netFormulary North of Tyne, Gateshead and North Cumbria NHS
Area Prescribing Committee Formulary  
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 Formulary Chapter 4: Central nervous system - Full Chapter
04.01  Hypnotics and anxiolytics
 note 

Hypnotics should not be prescribed for more than 10 nights without being reviewed.
Use in the elderly is discouraged.
Nitrazepam is no longer included in the formulary for use as a hypnotic

04.01.01  Hypnotics
Melatonin
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Formulary
  • First line: melatonin 2mg modified release tablets. 
  • Second line: melatonin 2mg modified release tablets (crushed).
  • Third line: Melatonin 1mg in 1ml solution (unlicensedunlicensed).

Approved Indications

Melatonin can be used to facilitate the induction of sleep, and increase the duration of sleep on the advice of an appropriate secondary care specialist, in the following situations:

1) Visually impaired or blind people with disturbed sleep wake cycles. Green plus
2) Delayed sleep phase syndrome and other circadian rhythm disorders.Green plus
3) Children with neurological or behavioural disorders including: Amber

  • Attention deficit hyperactivity disorder (ADHD).*
  • Chronic sleep onset insomnia.*
  • Neurodevelopmental disabilities (e.g. involving delayed brain maturation, sensory dysfunction - especially visual and dysfunction of sleep centres).*

4) Treatment of children and young adults with chronic fatigue syndrome / myalgic encephalomyelitis who have sleep difficulties (as recommended in NICE clinical guideline no. 53).* Amber
5) Prior to examinations such as a sleep encephalogram (EEG) in children and sedation prior to scans in paediatric oncology. Green plus
6) Patients with REM sleep behaviour disorder (RBD) - e.g. associated with degenerative conditions such as Parkinson’s disease or dementia, as a second line treatment to clonazepam. Green plus
7) To improve nocturnal sleep in critically ill patients (to aid weaning from mechanical ventilation) Green plus

*Note that for indications 3 and 4 in children and young people melatonin is classified as an ‘amber’ drug by the NoT APC therefore subject to formal shared care guidance.  Please follow link below for the most recent guideline

 

 
Link  MELATONIN – Melatonin Children and Young People (Updated June 2018)
   
04.01.01  Benzodiazepines
Controlled Drug Temazepam
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First Choice
Green
 
04.01.01  Zaleplon, Zolpidem and Zopiclone
Zopiclone
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Formulary
Green
  • To be used in accordance with NICE criteria
 
Link  NICE TA77: Zaleplon, zolpidem and zopiclone for the management of insomnia
   
04.01.01  Chloral and derivatives to top
Chloral Hydrate
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Formulary
Green
 
   
Chloral Hydrate 500mg in 5ml mixture
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Formulary
Green
 
   
04.01.01  Clomethiazole (Chlormethiazole)
Clomethiazole
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Formulary
Green
  • Alcohol withdrawal - chlordiazepoxide is preferred in the management of alcohol withdrawal.
 
   
04.01.01  Antihistamines
Promethazine Hydrochloride
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Formulary
Green
 
   
04.01.01  Alcohol
04.01.01  Sodium oxybate
Controlled Drug Sodium Oxybate 500mg/1ml oral solution (Xyrem®)
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Formulary
Red
High Cost Medicine
  • Approved for the treatment of narcolepsy with cataplexy in children only in accordance with NHS england clinical commissioning policy.
  • Must be prescribed by Dr Kirstie Anderson (specialist sleep service at NUTH).
  • The Northern (NHS) Treatment Advisory Group only recommends the use of sodium oxybate in adult patients who have received and benefited from treatment with sodium oxybate as commissioned by NHS England. i.e. continuing treatment for those >19 years old
  • The use of sodium oxybate in new adult patients is not recommended.
 
Link  Clinical Commissioning Policy: Sodium oxybate for symptom control of narcolepsy with cataplexy (children)
Link  NTAG - Treatment Appraisal Decision Summary - Sodium Oxybate
   
04.01.02  Anxiolytics to top
 note 

Benzodiazepines should not be used as an anxiolytic for more than 4 weeks without being reviewed. Use in the elderly is discouraged.

04.01.02  Benzodiazepines
Diazepam
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First Choice
Green
  • Diazepam 2mg tablets: are the preferred strength in primary care. 
  • Diazepam 10mg tablets: should no longer be used. 
  • Diazepam 10mg in 2ml injection (plain & emulsion): only approved for use in epilepsy (see section 4.8.2).
 
Chlordiazepoxide
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Formulary
Green
 
   
Lorazepam
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Formulary
Green
 
   
04.01.02  Buspirone
04.01.02  Beta blockers
04.01.02  Meprobamate
04.01.03  Barbiturates to top
04.02  Drugs used in psychoses and related disorders
04.02.01  Antipsychotic Drugs
 note 

The traffic light status of the treatment of psychosis and schizophrenia in adults will be reviewed in line with NICE CG178.

For more information on prescribing antipsychotics in primary care see the North of Tyne Information leaflet. 

Antipsychotic Drugs – Prescribing & Monitoring in Adults - Information for Primary Care

Chlorpromazine
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Formulary
Green
 
   
Haloperidol
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Formulary
Green
 
   
Prochlorperazine
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Formulary
Green
 
   
Sulpiride
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Formulary
Green
 
   
Trifluoperazine
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Formulary
Green
 
   
Zuclopenthixol
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Formulary
Green
 
   
04.02.01  First Generation Antipsychotic Drugs
Chlorpromazine
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Formulary
Green
 
   
Haloperidol
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Formulary
Green
 
   
Perphenazine
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Formulary
Green
 
   
Sulpride
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Formulary
Green
 
   
Flupentixol
(Flupenthixol)
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Alternatives
Green
 
   
Levomepromazine
(Methotrimeprazine)
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Alternatives
Green
  • For use in palliative care.
  • Note: Methotrimeprazine 6mg tablets are unlicensedunlicensed
 
   
Trifluoperazine
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Alternatives
Green
 
   
04.02.01  Second Generation Antipsychotic Drugs
Risperidone
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Formulary
Green plus
  • Note: risperidone orodispersible tablets should only be used in situations where the plain tablets are unsuitable.
 
