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Airedale NHS Foundation Trust
Airedale, Wharfedale and Craven CCG
 
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 Formulary Chapter 4: Central nervous system - Full Chapter
Notes:

Unless explicitly stated, any brand names included in brackets next to a drug's generic name are there solely to aid searching and identification, and should not be considered to limit use to that specific brand. 

For guidance on prescribing psychotropic drugs, refer to the Bradford District Care Trust Psychotropic Drug Formulary

North Yorkshire Primary Care Alcohol and Drug Misuse Service Medicines Formulary

North Yorkshire Primary Care Horizons Medicines Formulary (Craven patients only) - Jan 2020

 Details...
04.01  Hypnotics and anxiolytics
04.01.01  Hypnotics
Dexmedetomidine (Dexdor®)
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Restricted Drug Restricted
Red
  • Dexmedetomidine Injection

Approved for “off-licence” nasal or buccal administration for sedative pre-medication in children

Approved for sedation of adult patients on ICU requiring a sedation level of RASS 0 to -3

Consultant Anaesthetist use only

 
   
Melatonin  (Circadin ®)
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Restricted Drug Restricted
Amber SCG
  • Melatonin M/R Tablets (Circadin)

Restricted to paediatric patients only.

 
Link  Melatonin Shared Care Guideline
   
Melatonin
(Liquid)
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Restricted Drug Restricted
Red ULM
  • Melatonin 1mg/mL Liquid

Restricted to paediatric patients only.

 
Link  Unlicensed Medicines Consultant Request Form (ANHSFT access only)
Link  Unlicensed Medicines Patient Agreement for Use Form (ANHSFT access only)
Link  Unlicensed Medicines Patient Information Leaflet (ANHSFT access only)
Link  Unlicensed Medicines Policy (ANHSFT access only)
   
04.01.01  Benzodiazepines
 note 
  1. Benzodioazepines are indicated for the short term relief (two to four weeks only) of anxiety that is severe, disabling or causing the patient unacceptable distress occurring alone or in association with insomnia or short term psychosomatic, organic or psychotic illness.
  2. The use of benzodiazepines to treat short term ‘mild’ anxiety is inappropriate.
  3. Benzodiazepines should be used to treat insomnia only when it is severe, disabling or causing the patient extreme distress.

BNF (December 2018)

Temazepam
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Formulary Green Traffic LightTemazepam SF Solution
Green Traffic LightTemazepam Tablets

Green Traffic Light (Restricted) For premedication before surgery.


Note: Temazepam is very expensive in primary care 
Controlled Drug Schedule 3
   
Nitrazepam
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Restricted Drug Restricted
Green
  • Nitrazepam Tablets
  • Nitrazepam Oral Suspension

Reserved for existing patients only

 
Controlled Drug Schedule 4
   
04.01.01  Zaleplon, Zolpidem and Zopiclone
Zopiclone
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First Choice
Green
  • Zopiclone Tablets
 
Controlled Drug Schedule 4
Zolpidem
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Formulary
Green
  • Zolpidem Tablets
 
Controlled Drug Schedule 4
Link  NICE TA77: Guidance on the use of zaleplon, zolpidem and zopiclone for the short-term management of insomnia (April 2004)
   
04.01.01  Chloral and derivatives to top
Chloral Hydrate
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Formulary
Amber
  • Chloral Hydrate Solution (500mg/5ml strength kept at ANHSFT)

For specialist use only
Take care - other strengths available

 
   
04.01.01  Clomethiazole (Chlormethiazole)
04.01.01  Antihistamines
04.01.01  Alcohol
04.01.01  Sodium oxybate
04.01.02  Anxiolytics to top
04.01.02  Benzodiazepines
Chlordiazepoxide Hydrochloride
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Formulary
Green
  • Chlordiazepoxide Capsules
 
Controlled Drug Schedule 4
   
Diazepam
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Formulary
Green
  • Diazepam Tablets
  • Diazepam Solution
 
Controlled Drug Schedule 4
   
Lorazepam
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Formulary

Green Traffic Light Lorazepam Tablets

Red Traffic Light Lorazepam Injection

 
Controlled Drug Schedule 4
   
Oxazepam
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Formulary
Green
  • Oxazepam Tablets
 
Controlled Drug Schedule 4
   
04.01.02  Buspirone
Buspirone Hydrochloride
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Restricted Drug Restricted
Amber
  • Buspirone Tablets
     

Restricted to Consultant Psychiatrist recommendation only for short term treatment of anxiety

 
   
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
Chlorpromazine
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Restricted Drug Restricted
Amber
  • Chlorpromazine Tablets
  • Chlorpromazine Syrup
  • Red Chlorpromazine Injection

Restricted to Consultant Psychiatrist only 

 
   
Flupentixol
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Restricted Drug Restricted
Amber
  • Flupentixol Tablets
     

Restricted to Psychiatry specialist recommendation only

 
   
Haloperidol
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Restricted Drug Restricted
Amber
  • Haloperidol Capsules
  • Haloperidol Tablets
  • Haloperidol SF Solution
  • Green Haloperidol Injection (palliative care indication only)
     

Restricted to Psychiatry specialist recommendation only

 
   
Levomepromazine
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Restricted Drug Restricted
Amber
  • Levomepromazine Tablets
  • Green Levomepromazine Injection (palliative care indication only)
     

Restricted to Psychiatry specialist recommendation only

 
   
Pimozide
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Restricted Drug Restricted
Amber
  • Pimozide Tablets
     

Reserved for existing patients only

 
   
Promazine Hydrochloride
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Formulary
Amber
  • Promazine Tablets
  • Promazine Syrup

Restricted to Psychiatry specialist recommendation only

Note: Promazine tablets very expensive in primary care

 
   
Sulpiride
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Restricted Drug Restricted
Amber
  • Sulpiride Tablets

Restricted to Psychiatry specialist recommendation only

Note: In primary care 2 x 200mg is much more cost effective than 1 x 400mg tablets

 
   
Trifluoperazine
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Restricted Drug Restricted
Amber
  • Trifluoperazine Tablets
  • Trifluoperazine Syrup 
  • Trifluoperazine Solution

Restricted to Psychiatry specialist recommendation only

 
   
Zuclopenthixol (as dihydrochloride salt)
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Restricted Drug Restricted
Amber
  • Zuclopenthixol Tablets

Restricted to Psychiatry specialist recommendation only

 
   
Zuclopenthixol Acetate
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Restricted Drug Restricted
Red
  • Zuclopenthixol Injection

Consultant Psychiatrist use only.

 
   
04.02.01  Second-Generation Antipsychotic Drugs
Amisulpride
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Restricted Drug Restricted
Amber
  • Amisulpride Tablets
  • Amisulpride Oral Solution

Restricted to Psychiatry specialist recommendation only

 
   
Aripiprazole
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Restricted Drug Restricted
Amber
  • Aripiprazole Tablets
  • Aripirazole Orodispersible Tablets

Aripiprazole Oral Solution (note high cost, only use if the tablets or orodispersible tablets aren't appropriate)

Restricted for Consultant Psychiatrist recommendation only.

 
   
Clozapine (Clozaril®)
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Restricted Drug Restricted
Red
  • Clozapine Tablets

Restricted for Consultant Psychiatrist use only.

  • Registration needed for all patients on this treatment.
  • Service managed by BDCT. Contact 01274 363230 (Linfield Mount Pharmacy) in normal working hours for information or assistance.
 
Link  DSU: Clozapine: reminder of potentially fatal risk of intestinal obstruction, faecal impaction, and paralytic ileus (October 2017)
   
Lurasidone
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Restricted Drug Restricted
Amber
  • Lurasidone Tablets

Restricted for Psychiatry specialist recommendation only.

 
   
Olanzapine (Zyprexa®, Zalasta®)
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Restricted Drug Restricted Amber Traffic Light Olanzapine tablets

Red Traffic Light Olanzapine injection

Amber Traffic Light Olanzapine Orodispersible Tablets
  • Reserved for use in patients who cannot swallow tablets only

    Restricted for Psychiatry specialist recommendation only 
  •    
    Quetiapine (Seroquel®, Sondate XL)
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    Restricted Drug Restricted
    Amber
    • Quetiapine Tablets
    • Quetiapine MR Tablets

    Reserved for Psychiatry specialist recommendation only
    Note: Sondate XL® is the preferred brand of Quetiapine XL in primary care.

