardiovascular System
ATC Code Active Ingredient Dosage Form and Strength
Schedule V Prescriber Criteria
Protocol Pink Card
Pink Card Prescriber Criteria
Schedule V Entitlement
2.6.3 Other antianginal drugs C01DX16 Nicorandil Tablets 10mg Consultant Physicians,
Consultant Cardiologists MP 144
Ischaemic Heart Disease
2.6.4 Peripheral vasodilators and related drugs C04AD03 Pentoxifylline
(Oxypentifylline) Tablets 400mg Consultant Cardiologists,
Consultant Cardiac Surgeons, Consultant Vascular Surgeons, Consultant Rheumatologists
Peripheral Vascular Disease, Lupus Erythematosus, Systemic Sclerosis
2.6.5 3-KAT inhibitors C01EB15 Trimetazidine
Hydrochloride Tablets 20mg Consultant Physicians,
Consultant Cardiologists, Consultant Cardiac Surgeons
Ischaemic Heart Disease
2.7 Anticoagulants and protamine 2.7.1 Parenteral anticoagulants
B01AB01 Heparin Sodium in Sodium Chloride
Flushing Solution 10 IU/mL in 5mL
Consultants TBDF Hospitals only (TPN
patients only)
Small Intestinal Failure
B01AB05 Enoxaparin Sodium
Pre-filled syringe 20mg (2,000 IU)
Consultants MP 204
Enzyme Disorders, Malignant Diseases, Thromboprophylaxis in pregnancy
B01AB05 Enoxaparin Sodium
Pre-filled syringe 40mg (4,000 IU)
Consultants MP 204
Enzyme Disorders, Malignant Diseases, Thromboprophylaxis in pregnancy
Availability temporarily suspended due to problematic sourcing.
V3.0 September 2021
30 2. Cardiovascular System
ATC Code Active Ingredient Dosage Form and Strength
Schedule V Prescriber Criteria
Protocol Pink Card
Pink Card Prescriber Criteria
Schedule V Entitlement
B01AB05 Enoxaparin Sodium
Pre-filled syringe 60mg (6,000 IU)
Consultants MP 204
Enzyme Disorders, Malignant Diseases, Thromboprophylaxis in pregnancy
B01AB05 Enoxaparin Sodium
Pre-filled syringe 80mg (8,000 IU)
Consultants MP 204
Enzyme Disorders, Malignant Diseases, Thromboprophylaxis in pregnancy
B01AB05 Enoxaparin Sodium
Pre-filled syringe 100mg (10,000 IU)
Consultants MP 204
Enzyme Disorders, Malignant Diseases, Thromboprophylaxis in pregnancy
2.7.2 Oral anticoagulants B01AA03 Warfarin Tablets 1mg Consultants C Medical Practitioners Cardiac Arrhythmias, Cerebrovascular Disease,
Chronic Heart Failure, Chronic Liver Disease, Ischaemic Heart Disease, Lupus Erythematosus, Malignant Diseases, Peripheral Vascular Disease
B01AA03 Warfarin Tablets 3mg Consultants C Medical Practitioners Cardiac Arrhythmias, Cerebrovascular Disease, Chronic Heart Failure, Chronic Liver Disease, Ischaemic Heart Disease, Lupus Erythematosus, Malignant Diseases, Peripheral Vascular Disease
B01AA03 Warfarin Tablets 5mg Consultants C Medical Practitioners Cardiac Arrhythmias, Cerebrovascular Disease, Chronic Heart Failure, Chronic Liver Disease, Ischaemic Heart Disease, Lupus Erythematosus, Malignant Diseases, Peripheral Vascular Disease
V3.0 September 2021
31 2. Cardiovascular System
ATC Code Active Ingredient Dosage Form and Strength
Schedule V Prescriber Criteria
Protocol Pink Card
Pink Card Prescriber Criteria
Schedule V Entitlement
2.8 Antiplatelet drugs B01AC06 Aspirin Tablets 75mg Consultants, Specialist
Family Medicine PHCD [Hypertension Only]
C Medical Practitioners Cardiac Arrhythmias, Cerebrovascular Disease, Hypertension, Ischaemic Heart Disease, Peripheral Vascular Disease, Diabetes Mellitus Type 1, Diabetes Mellitus Type 2, Inherited Haemoglobinopathies, Malignant Diseases, Systemic Sclerosis
B01AC04 Clopidogrel Tablets 75mg Consultant Physicians MP 276 Ischaemic Heart Disease
B01AC07 Dipyridamole Tablets 25mg Consultants C Medical Practitioners Cerebrovascular Disease, Chronic Heart Failure, Ischaemic Heart Disease, Peripheral Vascular Disease, Diabetes Mellitus Type 1, Diabetes Mellitus Type 2, Systemic Sclerosis
B01AC07 Dipyridamole Tablets 100mg Consultants C Medical Practitioners Cerebrovascular Disease, Chronic Heart Failure, Ischaemic Heart Disease, Peripheral Vascular Disease, Diabetes Mellitus Type 1, Diabetes Mellitus Type 2, Systemic Sclerosis
2.9 Antifibrinolytic drugs and heamostatics B02BD02 Anti-Haemophilic
Factor VIII (stand-by)
Infusion 500IU Consultant Haematologists, Consultant Paediatricians, Consultant Infectious Diseases Physician
TBDF Hospitals
only
Inherited Bleeding Disorders
B02BD02 Anti-Haemophilic Factor VIII (stand-by)
Infusion 1000IU
Consultant Haematologists, Consultant Paediatricians, Consultant Infectious Diseases Physician
TBDF Hospitals
only
Inherited Bleeding Disorders
V3.0 September 2021
32 2. Cardiovascular System
ATC Code Active Ingredient Dosage Form and Strength
Schedule V Prescriber Criteria
Protocol Pink Card
Pink Card Prescriber Criteria
Schedule V Entitlement
B02BD06 Anti-Heamophilic Factor VIII Intermediate
Injection IV 500IU
Consultant Haematologists, Consultant Paediatricians, Consultant Infectious Diseases Physicians
TBDF Hospitals
only
Inherited Bleeding Disorders
B02BD03 Anti-Haemophilic Factor VIII inhibitor bypassing activity/fraction
Injection IV 500U or 1000U
Consultant Haematologists, Consultant Paediatricians, Consultant Infectious Diseases Physicians
TBDF Hospitals
only
Inherited Bleeding Disorders
B02BD04 Anti-Haemophilic Factor IX
Infusion 500IU Consultant Haematologists, Consultant Paediatricians, Consultant Infectious Diseases Physicians
TBDF Hospitals
only
Inherited Bleeding Disorders
B02BD08 Eptacog Alfa (Recombinant Factor VIIa) (stand-by)
Vials Consultant Anaesthetists, Consultant Haematologists
TBDF Hospitals
only
Inherited Bleeding Disorders
B02BB01 Fibrinogen Concentrate
Vials Consultants Haematologists
MP 212 TBDF
MDHP only
Inherited Bleeding Disorders
B02BD07 Factor XIII Concentrate
Vials Consultant Haematologists MP 211 TBDF
Hospitals only
Inherited Bleeding Disorders
B02AA02 Tranexamic Acid Tablets 500mg Consultants
Inherited Bleeding Disorders, Malignant Diseases
V3.0 September 2021
33 2. Cardiovascular System
ATC Code Active Ingredient Dosage Form and Strength
Schedule V Prescriber Criteria
Protocol Pink Card
Pink Card Prescriber Criteria
Schedule V Entitlement
2.10 Lipid-regulating drugs C10AA05 Atorvastatin Tablets 10mg Consultants, Specialist
Family Medicine PHCD
DM Consultants Cerebrovascular Disease, Genetic
Dyslipidaemia, Hypertension, Ischaemic Heart Disease, Peripheral Vascular Disease, Diabetes Mellitus Type 1, Diabetes Mellitus Type 2, Chronic Kidney Disease
C10AA05 Atorvastatin Tablets 20mg Consultants, Specialist Family Medicine PHCD
DM Consultants Cerebrovascular Disease, Genetic Dyslipidaemia, Hypertension, Ischaemic Heart Disease, Peripheral Vascular Disease, Diabetes Mellitus Type 1, Diabetes Mellitus Type 2, Chronic Kidney Disease
C10AA05 Atorvastatin Tablets 40mg Consultants, Specialist Family Medicine PHCD
DM Consultants Cerebrovascular Disease, Genetic Dyslipidaemia, Hypertension, Ischaemic Heart Disease, Peripheral Vascular Disease, Diabetes Mellitus Type 1, Diabetes Mellitus Type 2, Chronic Kidney Disease
C10AB02 Bezafibrate Modified Release Tablets 400mg
Consultants, Specialist Family Medicine PHCD
DM Consultants Genetic Dyslipidaemia, Hypertension, Ischaemic Heart Disease, Diabetes Mellitus Type 1, Diabetes Mellitus Type 2
C10AC01 Colestyramine Powder Consultants C Medical Practitioners Chronic Liver Disease, Genetic Dyslipidaemia, Ischaemic Heart Disease, Inflammatory Bowel Disease, Malignant Diseases
C10AB05 Fenofibrate Micronised 200mg Capsules or Nanocrystal 145mg Tablets
Consultants, Specialist Family Medicine PHCD
DM Consultants Genetic Dyslipidaemia, Hypertension, Ischaemic Heart Disease, Diabetes Mellitus Type 1, Diabetes Mellitus Type 2
C10AB05 Fenofibrate Micronised 67mg Capsules
Consultants, Specialist Family Medicine PHCD
DM Consultants Genetic Dyslipidaemia, Hypertension, Ischaemic Heart Disease, Diabetes Mellitus Type 1, Diabetes Mellitus Type 2
V3.0 September 2021
34 2. Cardiovascular System
ATC Code Active Ingredient Dosage Form and Strength
Schedule V Prescriber Criteria
Protocol Pink Card
Pink Card Prescriber Criteria
Schedule V Entitlement
C10AA07 Rosuvastatin Tablets 20mg Consultants, Specialist Family Medicine PHCD
MP 177 DM Consultants Cerebrovascular Disease, Genetic Dyslipidaemia, Hypertension, Ischaemic Heart Disease, Peripheral Vascular Disease, Diabetes Mellitus Type 1, Diabetes Mellitus Type 2, Chronic Kidney Disease
C10AA07 Rosuvastatin Tablets 40mg Consultants, Specialist Family Medicine PHCD
MP 177 DM Consultants Cerebrovascular Disease, Genetic Dyslipidaemia, Hypertension, Ischaemic Heart Disease, Peripheral Vascular Disease, Diabetes Mellitus Type 1, Diabetes Mellitus Type 2, Chronic Kidney Disease
C10AA01 Simvastatin Tablets 10mg Consultants, Specialist Family Medicine PHCD
DM Consultants Cerebrovascular Disease, Genetic Dyslipidaemia, Hypertension, Ischaemic Heart Disease, Peripheral Vascular Disease, Diabetes Mellitus Type 1, Diabetes Mellitus Type 2, Chronic Kidney Disease
C10AA01 Simvastatin Tablets 20mg Consultants, Specialist Family Medicine PHCD
DM Consultants Cerebrovascular Disease, Genetic Dyslipidaemia, Hypertension, Ischaemic Heart Disease, Peripheral Vascular Disease, Diabetes Mellitus Type 1, Diabetes Mellitus Type 2, Chronic Kidney Disease
C10AA01 Simvastatin Tablets 40mg Consultants, Specialist Family Medicine PHCD
DM Consultants Cerebrovascular Disease, Genetic Dyslipidaemia, Hypertension, Ischaemic Heart Disease, Peripheral Vascular Disease, Diabetes Mellitus Type 1, Diabetes Mellitus Type 2, Chronic Kidney Disease
V3.0 September 2021
35 3. Respiratory System
ATC Code Active Ingredient
Dosage Form and Strength
Schedule V Prescriber Criteria
Protocol Pink Card
Pink Card Prescriber Criteria
Schedule V Entitlement
3. Respiratory System 3.1 Bronchodilators
H02AB06 Prednisolone Soluble Tablets 5mg
Consultant Paediatricians
Addison's Disease, Chronic Asthma, Chronic Kidney Disease, Chronic Respiratory Failure, Cystic Fibrosis, Dermatomyositis/ Polymyositis, Epilepsy, Hypopituitarism, Inflammatory Bowel Disease, Lupus Erythematosus, Malignant Diseases, Myasthenia Gravis, Polymyalgia Rheumatica, Rheumatoid Arthritis, Spondyloarthritis
H02AB06 Prednisolone Tablets 1mg Consultants B Medical Practitioners Addison's Disease, Chronic Asthma, Chronic Kidney Disease, Chronic Liver Disease, Chronic Obstructive Pulmonary Disease, Chronic Respiratory Failure, Cystic Fibrosis, Dermatomyositis/ Polymyositis, Enzyme Disorders, Epilepsy, HIV/AIDS and HIV Related Diseases, Hypopituitarism, Inflammatory Bowel Disease, Leprosy, Lupus Erythematosus, Malignant Diseases, Multiple Sclerosis, Myasthenia Gravis,Neuromyelitis Optica, Polyartritis Nodosa, Polymyalgia Rheumatica, Rheumatoid Arthritis, Secondary Immunodeficiency Disorder, Spondyloarthritis, Systemic Sclerosis
V3.0 September 2021
36 3. Respiratory System
ATC Code Active Ingredient
Dosage Form and Strength
Schedule V Prescriber Criteria
Protocol Pink Card
Pink Card Prescriber Criteria
Schedule V Entitlement
H02AB06 Prednisolone Tablets 5mg Consultants GU Clinic Entitlement: GU Clinic Consultant
B Medical Practitioners,
Addison's Disease, Chronic Asthma, Chronic Immunobullous Disorders, Chronic Kidney Disease, Chronic Liver Disease, Chronic Obstructive Pulmonary Disease, Chronic Respiratory Failure, Cystic Fibrosis, Dermatomyositis/ Polymyositis, Enzyme Disorders, Epilepsy, HIV/AIDS and HIV Related Diseases, Hypopituitarism, Inflammatory Bowel Disease, Leprosy, Lupus Erythematosus, Malignant Diseases, Multiple Sclerosis, Myasthenia Gravis, Neuromyelitis Optica, Polyartritis Nodosa, Polymyalgia Rheumatica, Rheumatoid Arthritis, Secondary Immunodeficiency Disorder, Spondyloarthritis, Systemic Sclerosis
H02AB06 Prednisolone Tablets enteric-coated 5mg
Consultants B Medical Practitioners Addison's Disease, Chronic Asthma, Chronic Immunobullous Disorders, Chronic Kidney Disease, Chronic Liver Disease, Chronic Obstructive Pulmonary Disease, Chronic Respiratory Failure, Cystic Fibrosis, Dermatomyositis/ Polymyositis, Enzyme Disorders, Epilepsy, HIV/AIDS and HIV Related Diseases, Hypopituitarism, Inflammatory Bowel Disease, Leprosy, Lupus Erythematosus, Malignant Diseases, Multiple Sclerosis, Myasthenia Gravis, Neuromyelitis Optica, Polyartritis Nodosa, Polymyalgia Rheumatica, Rheumatoid Arthritis, Secondary Immunodeficiency Disorder, Spondyloarthritis, Systemic Sclerosis
V3.0 September 2021
37 3. Respiratory System
ATC Code Active Ingredient
Dosage Form and Strength
Schedule V Prescriber Criteria
Protocol Pink Card
Pink Card Prescriber Criteria
Schedule V Entitlement
3.1.1 Adrenoceptor agonists 3.1.1.1 Selective beta2 agonists
R03AC12/ R03AC13
Long Acting Beta2-Agonist for children aged 4-12 years (Formoterol or Salmeterol)
Inhaler Consultant Respiratory Physicians, Consultant Paediatricians, Specialist Respiratory Medicine Consultants
MP 270
Chronic Asthma, Chronic Respiratory Failure, Cystic Fibrosis
R03AC12/ R03AC13
Long Acting Beta2-Agonist for patients over 12 years (Formoterol or Salmeterol)
Inhaler Consultant Respiratory Physicians, Consultant Paediatricians, Specialist Respiratory Medicine Consultants, Consultant Geriatricians
MP 271
Chronic Asthma, Chronic Obstructive Pulmonary Disease, Chronic Respiratory Failure, Cystic Fibrosis
R03AC02 Salbutamol Inhaler 100mcg/puff
Consultants B Medical Practitioners Malignant Diseases, Chronic Asthma, Chronic Obstructive Pulmonary Disease, Chronic Respiratory Failure, Cystic Fibrosis
R03AC02 Salbutamol Respiratory Solution 5mg/mL
Consultants C Medical Practitioners Malignant Diseases, Chronic Asthma, Chronic Obstructive Pulmonary Disease, Chronic Respiratory Failure, Cystic Fibrosis
R03AC02 Salbutamol Syrup 2mg/5mL Consultants B Medical Practitioners Malignant Diseases, Chronic Asthma
R03AC02 Salbutamol Tablets 4mg Consultants B Medical Practitioners Malignant Diseases
R03AC03 Terbutaline Dry Powder Inhaler 500mcg
Consultant Respiratory Physicians, Consultant Paediatricians, Specialist Respiratory Medicine Consultants
MP 206
Chronic Asthma, Chronic Obstructive Pulmonary Disease, Chronic Respiratory Failure, Cystic Fibrosis
V3.0 September 2021
38 3. Respiratory System
ATC Code Active Ingredient
Dosage Form and Strength
Schedule V Prescriber Criteria
Protocol Pink Card
Pink Card Prescriber Criteria
Schedule V Entitlement
3.1.2 Antimuscarinic bronchodilators R03BB01 Ipratropium Inhaler
20mcg/dose Consultants
Malignant Diseases, Chronic Obstructive Pulmonary Disease, Chronic Respiratory Failure, Cystic Fibrosis
R03BB01 Ipratropium Nebuliser Solution 250mcg/mL
Consultants
Malignant Diseases, Chronic Obstructive Pulmonary Disease, Chronic Respiratory Failure, Cystic Fibrosis
R03BB07 Umeclidinium Dry Powder Inhaler 55mcg/dose
Consultant Respiratory Physicians
MP 111
Chronic Obstructive Pulmonary Disease
3.1.3 Theophylline R03DA04 Theophylline Prolonged
Release Tablets 200mg
Consultant Respiratory Physicians, Specialist Respiratory Medicine Consultants
Chronic Asthma, Chronic Obstructive Pulmonary Disease, Chronic Respiratory Failure
3.2 Corticosteroids R03BA01 Beclometasone
Dipropionate Inhaler 50mcg Consultants B Medical Practitioners Malignant Diseases, Chronic Asthma, Chronic
Respiratory Failure, Cystic Fibrosis
R03BA01 Beclometasone Dipropionate
Inhaler 250mcg Consultants
Malignant Diseases, Chronic Asthma, Chronic Obstructive Pulmonary Disease, Chronic Respiratory Failure, Cystic Fibrosis
R03BA02 Budesonide Dry Powder Metered Dose Inhaler 100mcg/ Dose
Consultant Respiratory Physicians, Consultant Paediatricians, Specialist Respiratory Medicine Consultants
MP 27
Chronic Asthma, Chronic Obstructive Pulmonary Disease, Chronic Respiratory Failure, Cystic Fibrosis
R03BA02 Budesonide Inhaler 200mcg/ Dose
Consultants MP 26
Chronic Asthma, Chronic Obstructive Pulmonary Disease, Chronic Respiratory Failure, Cystic Fibrosis
V3.0 September 2021
39 3. Respiratory System
ATC Code Active Ingredient
Dosage Form and Strength
Schedule V Prescriber Criteria
Protocol Pink Card
Pink Card Prescriber Criteria
Schedule V Entitlement
R03BA02 Budesonide Nebuliser Solution Ampoules 0.25mg/mL
Consultant Respiratory Physicians, Consultant Paediatricians, Consultant Oncologists, Specialist Respiratory Medicine Consultants
MP 28
Chronic Asthma, Chronic Respiratory Failure, Cystic Fibrosis
R03BA02 Budesonide Nebuliser Solution Ampoules 0.5mg/mL
Consultant Respiratory Physicians, Consultant Paediatricians, Consultant Oncologists, Specialist Respiratory Medicine Consultants
MP 28
Chronic Asthma, Chronic Respiratory Failure, Cystic Fibrosis
R03BA05 Fluticasone Inhaler 50mcg Consultant Respiratory Physicians, Consultant Paediatricians, Specialist Respiratory Medicine Consultants
MP 77
Chronic Asthma, Chronic Respiratory Failure, Cystic Fibrosis
R03BA05 Fluticasone Inhaler 250mcg Consultant Respiratory Physicians, Consultant Paediatricians, Specialist Respiratory Medicine Consultants
MP 78
Chronic Asthma, Chronic Obstructive Pulmonary Disease, Chronic Respiratory Failure, Cystic Fibrosis
3.3 Cromoglicate and related therapy, leukotriene receptor antagonists, and phosphodiesterase type-4 inhibitors 3.3.1 Leukotriene Receptor Antagonists
R03DC03 Montelukast Chewable Tablets 4mg
Consultant Respiratory Physicians, Consultant Paediatricians
MP 295
Chronic Asthma
V3.0 September 2021
40 3. Respiratory System
ATC Code Active Ingredient
Dosage Form and Strength
Schedule V Prescriber Criteria
Protocol Pink Card
Pink Card Prescriber Criteria
Schedule V Entitlement
R03DC03 Montelukast Chewable Tablets 5mg
Consultant Respiratory Physicians, Consultant Paediatricians
MP 295
Chronic Asthma
R03DC03 Montelukast Tablets 10mg Consultant Respiratory Physicians, Consultant Paediatricians
MP 295
Chronic Asthma
3.4 Antihistamines, hyposensitisation, and allergic emergencies 3.4.1 Antihistamines
N05BB01 Hydroxyzine Hydrochloride
Tablets 25mg Consultants B Medical Practitioners Addiction Disorders, Chronic Neurotic Disorders, Chronic Psychiatric Disorders Starting in Childhood, Chronic Liver Disease, Malignant Diseases, Severe Refractory Atopic Dermatitis
R06AD02 Promethazine Hydrochloride
Syrup 5mg/5mL Consultants A Medical Practitioners Addiction Disorders, Dermatomyositis/ Polymyositis, Malignant Diseases, Severe Refractory Atopic Dermatitis
R06AD02 Promethazine Hydrochloride
Tablets 10mg Consultants B Medical Practitioners Addiction Disorders, Dermatomyositis/ Polymyositis, Malignant Diseases, Severe Refractory Atopic Dermatitis
R06AD02 Promethazine Hydrochloride
Tablets 25mg Consultants B Medical Practitioners Addiction Disorders, Dermatomyositis/ Polymyositis, Malignant Diseases, Severe Refractory Atopic Dermatitis
3.4.2 Allergen Immunotherapy R03DX05 Omalizumab Injections
150mg Consultant Respiratory Physicians, Consultant Paediatricians
MP 294 TBDF
Hospitals only
Chronic Asthma
V3.0 September 2021
41 3. Respiratory System
ATC Code Active Ingredient
Dosage Form and Strength
Schedule V Prescriber Criteria
Protocol Pink Card
Pink Card Prescriber Criteria
Schedule V Entitlement
3.5 Oxygen V03AN01 Medical Oxygen
1.5m³ Gas Medical Practitioners
Chronic Obstructive Pulmonary Disease
3.6 Mucolytics R05CB02 Bromhexine Syrup 4mg/5mL Consultants A Medical Practitioners Malignant Diseases, Chronic Respiratory Failure
R05CB13 Dornase Alfa Nebuliser Solution 1000units/mL (2.5mg)
Consultant Paediatricians, Consultant Respiratory Physicians
MP 52
Cystic Fibrosis
R07AX02 Ivacaftor Tablets 150mg Consultant Paediatric Respiratory Medicine, Consultant Respiratory Physician
MP 308
Cystic Fibrosis
R07AX30 Ivacaftor + Lumacaftor
Granules 188mg + 150mg
Consultant Paediatric Respiratory Medicine
MP 309
Cystic Fibrosis
R07AX31 Ivacaftor + Tezacaftor
Tablets 150mg + 100mg
Consultant Paediatric Respiratory Medicine, Consultant Respiratory Physician
MP 310
Cystic Fibrosis
R07AX32 Ivacaftor + Tezacaftor + Elexacaftor
Tablets 75mg + 50mg + 100mg
Consultant Paediatric Respiratory Medicine, Consultant Respiratory Physician
MP 311
Cystic Fibrosis
V03AB23, R05CB01
N-Acetylcysteine Tablets 600mg Consultant Surgeons, Consultant Physicians, Consultant Respiratory Physicians
MP 252 TBDF
MDHP only
Chronic Respiratory Failure
V3.0 September 2021
42 3. Respiratory System
ATC Code Active Ingredient
Dosage Form and Strength
Schedule V Prescriber Criteria
Protocol Pink Card
Pink Card Prescriber Criteria
Schedule V Entitlement
3.7 Aromatic inhalations
R01AX10 Benzoin Tincture Tincture 50mL N/A A Medical Practitioners No Schedule V Entitlement
3.8 Cough preparations 3.8.1 Cough suppressants
R05DA04 Codeine Phosphate
Suspension 15mg/5mL
Consultants B Medical Practitioners Inherited Bleeding Disorders, Malignant Diseases, Chronic Respiratory Failure, Rheumatoid Arthritis
3.8.2 Expectorant and demulcent cough preparations R06AA52 Diphenhydramine
Containing Preparation for Chesty Cough
Oral Liquid Consultants A Medical Practitioners Malignant Diseases
V3.0 September 2021
43 4. Central Nervous System
ATC Code Active Ingredient Dosage Form and Strength
Schedule V Prescriber Criteria
Protocol Pink Card
Pink Card Prescriber Criteria
Schedule V Entitlement
4. Central Nervous System 4.1 Hypnotics and anxiolytics
4.1.1 Hypnotics N05BA01 Diazepam Syrup
2mg/5mL Consultants A Medical Practitioners Addiction Disorders, Cerebral Palsy, Chronic
Mood Disorders, Chronic Neurotic Disorders, Chronic Psychiatric Disorders Starting in Childhood, Dementia, Motor Neuron Disease, Multiple Sclerosis, Psychosis, Schizophrenia, Malignant Diseases
N05BA01 Diazepam Tablets 2mg Consultants A Medical Practitioners Addiction Disorders, Cerebral Palsy, Chronic Mood Disorders, Chronic Neurotic Disorders, Chronic Psychiatric Disorders Starting in Childhood, Dementia, Motor Neuron Disease, Multiple Sclerosis, Psychosis, Schizophrenia, Malignant Diseases
N05BA01 Diazepam Tablets 5mg Consultants A Medical Practitioners Addiction Disorders, Cerebral Palsy, Chronic Mood Disorders, Chronic Neurotic Disorders, Chronic Psychiatric Disorders Starting in Childhood, Dementia, Motor Neuron Disease, Multiple Sclerosis, Psychosis, Schizophrenia, Malignant Diseases
N05CD02 Nitrazepam Tablets 5mg Consultants B Medical Practitioners Addiction Disorders, Chronic Mood Disorders, Chronic Neurotic Disorders, Chronic Psychiatric Disorders Starting in Childhood, Psychosis, Schizophrenia
V3.0 September 2021
44 4. Central Nervous System
ATC Code Active Ingredient Dosage Form and Strength
Schedule V Prescriber Criteria
Protocol Pink Card
Pink Card Prescriber Criteria
Schedule V Entitlement
N06AD02 Promethazine Hydrochloride
Syrup 5mg/5mL
Consultants A Medical Practitioners Addiction Disorders, Dermatomyositis/ Polymyositis, Malignant Diseases, Severe Refractory Atopic Dermatitis
N06AD02 Promethazine Hydrochloride
Tablets 10mg Consultants B Medical Practitioners Addiction Disorders, Dermatomyositis/ Polymyositis, Malignant Diseases, Severe Refractory Atopic Dermatitis
N06AD02 Promethazine Hydrochloride
Tablets 25mg Consultants B Medical Practitioners Addiction Disorders, Dermatomyositis/ Polymyositis, Malignant Diseases, Severe Refractory Atopic Dermatitis
4.1.2 Anxiolytics N05BA08 Bromazepam Tablets 1.5mg Consultants A Medical Practitioners Addiction Disorders, Chronic Mood Disorders,
Chronic Neurotic Disorders, Chronic Psychiatric Disorders Starting in Childhood, Dementia, Psychosis, Schizophrenia
N05BA08 Bromazepam Tablets 3mg Consultants A Medical Practitioners Addiction Disorders, Chronic Mood Disorders, Chronic Neurotic Disorders, Chronic Psychiatric Disorders Starting in Childhood, Dementia, Psychosis, Schizophrenia
N05BA08 Bromazepam Tablets 6mg Consultants A Medical Practitioners Addiction Disorders, Chronic Mood Disorders, Chronic Neurotic Disorders, Chronic Psychiatric Disorders Starting in Childhood, Dementia, Psychosis, Schizophrenia
N05BE01 Buspirone Hydrochloride
Tablets 10mg Consultants
Addiction Disorders, Chronic Mood Disorders, Chronic Neurotic Disorders, Chronic Psychiatric Disorders Starting in Childhood
N05BA01 Diazepam Rectal Tubes 5mg/2.5mL
Consultants B Medical Practitioners Cerebral Palsy, Epilepsy, Malignant Diseases
N05BA01 Diazepam Rectal Tubes 10mg/2.5mL
Consultants B Medical Practitioners Cerebral Palsy, Epilepsy, Malignant Diseases
V3.0 September 2021
45 4. Central Nervous System
ATC Code Active Ingredient Dosage Form and Strength
Schedule V Prescriber Criteria
Protocol Pink Card
Pink Card Prescriber Criteria
Schedule V Entitlement
N05BA01 Diazepam Syrup 2mg/5mL
Consultants A Medical Practitioners Addiction Disorders, Cerebral Palsy, Chronic Mood Disorders, Chronic Neurotic Disorders, Chronic Psychiatric Disorders Starting in Childhood, Dementia, Motor Neuron Disease, Multiple Sclerosis, Psychosis, Schizophrenia, Malignant Diseases
N05BA01 Diazepam Tablets 2mg Consultants A Medical Practitioners Addiction Disorders, Cerebral Palsy, Chronic Mood Disorders, Chronic Neurotic Disorders, Chronic Psychiatric Disorders Starting in Childhood, Dementia, Motor Neuron Disease, Multiple Sclerosis, Psychosis, Schizophrenia, Malignant Diseases
N05BA01 Diazepam Tablets 5mg Consultants A Medical Practitioners Addiction Disorders, Cerebral Palsy, Chronic Mood Disorders, Chronic Neurotic Disorders, Chronic Psychiatric Disorders Starting in Childhood, Dementia, Motor Neuron Disease, Multiple Sclerosis, Psychosis, Schizophrenia, Malignant Diseases
N05BA06 Lorazepam Tablets 1mg Consultants A Medical Practitioners Addiction Disorders, Chronic Mood Disorders, Chronic Neurotic Disorders, Chronic Psychiatric Disorders Starting in Childhood, Dementia, Psychosis, Schizophrenia, Malignant Diseases
N05BA06 Lorazepam Tablets 2mg Consultants A Medical Practitioners Addiction Disorders, Chronic Mood Disorders, Chronic Neurotic Disorders, Chronic Psychiatric Disorders Starting in Childhood, Dementia, Psychosis, Schizophrenia, Malignant Diseases
V3.0 September 2021
46 4. Central Nervous System
ATC Code Active Ingredient Dosage Form and Strength
Schedule V Prescriber Criteria
Protocol Pink Card
Pink Card Prescriber Criteria
Schedule V Entitlement
4.2 Drugs used in psychoses and related disorders 4.2.1 Antipsychotic drugs
N05AA01 Chlorpromazine Hydrochloride
Tablets 25mg Consultants C Medical Practitioners Addiction Disorders, Chronic Mood Disorders, Chronic Neurotic Disorders, Chronic Psychiatric Disorders Starting in Childhood, Dementia, Psychosis, Schizophrenia, Malignant Diseases
N05AA01 Chlorpromazine Hydrochloride
Tablets 100mg Consultants C Medical Practitioners Addiction Disorders, Chronic Mood Disorders, Chronic Neurotic Disorders, Chronic Psychiatric Disorders Starting in Childhood, Dementia, Psychosis, Schizophrenia, Malignant Diseases
N05AH02 Clozapine Tablets 25mg Consultant Psychiatrists MP 42 TBDF
Hospitals only
Chronic Mood Disorders, Psychosis, Schizophrenia
N05AH02 Clozapine Tablets 100mg Consultant Psychiatrists MP 42 TBDF
Hospitals only
Chronic Mood Disorders, Psychosis, Schizophrenia
N05AF01 Flupentixol Dihydrochloride
Tablets 0.5mg Consultant Psychiatrists
Addiction Disorders, Chronic Mood Disorders, Psychosis, Schizophrenia
N05AD01 Haloperidol Capsules 0.5mg
Consultant Geriatricians, Consultant Haematologists, Consultant Oncologists, Consultant Palliative Care, Consultant Psychiatrists
