netFormulary South East London Joint Medicines Formulary NHS
Guy's and St Thomas' NHS Foundation Trust
Kings College Hospital NHS Foundation Trust
Lewisham and Greenwich NHS Trust
 
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 Formulary Chapter 4: Central nervous system - Full Chapter
Notes:
In this section "SPECIALISTS" refer to medical prescribers specialising in Mental Health unless otherwise stated. At Guy's and St Thomas' and Lewisham Hospitals this would refer to SLAM employed consultants
 Details...
04.01  Expand sub section  Hypnotics and anxiolytics
04.01.01  Expand sub section  Hypnotics
Melatonin m/r tabs (sleep disorders in children - off-label)

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Restricted Drug Restricted
Amber 3
SPECIALIST INITIATION ONLY
Sleep disorders in children (off-label)

Link  SE London APC Shared Care Guidancance for Melatonin for the treatment of Sleep disorders in Children and Adolescents (age 1 - 17 years)    
Melatonin m/r tabs, liquid (adult sleep clinic use - off-label)

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Restricted Drug Restricted
Amber 3
SLEEP DISORDER CENTRE USE ONLY
  • REM sleep behaviour disorder (off-label)
  • Delayed sleep phase disorder (off-label)
  • Free running disorder (off-label)
    The liquid is restricted to use in swallowing difficulties, or in patients on a specific dose that is not practical to be given from the 2mg m/r tabs
  •    
    Venlafaxine m/r tabs (adult sleep clinic use - off-label)

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    Restricted Drug Restricted SLEEP DISORDER CENTRE USE ONLY
    Cataplexy (off-label)
       
    Melatonin tabs (Bio-melatonin brand) (adult sleep clinic use)

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    Restricted Drug Unlicensed
    Red
    SLEEP DISORDER CENTRE USE ONLY
  • Restricted to use in adult circadian rhythm disorders where a more sedative and immediate acting melatonin is required
  •    
    04.01.01  Expand sub section  Benzodiazepines
    Nitrazepam tabs, oral suspension

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    Formulary
       
    Controlled Drug  Temazepam tabs, oral solution

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    Formulary
       
    Loprazolam tabs

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    Formulary
       
    Clonazepam tabs

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    Restricted Drug Restricted
    Amber 2
    SLEEP DISORDER CENTRE USE ONLY
  • Parasomnias (off-label)
  • REM sleep behaviour disorder (off-label)
  •    
    04.01.01  Expand sub section  Zaleplon, Zolpidem and Zopiclone
    Zolpidem tabs (insomnia)

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    Formulary
       
    Zopiclone tabs (insomnia)

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    Formulary
       
    04.01.01  Expand sub section  Chloral and derivatives to top
    Chloral hydrate liquid

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    Restricted Drug Restricted INITIATION BY SPECIALIST ONLY
       
    04.01.01  Expand sub section  Clomethiazole (Chlormethiazole)
    Clomethiazole caps

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    Formulary
       
    04.01.01  Expand sub section  Sodium oxybate
    Controlled Drug  Sodium oxybate oral solution

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    Restricted Drug Restricted
    High Cost Medicine
    Amber 2
    RESTRICTED USE – NAMED SPECIALIST CONSULTANTS AT GSTFT ONLY
    For disabling cataplexy in patients objectively diagnosed with narcolepsy and suffering from cataplexy of severity similar to the entry criteria for the positive US clinical trial.
       
    04.01.02  Expand sub section  Anxiolytics
    04.01.02  Expand sub section  Benzodiazepines
    Chlordiazepoxide caps, tabs

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    Formulary FIRST LINE FOR ACUTE ALCOHOL WITHDRAWAL
    Refer to local guidelines
       
    Diazepam tabs, oral solution, injection, rectal tubes

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    Formulary
       
    Lorazepam tabs, injection

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    Formulary
       
    04.01.02  Expand sub section  Buspirone to top
    Buspirone Hydrochloride tabs

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    Restricted Drug Restricted INITIATION BY SPECIALIST ONLY
       
    04.01.03  Expand sub section  Barbiturates
    04.02  Expand sub section  Drugs used in psychoses and related disorders
    04.02.01  Expand sub section  Antipsychotic Drugs
    Chlorpromazine tabs, syrup

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    Formulary
    Amber 2
       
    Haloperidol caps, tabs, oral liquid, injection

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    Formulary
    Amber 2
       
    Levomepromazine tabs, injection

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    Restricted Drug Restricted
    Amber 2
    INITIATION BY SPECIALIST ONLY
       
    Pimozide tabs

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    Formulary
    Red
       
    Prochlorperazine tabs, injection

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    Formulary
       
    Promazine hydrochloride tabs

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    Formulary
       
    Sulpiride tabs, oral solution

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    Restricted Drug Restricted
    Amber 2
    INITIATION BY SPECIALIST ONLY
       
    Trifluoperazine tabs, caps, oral solution

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    Restricted Drug Restricted
    Amber 2
    INITIATION BY SPECIALIST ONLY
       
    Zuclopenthixol acetate injection

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    Restricted Drug Restricted
    Red
    INITIATION BY SPECIALIST ONLY
       
    Zuclopenthixol dihydrochloride tablets

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    Restricted Drug Restricted
    Amber 2
    INITIATION BY SPECIALIST ONLY
       
    Haloperidol injection

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    Restricted Drug Restricted
    Red
    Approved off-label indication:
    Sedation in the ICU. Restricted to use in accordance with a local critical care guideline
       
    04.02.01  Expand sub section  Second-Generation Antipsychotic Drugs
    Amisulpride tabs, solution

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    Restricted Drug Restricted
    Amber 2
    INITIATION BY SPECIALIST ONLY
       
    Aripiprazole tabs

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    Restricted Drug Restricted
    Amber 2
    INITIATION BY SPECIALIST ONLY

    Link  NICE TA213: Aripiprazole for the treatment of schizophrenia in people aged 15 -17 years
    Link  NICE TA292: Aripiprazole for treating moderate to severe manic episodes in adolescents with bipolar I disorder    
    Clozapine tabs

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    Restricted Drug Restricted
    Red
    INITIATION BY SPECIALIST ONLY

    Link  MHRA Oct 17: Clozapine: reminder of potentially fatal risk of intestinal obstruction, faecal impaction, and paralytic ileus    
    Lurasidone tabs

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    Restricted Drug Restricted
    Red
    INITIATION BY SPECIALIST ONLY
    Restricted to use where a metabolically neutral atypical antipsychotic is required and aripiprazole is not suitable due to contraindication or intolerance

    Link  SEL APC recommendation - Lurasidone for the treatment of schizophrenia in adults aged 18 years and over    
    Olanzapine tabs, orodispersible tabs

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    Restricted Drug Restricted
    Amber 2
    INITIATION BY SPECIALIST ONLY
       
    Quetiapine tabs

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    Restricted Drug Restricted
    Amber 2
    INITIATION BY SPECIALIST ONLY
       
    Risperidone tabs, liquid, orodispersible tabs

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    Restricted Drug Restricted
    Amber 2
    INITIATION BY SPECIALIST ONLY
       
    04.02.02  Expand sub section  Antipsychotic depot injections to top
    Aripiprazole depot injection

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    Restricted Drug Restricted
    Amber 3
    SPECIALIST INITIATION
    GPs may be asked to take on prescribing under a the APC shared care agreement

    Link  SEL APC Shared Care Guidance for Aripiprazole prolonged- release suspension for injection (depot) for the treatment of schizophrenia in adults    
    Flupentixol decanoate injection