   
Amisulpride
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Formulary
Green plus
 
   
Aripiprazole
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Alternatives
Green plus
  • Approved for schizophrenia in people aged 15 to 17 years in line with NICE.
  • Approved for moderate to severe manic episodes in young people aged 13 and older with bipolar I disorder NICE. 
  • Aripriprazole 10mg & 15mg orodispersible tablets are approved for doses over 5mg for those patients who have difficulty swallowing. 
  • Aripiprazole 1mg in 1ml oral solution is only for doses of 5mg or less, or when titrating patients on doses of increments of less than 5mg, in patients who have difficulty swallowing tablets.
  • To be used in accordance with NICE criteria
  • Note: Aripiprazole 7.5mg/ml IM Injection is approved for use in rapid tranquilisation in patients with acute psychosis. Red Traffic Light NTW use only.
 
Link  NICE TA213: Aripiprazole for the treatment of schizophrenia in people aged 15 -17 years
Link  NICE TA292: Bipolar disorder (children) - aripiprazole
   
Clozapine
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Alternatives
Red
 
   
Olanzapine
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Alternatives
Green plus
  • Olanzapine orodispersible tablets should only be used in situations where the plain tablets are unsuitable. 
  • Olanzapine orodispersible tablets and injection are also approved for 2nd/3rd- line use in the management of delirium in critical care patients unlicensedunlicensed indication.
 
   
Quetiapine
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Alternatives
Green plus
  • 25mg, 100mg, 150mg 200mg & 300mg tablets 
  • 50mg, 200mg, 300mg & 400mg prolonged release tablets 
    • Prolonged release tablets are approved for use in patients who require an outside carer to administer their medicines, and for short term use when rapid dose titration is considered important e.g. where its use might avoid the need to admit the patient to hospital.


 
   
04.02.02  Antipsychotic depot injections to top
 note 

For detailed information on prescribing long-acting antopsychotic injections, see the following North of England information sheet.

Guidance on the Use of Antipsychotic Long-acting Injections in North of England

 

Zuclopenthixol Decanoate
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First Choice
Green
 
Aripiprazole (Abilify Maintena®)
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Alternatives
Green plus
  • NTAG approved for the treatment of schizophrenia as per its licensed indication and as outlined in the Guidance on the Use of Antipsychotic Long-acting Injections in the North of England.
 
Link  Aripiprazole (Abilify Maintena®, Otsuka Pharmaceuticals) long acting injection for schizophrenia
   
Flupentixol Decanoate
(REFER FOR FINAL DECISION)
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Alternatives
Green plus
 
   
Fluphenazine
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Alternatives
Green
  • Fluphenazine is to be discontinued in late 2018
    • All patients currently prescribed fluphenazine decanoate should have a medication review
 
   
Haloperidol Decanoate
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Alternatives
Green plus
 
   
Paliperidone
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Alternatives
Green plus
  • NTAG approved for the treatment of schizophrenia as per its licensed indication and as outlined in the Guidance on the Use of Antipsychotic Long-acting Injections in the North of England.
 
Link  Paliperidone long acting injection (Xeplion®) and Paliperidone 3 monthly injection (Trevicta®) Janssen-Cilag for schizophrenia.
   
Risperidone (Risperdal Consta®)
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Alternatives
Green plus
  • Only for use by psychiatrists in accordance with NTAG guidelines.
 
   
Zuclopenthixol Acetate (Clopixol Acuphase®)
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Alternatives
Red
  • For short-term use by NTW.
 
   
04.02.03  Drugs used for mania and hypomania
 note 

Other anticonvulsant drugs are used in the management of bipolar disorders e.g. Lamotrigine for the depressive phase. Such use is ‘off-licence’.

04.02.03  Benzodiazepines
04.02.03  Antipsychotic drugs
04.02.03  Carbamazepine
Carbamazepine
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Formulary
Green
 
   
04.02.03  Valproic acid to top
Sodium valproate 200mg, 300mg, and 500mg tablets (Epilim Chrono®)
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Formulary
Green
  • Sodium valproate 200mg, 300mg, and 500mg (Epilim Chrono®) tablets are approved for the prevention and treatment of manic episodes associated with bipolar disorder (unlicensedunlicensed indication). May be useful in patients unresponsive to lithium. 
  • Valproate must no longer be prescribed to women and girls of childbearing potential unless there is no alternative and they are on the Pregnancy Prevention Programme (PPP)
 
Link  Valproate medicines: Pregnancy Prevention Programme materials
   
Valproic Acid  (Depakote®)
(Semisodium valproate)
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Formulary
Green
  • Licensed alternative to sodium valproate MR tablets. 
  • Valproate must no longer be prescribed to women and girls of childbearing potential unless there is no alternative and they are on the Pregnancy Prevention Programme (PPP)
 
Link  Valproate medicines: Pregnancy Prevention Programme materials
   
04.02.03  Lithium
Lithium Carbonate
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Formulary
Amber
  • Prescribe by brand name.
 
Link  Lithium Shared Care Guideline
   
Lithium Citrate
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Formulary
Amber
  • Prescribe by brand name.
 
Link  Lithium Shared Care Guideline
   
04.03  Antidepressant drugs
04.03.01  Tricyclic and related antidepressant drugs
04.03.01  Tricyclic antidepressants
Amitriptyline
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First Choice
Green
 
Imipramine
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Formulary
Green
 
   
Lofepramine
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Formulary
Green
  • Safer than amitriptyline in overdosage, but not as effective.
 
   
Clomipramine
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Alternatives
Green
 
   
04.03.01  Related antidepressants to top
Trazodone
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First Choice
Green
  • Trazodone is widely used off-license for night sedation and behavioural symptoms of dementia.
 
04.03.02  Monoamine-oxidase inhibitors
Phenelzine
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Formulary
Green plus
  • For use on advice from psychiatrists only.
 
   
04.03.02  Reverible MAOIs
Moclobemide
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Formulary
Green plus
  • For use on advice from psychiatrists only.
 
   
04.03.03  Selective serotonin re-uptake inhibitors
Citalopram
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First Choice
Green
  • Please note maximum doses
    • Adults = 40mg
    • Elderly = 20mg
 
Fluoxetine
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First Choice
Green
  • 20mg capsules
  • 20mg dispersible tablets
    • first choice for patients unable to use the capsules
  • 20mg/5ml oral solution
 
Paroxetine
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First Choice
Green
 
Sertraline
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First Choice
Green
 
04.03.04  Other antidepressant drugs
 note 

These drugs are for use in patients not responding adequately to first-line treatments.

Agomelatine
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Alternatives
Green plus
  • NETAG approved for the treatment of depression only following an adequate trial of at least three alternative antidepressant drugs at maximally tolerated doses (as described by NICE and as stated in the BNF).

 

  • Prescribing and monitoring should be initiated by specialist mental health physicians. After a minimum of 12 weeks, prescribing may be transferred to primary care. 
 
