| Formulary Chapter 4: Central nervous system - Full Chapter
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| 04.01 |
Hypnotics and anxiolytics |
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Melatonin (Circadin ®)
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Formulary
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Melatonin
(capsules)
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 Unlicensed
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Temazepam
(tablets)
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Formulary
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From Monday 1 June 2015 prescriptions for temazepam will be required to meet full prescription requirements for Schedule 3 controlled drugs (CDs).
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 Legislative changes to prescription writing requirements for temazepam
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Diazepam liquid
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Formulary
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Inpatient use and prison settings only
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Temazepam
(SF solution)
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Formulary
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From Monday 1 June 2015 prescriptions for temazepam will be required to meet full prescription requirements for Schedule 3 controlled drugs (CDs).
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Legislative changes to prescription writing requirements for temazepam
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| 04.01.01 |
Zaleplon, Zolpidem and Zopiclone |
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Zopiclone
(tablets)
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First Choice
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NICE TA77: Zaleplon, zolpidem and zopiclone for the management of insomnia
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Zolpidem
(tablets)
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Formulary
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NICE TA77: Zaleplon, zolpidem and zopiclone for the management of insomnia
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| 04.01.01 |
Chloral and derivatives |
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Chloral Hydrate
(solution)
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Formulary
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| 04.01.01 |
Clomethiazole (Chlormethiazole) |
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Promethazine Hydrochloride
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Formulary
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| 04.01.02 |
Anxiolytics |
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Diazepam
(tablets)
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Formulary
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Oxazepam
(tablets)
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Formulary
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Chlordiazepoxide
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Formulary
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Adjunct in acute alcohol withdrawal
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Lorazepam
(tablets)
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Formulary
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Diazepam
(injection)
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Formulary
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Lorazepam
(injection)
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Formulary
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Oct 2018: supply issues with injection
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SPS: Shortage of Ativan (lorazepam) Injection 4 mg in 1 ml
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Buspirone Hydrochloride
(tablets)
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Formulary
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££ Second line
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| 04.01.03 |
Barbiturates |
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| 04.02 |
Drugs used in psychoses and related disorders |
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| 04.02.01 |
Antipsychotic Drugs |
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Chlorpromazine (oral)
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Formulary
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- tablets
- syrup
- Supported by ESCA, see link below.
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ESCA: Antipsychotics (oral)
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Chlorpromazine injection
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Formulary
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Flupentixol tablets
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Formulary
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- Supported by ESCA, see link below.
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ESCA: Antipsychotics (oral)
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Haloperidol (oral)
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Formulary
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- tablets
- capsules
- oral liquid sugar-free
- Supported by ESCA, see link below.
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ESCA: Antipsychotics (oral)
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Haloperidol injection
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Formulary
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- For rapid tranquilisation
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Levomepromazine injection
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Formulary
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Levomepromazine tablets
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Formulary
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- Supported by ESCA, see link below.
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ESCA: Antipsychotics (oral)
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Penfluridol (Oral)
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Formulary
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Pericyazine (oral)
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Formulary
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- £££
- Supported by ESCA, see link below.
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ESCA: Antipsychotics (oral)
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Perphenazine (oral)
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Formulary
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- £££
- Supported by ESCA, see link below.
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ESCA: Antipsychotics (oral)
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Sulpiride (oral)
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Formulary
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- Supported by ESCA, see link below.
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ESCA: Antipsychotics (oral)
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Trifluoperazine (oral)
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Formulary
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- tablets
- oral solution sugar-free
- Supported by ESCA, see link below.
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ESCA: Antipsychotics (Oral)
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Zuclopenthixol tablets
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Formulary
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- Supported by ESCA, see link below.
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ESCA: Antipsychotics (oral)
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| 04.02.01 |
First-Generation Antipsychotic Drugs |
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| 04.02.01 |
Second-Generation Antipsychotic Drugs |
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Amisulpride (oral)
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Formulary
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- tablets
- solution
- Supported by ESCA, see link below.
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ESCA: Antipsychotics (oral)
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Aripiprazole tablets
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Formulary
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- Supported by ESCA, see link below.
- use in Tourette's syndrome approved
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ESCA: Antipsychotics (oral)
NICE TA213: Aripiprazole for the treatment of schizophrenia in people aged 15 -17 years
NICE TA292: Bipolar disorder (children) - aripiprazole
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Olanzapine (oral)
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Formulary
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- tablets
- orodispersible tablets
- Supported by ESCA, see link below.
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ESCA: Antipsychotics (oral)
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Quetiapine tablets
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Formulary
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- Supported by ESCA, see link below.
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ESCA: Antipsychotics (oral)
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Quetiapine Modified-release preparations
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Formulary
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- 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.
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ESCA: Antipsychotics (oral)
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Risperidone (oral)
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Formulary
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- tablets
- liquid
- Supported by ESCA, see link below.
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ESCA: Antipsychotics (oral)
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Clozapine tablets
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Formulary
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| 04.02.02 |
Antipsychotic depot injections |
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Aripiprazole (Abilify Maintena®)
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Formulary
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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.
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Flupentixol Decanoate
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Formulary
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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.
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Fluphenazine Decanoate (Modecate®)
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Formulary
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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.
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Haloperidol (Haldol Decanoate®)
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Formulary
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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.
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Olanzapine Embonate (ZypAdhera®)
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Formulary
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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.
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Paliperidone (Trevicta®)
(Three-monthly depot injection)
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Formulary
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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.
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Paliperidone (Xeplion®)
(Monthly depot injection)
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Formulary
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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.
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Risperidone (Risperdal Consta®)
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Formulary
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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.
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Zuclopenthixol Decanoate
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Formulary
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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.