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    Restricted Drug Restricted
    Amber 2
    INITIATION BY SPECIALIST ONLY
       
    Fluphenazine decanoate injection

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    Restricted Drug Restricted
    Amber 2
    INITIATION BY SPECIALIST ONLY
       
    Haloperidol deconate injection

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    Restricted Drug Restricted
    Amber 2
    INITIATION BY SPECIALIST ONLY
       
    Paliperidone palmitate injection

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    Restricted Drug Restricted
    Amber 3
    INITIATION BY SPECIALIST ONLY
    GPs may be asked to take on prescribing under the APC shared care agreement for the monthly depot preparation only (Xeplion®)

    Red Traffic Light
    The 3-monthly preparation (Trevicta® - 175mg, 263mg, 350mg and 525mg strengths) is currently for hospital pescribing only

    Link  SE London APC Recommendation: Paliperidone depot injection for schizophrenia in adults
    Link  SE London APC Shared Care Guidance for Paliperidone long-acting injection for the treatment of schizophrenia in adults    
    Pipotiazine palmitate injection

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    Restricted Drug Restricted INITIATION BY SPECIALIST ONLY
       
    Risperidone depot injection

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    Restricted Drug Restricted
    Amber 2
    INITIATION BY SPECIALIST ONLY
       
    Zuclopenthixol decanoate injection

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    Restricted Drug Restricted
    Amber 2
    INITIATION BY SPECIALIST ONLY
       
    04.02.03  Expand sub section  Drugs used for mania and hypomania
    Asenapine tabs

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    Restricted Drug Restricted INITIATION BY SPECIALIST ONLY
       
    04.02.03  Expand sub section  Benzodiazepines
    Clonazepam tabs

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    Restricted Drug Restricted
    Amber 2
    Approved off-label indication:
    Mania (off-label)
    Dose = up to 2mg three times a day, tailored to patient response
    INITIATION BY SPECIALIST ONLY
       
    04.02.03  Expand sub section  Carbamazepine
    Carbamazepine tabs, m/r tabs, liquid (bipolar disorder)

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    Restricted Drug Restricted
    Amber 2
    INITIATION BY SPECIALIST ONLY
       
    04.02.03  Expand sub section  Valproic acid
    Sodium valproate m/r tabs (mood stabiliser)

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    Restricted Drug Restricted
    Amber 2
    Approved off-label indication:
    Mood stabiliser
    Dose = 500mg once daily increasing up to 2.5g daily in divided doses
    INITIATION BY SPECIALIST ONLY

    Communication materials have been provided by the MHRA to discuss the the risk of abnormal pregnancy outcomes with women of childbearing potential and girls. See link below

    Link  MHRA: Valproate and risk of abnormal pregnancy outcomes: new communication materials    
    Valproic acid tablets (as semisodium valproate) (mood stabiliser)

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    Restricted Drug Restricted
    Amber 2
    INITIATION BY SPECIALIST ONLY

    Communication materials have been provided by the MHRA to discuss the the risk of abnormal pregnancy outcomes with women of childbearing potential and girls. See link below

    Link  MHRA: Valproate and risk of abnormal pregnancy outcomes: new communication materials    
    04.02.03  Expand sub section  Lithium to top
    Lithium carbonate m/r tabs

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    Restricted Drug Restricted
    Amber 2
    INITIATION BY SPECIALIST ONLY
       
    Lithium citrate liquid

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    Restricted Drug Restricted
    Amber 2
    INITIATION BY SPECIALIST ONLY
       
    04.03  Expand sub section  Antidepressant drugs
    04.03.01  Expand sub section  Tricyclic and related antidepressant drugs
    04.03.01  Expand sub section  Tricyclic antidepressants
    Amitriptyline tabs, oral soution

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    Formulary
       
    Clomipramine caps

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    Restricted Drug Restricted INITIATION BY SPECIALIST ONLY

    Approved use includes the following off-label indication:
    Panic disorder - use in accordance with NICE CG113

    Link  NICE CG113: Generalised anxiety disorder and panic disorder in adults: management    
    Dosulepin tabs, caps

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    Formulary Red Traffic Light
    for new initiations

    Amber Traffic Light
    for existing patients
       
    Doxepin caps

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    Formulary
       
    Imipramine tabs

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    Formulary INITIATION BY SPECIALIST ONLY

    Approved use includes the following off-label indication:
    Panic disorder - use in accordance with NICE CG113

    Link  NICE CG113: Generalised anxiety disorder and panic disorder in adults: management    
    Lofepramine tabs, oral suspension

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    Formulary
       
    Nortriptyline tabs

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    Formulary
       
    Trimipramine tabs, caps

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    Restricted Drug Restricted INITIATION BY SPECIALIST ONLY
       
    04.03.01  Expand sub section  Related antidepressants
    Trazodone caps

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    Restricted Drug Restricted INITIATION BY SPECIALIST ONLY
       
    04.03.02  Expand sub section  Monoamine-oxidase inhibitors to top
    Phenelzine tabs

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    Restricted Drug Restricted
    Amber 2
    INITIATION BY SPECIALIST ONLY
       
    Tranylcypromine tabs

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    Restricted Drug Restricted
    Amber 2
    INITIATION BY SPECIALIST ONLY
       
    04.03.02  Expand sub section  Reverible MAOIs
    Moclobemide tabs

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    Restricted Drug Restricted INITIATION BY SPECIALIST ONLY
       
    04.03.03  Expand sub section  Selective serotonin re-uptake inhibitors
     note  Refer to MHRA guidance for SSRIs and SNRIs use and safety
    Citalopram tabs, oral drops

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    Formulary
       
    Escitalopram tabs

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    Restricted Drug Restricted INITIATION BY SPECIALIST ONLY
       
    Fluoxetine caps, liquid

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    Formulary
       
    Fluvoxamine tabs

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    Restricted Drug Restricted INITIATION BY SPECIALIST ONLY
       
    Paroxetine tabs, liquid

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    Formulary
       
    Sertraline tabs

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    Formulary
       
    04.03.04  Expand sub section  Other antidepressant drugs
     note  Refer to MHRA guidance for SSRIs and SNRIs use and safety
    Agomelatine tabs

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    Restricted Drug Restricted
    Red
    SPECIALIST PRESCRIBING ONLY
       
    Duloxetine caps

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    Restricted Drug Restricted INITIATION BY SPECIALIST ONLY
       
    Flupentixol tabs

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    Formulary
    Amber 2
       
    Mirtazapine tabs, orodispersible tabs

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    Formulary INITIATION BY SPECIALIST ONLY
       
    Reboxetine tabs

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    Restricted Drug Restricted INITIATION BY SPECIALIST ONLY
       
    Venlafaxine m/r tabs, m/r caps

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    Formulary
       
    Vortioxetine tabs

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    Formulary
    Green

    Link  NICE CG367: Vortioxetine for treating major depressive episodes    
    04.04  Expand sub section  CNS stimulants and other drugs used for attention deficit hyperactivity disorder
    Atomoxetine caps, oral solution

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    Restricted Drug Restricted
    Amber 3
    INITIATION BY SPECIALIST ONLY
    Treatment of ADHD in children and adults

    Refer to links in this section for ADHD shared care documentation
       
    Controlled Drug  Dexamfetamine tabs

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    Restricted Drug Restricted
    Amber 3
    INITIATION BY SPECIALIST ONLY
    Treatment of ADHD in children
    Treatment of ADHD in adults (off-label)

