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...
04.07.04.01  Expand sub section  Treatment of the acute migraine attack
Ibuprofen tabs

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Formulary
   
Paracetamol tabs, soluble tabs

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Formulary
   
Lidocaine infusion

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Restricted Drug Restricted
Red
Joint Formulary Committee approved off-label use (specialist headache clinic use only):
  • Short-lasting Unilateral Neuralgiform Headache attacks with conjunctival injection and Tearing (SUNCT)
  • Short-lasting Unilateral Neuralgiform Headache attacks with Cranial Autonomic Symptoms (SUNA)
    See dosing protocol from KCH for further information
  •    
    Aspirin injection

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    Restricted Drug Unlicensed
    Red
    SPECIALIST USE ONLY
    Inpatient management of severe withdrawal headache
    Dose = 1g once to three times daily for up to 4 days
       
    Indometacin injection

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    Restricted Drug Unlicensed
    Red
    SPECIALIST USE ONLY
    For the diagnosis of indometacin sensitive headaches (paroxysmal hemicranias)
    Dose = 100-200mg intramuscular test dose
       
    04.07.04.01  Expand sub section  5HT1 agonists
    Rizatriptan wafers

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    Formulary
       
    Sumatriptan tabs, injection

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    Formulary
       
    04.07.04.01  Expand sub section  Ergot alkaloids
    Dihydroergotamine injection

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    Restricted Drug Unlicensed
    Red
    SPECIALIST USE ONLY
    Inpatient treatment of medical refractory disabling migraine and cluster headaches.

    See dosing protocol from KCH for further information
       
    04.07.04.01  Expand sub section  Anti-emetics
    Metoclopramide tabs

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    Formulary Maximum daily dose of 30mg for a maximum of 5 days. See MHRA davice.

    Link  MHRA advice August 2013: Metoclopramide: risk of neurological adverse effects    
    Prochlorperazine suppositories

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    Formulary
       
     ....
    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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