     
       
    Risperidone (Risperdal®)
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    Formulary
    Amber
    • Risperidone Tablets
    • Risperidone Liquid
      Restricted to patients who are unable to swallow tablets.
    • Risperidone Orodispersible Tablets
      Reserved for patients who do not tolerate risperidone liquid, do to high cost.

    Restricted to Psychiatry specialist recommendation only

     
       
    04.02.02  Antipsychotic depot injections
    Flupentixol Decanoate
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    Restricted Drug Restricted
    Amber
    • Flupentixol Decanoate Injection

    Restricted to Psychiatry Specialist initiation only

     
       
    Fluphenazine Decanoate
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    Restricted Drug Restricted
    Red ULM
    • Fluphenazine Decanoate Injection

    Restricted to Psychiatry Specialist initiation only

    Note: the licensed product has been discontinued. An unlicensed, imported product is available.

     
       
    Haloperidol decanoate
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    Restricted Drug Restricted
    Amber
    • Haloperidol Decanoate Injection

    Restricted to Psychiatry Specialist initiation only

     
       
    Paliperidone (Xeplion®, Trevicta®)
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    Restricted Drug Restricted
    Amber
    • Paliperidone Injection (Xeplion®) Product for monthly administration only.
    • Paliperidone Injection (Trevicta®) Product for three-monthly administration only.

    Restricted to Psychiatry Specialist initiation only

     
       
    Risperidone (Risperdal Consta®)
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    Restricted Drug Restricted
    Amber
    • Risperidone Intramuscular Injection

    Restricted to Psychiatry Specialist initiation only

     
       
    Zuclopenthixol Decanoate
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    Restricted Drug Restricted
    Amber
    • Zuclopenthixol Decanoate Injection

    Restricted to Psychiatry Specialist initiation only

     
       
    Aripiprazole (Abilify Maintena®)
    (depot injection)
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    Restricted Drug Restricted
    Amber
    • Arpiprazole Depot Injection

    Restricted to Consultant Psychiatrist initiation only

    For 'named patient' use only

     
       
    Olanzapine embonate (ZypAdhera®)
    (depot injection)
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    Restricted Drug Restricted
    Red
    • Olanzapine Embonate Depot Injection

    Restricted to Consultant Psychiatrist use only

    For 'named patient' use only

     
       
    Pipotiazine palmitate
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    Restricted Drug Restricted
    Red ULM
    • Pipotiazine Injection

    Restricted to Psychiatry Specialist use only

    Note: the licensed products has been discontinued. An unlicensed, imported product is available.

     
    Link  Unlicensed Medicines Consultant Request Form (ANHSFT access only)
    Link  Unlicensed Medicines Patient Agreement for Use Form (ANHSFT access only)
    Link  Unlicensed Medicines Patient Information Leaflet (ANHSFT access only)
    Link  Unlicensed Medicines Policy (ANHSFT access only)
       
    04.02.03  Antimanic drugs to top
    04.02.03  Benzodiazepines
    04.02.03  Antipsychotic drugs
    04.02.03  Carbamazepine
    04.02.03  Valproic acid
    Valproic Acid (Depakote®)
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    Restricted Drug Restricted
    Amber
    • Valproic Acid as Semi Sodium Valproate Tablets

    For Consultant Psychiatrist initiation only.

    Please ensure all products are prescribed by brand

    Valproate can seriously harm an unborn child when taken during pregnancy and should be not taken by women of child-bearing age unless other treatments are ineffective or not tolerated. Female patients of child-bearing age taking valproate must be using reliable contraception.

    Pregnancy Prevention Programme materials available below:

     
    Link  Patient booklet
    Link  Patient Card
    Link  Guide for Healthcare Professionals
    Link  Risk Acknowledgement Form
    Link  DSU: Medicines related to valproate: risk of abnormal pregnancy outcomes (January 2015)
    Link  DSU: Valproate and of risk of abnormal pregnancy outcomes: new communication materials (February 2016)
    Link  DSU: Valproate medicines (Epilim, Depakote): contraindicated in women and girls of childbearing potential unless conditions of Pregnancy Prevention Programme are met (April 2018)
    Link  DSU: Valproate medicines: are you in acting in compliance with the pregnancy prevention measures? (December 2018)
    Link  DSU:Valproate Pregnancy Prevention Programme: temporary advice for management during coronavirus (COVID-19) (March 2020)
       
    04.02.03  Lithium to top
     note 

     

     

    Lithium
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    Formulary
    Amber
    • Lithium Carbonate M/R Tablets (Priadel®)
    • Lithium Citrate Liquid (Priadel®)
    • Lithium Citrate Syrup (Li-Liquid®)
    • Lithium Carbonate M/R Tablets (Camcolit®) Restricted - Reserved for existing patients only

    Lithium citrate tetrahydrate 509mg is equivalent to lithium carbonate 200mg. Preparations vary widely in bioavailability; changing the preparation requires the same precautions as initiation of treatment. 

     
    Link  BDCT: Lithium Prescribing Advice (June 2016)
       
    04.03  Antidepressant drugs
    04.03.01  Tricyclic and related antidepressant drugs
    04.03.01  Tricyclic antidepressants
    Amitriptyline Hydrochloride
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    Restricted Drug Restricted
    • Amitriptyline SF Solution
    • Amitriptyline Tablets

    Green Neuropathic pain

    Amber Depression


    Amitriptyline is not routinely recommended as an antidepressant but may be considered for neuropathic pain

    Use as an antidepressant restricted to Psychiatry Specialist recommendation only

     
       
    Clomipramine Hydrochloride
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    Restricted Drug Restricted
    Amber
    • Clomipramine Capsules
    • Clomipramine MR Tablets 

    Restricted to psychiatry specialist recommendation only

     
       
    Doxepin
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    Restricted Drug Restricted
    Amber
    • Doxepin Capsules

    Restricted to psychiatry specialist recommendation only

     
       
    Imipramine Hydrochloride
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    Restricted Drug Restricted
    Amber
    • Imipramine Tablets

    Restricted to psychiatry specialist recommendation only

     
       
    Lofepramine
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    Restricted Drug Restricted
    Amber
    • Lofepramine Tablets
    • Lofepramine SF Oral Suspension

    Restricted to Psychiatry specialist recommendation only

     
       
    Nortriptyline
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    Restricted Drug Restricted
    Amber
    • Nortriptyline Tablets

    Restricted to psychiatry specialist recommendation only

    Note: Nortriptyline is very expensive

     
       
    04.03.01  Related antidepressants
    Trazodone Hydrochloride
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    Formulary
    Green
    • Trazodone Tablets
    • Trazodone Capsules
    • Trazodone SF Liquid
     
       
    04.03.02  Monoamine-oxidase inhibitors to top
    Phenelzine
    View adult BNF View SPC online View childrens BNF  Track Changes
    Restricted Drug Restricted
    Amber
    • Phenelzine Tablets

    Restricted to Consultant Psychiatrist initiation only

     
       
    04.03.02  Reverible MAOIs
    Moclobemide
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    Restricted Drug Restricted
    Amber
    • Moclobemide Tablets

    Restricted to Consultant Psychiatrist initiation only

     
       
    04.03.03  Selective serotonin re-uptake inhibitors
    Sertraline (Lustral®)
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    First Choice
    Green
    Sertraline Tablets 
    Fluoxetine (Prozac®)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Green
    • Fluoxetine Capsules
    • Fluoxetine Liquid
     
    Link  MHRA: Fluoxetine: may slightly increase risk of heart defects in an unborn child if taken during pregnancy (September 2011)
       
    Citalopram (Cipramil®)
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    Formulary
    Green
    • Citalopram Tablets
    • Citalopram Oral Drops
      Note: 4 oral drops (8mg) are equivalent to a 10mg tablet
      Please prescribe the dose by number of drops rather than milligrams.
     