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| 04.02.03 |
Drugs used for mania and hypomania |
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Lamotrigine
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Formulary
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| 04.02.03 |
Drugs to manage Antipsychotic side effects |
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Procyclidine
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Formulary
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Hyoscine
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Formulary
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Trihexyphenidyl
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Formulary
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Pirenzipine (unlicensed)
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Formulary
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Hospital only
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Carbamazepine
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Formulary
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| 04.02.03 |
Valproic acid |
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Valproic Acid (Depakote®)
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Formulary
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 Use in men and women of non-child bearing potential
 Use in women and girls of childbearing potential (all indications). ESCA link below
Contraindicated in women of childbearing potential unless part of the Pregnancy Prevention Programme. See MHRA guidance
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BSSE APC ESCA Valproate medicines
Women of childbearing potential: Educational Risk Minimisation Materials
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Lithium Carbonate M/R tablets (Priadel®)
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Formulary
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- Supported by an ESCA, see link below.
- APC preferred brand is Priadel
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ESCA: Lithium
Lithium (GP monitoring) ESCA Shared care documents from Black Country Partnership NHS FT can be accessed from this here
Lithium (Hospital Monitoring) ESCA Shared care documents from Black Country Partnership NHS FT can be accessed from this here
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Lithium Citrate liquid
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Formulary
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- Supported by an ESCA, see link below.
- APC preferred brand Priadel
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ESCA: Lithium.
Lithium (GP monitoring) ESCA Shared care documents from Black Country Partnership NHS FT can be accessed from this here
Lithium (Hospital Monitoring) ESCA Shared care documents from Black Country Partnership NHS FT can be accessed from this here
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| 04.03 |
Antidepressant drugs |
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| 04.03.01 |
Tricyclic and related antidepressant drugs |
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| 04.03.01 |
Tricyclic antidepressants |
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Amitriptyline
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Formulary
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Tablets
Sugar Free solution £££
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Clomipramine
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Formulary
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Imipramine
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Formulary
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Tablets
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Lofepramine
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Formulary
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Tablets
Suspension
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| 04.03.01 |
Related antidepressants |
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Trazodone
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Formulary
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Tablets
Capsules
Sugar free liquid
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| 04.03.02 |
Monoamine-oxidase inhibitors |
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Moclobemide tablets
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Formulary
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| 04.03.03 |
Selective serotonin re-uptake inhibitors |
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Fluoxetine capsules
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First Choice
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Sertraline tablets
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First Choice
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Citalopram oral drops
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Formulary
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- Not recommended routinely due to QT prolongation risk
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Citalopram tablets
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Formulary
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- Not recommended routinely due to QT prolongation risk
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UKMI Q&A: What issues should be considered regarding drug induced QT prolongation?
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Fluoxetine liquid
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Formulary
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Paroxetine tablets
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Formulary
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Vortioxetine
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Formulary
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- In line with NICE
Specialist initiation and stabilisation before transfer to Primary Care
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NICE TA367: Vortioxetine for treating major depressive episodes (Nov 2015)
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| 04.03.04 |
Other antidepressant drugs |
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Pregabalin
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Second Choice
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- for generalised anxiety disorder
- ££
Schedule 3 Controlled Drug as of 01/04/2019
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NHS England: Rescheduling of Gabapentin and Pregabalin as Schedule 3 Controlled Drugs
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Agomelatine (Valdoxan®)
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Formulary
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Duloxetine (Cymbalta®)
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Formulary
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Mirtazapine
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Formulary
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tablets
orodispersible tablets ££
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Venlafaxine tablets
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Formulary
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Venlafaxine M/R
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Formulary
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APC preferred brands
- 1st choice: Vensir XL capsules (suggest switching generic prescriptions to this agent)
- 2nd choice: Venlalic XL tablets
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Bupropion
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Formulary
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off label use
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Tryptophan
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Formulary
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| 04.04 |
CNS stimulants and other drugs used for attention deficit hyperactivity disorder |
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Shared care documents from Black Country Partnership NHS FT can be accessed from this here |
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Atomoxetine (Strattera ®)
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Formulary
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Please note that commissioning discussion is underway. However the present status is as follows:-
Birmingham and Solihull CCG
Age 6 and over - Solihull practices. Supported with ESCA
Age 16 and over - Birmingham practices. Supported with ESCA
 Age under 16 - Birmingham practices
Sandwell and West Birmingham CCG
Age 6 and over. Supported with ESCA. Click here for shared care document for patients seen by Black Country Partnership NHS FT
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ESCA: Atomoxetine
Shared care documents from Black Country Partnership NHS FT can be accessed here
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Dexamfetamine
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Formulary
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Please note that commissioning discussion is underway. However the present status is as follows:-
Birmingham and Solihull CCG
Age 6 and over - Solihull practices. Supported with ESCA
Age 16 and over - Birmingham practices. Supported with ESCA
Age under 16 - Birmingham practices
Sandwell and West Birmingham CCG
Age 6 and over. Supported with ESCA. Click here for shared care document for patients seen by Black Country Partnership NHS FT
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ESCA: Dexamfetamine as Amfexa
Shared care documents from Black Country Partnership NHS FT can be accessed here
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Guanfacine (Intuniv®)
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Formulary
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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.