C Consultant Geriatricians, Consultant Haematologists, Consultant Oncologists, Consultant Palliative Care, Consultant Psychiatrists
Addiction Disorders, Chronic Mood Disorders, Chronic Neurotic Disorders, Chronic Psychiatric Disorders Starting in Childhood, Dementia, Psychosis, Schizophrenia, Malignant Diseases
V3.0 September 2021
47 4. Central Nervous System
ATC Code Active Ingredient Dosage Form and Strength
Schedule V Prescriber Criteria
Protocol Pink Card
Pink Card Prescriber Criteria
Schedule V Entitlement
N05AD01 Haloperidol Injections 5mg Consultant Haematologists, Consultant Oncologists, Consultant Palliative Care, Consultant Psychiatrists
Addiction Disorders, Chronic Psychiatric Disorders Starting in Childhood, Psychosis, Schizophrenia, Malignant Diseases
N05AD01 Haloperidol Oral Solution 2mg/mL
Consultant Geriatricians, Consultant Haematologists, Consultant Oncologists, Consultant Palliative Care, Consultant Psychiatrists
C Consultant Geriatricians, Consultant Haematologists, Consultant Oncologists, Consultant Palliative Care, Consultant Psychiatrists
Addiction Disorders, Chronic Mood Disorders, Chronic Neurotic Disorders, Chronic Psychiatric Disorders Starting in Childhood, Dementia, Psychosis, Schizophrenia, Malignant Diseases
N05AD01 Haloperidol Tablets 1.5mg Consultant Geriatricians, Consultant Haematologists, Consultant Oncologists, Consultant Palliative Care, Consultant Psychiatrists
C Consultant Geriatricians, Consultant Haematologists, Consultant Oncologists, Consultant Palliative Care, Consultant Psychiatrists
Addiction Disorders, Chronic Mood Disorders, Chronic Neurotic Disorders, Chronic Psychiatric Disorders Starting in Childhood, Dementia, Psychosis, Schizophrenia, Malignant Diseases
V3.0 September 2021
48 4. Central Nervous System
ATC Code Active Ingredient Dosage Form and Strength
Schedule V Prescriber Criteria
Protocol Pink Card
Pink Card Prescriber Criteria
Schedule V Entitlement
N05AD01 Haloperidol Tablets 5mg Consultant Geriatricians, Consultant Haematologists, Consultant Oncologists, Consultant Palliative Care, Consultant Psychiatrists
C Consultant Geriatricians, Consultant Haematologists, Consultant Oncologists, Consultant Palliative Care, Consultant Psychiatrists
Addiction Disorders, Chronic Mood Disorders, Chronic Neurotic Disorders, Chronic Psychiatric Disorders Starting in Childhood, Dementia, Psychosis, Schizophrenia, Malignant Diseases
N05AA02 Levomepromazine Tablets 25mg Consultant Haematologists, Consultant Oncologists, Consultant Paediatric Oncologists, Consultant Paediatricians, Consultant Palliative Care
MP 287
Malignant Diseases
N05AH03 Olanzapine Coated Tablets 10mg
Consultant Geriatricians, Consultant Psychiatrists
Addiction Disorders, Chronic Eating Disorders, Chronic Mood Disorders, Chronic Neurotic Disorders, Chronic Psychiatric Disorders Starting in Childhood, Dementia, Psychosis, Schizophrenia
N05AH03 Olanzapine Coated Tablets 5mg
Consultant Geriatricians, Consultant Psychiatrists
Addiction Disorders, Chronic Eating Disorders, Chronic Mood Disorders, Chronic Neurotic Disorders, Chronic Psychiatric Disorders Starting in Childhood, Dementia, Psychosis, Schizophrenia
N05AG02 Pimozide Scored Tablets 4mg
Consultant Psychiatrists MP 163
Psychosis, Schizophrenia
N05AB04 Prochlorperazine Tablets 5mg Consultants A Medical Practitioners Addiction Disorders, Psychosis, Schizophrenia, Malignant Diseases
V3.0 September 2021
49 4. Central Nervous System
ATC Code Active Ingredient Dosage Form and Strength
Schedule V Prescriber Criteria
Protocol Pink Card
Pink Card Prescriber Criteria
Schedule V Entitlement
N05AH04 Quetiapine Tablets 25mg Consultant Geriatricians, Consultant Psychiatrists
Addiction Disorders, Chronic Mood Disorders, Chronic Neurotic Disorders, Chronic Psychiatric Disorders Starting in Childhood, Dementia, Psychosis, Schizophrenia
N05AH04 Quetiapine Tablets 100mg Consultant Geriatricians, Consultant Psychiatrists
Addiction Disorders, Chronic Mood Disorders, Chronic Neurotic Disorders, Chronic Psychiatric Disorders Starting in Childhood, Dementia, Psychosis, Schizophrenia
N05AH04 Quetiapine Tablets 200mg Consultant Geriatricians, Consultant Psychiatrists
Addiction Disorders, Chronic Mood Disorders, Chronic Neurotic Disorders, Chronic Psychiatric Disorders Starting in Childhood, Dementia, Psychosis, Schizophrenia
N05AX08 Risperidone Syrup 1mg/mL Consultant Geriatricians, Consultant Psychiatrists
MP 175
Addiction Disorders, Chronic Mood Disorders, Chronic Neurotic Disorders, Chronic Psychiatric Disorders Starting in Childhood, Dementia, Psychosis, Schizophrenia
N05AX08 Risperidone Tablets 1mg Consultant Geriatricians, Consultant Psychiatrists
C Consultant Psychiatrists
Addiction Disorders, Chronic Mood Disorders, Chronic Neurotic Disorders, Chronic Psychiatric Disorders Starting in Childhood, Dementia, Psychosis, Schizophrenia
N05AX08 Risperidone Tablets 2mg Consultant Geriatricians, Consultant Psychiatrists
C Consultant Psychiatrists
Addiction Disorders, Chronic Mood Disorders, Chronic Neurotic Disorders, Chronic Psychiatric Disorders Starting in Childhood, Dementia, Psychosis, Schizophrenia
N05AL01 Sulpiride Capsules 50mg
Consultant Psychiatrists
Addiction Disorders, Chronic Mood Disorders, Chronic Psychiatric Disorders Starting in Childhood, Psychosis, Schizophrenia
N05AL01 Sulpiride Suspension 40mg/mL
Consultant Psychiatrists
Addiction Disorders, Chronic Mood Disorders, Chronic Psychiatric Disorders Starting in Childhood Psychosis, Schizophrenia
V3.0 September 2021
50 4. Central Nervous System
ATC Code Active Ingredient Dosage Form and Strength
Schedule V Prescriber Criteria
Protocol Pink Card
Pink Card Prescriber Criteria
Schedule V Entitlement
N05AL01 Sulpiride Tablets 200mg Consultant Psychiatrists
Addiction Disorders, Chronic Mood Disorders, Chronic Psychiatric Disorders Starting in Childhood, Psychosis, Schizophrenia
N05AB06 Trifluoperazine Tablets 5mg Consultants C Medical Practitioners Addiction Disorders, Chronic Mood Disorders, Chronic Neurotic Disorders, Chronic Psychiatric Disorders Starting in Childhood, Psychosis, Schizophrenia
N05AF05 Zuclopenthixol Acetate
Oily injection 50mg
Consultant Psychiatrists
Chronic Mood Disorders, Psychosis, Schizophrenia
N05AF05 Zuclopenthixol Dihydrochloride
Tablets 2mg Consultant Psychiatrists
Addiction Disorders, Chronic Mood Disorders, Psychosis, Schizophrenia
N05AF05 Zuclopenthixol Dihydrochloride
Tablets 10mg Consultant Psychiatrists
Addiction Disorders, Chronic Mood Disorders, Psychosis, Schizophrenia
N05AF05 Zuclopenthixol Dihydrochloride
Tablets 25mg Consultant Psychiatrists
Addiction Disorders, Chronic Mood Disorders, Psychosis, Schizophrenia
4.2.2 Antipsychotic depo injections N05AF01 Flupentixol
Decanoate Injection 20mg/mL
Consultant Psychiatrists
Addiction Disorders, Chronic Mood Disorders, Psychosis, Schizophrenia
N05AF01 Flupentixol Decanoate
Injection 100mg/mL
Consultant Psychiatrists
Addiction Disorders, Chronic Mood Disorders, Psychosis, Schizophrenia
N05AB02 Fluphenazine Decanoate
Injection 25mg
Consultant Psychiatrists
Chronic Mood Disorders, Chronic Psychiatric Disorders Starting in Childhood, Psychosis, Schizophrenia
N05AB02 Fluphenazine Decanoate
Injection 100mg
Consultant Psychiatrists
Chronic Mood Disorders, Chronic Psychiatric Disorders Starting in Childhood, Psychosis, Schizophrenia
N05AD01 Haloperidol Decanoate
Injection 50mg
Consultant Psychiatrists
Chronic Mood Disorders, Chronic Psychiatric Disorders Starting in Childhood, Psychosis, Schizophrenia
V3.0 September 2021
51 4. Central Nervous System
ATC Code Active Ingredient Dosage Form and Strength
Schedule V Prescriber Criteria
Protocol Pink Card
Pink Card Prescriber Criteria
Schedule V Entitlement
N05AD01 Haloperidol Decanoate
Injection 100mg
Consultant Psychiatrists
Chronic Mood Disorders, Chronic Psychiatric Disorders Starting in Childhood, Psychosis, Schizophrenia
N05AX08 Risperidone Depot Injection 25mg
Consultant Psychiatrists MP 291 FPOP & MHCs only
Psychosis, Schizophrenia
N05AX08 Risperidone Depot Injection 37.5mg
Consultant Psychiatrists MP 291 FPOP & MHCs only
Psychosis, Schizophrenia
N05AX08 Risperidone Depot Injection 50mg
Consultant Psychiatrists MP 291 FPOP & MHCs only
Psychosis, Schizophrenia
N05AF05 Zuclopenthixol Decanoate
Injection 200mg
Consultant Psychiatrists
Schizophrenia
4.2.3 Antimanic drugs N05AN01 Lithium
Carbonate Tablets 400mg Consultants C Medical Practitioners Chronic Mood Disorders, Chronic Neurotic
Disorders, Chronic Psychiatric Disorders Starting in Childhood, Psychosis, Schizophrenia
N05AN01 Lithium Citrate Tetrahydrate
Syrup 520mg/5mL (equivalent to 200mg Lithium Carbonate)
Consultant Psychiatrists MP 120
Chronic Mood Disorders, Psychosis
V3.0 September 2021
52 4. Central Nervous System
ATC Code Active Ingredient Dosage Form and Strength
Schedule V Prescriber Criteria
Protocol Pink Card
Pink Card Prescriber Criteria
Schedule V Entitlement
4.3 Antidepressant drugs 4.3.1 Tricyclic and related antidepressant drugs
N06AA09 Amitriptyline Tablets 10mg Consultants B Medical Practitioners Addiction Disorders, Chronic Mood Disorders, Chronic Neurotic Disorders, Chronic Psychiatric Disorders Starting in Childhood, Diabetes Mellitus Type 1, Diabetes Mellitus Type 2, Fibromyalgia, Malignant Diseases, Motor Neuron Disease, Multiple Sclerosis, Myalgic Encephalomyelitis, Polio and Post-Polio Syndrome, Psychosis, Schizophrenia, Spinal Cord Pathologies, Trigeminal Neuralgia
N06AA09 Amitriptyline Tablets 25mg Consultants B Medical Practitioners Addiction Disorders, Chronic Mood Disorders, Chronic Neurotic Disorders, Chronic Psychiatric Disorders Starting in Childhood, Diabetes Mellitus Type 1, Diabetes Mellitus Type 2, Fibromyalgia, Malignant Diseases, Motor Neuron Disease, Multiple Sclerosis, Myalgic Encephalomyelitis, Polio and Post-Polio Syndrome, Psychosis, Schizophrenia, Spinal Cord Pathologies, Trigeminal Neuralgia
N06AA04 Clomipramine Hydrochloride
Tablets 10mg Consultants C Medical Practitioners Addiction Disorders, Chronic Mood Disorders, Chronic Neurotic Disorders, Chronic Psychiatric Disorders Starting in Childhood, Malignant Diseases, Narcolepsy, Psychosis, Schizophrenia
N06AA04 Clomipramine Hydrochloride
Tablets 25mg Consultants C Medical Practitioners Addiction Disorders, Chronic Mood Disorders, Chronic Neurotic Disorders, Chronic Psychiatric Disorders Starting in Childhood, Malignant Diseases, Narcolepsy, Psychosis, Schizophrenia
V3.0 September 2021
53 4. Central Nervous System
ATC Code Active Ingredient Dosage Form and Strength
Schedule V Prescriber Criteria
Protocol Pink Card
Pink Card Prescriber Criteria
Schedule V Entitlement
N06AA02 Imipramine Hydrochloride
Tablets 10mg Consultants C Medical Practitioners Addiction Disorders, Chronic Eating Disorders, Chronic Mood Disorders, Chronic Neurotic Disorders, Chronic Psychiatric Disorders Starting in Childhood, Malignant Diseases, Psychosis, Schizophrenia
N06AA02 Imipramine Hydrochloride
Tablets 25mg Consultants C Medical Practitioners Addiction Disorders, Chronic Eating Disorders, Chronic Mood Disorders, Chronic Neurotic Disorders, Chronic Psychiatric Disorders Starting in Childhood, Malignant Diseases, Psychosis, Schizophrenia
N06AA21 Maprotiline Hydrochloride
Tablets 25mg Consultants
Addiction Disorders, Chronic Mood Disorders, Chronic Neurotic Disorders
N06AX03 Mianserin Hydrochloride
Tablets 10mg Consultants C Medical Practitioners Addiction Disorders, Chronic Mood Disorders, Chronic Neurotic Disorders
N06AX03 Mianserin Hydrochloride
Tablets 30mg Consultants C Medical Practitioners Addiction Disorders, Chronic Mood Disorders, Chronic Neurotic Disorders
N06AA09 Nortriptyline Tablets 10mg Consultants C Medical Practitioners Addiction Disorders, Chronic Mood Disorders, Chronic Neurotic Disorders, Chronic Psychiatric Disorders Starting in Childhood, Diabetes Mellitus Type 1, Diabetes Mellitus Type 2, Malignant Diseases, Multiple Sclerosis, Psychosis, Schizophrenia, Spinal Cord Pathologies
N06AA09 Nortriptyline Tablets 25mg Consultants C Medical Practitioners Addiction Disorders, Chronic Mood Disorders, Chronic Neurotic Disorders, Chronic Psychiatric Disorders Starting in Childhood, Diabetes Mellitus Type 1, Diabetes Mellitus Type 2, Malignant Diseases, Multiple Sclerosis, Psychosis, Schizophrenia, Spinal Cord Pathologies
V3.0 September 2021
54 4. Central Nervous System
ATC Code Active Ingredient Dosage Form and Strength
Schedule V Prescriber Criteria
Protocol Pink Card
Pink Card Prescriber Criteria
Schedule V Entitlement
4.3.2 Monoamine-oxidase inhibitors N06AG02 Moclobemide Tablets 150mg Consultant Psychiatrists MP 134
Addiction Disorders, Chronic Mood Disorders, Chronic Neurotic Disorders, Psychosis
4.3.3 Selective serotonin re-uptake inhibitors N06AB03 Fluoxetine Capsules
20mg Consultant Geriatricians, Consultant Psychiatrists
C Consultant Psychiatrists
Addiction Disorders, Chronic Eating Disorders, Chronic Mood Disorders, Chronic Neurotic Disorders, Chronic Psychiatric Disorders Starting in Childhood, Dementia, Psychosis, Schizophrenia
N06AB08 Fluvoxamine Maleate
Tablets 100mg Consultant Geriatricians, Consultant Psychiatrists
Addiction Disorders, Chronic Eating Disorders, Chronic Mood Disorders, Chronic Neurotic Disorders, Chronic Psychiatric Disorders Starting in Childhood, Dementia, Psychosis, Schizophrenia
N06AB05 Paroxetine Tablets 20mg Consultant Geriatricians, Consultant Oncologists, Consultant Psychiatrists, Consultant Palliative Care
C Consultant Psychiatrists, Consultant Palliative Care
Addiction Disorders, Chronic Eating Disorders, Chronic Mood Disorders, Chronic Neurotic Disorders, Chronic Psychiatric Disorders Starting in Childhood, Dementia, Malignant Diseases, Psychosis, Schizophrenia
4.3.4 Other antidepressant drugs N05AF01 Flupentixol
Dihydrochloride Tablets 0.5mg Consultant Psychiatrists
Addiction Disorders, Chronic Mood Disorders, Psychosis, Schizophrenia
N06AX16 Venlafaxine Modified Release Capsules 75mg
Consultant Geriatricians, Consultant Psychiatrists
Addiction Disorders, Chronic Mood Disorders, Chronic Neurotic Disorders, Chronic Psychiatric Disorders Starting in Childhood, Psychosis
V3.0 September 2021
55 4. Central Nervous System
ATC Code Active Ingredient Dosage Form and Strength
Schedule V Prescriber Criteria
Protocol Pink Card
Pink Card Prescriber Criteria
Schedule V Entitlement
4.4 CNS stimulants and drugs used in attention deficit hyperactivity disorder N06BA09 Atomoxetine Capsules
18mg Consultant Paediatricians (Community Paediatrics), Consultant Paediatricians (Paediatric Neurology and Neurodisability), Consultant Psychiatrists
MP 4
Chronic Psychiatric Disorders Starting in Childhood
N06BA09 Atomoxetine Capsules 25mg
Consultant Paediatricians (Community Paediatrics), Consultant Paediatricians (Paediatric Neurology and Neurodisability), Consultant Psychiatrists
MP 4
Chronic Psychiatric Disorders Starting in Childhood
N06BA09 Atomoxetine Capsules 40mg
Consultant Paediatricians (Community Paediatrics), Consultant Paediatricians (Paediatric Neurology and Neurodisability), Consultant Psychiatrists
MP 4
Chronic Psychiatric Disorders Starting in Childhood
N06BA02 Dexamfetamine Sulphate
Tablets 5mg Consultants
Chronic Psychiatric Disorders Starting in Childhood
N06BA04 Methylphenidate Hydrochloride
Tablets 10mg Consultant Paediatricians, Consultant Psychiatrists
C Consultant Paediatricians, Consultant Psychiatrists
Chronic Psychiatric Disorders Starting in Childhood, Narcolepsy
V3.0 September 2021
56 4. Central Nervous System
ATC Code Active Ingredient Dosage Form and Strength
Schedule V Prescriber Criteria
Protocol Pink Card
Pink Card Prescriber Criteria
Schedule V Entitlement
N06BA04 Methylphenidate Hydrochloride
Prolonged Release Tablets 18mg
Consultant Paediatricians (Community Paediatrics), Consultant Paediatricians (Paediatric Neurology and Neurodisability), Consultant Psychiatrists
MP 126
Chronic Psychiatric Disorders Starting in Childhood
N06BA04 Methylphenidate Hydrochloride
Prolonged Release Tablets 36mg
Consultant Paediatricians (Community Paediatrics), Consultant Paediatricians (Paediatric Neurology and Neurodisability), Consultant Psychiatrists
MP 126
Chronic Psychiatric Disorders Starting in Childhood
4.5 Drugs used in nausea and vertigo A04AD12 Aprepitant Capsules
80mg Consultant Heamatologists, Consultant Oncologists, Consultant Paediatric Oncologists, Consultant Palliative Care
MP 269
Malignant Diseases
A04AD12 Aprepitant Capsules 125mg
Consultant Heamatologists, Consultant Oncologists, Consultant Paediatric Oncologists, Consultant Palliative Care
MP 269
Malignant Diseases
V3.0 September 2021
57 4. Central Nervous System
ATC Code Active Ingredient Dosage Form and Strength
Schedule V Prescriber Criteria
Protocol Pink Card
Pink Card Prescriber Criteria
Schedule V Entitlement
R06AE03 Cyclizine Ampoules 50mg/mL
Consultant Anaesthetists, Consultant Haematologists, Consultant Obstetrics and Gynaecology, Consultant Oncologists, Consultant Paediatric Oncologists, Consultant Palliative Care
MP 267
Malignant Diseases
R06AE03 Cyclizine Tablets 50mg Consultants A Hospital Doctors Malignant Diseases
A03FA03 Domperidone Suspension 1mg/mL
Consultants MP 57 C Consultants Malignant Diseases
A03FA03 Domperidone Tablets 10mg Consultants
C Consultants Malignant Diseases
A03FA01 Metoclopramide Ampoules 10mg/2mL
Consultant Oncologists, Consultant Palliative Care
HU/TBDF Hospitals
only
Malignant Diseases
A03FA01 Metoclopramide Tablets 10mg Consultants Malignant Diseases
A04AA01 Ondansetron Syrup 4mg/5mL
Consultant Haematologists, Consultant Oncologists, Consultant Paediatric Surgeons, Consultant Paediatricians, Consultant Palliative Care
MP 153
Malignant Diseases
A04AA01 Ondansetron Tablets 4mg Consultants MP 154 Malignant Diseases
A04AA01 Ondansetron Tablets 8mg Consultants MP 154 Malignant Diseases
N05AB04 Prochlorperazine Tablets 5mg Consultants A Medical Practitioners Addiction Disorders, Psychosis, Schizophrenia, Malignant Diseases
V3.0 September 2021
58 4. Central Nervous System
ATC Code Active Ingredient Dosage Form and Strength
Schedule V Prescriber Criteria
Protocol Pink Card
Pink Card Prescriber Criteria
Schedule V Entitlement
4.6 Analgesics 4.6.1 Non-opioid analgesics
N02BA01 Aspirin Effervescent Tablets 300mg
Consultants B Medical Practitioners Malignant Diseases
N02BA01 Aspirin Tablets 300mg
B Medical Practitioners No Schedule V Entitlement
N02BE01 Paracetamol Suppositories 100mg or 125mg
Consultants A Medical Practitioners Motor Neuron Disease, Spinal Cord Pathologies, Malignant Diseases
N02BE01 Paracetamol Suppositories 250mg
Consultants A Medical Practitioners Motor Neuron Disease, Spinal Cord Pathologies, Malignant Diseases
N02BE01 Paracetamol Suppositories 500mg
Consultants A Medical Practitioners Motor Neuron Disease, Spinal Cord Pathologies, Malignant Diseases, Rheumatoid Arthritis
N02BE01 Paracetamol Syrup 120mg/5mL
Consultants A Medical Practitioners Motor Neuron Disease, Malignant Diseases, Rheumatoid Arthritis, Spondyloarthritis
N02BE01 Paracetamol Tablets 500mg Consultants B Medical Practitioners Motor Neuron Disease, Spinal Cord Pathologies, Inherited Bleeding Disorders, Polio and Post-Polio Syndrome, Malignant Diseases
4.6.2 Opioid analgesics R05DA04 Codeine
Phosphate Tablets 30mg Consultants
Motor Neuron Disease, Spinal Cord Pathologies, Trigeminal Neuralgia, Inflammatory Bowel Disease, Inherited Bleeding Disorders, Malignant Diseases, Rheumatoid Arthritis, Spondyloarthritis
N02AA08 Dihydrocodeine Tartrate
Tablets 30mg Consultants
Trigeminal Neuralgia, Malignant Diseases
V3.0 September 2021
59 4. Central Nervous System
ATC Code Active Ingredient Dosage Form and Strength
Schedule V Prescriber Criteria
Protocol Pink Card
Pink Card Prescriber Criteria
Schedule V Entitlement
N02AB03 Fentanyl Transdermal Patches 25mcg
Consultant Anaesthetists (Pain Clinic), Consultant Haematologists, Consultant Oncologists, Consultant Paediatric Oncologists, Consultant Palliative Care
MP 67
Malignant Diseases
N02AB03 Fentanyl Transdermal Patches 50mcg
Consultant Anaesthetists (Pain Clinic), Consultant Haematologists, Consultant Oncologists, Consultant Paediatric Oncologists, Consultant Palliative Care
MP 67
Malignant Diseases
N02AA01 Morphine Sulphate/ Hydrochloride (for Paediatric Use – Currently Mercury Pharma)
Injection 10mg/mL
Consultants
Spinal Cord Pathologies, Trigeminal Neuralgia, Malignant Diseases
N02AA01 Morphine Sulphate/ Hydrochloride (Currently Wockhardt)
Injection 10mg/mL
Consultants
Spinal Cord Pathologies, Trigeminal Neuralgia, Malignant Diseases
N02AA01 Morphine Sulphate/ Hydrochloride
Injection 15mg/mL
Consultants
Spinal Cord Pathologies, Trigeminal Neuralgia, Malignant Diseases
V3.0 September 2021
60 4. Central Nervous System
ATC Code Active Ingredient Dosage Form and Strength
Schedule V Prescriber Criteria
Protocol Pink Card
Pink Card Prescriber Criteria
Schedule V Entitlement
N02AA01 Morphine Sulphate/ Hydrochloride
Injection 20mg/mL
Consultants
Spinal Cord Pathologies, Trigeminal Neuralgia, Malignant Diseases
N02AA01 Morphine Sulphate
Injection 30mg/mL
Consultants
Spinal Cord Pathologies, Trigeminal Neuralgia, Malignant Diseases
N02AA01 Morphine Sulphate
Solution 10mg/5mL
Consultants
Motor Neuron Disease, Spinal Cord Pathologies, Trigeminal Neuralgia, Malignant Diseases
N02AA01 Morphine Sulphate
Slow-Release Tablets 10mg
Consultants
Motor Neuron Disease, Spinal Cord Pathologies, Trigeminal Neuralgia, Malignant Diseases
N02AA01 Morphine Sulphate
Slow-Release Tablets 30mg
Consultants
Motor Neuron Disease, Spinal Cord Pathologies, Trigeminal Neuralgia, Malignant Diseases
N02AA01 Morphine Sulphate
Slow-Release Tablets 60mg
Consultants
Motor Neuron Disease, Spinal Cord Pathologies, Trigeminal Neuralgia, Malignant Diseases
N02AA01 Morphine Sulphate
Slow-Release Tablets 100mg
Consultants
Motor Neuron Disease, Spinal Cord Pathologies, Trigeminal Neuralgia, Malignant Diseases
N02AD01 Pentazocine Tablets 25mg Consultants Motor Neuron Disease, Trigeminal Neuralgia
N02AX02 Tramadol Capsules 50mg
Consultant Physicians, Consultant Surgeons, Consultant Anaesthetists, Consultant Palliative Care, Consultants Oncologists, Pain Clinic Specialists, Consultant Neurologists
MP 192
Motor Neuron Disease, Spinal Cord Pathologies, Trigeminal Neuralgia, Malignant Diseases, Fibromyalgia, Myalgic Encephalomyelitis
V3.0 September 2021
61 4. Central Nervous System
ATC Code Active Ingredient Dosage Form and Strength
Schedule V Prescriber Criteria
Protocol Pink Card
Pink Card Prescriber Criteria
Schedule V Entitlement
4.6.3 Neuropathic pain N06AA09 Amitriptyline Tablets 10mg Consultants B Medical Practitioners Addiction Disorders, Chronic Mood Disorders,
Chronic Neurotic Disorders, Chronic Psychiatric Disorders Starting in Childhood, Diabetes Mellitus Type 1, Diabetes Mellitus Type 2, Fibromyalgia, Malignant Diseases, Motor Neuron Disease, Multiple Sclerosis, Myalgic Encephalomyelitis, Polio and Post-Polio Syndrome, Psychosis, Schizophrenia, Spinal Cord Pathologies, Trigeminal Neuralgia
N06AA09 Amitriptyline Tablets 25mg Consultants B Medical Practitioners Addiction Disorders, Chronic Mood Disorders, Chronic Neurotic Disorders, Chronic Psychiatric Disorders Starting in Childhood, Diabetes Mellitus Type 1, Diabetes Mellitus Type 2, Fibromyalgia, Malignant Diseases, Motor Neuron Disease, Multiple Sclerosis, Myalgic Encephalomyelitis, Polio and Post-Polio Syndrome, Psychosis, Schizophrenia, Spinal Cord Pathologies, Trigeminal Neuralgia
N06AA10 Nortriptyline Tablets 10mg Consultants C Medical Practitioners Addiction Disorders, Chronic Mood Disorders, Chronic Neurotic Disorders, Chronic Psychiatric Disorders Starting in Childhood, Diabetes Mellitus Type 1, Diabetes Mellitus Type 2, Malignant Diseases, Multiple Sclerosis, Psychosis, Schizophrenia, Spinal Cord Pathologies
V3.0 September 2021
62 4. Central Nervous System
ATC Code Active Ingredient Dosage Form and Strength
Schedule V Prescriber Criteria
Protocol Pink Card
Pink Card Prescriber Criteria
Schedule V Entitlement
N06AA10 Nortriptyline Tablets 25mg Consultants C Medical Practitioners Addiction Disorders, Chronic Mood Disorders, Chronic Neurotic Disorders, Chronic Psychiatric Disorders Starting in Childhood, Diabetes Mellitus Type 1, Diabetes Mellitus Type 2, Malignant Diseases, Multiple Sclerosis, Psychosis, Schizophrenia, Spinal Cord Pathologies
N03AX16 Pregabalin Capsules 75mg
Consultant Anaesthetists, Consultant Geriatricians, Consultant Neurologists, Consultant Oncologists, Consultant Palliative Care, Consultant Psychiatrists, Pain Clinic Specialists, Consultant Haematologists
MP 160
Epilepsy, Trigeminal Neuralgia, Malignant Diseases
N03AX16 Pregabalin Capsules 150mg
Consultant Anaesthetists, Consultant Geriatricians, Consultant Neurologists, Consultant Oncologists, Consultant Palliative Care, Consultant Psychiatrists, Pain Clinic Specialists, Consultant Haematologists
MP 160
Epilepsy, Trigeminal Neuralgia, Malignant Diseases
V3.0 September 2021
63 4. Central Nervous System
ATC Code Active Ingredient Dosage Form and Strength
Schedule V Prescriber Criteria
Protocol Pink Card
Pink Card Prescriber Criteria
Schedule V Entitlement
N03AX16 Pregabalin Capsules 300mg
Consultant Anaesthetists, Consultant Geriatricians, Consultant Neurologists, Consultant Oncologists, Consultant Palliative Care, Consultant Psychiatrists, Pain Clinic Specialists, Consultant Haematologists
MP 160
Epilepsy, Trigeminal Neuralgia, Malignant Diseases
4.6.4 Antimigraine drugs
4.6.4.1 Prophylaxis Treatment of acute migraine C02AC01 Clonidine
Hydrochloride Tablets 100mcg
Consultants C Consultants Addiction Disorders, Hypertension, Chronic Psychiatric Disorders Starting in Childhood
4.7 Antiepileptic drugs 4.7.1 Control of epilepsy
S01EC01 Acetazolamide Tablets 250mg Consultants Epilepsy, Glaucoma
N03AF01 Carbamazepine Controlled Release Tablets 200mg
Consultant Paediatricians, Consultant Neurologists, Consultant Psychiatrists, Consultant Geriatricians
Addiction Disorders, Chronic Mood Disorders, Chronic Psychiatric Disorders Starting in Childhood, Dementia, Epilepsy, Multiple Sclerosis, Psychosis, Schizophrenia, Spinal Cord Pathologies, Trigeminal Neuralgia, Malignant Diseases
N03AF01 Carbamazepine Controlled Release Tablets 400mg
Consultant Paediatricians, Consultant Neurologists, Consultant Psychiatrists, Consultant Geriatricians
Addiction Disorders, Chronic Mood Disorders, Chronic Psychiatric Disorders Starting in Childhood, Dementia, Epilepsy, Multiple Sclerosis, Psychosis, Schizophrenia, Spinal Cord Pathologies, Trigeminal Neuralgia, Malignant Diseases
V3.0 September 2021
64 4. Central Nervous System
ATC Code Active Ingredient Dosage Form and Strength
Schedule V Prescriber Criteria
Protocol Pink Card
Pink Card Prescriber Criteria
Schedule V Entitlement
N03AF01 Carbamazepine Syrup 100mg/5mL
Consultants C Medical Practitioners Addiction Disorders, Chronic Mood Disorders, Chronic Psychiatric Disorders Starting in Childhood, Dementia, Epilepsy, Multiple Sclerosis, Psychosis, Schizophrenia, Spinal Cord Pathologies, Trigeminal Neuralgia, Malignant Diseases
