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Coventry and Warwickshire Area Prescribing Committee
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 Formulary Chapter 4: Nervous system - Full Chapter
04.01  Hypnotics and anxiolytics
04.01.01  Hypnotics
Melatonin 2 mg MR tablets
(Circadin®)
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Green SI

Treatment of insomnia in children and adults with neurological and/or behavioural problems, including ADHD and autism
Dot Also in older adults with dementia where alternative hypnotics have failed

Preferred-

 
Link  APC SIDC16: Melatonin (Circadin)
Melatonin MR tablets
(Slenyto®)
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Formulary
Green SI

Treatment of insomnia in children and adolescents with Autism Spectrum Disorder (ASD) and/ or Smith-Magenis Syndrome 

 Preferred-

 

 
Link  APC SIDC15: Melatonin (Slenyto)
Melatonin 5 mg/5ml liquid
(Colour free, Alcohol free )
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Unlicensed Drug Unlicensed
Green SI

Treatment of insomnia in children and adults with neurological and/or behavioural problems, including ADHD and autism 

SecondLine-  Only prescribed where the prescriber concludes there is intolerance to tablets or tactile defensiveness to excipients/colouring treatment with licensed forms of melatonin

note Use special product KidMel® 1 mg/ml if tablets/capsules can not be crushed/mixed with food or liquids, available as a 200ml bottle

  • Alcohol free formulations are preferable for children.

 

 
04.01.01  Benzodiazepines
Temazepam tablets
(All licensed indication)
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Formulary
Second Line
 
Controlled Drug Schedule 3
Link  MHRA update: Benzodiazepines and opioids: reminder of risk of potentially fatal respiratory depression - 03/20
04.01.01  Zaleplon, Zolpidem and Zopiclone
Zopiclone tablets
(All licensed indications)
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Preferred
 
Controlled Drug Schedule 4
Zolpidem tablets
(All licensed indications)
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Second Line
 
Controlled Drug Schedule 4
04.01.01  Chloral and derivatives to top
04.01.01  Clomethiazole (Chlormethiazole)
Clomethiazole capsules
(All licensed indications)
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Second Line
In the elderly 
04.01.01  Antihistamines
04.01.01  Sodium oxybate
04.01.02  Anxiolytics
04.01.02  Benzodiazepines to top
Diazepam
(Anxiety)
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Preferred
Short term use only
Avoid oral solution 
Lorazepam
(Anxiety)
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Preferred
Short term use only 
Oxazepam
(Anxiety)
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Second Line
Short term use only 
04.01.02  Buspirone
Buspirone tablets
(Anxiety)
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Second Line
Longer term use 
04.01.02  Beta blockers
04.01.02  Meprobamate
04.01.03  Barbiturates
04.02  Drugs used in psychoses and related disorders to top
04.02.01  Antipsychotic Drugs
04.02.01  First-Generation Antipsychotic Drugs
Haloperidol
(Children)
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Green SI

Childhood behavioural disorders, Gilles de la Tourette syndrome, childhood


Preferred-

 
Haloperidol
(Adult)
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Green SA

Schizophrenia: treatment of symptoms and prevention of relapse, other psychoses: especially paranoid, mania and hypomania, mental or behavioural problems such as aggression, hyperactivity and self mutilation in the mentally retarded and in patients with organic brain damage, as an adjunct to short term management of moderate to severe psychomotor agitation, excitement, violent or dangerously impulsive behaviour, Gilles de la Tourette syndrome and severe tics


Preferred-

 
Haloperidol
(short acting injection)
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Green SA
First line use in CWPT - treatment of rapid control of the symptoms of hostility, aggression, hyperactivity, disruptive and violent behaviour, confusion, emotional withdrawal, hallucinations and delusions associated with acute and chronic schizophrenia, mania, and hypomania, and organic brain syndrome
 
Chlorpromazine
(Children)
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Green SI

Treatment of childhood schizophrenia and autism


SecondLine-

 
Chlorpromazine
(Adult)
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Formulary
Green SA

Schizophrenia and other psychoses (especially paranoia), mania and hypomania. In anxiety, psychomotor agitation, excitement, violent or dangerously impulsive behaviour. Induction of hypothermia


SecondLine-

 
Zuclopenthixol
(Clopixol®)
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Preferred
 
Flupentixol (Depixol®)
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Preferred
 
Benperidol
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Second Line

 
Pericyazine
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Second Line
 
Pimozide (Orap®)
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Second Line
 
Prochlorperazine
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Second Line
 
Sulpiride
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Formulary
Second Line
 
Trifluoperazine
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Second Line
 
Perphenazine
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Formulary
Second Line
 
04.02.01  Second-Generation Antipsychotic Drugs
Amisulpride
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Green SA

Treatment of acute and chronic psychoses


 Preferred-

 
Aripiprazole tablets
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Formulary
Green SA

Treatment of schizophrenia and episodes of mania 


 Preferred-

 
Link  NICE TA213: Aripiprazole for the treatment of schizophrenia in people aged 15 -17 years
Link  NICE TA292: Bipolar disorder (children) - aripiprazole
Olanzapine
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Green SA

Treatment of acute and chronic psychoses, mania


Preferred-

 
Risperidone tablets
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Green SA

Treatment of acute and chronic psychoses, mania 


Preferred-

 
Cariprazine Black Triangle
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Formulary
Green SI

Treatment of schizophrenia in adult patients


SecondLine- for primary care prescribing


 

 
Link  APC DPS097: Cariprazine
Lurasidone
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Formulary
Green SI

Treatment of schizophrenia


SecondLine-

 
Link  APC DPS057: Lurasidone
Quetiapine standard release tablets
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Formulary
Green SA

Treatment of schizophrenia and episodes of mania


Preferred-

 
Quetiapine XL
(Biquelle®)
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Green SA

Treatment of schizophrenia and episodes of mania


Prescribe by cost effective brand


SecondLine-

 
Clozapine
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Red SO

Treatment of resistant schizophrenia


Preferred-

 
Link  NICE QS80 section 4: Clozapine
04.02.02  Antipsychotic depot injections
Flupentixol decanoate
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Formulary
Green SI

Treatment of schizophrenia and other psychoses


Preferred-

 
Haloperidol decanoate
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Formulary
Green SI

Treatment of schizophrenia and other psychoses


Preferred-

 
Zuclopenthixol decanoate
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Formulary
Green SI

Treatment of schizophrenia and other psychoses, particularly with aggression and agitation


Preferred-

 
Aripiprazole long acting injection
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Formulary
Green SI

Treatment of schizophrenia, specialist to complete SIDC


SecondLine-

 
Link  APC DPS056: Aripiprazole LAI
Link  APC SIDC05: Aripiprazole LAI drug checklist
Paliperidone palmitate long acting injection
(1-monthly)
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Formulary
Green SI

Treatment of schizophrenia


Specialist to complete Drug Checklist (SIDC) on initiation before GP can continue prescribing


 SecondLine-

 
Link  APC DPS032: Paliperidone LA depot injection [1-monthly]
Link  APC SIDC03: Paliperidone LA depot injection [1-monthly] drug checklist
Paliperidone palmitate long acting injection
(3-monthly)
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Green SI

Treatment of schizophrenia in patients who have been stabilised on monthly paliperidone long acting injection for at least 12 months, specialist to complete SIDC


An exception to this would be patients already stabilised on the one monthly injection within primary care. Primary care could consider switching to the three monthly depot injection in line with the Drug Position Statement, the SPC and the checklist for assurance


SecondLine-

 
Link  APC DPS084: Paliperidone palmitate LAI [3-monthly]
Link  APC SIDC12: Paliperidone palmitate LAI (3-monthly) drug checklist
Risperidone long acting injection
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Formulary
Green SI