    Refer to links in this section for ADHD shared care documentation

    Link  SEL APC recommendation - Dexamfetamine for the treatment of ADHD in adults    
    Guanfacine m/r tabs

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    Restricted Drug Restricted
    Red
    SPECIALIST PRESCRIBING ONLY
    Restricted to use in ADHD in children where methyphenidate and atomoxetine are not suitable, not tolerated or have been ineffective

    Link  SEL APC Recommendation: Guanfacine for ADHD in children    
    Controlled Drug  Lisdexamfetamine caps

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    Restricted Drug Restricted
    Amber 3
    INITIATION BY SPECIALIST ONLY
    Treatment of ADHD in children and adults

    Refer to links in this section for ADHD shared care documentation

    Link  SEL APC Recommendation - Lisdexamfetamine for the treatment of ADHD in adults
    Link  SEL APC Recommendation - Lisdexamfetamine for the treatment of ADHD in children aged 6 years and over    
    Controlled Drug  Methylphenidate tabs, m/r tabs, m/r caps

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    Restricted Drug Restricted
    Amber 3
    INITIATION BY SPECIALIST ONLY
    Treatment of ADHD in children
    Treatment of ADHD in adults (off-label)

    Refer to links in this section for ADHD shared care documentation

    Extended release formulations to be prescribed by brand, as different formulations are not bioequivalent. Brands available:
  • Concerta
  • Xenidate
  • Matoride
  • Equasym
  • Medikinet
  •    
    Controlled Drug  Dexamfetamine tabs

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    Restricted Drug Restricted
    Red
    SLEEP CENTRE USE ONLY
    Narcolepsy and idiopathic hypersomnia (off-label)

    Restricted to patients who have not responded to modafinil, or where modafinil is contra-indicated

    Link  SEL APC Recommendation: Dexamfetamine for narcolepsy
    Link  SEL APC Recommendation: Methylphenidate and dexamfetamine for idiopathic hypersomnia in adults    
    Controlled Drug  Methylphenidate tabs, m/r tabs, m/r caps

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    Restricted Drug Restricted
    Red
    SLEEP CENTRE USE ONLY
    Narcolepsy and idiopathic hypersomnia (off-label)

    Restricted to patients who have not responded to modafinil, or where modafinil is contra-indicated

    Refer to APC recommendations for detailed information
    Extended release formulations to be prescribed by brand, as different formulations are not bioequivalent. Brands available:
  • Concerta
  • Xenidate
  • Matoride
  • Equasym
  • Medikinet

  • Link  SE London APC Recommendation: Methylphenidate and dexamfetamine idiopathic hypersomnia in adults    
    Modafinil tabs

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    Restricted Drug Restricted
    Amber 3
    INITIATION BY SPECIALIST ONLY
    Symptomatic relief of excessive sleepiness associated with narcolepsy

    Approved off-label indication:
    Idiopathic hypersomnia: Dose = 200 – 400 mg daily.
    Subject to production of a shared care agreement and patient information leaflet
       
    Mazindol tabs

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    Restricted Drug Unlicensed
    Red
    SLEEP CENTRE USE ONLY
    Narcolepsy and idiopathic hypersomnia after failure or intolerance to modafinil and amphetamines. Dose: 1–4mg daily.
    Subject to production of a shared care agreement and patient information leaflet
       
    04.05  Expand sub section  Drugs used in the treatment of obesity to top
    04.05.01  Expand sub section  Anti-obesity drugs acting on the gastro-intestingal tract
    Orlistat caps

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    Restricted Drug Restricted For treatment of obesity: Use in accorandance with NICE guidance (CG189)

    Approved off-label indication (specialist intiation only):
    Type V hypertriglyceridaemia (off-label): Dose = 120 mg three times a day with meals
       
    Orlistat caps

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    Formulary
       
    04.05.02  Expand sub section  Centrally acting appetite suppressants
    04.06  Expand sub section  Drugs used in nausea and vertigo
    04.06  Expand sub section  Antihistamines
    Cinnarizine tabs

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    Formulary
       
    Cyclizine tabs, injection

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    Formulary Follow local guidelines for use in post-operative nausea and vomiting
       
    Promethazine tabs, elixir, injection

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    Formulary
       
    04.06  Expand sub section  Phenothiazines and related drugs to top
    Droperidol injection

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    Formulary
    Red
    Prophylaxis and treatment of postoperative nausea and vomiting in accordance with its marketing authorisation.
       
    Prochlorperazine tabs, buccal tabs, syrup, injection

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    Formulary
       
    04.06  Expand sub section  Domperidone and metoclopramide
    Domperidone tabs, suspension

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    Formulary

    Link  MHRA advice May 2014: Domperidone: risks of cardiac side effects    
    Domperidone tabs, suspension (use as galactagogue - off-label)

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    Formulary
    Red
    Approved off-label indication:
  • Treatment of inadequate lactation
    Dose = 10mg three times a day
  •    
    Metoclopramide tabs, syrup, injection

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    Formulary Daily doses >30 mg and duration >5 days (off-label) may be used for symptom
    control in palliative care patients only

    Link  MHRA advice August 2013: Metoclopramide: risk of neurological adverse effects    
    04.06  Expand sub section  5HT3 antagonists
    Granisetron tabs, injection

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    Restricted Drug Restricted
    Amber 2
       
    Granisetron transdermal patch

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    Restricted Drug Restricted
    Red
    Prevention of nausea and vomiting associated with moderately or highly emetogenic chemotherapy

    Restricted to use where where oral antiemetic administration is complicated by factors making swallowing difficult
       
    Ondansetron tabs, injection

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    Formulary
    Amber 2
       
    04.06  Expand sub section  Neurokinin receptor antagonist
    Aprepitant caps

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    Formulary
    Red
    Approved for:
    Prevention of acute and delayed nausea and vomiting associated with highly emetogenic cisplatinbased cancer chemotherapy

    Prevention of nausea and vomiting associated with moderately emetogenic cancer chemotherapy only for subsequent chemotherapy cycles if the standard antiemetic regimen has failed with the initial chemotherapy cycle.
       
    Aprepitant caps

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    Restricted Drug Restricted
    Red
    Approved off-label indication:
    For the treatment of dihydroergotamine induced nausea where domperidone or 5HT3 antagonists have failed or are inappropriate
    For consultant headache specialist use only as per locally approved protocol
       
    04.06  Expand sub section  Cannabinoid
    Nabilone caps

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    Formulary
    Red
       
    04.06  Expand sub section  Hyoscine to top
    Hyoscine hydrobromide patch

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    Formulary
       
    04.06  Expand sub section  Other drugs for Ménière's disease
    Betahistine dihydrochloride tabs

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    Formulary
       
    04.07  Expand sub section  Analgesics
    04.07.01  Expand sub section  Non-opioid analgesics and compound analgesic preparations
    Aspirin tabs

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    Formulary
       
    Dilofenac sodium tabs, m/r tabs, dispersible tabs, suppositories

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    Formulary

    Link  MHRA Jun 2013: Diclofenac: new contraindications and warnings    
    Ibuprofen tabs, suspension

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    Formulary

    Link  MHRA Jun 2015: High-dose ibuprofen (≥2400mg/day): small increase in cardiovascular risk    
    Nefopam tabs

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    Formulary
       
    Paracetamol injection

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    Formulary Patients weighing less than 50 kg:
  • Max dose = 15 mg/kg
  • Minimum dose interval of 4 hours
  • Maximum daily dose must not exceed 60 mg/kg (without exceeding 3g)

    In severe renal insufficiency (creatinine clearance ≤30 mL/min):
  • Minimum dose interval of 6 hours