   
Duloxetine
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Alternatives
Green plus
  • For use on advice of psychiatrists as a third-line antidepressant - but only for use in patients who cannot tolerate high-dose (>150mg daily) venlafaxine, or patients with hypertension, established CHD or other cardiovascular risk factors which would make the use of high-dose venlafaxine undesirable.
    Also approved for third-line use (after drugs such as the tricyclic antidepressants and gabapentin) in the treatment of neuropathic pain on the advice of pain specialists.
 
   
Mirtazapine
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Alternatives
Green
  • Orodispersible mirtazapine tablets should only be prescribed for use when other formulations are unsuitable (more expensive).
 
   
Reboxetine
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Alternatives
Green
  • Not licensed in the elderly
 
   
Venlafaxine
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Alternatives
Green
  • For patients on doses of 300mg/day or more. Green Traffic Light
  • Patients who are deemed stable on doses of up to 225mg daily of MR venlafaxine should be switched to the equivalent dose of immediate release venlafaxine.
  • MR tablets are only to be used in patients currently prescribed doses of 300mg and over and for whom there is no suitable alternative, those who have experienced discontinuation reactions (at any dose), and for patients who need to take the once daily formulation in order to facilitate care visits.
 
Link  HIGH DOSE VENLAFAXINE (300 mg/day or over) - Information for Primary Care
   
Vortioxetine
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Alternatives
Green
  • Only approved for use in accordance with NICE guidance. 
 
Link  NICE TA367: Vortioxetine for treating major depressive episodes
   
04.04  CNS stimulants and other drugs used for attention deficit hyperactivity disorder to top
Controlled Drug Methylphenidate
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Formulary
Amber
  • Please prescribe by brand name
  • Approved for ADHD and the treatment of narcolepsy in adult and paediatrics.
  • 5mg & 10mg tablets
  • 5mg, 10mg, 20mg, 30mg and 40mg m/r capsules (Medikinet® XL)
  • 10mg, 20mg & 30mg m/r capsules (Equasym® XL)
  • 18mg, 27mg & 36mg m/r tablets (Xaggitin® XL) -
    • Existing patients who are prescribed Concerta® XL should be reviewed and switched to Xaggitin® XL as appropriate
    • Xaggitin® XL is bioequivalent to Concerta® XL
 
Link  ADHD Shared Care Guideline (Adult)
Link  ADHD Shared Care Guideline (Children and Young People)
   
Atomoxetine
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Formulary
Amber
  • 10mg, 18mg, 25mg, 40mg, 60mg, 80mg & 100mg capsules
  • 4mg/1ml oral solution - approved for patients with more complex needs e.g. younger patients and those with swallowing difficulties.
 
Link  ADHD Shared Care Guideline (Adult)
Link  ADHD Shared Care Guideline (Children and Young People)
   
Controlled Drug Dexamfetamine
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Formulary
  • 5mg tablets
  • ADHD Amber
  • Narcolepsy Please Note:
    • Doses 30mg or below daily Green plus
    • Doses above 30mg daily Red Traffic Light
 
Link  ADHD Shared Care Guideline (Adult)
Link  ADHD Shared Care Guideline (Children and Young People)
Link  DEXAMFETAMINE (Dexamphetamine) – for Primary Sleep Disorder
   
Controlled Drug Lisdexamfetamine
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Formulary
Amber
  • 20mg, 30mg, 40mg, 50mg, 60mg & 70mg capsules
  • For third line use and specialist initiation. Should only transferred to GPs after at least three month stable symptom control
  • Approved for the treatment of ADHD in adults
 
Link  ADHD Shared Care Guideline (Adult)
Link  ADHD Shared Care Guideline (Children and Young People)
   
Modafinil
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Formulary
Green plus
  • Only approved for limited use in the treatment of patients with narcolepsy.
 
Link  Modafinil – Information for Primary Care
   
Pitolisant (Wakix®)
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Alternatives
Red
  • Approved for use in patients with narcolepsy who experience psychomotor side effects with modafinil and dexamfetamine.
  • To be used in line with NTAG
 
Link  NTAG - Treatment Appraisal Decision Summary - Pitolisant (Wakix®) for the treatment of narcolepsy with or without cataplexy in adults.
Link  NTAG - Pitolisant for Narcolepsy Treatment Pathway
   
Guanfacine (Intuniv®)
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Alternatives
Amber
  • 1mg, 2mg, 3mg & 4mg prolonged release tablets
  • Approved for use in children and adolescents when 1st line stimulants and atomoxetine are contraindicated or ineffective.
  • Can also be prescribed in primary care by GPs in adults who started treatment in childhood and wish to continue, for whom stimulants are not suitable, not tolerated or have been shown to be ineffective under specialist supervision
 
Link  Shared Care Guidance - Guanfacine for the Management of ADHD in Children and Young People
   
04.04  Cocaine
04.05  Drugs used in the treatment of obesity
04.05.01  Anti-obesity drugs acting on the gastro-intestinal tract
Orlistat
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Formulary
Green
  • Only approved for use in accordance with NICE guidance. 
 
   
04.05.02  Centrally acting appetite suppressants
04.06  Drugs used in nausea and vertigo to top
04.06  Vomiting during pregnancy
04.06  Postoperative nausea and vomiting
04.06  Motion sickness
04.06  Other vestibular disorders
04.06  Cytotoxic chemotherapy to top
04.06  Palliative care
04.06  Migraine
04.06  Antihistamines
Cinnarizine
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Formulary
Green
 
   
Cinnarizine
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Formulary
Green
 
   
Cyclizine
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Formulary
Green
 
   
Promethazine Hydrochloride (Phenergan)
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Formulary
Green
 
   
04.06  Phenothiazines and related drugs
Chlorpromazine
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Formulary
Green
 
   
Haloperidol
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Formulary
Green
 
   
Levomepromazine
(Methotrimeprazine)
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Formulary
Green
  • Levomepromazine 6mg tablets unlicensedunlicensed.
  • Levomepromazine 25mg in 1ml injection is approved for use in palliative care. 
 
   
Prochlorperazine
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Formulary
Green
  • Note: Buccastem® 3mg tablets are only approved for the treatment of nausea associated with migraine when the oral route cannot be used due to vomiting.
 
   
04.06  Domperidone and metoclopramide to top
Metoclopramide
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Formulary
Green
  • Please refer to MHRA advice 
 
Link  Metoclopramide: risk of neurological adverse effects
   
Domperidone
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Unlicensed Drug Unlicensed
Green plus
  • Approved for use as a galactagogue to re-establish breastfeeding on specialist advice and following a cardiovascular risk assessment in light of MHRA advice.
 
