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...
04.04  Expand sub section  CNS stimulants and other drugs used for attention deficit hyperactivity disorder or sleep disorders
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 (ADHD)
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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 (ADHD)
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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

Note: extended release formulations to be prescribed by brand, as different formulations are not bioequivalent. Patients should remain on the same m/r brand they are initiated on. 

m/r brands available:

  • Concerta XL
  • Xenidate XL
  • Matoride XL
  • Delmosart
  • Xaggitin XL 
  • Equasym XL (caps)
  • Medikinet XL (caps)
 
   
Clomipramine caps (cataplexy - off-label)
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Formulary
Amber 3

Approved off-label indication:

  • Cataplexy

Sleep centre initiation only

Refer to SE London APC recommendation (link below), shared care agreement and cataplexy treatment pathway (link at end of section) for futher information

 
Link  SE London APC recommendation: Specific antidepressants (clomipramine and fluoxetine) for the management of cataplexy associated with narcolepsy
   
Controlled Drug Dexamfetamine tabs (sleep centre indications)
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Restricted Drug Restricted
Amber 3

Approved for:

  • Narcolepsy
  • Idiopathic hypersomnia (off-label)

Sleep centre initiation only

GPs can be asked to continue prescribing after 6 months treatment as per SE London shared care agreement (link at end of section)

Restricted to patients who have not responded to modafinil, or where modafinil is contra-indicated.  Refer to SE London APC narcolepsy treatment pathway and shared care agreement (link below)

 
   
Fluoxetine caps (cataplexy - off-label)
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Formulary
Amber 3

Approved off-label indication:

  • Cataplexy

Sleep centre initiation only

Refer to SE London APC recommendation (link below), shared care agreement and cataplexy treatment pathway (link at end of section) for futher information

 
Link  SE London APC recommendation: Specific antidepressants (clomipramine and fluoxetine) for the management of cataplexy associated with narcolepsy
   
Controlled Drug Methylphenidate tabs, m/r tabs, m/r caps (sleep centre use - off-label)
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Restricted Drug Restricted
Amber 3

Approved off-label indications:

  • Narcolepsy
  • Idiopathic hypersomnia

Sleep centre initiation only

GPs can be asked to continue prescribing after 6 months treatment as per SE London shared care agreement (link at end of section)

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

Refer to SE London APC narcolepsy treatment pathway (link below) for detailed information

Extended release formulations to be prescribed by brand, as different formulations are not bioequivalent. Brands available:

  • Concerta XL
  • Xenidate XL
  • Matoride XL
  • Delmosart
  • Xaggitin XL 
  • Equasym XL (caps)
  • Medikinet XL (caps)
 
   
Modafinil tabs
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Restricted Drug Restricted
Amber 3

Sleep centre initiation only

Symptomatic relief of excessive sleepiness associated with narcolepsy

Approved off-label indication:

Idiopathic hypersomnia: Dose = 200 – 400 mg daily.

Refer to APC recommendation, shared care agreement and treatment pathway for further information (links below)

 
   
Pitolisant tablets
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Restricted Drug Restricted
Red

Sleep centre use only

  • Approved for use in narcolepsy, with or with cataplexy in adults
  • Restricted to use as a last line treatment where modafinil and dexamfetamine or methylphenidate have failed to improve symptoms.

See APC recommendation for further information

 
Link  SE London APC recommendation: Pitolisant hydrochloride for the treatment of narcolepsy with or without cataplexy in adults
   
Venlafaxine m/r tabs (adult sleep clinic use - off-label)
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Restricted Drug Restricted
Amber 3

Approved off-label indication:

  • Cataplexy

Sleep centre initiation only

Refer to SE London APC shared care agreement and cataplexy treatment pathway (links nelow) for futher information

 
   
Mazindol tabs
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Unlicensed 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

 
   
 ....
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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