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 Formulary Chapter 25: A2 - Borderline (infant feeds,gluten free) - Full Chapter
Notes:
Click to view Infant Feed Formulary Infant Feeding Guidelines and Appropriate Prescribing of Specialist Infant Formula Milk

See GP guide - Oral Nutritional Supplements for guidance on prescribing oral nutritional supplements and food first approach.
Further useful resources can be found here

See Infant Formulae Prescribing in Cow's Milk Protein Allergy (CMPA) 

Cows Milk allergy advice from SASH dietitians

Guide to home challenge for food allergies SASH
 Details...
A2.03.01  Expand sub section  Specialised formulas: Infant and child
 note 

Cow’s Milk Protein Allergy (CMPA) is an adverse reaction to the protein in cow’s milk. Treatment is avoidance of cow’s milk and therefore, in many cases, a specialist infant formula is required for children aged up to 2 years.

To prevent wastage, the need for formula should be reviewed regularly using recent correspondence from Paediatrician / Dietitian (all children with CMPA should be reviewed by a paediatric dietitian to ensure nutritional adequacy).

Soya milk is a 3rd line option, due to glucose damage to teeth and uncertain effect of phytoestrogens.

These guidelines for GPs have been developed in consultation with our local Paediatric Dieticians. They provide an overview of:

The key things to consider when reviewing ongoing prescribing.
Formulae commonly used in cows’ milk protein allergy to help GPs make prescribing decisions on products and quantities.

A2.05  Expand sub section  Feed additives
A2.05.01  Expand sub section  Special additives for conditions of intolerance
A2.06.01  Expand sub section  Gluten-free foods
 note 

Following the national consultation on the availability of gluten-free foods on NHS prescription, the government has decided to restrict prescribing to bread and mixes only. The majority of consultation responses were in favour of this.

This means that Gluten-free foods from the following categories can no longer be prescribed on NHS prescription (or supplied via Gluten-Free Community Pharmacy LCS); biscuits, cereals, cooking aids, grains/flours and pasta.

They were added to the NHS blacklist on 4th Dec 2018.

In response to this and to align our list of products with appropriate prescribing quantities to CCGs in our area, we have approved a list of gluten-free foods for ongoing prescribing/supply via community pharmacy.

Gluten-free foods on prescription or supply via community pharmacy scheme will be limited to 8 units per patient per month from a list of fresh bread/rolls, long life bread and bread mixes as per the following list

Gluten Free Bread/Mix
(As per prescribing list)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Green
Limited to bread and mixes only as per list. Max 8 units per patient per month.
  • Only for those with diagnosis of coeliac disease or dermatitis herpetiformis (ACBS) 
  • Link  Gluten-free bread and mix list for prescribing
    Link  Gluten-free information for patients
       
    A2.06.01  Expand sub section  Bread to top
    A2.06.01  Expand sub section  Loaves
    A2.06.01  Expand sub section  Baguettes, buns and rolls
    A2.06.01  Expand sub section  Speciality breads
    A2.06.01  Expand sub section  Cookies and biscuits
    A2.06.01  Expand sub section  Crackers, crispbreads, and breadsticks to top
    A2.06.01  Expand sub section  Flour mixes and xanthan gu
    A2.06.01  Expand sub section  Flour mixes
    A2.06.01  Expand sub section  Xanthan gum
    A2.06.01  Expand sub section  Pasta
    A2.06.01  Expand sub section  Pizza bases to top
    A2.06.01.01  Expand sub section  Gluten and wheat-free foods
    A2.06.02  Expand sub section  Low-protein foods
    A2.06.02  Expand sub section  Bread
    A2.06.02  Expand sub section  Cake, biscuits, and snacks
    A2.06.02  Expand sub section  Cereals to top
    A2.06.02  Expand sub section  Desserts
    A2.06.02  Expand sub section  Flour mixes and egg substitutes
    A2.06.02  Expand sub section  Pasta
    A2.06.02  Expand sub section  Pizza bases
    A2.06.02  Expand sub section  Savoury meals and mixes to top
    A2.06.02  Expand sub section  Spreads
    A2.07  Expand sub section  Nutritional supplements for metabolic diseases
    A2.07  Expand sub section  Glutaric aciduria (type 1)
    A2.07  Expand sub section  Glucogen storage disease
    A2.07  Expand sub section  Homocystinuria or hypermethioninaemia to top
    A2.07  Expand sub section  Hyperlysinamia
    A2.07  Expand sub section  sovaleric acidaemia
    A2.07  Expand sub section  Maple syrup urine disease
    A2.07  Expand sub section  Methylmalonic or propionic acidaemia
    A2.07  Expand sub section  Other inborn errors of metabolism to top
    A2.07  Expand sub section  Phenylketonuria
    A2.07  Expand sub section  Tyrosinaemia
    A2.07  Expand sub section  Urea cycle disorders (other than arginase deficiency)
     ....
     Non Formulary Items
    Colief

