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
   
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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Formulary
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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Formulary
Amber 3
USE UNDER SPECIALIST SUPERVISION ONLY

For use in adults:

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

Red Traffic Light
For use in children <16 years (off-label)

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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Formulary
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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Formulary
Amber 2
Communication materials have been provided by the MHRA to discuss the the risk of abnormal pregnancy outcomes with women of childbearing potential and girls. See link below

Link  MHRA: 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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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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Amber 2
   
Clonazepam tabs

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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 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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