   
04.06  5HT3 antagonists
Ondansetron
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First Choice
Green
  • The cheapest available formulation should be used.
  • Ondansetron 4mg and 8mg oro-dispersible tablets/films are approved for the treatment of post-operative nausea and vomiting in patients who do not require IV access or are nil by mouth Red Traffic Light   

 
Palonosetron
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Alternatives
Red
  • Only approved for the second line treatment of chemotherapy induced nausea vomiting only.
 
   
Netupitant & Palonosetron (Akynzeo®)
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Alternatives
Red
  • To be used in accordance with Northern England Strategic Clincial Cancer Network (NCCN) Guidelines
 
   
04.06  Neurokinin receptor antagonist
Aprepitant
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Formulary
Red
  • For the prevention of chemotherapy induced nausea and vomiting (CINV) in high risk patients in accordance with North of England Cancer Network: CINV Guidelines in adult oncology and haematology patients
 
Link  Chemotherapy Induced Nausea and Vomiting (CINV) Anti-emetic Guidelines
   
Fosaprepitant
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Formulary
Red
  • For the prevention of chemotherapy induced nausea and vomiting (CINV) in high risk patients in accordance with North of England Cancer Network: CINV Guidelines in adult oncology and haematology patients
 
Link  Chemotherapy Induced Nausea and Vomiting (CINV) Anti-emetic Guidelines
   
04.06  Cannabinoid
Nabilone
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Formulary
Red
  • Also approved for very limited use in the treatment of chronic pain (unlicensedunlicensed) that has not responded to other treatments. Treatment must be initiated by pain consultants and reviewed after about one month. Treatment must be stopped immediately in non-responders.
  • Note: Nabilone 250 microgram capsules unlicensedunlicensed.
 
   
04.06  Hyoscine
Hyoscine Hydrobromide
(tablets/patches)
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Formulary
Green
  • For the management of excessive secretions where tablets are unsuitable.
 
   
Glycopyrronium bromide
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Formulary
Green plus
  •  1mg/5mL oral solution sugar free
    • Approved for the first line treatment of uncontrolled oral/respiratory secretions/sialorrhoea in Motor Neurone Disease/Home Ventilation patients who have cognitive impairment.
    • Approved for second line treatment of uncontrolled oral/respiratory secretions/sialorrhoea in Motor Neurone Disease/Home Ventilation  patients who have failed other treatment options such as hyoscine patches or who have intolerance to other agents.

  • 2mg/5ml oral solution (Sialanar®)
    • approved for the treatment of severe sialorrhoea in children and adolescents with chronic neurological disorders.

 
   
04.06  Other drugs for Ménière's disease to top
Betahistine Dihydrochloride
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Formulary
Green
 
   
04.07  Analgesics
04.07.01  Non-opioid analgesics and compound analgesic preparations
Paracetamol
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First Choice
Green
  • Paracetamol 1gram injection for IV infusion
    This is approved for limited short-term use where oral and rectal routes cannot be used and NSAIDs are not appropriate. 
  • In paediatric areas only, the 50ml formulation should be stocked.

 

  • Paracetamol suppositories
    unlicensedunlicensed preparations include 15mg, 30mg, 60mg, 120mg, 240mg, and 500mg. These are used in NUTH.
  • Licensed preparations include 60mg, 125mg, 250mg, and 500mg suppositories are available in primary care.
 
Naproxen tablets
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Green
 
   
Ibuprofen
View adult BNF View SPC online View childrens BNF  Track Changes
Alternatives
Green
 
   
Aspirin
View adult BNF View SPC online View childrens BNF  Track Changes
Alternatives
Green
 
   
Diclofenac
View adult BNF View SPC online View childrens BNF  Track Changes
Alternatives
Green
  • Oral diclofenac is restricted to short-term use for post operative pain.
  • If long-term use is required diclofenac is only approved for 4th line treatment (see below):
    • Ibuprofen low dose – first line treatment.
    • Naproxen low dose – second line treatment.
    • Naproxen high dose – third line treatment.
    • Diclofenac – fourth line treatment.

 
   
04.07.01  Compound analgesic preparations
Aspirin
View adult BNF View SPC online View childrens BNF  Track Changes
Alternatives
Green
 
   
04.07.02  Opioid analgesics
Codeine
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Green
  • The following codeine preparations are unlicensedunlicensed and approved for use:
    • codeine 30mg in 1ml injection CD
    • codeine 2mg, 3mg, 6mg, 15mg;
    • 30 mg suppositories.

 
   
Controlled Drug Morphine
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Green
  • Zomorph is the preferred formulation. 
  • Morphine 20mg, 30mg, 60mg, 100mg & 200mg sachets of MR granules for preparing oral  suspensions are only approved for use when other formulations are unsuitable. 
  • Note: the following unlicensedunlicensed preparations are also approved for use:
    • morphine 5mg in 1ml injection;
    • 10mg in 1ml preservative free injection;
    • 2mg in 5ml epidural
    • 50mg in 50ml PCA injection. 

 
   
Controlled Drug Diamorphine
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Green plus
  • Intranasal diamorphine (unlicensedunlicensed) is approved for use in children for the relief of severe pain due to clinically suspected limb fractures, burns and significant fingertip injuries. Appropriate risk assessments are to be conducted by each organisation in order to determine formulation of choice (e.g. ampoules or intranasal spray).
  • Note: intranasal diamorhine Red Traffic Light  
 
   
Controlled Drug Sufentanil (Zalviso®)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Red
  • 15microgram sublingual tablets
  • Approved only for Gateshead Health NHS Foundation Trust whose patients have had total knee replacement and are part of an enhanced recovery programme.
 
   
Controlled Drug Tramadol
View adult BNF View SPC online View childrens BNF  Track Changes
Alternatives
Green
  • 50mg capsules, 50mg dispersible tablets & 100mg/2ml injection
  • Only approved for use as a second-line weak opioid analgesic for use in patients where treatment with possible alternatives such as paracetamol, NSAIDs, and codeine is insufficiently effective, not tolerated or considered unsuitable for other reasons.
  • Note: modified release tramadol is not approved or recommended. 
 