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Lisdexamfetamine
(Elvanse®)
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Formulary
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Please note that commissioning discussion is underway. However the present status is as follows:-
Birmingham and Solihull CCG
Age 6 and over - Solihull practices. Supported with ESCA
Age 16 and over - Birmingham practices. Supported with ESCA
Age under 16 - Birmingham practices
Sandwell and West Birmingham CCG
Age 6 and over. Supported with ESCA. Click here for shared care document for patients seen by Black Country Partnership NHS FT
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ESCA: Lisdexamfetamine
Shared care documents from Black Country Partnership NHS FT can be accessed here
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Methylphenidate Modified-Release (tablets/capsules)
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Formulary
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Please note that commissioning discussion is underway. However the present status is as follows:-
Birmingham and Solihull CCG
Age 6 and over - Solihull practices. Supported with ESCA
Age 16 and over - Birmingham practices. Supported with ESCA
Age under 16 - Birmingham practices
Sandwell and West Birmingham CCG
Age 6 and over. Supported with ESCA. Click here for shared care document for patients seen by Black Country Partnership NHS FT
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ESCA: Methylphenidate
Shared care documents from Black Country Partnership NHS FT can be accessed here
Medicines Q&A: Methylphenidate for adults with ADHD
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Methylphenidate tablets
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Formulary
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Please note that commissioning discussion is underway. However the present status is as follows:-
Birmingham and Solihull CCG
Age 6 and over - Solihull practices. Supported with ESCA
Age 16 and over - Birmingham practices. Supported with ESCA
Age under 16 - Birmingham practices
Sandwell and West Birmingham CCG
Age 6 and over. Supported with ESCA. Click here for shared care document for patients seen by Black Country Partnership NHS FT
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ESCA: Methylphenidate
Shared care documents from Black Country Partnership NHS FT can be accessed here
Medicines Q&A: Methylphenidate for adults with ADHD
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Modafinil
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Formulary
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| 04.05 |
Drugs used in the treatment of obesity |
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| 04.05.01 |
Anti-obesity drugs acting on the gastro-intestingal tract |
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Orlistat capsules
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Formulary
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Orlistat 60mg capsules - Over the counter preparation suitable for self-care/purchase if appropriate
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| 04.05.02 |
Centrally acting appetite suppressants |
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| 04.06 |
Drugs used in nausea and vertigo |
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Dexamethasone tablets
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Formulary
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for resistant nausea and vomitting
£££
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| 04.06 |
Vomiting during pregnancy |
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| 04.06 |
Postoperative nausea and vomiting |
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| 04.06 |
Other vestibular disorders |
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| 04.06 |
Cytotoxic chemotherapy |
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Dexamethasone injection
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Formulary
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Cinnarizine tablets
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Formulary
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Cyclizine
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Formulary
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tablets
injection- for palliative care
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Promethazine Hydrochloride
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Formulary
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| 04.06 |
Phenothiazines and related drugs |
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Levomepromazine
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Formulary
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palliative care only
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Prochlorperazine
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Formulary
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tablets
buccal tablets
syrup
injection
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SPS: Shortage of Stemetil (prochlorperazine) 5mg in 5ml oral syrup
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Chlorpromazine Hydrochloride
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Formulary
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nausea
hyperemesis in pregnancy (off label use)
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| 04.06 |
Domperidone and metoclopramide |
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Domperidone
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Formulary
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tablets- short term use only
suppositories
SF suspension £££ - for patients with swallowing difficulties only
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Metoclopramide
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Formulary
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tablets
SF solution- £££-for patients with swallowing difficulties only
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Metoclopramide injection
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Formulary
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in palliative care
other indications
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Granisetron tablets
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Formulary
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Granisetron transdermal patch (Sancuso®)
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Formulary
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for use in oncology patients only
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Ondansetron
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Formulary
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- tablets
- melt tablets
- suppositories
- injection
- SF syrup - swallowing difficulties only
 hyperemesis in pregnancy (off label)
palliative care (off label)
Chemotherapy
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Palonosetron (Aloxi®)
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Formulary
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| 04.06 |
Neurokinin receptor antagonist |
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Aprepitant (Emend®)
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Formulary
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for use with chemotherapy only
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Hyoscine Hydrobromide
(300 microgram tablets)
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Formulary
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UKMI Q&A: Hypersalivation – can hyoscine hydrobromide be used to treat it?
UKMI Q&A: Hypersalivation treatment options
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Hyoscine Hydrobromide
(patch)
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Formulary
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£££
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| 04.06 |
Other drugs for Ménière's disease |
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Betahistine Dihydrochloride
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Formulary
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| 04.07.01 |
Non-opioid analgesics and compound analgesic preparations |
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| 04.07.01 |
Compound analgesic preparations |
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Aspirin 300mg dispersible tablets
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Formulary
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topical analgesia- for gargling
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Paracetamol
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Formulary
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tablets
SF suspension
500mg soluble tablets- high sodium content.Only for patients with swallowing difficulties.
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UKMI Q&A: Can Breastfeeding mothers take paracetamol?
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Paracetamol
(suppositories)
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Formulary
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Paracetamol (Perfalgan®)
(intravenous infusion)
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Formulary
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Paracetamol and codeine (Co-codamol ®15/500)
(tablets/ capsules)
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Formulary
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£££
Limited evidence.
For elderly community who would not tolerate separate ingredients or to support a step down review.
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Paracetamol and codeine (Co-codamol ®15/500)
(effervescent tablets)
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Formulary
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£££
Limited evidence.
High sodium content.
For elderly community who would not tolerate separate ingredients or to support a step down review.
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Paracetamol and codeine (Co-codamol® 30/500)
(effervescent tablets)
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Formulary
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£££
High sodium content
Use in chronic pain only, and for patients with swallowing difficulties.
