Clinical Guidelines

Prescribing guidelines and recommendations are approved and ratified by the Joint Area Prescribing Committee.

Members include primary and secondary care clinicians, representatives from commissioner and provider organisations and other stakeholders, working together to develop a consistent health community approach to medicines management.

This committee has a wide remit around formular management and clinical guidelines, but also considers the implementation of NICE guidance and manages the introduction of medicines and some prescribable medical devices across a health economy.

The Derbyshire JAPC have developed an abridged version of the most commonly prescribed formulary medicines in primary care:

Prescribing medicines in renal impairment (MHRA October 2019)

  • For most drugs and for most adult patients of average build and height, estimated Glomerular Filtration Rate (eGFR) should be used to determine dosage adjustments
  • Creatinine clearance (CrCl) should be calculated using the Cockcroft-Gault formula (see below) to determine doage adjustments for:
           - direct-acting oral anticoagulants (DOACs)
           - patients taking nephrotoxic drugs (e.g. vancomycin and amphotericin B)
           - elderly patients (ages 75 years and older)
           - patients at extremes of muscle mass (BMI <18kg/m2 or >40kg/m2)
           - patients taking medicines that are largely renally excreted and have a narrow therapeutic index e.g. digoxin and sotalol
  • When dose adjustments based on CrCl is important and no advice is provided in the relevant BNF monograph, consult the Summary of Product Characteristics
  • Reassess renal function and drug dosing in situations where eGFR and/or CrCL change rapidly e.g. acute kidney injury (AKI)

BNF Chapters & prescribing guidelines

In this section you will find the full formulary and prescribing guidelines relevant to the BNF Chapters.

BNF Chapter Appendices

Derby and Derbyshire CCG

Derby and Derbyshire CCG

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