On this page you will find information, links and resources around prescribing special order medicines.

Medicines are not always available in formulations that are suitable for patients with swallowing difficulties or for patients with enteral feeding tubes. The alteration of medication formulations may therefore be necessary, such as crushing tablets or prescribing a ‘special’ liquid formulation.

Our Specials Guidance provides information on available licensed formulations, suggests options for treatment within a drug class, or advises where tablets may be crushed, or capsules opened.

Whilst there is some information with regard to administration via feeding tubes, prescribers are advised to contact the CCG Medicines Management team for full details if administration via a feeding tube is necessary.

Licensed or Unlicensed?

Any alteration in the formulation of a medicine means that the medicine is used outside its product licence. The manufacturer of the product is no longer responsible for any adverse event or treatment failure. Instead, professionals responsible for prescribing, supplying and administering the drugs, become liable for any adverse event that the patient may experience.

Medications should only be given in an unlicensed manner when a licensed alternative is not available. Licensed routes of administration should be sought first.

When prescribing alternatives (licensed/unlicensed) it is important to consider:

  • Dose adjustments that need to be made with alternative liquid/ injection preparations.
  • Full dose directions need to be included on the prescription (if applicable) g. ’take one tablet, disperse in water and take once in the morning’.

Somerset Specials Guidance

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Disclaimer: This document is intended as a guide only - it is subject to clinical interpretation and judgement on an individual basis and the specific needs and best interests of the individual patient should be considered. It contains a list of commonly prescribed medicines and alternative methods of administration for patients with swallowing difficulties, feeding tubes or for patients prescribed unlicensed ‘specials’ medication. It considers alternative medicines, formulations, cost, and licensing. The list of medicines is not exhaustive. Prices of medicines may fluctuate.
It is advised that while every effort will be made to keep the information in this document current and correct, errors may have occurred and data for individual drugs may have changed. Where there is any doubt or if further information is needed – prescribers should check the manufacturers’ recommendations, published literature or other specialist sources e.g. NEWT Guidelines, Handbook of Drug Administration via Enteral Feeding Tubes.

Specialist Pharmacy Service Useful Links

The Specialist Pharmacy Service (SPS) has produced a number of useful resources on using medicines safely and effectively in patients with swallowing difficulties

Dermatology Special Medicines

Dermatology prescribing may rely significantly on unlicensed creams and ointments. The British Association of Dermatologists (BAD) has produced a list of preferred specials.

Use of Special Order Medicines in Children

Before accepting a request for prescribing (including specials) from secondary care, a prescriber should consider if the condition is suitable for taking on in primary care, for example complex paediatrics under the care of a consultant.