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Paracetamol and codeine (Co-codamol® 30/500)
(tablets/capsules)
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Formulary
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- Use with caution in patients aged over 65
- Contraindicated in children below the age of 12
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| 04.07.02 |
Opioid analgesics |
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Buprenorphine patches
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Formulary
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- for specialist initiation: specialist pain clinics, palliative care and for patients with swallowing difficulties
Patches should be prescribed by BRAND
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Buprenorphine sublingual tablets
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Formulary
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For use in opioid dependence, see section 4.10.3
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Codeine Phosphate
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Formulary
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- tablets
- 25mg/5ml syrup
- Use with caution in patients aged over 65
- Contraindicated in children below the age of 12
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Codeine Phosphate injection
(60mg/mL)
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Formulary
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Diamorphine salts
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Formulary
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Dihydrocodeine
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Formulary
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tablets
oral solution- for patients with swallowing difficulties
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Fentanyl patches
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Formulary
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Fentanyl lozenges
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Formulary
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Palliative care only
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Birmingham and Solihull CCG Policy for items which should not be prescribed in primary care
NHS Clinical Commissioners Items which should not routinely be prescribed in primary care: Guidance for CCGs
 Patient Information Leaflet
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Fentanyl Nasal Spray
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Formulary
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Birmingham and Solihull CCG Policy for items which should not be prescribed in primary care
NHS Clinical Commissioners Items which should not routinely be prescribed in primary care: Guidance for CCGs
Patient Information Leaflet
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Fentanyl sublingual tablets
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Formulary
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Palliative care only
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Birmingham and Solihull CCG Policy for items which should not be prescribed in primary care
NHS Clinical Commissioners Items which should not routinely be prescribed in primary care: Guidance for CCGs
Patient Information Leaflet
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Meptazinol (Meptid®)
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Formulary
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Methadone
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Formulary
|
For use in opioid dependence, see section 4.10.3
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Morphine
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Formulary
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tablets
M/R tablets
M/R capsules
Oral solution
injection
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Morphine
|
Formulary
|
suppositories
100mg/100ml PCA
5mg/5ml intrathecal injection
pre-filled syringes
|
|
|
Oxycodone
|
Formulary
|
- capsules
- M/R tablets
- SF solution
- For patients who do not tolerate morphine
|
|
|
Oxycodone injection
|
Formulary
|
|
|
|
Pethidine injection
|
Formulary
|
|
|
|
Tapentadol (Palexia®)
|
Formulary
|
|
|
|
Tramadol capsules
|
Formulary
|
- Third line after morphine and codeine
|
UKMI Q&A: risk of developing Serotonin Syndrome following concomitant use of tramadol with selective serotonin reuptake inhibitors (SSRIs)
|
Tramadol soluble tablets
|
Formulary
|
- Third line after morphine and codeine
- For patients with swallowing difficulties
- £££
|
|
|
|
|
|
|
|
|
| 04.07.02 |
Weak opioids |
|
|
|
|
| 04.07.02 |
Breakthrough pain |
|
|
|
|
|
|
| 04.07.03 |
Neuropathic pain |
|
|
Amitriptyline
|
Formulary
|
1st line
low abuse potential, low cost
off label use
|
|
|
Gabapentin
(tablets, capsules)
|
Formulary
|
- 2nd line
- please be aware of the abuse potential associated with this class of agent
Schedule 3 Controlled Drug as of 01/04/2019
|
NHS England: Advice for prescribers on the risk of the misuse of pregabalin and gabapentin
NHS England: Rescheduling of Gabapentin and Pregabalin as Schedule 3 Controlled Drugs
|
Duloxetine (Cymbalta®)
|
Formulary
|
3rd line after gabapentin
low abuse potential , high cost £££
on advice of specialist
not licensed for use in children
|
|
|
Pregabalin
|
Formulary
|
- 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.
Schedule 3 Controlled Drug as of 01/04/2019
|
NHS England: Advice for prescribers on the risk of the misuse of pregabalin and gabapentin
NHS England: Rescheduling of Gabapentin and Pregabalin as Schedule 3 Controlled Drugs
|
|
|
|
|
| 04.07.03 |
Trigeminal neuralgia |
|
|
Carbamazepine
|
Formulary
|
trigeminal neuralgia only
|
|
|
| 04.07.03 |
Postherpetic neuralgia |
|
|
Capsaicin
(cream 0.075%)
|
Formulary
|
|
|
|
Lidocaine 5% patch (Versatis®)
(patch)
|
Formulary
|
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)
|
Birmingham and Solihull CCG Policy for items which should not be prescribed in primary care
link to chapter 15
NHS Clinical Commissioners Items which should not routinely be prescribed in primary care: Guidance for CCGs
Patient Information Leaflet
|
| 04.07.04 |
Antimigraine drugs |
|
|
| 04.07.04.01 |
Treatment of the acute migraine attack |
|
|
| 04.07.04.01 |
Analgesics |
|
|
Analgesics (Migraleve Pink ®)
|
Formulary
|
|
|
|
| 04.07.04.01 |
5HT1 agonists |
|
|
Rizatriptan
|
Formulary
|
Tablets
Orodispersible tablets SF- reserve for patients who are vomiting due to migraine
 Wafer/oral lyophilisates SF £££
|
|
|
Sumatriptan
|
Formulary
|
Tablets (prescribe as generic)
Nasal spray £££
injection £££
|
|
|
Zolmitriptan
|
Formulary
|
Tablets
|
|
|
|
|
|
|
| 04.07.04.01 |
Ergot alkaloids |
|
|
|
|
| 04.07.04.01 |
Other drugs for migrane |
|
|
| 04.07.04.02 |
Prophylaxis of migraine |
|
|
Amitriptyline
|
Formulary
|
|
|
|
Botulinum Toxin Type A (botox®)
|
Formulary
|
In line with NICE
|
NICE TA260: Botox for migraine prophylaxis
|
Pizotifen
|
Formulary
|
Tablets
Elixir
|
|
|
Propranolol
|
Formulary
|
|
|
|
Topiramate
|
Formulary
|
- Amber specialist recommendation
|
|
|
Flunarizine
|
Formulary
|
Unlicensed medicine
|
|
|
|
|
|
|
|
|
|
|
| 04.08.01 |
Control of epilepsy |
|
|
| |
|
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 |
Partial seizures with or without secondary generalisation |
|
|
| 04.08.01 |
Generalised seizures |
|
|
| 04.08.01 |
Carbamazepine and Oxcarbazepine |
|
|
Carbamazepine
|
Formulary
|
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
|
UKMI Q&A: Why is there a limit on the dose and duration of use for carbamazepine suppositories?
|
Eslicarbazepine
|
Formulary
|
|
ESCA: Eslicarbazepine
|
Oxcarbazepine
|
Formulary
|
- 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.
|
|
|
|
|
Ethosuximide capsules
|
Formulary
|
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 |
Gabapentin and pregabalin |
|
|
Gabapentin
|
Formulary
|
- 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
Schedule 3 Controlled Drug as of 01/04/2019
|
NHS England: Rescheduling of Gabapentin and Pregabalin as Schedule 3 Controlled Drugs
|
Pregabalin
|
Formulary
|
- 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.