    Not to exceed 3g as total daily dose in the following patients:
  • Hepatocellular insufficiency
  • Chronic alcoholism
  • Chronic malnutrition or dehydration

    Short-term treatment of moderate pain and fever when administration by the intravenous route is clinically justified
  •    
    Paracetamol tabs, soluble tabs, oral suspension, suppositories

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    Formulary
       
    04.07.01  Expand sub section  Compound analgesic preparations
    Co-codamol tabs, dispersible tabs (paracetamol and codeine)

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    Formulary Strengths available:
  • Co-codamol 8/500
  • Co-codamol 30/500
  •    
    Co-dydramol 10/500 tabs (paracetamol and dihydrocodeine)

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    Formulary
       
    04.07.02  Expand sub section  Opioid analgesics to top
    Controlled Drug  Morphine salts tabs, m/r tabs, m/r caps, m/r suspension, oral solution, injection

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    First Choice First line strong oral opioid
    Controlled Drug  Oxycodone caps, m/r tabs, liquid, injection

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    Second Choice Second line opioid

    Restricted to use where morphine is not tolerated or contra-indicated
       
    Controlled Drug  Tapentadol m/r tabs

    View adult BNF  View SPC online
    Restricted Drug Restricted
    Amber 1
    INITIATION BY PAIN CONSULTANTS ONLY

    Third-line treatment for the management of severe chronic pain following the treatment failure/intolerance of morphine and one other strong opioid.

    When successfully treated patients are on a stable dose, care can be transferred to the patient’s GP with an accompanying letter explaining the change in chronic pain management.
       


    View adult BNF  View SPC online
    Formulary
       
    Controlled Drug  Alfentanil injection

    View adult BNF  View SPC online
    Formulary USE UNDER SPECIALIST SUPERVISION ONLY
       
    Controlled Drug  Buprenorphine patch (BuTrans®)

    View adult BNF  View SPC online
    Restricted Drug Restricted INITITIATION BY CONSULTANT ONLY
    Second line option for patients with chronic severe pain who:
  • Cannot tolerate large, oral, regular doses of weak opioids or non-opioid + weak opioid combination analgesics
  • Have conditions where use of anti-inflammatory drugs is not recommended or who have not tolerated such drugs
  •    
    Controlled Drug  Buprenorphine sublingual tabs, injection

    View adult BNF  View SPC online
    Formulary
       
    Codeine tabs, injection

    View adult BNF  View SPC online
    Formulary
    Controlled Drug = injection
       
    Controlled Drug  Diamorphine injection

    View adult BNF  View SPC online
    Formulary
       
    Dihydrocodeine m/r tabs

    View adult BNF  View SPC online
    Formulary
       
    Dihydrocodeine tabs, injection

    View adult BNF  View SPC online
    Formulary
    Controlled Drug = injection
       
    Controlled Drug  Fentanyl injection

    View adult BNF  View SPC online
    Formulary USE UNDER SPECIALIST SUPERVISION ONLY
       
    Controlled Drug  Fentanyl patches

    View adult BNF  View SPC online
    Formulary
       
    Controlled Drug  Fentanyl sublingual tabs, buccal tabs and nasal spray

    View adult BNF  View SPC online
    Restricted Drug Restricted PALLIATIVE CARE ONLY
    Management of breakthrough pain in adult patients already receiving maintenance opioid therapy for chronic cancer pain that is unresponsive to morphine sulphate oral solution

    Use in accordance with local guideline
       
    Controlled Drug  Hydromorphone caps

    View adult BNF  View SPC online
    Formulary
       
    Meptazinol tabs, injection

    View adult BNF  View SPC online
    Restricted Drug Restricted PAIN TEAM ONLY
       
    Controlled Drug  Methadone tabs, injection

    View adult BNF  View SPC online
    Restricted Drug Restricted USE UNDER SPECIALIST SUPERVISION ONLY
       
    Controlled Drug  Morphine suppositories

    View adult BNF  View SPC online
    Formulary
       
    Controlled Drug  Papaveretum and hyoscine injection

    View adult BNF  View SPC online
    Formulary
       
    Controlled Drug  Papaveretum injection

    View adult BNF  View SPC online
    Formulary
       
    Controlled Drug  Pethidine tabs, injection

    View adult BNF  View SPC online
    Formulary
       
    Controlled Drug  Tramadol caps, soluble tabs, injection

    View adult BNF  View SPC online
    Formulary m/r preparations are Non-Formulary
       
    Controlled Drug  Morphine 0.1%, 0.2% w/v topical gel

    View adult BNF  View SPC online
    Restricted Drug Unlicensed CONSULTANT SPECIALISTS ONLY

    Use in accordance with local guideline

    Treatment of pain localised to a cutaneous ulceration in a palliative care setting (PIL available on GTi)
       
    04.07.02  Expand sub section  Weak opioids
    04.07.02  Expand sub section  Strong opioids
    04.07.02  Expand sub section  Breakthrough pain
    04.07.02  Expand sub section  Injectable
    04.07.02  Expand sub section  Other to top
    04.07.03  Expand sub section  Neuropathic pain
    Amitriptyline tabs, oral solution

    View adult BNF  View SPC online
    Formulary Use in neuropathic pain is off-label

    Refer to SEL APC neuropathic pain guideline (link below)
       
    Carbamazepine tabs, liquid (neuropathic pain)

    View adult BNF  View SPC online
    Formulary SPECIALIST INITIATION ONLY
  • Use in neuropathic pain is off-label
  • Dose = 100 mg twice daily, increased gradually to a maximum of 200mg three times a day
  •    
    Clonazepam tabs

    View adult BNF  View SPC online
    Formulary Use in neuropathic pain is off-label
    Dose = 0.5mg at night, increased slowly up to 1mg twice daily as per response
       
    Duloxetine caps

    View adult BNF  View SPC online
    Formulary For painful diabetic neuropathy

    Refer to SEL APC neuropathic pain guideline (link below)
       
    Gabapentin caps (pain)

    View adult BNF  View SPC online
    Formulary Green Traffic Light
    Neuropathic pain - refer to SEL APC guideline (link below)

    Red Traffic Light
    Approved off-label indication:
  • Post-operative pain as a short course supplied by the hospital

  • Link  MHRA Oct 17: Gabapentin (Neurontin): risk of severe respiratory depression    
    Imipramine tabs

    View adult BNF  View SPC online
    Formulary Use in neuropathic pain is off-label
    Restricted to use where amitriptyline is not tolerated
  • Dose = 10 mg at night
  • May be increased gradually to 75 mg
  •    
    Nortriptyline tabs

    View adult BNF  View SPC online
    Restricted Drug Restricted Use in neuropathic pain is off label
    Restricted to use where sedation is a significant problem with amitriptyline

    Refer to SEL APC neuropathic pain guideline (link below)
       
    Pregabalin caps (neuropathic pain)

    View adult BNF  View SPC online
    Restricted Drug Restricted Third line choice for neuropathic pain after amitriptyline and gabapentin

    Refer to SEL APC neuropathic pain guideline (link below)
       
    Botulinum toxin type A (Xeomin® - myofascial pain and temporomandibular joint disorder)

    View adult BNF  View SPC online
    Restricted Drug Restricted
    High Cost Medicine
    Red
    Approved off-label indication:
    Myofascial pain in temporomandibular joint disorder:
    Category B* form required

  • Oral and maxillofacial surgery use only
  • Xeomin brand to be used
  • Dose = up to 100 units
  • Restricted to use in patients who fail standard treatments with jaw splints, NSAIDs and jaw exercises