N03AF01 Carbamazepine Tablets 200mg Consultants C Medical Practitioners Addiction Disorders, Chronic Mood Disorders, Chronic Psychiatric Disorders Starting in Childhood, Dementia, Epilepsy, Multiple Sclerosis, Psychosis, Schizophrenia, Spinal Cord Pathologies, Trigeminal Neuralgia, Diabetes Mellitus Type 1, Diabetes Mellitus Type 2, Malignant Diseases
N05BA09 Clobazam Tablets 10mg Consultant Neurologists, Consultant Paediatricians
Epilepsy
N03AE01 Clonazepam Tablets 0.5mg Consultants
Addiction Disorders, Chronic Mood Disorders, Chronic Neurotic Disorders, Chronic Psychiatric Disorders Starting in Childhood, Dementia, Epilepsy, Psychosis, Schizophrenia
N03AE01 Clonazepam Tablets 2mg Consultants
Addiction Disorders, Chronic Mood Disorders, Chronic Neurotic Disorders, Chronic Psychiatric Disorders Starting in Childhood, Dementia, Epilepsy, Psychosis, Schizophrenia
N03AD01 Ethosuximide Syrup 250mg/5mL
Consultants
Epilepsy
N03AD01 Ethosuximide Capsules 250mg
Consultants
Epilepsy
N03AX12 Gabapentin Tablets 100mg Consultant Neurologists, Consultant Paediatricians
MP 83
Epilepsy
V3.0 September 2021
65 4. Central Nervous System
ATC Code Active Ingredient Dosage Form and Strength
Schedule V Prescriber Criteria
Protocol Pink Card
Pink Card Prescriber Criteria
Schedule V Entitlement
N03AX12 Gabapentin Tablets 300mg Consultant Neurologists, Consultant Paediatricians
MP 83
Epilepsy
N03AX09 Lamotrigine Dispersible Tablets 5mg
Consultant Paediatricians, Consultant Neurologists, Consultant Psychiatrists
Chronic Mood Disorders, Chronic Neurotic Disorders, Chronic Psychiatric Disorders Starting in Childhood, Epilepsy
N03AX09 Lamotrigine Dispersible Tablets 25mg
Consultant Paediatricians, Consultant Neurologists, Consultant Psychiatrists
Chronic Mood Disorders, Chronic Neurotic Disorders, Chronic Psychiatric Disorders Starting in Childhood, Epilepsy
N03AX09 Lamotrigine Tablets 25mg Consultant Paediatricians, Consultant Neurologists, Consultant Psychiatrists
Chronic Mood Disorders, Chronic Neurotic Disorders, Chronic Psychiatric Disorders Starting in Childhood, Epilepsy
N03AX09 Lamotrigine Tablets 50mg Consultant Paediatricians, Consultant Neurologists, Consultant Psychiatrists
Chronic Mood Disorders, Chronic Neurotic Disorders, Chronic Psychiatric Disorders Starting in Childhood, Epilepsy
N03AX09 Lamotrigine Tablets 100mg Consultant Paediatricians, Consultant Neurologists, Consultant Psychiatrists
Chronic Mood Disorders, Chronic Neurotic Disorders, Chronic Psychiatric Disorders Starting in Childhood, Epilepsy
N03AX14 Levetiracetam Syrup 100mg/mL
Consultant Paediatricians, Consultant Palliative Care, Consultant Neurologists
MP 116
Epilepsy
N03AX14 Levetiracetam Tablets 500mg Consultant Paediatricians, Consultant Palliative Care, Consultant Neurologists
MP 115
Epilepsy
N03AX14 Levetiracetam Tablets 1000mg
Consultant Paediatricians, Consultant Palliative Care, Consultant Neurologists
MP 115
Epilepsy
N03AA02 Phenobarbital (Phenobarbitone)
Powder Consultants
Chronic Liver Disease, Epilepsy
N03AA02 Phenobarbital (Phenobarbitone)
Tablets 15mg or 30mg
Consultants B Medical Practitioners Epilepsy
V3.0 September 2021
66 4. Central Nervous System
ATC Code Active Ingredient Dosage Form and Strength
Schedule V Prescriber Criteria
Protocol Pink Card
Pink Card Prescriber Criteria
Schedule V Entitlement
N03AB02 Phenytoin Sodium
Capsules 50mg
Consultants
Epilepsy, Malignant Diseases
N03AB02 Phenytoin Sodium
Capsules 100mg
Consultants
Epilepsy, Malignant Diseases
N03AB02 Phenytoin Sodium
Syrup 30mg/5mL
Consultants
Epilepsy, Malignant Diseases
N03AX16 Pregabalin Capsules 75mg
Consultant Anaesthetists, Consultant Geriatricians, Consultant Neurologists, Consultant Oncologists, Consultant Palliative Care, Consultant Psychiatrists, Pain Clinic Specialists, Consultant Haematologists
MP 160
Epilepsy, Trigeminal Neuralgia, Malignant Diseases
N03AX16 Pregabalin Capsules 150mg
Consultant Anaesthetists, Consultant Geriatricians, Consultant Neurologists, Consultant Oncologists, Consultant Palliative Care, Consultant Psychiatrists, Pain Clinic Specialists, Consultant Haematologists
MP 160
Epilepsy, Trigeminal Neuralgia, Malignant Diseases
N03AX16 Pregabalin Capsules 300mg
Consultant Anaesthetists, Consultant Geriatricians, Consultant Neurologists, Consultant Oncologists, Consultant Palliative Care, Consultant Psychiatrists, Pain Clinic Specialists, Consultant Haematologists
MP 160
Epilepsy, Trigeminal Neuralgia, Malignant Diseases
V3.0 September 2021
67 4. Central Nervous System
ATC Code Active Ingredient Dosage Form and Strength
Schedule V Prescriber Criteria
Protocol Pink Card
Pink Card Prescriber Criteria
Schedule V Entitlement
N03AA03 Primidone Tablets 250mg Consultants C Medical Practitioners Epilepsy
N03AF03 Rufinamide Tablets 200mg Consultant Neurologist, Consultant Paediatrician
MP 293
Epilepsy
N03AG01 Sodium Valproate
Controlled Release Tablets 200mg
Consultants
Chronic Mood Disorders, Chronic Neurotic Disorders, Chronic Psychiatric Disorders Starting in Childhood, Dementia, Epilepsy, Malignant Diseases
N03AG01 Sodium Valproate
Controlled Release Tablets 500mg
Consultants
Chronic Mood Disorders, Chronic Neurotic Disorders, Chronic Psychiatric Disorders Starting in Childhood, Dementia, Epilepsy, Malignant Diseases
N03AG01 Sodium Valproate
Oral Solution 200mg/5mL
Consultant Geriatricians, Consultant Haematologists, Consultant Neurologists, Consultant Oncologists, Consultant Paediatricians, Consultant Psychiatrists
Chronic Psychiatric Disorders Starting in Childhood, Epilepsy, Malignant Diseases
N03AX11 Topiramate Tablets 25mg Consultant Neurologists, Consultant Paediatricians
MP 191
Epilepsy
N03AX11 Topiramate Tablets 50mg Consultant Neurologists, Consultant Paediatricians
MP 191
Epilepsy
N03AX11 Topiramate Tablets 100mg Consultant Neurologists, Consultant Paediatricians
MP 191
Epilepsy
N03AX11 Topiramate Tablets 200mg Consultant Neurologists, Consultant Paediatricians
MP 191
Epilepsy
N03AG04 Vigabatrin Sachets 500mg
Consultant Paediatricians, Consultant Neurologists
MP 198
Epilepsy
N03AG04 Vigabatrin Tablets 500mg Consultant Paediatricians, Consultant Neurologists
MP 197
Epilepsy
V3.0 September 2021
68 4. Central Nervous System
ATC Code Active Ingredient Dosage Form and Strength
Schedule V Prescriber Criteria
Protocol Pink Card
Pink Card Prescriber Criteria
Schedule V Entitlement
4.7.2 Drugs used in status epilepticus N05BA01 Diazepam Rectal Tubes
5mg/2.5mL Consultants B Medical Practitioners Cerebral Palsy, Epilepsy, Malignant Diseases
N05BA01 Diazepam Rectal Tubes 10mg/2.5mL
Consultants B Medical Practitioners Cerebral Palsy, Epilepsy, Malignant Diseases
4.8 Drugs used in parkinsonism and related disorders 4.8.1 Dopaminergic drugs used in parkinsonism
N04BB01 Amantadine Tablets 100mg Consultants
Huntington's Chorea, Multiple Sclerosis, Parkinson's Disease
G02CB01/ N04BC01
Bromocriptine Mesylate
Tablets 2.5mg Consultants
Addiction Disorders, Chronic Mood Disorders, Chronic Psychiatric Disorders Starting in Childhood, Dementia, Huntington's Chorea, Parkinson's Disease, Hypopituitarism, Pituitary Adenomas, Malignant Diseases, Psychosis, Schizophrenia
N04BA02 Levodopa + Benserazide Hydrochloride
Dispersible Tablets 100mg + 25mg
Consultant Geriatricians, Consultant Neurologists
MP 118
Parkinson's Disease
N04BA02 Levodopa + Benserazide Hydrochloride
Tablets 50mg + 12.5mg
Consultants C Medical Practitioners Parkinson's Disease
N04BA02 Levodopa + Benserazide Hydrochloride
Tablets 100mg + 25mg
Consultants C Medical Practitioners Parkinson's Disease
N04BA02 Levodopa + Benserazide Hydrochloride
Tablets 200mg + 50mg
Consultants C Medical Practitioners Parkinson's Disease
N04BA02 Levodopa + Carbidopa
Tablets 100mg + 10mg
Consultants C Medical Practitioners Cerebral Palsy, Parkinson's Disease
V3.0 September 2021
69 4. Central Nervous System
ATC Code Active Ingredient Dosage Form and Strength
Schedule V Prescriber Criteria
Protocol Pink Card
Pink Card Prescriber Criteria
Schedule V Entitlement
N04BA03 Levodopa + Carbidopa + Entacapone
Tablets 100mg + 25mg + 200mg
Consultant Geriatricians, Consultant Neurologists
MP 216
Parkinson's Disease
N04BC04 Ropinirole Tablets 250mcg
Consultant Geriatricians, Consultant Neurologists
MP 215
Parkinson's Disease
N04BC04 Ropinirole Tablets 1mg Consultant Geriatricians, Consultant Neurologists
MP 215
Parkinson's Disease
N04BC04 Ropinirole Tablets 5mg Consultant Geriatricians, Consultant Neurologists
MP 215
Parkinson's Disease
N04BD02 Rasagiline Tablets 1mg Consultant Neurologists, Consultant Geriatricians
MP 268
Parkinson's Disease
N04BD01 Selegiline Tablets 5mg Consultants C Medical Practitioners Parkinson's Disease
4.8.2 Antimuscarinic drugs used in parkinsonism N04AB02 Orphenadrine
Hydrochloride Tablets 50mg Consultants
Addiction Disorders, Chronic Mood Disorders, Chronic Neurotic Disorders, Chronic Psychiatric Disorders Starting in Childhood, Dementia, Parkinson's Disease, Malignant Diseases, Psychosis, Schizophrenia
N04AA04 Procyclidine Injection IM/IV 10mg/2mL
Consultant Geriatricians, Consultant Neurologists, Consultant Psychiatrists
Addiction Disorders, Chronic Mood Disorders, Chronic Neurotic Disorders, Chronic Psychiatric Disorders Starting in Childhood, Dementia, Parkinson's Disease, Psychosis, Schizophrenia
N04AA04 Procyclidine Syrup 5mg/5mL
Consultant Geriatricians, Consultant Neurologists, Consultant Psychiatrists
MP 168
Addiction Disorders, Chronic Mood Disorders, Chronic Neurotic Disorders, Chronic Psychiatric Disorders Starting in Childhood, Dementia, Parkinson's Disease, Psychosis, Schizophrenia
V3.0 September 2021
70 4. Central Nervous System
ATC Code Active Ingredient Dosage Form and Strength
Schedule V Prescriber Criteria
Protocol Pink Card
Pink Card Prescriber Criteria
Schedule V Entitlement
N04AA04 Procyclidine Tablets 5mg Consultant Geriatricians, Consultant Neurologists, Consultant Psychiatrists
Addiction Disorders, Chronic Mood Disorders, Chronic Neurotic Disorders, Chronic Psychiatric Disorders Starting in Childhood, Dementia, Parkinson's Disease, Psychosis, Schizophrenia
N04AA01 Trihexyphenidyl Hydrochloride (Benzhexol Hydrochloride)
Tablets 2mg Consultants C Medical Practitioners Cerebral Palsy, Chronic Mood Disorders, Chronic Neurotic Disorders, Chronic Psychiatric Disorders Starting in Childhood, Dementia, Huntington's Chorea, Motor Neuron Disease, Parkinson's Disease, Psychosis, Schizophrenia, Malignant Diseases
4.8.3 Drugs used in tremor, chorea, tics and related disorders N05AD01 Haloperidol Capsules
0.5mg Consultant Geriatricians, Consultant Haematologists, Consultant Oncologists, Consultant Palliative Care, Consultant Psychiatrists
C Consultant Geriatricians, Consultant Haematologists, Consultant Oncologists, Consultant Palliative Care, Consultant Psychiatrists
Addiction Disorders, Chronic Mood Disorders, Chronic Neurotic Disorders, Chronic Psychiatric Disorders Starting in Childhood, Dementia, Psychosis, Schizophrenia, Malignant Diseases
N05AD01 Haloperidol Injections 5mg Consultant Haematologists, Consultant Oncologists, Consultant Palliative Care, Consultant Psychiatrists
Addiction Disorders, Chronic Psychiatric Disorders Starting in Childhood, Psychosis, Schizophrenia, Malignant Diseases
V3.0 September 2021
71 4. Central Nervous System
ATC Code Active Ingredient Dosage Form and Strength
Schedule V Prescriber Criteria
Protocol Pink Card
Pink Card Prescriber Criteria
Schedule V Entitlement
N05AD01 Haloperidol Oral Solution 2mg/mL
Consultant Geriatricians, Consultant Haematologists, Consultant Oncologists, Consultant Palliative Care, Consultant Psychiatrists
C Consultant Geriatricians, Consultant Haematologists, Consultant Oncologists, Consultant Palliative Care, Consultant Psychiatrists
Addiction Disorders, Chronic Mood Disorders, Chronic Neurotic Disorders, Chronic Psychiatric Disorders Starting in Childhood, Dementia, Psychosis, Schizophrenia, Malignant Diseases
N05AD01 Haloperidol Tablets 1.5mg Consultant Geriatricians, Consultant Haematologists, Consultant Oncologists, Consultant Palliative Care, Consultant Psychiatrists
C Consultant Geriatricians, Consultant Haematologists, Consultant Oncologists, Consultant Palliative Care, Consultant Psychiatrists
Addiction Disorders, Chronic Mood Disorders, Chronic Neurotic Disorders, Chronic Psychiatric Disorders Starting in Childhood, Dementia, Psychosis, Schizophrenia, Malignant Diseases
N05AD01 Haloperidol Tablets 5mg Consultant Geriatricians, Consultant Haematologists, Consultant Oncologists, Consultant Palliative Care, Consultant Psychiatrists
C Consultant Geriatricians, Consultant Haematologists, Consultant Oncologists, Consultant Palliative Care, Consultant Psychiatrists
Addiction Disorders, Chronic Mood Disorders, Chronic Neurotic Disorders, Chronic Psychiatric Disorders Starting in Childhood, Dementia, Psychosis, Schizophrenia, Malignant Diseases
V3.0 September 2021
72 4. Central Nervous System
ATC Code Active Ingredient Dosage Form and Strength
Schedule V Prescriber Criteria
Protocol Pink Card
Pink Card Prescriber Criteria
Schedule V Entitlement
N07XX06 Tetrabenazine Tablets 25mg Consultants C Consultants Chronic Mood Disorders, Chronic Neurotic Disorders, Chronic Psychiatric Disorders Starting in Childhood, Dementia, Huntington's Chorea, Parkinson's Disease, Psychosis, Schizophrenia, Malignant Diseases
4.9 Drugs used in substance dependence N07BB01 Disulfiram Tablets 200mg Consultants C Hospital Doctors Addiction Disorders
N07BB04 Naltrexone Hydrochloride
Tablets 50mg Consultant Psychiatrists
Addiction Disorders, Chronic Psychiatric Disorders Starting in Childhood
4.10 Drugs for dementia N06DA02 Donepezil
Hydrochloride Tablets 5mg Consultant Geriatricians,
Consultant Neurologists, Consultant Psychiatrists
MP 58
Dementia
N06DA02 Donepezil Hydrochloride
Tablets 10mg Consultant Geriatricians, Consultant Neurologists, Consultant Psychiatrists
MP 58
Dementia
V3.0 September 2021
73 5. Infections
ATC Code Active Ingredient Dosage Form and Strength
Schedule V Prescriber Criteria
Protocol Pink Card
Pink Card Prescriber Criteria
Schedule V Entitlement
5. Infections 5.1 Antibacterial drugs
5.1.1 Penicillins J01CA04 Amoxicillin Capsules
250mg Consultants GU Clinic Entitlement: GU Clinic Consultants
A Medical Practitioners Chronic Kidney Disease, Chronic Liver Disease, Chronic Obstructive Pulmonary Disease, Chronic Osteomyelitis, Chronic Respiratory Failure, Congenital Indifference to Pain, Cystic Fibrosis, Diabetes Mellitus Type 1, Diabetes Mellitus Type 2, Down Syndrome, Gastric/Duodenal Ulcers, HIV/AIDS and HIV Related Diseases, Hospital Acquired Infections, Imperforate Anus, Malignant Diseases, Peripheral Vascular Disease, Primary Immunodeficiency Disorder, Secondary Immunodeficiency Disorder, Spinal Cord Pathologies
J01CA04 Amoxicillin Injection 250mg
Consultants A Medical Practitioners Malignant Diseases, Peripheral Vascular Disease
J01CA04 Amoxicillin Injection 500mg
Consultants A Medical Practitioners Malignant Diseases, Peripheral Vascular Disease
V3.0 September 2021
74 5. Infections
ATC Code Active Ingredient Dosage Form and Strength
Schedule V Prescriber Criteria
Protocol Pink Card
Pink Card Prescriber Criteria
Schedule V Entitlement
J01CA04 Amoxicillin Oral Suspension 125mg/5mL
Consultants A Medical Practitioners Chronic Kidney Disease, Chronic Liver Disease, Chronic Obstructive Pulmonary Disease, Chronic Osteomyelitis, Chronic Respiratory Failure, Congenital Indifference to Pain, Cystic Fibrosis, Diabetes Mellitus Type 1, Diabetes Mellitus Type 2, Down Syndrome, Gastric/Duodenal Ulcers, HIV/AIDS and HIV Related Diseases, Hospital Acquired Infections, Imperforate Anus, Malignant Diseases, Peripheral Vascular Disease, Primary Immunodeficiency Disorder, Secondary Immunodeficiency Disorder, Spinal Cord Pathologies
J01CR02 Amoxicillin + Clavulanic Acid
Oral Suspension 156mg/5mg
Consultants A Medical Practitioners Chronic Kidney Disease, Chronic Liver Disease, Chronic Obstructive Pulmonary Disease, Chronic Osteomyelitis, Chronic Respiratory Failure, Congenital Indifference to Pain, Cystic Fibrosis, Diabetes Mellitus Type 1, Diabetes Mellitus Type 2, Down Syndrome, HIV/AIDS and HIV Related Diseases, Hospital Acquired Infections, Malignant Diseases, Peripheral Vascular Disease, Primary Immunodeficiency Disorder, Secondary Immunodeficiency Disorder, Spinal Cord Pathologies
V3.0 September 2021
75 5. Infections
ATC Code Active Ingredient Dosage Form and Strength
Schedule V Prescriber Criteria
Protocol Pink Card
Pink Card Prescriber Criteria
Schedule V Entitlement
J01CR02 Amoxicillin + Clavulanic Acid
Tablets 250mg + 125mg
Consultants A Medical Practitioners Chronic Kidney Disease, Chronic Liver Disease, Chronic Obstructive Pulmonary Disease, Chronic Osteomyelitis, Chronic Respiratory Failure, Congenital Indifference to Pain, Cystic Fibrosis, Diabetes Mellitus Type 1, Diabetes Mellitus Type 2, Down Syndrome, HIV/AIDS and HIV Related Diseases, Hospital Acquired Infections, Malignant Diseases, Peripheral Vascular Disease, Primary Immunodeficiency Disorder, Secondary Immunodeficiency Disorder, Spinal Cord Pathologies
J01CE01 Benzylpenicillin Injection 600mg
Consultants A Medical Practitioners Congenital Indifference to Pain, Chronic Osteomyelitis, Hospital Acquired Infections, Malignant Diseases, Peripheral Vascular Disease, Spinal Cord Pathologies
J01CF05 Flucloxacillin Capsules 250mg
Consultants A Medical Practitioners Chronic Immunobullous Disorders, Chronic
Osteomyelitis, Congenital Ichthyosis,
Congenital Indifference to Pain, Cystic Fibrosis,
Diabetes Mellitus Type 1, Diabetes Mellitus
Type 2, HIV/AIDS and HIV Related Diseases,
Hospital Acquired Infections, Malignant
Diseases, Peripheral Vascular Disease, Spinal
Cord Pathologies
J01CF05 Flucloxacillin Injection 250mg
Consultants A Medical Practitioners Congenital Indifference to Pain, Chronic Osteomyelitis, Hospital Acquired Infections, Malignant Diseases, Peripheral Vascular Disease, Spinal Cord Pathologies
V3.0 September 2021
76 5. Infections
ATC Code Active Ingredient Dosage Form and Strength
Schedule V Prescriber Criteria
Protocol Pink Card
Pink Card Prescriber Criteria
Schedule V Entitlement
J01CF05 Flucloxacillin Syrup 125mg/5mL
Consultants A Medical Practitioners Chronic Immunobullous Disorders, Chronic Osteomyelitis, Congenital Ichthyosis, Congenital Indifference to Pain, Cystic Fibrosis, Diabetes Mellitus Type 1, Diabetes Mellitus Type 2, HIV/AIDS and HIV Related Diseases, Hospital Acquired Infections, Malignant Diseases, Peripheral Vascular Disease, Spinal Cord Pathologies
J01CE02 Phenoxymethylpenicillin (Penicillin
V)
Solution 125mg/5mL
Consultants C Medical Practitioners Chronic Kidney Disease, Chronic Osteomyelitis, Congenital Indifference to Pain, Hospital Acquired Infections, Inherited Haemoglobinopathies, Malignant Diseases, Peripheral Vascular Disease, Secondary Immunodeficiency Disorder, Spinal Cord Pathologies
J01CE02 Phenoxymethylpenicillin (penicillin
V)
Tablets 250mg Consultants C Medical Practitioners Chronic Kidney Disease, Chronic Osteomyelitis, Congenital Indifference to Pain, Hospital Acquired Infections, Inherited Haemoglobinopathies, Malignant Diseases, Peripheral Vascular Disease, Secondary Immunodeficiency Disorder, Spinal Cord Pathologies
5.1.2 Cephalosporins J01DB01 Cefalexin Capsules
250mg Consultants A Medical Practitioners Chronic Immunobullous Disorders, Chronic
Osteomyelitis, Congenital Ichthyosis, Congenital Indifference to Pain, Diabetes Mellitus Type 1, Diabetes Mellitus Type 2, Hospital Acquired Infections, Malignant Diseases, Peripheral Vascular Disease, Spinal Cord Pathologies
V3.0 September 2021
77 5. Infections
ATC Code Active Ingredient Dosage Form and Strength
Schedule V Prescriber Criteria
Protocol Pink Card
Pink Card Prescriber Criteria
Schedule V Entitlement
J01DB01 Cefalexin Syrup 125mg/5mL
Consultants A Medical Practitioners Chronic Immunobullous Disorders, Chronic Osteomyelitis, Congenital Ichthyosis, Congenital Indifference to Pain, Diabetes Mellitus Type 1, Diabetes Mellitus Type 2, Hospital Acquired Infections, Malignant Diseases, Peripheral Vascular Disease, Spinal Cord Pathologies
J01DC02 Cefuroxime Axetil Suspension 125mg/5mL
Consultants A Medical Practitioners Chronic Osteomyelitis, Congenital Indifference to Pain, Down Syndrome, Hospital Acquired Infections, Malignant Diseases, Peripheral Vascular Disease, Spinal Cord Pathologies
J01DC02 Cefuroxime Axetil Tablets 250mg Consultants A Medical Practitioners Chronic Osteomyelitis, Congenital Indifference to Pain, Down Syndrome, HIV/AIDS and HIV Related Diseases, Hospital Acquired Infections, Malignant Diseases, Peripheral Vascular Disease, Spinal Cord Pathologies
5.1.3 Tetracyclines J01AA02 Doxycycline Capsules
100mg Consultants GU Clinic Entitlement: GU Clinic Consultants
DM Medical Practitioners Chronic Immunobullous Disorders, Chronic Obstructive Pulmonary Disease, Chronic Osteomyelitis, Chronic Respiratory Failure, Congenital Indifference to Pain, Cystic Fibrosis, Diabetes Mellitus Type 1, Diabetes Mellitus Type 2, Hidradenitis Suppurativa, HIV/AIDS and HIV Related Diseases, Hospital Acquired Infections, Malignant Diseases, Peripheral Vascular Disease, Spinal Cord Pathologies
V3.0 September 2021
78 5. Infections
ATC Code Active Ingredient Dosage Form and Strength
Schedule V Prescriber Criteria
Protocol Pink Card
Pink Card Prescriber Criteria
Schedule V Entitlement
J01AA07 Tetracycline Capsules 250mg
Consultants A Medical Practitioners Chronic Immunobullous Disorders, Chronic Osteomyelitis, Congenital Indifference to Pain, Gastric/Duodenal Ulcers, Hospital Acquired Infections, Malignant Diseases, Peripheral Vascular Disease, Spinal Cord Pathologies
5.1.4 Aminoglycosides J01GB03 Gentamicin Injection
80mg (to be inhaled in cystic fibrosis)
Consultants TBDF MDHP only
Cystic Fibrosis
5.1.5 Macrolides J01FA10 Azithromycin
Capsules 250mg
Consultant Paediatricians, Infectious Disease Consultants, Consultant Respiratory Physicians, Mater Dei Hospital Antibiotic Team Consultants GU Clinic Entitlement: GU Clinic Consultants
MP 11
Primary Immunodeficiency Disorder, Secondary Immunodeficiency Disorder, Cystic Fibrosis
V3.0 September 2021
79 5. Infections
ATC Code Active Ingredient Dosage Form and Strength
Schedule V Prescriber Criteria
Protocol Pink Card
Pink Card Prescriber Criteria
Schedule V Entitlement
J01FA10 Azithromycin Capsules 500mg
Consultant Paediatricians, Infectious Disease Consultants, Consultant Respiratory Physicians, Mater Dei Hospital Antibiotic Team Consultants GU Clinic Entitlement: GU Clinic Consultants
MP 11
Primary Immunodeficiency Disorder, Secondary Immunodeficiency Disorder, Cystic Fibrosis
J01FA10 Azithromycin Suspension 200mg/5mL
Consultant Paediatricians, Infectious Disease Consultants, Consultant Respiratory Physicians, Mater Dei Hospital Antibiotic Team Consultants GU Clinic Entitlement: GU Clinic Consultants
MP 11
Primary Immunodeficiency Disorder, Secondary Immunodeficiency Disorder, Cystic Fibrosis
J01FA09 Clarithromycin Syrup 125mg/5mL
Consultant Paediatricians
Down Syndrome, Congenital Indifference to Pain, Gastric/Duodenal Ulcers, Chronic Osteomyelitis, HIV/AIDS and HIV Related Diseases, Hospital Acquired Infections, Chronic Respiratory Failure
V3.0 September 2021
80 5. Infections
ATC Code Active Ingredient Dosage Form and Strength
Schedule V Prescriber Criteria
Protocol Pink Card
Pink Card Prescriber Criteria
Schedule V Entitlement
J01FA09 Clarithromycin Tablets 250mg Consultants A Consultants Chronic Obstructive Pulmonary Disease, Chronic Osteomyelitis, Chronic Respiratory Failure, Congenital Indifference to Pain, Down Syndrome, Gastric/Duodenal Ulcers, HIV/AIDS and HIV Related Diseases, Hospital Acquired Infections, Malignant Diseases, Peripheral Vascular Disease, Spinal Cord Pathologies
J01FA01 Erythromycin Syrup 125mg/5mL
Consultants B Medical Practitioners Chronic Kidney Disease, Chronic Osteomyelitis, Congenital Indifference to Pain, Diabetes Mellitus Type 1, Diabetes Mellitus Type 2, HIV/AIDS and HIV Related Diseases, Hospital Acquired Infections, Malignant Diseases, Peripheral Vascular Disease, Secondary Immunodeficiency Disorder, Spinal Cord Pathologies
J01FA01 Erythromycin Capsules/ Tablets 250mg
Consultants GU Clinic Entitlement: GU Clinic Consultants
B Medical Practitioners Chronic Kidney Disease, Chronic Osteomyelitis, Congenital Indifference to Pain, Diabetes Mellitus Type 1, Diabetes Mellitus Type 2, HIV/AIDS and HIV Related Diseases, Hospital Acquired Infections, Malignant Diseases, Peripheral Vascular Disease, Secondary Immunodeficiency Disorder, Spinal Cord Pathologies
V3.0 September 2021
81 5. Infections
ATC Code Active Ingredient Dosage Form and Strength
Schedule V Prescriber Criteria
Protocol Pink Card
Pink Card Prescriber Criteria
Schedule V Entitlement
5.1.6 Clindamycin J01FF01 Clindamycin Capsules
150mg Consultants A Consultants Chronic Osteomyelitis, Congenital Indifference
to Pain, Diabetes Mellitus Type 1, Diabetes Mellitus Type 2, Hidradenitis Suppurativa, HIV/AIDS and HIV Related Diseases, Hospital Acquired Infections, Malignant Diseases, Peripheral Vascular Disease, Spinal Cord Pathologies
5.1.7 Some other antibacterials J01BA01 Chloramphenicol Capsules
250mg Consultants A Consultants Chronic Osteomyelitis, Congenital Indifference
to Pain, HIV/AIDS and HIV Related Diseases, Hospital Acquired Infections, Malignant Diseases, Spinal Cord Pathologies
J01XB01 Colistimethate Sodium (Colistin Sulphomethate Sodium)
Injection 1 MU (for inhalation in cystic fibrosis)
Consultant Infectious Diseases Physicians, Consultant Paediatricians, Consultant Respiratory Physicians
MP 44
Chronic Respiratory Failure, Cystic Fibrosis
J01XC01 Fusidate Sodium Tablets 250mg Consultants A Consultants Chronic Osteomyelitis, Congenital Indifference to Pain, Diabetes Mellitus Type 1, Diabetes Mellitus Type 2, HIV/AIDS and HIV Related Diseases, Hospital Acquired Infections, Malignant Diseases, Peripheral Vascular Disease, Spinal Cord Pathologies
V3.0 September 2021
82 5. Infections
ATC Code Active Ingredient Dosage Form and Strength
Schedule V Prescriber Criteria
Protocol Pink Card
Pink Card Prescriber Criteria
Schedule V Entitlement
J01XC01 Fusidic Acid Oral Suspension
250mg/5mL
Consultants A Consultants Chronic Osteomyelitis, Congenital Indifference to Pain, Diabetes Mellitus Type 1, Diabetes Mellitus Type 2, HIV/AIDS and HIV Related Diseases, Hospital Acquired Infections, Malignant Diseases, Peripheral Vascular Disease, Spinal Cord Pathologies
5.1.8 Sulphonamides and trimethoprim J01EE01 Co-Trimoxazole Syrup Adult
480mg/5mL Consultants B Medical Practitioners Chronic Immunobullous Disorders, Chronic
Kidney Disease, Chronic Osteomyelitis, Chronic Respiratory Failure, Congenital Ichthyosis, Congenital Indifference to Pain, Cystic Fibrosis, HIV/AIDS and HIV Related Diseases, Hospital Acquired Infections, Imperforate Anus, Inflammatory Bowel Disease, Malignant Diseases, Peripheral Vascular Disease, Primary Immunodeficiency Disorder, Secondary Immunodeficiency Disorder, Spinal Cord Pathologies
Officially deleted. Available until stocks last.