    View adult BNF View SPC online View childrens BNF Track Changes
    Non Formulary Colief is ACBS and should only be prescribed on the NHS for the relief of symptoms associated with lactose intolerance (defined by Drug tarrif)

    Definitions
    1. The Committee has defined proven lactose or sucrose intolerance as "A condition of intolerance to an intake of the relevant disaccharide confirmed by:
    (i) demonstrated clinical benefit of the effectiveness of the disaccharide free diet;
    and
    (ii) the presence of reducing substances and/or excessive acid (1.00pH) in the stools, a low concentration of the correspondent disaccharidase enzyme on intestinal biopsy, or by breath tests or lactose tolerance tests."
    http://www.ppa.org.uk/edt/March_2015/mindex.htm

    It can be purchased from a Community Pharmacy

     
    Fructose

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    VSL#3 (probiotic)

    View adult BNF View SPC online View childrens BNF Track Changes
    Non Formulary
    Black

    OTC Patients should be advised to purchase.

    Previously available to prescribe as approved food supplement on ACBS list for patients with ileoanal pouchitis only.  VSL#3 has now been removed from ACBS recommended list of products and no longer available on NHS prescription.

    Link  PCN 377-2018 (replaces PCN214a-2016) VSL#3 for use in adults for the maintenance of remission of ileoanal pouchitis induced by antibacterials
     
      
    Key
    note Notes
    Section Title Section Title (top level)
    Section Title Section Title (sub level)
    First Choice Item First Choice item
    Non Formulary Item Non Formulary section
    Restricted Drug
    Restricted Drug
    Unlicensed Drug
    Unlicensed
    Track Changes
    Display tracking information
    click to search medicines.org.uk
    Link to adult BNF
    click to search medicines.org.uk
    Link to children's BNF
    click to search medicines.org.uk
    Link to SPCs
    Cytotoxic Drug
    Cytotoxic Drug
    CD
    Controlled Drug
    High Cost Medicine
    High Cost Medicine
    Cancer Drugs Fund
    Cancer Drugs Fund
    NHSE
    NHS England
    Homecare
    Homecare
    CCG
    CCG

    Traffic Light Status Information

    Status Description

    Black

    Comment : Not to be routinely commissioned (prescribed) in any care setting (primary or secondary care). This may be due to a lack of good clinical evidence, cost effectiveness, concerns over safety or due to the availability of more suitable alternatives. As such, drugs classified as Black should be considered as non-formulary.   

    Red

    Initiation : Specialist only
    Repeat Prescribing : Specialist
    Monitoring : Specialist
    Comment : Prescribing must be in line with any specific treatment criteria outlined. In exceptional circumstances a GP may be asked to prescribe the specialist must provide adequate information and support.   

    Amber

    Initiation : Specialist only
    Repeat Prescribing : Primary care OR specialist
    Monitoring : Primary care OR specialist
    Comment : Monitoring according to Effective Shared Care Agreement (ESCA) for stabilised patients only. GP agreement should be requested by specialist and confirmed/declined by GP on a patient-by-patient basis.   

    Blue

    Initiation/Recommendation : Specialist only
    Repeat Prescribing : Primary care
    Monitoring : Primary care
    Comment : Should be initiated or recommended by a specialist. Monitoring of either medicine or disease does not require specialist skills or equipment   

    Green

    Initiation : Primary care or specialist
    Repeat Prescribing : Primary care
    Monitoring : Primary care
    Comment : Suitable for non specialist initiation   

    OTC

    Patients should be advised to purchase if approriate.  

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