North of Tyne, Gateshead and North Cumbria Formulary

	North of Tyne, Gateshead and North Cumbria
	Area Prescribing Committee Formulary

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Formulary Chapter 4: Central nervous system - Full Chapter

04.07.01

Non-opioid analgesics and compound analgesic preparations

Paracetamol

First Choice

Paracetamol 500mg tablets
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
- unlicensed 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

Formulary

Ibuprofen

Alternatives

Aspirin

Alternatives

Diclofenac

Alternatives

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.

NICE NG59: Low back pain and sciatica in over 16s: assessment and management

04.07.01

Compound analgesic preparations

Aspirin

Alternatives

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Key

	Notes
	Section Title (top level)
	Section Title (sub level)
	First Choice item
	Non Formulary section
	Restricted Drug
	Unlicensed
	Display tracking information
	Link to adult BNF
	Link to children's BNF
	Link to SPCs
	Scottish Medicines Consortium

	Cytotoxic Drug
	Controlled Drug
	High Cost Medicine
	Cancer Drugs Fund
	NHS England
	Homecare
	CCG

Traffic Light Status Information

Status	Description
	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.
	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.
	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.
	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.