   
Controlled Drug Buprenorphine
View adult BNF View SPC online View childrens BNF  Track Changes
Alternatives
Green plus
  • 200microgram sublingual tablets
  • 300microgram in 1ml injection
  • Buprenorphine patches (Preferred brand - Butec®) are approved for use in palliative care when fentanyl 12 microgram/hr transdermal patches exceed the patient’s analgesic requirements.
  • To be initiated by a specialist
 
   
Controlled Drug Fentanyl
View adult BNF View SPC online View childrens BNF  Track Changes
Alternatives
  • Fentanyl 200 microgram lozenges with oromucosal applicator are only approved for limited short-term use in RVI burns unit and for the treatment of very severe incident pain on the advice of pain/palliative care specialists Green plus
  • Fentanyl sublingual tablets (Abstral®) are also approved but only for patients experiencing incident pain during radiotherapy, restricted to palliative care use only Red.
  • 12, 25, 50, 75 & 100 microgram/hour transdermal patches (First choice brand - Mezolar®Green Traffic Light.
    • Mezolar® has replaced Matrifen® as the first choice brand. Patients who currently use Matrifen® can continue to do so if managing well.
 
   
Controlled Drug Hydromorphone
View adult BNF View SPC online View childrens BNF  Track Changes
Alternatives
Green
 
   
Controlled Drug Methadone
View adult BNF View SPC online View childrens BNF  Track Changes
Alternatives
Green plus
  • The following preparations are approved:
    • 5mg tablets;
    • 2mg in 5ml linctus;
    • 5mg in 5ml mixture DTF & 5mg in 5ml sugar free solution
    • 20mg in 1ml concentrated oral solution (unlicensedunlicensed)
    • 10mg in 1ml injection

 
   
Controlled Drug Oxycodone
View adult BNF View SPC online View childrens BNF  Track Changes
Alternatives
  • Approved only for use in patients who are intolerant of morphine. Green
  • Note: Oxycodone 50mg in 1ml injection  is also approved for use, but is restricted to controlled circumstances in palliative patients following risk assessment by individual organisations.Green Traffic Light
  • Approved for use as part of Enhanced Recovery After Surgery (ERAS) as part of multi-modal enhanced recovery pathway following hip and knee surgery Red
  • The Longtec® branded generic is preferred (most cost effective option).
  • The oral solution should be used instead of immediate release tablets. 


 
   
Controlled Drug Pethidine
View adult BNF View SPC online View childrens BNF  Track Changes
Alternatives
Green
 
   
Controlled Drug Tapentadol
View adult BNF View SPC online View childrens BNF  Track Changes
Alternatives
Green plus
  • Approved for use by chronic pain specialist in adults with severe pain who have been screened for a neuropathic element to their pain and are uncontrolled or experiencing GI side effects on existing therapy.
 
   
Controlled Drug Dihydrocodeine
View adult BNF View SPC online View childrens BNF  Track Changes
Alternatives
Red
  • Note: the use of dihydrocodeine 30mg tablets & 10mg in 5ml oral solution is no longer recommended for regular use. Codeine is the preferred weak opioid analgesic.
  • Dihydrocodeine is only approved for use in breast feeding mothers immediately postdelivery/ c-section where adequate pain relief has not been achieved using paracetamol and NSAIDs. Patients requiring contunation of dihydrocodeine following discharge (post delivery/c-section) can have dihydrocodeine prescribed in primary care (for short-term use only).
 
   
04.07.03  Neuropathic pain to top
 note 

Note: other drugs such as Ketamine (see section 15.1.1) may also be advised by pain/palliative care specialists in the management of neuropathic pain.

Amitriptyline
View adult BNF View SPC online View childrens BNF  Track Changes
First Choice
Green
 
Gabapentin
View adult BNF View SPC online View childrens BNF  Track Changes
Second Choice
Green
  • Gabapentin is also approved for hospital use  as an adjunct to other treatment in the management of peri/post-operative pain. Red Traffic Light unlicensedunlicensed
  • GPs should not be asked to prescribe gabapentin for this unlicensed indication.
 
   
Pregabalin
View adult BNF View SPC online View childrens BNF  Track Changes
Second Choice
Green plus
  • Pregabalin is restricted to use in the management neuropathic pain as a second choice where treatment with gabapentin has been unsuccessful or not tolerated.
 
   
Carbamazepine
View adult BNF View SPC online View childrens BNF  Track Changes
Alternatives
Green
  • Restricted use in treatment of trigeminal neuralgia only.
 
   
Duloxetine
View adult BNF View SPC online View childrens BNF  Track Changes
Alternatives
Green plus
  • For third-line use (after drugs such as the tricyclic antidepressants and gabapentin) in the treatment of neuropathic pain on the advice of pain specialists.
 
   
Phenytoin
View adult BNF View SPC online View childrens BNF  Track Changes
Alternatives
Green
 
   
Mexiletine
View adult BNF View SPC online View childrens BNF  Track Changes
Unlicensed Drug Unlicensed
Green plus
High Cost Medicine
  • For use in the treatment of neuropathic pain. ECG monitoring is required to be carried out by pain clinic consultants as part of the initiation process of mexiletine, as patients are required for cardiac arrhythmias.
 
   
04.07.03  Trigeminal neuralgia
04.07.03  Postherpetic neuralgia
Capsaicin
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
  • Qutenza® cutaneous patch approved for the treatment of neuropathic pain as fourth line agent for neuropathic pain and in line with the attached regionally agreed pathway. Red
  • 0.075% cream (Axsain®) approved for post hepatic neuralgia and peripheral diabetic neuropathy Green plus
 
Link  NTAG - Treatment Appraisal Decision Summary - Capsaicin (Qutenza)
Link  NTAG Pathway for the use of Qutenza (Capsaicin 8%) in the Neuropathic Pain Patient Group
   
Lidocaine 5% medicated plasters (700mg lidocaine/plaster)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Green plus
  • For use in the treatment of post-herpetic neuralgia only, on the advice of pain specialists and subject to an appropriate trial of efficacy in each individual patient.
 
   
04.07.03  Chronic facial pain
04.07.04  Antimigraine drugs
04.07.04.01  Treatment of the acute migraine attack to top
04.07.04.01  Analgesics
Paracetamol
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Green
 
   
Ibuprofen
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Green
 
   
Naproxen tablets
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Green
 
   
Aspirin
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Green
 
   
Diclofenac
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Green
 
   
04.07.04.01  5HT1 agonists
Sumatriptan
View adult BNF View SPC online View childrens BNF  Track Changes
First Choice
Green
 
Zolmitriptan 2.5mg tablets
View adult BNF View SPC online View childrens BNF  Track Changes
Alternatives
Green
 
   
Frovatriptan
View adult BNF View SPC online View childrens BNF  Track Changes
Alternatives
Green
 
   
04.07.04.01  Ergot alkaloids
04.07.04.01  Anti-emetics
Metoclopramide
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Green
  • Used to help promote absorption of analgesics.
 