V3.0 September 2021
83 5. Infections
ATC Code Active Ingredient Dosage Form and Strength
Schedule V Prescriber Criteria
Protocol Pink Card
Pink Card Prescriber Criteria
Schedule V Entitlement
J01EE01 Co-Trimoxazole Syrup Paediatric 240mg/5mL
Consultants B Medical Practitioners Chronic Immunobullous Disorders, Chronic Kidney Disease, Chronic Osteomyelitis, Chronic Respiratory Failure, Congenital Ichthyosis, Congenital Indifference to Pain, Cystic Fibrosis, HIV/AIDS and HIV Related Diseases, Hospital Acquired Infections, Imperforate Anus, Inflammatory Bowel Disease, Malignant Diseases, Peripheral Vascular Disease, Primary Immunodeficiency Disorder, Secondary Immunodeficiency Disorder, Spinal Cord Pathologies
J01EE01 Co-Trimoxazole Tablets 400mg + 80mg
Consultants B Medical Practitioners Chronic Immunobullous Disorders, Chronic Kidney Disease, Chronic Osteomyelitis, Chronic Respiratory Failure, Congenital Ichthyosis, Congenital Indifference to Pain, Cystic Fibrosis, Diabetes Mellitus Type 1, Diabetes Mellitus Type 2, HIV/AIDS and HIV Related Diseases, Hospital Acquired Infections, Imperforate Anus, Inflammatory Bowel Disease, Malignant Diseases, Peripheral Vascular Disease, Primary Immunodeficiency Disorder, Secondary Immunodeficiency Disorder, Spinal Cord Pathologies
J01EC02 Sulfadiazine Tablets 500mg Consultants
Chronic Osteomyelitis, Congenital Indifference to Pain, HIV/AIDS and HIV Related Diseases, Hospital Acquired Infections, Malignant Diseases, Peripheral Vascular Disease, Spinal Cord Pathologies
V3.0 September 2021
84 5. Infections
ATC Code Active Ingredient Dosage Form and Strength
Schedule V Prescriber Criteria
Protocol Pink Card
Pink Card Prescriber Criteria
Schedule V Entitlement
J01EA01 Trimethoprim Tablets 100mg Consultants A Medical Practitioners Chronic Kidney Disease, Chronic Osteomyelitis, Congenital Indifference to Pain, Hospital Acquired Infections, Imperforate Anus, Malignant Diseases, Peripheral Vascular Disease, Spinal Cord Pathologies
5.1.9 Antituberculosis drugs J04AB01 Cycloserine Tablets 250mg Consultant Infectious
Diseases Physicians, Paediatric Infectious Diseases Clinic Physicians, Consultant Respiratory Physicians, Chest Clinic Physicians
TBDF Hospitals
only
Tuberculosis
J04AK02 Ethambutol Tablets 100mg Consultant Infectious Diseases Physicians, Paediatric Infectious Diseases Clinic Physicians, Consultant Respiratory Physicians, Chest Clinic Physicians
As per AG TBDF
Hospitals only
Tuberculosis
J04AK02 Ethambutol Tablets 400mg Consultant Infectious Diseases Physicians, Paediatric Infectious Diseases Clinic Physicians, Consultant Respiratory Physicians, Chest Clinic Physicians
TBDF Hospitals
only
Tuberculosis
V3.0 September 2021
85 5. Infections
ATC Code Active Ingredient Dosage Form and Strength
Schedule V Prescriber Criteria
Protocol Pink Card
Pink Card Prescriber Criteria
Schedule V Entitlement
J04AD03 Ethionamide Tablets 250mg Consultant Infectious Diseases Physicians, Chest Clinic Physicians
MP 255 TBDF
Hospitals only
Tuberculosis
J04AC01 Isoniazid Tablets 100mg Consultant Infectious Diseases Physicians, Paediatric Infectious Diseases Clinic Physicians, Consultant Respiratory Physicians, Chest Clinic Physicians
TBDF Hospitals
only
Tuberculosis
J04AM02 Isoniazid + Rifampicin
Tablets 100mg + 150mg
Consultant Infectious Diseases Physicians, Paediatric Infectious Diseases Clinic Physicians, Consultant Respiratory Physicians, Chest Clinic Physicians
TBDF Hospitals
only
Tuberculosis
J04AM02 Isoniazid + Rifampicin
Tablets 150mg + 300mg
Consultant Infectious Diseases Physicians, Paediatric Infectious Diseases Clinic Physicians, Consultant Respiratory Physicians, Chest Clinic Physicians
TBDF Hospitals
only
Tuberculosis
V3.0 September 2021
86 5. Infections
ATC Code Active Ingredient Dosage Form and Strength
Schedule V Prescriber Criteria
Protocol Pink Card
Pink Card Prescriber Criteria
Schedule V Entitlement
J04AK01 Pyrazinamide Tablets 500mg Consultant Infectious Diseases Physicians, Paediatric Infectious Diseases Clinic Physicians, Consultant Respiratory Physicians, Chest Clinic Physicians
TBDF Hospitals
only
Tuberculosis
J04AB04 Rifabutin Capsules 150mg
Consultant Infectious Diseases Physicians, Chest Clinic Physicians
MP 259 TBDF
Hospitals only
Tuberculosis
J04AB02 Rifampicin Capsules 300mg
Consultants, Consultant Dermatologists
MP 174 TB
patients to collect item from Hospitals
only
Hidradenitis Suppurativa, Hospital Acquired Infections, Leprosy, Tuberculosis, Malignant Diseases
J04AB02 Rifampicin Oral Suspension 100mg/5mL
Consultants, Consultant Dermatologists
MP 174 TB
patients to collect item from Hospitals
only
Hidradenitis Suppurativa, Hospital Acquired Infections, Leprosy, Tuberculosis, Malignant Diseases
5.1.10 Antileprotic drugs J04BA01 Clofazimine Capsules/
Tablets 50mg Consultants
Leprosy, Malignant Diseases
V3.0 September 2021
87 5. Infections
ATC Code Active Ingredient Dosage Form and Strength
Schedule V Prescriber Criteria
Protocol Pink Card
Pink Card Prescriber Criteria
Schedule V Entitlement
J04BA02 Dapsone Tablets 50mg Consultants
Chronic Immunobullous Disorders, Dermatomyositis/ Polymyositis, Hidradenitis Suppurativa, HIV/AIDS and HIV Related Diseases, Leprosy, Lupus Erythematosus, Malignant Diseases, Severe Chronic Urticaria, Other Schedule V conditions as determined by a member of the Antibiotic Team
J04BA02 Dapsone Tablets 100mg Consultants
Chronic Immunobullous Disorders, Dermatomyositis/ Polymyositis, Hidradenitis Suppurativa, HIV/AIDS and HIV Related Diseases, Leprosy, Lupus Erythematosus, Malignant Diseases, Severe Chronic Urticaria, Other Schedule V conditions as determined by a member of the Antibiotic Team
L04AX02 Thalidomide Capsules/ Tablets 50mg
Consultant Rheumatologists, Consultant Dermatologists, Consultant Haematologists, Consultant Infectious Disease Physicians, Consultant Oncologists
MP 189 TBDF
Hospitals only
Leprosy, Malignant Diseases, Lupus Erythematosus
5.1.11 Metronidazole P01AB01 Metronidazole Suppositories
500mg Consultants A Medical Practitioners Gastric/Duodenal Ulcers, Hirschsprung's
Disease, Inflammatory Bowel Disease, Peripheral Vascular Disease, Spinal Cord Pathologies
V3.0 September 2021
88 5. Infections
ATC Code Active Ingredient Dosage Form and Strength
Schedule V Prescriber Criteria
Protocol Pink Card
Pink Card Prescriber Criteria
Schedule V Entitlement
P01AB01 Metronidazole Suspension 200mg/5mL
Consultants A Medical Practitioners Chronic Kidney Disease, Chronic Osteomyelitis, Congenital Indifference to Pain, Diabetes Mellitus Type 1, Diabetes Mellitus Type 2, Gastric/Duodenal Ulcers, Hirschsprung's Disease, HIV/AIDS and HIV Related Diseases, Hospital Acquired Infections, Inflammatory Bowel Disease, Malignant Diseases, Peripheral Vascular Disease, Primary Immunodeficiency Disorder, Secondary Immunodeficiency Disorder, Spinal Cord Pathologies
P01AB01 Metronidazole Tablets 200mg Consultants GU Clinic Entitlement: GU Clinic Consultants
A Medical Practitioners Chronic Kidney Disease, Chronic Osteomyelitis, Congenital Indifference to Pain, Diabetes Mellitus Type 1, Diabetes Mellitus Type 2, Gastric/Duodenal Ulcers, Hirschsprung's Disease, HIV/AIDS and HIV Related Diseases, Hospital Acquired Infections, Inflammatory Bowel Disease, Malignant Diseases, Peripheral Vascular Disease, Primary Immunodeficiency Disorder, Secondary Immunodeficiency Disorder, Spinal Cord Pathologies
5.1.12 Quinolones J01MA02 Ciprofloxacin Suspension
250mg/5mL Consultants MP 38
Cystic Fibrosis
V3.0 September 2021
89 5. Infections
ATC Code Active Ingredient Dosage Form and Strength
Schedule V Prescriber Criteria
Protocol Pink Card
Pink Card Prescriber Criteria
Schedule V Entitlement
J01MA02 Ciprofloxacin Tablets 250mg Consultants A Hospital Doctors Chronic Kidney Disease, Chronic Liver Disease, Chronic Osteomyelitis, Chronic Respiratory Failure, Congenital Indifference to Pain, Cystic Fibrosis, Diabetes Mellitus Type 1, Diabetes Mellitus Type 2, HIV/AIDS and HIV Related Diseases, Hospital Acquired Infections, Inflammatory Bowel Disease, Malignant Diseases, Peripheral Vascular Disease, Primary Immunodeficiency Disorder, Secondary Immunodeficiency Disorder, Spinal Cord Pathologies
J01MA12 Levofloxacin Tablets 500mg Mater Dei Hospital Antibiotic Team Consultants
MP173
Hospital Acquired Infections
J01MA14 Moxifloxacin Tablets 400mg Consultant Infectious Diseases Physicians
MP 250 TBDF
Hospitals only
Tuberculosis
J01MA06 Norfloxacin Tablets 400mg Consultants A Consultants Chronic Kidney Disease, Chronic Liver Disease, Chronic Osteomyelitis, Congenital Indifference to Pain, Hospital Acquired Infections, Peripheral Vascular Disease, Spinal Cord Pathologies
V3.0 September 2021
90 5. Infections
ATC Code Active Ingredient Dosage Form and Strength
Schedule V Prescriber Criteria
Protocol Pink Card
Pink Card Prescriber Criteria
Schedule V Entitlement
5.1.13 Urinary tract infections J01XE01 Nitrofurantoin Syrup
25mg/5mL Consultants A Medical Practitioners Chronic Kidney Disease, Congenital
Indifference to Pain, Imperforate Anus, Diabetes Mellitus Type 1, Diabetes Mellitus Type 2, Chronic Osteomyelitis, HIV/AIDS and HIV Related Diseases, Hospital Acquired Infections, Malignant Diseases, Peripheral Vascular Disease, Spinal Cord Pathologies
J01XE01 Nitrofurantoin Tablets 50mg Consultants A Medical Practitioners Chronic Kidney Disease, Congenital Indifference to Pain, Imperforate Anus, Diabetes Mellitus Type 1, Diabetes Mellitus Type 2, Chronic Osteomyelitis, HIV/AIDS and HIV Related Diseases, Hospital Acquired Infections, Malignant Diseases, Peripheral Vascular Disease, Spinal Cord Pathologies
5.2 Antifungal drugs J02AC01 Fluconazole Capsules
50mg Consultants MP 72
Primary Immunodeficiency Disorder, Secondary Immunodeficiency Disorder, HIV/AIDS and HIV Related Diseases, Malignant Diseases, Chronic Kidney Disease
J02AC01 Fluconazole Capsules 150mg
Consultants MP 72
Primary Immunodeficiency Disorder, Secondary Immunodeficiency Disorder, HIV/AIDS and HIV Related Diseases, Malignant Diseases, Chronic Kidney Disease
J02AC01 Fluconazole Suspension 50mg/5mL
Consultants MP 73
Primary Immunodeficiency Disorder, Secondary Immunodeficiency Disorder, HIV/AIDS and HIV Related Diseases, Malignant Diseases, Chronic Kidney Disease
V3.0 September 2021
91 5. Infections
ATC Code Active Ingredient Dosage Form and Strength
Schedule V Prescriber Criteria
Protocol Pink Card
Pink Card Prescriber Criteria
Schedule V Entitlement
D01BA01 Griseofulvin Tablets 125mg Consultants A Hospital Doctors Congenital Indifference to Pain, Chronic Osteomyelitis, Hospital Acquired Infections, Malignant Diseases
J02AC02 Itraconazole Capsules 100mg
Consultant Paediatricians, Consultant Infectious Diseases Physicians, Consultant Oncologists, Consultant Haematologists, Microbiologists
MP 108
Primary Immunodeficiency Disorder, Secondary Immunodeficiency Disorder, HIV/AIDS and HIV Related Diseases, Malignant Diseases, Chronic Kidney Disease, Cystic Fibrosis
J02AC02 Itraconazole Syrup 10mg/mL
Consultant Paediatricians, Consultant Oncologists, Consultant Haematologists, Consultant Infectious Diseases Physicians
MP 107
Primary Immunodeficiency Disorder, Secondary Immunodeficiency Disorder, HIV/AIDS and HIV Related Diseases, Malignant Diseases, Chronic Kidney Disease, Cystic Fibrosis
A07AA02 Nystatin Syrup 100000 IU
Consultants A Medical Practitioners Congenital Indifference to Pain, Primary Immunodeficiency Disorder, Secondary Immunodeficiency Disorder, Chronic Osteomyelitis, HIV/AIDS and HIV Related Diseases, Hospital Acquired Infections, Malignant Diseases, Chronic Kidney Disease, Chronic Immunobullous Disorders
V3.0 September 2021
92 5. Infections
ATC Code Active Ingredient Dosage Form and Strength
Schedule V Prescriber Criteria
Protocol Pink Card
Pink Card Prescriber Criteria
Schedule V Entitlement
J02AC04 Posaconazole Oral Suspension 40mg/mL
Consultant Infectious Diseases Physicians, Consultant Infectious Diseases Paediatricians, Consultant Haematologists, Consultant Oncologists, Mater Dei Hospital Antibiotic Team Consultants
MP 164 Chronic Kidney Disease, Cystic Fibrosis, HIV/AIDS and HIV Related Diseases, Malignant Diseases, Primary Immunodeficiency Disorder, Secondary Immunodeficiency Disorder
J02AC03 Voriconazole Tablets 200mg Consultant Haematologists, Consultant Infectious Diseases Paediatricians, Consultant Infectious Diseases Physicians, Consultant Intensivists, Consultant Microbiologists, Consultant Oncologists, Mater Dei Hospital Antibiotic Team Consultants
MP 305 Chronic Kidney Disease, Cystic Fibrosis, HIV/AIDS and HIV Related Diseases, Malignant Diseases, Primary Immunodeficiency Disorder, Secondary Immunodeficiency Disorder
V3.0 September 2021
93 5. Infections
ATC Code Active Ingredient Dosage Form and Strength
Schedule V Prescriber Criteria
Protocol Pink Card
Pink Card Prescriber Criteria
Schedule V Entitlement
5.3 Antivirals 5.3.1 HIV infection
5.3.1.1 Nucleoside reverse transcriptase inhibitors J05AR02 Abacavir +
Lamivudine Tablets 600mg + 300mg
Consultant Infectious Diseases Physicians, Consultant Hospital Infection Control Physicians
MP 292 TBDF
Hospitals only
HIV/AIDS and HIV Related Diseases
J05AF05 Lamivudine Oral Solution 10mg/mL
Consultant Paediatricians, Consultant Infectious Diseases Physicians
MP 256 TBDF
Hospitals only
HIV/AIDS and HIV Related Diseases
J05AF05 Lamivudine Tablets 100mg Consultant Gastroenterologists, Consultant Infectious Diseases Physicians
MP 110
Hepatitis B and C
J05AF05 Lamivudine Tablets 150mg Consultant Infectious Diseases Physicians, Consultant Hospital Infection Control
MP 99 TBDF
Hospitals only
HIV/AIDS and HIV Related Diseases
J05AF07 Tenofovir Disoproxil
Tablets 245mg Consultant Infectious Diseases Physicians, Consultant Gastroenterologists
MP 187
Hepatitis B and C, HIV/AIDS and HIV Related Diseases
J05AF01 Zidovudine (Azidothymidine)
Capsules 100mg
Consultant Infectious Diseases Physicians, Hospital Infection Control
MP 203 TBDF
Hospitals only
HIV/AIDS and HIV Related Diseases
V3.0 September 2021
94 5. Infections
ATC Code Active Ingredient Dosage Form and Strength
Schedule V Prescriber Criteria
Protocol Pink Card
Pink Card Prescriber Criteria
Schedule V Entitlement
J05AF01 Zidovudine (Azidothymidine) (stand-by)
Oral Solution 100mg/10mL
Consultant Paediatricians, Consultant Infectious Diseases Physicians, Paediatric Infectious Diseases Clinic Physician
MP 202 TBDF
Hospitals only
HIV/AIDS and HIV Related Diseases
J05AR01 Zidovudine+ Lamivudine
Tablets 300mg + 150mg
Consultant Infectious Diseases Physicians, Consultant Hospital Infection Control Physicians
MP 209 TBDF
Hospitals only
HIV/AIDS and HIV Related Diseases
5.3.1.2 Protease inhibitors
J05AR10 Lopinavir/ Ritonavir
Oral Solution 80mg + 20mg per mL
Consultant Infectious Diseases Physicians, Consultant Paediatricians
MP 257 TBDF
Hospitals only
HIV/AIDS and HIV Related Diseases
J05AR10 Lopinavir/ Ritonavir
Tablets 200mg + 50mg
Consultant Infectious Diseases Physicians, Consultant Hospital Infection Control
MP 221 TBDF
Hospitals only
HIV/AIDS and HIV Related Diseases
J05AE03 Ritonavir Capsules 100mg
Consultant Infectious Diseases Physicians
MP 176 TBDF
Hospitals only
HIV/AIDS and HIV Related Diseases
J05AE01 Saquinavir Capsules 500mg
Consultant Infectious Diseases Physicians
MP 178 TBDF
Hospitals only
HIV/AIDS and HIV Related Diseases
V3.0 September 2021
95 5. Infections
ATC Code Active Ingredient Dosage Form and Strength
Schedule V Prescriber Criteria
Protocol Pink Card
Pink Card Prescriber Criteria
Schedule V Entitlement
5.3.1.3 Non-nucleoside reverse transcriptase inhibitors J05AG03 Efavirenz Capsules
200mg Consultant Infectious Diseases Physicians
MP 208 TBDF
Hospitals only
HIV/AIDS and HIV Related Diseases
J05AG03 Efavirenz Tablets 600mg Consultant Infectious Diseases Physicians
MP 222 TBDF
Hospitals only
HIV/AIDS and HIV Related Diseases
J05AG01 Nevirapine Oral suspension 50mg/5mL
Consultant Paediatricians, Consultant Infectious Diseases Physicians
MP 258 TBDF
Hospitals only
HIV/AIDS and HIV Related Diseases
J05AG01 Nevirapine Tablets 200mg Consultant Infectious Diseases Physicians
MP 143 TBDF
Hospitals only
HIV/AIDS and HIV Related Diseases
5.3.1.4 Other antiretrovirals J05AX09 Maraviroc Tablets 300mg Consultant Infectious
Diseases Physicians MP 121
TBDF Hospitals
only
HIV/AIDS and HIV Related Diseases
5.3.2 Herpesvirus infections
5.3.2.1 Herpes simplex and varicella-zoster infection J05AB01 Aciclovir
(Acyclovir) Suspension 200mg/5mL
Consultants MP 3 A Consultant Dermatologists
Primary Immunodeficiency Disorder, Secondary Immunodeficiency Disorder, HIV/AIDS and HIV Related Diseases, Malignant Diseases, Chronic Kidney Disease
V3.0 September 2021
96 5. Infections
ATC Code Active Ingredient Dosage Form and Strength
Schedule V Prescriber Criteria
Protocol Pink Card
Pink Card Prescriber Criteria
Schedule V Entitlement
J05AB01 Aciclovir (Acyclovir)
Tablets 200mg Consultants GU Clinic Entitlement: GU Clinic Consultants
MP 2 A Consultant Dermatologists
Primary Immunodeficiency Disorder, Secondary Immunodeficiency Disorder, HIV/AIDS and HIV Related Diseases, Malignant Diseases, Chronic Kidney Disease
J05AB01 Aciclovir (Acyclovir)
Tablets 800mg Consultants MP 2 A Consultant Dermatologists
Primary Immunodeficiency Disorder, Secondary Immunodeficiency Disorder, HIV/AIDS and HIV Related Diseases, Malignant Diseases, Chronic Kidney Disease
5.3.2.2 Cytomegalovirus infection J05AB14 Valganciclovir Tablets 450mg Consultant Infectious
Diseases Physicians, Consultant Nephrologists, Consultant Cardiac Surgeons, Consultant Gastroenterologists
MP 247 TBDF
Hospitals only
Chronic Kidney Disease, Chronic Liver Disease, HIV/AIDS and HIV Related Diseases, Secondary Immunodeficiency Disorder
5.3.3 Viral Hepatitis 5.3.3.1 Chronic hepatitis C
J05AP51 Ledipasvir + Sofosbuvir
90mg + 400mg Tablets
Consultant Gastroenterologist (HCV Patient Management Committee), Consultant Infectious Disease Physician (HCV Patient Management Committee)
MP 112 TBDF
Hospitals Only
Hepatitis B and C
V3.0 September 2021
97 5. Infections
ATC Code Active Ingredient Dosage Form and Strength
Schedule V Prescriber Criteria
Protocol Pink Card
Pink Card Prescriber Criteria
Schedule V Entitlement
J05AB04 Ribavirin 200mg Capsules/ Tablets
Consultant Gastroenterologist (HCV Patient Management Committee), Consultant Infectious Disease Physician (HCV Patient Management Committee)
MP 171 TBDF
Hospitals Only
Hepatitis B and C
5.4 Antiprotozoal drugs 5.4.1 Antimalarials
P01BA01 Chloroquine Syrup 50mg/5mL
No Schedule V Entitlement. Can be prescribed by Medical Practitioners as per ‘Dispensing of Oral Antimalarials to Out-Patients’ (refer to page 10), or against payment.
P01BA01 Chloroquine Syrup 150mg base/5mL
No Schedule V Entitlement. Can be prescribed by Medical Practitioners as per ‘Dispensing of Oral Antimalarials to Out-Patients’ (refer to page 10), or against payment.
P01BA01 Chloroquine Tablets 250mg
No Schedule V Entitlement. Can be prescribed by Medical Practitioners as per ‘Dispensing of Oral Antimalarials to Out-Patients’ (refer to page 10), or against payment.
P01BC02 Mefloquine Tablets 250mg
No Schedule V Entitlement. Can be prescribed by Medical Practitioners as per ‘Dispensing of Oral Antimalarials to Out-Patients’ (refer to page 10), or against payment.
V3.0 September 2021
98 5. Infections
ATC Code Active Ingredient Dosage Form and Strength
Schedule V Prescriber Criteria
Protocol Pink Card
Pink Card Prescriber Criteria
Schedule V Entitlement
P01BB51 Proguanil Hydrochloride + Atovaquone
Tablets 100mg + 250mg
No Schedule V Entitlement. Can be prescribed by Medical Practitioners as per ‘Dispensing of Oral Antimalarials to Out-Patients’ (refer to page 10), or against payment.