Treatment of schizophrenia and other psychoses


SecondLine-

 
04.02.03  Drugs used for mania and hypomania to top
Lamotrigine
(Mood stabiliser)
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Second Line
 
04.02.03  Benzodiazepines
04.02.03  Antipsychotic drugs
04.02.03  Carbamazepine
Carbamazepine
(Mood stabliser)
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Second Line
 
04.02.03  Valproic acid
Valproic Acid Black Triangle
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Formulary
Amber SC

Treatment of manic episodes associated with bipolar disorder in females of child-bearing potential


Specialist must complete the MHRA Acknowledgement Risk Assessment form


SecondLine-

 
Link  APC SCA067: Valproate & Valproic Acid [Females of Chilbearing Potential].pdf
Link  MHRA update: Revised Annual Risk Acknowledgement Form - 04/19
Link  MHRA update: Valproate (Epilim¥, Depakote¥) pregnancy prevention programme: updated educational materials - 02/20
Valproic Acid
(Depakote®)
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Green SA

Treatment of manic episodes associated with bipolar disorder in males, and in females of NON child bearing potential


 

 
04.02.03  Lithium to top
Lithium (Priadel®)
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Amber SC

Treatment and prophylaxis of mania, bipolar disorder and recurrent depression, aggressive or self mutilating behavior


Must prescribe by brand


Preferred-

 
Link  APC SCA005: Lithium - shared care agreement
Link  APC WNSCA005: Lithium - Warwickshire North shared care agreement
Lithium Carbonate
(Camcolit®)
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Amber SC

Treatment and prophylaxis of mania, bipolar disorder and recurrent depression, aggressive or self mutilating behavior


Must prescribe by brand


SecondLine-

 
Link  APC SCA005: Lithium - shared care agreement
Link  APC WNSCA005: Lithium - Warwickshire North shared care agreement
Lithium Carbonate
(Essential Pharma®)
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Formulary
Amber SC

Treatment and prophylaxis of mania, bipolar disorder and recurrent depression, aggressive or self mutilating behavior


Must prescribe by brand


SecondLine-

 
Link  APC SCA005: Lithium - shared care agreement
Link  APC WNSCA005: Lithium - Warwickshire North shared care agreement
04.03  Antidepressant drugs
04.03.01  Tricyclic and related antidepressant drugs
04.03.01  Tricyclic antidepressants
Amitriptyline tablets
(Depression)
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Preferred
 
Clomipramine capsules
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Preferred
 
Lofepramine tablets
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Preferred
 
Imipramine tablets
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Formulary
Second Line
 
04.03.01  Related antidepressants
Trazodone
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Preferred
 
04.03.02  Monoamine-oxidase inhibitors to top
04.03.02  Reverible MAOIs
04.03.03  Selective serotonin re-uptake inhibitors
Citalopram tablets
(All licensed indications)
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Preferred
 
Fluoxetine 20 mg dispersible tablets
(All licensed indications)
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Formulary
Second Line
Swallowing difficulties 
Fluoxetine
(Children & adolescents)
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Formulary
Amber SC

For children and adolescents


Preferred-

 
Link  APC SCA048: Fluoxetine (children and adolescents) - shared care agreement
Fluoxetine 20 mg capsules
(Adult licensed indications)
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Preferred
 
Sertraline tablets
(Adult licensed indications)
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Preferred
 
Sertraline tablets
(Children licensed indications)
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Formulary
Amber SC

Treatment of anxiety, depression, obsessive compulsive disorder and post traumatic stress in children if fluoxetine is unsuccessful or not tolerated


SecondLine-

 
Link  APC SCA063: Sertraline (CAMHS) - shared care agreement
Citalopram oral drops
(Depression)
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Formulary
Second Line
Swallowing difficulties 
Escitalopram tablets
(Depression)
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Formulary
Second Line
10% dearer than citalopram 
04.03.04  Other antidepressant drugs
Mirtazapine tablets / orodispersible
(All licensed indications)
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Preferred
 
Vortioxetine
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Preferred

Treatment of major depressive episodes (to use after 2 other antidepressants drugs have failed)

 
Link  APC DPS077: Vortioxetine
Link  NICE TA367: Vortioxetine for treating major depressive episodes
Duloxetine capsules
(Depression)
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Second Line
 
Venlafaxine standard release tablets
(All licensed indications)
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Preferred

 High doses of above 300 mg should be initiated by a specialist as SI

 
Venlafaxine modified release capsules
(All licensed indications)
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Second Line

Known compliance problem or unacceptable side effects with standard release versions


Prescribe generically as capsules excluding Venlafaxine 225 mg capsules which should be prescribed as Vencarm XL

 
04.04  CNS stimulants and other drugs used for attention deficit hyperactivity disorder
Lisdexamfetamine capsules
(For adults )
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Formulary
Amber SC

Treatment of Attention Deficit Hyperactivity Disorder


Preferred-

 
Controlled Drug Schedule 2
Link  APC SCA052: Lisdexamfetamine (adult) - shared care agreement
Lisdexamfetamine capsules
(For children)
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Formulary
Amber SC

Treatment of Attention Deficit Hyperactivity Disorder


SecondLine-

 
Controlled Drug Schedule 2
Link  APC DPS045: Lisdexamfetamine [ADHD]
Link  APC SCA047: Lisdexamfetamine (children) - shared care agreement
Methylphenidate IR tablets & XL capsules
(Equasym® XL Medikinet® XL )
(For adults & children)
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Formulary
Amber SC

Treatment of Attention Deficit Hyperactivity Disorder


Preferred-

 
Controlled Drug Schedule 2
Link  APC SCA001: Methylphenidate (children) - shared care agreeement
Link  APC SCA051:Methylphenidate (adult) - shared care agreement
Methylphenidate XL tablets
(Concerta® XL )
(For adults & children)
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Formulary
Amber SC

Treatment of Attention Deficit Hyperactivity Disorder


SecondLine-

 
Controlled Drug Schedule 2
Link  APC SCA001: Methylphenidate (children) - shared care agreement
Link  APC SCA051: Methylphenidate (adult) - shared care agreement
Atomoxetine (Strattera®)
(For adults & children)
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Formulary
Amber SC

Treatment of Attention Deficit Hyperactivity Disorder


SecondLine-

 
Link  APC SCA002: Atomoxetine (children) - shared care agreement
Link  APC SCA050: Atomoxetine (adult) - shared care agreement
Guanfacine XL tablets
(Children/adolescents)
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Formulary
Amber SC

Treatment of Attention Deficit/Hyperactivity Disorder in children/adolescents 6 to 17 years of age


SecondLine-

 
Link  APC DPS083: Guanfacine - Drug Postioning Statement
Link  APC SCA061: Guanfacine - shared care agreement
Clonidine
(Unlicensed indication)
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Amber SC
Treatment of attention deficit hyperactivity disorder and tics in children 
Link  APC SCA005: Clonidine - shared care agreement
Dexamfetamine
(For adults & children)
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Formulary
Amber SC

Use as third line for management of attention deficit hyperactivity disorder

 
Controlled Drug Schedule 2
Link  APC SCA003: Dexamfetamine (Children ADHD)- shared care agreement
Link  APC SCA066: Dexamfetamine (Adult ADHD) - shared care agreement
Modafinil
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Green SA
Treatment of daytime sleepiness associated with narcolepsy with or without cataplexy
 
Pitolisant
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Red SO
Treatment of narcolepsy with or without cataplexy 
04.05  Drugs used in the treatment of obesity to top
04.05.01  Anti-obesity drugs acting on the gastro-intestingal tract
Orlistat 120 mg capsule
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Preferred
 
