netFormulary Birmingham, Sandwell, Solihull and environs APC Formulary NHS
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 Formulary Chapter 4: Central nervous system - Full Chapter
04.01  Expand sub section  Hypnotics and anxiolytics
04.01.01  Expand sub section  Hypnotics
Melatonin  (Circadin ®)
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Formulary
Red
 
   
Melatonin
(capsules)
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Unlicensed Drug Unlicensed
Red
 
   
04.01.01  Expand sub section  Benzodiazepines
Controlled Drug Temazepam
(tablets)
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Formulary
Green
High Cost Medicine
From Monday 1 June 2015 prescriptions for temazepam will be required to meet full prescription requirements for Schedule 3 controlled drugs (CDs). 
Link  Legislative changes to prescription writing requirements for temazepam
   
Controlled Drug Temazepam
(SF solution)
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Formulary
Green
From Monday 1 June 2015 prescriptions for temazepam will be required to meet full prescription requirements for Schedule 3 controlled drugs (CDs). 
Link  Legislative changes to prescription writing requirements for temazepam
   
04.01.01  Expand sub section  Zaleplon, Zolpidem and Zopiclone
Zopiclone
(tablets)
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First Choice
Green
 
Zolpidem
(tablets)
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Formulary
Green
 
Link  NICE TA77: Zaleplon, zolpidem and zopiclone for the management of insomnia
   
04.01.01  Expand sub section  Chloral and derivatives to top
Chloral Hydrate
(solution)
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Formulary
Red
 
   
04.01.01  Expand sub section  Clomethiazole (Chlormethiazole)
04.01.01  Expand sub section  Antihistamines
Promethazine Hydrochloride
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Formulary
Green
 
   
04.01.01  Expand sub section  Alcohol
04.01.01  Expand sub section  Sodium oxybate
04.01.02  Expand sub section  Anxiolytics to top
04.01.02  Expand sub section  Benzodiazepines
Diazepam
(tablets)
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Formulary
Green
 
   
Oxazepam
(tablets)
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Formulary
Green
 
   
Chlordiazepoxide
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Formulary
Green
Adjunct in acute alcohol withdrawal 
   
Lorazepam
(tablets)
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Formulary
Amber
 
   
Diazepam
(injection)
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Formulary
Red
 
   
Lorazepam
(injection)
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Formulary
Red
 
   
04.01.02  Expand sub section  Buspirone
Buspirone Hydrochloride
(tablets)
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Formulary
Green
££ Second line 
   
04.01.02  Expand sub section  Beta blockers
04.01.02  Expand sub section  Meprobamate
04.01.03  Expand sub section  Barbiturates to top
04.02  Expand sub section  Drugs used in psychoses and related disorders
04.02.01  Expand sub section  Antipsychotic Drugs
Chlorpromazine (oral)
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Formulary
Amber
  • tablets
  • syrup

  • Supported by ESCA, see link below.  
  • Link  ESCA: Antipsychotics (oral)
       
    Chlorpromazine injection
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    Formulary
    Amber
     
       
    Flupentixol tablets
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    Formulary
    Amber
  • Supported by ESCA, see link below.  
  • Link  ESCA: Antipsychotics (oral)
       
    Haloperidol (oral)
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    Formulary
    Amber
  • tablets
  • capsules
  • oral liquid sugar-free

  • Supported by ESCA, see link below.  
  • Link  ESCA: Antipsychotics (oral)
       
    Haloperidol injection
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    Formulary
    Amber
  • For rapid tranquilisation 
  •    
    Levomepromazine injection
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    Formulary
    Amber
     
       
    Levomepromazine tablets
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    Formulary
    Amber
  • Supported by ESCA, see link below.  
  • Link  ESCA: Antipsychotics (oral)
       
    Penfluridol (Oral)
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    Formulary
    Red
     
       
    Pericyazine (oral)
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    Formulary
    Amber
  • Supported by ESCA, see link below.  
  • Link  ESCA: Antipsychotics (oral)
       
    Perphenazine (oral)
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    Formulary
    Amber
  • Supported by ESCA, see link below.  
  • Link  ESCA: Antipsychotics (oral)
       
    Pimozide  (Orap®)
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    Formulary
    Red
     
       
    Sulpiride (oral)
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    Formulary
    Amber
  • Supported by ESCA, see link below.  
  • Link  ESCA: Antipsychotics (oral)
       
    Trifluoperazine (oral)
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    Formulary
    Amber
  • tablets
  • oral solution sugar-free

  • Supported by ESCA, see link below.  
  • Link  ESCA: Antipsychotics (Oral)
       
    Zuclopenthixol tablets
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    Formulary
    Amber
  • Supported by ESCA, see link below.  
  • Link  ESCA: Antipsychotics (oral)
       
    04.02.01  Expand sub section  First-Generation Antipsychotic Drugs
    04.02.01  Expand sub section  Second-Generation Antipsychotic Drugs
    Amisulpride (oral)
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    Formulary
    Amber
  • tablets
  • solution

  • Supported by ESCA, see link below.  
  • Link  ESCA: Antipsychotics (oral)
       
    Aripiprazole tablets
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    Formulary
    Amber
  • Supported by ESCA, see link below.
  • use in Tourette's syndrome approved 
  • Link  ESCA: Antipsychotics (oral)
    Link  NICE TA213: Aripiprazole for the treatment of schizophrenia in people aged 15 -17 years
    Link  NICE TA292: Bipolar disorder (children) - aripiprazole
       
    Olanzapine (oral)
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    Formulary
    Amber
  • tablets
  • orodispersible tablets

  • Supported by ESCA, see link below.  
  • Link  ESCA: Antipsychotics (oral)
       
    Quetiapine tablets
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    Formulary
    Amber
  • Supported by ESCA, see link below.  
  • Link  ESCA: Antipsychotics (oral)
       
    Quetiapine Modified-release preparations
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    Formulary
    Amber
  • Supported by ESCA, see link below.
  • Rationale for prescribing rather than first line antipsychotics to be provided with ESCA.


    APC preferred brands
    Biquelle XL, Sondate XL, Zaluron XL
    Choose most cost-effective option.  
  • Link  ESCA: Antipsychotics (oral)
       
    Risperidone (oral)
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    Formulary
    Amber
  • tablets
  • liquid

  • Supported by ESCA, see link below.  
  • Link  ESCA: Antipsychotics (oral)
       
    Clozapine tablets
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    Formulary
    Red
     
       
    04.02.02  Expand sub section  Antipsychotic depot injections to top
    Aripiprazole (Abilify Maintena®)
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    Formulary
    Red

    The APC's view is that, on clinical grounds, the status of antipsychotic depot injections should be amber with a framework in place in Primary Care before transfer.
    HOWEVER, until the commissioning arrangements have been agreed to allow safe transfer of patient care, the status will remain RED.

     
       
    Flupentixol Decanoate
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    Formulary
    Red
    The APC's view is that, on clinical grounds, the status of antipsychotic depot injections should be amber with a framework in place in Primary Care before transfer.
    HOWEVER, until the commissioning arrangements have been agreed to allow safe transfer of patient care, the status will remain RED.
     
       
    Fluphenazine Decanoate (Modecate®)
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    Formulary
    Red

    The APC's view is that, on clinical grounds, the status of antipsychotic depot injections should be amber with a framework in place in Primary Care before transfer.
    HOWEVER, until the commissioning arrangements have been agreed to allow safe transfer of patient care, the status will remain RED.

    • Discontinued by manufacturer by the end of 2018.
     