    Link  DSU: Citalopram and escitalopram: QT interval prolongation (December 2011)
    Link  MHRA: Citalopram: suspected drug interaction with cocaine (July 2016)
       
    Escitalopram (Cipralex®)
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    Formulary
    Green
    • Escitalopram Tablets
    • Escitalopram Oral Solution
     
    Link  DSU: Citalopram and escitalopram: QT interval prolongation (December 2011)
       
    Paroxetine (Seroxat®)
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    Restricted Drug Restricted
    Amber
    • Paroxetine Tablets
    • Paroxetine SF Liquid

      Restricted to specialist initiation only
     
       
    04.03.04  Other antidepressant drugs
    Mirtazapine (Zispin®)
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    First Choice
    Green
    • Mirtazapine Tablets
    • Mirtazepine Orodispersible Tablets
      Reserved for patients with swallowing difficulties only
     
    Venlafaxine (Efexor®)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Green
    • Venlafaxine Tablets
    • Venlafaxine M/R Capsules
      Reserved for use in patients who have already been stabilised on venlafaxine immediate release tablets
       

    Supported for use in line with NICE CG90: Depression in adults: recognition and management.
    Amber Traffic Light  Doses greater than 150mg daily are restricted to psychiatry specialist recommendation only.

     
    Link  NICE CG90: Depression in adults: Recognition and Management (Updated April 2016)
       
    Agomelatine (Valdoxan®)
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    Restricted Drug Restricted
    Amber
    • Agomelatine Tablets

    Restricted to Consultant Psychiatrist initiation only

     
       
    Duloxetine (Cymbalta®)
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    Restricted Drug Restricted
    Amber
    • Duloxetine Capsules. Cymbalta brand only 

    Restricted to Psychiatry Specialist recommendation only

     
       
    Flupentixol dihydrochloride (Fluanxol®)
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    Restricted Drug Restricted
    Amber
    • Flupentixol Dihydrochloride Tablets

    Restricted to Consultant Psychiatrist initiation only

     
       
    Reboxetine (Edronax®)
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    Restricted Drug Restricted
    Amber
    • Reboxetine Tablets

    Restricted to Consultant Psychiatrist initiation only

     
       
    Vortioxetine (Brintellix®)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Restricted Drug Restricted
    Amber
    • Vortioxetine Tablets

    For major depressive episodes in line with NICE TA367, when initiated and monitored by a Consultant Psychiatrist at BDCT only.

     
    Link  NICE TA367: Vortioxetine for treating major depressive episodes (November 2015)
       
    04.04  CNS stimulants and other drugs used for attention deficit hyperactivity disorder
    Methylphenidate Hydrochloride (Equasym®, Matoride®, Medikinet, Ritalin®, Concerta XL®)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Restricted Drug Restricted
    Amber
    • Methylphenidate Tablets 

    Restricted to Consultant Psychiatrist and Paediatrician initiation only.

    For use in line with NICE NG87: Attention deficit hyperactivity disorder: diagnosis and management (March 2018) - See link at the bottom of the section.

    Please prescribe by brand

     
    Controlled Drug Schedule 2
    Link  UKMI Q&A: Can methylphenidate be used for adults with attention deficit hyperactivity disorder (ADHD)? (August 2015)
       
    Atomoxetine (Strattera®)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Restricted Drug Restricted
    Amber
    • Atomoxetine Capsules 
    • Atomoxetine Oral Solution 

    Restricted to Consultant Psychiatrist and Paediatrician initiation only.

    For use in line with NICE NG87: Attention deficit hyperactivity disorder: diagnosis and management (March 2018) - See link at the bottom of the section.

     
    Controlled Drug Schedule 2
       
    Dexamfetamine (Amfexa®)
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    Restricted Drug Restricted
    Amber
    • Dexamfetamine Tablets
    • Dexamfetamine Oral Solution

     Restricted to Consultant Psychiatrist and Paediatrician initiation only.

    For use in line with NICE NG87: Attention deficit hyperactivity disorder: diagnosis and management (March 2018) - See link at the bottom of the section.

     
    Controlled Drug Schedule 2
       
    Lisdexamfetamine (Elvanse>®)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Restricted Drug Restricted
    Amber
    • Lisdexamfetamine Capsules

    Restricted to Consultant Psychiatrist and Paediatrician initiation only.

    For use in line with BDCT formulary for attention deficit hyperactivity disorder in children and adolescents.

     
    Controlled Drug Schedule 2
       
    Modafinil
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    Restricted Drug Restricted
    Amber
    • Modafinil Tablets 

    Restricted to Respiratory Consultant use only for the treatment of excessive daytime sleepiness associated with narcolepsy

     
       
    04.04  Cocaine to top
    04.05  Drugs used in the treatment of obesity
    04.05.01  Anti-obesity drugs acting on the gastro-intestingal tract
    Orlistat
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    Restricted Drug Restricted
    Green
    • Orlistat Capsules (120mg)

    Reserved for patients who are being treated according to NICE CG43

     
    Link  DSU: Orlistat: theoretical interaction with antiretroviral HIV medicines (March 2014)
       
    04.05.02  Centrally acting appetite suppressants
    04.06  Drugs used in nausea and vertigo
     note 

    04.06  Vomiting during pregnancy to top
    04.06  Postoperative nausea and vomiting
    04.06  Motion sickness
    Cinnarizine (Stugeron®)
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    Formulary
    Green
    • Cinnarizine Tabets
     
       
    04.06  Other vestibular disorders
    04.06  Cytotoxic chemotherapy
    04.06  Palliative care to top
    04.06  Migraine
    04.06  Antihistamines
    Cyclizine (Valoid®)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Green
    • Cyclizine Tablets
    • Cyclizine Injection
    • Cyclizine Liquid (unlicensed medicine)
     
    Link  RCOG - Management of Nausea and Vomiting of Pregnancy and Hyperemesis Gravidarum (June 2016)
       
    Doxylamine with pyridoxine
    (Xonvea®)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Black
    • Doxylamine with Pyridoxine gastro-resistant Tablets
     
       
    Promethazine teoclate (Avomine®)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Green
    • Promethazine Teoclate Tablets
     
    Link  RCOG - Management of Nausea and Vomiting of Pregnancy and Hyperemesis Gravidarum (June 2016)
       
    04.06  Phenothiazines and related drugs
    Prochlorperazine (Stemetil®, Buccastem®)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Green
    • Prochlorperazine Tablets
    • Prochlorperazine Injection
    • Prochlorperazine Buccal Tablets
    • Prochlorperazine Syrup
     
    Link  RCOG - The management of Nausea and Vomiting of Pregnancy and Hyperemesis Gravidarum (June 2016)
       
    Droperidol (Xomolix®)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Restricted Drug Restricted
    Red
    • Droperidol Injection 

    Restricted to Consultant Anaesthetist use only for the prevention and treatment of PONV in adult patients in whom other IV antiemetics are ineffective or contraindicated.

     
       
    04.06  Domperidone and metoclopramide
    Metoclopramide Hydrochloride (Maxolon®)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Second Choice
    Green
    • Metoclopramide Tablets
    • Metoclopramide Syrup
    • Metoclopramide Injection

    Metoclopramide should only be prescribed for short-term use (up to five days)

     
    Link  DSU Metoclopramide: risk of neurological adverse effects—restricted dose and duration of use (August 2013)
       
    Domperidone (Motilium®)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Third Choice
    Green
    • Domperidone Tablets
    • Domperidone SF Suspension

     
    Domperidone should be used at the lowest effective dose for short-term use (less than one week)

     
    Link  DSU: Domperidone for nausea and vomiting: lack of efficacy in children; reminder of contraindications in adults and adolescents (December 2019)
    Link  DSU: Domperidone: risks of cardiac side effects (May 2014)
    Link  MHRA: Apomorphine with domperidone: minimising risk of cardiac side effects (April 2016)
       
    04.06  5HT3 antagonists to top
    Ondansetron (Zofran®)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Green
    • Ondansetron Tablets
    • Ondansetron Orodispersible Tablets
    • Ondansetron Syrup
    • Ondansetron Injection 

    Restricted Item Ondansetron 8mg/4ml injection and 8mg tablets are restricted to use by consultant haematologists and oncologists for the prevention of nausea and vomiting induced by highly emetogenic chemotherapy.

