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...
04.10  Expand sub section  Drugs used in substance dependence
04.10.01  Expand sub section  Alcohol dependence
Acamprosate tabs

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Formulary
Amber 3
   
Disulfiram tabs

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Formulary
Amber 2
SPECIALIST INITIATION ONLY
   
Nalmefene tabs

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Restricted Drug Restricted
Red
INITIATION BY SUBSTANCE MISUSE SPECIALISTS ONLY
Use in accordance with NICE guidance for reducing alcohol consumption in people with alcohol dependence. Nalmefene should only be prescribed in conjunction with continuous psychosocial support focused on treatment adherence and reducing alcohol consumption.

Patients requiring treatment with nalmefene should be referred to their local drug and alcohol services

Link  NICE TA325: Nalmefene for reducing alcohol consumption in people with alcohol dependence    
Alcohol infusion

Restricted Drug Restricted
Red
RESTRICTED USE
Acute alcohol withdrawal in patients unable to take chlordiazepoxide.

Dose = 30 mL of 90% alcohol injection in 500 mL 5% dextrose solution, over a 24 hour period
   
04.10.02  Expand sub section  Nicotine dependence
Nicotine Replacement Therapy

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Formulary Products available:
  • Nicotinell patches
  • Nicorette invisi patches
  • Sublingual tablet
  • Orodispersible film
  • Lozenge
  • Medicated chewing gum
  • Spray
  • Inhalator
    Follow local guidelines for nicotine replacement therapy
  •    
    Varenicline tabs

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    Formulary

    Link  NICE TA123: Varenicline    
    04.10.03  Expand sub section  Opioid dependence
    04.10.03  Expand sub section  Opioid substitution therapy to top
    Controlled Drug  Buprenorphine and Naloxone sublingual tabs

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    Restricted Drug Restricted SLAM ONLY
       
    Controlled Drug  Buprenorphine sublingual tabs

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    Formulary
       
    Controlled Drug  Methadone hydrochloride oral solution

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    Formulary
       
    04.10.03  Expand sub section  Adjunctive therapy and symptomatic treatment
    Lofexidine tabs

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    Formulary
    Red
       
    04.10.03  Expand sub section  Opioid-receptor antagonists
    Naltrexone tabs

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    Formulary

    Link  NICE TA115: Naltrexone for the management of opioid dependence    
     ....
    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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