       
    Haloperidol (Haldol Decanoate®)
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    Formulary
    Red
    The APC's view is that, on clinical grounds, the status of antipsychotic depot injections should be amber with a framework in place in Primary Care before transfer.
    HOWEVER, until the commissioning arrangements have been agreed to allow safe transfer of patient care, the status will remain RED.
     
       
    Olanzapine Embonate (ZypAdhera®)
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    Formulary
    Red
    The APC's view is that, on clinical grounds, the status of antipsychotic depot injections should be amber with a framework in place in Primary Care before transfer.
    HOWEVER, until the commissioning arrangements have been agreed to allow safe transfer of patient care, the status will remain RED. 
       
    Paliperidone (Trevicta®)
    (Three-monthly depot injection)
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    Formulary
    Red
    The APC's view is that, on clinical grounds, the status of antipsychotic depot injections should be amber with a framework in place in Primary Care before transfer.
    HOWEVER, until the commissioning arrangements have been agreed to allow safe transfer of patient care, the status will remain RED.
     
       
    Paliperidone (Xeplion®)
    (Monthly depot injection)
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    Formulary
    Red
    The APC's view is that, on clinical grounds, the status of antipsychotic depot injections should be amber with a framework in place in Primary Care before transfer.
    HOWEVER, until the commissioning arrangements have been agreed to allow safe transfer of patient care, the status will remain RED.
     
       
    Risperidone (Risperdal Consta®)
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    Formulary
    Red
    The APC's view is that, on clinical grounds, the status of antipsychotic depot injections should be amber with a framework in place in Primary Care before transfer.
    HOWEVER, until the commissioning arrangements have been agreed to allow safe transfer of patient care, the status will remain RED.
     
       
    Zuclopenthixol Decanoate
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    Formulary
    Red
    The APC's view is that, on clinical grounds, the status of antipsychotic depot injections should be amber with a framework in place in Primary Care before transfer.
    HOWEVER, until the commissioning arrangements have been agreed to allow safe transfer of patient care, the status will remain RED.
     
       
    04.02.03  Expand sub section  Drugs used for mania and hypomania
    Asenapine
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    Formulary
    Red
    Hospital only 
       
    Lamotrigine
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    Formulary
    Amber
     
       
    04.02.03  Expand sub section  Benzodiazepines
    04.02.03  Expand sub section  Drugs to manage Antipsychotic side effects
    Procyclidine
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    Formulary
    Green
     
       
    Hyoscine
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    Formulary
    Amber
     
       
    Trihexyphenidyl
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    Formulary
    Amber
     
       
    Pirenzipine (unlicensed)
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    Formulary
    Red
    Hospital only 
       
    04.02.03  Expand sub section  Carbamazepine
    Carbamazepine
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    Formulary
    Amber
     
       
    04.02.03  Expand sub section  Valproic acid to top
    Valproic Acid (Depakote®)
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    Formulary
    Amber

    Contraindicated in women of childbearing potential unless part of the Pregnancy Prevention Programme.  See MHRA guidance

     
    Link  Women of childbearing potential: Educational Risk Minimisation Materials
       
    04.02.03  Expand sub section  Lithium
    Lithium Carbonate M/R tablets (Priadel®)
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    Formulary
    Amber
  • Supported by an ESCA, see link below.

  • APC preferred brand is Priadel  
  • Link  ESCA: Lithium
       
    Lithium Citrate liquid
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    Formulary
    Amber
  • Supported by an ESCA, see link below.

  • APC preferred brand Priadel 
  • Link  ESCA: Lithium.
       
    04.03  Expand sub section  Antidepressant drugs
    04.03.01  Expand sub section  Tricyclic and related antidepressant drugs
    04.03.01  Expand sub section  Tricyclic antidepressants
    Amitriptyline
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    Formulary
    Green
  • Tablets
  • Sugar Free solution £££ 
  •    
    Clomipramine
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    Formulary
    Amber
  • Capsules
  • M/R tablets 
  •    
    Imipramine
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    Formulary
    Green
  • Tablets 
  •    
    Lofepramine
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    Formulary
    Green
  • Tablets
  • Suspension 
  •    
    04.03.01  Expand sub section  Related antidepressants to top
    Trazodone
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    Formulary
    Green
  • Tablets
  • Capsules
  • Sugar free liquid 
  •    
    04.03.02  Expand sub section  Monoamine-oxidase inhibitors
    04.03.02  Expand sub section  Reverible MAOIs
    Moclobemide tablets
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    Formulary
    Amber
     
       
    04.03.03  Expand sub section  Selective serotonin re-uptake inhibitors
    Fluoxetine capsules
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    First Choice
    Green
     
    Sertraline tablets
    View adult BNF View SPC online View childrens BNF
    First Choice
    Green
     
    Citalopram tablets
    View adult BNF View SPC online View childrens BNF
    Second Choice
    Green
     
    Link  UKMI Q&A: What issues should be considered regarding drug induced QT prolongation?
       
    Paroxetine tablets
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    Second Choice
    Green
     
       
    Citalopram oral drops
    View adult BNF View SPC online View childrens BNF
    Formulary
    Green
     
       
    Fluoxetine liquid
    View adult BNF View SPC online View childrens BNF
    Formulary
    Green
     
       
    Vortioxetine
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    Formulary
    Amber
  • In line with NICE
    Specialist initiation and stabilisation before transfer to Primary Care 
  • Link  NICE TA367: Vortioxetine for treating major depressive episodes (Nov 2015)
       
    04.03.04  Expand sub section  Other antidepressant drugs
    Pregabalin
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    Second Choice
    Green
  • for generalised anxiety disorder
  • ££ 
  •    
    Agomelatine (Valdoxan®)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Amber
  • supported by a RICaD (in development) 
  •    
    Duloxetine (Cymbalta®)
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    Formulary
    Amber
  • Transfer to Primary care from Birmingham and Solihull Mental Health NHS FT to be accompanied by rationale for use/ restricted medicines form 
  •    
    Mirtazapine
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    Formulary
    Green
  • tablets
  • orodispersible tablets ££ 
  •    
    Venlafaxine tablets
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    Formulary
    Green
     
       
    Venlafaxine M/R
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    Formulary
    Green

    APC preferred brands

    • 1st choice: Vensir XL capsules (suggest switching generic prescriptions to this agent)
    • 2nd choice: Venlalic XL tablets
     
       
    Bupropion
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    Formulary
    Red
  • off label use 
  •    
    Tryptophan
    View adult BNF View SPC online View childrens BNF
    Formulary
    Red
     
       
    04.04  Expand sub section  CNS stimulants and other drugs used for attention deficit hyperactivity disorder to top
     note 

    Shared care documents from Black Country Partnership NHS FT can be accessed from this here

    Atomoxetine (Strattera®)
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    Formulary Please note that commissioning discussion is underway. However the present status is as follows:-
    Red Traffic Light Birmingham CrossCity CCG, Birmingham South Central CCG, Sandwell & West Birmingham CCG

    Amber Traffic Light  Supported with an ESCA- Solihull CCG
     
    Link  ESCA: Atomoxetine
       
    Controlled Drug Dexamfetamine
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    Formulary Please note that commissioning discussion is underway. However the present status is as follows:-
    Red Traffic Light Birmingham CrossCity CCG, Birmingham South Central CCG, Sandwell & West Birmingham CCG

    Amber Traffic Light Supported with an ESCA- Solihull CCG
     
    Link  ESCA: Dexamfetamine as Amfexa
       
    Guanfacine (Intuniv®)
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    Formulary
    Red
    for the treatment of ADHD in children and adolescents 6-17 years old for whom stimulants are not suitable, not tolerated or have been shown to be ineffective.  
       