Schedule 3 Controlled Drug as of 01/04/2019
|
NHS England: Rescheduling of Gabapentin and Pregabalin as Schedule 3 Controlled Drugs
|
|
|
|
|
Lacosamide
|
Formulary
|
- Tablets
- Syrup
- Supported by an ESCA, see link below.
|
ESCA: Lacosamide.
|
|
|
Lamotrigine
|
Formulary
|
- 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 |
Levetiracetam |
|
|
Levetiracetam
|
Formulary
|
- 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)
|
Formulary
|
- 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
|
|
|
|
|
Perampanel tablets
|
Formulary
|
- 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.
|
ESCA: Perampanel.
NICE CG137: The epilepsies: the diagnosis and management of the epilepsies in adults and children in primary and secondary care
|
| 04.08.01 |
Phenobarbital and other barbiturates |
|
|
Phenobarbital
|
Formulary
|
- Tablets
- Elixir
MHRA Advice
Patients being treated for epilepsy should be maintained on a specific manufacturer's product.
|
|
|
Primidone
|
Formulary
|
- Tablets
MHRA Advice
Patients being treated for epilepsy should be maintained on a specific manufacturer's product.
|
|
|
|
|
Phenytoin
|
Formulary
|
- Capsules
- Suspension
MHRA Advice
Patients being treated for epilepsy should be maintained on a specific manufacturer's product.
|
|
|
|
|
|
| 04.08.01 |
Rufinamide |
|
|
Rufinamide
|
Formulary
|
- 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.
|
ESCA: Rufinamide.
|
|
|
|
|
Topiramate
|
Formulary
|
- 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.
|
|
|
|
|
Sodium Valproate
|
Formulary
|
- 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.
 Use in men and women of non-child bearing potential
 Use in women and girls of childbearing potential (all indications). ESCA link below
Contraindicated in women of childbearing potential unless part of the Pregnancy Prevention Programme. See MHRA guidance
|
BSSE APC ESCA Valproate medicines
Women of childbearing potential: Educational Risk Minimisation Materials
Medicines related to valproate: risk of abnormal pregnancy outcomes
|
Sodium Valproate (Episenta®)
(M/R granules in capsules or sachets)
|
Formulary
|
- 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
|
BSSE APC ESCA Valproate medicines
Medicines related to valproate: risk of abnormal pregnancy outcomes
Women of childbearing potential: Educational Risk Minimisation Materials
|
|
|
Vigabatrin
|
Formulary
|
- Tablets
- Supported by an ESCA, see link below.
|
ESCA: Vigabatrin.
|
| 04.08.01 |
Zonisamide |
|
|
Zonisamide
|
Formulary
|
- 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.
|
ESCA: Zonisamide.
|
|
|
Clobazam
|
Formulary
|
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
|
Formulary
|
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.
|
|
|
|
|
Brivaracetam (Briviact®)
(oral formulations)
|
Formulary
|
- 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
|
|
|
Cannabidiol (Epidyolex®)
|
Formulary
|
In line with NICE
|
NICE TA 614: Cannabidiol with clobazam for treating seizures associated with Dravet syndrome
NICE TA 615: Cannabidiol with clobazam for treating seizures associated with Lennox–Gastaut syndrome
|
Brivaracetam (Briviact ®)
(injection)
|
Formulary
|
|
|
|
Stiripentol (Diacomit®)
(250mg capsules, sachets, 500mg capsules)
|
Formulary
|
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 |
Drugs used in status epilepticus |
|
|
Diazepam rectal tubes
|
Formulary
|
|
|
|
Midazolam buccal liquid (Buccolam®)
|
Formulary
|
|
|
|
Paraldehyde
|
Formulary
|
- Rectal solution 50% in olive oil
|
|
|
| 04.09 |
Drugs used in parkinsonism and related disorders |
|
|
|
|
| 04.09.01 |
Dopaminergic drugs used in Parkinsons disease |
|
|
| 04.09.01 |
Dopamine receptor agonists |
|
|
Apomorphine (APO-go®)
|
Formulary
|
|
|
|
Apomorphine (Dacepton®)
|
Formulary
|
- solution for injection in cartridge
|
|
|
Pramipexole IR tablets
|
Formulary
|
|
|
|
Ropinirole tablets
|
Formulary
|
- For use in Restless Legs - Supported by an ESCA, see link below.
|
ESCA: Ropinirole in Restless Legs syndrome.
|
Ropinirole M/R tablets
|
Formulary
|
|
|
|
Rotigotine patches
|
Formulary
|
|
|
|
|
|
Co-Beneldopa
|
Formulary
|
- Capsules
- M/R capsules
- Dispersible tablets
|
UKMI Q&A: How do you convert from co-beneldopa (Madopar®) prolonged-release capsules to dispersible tablets?
|
Co-Careldopa
|
Formulary
|
|
|
|
Co-Careldopa and Entacapone (Stalevo®)
|
Formulary
|
|
|
|
| 04.09.01 |
Monoamine-oxidase-B inhibitors |
|
|
Rasagiline (Azilect®)
|
Formulary
|
|
|
|
Selegiline Hydrochloride
|
Formulary
|
- Tablets
- Oral lyophilisate reserved for patients with swallowing difficulties in Parkinson's disease
|
|
|
| 04.09.01 |
Catachol-O-methyltransferase inhibitors |
|
|
Entacapone
|
Formulary
|
|
|
|
Opicapone (Ongentys®)
|
Formulary
|
- 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
|
ESCA: Opicapone
|
| 04.09.01 |
Amantadine |
|
|
Amantadine Hydrochloride
|
Formulary
|
- Capsules
- Syrup- for patients with swallowing difficulties
|
|
|
| 04.09.01 |
Mild to moderate dementia in Parkinsons disease |
|
|
| 04.09.02 |
Antimuscarinic drugs used in parkinsonism |
|
|
Procyclidine
|
Formulary
|
Tablets
SF syrup
|
|
|
Procyclidine
|
Formulary
|
Injection
|
|
|
Trihexyphenidyl
|
Formulary
|
|
|
|
| 04.09.03 |
Drugs used in essential tremor, chorea, tics, and related disorders |
|
|
Haloperidol
|
Formulary
|
|
|
|
Piracetam
|
Formulary
|
|
|
|
Primidone
|
Formulary
|
|
|
|
Propranolol
|
Formulary
|
|
|
|
Riluzole (Rilutek®)
|
Formulary
|
- Supported by an ESCA, see link below.
