netFormulary North of Tyne and Gateshead Area Prescribing Committee NHS
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 Formulary Chapter 4: Central nervous system - Full Chapter
04.02.01  Expand sub section  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

04.02.01  Expand sub section  First Generation Antipsychotic Drugs
04.02.01  Expand sub section  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
  • First choice in patients with treatment-resistant schizophrenia. 
 
   
Olanzapine
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Alternatives
Green plus
  • Olanzapine orodispersible tablets should only be used in situations where the plain tablets are unsuitable. 
  • Olanzapine 10mg injection is approved for rapid control of agitation and disturbed behaviours in patients with schizophrenia or manic episode, when oral therapy is not appropriate. 
  • 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.


 
   
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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
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Link to adult BNF
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Link to children's BNF
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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.  

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