    Lisdexamfetamine (Elvanse®)
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    Formulary
    Red
     
       
    Controlled Drug Methylphenidate Modified-Release
    (tablets/ capsules)
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    Formulary Please note that commissioning discussion is underway. However the present status is as follows:-
    Red Traffic Light Birmingham CrossCity CCG, Birmingham South Central CCG, Sandwell & West Birmingham CCG

    Amber Traffic Light Supported with an ESCA- Solihull CCG
     
    Link  ESCA: Methylphenidate
       
    Controlled Drug Methylphenidate tablets
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    Formulary
    Amber
    Please note that commissioning discussion is underway. However the present status is as follows:-
    Red Traffic Light Birmingham CrossCity CCG, Birmingham South Central CCG, Sandwell & West Birmingham CCG

    Amber Traffic Light Supported with an ESCA- Solihull CCG
     
    Link  ESCA: Methylphenidate
    Link  UKMI Q&A: Methylphenidate for adults with ADHD
       
    Modafinil
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    Formulary
    Amber
  • for narcolepsy
  • prescribe as generic 
  •    
    04.04  Expand sub section  Cocaine
    04.05  Expand sub section  Drugs used in the treatment of obesity
    04.05.01  Expand sub section  Anti-obesity drugs acting on the gastro-intestingal tract
    Orlistat capsules
    View adult BNF View SPC online View childrens BNF
    Formulary
    Green
     
       
    04.05.02  Expand sub section  Centrally acting appetite suppressants
    04.06  Expand sub section  Drugs used in nausea and vertigo to top
    Dexamethasone tablets
    View adult BNF View SPC online View childrens BNF
    Formulary
    Green
  • for resistant nausea and vomitting
  • £££ 
  •    
    04.06  Expand sub section  Vomiting during pregnancy
    04.06  Expand sub section  Postoperative nausea and vomiting
    04.06  Expand sub section  Motion sickness
    04.06  Expand sub section  Other vestibular disorders
    04.06  Expand sub section  Cytotoxic chemotherapy to top
    04.06  Expand sub section  Palliative care
    Dexamethasone injection
    View adult BNF View SPC online View childrens BNF
    Formulary
    Amber
  • palliative care only 
  •    
    04.06  Expand sub section  Migraine
    04.06  Expand sub section  Antihistamines
    Cinnarizine tablets
    View adult BNF View SPC online View childrens BNF
    Formulary
    Green
     
       
    Cyclizine
    View adult BNF View SPC online View childrens BNF
    Formulary
    Green
  • tablets
  • injection- for palliative care  
  •    
    Promethazine Hydrochloride
    View adult BNF View SPC online View childrens BNF
    Formulary
    Green
     
       
    04.06  Expand sub section  Phenothiazines and related drugs
    Levomepromazine
    View adult BNF View SPC online View childrens BNF
    Formulary
    Green
  • palliative care only 
  •    
    Prochlorperazine
    View adult BNF View SPC online View childrens BNF
    Formulary
    Green
  • tablets
  • buccal tablets
  • syrup
  • injection 
  •    
    Chlorpromazine Hydrochloride
    View adult BNF View SPC online View childrens BNF
    Formulary
    Red
  • nausea
  • hyperemesis in pregnancy (off label use) 
  •    
    04.06  Expand sub section  Domperidone and metoclopramide to top
    Domperidone
    View adult BNF View SPC online View childrens BNF
    Formulary
    Green
  • tablets- short term use only
  • suppositories
  • SF suspension £££ - for patients with swallowing difficulties only 
  •    
    Metoclopramide
    View adult BNF View SPC online View childrens BNF
    Formulary
    Green
  • tablets
  • SF solution- £££-for patients with swallowing difficulties only 
  •    
    Metoclopramide injection
    View adult BNF View SPC online View childrens BNF
    Formulary Green Traffic Light  in palliative care


    Red Traffic Light  other indications
     

       
    04.06  Expand sub section  5HT3 antagonists
    Granisetron tablets
    View adult BNF View SPC online View childrens BNF
    Formulary
    Red

     
       
    Granisetron transdermal patch (Sancuso®)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Red
  • for use in oncology patients only 
  •    
    Ondansetron
    View adult BNF View SPC online View childrens BNF
    Formulary
  • tablets
  • melt tablets
  • suppositories
  • injection
  • SF syrup - swallowing difficulties only

    Amber Traffic Light  hyperemesis in pregnancy (off label)

    Amber Traffic Light  palliative care (off label)

    Red Traffic Light  Chemotherapy 
  •    
    Palonosetron (Aloxi®)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Red
     
       
    04.06  Expand sub section  Neurokinin receptor antagonist
    Aprepitant (Emend®)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Red
  • for use with chemotherapy only 
  •    
    04.06  Expand sub section  Cannabinoid
    04.06  Expand sub section  Hyoscine
    Hyoscine Hydrobromide
    (300 microgram tablets)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Green
     
    Link  UKMI Q&A: Hypersalivation – can hyoscine hydrobromide be used to treat it?
    Link  UKMI Q&A: Hypersalivation treatment options
       
    Hyoscine Hydrobromide
    (patch)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Green
    £££ 
       
    04.06  Expand sub section  Other drugs for Ménière's disease to top
    Betahistine Dihydrochloride
    View adult BNF View SPC online View childrens BNF
    Formulary
    Green
     
       
    04.07  Expand sub section  Analgesics
    04.07.01  Expand sub section  Non-opioid analgesics and compound analgesic preparations
    04.07.01  Expand sub section  Compound analgesic preparations
    Aspirin 300mg dispersible tablets
    View adult BNF View SPC online View childrens BNF
    Formulary
    Green
  • topical analgesia- for gargling 
  •    
    Paracetamol
    View adult BNF View SPC online View childrens BNF
    Formulary
    Green
  • tablets
  • SF suspension
  • 500mg soluble tablets- high sodium content.Only for patients with swallowing difficulties. 
  • Link  UKMI Q&A: Can Breastfeeding mothers take paracetamol?
       
    Paracetamol
    (suppositories)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Red
     
       
    Paracetamol (Perfalgan®)
    (intravenous infusion)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Red
     
       
    Paracetamol and codeine (Co-codamol ®15/500)
    (tablets/ capsules)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Green
  • £££
  • Limited evidence.
  • For elderly community who would not tolerate separate ingredients or to support a step down review. 
  •    
    Paracetamol and codeine (Co-codamol ®15/500)
    (effervescent tablets)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Green
  • £££
  • Limited evidence.
  • High sodium content.
  • For elderly community who would not tolerate separate ingredients or to support a step down review. 
  •    
    Paracetamol and codeine (Co-codamol® 30/500)
    (effervescent tablets)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Green
  • £££
  • High sodium content
  • Use in chronic pain only, and for patients with swallowing difficulties. 
  •    
    Paracetamol and codeine (Co-codamol® 30/500)
    (tablets/capsules)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Green
  • Use in chronic pain only 
  •    
    04.07.02  Expand sub section  Opioid analgesics
    Controlled Drug Buprenorphine patches
    View adult BNF View SPC online View childrens BNF
    Formulary
    Amber
  • for specialist initiation: specialist pain clinics, palliative care and for patients with swallowing difficulties
  • supported by a RICaD (in development)

    Patches should be prescribed by BRAND 
  •    
    Controlled Drug Buprenorphine sublingual tablets
    View adult BNF View SPC online View childrens BNF
    Formulary
    Red
    For use in opioid dependence, see section 4.10.3 
       