|
ESCA: Riluzole
NICE TA20: Motor neurone disease - riluzole
|
Tetrabenazine
|
Formulary
|
|
|
|
| 04.09.04 |
Restless leg syndrome |
|
|
| 04.10 |
Drugs used in substance dependence |
|
|
| 04.10.01 |
Alcohol dependence |
|
|
Acamprosate (Campral EC®)
|
Formulary
|
|
|
|
Chlordiazepoxide
|
Formulary
|
Adjunct in acute alcohol withdrawal
|
|
|
Diazepam
|
Formulary
|
|
|
|
Disulfiram (Antabuse®)
|
Formulary
|
|
|
|
Nalmefene
|
 Restricted
|
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.
|
NICE TA 325: Nalmefene for reducing alcohol consumption in people with alcohol dependence
|
Naltrexone
|
Formulary
|
- Useful as an adjunct in the treatment of alcohol dependence after a successful withdrawal.
|
|
|
|
|
|
|
| 04.10.02 |
Nicotine dependence |
|
|
Nicotine replacement therapy
|
First Choice
|
|
What are the clinically significant drug interactions with cigarette smoking?
|
Bupropion Hydrochloride (Zyban®)
|
Second Choice
|
|
|
|
Varenicline (Champix®)
|
Second Choice
|
|
NICE TA123: Varenicline
|
| 04.10.03 |
Opioid dependence |
|
|
|
|
| 04.10.03 |
Opioid substitution therapy |
|
|
Methadone oral solution
|
Formulary
|
|
|
|
Buprenorphine S/L tablets
|
Formulary
|
|
|
|
Methadone tablets
|
Formulary
|
|
|
|
Methadone injection
|
Formulary
|
|
|
|
|
|
| 04.10.03 |
Adjunctive therapy and symptomatic treatment |
|
|
Lofexidine (BritLofex®)
|
Formulary
|
|
|
|
| 04.10.03 |
Opioid-receptor antagonists |
|
|
Naloxone
|
Formulary
|
Used to reverse opioid overdose.
|
|
|
Naltrexone (Nalorex®)
|
Formulary
|
|
NICE TA115: Drug misuse - naltrexone
|
|
|
Donepezil
|
Formulary
|
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.
|
Shared care documents from Black Country Partnership NHS FT can be accessed here
|
Galantamine
|
Formulary
|
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.
|
Shared care documents from Black Country Partnership NHS FT can be accessed here
|
Memantine
|
Formulary
|
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.
|
Shared care documents from Black Country Partnership NHS FT can be accessed here
|
Rivastigmine
|
Formulary
|
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.
|
Shared care documents from Black Country Partnership NHS FT can be accessed here
|
|
|
|
|
| 04.12 |
Drugs for sialorrhea |
|
|
Botulinum neurotoxin type A (Xeomin® )
|
Formulary
|
In line with NICE
|
NICE TA605: Xeomin (botulinum neurotoxin type A) for treating chronic sialorrhoea
|
Glycopyrronium bromide (Sialanar®)
(400mcg/ml)
|
Formulary
|
- Approved on formulary December 2017
- Specialist initiation and stabilisation
- £££
|
|
|
|
|
Azathioprine
(Neurology)
|
Formulary
|
Specialist use only for neurological conditions
|
|
|
Ciclosporin
(Neurology)
|
Formulary
|
Specialist use only for neurological conditions
|
|
|
Methotrexate
(Neurology)
|
Formulary
|
Specialist use only for neurological conditions
|
|
|
Mycophenolate
(Neurology)
|
Formulary
|
Specialist use only for neurological conditions
|
|
|
Tacrolimus
(Neurology)
|
Formulary
|
Specialist use only for neurological conditions
|
|
|
| .... |
| Non Formulary Items |
Acetazolamide
|
Non Formulary
|
|
|
|
Alfentanyl Sublingual Spray 5 mg in 5mL
|
Non Formulary
|
|
|
|
Almotriptan (Almogran®)
|
Non Formulary
|
|
|
|
Alprazolam
|
Non Formulary
|
|
|
|
Alprazolam (Xanax®)
|
Non Formulary
|
|
|
|
Amitriptyline and perphenazine (Triptafen®)
|
Non Formulary
|
|
|
|
Amitriptyline and perphenazine (Triptafen-M®)
|
Non Formulary
|
|
|
|
Amobarbital (amylobarbitone) and secobarbital (quinalbarbitone) (Tuinal®)
|
Non Formulary
|
|
|
|
Amobarbital (amylobrbitone) (Sodium Amytal®)
|
Non Formulary
|
|
|
|
Asenapine
|
Non Formulary
|
Hospital only |
|
|
Aspirin (Caprin®)
|
Non Formulary
|
|
|
|
Aspirin (Nu-Seals® Aspirin)
|
Non Formulary
|
|
|
|
Aspirin and codeine (Co-codaprin®)
|
Non Formulary
|
|
|
|
Aspirin and metoclopramide (MigraMax®)
|
Non Formulary
|
|
|
|
Aspirin and papaveretum (Aspav®)
|
Non Formulary
|
|
|
|
Benperidol (Anquil®)
|
Non Formulary
|
|
|
|
Benzatropine
|
Non Formulary
|
DISCONTINUED |
|
|
Bromocriptine
|
Non Formulary
|
No longer recommended in Parkinson disease |
|
|
Buprenorphine and Naloxone (Suboxone®)
|
Non Formulary
|
|
|
|
Butobarbital (butobarbitone) (Soneryl®)
|
Non Formulary
|
|
|
|
Cabergoline
|
Non Formulary
|
No longer recommended in Parkinson Disease |
|
|
Capsaicin
(8% patch)
|
Non Formulary
|
|
|
|
Cinnarizine and Dimenhydrinate (Arlevert®)
|
Non Formulary
|
|
|
|
Clomethiazole (Heminevrin®)
|
Non Formulary
|
|
|
|
Clonazepam
|
Non Formulary
|
|
|
|
Clonazepam
|
Non Formulary
|
|
|
|
Clonidine Hydrochloride
|
Non Formulary
|
|
|
|
Co-proxamol
|
Non Formulary
|