P01BD01 Pyrimethamine (stand-by)
Tablets 25mg Consultants TBDF Hospitals
only
HIV/AIDS and HIV Related Diseases
5.4.2 Antigiardial drugs P01AX05 Mepacrine
Hydrochloride Tablets 100mg Consultant Physicians MP 123
TBDF Hospitals
only
Lupus Erythematosus
5.5 Antihelmintics 5.5.1 Drugs for tapeworm infections
P02BA01 Praziquantel Tablets 500mg N/A A Consultant Infectious Diseases Physicians
No Schedule V Entitlement
5.5.3 Schistosomides (Bilharzias) P02BA01 Praziquantel Tablets 500mg N/A A Consultant Infectious
Diseases Physicians No Schedule V Entitlement
5.5.4 Filaricides P02CF01 Ivermectin Tablets 3mg N/A A Consultants, Senior
Public Health Physicians
No Schedule V Entitlement
5.5.5 Drugs for cutaneous larva migrans P02CF01 Ivermectin Tablets 3mg N/A A Consultants, Senior
Public Health Physicians
No Schedule V Entitlement
V3.0 September 2021
99 6. Endocrine System
ATC Code Active Ingredient Dosage Form and Strength
Schedule V Prescriber Criteria
Protocol Pink Card
Pink Card Prescriber Criteria
Schedule V Entitlement
6. Endocrine System 6.1 Drugs used in diabetes
6.1.1 Insulins
6.1.1.1 Short-acting insulins A10AB05 Insulin Aspart Cartridge
100IU/mL in 3mL
Consultants Endocrinology & Diabetes
MP 207 DM Consultants Endocrinology & Diabetes
Diabetes Mellitus Type 1
A10AB01 Insulin Neutral (Soluble Insulin)
Cartridge 100units/mL in 3mL
Consultants Endocrinology & Diabetes, Consultant Geriatricians, Consultant Paediatricians
MP 100 DM Consultants Endocrinology & Diabetes
Diabetes Mellitus Type 1, Diabetes Mellitus Type 2
A10AB01 Insulin Neutral (Soluble Insulin)
Injection SC 100IU/mL in 10mL
Consultants Endocrinology & Diabetes, Consultant Geriatricians, Consultant Paediatricians
DM Consultants Endocrinology & Diabetes
Diabetes Mellitus Type 1, Diabetes Mellitus Type 2, Gestational Diabetes
6.1.1.2 Intermediate- and long-acting insulins A10AD01 Insulin Biphasic
Isophane (Isophane + Neutral)
Cartridges (70%. 30%) 100IU/mL
Consultants Endocrinology & Diabetes, Consultant Geriatricians, Consultant Paediatricians
MP 100 DM Consultants Endocrinology & Diabetes
Diabetes Mellitus Type 1, Diabetes Mellitus Type 2
A10AD01 Insulin Biphasic Isophane (Isophane + Neutral)
Injection 100IU/mL
Consultants Endocrinology & Diabetes, Consultant Geriatricians, Consultant Paediatricians
DM Consultants Endocrinology & Diabetes
Diabetes Mellitus Type 1, Diabetes Mellitus Type 2, Gestational Diabetes
V3.0 September 2021
100 6. Endocrine System
ATC Code Active Ingredient Dosage Form and Strength
Schedule V Prescriber Criteria
Protocol Pink Card
Pink Card Prescriber Criteria
Schedule V Entitlement
A10AE04 Insulin Glargine Cartridge 100IU/mL
Consultants Endocrinology & Diabetes
MP 101 DM Consultants Endocrinology & Diabetes
Diabetes Mellitus Type 1, Diabetes Mellitus Type 2
A10AC01 Insulin Isophane Cartridge 100 units/mL in 3mL
Consultants Endocrinology & Diabetes, Consultant Geriatricians, Consultant Paediatricians
MP 100 DM Consultants Endocrinology & Diabetes
Diabetes Mellitus Type 1, Diabetes Mellitus Type 2
A10AC01 Insulin Isophane Injection 100 IU/mL in 10mL
Consultants Endocrinology & Diabetes, Consultant Geriatricians, Consultant Paediatricians
DM Consultants Endocrinology & Diabetes
Diabetes Mellitus Type 1, Diabetes Mellitus Type 2, Gestational Diabetes
6.1.2 Antidiabetic drugs
6.1.2.1 Sulphonylureas A10BB01 Glibenclamide Tablets 5mg Consultants DM Consultants
Endocrinology & Diabetes
Diabetes Mellitus Type 2, Gestational Diabetes, Malignant Diseases
A10BB09 Gliclazide Tablets 80mg Consultants DM Consultants Endocrinology & Diabetes
Diabetes Mellitus Type 2, Gestational Diabetes, Malignant Diseases
6.1.2.2 Biguanides A10BA02 Metformin Tablets
500mg Consultants, Specialist Family Medicine PHCD
DM Consultants Endocrinology & Diabetes
Diabetes Mellitus Type 1, Diabetes Mellitus Type 2, Gestational Diabetes, Hidradenitis Suppurativa, Malignant Diseases
6.1.2.3 Other Antidiabetic Drugs A10BH01 DPP-4 Inhibitors
[Gliptins] (Currently Vildagliptin)
Tablets 50mg Consultants Endocrinology & Diabetes
MP 89
Diabetes Mellitus Type 2
V3.0 September 2021
101 6. Endocrine System
ATC Code Active Ingredient Dosage Form and Strength
Schedule V Prescriber Criteria
Protocol Pink Card
Pink Card Prescriber Criteria
Schedule V Entitlement
A10BX02 Repaglinide Tablets 0.5mg
Consultants Endocrinology & Diabetes
Diabetes Mellitus Type 2
A10BX02 Repaglinide Tablets 2mg Consultants Endocrinology & Diabetes
Diabetes Mellitus Type 2
A10BK03 SGLT2 inhibitor (currently Empagliflozin)
Tablets 10mg Consultants Endocrinology & Diabetes
MP 182 Diabetes Mellitus Type 2
A10BK03 SGLT2 inhibitor (currently Empagliflozin)
Tablets 25mg
Consultants Endocrinology & Diabetes
MP 182 Diabetes Mellitus Type 2
6.1.3 Treatment of hypoglycaemia H04AA01 Glucagon Injection 1mg Consultants Endocrinology
& Diabetes DM Consultants
Endocrinology & Diabetes
Diabetes Mellitus Type 1, Diabetes Mellitus Type 2, Gestational Diabetes
6.2 Thyroid and antithyroid drugs 6.2.1 Thyroid hormones
H03AA01 Levothyroxine (Thyroxine)
Tablets 25mcg
Consultants C Medical Practitioners Chronic Mood Disorders, Down Syndrome, Turner Syndrome, Hypopituitarism, Malignant Diseases
H03AA01 Levothyroxine (Thyroxine)
Tablets 100mcg
Consultants C Medical Practitioners Chronic Mood Disorders, Down Syndrome, Turner Syndrome, Hypopituitarism, Malignant Diseases
H03AA02 Liothyronine Sodium (L-Tri-iodothyronine)
Tablets 25mcg
Consultants MP 242
Down Syndrome, Turner Syndrome, Hypopituitarism, Malignant Diseases
6.2.2 Antithyroid drugs H03BB01 Carbimazole Tablets 5mg Consultants C Medical Practitioners Malignant Diseases
H03BA02 Propylthiouracil Tablets 50mg Consultants C Medical Practitioners Malignant Diseases
V3.0 September 2021
102 6. Endocrine System
ATC Code Active Ingredient Dosage Form and Strength
Schedule V Prescriber Criteria
Protocol Pink Card
Pink Card Prescriber Criteria
Schedule V Entitlement
6.3 Corticosteroids 6.3.1 Replacement therapy
H02AA02 Fludrocortisone Acetate
Tablets 0.1mg
Consultants
Addison's Disease, Hypopituitarism, Secondary Immunodeficiency Disorder, Malignant Diseases, Chronic Kidney Disease
6.3.2 Glucocorticoid therapy H02AB02 Dexamethasone Tablets
0.5mg Consultants C Medical Practitioners Addison's Disease, Enzyme Disorders,
Hypopituitarism, Malignant Diseases
H02AB02 Dexamethasone Tablets 2mg Consultants
Addison's Disease, Enzyme Disorders, Hypopituitarism, Malignant Diseases
H02AB09 Hydrocortisone Tablets 5mg (Half Scored) or Tablets 10mg (Quarter Scored)
Consultant Paediatricians, Consultant Physicians
Addison's Disease, Enzyme Disorders, Epilepsy, Hypopituitarism, Malignant Diseases
H02AB09 Hydrocortisone Tablets 20mg Consultants C Consultants Addison's Disease, Enzyme Disorders, Epilepsy, Hypopituitarism, Malignant Diseases
H02AB09 Hydrocortisone Sodium Succinate
Injection 100mg
Consultants TBDF Hospitals
only
Addison's Disease, Hypopituitarism, Inherited Haemoglobinopathies, Malignant Diseases, Lupus Erythematosus
H02AB04 Methylprednisolone Tablets 4mg Consultant Dermatologists
Addison's Disease, Hypopituitarism, Malignant Diseases, Dermatomyositis/ Polymyositis, Lupus Erythematosus
H02AB04 Methylprednisolone Acetate
Injection IM 40mg/mL
Consultants
Myasthenia Gravis, Malignant Diseases, Rheumatoid Arthritis, Spondyloarthritis, Chronic Immunobullous Disorders
V3.0 September 2021
103 6. Endocrine System
ATC Code Active Ingredient Dosage Form and Strength
Schedule V Prescriber Criteria
Protocol Pink Card
Pink Card Prescriber Criteria
Schedule V Entitlement
H02AB04 Methylprednisolone (as Sodium Succinate or Hemisuccinate/ Hydrogen Succinate)
Injection 500mg
Consultants
Malignant Diseases, Neuromyelitis Optica
H02AB04 Methylprednisolone (as Sodium Succinate or Hemisuccinate/ Hydrogen Succinate)
Injection IM/IV 40mg
Consultants
Myasthenia Gravis, Chronic Immunobullous Disorders
H02AB06 Prednisolone Tablets 1mg Consultants B Medical Practitioners Addison's Disease, Chronic Asthma, Chronic Kidney Disease, Chronic Liver Disease, Chronic Obstructive Pulmonary Disease, Chronic Respiratory Failure, Cystic Fibrosis, Dermatomyositis/ Polymyositis, Enzyme Disorders, Epilepsy, HIV/AIDS and HIV Related Diseases, Hypopituitarism, Inflammatory Bowel Disease, Leprosy, Lupus Erythematosus, Malignant Diseases, Multiple Sclerosis, Myasthenia Gravis,Neuromyelitis Optica, Polyartritis Nodosa, Polymyalgia Rheumatica, Rheumatoid Arthritis, Secondary Immunodeficiency Disorder, Spondyloarthritis, Systemic Sclerosis
V3.0 September 2021
104 6. Endocrine System
ATC Code Active Ingredient Dosage Form and Strength
Schedule V Prescriber Criteria
Protocol Pink Card
Pink Card Prescriber Criteria
Schedule V Entitlement
H02AB06 Prednisolone Tablets 5mg Consultants GU Clinic Entitlement: GU Clinic Consultants
B Medical Practitioners Addison's Disease, Chronic Asthma, Chronic Immunobullous Disorders, Chronic Kidney Disease, Chronic Liver Disease, Chronic Obstructive Pulmonary Disease, Chronic Respiratory Failure, Cystic Fibrosis, Dermatomyositis/ Polymyositis, Enzyme Disorders, Epilepsy, HIV/AIDS and HIV Related Diseases, Hypopituitarism, Inflammatory Bowel Disease, Leprosy, Lupus Erythematosus, Malignant Diseases, Multiple Sclerosis, Myasthenia Gravis, Neuromyelitis Optica, Polyartritis Nodosa, Polymyalgia Rheumatica, Rheumatoid Arthritis, Secondary Immunodeficiency Disorder, Spondyloarthritis, Systemic Sclerosis
H02AB06 Prednisolone Tablets enteric-coated 5mg
Consultants B Medical Practitioners Addison's Disease, Chronic Asthma, Chronic Immunobullous Disorders, Chronic Kidney Disease, Chronic Liver Disease, Chronic Obstructive Pulmonary Disease, Chronic Respiratory Failure, Cystic Fibrosis, Dermatomyositis/ Polymyositis, Enzyme Disorders, Epilepsy, HIV/AIDS and HIV Related Diseases, Hypopituitarism, Inflammatory Bowel Disease, Leprosy, Lupus Erythematosus, Malignant Diseases, Multiple Sclerosis, Myasthenia Gravis, Neuromyelitis Optica, Polyartritis Nodosa, Polymyalgia Rheumatica, Rheumatoid Arthritis, Secondary Immunodeficiency Disorder, Spondyloarthritis, Systemic Sclerosis
V3.0 September 2021
105 6. Endocrine System
ATC Code Active Ingredient Dosage Form and Strength
Schedule V Prescriber Criteria
Protocol Pink Card
Pink Card Prescriber Criteria
Schedule V Entitlement
6.4 Sex hormones 6.4.1 Female sex hormones 6.4.1.1 Estrogens and HRT
G03CA57 Conjugated Estrogens (Equine)
Tablets 0.625mg
Consultants C Consultants Hypogonadism
G03CA57 Conjugated Estrogens (Equine)
Tablets 1.25mg
Consultants C Consultants Hypogonadism
G03CA03 Estradiol Tablets 1mg Consultants Obstetrics & Gynaecology, Consultants Endocrinology & Diabetes, Consultants Endocrinology (Transgender MDT)
C Consultants Obstetrics & Gynaecology
Turner Syndrome, Hypogonadism, Gender Identity & Sex Characteristics Related Conditions
G03FA10 Estradiol (as hemihydrate) + Dydrogesterone
Tablets 2mg + 10mg
Consultants Endocrinology & Diabetes, Consultant Oncologists, Consultant Haematologists
MP 234
Hypopituitarism, Malignant Diseases
G03CA01 Ethinylestradiol Tablets 10mcg
Consultant Paediatricians, Consultants Endocrinology & Diabetes, Consultants Endocrinology (Transgender MDT)
MP 235
Hypogonadism, Hypopituitarism, Malignant Diseases, Turner Syndrome, Gender Identity & Sex Characteristics Related Conditions
6.4.1.2 Progesterone G03DB01 Dydrogesterone Tablets 10mg N/A B Consultants No Schedule V Entitlement
G03DA02 Medroxyprogesterone Acetate
Tablets 5mg Consultants, Consultants Endocrinology (Transgender MDT)
Endometriosis/Adenomyosis, Hypogonadism, Malignant Diseases, Gender Identity & Sex Characteristics Related Conditions
G03DC02 Norethisterone Tablets 5mg Consultants B Hospital Doctors Turner Syndrome, Hypogonadism, Hypopituitarism, Malignant Diseases
V3.0 September 2021
106 6. Endocrine System
ATC Code Active Ingredient Dosage Form and Strength
Schedule V Prescriber Criteria
Protocol Pink Card
Pink Card Prescriber Criteria
Schedule V Entitlement
6.4.2 Male sex hormones and antagonists G03BA03 Testosterone Oily Injection
250mg Consultant Paediatricians, Consultants Endocrinology & Diabetes, Consultant Oncologists, Consultants Endocrinology (Transgender MDT)
MP 188
Hypogonadism, Hypopituitarism, Malignant Diseases, Gender Identity & Sex Characteristics Related Conditions
G03BA03 Testosterone Undecanoate
Injection 1000mg/4mL
Consultants Endocrinology & Diabetes, Consultants Endocrinology (Transgender MDT)
MP 279
Hypogonadism, Gender Identity & Sex Characteristics Related Conditions
G04CB01 Finasteride Tablets 5mg Consultant Dermatologists, Consultant Urologists, Consultants Endocrinology (Transgender MDT)
C Consultant Urologists Benign Prostatic Enlargement, Gender Identity & Sex Characteristics Related Conditions, Hidradenitis Suppurativa, Malignant Diseases
6.5 Hypothalamic and pituitary hormones and anti-estrogens 6.5.1 Hypothalamic and anterior pituitary hormones and anti-estrogens
G03GA01 Chorionic Gonadotrophin (HCG)
Injection 1000 IU
Consultants
Hypogonadism, Hypopituitarism
G03GA01 Chorionic Gonadotrophin (HCG)
Injection 5000 IU
Consultants
Hypogonadism, Hypopituitarism
H01AC01 Growth Hormone Recombinant (Somatropin)
Injection Consultant Paediatricians, Consultants Endocrinology & Diabetes
MP 88
Prader Willi Syndrome, Turner Syndrome, Hypopituitarism
V3.0 September 2021
107 6. Endocrine System
ATC Code Active Ingredient Dosage Form and Strength
Schedule V Prescriber Criteria
Protocol Pink Card
Pink Card Prescriber Criteria
Schedule V Entitlement
6.5.2 Posterior pituitary hormones and antagonists J01AA01 Demeclocycline
Hydrochloride Capsules 150mg
Consultant Physicians MP 49
Malignant Diseases
H01BA02 Desmopressin Nasal Spray 10mcg
Consultants Endocrinology & Diabetes, Consultant Paediatricians, Consultant Nephrologists, Consultant Oncologists
MP 50
Hypopituitarism, Malignant Diseases
H01BA02 Desmopressin Tablets 0.1mg
Consultants Endocrinology & Diabetes, Consultant Paediatricians, Consultant Nephrologists, Consultant Oncologists
MP 51
Hypopituitarism, Malignant Diseases
6.6 Drugs affecting bone metabolism 6.6.1 Calcitonin
H05BA01 Calcitonin (Salmon Synthetic)
Injection 100IU/mL
Consultants C Consultants Malignant Diseases, Paget's Disease
H05AA02 Teriparatide Pre-Filled Pen 20mcg/ 80mcL
Consultant Rheumatologists, Consultant Endocrinologists
MP 190
Multiple Sclerosis, Myasthenia Gravis, Inflammatory Bowel Disease, Chronic Liver Disease, Malignant Diseases, Chronic Kidney Disease, Chronic Asthma, Chronic Obstructive Pulmonary Disease, Chronic Respiratory Failure, Cystic Fibrosis, Dermatomyositis/ Polymyositis, Lupus Erythematosus, Polyartritis Nodosa, Polymyalgia Rheumatica, Rheumatoid Arthritis, Spondyloarthritis, Systemic Sclerosis
V3.0 September 2021
108 6. Endocrine System
ATC Code Active Ingredient Dosage Form and Strength
Schedule V Prescriber Criteria
Protocol Pink Card
Pink Card Prescriber Criteria
Schedule V Entitlement
6.6.2 Bisphosphonates and other drugs affecting bone metabolism M05BA02 Sodium
Clodronate Tablets 400mg
Consultant Oncologists, Consultant Haematologists
MP 41
Malignant Diseases
6.7 Other endocrine drugs 6.7.1 Bromocriptine and other dopaminergic drugs
G02CB01/ N04BC01
Bromocriptine Mesylate
Tablets 2.5mg
Consultants
Addiction Disorders, Chronic Mood Disorders, Chronic Psychiatric Disorders Starting in Childhood, Dementia, Huntington's Chorea, Parkinson's Disease, Hypopituitarism, Pituitary Adenomas, Malignant Diseases, Psychosis, Schizophrenia
G02CB03/ N04BC06
Cabergoline Tablets 0.5mg
Consultant Physicians MP 29
Pituitary Adenomas, Malignant Diseases
6.7.2 Drugs affecting gonadotrophins L02AE03 Goserelin Implants
3.6mg Consultant Obstetrics & Gynaecology, Consultant Oncologists, Consultants Endocrinology (Transgender MDT)
MP 86
Endometriosis/Adenomyosis, Malignant Diseases, Gender Identity & Sex Characteristics Related Conditions
L02AE03 Goserelin Implants 10.8mg
Consultant Oncologists, Consultant Urologists, Consultants Endocrinology (Transgender MDT)
MP 87
Malignant Diseases, Gender Identity & Sex Characteristics Related Conditions
V3.0 September 2021
109 6. Endocrine System
ATC Code Active Ingredient Dosage Form and Strength
Schedule V Prescriber Criteria
Protocol Pink Card
Pink Card Prescriber Criteria
Schedule V Entitlement
L02AE02 Leuprorelin Injections 3.75mg
Consultant Paediatricians, Consultants Endocrinology & Diabetes, Consultants Endocrinology (Transgender MDT)
MP 114
Precocious Puberty, Gender Identity & Sex Characteristics Related Conditions
V3.0 September 2021
110 7. Obstetrics, Gyaecology, and Urinary-tract Disorders
ATC Code Active Ingredient Dosage Form and Strength
Schedule V Prescriber Criteria
Protocol Pink Card
Pink Card Prescriber Criteria
Schedule V Entitlement
7. Obstetrics, Gynaecology, and Urinary-tract Disorders 7.1 Treatment of vaginal and vulval conditions
7.1.1 Vaginal and vulval infections D01AC01 Clotrimazole Cream 1% Consultants A Medical Practitioners Down Syndrome, Congenital Indifference to
Pain
G01AF02 Clotrimazole Pessaries 100mg
GU Clinic Entitlement: GU Clinic Consultants
A Medical Practitioners No Schedule V Entitlement
G01AF05 Econazole Pessaries 150mg
N/A A Consultants No Schedule V Entitlement
7.2 Drugs for Genitor-urinary disorders 7.2.1 Drugs for urinary retention
G04CA01 Alfuzosin Prolonged Release Tablets 10mg
Consultant Urologists Benign Prostatic Enlargement
C02CA04 Doxazosin Tablets 2mg Consultants [Hypertension Only], Specialist Family Medicine PHCD [Hypertension Only], Consultant Urologists
C Consultant Urologist Hypertension, Benign Prostatic Enlargement
G04CB02 Dutasteride Tablets 0.5mg Consultant Urologists Benign Prostatic Enlargement
7.2.2 Drugs for urinary frequency, enuresis and incontinence G04BD04 Oxybutynin
Hydrochloride Tablets 5mg Consultants C Consultants Multiple Sclerosis, Parkinson's Disease,
Spinal Cord Pathologies, Malignant Diseases, Neuromyelitis Optica
V3.0 September 2021
111 7. Obstetrics, Gyaecology, and Urinary-tract Disorders
ATC Code Active Ingredient Dosage Form and Strength
Schedule V Prescriber Criteria
Protocol Pink Card
Pink Card Prescriber Criteria
Schedule V Entitlement
7.2.3 Drugs used in urological pain A12BA02 Potassium Citrate Mixture
1.5g/5mL Consultant Nephrologists, Consultant Urologists, Consultant Paediatricians
Inborn Errors of Metabolism
V3.0 September 2021
112 8. Malignant Disease and Immunosuppresion
ATC Code Active Ingredient Dosage Form and Strength
Schedule V Prescriber Criteria
Protocol Pink Card
Pink Card Prescriber Criteria
Schedule V Entitlement
8. Malignant disease and immunosuppression 8.1 Cytotoxic drugs
V03AF03 Calcium Folinate (Leucovorin/ Folinic Acid)
Tablets 15mg Consultants TBDF Hospitals
only in Malignant Diseases
Enzyme Disorders, Malignant Diseases, Inborn Errors of Metabolism
8.1.1 Alkylating drugs L01AB01 Busulfan Tablets 2mg Consultant Oncologists,
Consultant Haematologists, Consultant Paediatricians
TBDF Hospitals
only
Malignant Diseases
L01AA02 Chlorambucil Tablets 2mg Consultants Malignant Diseases
L01AA01 Cyclophosphamide Tablets 50mg Consultants
Secondary Immunodeficiency Disorder, Malignant Diseases, Chronic Kidney Disease, Chronic Respiratory Failure, Dermatomyositis/ Polymyositis, Lupus Erythematosus, Polyartritis Nodosa, Rheumatoid Arthritis, Systemic Sclerosis
L01AD02 Lomustine Capsules 40mg
Consultant Haematologists, Consultant Oncologists, Consultant Paediatric Oncologists, Consultant Paediatricians
TBDF Hospitals
only
Malignant Diseases
L01AA03 Melphalan Tablets 2mg Consultants Malignant Diseases
V3.0 September 2021
113 8. Malignant Disease and Immunosuppresion
ATC Code Active Ingredient Dosage Form and Strength
Schedule V Prescriber Criteria
Protocol Pink Card
Pink Card Prescriber Criteria
Schedule V Entitlement
8.1.2 Antimetabolites L01BC06 Capecitabine Tablets 150mg Consultant Oncologists MP 31
TBDF Hospitals
only
Malignant Diseases
L01BC06 Capecitabine Tablets 500mg Consultant Oncologists MP 31 TBDF
Hospitals only
Malignant Diseases
L01BB05 Fludarabine Tablets 10mg Consultant Oncologists, Consultant Haematologists, Consultant Paediatricians
TBDF Hospitals
only
Malignant Diseases
L01BC02 Fluorouracil Cream 5% Consultant Dermatologists, Consultant Oncologists
Malignant Diseases
L01BB02 Mercaptopurine Tablets 50mg Consultants
Inflammatory Bowel Disease, Secondary Immunodeficiency Disorder, Chronic Liver Disease, Malignant Diseases, Chronic Kidney Disease
L01BA01/ L04AX03
Methotrexate Tablets 2.5mg Consultants
Inflammatory Bowel Disease, Secondary Immunodeficiency Disorder, Chronic Liver Disease, Malignant Diseases, Chronic Kidney Disease, Dermatomyositis/ Polymyositis, Lupus Erythematosus, Polyartritis Nodosa, Polymyalgia Rheumatica, Rheumatoid Arthritis, Severe Refractory Atopic Dermatitis, Spondyloarthritis, Systemic Sclerosis, Psoriasis
V3.0 September 2021
114 8. Malignant Disease and Immunosuppresion
ATC Code Active Ingredient Dosage Form and Strength
Schedule V Prescriber Criteria
Protocol Pink Card
Pink Card Prescriber Criteria
Schedule V Entitlement
L01BB03 Tioguanine Tablets 40mg Consultant Oncologists, Consultant Haematologists, Consultant Paediatricians
Malignant Diseases
8.1.3 Etoposide L01CB01 Etoposide Capsules
50mg Consultant Oncologists, Consultant Haematologists, Consultant Paediatricians
TBDF Hospitals
only
Malignant Diseases
8.1.4 Other antineoplastic drugs L01XX25 Bexarotene Capsules
75mg Consultant Haematologists, Consultant Oncologists
MP 18 TBDF
Hospitals only
Malignant Diseases
L01XE23 Dabrafenib Capsules 75mg
Consultant Oncologists MP 303
Malignant Diseases
L01XE03 Erlotinib Capsules/ Tablets 150mg
Consultant Oncologists MP 262 TBDF
Hospitals only
Malignant Diseases
L04AA18 Everolimus Tablets 0.25mg
Consultant Nephrologists MP 71 Chronic Kidney Disease
L04AA18 Everolimus Tablets 0.75mg
Consultant Nephrologists MP 71
Chronic Kidney Disease
L01XE10 Everolimus Tablets 5mg Consultant Oncologists MP 302 TBDF
Hospitals only
Malignant Diseases
V3.0 September 2021
115 8. Malignant Disease and Immunosuppresion
ATC Code Active Ingredient Dosage Form and Strength
Schedule V Prescriber Criteria
Protocol Pink Card
Pink Card Prescriber Criteria
Schedule V Entitlement
L01XE10 Everolimus Tablets 10mg Consultant Oncologists MP 302 TBDF
Hospitals only
Malignant Diseases
L01XX05 Hydroxycarbamide (Hydroxyurea)
Capsules 500mg
Consultant Oncologists, Consultant Haematologists, Consultant Paediatricians, Thalassaemia Clinic Consultants
C Consultant Oncologists, Consultant Haematologists, Consultant Paediatricians, Thalassaemia Clinic Consultants
Inherited Haemoglobinopathies, Malignant Diseases
L01XE01 Imatinib Capsules/ Tablets 100mg
Consultant Oncologists, Consultant Haematologists, Consultant Paediatricians
MP 95 TBDF
Hospitals only
Malignant Diseases
L01XE01 Lapatinib Tablets 250mg Consultant Oncologists MP 109 Malignant Diseases
L01XE08 Nilotinib Capsules 200mg
Consultant Haematologists MP 213
Malignant Diseases
L01XB01 Procarbazine Capsules 50mg
Consultants
Malignant Diseases
L01XE04 Sunitinib Capsules 12.5mg
Consultant Oncologists MP 264 TBDF
Hospitals only
Malignant Diseases
L01XE04 Sunitinib Capsules 25mg
Consultant Oncologists MP 264 TBDF
Hospitals only
Malignant Diseases
V3.0 September 2021
116 8. Malignant Disease and Immunosuppresion
ATC Code Active Ingredient Dosage Form and Strength
Schedule V Prescriber Criteria
Protocol Pink Card
Pink Card Prescriber Criteria
Schedule V Entitlement
L01XE04 Sunitinib Capsules 50mg
Consultant Oncologists MP 264 TBDF
Hospitals only
Malignant Diseases
L01AX03 Temozolomide Capsules 5mg Consultant Oncologists, Consultant Paediatric Oncologists
TBDF Hospitals
only
Malignant Diseases
L01AX03 Temozolomide Capsules 20mg
Consultant Oncologists, Consultant Paediatric Oncologists
TBDF Hospitals
only
Malignant Diseases
L01AX03 Temozolomide Capsules 100mg
Consultant Oncologists, Consultant Paediatric Oncologists
TBDF Hospitals
only
Malignant Diseases
L01AX03 Temozolomide Capsules 140mg
Consultant Oncologists, Consultant Paediatric Oncologists
TBDF Hospitals
only
Malignant Diseases
L01XE25 Trametinib Tablets 2mg Consultant Oncologists MP 304 Malignant Diseases
L01XX14 Tretinoin Capsules 10mg
Consultant Haematologists, Consultant Oncologists, Consultant Paediatric Oncologists
Malignant Diseases