    Codeine Phosphate
    View adult BNF View SPC online View childrens BNF
    Formulary
    Green
  • tablets
  • 25mg/5ml syrup
     
  •    
    Controlled Drug Codeine Phosphate injection
    (60mg/mL)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Red

     
       
    Controlled Drug Diamorphine salts
    View adult BNF View SPC online View childrens BNF
    Formulary
    Green
     
       
    Dihydrocodeine
    View adult BNF View SPC online View childrens BNF
    Formulary
    Green
  • tablets
  • oral solution- for patients with swallowing difficulties 
  •    
    Controlled Drug Fentanyl patches
    View adult BNF View SPC online View childrens BNF
    Formulary
    Amber
     
       
    Controlled Drug Fentanyl lozenges
    View adult BNF View SPC online View childrens BNF
    Formulary
    Red
  • Palliative care only 
  • Link  Patient Information Leaflet
       
    Controlled Drug Fentanyl Nasal Spray
    View adult BNF View SPC online View childrens BNF
    Formulary
    Red
     
    Link  Patient Information Leaflet
       
    Controlled Drug Fentanyl sublingual tablets
    View adult BNF View SPC online View childrens BNF
    Formulary
    Red
  • Palliative care only 
  • Link  Patient Information Leaflet
       
    Meptazinol (Meptid®)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Red
     
       
    Controlled Drug Methadone
    View adult BNF View SPC online View childrens BNF
    Formulary For use in opioid dependence, see section 4.10.3  
       
    Controlled Drug Morphine
    View adult BNF View SPC online View childrens BNF
    Formulary
    Green
  • tablets
  • M/R tablets
  • M/R capsules
  • Oral solution
  • injection 
  •    
    Controlled Drug Morphine
    View adult BNF View SPC online View childrens BNF
    Formulary
    Red
  • suppositories
  • 100mg/100ml PCA
  • 5mg/5ml intrathecal injection
  • pre-filled syringes 
  •    
    Controlled Drug Oxycodone
    View adult BNF View SPC online View childrens BNF
    Formulary
    Amber
  • capsules
  • M/R tablets
  • SF solution

  • For patients who do not tolerate morphine 
  •    
    Controlled Drug Oxycodone injection
    View adult BNF View SPC online View childrens BNF
    Formulary
    Red
     
       
    Controlled Drug Pethidine injection
    View adult BNF View SPC online View childrens BNF
    Formulary
    Red
     
       
    Controlled Drug Tapentadol (Palexia®)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Red
     
       
    Controlled Drug Tramadol capsules
    View adult BNF View SPC online View childrens BNF
    Formulary
    Green
  • Second line after morphine and codeine 
  • Link  UKMI Q&A: risk of developing Serotonin Syndrome following concomitant use of tramadol with selective serotonin reuptake inhibitors (SSRIs)
       
    Controlled Drug Tramadol soluble tablets
    View adult BNF View SPC online View childrens BNF
    Formulary
    Green
  • Second line after morphine and codeine
  • For patients with swallowing difficulties
  • £££ 
  •    
    04.07.02  Expand sub section  Weak opioids to top
    04.07.02  Expand sub section  Strong opioids
    04.07.02  Expand sub section  Breakthrough pain
    04.07.02  Expand sub section  Injectable
    04.07.02  Expand sub section  Other
    04.07.03  Expand sub section  Neuropathic pain to top
    Amitriptyline
    View adult BNF View SPC online View childrens BNF
    Formulary
    Green
  • 1st line
  • low abuse potential, low cost
  • off label use
     
  •    
    Gabapentin
    (tablets, capsules)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Green
  • 2nd line
  • please be aware of the abuse potential associated with this class of agent 
  • Link  NHS England: Advice for prescribers on the risk of the misuse of pregabalin and gabapentin
       
    Duloxetine (Cymbalta®)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Green
  • 3rd line after gabapentin
  • low abuse potential , high cost £££
  • on advice of specialist
  • not licensed for use in children 
  •    
    Pregabalin
    View adult BNF View SPC online View childrens BNF
    Formulary
    Amber
  • 4th line after duloxetine
  • on advice of specialist if duloxetine is unsuitable
  • please be aware of the abuse potential associated with this class of agent
  • From 17th July 2017, clinicians can now return to normal practice when prescribing pregabalin and no longer need to specify a brand name when prescribing for neuropathic pain. 
  • Link  NHS England: Advice for prescribers on the risk of the misuse of pregabalin and gabapentin
       
    04.07.03  Expand sub section  Trigeminal neuralgia
    Carbamazepine
    View adult BNF View SPC online View childrens BNF
    Formulary
    Green
  • trigeminal neuralgia only 
  •    
    04.07.03  Expand sub section  Postherpetic neuralgia
    Capsaicin
    (cream 0.075%)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Amber
  • Only strength licensed for post-herpetic neuralgia and diabetic peripheral polyneuropathy.

    For other strength, see section 10.3.2

     
  •    
    Lidocaine 5% patch (Versatis®)
    (patch)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Amber

    Approved only in patients who have been treated in line with NICE CG173 Neuropathic pain in adults: pharmacological management in non-specialist settings but are still experiencing neuropathic pain associated with previous herpes zoster infection (post-herpetic neuralgia)

    Awaiting RICaD (in development)

     
    Link  link to chapter 15
    Link  Patient Information Leaflet
       
    04.07.04  Expand sub section  Antimigraine drugs
    04.07.04.01  Expand sub section  Treatment of the acute migraine attack
    04.07.04.01  Expand sub section  Analgesics to top
    Analgesics (Migraleve Pink ®)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Green
     
       
    04.07.04.01  Expand sub section  5HT1 agonists
    Rizatriptan
    View adult BNF View SPC online View childrens BNF
    Formulary Green Traffic Light  Tablets
    Green Traffic Light  Orodispersible tablets SF- reserve for patients who are vomiting due to migraine

    Black Traffic Light  Wafer/oral lyophilisates SF £££
     
       
    Sumatriptan
    View adult BNF View SPC online View childrens BNF
    Formulary
    Green
  • Tablets (prescribe as generic)
  • Nasal spray £££
  • injection £££ 
  •    
    Zolmitriptan
    View adult BNF View SPC online View childrens BNF
    Formulary
    Green
  • Tablets 
  •    
    04.07.04.01  Expand sub section  Ergot alkaloids
    04.07.04.01  Expand sub section  Anti-emetics
    04.07.04.01  Expand sub section  Other drugs for migrane
    04.07.04.02  Expand sub section  Prophylaxis of migraine to top
    Amitriptyline
    View adult BNF View SPC online View childrens BNF
    Formulary
    Green
     
       
    Botulinum Toxin Type A (botox®)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Red
  • In line with NICE 
  • Link  NICE TA260: Botox for migraine prophylaxis
       
    Pizotifen
    View adult BNF View SPC online View childrens BNF
    Formulary
    Green
  • Tablets
  • Elixir 
  •    
    Propranolol
    View adult BNF View SPC online View childrens BNF
    Formulary
    Green
     
       
    Flunarizine
    View adult BNF View SPC online View childrens BNF
    Formulary
    Red

    Unlicensed medicine

     
       
    04.08  Expand sub section  Antiepileptics
    04.08.01  Expand sub section  Control of epilepsy
     note 

    Category

    Antiepileptic drugs

    MHRA Advice

    1

    phenytoin, carbamazepine, phenobarbital, primidone

    For these drugs, doctors are advised to ensure that their patient is maintained on a specific manufacturer’s product