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 |
Birmingham and Solihull CCG Policy for items which should not be prescribed in primary care
NHS Clinical Commissioners Items which should not routinely be prescribed in primary care: Guidance for CCGs
Patient Information Leaflet
|
Dextromoramide
|
Non Formulary
|
|
|
|
Dihydrocodeine Tartrate (DF 118 Forte®)
|
Non Formulary
|
|
|
|
Dihydrocodeine Tartrate (DHC Continus®)
|
Non Formulary
|
|
|
|
Dipipanone (Diconal®)
|
Non Formulary
|
|
|
|
Dolasetron Mesilate (Anzemet®)
|
Non Formulary
|
|
|
|
Dosulepin
|
Non Formulary
|
Tablets
Capsules
Sugar free solution |
Birmingham and Solihull CCG Policy for items which should not be prescribed in primary care
NHS Clinical Commissioners Items which should not routinely be prescribed in primary care: Guidance for CCGs
Patient Information Leaflet
|
Doxepin
|
Non Formulary
|
|
|
|
Doxylamine/pyridoxine (Xonvea®)
|
Non Formulary
|
Non-formulary June 2019 |
NICE Evidence Summary [ES20] Doxylamine/pyridoxine (Xonvea) for treating nausea and vomiting of pregnancy
|
Droperidol (Xomolix®)
|
Non Formulary
|
|
|
|
Eletriptan (Relpax®)
|
Non Formulary
|
|
|
|
Ergotamine Tartrate (Cafergot®)
|
Non Formulary
|
|
|
|
Ergotamine Tartrate (Migril®)
|
Non Formulary
|
|
|
|
Escitalopram (Cipralex®)
|
Non Formulary
|
|
|
|
Fentanyl Buccal Film (Breakyl)
|
Non Formulary
|
|
Birmingham and Solihull CCG Policy for items which should not be prescribed in primary care
NHS Clinical Commissioners Items which should not routinely be prescribed in primary care: Guidance for CCGs
Patient Information Leaflet
|
Flupentixol (Fluanxol®)
|
Non Formulary
|
|
|
|
Fluphenazine Hydrochloride (Moditen®)
|
Non Formulary
|
|
|
|
Flurazepam (Dalmane®)
|
Non Formulary
|
|
|
|
Fluvoxamine Maleate (Faverin®)
|
Non Formulary
|
|
|
|
Fluvoxamine Maleate (Fluvoxamine®)
|
Non Formulary
|
|
|
|
Fosaprepitant (Ivemend®)
|
Non Formulary
|
|
|
|
Fosphenytoin Sodium (Pro-Epanutin®)
|
Non Formulary
|
|
|
|
Frovatriptan
|
Non Formulary
|
|
|
|
Hydromorphone (Palladone®)
|
Non Formulary
|
|
|
|
Hydromorphone Hydrochloride (Palladone® SR)
|
Non Formulary
|
|
|
|
Isocarboxazid
|
Non Formulary
|
|
|
|
Isometheptene Mucate (Midrid®)
|
Non Formulary
|
|
|
|
Ketamine oral solution
|
Non Formulary
|
|
|
|
Lisuride
|
Non Formulary
|
|
|
|
Loprazolam
|
Non Formulary
|
|
|
|
Lurasidone (Latuda®)
|
Non Formulary
|
|
|
|
Meprobamate
|
Non Formulary
|
Manufacturer ceased 2016 |
|
|
Methysergide (Deseril®)
|
Non Formulary
|
|
|
|
Mianserin
|
Non Formulary
|
|
|
|
Morphine and cyclizine (Cyclimorph®)
|
Non Formulary
|
|
|
|
Nabilone
|
Non Formulary
|
|
|
|
Naltrexone- bupropion (Mysimba®)
|
Non Formulary
|
Not supported by NICE |
NICE TA 494: Naltrexone–bupropion for managing overweight and obesity
|
Naratriptan
|
Non Formulary
|
Removed from formulary May 2017 following 6-fold price increase. More cost-effective options available on formulary. |
|
|
Nefopam
|
Non Formulary
|
|
|
|
Nefopam (Acupan®)
|
Non Formulary
|
|
|
|
Nitrazepam
(suspension, tablets)
|
Non Formulary
|
|
|
|
Nortriptyline
|
Non Formulary
|
|
|
|
Nortriptyline
|
Non Formulary
|
|
|
|
Orphenadrine
|
Non Formulary
|
Discontinued by manufacturer December 2015 |
|
|
Orphenadrine
|
Non Formulary
|
Discontinued by manufacturer December 2015 |
|
|
Paliperidone
(oral)
|
Non Formulary
|
|
|
|
Papaveretum
|
Non Formulary
|
|
|
|
Paracetamol (Panadol OA®)
|
Non Formulary
|
|
|
|
Paracetamol and codeine (Co-codamol® 8/500)
|
Non Formulary
|
|
|
|
Paracetamol and dihydrocodeine (Co-dydramol®)
|
Non Formulary
|
|
|
|
Paracetamol and dihydrocodeine (Remedeine®)
|
Non Formulary
|
|
|
|
Paracetamol and methionine (Pardote®)
|
Non Formulary
|
|
|
|
Paracetamol and metoclopramide (Paramax®)
|
Non Formulary
|
|
|
|
Pentazocine
|
Non Formulary
|
|
|
|
Pergolide
|
Non Formulary
|
No longer recommended in Parkinson Disease |
|
|
Perphenazine
|
Non Formulary
|
|
|
|
Pethidine Hydrochloride and promethazine (Pamergan® P100)
|
Non Formulary
|
|
|
|
Pethidine tablets
|
Non Formulary
|
|
|
|
Phenelzine (Nardil®)
|
Non Formulary
|
|
|
|
Phenytoin
|
Non Formulary
|
|
|
|
Pimozide (Orap®)
|
Non Formulary
|
|
|
|
Pipotiazine Palmitate (Piportil® Depot)
|
Non Formulary
|
|
|
|
Pramipexole M/R tablets
|
Non Formulary
|
|
|
|
Prochlorperazine
|
Non Formulary
|
|
|
|
Promazine Hydrochloride (Promazine®)
|
Non Formulary
|
|
|
|
Promethazine teoclate (Avomine®)
|
Non Formulary
|
|
|
|
Promethazine Teoclate (Avomine®)
|
Non Formulary
|
|
|
|
Reboxetine (Edronex®)
|
Non Formulary
|
|
|
|
Retigabine
(Tablets)
|
Non Formulary
|
Advance notification of retigabine discontinuation from June 2017. Advice to healthcare professionals.