   
04.07.04.01  Other drugs for migrane to top
04.07.04.02  Prophylaxis of migraine
Pizotifen
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Green
 
   
Metoprolol
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Green
 
   
Propranolol
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Green
 
   
Topiramate
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Green
 
   
Clonidine
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Green
  • Clonidine is not generally recommended for migraine prophylaxis; may aggravate depression/cause insomnia.
 
   
Botulinum Toxin Type A
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Red
  • Only approved for use in accordance with NICE guidance. 
 
Link  NICE TA 260 - Botulinum toxin type A for the prevention of headaches in adults with chronic migraine
   
Amitriptyline
View adult BNF View SPC online View childrens BNF  Track Changes
Unlicensed Drug Unlicensed
Green
 
   
Imipramine
View adult BNF View SPC online View childrens BNF  Track Changes
Unlicensed Drug Unlicensed
Green
 
   
Sodium valproate
View adult BNF View SPC online View childrens BNF  Track Changes
Unlicensed Drug Unlicensed
Green
  • Note: sodium valproate 500mg & 1000mg MR granules (Episenta®) are also approved for use in those who have difficulty swallowing sodium valproate tablets. MR granules may be more convenient to use than large volumes of liquid formulations.
 
Link  Valproate medicines: Pregnancy Prevention Programme materials
   
04.07.04.03  Cluster headache
Lithium carbonate
View adult BNF View SPC online View childrens BNF  Track Changes
Unlicensed Drug Unlicensed
Amber
  • Lithium should be prescribed by brand name.
 
Link  Lithium Shared Care Guideline (Amber)
   
Lithium citrate
View adult BNF View SPC online View childrens BNF  Track Changes
Unlicensed Drug Unlicensed
Amber
  • Lithium should be prescribed by brand name.
 
Link  Lithium Shared Care Guideline (Amber)
   
04.08  Antiepileptics
04.08.01  Control of epilepsy
 note 

The MHRA recommend that patients on certain antiepileptic drugs remain on the same brand where possible. In order to help decide which anti-epileptics may or may not be switched the MHRA have classified anti-epileptics in to 3 categories.

Category 1 - the patient should be maintained on a specific manufacturer’s product (carbamazepine, phenobarbital and phenytoin)

Category 2 - 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 (clobazam, clonazepam, eslicarbazepine acetate, lamotrigine, oxcarbazepine, perampanel, retigabine, rufinamide, sodium valproate, topiramate, and zonisamide).

Category 3 - 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 (acetazolamide, brivaracetam, ethosuximide, gabapentin, lacosamide, levetiracetam, pregabalin, stiripentol, and vigabatrin).

Acetazolamide
(Category 3)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Green
 
   
Brivaracetam
(Category 3)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Green plus
  • Approved for use as adjunctive therapy in patients with severe/intractable partial onset seizures e.g. a sezuire frequency of 1 per week following failure of first-line adjunctive therapy. Response must be assessed within 3-6 months before transferring prescribing to primary or stopping treatment, as appropriate.
 
   
Carbamazepine
(Category 1)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Green
  • Carbamazepine 200mg and 400mg MR tablets (Tegretol® retard) are available on consultant request for those in whom conventional carbamazepine has been shown to be unsuitable Green Traffic Light
 
   
Clobazam
(Category 2)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Green plus
 
   
Clonazepam
(Catergory 2)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Green
  • Clonazepam 500microgram in 5ml sugar-free oral solution is also approved unlicensedunlicensed
 
   
Eslicarbazepine
(Category 2)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Green plus
  • Approved for use by specialists only in those patients for whom intolerance of carbamazepine is a major concern and when use of this agent is more cost effective than alternatives available.
 
   
Ethosuximide
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Green
 
   
Gabapentin
(Category 3)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Green
  • Note: gabapentin 250mg in 5ml is also approved unlicensedunlicensed.
 
   
Lacosamide
(Category 3)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Green plus
  • Only approved on advice from consultant neurologists, in patients that are refractory to treatment with other drugs.
 
   
Lamotrigine
(Category 2)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Green
 
   
Levetiracetam
(Category 3)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Green plus
 
   
Oxcarbazepine
(Category 2)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Green
 
   
Perampanel
(Category 2)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Green
  • NETAG approved for partial (focal) seizure epilepsy only when other treatment  options recommended by NICE have been tried or fully considered.
 
Link  NETAG - Perampanel (Fycompa®) for focal epilepsy
   
Controlled Drug Phenobarbital
(Category 1)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Green
 
   
Phenytoin
(Category 1)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Green
  • Note: phenytoin 30mg in 5ml suspension (base) – 90mg (15ml) is equivalent to one 100mg phenytoin sodium capsule 250mg in 5ml injection (sodium salt).
 
   
Pregabalin
(Category 3)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Green plus
  • Approved for specialist advice in the management of treatment resistant epilepsy. 
  • Also approved as a second line agent for General Anxiety Disorder. Although treatment can be given 2-3 times daily, it is more cost effective to give as a twice daily dose. 
 
   
Retigabine
(Category 2)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Green plus
  • Only approved for use in accordance with NICE guidance. 
 
Link  NICE TA232: Retigabine for the adjunctive treatment of adults with partial onset seizures in epilepsy with and without secondary generalisation
   
Rufinamide
(Category 2)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Red
  • Approved for limited use as a second or third-line treatment in patients with Lennox-Gastaut syndrome and related encephalopathies.
  • Should only be used on the advice of paediatric neurologists and other neurologists specialising in the treatment of epilepsy.
 
   
Sodium Valproate
(Category 2)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Green
  • Note: sodium valproate 500mg & 1000mg MR granules (Episenta®) - for possible use in those who have difficulty swallowing sodium valproate tablets. May be more convenient to use than large volumes of liquid formulations.
 
Link  Valproate medicines: Pregnancy Prevention Programme materials
   
Stiripentol
(Category 3)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Green plus
  • For use as adjunctive therapy of refractory generalised tonicclonic seizures in children with severe myoclonic epilepsy in infancy.
 
   
Topiramate
(Category 2)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Green plus
 
   
Vigabatrin
(Category 3)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Amber
 
Link  Shared Care Guidance Vigabatrin
   
Zonisamide
(Category 2)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Green
  • For specialist use only in patients that are refractory to treatment with other drugs
  • Use in children is unlicensedunlicensed.
 