    2

    valproate, lamotrigine, perampanel, retigabine, rufinamide, clobazam, clonazepam, oxcarbazepine, eslicarbazepine, zonisamide, topiramate

    For these drugs, the need for continued supply of a particular manufacturer’s product should be based on clinical judgement and consultation with patient and/or carer, taking into account factors such as seizure frequency and treatment history

    3

    levetiracetam, lacosamide, tiagabine, gabapentin, pregabalin, ethosuximide, vigabatrin  

    For these drugs, it is usually unnecessary to ensure that patients are maintained on a specific manufacturer’s product unless there are specific reasons such as patient anxiety and risk of confusion or dosing errors

    04.08.01  Expand sub section  Partial seizures with or without secondary generalisation
    04.08.01  Expand sub section  Generalised seizures
    04.08.01  Expand sub section  Carbamazepine and Oxcarbazepine to top
    Carbamazepine
    View adult BNF View SPC online View childrens BNF
    Formulary
    Green
  • Tablets
  • M/R tablets
  • SF liquid
  • Suppositories

    MHRA Advice
    Patients being treated for epilepsy should be maintained on a specific manufacturer's product- APC preferred brand is TEGRETOL 
  • Link  UKMI Q&A: Why is there a limit on the dose and duration of use for carbamazepine suppositories?
       
    Eslicarbazepine
    View adult BNF View SPC online View childrens BNF
    Formulary
    Amber
  • Should only be considered following referral to a tertiary care specialist and after oxcarbazepine has been tried.
  • Supported by an ESCA  
  • Link  ESCA: Eslicarbazepine
       
    Oxcarbazepine
    View adult BNF View SPC online View childrens BNF
    Formulary
    Amber
  • Tablets
  • Oral suspension

    MHRA Advice
    Care should be taken when switching between oral formulations.The need for continued supply of a particular manufacturer’s product should be based on clinical judgement and consultation with patient and/or carer, taking into account factors such as seizure frequency and treatment history. 
  •    
    04.08.01  Expand sub section  Ethosuximide
    Ethosuximide capsules
    View adult BNF View SPC online View childrens BNF
    Formulary
    Amber
    MHRA Advice
    When prescribing for epilepsy, the potential for clinically relevant differences to exist between different manufacturers’ products is considered to be extremely low. However, consider other patient/carer-related factors, such as negative perceptions about alternative products and/or other issues related to the patient such co-morbid autism, mental health issues, or learning disability.
     
       
    04.08.01  Expand sub section  Gabapentin and pregabalin
    Gabapentin
    View adult BNF View SPC online View childrens BNF
    Formulary
    Amber
  • Capsules
  • Tablets £££

    MHRA Advice
    It is usually unnecessary to ensure that patients are maintained on a specific manufacturer’s product unless there are specific reasons such as patient anxiety and risk of confusion or dosing errors
     
  •    
    Pregabalin
    View adult BNF View SPC online View childrens BNF
    Formulary
    Amber
  • Capsules

    MHRA Advice
    For patients being treated for epilepsy, it is usually unnecessary to ensure that patients are maintained on a specific manufacturer’s product unless there are specific reasons such as patient anxiety and risk of confusion or dosing errors.
     
  •    
    04.08.01  Expand sub section  Lacosamide
    Lacosamide
    View adult BNF View SPC online View childrens BNF
    Formulary
    Amber
  • Tablets
  • Syrup

  • Supported by an ESCA, see link below. 
  • Link  ESCA: Lacosamide.
       
    04.08.01  Expand sub section  Lamotrigine
    Lamotrigine
    View adult BNF View SPC online View childrens BNF
    Formulary
    Amber
  • Tablets
  • Dispersible tablets

    MHRA Advice
    Care should be taken when switching between oral formulations. The need for continued supply of a particular manufacturer’s product should be based on clinical judgement and consultation with patient and/or carer, taking into account factors such as seizure frequency and treatment history.
     
  •    
    04.08.01  Expand sub section  Levetiracetam to top
    Levetiracetam
    View adult BNF View SPC online View childrens BNF
    Formulary
    Amber
  • Tablets
  • SF oral solution
  • Coated granules in sachets (see Desitrend®)

    MHRA Advice
    It is usually unnecessary to ensure that patients are maintained on a specific manufacturer’s product unless there are specific reasons such as patient anxiety and risk of confusion or dosing errors
     
  •    
    Levetiracetam (Desitrend®)
    (coated granules in sachets)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Amber
  • Paediatrician initiation.
  • For patients up to and including 16 years of age unable to swallow tablets and in whom the liquid formulation is not appropriate or tolerated.

    MHRA Advice
    It is usually unnecessary to ensure that patients are maintained on a specific manufacturer’s product unless there are specific reasons such as patient anxiety and risk of confusion or dosing errors
     
  •    
    04.08.01  Expand sub section  Perampanel
    Perampanel tablets
    View adult BNF View SPC online View childrens BNF
    Formulary
    Amber
  • Supported by an ESCA, see link below.

    MHRA Advice
    When prescribing for epilepsy the patient should be assessed to make a clinical judgement if the same manufacturer’s product/brand is necessary taking into account factors such as seizure frequency and treatment history. Also take into account patient/carer-related factors such as their negative perceptions about alternative products and/or other issues related to the patient such co-morbid autism, mental health issues, or learning disability.

     
  • Link  ESCA: Perampanel.
    Link  NICE CG137: The epilepsies: the diagnosis and management of the epilepsies in adults and children in primary and secondary care
       
    04.08.01  Expand sub section  Phenobarbital and other barbiturates
    Controlled Drug Phenobarbital
    View adult BNF View SPC online View childrens BNF
    Formulary
    Amber
  • Tablets
  • Elixir

    MHRA Advice
    Patients being treated for epilepsy should be maintained on a specific manufacturer's product. 
  •    
    Primidone
    View adult BNF View SPC online View childrens BNF
    Formulary
    Amber
  • Tablets

    MHRA Advice
    Patients being treated for epilepsy should be maintained on a specific manufacturer's product. 
  •    
    04.08.01  Expand sub section  Phenytoin
    Phenytoin
    View adult BNF View SPC online View childrens BNF
    Formulary
    Amber
  • Capsules
  • Suspension

    MHRA Advice
    Patients being treated for epilepsy should be maintained on a specific manufacturer's product. 
  •    
    04.08.01  Expand sub section  Retigabine
     note 
    04.08.01  Expand sub section  Rufinamide to top
    Rufinamide
    View adult BNF View SPC online View childrens BNF
    Formulary
    Amber
  • Tablets
  • Supported by an ESCA, see link below.

    MHRA advises that when prescribing for epilepsy the patient should be assessed to make a clinical judgement if the same manufacturer’s product/brand is necessary taking into account factors such as seizure frequency and treatment history. Also take into account patient/carer-related factors such as their negative perceptions about alternative products and/or other issues related to the patient such co-morbid autism, mental health issues, or learning disability.
     
  • Link  ESCA: Rufinamide.
       
    04.08.01  Expand sub section  Tiagabine
    04.08.01  Expand sub section  Topiramate
    Topiramate
    View adult BNF View SPC online View childrens BNF
    Formulary
    Amber
  • Tablets

    MHRA Advice
    When prescribing for epilepsy the patient should be assessed to make a clinical judgement if the same manufacturer’s product/brand is necessary taking into account factors such as seizure frequency and treatment history. Also take into account patient/carer-related factors such as their negative perceptions about alternative products and/or other issues related to the patient such co-morbid autism, mental health issues, or learning disability.
     
