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...
04.08.01  Expand sub section  Control of epilepsy
04.08.01  Expand sub section  Carbamazepine and Oxcarbazepine
Carbamazepine tabs, m/r tabs, liquid, suppositories (epilepsy)
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Formulary
Amber 2

 
   
Eslicarbazepine tabs
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Formulary
Amber 3
USE UNDER SPECIALIST SUPERVISION ONLY 
   
Oxcarbazepine tabs
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Formulary
Amber 2
 
   
04.08.01  Expand sub section  Ethosuximide
Ethosuximide caps, elixir
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Amber 2
USE UNDER SPECIALIST SUPERVISION ONLY 
   
04.08.01  Expand sub section  Gabapentin and pregabalin
Gabapentin caps (epilepsy)
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Formulary
Amber 2
USE UNDER SPECIALIST SUPERVISION ONLY 
Link  MHRA Oct 17: Gabapentin (Neurontin): risk of severe respiratory depression
   
Pregabalin caps (epilepsy)
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Amber 2
USE UNDER SPECIALIST SUPERVISION ONLY 
   
04.08.01  Expand sub section  Lacosamide to top
Lacosamide tabs, syrup, injection
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Amber 3

USE UNDER SPECIALIST SUPERVISION ONLY

First 2 months supply to come from hospital GP information sheet requires completion for transfer of prescribing

 

 
Link  SEL APC Lacosamide GP information sheet
   
04.08.01  Expand sub section  Lamotrigine
Lamotrigine tabs, disp tabs
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Amber 2
USE UNDER SPECIALIST SUPERVISION ONLY 
   
04.08.01  Expand sub section  Levetiracetam
Levetiracetam tabs, oral soution, injection
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Amber 2
USE UNDER SPECIALIST SUPERVISION ONLY 
   
04.08.01  Expand sub section  Perampanel
Perampanel tabs
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Amber 3

SPECIALIST INITIATION ONLY

First 2 months supply to come from hospital.

Transfer of Care documentation requires completion before GP will take over prescribing

 
Link  Perampanel Screening Checklist, Notification of Initiation to GP and Transfer of Care / Prescribing Agreement
   
04.08.01  Expand sub section  Phenobarbital and other barbiturates
Controlled Drug Phenobarbital tabs, elixir, injection
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Formulary USE UNDER SPECIALIST SUPERVISION ONLY 
   
Primidone tabs
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Formulary USE UNDER SPECIALIST SUPERVISION ONLY 
   
04.08.01  Expand sub section  Phenytoin to top
Phenytoin tabs, caps, suspension
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Amber 2
 
   
04.08.01  Expand sub section  Retigaine
04.08.01  Expand sub section  Rufinamide
04.08.01  Expand sub section  Tiagabine
Tiagabine tabs
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Amber 3

SPECIALIST INITIATION ONLY

First 2 months supply to come from hospital GP information sheet requires completion for transfer of prescribing

 
Link  SEL APC Tiagabine GP Information Sheet
   
04.08.01  Expand sub section  Topiramate
Topiramate tabs, sprinkles (epilepsy)
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Amber 2
USE UNDER SPECIALIST SUPERVISION ONLY 
   
04.08.01  Expand sub section  Valproate to top
Sodium Valproate tabs, m/r tabs, oral solution, injection (epilepsy)
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Amber 2

Valproate must no longer be used in any girls or women able to have children unless she agrees to comply with a pregnancy prevention programme.

All women and girls who are prescribed valproate should contact their GP and arrange to have their treatment reviewed.

Communication materials have been provided by the manufacturers to discuss the risk of abnormal pregnancy outcomes with women and girls of childbearing potential. See links below.

 
Link  Treatment with valproate for female patients: Checklist for patients and prescribers
Link  Valproate- Patient Card – Risks in Female patients
Link  Valproate- Patient Guide – Risks in Female patients
Link  Valproate- Letter for Prescribers -Risks in Female patients
Link  Important Information for Healthcare Professionals on the Risks of Valproate in Female Patients
Link  MHRA Mar 2018: Valproate use by women and girls
Link  MHRA Apr 2017: Valproate and developmental disorders: new alert asking for patient review and further consideration of risk minimisation measures
Link  MHRA Feb 2016: Valproate and risk of abnormal pregnancy outcomes: new communication materials
   
04.08.01  Expand sub section  Vigabatrin
Vigabatrin tabs
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Formulary
Amber 2
USE UNDER SPECIALIST SUPERVISION ONLY 
   
04.08.01  Expand sub section  Zonisamide
Zonisamide caps
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Formulary
Amber 3

SPECIALIST INITIATION ONLY

GP may take over prescribing responsibility via SEL APC shared care guidance.

First 2 months supply to come from hospital.

 
Link  SEL APC Zonisamide for the treatment of epilepsy in adults
   
04.08.01  Expand sub section  Benzodiazepines
Clobazam tabs
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Formulary
Amber 2
 
   
Clonazepam tabs (epilepsy)
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Formulary
Amber 2

 
   
04.08.01  Expand sub section  Other Drugs
Brivaracetam tabs, oral solution
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Restricted Drug Restricted
Amber 3

Initiation by consultant neurologist only

Adjunctive third line treatment option for partial-onset seizures with or without secondary generalisation in adults

Not be used concomitantly with levetiracetam as available evidence suggests there is no additional benefit from use of this combination

 
Link  SE London APC recommendation: Brivaracetam for partial onset sesizures in epilepsy
   
 ....
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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