   
04.08.01  Partial seizures with or without secondary generalisation to top
04.08.01  Generalised seizures
04.08.01  Carbamazepine and Oxcarbazepine
04.08.01  Ethosuximide
04.08.01  Gabapentin and pregabalin
04.08.01  Lacosamide to top
04.08.01  Lamotrigine
04.08.01  Levetiracetam
04.08.01  Perampanel
04.08.01  Phenobarbital and other barbiturates
04.08.01  Phenytoin to top
04.08.01  Retigaine
04.08.01  Rufinamide
04.08.01  Rufinamide
04.08.01  Tiagabine
04.08.01  Topiramate to top
04.08.01  Valproate
04.08.01  Vigabatrin
04.08.01  Zonisamide
04.08.01  Benzodiazepines
04.08.01  Other Drugs to top
04.08.02  Drugs used in status epilepticus
Diazepam
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Green
 
   
Controlled Drug Midazolam
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Green plus
  • Buccolam® 5mg/ml alcohol-free buccal solution, and Buccolam® 2.5mg, 5mg, 7.5mg and 10mg prefilled oral syringes are approved as first choice for status epilepticus in children aged 3 months to 18 years.
  • Epistatus® 10mg in 1ml oromucosal solution pre-filled oral syringes is approved for use in the treatment of epileptic seizures in infants under 3 months and adults over 18 years of age. 
    Injection solutions (section 15.1.4) can also be given buccally
  • Midazolam 2.5mg in 5ml oral solution is approved for use as a sedative. To be used in preference to administering the injection orally (more cost effective).unlicensedunlicensed
 
   
Clonazepam
View adult BNF View SPC online View childrens BNF  Track Changes
Alternatives
Green plus
  • For initiation by neurologists only.
 
   
Lorazepam
View adult BNF View SPC online View childrens BNF  Track Changes
Alternatives
Green plus
  • For initiation by neurologists only.
  • Lorazepam  2mg/ml suspension & 4mg/ml suspension are also approved but are unlicensedunlicensed.
  • Buccal administration of lorazepam suspensions are only approved for use in paediatrics in children with status epilepticus in whom buccal midazolam, rectal paraldehyde or rectal diazepam are ineffective.Red Traffic Light
 
   
Phenytoin sodium 250mg in 5ml injection
View adult BNF View SPC online View childrens BNF  Track Changes
Alternatives
Green plus
  • For initiation by neurologists only.
 
   
Paraldehyde rectal liquid
View adult BNF View SPC online View childrens BNF  Track Changes
Unlicensed Drug Unlicensed
Green plus
  • For initiation by neurologists only.
 
   
04.08.03  Febrile convulsions
Paracetamol
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Green
 
   
04.09  Drugs used in parkinsonism and related disorders
04.09.01  Dopaminergic drugs used in Parkinsons disease
Safinamide
View adult BNF View SPC online View childrens BNF  Track Changes
Alternatives
Green plus
  • 50mg and 100mg tablets
  • Approved for use in Parkinson's Disease patients on levodopa who are having motor fluctuations affecting their quality of life as an alternative to rasagiline.
 
   
04.09.01  Dopamine receptor agonists to top
Apomorphine
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Red
  •  Apomorphine 10mg lozenges are also approved (RVI) unlicensedUnlicensed
 
   
Bromocriptine
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Green plus
 
   
Pramipexole
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Green plus
  • Approved for second line use in Parkinson's disease. 
 
   
Ropinirole
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
  • Ropinirole once daily formulation is only approved for use in Parkinson’s disease patients with proven compliance. Green plus
  • Approved for first line use in patients with restless legs syndrome. Green
 
   
Rotigotine
(Parkinsons)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Green plus
  • For use on the advice of specialists in the treatment of Parkinson's disease. Mainly for use in patients who have difficulty with swallowing.
  • Approved for second line use in patients with restless legs syndrome.
 
   
04.09.01  Levodopa
Co-Beneldopa
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Green
 
   
Co-Careldopa
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Green plus
 
   
Co-Careldopa and Entacapone
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Green plus
 
   
04.09.01  Monoamine-oxidase-B inhibitors
Rasagiline
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Green plus
 
   
Selegiline Hydrochloride
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Green
 
   
04.09.01  Catachol-O-methyltransferase inhibitors
Entacapone
View adult BNF View SPC online View childrens BNF  Track Changes
First Choice
Green plus
 
Opicapone
View adult BNF View SPC online View childrens BNF  Track Changes
Alternatives
Green plus
  • Approved as an alternative to tolcapone in patients with Parkinson's disease in whom entacapone has not been tolerated or failed.
 
   
Tolcapone
View adult BNF View SPC online View childrens BNF  Track Changes
Alternatives
Red
 
   
04.09.01  Amantadine
Amantadine
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Green plus
  • For use on the advice of neurologists.
 
   
04.09.02  Antimuscarinic drugs used in parkinsonism to top
Orphenadrine
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Green
  • 5mg/5ml Liquid
 
   
Procyclidine
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Green
 
   
Trihexyphenidyl
(Benzhexol)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Green
 
   
04.09.03  Drugs used in essential tremor, chorea, tics, and related disorders
Botulinum Toxin Type A (Botox®)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Red
High Cost Medicine
  • Botox also approved for use in paediatric patients with severe bladder over- activity and neuropathic bladder who have not responded to other treatment.
  • Prescribe by brand name.
 
   
Botulinum Toxin Type A (Dysport®)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Red
High Cost Medicine
  • Prescribe by brand name.
 
   
Botulinum Toxi Type A injection (Xeomin ® )
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Formulary
Red
High Cost Medicine
  • Similar potency to Botox®, and may be less expensive (depending on price agreements/ contracts), but not licensed for the full range of indications.
 
   
Botulinum Toxin Type A (Vistabel®)
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Formulary
Red
High Cost Medicine
  • Restricted to use in private patients receiving aesthetic treatment. 
  • Prescribe by brand name.
 
   
Botulinum Toxin Type B (NeuroBloc®)
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Formulary
Red
High Cost Medicine
 
   
Riluzole
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Formulary
Red
High Cost Medicine
  • Approved for motor neurone disease in line with NICE. 
  • Note: riluzole oral suspension approved only when other preparations (including crushing tablets) are not suitable.
 
Link  NICE TA20: Motor neurone disease - riluzole
   
Tetrabenazine
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Formulary
Green plus
  • For use on the advice of neurologists. 
 
   
Haloperidol
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Formulary
Green
 
   
Memantine
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Formulary
Green plus
  • Approved for use as last line drug after other alternatives have been considered, in the treatment of congenital and acquired nystagmus.
 
   
04.09.03  Torsion dystonias and other involuntary movements
04.10  Drugs used in substance dependence
04.10  Alcohol dependence
04.10  Cigarette smoking to top
04.10  Opioid dependence
04.10.01  Alcohol dependence
Acamprosate
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Formulary
Green plus
 
   
Chlordiazepoxide
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Formulary
Green
 
   
Disulfiram
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Formulary
Green
 
   
Nalmefene
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Formulary
Green plus
  • Only approved for use in accordance with NICE guidance. 
 