  •    
    04.08.01  Expand sub section  Valproate
    Sodium Valproate
    View adult BNF View SPC online View childrens BNF
    Formulary
    Amber
    • E/C tablets
    • M/R tablets
    • Crushable tablets
    • SF liquid
    • M/R granules see Episenta®
      MHRA Advice
      Care should be taken when switching between oral formulations. The need for continued supply of a particular manufacturer’s product should be based on clinical judgement and consultation with patient and/or carer, taking into account factors such as seizure frequency and treatment history.

    Contraindicated in women of childbearing potential unless part of the Pregnancy Prevention Programme.  See MHRA guidance

     
    Link  Women of childbearing potential: Educational Risk Minimisation Materials
    Link  Medicines related to valproate: risk of abnormal pregnancy outcomes
       
    Sodium Valproate (Episenta®)
    (M/R granules in capsules or sachets)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Amber
    • Paediatrician initiation.
    • For patients with epilepsy aged up to and including 16 years of age unable to swallow tablets and who require a modified release formulation in whom other formulations are more expensive or not appropriate.
      MHRA Advice
      Care should be taken when switching between oral formulations. The need for continued supply of a particular manufacturer’s product should be based on clinical judgement and consultation with patient and/or carer, taking into account factors such as seizure frequency and treatment history.

    Contraindicated in women of childbearing potential unless part of the Pregnancy Prevention Programme.  See MHRA guidance

     
    Link  Medicines related to valproate: risk of abnormal pregnancy outcomes
    Link  Women of childbearing potential: Educational Risk Minimisation Materials
       
    04.08.01  Expand sub section  Vigabatrin
    Vigabatrin
    View adult BNF View SPC online View childrens BNF
    Formulary
    Amber
  • Tablets
  • Supported by an ESCA, see link below. 
  • Link  ESCA: Vigabatrin.
       
    04.08.01  Expand sub section  Zonisamide to top
    Zonisamide
    View adult BNF View SPC online View childrens BNF
    Formulary
    Amber
  • Capsules
  • Supported by an ESCA, see link below.

    MHRA Advice
    When prescribing for epilepsy the patient should be assessed to make a clinical judgement if the same manufacturer’s product/brand is necessary taking into account factors such as seizure frequency and treatment history. Also take into account patient/carer-related factors such as their negative perceptions about alternative products and/or other issues related to the patient such co-morbid autism, mental health issues, or learning disability.
     
  • Link  ESCA: Zonisamide.
       
    04.08.01  Expand sub section  Benzodiazepines
    Clobazam
    View adult BNF View SPC online View childrens BNF
    Formulary
    Amber
    MHRA Advice
    Care should be taken when switching between oral formulations. The need for continued supply of a particular manufacturer’s product should be based on clinical judgement and consultation with patient and/or carer, taking into account factors such as seizure frequency and treatment history.
     
       
    Clonazepam tablets
    View adult BNF View SPC online View childrens BNF
    Formulary
    Amber
    MHRA Advice
    Care should be taken when switching between oral formulations. The need for continued supply of a particular manufacturer’s product should be based on clinical judgement and consultation with patient and/or carer, taking into account factors such as seizure frequency and treatment history.
     
       
    04.08.01  Expand sub section  Other Drugs
    BrivaracetamBlack Triangle (Briviact®)
    (oral formulations)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Amber
    • Initiation by Tertiary Epilepsy Specialist only.
    • For adjunctive therapy in the treatment of partial-onset seizures with or without secondary generalisation in adult and adolescent patients from 16 years of age with severe refractory epilepsy warranting tertiary specialist input for patients who have tried three or more AEDs. The patient has used levetiracetam and has documentation of intolerance and patient is using a third line agent (perampanel, zonisamide, lacosamide, eslicarbazepine) which would be replaced by brivaracetam.
    • Supported by an ESCA
     
       
    Brivaracetam (Briviact ®)
    (injection)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Red
     
       
    Stiripentol (Diacomit®)
    (250mg capsules, sachets, 500mg capsules)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Red
    Severe myoclonic epilepsy in infancy (Dravet syndrome)
    APC supports use in Adults: for continuation of therapy started in childhood. (Note Off Label use in adults) 
       
    04.08.02  Expand sub section  Drugs used in status epilepticus
    Diazepam rectal tubes
    View adult BNF View SPC online View childrens BNF
    Formulary
    Green
     
       
    Midazolam buccal liquid (Buccolam®)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Green
     
       
    Paraldehyde
    View adult BNF View SPC online View childrens BNF
    Formulary
    Amber
  • Rectal solution 50% in olive oil 
  •    
    04.09  Expand sub section  Drugs used in parkinsonism and related disorders
    04.09.01  Expand sub section  Dopaminergic drugs used in Parkinsons disease to top
    04.09.01  Expand sub section  Dopamine receptor agonists
    Apomorphine
    View adult BNF View SPC online View childrens BNF
    Formulary
    Amber
  • Pen injector
  • Injection

  • Supported by an ESCA, see link below. 
  • Link  ESCA: Apomorphine
       
    Pramipexole IR tablets
    View adult BNF View SPC online View childrens BNF
    Formulary
    Amber
  • Supported by an ESCA, see link below.  
  • Link  ESCA: Pramipexole
       
    Ropinirole tablets
    View adult BNF View SPC online View childrens BNF
    Formulary
    Amber
  • For use in Parkinsonism - Supported by an ESCA, see link below.

  • For use in Restless Legs - Supported by an ESCA, see link below. 
  • Link  ESCA: Ropinirole in Parkinsonism.
    Link  ESCA: Ropinirole in Restless Legs syndrome.
       
    Ropinirole M/R tablets
    View adult BNF View SPC online View childrens BNF
    Formulary
    Amber
  • For use in Parkinsonism - Supported by an ESCA, see link below.

     
  • Link  ESCA: Ropinirole in Parkinsonism.
       
    Rotigotine patches
    View adult BNF View SPC online View childrens BNF
    Formulary
    Amber
  • Supported by an ESCA, see link below. 
  • Link  ESCA: Rotigotine patches.
       
    04.09.01  Expand sub section  Levodopa
    Co-Beneldopa
    View adult BNF View SPC online View childrens BNF
    Formulary
    Amber
  • Capsules
  • M/R capsules
  • Dispersible tablets 
  • Link  UKMI Q&A: How do you convert from co-beneldopa (Madopar®) prolonged-release capsules to dispersible tablets?
       
    Co-Careldopa
    View adult BNF View SPC online View childrens BNF
    Formulary
    Amber
  • Tablets
  • M/R tablets 
  •    
    Co-Careldopa and Entacapone (Stalevo®)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Amber
  • Tablets
  • Supported by an ESCA, see link below. 
  • Link  ESCA: Stalevo.
       
    04.09.01  Expand sub section  Monoamine-oxidase-B inhibitors
    Rasagiline  (Azilect®)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Amber
  • Tablets
  • Supported by an ESCA, see link below. 
  • Link  ESCA: Rasagiline
       
    Selegiline Hydrochloride
    View adult BNF View SPC online View childrens BNF
    Formulary
    Amber
  • Tablets
  • Supported by an ESCA, see link below. 
  • Link  ESCA: Selegiline.
       
    04.09.01  Expand sub section  Catachol-O-methyltransferase inhibitors
    Entacapone
    View adult BNF View SPC online View childrens BNF
    Formulary
    Amber
  • Tablets
  • Supported by an ESCA, see link below. 
  • Link  ESCA: Entacapone.
       