  • Link  SE London APC Recommendation: Botulinum toxin A for myofascial pain syndrome in temporomandibular jaw dysfunction    
    Nabilone caps

    View adult BNF  View SPC online
    Restricted Drug Restricted
    Red
    Approved off-label indication:
    For neuropathic pain in patients who have not responded to all other available anti-neuropathic agents (given alone or in combination) or where use of these has induced unmanageable side effects.
  • Dose: 1 mg twice dialy
  • Some patients may use 1 mg when required 2-3 times per week
    CONSULTANT SPECIALISTS ONLY
  •    
    Clonazepam injection

    View adult BNF  View SPC online
    Restricted Drug Unlicensed Neuropathic pain when systemic administration is required in the Palliative Care setting
       
    04.07.03  Expand sub section  Postherpetic neuralgia
    Capsaicin 0.075% cream

    View adult BNF  View SPC online
    Formulary For localised neuropathic pain or for those who wish to avoid or cannot tolerate oral treatment

    Licensed for post-herpetic neuralgia and diabetic peripheral neuropathy only

    Refer to SEL APC neuropathic pain guideline (link above)
       
    04.07.04  Expand sub section  Antimigraine drugs
    04.07.04.01  Expand sub section  Treatment of the acute migraine attack
    Ibuprofen tabs

    View adult BNF  View SPC online
    Formulary
       
    Paracetamol tabs, soluble tabs

    View adult BNF  View SPC online
    Formulary
       
    Lidocaine infusion

    View adult BNF  View SPC online
    Restricted Drug Restricted
    Red
    Joint Formulary Committee approved off-label use (specialist headache clinic use only):
  • Short-lasting Unilateral Neuralgiform Headache attacks with conjunctival injection and Tearing (SUNCT)
  • Short-lasting Unilateral Neuralgiform Headache attacks with Cranial Autonomic Symptoms (SUNA)
    See dosing protocol from KCH for further information
  •    
    Aspirin injection

    View adult BNF
    Restricted Drug Unlicensed
    Red
    SPECIALIST USE ONLY
    Inpatient management of severe withdrawal headache
    Dose = 1g once to three times daily for up to 4 days
       
    Indometacin injection

    View adult BNF
    Restricted Drug Unlicensed
    Red
    SPECIALIST USE ONLY
    For the diagnosis of indometacin sensitive headaches (paroxysmal hemicranias)
    Dose = 100-200mg intramuscular test dose
       
    04.07.04.01  Expand sub section  5HT1 agonists to top
    Rizatriptan wafers

    View adult BNF  View SPC online
    Formulary
       
    Sumatriptan tabs, injection

    View adult BNF  View SPC online
    Formulary
       
    04.07.04.01  Expand sub section  Ergot alkaloids
    Dihydroergotamine injection

    View adult BNF
    Restricted Drug Unlicensed
    Red
    SPECIALIST USE ONLY
    Inpatient treatment of medical refractory disabling migraine and cluster headaches.

    See dosing protocol from KCH for further information
       
    04.07.04.01  Expand sub section  Anti-emetics
    Metoclopramide tabs

    View adult BNF  View SPC online
    Formulary Maximum daily dose of 30mg for a maximum of 5 days. See MHRA davice.

    Link  MHRA advice August 2013: Metoclopramide: risk of neurological adverse effects    
    Prochlorperazine suppositories

    View adult BNF  View SPC online
    Formulary
       
    04.07.04.02  Expand sub section  Prophylaxis of migraine
    Amitriptyline tabs (migraine prophylaxis - off-label)

    View adult BNF  View SPC online
    Formulary Use for migraine prophylaxis is off-label

    Dose = 10mg at night increasing to 50-75mg at night as per response
       
    Botulinum Toxin Type A (Botox® - migraine)

    View adult BNF  View SPC online
    Restricted Drug Restricted
    High Cost Medicine
    Red
    Approved for use as per resctritions in the NICE guidance for the use of botulinum toxin in chronic migraine

    Link  NICE TA260: Botox for migraine prophylaxis    
    Dosulepin tabs, caps (migraine prophylaxis - off-label)

    View adult BNF  View SPC online
    Formulary Use for migraine prophylaxis is off-label
    Dose = 25 mg at night, increasing if necessary to 75-150mg at night or in divided doses

    Red Traffic Light for new initiations

    Amber Traffic Light for existing patients
       
    Lidocaine injection 2% (chronic headache - off-label)

    View adult BNF  View SPC online
    Restricted Drug Restricted
    Red
    Approved off-label indication (specialist headache clinic use only):
    Greater occipital nerve block for treatment of chronic headache.
  • Restricted to use where oral and other conventional treatments are insufficient or not tolerated.
  • Dose = 3ml (60mg)
  •    
    Methylprednisolone acetate 80mg (Depo-Medrone® - chronic headache)

    View adult BNF  View SPC online
    Restricted Drug Restricted
    Red
    Approved off-label indication (specialist headache clinic use only):
    Greater occipital nerve block for treatment of chronic headache.
  • Restricted to use where oral and other conventional treatments are insufficient or not tolerated.
  • Given in conjunction with with 3ml of lidocaine 2% (i.e. 60mg of lidocaine plus 80mg methylprednisolone acetate)
  •    
    Pizotifen tabs, elixir

    View adult BNF  View SPC online
    Formulary
       
    Propranolol tabs (migraine prophylaxis)

    View adult BNF  View SPC online
    Formulary
       
    Sodium valproate tabs (migraine prophylaxis - off-label)

    View adult BNF  View SPC online
    Formulary
    Amber 2
    USE ON SPECIALIST ADVICE
    Use in migraine prophylaxis is off-label

    Communication materials have been provided by the MHRA to discuss the the risk of abnormal pregnancy outcomes with women of childbearing potential and girls. See link below

    Link  MHRA: Valproate and risk of abnormal pregnancy outcomes: new communication materials    
    Topiramate tabs, sprinkles (migraine prophylaxis)

    View adult BNF  View SPC online
    Formulary
    Amber 2
       
    Methysergide tabs

    View adult BNF  View SPC online
    Formulary REQUIRES HOSPITAL SUPERVISION
       
    04.07.04.03  Expand sub section  Cluster headache
    04.08  Expand sub section  Antiepileptics to top
    04.08.01  Expand sub section  Control of epilepsy
    04.08.01  Expand sub section  Carbamazepine and Oxcarbazepine
    Carbamazepine tabs, m/r tabs, liquid, suppositories (epilepsy)

    View adult BNF  View SPC online
    Formulary
       
    Eslicarbazepine tabs

    View adult BNF  View SPC online
    Formulary
    Amber 3
    USE UNDER SPECIALIST SUPERVISION ONLY
       
    Oxcarbazepine tabs

    View adult BNF  View SPC online
    Formulary
    Amber 2
       
    04.08.01  Expand sub section  Ethosuximide
    Ethosuximide caps, elixir

    View adult BNF  View SPC online
    Formulary
    Amber 2
    USE UNDER SPECIALIST SUPERVISION ONLY
       
    04.08.01  Expand sub section  Gabapentin and pregabalin
    Gabapentin caps (epilepsy)

    View adult BNF  View SPC online
    Formulary
    Amber 2
    USE UNDER SPECIALIST SUPERVISION ONLY

    Link  MHRA Oct 17: Gabapentin (Neurontin): risk of severe respiratory depression    
    Pregabalin caps (epilepsy)

    View adult BNF  View SPC online
    Formulary
    Amber 2
    USE UNDER SPECIALIST SUPERVISION ONLY
       
