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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
 Details...
04.07.02  Expand sub section  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
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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
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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®.)
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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®)
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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®)
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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
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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
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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
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Formulary
Red
  • Meptazinol Injection
 
   
Pethidine
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Restricted Drug Restricted
Red
  • Pethidine Injection 

Reserved for obstetric use only

 
Controlled Drug Schedule 2
   
Syrup
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Restricted Drug Restricted
Green
  • Syrup BP (66.7%) 50ml (Special)

For neonatal use only

 
   
Alfentanil
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Restricted Drug Restricted
Red
  • Alfentanil Injection

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

 
Controlled Drug Schedule 2
   
Diamorphine
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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
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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
   
 ....
 Non Formulary Items
Controlled Drug  Oxycodone and Naloxone  (Targinact®)

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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  Paracetamol and Tramadol

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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®)

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Non Formulary
Black


Black Traffic Light Tapentadol is not routinely commissioned


 
  
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
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  

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