    Opicapone (Ongentys®)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Amber
  • Second-line therapy to entacapone, in patients who fail to respond to, or are intolerant of, entacapone, in situations where apomorphine therapy has been considered.

  • Supported by an ESCA, see link below
     
  • Link  ESCA: Opicapone
       
    04.09.01  Expand sub section  Amantadine to top
    Amantadine Hydrochloride
    View adult BNF View SPC online View childrens BNF
    Formulary
    Amber
  • Capsules
  • Syrup- for patients with swallowing difficulties 
  •    
    04.09.01  Expand sub section  Mild to moderate dementia in Parkinsons disease
    04.09.02  Expand sub section  Antimuscarinic drugs used in parkinsonism
    Procyclidine
    View adult BNF View SPC online View childrens BNF
    Formulary
    Green
  • Tablets
  • SF syrup
     
  •    
    Procyclidine
    View adult BNF View SPC online View childrens BNF
    Formulary
    Red
  • Injection 
  •    
    Trihexyphenidyl
    View adult BNF View SPC online View childrens BNF
    Formulary
    Amber
  • Tablets 
  •    
    04.09.03  Expand sub section  Drugs used in essential tremor, chorea, tics, and related disorders
    Haloperidol
    View adult BNF View SPC online View childrens BNF
    Formulary
    Amber
     
       
    Piracetam
    View adult BNF View SPC online View childrens BNF
    Formulary
    Amber
  • Tablets
  • Oral solution 
  •    
    Primidone
    View adult BNF View SPC online View childrens BNF
    Formulary
    Amber
     
       
    Propranolol
    View adult BNF View SPC online View childrens BNF
    Formulary
    Green
     
       
    Riluzole (Rilutek®)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Amber
  • Supported by an ESCA, see link below. 
  • Link  ESCA: Riluzole
    Link  NICE TA20: Motor neurone disease - riluzole
       
    Tetrabenazine
    View adult BNF View SPC online View childrens BNF
    Formulary
    Amber
  • Tablets 
  •    
    04.09.04  Expand sub section  Restless leg syndrome
    04.10  Expand sub section  Drugs used in substance dependence to top
    04.10.01  Expand sub section  Alcohol dependence
    Acamprosate (Campral EC®)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Amber
     
       
    Chlordiazepoxide
    View adult BNF View SPC online View childrens BNF
    Formulary
    Green
  • Adjunct in acute alcohol withdrawal 
  •    
    Diazepam
    View adult BNF View SPC online View childrens BNF
    Formulary
    Green
     
       
    Disulfiram (Antabuse®)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Amber
     
       
    Nalmefene
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red
    Restricted to Specialist Substance Misuse Services only
  • Reach Out Recovery (CRI) in Birmingham. Single point of contact 24/7 Tel: 0121 227 5890 Link Reach Out Recovery website
  • Swanswell in Sandwell Tel: 0121 553 1333 Link to Swanswell website
  • SIAS in Solihull Tel:0121 301 3600 Link to SIAS website


    The Nalmefene for reducing alcohol consumption technology appraisal (TA325) recommends this drug as a possible treatment for people with alcohol dependence who:
    • are still drinking more than 7.5 units per day (for men) and more than 5 units per day (for women) 2 weeks after an initial assessment and
    • do not have physical withdrawal symptoms and
    • do not need to either stop drinking straight away or stop drinking completely
    The guidance also recommends that nalmefene should only be prescribed in conjunction with continuous psychosocial support focused on treatment adherence and reducing alcohol consumption.
     
  • Link  NICE TA 325: Nalmefene for reducing alcohol consumption in people with alcohol dependence
       
    Naltrexone
    View adult BNF View SPC online View childrens BNF
    Formulary
    Amber
  • Useful as an adjunct in the treatment of alcohol dependence after a successful withdrawal.  
  •    
    04.10.02  Expand sub section  Nicotine dependence
    Nicotine replacement therapy
    View adult BNF View SPC online View childrens BNF
    First Choice
    Green
     
    Bupropion Hydrochloride (Zyban®)
    View adult BNF View SPC online View childrens BNF
    Second Choice
    Green
     
       
    Varenicline (Champix®)
    View adult BNF View SPC online View childrens BNF
    Second Choice
    Green
     
    Link  NICE TA123: Varenicline
       
    04.10.03  Expand sub section  Opioid dependence
    04.10.03  Expand sub section  Opioid substitution therapy
    Controlled Drug Methadone oral solution
    View adult BNF View SPC online View childrens BNF
    Formulary
    Amber
     
       
    Controlled Drug Buprenorphine S/L tablets
    View adult BNF View SPC online View childrens BNF
    Formulary
    Amber
     
       
    Controlled Drug Methadone tablets
    View adult BNF View SPC online View childrens BNF
    Formulary
    Red
     
       
    Controlled Drug Methadone injection
    View adult BNF View SPC online View childrens BNF
    Formulary
    Red
     
       
    04.10.03  Expand sub section  Adjunctive therapy and symptomatic treatment to top
    Lofexidine (BritLofex®)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Red
     
       
    04.10.03  Expand sub section  Opioid-receptor antagonists
    Naloxone
    View adult BNF View SPC online View childrens BNF
    Formulary
    Green
  • Used to reverse opioid overdose.  
  •    
    Naltrexone (Nalorex®)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Amber
     
    Link  NICE TA115: Drug misuse - naltrexone
       
    04.11  Expand sub section  Drugs for dementia
    Donepezil
    View adult BNF View SPC online View childrens BNF
    Formulary
    Red
  • tablets
  • orodispersible 10mg tablets sugar free (pack of 28)


    The APC's view is that on clinical grounds, the status of these drugs for dementia should be amber, with a framework in place in primary care before transfer.
    HOWEVER, until the commissioning arrangements have been agreed to allow safe transfer of patient care, the status will remain RED.

     
  •    
    Galantamine
    View adult BNF View SPC online View childrens BNF
    Formulary
    Red
  • tablets
  • M/R capsules
  • Oral solution

    The APC's view is that on clinical grounds, the status of these drugs for dementia should be amber, with a framework in place in primary care before transfer.
    HOWEVER, until the commissioning arrangements have been agreed to allow safe transfer of patient care, the status will remain RED.

     
  •    
    Memantine
    View adult BNF View SPC online View childrens BNF
    Formulary
    Red
  • Tablets

    The APC's view is that on clinical grounds, the status of these drugs for dementia should be amber, with a framework in place in primary care before transfer.
    HOWEVER, until the commissioning arrangements have been agreed to allow safe transfer of patient care, the status will remain RED.
     
  •    
    Rivastigmine
    View adult BNF View SPC online View childrens BNF
    Formulary
    Red
  • capsules
  • patches

    The APC's view is that on clinical grounds, the status of these drugs for dementia should be amber, with a framework in place in primary care before transfer.
    HOWEVER, until the commissioning arrangements have been agreed to allow safe transfer of patient care, the status will remain RED.
     