    The  EMA has identified a potential increased risk of orofacial clefts when ondansetron is taken during the first trimester of pregnancy. Ondansetron should therefore only be used during the first trimester of pregnancy if the benefit clearly outweighs the risk and these risks have been discussed with the patient.

     
    Link  DSU: Ondansetron for intravenous use: dose-dependent QT interval prolongation (July 2013)
    Link  Post Operative Nausea and Vomiting guideline (ANHSFT access only)
       
    Granisetron (Sancuso®)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Restricted Drug Restricted
    Red
    • Granisetron Transdermal Patch 

    Restricted for use for the prevention of chemotherapy induced nausea and vomiting in patients with swallowing difficulties who are undergoing multi-day chemotherapy regimens.

     
       
    Palonosetron (Aloxi®)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Restricted Drug Restricted
    Red
    • Palonosetron Soft Capsules

    Approved second-line for the prevention of nausea and vomiting associated with moderately emetogenic chemotherapy (as an alternative to aprepitant).

     
       
    Netupitant 300mg + palonosetron 0.5mg capsules (Akynzeo®)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Restricted Drug Restricted
    Red
    • Netupitant 300mg + Palonosetron 0.5mg Capsules

    Approved for a 12-month audit for the prevention of acute and delayed nausea and vomiting associated with highly emetogenic cisplatin-based chemotherapy.

    Restricted to Haematology / Oncology use only.

     
       
    04.06  Neurokinin receptor antagonist
    Dexamethasone
    View adult BNF View SPC online View childrens BNF  Track Changes
    Restricted Drug Restricted Green Traffic Light Dexamethasone tablets
    Green Traffic Light Dexamethasone soluble tablets
    Red Traffic Light Dexamethasone (as sodium phosphate)injection
    Note: the dose is expressed in mg of dexamethasone base.

    Restricted to use by Consultant Haematologist and Oncologists for prevention of nausea and vomiting induced by highly emetogenic chemotherapy 
    Link  NICE TA505: Ixazomib with lenalidomide and dexamethasone for treating relapsed or refractory multiple myeloma (February 2018)
       
    Levomepromazine (Nozinan®)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Restricted Drug Restricted
    Green
    • Levomepromazine Tablets
    • Levomepromazine Injection

    Restricted for palliative care or Psychiatry Consultant recommendation only.

     
       
    Aprepitant (EMEND®)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Restricted Drug Restricted
    Red
    • Aprepitant Capsules

    For use during cisplatin-based chemotherapy

     
       
    04.06  Cannabinoid
     note 

    Cannabis-based products for medicinal use - Statement from ANHSFT following changes in legislation (November 2018)      Black

     MHRA: Cannabis-based products for medicinal use (October 2018)

     Medical cannabis (and cannabis oils) - NHS (November 2018)

    04.06  Hyoscine
    Hyoscine Hydrobromide (Kwells®)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Green
    • Hyoscine hydrobromide tablets
      Restricted Item Hyoscine hydrobromide injection
      Restricted Item Hyoscine hydrobromide patch
      Restricted for the treatment of excessive salivation and for the reduction of secretions.
     
    Link  UKMI Q&A: Hypersalivation – can hyoscine hydrobromide be used to treat it? (June 2015)
       
    04.06  Other drugs for Ménière's disease
    Betahistine Dihydrochloride (Serc®)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Green
    • Betahistine Tablets
     
       
    04.07  Analgesics to top
     note 

    Adult acute pain analgesic ladder (ANHSFT access only) February 2017

    04.07.01  Non-opioid analgesics and compound analgesic preparations
    Paracetamol
    View adult BNF View SPC online View childrens BNF  Track Changes
    First Choice
    Green
    • Paracetamol Caplets/Tablets
    • Paracetamol Suspension Paracetamol Suppositories
      Restricted Item Paracetamol Soluble Tablets (restricted to patients with swallowing difficulties only. Note: high sodium content of tablets and increased cost)
     
    Paracetamol
    (Intravenous infusion)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Restricted Drug Restricted
    Red
    • Paracetamol Infusion

    Restricted to patients in whom the oral route isn't available or appropriate.

     
       
    Aspirin
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Green
    • Aspirin Dispersible Tablets
    • Aspirin EC Tablets
    • Aspirin Suppositories
     
       
    Nefopam
    View adult BNF View SPC online View childrens BNF  Track Changes
    Restricted Drug Restricted
    Black
    • Nefopam Tablets 

    Under review - reserved for existing patients only.

     
    Link  Cochrane review:nefopam for acute post- op pain (July 2009)
       
    04.07.01  Compound analgesic preparations
     note 

    Compound analgesics

    Compound analgesic preparations containing paracetamol with a low does of opioid analgesic are commonly used but their advantages have not been substantiated. The low dose of opioid may be enough to cause opioid side effectcs (particularly constipation) and can complicate the treatment of overdoasge yet may not provide significant additional relief of pain. (BNF)

    Paracetamol and codeine (Co-codamol)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Green
    • Co-codamol Tablets 30/500 (paracetamol 500mg, codeine phosphate 30mg)
    • Restricted Item Effervescent tablets are available, but are resticted to patients with swallowing difficulties because of the high sodium content and increased cost.
    • Co-codamol 8/500 (paracetamol 500mg, codeine phosphate 8mg).
    • Note, this strength is not included in the ANHSFT Acute pain analgesic ladder. Please refer to the link below for preferred products.
    • Restricted Item Effervescent tablets are available, but are resticted to patients with swallowing difficulties because of the high sodium content and increased cost.
     
    Controlled Drug Schedule 5
    Link  ANHSFT Adult Acute Pain Analgesic Ladder (ANHSFT access only)
    Link  EMA: Codeine not to be used in children below 12 years for cough and cold (April 2015)
       
    Paracetamol and dihydrocodeine (Co-dydramol®)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Green
    • Co-dydramol 10/500 Tablets (paracetamol 500mg with dihydrocodeine 10mg)

    Note, this strength is not included in the ANHSFT Acute pain analgesic ladder. Please refer to the link below for preferred products.

     
    Controlled Drug Schedule 5
    Link  ANHSFT Adult Acute Pain Analgesic Ladder (ANHSFT access only)
    Link  EMA: Codeine not to be used in children below 12 years for cough and cold (April 2015)
    Link  MHRA Drug Safety Update: Co-dydramol: prescribe and dispense by strength to minimise risk of medication error (January 2018)
       
    04.07.02  Opioid analgesics
     note 

    NICE NG46: Controlled drugs: safe use and management (April 2016)

    Adult acute pain analgesic ladder (ANHSFT access only) February 2017

    Codeine Phosphate
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary

    Green Traffic Light Codeine phosphate Tablets
    Green Traffic Light Codeine phosphate Syrup
    Red Traffic Light Codeine phosphate Injection

     
    Controlled Drug Schedule 5 (tablets) Schedule 2 (injection
    Link  DSU: Codeine: restricted use as analgesic in children and adolescents after European safety review (June 2013)
    Link  EMA: Codeine not to be used in children for cough and cold (April 2015)
    Link  UKMI: Codeine and breastfeeding: Is it safe and what are the alternatives? (updated March 2016)
       
    Dihydrocodeine
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary

    Green Traffic Light Dihydrocodeine Solution
    Green Traffic Light Dihydrocodeine Tablets
    Green Traffic Light Dihydrocodeine MR Tablets  
    Red Traffic Light Dihydrocodeine Injection

     
    Controlled Drug Schedule 5 (tablets). Schedule 2 (injection)
       
    Tramadol (Marol®, Zydol®.)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary

    Green Traffic Light Tramadol Capsules - First choice product
    Green Traffic Light Restricted Item Tramadol M/R Tablets and Capsules - Not to be used for patients with acute pain
    Green Traffic Light Restricted Item Tramadol Soluble Tablets - Reserved for patients with swallowing difficulties only

    In Primary care, please prescribe Marol®, the most cost-effective brand.