    04.08.01  Expand sub section  Lacosamide to top
    Lacosamide tabs, syrup, injection

    View adult BNF  View SPC online
    Formulary
    Amber 3
    USE UNDER SPECIALIST SUPERVISION ONLY

    For use in adults:

    First 2 months supply to come from hospital
    GP information sheet requires completion for transfer of prescribing

    Red Traffic Light
    For use in children <16 years (off-label)

    Link  SEL APC Lacosamide GP information sheet    
    04.08.01  Expand sub section  Lamotrigine
    Lamotrigine tabs, disp tabs

    View adult BNF  View SPC online
    Formulary
    Amber 2
    USE UNDER SPECIALIST SUPERVISION ONLY
       
    04.08.01  Expand sub section  Levetiracetam
    Levetiracetam tabs, oral soution, injection

    View adult BNF  View SPC online
    Formulary
    Amber 2
    USE UNDER SPECIALIST SUPERVISION ONLY
       
    04.08.01  Expand sub section  Perampanel
    Perampanel tabs

    View adult BNF  View SPC online
    Formulary
    Amber 3
    SPECIALIST INITIATION ONLY
    First 2 months supply to come from hospital. Transfer of Care documentation requires completion before GP will take over prescribing

    Link  Perampanel Screening Checklist, Notification of Initiation to GP and Transfer of Care / Prescribing Agreement    
    04.08.01  Expand sub section  Phenobarbital and other barbiturates
    Controlled Drug  Phenobarbital tabs, elixir, injection

    View adult BNF  View SPC online
    Formulary USE UNDER SPECIALIST SUPERVISION ONLY
       
    Primidone tabs

    View adult BNF  View SPC online
    Formulary USE UNDER SPECIALIST SUPERVISION ONLY
       
    04.08.01  Expand sub section  Phenytoin to top
    Phenytoin tabs, caps, suspension

    View adult BNF  View SPC online
    Formulary
    Amber 2
       
    04.08.01  Expand sub section  Retigaine
    04.08.01  Expand sub section  Rufinamide
    04.08.01  Expand sub section  Tiagabine
    Tiagabine tabs

    View adult BNF  View SPC online
    Formulary
    Amber 3
    SPECIALIST INITIATION ONLY
    First 2 months supply to come from hospital
    GP information sheet requires completion for transfer of prescribing

    Link  SEL APC Tiagabine GP Information Sheet    
    04.08.01  Expand sub section  Topiramate
    Topiramate tabs, sprinkles (epilepsy)

    View adult BNF  View SPC online
    Formulary
    Amber 2
    USE UNDER SPECIALIST SUPERVISION ONLY
       
    04.08.01  Expand sub section  Valproate to top
    Sodium Valproate tabs, m/r tabs, oral solution, injection (epilepsy)

    View adult BNF  View SPC online
    Formulary
    Amber 2
    Communication materials have been provided by the MHRA to discuss the the risk of abnormal pregnancy outcomes with women of childbearing potential and girls. See link below

    Link  MHRA: Valproate and risk of abnormal pregnancy outcomes: new communication materials    
    04.08.01  Expand sub section  Vigabatrin
    Vigabatrin tabs

    View adult BNF  View SPC online
    Formulary
    Amber 2
    USE UNDER SPECIALIST SUPERVISION ONLY
       
    04.08.01  Expand sub section  Zonisamide
    Zonisamide caps

    View adult BNF  View SPC online
    Formulary
    Amber 3
    SPECIALIST INITIATION ONLY
    GP may take over prescribing responsibility via SEL APC shared care guidance.
    First 2 months supply to come from hospital.

    Link  SEL APC Zonisamide for the treatment of epilepsy in adults    
    04.08.01  Expand sub section  Benzodiazepines
    Clobazam tabs

    View adult BNF  View SPC online
    Formulary
    Amber 2
       
    Clonazepam tabs

    View adult BNF  View SPC online
    Formulary
    Amber 2
       
    04.08.01  Expand sub section  Other Drugs
    Brivaracetam tabs, oral solution

    View adult BNF  View SPC online
    Restricted Drug Restricted
    Amber 3
    Initiation by consultant neurologist only
    Adjunctive third line treatment option for partial-onset seizures with or without secondary generalisation in adults

    Not be used concomitantly with levetiracetam as available evidence suggests there is no additional benefit from use of this combination

    Link  SE London APC recommendation: Brivaracetam for partial onset sesizures in epilepsy    
    04.08.02  Expand sub section  Drugs used in status epilepticus to top
    Diazepam injection, rectal tubes

    View adult BNF  View SPC online
    Formulary
       
    Levetiracetam injection

    View adult BNF  View SPC online
    Formulary Approved off-label indication:
    Status epilepticus
    Restricted to neurology consultant advice only
       
    Lorazepam injection

    View adult BNF  View SPC online
    Formulary The SPC for Ativan® injection supports intravenous and intramuscular use
       
    Controlled Drug  Midazolam buccal liquid

    View adult BNF  View SPC online
    Formulary
    Amber 2
    The first-line product is Buccolam® which is available as 10 mg/2 mL in a pre-filled syringe. The dose for patients 10 years and older is 10mg

    If a more specific dose than those available using Buccolam® pre-filled syringes is required a second-line product, Epistatus® (unlicensed product), is available as 50mg/5mL
       
    Paraldehyde injection (given as an enema)

    View adult BNF  View SPC online
    Formulary
       
    Phenytoin sodium injection

    View adult BNF  View SPC online
    Formulary
       
    04.08.03  Expand sub section  Febrile convulsions
    04.09  Expand sub section  Drugs used in parkinsonism and related disorders
    04.09.01  Expand sub section  Dopaminergic drugs used in Parkinsons disease
    04.09.01  Expand sub section  Dopamine receptor agonists
    Apomorphine injection, infusion

    View adult BNF  View SPC online
    Formulary
    Amber 3
    SPECIALIST INITIATION ONLY

    Link  SE London APC Shared Care Agreement: Apomorphine for Parkinson’s Disease    
    Bromocriptine tabs

    View adult BNF  View SPC online
    Formulary
       
    Cabergoline tabs

    View adult BNF  View SPC online
    Formulary
    Amber 2
    SPECIALIST INITIATION ONLY
       
    Pergolide tabs

    View adult BNF  View SPC online
    Formulary Red Traffic Light
    For all new patients

    Amber Traffic Light
    For existing patients managed in primary care
       
    Pramipexole tabs, m/r tabs (Parkinson's disease)

    View adult BNF  View SPC online
    Formulary
    Amber 2
       
    Ropinirole tabs, m/r tabs (Parkinson's disease)

    View adult BNF  View SPC online
    Formulary
    Amber 2

    Link  SE London APC Recommendation: Ropinirole MR tabs for Parkinson’s Disease    
    Rotigotine patches

    View adult BNF  View SPC online
    Formulary
    Amber 2
    SPECIALIST INITIATION ONLY
    Treatment of the signs and symptoms of early-stage idiopathic Parkinson’s disease as monotherapy (i.e. without levodopa) or in combination with levodopa (i.e.
    over the course of the disease) through to late stages when the effect of levodopa wears off or becomes inconsistent and fluctuations of the therapeutic effect
    occur.