V3.0 September 2021
117 8. Malignant Disease and Immunosuppresion
ATC Code Active Ingredient Dosage Form and Strength
Schedule V Prescriber Criteria
Protocol Pink Card
Pink Card Prescriber Criteria
Schedule V Entitlement
8.2 Drugs affecting the immune response 8.2.1 Antiproliferative immunosuppressants
L04AX01 Azathioprine Tablets 50mg Consultants
Myasthenia Gravis, Inflammatory Bowel Disease, Secondary Immunodeficiency Disorder, Chronic Liver Disease, Malignant Diseases, Chronic Kidney Disease, Chronic Respiratory Failure, Dermatomyositis/ Polymyositis, Lupus Erythematosus, Polyartritis Nodosa, Rheumatoid Arthritis, Severe Refractory Atopic Dermatitis, Spondyloarthritis, Systemic Sclerosis, Chronic Immunobullous Disorders, Psoriasis, Neuromyelitis Optica
L04AA06 Mycophenolate Mofetil
Oral Suspension 1g/5mL
Consultant Cardiac Surgeons, Consultant Gastroenterologists, Consultant Nephrologists, Consultant Paediatricians
MP 141
Chronic Kidney Disease, Chronic Liver Disease, Lupus Erythematosus, Secondary Immunodeficiency Disorder
L04AA06 Mycophenolate Mofetil
Capsules 250mg
Consultant Cardiac Surgeons, Consultant Gastroenterologists, Consultant Nephrologists, Consultant Paediatricians, Consultant Rheumatologists
MP 145
Chronic Kidney Disease, Chronic Liver Disease, Lupus Erythematosus, Myasthenia Gravis, Secondary Immunodeficiency Disorder
V3.0 September 2021
118 8. Malignant Disease and Immunosuppresion
ATC Code Active Ingredient Dosage Form and Strength
Schedule V Prescriber Criteria
Protocol Pink Card
Pink Card Prescriber Criteria
Schedule V Entitlement
L04AA06 Mycophenolate Mofetil
Tablets 500mg Consultant Cardiac Surgeons, Consultant Gastroenterologists, Consultant Nephrologists, Consultant Paediatricians, Consultant Rheumatologists
MP 145
Chronic Kidney Disease, Chronic Liver Disease, Lupus Erythematosus, Myasthenia Gravis, Secondary Immunodeficiency Disorder
L04AA06 Mycophenolate Sodium
Gastro-Resistant Tablets 180mg
Consultant Nephrologists, Consultant Paediatricians (Paediatric Nephrology)
MP 140
Chronic Kidney Disease
L04AA06 Mycophenolate Sodium
Gastro-Resistant Tablets 360mg
Consultant Nephrologists, Consultant Paediatricians (Paediatric Nephrology)
MP 140
Chronic Kidney Disease
8.2.2 Corticosteroids and other immunosuppressants L04AD01 Ciclosporin
(Cyclosporin) Capsules 25mg
Consultants MP 46
Inflammatory Bowel Disease, Secondary Immunodeficiency Disorder, Chronic Kidney Disease, Chronic Liver Disease, Malignant Diseases, Rheumatoid Arthritis, Severe Chronic Urticaria, Severe Refractory Atopic Dermatitis, Spondyloarthritis, Psoriasis
L04AD01 Ciclosporin (Cyclosporin)
Capsules 100mg
Consultants MP 46
Inflammatory Bowel Disease, Secondary Immunodeficiency Disorder, Chronic Kidney Disease, Chronic Liver Disease, Malignant Diseases, Rheumatoid Arthritis, Severe Chronic Urticaria, Severe Refractory Atopic Dermatitis, Spondyloarthritis, Psoriasis
V3.0 September 2021
119 8. Malignant Disease and Immunosuppresion
ATC Code Active Ingredient Dosage Form and Strength
Schedule V Prescriber Criteria
Protocol Pink Card
Pink Card Prescriber Criteria
Schedule V Entitlement
L04AD01 Ciclosporin (Cyclosporin)
Oral Solution 100mg/mL
Consultants MP 47
Secondary Immunodeficiency Disorder, Chronic Kidney Disease, Chronic Liver Disease, Rheumatoid Arthritis, Severe Chronic Urticaria, Severe Refractory Atopic Dermatitis, Psoriasis, Malignant Diseases
L04AA06 Sirolimus Tablets 1mg Consultant Nephrologists MP 231 Chronic Kidney Disease
L04AD02 Tacrolimus Capsules 0.5mg
Consultant Gastroenterologists, Consultant Paediatricians, Consultant Nephrologists
MP 210
Chronic Kidney Disease, Chronic Liver Disease
L04AD02 Tacrolimus Capsules 1mg Consultant Gastroenterologists, Consultant Paediatricians, Consultant Nephrologists
MP 210
Chronic Kidney Disease, Chronic Liver Disease
L04AD02 Tacrolimus Capsules 5mg Consultant Gastroenterologists, Consultant Paediatricians, Consultant Nephrologists
MP 210
Chronic Kidney Disease, Chronic Liver Disease
8.2.3 Other immunomodulating drugs N07XX09 Dimethyl
Fumarate Gastro-Resistant Hard Capsules 120mg
Consultant Neurologists MP 60
Multiple Sclerosis
N07XX09 Dimethyl Fumarate
Gastro-Resistant Hard Capsules 240mg
Consultant Neurologists MP 60
Multiple Sclerosis
L04AA27 Fingolimod Capsules 0.5mg
Consultant Neurologists MP 70
Multiple Sclerosis
V3.0 September 2021
120 8. Malignant Disease and Immunosuppresion
ATC Code Active Ingredient Dosage Form and Strength
Schedule V Prescriber Criteria
Protocol Pink Card
Pink Card Prescriber Criteria
Schedule V Entitlement
L03AB11 Peg-Interferon Alfa 2a
Pre-filled Syringe 180mcg
Consultant Gastroenterologists, Consultant Haematologists, Consultant Infectious Diseases Physicians, Consultant Oncologists
MP 102
Hepatitis B and C, Malignant Diseases
L03AB07 Interferon Beta 1a
Injection 30mcg (6M IU)
Consultant Neurologists
Multiple Sclerosis
L03AB08 Interferon Beta 1b
Injection 9.6M IU
Consultant Neurologists
Multiple Sclerosis
L03AB03 Interferon Gamma
Injection 100mcg
Consultant Paediatricians, Consultant Respiratory Physicians, Consultant Infectious Diseases Physicians
MP 104 TBDF
Hospitals only
Primary Immunodeficiency Disorder
L04AX04 Lenalidomide Capsules 5mg Consultant Oncologists, Consultant Haematologists
MP 263 TBDF
Hospitals only
Malignant Diseases
L04AX04 Lenalidomide Capsules 10mg
Consultant Oncologists, Consultant Haematologists
MP 263 TBDF
Hospitals only
Malignant Diseases
L04AX04 Lenalidomide Capsules 15mg
Consultant Oncologists, Consultant Haematologists
MP 263 TBDF
Hospitals only
Malignant Diseases
V3.0 September 2021
121 8. Malignant Disease and Immunosuppresion
ATC Code Active Ingredient Dosage Form and Strength
Schedule V Prescriber Criteria
Protocol Pink Card
Pink Card Prescriber Criteria
Schedule V Entitlement
L04AX04 Lenalidomide Capsules 25mg
Consultant Oncologists, Consultant Haematologists
MP 263 TBDF
Hospitals only
Malignant Diseases
L04AA31 Teriflunomide Tablets 14mg Consultant Neurologists MP 195 Multiple Sclerosis
L04AX02 Thalidomide Capsules/ Tablets 50mg
Consultant Rheumatologists, Consultant Dermatologists, Consultant Haematologists, Consultant Infectious Disease Physicians, Consultant Oncologists
MP 189 TBDF
Hospitals only
Leprosy, Malignant Diseases, Lupus Erythematosus
8.3 Sex hormones and hormone antagonists in malignant diseases 8.3.1 Estrogens
G03CB02/ L02AA01
Diethylstilbestrol (Stilboestrol)
Tablets 1mg Consultants C Consultants Malignant Diseases
G03CA01 Ethinylestradiol Tablets 10mcg Consultant Paediatricians, Consultants Endocrinology & Diabetes, Consultants Endocrinology (Transgender MDT)
MP 235
Turner Syndrome, Hypopituitarism, Malignant Diseases, Gender Identity & Sex Characteristics Related Conditions
8.3.2 Progestogens L02AB02 Medroxyprogester
one Acetate Tablets 100mg Consultants, Consultants
Endocrinology (Transgender MDT)
Malignant Diseases, Gender Identity & Sex Characteristics Related Conditions
V3.0 September 2021
122 8. Malignant Disease and Immunosuppresion
ATC Code Active Ingredient Dosage Form and Strength
Schedule V Prescriber Criteria
Protocol Pink Card
Pink Card Prescriber Criteria
Schedule V Entitlement
8.3.3 Hormone antagonists 8.3.3.1 Breast cancer
L02BG03 Anastrozole Tablets 1mg Consultant Oncologists
Malignant Diseases
L02BG06 Exemestane Tablets 25mg Consultant Oncologists MP 64 TBDF
Hospitals only
Malignant Diseases
L02AE03 Goserelin Implants 3.6mg
Consultant Obstetrics & Gynaecology, Consultant Oncologists, Consultants Endocrinology (Transgender MDT)
MP 86
Endometriosis/Adenomyosis, Malignant Diseases, Gender Identity & Sex Characteristics Related Conditions
L02BG03 Letrozole Tablets 2.5mg Consultant Oncologists
Malignant Diseases
L02BA01 Tamoxifen Tablets 20mg Consultants C Medical Practitioners Malignant Diseases
8.3.3.2 Prostate cancer L02BX03 Abiraterone Tablets 500mg Consultant Oncologists MP 8 Malignant Diseases
L02BB03 Bicalutamide Tablets 50mg Consultant Urologists, Consultant Oncologists
MP 19
Malignant Diseases
G03HA01 Cyproterone Acetate
Tablets 50mg Consultants, Consultants Endocrinology (Transgender MDT)
Precocious Puberty, Malignant Diseases, Gender Identity & Sex Characteristics Related Conditions
L02BB04 Enzalutamide Capsules 40mg
Consultant Oncologists MP 300
Malignant Diseases
L02BB01 Flutamide Tablets 250mg Consultant Oncologists, Consultant Urologists
Malignant Diseases
L02AE03 Goserelin Implants 10.8mg
Consultant Oncologists, Consultant Urologists, Consultants Endocrinology (Transgender MDT)
MP 87
Malignant Diseases, Gender Identity & Sex Characteristics Related Conditions
V3.0 September 2021
123 8. Malignant Disease and Immunosuppresion
ATC Code Active Ingredient Dosage Form and Strength
Schedule V Prescriber Criteria
Protocol Pink Card
Pink Card Prescriber Criteria
Schedule V Entitlement
8.3.3.3 Somatostatin analogues H01CB02 Octreotide Injection
200mcg/mL (multidose)
Consultants Endocrinology & Diabetes, Consultant Gastroenterologists, Consultant Oncologists, Consultant Surgeons, Consultant Palliative Care
MP 147 TBDF
Hospitals only
Pituitary Adenomas, Malignant Diseases
H01CB02 Octreotide Long Acting (stand-by)
Injection IM 10mg
Consultants Endocrinology & Diabetes, Consultant Gastroenterologists, Consultant Oncologists, Consultant Surgeons
MP 149 TBDF
Hospitals only
Cardiac Arrythmias, Chronic Heart Failure, Ischaemic Heart Disease, Malignant Diseases, Pituitary Adenomas
H01CB02 Octreotide Long Acting
Injection IM 20mg
Consultants Endocrinology & Diabetes, Consultant Gastroenterologists, Consultant Oncologists, Consultant Surgeons
MP 149 TBDF
Hospitals only
Cardiac Arrythmias, Chronic Heart Failure, Ischaemic Heart Disease, Malignant Diseases, Pituitary Adenomas
H01CB02 Octreotide Long Acting
Injection IM 30mg
Consultants Endocrinology & Diabetes, Consultant Gastroenterologists, Consultant Oncologists, Consultant Surgeons
MP 149 TBDF
Hospitals only
Cardiac Arrythmias, Chronic Heart Failure, Ischaemic Heart Disease, Malignant Diseases, Pituitary Adenomas
V3.0 September 2021
124 9. Nutrition and Blood
ATC Code Active Ingredient Dosage Form and Strength
Schedule V Prescriber Criteria
Protocol Pink Card
Pink Card Prescriber Criteria
Schedule V Entitlement
9. Nutrition and Blood 9.1 Anaemias and some other blood disorders
9.1.1 Iron-deficiency anaemias
9.1.1.1 Oral iron B03AD02 Iron + folic acid Tablets/
Capsules Consultants B Medical Practitioners Inflammatory Bowel Disease, Secondary
Immunodeficiency Disorder, Malignant Diseases, Chronic Kidney Disease
B03AA02 Oral Iron (Currently Ferrous Fumarate 200mg [65mg elemental iron])
Tablets/ Capsules
Consultants B Medical Practitioners Inflammatory Bowel Disease, Secondary Immunodeficiency Disorder, Malignant Diseases, Chronic Kidney Disease, Cystic Fibrosis
B03AB03 Sodium Feredetate (oral
iron)
Solution 190mg/5mL equivalent to 27.5mg iron
Consultants B Medical Practitioners Inflammatory Bowel Disease, Secondary Immunodeficiency Disorder, Malignant Diseases, Chronic Kidney Disease, Cystic Fibrosis
9.1.2 Drugs used in megaloblastic anaemias B03BB01 Folic Acid Oral solution
2.5mg/5mL Consultant Paediatricians, Consultant Rheumatologists
MP 80
Secondary Immunodeficiency Disorder, Dermatomyositis/ Polymyositis, Lupus Erythematosus, Rheumatoid Arthritis, Spondyloarthritis
V3.0 September 2021
125 9. Nutrition and Blood
ATC Code Active Ingredient Dosage Form and Strength
Schedule V Prescriber Criteria
Protocol Pink Card
Pink Card Prescriber Criteria
Schedule V Entitlement
B03BB01 Folic Acid Tablets 5mg Consultants B Medical Practitioners Inflammatory Bowel Disease, Inherited Haemoglobinopathies, Secondary Immunodeficiency Disorder, Chronic Liver Disease, Malignant Diseases, Inborn Errors of Metabolism, Chronic Kidney Disease, Dermatomyositis/ Polymyositis, Lupus Erythematosus, Polymyalgia Rheumatica, Polyartritis Nodosa, Rheumatoid Arthritis, Spondyloarthritis, Systemic Sclerosis, Psoriasis
B03BA03 Hydroxocobalamin (Vitamin B12)
Injection 1mg Consultants C Medical Practitioners Inflammatory Bowel Disease, Enzyme Disorders, Secondary Immunodeficiency Disorder, Malignant Diseases, Inborn Errors of Metabolism, Chronic Kidney Disease
9.1.3 Drugs used in hypoplastic, haemolytic, and renal anaemias V03AC03 Deferasirox Film-coated
tablets 180mg Thalassaemia Clinic Consultants, Consultant Haematologists
MP 277
Inherited Haemoglobinopathies, Malignant Diseases
V03AC03 Deferasirox Film-coated tablets 360mg
Thalassaemia Clinic Consultants, Consultant Haematologists
MP 277
Inherited Haemoglobinopathies, Malignant Diseases
B03XA01 Recombinant Human Erythropoietin
Pre-filled syringe 2000 IU
Consultant Gastroenterologists, Consultant Haematologists, Consultant Nephrologists, Consultant Paediatricians
MP 65
Chronic Kidney Disease, Malignant Diseases
V3.0 September 2021
126 9. Nutrition and Blood
ATC Code Active Ingredient Dosage Form and Strength
Schedule V Prescriber Criteria
Protocol Pink Card
Pink Card Prescriber Criteria
Schedule V Entitlement
B03XA01 Recombinant Human Erythropoietin
Pre-filled syringe 3000 IU
Consultant Gastroenterologists, Consultant Haematologists, Consultant Nephrologists, Consultant Paediatricians
MP 65
Chronic Kidney Disease, Malignant Diseases
B03XA01 Recombinant Human Erythropoietin
Pre-filled syringe 4000 IU
Consultant Gastroenterologists, Consultant Haematologists, Consultant Nephrologists, Consultant Paediatricians
MP 65 Chronic Kidney Disease, Malignant Diseases
9.1.4 Drugs used in neutropenia L03AA02 Filgrastim (Rec.
Human G-CSF) Injection 30 MIU
Consultant Oncologists, Consultant Haematologists, Consultant Paediatricians, Consultant Infectious Diseases Physician
MP 69 HU/ TBDF Hospitals
only
HIV/AIDS and HIV Related Diseases, Malignant Diseases, Primary Immunodeficiency Disorder
9.2 Fluids and electrolytes 9.2.1 Oral preparations for fluid and electrolyte imbalance
9.2.1.1 Oral potassium V03AE01 Polystyrene
Sulfonate (e.g.
Calcium Resonium®)
Powder Consultants
Secondary Immunodeficiency Disorder, Malignant Diseases, Chronic Kidney Disease
V3.0 September 2021
127 9. Nutrition and Blood
ATC Code Active Ingredient Dosage Form and Strength
Schedule V Prescriber Criteria
Protocol Pink Card
Pink Card Prescriber Criteria
Schedule V Entitlement
A12BA01 Potassium Chloride
Syrup 1mmol/mL (7.5%)
Consultants C Medical Practitioners Chronic Heart Failure, Hypertension, Secondary Immunodeficiency Disorder, Malignant Diseases, Chronic Kidney Disease, Chronic Liver Disease
A12BA30 Potassium Supplement
Effervescent Tablets
Consultants, Specialist Family Medicine PHCD [Hypertension Only]
C Medical Practitioners Chronic Heart Failure, Hypertension, Secondary Immunodeficiency Disorder, Malignant Diseases, Chronic Kidney Disease, Chronic Liver Disease
9.2.1.2 Oral sodium and water A07CA Oral Rehydration Powder Consultants A Medical Practitioners Malignant Diseases
9.2.1.3 Oral bicarbonate A02AH Sodium
Bicarbonate Tablets 500/600mg
Consultants C Hospital Doctors Enzyme Disorders, Secondary Immunodeficiency Disorder, Chronic Kidney Disease
9.2.2 Parenteral preparations for fluid and electrolyte imbalance 9.2.2.1 Electrolytes and water
B05XA03 Sodium Chloride Injection IV 0.9% in 10mL Pack
Consultants
Malignant Diseases For nebulisation in Chronic Asthma, Chronic Obstructive Pulmonary Disease, Chronic Respiratory Failure, Cystic Fibrosis or Malignant Diseases
V3.0 September 2021
128 9. Nutrition and Blood
ATC Code Active Ingredient Dosage Form and Strength
Schedule V Prescriber Criteria
Protocol Pink Card
Pink Card Prescriber Criteria
Schedule V Entitlement
V07AB Water for injection
Ampoule 5mL Consultants
With Colistimethate sodium or Gentamicin injections (for nebulisation) in Chronic Respiratory Failure or Cystic Fibrosis With catheters in the following conditions: Cerebral Palsy, Cerebrovascular Disease, Chronic Kidney Disease, Chronic Obstructive Pulmonary Disease, Chronic Respiratory Failure, Congenital Indifference to Pain, Cystic Fibrosis, Dementia, Diabetes Mellitus Type 1, Diabetes Mellitus Type 2, Diverticular Disease requiring Stoma Care, Enzyme Disorders, Huntington's Chorea, Malignant Diseases, Motor Neuron Disease, Parkinson's Disease, Peripheral Vascular Disease, Spinal Cord Pathologies
V07AB Water for injection
Ampoule 10mL
Consultants
Malignant Diseases
9.3 Intravenous nutrition 9.3.1 Proprietary infusion fluids for parenteral feeding
B05BA Total Parenteral Nutrition (Adult)
Intravenous Nutrition
Consultants TBDF Hospitals only (TPN
patients only)
Small Intestinal Failure
V3.0 September 2021
129 9. Nutrition and Blood
ATC Code Active Ingredient Dosage Form and Strength
Schedule V Prescriber Criteria
Protocol Pink Card
Pink Card Prescriber Criteria
Schedule V Entitlement
B05BA02 Parenteral Fat Emulsion LCT
Emulsion for Intravenous Infusion 20% in 500mL
Consultants TBDF Hospitals only (TPN
patients only)
Small Intestinal Failure
9.3.2 Supplementary preparations
B05XA31 Trace Elements + Electrolytes
Infusion (Adults)
Consultants TBDF Hospitals only (TPN
patients only)
Small Intestinal Failure
A11BA Multivitamins (Cernevit®) for TPN for Adults and Children Over 11 Years
Infusion Consultants TBDF Hospitals only (TPN
patients only)
Small Intestinal Failure
9.4 Minerals 9.4.1 Calcium and magnesium
9.4.1.1 Calcium supplements A12AA04 Calcium Tablets
Effervescent 400-500mg
Consultant Paediatricians, Consultant Physicians
MP 30
Enzyme Disorders, Hypoparathyroidism, Secondary Immunodeficiency Disorder, Chronic Kidney Disease
V3.0 September 2021
130 9. Nutrition and Blood
ATC Code Active Ingredient Dosage Form and Strength
Schedule V Prescriber Criteria
Protocol Pink Card
Pink Card Prescriber Criteria
Schedule V Entitlement
A12AA04 Calcium Carbonate
Chewable Tablets or Tablets 1250mg (equivalent to 500mg elemental calcium)
Consultants
Inflammatory Bowel Disease, Enzyme Disorders, Hypoparathyroidism, Secondary Immunodeficiency Disorder, Chronic Liver Disease, Malignant Diseases, Chronic Kidney Disease, Paget's Disease, Rheumatoid Arthritis, Spondyloarthritis, Chronic Immunobullous Disorders
A12AA05 Calcium Lactate Tablets 300mg (equivalent to 39mg elemental calcium)
Consultants C Medical Practitioners Inflammatory Bowel Disease, Enzyme Disorders, Hypoparathyroidism, Secondary Immunodeficiency Disorder, Chronic Liver Disease, Malignant Diseases, Chronic Kidney Disease, Chronic Immunobullous Disorders
9.4.1.2 Hypercalcaemia and hypercalciuria
H05BX01 Cinacalcet Tablets 30mg Consultant Nephrologists, Consultant Oncologists, Consultant Endocrinologists
MP 48 Chronic Kindey Disease, Malignant Diseases
9.4.1.2 Magnesium A12CC Magnesium
Glycerophosphate Tablets 97.2mg (4mmol)
Consultant Gastroenterologists, Consultant Haematologists, Consultant Nephrologists, Consultant Oncologists, Consultant Paediatricians
MP 122 TBDF
Hospitals only
Chronic Kidney Disease, Chronic Liver Disease, Inborn Errors of Metabolism, Malignant Diseases, Secondary Immunodeficiency Disorders
V3.0 September 2021
131 9. Nutrition and Blood
ATC Code Active Ingredient Dosage Form and Strength
Schedule V Prescriber Criteria
Protocol Pink Card
Pink Card Prescriber Criteria
Schedule V Entitlement
9.4.2 Phosphorus 9.4.2.1 Phosphate supplements
A12CX Phosphate Supplement
Tablets Effervescent
Consultant Paediatricians, Consultant Physicians
MP 165
Enzyme Disorders, Secondary Immunodeficiency Disorder, Malignant Diseases, Chronic Kidney Disease
9.4.2.2 Phosphate-Binding agents V03AE03 Lanthanum Chewable
tablets 750mg Consultant Nephrologists MP 273
Chronic Kidney Disease
9.5 Vitamins 9.5.1 Vitamin A
A11CA01 Vitamin A (Retinol)
Tablets 25,000 IU or 50,000 IU
Consultants
Chronic Liver Disease, Cystic Fibrosis
A11CB Vitamin A + D Tablets 4000 IU + 400 IU
N/A A Medical Practitioners No Schedule V Entitlement
9.5.2 Vitamin B group A11HA01 Nicotinamide Tablets 250mg Consultant Dermatologists
Chronic Immunobullous Disorders
A11HA02 Pyridoxine (Vitamin B6)
Tablets 10mg or 20mg
Consultants TB patients to collect item from Hospitals
only
C Medical Practitioners Enzyme Disorders, HIV/AIDS and HIV Related Diseases, Tuberculosis, Inborn Errors of Metabolism
V3.0 September 2021
132 9. Nutrition and Blood
ATC Code Active Ingredient Dosage Form and Strength
Schedule V Prescriber Criteria
Protocol Pink Card
Pink Card Prescriber Criteria
Schedule V Entitlement
A11HA02 Pyridoxine (Vitamin B6)
Tablets 50mg Consultants TB patients to collect item from Hospitals
only
C Medical Practitioners Enzyme Disorders, HIV/AIDS and HIV Related Diseases, Tuberculosis, Inborn Errors of Metabolism, Malignant Diseases
A11DA01 Thiamine (Vitamin
B1) Tablets 50mg Consultants C Medical Practitioners Addiction Disorders, Enzyme Disorders,
Chronic Liver Disease, Inborn Errors of Metabolism
A11EA Vitamin B Compound Strong (Nicotinamide+ Pyridoxine + Riboflavin +
Thiamine) *
Tablets 20mg + 2mg + 2mg + 5mg
Consultants B Medical Practitioners Chronic Liver Disease
9.5.3 Vitamin C A11GA01 Ascorbic Acid Tablets Consultants B Medical Practitioners Inborn Errors of Metabolism
9.5.4 Vitamin D A11CC03 Alfacalcidol
(1-α Hydroxyvitamin D3)
Tablets 0.25mcg
Consultants C Consultants Inflammatory Bowel Disease, Enzyme Disorders, Hypoparathyroidism, Secondary Immunodeficiency Disorder, Chronic Liver Disease, Malignant Diseases, Chronic Kidney Disease, Cystic Fibrosis, Chronic Immunobullous Disorders
* Preparation temporarily available instead of Vitamin B Complex (Nicotinamide 15mg, Riboflavin 1mg, Thiamine 1mg)
V3.0 September 2021
133 9. Nutrition and Blood
ATC Code Active Ingredient Dosage Form and Strength
Schedule V Prescriber Criteria
Protocol Pink Card
Pink Card Prescriber Criteria
Schedule V Entitlement
A11CC03 Alfacalcidol (1-α Hydroxyvitamin D3)
Tablets 1mcg Consultants
Inflammatory Bowel Disease, Enzyme Disorders, Hypoparathyroidism, Secondary Immunodeficiency Disorder, Chronic Liver Disease, Malignant Diseases, Chronic Kidney Disease, Cystic Fibrosis, Chronic Immunobullous Disorders
A11CC03 Alfacalcidol (1-α Hydroxyvitamin
D3)
Oral Drops 2mcg/mL
Consultants MP 5
Chronic Liver Disease, Enzyme Disorders, Hypoparathyroidism, Inflammatory Bowel Disease, Secondary Immunodeficiency Disorder, Malignant Diseases, Chronic Kidney Disease, Cystic Fibrosis, Chronic Immunobullous Disorders
9.5.5 Vitamin E A11HA03 Vitamin E (Alpha
Tocopheryl) Suspension 100mg/mL
Consultant Paediatricians, Consultant Gastroenterologists, Consultant Respiratory Physicians, Consultants Endocrinology & Diabetes
MP 199
Small Intestinal Failure, Enzyme Disorders, Chronic Liver Disease, Inborn Errors of Metabolism, Cystic Fibrosis
A11HA03 Vitamin E (dl-
Alpha Tocopheryl Acetate or d-Alpha Tocopherol)
Capsules/ Tablets 100mg-200mg (dl-Alpha Tocopheryl Acetate) OR 67mg-135mg (d-Alpha Tocopherol)
Consultant Paediatricians, Consultant Gastroenterologists, Consultant Respiratory Physicians, Consultants Endocrinology & Diabetes
MP 200
Small Intestinal Failure, Enzyme Disorders, Chronic Liver Disease, Inborn Errors of Metabolism, Cystic Fibrosis
V3.0 September 2021
134 9. Nutrition and Blood
ATC Code Active Ingredient Dosage Form and Strength
Schedule V Prescriber Criteria
Protocol Pink Card
Pink Card Prescriber Criteria
Schedule V Entitlement
A11HA03 Vitamin E (Alpha
Tocopheryl) Capsules 670mg (1000 IU)
Consultant Paediatricians, Consultant Gastroenterologists, Consultant Respiratory Physicians, Consultants Endocrinology & Diabetes
MP 200
Small Intestinal Failure, Chronic Liver Disease, Inborn Errors of Metabolism, Cystic Fibrosis
9.5.6 Vitamin K B02BA02 Menadiol Sodium
Phosphate*
Tablets 10mg Consultants
Cystic Fibrosis
B02BA01 Phytomenadione (Vitamin K1)
Injection 10mg/mL in 1mL
Consultants HU/TBDF Hospitals only for oral use
Chronic Liver Disease, Cystic Fibrosis, Malignant Diseases
B02BA01 Phytomenadione (Vitamin K1)
Injection 10mg/mL in 0.2mL
Consultants HU/TBDF Hospitals only for oral use
Chronic Liver Disease, Cystic Fibrosis, Malignant Diseases
9.5.7 Multivitamin preparations A11BA Multivitamins
(Abidec®) Drops Consultant Paediatricians MP 135
Cystic Fibrosis
A11AA03 Multivitamins + mineral preparation (Ketovite®)
Syrup Consultant Paediatricians, Consultant Physicians, Consultant Gastroenterologists
MP 137
Inborn Errors of Metabolism
* Availability temporarily suspended due to problematic sourcing.