    Red Traffic Light Tramadol injection

     
    Controlled Drug Schedule 3
    Link  UKMI QA: What is the risk of developing Serotonin Syndrome following concomitant use of tramadol with selective serotonin reuptake inhibitors (SSRIs)? (May 2014)
       
    Morphine (MST®, Zomorph®)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary

    Green Traffic Light Morphine Sulphate Oral Solution
    Green Traffic Light Morphine Sulphate MR Sachets
    Green Traffic Light Morphine Sulphate MR Tablets - Please prescribe by brand.
    Green Traffic Light Morphine Sulphate Injection - Caution with different strengths. ANHSFT high strength for Aseptics only

    ANHSFT currently have stock of the Hameln brand of 10mg/1ml morphine sulphate injection. It does not contain preservatives and is available for spinal anaesthesia as an alternative during the diamorphine shortage.

     

     
    Controlled Drug Schedule 2
    Link  UKMI: Shortage Memo DIAMORPHINE revised 16 May 2019
       
    Oxycodone (OxyContin®, OxyNorm®, Longtec®, Shortec®)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Restricted Drug Restricted

    Green Traffic Light Oxycodone Capsules
    Green Traffic Light Oxycodone M/R Tablets
    Green Traffic Light Oxycodone Liquid
    Green Traffic Light Oxycodone SF Liquid

    Reserved for second line use.


    In primary care, please prescribe Longtec® and Shortec® brands, as they are the most cost-effective.
     
     Green Traffic Light  Oxycodone Injection - restricted to use in pharmacy aseptics for the preparation of syringes or palliative care.

     
    Controlled Drug Schedule 2
       
    Buprenorphine
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Green
    • Buprenorphine transdermal patches - Not to be used for opioid naïve patients.
    • BuTrans® 7-day release patches.
    • Transtec® 4-day release patches.
    • Hapoctasin® 3-day release patches
    • Butec® 7-day release patches Primary care use only - preferred brand in primary care
      Reletrans®
      7-day release patches Primary care use only

     

    Buprenorphine patches are reserved for:

    • Elderly patients requiring chronic pain relief who are unable to take oral opioid medication or who are non-compliant with syringe drivers.
    • For selected oncology patients.
    • Consider use in place of morphine in cases of renal impairment
    • Long term use is discouraged and patients should undergo regular review
    • Please prescribe Butec® brand in Primary Care, as it is the most cost-effective.
    • Please note: Butrans® and Butec® 7-day patches are clinically equivalent. Patients may be switched between brands appropriately when required.
       
       
      Red Traffic Light Buprenorphine injection
     
    Controlled Drug Schedule 3
       
    Fentanyl
    View adult BNF View SPC online View childrens BNF  Track Changes
    Restricted Drug Restricted

    Green Traffic Light Fentanyl Transdermal Patches

    • Please ensure that the brand prescribed is written on the discharge prescription
    • Not to be used in opioid naïve patients.
    • Low cost brand such as Mezolar® advised in primary care.

    Red Fentanyl Injection

    Black Fentanyl Sublingual Tablets (Abstral®)

    • Reserved for the treatment of breakthrough cancer pain in patients in whom standard treatments (morphine or oxycodone) are ineffective or not tolerated
    • Not for routine prescribing in primary care in-line with NHSE recommendation (2017).

    Black Fentanyl Lozenges (Actiq®)

     
    Controlled Drug Schedule 2
    Link  DSU: Transdermal fentanyl patches: life-threatening and fatal opioid toxicity from accidental exposure, particularly in children
    Link  Items which should not be routinely prescribed in primary care: Guidance for CCGs (November 2017)
       
    Meptazinol
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Red
    • Meptazinol Injection
     
       
    Pethidine
    View adult BNF View SPC online View childrens BNF  Track Changes
    Restricted Drug Restricted
    Red
    • Pethidine Injection 

    Reserved for obstetric use only

     
    Controlled Drug Schedule 2
       
    Syrup
    View adult BNF View SPC online View childrens BNF  Track Changes
    Restricted Drug Restricted
    Green
    • Syrup BP (66.7%) 50ml (Special)

    For neonatal use only

     
       
    Alfentanil
    View adult BNF View SPC online View childrens BNF  Track Changes
    Restricted Drug Restricted
    Red
    • Alfentanil Injection

    Restricted to theatre, ICU and palliative care consultant use only.

     
    Controlled Drug Schedule 2
       
    Diamorphine
    View adult BNF View SPC online View childrens BNF  Track Changes
    Restricted Drug Restricted
    Red
    • Diamorphine Injection 5mg

     Use restricted to:

    • A&E (intranasal use only in children)
    • Labour ward (obstetric use)
    • Theatre & Recovery - For IT/ IV/ epidural use, mainly for obstetric cases 

    Higher strength preparations restricted to use in pharmacy aseptics only.

     
    Controlled Drug Schedule 2
       
    Hydromorphone
    View adult BNF View SPC online View childrens BNF  Track Changes
    Restricted Drug Restricted
    Amber
    • Hydromorphone Capsules
    • Hydromorphone M/R Capsules

    Restricted to palliative care consultant recommendation, for patients who are intolerant to morphine.

    Red Traffic Light Hydromorphone Injection - ANHSFT use only

     
    Controlled Drug Schedule 2
       
    04.07.03  Neuropathic pain and functional pain
    Actipatch®
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Black
    • Actipatch®
       

     Not yet reviewed.

     
       
    Amitriptyline
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Green
    • Amitriptyline Tablets
    • Amitriptyline Solution

     For the treatment of neuropathic pain.

     
    Link  NICE CG173: Neuropathic pain in adults: pharmacological management in non-specialist settings (April 2018)
       
    Duloxetine (Cymbalta® )
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Green
    • Duloxetine Capsules

    For the treatment of neuropathic pain.

     
    Link  NICE CG173: Neuropathic pain in adults: pharmacological management in non-specialist settings (April 2018)
       
    Pregabalin
    View adult BNF View SPC online View childrens BNF  Track Changes
    Restricted Drug Restricted
    Green
    • Pregabalin Capsules

    For the treatment of neuropathic pain.

     
    Link  DSU: Pregabalin (Lyrica), gabapentin (Neurontin) and risk of abuse and dependence: new scheduling requirements from 1 April (April 2019)
    Link  NICE CG173: Neuropathic pain in adults: pharmacological management in non-specialist settings (April 2018)
       
    04.07.03  Trigeminal neuralgia to top
    04.07.03  Postherpetic neuralgia
    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 to top
    04.07.04.01  5HT1 agonists
    Sumatriptan
    View adult BNF View SPC online View childrens BNF  Track Changes
    First Choice
    Green
  • Sumatriptan Tablets
  • Sumatriptan Nasal Spray
  • Sumatriptan Syringe pre-filled syringes
     
  • Rizatriptan (Maxalt®)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Green
  • Rizatriptan tablets
  • Rizatriptan orodispersible tablets - Please do not prescribe lyophilisates or by brand due to high cost 
  •    
    Zolmitriptan (Zomig®)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Green
  • Zolmitriptan tablets
  • Zolmitriptan orodispersible tablets - Please note 5mg orodispersible tablets are significantly more expensive than the 2.5mg strength in primary care 
  •    
    04.07.04.01  Ergot alkaloids
    04.07.04.01  Anti-emetics
    04.07.04.01  Other drugs for migrane
    04.07.04.02  Prophylaxis of migraine to top
    Pizotifen
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Green
    • Pizotifen Tablets
     
       
    04.07.04.03  Cluster headache
    04.08  Antiepileptics
    04.08.01  Control of epilepsy
    04.08.01  Partial seizures with or without secondary generalisation
    04.08.01  Generalised seizures to top
    04.08.01  Carbamazepine and Oxcarbazepine
    Carbamazepine
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
  • Carbamazepine SF Liquid
  • Carbamazepine Tablets
  • Carbamazepine MR Tablets
  • Carbamazepine Suppositories

    Green Traffic Light Carbamazepine for the management of trigeminal neuralgia
    Amber Traffic Light Carbamazepine for the management of epilepsy, or for use as a mood stabiliser. (Restricted to consultant initiation only)

    The MHRA recommends that patients should be maintained on a specific manufacturer’s product.
    In Primary Care - Tegretol MR is a cost-effective brand 
  • Link  UKMI QA: Why is there a limit on the dose and duration of use for carbamazepine suppositories? (November 2014)
       
    04.08.01  Ethosuximide
    Ethosuximide
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Amber
  • Ethosuximide Capsules
  • Ethosuximide Syrup

    It is usually unnecessary to ensure that patients are maintained on a specific manufacturer’s product unless there are specific concerns such as patient anxiety, and risk of confusion or dosing errors.
     