Link  NICE CG189: Obesity: identification, assessment and management
04.05.02  Centrally acting appetite suppressants
Liraglutide (Saxenda®) Black Triangle
(Obesity)
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Formulary
Red SO

Treatment of obesity
Not approved for use at UHCW

 
Link  APC DPS087: Liraglutide
04.06  Drugs used in nausea and vertigo
Ondansetron subcut injection
(Unlicensed indication)
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Preferred

For nausea and vomiting in palliative care

 
Haloperidol subcut injection
(Unlicensed indication)
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Preferred
 
Netupitant & Palonosetron
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Red SO

Prevention of acute and delayed nausea and vomiting associated with moderately and highly emetogenic chemotherapy

 
04.06  Vomiting during pregnancy
04.06  Postoperative nausea and vomiting to top
04.06  Motion sickness
04.06  Other vestibular disorders
04.06  Cytotoxic chemotherapy
04.06  Palliative care
04.06  Migraine to top
04.06  Antihistamines
04.06  Phenothiazines and related drugs
04.06  Domperidone and metoclopramide
Domperidone oral
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Formulary
Preferred

Used for nausea and vomiting in palliative care


Refer to APC CG040 guidance

 
Link  MHRA update: Domperidone for nausea and vomiting: lack of efficacy in children; reminder of contraindications in adults and adolescents - 12/19
Metoclopramide subcut injection
(Unlicensed indication)
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Preferred

Used for nausea and vomiting in palliative care


Refer to APC CG040 guidance

 
04.06  5HT3 antagonists
Granisetron
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Red SO
Chemotherapy-induced nausea & vomiting maximum 5 days of therapy during treatment
Prevention of post-operative nausea & vomiting inpatient use only
 
Granisetron
(Unlicensed indication)
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Green SA
Treatment in pregnancy, longer-term use in chemotherapy patients
 
Ondansetron
(Unlicensed indications)
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Formulary
Green SA

Treatment in pregnancy, longer-term use in chemotherapy patients

 
Link  MHRA update: Ondansetron: small increased risk of oral clefts following use in the first 12 weeks of pregnancy - 01/20
Ondansetron
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Formulary
Red SO
Moderately or severely emetogenic chemotherapy or moderately emetogenic radiotherapy (Given just prior to treatment)
Chemotherapy-induced nausea & vomiting (Maximum 5 days of therapy)
Prevention of post-operative nausea & vomiting (Inpatient use only)
 
Ondansetron injection
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Formulary
Red SO
In-patient treatment of post-operative nausea & vomiting
 
Palonosetron
(Unlicensed indications)
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Formulary
Green SA
Treatment in pregnancy, longer-term use in chemotherapy patients
 
Palonosetron
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Red SO
Moderately and severely emetogenic chemotherapy [Given just prior to treatment]
 
04.06  Neurokinin receptor antagonist to top
Aprepitant
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Formulary
Red SO
Treatment of nausea & vomiting associated with moderately and highly emetogenic chemotherapy
 
04.06  Cannabinoid
Nabilone
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Red SO
Treatment of nausea and vomiting induced by cytotoxic chemotherapy
 
04.06  Hyoscine
04.06  Other drugs for Ménière's disease
04.07  Analgesics
04.07.01  Non-opioid analgesics and compound analgesic preparations to top
04.07.01  Paracetamol and compound analgesic preparations
Paracetamol & codeine
(Co-codamol® 30/500)
(All licensed indications)
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Formulary
Preferred

For nociceptive pain refer to APC pain guidance above


Prescribe as Zapain tablets cost effective brand


 

 
Paracetamol tablets
(All licensed indications)
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Preferred
 
Paracetamol & codeine 30/500 dispersible tablets
(Co-codamol® 30/500)
(All licensed indications)
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Formulary
Second Line

swallowing difficulties. NB high sodium content

 
Paracetamol 120 mg/5ml & 250 mg/5ml oral suspension - sugar free
(All licensed indications)
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Formulary
Second Line
swallowing difficulties 
Paracetamol suppositories
(All licensed indications)
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Formulary
Second Line
Only when tablets and liquid not appropriate - ensure licensed strengths used 
04.07.02  Opioid analgesics
Codeine oral
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Formulary
Preferred

For nociceptive pain


Refer to APC CG003 guidance in yellow section below

 
Dihydrocodeine
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Formulary
Preferred

For nociceptive pain


Refer to APC CG003 guidance in yellow section below

 
Morphine MR (12 hour release)
(All licensed indications)
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Formulary
Preferred

For nociceptive pain


Refer to APC CG003 guidance in yellow section below


Prescribe as Zomorph capsules cost effective brand


For patients who cannot swallow the Zomorph®capsules, the contents can be administered directly in semi-solid food (puree, jam, yoghurt)or via gastric or gastrostomy tubes of a diameter of more than 16 F.G with an open distal end or lateral pores. It is sufficient to rinse the tube with 30ml to 50ml of water”

 
Controlled Drug Schedule 2
Morphine standard release
(All licensed indications)
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Preferred

For initiation for opiates and breakthrough analgesia whilst on MR opiates

 
Controlled Drug Schedule 2
Morphine subcut injection
(Unlicensed indication)
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Preferred

Used for pain control in palliative care


Refer to APC CG040 guidance in yellow section below

 
Controlled Drug Schedule 2
Oxycodone MR
(All licensed indications)
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Formulary
Second Line

Under the advice of palliative care team only


Prescribe as Longtec cost effective brand

 
Controlled Drug Schedule 2
Oxycodone standard release
(All licensed indications)
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Formulary
Second Line

Under the advice of palliative care team only


Prescribe as Shortec  cost effective brand 

 
Controlled Drug Schedule 2
Oxycodone subcut injection
(Unlicensed indication)
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Formulary
Second Line

For pain control in palliative care


Refer to APC CG040 guidance in yellow section below

 
Controlled Drug Schedule 2
Tramadol 50 mg standard release capsules
(Neuropathic pain )
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Formulary
Preferred

All licensed indications  - further information refer to APC CG003 guidance in yellow section below

 
Controlled Drug Schedule 3
Tramadol 50 mg standard release capsules
(Nociceptive pain)
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Formulary
Second Line

All licensed indications - further information refer to APC CG003 guidance in yellow section below

 
Controlled Drug Schedule 3
Tramadol MR
(All licensed indications)
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Second Line

Use only for longer duration required for overnight pain


Prescribe as Marol or Zytram tablets most cost effective brand, if capsules are required use Maxitram capsules


For neuropathic pain further information refer to APC CG003 guidance in yellow section below 

 
Controlled Drug Schedule 3
Buprenorphine patch
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Formulary
Second Line

For nociceptive and neuropathic pain further information refer to APC CG003 guidance in yellow section below 


Strong opioids not generally of benefit for neuropathic pain


Prescribe as Butec or Reletrans cost effective brand

 
Controlled Drug Schedule 3
Diamorphine injection
(All licensed indications)
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Formulary
Second Line

For use in syringe drivers

 
Controlled Drug Schedule 2
Diamorphine subcut injection
(Unlicensed indication)
View adult BNF View SPC online View childrens BNF
Formulary
Second Line

For pain control in palliative care


Refer to APC CG040 guidance in yellow section below

 
Controlled Drug Schedule 2
Dihydrocodeine MR
View adult BNF View SPC online View childrens BNF
Formulary
Second Line
For nociceptive pain refer to APC guidance above  
Fentanyl immediate release sublingual tablets
View adult BNF View SPC online View childrens BNF
Formulary
Green SA

Only for use in palliative care when short acting oral morphine ineffective and specific criteria met.
See further details on the blacklisted indications below

 
Controlled Drug Schedule 2
Fentanyl patches
(All licensed indications)
View adult BNF View SPC online View childrens BNF
Formulary
Second Line

Swallowing difficulties.
Prescribe as Mezolar matrix, Matrifen or Fencino cost effective brand

 
Controlled Drug Schedule 2
Hydromorphone capsule
View adult BNF View SPC online View childrens BNF
Formulary
Green SA

For the relief of severe pain in cancer


Use on advice of palliative care team

 
Controlled Drug Schedule 2
Hydromorphone injection
View adult BNF View SPC online View childrens BNF
Formulary
Red SO

For the relief of severe pain in cancer

 
Controlled Drug Schedule 2
Tapentadol SR (Palexia®)
View adult BNF View SPC online View SMC online View childrens BNF
Formulary
Green SI

Treatment of pain that can only be treated with opioids in line with pain guidelines.