    RESTRICTED TO CONSULTANTS SPECIALISING IN THE TREATMENT OF RESTLESS LEG SYNDROME (RLS):
    Treatment of moderate to severe idiopathic RLS (maximum Dose = 3 mg/24 hours) in adult patients who:
    • Are having distressing symptoms at rest and/or during the day
    • Have not achieved meaningful benefit on previous dopamine agonist
    • Have demonstrated augmentation of symptoms due to previous agonist treatment

    Refer to RLS pathway below
       
    04.09.01  Expand sub section  Levodopa to top
    Co-beneldopa caps, disp tabs, m/r caps

    View adult BNF  View SPC online
    Formulary
       
    Co-careldopa and Entacapone tabs

    View adult BNF  View SPC online
    Formulary
    Amber 2
       
    Co-careldopa intestinal gel (Duodopa®)

    View adult BNF  View SPC online
    Formulary
    High Cost Medicine
    Red
    RESTRICTED USE - ALL REFERRALS FOR PRESCRIBING SHOULD BE MADE TO
    PROFESSOR RAY CHAUDHURI AT KCH

    Treatment of advanced levodopa responsive Parkinson’s disease in patients with severe motor fluctuations and hyper-/dyskinesia when available combinations of Parkinson medicinal products have not given satisfactory results.

    Refer to NHSE commissioning criteria

    Blueteq prior approval required

    Link  NHS England Commissioning position on levodopa/carbidopa intestinal gel (DO4/P/e) (July 2015)    
    Co-careldopa tabs, m/r tabs

    View adult BNF  View SPC online
    Formulary
       
    04.09.01  Expand sub section  Monoamine-oxidase-B inhibitors
    Rasagiline tabs

    View adult BNF  View SPC online
    Formulary
    Amber 2
    INITIATION BY SPECIALIST ONLY
    Treatment for early Parkinson’s disease. To be used as monotherapy and gradually withdrawn when more symptomatic treatments are required. Not to be used in combination with levodopa
       
    Selegiline hydrochloride tabs, liquid

    View adult BNF  View SPC online
    Formulary
    Amber 2
    SPECIALIST INITIATION ONLY
       
    04.09.01  Expand sub section  Catachol-O-methyltransferase inhibitors
    Entacapone tabs

    View adult BNF  View SPC online
    Formulary
    Amber 2
       
    04.09.01  Expand sub section  Amantadine
    Amantadine caps, syrup

    View adult BNF  View SPC online
    Formulary
    Amber 2
    Approved for use in:
  • Parkinson's Disease
  • Fatigue in Multiple Sclerosis (off-label) as per NICE Clinical Guideline 186. Dose as per licensed use.

    Not approved for use in influenza
    (see NICE TA168)

  • Link  NICE CG186: Multiple sclerosis in adults: management    
    04.09.01  Expand sub section  Mild to moderate dementia in Parkinsons disease
    04.09.02  Expand sub section  Antimuscarinic drugs used in parkinsonism to top
    Benzatropine injection

    View adult BNF  View SPC online
    Formulary
       
    Orphenadrine tabs

    View adult BNF  View SPC online
    Formulary
       
    Procyclidine tabs, syrup, injection

    View adult BNF  View SPC online
    Formulary
       
    Trihexyphenidyl (benzhexol) tabs

    View adult BNF  View SPC online
    Formulary
       
    04.09.03  Expand sub section  Drugs used in essential tremor, chorea, tics, and related disorders
    Haloperidol tabs

    View adult BNF  View SPC online
    Formulary
    Amber 2
       
    Riluzole tabs

    View adult BNF  View SPC online
    Formulary
    High Cost Medicine

    Link  NICE TA20: Guidance on the use of Riluzole (Rilutek) for the treatment of Motor Neurone Disease    
    Tetrabenazine tabs

    View adult BNF  View SPC online
    Formulary
    Red
       
    04.09.03  Expand sub section  Torsion dystonias and other involuntary movements
    Botulinum Toxin Type A (Botox® Xeomin® Dysport®)

    View adult BNF  View SPC online
    Formulary
    High Cost Medicine
    Red
    To be prescribed by brand, as different preparations are not dose equivalent
       
    Botulinum Toxin Type B (NeuroBloc®)

    View adult BNF  View SPC online
    Formulary
    High Cost Medicine
    Red
    For use as an alternative to Botulinum toxin A in the presence of antibodies to Botulinum toxin A

    Category B* form required

    Link  MHRA March 2013: Botulinum toxin type B (Neurobloc): serious known risks    
    04.09.04  Expand sub section  Restless legs syndrome
     note 
    Pramipexole tabs (restless legs syndrome)

    View adult BNF  View SPC online
    First Choice
    Amber 2
    Immediate release preparation only
    Ropinirole tabs (restless legs syndrome)

    View adult BNF  View SPC online
    First Choice
    Amber 2
    Immediate release preparation only
    Gabapentin caps (restless legs syndrome)

    View adult BNF  View SPC online
    Second Choice
    Amber 2
    Approved for use in restless legs syndrome (off-label) with the following restrictions:
  • Specialist neurologist or sleep centre use only
  • In patients intolerant to dopamine agonists, or who have a history of insomnia or compulsive behaviours
  • Dose = 300 mg to 1200 mg at night
    Refer to SE London treatment pathway below

  • Link  MHRA Oct 17: Gabapentin (Neurontin): risk of severe respiratory depression
    Link  SE London APC Recommendation: Gabapentin and Pregabalin for Restless Legs Syndrome    
    Pregabalin caps (restless legs syndrome)

    View adult BNF  View SPC online
    Second Choice
    Amber 2
    Approved for use in restless legs syndrome (off-label) with the following restrictions:
  • Specialist neurologist or sleep centre use only
  • In patients intolerant to dopamine agonists, or who have a history of insomnia or compulsive behaviours
  • Reserved for patients intolerant to gabapentin for this indication
  • Dose = 25 mg to 300 mg at night
    Refer to SE London treatment pathway below

  • Link  SE London APC Recommendation: Gabapentin and Pregabalin for Restless Legs Syndrome    
    Rotigotine patches (restless legs syndrome)

    View adult BNF  View SPC online
    Second Choice
    Amber 2
    Restricted to use in restless legs syndrome in patients where who have experiences augmentation of symptoms with oral dopamine agonists or where there is a predominant presence of daytime symptoms
       
    Clonazepam tabs (restless legs syndrome)

    View adult BNF  View SPC online
    Third Choice
    Amber 2
    Approved for use in restless legs syndrome (off-label) with the following restrictions:
  • Specialist neurologist or sleep centre use only
  • Refractory cases where dopamine agonists and gabapentin/pregabalin have failed, and insomnia is a significant symptom
  • Dose = 0.25mg to 4mg at night
    Refer to SE London treatment pathway below

  • Link  SE London APC Recommendation: Hypnotics for Restless Legs Syndrome    
    Zolpidem tabs (restless legs syndrome)

    View adult BNF  View SPC online
    Third Choice
    Amber 2
    Approved for use in restless legs syndrome (off-label) with the following restrictions:
  • Specialist neurologist or sleep centre use only
  • Refractory cases where dopamine agonists and gabapentin/pregabalin have failed, and insomnia is a significant symptom
  • Dose = 5mg to 10 mg at night
    Refer to SE London treatment pathway below

  • Link  SE London APC Recommendation: Hypnotics for Restless Legs Syndrome    
    Zopiclone tabs (restless legs syndrome)

    View adult BNF  View SPC online
    Third Choice
    Amber 2
    Approved for use in restless legs syndrome (off-label) with the following restrictions:
  • Specialist neurologist or sleep centre use only
  • Refractory cases where dopamine agonists and gabapentin/pregabalin have failed, and insomnia is a significant symptom
  • Dose = 3.75mg to 15mg at might
    Refer to SE London treatment pathway below

