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 2

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.

 
   
Controlled Drug Alfentanil injection
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Formulary USE UNDER SPECIALIST SUPERVISION ONLY 
   
Controlled Drug Buprenorphine patch (weekly preparation)
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Restricted Drug Restricted

INITIATION 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, patches (96 hour)
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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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Unlicensed 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
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
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Link to adult BNF
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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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