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
SPECIALIST INITIATION ONLY
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
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.
Treatment can be initiated in primary care after a recommendation from an appropriate specialist
Specialist initiation followed by maintenance prescribing in primary care
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