  • Link  SE London APC Recommendation: Hypnotics for Restless Legs Syndrome    
    Codeine tabs (restless legs syndrome)

    View adult BNF  View SPC online
    Third Choice
    Amber 2
    Approved for use in restless legs syndrome (off-label) with the following restrictions:
  • Specialist neurologist or sleep centre use only
  • Refractory cases where dopamine agonists and gabapentin/pregabalin have failed and pain is a significant symptom
  • Dose = 30 mg to 90 mg at night
    Refer to SE London treatment pathway below

  • Link  SE London APC Recommendation: Opioids for Restless Legs Syndrome    
    Tramadol caps (restless legs syndrome)

    View adult BNF  View SPC online
    Third Choice
    Amber 2
    Approved for use in restless legs syndrome (off-label) with the following restrictions:
  • Specialist neurologist or sleep centre use only
  • Refractory cases where dopamine agonists and gabapentin/pregabalin have failed and pain is a significant symptom
  • Dose = 50 to 200mg nocte
    Refer to SE London treatment pathway below

  • Link  SE London APC Recommendation: Opioids for Restless Legs Syndrome    
    Oxycodone/naloxone SR tabs (Targinact® - restless legs)

    View adult BNF  View SPC online
    Third Choice
    Amber 2
    Approved for use in restless legs syndrome (off-label) with the following restrictions:
  • Specialist neurologist or sleep centre use only
  • Refractory cases where dopamine agonists and gabapentin/pregabalin have failed and pain is a significant symptom
  • Reserved for patients who have failed to tolerate other opioids for management of pain in restless legs syndrome
  • Dose = 5mg/2.5mg to 60mg/30mg twice daily
    Refer to SE London treatment pathway below

  • Link  SE London APC Recommendation: Opioids for Restless Legs Syndrome    
    04.10  Expand sub section  Drugs used in substance dependence
    04.10.01  Expand sub section  Alcohol dependence to top
    Acamprosate tabs

    View adult BNF  View SPC online
    Formulary
    Amber 3
       
    Disulfiram tabs

    View adult BNF  View SPC online
    Formulary
    Amber 2
    SPECIALIST INITIATION ONLY
       
    Nalmefene tabs

    View adult BNF  View SPC online
    Restricted Drug Restricted
    Red
    INITIATION BY SUBSTANCE MISUSE SPECIALISTS ONLY
    Use in accordance with NICE guidance for reducing alcohol consumption in people with alcohol dependence. Nalmefene should only be prescribed in conjunction with continuous psychosocial support focused on treatment adherence and reducing alcohol consumption.

    Patients requiring treatment with nalmefene should be referred to their local drug and alcohol services

    Link  NICE TA325: Nalmefene for reducing alcohol consumption in people with alcohol dependence    
    Alcohol infusion

    Restricted Drug Restricted
    Red
    RESTRICTED USE
    Acute alcohol withdrawal in patients unable to take chlordiazepoxide.

    Dose = 30 mL of 90% alcohol injection in 500 mL 5% dextrose solution, over a 24 hour period
       
    04.10.02  Expand sub section  Nicotine dependence
    Nicotine Replacement Therapy

    View adult BNF  View SPC online
    Formulary Products available:
  • Nicotinell® patches
  • Nicorette® invisi patches
  • Sublingual tablet
  • Orodispersible film
  • Lozenge
  • Medicated chewing gum
  • Spray
  • Inhalator
    Follow local guidelines for nicotine replacement therapy
  •    
    Varenicline tabs

    View adult BNF  View SPC online
    Formulary

    Link  NICE TA123: Varenicline    
    04.10.03  Expand sub section  Opioid dependence
    04.10.03  Expand sub section  Opioid substitution therapy
    Controlled Drug  Buprenorphine and Naloxone sublingual tabs

    View adult BNF  View SPC online
    Restricted Drug Restricted SLAM ONLY
       
    Controlled Drug  Buprenorphine sublingual tabs

    View adult BNF  View SPC online
    Formulary
       
    Controlled Drug  Methadone hydrochloride oral solution

    View adult BNF  View SPC online
    Formulary
       
    04.10.03  Expand sub section  Adjunctive therapy and symptomatic treatment
    Lofexidine tabs

    View adult BNF  View SPC online
    Formulary
    Red
       
    04.10.03  Expand sub section  Opioid-receptor antagonists to top
    Naltrexone tabs

    View adult BNF  View SPC online
    Formulary

    Link  NICE TA115: Naltrexone for the management of opioid dependence    
    04.11  Expand sub section  Drugs for dementia
    Donepezil tabs

    View adult BNF  View SPC online
    First Choice
    Amber 3
    Rivastigmine caps, oral solution, patches

    View adult BNF  View SPC online
    Second Choice
    Amber 3
    Mild to moderate dementia in Alzheimer’s disease, in patients that are intolerant to, or do not have a sustained response to, donepezil
       
    Galantamine tabs, m/r tabs, oral solution

    View adult BNF  View SPC online
    Third Choice
    Amber 3
       
    Memantine tabs, oral solution

    View adult BNF  View SPC online
    Formulary
    Amber 3
       
    Memantine tabs, oral solution

    View adult BNF  View SPC online
    Formulary
    Red
    Approved off-label indication:
    Management of behavioural and psychological symptoms in dementia, when nonpharmacological interventions have failed and there is severe distress or risk of harm to the patient or others

    Restricted to Consultant Clinical Gerontologists with a special interest in dementia, Consultants in Mental Health for Older Adults and Consultants in Liaison Psychiatry – prescribing to be continued by consultant
       
    04.12  Expand sub section  Miscellaneous preparations
    3,4 Diaminopyridine tabs

    Restricted Drug Unlicensed Congenital myaesthenia, Eaton- Lamberts myaesthenic syndrome, multiple sclerosis
       
    Fluorescein sodium injection 10%

    Restricted Drug Unlicensed For the visualisation of cerebrospinal fluid rhinorrhoea following endoscopic skull base surgery. Maximum dose: 50mg

    only Martindale brand has QA approval for this intrathecal administration
       
     ....
    Key
    note Notes First Choice Item First Choice item
    Section Title Section Title (top level) Non Formulary Item Non Formulary section
    Section Title Section Title (sub level)
    Cytotoxic Drug
    Cytotoxic Drug
    Restricted Drug
    Restricted Drug
    CD
    Controlled Drug
    Unlicensed Drug
    Unlicensed
    High Cost Medicine
    High Cost Medicine
    click to search medicines.org.uk
    Link to SPCs
    click to search medicines.org.uk
    Link to adult BNF
    Track Changes
    Display tracking information
    click to search medicines.org.uk
    Cancer Drugs Fund
    Cancer Drugs Fund
       

     

    Traffic Light Status Information

    Status Description
      Red   Specialist Prescribing only. The responsibility for prescribing, monitoring, dose adjustment and review should remain with the specialist. In very exceptional circumstances a specialist may discuss individual patient need for a RED drug to be prescribed by a GP and the GP should consider informing the Medicines Management team before a decision is made to prescribe for individual patients.   
      Amber 1   Treatment can be initiated in primary care after a recommendation from an appropriate specialist  
      Amber 2   Specialist initiation followed by maintenance prescribing in primary care  
      Amber 3   Specialist initiation with ongoing monitoring required. After dose stabilisation GPs can be requested to take over prescribing responsibilities using the approved APC shared care documentation  
      Green   Specialist and non-specialist initiation  
      Grey   Not recommended for prescribing  

    netFormulary