Link  NICE TA325: Nalmefene for reducing alcohol consumption in people with alcohol dependence
   
Naltrexone
(alcohol dependence)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Red
 
   
04.10.02  Nicotine dependence
Bupropion Hydrochloride
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Formulary
Green
 
   
Nicotine
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Formulary
Green
  • The following nicotine replacement treatments are approved:
    • Nicotine gum -  2mg & 4mg sugar-free chewing gum (Nicorette® is the gum of choice).
    • Nicotine 16 hour patch - 10mg, 15mg, and 25mg/16 hour patches (Nicorette® Invisi). 
    • Nicotine 24 hour patch - 7mg & 14mg, and 21mg /24 hour patches (Nicotinell® is the patch of choice as potential savings to be made).
    • Nicotine lozenges - 2mg and 4mg lozenges (Niquitin® is the lozenge of choice), 1.5mg and 4mg mini lozenges (NiQuitin® Minis Lozenges).
    • Nicotine 2mg sublingual tablets.
    • Nicotine inhalator -  15mg cartridges for use in inhalator.
    • Nicotine oromucosal spray - Nicorette® Quickmist 1mg per dose.
 
   
Varenicline
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Formulary
Green
  • Only approved for use in accordance with NICE guidance. 
 
Link  NICE TA123: Varenicline
   
04.10.03  Opioid dependence
Controlled Drug Buprenorphine 400 microgram, 2mg, and 4mg sublingual tablets
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Formulary
Red
  • Only approved for use in accordance with NICE guidance. 
  • In the treatment of substance misuse the 400microgram strength should be prescribed as Subutex® to avoid a product licensed for pain relief being supplied
 
   
Controlled Drug Buprenorphine and Naloxone (Suboxone®)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Red
 
   
Lofexidine (BritLofex®)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Red
 
   
Controlled Drug Methadone
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Formulary
Green plus
  • Methadone 5mg in 5ml oral solution and 5mg in 5ml sugar free solution are both approved for the management of opioid dependence in line with NICE.
 
   
Naltrexone 50 mg tablets (Nalorex®)
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Formulary
Red
  • Approved for the management of opioid dependence in detoxified formerly opioid-dependent people in line with NICE.
  • Also approved for use in reducing agitation and/ or selfinjurious behaviour in patients with learning disabilities or autism (unlicensedunlicensed indication). Treatment must be initiated by an appropriate hospital specialist and GPs should only be asked to prescribe it for responders in accordance with a shared care guidelineAmber Traffic Light
 
Link  Naltrexone Shared Care Guidance
Link  NICE TA115: Drug misuse - naltrexone
   
04.10.03  Opioid substitution therapy to top
04.10.03  Adjunctive therapy and symptomatic treatment
04.10.03  Opioid-receptor antagonists
04.11  Drugs for dementia
 note 

Treatment with these drugs should only be initiated by psychogeriatricians and certain neurologists.
ACETYLCHOLINESTERASE INHIBITORS: INFORMATION FOR PRIMARY CARE

Donepezil
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First Choice
Green plus
  • Only approved for use in accordance with NICE guidance. 
 
Galantamine
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Alternatives
Green plus
  • Only approved for use in accordance with NICE guidance. 
  • The oral solution is only approved for limited short-term use in the management of hospital patients who are unable to swallow tablets/ capsules. It is not for use in patients whose dementia is so severe that they can no longer swallow tablets.
 
Link  NICE TA217: Donepezil, galantamine, rivastigmine and memantine for the treatment of Alzheimer’s disease
   
Memantine
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Alternatives
Green plus
  • Only approved for use in accordance with NICE guidance. 
 
Link  MEMANTINE: INFORMATION FOR PRIMARY CARE
Link  NICE TA217: Donepezil, galantamine, rivastigmine and memantine for the treatment of Alzheimer’s disease
   
Rivastigmine
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Alternatives
Green plus
  • Only approved for use in accordance with NICE guidance. 
  • Rivastigmine patches are approved for patients unable to tolerate treatment with oral rivastigmine due to nausea and vomiting, and for patients requiring treatment with an acetylcholinesterase inhibitor who are unable to take oral medication e.g. due to swallowing difficulties or ‘nil by mouth’ prior to surgery.
 
Link  NICE TA217: Donepezil, galantamine, rivastigmine and memantine for the treatment of Alzheimer’s disease
   
04.12  Miscellaneous
Dehydrated alcohol 100% BP for Injection
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Red
  • Approved for intrathecal neurolysis treatment of intractable pain due to cancer in terminally ill patients
 
   
Phenol 5% in Glycerol Injection
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Red
  • Approved for intrathecal neurolysis treatment of intractable pain due to cancer in terminally ill patients
 
   
 ....
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
Cancer Drugs Fund
Cancer Drugs Fund
NHSE
NHS England
Homecare
Homecare
CCG
CCG

Traffic Light Status Information

Status Description

Red

Drugs for hospital use only. The responsibility for initiation and monitoring treatment should rest with an appropriate hospital clinician and the drug should be supplied through the hospital throughout the duration of treatment. In some very exceptional circumstances (e.g. due to distance from the hospital, storage, supply or mobility/transport problems) it may be appropriate for the GP to be asked to prescribe a Red drug. This should be negotiated on an individual patient basis and should only be done with the GP’s prior informed agreement where the roles of the GP and hospital services are clearly defined and agreed. The GP should not feel under pressure to prescribe in these circumstances.   

Amber

Drugs initiated by hospital specialist, but where continuing treatment by GPs may be appropriate under a shared care arrangement. The specialist should send the GP a copy of the shared care agreement to sign. The GP should sign the shared care agreement, or indicate they do not want to be part of such an agreement, and return a copy back to the specialist. Shared care guidelines are available or are being developed for most of the drugs listed as Amber. If no shared care guideline is available, the hospital specialist should provide the patient’s GP with sufficient information and support to allow treatment to be continued and managed safely in primary care.  

Green plus

Drugs normally recommended or initiated by hospital specialist, but where the provision of an information leaflet may be appropriate to facilitate continuing treatment by GPs. Many of these information sheets are in the process of development.  

Green

Drugs where prescribing by GPs is appropriate. Drugs not classified as Red, Amber or Green Plus (formerly blue in North of Tyne) are generally classified as ‘Green’ by default. The Green drugs listed here include those products normally initiated by hospital specialists where there was a need for discussion and debate as to the category in which they should be placed.  

netFormulary