V3.0 September 2021
135 9. Nutrition and Blood
ATC Code Active Ingredient Dosage Form and Strength
Schedule V Prescriber Criteria
Protocol Pink Card
Pink Card Prescriber Criteria
Schedule V Entitlement
A11AA03 Multivitamins + mineral preparation (Ketovite®)
Tablets Consultant Paediatricians, Consultant Physicians, Consultant Gastroenterologists
MP 136
Inborn Errors of Metabolism
9.6 Metabolic disorders
9.6.1 Drugs uses in metabolic disorders
G04BX16 Tiopronin Tablets 250mg Consultant Nephrologists, Consultant Paediatric Nephrologists, Consultant Urologists
MP 193
Chronic Kidney Disease
V3.0 September 2021
136 10. Musculoskeletal and Joint Diseases
ATC Code Active Ingredient Dosage Form and Strength
Schedule V Prescriber Criteria
Protocol Pink Card
Pink Card Prescriber Criteria
Schedule V Entitlement
10. Musculoskeletal and Joint Diseases 10.1 Drugs used in rheumatic diseases and gout
10.1.1 Non-Steroidal anti-inflammatory drugs M01AB05 Diclofenac Sodium Suppositories
12.5mg Consultant Paediatricians
A Consultant Paediatricians
Spinal Cord Pathologies, Congenital Indifference to Pain, Lupus Erythematosus, Rheumatoid Arthritis, Spondyloarthritis, Systemic Sclerosis
M01AB05 Diclofenac Sodium Suppositories 100mg
Consultants A Medical Practitioners
Spinal Cord Pathologies, Congenital Indifference to Pain, Malignant Diseases
M01AB05 Diclofenac Sodium Tablets 25mg Consultants B Medical Practitioners
Spinal Cord Pathologies, Congenital Indifference to Pain, Polio and Post-Polio Syndrome, Malignant Diseases, Lupus Erythematosus, Rheumatoid Arthritis, Spondyloarthritis, Systemic Sclerosis
M01AE01 Ibuprofen
Oral Suspension 100mg/5mL
Consultant Oncologists, Consultant Paediatric Oncologists, Consultant Paediatric Surgeons, Consultant Paediatricians, Consultant Palliative Care, Consultant Rheumatologists
MP 92
Chronic Kidney Disease, Malignant Diseases, Lupus Erythematosus, Rheumatoid Arthritis, Spondyloarthritis
M01AE01 Ibuprofen Tablets 200mg Consultants B Medical Practitioners
Spinal Cord Pathologies, Congenital Indifference to Pain, Polio and Post-Polio Syndrome, Malignant Diseases, Lupus Erythematosus, Systemic Sclerosis
V3.0 September 2021
137 10. Musculoskeletal and Joint Diseases
ATC Code Active Ingredient Dosage Form and Strength
Schedule V Prescriber Criteria
Protocol Pink Card
Pink Card Prescriber Criteria
Schedule V Entitlement
M01AB01 Indometacin Capsules 25mg
Consultants B Medical Practitioners
Congenital Indifference to Pain, Malignant Diseases
M01AG01 Mefenamic Acid Capsules 250mg
Consultants B Medical Practitioners
Congenital Indifference to Pain, Polio and Post-Polio Syndrome, Malignant Diseases
M01AC06 Meloxicam Tablets 7.5mg Consultant Rheumatologists, Consultant Palliative Care, Consultant Oncologists, Consultant Geriatricians
MP 45
Malignant Diseases, Rheumatoid Arthritis, Spondyloarthritis
M01AE02 Naproxen Tablets 250mg Consultants B Medical Practitioners
Congenital Indifference to Pain, Malignant Diseases, Lupus Erythematosus, Paget's Disease, Rheumatoid Arthritis, Spondyloarthritis, Systemic Sclerosis
10.1.2 Corticosteroids
10.1.2.1 Local corticosteroids injections H02AB04 Methylprednisolon
e Acetate Injection IM 40mg/mL
Consultants
Myasthenia Gravis, Malignant Diseases, Rheumatoid Arthritis, Spondyloarthritis, Chronic Immunobullous Disorders
10.1.3 Drugs that suppress the rheumatic disease process L04AB04 Adalimumab Solution for
Injection in Pre-filled Syringes 40mg
Consultant Dermatologists, Consultant Gastroenterologists, Consultant Paediatrician, Consultant Rheumatologists
MP 307 Hidradenitis Suppurativa, Inflammatory Bowel Disease, Psoriasis, Rheumatoid Arthritis, Spondyloarthritis
V3.0 September 2021
138 10. Musculoskeletal and Joint Diseases
ATC Code Active Ingredient Dosage Form and Strength
Schedule V Prescriber Criteria
Protocol Pink Card
Pink Card Prescriber Criteria
Schedule V Entitlement
L04AX01 Azathioprine Tablets 50mg Consultants
Myasthenia Gravis, Inflammatory Bowel Disease, Secondary Immunodeficiency Disorder, Chronic Liver Disease, Malignant Diseases, Chronic Kidney Disease, Chronic Respiratory Failure, Dermatomyositis/ Polymyositis, Lupus Erythematosus, Polyartritis Nodosa, Rheumatoid Arthritis, Severe Refractory Atopic Dermatitis, Spondyloarthritis, Systemic Sclerosis, Chronic Immunobullous Disorders, Psoriasis, Neuromyelitis Optica
L04AD01 Ciclosporin (Cyclosporin)
Capsules 25mg
Consultants MP 46
Inflammatory Bowel Disease, Secondary Immunodeficiency Disorder, Chronic Kidney Disease, Chronic Liver Disease, Malignant Diseases, Rheumatoid Arthritis, Severe Chronic Urticaria, Severe Refractory Atopic Dermatitis, Spondyloarthritis, Psoriasis
L04AD01 Ciclosporin (Cyclosporin)
Capsules 100mg
Consultants MP 46
Inflammatory Bowel Disease, Secondary Immunodeficiency Disorder, Chronic Kidney Disease, Chronic Liver Disease, Malignant Diseases, Rheumatoid Arthritis, Severe Chronic Urticaria, Severe Refractory Atopic Dermatitis, Spondyloarthritis, Psoriasis
L04AD01 Ciclosporin (Cyclosporin)
Oral Solution 100mg/mL
Consultants MP 47
Secondary Immunodeficiency Disorder, Chronic Kidney Disease, Chronic Liver Disease, Rheumatoid Arthritis, Severe Chronic Urticaria, Severe Refractory Atopic Dermatitis, Psoriasis, Malignant Diseases
L04AB01 Etanercept (Enbrel®)
Injection 25mg
Consultant Dermatologists, Consultant Rheumatologists
MP 66
Psoriasis, Rheumatoid Arthritis
V3.0 September 2021
139 10. Musculoskeletal and Joint Diseases
ATC Code Active Ingredient Dosage Form and Strength
Schedule V Prescriber Criteria
Protocol Pink Card
Pink Card Prescriber Criteria
Schedule V Entitlement
L04AB01 Etanercept (Benepali®)
Pre-filled Pen 50mg
Consultant Dermatologists, Consultant Rheumatologists
MP 66
Psoriasis, Rheumatoid Arthritis
L04AB01 Etanercept (Currently Erelzi®)
Pre-filled Pen 50mg
Consultant Dermatologists, Consultant Rheumatologists
MP 66
Psoriasis, Rheumatoid Arthritis
P01BA02 Hydroxychloroquine Sulphate
Tablets 200mg Consultants
Dermatomyositis/ Polymyositis, Lupus Erythematosus, Rheumatoid Arthritis, Spondyloarthritis
L04AA13 Leflunomide Tablets 10mg, 20mg
Consultant Rheumatologists
MP 113
Rheumatoid Arthritis, Spondyloarthritis
L01BA01/ L04AX03
Methotrexate Tablets 2.5mg Consultants
Inflammatory Bowel Disease, Secondary Immunodeficiency Disorder, Chronic Liver Disease, Malignant Diseases, Chronic Kidney Disease, Dermatomyositis/ Polymyositis, Lupus Erythematosus, Polyartritis Nodosa, Polymyalgia Rheumatica, Rheumatoid Arthritis, Severe Refractory Atopic Dermatitis, Spondyloarthritis, Systemic Sclerosis, Psoriasis
M01CC01 Penicillamine Tablets 250mg Consultants C Consultants Chronic Liver Disease
A07EC01 Sulfasalazine Tablets 500mg Consultant Gastroenterologists, Consultant Paediatricians, Consultant Surgeons, Consultant Rheumatologists
Inflammatory Bowel Disease, Rheumatoid Arthritis, Spondyloarthritis
V3.0 September 2021
140 10. Musculoskeletal and Joint Diseases
ATC Code Active Ingredient Dosage Form and Strength
Schedule V Prescriber Criteria
Protocol Pink Card
Pink Card Prescriber Criteria
Schedule V Entitlement
10.1.4 Gout and cytotoxic induced hyperuricaemia M04AA01 Allopurinol Tablets 100mg Consultants C Medical
Practitioners Enzyme Disorders, Malignant Diseases, Inborn Errors of Metabolism, Crystal Deposition Disease
M04AA01 Allopurinol Tablets 300mg Consultants C Medical Practitioners
Enzyme Disorders, Malignant Diseases, Inborn Errors of Metabolism, Crystal Deposition Disease
M04AC01 Colchicine Tablets 500mcg
Consultants C Medical Practitioners
Chronic Immunobullous Disorders, Crystal Deposition Disease, Enzyme Disorders, Hidradenitis Suppurativa
10.2 Drugs used in neuromuscular disorders 10.2.1 Drugs that enhance neuromuscular transmission
N07AA02 Pyridostigmine Bromide
Tablets 60mg Consultants
Myasthenia Gravis
10.2.2 Skeletal muscle relaxants M03BX01 Baclofen Syrup
5mg/5mL Consultant Paediatricians, Consultant Neurologists, Consultant Palliative Care, Consultant Oncologists, Consultant Geriatricians, Consultant Anaesthetists, Pain Clinic Specialists
MP 14
Cerebrovascular Disease, Cerebral Palsy, Huntington's Chorea, Motor Neuron Disease, Multiple Sclerosis, Spinal Cord Pathologies, Malignant Diseases
V3.0 September 2021
141 10. Musculoskeletal and Joint Diseases
ATC Code Active Ingredient Dosage Form and Strength
Schedule V Prescriber Criteria
Protocol Pink Card
Pink Card Prescriber Criteria
Schedule V Entitlement
M03BX01 Baclofen Tablets 10mg Consultants
Cerebrovascular Disease, Cerebral Palsy, Huntington's Chorea, Motor Neuron Disease, Multiple Sclerosis, Spinal Cord Pathologies, Trigeminal Neuralgia, Malignant Diseases, Neuromyelitis Optica
M03CA01 Dantrolene Sodium Capsules 25mg
Consultants
Cerebral Palsy, Motor Neuron Disease, Multiple Sclerosis, Spinal Cord Pathologies
N05BA01 Diazepam Syrup 2mg/5mL
Consultants A Medical Practitioners
Addiction Disorders, Cerebral Palsy, Chronic Mood Disorders, Chronic Neurotic Disorders, Chronic Psychiatric Disorders Starting in Childhood, Dementia, Motor Neuron Disease, Multiple Sclerosis, Psychosis, Schizophrenia, Malignant Diseases
N05BA01 Diazepam Tablets 2mg Consultants A Medical Practitioners
Addiction Disorders, Cerebral Palsy, Chronic Mood Disorders, Chronic Neurotic Disorders, Chronic Psychiatric Disorders Starting in Childhood, Dementia, Motor Neuron Disease, Multiple Sclerosis, Psychosis, Schizophrenia, Malignant Diseases
N05BA01 Diazepam Tablets 5mg Consultants A Medical Practitioners
Addiction Disorders, Cerebral Palsy, Chronic Mood Disorders, Chronic Neurotic Disorders, Chronic Psychiatric Disorders Starting in Childhood, Dementia, Motor Neuron Disease, Multiple Sclerosis, Psychosis, Schizophrenia, Malignant Diseases
V3.0 September 2021
142 11. Eye
ATC Code Active Ingredient Dosage Form and Strength
Schedule V Prescriber Criteria
Protocol Pink Card
Pink Card Prescriber Criteria
Schedule V Entitlement
11. Eye 11.1 Anti-infective eye preparations
11.1.1 Antibacterials S01AA01 Chloramphenicol Eye Drops
0.5% Consultants A Medical Practitioners HIV/AIDS and HIV Related Diseases
S01AA01 Chloramphenicol Eye Ointment 1%
Consultants A Medical Practitioners HIV/AIDS and HIV Related Diseases
S03AA06 Dexamethasone+ Framycetin + Gramicidin
Ear/Eye Drops 0.05% + 0.5% + 0.005%
A Medical Practitioners No Entitlement
11.1.2 Antivirals S01AD03 Aciclovir (Acyclovir) Eye Ointment
3% N/A A Consultant
Ophthalmologists No Schedule V Entitlement
11.2 Corticosteroids and anti-inflammatory preparations 11.2.1 Corticosteroids
S01BA01 Dexamethasone Eye Drops 0.1%
Consultants A Medical Practitioners Vascular Disease of the Retina, Malignant Diseases
11.2.2 Other anti-inflammatory preparations S01XG01 Sodium
Cromoglicate Eye Drops 2% N/A A Medical Practitioners No Schedule V Entitlement
11.3 Mydriatics and cycoplegics S01FA01 Atropine Sulphate Eye Drops 1% Consultants
Vascular Disease of the Retina, Malignant Diseases
S01FA04 Cyclopentolate Hydrochloride
Unit Dose Eye Drops 1%
Consultant Ophthalmologists
C Consultant Ophthalmologists
Vascular Disease of the Retina
V3.0 September 2021
143 11. Eye
ATC Code Active Ingredient Dosage Form and Strength
Schedule V Prescriber Criteria
Protocol Pink Card
Pink Card Prescriber Criteria
Schedule V Entitlement
S01FA06 Tropicamide Unit Dose Eye Drops 0.5%
Consultant Ophthalmologists
Vascular Disease of the Retina
11.4 Treatment of glaucoma S01EC01 Acetazolamide Tablets 250mg Consultants Epilepsy, Glaucoma
S01ED02 Betaxolol Hydrochloride
Eye Drops Suspension 0.25% or Eye Drops Solution 0.5%
Consultant Ophthalmologists
Glaucoma
S01EA05 Brimonidine Tartrate
Eye drops 0.2%
Consultant Ophthalmologists
Glaucoma
S01EC04 Brinzolamide Eye drops 10mg/mL
Consultant Ophthalmologists
Glaucoma
S01ED01, S01ED02, S01ED03
Beta-Blocker preservative free (Timolol, Betaxolol or Levobunolol)
Eye Drops Consultant Ophthalmologists
MP 127
Glaucoma
S01EB01 Pilocarpine Hydrochloride
Eye drops 1% Consultants C Medical Practitioners Glaucoma, Malignant Diseases
S01EB01 Pilocarpine Hydrochloride
Eye drops 2% Consultants C Medical Practitioners Glaucoma, Malignant Diseases
S01EB01 Pilocarpine Hydrochloride
Eye drops 4% Consultants C Medical Practitioners Glaucoma, Malignant Diseases
S01EE01, S01EE04
Prostaglandin Analogues (Currently Latanoprost)
Eye drops Consultant Ophthalmologists
Glaucoma
V3.0 September 2021
144 11. Eye
ATC Code Active Ingredient Dosage Form and Strength
Schedule V Prescriber Criteria
Protocol Pink Card
Pink Card Prescriber Criteria
Schedule V Entitlement
S01EE04 Travoprost (Benzalkonium Free)
Eye drops Consultant Ophthalmologists
MP 194
Glaucoma
S01ED01 Timolol Maleate Eye Drops 0.25%
Consultants C Medical Practitioners Glaucoma
S01ED01 Timolol Maleate Eye Drops 0.5%
Consultants C Medical Practitioners Glaucoma
11.5 Miscellaneous ophthalmic preparations 11.5.1 Tear deficiency, ocular lubricants, and astringents
S01KA02 Hypromellose Eye Drops 0.3% - 0.5%
Consultants B Medical Practitioners Malignant Diseases
V3.0 September 2021
145 12. Ear, Nose and Oropharynx
ATC Code Active Ingredient Dosage Form and Strength
Schedule V Prescriber Criteria
Protocol Pink Card
Pink Card Prescriber Criteria
Schedule V Entitlement
12. Ear, Nose and Oropharynx 12.1 Drugs acting on the ears
12.1.1 Otitis externa S03CA01 Dexamethasone+
Framycetin + Gramicidin
Ear/Eye Drops 0.05% + 0.5% + 0.005%
N/A A Medical Practitioners No Schedule V Entitlement
S03AA06 Gentamicin Ear/Eye Drops 0.3%
N/A A Medical Practitioners No Schedule V Entitlement
12.2 Drugs acting on the nose 12.2.1 Drugs used in nasal allergy
R01AD01 Beclometasone Dipropionate
Nasal Spray 50mcg
Consultants B Consultants Malignant Diseases
12.2.2 Topical nasal decongestants R01AA07 Xylomethazoline
Hydrochloride Nasal Drops 0.05%
N/A A Medical Practitioners No Schedule V Entitlement
R01AA07 Xylomethazoline Hydrochloride
Nasal Drops 0.1%
N/A A Medical Practitioners No Schedule V Entitlement
12.3 Drugs acting on the oropharynx 12.3.1 Mouthwashes, gargles, and dentifrices
A01AB03 Chlorhexidine Gluconate
Mouthwash 0.2%
Consultants A Dentists, Hospital Doctors
Down Syndrome, Congenital Indifference to Pain, Malignant Diseases, Chronic Immunobullous Disorders
A01AB02/ D08AX01
Hydrogen Peroxide
Solution 6% Consultants A Medical Practitioners Congenital Indifference to Pain, Malignant Diseases, Chronic Immunobullous Disorders
V3.0 September 2021
146 12. Ear, Nose and Oropharynx
ATC Code Active Ingredient Dosage Form and Strength
Schedule V Prescriber Criteria
Protocol Pink Card
Pink Card Prescriber Criteria
Schedule V Entitlement
12.3.2 Treatment of dry mouth A01AD11 Artificial Saliva Solution Designate ENT
Consultants, Consultant Heamatologists, Consultant Oncologists, Consultant Palliative Care
Malignant Diseases
V3.0 September 2021
147 13. Skin
ATC Code Active Ingredient Dosage Form and Strength
Schedule V Prescriber Criteria
Protocol Pink Card
Pink Card Prescriber Criteria
Schedule V Entitlement
13. Skin 13.1 Emollient and barrier preparations
13.1.1 Emollients D02AX Aqueous Cream Cream Consultants B Medical Practitioners Congenital Ichthyosis, Diabetes Mellitus Type
1, Diabetes Mellitus Type 2, Down Syndrome, Malignant Diseases, Psoriasis, Severe Refractory Atopic Dermatitis
D02AX Compound Emollient Preparation (Currently Lipobase®)
Cream Consultant Dermatologists
Congenital Ichthyosis, Malignant Diseases, Psoriasis, Severe Refractory Atopic Dermatitis
D02AX Emulsifying Ointment
Ointment Consultant Dermatologists
Congenital Ichthyosis, Psoriasis
D02AC White Soft Paraffin
Ointment Consultants
Congenital Ichthyosis, Malignant Diseases, Psoriasis
D02AE51 Urea Cream/ Lotion 10%
Consultant Dermatologists
Congenital Ichthyosis
13.1.1.1 Emollient bath additives D02AX Emollient Bath or
Shower Preparation
Solution Consultant Dermatologists
B Consultant Dermatologists
Congenital Ichthyosis, Malignant Diseases, Psoriasis, Severe Refractory Atopic Dermatitis
V3.0 September 2021
148 13. Skin
ATC Code Active Ingredient Dosage Form and Strength
Schedule V Prescriber Criteria
Protocol Pink Card
Pink Card Prescriber Criteria
Schedule V Entitlement
13.1.2 Barrier preparations D02AB Zinc Based
Barrier Cream/ Ointment
Cream/ Ointment
Consultants B Medical Practitioners Malignant Diseases
13.2 Topical corticosteroids D07AC01 Betamethasone
Dipropionate [Potency: potent]
Cream 0.05% Consultant Dermatologists
C Consultant Dermatologists
Chronic Immunobullous Disorders, Congenital Ichthyosis, Dermatomyositis/ Polymyositis, Lupus Erythematosus, Malignant Diseases, Psoriasis, Severe Refractory Atopic Dermatitis
D07AC01 Betamethasone Valerate [Potency: potent]
Cream 0.1% Consultants B Medical Practitioners Chronic Immunobullous Disorders, Congenital Ichthyosis, Dermatomyositis/ Polymyositis, Lupus Erythematosus, Malignant Diseases, Psoriasis, Severe Refractory Atopic Dermatitis, Systemic Sclerosis
D07AC01 Betamethasone Valerate [Potency: moderate]
Ointment 0.025%
Consultant Dermatologists
Chronic Immunobullous Disorders, Congenital Ichthyosis, Dermatomyositis/ Polymyositis, Lupus Erythematosus, Malignant Diseases, Psoriasis, Severe Refractory Atopic Dermatitis, Systemic Sclerosis
D07AC01 Betamethasone Valerate [Potency: potent]
Ointment 0.1%
Consultants B Medical Practitioners Chronic Immunobullous Disorders, Congenital Ichthyosis, Dermatomyositis/ Polymyositis, Lupus Erythematosus, Malignant Diseases, Psoriasis, Severe Refractory Atopic Dermatitis, Systemic Sclerosis
D07AC01 Betamethasone Valerate [Potency: potent]
Scalp Application 0.1%
Consultants B Hospital Doctors Chronic Immunobullous Disorders, Congenital Ichthyosis, Dermatomyositis/ Polymyositis, Lupus Erythematosus, Psoriasis, Severe Refractory Atopic Dermatitis
V3.0 September 2021
149 13. Skin
ATC Code Active Ingredient Dosage Form and Strength
Schedule V Prescriber Criteria
Protocol Pink Card
Pink Card Prescriber Criteria
Schedule V Entitlement
D07AD01 Clobetasol Propionate [Potency: very potent]
Cream 0.05% Consultant Dermatologists
B Consultant Dermatologists
Chronic Immunobullous Disorders, Congenital Ichthyosis, Dermatomyositis/ Polymyositis, Lupus Erythematosus, Malignant Diseases, Psoriasis, Severe Refractory Atopic Dermatitis, Systemic Sclerosis
D07AD01 Clobetasol Propionate [Potency: very potent]
Ointment 0.05%
Consultant Dermatologists
B Consultant Dermatologists
Chronic Immunobullous Disorders, Congenital Ichthyosis, Dermatomyositis/ Polymyositis, Lupus Erythematosus, Malignant Diseases, Psoriasis, Severe Refractory Atopic Dermatitis, Systemic Sclerosis
D07AD01 Clobetasol Propionate [Potency: very potent]
Scalp Application 0.05%
Consultant Dermatologists
B Consultant Dermatologists
Chronic Immunobullous Disorders, Congenital Ichthyosis, Dermatomyositis/ Polymyositis, Lupus Erythematosus, Psoriasis, Severe Refractory Atopic Dermatitis, Systemic Sclerosis
D07AA02 Hydrocortisone [Potency: mild]
Cream 1% Consultants A Medical Practitioners Chronic Immunobullous Disorders, Congenital Ichthyosis, Dermatomyositis/ Polymyositis, Down Syndrome, Malignant Diseases, Psoriasis, Severe Refractory Atopic Dermatitis
D07AA02 Hydrocortisone [Potency: mild]
Ointment 1% Consultants A Medical Practitioners Chronic Immunobullous Disorders, Congenital Ichthyosis, Dermatomyositis/ Polymyositis, Down Syndrome, Malignant Diseases, Psoriasis, Severe Refractory Atopic Dermatitis
D07AB02 Hydrocortisone Butyrate [Potency: potent]
Cream 0.1% Consultants B Medical Practitioners Chronic Immunobullous Disorders, Congenital Ichthyosis, Dermatomyositis/ Polymyositis, Lupus Erythematosus, Malignant Diseases, Psoriasis, Severe Refractory Atopic Dermatitis, Systemic Sclerosis
V3.0 September 2021
150 13. Skin
ATC Code Active Ingredient Dosage Form and Strength
Schedule V Prescriber Criteria
Protocol Pink Card
Pink Card Prescriber Criteria
Schedule V Entitlement
D07AB02 Hydrocortisone Butyrate [Potency: potent]
Cream Fatty Base
Consultants B Medical Practitioners Chronic Immunobullous Disorders, Congenital Ichthyosis, Dermatomyositis/ Polymyositis, Lupus Erythematosus, Malignant Diseases, Psoriasis, Severe Refractory Atopic Dermatitis, Systemic Sclerosis
D01AC52/ D07XA01
Miconazole + Hydrocortisone [Potency: mild]
Cream 2% + 1%
Consultant Dermatologists
Congenital Ichthyosis, Psoriasis
D07AC13 Mometasone Furoate [Potency: potent]
Cream 0.1% Consultant Dermatologists
Chronic Immunobullous Disorders, Congenital Ichthyosis, Dermatomyositis/ Polymyositis, Lupus Erythematosus, Malignant Diseases, Psoriasis, Severe Refractory Atopic Dermatitis
D07AC13 Mometasone Furoate [Potency: potent]
Ointment 0.1%
Consultant Dermatologists
Chronic Immunobullous Disorders, Congenital Ichthyosis, Dermatomyositis/ Polymyositis, Lupus Erythematosus, Malignant Diseases, Psoriasis, Severe Refractory Atopic Dermatitis
D07XC01 Salicylic Acid + Betamethasone [Potency: potent]
Ointment 3% + 0.05%
Consultant Dermatologists
C Consultant Dermatologists
Chronic Immunobullous Disorders, Congenital Ichthyosis, Psoriasis
D07XC01 Salicylic Acid + Betamethasone [Potency:
potent]
Scalp Application 2% + 0.05%
Consultant Dermatologists
Chronic Immunobullous Disorders, Congenital Ichthyosis, Psoriasis
Officially deleted. Available until stocks last.
V3.0 September 2021
151 13. Skin
ATC Code Active Ingredient Dosage Form and Strength
Schedule V Prescriber Criteria
Protocol Pink Card
Pink Card Prescriber Criteria
Schedule V Entitlement
13.3 Preparations for eczema and psoriasis 13.3.1 Preparations for psoriasis
D05BB02 Acitretin Capsules 10mg
Consultant Dermatologists
Congenital Ichthyosis, Hidradenitis Suppurativa, Lupus Erythematosus, Malignant Diseases, Psoriasis
D05BB02 Acitretin Capsules 25mg
Consultant Dermatologists
Congenital Ichthyosis, Hidradenitis Suppurativa, Lupus Erythematosus, Malignant Diseases, Psoriasis
D05AX02 Calcipotriol Ointment 50mcg/g
Consultant Dermatologists
Psoriasis
D05AX52 Calcipotriol + Betamethasone [Potency: potent]
Ointment or Cutaneous Foam 50mcg/g + 500mcg/g
Consultant Dermatologists
Psoriasis
D05AA Coal Tar* Shampoo Consultants B Medical Practitioners Congenital Ichthyosis, Psoriasis
EXTEMP2 Miconazole + Hydrocortisone Butyrate
Cream 1:1 Consultant Dermatologists
TBDF Hospitals
only
Psoriasis
EXTEMP3 Salicylic Acid + Betamethasone
Cream 5% Consultant Dermatologists
TBDF Hospitals
only
Psoriasis
EXTEMP4 Salicylic Acid + Betamethasone
Cream 10% Consultant Dermatologists
TBDF Hospitals
only
Psoriasis
* Availability temporarily suspended due to problematic sourcing.
V3.0 September 2021
152 13. Skin
ATC Code Active Ingredient Dosage Form and Strength
Schedule V Prescriber Criteria
Protocol Pink Card
Pink Card Prescriber Criteria
Schedule V Entitlement
EXTEMP5 Salicylic Acid + Betamethasone
Ointment 5% Consultant Dermatologists
TBDF Hospitals
only
Psoriasis
EXTEMP6 Salicylic Acid + Betamethasone
Ointment 10%
Consultant Dermatologists
TBDF Hospitals
only
Psoriasis
EXTEMP7 Salicylic Acid + Clobetasol
Cream 5% Consultant Dermatologists
TBDF Hospitals
only
Psoriasis
EXTEMP8 Salicylic Acid + Clobetasol
Cream 10% Consultant Dermatologists
TBDF Hospitals
only
Psoriasis
EXTEMP9 Salicylic Acid + Clobetasol
Ointment 5% Consultant Dermatologists
TBDF Hospitals
only
Psoriasis
EXTEMP10 Salicylic Acid + Clobetasol
Ointment 10%
Consultant Dermatologists
TBDF Hospitals
only
Psoriasis
EXTEMP11 Salicylic Acid + Hydrocortisone butyrate
Cream 5% Consultant Dermatologists
TBDF Hospitals
only
Psoriasis
EXTEMP12 Salicylic Acid + Hydrocortisone butyrate
Cream 10% Consultant Dermatologists
TBDF Hospitals
only
Psoriasis
EXTEMP1 Menthol + Aqueous Cream
Cream Consultant Dermatologists
TBDF Hospitals
only
Psoriasis
V3.0 September 2021
153 13. Skin
ATC Code Active Ingredient Dosage Form and Strength
Schedule V Prescriber Criteria
Protocol Pink Card
Pink Card Prescriber Criteria
Schedule V Entitlement
13.3.2 Drugs affecting the immune response L04AB04 Adalimumab Solution for
Injection in Pre-filled Syringes 40mg
Consultant Dermatologists, Consultant Gastroenterologists, Consultant Paediatrician, Consultant Rheumatologists
MP 307 Hidradenitis Suppurativa, Inflammatory Bowel Disease, Psoriasis, Rheumatoid Arthritis, Spondyloarthritis
L04AD01 Ciclosporin (Cyclosporin)
Capsules 25mg
Consultants MP 46
Inflammatory Bowel Disease, Secondary Immunodeficiency Disorder, Chronic Kidney Disease, Chronic Liver Disease, Malignant Diseases, Rheumatoid Arthritis, Severe Chronic Urticaria, Severe Refractory Atopic Dermatitis, Spondyloarthritis, Psoriasis
L04AD01 Ciclosporin (Cyclosporin)
Capsules 100mg
Consultants MP 46
Inflammatory Bowel Disease, Secondary Immunodeficiency Disorder, Chronic Kidney Disease, Chronic Liver Disease, Malignant Diseases, Rheumatoid Arthritis, Severe Chronic Urticaria, Severe Refractory Atopic Dermatitis, Spondyloarthritis, Psoriasis
L04AD01 Ciclosporin (Cyclosporin)
Oral Solution 100mg/mL
Consultants MP 47
Secondary Immunodeficiency Disorder, Chronic Kidney Disease, Chronic Liver Disease, Rheumatoid Arthritis, Severe Chronic Urticaria, Severe Refractory Atopic Dermatitis, Psoriasis, Malignant Diseases
L04AB01 Etanercept (Enbrel®)
Injection 25mg
Consultant Dermatologists, Consultant Rheumatologists
MP 66
Psoriasis, Rheumatoid Arthritis
V3.0 September 2021
154 13. Skin
ATC Code Active Ingredient Dosage Form and Strength
Schedule V Prescriber Criteria
Protocol Pink Card
Pink Card Prescriber Criteria
Schedule V Entitlement
L04AB01 Etanercept (Benepali®)
Pre-filled Pen 50mg
Consultant Dermatologists, Consultant Rheumatologists
MP 66
Psoriasis, Rheumatoid Arthritis
L04AB01 Etanercept (Currently Erelzi®)
Pre-filled Pen 50mg
Consultant Dermatologists, Consultant Rheumatologists
MP 66
Psoriasis, Rheumatoid Arthritis
L01BA01/ L04AX03
Methotrexate Tablets 2.5mg
Consultants
Inflammatory Bowel Disease, Secondary Immunodeficiency Disorder, Chronic Liver Disease, Malignant Diseases, Chronic Kidney Disease, Dermatomyositis/ Polymyositis, Lupus Erythematosus, Polyartritis Nodosa, Polymyalgia Rheumatica, Rheumatoid Arthritis, Severe Refractory Atopic Dermatitis, Spondyloarthritis, Systemic Sclerosis, Psoriasis
13.4 Acne 13.4.1 Oral preparations for acne
D10BA01 Isotretinoin Capsules 20mg
Consultant Dermatologists
C Consultant Dermatologists
Congenital Ichthyosis
13.6 Anti-infective skin preparations 13.6.1 Antibacterial preparations
13.6.1.1 Antibacterial preparations also used systemically D06BX01 Metronidazole Gel 0.75% Consultant Oncologists,
Consultant Palliative Care, Consultant Dermatologists
MP 129
Malignant Diseases
V3.0 September 2021
155 13. Skin
ATC Code Active Ingredient Dosage Form and Strength
Schedule V Prescriber Criteria
Protocol Pink Card
Pink Card Prescriber Criteria
Schedule V Entitlement
13.6.2 Antifungal preparations D01AC01 Clotrimazole Cream 1% Consultants A Medical Practitioners Down Syndrome, Congenital Indifference to
Pain
D01AC02 Miconazole Cream 2% Consultants A Medical Practitioners Down Syndrome, Congenital Indifference to Pain
13.6.3 Antiviral preparations D06BB03 Aciclovir
(Acyclovir) Cream 5% N/A A Consultant
Dermatologists No Schedule V Entitlement
13.6.4 Parasiticidal preparations P03AX03 Malathion Liquid 0.5%
w/w N/A A Medical Practitioners No Schedule V Entitlement
P03AC04 Permethrin Preparation for Treatment of Head Lice and Nits 1% w/w
N/A A Medical Practitioners No Schedule V Entitlement
P02CF01 Ivermectin Tablets 3mg N/A A Consultants, Senior Public Health Physicians
No Schedule V Entitlement
13.6.5 Preparations for minor cuts and abrasions D11AX05 Magnesium
Sulphate Paste Consultants A Medical Practitioners Malignant Diseases
V3.0 September 2021
156 13. Skin
ATC Code Active Ingredient Dosage Form and Strength
Schedule V Prescriber Criteria
Protocol Pink Card
Pink Card Prescriber Criteria
Schedule V Entitlement
13.7 Skin cleansers and antiseptics 13.7.1 Chlorhexidine salts
D08AC52 Chlorhexidine Gluconate in Isopropyl Alcohol
Solution (Hand Cleansing)
Consultants MP 37 TBDF
Hospitals only (TPN patients
only)
Small Intestinal Failure
13.7.3 Oxidisers and dyes A01AB02/D08AX01
Hydrogen Peroxide
Solution 6% Consultants A Medical Practitioners Congenital Indifference to Pain, Malignant Diseases, Chronic Immunobullous Disorders
13.7.4 Preparations for promotion of wound healing Wound Dressing
Emulsion (Currently Trolamine [Biafine®])
Emulsion Consultant Dermatologists, Consultant Oncologists, Consultant Surgeons
MP 201
Malignant Diseases
13.8 Sunscreen preparations D02BA Sunscreen SPF
50+ Milk or Lotion
Consultant Dermatologists, Consultant Rheumatologists
MP 180
Lupus Erythematosus, Psoriasis
V3.0 September 2021
157 14. Anaesthesia
TC Code Active Ingredient
Dosage Form and Strength
Schedule V Prescriber Criteria
Protocol Pink Card
Pink Card Prescriber Criteria
Schedule V Entitlement
14. Anaesthesia 14.1 General anaesthesia 14.1.1 Antimuscarinic Drugs
A03AB02 Glycopyrrolate (Glycopyrronium) (stand-by)
Injections 0.6mg
Consultants TBDF MDHP only
Cerebral Palsy, Epilepsy, Motor Neuron Disease, Malignant Diseases
A04AD01, N05CM05
Hyoscine Hydrobromide
Injections 400mcg
Consultant Palliative Care TBDF Hospitals
only
Malignant Diseases
14.1 Local anaesthesia D04AB01 Lidocaine
Hydrochloride (Lignocaine Hydrochloride)
Gel 2% Consultants C (Cathe
teri-sation)
Hospital Doctors With catheters in the following conditions: Cerebral Palsy, Cerebrovascular Disease, Chronic Kidney Disease, Chronic Obstructive Pulmonary Disease, Chronic Respiratory Failure, Congenital Indifference to Pain, Cystic Fibrosis, Dementia, Diabetes Mellitus Type 1, Diabetes Mellitus Type 2, Diverticular Disease requiring Stoma Care, Enzyme Disorders, Hirschsprung's Disease, Huntington's Chorea, Malignant Diseases, Motor Neuron Disease, Parkinson's Disease, Peripheral Vascular Disease, Spinal Cord Pathologies
V3.0 September 2021
158 14. Anaesthesia
TC Code Active Ingredient
Dosage Form and Strength
Schedule V Prescriber Criteria
Protocol Pink Card
Pink Card Prescriber Criteria
Schedule V Entitlement
14.2 Topical local anaesthetics and antipruritics D04AX Calamine Lotion Cream/
Lotion N/A A Medical Practitioners No Schedule V Entitlement
D04AX Crotamiton Cream Consultants A Medical Practitioners Dermatomyositis/ Polymyositis
V3.0 September 2021
159 14. Anaesthesia
ATC Code Active Ingredient
Dosage Form and Strength
Schedule V Prescriber Criteria
Protocol Pink Card
Pink Card Prescriber Criteria
Schedule V Entitlement
15. Consumables STOMA Stoma and
Related Consumables
Consultants
Chronic Kidney Disease, Diverticular Disease requiring Stoma Care, Hirschsprung's Disease, Imperforate Anus, Inflammatory Bowel Disease, Small Intestinal Failure, Malignant Diseases
STOMA Adhesive Remover
Consultants
Chronic Kidney Disease, Diverticular Disease requiring Stoma Care, Hirschsprung's Disease, Imperforate Anus, Inflammatory Bowel Disease, Small Intestinal Failure, Malignant Diseases
STOMA Deodorizing Agent
Consultants
Chronic Kidney Disease, Diverticular Disease requiring Stoma Care, Hirschsprung's Disease, Imperforate Anus, Inflammatory Bowel Disease, Small Intestinal Failure, Malignant Diseases
V3.0 September 2021
160 15. Consumables
ATC Code Active Ingredient
Dosage Form and Strength
Schedule V Prescriber Criteria
Protocol Pink Card
Pink Card Prescriber Criteria
Schedule V Entitlement
STOMA
Flanges Wafer Consultants
Chronic Kidney Disease, Diverticular Disease requiring Stoma Care, Hirschsprung's Disease, Imperforate Anus, Inflammatory Bowel Disease, Small Intestinal Failure, Malignant Diseases
STOMA
Gauze (non-sterile)
Consultants
Chronic Kidney Disease, Diverticular Disease requiring Stoma Care, Hirschsprung's Disease, Imperforate Anus, Inflammatory Bowel Disease, Small Intestinal Failure, Malignant Diseases
STOMA Pouches Closed
Consultants Chronic Kidney Disease, Diverticular Disease requiring Stoma Care, Hirschsprung's Disease, Imperforate Anus, Inflammatory Bowel Disease, Small Intestinal Failure, Malignant Diseases
V3.0 September 2021
161 15. Consumables
ATC Code Active Ingredient
Dosage Form and Strength
Schedule V Prescriber Criteria
Protocol Pink Card
Pink Card Prescriber Criteria
Schedule V Entitlement
Equipment related to the condition and/or treatment of that condition
Consultants
Cerebral Palsy, Cerebrovascular Disease, Chronic Immunobullous Disorders, Chronic Kidney Disease, Chronic Obstructive Pulmonary Disease, Chronic Osteomyelitis, Chronic Respiratory Failure, Congenital Indifference to Pain, Cystic Fibrosis, Dementia, Diabetes Mellitus Type 1, Diabetes Mellitus Type 2, Diverticular Disease requiring Stoma Care, Enzyme Disorders, Epilepsy, Gastro-Oesophageal Reflux Disease, Hirschsprung's Disease, Hospital Acquired Infections, Huntington's Chorea, Imperforate Anus, Inflammatory Bowel Disease, Inherited Bleeding Disorders, Leprosy, Malignant Diseases, Motor Neuron Disease, Multiple Sclerosis, Parkinson's Disease, Peripheral Vascular Disease, Primary Immunodeficiency Disorder, Small Intestinal Failure, Spinal Cord Pathologies
V3.0 September 2021
162 15. Consumables
ATC Code Active Ingredient
Dosage Form and Strength
Schedule V Prescriber Criteria
Protocol Pink Card
Pink Card Prescriber Criteria
Schedule V Entitlement
V07AY Lubricating Jelly Consultants
With catheters in the following conditions: Cerebral Palsy, Cerebrovascular Disease, Chronic Kidney Disease, Chronic Obstructive Pulmonary Disease, Chronic Respiratory Failure, Congenital Indifference to Pain, Cystic Fibrosis, Dementia, Diabetes Mellitus Type 1, Diabetes Mellitus Type 2, Diverticular Disease requiring Stoma Care, Enzyme Disorders, Hirschsprung's Disease, Huntington's Chorea, Malignant Diseases, Motor Neuron Disease, Parkinson's Disease, Peripheral Vascular Disease, Spinal Cord Pathologies
V3.0 September 2021
163 A1 Borderline Substances
ATC Code Active Ingredient
Dosage Form and Strength
Schedule V Prescriber Criteria
Protocol Pink Card
Pink Card Prescriber Criteria
Schedule V Entitlement
A1 Borderline Substances A1.1 Enteral feeds (non-disease specific)
A1.1.1 Enteral feeds (non-disease specific): less than 5g protein/100mL A1.1.1.1 Enteral feeds: 1kcal/mL and less than 5g protein/100mL
V06 Complete Nutritional Preparation (e.g. Nutrison®, Nutricomp® Standard)
Liquid 500mL Consultants C Medical Practitioners Cerebrovascular Disease, Cerebral Palsy, Dementia, Epilepsy, Huntington's Chorea, Motor Neuron Disease, Multiple Sclerosis, Parkinson's Disease, Down Syndrome, Small Intestinal Failure, Malignant Diseases
A1.1.2 Enteral feeds (non-disease specific): 5g (or more) protein/100mL
A1.1.2.1 Enteral feeds: 1.5kcal/mL and 5g (or more) protein/100mL V06 Complete
Nutritional Preparation (e.g. Resource Energy®, formerly known as Ensure®, Clinutren®)
Liquid 200mL Consultants C Medical Practitioners Cerebrovascular Disease, Cerebral Palsy, Dementia, Epilepsy, Huntington's Chorea, Motor Neuron Disease, Multiple Sclerosis, Parkinson's Disease, Down Syndrome, Small Intestinal Failure, Malignant Diseases
A1.1.2.2 Enteral feeds: less than 1kcal/mL and less than 5g protein/100mL V06 Elemental
Formulas (e.g.