  •    
    04.12  Expand sub section  Drugs for sialorrhea
    Glycopyrronium bromide (Sialanar®)
    (400mcg/ml)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Amber
  • Approved on formulary December 2017
  • Specialist initiation and stabilisation
  • £££ 
  •    
     ....
     Non Formulary Items
    Acetazolamide

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Controlled Drug  Alfentanyl Sublingual Spray 5 mg in 5mL

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Almotriptan  (Almogran®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Alprazolam

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Alprazolam  (Xanax®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Amitriptyline and perphenazine  (Triptafen®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Amitriptyline and perphenazine  (Triptafen-M®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Controlled Drug  Amobarbital (amylobarbitone) and secobarbital (quinalbarbitone)  (Tuinal®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Controlled Drug  Amobarbital (amylobrbitone)  (Sodium Amytal®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Aspirin  (Caprin®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Aspirin  (Nu-Seals® Aspirin)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Aspirin and codeine  (Co-codaprin®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Aspirin and metoclopramide  (MigraMax®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Aspirin and papaveretum  (Aspav®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Benperidol  (Anquil®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Benzatropine

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Black
    DISCONTINUED
     
    Bromocriptine

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Black
    No longer recommended in Parkinson disease
     
    Controlled Drug  Buprenorphine and Naloxone  (Suboxone®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Controlled Drug  Butobarbital (butobarbitone)  (Soneryl®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Cabergoline

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Black
    No longer recommended in Parkinson Disease
     
    Capsaicin
    (8% patch)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Black
     
    Cinnarizine and Dimenhydrinate  (Arlevert®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Clomethiazole  (Heminevrin®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Clonazepam

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Clonazepam

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Clonidine Hydrochloride

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Black
     
    Co-proxamol

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Black
  • In line with NHS England's Guidance for CCGs: Items which should not routinely be prescribed in primary care (Dec 2017)

    Click here to access guidance
  • Link  Patient Information Leaflet
     
    Controlled Drug  Dextromoramide

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Controlled Drug  Dihydrocodeine Tartrate  (DF 118 Forte®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Controlled Drug  Dihydrocodeine Tartrate  (DHC Continus®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Controlled Drug  Dipipanone  (Diconal®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Dolasetron Mesilate  (Anzemet®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Dosulepin

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Black
  • Tablets
  • Capsules
  • Sugar free solution
  • Link  Patient Information Leaflet
     
    Doxepin

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Black
     
    Droperidol  (Xomolix®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Eletriptan  (Relpax®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Ergotamine Tartrate  (Cafergot®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Ergotamine Tartrate  (Migril®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Escitalopram  (Cipralex®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Black
     
    Fentanyl Buccal Film  (Breakyl)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Link  Patient Information Leaflet
     
    Flupentixol  (Fluanxol®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Fluphenazine Hydrochloride  (Moditen®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Flurazepam  (Dalmane®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Fluvoxamine Maleate  (Faverin®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Fluvoxamine Maleate  (Fluvoxamine®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Fosaprepitant  (Ivemend®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Fosphenytoin Sodium  (Pro-Epanutin®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Frovatriptan

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Controlled Drug  Hydromorphone  (Palladone®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Black
     
    Controlled Drug  Hydromorphone Hydrochloride  (Palladone® SR)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Black
     
    Isocarboxazid

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Isometheptene Mucate  (Midrid®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Ketamine oral solution

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Lisuride

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Loprazolam

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Lurasidone  (Latuda®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Black
     
    Controlled Drug  Meprobamate

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Methysergide  (Deseril®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Mianserin

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Controlled Drug  Morphine and cyclizine  (Cyclimorph®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Nabilone

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Naltrexone- bupropion  (Mysimba®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
  • Not supported by NICE
  • Link  NICE TA 494: Naltrexone–bupropion for managing overweight and obesity
     
    Naratriptan

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Black
  • Removed from formulary May 2017 following 6-fold price increase. More cost-effective options available on formulary.
  •  
    Nefopam

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Black
     
    Nefopam  (Acupan®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Nitrazepam
    (suspension, tablets)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Black
     
    Nortriptyline

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Nortriptyline

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Black
     
    Orphenadrine

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Black
  • Discontinued by manufacturer December 2015
  •  
    Orphenadrine

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Black
    Discontinued by manufacturer December 2015
     
    Paliperidone
    (oral)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Black
     
    Controlled Drug  Papaveretum

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Black
     
    Paracetamol  (Panadol OA®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Paracetamol and codeine  (Co-codamol® 8/500)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Paracetamol and dihydrocodeine  (Co-dydramol®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Black
     
    Paracetamol and dihydrocodeine  (Remedeine®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Paracetamol and methionine  (Pardote®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Paracetamol and metoclopramide  (Paramax®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Controlled Drug  Pentazocine

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Pergolide

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Black
    No longer recommended in Parkinson Disease
     
    Perphenazine

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Controlled Drug  Pethidine Hydrochloride and promethazine  (Pamergan® P100)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Controlled Drug  Pethidine tablets

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Black
     
    Phenelzine  (Nardil®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Phenytoin

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Pipotiazine Palmitate  (Piportil® Depot)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Pramipexole M/R tablets

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Black
     
    Pregabalin

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Prochlorperazine

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Black
     
    Promazine Hydrochloride  (Promazine®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Black
     
    Promethazine teoclate  (Avomine®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Promethazine Teoclate  (Avomine®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Reboxetine  (Edronex®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Black
     
    Retigabine
    (Tablets)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Black
  • Advance notification of retigabine discontinuation from June 2017. Advice to healthcare professionals.
    Click here
  • Link  NICE TA232: Retigabine for the adjunctive treatment of adults with partial onset seizures in epilepsy with and without secondary generalisation
     
    Rimonabant  (Acomplia®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Safinamide

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Controlled Drug  Secobarbital (quinalbarbitone)  (Seconal Sodium® )

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Sertindole  (Serdolect®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Sibutramine Hydrochloride  (Reductil®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Sodium Oxybate  (Xyrem®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Sodium valproate

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Sodium valproate

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Sumatriptan  (Imigran® Radis)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Controlled Drug  Targinact (Oxycodone/Naloxone)  (Targinact®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Black
    Link  Patient Information Leaflet
     
    Tiagabine  (Gabitril®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Tolcapone  (Tasmar®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Tolfenamic Acid  (Clotam®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Topiramate

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Tramadol Hydrochloride and paracetamol  (Tramacet®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Black
  • In line with NHS England's Guidance for CCGs: Items which should not routinely be prescribed in primary care (Dec 2017)

    Click here to access guidance
  • Link  Patient Information Leaflet
     
    Tramadol MR capsules

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Black
     
    Tramadol oral drops

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Tranylcypromine

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Triclofos Sodium  (Triclofos® oral Solution BP (Triclofos Elixir))

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Black
     
    Trimipramine

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Black
  • Tablets
  • Capsules
  • Link  Patient Information Leaflet
     
    Tropisetron  (Navoban®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Zaleplon  (Sonata®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Black
     
    Ziprasidone  (Zeldox®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Zotepine

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Black
    Discontinued in 2011
     
    Zuclopenthixol Acetate  (Clopixol Acuphase®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
      
    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 children's BNF
    click to search medicines.org.uk
    Link to SPCs
    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

    Green

    Medicines which are suitable for initiation and maintenance prescribing by primary and secondary care clinicians. These medicines should be initiated and prescribed within their licensed indications.  

    Amber

    Initiation and maintenance of prescribing by Specialists and transfer to Primary Care prescribing when appropriate, or initiation and maintenance of prescribing in Primary Care following recommendation from a Specialist.

    Some amber medicines require agreement with the local (internal) medicines committee prior to initiation; others may require a framework to support safe transfer and maintenance of care such as a RICaD or ESCA. The Formulary will be annotated to reflect these requirements.   

    Red

    Medicines for initiation and maintenance prescribing by Specialists only  

    Black

    Non-formulary medicines- medicines not recommended for routine primary care prescribing.  

    Grey

    Positive NICE TA and /or awaiting local clarification on place in therapy ; Please contact your Medicines Optimisation team for more information.  

    netFormulary