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...
04.07.02  Expand sub section  Opioid analgesics
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

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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.
   


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Formulary
   
Controlled Drug  Alfentanil injection

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Formulary USE UNDER SPECIALIST SUPERVISION ONLY
   
Controlled Drug  Buprenorphine patch (BuTrans®)

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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

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    Formulary
       
    Codeine tabs, injection

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    Formulary
    Controlled Drug = injection
       
    Controlled Drug  Diamorphine injection

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    Formulary
       
    Dihydrocodeine m/r tabs

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    Formulary
       
    Dihydrocodeine tabs, injection

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    Formulary
    Controlled Drug = injection
       
    Controlled Drug  Fentanyl injection

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    Formulary USE UNDER SPECIALIST SUPERVISION ONLY
       
    Controlled Drug  Fentanyl patches

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    Formulary
       
    Controlled Drug  Fentanyl sublingual tabs, buccal tabs and nasal spray

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    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

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    Formulary
       
    Meptazinol tabs, injection

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    Restricted Drug Restricted PAIN TEAM ONLY
       
    Controlled Drug  Methadone tabs, injection

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    Restricted Drug Restricted USE UNDER SPECIALIST SUPERVISION ONLY
       
    Controlled Drug  Morphine suppositories

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    Formulary
       
    Controlled Drug  Papaveretum and hyoscine injection

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    Formulary
       
    Controlled Drug  Papaveretum injection

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    Formulary
       
    Controlled Drug  Pethidine tabs, injection

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    Formulary
       
    Controlled Drug  Tramadol caps, soluble tabs, injection

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    Formulary m/r preparations are Non-Formulary
       
    Controlled Drug  Morphine 0.1%, 0.2% w/v topical gel

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    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 to top
    04.07.02  Expand sub section  Other
     ....
    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
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    Link to SPCs
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    Link to adult BNF
    Track Changes
    Display tracking information
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    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  

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