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:

Where a formulary entry does not detail a medicine’s indications for use, the medicine can be assumed to be approved for all licensed indications.

Formulary approved "off-label" use is detailed separately.

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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Formulary
Amber 2

Approved off-label indications:

  • REM sleep behaviour disorder (usual dose 0.5 mg to 16 mg nocte)
  • Non-REM parasomnia (usual dose 0.5 mg to 6 mg nocte)
  • Delayed sleep phase disorder (usual dose 0.5 mg nocte)
  • Non-24 hours sleep-wake disorder (free running disorder) (usual dose 0.5 mg nocte)

Sleep centre initiation only

Refer to APC guidance and pathways (links below) for further information

The liquid (unlicensed preparation) 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

 
Link  SE London APC recommendation: Specific agents for non-REM parasomnia in adults
   
Pramipexole tabs (REM behaviour disorder - off-label)
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Formulary
Amber 2

Approved off-label indication:

  • REM behaviour disorder in adults

Usual dose = 88 micrograms to 540 micrograms nocte

Sleep centre initiation only

Refer to SE London APC recommendation and pathway (links below) for further detail

 
Link  SE London APC recommendation: Specific agents for REM behaviour disorder in adults
   
Rotigotine patch (REM behaviour disorder - off-label)
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Formulary
Amber 2

Approved off-label indication:

  • REM behaviour disorder in adults

Usual dose = 1 mg - 3 mg /24hr patch daily

Sleep centre initiation only

Refer to SE London APC recommendation and pathway (links below) for further detail

 
Link  SE London APC recommendation: Specific agents for REM behaviour disorder in adults
   
Donepezil tabs (REM behaviour disorder - off-label)
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Formulary
Amber 2

Approved off-label indication:

  • REM behaviour disorder in adults

Usual dose = 5 mg to 10 mg nocte

Sleep centre initiation only

Refer to SE London APC recommendation and pathway (links below) for further detail

 
Link  SE London APC recommendation: Specific agents for REM behaviour disorder in adults
   
Agomelatine tabs (REM behaviour disorder - off-label)
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Formulary
Red

Approved off-label indication:

  • REM behaviour disorder in adults (as a last line option where all other treatments have failed)

Usual dose = 25 mg to 50 mg nocte

Sleep centre prescribing use only

Refer to SE London APC recommendation and REM behaviour disorder pathway (links below) for further information

 
Link  SE London APC reocmmendation: Sodium oxybate and agomelatine as last line options for the management of REM behaviour disorder in adults
   
Clomipramine caps (Non-REM parasomnia - off-label)
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Formulary
Amber 2

Approved off-label indication:

  • Non-REM parasomnia in adults

Usual dose = 10 mg to 75 mg nocte

Sleep centre initiation only

Refer to SE London APC recommendation and pathway (links below) for further detail

 
Link  SE London APC recommendation: Specific agents for non-REM parasomnia in adults
   
Fluoxetine caps (Non-REM parasomnia - off-label)
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Formulary
Amber 2

Approved off-label indication:

  • Non-REM parasomniain adults

Usual dose = 20 mg to 60 mg daily

Sleep centre initiation only

Refer to SE London APC recommendation and pathway (links below) for further detail

 
Link  SE London APC recommendation: Specific agents for non-REM parasomnia in adults
   
Imipramine tabs (Non-REM parasomnia - off-label)
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Formulary
Amber 2

Approved off-label indication:

  • Non-REM parasomnia in adults

Usual dose = 50 mg to 300 mg nocte

Sleep centre initiation only

Refer to SE London APC recommendation and pathway (links below) for further detail

 
Link  SE London APC recommendation: Specific agents for non-REM parasomnia in adults
   
Sertraline tabs (Non-REM parasomnia - off-label)
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Formulary
Amber 2

Approved off-label indication:

  • Non-REM parasomniain adults

Usual dose = 25 mg to 150 mg daily

Sleep centre initiation only

Refer to SE London APC recommendation and pathway (links below) for further detail

 
Link  SE London APC recommendation: Specific agents for non-REM parasomnia in adults
   
Melatonin tabs (Bio-melatonin brand) (adult sleep clinic use)
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Unlicensed 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

Refer to APC guidance and pathways (links below) for further information

 
   
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 (Sleep centre use - off-label)
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Formulary
Amber 2

Approved off-label indications:

  • Non-REM parasomnia
  • REM sleep behaviour disorder

Usual dose = 0.25 mg to 4 mg nocte

Sleep centre initiation only

Refer to APC recommendation (link below) and pathways (links above)

 
Link  SE London APC recommendation: Specific agents for non-REM parasomnia in adults
   
Diazepam tabs (Sleep centre use - off-label)
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Formulary
Amber 2

Approved off-label indication:

  • REM behaviour disorder in adults
  • Non-REM parasomnia in adults

Usual dose = 2 mg to 10 mg nocte

Sleep centre initiation only

Refer to SE London APC recommendations (links below) and pathways (links above) for further detail

 
Link  SE London APC recommendation: Specific agents for non-REM parasomnia in adults
Link  SE London APC recommendation: Specific agents for REM behaviour disorder in adults
   
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  
   
Zopiclone tabs (Sleep centre use - off-label)
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Formulary
Amber 2

Approved off-label indication:

  • REM behaviour disorder in adults
  • Non-REM parasomnia in adults

Usual dose = 3.75 mg to 15 mg nocte

Sleep centre initiation only

Refer to SE London APC recommendations (links below) and pathways (links above) for further detail

 
Link  SE London APC recommendation: Specific agents for non-REM parasomnia in adults
Link  SE London APC recommendation: Specific agents for REM behaviour disorder in adults
   
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 (cataplexy)
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Restricted Drug Restricted
Amber 3
High Cost Medicine

Sleep centre initiation use only

For disabling cataplexy in patients objectively diagnosed with narcolepsy

Refer to SE London Shared Care agreement for further information (link below)

 
Link  SE London APC Shared Care Agreement: Management of Narcolepsy (+/- Cataplexy) and Idiopathic Hypersomnia in adults
   
Controlled Drug Sodium oxybate oral solution (REM behaviour disorder - off-label)
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Restricted Drug Restricted
Red
High Cost Medicine

Approved off-label indication:

  • REM behaviour disorder in adults (as a last line option where all other treatments have failed)

Usual dose = 4.5 g to 9 g nocte in 2 divided doses

Sleep centre prescribing use only

Refer to SE London APC recommendation (link below) and REM behaviour disorder pathway (link above) for further information

 
Link  SE London APC recommendation: Sodium oxybate and agomelatine as last line options for the management of REM behaviour disorder in adults
   
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
 ....
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 SPCs
SMC
Scottish Medicines Consortium
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

Red

Specialist or hospital prescribing only. The responsibility for prescribing, monitoring, dose adjustment and review should remain with the specialist or hospital. 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  

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