Specialist to complete Drug Checklist (SIDC) on initiation before GP can continue prescribing


SecondLine-

 
Controlled Drug Schedule 2
Link  APC DPS018: Tapentadol SR
Link  APC SIDC09: Tapentadol SR drug checklist
Link  MHRA update: Tapentadol (Palexia): risk of seizures and reports of serotonin syndrome when co-administered with other medicines - 01/19
Dihydrocodeine injection
View adult BNF View SPC online View childrens BNF
Formulary
Red SO

Relief of severe pain

 
Controlled Drug Schedule 2
04.07.03  Neuropathic pain
Amitriptyline
(Neuropathic pain)
View adult BNF View SPC online View childrens BNF
Formulary
Preferred
 
Gabapentin
(Neuropathic pain)
View adult BNF View SPC online View childrens BNF
Formulary
Preferred
 
Controlled Drug Schedule 3 from 01/04/2019
Link  MHRA update: Pregabalin (Lyrica), gabapentin (Neurontin) and risk of abuse and dependence: new scheduling requirements from 1 April - 04/19
Link  NHSE: Rescheduling of Gabapentin and Pregabalin as Schedule 3 Controlled Drugs
Nortriptyline
(Neuropathic pain)
View adult BNF View SPC online View childrens BNF
Formulary
Second Line
Unlicensed indication amitriptyline & imipramine intolerance 
Amitriptyline liquid
(Neuropathic pain)
View adult BNF View SPC online View childrens BNF
Formulary
Second Line

Unlicensed indication
Swallowing difficulties, prescribe licensed strengths

 
Duloxetine
(Neuropathic pain)
View adult BNF View SPC online View SMC online View childrens BNF
Formulary

Use as third line: Licensed for diabetic neuropathy only but potential for use outside of license in line with NICE

 
Imipramine
(Neuropathic pain)
View adult BNF View SPC online View childrens BNF
Formulary
Preferred
Unlicensed indication  
Pregabalin
(Neuropathic pain)
View adult BNF View SPC online View childrens BNF
Formulary

Use as fourth line: Prescribe the most appropriate dose twice daily.
Use if other choices or combinations ineffective or not tolerated


Prescribe generically for all indications

 
Controlled Drug Schedule 3 from 01/04/2019
Link  MHRA update: Pregabalin (Lyrica), gabapentin (Neurontin) and risk of abuse and dependence: new scheduling requirements from 1 April - 04/19
Link  NHSE: Rescheduling of Gabapentin and Pregabalin as Schedule 3 Controlled Drugs
04.07.03  Trigeminal neuralgia
Carbamazepine
(Trigeminal neuralgia)
View adult BNF View SPC online View childrens BNF
Formulary
Preferred
 
04.07.03  Postherpetic neuralgia to top
Capsaicin cutaneous patch
View adult BNF View SPC online View SMC online View childrens BNF
Formulary
Red SO

Treatment of peripheral neuropathic pain

 
Link  APC DPS010: Capsaicin cutaneous patch
04.07.03  Chronic facial pain
04.07.04  Antimigraine drugs
04.07.04.01  Treatment of the acute migraine attack
04.07.04.01  Analgesics
04.07.04.01  5HT1 agonists to top
Sumatriptan tablets
(Acute migraine)
View adult BNF View SPC online View childrens BNF
Formulary
Preferred
 
Zolmitriptan tablets
(Acute migraine)
View adult BNF View SPC online View childrens BNF
Formulary
Preferred
 
Naratriptan tablets
(Acute migraine)
View adult BNF View SPC online View childrens BNF
Formulary
Second Line
 
Zolmitriptan orodispersible tablets
(Acute migraine)
View adult BNF View SPC online View childrens BNF
Formulary
Second Line
Swallowing difficulties 
04.07.04.01  Ergot alkaloids
04.07.04.01  Anti-emetics
04.07.04.01  Other drugs for migrane
Flunarizine
(Unlicensed)
Formulary
Red SO

Treatment of migraine

 
04.07.04.02  Prophylaxis of migraine
Botulinum toxin A
(Botox®)
View adult BNF View SPC online View childrens BNF
Formulary
Red SO
High Cost Medicine
BlueTeq

Prophylaxis of chronic migraine headaches


Prescribe by brand as products not interchangeable

 
Link  NICE TA260: Botox for migraine prophylaxis
Propranolol modified release capsules
View adult BNF View SPC online View childrens BNF
Formulary
Preferred

Prophylaxis of migraine

 
Link  NICE CG150: Headaches
Topiramate
View adult BNF View SPC online View childrens BNF
Formulary
Green SA
Prophylaxis of migraine
 
04.07.04.03  Cluster headache to top
04.08  Antiepileptics
04.08.01  Control of epilepsy
Brivaracetam injection
View adult BNF View SPC online View childrens BNF
Formulary
Red SO
Adjunctive therapy in the treatment of partial-onset seizures  
Brivaracetam oral
View adult BNF View SPC online View childrens BNF
Formulary
Green SI
Adjunctive therapy in the treatment of partial-onset seizures
 
04.08.01  Partial seizures with or without secondary generalisation
04.08.01  Generalised seizures
04.08.01  Carbamazepine and Oxcarbazepine to top
Oxcarbazepine
View adult BNF View SPC online View childrens BNF
Formulary
Green SA
Treatment of epilepsy
 
Carbamazepine
View adult BNF View SPC online View childrens BNF
Formulary
Green SA
Treatment of epilepsy - MHRA advises prescribing by brand to avoid loss of seizure control by switching brands
 
Eslicarbazepine
View adult BNF View SPC online View childrens BNF
Formulary
Green SA
Treatment of epilepsy  
04.08.01  Ethosuximide
Ethosuximide
View adult BNF View SPC online View childrens BNF
Formulary
Green SA
Treatment of epilepsy
 
04.08.01  Gabapentin and pregabalin
Gabapentin
View adult BNF View SPC online View childrens BNF
Formulary
Green SA
Treatment of epilepsy
 
Pregabalin
View adult BNF View SPC online View childrens BNF
Formulary
Green SA
Treatment of epilepsy
 
04.08.01  Lacosamide
Lacosamide
View adult BNF View SPC online View childrens BNF
Formulary
Green SA
Adjunctive treatement of partial seizures with or without secondary generalisation
 
04.08.01  Lamotrigine
Lamotrigine
View adult BNF View SPC online View childrens BNF
Formulary
Green SA
Treatment of epilepsy
 
04.08.01  Levetiracetam to top
Levetiracetam
View adult BNF View SPC online View childrens BNF
Formulary
Green SA
Treatment of epilepsy
 
04.08.01  Perampanel
Perampanel
View adult BNF View SPC online View SMC online View childrens BNF
Formulary
Green SA

Adjunctive treatment of partial onset seizures with or without secondary generalised seizures

 
Link  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
View adult BNF View SPC online View childrens BNF
Formulary
Green SA