Elemental 028® Extra)
Powder Consultant Paediatricians, Consultant Gastroenterologists
MP 61
Gastro-Oesophageal Reflux Disease, Inflammatory Bowel Disease, Small intestinal Failure, Malignant Diseases
V3.0 September 2021
164 A1 Borderline Substances
ATC Code Active Ingredient
Dosage Form and Strength
Schedule V Prescriber Criteria
Protocol Pink Card
Pink Card Prescriber Criteria
Schedule V Entitlement
A1.1.3 Enteral feeds (non-disease specific): Child under 12 years A1.1.3.1 Enteral feeds, Child: 1kcal/mL and less than 4g protein/100mL
V06 Paediatric Liquid Food Preparation (e.g.
Paediasure®)
Liquid Consultant Paediatricians MP 158
Chronic Heart Failure, Cerebral Palsy, Down Syndrome, Gastro-Oesophageal Reflux Disease, Small Intestinal Failure, Malignant Diseases
A1.2 Nutritional supplements (non-disease specific) A1.2.1 Nutritional supplements: 5g (or more) protein/100mL
A1.2.2.2 Nutritional supplements: More than 1.5kcal/mL and 5g (or more) protein/100mL V06 Diet
Supplementation (e.g. FoodLink®, Sustagen®)
Powder
C Hospital Doctors No Schedule V Entitlement
A1.3 Specialised formulas A1.3.1 Specialised formulas: Infant and child – Amino acid-based formula
V06 Elemental Infant Formula (e.g. Neocate® LCP or Alfamino®)
Powder Consultant Paediatricians MP 62
Gastro-Oesophageal Reflux Disease, Small intestinal Failure, Inborn Errors of Metabolism
A1.3.2 Specialised formulas: Infant and child – Hydrolysate formula V06DF Milk Substitute
(e.g. Pregestimil®)
Powder Consultants
Enzyme Disorders, Inborn Errors of Metabolism
V3.0 September 2021
165 A1 Borderline Substances
ATC Code Active Ingredient
Dosage Form and Strength
Schedule V Prescriber Criteria
Protocol Pink Card
Pink Card Prescriber Criteria
Schedule V Entitlement
A1.3.3 Specialised formulas: Infant and child – Soya-based formula V06DF Milk Substitute
[Soya Based] (e.g. SMA ® Wysoy)
Powder Consultants
Enzyme Disorders, Inborn Errors of Metabolism
A1.4 Feed supplements A1.4.1 High-energy supplements
A1.4.1.1 High-energy supplements: carbohydrate V06DC Carbohydrate
Source Supplement (e.g. Maxijul®)
Powder Consultants MP 32
Chronic Heart Failure, Cerebral Palsy, Motor Neuron Disease, Multiple Sclerosis, Parkinson's Disease, Down Syndrome, Enzyme Disorders, Malignant Diseases
A1.4.1.2 High-energy supplements: fat V06 Fat and
Carbohydrate Food Supplement (e.g. Duocal®)
Powder Consultant Paediatricians MP 68
Chronic Heart Failure, Cerebral Palsy, Down Syndrome, Enzyme Disorders
A1.4.1.3 High-energy supplements: protein V06B Protein (e.g.
Forceval®) Powder Consultants
Epilepsy, Motor Neuron Disease
V06B Protein (e.g.
Casilan®, Promod®, Protifar®)
Powder 70-90% (high)
Consultants
Cerebral Palsy, Epilepsy, Motor Neuron Disease, Multiple Sclerosis, Parkinson's Disease, Malignant Diseases
V3.0 September 2021
166 A1 Borderline Substances
ATC Code Active Ingredient
Dosage Form and Strength
Schedule V Prescriber Criteria
Protocol Pink Card
Pink Card Prescriber Criteria
Schedule V Entitlement
A1.5 Feed additives A1.5.1 Feed thickeners and pre-thickened food
V07A Fluid thickener Powder Consultants C Consultants Cerebrovascular Disease, Cerebral Palsy, Dementia, Epilepsy, Huntington's Chorea, Motor Neuron Disease, Multiple Sclerosis, Parkinson's Disease, Down Syndrome, Polio and Post-Polio Syndrome, Malignant Diseases
A1.5.2 Flavouring preparations Flavour Sachets
(to be added with SHS products)
Sachets Consultant Paediatricians, Consultant Gastroenterologists, Dieticians
MP 232
Inflammatory Bowel Disease, Small intestinal Failure, Enzyme Disorders, Malignant Diseases
A1.6 Foods for special diets A1.6.1 Gluten-free foods
V06 Gluten Free Dietary Items
Voucher Scheme for Coeliac Patients
Consultant Gastroenterologists, Consultant Paediatricians, Consultant Surgeons
MP 85
Coeliac Disease
A1.6.2 Low-protein foods V06 Low-protein
bread Consultants
Chronic Kidney Disease
V06 Low-protein cracker bread
Consultants
Chronic Kidney Disease
V06 Low-protein flavoured biscuits
Consultants
Chronic Kidney Disease
V3.0 September 2021
167 A1 Borderline Substances
ATC Code Active Ingredient
Dosage Form and Strength
Schedule V Prescriber Criteria
Protocol Pink Card
Pink Card Prescriber Criteria
Schedule V Entitlement
V06 Low-protein flour
Consultants
Chronic Kidney Disease
V06 Low-protein pasta
Consultants
Chronic Kidney Disease
V06 Low-protein plain biscuits
200g Consultants
Chronic Kidney Disease
V3.0 September 2021
168 Index
Index
A
Abacavir + Lamivudine, 93
Abidec®, 134
Abiraterone, 122
Acetazolamide, 63, 143
Aciclovir (Acyclovir), 95, 96, 142, 155
Acitretin, 151
Adalimumab, 16, 137, 153
Alfacalcidol, 132, 133
Alfuzosin, 110
Allopurinol, 140
Alpha Tocopheryl (Vitamin E), 133, 134
Amantadine, 68
Amiloride + Hydrochlorothiazide, 22
Amiodarone HCl, 23
Amitriptyline, 52, 61
Amlodipine, 28
Amoxicillin, 73, 74
Amoxicillin + Clavulanic Acid, 74, 75
Anastrozole, 122
Angiotensin-II Receptor Anatagonists, 27
Antacid Compound Preparation, 11
Anti-Haemophilic Factor IX, 32
Anti-Haemophilic Factor VIII (stand-by), 31
Anti-Haemophilic Factor VIII inhibitor bypassing activity,
32
Anti-Heamophilic Factor VIII Intermediate, 32
Aprepitant, 56
Aqueous Cream, 147
Artificial Saliva, 146
Ascorbic Acid, 132
Aspirin, 31, 58
Atenolol, 23
Atomoxetine, 55
Atorvastatin, 33
Atropine Sulphate, 11, 142
Azathioprine, 16, 117, 138
Azidothymidine, 93, 94
Azithromycin, 78, 79
B
Baclofen, 140, 141
Beclometasone Dipropionate, 38, 145
Bendroflumethiazide (Bendrofluazide), 21
Benzhexol Hydrochloride, 70
Benzoin Tincture, 42
Benzylpenicillin, 75
Beta-Blocker preservative free, 143
Betamethasone Dipropionate, 148
Betamethasone Valerate, 148
Betaxolol, 143
Betaxolol Hydrochloride, 143
Bexarotene, 114
Bezafibrate, 33
Bicalutamide, 122
Bisacodyl, 18
Brimonidine Tartrate, 143
Brinzolamide, 143
Bromazepam, 44
Bromhexine, 41
Bromocriptine Mesylate, 68, 108
Budesonide, 15, 38, 39
Bumetanide, 21, 22
Buspirone Hydrochloride, 44
Busulfan, 112
C
Cabergoline, 108
Calamine Lotion, 158
Calcipotriol, 151
Calcipotriol+ Betamethasone, 151
Calcitonin (Salmon Synthetic), 107
Calcium, 28, 112, 129, 130
Calcium Carbonate, 130
Calcium Folinate, 112
Calcium Lactate, 130
Capecitabine, 113
Captopril, 26
Carbamazepine, 63, 64
Carbimazole, 101
Carbohydrate Source Supplement (Maxijul®), 165
Carvedilol, 23
Cefalexin, 76, 77
Cefuroxime Axetil, 77
Cernevit™-12, 129
Chlorambucil, 112
Chloramphenicol, 81, 142
Chlorhexidine Gluconate, 145
Chlorhexidine Gluconate in Isopropyl Alcohol, 156
Chloroquine, 97
Chlorpromazine Hydrochloride, 46
Chorionic Gonadotrophin (HCG), 106
Ciclosporin (Cyclosporin), 16, 17, 118, 119, 138, 153
Cinacalcet, 130
Ciprofloxacin, 88, 89
V3.0 September 2021
169 Index
Clarithromycin, 79, 80
Clindamycin, 81
Clobazam, 64
Clobetasol Propionate, 149
Clofazimine, 86
Clomipramine Hydrochloride, 52
Clonazepam, 64
Clonidine Hydrochloride, 25, 63
Clopidogrel, 31
Clotrimazole, 110, 155
Clozapine, 46
Coal Tar, 151
Co-amilofruse (Amiloride + Furosemide [Frusemide]), 23
Co-Danthramer, 18
Codeine Phosphate, 13, 42, 58
Colchicine, 140
Colestyramine, 20, 33
Colistimethate Sodium, 81
Colistin Sulphomethate Sodium, 81
Complete Nutritional Preparation, 163
Compound Emollient Preparation (Currently Lipobase®),
147
Conjugated Estrogens, 105
Consumables, 159
Co-Trimoxazole, 82, 83
Crotamiton, 158
Cyclizine, 57
Cyclopentolate Hydrochloride, 142
Cyclophosphamide, 112
Cycloserine, 84
Cyproterone Acetate, 122
D
Dabrafenib, 114
Dantrolene Sodium, 141
Dapsone, 87
Deferasirox, 125
Demeclocycline Hydrochloride, 107
Desmopressin, 107
Dexamethasone, 102, 142
Dexamethasone+ Framycetin + Gramicidin, 142, 145
Dexamfetamine Sulphate, 55
Diazepam, 43, 44, 45, 68, 141
Diclofenac Sodium, 136
Diet Supplementation, 164
Diethylstilbestrol (Stilboestrol), 121
Digoxin, 21
Dihydrocodeine Tartrate, 58
Diltiazem, 28
Dimethyl Fumarate, 119
Diphenhydramine Citrate + Menthol, 42
Dipyridamole, 31
Disopyramide, 23
Disulfiram, 72
Docusate Sodium, 18
Domperidone, 57
Donepezil, 72
Dornase Alfa, 41
Doxazosin, 25, 110
Doxycycline, 77
DPP-4 Inhibitors, 100
Duocal®, 165
Dutasteride, 110
Dydrogesterone, 105
E
Econazole, 110
Efavirenz, 95
Elemental 028® Extra, 163
Elemental Formulas, 163
Elemental Infant Formula, 164
Emollient Bath or Shower Preparation, 147
Empagliflozin, 101
Emulsifying Ointment BP, 147
Enalapril, 26
Enoxaparin Sodium, 29, 30
Enzalutamide, 122
Eptacog Alfa (Recombinant Factor VIIa) (stand-by), 32
Erlotinib, 114
Erythromycin, 80
Estradiol, 105
Estradiol (as hemihydrate) + Dydrogesterone, 105
Etanercept, 138, 139, 153, 154
Ethambutol, 84
Ethinylestradiol, 105, 121
Ethionamide, 85
Ethosuximide, 64
Etoposide, 114
Everolimus, 114, 115
Exemestane, 122
F
Factor XIII Concentrate, 32
Fat and Carbohydrate Food Supplement, 165
Fenofibrate, 33
Fentanyl, 59
Ferrous Gluconate, 124
Fibrinogen Concentrate (stand-by), 32
Filgrastim (Rec. Human G-CSF), 126
Finasteride, 106
Fingolimod, 119
Flavour Sachets, 166
Flecainide, 23
Flucloxacillin, 75, 76
Fluconazole, 90
Fludarabine, 113
Fludrocortisone Acetate, 102
Fluid thickener, 166
Fluorouracil, 113
Fluoxetine, 54
Flupentixol Decanoate, 50
V3.0 September 2021
170 Index
Flupentixol Dihydrochloride, 46, 54
Fluphenazine Decanoate, 50
Flutamide, 122
Fluticasone, 39
Fluvoxamine Maleate, 54
Folic Acid, 124, 125
Folinic Acid, 112
FoodLink®, 164
Furosemide, 22
Fusidate Sodium, 81
Fusidic Acid, 82
G
Gabapentin, 64, 65
Gentamicin, 78, 128, 145
Glibenclamide, 100
Gliclazide, 100
Gliptins, 100
Glucagon, 101
Gluten Free Dietary Items, 166
Glycerol, 18
Glyceryl Trinitrate, 27
Glycopyrolate (Glycopyrronium) (stand-by), 123
Glycopyrrolate (Glycopyrronium) (stand-by), 157
Goserelin, 108, 122
Griseofulvin, 91
Growth Hormone Recombinant, 106
H
Haloperidol, 46, 47, 48, 70, 71
Haloperidol Decanoate, 50, 51
HCG, 106
Heparin Sodium in Sodium Chloride, 29
Hydralazine, 25
Hydrocortisone, 15, 102, 149
Hydrocortisone Butyrate, 149, 150
Hydrocortisone Sodium Succinate, 102
Hydrogen Peroxide, 145, 156
Hydroxocobalamin, 125
Hydroxycarbamide, 115
Hydroxychloroquine Sulphate, 139
Hydroxyurea, 115
Hydroxyzine Hydrochloride, 40
Hyoscine Butylbromide, 11
Hyoscine Hydrobromide, 157
Hypromellose, 144
I
Ibuprofen, 136
Imatinib, 115
Imipramine Hydrochloride, 53
Indometacin, 137
Insulin Aspart, 99
Insulin Biphasic Isophane (Isophane + Neutral), 99
Insulin Glargine, 100
Insulin Isophane, 100
Insulin Neutral (Soluble Insulin, 99
Interferon Beta 1a, 120
Interferon Beta 1b, 120
Interferon Gamma, 120
Ipratropium, 38
Iron + folic acid, 124
Isoniazid, 85
Isoniazid + Rifampicin, 85
Isosorbide Dinitrate, 27
Isosorbide Mononitrate, 27, 28
Isotretinoin, 154
Ispaghula Husk, 17
Itraconazole, 91
Ivacaftor, 41
Ivacaftor + Lumacaftor, 41
Ivacaftor + Tezacaftor, 41
Ivacaftor + Tezacaftor + Elexacaftor, 41
Ivermectin, 98, 155
K
Ketovite®, 134
L
Labetalol Hydrochloride, 23, 24
Lactulose, 19
Lamivudine, 93
Lamotrigine, 65
Lanthanum, 131
Lapatinib, 115
Latanoprost, 143
Ledipasvir + Sofosbuvir, 96
Leflunomide, 139
Lenalidomide, 120, 121
Letrozole, 122
Leucovorin, 112
Leuprorelin, 109
Levetiracetam, 65
Levobunolol, 143
Levodopa + Benserazide Hydrochloride, 68
Levodopa + Carbidopa, 68
Levodopa + Carbidopa + Entacapone, 69
Levofloxacin, 89
Levomepromazine, 48
Levothyroxine (Thyroxine), 101
Lidocaine Hydrochloride, 157
Liothyronine Sodium (L-Tri-iodothyronine), 101
Lisinopril, 26
Lithium Carbonate, 51
Lithium Citrate, 51
Lomustine, 112
Long Acting Beta2-Agonist, 37
Loperamide, 13
Lopinavir/Ritonavir, 94
V3.0 September 2021
171 Index
Lorazepam, 45
Low-protein bread, 166
Low-protein cracker bread, 166
Low-protein flavoured biscuits, 166
Low-protein flour, 167
Low-protein pasta, 167
Low-protein plain biscuits, 167
Lubricating Jelly, 162
M
Magnesium Glycerophosphate, 130
Magnesium Hydroxide + Aluminium Hydroxide +
Simeticone, 11
Magnesium Sulphate, 155
Malathion, 155
Maprotiline Hydrochloride, 53
Maraviroc, 95
Maxijul®, 165
Mebeverine Hydrochloride, 11
Medical Oxygen, 41
Medroxyprogesterone Acetate, 105, 121
Mefenamic Acid, 137
Mefloquine, 97
Meloxicam, 137
Melphalan, 112
Menadiol Sodium Phosphate, 134
Menthol + Aqueous Cream, 152
Mepacrine Hydrochloride, 98
Mercaptopurine, 17, 113
Mesalazine, 14
Mesalazine, 14
Metformin, 100
Methotrexate, 17, 113, 139, 154
Methyldopa, 25
Methylphenidate Hydrochloride, 55, 56
Methylprednisolone, 102
Methylprednisolone (as Sodium Succinate or
Hemisuccinate/ Hydrogen Succinate), 103
Methylprednisolone (as Sodium Succinate or
Hemisuccinate/ Hydrogen Succinate), 103
Methylprednisolone Acetate, 102, 137
Metoclopramide, 57
Metolazone Tartrate, 21
Metoprolol Tartrate, 24
Metronidazole, 87, 88, 154
Mexiletine, 23
Mianserin Hydrochloride, 53
Miconazole, 150, 151, 155
Miconazole + Hydrocortisone, 150
Miconazole + Hydrocortisone Butyrate, 151
Micro-Enemas, 19
Milk Substitute (Pregestimil®), 164
Milk Substitute [Soya Based] (SMA ® Wysoy), 165
Misoprostol, 13
Moclobemide, 54
Mometasone Furoate, 150
Montelukast, 39, 40
Morphine, 59, 60
Moxifloxacin, 89
Multivitamins, 129, 134
Multivitamins + mineral preparation, 135
Mycophenolate Mofetil, 117, 118
Mycophenolate Sodium, 118
N
Naltrexone Hydrochloride, 72
Naproxen, 137
Neocate®, 164
Nevirapine, 95
Nicorandil, 29
Nicotinamide, 131
Nifedipine, 28
Nilotinib, 115
Nitrazepam, 43
Nitrofurantoin, 90
Norethisterone, 105
Norfloxacin, 89
Nortriptyline, 53, 61, 62
Nutrini®, 164
Nutrison® or Nutricomp® Standard, 14, 163
Nystatin, 91
O
Octreotide, 123
Octreotide Long Acting, 123
Olanzapine, 48
Omalizumab, 40
Omeprazole, 13
Ondansetron, 57
Oral Iron, 124
Oral Rehydration, 127
Orphenadrine Hydrochloride, 69
Osmotic Laxative for Constipation, 19
Oxybutynin Hydrochloride, 110
P
Paediasure®, 164
Paediatric Liquid Food Preparation, 164
Pancreatin, 20
Paracetamol, 58
Paraffin White Soft, 147
Parenteral Fat Emulsion LCT, 129
Paroxetine, 54
Peg-Interferon Alfa 2a, 120
Penicillamine, 139
Penicillin V, 76
Pentazocine, 60
Pentoxifylline (Oxypentifylline), 29
Perindopril, 27
V3.0 September 2021
172 Index
Permethrin, 155
Phenobarbital (Phenobarbitone), 65
Phenoxybenzamine, 26
Phenoxymethylpenicillin, 76
Phenytoin Sodium, 66
Phosphate, 19, 131
Phosphate Supplement, 131
Phytomenadione (Vitamin K1), 134
Pilocarpine Hydrochloride, 143
Pimozide, 48
Polystyrene Sulfonate (e.g. Calcium Resonium®), 126
Posaconazole, 92
Potassium Chloride, 127
Potassium Citrate, 111
Potassium Supplement, 127
Praziquantel, 98
Prazosin Hydrochloride, 26
Prednisolone, 16, 35, 36, 103, 104
Pregabalin, 62, 63, 66
Primidone, 67
Procarbazine, 115
Prochlorperazine, 48, 57
Procyclidine, 69, 70
Proguanil Hydrochloride + Atovaquone (stand-by), 98
Promethazine Hydrochloride, 40, 44
Propafenone, 23
Propranolol Hydrochloride, 24
Propylthiouracil, 101
Prostaglandin Analogues, 143
Protein (Casilan®, Promod®, Protifar®), 165
Protein (Forceval®), 165
Pyrazinamide, 86
Pyridostigmine Bromide, 140
Pyridoxine (Vitamin B6), 131, 132
Pyrimethamine (stand-by, 98
Q
Quetiapine, 49
R
Ranitidine, 12
Rasagiline, 69
Recombinant Human Erythropoietin, 125, 126
Repaglinide, 101
Resource Energy®,, 163
Ribavirin, 97
Rifabutin, 86
Rifampicin, 86
Risperidone, 49, 51
Ritonavir, 94
Ropinirole, 69
Rosuvastatin, 34
Rufinamide, 67
S
Salbutamol, 37
Salicylic Acid + Betamethasone, 150, 151, 152
Salicylic Acid + Clobetasol, 152
Salicylic Acid + Hydrocortisone butyrate, 152
Salmeterol, 37
Saquinavir, 94
Selegiline, 69
Senna, 18
SGLT2 inhibitor, 101
Sildenafil, 25
Simvastatin, 34
Sirolimus, 119
Sodium Bicarbonate, 127
Sodium Clodronate, 108
Sodium Cromoglicate, 142
Sodium Feredetate (oral iron), 124
Sodium Valproate, 67
Somatropin, 106
Sotalol, 24
Spironolactone, 22
Stoma and Related Consumables, 159
Sucralfate, 12
Sulfadiazine, 83
Sulfasalazine, 14, 15, 139
Sulpiride, 49, 50
Sunitinib, 115, 116
Sunscreen SPF 50+, 156
Sustagen®, 164
T
Tacrolimus, 119
Tamoxifen, 122
Temozolomide, 116
Tenofovir, 93
Terbutaline, 37
Teriflunomide, 121
Teriparatide, 107
Testosterone Undecanoate, 106
Tetrabenazine, 72
Tetracycline, 78
Thalidomide, 87, 121
Theophylline, 38
Thiamine (Vitamin B1), 132
Thyroxine, 101
Timolol, 143
Timolol Maleate, 144
Tioguanine, 114
Tiopronin, 135
Topiramate, 67
Total Parenteral Nutrition (Adult), 128
Trace Elements + Electrolytes, 129
Tramadol, 60
Trametinib, 116
V3.0 September 2021
173 Index
Tranexamic Acid, 32
Travoprost, 144
Tretinoin, 116
Trifluoperazine, 50
Trihexyphenidyl Hydrochloride, 70
Trimetazidine Hydrochloride, 29
Trimethoprim, 84
Tropicamide, 143
U
Umeclidinium, 38
Urea, 147
Ursodeoxycholic Acid, 20
V
Valganciclovir, 96
Valsartan, 27
Venlafaxine, 54
Verapamil, 28
Vigabatrin, 67
Vitamin A (Retinol), 131
Vitamin A + D, 131
Vitamin B Complex (Nicotinamide+ Riboflavin +
Thiamine), 132
Vitamin B1, 132
Vitamin B12, 125
Vitamin B6, 131
Vitamin E, 133, 134
Vitamin K1, 134
Voriconazole, 92
W
Warfarin, 30
Water for injection, 128
Wound Dressing Emulsion (Currently Trolamine
[Biafine®]), 156
X
Xylomethazoline Hydrochloride, 145
Z
Zidovudine, 93, 94
Zidovudine+ Lamivudine, 94
Zinc Based Barrier Cream/Ointment, 148
Zuclopenthixol Acetate, 50
Zuclopenthixol Decanoate, 51
Zuclopenthixol Dihydrochloride, 50