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...
04.07.03  Expand sub section  Neuropathic pain
Amitriptyline tabs, oral solution

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Formulary Use in neuropathic pain is off-label

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

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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

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    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

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    Formulary For painful diabetic neuropathy

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

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    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

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    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

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    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)

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    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)

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    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

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    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

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    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

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    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)
       
     ....
    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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