Treatment of epilepsy - MHRA advises prescribing by brand to avoid loss of seizure control by switching brands

 
Controlled Drug Schedule 3
Primidone
View adult BNF View SPC online View childrens BNF
Formulary
Green SA
Treatment of epilepsy - MHRA advises prescribing by brand to avoid loss of seizure control by switching brands
 
04.08.01  Phenytoin
Phenytoin
View adult BNF View SPC online View childrens BNF
Formulary
Green SA
Treatment of epilepsy - MHRA advises prescribing by brand to avoid loss of seizure control by switching brands
 
04.08.01  Retigaine
Retigabine
View adult BNF View SPC online View childrens BNF
Formulary
Amber SC

Adjunctive treatment of focal seizures with ot withput secondary generalisation

 
Link  APC SCA040: Retigabine - shared care agreement
Link  NICE TA232: Retigabine for the adjunctive treatment of adults with partial onset seizures in epilepsy with and without secondary generalisation
04.08.01  Rufinamide to top
Rufinamide (Inovelon®)
View adult BNF View SPC online View childrens BNF
Formulary
Amber SC
Lennox-Gestaut Syndrome
 
Link  APC SCA038: Rufinamide - shared care agreement
04.08.01  Tiagabine
Tiagabine (Gabitril®)
View adult BNF View SPC online View childrens BNF
Formulary
Green SA

Adjunctive treatment for local seizures with or without secondary generalisation that are not satisfactorily controlled by other antiepileptics

 
04.08.01  Topiramate
Topiramate
View adult BNF View SPC online View childrens BNF
Formulary
Green SA
Treatment of epilepsy including Lennox-Gestaut Syndrome
 
04.08.01  Valproate
Sodium Valproate
View adult BNF View SPC online View childrens BNF
Formulary
Green SA

Treatment of epilepsy in males, and females of NON child bearing potential

 
Sodium Valproate Black Triangle
View adult BNF View SPC online View childrens BNF
Formulary
Amber SC

Treatment of epilepsy in females of child-bearing potential


Specialist must complete the MHRA Acknowledgement Risk Assessment form


SecondLine-

 
Link  APC SCA067: Valproate & Valproic Acid [Females of Chilbearing Potential].pdf
Link  MHRA update: Revised Annual Risk Acknowledgement Form - 04/19
Link  MHRA update: Valproate (Epilim¥, Depakote¥) pregnancy prevention programme: updated educational materials - 02/20
04.08.01  Vigabatrin
Vigabatrin (Sabril®)
View adult BNF View SPC online View childrens BNF
Formulary
Green SI

Treatment of epilepsy

 
04.08.01  Zonisamide to top
Zonisamide (Zonegran®)
View adult BNF View SPC online View childrens BNF
Formulary
Green SI

Adjunctive therapy for refractory partial seizures with or without secondary generalisation

 
04.08.01  Benzodiazepines
Clobazam
View adult BNF View SPC online View childrens BNF
Formulary
Green SA
Treatment of epilepsy
 
Clonazepam
View adult BNF View SPC online View childrens BNF
Formulary
Green SA
Treatment of epilepsy
 
04.08.02  Drugs used in status epilepticus
Midazolam (Buccolam®)
View adult BNF View SPC online View childrens BNF
Formulary
Green SI

Treatment of prolonged, acute convulsive seizures


Preferred-

 
Controlled Drug Schedule 3
Midazolam (Epistatus®)
View adult BNF View SPC online View childrens BNF
Formulary
Green SI

Treatment of prolonged, acute convulsive seizures


Licensed preparation can be used under the direction of a specialist only, in patients who have shown a delayed response to the preferred choice


 SecondLine-

 
Controlled Drug Schedule 3
Fosphenytoin
View adult BNF View SPC online View childrens BNF
Formulary
Red SO
Treatment of status epilepticus, seizures associated with neurosurgery or head injury, or when oral phenytoin not possible
 
04.08.03  Febrile convulsions
04.09  Drugs used in parkinsonism and related disorders
04.09.01  Dopaminergic drugs used in Parkinsons disease to top
Opicapone
View adult BNF View SPC online View childrens BNF
Formulary
Green SI
Treatment of Parkinson's Disease. For use when entacapone inappropriate
 
Link  APC DPS085: Opicapone
Safinamide Black Triangle
View adult BNF View SPC online View childrens BNF
Formulary
Green SI

Treatment of Parkinson's disease

 
Link  APC DPS086: Safinamide
04.09.01  Dopamine receptor agonists
Pramipexole
View adult BNF View SPC online View childrens BNF
Formulary
Green SA

Treatment of Parkinson's disease, prescribe as Pipexus cost effective brand


Preferred-

 
Ropinirole MR
View adult BNF View SPC online View childrens BNF
Formulary
Green SA

Treatment of Parkinson's disease, prescribe as Spiroco cost effective brand


Preferred-

 
Rotigotine patch
View adult BNF View SPC online View childrens BNF
Formulary
Green SA

Treatment of Parkinson's disease


Preferred-

 
Apomorphine
(APO-go ®, Dacepton®)
View adult BNF View SPC online View childrens BNF
Formulary
Amber SC

Third-line option - Treatment of Parkinson's disease


Prescribe by brand

 
Link  APC SCA011: Apomorphine - shared care agreement
04.09.01  Levodopa
Co-beneldopa immediate release
View adult BNF View SPC online View childrens BNF
Formulary
Green SA

Treatment of Parkinson's disease


Preferred-

 
Co-careldopa immediate release
View adult BNF View SPC online View childrens BNF
Formulary
Green SA

Treatment of Parkinson's disease


Preferred-

 
Careldopa/entacapone/levodopa
View adult BNF View SPC online View childrens BNF
Formulary
Green SA

Treatment of Parkinson's disease


Prescribe as Stanek or Sastravi cost effective brand


SecondLine-

 
Co-beneldopa controlled release
View adult BNF View SPC online View childrens BNF
Formulary
Green SA

Treatment of Parkinson's disease


SecondLine-

 
Co-careldopa controlled release
View adult BNF View SPC online View childrens BNF
Formulary
Green SA

Treatment of Parkinson's disease


SecondLine-

 
Levodopa/carbidopa
(Duodopa®)
View adult BNF View SPC online View childrens BNF
Formulary
Red SO
Fourth line option - Treatment of Parkinson's Disease
 
04.09.01  Monoamine-oxidase-B inhibitors
Rasagiline
View adult BNF View SPC online View childrens BNF
Formulary
Green SA

Treatment of Parkinson's disease


Preferred-

 
Selegiline Hydrochloride
View adult BNF View SPC online View childrens BNF
Formulary
Green SA

Treatment of Parkinson’s disease and symptomatic Parkinsonism


Preferred-

 
04.09.01  Catachol-O-methyltransferase inhibitors
Tolcapone
View adult BNF View SPC online View childrens BNF
Formulary
Amber SC

Treatment of Parkinson's Disease. For use when entacapone inappropriate


SecondLine-

 
Link  APC SCA053: Tolcapone [Parkinsons Disease] - shared care agreement
Link  APC WNSCA053: Tolcapone - Warwickshire North shared care agreement
Entacapone
View adult BNF View SPC online View childrens BNF
Formulary
Green SA

Treatment of Parkinson's disease


SecondLine-

 
04.09.01  Amantadine to top
Amantadine
View adult BNF View SPC online View childrens BNF
Formulary
Green SA

Treatment of Parkinson's disease


SecondLine- 

 
04.09.02  Antimuscarinic drugs used in parkinsonism
Orphenadrine
View adult BNF View SPC online View childrens BNF
Formulary
Green SA
Treatment of Parkinson's disease
 