  •    
    04.08.01  Gabapentin and pregabalin
    04.08.01  Lacosamide
    Lacosamide  (Vimpat® )
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Amber
    • Lacosamide Tablets
    • Lacosamide Syrup
    • Lacosamide Solution for Infusion
       

    Adjunctive treatment of focal seizures with or without secondary generalisation when at least two other antiepileptics recommended by NICE (carbamazepine or lamotrigine) in conjunction with a second-line antiepileptic (levetiracetam, sodium valproate) have failed to control seizures.

    It is usually unnecessary to ensure that patients are maintained on a specific manufacturer’s product unless there are specific concerns such as patient anxiety, and risk of confusion or dosing errors.

     
       
    04.08.01  Lamotrigine to top
    Lamotrigine
    View adult BNF View SPC online View childrens BNF  Track Changes
    Restricted Drug Restricted
    Amber
    • Lamotrigine Tablets
    • Lamotrigine Dispersible Tablets
    • Lamotrigine (Lamictal) Chewable/ Dispersible Tablets

    MHRA recommends that 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.

    Restricted to Consultant Neurologist initiation only (epilepsy)

    Restricted to Consultant Psychiatrist initiation only if being used as a mood stabiliser

     
       
    04.08.01  Levetiracetam
    Levetiracetam (Keppra®)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Amber
    • Levetiracetam Tablets
    • Levetiracetam Oral Solution


    It is usually unnecessary to ensure that patients are maintained on a specific manufacturer’s product unless there are specific concerns such as patient anxiety, and risk of confusion or dosing errors.

    Red Traffic Light Levetiracetam infusion 

    Green Levetiracetam infusion (For palliative care use only)

     
    Link  EMA recommends measures to ensure safe use of Keppra oral solution (October 2016)
       
    04.08.01  Phenobarbital and other barbiturates
    Phenobarbital
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Amber
    • Phenobarbital Tablets
    • Phenobarbital Elixir 
       

    MHRA recommends that patients should be maintained on a specific manufacturer’s product.

    Red Traffic Light  Phenobarbital Injection

     
    Controlled Drug Schedule 3
       
    Primidone
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Amber
    • Primidone Tablets

    MHRA recommends that patients should be maintained on a specific manufacturer’s product.

     
       
    04.08.01  Phenytoin
    Phenytoin
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Amber
    • Phenytoin Suspension
    • Phenytoin Sodium Capsules
    • Phenytoin Sodium Tablets

    MHRA recommends that patients should be maintained on a specific manufacturer’s product.

    Red Traffic Light Phenytoin injection

     
    Link  Epanutin (phenytoin) 30mg5ml Oral Suspension– Supply Disruption
    Link  Letter of temporary cessation of Epanutin Oral Suspension
    Link  Risk of death and severe harm from error with injectable phenytoin
       
    04.08.01  Retigaine
    04.08.01  Rufinamide to top
    04.08.01  Tiagabine
    04.08.01  Topiramate
    Topiramate
    View adult BNF View SPC online View childrens BNF  Track Changes
    Restricted Drug Restricted
    • Topiramate Tablets
    • Topiramate Sprinkle Caspules
      Reserved for patients unable to swallow tablets only due to high cost.

    Green For migraine prophylaxis

    Amber Traffic Light For epilepsy


    Restricted to Consultant Neurologist recommendation only

     
    Link  NICE CG150: Headaches in over 12s: diagnosis and management (Nov 2015)
       
    04.08.01  Valproate
    Sodium Valproate
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Amber

           Sodium Valproate - Epilim® brand

    • Sugar free Liquid
    • Enteric-Coated Tablets
    • Enteric-Coated, Modified-Release Tablets (Epilim Chrono®)
    • Crushable Tablets
    • Syrup

      Sodium Valproate - Orlept® brand
    • Sugar-free Liquid
    • Enteric-Coated Tablets

      Sodium Valproate - Episenta® brand
    • Modified-release Capsules
    • Modified-release Sachets

    Red Traffic Light Sodium Valproate (Epilim®) Injection
    Red Traffic Light Sodium Valproate (Episenta®) Injection

    The MHRA recommends that 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.

    Valproate can seriously harm an unborn child when taken during pregnancy and should be not taken by women of child-bearing age unless other treatments are ineffective or not tolerated. Female patients of child-bearing age taking valproate must be using reliable contraception.

    Pregnancy Prevention Programme materials available below:

     
    Link  Patient booklet
    Link  Patient Card
    Link  Guide for Healthcare Professionals
    Link  Risk Acknowledgement Form
    Link  DSU: Medicines related to valproate: risk of abnormal pregnancy outcomes (January 2015)
    Link  DSU: Valproate and of risk of abnormal pregnancy outcomes: new communication materials (February 2016)
    Link  DSU: Valproate medicines (Epilim, Depakote): contraindicated in women and girls of childbearing potential unless conditions of Pregnancy Prevention Programme are met (April 2018)
    Link  DSU: Valproate Pregnancy Prevention Programme: temporary advice for management during coronavirus (COVID-19) (March 2020)
    Link  DSU:Valproate and developmental disorders: new alert asking for patient review and further consideration of risk minimisation measures (April 2017)
    Link  DSU:Valproate medicines: are you in acting in compliance with the pregnancy prevention measures? (December 2018)
       
    04.08.01  Vigabatrin
    Vigabatrin
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Amber
  • Vigabatrin Tablets
  • Vigabatrin Sachets

    It is usually unnecessary to ensure that patients are maintained on a specific manufacturer’s product unless there are specific concerns such as patient anxiety, and risk of confusion or dosing errors.
     
  •    
    04.08.01  Zonisamide to top
     note  Tertiary centre recommendation only.
    04.08.01  Benzodiazepines
    Clobazam
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Amber
    • Clobazam Tablets
    • Clobazam Suspension

      MHRA recommends that 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.
     
    Controlled Drug Schedule 4
       
    Clonazepam
    View adult BNF View SPC online View childrens BNF  Track Changes
    Restricted Drug Restricted
    Amber
    • Clonazepam SF Solution
    • Clonazepam Tablets

    Restricted to specialist initiation only

    Refer to the BDCT Psychotropic formulary below if recommended by psychiatry.

    MHRA recommends that 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.

    Red Traffic Light  Clonazepam Injection

     
    Controlled Drug Schedule 4
    Link  
    Link  BDCT Psychotropic Drug Formulary (2016)
       
    04.08.01  Other Drugs
    Perampanel (Fycompa®)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Restricted Drug Restricted
    Amber
    • Perampanel Tablets

    Adjunctive treatment of focal seizures with or without secondary generalisation when at least two other antiepileptics recommended by NICE (carbamazepine or lamotrigine) in conjunction with a second-line antiepileptic (levetiracetam, sodium valproate) have failed to control seizures.

    Restricted to consultant neurologist initiation only

     
       
    Stiripentol sachets
    View adult BNF View SPC online View childrens BNF  Track Changes
    Restricted Drug Restricted
    Amber
    • Stiripentol Sachets 

    Restricted to consultant neurologist initiation only

     
       
    04.08.02  Drugs used in status epilepticus
    Clonazepam
    (Status)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Red
    • Clonazepam Injection
     
    Controlled Drug Schedule 4
       
    Diazepam
    (status)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Red
    Green Traffic Light Diazepam Rectal Tubes
    Red Traffic Light Diazepam Emulsion Injection
    Red Traffic Light Diazepam Injection  
    Controlled Drug Schedule 4
    Link  SPS - Shortage of Diazemuls (April 2020)
       
    Lorazepam
    (status)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Red
    • Lorazepam Injection
     
    Controlled Drug Schedule 4
       
    Midazolam (Buccolam®)
    (status)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Green
    • Midazolam Oromucosal Solution - Buccolam ®

    Please note this is a different strength to the previously used, unlicensed product. It should be prescribed by the brand name with the dose in mLs and mgs. 
     