Click here
|
NICE TA232: Retigabine for the adjunctive treatment of adults with partial onset seizures in epilepsy with and without secondary generalisation
|
Rimonabant (Acomplia®)
|
Non Formulary
|
|
|
|
Safinamide
|
Non Formulary
|
|
|
|
Secobarbital (quinalbarbitone) (Seconal Sodium® )
|
Non Formulary
|
|
|
|
Sertindole (Serdolect®)
|
Non Formulary
|
|
|
|
Sibutramine Hydrochloride (Reductil®)
|
Non Formulary
|
|
|
|
Sodium Oxybate (Xyrem®)
|
Non Formulary
|
|
|
|
Sodium valproate
|
Non Formulary
|
|
|
|
Sodium valproate
|
Non Formulary
|
|
|
|
Sumatriptan (Imigran® Radis)
|
Non Formulary
|
|
|
|
Targinact (Oxycodone/Naloxone) (Targinact®)
|
Non Formulary
|
|
Birmingham and Solihull CCG Policy for items which should not be prescribed in primary care
NHS Clinical Commissioners Items which should not routinely be prescribed in primary care: Guidance for CCGs
Patient Information Leaflet
|
Tiagabine (Gabitril®)
|
Non Formulary
|
|
|
|
Tolcapone (Tasmar®)
|
Non Formulary
|
|
|
|
Tolfenamic Acid (Clotam®)
|
Non Formulary
|
|
|
|
Tramadol Hydrochloride and paracetamol (Tramacet®)
|
Non Formulary
|
|
Birmingham and Solihull CCG Policy for items which should not be prescribed in primary care
NHS Clinical Commissioners Items which should not routinely be prescribed in primary care: Guidance for CCGs
Patient Information Leaflet
|
Tramadol MR capsules
|
Non Formulary
|
|
|
|
Tramadol oral drops
|
Non Formulary
|
|
|
|
Tranylcypromine
|
Non Formulary
|
|
|
|
Triclofos Sodium (Triclofos® oral Solution BP (Triclofos Elixir))
|
Non Formulary
|
|
|
|
Trimipramine
|
Non Formulary
|
Tablets
Capsules |
Birmingham and Solihull CCG Policy for items which should not be prescribed in primary care
NHS Clinical Commissioners Items which should not routinely be prescribed in primary care: Guidance for CCGs
Patient Information Leaflet
|
Tropisetron (Navoban®)
|
Non Formulary
|
|
|
|
Zaleplon (Sonata®)
|
Non Formulary
|
|
|
|
Ziprasidone (Zeldox®)
|
Non Formulary
|
|
|
|
Zotepine
|
Non Formulary
|
Discontinued in 2011 |
|
|
Zuclopenthixol Acetate (Clopixol Acuphase®)
|
Non Formulary
|
|
|
|
| |
Key |
|
|
|
|
Cytotoxic Drug
|
|
|
Controlled Drug
|
|
High Cost Medicine
|
|
Cancer Drugs Fund
|
|
NHS England |
|
Homecare |
|
CCG |
|
Traffic Light Status Information
| Status |
Description |
|
Prescribing in children
The APC notes that the informed use of unlicensed medicines or of licensed medicines for unlicensed applications (‘off-label’ use) is often necessary in paediatric practice.
The APC advises GPs to consider specialist prescribing recommendations for Green and Amber medicines that are not subject to ESCAs or RICaDs in combination with the information provided in the BNFC which goes beyond that of marketing authorisations. The BNFC has been designed for rapid reference and the information presented has been carefully selected to aid decisions on prescribing.
|
|
Medicines suitable for routine use within primary care. Initiation and maintenance of prescribing by Specialists, GPs and other qualified clinicians. |
|
Amber Specialist Initiation: Initiation and maintenance of prescribing by Specialists and transfer to Primary Care prescribing when appropriate. This may be supported by a RICaD, annotated within the formulary entry. |
|
Amber Specialist Recommendation: Initiation and maintenance of prescribing in Primary Care following recommendation from a Specialist. |
|
Amber Shared Care: Initiation and maintenance of prescribing by Specialists and transfer to Primary Care prescribing, in accordance with an ESCA, annotated within the formulary entry. |
|
Medicines for initiation and maintenance prescribing by Specialists only. |
|
Non-formulary Medicines which APC/Trust DTC has actively reviewed and do not recommend for use. |
|
Positive NICE TA and/or awaiting local clarification on place in therapy; Please contact your Medicines Optimisation team for more information. |
|
The term 'Specialist' refers to Consultants, General Practitioners and Independant Prescribers with a Specialist Interest. |
|
|
|