Procyclidine
View adult BNF View SPC online View childrens BNF
Formulary
Green SA
Treatment and symptomatic relief of all forms of Parkinson's disease . Control of extrapyramidal symptoms induced by neuroleptic drugs
 
Trihexyphenidyl
View adult BNF View SPC online View childrens BNF
Formulary
Green SI
Treatment of all forms of Parkinsonism
 
04.09.03  Drugs used in essential tremor, chorea, tics, and related disorders
Piracetam (Nootropil®)
View adult BNF View SPC online View childrens BNF
Formulary
Amber SC
Adjunctive treatment of cortical myoclonus
 
Link  APC SCA042: Piracetam - shared care agreement
Riluzole (Rilutek®)
View adult BNF View SPC online View childrens BNF
Formulary
Amber SC
High Cost Medicine
To extend life or the time to mechanical ventilation for patients with amyotrophic lateral sclerosis - motor neurone disease
 
Link  APC SCA010: Riluzole - shared care agreement
Link  APC WNSCA010: Riluzole - Warwickshire North shared care agreement
Link  NICE TA20: Motor neurone disease - riluzole
Tetrabenazine
View adult BNF View SPC online View childrens BNF
Formulary
Red SO
Treatment of movement disorders due to Huntingdon's chorea, hemiballismus, senile chorea and related neurological conditions and severe tardive dyskinesia
 
04.09.03  Torsion dystonias and other involuntary movements
Botulinum toxin A
(Azzalure®, Bocouture®, Botox®, Vistabel®, Dysport®, Xeomin®)
View adult BNF View SPC online View childrens BNF
Formulary
Red SO
High Cost Medicine
BlueTeq

Treatment of focal spasticity, spasmodic torticollis, blepharospasm, hemifacial spasm, post stroke spasticity of the upper limb, temporary improvement in the appearance of facial lines


Prescribe by brand as products not interchangeable

 
Botulinum toxin B
(NeuroBloc®)
View adult BNF View SPC online View childrens BNF
Formulary
Red SO
Treatment of cervical dystonia
 
04.09.04  Restless leg syndrome
Pramipexole tablets
View adult BNF View SPC online View childrens BNF
Formulary
Preferred

Treatment of Restless Legs Syndrome (RLS) - review patient after 3 months  

 
Ropinirole tablets
(RLS)
View adult BNF View SPC online View childrens BNF
Formulary
Preferred

Treatment of Restless Legs Syndrome (RLS) -- review patient after 3 months  

 
Rotigotine patch
View adult BNF View SPC online View childrens BNF
Formulary
Preferred

Treatment of Restless Legs Syndrome (RLS) - review patient after 3 months  

 
04.10  Drugs used in substance dependence to top
04.10.01  Alcohol dependence
Acamprosate
(Campral EC®)
View adult BNF View SPC online View childrens BNF
Formulary
Amber SC
maintenance of abstinence in alcohol depenence 
Link  APC SCA013: Acamprosate - shared care agreement
Disulfiram (Antabuse®)
View adult BNF View SPC online View childrens BNF
Formulary
Amber SC
Adjunct in the treatment of chronic alcohol dependence (under medical supervision). 
Link  APC SCA012: Disulfiram - shared care agreement
04.10.02  Nicotine dependence
Varenicline (Champix®)
View adult BNF View SPC online View childrens BNF
Formulary
Preferred
 
Link  NICE TA123: Varenicline
04.10.03  Opioid dependence
04.10.03  Opioid substitution therapy
Buprenorphine
(All brands)
View adult BNF View SPC online View childrens BNF
Formulary
Amber SC

Treatment of opioid dependence


Specialist to provide a share care agreement as required

 
Controlled Drug Schedule 3
Methadone
View adult BNF View SPC online View childrens BNF
Formulary
Amber SC

Opioid dependence


Specialist to provide a share care agreement as required

 
Controlled Drug Schedule 2
04.10.03  Adjunctive therapy and symptomatic treatment to top
Lofexidine
View adult BNF View SPC online View childrens BNF
Formulary
Amber SC

Management of symptoms of opioid withdrawal


Specialist to provide a share care agreement as required

 
04.10.03  Opioid-receptor antagonists
Naltrexone (Nalorex®)
View adult BNF View SPC online View childrens BNF
Formulary
Amber SC
Adjunct to prevent relapse in detoxified formerly opioid-dependent patients(who have remained opioid-free for at least 7-10 days)
 
Link  NICE TA115: Drug misuse - naltrexone
04.11  Drugs for dementia
Donepezil tablets
View adult BNF View SPC online View childrens BNF
Formulary
Green SA

Mild to moderate dementia in Alzheimer's disease


Preferred-

 
Link  NICE NG97: Dementia: assessment, management and support for people living with dementia and their carers
Galantamine modified release capsules
(Gatalin XL®)
View adult BNF View SPC online View childrens BNF
Formulary
Green SA

Mild to moderate dementia in Alzheimer's disease

Prescribe as Gatalin XL cost effective brand, this is more cost effective than standard release


Preferred-

 
Link  NICE NG97: Dementia: assessment, management and support for people living with dementia and their carers
Rivastigmine capsules
View adult BNF View SPC online View childrens BNF
Formulary
Green SA

Mild to moderate dementia in Alzheimer's disease


Preferred-

 
Link  NICE NG97: Dementia: assessment, management and support for people living with dementia and their carers
Memantine tablets
View adult BNF View SPC online View childrens BNF
Formulary
Green SA

Mono therapy in moderate to severe dementia in Alzheimer’s disease


 

 
Link  NICE TA97: Dementia: assessment, management and support for people living with dementia and their carers
Memantine tablets
View adult BNF View SPC online View childrens BNF
Formulary
Preferred

For augmentation of AChEI in moderate to severe Alzheimer’s disease


 


 


 

 
Link  NICE TA97: Dementia: assessment, management and support for people living with dementia and their carers
Rivastigmine
(Parkinsons Disease)
View adult BNF View SPC online View childrens BNF
Formulary
Amber SC
Treatment of Dementia associated with Parkinson’s disease 
Link  APC SCA064: Rivastigmine for Dementia [Associated with Parkinson’s disease] - share care agreement
 ....
 Non Formulary Items
Agomelatine (Valdoxan®)

View adult BNF View SPC online View SMC online View childrens BNF
Non Formulary
Green SI

 Treatment of major depressive episodes

Link  APC DPS048: Agomelatine
Almotriptan (Almogran®)

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

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

View adult BNF View SPC online View childrens BNF
Non Formulary
Non Formulary
Amitriptyline liquid
(Depression)

View adult BNF View SPC online View childrens BNF
Non Formulary
Non Formulary
Aripiprazole liquid or orodispersible

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

View adult BNF View SPC online View childrens BNF
Non Formulary
Green SA

Treatment of moderate to severe manic episodes associated with bipolar disorder


 

Link  APC DPS022: Asenapine
Aspirin & metoclopramide
(eg: MigraMax®)

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

View adult BNF View SPC online View childrens BNF
Non Formulary
Non Formulary
Prophylaxis of migraine
Atomoxetine liquid

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

Use SC

Botulinum toxin A
(Azzalure®, Bocouture®,Botox®,Vistabel® )

View adult BNF View SPC online View childrens BNF
Non Formulary
Red SO
High Cost Medicine
Temporary improvement in the appearance of facial lines


Prescribe by brand as products not interchangeable

Bromocriptine

View adult BNF View SPC online View childrens BNF
Non Formulary
Non Formulary
SA- - Treatment of Parkinson's disease
Buprenorphine sublingual tablet
(Temgesic®)

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


Controlled Drug Schedule 3
Cabergoline

View adult BNF View SPC online View childrens BNF
Non Formulary
Non Formulary
SA- - Treatment of Parkinson's disease
Chloral betaine