    Please note Schedule 3 CD and is subject to special prescription requirements and to safe custody requirements.

     
    Controlled Drug Schedule 3
       
    Paraldehyde
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Red
    • Paraldehyde Injection
    • Paraldehyde/ Olive Oil Enema 50%
     
       
    04.08.03  Febrile convulsions
    04.09  Drugs used in parkinsonism and related disorders to top
    04.09.01  Dopaminergic drugs used in Parkinsons disease
     note 

    Dopamine receptor agonists

    04.09.01  Dopamine receptor agonists
    Ropinirole
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    • Ropinirole Tablets
    • Ropinirole SR Tablets -Please prescribe Ippinia XL® or Spiroco XL® brands in primary care
    • Ropinirole Starter Pack

    Green Traffic Light Restless legs - No restrictions on prescribing.

    Amber Traffic Light Parkinson's disease - Restricted to consultant neurologist and care of the elderly consulant initiation only.

     
       
    Pramipexole
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    • Pramipexole Tablets

    Green Traffic Light Restless legs - No restrictions on prescribing.

    Amber Traffic Light Parkinson's disease - Restricted to consultant neurologist and care of the elderly consulant initiation only, for use in patients who do not respond to, or are intolerant of ropinerole.

    Pipexus MR® is the preferred brand in primary care for the modified-release preparation.

     
       
    Rotigotine
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Amber
    • Rotigotine Transdermal Patches

    Restricted to use in patients with advanced Parkinson’s disease with swallowing difficulties

     
       
    Apomorphine
    View adult BNF View SPC online View childrens BNF  Track Changes
    Restricted Drug Restricted
    Amber
    • Apomorphine Pens

    Restricted to Consultant Neurologist and Care of the elderly physician initiation only.

     
    Link  Leeds Amber Guidance for Apomorphine for Parkinson’s Disease
    Link  MHRA DSU: Apomorphine with domperidone: minimising risk of cardiac side effects (April 2016)
       
    04.09.01  Levodopa
    Co-Beneldopa (Madopar®)
    (levodopa and benserazide )
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Amber
    • Co-beneldopa Capsules
    • Co-beneldopa MR Capsules
    • Co-beneldopa Dispersible Tablets
     
    Link  UKMI QA:How do you convert from co-beneldopa (Madopar®) prolonged-release capsules to dispersible tablets? (March 2013)
       
    Co-Careldopa (Sinemet®)
    (levodopa and carbidopa)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Amber
    • Co-careldopa Tablets
    • Co-careldopa MR Tablets
     
       
    Co-Careldopa and Entacapone (Stalevo®, Stanek®)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Restricted Drug Restricted
    Amber
    • Stalevo Tablets

    Restricted to patients with Parkinson’s disease requiring triple therapy with levodopa, carbidopa and entacapone

     
       
    04.09.01  Monoamine-oxidase-B inhibitors
    Selegiline Hydrochloride (Eldepryl®, Zelapar®)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Amber
    • Selegiline Tablets
    • Selegiline Liquid
     
       
    Rasagiline (Azilect®)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Restricted Drug Restricted
    Amber
    • Rasagiline Tablets

    Restricted to Consultant Neurologist and Department of Elderly Medicine Physician recommendation only.

    For patients intolerant of selegiline or who are likely to develop psychotic side effects or sleep disturbances as a result of treatment.

     
       
    Safinamide (Xadago®)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Amber
    • Safinamide Tablets

    Approved for the treatment of idiopathic Parkinson’s disease in adult patients, as add-on therapy to a stable dose of Levodopa (L-dopa) alone or in combination with other PD medicinal products in mid-to late-stage fluctuating patients.

    Reserved for use in patients in whom selegiline and rasagiline are not tolerated or not appropriate.

    Use restricted to consultant neurologist and care of the elderly physician consultants only.

     
       
    04.09.01  Catachol-O-methyltransferase inhibitors to top
    Entacapone (Comtess®)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Restricted Drug Restricted
    Amber
    • Entacapone Tablets 200mg

    Restricted to consultant neurologist or care of the elderly physician initiation only

     
       
    Opicapone (Ongentys ®)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Restricted Drug Restricted
    Amber
    • Opicapone Capsules

    For the treatment of late stage Parkinson’s disease with motor fluctuations as an alternative for patients unable to tolerate entacapone.

    Parkinson’s Disease Consultant or Consultant Neurologist initiation.

     
       
    04.09.01  Amantadine
    Amantadine Hydrochloride (Symmetrel®)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Restricted Drug Restricted
    Amber
    • Amantadine Capsules

    Restricted to Consultant Neurologist and Department of Elderly Medicine Physicians recommendation only in-line with NICE CG35: Parkinson's disease in the over 20s.

     
       
    04.09.02  Antimuscarinic drugs used in parkinsonism
    Orphenadrine Hydrochloride
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Amber
    • Orphenadrine Elixir
     
       
    Procyclidine Hydrochloride (Kemadrin®)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary Green Traffic Light Procyclidine Tablets
    Green Traffic Light Procyclidine SF Syrup
    Red Traffic Light Procyclidine injection 
       
    Trihexyphenidyl Hydrochloride
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Green
  • Trihexyphenidyl Syrup
  • Trihexyphenidyl Tablets 
  •    
    04.09.03  Drugs used in essential tremor, chorea, tics, and related disorders
    Riluzole (Rilutek®)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Restricted Drug Restricted
    Amber
    • Riluzole Tablets

    Restricted to Consultant Neurologist recommendation only. For patients with AML form of motor neurone disease

     
    Link  NICE TA20: Guidance on the use of Riluzole (Rilutek) for the treatment of Motor Neurone Disease (January 2001)
       
    Tetrabenazine
    View adult BNF View SPC online View childrens BNF  Track Changes
    Restricted Drug Restricted
    Amber
    • Tetrabenazine Tablets

    Restricted to specialist recommendation only

     
       
    04.09.03  Torsion dystonias and other involuntary movements
    Botulinum Toxin Type A (Botox®)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Restricted Drug Restricted
    Red
    • Botulinum A Toxin (Botox® Injection)

    Restricted to Consultant Urologist/Neurologist/Orthopaedic/Maxillofacial use only.

    All other requests should be authorised by a senior clinical pharmacist. Botox units are not equivalent to units of other brands.

     
    Link  NICE TA260: Botox for migraine prophylaxis June 2012)
       
    Botulinum Toxin Type A (Dysport®)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Restricted Drug Restricted
    Red
    • Botulinum A Toxin (Dysport®)

    For treatment of focal spasticity in children with cerebral palsy as an alternative to the Botox® brand.

    Use restricted to Consultant Paediatricians.

    Dysport units are not equivalent to units of other brands.

     
       
    Botulinum Toxin Type A (Xeomin®)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Restricted Drug Restricted
    Red
    • Botulinum A Toxin (Xeomin® Injection)
     
    Link  NICE TA605: Xeomin (botulinum neurotoxin type A) for treating chronic sialorrhoea (October 2019)
       
    04.10  Drugs used in substance dependence to top
    04.10  Alcohol dependence
    04.10  Cigarette smoking
    04.10  Opioid dependence
    04.10.01  Alcohol dependence
    Acamprosate  (Campral EC®)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Restricted Drug Restricted
    Amber
    • Acamprosate E/C Tablets

    Restricted to Specialist Alcohol Services recommendation only

     
       
    Disulfiram (Antabuse®)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Restricted Drug Restricted
    Amber
    • Disulfiram Tablets

    Restricted to Specialist Alcohol Services recommendation only

     
       
    Nalmefene (Selincro®)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Restricted Drug Restricted
    Red
    • Nalmefene Tablets

    Restricted to use by Specialist Alcohol Services only

     
       
    04.10.02  Nicotine dependence to top
    Nicotine (Nicorette® )
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Green
    • Nicorette inhalator 10mg, 15mg Refill
    • Nicorette inhalator Starter Pack
     
       
    Nicotine (Nicorette® )
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Green
    • Nicorette 2mg Gum

    Initiated by smoking cessation nurse.

