| Formulary Chapter 4: Central nervous system - Full Chapter
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| Notes: |
Where a formulary entry does not detail a medicine’s indications for use, the medicine can be assumed to be approved for all licensed indications.
Formulary approved "off-label" use is detailed separately.
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 |
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| Details... |
| 04.09.01 |
Dopaminergic drugs used in Parkinsons disease |
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| 04.09.01 |
Dopamine receptor agonists |
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Apomorphine injection, infusion
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Formulary
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 SPECIALIST INITIATION ONLY
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 SE London APC Shared Care Agreement: Apomorphine for Parkinson’s Disease
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Bromocriptine tabs
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Formulary
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Cabergoline tabs
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Formulary
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SPECIALIST INITIATION ONLY
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Pergolide tabs
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Formulary
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 For all new patients
 For existing patients managed in primary care
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Pramipexole tabs, m/r tabs (Parkinson's disease)
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Formulary
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Ropinirole tabs, m/r tabs (Parkinson's disease)
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Formulary
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SE London APC Recommendation: Ropinirole MR tabs for Parkinson’s Disease
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Rotigotine patches (Parkinson's disease)
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Formulary
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SPECIALIST INITIATION ONLY
Treatment of the signs and symptoms of early-stage idiopathic Parkinson’s disease as monotherapy (i.e. without levodopa) or in combination with levodopa (i.e. over the course of the disease) through to late stages when the effect of levodopa wears off or becomes inconsistent and fluctuations of the therapeutic effect occur.
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Levodopa |
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Co-beneldopa caps, disp tabs, m/r caps
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Formulary
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Co-careldopa and Entacapone tabs
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Formulary
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Co-careldopa intestinal gel (Duodopa®)
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Formulary
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 RESTRICTED USE - ALL REFERRALS FOR PRESCRIBING SHOULD BE MADE TO PROFESSOR RAY CHAUDHURI AT KCH
Treatment of advanced levodopa responsive Parkinson’s disease in patients with severe motor fluctuations and hyper-/dyskinesia when available combinations of Parkinson medicinal products have not given satisfactory results.
Refer to NHSE commissioning criteria
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NHS England Commissioning position on levodopa/carbidopa intestinal gel (DO4/P/e) (July 2015)
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Co-careldopa tabs, m/r tabs
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Formulary
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| 04.09.01 |
Monoamine-oxidase-B inhibitors |
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Rasagiline tabs
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Formulary
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INITIATION BY SPECIALIST ONLY
Treatment for early Parkinson’s disease.
To be used as monotherapy and gradually withdrawn when more symptomatic treatments are required.
Not to be used in combination with levodopa
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Selegiline hydrochloride tabs, liquid
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Formulary
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SPECIALIST INITIATION ONLY
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| 04.09.01 |
Catachol-O-methyltransferase inhibitors |
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Entacapone tabs
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First Choice
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Entacapone is the first line COMT-inhibitor of choice.
See the Management of Motor Symptoms in Parkinson's Disease SEL pathway (link above) for detailed prescribing advice.
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Opicapone caps
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Second Choice
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Opicapone is approved for use as an adjunctive therapy to levodopa/DOPA decarboxylase inhibitors in adults with Parkinson’s disease and end-of-dose motor fluctuations.
Opicapone is restricted for use as a 2nd line COMT-inhibitor, where entacapone (first line choice) is ineffective or inappropriate due to swallowing difficulties (entacapone is film coated and a larger tablet)
See SEL APC recommendation (link below) and Management of Motor Symptoms in Parkinson's Disease SEL pathway (link above) for further prescribing advice.
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SEL APC recommendation: opicapone adjunctive therapy for the management of end-of-dose motor fluctuations in adults with Parkinson’s disease
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| 04.09.01 |
Amantadine |
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Amantadine caps, syrup (Parkinson's disease and multiple sclerosis)
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Formulary
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Approved for use in:
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 NICE CG186: Multiple sclerosis in adults: management
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| 04.09.01 |
Mild to moderate dementia in Parkinsons disease |
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| Non Formulary Items |
Amantadine (influenza)
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Non Formulary
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Not approved for use in SE London for treatment of influenza as per NICE technology appraisal guidance (see link below)
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Amantadine, oseltamivir and zanamivir for the treatment of influenza
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Key |
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Cytotoxic Drug
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Controlled Drug
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High Cost Medicine
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Cancer Drugs Fund
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NHS England |
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Homecare |
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CCG |
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Traffic Light Status Information
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Description |
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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.
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Treatment can be initiated in primary care after a recommendation from an appropriate specialist |
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Specialist initiation followed by maintenance prescribing in primary care |
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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 |
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Specialist and non-specialist initiation |
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Not recommended for prescribing |
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