View adult BNF View SPC online View childrens BNF
Non Formulary
Non Formulary
Chloral hydrate

View adult BNF View SPC online View childrens BNF
Non Formulary
Non Formulary
Chloral hydrate
(Chloral Elixir®, Paediatric, BP 2000)

View adult BNF View SPC online View childrens BNF
Non Formulary
Non Formulary
Chlorpromazine liquid

View adult BNF View SPC online View childrens BNF
Non Formulary
Non Formulary
Clozapine liquid

View adult BNF View SPC online View childrens BNF
Non Formulary
Red SO

Treatment of resistant schizophrenia

Co-proxamol
(Distalgesic®)

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

No longer licensed. Potential safety risks outweigh benefits


Advice: If opioid needed, consider co-codamol 30/500 prescribed as cost effective Zapain tablets

Decongestant with paracetamol
(e.g. Benylin 4 Flu®,Lemsip®,Day & Night Nurse®)

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

Follow guidance on self care


Advice: Intended for patient to purchase if appropriate

Link  NHS Choices guidance: common cold
Diazepam oral solution
(Anxiety)

View adult BNF View SPC online View childrens BNF
Non Formulary
Non Formulary
Diphenhydramine (Nytol®)

View adult BNF View SPC online View childrens BNF
Non Formulary
Non Formulary
Dipipanone/cyclizine

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


Controlled Drug Schedule 2
Dosulepin

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

NHS England guidance state that this should not routinely be prescribed in primary care

Link  APC RD043: Dosulepin Prescribing Guide
Doxepin (Sinepin®)

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

View adult BNF View SPC online View childrens BNF
Non Formulary
Non Formulary
Eslicarbazepine
(Mood stabiliser)

View adult BNF View SPC online View childrens BNF
Non Formulary
Non Formulary
Fentanyl
(Effentora® buccal tablets)
(immediate release tablets)

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

Little evidence that this is better than morphine. Not cost-effective


Advice: Use short acting morphine for breakthrough pain



Controlled Drug Schedule 2
Fentanyl immediate release lozenges
(Actiq®)

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

NHS England guidance state that this should not routinely be prescribed in primary care


 



Controlled Drug Schedule 2
Fentanyl Nasal Spray
(Instanyl®, PecFent®)
(immediate release)

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

Little evidence that this is better than morphine. Not cost-effective


Advice: Use short acting morphine for breakthrough pain



Controlled Drug Schedule 2
Fentanyl sublingual tablets
(Abstral)

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Non Formulary
Black BL

Unless patient meets agreed criteria in palliative care and is initiated by a palliative care specialist


Advice: Use short acting morphine for breakthrough pain (unless above criteria met)


note 


Abstral Prescribing Criteria


All of the following critera must be met in order for Abstral® to be prescribed only for adult patients:


For whom:


- management of breakthrough/incident pain
- patient with a background of chronic pain (NB: Abstral® is licensed for chronic cancer pain)
- patients considered "tolerant" to opioid therapy (guidance states that patients are considered tolerant to opioids if they take 60 mg/24hrs of oral morphine or equivalent)


By whom:
- Abstral® must only be initiated by the Specialist Palliative Care Team
When:


- Immediate release morphine sulphate should be used first line for breakthrough pain (unless otherwise contraindicated)
- Abstral® can only be prescribed for breakthrough/incident pain in the following circumstances:
- Where use of first line immediate release opioids is causing the patient intolerable/unacceptable side effects e.g. somnolence, neurotoxicity, severe impairment to daily living. (NB. This does not include manageable or anticipated effects e.g. nausea or constipation)
- Where patients have severe renal impairment (potentially resulting in accumulation of first-line opioids)
- Where prescribing Abstral® would spare the need for regular parenteral breakthrough opioid doses
- For incident pain where the onset of action is required to be faster than that of first-line opioids



Controlled Drug Schedule 2
Fluoxetine 10 mg/60 mg

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Non Formulary
Non Formulary
For 60 mg use 3 x 20 mg capsules
For 10 mg use half x 20 mg dispersible tablet
Fluoxetine liquid

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Non Formulary
Non Formulary
For liquid use dispersible tablets
Flupentixol (Fluanxol®)

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Non Formulary
Non Formulary
Fluphenazine decanoate
(Modecate® 25 mg/ml and Modecate® concentrate injection 100 mg/ml) )

View adult BNF View SPC online View childrens BNF
Non Formulary
Discontinued Medicines

note  All presentations are now discontinued.


We have been advised this was due to the unpredictability of the supply of fluphenazine decanoate from the third party manufacturer in South Africa. The discontinuation was not due to any safety issue.



  • All patients previously treated with fluphenazine decanoate should now have been reviewed and switched to an alternative therapy. Patients open to Coventry and Warwickshire Partnership Trust  will have been reviewed by the trust. 

  • GP’s can contact the ‘GP Mental Health Advice Line’ if they require any further advice - tel: 024 7696 7897 Open Mon-Fri (excluding Bank Hols) 09:45 to 16:30 


 


 

Flurazepam

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Non Formulary
Non Formulary
Fosaprepitant

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Non Formulary
Red SO
Treatment of nausea & vomiting associated with moderately and highly emetogenic chemotherapy
Frovatriptan

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Non Formulary
Non Formulary
Galantamine liquid

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Non Formulary
Non Formulary

SA-  If there is a clinical need to prescribe

Haloperidol liquid

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Non Formulary
Non Formulary
Imipramine liquid

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Non Formulary
Non Formulary
Isocarboxazid

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Non Formulary
Not Recommended
Treatment of the symptoms of depressive illness
Ketamine oral solution
(unlicensed)

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Non Formulary
Red SO
Treatment of chronic pain
Lithium Carbonate
(e.g.Liskonum®)

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Non Formulary
Non Formulary

All brands except priadel and camcolit/Essential Pharma


use SC  see info above

Lithium citrate liquid

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Non Formulary
Non Formulary
Use SC
Lofepramine liquid

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Non Formulary
Non Formulary
Loprazolam

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Non Formulary
Non Formulary
Lormetazepam

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Non Formulary
Non Formulary
Melatonin capsules/tablets & liquids
(All strengths)

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Unlicensed Drug Unlicensed
Non Formulary

Unlicensed products may have unpredictable supply chains and pricing. Patients may be subjected to unnecessary delays in obtaining treatment or delays in transfer of care hence these products are not recommended.

Licensed alternatives such as Circadin® should be considered where possible

 

 

 

 

Melatonin:1mg/ml liquid & 3 mg tablets
(Colonis®)

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Non Formulary
Black BL

Licensed for jet lag, not available on the NHS

Link  NICE CKS: Sleep disorders - shift work and jet lag
Memantine liquid

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Non Formulary
Non Formulary

SA-  If there is a clinical need to prescribe

Controlled Drug  Meprobamate

View adult BNF
Non Formulary
Discontinued Medicines
Link  MHRA update: Meprobamate: licence to be cancelled - 04/16
Meptazinol

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Non Formulary
Non Formulary
Metoprolol

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Non Formulary
Non Formulary
Prophylaxis of migraine
Mianserin

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Non Formulary
Non Formulary
Midazolam (Epistatus®)

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Non Formulary
Not Recommended

All unlicensed unlicensed preparations



Controlled Drug Schedule 3
Moclobemide (Manerix®)

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Non Formulary
Not Recommended
Treatment of major depression and social phobia
Modafinil (Provigil®)

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Non Formulary
Not Recommended
All unlicensed indications in line with EMEA/MHRA advice
Morphine suspension
(MST Continus®)
(All licensed indications)

