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 Formulary Chapter 4: Central nervous system - Full Chapter
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04.09.01  Expand sub section  Dopaminergic drugs used in Parkinsons disease
04.09.01  Expand sub section  Dopamine receptor agonists
Apomorphine
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Formulary
Amber
  • 5mg/1ml (20ml) solution for infusion for infusion pumps & 10mg/1ml (3ml) solution for injection cartridges (Dacepton®) - NEW PATIENTS
  • 30mg/3ml solution for injection (APO-go®) - Patients commenced on treatment prior to July 2022 can continue on APO-go® (including 50mg/10ml solution for infusion pre-filled syringes for infusion pumps)
  • Apomorphine 10mg lozenges are also approved (RVI) unlicensedUnlicensed
 
Link  County Durham Shared Care Guidelines: Apomorphine
Link  MHRA Drug Safety Update (April 2016): Apomorphine with domperidone: minimising risk of cardiac side effects
Link  North of Tyne, Gateshead and North Cumbria - Apomorphine - Shared Care Guidance
Link  South Tyneside & Sunderland APC Shared Care Guideline - Apomorphine injection or infusion for Parkinson’s disease
Link  Tees Valley Shared Care Guidelines: Apomorphine
 
Bromocriptine
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Formulary
Green plus
 
 
Pramipexole
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Formulary
Green plus
  • Approved for second line use in Parkinson's disease. 
 
 
Ropinirole
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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)
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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  Expand sub section  Levodopa
04.09.01  Expand sub section  Monoamine-oxidase-B inhibitors
04.09.01  Expand sub section  Catachol-O-methyltransferase inhibitors to top
04.09.01  Expand sub section  Amantadine
04.09.01  Expand sub section  Mild to moderate dementia in Parkinsons disease
 ....
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
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Link to adult BNF
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Link to children's BNF
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Cytotoxic Drug
Cytotoxic Drug
CD
Controlled Drug
High Cost Medicine
High Cost Medicine
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. For all RED drugs automatically added to the formulary in response to a positive NICE TA: Prescribers need to ensure that local Trust new drug governance procedures and pharmacy processes are followed before any prescribing.  

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 a specialist (hospital or GP with an extended role https://www.rcgp.org.uk/gpwer), but can be safely maintained in primary care with very little or no monitoring required. In some cases there may be a further restriction for use outlined - these will be defined in each case. Provision of additional information, or an information leaflet, may be appropriate in some cases to facilitate continuing treatment by GPs.  

Green

Drugs where prescribing by GPs is appropriate. Can be initiated and prescribed in all care settings, and if appropriate, discontinued without recourse to secondary care.  

Black

NOT APPROVED: Drugs that have been considered by NTAG or the NENC ICB Medicines Subcommittee (or other approved body) and are not approved for prescribing within the North East and North Cumbria.   

Brown

UNDER REVIEW: drugs whose current formulary status or RAG status is currently under review.  

Not Recomended

NOT REVIEWED: Drugs that haven not been reviewed yet. This usually means that an application is in progress. These drugs are not normally considered appropriate for prescribing in the North East and North Cumbria until such time that a decision is taken on their formulary status.  

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