     
       
    Nicotine (Nicotinell®)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Green
    • Nicotinell 1mg Lozenges
     
       
    Nicotine (NiQuitin® CQ)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Green
    • Niquitin CQ 7mg Patches (24 hour)
    • Niquitin CQ 14mg Patches (24 hour)
    • Niquitin CQ 21mg Patches (24 hour)
    • Niquitin Minis Lozenges 1.5mg, 4mg

    The 24 hour patches can be removed after 16 hours, if for example, nicotine replacement therapy is not required at night.

     
       
    Nicotine (NiQuitin® CQ)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Green
    • Niquitin CQ Lozenges (2mg, 4mg)

    Initiated by smoking cessation nurse.

     
       
    Varenicline (Champix®)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Restricted Drug Restricted
    Green
    • Varenicline Tablets 

    Initiated by smoking cessation nurse

    For use in-line with NICE TA123 (July 2007)

     
    Link  MHRA Varenicline and suicidal behaviour: cohort study provides some reassurance (October 2009)
    Link  NICE TA123: Varenicline for smoking cessation (July 2007)
       
    Bupropion (Zyban®)
    (Prolonged Release Tablets)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Restricted Drug Restricted
    Green
    • Bupropion Prolonged Release Tablets

    For primary care use only.

     
       
    04.10.03  Opioid dependence
    04.10.03  Opioid substitution therapy
    Methadone
    View adult BNF View SPC online View childrens BNF  Track Changes
    Restricted Drug Restricted
    Amber
    • Methadone Tablets
    • Methadone Mixture
    • Methadone sugar-free Mixture

    Restricted for treatment of opioid addiction

    Red Traffic Light Methadone Injection

     
    Controlled Drug Schedule 3
       
    Buprenorphine (Subutex®)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Amber
    • Buprenorphine Sublingual Tablets
     
    Controlled Drug Schedule 3
       
    Buprenorphine and Naloxone (Suboxone®)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Restricted Drug Restricted
    Amber
    • Suboxone® Sublingual Tablets 

    Restricted to specialist substance misuse services only, or for existing patients only.

    Restricted for treatment of opioid addiction.

     
    Controlled Drug Schedule 3
       
    04.10.03  Adjunctive therapy and symptomatic treatment
    04.10.03  Opioid-receptor antagonists
    04.11  Drugs for dementia to top
    Donepezil (Aricept®)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Restricted Drug Restricted
    Amber
    • Donepezil Tablets
    • Donepezil Orodispersible Tablets
       

    For the treatment of moderate Alzheimer’s disease.

    Restricted to Consultant Psychiatrist and Department of Elderly Medicine Physician recommendation only.

    For use in-line with NICE TA217 (June 2018).

     
    Rivastigmine (Exelon®)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Restricted Drug Restricted
    Amber
    • Rivastigmine Capsules
    • Rivastigmine Oral Solution
    • Rivastigmine Transdermal Patches

    For the treatment of Parkinson’s disease dementia. Treatment initiated at ANHSFT and continued in Primary Care under a Shared Care Guideline.

    For other indications - Restricted to Bradford District Care Trust and existing patients. 

    For use in-line with NICE TA217 (June 2018).

     
    Link  MHRA warning regarding errors with rivastigmine patches (June 2010)
    Link  NICE TA217: Donepezil, galantamine, rivastigmine and memantine for the treatment of Alzheimer’s disease (June 2018)
       
    Galantamine
    View adult BNF View SPC online View childrens BNF  Track Changes
    Restricted Drug Restricted
    Amber
    • Galantamine Solution
    • Galantamine Tablets
    • Galantamine MR Tablets

    Restricted for BDCT, 8mg tablets must not be halved, If 4mg are required, use the oral solution.

    For use in-line with NICE TA217 (June 2018).

    Gatalin®is the brand preferred by Airedale Wharfedale Craven CCG

     
    Link  NICE TA217: Donepezil, galantamine, rivastigmine and memantine for the treatment of Alzheimer’s disease (June 2018)
       
    Memantine
    View adult BNF View SPC online View childrens BNF  Track Changes
    Restricted Drug Restricted
    Amber
    • Memantine Tablets
    • Memantine Oral Drops

    For use in-line with NICE TA217 (June 2018).

     
    Link  NICE TA217: Donepezil, galantamine, rivastigmine and memantine for the treatment of Alzheimer’s disease (June 2018)
       
     ....
     Non Formulary Items
    Dosulepin Hydrochloride

    View adult BNF View SPC online View childrens BNF Track Changes
    Non Formulary
    Black

    Not for routine prescribing in primary care in-line with NHSE recommendation (2017). 

    Link  Items which should not be routinely prescribed in primary care: Guidance for CCGs (November 2017)
     
    e-Cigarettes

    View adult BNF View SPC online View childrens BNF Track Changes
    Non Formulary
    Black
    e-Cigarettes are not routinely commissioned.
    Awaiting National Guidance.
     
    Liraglutide  (Saxenda®)

    View adult BNF View SPC online View childrens BNF Track Changes
    Non Formulary
    Black

    Liraglutide for the treatment of obesity. Not routinely commissioned, based on cost of treatment with lack of evidence to support significant or sustained weight loss.

     
    Naltrexone/bupropion (8mg/90mg)  (Mysimba®)

    View adult BNF View SPC online View childrens BNF Track Changes
    Non Formulary
    Black
    Not routinely commissioned due to safety and efficacy concerns.
    Link  DSU: Naltrexone/bupropion (Mysimba▼): risk of adverse reactions that could affect ability to drive (August 2019)
    Link  NICE TA494: Naltrexone–bupropion for managing overweight and obesity (December 2017)
     
    Controlled Drug  Oxycodone and Naloxone  (Targinact®)

    View adult BNF View SPC online View childrens BNF Track Changes
    Non Formulary
    Black

    Not for routine prescribing in primary care in line with NHSE recommendation.

    Link  NHSE: Items which should not routinely be prescribed in primary care: Guidance for CCGs (2017)
     
    Paliperidone tablets  (Invega®)

    View adult BNF View SPC online View childrens BNF Track Changes
    Non Formulary
    Black
    Paliperidone modified release tablets are not routinely commissioned based on significant cost without additional clinical benefits in comparison with risperidone tablets.
     
    Controlled Drug  Paracetamol and Tramadol

    View adult BNF View SPC online View childrens BNF Track Changes
    Non Formulary
    Black

    Not for routine prescribing in primary care in line with NHSE recommendation.

    Link  NHSE: Items which should not routinely be prescribed in primary care: Guidance for CCGs (2017)
     
    Controlled Drug  Tapentadol  (Palexia®)

    View adult BNF View SPC online View childrens BNF Track Changes
    Non Formulary
    Black


    Black Traffic Light Tapentadol is not routinely commissioned


     
    Trimipramine

    View adult BNF View SPC online View childrens BNF Track Changes
    Non Formulary
    Black

    Not for routine prescribing in primary care in line with NHSE recommendation.

    Link  NHSE: Items which should not routinely be prescribed in primary care: Guidance for CCGs (2017)
     
      
    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
    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

    Green

    Green - Drugs suitable for generalised use in accordance with position summary. Inform primary care of need to prescribe using a TTO chart if in patient or Treatment Advice Note (TAN) if Outpatient.   

    Amber

    Amber - these drugs require specialist initiation or recommendation  

    Amber SCG

    Amber Share Care - Drugs suitable for generalist use, in accordance with position summary, normally following specialist initiation and stabilisation. Ongoing division of responsibility for drug and disease monitoring between specialist and GP by a Shared Care Guideline (SCG). If no SCG in place status reverts to red.  

    Red

    Red - Drugs for specialist use only, in accordance with position summary. GP’s should not be asked to prescribe these products.  

    Red ULM

    Red ULM - Unlicensed medicines for specialist use only, in accordance with position summary. GP’s should not be asked to prescribe these products.  

    Grey

    Grey drugs - No formal commissioning position. Check appropriate CCG /NHSE commissioning list or contact CCG/NHSE Medicines Management team for advice. Fill in individual funding request for appropriate CCG/NHSE. This will need to be signed by the Chief Pharmacist and a copy of the relevant DTC submission attached.   

    Black

    Black - Drugs not routinely commissioned so should not usually be prescribed  

    netFormulary