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Non Formulary
Non Formulary

Zomorph® capsules may be opened and mixed with soft food and water if swallowing difficulties



Controlled Drug Schedule 2
Nadolol

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Non Formulary
Non Formulary
Prophylaxis of migraine
Nalmefene

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Non Formulary
Link  NICE TA325: Nalmefene for reducing alcohol consumption in people with alcohol dependence
Naloxone/oxycodone
(Targinact®)

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Non Formulary
Not Recommended

No advantage over oxycodone with laxatives



Controlled Drug Schedule 2
Link  APC DPS080: Oxycodone-naloxone [Restless Leg Syndrome
Naltrexone/bupropion
(Mysimba®) Black Triangle

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Non Formulary
Not Recommended

Management of weight in adult patients, as a adjunct to a reduced-calorie diet and increased physical activity

Link  APC DPS089: Naltrexone/bupropion (Mysimba)
Link  MHRA update: https://www.gov.uk/drug-safety-update/naltrexone-bupropion-mysimba-risk-of-adverse-reactions-that-could-affect-ability-to-drive - 08/19
Link  NICE TA494: Naltrexone–bupropion for managing overweight and obesity
Nefopam

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Non Formulary
Non Formulary
Nitrazepam

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Non Formulary
Non Formulary
Nortriptyline
(Allegron®)

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Non Formulary
Non Formulary
Olanzapine embonate depot

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Non Formulary
Non Formulary

Currently not available in CWPT except for when in-line with CWPT criteria then to be used as SO

Olanzapine orodispersible

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Non Formulary
Non Formulary
Orlistat (Alli® 60 mg)

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Non Formulary
Black BL

OTC product - Intended for patient to purchase


 

Oxcarbazepine
(Mood stabiliser)

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Non Formulary
Non Formulary

Paliperidone oral

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Non Formulary
Not Recommended
Treatment of schizophrenia and manic episodes
Paracetamol & codeine - all brand & formulations
(e.g. Solpadeine plus®,Solpadeine Max®, Solpadeine headache®)

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Non Formulary
Black BL

OTC products - Intended for patients to purchase


Advice: Consider alternatives

Paracetamol & codeine (Co-codamol)
(8/500, 15/500)

View adult BNF View SPC online View childrens BNF
Non Formulary
Non Formulary
Paracetamol & codeine (Co-codamol) capsules
(30/500)

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Non Formulary
Non Formulary
Paracetamol & dihydrocodeine
(Co-dydramol®)

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Non Formulary
Non Formulary
Paracetamol & metoclopramide
(eg: Paramax®)

View adult BNF View SPC online View childrens BNF
Non Formulary
Non Formulary
Paroxetine tablet/liquid

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Non Formulary
Non Formulary

Seek specialist advice before prescribing

Pergolide

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Non Formulary
Non Formulary
SA- - Treatment of Parkinson's disease
Pethidine oral

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Non Formulary
Non Formulary


Controlled Drug Schedule 2
Phenelzine (Nardil®)

View adult BNF View SPC online View childrens BNF
Non Formulary
Not Recommended
Depression clinically characterised as 'atypical', 'non endogenous', neurotic' or where treatment with other antidepressants has failed
Prochlorperazine
(e.g. Buccastem M®)

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Non Formulary
Black BL

OTC product - Intended for patient to purchase


Advice: Consider alternative bucal preparation

Promethazine
(Hypnotics)

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Non Formulary
Non Formulary
Propranolol standard release

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Non Formulary
Non Formulary
Prophylaxis of migraine
Reboxetine (Edronex®)

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Non Formulary
Non Formulary
Risperidone liquid or orodispersible

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Non Formulary
Non Formulary
Rivastigmine patches

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

SA-  If there is a clinical need to prescribe

Rizatriptan (Maxalt®)

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Non Formulary
Non Formulary
Ropinirole standard release

View adult BNF View SPC online View childrens BNF
Non Formulary
Non Formulary
SA- - Treatment of Parkinson's Disease
Sertindole
(Unlicensed)

View adult BNF View SPC online View childrens BNF
Non Formulary
Red SO

Treatment of schizophrenia


 

Sertraline liquid
(Lustral®)

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

View adult BNF View SPC online View childrens BNF
Non Formulary
Red SO
High Cost Medicine

Treatment of narcolepsy with cataplexy


Not commissioned by C&W CCGs



Controlled Drug Schedule 2
Sulpiride liquid

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

View adult BNF View SPC online View childrens BNF
Non Formulary
Black BL
Prescribe generically
Tafamidis

View adult BNF View SPC online View childrens BNF
Non Formulary
Red SO
High Cost Medicine
Treatment of transthyretin familial amyloid polyneuropathy
Tapentadol IR

View adult BNF View SPC online View SMC online View childrens BNF
Non Formulary
Not Recommended

Not recommended by APC due to lack of evidence for additional benefit compared to established therapies



Controlled Drug Schedule 2
Timolol

View adult BNF View SPC online View childrens BNF
Non Formulary
Non Formulary
Prophylaxis of migraine
Tramadol with paracetamol
(Tramacet®)

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

Combination not cost-effective



Controlled Drug Schedule 3
Tranylcypromine

View adult BNF View SPC online View childrens BNF
Non Formulary
Not Recommended
Treatment of symptoms of depressive illness especially where phobic symptoms are present or where treatment with other types of anti-depressants has failed
Trimipramine
(Surmontil®)

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

NHS England guidance state that this should not routinely be prescribed in primary care

Tryptophan tablets

View adult BNF View SPC online View childrens BNF
Non Formulary
Amber SC

Adjunctive therapy for depression resistant to standard antidepressants

Link  APC SCA049: Tryptophan (Treatment resistant depression) - shared care agreement
  
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
SMC
Scottish Medicines Consortium
Cytotoxic Drug
Cytotoxic Drug
CD
Controlled Drug
High Cost Medicine
High Cost Medicine
Blueteq
High Cost Drug Approval System

Traffic Light Status Information

Status Description

Preferred

Clinicians are free to prescribe these drugs. They are regarded as cost effective choices which have evidence to support their use.  

Second Line

These drugs should only be prescribed in the scenarios described in the formulary after preferred drug(s) have been ruled out.  

Non Formulary

Non-formulary choice - the vast majority of a patient’s needs should be met by use of formulary preferred choices and second line options when appropriate. Therefore the Clinician should only use a non-formulary drug if this can be justified and it is recommended that all such instances are recorded in the patient record.  

Green SA

Specialist Advised – Specialists may simply advise a patient’s GP to initiate these drugs themselves after they have made an initial assessment. Note: SA drugs can be initiated by the specialist according to patient need and also depending on local commissioning arrangements which may mandate, through the contract between provider and commissioner, that all SA drugs are treated as SI.  

Green SI

Specialist Initiation - These drugs must be initiated, i.e. the first dose prescribed, by the specialist and then may be continued when appropriate by the patient’s GP following communication from the specialist.  

Amber SC

Shared Care - Responsibility for prescribing may be transferred from secondary to primary care with the agreement of an individual GP and when agreed shared care arrangements have been established. The specialist MUST stabilize the patient before asking for care to be transferred. Only specialists should initiate these drugs. Prescribing should be transferred to GPs according to an Shared Care Agreement [SCA]   

Red SO

Specialist Only - These drugs are deemed to be not appropriate for prescribing by GPs. Specialists should not ask GPs to prescribe these drugs.   

Black BL

Black Listed Medicines - These drugs are considered inappropriate for prescribing in Coventry & Warwickshire as they are either not cost-effective or of proven benefit or both.   

Not Recommended

Not Recommended - These are drugs that are not recommended for use.  

Discontinued Medicines

Discontinued medicines - These are drugs that are no longer available to prescribe   

netFormulary